National Center for Health Statistics' 2019 Research and Development Survey, RANDS 3.

Objective This report on the third round of the Research and Development Survey (RANDS 3) provides a general description of RANDS 3 and presents percentage estimates of selected demographic and health-related variables from the overall sample and by one set of experimental groups embedded in the survey. Statistical tests comparing estimates for the two randomized groups were conducted to evaluate the randomization. Methods NORC at the University of Chicago conducted RANDS 3 for the National Center of Health Statistics in 2019 using its AmeriSpeak Panel in web-only mode. To assess question-response patterns, probe questions and four sets of experiments were embedded in RANDS 3, with panelists randomized into two groups for each set of experiments. Participants in each group received questions with differences in wording, question-andresponse formats, or question order. Results Of the 4,255 people sampled, 2,646 completed RANDS 3 for a completion rate of 62.2% and a weighted cumulative response rate of 18.1%. Iterative raking was performed using demographic and selected health condition variables to calibrate the RANDS 3 sample to 2019 National Health Interview Survey (NHIS) estimates. As a result, the overall demographic distribution and percentages of asthma, diabetes, hypertension, and high cholesterol for the calibrated RANDS 3 sample aligned with the percentages estimated from the 2019 NHIS. The distributions of demographic and healthrelated variables were comparable between the two randomized groups examined except for ever-diagnosed hypertension. Conclusion As part of a research series using probability-based survey panels, RANDS 3 included health-related questions with a focus on disability and opioids. Because RANDS is an ongoing research platform, a variety of persistent and emergent research questions relating to survey methodology will continue to be examined in current and future rounds of RANDS.

Prevalence of Alzheimer's disease dementia in the 50 US states and 3142 counties: A population estimate using the 2020 bridged-race postcensal from the National Center for Health Statistics.

INTRODUCTION: This study estimates the prevalence and number of people living with Alzheimer's disease (AD) dementia in 50 US states and 3142 counties. METHODS: We used cognitive data from the Chicago Health and Aging Project, a population-based study, and combined it with the National Center for Health Statistics 2020 bridged-race population estimates to determine the prevalence of AD in adults ≥65 years. RESULTS: A higher prevalence of AD was estimated in the east and southeastern regions of the United States, with the highest in Maryland (12.9%), New York (12.7%), and Mississippi (12.5%). US states with the highest number of people with AD were California, Florida, and Texas. Among larger counties, those with the highest prevalence of AD were Miami-Dade County in Florida, Baltimore city in Maryland, and Bronx County in New York. DISCUSSION: The state- and county-specific estimates could help public health officials develop region-specific strategies for caring for people with AD.

A Comparison of the Mortality Experience of U.S. Adults Estimated With the 2006-2018 National Health Interview Survey Linked Mortality Files and the Annual U.S. Life Tables.

Objective-Linking data is a powerful mechanism to provide policy-relevant information. The National Center for Health Statistics' Data Linkage Program produces linked mortality files (LMFs) for research by linking data from the National Center for Health Statistics' surveys, including the National Health Interview Survey (NHIS), to mortality data from the National Death Index. Assessing the accuracy of the linked data is an important step in ensuring its analytic use. This report compares the cumulative survival probabilities estimated with the 2006-2018 NHIS LMFs to those from the annual U.S. life tables.

Calibration Weighting Methods for the National Center for Health Statistics Research and Development Survey.

Objectives The Research and Development Survey (RANDS) is a series of web-based, commercial panel surveys that have been conducted by the National Center for Health Statistics (NCHS) since 2015. RANDS was designed for methodological research purposes,including supplementing NCHS' evaluation of surveys and questionnaires to detect measurement error, and exploring methods to integrate data from commercial survey panels with high-quality data collections to improve survey estimation. The latter goal of improving survey estimation is in response to limitations of web surveys, including coverage and nonresponse bias. To address the potential bias in estimates from RANDS,NCHS has investigated various calibration weighting methods to adjust the RANDS panel weights using one of NCHS' national household surveys, the National Health Interview Survey. This report describes calibration weighting methods and the approaches used to calibrate weights in web-based panel surveys at NCHS.

Evaluation of the National Center for Health Statistics Data Presentation Standards for Rates From Vital Statistics and Sample Surveys.

For the CIs used in the Standards for rates from vital statistics and complex health surveys, this report evaluates coverage probability, relative width, and the resulting percentage of rates flagged as statistically unreliable when compared with previously used standards. Additionally, the report assesses the impact of design effects and the denominator's sampling variability, when applicable.

Overview of the 2019 National Health Interview Survey Questionnaire Redesign.

Data System. Federal health surveys, like the National Health Interview Survey (NHIS), represent important surveillance mechanisms for collecting timely, representative data that can be used to monitor the health and health care of the US population. Data Collection/Processing. Conducted by the National Center for Health Statistics (NCHS), NHIS uses an address-based, complex clustered sample of housing units, yielding data representative of the civilian noninstitutionalized US population. Survey redesigns that reduce survey length and eliminate proxy reporting may reduce respondent burden and increase participation. Such were goals in 2019, when NCHS implemented a redesigned NHIS questionnaire that also focused on topics most relevant and appropriate for surveillance of child and adult health. Data Analysis/Dissemination. Public-use microdata files and selected health estimates and detailed documentation are released online annually. Public Health Implications. Declining response rates may lead to biased estimates and weaken users' ability to make valid conclusions from the data, hindering public health efforts. The 2019 NHIS questionnaire redesign was associated with improvements in the survey's response rate, declines in respondent burden, and increases in data quality and survey relevancy. (Am J Public Health. 2023;113(4):408-415. https://doi.org/10.2105/AJPH.2022.307197).

Propensity-score Adjusted Estimates for Selected Health Outcomes From the Research and Development Survey.

To evaluate the quality of web surveys, the National Center for Health Statistics' Division of Research and Methodology has been conducting a series of studies with survey data from commercially recruited panels,referred to as the Research and Development Survey (RANDS). This report describes the propensity-score adjusted estimates from the second round of RANDS (RANDS 2) using the 2016 National Health Interview Survey (NHIS).

Guidance for Selecting Model Options in the National Cancer Institute Joinpoint Regression Software.

The purpose of this report is to provide guidance to users of NCHS data in the selection of modeling options when using the NCI Joinpoint regression software to analyze trends. This report complements another report, "National Center for Health Statistics Guidelines for Analysis of Trends." Considerations are presented for selecting the modeling options, with examples illustrating the choices. The tradeoffs and consequences of choosing the various modeling options using data from NCHS data systems are discussed.encounters.

Sexual Orientation Differences in Access to Care and Health Status, Behaviors, and Beliefs: Findings from the National Health and Nutrition Examination Survey, National Survey of Family Growth, and National Health Interview Survey.

Objective-This report demonstrates use of three National Center for Health Statistics (NCHS) data systems to study differences in health by sexual orientation. Sexual orientation differences in a broad selection of health indicators were examined using the National Health and Nutrition Examination Survey (NHANES), National Survey of Family Growth (NSFG), and National Health Interview Survey (NHIS).

National Health Interview Survey, COVID-19, and Online Data Collection Platforms: Adaptations, Tradeoffs, and New Directions.

High-quality data are accurate, relevant, and timely. Large national health surveys have always balanced the implementation of these quality dimensions to meet the needs of diverse users. The COVID-19 pandemic shifted these balances, with both disrupted survey operations and a critical need for relevant and timely health data for decision-making. The National Health Interview Survey (NHIS) responded to these challenges with several operational changes to continue production in 2020. However, data files from the 2020 NHIS were not expected to be publicly available until fall 2021. To fill the gap, the National Center for Health Statistics (NCHS) turned to 2 online data collection platforms-the Census Bureau's Household Pulse Survey (HPS) and the NCHS Research and Development Survey (RANDS)-to collect COVID-19‒related data more quickly. This article describes the adaptations of NHIS and the use of HPS and RANDS during the pandemic in the context of the recently released Framework for Data Quality from the Federal Committee on Statistical Methodology. (Am J Public Health. 2021;111(12):2167-2175. https://doi.org/10.2105/AJPH.2021.306516).

Homicide During Pregnancy and the Postpartum Period in the United States, 2018-2019.

OBJECTIVE: To estimate the national pregnancy-associated homicide mortality ratio, characterize pregnancy-associated homicide victims, and compare the risk of homicide in the perinatal period (pregnancy and up to 1 year postpartum) with risk among nonpregnant, nonpostpartum females aged 10-44 years. METHODS: Data from the National Center for Health Statistics 2018 and 2019 mortality files were used to identify all female decedents aged 10-44 in the United States. These data were used to estimate 2-year pregnancy-associated homicide mortality ratios (deaths/100,000 live births) for comparison with homicide mortality among nonpregnant, nonpostpartum females (deaths/100,000 population) and to mortality ratios for direct maternal causes of death. We compared characteristics and estimated homicide mortality rate ratios and 95% CIs between pregnant or postpartum and nonpregnant, nonpostpartum victims for the total population and with stratification by race and ethnicity and age. RESULTS: There were 3.62 homicides per 100,000 live births among females who were pregnant or within 1 year postpartum, 16% higher than homicide prevalence among nonpregnant and nonpostpartum females of reproductive age (3.12 deaths/100,000 population, P<.05). Homicide during pregnancy or within 42 days of the end of pregnancy exceeded all the leading causes of maternal mortality by more than twofold. Pregnancy was associated with a significantly elevated homicide risk in the Black population and among girls and younger women (age 10-24 years) across racial and ethnic subgroups. CONCLUSION: Homicide is a leading cause of death during pregnancy and the postpartum period in the United States. Pregnancy and the postpartum period are times of elevated risk for homicide among all females of reproductive age.

A Revised ICD-10-CM Surveillance Case Definition for Injury-related Emergency Department Visits.

Background-Administrative data from medical claims are often used for injury surveillance. Effective October 1, 2015, hospitals covered by the Health Insurance Portability and Accountability Act were required to use the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) to report medical information in administrative data. In 2017, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed ICD-10-CM surveillance case definition for injuryrelated emergency department (ED) visits. At the time, ICD-10-CM coded data were not available for testing. When data became available, NCHS and NCIPC collaborated with the Council of State and Territorial Epidemiologists and epidemiologists from state and local health departments to test and update the proposed definition. This report summarizes the results and presents the 2021 revised ICD-10-CM surveillance case definition.

Anthropometric Reference Data for Children and Adults: United States, 2015-2018.

Based on nationally representative anthropometric data, the National Center for Health Statistics (NCHS) has published reference tables on the distribution of various body measurements for the U.S. population (1-5). National Health and Nutrition Examination Survey (NHANES) data are the primary source of body measurement information for the U.S. population. These measurements reflect the mean weight, height, length, and various circumferences of U.S. children and adults. Anthropometry is a measure of nutritional or general health status, dietary adequacy, and growth. This report presents anthropometric reference data from the years 2015-2018 for U.S. children and adults.

The Association Between Psychological Distress and Cancer Mortality in the United States: Results from the 1997-2014 NHIS-NDI Record Linkage Study.

BACKGROUND/PURPOSE: Psychological distress can influence cancer mortality through socioeconomic disadvantage, health-risk behaviors, or reduced access to care. These disadvantages can result in higher risks of cancer occurrence, a delayed cancer diagnosis, hamper adherence to treatment, and provoke inflammatory responses leading to cancer. Previous studies have linked psychological distress to cancer mortality. However, studies are lacking for the U.S. population. METHODS: This study examines the Kessler six-item psychological distress scale as a risk factor for U.S. cancer mortality using the pooled 1997-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N = 513,012). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates. RESULTS: In Cox models with 18 years of mortality follow-up, the cancer mortality risk was 80% higher (hazard ratio [HR] = 1.80; 95% CI = 1.64, 1.97) controlling for age; 61% higher (HR = 1.61; 95% CI = 1.46, 1.76) in the SES-adjusted model, and 33% higher (HR = 1.33; 95% CI = 1.21, 1.46) in the fully-adjusted model among adults with serious psychological distress (SPD), compared with adults without psychological distress. Males, non-Hispanic Whites, and adults with incomes at or above 400% of the federal poverty level had greater cancer mortality risk associated with SPD. Using an 8 years of mortality follow-up, those with SPD had 108% increased adjusted risks of mortality from breast cancer. CONCLUSION: Our study findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing cancer mortality.

The National Center for Health Statistics' 2015 and 2016 Research and Development Surveys.

Objective: This report provides a general description of the background and operation of the first two rounds of the Research and Development Survey (RANDS), a series of cross-sectional surveys from probability-sampled commercial survey panels. The Division of Research and Methodology of the National Center for Health Statistics (NCHS) conducted the first two rounds of RANDS in 2015 and 2016. RANDS 1 and 2 are being used primarily for question design evaluation and for investigating statistical methodologies for estimation. Methods: NCHS contracted with Gallup, Inc. to conduct RANDS 1 in Fall 2015 and RANDS 2 in Spring 2016. RANDS 1 and 2 were conducted using a web survey mode and included survey questions from the National Health Interview Survey (NHIS) that were specifically chosen to provide comparison and evaluation of the survey methodology properties of web surveys and traditional household surveys. In this report, some demographic and health estimates are provided from both sources to describe the RANDS data. Results: In RANDS 1, 2,304 out of the original 9,809 invited panel members completed the survey, for a completion rate of 23.5%. In RANDS 2, 2,480 of the initial 8,231 invited respondents completed the survey, for a completion rate of 30.1%. RANDS 1 and 2 participants were similar to the quarterly NHIS participants with respect to sex, census region, and whether they had worked for pay in the previous week. Other characteristics varied, including age, race and ethnicity, and income. Most health estimates differed between RANDS and NHIS. Public-use versions of the RANDS data can be found at: https://www.cdc.gov/nchs/rands. Conclusion: RANDS is an ongoing platform for research to understand the properties of probability-sampled recruited panels of primarily web users, investigating and developing statistical methods for using such data in conjunction with large nationally representative health surveys, and for extending question-design evaluations.

Heavy Drinking Among U.S. Adults, 2018.

Heavy drinking is defined as the average consumption of more than 7 drinks per week for women and more than 14 drinks per week for men in the past year (1). Heavy drinking is associated with an increased risk of alcohol use disorders, suicide, interpersonal violence, traffic injuries, liver disease, certain cancers and infectious diseases, and adverse birth outcomes in pregnant women (1,2). This report describes adult alcohol use in the United States and presents the prevalence of heavy drinking by demographic characteristics, select mental health indicators, and select measures of health care access and utilization.

Antidepressant Use Among Adults: United States, 2015-2018.

In 2018, an estimated 7.2% of American adults had a major depressive episode in the past year (1). Depression is associated with diminished quality of life and increased disability (2). Antidepressants are one of the primary treatments for depression (3) and are among the most frequently used therapeutic medications in the United States (4). This data brief provides recent prevalent estimates for antidepressant use among U.S. adults aged 18 and over, by age, sex, race and Hispanic origin, and education. Trends in antidepressant use over the decade from 2009-2010 through 2017-2018 are described.

Comparative Analysis of the National Health Interview Survey Public-use and Restricted-use Linked Mortality Files.

Linking national survey data with administrative data sources enables researchers to conduct analyses that would not be possible with each data source alone. Recently, the Data Linkage Program at the National Center for Health Statistics (NCHS) released updated linked mortality files, including the National Health Interview Survey data linked to the National Death Index mortality files. Two versions of the files were released: restricted-use files available through NCHS and Federal Statistical Research Data Centers and public-use files. To reduce the reidentification risk, statistical disclosure limitation methods were applied to the public-use files before they were released. This included limiting the amount of mortality information available and perturbing cause of death and follow-up time for select records. To assess the comparability of the restricted-use and public-use files, relative hazard ratios for all-cause and cause-specific mortality using Cox proportional hazards models were estimated and compared. The comparative analysis found that the two data files yielded very similar descriptive and model results.

Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release, 2018.

This report describes changes in how the National Center for Health Statistics (NCHS) will code, publish, and release maternal mortality data and presents official 2018 maternal mortality estimates using a new coding method. Due to the incremental implementation of the pregnancy status checkbox item on the 2003 revised U.S. Standard Certificate of Death, NCHS last published an official estimate of the U.S. maternal mortality rate in 2007. As of 2018, implementation of the revised certificate, including its pregnancy checkbox, is complete for all 50 states (noting that California implemented a different checkbox than that on the U.S. Standard Certificate of Death), allowing NCHS to resume the routine publication of maternal mortality statistics. However, an evaluation of data quality indicated some errors with the reporting of maternal deaths (deaths within 42 days of pregnancy) following adoption of the checkbox, including overreporting of maternal deaths among older women. Therefore, NCHS has adopted a new method (to be called the 2018 method) for coding maternal deaths to mitigate these probable errors. The 2018 method involves further restricting application of the pregnancy checkbox to decedents aged 10-44 years from the previous age group of 10-54. In addition, the 2018 method restricts assignment of maternal codes to the underlying cause alone when the checkbox is the only indication of pregnancy on the death certificate, and such coding would be applied only to decedents aged 10-44 based solely on the checkbox when no other pregnancy information is provided in the cause-of-death statement. Based on the new method, a total of 658 deaths were identified in 2018 as maternal deaths. The maternal mortality rate for 2018 was 17.4 deaths per 100,000 live births, and the rate for non-Hispanic black women (37.1) was 2.5 to 3.1 times the rates for non-Hispanic white (14.7) and Hispanic (11.8) women. Rates also increased with age. Maternal mortality rates calculated without using information obtained from the checkbox are also presented for 2002, 2015, 2016, 2017, and 2018 to provide comparisons over time using a comparable coding approach across all states.