Sources of Public Health Data

Question 1

What are Epidemiological Surveillance Systems?

Answer 1

The systematic collection of data pertaining to the occurrence of specific diseases, the analysis and interpretation of these data, and the dissemination of consolidated and processed information to contributors to the program and other interested persons.

Question 2

What are Surveillance systems used to monitor disease trends and plan public health programs?

Answer 2

Vital statistics
Disease reporting systems
Surveys

Question 3

What are some more specialized surveillance systems?

Answer 3

Sentinel surveillance (disease-specific)
Zoonotic disease surveillance
Adverse events surveillance
Syndromic surveillance
Disease registries
Laboratory surveillance

Question 4

In United States, where are vital statistics available from?

Answer 4

National Center for Health Statistics
State vital records offices
CDC WONDER – online system containing data on births, deaths, many diseases from Centers for Disease Control and Prevention (CDC)

Question 5

What are vital events and what does the registration system do?

Answer 5

deaths, births, marriages, divorces, and fetal deaths (≥28 weeks pregnancy)

The vital registration system in the United States collects information routinely on these events.

Question 6

what collects national birth and death statistics?

Answer 6

Vital and Health Statistics Series
National Death Index

Question 7

What are some limitations to mortality data?

Answer 7

Chronic illnesses
Multiple causes of death
Lack of standardization of diagnosis criteria
Stigmas attached to certain diseases
Completeness of records
Changes in ICD codes over time

Question 8

Who complies and publishes national mortality rates?

Answer 8

National Center for Health Statistics (NCHS)

Question 9

Death certificate data in the United States include the following information:

Answer 9

Demographic characteristics (e.g., age)
Date and place of death (e.g., hospital)
Cause of death (i.e., immediate cause and contributing factors)

Question 10

What demographic characteristics are typically recorded in death certificates?

Answer 10

age
sex
race

Question 11

What causes death are typically recorded in death certificates?

Answer 11

cause of death
immediate cause
contributing factors

Question 12

What do birth statistics include and what are they used for?

Answer 12

Include live births and fetal deaths
Presumed to be nearly complete
Used to calculate birth rates
Helpful in understanding birth defects, length of gestation, birth weight, and demographic background of the mother

Question 13

What does the U.S. bureau of the census provide?

Answer 13

data that can be used to define the denominator in rates
Official estimates of total population size and subdivisions of the population by geographic area
Census conducted every 10 years

Question 14

What does public health surveillance refer to?

Answer 14

the systematic and continuous gathering of information about the occurrence of diseases and other health phenomena

The process of ascertainment of cases of disease in a population or community
Passive or Active

Question 15

What is passive surveillance?

Answer 15

Based on data reported by health care providers
Commonly used for infectious diseases (Notifiable Diseases)
Subject to underreporting and incompleteness
Local outbreaks may be missed
Inexpensive

Question 16

What is active surveillance?

Answer 16

Field workers make periodic visits to clinics and hospitals to collect data on incident cases
Very useful if an outbreak is suspected or begun to keep track of the number of cases
It is often more complete than passive surveillance
Relatively expensive and requires more time

Question 17

What does the disease reporting systems in the United States provide?

Answer 17

Disease reporting is mandated by state law
List of reportable diseases varies by state
States report nationally notifiable diseases to CDC on voluntary basis
List of notifiable diseases updated regularly by Council of State and Territorial Epidemiologists and CDC

Question 18

What does the National Notifiable Disease Surveillance System (NNDSS) do?`

Answer 18

By legal statute, physicians and other healthcare providers must report cases of certain diseases, known as reportable and notifiable diseases, to health authorities.

Usually infectious and communicable diseases that might endanger a population

Question 19

What is sentinel surveillance?

Answer 19

Alternative to population-based surveillance
Involves collecting data from sample of reporting sites (sentinel sites)
~Selected health care providers
~Used by disease programs such as HIV and malaria
Allows states to monitor trends using relatively small amount of information

Question 20

What is syndromic surveillance?

Answer 20

Describes “…using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response”

Relatively new surveillance method
Uses clinical information about disease signs and symptoms, before diagnosis is made
Often use electronic data from hospital emergency rooms

Question 21

What are some examples of syndromic surveillance?

Answer 21

New York City operates syndromic surveillance system
~Emergency department chief-complaint data from approximately 44 hospitals

In 2002, system detected higher than usual number of diarrheal and vomiting symptoms

Health department notified hospital emergency departments of possible outbreak
~Collected stool specimens, several tested positive for norovirus

Question 22

What are the Adverse Event Reporting system (AERS) and the Vaccine Adverse Event Reporting System (VAERS) used for?

Answer 22

Adverse event is ‘any unfavorable and unintended sign (e.g., an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal product, combination product, or medical device, whether or not considered related to the product’
Same for the VAERS, but for adverse events reportable specifically attributable to receiving a vaccine

Any healthcare provider and/or member of the public and submit an AERS/VAERS report

Question 23

What are some examples of surveys and data collection systems from the national center for health statistics (NCHS)?

Answer 23

National Health Interview Survey (NHIS)
National Health and Nutrition Examination Survey (NHANES)
National Vital Statistics System (NVSS)
Youth Risk Behavior Surveillance System (YRBSS)

Question 24

What is the national health interview survey (NHIS)?

Answer 24

The NCHS conducts the NHIS, which has been in operation since 1957.

Data from the NHIS are used for monitoring how well the nation is progressing toward specific health objectives as well as for tracking people’s health status and access to health care.

The goal of the survey is to collect data from a representative sample of the U.S. population.

Question 25

The NHIS in-person household interview survey.

Answer 25

With some telephone follow-up
Performed by trained U. S. Census Bureau interviewers
Computer-assisted personal interviewing

Question 26

Who provides information to the NHIS for each family within a household?

Answer 26

A knowledgeable adult 18 or older responds for him/herself and all other family members (Family Respondent)

One adult 18 or older (Sample Adult) and one child under age 18 (Sample Child) are randomly selected for more extensive set of questions. The adult answers for his/her self, while a knowledgeable adult answers for the child

Question 27

What is the core content of the NHIS?

Answer 27

Socio-demographics and Health conditions
Health care access and utilization
Health behaviors and risk factors
Supplemental Modules
~Different each year
~New topics or more detail on core topics
~Sponsors of supplement: National Cancer Institute (NCI), United States Department of Agriculture (USDA), Office of the Assistant Secretary for Planning and Evaluation (ASPE), National Center for Environmental Health (NCEH)

Question 28

What is the National Health and Nutrition Examination Survey (NHANES)?

Answer 28

Evolved from the National Health Survey Act of 1956
~The act provided for the creation of studies to characterize illness and disability in the United States.
~Objective: assess the health and nutritional status of adults and children in the US
A special feature
~Collection of information from physical examinations coupled with interviews
Operates as a continuous survey with data released in 2-year cycles (since 1999).

Question 29

How does NHANES work?

Answer 29

Multistage probability sample with clustered design
~Oversampling of black, Hispanic, and Asian, Older persons aged 80+, Low income whites
~Samples civilian, non-institutionalized persons

Provides population-based estimates of:
~Health conditions, Nutrition status and diet behaviors
~Awareness, treatment and control of selected diseases
~Environmental exposures
~Establish and maintain a biospecimen program

Question 30

What information does the NHANES home interview collect of?

Answer 30

Smoking
Taste & Smell
Physical Activity
Reproductive history
Housing characteristics
Prescription Medications use
Sleep behaviors and disorders
Alcohol Use
Acculturation
Mental Health
Food Security
Pesticide Use
Early Childhood
Medical Conditions
Housing characteristics
Hospital Utilization & Access to Care

Question 31

What are some laboratory tests the NHANES runs?

Answer 31

Complete blood count
Pregnancy test
Nutritional biomarkers
Glucose
Lipid profile
Hormone tests
Infectious diseases
~Hepatitis viruses
~Sexually transmitted infections
Environmental chemicals
Water fluoride levels
Biochemistry profile

Question 32

What is the National Vital Statistics System (NVSS)?

Answer 32

The National Center for Health Statistics (NCHS):
~Contracts with jurisdictions that are responsible for registering vital events.
~Develops standardized forms such as death certificates used for reporting vital events

Information from NVSS is used in Vital Statistics of the United States and National Vital Statistics Reports (NVSR).

Question 33

What are some National Health-Related Surveys: Examples of Health Issue-Specific Surveys?

Answer 33

National Immunization Survey (NIS)
National Maternal and Infant Health Survey
National Electronic Injury Surveillance System (NEISS)
National Survey on Drug Use & Health
National Survey of Family Growth
Birth Defects Surveillance and Research Program

Question 34

What are some National Health-Related Surveys: Examples of Healthcare Provider Surveys

Answer 34

National Hospital Discharge Survey (NHDS)
National Ambulatory Medical Care Survey (NAMCS)
National Hospital Ambulatory Medical Care Survey (NHAMCS)
National Nursing Home Survey
National Home and Hospice Care Survey
National Study of Long-Term Care Providers (NSLTCP)

Question 35

What is the Behavioral Risk Factor Surveillance system (BRFSS)?

Answer 35

Used by the United States to monitor at the state level behavioral risk factors that are associated with chronic diseases
~Interview questions designed to limit response bias as much as possible

Examples of data collected relate to:
~Health risk behaviors
~Preventive health practices
~Healthcare access

Question 36

What is the Youth Behavioral Risk Factor Surveillance System (YBRFFS)?

Answer 36

Sub-system called Youth Behavioral Risk Factor Surveillance System (YBRFFS)
~Targets minors specifically
~One of the only survey systems existing that interviews minors directly and without parental supervision (still requires parental consent)

Question 37

What are some Examples of organizations that provide international and foreign data regarding disease and health?

Answer 37

World Health Organization (WHO)
~Provides global infectious disease surveillance
~Yields data on health indicators
~Collects mortality data

European Union
~Public health data include social and health inequalities and determinants of health.

Question 38

What are some Disease reporting required internationally by World Health Organization through International Health Regulations?

Answer 38

Smallpox
Wild-type poliomyelitis
Severe acute respiratory syndrome (SARS)
Human influenza and coronaviruses caused by new subtypes
Any public health emergency of international concern