prevalence, risk factors, functional health outcomes, clinical care information, and demographic characteristics); costs and source(s) of funding for the system; and data dissemination (i.e., online availability of data, online query, and who can obtain access).

Of the 49 requests, 35 responses were received. Information on eight additional data collection approaches was obtained through published literature and online queries (see Appendix A). The following discussion reviews the strengths and limitations of various types of data collection efforts, including surveys, registries, cohort studies, administrative and health services data, vital statistics, and data regarding hospital performance.



Routine surveys are particularly valuable surveillance tools for chronic diseases and health-related behaviors. In general, surveys are most useful for disease surveillance when they ask people about information for which they may be the most valid and reliable source (e.g., their own private behaviors, attitudes, or mental health status), or for which they can report with reasonable reliability, even if they are not the only or most valid source of information (e.g., whether he or she went to the doctor in the past month). In some cases, surveys link such self-reported data to data collected from other sources. The following sections of this chapter discuss major surveys at the national level as well as examples of state and local surveys. The discussion includes a description of the purpose of the survey, its methods, the extent to which data are collected on topics relevant to cardiovascular and chronic pulmonary diseases, and how data are disseminated. Each description includes a brief discussion of strengths and limitations.

National Population-Based Surveys

The Behavioral Risk Factors Surveillance System (BRFSS) The BRFSS, nationally coordinated by the CDC and conducted by state health departments in all 50 states and the District of Columbia, is a state-based system of cross-sectional health surveys of adults. It collects information on health risk behaviors, preventive health practices, and healthcare access, primarily related to the areas of chronic disease and injuries. The BRFSS has been the primary source of state-level population health estimates from surveys and has been available in all states since 1984. States may request information from the CDC; the information includes samples of telephone numbers with substate or local strata, an option taken by 41 states. The core questionnaire is required of all states. Data collection is funded by several sources, including state and federal agencies and private organizations. The CDC supports a portion of the data collection efforts, and the states provide their own funding for optional modules and state-added questions. Private partners also support collection of data in the different states. BRFSS data are widely used for policy development and advocacy at both the national and state levels.

The BRFSS questionnaire is administered on a continuous basis by telephone using random-digit dial sampling methods. The design consists of a probability sample of all households with telephones in the state. Survey respondents are between the ages of 18 and 99, and only one adult per household is interviewed. As part of the core survey questionnaire developed by the CDC, self-reported information is routinely collected on diagnosed health conditions, including stroke, congestive heart failure (CHF), coronary heart disease (CHD), diabetes, and asthma, but not chronic obstructive pulmonary disease (COPD). The CDC provides an optional module on COPD that states may include at their discretion (and expense). The core questionnaire also collects information on diagnosis of cardiovascular risk factors, including hypertension, diabetes, and high cholesterol. Questions on tobacco use, alcohol consumption, physical activity, nutrition, and weight status, including consumption of fruits and vegetables, are also asked. Limited data are also collected on access to, and use of, healthcare services, including preventive services.

Sociodemographic data collected include age, sex, race/ethnicity, marital status, education, employment, and household income. Most states and localities with BRFSS surveys have the ability to examine prevalence of health conditions and risk factors by major race/ethnic and income groups. Race/ethnicity is collected as Hispanic, white, black or African American, Asian, Native Hawaiian or Other Pacific Islander, and American Indian or Alaskan

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