The National Health Interview Survey NHIS

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The National Health Interview Survey (NHIS)The
National Health and Nutrition Examination Survey
(NHANES)
Occupational Surveillance Systems
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1993-1995Epidemiology of Hearing Loss in
Hispanics National Institute on Deafness
Other Communication Disorders  
1995-2001 Sensory Impairment, Functional Status
and AgingNational Institute on Aging
 1998-2001Epidemiology of Visual Impairment in
Hispanic ChildrenNational Eye Institute2002-200
8 Surveillance of Morbidity and Mortality in US
Workers National Institute on Occupational
Safety Health
Prologue
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National Health Interview Survey

• National Center for Health Statistics (NCHS)
• Continuous multipurpose multistage area
  probability survey
• Sample representative of non-institutionalized US
  civilian population living at addressed dwellings
  
• Annually since 1957

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National Health Interview Survey

• Kaminski Spirtas (1980) at NIOSH
• Proportionate Morbidity Ratios (PMRs) with
  1969-74 NHIS
• Morbidity, disability, reported healthcare use
  patterns for 498,580 individuals by
  industry/occupation
• Confirmation of established results
• New Associations
• NHIS data could be used as a surveillance system
  for occupational diseases for all US workers
  recommended its use for this purpose be explored
  further

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NHIS Advantages Disadvantages

• Advantages
• Population-based NATIONAL Survey
• Select oversampling of populations of interest
• Large cross-sectional samples which can be pooled
• Trend analyses
• Mortality linkage available
• Detailed occupational/industrial codes lt1997

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NHIS Advantages Disadvantages

• Disadvantages
• Self-report
• Cross-sectional
• No individual exposure information
• Limited occupation-specific data available
• Often just currently held job

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NHIS Occupational Research Examples

• Online occupational monographs using pooled data
  from 1986-1994 1997-2004
• Morbidity
• Mortality
• Health Disparities-focused morbidity report
• Race-ethnicity, insurance status
• Available in PDF and Excel formats

http//www.rsmas.miami.edu/groups/niehs/niosh
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NHIS Occupational Research Examples

• Occupation-Specific
• Research

AJPH 2004 94 1938-1939
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NHIS Occupational Research Examples

• Screening behaviors
• health disparities

AJPH, in press
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NHIS Occupational Research Examples

• Practice guidelines
• compliance

Tobacco Control 2007 16 325-8
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NHIS Occupational Research Examples

• Trend analyses

AJPH 2005 95 1614-1622
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(No Transcript)
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NHIS Occupational Research Examples

• Trend analyses

PAHO, under review
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NHIS Occupational Research Examples

• Trend analyses

Am J Industrial Med, under review
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NHIS Occupational Research Examples

• Mortality studies

J Occupational Environmental Med JOEM 2006
48 823-832.
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NHIS Occupational Research Examples

• Morbidity ranking studies with ecologic
  classification

Am J Industrial Med (in press)
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NHIS Occupational Research Examples

• Testing of etiologic hypotheses

J of Gerontology, 2007
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National Health and Nutrition Examination Survey
http//www.famri.org/core/
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National Health and Nutrition Examination Survey

• Employs complex sampling strategy to obtain
  representative sample of the US civilian,
  non-institutionalized population.
• African Americans Mexican Americans are
  over-sampled (now all Hispanics)
• Physical examinations collection of biological
  data takes place at mobile examination centers
• Now continuously in the field data release in
  two-year blocks

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NHANES Advantages Disadvantages

• Advantages
• Population-based
• Select oversampling of populations of interest
• Comprehensive data on health status
• Exposure data available (e.g., PAHs)
• Trend analyses
• Mortality linkage available

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NHANES Advantages Disadvantages

• Disadvantages
• Limited sample sizes (2,000 workers survey
  period with complete data)
• Cross-sectional
• Limited occupation-specific data available
• Not possible to examine detailed occupational
  codes

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NHANES Occupational Research Examples

• Trend analyses

JOEM 2008 50 57-63
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NHANES Occupational Research Examples

• Exposure Studies

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NHANES Occupational Research Examples

• Association Studies

Menopause, 2008
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NHANES Occupational Research Examples

• Validation Studies

JOEM, 2008
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Conclusions

• Echoing and expanding on the conclusions of
  Kaminski Spirtas from over 25 years ago

--both the NHIS and NHANES can be valuable tools
for the ongoing surveillance of the health status
of the US worker. --the context of these ongoing
surveillance activities must focus on persistent
and growing health disparities in the US worker
population
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Morbidity and Mortality, and Health Disparities
by Industry National Institute on Occupational
Safety Health   2008-2010  
Epilogue

• Full indirect contract
• Will generate worker monographs based on NHIS
  which examine health status of workers classified
  by industry (NORA sectors)
• Strong health disparities focus

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Surveillance of Morbidity and Mortality in US
Workers National Institute on Occupational
Safety Health 2008-2012    
Epilogue

• Focus will be on the health status of youth
  workers
• Economic and quality-of-life measures to be added
• Two new datasets to be added
• National Longitudinal Survey of Youth 79
  (NLSY79)
• National Longitudinal Survey of Adolescent Health
  (Add Health)

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NORA and the Aging US WorkerNational Institute
on Occupational Safety Health 2009-2014
(undergoing 2nd review)  
Epilogue

• Focus will be on the health status of workers 65
  years and older
• Economic and quality-of-life measures to be added
• Two new datasets to be added
• Medical Expenditure Panel Survey (MEPS)
• Health and Retirement Survey (HRS)

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Questions

• http//www.rsmas.miami.edu/groups/niehs/niosh