Secondary Database Analysis II
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Secondary Database Analysis II
Sources and Uses of Extant Databases
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Last Time – Uses
Secondary Data: Can provide new information on health care delivery (quality;
geographic variation; post-marketing adverse events; cost), on natural the history of disease, and on regulatory matters.
Can save data-collection resources: time, money, personnel, participant burden
Can save researcher resources: your time, your money May permit you to build your CV without anyone’s help or
funds – just your time (but co-authors are a good thing) Can provide preliminary data for a grant proposal May enable research on rare events or difficult populations
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Last Time – Precautions Take note of the study design; is it suitable? What are inclusion & exclusion criteria? Why? How does that
affect the sample and generalizability? What bias may be inherent in the database – perhaps from the
population or from the method of measurement? Selection bias: who got included; migration: who was lost/gained and why; other sources of systematic error (bias)
Control for bias – restrict (lose generalizability); match (limited # factors); stratify; adjust with covariates; then discuss potential impact of uncorrected bias on your results; could conduct sensitivity analyses on multivariable models
Risk adjustment – outcome-specific; an index incorporates many predictors – do you need to study some separately?; comorbidity index for case-mix adjustment (e.g., Charlson); other predictors based on your reading of the literature; propensity scores (for treatment choice; good for small datasets, for non-randomized studies of treatment effect)
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Data Sources
Financial or Claims Files Electronic Medical Records Survey Data Trial Data
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NHLBI Clinical Trialshttp://www.nhlbi.nih.gov/resources/deca/default.htm - National Heart Lung & Blood Institute
Study Name Prepared/Updated ↓
Asymptomatic Cardiac Ischemia Pilot (ACIP) 01/2000
Lung Health Study (LHS) 08/2001
Thrombolysis in Myocardial Infarction Study (TIMI II) 08/2001
Intermittent Positive Pressure Breathing (IPPB) 05/2001
Post Coronary Artery Bypass Graft Study (CABG) 05/2001
Antiarrhythmics Versus Implantable Defibrillators(AVID) 02/2002
Asthma Clinical Research Network: Beta Agonist in Mild Asthma (ACRN: BAGS) 02/2002
Digitalis Investigation Group (DIG) 02/2002
Asthma Clinical Research Network: Colchicine in Moderate Asthma (ACRN: CIMA) 02/2002
Psychophysiological Investigation of Myocardial Ischemia (PIMI) 07/2002
Coronary Artery Surgery Study (CASS) 07/2003
High Frequency Ventilation in Premature Infants Study (HIFI) 07/2003
Multiple Risk Factor Intervention Trial (MRFIT) 07/2003
Raynaud's Treatment Study (RTS) 05/2003
Acute Respiratory Distress Syndrome Clinical Network (ARDSNet 01/03): Lower versus higher tidal volume, lisofylline treatment and ketoconazole treatment (3 study factorial)
07/2003
… etc.
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NHLBI Clinical Trials - most recent
Study Name Prepared/Updated ↓
Public Access Defibrillation (PAD) Community Trial 08/2007
Bypass Angioplasty Revascularization Investigation (BARI) 11/2007
Women's Health Initiative: Clinical Trials (WHI-CT) 02/2008
Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial
03/2008
Acute Respiratory Distress Syndrome Clinical Network (ARDSNet02): Efficacy of Corticosteroids as Rescue Therapy for the Late Phase of Acute Respiratory Distress Syndrome (
LaSRS)
05/2008
Acute Respiratory Distress Syndrome Clinical Network (ARDSNet05): Fluid and Catheter Treatment Trial (FACTT)
05/2008
Viral Activation Transfusion Study (VATS) 05/2008
National Emphysema Treatment Trial (NETT) 08/2008
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NHLBI Epidemiology Studies (selected)http://www.nhlbi.nih.gov/resources/deca/directry.htm
Study Name Prepared/Updated
A Case-Control Etiologic Study of Sarcoidosis (ACCESS) 04/2004
Atherosclerosis Risk in Communities Study (ARIC) 01/2008
Bogalusa Heart Study (BHS) 12/2006
Cardiovascular Health Study (CHS) 07/2008
Coronary Artery Risk Development in Young Adults (CARDIA) 11/2007
Cord Blood Transplant Study (COBLT) 01/2007
Framingham Heart Study-Cohort 03/2007
Framingham Heart Study-Offspring 05/2007
Honolulu Heart Program (HHP) 01/2004
Lipid Research Clinics- Prevalence Study (LRCPS) 02/2005
NHLBI Growth and Health Study (NGHS) 09/2005
National Longitudinal Mortality Study (NLMS) 01/2000
Puerto Rico Heart Health Program (PRHHP) 12/2002
Cooperative Study of Sickle Cell Disease (CSSCD) 07/2008
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National Center for Health Statistics (NCHS)
http://www.cdc.gov/nchs/
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NCHS Public-use Data Files & Documentation
About Public-use data files - http://www.cdc.gov/nchs/datawh/ftpserv/ftpdata/aboutpud.htm Data Release Policy - http://www.cdc.gov/nchs/about/policy/reldata.htm Data Use Restrictions - http://www.cdc.gov/nchs/datawh/dur.htm NHANES III Errata
Data from the National Health and Nutrition Examination Survey (NHANES) What’s New http://www.cdc.gov/nchs/about/major/nhanes/whatsnew.htm Third National Health and Nutrition Examination
http://www.cdc.gov/nchs/about/major/nhanes/nh3data.htm Reference Manuals and Reports/Plan and Operations http://www.cdc.gov/nchs/data/nhanes/nhanes3/cdrom/main.pdfAnalytic Guidelines http://www.cdc.gov/nchs/data/nhanes/nhanes3/nh3gui.pdfNHANES I Epidemiologic Followup Study (NHEFS)
http://www.cdc.gov/nchs/products/elec_prods/subject/nhefs.htm
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Longitudinal Studies of Aging (LSOA ) http://www.cdc.gov/nchs/lsoa.htm - available on CD
National Health Interview Survey (NHIS)http://www.cdc.gov/nchs/nhis.htm
National Center for Health Statistics (NCHS)
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National Ambulatory Medical Care Survey (NAMCS), 1993-2000http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm
National Ambulatory Medical Care Survey (NAMCS), 1973-1992http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm
National Hospital Ambulatory Medical Care Survey (NHAMCS), 1992-2000 http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm
National Hospital Discharge Survey (NHDS), 1996-2000& National Survey of Ambulatory Surgery (NSAS), 1994-1996
http://www.cdc.gov/nchs/about/major/hdasd/nhds.htm
National Home and Hospice Care Survey (NHHCS), 1996http://www.cdc.gov/nchs/nhhcs.htm
National Nursing Home Survey (NNHS), 1995 and 1997http://www.cdc.gov/nchs/nnhs.htm
NCHS
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Behavioral Risk Factor Surveillance System (BRFSS)
http://www.cdc.gov/brfss/ Datasets are large – ASCII version may be
15Mb for a single year Documentation is online with data 24 years of data available at
http://www.cdc.gov/brfss/technical_infodata/surveydata.htm
Don’t forget the citation! http://www.cdc.gov/brfss/suggestedcitation.htm
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VA Data
Data descriptions and access details are documented (http://www.virec.research.va.gov) No public use files; must be VA employee/WOC Data: administrative, hospital/facility level data, medical record information, patient-level medical care data including procedures, surgeries, radiography, laboratory (some), pharmacy, and diagnoses, all in SAS datafiles 5.5 million patients with incentive to stay in the system
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Healthcare Cost and Utilization Project (HCUP)
Largest collection of all-payer longitudinal hospital data in US available for release to researchers
Family of administrative databases and tools maintained by AHRQ
As of 2002 data, 35 state-level data organizations contribute data on hospital stays including Texas
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http://www.hcup-us.ahrq.gov/home.jsp What's New – right-hand insetWhat is HCUPHCUP Products (data are not free)HCUP Services
FACT SHEET – very informativeNote the Clinical Classifications Software (CCS) & Comorbidity Software (this is free)
HCUP DatabasesState Inpatient Databases (SID)State Ambulatory Surgery Databases (SASD)State Emergency Department Databases (SEDD)Nationwide Inpatient Sample (NIS)Kids' Inpatient Database (KID)
Healthcare Cost & Utilization Project (HCUP)
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Another AHRQ product - http://www.meps.ahrq.gov/
Overview: MEPS Web SiteThe Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States.
MEPS Web SiteSurveys used, data available, canned reports, data FAQ’s, MEPSnet query tools, etc.
http://www.meps.ahrq.gov/mepsweb/data_stats/data_overview.jsp
Medical Expenditure Panel Survey (MEPS)
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DATA from Substance Abuse and Mental Health Data Archives (SAMHDA)
http://www.icpsr.umich.edu/SAMHDA/ "A national resource providing public data
access and online analysis"SAMHDA Helpline: 1-888-741-7242
Local: (734) 615-9524Fax: (734) 647-8200e-mail: [email protected]
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CTS Surveys: from HSC, funded by RWJF, stored at ICPSR
- Household Survey, Employer Survey, Physician SurveyTo provide an in-depth look at the issues and challenges physicians face in the rapidly changing health care system, HSC's Community Tracking Study includes a Physician Survey.
http://www.hschange.org/index.cgi?data=04 Get data from ICPSR http://www.icpsr.umich.edu/HMCA/
Health Medical & Care Archive (HMCA) - Health System Change (HSC) – The Robert Wood Johnson Foundation – ICPSR Archives
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SEER: Surveillance Epidemiology & End Results
http://seer.cancer.gov/registries/ SEER*Stat software:
http://seer.cancer.gov/seerstat/
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Websites with Database Lists
AHRQ http://www.ahrq.gov/ NLM http://www.nlm.nih.gov/ CDC http://www.cdc.gov/ VIREC http://www.virec.research.va.gov/ HERC http://www.herc.research.va.gov/ ICPSR http://www.icpsr.umich.edu/ Census & CDC: http://dataferrett.census.gov/
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Who Will Fund Your Analyses?
Your institution has a listserv: [email protected] NIH has career development awards : http://grants1.nih.gov/training/ -- and RFAsAnd there are Program Announcements that are pertinent, e.g., these from NIAAA:
Secondary Analysis of Existing Alcohol Epidemiology Data (R21): PA-08-168 http://grants.nih.gov/grants/guide/pa-files/PA-08-168.html
Secondary Analysis of Existing Alcohol Epidemiology Data (R03): PA-08-169 http://grants.nih.gov/grants/guide/pa-files/PA-08-169.html
VA HSR&D has grants (PI must be or become 5/8+ VA) http://www.hsrd.research.va.gov/for_researchers/ Foundations have grants (ADA, AHRQ, Hogg, NARSAD, etc.) Local pots of money