National Health and Nutrition Examination Survey, 2015-2018: Sample Design and Estimation Procedures.

Background The purpose of the National Health and Nutrition Examination Survey (NHANES) is to produce national estimates representative of the total noninstitutionalized civilian U.S. population. The sample for NHANES is selected using a complex, four-stage sample design. NHANES sample weights are used by analysts to produce estimates of the health-related statistics that would have been obtained if the entire sampling frame (i.e., the noninstitutionalized civilian U.S. population) had been surveyed. Sampling errors should be calculated for all survey estimates to aid in determining their statistical reliability. For complex sample surveys, exact mathematical formulas for variance estimates that fully incorporate the sample design are usually not available. Variance approximation procedures are required to provide reasonable, approximately unbiased, and design-consistent estimates of variance. Objective This report describes the NHANES 2015-2018 sample design and the methods used to create sample weights and variance units for the public-use data files, including sample weights for selected subsamples, such as the fasting subsample. The impacts of sample design changes on estimation for NHANES 2015-2018 are described. Approaches that data users can use to modify sample weights when combining survey cycles or when combining subsamples are also included.