Federal Health Survey Research Articles

Overview of the 2019 National Health Interview Survey Questionnaire Redesign.

Data System. Federal health surveys, like the National Health Interview Survey (NHIS), represent important surveillance mechanisms for collecting timely, representative data that can be used to monitor the health and health care of the US population. Data Collection/Processing. Conducted by the National Center for Health Statistics (NCHS), NHIS uses an address-based, complex clustered sample of housing units, yielding data representative of the civilian noninstitutionalized US population. Survey redesigns that reduce survey length and eliminate proxy reporting may reduce respondent burden and increase participation. Such were goals in 2019, when NCHS implemented a redesigned NHIS questionnaire that also focused on topics most relevant and appropriate for surveillance of child and adult health. Data Analysis/Dissemination. Public-use microdata files and selected health estimates and detailed documentation are released online annually. Public Health Implications. Declining response rates may lead to biased estimates and weaken users' ability to make valid conclusions from the data, hindering public health efforts. The 2019 NHIS questionnaire redesign was associated with improvements in the survey's response rate, declines in respondent burden, and increases in data quality and survey relevancy. (Am J Public Health. 2023;113(4):408-415. https://doi.org/10.2105/AJPH.2022.307197).

Trends in Collection of Disaggregated Asian American, Native Hawaiian, and Pacific Islander Data: Opportunities in Federal Health Surveys.

Collection of data for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) persons that is disaggregated by ethnic subgroup may identify disparities that are not apparent in aggregated data. Using content analysis, we identified national population surveys administered by the US Department of Health and Human Services (HHS) and evaluated trends in the collection of disaggregated AANHPI data between 2011 and 2021. In 2011, 4 of 15 surveys (27%) collected disaggregated data for Asian American, 2 of 15 surveys (13%) collected data on Native Hawaiian, and 2 of 15 surveys (13%) collected disaggregated data for Pacific Islander people. By 2019, 14 of 21 HHS-administered surveys (67%) collected disaggregated data for Asian American (6 subgroups), 67% collected data on Native Hawaiian, and 67% collected disaggregated data on Pacific Islander (3 subgroups) people. Collection of disaggregated AANHPI data in HHS-administered surveys increased from 2011 to 2021, but opportunities to expand collection and reporting remain. Strategies include outreach with community organizations, increased language assistance, and oversampling approaches. Increased availability and reporting of these data can inform health policies and mitigate disparities. (Am J Public Health. 2022;112(10):1429-1435. https://doi.org/10.2105/AJPH.2022.306969).

Diabetes Prevalence Among Underserved Older Adults in the US: The Case of Native Hawaiians and Pacific Islanders

The effects of chronic diabetes among older adults in the United States represent ongoing challenges in diagnosis, treatment, comorbidities, amputations, and the increased risk of death. These challenges are made more complicated among underserved populations due to limited access to healthcare, medication costs, and later diagnosis of the condition. These issues are particularly true for the NHPI population, which has high rates of lifetime diabetes, greater levels of poverty, and inadequate health insurance. Useful statistics about diabetes among the NHPI have been difficult to obtain due to their small population size and lack of inclusion in federal health surveys. While early work by Panapasa examined prevalence among NHPI males in California, no reliable measures of diabetes among older NHPI’s existed at the national level. Released in 2017, the 2014 Native Hawaiian Pacific Islander National Health Interview Survey represents the first representative survey of the health and socio-economic correlates for this population, allowing the examination of health conditions such as diabetes at the national level. This presentation will examine the prevalence of diabetes among NHPI’s aged 60 and older and the impacts of this disease on overall health and quality of life. The paper will use the NHPI-NHIS to examine the use and access to diabetic medications and overall access to affordable health care. The paper will examine differences by age group, gender, immigration status, and ethnicity. While we know the overall prevalence of diabetes is high, this paper will offer new information on differentials within the older NHPI population.

Data Disaggregation with American Indian/Alaska Native Population Data

More than any other racial group, American Indian/Alaska Natives (AIAN) face the risk of imprecise survey estimates due to survey processes regarding the classification, tabulation, and weighting of race/ethnicity. Variations in approaches to classifying racial and ethnic populations in federal and state health statistics have substantial implications for how we measure health status, access to healthcare, healthcare quality, and health equity. We identify strategies to improve data capacity for AIAN in federal health surveys by exploring current approaches to collecting and coding of AIANs across eight population-based health surveys (seven federal surveys and the California Health Interview Survey). Our analysis assesses how different coding and weighting decisions affect the classification and measurement of the AIAN population by comparing single-race non-Hispanic/Latino AIAN to more expansive classifications that include not only those reporting AIAN race alone, but also individuals reporting AIAN race in combination with other races and/or in combination with Hispanic/Latino ethnicity. Our results provide insight into the representativeness of each survey on the AIAN population and our ability to draw conclusions about the health of the AIAN population and the health disparities they face. The results show considerable variation across surveys in their measurement of the AIAN population based on survey classification, tabulation, and weighting approaches.

Response Variations to Survey Items About Firearms in the 2004 and 2017 Behavioral Risk Factor Surveillance System.

The aim of this investigation was to document the prevalence and correlates of refusing to answer a US federal health survey item about firearms in the household. The cross-sectional analysis was conducted with 2004 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey data from Texas, Oregon, Idaho, California, Kansas, and Utah states whose surveys included items about firearms in the household. Probability-based samples of adults over the age of 18 (n = 34 488 in 2017 BRFSS; n = 33 136 in 2004 BRFSS). Dichotomized measure of whether respondents answered versus refused to answer "Are any firearms now kept in or around your home?" Weighted multiple logistic regression was used to assess how sociodemographic and health-related characteristics were associated with item refusal. Approximately 1.8% (95% CI: 1.6-2.1) of respondents in 2004 and 3.9% (95% CI: 3.4-4.5) of respondents in 2017 sample refused the firearms item (P < .01). Men were more likely than women (2004: adjusted odds ratio [aOR] = 1.81, 95% CI: 1.24-2.62; 2017: aOR = 1.60, 95% CI = 1.17-2.18) and Latino/a respondents were less likely than white respondents (2004: aOR = 0.24, 95% CI: 0.10-0.60; 2017: aOR = 0.21, 95% CI: 0.13-0.34) to refuse the firearms question. In 2004, refusal was more likely among older than younger respondents, but in 2017, age was not associated with refusal. Refusal to firearm-related survey items along sociodemographic characteristics warrants further research. Community-informed strategies (eg, focus groups, cognitive testing, in-depth interviews) could improve the context and wording of firearm-related items to maximize response to these items in public health surveys.

Identifying optimal survey-based algorithms to distinguish diabetes type among adults with diabetes

ObjectivesSurveys for U.S. diabetes surveillance do not reliably distinguish between type 1 and type 2 diabetes, potentially obscuring trends in type 1 among adults. To validate survey-based algorithms for distinguishing diabetes type, we linked survey data collected from adult patients with diabetes to a gold standard diabetes type. Research design and methodsWe collected data through a telephone survey of 771 adults with diabetes receiving care in a large healthcare system in North Carolina. We tested 34 survey classification algorithms utilizing information on respondents’ report of physician-diagnosed diabetes type, age at onset, diabetes drug use, and body mass index. Algorithms were evaluated by calculating type 1 and type 2 sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) relative to a gold standard diagnosis of diabetes type determined through analysis of EHR data and endocrinologist review of selected cases. ResultsAlgorithms based on self-reported type outperformed those based solely on other data elements. The top-performing algorithm classified as type 1 all respondents who reported type 1 and were prescribed insulin, as “other diabetes type” all respondents who reported “other,” and as type 2 the remaining respondents (type 1 sensitivity 91.6%, type 1 specificity 98.9%, type 1 PPV 82.5%, type 1 NPV 99.5%). This algorithm performed well in most demographic subpopulations. ConclusionsThe major federal health surveys should consider including self-reported diabetes type if they do not already, as the gains in the accuracy of typing are substantial compared to classifications based on other data elements. This study provides much-needed guidance on the accuracy of survey-based diabetes typing algorithms.

Telephone health survey estimates: Effects of nonresponse and sample limitations

The objective of this study was to assess nonresponse error in telephone health survey data based on an address-based sample. Telephone and in-person interviews in Greater Boston. Interviewers attempted telephone interviews at addresses that were matched to telephone numbers using questions drawn from federal health surveys. In-person household interviews were carried out with telephone nonrespondents and at addresses without matching telephone numbers. After adjusting for demographic differences, only eight of 15 estimates based on the telephone interviews lay within two standard errors of the estimates when data from all three groups were included. For health surveys of address-based samples, many estimates based on telephone respondents differ from the total population in ways that cannot be corrected with simple demographic adjustments.

Cognitive Testing of the Brief Breastfeeding and Milk Expression Recall Survey.

Major U.S. federal maternal and child health surveys collect an infant feeding history for children under 6 years of age using survey questions that have changed little over decades. Yet, infant feeding and lactation practices have changed with the increasing popularity of milk expression (pumping). Cognitive interviews were conducted to test the 9-item Brief Breastfeeding and Milk Expression Recall Survey (BaByMERS) with a diverse sample of 15 U.S. mothers of children 1-5 years of age. A 42-item coding scheme was applied to identify interviewer and respondent problems in fielding and answering the questions. Problems were examined in relation to demographics and infant feeding and lactation history. The extent of problems was modest. Of 42 possible problem codes, only 9 were identified as actual problems for one or more respondents on one or more questions. The most common problems involved uncertainty about the timing of when one started expressing milk, making a mental shift to realize that maternal milk expression and the child's consumption of that milk could be distinct concepts, and difficulty with certain terms or phrases. Problems tended to arise among mothers with more complex infant feeding or lactation histories, who also tended to be those with higher levels of education. BaByMERS is a promising, brief tool for collecting a recalled infant feeding or lactation history among mothers with young children. Future research can evaluate additional characteristics of the tool to further confirm its utility for large epidemiological studies of maternal and child health.

Current status of allergy prevalence in Germany: Position paper of the Environmental Medicine Commission of the Robert Koch Institute.

The lifetime prevalence of allergic diseases in adults in Germany [self-reported doctor diagnosed allergic diseases, Study on Adult Health in Germany (Studie zur Gesundheit Erwachsener in Deutschland, DEGS1, 2008–2011) of the Robert Koch Institute] is 8.6 % for asthma, 14.8 % for hay fever, 3.5 % for atopic dermatitis, 8.1 % for contact dermatitis, 4.7 % for food allergies, and 2.8 % for insect venom allergies. Almost 20 % of German adults are currently affected by at least one allergy.In tests on 50 common single allergens and two mixtures comprising either inhalant allergens or grass pollen allergens, 48.6 % of participants exhibited at least one allergic sensitization (specific IgE antibody detection). Overall, 33.6 % of participants were sensitized to inhalant allergens, 25.5 % to at least one food allergens, and 22.6 % to at least one insect venom allergens. A comparison of data on adults from 1998 [Federal Health Survey 1998 (Bundes-Gesundheitssurvey 1998, BGS98) of the Robert Koch Institute] and 2008–2011 (DEGS1) shows an increase in prevalence over time of almost three percentage points, while the rate of sensitization to inhalant allergens has increased from 29.8 % to 33.6 %. The prevalence of doctor diagnosed hay fever, atopic dermatitis, and food allergies, on the other hand, has remained virtually unchanged over the last 15 years.The Germany-wide lifetime prevalence of allergic diseases in children and adolescents [Study on the Health of Children and Adolescents in Germany (Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland, KiGGS initial survey, 2003–2006) of the Robert Koch Institute] was 4.7 % for asthma, 10.7 % for hay fever, and 13.2 % for atopic dermatitis. Altogether, 40.8 % of German children and adolescents were sensitized to at least one of the inhalant or food allergens measured, while 20.0 % were sensitized to at least one food allergen. A marked increase in hay fever prevalence among East German children in the 1990s has resulted in an alignment of prevalence rates in East and West Germany. In contrast to adults, there was no longer a discernible difference in the prevalence of asthma, hay fever, and allergic sensitization in children between the western and eastern German federal states.In international comparisons with prevalence data from other studies, the participating German centers are in the lower third of the distribution of frequency for both children and adults.

Abstract A76: Cancer control outcomes in Asian Americans: Using secondary data from large surveys to investigate populations with limited sample

Abstract Background: Cancer control researchers studying Asian Americans face many challenges in utilizing/analyzing health survey data due to limited sample sizes and population heterogeneity resulting in underrepresented in many health surveys. National-level initiatives have begun to address this problem, including a recent White House initiative to increase representation of Asian Americans and Pacific Islanders in research, data-collection, and analysis on AAPI populations and subpopulations. Within public health and specifically behavioral epidemiology, identifying and triangulating sources of data on Asian Americans can illuminate facilitate better understanding of health outcomes as well as behavioral mediators and moderators impacting this population. Purpose of Study: This project examines federal and state health surveys relevant to cancer control to: 1) identify sources and types of Asian American data, 2) identify the gaps in behavioral research in Asian Americans and 3) facilitate research in Asian American cancer health disparities. Special attention is paid to measurement of cancer control and prevention, including relevant health behaviors and social determinants. Method: Publically available health surveys including Asian-Americans will be presented and discussed, including but not limited to: the National Health Interview Survey, National Health and Nutrition Examination Survey, Health Information National Trends Survey, the Tobacco Use Supplement to the Current Population Survey, and the California Health Interview Survey. The analysis identifies how Asian Americans are reported and classified and highlights behavioral constructs relevant to cancer incidence and mortality. Differences between surveys will be presented along with an applied example of how data from different surveys may be merged together to create larger sample sizes to increase analytic power. Discussion: The results of this project will demonstrate the utility of using multiple data sets to better understand cancer-related outcomes in Asian American populations. The applied example of a combined analysis will address analytic challenges and opportunities in studying populations with small sample sizes and with heterogeneous sub-groups using available nationally representative data. Finally, we will discuss ways in which the available data can illuminate gaps in behavioral research in cancer control among Asian Americans. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A76.

Health Risks, Chronic Diseases, and Access to Care Among US Pacific Islanders

Because Pacific Islanders and Asian Americans have often been aggregated in federal health surveys, we assessed whether they differ substantially in important health measures. Retrospective analyses of the 2005-2007 Behavioral Risk Factor Surveillance System (BRFSS) surveys. A total of 2,609 Pacific Islanders, 17,892 Asians, and 894,289 whites over age 18. We compared self-reported health risk factors (smoking, BMI > or = 25 kg/m(2), alcohol intake, physical activity, fruit/vegetable intake), chronic diseases (diabetes, hypertension, coronary heart disease, asthma, hypercholesterolemia, arthritis, fair or poor health status), and access to care (insurance status, cost barriers, and regular physician) for Pacific Islanders relative to Asian Americans and whites. Logistic regression was used to adjust for sociodemographic factors. Pacific Islanders were more likely than Asian Americans to report an elevated body-mass index (adjusted odds ratio 2.26; 95% confidence interval 1.80, 2.84), current smoking (2.15; 1.57, 2.93), and high alcohol intake (3.14; 1.60, 6.18), but also more likely to report adequate physical activity (1.62; 1.23, 2.14). Pacific Islanders reported higher adjusted rates of hypertension (1.50; 1.06, 2.13), diabetes (1.82; 1.25, 2.63), asthma (2.32; 1.65, 3.25), and arthritis (1.68; 1.20, 2.35). Pacific Islanders also more frequently reported having fair or poor health (1.46; 1.05, 2.04). Most differences in self-reported health status and chronic disease outcomes were mediated by higher rates of overweight and obesity, but not higher rates of smoking, among Pacific Islanders. Differences in smoking, hypertension, and diabetes were more pronounced among Pacific Islander women than men. Relative to whites, Pacific Islanders were more likely to report a diagnosis of diabetes (1.56; 1.13, 2.14) and less likely to report arthritis (0.61; 0.46, 0.82). All other outcomes measures were statistically similar for whites and Pacific Islanders. Health surveys and policies should distinguish between Pacific Islanders and Asian Americans given the significantly higher rates of health risks and chronic diseases among Pacific Islanders.

Buyouts, Layoffs Can Be Toxic to Mental Health

Buyouts, Layoffs Can Be Toxic to Mental Health

Einzelindikator oder Index? Maße sozialer Differenzierung im Vergleich

We have examined whether the effects of indicators of social differentiation differ from index measures. The comparisons were performed with analyses on health inequalities. Several types of health impairment (subjective health, diabetes, 7-day prevalence of back pain) were considered in order to draw conclusions on the generalisability of the results. The effects of education, occupational position and income were examined alone and in combined analyses. These were compared with effects obtained by Winkler's index of socioeconomic status. In addition, an index of cumulative disadvantage was introduced. This includes the upper and the lower extreme categories of the three main indicators of social differentiation. The analyses were based on data of the Federal Health Survey 1998. Only the age groups between 30 and 65 years were considered. The available case number was n=4 692 men and women. Subjective health, diabetes and the 7-day prevalence of back pain were used as dependent variables. All analyses were performed using logistic regression. Differences between effect sizes were tested using the likelihood difference test. Effects of the three main indicators of social differentiation were obtained in nearly all analyses. This holds both if they had been considered alone or in combination. Use of Winkler's classification produced similar or smaller effect sizes than analyses with single indicators. Marked additive effects of single indicators (cumulative disadvantage) emerged for subjective health and for diabetes, but not for back pain. The application of index measures may conceal effects of single indicators, thus differential relationships may not be discovered. In studies on health inequalities, indices should not be used at all or only be used in combination with single indicators.

The Prevalence of Body Dysmorphic Disorder in the United States Adult Population

In clinical samples, body dysmorphic disorder (BDD) is associated with substantial suffering and reduced quality of life. Limited surveys report widely varying prevalence estimates. To better establish the prevalence of BDD, we conducted a United States nationwide prevalence survey. We conducted a random sample national household telephone survey in the spring and summer of 2004 and interviewed 2,513 adults, of whom 2,048 qualified for the BDD-module administration. The computer-assisted, structured interviews, conducted by trained lay interviewers, addressed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for BDD, along with information regarding several impulse-control disorders and the respondents' financial and demographic data. The rate of response was 56.3%, which compared favorably with rates in federal national health surveys. The cooperation rate was 97.6%. Respondents included a higher percentage of women and people >55 years of age than in the US adult population, and a lower percentage of Hispanics. The estimated point prevalence of DSM-IV BDD among respondents was 2.4% (49/2,048) (by gender: 2.5% for women, 2.2% for men), exceeding the prevalence of schizophrenia and bipolar disorder type I and about that of generalized anxiety disorder. BDD prevalence decreased after 44 years of age, and a larger proportion of BDD respondents were never married. Of those meeting DSM-IV criteria for BDD, 90% (45/49) met the DSM-IV distress criterion, and 51% (25/49) met the interference-with-functioning criterion. A study using clinically valid interviews is needed to evaluate these results. Such studies could inform treatment by documenting rates of seeking treatment from various sources, suicide attempt rates, and the prevalence of comorbid conditions.

Twenty-Five Years Of Health Surveys: Does More Data Mean Better Data?

Major increases in the resources devoted to the collection of health-related data and advances in survey methodology may be offset by more nonresponse and coverage bias resulting from privacy concerns, technological changes, and an increasingly complex health care environment. Hence, it is unclear whether policymakers today are basing their decisions on data that are of higher or even the same quality as those collected twenty-five years ago. We offer several recommendations for improving data quality, including changes related to Office of Management and Budget review, broad reexamination of the federal health survey portfolio, and greater investment in survey methods research.

Estimated Prevalence of Compulsive Buying Behavior in the United States

Objective: Compulsive buying (uncontrolled urges to buy, with resulting significant adverse consequences) has been estimated to affect from 1.8% to 16% of the adult U.S. population. To the authors’ knowledge, no study has used a large general population sample to estimate its prevalence. Method: The authors conducted a random sample, national household telephone survey in the spring and summer of 2004 and interviewed 2,513 adults. The interviews addressed buying attitudes and behaviors, their consequences, and the respondents’ financial and demographic data. The authors used a clinically validated screening instrument, the Compulsive Buying Scale, to classify respondents as either compulsive buyers or not. Results: The rate of response was 56.3%, which compares favorably with rates in federal national health surveys. The cooperation rate was 97.6%. Respondents included a higher percentage of women and people ages 55 and older than the U.S. adult population. The estimated point prevalence of compulsive buying among respondents was 5.8% (by gender: 6.0% for women, 5.5% for men). The gender-adjusted prevalence rate was 5.8%. Compared with other respondents, compulsive buyers were younger, and a greater proportion reported incomes under $50,000. They exhibited more maladaptive responses on most consumer behavior measures and were more than four times less likely to pay off credit card balances in full. Conclusions: A study using clinically valid interviews is needed to evaluate these results. The emotional and functional toll of compulsive buying and the frequency of comorbid psychiatric disorders suggests that studies of treatments and social interventions are warranted.

Estimated Prevalence of Compulsive Buying Behavior in the United States

Compulsive buying (uncontrolled urges to buy, with resulting significant adverse consequences) has been estimated to affect from 1.8% to 16% of the adult U.S. population. To the authors' knowledge, no study has used a large general population sample to estimate its prevalence. The authors conducted a random sample, national household telephone survey in the spring and summer of 2004 and interviewed 2,513 adults. The interviews addressed buying attitudes and behaviors, their consequences, and the respondents' financial and demographic data. The authors used a clinically validated screening instrument, the Compulsive Buying Scale, to classify respondents as either compulsive buyers or not. The rate of response was 56.3%, which compares favorably with rates in federal national health surveys. The cooperation rate was 97.6%. Respondents included a higher percentage of women and people ages 55 and older than the U.S. adult population. The estimated point prevalence of compulsive buying among respondents was 5.8% (by gender: 6.0% for women, 5.5% for men). The gender-adjusted prevalence rate was 5.8%. Compared with other respondents, compulsive buyers were younger, and a greater proportion reported incomes under 50,000 US dollars. They exhibited more maladaptive responses on most consumer behavior measures and were more than four times less likely to pay off credit card balances in full. A study using clinically valid interviews is needed to evaluate these results. The emotional and functional toll of compulsive buying and the frequency of comorbid psychiatric disorders suggests that studies of treatments and social interventions are warranted.

The evolution of educational inequalities in smoking: a changing relationship and a cross‐over effect among German birth cohorts of 1921–70

To investigate the evolution of the relationship between education and smoking behaviour (ever-smoking and age of initiation) among German birth cohorts of 1921-70. A total of 5297 respondents to the German Federal Health Survey of 1998 were divided into 10-year sex-birth-education cohorts. Self-reported smoking histories (ever-smoking and the age of starting smoking). There was an inversion of the educational gradient around the birth cohorts of 1931-40 for men and 1941-50 for women. For men, the educational cross-over in smoking was due to a stronger decrease of the ever-smoking prevalence of the highly educated compared to the least educated. In women it was due to a stronger increase in ever-smoking prevalence among the least educated compared to the highly educated. This educational cross-over effect was also be detected for the average age of starting smoking, and involved the same cohorts. Additionally, in the youngest birth cohorts the differences between the least and highest educated of each gender were greater than the differences between the genders. The educational differences in smoking prevalence are stable in men but in women they are widening. Hence, socio-economic inequalities in health due to smoking will rise in women in the next decades, while they will stabilize in men.

The Prevalence of Fullness, Heartburn and Nausea among Persons with and without Diabetes Mellitus in Germany

Gastrointestinal symptoms are commonly reported among persons with diabetes mellitus and are attributed to gastropathy as an expression of autonomic neuropathy. These symptoms are also frequent in the general population. The goal of this study was to compare the prevalence of fullness, heartburn and nausea in the German population among persons with and without diabetes mellitus. A cross-sectional study was performed using the German Federal Health Surveys 1987, 1991 and 1998, and involving a representative random sample of German citizens (n = 18 411) aged 25 to 69 years. A comparison was made of the prevalence of self-reported symptoms among persons with and without self-reported diabetes mellitus. Diabetes mellitus is significantly associated only with nausea in males (OR, 1.75) and in females (OR, 1.88). In both groups, persons with or without diabetes, the prevalence of fullness (28 vs. 21 %) and heartburn (23 vs. 18 %) are about the same, whereas nausea is much less common (12 vs. 6 %). Women suffered more often from nausea than men in people with diabetes and from fullness and nausea in non-diabetic patients. No correlation between age group and the percentage of persons (both sexes) suffering from a certain complaint can be found in persons with diabetes. The prevalence of some gastrointestinal symptoms is higher in persons with diabetes. It is related to gender, but not to age. The association with diabetic gastropathy remains unclear.

Commentary—How to Improve Federal Health Data for Coverage, Access, and State‐Specific Needs

Commentary—How to Improve Federal Health Data for Coverage, Access, and State‐Specific Needs