Survey Data from the Centers for Disease Control and Prevention - PowerPoint PPT Presentation

Survey Data from the Centers for Disease Control and Prevention – Oversampling of Asians Judith A. McDivitt, Ph.D. 2014 AANHPI Diabetes Coalition Conference May 2, 2014 National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation www.cdc.gov/diabetes

Datasets ❑ National Health and Nutrition Examination Survey ❑ National Health Interview Survey

National Health and Nutrition Examination Survey (NHANES) ❑ Assess health and nutritional status of adults and children in U.S. ❑ Home interviews -- demographic, socioeconomic, dietary, health-related questions ❑ Physical examinations in mobile centers – medical, dental, physiological measurements, including: ▪ Blood pressure ▪ Cholesterol – total, HDL, LDL ▪ Glucose ▪ Glucohemoglobin (HbA1c) ▪ Oral glucose tolerance (morning exams only)

Sampling Process ❑ Nationally representative sample of about 5000 people each year (civilian, non-institutionalized) ▪ Oversampling of people 60+, African Americans, Asians, and Hispanics ❑ 4-stage process to select: ▪ Primary sampling units (PSUs -- counties or small groups of contiguous counties) – 15 each year ▪ Segments within PSUs that constitute a block or group of blocks containing a cluster of households ▪ Specific households within segments ▪ Individuals within a household

Sampling Within Households ❑ List all people in household ❑ Identify any who consider selves Hispanic or Latino ❑ Identify those who consider selves: ▪ American Indian or Alaskan Native ▪ Asian ▪ Black or African American ▪ Native Hawaiian or Pacific Islander ▪ White ▪ Other ❑ Apply sampling algorithm at each step

Facilitating Asian Over-sampling ❑ Survey materials translated into Mandarin Chinese (traditional and simplified), Korean, and Vietnamese. ❑ Recorded and written translations posted on NHANES participants’ web page ❑ Short video on what is involved ▪ Available in Mandarin, Korean, Vietnamese, and Hindi ❑ Cultural competency training of staff ❑ Local interpreters when necessary and translated glossaries of terms, hand cards, and exam scripts

Oversampling of Asians ❑ Data released in 2-year cycles ❑ 2011-2012 ▪ Total -- 9,756 adults completed the interview and 9,338 were examined. ▪ 754 Asians adults completed interview • About 332 examined in morning and had fasted • 77 had diabetes ❑ Need at least 4 years of data for acceptable reliability for detailed analyses of Asian sample ▪ 2011-2014 will include about 1500 Asians

Demographic characteristics of Asian and non- Hispanic white adults in U.S.: NHANES 2011– 2012

Prevalence of High BMI among Asian adults in U.S.: NHANES 2011–2012

Prevalence of hypertension among Asian adults in U.S.: NHANES, 2011–2012

Prevalence of measured high total cholesterol among Asian adults in U.S.: NHANES 2011– 2012

Prevalence of measured low HDL cholesterol among Asian adults in U.S.: NHANES 2011– 2012

Issues ❑ High % of foreign-born people in sample versus Census ❑ BMI cut points for Asians not used ▪ Will do when have 4 years of data ❑ Difference in low HDL between men and women

Diabetes Brief Coming Soon ❑ Total prevalence of diabetes (self reported diagnosis, diabetes based on fasting glucose level or A1c) ❑ Undiagnosed diabetes (based on FPG or A1c among those who do not self report) ❑ Type of diabetes treatment reported by those with self reported diabetes ❑ A1c levels among those with self report of diabetes

How to Access the NHANES Database ❑ Most data publicly available ❑ Main NHANES page http://www.cdc. gov/nchs/nhanes.htm http://www.cdc. gov/nchs/nhanes.htm ❑ 2011-2012 data page http://wwwn.cdc. gov/nchs/nhanes/search/nhanes11_12.aspx

National Health Interview Survey (NHIS) ❑ Cross-sectional household in-person interview – household and family, 1 adult, 1 child ▪ 2011 – 39,509 households and 33,014 individual adults ❑ Done yearly ❑ Continuous data collection ❑ Core questions ▪ Household -- demographics ▪ Family -- health status and limitations, injuries, healthcare access and use, health insurance, income and assets ▪ Selected adult and child -- health status (diabetes and prediabetes), health care services, health behaviors

Sampling Process ❑ 4 -stage process ▪ Sample of 428 PSUs (county, small group of contiguous counties, or metropolitan statistical area) across 50 states and DC ▪ Within a PSU -- sample smaller geographic segments (with up to 16 addresses) ▪ Select households ▪ Select 1 parent, 1 child (if present)

Oversampling of Asians ❑ Started in 1996 ❑ Two methods ▪ Stage 2 -- select geographic segments with higher # Asians at a higher rate ▪ Stage 3 – screen for Asians in selecting households

Diagnosed Diabetes in U.S. by Race and Sex: NHIS 1980–2011

2011 Sample of Asians ❑ Total Asian - 7569 ▪ Asian Indian – 1297 ▪ Chinese – 1509 ▪ Filipino – 1689

Demographics (Preliminary) ❑ Male - 47% Female - 53% ❑ Age ▪ 18-44 – 56% ▪ 45-64 – 32% ▪ 65-74 – 8% ▪ 75+ - 4% ❑ Education ▪ Less than high school – 13% ▪ Completed high school – 19% ▪ More than high school – 66%

Diagnosed Diabetes in U.S. by Age, Race and Sex: NHIS 2011

How to Access the NHIS Databases ❑ Most data publicly available (up to 2012) ❑ Main NHIS page http://www.cdc.gov/nchs/nhis.htm ❑ Page where can access data sets and documentation http://www.cdc. gov/nchs/nhis/quest_data_related_1997_forward.htm

Good News! ❑ 2014 Native Hawaiian and Pacific Islander NHIS ▪ Select 4000 additional households with 1+ NHPI residents ▪ Nationally-representative sample from all 50 states and DC ▪ Collected by Census Bureau interviewers with training on NHPI cultural sensitivity and awareness ▪ Public use data file available mid-2015

THANK YOU!

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation