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National Health Interview Survey Early Release Program
N ATIONAL CENTER FOR HEA LTH STATISTICS
Technical Notes for Early Release of Selected Estimates
Based on Data from the National Health Interview Survey
Jeannine S. Schiller, M.P.H. and Tina Norris, Ph.D.
Division of Health Interview Statistics, National Center for Health Statistics
Technical Notes
All estimates presented are based on preliminary data files. The January 2019–December 2022 estimates are
being released prior to final data editing and final weighting to provide access to the most recent information
from the National Health Interview Survey (NHIS). In the past, differences between estimates calculated using
preliminary data files and final data files were typically less than 0.1 percentage point. In 2019, the NHIS
underwent a questionnaire redesign to better meet the needs of data users. The aims of the redesign were to
improve the measurement of covered health topics, reduce respondent burden by shortening the length of the
questionnaire, harmonize overlapping content with other federal surveys, establish a long-term structure of
ongoing and periodic topics, and incorporate advances in survey methodology and measurement. For more
information about the redesigned NHIS visit the website at:
https://www.cdc.gov/nchs/nhis/2019_quest_redesign.htm. Following the redesign, the original key health
indicators published based on the 1997–2018 NHIS were reevaluated, and a new set was chosen.
The 22 measures include outcomes of health status (disability status, six or more workdays missed due to
illness, injury, or disability in the past 12 months, asthma episode in the past 12 months, diagnosed hypertension
in the past 12 months, regularly experienced chronic pain, regularly had feelings of worry, nervousness or anxiety,
and regularly had feelings of depression); health care service use (doctor visit in the past 12 months, hospital
emergency department visit in the past 12 months, counseled by a mental health professional in the past 12
months, dental exam or cleaning in the past 12 months, blood pressure check in the past 12 months, and receipt
of influenza vaccination in the past 12 months); health care access (did not get needed medical care due to cost in
the past 12 months, did not get needed mental health care due to cost in the past 12 months, and did not take
medication as prescribed to reduce costs in the past 12 months); health insurance coverage (for adults aged 18–64:
uninsured at time of interview, private health insurance coverage at time of interview, public health plan coverage
at time of interview, and exchange-based private health insurance coverage at time of interview); and health
behaviors (current cigarette smoking and current electronic cigarette use). Additional indicators may be included
in future releases based on changing public health surveillance needs and data availability on the NHIS. Quarterly
estimates for January 2019–December 2022 are available in the NHIS Quarterly Release Tables data query tool,
and biannual estimates for January 2019–December 2022 are available in the NHIS Biannual Release Tables data
query tool.
Data source
Data used to produce this Early Release report are derived from the Sample Adult component from the
January 2019–December 2022 NHIS. NHIS is a nationally representative household survey conducted throughout
the year to collect information on health status, health-related behaviors, and health care access and utilization.
The NHIS interview begins by identifying everyone who usually lives or stays in the household. Then, one “sample
adult” aged 18 years or older and one “sample child” aged 17 years or younger (if any children live in the
household) are randomly selected. Information about the sample adult is collected from the sample adult
themselves unless they are physically or mentally unable to do so, in which case a knowledgeable proxy can answer
for the sample adult. Data analysis was based on information collected on 32,391 sample adults in 2019, 31,568
sample adults in 2020, 29,696 sample adults in 2021, and 27,654 sample adults in 2022.
The NHIS contains content that is included in the survey every year (annual core), while other content is
scheduled to appear on a periodic basis (rotating core). As a result, not all measures contained in the Early Release
have data for every year. Measures that only apply to specific survey years are noted in the Appendix. Visit the
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NHIS website at: https://www.cdc.gov/nchs/nhis.htm for more information about the design, content, and use of
NHIS.
Estimation procedures
NCHS creates survey sampling weights to produce representative national estimates. The base weight is
equal to the inverse of the probability of selection of the sample address. These weights are adjusted for household
and person-level nonresponse using multilevel models predictive of response propensity. Nonresponse-adjusted
weights are further calibrated to U.S. Census Bureau population projections and American Community Survey
one-year estimates for age, sex, race and ethnicity, educational attainment, housing tenure, census division and
metropolitan statistical area status.
Point estimates and estimates of their variances were calculated using SUDAAN software (RTI International,
Research Triangle Park, N.C.) to account for the complex sample design of NHIS, taking into account stratum and
primary sampling unit (PSU) identifiers. The Taylor series linearization method was chosen for variance
estimation. All estimates shown meet the NCHS standards of reliability as specified in “National Center for Health
Statistics Data Presentation Standards for Proportions” (1).
Comparison of estimates
Due to the COVID-19 pandemic, NHIS data collection switched to a telephone-only mode beginning on
March 19, 2020. Personal visits to households resumed in selected areas in July 2020 and in all areas of the
country in September 2020. However, interviews were still attempted by telephone first and a majority were
completed by telephone. Additionally, starting in August and continuing through the end of December, a
subsample of adult respondents who completed the NHIS in 2019 were recontacted by telephone and asked to
participate again, completing the 2020 NHIS questionnaire. Estimates for 2020 are based on data from both
samples.
Since the NHIS did not switch to telephone-only mode until late March, these changes had little impact on
Quarter 1 of 2020 (January–March). However, response rates were lower and respondent characteristics were
different in April–December 2020. Survey weights were adjusted to account for these changes in respondent
characteristics. An evaluation of nonresponse bias following survey weighting is available online
(https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2020/nonresponse-report-
508.pdf). It revealed that the weighted 2020 sample still underrepresented adults living alone and adults with
family income below the federal poverty level. Caution should be used in interpreting differences observed in
estimates between 2020 and other time periods.
The “telephone first” data collection approach that began in July 2020 continued through April 2021. Pre-
pandemic interviewing procedures (personal visit first) resumed in May 2021, but the majority of completed NHIS
interviews in 2021 were still conducted by telephone. However, analyses of weighted estimates suggest that biases
observed in 2020 did not persist in 2021. In the past, differences between estimates in Summary Health Statistics
(based on final data files) and those found in NHIS Early Release products (based on preliminary data files) were
typically less than 0.3 percentage points. As a result of the impact of the COVID-19 pandemic on data collection,
differences between 2021 NHIS estimates in these products may be greater. From January through December
2022, approximately 56% of sample adult interviews were completed by telephone.
Did not take medication as prescribed to reduce costs in the past 12 months
Respondents who took prescription medication in the past 12 months were asked a series of questions about
ways in which they may not have taken the medication as prescribed in order to save money. Estimates are based
on a positive response to at least one question about skipping medication doses to save money, taking less
medicine to save money, or delay filling a prescription to save money. Questions and response options related to
this indicator can be found in the Appendix.
Disability status
Disability is defined by the reported level of difficulty (no difficulty, some difficulty, a lot of difficulty, or
cannot do at all) in six functioning domains: seeing (even if wearing glasses), hearing (even if wearing hearing
aids), mobility (walking or climbing stairs), communication (understanding or being understood by others),
cognition (remembering or concentrating), and self-care (such as washing all over or dressing). Sample adults who
responded "a lot of difficulty" or "cannot do at all" to at least one question were considered to have a disability.
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Questions and response options for the six domains used to construct the disability status composite can be found
in the Appendix.
Diagnosed hypertension
Diagnosed hypertension is defined as report of hypertension or high blood pressure in the past 12 months or
any medication use prescribed by a doctor for high blood pressure among adults. Questions and response options
related to hypertension estimates can be found in the Appendix.
Exchange-based private health insurance coverage at time of interview
Exchange-based coverage is a private health insurance plan purchased through the Health Insurance
Marketplace or state-based exchanges that were established as part of the Affordable Care Act (ACA) of 2010 (P.L.
111–148, P.L. 111–152). This measure is limited to adults aged 18–64 as almost all adults aged 65 and over are
eligible for Medicare. In general, if an adult reports that they have coverage through the exchange, that report is
considered accurate unless there is other information (e.g., plan name or information about premiums) that
clearly contradicts that report. Similarly, if an adult does not report having coverage through the exchange, that
report is considered accurate unless other information clearly contradicts that report. For a more complete
discussion of the procedures used in classifying exchange-based coverage, see
https://www.cdc.gov/nchs/nhis/insurance.htm.
Influenza vaccination
Receipt of a flu vaccination is defined by report of having received a vaccination in the past 12 months as
opposed to during a flu season (see: https://www.cdc.gov/flu/fluvaxview). Responses to the influenza vaccination
question used to calculate the estimates presented cannot be used to determine when, during the preceding 12
months, the subject received the influenza vaccination. In addition, estimates are subject to recall error, which will
vary depending on when the question is asked, because the receipt of an influenza vaccination is seasonal.
Questions and response options related to influenza vaccination estimates can be found in the Appendix.
Private health insurance coverage at time of interview
Private health insurance coverage includes any comprehensive private insurance plan (including health
maintenance and preferred provider organizations). These plans include those obtained through an employer,
purchased directly, purchased through local or community programs, or purchased through the Health Insurance
Marketplace or a state-based exchange. Private coverage excludes plans that pay for only one type of service, such
as dental or vision care. A small number of people (2–3%) were covered by both public and private plans and were
included in both categories. This measure is limited to adults aged 18–64 as almost all adults aged 65 and over are
eligible for Medicare. Questions and response options related to this indicator can be found in the Appendix.
Public health plan coverage at time of interview
Public health plan coverage includes Medicaid, Children's Health Insurance Program (CHIP), state-sponsored
or other government-sponsored health plan, Medicare, and military plans. A small number of people (2–3%) were
covered by both public and private plans and were included in both categories. This measure is limited to adults
aged 18–64 as almost all adults aged 65 and over are eligible for Medicare. Questions and response options related
to this indicator can be found in the Appendix.
Regularly had feelings of depression
Regularly had feelings of depression is defined as report of a) feeling depressed daily and describing the level
of depression as “somewhere in between a little and a lot” or “a lot” or b) feeling depressed weekly and describing
the level of depression as “a lot.” Questions and response options related to depression estimates can be found in
the Appendix.
Regularly had feelings of worry, nervousness, or anxiety
Regularly had feelings of worry, nervousness, or anxiety is defined as report of a) feeling worried, nervous, or
anxious daily and describing the level of those feelings as “somewhere in between a little and a lot” or “a lot” or b)
feeling worried, nervous, or anxious weekly and describing the level of those feelings as “a lot.” Questions and
response options related to this indicator can be found in the Appendix.
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Six or more workdays missed due to illness, injury or disability in the past 12 months
Six or more workdays missed due to illness, injury, or disability in the past 12 months is defined in 2019–
2020 as a report of six or more workdays missed due to illness, injury, or disability by adults who a) worked for pay
in the week prior to the interview, b) had a job or business in the week prior to the interview, but were temporarily
absent, c) had seasonal or contract work, d) worked at a job or business but not for pay, or e) were not currently
working but had some period of employment in the past 12 months. Starting in 2021, this indicator is defined as a
report of six or more workdays missed due to illness, injury, or disability by adults who a) worked for pay in the
week prior to the interview, b) had a job or business in the week prior to the interview, but were temporarily
absent, c) worked at a job or business but not for pay, or d) were not currently working but had some period of
employment in the past 12 months. Those who had seasonal or contract work are no longer included in this
indicator unless they also worked in the past 12 months. Questions and response options related to estimates of
the number of workdays missed can be found in the Appendix.
Uninsured at time of interview
A person was defined as uninsured if they did not have any private health insurance, Medicare, Medicaid,
Children's Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, or
military plan. A person was also defined as uninsured if they had only Indian Health Service coverage or had only a
private plan that paid for one type of service, such as dental or vision care. This measure is limited to adults aged
18–64 as almost all adults aged 65 and over are eligible for Medicare. Questions and response options related to
this indicator can be found in the Appendix.
References
1. Parker JD, Talih M, Malec DJ, et al. National Center for Health Statistics data presentation standards for
proportions. National Center for Health Statistics. Vital Health Stat 2(175). 2017. Available from:
https://www.cdc.gov/nchs/data/series/sr_02/sr02_175.pdf.
Suggested Citation
Schiller JS, Norris T. Early release of selected estimates based on data from the January 2019–December 2022
National Health Interview Survey. National Center for Health Statistics. April 2023. Available from:
https://www.cdc.gov/nchs/nhis.htm.
Appendix. 2019–2022 National Health Interview Survey Questions Used
to Define Selected Health Measures
Alphanumeric codes refer directly to the question(s) on the 2019–2022 National Health Interview Survey used to
define the health measure.
Asthma episode in the past 12 months
AST.0010 Have you ever been told by a doctor or other health professional that you had asthma?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
AST.0030 During the past 12 months, have you had an episode of asthma or an asthma attack?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
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Blood pressure check in the past 12 months (2019 and 2021 only)
PRV.0010 When was the last time you had your blood pressure checked by a doctor, nurse, or other health
professional?
(0) Never
(1) Within the past year (anytime less than 12 months ago)
(2) Within the last 2 years (1 year but less than 2 years ago)
(3) Within the last 3 years (2 years but less than 3 years ago)
(4) Within the last 5 years (3 years but less than 5 years ago)
(5) Within the last 10 years (5 years but less than 10 years ago)
(6) 10 years ago or more
(7) Refused
(9) Don’t know
Counseled by a mental health professional in the past 12 months
MHC.0020 During the past 12 months, did you receive counseling or therapy from a mental health
professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
Current cigarette smoking
CIG.0020 Have you smoked at least 100 cigarettes in your entire life?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
CIG.0030 Do you now smoke cigarettes every day, some days or not at all?
(1) Every day
(2) Some days
(3) Not at all
(7) Refused
(9) Don’t know
Current electronic cigarette use
CIG.0070 Have you used an e-cigarette or other electronic vaping product, even just one time, in your
entire life?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
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CIG.0080 Do you now use e-cigarettes or other electronic vaping products every day, some days, or not at
all?
(1) Every day
(2) Some days
(3) Not at all
(7) Refused
(9) Don’t know
Dental exam or cleaning in the past 12 months (2019, 2020, and 2022 only)
DNC.0020 About how long has it been since you last had a dental examination or cleaning?
(0) Never
(1) Within the past year (anytime less than 12 months ago)
(2) Within the last 2 years (1 year but less than 2 years ago)
(3) Within the last 3 years (2 years but less than 3 years ago)
(4) Within the last 5 years (3 years but less than 5 years ago)
(5) Within the last 10 years (5 years but less than 10 years ago)
(6) 10 years ago or more
(7) Refused
(9) Don’t know
Did not get needed medical care due to cost in the past 12 months
UTZ.0110 During the past 12 months, was there any time when needed medical care, but did not get it
because of the cost?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
Did not get needed mental health care due to cost in the past 12 months
MHC.0050 During the past 12 months, was there any time when needed counseling or therapy from a
mental health professional, but did not get it because of the cost?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
Did not take medication as prescribed to reduce cost in the past 12 months
PMD.0010 At any time in the past 12 months, did you take prescription medication?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
PMD.0020 During the past 12 months, were any of the following true for you? ...You skipped medication
doses to save money?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
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PMD.0030 During the past 12 months, were any of the following true for you? ...You took less medication
to save money?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
PMD.0040 During the past 12 months, were any of the following true for you? ... You delayed filling a
prescription to save money?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
Disability status
COG.0010 Do you have difficulty remembering or concentrating?
(1) No difficulty
(2) Some difficulty
(3) A lot of difficulty
(4) Cannot do at all
(7) Refused
(9) Don’t know
COM.0010 Using your usual language, do you have difficulty communicating, for example, understanding or
being understood?
(1) No difficulty
(2) Some difficulty
(3) A lot of difficulty
(4) Cannot do at all
(7) Refused
(9) Don’t know
HEA.0030 Do you have difficulty hearing, even when using your hearing aid(s)? Would you say no difficulty,
some difficulty, a lot of difficulty, or you cannot do this at all?
(1) No difficulty
(2) Some difficulty
(3) A lot of difficulty
(4) Cannot do at all
(7) Refused
(9) Don’t know
MOB.0010 Do you have difficulty walking or climbing steps? Would you say no difficulty, some difficulty, a
lot of difficulty, or you cannot do this at all?
(1) No difficulty
(2) Some difficulty
(3) A lot of difficulty
(4) Cannot do at all
(7) Refused
(9) Don’t know
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UPP.0010 Do you have difficulty with self-care, such as washing all over or dressing? Would you say no
difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
(1) No difficulty
(2) Some difficulty
(3) A lot of difficulty
(4) Cannot do at all
(7) Refused
(9) Don’t know
VIS.0030 Do you have difficulty seeing, even when wearing glasses or contact lenses? Would you say no
difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
(1) No difficulty
(2) Some difficulty
(3) A lot of difficulty
(4) Cannot do at all
(7) Refused
(9) Don’t know
Doctor visit in the past 12 months
UTZ.0020 About how long has it been since you last saw a doctor or other health care professional about
your health?
(0) Never
(1) Within the past year (anytime less than 12 months ago)
(2) Within the last 2 years (1 year but less than 2 years ago)
(3) Within the last 3 years (2 years but less than 3 years ago)
(4) Within the last 5 years (3 years but less than 5 years ago)
(5) Within the last 10 years (5 years but less than 10 years ago)
(6) 10 years ago or more
(7) Refused
(9) Don’t know
Health insurance coverage
INS.0010 The next questions are about health insurance. Include health insurance obtained through
employment or purchased directly as well as government programs like Medicare, Medicaid, and
the Children's Health Insurance Program that provide medical care or help pay medical bills. Are
you covered by any kind of health insurance or some other kind of health care plan?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
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INS.0020 What kinds of health insurance or health care coverage do you have? Is it...Private health
insurance, Medicare, Medicare supplement, Medicaid, Children's Health Insurance Program or
CHIP, military related health care including TRICARE, CHAMPUS, VA health care and CHAMP-
VA, Indian Health Service, a state-sponsored health plan, or another government program?
(1) Private health insurance
(2) Medicare
(3) Medigap
(4) Medicaid
(5) Children's Health Insurance Program (CHIP)
(6) Military related health care: TRICARE (CHAMPUS) / VA health care / CHAMPVA
(7) Indian Health Service
(8) State-sponsored health plan
(9) Other government program
(10) No coverage of any type
(97) Refused
(99) Don’t know
INS.0040 There is a program called Medicaid that pays for health care for persons in need. Are you covered
by Medicaid?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
Hospital emergency department visit in the past 12 months
UTZ.0080 During the past 12 months, how many times have you gone to a hospital emergency room about
your health?
(00-96) Range of values
(97) Refused
(99) Don’t know
Diagnosed hypertension in the past 12 months
HYP.0020 Have you ever been told by a doctor or other health professional that you had hypertension, also
called high blood pressure?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
HYP.0030 Were you told on two or more different visits that you had hypertension or high blood
pressure?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
HYP.0040 During the past 12 months, have you had hypertension or high blood pressure?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
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HYP.0050 Are you now taking any medication prescribed by a doctor for your high blood pressure?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
Receipt of influenza vaccination in the past 12 months
IMS.0030 There are two types of flu vaccinations. One is a shot and the other is a spray, mist, or drop in
the nose. During the past 12 months, have you had a flu vaccination?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
Regularly experienced chronic pain (2019–2021 only)
PAI.0020 In the past three months, how often did you have pain? Would you say never, some days, most
days, or every day?
(1) Never
(2) Some days
(3) Most days
(4) Every day
(7) Refused
(9) Don’t know
Regularly had feelings of depression
DEP.0010 How often do you feel depressed? Would you say daily, weekly, monthly, a few times a year, or
never?
(1) Daily
(2) Weekly
(3) Monthly
(4) A few times a year
(5) Never
(7) Refused
(9) Don’t know
DEP.0030 Thinking about the last time you felt depressed, how depressed did you feel? Would you say a
little, a lot, or somewhere in between?
(1) A little
(2) A lot
(3) Somewhere in between a little and a lot
(7) Refused
(9) Don’t know
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Regularly had feelings of worry, nervousness, or anxiety
ANX.0010 How often do you feel worried, nervous or anxious? Would you say daily, weekly, monthly, a few
times a year, or never?
(1) Daily
(2) Weekly
(3) Monthly
(4) A few times a year
(5) Never
(7) Refused
(9) Don’t know
ANX.0030 Thinking about the last time you felt worried, nervous or anxious, how would you describe the
level of these feelings? Would you say a little, a lot, or somewhere in between?
(1) A little
(2) A lot
(3) Somewhere in between a little and a lot
(7) Refused
(9) Don’t know
Six or more workdays missed due to illness, injury, or disability in the past 12 months
EMP.0010 Last week, did you work for pay at a job or business?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
EMP.0020 Did you have a job or business last week, but were temporarily absent due to illness, vacation,
family or maternity leave, or some other reason?
(1) Yes
(2) No
(7) Refused
(9) Don’t know
EMP.0050 (2019–2020) What is the main reason you were not working for pay at a job or business last week?
EMP.0030 (2021–2022)
(1) Unemployed, laid off, looking for work
(2) Seasonal/contract work
(3) Retired
(4) Unable to work for health reasons/disabled
(5) Taking care of house or family
(6) Going to school
(7) Working at a job or business but not for pay
(8) Other
(97) Refused
(99) Don't Know
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EMP.0060 (2019–2020) When was the last time you worked for pay at a job or business, even if only for a few
days?
EMP.0040 (2021–2022)
(1) Within the past 12 months
(2) 1-5 years ago
(3) Over 5 years ago
(4) Never worked
(7) Refused
(9) Don’t know
EMP.0090 During the past 12 months, about how many days of work did you miss because of illness, injury
or disability?
(000-365) Range of values
(997) Refused
(999) Don’t know
