national population health survey 2004 congress of the humanities and social sciences all congress...
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NNationalationalPPopulationopulation
HHealthealthSSurveyurvey
2004 Congress of the Humanities and Social Sciences
All Congress Symposium - A Journey through data: the riches of the RDCs
Part 3 - Population Health: The National Population Health Survey (NPHS)
June 2, 2004, Winnipeg
France BilocqChief NPHS
Health Statistics Division
Statistics Canada
2
PresentationPresentation
Overview of population health surveys NPHS description NPHS content NPHS Microdata and documentation NPHS Usage Products and Web-sites
Overview of Population Heath SurveysOverview of Population Heath Surveys
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ObjectivesObjectives
Aid in the development of public policy; Understand the determinants of health; Collect data on the economic, social,
demographic, occupational and environmental correlates of health;
Increase the understanding of the relationship between health status and health care utilization;
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ObjectivesObjectives
Follow a panel of people to reflect the dynamic processes of health (NPHS);
Provide a means to supplement content and sample;
Provide the possibility of linking survey data to other data sourcesadministrative data
Population Health Population Health SurveysSurveys
NPHS Household
Longitudinal & X-sectional(National & Provincial)
NPHS North
Longitudinal & X-sectional(Territories)
NPHS Institutions
Longitudinal & X-sectional (-C3)(National)
HEALTH SURVEYS
1994-1999
Since 2000
HEALTH SURVEYS
NPHS Household
Longitudinal(National & Provincial)
NPHS Institutions
Longitudinal(National)
CCHS
Cross-sectional(Provinces + Territories)
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Population Health SurveysPopulation Health Surveys
NPHS
Cross-sectional and longitudinal
National, Provincial North component Institutions component
(national)
Core, focus, buy-ins & supplements
CCHS
Cross-sectional
National, provincial/ territorial & regional (health regions)
Common, selection of optional modules to fulfil health regions needs, sub-sample, buy-ins & supplements
NPHS descriptionNPHS description
Institutions component North component Household component Content
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NPHSNPHS
Cross-sectional (x-sec.)survey given population at one point in time
Longitudinal (Long.)designed to survey selected population
repeatedly over time
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NPHSNPHS
Started in 1994-1995 Conducted every two years
Cycle 1 (1994-1995): Household & Institutions & North (long, x-sec)
Cycle 2 (1996-1997): Household & Institutions & North (long, x-sec)
Cycle 3 (1998-1999): Household &North (long, x-sec), Institutions (long)
Cycle 4 (2000-2001): Household & Institutions (long.)
Cycle 5 (2002-2003): Household & Institutions (long.)
Cycle 6 (2004-2005): Household (long.)
…
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NPHS NPHS Institutions componentInstitutions component
Longitudinal & x-sectional: Cycles 1 & 2Strictly longitudinal: Cycle 3
Target populationNon autonomous residents of long term (more
then 6 months) health care establishments (4+ beds) in all provinces
• excludes the territories, Indian Reserves and Canadian Forces Bases, correctional facilities, prisons, young offender facilities, orphanages and religious institutions.
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NPHS NPHS Institutions componentInstitutions component
Designed to produce national estimates only. Cycle 1 Sampling frames
HSD residential care facilities listHSD hospitals list
Longitudinal sampleCycle 1 respondents: 2,287 longitudinal
sample. Cross-sectional sample C2: Top-up
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NPHS NPHS Institutions componentInstitutions component
Field operations conducted by STC Data collection: Jan y2 - May y2 Paper questionnaires
Institution control form • Ask about Institution policies
Respondent questionnaire• based on household « core » content• mostly in-person interviews
Collected mainly in person
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NPHS NPHS Institutions componentInstitutions component
High proxy rate (71% in C4) Next of kinInstitution staffFamily member
High mortality 1/3 each cycle Used to survey institutionalized respondents
from the household component
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NPHS NPHS North componentNorth component
Longitudinal & x-sectional C1, C2 and C3Longitudinal data C3 not processed)
Target populationhousehold residents aged 12 + living in each
territory (+ Nunavut in C3)• excludes Indian reserves, Canadian Forces Bases
and unorganized or extreme remote areas
Designed to produce estimates at the territory level.
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NPHS NPHS North componentNorth component
C1 Sample size: 2,000 Cross-sectional sample C2 and C3: top-up Integrated NPHS / NLSCY survey
reduce respondent burden Field operations conducted by Yukon & NWT
statistical agenciesCollection challenges (moving/scattered
population)
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NPHS NPHS North componentNorth component
Data collection: November y1 - March y2 Paper questionnaire
includes most of household « core » content Collected in person & by telephone data
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NPHSNPHS Household componentHousehold component
Target populationHousehold residents all ages in all provinces
• excludes Indian reserves, Canadian Forces Bases and some remote areas in northern Québec & Ontario
Children aged 0-11 (2,022) collected via NLSCY in C1 and « repatriated » in NPHS in C2
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NPHSNPHS Household componentHousehold component
Designed to produce provincial & national level estimates
Cycle 1 sampling frameBased on Labour Force Survey (LFS) frame &
Enquête sociale et de santé (Québec only)• Sample of households• One member selected per household at collection
longitudinal panel
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NPHSNPHS Household componentHousehold component
Longitudinal sampleCycle 1 responding selected members +
children from NLSCY formed the NPHS longitudinal panel 17,276.
Subsequent cycles from C2 and on
Survey same panel of respondents.
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NPHSNPHS Household componentHousehold component
Province Longitudinal sample Cycle 1 (1994-1995)
Nfld 1,082 P.E.I. 1,037 N.S. 1,085 N.B. 1,125 Qc 3,000 Ont. 4,307 Man. 1,205 Sask. 1,168 Alta 1,544 B.C. 1,723 Total 17,276
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NPHSNPHS Household componentHousehold component
NPHS x-sectional samples:Longitudinal sample (panel)
• 17,276 respondents selected in C1• Except 0-11 in C1, partials and deaths
Buy-ins ($) (C1+C2)• Sample bought by provinces to increase
geographical resolution
Top-ups (C3)• Sample to complement the panel to obtain good x-
sectional representation
NPHS Household componentNPHS Household component Cross-sectional samples compositionCross-sectional samples composition
Cycle 1 Cycle 2 Cycle 3
Longitudinal Longitudinal Longitudinal Panel Panel Panel
Excluding Excluding ExcludingKids 0-11 Partials PartialsPartials Deaths Deaths
Buy-in (3,000) Buy-in (65,000) Top-up (4,000)
Total: 17,626 Total: 17,244
Total: 81,804
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NPHSNPHS Household componentHousehold component
C1 (1994-1995) buy-in for x-sec sampleOntario ( 1500 hhlds) & Manitoba ( 400
hhlds)• Sub-provincial geography (health district/region)
N.B. ( 150 hhlds) & B.C. (800 hhlds)• Increase coverage of certain areas only
Sampling: RDD method for B.C. LFS design elsewhere
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NPHSNPHS Household componentHousehold component
C2 (1996-1997) buy-in for x-sec sampleOntario, Manitoba, AlbertaSub-provincial geography (health district/region)
• Ont.: 6 major regions with sub-regions (37,800 hhlds)• Man.: 11 regions ( 11,200 hhlds, incl. 0-11)• Alta.: 17 regions ( 13,500 hhlds, incl. 0-11)
Sampling: RDD method
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NPHSNPHS Household componentHousehold component
C3 (1998-1999) top-up for x-sec sampleAll provincesTo be representative of 1998-1999 population
• Added births and immigrants – Selected from LFS rotate-out samples ( 1,300 hhlds)
• Added Cycle 1 non-respondents, unable to trace– ( 2,800 hhlds)
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NPHSNPHS Household componentHousehold component
Sample summaryFor 1st three cycles, data were collected to
serve both longitudinal and x-sectional purposes
Longitudinal:• 17,276 (same sample for all cycles)• Results drawn from the longitudinal data will
always relate to the 1994-1995 Canadian population
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NPHSNPHS Household componentHousehold component
Cross-sectional:• Longitudinal + supplementary samples• Supplementary samples:
– provincial buy-ins and/or top-up samples– not followed up from one cycle to the other
• Results drawn from the cross-sectional always refers to the years data were collected e.g. C3 data represents the 1998-1999 Canadian population
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NPHSNPHS Household componentHousehold component
Field operations conducted by STC Data collection: June y1 - June y2
Q1-Q4 plus Q5• operational reasons / seasonality
Questionnaire Computer Assisted Interview 55 minutesContent development (Provincial Ministries of
Health, Health Canada, data users, researchers …)Built in skip patterns & edits
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NPHSNPHS Household componentHousehold component
Collected in-person for C1, by telephone from C2 and on
From C1 to C3 (longitudinal & X-sectional): Two questionnaires : General & Health
• «General» used to collect health data from all household members
– household composition may be different from one cycle to the other
• «Health» used to collect more detailed health data from 1 selected member (include longitudinal panel member).
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NPHSNPHS Household componentHousehold component
Cycle 1 Cycle 2 Cycle 31994-1995 1996-1997 1998-1999
Selected people 17,626 81,804 17,244(Health file)
Total number of household membersincluding the selected people 58,439 210,377 49,046(General file)
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NPHSNPHS Household componentHousehold component
From C4 and on (longitudinal only)One questionnaire
• Combines general and health questionnaires– Roster of household members like for C123– Household information collected from longitudinal
respondent to derive household related characteristics
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NPHSNPHS Household componentHousehold component
Cycle 1 Cycle 2 Cycle 3 Cycle 4 Cycle 51994-1995 1996-1997 1998-1999 2000-2001 2002-2003
Longitudinal Full file 17,276 15,666* 14,618** 13,582 12,546Full response at each cycle
* C2 Master file: 15,670 records, 4 records miscoded to deceased ==> non-response
** C3 Master file: 14619 records, 1 record miscoded to deceased ==> non-response
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NPHS Household componentNPHS Household component
Interviewer training, manuals, guide Respondents’ relations strategy
Introduction letter Gifts (Calendar, fridge magnet, medical wallet kit)Brochure Newspaper clip (C6)Thank you letter
• Roulette with NPHS results
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NPHS Household componentNPHS Household component
Non-response: Refusal and no contact letterResends in subsequent QsWeights adjustment
TracingLongitudinal sample onlyProvide change of address cardUse contacts provided by respondentOther (Post office, Canada 411,WEB, etc.)If traced then interview
NPHS ContentNPHS Content
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NPHS ContentNPHS Content
Common to all cycles Changes: focus, addition, brought back… Supplements - separate data outputs
C1 Health Promotion Survey (Health Canada)C2 asthma (Health Canada)C3 Food Insecurity (HRDC)
Buy-In
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NPHS Content - All cyclesNPHS Content - All cycles
Alcohol consumption Blood pressure check Chronic conditions * Drug use General Health Health Care Utilisation * Health Status (HUI) Height / weight Injuries Insurance (not C1) Mental Health Physical activities Restriction of activities *
Repetitive strain (not C1) Self-perceived health Smoking Social support Two-week disability (not C4...) * Women’s / Preventive health Household composition * Education * Income * Labour force * Socio-demographic
characteristics * Survey administration
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NPHS ContentNPHS Content
StressSelf-esteem, C1, C4Ongoing problems C5, core as of C6Recent life events C1, C4Childhood & adult stressors C1, C4Work stress C5 core as of
C6Mastery C5 core as of C6Self-perceived stress C4 +Sense of coherence C1 & C3
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NPHS ContentNPHS Content
Access to services, C2Blood pressureBreast feedingDental visitsEmergency servicesEye examinationsFlu shotsInsurance coverage Alcohol dependence + opinion C2, C5
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NPHS ContentNPHS Content
Diet / Nutrition C3, C5, C6 Family medical history C3 Self-care C3 Smoking
Tobacco alternatives C3Strength C5+Dependence C6+ Smoking initiation C6+
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NPHS ContentNPHS Content
Chronic conditions C4ArthritisHeart diseaseDiabetes
Sleep C5, core as of C6 Body image C5, core as of C6 Family history: depression C6 General: Life satisfaction C6
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NPHS ContentNPHS Content
Coping (16 questions CCHS) C6 Household level of education C6 Added income category C6
$80,000 - $100,000
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NPHS Content – NPHS Content – SupplementsSupplements
Health Canada, Health Promotion Survey C1 Alcohol during pregnancy Breastfeeding Body image Health care services Injury prevention Nutrition choices, habits Sexual health Smoking - attitude Sources of health information
C2: Health Canada, Asthma C3: HRDC, Food insecurity
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NPHS NPHS Content - Buy-inContent - Buy-in
Health Canada, Health Promotion Survey, C2Breast self-examinationSexual health HIVNutrition choices, habitsFood insecurityBreastfeedingPregnancyRoad safety Alcohol - attitude Smoking - attitude
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NPHS Content - Buy-inNPHS Content - Buy-in
Manitoba Coping C1
Alberta Attitude toward parents C1 Coping C1 & C2 Sources of health information C2 Sexual health C2 Social support C2 Health services / child health services C2 Tanning / UV exposure C2 Violence & personal safety C2
Health Canada Residence history (20 years) C5
NPHSNPHS
MicrodataDocumentation
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Master
MicrodataMicrodata
RecordsVariables
SharePUMF
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NPHS MicrodataNPHS Microdata
Master FileStatistics CanadaResearch Data Centres (RDCs)Remote AccessHousehold Cycle 1, 2 and 3
• Cross-sectional: General and health master fileHousehold Cycle 2 and 3
• Longitudinal – Full Household Cycle 4 +
• Longitudinal (subsets)
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NPHS- MicrodataNPHS- Microdata
As of C4: Master file: contains all panel members (17,276)
4 subsets of respondents (flags, sampling weights and bootstrap weights) 1. Longitudinal Square (complete panel; 17,276 records)
2. Longitudinal Full- Master (Complete response in all cycles)
3. Longitudinal Full Extreme - Master (Complete response in extreme cycle e.g. for C5: C1 and C5)
4. Longitudinal Full - Share (Complete response in all 5 cycles + agree to share; 12,221 records)
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NPHS MicrodataNPHS Microdata
Master FileInstitutions Cycle 1 and 2
• Cross-sectional • Longitudinal
Institutions Cycle 3, 4 and 5• Longitudinal
North Cycle 1 and 2• Cross-sectional• Longitudinal
North Cycle 3• Cross-sectional
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NPHS MicrodataNPHS Microdata
Master FileAsthma and Food insecurity master file available in
RDC upon request only
Share FileTo be used by share partners: Health Canada and
provincial Ministries of health Same pattern as Master except for supplements.Only contains respondents who agreed to shareHousehold, Institutions: sharing rate 96%North: no provision for data sharing
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NPHS MicrodataNPHS Microdata
Public Use Microdata File (PUMF)Household Cycles 1, 2 and 3, General and health
• Cross-sectional only
Institution Cycles 1 and 2• Cross-sectional only
Health Promotion Survey (Supplement C1)• Available in RDC upon request
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NPHS - DocumentationNPHS - Documentation
DocumentationUser guide: PUMFLongitudinal documentation
• Collection, processing, response rate, weighting, variable naming convention, etc.
QuestionnairesData dictionaryRecord layout (SAS & SPSS)Derived variables document
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NPHS - DocumentationNPHS - Documentation
8 characters in length Example: DHC6_AGE
1–2 variable section name DH: Demographic/ Hhld section
3 survey type C: Core content
4 year (4, 6, 8 …) 6: 1996-97 cycle
5 variable type _: From question.
6–8 variable name/number AGE: variable name
Will not match original 1994: conversion layouts available
NPHS - UsageNPHS - Usage
Rules Complex design Weights Attrition
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NPHS – Usage “Rules”NPHS – Usage “Rules”
Only statistical aggregates may be published
Aggregates released must not identify a person, business or organisation directly or indirectly
Information can not be released before the official release by Statistics Canada
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NPHS – Usage “Rules”NPHS – Usage “Rules”
Respondent information can not be linked to administrative health records without consent to do so from the respondent (linking question)Share partners obtain link file upon request
• For respondents who agreed to both sharing and linking data.
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NPHS – Usage “Rules”NPHS – Usage “Rules”
Master file and share files are to be treated as confidential and must be protected.
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Stratum #1
Stratum #2
#1: Each province was divided into strata
#2: Clusters selected within strata (PPS sampling) (1st stage)
#3: Dwellings selected within clusters (2nd stage)
#4: Respondent selected within responding dwellings (3rd stage)
ProvinceProvince
NPHS NPHS Usage – Complex DesignUsage – Complex Design
COMPLEX DESIGN
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NPHS NPHS Usage – Complex DesignUsage – Complex Design
Variance estimation with complex multistage cluster sample designNo exact formula for estimationApproximate approach required
Approximate methods for variance estimation:Taylor linearizationReplication methods
• Balanced Repeated Replication• Jackknife• Bootstrap
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Bootstrap weightsComplex survey design => no formula for variance
estimationBootstrap weights are provided (500)
• For each subset of respondents
Bootvar (macros)Totals, ratios, differences of ratios, linear & logistic
regression parametersSAS & SPSS
NPHS NPHS Usage – Complex DesignUsage – Complex Design
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Household Bootstrap weights
• All cycles , all master files , all share files• No bootstrap weights for the PUMFs
InstitutionsBootstrap weights starting in C3
North No bootstrap weightsProvide SAS program to estimate variance
NPHS NPHS Usage – WeightsUsage – Weights
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Household component Cycle 1, 2, 3 Creation of cross-sectional coordinated
bootstrap weightsCross-sectional samples for C1, 2, 3 not completely
independent (include longitudinal panel members) Impact reduce varianceFor General and Health filesMaster and Share files, Cycles 1, 2 and 3 CD-ROM in RDCs
NPHS NPHS Usage - WeightsUsage - Weights
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Post-stratification based on Census projectionsCycles 1, 2 based on 1991 censusCycles 3, 4 and 5, based on 1996 Census
• Previous files not changed
NPHS NPHS Usage - WeightsUsage - Weights
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NPHS – Usage AttritionNPHS – Usage Attrition
Attrition longitudinal household componentGeneral definition
Loss in sample size due to deaths, non-response, movements out-of-scope and untraceable situations
NPHS definition: Loss in sample size due to non-response and
untraceable situations– No out-of-scope– Deaths are considered as a response
(analytical value)
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NPHS – Usage AttritionNPHS – Usage Attrition
Cycle 1 1994-95
Cycle 5 (Full-Master)
2002-2003 Sexe
Count Count % Men 8,047 5,661 29.7 Women 9,229 6,885 25.4 Total 17,276 12,546 27.4
Cycle 1 1994-1995
Cycle 5 (Full-Master)
2002-2003
Province (Cycle1)
Count Count % Nfld 1,082 822 24.0 PEI 1,037 803 22.6 N.S. 1,085 775 28.6 N.B. 1,125 824 26.8 Qc 3,000 2,189 27.0 Ont. 4,307 2,990 30.6 Man. 1,205 921 23.6 Sask. 1,168 922 21.1 Alta 1,544 1,111 28.0 B.C. 1,723 1,189 31.0 Canada 17,276 12,546 27.4
Observed attrition (Full-Master) after 5 cycles
Cycle 1 1994-95
Cycle 5 (Full-Master)
2002-2003
Age groups (years)
Count Count % 0 to 11 2,022 1,676 17.1
12 to 19 1,584 1,053 33.5
20 to 34 4,220 2,739 35.1
35 to 54 5,006 3,570 28.7
55 and over 4,444 3,508 21.1
Total 17,276 12,546 27.4
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NPHS – Usage AttritionNPHS – Usage Attrition
A different look at attrition Use any combination of 2 consecutive cycles as
the unit of analysis (person-year unit).
From Cycle 4 Master file: • Potential sample of 51,828 (3*17,276) person-year units• Reduced to 44,700 because of non-response (86%)
From Cycle 5 Master file: • Potential sample of 69,104 (4*17,276) person-year units• Reduced to 58,080 because of non-response (84%)
NPHS NPHS
Products WEB Contacts
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NPHS ProductsNPHS Products
CANSIM II main dissemination vehiclex-sectional tabulations from NPHS 1st three
cycles tablefew longitudinal tabulationscounts, % and confidence intervalsnational & provincial levelsage and sex
Canadian Statistics E-Pubs: Health Indicators
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NPHS ProductsNPHS Products
Health ReportsSTC quarterly publicationWide range of analytical articles based on
the NPHS14 (4), released
• Repetitive strain injuries.
15 (1) released, Daily January 21, 2004 Stress, health and the benefit of social support Incident arthritis in relation to excess weight
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NPHS ProductsNPHS Products
Joint STC - CIHI publications“How Healthy are Canadians”“Health Care in Canada”
• both are annual publications
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WEB SitesWEB Sites
NPHS questionnaires and documentation are available on STC ’s Web site at:www.statcan.ca/health_surveys
Main entry point for analytical products and tabular statisticshttp://www.statcan.ca/cgi-bin/downpub/
freepub.cgi?subject=2966#2966
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Contact InfoContact Info
Mario Bédard, Data Access Unit, Population Health Surveys
Health Statistics Division, Statistics Canada (613) 951-8933,
mario.bedard@statcan.ca nphs-ensp@statcan.ca
France Bilocq, Chief, NPHS Health Statistics Division, Statistics Canada
(613) 951-6956, france.bilocq@statcan.ca
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