National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

National Health Interview Survey (NHIS):

Focus on Pain

Margaret Lethbridge-Çejku, PhDDivision of Health Interview Statistics

The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the

Centers for Disease Control and Prevention

National Health Interview Survey Purpose

Collect data on the health status and health care utilization of the US population

Address specific issues of current public health concern

Provide a “snapshot” of US population’s health

Monitor trends

Track progress towards national health objectives

Public health research

NHIS Sample design

Nationally representative of the civilian, non-institutionalized population of the US

Oversampling of black, Hispanic, and Asian persons

Multistage probability sample with clustered design

Sample selected so each week is representative

Sample redesigned about every 10 years, following decennial census

The NHIS Questionnaire since the 1997 redesign

Basic module [ CORE ] same every year family, sample adult, and sample child questionnaires includes injury episode file

Supplemental questions [imbedded in core files] expand on topics already included in basic moduleobtain detailed info for sample adult/child typically one-time or periodic

Topical supplements add-in segment - flexibility to address new topics

Linkage with NHIS data

Medical Expenditure Panel Survey (MEPS)

Mortality data in the National Death Index

Cycles 4 and 5 of the National Survey of Family Growth (NSFG) 1993, 1995

National Immunization Provider Record Check Study (NHIS/NIPRCS) 1997-1999

Pain questions in the NHISAdults

Jaw pain (orofacial pain or TMD)Neck painLow back painJoint painChronic joint symptomsMigraine

Other pain-related questions in the NHISAdults

Chronic conditionsCardiovascular diseaseDiabetesRespiratory conditionsCancerArthritis

Functional limitations: social and physicalActivities of daily living (ADLs and IADLs)Injury episodes

Pain and pain-related questions in the NHISChildren

Headaches/migrainesChronic and non-chronic conditions

Ear infectionsCerebral palsyMuscular dystrophySickle cell anemiaCystic fibrosisArthritis

Activity limitations: school and playActivities of daily living (ADLs and IADLs)Injury episodes

Supplements with pain-related data

1989 Orofacial pain supplement1994-95 NHIS-D Disability survey and

Supplement on Aging2002 Complementary and alternative

medicine (again in 2007)

Conceptual framework for analyzing NHIS pain data

Demographic characteristics- age, race/ethnicity, family structure, income,

education

Mediating health factors- health behaviors (including alcohol, tobacco use),

health insurance, access to care and health care utilization

Health outcomes- activity limitations, health status, mental health,

co-morbidities: chronic conditions, injury

NHIS: Focus on PainExamples

Prevalence of US adults with migraine or severe Prevalence of US adults with migraine or severe headache during preceding 3 months, by sex and ageheadache during preceding 3 months, by sex and age

SOURCE: Unpublished. Data from the National Health Interview Survey 2005.

0

5

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30

18-44 45-64 65-74 75+

Age in years

Per

cen

tag

e

Women Men

Prevalence of facial pain in non-Hispanic adult women Prevalence of facial pain in non-Hispanic adult women by age and race: United States 2002by age and race: United States 2002

Adjusted for socio-economic differences.

SOURCE: adapted from IADR 84rd General Session in Brisbane: Isong U, Fanshy SA, Plesh O, J Dent Res, 2006 (www.dentalresearch.org).

0

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4

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8

10

18-24 25-44 45-64 65+

Age in years

Per

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e

NH White NH Black

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10

15

20

25

30

35

Hispanic NH White NH Black

Per

cen

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e

Men Women

Prevalence of chronic joint symptoms in US adults, by Prevalence of chronic joint symptoms in US adults, by sex and race/ethnicity: NHIS 2004sex and race/ethnicity: NHIS 2004

Adjusted for age

SOURCE: Lethbridge-Cejku M, Rose D, Vickerie J. Summary health statistics for US Adults: National Health Interview Survey, 2004. National Center for Health Statistics.Vital Health Stat 10 (228). Hyattsville, MD 2006

0

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8

10

12

Migraine Neck Pain Low Back Pain Chronic JointSymptoms

Nu

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er o

f D

ays

Condition Without condition

Mean number of work days lost by employed adults Mean number of work days lost by employed adults with selected pain conditionswith selected pain conditions

Adjusted for age.

SOURCE: Lethbridge-Cejku, M. Unpublished. Data from the National Health Interview Survey 2005.

Prevalence of selected pain conditions by level of Prevalence of selected pain conditions by level of education: US adults, 25 years and overeducation: US adults, 25 years and over

Adjusted for age

SOURCE: Lethbridge-Cejku M, Rose D, Vickerie J. Summary health statistics for US Adults: National Health Interview Survey, 2004. National Center for Health Statistics.Vital Health Stat 10 (228). Hyattsville, MD 2006

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35

Migraine Neck Pain Back Pain Face/Jaw Pain

Per

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< HS HS or GED Some College BA/BS +

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20

30

40

Migraine Neck Pain Back Pain Face/Jaw Pain

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Poor Near Poor Not Poor

Prevalence of selected pain conditions by poverty Prevalence of selected pain conditions by poverty status: US adults, 18 years and overstatus: US adults, 18 years and over

Adjusted for age

SOURCE: Lethbridge-Cejku M, Rose D, Vickerie J. Summary health statistics for US Adults: National Health Interview Survey, 2004. National Center for Health Statistics.Vital Health Stat 10 (228). Hyattsville, MD 2006

Prevalence of low back pain in men and women by Prevalence of low back pain in men and women by body mass index (BMI)body mass index (BMI)

Adjusted for age

Underweight is defined as a BMI <18.5, healthy weight as a BMI of 18.5 to <25.0, overweight as a BMI of 25 to <30, and obesity as a BMI of >= 30.

SOURCE: Lethbridge-Cejku, M. Unpublished. Data from the National Health Interview Survey 2005.

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50

Underweight Healthy Weight Overweight Obese

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Men Women

Prevalence of complementary and alternative medicine Prevalence of complementary and alternative medicine (CAM) use during past 12 months for selected pain (CAM) use during past 12 months for selected pain

conditionsconditions

Adjusted for age. CAM usage excludes megavitamin therapy and prayer.

SOURCE: Adapted from Barnes P, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States 2002. Advance data from vital and health statistics (343). Hyattsville, MD: National Center for Health Statistics. 2004

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Migraine Neck Pain Back Pain Joint Pain RecurringPain

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Copyright ©2006 American Academy of Pediatrics

Source: Strine TW, Okoro CA, McGuire LC, Balluz, LS. The Associations among childhood headaches, emotional and behavioral difficulties, and health care use. Pediatrics 2006;117:1728-1735. Data from NHIS 2003 Child Core and supplemental SDQ-EX data.

Prevalence of high individual domain and total difficulties scores among Prevalence of high individual domain and total difficulties scores among children aged 4 to 17 years with and without frequent severe headacheschildren aged 4 to 17 years with and without frequent severe headaches

Copyright ©2006 American Academy of Pediatrics

Source: Strine TW, Okoro CA, McGuire LC, Balluz, LS. The Associations among childhood headaches, emotional and behavioral difficulties, and health care use. Pediatrics 2006;117:1728-1735. Data from NHIS 2003 Child Core and supplemental SDQ-EX data.

Impact of difficulties with emotions, concentration, behavior, or getting Impact of difficulties with emotions, concentration, behavior, or getting along with other children on everyday functioning of children aged 4 to along with other children on everyday functioning of children aged 4 to

17 years with and without frequent severe headaches17 years with and without frequent severe headaches

Increased likelihood of Any Herb Use with Co-occurrence of Increased likelihood of Any Herb Use with Co-occurrence of Depression/Anxiety and Pain : NHISDepression/Anxiety and Pain : NHIS 2002 CAM Supplement2002 CAM Supplement

Adjusted Odds Ratios

Women Men

Depression/Anxiety & Pain 1.25 1.37

Pain alone 1.00 1.00

p=0.03 p=0.01

Depression/Anxiety & Pain 1.27 1.43

Depression/Anxiety alone 1.00 1.00

p=0.02 p=0.01

Source: Adapted from Wallace et al. Project 4: Epidemiological Studies of Botanical Dietary Supplements. Iowa Botanical Supplements Research Center, 2005. Data source: NHIS 2002 Complimentary and Alternative Medicine Supplement

Serious difficulty in physical functioning by selected Serious difficulty in physical functioning by selected pain statuspain status

Separate logistic regressions adjusted for age, sex, race/ethnicity, poverty, and education in all models. Referent groups are persons without the condition.

Serious difficulty defined as “Can’t do this activity” or “Very difficult to do”. Activities: walking, standing, stooping, climbing stairs, sitting, reaching overhead, grasping, lifting 10 lbs., pushing object.Source: Lethbridge-Cejku, M. Unpublished. Data from the National Health Interview Survey 2000-2002

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2.00

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6.00

Migraine Neck Pain Back Pain Chronic JointSymptoms

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Unable to work by selected pain statusUnable to work by selected pain status

Separate logistic regressions adjusted for age, sex, BMI, race/ethnicity, poverty, and education in all models. Referent groups are persons without the condition.

Source: Lethbridge-Cejku, M. Unpublished. Data from the National Health Interview Survey 2005.

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Migraine Neck Pain Back Pain Chronic JointSymptoms

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Where to find out more about the NHIS:

http://www.cdc.gov/nchs/nhis.htm

downloadable public use data files and documentation

SAS, Stata, and SPSS programs

publications in Adobe Acrobat format

http://www.cdc.gov/subscribe.html

subscribe to the NHIS electronic mailing list

Special Request Files: in-house data (with suppressed information) through Research Data Center