Oral Health, U.S. 2002 Annual Report
Section F: TECHNICAL NOTES
Sources of Data
A brief description of each of the surveys used as a data source in Oral Health
U.S., 2002 follows. Included are:
Behavioral Risk Factor Surveillance System (BRFSS)
BRFSS collects uniform, state-specific data on preventive health practices and
risk behaviors that are linked to chronic diseases, injuries, and preventable
infectious diseases in the U.S. adult population. The BRFSS consists of three
major parts: the core components, optional modules, and state-added questions.
The core components are administered in all states. Each state decides whether
to include optional modules in its state data collection. The states can also
add additional questions relevant to their needs.
The BRFSS is conducted annually by the Centers for Disease Control and
Prevention (CDC) jointly with all 50 states, the District of Columbia, and
three territories. Most states use a disproportionate stratified sampling
design. Data are collected through standardized telephone interviews based on a
random sample of residential telephone numbers within each state. Interviews
are conducted with civilian adults (18 years of age and older) living in
households with a telephone.
The tobacco-related questions are included in the core and are nationally
representative. Data from the 1996, 1997, and 1999 surveys were used in this
report. The health insurance questions were asked in the core. However, the
dental insurance question was asked in the oral health optional module and is
not nationally representative. The oral health module of BRFSS had been an
optional module. However, in the 1999 survey it was included in the "emerging"
core. It may become part of the core at a later date and provide nationally
representative data. Oral health-related topics include caries, access to
dental care, dental insurance, gingivitis, smokeless tobacco, cigarette use,
and dental visits.
For more information, visit
http://www.cdc.gov/brfss.
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First National Health and Nutrition Examination Survey (NHANES I) 1971–75
NHANES I was conducted from 1971 through 1975 on a national probability sample
of approximately 32,000 persons, aged 1-74 years, from the civilian,
noninstitutionalized U.S. population. It excluded people residing on Indian
reservations. A multistage, stratified probability sample design was used.
Successive sampling units used were the primary sampling unit (a county or
counties), census enumeration district, segment (a cluster of households),
household, eligible person, and sample person. Certain population groups
thought to be at high risk for malnutrition were also oversampled. These groups
included people living below the federal poverty level, preschool children,
women of childbearing age, and elderly persons. The survey included 31,973
interviewed persons, of whom 23,808 had a physical exam. A subsample of persons
25-74 years of age (3,854) received more detailed health examinations. After
the nutrition survey, the detailed medical examination was also given to
additional adults 25-74 years of age. This group formed the NHANES I
Augmentation.
Extensive data on health and nutrition were collected by interview, physical
exam, and clinical measurements. Examinations were carried out in specially
constructed mobile examination centers. The general physician's examination
gathered data on physical conditions pertinent to nutrition and certain chronic
diseases. A specific dental examination focused on caries, periodontal disease,
oral hygiene, edentulism, chewing and eating difficulties, treatment needs, and
occlusion.
For more information, visit
http://www.cdc.gov/nchs/nhanes.htm.
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Medical Expenditure Panel Survey-Household Component (MEPS-HC)
MEPS-HC provides nationally representative estimates of health services used by
the U.S. civilian noninstitutionalized population, the cost of these services,
and health insurance coverage. The MEPS-HC collects data on demographic
characteristics, health conditions and health status, health care utilization,
access to care, satisfaction with care, charge and payment information,
employment and income, health insurance, and interview administration. The
MEPS-HC is one of four component surveys within the MEPS; the other components
are the Medical Provider Component, the Insurance Component, and the Nursing
Home Component.
The MEPS-HC collects data from a nationally representative sample of households
through an overlapping panel design. In this design, data are collected through
a preliminary contact followed by a series of five rounds of interviews over a
2½-year period. Two calendar years of medical expenditures and utilization are
collected from each household. As an overlapping panel survey, this series of
data collection rounds is launched again each subsequent year on a new sample
of households drawn from the National Health Interview Survey sampling frame to
provide overlapping panels of survey data, which, when combined with other
ongoing panels, will provide continuous and current estimates of health care
expenditures at both the person and household level.
Oral health-related variables include reason for dental visit, traumatic
injuries, dental care utilization, dental services received, medications,
dental expenses, and payment. The 1996 and 1997 versions were used in this
report.
For more information, visit
http://www.meps.ahrq.gov.
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National Health Accounts (NHA)
The NHA identifies all goods and services that relate to health care in the
nation and determines the amount of money used for the purchase of these goods
and services. NHA data are collected and compiled by the Centers for Medicare
and Medicaid Services (formerly the Health Care Financing Administration). The
NHA collects data on all of the main components of the health care system and
the sources of funds that finance the purchases. The NHA collects data on an
annual basis and applies a common set of definitions that allow comparisons to
be made among categories and over time.
The NHA reports national expenditures for dental services and specifies
expenditures by source of payment. Expenditures by source of payment are
reported by out of pocket payments, private insurance, total private consumer
funds, and federal, state and local, and total government funds. Population
totals are provided to allow for cost per capita calculations.
For more information, visit
http://www.who.int/nha/en/*.
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National Health Interview Survey (NHIS)
The NHIS is conducted annually by the National Center for Health Statistics,
Centers for Disease Control and Prevention. It has been conducted continuously
since it began in 1957. The NHIS collects data regarding the extent and
distribution of illness, disability and chronic impairments, activity
limitations, injuries, and the use of health services. Each year special topics
are added as supplements. NHIS employs a multistage probability sample of the
civilian noninstitutionalized U.S. population and collects data through
personal household interviews. The NHIS sample includes an oversampling of
blacks and Hispanics. Information is obtained about each member of the
household.
The NHIS questionnaire that was fielded from 1982 to 1996 consisted of a core
questionnaire plus current health topic supplements. In 1997, the NHIS
questionnaire was redesigned to include a core questionnaire composed of three
components: the Family Core, Sample Adult Core, and Sample Child Core.
Oral health-related variables collected in the NHIS include missing teeth, oral
cancer, and tobacco. Data from the 1989, 1992, and 1998 NHIS were used in this
report. In the 1989 NHIS, supplements on dental care and orofacial pain were
included. Questions for these supplements were asked of a subsample of the NHIS
respondents.
For more information, visit
http://www.cdc.gov/nchs/nhis.htm.
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National Hospital Ambulatory Medical Care Survey (NHAMCS)
The NHAMCS collects data on the utilization and provision of ambulatory care
services in hospital emergency and outpatient departments. It has been
conducted annually by the National Center for Health Statistics, Centers for
Disease Control and Prevention since 1992. The NHAMCS is a national probability
sample of visits to the emergency and outpatient departments of
noninstitutional general and short-stay hospitals. The NHAMCS uses a four-stage
probability design of primary sampling units (PSUs), hospitals within PSUs,
clinics within hospitals, and patient visits within clinics. Hospital staff
complete a Patient Record form for a systematic random sample of patient visits
during a randomly assigned 4-week reporting period.
Data are obtained on demographic characteristics of patients, expected source of
payment, patients' complaints, physicians' diagnoses, diagnostic/screening
services, procedures, medication therapy, disposition, types of health care
professionals seen, causes of injury where applicable, and certain
characteristics of the hospital. Data specific to oral health include emergency
dental care, dental care satisfaction, and dental services received.
Data from the 1999 NHAMCS were analyzed for this report.
For more information, visit
http://www.cdc.gov/nchs/about/major/ahcd/nhamcsds.htm.
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National Medical Care Expenditure Survey (NMCES): 1977
NMCES was the first in a series of three national probability surveys conducted
by the Agency for Healthcare Research and Quality on the financing and use of
medical care in the United States. The NMCES sample used a stratified,
multistage area probability design to sample the civilian noninstitutionalized
population of the United States. This survey obtained data from respondents on
their insurance status and on health services use and expenditures. NMCES
collected data on population characteristics, health status, access to care,
health insurance coverage, personal and family health care use, and
expenditures and sources of payment for medical and related services. Data were
also gathered on hospital inpatient care and ambulatory physician and
nonphysician care. Oral health-related variables included the use, costs, and
source of payment for dental services.
For more information, visit
http://www.ahrq.gov.
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National Medical Expenditure Survey (NMES), 1987: Household Survey
NMES provided extensive information on the use of health services, health
expenditures, and the financing of these expenditures. The NMES Household
Survey was one of four component surveys of the NMES. The other three
components were the Institutionalized Population Component, the Survey of
American Indian/Alaska Natives, and the Medicare Records Component. In
addition, the Household Survey was supplemented with a Medical Provider Survey
and a Health Insurance Plans Survey.
The Household Survey of NMES was based on a national probability sample of the
civilian noninstitutionalized population in the United States. The survey
sample used a stratified multistage area probability design. Oversampled
population subgroups included poor and low-income families, the elderly, the
functionally impaired, blacks, and Hispanics. The Household Survey included
four rounds of personal and telephone interviews at 4-month intervals. Data
were collected on household composition, employment, insurance characteristics,
illnesses, use of health services, expenditures, and health care sources of
payment.
Oral health-related data included dental visit information, use of dental
services, dental expenses, and sources of payment.
For more information, visit
http://www.ahrq.gov.
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National Nursing Home Survey (NNHS)
The NNHS provides information on nursing homes from the perspectives of the
provider of services as well as of the recipient. The NNHS is a continuing
series of national sample surveys of nursing homes, their residents, and their
staff. This survey has been conducted in 1973-74, 1977, 1985, 1995, 1997, and
1999.
The NNHS uses a stratified two-stage probability design. The first stage of
selection is a probability sample of the nursing facilities defined by bed size
and certification. All nursing homes included in this survey have at least
three beds and either are certified by Medicare or Medicaid as a skilled
nursing or intermediate care facility or have a state license to operate as a
nursing home. The second stage is the selection of current residents and
discharges. A sample of up to six current residents and six discharges per
facility is selected.
Data about the facilities include characteristics such as size, ownership,
Medicare/Medicaid certification, occupancy rate, days of the care provided, and
expenses. For recipients, data are obtained on demographic characteristics,
health status, and services received.
Oral health-related data include dental care utilization, denture ownership and
use, dental services received, edentulism, and perceived oral health status.
Data from the 1997 NNHS were analyzed for this report.
For more information, visit
http://www.cdc.gov/nchs/nnhs.htm.
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National Oral Health Surveillance System (NOHSS)
The NOHSS is designed to help public health programs monitor the burden of oral
disease, use of the oral health care delivery system, and the status of
community water fluoridation on both a state and national level. The NOHSS
includes indicators of oral health, guidelines for oral conditions and oral
health care, information on state dental programs, and links to other important
sources of oral health information. Data sources for NOHSS include national and
state-based surveys. Oral health-related data include caries, edentulism, oral
cancer, oral lesions, sealants, and untreated dental decay.
For more information, visit
http://www.cdc.gov/nohss.
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National Survey of Oral Health-U.S. Employed Adults 1985–1986
This survey was designed to establish the prevalence of coronal caries, root
caries, and periodontal destruction in a readily accessible adult population to
permit future detection of trends by geographic region and within 5-year age
intervals.
The sample of employed adults was selected through the use of a cascading
five-stage sample design that comprised, successively, primary sampling units
(counties or groups of contiguous counties), ZIP code areas within counties,
clusters of business establishments within ZIP code areas, establishments
within clusters, and employees of these establishments. Employees in the
categories of agriculture and mining and those working as household domestics
were excluded from the survey because of lack of access or economic reasons.
The stratification variables were standard metropolitan statistical areas,
percent urban, income, percent establishments with 100+ employees, and percent
minority employees. A dentist administered a questionnaire and performed an
oral clinical exam at the facility or in a mobile examination center.
Oral health-related variables include coronal caries, edentulism, periodontal
disease, loss of attachment, frequency of dental visits, and gingival bleeding.
For more information, visit
http://www.nidcr.nih.gov.
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National Survey of Oral Health in U.S. School Children 1986–87
This survey was designed to provide precise estimates of the prevalence of
dental caries in school children. It was also designed to provide statistically
reliable estimates of the prevalence and severity of dental fluorosis, gingival
bleeding, periodontal diseases, and soft tissue lesions.
The sampling frame for the survey consisted of all children in grades K-12
enrolled in public or private schools in the United States (excluding Alaska).
A multistage probability sample was drawn that represented 43 million children
in the selected age groups. Special education, vocational-technical,
pre-kindergarten, adult education, and remedial classes were excluded. The
three-stage sample design consisted of primary sampling units-school districts
or groups of contiguous school districts; schools within the selected school
districts; classrooms within the selected schools. At the third stage of
sampling, all students within the sampled classrooms were candidates for
examination. Signed parental consent forms were required for the oral
examinations.
Questionnaires completed by the parents or guardians provided extensive
residential histories and information regarding the sources of drinking water,
including natural or adjusted fluoride exposure. Data collection forms used
included the Dental Caries Examination Form, Periodontal Examination Form, Oral
Mucosal Tissue Examination Form, Residential History Form, and Questionnaire on
Use of Tobacco Products and Alcohol.
Oral health-related data include coronal caries, fluoride supplements, oral
lesions, cigarette use, periodontal disease, smokeless tobacco use, and
sealants.
For more information, visit
http://www.nidcr.nih.gov.
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National Vital Statistics System (NVSS)
The NVSS is responsible for the nation's official vital statistics (births,
deaths, marriages, divorces, and fetal deaths). These vital statistics are
provided through state-operated registration systems. Standard forms for the
collection of the data and model procedures for the uniform registration of the
events are developed and recommended for state use through cooperative
activities of the states and the National Center for Health Statistics.
Oral health-related data include oral malformations and deaths due to oral
cancers. The 1998 mortality data and the 1998 natality data were used in this
report.
For more information, visit
http://www.cdc.gov/nchs/nvss.htm.
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1999 Oral Health Survey of American Indian and Alaska Native Dental Patients
This survey examined the oral health status, trends, and treatment patterns
among American Indians/Alaska Natives. This nationwide dental patient-based
survey used a convenience sample of dental clinic users. The sample was
designed to estimate the oral health status of American Indian and Alaska
Native dental patients at both the national level and within the Indian Health
Service's 12 Area Programs. Tribal, urban, and/or Indian Health Service dental
clinics within these 12 areas voluntarily participated in the survey. Each
participating area was asked to examine at least 200 patients within each of
five age groups. Some areas oversampled children, while other areas did not
examine adults or elders. Sampling differences were adjusted to represent some
350,000 Native Americans who receive care in these clinics each year. The
survey collected data from 12,881 dental patients ranging in age from 2 to 96
years.
A questionnaire was administered and a clinical exam performed. Data were
collected on demographic and health factors including tobacco use and diabetes.
Examinations provided data on oral pathology status, oral prosthetic appliance
status, edentulism, fluorosis status, root caries, dental caries status of
permanent and/or primary teeth, and periodontal status.
For more information, visit
http://www.ihs.gov.
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School Health Policies and Programs Study
The purposes of this survey are to monitor the status of the nation's school
health policies and programs, describe the professional qualifications of
personnel delivering health care and coordinating school health activities, and
identify factors that facilitate or impede health care delivery.
Data are collected to assess characteristics of eight components at the
elementary, middle/junior high, and senior high school levels. These are health
education, physical education, health services, food service, school policy,
mental health and social services, faculty and staff health promotion, and
family and community involvement.
For more information, visit
http://www.cdc.gov/nccdphp/dash/shpps/index.htm.
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Synopses of State and Territorial Dental Public Health Programs
Data for the synopses were collected from state and territorial dental
directors through a short questionnaire. Information collected in the survey
fell into three main categories: demographics, administration, and programs.
Included in the demographics section were questions related to the number of
Medicaid-eligible children in the state, number of dental schools, and number
of licensed dentists. The administration section included questions related to
full-time equivalent employees and funding sources. The programs section
included questions related to programs funded, collected, or facilitated by the
state's dental health program. These programs included access to care,
community water fluoridation, dental screening, dental sealants, early
childhood caries, oral health education, tobacco cessation, and fluoride
supplements. Data were reported for the most recent completed year. Generally,
this is for the fiscal year ending prior to February of each year.
The data for the synopses can be found at
http://apps.nccd.cdc.gov/synopses/. The information is supplied
by the Association of State and Territorial Dental Directors,
http://www.astdd.org*.
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Surveillance, Epidemiology, and End Results (SEER)
SEER collects information on cancer incidence and survival in the United
States. The SEER program currently collects and publishes cancer incidence and
survival data from 11 population-based cancer registries and 3 supplemental
registries covering approximately 14% of the U.S. population. Information on
more than 2.5 million in situ and invasive cancer cases is included in the SEER
database, and approximately 160,000 new cases are added each year within the
SEER catchment areas. The SEER registries routinely collect data on patient
demographics, primary tumor site, morphology, stage at diagnosis, first course
of treatment, and follow-up for vital status.
Oral health-related variables include oral cancers. Data from 1992-1997 were
used in this report.
For more information, visit
http://seer.cancer.gov.
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Third National Health and Nutrition Examination Survey (NHANES III) 1988–94
NHANES III obtained information about the health and nutrition status of the
U.S. population including services received for or because of health
conditions. The goals of NHANES III were to estimate national prevalence of
selected diseases and risk factors, estimate national population distributions
of selected health parameters, document and investigate reasons for secular
trends in selected diseases and risk factors, contribute to an understanding of
disease etiology, and investigate the natural history of selected diseases.
NHANES III used a stratified multistage probability design. The sample
represents the total civilian noninstitutionalized population, 2 months of age
or older. Primary sampling units were selected in the first stage, area
segments were selected in the second stage, households were selected in the
third stage, and individuals were selected in the final stage. An interviewer
administered a household and family (if appropriate) questionnaire in person. A
clinical exam was administered in a medical examination center or in the home
if the person was unable to come to the center.
Oral health-related variables include coronal caries, early childhood caries,
root caries, edentulism, oral mucosa, orthodontia, and perceived treatment
needs.
For more information, visit
http://www.cdc.gov/nchs/products.htm.
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Uniform Data System (UDS)
The UDS is used to collect data on the Bureau of Primary Health Care, Health
Resources and Services Administration-sponsored programs in the areas of
medical, dental, behavioral, and enabling services to ensure compliance with
legislative mandates and to report to Congress and policymakers on program
accomplishments. The UDS has two components: the Universal Report and the Grant
Reports. These reports provide data on services, staffing, and financing across
all the programs that are monitored. The grantee recipient submits annual
reports through the UDS electronically. Standard forms are used by all grantees
to increase validity and reliability.
The UDS contains reports on services offered, user demographics, socioeconomic
characteristics, staffing and utilization, selected diagnoses and services,
prenatal profile, costs, managed care, and revenue.
Oral health-related data include preventive care/oral hygiene, restorations,
emergency dental care, staffing of oral health care providers, dental care
utilization, and dental care expenses.
For more information, visit
http://www.bphc.hrsa.gov/uds.
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Water Fluoridation Reporting System (Formerly Fluoridation Census)
The Water Fluoridation Reporting System monitors the number of people in the
United States served by fluoridated water systems. It was last conducted in
2000. States reported data on each fluoridated water system and the communities
each system served. The state reports included fluoridation status and type of
water system-adjusted, consecutive (water purchased from another system), or
natural; the system from which water was purchased, if consecutive; the
population receiving fluoridated water; the date when fluoridation started; and
the chemical used for fluoridation, if adjusted.
The Water Fluoridation Reporting System was maintained by the Centers for
Disease Control and Prevention's National Center for Prevention Services,
Division of Oral Health and participating states.
The 2000 data were used in this report.
For more information, visit
http://www.cdc.gov/nohss/FSMain.htm.
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Youth Risk Behavioral Surveillance System (YRBSS)
The YRBSS is an epidemiologic surveillance system that was established to
monitor the prevalence of youth behaviors that influence health. The YRBSS
includes two components: the national school-based survey and the national
alternative high school survey. This report uses data from the national
school-based survey. The YRBSS focuses on priority health-risk behaviors
established during youth. These include behaviors that result in intentional
and unintentional injuries; tobacco use; alcohol and other drug use; sexual
behaviors that result in HIV infection, other sexually transmitted diseases,
and unintended pregnancies; dietary behaviors; and physical activity.
The YRBSS uses a three-stage cluster sample design to produce a nationally
representative sample of 9th through 12th grade students in the United States.
The first-stage sampling frame includes primary sampling units consisting of
large counties or groups of smaller, adjacent counties selected with
probabilities proportional to school enrollment size. At the second stage of
selection, schools are selected with probability proportional to school
enrollment size. Schools with substantial numbers of black and Hispanic
students are sampled at relatively higher rates than other schools. The final
stage of sampling consists of randomly selecting within each chosen school at
each grade, 9 through 12, one or two intact classes of a required subject such
as English or social studies. All students in selected classes are eligible to
participate.
The 1993, 1995, 1997, and 1999 surveys were used in this report.
For more information, visit
http://www.cdc.gov/nccdphp/dash/yrbs/.
* Links to non-Federal organizations are
provided solely as a service to our users. Links do not constitute an
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should be inferred. The CDC is not responsible for the content of the individual
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