The sources in this chapter contain data on all aspects of health and health care, including nutrition, mental health, dental care, and financial aspects of the health care system, along with data on physical illnesses from cancer to cholera. For the purposes of this book, substance abuse is also considered to be a health issue, and data sources on that topic are included in this chapter as well. Some sources for data about births and deaths are included in this chapter, but additional sources for those topics can be found in chapter 20 with other sources for demographic data.
Major Sources: United States
National Center for Health Statistics
The National Center for Health Statistics (NCHS, www.cdc.gov/nchs/), a department within the Centers for Disease Control (CDC), distributes an almost overwhelming amount of data on the health status of Americans, gathered and disseminated through many programs. The data ranges in complexity from simple statistics—say, the number of people diagnosed with whooping cough per year—published in FastStats (www.cdc.gov/nchs/fastats/), to massive raw data sets produced by the following three major ongoing survey projects:
National Health and Nutrition Examination Survey (NHANES, www.cdc.gov/nchs/nhanes.htm). For this survey, individuals are asked about many aspects of their health and wellness: the foods they eat, how much sleep they get, how frequently they exercise, the last time they saw a dentist, what kind of health insurance they have, which prescription medications they take. Individuals are also given a thorough physical examination and a panel of medical tests, including hearing tests, tests of muscle strength, and tests to screen for various diseases. NHANES, which has been conducted in various forms since the 1970s, is the most extensive of the surveys managed by NCHS.
National Health Interview Survey (NHIS, www.cdc.gov/nchs/nhis.htm). This survey asks some questions similar to those in NHANES, concerning health conditions affecting individuals, the kind of health insurance they have, their exercise habits, their access to medical and dental care, and the like. NHIS does not, however, include the same detailed information about food intake, nor does it include any kind of physical examination or medical test. It has been conducted since 1957, although data only from 1963 to present is available to researchers.
National Health Care Surveys (NHCS, www.cdc.gov/nchs/dhcs.htm). Unlike NHANES and NHIS, which gather information from consumers of health care, the surveys within NHCS gather information from providers: hospitals, primary care physicians, nursing homes, home health aides, and others. These surveys contain data about topics such as the number of doctor’s visits annually, broken down by various types of physicians and by various demographic groupings, and the reasons for doctor’s visits, which are covered by the National Ambulatory Medical Care Survey (NAMCS); the number of emergency room visits, along with characteristics of the patients (e.g., age, gender, race) and of the visit (e.g., wait times, triage status, reason for the visit), which are included in the National Hospital Ambulatory Medical Care Survey (NHAMCS); and the reasons for hospital stays and demographic information about the patients, which are the topics on the National Hospital Care Survey (NHCS; formerly the National Hospital Discharge Survey). In addition to these three ongoing surveys, the NHCS has done intermittent or one-time surveys such as the National Nursing Home Survey, the National Home and Hospice Care Survey, the National Survey of Residential Care Facilities, the National Home Health Aide Survey, and the National Nursing Assistant Survey.
NCHS also manages the National Vital Statistics System (see chapter 20) as well as several smaller surveys. These smaller surveys include the National Survey of Family Growth, which covers topics related to contraception, pregnancy, and sexuality; the National Survey of Children’s Health, which surveys parents about their children’s health insurance, health care, social and emotional development, activities, and other topics related to their children’s physical and mental health; the National Survey of Children with Special Health Care Needs, which covers similar topics but includes only children with physical or mental illnesses, disabilities (including learning disabilities), or developmental delays; and the National Immunization Survey, which gathers information about children’s immunization history along with some demographic data. A full list of the types of data collected by various NCHS programs can be found on the NCHS website (www.cdc.gov/nchs/data/factsheets/factsheet_summary.htm).
Major Sources: World
World Health Organization
The World Health Organization (for data, www.who.int/research/en/) is the major international source for data on health and health care. Much of its data is distributed through the Global Health Observatory Data Repository (http://apps.who.int/gho/data/), which contains tables of data, typically at the country level, for dozens of indicators, including the incidence of diseases such as cholera, malaria, meningitis, HIV/AIDS, and other sexually transmitted infections; indicators of the quality of the health care system, such as per-capita spending on health care and number of hospitals per 100,000 people; indicators of alcohol and tobacco usage and control, such as whether the government bans smoking in certain types of environments or limits the sale of alcohol to people over a certain age; and environmental factors that impact health, such as UV radiation exposure and air pollution levels.
Minor Sources
Demographic and Health Surveys
Demographic and Health Surveys (DHS, www.dhsprogram.com) is funded by the United States Agency for International Development (USAID) to conduct surveys about maternal and child health, including topics related to family planning, in developing countries. These surveys are a rarity in the world of data, including subnational data for developing countries (data for provinces within countries, not just for the whole country), time series (some countries have six waves of data going back to the late 1980s), and a survey approach that allows measurement of opinions, beliefs, and other factors that are not easily captured by administrative records. Raw data from the surveys is available to users who register with DHS.
Agency for Healthcare Research and Quality (U.S. Department of Health and Human Services)
In the United States, the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services, is a good source for economic data about health care (as opposed to data about medical conditions, the major focus of NCHS). It is responsible for two major data collection and dissemination projects, the Medical Expenditure Panel Survey (MEPS, http://meps.ahrq.gov/mepsweb/) and the Healthcare Cost and Utilization Project (HCUP, http://hcupnet.ahrq.gov). MEPS gathers data on the amount of money consumers and businesses spend on various types of health care and health insurance; HCUP collects information about the nature and costs of hospital visits, including emergency room visits. Data is also gathered on outpatient surgeries, but that data is not freely available.
Centers for Disease Control (U.S. Department of Health and Human Services)
The CDC has several additional data resources beyond those managed by NCHS. The Behavioral Risk Factor Surveillance System (BRFSS, www.cdc.gov/brfss/) is a long-running survey that includes questions about health conditions and behaviors that can impact health, such as eating fruits and vegetables and using seatbelts. Data from BRFSS is available both through user-friendly online databases and as microdata. The Web-based Injury Statistics Query and Reporting System (WISQARS, www.cdc.gov/injury/wisqars/index.html) disseminates detailed data about injuries of all sorts, including fatal and nonfatal injuries both accidental and intentional. The NCHHSTP Atlas (www.cdc.gov/nchhstp/atlas/), produced by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, displays state-level data on the incidence of those diseases. Many other resources can be found by searching the CDC site.
National Cancer Institute (U.S. National Institutes of Health)
One of the best sources for data and statistics about cancer is the Surveillance Epidemiology and End Results Program database (SEER, http://seer.cancer.gov), which is produced by the National Cancer Institute, part of the U.S. National Institutes of Health. Although the raw SEER data is restricted-use, extensive statistics and aggregate data are freely available. The statistics and aggregate data include information about the incidence, prevalence, survival times, and deaths from many types of cancer; this data can be broken down with a great deal of demographic and geographic precision.
Substance Abuse and Mental Health Services Administration (U.S. Department of Health and Human Services)
Another agency within the Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration (SAMHSA), publishes both aggregate data and microdata about behavioral health issues. The aggregate data, available on its website (www.samhsa.gov/data/), includes quantitative information about drug use among people 12 years and older, gathered via the National Survey on Drug Use and Health (NSDUH); statistics about drug overdoses and other drug-related events that result in deaths or emergency room visits, gathered by the Drug Abuse Warning Network (DAWN); information about facilities that provide treatment for substance abuse and the people who are treated there, gathered by the National Survey of Substance Abuse Treatment Services (N-SSATS) and the Treatment Episode Data Set (TEDS), respectively; and state-level statistics about mental health care. Microdata created by SAMHSA is available in the Substance Abuse and Mental Health Data Archive (SAMHDA, www.icpsr.umich.edu/icpsrweb/SAMHDA/), which is hosted by the Interuniversity Consortium for Political and Social Research.
Interuniversity Consortium for Political and Social Research
The Interuniversity Consortium for Political and Social Research (ICPSR) allows researchers to perform online analyses of data from several NCHS surveys, including NHANES and the National Survey of Family Growth, using Survey Description and Analysis (SDA) software. This feature is freely available, even for researchers who are not affiliated with an ICPSR member institution. Online data analysis is also available for many of the data sets in SAMHDA, NAHDAP, and NACDA, although in some cases access may be limited to ICPSR members. (See appendix B for instructions on using SDA to analyze data online.)
National Institute on Drug Abuse
The National Institute on Drug Abuse, part of the U.S. federal government and housed within the U.S. National Institutes of Health, publishes data on both drug addiction and HIV/AIDS via ICPSR. Its data archive, the National Addiction and HIV Data Archive Program (NAHDAP, www.icpsr.umich.edu/icpsrweb/NAHDAP/index.jsp), contains extensive data on the use of tobacco, alcohol, and other drugs, including drug use among teenagers, prisoners, and other specific populations. One notable survey contained in NAHDAP is “Monitoring the Future: A Continuing Study of the Lifestyles and Values of Youth,” which has surveyed high school seniors annually since 1975, and eighth-graders and tenth-graders annually since 1991. The Monitoring the Future Surveys contain questions on alcohol, drugs, smoking, crime, and sex, as well as questions about the place of religion and respondents’ parents in their lives, their goals in life, and many other topics.
National Archive of Computerized Data on Aging
Another federally sponsored, health-related data collection hosted at ICPSR is the National Archive of Computerized Data on Aging (NACDA, www.icpsr.umich.edu/icpsrweb/NACDA/), which is sponsored by the National Institute on Aging. It has some data sets on older adults in other countries as well as those in the United States. Some of the data in NACDA is available only to ICPSR subscribers, but much of it is freely available to the general public.
Dartmouth Atlas of Health Care
The Dartmouth Atlas of Health Care (www.dartmouthatlas.org) illustrates geographic disparities in health care utilization in the United States. Most of the data is available on a regional basis; some is also available at the level of counties or of specific hospitals. Available indicators, to name just a few, are average amount of Medicare reimbursements per person enrolled in Medicare, number of knee replacements performed per 1,000 people enrolled in Medicare, and number of hospital beds per 1,000 people in the region. Although the site has a clear rhetorical purpose—to argue that some areas of the country are spending too much on health care, relative to the benefits to the patients—it is still a useful and visually engaging source of data on this topic.
National Health Service (England)
In England, the National Health Service (NHS) publishes remarkably detailed data about the health care it provides through the Health and Social Care Information Centre (www.hscic.gov.uk). This data goes down to the level of individual hospitals or individual practices for some indicators, including number of prescriptions written by general practitioners for various drugs and cost for those prescriptions. Other aggregate data available at the level of individual NHS trusts includes number of emergency room visits, broken down by the patients’ genders and ages and by the information about the visit (day of the week, time of arrival, length of visit, etc.); percentage of patients receiving various tests and treatments for various types of cancer; and number of people referred for or receiving psychiatric treatment and some information about the outcome of that treatment. There is also national-level data on drinking and smoking behavior.
Other National Health Agencies
Australia and New Zealand make available substantial health statistics. The Australian Institute of Health and Welfare (AIHW, www.aihw.gov.au) has an extensive array of both statistical publications and data tables and “data cubes,” which allow for interactive, online exploration of the data. New Zealand’s Ministry of Health (www.health.govt.nz) conducts and reports on a variety of surveys, from the New Zealand Health Survey, which covers many topics related to health and health care, to more focused surveys such as the Nutrition Survey and the Oral Health Survey. Access to microdata from the Ministry of Health Surveys is restricted, but many statistics are available on the ministry’s website.