Using NCHS Survey Data Linked to the National Death Index (NDI) for Studying Social Factors and Health Clinton J. Thompson, Ph.D., M.Stat Health Statistician OAE | NCHS | CDC AcademyHealth 2017 Annual Research Meeting June 25-27 • New Orleans, LA 1 / 20
Outline The Linked Mortality File (LMF) and the National Death Index (NDI) with data through December 31, 2015 Creation of the LMF Preliminary Snapshots of the LMF Accessing and Using the LMF 2 / 20
The LMF and the NDI 3 / 20
The LMF and the NDI NCHS links various surveys with death certificate records from the NDI. This file is known as the LMF . The soon-to-be-available restricted-use LMF includes NDI data through 12/31/2015 LMFs historically updated every 3-4 years 4 / 20
Which Surveys Link? National Health Interview Survey (NHIS) 1985-2014 Supplement on Aging (SOA) Second Longitudinal Study of Aging (LSOA II) National Health and Nutrition Examination Survey (NHANES) 1999-2014 NHANES I Epidemiologic Follow-up Survey (NHEFS) NHANES III National Nursing Home Survey (NNHS) 1985, 1995, 1997, 2004 National Home and Hospice Care Survey (NHHCS) 2007 5 / 20
What is the NDI? The NDI is a centralized database of U.S. death records gathered from states’ vital statistics offices Established to aid health & medical researchers in their research Became operational in 1981 Includes death record information for persons dying in the U.S. or a U.S. territory from 1979 onward Death records added annually Detailed information on underlying and multiple cause of death available 6 / 20
Why Use the LMF? The NDI does not have social factors and health-related information on the file The cross-sectional survey data do not have outcomes like death or cause of death The linked file allows for analyses that would not be possible with each data source alone The LMF adds a longitudinal component to the survey data 7 / 20
Creation of the LMF 8 / 20
Linkage Method Based on framework developed by Fellegi & Sunter (1969) and implemented by NCHS staff working with NDI Score assigned to reflect degree of agreement between NCHS survey submission record and NDI death record Score based on sum of weights for each data item in the record match � 1 Weight, w i , for i th field given by w i = log 2 � , where p i is p i proportion of given characteristic in population 9 / 20
Linkage Eligibility Linkage Eligibility : Requires sufficient data for all elements in one of the three combinations below: SSN, Last Name, First Name SSN, Sex, Month of Birth, Year of Birth Last Name, First Name, Month of Birth, Year of Birth Not all survey participants are eligible for linkage to the NDI but eligibility is ≥ 95% for most surveys 10 / 20
Preliminary Snapshots of the LMF with Mortality through December 31, 2015 11 / 20
Analysis Example: NHIS 2005 and the LMF — Preliminary Estimates Analysis restricted to survey participants ≥ 45y at time of survey. The estimates are weighted column percentages. Mortality Status Variable Assumed Alive Declared Deceased Age in years (grouped) 45-64 76.6% 30.8% 65-84 22.5% 54.4% 85+ 0.9% 14.8% Sex Male 45.8% 50.2% Female 54.2% 49.8% Health Status Good/Fair/Poor/Unknown 44.1% 70.7% Excellent/Very Good 55.9% 29.3% 12 / 20
through 2015 — Preliminary Estimates Declared Deceased (Unweighted %) with Mortality Deceased (%) -- Unweighted [Preliminary!] 0 10 20 30 40 NHANES III NHANES 1999-2000 NHANES 2001-2002 NHANES 2003-2004 NHANES 2005-2006 NHANES 2007-2008 NHANES 2009-2010 NHANES 2011-2012 NHANES 2013-2014 NHIS 1985 NHIS 1986 NHIS 1987 NHIS 1988 NHIS 1989 NHIS 1990 Select Surveys NHIS 1991 NHIS 1992 NHIS 1993 NHIS 1994 NHIS 1995 NHIS 1996 NHIS 1997 NHIS 1998 NHIS 1999 NHIS 2000 NHIS 2001 NHIS 2002 NHIS 2003 NHIS 2004 NHIS 2005 NHIS 2006 NHIS 2007 NHIS 2008 NHIS 2009 NHIS 2010 NHIS 2011 NHIS 2012 NHIS 2013 NHIS 2014 13 / 20
Ten Leading Causes of Death: Unweighted Counts for Select Surveys — Preliminary Estimates Aggregated Number of Leading Causes of Death for Select Surveys Intentional self−harm (suicide) Nephritis (kidney disease) Leading 10 Causes of Death Influenza and pneumonia Unweighted Count <=150 Diabetes mellitus 151−300 Alzheimer's disease 301−500 501−1,000 Cerebrovascular diseases (stroke) 1,001−2,000 Accidents 2,001−5,000 5,001−15,000 Chronic lower respiratory disease Malignant neoplasms Diseases of heart 4 4 0 1 0 0 2 2 − S 5 I H 0 0 N 2 S I H N Select Surveys Leading CODs based on NCHS Data Brief, No. 267 (National Vital Statistics System, Mortality) 14 / 20
Accessing and Using the LMF 15 / 20
Restricted-Use vs. Public-Use • Currently Available: Follow-up through 2011 • Updated Release: Restricted-Use ⇒ Summer 2017; Public-Use ⇒ 2018 File Details Restricted-Use Public-Use Dates Detailed date of death, birth Date of death represented by date, and interview date quarter/year of death or follow- up time, no birth date or inter- view date Cause of death Detailed underlying (UCOD) and Top 10 UCOD and 3 MCOD indi- multiple cause of death (MCOD) cators: Diabetes, Hypertension, information and Hip Fracture Participants Both adults and children Only adults Perturbed data on No perturbation Perturbed information: cause of death death for select decedents (vital status is not perturbed for any participants) 16 / 20
Where Do I Begin? Visit the NDI mortality data pages of the data linkage website: http://www.cdc.gov/nchs/data-linkage/mortality.htm 17 / 20
Previous Analyses Using the LMF 18 / 20
Summary The LMF provides opportunities for new research concerning health, social factors, and methodological questions Designed to maximize the scientific value of the NCHS population-based surveys Efficient means to add information The public-use LMF is available online but the restricted-use LMF must be accessed through the RDC ( https://www.cdc.gov/rdc/index.htm ) An updated restricted-use LMF with mortality follow-up through 2015 is expected this summer 19 / 20
?!? Questions? Comments? Thank you! Email Contact: cjthompson1@cdc.gov Many thanks to the SPB Linkage Mortality Team: Jim Brittain | Eileen Call | Adam Fedorowicz | Cordell Golden | Dedun Ingram | Patsy Lloyd | Lisa Mirel | Sam Peng | Jennifer Sayers | Yu Sun | Keith Zevallos | Cindy Zhang 20 / 20
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