Local Health Survey Research Articles

Addressing selection biases within electronic health record data for estimation of diabetes prevalence among New York City young adults: a cross-sectional study

IntroductionThere is growing interest in using electronic health records (EHRs) for chronic disease surveillance. However, these data are convenience samples of in-care individuals, which are not representative of target populations...

Immigrant assimilation in health care utilisation in Spain

Abundant evidence has tracked the labour market and health assimilation of immigrants, including static analyses of differences in how foreign-born and native-born residents consume health care services. However, we know much less about how migrants’ patterns of healthcare usage evolve with time of residence, especially in countries providing universal or quasi-universal coverage. We investigate this process in Spain by combining all the available waves of the local health survey, which allows us to separately identify period, cohort, and assimilation effects. We find robust evidence of migrant assimilation in health care use, specifically in visits to general practitioners and emergency care and among foreign-born women. The differential effects of ageing on health care use between foreign-born and native-born populations contributes to the convergence of utilisation patterns in most health services after 15 years in Spain. Substantial heterogeneity by the time of arrival and by region of origin both suggest that studies modelling future welfare state finances would benefit from a more thorough assessment of migration.

Generating data to facilitate more equitable distribution of health resources: an illustration of how local health surveys can identify probable need in mixed socio-economic regions

ObjectivesThis study aimed to (1) encourage allocation of governmental and grant funds to the administration of local area health surveys and (2) illustrate the predictive impact of socio-economic resources on adult health status at the local area level to provide an example of how health surveys can identify residents with the greatest health needs. Study designRandomly sampled and weight-adjusted regional household health survey (7501 respondents) analyzed with categorical bivariate and multivariate statistics, combined with Census data. Survey sample consists of the lowest, highest, and near highest ranked counties in the County Health Rankings and Roadmaps for Pennsylvania. MethodsSocio-economic status (SES) is measured regionally with Census data consisting of seven indicators and individually with Health Survey data consisting of five indicators based on poverty level, overall household income, and education. Both of these composite measures are examined jointly for their predictive effects on a validated health status measure using binary logistic regression. ResultsOnce county-level measures of SES and health status are broken down into smaller areas, better identification of pockets of health need is possible. This was most strongly revealed in an urban county, Philadelphia, which is ranked lowest of 67 counties on health measures in the state of Pennsylvania, yet when broken down into ‘neighborhood clusters’ contained both the highest- and lowest-ranked local area in a five-county region. Overall, regardless of the SES level of the County subdivision one lives in, a low-SES adult has close to six times greater odds of reporting ‘fair or poor health status’ than does a high-SES adult. ConclusionLocal health survey analysis can lead to a more precise identification of health needs than surveys attempting to cover broad areas. Low-SES communities within counties, and low-SES individuals, regardless of the community they live in, are substantially more likely to experience fair to poor health. This adds urgency to the need to implement and investigate socio-economic interventions, which can hopefully improve health and save healthcare costs. Novel local area research can identify the impact of intervening variables such as race in addition to SES to add more specificity in identifying populations with the greatest health needs.

ZIP Code-Level Estimates from a Local Health Survey: Added Value and Limitations.

We assessed the added value and limitations of generating directly estimated ZIP Code-level estimates by aggregating 5years of data from an annual cross-sectional survey, the New York City Community Health Survey (n = 44,886) from 2009 to 2013, that were designed to provide reliable estimates only of larger geographies. Survey weights generated directly-observed ZIP Code (n = 128) level estimates. We assessed the heterogeneity of ZIP Code-level estimates within coarser United Hospital Fund (UHF) neighborhood areas (n = 34) by using the Rao-Scott Chi-Square test and one-way ANOVA. Orthogonal linear contrasts assessed whether there were linear trends at the UHF level from 2009 to 2013. 22 of 37 health indicators were reliable in over 50% of ZIP Codes. 14 of the 22 variables showed heterogeneity in ≥4 UHFs. Variables for drinking, nutrition, and HIV testing showed heterogeneity in the most UHFs (9-24 UHFs). In half of the 32 UHFs, >20% variables had within-UHF heterogeneity. Flu vaccination and sugary beverage consumption showed significant time trends in the largest number of UHFs (12 or more UHFs). Overall, heterogeneity of ZIP Code-level estimates suggests that there is value in aggregating 5years of data to make direct small area estimates.

Gender-specific correlates of perceived life stress: a population-based study, Montreal, Canada, 2012

To identify the gender-specific correlates of perceived life stress in a representative sample of theMontreal population. Data were extracted from theLocal Health Survey Program (called "TOPO") collected in 2012. TOPO-2012 provided information on chronic diseases, their determinants and risk factors, as well as lifestyle and health services utilization. Poisson regression was used to identify significant correlates of perceived life stress. Single-parent females were 21% more likely (RR = 1.21; 95% CI = 1.04-1.42) to report stressful life compared to females living alone. Females born in Canada or established female immigrants were significantly more likely to report stressful life (respectively RR = 1.34; 95% CI = 1.12-1.60 and RR = 1.31; 95% CI = 1.08-1.58) than recent female immigrants. Furthermore, females living in a privileged material neighbourhood reported significantly higher perceived life stress (14% higher) than females living in a deprived neighbourhood. On the other hand, males with higher annual household income were 9% more likely (OR = 1.09; 95% CI = 1.05-1.14) to perceive life stress than males reporting a lower income. Also, overweight males reported higher stress (RR = 1.13; 95% CI = 1.01-1.26) than their normal weighted counterparts. Additionally, males who were diagnosed with a physical health problem were more likely to report stressful life (RR = 1.44; 95% CI = 1.28-1.61) than males who did not report any physical health problem. Identifying correlates of stress at the population level may help researchers characterize people vulnerable to daily stress, provide health agencies the advantage to forecast and prevent its occurrence and diseases associated with it, as well as offer policy advocates a pivotal edge to reduce disparities in population health.

A Health Impact Assessment of California’s Proposed Cap-and-Trade Regulations

To identify unintended health effects of California's controversial cap-and-trade regulations and establish health-promoting policy recommendations, we performed a health impact assessment. We used literature reviews, public data, and local health surveys to qualitatively assess potential health risks and benefits related to changes in employment and income, energy costs, effects of emission offset projects, and cobenefits from the allocation of program revenue. We examined case studies from various communities to find existing social, economic, and environmental health conditions. We found that policy implementation will minimally impact job creation (< 0.1% change) and that health effects from job sector shifts are unlikely. Fuel prices may increase (0%-11%), and minor negative health effects could accrue for some low-income households. Offset projects would likely benefit environmental health, but more research is needed. Allocating some program revenue for climate change adaptation and mitigation would have substantial health benefits. Health impact assessment is a useful tool for health agencies to engage in policy discussions that typically fall outside public health. Our results can inform emission reduction strategies and cap-and-trade policy at the federal level.

Utilização de medicamentos e fatores associados: um estudo de base populacional no Município de Campinas, São Paulo, Brasil

This article analyzes prevalence rates in the use of medication according to demographic, socioeconomic, and health-related behavioral variables through a population-based cross-sectional study of individuals 18 years and older (n=941) in Campinas, São Paulo State, Brazil. The study used multistage sampling, both stratified and cluster. Chi-square test was performed, and adjusted prevalence ratios were estimated by gender and age, both with 95% confidence intervals. A Poisson multiple regression model was developed, and the following factors were associated with use of medication: female gender, age 40 and over, reported illness in the previous two weeks, and number of chronic diseases. The most widely consumed drugs were for the cardiovascular and nervous systems, besides herbal remedies. Prevalence of medication in Campinas was lower than in most studies. Local health surveys could help identify drug use patterns and guarantee more appropriate interventions for pharmaceutical care policy.

Health status of the Bulgarian population: social determinants, recent dynamics and policy implications

This paper sets out to review the situation with regard to health status of the Bulgarian population and its main determinants. Revealing their recent dynamics, the study also aims to predict the future trends. It tries to interrelate the diseases burden and its determinants with necessary policy responses. High lighting the main challenges it draws out policy implications. The methods involve analysis of the current demographic and health situation and assessment of its dynamics. Some trends are analyzed comparatively for the different gender and residence population groups. The study is based on an analysis of previously published reports and official statistics. It also draws upon a number of national and local health surveys. Targeted and sustained investment is necessary to reverse the negative trends of population health and its social determinants. Clearly formulated, evidence-based, comprehensive and consistent policy is needed for integrated control of risk factors and chronic diseases, emphasizing on prevention and health promotion. Tangible political commitment, multisectoral collaboration and public participation are required for developing, implementing and sustaining healthy public policies. Scripta Scientifica Medica 2008; 40(2): 111-116.

La otra transición epidemiológica: hitos en el desarrollo de la epidemiología de los factores de riesgo en Colombia

The history of risk factor epidemiology is detailed as it emerged in Colombia as well as more recent developments. The origins of risk factor epidemiology are described in the context of the national health situation of the mid-20th century, when changes were occurring in the profiles of infectious and nutritional diseases in comparison to chronic diseases and traumatisms. The main achievements in the history of national risk factor epidemiology are described, including: the studies on endemic goiter, gastric and uterine cervical cancers, adverse effects of child undernourishment, and the institution of local health surveys. The important influence of the Rockefeller Foundation and the Pan American Health Organization on the epidemiology education in Colombia is highlighted. Finally, the main, currently active research lines in epidemiology are described. Investigative guidelines are suggested for future historians of Colombian public health and epidemiology.

Measuring the Success of Local Health Surveys Using Participatory-Based Research Practices

a wide range of purposes—to measure the local burden of health conditions, identify community concerns, gauge awareness of health resources, inform policy, and evaluate public health interventions. A challenge to all community health surveys, irrespective of objective or who conducts them is quality of measurement. Decades of research on survey methods and validation studies have identified how easily gross error or poorly constructed questions can render painstakingly-collected information useless or cause deviation from stated objectives.

The Adequacy of Household Survey Data for Evaluating the Nongroup Health Insurance Market

To evaluate the accuracy of household survey estimates of the size and composition of the nonelderly population covered by nongroup health insurance. Health insurance enrollment statistics reported to New Jersey insurance regulators. Household data from the following sources: the 2002 Current Population Survey (CPS)-March Demographic Supplement, the 1997 and 1999 National Surveys of America's Families (NSAF), the 2001 New Jersey Family Health Survey (NJFHS), a 2002 survey of known nongroup health insurance enrollees, a small 2004 survey testing alternative health insurance question wording. To assess the extent of bias in estimates of the size of the nongroup health insurance market in New Jersey, enrollment trends are compared between official enrollment statistics reported by insurance carriers to state insurance regulators with estimates from three general population household surveys. Next, to evaluate possible bias in the demographic and socioeconomic composition of the New Jersey nongroup market, distributions of characteristics of the enrolled population are contrasted among general household surveys and a survey of known nongroup subscribers. Finally, based on inferences drawn from these comparisons, alternative health insurance question wording was developed and tested in a local survey to test the potential for misreporting enrollment in nongroup coverage in a low-income population. Data for nonelderly New Jersey residents from the 2002 CPS (n=5,028) and the 1997 and 1999 NSAF (n=6,467 and 7,272, respectively) were obtained from public sources. The 2001 NJFHS (n=5,580 nonelderly) was conducted for a sample drawn by random digit dialing and employed computer-assisted telephone interviews and trained, professional interviewers. Sampling weights are used to adjust for under-coverage of households without telephones and other factors. In addition, a modified version of the NJFHS was administered to a 2002 sample of known nongroup subscribers (n=1,398) using the same field methods. These lists were provided by four of the five largest New Jersey nongroup insurance carriers, which represented 95 percent of all nongroup enrollees in the state. Finally, a modified version of the NJFHS questionnaire was fielded using similar methods as part of a local health survey in New Brunswick, New Jersey, in 2004 (n=1,460 nonelderly). General household sample surveys, including the widely used CPS, yield substantially higher estimates of nongroup enrollment compared with administrative totals and yield estimates of the characteristics of the nongroup population that vary greatly from a survey of known nongroup subscribers. A small survey testing a question about source of payment for direct-purchased coverage suggests than many public coverage enrollees report nongroup coverage. Nongroup health insurance has been subject to more than a decade of reform and is of continuing policy interest. Comparisons of unique data from a survey of known nongroup subscribers and administrative sources to household surveys strongly suggest that the latter overstates the number and misrepresent the composition of the nongroup population. Research on the nongroup market using available sources should be interpreted cautiously and survey methods should be reexamined.

Insights from a large rural population laboratory: Health census `89 and `99

PURPOSE: Data are limited on health status behaviors and use of health services for rural residents. Yet rural areas now have higher rates of chronic diseases, such as coronary heart disease, than urban areas.METHODS: A population laboratory (Health Census) was established in rural Central NY (Otsego County) to study these variables in this population. HC `89 was a door-to-door enumeration of all permanent households in the country. In 1989, 44,500 adults in 18,000 households provided data on individual health screenings, cancer and cardiovascular risk factors, health behaviors, chronic disease, access to care, preventive services use, health insurance and emergency department utilization. Data collection for HC `99 will identify 10-year trends; it also includes baseline data for children. Also, households in six surrounding rural counties (N = 10,000) were sampled; cost benefits of different survey methods were assessed. Questions about perceived health status, and special health and pediatric preventive care needs were included. After 10 years of social change, many limitations of traditional survey methods became apparent; much more varied and frequent types of follow-up were needed to achieve adequate response rates.RESULTS: The HC `89 final response rate was 86%. There were significant socioeconomic gradients in use of preventive services (blood pressure screening, rectal exams, mammograms and Pap smears). Adults without health insurance or Medicaid had much lower utilization rates of screening tests and higher rates of cigarette smoking and obesity. Several community intervention programs were implemented as a result of HC `89. HC `99 provides additional analyses to examine change in preventive service use, self-reported chronic disease, and health services use; it will likely verify the persistence of socioeconomic gradients. Response rates are similar to `89, but achieved only with more intensive reinforcement.CONCLUSIONS: HC `89 confirmed a lag in positive health indices in rural populations in Central NY. Both newer methodologies now needed and results of HC `99 will serve as guides for smaller rural counties to develop affordable local health surveys and plan intervention strategies.

Prevalence of Hypertension in Bus Drivers

1. To test whether prevalence of hypertension was higher among these bus drivers than among employed individuals in general, drivers were compared to three groups: individuals from both a national and local health survey and individuals undergoing baseline health exams prior to employment as bus drivers. 2. After adjustment for age and race, hypertension rates for bus drivers were significantly greater than rates for the three comparison groups. 3. These findings support previous results from international studies of bus drivers suggesting that exposure to the occupation of driving a bus may carry increased health risk.

Prevalence of hypertension in bus drivers.

This paper reports the results of a cross-sectional study conducted to evaluate the prevalence of hypertension in 1500 black and white male bus drivers from a large urban transit system in the US. Data for this study were compiled from the files of an occupational health clinic which conducts biennial medical examinations for drivers' license renewal. To test whether prevalence of hypertension was higher among bus drivers than among employed individuals in general, drivers were compared to three groups: individuals from both a national and local health survey and individuals undergoing baseline health examinations prior to employment as bus drivers. After adjustment for age and race, hypertension rates for bus drivers were significantly greater than rates for each of the three comparison groups. These findings support previous results from international studies of bus drivers suggesting that exposure to the occupation of driving a bus may carry increased health risk. This research has expanded into an on-going study which has the goals of clarifying the extent of hypertension in bus drivers and identifying specific behavioural and occupational factors that may be responsible for increased risk of cardiovascular disease.

Potentials of local health surveys: a state-of-the-art summary.

This paper provides a state-of-the-art summary of the potentials and limitations of local surveys for assessing health problems in local areas. The information they provide may be helpful for a variety of purposes such as measuring the need for services, planning programs to address these needs, and evaluating their impact. Particular advantages of surveys are that they: provide information on the needs of people who have not sought care; permit special studies of particular target groups; provide data on variables which are only available from "asking" people; enable information to be collected on a range of correlates and indicators of health care behavior; provide an opportunity for examining relationships among variables; and permit well-timed community estimates of the impact of experimental programs. Limitations include the validity and reliability of survey data, and the costs and other problems of survey implementation.