Integrated Health Interview Series Research Articles

The Association Between Physical Functioning and Healthcare Utilization Among Cancer Survivors

Previous studies have demonstrated financial strain among cancer survivors, partly mediated by healthcare expenditures due to the increased care cancer survivors require. Healthcare expenditures among adults aged ≥ 70 years are also associated with lower physical functioning as well as increased total medical visits. However, no study to-date has examined the association between physical functioning, healthcare expenditures, and total medical visits among adult cancer survivors of all ages. Thus, we sought to assess this relationship. Data on a number of health indicators are collected in noninstitutionalized civilian adults by the U.S. Medical Expenditure Panel Survey. For this study, harmonized data of participants reporting a cancer diagnosis were extracted from the Integrated Health Interview Series from 2007-2017. The Physical Component Score (PCS) is a validated measure of physical functioning ranging in score from 0 to 100 points, higher scores representing better health. Data was collected on counts of visits in several treatments settings as proxy for healthcare utilization such as inpatient, outpatient, emergency department, home health services, and “other” medical visits. Medical expenditure data was also collected that included all medical payments for such visits. Multivariable logistic regression defined adjusted odds ratios (AOR) with 95% confidence intervals (95CI) for healthcare utilization as dependent variable and PCS as an independent variable of interest. A separate model was also run for total medical expenditure as the dependent variable and PCS as an independent variable. Among 290,700 participants, adult cancer survivors were less likely to be in the top quartiles (Q3, Q4) of PCS scores relative to adults without cancer (20.33% vs 47.15%, AOR 0.78, 95CI 0.70-0.87, P<0.001). Having cancer was also associated with increased medical expenditures (median $4,845 vs $500, AOR 3.02, 95CI 2.53-3.61, P<0.001) and increased medical visits (median 0 [IQR 0, 1] vs. 0 [IQR 0, 3] visits, AOR 1.62, 95CI 1.51-1.74, P<0.001). Among 45,975 adult cancer survivors, those in Q1 of PCS score (lowest PCS score and worst physical functioning) had the highest medical expenditures relative to other quartiles (median $7,594 Q1; $3,256 Q2; $2,113 Q3; $2,181 Q4). Furthermore, adult cancer survivors in Q1 were more likely to have the highest medical visits (median visits: Q1 [referent], 1 [IQR 0, 6]; Q2, 0 [IQR 0, 2], AOR 0.67, 95CI 0.60-0.75, P<0.001; Q3, 0 [0, 1] AOR 0.50, 95CI 0.42-0.60, P<0.001; Q4, 0 [IQR 0, 1] AOR 0.43, 95CI 0.35-0.51, P<0.001). Lower physical functioning is associated with increased medical expenditure, medical visits and increase in healthcare utilization in cancer survivors. Lower physical functioning has been shown to predict higher mortality and morbidity. Our results show the need for improving physical functioning in cancer survivors which may mitigate the high healthcare costs incurred by this population.

Mental distress and mental health services receipt in foreign-born survivors of cancer: A national health interview survey analysis.

e19001 Background: There is a greater burden of mental illness, in survivors of cancer compared with the general population. Though mental health interventions may reduce mental distress and improve subsequent oncological outcomes, there are disparities in mental health service (MHS) receipt in immigrant populations. Therefore, we examined contemporary patterns of mental distress and mental health service receipt by immigrant status in cancer survivors in the United States. Methods: Data are collected in non-institutionalized civilian adults by the US National Health Interview Survey. For this study, harmonized data of participants reporting a cancer diagnosis were extracted from the Integrated Health Interview Series from 2009-2018. Sample weight-adjusted estimates of mental distress were defined by the validated Kessler 6 (K6). MHS receipt in the past 12 months was estimated, stratified by K6 status. Multivariable logistic regression defined adjusted odds ratios (AOR) and 95% confidence intervals (95CI) for the odds of MHS receipt, with birth status (US vs. non-US) as the primary independent variable of interest. Results: Among 14,653 adult survivors of cancer and 207,018 adults without cancer, 4.16% vs. 3.01% had K6 &gt;13, respectively (AOR 0.96, 95CI 0.87-1.07, P = 0.504). Among survivors of cancer, younger age, female sex, and white race were associated with K6&gt;13, while factors associated with lower MHS receipt included non-US born status, non-white race, and older age. The distribution of severe mental illness (K6&gt;13) did not differ by place of birth. However, non-US birth status was associated with lower MHS receipt among survivors of cancer with K6 &lt; 13 (5.61% vs 8.15%, AOR 0.67, 95CI 0.49-0.92, P = 0.013), and there was a greater disparity among those with K6&gt;13 (9.43% vs 37.8%, AOR 0.19, 95CI 0.08-0.45, P &lt; 0.001) (Pinteraction= 0.002). Conclusions: In this large contemporary cross-sectional survey, though there was a similar distribution of mental distress in survivors of cancer based on birth status, non-US born adults with severe mental distress (K613) were 81% less likely to receive MHS relative to US born adults. These data suggest that immigrant survivors of cancer who suffer from severe mental distress may be a greater risk not receiving appropriate MHS, which could lead to subsequent adverse outcome. Given the demonstrated gap in use of MHS in non-US born adults with cancer and severe mental distress, increased efforts are needed to screen for mental illness and the need for MHS in immigrant populations.

Health and Health Care Use Among Individuals at Risk to Lose Health Insurance With Repeal of the Affordable Care Act

This study uses the Integrated Health Interview Series of the 2015 National Health Interview Survey to assess the health and health care use by individuals at risk of losing of losing health insurance with repeal of the Affordable Care Act.

Relationships between tinnitus and the prevalence of anxiety and depression.

Quantify the relationships between tinnitus, and anxiety and depression among adults. Cross-sectional analysis of a national health survey. Adult respondents in the 2007 Integrated Health Interview Series tinnitus module were analyzed. Data for tinnitus symptoms and severity and reported anxiety and depression symptoms were extracted. Associations between tinnitus problems and anxiety, depression, lost workdays, days of alcohol consumption, and mean hours of sleep were assessed. Among 21.4 ± 0.69 million adult tinnitus sufferers, 26.1% reported problems with anxiety in the preceding 12 months, whereas only 9.2% of those without tinnitus reported an anxiety problem (P < .001). Similarly, 25.6% of respondents with tinnitus reported problems with depression, whereas only 9.1% of those without tinnitus reported depression symptoms (P < .001). Those reporting tinnitus symptoms as a "big" or "very big" problem were more likely to concurrently report anxiety (odds ratio [OR]: 5.7; 95% CI: 4.0-8.1; P < .001) and depression (OR: 4.8; 95% CI: 3.5-6.7; P < .001) symptoms. Tinnitus sufferers reported significantly fewer mean hours of sleep per night (7.00 vs. 7.21; P < .001) and greater mean days of work missed (6.94 vs. 3.79, P < .001) compared to those who did not report tinnitus. Mean days of alcohol consumption between the two groups were not significantly different. Tinnitus symptoms are closely associated with anxiety, depression, shorter sleep duration, and greater workdays missed. These comorbidities and sequelae should be recognized and addressed to optimally manage patients with chronic and bothersome tinnitus. 4 Laryngoscope, 2016 127:466-469, 2017.

Association between Non-Cigarette/Smokeless Tobacco and Hypertension in the National Health Interview Survey: A Pseudo-Panel Analysis

This study sought to examine assumption between having ever used non-cigarette tobacco or smokeless tobacco, and a diagnosis of hypertension among a sample of 13, 086 United States adults participating in the National Health Interview Series from 2012-2014. A pseudo-panel analysis of data extracted from the Integrated Health Interview Series Survey was conducted. The generalized linear mixed model was used to quantify the effect of a history of non-cigarette tobacco, smokeless tobacco, and socio-demographic predictor variables on the response variable, a diagnosis of hypertension. The transformed data, based on the pseudo-panel technique, resulted in fifty-seven (57) birth cohorts and followed in 2012, 2013, and 2014. The mean age was 51.6 years (±12.4). The findings of this study revealed that the odds of hypertension diagnosis for non-cigarette tobacco users was 0.8846 times lower (95% CI: 0.7907, 0.9896) than non-users after adjusting for possible confounders such as age, language, education, income and years of smoking. Our study suggested that the association between the use of non-cigarette tobacco and the diagnosis of hypertension among the sample population is consistent enough to assume a less plausible association between the two variables.

Association between Non-Cigarette/Smokeless Tobacco and Hypertension in the National Health Interview Survey: A Pseudo-Panel Analysis

This study sought to examine assumption between having ever used non-cigarette tobacco or smokeless tobacco, and a diagnosis of hypertension among a sample of 13, 086 United States adults participating in the National Health Interview Series from 2012-2014. A pseudo-panel analysis of data extracted from the Integrated Health Interview Series Survey was conducted. The generalized linear mixed model was used to quantify the effect of a history of non-cigarette tobacco, smokeless tobacco, and socio-demographic predictor variables on the response variable, a diagnosis of hypertension. The transformed data, based on the pseudo-panel technique, resulted in fifty-seven (57) birth cohorts and followed in 2012, 2013, and 2014. The mean age was 51.6 years (±12.4). The findings of this study revealed that the odds of hypertension diagnosis for non-cigarette tobacco users was 0.8846 times lower (95% CI: 0.7907, 0.9896) than non-users after adjusting for possible confounders such as age, language, education, income and years of smoking. Our study suggested that the association between the use of non-cigarette tobacco and the diagnosis of hypertension among the sample population is consistent enough to assume a less plausible association between the two variables.

Social Capital Accessibility of Intermarrieds

Grounded in Bourdieu’s social capital theory, the study’s purpose was to investigate social capital accessibility of intermarrieds compared to intramarrieds. Using the 2001 Integrated Health Interview Series data, two generalized linear models with Poisson distribution and identity link were performed: Model 1 compared intermarrieds to intramarrieds; Model 2 compared specific types of intermarrieds to intramarrrieds. Model 1 indicated that intermarrieds had less accessibility to social capital than intramarrieds. Model 2 indicated that intermarrieds, particularly interracially marrieds, had less social capital accessibility than intramarrieds, although the influence was moderate. Social capital accessibility of the interethnically or internationally marrieds was not significantly different from that of intramarrieds. Findings provide partial support to previous research concerning a lack of social capital accessibility for intermarrieds.

Cause, nature and care-seeking behaviour for injuries among community-dwelling older adults, USA, 2004–2013

ObjectiveTo describe the cause and nature of injuries, and care-seeking behaviour following injury, among community-dwelling older adults.MethodsWe used 10 years of the nationally representative Integrated Health Interview Series data, providing...

Disability, Health Insurance and Psychological Distress among US Adults: An Application of the Stress Process.

Structural resources, including access to health insurance, are understudied in relation to the stress process. Disability increases the likelihood of mental health problems, but health insurance may moderate this relationship. We explore health insurance coverage as a moderator of the relationship between disability and psychological distress. A pooled sample from 2008-2010 (N=57,958) was obtained from the Integrated Health Interview Series. Chow tests were performed to assess insurance group differences in the association between disability and distress. Results indicated higher levels of distress associated with disability among uninsured adults compared to their peers with public or private insurance. The strength of the relationship between disability and distress was weaker for persons with public compared to private insurance. As the Affordable Care Act is implemented, decision-makers should be aware of the potential for insurance coverage, especially public, to ameliorate secondary conditions such as psychological distress among persons who report a physical disability.

Non-linear associations between stature and mate choice characteristics for American men and their spouses.

Although male height is positively associated with many aspects of mate quality, average height men attain higher reproductive success in US populations. We hypothesize that this is because the advantages associated with taller stature accrue mainly from not being short, rather than from being taller than average. Lower fertility by short men may be a consequence of their and their partner's lower scores on aspects of mate quality. Taller men, although they score higher on mate quality compared to average height men, may have lower fertility because they are more likely to be paired with taller women, who are potentially less fertile. We analyzed data from The Integrated Health Interview Series (IHIS) of the United States (N = 165,606). Segmented regression was used to examine patterns across the height continuum. On all aspects of own and partner quality, shorter men scored lower than both average height and taller men. Height more strongly predicted these aspects when moving from short to average height, than when moving from average to taller heights. Women of a given height who scored lower on mate quality also had shorter partners. Shorter men faced a double disadvantage with respect to both their own mate quality and that of their spouses. Scores of taller men were only marginally higher than those of average height men, suggesting that being tall is less important than not being short. Although effect sizes were small, our results may partly explain why shorter and taller men have lower fertility than those of average stature.

(Un)Healthy Immigrant Citizens

This research argues that immigrants' political, social, and economic incorporation experiences, which are embedded in individual life course trajectories and heavily influenced by governmental policies, play an important role in producing diverse health outcomes among older U.S. foreign-born persons. Using data from the 2008-2010 American Community Survey and 1998-2010 Integrated Health Interview Series, we demonstrate how naturalization, a key indicator of social and political inclusion, is related to functional health in midlife and older age. Consistent with the theoretical framework, we find that among those foreign-born who immigrated as children and young adults, naturalized citizens show better health at older ages compared with noncitizens, although this relationship is partly mediated by education. But among those older foreign-born who immigrated at middle and older ages, naturalized citizens report worse health compared with noncitizens. Moreover, this negative health selection into naturalization becomes stronger for those naturalizing after the 1996 Welfare Reform Act.

Abstract 362: Impact of Veteran Status on Prevalence of Hypertension in Seniors

Background: Knowledge of risk factors for development of hypertension in elderly may contribute to prevention and screening efforts. Currently, it is unclear whether veteran status can be considered as a risk factor for hypertension in elderly population. In this study, we compared the prevalence of hypertension in elderly veterans and non-veterans. Methods: The Integrated Health Interview Series (IHIS) is a harmonized dataset for the U.S. National Health Interview Survey (NHIS). Using the IHIS 1997-2010 dataset, population-based prevalence of hypertension among elderly veterans (age ≥ 65) was compared to non-veterans. Veteran status was defined as a positive answer to the question, “Have you ever been honorably discharged from active duty in the U.S. Army, Navy, Air Force, Marine Crops, or Coast Guard?” Diagnosis of hypertension was based on self-report. Prevalence of hypertension was calculated for veterans and non-veterans. Sampling weights that adjust for the complex design of the NHIS were applied in all analyses presented. Statistical analyses were performed using SAS 9.0. Results: Overall 55.0% of elderly veterans reported to have hypertension compared to 57.5% of non-veteran civilians. (Rao-Scott chi square, p&lt;.0001). The prevalence of hypertension was higher among veterans (54.9% vs. 51.6%, p&lt;.0001) in men, but in women the prevalence was higher among non-veterans (59.0% vs. 57.1%, p=0.4). After adjusting for age, race, marital status, poverty level, Body Mass Index (BMI), education, smoking, and alcohol drinking status, elderly veterans showed 20% increased (OR 1.2, CI 1.1-1.3) risk for hypertension. Further stratified by gender, both in men and women the risk was increased by 10% with statistical significance. Conclusion: Overall the prevalence of hypertension was higher in non-veteran group. However, the logistic regression model revealed that history of being enrolled in military may have a lasting effect on the health of seniors.

Care From Family Physicians Reported by Pregnant Women in the United States

We describe the proportion of family physicians providing care of any sort to pregnant women in the United States from 2000 to 2009. We used a repeat, cross-sectional design with data from the nationally representative Integrated Health Interview Series (2000-2009) for respondents who reported being pregnant at the time of the survey (N = 3,204). Using multivariate logistic regression, we modeled changes over time in pregnant women's reports of care from family physicians. We used interaction terms to test for regional differences in trends. Approximately one-third of pregnant women reported having seen or talked to a family physician for medical care during the prior year, a percentage that remained stable for the period of 2000 to 2009 (adjusted odds ratio for annual change = 1.006). Most pregnant women reported care from multiple types of clinicians, including family physicians, obstetrician-gynecologists, midwives, nurse practitioners, and physician assistants. There were regional differences in trends in family physician care; pregnant women in the North Central United States increasingly reported care from family physicians, whereas women in the South reported a decline (6.7% annual increase vs 4.7% annual decrease, P ≥.001). Trends in family medicine care for pregnant women have remained steady for the nation as a whole, but they differ by region of the United States. Most pregnant women reported care from multiple clinicians, highlighting the importance of care coordination for this patient population.

Abstract 284: Association of Veteran Status with Hypertension Prevalence in Women

Background: The high prevalence of hypertension in the US adult population represents a serious public health challenge. High hypertension rates result in substantial cardiovascular morbidity and mortality and in elevated health care expenditures. A better understanding of risk factors for development of hypertension in adults may contribute to hypertension prevention efforts. Currently, it is unclear whether veteran status is associated with hypertension risk in women. The goal of this project was to assess the association between veteran status and risk of developing hypertension in women. Methods: The Integrated Health Interview Series (IHIS) is a harmonized dataset for the U.S. National Health Interview Survey (NHIS). Using the IHIS 1997-2010 dataset, population-based prevalence of hypertension among female veterans was compared to non-veterans. For the purpose of analysis, only Whites and African Americans were included in the sample dataset. Veterans were participants who answered ‘Yes’ to the question, “Have you ever been honorably discharged from active duty in the U.S. Army, Navy, Air Force, Marine Crops, or Coast Guard?” Diagnose of hypertension was self-reported. Regression models were performed to evaluate the association between veteran status and the risk of hypertension. Socio-demographic factors and health behaviors were accounted for in the analysis. Sampling weights that adjust for the complex design of the IHIS were applied to all analyses presented. Statistical analyses were performed using SAS version 9.0. Results: Veteran African American women aged 18-40 years of age had a hypertension prevalence rate of 14.8% while non-veterans had a prevalence rate of 14.2%. In White women the prevalence of hypertension was 8.7% among veterans and 7.9% in non-veteran civilians. Hypertension prevalence in African American women older than 40 was 39.1% among veterans and 56.4% in non-veterans (p&lt;0.0001). In White women of the same age-group the prevalence of hypertension was 37.7% among veterans and 39.6% in non-veteran civilians (p&lt;0.005). After adjusting for age, marital status, poverty level, Body Mass Index (BMI), education, smoking, alcohol drinking, and exercise, African American veterans were 24% less likely to have hypertension than non-veteran civilians with statistical significance (OR 0.76, CI 0.6-0.9). There was a 2% risk reduction for hypertension for White veterans but without statistical significance. Conclusion: The prevalence of hypertension was significantly lower in female veterans than in non-veteran females. African American female veterans were 24% less likely to have hypertension than non-veteran African American females, and this association remained significant after adjusting for socio-demographic and health behavior factors.

Recent Trends in Clinicians Providing Care to Pregnant Women in the United States

Health care needs of pregnant women are met by a variety of clinicians in a changing policy and practice environment. This study documents recent trends in types of clinicians providing care to pregnant women in the United States. We used a repeat cross-sectional design and data from the Integrated Health Interview Series (2000-2009), a nationally representative data set, for respondents who reported being pregnant at the time of the survey (N = 3204). Using longitudinal logistic regression models, we analyzed changes over time in pregnant women's reported use of care from 1) obstetrician-gynecologists; 2) midwives, nurse practitioners (NPs), or physician assistants (PAs); or 3) both an obstetrician-gynecologist and a midwife, NP, or PA. The percentage of pregnant women who reported seeing an obstetrician-gynecologist (87%) remained steady from 2000 through 2009. After controlling for demographic and clinical variables, the percentage who reported receiving care from a midwife, NP, or PA increased 4% annually (yearly adjusted odds ratio [AOR] 1.04; P < .001), indicating a cumulative increase of 48% over the decade. The percentage of pregnant women who received care from both an obstetrician-gynecologist and a midwife, NP, or PA also increased (AOR 1.027; P < .001), for a cumulative increase of 30%. The increasing role of midwives, NPs, and PAs in the provision of maternity care suggests changes in the perinatal workforce and practice models that may promote collaborative care and quality improvement. However, better data collection is required to gather detailed information on specific provider types, these trends, and their implications.

Use of the integrated health interview series: trends in medical provider utilization (1972-2008).

The Integrated Health Interview Series (IHIS) is a public data repository that harmonizes four decades of the National Health Interview Survey (NHIS). The NHIS is the premier source of information on the health of the U.S. population. Since 1957 the survey has collected information on health behaviors, health conditions, and health care access. The long running time series of the NHIS is a powerful tool for health research. However, efforts to fully utilize its time span are obstructed by difficult documentation, unstable variable and coding definitions, and non-ignorable sample re-designs. To overcome these hurdles the IHIS, a freely available and web-accessible resource, provides harmonized NHIS data from 1969-2010. This paper describes the challenges of working with the NHIS and how the IHIS reduces such burdens. To demonstrate one potential use of the IHIS we examine utilization patterns in the U.S. from 1972-2008.

Trends in the Association of Obesity and Self-Reported Overall Health in 30 Years of the Integrated Health Interview Series

This research examines trends in the relationship between obesity based on self-report height and weight and self-perceived health over a 30-year period. Importantly, this period included the articulation of comprehensive public health campaigns on excess weight and thus provides opportunities for assessment of the efficacy of the campaign, as well as the broader psycho-social impact of excess weight. Using novel data from the Integrated Health Interview Series, odds ratios for the association between obesity and self-perceived health were estimated for repeated cross-sectional samples that are nationally representative of noninstitutionalized American adults aged 18-85 and older spanning 1976-2006. Our findings show that (i) there are weak associations between obesity and self-perceived poor health; (ii) these associations are particularly small among men, often to the point of being nonexistent; and (iii) weak relationships for both men and women have remained virtually unchanged over the past 30 years. Several reasons why the public health campaign around excess weight has had limited traction are discussed including the collective problem of excess weight in America and how this undermines current approaches in public health efforts addressing excess weight.

A Half Century of Health Data for the U.S. Population: The Integrated Health Interview Series

The U.S. National Health Interview Survey (NHIS) is the world's longest survey time series of health data and a rich source of information on health conditions, behaviors, and care from the 1960s to the present. NHIS public-use files are difficult to use for long-term analysis, due to complex file structure, changes in questionnaire content, and evolving variable names and coding schemes. Researchers at the Minnesota Population Center have created the Integrated Health Interview Series (IHIS) to overcome these problems. IHIS provides access to thousands of consistently coded and well-documented NHIS variables on the Internet and makes it easy to analyze health trends and differentials. IHIS multiplies the value of NHIS data by allowing researchers to make consistent comparisons over half a century and thus to study U.S. health status as a dynamic process. This article describes the main features of IHIS and suggests fruitful avenues for historical research using these invaluable health data.

The Burden of Culture? Health Outcomes Among Immigrants from the Former Soviet Union in the United States

Immigrants in the U.S. often experience better health than the native-born, and many explanations for this phenomenon center around the positive health behaviors that immigrants bring from their home cultures. Immigrants from the former Soviet Union may be an exception; because they come from societies where unhealthy lifestyles and high mortality are common, they are often expected to experience worse health than the native population. Using data from the Integrated Health Interview Series, I compare FSU immigrants with U.S.-born, non-Hispanic whites on several health measures. FSU immigrants are twice as likely as native whites to report fair or poor health, but they are less likely to smoke or drink, and are less likely to report a functional limitation. FSU immigrants' advantage in functional limitation is largely explained by their very high levels of education and marriage, indicating that selectivity is important to understanding the health of this population.

Four decades of population health data: the integrated health interview series as an epidemiologic resource.

The National Health Interview Survey (NHIS) is a primary source of information on the changing health of the US population over the past 4 decades. The full potential of NHIS data for analyzing long-term change, however, has rarely been exploited. Time series analysis is complicated by several factors: large numbers of data files and voluminous documentation; complexity of file structures; and changing sample designs, questionnaires, and variable-coding schemes. We describe a major data integration project that will simplify cross-temporal analysis of population health data available in the NHIS. The Integrated Health Interview Series (IHIS) is a Web-based system that provides an integrated set of data and documentation based on the NHIS public use files from 1969 to the present. The Integrated Health Interview Series enhances the value of NHIS data for researchers by allowing them to make consistent comparisons across 4 decades of dramatic changes in health status, health behavior, and healthcare.