1、Analyses of extended set questions using the U.S. National Health Interview Survey,Mitchell Loeb / Jennifer MadansNational Center for Health Statistics/ Washington Group on Disability Statistics,The NHIS is a cross-sectional household survey of the civilian, non-institutionalized population of the U
2、nited States, conducted annually by NCHS since 1957. Data are collected in person from a sample based on a multistage probability design. Annually, the sample comprises approximately 35,000 households containing about 87,500 persons per year,National Health Interview Survey,WG short set of questions
3、:,Because of a Health problem: Do you have difficulty seeing even if wearing glasses? Do you have difficulty hearing even if using a hearing aid? Do you have difficulty walking or climbing stairs? Do you have difficulty remembering or concentrating? Do you have difficulty with (self-care such as) wa
4、shing all over or dressing? Using your usual language, do you have difficulty communicating (for example understanding or being understood by others)?Response categories: No - no difficulty; Yes - some difficulty; Yes - a lot of difficulty; Cannot do at all,WG Recommendation:,For purposes of reporti
5、ng and generating internationally comparable data, the WG has recommended the following cutoff be used to define the population of persons with disabilities: The sub-population disabled includes everyone with at least one domain that is coded as a lot of difficulty or cannot do it at all.,Rational f
6、or Extended Set Questions:,To include additional domains that were not included in the Short Set (upper body functioning, affect, pain, and fatigue) To include more information per domain (for example, use of assistive devices/aids, and functioning with and without assistance) To develop a single me
7、asure, per domain, for un-accommodated functioning To use the additional information per domain to develop a continuum of functioning that would supplement the Short Set,What are the challenges going from a single question per domain to multiple questions per domain?The need to determine the added v
8、alue of multiple questions. The need to be able to combine multiple indicators to form a continuum of functional difficulty.,Going from SS to Extended set,Do you have difficulty seeing, even when wearing glasses? (SS) Initial analyses using proposed extended set questions (difficulty with near and f
9、ar vision) did not create a continuum of functioning, so the questions were not included in the Extended set.,Vision: Extended set/Short set question,Do you have difficulty seeing, even when wearing glasses? SS (NHIS 2011),Using your usual language, do you have difficulty communicating, for example,
10、 understanding or being understood? (SS),Communication: Extended set/Short set question,Using your usual language, do you have difficulty communicating, for example, understanding or being understood? SS (NHIS 2011),Do you have difficulty hearing, even when using a hearing aid? (SS) Do you have diff
11、iculty hearing what is said in a conversation with one other person in a quiet room even when wearing your hearing aid(s)? Do you have difficulty hearing what is said in a conversation with one other person in a noisier room even when wearing your hearing aid(s)?Analyses were conducted on Q2 and Q3.
12、,Hearing: Extended set questions,Do you have difficulty hearing, even when using a hearing aid? SS (NHIS 2011),Difficulty hearing in a noisy room by quiet room (NHIS 2011),Hearing Indicator,Hearing Indicator by WG-SS Question,Employment status last week (2010),Do you have difficulty remembering or c
13、oncentrating? (SS) Do you have difficulty remembering, concentrating, or both? How often do you have difficulty remembering? (Frequency) Do you have difficulty remembering a few things, a lot of things, or almost everything? (Intensity) Analyses conducted on Q2, Q3 and Q4,Cognition: Extended set que
14、stions,Do you have difficulty remembering or concentrating? SS (NHIS 2010),Difficulty remembering: Intensity by Frequency (NHIS 2010) (see Handout),Remembering Indicator,Which of the following, if any, describe your difficulty remembering? I forget things because I am busy and have too much to remem
15、ber. My difficulty is getting worse. My difficulty has put me or my family in danger. I forget only little or inconsequential things. I must write down important things, such as my address or when to take medicine, so that I do not forget. My family members or friends are worried about my difficulty
16、 remembering. My difficulty is normal for someone my age.,2010 NHIS Probe Questions:,Remembering Indicator by Probes,Effect of adding difficulty concentrating,*116 individuals with concentrating only were allocated as follows: 112 with a little difficulty on the SS question were classified as 2 4 wi
17、th a lot of difficulty on the SS question were classified as 3Those with both remembering and concentrating difficulty were upgraded 7 individuals from 2 to 3, and 40 individuals from 3 to 4,Cognition Indicator,ADL/IADL (2010),Employment status last week (2010),In the past 3 months, how often did yo
18、u have pain? (Intensity)Thinking about the last time you had pain, how much pain did you have? (Frequency),Pain: Extended set questions,Pain Intensity by Frequency of pain in past 3 months,Pain Indicator,Which of the following, if any, describe your pain? It is constantly present. Sometimes Im in a
19、lot of pain and sometimes its not so bad. Sometimes its unbearable and excruciating. When I get my mind on other things, I am not aware of the pain. Medication can take my pain away completely. My pain is because of work. My pain is because of exercise.,2010 NHIS Probe Questions:,Pain Indicator by P
20、robe Questions,Employment status last week (2010),In the past 3 months, how often did you feel very tired or exhausted? (Frequency)Thinking about the last time you felt very tired or exhausted, how long did it last? (Duration)Thinking about the last time you felt this way, how would you describe the
21、 level of tiredness? (Intensity),Fatigue: Extended set questions,How long it lasted by How often felt very tired by Level of tiredness (Handout),Fatigue Indicator,Is your tiredness the result of any of the following? Too much work or exercise? Not getting enough sleep? A physical or health-related p
22、roblem? Something else?,2010 NHIS Probe Questions:,Fatigue Indicator by Probes,Employment status last week (2010),How often do you feel worried, nervous or anxious? (Frequency)Thinking about the last time you felt worried, nervous or anxious, how would you describe the level of these feelings? (Inte
23、nsity)Do you take medication for these feelings?,Anxiety: Extended set questions,Challenge to combining the questions into a single anxiety indicator,Medication variable: what did taking medication for anxiety mean? Should everyone reporting medication use be considered anxious?Medication is an acco
24、mmodation. (Prevalence of taking medication is 9.2%),Frequency of Anxiety by Anxiety Intensity and Use of Meds,Anxiety Indicator,Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? My feelings are caused by the type and amount of work I do. Someti
25、mes the feelings can be so intense that my chest hurts and I have trouble breathing. These are positive feelings that help me to accomplish goals and be productive. * The feelings sometimes interfere with my life, and I wish that I did not have them. *,2010 NHIS Probe Questions:,Which of the followi
26、ng statements, if any, describe your feelings of being worried, nervous, or anxious? If I had more money or a better job, I would not have these feelings. Everybody has these feelings. They are part of life and are normal. I have been told by a medical professional that I have anxiety.,2010 NHIS Pro
27、be Questions:,Probe questions,Asked only of persons who reported daily, weekly or monthly anxiety or who reported taking medication for anxiety,Anxiety Indicator by Probes,Employment status last week (2010),How often do you feel depressed? (Frequency)Thinking about the last time you felt depressed,
28、how depressed did you feel? (Intensity)Do you take medication for depression?,Depression: Extended set questions,Challenge to combining the questions into a single depression indicator,Medication variable: what did taking medication for depression mean? Should everyone reporting medication use be co
29、nsidered depressed?Medication is an accommodation. (Prevalence of taking medication is 8.5%),Frequency of Depression by Depression Intensity and Use of Meds,Depression Indicator,Which of the following statements, if any, describe your feelings of being depressed? My feelings are caused by the death
30、of a loved one. Sometimes the feelings can be so intense that I cannot get out of bed. The feelings sometimes interfere with my life, and I wish that I did not have them. *,2010 NHIS Probe Questions:,Which of the following statements, if any, describe your feelings of being depressed? If I had more
31、money or a better job, I would not have these feelings. Everybody has these feelings. They are part of life and are normal. I have been told by a medical professional that I have depression.,2010 NHIS Probe Questions:,Probe questions,Asked only of persons who reported daily, weekly or monthly depres
32、sion or who reported taking medication for depression,Depression Indicator by Probes,Employment status last week (2010),SS Do you have any difficulty walking or climbing steps? Do you have difficulty walking 100 yards on level ground, that would be about the length of one football field or one city
33、block without the use of your aid? Do you have difficulty walking a third of a mile on level ground, that would be about the length of five football fields or five city blocks without the use of your aid? Do you have difficulty walking up or down 12 steps without the use of your aid? Analyses conduc
34、ted on Q2, Q3 and Q4,Mobility: Extended set questions,Do you have difficulty walking or climbing steps? SS (NHIS 2010),Difficulty walking 1/3 mile by difficulty walking 100 yards (NHIS 2010),Walking Indicator,Adding difficulty with steps,Mobility Indicator,ADL/IADL (2010),Employment status last week
35、 (2010),Do you have difficulty with self-care, such as washing all over or dressing? SS Do you have difficulty raising a 2 liter bottle of water or soda from waist to eye level? Do you have difficulty using your hands and fingers, such as picking up small objects, for example, a button or pencil, or
36、 opening or closing containers or bottles? Note: Q2 & Q3 are used for the upper body indicator. Q1 remains the self-care indicator.,Upper body: Extended set questions,Do you have difficulty with self-care, such as washing all over or dressing? SS (NHIS 2010),Difficulty lifting 2 liter bottle by difficulty using hands/fingers (NHIS 2010),Upper body Indicator,ADL/IADL (2010),Employment status last week (2010),
