A Brief Introduction to Four National Health Databases in the United States

Yunwei Gai, Nadia Nelipa, Frederick Afonso


Health and medical care pervade every aspect of our lives. As the world population ages, an entirely new demographic stress will be put on healthcare systems. Some estimates project healthcare costs in the United States to account for 20% of GDP in the next few years. In comparison, China’s total expenditure on health as a percentage of GDP has risen steadily and it is currently below 6%. However, with the rise of life expectancy, an aging population and higher living standards, health expenditure in China will continue to rise.  Another challenge China faces is healthcare system reform to ensure equity and to reduce health disparity. To solve these challenges, accurate collection of health statistics at the national level is needed.

In this article, we introduce and compare four national health databases in United States, which are pillars for evaluating national health profile and for formulating national health policies. The four databases are National Health Interview Survey (NHIS), Medical Expenditure Panel Survey (MEPS), National Health and Nutrition Examination Survey (NHANES) and Behavioral Risk Factor Surveillance System (BRFSS). As an example, we illustrate how to derive the prevalence of cholesterol screening from the four databases. Despite differences, the overall distributions follow similar patterns across four datasets. These databases can be linked with other data sources to answer more complicated questions in health and healthcare.

We hope that this article can draw the attention of Chinese health researchers and policymakers on the importance of health surveillance and can lead to more discussions and interest on how China can benefit from the U.S. experience in conducting health surveillance at the national level.


health database, China, MEPS, BRFSS, NHANES

Full Text:



Carlson, S. A., Densmore, D., Fulton J.E., Yore M.M., and H.W. Kohl, 3rd (2009). “Differences in Physical Activity Prevalence and Trends from 3 U.S. Surveillance Systems: NHIS, NHANES, and BRFSS.” Journal of Physical Activity and Health 6 (Supplement) 1: S18–27.

Coughlin, S.S., Leadbetter, S., Richards, T., and S.A. Sabatino (2008). “Contextual analysis of breast and cervical cancer screening and factors associated with health care access among United States women.” Social Science & Medicine 66: 260–275.

Cutler, D (2010). “How Health Care Reform Must Bend the Cost Curve.” Health Affairs 29(6): 1131–35.

Dall, T.M., Fulgoni, V.L. 3rd., Zhang, Y., Reimers, K.L., Packard, P.T., and J. D. Astwood (2009). “Potential Health Benefits and Medical Cost Savings from Calorie, Sodium, and Saturated Fat Reductions in the American Diet.” American Journal of Health Promotion 23(6): 412–422.

Dave, D.M. and I.R. Kelly IR (2011). “How does the business cycle affect eating habits?” Social Science & Medicine (Epub ahead of print).

Druss, B.G., Zhao, L., Von Esenwein, S., Morrato, E.H., and S.C. Marcus (2011). “Understanding Excess Mortality in Persons With Mental Illness: 17-Year Follow Up of a Nationally Representative US Survey.” Medical Care 49(6): 599–604.

Fahimi, M., Link, M., Mokdad, A., Schwartz, D.A., and P. Levy (2008). “Tracking Chronic Disease and Risk Behavior Prevalence as Survey Participation Declines: Statistics from the Behavioral Risk Factor Surveillance System and Other National Surveys.” Preventing Chronic Disease 5(3): A80.

Gaskin, D.J., Dinwiddie, G.Y., Chan, K.S., and R. McCleary (2011). “Residential Segregation and Disparities in Health Care Services Utilization.” Medical Care Research and Review (Epub ahead of print).

Hanmer, J., Lawrence, W.F., Anderson, J.P., Kaplan, R.M., and G.F. Dennis (2006). “Report of Nationally Representative Values for the Noninstitutionalized US Adult Population for 7 Health-Related Quality-of-Life Scores.” Medical Decision Making 26(4): 391–400.

Hser, Y., Du, J., Li, J., Zhao, M., Chang, Y.J., and C.Y. Peng (2011). “Hepatitis C among methadone maintenance treatment patients in Shanghai and Kunming, China.” Journal of Public Health (Epub ahead of print).

Johnson P.O., Lynn, A.B., Call, K.T., and D. Michael (2010). “American Indian/Alaska Native Uninsurance Disparities: A Comparison of 3 Surveys.” American Journal of Public Health 100(10): 1972–79.

Liu, H (2008). “The China health and nutrition survey: an important database for poverty and inequality research.” Journal of Economic Inequality 6: 373–376.

Macek, M. D., Manski, R.J., Vargas, C.M., and J.F. Moeller (2002). “Comparing Oral Health Care Utilization Estimates in the United States across Three Nationally Representative Surveys.” Health Services Research 37(2): 499–521.

Mojtabai, R (2011). “National Trends in Mental Health Disability, 1997–2009.” American Journal of Public Health 101(11): 2156–2163.

Norris, S.L., Kansagara, D., Bougatsos, C., and P. Nygren (2008). “Screening for Type 2 Diabetes: Update of 2003 Systematic Evidence Review for the U.S. Preventive Services Task Force.” Evidence Synthesis No. 61. AHRQ Publication No. 08-05116-EF-1. Rockville, Maryland: Agency for Healthcare Research and Quality.

Ormond, B.A., Spillman, B.C., Waidmann, T.A., Caswell, K.J., and B. Tereshchenko (2011). “Potential National and State Medical Care Savings from Primary Disease Prevention.” American Journal of Public Health 101(1): 157–64.

Pleis, J.R., Lucas, J.W., and B.W. Ward (2008). “Summary health statistics for U.S. adults: National Health Interview Survey, 2008.” Vital Health Statics 10(242): 1-157.

Short, P.F., John R.M., and P. Rajeshwari (2011). “Medical Expenditures of Adult Cancer Survivors Aged <65 Years in the United States.” Cancer 117(12): 2791-800.

Stommel, M., and C. Schoenborn (2009). “Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001-2006.” BMC Public Health 9(1): 421–431.

Sun, P., Unger, J.B., Palmer, P., Ma, H., Xie, B., Sussman, S., and C.A. Johnson (2011). “Relative income inequality and selected health outcomes in urban Chinese youth.” Social Science & Medicine (Epub ahead of print).

United States (2003). “How Many People Lack Health Insurance and For How Long?” Washington, D.C.: Congress of the United States, Congressional Budget Office. http://www.cbo.gov/ftpdocs/42xx/doc4210/05-12-Uninsured.pdf accessed on December 10, 2011.

United States (2007). “CBO's health insurance simulation model: A technical description.” Washington, D.C.: Congress of the U.S., Congressional Budget Office. http://www.cbo.gov/ftpdocs/87xx/doc8712/10-31-HealthInsurModel.pdf. Accessed on December 10, 2011.

United States (2010). “An Act Entitled the Patient Protection and Affordable Care Act.” Washington, D.C.: the United States Government Printing Office http://www.healthcare.gov/law/introduction/index.html; accessed on October 28, 2011.

United States (2010). “CBO's Cost Estimate for James Zadroga 9/11 Health and Compensation Act of 2010.” Washington, D.C.: Congress of the U.S., Congressional Budget Office. http://www.cbo.gov/ftpdocs/115xx/doc11592/hr847.pdf accessed on December 10, 2011.

World Health Organization (2011). “World Health Statistics 2011.” Geneva, Switzerland: World Health Organization.

Wagstaff, A., Lindelow, M., Jun, G., Ling, X., and Q. Juncheng (2009). “Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme.” Journal of Health Economics 28(1):1–19.

Ye, J., Mack, D., Fry-Johnson, Y., and K. Parker (2011). “Health Care Access and Utilization Among US-Born and Foreign-Born Asian Americans.” Journal of Immigrant and Minority Health (Epub ahead of print).


  • There are currently no refbacks.

Copyright (c) 2015 Yunwei Gai, Nadia Nelipa, Frederick Afonso

Copyright © 2010-2016 by The China Health Policy and Management Society