Toward a 21st Century National Data Infrastructure: Enhancing Survey Programs by Using Multiple Data Sources (2023) / Chapter Skim
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6 Data Linkage to Supplement Health Surveys
6 Data Linkage to Supplement Health Surveys
Pages 125-140
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From page 125... ...
, researchers can gain additional insights about health and diseases nationally and in population subgroups. Sections 6.1 and 6.2 review key household surveys and administrative data sources used in linkage projects by the U.S.
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From page 126... ...
Some content is included every year, including demographic information, health insurance coverage, health care access and use, chronic conditions, health-related behaviors such as diet and physical activity, and functioning and disability. Other questions are asked on a rotating schedule.2 One "sample adult" aged 18 years or older and one "sample child" aged 17 years or younger (if applicable)
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From page 127... ...
The examination component, conducted by trained medical personnel, includes laboratory tests and medical, dental, and physiological measurements. Because it measures aspects of health directly, data from the NHANES can be used to estimate the prevalence of major diseases and risk factors.
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6.2 SOURCES OF ADMINISTRATIVE DATA ON HEALTH The NCHS has a robust program linking data from its surveys with administrative data, including the National Death Index (NDI) , Social Security and Supplemental Security Income benefit records collected by the Social Security Administration (SSA)
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Using Medicare and Medicaid data together with survey data allows researchers to study some of the populations excluded from the NHIS and NHANES, such as people living in institutions. Health care needs and expenditures of nursing home residents differ from those of people of similar age who live in households or non institutional group quarters, and Medicare and Medicaid data, either alone or combined with other data sources, can provide information on the health trajectories of nursing home residents.
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From page 130... ...
estimated from CPS ASEC data that in 2021, 5 percent of all children under age 19 had no health insurance coverage, but the uninsurance rate was 8.6 percent for Hispanic children and 18.6 and 22.6 percent for foreign-born and noncitizen children, respectively. 11 An inventory of NCHS survey data already linked with administrative records can be found at https://www.cdc.gov/nchs/data/datalinkage/LinkageTable.pdf.
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From page 131... ...
listed areas in which linked data have been used in evidence-based policymaking: to study health insurance coverage and costs, to evaluate policies such as smoking-cessation programs, and to generate evidence that can be used to improve public health. She mentioned the following examples of studies that used linked NCHS data:
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From page 132... ...
In studies 4–6, information about the type of Medicare plan, health care usage, and medical costs came from the Medicare data. The health surveys also do not ask about housing assistance; that information, for studies 7–9, came from the linked HUD data.
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. In addition, some administrative records datasets include only part of the population of interest (for example, Medicare data do not have claims information on Medicare Advantage participants)
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(2017) investigated potential bias in linked NHISHUD and NHANES-HUD data by comparing estimates of housing characteristics and demographic information computed from HUD administrative files with estimates calculated from the set of linked records.
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(2017) found that even small numbers of missed links between a survey and the NDI can result in large underestimation of mortality rates for older age groups, a phenomenon they dubbed the "Methuselah effect."13 Investigating and Documenting Properties of Linked Survey Data NCHS has performed multiple investigations of the quality of linked datasets, and a perusal of their work suggests some "best practices" for investigating and documenting the quality of linked data.14 • Identify the exact datasets that were linked, with an assessment of coverage, missing data, and measurement methods.
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From page 136... ...
These linkage procedures and documentation can serve as models for other partnerships between program-oriented and federal statistical agencies. 6.5 LINKAGE OF LONGITUDINAL HEALTH SURVEYS Longitudinal datasets allow researchers to investigate the dynamics of human behavior, such as how participation in government transfer programs might relate to subsequent labor force behavior or utilization of
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From page 137... ...
Attrition in a longitudinal survey, when combined with missing administrative data and missed links, can cause the set of survey respondents having data across all time periods and for all variables of interest to be small. Issues of consent for longitudinal data linkage are also more complex (Jäckle et al., 2021a)
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From page 138... ...
Linkage to SSA records provides earnings histories, benefit histories, and application histories for disability and Supplemental Security Income of HRS participants. One of the main goals of the HRS is to understand the relationship between medical history and financial status and how health care usage changes as people age.
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From page 139... ...
. • Monetary cost of dementia, using self-reports on the HRS to esti mate out-of-pocket spending and nursing home costs, and linked Medicare claims data to identify costs paid by Medicare (Hurd et al., 2013)
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