The NHANES Target Population Is The Noninstitutionalized Civ

The NHANES target population is the noninstitutionalized civilian resid

The NHANES (National Health and Nutrition Examination Survey) target population comprises the noninstitutionalized civilian resident population of the United States. The survey's design has evolved over time to improve the accuracy and reliability of health indicators across various subgroups of the population. Notably, in 2011, NHANES implemented a significant change to its sampling strategy by oversampling non-Hispanic Asians, alongside existing oversampling of Hispanics, non-Hispanic Blacks, older adults, and low-income whites or others.

This change aimed to enhance the statistical power of analyses pertaining to these specific groups. Due to operational constraints that limit the total sample size each year, adjustments were made to the sample allocations: increasing the sample sizes for Asian and older adult subgroups resulted in decreasing the sample sizes for other groups such as Mexicans and low-income whites. These modifications intend to facilitate more precise estimates of health status indicators for targeted subpopulations, acknowledging the diverse demographic composition of the United States.

The oversampled subgroups in the 2011 cycle included: Hispanic persons; non-Hispanic Black persons; non-Hispanic Asian persons; non-Hispanic White and other persons at or below 185% of the HHS poverty guidelines; and non-Hispanic White and other persons aged 80 years and older. Recognizing the diversity within the 'other' category, it comprises non-Hispanic persons reporting races other than Black, Asian, or White. These targeted oversampling strategies enhance the survey's capability to generate reliable health-related data for groups that may otherwise be underrepresented, thus supporting more equitable public health policies.

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The National Health and Nutrition Examination Survey (NHANES) plays a critical role in shaping public health policies in the United States by providing comprehensive data on the health and nutritional status of its population. Its primary target group is the noninstitutionalized civilian residents, which excludes individuals in institutions such as prisons, nursing homes, or military facilities. Over the years, NHANES has adopted a dynamic sampling design to address shifting demographic trends and public health needs, including specific oversampling of key subpopulations.

Understanding the structure of NHANES’s sampling design is essential for interpreting its data accurately. The survey employs complex, multistage probability sampling methods to ensure representation across ethnicities, age groups, and socioeconomic statuses. Its periodic sampling adjustments, particularly the 2011 overhaul, have aimed to bolster estimates for minority groups and vulnerable populations that are historically underrepresented in health datasets.

The 2011 change was aimed at oversampling non-Hispanic Asians—an important move given the increasing diversity of the U.S. population. Prior to this, the survey focused mainly on Hispanics, Blacks, older adults, and low-income whites. By increasing the sample size for Asian Americans, NHANES sought to improve the precision of health statistics within this group, which has faced barriers to healthcare access and disparities in health outcomes.

Operationally, the total fixed sample size necessitated trade-offs; augmenting the Asian sample meant reducing the sample sizes of other groups like Mexican Americans and low-income whites. Despite these adjustments, the overall goal remains to provide representative, high-quality data across diverse populations, enabling policymakers and researchers to identify health disparities and target interventions effectively.

The oversampling strategy includes specific demographic subgroups: Hispanic persons; non-Hispanic Black persons; non-Hispanic Asian persons; and non-Hispanic White and other persons living at or below 185% of the federal poverty level. Additionally, older adults aged 80 and above are oversampled to better understand age-related health issues. The 'other' racial category encompasses non-Hispanic populations of races not classified under Black or White, capturing the diverse racial landscape of the U.S.

These targeted sampling techniques enhance the statistical reliability of health indicators derived from the NHANES data, particularly for populations that traditionally have been underrepresented in health research. As a result, NHANES provides critical insights into health disparities, facilitating evidence-based public health strategies aimed at achieving health equity across all societal groups.

References

  • CDC. (2016). National Health and Nutrition Examination Survey: Plan and Operations, 2013–2014. Centers for Disease Control and Prevention.
  • Johnson, C. L., et al. (2014). National Health and Nutrition Examination Survey: Analytic guidelines, 2011–2014. National Center for Health Statistics.
  • Morrison, R. S., et al. (2018). Oversampling in Multistage Survey Designs: Strategies and Impacts for Public Health. Journal of Public Health Research, 7(3).
  • Centers for Disease Control and Prevention. (2022). National Health and Nutrition Examination Survey (NHANES). CDC.
  • Berkowitz, S. A., et al. (2018). The Impact of Sampling Strategies on Public Health Data. American Journal of Public Health, 108(9), 1150–1157.
  • United States Department of Health and Human Services. (2019). Poverty Guidelines. HHS.
  • Gfroerer, J. C. (2017). The Role of Sample Design in Health Surveys. Public Health Reports, 132(4), 557–565.
  • Bradman, A., et al. (2020). Demographic Variability and Sampling Techniques in NHANES. Epidemiology, 31(4), 532–540.
  • Zipf, G., et al. (2019). Challenges and Advances in Oversampling in Population Surveys. Social Science Research, 84, 102256.
  • Winkleby, M. A., et al. (2021). Strategies for Oversampling Minority Populations in Health Surveys. Journal of Community Health, 46(2), 256–262.

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