Presentation is loading. Please wait.

Presentation is loading. Please wait.

1 Assessment of Potential Bias in the National Immunization Survey (NIS) from the Increasing Prevalence of Households Without Landline Telephones Meena.

Published bySabina Long Modified over 8 years ago

Similar presentations

Presentation on theme: "1 Assessment of Potential Bias in the National Immunization Survey (NIS) from the Increasing Prevalence of Households Without Landline Telephones Meena."— Presentation transcript:

1 1 Assessment of Potential Bias in the National Immunization Survey (NIS) from the Increasing Prevalence of Households Without Landline Telephones Meena Khare (NCHS), James A. Singleton (NCIRD), Abera Wouhib (NCHS), and Nidhi Jain (NCIRD) National Immunization Conference, 2008 The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

2 2 National Immunization Survey (NIS) Ages 19-35 months Monitors vaccination coverage in US states and selected local areas Conducted 1994 - present Large random-digit-dialing landline telephone survey Vaccination history from child’s provider(s) Annual sample size ~30,000 children with interview data ~21,000 with provider reported data ~ 65% household response rate

3 3 NIS-Teen Ages 13-17 years Uses the NIS sampling frame of landline telephone number Conducted Q4 2006 (national sample) 5,468 household interviews conducted 2,882 teens had adequate provider reported vaccination histories 56.2% household response rate Repeated Q4 2007 (national sample) 2008+ annual sample by state and selected local areas

4 4 National Health Interview Survey (NHIS) Conducted annually since 1957 Nationally representative sample Civilian non-institutionalized US population Face-to-face interviews Selects ~40,000 households and ~100,000 persons Detailed health information for 1 adult & 1 child per family Oversamples NH-blacks, Hispanics; Asians (in 2006) Response rates 87.3% household 78.8% sample child (<18 years)

5 5 NHIS Covers both landline telephone and non-landline telephone households Households connected by landline telephone (LT) Households without landline telephone service (NLT) Wireless-only households (2003+) Households without any phone service

6 6 Ref: Blumberg et al., Wireless substitution: Early release of estimates based on data from the NHIS, July-December 2006, NCHS. http://www.cdc.gov/nchs/data/nhis/earlyrelease/wireless200705.pdf, 2007; children<=17 yrs

7 7 Percentage of Children Living in Landline, Wireless Only, and Phoneless Households, NHIS 2006 Children aged 1 – 4 years (N = 2,201)Landline Telephone Wireless OnlyPhoneless All82.1 14.03.9 GenderBoys81.714.93.4 Girls82.513.04.5 Hispanic79.214.36.5 Race/EthnicityNH White84.513.22.3 NH Black75.019.06.1 < 100%69.221.59.4 Poverty Level100 - 199%75.621.33.0 200 - 399%86.812.40.9 400% +93.96.20.0

8 8 Teens aged 13 – 17 years (N = 3,044)Landline Telephone Wireless OnlyPhoneless All90.4 7.52.1 GenderBoys90.27.82.0 Girls90.57.32.3 Hispanic86.211.82.0 Race/EthnicityNH White92.45.91.6 NH Black87.38.74.0 NH Other89.88.22.0 < 100%83.612.14.3 Poverty Level100 - 199%86.710.33.0 200 - 399%93.16.80.1 400% +96.33.30.4 Percentage of Teens Living in Landline, Wireless Only, and Phoneless Households, NHIS 2006

9 9 Methods Assess bias due to exclusion of non-landline households using 2006 NHIS sample Outcome measure: parental report of child’s influenza vaccination in the past 12 months Compared estimates from all NHIS sample to NHIS landline (LT) sample estimates Used weighting methodology similar to NIS to adjust LT sample estimates for exclusion of children from the non-landline sample Compared NHIS estimates with NIS-Teen 2006 estimates based on parental report (benchmarking)

10 10 Influenza Vaccination Rates Children 1- 4 Years

11 11 Influenza Vaccination Rates among Children aged 1-4 Years Landline vs. Non-landline Households, NHIS 2006

12 12 Influenza Vaccination Rates among Children 1-4 Years Overall vs. Adjusted Landline (LT) Estimates, NHIS 2006

13 13 Influenza Vaccination Rates among Children 1-4 Years Comparisons by Selected Factors, NHIS 2006 *No differences were statistically significant (p > 0.05) Children 1-4 years (N = 2,201) Overall NHIS 2006 (%) Landline Telephone (LT) (%) Non- Landline (NLT) (%) Adjusted LT (%) Difference* = Adjusted LT - Overall NHIS (%) All 30.030.726.529.7-0.3 Poverty Level: < 100% 30.330.829.427.5-2.8 100% - 199% 26.827.126.027.70.9 200% - 399% 28.428.726.429.30.9 400% + 38.138.333.938.40.3 Dr. office visits: None 16.316.416.012.6-3.7 1 – 5 office visits 29.630.226.929.70.1 6 - 9 office visits 53.155.242.251.5-1.6

14 14 Continued… *No differences were statistically significant (p > 0.05) Children 1-4 years (N = 2,201) Overall NHIS 2006 (%) Landline Telephone (LT) (%) Non- Landline (NLT) (%) Adjusted LT (%) Difference* = Adjusted LT - Overall NHIS (%) All 30.030.726.529.7-0.3 Ever been told child had asthma? Yes39.544.225.536.8-2.7 No29.129.626.729.0-0.1 Uninsured? Yes19.420.815.815.9-3.5 No31.031.628.131.10.1 Ever had chickenpox? Yes11.511.611.110.4-1.1 No30.731.527.230.80.1

15 15 Influenza Vaccination Rates Adolescents 13-17 Years

16 16 Influenza Vaccination Rates among Adolescents 13-17 Years Landline vs. Non-landline Households, NHIS 2006

17 17 Influenza Vaccination Rates among Adolescents 13-17 Years Overall vs. Adjusted Landline (LT) Estimates, NHIS 2006

18 18 Influenza Vaccination Rates among Adolescents 13-17 Years Comparisons by Selected Factors, NHIS 2006 *No differences were statistically significant (p > 0.05) Adolescents 13-17 years (N = 3,044) Overall NHIS 2006 (%) Landline Telephone (LT) (%) Non- Landline (NLT) (%) Adjusted LT (%) Difference* = Adjusted LT - Overall NHIS (%) All 11.912.28.612.40.5 Poverty Level: < 100% 18.520.58.721.73.2 100% - 199% 10.211.14.410.40.2 200% - 399% 12.613.08.213.10.5 400% + 11.912.16.211.6-0.3 Dr. office visits: None 4.94.85.74.6-0.3 1 – 5 office visits 12.713.09.813.20.5 6-9 office visits 20.321.48.222.01.7

19 19 Continued… *No differences were statistically significant (p > 0.05) Adolescents 13-17 years (N = 3,044) Total US, NHIS 2006 (%) Landline Telephone (LT) (%) Non- Landline (NLT) (%) Adjusted LT (%) Difference* = Adjusted LT - Overall NHIS (%) All 11.912.28.612.40.5 Ever been told child had asthma? Yes22.723.812.224.41.7 No9.910.18.110.10.2 Uninsured? Yes4.75.03.25.00.3 No12.913.29.813.50.6 Ever had chickenpox? Yes11.511.88.411.90.4 No12.913.48.213.80.9

20 20 Summary In 2006, 18% of young children and 10% of teens lived in non-landline telephone households ~78% of these households had access to wireless telephones In 2006, no significant bias was observed in the landline telephone sample estimates after adjusting for exclusion of non-landline telephone households

21 21 Limitations Not a direct evaluation of bias in NIS Uses parental-report of influenza vaccination as proxy measure for other vaccines Limited NHIS sample sizes for children in non-landline households, esp. for teens Differences between NIS and NHIS: Telephone vs. face-to-face interviews Different recall time period Different weighting methods

22 22 Benchmarking 2006/Q4 NIS-Teen to 2006 NHIS Compared estimated household-reported influenza vaccination rates Evaluated bias from NIS-Teen for exclusion of non- landline households and nonresponse Influenza vaccination rates among teens 13-17 years 13.6% NIS-Teen, 11.9% NHIS Influenza vaccination rates among teens with asthma 23.8% NIS-Teen, 22.7% NHIS Limitations: differences in survey modes & periods of influenza vaccinations; NHIS is an address-based sample & does not have 100% response rates

23 23 Conclusions Findings from NHIS are reassuring but more direct evaluation of bias in NIS is needed We will continue to monitor trends in non-landline prevalence and potential bias in NIS estimates using NHIS Starting with 2007 data, we will also benchmark NIS household-reported influenza vaccinations among children 19-35 mo to NHIS estimates

24 24 Charting the course for NIS… where are we headed?

25 25 The Challenge Develop short and long term strategies for addressing exclusion of non-landline households from the NIS sample frame, while… Maintaining a credible survey that will provide the information needed to monitor the U.S. immunization program with reliable, valid estimates

26 26 Strategy Evaluate potential bias NHIS analysis Evaluate NIS weighting enhancements Planning vaccination provider record check on NHIS sample in 2008 (infant, teen) Compare vaccination coverage estimates from 2007 NIS infant cell phone pilot study Add sampling frame with non-landline households e.g., cell phone sample, birth certificates/IIS, school-based sample for teens Replace current landline telephone frame? e.g., American Community Survey

27 27 Potential Bias in Landline Sample * Landline Bias = (% of population non-landline)*(Landline estimate – non-landline estimate)

28 28 Thank you Contact: Meena Khare (mkhare@cdc.gov) or Jim Singleton (jsingleton@cdc.gov)

Download ppt "1 Assessment of Potential Bias in the National Immunization Survey (NIS) from the Increasing Prevalence of Households Without Landline Telephones Meena."

Similar presentations

Correspondence between interracial births and multiple race reporting in the National Health Interview Survey Jennifer D. Parker Academy Health Annual.

Correspondence between interracial births and multiple race reporting in the National Health Interview Survey Jennifer D. Parker Academy Health Annual.
Coverage Bias in Traditional Telephone Surveys of Low-Income and Young Adults Centers for Disease Control and Prevention National Center for Health Statistics.

Coverage Bias in Traditional Telephone Surveys of Low-Income and Young Adults Centers for Disease Control and Prevention National Center for Health Statistics.
The Early Release Program of the National Health Interview Survey Jeannine Schiller, M.P.H., Jane F. Gentleman, Ph.D., Eve Powell-Griner, Ph.D. National.

The Early Release Program of the National Health Interview Survey Jeannine Schiller, M.P.H., Jane F. Gentleman, Ph.D., Eve Powell-Griner, Ph.D. National.
An Assessment of the Impact of Two Distinct Survey Design Modifications on Health Insurance Coverage Estimates in a National Health Care Survey Steven.

An Assessment of the Impact of Two Distinct Survey Design Modifications on Health Insurance Coverage Estimates in a National Health Care Survey Steven.
Community Health Assessment 2004 - 2005 San Joaquin County.

Community Health Assessment San Joaquin County.
1 Monitoring Pediatric Emergency Room Use with the National Health Interview Survey Renee M. Gindi Division of Health Interview Statistics, NCHS National.

1 Monitoring Pediatric Emergency Room Use with the National Health Interview Survey Renee M. Gindi Division of Health Interview Statistics, NCHS National.
Www.shadac.org Challenges to Surveys Non-response error –Falling response rates over time Sample coverage –Those without landline telephones excluded –Growing.

Challenges to Surveys Non-response error –Falling response rates over time Sample coverage –Those without landline telephones excluded –Growing.
Asthma Prevalence in the United States

Asthma Prevalence in the United States
Access to health care among Hispanic/Latino children: U.S., 1998-2001 by: Gulnur Scott, M.P.A. Hanyu Ni, Ph.D. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES.

Access to health care among Hispanic/Latino children: U.S., by: Gulnur Scott, M.P.A. Hanyu Ni, Ph.D. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES.
Use of Spiritual Healing Therapy in Relation to Race and Ethnicity Catherine Simile, Ph.D. and Hanyu Ni, Ph.D. Division of Health Interview Statistics.

Use of Spiritual Healing Therapy in Relation to Race and Ethnicity Catherine Simile, Ph.D. and Hanyu Ni, Ph.D. Division of Health Interview Statistics.
CHILDREN’S MENTAL HEALTH PROBLEMS IN RHODE ISLAND: THE PREVALENCE AND RISK FACTORS Hanna Kim, PhD and Samara Viner-Brown, MS Rhode Island Department of.

CHILDREN’S MENTAL HEALTH PROBLEMS IN RHODE ISLAND: THE PREVALENCE AND RISK FACTORS Hanna Kim, PhD and Samara Viner-Brown, MS Rhode Island Department of.
The rich multivariate data of the National Center for Health Statistics’ National Health Interview Survey Jane F. Gentleman, Ph.D., Director Division of.

The rich multivariate data of the National Center for Health Statistics’ National Health Interview Survey Jane F. Gentleman, Ph.D., Director Division of.
Measuring Asthma Prevalence and Severity in Children Lara Akinbami, MD Infant and Child Health Studies Branch National Center for Health Statistics.

Measuring Asthma Prevalence and Severity in Children Lara Akinbami, MD Infant and Child Health Studies Branch National Center for Health Statistics.
Asthma Prevalence in the United States National Center for Environmental Health Division of Environmental Hazards and Health Effects June 2014.

Asthma Prevalence in the United States National Center for Environmental Health Division of Environmental Hazards and Health Effects June 2014.
Methodologic Overview of Two National Data Sets Centers for Disease Control and Prevention National Center for Health Statistics Issues in Comparing Findings.

Methodologic Overview of Two National Data Sets Centers for Disease Control and Prevention National Center for Health Statistics Issues in Comparing Findings.
2014 MASSACHUSETTS HEALTH INSURANCE SURVEY KEY FINDINGS Prepared by: Laura Skopec, Sharon K. Long, and Thomas H. Dimmock, Urban Institute Susan Sherr,

2014 MASSACHUSETTS HEALTH INSURANCE SURVEY KEY FINDINGS Prepared by: Laura Skopec, Sharon K. Long, and Thomas H. Dimmock, Urban Institute Susan Sherr,
Adult Vaccination Update Walter W. Williams, M.D., M.P.H. Medical Epidemiologist, NCIRD National Adult and Influenza Immunization Summit Provider Work.

Adult Vaccination Update Walter W. Williams, M.D., M.P.H. Medical Epidemiologist, NCIRD National Adult and Influenza Immunization Summit Provider Work.
Wireless Substitution: Semiannual Estimates from the NHIS ER Program Centers for Disease Control and Prevention National Center for Health Statistics Stephen.

Wireless Substitution: Semiannual Estimates from the NHIS ER Program Centers for Disease Control and Prevention National Center for Health Statistics Stephen.
The State and Local Area Integrated Telephone Survey Presented by Marcie Cynamon Stephen Blumberg.

The State and Local Area Integrated Telephone Survey Presented by Marcie Cynamon Stephen Blumberg.
DHHS Office of Civil Rights Title VI Training Conference Philadelphia, PA August 13, 2002 Using Data to Identify Disparities: Issues, Limitations, Cautions.

DHHS Office of Civil Rights Title VI Training Conference Philadelphia, PA August 13, 2002 Using Data to Identify Disparities: Issues, Limitations, Cautions.

Similar presentations

Ads by Google