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on laboratory measurements, and thus their impact on the
evaluation of data over time. Crossover studies have been
conducted to evaluate the impact of laboratory changes on
both FPG and A1c. The recommended adjustments to FPG to
account for laboratory changes from 2005–2006 to present
have been incorporated in estimates presented in Health,
United States so that these estimates are compatible with
those from earlier years. NHANES does not recommend any
adjustments to the A1c data.
Estimates presented in Health, United States may differ from
other estimates based on the same data and presented
elsewhere if different weights, age-adjustment groups,
definitions, or trend adjustments are used.
For more information, see: http://wwwn.cdc.gov/nchs/
nhanes/2011-2012/GHB_G.htm and http://wwwn.cdc.gov/
nchs/nhanes/2011-2012/GLU_G.htm.
Diagnosis—Diagnosis is the act or process of identifying or
determining the nature and cause of a disease or injury
through evaluation of patient history, examination, and
review of laboratory data. Diagnoses in the National Hospital
Discharge Survey, the National Ambulatory Medical Care
Survey, and the National Hospital Ambulatory Medical Care
Survey are abstracted from medical records and coded to
the International Classification of Diseases, 9th Revision,
Clinical Modification (ICD–9–CM).
For a given medical care encounter, the first-listed diagnosis
can be used to categorize the visit, or if more than one
diagnosis is recorded on the medical record, the visit can be
categorized based on all diagnoses recorded. Analyzing
first-listed diagnoses avoids double-counting events such as
visits or hospitalizations; the first-listed diagnosis is often,
but not always, considered the most important or dominant
condition among all comorbid conditions. However, the
choice of the first-listed diagnosis by the medical facility may
be influenced by reimbursement or other factors. A hospital
discharge would be considered a first-listed stroke discharge
if the diagnosis code for stroke was recorded in the first
diagnosis field on the hospital record. An any-listed stroke
discharge would classify all diagnoses of stroke recorded on
the hospital face sheet, regardless of the order in which they
are listed. Any-listed diagnoses double-count events such as
visits or hospitalizations with more than one recorded
diagnosis but provide information on the burden a specific
diagnosis presents to the health care system. (Also see
Appendix II, External cause of injury; Injury; Injury-related
visit.)
Diagnostic and other nonsurgical procedure—See
Appendix II, Procedure.
Discharge—The National Health Interview Survey defines a
hospital discharge as the completion of any continuous
period of stay of one night or more in a hospital as an
inpatient. According to the National Hospital Discharge
Survey and the Healthcare Cost and Utilization
Project—National (Nationwide) Inpatient Sample, a
discharge is a completed inpatient hospitalization. A
hospitalization may be completed by death or by release of
the patient to the customary place of residence, a nursing
home, another hospital, or other locations. (Also see
Appendix II, Admission; Average length of stay; Days of care;
Hospital utilization; Inpatient.)
Domiciliary care home—See Appendix II, Long-term care
facility; Nursing home.
Drug—Drugs are pharmaceutical agents, by any route of
administration, for the prevention, diagnosis, or treatment of
medical conditions or diseases. Data on specific drug use are
collected in several NCHS surveys. (Also see Appendix II,
Multum Lexicon Plus therapeutic class.)
National Health and Nutrition Examination Survey
(NHANES)—Drug information from NHANES III and from
NHANES for 1999 and subsequent years was collected
during in-person interviews conducted in participants'
homes. Starting with 2001 data, participants were asked
whether they had taken a medication in the past 30 days
for which they needed a prescription. For 1999–2000 and
1988–1994 data, the question wording differed slightly;
participants were asked whether they had taken a
prescription medication in the past month. For all survey
years, those who answered ‘‘yes’’ were asked to provide
the prescription medication containers for the
interviewer. For each medication reported, the
interviewer entered the product's complete name from
the container. If no container was available, the
interviewer asked the participant to verbally report the
name of the medication. In addition, participants were
asked how long they had been taking the medication
and the main reason for use.
All reported medication names were converted to their
standard generic ingredient name. For multi-ingredient
products, the ingredients were listed in alphabetical
order and counted as one drug (e.g., Tylenol #3 was listed
as acetaminophen; codeine). No trade or proprietary
names were provided on the data file.
Drug data from NHANES provide a snapshot of all
prescribed drugs reported by a sample of the civilian
noninstitutionalized population for a 30-day period (or
past month, for earlier survey years). Drugs taken on an
irregular basis, such as every other day, once per week, or
for a 10-day period, were captured in the 30-day recall
period. Data shown in Health, United States for the
percentage of the population reporting multiple
prescription drugs during the past 30 days include a
range of drug utilization patterns; for example, persons
who took three or more drugs daily during the past 30
days or persons who took a different drug three separate
times would be classified as taking three or more drugs
in the past 30 days, as long as at least three different
drugs were taken at some time during the past 30 days.
408 Appendix II. Definitions and Methods Health, United States, 2014