A comparison of prevalence estimates for selected health indicators and chronic diseases or conditions from the Behavioral Risk Factor Surveillance System, the National Health Interview Survey, and the National Health and Nutrition Examination Survey, 2007–2008
Highlights
► Prevalence estimates of health indicators were similar between BRFSS and other national surveys. ► Scrutiny of questions, objectives, and modes is warranted when comparing survey results. ► The findings support BRFSS data reliability in health surveillance.
Introduction
There are three major ongoing health surveys in the United States: the National Health Interview Survey (NHIS) (Centers for Disease Control and Prevention, 2011a), the National Health and Nutrition Examination Survey (NHANES) (Centers for Disease Control and Prevention, 2009), and the Behavioral Risk Factor Surveillance System (BRFSS) (Centers for Disease Control and Prevention, 2011c). The NHIS and the NHANES were established in the late 1950s and early 1960s by the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC) according to the 1956 National Health Survey Act Public Law 652 (Centers for Disease Control and Prevention, 2009, Centers for Disease Control and Prevention, 2011a). Although both surveys collect data from participants representative of civilian non-institutionalized U.S. population using a complex, multistage, probability sampling design, there are some differences in survey contents and time frames between the NHIS and NHANES. The NHIS and NHANES data are collected through a personal household interview conducted by interviewers using Computer Assisted Personal Interviewing (CAPI) technology. Different from either NHIS or NHANES, the BRFSS is a state-based health survey system in all 50 states, the District of Columbia (DC), and territories (Centers for Disease Control and Prevention, 2011c). BRFSS was established in 1984 by the CDC. Computer Assisted Telephone Interviewing (CATI) technology is used to collect data.
The combined state BRFSS data have been compared to national household survey data in the past and the findings of those comparisons suggest that nationwide estimates from BRFSS data are similar to those from NHIS or those from NHANES for several major health outcome measures (Fahimi et al., 2008, Gentry et al., 1985, Mokdad et al., 2003, Nelson et al., 2003). Emerging challenges facing telephone surveys (e.g., increasing households with cell phone only and decreasing response rates) have the potential to adversely impact on the validity and reliability of the BRFSS data (Kempf and Remington, 2007, Lee et al., 2010). To assess whether the BRFSS data continue to provide comparable national estimates as other national surveys, we conducted this study to compare the prevalence estimates of six health indicators and six chronic diseases or conditions that were measured using identical or similar questions in the BRFSS, the NHIS, and the NHANES surveys conducted in 2007 and 2008.
Section snippets
Survey design
The sampling plan of the NHIS follows a multistage area probability design that permits the representative sampling of households and civilian non-institutional group quarters (Centers for Disease Control and Prevention, 2011a). The response rate for the adult sample person component was 67.8% and 62.6% in the 2007 and 2008 NHIS, respectively. The NHANES uses a complex, multistage, probability sampling design to select participants representative of the civilian non-institutionalized population
Results
A total of 807,524 adults in the 2007–2008 BRFSS surveys, 44,262 adults in the 2007–2008 NHIS surveys, and 5871 adults in the 2007–2008 NHANES surveys were analyzed in this study. There were no statistically significant differences in the weighted percentages of men or women, adults aged 18 to 44 years, adults aged 65 years or older, NH whites, and adults with a high school education (Table 1). The BRFSS survey, however, had lower weighted percentages of adults aged 45 to 64 years, NH blacks, and
Discussion
Overall, the BRFSS survey yielded similar prevalence estimates for the majority of the selected health indicators and chronic diseases as the NHIS or NHANES survey. Except for physical inactivity and self-rated poor or fair health, the absolute differences in the prevalence estimates ranged from 0.7 to 3.9 percentage points and the relative differences ranged from 2.3% to 20.2% among selected health indicators. Except for MI, asthma, and arthritis, the absolute differences in the prevalence
Abbreviations
- BMI
body mass index
- BRFSS
Behavioral Risk Factor Surveillance System
- CAPI
computer-assisted personal interviewing
- CATI
computer-assisted telephone interviewing
- CDC
Centers for Disease Control and Prevention
- CHD
coronary heart disease
- DC
District of Columbia
- MI
myocardial infarction
- NHANES
National Health and Nutrition Examination Survey
- NHIS
National Health Interview Survey
- SE
standard error
Author contributions
C.L. provided study concept and design, acquired data, analyzed and interpreted data, provided statistical analysis, wrote the manuscript, and reviewed/edited the manuscript. L.S.B. and E.S.F. provided study concept and design, interpreted data, reviewed/edited the manuscript, and supervised the study. C.A.O., G. Z., and C.P. provided study concept and design, interpreted data, and reviewed/edited the manuscript.
Disclaimer
The findings and conclusions in this report are those of the authors and do not necessarily represent the official positions of the Centers for Disease Control and Prevention.
Conflict of interest statement
The authors declare that they have no conflict of interest relevant to this study.
Measures and original questions of selected health indicators and chronic diseases or conditions in the BRFSS, the NHIS, and the NHANES, 2007-2008.Measure Original Survey Questions and Responses Empty Cell BRFSS NHIS NHANES Health indicator Current smoking 1. Have you smoked at least 100 cigarettes in your entire life?
1 Yes
2 No
7 Don't know/Not sure
9 Refused
2. Do you now smoke cigarettes every day, some days, or not at all?
1 Every day
2 Some days
3 Not at all
7 Don't know/Not sure
9 Refused1. Have you smoked at least
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