Analytical Example Using NHIS Data Files John R. Pleis.
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Transcript of Analytical Example Using NHIS Data Files John R. Pleis.
![Page 1: Analytical Example Using NHIS Data Files John R. Pleis.](https://reader036.fdocuments.net/reader036/viewer/2022062805/5697bfed1a28abf838cb8c0d/html5/thumbnails/1.jpg)
Analytical Example Using NHIS Data Files
Analytical Example Using NHIS Data Files
John R. Pleis John R. Pleis
![Page 2: Analytical Example Using NHIS Data Files John R. Pleis.](https://reader036.fdocuments.net/reader036/viewer/2022062805/5697bfed1a28abf838cb8c0d/html5/thumbnails/2.jpg)
Research QuestionResearch Question
Is the type of health insurance coverage held by adults > 65 years of age associated with
flu shot use?
Is the type of health insurance coverage held by adults > 65 years of age associated with
flu shot use?
![Page 3: Analytical Example Using NHIS Data Files John R. Pleis.](https://reader036.fdocuments.net/reader036/viewer/2022062805/5697bfed1a28abf838cb8c0d/html5/thumbnails/3.jpg)
Additional CovariatesAdditional Covariates
• Race/ethnicity
• Region of residence
• Education, marital status, sex
• Smoking
• Number of physician office visits
• Race/ethnicity
• Region of residence
• Education, marital status, sex
• Smoking
• Number of physician office visits
![Page 4: Analytical Example Using NHIS Data Files John R. Pleis.](https://reader036.fdocuments.net/reader036/viewer/2022062805/5697bfed1a28abf838cb8c0d/html5/thumbnails/4.jpg)
Additional CovariatesAdditional Covariates
• Regular place of health care
• Selected chronic conditions
• diabetes, respiratory difficulties, or heart disease
• Low-income program participation
• Regular place of health care
• Selected chronic conditions
• diabetes, respiratory difficulties, or heart disease
• Low-income program participation
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Data Files Data Files
• Determine which data files are needed for the analysis
• A good source for determining the file content is the Survey
• Description document:http://www.cdc.gov/nchs/nhis.htm
• Determine which data files are needed for the analysis
• A good source for determining the file content is the Survey
• Description document:http://www.cdc.gov/nchs/nhis.htm
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Data FilesData Files• This analysis will utilize data
from several files, which include:
• Person
• Sample adult
• Family
• This analysis will utilize data from several files, which include:
• Person
• Sample adult
• Family
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Person FilePerson File• Each person record also has a
sampling weight
• Used to inflate each observation
• Adjusted for non-response as well as U.S. Census population totals by age, sex, and race/ethnicity
• Each person record also has a sampling weight
• Used to inflate each observation
• Adjusted for non-response as well as U.S. Census population totals by age, sex, and race/ethnicity
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Person FilePerson File
• Sum of the weights = Size of the Civilian Non-Institutionalized Population
• For more information regarding weights and other design issues, please attend:Practical Applications in Design and Analysis of Complex Sample
Surveys (Session # 30)
• Sum of the weights = Size of the Civilian Non-Institutionalized Population
• For more information regarding weights and other design issues, please attend:Practical Applications in Design and Analysis of Complex Sample
Surveys (Session # 30)
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Sample Adult FileSample Adult File• Each sample adult record
has a sampling weight • Different from the person
sampling weight• Sum of the weights = Size of
the Civilian Non-Institutionalized Population of adults > 18 years of age
• Each sample adult record has a sampling weight
• Different from the person sampling weight
• Sum of the weights = Size of the Civilian Non-Institutionalized Population of adults > 18 years of age
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Sampling WeightsSampling Weights
• Each data file has its own sampling weights
• Weights should be used, if not:
• Totals, means, and proportions are affected
• Estimates such as regression coefficients are biased
• Each data file has its own sampling weights
• Weights should be used, if not:
• Totals, means, and proportions are affected
• Estimates such as regression coefficients are biased
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2000: Race/ethnicity (%)Sample Adults (aged >
65)
2000: Race/ethnicity (%)Sample Adults (aged >
65)
Source: 2000 NHISSource: 2000 NHIS
RACE/ETHNICITY UNWEIGHTED WEIGHTED
Hispanic 9.3 5.9
NH White 77.8 83.9
NH Black 11.3 8.2
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Sample DesignSample Design• The NHIS has a complex
sample design• The sample design affects
the computation of variance of estimates
• A complex sample will produce larger variances than a Simple Random Sample (SRS)
• The NHIS has a complex sample design
• The sample design affects the computation of variance of estimates
• A complex sample will produce larger variances than a Simple Random Sample (SRS)
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Sample DesignSample Design• Compared to a SRS,
confidence intervals are wider, and statistical significance is harder to achieve for complex survey data
• If variance estimates are needed, the complex sample design should be accounted for in the analysis
• Compared to a SRS, confidence intervals are wider, and statistical significance is harder to achieve for complex survey data
• If variance estimates are needed, the complex sample design should be accounted for in the analysis
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NHW vs. NHB Men Aged < 65: Bed Days
NHW vs. NHB Men Aged < 65: Bed Days
(1) (2) (3)
SRSUnweighted
SRSWeighted
ComplexWeighted
NHW NHB NHW NHB NHW NHB
Mean 3.42 5.19 3.52 5.36 3.52 5.36
S.E. ofMean .23 .78 .28 .89 .28 1.01
t-stat 2.18 1.96 1.79
Sig. Level p = .0293 p = .0497 p = .0738
Source: 2000 NHIS
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Research QuestionResearch QuestionIs the type of health
insurance coverage held by adults > 65 years of age
associated with flu shot use?
Is the type of health insurance coverage held by
adults > 65 years of age associated with flu shot use?
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Additional CovariatesAdditional Covariates
• Race/ethnicity• Region of residence• Education, marital status,
sex• Smoking• Number of physician office
visits
• Race/ethnicity• Region of residence• Education, marital status,
sex• Smoking• Number of physician office
visits
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Additional CovariatesAdditional Covariates
• Regular place of health care
• One place that the adult usually went to when either sick care or preventive health care was needed
• Does not include emergency rooms (< 0.5% of the sample)
• Regular place of health care
• One place that the adult usually went to when either sick care or preventive health care was needed
• Does not include emergency rooms (< 0.5% of the sample)
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Additional CovariatesAdditional Covariates
• Respiratory difficulties
• Asthma (EVER)
• Chronic Obstructive Pulmonary Disease (COPD)
• Respiratory difficulties
• Asthma (EVER)
• Chronic Obstructive Pulmonary Disease (COPD)
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Additional CovariatesAdditional Covariates
• Heart disease (EVER)
• Coronary heart disease
• Angina pectoris
• Heart attack
• Any other heart condition
• Heart disease (EVER)
• Coronary heart disease
• Angina pectoris
• Heart attack
• Any other heart condition
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Additional CovariatesAdditional Covariates
• Low-income programs
• Supplemental Security Income
• Temporary Assistance for Needy Families (TANF)
• Food stamps
• Governmental rental assistance
• Low-income programs
• Supplemental Security Income
• Temporary Assistance for Needy Families (TANF)
• Food stamps
• Governmental rental assistance
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Creating the FileCreating the File
• Not all the variables of interest for this analysis are contained in one file
• The Person, Sample Adult, and Family files can be merged to create one data file
• Not all the variables of interest for this analysis are contained in one file
• The Person, Sample Adult, and Family files can be merged to create one data file
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Creating the FileCreating the File
• Person file
• Health insurance
• Race/ethnicity (all)
• Governmental rental assistance (last 12 months)
• Person file
• Health insurance
• Race/ethnicity (all)
• Governmental rental assistance (last 12 months)
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Creating the FileCreating the File• Sample Adult file
• Flu shot use (last 12 months)
• Race/ethnicity (partial)
• Smoking, chronic conditions
• Number of physician office visits (last 12 months)
• Sample Adult file
• Flu shot use (last 12 months)
• Race/ethnicity (partial)
• Smoking, chronic conditions
• Number of physician office visits (last 12 months)
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Creating the FileCreating the File• Sample Adult file
• Sample Adult weight
• Sample Adult file
• Sample Adult weight
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Creating the FileCreating the File• Family file
• Any family member received any of the following in the past 12 months:• Supplemental Security Income• TANF• Food stamps
• Family file
• Any family member received any of the following in the past 12 months:• Supplemental Security Income• TANF• Food stamps
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Creating the FileCreating the File• Person and Sample Adult files
• Education, marital status, sex
• All files
• Region of residence
• STRATUM/PSU (design info for correct variance estimates)
• Person and Sample Adult files
• Education, marital status, sex
• All files
• Region of residence
• STRATUM/PSU (design info for correct variance estimates)
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Creating the FileCreating the File
• Data available at the NHIS URL:
http://www.cdc.gov/nchs/nhis.htm
• Data available at the NHIS URL:
http://www.cdc.gov/nchs/nhis.htm
• SAS and SPSS programs are
also available to create datasets
from the provided data
• SAS and SPSS programs are
also available to create datasets
from the provided data
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Creating the FileCreating the File• Merge the Person, Sample
Adult, and Family files together to create one data file
• Needed to merge files to analyze the association between health insurance coverage and flu shot use
• Merge the Person, Sample Adult, and Family files together to create one data file
• Needed to merge files to analyze the association between health insurance coverage and flu shot use
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Creating the FileCreating the File
• Each person and each family has a unique identifier (ID) in the NHIS
• These IDs are used to merge the data sets together
• Each person and each family has a unique identifier (ID) in the NHIS
• These IDs are used to merge the data sets together
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Creating the FileCreating the File• Person-level ID
• Created from household number
• (HHX) and person number (PX)
• Family-level ID
• Created from household number
• (HHX) and family number (FMX)
• Person-level ID
• Created from household number
• (HHX) and person number (PX)
• Family-level ID
• Created from household number
• (HHX) and family number (FMX)
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Creating the FileCreating the File
SampleAdult file
Person file
= Adults aged < 65, non-Sample Adults aged > 65, and all children
Familyfile
= New file
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Creating the FileCreating the File
• Why not drop the records for all children, all Adults aged < 65, and all adults aged > 65 who were non-Sample Adults?
• Depending on the situation, this could alter the variance estimates
• Why not drop the records for all children, all Adults aged < 65, and all adults aged > 65 who were non-Sample Adults?
• Depending on the situation, this could alter the variance estimates
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Creating the FileCreating the File
• Important to retain the file with all the observations and target the analysis to the particular domain of interest
• Several software packages for analyzing survey data (such as SUDAAN and STATA) have this capability
• Important to retain the file with all the observations and target the analysis to the particular domain of interest
• Several software packages for analyzing survey data (such as SUDAAN and STATA) have this capability
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Analysis Analysis • Crosstabs of flu shot
propensity among adults > 65 years of age
• Multiple logistic regression • Data from the NHIS 2000
public use files
• Crosstabs of flu shot propensity among adults > 65 years of age
• Multiple logistic regression • Data from the NHIS 2000
public use files
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Subpopulation Analyzed
Subpopulation Analyzed
• 6,180 Sample Adults > 65 years of age
• Representing a population of 32.7 million
• 6,180 Sample Adults > 65 years of age
• Representing a population of 32.7 million
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AnalysisAnalysis
• 89 adults > 65 years of age (1%) did not provide their flu shot status and were excluded from the analysis
• 89 adults > 65 years of age (1%) did not provide their flu shot status and were excluded from the analysis
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Flu Shot Rates By Health Insurance (aged >
65)
Flu Shot Rates By Health Insurance (aged >
65)
Medicaid and Medicare 54%Medicare 58%Medicare and Private 69%Medicare and other 72%
Medicaid and Medicare 54%Medicare 58%Medicare and Private 69%Medicare and other 72%
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Flu Shot Rates By Race/ethnicity (aged
> 65)
Flu Shot Rates By Race/ethnicity (aged
> 65)
Non-Hispanic black 48%Hispanic 56%Non-Hispanic other 62%Non-Hispanic white 67%
Non-Hispanic black 48%Hispanic 56%Non-Hispanic other 62%Non-Hispanic white 67%
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Flu Shot Rates By Education (aged >
65)
Flu Shot Rates By Education (aged >
65)< High School 58%High school/GED 65%Some college 66%A.A. degree 66%Bachelor’s degree + 74%
< High School 58%High school/GED 65%Some college 66%A.A. degree 66%Bachelor’s degree + 74%
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Flu Shot RatesBy Regular Place of
Health Care (aged > 65)
Flu Shot RatesBy Regular Place of
Health Care (aged > 65)
Yes 65%No 25%
Yes 65%No 25%
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Flu Shot RatesBy No. of Physician Office Visits, Last Year (aged >
65)
Flu Shot RatesBy No. of Physician Office Visits, Last Year (aged >
65)None 38%1 visit 60%2-3 visits 61%4-5 visits 67%6-7 visits 69%
None 38%1 visit 60%2-3 visits 61%4-5 visits 67%6-7 visits 69%
8-9 visits 72%
10-12 visits73%
13-15 visits74%
16+ visits 75%
8-9 visits 72%
10-12 visits73%
13-15 visits74%
16+ visits 75%
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05
dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUEHEALTH
INSURANCE
Medicare and
Medicaid 0.96 0.74
Medicare (1.00) -Medicare
andPrivate
1.34 0.00
Medicare and
Other 1.89 0.01
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05
dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUE
RACE/ETHNICITY NH black (1.00) -
Hispanic 1.40 0.03
NH other 1.20 0.53
NH white 1.65 0.00
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
IND. VAR. LEVEL OR P-VALUE
EDUCATION < HS (1.00) -
HS / GED 1.26 0.00Some
college 1.22 0.06
A.A. degree 1.30 0.05
Bachelors + 1.64 0.00
dependent variable = flu shot in last 12 monthsp<0.05dependent variable = flu shot in last 12 monthsp<0.05
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUE
DR. VISITS None (1.00) -
1 1.97 0.00
2-3 1.86 0.00
4-5 2.56 0.00
6-7 2.72 0.00
8-9 3.16 0.00
10-12 3.29 0.00
13-15 3.29 0.00
16+ 3.34 0.00
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUE
REGULAR PLACE OF
CAREYes 2.87 0.00
No (1.00) -
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05
dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUE
REGION Northeast (1.00) -
Midwest 1.01 0.92
South 1.05 0.58
West 1.34 0.01
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05
dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUE
MARITALSTATUS
NeverMarried 1.33 0.28
Married 1.28 0.04
Separated 1.16 0.58
Widowed 1.30 0.03
Divorced (1.00) -
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUE
SEX Female 0.89 0.09
Male (1.00) -
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUE
LOWINCOME
PROGRAMSYes (1.00) -
No 1.14 0.25
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUE
SMOKINGSTATUS Current (1.00) -
Former 1.48 0.00
Never 1.47 0.00
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUE
HEARTDISEASE Yes 1.29 0.00
No (1.00) -
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUE
DIABETES Yes 1.01 0.95
No (1.00) -
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Odds Ratio (OR) From Logistic Regression
Odds Ratio (OR) From Logistic Regression
dependent variable = flu shot in last 12 monthsp<0.05dependent variable = flu shot in last 12 monthsp<0.05
IND. VAR. LEVEL OR P-VALUE
RESP.PROBLEM
SYes 1.23 0.02
No (1.00) -