Data Sources—Centers for Disease Control and Prevention (CDC)

2009 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

Behavioral Risk Factor Surveillance System (BRFSS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).

Mode of Administration

Telephone interview. Computer-assisted telephone interviewing (CATI) has been used since 2004. State data may be collected directly by the State health department or through a contractor. In 2007, 12 State health departments collected their data in-house; 42 contracted data collection to university survey research centers or commercial firms.

Survey Sample Design

BRFSS is a State-based system of telephone health surveys of adults age 18 and over who reside in households with telephones.

Random-digit-dialed (RDD) probability design was used initially. Disproportionate stratified sample (DSS) design has been implemented since 2003 and the number of States using DSS is increasing. In the DSS design most commonly used in the BRFSS, telephone numbers are divided into two strata, high density and medium density. Strata are sampled separately. Telephone numbers in the high-density stratum are sampled at the highest rate. In 2007, 50 States and the District of Columbia used DSS design. Guam, Puerto Rico, and the U.S. Virgin Islands used RDD design.

One resident household was selected if a selected telephone number reached a household. One adult in the household was randomly selected to be interviewed.

Primary Survey Content

The objective of the BRFSS is to collect uniform, State-specific data on preventive health practices and risk behaviors that are linked to chronic diseases, injuries, and preventable infectious diseases in the adult population.

The survey consists of core questions asked in all States, standardized optional questions on selected topics that are administered at the State's discretion, a rotating set of core questions asked every other year in all States, and State-added questions developed to address State-specific needs. Questions cover behavioral risk factors (e.g., alcohol and tobacco use), preventive health measures, HIV/AIDS, health status, activity limitations, and health care access and utilization.

Population Targeted

U.S. civilian noninstitutionalized population age 18 and over who reside in households with telephones.

Demographic Data

Gender, age, educational attainment, race/ethnicity, household income, employment status, and marital status.

Years Collected

Since 1984. The number of States participating in the survey has increased from 15 in 1984 to 50 States, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands since 2001.

Schedule

Annual. Data are collected monthly.

Geographic Estimates

National; State; smaller area estimates possible in some States.

Contact Information

Agency home page: http://www.cdc.gov.

Data system home page: http://www.cdc.gov/brfss.

References

Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System operational and user's guide. Version 3.0. Atlanta, GA: U.S. Department of Health and Human Services; December 12, 2006.

Go to http://www.cdc.gov/brfss/technical_infodata/index.htm for a collection of documents and survey data providing technical and statistical information regarding the BRFSS, such as comparability and sampling information.

National Ambulatory Medical Care Survey (NAMCS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Type Center for Health Statistics (NCHS).

Mode of Administration

Field personnel meet with participating office-based physicians and instruct them in survey data collection methods. Physicians are asked to complete a 1-page questionnaire (Patient Record Form) on a sample of their office visits during their assigned reporting period.

Survey Sample Design

A multistage probability design is used. The first-stage sample consisted of 84 primary sampling units (PSUs) in 1985 and, beginning in 1989, 112 PSUs, which were selected from about 1,900 such units into which the United States had been divided. In each sample PSU, a sample of practicing non-Federal office-based physicians is selected from master files maintained by the American Medical Association and the American Osteopathic Association. The final stage involves systematic random samples of office visits during randomly assigned 7-day reporting periods. In 1985, the survey excluded Alaska and Hawaii. Starting in 1989, the survey included all 50 States and the District of Columbia.

From 2003 to 2005, a sample of 3,000 physicians was selected. The response rates were 66 to 70%, with more than 25,000 visits. � In 2006, 3,500 physicians were selected and the response rate was 64%, with 29,392 visits.

Primary Survey Content

Data are collected from medical records on type of provider seen; reason for visit; diagnoses; drugs ordered, provided, or continued; and selected procedures and tests ordered or performed during the visit. Patient data include age, sex, race, and expected source of payment. Data are also collected on selected characteristics of physician practices.

Population Targeted

Sample data are weighted to produce national estimates of office visits.

The basic sampling unit is the patient visit. � The specialties of anesthesiology, pathology, and radiology are not included. Also not included are contacts by telephone, visits made outside the physician's office, visits in hospitals or institutional settings, and visits made for administrative purposes only.

Demographic Data

Patient's age, gender, race, and ethnicity.

Years Collected

Annual from 1973-1981; again in 1985; resumed an annual schedule in 1989.

Schedule

Annual.

Geographic Estimates

National; four U.S. Census Bureau regions.

Notes

The NAMCS is a visit-based survey rather than a population-based survey. Therefore, estimates of incidence and prevalence of disease cannot be computed. The survey is cross-sectional in nature. Multiple visits may be made by the same person within the sample.

Contact Information

Agency home page: http://www.cdc.gov/nchs/.

Data system home page: http://www.cdc.gov/nchs/ahcd.htm.

References

Hing E, Cherry D, Woodwell DA. National Ambulatory Medical Care Survey, 2003 summary. Advance Data From Vital and Health Statistics. No. 365. Hyattsville, MD: NCHS; 2005. Available from: http://www.cdc.gov/nchs/data/ad/ad365.pdf. [Plugin Software Help]

Cherry DK, Hing E, Woodwell DA, et al. National Ambulatory Medical Care Survey: 2006 summary. Natl Health Stat Report 3. Hyattsville, MD: National Center for Health Statistics; 2008.

National Health and Nutrition Examination Survey (NHANES)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Name National Type Center for Health Statistics (NCHS).

Mode of Administration

In-person interview in the household and in a private setting in the mobile examination center. Standardized physical examinations and laboratory tests in mobile examination centers.

Survey Sample Design

The NHANES sample design has been changed over time since 1960. The NHANES III conducted from 1988 to 1994 consisted of two phases of equal length and sample size. Phase 1 and Phase 2 comprised random samples of the civilian U.S. population living in households. Beginning in 1999, NHANES became a continuous, annual survey. The sample design is a complex, multistage, clustered design using unequal probabilities of selection. �In 1999-2006, African Americans, Mexican Americans, persons with low income, persons 12-19 years of age, and persons 60 years and older were oversampled.

The NHANES samples 30 PSUs within a 2-year survey cycle. The sample size in each PSU is roughly equal and is intended to yield about 5,000 examined persons per year. �From 1988-2006, the household interview response rates are in the range of 79 to 86%, and the medical examination response rates are in the range 76 to 80%.

Primary Survey Content

The NHANES includes clinical examinations, selected medical and laboratory tests, and self-reported data.

The NHANES has collected data on chronic disease prevalence and conditions (including undiagnosed conditions), risk factors, dietary intake and nutritional status, immunization status, infectious disease prevalence, health insurance, and environmental exposures. Other topics addressed include hearing, vision, mental health, anemia, diabetes, cardiovascular disease, osteoporosis, obesity, oral health, and physical fitness.

Population Targeted

For NHANES, the civilian noninstitutionalized population residing in the United States age 2 months and over. Beginning in 1999, persons of all ages are included.

Demographic Data

Gender, age, education, race/ethnicity, place of birth, income, occupation, and industry.

Years Collected

From 1960 to 1962 (National Health Examination Survey [NHES] I), 1963-1965 (NHES II), 1966-1970 (NHES III), 1971-1974 (NHANES I), 1976-1980 (NHANES II), 1982-1984 (Hispanic Health and Nutrition Examination Survey), 1988-1994 (NHANES III), 1999-2006 (NHANES). �

Schedule

Fielded periodically (1960-1994); continuously beginning in 1999, with data releases occurring in 2-year cycles.

Geographic Estimates

National; four U.S. Census Bureau regions (from 1988).

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/nhanes.htm.

References

Ezzati TM, Massey JT, Waksberg J, et al. Sample design: Third National Health and Nutrition Examination Survey. Vital Health Stat 1992;2(113).

National Center for Health Statistics. Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-94. Vital Health Stat 1994;1(32).

Analytic and reporting guidelines: the Third National Health and Nutrition Examination Survey (NHANES). Hyattsville, MD: National Center for Health Statistics; September, 2006. Available at: http://www.cdc.gov/nchs/nhanes/nhanes2005-2006/nhanes05_06.htm.

National Health Interview Survey (NHIS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Name National Type Center for Health Statistics (NCHS).

Mode of Administration

Personal interview in households, using computer-assisted personal interviewing (CAPI); administered by professional interviewers and conducted in English and Spanish (the CAPI Spanish version was initiated in mid-1998). A new NHIS instrument, which utilizes Blaise® computer-assisted interviewing software, was implemented for the 2004 survey year.

Survey Sample Design

The NHIS is a cross-sectional household interview survey. Sampling and interviewing are continuous throughout each year. The sampling plan follows a multistage area probability design that allows representative sampling of households. The sampling plan is redesigned after every decennial census. The current sampling plan was implemented in 2006. It has many similarities to the previous sampling plan, which was in place from 1995 to 2005.

The first stage of the current sampling plan consists of a sample of 428 PSUs drawn from approximately 1,900 geographically defined PSUs that cover the 50 States and the District of Columbia. A PSU consists of a county, a small group of contiguous counties, or a metropolitan statistical area. Within a PSU, two types of second-stage units are used: area segments and permit segments. Area segments are defined geographically and contain an expected 8, 12, or 16 addresses. Permit segments cover housing units built after the 2000 census. The permit segments are defined based on updated lists of building permits issued in the PSU since 2000 and contain an expected four addresses.

The current NHIS sample design continues oversampling Blacks and Hispanics, which was a new feature of the previous sample design. A new feature of the current design is that Asians are oversampled as well. In addition, the adult selection process has been revised so that Black, Hispanic, and Asian people age 65 and over have an increased probability of being selected. The new sample design is anticipated to result in approximately 87,500 people residing in 35,000 households with completed interviews each year. The survey is designed so that the sample scheduled for each week is representative of the target population and the weekly samples are additive over time.

Primary Survey Content

Information is obtained on demographic characteristics, illnesses, injuries, impairments, chronic conditions, use of health resources, health insurance, and other health topics. The core household interview asks about everyone in the household. Additional questions are asked of one sample adult and one sample child (under 18 years) per family in the household. The sample adult questionnaire includes chronic health conditions and activity limitations, health behaviors, health care access, health care provider contacts, immunizations, and AIDS knowledge and attitudes. The sample child questionnaire includes questions about chronic health conditions, activity limitations, health status, behavior problems, health care access and use, and immunizations. Child data are proxy reported by a parent or other knowledgeable adult respondent. Adult sample person data are all self-reported. Special modules are fielded periodically and cover areas such as cancer, prevention, disability, and use of complementary and alternative medicine.

Population Targeted

Civilian noninstitutionalized population residing in the United States, all ages.

Demographic Data

Gender, age, race/ethnicity, education, income, marital status, place of birth, industry, and occupation.

Years Collected

Continuously since 1957. Current sample design began in 2006; current questionnaire design began in 1997.

Schedule

Annual.

Geographic Estimates

National; four U.S. Census Bureau regions; some of the 10 Health and Human Services regions; some States; metropolitan and nonmetropolitan areas.

Notes

The annual NHIS response rate is close to 90 percent of the eligible households in the sample.

NHQR and NHDR tables report activity limitations and metropolitan statistical areas.

Metropolitan statistical areas are based on the 2000 Office of Management and Budget (OMB) standards for defining metropolitan and micropolitan areas and on the 2000 census:

  • Metropolitan categories:
    • Large Central—Central counties in metro areas of 1 million or more population.
    • Large Fringe—Outlying counties in metro areas of 1 million or more population.
    • Medium—Counties in metro areas of 250,000-999,999 population.
    • Small—Counties in metro areas of 50,000-249,999 population.
  • Nonmetropolitan categories:
    • Micropolitan—Counties in areas with an urban cluster of 10,000-49,999 population.
    • Noncore—Nonmicropolitan.

For details, the 2006 NCHS Urban-Rural Classification Scheme for Counties is available at http://www.cdc.gov/nchs/data_access/urban_rural.htm.

Adults with a disability are defined to be those with physical, sensory, and/or mental health conditions that can be associated with a decrease in functioning in such day-to-day activities as bathing, walking, doing everyday chores, and/or engaging in work or social activities. 

Limitations in basic activities represent problems with mobility and other basic functioning at the person level. Basic activities include problems with mobility; self-care (activities of daily living, or ADLs); domestic life (instrumental ADLs); and activities dependent on sensory functioning (limited to persons who are blind or deaf).

Limitations in complex activities represent limitations encountered when the person, in interaction with his or her environment, attempts to participate in community life. Complex activities include limitations experienced in work; and in community, social, and civic life. These two categories are not mutually exclusive since persons may have limitations both in basic activities and in complex activities.

Neither basic nor complex activities includes adults with neither basic nor complex activity limitations.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/nhis.htm.

References

For more details, refer to the NHIS description documents available from the datasets and documentation section at http://www.cdc.gov/nchs/nhis.htm.

National Center for Health Statistics. Data file documentation, National Health Interview Survey, 2006 (machine-readable data file and documentation). Hyattsville, MD: Centers for Disease Control and Prevention; 2007.

National Center for Health Statistics. Data file documentation, National Health Interview Survey, 2005 (machine-readable data file and documentation). Hyattsville, MD: Centers for Disease Control and Prevention; 2006.

National HIV/AIDS Surveillance System

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).

Description

The HIV/AIDS Surveillance System is the Nation's source for timely information used to track the epidemic. CDC funds and assists State and local health departments to collect the information. Health departments report their data to CDC.

Since the epidemic was first identified in the United States in 1981, population-based AIDS surveillance has been used to track the progression of the HIV epidemic. Since 1985, many States have implemented HIV case reporting as part of their comprehensive HIV/AIDS surveillance programs. As of December 31, 2007, 53 areas had laws or regulations requiring confidential reporting by name for adults, adolescents, and children with confirmed HIV infection (not AIDS) in addition to the reporting of persons with AIDS.

All 50 States, the District of Columbia, and U.S. dependent areas report AIDS cases to CDC by using a uniform surveillance case definition and case report form. The original definition was modified in 1985 and 1987. The case definition for adults and adolescents was modified again in 1993.

Primary Content

Mode of exposure to HIV, case definition category, and other clinical and demographic information.

Population Targeted

Entire population of all 50 States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and other U.S. territories. AIDS data are nationally representative.

Demographic Data

Age, gender, race, ethnicity, State and county of residence, country of birth, and living status.

Years Collected

Since 1981.

Schedule

The HIV/AIDS Surveillance Report is published annually. Supplemental reports are published on an ad hoc basis and are available online at http://www.cdc.gov/hiv/dhap.htm.

Geographic Estimates

National, State, region, and metropolitan statistical area.

Contact Information

Agency home page: http://www.cdc.gov.

Data system home page: http://www.cdc.gov/hiv/topics/surveillance/index.htm.

References

HIV/AIDS Surveillance Report, 2007. Vol. 19. Atlanta: Centers for Disease Control and Prevention; 2009. Available at: http://www.cdc.gov/hiv/topics/surveillance/resources/reports/.

National Home and Hospice Care Survey (NHHCS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Name National Type Center for Health Statistics (NCHS).

Mode of Administration

The 2007 NHHCS was administered in sampled home health and hospice agencies using a computer-assisted personal interviewing (CAPI) instrument. CAPI consisted of five modules, and interviewers were instructed to complete the agency qualification items first to ensure that the agency was eligible to participate in the survey. Interviewers were then free to administer the Agency Qualifications and Characteristics (AQ) module and the other four modules in any order depending on the availability of designated agency staff to answer the survey questions. Data were collected through in-person interviews with agency directors and their designated staffs; no interviews were conducted directly with patients or their families and/or friends. �

Survey Sample Design

The 2007 NHHCS used a stratified two-stage probability sample design. The first stage was the selection of home health and hospice agencies from the sampling frame of more than 15,000 agencies. The primary sampling strata of agencies were defined by agency type and metropolitan statistical area (MSA) status. Within these sampling strata, agencies were sorted by census region, ownership, certification status, State, county, ZIP Code, and size (number of employees). For the 2007 NHHCS, 1,545 agencies were systematically and randomly sampled with probability proportional to size.

The second stage of sample selection was completed by the interviewers during the agency interviews. The current home health patients and hospice discharges were randomly selected by a computer algorithm, based on a census list provided by each agency director or his/her designee. Up to 10 current home health patients were randomly selected per home health agency, up to 10 hospice discharges were randomly selected per hospice agency, and a combination of up to 10 current home health patients and hospice discharges were randomly selected per mixed agency.

The sampling frame for the 2007 NHHCS was constructed using three sources: (1) Centers for Medicare & Medicaid Services Provider of Services file of home health agencies and hospices, (2) State licensing lists of home health agencies compiled by a private organization, and (3) National Hospice and Palliative Care Organization file of hospices. The combined files were matched and identified duplicates were removed, resulting in a sampling frame of 15,488.

Primary Survey Content

The CAPI instrument consisted of five modules: Agency Qualifications and Characteristics (AQ), Patient Sampling (PS), Patient Health (PH), Patient Charges and Payments (PA), and Aide Sampling (AS).

Agency data collected included information on the year an agency was established, types of services an agency provided, referral sources, specialty programs, and staffing characteristics. Data collected on home health patients and hospice discharges included age, sex, race and ethnicity, services received, length of time since admission, diagnoses, medications taken, and advance directives.

Population Targeted

Home health and hospice agencies, their staff members, their services, and their patients in the United States.

Demographic Data

Gender, age, race/ethnicity, and other items.

Years Collected

NHHCS was first conducted in 1992 and was repeated in 1993, 1994, 1996, 1998, and 2000, and most recently in 2007.

Schedule

Selected years.

Geographic Estimates

National; four U.S. Census Bureau regions; some States; metropolitan and nonmetropolitan areas.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/nhhcs.htm.

References

For more details, refer to the NHHCS survey documents available at http://www.cdc.gov/nchs/nhhcs/nhhcs_questionnaires.htm.

National Hospital Ambulatory Medical Care Survey (NHAMCS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Mode of Administration

The NHAMCS collects data on the utilization and provision of medical care services provided in hospital emergency and outpatient departments. Hospital staff were asked to complete 1-page questionnaires (Patient Record forms) on a sample of their patient visits during an assigned reporting period.

Survey Sample Design

The NHAMCS is a national probability sample survey of visits to emergency departments (EDs) and outpatient departments (OPDs) of non-Federal, short-stay, and general hospitals in the United States. The NHAMCS uses a 4-stage probability design that involves samples of PSUs, hospitals within PSUs, clinics within hospitals, and patient visits within clinics and/or emergency service areas. Hospital staff are asked to complete Patient Record forms (PRFs) for a systematic random sample of patient visits occurring during a randomly assigned 4-week reporting period during the survey year. �

About 400 EDs and 225 OPDs participate each year. In 2006, the number of PRFs completed for EDs was 35,849 and for OPDs 31,505. The hospital response rate was 83% for EDs and 73% for OPDs.

Primary Survey Content

The NHAMCS includes two files: ED visits and OPD visits. Information is obtained on various aspects of patient visits, including patient, hospital, and visit characteristics. The survey form is redesigned every 2 to 4 years to address changing health data needs. Among the items collected are patient's age, gender, race, and ethnicity; patient's expressed reason for visit; intentionality of injury, if any; physician's diagnoses; diagnostic services ordered or provided; procedures provided; medications; providers seen; visit disposition; immediacy with which patient should be seen; and expected source of payment. Items collected that are specific to the ED include mode of arrival, waiting time, duration of time in the ED, initial vital signs, and cause of injury.

Population Targeted

The survey is a representative sample of visits to EDs and OPDs of non-Federal, short-stay, or general hospitals, exclusive of Federal, military, and Veterans Affairs hospitals, located in the 50 States and the District of Columbia. Telephone contacts and visits for administrative purposes are excluded. NHAMCS is weighted to give national estimates of ED and hospital OPD visits.

Demographic Data

Patient's age, gender, race, and ethnicity.

Years Collected

Since 1992.

Schedule

Annual.

Geographic Estimates

National; four U.S. Census Bureau regions.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/ahcd.htm.

References

McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2001 emergency department summary. Advance Data From Vital and Health Statistics. No. 335. Hyattsville, MD: National Center for Health Statistics; June 4, 2003.

McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary. Advance Data From Vital and Health Statistics. No. 340. Hyattsville, MD: National Center for Health Statistics; 2004.

Hing E, Middleton K. National Hospital Ambulatory Medical Care Survey: 2002 outpatient department summary. Advance Data From Vital and Health Statistics. No. 345. Hyattsville, MD: National Center for Health Statistics; 2004.

National Hospital Discharge Survey (NHDS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Mode of Administration

Manual sample selection and abstraction of inpatient medical records by U.S. Census Bureau field personnel or automated data collection through the purchase of electronic files from commercial sources, States, or hospitals.

Survey Sample Design

The 1965-1987 NHDS was a two-stage stratified systematic random sample. Under the 1988 redesign, hospitals were selected using a modified three-stage stratified design. Units selected at the first stage consisted of either hospitals or geographic areas. The geographic areas were PSUs used for the 1985-1994 National Health Interview Survey, which are geographic areas such as counties or townships. Hospitals within PSUs were then selected at the second stage. Strata at this stage were defined by geographic region, PSU size, abstracting service status, and hospital specialty-size groups. Within these strata, hospitals were selected with probabilities proportional to their annual number of discharges. At the third stage, a sample of discharges was selected by a systematic random sampling technique.

In 2005, 501 hospitals were selected: 473 were within scope, and 444 participated (94% responded). Data were collected from medical records for approximately 375,000 discharges. �

Primary Survey Content

The NHDS collects and produces national estimates on characteristics of inpatient stays in non-Federal short-stay hospitals in the United States.

Patient information collected includes demographics, length of stay, diagnoses, and procedures. Hospital characteristics collected include region, ownership, and bed size.

Population Targeted

The NHDS contains a sample of discharges from non-Federal, noninstitutional hospitals located in the 50 States and the District of Columbia. Only hospitals with an average length of stay for all patients of less than 30 days or with a general (medical/surgical) or children's specialty are included in the survey.

NHDS data are weighted to give national and regional estimates of hospital discharges from non-Federal, noninstitutional hospitals.

Demographic Data

Patient's age, gender, race, and ethnicity.

Years Collected

1965 to present.

Schedule

Annual.

Geographic Estimates

National, four U.S. Census Bureau regions.

Notes

Data on race are not available from some hospitals because the hospitals provide data from billing forms that do not include race as a required item. In general, nonresponse for race in the NHDS is about 22 to 25%. Nonresponse for Hispanic origin is greater, at about 60 to 63% annually.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/nhds.htm.

References

Kozak LJ. Underreporting of race in the National Hospital Discharge Survey. Advance Data From Vital And Health Statistics. No. 265. Hyattsville, MD: National Center for Health Statistics; 1995.

Dennison CF, Pokras R. Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital and Health Statistics 2000;1(39).

National Immunization Survey (NIS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Diseases (NCIRD) and National Center for Health Statistics (NCHS).

Mode of Administration

First stage: telephone interviews with households with age-eligible children; second stage: provider reports of vaccination information from the child's medical record.

Survey Sample Design

In each of 56 or more State and local geographic areas (which together make up the United States), the NIS draws independent quarterly samples of telephone numbers and then uses random-digit dialing to identify households that have one or more children ages 19 to 35 months. In the telephone interview, the interviewer collects vaccination information for each such child and obtains permission to contact the providers of the child's vaccinations. In a second phase, a mail survey, the NIS asks the providers to report vaccination information from the child's medical record. This information is generally more accurate and complete than the household's information.

Primary Survey Content

The NIS is a continuing nationwide telephone sample survey to monitor vaccination coverage rates among children ages 19 to 35 months. �

Data collected include vaccination status and timing for diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTP/DT/DTAP); polio vaccine; measles, mumps, and rubella vaccine (MMR); Haemophilus influenzae type B vaccine (Hib); hepatitis B vaccine (Hep B); varicella zoster vaccine; pneumococcal conjugate vaccine (PCV); hepatitis A (Hep A); and influenza. The data are collected by race and ethnicity, income, location of residence, geographic division, State, and selected urban areas.

Population Targeted

Children ages 19 to 35 months living in the United States at the time of the interview.

Demographic Data

Gender, race/ethnicity, income, location of residence, four U.S. Census Bureau regions.

Years Collected

Since 1994. Data collection for varicella began in July 1996; data collection for PCV began in July 2001.

Schedule

Quarterly samples, reported annually.

Geographic Estimates

National, State, and local areas.

Contact Information

Agency home page: � http://www.cdc.gov/vaccines/.

NIS estimates home page: � http://www.cdc.gov/vaccines/stats-surv/default.htm.

Data system home page: http://www.cdc.gov/nis.

References

Zell ER, Ezzati-Rice TM, Battaglia MP, et al. National Immunization Survey: the methodology of a vaccination surveillance system. Public Health Rep 2000;115(1):65-77.

National Tuberculosis Surveillance System (NTBSS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of Tuberculosis Elimination (DTBE).

Description

Reports of verified cases of tuberculosis (RVCT) are submitted to DTBE, CDC, by 60 reporting areas (the 50 States, the District of Columbia, New York City, Puerto Rico, and seven other jurisdictions in the Pacific and Caribbean). In January 1993, an expanded system was developed to collect additional information for each reported TB case in order to better monitor trends in TB and TB control. A software package (SURVS-TB) for data entry, analysis, and transmission of case reports to CDC was designed and implemented as part of the expanded TB surveillance system. In 1998, the Tuberculosis Information Management System (TIMS) replaced SURVS-TB.

In total, 13,299 TB cases were reported in the United States in 2007.

Primary Content

Number of new TB cases, patient management, and program evaluation.

In the expanded system started in January 1993, the RVCT form for reporting TB cases was revised to collect information on occupation, initial drug regimen, HIV test results, history of substance abuse and homelessness, and residence in correctional or long-term care facilities at the time of diagnosis. RVCT Follow Up Report-1 was added to collect drug susceptibility results for the initial M. tuberculosis isolate from patients with culture-positive disease. To evaluate the outcomes of TB therapy, RVCT Follow Up Report-2 was added to collect information on the reason and date therapy was stopped, type of health care provider, sputum culture conversion, use of directly observed therapy, and results of drug susceptibility testing for the final M. tuberculosis isolate from patients with culture-positive disease.

Population Targeted

Civilian population residing in the United States at diagnosis of TB.

Demographic Data

Age, gender, race, and country of origin.

Years Collected

Since 1953 (in aggregate form). Since 1985 (in individual case report form).

Schedule

Annual.

Geographic Estimates

National and States.

Contact Information

Agency home page: http://www.cdc.gov.

Data source home page: http://www.cdc.gov/tb.

References

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination. Reported tuberculosis in the United States, 2007. Atlanta, GA: Centers for Disease Control and Prevention; September 2008. Available at: http://www.cdc.gov/tb/statistics/reports/2007/default.htm.

National Vital Statistics System—Linked Birth and Infant Death Data (NVSS-I)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Name National Type Center for Health Statistics (NCHS).

Description

NCHS's Division of Vital Statistics obtains information on births and deaths from the registration offices of each of the 50 States, New York City, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and Northern Mariana Islands. Before 1972 microfilm copies of all death certificates and a 50% sample of birth certificates were received from all registration areas and processed by NCHS. In 1972, some States began sending their data to NCHS through the Cooperative Health Statistics System (CHSS). States that participated in the CHSS program processed 100% of their death and birth records and sent the entire data file to NCHS on computer tapes.

Currently, data are sent to NCHS through the Vital Statistics Cooperative Program (VSCP), following the same procedures as CHSS. The number of participating States grew from 6 in 1972 to 46 in 1984. Starting in 1985, all 50 States and the District of Columbia participated in VSCP.

In the linked birth and infant death data set, the information from the death certificate is linked to the information from the birth certificate for each infant less than age 1 who dies in the United States, Puerto Rico, the Virgin Islands, and Guam. Starting with data year 1995, more timely linked file data are produced in a period data format preceding the release of the corresponding birth cohort format. The 2005 period linked file contains a numerator file that consists of all infant deaths occurring in 2005 that have been linked to their corresponding birth certificates, whether the birth occurred in 2004 or 2005.

Other changes to the dataset starting with 1995 data include addition of record weights to correct for the 1.0 to 1.41% of records that could not be linked in 2000 to 2005 (2% in 1995 to 1999) and for the addition of an imputation for unstated birth weight.

Primary Survey Content

The vital statistics general mortality data are a fundamental source of geographic and cause-of-death information and some demographic information. The birth certificate is the primary source of demographic information, such as age, race, and Hispanic origin of the parents; maternal education; live birth order; and mother's marital status; and of maternal and infant health information, such as birth weight, period of gestation, plurality, prenatal care use, and maternal smoking.

Population Targeted

Infants in 50 States and the District of Columbia.

Demographic Data

Age, gender, race, and Hispanic origin of infant and parents. Mother's education and marital status.

Years Collected

Linked data are available for the data years 1983-1991 and 1995-2006.

Schedule

Data are collected/produced annually.

Geographic Estimates

National, by States.

Place of death is classified by State and county. In residence classification, all deaths are allocated to the usual place of residence as reported on the death certificate and are classified by State, county, and city.

Notes

Data on mother's educational attainment, tobacco use during pregnancy, and prenatal care based on the 2003 revision are not comparable with data based on the 1989 revision of the U.S. Standard Certificate of Live Birth.

NHQR and NHDR tables report geographic location. � Geographic locations are based on the 2000 Office of Management and Budget standards for defining metropolitan and micropolitan areas and on the 2000 census:

  • Metropolitan categories:
    • Large Central—Central counties in metro areas of 1 million or more population.
    • Large Fringe—Outlying counties in metro areas of 1 million or more population.
    • Medium—Counties in metro areas of 250,000-999,999 population.
    • Small—Counties in metro areas of 50,000-249,999 population.
  • Nonmetropolitan categories:
    • Micropolitan—Counties in areas with an urban cluster of 10,000-49,999 population.
    • Noncore—Nonmicropolitan.

Details are in the 2006 NCHS Urban-Rural Classification Scheme for Counties, available at http://www.cdc.gov/nchs/data_access/urban_rural.htm.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/linked.htm.

References

Mathews TJ, MacDorman MF. Infant mortality statistics from the 2005 period linked birth/infant death data set. Natl Vital Stat Rep 2008;57(2).

National Vital Statistics System—Mortality (NVSS-M)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Description

NVSS mortality files include data for the 50 States, the District of Columbia, and the territories of Puerto Rico, Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Marianas. All deaths occurring in those areas are included (approximately 2.3 to 2.4 million annually).

By law, the registration of deaths is the responsibility of the funeral director. Administrative records (death certificates) completed by funeral directors, physicians, medical examiners, and coroners are filed with State vital statistics offices. Selected statistical information is forwarded to NCHS to be merged into a national statistical file.

Beginning with 1989, revised standard certificates replaced the 1978 versions; implementation of the next revision, for 2003, is being phased in by the States. Demographic information on the death certificate is provided by the funeral director and is based on information supplied by an informant. Medical certification of cause of death is provided by a physician, medical examiner, or coroner.

�Currently, data are sent to NCHS through the Vital Statistics Cooperative Program (VSCP). The number of States participating in the VSCP program grew from 6 in 1972 to 46 in 1984. Starting in 1985, all 50 States and the District of Columbia participated in VSCP.

Primary Content

Year of death, place of decedent's residence, place death occurred, age at death, day of week and month of death, Hispanic origin (beginning in 1984), race, marital status (beginning in 1979), place of birth, gender, underlying and multiple causes of death for all States, injury at work (beginning in 1993), hospital and patient status, and educational attainment (beginning in 1989) for selected States.

Population Targeted

U.S. population.

Demographic Data

Sex, race, Hispanic origin, age at death, place of decedent's residence, educational attainment for selected States, and marital status. Race and ethnic origin are separate items on the death certificate. Beginning with 1992 data, California, Hawaii, Illinois, New Jersey, New York, Texas, and Washington reported expanded Asian and Pacific Islander categories of Asian Indian, Korean, Vietnamese, Samoan, and Guamanian. The rest of the States reported a combined Other Asian and Pacific Islander category in addition to the categories of White, Black, American Indian, Chinese, Hawaiian, Japanese, and Filipino that all States report. As of 1997, all States report Hispanic origin. The categories reported include Mexican, Puerto Rican, Cuban, Central and South American, and Other Hispanic. Beginning with data for 2003, multiple-race data will be available for selected States.

Years Collected

The data system began in 1880, but not all States participated before 1933. Coverage for deaths has been complete since 1933.

Schedule

Annual.

Geographic Estimates

National, regional, State, and county. Beginning with 1989 data, some changes were initiated to increase confidentiality protection. Identifying information, including date of death and geographic identifiers for counties of fewer than 100,000 persons, is not available for public use.

Notes

Data on educational attainment have been revised since 2004. � Some States implemented the 2003 revision of the U.S. Standard Certificate of Live Birth, while others still use the 1989 revision of the U.S. Standard Certificate of Live Birth. To prevent inappropriate comparison, the 2009 NHQR and NHDR did not report data on educational attainment.

NHQR and NHDR tables report geographic location. � Geographic locations are based on the 2000 Office of Management and Budget standards for defining metropolitan and micropolitan areas and on the 2000 census:

  • Metropolitan categories:
    • Large Central—Central counties in metro areas of 1 million or more population.
    • Large Fringe—Outlying counties in metro areas of 1 million or more population.
    • Medium—Counties in metro areas of 250,000-999,999 population.
    • Small—Counties in metro areas of 50,000-249,999 population.
  • Nonmetropolitan categories:
    • Micropolitan—Counties in areas with an urban cluster of 10,000-49,999 population.
    • Noncore— Nonmicropolitan.

Details are in the 2006 NCHS Urban-Rural Classification Scheme for Counties, available at http://www.cdc.gov/nchs/data_access/urban_rural.htm.

Contact Information

Agency home page: � http://www.cdc.gov/nchs.

Data system home page: � http://www.cdc.gov/nchs/deaths.htm.

References

Miniño AM, Heron MP, Murphy SL, et al. Deaths: final data for 2004. Natl Vital Stat Rep 2007;55(19).

Kochanek KD, Smith BL. Deaths: preliminary data for 2002. Natl Vital Stat Rep 2004;52(13).

National Vital Statistics System—Natality (NVSS-N)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Description

NVSS natality files include data for the 50 States, the District of Columbia, and the territories of Puerto Rico, Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Marianas. All births occurring in those areas are included (approximately 4 million annually).

State laws require birth certificates to be completed for all births. The registration of births is the responsibility of the professional attendant at birth, generally a physician or midwife. Federal law mandates national collection and publication of birth and other vital statistics data.

Birth certificates completed by physicians and midwives are filed with State vital statistics offices; selected statistical information is forwarded to NCHS to be merged into a national statistical file. Standard forms for the collection of the data and model procedures for the uniform registration of the events are developed and recommended for State use through cooperative activities of the States and NCHS. Beginning with 1989, revised standard certificates replaced the 1978 versions; implementation of the next scheduled revision, for 2003, is being phased in by the States. � �

Primary Content

Demographic information, year, date, place of birth, and live-birth order.

Maternal and infant health information, including month prenatal care began, number of prenatal visits, medical risk factors, tobacco use, alcohol use, maternal weight gain, obstetric procedures, attendant at birth, method of delivery, place of delivery, complications of labor and/or delivery, period of gestation, birth weight, Apgar score, abnormal conditions of newborn, congenital anomalies, and plurality.

Population Targeted

U.S. resident population.

Demographic Data

Child: Sex.

Mother and father: Race, Hispanic origin (beginning in 1978), age, place of mother's residence, and educational attainment (beginning in 1978) (education of father not currently collected).

Mother: marital status.

Race and Hispanic origin are separate items on the birth certificate. Beginning with 1992 data, California, Hawaii, Illinois, New Jersey, New York, Texas, and Washington have reported expanded Asian and Pacific Islander (API) categories of Asian Indian, Korean, Vietnamese, Samoan, and Guamanian. Eleven States currently collect expanded categories. The rest of the States report a combined Other Asian and Pacific Islander category in addition to the categories of White, Black, American Indian, Chinese, Hawaiian, Japanese, and Filipino that all States report. As of 1993, all States report Hispanic origin. The categories reported include Mexican, Puerto Rican, Cuban, Central and South American, and Other Hispanic.

Years Collected

The national birth registration system was established in 1915. Not all States participated before 1933. Coverage for births has been complete since 1933.

Schedule

Annual.

Geographic Estimates

National, regional, State, and county; also cities of 100,000 population or more. Beginning with 1989 data, some changes were initiated to increase confidentiality protection. Identifying information, including geographic identifiers for counties of fewer than 100,000 persons, is not available for public use.

Notes

Data on mother's educational attainment, tobacco use during pregnancy, and prenatal care have been revised since 2004. � Some States implemented the 2003 revision of the U.S. Standard Certificate of Live Birth, while others still use the 1989 revision of the U.S. Standard Certificate of Live Birth. To prevent inappropriate comparison, the 2009 NHQR and NHDR did not report NVSS-N data.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/births.htm.

References

Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2004. Natl Vital Stat Rep 2006;55(1).

Hamilton BE, Sutton PD, Ventura SJ. Revised birth and fertility rates for the 1990s and new rates for Hispanic populations, 2000 and 2001: United States. Natl Vital Stat Rep 2003;51(12).

Sutton PD, Mathews TJ. Trends in characteristics of births by State: United States, 1990, 1995, and 2000-2002. Natl Vital Stat Rep 2004;52(19).


 

Current as of March 2010
Internet Citation: Data Sources—Centers for Disease Control and Prevention (CDC): 2009 National Healthcare Quality and Disparities Reports. March 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr09/datasources/cdc.html