1. Rosemarie Hirsch M.D., M.P.H.
Measuring Health Care Quality from the National Health and Nutrition Examination Survey (NHANES)
Rosemarie Hirsch M.D., M.P.H.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics

2. Presentation Topics NHANES overview
Health condition components and health care quality measures collected
Examples of healthcare quality analyses
Public data files and access

3. NHANES NHES I: 1960-62, ages 18-79 NHES II: 1963-65, ages 6-11
NHES III: , ages 12-17
NHANES I: , ages 1-74
NHANES II: , ages 6 mos.-74
HHANES: , ages 6 mos.-74
NHANES III: , ages 2 mos. and older
NHANES: 1999 and beyond, all ages

4. Current NHANES Sample Design Eligible population
Continuous data collection beginning in 1999
Annual national sample of 5,000 persons
Eligible population
Civilian, non-institutionalized population
Residents of all states and D.C.
All ages

5. NHANES – Oversampling African Americans Mexican Americans
Adolescents aged 12-19
Persons aged 60+
Pregnant women
Low-income families

6. NHANES Household Interview
Traditional CAPI interviewing with portable keyboard.

7. NHANES Household Interview
Broad range of health conditions
Environmental and occupational exposures
Health behaviors
Nutrition and dietary supplements
Prescribed medications

8. NHANES Mobile Exam Center

9. NHANES Examination Standardized physical exam
Conducted at mobile exam center
Medical & dental exams
Physiological measurements
Laboratory test
Administered by trained medical personnel

10. NHANES Mobile Exam Center

11. NHANES TOPICS Oral health Cardiovascular disease
Diabetes, lower extremity disease
Bone status, osteoporosis
Fitness, strength and functional limitation
Vision, hearing and balance
Oral health

12. NHANES TOPICS, Continued
Nutrition
Anthropometry
Mental health
Risk behaviors
Reproductive health
Environmental exposures
Infectious diseases and immunization status

13. NHANES Laboratory CBC and WBC differential Pregnancy test
Blood, urine and vaginal swab processing
76 different vials of samples
26 laboratories
300 laboratory assays

14. Landmark findings and public health results
High blood lead levels
Lead out of gasoline
Low folate levels
Mandatory food fortification
Rising levels of obesity
Public health action plan
Racial and ethnic disparities in Hepatitis B
Universal vaccination of all infants & children

15. Data Analysis Examples
Health Care Quality
Data Analysis Examples

16. Source: 2004 National Healthcare Quality Report
Ever Had Blood Cholesterol Checked: Percent of U.S. Adults Age 40+ years
Source: 2004 National Healthcare Quality Report

17. Source: 2004 National Healthcare Quality Report
Ever Told by Doctor Had High Blood Cholesterol: Percent of U.S. Adults Age 40+ years
Source: 2004 National Healthcare Quality Report

18. Source: 2004 National Healthcare Quality Report
Taking Cholesterol-lowering Medications: Percent of U.S. Adults Age 40+ years Ever Told by Doctor they had High Blood Cholesterol
Source: 2004 National Healthcare Quality Report

19. Source: 2004 National Healthcare Quality Report
Cholesterol and HgA1c Control: Percent of U.S. Adults Age 18+ years with Diagnosed Diabetes
Source: 2004 National Healthcare Quality Report

20. Percent of U.S. Adults age 20-74 years with Hypertension
Source: Health United States, 2003

21. Awareness, Treatment and Control: Percent of U. S
Awareness, Treatment and Control: Percent of U.S. Adults Age years with Hypertension
Source: JNC 7 Report, 2003

22. Health Care Quality Data for Cholesterol and Hypertension
NHES
NHANES I
NHANES II
NHANES III
NHANES
NHANES

26. NHANES Data Directly download from our website
           
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