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).

The U.S. National Vital Statistics System: Transitioning Into the 21st Century, 1990-2017.

This report describes the history of the National Vital Statistics System, with a focus on the period 1990-2017. The vital statistics system is the country's most enduring program of data collection on the health of the population. It is based on information reported on the certificates of births and deaths and reports of fetal deaths, collected in each of the states and independent registration areas. Over the last two decades, the vital statistics system has experienced far-reaching changes, and has shifted in important ways to emphasize data quality, timeliness, and analysis. The changes underlying these areas are described.

Long-Term Trends in Black and White Mortality in the Rural United States: Evidence of a Race-Specific Rural Mortality Penalty.

PURPOSE: The rural mortality penalty-growing disparities in rural-urban macro-level mortality rates-has persisted in the United States since the mid 1980s. Substantial intrarural differences exist: rural places of modest population size, close to urban areas, experience a greater mortality burden than the most rural locales. This research builds on recent findings by examining whether a race-specific rural mortality penalty exists; that is, are some rural areas more detrimental to black and/or white mortality than others? METHODS: Using data from the Compressed Mortality File from 1968 to 2012, we calculate annual age-adjusted, race-specific mortality rates for all rural-urban regions designated by the Rural-Urban Continuum Codes. Indicators for population, socioeconomic status, and health infrastructure, as a proxy for access to care, are used as predictors of race-specific mortality in multivariable regression models. FINDINGS: Three important results emerge from this analysis: (1) there is a substantial mortality disadvantage for both black and white rural Americans, (2) the most advantageous regions of mortality for blacks exhibit higher mortality than the most disadvantageous regions for whites, and (3) access to health care is a much stronger predictor of white mortality than black mortality. CONCLUSIONS: The rural mortality penalty is evident in race-specific mortality trends over time, with an added disadvantage in black mortality. The rate of mortality improvement for rural blacks and whites lags behind their same-race, urban counterparts, creating a diverging gap in race-specific mortality trends in rural America.

Reengineering vital registration and statistics systems for the United States.

For more than a hundred years, the United States has operated a decentralized vital statistics system as an essential component of public health. Statistics based on births and deaths registered in the United States are a primary source of data used to track health status, to plan, implement, and evaluate health and social services, and to set health policy. The national vital statistics system provides nearly complete, continuous, and comparable federal, state, and local data. The system, however, is based on outmoded vital registration practices and structures, which raises concerns about data quality, timeliness, and the lack of real-time linkage capabilities. While many organizations are working together to address these issues and have made notable achievements, questions remain to be answered. Efforts to rejuvenate the nation's vital statistics system will need to expand dramatically to provide public health with a timely, high-quality, and flexible system to monitor vital health outcomes at the local, state, and national levels.

Design and operation of the 1995 National Survey of Family Growth.

PIP: In the US, the 1995 National Survey of Family Growth (NSFG) was designed to provide richer data than previous NSFG surveys from 1973, 1976, 1982, and 1988. Planning for the 1995 NSFG took place at a series of meetings beginning in 1990. Pretesting of the expanded questionnaire, the new computer-assisted personal interviewing method, and the audio computer-assisted, self-interviewing method for sensitive topics occurred in 1993 and led to the decision to offer a cash incentive to respondents and to use the new interviewing methods. The revised questionnaire collected information on event histories, pregnancy history and family formation, partner history, sterilization and fecundity, contraception and birth expectations, use of family planning and other medical services, demographic characteristics, abortion history, number of sexual partners, and rape. The sample for the 1995 NSFG included 14,000 civilian, noninstitutionalized women of reproductive age, 13,795 of whom proved eligible. Of these, 79% completed interviews. Quality control measures included careful design and testing of the questionnaire, use of a Life History Calendar, intensive interviewer training, consistency checks, and use of the incentive. Sampling weights for each respondent were used to derive nationally representative statistical estimates. Sampling errors were created to reflect the complexity of the sample. Research based on the results of the 1995 NSFS has only begun to take advantage of the potential offered by these data.^ieng

The role of NCHS data systems in the evaluation of intervention and prevention strategies.

Intervention and prevention strategies for the U.S.A. for the year 2000 have been broadly defined into 22 priority areas encompassing 332 health objectives. NCHS and its data systems have the major responsibility for providing the data for half of these objectives and assisting in a wide array of other data programmes both within and outside of CDC. This paper describes the process used to arrive at these objectives, highlights a few of them, and presents four examples of objectives NCHS is engaged in tracking: breast cancer mortality, breast examinations, infant mortality and cholesterol levels.

US National Health Data on Asian Americans and Pacific Islanders: a research agenda for the 1990s.

OBJECTIVES: In spite of over 30 years of periodic nationwide surveys, we have thus far only the most rudimentary estimates of the determinants of the health of Asian Americans and Pacific Islanders. This paper explores ways to improve the capability of the National Center for Health Statistics (NCHS) to collect national health data on these populations. METHODS: The NCHS "race" coding practices are reviewed, their limitations stated, ways to improve the numerator and denominator data discussed, and a research agenda presented. RESULTS: Resources can be intensified to produce better denominator data, and to improve the collection of detailed ethnicity information for the numerators, in at least the three states (California, New York, and Hawaii) where the majority of Asian/Pacific Islanders lived in 1990. Subsequently, these efforts should be extended to the 10 states where 79% of these individuals reside or to the top 15 metropolitan areas where they are concentrated. CONCLUSIONS: If the recommendations are implemented, several coordinated multisite, multiwave epidemiologic surveys can be conducted using standardized interview instruments and data collection procedures that will capitalize on the geographic distribution of Asian/Pacific Islanders.

Functions of the Coordination and Maintenance Committee and modifying the ICD-9-CM, Volumes 1 and 2.

Balancing the multiple uses of ICD-9-CM with its central purpose as a statistical classification system is the function of the Coordination and Maintenance Committee. This article describes the process to modify diagnosis and procedure codes and how AHIMA members can contribute to improving ICD-9-CM.

Computer assisted telephone interviewing: effects on interviewers and respondents.

The effects of using a computer assisted telephone interviewing system on response distributions, interviewer behavior, and other nonsampling errors are measured through a survey experiment which randomly assigned cases either to a paper questionnaire or a CATI version. There were few differences in response distributions obtained in the two modes, some evidence of reduced interviewer variance among CATI cases, but little difference in response rates between the methods. Interviewers, who conducted interviews in both methods, tended to have no clear preference between them, but favored the CATI system for ease of following the questionnaire and the paper version for ease of making changes to prior answers.

Issues in protecting confidentiality in national health statistics.

This paper reviews the confidentiality policies of the National Center for Health Statistics (NCHS). It relates these both to the 1974 Privacy Act and to the needs of users of health statistics. The four major issues considered in the paper are: (1) the implications of present confidentiality laws with respect to NCHS, (2) the issue of gaining informed consent in telephone interviews, (3) questions concerning the release of NCHS information on public use data tapes, (4) the implications for NCHS policies of the recently proposed legislation on the confidentiality of federal statistical records.