1. Accessing and Using NCHS Data: An Overview and Demonstration of NCHS Data Access Tools 2006 NCHS Data Users Conference Hands-On Session 66 July 12, 2006 Ann Aikin

2. FASTATS A – Z Reports, such as Health, U.S. and Advanced Data Data Warehouse Data Highlights Health E-Stats Accessing NCHS Data: Let Me Count the Ways… Beyond 20/20 Tables: Health Data for All Ages and Trends in Health and Aging Healthy People DATA 2010 CDC WONDER WISQARS Combined Health Data Sources

3. Accessing Data Sets (public use): Accessing NCHS Data: Let Me Count the Ways… ASCII Data Sets (complete public use file) SETS (complete public use file, with documentation and software to access files) Data Resource Center for Child and Adolescent Health Online Query Tool (data from two SLAITS surveys--National Survey of Children with Special Health Care Needs and National Survey of Children's Health) Research Data Center (a fee-based service that provides access to confidential data and data access for those needing assistance)

4. Information to Help Access Data Listservs NCHS Definitions NCHS Survey Measures Catalog: Children and Adolescent Mental Health Coming Soon! Ambulatory Care Drug Database System Technical Reports and Data Documentation! Other Published Reports, such as Series Reports… Accessing NCHS Data: Let Me Count the Ways…

5. Overview of NCHS Data Access Tools ToolEaseLevel Available Beyond 20/20  Health Data for All Ages, Trends in Health and Aging CDC Wonder  Mortality, Natality DATA2010  Healthy People Objectives WISQARS  Injury Data Child and Adolescent Health Online Query Tool  National Survey of Children's Health, National Survey of Children with Special Health Care Needs SETS  Selected NCHS sets: Over 80 Available!

6. Health Insurance Coverage To provide a complete picture of the uninsured population, the National Health Interview Survey (NHIS) tracks: persons who currently lack coverage; persons uninsured at any time in the previous year; persons who have experienced lack of coverage for more than a year. Health care surveys also report health insurance measures, such as the National Ambulatory Care Survey (NAMCS), which reports expected source of payment from doctor visits.

7. Health Insurance Coverage: From the NHIS—Lack of Coverage Data are released from NHIS  In ASCII (raw data files)  On the Internet, as an Early Release  In publications (forthcoming)  In Data2010, as a Healthy People 2010 Objective  In a customizable table on the Health Data for All Ages site (update to 2004 forthcoming)  Other sources, such as Health, United States, FASTSTATS etc…

8. NHIS Early Release: Percentage of persons of all ages without health insurance coverage at the time of interview: United States, 1997–2005 From: Early Release of Selected Estimates Based on Data From the 2005 National Health Interview Survey, Lack of health insurance coverage and type of coverage, Figure 1.1. http://www.cdc.gov/nchs/data/nhis/earlyrelease/200606_01.pdf

9. Health Insurance Coverage: NHIS data in Health, U.S.

10. Health Data for All Ages also provides health insurance statistics In this pretabulated table, NHIS data years are combined to make the statistics more reliable and more useful for breakdowns by age, sex, race/ethnicity and geography.

11. Health Insurance…Expected Source of Payment from Health Care Surveys Data are released from the health care surveys  In ASCII (raw data files)  On the Internet, as a Health E Stat  In publications, such as Advanced Data  Other sources, such as Trends in Health and Aging, Health, United States, FASTSTATS etc…

12. Health E-Stat Release of Doctor Visit Data: Percent Distribution of Ambulatory Care Visits by Setting Type, According to Expected Source of Payment, 2004 From: Health E-Stat, “Ambulatory Medical Care Utilization Estimates for 2004” Accessed on July 1, 2006.

13. Prescription Drug Use Prescription drug use is in the rise in America… In 1999-2002, 45 percent of Americans used a prescription drug in the last month, while 18 percent used three or more; and use among seniors is much higher.

14. NCHS Statistics on Prescription Drugs To find out more about drug use in America, we will use the following data tools: National Survey of Children’s Health Data Resource Tool to find statistics on children’s use of prescription drugs Trends in Health and Aging to find statistics on the distribution of drug mentions in doctor offices Ambulatory Care Drug Database System to find the number of drug mentions for a specific drug WISCARS to find the number of drug-related adverse effect deaths

15. Prescription Drug Use in SLAITS National Survey of Children’s Health

16. Child and Adolescent Health Measurement Initiative (2005). National Survey of Children’s Health, Data Resource Center on Child and Adolescent Health website. Retrieved 06/30/2006 from www.nschdata.org.www.nschdata.org

17. Prescription Drug Use in SLAITS National Survey of Children’s Health

18. Distribution of Drug Mentions … by Patient's Age, Sex, and Race. United States, Selected Years, 1989-2002. NAMCS, NHCS (NAD02a) Centers for Disease Control and Prevention. National Center for Health Statistics. Trends in Health and Aging. http://www.cdc.gov/nchs/hdi.htm. June 30, 2006.http://www.cdc.gov/nchs/hdi.htm

19. Using WISQARS for Adverse Drug Deaths (Fatal Injuries) Statistics Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). June 30, 2006. Available from URL: www.cdc.gov/ncipc/wisqars. www.cdc.gov/ncipc/wisqars

20. Using WISQARS for Adverse Drug Deaths (Fatal Injuries) Statistics Step 1: For our example, we will choose “All Intents”

21. Using WISQARS for Adverse Drug Deaths (Fatal Injuries) Statistics Step 2: For our example, we will choose “Drugs, adverse effects” in the Adverse Effects injury category

22. Using WISQARS for Adverse Drug Deaths (Fatal Injuries) Statistics Step 3: For our example, we will choose the default settings for geography, race, Hispanic origin, sex and Output Options. For years, we will choose “1999 to 2003.”

23. Using WISQARS for Adverse Drug Deaths (Fatal Injuries) Statistics Steps 4 and 5: Under Advanced Options, we will select the age groups “20-24 and 60-64” and we will leave the age- adjusted default to the year 2000. We will also select output group 1 to “Age Group”

24. Using WISQARS for Adverse Drug Deaths (Fatal Injuries) Statistics Output Table:

25. Using the Ambulatory Care Drug Database System to Find the Number of Drug Mentions for a Specific Drug

26. Using the Ambulatory Care Drug Database System to Find the Number of Drug Mentions for a Specific Drug- LOPRESSOR, a Beta Blocker Used by Heart Patients Step 1: Type in the name of the drug in the drug name box. Step 2: You can also select the 2- digit) NDC Class Category 05 and the Prescription Status of Prescription Drug. Step 3: Select the Search Database button.

27. Using the Ambulatory Care Drug Database System to Find the Number of Drug Mentions for a Specific Drug- LOPRESSOR, a Beta Blocker Used by Heart Patients In 2004, there were over 4 million drug mentions for Lopressor. If you click any of the highlighted words, you will bring up the drug characteristics information.

28. Using the Ambulatory Care Drug Database System to Find the Number of Drug Mentions for a Specific Drug- LOPRESSOR, a Beta Blocker Used by Heart Patients

29. Using CDC Wonder to Create Parkinson’s Disease Table

30. Step 1 For this example, we will leave the defaults for area, population, and years

31. Using CDC Wonder to Create Parkinson’s Disease Table Step 2 Click the box to age-adjust to year 2000. Please note WONDER provides more information on age-adjustment.

32. Using CDC Wonder to Create Parkinson’s Disease Table Step 3: Selecting Cause of Death Type in “Parkinson” and hit the Keyword Search button. Select the Keyword Search button and

33. Using CDC Wonder to Create Parkinson’s Disease Table Step 3: Selecting Cause of Death Select G20 and G21, per NVSR 54 #13 Table 9, page 29, the codes used for Parkinson’s Disease. Hit the “Move Individual Codes” button.

34. Using CDC Wonder to Create Parkinson’s Disease Table Steps 4 and 5 In step 4, summarize the data by ‘Year” and keep the defaults for step 5.

35. Using CDC Wonder to Create Parkinson’s Disease Table Output table:

36. Cesarean Delivery Statistics: Healthy People Objectives, Health Data for All Ages, and SETS Lowering the cesarean rate in the United States has been a goal for the past 25 years. Separate objectives were formulated for low-risk women giving birth for the first time (a subset of all women having a first birth) and for low- risk women who had a prior cesarean birth. The objectives set a target of 15 percent for cesarean delivery and 63 percent for repeat cesarean delivery. From: National Vital Statistics Reports, Vol. 54, No. 4, September 22, 2005, Table 1. Cesarean rates for first births to low- risk women by age and race and Hispanic origin of mother: United States… page 6.

37. Healthy People Objectives-- Cesarean Delivery Step 1: Type in “cesarean” in the keyword box and the button. The Healthy People Objectives with the word “cesarean” will appear in the objective box below. In this case, there were two objectives with cesarean: Objective 16-09a and 16-09b.

38. Healthy People Objectives-- Cesarean Delivery Step 2: Choose the Submit button and the 16-09a table with the base line year and percent, the data years 1998-2005 and the 2010 target will appear.

39. Health Data for All Ages produces a table on cesarean rates for low-risk women

40. Customizing the Cesarean Deliveries Table for To Show Only Prior Cesarean Deliveries Step 1: Click on the Cesarean cell. Step 2: Deselect the default selections by choosing the button. Select “Prior Cesarean” from the list. Choose the table button and the table will only show prior cesarean deliveries.

41. Customizing for Specific Locations Step 3: To further customize the table, I would only like to look at Maryland, Washington DC, and Virginia. To do this, you need to select Location, deselect the defaults, and check the appropriate boxes for the locations I want to view. Select the table icon again to view your selections.

42. Looking at Race and Ethnicity Step 4: To look at specific race and ethnicity, we want to further customize our table view. To do this, we need to physically drag and drop the Race/Ethnicity cell into the Cesarean cell. (The Cesarean cell the moves to the old position). Move the cells so the order is Maternal Age, Race/Ethnicity, Location.

43. Prior Cesarean Delivery among Low- Risk Women in Maryland, the District of Columbia, and Virginia by Race and Ethnicity for All Ages

44. These data can also be charted or exported. To chart, select the chart button and then the printer friendly button.

45. Using SETS to Create a Cesarean Delivery Table To match estimates published in our reports, such as the Trends in Cesarean Rates for First Births and Repeat Cesarean Rates for Low-Risk Women: United States, 1990- 2003. Trends in Cesarean Rates for First Births and Repeat Cesarean Rates for Low-Risk Women: United States, 1990- 2003 From: National Vital Statistics Reports, Vol. 54, No. 4, September 22, 2005, Table 1. Cesarean rates for first births to low- risk women by age and race and Hispanic origin of mother: United States… page 6.

46. Using SETS to Create a Cesarean Delivery Table—Getting Started Step 2: Choose the correct drive, and the NCHS folder. Step 3: Choose the Nata2003 file. Step 4: Accept the usage requirements. Step 1: Open the SETS folder and the SETS Interface.

47. Using SETS to Create a Cesarean Delivery Table—Getting Started Step 3: From the menu, go to Table and Assist. Step 2: Choose the 2003 Natality File in the Data Folder…and Tabulate data. Step 1: Go to file, and select Open, and Set.

48. Using SETS to Create a Cesarean Delivery Table– Selecting only U.S. Born Residents 1. Go to Records and the choose Select. Click Assist. 2. Double click on the empty Field box. Add choose 4. Choose RESTATUS (Resident Status) from the list and Select. Choose the =! Operator from the pull down list and double click on the Code box and choose 4 (FOREIGN RESIDENTS). 3. Type “foreign” in the search box and choose OK. 5. Go back to the list of Field boxes…

49. Using SETS to Create a Cesarean Delivery Table– Selecting only Low Risk Pregnancies full-term pregnancy (at least 37 completed weeks of gestation RGEST3=, or “37 Weeks and over”), singleton pregnancy (not a multiple pregnancy ), safe fetal presentation (head in a downward position in the birth canal). 6. To look at only low risk pregnancy, we need to select the our records: Please note: RESTATUS =! 4 was selected previously. We also need to select “Detailed Total Birth Order” or RTBO = 01 (first birth) to recreate the Table 1 in the report, which only includes first births. 7. Accept the record selection and choose Select, when prompted.

50. Using SETS to Create a Cesarean Delivery Table- Recoding a Field To create the age groups used in the table, we need to create a recode in SETS. To do this: 1.Go to Recodes and Create. 2.Type in the file name of your recode and save to your hard drive (c) and go to Recode and Assist. 3.Double click on the Based on field box, and 4.Type in age and choose OK. Choose RMAGE9, or Age of Mother Recode 9 and choose the Select button.

51. Using SETS to Create a Cesarean Delivery Table- Creating a Recode 1.Type in a new recode name, and double click the first codes box (agerecode). 2.Choose codes 1 and 2 and Select. Type in an optional category label, such as, “Under age 20 years.” 3.Double click on the second code box and choose code 3. 4. Continue this process until you’ve created 6 categories to match the ones in the publication.

52. Using SETS to Create a Cesarean Delivery Table- Creating a Recode 5.Go to Recodes and select Attach. 6. Your age recode will now show up in the fields and recodes list.

53. Using SETS to Create a Cesarean Delivery Table Step 1: Go to Table and Assist. This brings up the Table Assistance template. Step 2: Select your age recode and the RDELMTH field by highlighting it and selecting the Add button. So they appear in the Table fields box to the right.

54. Using SETS to Create a Cesarean Delivery Table Step 3. Go to the Nesting options table (2), leave the defaults and go to table 3, Generate Statements. Step 4. Choose the Generate button and go to the Begin tabulation table (4). Select the Begin button.

55. Using SETS to Create a Cesarean Delivery Table The table from SETS matches the table produced in the NVSR report!

56. Using SETS to Create a Cesarean Delivery Table with our Age Recode How would you create this table in SETS?

57. In SETS, you can also browse the data….

58. or chart and export your data

59. or create and edit your own data sets using the SETS Designer Kit and Editor For more information, please see www.cdc.gov/nchs/sets.htm

60. Now It’s Your Turn! Can You…. Find the age-adjusted rate for Drug-Induced Deaths (Healthy People Objective, 26-03) Using DATA2010, create a table for Healthy People Objective 26-03 for the District of ColumbiaDATA2010

61. Now It’s Your Turn! Can You…. Can you find the percent of children (ages 0-17) uninsured in two parent households and mother- only households for the District of Columbia and the US using the Data Resource Center’s National Survey of Children’s Health?Data Resource Center’s National Survey of Children’s Health Hint: Select Healthy People 2010 Goals, and Goal #1 (Access to Quality Health Services). Then choose Objective 1-1 (% of children uninsured)

62. Now It’s Your Turn! Can You…. Find the death rate for Parkinson’s disease? Using Trends in Health and Aging, chart the trends in death rates from 1981-2003. Can you also customize the chart so it shows the trends by sex?Trends in Health and Aging Hint: go to the mortality folder, and choose the second table, Death Rates by Age, Sex, Race, and Underlying Cause. United States, 1981-2003 (NMR03a)

63. Now It’s Your Turn! Can You…. Find the number of vaginal births in the District of Columbia for 2003? For extra credit…can you tell me how many of primary c-sections in DC there were in 2003? What about the total number of births to white and black mothers in DC in 2003? Hints: To create this table, you will need to use the field “STRESEXP” or expanded State of Residence. Don’t forget to exclude foreign residents before you create the table! When you go to create the table, you will want to run a table using the field “RDELMTH” or the method of delivery recode.

64. Contact Information Ann Aikin (NCHS Data Tools Specialist) aia3@cdc.gov 301-458-4069 Avay Dolberry (SETS Specialist) ADolberry@cdc.gov 919.541.2700 aia3@cdc.gov ADolberry@cdc.gov Phyllis Chappell (Beyond 20/20 Specialist) PChappell@cdc.gov 919.541.4466 Connie Banks (Beyond 20/20 and SETS Specialist) CBanks@cdc.gov 919.541.3624 PChappell@cdc.gov CBanks@cdc.gov Susan Temple (Beyond 20/20 and SETS Specialist) STemple@cdc.gov 919.541.4923 STemple@cdc.gov