Behavioral Risk Factor Surveillance System and American Community Survey Estimates of Vision Difficulty Prevalence.

Importance: Inconsistent estimates of self-reported vision impairment across survey sources may cause confusion about the true size of the population with vision problems. Objective: To explain why the American Community Survey (ACS) and Behavioral Risk Factor Surveillance System (BRFSS) produce different prevalence estimates for self-reported vision problems in the US, despite using the same question wording. Design, Setting, and Participants: This was a cross-sectional analysis of the 2021 ACS and BRFSS using subgroup analysis and decomposition. Respondents were from 49 states and the District of Columbia. Included in the analysis were a civilian noninstitutionalized population 18 years and older. Data were analyzed from August 2022 to October 2023. Intervention: Aspects of sample design and composition. Main Outcomes and Measures: Self-reported vision problems. Results: This study included a weighted sample of 2.8 million individuals (median [IQR] age, 47.7 [32.8-63.1] years; 51% male). The estimate of self-reported vision problems prevalence from the BRFSS (4.89%; 95% CI, 4.73%-5.04%) was 1.7 times as high as the estimate from the ACS (2.95%; 95% CI, 2.92%-2.97%) for similarly defined populations. If the BRFSS sample were weighted to align with the composition of other disability types in the ACS, the prevalence of vision problems would be 3.67% (95% CI, 3.53%-3.80%), closing about 63% of the gap between survey estimates. Conclusion and Relevance: Results of this survey study suggest that the focus on health may be associated with the higher prevalence in the BRFSS through differential nonresponse or question priming. Differences in other survey operations including frame construction, proxy reporting, and imputation had little impact.

Validating Reports of Chronic Conditions in the Medicare CAHPS Survey.

BACKGROUND: The Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey includes items about chronic conditions, health history, and self-rated health. Questions remain about the concordance between patient reports and administrative sources on questions related to health history. OBJECTIVE: To validate CAHPS measures of chronic conditions against claims-based measures from the Medicare Chronic Conditions Warehouse (CCW). METHODS: We linked CAHPS responses from 301,050 fee-for-service Medicare beneficiaries in 2010-2012 with summaries of their claims in the CCW and identified nearest equivalent measures of conditions across sources. We calculated sensitivities and specificities for conditions and estimated regression models to assess the effects of patient characteristics on the sensitivity. RESULTS: The sensitivity of CAHPS measures differed across conditions, ranging from 0.513 for history of stroke to 0.773 for history of cancer. Sensitivity was generally lower for older beneficiaries, those reporting good self-rated health, and those with fair or poor mental health. Specificity was 0.904 or greater for all conditions, up to 0.961 for stroke. CONCLUSIONS: Despite difference in timeframes and definitions of conditions, the measured sensitivities demonstrated reasonable validity. Variation in sensitivity is consistent with covariates that either directly measure health severity within a diagnosis or can be construed as a proxy for severity of illness.

The disparate impact of the ACA-dependent expansion across population subgroups.

OBJECTIVE: This study presents evidence on how the dependent provision in the Affordable Care Act (ACA) differentially affected coverage for young adults across states and population subgroups. STUDY DESIGN/METHODS/DATA: The data derive from the American Community Survey. Using a difference-in-difference design, we compare the target population (ages 19-25) with a control group (ages 26-29). PRINCIPAL FINDINGS: Net private health insurance coverage increased by 4.6 percentage points and overall coverage increased by 4.2 percentage points for people aged 19-25; more for Whites than non-White subgroups. CONCLUSIONS AND IMPLICATIONS: Changes in coverage for states appear driven by demographics rather than the existence of prior dependent expansions by the state. Disparities in health care coverage remain, but the absolute level of coverage is improving.