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:

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! (96,288 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