Centers for Disease Control and Prevention

Household Survey Comparison

Melissa Heinen, M.P.H.

Margaret Warner, Ph.D.

Lois Fingerhut, M.A.

Montreal 2002

Importance of Household Surveys

•Not limited to medical records

•Health professionals description

•More detail about the event

•Costs and resources

National Household Injury Surveys

Surveys reviewed

•Canada – Canadian Community Health Survey (CCHS) and the National Population Health Survey (NPHS)

•New Zealand – National Health Survey

•Scotland – Scottish Health Survey

•South Africa – South African Demographic and Health Survey

•United States – National Health Interview Survey

SOURCE: CDC/NCHS

National Household Injury Surveys

Items compared

•Recall Period

•Severity Threshold

•Survey Methodology

•Unit of Analysis

•Injury Definitions

•Survey Frequency

•Probing / Screening Question

SOURCE: CDC/NCHS

Recall Period

Items to consider

•Memory decay

•Telescoping

•Heaping

•Sample size / relative standard error

SOURCE: CDC/NCHS

Annual estimates of injury and poisoning conditions using different recall periods,

NHIS 1997

30

35

40

45

50

55

0 0.5 1 1.5 2 2.5 3

Months of recall

Mil

lio

ns

Injury andpoisoningconditions

Recall Period

SOURCE: CDC/NCHS

Canada 12-months

New Zealand 12-months

Scotland 12-months

South Africa 1-month

United States 3-months

Severity Threshold

Measurements

•Limitation in daily activities

•Medical advice or treatment

•Hospitalization status

SOURCE: CDC/NCHS

Severity Threshold

Items to consider

•Health insurance coverage

•Subjective - health seeking behaviors

•Accessibility of health professional (rural vs. urban)

•Emergency department visits

SOURCE: CDC/NCHS

Severity Threshold

SOURCE: CDC/NCHS

Canada Limitation of normal activities

New Zealand Received medical treatment

Scotland Saw a doctor, nurse, or other health professional

South Africa Treated by a doctor or a nurse

United States Got medical advice or treatment

Survey Methodology

Items to consider

•Non-response rates

•Representation

•Sensitive questions and non-reporting

•Cost and resources

SOURCE: CDC/NCHS

Survey Methodology

SOURCE: CDC/NCHS

Canada NPHS -Telephone

CHHS – Telephone and face-to-face

New Zealand Face-to-face

Scotland Face-to-face

South Africa Face-to-face

United States Face-to-face

Unit of Analysis

Items to consider

•Comparability of numbers•Events (e.g., car crash)•Persons•Most severe•Most recent•Conditions (e.g., fractured leg)

SOURCE: CDC/NCHS

Unit of Analysis

SOURCE: CDC/NCHS

Canada Injury events

New Zealand Injured persons

Scotland Person based – most recent injury-related event

South Africa Injured persons

United States Injury events

Injury Definitions

Items to consider

•Self report vs. coding of self reports (ICD coding)

•Comparability

SOURCE: CDC/NCHS

Injury Definitions

SOURCE: CDC/NCHS

Canada ICD coded injuries

New Zealand ICD coded injuries

Scotland Self reported accidents

South Africa Self reported injuries

United States ICD coded injuries

Survey Frequency

Items to consider

•Trends over time

•Assess data

•Sample size

SOURCE: CDC/NCHS

Survey Frequency

SOURCE: CDC/NCHS

Canada Conducts surveys annually and reports results every two years

New Zealand Conducts survey every three years

Scotland Conducts survey every three years

South Africa Conducts survey every five years

United States Conducts survey and reports results annually

Screener Question

Items to consider

•Length

•Complexity

•Embedded examples

SOURCE: CDC/NCHS

Screener Question

SOURCE: CDC/NCHS

Canada “(Not counting repetitive strain injuries), in the past 12 months, that is from ## to yesterday, were you injured?”

New Zealand “In the last 12 months, have you had an injury which you received medical treatment?”

Scotland “How many accidents – about which you saw a doctor, nurse, or other health professional – have you had in the last 12 months?”

Screener Question

SOURCE: CDC/NCHS

South Africa “Did you have any injury that was treated by a doctor or a nurse in the last 30 days?”

United States “During the past 3 months, that is since ###, were you or anyone in the family injured or poisoned seriously enough that you got medical advice or treatment?”

US Survey

•Decrease injury rate

•Cognitive testing -screening question

•Length

•Definitions

•Severity

Screener QuestionProposed changes for US

• During the past 3 months, that is since ##, did you have an injury where any part of your body was hurt, for example, with a broken bone, sprain, burn, wound, cut, bruise, or animal or insect bite?

• During the past 3 months, how many times were you injured?

• Did you talk to or see a medical professional about any of these injuries?

• Of the # times that you were injured, how many of those times was the injury serious enough that you consulted a medical professional?

SOURCE: CDC/NCHS

Screener QuestionProposed changes for US

• During the past 3 months, that is since ##, were you poisoned by swallowing or breathing in a harmful substance such as bleach, carbon monoxide, or too many pills or drugs? (Do not include food poisoning, sun poisoning, or poison ivy rashes)

• During the past 3 months, how many different times were poisoned?

• Did you talk to or see a medical professional about any of these poisonings?

• Of the # times that you were poisoned, how many of those times was the poisoning serious enough that you consulted a medical professional?

SOURCE: CDC/NCHS

National Household Injury Surveys

Additional items to consider

• Placement of injury section within a larger survey

• Length of survey

• Sample selection

• Definitions of injuries and poisonings

• Narrative introduction to the section

• Weighting of data

• Respondent vs. Proxy

SOURCE: CDC/NCHS

National Household Injury Surveys

Generic considerations

•Continuous funding

•Strong lobbying

•Demonstrating usefulness of data

SOURCE: CDC/NCHS

Centers for Disease Control and Prevention

Website: http://www.cdc.gov/nchs/about/otheract/ice/housesur.htm

Considerations

• Should our goal be to compare our selves to each other to have better questions and survey methodology?

• Is it a worthwhile goal to standardize questions?

•Cause compatible with ICD?

•Should health behaviors be a priority?

• Is it even worth comparing numbers?