U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Overview of Office of Analysis and Epidemiology Diane Makuc, Dr.P.H. January 23, 2004

Office of Analysis and Epidemiology (OAE) History Office started by former NCHS Director Dorothy Rice in mid-1970’s. Jack Feldman was Office Director for more than 20 years. Role Cross-cutting analytic program Collaborative projects with others in NCHS, CDC, HHS, and beyond

OAE Organization Interdisciplinary staff organized into units that focus on: Health, United States Healthy People 2010 Aging and chronic disease Infant, child, and women’s health Injury and disability File linkage

OAE Activities Monitoring the health of the Nation Assessing and developing health data Interagency/international collaborations to improve data Research on significant health issues and methods Training Disseminating data electronically

Monitoring the Health of the Nation

Healthy People 2010 HHS health promotion and disease prevention agenda for the nation 2 overarching national goals: Increase quality and years of healthy life Eliminate disparities in health 467 specific objectives NCHS provides expertise and data for tracking progress

Healthy People 2010 Progress Reviews Monthly meeting chaired by Assistant Secretary for Health Covers one of 28 focus areas each month (e.g. heart disease and stroke, tobacco use, mental health, etc.) NCHS presents data tracking progress towards objectives Data presentations available on web

NCHS Statistical Workshop on Tracking Health Indicators Mortality data Mortality data Age adjustment Age adjustment Life tables Life tables State data State data Race/ethnicity classification Race/ethnicity classification Measuring health disparities Measuring health disparities Topics: Variability Variability Small area estimation Small area estimation Basic epidemiologic methods Basic epidemiologic methods Target-setting methods Target-setting methods Data availability via websites Data availability via websites Hands-on exercises Hands-on exercises

Assessing and Developing Health Data

NCHS Automated Tracking System Tracks current addresses of NCHS survey participants. Current addresses facilitate possible recontacts and enhance file linkages. Uses Post Office mailout and National Change of Address data base.

File Linkage NCHS survey data files are being linked to other files to enhance their usefulness for research and policy analysis. File linkage adds prospective data on morbidity, health care use, and mortality to cross-sectional and longitudinal surveys.

NCHS Surveys with Current Linkage Activities National Health Interview Survey (NHIS) National Health and Nutrition Examination Surveys (NHANES) Second Longitudinal Study on Aging (LSOA II) Baseline: 1994 NHIS Supplement on Aging for ages 70+ Followup: and

NHIS NHANES LSOA II Current File Linkage Activities SurveyMortality Linkage data and years of coverage Medicare Social Security Years " " " "" "" "" 1 Medicare data are enrollment, utilization, and payment. 2 Social Security data are income and disability determination. 12

Analysis of probabilistic matching techniques used by National Death Index to identify deaths. Evaluation of linkage success when Social Security Number is incomplete or inaccurate. Cognitive testing regarding effect on nonresponse of asking respondents for last 4 digits of SSN (with Census). Evaluation of bias introduced through probabilistic matching techniques. File Linkage Evaluation Research

Planning the National Children’s Study Prospective cohort study of the relationship between environment and health for about 100,000 children and their families. Congress authorized NICHD in collaboration with CDC, EPA and other agencies to plan, develop, and implement the study. Website:

Interagency and International Collaborations to Improve Health Data

Federal Interagency Forums Forum on Child and Family Statistics Website: Forum on Aging-related Statistics Website: Work to improve collection, reporting, and dissemination of data Publish reports on Key Indicators of Well- being

International Collaborative Effort (ICE) on Injury Statistics Participants: 15 countries and organizations Addresses issues in collecting, coding, and grouping injury data to improve comparability and quality of data. 10 th year Major products include: External cause of injury matrix for mortality Barell Matrix for morbidity data Website:

Research on Significant Health Issues and Methods

Selected Research Areas: Aging Trends in summary measures of health Life expectancy and lifetime health spending by health state Trends in healthy life expectancy and compression of morbidity Mental health of the elderly Prevalence of depression and GAD Trends in the use of mental health services Relation of disability to depression Prescription drug use among the elderly

Selected Research Areas: Infant and Child Health Socioeconomic and racial/ethnic differences in maternal, infant, and child health Outcomes of multiple pregnancies Asthma morbidity and mortality ADHD Use of psychotropic drugs Risk of injury

Selected Research Areas: Injury Injury deaths: 2001 Collaboration with Mortality Statistics Branch First of annual series on injury mortality Detailed data needed for injury prevention Uses external cause of injury mortality matrix Mechanism (fall, motor vehicle traffic...) Intent (unintentional, homicide, suicide…) Uses multiple cause of death data to identify nature of injury (head, thorax, …)

Selected Research Areas: Race-bridging Collaborative project to bridge the transition from single-race to multiple-race Federal data collection standards. Statistical models developed to assign multiple- race population counts collected from Census 2000 to single-race categories. Used to create single-race population estimates to estimate birth and death rates. Evaluation of models and population estimates is ongoing.

Training (Undergraduate to Post-doctoral) Epidemic Intelligence Service (EIS) (2 years) Fellows (1-2 years) ASPH ATPM Interns (3 months) ASPH JPSM Hispanic Association of Colleges and Universities (HACU)

Disseminating Data Electronically

Disseminating data electronically Interactive tables on web and CD using 20/20 software Trends in Health and Aging Healthy Women (State data by race) Asthma-related trends (under development) Data2010 on web Health, US on web Compressed mortality file – on web and CD (County level mortality and population data)

Data Warehouse on Trends in Health and Aging Topics include life expectancy, functional status, healthcare use and costs, chronic conditions, insurance, mortality…. Aggregated by age, sex, race/ethnicity Trends from as early as 1900, regular updates Focus on older adults, also has younger groups

Data Warehouse on Trends in Health and Aging (cont’d) Access on web and CD Tables (charts, maps, explanatory notes) Website:

Aging Trends Reports Teaching Modules for academia and practitioners Banco de Datos sobre Tendencias en la Salud y el Envejecimiento (Spanish version of the Data Warehouse) Annual Aging CD-ROM Presentations, Demonstrations, Workshops Trends in Health and Aging Outreach and Education

OAE Funding Sources National Institute on Aging (NIA) National Institute for Child Health and Development (NICHD) NIH Office of Behavioral and Social Sciences Research (OBSSR) HHS Office of Assistant Secretary for Planning and Evaluation (ASPE) Environmental Protection Agency (EPA)