Discrepancies in Self-Report Diabetes Survey yquestions using NHANES, NHIS, and CHIS data Sarah Lessem National lcenter for Health Statistics ti ti CDC Behavioral Scientist DC-AAPOR WSS Summer Conference Preview/Review August 3, 2015 Accepted for 2015 International Total Survey Error Conference Department of Health and Human Services Centers for Disease Control and Prevention
Disclaimer
Discrepancies in Reporting not Discrepancies in Health Using diabetes as an example to show discrepancies in data a quality Harder to understand health disparities when data quality varies by demographic Using survey data as a indicator of response process
Three Datasets National Health and Nutrition Survey 1999-2012 (NHANES) National Health Interview Survey 1997-2013 (NHIS) California Health Interview Survey 2003-20122012 (CHIS)
Data Discrepancies Diagnosed at a Young Age No Insulin (NHANES; NHIS; CHIS) Type 1 - No Insulin (CHIS) Medication Mismatch (NHANES)
Type 1 & Type 2 Diabetes Insulin Age of Diagnosis Type 1 Type 2
Type 1 & Type 2 Diabetes Insulin Age of Diagnosis Type 1 Type 2 Always
Type 1 & Type 2 Diabetes Type 1 Type 2 Insulin Always Sometimes Age of Diagnosis
Type 1 & Type 2 Diabetes Type 1 Type 2 Insulin Always Sometimes Age of Diagnosis Any age (most often <30 years)
Type 1 & Type 2 Diabetes Type 1 Type 2 Insulin Always Sometimes Age of Diagnosis Any age (most often <30 years) Currently: 10 years+ Prior to 1990: 20 years+
Discrepancy 1: Reports: Diagnosed at a Young Age and Do Not Take Insulin National Health and Nutrition Survey (NHANES) National Health Interview Survey (NHIS) California Health Interview Survey (CHIS)
How old were you when a doctor or other health professional FIRST told you that you had diabetes or sugar diabetes? Reports under age 10 in any year Reports under age 20 pre-1990 No Are you NOW taking insulin? Younger Diagnosis Older Diagnosis Takes Insulin Type 1 Type 1 or Type 2 No Insulin???? Type 2
Percentage reporting young age of diagnosis who do not report insulin NHANES NHIS CHIS Overall 55.4% 47.2% 42.0% Younger Diagnosis Older Diagnosis Takes Insulin Type 1 Type 1 or Type 2 No Insulin???? Type 2
Percentage reporting gyoung age of diagnosis who do not report insulin Age categories NHANES*** NHIS*** CHIS** 18-44 27.8% 28.0% 32.4% 45-64 60.3% 50.8% 46.4% 65+ 74.3% 71.2% 66.3% Race NHANES*** NHIS*** CHIS*** White 50.4% 42.9% 25.6% Black 50.9% 52.8% 34.1% American -- 66.3% 35.1% Indian Asian -- 70.7% 68.5% Hispanic 82.1% 58.7% 69.5% Gender NHANES* NHIS CHIS Male 46.4% 45.6% 43.6% Female 64.1% 48.7% 40.0%
Percentage reporting gyoung age of diagnosis Insurance NHANES NHIS*** CHIS** Private 48.2% 40.4% 28.2% Public 68.1% 51.7% 50.6% Uninsured 47.5% 57.1% 61.1% who do not report insulin Educational Attainment NHANES ** NHIS*** CHIS** < High School 73.3% 59.0% 65.8% High school/ged 47.0% 49.1% 58.4% Some College /AA 51.5% 42.3% 25.5% Bachelors + 25.7% 34.1% 26.5% Poverty Status NHANES NHIS*** CHIS** <200% 61.8% 54.9% 57.3% 200%-399% 50.0% 40.8% 47.4% 400% + 49.7% 36.0% 18.7%
Discrepancy 2: Reports: Type 1 Diabetes and Do Not Take Insulin California Health Interview Survey (CHIS)
Were you told that you had type 1 or type 2 diabetes? [IF NEEDED, SAY: type 1 diabetes results from the body s failure to produce insulin and is usually diagnosed in children and young adults. Type 2 diabetes results from insulin resistance and is the most common form of diabetes. ] Type 1 Are you currently taking insulin? No Type 1 Type 2 Insulin Use Always Sometimes No Insulin Use Never Sometimes
Percentage of respondents reporting Type 1 Diabetes who do not report insulin 60.3% Type 1 Type 2 Insulin Use Always Sometimes No Insulin Use Never Sometimes
Percentage of respondents reporting Type 1 Diabetes who do not report insulin Age categories** 18-44 53.2% Education*** 45-64 62.1% 65+ 67.4% Gender Male 62.4% Female 57.5% Race*** NH White 34.2% NH Black 54.8% American Indian 50.0% 0% Asian 76.8% Hispanic 74.0% Insurance Status*** Private 46.7% Public 63.5% No Insurance 75.2% <High School 77.5% High School/GED 60.5% Some College/AA 47.2% Bachelors+ 40.8% Poverty Ratio*** <200% 69.1% 200%-399% 57.8% 400% + 40.6%
Discrepancy 3 Diabetes Medication Mismatch: Responds Yes when asked if takes diabetes pills or insulin, but not listed in medication inventory or vice versa National Health and Nutrition Survey (NHANES)
Are you NOW taking diabetic pills to lower your blood sugar? These are sometimes called oral agents or oral hypoglycemic agents. Are you NOW taking insulin? In the past month have you used or taken medication for which a prescription is needed? Are you NOW taking gpills? Are you NOW taking insulin? Pills in Inventory Yes Takes Pills No??? OR Insulin in Inventory Yes Takes Insulin No??? Pills not in Inventory??? No Pills Insulin not in Inventory??? No Insulin
Percentage of Respondents with Diabetes Medication Mismatch 10.6% Are you NOW taking gpills? Are you NOW taking insulin? Pills in Inventory Yes Takes Pills No??? OR Insulin in Inventory Yes Takes Insulin No??? Pills not in Inventory??? No Pills Insulin not in Inventory??? No Insulin
Percentage of Respondents with Diabetes Medication Mismatch Age categories* 18-44 10.0% 45-64 8.6% 65+ 13.2% Gender Male 11.0% Female 10.3% Race NH White 10.3% NH Black 11.7% Hispanic 12.6% Education*** <High School 13.8% High School/GED 11.6% Some College/AA 9.4% Bachelors+ 5.4% Insurance Status** Private 8.7% Public 13.7% No Insurance 11.3% Poverty Ratio* <200% 12.1% 1% 200%-399% 10.1% 400% + 6.9%
Summary Discrepancies in Reporting Diabetes Data Similar patterns across datasets Highest Rates of Discrepancies c es among: Older ages Hispanics & Asians Lower Education Uninsured Lower Income
Thank You Sarah Lessem slessem@cdc.gov Telephone: 301.458.4209 The findings and conclusions in this report are those of the author and do not necessarily represent the official position of thecenters for Disease Control and Prevention. Department of Health and Human Services Centers for Disease Control and Prevention