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MEPS HC-120: 2008 Medical Conditions

November 2010

Agency for Healthcare Research and Quality
Center for Financing, Access, and Cost Trends
540 Gaither Road
Rockville, MD 20850
(301) 427-1406


Table of Contents

A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Survey Management and Data Collection
Technical and Programming Information
1.0 General Information
2.0 Data File Information
2.1 Codebook Structure
2.2 Reserved Codes
2.3 Codebook Format
2.4 Variable Naming
2.5 File Contents
2.5.1 Identifier Variables (DUID-CONDRN)
2.5.2 Medical Condition Variables (PRIOLIST-CCCODEX)
2.5.2.1 Priority Conditions and Injuries
2.5.2.2 Age Priority Condition Began/Date Accident Occurred
2.5.2.3 Follow-up Questions for Injuries and Priority Conditions
2.5.2.4 Considerations for Making Estimates Using the MEPS Conditions File
2.5.2.4.1 Conditions File vs. Priority Conditions
2.5.2.4.2 Sources for Conditions on the MEPS Conditions File
2.5.2.5 Treatment of Data from Rounds Not Occurring in 2008
2.5.2.6 Rounds in Which Conditions Were Reported/Selected (CRND1 – CRND5)
2.5.2.7 Disability Flag Variables
2.5.2.8 Diagnosis Condition and Procedure Codes
2.5.2.9 Clinical Classification Codes
2.5.3 Utilization Variables (OBNUM – RXNUM)
3.0 Survey Sample Information
3.1 Overview
3.2 Details on Person Weight Construction
3.2.1 MEPS Panel 12 Weight
3.2.2 MEPS Panel 13 Weight
3.2.3 The Final Weight for 2008
3.2.4 Additional Adjustment to 2008 Person Weights for Persons Age 65 and Over
3.2.5 Coverage
3.3 Using MEPS Data for Trend Analysis
4.0 Merging/Linking MEPS Data Files
4.1 National Health Interview Survey
4.2 Longitudinal Analysis
References
Appendix 1: Variable-Source Crosswalk
Appendix 2: Condition, Procedure and Clinical Classification Code Frequencies|
Appendix 3: Clinical Classification Code to ICD-9-CM Code Crosswalk
Appendix 4: List of Priority Conditions

A. Data Use Agreement

Individual identifiers have been removed from the micro-data contained in these files. Nevertheless, under sections 308 (d) and 903 (c) of the Public Health Service Act (42 U.S.C. 242m and 42 U.S.C. 299 a-1), data collected by the Agency for Healthcare Research and Quality (AHRQ) and/or the National Center for Health Statistics (NCHS) may not be used for any purpose other than for the purpose for which they were supplied; any effort to determine the identity of any reported cases is prohibited by law.

Therefore in accordance with the above referenced Federal Statute, it is understood that:

  1. No one is to use the data in this data set in any way except for statistical reporting and analysis; and

  2. If the identity of any person or establishment should be discovered inadvertently, then (a) no use will be made of this knowledge, (b) the Director Office of Management AHRQ will be advised of this incident, (c) the information that would identify any individual or establishment will be safeguarded or destroyed, as requested by AHRQ, and (d) no one else will be informed of the discovered identity; and

  3. No one will attempt to link this data set with individually identifiable records from any data sets other than the Medical Expenditure Panel Survey or the National Health Interview Survey.

By using these data you signify your agreement to comply with the above stated statutorily based requirements with the knowledge that deliberately making a false statement in any matter within the jurisdiction of any department or agency of the Federal Government violates Title 18 part 1 Chapter 47 Section 1001 and is punishable by a fine of up to $10,000 or up to 5 years in prison.

The Agency for Healthcare Research and Quality requests that users cite AHRQ and the Medical Expenditure Panel Survey as the data source in any publications or research based upon these data.

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B. Background

1.0 Household Component

The Medical Expenditure Panel Survey (MEPS) provides nationally representative estimates of health care use, expenditures, sources of payment, and health insurance coverage for the U.S. civilian non-institutionalized population. The MEPS Household Component (HC) also provides estimates of respondents’ health status, demographic and socio-economic characteristics, employment, access to care, and satisfaction with health care. Estimates can be produced for individuals, families, and selected population subgroups. The panel design of the survey, which includes 5 Rounds of interviews covering 2 full calendar years, provides data for examining person level changes in selected variables such as expenditures, health insurance coverage, and health status. Using computer assisted personal interviewing (CAPI) technology, information about each household member is collected, and the survey builds on this information from interview to interview. All data for a sampled household are reported by a single household respondent.

The MEPS-HC was initiated in 1996. Each year a new panel of sample households is selected. Because the data collected are comparable to those from earlier medical expenditure surveys conducted in 1977 and 1987, it is possible to analyze long-term trends. Each annual MEPS-HC sample size is about 15,000 households. Data can be analyzed at either the person or event level. Data must be weighted to produce national estimates.

The set of households selected for each panel of the MEPS HC is a subsample of households participating in the previous year’s National Health Interview Survey (NHIS) conducted by the National Center for Health Statistics. The NHIS sampling frame provides a nationally representative sample of the U.S. civilian non-institutionalized population and reflects an oversample of blacks and Hispanics. In 2006, the NHIS implemented a new sample design, which included Asian persons in addition to households with black and Hispanic persons in the oversampling of minority populations. MEPS further oversamples additional policy relevant sub-groups such as low income households. The linkage of the MEPS to the previous year’s NHIS provides additional data for longitudinal analytic purposes.

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2.0 Medical Provider Component (MPC)

Upon completion of the household CAPI interview and obtaining permission from the household survey respondents, a sample of medical providers are contacted by telephone to obtain information that household respondents can not accurately provide. This part of the MEPS is called the Medical Provider Component (MPC) and information is collected on dates of visit, diagnosis and procedure codes, charges and payments. The Pharmacy Component (PC), a subcomponent of the MPC, does not collect charges or diagnosis and procedure codes but does collect drug detail information, including National Drug Code (NDC) and medicine name, as well as date filled and sources and amounts of payment. The MPC is not designed to yield national estimates. It is primarily used as an imputation source to supplement/replace household reported expenditure information.

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3.0 Survey Management and Data Collection

MEPS HC and MPC data are collected under the authority of the Public Health Service Act. Data are collected under contract with Westat, Inc. Data sets and summary statistics are edited and published in accordance with the confidentiality provisions of the Public Health Service Act and the Privacy Act. The National Center for Health statistics (NCHS) provides consultation and technical assistance.

As soon as data collection and editing are completed, the MEPS survey data are released to the public in staged releases of summary reports, micro data files, and tables via the MEPS Web site: www.meps.ahrq.gov. Selected data can be analyzed through MEPSnet, an on-line interactive tool designed to give data users the capability to statistically analyze MEPS data in a menu-driven environment.

Additional information on MEPS is available from the MEPS project manager or the MEPS public use data manager at the Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850 (301-427-1406).

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C. Technical Information

1.0 General Information

This documentation describes the data contained in MEPS Public Use Release HC-120, which is one in a series of public use data files to be released from the 2008 Medical Expenditure Panel Survey Household Component (MEPS HC).

Released in ASCII (with related SAS and SPSS programming statements and data user information) and SAS formats, this public use file provides information on household-reported medical conditions collected on a nationally representative sample of the civilian noninstitutionalized population of the United States for calendar year 2008 MEPS HC. The file contains 36 variables and has a logical record length of 105 with an additional 2-byte carriage return/line feed at the end of each record.

This documentation offers a brief overview of the types and levels of data provided and the content and structure of the files. It contains the following sections:

Data File Information
Survey Sample Information
Merging/Linking MEPS Data Files
Appendices
    Variable to Source Crosswalk
    Detailed ICD-9-CM Condition, Procedure, and Clinical Classification Code Frequencies
    Clinical Classification Code to ICD-9-CM Code Crosswalk
    List of Priority Conditions

A codebook of all the variables included in the 2008 Medical Conditions File is provided in an accompanying file.

For more information on MEPS survey design, see T. Ezzati-Rice, et al., 1998-2007 and S. Cohen, 1996. A copy of the survey instrument used to collect the information on this file is available on the MEPS Website: www.meps.ahrq.gov.

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2.0 Data File Information

This file contains 102,169 records. Each record represents one medical condition reported by a household survey respondent who resides in an eligible responding household and who has a positive person or family weight.

A new section, Priority Conditions Enumeration (PE), was added in Panel 12. The PE section asks a series of questions regarding whether the person has ever been diagnosed with a specified priority condition (e.g., diabetes). If the answer is yes, then CAPI automatically creates a condition record that is flagged as a priority condition (PRIOLIST = 1). Respondents may also report medical conditions in the Condition Enumeration (CE), medical events, and Disability Days (DD) sections. Prior to Panel 12, the interviewer manually identified whether a condition collected in the CE, events, or DD sections was a priority condition based on a list provided in the help text. In addition to changing the method of assigning priority condition status from manual to automated, the list of priority conditions changed in Panel 12. See Appendix 4 for details.

In Panel 12, round-specific questions (SEEDREV#, STILTR#, OVRALL#, FURTCA#, FOLOCA#, SEEDREF#)and some accident/injury follow-up questions (ACDNTLOC, INOUTHH, VEHICLE, WEAPON, POISON, FIREBURN, DROWN, SPORTS, FALL, ACDNTOTH, RECOVER) were no longer collected.

Records meeting one of the following criteria are included on the file:

In Panel 13:

  • Round 1 and Round 2 conditions that are not priority conditions;
  • Round 1 and Round 2 priority condition records that are current. A current condition is defined as a condition linked to a 2008 event or disability day, or a condition the person is currently experiencing (i.e., a condition selected in the CE section);
  • Round 3 conditions that were linked to a 2008 event;
  • Round 3 conditions that were due to an accident or injury and began before 2008;
  • Round 3 priority condition records where the age of diagnosis is less than or equal to the person’s age as of 12/31/2008 or where the age of diagnosis is refused, don’t know, or not ascertained, and the condition is current; or
  • Round 3 priority conditions where 50 percent or more of person’s reference period occurred in 2008.

In Panel 12:

  • Round 3, Round 4, and Round 5 condition records that are not priority conditions;
  • Round 3, Round 4, and Round 5 priority condition records that are current. A current condition is defined as a condition linked to a 2008 event or disability day or a condition the person is currently experiencing (i.e., a condition selected in the CE section); or
  • Round 1 and Round 2 condition records that are linked to a 2008 event or disability day, or a condition the person is currently experiencing in 2008 (i.e., a condition selected in the CE section).

Overlap Condition Records (in 2007 and 2008)

Application of the above selection rules indicates that all Panel 12 Round 3 conditions delivered in the 2007 file will be included on the 2008 file if the person has a positive person or family weight in 2008.

For each variable on the file, the codebook provides both weighted and unweighted frequencies. Because the conditions identified in this file are derived from self-reports, these data cannot be used to make estimates of disease, prevalence of health conditions, or mortality/morbidity. However, data users can make estimates of treated prevalence.

Data from this file can be merged with 2008 MEPS person-level data to append person-level characteristics such as demographic or health insurance characteristics to each record by using DUPERSID (see Section 4.0 for details). Since each record represents a single condition reported by a household respondent, some household respondents may have multiple medical conditions and thus will be represented on multiple records on this file. Other household respondents may have reported no medical conditions and thus will have no records on this file. Still other respondents may have reported a medical condition that did not meet the criteria above and thus will have no records on this file. Data from this file also can be merged to 2008 MEPS Event Files (HC-118A through HC-118H) by using the link files provided in HC-118I. (See HC-118I for details.)

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2.1 Codebook Structure

The codebook and data file list variables in the following order:

Unique person identifiers
Unique condition identifiers
Medical condition variables
Utilization variables
Weight and variance estimation variables

Note that the person identifier is unique within this data year.

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2.2 Reserved Codes

The following reserved code values are used:

Value Definition
-1 INAPPLICABLE Question was not asked due to skip pattern
-7 REFUSED Question was asked and respondent refused to answer question
-8 DK Question was asked and respondent did not know answer
-9 NOT ASCERTAINED       Interviewer did not record the data

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2.3 Codebook Format

This codebook describes an ASCII data set and provides the following programming identifiers for each variable:

Identifier Description
Name Variable name (maximum of 8 characters)
Description       Variable descriptor (maximum 40 characters)
Format Number of bytes
Type Type of data: numeric (indicated by NUM) or character (indicated by CHAR)
Start Beginning column position of variable in record
End Ending column position of variable in record

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2.4 Variable Naming

In general, variable names reflect the content of the variable, with an 8-character limitation. For questions asked in a specific round, the end digit in the variable name reflects the round in which the question was asked. Edited variables end in an "X" and are so noted in the variable label. (CONDIDX, which is an encrypted identifier variable, also ends in an "X".)

Variables contained in this delivery were derived either from the questionnaire itself or from the CAPI. The source of each variable is identified in Appendix 1 "Variable to Source Crosswalk." Sources for each variable are indicated in one of three ways: (1) variables derived from CAPI or assigned in sampling are so indicated; (2) variables collected at one or more specific questions have those numbers and questionnaire sections indicated in the "SOURCE" column; and (3) variables constructed from multiple questions using complex algorithms are labeled "Constructed" in the "SOURCE" column.

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2.5 File Contents

2.5.1 Identifier Variables (DUID-CONDRN)

The definitions of Dwelling Units (DUs) and Group Quarters in the MEPS HC are generally consistent with the definitions employed for the National Health Interview Survey (NHIS). The dwelling unit ID (DUID) is a 5-digit random number assigned after the case was sampled for MEPS. The person number (PID) uniquely identifies each person within the dwelling unit. The variable DUPERSID uniquely identifies each person represented on the file and is the combination of the variables DUID and PID. CONDN indicates the condition number as it was reported during the interview for an individual respondent (e.g., condition number 1, 2, 3, etc.) plus a control digit. The current range for CONDN is 11-481 and the largest range of records for any person on the file is 1-42. Note that this discrepancy is expected, as condition numbers are not sequentially assigned by the CAPI. In other words, if CONDN is set to 10 for a person's first condition, then CONDN might be set to 17 for the person's second condition. CONDIDX uniquely identifies each condition (i.e., each record on the file) and is the combination of DUPERSID and the condition number CONDN. For CONDIDX, the condition number is padded with leading zeroes to ensure consistent length.

PANEL is a constructed variable used to specify the panel number for the interview in which the condition was reported. PANEL will indicate either Panel 12 or Panel 13.

CONDRN indicates the round in which the condition was first reported. For a small number of cases, conditions that actually began in an earlier round were not reported by respondents until subsequent rounds of data collection. During file construction, editing was performed for these cases in order to reconcile the round in which a condition began and the round in which the condition was first reported.

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2.5.2 Medical Condition Variables (PRIOLIST-CCCODEX)

This file contains variables describing medical conditions reported by respondents in several sections of the MEPS questionnaire, including the Condition Enumeration section, all questionnaire sections collecting information about health provider visits, prescription medications, and disability days (see Variable-Source Crosswalk in Appendix 1 for details).

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2.5.2.1 Priority Conditions and Injuries

Certain conditions were a priori designated as "priority conditions" (PRIOLIST=1) due to their prevalence, expense, or relevance to policy. Some of these were long-term, life-threatening conditions, such as cancer, diabetes, emphysema, high cholesterol, hypertension, ischemic heart disease, and stroke. Others were chronic manageable conditions, including arthritis and asthma. The only mental health condition on the priority conditions list is attention deficit hyperactivity disorder/attention deficit disorder. For a complete listing of priority conditions for Panel 12 and beyond, and prior to Panel 12, see Appendix 4.

Prior to Panel 12, priority conditions were identified as such in the field by MEPS interviewers. Occasionally, priority conditions were not identified as such due to interviewer misinterpretation. Consequently, these records are missing the followup questions described below. Likewise, some conditions were inaccurately identified as priority conditions. These records do have follow-up questions even though they are not priority conditions. Beginning in Panel 12, priority conditions were flagged as such by CAPI, thus preventing inaccurate identification.

When a condition was first mentioned, respondents were asked whether it was due to an accident or injury (INJURY=1). Only non-priority conditions (i.e., conditions reported in a section other than PE) are eligible to be injuries. The interviewer is prevented from selecting priority conditions as injuries.

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2.5.2.2 Age Priority Condition Began/Date Accident Occurred

The month and year a priority condition began (CONDBEGM and CONDBEGY) were dropped in Panel 12. The age of diagnosis (AGEDIAG) was collected for all priority conditions, except joint pain. The day, month, and year an accident or injury occurred (ACCDENTD, ACCDENTM, and ACCDENTY) were collected only for accident/injury conditions. If the respondent did not know the accident year, or refused to provide it, or if the year was not ascertained (ACCDENTY in (-7, -8, -9)), a follow-up question gathered whether the accident occurred before or after January 1 of the reference year (ACCDNJAN). If the respondent replied that the accident occurred after January 1 of the reference year (ACCDNJAN = 2), then the reference year was used to set the accident year and ACCDNJAN was reset to Inapplicable (-1).

To ensure confidentiality, the accident year was bottom-coded to 1923 and age of diagnosis was top-coded to 85. This corresponds with the date of birth bottom-coding and age top-coding in person-level PUFs.

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2.5.2.3 Follow-up Questions for Injuries and Priority Conditions

When a respondent reported that a condition resulted from an accident or injury (INJURY=1), respondents were asked during the round in which the injury was first reported whether the accident/injury occurred at work (ACCDNWRK). Persons aged 15 and younger were not asked this question and the condition was coded ACCDNWRK = -1 for those persons.

For cancer conditions collected in the PE section, a follow-up question was asked when the cancer is first reported to determine whether the cancer is in remission/under control (REMISSN).

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2.5.2.4 Considerations for Making Estimates Using the MEPS Conditions File
2.5.2.4.1 Conditions File vs. Priority Conditions

Priority conditions created in the Priority Condition Enumeration (PE) section, including chronic conditions, were asked in the context of "has person ever been told by a doctor or other health care professional that they have (condition)?" If the response is Yes (1), then a condition record is generated. Note that priority conditions are included in the Conditions PUF only if the condition is current. A current condition is defined as a condition linked to an event or disability day or a condition the person is currently experiencing (i.e., a condition selected in the CE section).

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2.5.2.4.2 Sources for Conditions on the MEPS Conditions File

Conditions can be added to the MEPS conditions roster in several ways. A condition can be reported in the Priority Condition Enumeration (PE) section in which persons are asked if they have ever been diagnosed with specific conditions. The condition can be identified as the reason reported by the household respondent for a particular medical event (hospital stay, outpatient visit, emergency room visit, home health episode, prescribed medication purchase, or medical provider visit). The condition may be reported as the reason for one or more episodes of disability days. Finally, the condition may be reported by the household level respondent as a condition "bothering" the person during the reference period (see question CE03).

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2.5.2.5 Treatment of Data from Rounds Not Occurring in 2008

Prior to the 2008 file, priority conditions reported during Rounds 1 and 2 of the second year panel were included on the file even if the conditions were not related to an event or disability day or reported as a serious condition occurring in the second year of the panel. Beginning in 2008, conditions are included on the file only if they are current conditions. A current condition is defined as a condition linked to an event or disability day or a condition the person is currently experiencing (i.e., a condition selected in the Condition Enumeration (CE) section). Conditions from Rounds 1 and 2 that are not included in the 2008 file are available in the 2007 Medical Conditions File. Note that, for some Rounds 1 and 2 records, data may not be available on the previous year’s file. This situation can occur when a person does not have a positive person or family weight in the first year but is assigned a positive weight in the subsequent year. The situation can also occur if the condition is a priority condition for which no events or disability days were reported in the first year but are reported in the second year. For 2008, 45 conditions from Panel 12 Rounds 1 and 2 are included on the 2008 Medical Conditions File, but did not appear on the previous year’s file. Of these, 2 are because the person did not have a positive family weight in 2007, and 43 are because the priority condition was not current in 2007.

The variables PRIORFLG and INJURFLG were dropped in 2008. Note: Priority conditions are generally chronic conditions. Even though a person may not have reported an event or disability day in 2008 due to the condition, or reported generally experiencing the condition in 2008, analysts should consider that the person is probably still experiencing the condition. If a Panel 12 person reported a priority condition in Round 1 or 2 and did not have an event or disability day for the condition in Round 3, 4, or 5, the condition will not be included on the 2008 Medical Conditions File.

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2.5.2.6 Rounds in Which Conditions Were Reported/Selected (CRND1 – CRND5)

A set of constructed variables indicates the round in which the condition was first reported (CONDRN), and the subsequent round(s) in which the condition was selected (CRND1 – CRND5). The condition may be reported or selected when the person reports an event or disability day that occurred due to the condition, or the condition may be selected as a serious condition that is not linked to any events or disability days. For example, consider a condition for which CRND1 = 0, CRND2 = 1, and CRND3 = 1. For non-priority conditions, this sequence of CRND indicators on a condition record implies that the condition was not present during Round 1 (CRND1 = 0), was first mentioned during Round 2, and was selected during Round 3. For priority conditions, it is necessary to look at CONDRN rather than CRND# to determine in which round the condition was first reported. In addition to the scenario above, this sequence of CRND indicators may imply for priority conditions that the condition was reported in the PE section in Round 1 but was not connected with an event or disability day, and not selected in the CE section as a current condition until Rounds 2 and 3.

Due to age-related confidentiality concerns, pregnancy conditions for women under 16 and over 44 where there is no CRND in the round in which the condition was reported have CRND# updated to 1 for that round.

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2.5.2.7 Disability Flag Variables

This file contains three flag variables indicating whether a condition is associated with a missed work day (MISSWORK), a missed school day (MISSSCHL), or a day spent in bed (INBEDFLG). Due to the MEPS instrument design, there is no link indicating the specific numberof disability days associated with a particular medical condition.

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2.5.2.8 Diagnosis Condition and Procedure Codes

The medical conditions and procedures reported by the Household Component respondent were recorded by the interviewer as verbatim text, which was then coded by professional coders to fully-specified ICD-9-CM codes, including medical condition and V codes (see Health Care Financing Administration, 1980). Although codes were verified and error rates did not exceed 2.5 percent for any coder, analysts should not presume this level of precision in the data; the ability of household respondents to report condition data that can be coded accurately should not be assumed (see Cox and Iachan, 1987; Edwards, et al, 1994; and Johnson and Sanchez, 1993). Some condition information is collected in the Medical Provider Component of MEPS. However, since it is not available for everyone in the sample, it is not used to supplement, replace, or verify household reported condition data.

Professional coders followed specific guidelines in coding missing values to the ICD-9-CM diagnosis condition and procedure variables. The ICD-9-CM diagnosis condition variable (ICD9CODX) was coded -9 where the verbatim text fell into one of three categories: (1) the text indicated that the condition was unknown (e.g., DK); (2) the text indicated the condition could not be diagnosed by a doctor (e.g., doctor doesn’t know); or (3) the specified condition was not codeable and a procedure could not be discerned from the text. ICD9CODX was coded -1 where the verbatim text strictly denoted a procedure and not a condition. The ICD-9-CM procedure variable (ICD9PROX) was coded -9 where the verbatim text strictly denoted a procedure, but the text was not specific enough to assign a procedure code. ICD9PROX was set to -1 where the text strictly specified a condition and not a procedure.

In order to preserve confidentiality, nearly all of the diagnosis condition codes provided on this file have been collapsed from fully-specified codes to 3-digit code categories. Table 1 in Appendix 2 provides unweighted and weighted frequencies for all ICD-9-CM condition code values reported on the file. In this table, values that reflect this collapsing have an asterisk in the label indicating that the 3-digit category includes all the subclassifications within that category. For example, the ICD9CODX value of 034 "Strep Throat/Scarlet Fev *" includes the fully-specified subclassifications 034.0 and 034.1; the value 296 "Affective Psychoses*" includes the fully-specified subclassifications 296.0 through 296.99. Less than 1 percent of the records on this file were edited further by collapsing two or more 3-digit codes into one 3-digit code.

Similarly, most of the procedure codes were collapsed from fully-specified codes to 2-digit category codes. Table 2 in Appendix 2 provides unweighted and weighted frequencies for ICD9PROX, and this type of collapsing is identified by an asterisk in the variable label. For example, the ICD9PROX value of 81 "Joint Repair*" includes subclassifications 81.0 through 81.99. Less than 1 percent of records were further edited to combine two or more 2-digit categories.

Note that, for conditions related to certain medical events, the ICD-9-CM codes on this file are also released in the Prescribed Medicines, Emergency Room Visits, Office-based Medical Provider Visits, Outpatient Department Visits, and Inpatient Hospital Stays Event Files. Because the ICD-9-CM codes have been collapsed, it is possible for there to be duplicate ICD-9-CM condition or procedure codes linked to a single medical event when different fully-specified codes are collapsed into the same code. For information on merging data on this file with the 2008 MEPS Event Files (HC-118A through HC-118H) refer to the link files provided in HC-118I, and see HC-118I for details.

In a small number of cases, diagnosis condition and procedure codes were further recoded to -9 if they denoted a pregnancy for a person younger than 16 or older than 44. There were 17 records recoded in this manner on the 2008 Medical Conditions File. The person’s age was determined by linking the 2008 Medical Conditions File to the 2007 and 2008 Person-Level Use PUFs. If the person’s age is under 16 or over 44 in the round in which the condition or procedure was reported, the appropriate condition or procedure code was recoded to -9.

Users should note that because of the design of the survey, most deliveries (i.e., births) are coded as pregnancies. For more accurate estimates for deliveries, analysts should use RSNINHOS "Reason Entered Hospital" found on the Hospital Inpatient Stays Public Use File (HC-118D).

Conditions and procedures were reported in the same sections of the HC questionnaire (see Variable-Source Crosswalk in Appendix 1). Labels for all values of the variables ICD9CODX and ICD9PROX, as shown in Tables 1 and 2, are provided in the SAS programming statements included in this release (see the H120SU.TXT file).

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2.5.2.9 Clinical Classification Codes

ICD-9-CM condition codes have been aggregated into clinically meaningful categories that group similar conditions (CCCODEX). CCCODEX was generated using Clinical Classification Software (formerly known as Clinical Classifications for Health Care Policy Research (CCHPR)), which aggregates conditions and V-codes into mutually exclusive categories, most of which are clinically homogeneous (Elixhauser, et al, 2000). Appendix 3 lists the ICD-9-CM codes that have been aggregated for each clinical classification category.

The reported ICD-9-CM condition code values were mapped to the appropriate clinical classification category prior to being collapsed to 3-digit ICD-9-CM condition codes. The result is that every record which has an ICD-9-CM diagnosis code also has a clinical classification code.

As with ICD9CODX and ICD9PROX, professional coders followed specific guidelines in setting CCCODEX to a missing value. CCCODEX was coded -9 where the verbatim text fell into one of three categories: (1) the text indicated that the condition was unknown (e.g., DK); (2) the text indicated the condition could not be diagnosed by a doctor (e.g., doctor doesn’t know); or (3) the specified condition was not codeable and a procedure could not be discerned from the text. CCCODEX was coded -1 where the verbatim text strictly denotes a procedure and not a condition.

A small number (less than 1 percent) of clinical classification codes have been edited for confidentiality purposes. Table 3 in Appendix 2 provides weighted and unweighted frequencies for CCCODEX. Labels for all values of the variable CCCODEX, as shown in Table 3, are provided in the SAS programming statements included in this release (see the H120SU.TXT file).

In a small number of cases, clinical classification codes were further recoded to -9 if they denoted a pregnancy for a person younger than 16 or older than 44. There were 17 records recoded in this manner on the 2008 Medical Conditions File. The person’s age was determined by linking the 2008 Medical Conditions File to the 2007 and 2008 Person-Level Use PUFs. If the person’s age is under 16 or over 44 in the round in which the condition was reported, the appropriate clinical classification code was recoded to -9.

Note that, prior to 2004, the range for the variable CCCODEX was 001 through 260. In 2004, revisions to the coding of mental disorders were implemented. The codes 650 through 663 replaced 065 through 075 in 2004. Beginning in 2007, the mental disorders codes were reorganized again. Alcohol and substance abuse disorders were broken into separate categories, and miscellaneous mental disorders was renumbered.

Analysts should use the clinical classification codes listed in the Conditions PUF document (HC-120) and the Appendix to the Event Files (HC-118I) document when analyzing MEPS conditions data. Although there is a list of clinical classification codes and labels on the Healthcare Cost and Utilization Project (HCUP) Website, if updates to these codes and/or labels are made on the HCUP Website after the release of the 2008 MEPS PUFs, these updates will not be reflected in the 2008 MEPS data.

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2.5.3 Utilization Variables (OBNUM – RXNUM)

The variables OBNUM, OPNUM, HHNUM, IPNUM, ERNUM, and RXNUM indicate the total number of 2008 events that can be linked to each condition record on the current file, i.e., office-based, outpatient, home health, inpatient hospital stays, emergency room visits, and prescribed medicines, respectively.

These counts of events were derived from Expenditure Event Public Use Files (HC-118G, HC-118F, HC-118H, HC-118D, HC-118E, and HC-118A). Events associated with conditions include all utilization that occurred between January 1, 2008 and December 31, 2008.

Because persons can be seen for more than one condition per visit, these frequencies will not match the person or event-level utilization counts. For example, if a person had one inpatient hospital stay and was treated for a fractured hip, a fractured shoulder and a concussion, each of these conditions has a unique record in this file and IPNUM=1 for each record. By summing IPNUM for these records, the total inpatient hospital stays would be three when actually there was only one inpatient hospital stay for that person and three conditions were treated. These variables are useful for determining the number of inpatient hospital stays for head injuries, hip fractures, etc.

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3.0 Survey Sample Information

3.1 Overview

There is a single full year person-level weight (PERWT08F) assigned to each record for each key, in-scope person who responded to MEPS for the full period of time that he or she was in-scope during 2008. A key person either was a member of an NHIS household at the time of the NHIS interview, or became a member of a family associated with such a household after being out-of-scope at the time of the NHIS (the latter circumstance includes newborns as well as persons returning from military service, an institution, or living outside the United States). A person is in-scope whenever he or she is a member of the civilian noninstitutionalized portion of the U.S. population.

There has been an important change in the MEPS sample design that is worth noting. The MEPS sample of households for Round 1 of a given MEPS panel is a subsample of the responding households to the previous year’s National Health Interview Survey (NHIS). A new NHIS sample design was implemented in 2006 with a new sample of PSUs and segments, independent of the sample design used from 1995-2005. Thus, MEPS Panel 12 households fielded initially in 2007, selected from the 2006 NHIS household respondents, are from a sample design independent of those sampled for MEPS Panel 11 from among 2005 NHIS household respondents. As a result, with two national samples of PSUs and segments fielded for MEPS and with a somewhat reduced sample size for Panel 12, the amount of clustering is reduced with the expectation of some increase in precision for 2007 MEPS estimates. There will also be more degrees of freedom due to more variance strata available for variance estimation purposes. The trade-off for these expected increases in precision and degrees of freedom is that it is more expensive to field a sample that is less concentrated. In 2008 both MEPS panels will have been sampled from the new NHIS sample design, with corresponding reductions in survey costs, precision, and degrees of freedom.

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3.2 Details on Person Weight Construction

The person-level weight PERWT08F was developed in several stages. Person-level weights for Panels 12 and 13 were created separately. The weighting process for each panel included an adjustment for nonresponse over time and calibration to independent population figures. The calibration was initially accomplished separately for each panel by raking the corresponding sample weights to Current Population Survey (CPS) population estimates based on five variables. The five variables used in the establishment of the initial person-level control figures were: census region (Northeast, Midwest, South, West); MSA status (MSA, non-MSA); race/ethnicity (Hispanic, non-Hispanic with black as sole reported race, non-Hispanic with Asian as sole reported race, and other); sex; and age. A 2008 composite weight was then formed by multiplying each weight from Panel 12 by the factor .39 and each weight from Panel 13 by the factor .61. The choice of factors reflected the relative sample sizes of the two panels, helping to limit the variance of estimates obtained from pooling the two samples. The composite weight was again raked to the same set of CPS-based control totals. When poverty status information derived from income variables became available, a final raking was undertaken on the previously established weight variable. Control totals were established using poverty status (five categories: below poverty, from 100 to 125 percent of poverty, from 125 to 200 percent of poverty, from 200 to 400 percent of poverty, at least 400 percent of poverty) as well as the original five variables used in the previous calibrations.

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3.2.1 MEPS Panel 12 Weight

The person-level weight for MEPS Panel 12 was developed using the 2007 full year weight for an individual as a "base" weight for survey participants present in 2007. For key, in-scope respondents who joined an RU some time in 2008 after being out-of-scope in 2007, the 2007 family weight associated with the family the person joined served as a "base" weight. The weighting process included an adjustment for nonresponse over Rounds 4 and 5 as well as raking to population control figures for December 2008. These control figures were derived by scaling back the population totals obtained from the March 2009 CPS to correspond to a national estimate for the civilian noninstitutionalized population provided by the Census Bureau for December 2008. Variables used in the establishment of person-level control figures included: census region (Northeast, Midwest, South, West); MSA status (MSA, non-MSA); race/ethnicity (Hispanic, black but non-Hispanic, Asian but non-Hispanic, and other); sex; and age. Key, responding persons not in-scope on December 31, 2008 but in-scope earlier in the year retained, as their final Panel 12 weight, the weight after the nonresponse adjustment.

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3.2.2 MEPS Panel 13 Weight

The person-level weight for MEPS Panel 13 was developed using the MEPS Round 1 person-level weight as a "base" weight. For key, in-scope respondents who joined an RU after Round 1, the Round 1 family weight served as a "base" weight. The weighting process included an adjustment for nonresponse over Round 2 and the 2008 portion of Round 3 as well as raking to the same population control figures for December 2008 used for the MEPS Panel 12 weights. The same five variables employed for Panel 12 raking (census region, MSA status, race/ethnicity, sex, and age) were used for Panel 13 raking. Similarly, for Panel 13, key, responding persons not in-scope on December 31, 2008 but in-scope earlier in the year retained, as their final Panel 13 weight, the weight after the nonresponse adjustment.

Note that the MEPS Round 1 weights incorporated the following components: the original household probability of selection for the NHIS; ratio-adjustment to NHIS-based national population estimates at the household (occupied dwelling unit) level; adjustment for nonresponse at the dwelling unit level for Round 1; and poststratification to figures at the family and person level obtained from the March CPS data base of the corresponding year (i.e., 2007 for Panel 12 and 2008 for Panel 13).

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3.2.3 The Final Weight for 2008

The composite weights of two groups of persons who were out-of-scope on December 31, 2008 were poststratified. Specifically, the weights of those who were in-scope some time during the year, out-of-scope on December 31, and entered a nursing home during the year were poststratified to a corresponding control total obtained from the 1996 MEPS Nursing Home Component. Those who died while in-scope during 2008 were poststratified to corresponding estimates derived using data obtained from the Medicare Current Beneficiary Survey (MCBS) and Vital Statistics information provided by the National Center for Health Statistics (NCHS). Separate decedent control totals were developed for the "65 and older" and "under 65" civilian noninstitutionalized populations. The sum of the person-level weights across all persons assigned a positive person level weight is 304,375,942.

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3.2.4 Additional Adjustment to 2008 Person Weights for Persons Age 65 and Over

In developing the final 2008 person-level weights (PERWT08F), an adjustment was made at the end of the process to mitigate a noticeable decline in the proportion of elderly persons with at least one hospital stay based on the weight derived using the traditional MEPS weighting methodology. This decline is inconsistent with trends in MEPS and other data sources and the underlying explanation is under investigation. A ratio adjustment strategy was applied only to weights for persons age 65 and over (3,493 persons) and therefore it did not affect the weights for persons under age 65 (29,573 persons). Moreover, the adjustments were carried out by MSA status based on a logistic regression analysis that showed inconsistent changes from 2007 to 2008 in the likelihood of hospitalization for MSA residents versus non-MSA residents. The table below shows the derivations of the adjustment factors that were applied (total of 4 factors) to the previously described final weights.

Ratio Adjustment Factors Applied to Analytic Weight Variable for Persons Age 65 and older

# of Hospital Stays (IPDIS08) MSA Resident Non-MSA Resident
0 .808/.845 = 0.9562 .808/.780 = 1.0359
1 or more .192/.155 = 1.2387 .192/.220 = 0.8727

Within each of the 2 MSA subgroups, separate factors were developed for persons with no hospital stays and for persons with at least one stay. The numerators are based on MEPS annual averages of the proportion of elderly persons with at least one hospital stay for the preceding 3 year period (2005-07) and can be regarded as control proportions. The denominators of the factors reflect estimated proportions based on the traditional final weight. For MSA residents, applying these factors to the weights had the joint effect of inflating the estimated proportion of elderly persons with at least one hospital stay while proportionately deflating the proportion with no stays. For non-MSA residents, applying these factors to the weights had the joint effect of deflating the estimated proportion of elderly persons with at least one hospital stay while proportionately inflating the proportion with no stays.

Finally, the weights for the elderly were adjusted by a constant factor to compensate for the negligible impact of rounding on the aggregate weights that resulted from applying the factors in the table above. This factor was derived as the ratio of the sum of weights prior to applying the factors to the sum after applying the factors (39,742,176 / 39,737,780).

Overall, the weighted population estimate for the civilian noninstitutionalized population for December 31, 2008 is 300,257,026 (PERWT08F>0 and INSC1231=1). The sum of the person-level weights across all persons assigned a positive person-level weight is 304,375,942.

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3.2.5 Coverage

The target population for MEPS in this file is the 2008 U.S. civilian noninstitutionalized population. However, the MEPS sampled households are a subsample of the NHIS households interviewed in 2006 (Panel 12) and 2007 (Panel 13). New households created after the NHIS interviews for the respective Panels and consisting exclusively of persons who entered the target population after or after 2006 (Panel 12) or after 2007 (Panel 13) are not covered by MEPS. Neither are previously out-of-scope persons who join an existing household but are unrelated to the current household residents. Persons not covered by a given MEPS panel thus include some members of the following groups: immigrants; persons leaving the military; U.S. citizens returning from residence in another country; and persons leaving institutions. The set of uncovered persons constitutes only a small segment of the MEPS target population.

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3.3 Using MEPS Data for Trend Analysis

MEPS began in 1996, and the utility of the survey for analyzing health care trends expands with each additional year of data. However, it is important to consider a variety of factors when examining trends over time using MEPS. Statistical significance tests should be conducted to assess the likelihood that observed trends may be attributable to sampling variation. The length of time being analyzed should also be considered. In particular, large shifts in survey estimates over short periods of time (e.g. from one year to the next) that are statistically significant should be interpreted with caution, unless they are attributable to known factors such as changes in public policy, economic conditions, or MEPS survey methodology. Looking at changes over longer periods of time can provide a more complete picture of underlying trends. Analysts may wish to consider using techniques to smooth or stabilize analyses of trends using MEPS data such as comparing pooled time periods (e.g. 1996-97 versus 2004-05), working with moving averages, or using modeling techniques with several consecutive years of MEPS data to test the fit of specified patterns over time. Finally, researchers should be aware of the impact of multiple comparisons on Type I error. Without making appropriate allowance for multiple comparisons, undertaking numerous statistical significance tests of trends increases the likelihood of concluding that a change has taken place when one has not.

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4.0 Merging/Linking MEPS Data Files

Data from the current file can be used alone or in conjunction with other files. Merging characteristics of interest from person-level files expands the scope of potential estimates. See HC-118I for instructions on merging the Condition File to the Medical Event Files. Person-level characteristics can be merged to this Conditions File using the following procedure:

  1. Sort the person-level file by person identifier, DUPERSID. Keep only DUPERSID and the variables to be merged onto the Conditions File.
     
  2. Sort the Conditions File by person identifier, DUPERSID.
     
  3. Merge both files by DUPERSID, and output all records in the Conditions File.
     
  4. If PERS contains the person-level variables, and COND is the Conditions File, the following code can be used to add person-level variables to the person’s conditions in the condition-level file.

PROC SORT DATA=PERS(KEEP=DUPERSID AGE SEX EDUCLEVL)
OUT=PERSX; BY DUPERSID;
RUN;

PROC SORT DATA=COND; BY DUPERSID;
RUN;

DATA COND;
MERGE COND (IN=A) PERSX(IN=B); BY DUPERSID;
IF A;
RUN;

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4.1 National Health Interview Survey

Data from this file can be used alone or in conjunction with other files for different analytic purposes. Each MEPS panel can also be linked back to the previous years’ National Health Interview Survey public use data files. For information on obtaining MEPS/NHIS link files please see www.meps.ahrq.gov/data_stats/more_info_download_data_files.jsp.

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4.2 Longitudinal Analysis

For Panels 1 through 8, panel-specific files (called Longitudinal Weight Files) containing estimation variables to facilitate longitudinal analysis are available for downloading in the data section of the MEPS Web site. To create longitudinal files for these panels, it is necessary to link data from two subsequent annual files that contain data for the first and second years of the panel, respectively. Starting with Panel 9, it is not necessary to link files for longitudinal analysis because Longitudinal Data Files have been constructed and are available for downloading on the Web.

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References

Cohen, S. B. (1996). The Redesign of the Medical Expenditure Panel Survey: A Component of the DHHS Survey Integration Plan. Proceedings of the COPAFS Seminar on Statistical Methodology in the Public Service.

Cox, B. and Iachan, R. (1987). A Comparison of Household and Provider Reports of Medical Conditions. Journal of the American Statistical Association 82(400): 1013-18.

Edwards, W. S., Winn, D. M., Kurlantzick, V., et al. Evaluation of National Health Interview Survey Diagnostic Reporting. National Center for Health Statistics, Vital Health 2(120). 1994.

Elixhauser, A., Steiner, C. A., Whittington, C. A., and McCarthy, E. Clinical Classifications for health policy research: Hospital inpatient statistics, 1995. Healthcare Cost and Utilization project, HCUP-3 research Note. Rockville, MD: Agency for Healthcare Research and Quality; 2000. AHCPR Pub. No. 98-0049.

Ezzati-Rice, T.M., Rohde, F., Greenblatt, J., Sample Design of the Medical Expenditure Panel Survey Household Component, 1998–2007. Methodology Report No. 22. March 2008. Agency for Healthcare Research and Quality, Rockville, MD.

Health Care Financing Administration (1980). International Classification of Diseases, 9th Revision, Clinical Modification (ICD-CM). Vol. 1. (Department of Health and Human Services Pub. No (PHS) 80-1260). Department of Health and Human Services: U.S. Public Health Services.

Johnson, Ayah E., and Sanchez, Maria Elena. (1993), "Household and Medical Reports on Medical Conditions: National Medical Expenditure Survey." Journal of Economic and Social Measurement, 19, 199-223.

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Appendix 1. Variable-Source Crosswalk

Unique Identifier Variables
Variable Label Source1
DUID Dwelling Unit ID Assigned In Sampling
PID Person Number Assigned In Sampling
DUPERSID Person ID (DUID + PID) Assigned In Sampling
CONDN Condition Number CAPI Derived
CONDIDX Condition ID CAPI Derived
PANEL Panel Number Constructed
CONDRN Condition Round Number CAPI Derived

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Medical Condition Variables
Variable Label Source1
PRIOLIST Is Condition On Priority List CN02
AGEDIAG Age When Diagnosed PE section
REMISSN Is Cancer in Remission/Under Control PE25
CRND1 Has Condition Information In Round Constructed
CRND2 Has Condition Information In Round Constructed
CRND3 Has Condition Information In Round Constructed
CRND4 Has Condition Information In Round Constructed
CRND5 Has Condition Information In Round Constructed
INJURY Was Condition Due To Accident/Injury CN02
ACCDENTD Date Of Accident -- Day CN06
ACCDENTM Date Of Accident -- Month CN06
ACCDENTY Date Of Accident -- Year CN06
ACCDNJAN Accident/Injury Occur Before/After Jan 1 CN06A
ACCDNWRK Did Accident Occur At Work CN07
MISSWORK Flag Associated With Missed Work Days DD03
MISSSCHL Flag Associated With Missed School Days DD06
INBEDFLG Flag Associated With Bed Days DD09
ICD9CODX ICD-9-CM Code For Condition - Edited CE05, HS04, ER04, OP09,
MV09, HH05, PM09 (Edited)
ICD9PROX ICD-9-CM Code For Procedure - Edited CE05, HS04, ER04, OP09,
MV09, HH05, PM09 (Edited)
CCCODEX Clinical Classification Code - Edited Constructed/Edited

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Utilization Variables
Variable Label Source1
HHNUM # Home Health Events Assoc. w/ Condition Constructed
IPNUM # Inpatient Events Assoc. w/ Condition Constructed
OPNUM # Outpatient Events Assoc. w/ Condition Constructed
OBNUM # Office-Based Events Assoc. w/ Condition Constructed
ERNUM # ER Events Assoc. w/ Condition Constructed
RXNUM # Prescribed Medicines Assoc. w/ Cond. Constructed

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Weights and Variance Estimation Variables
Variable Label Source1
PERWT08F Expenditure File Person Weight, 2008 Constructed
VARSTR Variance Estimation Stratum, 2008 Constructed
VARPSU Variance Estimation PSU, 2008 Constructed

1See the README file in the Survey Instruments section of the MEPS home page for information on the MEPS HC questionnaire sections (e.g., CN, DD) shown in the Source column.

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Appendix 2. Condition, Procedure, and Clinical Classification Code Frequencies

Appendix 3. Clinical Classification Code to ICD-9-CM Code Crosswalk

Appendix 4. List of Priority Conditions

Beginning in PANEL 12

  • Hypertension/High Blood Pressure
  • Coronary Heart Disease
  • Angina/Angina Pectoris
  • Heart Attack/Myocardial Infarction (MI)
  • Other Heart Disease (not coronary heart disease, angina, or heart attack)
  • Stroke/Transient Ischemic Attack (TIA)/Mini-stroke
  • Emphysema
  • Chronic Bronchitis
  • High Cholesterol
  • Cancer/Malignancy
  • Diabetes/Sugar Diabetes
  • Joint Pain
  • Arthritis
  • Asthma
  • Attention Deficit Hyperactivity Disorder (ADHD)/Attention Deficit Disorder (ADD)

Prior to PANEL 12

  1. LONG-TERM, LIFE THREATENING CONDITIONS:

    • Cancer (of any body part)
    • cancer
    • tumor
    • malignancy
    • malignant tumor
    • carcinoma
    • sarcoma
    • lymphoma
    • Hodgkin’s disease
    • leukemia
    • melanoma
    • metastasis
    • neuroma
    • adenoma

    • Diabetes
    • diabetes
    • diabetes mellitus
    • high blood sugar
    • juvenile diabetes (Type I diabetes)
    • adult-onset diabetes (Type II diabetes)
    • diabetic neuropathy

    • Emphysema
    • emphysema
    • chronic obstructive pulmonary disease (COPD)
    • chronic bronchitis (MUST use the word ("chronic", only for adults)
    • chronic obstructive bronchitis (MUST use the word "chronic", only for adults)
    • smoker’s cough

    • High Cholesterol
    • high cholesterol
    • high or elevated triglycerides
    • hyperlipidemia
    • hypercholesterolemia

    • HIV/AIDS
    • HIV
    • AIDS

    • Hypertension
    • hypertension
    • high blood pressure

    • Ischemic Heart Disease
    • ischemic heart disease (MUST use the word "ischemic")
    • angina
    • angina pectoris
    • coronary artery disease
    • blocked, obstructed, or occluded coronary arteries
    • arteriosclerosis
    • myocardial infarction
    • heart attack

    • Stroke
    • stroke
    • cerebral hemorrhage
    • cerebral aneurysm
    • transient ischemic accident
    • transient ischemic attack
    • apoplexy
    • carotid artery blockage
    • arterial thrombosis in brain
    • blood clot in brain

  2. CHRONIC, MANAGEABLE CONDITIONS:

    • Arthritis
    • rheumatoid arthritis
    • degenerative arthritis
    • osteoarthritis
    • bursitis
    • rheumatism

    • Asthma
    • anything with the word ‘asthma’ or ‘asthmatic’

    • Gall Bladder Disease
    • gall bladder disease, trouble, attacks, infection, or problems
    • gallstones

    • Stomach Ulcers
    • stomach ulcer
    • duodenal ulcer
    • peptic ulcer
    • bleeding ulcer
    • ulcerated stomach
    • perforated ulcer

    • Back Problems of Any Kind
    • back problems or pain of any kind (lower or upper back)
    • sore, hurt, injured, or stiff back
    • backache
    • anything with the words ‘vertebra’, ‘vertebrae’, ‘lumbar’, ‘spine’, or ‘spinal’
    • strained or pulled muscle in back
    • muscle spasms
    • back spasms
    • bad back
    • lumbago
    • sciatica or sciatic nerve problems
    • disc problems: herniated, ruptured, slipped, compressed, extruded, dislocated, deteriorated, or misaligned discs

  3. MENTAL HEALTH ISSUES:

    • Alzheimer’s Disease and Other Dementias
    • anything with the words ‘Alzheimer’s’ or ‘dementia’
    • organic brain syndrome

    • Depression and Anxiety Disorders
    • depression (including severe, chronic, or major depression)
    • dysthymia
    • dysthymic disorder
    • bipolar disorder
    • manic depression or manic depressive illness
    • anxiety attacks
    • panic attacks
    • anxiety
    • nerves
    • nervous condition
    • nervous breakdown

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