# Getting Started with NHANES Data

## Motivation

The National Health and Nutrition Examination Survey (NHANES) is one of the most widely used public health datasets in the U.S., spanning over two decades of continuous data collection. Working with NHANES data directly from the CDC presents two recurring problems:

1. Server reliability. The CDC’s data servers are frequently slow or unresponsive, which breaks reproducible workflows.
2. Cycle management. The CDC publishes data in two-year cycles with letter suffixes (`DEMO`, `DEMO_B`, …, `DEMO_L`). Combining cycles requires tracking naming conventions and reconciling type differences across waves.

nhanesdata addresses both issues by hosting pre-merged, type-harmonized datasets on Cloudflare R2 with public access. A single call to `read_nhanes("demo")` returns all demographics data from 1999-2023 with a `year` column identifying each survey cycle.

## Acknowledgments

This package builds on the nhanesA package, which provides the underlying interface to NHANES data in R.

## Installation

    # install.packages("pak")
    pak::pak("kyleGrealis/nhanesdata")

    library(nhanesdata)
    library(dplyr)
    library(ggplot2)

## Loading Data

    #> Loading: DEMO
    #> DEMO complete! (113,249 rows)

    demo <- read_nhanes("demo")
    glimpse(demo)

Every dataset includes two key columns:

- `year`: Survey cycle start year (1999, 2001, 2003, …, 2017, 2021)
- `seqn`: Respondent sequence number (unique within a cycle, used for joining)

Dataset names are case-insensitive: `"demo"`, `"DEMO"`, and `"Demo"` all work.

## Example: Age Distribution Over Time

    demo |>
      filter(!is.na(ridageyr)) |>
      ggplot(aes(x = ridageyr)) +
      geom_histogram(binwidth = 5, fill = "steelblue", color = "white") +
      facet_wrap(~year, ncol = 4) +
      labs(
        title = "NHANES Age Distribution by Survey Cycle",
        x = "Age (years)",
        y = "Count"
      ) +
      theme_minimal()

## CDC Dataset Naming

When you call `read_nhanes("demo")`, you receive data that the CDC publishes across multiple cycle-specific tables:

CDC Table | Survey Years | Package Behavior
--- | --- | ---
DEMO | 1999-2000 | Merged into a single `demo` dataset
DEMO_B | 2001-2002 | with a `year` column and
DEMO_C | 2003-2004 | harmonized data types
… | … | across all cycles.
DEMO_L | 2021-2023 |

This matters when you need CDC documentation for a specific variable. Use `get_url()` to retrieve the codebook URL for any cycle-specific table:

    get_url("DEMO")   # 1999-2000 codebook
    get_url("DEMO_I") # 2015-2016 codebook

The 2019-2020 cycle (suffix K) is excluded from all datasets. See `vignette("covid-data-exclusion")` for details.

## Joining Multiple Datasets

Combine datasets using `seqn` and `year` as join keys:

    demo <- read_nhanes("demo")
    bpx <- read_nhanes("bpx")
    bmx <- read_nhanes("bmx")

    analysis_data <- demo |>
      inner_join(bpx, by = c("seqn", "year")) |>
      inner_join(bmx, by = c("seqn", "year")) |>
      select(year, seqn, ridageyr, riagendr, bpxsy1, bmxbmi)

Always join on both `seqn` and `year`. Each `seqn` is unique within its cycle, and joining on both columns ensures participants are matched within the same survey period.

## Filtering by Survey Year

    demo <- read_nhanes("demo")

    # Recent cycles only
    recent <- demo |>
      filter(year >= 2015)

    # Compare time periods
    demo |>
      mutate(
        period = case_when(
          year < 2010 ~ "1999-2009",
          year < 2020 ~ "2010-2019",
          TRUE ~ "2020+"
        )
      ) |>
      group_by(period) |>
      summarise(n = n())

## Finding Variables

### By keyword

    term_search("blood pressure")

Returns variable names, table names, descriptions, and collection years. From there you can identify the base table name (e.g., `BPX`) for use with `read_nhanes()`.

### By variable name

    var_search("BPXSY1")

Shows which cycles contain a specific variable.

### In loaded data

    #> Loading: BMX
    #> BMX complete! (105,626 rows)

    "bmxht" %in% names(bmx)
    #> [1] TRUE

All search functions are case-insensitive.

## Complete Example: Blood Pressure by Age Group

    demo <- read_nhanes("demo")
    bpx <- read_nhanes("bpx")

    bp_analysis <- demo |>
      filter(ridageyr >= 18) |>
      select(seqn, year, ridageyr, riagendr, ridreth1) |>
      inner_join(
        bpx |> select(seqn, year, bpxsy1, bpxdi1),
        by = c("seqn", "year")
      ) |>
      filter(!is.na(bpxsy1), !is.na(bpxdi1), bpxsy1 > 0, bpxdi1 > 0) |>
      mutate(
        age_group = cut(
          ridageyr,
          breaks = c(18, 30, 40, 50, 60, 70, 80, Inf),
          labels = c(
            "18-29", "30-39", "40-49", "50-59",
            "60-69", "70-79", "80+"
          ),
          right = FALSE
        )
      )

    bp_summary <- bp_analysis |>
      group_by(age_group) |>
      summarize(
        n = n(),
        mean_systolic = mean(bpxsy1),
        mean_diastolic = mean(bpxdi1),
        .groups = "drop"
      )

    bp_summary |>
      ggplot(aes(x = age_group)) +
      geom_col(aes(y = mean_systolic), fill = "coral", alpha = 0.7) +
      geom_col(aes(y = mean_diastolic), fill = "steelblue", alpha = 0.7) +
      labs(
        title = "Blood Pressure Increases with Age",
        subtitle = "Mean systolic (coral) and diastolic (blue) BP by age group",
        x = "Age Group",
        y = "Blood Pressure (mmHg)"
      ) +
      theme_minimal() +
      theme(axis.text.x = element_text(angle = 45, hjust = 1))

## Next Steps

- Browse the dataset catalog for the full list of available tables
- Learn about creating survey design objects with proper weighting for multi-cycle analyses
- Read about the 2019-2020 cycle exclusion
- Use `?read_nhanes` for function documentation
- File issues or feature requests on GitHub