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Focus on Prescription Drug Use Data from the National Center for Health Statistics IV

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Focus on Prescription Drug Use Data from the National Center for Health Statistics IV Powered By Docstoc
					Prescription Medication Data
             collected in the
  National Health and Nutrition
 Examination Survey (NHANES)


          Ryne Paulose, Ph.D.


  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
  Centers for Disease Control and Prevention
  National Center for Health Statistics
                 Topics

•   NHANES
•   NHANES prescription medication data
•   Data collection and editing
•   Public data files and access
•   Examples of data analyses
NHANES - Objective


• To assess the health and
 nutritional status of adults and
 children in the United States
               NHANES
•   NHES I: 1960-62, ages 18-79
•   NHES II: 1963-65, ages 6-11
•   NHES III: 1966-70, ages 12-17
•   NHANES I: 1971-75, ages 1-74
•   NHANES II: 1976-80, ages 6 mos.-74
•   HHANES: 1982-84, ages 6 mos.-74
•   NHANES III: 1988-94, ages 2 mos. and older
•   NHANES: 1999 and beyond, all ages
                  NHANES
Sample Design
    • Continuous data collection beginning in 1999
    • Annual national sample of 5,000 persons


Eligible population
    • Civilian, non-institutionalized population
    • Residents of all states and D.C.
    • All ages
NHANES – Oversampling
    •   African Americans
    •   Mexican Americans
    •   Adolescents aged 12-19
    •   Older persons aged 60+
    •   Pregnant women
    •   Low-income family
NHANES Household Interview




           • Traditional CAPI interviewing
             with portable keyboard.
NHANES Household Interview

• Broad range of health conditions
• Environmental and occupational
  exposures
• Health behaviors
• Nutrition and dietary supplements
• Prescribed medications
NHANES Mobile Exam Center
     NHANES Examination

•   Standardized physical exam
•   Conducted at mobile exam center
      • Medical & dental exams
      • Physiological measurements
      • Laboratory test
•   Administered by trained medical
    personnel
NHANES Mobile Exam Center
    NHANES TOPICS

•   Cardiovascular disease
•   Diabetes, lower extremity
    disease
•   Bone status, osteoporosis
•   Oral health
•   Vision
•   Hearing and balance
•   Fitness and strength
NHANES TOPICS, Continued

     • Nutrition
     • Anthropometry
     • Mental health
     • Risk behaviors
     • Reproductive health
     • Environmental exposures
     • Infectious diseases
NHANES Laboratory

• CBC and differential
• Pregnancy test
• Blood, urine and vaginal swab
 processing
      76 different vials of samples
      26 laboratories
      300 laboratory assays
     Landmark findings and
      public health results
• High blood lead levels
      Lead out of gasoline

• Low folate levels
      Mandatory food fortification

• Rising levels of obesity
      Public health action plan

• Racial and ethnic disparities in Hepatitis B
      Universal vaccination of all infants & children
Prescription Medication
          Data
          NHANES
  Prescription Medications

• Collected in personal interviews…
      • by trained interviewers
      • for all ages (>16, self-report;
        <16, proxy)
      • using medication inventory
        method
NHANES Prescription Medications

  • “In the past 30 days have you used a
    medication for which a prescription was
    needed?”

  • “What were they?”

  • “May I please see the containers of all
    prescription medicines you used?”

  • Also record duration of use and reason for
    use
                                 Computer Assisted
                                Data Entry & Coding
GIANT PHARMACY                   Store No. 1234
New Hampshire Ave., Silver Spring, MD


Rx 055 445 3456
JANE DOE
Rx Date: 01/05/02 Pharmacist: NH Qty: 100.0
TAB

TAKE 1 TABLET(S) TWICE A DAY

Glucophage TAB 500MG

MAY NOT REFILL




Interviewer types
in exact product
name from label
                 Computer Assisted
                Data Entry & Coding
A look-up
window
appears on
the screen
with possible
matches
     Post Data Collection Editing
•   Convert drug names to generic ingredient name
         • Prozac      Fluoxetine Hydrochloride
         • Tylenol #3  Acetaminophen; Codeine

•   Remove products incorrectly reported/recorded
         • e.g., non-prescription products
         • e.g., prescription dietary supplements & vitamins

•   Assign therapeutic class codes
         • FDA’s National Drug Code Directory
         • Assign up to 6 codes per generic name
         • Codes are listed in numerical order
       Prescription Medication
      Public Use Data File 1999+
•   Drug product level file
               » Person with multiple drugs has multiple records

•   Variables…
       •   Respondent ID number
       •   Taken prescription medicine, past month (yes/no)
       •   Standard generic ingredient name
       •   Standard generic ingredient code
       •   FDA/NDC drug class codes 1-6
       •   Medicine container seen by interviewer (yes/no)
       •   Number of days taken medicine
       •   Number of Beta-agonist canisters, past month
       •   Number of prescription medicines taken
Prescription Medication Data

  • Currently available…
      • NHANES III
      • NHANES 1999-2000


  • Expected in first quarter of 2005
      • NHANES 2001-2002
          NHANES Data

Directly download from
our website
http://www.cdc.gov/nchs/nhanes.htm
Click here to
learn about the
questionnaire
data
Click on
hyperlinks,
download
self-
extracting
zip files
      Uses of NHANES Prescription
            Medication Data
• To estimate prescription drug use in the
  civilian non-institutionalized US population
• To identify patterns of use in different
  demographic groups (e.g., race and age
  groups)
• Identify inappropriate use and potential
  adverse effects.
Most frequently used prescription psychotropic
medications in the past month among persons
17 years and older: United States, 1999-2000
Drug Class
             Generic Drug Name
Anxiolytics/Sedatives/Hypnotics

             Alprazolam (Xanax®)


             Lorazepam (Ativan®)


             Hydroxyzine (Atarax®)

Antidepressants

             Fluoxetine (Prozac®)


             Sertraline (Zoloft®)


             Paroxetine (Paxil®)
          NHANES Data

Directly download from
our website
http://www.cdc.gov/nchs/nhanes.htm

				
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