Combining information from multiple surveys for assessing health disparities

Abstract

Despite advances in public health practice and medical technology, the disparities in health among the various racial/ethnic and socioeconomic groups remain a concern which has prompted the Department of Human and Health Services to designate the elimination of disparities in health as an overarching goal of Healthy People 2010. To assess the progress towards this goal, suitable measures are needed at the population level that can be tracked over time; Statistical inferential procedures have to be developed for these population level measures; and the data sources have to be identified to allow for such inferences to be conducted. Popular data sources for health disparities research are large surveys such the National Health and Interview Survey (NHIS) or the Behavior Risk Factor Surveillance System (BRFSS). The self-report disease status collected in these surveys may be inaccurate and the errors may be correlated with variables used in defining the groups. This article uses the National Health and Nutritional Examination Survey (NHANES) 99-00 to assess the extent of error in the self-report disease status; uses a Bayesian framework develop corrections for the self-report disease status in the National Health Interview Survey (NHIS) 99-00; and compares inferences about various measures of health disparities, with and without correcting for measurement error. The methodology is illustrated using the disease outcome hypertension, a common risk factor for cardiovascular disease.