User Notes

Accessing MEPS Condition, Event, and Prescribed Medicine Records through IPUMS

Topics covered in this user note include:

  1. Condition Records
  2. Event Records
  3. Prescribed Medicine Records
  4. Linking Condition and Event Records
  5. Linking Condition and Event Records to Person and Round Variables
  6. Additional Resources

Overview

As part of the MEPS Household Component interview, family respondents are asked to report medical conditions, prescription medications, and medical events for each family member. Information collected from these questions are used to generate the medical conditions, prescribed medicine, and event files. IPUMS MEPS offers variables from the medical condition and event files on the condition (RECTYPE="X") and event (RECTYPE="E") records, respectively. Data from these records can be linked to each other and with Person and Round level records. Condition and event records are only available in hierarchical extracts. Currently, prescribed medicine records are not offered through IPUMS MEPS, but work to add them to the IPUMS MEPS database is underway.

Conditions

As part of the MEPS Household Component interview, respondents are asked about the medical conditions they and other family members have experienced. Condition data on the MEPS can be used to generate estimates of treated prevalence, but should not be used to make estimates of disease, prevalence of health conditions, or mortality/morbidity (AHRQ MEPS HC-137 2010 Medical Conditions pg. 8). When conducting trend analyses using condition records, users should be aware of ways in which the medical conditions data has changed over time, including updates to the definition of "current conditions" and switching from ICD-9-CM to ICD-10-CM codes. These changing definitions and codes are described below.

Current Conditions

Conditions reported by the family respondent are only included in the medical conditions data if the condition is considered a current condition. The criteria for what are considered current conditions, and thus included in the medical conditions data, has changed as AHRQ has updated the MEPS survey design.

1996-2007

For 1996-2006 and Panel 11 in 2007, medical conditions reported by the family survey respondent are included in the medical conditions data if: (1) the condition is linked to a medical event or prescribed medicine during the calendar year, (2) is identified as a priority condition, such as cancer, diabetes, heart disease, and asthma (see PRTYCOND for more information on priority conditions), or (3) is reported during the current year; a condition is considered reported during the current year if it meets one of the following criteria:

  1. Reported in Rounds 1 or 2 by the family respondent in the first year of the MEPS panel (relative year 1)
  2. Reported in Rounds 4 or 5 by the family respondent in relative year 2
  3. Reported in Round 3 and
    1. Was due to an accident or injury, or
    2. More than 50 percent of the person's reference period for Round 3 occurred in the calendar year, or
    3. For persons in relative year 2, the condition was not reported on the previous calendar year's file
2008-2017

For Panel 12 in 2007 and 2008-2017, medical conditions reported by the family respondent are included in the medical conditions data if the condition is linked to an event or prescribed medicine during the calendar year or the person is currently experiencing the condition. A person is considered to be currently experiencing a condition if the condition is selected in the Condition Enumeration section or, for priority conditions, the age of diagnosis is before the end of the calendar year or the age of diagnosis is unknown.

2018 forward

Beginning with Panel 21 Round 5 and Panel 22 Round 3 (the last round collected in 2017 for both panels), medical conditions reported by the family respondent, including priority conditions, are only included in the medical conditions data if the condition is linked to an event or prescribed medicine during the calendar year. This is a departure from previous approaches to identifying which reported conditions would be included in the medical conditions data. Although they have been excluded from the medical conditions data beginning in 2018, data on priority conditions that are not linked to a medical event in the current calendar year are still included on the person-level data (e.g., CHEARTDIEV, DIABETICEV).

These changes to the definition of current condition affect the number of condition records included on the MEPS public use files and will impact trend analyses.

Medical Condition Coding

From 1996 to 2015, medical conditions in MEPS are coded with ICD-9-CM diagnosis (ICD9CODE) and procedure codes (ICD9PROC). Beginning in 2016, medical conditions in MEPS are coded with ICD-10-CM diagnosis codes (ICD10CODE) and procedure codes are no longer offered. Users should be aware that ICD-9-CM and ICD-10-CM diagnosis codes that seem comparable may hide large underlying differences. The CDC notes that ICD-9-CM codes are very different from ICD-10-CM codes; there are nearly five times as many diagnosis codes for ICD-10-CM compared to ICD-9-CM and nearly 19 times as many procedure codes. Additionally, conditions have been grouped differently and some have been renamed. At this time IPUMS MEPS does not provide a crosswalk between ICD-9-CM and ICD-10-CM codes.

Figure 1 below, from a case study by the Healthcare Cost and Utilization Project, shows the impact the change from ICD-9-CM to ICD-10-CM codes can have upon analyses.

Figure 1. Inpatient Stays With a Diagnosis of Adverse Effects of Opioids by Age, 2015 Q1 Through 2016 Q3

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Events

The event record on IPUMS MEPS is composed of seven separate files that are produced by AHRQ: (1) office-based medical provider visits, (2) outpatient visits, (3) emergency room visits, (4) inpatient hospitalization stays, (5) dental visits, (6) other medical expenses, and (7) home health. Which file an event record was derived from can be determined with the variable EVENTYPE. While the variables offered differ between files, they share several commonalities. Each record represents a single medical event, which is defined as a visit for most event files, as a stay for inpatient hospitalizations, and a purchase for other medical expenses. The home health event type is slightly different from the other event types. Please see the Home Health section below for an explanation of the home health event type record.

Users should be aware that from 1996-2004, purchases of insulin and diabetic supplies were included on the other medical expenses and prescribed medicines files. Beginning in 2005, purchases of insulin and diabetic supplies were excluded from the other medical expenses file and only included on the prescribed medicines files.

Home Health

Home health event records have a slightly different meaning from the other event types where each record represents a discrete event (i.e., visit to a medical provider, purchase of medical equipment, etc.). The records for home health events represent one month of similar home health services by a provider. This means that if a person has a nurse that comes every day throughout the year to provide care, there will be 12 home health event records for that person: one record for every month in which they received those home health services. If the person has multiple providers providing home health services during the same month, each provider would be represented on a different record.

Home health services are eligible to be reported in MEPS if they are provided by one of three kinds of providers: (1) formal (paid) home health agency providers, (2) paid independent providers (self-employed), and (3) informal providers who do not reside in the same household as the MEPS sampled person. Care from informal providers who live in the same household as the sampled person are not reported in MEPS.

Prescribed Medicines

AHRQ also considers the prescribed medicines file as another event type in addition to those listed above. IPUMS MEPS made the decision to offer prescribed medicine records on a different record type than the other event files due to structural differences between the prescribed medicine records and other event type records. Although prescribed medicine records are not currently offered through IPUMS MEPS, work to add them to the IPUMS MEPS database is underway.

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Condition-Event Linking

In addition to the condition and event records, IPUMS MEPS also offers the condition-event link record which enables users to link condition and event records together (When you add a condition variable to your data cart, all variables from the condition-event link record are automatically added to your data cart as well). To link these records together, IPUMS MEPS staff have created MEPSCONDID on the condition record, MEPSEVNTID on the event record, and MEPSCONDIDJ and MEPSEVNTIDJ on the condition-event link record. IPUMS MEPS staff advise using YEAR when linking multiple years of condition and event records because records reported in Round 3 are allowed to be present in both years of data collection for that person (e.g., a condition reported in Round 3 by a member of Panel 21 could be present in the condition data in 2016 and 2017).

Because prescribed medicine records are not currently offered through IPUMS MEPS, condition-event link records with an EVENTYPEJ value equal to 8 (Prescribed Medicines) will not link to any event records.

The general process for linking condition and event records can be described as follows (there are other processes that can be used to link the condition and event records; this is just one example):

  1. Link the condition and condition-event link record using MEPSCONDID to MEPSCONDIDJ, and YEAR. Save the result. This will be a one-to-many link going from condition to condition-event link records. All records on the condition-event link record will have a match on the condition record, but not all condition records will have a match on the condition-event link record prior to 2018. Beginning in 2018 all condition records will have a match on the condition-event link record because conditions reported by the survey respondent are only included in the data if the condition links to an event or prescribed medicine purchase during the calendar year.
  2. Link the event and condition-event link record using MEPSEVNTID to MEPSEVNTIDJ, and YEAR. Save the result. This will be a one-to-many link going from event to condition-event link records. All records on the condition-event link record with an EVENTYPEJ value not equal to 8 (Prescribed Medicines) will have a match on the event record, but not all event records will have a match on the condition-event link record because, for example, a person can visit a medical provider for a general checkup that is not related to a specific condition.
  3. Link the result from steps 1 and 2 using MEPSCLNKID and YEAR. This will be a one-to-one link and all records with a non-missing EVENTYPEJ value not equal to 8 will have a match. The result will be a file with records that represent an event-condition pair, where one event can be associated with multiple conditions and one condition can be associated with multiple events.

To help users properly link condition and event records, IPUMS MEPS staff have provided linking syntax files. These linking files will work with multiple years of IPUMS MEPS data.

Additionally, IPUMS MEPS offers the original condition and event identifiers created by AHRQ, CONDID and EVNTID, which can be used to link to the original AHRQ files to incorporate variables that are not yet offered through IPUMS MEPS into analyses. Condition and event records can also be linked to prescribed medicine records, which are not yet offered through IPUMS MEPS.

Figure 2. Diagram of linking condition and event records

Linking to Person and Round Variables

Condition and event records can also be linked to the Person and Round records using the variables MEPSID and YEAR. Linking to the person and/or round records allows users to add demographic, employment, health insurance, and other information that can enrich analyses of the condition and event records.

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Additional Resources

AHRQ Publication from 2008: Understanding and Analyzing MEPS Household Component Medical Condition Data

2018 Medical Conditions Survey Documentation (MEPS HC-207)

2012 Medical Conditions Survey Documentation (MEPS HC-154)

2018 Office-based Medical Provider Visits Survey Documentation (MEPS HC-206G)

2017 Home Health Survey Documentation (MEPS HC-197H)

2005 Other Medical Expenses Survey Documentation (MEPS HC-094C)