Vital and

Health Statistics

Advance Data

From Vital and

Health Statistics:

Numbers 241-250

Series 16:

Compilations of Advance Data

From Vital and Health Statistics

No. 25

Data in this report from health and demographic surveys present statistics by age

and other variables on health of the foreign-born population; firearm and motor

vehicie injury mortality; AiDS knowiedge and attitudes; nursing homes and board

and care homes; summaries of outpatient departments, emergency departments,

and hospitai discharge survey data; problems associated with use of marijuana or

cocaine among persons 18-44 years old; characteristics of eiderly home heaith

patients; and injury prevention measures in households with children. Estimates are

based on the civilian noninstitutionalized population of the United States, These

reports were originalitypublished in 1993 and 1594.

U,S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

July 1995

DHHS Publlcatlon No. (PHS) 95-1884
Copyright information

Ail material appearing in WIS report is in the public d+xnein and may be

reproduced or copied without perrnieeicw citation as to source, however, is

appreciated.

Suggaatsd cltatlon

National Center for Haalfh Statistics. Advance data from vital and health

statistic numbers 241 –250. National Center for Health Statistics. Vil Heakh

Stat 16(25). 1995.
National Center for Health Statistics

Jack R. Anderson, Acting Director

Jennifer H. Madam, Ph.D., Acting Deputy Director

Jacob J. Feldm~ Ph.D., Associate Director for Analysis,

Epidemwlogy and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Peter L. Hurley, Associate Director for Wtal and Health

Statistics Systems

(Vacant), Associate Director for International Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology
Health of the Foreign-Born Population: United States, 1989-90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Firearm and Motor Vehicle Injury Mortality Variations by State, Race, and Ethnicity United States, 1990-91 . . . . . . .

AIDS Knowledge and Attitudes for 1992 Data fkom the National Health Interview Survey . . . . . . . . . . . . . . . . . . . . . .

Nursing Homes and Board and Care Homes Data From the 1991 National Health Provider Inventory. . . . . . . . . . . . .

National Hospital Ambulatory Medical Care Survey 1992 Emergency Department Summary . . . . . . . . . . . . . . . . . . . .

Restricted Activity Days and Other Problems Associated with Use of Marijuana or Cocaine Among

Persons 18-44 Years of Age: United States, 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Characteristics of Elderly Home Health Patients Preliminary Data from the 1992 National Home and

Hospice Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Outpatient Department Summary: National Hospital Ambulatory Medical Care Survey,1992, . . . . . . . . . . . . . . . . . . . . .

Summary: National Hospital Discharge Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Injury Prevention Measures in Households With Children in the United States, 1990 . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. 241

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No. 244

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No. 248

No. 249

No. 250

...

Ill
Number 241 ● February 14, 1994

Advance

Data

From Vi and Health Statistics of the CENTERS FOR DISEASE CONTROLAND PREVENTION/National Centerfor HealthStatistics

Health of the Foreign-Born Population: United States,

1989-90

by Elizabeth Hervey Stephen, Georgetown University; Karen Foote, National Aoademy of Sciences;

Gerry E. Hendershot and Charlotte A. Schoenbom, Division of Health Interview Statistics

Introduction

In 1990, the foreign-born population

of the United States reached an all-time

high of 19.8 million persons, an increase

of 5.7 million persons since the 1980

Census (l). According to the most

recent census, about 7.9 percent of the

population was foreign-born compared

with an all-time low of 4.7 percent in

1970 and an all-time high of 14.7

percent in 1910 (2). Immigrants come to

the United States from all over the

world, and their health status and

medical care utilization reflect their

diverse experiences in both their

countries of birth and in the United

States. It is important to monitor the

health of the foreign-born populatio~

because their health care needs as well

as their access to care may differ from

that of persons born in the United

States.

This report presents selected health

statistics for the foreign-born population

according to Hispanic origin, duration of

residence, and selected

sociodemographic characteristics.

Further breakdowns by specfic ethnic or

national origins were not possible

because of the relatively small sample

sizes for specific groups.

Sources and limitations of the

data

Since 1985, the National Center for

Health Statistics has gathered

information on the birthplace of persons

18 years of age and over as a part of the

National Health Interview Survey

(NHIS) (3). This report presents

estimates for selected indicators of

health status and medical care utilization

for the native-born and foreign-barn

populations in the United States. These

indicators includti respondent-assessed

general health status, limitation of usual

activities due to impairments or chronic

health conditiom, days spent in bed due

to health conditio~ and physician

contacts. To make reliable estimates of

statistics for smaller subgroups of the

foreign-born population, samples from

the 1989 and 1990 NHIS were

combined.

In 1989, for the list time, the NHIS

collected data on the Iengjh of time that

foreign-born persons had lived in the

United States. For each foreign-born

person, respondents were asked,

“Altogether, how many years has

~rsons’s name] lived in the United

States?” Because foreign-born residents

may have spent time living outside the

United States since their first arrival, the

wording of the question was intended to

elicit the number of years the person

was actually a resident in the United

States since their iirst arrival.

Immigrants with different durations of

residence might be expected to have

different patterns of health status and

health care utilization, either because

there have been historical differences in

the health of immigrant cohorts or

because duration of residence in the

United States has an effect on health.

For this reason, data on the foreign-born

are presented separately by duration of

residence.

Immigrants may differ from

U.S.-born adults in terms of

sociodemographic characteristics that are

related to health. Sociodemographic

profiles may also vary by national

origin. The NHIS does not contain

detailed information on national origin

but it does allow classification of

Hispanic origin based on a question

asking respondents to identify

themselves as Hispanic or not of

H.iSpSlliC Oli@IL Although with thiS

defition Hispanic origin does not

necessarily mean that the person was

born in a Spanish-speaking country, this

is likely to be generally true. In this

repo~ data are presented by selected

@5%RV1CQ.0

*+

** %

-@

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

~* Public Heafth Serviee

s

s Centers for Disease Control and Prevention %

%.

>

+44 National Center for Health Statistics SK

*,~a JY&l%%%l
2 Advance Data No. 241 ● February14, 1994

sociodemographic characteristics for the

total native-born and total foreign-born

populations and for native-born and

foreign-born persons of Hispanic origin.

Immigrants are much younger, on

average, than the native-born U.S.

population. Because health indicators

tend to decline with increasing age, the

younger, immigrant population may

appear to be healthier than the nativeborn population. For that reason, both

unadjusted and age-adjusted estimates

are shown in this report.

The statistics presented in this

report show the effect of immigration

status, after controlling for a number of

other factors known to influence health

outcomes. Other characteristics of

immigrants that could have tiected the

results are not as easily measured. For

example, survey coverage of immigrant

populations may be somewhat lower

than for native-born residents due to

language barriers, fear of being

interviewed because of illegal status,

and unstable or nonhousehold living

arrangements. The importance of such

factors for measuring health outcomes

may vary by immigrant group. These

factors should be kept in mind when

interpreting the findings presented in

this report, although their effects are

expected to be small.

In the discussion that follows, the

focus is on three comparison

between the total adult U.S.-born

population and the total adult

foreign-born population

between U.S.-born Hispanic adults

and foreign-born Hispanic adults; and

among three groups of immigrants

classified by duration of residence in

the United States (less than 5 years,

5–9 years, and 10 years or more).

Unless otherwise indicated,

statistical differences discussed in this

report have been tested and found to be

statistically significant at the 0.05 level.

It should be noted that many factors

afkct health care and health status. The

ditlerences between immigrants and

native-born persons noted in this report

may result from any number of factors

and should not be considered to be

solely the result of place of birth or

duration of residence. A brief discussion

of statistical reliability and other aspects

of the NHfS design is presented in the

Technical notes.

Findings

Characteristics of the foreign-born

population

Foreign born is defined as having

been born outside of the 50 United

States or the District of Columbia. The

categories of birthplace do not

necessarily correspond to citizenship or

legal status, for which data were not

available in the NHIS. In particular,

persons born outside the United States

but in other areas under U.S.

jurisdiction, such as Puerto Rico, are

classified for this report as “foreign

born,” although they have had certain

rights of U.S. citizenship since birth.

Native born is defined as having been

born in one of the 50 United States or

the District of Columbia. Table 1 shows

the average annual number of persons

18 years of age and over according to

immigrant status, Hispanic origin, and

duration of residence in the United

States for the foreign born. Also shown

are percent distributions of each of those

groups by age, income, education,

geographic region, and sex.

Classification of persons as

Hispanic, whether U.S. or foreign bo~

was based on responses to a question

that asked if the sample person’s

national origin or ancestry corresponded

to any of those on a printed list of

Hispanic-origin groups. Persons were

classified as Hispanic if their national

origin or ancestry was given as Puerto

Rican, Cuban, Mexican/Mexicano,

Chicano, other Latin American, or other

Spanish.

It should be noted that the data in

this report, including birthplace, origin,

and length of time in the United States,

are based on responses by household

respondents, sometimes acting as

proxies for absent adult family

members. Some respondents may not

have provided accurate informatio~

either from lack of Imowledge or an

unwillingness to share it. The extent and

effect of this source of error is not

known but assumed to be small.

Table 1 shows that recent

immigrants, particularly Hispanics, were

more concentrated in the younger ages

than the U.S.-born population. This age

distribution reflects a labor-based

migration with a concentration of

immigrants in the early labor years.

Immigrants who have been in the

United States 10 years or longer were

older than more recent immigrants.

Foreign-born adults were less

educated than U.S.-born adults, and

Hispanic immigrants were less educated

than immigrants from other parts of the

world. The dMerences were dramatic

78.7 percent of the total native-born

population had completed 12 years or

more of school compared with 64.5

percent of all immigrants, 44.8 percent

of all Hispanic immigrants, anld41.1

percent of the most recent HisIpanic

immigrant group. Annual family income

reflected these same socioeconomic

differences. Recent Hispanic immigrants

(67.4 percent) were more than twice as

likely as the total U.S.-born aclult

population (31.9 percent) to have had an

annual family income of less than

$20,000. The Northeast and West had

larger proportions of immigrant

populations than the Midwest and

South, and Hispanic immigrants were

concentrated in the West.

Because the foreign-born population

differs from the U.S.-born population,

and the immigrant groups diiler by

length of time in the United States, the

data in tables 2–5 are shown by these

variables and are adjusted for age.

Respondent-assessed health

status

Table 2 shows the percerrt of

persons 18 years of age and over who

were reported to have been in fair or

poor health, based on answers to the

question, “Would you say ~erson’s

name] health is excellent, very good,

good, fair, or poor?” As seen in the first

panel, similar proportions of the total

foreign-born and U.S.-born populations

reported having been in fair ampoor

health (11.6 and 12.1 percent,

respectively). When age was adjusted,

12.4 percent of immigrants and 12.0

percent of natives reported hawing been

in fair or poor health. In comparing the

respondent-assessed health, (using

age-adjusted figures) the follc]wing
Advance Data No. 241 ● February 14, 1994 3

subgroups of the total foreign-born

population were less likely than the

corresponding subgroups of the total

U.S.-born population to be in fair or

poor healtlx persons with an annual

family income less than $20,000,

persons with less than 12 years of

education, and persons living in the

south.

Comparing the foreign-born

population by length of residence in the

United States shows that the most recent

immigrants were the healthiest of the

three immigrant groups. This general

pattern persisted even when age was

controlled, suggesting that in recent

years the immigration process has

tended to select persons in good health.

In almost all comparisons shown in

table 1, the most recent immigrants were

less likely than immigrants who had

been here 5-9 years or 10 years or

longer to report being in fair or poor

health, although differences between

adjacent categories were not always

statistically significant.

Comparing the most recent Hispanic

immigrants with U.S.-born Hispanics,

controlling for age, the same general

pattern prevailed. Recent immigrants

were less likely to be in fair or poor

health, although, again, not all of these

differences were statistically si~cant.

An apparent reversal of this pattern

among Hispanics in the Northeast was

not statistically significant. For most

comparisons the differences were quite

larg~ for instance (using age-adjusted

numbers), 4.4 percent of recent male

Hispanic immigrants report being in fair

or poor health compared with 16.0

percent of U.S-born Hispanic males.

The relationship between selected

sociodemographic characteristics and

assessed health status were similar for

the foreign- and native-born populations.

In nearly all groups-immigrant, native

born, Hispanic, and non-Hispanic—

persons with less than 12 years of

education and persons with incomes of

less than $20,000 were twice as likely to

be in fair or poor health as persons with

12 years of education or more and those

with incomes of $20,000 or more. For

example, among foreign-born persons

who had lived in the United States 10

years or longer, 19.6 percent of those

with less than 12 years of education

were in poor or fair health compared

with 8.9 percent of those with 12 years

of education or more. Sex differences

were also noted. Prevalence of fair or

poor health was higher for females than

for males in nearly all immigrant and

native-born groups shown-the largest

diiTerences being observed among the

most recent immigrants. Hispanic female

immigrants who arrived in the past 5

years were more than three times as

likely to be in poor or fair health as

their male counte~arts.

Limitation in activity

Table 3 shows the percent of

persons who reported having been

limited in usual activities because of a

chronic health condition. In almost all

sociodemographic subgroups, using

either unadjusted or age-adjusted figures,

the total foreign-born population was

less likely than the comparable total

U.S.-born population to have a

limitation of activity. The same pattern

was observed when comparing the most

recent Hispanic immigrants with

U.S.-born Hispanics. Recent Hispanic

immigrants were less likely to have had

activity limitations, even when age was

controlled. As suggested earlier, this was

likely a result of selective immigration.

That is, heallhy persons in the country

of origin were more likely than others to

immigrate to the United States.

Foreign-born persons of all origins

who have lived in the United States less

than 5 years were much less likely to

have a limitation of activity than were

foreign-born persons who had been in

the United States 10 years or more. Age

adjusting reduced the dillerences, but in

some cases the differences were still

quite large. For example, using the

age-adjusted figures, 11.6 percent of the

most recent female immigrants had a

limitation of activity compared with

16.1 percent of foreign-born females

who had been in the United States 10

years or longer. The immigrants who

had been in the United States 5–9 years

were behveen the other tsvo immigrant

groups in every sociodemographic

subgroup, although differences between

the 5–9-year duration group and

adjacent duration groups were not

always significant.

For Hispanic-origin immigrants the

same pattern held. In gener~ a smaller

proportion of the most recent

immigrants had a limitation of activity

compared with the immigrants who had

been in the United States 10 years or

more. These differences were somewhat

smaller in the age-adjusted estimates.

Bed days

Table 4 shows the percent of

persons who, during the year prior to

interview, had 4 days or more in which

they stayed in bed for more than

one-half of the day because of a health

condition. It should be noted that the

number of bed days measures both

health conditions (for example,

tlequency and severity) and responses to

those conditions (for example,

willingness and ability to forego usual

activities). Among persons experiencing

the same frequency and severity of

disease, different numbers of bed days

may occur because of differences in

their willingness and abiIity to forego

usual activity.

Overall, foreign-born adults were

less likely than U.S.-born adults to have

had 4 bed days or mor~ the differences

were significant in every subgroup

except for persons living in the

Northeast and Midwest. In every

sociodemographic group shown in table

4, foreign-born persons who had been in

the United States less than 5 years were

significantly less likely to have spent 4

days or more in bed than their

counterparts who had lived in the

United States for 10 years or Ionger.

This is consistent with the findings

presented earlier that recent immigrants

were less likely than immigrants who

had been in the United States for 10

years or longer to be in fair or poor

health. Immigrants who had lived in the

United States 5-9 years were between

the other two duration groups in terms

of bed days reported. Although not all

dHerences were statistically signitkan~

the overall pattern was consistent.

Among immigrants, the longer they

were residents in the United States, the

greater the probability that a person

would have spent an average of 4 days
4 Advance Data No. 241 ● February 14, 1994

or more in bed due to illness or injury

in the past year.

Overall, findings for Hispanic-origin

immigrants paralleled those for

immigrants as a whole. The most recent

Hispanic-origin immigrants were

generally the healthiest of the three

duration groups, although, again, not all

differences were statistically significant.

Physician contacts

Table 5 shows the percent of

persons with six physician contacts or

more (visit or telephone call with a

doctor or health care provider working

under a doctor’s supervision) during the

year prior to the interview. Six visits

was chosen as it is above the average

for the U.S. population. It should be

noted that the number of physician

contacts reflects, as does the number of

bed days, the frequency and severity of

health conditions and access to health

care.

Although the differences were

smaller than in some of the previous

tables, the total foreign-born population

was less likely than the U.S.-born

population to have had six or more

physician contacta. Foreign-born persons

who had lived in the United States less

than 5 years generally were less likely

than persons who had lived in the

United States 10 years or more to have

had six or more physician contacts.

Similarly, in comparing the

foreign-born Hispanic population by

duration of residence in the United

States, the most recent Hispanic

immigrants were less likely to have had

six or more physician contacts than

Hispanic immigrants who had been in

the United States 10 years or more.

As was found for other measures of

health status, sociodemographic

variations were similar for immigrant

and U.S.-born adults. Regardless of

immigration status, females were much

more likely than males to have had six

or more physician contacts. For

instance, 21.2 percent of recent female

Hispanic immigrants had six or more

physician contacts compared with 9.1

percent of the recent male Hispanic

immigrants. Similarly, 23.2 percent of

native-born females had six or more

contacts compared with 14.1 percent of

native-born males. In general, among

both immigrant and U.S.-born adults,

persons with incomes under $20,000 or

less than 12 years of education were

more likely than persons with higher

incomes or more education to have had

six or more physician contacts.

Summary

The health status of immigrants is

of vital interest to health policy planners

as the number of immigrants in the

United States increases. This report has

shown that, overall, foreign-born

persons had better health than the

U.S.-born population, although this

health advantage varied by length of

residence in the United States. In

virtually every measure of health statns,

and with regard to almost every

sociodemographic characteristic, the

most recent immigrants were healthier

than foreign-born persons who have

lived in the United States 10 years or

more as well as healthier than the

U.S.-born population. Immigrants who

had lived in the United States 10 years

or longer were generally healthier than

U.S.-born adults, although the

differences were not as striking as

between recent immigrants and the

native-born population.

These findings may be explained in

several ways. First, recent cohorts of

immigrants may have been healthier

than earlier cohorts of immigrants at the

time of immigration. If so, as their

duration of residence in the United

States increases, they will continue to be

significantly healthier than native-born

persons. Second, earlier cohorts of

immigrants may have been as healthy as

recent cohorts at the time of

immigration, but their health has

deteriorated with increased duration of

residence in the United States. This

suggests that immigrants had or

acquired physical conditions or

behaviors that put them at risk in their

new environment or that access to

health care has been limited. It also

suggests that more recent cohorts of

immigrants could experience a similar

deterioration of health as their duration

of residence in the United States

increases. Finally, these findings may

reflect a combination of these influences

or other factors not considered. To

understand these patterns will require

additional research, including

comparative studies of the health of

immigrants in the United States with the

health of nonmigrants (stayers) in the

countries of immigrant origin.

References

1.

2.

3.

4.

5.

U.S. Bureau of the Census,Ethnic

and HispanicBranch.1990CPH-L90, 1990Censusspecialtabulations.

Washington,D.C.: Government

Printing Office.1992.

Jasso G, RosenzweigMR. The new

chosen people Immigrantsin the

UnitedStates.NewYork Russell

SageFoundation.1990.

HendershotGE. Health of the

foreign-bornpopulation United

States, 1985-86.Advancedata from

vital and health statistic~no 157.

Hyattsville,Maryland National

Centerfor HealthStatistics.1988.

AdamsPF, BensonV.Current

estimatesfrom the NationalHealth

InterviewSurvey,1989.National

Centerfor HealthStatistics.Vhl

HealthStat 10(176).1990.

AdamsPF,BensonV.Current

estimatesfrom the NationalHealth

InterviewSurvey,1990.National

Centerfor HealthStatistics.Vkid

HealthStat 10(181).1991.
Table 1. Average annual number and percent distribution of persons 18 yearg of age and over by Immlgrarrtstatus, Iilspanlc orlgln, and duration of reslderrce,according to aelectad cherecterletlcw

United States, 19s9-20

Immigrant status

Immfgrent

Afl origins Hispanic origin

Nativeborn Duration of residence in the Unitsd States Duration of residence in the United States

,4//

immigrant Hispanic All L&%$than 5-9 10years All

Selected characteristic

Leas than 5-9 10 years

statuses’ .4/1origins w“gin duratiorrs2 5 years years or more durations2 5 years years or more

Ali persons. . . . . . . . . . . . . . . . . . . . . . . . .

All persons. . . . . . . . . . . . . . . . . . . . . . . . .

Age

16-24yaars . . . . . . . . . . . . . . . . . . . . . . . .

25-34years . . . . . . . . . . . . . . . . . . . . . . . .

35-44years . . . . . . . . . . . . . . . . . . . . . . . .

45-84years . . . . . . . . . . . . . . . . . . . . . . .

65yearsandover . ., ...,..., . . . . . . . . .

Annual fsmilyinoome

Lessthan$20,000 . . . . . . . . . . . . . . . . . . . .

$20,0000rmore . . . . . . . . . . . . . . . . . . . . .

Education

Lessthsn 12yeara . . . . . . . . . . . . . . . . . . .

12yest30rmore . . . . . . . . . . . . . . . . . . . . .

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . .

South, . . . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . . . .

sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . .

‘Includesunknownlmmigrsntstatus.

2Excludesunknownduralion,

160,466

100.0

14.0

23.7

20.3

25.7

16,3

32.7

64.0

21.7

77.3

21.0

24.3

33.9

20.9

47.5

52.5

181,8W

100.0

13.9

23.3

20.2

25.8

16,7

31.9

84.8

20.2

78.7

19.9

25.8

35.1

19.2

47.!5

52.5

6,501

100.0

25.2

29.9

19.6

18.2

7.0

39.2

57.6

29.5

69.7

11.4

8.7

35.2

44.7

47.1

52.9

17,888

100.0

14.2

27.1

21.0

24.4

13.4

39.4

57.9

34.6

84.5

30.6

11.4

22.7

36.4

47.8

52.2

Number in thousands

3,210 3,028

Peroent distribution

100.0 100.0

29.3 19.3

39.3 41.3

15.7 22.3

12.2 13.1

3.4 4.0

54.1 42.1

43.7 55.3

33.3 38.8

66.7 62.4

29.6 27.8

11.2 8.9

22.4 24,2

36.9 39.0

49.6 52.0

50.4 48.0

11,860

100.0

6.7

20.0

22.1

30.6

18.6

34.7

62.4

34.4

64.8

31.6

12,0

22,4

24.0

46.3

53.7

6,882

100.0

18.3

30.7

21.6

22.1

7.2

51.7

46.2

64.3

44.6

24.0

7.1

28.5

40.4

49.1

60.9

1,262

100.0

39.6

36.0

13.1

9.3

2.1

67.4

31.1

57.3

41.4

23.7

7.6

25.3

43.4

52.0

4s.0

1,256

100.0

24.7

44.3

18.3

10.5

2,1

54.8

43.1

5s.2

41.2

21.6

6.6

28.7

42.1

52.9

47.1

4,474

100.0

10.6

25.5

24.9

29.0

10.1

46.5

51.3

52.4

46.8

24.6

7.0

28.1

39.1

47.3

52.6
Table 2. Percent and age-adjuated percent of persona 18 yeare of age and over whose reapondant-aaeeaaed health waa fair or poor, by Immigrant atatua, Hlapanic orlgln, and duretlon of realdence:

United Statea, 1988-80

Immigrant status

Immigrant

All origins Hispanic origin

Native born Duration of residence in the United States Duration of residence in the United States

,4//

immigrant Hispanic All Less then 5-9 10 years All Less than 5-9 10 years

statuses’ All origins origin durations2 5 years yeara or more durations2 5 years years or more

All persons . . . . . . . . . . . . . . . . . . . . . . . . .

Annual family income

Lessthan $20,00il . . . . . . . . . . . . . . . . . . . .

$20,0000rmore . . . . . . . . . . . . . . . . . . . . .

Eduoation

Lessthan 12years . . . . . . . . . . . . . . . . . . .

12yearsormore . . . . . . . . . . . . . . . . . . . . .

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . .

All pereons . . . . . . . . . . . . . . . . . . . . . . . . .

Annual family income

Lessthan$20,000 . . . . . . . . . . . . . . . . . . . .

$20,0000rmore . . . . . . . . . . . . . . . . . . . . .

..-

Eduoetion

Lessthan 12years . . . . . . . . . . . . . . . . . . .

12yearsormore . . . . . . . . . . . . . . . . . . . . .

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . .

Midwast . . . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.0

21.8

6.9

26.4

7.9

9.9

10.9

14.9

10.6

10.9

13.0

12.0

21.1

7.6

22.6

6.7

9.6

10.9

14.9

11.1

11.3

12.7

12.1

22.4

6.9

27.9

7.9

9.3

10.9

15.4

10.5

11.0

13.0

12.0

21.5

7.6

23.6

8.7

8.9

10.9

15.2

10.7

11.4

12.5

13.1

21.6

7.2

24.7

8.1

8.2

6.7

16.3

12.7

11.8

14.3

16.8

26.8

9.7

26.5

11.5

9.9

12.6

20.4

15.9

16.0

17.6

11.6

17.5

7.5

19.0

7.5

13.2

11.5

9.4

11.6

9.4

13.5

12.4

18.6

8.7

18.4

8.8

13.2

11.2

10.7

13.0

10.7

13.9

6.3

6.6

3.6

10.0

4.5

6.7

*4.2

4.3

7.8

4.5

6.1

Percent

8.4

12.7

5.3

12.8

5.7

8.8

*5.9

7.5

9.1

7.1

9.7

Age-adjusted percent

9.7 13.3

13.5 19.5

6.5 9.0

13.5 17.2

7.3 10.3

10.7 14.1

7.5 *18.0

5.3 12.6

12.1 12.7

6.6 11.6

12.1 14.9

13.8

22.8

8.8

23.1

8.8

15.9

14.4

11.3

13.4

11.5

15.8

12.7

20.4

9.0

19.6

6.9

13.7

12.0

11.1

13.2

11.1

14.0

13.1

17.1

8.9

17.3

8.0

17.7

11.3

11.0

12.1

10.5

15.6

16.2

20.7

12.0

20.2

10.5

19.5

16.3

13.2

16.3

13.4

18.6

6.9

8.2

●4.3

9.0

4,0

10.0

●4.2

●6.3

5.6

3.2

10.9

11.6

15.3

●6.6

15.1

6.9

14.5

*4.6

9.1

11.8

4.4

16.4

6.9

11.0

6.7

10.9

6.2

11.4

7.2

6.7

9.5

7.8

10.3

15.2

16.6

15.2

17.0

12.1

17.3

*22.8

11.4

15.4

14.5

16.1

16.0

22.7

10.1

21.9

9.4

21.2

14.6

13.5

14.6

13.6

16.2

17.1

23.1

12.2

21.8

11.0

20.9

17.9

13.6

16.8

i4.6

19.0

‘Includes unknown Immigrantstatus.

‘Excludes unknown duration.
Table 3. percent and age-adjusted percent of persons 18 yeers of qfe end over who were Ilmttad In activity due to a chronic condition or Impfdrmerrt,by Immigrant etatue, Hlepanlc orlghr, and duration of

residence: Urdted Statee, 1S63-90

[mmigrent s.Wus

Immigrant

All orighs Hispanic origin

Native borrr Duration of residence in the United States Dwation of residence in the United states

All

immigrant Hisparrlo All Lass than 5-9 10yaars Afl Less then 5-9 10 years

statuses’ All origins origin duratiorrs2 5 yesm years or more duratiorrsz 5 years years or more

All persons. . . . . . . . . . . . . . . . . . . . . . . . .

Annual family income

Lessthan $20,000 . . . . . . . . . . . . . . . . . . . .

$20,0000r more . . . . . . . . . . . . . . . . . . . . .

Education

Lewthan 12yeare . . . . . . . . . . . . . . . . . . .

12yeaffi ormore . . . . . . . . . . . . . . . . . . . . .

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . .

Midwest. . . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allpersonsi . . . . . . . . . . . . . . . . . . . . . . . .

Annual family income

Lessthan$20,000 . . . . . . . . . . . . . . . . . . . .

$20,0000rmore . . . . . . . . . . . . . . . . . . . . .

Education

Lessthan 12yeare . . . . . . . . . . . . . . . . . . .

12yearsormore . . . . . . . . . . . . . . . . . . . . .

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . .

Midwest. . . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . .

17.0

27.5

11.7

30.0

13.3

15.7

16,9

18.4

16.2

16.2

17.8

17.0

26.3

13.0

25.3

14.4

15.2

16.8

18.4

16.8

16.7

17.2

17.5

28.8

12.0

32.3

13.6

15.9

17.0

16,9

17.2

16.8

18.1

17.4

27.4

13,2

27.2

14.7

15.3

17.0

18.7

17.5

17.2

17.5

13.9

19.7

10.0

22.5

10.2

10.4

13.1

14.7

14.3

13.7

14.1

18.0

24.7

13.3

24.0

14.4

14.0

16.5

19.0

18.1

17.6

18.4

12.8

17.6

9.3

18.4

9.6

14.7

14.0

11.7

11.5

11,0

14.5

13.9

19.1

10.8

17.5

11.5

14.6

13.6

13.6

13.4

12,5

14.9

Percent

5.5 7.0

6.3 9.5

4.6 5.3

7.2 9.2

4.5 5.5

6.5 7.6

*5.6 *5.5

4.2 6.6

5.4 6.7

6.0 6.6

6.1 7.4

Age-adjusted percent

10.6 12.5

13.5 16.2

8.4 10.4

11.0 14.3

10.8 11.1

12.8 13.2

*11.3 *13.O

9,5 13.7

10.3 11.6

9.2 13.1

11.6 12.2

16,3

25.3

11.2

24.0

12.1

18.4

17.6

15.2

14.7

14.0

18.3

14.9

22,0

11.5

19.5

12,3

15.7

14.5

14.8

14.5

13.4

16.1

11.7

14.9

6.3

14.3

8.6

15.8

11.3

12.3

9.0

10.0

13.4

15.3

19.0

11.8

17.4

12.2

16.2

16.9

14.7

13.2

13,3

16.8

4.8

4.9

*4.6

4.8

4.2

6.4

7.3

‘%.8

%2.9

3.7

5.6

9.9

11.9

%.9

9.9

11.2

13.1

~.6

%.3

%.9

%

6.4

7.4

5.4

6.7

6.0

8.5

7.2

6.7

4.7

6.3

6.4

13.5

13.9

12.4

12.8

15.0

12.3

22.7

13.4

8.7

17.3

11.1

15.2

21.4

9.7

19.6

10.3

19.7

13.7

16.0

12.1

13.1

17.2

16.5

21.9

12.1

19.6

12.4

20.1

19.2

16.1

14.2

T4.4

18,3

‘Includesunknovmimmigrantetetus.

2ExdudesunknowndursUon.
Table 4. Parcent and age-adJuated percant of persons 18 yaare of age and over who had 4 or mora bed daya in the paat yaar, by Imm[grant statue, Hlapanlc origin, and duration of raaidenotx United Statas,

1988-80

Selected characteristic

Imm;grant status

Immigrant

Ail origins Hkpanio origin

Native born Duration of residence in the United States Duration of residence in the United States

All

immigrant Hispanic All Less than 5-9 10 years All Lees than 5-9 10 years

statuses’ All origins origin durations 5 years yeara or more durations2 5 years years or more

All persons . . . . . . . . . . . . . . . . . . . . . . . . .

Annual family income

Lessthan $20,000 . . . . . . . . . . . . . . . . . . . .

$20,0000rmore . . . . . . . . . . . . . . . . . . . . .

Education

Lessthan 12years . . . . . . . . . . . . . . . . . . .

12yearsormore . . . . . . . . . . . . . . . . . . . . .

Ragion

Northeast . . . . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Waft . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . .

All pereons . . . . . . . . . . . . . . . . . . . . . . . . .

Annual family income

Leeethan$20,000 . . . . . . . . . . . . . . . . . . . .

$20,00fJormore . . . . . . . . . . . . . . . . . . . . .

Education

Leeethan 12years . . . . . . . . . . . . . . . . . . .

12yearsormore . . . . . . . . . . . . . . . . . . . . .

Region

Norlheaat . . . . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . .

20.7

25.4

18.8

24.7

19.7

19.9

20.0

21.1

21.8

16.7

24.4

20.7

25.5

18.8

23.8

19.7

19.8

20.0

21.1

21.8

18.9

24.4

21.1

26.2

16.9

25.9

20.0

20.0

20.1

21.5

23.1

17.1

24.8

21.1

26.4

19.1

25.4

20.0

19.9

20.1

21.4

23.1

17.3

24.6

22.3

26.1

19.9

25.2

21.3

23.0

20.9

20.9

23,6

17.0

27.1

22.8

26.9

20.0

25.6

20.5

25.2

21.5

21.7

23.5

18.2

28.8

17.2

19.6

15.7

18.4

18.8

19.2

16.0

15.9

16.2

13.1

21.0

i7.6

20.1

16.2

18.0

17.1

19.1

17.9

16.4

16.6

13.6

21.1

Percent

12.2 f4.8

13.3 15.3

11.0 14.5

11.4 13.1

12.5 15.8

13.1 16.6

13.6 15.5

12.0 15.0

11.2 13.0

7.3 11.0

16.9 16.6

Age-adjusted percent

13.2 16.1

13.2 17.5

13.1 15.2

12.6 14.7

13.1 17.0

16,3 16.2

13.8 21.9

11.6 17.7

11.6 13.1

8.3 12.9

17.5 19.4

19.3

23.9

16.9

21.6

18.0

21.4

19.5

17.2

18.6

15.4

22.6

18.9

23.0

17.0

20.5

18.0

20.4

16.4

17.3

18.6

15.2

22.2

16.8

16.5

15.3

16.4

17.5

21.1

15.0

15.6

15.6

12.6

21.0

18.3

20.0

17.2

17.9

18.8

22.2

16.7

16.7

17.2

14.2

22.2

11.6

11.4

12.5

9.1

15.3

15.1

*6.3

12.9

9.7

6.9

16.7

14.6

11.9

19.1

12.3

19.4

23.3

*4.5

14.0

9.3

7.3

19.6

13.5

15.6

11.1

13.0

14.3

15.5

●14.5

15.0

11.3

10.7

16.4

18.1

19.4

16.8

15.9

21.6

19.1

*1 7.9

19.9

12.4

16,7

19.6

19.3

22.3

16.9

19.8

16.8

24.1

17.5

16.4

18.8

14.9

23.3

19.6

22.5

18.0

20.0

19,3

24.7

18.0

16.5

19.4

15.5

23.6

1!n~@Is unknown immigrant status.

‘Excludes unknown duration.
Table 5. Percent and ageadjustad percent of persons 18 yeare of age and over who hd eix or more phynlclanomteots In the past year, by Irnmlgrantetetue, Hlepanlo orlgln, and duration of realden~

United States, 1968-80

.%rleotacfcharaoterfstlc

Immfgrent status

Immigrant

,4/ origins Hispanic origin

Native born Duration of residence in the United States Duration of rasidenoe in the United States

All

immigrant Hispanic Afl Leas than 5-9 10years

statuses’

All Less than 5-9

.41 origins on~in duretions2 5 years

10years

years or more duretions2 5 years years or more

Allperaons . . . . . . . . . . . . . . . . . . . . . . . . .

Annual family income

Lessthan $20,croo, . . . . . . . . . . . . . . . . . . .

$20,0000rmore . . . . . . . . . . . . . . . . . . . . .

Education

Lessthen 12yaara . . . . . . . . . . . . . . . . . . .

12yearsormore . . . . . . . . . . . . . . . . . . . . .

Region

Northaaat . . . . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . .

weft . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male .,.....,,.........,,.. . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . .

All persons. , . . . . . . . . . . . . . . . . . . . . . . .

Annual familyinoome

Lessthan$20,0(Xk . . . . . . . . . . . . . . . . . . . .

$20,0000rmore ., . . . . . . ..m... . . . ...,

Education

Lessthan 12yeara . . . . . . . . . . . . . . . . . . .

12yearsormore . . . . . . . . . . . . . . . . . . . . .

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Waft . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . .

18.6

22.7

16,7

23,2

17.3

19.0

16.2

18.0

19.4

13.5

23.1

16.5

21.7

17.4

20.8

17.9

18.8

18.1

16.0

19.6

13.6

23.0

18.9

23.3

16.9

24.1

17.6

19.3

16.3

18.3

20.1

13.8

23.4

18.8

22.2

17.7

21.4

18.1

19.0

18.3

16.2

20.3

14.1

23.2

17.3

21.0

14.9

m.3

16.0

17.8

15.8

15.7

18.7

11.2

22.7

19.0

22,8

i8.3

20.6

17.5

21.2

18.6

16.0

19.6

13.8

23.7

15.8

16.6

14.2

18.8

14.2

17.7

14.4

14.i

15.8

10.5

20.8

16.4

18,9

16.1

18.2

15.2

17.7

14.2

15.3

16.8

11.7

20.9

Peroent

11.2 13.5

11.7 14.7

10.6 13.0

11.4 14.8

11.0 12.9

13.4 14.7

10.3 12.6

12.6

IH 13.3

5.2 7.8

17.2 19.8

Age-adjusted parcent

14.0 16.3

14.9 19.4

13.1 14.2

13.4 17,3

14.1 15.8

18.7 18.5

10.4 18.4

11.0 16.8

13.5 15.2

10.3 12.5

17.9 20.7

17.7

22.6

15.1

21.9

15.4

19.6

15.8

15.8

17.9

12.8

21.9

17.1

20.7

15.5

19.5

15.6

18.0

14,3

15,9

18.1

12.4

21.4

16.4

18.7

13,9

17.6

14.9

21.8

14.2

14.3

15.0

10.3

22.3

19.2

21,9

16.4

20.4

17.0

23.9

18.3

16.7

17.4

13.6

24.5

11.2

11.1

11.2

10.1

12.8

16.4

*8.3

6.5

10.4

4.3

18.6

15.8

15.4

14.8

16.7

16.8

23.7

V.o

13.4

13.0

9.1

21.2

13.3

15.1

11.3

13.3

13.5

16.2

*8.4

13.9

11.9

8.1

18.9

18.6

20.9

15.0

15.9

21.9

18.0

*8.8

22.3

12.6

17.0

21.1

18.7

23.0

15.0

21.3

15.8

24.6

17.5

15.8

17.3

12.8

24.0

20.0

23.6

16.9

21.7

17,0

24.9

20,9

16.4

18.7

14.2

25,3

‘ Includasunknownimmigrantstatus.

2Excludesunknwn duration,
10 Advance Data No. 241 ● February 14, 1994

Technical notes

The National Health Interview

Survey is a continuous, cross-sectional,

national survey conducted by household

interview. Each week a probability

sample of households in the civilian

noninstitutionalized population of the

United States is intewiewed to obtain

information on the health status of each

member of the household as well as

other background characteristics. The

1989 survey included 45,711 households

containing 116,929 persons. Among

these were 8,142 persons who were

reported to have been born outside of

the United States. The 1990 survey

included 46,476 households containing

119,631 persons. This included 8,851

persons who were reported to have been

born outside of the United States.

All persons 17 years of age and

over were asked to participate in the

interview. Proxy responses were

accepted from other adult family

members for children and teens under

17 years of age and for adults not

present or unable to respond for

themselves. About two-thirds of all adult

family members responded for

themselves.

Because the estimates shown in this

report are based on a sample, they are

subject to sampling error. A measure of

the sampling error is given by the

standard error. Approximate standard

errors for estimated percents in this

report are given by the formula:

‘E@=rTwhere SE is the standard error, p is the

estimated percent, and y is the estimated

base of the percent. The bases of the

percents in table 1 are shown in the first

line and the bases of the percents shown

in tables 2–5 can be calculated from the

data in table 1.

The approximate standard error of

the difference between percents is given

by the formula:

percents. In this report, a difference was

considered statistically significant at the

0.05 level if the difference between the

two percents was at least twice as large

as its standard error.

More detailed discussions of the

sample design, estimating procedures,

procedures for estimating standard

errors, nonsampling emors, and

definitions of terms used in this report

have been published (4,5).

where xl and Xzare the two percents

being compared, xl – ~ is the

difference betsveen them, and SE(XJ and

SE(XJ are the standard errors of the two
Number 242 ● January 27, 1994

Advance

Data

FromVi and Health Statisticsofthe CENTERS FOR DISEASE CONTROLAND PREVENTION/Nationa! Centerfor H&dth Stat&k

Firearm and Motor Vehicle Injury Mortality-Variations by

State, Race, and Ethnicity: United States, 1990-91

by Lois A. Fingerhut, M.A.; Cheryl Joneq and Diane M. Makuc, Dr.P.H.; Division of Analysis

Introduction

In 1991, motor vehicles were

responsible for more injury deaths than

any other cause of injury. Firearms were

the second leading cause of injury death.

Motor vehicle crash- and firearm-related

injuries accounted for 55 percent of all

injury deaths in the United States in 1991;

43336 people died as the result of injuries

sustained during motor vehicle crashes and

38,317 people died as the result of lirearmrelated injuries (12).

From 1980 through 1985, motor

vehicle crash and &earm death rates

decreased by 18 and 11 percent,

respectively. From 1985 through 1991,

the motor vehicle crash death rate

continued to decrease (by 10 percent),

whereas the death rate due to firearms

increased by 14 percent. The more

recent period, 1988 through 1991, was

one of faster change for lmth causes of

dea~ the motor vehicle death rate declined

14pereen$ at an average annual rate of

4.8 percent per year, while the firearm

death rate increased 9 percent at an

average annual rate of 3.2 pereent per year.

If these recent trends (1988 through 1991)

in motor vehicle crash and Iirearm

mortality were to continue,ilrearms wouId

displace motor vehicle crashes as the

leading cause of injury death in the United

Statesby the mid-1990’s. If predictions

of when the crossover would occur were

based upon longer term trends, for

example, 1968 through 1991, iirearm

deaths would outnumber motor vehicle

deaths by the year 2003 (2).

The Healthy People 2000 initiative

includes objectives for reducing motor

vehicle crash fatalities for persons of all

ages, and in particular for persons 15-24

years of age, and for American Indian/

Alaskan Native persons (3). In additioq

there are several objectives directed

towards the reduction of homicide,

suicide, and weapon-related vioIent

death rates for all persons, and

speciikally for males 15-34 years of

age, black persons, persons of Hispanic

origin, and American Indian/Alaskan

Native males.

Recent increases in firearm

mortality have been greatest among

adolescents and young adults. From

1988 through 1991, the firearm death

rate for persons 15–24 years increased

40 percent to 28.9 per 100,000

population, and the motor vehicle death

rate declined 15 percent to 32.0 per

100,000 population. Also during this

period, the 13rearmdeath rate for persons

25-34 years increased 8 percent to 22.1

per 100,000, and the motor vehicle

death rate decreased 12 percent to 21.2

per 100,000. In 1991, the firearm death

rate for persons 15–24 years of age was

only 10 percent lower than the motor

vehicle death rate, and at 25-34 years

the tirearm death rate exceeded the

motor vehicle death rate by 4 percent

(figure 1).

Large racial differentials in iirearm

mortality have been previously reported

for the white and black populations

(4,5). Death rates for other racial and

ethnic groups could not be estimated

previously for non-Census years because

age and State-speci6c intereensal

population estimates (needed for

estimates of the Hispanic population)

were unavailable.

In this repo* numbers of firearm

and motor vehicle deaths are compared

within States for persons of all races in

1991, and within States for the nonHispanic white, Hispanic, black Asian

and PacMc Islander, and Arneriean

Indian/Alaskan Native (hereafter

referred to, respectively, as Asian and

American Indian) populations for

199&91. The extent to which homicide

and suicide eontribute to iirearm deaths

is also examined for these groups. In

additioq this report includes an analysis

of State-, race-, and ethnic-spec%c

firearm and motor vehicle death rates

for persons 15-34 years of age.

**SSWCQ.

@ *%

*+

~

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

$ Centers for Disease Control and Prevention -6‘%%3

National Center for Health statistics glxj

+~a N%%!%%m
2 Advance Data No. 242 ● January 27, 1994

Methods

Data by State

Total numbers of firearm and motor

vehicle deaths for 1990 and 1991 are

shown for all States in table 1. Two

years of data, 1990-91, were combined

in tables 24 because of the small

numbers of annual deaths in some

minority populations and in the age

group 15–34 years. Numbers of deaths

in 1990-91 are shown for all States in

table 2. However, the text highlights

data only for States in which the

combined numbers of firearm and motor

vehicle deaths for 199&91 exceeded

100. State- and racelethnic-speci fic death

rates for persons 15–34 years of age for

1990-91 were included in table 4 if the

death rate was based on at least 20

deaths, and are shown with an asterisk if

they were based on fewer than 50

deaths.

Hispanic origin

In 1990, mortality data for the

Hispanic origin population were based

on deaths to residents of 45 States and

the District of Columbia whose data

were at least 90 percent complete (6). In

1991, the number of States with

mortality data by Hispanic origin

increased to 47. Data on people of

Hispanic origin from New York New

Hampshire, and Oklahoma were not

included in 1990 or 1991, and data for

Connecticut and Louisiana were

excluded for 1990. Data for New York

were excluded in 1990 and 1991

because more than 10 percent of the

death certificates from New York City

were classified to “unknown origin. ”

Thus, deaths and death rates for

non-Hispanic white and Hispanic

populations reported here are not

national in scope. They do, however,

include almost 90 percent of the

Hispanic population in 1990-91 (1,6).

Quality of race data

In estimating race- and ethnicspectic death rates, it is important that

race and ethnicity be consistently

reported in the numerator and

denominator of the death rate. In a study

of the agreement between race and

Motor vehicle Firearms

50

+ +

45

F

+=”+ s=

‘L______ 1985 1986 1987 1988 18s9 la90 1991

Year

Figure 1. Firearm and motor vehicle craeh death rates for persons 15-24 and 25-34 years

of age: Unitad States, 1985-91

ethnic identification as reported on death

certificates and as reported by the

Bureau of the Census, it was found that

agreement rates were high for the

non-Hispanic white, Hispanic, and black

populations (7). However, persons

classified as American Indian or Asian

by the Census (household respondents)

were sometimes classified as white on

their death certificates leading to a

potential underestimation of death rates

for American Indians by 22 percent and

for Asian persons by 12 percent (7).

Cause of death classifications are

found in the technical appendix.

Results

Numbers of deaths for the

total population (table 1)

Throughout most of the 1980’s,

motor vehicle deaths exceeded firearm

deaths in all States with the exceptions

of Alaska, Louisiana, and the District of

Columbia. (Data upon request.) In 1990,

Maryland, New York, Texas, Alaska,

Louisiana, and the District of Columbia

had more firearm than motor vehicle

deaths. In 1991, there were more firearm

deaths than motor vehicle deaths in

California, Louisiana, Nevada, New

Yorlq Texas, Vuginia, and the District of

Columbia. In Maryland, the numbers of

firearm and motor vehicle deaths were

identical in 1991.

Race- and ethnic-specific numbers

of deaths (table 2)

Among non-Hispanic white persons

in 1990-91, fiearm deaths exceeded

motor vehicle deaths by 5 percent in

Nevada. Four of five tiearm deaths

(79 percent) in Nevada were suicides. In

Arizona, Texas, New Mexico, amd

Wyoming, the numbers of firearm deaths

were less than 10 percent below the

number of motor vehicle deaths. In

Arizona, New Mexico, and Wyoming,

three-fourths of the firearm deaths were

suicides, and in Texas, about two-thirds

(68 percent) were suicides. Nearly

three-fourths of all non-Hispanic white

firearm victims died as a result of a

suicide.

Among Hispanic persons in the 15

States that had at least 100 totad iirearm

and motor vehicle deaths in 1990-91,

firearm deaths exceeded motor vehicle

deaths in Illinois and Pennsylvania, and

78-80 percent of those firearm deaths

were homicides. In California,

Massachusetts, and Texas, the munbers
Advance Data No, 242 ● January 27,1994 3

of firearm deaths were less than

10 percent lower than the number of

motor vehicle deaths. Four of five

firearm deaths in California and

Massachusetts were homicides, and two

of three in Texas were homicides.

Overall, about 70 percent of Hispanic

firearm victims died in a homicide

(excludes data from New York).

In the black population, firearm

deaths exceeded motor vehicle deaths in

all but three-New Jersey, Mississippi

and South Carolina+f the 31 States

(where there were at least 100 total

firearm and motor vehicle deaths). In

New Jersey, the number of iirearm

deaths was less than 5 percent below the

number of motor vehicle deaths. In

Mississippi and South Carolin~ firearm

deaths were lower than motor vehicle

deaths by 19 and 28 percent

respectively. On the other hand, in

Wisconsin and the District of Columbia,

the ratio of tiearm deaths to motor

vehicle deaths ranged from 4-&l. In the

District of Cohunbi~ 96 percent of

Iirearm deaths were homicides. In

another 21 States, the ratio averaged 2-3

firearm deaths for every 1 motor vehicle

death. Overall, 85 percent of black

victims of firearm mortality died in a

homicide.

For the Asian population, 4 States

had at least 100 deaths from firearm and

motor vehicle injuries. Texas was the

only State to have more iirearm than

motor vehicle deaths 73 percent of

those firearm deaths were homicides.

Among all Asian persons, 64 percent of

firearm deaths were homicides.

For the American Indian/Alaskan

Native populatio~ 5 States had at least

100 deaths from firearm and motor

vehicle injuries, and only Alaska had

more firearm than motor vehicle deaths.

(Alaska had a disproportionate number

of unintentional firearm deaths.)

Death rates for all persons 15-34

years of age (table 3)

Among adolescents and young

adults 15–34 years of age in 1990-91,

the iirearm death rate was 11 percent

lower than the motor vehicle crash death

rate, 24.4 compared with 27.3 per

100,000. In four States @linois,

Maryland, Louisiana, and Texas), the

tirearm death rates were 13 to

26 percent higher than the respective

motor vehicle death rates. In New Yor&

the death rate for iirearms exceeded the

rate for motor vehicle deaths by

61 percent (28.1 compared with 17.4 per

100,000), and in the District of

Columbi~ the firearm death rate was 8.6

times the motor vehicle death rate

(119.8 compared with 14.0 per 100,000).

With few exceptions, there were

low (relative to the United States rates)

firearm and motor vehicle death rates in

the New England, Middle Atlantic, and

the East North Central States. Low

firearm death rates were also reported in

the West North Central States. Of the

States with relatively large numbers

(several hundred) of injury deaths,

Iirearm and motor vehicle death rates in

New Jersey and Massachusetts were

among the lowest (9.6 and 15.3 per

100,000, respectively, in New Jersey and

8.3 and 15.9 per 100,000, respectively,

in Massachusetts). On the other hand, in

five States (Alabama, Mississippi,

Arkansas, Louisiana, and Nevada) the

firearm and the motor vehicle death

rates were at least 25 percent greater

than the respective national rates for all

persons 15–34 years in 1990-91.

Race- and ethnic-specific death

rates for persons 15+4 years

(table 4)

National fiearm death rates for

black Hispanic, and American Indian

persons 15–34 years were, respectively,

4.7, 1.9, and 1.6 times the firearm death

rate for non-Hispanic white persons

(15.2 per 100,000). The firearm death

rate for Asian persons was 30 percent

lower than the rate for non-Hispanic

white persons. The motor vehicle death

rate for American Indian persons (50.6

per 100,000), was 1.8-2.2 times the

respective death rates for non-Hispanic

white, Hispanic, and black persons, and

3.7 times the rate for Asian persons. For

black persons 15-34 years, the firearm

death rate was 3.1 times the motor

vehicle death ratq for Hispanic persons,

the two death rates were sirnilq for

non-Hispanic white and American

Indian persons, the fmearm death rates

were about half the motor vehicle ratey

and for Asian persons, the firearm death

rate was 22percent below the motor

vehicle death rate.

For non-Hispanic white persons

15–34 years of age, the firearm death

rate did not exceed the motor vehicle

death rate in any State. In Arizona and

Wyoming, the Iirearm death rates for

non-Hispanic white persons were,

respectively, 11 and 17 percent less than

the respective motor vehicle death rates

as a result of higher than average

iirearm death rates for non-Hispanic

white persons.

For Hispanic persons 15-34 years

(where, overall, the two death rates were

similar) in California and Texas, the

iirearm death rates exceeded the motor

vehicle death rates by 14 and

18 percen$ respectively, both as a result

of higher than average firearm death

rates (33.5 and 33.6 compared with 29.6

per 100,000). In Illinois, the firearm

death rate was 67 percent greater than

the motor vehicle death rate, as a result

of a lower than average motor vehicle

death rate.

For black persons 15-34 years of

age, (where the Ilrearm to motor vehicle

death rate ratio was 3.1:1) the ratio in

New York was 6:1 as a result of a much

lower than average motor vehicle death

rate (12.6 compared with 23.0 per

100,000). In Illinois, Michigan, and

Missouri, the firearm to motor vehicle

death rate ratios were 5.2–5.7: 1 as a

result of higher than average firearm and

lower than average motor vehicle death

rates.

For Asian persons 15-34 years, the

firearm death rates in Texas and

California were 1.8 and 1.3 times the

national rate for Asian persons (19.1 and

13.5 compared with 10.7 per 100,000).

The motor vehicle death rate in Hawaii

was 1.6 times the national average (22.3

compared with 13.7 per 100,000).

For American Indian persons 15–34

years, the firearm death rate in Alaska

was 4 times the national average for all

American Indians (100.6 compared with

24.1 per 100,000). The motor vehicle

death rates in Arizona and New Mexico

were, respectively, 2.0 and 2.5 times the

national average for American Indians

(103.0 and 124.7 compared with 50.6

per 100,000).

In several States, comparisons of

firearm and motor vehicle death rates
4 Advance Data No. 242 ● January 27,1994

for persons 15–34 years across three or

more race and ethnic groups were

possible:

●

●

●

●

●

●

In New Jersey, (where firearm and

motor vehicle death rates for

non-Hisprmic white, Hispanic, and

black persons were lower than the

national average) the firearm death

rate for black persons (26.7 per

100,000) was 2.2 and 5.1 times the

respective rates for Hispanic and

non-Hispanic white persons. The

motor vehicle death rates for all three

groups in New Jersey were similar

(14.8-17.5 per 100,000).

In Pennsylvania, the firearm death

rate for black persons (71.1 per

100,000) was 1.7 and 6.0 times the

respective rates for Hispanic and

non-Hispanic white persons.

In lllinois, the firearm death rate for

black persons (94.2 per 100,000) was

3.2 and 9.6 times the respective rates

for Hispanic and non-Hispanic white

persons, and the motor vehicle death

rate for non-Hispanic white persons

(24.8 per 100,000) was 1.4 times the

respective rates for Hispanic and

black persons.

In Florida, the firearm death rate for

black persons (70.5 per 100,000) was

3.4 and 3.8 times the respective rates

for Hispanic and non-Hispanic white

persons, and the motor vehicle death

rate for non-Hispanic white persons

(32.4 per 100,000) was 1.2 times the

rates for black and Hispanic persons.

In Texas, firearm death rates for

non-Hispanic white, Hispanic, black

and Asian persons were higher than

the national averages for those

groups. The firearm death rate for

black persons (84.9 per 100,000) was

2.5, 4.0, and 4.4 times the respective

rates for Hispanic, non-Hispanic

white, and Asian persons. Motor

vehicle death rates were similar for

non-Hispanic white, Hispanic, and

black persons (27.1-30.2 per 100,00).

In Arizona, the firearm death rates

were higher than average for

non-Hispanic white persons, and

average for Hispanic and black

persons. The firearm death rate for

black persons (66.6 per 100,000) was

2.3 and 2.8 times the respective rates

for Hispanic and non-Hispanic white

persons. The motor vehicle death rate

for American Indians (103.0 per

100,000) was 3.1 and 3.9 times the

respective rates for Hispanic and

non-Hispanic white persons in

Arizona.

. In New Mexico, the motor veticle

death rate for American Indians

15–34 years of age (124.7 per

100,000) was 2.4 and 4.2 times the

respective rates for Hispanic and

non-llispanic white persons in New

Mexico.

● In California, the firearm death rate

for black persons (89.7 per 100,000)

was 2.7, 5.8, and 6.6 times the

respective rates for Hispanic,

non-Hispanic white, and Asian

persons. Motor vehicle death rates

were higher for Hispanic and

non-I-Iispanic white persons (29.5 and

25.8 per 100,000) than for black

(21.4 per 100,000) or Asian persons

(14.2 per 100,000).

Discussion

The two leading causes of injury

death in the United States continue to be

motor vehicles and firearms. Death rates

for motor vehicle injuries and for

firearm injuries, however, have been

converging in recent years as a result of

declines in the former and increases in

the latter. If the trends observed from

the late 1960’s through 1991 continue,

firearms will claim more lives than

motor vehicles very early in the next

decade. In several States this crossover

has already occurred.

Efforts to reduce motor vehicle

death rates have proven successful.

Effective interventions have included

increasing public awareness, education,

legal proscriptions, innovative vehicle

and equipment designs, improved

roadways, and enhanced medical

systems (both emergency services and

trauma care) (8). The importance of

safety seats and safety belts for children

and adults and of bicycle and

motorcycle helmets is being continually

reinforced. The risks in alcohol

consumption and driving are being

continually addressed.

Prevention strategies to reduce

firearm death rates must be tried and

evaluated. The same level of attention

that was, and continues to be, paid to

the reduction of motor vehicle death

rates must be directed toward lowering

firearm mortality.

References

1. National Center for Health Statistics.

Advance report on final mortality

statistics, 1991. Monthly vital

statistics repoti, vol 42, no 2. suppl.

Hyattsville, Maryland: Public Health

Service. 1993.

2. National Center for Health Statistics

unpublished data.

3. U.S. Department of Health and Human

SeMces. Healthy people 200& National

health promotion and disease prevention

ObjWtiVeS. Washington Public Health

seMce. 1991.

4. Fingerhut LA. Firearm mortality

among children, youth, and young

adults 1–34 years of age, trends and

current statw United States,

1985-90. Advance data from vital

and health statistics; no 231.

Hyattsville, Maryland National

Center for Health Statistics. 1993.

5. Fingerhut @ Ingram DD, ancl

Feldman JJ. Firearm and nontirearm

homicide among persons 15-1!9 years

of agti dtierences by level of

urbanization, United States, 1979

through 1989. JAMA.

199~267:3048-3053.

6. National Center for Health Statistics.

Advance report of iinal mortaWy

statistics, 1990. Monthly vital

statistics repoti, vol 41 no 7, suppl.

Hyattsville, Maryland Public Health

Service. 1993.

7. Sorlie PD, Rogot E, Johnson NJ.

Validity of demographic

characteristics on the death

certificate. Epidemiology vol 3 no 2.

1992.

8. Centers for Disease Control and

Prevention. Position papers fralm the

Third National Injury Control

Conference. Denver, Colorado,,

April 1991.

9. World Health Organization. Manual

of the International Statistical

Classification of Diseases, Injuries,

and Causes of Death, based on the

recommendations of the Ninth

Revision Conference, 1975. Genevrx

World Health Organization. 1977.

10. U.S. Bureau of the Census. U.S.

population estimates, by age, sex,

race, and Hispanic origin: 1981–91.

Series P-25, No. 1095 Advance

Report. 1993.
Advance Data No. 242 ● January27,1994 5

Table1. Firearmand motorvehicledeathsand ratioof firearmto motorvehicledeathsby StetIXUnitedStates,1990and 1981

1990 1991

Motor

State l%earm

Motor

vehicle Ratio H-eann vehiole Ratio

Unitad states . . . . . . . . . . . . . . . .

New England

Cannaoticut..... . . . . . . . . . . .

Maine . . . . . . . . . . . . . . . . . . .

Massachusetts . . . . . . . . . . . . . .

New Hampshire . . . . . . . . . . . . .

Rtmdelsland . . . . . . . . . . . . . . .

Vermont . . . . . . . . . . . . . . . . . .

Middle Atlantic

New Jemey . . . . . . . . . . . . . . . .

New York . . . . . . . . . . . . . . . . .

Pennsylvania . . . . . . . . . . . . . . .

East North Centrak

Illinois . . . . . . . . . . . . . . . . . . .

Indiana . . . . . . . . . . . . . . . . . . .

Michigan . . . . . . . . . . . . . . . . . .

Ohio . . . . . . . . . . . . . . . . . . . .

VJsconsin . . . . . . . . . . . . . . . . .

WestNorthCen&ak

Iowa . . . . . . . . . . . . . . . . . . . .

Kansas . . . . . . . . . . . . . . . . . .

Minnesota . . . . . . . . . . . . . . . . .

Missouri . . . . . . . . . . . . . . . . .

Nebraska . . . . . . . . . . . . . . . . .

North Dakota . . . . . . . . . . . . . . .

South Dakota . . . . . . . . . . . . . . .

SouthAtlanti~

Delaware . . . . . . . . . . . . . . . . .

DistdctofColumbia . . . . . . . . . . .

Florida . . . . . . . . . . . . . . . . . . .

Georgia . . . . . . . . . . . . . . . . . .

Maryland . . . . . . . . . . . . . . . . .

NorlhCarolina . . . . . . . . . . . . . .

South Carolina . . . . . . . . . . . . . .

Virginia . . . . . . . . . . . . . . . . . .

WestVirginia . . . . . . . . . . . . . . .

East South Central:

Alabama . . . . . . . . . . . . . . . . . .

Kentucky . . . . . . . . . . . . . . . . .

Mississippi . . . . . . . . . . . . . . . .

Tennessee . . . . . . . . . . . . . . . .

WestSouthCentral:

Arkansas . . . . . . . . . . . . . . . . .

Louisiana . . . . . . . . . . . . . . . . .

Oklahoma . . . . . . . . . . . . . . . . .

Texas . . . . . . . . . . . . . . . . . . .

Mountain

Arizona . . . . . . . . . . . . . . . . . .

Colorado . . . . . . . . . . . . . . . . .

Idaho . . . . . . . . . . . . . . . . . . . .

Montana . . . . . . . . . . . . . . . . . .

Nevada . . . . . . . . . . . . . . . . . .

NewM6tdm . . . . . . . . . . . . . . .

~Zrni~IIllllIIIIIIIIlll

Pacifb

Alaska . . . . . . . . . . . . . . . . . . .

Caliiomia . . . . . . . . . . . . . . . . .

Hawaii . . . . . . . . . . . . . . . . . . .

Oregon . . . . . . . . . . . . . . . . . .

Washington . . . . . . . . . . . . . . . .

37,155

256

114

306

97

66

59

447

2,418

1,387

1,510

732

1,415

1,178

517

225

289

374

a65

1643

47

63

59

336

2,411

1,264

742

1,181

633

981

257

912

641

544

971

467

1,050

483

3,479

688

422

165

151

266

265

201

80

106

4,628

56

379

536

46,814

419

210

860

164

104

80

936

~408

1,840

1,645

1,033

1,687

1,729

806

492

475

860

1,082

263

120

163

142

71

2,879

1,650

702

1,467

942

1,059

472

1,241

656

657

1,210

633

979

717

3,359

893

574

250

205

320

455

282

89

100

5,454

179

559

912

0.79

0.62

0.54

0.45

0.59

0.63

0.86

0.46

1.00

0.75

0.82

0.67

0.64

o.6a

0.64

0.46

0.61

0.57

0.60

0.57

0.39

0.42

0.42

4.73

0.64

0.78

1.08

0.81

0.67

0.83

0.54

0.73

0.75

0.63

O.ea

0.74

1.07

O.&

1.04

0.78

0.74

0.66

0.74

0.38

0.56

0.6s

0.91

1.06

0.38

0.31

0.66

0.58

36,317

287

123

307

63

55

62

426

2,515

1,302

1,574

722

1,498

1,234

491

241

344

351

942

169

45

75

63

344

2,323

1,377

708

1,265

619

884

282

926

605

614

1,003

433

1,101

503

3,727

636

428

145

144

333

286

214

65

86

5,064

57

367

550

43,536

33s

196

614

163

93

91

857

2,226

1,723

1,687

1,047

1,513

1,656

823

503

440

586

1,023

3m

93

146

106

66

2,517

1,466

706

1,407

897

96s

431

1,225

621

812

1,161

639

669

660

3,228

814

566

252

181

272

431

269

111

102

5,0a9

140

500

766

0.88

0.86

0.63

0.50

0.54

0.59

0.90

0.50

1.13

0.76

0.94

0.69

0.99

0.78

0.60

0.48

0.78

0.59

0.92

0.56

0.46

0.51

0.50

5.21

0.92

0.94

1.00

0.80

0.68

1.02

0.68

0.76

0.74

0.76

0.66

0.76

1.27

0.74

1.15

0.66

0.73

0.66

0.60

1.22

0.67

0.60

0.77

0.96

1.01

0.41

0.73

0.72
6 Advance Data No. 242 ● January 27, 1994

Table 2. Firearm and motor vehicle deaths by race, ethnicity, and Stat& United States, 1990-91

Asian and Pacific

Non-Hispanic white Hispanic

American In&an/

Black islander Alaskan native

Motor Motor Motor Motor Motor

State Firearm vehicle Firearm vehicle Firearm vehicle firearm vehicle Firearm vehicle

Unled States’ . . . . . . . .

New England:

Connecticut? . . . . .

Maine . . . . . . . . . . . .

Massachusetts. . . . . . .

New Hampshire . .

Rhode Island. . . . . . . .

Vermont . . . . . . . . . . .

Middle Atlantic

New Jersey . . . . . . . . .

New York . . . . . . . . . .

Pennsylvania. . . . . . . .

East North Central:

Illinois . . . . . . . . . . . .

Indiana . . . . . . . . . . . .

Michigan. . . . . . . . . . .

Ohio . . . . . . . . . . . . .

WScOnsin . . . . . . . . . .

Wesf North Centrsk

Iowa . . . . . . . . . . . . .

tQmsas . . . . . . . . . . .

Minnesota . . . . . . . . . .

Missouri . . . . . . . . . . .

Nebraska . . . . . . . . . .

North Dakota... . . . . .

South Dakota . . . . . . . .

South Atlantic:

Delaware . . . . . . . . . .

Dietrict of Columbia. . .

Florida . . . . . . . . . . . .

Georgia . . . . . . . . . . .

Maryland . . . . . . . . . .

North Carolina. . . . . . .

South Carolina. . . . . .

Virginia . . . . . . . . . . .

West Virginia . . . . . . .

East South Central:

Alabama . . . . . . . . . . .

Kentucky . . . . . . . . . .

Mississippi . . . . . .

Tennessee . . . . . . . . .

West South Central:

Arkansas . . . . . . . . . .

Louisianaz. . . . . . . . . .

Oklahoma . . . . . . . . . .

Texas . . . . . . . . . . . .

Mountain:

Arizona . . . . . . . . . . .

Colorado . . . . . . . . . .

Idaho. . . . . . . . . . . . .

Montana . . . . . . . . . . .

Nevada . . . . . . . . . . .

New Mexico . . . . . . . .

Utah . . . . . . . . . . . . .

Wyoming . . . . . . . . . .

Pacific

Alaska . . . . . . . . . . . .

California . . . . . . . . . .

Hawaii . . . . . . . . . . . .

Oregon . . . . . . . . . . .

Washington . . . . . . . . .

41,413

175

220

393

. . .

83

136

471

. . .

1,850

1,289

1,127

1,501

1,767

776

432

494

635

1,210

277

86

118

82

14

3,009

1,565

632

1,577

802

1,258

517

1,136

1,131

652

1,379

673

514

. . .

3,622

gel

671

294

265

470

265

374

164

118

4,573

40

685

900

61,730

270

372

1,109

. . .

173

164

1,303

..-

3,215

2,737

1,965

2,657

3,021

1,536

952

776

1,162

1,874

544

175

230

209

18

3,901

2,255

1,005

2,112

1,215

1,520

676

1,649

1,585

1,025

2,011

1,041

597

..-

3,950

1,019

664

445

307

446

296

460

175

138

5,741

93

926

1.372

6,664

37

50

. . .

16

112

---

101

291

29

46

24

26

4

27

5

22

10

1

1

16

507

29

25

30

10

28

4

12

4

4

2

9

. . .

1,667

225

118

12

3

45

212

25

7

7

2,797

14

20

46

7,863

13

2

52

. . .

10

1

164

. . .

64

214

32

69

30

15

14

26

21

29

16

1

1

8

9

653

71

26

44

11

50

4

16

5

4

16

11

18

. . .

1,666

337

202

40

4

78

364

41

13

4

3,105

30

60

135

21,200

123

1

158

2

15

274

2,050

722

1,476

286

1,321

664

193

21

96

60

567

36

2

27

653

1,243

1,026

777

791

435

643

26

684

103

497

573

266

1,093

126

1,806

86

54

2

71

19

2

2

3

1,392

4

28

65

10,765

61

2

77

3

11

1

285

651

247

491

116

378

296

43

16

45

11

170

12

1

31

107

766

751

339

640

606

411

17

563

71

611

318

196

526

84

800

36

37

1

1

32

13

4

2

6

762

8

7

54

960

5

16

3

1

18

72

19

16

3

6

6

6

7

6

4

4

1

2

16

21

16

7

2

17

4

1

4

3

3

9

2

86

17

2

8

4

5

1

3

430

64

6

26

1,702

4

2

20

2

46

100

31

50

5

40

21

12

8

11

21

11

1

2

1

38

27

33

10

9

20

5

4

6

5

10

2

12

4

70

12

13

2

3

12

6

12

6

706

206

18

61

530

1

2

1

1

3

1

3

13

3

5

2

3

21

3

3

3

22

7

3

3

34

1

1

2

1

3

1

2

45

7

76

7

4

22

16

46

6

1

72

42

1

8

27

1,343

1

4

3

2

1

21

3

5

5

27

4

23

2

10

42

7

5

37

76

21

1

2

60

3

3

1

6

5

3

5

106

6

304

11

14

70

15

187

24

19

47

63

26

61

‘Data for nor+ispsnic whte and Hispanic totals do not include the nonreporting states (New Harnpshirsof Oklahoma) or NewYork.

2DataareforlS91 oniy
Advance Data No. 242 ● January 27, 1994 7

Table 3. Firearm and motor vehicle death rates, number of deaths, and ratio of firearm to motor vehicle deaths, for persons 15-34 yeare

of age by State: United States, 1990-91

Deathsper l~,(WO population Dasftrs

Motor

State

Motor

firearm vehicle I%BErrn vahicfe Ratio

United States . . . . . . . . . . . . . . . . . . . . . . . .

New En-gland

OOnnacticut. . . . . . . . . . . . . . . . . . . . . . . .

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . .

Massachusetts . . . . . . . . . . . . . . . . . . . . . .

NewHampshire . . . . . . . . . . . . . . . . . . . . .

RhodeIsland . . . . . . . . . . . . . . . . . . . . . . .

Vermont.. . . . . . . . . . . . . . . . . . . . . . . . .

Middle Aflanticx

NewJersey . . . . . . . . . . . . . . . . . . . . . . . .

NewYork . . . . . . . . . . . . . . . . . . . . . . . . .

Pennsylvania . . . . . . . . . . . . . . . . . . . . . . .

EastNorthCentral:

Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indiana. . . . . . . . . . . . . . . . . . . . . . . . . . .

Michigan. . . . . . . . . . . . . . . . . . . . . . . . . .

Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wismrrsin . . . . . . . . . . . . . . . . . . . . . . . . .

West North Oenfral:

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . .

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . .

Missouri . . . . . . . . . . . . . . . . . . . . . . . . .

Nebraska . . . . . . . . . . . . . . . . . . . . . . . . .

North Dakota . . . . . . . . . . . . . . . . . . . . . . .

South Dakota. . . . . . . . . . . . . . . . . . . . . . .

South Atlantic

Delaware . . . . . . . . . . . . . . . . . . . . . . . . .

DiatriotofOolumbia . . . . . . . . . . . . . . . . . . .

Florida . . . . . . . . . . . . . . . . . . . . . . . . . . .

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . .

Maryland . . . . . . . . . . . . . . . . . . . . . . . . .

NorthOamlina . . . . . . . . . . . . . . . . . . . . . .

SouthOaroline . . . . . . . . . . . . . . . . . . . . . .

Virginia . . . . . . . . . . . . . . . . . . . . . . . . . .

WestVirginia . . . . . . . . . . . . . . . . . . . . . . .

EastSouth Central

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . .

Kentucky . . . . . . . . . . . . . . . . . . . . . . . . .

Mk3siasippi .. . . . . . . . . . . . . . . . . . . . . . .

Tennessee . . . . . . . . . . . . . . . . . . . . . . . .

WestSouthOentral:

.Mranaas. . . . . . . . . . . . . . . . . . . . . . . . .

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . .

Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . .

Texas . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mountain

Arizona. . . . . . . . . . . . . . . . . . . . . . . . . .

Colorado . . . . . . . . . . . . . . . . . . . . . . . . .

Idaho. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Montana . . . . . . . . . . . . . . . . . . . . . . . . . .

Nevada . . . . . . . . . . . . . . . . . . . . . . . . . .

New Mexico . . . . . . . . . . . . . . . . . . . . . . .

Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wyoming . . . . . . . . . . . . . . . . . . . . . . . . .

Pacific:

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . .

OaIiiomia . . . . . . . . . . . . . . . . . . . . . . . . .

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oregon . . . . . . . . . . . . . . . . . . . . . . . . . .

Washington . . . . . . . . . . . . . . . . . . . . . . . .

24.4

15.3

14.2

8.3

11.6

9.5

15.4

9.6

26.1

18.8

25.5

20.1

26.9

16.7

17.1

11.0

19.4

12.1

28.1

14.7

9.7

16.0

11.6

119.8

27.2

29.1

27.A

26.9

26.3

23.4

22.6

33.1

22.0

34.9

30.3

32.5

45.4

21.9

33.2

27.2

17.1

18.8

24.4

33.8

26.6

16.7

28.4

32.8

27.6

8.2

17.1

15.2

27.3

20.1

27.3

15.9

23.1

14.6

28.3

15.3

17.4

23.4

22.5

28.4

24.6

24.7

25.5

29.9

29.6

22.3

34.2

27.9

26.0

32.4

24.3

14.0

30.8

33.2

22.4

31.6

40.4

24.3

44.2

44.2

36.9

49.3

36.9

43.7

36.0

33.0

29.3

32.5

26.8

36.3

40.8

37.2

49.2

22.8

40.7

26.4

25.9

21.9

30.3

27.6

36,911

315

107

330

83

62

55

461

3,223

1,339

1,665

708

1,593

1,127

521

180

286

334

679

140

36

66

51

522

2,05s

1,281

661

1,179

me

977

237

644

514

572

938

455

1,233

423

3,607

&39

369

114

111

267

273

192

81

126

5,643

60

267

467

43,534

415

206

633

165

95

105

73a

2,WI

1,672

1,643

1,032

1,456

1,664

778

491

451

619

1,072

286

102

134

107

61

2,328

1,459

704

1,364

933

1,015

463

1,126

663

607

1,143

812

978

637

3,367

763

578

220

166

294

470

262

112

109

5,296

180

!%)6

648

0.68

0.76

0.52

0.52

0.50

0.65

0.53

0.63

1.61

0.60

1.13

0.66

1.02

0.66

0.67

0.37

0.66

0.54

0.62

0.53

0.37

0.49

0.48

8.56

0.66

0.86

1.22

0.65

0.65

0.96

0.51

0.75

0.60

0.71

0.62

0.74

1.26

0.66

1.13

0.64

0.64

0.52

0.60

0.91

0.56

0.73

0.72

1.15

1.07

0.37

0.56

0.55
8 Advance Data No. 242 ● January 27,1994

Table 4. Death rates due to firearm and motor vehicle injuries among persons 15-34 yeara of age by race, ethnlclty, and Statw Llnited

States, 1990-81

Asian and Paciric American Indian/

Non-Hispanic white Hispanic Black Islander Alaskan native

Motor Motor Motor Motor Motor

State Fireann vehicle Firearm vehicle t%eann vehicle Fireamr vehicle firearm vehiole

United States’ . . . . .

New England:

Connecticutz. . . . . . . .

Maine . . . . . . . . . . . .

Massachusetts. . . . . . .

New Hampshire. . . .

Rhode Island. . . . . . . .

Vermont . . . . . . . . . . .

Middle Atlantic

New Jersey . . . . . . . . .

New York . . . . . . . . . .

Pennsylvania. . . . . . . .

East North Central:

Illinois . . . . . . . . . . . .

Indiana . . . . . . . . . . . .

Michigan, . . . . . . . . . .

Ohio . . . . . . . . . . . . .

Wisconsin . . . . . . . . . .

West North CentraL

Iowa . . . . . . . . . . . . .

Kansas . . . . . . . . . . .

Minnesota . . . . . . . . . .

Missouri . . . . . . . . . . .

Nebraska . . . . . . . . . .

North Dakota . . . . . . . .

South Dakota... . . . . .

SouthAtlantic

Delaware . . . . . . . . . .

Districtof Columbia. . . .

Florida . . . . . . . . . . . .

Georgia . . . . . . . . . . .

Maryland . . . . . . . . . .

North Carolina. . . . . . .

South Carolina. . . . . .

Virginia . . . . . . . . . . .

WestVirginia. . . . . . . .

East South Centrah

Alabama . . . . . . . . . . .

Kentucky . . . . . . . . . .

Mississippi. . . . . . . . .

Tennessee . . . . . . . . .

WestSouthCentral:

Arkansas . . . . . . . . . .

Louisianaz. . . . . . . . .

Oklahoma . . . . . . . . . .

Texas . . . . . . . . . . . .

Mountain:

Arizona . . . . . . . . . . .

Colorado . . . . . . . . . .

Idaho . . . . . . . . . . . . .

Montana . . . . . . . . . . .

Nevada . . . . . . . . . . .

New Mexico . . . . . . . .

Utah . . . . . . . . . . . . .

Wyoming . . . . . . . . . .

15.2

10.0

13.9

4.6

. . .

*5. 1

15.2

5.2

. . .

11.8

9.8

16.0

12.2

11.8

12.4

10.1

15.5

10.5

16.8

12.1

%3

13.8

●8.9

*

18.8

19.5

11.8

t 9.6

20.6

15.5

21.3

21.2

21.7

23.9

21.3

24.5

24.6

..-

21.1

23.8

14.9

19.5

23.2

27.5

22.6

15.9

32.1

28.4

17.8

25.9

15.8

. . .

14.2

27.2

14.8

. . .

24.4

24.8

30.8

25.3

25.9

26.7

30.2

26.6

22.1

36.4

28.6

21.4

24.5

27.5

*

32.4

35.7

25.3

32.4

39.9

25.9

44.9

47.1

38.8

50.8

39.1

44.8

37.4

. . .

30.2

26.7

25.3

35.5

33.7

36.3

29.8

20.8

3S.6

29.6

%3.0

*

*1 4.6

---

*

●

12.3

---

42.7

29.3

*

*1 9.8

*

%?S.1

*

●

*

*

●

●

*

*

*

20.6

%?0.2

*

%3.7

*

*

*

*

*

*

*

*

*

---

33.6

29.4

24.6

*

*

*26.7

33.1

*

●

28.7

*

*

*I 4.2

-..

*

*

14.9

. . .

%?0.5

17.5

*

?7.8

*

*

●

*

*

*

●

●

*

*

*

27.2

50.0

*

%36.4

*

?23.5

*

*

*

*

*

●

*

. . .

28.5

33.5

35.8

*

●

*43.O

51.8

%3.3

*

Deaths per t 00,000 population

70.7

48.0

*

50.6

*

*

*

26.7

75.6

71.1

94.2

64.9

107.4

58.5

85.1

*

64.4

*56.6

109.1

*61 .9

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*

*24.4

191.7

70.5

51.7

67.9

47.8

38.7

56.1

*55.3

64.2

26.6

52.5

72.1

68.8

89.5

50.3

84.9

66.6

%5.5

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85.1

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*

23.0

*15.7

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*1 5.0

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17.5

12.6

16.1

17.1

17.7

18.7

17.6

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%?8.0

*

20.6

*

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*

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*1 7.9

26.5

26.9

17.6

27.9

42.7

t 9.7

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36.8

*18.1

46.2

27.8

36.9

28.5

%22.6

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35.0

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103.0

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*1 32.7

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124.7

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*
Advance Data No. 242 ● Januarv 27.1994

Table 4. Death rates due to firearm and motor vehicle injuries among persons 15-34 yeara of age by race, ethnicity, and Stabx United

States, 199(H1-Con.

Aaianand P& AmarioW \rrdi@

Non-Hispanic white Hispanic Blaok Islander Alaskan natiw

Motor Motor Motor

State

Motor Motor

firearm vehicle Erearrn vehicle firearm vehicfa I%eEmn vahide I%earrn vehicle

Pacific

Alaska . . . . . . . . . . . . 19.4 26.6 * * ● * * *

IQO.6 ●4I .9

Caliiomia . . . . . . . . . . 15.5 25.6 33.5 29.5 69.7 21.4 13.5 14.2 *1 4.6 *1 5.6

Hawaii . . . . . . . . . . . .

*

21.2 * * ● * %.6 22.3 ● *

Oregon . . . . . . . . . . . 16.4 26.5 *

67.0 *64.8 * * * ● *

Washington . . . . . . . . . 12.9 25.8 %21.1 49.6 51.1 %30.2 * V4.7 ● %6.1

‘Data fer non-Hi.sw”cwhiie and Hispsn”ctotalsda netincludethe nonrep”ng Slates (NewHampshirew Oklaherm)of NewYork.

2Dataarefor1991 rely.

Notsx Rstes shownif bssadon at leest20 deaths.

Ratesare ssterisksd~ Man they am basedonfewerthen50 deaths.
10 Advance Data No. 242 ● January 27, 1994

Technical notes

Mortality

Deaths are based on information

from all death certificates filed in the 50

States and the District of Columbia.

Mortality statistics are based on

information coded by the National

Center for Health Statistics (NCHS)

from copies of the original death

certificates received from the State

registration offices and on State coded

data provided to NCHS through the

Vital Statistics Cooperative Program.

For each year 1980 through 1991,

the numbers of deaths reported by

Alaska have been different from the

numbers reported for Alaska by the

NCHS because NCHS did not receive

changes resulting from Alaska’s

amended vital records. These differences

have been larger for external than for

natural causes of death. Alaska reported

221 deaths among residents from

firearms and 238 deaths from motor

vehicles for 1990-91.

Residence versus occurrence

Firearm and motor vehicle deaths

were classified by State of residence of

the decedent. Classifying death rates by

State (or county) of residence is the

usual practice in mortality reporting

because population counts (the

denominators of the death rates) are

based on place of residence. (County of

occurrence of death is also coded from

the death certificate and is available for

analysis from data tapes.) For deaths

caused by injuries, residence may not be

the most meaningful method of

classification. For injury prevention

activities, it is more useful to know

where the injury event occurred rather

than where the victim resided or where

the death occurred, National vital

statistics data are not coded to identify

the location of where the event occurred

(e.g., the motor vehicle crash site or the

street comer where the firearm was

discharged) but rather where the death

occurred (e.g., location of hospital). It is

known, however, that for 94 percent of

all injury fatalities, the State of

residence and occurrence were the same.

Differences between the State of

occurrence of the death and the State of

residence are less frequent for firearm

fatalities than for motor vehicle crashes.

In 1991, 96 percent of firearm fatality

victims died in their State of residence

compared with 90 percent of motor

vehicle crash victims.

Cause-of-death classification

Cause of death was coded in

accordance with the Ninth Revision of

the International Classification of

Diseases (9). Firearm deaths include

external cause codes: E922

(unintentional firearm injury), E965.0-

E965.4, E970 @rearm homicide),

E955.O-E955.4 (firearm suicide), and

E985.O-E985.4 (firearm deaths for

which the intent was unknown). Motor

vehicle deaths include external cause

codes E81O-E825.

Population

Population counts for 1990 are

based on the April 1990 enumeration

and 1991 counts are postcensal

population estimates (10).

Random variation

Although the mortality data in this

report are not subject to sampling error,

they may be affected by random

variation in the number of deaths

involved. When the number of events is

small (perhaps less than 100) and the

probability of such an event is small,

considerable caution must be observed

in interpreting the data. Such infrequent

events may be assumed to follow a

Poisson probability distribution. For this

distribution, a simple approximation

may be used to estimate the confidence

interval, as follows:

If N is the number of registered

deaths in the population and R is the

corresponding rate, the chances are 19

in 20 (approximate 95-percent

confidence interval) that

L N-2rN and N+2 CN

covers the “true” number of events.

2“‘-2&‘d ‘+2%

covers the “true” rate.

If the rate RI corresponding to NI

events is compared with the rate R2

corresponding to N2 events, the

difference between the two rates may be

regarded as statistically significant if it

exceeds

Additional information on random

variation may be found in the ‘Technical

Appendix of T4tal Statistics of the

United States, 1989, Volume Il.,

Mortality, Part A.

Rates of change

Annual rates of change are

represented by the slope of a least

squares regression line through the

logarithm of the annual rates.
Number 243 ● February 23, 1994

Advance

Data

FromVI and HealthStatisticsofthe CENTERS FOR DISEASE CONTROLAND PREVENTION/National Centerfor HealthStatistics

AIDS Knowledge and Attitudes for 1992

Data From the National Health Interview Survey

by Charlotte A. Schoenborn, M. P.H., Shannon L. Marsh, and Ann M. Hardy, Dr.P.H.,

Division of Health Interview Statistics

Highlights

In 1992, levels of knowledge about

the major modes of human

immunodeficiency (HIV) transmission

remained high in all sociodemographic

groups examined. Knowledge about

other aspects of acquired

immunodeficiency syndrome (AIDS)

was more variable with older and less

educated adults generally being less

knowledgeable. Changes in knowledge

between 1991 and 1992 included

●

●

●

●

An increase horn 86 to 95 percent in

the proportion who had heard the

AIDS virus referred to as “HIV”

An increase from 15 to 22 percent in

the proportion of young adults (18-29

years of age) who planned to be

tested in the next year

An increase from 13 to 17 percent in

the proportion of adults who had a

coworker, relative, or friend with

AIDs

An increase from 69 to 75 percent in

the proportion of parents of 10-17-

year-olds who had ever discussed

AIDS with their children

Introduction

The National Center for Health

Statistics (NCHS) has included

questions about HIV and AIDS as part

of the National Health Interview Survey

(IWHS) since 1987. The purpose of

these questions is to provide populationbased data on aduIts’ knowledge about

AIDS and transmission of HIV and on

their experience with HIV antibody

testing. Such information is used to help

plan and monitor various educational

and prevention programs. The

questionnaire used in 1991 and 1992 is

the fourth version of this survey. While

new questions have been introduced in

each version to meet changing data

needs, many questions have been used

repeatedly to allow for examination of

trends. NCHS has routinely published

results from this survey in the Advance

Data From Wal and Health Statistics

series (1–8). In addition, public use data

tapes of the 1987-92 surveys are

currently available and more detailed

exploration of the data is encouraged,

The NHIS AIDS questiomaires

have been developed by NCHS and an

Interagency Task Force created by the

Public Health Service Health Data

Policy Committee. The Task Force

includes representatives from other

centers within the Centers for Disease

Control and Prevention and from the

Office of the Assistant Secretary for

Health, the NationaI AIDS Program

Office, the National Institutes of Health,

the Food and Drug Administration, the

Office of Population Affairs, the Indian

Health Service, the Agency for Health

Care Policy and Research, and the

Health Resources and Services

Administration.

Data and methods

This report presents data from the

1992 National Health Interview Survey

of Aids Knowledge and Attitudes. The

1992 questionnaire was identical to the

1991 NWS on AIDS. Thus, trend

comparisons between 1991 and 1992

can be readily made. Caution should be

exercised when comparing these data

with data from earlier years due to

changes in question wording, placemen~

and skip patterns in the 1991-92

questionnaire. A discussion of issues

related to such trend comparisons may

be found in the annual report of 1991

findings (8). Details about the sample

design and the estimation procedures

can be found in the Technical notes at

the end of this report.

# SWG*.O

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U.S. DEPARTMENTOF HEALTHAND HUMANSERVICES

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Centers for Disease Control and Prevention

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2 Advance Data No. 243 ● February 23, 1994

Table 1 shows percent distributions

by response categories to most of the

items included in the 1992 NHIS AIDS

questionnaire for the total adult

population, ages 18 years and over, as

well as various subgroups defined by

age, sex, race and ethnicity, and

education. In most cases, the actual

questions asked are reproduced verbatim

in the tables along with the response

categories. Refusals and other

nonresponse categories (generally less

than 1 percent of total responses) are

excluded from the denominator in the

calculation of estimates, but responses

of “don’t know” are included. The

NHIS AIDS survey uses the phrase “the

AIDS virus” rather than “HIV” because

it is felt to be more widely recognized

however, in this report the two terms are

used synonymously.

Selected findings

Sources of information

In 1992, 87 percent of adults stated

that they had received information about

AIDS in the past month. Of all sources

listed, television programs (75 percent),

newspaper articles (52 percent),

magazine articles (44 percent), and radio

programs (38 percent) comprised the

primary sources of information. Each of

these represent modest increases over

1991 estimates.

When specifically asked about

exposure in the previous month to

public service announcements (PSA’S),

84 percent reported viewing them on

television, 49 percent hearing them on

radio, and 10 percent seeing public

service posters in airports. Generally

speaking, persons under age 50 and

those with more than 12 years of

education appeared to have had more

exposure to PSA’S than had their

counterparts.

Of the parents of 10-17-year-olds,

75 percent reported ever discussing

AIDS with them, up from 69 percent in

1991. Overall, white (77 percent) and

black (75 percent) parents were more

likely to talk to their children than

Hispanic parents (67 percent). Women

were much more likely than men to

have discussed the topic with their

children (84 percent versus 64 percent),

and parents 3049 years old were more

likely to have done so than both

younger and older parents. The percent

of parents discussing AIDS with their

children increased with years of

education, from 64 percent for those

with less than 12 years of education to

79 percent for those with more than 12

years of education. Seventy-six percent

of parents reported that their children

received instruction on AIDS at school.

General AIDS knowledge

In 1992, of the adults asked to

assess their knowledge of AIDS,

26 percent stated they knew “a lot”

while 45 percent stated they knew

“some.” About 28 percent of adults said

they knew “little” (21 percent) or

“nothing” (7 percent) about AIDS.

Marked educational differences were

noted: 46 percent of adults with less

than 12 years of education felt they

knew at least “some” about AIDS

compared with 85 percent of those with

more than 12 years of education.

Concerning the three main modes of

transmission, the level of AIDS

knowledge was high in 1992—as it had

been the previous year. Ninety-six

percent of adults knew that the AIDS

virus can be transmitted through sexual

intercourse, 94 percent knew that it can

pass from a pregnant woman to her

baby, and 96 percent said it was “very

likely” that a person can get the AIDS

virus from sharing needles with an

infected person. Knowledge was lowest

for items related to the effects and

treatment associated with AIDS

infection. Fifty-four percent knew that

AIDS can damage the brain, 71 percent

knew that certain drugs can lengthen the

life of an infected person, and

60 percent knew that early treatment of

the disease reduces symptoms. Between

20 and 30 percent of respondenta did not

know the correct responses to these

questions. Overall, minority persons,

persons with less than 12 years of

education, and those 50 years of age and

older were less likely to respond

correctly to the general AIDS

knowledge questions.

The most striking difference in

general AIDS awareness between 1991

and 1992 was a 9 percentage point

increase, from 86 percent to 95 percent,

in adults who heard the AIDS virus

referred to as “HIV.” Also in 1992, a

greater proportion of adults understood

that AIDS was an infectious disease

caused by a virus (85 percent versus

81 percent in 1991), a person can be

infected with HIV and yet not have

AIDS (84 percent versus 78 percent), an

infected person can look and feel

healthy (86 percent versus 80 percent),

drugs can len~hen the life of an

infected person (71 percent versus

67 percent), and early treatment of the

disease can reduce symptoms

(60 percent versus 56 percent). There

was little change noted in the

proportions of correct responses for

other items, such as: there is no cure

(93 percent versus 92 percent) and there

is no vaccine available (83 percent

versus 82 percent).

Misperceptions about HIV

transmission

Respondents were asked tc) evaluate

the likelihood that HIV transmission

could occur with various forms of

casual contact, for example, worlcing

near an infected person. Since 1991, the

NHIS has used a revised response

format with six response categories

ranging from “very likely” to

“definitely not possible” and “’don’t

know.” There was little change between

1991 and 1992 in the estimates for

misperceptions. The most notable

difference was a 3-point increalse in the

percent of respondents who felk it was

very unlikely that someone could

become infected with HIV by attending

school with an HIV-infected clhild or

working near someone who is infected

with HIV (44 percent in 1992 compared

with 41 percent a year earlier), In both

items there was a corresponding

decrease in the estimate for those who

felt transmission was “definitely not

possible,” suggesting that there might

have been a shift between these two

response categories. The proportion of

adults who felt contracting AIDS

through being cared for by an infected

health care worker was “very likely”

remained relatively unchangeci between

1991 (27 percent) and 1992 (2!6percent)

while the proportions who said it was
Advance Data No. 243 ● February23, 1994 3

“somewhat likely” (36 percent) or

“somewhat unlikely” (15 percent) in

1992 were slightly higher than in 1991

(33 percent and 13 perceng

respectively).

The 1992 NHIS revealed little

difference between males and females

regarding misperceptions about

transmission. Overall, white persons,

adults under 50 years of age, and

persons with more than 12 years of

education were more likely to believe

that HIV transmission through casual

contact was “very unlikely” or

“definitely not possible.” The modes of

casual contact with the lowest

percentage of respondents believing that

HIV transmission was “very likely” or

“somewhat liiely” were working near

someone (7 percent) and attending

school with someone who is infected

with HIV (7 percent). The mode of

transmission that was most likely to be

perceived incorrectly as “very likely” or

“somewhat likely” was being cared for

by an infected health care worker

(62 percent). Regarding all other modes

of casual contact, between 17 and

27 percent of adults believed HIV

transmission was “very likely” or

“somewhat likely.”

Blooddonationand blood

screening

Patterns of past blood donation

remained unchanged compared with

earlier years. In 1992, 19 percent of

adults reported having donated blood

since March 1985 (when routine

screening of donated blood for HIV

began), and 6 percent had donated in the

past year. As was found in previous

years, the proportion of adults reporting

blood donations increased steadily with

years of education: only 2 percent of

persons with less than 12 years of

education had donated blood in the past

12 months compared with 9 percent of

adults with more than 12 years of

education. Similarly striking education

diiTerences were noted for donations

since March 1985:7 percent of non-high

school graduates had donated during this

time period compared with 16 percent of

high school graduates and 27 percent of

adults who had post-high school

education.

In 1992, 62 percent of adults

reported that a person could not get HIV

while giving or donating blood for use

by others, 29 percent felt they could,

and 9 percent of adults did not know.

Misperceptions about transmission of

HIV by donating blood were higher

among black adults (43 percent reporting

AIDS could be transmitted this way

compared with 26 percent of white

adults), and those with less than 12

years of education (39 percent compared

with 23 percent of those with more than

12 years of school). It should be noted

that we cannot distinguish if respondents

believe such transmission is likely or

only a theoretical possl%ility if standard

blood bank practices are not followed.

Also, despite attempts to make this

question clear, some respondents may

still mistakenly believe we are asking

about getting HIV from receiving blood.

Further reilnement of this question may

help clarify the responses being elicited.

Seventy-nine percent of adults

believed that blood donations are

routinely tested for the AIDS virus. Men

and women did not differ in terms of

their knowledge of routine screening of

blood donations, but other

sociodemographic differences were

noted. Knowledge was higher among

adults 18J29 years of age (82 percent)

and 3049 years (84 percent) than

among persons over age 50 (72 percent).

White persons were more

knowledgeable (82 percent) than black

persons or Hispanic persons

(68 percent). Finally, those with more

than 12 years of education were

considerably more knowledgeable about

routine screening (87 percent knew

blood was routinely screened) than

persons with fewer years of education

(62 to 79 percent).

HIVantibodytesting

Considering HIV testing done for

all reasons, including blood donation, in

1992 an estimated 32 percent of adds

in the United States had ever been

tested for antibodies to HIV (data not

shown) compared with 29 percent a year

earlier. All questions related to HIV

testing told the respondent to

speci.iically exclude testing that was

done as part of blood donations. Thus,

the following discussion is limited to

testing not done as part of blood

donations.

In 1992, not including blood

donations, about 18 percent of adults

said they had been tested for the AIDS

virus. Testing was more common among

persons in the younger age groups:

27 percent of persons ages 18-29 years

and 22 percent of those 30-49 years had

been tested at least once compared with

8 percent of adults aged 50 years and

over. Of those who had been tested,

about 6 in 10 had been tested only once.

About one-half of those who had been

tested were most recently tested in the

12 months prior to interview (9 percent).

In general, the reasons for having

had their most recent HIV antibody test

did not change dramatically belsveen

1991 and 1992, although the percent of

persons who were tested solely to iind

out if they were infected did increase

slightly (from 25 percent in 1991 to

30 percent in 1992). Another 7 percent

were referred by their doctor, the health

department, or their sex partner for

testing. Twelve percent had been tested

for hospitalization or a surgical

procedure, 16 percent to apply for health

or life insurance, 6 percent for military

induction, and 6 percent for

employment. While immigration was

only mentioned by 4 percent of all

adults tested, it was mentioned by

23 pxent of Hispanic aduIts tested.

Although still quite high, the proportion

of Hispanic persons giving this reason

in 1992 was down noticeably from 1991

when 31 percent of Hispanic adults cited

immigration as a reason for testing. f%

in 1991, most of those in 1992 who

reported testing had their last test at

their doctor or HMO (28 percent), at a

hospital, emergency room, or an

outpatient clinic (24 percent), or at a

community health clinic (8 percent).

Eighty percent of persons who had

been tested for AIDS received the

results of their most recent test. Persons

under 30 years of age were sIightly

more likely than older persons to have

gotten their results. The percent of

persons receiving theh test results

remained unchanged between 1991 and

1992 for persons 18-29 years

(83 percent) and persons 30-49 years

(79 percent), but rose among persons 50
4 Advance Data No. 243 ● February 23, 1994

years and older (78 percent compared

with 72percent in 1991). Black adults

(85 percent) and Hispanic adults

(84 percent) were more likely to have

obtained their results than were white

adults (78 percent). Among those who

received their test results, 58 percent

received them in person, 17 percent

received them by telephone, and

16 percent were notified in the mail. In

1992, almost all adults tested said they

felt their results were accurate

(97 percent) and that their results were

handled properly in terms of

confidentiality (94 percent).

The proportion who indicated that

they plan to be tested in the next year

was 11 percent, up from 9 percent in

1991. The largest increase in the

proportion who planned to be tested was

seen among persons 18-29 years of age

(22 percent compared with 15 percent in

1991) and among black persons

(26 percent compared with 21 percent a

year earlier). Of those who planned to

be tested, 72 percent said one reason

that they would be tested was that they

“wanted to know if they were infected,”

compared with 67 percent in 1991.

Black adults (82 percent) were much

more likely than white adults

(65 percent) to give this answer. Other

reasons cited for testing expected in the

next year were blood donation

(17 percent), application for a job

(7 percent), and application for life or

health insurance (9 percent).

In 1992, the NHIS asked those

adults who had not been tested for HIV

why they had not done so. The most

common response, given by 81 percent

of those never tested, was that they did

not consider themselves to be at risk for

AIDS. Very few respondents (less than

2 percent) chose as reasons for not

having been tested any of the

recognized barriers to testing such as

fear of discrimination, not knowing

where to go for testing, and not trusting

the medical community to keep results

confidential. The remainder listed fear of

needles (1 percent), another unspecified

reason (9 percent), or said they did not

know why they had not been tested

(9 percent). There were no meaningful

changes between 1991 and 1992.

In 1992, 79 percent of adults

recognized that after one is infected

with HIV there is a period of time

before the blood test shows the

infection. Only 2 percent did not believe

this to be true and another 18 percent

responded “don’t know.” In 1991,

74 percent knew about this latent period.

Knowledge levels increased across all

sociodemographic groups, but persons

with less than 12 years of education

(63 percent), Hispanic adults

(70 percent), and those 50 years and

over (70 percent) remained the least

likely to be aware of the fact that HIV

infection does not show in blood tests

immediately.

Awareness about zidovudine

The drug zidovudine (AZT), also

known as Retrovir, was the first

approved antiviral drug used for the

treatment of HIV. Awareness of AZT

increased from 51 percent in 1991 to

58 percent in 1992. Awareness was

highest among persons between the ages

of 30-49 (68 percent) compared with

younger and older persons. Sharp

educational differences were found.

Only 30 percent of adults with less than

12 yeara of education had heard of AZT

compared with about three-fourths of

those with more than 12 years. Of the

race-ethnic groups shown, knowledge

was markedly lower among Hispanic

adults (36 percent) compared with black

adults (52 percent) and white adults

(62 percent). Although significant

sociodemographic differentials persist,

knowledge levels increased in all

subgroups between 1991 and 1992.

Of the adults who had heard of

AZT, 83 percent knew that it can delay

or slow down the symptoms of HIV

infection, 92 percent were aware that

AZT does not cure people with AIDS,

61 percent knew that the drug has side

effects, and 35 percent knew AZT is

only appropriate for an HIV-infected

individual at certain times during the

illness. Ftity-five percent of the adults

surveyed knew there are other drugs

available to treat AIDS-related illnesses,

up from 50 percent in 1991. Thirty-two

percent answered “don’t know” and

12 percent said they did not believe

other drugs exist. Knowledge of AZT,

like most other AIDS-related knowledge,

was lowest among less educated adults

and persons 50 years or older. Men and

women generally did not diiler in their

knowledge of XZT but they did differ in

terms of their knowledge of the

existence of drugs other than AZT for

treatment of AIDS-related illnesses.

Fifty-nine percent of the men knew such

drugs existed compared with 52 percent

of the women. The pattern of

sociodemographic variations did not

change between 1991 and 1991!.

Perceptions about condoms

The NHIS surveyed respondents

about their knowledge of condoms. The

survey questions included the perceived

efficacy of condoms in preventing

sexual transmission of ~, the relative

efficacy of latex versus naturalmembrane condoms, and the effect of

oil-based lubricants on condoms. In

1992, about 8 out of 10 adults believed

that condoms were either “very

effective” (26 percent) or “somewhat

effective” (54 percent) in preventing

sexual transmission of HIV Males were

more likely than females to believe that

condom use is “very effective’”

(30 percent versus 22 percent). Not

surprisingly, the percent of adults who

responded “very effective” increased

with education and decreased ‘with age.

The 1992 NHIS also contained two

questions intended to measure

understanding of correct condom use.

The items asked the relative eflicacy of

latex and natural-membrane condoms

and if oil-based lubricants cause

condoms to break. Despite a high

percent of adults (80 percent) who

considered condom use to be at least

somewhat effective in preventing HIV

transmission, only 27 percent knew that

there was a difference in efficacy

between latex and mtural-membrane

condoms. A strikin@y high percent of

adults (55 percent) said they clid not

know if latex and natural-membrane

condoms were equally effective and

16 percent believed there was no

difference.

One-third of adults correctly

responded that oil-based lubricants may

destroy the effectiveness of condoms

while 60 percent did not know the effect

of oil-based lubricants. Five percent

believed there was no harmful effect.

White and black adults were more likely
Advance Data No. 243 ● February 23, 1994 5

to respond correctly (34 percent) than

were Hispanic adults (28 percent).

Younger adults and persons with more

than 12 years of education were twice

as likely to understand the damaging

effect of oil-based lubricants (44 percent

and 42 percent, respectively) as were

persons 50 years and older (19 percent)

or those with less than 12 years of

education (21 percent). The latter groups

were most likely to respond “don’t

know” (74 percent and 70 percent,

respectively) of all population subgroups

shown. Finally, men were somewhat

more lmowledgeable than women with

36 percent responding that oil-based

lubricants destroyed condom

effectiveness, compared with 30 percent

of womeq women were more likely to

say they didn’t know (63 percent

compared with 56 percent of men.)

Risk of HIV infection

The percent of adults who felt there

was no chance they currently had AIDS

virus declined from 80 percent to

73 percent between 1991 and 1992. The

percent who felt they had no chance of

contracting HIV in the future also

declined, from 72 percent in 1991 to

64 percent a year later. The 7 to

8 percent difference between 1991 and

1992 appears to have shifted from those

who feel they have no chance to those

who feel they have a low chance. The

percent of adults who felt they had no

chance of having or getting the virus

increased with age. About one-half of

persons under age 30 years felt they had

no chance of getting AIDS compared

with three-fourths of those 50 years and

older. Perception of personal risk

increased with level of educatiom,

72 percent of persons with less than 12

years of education felt they had no

chance of getting the virus compared

with 57 percent of persons with more

than 12 years of education. Finally,

women (67 percent) were more likely

than men (62 percent) to report that they

were not at any risk of getting the AIDS

virus.

Overall, 2 percent of adults reported

a “high” or “medium” chance of

currently having AIDS. Persons under

age 30 years, bIack persons, and

Hispanic persons were the most likely to

believe that they might have been

intected (4 percent each). In terms of the

chances for future infection, 4 percent of

respondents reported a “high” or

“medium” chance of becoming infected.

Againj younger adults, black persons,

and Hispanic persons were the most

likely to feel they had at least a

“medium” chance of getting AIDS in

the future.

In 1992, 4 percent of adults reported

participating in one or more high risk

behaviors associated with HIV infection.

This percentage does not vary

significantly from past years. The only

significant difference between

sociodemographic groups can be found

in individuals 50 years of age and older.

Only 1 percent of persons in this age

group reported participation in any of

the high risk behaviors compared with 3

to 6 percent of persons in the other

population subgroups.

Knowing someone with AIDS

Since 1991, respondents have been

asked whether they ever had a

coworker, friend, or relative who has

had AIDS or the AIDS virus. In 1992,

5 percent of the respondents reported

having had a coworker with HIV or

AIDS. Adults 3049 years of age and

those with more than 12 years of

education were the most likely of all

groups shown to have had a coworker

with HIV or MIX (8 percent and

9 percent, respectively).

In 1992, excluding coworkers,

12 percent of adults reported having a

friend or relative with HIV or AIDS

compared with 9 percent a year earlier.

Black adults were more Iikely than

white adults to report having a friend or

relative with HIV or AIDS (17 percent

versus 12 percent). Age and educational

differences were also noted. Eight

percent of adults 50 years of age and

older had a friend or relative with HIV

or AIDS compared with 15 percent of

persons 3049 years of age. Similarly,

7 percent of persons with less than 12

years of education had an infected

friend or relative compared with

16 percent of persons with more than 12

years of education.

References

1.

2.

3.

4.

5.

6.

7.

8.

Dawson DA Thomberry OT. AIDS

knowledge and attitudes for

December 198Z Provisional data

from the National Health Interview

Survey. Advamx data from vital and

health statistiG, no 153. HyattsviUe,

Maryland: National Center for Health

Statistics. 1988.

Hardy W Dawson DA. AIDS

knowledge and attitudes for

December 1988 Provisional data

from the National Health Interview

Survey. Advance data from vital and

health statistics; no 175. HyattsvilIe,

Maryland National Center for Health

Statistics. 1989.

Hardy AM. ALDS knowledge and

attitudes for October-December

1989: Provisional data from the

National Health Interview Survey.

Advance data from vital and health

statistiq no 186. Hyattsville,

Maryland: National Center for Health

statistics.1990.

Dawson DA. AIDS knowledge and

attitudes for January-March 1990:

Provisional data tlom the National

Health Interview Survey. Advance

data from vital and heahh statistics;

no 193. Hyattsville, Maryland:

National Center for Health Statistics.

1990.

Fitti JE, Cynamon M. AIDS

knowledge and attitudes for AprilJune 1990: Provisional data from the

National Health Interview Survey.

Advance &ta from vital and health

statistics; no 195. Hyattsville,

Maryland National Center for Health

statistics.1990.

Adams PF, Hardy AM. AIDS

knowledge and attitudes for JLIIySeptember 1990: Provisional data

from the National Health Interview

Survey. Advance data from vital and

health statisti=, no 198. HyattsviUe,

Maryland: National Center for Health

statistics.1991.

Hardy AM. AIDS knowledge and

attitudes for October-December 1990:

Provisional data from the National

HeaIth Interview Survey. Advance

data from vital and health statistics;

no 204. Hyattsville, Maryland:

National Center for Health Statistics.

1991.

Hardy AM. AIDS bowledge sad

attitudes for January-March 1991:

Provisional data from the National

Health Interview Survey. Advance

data from vital and health statistic

no 216. HyattsvilIe, Maryland

National Center for Health Statistics.

1992.
6 Advance Data No. 243 ● February 23, 1994

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.05

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

* Figure doea not meet standard of

reliability or precision (see

Technical notes)
Advance Data No. 243 ● February 23, 1994 7

Table 1. Estimates of the percent of pereons 18 years of age and over with aalactad AIDS knowledge and attitudes from the 1992

National Health Interview Survey, by selected characterisiti~ United States, 1992

[Data are based on householdinterviewsof the civiliannoninstitutionalizedpopulation.The surveydesign, general qualifications,and information

on the reliabilii of the estimatesare given in Teohnioalnotes]

Race or ehicity

A&ra Sex Non-H;sPvJh Educafion

16’-28 30-$9 50 years Laas than 12

AIDS knowledge or aitiiude

Mom r%an

ToW years years and over Male Female Write Black Hispanic 12 yaafa years 12 years

1.

2.

2a.

2b.

2C.

3.

4.

5.

5a.

5b.

5C.

5d.

5a.

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How much would you say yw know about AIDS?

A lit . . . . . . . . . . . . . . . . . . . . . . . . . . .

Borne . . . . . . . . . . . . . . . . . . . . . . . . . .

Ailffle . . . . . . . . . . . . . . . . . . . . . . . . . .

NothiW . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

in the paat month have youSeen any Public Sarvica Announcements about AIDS

on television?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Heard any Public Service Announcements about AIDS

on the radio?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

SaananyPublicSem”ca Postersinakporta

almutAIDS?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Irrthapastmonth, haveyouracaived information

abut AIDS from any of these aourcas?l

Televidonprograms . . . . . . . . . . . . . . . . . .

Radloprograms . . . . . . . . . . . . . . . . . . . . .

Magadneartidae . . . . . . . . . . . . . . . . . . . .

Newspaperartides . . . . . . . . . . . . . . . . . . .

Streatsignwllboards . . . . . . . . . . . . . . . . .

Store displa@tored istributadb rcchures. . . . . .

Bus/straetcar/suixvaydisplaya . . . . . . . . . . . .

Healthdepartmantbrochuras.... . . . . . . . . .

Workplacadistrlbutadbrochuras . . . . . . . . . . .

Schooldistributadbrochuras... . . . . . . . . . .

Churchdlstributadbrcdxrras.... . . . . . . . . .

Communityorganization . . . . . . . . . . . . . . . .

Friend/acquaintenoa . . . . . . . . . . . . . . . . . .

AIDShrMkre . . . . . . . . . . . . . . . . . . . . . . .

(Mar . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Racaivad no AIDS information inpaat month. . . .

Haveyoutwardtha AIDSviruscdladby thanama

“HIV”?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Tallmewhstharyou thlnktlwfdlowingstatenwnta are

true or false or if you don’t know it they are true or

false.

AIDScanrsducathe body’anatural protactlon

against disease.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

AIDS can damage the brain.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oon’tknow . . . . . . . . . . . . . . . . . . . . . . .

AIDSisaninfsctioua diseasecauwdby avirus.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Apareoncanbeinfactad wiftrthaAIDSvirua and

not have the &aa.sa AIDS.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Donlknow . . . . . . . . . . . . . . . . . . . . . . .

ANYoarsonwith theAiDSviruacan oasaitonto

som&nee!sethrough aaxuatlnterc&rraa.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Ssafmbwtesat~oftable.

100

26

45

21

7

0

64

14

2

49

46

s

10

66

2

75

36

44

52

19

9

7

16

12

10

5

5

10

1

3

1

13

95

4

1

67

1:

54

15

m

65

4

10

64

4

12

36

1

3

100

31

so

i7

2

0

65

14

1

57

40

3

11

67

2

77

45

49

46

27

12

12

23

13

18

5

6

15

2

3

0

9

97

3

0

W

3

7

46

24

30

92

3

5

86

5

7

38

1

2

100

31

50

17

3

0

67

12

1

54

43

s

11

S7

2

77

41

47

56

21

9

s

17

16

11

5

6

11

2

4

0

11

67

3

0

92

3

6

55

17

27

90

4

6

69

4

7

98

1

2

100

18

37

29

16

0

60

16

3

37

m

s

s

20

2

71

28

37

51

12

6

4

10

6

3

5

4

6

1

2

1

17

91

7

2

n

4

17

53

7

34

75

6

19

75

4

21

83

0

6

100

26

45

22

7

0

64

15

2

52

45

3

11

67

2

75

42

41

53

21

9

8

14

12

9

5

5

10

1

3

1

12

85

4

1

66

3

9

54

16

WI

67

4

9

64

4

12

86

1

3

100

27

45

20

7

0

64

14

2

46

52

s

10

69

2

74

34

47

51

18

8

7

1s

13

11

6

5

11

2

4

1

13

e5

4

1

66

4

10

54

14

31

63

1:

34

4

12

ee

o

3

100

27

47

20

6

0

64

14

2

47

50

3

9

so

2

74

28

44

53

1s

7

5

14

11

9

4

4

9

1

3

1

13

66

3

1

30

3

6

53

16

31

65

5

10

66

3

11

36

1

3

Icil

25

39

23

13

66

13

1

57

42

2

14

64

2

76

44

44

49

25

12

14

24

17

13

11

9

15

3

4

1

13

34

4

1

76

8

17

59

11

30

66

2

10

60

6

14

e5

1

4

100

25

40

27

8

SI

i6

1

57

40

2

15

62

4

75

46

41

49

25

14

Is

22

12

12

8

5

13

3

3

0

12

64

14

2

79

s

16

56

14

27

66

4

10

77

7

16

08

1

3

100

14

32

32

22

0

77

21

3

37

60

3

7

91

2

8s

28

26

35

12

7

6

13

5

7

4

4

s

1

2

1

21

65

12

3

68

6

26

55

8

37

75

4

21

68

6

26

91

1

s

100

23

48

24

5

0

6a

13

1

46

49

3

s

60

2

75

37

42

51

1s

9

6

15

11

9

5

4

10

1

2

1

13

66

3

1

87

4

9

54

14

32

65

5

10

64

4

11

97

1

3

100

36

46

13

2

0

66

13

1

55

42

3

13

65

2

77

43

55

62

24

9

9

18

17

12

8

7

12

1

5

0

8

e6

1

0

e8

2

3

54

20

26

91

4

5

92

3

5

se

1

1
8 Advance Data No. 243 ● Februarv23,1994

Table 1. Estimates of the percent of persons 18 yeara of age and over with eelested AIDS knowledge and attitudes from the 1992

National Health Interview Survey, by selected charaoterisitlce: United States, 1992-Con.

[Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are given in Technical notes]

Race or etfrniciiy

Age Sex Non-Hispanic Edusaifon

16-29 30-49 50 yeara Leas fhall 12 More than

A/DS knowbdge or affrlude To@I yesrs years and over Male Female White Black Hispanic 12 yeara yaarw 12 yeara

Sf.

Sg.

5h.

5i.

5j.

5k.

6.

6a.

6b.

60.

6d.

*.

A pregnantwomen who haa the AIDS virus can give

it to her baby.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow, . . . . . . . . . . . . . . . . . . . . . .

A pareonwho has the AIDS virus can look and feel

well and healthy.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

There are dregs available which oan lengthen

the life of a person infestedwith the AIDS virus.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . . . .

Early treatment of the AIDS virus infectionoan

reduaa symptomsin an infected person.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Thera is a vascine available to the publicthat

protestsa personfrom gettingthe AIDS virus.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

There ia no awe for AIDS at present.

Tee . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

How likely do you think it is that a personwill get

AIDSortheAIDS virusinfaationfromWorkingnearsomaone withtheAIDSvirws?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . .

Somawhatlikely . . . . . . . . . . . . . . . . . . . .

$omawhatunlikely . . . . . . . . . . . . . . . . . . .

Veryunlikeiy . . . . . . . . . . . . . . . . . . . . . . .

DefinitelynotpoaaibIe . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Etinginareatauranf wherethecookhaa theAIDS

virus?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . .

Somawhatlikely . . . . . . . . . . . . . . . . . . . .

Somawhatunlikely . . . . . . . . . . . . . . . . . . .

Ve~unlikely . . . . . . . . . . . . . . . . . . . . . . .

Defintelynotposeible . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . .

Sharing plates, forks, or glasses with someone who

haatheAIDSvirus?

Veryiikely . . . . . . . . . . . . . . . . . . . . . . . .

Somawhatlikely . . . . . . . . . . . . . . . . . . . .

Somawhatunlikely . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . .

Definitelynotpesaible . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Using publictoilets?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . .

Somawhatlikely . . . . . . . . . . . . . . . . . . . .

Somawhatunlikely . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . .

Defin”*lynotpoasible . . . . . . . . . . . . . . . . .

Don’tkrmw . . . . . . . . . . . . . . . . . . . . . . .

Sharingneedlesfor drug usawithsomeone whohee

fheAIDSvkus?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . .

Somawhatiikely . . . . . . . . . . . . . . . . . . . .

Somewhatunlikely . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . .

Definitalynotpossible . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . .

Saefeotnotesatand oftable.

94

f

5

66

5

9

7f

7

22

60

10

30

3

63

14

93

2

5

2

5

7

44

36

6

7

17

f3

35

f9

10

9

f6

13

32

16

10

6

11

11

36

26

9

96

1

0

0

0

2

96

1

3

91

4

5

71

9

20

61

12

27

4

S5

If

93

3

4

2

4

7

45

39

3

5

16

15

37

19

5

7

15

15

36

22

5

5

11

13

39

2s

4

97

1

0

1

0

1

96

1

4

91

4

5

75

7

f6

65

10

25

2

8S

9

95

2

3

2

5

7

44

39

3

6

16

14

37

21

7

9

17

14

34

19

7

5

9

11

40

26

6

97

t

o

0

0

1

91

1

9

77

7

16

65

6

29

63

8

39

4

75

21

60

3

7

3

5

7

44

31

11

8

17

11

32

15

17

11

20

11

27

14

16

7

14

10

35

21

15

92

2

0

0

0

5

93

1

6

67

4

9

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61

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65

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33

18

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26

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92

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67

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59

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28

23

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15

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26

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69

10

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29

15

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20

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25

15

19

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19

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24

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29

16

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9

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1
Advance Data No. 243 ● February23, 1994 9

Table 1. Estimates of the percent of pereons 18 yeare of age snd over with selected AIDS knowledge and attitudes from the 1892

National Health Interview Survey, by selected characterisitim United Ststee, 1992<on.

Pats are based on household interviews of the civilian noninstitutionahzed population. The survey design, general qualifications, and information

on the reliabilii of the estimates are given in Technical notea]

Ram w ethnicify

Age Sex Non-Hia@nk Education

16-29 3049 50 yeara Less than 12

AIDS knowledge or attiiude

More #an

ToW yeara years and over Mab Female White Black Hiaparris 12 years years 12 yeara

Sf.

69.

6h.

Si.

7.

10.

11.

12.

13a.

13b.

14.

Salng soughed or anaszad on by someone who haa

the AIDS virus?

Veryiikaty . . . . . . . . . . . . . . . . . . . . . . . . 9

Somewhat likely . . . . . . . . . . . . . . . . . . . . 18

.%mawhatunlikaly . . . . . . . . . . . . . . . . . . . 15

Varyunlikely . . . . . . . . . . . . . . . . . . . . . . . 32

Definitelynotpoasible . . . . . . . . . . . . . . . . . 15

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 11

Attendkrgschoolwith a child whohas the AIDS virus?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . . 2

Somewhat iikely . . . . . . . . . . . . . . . . . . . . 5

%newhstunlikaIy.. . . . . . . . . . . . . . . . . . 7

Veryunlikaly . . . . . . . . . . . . . . . . . . . . . . . 44

Definitelynotposeible . . . . . . . . . . . . . . . . . 35

Dorr’tknow . . . . . . . . . . . . . . . . . . . . . . . 7

Mosquitoasor other insasta?

Vefylikely . . . . . . . . . . . . . . . . . . . . . . . . 9

Somawhatlikaly . . . . . . . . . . . . . . . . . . . . 16

Somawhatunlikely . . . . . . . . . . . . . . . . . . . 9

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . 25

Dtinitelynot poeaible . . . . . . . . . . . . . . . . . 20

Don’tknmv . . . . . . . . . . . . . . . . . . . . . . . 21

Saing cared for by a nurse, doctor,dentist,or other

health care worker who has the AIDS virus?

Verylikaly . . . . . . . . . . . . . . . . . . . . . . . . 26

Somawhatlikaly . . . . . . . . . . . . . . . . . . . . 36

Somawhatunlikely . . . . . . . . . . . . . . . . . . . 15

Veryunlikaly . . . . . . . . . . . . . . . . . . . . . . . 15

Definitelynotposaible . . . . . . . . . . . . . . . . . 3

Don’tkrrow . . . . . . . . . . . . . . . . . . . . . . . 6

Can a pereon get AIDS or the AIDS virus infastion

while givingor donating bloodfor use by others?

Yea . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 9

Have yowaver dlscueeed AIDS with any of your

childrenaged 10-1 7?2

Yea.l, . . . . . . . . . . . . . . . . . . . . . . . . . 75

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 0

Haveany orallofyour chlldrana ad10-17 had

inetrustionat school about AIDS?$’

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 15

Have you ever given or donated blood?

Yea . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 0

Have you donated blmxt since March 1985?

Yea . . . . . . . . . . . . . . ...<.... . . . . . . 19

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 1

Have you danated blcad in the paat 12 months?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9:

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 1

Howmanytimesin thepast12months haveyou

donated blood?

Once . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Twice. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Thraetimesornwre . . . . . . . . . . . . . . . . . . 1

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 0

Didtmtdonatebloodinpaet12month@ . . . . . . 94

SSefootnotasaterxl oftabla.

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91
10 Advance Data No. 243 ● February 23, 1994

Table 1. Estlmatea of the percent of pereons 18 years of age and over with selaoted AIDS knowledge and attitudes from the 1992

National Health interview Survey, by seiacted characterisiticx United States, 199Xon.

[Data are based on househoid interviews of the civilian nonirtstitutionalized population. The survey design, general qualifications, and information

on the reiiabiiii of the eslimates are given in Technicai notes]

Raceof ethniciiy

Age sex Non-Hispanic Education

18-29 30-49 50 years Leaa than 12 More than

A/DS /mow/edge or attitude Total years years and over Male Female White Black H@@c 72 W* Yeafs 12 Y=

15.

16.

17a.

17b.

1s.

19.

20.

21.

To the best of your knowfadge,are blooddonations

routinelyteatad for the AIDS virus infection?

Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 14

Was one of your reasons for donatingblood because

you wanted to be tested for the AIDS vkua infacflon?4

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

No . . . . . . . . . . . . . . . . . . . . . . . . . . . SS

Don’t know . . . . . . . . . . . . . . . . . . . . . . . –

Except for blind donationssinsa 1985, have you had

your bled teared for the AIDS virus intaofion?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 6

Why haven’t you bean taatad?1,5

Don’tmnslder myaelfatrlskof AIDS . . . . . . . . 81

Don’t believe anythingsan be done if I am

positive. . . . . . . . . . . . . . . . . . . . . . . . . 0

Don’tlike needles. . . . . . . . . . . . . . . . . . . . 1

Afraid ofloaing job, insurance, housing,frienda,

family ifpaople knew lwaapostive. . . . . . . . 0

Don’ttrust medisal cllnlcahospitalsto keep test

resultaconfidential . . . . . . . . . . . . . . . . . . 0

Already know whether I have the AIDS virus

intaation . . . . . . . . . . . . . . . . . . . . . . . . 1

Don’tknowwhere togoforateal . . . . . . . . . 1

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 9

How many times have you had your bloodtestad for

the AIDS virus infeofion,not Indudlng blwd

donations?

Once . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Twice. . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Threetimesormore . . . . . . . . . . . . . . . . . . 3

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 0

Neverhadta# . . . . . . . . . . . . . . . . . . . . . 62

Howmanytimesin thepast12montha haveyouhad

your bloodfaetadfor fheAIDSvirua infacflon,not

includingblood donations?

None . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

once . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Twice. . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Threetimasormore . . . . . . . . . . . . . . . . . . 0

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 0

Neverhadtes@ . . . . . . . . . . . . . . . . . . . . . 82

Oidyouhavaany oftheAIDSblood teaW1,7

Forhosp’talizati onorasurgls alprooadure?. . . . 13

Toapplyforhealth insurance? . . . . . . . . . . . . 5

Toapplyforlifeinsuransa? . . . . . . . . . . . . . . 12

Foremployment? . . . . . . . . . . . . . . . . . . . . 6

Toapplyforamarriagelicanse? . . . . . . . . . . . 4

Formilitaryindustionormilitaryaawisa? . . . . . 7

Forimmigration? . . . . . . . . . . . . . . . . . . . . 5

Justtofindoutifyouweralnfastad?. . . . . . . . . 30

Basauseofreferrel bythedoctor? . . . . . . . . . . 5

Baoause ofraferral bythe Health Department?. . . 1

Raferradbyyouraexpartrw? . . . . . . . . . . . . 1

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 0

Whenwaayourlaat AIDSbloodteatfor theAIDSvirus

infastionnotinduding blooddonation?7

1s92 . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

1961 . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

1660 . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 6

%efoatnotesatecd eftable.

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14

9

6

3

2

1

5
Advance Data No. 243 ● February 23, 1994 11

Table 1. Estimates of the percent of persons 18 years of age and over with selected AIDS knowfedga and attitudes from the 1882

National Health Intewiew Suwey, by selected characteristics: United states, 1882-Con.

[Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are given in Tahnical notes]

Raceoreifmkaly

AP sex Abn-H@ranic Educatbn

78-+9 So-f.9 5oyeers

AIDS krwwfedy or attitude

Lees than 12 Mom fhan

Totsf years years and ovar MaIa Femefe Write Ekrck Hisparrk 12years yea-s 12 years

22.

2s.

25.

26.

28.

23.

30.

31.

Did you have your last AIDS bloodtaat-1.7

For hospitahation or a surgical procedure?. . . . . 12

Toapplyfor health insurance? . . . . . . . . . . . . 4

Toapplyfor liieinaurarme? . . . . . . . . . . . . . . 12

Foremployment? . . . . . . . . . . . . . . . . . . . . 6

To apply for a marriage license? . . . . . . . . . . . S

For military inductionor miiiiry service? . . . . . . 6

Forimmigration? . . . . . . . . . . . . . . . . . . . . 4

Justtotind outifyouwera infacted?. . . . . . . . . 30

Bacauaeofraferrel bythedcctor? . . . . . . . . . . 5

Because of referral by the Health Department?. . . 1

Referrad byyoursaxpartner’? . . . . . . . . . . . . 1

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 0

Not includinga blood donation,where did you have

your last blcad teat for the AIDS vims?7

AIDS dinichmmaelinghsting site . . . . . . . . . . 1

t%mmun~heatth clinic . . . . . . . . . . . . . . . . 8

Cllnicrun byemployer . . . . . . . . . . . . . . . . . 2

DoctorAiMO. . . . . . . . . . . . . . . . . . . . . . . 28

Hospital/emergency roodoutpatiant clinic. . . . . . 24

STDdinic . . . . . . . . . . . . . . . . . . . . . . . . 0

Famllyplennlng dhsIc . . . . . . . . . . . . . . . . . 1

Prenatal clinlc. . . . . . . . . . . . . . . . . . . . . . 0

Tuberculosisclini c . . . . . . . . . . . . . . . . . . 0

Publlcdinlc . . . . . . . . . . . . . . . . . . . . . . . 5

Other clini c . . . . . . . . . . . . . . . . . . . . . . 4

Drugtraatment facilii . . . . . . . . . . . . . . . . . 0

Mll~ltiud~wwi~ sfie . . . . . . . . . . . . . 6

immigrationsite............,.. . . . . . . 1

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Donlknow . . . . . . . . . . . . . . . . . . . . . . . 1

Did you get the results of your last teat?7

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . so

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Donlknow . . . . . . . . . . . . . . . . . . . . . . . 1

Was this because you decided you didn’twant the

resultsor was if because you ware unable to get the

raeulta?s

Didn’twant . . . . . . . . . . . . . . . . . . . . . . . 9

Unable toget . . . . . . . . . . . . . . . . . . . . . . 21

Both . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Gthar. . . .. c . . . . . . . . . . . . . . . . . . . . . 56

Don’tkrrow . . . . . . . . . . . . . . . . . . . . . . . 13

Were the resuttagiven In parson, by telephone, by

mail, or in acme other WSY?9

Inparscn . . . . . . . . . . . . . . . . . . . . . . . . 56

Bytelephone . . . . . . . . . . . . . . . . . . . . . . 17

Bymail . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 0

Do you believe the results of your last teat ware

accurate?g

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 2

Doyoufaelthatthe wnridentialiiofthe resuitacf

yourlasttaatforthe AIDSvkusinfection waahandled

PwrfY?~

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . 4

Doyouexpacttohave abloodtestforthe AIDSvirua

infactioninthenext 12montha?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Don’timcw . . . . . . . . . . . . . . . . . . . . . . . s

Saefcctnotesatemd oftable.

10

3

6

7

5

9

5

34

4

1

1

22

0

2

10

2

26

22

0

2

1

7

3

0

9

0

s

o

63

16

1

10

20

1

57

12

62

14

13

9

0

97

1

2

84

4

2

22

68

11

11

6

16

7

3

5

4

28

4

0

1

18

0

2

7

2

27

23

0

1

0

0

4

4

0

5

1

11

1

79

21

1

8

24

1

55

10

55

19

17

7

0

8a

1

1

34

2

4

11

81

6

22

4

10

4

2

2

3

23

7

0

0

23

1

0

6

2

31

31

0

1

3

0

2

1

10

1

7a

20

1

10

12

54

23

56

18

16

8

1

97

3

82

1

6

4

3a

7

9

6

16

s

3

io

4

27

4

1

1

15

0

1

7

2

24

21

0

1

0

5

4

1

10

1

12

1

78

21

1

9

26

1

52

11

54

17

20

9

0

97

:

64

2

4

:

8

16

3

7

5

3

2

5

S2

5

0

0

25

0

1

8

2

32

27

0

2

1

0

5

3

2

1

6

0

62

17

1

s

15

1

60

15

63

18

12

8

0

96

1

1

64

3

3

10

62

8

Is

5

15

5

4

7

1

26

4

0

1

22

0

1

e

2

28

23

0

1

0

3

3

0

7

0

11

1

78

21

1

7

1s

1

61

12

52

20

18

9

1

86

1

1

64

2

3

9

65

6

12

3

8

7

2

7

1

33

9

1

1

17

0

1

13

2

2s

26

0

1

1

7

2

0

7

1

6

0

65

15

0

10

26

1

44

16

63

14

13

5

0

97

1

2

65

2

3

2s

53

15

11

2

5

10

4

3

2s

27

4

0

1

12

0

2

11

3

22

2s

2

1

0

11

6

3

4

6

0

64

15

1

17

*

se

10

74

10

12

4

97

0

3

91

2

6

17

70

12

16

1

2

5

2

2

13

28

6

1

0

21

0

1

10

2

24

31

0

1

1

9

5

0

2

2

7

0

30

18

2

8

26

1

49

17

75

12

9

4

0

86

0

4

62

2

6

11

78

11

14

3

6

7

4

7

2

31

5

1

1

21

0

1

6

2

29

24

0

2

0

0

6

3

1

7

1

9

0

63

17

0

7

24

1

51

15

61

18

14

7

0

97

1

2

65

2

2

11

61

8

10

6

17

6

3

7

3

26

3

0

1

19

0

1

7

2

26

22

0

1

0

3

4

0

7

1

12

1

78

21

1

10

16

1

w

10

51

19

20

10

1

66

1

1

8s

3

3

12

81

7
12 Advance Data No. 243 ● February 23, 1994

Table 1. Estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the 1892

National Health Intewiew Survey, by selected characteristics: United States, 1892-Con.

[Dats are based on household interviews of the civilian noninstitutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are given in Technical notes]

Race or ethnicity

Age sax Non-Hispanic Education

18-28 30+9 50 years Less than 12 More tfren

AIDS knowfedge or attitude Total years yeara and over Male Female White slack Hispanic 12 years years 12 years

32.

3s.

34.

34a.

34b.

37.

38.

38a.

38b.

38C.

Tell me if each of these statements explain why you

expect to have the bloodtest In the next

12 months.10

Bacause k will be pat of a blood donation . . . . .

Baceusa it will be part of hospitatizatlonor

surgery youexpectto have . . . . . . . . . . . . .

Because you expect to apply for Me or health

insurance. . . . . . . . . . . . . . . . . . . . . . . .

Because you expect to apply for a job. . . . .

13ecauseyou expacl to join the milii . . . . . .

13acauseyou expect to apply for a marriage

license . . . . . . . . . . . . . . . . . . . . . . . . .

Because you want to know the results. . . .

Because it will be a required pati of some other

activitythat includ~ automaticAIDS testbsg. . .

Where will you o to have a bloodteat for the AIDS

virus infection?f%

AIDS clinic/counseling/testingsti . . . . . . . .

timmun”~health clinic . . . . . . . . . . . . . . . .

C!inicrun byemployer . . . . . . . . . . . . . . . . .

Doctoril-fMO. . . . . . . . . . . . . . . . . . . . . . .

Hospital/emergencyrmn/outpatient clinic. . . . . .

STD clinic . . . . . . . . . . . . . . . . . . . . . . . .

Family planningclinlo . . . . . . . . . . . . . . . . .

Pranstal clinic. . . . . . . . . . . . . . . . . . . . . .

Tulmrculosisclinic . . . . . . . . . . . . . . . . . .

Public ciinic . . . . . . . . . . . . . . . . . . . . .

Other clinic . . . . . . . . . . . . . . . . . . . . . . .

Drugtreatment fecilii . . . . . . . . . . . . . . . . .

Military induction/sewicssite . . . . . . . . . . .

Immigrationsite. . . . . . . . . . . . . . . . . . . . .

Other. . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . . . .

Tell me whether you think the followingstatements

about the bloodteat for the AIDS virus infectionare

true or false or it you do not knowwhether they are

true or fdsa.

Sometimes the resultsof a bloodtest for the AIDS

virus infectioncan be wrong.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False. . . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . .

After a parson becomes infectedwith the AIOS virus,

there can be a periodof time before the test shows

the infection.

Tee . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Haveyouaverheard ofadrugcalledAZC alao

knownas zidovudineor Retrovir?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . .

Tellmewhatheryou thinkthefollowingatatamenta

aboutAZT are true orfalse or if you don’t know

whetherthey are true or felse.ll

~ can delay or slow down the symptomsof AIDS

virus infection.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . .

~ cures people withAIDS.

True . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . .

AZT has no knownaide affects.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

%efoetnotasstend oftable.

17

8

9

7

2

7

72

20

2

10

2

36

17

0

1

0

0

6

3

3

0

1

7

76

6

18

79

2

1s

56

3a

4

63

2

15

1

92

7

4

81

35

15

8

10

10

3

11

76

19

2

12

2

32

17

0

2

0

7

3

3

0

1

9

76

8

16

65

3

12

56

42

2

86

1

12

1

84

5

4

65

30

18

6

9

7

1

5

89

20

2

10

2

3s

16

0

1

0

8

2

3

0

2

5

79

7

14

83

3

14

68

30

3

65

2

13

1

93

6

4

65

31

18

8

4

2

2

1

66

21

1

9

2

46

20

0

—

2

3

1

2

3

73

3

24

70

2

28

46

46

5

77

2

22

1

66

11

5

51

44

18

5

11

9

3

8

66

22

2

9

‘3

3s

18

0

1

6

2

5

0

1

7

76

8

16

79

3

19

59

37

4

83

2

15

1

92

7

4

81

35

15

8

6

6

1

8

76

18

2

12

2

38

16

0

2

0

0

6

3

1

0

2

6

76

6

18

60

2

18

57

39

4

62

2

16

1

91

8

4

61

35

21

5

7

4

1

8

65

16

2

6

2

36

15

0

2

5

2

4

0

2

6

78

6

17

81

2

17

62

34

3

83

1

15

1

92

7

3

62

34

10

7

10

11

3

7

82

24

1

17

2

36

19

0

1

0

8

2

3

1

6

74

6

20

60

2

16

52

43

5

79

2

19

1

8a

10

7

57

36

6

9

12

12

4

7

78

21

3

9

4

32

15

—

1

0

8

5

2

0

1

13

65

10

5

70

3

27

36

61

3

82

2

16

1

91

6

6

56

37

10 15 21

12 6 4

6 9 9

9 9 6

4 1 2

10 8 7

80 73 67

22 22 18

2 2 2

13 11 9

1 3 2

31 36 39

21 16 14

0 0 0

1 2 1

0-

0-

9 7 4

4 3 2

—

1 3 4

0 0

1 1 2

9 7 5

62

7

32

63

3

35

30

65

5

70

3

27

1

82

16

5

45

51

75

6

18

79

3

18

54

42

4

70

2!

20

II

90

9

4

54

42

63

6

11

86

2

10

76

22

2

68

1

11

1

94

5

4

6s

27
Advance Data No. 243 ● Februarv 23.1994 13

Table 1. Estimates of the percent of persons 18 years of age and over with seleoted AfDS knowledge and attitudes ttom the 1892

National Health Interview Survey, by selected charaoterisitkx United States, 1992-Con.

[Data are based on householdinterviewsof the civiliannonirrstit~-onalizedpopulation.The surveydesign, general qualifications,and information

on the reliabilityofthe estimatesare given in Technicalnotes]

Race or eitrnhiiy

A@ sax Non-Hiaparric Education

16-29 W--49 50 yam Less than 12

AIDS knowledge or attitude

More ttrarr

ToW years years and ovar Male female Write Slack Hi~ic 12 years years 12 yaela

36d.

36a.

39.

40.

41.

42.

42a.

42b.

43.

44.

45.

46.

AZT is appropriate for a person with the AIDS virus

infection only at certain timas during the illness.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False.. . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Thera are other druga avallsble to treat AIDS-related

illnesses.

Tme . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Did you have a blood transfusion et any time

between 1977 and 1685?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Do you have frequent blood tranafr.sions because of

sickle call or chronic anemia?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

How affediva do you think the use of a cundom la to

prevent getting the AIDS virus through sexual acfivii

Veryaffactive . . . . . . . . . . . . . . . . . . . . . .

Somawhat affactlve . . . . . . . . . . . . . . . . . . .

Notatell afkctive. . . . . . . . . . . . . . . . . . .

Don’tknow howaffactiva . . . . . . . . . . . . . . .

Don’tknowmathcd . . . . . . . . . . . . . . . . . . .

Tell ma whether you think tha following statements

are true or false or whether you don’t know whather

they are true or false.

latex condoms and natural-membrane condoms are

equally good at preventing transmission of the AIDS

virus.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Don’tknowmathod . . . . . . . . . . . . . . . . . . .

Oil-based lubricants can cause latex mnhna to

break.

True . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Don’tknowmethod . . . . . . . . . . . . . . . . . . .

What are your chances of having the AIDS virus?

High . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medium . . . . . . . . . . . . . . . . . . . . . . . . .

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknmv . . . . . . . . . . . . . . . . . . . . . . .

Whatareyourchancas ofgat@theAIDS virus?

High . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medium . . . . . . . . . . . . . . . . . . . . . . . . .

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

W&-lighchanceof alreadyhavingthaAIDS

. . . . . . . . . . . . . . . . . . . . . . . . . .

Have you aver had a caworker who had AIDS or the

AIDS VhlS?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Naverworked, naverhadacoworker . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Besldasaw-worker, havayouaverhad afriendor

relative who had AIDS or the AIDS virus?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Saafcotnotssaterxl oftabla.

85

12

53

55

12

32

5

94

1

0

100

0

26

54

4

14

2

16

27

55

2

33

5

80

2

0

2

22

73

2

1

3

23

64

3

0

5

66

1

8

12

64

4

40

12

46

64

14

32

2

97

1

0

100

0

32

58

3

7

1

28

34

42

1

44

7

47

1

1

3

32

82

2

1

5

38

53

2

1

5

68

1

6

13

83

4

37

13

50

60

11

29

5

84

1

0

100

0

28

57

4

10

1

17

33

49

1

3s

6

55

1

1

2

25

71

2

1

3

33

60

3

1

8

83

0

9

15

61

4

27

10

68

50

11

39

7

91

2

0

100

0

18

49

5

24

3

l-l

15

71

3

19

4

74

3

0

1

12

83

3

0

1

la

77

4

0

3

39

1

7

s

89

3

86

12

52

59

11

30

5

88

1

0

0

30

52

3

13

1

19

30

50

1

38

7

58

1

0

2

23

72

2

1

3

31

62

3

0

6

64

0

10

11

65

4

Percmt.fwtribution

35

12

54

52

13

2s

5

84

1

0

100

0

2%2

56

1;

2

14

25

59

2

30

4

83

2

1

2

21

74

2

0

3

27

67

3

1

5

87

1

8

1s

64

3

34

11

54

57

11

32

5

94

1

0

100

0

25

58

4

13

1

15

29

55

1

84

5

80

1

0

2

23

74

2

0

3

30

65

2

0

5

66

1

6

12

85

3

36

15

49

49

15

3s

5

98

1

0

100

0

26

47

5

X)

2

21

20

58

2

34

6

58

2

1

3

22

67

6

1

4

27

80

6

1

6

84

1

9

17

7s

5

41

15

43

47

19

33

4

95

1

0

100

0

27

46

5

16

6

19

21

54

6

26

7

58

6

1

3

17

74

5

1

4

22

67

5

1

5

83

3

6

14

81

4

25

12

63

39

15

46

5

92

2

0

0

19

42

6

26

5

15

13

8s

5

21

4

70

5

1

2

13

78

5

1

3

17

72

6

1

2

90

2

7

7

69

4

30

12

58

47

13

39

5

e4

1

0

100

0

24

5a

4

14

2

18

22

58

2

26

6

68

2

0

2

20

75

2

1

3

26

88

3

0

4

39

1

7

10

66

4

40

12

43

83

10

28

5

34

1

0

100

0

30

58

3

7

1

15

38

45

1

42

6

51

1

0

2

28

88

1

1

3

37

57

2

0

9

82

0

9

16

80

4
14 Advance Data No. 243 ● February 23, 1994

Table 1. Estimates of the percent of persons 18 yeare of age and over with selected AIDS knowledge and attitudes from the 1992

National Health Interview Survey, by selected characterlsitlcrx United States, 1992-Con.

[Data are based on household interviews of the civilian noninetitutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are given in Technical notes]

Race or ethnioiiy

Age Sex Non-Hispanic Education

1.9+9 30--$9 50 years

AIDS knowledge or atide

Less then 12 &fOfSthan

ToW years years arrd over Male Feme/e IrVMe Black Hispanic 12 years years 12 yews

Percent distribution

47. Are any of these statements true for you?

a. You have hemophiliaor another clottingdisorder

and havs received clotting factor concentrations

since 1977.

b. You area man who has had sex with another

man at some time since 1977, even 1 time.

c. You have taken illegal drugs by needle at any

time since 1977.

d. You have had sex for money or drugs at any time

since 1977.

e. Since 1977, you are or have been the sax partner

of any personwho would answer yes to any of

the kerns above (a-d)

Yestoet least l statement . . . . . . . . . . . . . . 4 6 5 1 4 3 4 5 5 3

Notoell statements . . . . . . . . . . . . . . . . . . 96 w 95

4 4

99 95 97 66 95 95 97

Don’t know . . . . . . . . . . . . . . . . . . . . . . . 0

es

o 0

96

0 0 0 0 1 0 0 0 0

lMultipleresponsesmay addto morethan 100.

2Sasadon personsanswering“yes”to questionS,“Do you have any childrenaged 10 threugh 17?”

3Based M parsons answering “no” or “donl know” to quesUons 12, 13s, or 13b.

4S2sad on perecms answsrfcg ‘yes” to questions 1Ss and 15.

%sad on parsons mswsrfng “no” to question 17a,

‘Baaed on parsons answering “no” or “don? knofl to quetion 17s.

7Basad on perso+!s answering “yes” to question 17a.

sBssad M parsoms answering “no” or “don’t know” to question 25.

‘Based cm parsons snswerfrig “yes” to question 25.

10- on parsons answering “yes” to question 31.

11w ~ peMS answering “yes” to question 37.

NOTE HMO is heaith msintemance organization. STD is sexually transmitted disasse.
Advance Data No. 243 ● February23,1994 15

Technical notes

The National Health Interview

Survey (NH(S) is a continuous,

cross-sectional household interview

survey. Each week a probability sample

of the civilian noninstitutionalized

population residing in the United States

is interviewed by personnel of the U.S.

Bureau of the Census to obtain

information on the health and other

characteristics of each member of the

household. Information on special health

topics is collected for all or a sample of

household members. The 1992 National

Health Interview Survey of AIDS

tiowledge and Attitudes was asked of

one randomly chosen adult 18 years of

age or over in each family. The AIDS

portion of the 1992 NHIS was

administered in one-half of sample

household$ thus estimates in this report

are based on completed interviews with

20,974 individuals-approximately

one-half of the sample size in 1991.

Responses were weighted to produce

population estimates, although variances

are somewhat larger due to the reduced

sample size. In 1992, the response rate

to the basic NHIS core questionnaire

Table L Sample sizes for 1992 National Health Interview Survey of AIDS Knowledge and

Attitudes and satimeted adult population 18 yeara of age and over, by aaieeted charaeteristicw United states, 1992

Estimated

Sample

Charaofenstic

population

size in thouaanok

Alladutk . . . . . . . . . . . . . . . . . . 20,974 164,963

Age

18-29 yeara . . . . . . . . . . . . . . . . 4,679 44,049

3049years . . . . . . . . . . . . . . . . 8,728 78,340

50yearaand over . . . . . . . . . . . . 7,S26 84,074

Sex

Male . . . . . . . . . . . . . . . . . . . . . 8,922 38,157

Female . . . . . . . . . . . . . . . . . . . 12,052 96,606

Race and ethnicity

Non-Hspanic whtie . . . . . . . . . . . . 15,863 140,497

Non-f+ispani cblaok . . . . . . . . . . . 2,781 20,237

Hispanic . . . . . . . . . . . . . . . . . . . 1,456 14,333

Education

Lessthan 12years . . . . . . . . . . . . 4,332 37,722

12yesm . . . . . . . . . . . . . . . . . . . 7,652 86,315

Morethan 12years . . . . . . . . . . . . 8,847 75,784

was 95.7 percent; for the NHIS AIDS

supplement it was 86.9 percent.

Therefore, the overall response rate to

the 1992 AIDS survey was 83.2 percent

(core response rate x supplement

response rate).

Table I contains the estimated

population size of each of the

demographic subgroups included in

table 1 to allow readers to derive

estimates of the number of people in the

United States with a given characteristic,

for example, the number of women who

have had their blood tested for HIV. The

population estimates in table I are based

on 1992 data horn the NHIS inflated to

national population controls by age,

race, and sex. The population controls

are based on the 1980 census carried

forward to 1992. These estimates,

therefore, may ditTer from 1990 census

results brought forward to the survey

date. Population controls incorporating

1990 census results will be used for

survey estimation beginning later in the

decade.

Table II shows approximate

standard errors for most of the estimates

presented in table 1. These standard

error estimates were derived by applying

a design effect of 1.3 to the standard

errors that would have been obtained

with a simple random sample design.

The reader is cautioned about comparing

estimates when the denominator is small

(for example, when looking only at

those persons who did not receive the

results of their HIV antibody test). A

final data file covering the entire 1992

dats collection period is available.

Table il. Standard errors, expressed in percentage pointa, of estimated percents from the 1992 Nationai Health interview Survey of AtDS

Knowiedge and Attitudes, by seleetad chareoteriatiea: United states,1992

Age sex Raoe arxi ethnioity Education

E.stinsted 18-29 3	 .50yews

pament Total

Lass fhsn 12 More ihan

years years and over Male Fema/e Write Black Hispanio 12yesrs years 12 years

5or95 . . . . . 0.2 0.4 0.3 0.3 0.3 0.3 0.2 0.5 0.7 0.4

100r80 . . . . 0.3 0.6 0.4

0.3

0.4

0.3

0.4 0.4 0.3 0.7 1.0 0.6

150r35 . . . . 0.3 0.7 0.5

0.4

0.5

0.4

0.5 0.4 0.4 0.9 1.2 0.7

200r30 . . . . 0.4 0.8 0.6

0.5

0.6

0.5

0.5 0.5 0.4 1.0 1.3 0.8 0.6 0.5

250r75 . . . . 0.4 0.6 0.6 0.6 0.6 0.5 0.4 1.1 1.5 0.8

300r70 . . . . 0.4 0.9 0.7

0.6

0.7

0.6

0.8 0.5 0.5 1.1 1.5 0.9

350r65 . . . . 0.4 0.9 0.7

0.7

0.7

0.6

0.6 0.6 0.5 1.2 1.6 0.9

400r60 . . . . 0.4 0.9 0.7

0.7

0.7

0.6

0.7 0.8 0.5 1.2 1.7 1.0

450r55 . . . . 0.4 0.9 0.7

0.7

0.7

0.7

0.7 0.6 0.5 1.2 1.7 1.0

50 . . . . . . . . 0.4 0.9 0.7

0.7

0.7

0.7

0.7 0.6 0.5 1.2 1.7 1.0 0.7 0.7
16 Advance Data No. 243 ● Februarv 23, 1994

Suggested citation

Schoenborn CA, Marsh SL, Hardy AM. AIDS

knowledge and attitudes for 1992: data tlom

the National Health Interview Survey. Advance

data from vital and health statieticq no 243.

Hyattsville, Maryland: National Center for

Health Statistics. 1994.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Director

Manning Feinieib, M. D., Dr. P.H.

Deputy Director

Jack R. Anderson

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERViCES

Pubiic Heaith Service

Centers for Disease Control and Prevention

National Center for Heaith Statistics m

6525 Beicrest Road

Hyattsviiie, Maryiand 20782

OFFiCiAL BUSiNESS

PENALTY FOR PRiVATE USE, $3OO

To receive this publication reguiariy, contact

the Nationai Center for Heaith Statistics by

caliing 301-436-8500

DHHS Publication No. (PHS) 94-1250
Number 244 ● February 23, 1994

——

Data

FromVi end HeatthSWW”OSofthe CENTERS FOR DISEASE CONTROLAND PREVENTION/NatiOrEII Centerfor HealthStaMes

Nursing Homes and Board and Care Homes

Data From the 1991 National Health Provider Inventory

by Al Sirrocco, Division of Health Care Statistics

Introduction

The 1991 National Health Provider

Inventory (NHPI) was a survey of

nursing homes, board and care homes,

hospices, and home health agencies.

This report deals primarily with nursing

homes and board and care homes but

includes some discussion of home health

care.

The NHPI was previously known as

the Inventory of Long-Term Care Places

(ILTCP), which was conducted in 1986

(l). Before that, it was known as the

National Master Facility Inventory

w, which was conducted eight

times-the fist in 1967 (2) and the last

in 1982 (3). These inventories included

primarily nursing homes and residential

care homes (now called board and care

homes).

The current name (National Health

Provider Inventory) refleeta an

expansion to include home health

agencies and hospices, which provide

health services to individuals in their

place of residence. Information

concerning survey mailout procedures,

the classification system that was used,

and definitions of terms are given in the

Technical notes.

Discussion

There were 15,511 nursing homes

and 31,431 board and care homes

identified in 1991. The musing homes

had 1,615,686 beds and 1,478,217

residenta, and the board and care homes

had 482,650 beds and 413,040 residenta

(table 1).

The discussion on nursing homes

will center on the 14,744 that were

freestanding as opposed to those that

were hospital-based. Table 2 summarizes

Table1. Numberof nursing homesand boardandcamhomes,beds,and residents,by

type of facility:UnftadStates,1991

Tpe of faciliiy Facilities Beds Residwrts

All faciliies.. . . . . . . . . . . . . . . . . . . . . 46,942 2,086,336 1,691,257

Nursinghomes . . . . . . . . . . . . . . . . . . . 15,511 1,615,686 1,478,217

Freestanding. . . . . . . . . . . . . . . . . . . 14,744

Hospital-based. . . . . . . . . . . . . . . . . .

1,558,394 1,426,320

767 56,282 51,697

Boardandcare homes’ . . . . . . . . . . . . . . 31,431 462,650 413,040

Notforthe mentallyretarded . . . . . . . . . 16,262 362,014 302,620

Forthementslly retarded . . . . . . . . . . . 13,169 120,636 110,220

‘&cludes8,578nonrespondingboardandcarehomes.

the data for the 767 nursing homes that

were hospital-based. From this point on,

all references to nursing homes will be

referring only to the freestanding

nuraiug homes. For the board and care

homes, the diaeuaaion will cover only

the 31,431 responding homes. It was not

feasible to impute data for the 8,578

nonresponding homes.

The 14,744 nursing homes,

consisting of 1,559,394 beds and

1,426,320 residents are diatriiuted by

bed-size groups, by ownership type, and

by geographic region (table 3). The table

shows that almost 90 percent (13,069) of

these nursing homes had between 25

and 199 bedq and more than 70 percent

(10S22) were under for-profit

ownership. When mmbin@ the

Midwest and South regiona had twice as

many nursing homes and ahnost twice

aa many beds ss the Northeast and West

regions combined.

‘l%ble4 shows how the distribution

of the homes by bed-size groups varied

between geographic regions. For

example, nearly two-thirds of the

nursing homes in the Weat had fewer

than 100 beds, whereas less than

one-half of the homes in the Northeast

and the South had fewer than 100 beds.

The Northeast had a much higher

percentage of large homes (200 beds or

more) than the other regions. Its

mvrcfi,ti #tl

,$ %

#

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

[

Public Health Service

Centers for Disease Controland Prevention B%.

>‘+-%. National Center for Health Statistics CENr cmAmFmo mav
2 Advance Data No. 244 ● February 23, 1994

Table 2. Number of hospital-based facilities, beds, and residents, by seiected

characteristics: United states, 1991

Selected charaoterfstic Facilities Beds Residents

Total faciliies . . . . . . . . . . . . . . . . 767 56,292 51,897

Bed size

Lessthan 25 beds . . . . . . . . . . . . . . . . . 145 2,327 2,022

25-99 beds . . . . . . . . . . . . . . . . . . . . . . 477 24,516 22,686

100-199 beds . . . . . . . . . . . . . . . . . . . . 97 12,518 11,782

200 bedsormore . . . . . . . . . . . . . . . . . . 46 16,931 15,407

Ownership

Profit. . . . . . . . . . . . . . . . . . . . . . . . . . 63 5,344 4,619

Nonprofit . . . . . . . . . . . . . . . . . . . . . . . 432 27,563 25,686

Government . . . . . . . . . . . . . . . . . . . . . 272 23,385 21,392

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . . . 138 16,398 15,233

Midwest . . . . . . . . . . . . . . . . . . . 279 17,406 16,132

South . . . . . . . . . . . . . . . . . . . . . . 172 12,104 11,234

West . . . . . . . . . . . . . . . . . . . . . . . . . . 178 10,3s4 9,288

13.8 percent was in sharp contrast to the

West’s 4.1 percent, the South’s

5.4 percent, and the Midwest’s

7.7 percent.

Table 5 shows the difference in the

average bed size and occupancy ratesby

ownership and geographic region. The

Northeas~ which had the second fewest

homes, compensated by having the

highest average bed size at124 beds.

(This was reflected in the higher

percentage oflarge homes shownin

table 4). Ontheotherhand, the West not

only had the fewest homes it also had

the lowest average bed size (93 beds).

The occupancy rates for numing

homes (table 5) indicate that the West

had the lowest rate (89.6 percent) of any

region. This occurred even though the

West had fewer homes and beds than

the other regiona. This suggests that

there was not a shortage of nursing

home beds in the WesC despite the

small number of available beds. By

contrast, even with the larger homes, the

Northeast had an occupancy rate of

95.3 percent, which indicated a much

higher use of nursing homes in that

region.

Tables 6 and 7 display, by

geographic region and type of home, the

number of beds per 1,000 resid[ent

population ages 85 years and over and

65 years and over, respectively.

Compared with the other regions, the

West showed substantially fewm nursing

home beds in each population /group.Its

rate of 376.9 for the 85 and over

population was well below the rate of

458.6 of the Northeast (the next lowest)

and far below the rate of 605.1 of the

Midwest (the highest).

Similarly, the West’s 35.3 rate for

the 65 and over population in nursing

homes was well below the 46.0 of the

South (the next lowest), and far below

the 66.0 of the Midwest (the highest).

The bed to population rates for

board and care homes, compared with

the rates for nursing homes, were

virtually reversed in each regicm (tables

6 and 7). The West had, by far, the

higheat board and care home bed rates

for both population groups; the

Midwest, which had the highest nursing

home bed rates for both group,, hat by

far, the lowest board and care home bed

rates. The Northeast and South flipflopped their positions as well.

While tables 6 and 7 looked at

nursing home and board and mre home

Tabie 3. Number of homes, beds, and residents for nursing homes and board and care homes by type of home and seieetad

characteristics: United States, 1691

Nursing homes’ .4 board and care home.#

Selected characteristic Facilities Bads Residents Facilities Beds Residents

Total facilities . . . . . . . . . . . . . 14,744 1,559,394 1,426,320 31,431 4s2,650 413,040

Bed size

Lessthan 25 beds . . . . . . . . . . 563 8,101 7,105 27,377 204,816 II 79,473

25-99 beds . . . . . . . . . . . . . . 7,041 456,704 418,225 3,352 160,883 II38,036

100-199 beds . . . . . . . . . . . . . 6,028 792,348 724,966 544 71 ,a63 59,605

200 beds or more. . . . . . . . . . . 1,112 302,241 276,024 158 45,088 35,927

Ownership

Profit . . . . . . . . . . . . . . . . . . 10,522 1,086,807 984,560 19,726 309,469 269,041

Nonprofd . . . . . . . . . . . . . . . . 3,497 372,272 348,090 9,684 143,142 “126,516

Government . . . . . . . . . . . . . . 726 100,215 93,670 2,011 30,039 25,483

Geographic region

Northeast . . . . . . . . . . . . . . . . 2,654 328,435 312,864 5,660 110,359 97,134

Midwest . . . . . . . . . . . . . . . . . 5,137 518,917 468,636 8,817 105,515 91,742

South . . . . . . . . . . . . . . . . . . 4,708 503,522 457,944 7,090 131,982 111,s40

West . . . . . . . . . . . . . . . . . . . 2,245 208,520 186,876 9,664 134,794 112,324

‘Excludeshosp”til-based faciRies.

2Excludes 8,578 nonresponding board and care homes.
Advance Data No. 244 ● February23, 1994 3

Table 4, Number and percent distribution of

nursing homes and board and care homes

by bed size, according to geographic

region: United States, 1991

Table 6. Number of nursing home beds and board and care home beds per 1,000

population 65 years and over, by type of home and geographic region: United States,

1991

Bads par 1,000 U.S. population

85 yeara and over inGeographic region

Nursirq Board and

homes care homes2

Number

United States . . . . . . . . ...14.744 31,431

Northeast . . . . . . . . . . . . 2,654 5,880

Midwest . . . . . . . . . . . . 5,137 8,817

south . . . . . . . . . . . . . . 4,708 7,090

west . . . . . . . . . . . . . . 2,245 9,s64

Percent distribution

Northeset . . . . . . . . . . . . . 100.0 100.0

Lessthan 25 beds . . . . . . 4.9 82.0

25-99 . . . . . . . . . . . . . . 37.3 15.0

100-199 . . . . . . . . . . . . 43.9 2.1

200 badsormore . . . . . . 13.8 1.0

Midwest . . . . . . . . . . . . . . 100.0 100.0

Lessthsn25 beds . . . . . . 3.7 91.8

25-98 . . . . . . . . . . . . . . 52.6 6.8

100-199 . . . . . . . . . . . . 38.0 1.0

200 bedscvmore . . . . . . . 7.7 0.3

Sold. . . . . . . . . . . . . . . 100.0 100.0

Leeethan25 beds . . . . . . 2.7 81.5

25-88 . . . . . . . . . . . . . . 42.8 15.7

lW-199. . . . . . . . . . . . 49.1 2.4

200 bedaorrnore . . . . . . . 5.4 0.5

West . . . . . . . . . . . . . . . . 100.0 100.0

Lssethsn25 beds . . . . . . 5.1 89.8

25-99 . . . . . . . . . . . . . . 59.5 8.0

100-199 . . . . . . . . . . . . 31.4 i .7

200 bedsormore . . . . . . . 4.1 0.5

All Nursin

9

Soard and

Geographic region homes homes cam Irornass’e

United States . . . . . . . . . . . . . . . . 602.3 484.5 114.8

Northeast . . . . . . . . . . . . . . . . . . 578.7 453.6 120.1

Miiwe3t . . . . . . . . . . . . . . . . . . . 879.9 605.1 74.8

South . . . . . . . . . . . . . . . . . . . . 583.5 480.6 102.9

west . . . . . . . . . . . . . . . . . . . . . 569.0 376.9 192.1

‘ Seeedon U.S.Bureauofthe Censusestimatesofthe Unitedstsks reeidenfIWXIlefbn ages 85 yesrs ad over,se of July 1,

Iwl.

2 ExoludeeIwspial-bewd faciliiee.

3 Exdude38,578 nonreepondingboardendcare homes.

4 Excludes13,1S9 boardsnd csre homesforthe msnteJlyretarded.

bed supply for the aged population in

each region, tables 8 and 9 approached

this issue from the utilization side

(actual usage by the aged population).

Since the population figures were for the

85 years and over and the 65 yesrs and

over groups, estimate3 for these age

groups were made for the residents in

nmeing homes and board and care

homes. Board and care homes for the

mentally retarded were excluded from

tables 6-9 because almost 90 percent of

their residents were under 65 years of

age (see table 12).

The number of residents 85 years

and over and 65 years and over were

estimated for each type of home snd

geographic region. These eetimates,

along with their rates per 1,000 U.S.

population, are found in tables 8 and 9,

respectively. The rates showed the same

pattern as in tables 6 and 7. Namely, the

Midwest was a big user of nursing

homes and a relatively small user of

board and care homes, while the West

was a small user of nursing homes and

a relatively big user of board and care

homes. The Northeast and South were

between these extremes.

Several possibilities emerged from

these findings.

‘Excludesflospirel-basedfecmfee.

2EKlW&S8,578 nonreepomdingboardendcam homes.

Table 5. Average number of beds and percent occupancy rate of nursing homes and

board and care homes, by type of home and selected charwterktice: United States, 1991 ●

●

●

The elderly in the West were

healthier and not as dependent on

nursing home care as those in other

regions. This allowed them to use the

less intensive services found in bosrd

and care homes.

The need for nursing home care was

similar in each region. However, due

to a lack of nursing home beds in

certain areas, or due to the higher

cost of nursing home care, bosrd and

care homes were chosen instead of

nursing homes.

The usc of bosrd and care homes was

Nursing hornasl Eoardandcere homas2

Avaraw Occupancy Average occupancy

bad sr2e rate bed size rate

Seleotsd chsraotenstio Number Percent Number Percent

Tofslhomes . . . . . . . . . . . . . . . . . . . . .

Sad size

Lessthan25 bale . . . . . . . . . . . . . . . . .

25-99 bede. . . . . . . . . . . . . . . . . . . . . .

100-199 bads . . . . . . . . . . . . . . . . . . . .

200 bed30rrnore . . . . . . . . . . . . . . . . . .

Ownership

Profit. . . . . . . . . . . . . . . . . . . . . . . . . .

Nonprofit . . . . . . . . . . . . . . . . . . . . . . .

Governmen t . . . . . . . . . . . . . . . . . . . .

Gacgrephic regbn

Northeast . . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . . .

south . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . .

106 91.5 15 85.6

14

65

131

272

87.7

91.6

91.5

91.3

8

43

132

285

87.6

85.8

829

79.7

103

107

13s

90.6

83.5

83.5

16

15

15

83.7

89.8

84.8 independent of the use of nursing

homes. The higher use of board and

care homes in some regions merely

reflected an rdtemative, not to nursing

homes but to home heslth care in

those parts of the country.

To study this third possibility, data

from the home health agency portion of

124

101

107

83

95.3

80.3

90.9

33.6

19

12

19

14

8s.0

38.9

84.7

33.3

‘EscludeeIwepital-baeedfaoiliies.

2Escludee8,57S nonrespondingboatf andcere homes,
4 Advance Data No. 244 ● February 23, 1994

Table 7. Number of nursing home beds and board and care home beds per 1,000

population 85 yeare and over, by type of home and geographic region: United States,

1991

Beds per 1,000 U.S. population’

65 years and over inAll Nursin

2

Board and

Geographic rsgion homes horn care homes3’4

United States . . . . . . . . . . . . . . . . 60.5 49.1 11.4

Northeeet. . . . . . . . . . . . . . . . . . 58.8 46.6 12.2

Mkhvest. . . . . . . . . . . . . . . . . . . 74.2 66.0 8.2

South . . . . . . . . . . . . . . . . . . . . 55.6 46.0 9.6

West . . . . . . . . . . . . . . . . . . . . . 53.3 35.3 18.0

‘ Baaed on U.S. Bureau of the Censue estimates of the UnitedStatesresidentpopulationages 65 years and over,as of July1,

1991.

2Excludashospital-basedfsdliies.

3Excludss8,578 nonrqxmding boardand Sarahomes.

4Excludss13,169 Inxudand safe homesforthe mentallyretarded.

Tabie 8. E@imated number of residenta 8S yeare and over in nursing homes and board

and care homes, and number per 1,000 population 85 yeare and over, by type of home

and geographic region: United states, 1881

Gsog~hic rsgfon

Eeflmatsd number of rssiderrfs85 years wrd over inNursing homes’ Bosrdarrd care homes’s

Nu~bw#r Nu~b&per

Number in yo:ber~

thouewrds p0pLlation4 popLation4

Unitsd8tates . . . . . . . . . . . . . . . . 552 175.1 64 20.3

Northeast. . . . . . . . . . . . . . . . . . . 131 183.0 15 20.9

Midwest. . . . . . . . . . . . . . . . . . . 190 221.4 10 11.7

south . . . . . . . . . . . . . . . . . . . . . 182 157.9 19 18.5

West . . . . . . . . . . . . . . . . . . . . . 83 124.8 20 36.2

‘Excludeshospital-basedfacilities.

2 Exsludea8,578 ncnrespondingboardandsafe homes

‘Excludes13,169 boardand safe homesforthe mentallyratefdad.

4Baaadon U.S. Bureauofthe Censusestimatesofthe United States resident population ages S5 yeas and over, as of July 1,

1881.

Tabie 9. Estimated number of residenta 86 yeare and over in nursing homes and board

and care homes, and number per 1,000 population 86 years and over, by type of home

and geographic region: United States, 1991

Estimated number of residents 65 years and over inNursing homes’ Board and sare homes20s

Nu~b&per Mr~b&per

Number in Number In

Geographic region thousands popkitimr4 thousands popL/stion4

Unitsd Stafss . . . . . . . . . . . . . . . . 1,31s 41.5 207 6.5

Northeast. . . . . . . . . . . . . . . . . . . 295 41.8 52 7.4

Midwest . . . . . . . . . . . . . . . . . . . 423 54.6 32 4.1

South. . . . . . . . . . . . . . . . . . . . . 421 38.5 61 5.6

west . . . . . . . . . . . . . . . . . . . . . 173 29.3 62 10.5

‘Excludes hosp”ti-basal faciWies.

2ExClUdes 8,578 nonraspwKling board snd care homes.

%xdudea 13,169 boardandcara homesforthe mentsllyretarded.

4Bssedon US. Suresuofthe Censusestimatesof the UnitedStstaaresidentpopulaficnages 85 years andovar,es ofJu~ 1,

1991.

the 1991 NHPI were examined. Home while minimizing the effects of

health care is provided to individuals disability and illness-including

and families in their places of residence terminal illness.

for the purpose of promoting, Table 10 shows the regional

maintaining, or restoring health, or for distribution of home health patients in

maximizing the level of independence 1991 (4). When the figures in table 10

were viewed in conjunction with the

nursing home and board and care home

datq the regions showed widely

difEering health care usages. Since

three-fourths of all home healtlh care

patients were 65 years and over (5),

estimates were made for this age group.

Percents of the U.S. population by

region were computed for these home

health care patients to compare them

with the rates that were cdcuhdted for

the nursing home and bosrd end care

home residents 65 years and over in

table 9.

Table 10 shows the West had

substantially fewer (101,000) home

health care patients 65 years and over

than the other regions, while tlhe South

had the most (321,000). Since the South

had nearly twice as many people m the

West in the 65 yeara and over age group

(10.9 million versus 5.9 million

according to U.S. Bureau of the Cenaua

estimates for 1991), this dispwity in

numbers of home health care patients

could be misleading. By dividkg the

number of patients by the number of

people in each region, a standardized

rate was produced that gave a more

meaningful regionrd comparison.

Although not as disparate as the

raw numbers indicated, the rates per

1,000 population in table 10 still showed

that the West used home health care

much leas than the South (17.1

compared with 29.3). Even more

noticeable in this table was the

Northeast’s 41.8 usage rate, by far the

highest of all regions. To put these three

figures in perspective, consider the

following. If the usage rate in the West

were 29.3 instead of 17.1, the number of

people 65 years and over using home

health care in the West would have been

171,000 instead of 101,000. IjEit were

41.8, the number would have been

248,000.

Combining the information obtained

from tables 9 and 10 showed that for

the United States as a whole, for every

1,000 people 65 years of age and over,

approximately 77 people were either in

nursing homes (42 people), in board and

care homes (6 people), or receiving

home health care (29 people),

The NortheasL with 91, and the

Midwest, with 84, were above this

national rate, while the South was
Advance Data No. 244 ● February 23, 1994 5

Table 10. Eatlmated number of current patients 65 years and over receiving home health

care, and number per 1,000 population 65 years and over, by geographic region:

United States, 1991

Estimated number of

current home health Number par l,cXXI

Geographic ragion patients (in thousands)’ U.S. population

United States . . . . . . . . . . . . . . . 918 28.9

Northeast . . . . . . . . . . . . . . . . . . 295 41.8

Midwest . . . . . . . . . . . . . . . . . . . 201 25.6

South . . . . . . . . . . . . . . . . . . . . 321 29.3

West . . . . . . . . . . . . . . . . . . . . . 101 17.1

‘Swrca unpublishti home heeilh care date from the 1S81 NHPI.

2Bseed on U.S. Bureau of the census estimates of the Unkd States resident population ages S5 years arni OVW, se of July 1,

1881.

Table 11. Ratio of board and cara home residents 65 years and over to home health care

patients 66 years and over, by geographic region: United States, 1991

Ratio of &ard end care home residents

Geographic region to home hes#tr care pstierrts’’2(percent)

Unitad States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.5

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.6

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.9

south. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.0

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61.4

‘Excludes 8,57S nonraqxmding boerrl SIXI care homes.

2 Escludes 13,1SS board end cers homes fer the mentrlly retards-i

Table 12. Percent distribution of residents In nursing homes and board and care homes

by typa of facility and age of resident, according to geographic region: United States,

1991

Geographic ragion

Type of facility and age of resident ToteI Nodhaaat Miokast south Weat

Nureing homes’

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Undar22years . . . . . . . . . . . . . . . . . . . . . . . . . .

22t064yeers . . . . . . . . . . . . . . . . . . . . . . . . . . .

65t084years . . . . . . . . . . . . . . . . . . . . . . . . . . .

85years andover . . . . . . . . . . . . . . . . . . . . . . . . .

All board and osre homes2

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Undar22years . . . . . . . . . . . . . . . . . . . . . . . . . .

22t084years . . . . . . . . . . . . . . . . . . . . . . . . . . .

65t084years . . . . . . . . . .’....... . . . . . . . . . .

85years and over . . . . . . . . . . . . . . . . . . . . . . . . .

Soard and care homes not for the mentally retarded2

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 22years . . . . . . . . . . . . . . . . . . . . . . . . . .

22t064yaars . . . . . . . . . . . . . . . . . . . . . . . . . . .

65t084years . . . . . . . . . . . . . . . . . . . . . . . . . . .

S5years andover . . . . . . . . . . . . . . . . . . . . . . . . .

Soerd and oara hornas for the mentally retardad2

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under22years . . . . . . . . . . . . . . . . . . . . . . . . . .

22t064years . . . . . . . . . . . . . . . . . . . . . . . . . . .

65t064yeans . . . . . . . . . . . . . . . . . . . . . . . . . . .

85yearsandover . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

0.2

7.4

53.7

3s.7

100.0

4.3

43.4

36.7

15.6

100.0

2.1

28.7

47.0

21.2

100.0

10.1

79.1

9.6

1.2

Peroantdistribti”on

100.0

0.2

5.6

52.3

41.8

100.0

3.7

41.3

39.3

15.7

100.0

1.5

30.0

48.0

20.5

100.0

10.8

76.9

11.9

0.4

1OQ.o

0.2

7.9

51.3

40.7

100.0

6.0

!s6.5

26.5

11.0

100.0

3.2

39.9

39.1

17.8

100.0

9.8

79.6

9.0

1.6

100.0

0.2

7.2

56.9

35.6

100.0

3.9

38.3

40.5

17.3

10+3.0

2.1

27.4

46.6

21.7

100.0

10.3

76.2

11.6

1.9

0.3

9.5

54.1

36.1

100.0

3.8

39.0

39.2

18.0

100.0

1.9

25.0

49.6

23.4

100.0

9.6

82.9

6.7

0.9

‘=CkIdeShOSDikWMSSd fSCiliieS.

2Excludes 8,578 nonresponding board end care homes.

somewhat below it at 73. The West,

with57,wasnot onlywellbelow the

national rate but so farbelowthe

Northeast rste that itneedsto beput in

perspective. Forexsmple, ifthe West

had the same rate as the Northeast (91

per 1,000 instead of 57), its number of

people in nursing homes, board and csre

homes, and home health care would

have been 538,000 instead of 331,000.

(Note: These numbers might include

multiple counting of some individuals.

This was possible because of the

7-month duration of the survey, which

was sufficient time forindividuak to be

discharged fkom one setting snd

admitted to snother.)

Looking past these combined rates

to the three sepsrate rates, it was found

that, relative to the other regions:

The Midwest relied heavily on

nursing homes, little on board snd

care homes, and moderately on home

health care.

The Northeast relied heavily on rdl

three, with much more relisnce on

home herdth care thsn the other

regions.

The South had rates near the nationrd

average for all three, so it had

moderate usage of 811three types of

care.

The West relied relatively little on

nursing homes snd home health care,

while relying more than rtny other

region on bosrd snd care homes.

As a further comparison of the use

of board snd care homes versus the use

of home heslth care by region, table 11

displayed the ratio (expressed as a

pereent) of board rind care home

residents 65 years and over, to home

health care patients 65 yesrs snd over.

The table showed the West with

61.4 percent as many bosrd snd csre

home residents as home heslth care

patient% or, expressed snother way, the

West had 39 pereent more home herdth

patients thsn bosrd snd csre home

residents. Each of the other tluee

regions, whose ratios ranged between

15.9 percent and 19.0 percen~ had better

than 80.0 percent more home herdth care

patients than bosrd snd csre home

residents.

This Iinding for the West seemed to

support the third possibility mentioned
6 Advance Data No. 244 ● Februarv 23, 1994

Table 13. Number and percent distribution of board and care homes by type of home and bed-size group, according to geographic

region: United States, 1991

Geographic region

Type of home and b&-size group Total Northeast Midwest South Wat

Board and safe homes not for the mentallyretarded’

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l–2bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3-9 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10-24 bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-69beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100-199bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200bedsormore . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l-2bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3-9bsds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10-24Ms.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-99bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100-199bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200 bedsormore . . . . . . . . . . . . . . . . . . . . . . . . . . .

Board and care homes for the mentally retarded’

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l-2bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3-9beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10-24bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-99bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100-199beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200bedsormore . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l–2beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wed s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10-24beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-99 be@ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100-199bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200bedsormore . . . . . . . . . . . . . . . . . . . . . . . . . . .

18,262 3,180

868 121

8,992 900

4,S83 t ,241

2,927 766

4s9 107

123 43

100.0 100.0

4.6 3.8

49.2 28.3

26.7 39.0

16.0 24.1

2.6 3.4

0.7 1.4

t3,169 2,460

1,645 290

9,068 1,584

t ,921 495

425 79

75 11

35 11

100.0 100.0

12.5 11.7

6s.9 64.3

t 4.6 20.0

3.2 3.2

0.6 0.4

0.3 0.4

Numberofhomes

4,005

286

1,898

1,266

478

59

16

Percent distribution

100.0

7.1

47.4

31.7

11.9

1.5

0.4

Numberothomes

4,812

767

3,187

691

124

32

11

Pereentdistrfbution

100.0

15.9

66.2

14.4

2.6

0.7

0.2

4,791

221

2,044

1,379

979

146

22

100.0

4.6

42.7

28.8

20.4

3.0

0.5

2,299

216

1,559

362

131

21

10

100.0

9.4

67.8

15.7

5.7

0.9

0.4

6,286

240

4,150

995

702

157

42

100.0

3.8

66.0

15.6

11.2

2.5

0.7

3,578

372

2,726

373

91

11

3

100.0

10.4

76.2

10.4

2.5

0.3

0.1

‘Excludes8,578 nanrespondingboardandcars homes.

earlier—namely, that in some part3 of

the country, board and care homes were

chosen asaltematives to home health

care.

Thefollowingare additional

findings for board and care homes.

The vast majority were small, with

27,377 (87,1 percent) having less than

25 beds (table 3); and, to bemore

precise, two-thirds of the homes had

less than 10 beds (not shown).

Most (19,726 or 62.8 percent) were

under for-profit ownership (table 3).

Board and care homes had an overall

occupancy rate of 85.6 percent

(table 5). The smaller homes had

higher occupancy rates than the larger

h0me8; this was directly opposite to

thenursinghomes, whichshowedthe

larger homes with higher occupancy

rates than the smaller homes.

Table 12 shows the distributionof

residents in board and care homes. More

than one-half of their residents were

over65 years ofage and another

43 percent were 22-64 year60f age.

However,whenthe boardandcare

homes were split into those primarily

serving the mentally retarded and those

that were not,a much different age

distribution appeared. Inthe homes that

were NOT for the mentally retarded,

nearly 70percxmt of their residents were

65 years and older. By contrast, only

about 10 percent of the residents in

homes for the mentally retarded were 65

years and older. These figures were

fairly consistent for each region.

Table13 displays the bed-size

difEerencesbebveen thesetwotypesof

board and care homes. The most

common bed size group for both types

of homes was three to nine beds (about

9,000 homes in each). In the one to two

bed range, there were nearly twiceas

many board and care homes for the

mentally retarded as there were homes

not for the mentally retarded. However,

for each ofthe other bed-size groups,

there were substantially fewer homes for

the mentally retarded.

Insummary,thedata fornursing

homes,boardand carehomes, and home

health agencies suggested that the health

care needs of the older population

varied greatly from onepart of the

country to another. The fact that the

higher rates for using these services
Advance Data No. 244 ● Februarv 23, 1994 7

occurred in the Northeast and Midwest

(colder climates), and the lower rates

occurred in the South and West (warmer

climates) might be significant. In all

likelihood, the rates also varied greatly

nom State to State, even within the

same region. These issues will be

explored further and will be included in

a future report.

References

1.

2.

3.

4.

5.

6.

%mcco A. Nursinghome

characteristics:1986 Inventory of

Long-Term Care Places. National

Center for Health Statistics. Vhal

Health Stat 14(33). 1989.

HoUis G. Design and methodology of

the 1967 Master Facility Inventory

Survey. National Center for Health

Statistics. Vital Health Stat 1(9).

1971.

Roper D. Nursing and related care

homes as reported from the 1982

National Master Facility Inventory

Survey. National Center for Health

Statistics. Wtal Health Stat 14(32).

1986.

Delfosse R. Hospice and home health

agency characteristics 1991 National

Health Provider Inventory. National

Center for Health Statistics. Wal

Health Stat. In preparation.

Strahan G. Overview of home health

and hospice care patientx

Preliminary data from the 1992

National Home and Hospice Care

Survey. Advance data from vital

health statisti~ no 235. Hyattsville,

Maryland National Center for Health

Statistics. 1993.

Ekhmd D. The Agency Reporting

System for maintaining the national

inventory of hospitals and

institutions. National Center for

Health Statistics. Vital Health Stat

1(6). 1968.

Technical notes

Mailout

The National Center for Health

Statistics (NCHS), through a

Reimbursable Agreement with the

Bureau of the Census, conducted the

1991 NHPI. The facility mailing list

consisted of 73,106 addresses from a file

created by NCHS by matching State and

national directories of nursing homes

and board and care homes obtained

through the Agency Reporting System

(6) against a master file of such places

iiom the 1986 Inventory of Long-Term

Care Places (the last such survey

conducted).

Any facility found in a directory

that did not appear on the master Iile

was considered to be new, was assigned

a unique JD number, and was added to

the facility file. After adding the new

facilities, a matching process was

conducted to remove duplicates from the

file. Any duplicates remaining on the

iile after this process would, in theory,

be reported by respondents (per

instructions on the questionmhe).

The first questiomaire mailout was

initiated by the Bureau of the Census on

April 5, 1991, and this was followed a

week later by a reminder letter. On May

10, a second questionnaire was sent to

all nonresponding facilities, and on June

14, a third questiomaire was sent to the

remaining nonrespondents.

Ttvo weeks after the end of the

third mailout, approximately 21,600

facilities had still not responded to the

survey. Of the 21,600 facilities, nearly

17,200 were board and care homes.

Because of this large number of

nonrespondents, resource constraints

made it impossible to conduct telephone

followups for all of these cases. The

decision was made to followup all

nursing home nonrespondents but only

one-half of the board and care

nonrespondents. As a resul~ there were

8,578 nonresponding board and care

cases that will not be included in the

data presented in this report.

The remaining facilities were

followed up by telephone and this

procedure was completed on November

1, 1991. The final facility response rate,

excluding those board and care places

not in the followup, was 99 percent

(there were 262 refusals). If the 8,578

were counted in the calculation as

in-business and nonresponses, the

response rate for ticilities would be

84 percent.

Classification system

Excluding the 8,578 nonresponding

board and care homes and the 262

facilities that refused to participate, each

of the remaining facilities was classified

as either a nursing home (15,511) or a

board and care home (31,431).

During the classification process,

the file was found to contain many

facilities for the mentally retarded,

including Intermediate Care Facilities

for the Mentally Retarded (ICF-MR).

This was expected since State

directories of board and care homes

often include facilities for the mentally

retarded, and State directories of nursing

homes often include ICF-MRS.

For purposes of this survey, no

facilities for the mentally retarded were

classified as nursing homes. However, if

a facility was primarily a nursing home

and happened to be cetied as an

ICF-h@ it would have been classified

as a nursing home. As a result, this file

contains 24 nursing homes that were

also ICF-MRS, 1,965 board and care

homes that were sIso ICF-MRS, and

11,204 board and care homes that were

non-ICF-MR facilities for the mentally

retarded.

The classification system used to

separate nursing homes from board and

care homes relied heavtiy on the

following criterkx

. how the rmpondent categorized the

home

● if the home was certiiied or not

. how many beds were set up and

staffed for use (a nursing home by

NCHS’S definition must have three or

more beds)

● ifregistered nurses or licensed

practical nurses were employed by

the home

● what types of services were offered in

the home

. whether the home primarily served

people who were mentally retarded

Based on combinations of these

results, each facility was assigned a

code of either “NH” or “BC.” Neither

the classification matrix nor the

questiomaire could be included in this

report due to space limitations. They

will instead be shown in future reports.

Definition of terms

Nursing honre-A nursing home is

a facility with three beds or more that is

either licensed as a nursing home,

certified as a nursing facility under
8 Advance Data No. 244 ● February 23, 1994

Medicare or Medicaid, identified as a

nursing care unit of a retirement center,

or determined to provide nursing or

medical care.

Freestanding nursing home—This is

a nursing home that is not part of a

hospital (neither structurally connected

to, nor organizationally considered part

of the hospital).

Hospital-based nursing home—This

is a nursing home that is part of a

hospital (either organizationally or

structurally).

Board and care homel%is is a

generic term used to describe a

residential setting that provides either

routine general protective oversight or

assistance with activities necessary for

independent living to mentally or

physically limited persons.

Bed—A nursing home or board and

care home bed is one that was set up

and staffed for use at the time of the

survey. Beds for day-care-only patients

were not included. For hospitals and

retirement centers, only the beds in their

nursing home units were included.

Resident—A resident is a person

who has been formally admitted to, but

not discharged from, a nursing home or

board and care home and who stayed in

the home the night prior to the survey.

Ownershi~nership refers to

the type of organization that controls

and operates the home. Proprietary

homes are operated under private

commercial ownership; nonprofit homes

are operated under voluntary or

nonprofit auspicss, which may or may

not be church related, government

ownership refers to homes operated

under Federal, State, or local

government auspices.

Occupancy rate-An occupancy

rate is the percent of beds that ‘were

occupied by residents at the time of the

survey. It is computed by dividing the

total number of residents by the total

number of beds.

Average bed size-Average. bed size

is the statistic produced by dividing the

total number of beds by the total

number of homes.

Beds per 1,000 population-—This is

the statistic produced by dividing the

total number of beds by the total

population (for the age group being

considered) multiplied by 1,000.

Suggested citation

Skrocco A. Nursing homes and board and

care homes. Advance data from vital and

health statiaticq no 244. Hyattsville, Maryland:

Nationai Center for Heaith Statistics. 1994.

Copyright information

All material appearing in this report is in the

pubiic domain and maybe reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Heaith Statistics

Director

Manning Feinleib, M. D., Dr. P.H.

Deputy Director

Jack R. Anderson

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Heaith Service

Centers for Disease Controi and Prevention

Nationai Center for Health Statistics m!

6525 Belcrest Road

Hyattaviile, Maryiand 20782

OFFICiAL BUSINESS

PENALTY FOR PRiVATE USE, $300

To receive this publication regularly, contact

the National Center for Health Statistics by

caiiing 301-436-8500

DHHS Publication No. (PHS) 94-1250
Number 245 ● March 2, 1994

Advance

Data

FromVi and HealthStatiatiosofthe CENTERS FOR DISEASE CONTROLAND PREVENllON/National Centerfor HealthStatistics

National Hospital Ambulatory Medical Care Survey: 1992

Emergency Department Summary

by Linda F. McCaig, M. P.H., Division of Health Care Statistics

In December 1991, the National

Center for Health Statistics inaugurated

the National Hospital Ambulatory

Medical Care Survey (NHAMCS) to

gather and disseminate information

about the health care provided by

hospital emergency and outpatient

departments to the population of the

United States. Ambulatory medical care

is the predominant method of providing

health care services in the United States.

Since 1973, data have been collected on

patient visits to physicians’ offices

through the National Ambulatory

Medical Care Survey (NAMCS).

However, visits to hospital emergency

and outpatient departments, which

represent a significant segment of total

ambulatory medical care, are not

included in the NAMCS (l).

Furthermore, hospital ambulatory

patients are known to difEerfrom office

patients in their demographic

characteristics and are also thought to

differ in medical aspects (2). Therefore,

the omission of hospital ambulatory care

from the ambulatory medical care

database leaves a significant gap in

coverage and limits the utility of the

current NAMCS data. The NHAMCS

fills this data gap. This survey was

endorsed by the American Hospital

Association, the Emergency Nurses

Association, and the American College

of Emergency Physicians.

This report presents data on

emergency department (ED) visits from

the 1992 NHAMCS, a national

probability survey conducted by the

Division of Health Care Statistics,

National Center for Health Statistics,

Centers for Disease Control and

Prevention. A forthcoming report will

provide data on visits to outpatient

departments.

The estimates presented in this

report are based on a sample rather than

on the entire universe of hospital ED

visits. Therefore, they are subject to

sampling variability. The technical notes

include a brief overview of the sample

design used in the 1992 NHAMCS and

an explanation of sampling errors. A

detailed description of the 1992

NHAMCS sample design and survey

methodology will be published.

The ED Patient Record form is used

by hospitals participating in the

NHAMCS to record information about

patient visits. This form (figure 1) serves

as a referenee for readers as they review

the survey tidings presented in this

document.

Patient characteristics

During the 12-month period from

January-December 1992, an estimated

89.8 million visits were made to ED’s

of non-FederaI, short-stay, or general

hospitals in the United States-about

35.7 visits per 100 persons. ED visits by

patient’s age, sex, and race are shown in

table 1. Persons 75 years of age and

over had a higher ED visit rate (55.8

visits per 100 persons) than persons in

the five other age categories. Females

made 51.9 percent of all ED visits.

There was no significant difference in

total visit rates by sex.

White persons made 78.5 percent of

all ED visits, with black persons and

Asian/Paciiic Islanders accounting for

19.1 percent and 1.6 percent,

respectively. The visit rate for black

persons was si~cantly higher than for

white persons overall and in the

following age categories 15–24 years,

25-44 years, and 45-64 years.

Emergency department visit

characteristics

The largest proportion of ED visits

were made in the South (32.9 percent);

the Midwest had a higher ED visit rate

(42.0 visits per 100 persons) than the

West (31.5 visits per 100 persons)

(table 1).

Urgencyof visit

The majority (55.4 percent) of ED

visits were not urgent and 44.6 pereent

*SEwccs.

-# ~*, *$’

-g

U.S. DEPARTMENTOF HEALTHAND HUMANSERVICES

.& Public Health Service

:% Centers for Disease Control and Prevention

s

%.

>

National Center for Health Statistics CDC

%*41X C~ FGR USE&5E CONTIWL

AND PREwNllCN
2 Advance Data No. 245 ● March 2, 1994

Department of Health and Human Sefvices

Public Health Service, Centers for Disease Control

OMB No. 0920-0278

National Center for Health Sbmistica CDC 64.53

NOTICE - Information cnntamed on this form wh!ch would permit identification of any individual or escabhshment has been collected wtth a guarantee that it will be held in

strict confidence, will be utad only for Purposas stated for this study, and WIII not be disclosed or released to others without the consent of the indiwdual or the establishment

in accordance with section 306(d] of the Pubhc Health Service Act (42 USC 242m). Public rapwtmg burden for this phtsa of the survey is estimatedto weraga 3 minute$ pet

raspome. If vou have any commentt regarding the burden est!mate or any other aspect of this twwv, including suggestions for raducing this burden, send them to the PHS

Reports Clesrance Officer; Attn: PRA: HHH Building. Rm. 721 .8; 200 Independence Ave., S.W., Wa$hinqton, OC 20201, and to the Office of Management and Budget; Poperwork Reduction Project (092U1278]; Wetfmgton, DC 20503.

—

NATIONAL HOSPITAL AMBULATORY

MEDICAL CARE SURVEY

EMERGENCY DEPARTMENT

PATlENT RECORD

.—. — —.—.—— ———— ——. — -——. — ——— ——— ——— —.——.—. ———— .——.— .

3. DATE OF VISIT 5. SEX 6. RACE 7. ETHNICITY 8. EXPECTED SOURCE(S) OF PAYMENT 9. MAJOR REASON

I a White

(Check all that apply) FOR THIS VISIT

~ , n ~ma,a , ~ ~,ack

(Check one)

! m Hitpanic 1 n Medicare 5 D l#$={#het t D I“jw-y,firatv itit

10. CAUSE OF INJURY

(Complete ~injury is marked

in 9. Describe cause and

pkxe of injury.)

13. URGENCY OF THIS VISIT

(Check only one)

, ❑ Urgent/Emergem

2(1 Nonwrgent

14. IS PROBLEM ALCOHOLOR DRUG-RELATED?

1 ❑ fUenhw

2 a Alcohol-related

—

3 U Drug.related

4 ❑ 6oth

I

E3fcimol

Aleut I

—

2 D Madicaid

6

3 0 $%’%mment 7uNochar9a

. n Pri”aml . n -h..

I 4~ Illnesa,follow*p —

r—r. —

I

2 U Injury, follow.up

i ❑ Patient paid

3 ~ llln~. first visit

, , I !

11. PATIENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER 12. PHYSICIAN’S DIAGNOSES

REASON(S) FOR THIS VISIT (In patient %own words)

●. Principal diagno$i$/

a. Most impartam:

problem wooi-md

with item Ila. —

b. other: b. Othar: —

c. Dthti c. Othar: —

15. DIAGNOSTICISCREENING SERVICES

(Check all ordered or prouided. )

I ❑ Nom 7 ❑ ate3t X.ray

2 ❑ Wad prassurechack 9 ❑ Extremity x-ray

3 Q Urinalysis to Q CTscan/MRl

4 ❑ HIV serology 11a Otgfiagnostic

5 a Other blood test

12 ❑ Other (Specrfy)

6 D EKG

7 ❑ Mantd statusexarn

1.

2

3.

4.

5.

17. MEDICATION

(Record all new or continued mediation ordered, administered, or provided

at this utsit. Use the same bmnd name or generic name entered on any Rx

or medical record. Include immurtiaattins and desemntizing agentm )

16. PROCEDURES (Check all provided on thi6 vieit)

1 n Nona 6 ❑ Wound cam

2 ❑ E#oldoqoeal 7 ❑ Eve/ENT cant

a a Orthopedic am

30CPR

9 D Bladd w crtheter

4 ❑ IV fluidz

to O Lm!barfmct”ra

5 ❑ NG tube/

qastric Iavaae

18. DISPOSITION THIS VISIT

(Check all that apply)

I ❑ Ratumto ED PRN

2 D Return to ED . appointment

3 ❑ Rmum to mfamng phyaicisn

4 ❑ Refertootherphysicizm/clinic

5 0 Mmit to hospaai

6 ❑ Tmnsfar to other facility

? U DO/Vdiad in ED

8 a Left AMA

9 0 No follow+lp plamwd

100 Other (Specify)

19. PROVIDERS SEEN

THIS VISIT

(Check all that apply)

1❑ Raatient/intern

2 ❑ Staff Physicim

3 0 Odter physician

4 ❑ mv5i.5~ amstant

5 0 Nur3e practitioner

8 ❑ Ragistwednurse

7 ❑ LiLi~t3ed practical

a (1 Nur#a ●ide

Figure 1. Patient Record form.
Advance Data No. 245 ● March 2, 1994 3

Table 1. Number, percent distribution, and annual rate of emergency department visits with corresponding standard errors by selaeted

patient and emergenoy department charaoterlstkx United States, 1992

Number of Stsndard standard Number of

w“sitsin error in P.wcent

Characteristic

error of

thousands ffrousends

visits per 100

distribution percent persons per yes+

Allvisits. . . . . . . . . . . . . . . . . . . . . . .

Patientcharacteristic

Age

Under 15yeara . . . . . . . . . . . . . . . . . . .

15-24 years. . . . . . . . . . . . . . . . . . . . .

2544years . . . . . . . . . . . . . . . . . . . . .

4E-64years . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . .

75years and over . . . . . . . . . . . . . . . . .

Sex and agw

Female. . . . . . . . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . . . . . .

15-24 yeara . . . . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . .

75yeara andover . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . . . . . .

16-24years . . . . . . . . . . . . . . . . . . .

25-44years . . . . . . . . . . . . . . . . . . .

4w54yeaB . . . . . . . . . . . . . . . . . . .

65-74year3 . . . . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . . . . .

Race and age

Wlsiie. . . . . . . . . . . . . . . . . . . . . . . . .

Under15yaars . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . .

2E-44years . . . . . . . . . . . . . . . . . . .

45-84years . . . . . . . . . . . . . . . . . . .

8%74yeara . . . . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . .

Under15yeara . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . .

2541years . . . . . . . . . . . . . . . . . . .

45-64yeam . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . .

75yearaandover . . . . . . . . . . . . . . . .

Allotherracwt

Asian/Pacificlslander. . . . . . . . . . . . . . .

Americanindian/EskimolAleut.. . . . . . . . .

Emergencydepartmerrtcharacteristic

Geographicragiom

Northeast . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . .

South. . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . .

89,796 3,202 100.0 ... 35.7

22,523

14,846

27,240

12,509

5,808

6,871

1,465

702

1,087

526

267

313

26.1

16.5

30.3

13.9

6.5

7.7

1.3

0.4

0.7

0.4

0.2

0.3

39.9

43.2

33.5

25.8

31.4

55.8

46,612

10,196

8,051

14,045

6,628

3,350

4,342

43,164

12,327

6,797

13,195

5,680

2,456

2,529

1,888

640

421

615

302

175

216

1,605

676

336

560

279

121

143

51.9

11.4

9.0

15.6

7.4

3.7

4.8

48.1

13.7

7.6

14.7

6.5

27

2.8

0.4

0.6

0.3

0.4

0.3

0.2

0.2

38.1

37.0

46.6

34.0

28.3

32.9

56.4

0.4 36.3

42.7

39.6

33.0

25.2

29.7

54.8

0.6

0.2

0.4

0.2

0.1

0.1

70,47a

16,878

11,598

20,579

10,134

5,017

6,272

17,150

5,132

2,877

5,640

2,111

835

505

3,006

1,028

628

845

477

262

288

1,082

761

214

437

Isir

68

64

78.5

18.6

12.9

229

11.3

5.6

7.0

19.1

5.7

3.2

6.5

2.4

0.8

0.6

1.3

0.8

0.4

0.6

0.4

0.2

0.3

1.2

0.9

0.2

0.5

0.2

0.1

0.1

33.6

37.5

42.2

30.4

24.3

30.7

*.2

54.5

57.3

!%.4

68.6

42.3

4! .6

51.7

1,400

W69

247

315

1.6

+0.9

0.3

0.4

--—

16,950

25,790

29,642

17,515

1,106

2,051

1,778

1,546

18.9

26.7

32.9

19.5

1.2

1.9

1.8

1.6

33.9

42.0

35.0

31.5

‘BssedonU.6.BureauoftheCansussstknatesofthecivilian, noninetiruhaliieclpopu!afimoftlwlfnitwl8tatesaeofJulyl,1892.

were urgent/emergent (table 2). When than 15 yearsof age. There wasno (table 3). Eighty-seven percent of all ED

compared with all other age categories, significant difference between urgent or visit8 were first visits for the presenting

persons 75 yearsof age and overhad nonurgent visit rates by sex. problem.

the highest urgent visit rate (36.6 visits

per 100 persons). Persons 15-24 ye8rs Type of visit Injury-related visits

ofagehad ahigher rate ofnonurgent The majority of ED visits A visit was considered to be

visits (26.3 visits per 100 persons) than (58.5 percent) were made for illness and injury related if ’’injury, flrstvisit”or

any other age group except children less 35.2 percent were made for injury “injury, follow-up’’ was recorded in
4 Advance Data No. 245 ● March 2, 1994

Table 2. Number and annual rate of urgent/emergent and nonurgent emergency department visits with corresponding standard errors by

patient’s age, sex, and race: United States, 1992

Number of

Number of Number of

Number of Standard

rtorwrgerrt

urgent visits nonurgent Standard vkits per

urgent visits in error in per 100 parsons visits in error in 100 persons

Patient characteristic thousands thousands per yesrT thousands thousands pw year’

All urgentiemergent visits. . . . . . . .

Age

Under 15years . . . . . . . . . . . . . . . . . . .

15-24 yeara . . . . . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . . . . .

45-64 yeara . . . . . . . . . . . . . . . . . . . . .

S5-74years . . . . . . . . . . . . . . . . . . . . .

75yeara and over . . . . . . . . . . . . . . . . .

Sex and age

Female . . . . . . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . . . . . . .

15-24 yeara . . . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . . . . . .

45-84 years . . . . . . . . . . . . . . . . . . . . .

65-74yaars . . . . . . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . .

Under15years . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . . . .

25-44years . . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . . . . . .

Race and age

White . . . . . . . . . . . . . . . . . . . . . . . . .

Under15yeara . . . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . . . .

25-44years . . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . .

Under15yeara . . . . . . . . . . . . . . .

lG24years . . . . . . . . . . . . . . . . . . . . .

25-44years . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . . . . . .

40,079 1,603 15.9 49,718 2.175 19.8

24.2

26.3

19.9

12.6

12.8

19.1

20.3

23.1

29.3

20.5

13.8

13.8

19.6

19.2

25.3

23.3

19.2

11.4

11.7

18.3

18.3

22.8

25.2

17.9

11.8

12.3

19.2

31.8

34.0

36.2

36.4

21.6

17.6

17.0

8,874 1,030 15.7 13,649

5,800 353 16.9 9,048

11,080 514 13.6 16,160

6,379 321 13.2 6,131

3,434 193 18.6 2,371

4,513 236 36.6 2,358

756

499

818

334

164

148

20,338 904 15.7 26,275 1,216

34a

299

484

226

119

106

1,087

446

241

422

154

74

73

3,642

2,992

5,573

3,159

1,943

2,629

418

213

13.9

17.3

13.5

12.5

19.1

36.7

6,353

5,059

8,472

3,471

1,407

1,513

295

174

114

161

19,741 945 16.2 23,443

5,031

2,807

5,508

3,220

1,492

1,W4

628 17.4

18.4

13.6

13.6

18.0

36.5

7,298

3,990

7,889

2,660

984

845

181

256

187

109

107

32,097 1,560

589

325

452

300

160

222

833

531

99

191

109

56

51

15.3

14.7

17.0

12.5

12.5

18.3

37.0

22.8

23.3

20.2

23.2

20.7

24.1

34.7

38,361

10,250

6,938

12,106

4,928

2,020

2,141

9,992

3,045

1,847

3,589

1,076

289

166

2,005

664

437

892

286

160

143

703

330

178

307

111

40

25

6,629

4,882

8,473

5,206

2,997

4,131

7,156

2,087

1,030

2,271

1,035

396

339

‘BasadonU.S. BureauoftheCansus estimatssofthe ctihsn, nonin~tionaliied populationofthe UnitadStatesas ofJulyl, 1992.

item 9. AImost 31.6 million ED visits

were made for injury (table 4). Persons

15–24years ofage had ahigher

injury-related visit rate (18.9 visits per

100 persons) than persons in eachof the

other five age categories. Males had

higher injury-related visit rates (14.8 per

100 persons) than females (10.5 per 100

persons) overall and in each age

category except for65–74 years and75

years andover, where females had

higher rates. There was no significant

difference between injury-related visit

rates by race. However, black people

had a higher rate than white people

among persons 25-44 years ofage,

while white people had a higher rate

than black people inthe75 years and

over ageeategory.

Causeof injury

Up to three external causes of

injury are coded and classified according

to the International Classificationof

Diseases, 9th Revisioq Clinical

Modification (ICD-9-CM) (3).

Displayed intable5 are ED visits

by the first-listed cause of injuly using

the major cause of injury categories

specified bythe ICD-9-CM. “Other

accidents’’wasthe most frequently

recorded cause of injury and represented

35.8 percent of visits in which a cause

was reported. Aeeidental falls

(26.6 percent) and motor vehic!le

accidents (14.3 percent) were also

prominent on the list.
Advance Data No. 245 ● March 2, 1994 5

Table 3. Number and percent distribution of emergency department visits with

corresponding standard errors by major reason for this visit United states, 1992

Number of Standard Standard

w“sitsin error in Percent acror of

blsit shsracteristic thousands thousands ditiibution oarserrt

Allvisita . . . . . . . . . . . . . . . . . . . . . . . 89,796 3,202 100.0 ...

Major reason for this visit

Allihweavisits . .. . . . . . . . . . . . . . . . . 52,528 2128 58.5 0.9

Illness, fnstvisit. . . . . . . . . . . . . . . . . . 49,691 2,033 55.3 0.9

Illness, follow-up . . . . . . . . . . . . . . . . . . 2,637 229 3.2 0.2

All injury visits . . . . . . . . . . . . . . . . . . . 31,567 1,210 35.2 0.7

Injury, first visit . . . . . . . . . . . . . . . . . . . 28,369 1,046 31.6 0.7

Injury, follow-up . . . . . . . . . . . . . . . . . . . 3,178 241 3.5 0.2

Allvis.tsfor other reasons . . . . . . . . . . . . 4,4s0 511 4.9 0.6

Unknown . . . . . . . . . . . . . . . . . . . . . . . 1,271 16s 1.4 0.2

Table 4. Number, percent diatrlbution, and annual rate of injury-relsted emergency

department visits with corresponding atsndard errors by patient’s age, sek and racm

United States, 1992

Numbarof Standard Standard Number of

visits in error in Percent error of

Patient characteristic

viiits per 100

~OUSSndS thousands distrib~”on persent persons paryaar’

Allinjury-related visita. . . . . . . . . .

Age

Under 15years . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . .

75yeare andover . . . . . . . . . . . .

Sex and age

Female . . . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . . .

15-24 yesrs . . . . . . . . . . . . . . . .

25-44 yeara . . . . . . . . . . . . . . . .

45-84 years . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . .

75yeare andover . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . .

Under15years . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . .

25+4y0ara . . . . . . . . . . . . . . . .

45-64yeara . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . .

Race and age

While . . . . . . . . . . . . . . . . . . . .

Under15years . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . .

25-44years . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . .

75yesrsandover . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . .

Under15yeara . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . .

25-44yeare . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . .

31,567

8,162

6,469

10,500

3,661

1,305

1,430

13,540

3,290

2,442

4,305

1,647

662

1,004

18,027

4,872

4,048

6,195

2,034

453

426

26,271

6,794

5,456

8,405

3,066

1,160

1,359

4,556

1,2i4

903

1,783

490

111

54

1,210

426

307

448

207

%

100

539

181

14s

237

101

66

77

734

278

206

260

151

49

50

1,160

372

293

418

197

93

101

304

136

82

151

61

23

12

100.0

25.9

20.6

3s.3

11.7

4.1

4.5

42.9

10.4

7.7

13.6

5.2

2.7

3.2

57.1

15.4

12.6

19.6

6.4

1.4

1.3

63.2

21.5

17.3

28.6

9.6

3.7

4.3

14.4

3.8

2.9

5.6

1.6

0.4

0.2

. . .

0.9

0.5

0.8

0.5

0.3

0.3

0.6

0.4

0.3

0.6

0.3

0.2

0.2

0.6

0.6

0.4

0.6

0.4

0.1

0.2

1.1

0.7

0.5

0.7

0.5

0.3

0.3

1.0

0.5

0.3

0.5

0.2

0.1

0.0

12.6

14.5

18.9

12.9

7.6

7.1

11.6

10.5

11.9

14.1

10.4

6.5

6.4

13.0”

14.8

16.9

23.7

15.5

8.7

5.5

9.2

12.5

15.1

19.9

12.4

7.4

7.1

12.2

14.5

13.6

17.7

16.2

9.6

6.8

5.5

‘Baaed on U.S. Bureauofthe Ceneus@“matesofthe cMlian,noninstiruhaliiad populaticmoftlw UnitedStatesas ofJuly1,

1s92.

Alcohol- ordrug-related problem

Over 2.7percent of ED visits were

recorded asbeing alcohol related and

1.1 percent were drug related (table 6).

For injury-related ED visits, the

proportion of visits that were alcohol

related (3.6percent) was higher than

that for noninjury-related visits

(2.3 percent). The most commonly

recorded principal diagnosis for an

alcohol-related ED visit was alcohol

abuse, and fora drng-related visit it was

“poisoning by other and unspecified

drngsandmedicinel substances.”

Reasonforvisit

Initemll of the Patient Record

form, thepatient’s (orpatient

surrogate’s) “complaint(s), symptom(s),

or other reason(s) for this visit (In

patient’s own words)” is recorded. Up

to three reasons for visit are coded and

classified according to A Reason for

Viiit Classification for Ambulatory Care

(WC) (4). The principal reason is the

problem, complaing or reason listed first

in item llaof the ED Patient Record

form.

The RVC is divided into eight

modules or groups of reasons as shown

intable7. More than 71.3 percent of all

visits were made for reasons classified

as symptoms with general symptoms

accounting for 15.2percent of all visits

and symptoms referable to the

musculoskeletal system accounting for

14.8 percent.

The 20 most ikequently mentioned

principal reasons for visi$ representing

46.3 percent of all visits, are shown in

table 8. It is important to note that the

rank ordering presented in this and other

tables may not always be reliable

because near estimates may not differ

from each other due to sampling

variability. “Stomach and abdominal

pain, cramps and spasms” was the most

frequently mentioned reason for visit

overall (5.5 percent), while “laceration

andcuts-upper extremity” was the most

frequently mentioned reason for visit in

the injury module (2.6 percent).

Principal diagnosis

Theprincipal diagnosis or problem

associated with the patient’s most
Advance Data No. 245 ● March 2, 1994

Table 5. Number and percent distribution of emergency department viaits with corresponding standard errors by cause of injury

United States, 1992

Number of Standard Standard

visits in error in Percent

Cause of injury and E code’

error of

thousands thousands distribution percent

Allvis”b with an E code entered.. . . . . . . . . . . . . . . . . . . . 28,812 1,127 100.0 . . .

Otheracciderrts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E91&E928 10,309 477 35.8 0.7

Accidentalfalls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E660-E866 7,869 348 26.6 0.8

Motorvehicle accidents, traffic and non-traftkq . . . . . . . . . . . . . . . . . . .E81O-E825 4,130 196 14.3 0.5

Homicideand injury purposely inflicted byotherperaons . . . . . . . . .E960-E969 1,553 119 5.4 0.4

Accidents duetonatural and environmental factors. . . . . . . . . . . . . . .E900-E909 1,374 110 4.8 0.3

Accidentscaused bysubmersion, suffocation, andforeignbodies . . . . ..E910-E915 1,040 64 3.6 0.3

Otherroadvehicleaccidents... . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E82&E829 635 71 2.2 0.2

Surgical and medical procedures as the cause of abnormal reaction

of patient or later complication without mention of misadventure

atthetime of procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E878-E879 404 49 1.4 0.2

Drugs, medicinal and biological substances causing adverse effects

intherapeufic use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E930-E949 370 52 1.3 0.2

Accidetial poisoning bydmgs, medcinal sub~n~s, andtiologicals. . . . . .E650-E658 332 50 1.2 0.2

Accidetial poisoning byother solid andtiquid subSances, gases, andvapffi. .E860-E669 192 35 0.7 0.1

Suicide andself-infiicted injury . . . . . . . . . . . . . . . . . . . E950-E959 160 38 0.6 0.1

Accidents caused by fireandflames. . . . . . . . . . . . . . . . . . . . . . . . . .. E890-E699 127 25 0.4 0.1

Late effecfs ofaccidental injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E928 52 13 0.2 0.0

lnjuryundeterrnined whether accidentally orpurposely inflicted. . . . .E980-E969 39 10 0.1 0.0

Other? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 21 0.4 0.1

Unknowns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 45 1.1 0.2

‘Bmdmtie /ntemationa/ C/asfimdon of Dise~es, WRewsim, C/iniAMtifimtim (lCW~(3).

21ncludes railway amidenta (E600-E807); water transport accidents (E330-E33s); sir and spaca transpwi accidents (ES40-E345~ vehnicle accidents not slseMere classbiable (ES46-ES43);

pisadventurea topatients during surgical sndmedical care (ES7&E876); l~dintmetion (E97M978] aMinju~r~uH~ tiomo~tims tiww(EXW).

“Includes urmdable E codes and illegible E o+xk.

important reason for visit and any other

significant current diagnoses are

recorded in item 12. Up to three

diagnoses are coded and classified

according to the ICD-9-CM (3).

Displayed in table 9 are ED visits by

principal diagnosis using the major

disease categories specified by the

ICD–9-CM. Injury and poisoning

accounted for 32.7 percent of all visits,

and diseases of the respiratory system

accounted for 12.1 percent.

The 20 most frequently reported

principal diagnoses are shown in

table 10. These are categorized at the

three-digit coding level of the

ICD-9-CM and account for 38.4 percent

of all ED visits. The most commonly

recorded diagnosis was suppurative and

unspecified otitis media, occurring at

3.5 percent of all visits.

Diagnostic and screening services

Statistics on various diagnostic and

screening services ordered or provided

by hospital staff during an ED visit are

displayed in table 11. Approximately

87.9 percent of all ED visits included

one or more diagnostic or screening

service. The most frequently mentioned

diagnostic sewice was blood pressure

check, recorded at 73.7 percent of visits.

Other frequently mentioned services

included other blood test (28.7 percent),

chest x ray (16.8 percent), urinalysis

(15.2 percent), and extremity x ray

(15.1 percent).

Table 6. Number and percent distribution of alcohol- or drug-related emergency

department visits with corresponding standard errors: United States, 1992

Number of Standard standard

visita in error in Percent error of

Wit characteristic thousands thousands distribution percent

Allvisits . . . . . . . . . . . . . . . . . . 89,796 3,202 100.0 . .

Alcohol- or drug-related visit

Neither . . . . . . . . . . . . . . . . . . . 66,015 3,026 95.6 0.2

Alcohol-related . . . . . . . . . . . . . . 2,459 196 2.7 0.2

Drug-related . . . . . . . . . . . . . . . 996 91 1.1 0.1

Both . . . . . . . . . . . . . . . . . . . . 327 44 0.4 0.0

Readers should note that for items

8, 15, 16, 18, and 19, hospital stafl were

asked to check all of the applicable

categories for that item with thle result

that multiple responses could be coded

for each visit.

Procedures

Procedures were performed at

42.3 percent of ED visita (table 12). The

most frequently mentioned procedure

was the administration of intravenous

fluids, recorded at 14.4 percent of visits.

Other frequently mentioned procedures

were wound care (12.9 percent) and

orthopedic care (7.9 percent).

Expected source of payment

Expected sources of payment were

most often private/commercial insurance

(36.0 percent), Medicaid (22.7 ]percent),

and Medicare (15.1 percent) (ta~ble13).

“Patient paid” and “HMO/other

prepaid” were mentioned at 13.8 and

7.3 percent of ED visits, respectively.

The patient-paid category includes the

patient’s contribution toward “copayments” and “deductibles.”
Advance Data No. 245 ● March 2,1994 7

Table 7. Number and percent distribution of emergency department visits with corresponding standard errors by patient’s principal

reason for visit: Unfted States, 1992

Number of S&nw Standard

w“sit5in en-or in Percent

Princi@ reason rbr visit and RVG code’

error of

thousands thousands distributbn percent

Alltisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69,796 3,202 100.0 . . .

Symptom mcdule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S001-S988 64,049 2,420 71.3 0.6

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S001+099 13,615 543 15.2 0.3

Symptoms referable to psychological/mental diacrdera. . . . . . . . . . S100-S199 1,389 131 1.6 0.1

Symptoms referable to the newoua system

(excluding sense organs) . . . . . . . . . . . . . . . . . . . . . . . . . . ..S200+259 5,350 246 6.0 0.2

Symptoms referable to the cardiovascular/lymphatic system. . . . . . .S260-8299 659 62 0.7 0.1

Symptoms referable tothaeyesand eara. . . . . . . . . . . . . . . . ..~99 3,426 201 3.6 0.2

Symptoms referable to the respiratory system . . . . . . . . . . . . . . . S400-S493 10,333 663 11.5 0.4

Symptoms referable to the digestive system . . . . . . . . . . . . . . . . S54WS639 10,356 476 11.5 0.3

Symptoms referable to the genitounnery system. . . . . . . . . . . . . . S640-S828 3,131 175 3.5 0.1

Symptoms referable to the skin, hair, and nails . . . . . . . . . . . . . . S630-S699 2,453 156 2.7 0.1

Symptoms referable to the muaculoskeletal system. . . . . . . . . . . . S900-S998 13,324 560 14.8 0.4

Diseaae module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. DOO1-D999 2,828 1,666 3.1 0.2

Diagnostic, screening, and preventive module. . . . . . . . . . . . . . . . . X1OO-X569 754 8s 0.6 0.1

Treatment mcdule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. TIOO-T898 2#34 143 2.6 0.1

Injuries andadverse effectamodule. . . . . . . . . . . . . . . . . . . . . .. JOOIA899 18,261 773 20.3 0.6

Test raaulte module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. RI OO-R700 163 33 0.2 0.0

Administrative module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. A1OO-A14O 126 26 0.1 0.0

Other? ’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. U990-U989 1,231 161 1.4 0.2

‘BesedonA Reasonfir Vdt C/assirimb@rtirAnrbu/srcryCars (RVC)(4).

‘Includesprcblemsand mmpleirrtsnotelsewtwe clamilied,enb%! of “none,”blsnks,and illegibleentries.

Table 8. Number and percent distribution of emergency department visits wfth corresponding standard errors by the 20 prfnclpal

reasons for visft most frequently mentioned by patlenW United States, 1992

Number of StSndanl standard

visits in error in Percent

Reason fir visit and RVC code’ thousands thousands distribution zd

Allvieits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stomach and abdominal pain, cramps and spasms. . . . . . . . . . . . . . . . . .S545

Chest painand related symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . ..S050

Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S010

Headache, pain in head. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S210

l-aceratio nandcuts-uppe rexfrem” ~... . . . . . . . . . . . . . . . . . . . . . . ..J225

Shortness of breath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S415

Cough. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S440

Backsymptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S805

Symptoms rafersbleto throat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S455

Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S530

Pain, sitenot raferableto aspacific bodysyetem . . . . . . . . . . . . . . . . . ..S055

Earache orearinfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S355

Laceration andcut.s-facial area..... . . . . . . . . . . . . . . . . . . . . . . . ..J21o

Handandfinger symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S960

Necksymptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S800

SIdnmsh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S660

Laboradordficuitbreathing(dyspnea) . . . . . . . . . . . . . . . . . . . . . . . . .S420

Legaymptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S920

Kneesymptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S925

F~tandtoesymptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S335

Allotherraascns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

89,796

4,955

3,678

2&5

Z347

2,025

1,397

1,958

1,957

1,877

1,812

1,614

1,465

1,330

1,325

1,305

1,238

1,154

1,102

1,06s

3,202

246

250

271

155

143

131

2C4

116

172

168

120

133

.39

101

68

97

95

62

65

62

1,775

100.0

5.5

5.2

4.1

2.8

2.6

2.3

22

22

2.2

2.1

2.0

1.8

1.7

1.5

1.5

1.5

1.4

1.3

1.2

1.2

53.8

. . .

0.2

0.2

0.3

0.2

0.1

0.1

0.2

0.1

0.2

0.2

0.1

0.1

0.1

0,1

0.1

0.1

0.1

0.1

0.1

0.1

0.5

‘BssedcnAResscn forWitC&ssiricaiicrr rbrAmMsrcryCare (RVC)(4).
8 Advance Data No. 245 ● March 2, 1994

Table 9. Number and percent distribution of emergency department visits with correapondlng standard errors by principai diagnosis

United States, 1992

Number of Standard Standard

visits in error in Percent error of

Principal diagnosis and ICD-9-CM code’ thousands tfrousands distribution percent

Allvisfte . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89,796 3,202 100.0 . . .

Infectiousandparasiticdiseases. . . . . . . . . . . . . . . . . . . . . . . . ...001-139

Naoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Endwfine, nutritional, andmetahlic dseases andimmun~tisorders. . .240-279

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Diseasesofthe newoussyetemand sense organs. . . . . . . . . . . . . . . .320-3S9

Oiseaeesoffhecirculatorysystem . . . . . . . . . . . . . . . . . . . . . . ...390-459

Oiseasesoftheraepiretofysyatem . . . . . . . . . . . . . . . . . . . . . . ...460-519

Diseasesofthedigastivesystem. . . . . . . . . . . . . . . . . . . . . . . . ..520-579

Oiseaeesofthegenitourinaysystem . . . . . . . . . . . . . . . . . . . . . . . .560-629

Oiseaeasofthaskin andsubcufaneoustissue . . . . . . . . . . . . . . . . .680-709

Diseases of themusculoskeie@l sySemand conn@ive tissue. . ...710-739

Symptoms, signs, andill-definad condtions . . . . . . . . . . . . . . . . . ...780-799

Injuryandpoisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-999

Supplementa~classification.... . . . . . . . . . . . . . . . . . . . . . . . ..VOI–V82

Aliotherdiagnoses2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,113

254

1,087

2,381

8,026

3,875

10,905

5,469

3,610

2,666

3,812

10,484

29,389

3,000

2,511

1,012

215

35

73

206

365

179

605

280

202

193

165

496

1,092

170

157

142

3.5

0.3

1.2

2.7

6.7

4.3

12.1

6.1

4.2

3.0

4.2

11.7

32.7

3.3

2.6

1.1

0.2

0.0

0.1

0.2

0.3

0.2

0.4

0.2

0.2

0.2

0.2

0.3

0.7

0.2

0.2

0.2

'B=Wmtie /ntematiom/ C/asfimtion of Diseases, WRew3fm, C/inics/Mwfiricstion (lC~Ml (3).

21ncludesdisaasas eftheblood and bloed-forMing0rgSns (280-289); mmplicdonsof ~qnm~, cNldMti, mdtiepu~Mum (@W6~w~en’~l mmdmu0759); mdw!tinmtitions

originating in tie perinatsl pericd ~60-779).

‘includes blank diagnoses, unmdsble diagnoses, and Illagibie disgnosas.

Table 10. Number and percent distribution of emergency department visits with corresponding standard errore by the 20 principal

diagnoses most tlequently recorded by physician= United States, 1992

Number of Skurdard Standard

visits in error in Percent error of

Principal diagnosis and ICD-9-CM cmde’ thousands thousands distribution percent

Allvis”k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ----- 89,798 3,202 100.0 . . .

Suppurative andunspecified otitis media . . . . . . . . . . . . . . . . . . ...382

Symptoms involving respirato~ system andotherche@ symptoms. . . . . . ...786

Other openwound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-.873

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . ...789

Generai symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .781J

Acufeupper respiratory infactions ofmultiple orunepecifiad sfias. . . . . . . . ..465

Sprains andstrains ofother andunspecified parte of back . . . . . . . . . . . ...847

Other noninfectious gasfroententis andcoliiis . . . . . . . . . . . . . . . . . . . . ..558

Contusion oflowar limb andofother andunspecifiad sites. . . . . . . . . . . . ..924

Open wound of finger(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S83

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .493

Sprains andstrains ofankleandfoot. . . . . . . . . . . . . . . . . . . . . . . . . . .S45

Other disorders ofurethra and urinary tract. . . . . . . . . . . . . . . . . . . ...-.599

Open wound ofother andunspecified sites, except limbs. . . . . . . . . . . ...879

Contusion ofupper limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...923

Acute pha~ngifis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .462

Symptoms involving head andnack. . . . . . . . . . . . . . . . . . . . . . . . . . . .764

Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . .486

Bronchitis, notspecified aaacuteorchronic . . . . . . . . . . . . . . . . . ...490

Injury to blood vesseis ofhead and neck . . . . . . . . . . . . . . . . . . ..-. -..WO

Ail other diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,162

2,867

2,578

2,353

2,340

1,998

1,829

1,805

1,784

1,617

1,467

1,357

1,340

1,295

1,273

1;260

1,244

1,142

1,041

1,012

302

179

133

157

145

199

135

150

133

112

106

96

92

115

93

103

80

109

77

142

1,976

3.5

3.0

2.9

2.6

2.6

2.2

2.0

2.0

2.0

1.8

1.6

1.5

1.5

1.4

1.4

1.4

1.4

1.3

1.2

1.1

61.5

0.3

0.2

0.1

0.1

0.1

0.2

0.1

0.2

0.1

0.1

0.1

0.1

0.1

0.1

0.1

0.1

0.1

0.1

0.1

0.2

0.6

'B*timtie /n!emational C/asfiation of Diseases, WRetision, Cfinid Mtifimtim (iCPKw (3).
Advance Data No. 2450 March 2, 1994 9

Table 11. Number and percent distribution of emergency department visfts with corresponding stendard errors by selected

diagnoatickrx’eening service= United States, 1992

Number of vkits Standard error

Disgnosti@craening sem”ces ordered or provided by hospkaf staf?

Percent Standard error

in thousands inthousands distribution of percent

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89,796 3,202 Ifll.o . . .

Blood preasure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66,177 2,637 73.7 1.3

Other blcedteet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,812 1,069 28.7 0.6

Chest xray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,062 624 16.8 0.4

Urinalysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,620 621 15.2 0.4

IXtremityxray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,539 544 15.1 0.4

EKG2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,666 549 13.2 0.4

OtherdiagnoW.cimaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,363 452 10.4 0.4

Mentsletatusexsrn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,276 877 5.9 0.9

CTscsr@lR13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,161 157 2.4 0.2

Hhfserology’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 52 0.3 0.1

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,725 1,416 19.7 i.3

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,661 727 12.1 0.7

‘Numbermayaxcwxl totelbscausemors thsnorsaservicamaybe reportedpertisit.

2EKGiselec!rocrirdi0@em.

3CTisoom~edzed tomqrrephy.MRIIs magsetiereszwwe imaging.

4HIV is humeri immunedetkiewy vims.

Table 12. Number and percent distribution of emergency department visits with corresponding standard errors by selectsd procedures

United States, 1992

Numberofvisits Starrdarderror Percwnt

Proaedurasprovided byhospitalstaff’

Stsndarderror

in thousands in thousands distrilwtion ofpemarrt

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intrsvenousfluids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Woundeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Orthopadiceare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Eye/ENTcare2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bladderesthater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nasogaetrictube/gsetriclavage.. . . . . . . . . . . . . . . . . . . . . . . . .

Endotrachealintubation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CPR3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lumbar Puncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

69,786

12,955

11,550

7,072

2,464

2,319

S78

406

291

244

6,682

51,763

3,202

601

520

378

216

157

79

44

31

41

453

1,969

1W.o

14.4

12.9

7.9

2.8

2.6

1.0

0.5

0.3

0.3

7.5

57.7

.. .

0.4

0.4

0.3

0.2

0.2

0.1

0.0

0.0

0.0

0.4

0.8

~Numbermayexoead teralbecaussnwe Umnonaprocedure meyberepxIed pervisit

2ENTiseare, nose, and threat.

3CPR ie wdiopulmonaryreeuecitetiori.

Providers seen

A registered nurse and staff

physicisn were seen at 83.1 percent and

82.5 percent of ED visits, respectively

(table 14).

Disposition of visit

About 14percentof EDvisits

resulted in hospital admission (table 15).

Thirty-seven percent of ED visits

resulte dinareferralto another

physician orclinic, andfor25.Opercent

the disposition was “retumtoED

PRN.”

References

1. BrysntE, ShimizuI.Ssrnpledesign,

ssrnplingvarisnce, and estimation

procedures fortheNationrd

2.

3.

4.

5.

AmbulatoryMedicsl Care Survey.

National Center for Health Statistics.

Vital Herdth Stat 2(108). 1988.

Loft JD, SheatsIey PB, Frankel MR.

Comparison report onthehospitsl

ambulatorymedksl careevalustion

study.ContractNo. 282-82-2111.

Chicago, Illinoix National Gpinion

Research Center. 1985.

Public HealthService sndHealth

CsreFinsncingAdministration.

International Classification of

Diseases, %hrevision, Clinical

Moditicstion. Wsahington, D.C;

Public Heslth Servicc. 1991.

Schneider D, Appleton L, McLcmore

T.Aressonforvisit clsssiikationfor

ambulatory care. National Center for

Health Statistics.Wrd HealthStst

2(78).1979.

ShshBWBarnwell BG,HuntPN,La

V’geLM.SUDAAN user’smanusl,

release 5.50.Research TrisngleParkj

North CsroIinz Rese8rch Triangle

Institute. 1991.

Additional information

Additional reports that utilize 1992

NHAMCS data are forthcoming. Survey

data will also be available on computer

tape from the National Technical

Information Service at a nominal cost in

summer 1994. Questions regarding this

repo* future reports, or the NHAMCS

maybe directed to the Ambulatory Care

Statistics Branch by calling (301)

436-7132.
10 Advance Data No. 245 ● March 2, 1994

Table 13. Number and percent distribution of emergency department visits with corresponding standard errors by patient’a expeatad

source of payment United States, 1992

Number of standard Standard

visits in error in Percent error of

Expected source of payment’ thousands thousands distribubon penwnt

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89,706 3,202 100.0 . . .

Private/commercial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patientpaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HMO/otherprepaid2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Othergovernment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nochsrge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

32,332

20,340

13,5S2

12,402

6,566

4,032

~?$

6,117

1,505

1,614

1,215

561

70s

756

399

357

468

271

36.0

22.7

15.1

13.8

7.3

4.5

*0.O

6.8

1.7

1.1

1.0

0.5

0.7

0.8

0.4

0.4

0.5

0.3

‘Numbersmay excesd total because more then one source of peymentmay be cededfor eechvM.

2HMOisheatth rnsintenanceorgsnization.

Tabie 14. Number and percent distribution of emergency department visits with corresponding standard errors by type of provider seen:

UnItedStstes,1992

Number of Standard Standard

visits in error in Percent enwr of

Type of provider’ thousands thousands distribution percent

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89,796 3,202 100.0 ,..

Registered nurse . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ststfphysicien . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reeidentfintem . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherphysician . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nurse’sside . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Licensed practical nurse . . . . . . . . . . . . . . . . . . . . . . .

Physicianseeiatsnt . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nurse practitioner . . . . . . . . . . . . . . . . . . . . . . . . . . .

74,635

74,080

12,294

10,535

8,494

5,837

1,757

1,74a

3,112

3,062

1,385

1,209

1,195

898

353

451

83.1

82.5

13.7

11.7

9.5

6.5

2.0

1.9

1.5

1.6

1.5

1.3

1.3

1.0

0.4

0.5

‘Numbersmayexceed totelbecausemorethenonefxevider maybe reportedpsrvislt.

Tebie 15. Number and percent distribution of emergency department visits with corresponding standard errors by disposition of vis~

United Ststes,1992

Number of Standard standard

visits in error in Percent error of

Disposition’ thousands thousands distribution percent

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89,796 3,202 100.0 .,.

Refertootherphysician/ciinic. . . . . . . . . . . . . . . . . . .

ReturntoED PRN2 . . . . . . . . . . . . . . . . . . . . . . . . . .

Returntorefenfng physician. . . . . . . . . . . . . . . . . . . . .

Admittohoep”W1 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nofollow-up planned . . . . . . . . . . . . . . . . . . . . . . . . .

ReturntoEDappointment . . . . . . . . . . . . . . . . . . . . . .

Transfertootherfaciiii . . . . . . . . . . . . . . . . . . . . . . . .

LeftAMA3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOA/diedinED4 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

33,215

22,429

19,030

12,110

5,339

4,322

1,093

1,047

282

4,5s9

1,606

1,507

1,404

583

629

403

85

107

36

545

37.0

25.0

21.2

13.5

5.9

4.8

1.2

1.2

0.3

5.1

1.4

1.4

1.4

0.5

0.6

0.4

0.1

0.1

0.0

0.6

‘Numbers may exceed total because more fhsn me diqmition mey be reported per visit

2PRN is se needed.

3AMAisagsinsl medicsladvke.

400Aisdesdon arrivs!.
Advance Data No. 24S ● March 2, 1994 11

Technical notes

Source of data and sample

design

The information presented in this

report is based on data collected in the

1992 National Hospital Ambulatory

Medical Care Survey (NHAMCS) from

December 2, 1991, through December

27, 1992. The data were adjusted to

produce annual estimates. The target

universe of the NHAMCS includes

visits made in the United States by

patients to emergency departments

(ED’s) and outpatient departments

(OPD’S) of non-Federal, short-stay, or

general hospitals. Telephone contacts are

excluded.

A four-stage probability sample

design is used in the NHAMCS,

involving samples of primary sampling

units (PSU’S), hospitals with ED’s

and/or OPD’S within PSU’S, ED’s

within hospitals and/or clinics within

OPD’S,‘and patient visits within ED’s

and/or clinics. For 1992, a sample of

524 non-Federal, short-stay, or general

hospitals was selected from the SMG

Hospital Market Database. Of this

group, 474 hospitals were in scope, or

eligible to participate in the survey. The

hospital response rate for the NHAMCS

during this period was 93 percent. Based

on the induction interview, 437 of the

sample hospitals had ED’s. Hospital

staff were asked to complete Patient

Record forms (figure 1) for a systematic

random sample of patient visits

occurring during a randomly assigned

4-week reporting period. The number of

Patient Record forms completed for

ED’s was 36,271.

Characteristics of the hospital, such

as ownership and expected number of

ED visits, were obtained from the

hospital administrator during an

induction interview. The U.S. Bureau of

the Census, Housing Surveys Branch,

was responsible for the survey’s data

collection. Data processing operations

and medical coding were performed by

the National Center for Health Statistics,

Health Care Surveys Section, Research

Triangle ParlL North Carolina.

Sampling errors

The standard error is primarily a

measure of the sampling variability that

occurs by chance when only a sample,

rather than an entire universe, is

surveyed. The standard error ako

reflects part of the measurement error,

but does not measure any systematic

biases in the data. The chances are 95

out of 100 that an estimate horn the

sample differs from the value that would

be obtained from a complete census by

less than twice the standard error.

The standard errors used in this

report were approximated using

SUDAAN software. SUDAAN

computes standard errors by using a

tit-order Taylor approximation of the

deviation of estimates from their

expected values. A description of the

software and the approach it uses has

been published (5). Exact standard error

estimates were used in tests of

significance in this report. Standard

errors for all estimates are presented in

each table. Standard errors for rates can

be calculated using the relative standard

errors (RSE) for the number of visits

(i.e., multiply the rate by the RSE for

the estimate of interest).

Adjustments for hospital

nonresponse

Estimates from IWIAMCS data

were adjusted to account for sample

hospitals that were in scope but did not

participate in the study. This adjustment

was calculated to minimize the impact

of nonresponse on tial estimates by

imputing to nonresponding hospitals

data from visits to similar hospitals. For

this purpose, hospitak were judged

similar if they were in the same region,

ownership control group, and

metropolitan statistical area control

group.

Adjustments for ED and/or

clinic nonresponse

E&imates from NHAMCS data

were adjusted to account for ED’s and

sample clinics that were in scope but

did not participate in the study. This

adjustment was calculated to minimize

the impact of nonresponse on final

estimates by imputing to nonresponding

ED’s or clinics’ data flom visits to

similar ED’s or clinics. For this purpose,

ED’s or clinks were judged sknilar if

they were in the same ED or clinic

group.

Test of significance and

rounding

The determination of statistical

inference is based on the t-test. The

Bonfemoni inequality was used to

establish the critical value for

statistically significant differences (0.05

level of confidence). Terms relating to

differences such as “higher than”

indicate that the dit7erences are

statistically significant. A lack of

comment regarding the difference

between any two estimates does not

mean that the difference was tested and

found to be not significant.

In the tables, estimates of ED visits

have been rounded to the nearest

thousand. Consequently, estimates will

not always add to totals. Rates and

percents were calculated horn original

unrounded figures and do not

necessarily agree with percents

calculated from rounded data.

Definition of terms

Patient-An individual seeking

personal health services who is not

currently admitted to any health care

institution on the premises.

Hospital-All hospitals with an

average length of stay for all patients of

less than 30 days (short-stay) or

hospitals whose specialty is general

(medical or surgical) or children’s

general. Federal hospitals and hospital

units of institutions and hospitals with

fewer than six beds sttied for patient

use are excluded.

Emergency deprtment-Hospital

facility for the provision of unscheduled

outpatient services to patients whose

conditions require immediate care and is

staffed 24 hours a day. If an ED

provided emergency services in different

areas of the hospital, then all of these

areas were selected with certainty into

the sample. Off-site emergency

departments open less than 24 hours are

included if sttied by the hospital’s

emergency department.

Outpatient departnzent-Hospital

facility where nonurgent ambulatory
12 Advance Data No. 245 ● March 2, 1994

medical care is provided under the

supervision of a physician.

Viiit-A direct personal exchange

between a patient and a physician or

other health care provider working

under the physician’s supervision, for

the purpose of seeking care and

receiving personal health services.

Urgentlemergent—A patient visit in

which the patient requires immediate

attention for an acute illness or injury

that threatens life or function and where

delay would be harmful to the patient.

Nonurgent—Patient does not require

attention immediately or within a few

hours.

Symbols

--- Data not available

. . . Categoy not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.05

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

* Figure does not meet standard of

reliability or precision (more than

30-percent relative standard error

in numerator of percent or rate)

Suggeeted citation Copyright Information

McCaig LF. National Hospital Ambulatory

Medical Care Survey 1992 emergency

All material appearing in this report is in the

department summary. Advance data from vital

public domain and may be reproduced or

and health statistic no 245. Hyattsville,

mpied without permission; citation as to

Marvland: National Center for Health

source, however, is appreciated.

Stst&ica. 1994.

National Center for Health Stetiatics

Director

Manning Feinieib, M. D., Dr. P.H.

Deputy Director

Jack R. Anderson

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics m

6525 Belcrest Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

To receive this publication regularly, contact

the National Center for Health Statistics by

calling 301-436-8500

DHHS Publication No. (PHS) 94-1250
Number 246 ● April 8, 1994

Advance

Data

From Vil and Health statisticsof the CENTERS FOR DIS13WE CONTROL AND PREVENTION/National Center for Health Statktics

Restricted Activity Days and Other Problems Associated

With Use of Marijuana or Cocaine Among Persons 1844

Years of Age: United States, 1991

by David W. Keer, M.A., Division of Health Interview Statistics, National Center for Health Statistics; James D.

Colliver, Ph. D., Andrea N. Kopstein, M. P.H., Arthur L. Hughes, M.S., Division of Epidemiology and Prevention

Research, National Institute on Drug Abuse; Joseph C. Gfroerer, (Mce of Applied Studies, Substance Abuse and

Mental Health Services Administration; Stewart C. Rice, Jr., and Charlotte A. Schoenborn, M.P.H., Division of Health

Interview Statistics, National Center for Health Statistics

Introduction

In 1991, the Division of Health

Interview Statistics (DHIS), the National

Center for Health Statistics (NCHS),

fielded a Drug and Alcohol Use Survey

(DAU) as part of the National Health

Interview Survey (NHIS). The DHIS

collaborated with the National Institute

on Drug Abuse on the development of

the survey. The Questionnaire Design

Research Laboratory at NCHS assisted

in the development of the questionnaire

and review of data collection methods.

The DAU questionnaire was selfadministered and was a part of the

NHIS data collection conducted by the

U. S. Bureau of the Census. In

conjunction with other parts of the

NHIS questionnaire, the NHIS-DAU

allows one to assess associations

between use of marijuana and cocaine,

problems related to use of the drugs,

and various health status indicators.

The NHtS is a household survey of

the civiIian noninatitutionalized

population of the United States. As with

all special topic questionnaires that are

part of the NHIS, the DAU can be

linked to general health data and other

information obtained in the NHIS to

allow extensive analyses. The NHIS

data collection consists of two park a

basic health and demographic

questiomaire that remains the same

each year and is completed for each

household member and special topic

questionnaires. The content of the

special topic questiomaires varies from

year to year, and these questionnaires

are usually administered to a randomly

sampled adult in each family. In 1991,

in addition to the DAU, the special

topics included hearing Health

Promotion and Disease Prevention

(HPDP); AIDS-related lmowledge,

attitudes, and behavior% and family

income.

The DAU questionnaire was

restricted to persons 1S-44 years of age.

Although the questions covered use of a

range of illicit drugs and licit drugs

subject to abuse, the greatest number of

items pertained to marijuana and

cocaine. For marijuana and cocaine, the

questions covered the recency and

tiequency of use and included items

related to problems and drug-related

behaviors associated with abuse and

dependence. These latter items were

developed to reflect discrete diagnostic

criteria for cocaine and marijuana

dependence and abuse as described in

the Diagnostic and Statistical Manual of

Mental Disorders, Third edition,

Revised (DSM-111-R)(l). Separate sets

of items on the questionnaire focused on

marijuana- and cocaine-related problem

and use behavior during the

respondent’s lifetime and during the

year prior to the survey.

The primary goals of this Advamz

Data are to:

● briefly discuss the reIationahip

between restricted activity days and

use of cocaine and marijuan~

● present data on problems and

drug-related behaviors associated with

cocaine and marijuana dependence

and abuse, and

● provide documentation of the

methodology of the NHIS-DAU.

Restricted activity days, which are

sometimes used as indicators of health

**Sm’lctsti

*+

$

*

$

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

$

Public Health Service

Centers for Disease Control and Prevention “%

%

>%+v~a National Center for Health Statistics ~fiI%$ c~
2 Advance Data No. 246 ● April 8, 1994

status, may also reflect a pattern of drug

use. As noted earlier, the items that

assess dependency and abuse were

developed based upon clinical criteria

provided in the DSM-111-R.

All tables presented in this report

use standard NHIS age groupings to

differentiate persons 1S44 years of age;

however, the age categories are wide

enough to allow some age effects within

them, so that some of the differences

between drug use categories may be

confounded by age differences. Data are

also shown separately for males and

females. At the present time, these

demographic groupings have proven the

most statistically reliable for reporting

results from the drug use questionnaire.

Recency of use of marijuana and

cocaine, whether “past year” or

“lifetime” use, forms the basis of most

tables in this report. The past year frame

corresponds to the time reference period

for many measures in the NHIS. For

reasons discussed in the Technical notes,

this Advance Data does not report

overall prevalence of drug use.

Restricted activity days and

marijuana and cocaine use

Initially, three measures of health

status were considered for inclusion in

the current repo~ perceived or selfperceived health status, limitation of

major life activities, and restricted

activity (RA) days. Early analyses (not

shown here) indicate that, when

controlling for age and se~ there are

few, if any, statistically significant

associations between use of marijuana

or cocaine and self-perceived health

status or limitations of activity, as

measured in the NHIS basic health and

demographic interview. The apparent

lack of statistical significance seems

intuitive given that the age group for the

DAU, 1S-44 years of age, has a low

incidence of fair or poor health and

limitations of activity.

In the analysis of associations

between use of marijuana or cocaine

and selected health status measures,

respondents were grouped according to

six categories of drug use

1. Persons who had never used either

dreg.

2.

3.

4.

5.

6.

Persons who had used marijuana

during the past year but who had

never used cocaine.

Persons who had used marijuana

during the past year and had used

cocaine at some point prior to the

past year (lifetime use).

Persons who had used both

marijuana and cocaine during the

past year.

Persons who had used marijuana at

some point prior to the past year

(lifetime use), but had not used

marijuana during the past year and

had never used cocaine.

Persons who had used both

marijuana and cocaine at some point

prior to the past year (lifetime use),

but had not used either drug during

the past year.

The groupings were designed to include

all possible combinations of marijuana

and cocaine use. Numbers for persons

who had used cocaine but had never

used marijuana are not shown in this

report because so few persons were in

this group.

The question used to determine

recency of use of marijuana or cocaine

asked

When was the most recent time that

you used (mar@ana/cocaine)?

A.

B.

c.

D.

E.

Within the past week (7 days).

More than 1 week but less than 1

month (30 days) ago.

One or more months ago but less

than 1 year ago.

One or more years ago.

I HAYE NEVER used (nzarijuana/

cocaine), not even once.

Three types of RA days are

included in the measure reported in

table 1: work-loss days for currently

employed persons, bed days, and

cut-down days. A work-loss day is one

on which a currently employed person

1S-44 years of age missed more than

half a day from a job or business

because of illness or injury. A bed day is

one during which a person stayed in bed

more than half a day because of illness

or injury. A cut-down day is a day on

which a person cut down for more than

half a day on the things he or she

usually does.

The measures of RA days were

obtained from a series of questions

asked of the household respondent

during the NH(S basic interview. In the

NHIS, RA days are measured for the

2-week period that immediately

preceded the interview week. The

questions and data edits are designed to

account for overlap among the types of

RA days and to specify that the RA

days of interest are those that olccur

“because of illness or injury”; the RA

days are included whether caused by

acute or chronic illness. It is important

to note that it is assumed that the

respondent can identify and report only

those RA days that arose because of

illness or inj~.

Table 1 shows the percent of

persons 1S-44 years of age witlh one or

more RA days during the 2 weeks prior

to the household interview, by marijuana

and cocaine use, age, and sex. IFigure1

illustrates diilerences in the percent of

persons with RA days by marijuana and

cocaine use. Generally, discussion of RA

days is more difficult than discussion of

yearly estimates because the NHIS

measures RA days that occurred in the

2-week period preceding the interview

week. In the current case, however, the

comparison is of the dtierences between

users or nonusers of marijuana or

cocaine. If the 2-week estimate were

converted to an annual figure, any

conversion factors would tiect all

classes equally and would not change

the underlying relationships between

different groups of drug users.

RA days are less likely to be

reported for a person who had never

used cocaine or marijuana or had used

marijuana at some point but had never

used cocaine. Put another way, among

persons 1S-44 years of age, use of

cocaine-whether during the year prior

to the interview or in the more distant

past—is associated with a greater

Iiielihood of having RA days. The

differences are statistically significant,

occur across most groupings by drug

use and age, and are seen for both men

and women. Not shown are data

indicating that the patterns are the same

whether respondents are white or black.

Because of sample size, the number of

respondents who were black and

reported any past year use of marijuana
Advance Data No. 246 ● Am’il 8, 1994

Table 1. Percent (and standard error) of persons 18+4 yesrs of age with one or more restricted aetlvity days during the 2 weeks prior to

the household interview, by marijuana and cooaine use, age, and sex United States, 1991

Man@na and cccaina use’

Used within paatyear LYatlrne use but not past year

NW&

Mari@a Marijuana

Age and sex

man@rfa only never onl~ prior Man@na h4anjuana Mmrjuarra

or cocaine usad cocaine -“ne use and @Xairre Onk and cocaine

Age

13-44 yeara . . . . . . . . . . . . . . . . . . . . . 8.7 (0.3)

16-24 years . . . . . . . . . . . . . . . . . . . . 8.2 (0.6)

25-34 yeafa, . . . . . . . . . . . . . . . . . . . 7.9 (0.5)

35-44 yeara . . . . . . . . . . . . . . . . . . . . 9.7 (0.5)

sex

Male, 1844yeara . . . . . . . . . . . . . . . . . . 6.9 (0.4)

16-24 year3 . . . . . . . . . . . . . . . . . . . . 8.3 (0.8)

25-34 yeara . . . . . . . . . . . . . . . . . . . . 6.3 (0.7)

35-44 years . . . . . . . . . . . . . . . . . . . . 7.9 (0.6)

Female, 1844yeara . . . . . . . . . . . . . . . . 10.1 (0.4)

l&24yeara . . . . . . . . . . . . . . . . . . . . 9.9 (1.0)

25+4yaara . . . . . . . . . . . . . . . . . . . . 9.2 (0.6)

35-44 yaarrs . . . . . . . . . . . . . . . . . . . . 11.0 (0.7)

10.5 (1.1)

10.0 (1.7)

10.1 (1.8)

12.8 (2.8)

9.5 (1.3)

7.3 (1.7)

9.9 (2.3)

13.8 (3.6)

11.9 (1.9)

13.2 (2.6)

10,4 (2.4)

-0.7 (4.3)

14.7 (1.3)

14.3 (3.1)

13.2 (1.8)

18.2 (3.3)

13.2 (1.7)

W.1 (3.5)

11.8 (2.1)

17.3 (4.2)

17.7 (2.7)

~9.8 (6.2)

18.0 (3.4)

%20.3 (8.9)

16.2 (2.6)

17.0 (4.6)

15.9 (2.9)

~5.5 (6.8)

15.8 (3.0)

Y7.O (5.9)

15.1 (3.6)

W6.I (9.1)

17.2 (3.7)

97.2 (7.1)

16.7 (5.2)

~3.8 (6.1)

.10.2 (0.5)

10.3 (1.4)

9.4 (0.6)

11.0 (0.6)

8,2 (0.7)

8.8 (1.9)

6.8 (0.6)

9.3 (1.2)

12.3 (0.6)

11.7 (1.8)

11.8 (0.8)

13.2 (1.2)

13.6 (1.1)

18.2 (4.1)

12,6 (1.3)

14.0 (1.7)

11.7 (1.4)

19.8 (5.8)

9.7 (1.6)

127 (2.2)

16.2 (1.6)

W6.8 (5.1)

16.0 (2.0)

16,3 (2.3)

NOTE All standardarrofasra shownin parentheses.

‘VW few raapcmdentawhorafwtad usingoccuinea“d thattheyhad neverusedmsriiuana.Forthatreason,noliguraaare shownfor%xsina C& use.

15

10

5

0-

Never usad

more

Pastyear

m never c

Past yeef

m Iiietimec

Life#e

SOURCEOanfersforDiseaseCcmtmlendPravamkm,NationalOemtwforHealrh3tariis, Uriki States,1981

Figure 1. Percent of persons 18-44 years of age with one or more restricted activity days

in past 2 weeke, by use of marijuana (m) and cocaine (c): United States, 1991

or cocaine was too small to allow during the 2 weelw prior to the

reliable analysi~ for that reason, the household interview. Of people who had

data are not shown in table 1. never used cocaine, the estimates of

Depending upon the recency of those with one or more RA days ranged

cocaine use, 13.6 to 16.2 percent of all from 8.7 to 10.5 percen~ depending

persons ages 18-44 who had used upon whether or not the person had

cocaine had one or more RA days used marijuana at some point.

As table 1 indicates, the positive

association between RA days and use of

cocaine is consistent for both men and

women 18-44 years of age. Among men

18-44 who had used cocaine, the range

having RA days during the 2-week

period was 11.7 to 15.8 pereen~ while

among women who had used cocaine,

the range was 16.2 to 17.7 percent. For

men who had never used cocaine, 6.9 to

9.5 percent had M days and for women

who had never used cucaine, RA days

were reported for 10.1 to 12.3 percent.

It is found, then, that 18-44 year

olds who use, or used, cocaine, have

significantly more RA days related to

illness and injury. However, it is

noteworthy that the DAU was

administered onlyto persons ages

18-44, a group less likely than older

persons to be in fair or poor health or to

have activity limitations. As the current

report suggests, the relationship between

RA days and drug use warrants further

study and might be analyzed in the

context of other health-related activities

and specific health conditions.

Behaviors associated with

marijuana use

Persons who had used msrijuana

during the 12 months prior to the survey

were asked 19 questions regarding

problems or marijuana-related behaviors
4 Advance Data No. 246 ● April 8, 1994

they might have experienced in the

same time period as a result of using the

drug. The items were selected to reflect

components of abuse and dependence

based on DSM-111-Rdiagnostic criteria.

This section includes data only for

persons reporting past year marijuana

use. The data for individual items

discussed here excludes 10.4 to

11.0 percent of persons because of item

nonresponse; see the Technical notes for

further information.

Table 2 shows the prevalence of

reported problems and marijuana-related

behaviors among past year users. The

data are displayed by sex and three age

groupings (18-24, 25–34, and 35-44).

The problem questions include no

information on frequency of

occurrences. Therefore, a positive

response could mean as few as one

occurrence during the year prior to the

interview.

Overall, 20.0 percent of past year

marijuana users reported using

marijuana more often than planned.

There was not much ditTerence by se%

but 18-24-year-old users were more

likely than users in the two older age

groups to respond positively to this

question.

A large percent (26.’7)of past year

marijuana users responded positively to

the item on being high on at least one

occasion while at home caring for their

family. A greater proportion of men

(29.3 percent) reeponded positively to

this item as compared with women

(22.0 percent). Past year users :25and

older were more likely than the

youngest age group to report this

problem behavio~ 34.3 percent of those

Table 2. Percent (and standard error) of paat year marijuana users 1S+4 yeare of age reporting behaviors assockited with marijuana

use, by sex and age: United States, 1991

Sex Age

Problems associated with marijuana use 18-24 25+4 35-44

expan”enced in the pest year Total Male Female years years years

During the past 12 months, have you—

Ended up using marijuana more often than you

thought youwould? . . . . . . . . . . . . . . . . . . . .

Triad to cut down or stop using marijuana but found

thatyouoouldn’t? . . . . . . . . . . . . . . . . . . . . .

Used marijuana evary day for 2 weeks or more? . . .

Been high on marijuana while you were at work or at

school? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Been high on marijuana while you were at home

taking care of your home or family? . . . . . . . . . .

Skipped going to work or school because you were

high onmanjuena? . . . . . . . . . . . . . . . . . . . .

Had problems with work, schcd, or with the police

because ofusingmerijuena? . . . . . . . . . . . . . .

Continued to use marijuana even when you knew it

was causing you problems with work, school, or

w“tithe police? . . . . . . . . . . . . . . . . . . . . . . .

Failed to take care of your home or family because

youwere high on marijuana? . . . . . . . . . . . . . .

Had probleme with your family or friende because of

using marijuana? . . . . . . . . . . . . . . . . . . . . . .

Continued to use marijuana evan when you knew it

was caueing you problems with your family or

frfends? . . . . . . . . . . . . . . . . . . . . . . . . . . .

Driven a oar or other vehicle within 3 hours after

using marijuana? . . . . . . . . . . . . . . . . . . . . . .

Spent less time on activities that uead to be important to you-like playing sports, hobbies, or other

interests-so that you aould use marijuana? . . . . .

Felt deprassed, anxious, or uninterested in things

because ofusingmerijuana? . . . . . . . . . . . . . .

Continued to use marijuana even though you knew it

made you feel depressed, anxious, or uninterested

in things? . . . . . . . . . . . . . . . . . . . . . . . . . .

Built up a tolerance to marijuana so that the same

amount of mtiluana had less effeof than before? . .

Felt sick or irrftable because you stopped or cut

down onyourmanjuana use? . . . . . . . . . . . . . .

Used alcohol or drugs because you fett sick or

irritable when you stopped or cut down on your

marijuana use? . . . . . . . . . . . . . . . . . . . . . . .

Gone to self-help group, counselor, doctor, or other

professional to get help because of your marijuana

use? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20.0 (1.1)

6.7 (0.7j

21.0 (1.1)

21.6 (1.1)

26.7 (1.2)

3.a (0.5)

4.0 (0.6)

3.7 (0.5)

2.6 (0.5)

4.9 (0.7)

4.8 (0.6)

45.9 (1.3)

7.8 (0.8)

10.4 (0.9)

8.9 (0.8)

16.2 (1.1)

5.6 (0.7)

5.0 (0.7)

2.4 (0.4)

Percent (SE) of past year marijuana users responding yes’

20.6 (1.4)

7.4 (0.9)

24.0 (1.5)

25.8 (1.5)

29.3 (1 .5)

5.1 (0.7)

5.3 (0.9)

4.7 (0.8)

3.1 (0.6)

6.1 (0.9)

6.1 (0.9)

51.0 (1.7j

8.9 (1.1)

11.4 (1.2)

10.0 (1.1)

18.3 (1.5)

6.4 (1.0)

6.0 (1.0)

2.5 (0.5)

19.0 (1.8)

5.5 (1.0)

15.5 (1.rj

13.9 (1.5)

22.0 (1.7)

1.5 (0.4)

*1.5 (0.5)

2.0 (0.5)

*1.7 (0.8)

2.6 (0.7)

2.4 (0.6)

36.4 (20)

5.7 (0.9)

6.5 (1.1)

7.0 (1.0)

12.4 (1.5)

4.7 (0.9)

3.1 (0.8)

2.1 (0.5)

25.7 (2.1)

5.9 (0.9)

19.5 (1.rj

25.1 (2.1)

19.0 (1.8)

6.2 (1.1)

5.8 (1.3)

4.8 (1.1)

%3.4 (1.1)

6.7 (1.3)

5.7 (1.1)

41.9 (2.3)

9.2 (1.4)

11.5 (1.4)

8.a (1.3)

18.8 (1.9)

6.2 (1.2)

5.7 (1.2)

%?.1 (0.7’)

19.1 (1.6)

6.4 (1.2)

22.9 (1.8)

21.2 (1.6)

29.4 (1.6)

3.4 (0.7)

3.6 (0.8)

3.8 (0.7j

2.6 (0.7j

4.6 (0.9)

5.0 (0.9)

48.5 (1.9)

7.9 (1.2)

11.3 (1.3)

10.6 (1.3)

17.1 (1.6)

6.6 (1.1)

5.2 (1.0)

2.7 (0.6)

‘12.3 (1.6)

4.5 (1.2)

19.4 (2.2)

16.6 (2.1)

34.3 (2.7)

%3.7 (0.4)

*1.5 (0.7)

*1.8 (0.8)

*1.3 (0.6)

%2.4 (0.9)

%3.0 (0.9)

47.0 (3.1)

4.9 (1.2)

6.6 (1.3)

5.5 (1.2)

9.9 (1.8)

3.6 (1.0)

%3 (1.1)

*2.O (0.6)

NOTE All standsrderrorsare showmin parentheses.

‘Peromtages calculatedexcludimgunknowns%e Technicalnotes.
Advance Data No. 246 ● April 8,1994 5

users 35-44 years of age and

29.4 percent of those 25-34 years of age

responded positively compared with

19.0 percent of those 18-24 years of

age.

Overall, 16.2 percent of past year

marijuana users repmted that they had

built up a tolerance to the drug so that

the same amount of marijuana had less

effect than before. This problem was

more likely among male past year usera

(18.3 percent for males versus

12.4 percent of the female users). This

problem was also more likely to occur

among users who were 18-34 years of

age as compared with the oldest users.

One statistic from the survey was

the percent of past year marijuana users

that reported driving at least once in the

past year within 3 hours of smoking

marijuana. Overall, 45.9 percent of the

past year users reported driving under

the iniluence of this drug. Males were

much more likely than females to report

this problem behavior (51.0 percent of

male users compared with 36.4 percent

of female users).

Approximately one%fth of past year

marijuana users reported being high on

marijuana while at school or while at

work. Males were about twice aa likely

as their female counterparts (25.8

compared with 13.9 percent) to report

this problem behavior. Users between

the ages of 18-24 were more likely than

users in the oldest age group to report

being high on marijuana at school or

work

A large proportion of past year

users reported frequent use of the drug.

Overall, 21.0 percent of past year usera

reported using marijuana every day for

2 weeks or more in the past year.

Although frequent use did not di.tier

much by age, a greater proportion of

males (24.0 percent) as compared with

females (15.5 percent) reported this

behavior.

Figure 2 illustrates reporting of

selected behaviors by all past year users.

Figure 3 shows the percent of past year

marijuana users reporting selected

problems by sex. Figyre 4 shows the

percent of past year marijuana users

reporting selected problems by age.

Behaviors associated with

cocaine use

Persons who had used cocaine

during the 12 months prior to the survey

Used more oftenthan planned

E

20.0

Triedto cut down butcouldrmt 6.7

Used daily for 2 W* w more 21.0

Been highwhile at schoolor work 21.6

8aen highat home while caringfor kunily 26.7

Skippedwork or schoolbecause high 3.8

Had problemswithwork, school,or polka

Continuedto use despite work, school,

Had problemswithfamily orfrkmds

Continuedto use despite problemsw“th

family orfriands

Drivencar within3 hoursafter using 45.9

Spent lass time on tiMties

Felt depressed or anxious

Continuedto use des+ite depre-”on

w m“ely

Builtuptolerance

Feltsick beoause of hying@dSC#I

Used drugsor aleohd because sickfrom

cattingdown

..- .

I # s v s 1 1 1 * s 1

0.0 5.0 10.015.020.025.030.0 35.040.045.050.0

Pereent

SOURCE centersfw Dkesse Cmrml d PrevantbmNaihmd CmIwfu HealthSi@sUca,hited Skti, 1901

Figure 2. Percent of pest year marijuana uaera reporting eeleetad bahaviora in the past

yiar: United States, 1991-

Drove less

than 3 hours

after use

schr&ENii

High with

family

Builtup

tolerance

I

■ Tti ❑ Males 18-44 ❑ Females 18-44

51.0

0 10 20 40 50 60

Pe%Nlt

SOURC= C&Itemfor Oiasam Cmtml d Prevsrtbm NaSond CaWfcf timlUI Stddcs, Utited States,1SS1

Figure 3. Percent of past year marijuana were reporting aeleeted problems in past year,

by wc Unltecl States, 1991
6 Advance Data No. 246 ● April 8, 1994

= Total ~ 18-24 ~ 25-34 m 35-44

I

year olds year olds year olds

Drove leas

tha~;eo::: .5

High at

school/work

Highwith

family

1

0 10 20 40 50 60

Pe%%nt

SOURCE Centers for O&ase &mtml and prevention, National Center for Health Statktics, Urited States, 1991

Figure 4. Percent of past year marijuana users reporting selected problems in past year,

by age: United states, 1991

were asked 21 questions regarding

problems or cocaine-related behaviors

they might have experienced in the

same time period as a result of using the

drug. The items were selected to reflect

components of abuse and dependence

based on DSM-111-Rdiagnostic criteria.

Figure 5 and table 3 show the estimated

percentage reporting cocaine-related

problems or behaviors in the overall

user population and according to sex

and age. The data for individual items

discussed here excludes 13.3 to

14.5 percent of persons because of item

nonresponse; see the Technieal notes for

further information.

One-quarter (26.7 percent) of past

year cocaine users said that, in the past

year, they had used the drug more often

than they had planned. Around one-half

as many (13.4 percent) had tried to eut

down or stop using cocaine but found

they could not.

Driving a car, at least once in the

past year, within an hour after using

cocaine was reported by 43.5 percent of

past year users. Male users were more

likely than female users (49.2 percent

versus 29.1 percent, respectively) to

have driven after using cocaine.

More than one-sixth (17.9 percent)

of cocaine users said they had been high

on the drug at school or work. Males

were more likely than females (20.8

versus 10.5 percent, respectively) to

have been high in these settings.

Skiuuin~ school or work because of

being high on cocaine or experiencing

its aftereffects was acknowledged by

10.7 pereent of users, and 9.1 percent

Over one-sixth (17.2 percent) of the

past year cocaine users said they had

been high on the drug while at home

caring for their family, and 10.()percent

had at least one occasion on which they

failed to take care of their home or

family because they were high on

cocaine or feeling its aftereffects.

Problems with family or friends because

of cocaine use were reported by

16.4 percent of users, and 14.8 percent

had continued to take the drug despite

these problems with family or friends.

One-fifth (20.4 pereent) of cocaine

users said the drug had made them feel

depressed, anxious, uninterested in

things, or suspicious or distrustful of

people. This percent was higher for

persons 25-34 years of age than for

those 18-24 years of age (23.2 versus

13.9 percent, respectively). Continued

use of cocaine despite these emotional

effects was reported by 16.1 percent.

said ~hey had experienced problems with One-eighth (13.2 percent) said their use

school, workj or the police because of of cocaine had caused them to spend

using cocaine. less time on activities that usecl to be

Usad more oftenthan planned

Triadto cutdown but could not

Used daiiyfor 2 weeks or more

Seen highwhile at schoolor work

6een highat home while caringforfamily

Skippad work or schoolbecause high

Had problemswithwork, school,or police

Continuedto use despitework, school,or

policeproblems

Failedto take care of family

Had problemswithfamily orfriends

Continuedto use despiteproblemswith

family orfriends

Drivencar within1 hour after using 43.5

Spent lesstime on activities

Had health problems

Continuedto use despite health problems

Fait depressed or anxious

Continuedto use despitedepression

or anxiety

EWltuptolerance

Felt sick because of tryingto stop

or cut down

Usad drugsor alcoholbecause sickfrom

cuttingdown

Gone to self- help groupor professional 9.2

for help -

1 1 I 1 I 1 t 1

0.0 5.0 10.015.020.025 .030.0 35.040.045,050.0

Percent

SOURCE Centem frx Oiiase CMtrd and Prwmtion, Naiional Cwder for Heakh Statistics, Untied States, 1991

Figure 5. Percent of past year cocaine users reporting seleetsd behaviors In the past

yeafi United States, 1991
Advance Data No. 246 ● April 8,1994 7

Table 3. Percent (and standard error) of past year cocaine users 1S-44 yeara of age reporting behaviors aaeoeiated with cocaine use, by

aex and agtx United States, 1991

sex AGIS

Problems associated with cocaineuse 13-24 25-34 35-44

experienced in the past year Total Male Female yesra Y w

Duringthe past 12 months,have youEndedup usingoccainemoreoftenthan you thought

youwould? . . . . . . . . . . . . . . . . . . . . . . . . .

Triedto cutdownor stop using cocaine butfound

thatyoucouldn’t? . . . . . . . . . . . . . . . . . . . . .

Used oocaineevery day for 2 weeks or more? . . . .

seen highon oooaha orfeeling its after effectswhile

youwere atworkoratsohool? . . . . . . . . . . . . .

Bsan highon oooaineor feelingitsaffereffeotswhile

youwere at hometakingoare of your homeor

family? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skippedgoingto workor sohoolbecauseyou were

highon cooaineor feelingits aftereffects? . . . . . .

Had pmbiemswithwork, schooi,or withthe police

becausaofusing cocaine? . . . . . . . . . . . . . . . .

Continuedto use ooa”ne even when you knew it

was causingyou problemswithwork, school,or

withfhapelioe? . . . . . . . . . . . . . . . . . . . . . . .

Failedto take care of your homeor familybsoausa

youwere highon oooaineorfeelingits

aftereffects?. . . . . . . . . . . . . . . . . . . . . . . . .

Had problemswithyourfamilyor friendsbecauseof

usingeocahe?. . . . . . . . . . . . . . . . . . . . . . .

Continuedto use cocaineeven when you knew il

was causingyou problemswithyourfamilyor

friends? . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drivena car or othervehiolewithin1 hourafter using

Cocaine?, . . . . . . . . . . . . . . . . . . . . . . . . . .

Spentlesstime on actMies that usedto be

importantto you-like playingsports,hobbies,or

otherirderast.s+m that you couldusa corxine? . . .

Had healthproblemscaused by usingcocaine? . . .

Continuedto use cocaineeven when you knew if

was oausingyou hearthproblems?. . . . . . . . . . .

Felt depressed,anxious,uninterestedin things,or

suspiciousor dirirustfulof peoplebaosuseof usi~

mcsine? . . . . . . . . . . . . . . . . . . . . . . . . . . .

Continuedto use eoeaineeven thoughyou knew i-t

made youfeel dapresswl, amdoua,or uninterested

inthings,or suspiciousor distmsffulof ~ople? . . .

Buittup a toleranosto cecaine so that the same

amountof cocainehad less effectthan before? . . .

Felt sickor irritablebseausayou stoppedor out

downonyour oocsineuse? . . . . . . . . . . . . . . .

Uaad alcoholor drugsbecauseyoufelt sickor inftablewhen you stoppedor outdownon your

cocaineuse? . . . . . . . . . . . . . . . . . . . . . . . .

Goneto seti-heipgroup,counselor,dootor,or other

professionalto get help becauseof your ccdne

u~? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26.7 (2.7)

13.4 (2.0)

a.2 (I .5)

17.9 (2.1)

17.2 (2.2)

10.7 (1.6)

9.1 (1.5)

9.6 (1.7)

10.0 (1.8)

16.4 (2.0)

14.6 (1.9)

43.5 (2.8)

13.2 (2.0)

6.2 (1.6)

9.1 (1.6)

20.4 (2.3)

16.1 (2.1)

13.9 (2.0)

11.4 (1.6)

13.3 (1.9)

9.2 (1.5)

Percent (SE) of pasl year oecaineusersrespondingyesi

27.9 (3.3)

14.7 (2.5)

9.4 (1.6)

20.6 (2.7)

18.8 (2.7’)

11.9 (2.0)

11.4 (2.1)

11.1 (2.1)

10.6 (2.2)

17.5 (2.4)

16.2 (2.4)

49.2 (3.4)

14.3 (2.5)

9.0 (2.0)

10.2 (2.1)

222 (2.9)

18.0 (2.7)

15.6 (2.5)

13.0 (2.3)

13.5 (2.3)

10.5 (1.9)

23.7 (3.6)

10.2 (2.5)

%.0 (1.8)

10.5 (2.6)

13.2 (3.3)

W.7 (24)

%3.4 (1.5)

%.6 (2.2)

7.9 (2.3)

13.5 (3.0)

11.1 (2.6)

29.1 (4.2)

10.3 (2.5)

%.0 (2.0)

%.4 (2.1)

16.0 (3.1)

11.4 (27)

9.6 (2.5)

7.3 (2.2)

12.9 (28)

%.1 (2.0)

26.8 (5.0)

W.O (2.6)

%.4 (2.6)

11.5 (3.1)

10.1 (2.9)

10.7 (29)

%.0 (2.3)

W.6 (2.5)

V.5 (2.5)

12.7 (3.2)

%.4 (2,6)

39.7 (6,1)

*10.0 (3.0)

%3.2 (1.7)

%3.5 (1.7)

13.9 (3.4)

11.8 (3.1)

125 (3.5)

9.2 (2.8)

10.6 (3.1)

*5.3 (2.1)

27.8 (3.6)

13.5 (3.0)

%.0 (2.1)

19.3 (29)

19.1 (3.3)

10.2 (2.4)

10.9 (26)

10.4 (3.0)

10.5 (2.8)

18.4 (3.1)

ia.7 (3.1)

46.7 (4.0)

13.6 (2.9)

28 (25)

10.7 (2.5)

23.2 (3.2)

17.6 (3.1)

13.3 (2.5)

11.9 (2.9)

16.5 (3.0)

11.3 (2.6)

25.4 (4.6)

19.0 (4.3)

~2.9 (4.2)

22.9 (5.8)

21.9 (5.1)

W1.9 (4.2)

%r.o (4.1)

*11.1 (4.0)

●12.1 (4.2)

16.5 (4.8)

*13.9 (4.5)

40,9 (6.0)

16.4 (4.2)

*13.2 (4.1)

*12.6 (4.1)

22.5 (6.6)

17.9 (5.2)

17.1 (4.7)

*13.2 (4.3)

%.4 (3.2)

W.6 (3.8)

NOTE All standardmors are shownin psrsrrthssss.

lPwcentsgescakdatedsxcludingunknmw%see Tschnicalnotes

important to them, such as playing

sports, hobbies, or other interests.

During the year prior to the

interview, 8,2 percent of the cocaine

users had experienced health problems

that they attributed to the drug.

One cocaine user in 12 (8.2 percent)

had used the dmg daily for 2 weeks or

longer in the past year. One-seventh

(13.9 percent) said that they had “built

up a tolerance for cocaine so that the

same amount of cocaine had less effect

than before,” One in nine (11.4 percent) References

acknowledged having felt sick or

1. irritable because of stopping or reducing

cocaine use, and 13.3 percent had used

alcohol or drugs to relieve this sickneaa

or irritability. Nine percent had gone to

a self-help group, counselor, doctor, or 2.

other professional to get help becauae of

their cocaine use.

AmerieanPsychiatricAssociation.

Diagnostic and Statistical Manual of

Mental Disorders. 3d ed, revised.

Washington: Ameriean Psychiatric

Asscxiation. 1987.

Massey JT, Moore TF, Parsons ~

Tadros W. Design and estimation for

the National Health Interview

Survey, 1985-94. National Center for

Health Statistics. Vital Health Stat

2(110). 1989.
8 Advance Data No. 246 ● April 8, 1994

3. Shah BV, Barnwell BG, Hunt PN,

LaVange LM. SUDAAN User’s

Manual, Release 5.50. Research

Triangle Park, North Carolina

Research Triangle Institute. 1991.

4. Shah BV. SESUDAiN: Standard

Errors Program for Computing of

Standardized Rates from Sample

Survey Data. Research Triangle Park,

North Carolina Research Triangle

Institute. 1981.

5. Adams PF, Benson V. Current

estimates from the Natioml Health

Interview Survey, 1991. National

Center for Health Statistics. Wal and

Health Stat 10(184). 1992.
Advance Data No. 246 ● April 8,1994 9

Technical notes

General information

The estimates presented in this

report are based on the National Health

Interview Survey (NHIS), an ongoing

survey of households in the United

States, conducted by the National Center

for Health Statistics. Each wee~ a

probability sample of the civilian

noninstitutionalized population of the

United States is surveyed for the NHIS

by interviewers employed by the U.S.

Bureau of the Census. Interviewers

obtain information about the health and

other characteristics of each member of

the households in the NHIS sample.

The NHIS has been conducted

continuously since 1957. The sample

design of the survey has undergone

changes following each census. This

periodic redesign of the NHIS sample

allows the incorporation of the latest

population information from the most

recent Decennial Census and permits the

alignment of the sample design with

changes in survey objectives. The data

presented in this report were collected

based on the IUHISsample design

implemented in 1985. A detailed

description of the sample design is

contained in the publication entitled

Design and Estbnation for the National

Health Interview Survey, 1985–94 (2).

The 1991 NHIS sample

encompassed completed interviews for

the basic health questiomaire of 46,761

households and 120,032 persons. The

NHIS Drug and Alcohol Use (DAU)

questiomaire was completed by 21,174

persons 18-44 years of age. The sample

for the DAU was a subset of the sample

selected for the 1991 NHIS special topic

questiomaire on Health Promotion and

Disease Prevention (HPDP). Within each

NHIS sample household, one adult 18

years of age or over was randomly

selected to be interviewed for several

special topic questiomaires, including

the HPDP and the DAU. If the sample

person was 18-44 years of age, he or

she was given the DAU to complete; no

proxy responses were allowed. If the

sample person was older than 44 years

of age, information on drug and alcohol

use was not obtained in that household.

If the sample person ages 1841 was

not at home at the time the basic NHIS

was administered, the interviewer

attempted a return visit so that the

sample person could complete the DAU.

No telephone followup was permitted

for the DAU. In certain circumstances,

such as when language or literacy were

problems or when the respondent

requested that the questions be rea~ the

Bureau of the Census interviewer could

read the questions to the respondent.

Response rates

The overall response rate for the

1991 NHIS-DAU was 75.7 percent. The

response rate for NHIS sample

households was 95.7 percen~ among

persons identified in the household

interview as being eligible for the DAU

questionnaire, the response rate was

79.1 percent. The overall response rate

is estimated as a product of these two

rates (95.7 percent x 79.1 percent =

75.7 percent). Because

sociodemographic characteristics of

sample persons in nonresponding

households are unknown, discussion of

response rates for subgroups is limited

to rates for those identified as eligiile

for the DAU questionnaire.

Response rates were noticeably

higher for women (82.9 percent) than

for men (74.5 percent) and somewhat

higher for white persons (79.7 percent)

than for black persons (76.9 percent). In

terms of the age groups discussed in this

report, response rates were about the

same for persons 18-24 years

(79.5 percent) and persons 25-34 years

(80.0 percent) rates were somewhat

lower for persons 35-14 years of age

(77.9 percent). These response rates are

lower than most NHIS special topic

surveys. This may be due to the

sensitive nature of the questions, or

more likely, to the respondent rule that

all followup contacts had to be made in

persou no telephone followup was

permitted as is typical for most NHIS

special topic surveys. The relatively low

response rate for the DAU may have

been a factor in the overall reported

drug use if heavy users were less likely

to complete the questionnaire than were

light users or nonusers.

Comparison to other nationai data

on drug use

The primary purpose of the

NHIS-DAU was to collect data to study

relationships between drug use and the

various health status indicators provided

by the NHtS. Although the DAU was

not intended to provide estimates of the

prevalence of drug use, such estimates

can be produced from the data.

Comparisons to estimates from the

National Household Survey on Drug

Abuse (NHSDA), the Federal

Government’s ongoing primary source

of drug use dam indicate that the

NHIS-DAU generally found lower rates

of use than the NHSDA In interpreting

prevalence estimates (and also analyses

of the relationship between drug use and

health status) from the NHIS-DAU, it is

important to recognize the diflerent

estimates and to understand the

methodological differences between the

two surveys that may have caused some

of the diEerences.

Both surveys cover the civilian

noninstitutionrdized population in the

United States, but the NHIS included

only 18-44-year-olds, while the NHSDA

includes all persons age 12 and older.

Because illicit drug use is highly

correlated with age, any comparison

between the two surveys must control

for age, for example, by restricting

NHSDA estimates to HM4-year-cdds.

The 1991 NHSDA estimate of past year

marijuana use among l&14-year-olds

was 15.2 percent compared with

9.3 percent from the NHIS. Past year

cocaine prevalence was 5.1 percent from

the NHSDA and 2.1 percent from the

mm.

Even controlling for age, however,

there are a number of methodological

differences between the two surveys that

could explain the inconsistent estimates.

Research has shown that drug use

prevalence estimates are highly sensitive

to the data collection and estimation

methods used (for example, mode of

administratio~ privacy during interview,

editing, and imputation) so different

results could be expected. The following

are the major methodological differences

between the two surveys:

1. The NHIS was conducted JanuaryDecember 1991 while the NHSDA

was conducted January– June.

2. The questionnaires were differen$

not only in the wording of the drug
10 Advance Data No. 246 ● April 8, 1994

3.

4.

5.

use questions but also in terms of

the context. The NHIS-DAU is

administered at the end of a

comprehensive interview on

health-related issues while the

NHSDA questionnaire primarily

focuses on various aspects of

substance use and abuse. Although

both surveys employed selfadministered answer sheets for drug

use questions, the NHIS-DAU was

the only self-administered portion of

the entire interview while the

NHSDA included a series of nearly

20 separate self-administered answer

sheets.

The fieldwork in the surveys was

conducted by different

organizations-NHIS by the Census

Bureau and NHSDA by Research

Triangle Institute.

Response rates for sample persons

were different in the two studie%

83.6 percent for I%l%year-olds in

the NHSDA and 79.1 percent for the

NHIS-DAU. Household response

rates were 96.5 percent in the

NHSDA and 95.7 percent in the

NHIS-DAU.

Editing, imputation, and nonresponse

adjustment procedures were di.tTerent

in the hvo surveys.

Missing and unknown data

The DAU was self-administered and

did not list “don’t know” as a valid

response to any question. As a result, in

the final data set, one cannot distinguish

between missing responses and “don’t

know” responses. For that reason, in

this report, observations for which

tabulation variables are unknown or

missing are excluded from the

calculations of percentages. For analyses

related to the health status variables,

fewer than 5 percent of cases had such

values in any of the relevant data fields.

Item nonresponse appears evenly

distributed across the demographic

groups shown in the tables related to

health status variables. Much of the item

nonresponse appears to reflect errors in

completion of the questionnaire for

example, individuals who had denied

use of marijuana simply skipped over

the questions related to cocaine use.

For the questions related to

problems associated with drug use, data

on the percent of persons experiencing

problems excludes persons who failed to

respond to the pertinent questions

despite having reported use of the

pertinent drug. Exclusion of these

observations makes the tacit assumption

that the persons who failed to respond

to the items would have answered them

in a manner similar to those who

responded. For items on past year

marijuana-related problems, 10.4 to

11.0 percent of users did not respond

and nonresponse for cocaine-related

problems items ranged from 13.3 to

14.5 percent. Nonresponse on these

items was largely accounted for by

respondents who skipped blocks of

questions. Nomesponse was reasonably

similar for males and females and across

age categories but differed by race.

Black respondents were less likely than

white respondents to complete all

relevant questionnaire items.

Disaggregations by race were not shown

in the tables because the reduced sample

sizes for black respondents for specific

items increased the standard errors and

may have increased the potential bias of

the estimates for persons in that

category. The overall estimates and

estimates by sex and age may have

some potential nonresponse bias,

including possible bias resulting from

the diHerential nonresponse across race

categories.

Precision of the estimates

When producing estimates from any

sample survey, two types of errors are

possible—nonsampling error and

sampling error. Nonsampling errors

result from difficulties in the

interpretation of the questionnaire,

inability to recall information, reluctance

to answer particular questions, coding

errors, computer processing errors, and

other errors. Nonsampling errors are

reduced through use of improved

questionnaires, data editing, and periodic

retraining of interviewers.

The sampling error of an estimate is

the error caused by the selection of a

sample instead of a complete

enumeration. The standard error and

relative standard error are the primary

measures of sampling error in sample

surveys. The relative standard error,

which is the standard error divided by

the value of the estimate itself and

expressed as a percent, is used as a

criterion of precision. In this report,

estimates that have a relative standard

error of 30 percent or greater are shown

with an asterisk (*) indicating that those

estimates do not meet the DHIS

standard of precision or reliability.

Tables in this report include the standard

errors.

Because of the complex design of

the NHIS sample, SUDAAN (3) and

SESUDAAN (4), computer programs for

computing standard errors of rates (or

percents) from complex samples were

utilized.

Tests of significance

In this report, statistical inference is

based on the two-sided test of

hypothesis ~Pl=Pz versus HIL:Pl#PJ

with a critical value of 1.96 (0.05 level

of si~cance). Terms such as “higher”

and “less” indicate that differences are

statistically significant. Terms such as

“similar” or “no difference” mean that

no statistically significant difference

exists between the estimates being

compared. A lack of comment on the

Werences between any two estimates

does not necessarily mean that the

difference was tested and found not to

be significant. In calculating the test

statistics, the standard errors of the

differences take into account the

correlation between the categories being

compared. To illustrate, the test statistic

used to determine statistical significance

was calculated as:

(PI -P2)

z = SE (pI ‘P~

where pl and p2 are the two percents

being compared and

SE @l-p)=

qSE@1)2+SE(P~2-p”sE @l]I”sE @J

is the standard error of the difference

between pl and p2 with p defined as the

correlation between pland p2 The terms

SE (PI) and SE (pJ are the standard

error of plandp2, respectively. In this

report, the d~erence between the two
Advance Data No. 246

● April 8, 1994 11

estimates is said to be statistically

significant ifz is either greater than 1.96

or less than –1 .96. Note that since

SE (pl-pJ takes into account the

correlation between the two estimates,

calculations of test statistics based

simply on the standard errors as shown

in the tables of this report (i.e., ignoring

the termp .SE(pJ .SE&) in the

expression for SE@l-PJ) may not yield

the same conclusions regarding

statistical signikance as those reflected

in the discussion. In fact, if this

correlation is positive, then the test will

always be conservative. That is, results

of the revised tests may not reject the

null hypothesis ~P1=PJ as often as

they should. A difference that is statistically

significant does not necessarily

correspond toa large or important

difference. What it does imply is that

one can conclude (witha small chance

of being incorrect) that ifa census was

conducted, the estimates PI and pz

would not be the same.A difference that

is not statistically significant may have

resulted from random fluctuations in the

estimates due to selectinga sample

instead ofa census. Nonsampling errors

such as response and nonresponse errors

may also rdlect the outcome of

significance tests.

Related documentation

More detailed discussion of the

sample design of the NHIS, estimating

procedures, procedures for estimating

standard errors, nonsampling errors, and

definitions of other sociodemographic

terms used in this report has been

published in Series 10 of Vital and

Health Statistics (5). A public use data file based on the

1991 DAU was released in May 1993.

Information regarding its purchase may

be obtained by writing to the Division

of Health Interview Statistics, National

Center for Health Statistics, 6525

Belcrest Road, Hyattsville, Maryland

20782.

-.. . . . —

0.0 z*

Symbols

Data not available

Category not applicable

Quantity zero

Quantity more than zero but less

than 0.05

Quantity more than zero but lees

than 500 where numbers are

roundedto thousands

Figure does not meet standard of

reliabilityor precision(more than

30-percent relative standard error

in numerator of percent or rate)
12 Advance Data No. 246 ● April 8, 1994

Suggested citation

Keer DW, Colliver JD, Kopstein AN, et al.

Restricted activity days and other problems

associated with use of marijuana or cocaine

among persons 16-44 years of age United

States, 1991. Advance data from vital and

health statistiq no 246. Hyattsville, Maryland:

National Center for Health statistics. 1994.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Setvice

National Center for Health Statistics

Director

Manning Feinleib, M. D., Dr. IP.H.

Deputy Director

Jack R. Anderson

BULK R4TE

POSTAGE & FEES PAID

PHS/NCHS

Centers for Disease Control and Prevention

National Center for Health Statistics

PERMIT”NO. G-261

6525 Belcrest Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

To receive this publication regularly, contact

the National Center for Health Statistics by

calling 301-436-8500

DHHS Publication No. (PHS) 94-1250
Number 247 ● March 28, 1994

Advance

Data

FromVi and Health statisticsofthe CENTERS FOR DISEASE CONTROLAND PREVENTION/National Centerfor HealthStaMies

Characteristics of Elderly Home Health Patients: Preliminary

Data From the 1992 National Home and Hospice Care Survey

by Esther Hing, Division of Health Care Statistics

Introduction

Provision of formal home health

services has increased dramatically in

the last 30 years, due in large part to

increased public funding of home health

services through the Medicare and

Medicaid programs (l). In 1991, for

example, 65 of every 1,000 Medicare

enrollees received home health services

compared with 16 of every 1,000

Medicare enrollees in 1974 (2,3).

Growth in the home health industry has

also occurred as the introduction of

Medicare’s Prospective Payment System

for hospitals resulted in the need for

more post-acute care in the community

(1,4). Home health agencies provide

many therapies to assist early discharge

from a hospital, including physical

therapy, postbum and postsurgical

therapy, decubitns treatment, pulmonary

therapy, and occupational therapy (4).

New opportunities for care in the home

have also been created as medical

technology has been adapted from the

hospital to the home setting. Parenteral

therapies (including parenteral nutrition,

chemotherapy, antibiotic therapy,

anticoagulation infusions, and

transfusion of blood and blood

products), oxygen therapy, and home

dialysis are some of the services

previously provided only in acute care

hospitals that are now provided by home

health agencies (4).

This report presents findings on

home health service utilization by the

elderly regardless of agency certification

by Medicare or Medicaid, and regardless

of patient funding source. The data

presented are preliminary estimates from

the 1992 National Home and Hospice

Care Survey, the first annual survey of

hospices, home health agencies, and

their respective patients. The National

Center for Health Statistics (NCHS)

instituted this nationwide sample survey

in response to the rapid growth in the

number of these agencies in the United

States (5). The 1,500 agencies included

in the survey were selected from a

universe of 8,036 agencies classified by

the 1991 National Provider Inventory

~0 (6) ss agencies providing home

health or hospice care. Also included in

the universe was a sample of potentially

new agencies identified between

November 1991 (when the 1991 NHPI

was completed) and June 1992. Detailed

information on sample design, selection

methods, data collection procedures, and

sampling errors is included in the

Technical notes.

Estimates in this report are based on

the two patient samples (current patients

on the agency’s rolls as of the night

before the survey and discharges [alive

and dead] during the last 12 months).

Data were collected by interviewing

knowledgeable staff members, who

referred to the patient’s medical records.

Although the survey included patients

horn hospices and home health

agencies, data presented in this report

are based only on home health patients

aged 65 yews and over, that is, based on

responses from 3,654 discharges and

3,897 current patients. Estimates for this

report are preliminary. Further editing of

the data may produce estimates slightly

difterent from the estimates shown here.

Current patient characteristics

On any given day during the survey

period in 1992, there were 929,500

elderly home herdth patients, who

represented 3 out of 4 of the 1.2 million

patients served by home health agencies

(7). These patients were predominantly

female (66 percent), of white race

(70 percent), non-Hispanic (69 percent),

widowed (44 percent), or married

(35 percent) (table 1). Most of these

patients (71 psrcent) were served by

home health agencies located in a

Metropolitan Statistical Area (MSA)

(table 1). An MSA is an urban area

defined by the U.S. Office of

Management and Budget on the basis of

&’-%..

$

~

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

c

~m

Public Health Service f

Centers for Disease Controland Prevention

“..> National Center for Health Statistiee ..— .

flx
2 Advance Data No. 247 ● March 28,1994

Table 1. Number and percent distribution of elderly home health patients by demographic

characteriatic~ United States, 1992

Percent

Demographic characteristics Number distribution

Table 2. Number of elderly home health

patients, percent distribution by length of

service since admission, mean and median

length of service since admission:

United States, 1992

Length of service Current patients

sinoe admission in 1992

Tota165yeare of age . . . . . . . . . . . . . . .

Age

65-74 years . . . . . . . . . . . . . . . . . . . .

75-64 years . . . . . . . . . . . . . . . . . . . . .

85yeare andover . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . .

Race

Whtie . . . . . . . . . . . . . . . . . . . . . . . . .

Blackandother . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . .

Hispanic Origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . .

Current maritaletatus

Married . . . . . . . . . . . . . . . . . . . . . . . .

Widowed . . . . . . . . . . . . . . . . . . . . . . .

Divorced/separated . . . . . . . . . . . . . . . .

Nevermarried . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . .

Living quarteffi

Priiate or semiprivate residenw

Privateresidence . . . . . . . . . . . . . . .

Rentedroorrdboard . . . . . . . . . . . . . . .

Ratirementhome . . . . . . . . . . . . . . . .

Bosrdand csre/residential care fecilii . . .

Healthfacilii . . . . . . . . . . . . . . . . . . . .

otherorunknown . . . . . . . . . . . . . . . . .

Location

MA. . . . . . . . . . . . . . . . . . . . . . . . .

Non-MSA . . . . . . . . . . . . . . . . . . . .

Census ragion

Northeast . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . .

929,500 100.0

Total, 65 years of age and

over . . . . . . . . . . . . . . . 92!1,500

300,000

415,400

214,100

32.3

44.7

23.0 Perosntdiefribution

All lengthsofservice . . . . . “100.0

Under15days . . . . . . . . .

15-30days . . . . . . . . . . .

31-60days . . . . . . . . . . .

61-80days . . . . . . . . . . .

91 daysormore . . . . . . . .

Mean (inlays) . . . . . . . . .

Median (inlays) . . . . . . . .

6.3

11.0

15.9

9.2

57.5

:322.4

‘124.0

280,100

649,400

30.1

69.9

661,400

113,200

105,600

164,900

70.1

12.2

11.4

17.7

As shown in table 1, nearly all

current patients (96 percent) were living

in a private or semiprivate residence

(retirement home, rented room, or

boardinghome)or some other

noninstitutional residential setting

(3 percent) while receiving home health

services. h estimated 4,700 cuxrent

patients, however, received home health

services while in a hospital, nursing

home, or other health facility. Because

home health services are primarily used

by the noninstitutionalized population,

the rates presented in table 3 exclude

patients who received home health

servicesin ahealth care facility.

In 1992, On any given day during

the survey period,30 ofevery 1,000

civilian noninstitutionalized population

aged65 years and over received home

health care (table 3). Use of home health

services by the civilian

noninstitutionalized population increased

with age; home health useincmased

from 16perl,000 population aged

65–74yearsto82 per 1,000 population

aged 85 years and over. Elderly women

used home health services more often

than elderly men. Home health use

among elderly women was67percent

higher than that for elderly men (36 per

1,000 elderly women compared[with 22

per 1,000 elderly men). As shown in

table 3, home health uae varied by

location and region. The numbm of

home health patients per 1,000

population in areas outside urban

MSA’S (34 per 1,000 population aged

65 years and over) was higher than

inside MSA’S (29 per 1,000 population

29,80il

641,900

267,s00

3.2

89.1

27.7

324,500

406,600

30,200

40,500

127.700

34.9

43.7

3.2

4.4

13.7

866,400

9,200

20,100

24,900

4,700

*

93.2

1.0

2.2

2.7

0.5

*

668,100

271,400

70.6

29.2

287,000

197,900

323,700

121,000

30.9

21.3

34.8

13.0

the 1980 census (8). There was also

regional variation in the distribution of

home health patient~ a larger proportion

of home health patients werein the

South and Northeast census regions (35

and 31 percent) than in the Midwest or

West regions (13 and 21 percent). The

regional distribution of patients partially

reflects the distributions of home health

agencies; according to the 1991 NHPI,

39 percent of home health agencies were

located in the South, while 29 percent

were in the Midwest, 19perccnt were in

the Northeast, and 14percent werein

the West (6).

Most of these patients had been

served on a continuing basis; 58 percent

had been in the program for more than

90 days (table 2). The average lenglh of

service (up to the day of the survey)

was 322.4 days. The length of service

distribution was skewed, however, since

the median length of service since

admission was 124 days.
Advance Data No. 247 ● March 28.1994

Table 3. Civilian noninatitutionalized population S5 years of age and over, and number of

current home health patients per 1,000 population S5 years of age and over by age, sew

Ioeation, and region: United States, 1s92

1892 civiliannoninstitutionalized Number of 1992 current

pqurlationagd home healthpatientaper

65 years and over l,@O populsikmagad

Populationcharacteristic in thousands 65 years of age and over’

Tota165yeafs ofage Andover . . . . . . . . . . . . . .

Age

6S-74yeare . . . . . . . . . . . . . . . . . . . . . . . . . .

76-84 years. . . . . . . . . . . . . . . . . . . . . . . . . .

86yearaand over . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location

MA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-MSA . . . . . . . . . . . . . . . . . . . . . . . . . . .

Census region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . .

South. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30,792

18,470

9,698

2,624

12,s92

17,699

22,890

7,901

6,822

7,480

10,613

5,888

30.3

16.2

42.8

81.6

21.7

36.3

28.8

34.4

42.1

28.4

30.5

20.6

‘Numerator excludes home hsaMr patianta who received csra in a heaith Wilt-j.

Tabie4. Numberand percentofeideriy home health patienta byfunotionalatatus inthe

aetivitiesofdaiiy iivingandinatru mentaiaetivities ofdaiiyliving ,andcontinancw

UnitadStates,1992

Funcfionalstaius

Tota185yearsofageandover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Receivedperaonal helpwiththefollowing activifiesofADL

Bafhingorshowering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dressing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Transfenfnginoroutofbedaorchair . . . . . . . . . . . . . . . . . . . . . . . . . . .

Usingthetoiletmom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contineneastatus

Dficultycontroilingbladder.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dflcultycontmlling bowels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hadostomy, indwellingcatheter,orsimilardevica . . . . . . . . . . . . . . . . . . .

Receivedpersonalhelpin-”ngforthisdevica . . . . . . . . . . . . . . . . . . . .

Received personal help wifhthefollowing lADL

Doinglighthousework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Managingmoney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Shoppingforgrocarfeaorclothes.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lfsingthetelephone (dialing orreceiving cells) . . . . . . . . . . . . . . . . . . . . .

Prepanngmeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Takingmedicstions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PersorralhelpwifhADL’S andIADL’S

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Helpwith lADL’sonly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HelpwifhoneADL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HelpwifhtwoADL’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HelpwiththreeADL’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HelpwithfourADL’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HelpwithfiveADL’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

currant

patients

929,500

100.0

S8.3

49.1

13.4

38.4

27.4

13.1

21.3

12.7

11.2

37.6

3.1

14.9

4.6

24.9

28.5

28.6

10.9

7.6

16.1

13.4

14.8

8.7

aged 65 years and over). Home health

use was also higher in the Northeast (42

per1,000population aged65yeamand

over)thaninthe remaining regions

(20-30per l,000population).

In this report health status refers to

the patient’s functional status (yeraonal

help with the activities of daily living,

peraonalhelpwiththe instrumental

activitiesofdaily Iiving, andcontinenee

status) and primary (or Iirst-listed)

diagnosisatthetime ofadmission.The

activitiesofdaily living(ADL’s)are

basic activities that reflectan

individual’s capacity for self-care such

as bathing,dreasing ,usingthetoilet

room, transferring inandout ofa bedor

chair, and eating. For currentpatienta,

ADL assistance refers to help received

by home health stail atthetime of the

survey. ’f’ hemostfrequentADLthat

elderly cumentpatients received help

withwasbathing (56pereent), followed

by dressing (49 pereent), transferring in

oroutofabedor chair(37pereent),

using the toilet room (27percent), and

eating (13 percent) (table 4). .4s

expecte~ the proportions ofelderly

home health patienta requiringperacmal

assistaneearemuch higherthsnfound

arnongthe noninatitutionalized elderly

population. For example, according to

data from the 1987 National Medical

Expenditures Survey (NMES), 7 pereent

of noninstitutionalized elderly bathed

with personal assistance, 4percent

dressed with personal assistance, and

3 percent transferred out of a bed or

chair with personal assistance (9).

In addition to aasistanee with

ADL’s, 13 pereent of current patients

had cWTIcultycontrolling bladder

function. Eleven percent of current

patients had an ostomy, indwelling

catheter, orsimilardeviee, and

10 percent received help from home

health stall in caring for this deviee.

The instrumental activities of daily

living (L4DL’s) are complex t88k8 that

enable anindividurd to live

independently in the community. The

L4DL’s are more complex than the

ADL’s since some IADL’s such as

shopping for groceries involve cognitive

and physical functioning, whereas

transferring in or out of a bed or chair

involves only physical functioning. The

L4DL’s used in this report are doing
4 Advance Data No. 247 ● March 28,1994

light housework preparing meals, taking

medications, shopping for groceries or

clothes, using the telephone, and

managing money. In this report IADL

assistance refers to help received by

home health stafEat the time of survey.

In 1992 the most frequent L4DL that

elderly current patients received help

with was doing light housework

(38 percent), followed by taking

medications (27 percent), preparing

meals (25 percent), shopping for

groceries or clothes (16 percent), using

the telephone (4 percent), and managing

money (4 percent). Home health patients

were also more dependent in performing

these activities than the

noninstitutionalized elderly; according to

the 1987 NMES, 6 percent of

noninstitutionalized elderly did light

housework with personal assistance,

5 percent prepared meals with personal

assistance, and 4 percent shopped with

personal assistance (9).

Nearly three-fourths of elderly

home herdth patients received help with

either an ADL or L4DL (73 percent),

and 61 percent of current patients

received help with at least one ADL.

Only 12 percent of current patients

received assistance with only IADL’s.

These findings indicate the high degree

of functional dependence of elderly

home health patients compared to most

noninstitutionalized elderly persons.

Data from the 1987 National Medical

Expenditures Survey found that

20 percent of the noninstitutionalized

elderly had difficulty with at least one

ADL or IADL, 11 percent had difficulty

with at least one AD~ and 8 percent

had difficulty with only IADL’s (9). In

1987, 15 percent of persons with

difficulty in basic life (ADL or IADL)

activities received formal home care

service (10).

Another indicator of elderly home

health patients’ health status is their

primary diagnosis at admission (table 5).

Diagnostic information was collected

from agency staff, who referred to

patient medical records; this information

was then coded according to the

International Classification of Diseases,

Clinical Modifications, Ninth Revision

(ICD-9-CM)(ll). As shown in table 5,

elderly home health patients were

admitted with a variety of chronic and

acute primary diagnoses. The most

frequent primary diagnosis was heart

Table 5. Number and percent distribution of elderly home health patients by primary diagnosis et admission: United Stete~ 1992

ICD–9-CM diagnostic category and cude

Tota165yaers ofage And over.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pereent distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious andparasitic diaeasea . . . . . . . . . . . . . . . . . . . . . . . . ...001-139

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..14G239

Malignant neoplaams . . . . . . . . . . . . . . . . . . . . . . . . ...140-208.230-234

Endocrine, nutritional and metabolic diseases and immunity dlsordere . .240-279

Oiabetes melliius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250

Oiaeaaes of the blood and blood-forming organs . . . . . . . . . . . . . . ...280-289

Mental disordera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..28fX3f9

Oieeaaes of the nervous system and sense organs. . . . . . . . . . . . . ...320-389

OLseases of theciroulatory syatem. . . . . . . . . . . . . . . . . . . . . . . ...3-19

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Heart disease. . . . . . . . . . . . .391 --392.0,393+9S,402, 404,410-416,420-429

Cerabrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..43G436

Oiseasee of therespiratory system... . . . . . . . . . . . . . . . . . . . . ...460-519

Chronic obstructive pulmonay dieeaee. . . . . . . . . . . . . . . . . . . . . .490496

Daeases&the digeStie sy@em . . . . . . . . . . . . . . . . . . . . . . . . . ..52=79

Oiseasesof thegenitourinary ayatem . . . . . . . . . . . . . . . . . . . . ..560-629

Oiseases of the skin and subcutaneous tissue. . . . . . . . . . . . . . . . . . .6s0-709

Skin ulcets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .707

Oiseaaes of the musculoskeletal system and mnnactive tissue . . . . . ...710-739

Arthopathies and related disorders . . . . . . . . . . . . . . . . . . . . . . ..710-719

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...740-759

Symptoms, signs, and ill-defined renditions . . . . . . . . . . ...780-799

Injury and poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S00-S99

Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-629

Supplementary claeaification orunknown . . . . . . . . . . . . . . . . . . . . . . . . . . .

Current patients

in 1992

929,500

100.0

0.8

5.9

5.6

9.9

7.9

3.5

1.8

4.8

30.2

4.6

15.4

6.4

7.2

3.6

3.5

2.1

4.1

2.9

10.4

6.8

*

4.9

7.7

4.3

3.0

disease (15 percent), followed by

diabetes mellitus (8 percent),

arthropathies and related disorders

(7 percent), cerebrovascular disease

(6 percent), malignant neoplasms

(6 percent), essential hypertension

(5 percent), fractures, all sites

(4 percent), and chronic obstmctive

pulmonary disease (4 percent). These

diagnoses accounted for 55 percent of

all first-listed diagnoses at admission.

Table 6 presents services received

by home health current patients during

the last billing period. Although the

billing period for current patients

showed considerable variation, the most

frequent billing period covered one

month. In 1992, 4 out of 5 elderly home

health patients received skilled nursing

services (80 percent), while half

(50 percent) received personal care

services during the last billing period.

Physical therapy (16 percent),

homemaker and/or companion services

(11 percent), social services (10 percent),

medications (7 percent), and

occupational and/or vocational therapy

(4 percent) were received less

frequently.

It should be noted that data~on ADL

and L4DL assistance (table 4) difEer

from the percent of patients receiving

personal care (generally ADL activities)

and homemaker and/or companion

services (generally IADL activities) in

table 6 because of temporal andl

reporting dMerences. Personal help from

agency staff in performing ADL and

IADL activities was reported by agency

stafl for the time of the survey. In

contrast, data on services received were

usually obtained from billing records for

the last billing period.

In 1992, Medicare was the

predominant funding source for home

health carq 71 percent of elderly

patients relied on Medicare as their

primary payment source (table 6). To be

eligible for Medicare home health

benefits, a beneficiary must be

homebound, be under the care of a

physician who establishes a holmehealth

care plan, and need at least one of the

following intermittent skilled nursing

care, physical therapy, speech therapy,

or continuing occupational therapy. The

beneficiary must receive medically

reasonable, necessary care from a
Advance Data No. 247 ● March28,1994 5

Table 6. Numinx’ of elderly home health

patients and pareent by aerviees reeeived

and primary source of payment iaat biliing

period: United States, 1992

current

Servicasreceived and primary patients

souroeof payment1s9 billingperiod in 1992

Total 65 years of age and over . . . . .

Peroentdistribution. . . . . . . . . . . .

*M-WS receivedlastbillingperiod

Skillednursingservices. . . . . . . . . .

PeraOnalcare . . . . . . . . . . . . . . . .

.%cial.mvices . . . . . . . . . . . . . . .

counseling. . . . . . . . . . . . . . . . . .

Madiitions . . . . . . . . . . . . . . . . .

Phyakxdtherepy... . . . . . . . . . . .

Homemaker/companionservice. . . . .

Rafemalaarvioaa. . . . . . . . . . . . . .

Oiataryand nutritionalaetvioa. . . . . .

F%@CiWIStW@S...... . . . . . .

!+ighteo hoar e . . . . . . . . . . . . . .

Occupationaltherapy/ vocational

therapy . . . . . . . . . . . . . . . . . . .

Speashtharapy/audiology. . . . . . . .

Primaryaouroeof payment

last billingperiod

Privateinsurance. . . . . . . . . . . . . .

Owninoome. . . . . . . . . . . . . . . . .

Medii . . . . . . . . . . . . . . . . . . .

Medii”d . . . . . . . . . . . . . . . . . . .

Othergovernmentassistanceor

welfare. . . . . . . . . . . . . . . . . . . .

Other paymentsourceaorunknown. .

929,500

100.0

80.2

49.6

9.6

26

7.9

15.9

11.4

2.5

2.1

2.1

0.8

3.7

1.5

3.3

3.0

71.7

10.1

4.5

7.5

Medicare-certilied home health ageney.

These restrictions have limited use of

Medicare home health services for

chronic skilled nursing care (12). Such

restrictions do not apply to home health

services funded by Medicaid or other

government programs. In 1992,

10 percent of elderly patients relied on

Medicaid for primary paymen~ while

5 percent relied on other government

assistance or welfare. Medicaid is a joint

Federal-State medical assistance

program for persons who qualify for

welfare and to some of the “medically

needy” (those who would be on welfare

if their incomes were a little lower). The

State-set criteria for Medicaid eligibility

vary horn State to State but cover most

poor people in the United States. Other

government programs that pay for home

health services include State and Ioeal

governments, the Older Americans Act

(Title III), and Title XX Social Service

Block Grants.

Although the number of long-term

care polities issued in the last few years

have increased (13). onlv 3 oercent of

home health patients relied on private

insurance as their primary payment

source. Three percent of current patients

relied on their own income or family

income for payment.

Discharged patient

characteristics

During 1991–92 there were an

estimated 3.1 million discharges horn

home health agencies (7). Discharges

represent discharge eventa, that is, the

number of times patients completed an

episode of care and were removed from

the home health agency’s rolls during

the 12 months preceding the survey.

Discharges are not the same as

discharged patients, since a patient could

be included more than once if that

individual had more than one episode of

care during the year. The extent of

multiple episodes of are by a single

individual in the discharge sample is

unknown. The annual number of

discharges from home health agencies

indicates that the volume of serviees

provided by these agencies is extensive.

As was found among current patients,

nearly three-fourths (74 percent) of

home health discharges were aged 65

years and over.

)

One of the advantages of looking at

discharges compared with current

patients is that information is available

on the completed episode of care,

including the reasons for disehsrge from

the home health agency. A discharge

may be due either to an improvement or

stabilization of the condition causing

admission, or due to a worsening of the

condition, leading to transfer to a

hospital, nursing home, or death. In

1991-92, 92 percent of elderly discharge

patients were alive at discharge. The

fatality rate among home health

agencies is the percent of discharges

released tim the agency’s roster due to

death. In 1991-92, the fatality rate

among discharges aged 65 years and

over was 8 percent (figure 1). Fifty-three

percent of home health discharges were

released from care because the patient

recovered (14 percent) or stabilized

(39 percent), while 20 percent were

discharged because their condition

worsened such that hospitalization or

transfer to a nursing home was

neeesssry.

The distribution of length of service

for discharges with completed episodes

of care indicates that the majority of

discharges had shorter episodes of care

than current patients. The average length

of service for discharges was 95 day%

Oispositon

Reeovered

Stebiiizad

Daeeesed

Hosp-kdized

Nursing home transfer

Other or unknown

38.6

0 10 20 30 40 50

Percent dhtribtion

\ /, # ,.––––––- -— Figure 1. Disposition of elderiy home health diaehargea: United States, 1991-92
6 Advance Data No. 247 ● March 28.1994

_ 1%11-%?discharge. K2KJ I$l%?c.rrentpatie.ts

20

10

0

9.3 9.2

57.7

1-14 15-30 31-60 61-90 91 or more

Length of service in days

NOTE Len@ of servica fcf discharges is completed epkode, time sirwe admission othenvise.

Figure 2. Length of serviea for elderly home health discharges and current patlenk

United States, 1991-g2

the median length of service was 42

days. In contrast, the average length of

service since admission for current

patients was 322 days with a median

stay of 124 days. As illustrated in

figure 2 discharges were more likely to

have short episodes of care lasting 60

days or less (68 percent) than current

patients (33 percent). Conversely, current

patients were more likely to have

episodes of care lasting more than 90

days (58 percent) than elderly discharges

were (23 percent). This difference is

due, in large part, to survey

methodology; patients with short

episodes of care are more likely to be in

the discharge sample than in the current

patient (one day) sample (14).

Despite the differences in length of

service, home health discharges were

similar to current patients in age, sex,

location, and regional distributions

(table 7). Discharges differed from

current patients, however, in health

status and services received last billing

period.

As measured by help received in

performing the ADL’s and IADL’s,

discharges patients appeared to be in

better health than current patients.

Overall, 62 percent of discharge

received help with either ADL or IADL

activities at discharge or just before

discharge (table 8), compared with

71 percent of current patients at the time

of the interview. A lower proportion of

discharges than current patients reeeived

help with bathing or showering

(46 pereent compared with 56 percent)

and with dressing (39 percent compared

with 49 percent). Similarly, a smaller

percentage of discharges received help

in doing light housework (26 percent),

preparing meals (18 percent), and

shopping for groceries or clothes

(8 pereent) than current patients did.

There were differences in the

ranking of primary admitting diagnoses

for discharges compared with current

patients. The most frequent admitting

diagnoses for discharges were: heart

disease (18 percent), malignant

neoplasms (9 percent), fractures, all sites

(8 percent), eerebrovascular diseaae

(7 percent), diabetes mellitus (6 percent),

arthropathies and related disorders

(5 percent), chronic obstructive

pulmonary disease (5 percent), and

essential hypertension (4 percent)

(table 9). While heart disease ‘wasthe

most frequent admitting diagnosis for

current and discharged patients, the

second- and third-rrmked admitting

diagnoses for discharges were conditions

likely to have required post-acute care

(malignant neoplasms and fractures, all

sites), while the comparably ranked

diagnoses for current patients (diabetes

mellitus and arthropathies and related

disorders) were more chronic in nature.

Home health services receivedl by

discharges also reflect a greater use of

post-acute services than home health

serviees for chronic conditions

(table 10). A larger proportion of

discharges received skilled nursing

services (86 percent) and physical

therapy (26 percent) than current

patients (80 and 16 percent). CMrent

patients, on the other hand, were more

likely to have received personal care

(50 percent), and homemaker and/or

companion serviees (11 percent) than

discharges (39 and 5 percent).

Similar to current patients, the

primary source of payment for home

health discharges was third-party payers,

principally Medicare. In 1991--92 the

most frequent primary source of

payment for discharges was Medicare

(83 pereent), followed by priviite

insurance (5 pereent), and Medicaid

(4 percent) (table 10). The percent

relying on Medicare for primary

payment was higher among discharges

than current patients, while current

patients were more likely to rely on

Medicaid as the primary funding source

than discharges were.

Conclusions

A previous study found that

15 pereent of the population with

dficulty in basic life activities received

formal home care services (10). The

findings of this report indicate the role

home health agencies play in providing

care to the population at risk of needing

long-term care in 1992. Home health

agencies provide not only long-term

maintenance care, but also skilled

rehabilitative and therapeutic services

(4). Many of the findings of this report

refleet the major role Medicare plays in

funding home health care. Starting in
Advance Data No. 247 ● March 28,1994 7

Table 7. Number and percent distribution of elderly discharges from home health agencies by demographic characteristic= United States, 1991-92

Demographiccharacteristics

Pereerrt

Number distribution

Total,agad65years Andover. . . . . . . . . . . . . . . . . . . . . . . .

Age

65-74 yeara. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-S4yesra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85yearsand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

Whtie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blackandother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hispanicotigin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-Hispanic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Maritalatatusatdischarge

Married. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Widowad. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oivorcar!kepsrated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nevermarriad. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Livingquarters

Privateor semiprivateresidencw

Pnvateresidenea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rented romnbardinghouse... . . . . . . . . . . . . . . . . . . . .

Ratirementhome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bosrdandcare/residentialcarefaciMy . . . . . . . . . . . . . . . . . .

Healthfacilii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherorunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location

MSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-MSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Census region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

South. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,274,500

762,700

1,041,400

470,400

770,000

1,504,500

1,614,500

201,200

173,S00

458,600

1,416,600

751,700

=,200

905,300

62,800

83,eoo

344,700

2,133,400

*

40,s00

45,900

22,300

*

1,771,800

502,700

708,200

425,400

673,(S00

487,300

100.0

33.5

45.8

20.7

33.9

66.1

71.0

8.8

7.6

20.2

4.7

62.3

33.1

37.7

39.8

3.6

3.7

15.2

83.8

*

1.8

2.0

1.0

*

77.9

22.1

31.1

18.7

28.6

20.5

1965, when Title XVII (Medicare) of

the Social Security Act was enacted,

Medicare Coverage ofhomeherdth

services has been limited to post-acute

carefocusingon recuperative care rather

thanlong-termmaintenance care.

Medicarewasthe primarysourceof

payment for83percent ofelderly

discharges dnring 1991-92 andfor

71 percent of elderly current patientsin

1992.

This reporthasfound that home

health agencies provide primarily skilled

rehabilitative and therapeutic services, or

“medically oriented’’ home care. In

1987, natiortal expenditures for

medicall yoriente dhomehealth care

wereestimated tobe5biUiondolk+rs

accordingtothe National Health

Aceounts(15), while anotherstndy,the

1987 National Medical Expenditures

Survey(NMES)estimated annual

expenditures for homehealthcare,

includingcarepaid tohomemskers and

personal care providers, to be 11.6

billiondollar s(lfj).This implies that

medically oriented homehealthcare

represents less than half of formal home

health services rendered to the long-term

care population.

Homehealthcare isthefastest

growing segment ofthe health care

system. In1991 expenditurea for home

health care were 29 percent higher than

in1990(15). Due to the rising cost of

long-term care, many legislative

proposals have been consideredto

control these costa. I?indings from the

NationalHomeand Hospice Care

Survey can be used to monitor changes

in utilization of home health services as

the range of services provided and the

types of patients cared for change.

References

1.

2.

3.

4.

5.

6.

7.

8.

Applebamn ~ Phillips P. Assuring

the quality of in-home care: The

“other” challenge for long-term care.

Gerontologist 30(4):-50. 1990.

Silverman HA. Use of Medicruecovered home health agency sewkes,

1988. Health Care Financing Rev

12(2):113-126. 1990.

Health Care Financing

Administration. 1993 data

compendium Health Care Financing

Adrniuistration. Baltimore, Maryland.

1993.

Keenan JM, Fanale JE. Home canx

Past and present, problems and

potential. J Am Genatr Soc 3%1076-

83.1989.

Institute of Medicine. Toward a

NationaI Health Care Survey, a data

system for the 21st century.

Washington: National Academy

Press. 1992.

Delfosse R. Hospice and home health

agency charactenstkx 1991 National

Health Provider Inventory. National

Center for Health Statistics. Vkd

Health Stat. In preparation.

Strshan GW. Gverview of home

health and hospice care patients:

Preliminary data from the 1992

National Home and Hospice. Care

Survey. Advance data from vital and

health statistics; no 235. Hyattsville,

Maryland National Center for Health

Statistics. 1992.

Federal Register. January 3, 1980

(part 6).
8 Advance Data No. 247 ● March 28,1994

Table 8. Number and percent of elderly home health discharges by functional status In 17. National Center for Health Statistics.

the activities of daily living and instrumental activities of daily living, and continenctx

United States, 1991-92 Development and maintenance of a

national inventory of hospitals and

Discharges from institutions. National Center for

home health agencies

Functional status Health Statistics. Vital Health Stat in 1891-92

1(3). 1965.

Tota185years ofage And over... . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,274,500 18. Massey JT, Moore TF, Parsons VL,

Percent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 Tadros W. Design and estimation for

the National Health Interview

Received personal help with the following ADL Survey, 1985-94. National Center for

Bathing orshowering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45.9 Health Statistics. Vhal Health !$tat

Dressing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.3 2(110). 1989.

Eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.2

Tranaferringin oroutofbedsorohair . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19. Hoi3iIKuIK Spectications for

32.9

Usingthetoiletroom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.8 selectingNHHCS sample homle

health agencies and hospices.

Continence status

Dficullycontrollingbladder... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dticultycorrtrollin gbowels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hadostomy, indwelling estheter, orsimilardavice. . . . . . . . . . . . . . . . . . .

Received parsonal helpincaring forthisdevice . . . . . . . . . . . . . . . . . . .

Raceivadpsrsonal helpwiththefollowing IADL

Doinglighthousework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Managingmonay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Shoppingforgroceriesorclothes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Usingthetelephone (dialingor raeaiving calls) . . . . . . . . . . . . . . . . . . . . . .

Preparing meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Taking medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unpublished memo. 1992.

14.8 20.ShshBV,Bamwell BG,HuntlPN,L.a

15.0 VangeLM.SUDAAN user’smanual,

10.9 release 5.50.Research TriangleParlG

8.4 NorthCarolina Research Triangle

Institute. 1991.

26.0

1.5

8.2

*

17.8

25.4

-..

Parsonal help with ADL’S and IADL’S

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.9 ---

HelpwithlADL’sonly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.3

HelpwithoneADL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.9 . . .

HelpwithtwoADl_s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.5 _

HelpwiththreeADL’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.1

HelpwithfourADL’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.5 0.0

HelpwithfiveADL’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9

9, LeonJ, LairT.Functional statuaof

the noninstitutionalized elderly

EstimatesofADL andIADL

diilkulties. National Medical

Expenditures Survey Research

Findings 4. Agency for Health Care

Policy and Research. Roclwille,

Maryland: Public Health Service.

1990.

10. LaPlanteMP,Miller KS.Peoplewith

disabilities in basic life activities in

the U.S. Disability statistics abstract

number3. National Institute on

Disability and Rehabilitation

Research. U.S. Department of

Education. 1992.

11. Public Health Service and Health

Care FinancingAdministration.

International Clasatication of

Diseases, 9th Revision, clinical

moditkation.Washingtorx Public

Health Semice. 1980.

12. Bishop C, Skwara KC. Recent

growthofMedicare home health.

Health Mairs. 96-103.1993.

z

13. Health Insurance Association of *

America. Highlights from the 1989

Long-Term Care Survey.

Unpublished data presented at the

annual PrivateLong-Term Care

symbols

Data notavailable

Category nonapplicable

Quantity zero

Quantity morethan zero butless

than O.05

Quantity morethan zero butless

than 500where numbers are

rounded tothousands

Figure does notmeet standardof

reliability or precision (more than

30-percent relative standard error

in numerator of percent or rate)

Insurance Conference. Orlando,

Floridz 1990.

14. Keeler E, Kane R, Solomon D.

Short- and long-term residents in

nursing homes. Med Care 19:36>9.

1981.

15. Letsch SW, Lazenby HC, Lcvit KR,

Cowan CA. National health

expenditures, 1991. Health Care

Fmrmcing Rev 14(2):1–30. 1992.

16. Altrnan B~ Walden DC. Home

health care: Use, expenditures, and

sources of payment. National

Medical Expenditures Survey

Research Findings 15. Agency for

Health Care Policy and Research.

Rockville, Maryland: Public Health

Service. 1993.
Advance Data No. 247 ● March28,1994 9

Table 9. Number of elderly home health discharges, and percent distribution by primary

diagnosis at admiasiom United States, 1992

ICD-6-CM diagnostic category and code

Tota165years Andover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pemantdistrfbution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectiousandparasitic diseasea . . . . . . . . . . . . . . . . . . . ...001-138

Neoplasm.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignantnaoplasms. . . . . . . . . . . . . . . . . . . . ..140-20cr.23cr-z34

Endocrine,nutritionalandmatabolicdiseases andimmun-~

disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...240-279

Diabatesmalliius. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..250

Diseasesofthe bloodandblood-formingorgana . . . . . . . . . . ..26cr-2ssI

Mentaldisordara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Diseasasofthe newousayatemandsanse o~sns. . . . . . . . ...320-339

Oiseasesofthearculatorysystem . . . . . . . . . . . . . . . . . . . ..3s0-319

Essentialhyparlension. . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4oI

Heartdisaase . . . . . . . .391-392.0,393-396,402, 404,410-416,420-429

Cerebmvasculardieeeae. . . . . . . . . . . . . . . . . . . . . . . . ..480-13s

Disaasasoftherespiratoryayatem. . . . . . . . . . . . . . . . . . . ..4.so-519

Chronioobstructivepulrnonarydisease. . . . . . . . . . . . . . . ..4sro+66

Disessasofthedigestiiesystem. . . . . . . . . . . . . . . . . . . . ..520-5n

Diseasesofthegenitourinarysyatem . . . . . . . . . . . . . . . . ...530-629

Diseesesoftheskinandsubcutarmoustissue. . . . . . . . . . . ...660-709

Skinulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..707

Diseasesofthe musouloskeletalsyatemandoonnectiietissue . ..71&738

Atthopathiasandrelatadd-ra.. . . . . . . . . . . . . . . . ...710-719

Congenitalanomalies. . . . . . . . . . . . . . . . . . . . . . . . . . ...740-753

Symptoms,signs,andill-definecfcondiiions.. . . . . . . . . . . . ...76&799

Injuryandpoisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~

Fractures,allsites . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..soo-s2g

Supplementaryclassirloatiinorunknown. . . . . . . . . . . . . . . . . . . . . .

Discharges torn

home health agencies

in 1991-82

2,274,500

100.0

●

9.1

8.8

8.4

6.0

0.8

1.6

2.6

32.1

3.7

18.0

6.6

6.6

4.5

4.9

3.2

2.7

1.7

10.2

5.3

*

2.0

12.2

7.6

0.9

Table 10. Number of elderly home heatth discharges and percent by asnricea recaived and

primary source of payment laat billing period Unitad States, 1991-92

s

Diaclwgaa rhrn

an?cea racaiked andpnmary aourva of home haakh agencies

paymentlast billingperiod in 1991-92

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Setvices receivedlast billingperiod

Skilladnur3ingservioss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Personaloare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Socialservioas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Counseling.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mediations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physicaltherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Homemaker/companionsarvkas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Respitecere. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Referralservkea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diataryandnutritionalaervims.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Waicianawbaa. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hightechoare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Occupationaltherapy/vocationaltherapy. . . . . . . . . . . . . . . . . . . . . . . . .

Spaachtherapy/audiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mealsonwheels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Primarysoumaofpayment Iaatbillingpariod

Privateinsurance.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ownincome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medicare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medicaid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Othergovemmentassistanceorwetfare . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpaymentemrcesorunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,274,500

Im.o

86.1

39.2

12.2

3.8

6.3

26.3

4.5

0.3

2.0

1.9

1.9

0.8

5.3

2.3

0.7

4.8

1.7

63.3

3.7

0.7

6.6
10 Advance Data No. 247 ● March 28,1994

Technical notes

Source of data

The sampling frame consisted of all

home health agencies and hospices

identified in the 1991 National Health

Provider Inventory (NHPI) and all

agencies opened for business between

1991 and June 30, 1992, as identified

through the Agency Reporting System

(17). The NHYI is a comprehensive

census of nursing and related care

homes, residential care homes, facilities

for the mentally retarded and mentally

ill, home health agencies, and hospices

conducted by the National Center for

Health Statistics (6).

The sample design for the 1992

NHHCS is a stratified three-stage

probability design. Primary Sampling

Units (PSU’S) are selected at the first

stage, agencies are selected at the

second stage, and current residents and

discharges are selected at the third stage.

The first stage utilized the selection

procedures that obtained the 198 PSU’S

used for the National Health Interview

Survey (NHIS), a survey of the civilian

noninstitutionrdized population of the

United States (18). The PSU’S are

counties, groups of counties, county

equivalents (such as parishes or

independent cities), or towns and

townships (for some PSU’S in New

England). To minimize data collection

costs and to establish linkage betsveen

the two surveys, home health agencies

and hospices were selected within the

same PSU’S included in the NHIS

allowing future research on availability

and use of services (5).

The second stage involved the

selection of agencies within six primary

strata of agencies. These strata were

formed in the 1992 sampling frame on

the basis of type of agency ~ospices

compared with home health agencies

and mixed agencies (jxoviding both

types of care or unknown)], and type of

PSU [self-representing (SR) compared

with non-self-representing (NSR), and

within NSR PSU’s, metropolitan

statistical area (MSA) compared with

non-MSA]. MSA is a metropolitan

statistical area defined by the U.S.

Office of Management and Budget on

the basis of the 1980 census. Within

these sampling stratum, agencies were

arrayed by four regions, five types of

ownership, two types of certification

status, and finally by the number of

patients currently being served by the

agency. The number of agencies selected

from each sampling stratum was based

primarily on results of leading to the

best sample design for the 1992

NHHCS. Hospices in the NSR PSU’S

and home health agencies, mixed

agencies in the non-MS~ and NSR

PSU’S were selected with certainty.

Hospices in the SR PSU’S and home

health agencies and mixed agencies in

the MSA-NSR PSU’S, and the SR

PSU’S were selected with probability

proportional to the current patient size

(as reported in the NHPI sampling

frame). A total sample of 1,500 agencies

were selected; 384 were hospices, and

the rest were home health agencies or

mixed agencies (19).

The final stage is a systematic

random selection of six patients

currently served by the agency and six

patients discharged iiom care during the

last complete 12-month period.

Response rates for each stage of the

sample follow:

Response Number

Sampling unit rate responding

Agency 90 1,245

Current patients 99 6,897

Discharged

patients 99 6,765

Data collection procedures

The data collection for the NHHCS

began with a letter sent to all 1,500

sampled agencies informing the

administrator of the authorizing

legislation, purpose, and content of the

survey. Within a week to 10 days after

the letter was mailed, the interviewer

assigned to conduct the survey for a

particular agency made telephone

contact to discuss the survey and to

arrange an appointment with the

administrator or person designated by

the administrator.

Three questionnaires and two

sampling lists were used to collect the

data. The Facility Questionnaire was

completed with the administrator or

designee. The interviewer would next

complete the Current Patient Sampling

List (CPSL) and Discharged Patient

Sampling List (DPSL). With the CPSL,

the interviewer listed all patients on the

register of the agency on the evening

before the day of the survey. The DPSL

was used to list all discharges from

agencies during the 12 full months

before the month of the survey.

Sampling of current patients and

discharged patients within agencies was

done by using tables showing sets of

sample line numbers for each possible

count of current patients and discharged

patients in the agency. The interviewer

drew a sample of up to six current

patients and up to six discharges.

After the samples had been

selected, the Current Patient

Questionnaire and Discharged :Patient

Questionnaire were completed for each

sampled person by interviewing the staff

member most familiar with the care

provided to the patient. The respondent

was requested to refer to the medical or

other records whenever necessary.

Sampling variability

Because the statistic presented in

this report are based on a sample, they

will differ somewhat from figures that

would have been obtained if a complete

census had been taken using the same

schedules, instructions, and procedures.

The standard error is primarily a

measure of the variability that occurs by

chance because only a sample, rather

than the entire universe, is surveyed.

The standard error also reflects part of

the measurement error, but it does not

measure any systematic biases in the

data. The chances are 95 out of 100 that

an estimate from the sample MYersfrom

the value that would be obtained from a

complete census by less than twice the

standard error.

The standard errors used in this

report were approximated using

SUDAAN software. SUDAAN

computes standard errors by using a

first-order Taylor approximation of the

deviation of estimates from their

expected values. A description of the

software and the approach it uses has

been published (20). Exact standard

error estimates were used in tests of
Advance Data No. 247 ● March28,1994 11

signiilcance in this report. A generalized

variance function was produced for

aggregate preliminary estimates of

discharges and current patients by fitting

the data presented in this report and

from an earlier publication (7) into

curves using the empirically determined

relationship between the size of an

estimate X and its relative variance (rel

var X). This relationship is expressed as:

S.2 b

relvarX=-=a+~ X2

where a and b are regression estimates

determined by an iterative procedure.

Estimates of standard errors for percents

of the estimated number of discharges

and estimates of standard errors for

percents of the estimated number of

current patients are presented in table I.

The Z-test with a 0.05 level of

significance was used to test all

comparisons mentioned in this report.

Not all observed differences were teste~

so lack of comment in the text does not

mean that the diilerence was not

statistically significant.

Table L Standard errors for parcenta of eatlmatad number of 1991-92 dlachargee and

number 1992 current patient= National Home and Hoapke Cara Smvey, 1992

Baae of 1991%2 elderly Eaaa of 1992 Cunwrt

hcina healthdiachergea eldmfyhcma heafih

P@@@

EStimatadpercent

patientbt=ga

(2,274A%W) ,

3tandard error in percerrtaga points

lor99 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.3

5or95 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 0.6

100r90 . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 0.6

200r80 . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 1.1

SOor70 . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 1.3

50 . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. 1.5 1.4
12 Advance Data No. 247 ● March 28,1994

Suggested cftation Copyright information

Hing E. Characteristics of elderly home health All material appearing in this report is in the

patients: Preliminary data horn the 1992

National Home and Hospice Care Survey.

public domain and may be reproduced or

Advance data from vtal and health statisti~ copied without permission; citation as to

no 247. Hyattsville, Maryland: National Center source, however, is appreciated.

for Health-Statistics. 1994.

National Center for Health statistics

Director

Manning Feinleib, M. D., Dr. P.H.

Deputy Director

Jack R. Anderson

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

6525 Belcrest Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

To receive this publication regularly, contact

the National Center for Health Statistics by

calling 301-436-6500

BULK RATE

POSTAGE & FEES PAID

PHS/NCHS

PERMIT NO. G-261

DHHS Publication No. (PHS) 94-1250
Number 248 ● March 9, 1994

Advance

Data

From Vi and Health Stat&k ofthe CENTERS FOR DISEASE CONTROL~D PREVENTION/N~”@ Centerfor Healthstati~”os

National Hospital Ambulatory Medical Care Suwey: 1992

Outpatient Department Summary

by Linda F. McCaig, M.P.H., Divisionof Health Care Statistics

In December 1991, the National

Center for Health Statistics inaugurated

the National Hospital Ambulatory

Medical Care Survey @IHAMCS) to

gather and disseminate information

about the health care provided by

hospital emergency and outpatient

departments to the population of the

United States. Ambulatory medical care

is the predominant method of providing

health care services in the United States.

Since 1973, data have been collected on

patient visits to physicians’ offices

through the National Ambulatory

Medical Care Survey (NAMCS).

However, visits to hospital emergency

and outpatient departments, which

represent a significant segment of total

ambulatory medical care, are not

incIuded in the NAMCS (l).

Furthermore, hospital ambulatory

patients are known to diiTerfrom office

patients in their demographic

characteristics and are also thought to

differ in medical aspects (2). Therefore,

the omission of hospital ambulatory care

from the ambulatory medical care

database leaves a significant gap in

coverage and limits the utility of the

current NAMCS data. The NHAMCS

fills this data gap. This survey was

endorsed by the American Hospital

Association, the Emergency Niuses

Association, and the American College

of Emergency Physicians.

This report presents data on

outpatient department (OPD) visits from

the 1992 (NHAMCS), a national

probability survey conducted by the

Division of Health Care Statistics,

National Center for Health Statistics,

Centers for Disease Control and

Prevention. A previously published

report highlighted visits to emergency

departments (3).

The estimates presented in this

report are based on a sample rather than

on the entire universe of hospital OPD

visits. Therefore, they are subject to

sampling variability. The technical notes

include a brief overview of the sample

design used in the 1992 NHAMCS and

an explanation of sampling errors. A

detailed description of the 1992

NHAMCS sample design and survey

methodology will be published.

The OPD Patient Record form is

used by hospitals participating in the

NHAMCS to record information about

patient visits. This form (figure 1) serves

as a reference for readers as they review

the survey tidings presented in this

document.

Patient characteristics

During the 12-month period from

January through December 1992, an

estimated 56.6 million visits were made

to OPD’S of non-Federal, short-stay, or

general hospitals in the United

States-about 22.5 visits per 100

persons. OPD visits by patient’s age,

sex, and race are shown in table 1.

There were no signiibnt differences in

OPD visits rates between any of the age

groups. Females made 61.4 percent of

all OPD visits and had a higher visit

rate (26.9 visits per 100 persons) than

males (17.9 visits per 100 persons).

White persons made 74.3 percent of

all OPD visits, with black persons and

Asian/Pacitic Islanders accounting for

22.2 and 2.8 percent, respectively. The

visit rate for black persons was

significantly higher than for white

persons overall and in all age categories

except persons less than 15 years and 75

years and over.

Outpatient department visit

characteristics

By region, the largest proportion of

OPD visits were made in the Northeast

(29.1 percent). Msit rates in the

Northeast (33.0 visits per 1043pemons)

and the West (25.0 visits per 100

persons) were higher than in the South

(13.2 visits per 100 persons).

A clinic was defied as an

administrative unit of the outpatient

U.S. DEPARTMENT OF HEALTH AND HUMAN SERViCES

Public Health Sewice

Centers for Dkease Controland Prevention

National Center for Health Statistics eEwrE CDC NmmE Fosm
2 Advance Data No. 248 ● March 9, 1994

Department of Health and Human Services

Public Health Service, Centers for Disease Control

OMB No. 0920-0278

National Center for Health Statistics CDC 64.54

NOTICE - Information contained on this form which would permit identification of any Individual or establishment has been collected with a guarantee that it will be held in

1

strict confidence, WIII be used only for purpcms stated for this study, and will not be d lsclosed or released to others without the consent of the individual or the establishment

in accordance with sect!on 308(d) of the Publtc Health Service Act (42 USC 242m ), Public reporting burden for this phasa of the survey is estimated to av.way 3 minutes per

response. If you have any comments regarding the burden est!mate or any other aspect of this survey, including suggestlom for reducing this burden, send them m the PHS

Reparts Clearance Of ftcer; Attn: PRA: HHH BuJdmg, Rm, 721 .B: 200 Independence Ave., S.W., Washington, OC 20201, and to the Office of Management and 8udget: Paper.

work Reduction Project (0920.0278); Washington, OC 20503.

NATIONAL HOSPITAL AMBULATORY

MEDICAL CARE SURVEY

OUTPATIENT DEPARTMENT

PATlENT RECORD

-—- -.— ——. ——— ——. ___ ___ — ___ — — ___ — — — —___—— ——— ___ —.—— —

3, DATE OF VISIT 5. SEX 6. RACE 7. ETHNICITY 8. EXPECTED SOURCE(S) OF PAYMENT 9. WAS PAT lENT

1 ❑ Wfute

(Check all that apply) REFERRED FOR

~ , n Female 2 ❑ Black

THIS VISIT BY

Month Dav Year I O Hmpantc I Q Medmare 5 ❑ ~&M&ther ANOTHER

$. DATE OF BIRTH 3 ❑ &lan/Paclftc 2 ❑ Medice8d

6 ❑ f%em paid

PHYSICIAN?

Islander 2mrJ0t

2 ❑ Male 4 ❑ fi;~yn Ospantc 3 ❑ Other

government 7 ❑ No charge I ❑ Yes

I I

Month Day Year Eskimo/ 4 l_J Private/ 8 n Other

Aleut 02mmerctal

ZDNO

10. PATIENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER 11. PHYSICIAN’S DIAGNOSES

REASON(S) FOR THIS VISIT (m Patient’s own words)

12. l+AS PATlENT BEEN SEEN

IN THIS CLINIC BEFORE?

a. Pnnc#pald,agnousf

m.Mostimportant.

problem associated

with Item 10a. 7 0 Yes 20N0

+

x Other: b, Other: If yes, for the condttion in

item lla7

:. Other: c. Other: I ❑ Yes 2DN0

I

13. AMBULATORY SURGICAL 14. DIAGNOSTIC/SCREENING SERVICES 15. THERAPEUTIC SERVICES

PROCEDURE(S) (Check all ordered or provided. )

(Record any outpatient diagnostic

(Check ail ordered or provided. Exclude medication)

or therapeutic procedure. For the ! ❑ None 1, IJ Pa, test I a None

firet, check appropriate boxes.) 2 n 8100d pressure !2 O Strep throar test COUNSELING/EOUCATION:

3 ❑ Urmalysls 13 ❑ HIv serology z ❑ Diet 8 D Smokifigcess.m!o”

* ❑ EKG resting 14 0 Cholesterol measure 3 ❑ Exercise 9 ❑ Farnily/w3cial

m. 5 Q EKG exerctse 15 Q Other lab test 4 ❑ Cholesterol reddct!on I o ❑ Growth/development

1 ❑ ~hedul~ 3 ❑ Local a“e~theu, 6 ❑ Mammogram ,6 D I-lewi”gtest

50 Weight red.cmm I I ❑ Family planning

2 ❑ Performed 4 0 Regional anesthesia 7 D Chest x.rav 17 n Vauat acuity

6 0 Drug abuse 12 ❑ Other counseling

5 ❑ General anesthesia 8 ❑ Other radiology 1a ❑ Mental status exam

7 ❑ Akmhol abuse

9 ❑ Allwgy testing

OTHER THERAPY:

19 ❑ Dther (Sporif>)

13 ❑ Psychotherapy

10 ❑ Smrometrv

16 ❑ Physiotherapy

3. 14 n tirredive Iemes 17 ❑ Other therapy (Specify)

15 ❑ Hesmi”g aid

16. MEDICATION 17. DISPOSITION THIS VISIT

(Record all new or continued medications ordered, administmed, or promded

IB. PROVIDERS SEEN

(Check all that apply) THIS VISIT

on this uislt. Use the same brand name or generic name on any Rx or (Check all that apply)

medical record, Include immunizations and desensitizing agents. )

I ❑ Return to clinic PRN

❑ None NEW MEDICATION? 2 ❑ Return to clinic aPWintrnem I ❑ Resident/Intern

3 ❑ Telephone foHOw.up pia””ed 2 ❑ Staff physician

1, tnYes2DNo 4 0 Return to referring phy$ician 3 a Other physician

z.

5 ❑ Refer tO other Phvsiciadcli”ic 4 ❑ Physic”lan assistant

IO Ye22DNo

6 ❑ Admit to hospital 6 ❑ Nurse practitioner

3. ID Yas20No 7 •l No fOllOW+Pplanned 6 ❑ Registered nurse

B a Other (Specify) 7 ❑ Licensed practical nurse

4, 10 Yes2a N0 8 a Nurse’s aide

5. 1nYes2aN0

I

Figure 1. Patient Record form.
Advance Data No. 248 ● March 9, 1994 3

Table 1.Number, percent dlstributlon, and annual rate of outpatient department visits with corresponding standard errors by aaleetad

patient and outpatient department charaeteristlos: Unitad States, 19S2

Numberof Standard standard Numberof

visitsin envr in Percent errorof

Characteristic

visitsper 100

tirousands thousands distribution pa-cart personsper year’

Allvisits . . . . . . . . . . . . . . . . . . . . . . . 66,605 4,446 100.0 . . . 22.5

Patient characteriatio

Age

Under 15years . . . . . . . . . . . . . . . . . . .

16-24 yaara . . . . . . . . . . . . . . . . . . . . .

25-14 yaara . . . . . . . . . . . . . . . . . . . . .

45-64 yeers . . . . . . . . . . . . . . . . . . . . .

65-74 yaera . . . . . . . . . . . . . . . . . . . . .

75years and over . . . . . . . . . . . . . . . . .

12,713

7,242

16,464

11,285

5,031

3,640

1,633

566

1,307

964

521

702

22.5

12.8

29.1

20.0

8.9

6.8

2.0

0.7

1.1

0.9

0.6

0.9

22.5

21.1

20.3

23.3

27.2

31.2

Sex and age:

Female . . . . . . . . . . . . . . . . . . . . . . . .

Under 15yeara . . . . . . . . . . . . . . . . .

15-24 yaara . . . . . . . . . . . . . . . . . . .

25-44 yaerS . . . . . . . . . . . . . . . . . . .

45-64 yeara . . . . . . . . . . . . . . . . . . .

65-74 yearS . . . . . . . . . . . . . . . . . . .

75yeereand ovar . . . . . . . . . . . . . . . .

34,741

6,146

5,222

10,662

7,130

3,i37

2,423

21,664

6,565

2,020

5,602

4,165

1,694

1,417

2,660

772

446

637

622

313

465

1,924

875

235

661

407

243

61.4

10.9

9.2

18.9

12.6

5.5

4.3

38.6

11,6

3.6

10.3

7.4

3.3

2.5

1.0

1.0

0.6

0.8

0.7

0.3

0.6

1.0

1.1

0.3

0.7

0.4

0.3

0.3

26.9

22.3

30.2

25.8

26.3

30.8

31.4

17.9

22.7

11.8

14.5

17.9

22.9

30.7

Male . . . . . . . . . . . . . . . . . . . . . . . . .

Under15yaara . . . . . . . . . . . . . . . . .

l%24yeara . . . . . . . . . . . . . . . . . . .

25-44y6er23 . . . . . . . . . . . . . . . . . . .

45-64yaam . . . . . . . . . . . . . . . . . . .

65-74yeara . . . . . . . . . . . . . . . . . . .

75yearsandovar . . . . . . . . . . . . . . . . 23s

Raoa and age

While . . . . . . . . . . . . . . . . . . . . . . . . .

Under15yaam . . . . . . . . . . . . . . . . .

15-24yeara . . . . . . . . . . . . . . . . . . .

25-44yeera . . . . . . . . . . . . . . . . . . .

45-64yaara . . . . . . . . . . . . . . . . . . .

65-74yeers . . . . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . . . . .

42,034

9,224

5,328

12,280

8,330

3,772

3,089

12,549

3,135

1,633

3,546

2,466

1,099

650

3,779

1,259

486

1,076

765

425

74.3

16.3

9.4

21.7

14.7

6.7

5.5

22.2

5.5

2.9

6.3

4.4

1.9

1.1

20.1

20.5

19.4

18.1

20.0

23.0

27.8

2.2

1.6

0.6

1.0

0.8

0.5

0.9

2.1

0.9

0.3

0.7

0.5

0.3

0.2

666

Black . . . . . . . . . . . . . . . . . . . . . . . . .

Under15yaara . . . . . . . . . . . . . . . . .

15-24yaara . . . . . . . . . . . . . . . . . . .

25-44yeara . . . . . . . . . . . . . . . . . . .

45-64yaera . . . . . . . . . . . . . . . . . . .

65-74yeara . . . . . . . . . . . . . . . . . . .

75yaaraandover . . . . . . . . . . . . . . . .

1,415

570

164

465

39.9

35.0

32.0

36.2

49.9

66.8

66.4

325

203

149

Aliotharraoes

Aaiadl%cificlslander. . . . . . . . . . . . . . .

AmericanlndianEskimo/Aleut . . . . . . . . . .

1,609

*41 4

272

168

28

0.7

0.5

YL3

---

---

Outpatientdepartment characteristic

Gwgaphicregiorx

Notthaaat . . . . . . . . . . . . . . . . . . . . . . 16,497 2,369 28.1 3.5 33.0

West . . . . . . . . . . . . . . . . . . . . . . . . . 13,906 1,664 24.6 2.6 25.0

Midwest . . . . . . . . . . . . . . . . . . . . . . . 15,049 3,176 26.6 4.1 24.5

south . . . . . . . . . . . . . . . . . . . . . . . . . 11,153 1,242 19.7 2.3 13,2

‘Basedcm U.S. Burwti* ~us@ma&&ti Ml~, nonin9Mbnshz“edPo@stimoftheUnitedStstesFSofJulyl, 1ss2,

department where ambulatory medical

care is provided under the supervision

ofaphysician. Clinicswhereonly

ancillary services, such as radiology,

renal dialysis, and pharmacy, were

provided or other settings in which

physician services were not typically

provided were out of scope for the

survey. In addition, ambulatory surgery

centers were out ofscopebecauae they

areincludedin the National Survey of

Ambulatory Surgery.

Clinics were classified into six types

as presented in table 2. Half of all OPD

visits (49.9 percent) were made to

general medicine chks which included

intemalmedicine andprimarycare

clinics. Pediatric, surgery, and obstetrics

andgyneccrlogy clinicaaccounted for

13.5perceng 12.7 peraxr~ and

10.1 percent of visit3, respectively. The

“other” clinic category included

psychiatry and neurology clinics. The

“substance abuse” category included all
Advance Data No. 248 ● March 9, 1994

Table 2. Number and percent distribution of outpatient department visits with

corresponding standard errora by type of ciinitx United States, 1992

Number of Standard Standard

visits in error in Percent error of

W.Sitcharacferktic thousands thousands diati”bution percent

Allvisite . . . . . . . . . . . . . . . . . . . . . . 58,605 4,446 100.0 . . .

Type of clinic

General medicine . . . . . . . . . . . . . . . . . 28,248 3,329 49.9 3.5

Pediatrioa . . . . . . . . . . . . . . . . . . . . . . 7,620 1,296 13.5 2.0

Surgery . . . . . . . . . . . . . . . . . . . . . . . . 7,187 1,164 12.7 2.0

Obatetricaandgynacology . . . . . . . . . . . . 5,740 810 10.1 1.4

Subetanceabuaa . . . . . . . . . . . . . . . . . %18 436 *1.4 0.7

Other . . . . . . . . . . . . . . . . . . . . . . . . . 6,993 1,664 12.4 2.7

Tabie3. Number and parcent dlatribution ofoutpatient department visitawith

corresponding atandard errora by raferrai atatusand prior-visit status: United States,

1992

Numberof Standard Stwdard

visits in error in Percent error of

Viitoharacterisitc thousands thousands distribution percent

All visits . . . . . . . . . . . . . . . . . . . . . . . 56,805 4,446 100.0 . . .

Referral status

Not referred by another physician . . . . . . . 50,163 4,298 66.7 1.6

Referred by another physician. . . . . . . . . . 6,421 936 11.3 1.6

Prior-visit status

Oldpetient . . . . . . . . . . . . . . . . . . . . . . 44,180 3,953 78.0 1.7

Old problem . . . . . . . . . . . . . . . . . . 35,835 3,014 63.0 1.5

Newproblem . . . . . . . . . . . . . . . . . . . 8,545 1,255 15.1 1.5

New patient . . . . . . . . . . . . . . . . . . . . . 12,425 1,122 22.0 1.7

types of alcohol and drug abuse clinics

except methadone maintenance clinics,

which were specifically excluded from

the survey.

Referral status and prior visit

status

Approximately 11.3 percent of OPD

visits were made as the result of a

referral from another physician (table 3).

The majority of OPD visits

(78.0 percent) were made by patients

who had been seen in the clinic on a

previous occasio~ and more than half

(63.0 percent) of all visits were made by

persons returning to the clinic for care

of a previously treated problem. Only

22.0 percent of visits were made by new

patients, that is, patients who had not

been seen in that clinic before.

Reason for visit

In Item 10 of the Patient Record

form, the patient’s (or patient

surrogate’s) “complaint(s), symptom(s),

or other reason(s) for this visit in the

patient’s own words” is recorded. Up to

three reasons for visit are coded and

classified according to A Reason for

Viiit Classification for Ambulatory Care

(WC) (4). The principal reason is the

problem, complain4 or reason listed tit

in item 10a of the OPD Patient Record

form.

The RVC is divided into eight

modules or groups of reasons (table 4).

Approximately 42.6 percent of all visits

were made for reasons classified as

symptoms, with the diagnostic/screening

and preventive module and the treatment

module accounting for 19.4 and

16.8 percent of visits, respectively. The

20 most frequently mentioned principal

reasons for visit, representing

41.5 percent of all visits, are shown in

table 5. It is important to note that the

rank ordering presented in this and other

tables may not always be reliable

because near estimates may not diiler

from each other due to sampling

variability. “Progress visit” was the

most frequently mentioned visit overall

(7.4 percent), reflecting the large number

of return visits for a previously treated

problem. “Cough” was the most

frequently mentioned reason for visit in

the symptom module (2.1 percent).

Principal diagnosis

The principal diagnosis or problem

associated with the patient’s most

important reason for visit and any other

sigrdicant current diagnoses are

recorded in Item 11. Up to three

diagnoses are coded and classified

according to the International

Classi@ation of Diseases, 9th Reviswq

Clinical Modification (ICD-!MCM) (5).

OPD visits by principal diagnosis using

the major disease categories specified by

the ICD-9-CM are shown in table 6.

The supplementary classilicaticms, which

describe circumstances other than a

disease or injury, are recorded as

diagnoses. They accounted for

21.9 percent of all OPD visits.

The 20 most frequently reported

principal diagnoses are shown in table 7.

These are categorized at the three-digit

coding level of the ICD-9-CM and

account for 35.3 percent of all OPD

visits. The most commonly recorded

diagnosis was “normal pregnancy,”

occurring at 5.9 percent of all visits.

Ambulatory surgical

procedures

Hospital staff were asked to record

up to two ambulatory surgical

procedures that were scheduled or

performed at the visit. The prctcedures

are categorized at the three-digit coding

level of the ICD-9-CM, volume 3.

Ambulatory surgical procedures were

reported at 7.8 percent of all C)PDvisits,

accounting for 4.4 million procedures

scheduled or petiormed. Due to small

sample sizes, only two of the ten most

frequently reported surgical procedures

had estimates considered to be reliable.

“Diagnostic procedure on vagina and

cul-de-sac” and “other local excision or

destruction of lesion or tissue of skin

and subcutaneous tissue” were recorded

for 220,720 visits (0.4 percent) and

189,002 visits (0.3 percent), respectively.
Advance Data No. 248 ● March 9, 1994 5

Table 4. Number and percant distribution of outpetiant department vlsita with corresponding standard errors by patient’s principal

reason for VISK United States, 1992

Number of StandSd standard

Principalreason rbr visitand RVC code’

visitsin errorin Percent errorof

thousands thousands dism”buticm percenf

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Symptom module . . . . . . . . . . . . . . . . . . . . . . . . . ..S001-S999

General symptoms . . . . . . . . . . . . . . . . . . . . . . . ..S001-S099

Symptoms referable to psychologicaVmental disorders. .. S100-S1 99

Symptoms referable to the nervous system (excluding

sanseorgans) . . . . . . . . . . . . . . . . . . . . . . . . . . ..S200-S259

Symptoms referable to the cardiovascular/iymphatic

system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S260-S299

Symptoms referable to the eyes and ears. . . . . . . . . . .S300-S399

SymPtoms refarableto tierespiratorysyetem . . . . . . ..S4M98

Symptoms referable tothedigeetive system . . . . . . . ..S500-S639

Symptoms referable tothegenitounnary eystem. . . . . . .S640+629

Symptoms referable to the skin, hair, and nails. . . . . . . .S830-S399

Symptoms referable to the musculoskeletal system . . . . .S900-S989

Diseasa module . . . . . . . . . . . . . . . . . . . . . . . . . . ..000%D888

Oiagnostickmening and preventive mcdule. . . . . . . . . . .X1OO-X598

Treatment module . . . . . . . . . . . . . . . . . . . . . . . . . ..TIoO-T899

Injuries and adverse effects mcdule. . . . . . . . . . . . . . . . .JOOI-J998

Testresults mcdule . . . . . . . . . . . . . . . . . . . . . . . . ..R1oO-R7OO

Administrative module. . . . . . . . . . . . . . . . . . . . . . . ..AIOL3-A140

Other ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..U98GU928

56,605

24,107

3,36a

1,853

1,249

202

2,462

3,986

2@el

1,992

4,535

6,045

11,001

9,531

2,466

640

516

2,099

4,446

2,212

360

329

127

36

331

715

245

210

245

484

804

977

1,160

366

98

105

524

100.0

426

5.9

3.3

2.2

0.4

4.3

7.1

4.2

3.6

3.5

8.0

10.7

19.4

16.6

4.4

1.5

0.9

3.7

. . .

1.6

0.4

0.5

0.2

0.1

0.4

0.9

0.3

0.3

0.3

0.6

0.8

1.2

1.4

0.5

0.2

0.2

0.8

‘Sassden ARssson ri)r WitClassMmbon . rbrAfrrrxr!aroty care (Rvc)(4).

‘Includesproblemsandcomplaintsnotelsewtws ckeeirWd,entriesof “none,”blanks,and illsgiMeretries.

Table 5. Number and percent dietrlbution of outpatient department visits with corresponding standard errors by ths 20 principal reasons

for visit moat frequently mentioned by patIenW United States, 1992

Number of Sfendard

visitsin errorin Percent

Reason rbrvisitand RVC code’

errorof

thousands hwsands disfribufion wnt

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56,60s 4,446 100.0 . . .

Prograsevisit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..T800

Ganeral medical examination . . . . . . . . . . . . . . . . . . . . . . ..X1OO

Routine prenatal examination . . . . . . . . . . . . . . . . . . . . . . ..X205

Well babyexamination . . . . . . . . . . . . . . . . . . . . . . . . . . ..XI05

Cough. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S440

Postoperative visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..T20S

Stomach andabdominal pah,crampsandspasrns. . . . . . . . . . .S545

Earache orearinfection . . . . . . . . . . . . . . . . . . . . . . . . . ..S355

Symptoms referable tothroat . . . . . . . . . . . . . . . . . . . . . . ..S456

Sackeymptorns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S905

Mediation, otharand unspacifiad . . . . . . . . . . . . . . . . . . . ..TI15

Skin rash. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S880

Diabetes melliius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..D2O5

Chastpain and related symptoms . . . . . . . . . . . . . . . . . . . ..S050

Oapraesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S110

Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S010

Painand relatad symptoms, generalized, site unspecified . . . . . .S080

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..D510

Knw symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S925

Headache, pain inhead . . . . . . . . . . . . . . . . . . . . . . . . . ..S210

Allotherraaeons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4,216

3,0343

1,497

1,163

1,037

634

644

838

763

~27

687

668

641

639

838

%32

556

535

488

33,124

696

403

408

230

332

163

ao

130

161

84

242

92

172

91

156

153

160

109

108

62

2,619

7.4

5.4

5.3

2.6

2.1

1.6

1.6

1.5

1.5

1.3

1.3

1.2

1.2

1.1

1.1

1.1

1.1

1.0

0.9

0.9

58.5

1.0

0.5

0.7

0.4

0.5

0.2

0.1

0.2

0.2

0.1

0.4

0.1

0.3

0.2

0.3

0.2

0.3

0.2

0.2

0.1

1.3

bsadonARssmrforV7 aaswkah. lbrAmMetcfy cars (RvC) (4).

Diagnostic and screening 70.6 percent of all OPD visits included mentioned services included other lab

services one or more diagnostic or screening test (20.2 percent) and urinalysis

Statistics on various diagnostic and services. The most frequently mentioned (11.4 percent).

screening services ordered or provided diagnostic or screening service was a Readers should note that for items

byhospital staff during an OPD visit are blWdpressUe chec~remrdedat 8, 14, 15, 17, and 18 on the OPD

displayed in table 8. Approximately 47.8percent of visits. Other frequently Patient Record form, hospital staff were
6 Advance Data No. 248 ● March 9, 1994

Table 6. Number and percent distribution of outpatient department visits with corresponding standard errors by principal diagnoslx

United States, 1992

Number of S&rrdard standard

visks in error in Percent error of

Principal diagnosis and ICD-9-CM cude’ thousands tfrousands distribution ,oeroant

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56,605 4,446 100.0 . . .

Infectious andparasific diseases . . . . . . . . . . . . . . . . . . . . ...001-139 2,001 28a 3.5 0.4

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239 3,127 559 5.5 0.9

Endocrine, nutritional and metabolic diseases and immunity

disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...240-279 2,184 292 3.9 0.4

Mentaldisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..290-319 3,531 656 6.2 1.0

Oiseasesofthe newoussyatemand sense organs . . . . . . . . . . ..320-389 4,629 548 6.2 0.6

Oiseaeeaofthacirculatorysystem . . . . . . . . . . . . . . . . . . . . . ..390-t59 3,34s 469 5.9 0.6

Disaasesoftheraspiratorysystem . . . . . . . . . . . . . . . . . . . . . . .460-519 4,606 743 8.1 0.9

Diseaseeofthedigestiiesystem. . . . . . . . . . . . . . . . . . . . . . . . 520-579 1,691 221 3.3 0.3

Dieeaseaofthe genitourinarysystem. . . . . . . . . . . . . . . . . . . . .560+29 2,694 306 4.6 0.5

Diseasesofthe skin andsuboutaneoustissue. . . . . . . . . . . . ...660-709 1,896 228 3.4 0.3

Oiseasas ofthamusculoskeletal system andwnnactive tissue . . . . .710-739 3,415 398 6.0 0.5

Symptoms, signs, andill-definad condtions . . . . . . . . . . . . . . . ...78&799 3,132 314 5.5 0.4

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600-999 4,189 521 7.4 0.7

Supplementary classification . . . . . . . . . . . . . . . . . . . . . . . . .. VOI–V82 12,392 1,026 21.9 1.3

Allotherdiagnosas2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,766 432 4.9 0.6

Unknown3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762 la4 1.4 0.3

‘B=d~Me/ntemadom/ C/-fiation of Diwases, WRs@/m, C/inkefMdrkWxr(lCWM) (5).

‘Includes diseases of the blood and blood-forming organs (28C-289): mmplkstlons of F#s@anoy, oh[ldbirth, and the pu-”um (630-876h mngen”til smmsliss (740-759h and cwtain mndtions

originating in tie perinatd pericd (760-779).

31ncludea blank diegnoses, unmdable diegmmes,and illegible diagnoses.

Table 7. Number and percent distribution of outpatient department visits with corresponding standard errors by the 20 principal

diagnoses moat fraquentiy rendered by hospitai staff United States, 1992

Number of Standard standard

w“sitsin

Principal diagnosis and ICD-9-CM code’

error in Percent error of

thousands thousamds distribution oement

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Normal pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V22

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Health supervision ofinfantorchild. . . . . . . . . . . . . . . . . . . . . . . . ..V20

General msdical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V70

Suppurative andunspasifiad otitismadia. . . . . . . . . . . . . . . . . . . . ...382

Diabates melliius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..25o

Other poeteurgical states . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V45

Acute upper re8pirato~ infetiions ofmultiple orunspecfid sties. . . . . ...465

Special investigations and examinations. . . . . . . . . . . . . . . . . . . .V72

Other andunspesified disorders of back. . . . . . . . . . . . . . . . . . . . ...724

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...780

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...473

Neurotic disordare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300

Alcohol dependence syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . ...303

Sym@oma invoMng respimto~sySem andothercheS symptoms. . . . ...786

Ofherdisordere ofurathra andurina~tracf . . . . . . . . . . . . . . . . . . ...599

Follow-up examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V67

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Malignantneoplasm offemalebraast . . . . . . . . . . . . . . . . . . . . . . . . .174

All otherdiagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

56,605

3,316

1,669

1,678

1,617

1,353

1,24a

1,097

1,054

709

679

646

644

614

606

*602

534

465

460

●453

449

36,666

4,446

449

292

254

216

2721

216

159

302

203

121

106

111

159

134

302

102

74

63

164

123

2,972

100.0

5.9

3.0

3.0

2.9

2.4

2.2

1.9

1.9

1.3

1.2

1.1

1.1

1.1

1.1

*1.1

0.9

0.8

0.8

%8

0.6

64.8

.. .

0.8

0.4

0.4

0.3

0.3

0.3

0.3

0.4

0.3

0.2

0.2

0.2

0.2

0.2

0.5

0.2

0.1

0.1

0.3

0.2

1.2

'B=40ntie lntemationd~asfimtion of Diseaws, WRetisim, Clinld MMfimtim(lCWM) (5).

asked to check all of the applicable counseling, education, or other

categories for that item, with the result nonmedication therapy (table 9). Diet

that multiple responses could be coded counseling, occurring at 9.5 percent of

for each visit. visits, was the most frequently reecrrded

counselingledueation service ordered or

Therapeutic services provided, while psychotherapy,

occurring at 3.1 percent of visits, was

About a third (37.2 pereent) of all the most frequently mentioned other

OPD visits included some form of therapeutic service.

Medication therapy

Hospital staff were instruded to

record all new or continued medications

ordered, administered, or provided at the

visit, including prescription and

nonprescription preparations and

immunizations and desensitizing agents.

Up to five medications, or drug
Advance Data No. 248 ● March 9, 1994 7

Table 8. Number and percent distribution of outpatient department visits with

corresponding standard errors by sslsetsd diagnostic/scresnIng Servicex United States,

1992

Number of Slzndard standard

Diagrrosticikreaning servioes ordered or w“siisin eti-or in Parcerrt error of

pmtidad by hospi&I Stdf’ thousarhis thouasnds disti”bufion percent

Al[visits . . . . . . . . . . . . . . . . . . . . . . . 56,s05

Blwdpresaure . . . . . . . . . . . . . . . . . . . 27,075

Other labteat . . . . . . . . . . . . . . . . . . . . 11,459

Urinalysis. . . . . . . . . . . . . . . . . . . . . . 6,430

Other radiology . . . . . . . . . . . . . . . . . . . 4,322

Visual acuity . . . . . . . . . . . . . . . . . . . . . 2,131

Papteat . . . . . . . . . . . . . . . . . . . . . . . 1,971

Cheat xray . . . . . . . . . . . . . . . . . . . . . 1,945

EKC3-restinf . . . . . . . . . . . . . . . . . . 1,718

Mammogram . . . . . . . . . . . . . . . . . . . . 1,077

Chola-sterolmeasure. . . . . . . . . . . . . . . . 805

Mentalstatusexarn . . . . . . . . . . . . . . . . 851

Heanngteat . . . . . . . . . . . . . . . . . . . . . 811

Strepthroattest . . . . . . . . . . . . . . . . . . 565

HIVserolcgy . . . . . . . . . . . . . . . . . . . . 245

EKG—exerciae2 . . . . . . . . . . . . . . . . . 1!S6

Spiromatry . . . . . . . . . . . . . . . . . . . . . . 130

Allergytesting . . . . . . . . . . . . . . . . . . . %35

Other . . . . . . . . . . . . . . . . . . . . . . . . . 10,03s

None . . . . . . . . . . . . . . . . . . . . . . . . . 16,S31

4,446

2,713

1,107

718

537

489

289

264

244

201

166

182

105

151

54

46

38

18

1,64s

1,541

100.0

47.8

20.2

11.4

7.6

3.8

3.5

3.4

3.0

1.9

1.6

i .5

1.1

1.0

0.4

W.3

0.2

YLl

17.7

29.4

. . .

2.4

1.2

1.1

0.8

0.8

0.5

0.5

0.4

0.3

0.3

0.3

0.2

0.2

0.1

0.1

0.1

0.0

2.0

2.0

‘Numbsrsmaysxceedtotalnamberofvieitstwmmemorethsncme sefvbemsykrepmtsdpfsvisit

2EKGiselectrocsrdiogrem.

Table9.Numberand percentdistrlbutfon ofoutpatientdepatient visitswitfr

corresponding standard errorsbyeekrctsd therapeutic service8 UnftedStetes,l 992

Number of standard StSndalxi

Therepauticsarviasa orderedorprtwfdad by waits in error in Percent error of

hospital staff’ thousands thousano?s diabibutkvr pamrrt

Allvisits . . . . . . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . . . .

Counseling/education

Diet . . . . . . . . . . . . . . . . . . . . . . . . . .

Exercise . . . . . . . . . . . . . . . . . . . . . . .

Growth/development. . . . . . . . . . . . . . . .

Family/social . . . . . . . . . . . . . . . . . . . .

Almholabuse . . . . . . . . . . . . . . . . . . .

Weightreduotion . . . . . . . . . . . . . . . . . .

Familyplanning . . . . . . . . . . . . . . . . . . .

Smokingoaasatiin . . . . . . . . . . . . . . . . .

Drugabuse . . . . . . . . . . . . . . . . . . . . .

Cholasterolreduction . . . . . . . . . . . . . . .

Otharcounaeling . . . . . . . . . . . . . . . . . .

Other therapy

Psychotherapy . . . . . . . . . . . . . . . . . . .

Physiotherapy . . . . . . . . . . . . . . . . . . . .

Corrective lenses . . . . . . . . . . . . . . . . . .

Heanngaid . . . . . . . . . . . . . . . . . . . . .

Othertherapy . . . . . . . . . . . . . . . . . . . .

5s,605

85,532

5,351

2,464

1,s3s

1,749

676

635

823

662

So5

7,9S4

1,754

1,416

214

*19

3,186

4,446

3,195

S48

339

252

336

363

148

134

113

180

107

930

392

363

59

7

475

100.0

62.8

9.5

4.4

3.2

3.1

*1.7

1.5

1.5

1.5

1.2

0.9

14.1

3.1

2.5

0.4

W.o

5.6

. . .

2.1

0.9

0.6

0.4

0.6

0.6

0.2

0.2

0.2

0.3

0.2

1.3

0.6

0.6

0.1

0.0

0.7

‘Numbsrsmsyexmed totslnumberofvislts Lwcausemomthan oneservicemsylM rspwtedpwvisit.

mentions, are coded for each visit. As any medication. TheNHAMCSdrug

used in the NHAMCS, the term “drug” data base permits classification by a

is interchangeable with the term wide range of variables, including

“medicatio~’’a ndthe term speciiic drug entry name, trade name,

“prescribing” is used broadly to mean generic class, therapeutic category,

ordering, administering, or providing prescription or nonpreseription ststua,

federally-controlled substance status, and

composition status (that is, whether the

drug is a single- or multiple-ingredient

product). A report describing the method

andinstmments used to collect and

process drug information has been

published (6).

There was a total of 63.3 million

drug mentiom or 8n average of 1.1 drug

mentions per OPD visit. The 20

medications most frequently prescribed

at OPD visits are shown in table 10 by

drug entry name and therapeutic

classification. This classifkation is based

on the therapeutic categories used in the

Natkmal Drug Code Directory, 1985

edition (7). Tylenol was the medication

most frequently prescribed, with 1.2

million mentione, or 2.2 percent of the

total. It W83 followed by 81110XiCti

(1.7 perecnt), prenatal vitamins

(1.5 percent), and prednisone

(1.4 percent).

Expected source of payment

Expeeted sourecs of payment were

most often Medicaid (31.2 pereent),

privatekxmnereird insumnce

(23.8 percent), and Medicare

(16.3 pereent) (table 11). “Patient paid”

and “HMO/Other prepaid” were

indicated at 13.7 and 7.7 pereent of

OPD visits, respectively. The patientpaid category includes the patient’s

contribution toward “copayments” and

“deduetiiles.”

Providers seen this visit

A staff physicisn was seen at the

majority of OPD visits (62.9 percent).

Registered nurses were seen at

38.3 percent of visits and residents

and/or interns were seen at 32.4 pereent

of visits (table 12).

Disposition of this visit

The majority of OPD visits

(65.0 percent) resulted in another

appointment to return to the clinic. This

and the previously mentioned tiding

that most OPD patients had been seen in

the clinic before are indications of the

continuous nature of care provided in

the OPD setting. For 17.2 percent of

visit8, the disposition was “return to

clinic PRN” (table 13). Only 1.2 pereent
8 Advance Data No. 248 ● March 9,1994

Table 10. Number and percent distribution for the 20 drugs most frequently prescribed et outpatient department visits with

corresponding standard errore, by entry name of drug: United States, 1992

Number of Standard Standard

v&% in error in Percent error of 7trerapeutic

Entry name of drug’ tfroussnds thousands distribution percent classifieationz

All drug mentions . . . . . . . . . . . . . . . . . . 83,299 6,813 100.0 . . . . . .

Tylenol . . . . . . . . . . . . . . . . . . . . . . . . 1,241 193 2.2 0.3 General analgesics

Amoxiciliin . . . . . . . . . . . . . . . . . . . . . . 860 135 i .7 0.2 Penicillins

Prenatal vitsmins . . . . . . . . . . . . . . . . . . 836 172 1.5 0.3 Viins, minerals

Prednisone . . . . . . . . . . . . . . . . . . . . . 784 151 1.4 0.2

Motrin. . . . . . . . . . . . . . . . . . . . . . . . .

Adrenal eorticosteroids

780 97 1.4 0.2 Antiarthritica

Diphtheria & tetanus toxoids with

pertusaisvacoine . . . . . . . . . . . . . . . . . 697 112 1.2 0.2 Vaccines and antiserums

Amoxil . . . . . . . . . . . . . . . . . . . . . . . . ●649 358 *1.1 0.6 Penicillins

Premafin . . . . . . . . . . . . . . . . . . . . . . . 646 106 1.1 0.2 Eatrogensandprogesfins

Poliovirusvaccine . . . . . . . . . . . . . . . . . 837 111 1.1 0.2 Vaccineaanda ntiserums

Ferroussulfete . . . . . . . . . . . . . . . . . . . 615 123 1.1 0.2 Agents used to treat deficiency anemias

LaSix . . . . . . . . . . . . . . . . . . . . . . . . . 592 65 1.0 0.1 Oiuretics

Zsntac . . . . . . . . . . . . . . . . . . . . . . . . 564 77 1.0 0.1 Agenta used in disorders of upper GI tract

Vasotec . . . . . . . . . . . . . . . . . . . . . . . . 514 84 0.9 0.1 Antihypartensiveagenta

Proventil . . . . . . . . . . . . . . . . . . . . . . . 506 116 0.9 0.2 Broncherllators, antiasthmatics

Insulin . . . . . . . . . . . . . . . . . . . . . . . . 501 113 0.9 0.2 Bloodglucoseregulatora

Tylenolwithcodeine . . . . . . . . . . . . . . . . 426 75 0.9 0.1 Generalanesthe60s

Naprosyn . . . . . . . . . . . . . . . . . . . . . . . 489 73 0.9 0.1 Antiatthritica

Procardia . . . . . . . . . . . . . . . . . . . . . . 470 100 0.8 0.1 Antianginalaganfs

Haemophilus Bmnjugatevaccine . . . . . . . 455 83 0.8 0.1 Vaccins=sand antiserums

Synthroid . . . . . . . . . . . . . . . . . . . . . . *447 148 0.8 0.2 Agentsuaedtotreat thyroiddiseeae

‘Thaenfrymadeby fhehosphalstaffon theprsaffl”pticmor othermedicalracords. Thismaykatiade nsme,ganarfonsma, wdesirsdfhsrapardk sffazt

%hqWioclaSifi@o nisb=dontieN~dDmg~e~*~, 19Wdtin ~.ln~ti-admgkdmweWm~ olessiicstion,itwss listsdinttwoste9wy for

wfkhitwssmostfrsquentiy pisscrii.

Table ll. Number and percent dktribtttlon ofoutpetient department visltswith

corresponding atandarderrom by patlent’s expected source of paymenti Unltad Sttttes,

1992

Number of Standard Standard

visits in error in Percent

ExpectedsOufCaof payment’

error of

thousends thousands distrifxrtbn percent

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56,805 4,446 100.0 . . .

Expected payment same

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,647 1,614 31.2 2.1

Private orcommercial . . . . . . . . . . . . . . . . . . . . . . 13,478 2,230 23.8 2.7

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,240 1,160 16.3 1.2

Patient-paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,747 1,027 13.7 1.3

HMO/other prapaid2 . . . . . . . . . . . . . . . . . . . . . . . 4,364 671 7.7 1.1

Other government . . . . . . . . . . . . . . . . . . . . . . . . 3,884 522 6.5 0.6

Nocharge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,840 450 2.9 0.8

other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,116 384 5.5 0.7

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *1,712 680 %0 1.1

‘Numbers may exaaad total because more than one source of payment may be coded far each visii

2HMOisheslth msintanance orgsrkafion.

Table 12. Number and percentdiatribzftlon ofoutpetiertt department vksitewith

correponding standard errors, bytype of provider seen: Unitad States, l 992

Number of Standard Standard

vkits in error in Percent error of

Typeofprovide$ thousands thousands distribution percent

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56,605 4,446 100.0 . . .

Staffphysician . . . . . . . . . . . . . . . . . . . . . . . . . . 35,614 3,5S2 62.9 2.4

Registerednurse . . . . . . . . . . . . . . . . . . . . . . . . . 21,704 2,025 3s.3 2.9

Residertthtem. . . . . . . . . . . . . . . . . . . . . . . . . . 18,365 1,797 32.4 25

Nurse’saide . . . . . . . . . ----- . . . . . . . . . . . . . . 7,390 1,062 13.1 1.6

Licensedpr8etieal nurse . . . . . . . . . . . . . . . . . . . . 6,768 972 12.0 1.6

Nurse practitioner . . . . . . . . . . . . . . . . . . . . . . . . 2,975 452 5.3 0.7

Ofherphysician . . . . . . . . . . . . . . . . . . . . . . . . . . 2,855 519 5.0 1.0

Physicianassistant . . . . . . . . . . . . . . . . . . . . . . . *I ,641 560 3.3 0.9

‘Numbsfsmayaxceed totslbecauaemore thsneneprovider maybereportsd p%rvisit

of OPD visits resulted in hospital

admission.

Additional reports that utilize 1992

NHAMCS data will be published. In

additiow survey data willbe awailable

on computer tape tlom the National

Technicsl Information Service at a

nominal cost in the summer of 1994.

Questions regarding this report, future

reporte, orthe NHAMCS may be

directed to the Ambulatory Care

Statistics Branch by calling

(301) 436-7132.

References

1.

2.

3.

Bryant E, Shimizo I. %znple design,

ssmpling variance, and estimtion

procedures for the National

Ambulatory Medical Care Survey.

Wal Health Stat 2(108). 1988.

Loft JD, Sheatsley PB, Frankel MR.

Comparison report on the hospital

smbulatozy medical care evaluation

study. Contract No. 282-82-2111.

Chicago, Illinois National Opinion

Research Center. 1985.

McCaig LF. National Hospital

Ambulatory Medical Care Survey:

1992 Bmergency Deprnbnent

Summary. Advsnce data from vital

and health statistics; no. 245.

Hyattsville, Maryland Natioml

Center for Health Statistics. 11994.
Advance Data No. 248 ● March9, 1994 9

Table13.Numberand pereentdistributionof outpatientdepartmentvlaitswith -..

correspondingetandarderroraby dispositionof vlsk UnitedStateaj1S92

Number of Stano!d Stan&ml ‘--

viaiis in etror in Pwatwt Wrcxof . . .

Dispdtion’ thousands ttxwads d%tribulion /xucrmt

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56,60s 4,446 100.0 . . .

Returntodinic-appointment . . . . . . . . . . . . . . . . . 36,776 3,066 65.0 23 0.0

Retumto dinio PRN2 . . . . . . . . . . . . . . . . . . . . . . 9,720 1,s64 17.2 1.6

Ratumtoother phyaioiaddinic. . . . . . . . . . . . . . . . 3,888 458 6.9 0.7

Retumto referringphysician. . . . . . . . . . . . . . . . . . 3,417 862 6.0 1.7 z

No followup plarmad... . . . . . . . . . . . . . . . . . . . . 2,287 361 4.0 0.6

Telephonefollowupplanned. . . . . . . . . . . . . . . . . . 1,406 203 25 0.3

Admittohospital . . . . . . . . . . . . . . . . . . . . . . . . . 70s 141 1.2 0.2

other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,736 462 4.8 0.7 *

‘Numberamayaxmsritdalm!mlwofviaitsbecauaamom2hanonsd~maybere@ad parviait.

2PRNiaasneeded.

symbols

Data not available.

Category not applicable

Quantityzero

Quantitymore than zero but less

tilan 0.05

Quantitymore than zero but 1ss

than 500 where numbersare

roundedto thousands

Figure does not meet standardof

reliabilii or pecision (more than

30-percant relative standard error

in numemtor of percent or rate)

4.

5.

6.

7.

8.

Schneider D, Appleton I.+McLemore

T. A reason for visit classtieation for

ambulatory care. National Center for

Health Statistics. Vital Health Stat

2(78). 1979.

Public Health Serviee and Health

Care Financing Administration.

International classification of

diseases, 9th revisioq clinical

modification. Washingtorx Public

Health Service. 1991.

Koch ~ Campbell W. The collection

and processing of drug information.

National Ambulatory Medieal Care

Survey, 1980. National Center for

Health Statistics. Vital Health Stat

2(90). 1982.

Food and Drug Administration.

National drug code directory, 1985

Edition. WashingtoIX Public Health

Service, 1985.

Shah By Barnwell BG, Hunt PN, La

Wnge LM. SUDAAN user’s manual

release 5.50. Research Triangle Parlq

North Carolimx Research Triangle

Institute. 1991.
10 Advance Data No. 248 ● March 9, 1994

Technical notes

Source of data and sample

design

The information presented in this

report is based on data collected in the

1992 National Hospital Ambulatory

Medical Care Survey (NHAMCS) from

December 2, 1991, through December

27, 1992. The data were adjusted to

produce annual estimates. The target

universe of the NHAMCS includes

visits made in the United States by

patients to emergency departments

(ED’s) and outpatient departments

(OPD’S) of non-Feder& short-stay, or

general hospitals. Telephone contacts are

excluded.

A four-stage probability sample

design is used in the NHAMCS,

involving samples of primary sampling

units (PSU’S), hospitals with ED’s

and/or OPD’S within PSU’S, ED’s

within hospitals andlor clinics within

OPD’S, and patient visits within ED’s

and/or clinics. For 1992, a sample of

524 non-Federal, short-stay or general

hospitals was selected from the SMG

Hospital Market Database. Of this

group, 474 hospitals were in scope, or

eligible to participate in the survey. The

hospital response rate for the NHAMCS

during this period was 93 percent. Based

on the induction interview, 314 of the

sample hospitals had OPD’S. Hospital

staff were asked to complete Patient

Record forms (figure 1) for a systematic

random sample of patient visits

occurring during a randomly assigned

4-week reporting period. The number of

Patient Record forms completed for

OPD’S was 35,114.

Characteristics of the hospital, such

as ownership and expected number of

OPD visits, were obtained from the

hospital administrator during an

induction interview. The U.S. Bureau of

the Census, Housing Surveys Branch,

was responsible for the survey’s data

collection. Data processing operations

and medical coding were performed by

the National Center for Health Statistics,

Health Care Surveys Section, Research

Triangle ParlG North Carolina.

Sampling errors

The standard error is primarily a

measure of the sampling variability that

occurs by chance when only a sample,

rather than an entire universe, is

surveyed. The standard error also

reflects part of the measurement error,

but does not measure any systematic

biases in the data. The chances are 95

out of 100 that an estimate from the

sample differs from the value that would

be obtained from a complete census by

less than twice the standard error.

The standard errors used in this

report were approximated using

SUDAAN software. SUDAAN

computes standard errors by using a

first-order Taylor approximation of the

deviation of estimates from their

expected values. A description of the

software and the approach it uses has

been published (8). Exact standard error

estimates were used in tests of

significance in this report. Standard

errors for all estimates are presented in

each table. Standard errors for rates can

be calculated using the relative standard

errors (RSE) for the number of visits

(i.e., multiply the rate by the RSE for

the estimate of interest).

Adjustments for hospital

nonresponse

Estimates horn NHAMCS data

were adjusted to account for sample

hospitals that were in scope but did not

participate in the study. This adjustment

was calculated to minimize the impact

of nonresponse on final estimates by

imputing to nonresponding hospitals

data from visits to similar hospitals. For

this purpose, hospitals were judged

similar if they were in the same region,

ownership control group, and

metropolitan statistical area control

group.

Adjustments for ED and/or

clinic nonresponse

Estimates from NHAMCS data

were adjusted to account for ED’s and

sample clinics which were in scope but

did not participate in the study. This

adjustment was calculated to minimize

the impact of nonresponse on final

estimates by imputing to nonresponding

EJ)’s or clinics’data from visits to

similar ED’s or clinics. For this purpose,

ED’s or clinics were judged similar if

they were in the same ED or clinic

group.

Test of significance and

rounding

The determination of statistical

inference is based on the t-test. The

Bonferroni inequality was used to

establish the critical value for

statistically significant differences (0.05

level of confidence). Terms relating to

differences such as “higher than”

indicate that the diiTerence is statistically

significant. A lack of comment regarding

the diiYerencebetween any two

estimates does not mean that the

difference was tested and found to be

not significant.

In the tables, estimates of OPD

visits have been rounded to the nearest

thousand. Consequently, estimates will

not always add to totals. Rates and

percents were calculated from original

unrounded figures and do not

necessarily agree with percents

calculated horn rounded data.

Definition of terms

Patient-An individual seeking

personal health services who is not

currently admitted to any health care

institution on the premises.

Hospital—AU hospitals with an

average length of stay for all patients of

less than 30 days (short-stay) m

hospitals whose specialty is general

(medical or surgical) or children’s

general. Federal hospitals and hospital

units of institutions and hospitals with

fewer than six beds staffed for patient

use are excluded.

Emergency departnzent-Hospital

facility for the provision of unscheduled

outpatient services to patients whose

conditions require immediate care and

which is sttied 24 hours a day. If an

ED provided emergency services in

different areas of the hospital, then all of

these areas were selected with certainty

into the sample. Off-site emergency

departments open less than 24 hours are

included if staffed by the hospital’s

emergency department.

Outpatient department-Hospital

facility where non-urgent ambulatory

medical care is provided under the

supervision of a physician.

Clinic—An administrative unit of

the outpatient department where
Advance Data No. 248

● March9,1994 11

ambulatory medieal care is provided

under the supervision ofa physician.

The following are examples of the types

of clinics excluded from the NHAMCS:

ambulatory surgical centers,

chemotherapy, employee health service,

renal dialysis, methadone maintenance,

and radiology.

Viit—A direct personal exchange

betweena patient anda physician or

other health care provider working

under the physician’s supervision, for

the purpose of seeking care and

receiving personal health services.
12 Advance Data No. 248 ● March 9, 1994

Trade name disclaimer

The use of trade names is for identification

only and does not imply endorsement by the

Public Health Service, U.S. Department of

Health and Human Services.

Suggested citation copyright information

McCaig LF. Outpatient Department Summary All material appezuing in this report is in the

National Hospital Ambulatory Medical Care public domain and may be reproduced or

Survey, 1992. Advance data horn vital and copied without permission; citation as to

health statistic no 246. Hyattsville, Maryland: source, however, is appreciated.

National Center for Health ~atistics. 1994.

National Center for Health Statistics

Director

Manning Feinleib, M. D., Dr. P.H.

Deputy Director

Jack R. Anderson

U.S. DEPARTMENT OF HEAL~ AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

6525 Belcrest Road

Hyattaville, Maryland 20782

OFFICIAL BUSINESS

PENALW FOR PRIVATE USE, $300

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DHHS Publication No. (PHS) 94-1250
Number 249 ● April 8, 1994

Advance

Data

From Vial and Health Statistics of the CENTERS FOR DISEASE CONTROL AND PREVENTION/Nationai Center tbr Health Statiics

1992 Summary: National Hospital Discharge Survey

by Edmund J. Graves, Division of Health Care Statistics

Introduction

During 1992, an estimated 31.0

million inpatients, excluding newborn

infants, were discharged from short-stay

non-Federal hospitals in the United

States. These patients used 190.4 million

days of inpatient hospital care. The

discharge rate was 122.1 discharges per

1,000 civilian population and the

average length of stay was 6.2 days.

These and other statistics presented

in this report are based on data colIected

by means of the National Hospital

Discharge Survey (NHDS), a continuous

survey that has been conducted by the

National Center for Health Statistics

(NCHS) since 1965. In 1992, data were

abstracted from the medical records of

approximately 274,000 patients

discharged from 494 short-stay

non-Federal hospitals. Begimdng in

1988, a new three-stage stratified sample

design was put in operation. A brief

description of the new design, data

collection procedures, and estimation

process and detitions of terms used in

this report can be found in the section

entitled “Technical notes.” A description

of the development and design of the

original NHDS, which was in operation

from 1965 to 1987, has been published

(l). Differences may exist between data

for 1988-92 and earlier years because of

the redesign of the survey.

Medical data for hospitalized

patients are coded according to the

International Classification of Diseases,

9th Revisiorq Clinical Mxiijication

(ICP9-CM.) (2). Up to seven diagnoses

and four procedures are coded for each

discharge. Although diagnoses included

in the ICD-9-CM section entitled

“Supplementary classification of

external causes of injury and poisoning”

(codes E800-E999) are used in the

NHDS, these diagnoses are excluded

from this report. The conditions

Acknowledgments

diagnosed and procedures performed

are presented here by chapter of

ICD-9-CM. Within these chapters, a

few diagnoses and procedures or groups

thereof also are shown. These specific

categories were selected primarily

because of their large estimates or

because they are of special interest.

More detailed analyses of NHDS data

are published in Series 13 of the NCHS

Ktal and Health Statistics reports.

Starting in 1985, some hospitals

participating in the NHDS have

submitted machine-readable data tapes.

In 1992, approximately 34 percent of

the hospitals used this method to submit

data.

Beginning in 1991 and continuing

in 1992 all ICD-9-CM procedure codes

were used in the NHDS. In previous

years, selected codes were excluded.

These were primarily codes for certain

miscellaneous diagnostic and therapeutic

procedures.

This report was prepared irr the DIvirion of Health Care Statistics. Jean Kozak and Blaine Wood of the Hospital Care Statistics Branch provided technical

assistance in developing the style and content of this report. Michael J. Monsour of the Techrrieal %vices BranclL provided asaisfarree in pmdrreirrg

estimates of reliability. Dorothy Graham of the Technical SeMces Branch verified the estimates in the report and Chaxka Adams and Makohrr Graham of

the Technical Serviees Branch provided advice on the computer programming aspeets of the report This report was edited by Klaudia Cox and ~set by

Amrette F. Faeemire of the Publications Branch, Divk+on of Data %viees.

~+@5wr*

$

‘o+

-g

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

$

Public Health Service

Centers for Disease Control and Prevention $%.haa >

National Center for Health statistics CENTESSRRCWXSEC CDCWTXOL

am mmEN’rrw
2 Advance Data No. 249 ● April 8,1994

Table 1. Number of inpatients discharged from shofi-stay hospitals by seleetad

charaeteriatiea: United States, 1992

[Discharges from non-Faderal hospitals. Excludes newborn infants]

Data highlights

Utilization by patient and hospital

characteristics

The number, rate, and average

length of stay of patients discharged

from short-stay non-Federal hospitals

are shown by age, geographic region,

and sex in tables 1–3. The 31.0 ndlion

patients discharged from short-stay

hospitals during 1992 comprised sn

estimated 12.4 million males and 18.5

million females. The rate per 1,000

population for females was lQ, which

was 41 percent higher than the rate of

101 for males. The number and rate of

discharges are higher for females thsn

for males largely becauae of women

15-44 years of age who are hc)spitalized

for deliveries and pregnancy-related

conditions.

The average length of stay was 6.7

days for males and 5.8 days for femsles

during 1992. The average length of stay

of the 3.9 million women who were

hospitalized for deliveries was 2.6 days.

The average length of stay was 4.9 days

for patients under 15 years of age, 4.3

days for patients 15-44 years of age, 6.3

days for patients 45-64 yeare of age,

and 8.2 days for patients 65 years of age

and over.

The number of discharges from

short-stay hospitals by geographic

region during 1992 ranged from 11.3

million in the South to 5.4 million in

the West. Regional dM’ereneeein the

number of discharges are accounted for

in part by variations in the population

sizes. The rates per 1,000 population

ranged horn 140 in the Northeast

region to 100 in the West. Average

lengths of stsy by geographic region

were 5.2 days in the West, 6.0 days in

the South, 6.2 days in the Miclwest, and

7.2 days in the Northeast.

Utilization by diagnosis

Diseases of the circulatory system

ranked first in 1992 of the ICD-9-CM

diagnostic chapters as a principal or

iirst-listed diagnosis for patients

discharged from non-Federal short-stay

hospitals. These conditions accounted

for an estimated 5.6 million discharges.

Other leading ICD-9-CM diagnostic

chapters were supplementary

BoUr

Selaofad cheraoterkfic sexes Male Female

Number of patienta discharged in thousands

Total. . . . . . . . . . . . . . . . . . . . . 30,951 12,406 18,545

Age

Under 15years . . . . . . . . . . . . . .

15-44 years . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . .

65yeare and over . . . . . . . . . . . .

2,531 1,416 1,115

11,227 3,162 S,064

6,329 3,1s5 3,194

10,864 4,692 6,172

Region

Northeast . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . .

south . . . . . . . . . . . ..!......

West . . . . . . . . . . . . . . . . . . . .

7,141 2,985 4,156

7,121 2,924 4,197

11,256 4,472 6,784

5,483 2,026 3,407

Table 2. Rate of inpatients discharged from short-stay hospitals by seleeted

charaeteristiex Unitad States, 1992

[Discharges from non-Faderal hospitals. Excludes newborn infants]

Both

Selected characteristic sexes Male Female

Rate of patients discharged par 1,OIW population

Total. . . . . . . . . . . . . . . . . . . . . 122.1 100.8 142.2

Age

Under 15yeara . . . . . . . . . . . . . .

15-44 yeare . . . . . . . . . . . . . . . .

45-64 yeare . . . . . . . . . . . . . . . .

65yeere andover . . . . . . . . . . . .

45.2 49.4 40.8

86.0 34.4 137.1

131.0 134.7 127.6

336.5 359.7 320.S

Region

Northeast . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . .

south . . . . . . . . . . . . . . . . . . . .

Weat . . . . . . . . . . . . . . . . . . . .

138.9 121.7 156.9

117.5 99.4 134.6

12S.9 106.2 150.1

e9.5 74.9 123.7

Table 3. Average length of stay for inpatients discharged from short-stay hospitais by

seleetad charaeteristioe: United States, 1992

[Dscharges from non-Federal hospitals. Excludes newborn infants]

Both

Selected characteristic sexes Ma/a Female

Average length of stay in daya

Total . . . . . . . . . . . . . . . . . . . . 6.2 6.7 5.8

Age

Under 15years . . . . . . . . . . . . . .

lS44years . . . . . . . . . . . . . . . .

46-64 years . . . . . . . . . . . . . . . .

66yeara andover . . . . . . . . . . . .

4.9

4.3

6.3

8.2

4.9

6.0

6.4

8.0

4.6

3.7

6.2

8.4

Region

Northeast . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . .

7.2

6.2

6.0

5.2

7.5

6.7

6.5

6.1

6.9

5.8

5.6

4.6
Advance Data No. 249 ● April 8,1994 3

classifications (including females with

deliveries) (4.4 million discharges),

diseases of the digestive system (3.2

million discharges), and diseases of the

respiratory system (2.9 million

discharges). Approximately 52 percent

of the patients discharged from

non-Federal short-stay hospitals were

included in these four ICD-9-CM

diagnostic chapters.

The diagnostic categories presented

in this report were selected either

because they appear as principal or

first-listed diagnoses with high

frequency or because the conditions are

of special interest. Many of these

categories (such as malignant

neoplasms, psychoses, and fractures) are

groupings of more detailed diagnoses.

The number and rate of discharges

and average length of stay for each

ICIM-C!M diagnostic chapter and

selected categories are shown by sex

and age in tables 4-6. The most

common diagnostic categories for all

patients were deliveries and heart

disease. Other leading diagnostic

categories were malignant neoplasms,

pneumonia, and fractures. Excluding

deliveries, these last four diagnostic

categories were the leading first-listed

diagnoses for both males and females.

Some of the more common diagnoses

for patients under 15 years of age were

acute respiratory infections, pneumoni%

and asthma. For patients 15-44 years of

age, frequent diagnoses were deliveries,

psychoses, and fractures. For patients

45-64 years of age and 65 years of age

and over, heart disease and malignant

neoplasms were major causes of

hospitalization. The average length of

stay for all patients ranged from 1.3

days for chronic disease of tonsils and

adenoids to 12.9 for psychosis.

Utilization by procedure

One or more surgical or nonsurgical

procedures were performed for an

estimated 20.4 million of the 31.0

million inpatients discharged fi-om

short-stay hospitals during 1992. A total

of 42.6 million procedures, or an

average of 2.1 per patient who

underwent at least one procedure, were

recorded in 1992.

Procedures are grouped in the tables

of this report by the ICD-9-CM

procedure chapters. Selected procedures

within these chapters also are presented

by spectic categories. Some of these

categories (such as cesarean section and

hysterectomy) are presented as single

categories even though they are divided

into more precise subgroups in

ICD-9-CM.

More than three-fourths of all the

surgical and nonsurgical procedures

performed during 1992 are listed in just

5 of the 16 procedure chapters. These

were miscellaneous diagnostic and

therapeutic procedures (13.9 million),

obstetrical procedures (6.7 million),

operations on the digestive system (5.4

million), operations on the

cardiovascular system (4.4 million), and

operations on the musculoskeletal

system (3.3 million).

The number and rate of all-listed

procedures in 1992 for each IC!D-9-CM

procedure chapter and selected

procedure categories are shown by sex

and age in tables 7 and 8. Of the 42.6

million procedures performed during

199216.8 million were for males and

25.8 million were for females. The

corresponding rates per 100,000

population were 16,815.7 for both sexes,

13,642.3 for males, and 19,810.6 for

females. Frequent procedures for males

were artenography and

angiocardiography, computerized axial

tomography, and diagnostic ultrasound.

Procedures commonly performed on

females were episiotomy, fetal EKG and

fetal monitoring, cesarean section, and

diagnostic ultrasound.

The rate of procedures by age per

100,000 population ranged from 3,871.1

for patients under 15 years of age to

45,643.8 for patients 65 years of age

and over. Commonly performed

procedures for patients under 15 years

of age were respiratory therapy, spinal

tap, computerized axial tomography, and

diagnostic ultrasound for patients 1544

years of age, episiotomy, fetal EKG and

fetal monitoring, and cesarean sectiorq

for patients 45-64 years of age,

arteriography and angiocardiography,

cardiac C.atheterizatio&and diagnostic

ultrasound; for patients 65 years of age

and over, arteriography and

angiocardiography, diagnostic

uItrasounq and computerized axial

tomography.

References

1.

2.

3.

4.

5.

Simmons WR. Developmentof the

design of the NCHSHospitalDischarge

Survey.NationalCenterfor Health

Statistics.VitalHealthStat 2(39). 1970.

Public HealthSeMce and HealthCare

FinancingAdministration.International

Clssdication of Diseases,9th Revision,

ClinicalModi.tication.WashingtonPublic

HealthService.3rd ed. 1980.

SMG MarketingGroup,Iuc. Hospital

MarketDatabase.ChicsgcxHealthcare

InformationSpecialists.1987.

SMG Marketing Group, Inc. Hospital

Market Database. Chicagm Heslthcare

Information Specialists. A@ 1991.

Shah BV. SESUDAAN: Standard errors

program for computing of standardized

rates from sample survey data. Research

Triangle Psr~ North CsrOliwc Research

Triangle Institute. 1981.
Advance Data No. 249 ● April 8,1994

Table 4. Number of Inpatients dlacharged from ahoti-stay hospitals, by category of fh’at-llstad diagnosis, sew and agm United States,

1992

[Discharges from non-Faderal hospitals. Excludes newborn infants. Diagno<lc groupings and code number inclusions are based on the International Classification of

Diseases, WI f7evkion, Clinical Modification (lCD-+CM)]

Sex Age

under 1544 45-64

Category of fir’Wisted diagnosis and ICD-9-CM Code

65 years

Totsf Mafe Female 15 years yeara years arrd over

Allcondtions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious andparasitic diseases . . . . . . . . . . . . . . . . . . . . . . . ..001 -1!39

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .038

Neopleams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..140-28g

Mti!gnant neopleams . . . . . . . . . . . . . . . . . . . . . . . ..14&20s.23&2w

Malignant neoplasm of large intestine and rectum . . . . ...153-154.197.5

Meliinanf neoplasm of trachea, bronchus, and lung . . ...162.197.0.197.3

Malignant neoplasm of breast. . . . . . . . . . . . . . . . . . .174-175.198.81

Sanign neoplaams end naopleams of uncertain

behavior and unspecified nature . . . . . . . . . . . . . . ...21 0-229,23%289

Endcerine, nutritional and metabolic diseases,

andimmunity disordera . . . . . . . . . . . . . . . . . . . . . . . . . . . ...240-279

Diabetes melliius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..25o

Volume depktion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...276.5

Diseases of the blood and blood-forming organs. . . . . . . . . . . . ...260-269

Mental diaordara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...200-319

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-299

Akoholdepandences yndrome . . . . . . . . . . . . . . . . . . . . . . . . . ..3o3

Diseases of the nervous system and sense organs . . . . . . . . . . ...320-368

Diseases of the central nervous system . . . . . . . . . . ...320-338.340-348

Diseeaesof theeerend meatoidprocaaa. . . . . . . . . . . . . . . ...360-389

Diseaaesof thecirculatory system . . . . . . . . . . . . . . . . . . . . . ...390459

HaarIdisaase . . . . . . . . . . .391 -392.0,3~,402,404,410416,420420

Acute myocerdial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . ..4Io

Coronary atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . ...414.0

Other iachamichastt disesae. . . . . . . . . . . . . . . .411+13,414.1414.9

Cerdiacdyarhythmiaa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Congeatiie heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . ..426.o

Cerebrovaacuier disease . . . . . . . . . . . . . . . . . . . . . . . . . . ..430-ts6

Disesaes of therespiretory ayatem . . . . . . . . . . . . . . . . . . . . . ..460+19

Acutaraspiretory intactions . . . . . . . . . . . . . . . . . . . . . . . . ...460466

Chronic diseeaeoftonsila andadenoide. . . . . . . . . . . . . . . . . . . . . .474

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...460436

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Diseeaesof thedigaatiie system . . . . . . . . . . . . . . . . . . . . . ...520-579

Ulcarsofthe atomach andsmall inteatina . . . . . . . . . . . . . . ...531-534

Appandicilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...640-643

Inguinelhemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..55o

Noninfectiousenteritisandcdiis . . . . . . . . . . . . . . . . . . . . . ..55&%6

Choleliieais . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...574

Diseaaesofthegenitourinarysyatem. . . . . . . . . . . . . . . . . . . ...560-829

Cakulusofkiineyand ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . .592

Hyparplaaiaofproatata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .600

Complications ofpregnsncy, childbirth, andthepuerperiuml. . . . . . . .63&876

Aborfionaendectopic end molerpregnencies . . . . . . . . . . . . ...630-639

Dkeasesoffheskin endsubcutanaoustissue . . . . . . . . . . . . . . . .630-709

Celluliisandebacaas . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..661+62

Diseaaesofthemusculoskeletalayslem andmnnectivetissua. . . ...710-738

Arthropethiesand related diaordm.. . . . . . . . . . . . . . . . . . ...710-719

Interverfebraldiaodiaordera... . . . . . . . . . . . . . . . . . . . . . . . ...722

Congenit61anomaliea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...740-759

Certdncondtionsoriginetingintheperinatal period. . . . . . . . . . ...76&779

Symptoms, signs, andill-definad condiions. . . . . . . . . . . . . . . ...760-799

Injuryandpoiaoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .600-899

Fractures, allsitaa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..600+29

Fractureofnackoffemur . . . . . . . . . . . . . . . . . . . . . . . . . . . . .820

Intracranialinjuriaa (excludingthoae withskullfmcture) . . . . . . ...850-654

Iacarationsandopanwounds . . . . . . . . . . . . . . . . . . . . . . ..870+04

Supplemenfarydaasifications.. . . . . . . . . . . . . . . . . . . . . . . ..VOI–V82

Fema!eswithdeliienes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27

30,951

608

279

1,999

1,577

161

215

170

422

1,176

476

306

322

1,711

806

258

706

314

145

5,597

3,935

747

416

971

542

822

628

2,923

376

73

1,068

463

3,187

232

227

112

354

512

2,018

218

221

662

179

462

307

1,610

564

407

191

141

350

2,701

1,016

278

152

160

4,363

3,910

12,406

403

131

845

766

78

124

*

79

487

207

122

137

866

‘#IQ

186

330

147

72

2,866

2,063

456

265

505

256

373

375

1,436

187

32

535

201

1,392

115

135

96

134

154

730

148

221

. . .

. . .

230

156

714

212

222

102

81

173

1,405

485

73

97

130

207

. . .

16,545

404

146

1,154

812

63

91

169

342

691

269

166

166

643

500

88

378

167

73

2,730

1,652

289

130

467

286

449

464

1,466

189

41

524

283

1,795

117

92

14

220

356

1,269

75

. . .

662

179

282

146

886

342

185

89

80

177

1,2s6

662

205

56

60

4,i 76

3,910

2,631

203

24

57

41

●

●

*

16

113

19

65

53

73

26

*

138

43

72

33

21

●

*

*

%

7

*

735

215

51

208

183

249

*

55

16

92

*

75

*

*

*

44

25

38

13

*

137

137

66

298

9a

*

27

25

80

10

11,227

224

26

372

165

*

v

27

188

256

134

42

87

1,028

460

177

197

120

21

401

242

43

21

62

39

19

29

460

54

20

136

117

895

41

135

17

110

170

772

102

*

659

177

141

84

508

122

198

34

*

141

1,033

316

10

69

117

4,0i 7

3,685

6,329

121

51

632

600

44

86

73

132

301

146

46

59

362

207

62

138

64

18

1,681

1,185

262

177

350

138

144

173

601

35

*

161

78

819

66

26

25

80

160

460

76

49

*

*

113

82

486

132

147

14

90

488

149

21

19

21

116

*

10,W4

259

178

936

6s2

111

122

70

86

507

174

153

124

257

195

17

235

87

34

3,532

2,487

441

217

559

859

661

623

1,227

71

*

556

76

1,224

125

11

53

91

181

891

37

173

. . .

. . .

165

106

598

288

62

*6

*

53

874

453

244

37

16

170

li%-r&Iisrwdngr@s forfemalsswilhdslivedes iscodsdV27,shmvn tmder”supplsmentaryckSMcatiOflS.”
Advance Data No. 249 ● AIXil 8.1994

Table 5. Rate of inpatients discharged from short-stay hospitais, by category of fira&listed diagnosis, ae~ and S@ Unltad Stataa, 1992

[Dischargesfrom non-Faderalhospitals.Excludesnewborninfants.Diagnosticgroupingsand oodenumberindueionsare basedon tfw /rEarnationa/C&@%#on of

Diseases, 9th Revision,ClinicalModifidion (ICD-6-CM)]

sax A@

under 1544 45-64 65psla

Categoryof first-listeddiagnosisand ICD-8-CM Coda Total Msla F&naia 15yeaLs ~ yews andowr

Alicundiiis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infaotiousandpamsitic diaeasas. . . . . . . . . . . . . . . . . . . . . . ...001-138

.%ptioemia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Naoplasms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignantneoplasms.... . . . . . . . . . , . . . . . . . . ...140-206.230-234

Malignant neoplasmof large intestineand raotum. . . . . . .1W154,197.5

Maliinant neoplasmof trachea, bronohus,and lung . . ...162197.0.197.3

Malignantnaoplasmofbraaet . . . . . . . . . . . . . . . . . . .174-175.196.61

Berign naoplaarneend naoplssmsof uncertain

behaviorand unspWfied nature. . . . . . . . . . . . . . . . . .210+29,235-238

Endwina, nutritionaland metebolii diseases,

and immunitydisorders. . . . . . . . . . . . . . . . . . . . . . . . . . . ...240-279

Diibstsa mellitus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Volurnadeplatiorr. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...276.5

Oisaasasofthe Wandblood-formingorgane. . . . . . . . . . . . ...260-268

Mentaldieordam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Psychoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-289

Alcohc4dapandencesyndrome . . . . . . . . . . . . . . . . . . . . . . . . ...303

~~sdtienem~~emati-n~o~am . . . . . . . . . . . ..~

DBeases ofthaoantral nervousaystem. . . . . . . . . . . ..3~.340-349

D~oftheear andme,stoidpmcaaa. . . . . . . . . . . . . . . . ..360-3S8

Dmasasofthe arculato+ysystem. . . . . . . . . . . . . . . . . . . . . ...330-459

Heart dieeaaa. . . . . . . . . . .381-882.0,383+96,402,404,41 0-416,420-429

Aoutemyocardialinfarction . . . . . . . . . . . . . . . . . . . . . . . . . ...410

Coronaryafherosolerosis. . . . . . . . . . . . . . . . . . . . . . . . . . ...414.0

CXheriactwmi oheartdisaase.. . . . . . . . . . . . . . .411-413,414.1+14.9

Cardieodysrhythmias. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Congestivehaartfailure . . . . . . . . . . . . . . . . . . . . . . . . . . ...426.0

CerebrWascallardisaaae . . . . . . . . . . . . . . . . . . . . . . . . . . ..430-43s

Diaaasaaof theraspiratorysyatarn . . . . . . . . . . . . . . . . . . . . ...460-619

Aoutera@@oryinfaction s. . . . . . . . . . . . . . . . . . . . . . . . . ..46@tS6

Chronicdieaaaaoftonsilsandadanoids. . . . . . . . . . . . . . . . . . . ...474

Pneumonia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4S0-466

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .433

D*ssasofthed~ivesyatem. . . . . . . . . . . . . . . . . . . . . ...520-678

Ulcarsoffheatomachandsmall intestine. . . . . . . . . . . . . . . . ..531-534

Appendicitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inguinalhwnia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550

Noninfactiousenteritisamlmliiis. . . . . . . . . . . . . . . . . . . . ...555-556

Choleliihiasis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .574

Dieeaeasoftheganilourinary system. . . . . . . . . . . . . . . . . . . ...560-628

Calculusofktineyandurater... . . . . . . . . . . . . . . . . . . . . . . . ..682

Hyperplaaiaofprcetate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .W

Complains ofpragnancy,chWb%th,andthe puarpariuml. . . . . ...630-676

Abortiinaandeotopicandmolarpregnanobs . . . . . . . . . . . . ...630-633

~~~s~tiestin~dsuhtimustisue . . . . . . . . . . . . . ...660-708

Celluliisandabacaaa . . . . . . . . . . . . . . . . . . . . . . . . . . . ...661-662

Disaaaasofthemuaculcakeletalaystamand connaotivetissue. . . ...710-739

Arthropathiasandralatadd*rdera.. . . . . . . . . . . . . . . . . . ...710-719

lntervarlebraldiscdiaordars.... . . . . . . . . . . . . . . . . . . . . . . . ..722

Cagdtalanomalias . . . .. . . . . . . . . . . . . . . . . . . . . . . . . ...740-759

Cartsincmdiiionsoriginatingintheparhwtalperiod . . . . . . . . . . ...760-779

Symptoms,signs,and illda%wcfcondiiona . . . . . . . . . . . . . . . ...760-798

lnjuryandpoiaoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .600-899

Fractures,allsites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600-628

Fracturaofnackoffemur . . . . . . . . . . . . . . . . . . . . . . . . . . . ..620

Intracranialinjuri& (excludingthosawithskullfracture). . . . . . ..~

Laoarationaandopanwounds . . . . . . . . . . . . . . . . . . . . . . . ..870+04

Supplementaryclasshications.... . . . . . . . . . . . . . . . . . . . . ..VOI-V62

Femaleswithdaliw.es . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27

1,221.0

31.9

11.0

78.9

62.2

6.3

8.5

6.7

16.6

46.5

18.8

12.2

12.7

67.5

35.8

10.2

27.9

12.4

5.7

220.8

165.2

28.5

16.4

36.3

21.4

32.4

327

115.3

14.8

2.9

41.8

18.3

125.7

9.1

9.0

4.4

1319

2Q.2

76.6

8.6

8.7

26.1

7.0

18.2

12.1

63.5

21.9

16.0

7.6

5.6

13.8

106.6

40.1

11.0

6.0

7.1

172.9

154.2

Rateotinpatientsdkohqad per 10,OOOpopulation

1,006.0

32.8

10.6

66.6

62.2

6.3

10.1

●

6.4

39.5

16.6

9.9

11.2

70.5

33.2

15.9

26.8

11.9

5.8

232.9

168.3

37.2

23.2

41.0

20.8

30.3

30.5

116.7

15.2

2.6

43.5

16.3

113.1

9.3

11.0

7.9

10.9

125

59.3

11.6

18.0

. . .

18.7

129

56.0

17.2

18.0

8.3

6.6

14.0

114.1

37.8

5.9

7.9

10.5

16.8

. . .

1,4220

31.0

11.4

66.5

623

6.4

7.0

13.0

26.3

53.0

20.6

14.2

14.2

64.7

36.3

4.8

29.0

12.8

5.6

208.4

1420

221

10.0

35.8

21.9

34.4

34.8

114.0

14.5

3.2

40.1

20.1

137.7

8.9

7.1

1.1

18.8

27.5

96.8

5.8

. . .

50.8

13,7

17.8

11.4

66.7

26.3

14.2

6.8

4.6

13.6

68.4

42.3

15.7

4.3

3.8

320.2

289.8

452.4

36.3

4.4

10.2

7.3

●

●

●

2.9

20.2

3.4

11.6

9.4

13.1

4.6

●

24.7

7.7

12.9

5.9

3.8

*

*

●

w-l

~ .3

*

131.3

36.5

9,1

37.2

34.4

44.5

*

9.6

2.9

16.5

●

13.4

*

●

●

7.9

4.5

6.8

2.3

●

24.5

24.6

11.7

53.3

17.5

*

4.9

4.5

74.4

1.8

960.0

19.2

22

31.8

15.8

●

W.6

2.3

16.0

21.9

11.5

3.6

7.4

M.o

41.0

15.2

16.8

10.2

1.8

34.3

20.7

3.7

1.8

5.3

3.4

1.6

25

39.3

4,6

1.7

11.5

10.0

76.6

3.5

11.6

1.5

9.4

14.5

66.0

8.8

*

!%.3

15.2

12.0

8.0

43.5

10.4

16.9

29

*

12.0

2a.3

27.1

0.9

5.9

10.0

343.5

333.1

1,310.2

25.0

10.5

130.8

103.5

9.2

17.8

15.1

27.3

624

30.7

9.9

122

72.8

42.9

12.8

28.5

13.2

3.7

337.6

245.3

54.2

36.7

72.4

26.5

23.9

35.7

103.7

7.3

●

322

16,1

169.6

13.6

5.5

5.1

12.4

33.1

89.0

15.8

10.0

*

●

23.3

16.9

86.5

27.3

30.4

2.9

18.6

102.7

30.8

4.2

3.9

4.4

24.0

*

3,365.0

60.3

66.0

290.5

263.8

34.5

37.8

21.7

26.7

157.1

53.9

47.4

36.4

79.7

60.4

5.2

72.8

26.8

10.6

1,083.9

770.4

136.6

67.2

173.3

111.1

201.6

183.0

380.0

22.1

*

1721

23.6

378.2

36.7

3.3

16.4

26.2

66.1

214.1

11.5

53.5

. . .

. . .

51.1

32.8

165,1

WI

19.1

%?.0

*

16.6

270.7

140.4

75.7

11.4

4.9

52.7

. . .

lFirst-listeddiagmsiaforfernaleswithde!hwiesiscodedV27,shcwnumder”eupplaaremtay ~.”
6 Advance Data No. 249 ● April 8,1994

Table 6. Average length of atey for Inpatients discharged from short-stay hospitals, by category of first-listed diagnosis, sex, and age:

United States, 1992

[Discharges from non-Federsl hospitals. Exoludes newborn infants. Diagnostic groupings and code number inclusions are based on the krternatiord C/aesii7catiorrof

Diseases, %h Revision, C/inica/ Modh%ation (lCD-%CM)]

sax Age

Under 15-44 45-64 65 years

Category of first-listed diagnosis and ICD–9-CM Code Total Male Female 15 years years years and over

Allcondtions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious andparasific diseaaea. . . . . . . . . . . . . . . . . . . . . . ...001-138

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignentneoplasms . . . . . . . . . . . . . . . . . . . . . . . ..14G208.23G234

Malignantneoplasm oflargeinteatine and rectum. . . . . . ...153-154.197.5

Malignant neopkrsmoftrschea,b ronchus,andlung . . ...162.197.0.197.3

Malignantneoplasm ofbreast. . . . . . . . . . . . . . . . . . .174-175.196.81

Sanign nsoplasms and neoplasms of uncertain

behavior andunspecifiad neture. . . . . . . . . . . . . . ...210-229.235-239

Endocrine, nutritional and metabolic diseases,

andimmun”~ disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . ...240-279

Diebates melliis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..250

Volumedeplafion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..276.5

Disessesoftheblood andblood-forming organs. . . . . . . . . . . . . . .26(!-289

Mental disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..290-319

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-299

Almholdependencesyndrome.. . . . . . . . . . . . . . . . . . . . . . . . ..303

Diseesesofthe nervous systemandsense organs . . . . . . . . . . . ..320+89

Diseesesofthecentrel nervous system . . . . . . . . . . . . .320-336,34W49

Diseasesoftheearand meatoidprocess. . . . . . . . . . . . . . . ...360-389

Diseasesofthecirculatory system. . . . . . . . . . . . . . . . . . . . . ...390-459

Heartdisessa . . . . . . . . . . .391-392.0,363+96,402,404,410-416,420-428

Acufemyocsrdial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . .410

Ceronarysthercsclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . ...414.0

Dtherischemic heart disease. . . . . . . . . . . . . . . .411-413,414.1-414.9

Cardiacdysrhythmisa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .427

Ccmgestiieheartfailure . . . . . . . . . . . . . . . . . . . . . . . . . . ...426.0

Cerebrovasculardisesae . . . . . . . . . . . . . . . . . . . . . . . . . . ..43&t36

Disaasesoftherespiratorysystem . . . . . . . . . . . . . . . . . . . . . ..460-519

Acute respiratoryinfsctions . . . . . . . . . . . . . . . . . . . . . . . . ...480466

Chronicdiseasaoftonsilsandadenoids. . . . . . . . . . . . . . . . . . . ...474

Pneumonia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..480-486

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .493

Diseasesofthedigastivesystem . . . . . . . . . . . . . . . . . . . . . . ..52&579

Uloarsoftheatomach andsmallinteathe. . . . . . . . . . . . . . . . ..531-534

Appendiciti s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...540-643

Inguinalhemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550

Noninfectious enteritis sndooliiis . . . . . . . . . . . . . . . . . . . . ...555-558

Cholelithiesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...574

Diseasesofthegenitourinarysystem . . . . . . . . . . . . . . . . . . . . ..5W428

Csloulusofkidneyand ureter... . . . . . . . . . . . . . . . . . . . . . . . ..592

Hyperplasiaofprostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..600

Complications ofpregnancy, childbirth, andthepuerperiuml. . . . . ...630-676

Abortionsand eotopicandmolar pregnancies . . . . . . . . . . . . ...630-639

Diseaaesoftheskin andsubcufanaous tissue . . . . . , . . . . . . . . . .33&708

Cellulitisand abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . ...881-682

Diseases of themusculoskeletal system andmnneotive tieaue. . . . ..710-739

Arthropathiesand related disorders. . . . . . . . . . . . . . . . . . . ...710-719

Intervertebraldiscdiacrders... . . . . . . . . . . . . . . . . . . . . . . . ...722

Congenifalanomelies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...740-759

Certain cundtiona originating intheperinatal period . . . . . . . . . . ...760-779

Symptoms, signs,and ill-defined condtions . . . . . . . . . . . . . . . ...760-798

Injuryand poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-859

Fractures,allsifes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-629

Frsotureofneckoffemur . . . . . . . . . . . . . . . . . . . . . . . . . . . ..820

Infracrenial injuries (excludingthosewith skullfraoture) . . . . . . ...860-854

bcerationsandopanwounds. . . . . . . . . . . . . . . . . . . . . . . ..87G904

Supplementsyclassificstions... . . . . . . . . . . . . . . . . . . . . . . .VOI–V62

Femaleswithdeliverfee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27

6.2

7.9

10.8

7.7

8.5

11.5

6.3

4.1

4.6

6.4

6.9

6.4

6.0

10.9

12.9

9.4

5.5

8.8

2.6

7.0

6.7

8.1

5.6

5.0

5.2

7.9

8.8

6.6

4.0

1.3

6.3

4.3

5.6

8.9

4.4

2.5

4.9

4.4

4.7

3.1

4.4

2.6

2.0

7.8

6.7

8.2

7.3

4.4

6.3

12.4

3.0

6.2

1:

5.5

3.6

3.1

2.6

6.7

8.0

10.7

8.6

8.9

11.0

6.1

*

6.4

6.3

7.0

8.1

5.9

10.2

12.0

9.0

5.7

9.3

2.5

6.9

6.4

7.7

5.5

4.9

4.9

7.8

8.9

6.7

3.7

1.4

8.5

3.6

5.6

6.2

4.4

2.5

4.9

5.2

6.0

2.9

4.4

. . .

. . .

7.1

6.2

5.5

5.9

4.0

6.6

13.5

3.0

5.8

1:

5.1

3.6

7.8

. . .

Aversgelengthof sfsyindays

5.6

7.9

10.9

7.0

8.2

11.9

6.6

4.1

4.2

6.4

6.8

6.6

6.2

11.5

13.7

10.7

5.3

6.4

2.8

7.2

7.0

8.8

6.0

5.1

5.5

8.0

8.8

6.6

4.2

1.2

6.1

4.9

5.9

7.7

4.5

2.7

4.9

4.0

4.5

3.5

. . .

2.6

2.0

8.4

7.3

6.8

8.1

4.9

5.8

10.7

2.9

6.7

8.4

11.6

6.3

4.5

2.9

2.6

4.9

4.0

7.0

7.0

7.8

*

*

*

5.2

4.0

4.1

3.0

3.8

16.4

16.4

*

3.7

6.8

2.3

7.4

7.9

*

*

*

*e.i

%7

*

3.5

3.4

1.2

4.5

2.9

3.7

*

4.1

1.4

2.7

*

4.0

*

*

●

3.9

4.0

5.5

7.0

●

6.9

12.3

2.6

3.7

4.3

*

2.3

2.2

4.1

3.3

4.3

8.1

10.9

5.5

7.0

*

11.2

4.2

4.0

4.8

5.1

4.0

5.7

10.2

12.2

9.9

5.2

6.8

2.0

5.4

5.3

5.7

3.9

3.8

3.0

6.6

9.1

5.0

3.2

1.4

7.2

4.0

4.4

5.0

4.0

1.5

4.9

2.9

3.6

2.8

*

2.8

2.0

5.5

5.1

3.9

3.3

3.7

4.7

●

2.6

4.8

5.7

8.4

4.9

3.5

2.6

2.6

6.3

8.6

10.6

7.4

8.3

10.3

8.1

4.0

4.2

6.0

6.8

5.8

5.7

10.6

13.1

7.9

6.1

9.3

2.5

6.2

5.7

7.4

4.9

4.3

4.5

6.9

8.9

7.1

4.8

*

8.0

6.1

5.5

6.7

5.8

2.9

4.7

4.0

4.2

2.6

3.8

*

*

7.9

7.3

5.2

6.4

4.2

5.5

2.7

6.2

6.6

11.1

6.9

4.8

6.1

*

8.2

10.6

11.4

8.8

9.0

12.0

8.3

4.1

6.6

7.9

8.6

8.8

7.4

12.4

13.8

9.3

6.5

12.3

3.8

7.6

7.2

8.8

6.4

5.5

5.7

8.2

8.8

9.2

6.1

*

10.1

6.6

7.4

7.7

8.5

3.0

7.3

6.1

6.3

4.4

4.6

. . .

. . .

10.8

8.5

9.1

9.3

7.1

%.2

●

4.7

8.9

10.2

11.9

8.3

7.0

11.9

. ..

Ii%s+listaddiagnosisforfemsleswithdalhwriesiscodadV27,shown under’’eupplamantwycbaifkdons.”
Advance Data No. 249” April 8,1994 7

Table 7. Number of all-listwt procedures for inpatients discharged from short-stay hospitals, by procedure category, se% and agm

United States, 1992

[Dischargesfrom non-Faderalhospitals.Excludesnewborninfants.Prooadursgroupingsand m% numberinclusionsare based onthe /ntemstiorrs/O&rssit%afiorrof

Diseases, Wr Ravish, Clinical Modiricatiorr (ICD-9-OM)]

Sex Age

under 15-44 45-64 6.5years

Prvcsdure oategory and ICD-9-OM Oode Tdal Male Famale 15 years years years and over

All procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operationsonthenervous system . . . . . . . . . . . . . . . . . . . . . . ...01-5

Spinaltap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...03.31

Operationsontheendocrine system. . . . . . . . . . . . . . . . . . . . . ...06-07

Operationsonthe aye. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...06-16

0p3_ationsonthaesr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...16-20

Operationsonthe nose, mouth,and pharynx . . . . . . . . . . . . . . . ...21-28

Tonsillectomywithor w.tiout adenoidactomy. . . . . . . . . . . . . . .26.2–28.3

Operationsonthe respiratorysystem . . . . . . . . . . . . . . . . . . . . . ..30+4

Bronchoscopywithor withmdbiopsy. . . . . . . . . . . . . . .33.21-33.24.33.27

Oparatiorraonthecardiovascular syatem. . . . . . . . . . . . . . . . . . ...3.5-32

Removalofcoronsyarley obstruction. . . . . . . . . . . . . . . . . . . ...86.0

Coronaryar/erybypass grsf&l. . . . . . . . . . . . . . . . . . . . . . . . . ...36.1

Cardiacoafhetenzstion. . . . . . . . . . . . . . . . . . . . . . . . . . .37.2%37.23

Insertion,replacement,removal,and revision

ofpaoernakerleadsordevice . . . . . . . . . . . . . . . . . . . . . ...37.7-37.6

Shuntorvssoulsr bypass. . . . . . . . . . . . . . . . . . . . . . . . ...39.0-39.2

Hemorfialyaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...39.95

Oparafionsonthehemic andlymphatic aystem . . . . . . . . . . . . . . . ..4O4l

Operationsonthedigeative system.. . . . . . . . . . . . . . . . . . . . ...42-&t

Endoacopyofsmall intestinewithorwithoutbiopsy. . . . . .45.11-45.14.45.16

Enrfoawpyof large intestinewithorwithoutbiopay . . . . . . . . .45.2145.25

Partialexcisionoflarge intestine...,.. . . . . . . . . . . . . . . . . . ...45.7

Appendectomy,excludingincidental. . . . . . . . . . . . . . . . . . . . . ...47.0

Cholecystscfomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...51.2

Repsirofinguirral herni a........ . . . . . . . . . . . . . . . . ...53.0-68.1

Lysisof petffonaaladhesions . . . . . . . . . . . . . . . . . . . . . . . . . ...54.5

Operationsontheunnsry system. . . . . . . . . . . . . . . . . . . . . . . ...55-59

Oysfoscopywithorwithoutbiopsy . . . . . . . . . . . . . . . . . . . .57.31-57.33

Oparationaonthemale gen.hlorgsns.. ., . . . . . . . . . . . . . . . . ...60-64

Prosfatectorny. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...60.2-60.6

OprdoMontie female gentilorgans . . . . . . . . . . . . . . . . . . . ..W7l

Oophoracfomyandaalpingo-oophoractomy.. . . . . . . . . . . . . . .65.%65.6

6ilatersl destructionorosclusionof fallo@antubas . . . . . . . . ...66.2-66.3

Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..66.3-6S.7

Dilafbnand curettageofu terr.m... . . . . . . . . . . . . . . . . . . . . . ...69.0

Repsirofoyatcwelaandrectocele . . . . . . . . . . . . . . . . . . . . . . . ..7o.5

Obstetrfcdprocdures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72-75

Episiotornywithor wfthoutforceps

orvacuumextrsction . . . . . . . . . . . . . . . . . .72.1,72.21,7231,72.71,73.6

Atificial nrptureofmemlxsnaa . . . . . . . . . . . . . . . . . . . . . . . . ...73.0

Cessrean section. . . . . . . . . . . . . . . . . . . . . . . . .74.0-74.2.74.4.74.89

FataIEKG (acslp)and fetal monitoring,nototharwisesp4fied . .75.32,75.34

Repsirofcurrent obatatriclaceration. . . . . . . . . . . . . . . . . ...75.5-75.6

Operationsonthemusculoskeletal system. . . . . . . . . . . . . . . . . ...76-64

PaItial excisionof bone. . . . . . . . . . . . . . . . . . . . . .76.2-76.3,77.&77.6

Opanraduotionof frasturewifhintemsl fixation. . . . . . . . . . . . . . ...79.3

Excisionordastructionofintewerfebrat disc. . . . . . . . . . . . . . . . . ..6o.5

Totslhipreplacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...81.51

Totslkneereplacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...81.54

Operationsontheintegumentary syatem . . . . . . . . . . . . . . . . . . ...65-66

Maataotomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...65.4

Dabridementofwound, infection,or bum. . . . . . . . . . . . . . . .66.22.66.26

Skirrgraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...66.6-66.7

Miscallaneousdiagnoatioandtherapeuticprooadures . . . . . . . . . . ...87-99

Computenzedaxialtomography. . . . . . . . . .87.03.87.41.87.71,66.01,66.36

Program.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67.73-67.75

Artericgraphyandangitxwdiogrsphyusingmntrastrnatarisl . . ...66A-66.5

Diagnostiouitrssounrf. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66.7

~rculatorymonitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..69.6

Radioiaotopeacan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92.0-92.1

Respiratorytherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...98.9

42,627

921

339

102

832

121

533

60

1,031

315

4,424

389

466

1,026

274

178

322

386

5,356

573

217

261

525

139

344

1,413

414

538

353

2,302

464

360

660

173

i41

6,664

1,611

729

921

1,241

790

3,266

“222

417

319

127

167

1,371

117

306

108

13,654

1,266

203

1,771

1,456

596

464

819

Numbarofall-liatad prcwadureainthouaands

. --- 16,791

442

164

28

162

68

260

33

575

178

2,630

262

347

636

140

99

156

202

2,256

405

236

91

143

165

121

67

776

28t

539

353

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

1,652

115

187

175

49

53

563

*

178

59

6,615

606

106

1,060

667

287

203

361

25,636

479

155

72

168

53

252

46

466

136

1,784

t36

122

392

134

79

167

195

3,100

459

335

126

118

360

18

277

637

123

. . .

. . .

2,302

464

2ao

560

173

141

6,664

1,611

728

921

1,241

780

1,614

107

230

144

79

115

608

116

129

46

7,238

656

98

711

671

308

261

436

2,166

194

146

*

27

64

119

51

66

26

152

*

●

15

*

*

●

20

218

15

*

*

57

*

20

*5

46

9

40

. . .

v

*

*

*

*

*

16

*5

*

*

*

*

171

9

21

*

*

91

20

11

806

66

*

20

63

35

t2

16a

16,264

307

63

39

62

31

227

25

186

56

501

30

16

a5

%

20

81

71

1,430

151

78

23

159

177

20

165

331

62

32

●

1,S32

238

378

33s

136

36

6,642

1,604

727

918

1,236

787

1,252

35

151

157

10

●

453

19

92

3s

3,128

266

6S

184

366

101

62

128

9,461

206

56

38

70

10

101

*

282

82

1*544

‘!77

200

432

51

62

103

114

1,332

212

142

56

28

162

31

78

352

96

108

74

511

168

*

165

26

56

%

*

*

*

*

*

841

73

74

118

33

36

382

44

62

30

3,550

28Q

62

714

338

130

133

159

14,736

213

54

21

173

15

65

*

457

138

2,226

192

252

466

214

82

136

192

2,378

“436

346

133

16

165

69

95

662

245

357

278

222

55

. . .

m

9

47

. . .

. . .

. . .

. . .

. . .

. . .

1,002

46

171

44

64

126

445

54

113

32

6,266

621

6a

644

6s9

329

237

365

lllenumbsrofdisctwgerfpatiantswithaconmaryartstybypassgraft W.53090000.
8 Advance Data No. 249 ● April 8,1994

Table 8. Rate of all-listed procedures for Inpatients discharged from short-stay hospitals, by procedure category, sax, and age

United Statea, 1992

[Discharges from non-Faderal hospitals. Excludes newborn infants. Procedure groupings and code number irrolusionsare based on the International Classification of

Diseases, Wr Revision, Clinical Ahdirication (ICD-9-CM)]

Sex Age

Under 1544 45-64 65 years

Procedure category and ICD-9-CM Code Total Mafe Femafe 15 yeara yeare years and over

Allprceedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operations onthenewous system . . . . . . . . . . . . . . . . . . . . . . ...01-05

Spineftsp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...03.31

Operations ontheendccrine eystem. . . . . . . . . . . . . . . . . . . . . ...06-07

Operationsontheaye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .08-16

Operationsontheeer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-20

Operationsonthe nose,rnouth,and pharynx . . . . . . . . . . . . . . . ...21-29

Tonsilleotomyw”ti orwithoutadenoideetomy . . . . . . . . . . . . . . .28.2-28.3

Oparetionsontherespiratorysyefem . . . . . . . . . . . . . . . . . . . . . . .30-34

Bronchoscopywith orwithoutbiopsy. . . . . . . . . . . . . . .33.21-33.24.33.27

Operations ontheoardiovaecularsyatem . . . . . . . . . . . . . . . . ...35-39

Removelofcoronaryarteryobefruotion . . . . . . . . . . . . . . . . . . . ...36.0

Ooroneryatierybypeeegrafti..... . . . . . . . . . . . . . . . . . . . . ...36.1

Cardiaccatheterization . . . . . . . . . . . . . . . . . . . . . . . . . . .37.21+7.23

Insertion, replacement, removal, and revision

ofpacemaker leads ordevica . . . . . . . . . . . . . . . . . . . . . ...37.7-7.6

Shunt orvascular bypeee . . . . . . . . . . . . . . . . . . . . . . . . . . .39.0+9.2

Hemodialyeie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...39.95

Operationsonthe heroic andlymphaticsystem . . . . . . . . . . . . . . ...4041

Operationsonthedigeetivesystem . . . . . . . . . . . . . . . . . . . . . . ..42-54

Endoscopyofsmall inte~”ne withorwlhout biopsy. . . . . .45.1145.14.45.16

Endoscopyoflarge intestine withorwithout biopsy . . . . . . . . .45.21-45.25

Pa~ialexcisionoflargeintaefine.. . . . . . . . . . . . . . . . . . . . . . . ..45.7

Appendectomy, excluding incidental . . . . . . . . . . . . . . . . . . . . . ...47.0

Cholecyetaotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..51.2

Repairofinguinalhemia . . . . . . . . . . . . . . . . . . . . . . . . . . .53.0-53.1

Lysisofperftoneal adhesions . . . . . . . . . . . . . . . . . . . . . . . . . ...54.5

Operafionsonthe urinerysystem. . . . . . . . . . . . . . . . . . . . . . . ...55-59

Cyetoscopywith orwithoutbiopsy. . . . . . . . . . . . . . . . . . ..57.31-57.S3

Operetionsonthe malegenitalorgans. . . . . . . . . . . . . . . . . . . . . ..60+4

Proetetacfomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...60.243.6

Operations onthefemale genitslorgans . . . . . . . . . . . . . . . . . . ...65-71

Oophorectomy andeslpingo-oophoreotomy. . . . . . . . . . . . . . . .65.3+5.6

Silaterel destruction orocclusionoffallopiantubes . . . . . . . . . . .66.2-66.3

Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...66.3-66.7

Dilationandcurattageofuferus... . . . . . . . . . . . . . . . . . . . . . . ..69.0

Repairofcystocsleand racfocele. . . . . . . . . . . . . . . . . . . . . . . ..70.5

Obsletricel procsdurae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..72–75

Epieiotomy with or without forceps or

vacuum extraction. . . . . . . . . . . . . . . . . . .72.1,72 .21,72.31,72.71,73.6

Artiicial rupture of membranes . . . . . . . . . . . . . . . . . . . . . . . . ...73.0

Caaareansection. . . . . . . . . . . . . . . . . . . . . .74.0-74.2,74.4,74.99

Fatal EKG(scelp) and fetal monitonng, nototherwise specified . .75.32,75 .34

Repairofcurrent obstetnclaceration . . . . . . . . . . . . . . . . . . . .75.5-75.6

Operations onthemusculoskelatal system. . . . . . . . . . . . . . . . . ...76-34

Partial excisionofbone. . . . . . . . . . . . . . . . . .76.2–76.3,77.6-77.8

Open raductionoffracfurawith internal fixation. . . . . . . . . . . . ...79.3

Excision ordestruction ofintervertebrel disc... . . . . . . . . . . . . ...80.5

Tofalhipreplacemenf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...81.51

Totalknee replaoament . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...81.64

Operations ontheintegumentatysyetem . . . . . . . . . . . . . . . . . . ...85-86

Mastectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...85.4

Debridement ofwound, infection,or burn... . . . . . . . . . . . . .36.22.66.28

Skin gratt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...66.6-36.7

Miscellanaousdiagntitcandtherapeutic procedures . . . . . . . . . . ...87-98

Computenzad axial tomography. . . . . . .67.03,67.41,67.71,68.01,38.38

Pyekrgram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87.73-87.75

Artericgraphyand angiocardiography using contrasfmaterial . . ...88.4-88.5

Diagnrxticultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..8S.7

Circulatorymonitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..39.6

Radioisotopescen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..92.W92-I

Respiratorytherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93.9

16,615.7

363.2

133.7

40.0

130.9

47.7

210.1

31.4

406.7

124.4

1,745.1

157.2

184.8

405.6

106.1

70.3

127.2

156.6

2,113.6

341.0

226.0

85.6

102.9

207.1

54.9

135.5

557.4

163.5

212.5

139.1

908.2

133.1

148.8

228.8

63.3

55.7

2,628.9

635.4

287.5

363.3

469.6

311.6

1,236.3

87.6

164.4

125.9

50.1

66.1

540.9

46.0

121.4

42.5

5,465.1

499.4

79.9

688.7

575.2

234.9

133.1

323.2

Rate of all-listed procedures per 100,000 population

13,642.3

359.1

149.4

23.6

131.9

54.9

227.7

26.9

467.0

144.4

2,136.9

213.3

281.8

517.1

113.5

30.6

126.5

164.4

1,834.4

329.1

193.5

74.0

116.1

133.9

98.2

54.4

630.5

236.5

437.8

286.6

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. .

. . .

1,342.3

93.7

151.9

142.4

39.4

42.9

457.7

*

145.0

43.1

5,374.2

493.9

86.0

861.3

477.2

232.9

165.3

309.6

19,610.6

367.1

118.8

55.6

128.9

41.0

193,6

36.6

349.8

i 05.5

1,375.4

104.3

93.2

300.4

102.9

60.4

127.6

149.7

2,377.0

352.1

256.7

96.6

90.4

276.1

14.1

212.1

486.5

94.6

. . .

. . .

1,765.4

355.9

291.1

444.7

132.6

103.2

5,108.9

1,235.1

558.9

706.1

951.6

606.1

1,237.4

81.7

176.3

110.4

80.2

87.9

619.4

88.6

99.1

37.1

5,551.0

504.7

75.1

545.2

667.6

236.9

199.9

335.9

3,671.1

347.6

260.7

*

47.6

115.2

212.9

90.6

153.0

50.3

272.3

*

*

27.0

*

*

●

35.7

339.6

26.7

●

●

102.5

*

35.4

%.7

86.0

16.9

72.3

. . .

●12.4

*

*

●

*

*

28.4

W.6

*

●

*

*

306.1

16.9

37,5

*

*

162.6

—

36.1

19.3

1,622.5

121.8

*

35.3

113.1

62.1

21.4

300.0

13,807.5

262.6

71.3

33.4

53.4

26.2

194.3

21.5

168.0

47.6

428.8

25.3

13.6

81.3

*6.9

17.3

69.2

60.6

1,222.5

129.2

67.3

20.0

136.0

151.5

17.2

141.1

263.0

53.0

27.4

*

1,335.9

204.5

323.4

286.3

117.9

30.4

5,679.4

1,371.5

621.3

784.9

1,056.7

673.4

1,070.2

81.1

129.1

134.6

8.7

*

387.4

16.4

76.9

29.7

2,674.7

244.7

56.8

165.5

313.2

86.4

69.9

109.0

19,535.5

427.4

114.7

7a.4

144.8

21.7

209.8

*

604.2

190.9

3,197.0

366.2

413.7

683.8

104.6

129.0

213.0

236.6

2,757.4

439.9

293.1

116.3

59.5

335.6

63.3

162.3

728.8

202.3

226.6

153.4

1,058.7

350.0

*

382.8

53.5

120.9

*1 3.2

*

*

*

*

*

1,740.5

150.8

153.4

244.1

68.1

79.5

791.2

90.5

169.3

61.7

7,349.2

600.9

128.9

1,477.7

702.4

269.9

276.1

326.8

45,643.8

659.3

167.6

65.4

535.0

47.9

263.2

*

1,415.6

431.5

6,894.1

594.4

761.7

1,506.3

6s1 .7

284.8

426.3

596.1

7,365.8

1,504.6

1,076.7

411.6

48.4

571.6

212.9

293.7

2,112.2

759.9

1,105.3

861.2

686.8

169.1

. . .

166.6

28.1

146.5

. . .

. . .

. . .

. . .

. . .

. . .

3,104.4

139.0

529.2

136.4

260.2

391.1

1,378.1

166.5

351.4

98.9

19,414.7

1,925.0

209.5

2,614.1

2,134.7

1,020.4

734.2

1,130.6
Advance Data No. 249 ● April 8,1994 9

Technical notes

Survey methodology

Source of data

The National Hospital Discharge

Survey covers discharges from

noninstitutional hospitals, exclusive of

Feder@ military, and Department of

Veterans AWrs hospitals, located in the

50 States and the District of Columbia.

Only short-stay hospitals (hospitals with

an average length of stay for all patients

of fewer than 30 days) or those whose

specialty is general (medical or surgical)

or children’s general are included in the

survey. These hospitals must also have

six beds or more staffed for patient use.

From 1988 through 1990, the

NHDS sampling frame consisted of

hospitals that were listed in the April

1987 SMG Hospital Market Database

(3), met the above criteri~ and began

accepting patients by August 1987. In

1991 the sampling frame was updated to

include hospitals from the 1991 SMG

Hospital Database (4). For 1992, the

sample consisted of 528 hospitals. Of

the 528 hospitals, 14 were found to be

out of scope (ineligible) because they

went out of business or otherwise failed

to meet the criteria for the NHDS

universe. Of the 514 in-scope (eligible)

hospitals, 494 responded to the survey.

Sample design and data collection

The NCHS has conducted the

NHDS continuously since 1965. The

original sample was selected in 1964

from a frame of short-stay hospitals

listed in the National Master Facility

Inventory. That sample was updated

periodically with samples of hospitals

that opened later. Sample hospitals were

selected with probabilities ranging from

certainty for the largest hospitals to 1 in

40 for the smallest hospitals. WWn

each sample hospital, a systematic

random sample of discharges was

selected. A report on the design and

development of the original NHDS has

been published (l).

Beginning in 1988, the NHDS

sample includes with certainty all

hospitals with 1,000 beds or more or

40,000 discharges or more annually. The

remaining sample of hospitrds is based

on a stratified three-stage design. The

tirst stage consists of a selection of 112

primary sampling units (PSU’S) that

comprise a probability subsample of

PSU’S to be used in the 1985-94

National Health Interview Survey. The

second stage consists of a selection of

noncertainty hospitals from the sample

PSU’S. At the third stage, a sample of

discharges was selected by a systematic

random sampling technique.

Two data collection procedures

were used for the survey. The first was a

manual system of sample selection and

data abstraction. The second was an

automated method, used for

approximately 34 percent of the

respondent hospitals in 1992, that

involved the purchase of data tapes from

abstracting service organizations, State

data systems, or hospitals.

In the manual system, the sample

selection and the transcription of

information from the hospital records to

abstract forms were performed at the

hospitals. The completed forms, along

with sample selection control sheets,

were forwarded to NCHS for coding,

editing, and weighting. Of the hospitals

using the manual system in 1992, about

58 percent had the work performed by

their own medical records staff. In the

remaining hospitals using the manual

system, persomel of the U.S. Bureau of

the Census did the work on behalf of

NCHS.

For the automated system, NCHS

purchased tapes containing

machine-readable medical record data

that were systematically sampled by

NCHS.

The medical abstract form and the

automated data tapes contain items

relating to the personal characteristics of

the patien~ including birth date, sex,

race, and marital status but not name

and addr~ administrative information,

including admission and discharge dates,

discharge status, and medical record

numbeq and medical information,

including diagnoses and surgical and

nonsurgical operations or procedures.

Since 1977, patient ZIP Code, expected

source of payment and dates of surgery

have also been collected. (The medicaI

record number and patient ZIP Code are

confidential information and are not

available to the public.)

Presentation of estimates

The relative standard error of the

estimate and the number of sample

records on which the estimate is based

(referred to as the sample size) are used

to identi@ estimates with relatively low

reliability.

Because of the complex sample

design of the NHDS, estimates of less

than 5,000 are not presente~ only an

asterisk (*) appears in the tables. These

estimates generally have a relative

standard error of more than 30 percent

or are based on a sample of fewer than

30 cases. Estimates of 5,000 to 9,000

are preceded by an asterisk (*) to

indicate that they should not be assumed

to be reliable. These estimates are

generally based on fewer than 60 cases.

Sampling errors and rounding

of numbers

The standard error is primarily a

measure of sampling variability that

occurs by chance because only a sample

rather than the entire universe is

surveyed. The relative standard error of

the estimate is obtained by dividing the

standard error by the estimate itself and

is expressed as a percent of the estimate.

The resulting value is multiplied by 100,

so the relative standard error is

expressed as a percent of the estimate.

Estimates of sampling variability

were calculated with SESUDAAN

software, which computes standard

errors by using a tit-order Taylor

approximation of the deviation of

estimates from their expected values. A

description of the software and the

approach it uses has been published (5).

The constants for relative standard

error curves for the 1992 National

Hospital Discharge Survey are presented

in table I. The relative standard error

~SE.(X)] of an estimate X may be

estimated from the formula:

RS~X) = 100 ZX

where X, a, and b are as defied in table

I.

Estimates have been rounded to the

nearest thousandth. For this reason,

figures within tables do not always add

to the
10 Advance Data No. 249 ● April 8,1994

totals. Rates and average lengths of stay

were calculated from original,

unrounded figures and will not

necessarily agree precisely with rates or

average lengths of stay calculated from

rounded data.

Tests of significance

In this report, statistical inference is

based on the two-sided test with a

critical value of 1.96 (0.05 level of

significance). Terms such as “higher”

and “less” indicate that diilerences are

statistically significant. Terms such as

“similar” or “no difference” mean that

no statistically significant difference

exists between the estimates being

compared. A lack of comment on the

difference between any two estimates

does not mean that the difference was

tested and found not to be significant.

Terms relating to

hospitalization

Hospitals41 hospitals with an

average length of stay for all patients of

fewer than 30 days or hospitals whose

specialty is general (medical or surgical)

or children’s general are eligl%le for

inclusion in the National Hospital

Discharge Survey, except Federal

hospitrds, hospital units of institutions,

and hospitals with fewer than six beds

sttied for patients’ use.

Patient+ person who is formally

admitted to the inpatient service of a

short-stay hospital for observation care,

diagnosis, or treatment. The terms

“patient” and “inpatient” are used

synonymously.

Newborn infant~ patient admitted

by birth to a hospital.

Dkcharge—’e formal release of a

patient by a hospital; that is, the

termination of a period of

hospitalization by death or by

disposition to place of residence, nursing

home, or another hospital. The terms

“discharges” and “patients discharged”

are used synonymously.

Discharge rate—The ratio of the

number of hospital discharges during a

year to the number of persons in the

civilian population on July 1 of that

year.

Days of car-e-The number of

patient days accumulated by a patient at

time of discharge. A stay of less than 1

day @atient admission and discharge on

the same day) is counted as 1 day in the

summation of total days of care. For

patients admitted and discharged on

different days, the number of days of

care is computed by counting all days

from (and including) the date of

admission to (but not including) the date

of discharge.

Average length of stay—l%e number

of days of care accumulated by patients

Table L Estimated parameters for relative standard error equetions for National Hospltsl

Discharge Survey statistics, by sex, age, and geographic region: United States, 1992

Number of discharges or

first-listed diagnoses Number of prooeduras

Characteristic a b a b

Total. . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . .

Age

Under 15years . . . . . . . . . . . . . . .

15-44 yeara . . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . .

65years andover . . . . . . . . . . . . .

Region

Northeast . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . .

o.000a7

0.00377

0.00089

0.06075

0.01261

0.00656

0.00175

0.00275

0.003S8

0.00s75

0.00006

449.059

3.55.244

404.530

61.775

44.505

147.706

464.631

277.031

296.767

464.132

1,168.044

0.00143

0.0046s

0.00124

0.10246

0.00903

0.00494

0.00966

0.00556

0.00567

0.00296

0.00631

377.158

336.276

416.641

74.715

153.675

295.564

266.155

166.464

240.949

430.632

735.033

discharged during the year divided by

the number of these patients.

Terms relating to diagnoses

Diagnosis-4 disease or injury (or

factor that influences health status and

contact with health services that is not

itself a current illness or injury) on the

medical record of a patient.

Principal diagnosi.-The oondition

established after study to be chiefly

responsible for occasioning the

admission of the patient to the hospitrd

for care.

First-listed diagnosis-The coded

diagnosis identtied as the principal

diagnosis or listed first on the face sheet

or discharge summary of the medical

record if the principal diagnosis cannot

be identified. The number of fist-listed

diagnoses is equivalent to the munber of

discharges.

Terms relating to procedures

Procedure4 surgical or

nonsurgical operation, diagnostic

procedure, or special treatment reported

on the medical record of a patient.

Beginning with the 1991 data, all

ICD-9-CM procedure codes am used in

the NHDS. Previously selected codes,

primarily codes for miscellaneous

diagnostic and therapeutic procedures,

were not used.

All-listed procedures—The number

of procedures on the face sheet of the

medicrd record. In the NHDS a

maximum of four procedures are coded.

Rate ofprocedura—’e ratio of

the number of procedures during a year

to the number of persons in the civilian

population on July 1 of that year

determines the rate of procedures.

Demographic terms

Population-The U.S. resident

population excluding members (ofthe

Armed Forces.

Age-Patient’s age at birthiay prior

to admission to the hospital.

Geographic region—Hospitals are

classified by location in one of the four

geographic regions of the United Ststes
Advance Data No. 249 ● April 8,1994 11

that correspond to those used by the

U.S. Bureau of the Census.

Region

Northeast, . . .

Midwest. . . . .

south . . . . . . .

West. . . . . . . .

States included

Maine, New Hampshire,

Vermont, Massachusetts,

Rhode Island,

Connecticut New Yorlq

New Jersey, and

Pennsylvania

Michigan, Ohio, Illinois,

Indiana, Wiscons@

Minnesota, Iowa,

Missouri, North Dakota,

South Dakota, Nebraska,

and Kansas

Delaware, Maryland,

District of Columbia,

Vqgi@ West Vigini%

North Carolina, South

Carolina, Georgi%

Florida, Kentucky,

Temessee, Alabama,

Mississippi, Arkansas,

Louisiana, Oklahom&

and Texas

Montana, Idaho,

Wyoming, Colorado,

New Mexieo, Arizona,

Utah, Nevada,

Washington, Orego~

California, Hawaii, and

Alaska

Symbols

--- Data not available

. . . Categoty not applicable

Quantityzero

0.0 Quantity more than zero but less

than 0.05

z Quantity more than zero but lees

than 500 where numbers are

roundedto thousands

* Figure does not meet standard

of reliabilityor preoision

(see Technioal notes)

# Figure suppressedto oompiywith

confidentialii requirements
12 Advance Data No. 249 ● April 8,1994

Suggested citation Copyright information National Center for Health Statistics

Graves EJ. 1992 Summary Nationsi Hospital Ail material appearing in this report is in the Director

Discharge Survey. Advance data from vital

and health statistic no 249. Hyattsviiie,

pubiic domain and maybe reproduced or Manning Feinieib, M.D., Dr. P.IH.

Maryiand: Nationai Center for Health

copied without permission; citation as to

source, however, is appreciated. Deputy Director

Statistics. 1994. Jack R. Anderson

U.S. DEPARTMENT OF HEAL~ AND

HUMAN SERViCES

Public Health Service

Centers for Disease Oontroi end Prevention

Nationai Center for Health statistics m

6525 Seicrest Road

Hyattsvilie, Maryiand 20762
Number 250 . May 31, 1994

Advance

Data

From Vi and Health Statbtics of the CENTERS FOR DISEASE CONTROL AND PREVENTION/NationaI Center for Health StatMCS

Injury Prevention Measures in Households With

Children in the United States, 1990

by Michelle Mayer, R.N., M. P.H., Schml of Public Health, The University of North Carolina at Chapel Hill, and

Felicia B. LeClere, Ph.D., Division of Health Interview Statistics, National Center for Heatth Statistics

Introduction

As the leading cause of death

among children, injuries claim more

children’s lives annually than the next

six causes of childhood death combined

(1,2). Motor vehicle accidents are the

major cause of deaths due to injury in

childhood. In 1991, the motor vehicle

fatality rate for children ages 5–14 was

5.6 per 100,000 persons. In the same

year, the death rate for the same age

group from other accidents and adverse

effects-which includes deaths from

fires, drownings, poisonings, sufFocatiorL

firearms, and falls-was 4.6 persons per

100,000 persons (2). Injuries lead not

only to excess mortality but also to

permanent and temporary disability and

substantial economic costs. Each year,

the consequences of childhood injuries

include 30,000 permanent disabilities,

600,000 hospitalizations, and 16 million

emergency room visits (3).

Healthy People 2000, the

health-related goals set by the U.S.

Department of Health and Human

Services, acknowledges and addresses

the need for childhood injury prevention

in the United States (4). Healthy People

2000 targets reductions in injury-related

death rates and increases in individual

use of preventive devices, such as car

restraints and smoke detectors, and

expansions of injury prevention

education in schools and primary care

sites. In addition, Healthy People 2000

highlights the importance of targeting

interventions for achieving these goals

at high-risk populations. Children are

among the high-risk populations

identied for injury-related deaths due

to motor vehicle crashes, drownings,

poisonings, and residential iires.

Subgroups within each target

poptiation at greatest risk for stiering

injuries must be identied. By doing so,

interventions specifically designed to

increase the awareness and utilization of

injury prevention techniques within

these subgroups may be developed and

implemented. This process allows

resources to be devoted to decreasing

risk among those individuals, families,

and communities most vulnerable and

enhances the potential of these programs

to meet the Healthy People 20iW goals.

To target high-risk populations, the

aociodemographic correlates of injury

prevention behaviors must be identified.

Past efforts to describe the

sociodemographic characteristics

associated with increased childhood

injury risk have highlighted related

I%ctom,however, tidings vary across

studies, are not consistently signikan~

and are not often generalizable to the

nation as a whole. Factors such as

fhmily incomq mother’s marital and

employment status; educational

attaimnen~ age, race, number of

children in the household; and child’s

personality characteristics have teen

found to be associated with childhood

injury experience (5-10).

The literature on parental

knowledge and utilization of injury

prevention techniques suggests that

parents underestimate the threat posed

by childhood injuries (11–12). While the

majority of parents claim to use

prevention control measures, the

usefulness of the measures employed,

such as “being careful,” remains

questionable at best. Of those

precautions mentioned, only the parental

assessment of child safety restraints was

consistent with the true efficacy of the

approach. Evidence suggests that parents

of higher socioeconomic status were

more likely to use effective injury

+.@sm.m&

*+4 ‘%

-g

U.S. DEPARTMENTOF HEALTHAND HUMANSERVICES

~

Public Health Service

Centers for Disease Control and Prevention

?+*

>%m National Center for Health statistics ~myl= CDC
2 Advance Data No. 250 ● Mav 31,1994

prevention measures than their low

income counte~arts (12).

The current literature offers limited

information on the correlates of parental

knowledge and utilization of injury

prevention measures. This analysis uses

data from the National Health Interview

Survey (NHIS) on Injury Control and

Child Health to describe the knowledge

and use of injury prevention techniques

in households with children by selected

sociodemographic and geographic

characteristics. With these estimates, the

progress toward the Healthy People

2000 goals can be tracked as well as

aided by the identification of population

groups at high risk of injury.

Methods

This report uses data from the 1990

NHIS. The survey, performed each year

since 1957, collects demographic and

health data on the noninstitutionaliz@

civilian population of the United States

from which national estimates of

household and individual characteristics,

disease incidence and prevalence,

general health status measures, and

health services utilization can be

estimated. The interview contains two

portions each yew. the basic

questionnaire, which collects similar

information each year, and topic-specific

annual questionnaires. In 1990, the

Injury Control and Child Safety and

Health questionnaire collected data on

the household characteristics of all

children from the household. Data on

33,243 children were collected from the

respondent adult in the household.

Using SUDAAN, a SAS-based

statistical package, the injury prevention

knowledge and behavior patterns of the

household in which the sample child

resides are presented by various

sociodemographic characteristics. The

SUDAAN package estimates standard

errors, which account for the effect of a

complex, multistage sampling design

such as the one used for the NHIS (13).

The prevention measures of interest

include the utilization of restraint

devices in motor vehicles, possession of

a functional smoke detector, awareness

of poisoning-related interventions, and

use of appropriate scald prevention

techniques. Child characteristics

explored include age, gender, race, and

Hispanic origin. Children are also

classified by the attributes of their

household—including family structure,

the educational attainment of the

responsible adult in the househol~

household income, and number of

household members-as well as by

geographic characteristics of their

household—including region of the

country, residential setting, and housing

type.

The Injury Control and Child

Health Supplement questionnaire

contains data regarding the knowledge

and use of measures aimed at the

prevention of injuries due to residential

fires, scalds, unintentional poisonings,

and motor vehicle accidents. For a

number of measures, data collection

targeted only children in those age

groups for which the information was

appropriate. Poisoning prevention data

were collected for children under the

age of 10. Safety restraint includes the

use of car safety seats for those children

under 5 and seat belt use for those

children ages 5–17. All other estimates

refer to all children 17 years of age and

under.

The Technical notes portion of this

report details information regarding the

survey design, sampling procedure, and

the NHIS questionnaire document. It

also describes the weighting procedures,

the establishment of the reliability of

estimates, and the adjustment of the

standard errors required by the sampling

design. The means of determining

statistical significance are also included.

All comparisons reported in the text are

statistically significant at the 0.05 level

unless otherwise noted.

Tables 1–5 contain national

estimates of the number and percentage

of children living in households in

which various injury prevention

techniques are known and employed. In

addition to the overall estimates, the

percentage of children in these

households are shown by selected

demographic characteristics. These

percentages allow for the comparison of

injury prevention behaviors across

various groups and identm those groups

less likely to know about and use

preventive measures. Interventions

targeted for and tailored to these groups

may enhance progress toward the year

2000 objectives.

Results

Use of the household injury

prevention measures varies considerably

across measures and among various

sociodemographic groups. In general,

the use of smoke detectors and car

safety restraints exceeds the usle of scald

and poison prevention measures. The

use of prevention measures varies

consistently across race and ethnic

groups, educational level of the

responsible adult, and household income

and poverty status. For certain measures,

dMerences in use also exist by family

types, housing types, residential are%

and region.

Fire prevention

As shown in table 1, approximately

66.6 percent of respondents in

households with a child under the age of

17 claimed to have at least one

functional smoke detector in the

residence. Respondents were also asked

to identify appropriate means for testing

the smoke detector. Accurate means

include testing, going off due to smoke

andlor cooking, changing batteries,

checking the light indicator, or listening

for the low battery warning beep.

Among children under 17 years of age,

64.7 percent lived in households where

the smoke detector had been tested

appropriately. Respondents were also

asked the proximity of the detector to

the sleeping quartem. Smoke detectors

located near sleeping areas are more

likely to wake household members

during a fire. Smoke detectors were

located near sleeping areas in

households of 62.7 percent of children.

White and non-Hispanic persons

were more likely than their black and

Hispanic counterparts to have a

functional smoke detector, test it

appropriately, and have one located near

to a sleeping area. Children living in

households where the educational level

of the responsible adult was below 12

years were less likely to indicate use of

these measures than those residing in

households in which the responsible

adult had 12 or more years of education.

Likewise, household use of these
Advance Data No. 250 ● Mav 31,1994 3

Fire prevention measure

~ ~&’@:pke O-– – -0 A##priate + .“”-”--..+ NEIS sle~ing

100

[

80 -

60 -

40

2L——————

Less 5-7 7-10 10-15 15-20 20-25 25-35 35-50 50and

than 5 over

Family income (inthousands)

SOURCE National Health Interview Survey, 1990

Figure 1. Pereent of children in households using fire prevention measunx United

sites, 1990

measures increased with the income

level of the household (see figure 1).

Compared with children living with both

biological parents, children living with

their biological mother only or in some

other type of family household were less

likely to reside in households

participating in the fire prevention

measures previously descriied. Children

residing in households with six or more

members were less likely than those in

households with three to five members

or two or fewer members to be

protected by household use of fire

prevention measures.

The geographic variables examined

include housing type, residential area,

and region of the country. Housing type

was not significantly related to use of

smoke detectors. However, children

living in metropolitan statistical areas

(MSA), non-central city, were more

likely than those living in central cities

or non-metropolitan areas to live in

households taking tie prevention

measures. Likewise, those living in the

Midwest were more likely to use these

measures than those living in the

Northeastern, Southern, and Western

regions of the United States.

Scald prevention

Table 2 shows the prevalence of

scald prevention measures usage to be

much lower than that of fire prevention

measures. The scald prevention

measures examined are household hot

water temperature known, household hot

water temperature set below 125 degrees

Fahrenhei~ hot water temperature tested

appropriately, thermometer used to test

the water temperature in the last 12

months, and safe water temperature

known. Overall, 23.1 pereent of children

under 17 live in households where the

water temperature is known. Only

9.2 percent of children live in

households where the water temperature

is known to be below 125 degrees ye~

21.5 percent of respondents cited the

scalding temperature of water to be at or

above 125 degrees. There is a

discrepancy between knowledge and

action in the adoption of scald

prevention measures. Appropriate means

of testing water temperature include

using a thermometer and checking the

hot water tank setting. Only members of

the households of 17.3 percent of U.S.

children know and use these means to

test their water temperature. Only

3.2 percent of children reside in

households where the water temperature

has been tested by a thermometer in the

last 12 months.

White persons were more likely

than non-white persons to use all add

prevention meaaures examine& except

Imowing safe water temperature.

Non-Hispanic persons were more likely

to participate in these practices than

Hispanic persons. A3 with fire

prevention measures, the use of add

prevention measures increaaes with level

of education and income. Those with 12

or more years of edueation were

significantly more likely to employ these

techniques than those with less than 12

years of education. Children living in

households below the Federal poverty

level are less likely than those living at

or above this level to participate in these

preventive measures. Figure 2 depicts

the relationship between income level

and use of scald prevention measures.

Children living with their biological

parents were more likely than those

living with their biological mother only

or in other family types to be in a

household where the water temperature

is kuown, below 125 degrees, and tested

appropriately. Those households with

hvo or fewer members were less likely

than those with three to five members to

use these methods.

As with fire prevention measures,

use of scald prevention measures does

not seem to vary by housing type. Those

children living in mobile homes or other

residence types were equally likely as

those in houses, apartments, or flats to

be in a household utilizing these

measures. Only those living in MSAcentral cities were less likely than those

living in MSA-non-central cities to be in

households where the water temperature

waa known, below 125 degrees, and

tested appropriately. Those living in the

Midwest are more likely than those

living in the Northeaat, South, and West

to reside in households where the water

temperature is known. Children living in

the West were leas likely than those in

the Midwest to be in households where

the water temperature was known to be

below 125 and tested appropriately.
4 Advance Data No. 250 ● May 31,1994

~ Thermometer ~ -

~ Sa$wernperature

used

35 r

30

25

20

15

10

5

0

Less 5-7 7-10 10-15 15-20 20-25 25-35 35-50 50and

than 5 over

Family income (inthousands)

SOURCE National Health Interview Survey, 1990

Figure 2. Percent of children In households using scald prevention method= United

states, 1990

Poisoncontrolmeasure

80

60

40

20

.x--~

,x”

#x’

01 , , , m ,

Less 5-7 7-10 10-15 15-20 20-25 25-35 35-50 50and

than 5 over

Family income @ thousands)

SOURCE NationalHealthInterviewSurvey,1990

Figure 3. Percent of children in households using poison control messurss: United

SE4tes, 1990

Poison control respondenta only in households where

the sample child was below the age of

As previously stated, the poison 10. The poison control measures

control questions were asked of examined include familiarity with the

Poison Control Center, having the

telephone number of the local Poison

Control Center, and availability of

ipecac syrup in the household. These

findings are presented in table 3. While

the majority of children (74.4 percent)

lived in households in which the

respondent had heard of the Poison

Control Center, only 49.7 and

25.6 percent of children lived in

households where the number of the

Poison Control Center was known or

had ipecac on hand, respectively.

The diEerential use of poison

control measures among various

sociodemographic groups follows trends

similar to those identified in the analysis

of fire and scald prevention measures.

White persons and non-Hispanic pereons

are more likely to use these means than

their non-white and Hispanic

counterparts, respectively. Only the use

of ipecac syrup was higher among those

families with a sample child between

the ages of 14 as compared with the

other age groups. This is an especially

important findhg given that toddlers are

at greatest risk for poison-related deaths.

As with other preventive measures,

poison control measures increase with

education and income. Ae shown in

figure 3, those children with family

incomes of $50,000 per year and above

were more likely than those in income

categories below $25,000 per year to

use these measures. Similarly, those

living at or above the Federal poverty

level were more likely to use these

means. Children living in households

with their biological parents and those

in households with three to five

members were more likely to be in

households where the number to the

Poison Control Center was known and

ipecac was on hand than those children

in households of other family types and

sizes.

Children living in mobile homes

were less likely to have ipecac on hand

in the household than those living in

houses, apartments, or flats. Likewise,

those living in central cities were less

likely than those in MS& non-central

cities to participate in any of the poison

control measures examined. Those living

in non-metropolitan, non-farm

households were less likely than their

MSA-non-central city counterparts to

have ipecac on hand. With the exception

of the use of ipecac syrup in the
Advance Data No. 250 ● Mav 31,1994 5

Northeast, residents of the Midwest

were more likely to use poison control

measures than those residing in other

regions of the country.

Car safety

The analysis,shown in table 4,

demonstrates that use of car safety seats

among those children under the age of 5

is fairly prevalent. Of those children

under the age of 5, 76 percent had been

brought home from the hospital in a car

safety seat. At the time of the interview,

nearly 65 percent of the sample children

currently had a car safety seat. The

majority (59.4 percent) of the sample

children were reported to “always” use

their car safety sea~ while only a

fraction (0.7 percent) never used one.

The use of safety seats decreased with

age as older children substitute seat

belts for car seats. Infants under 1 year

were significantly more likely than those

children between the ages of 14 to

have a car seat and “always” use it.

Moreover, those children under the age

of 1 year were slightly more likely to

have been brought home from the

hospital in a car seat than their older

counterparts. Some of these ddlerences

may be due to a cohort effect with later

cohorts of children more likely to be

placed in car seats. This may be due to

increased awareness of the effectiveness

of car safety seats in reducing motor

vehicle related injuries as well as

changes in State laws as they relate to

car seat use. Those children in

households where the respondent’s seat

belt use frequency was reported as

“always” were more likely than those

children in households in which the

respondent’s use was reported as

“often, “ “sometimes,” or “never” to

have been brought home from the

hospital in a car safety seat, to presently

have a safety seat and “always” use the

safety seat.

Consistent with the other preventive

measures examined, the associations

between race, ethnicity, household

education, income, and car safety seat

use mirror the relationships previously

described between these variables and

other preventive measures. Figure 4

shows the relationship between income

level and use of car safety seats and seat

Car safety measure

~ Homeincar -- *~~n:~ %----% AJqsuse +--- +AJeV ~kw

seat r

100

So

40

20

0

Less 5-7 7-10 10-15 15-20 20-25 25-35 3S-S0 50and

than 5 over

Family imxme @ thousands)

SOURCE National Health Interview Survey, 1990

Figure4. Percentof childrenusingearsafetyseatsandseatbelts:Unitedstates,1990

belts. Children living with their

biological parents were more likely than

those living with their biological mother

only or in other family types to have a

car seat and “aIways” use it. Children

from households with two or fewer

members or six or more members were

less likely than those in households with

three to five members to have a car

safety seat and “always” use it.

The relationships between the three

geographic variables and car restraint

use is less consistent than the

relationships between these variables

and other preventive measures. Children

from families residing in MS&

non-central city households were more

likely to have a car safety seat and

“always” use it than those living in

MS& central city areas. However,

children from MS& non-central cities

were less likely than those from

non-MSA farm households to have been

brought home from the hospital in a

safety sea~ to presently have a safety

sea~ and to “always” use the safety

seat.

The frequency of seat belt use by

sample children between the ages of

5-17 is presented in table 5. Among

these childre% 60.2 percent “always”

use their seat belts. However, children

above the age of 9 are less likely to

“always” use their seat belts than their

5-9-year-old counterparts. Lower rates

of seat belt use among children may

explain the nearly tenfold difference in

motor vehicle fatality risk between

children 15–19 yeara of age and those

under the age of 10 (14). The practice

of “always” using one’s seat belt is

lower among those children who are

non-white, as it is among Hispanic

children. The percent of children always

using their seat belt increases with the

educational level of the responsible

adult in the househol~ the income level

of the family, and the frequency with

which the respondent adult uses his/her

seat belt. Children living in households

where both biological parents are

present are more likely than those in all

other family types to “always” use their

seat belt. Children living in MS&

non-central city areas and those residing

in the Midwest are more likely than

those living in other residential areas

and regions to “always” wear their seat

belt.

Dkcussion

The results presented here indicate

that certain sociodemographic
6 Advance Data No. 250 ● Mav 31,1994

characteristics are associated with the

knowledge and use of household

preventive measures. Specifically, these

variables include race, ethnicity,

educational attainment of responsible

adult, family income level, and poverty

status. In addition, family structure and

size seems to be associated with most

preventive measures, with those children

from intact families and those with

families of three to five members being

more likely to be in households

adopting preventive practices than

children from other family types and

sizes. Of the geographic variables

examined, only region and residential

area have an association with any of the

preventive measures examined. Housing

type failed to be associated with most

measures. This is especially interesting

in light of the finding in a previous

study that mobile home residents were

at increased risk for fire-related

mortality; yet, they experienced less of a

protective effect from smoke detectors

than those living in other housing types

(15). In that study, the presence of a

smoke detector in a mobile home had

less Mluence on the likelihood of a

death resulting from a fire in the

residence than in other housing types.

This report corroborates this finding and

suggests that this increased risk may be

due to some other factor than smoke

detector utilization.

Data from the NHIS questionnaire

on Injury Control and Child Health and

Safety provide timely national estimates

of the prevalence of household adoption

of injury prevention measures. While the

majority of households utilize the fire

prevention and car safety measures

examined, increased adoption of these

behaviors remains necessary to reach the

year 2000 objectives. Only a smrdl

percent of children live in households

that use scald prevention and poison

control techniques. This report provides

useful insight into the association

between the knowledge and use of

household injury prevention measures

and sociodemographic characteristics for

those households with children. The

findings identify populations at risk and

serve as a useful guide for the

classification of populations with limited

knowledge and use of injury prevention

measures. Future injury reduction

interventions should incorporate this

information into the design and

implementation of their programs.

A public use data file based on the

1990 NEHSInjury Control and Child

Health questionnaire is available.

Information regarding this data file may

be obtained by writing to the Systems

and Programming Branch, Division of

Health Interview Statistics, 6525

Belcrest Road, Hyattsville, MD 20782.

References

1.

2.

3.

4.

5.

6.

7.

8.

9.

Dershewitz~ WilliamsonJW.Prevention of childhood householdinjuriex A controlled clinical trial. Am J

Pub Health 67:1148-53.1977.

National Center for Health Statistics.

Advance report of final mortality statistics, 1991. Monthly vital statistics

repoti, VOI42 no 2, suppl. Hyattsville,

Maryland Public Health Service. 1993.

Rodriguez JG. Childhood injuries in

the United States A priority issue. Am

J Dis Child 144:625-6.1990.

Public Health Service. Healthy People

2000 National Health Promotion and

Disease Prevention Objectives. Washington, DC U.S. Department of Health

and Human Services. 1990.

McCormick MC, Shapiro S, Starlield

BH. Injury and its correlates among

l-year-old children. Am J Dis Child

135:159-63.1981.

Larson CP, Pleas B. Risk factors for

injury in a 3-year-old birth cohort. Am

J Dis Child 1421052–7. 1988.

Wickhmd & Moss S, Floyd F. E&cts

of maternal education, age, and parity

on fatal infant accidents. Am J Pub

Health 741150-52.1984.

Horwitz SM, Morgenstem H, DiPietro

L, Morrison CL. Determinants of pediatric injuries. Am J Dis Child

142605–11. 1988.

Wadsworth J, Burnell J, Taylor B,

Butler N. Family type and accidents in

preschool children. J Epid Community

Health 36:3141983.

10. Nersesian WS, Petit MR, Shaper R,

Lemieux D, Naor E. Childhood death

and poverty A study of all childhood

deaths in Maine, 1976-80. Pediatrics

75:41–50. 1985.

11. Halperin SF, Bass ~ Mehta KA.

Knowledge of accident prevention

among parents of young children in

nine Massachusetts towns. Public

Health Rep 98:54*53. 1987.

12. Eichelberger MR, Gotshall CS, Feely

HB, Harstad P, Bowman LM. Parental

attitudes and knowledge of child safety.

Am J Dis Child 144714-20.1990.

13. Shah BY Barnwell BG, Hunt PN,

LaVange LM. SUDAAN users’

msn@ Release 6.0. Research Triangle Park, NC Research Triangle

Park Institute. 1992.

14. Rosenberg ML, Rodriguez JG, Chorba

TL. Childhood injuries Where we are.

Pediatrics Suppk1084-91. 1990.

15. Runysn CW, Bsngdiwala S1, Linzer

~ Sacks JJ, Butts J. Risk factors for

fatal residential fires. NEJM

32185%3. 1992.

16. Adams PF, Benson V. Current estimates for the National Health Interview Survey. National Center for

Health Statistics. VM Health Stat

10(181). 1991.
Advance Data No. 250 ● May 31,1994 7

Table 1. Percent (and standard error) of children living In households using specified fire prevention measuresj by selected

soclodemographic characteristics: United States, 1990

All Rmdior@ smoke

children

Smoke decfor

detectorin the Smoke defectcw

Cheracferistic

kxxded new

ages 0-17 househokl fesfed q)mptiaw --

T~l . . . . . . . . . . . . . . . . . . . . . .

Children’scharacteristics

Race:

While. . . . . . . . . . . . . . . . . . . . . .

Non-whiie . . . . . . . . . . . . . . . . . .

Hispanicorigin:

Non-Hispanic. . . . . . . . . . . . . . . . .

Hispanic . . . . . . . . . . . . . . . . . . .

Age

Lasethan l year . . . . . . . . . . . . . .

l-4yeara . . . . . . . . . . . . . . . . . .

5+tyears . . . . . . . . . . . . . . . . . . .

10yearsoroldar . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . .

Householdcharacterietics

Responsibleadult’seducation

Laaathsn 12years . . . . . . . . . . . . .

12yeat3 . . . . . . . . . . . . . . . . . . . .

Morethan 12years . . . . . . . . . . . . .

Femilyatruotur+x

Biologicalmotherendfather . . . . . . .

Siologicalmotheronly . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . .

Familysizw

2orfawerparsorra . . . . . . . . . . . . .

2-6peraons . . . . . . . . . . . . . . . . .

6ormore~raona . . . . . . . . . . . . . .

lncom8

Lesathsn$5,000 . . . . . . . . . . . . . .

$WOQ-$6,888 . . . . . . . . . . . . . . . .

$7XW+W99....... . . . . . . . . .

$K@oo-$14,889 .. . . .. . . . . . . . .

$15,000-$19,889 . . . . . . . . . . . . . .

$20,000+24,989 . . .. . . . . . . . . . .

$25@o-$34,999.. .. . . . . . . . . . .

$35,000+48,W8 . . . . . . . . . . . . . .

@saterthan $50,000. . . . . . . . . . . .

Poverystatus

Atorabovethepovertylevel . . . . . . .

Selowthepoverlylavel . . . . . . . . . .

Geogrephiccharacterietics

HousingtypEx

House,apartnrent,flat . . . . . . . . . . .

Mobilehome . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . .

Residentialarea

Mwoentralclty . . . . . . . . . . . . . .

MSA, non-rxmtraloity. . . . . . . . . . . .

Non-MSA,non-farm . . . . . . . . . . . . .

Non-MSA,famr . . . . . . . . . . . . . . .

Regiom

Nor&heeet. . . . . . . . . . . . . . . . . . .

Midwest. . . . . . . . . . . . . . . . . . . .

south . . . . . . . . . . . . . . . . . . . . .

weat . . . . . . . . . . . . . . . . . . . . .

Number

(inthousands) Pelcent (stamkd error)

64,651

52,062

12,580

56,012

8,640

4,075

15,010

16,366

27,201

=,066

31,565

8,666

23,640

31,736

45,279

10,318

8,646

2,693

50,439

11,319

2,697

1,530

2,467

4,865

5,567

4,697

9,872

11,372

12,637

49,550

I o,45a

133,240

3,617

794

19,211

31,176

13,606

656

11,602

15,633

22,725

14,291

66.6

66.2

Su.1

66.4

54.7

67.8

67.7

67.6

65.1

66.6

66.6

50.3

63.9

73.8

68.3

56.1

54.0

86.7

63.0

55.7

54.8

52.6

54.6

57.1

61.8

64.4

71.9

76.9

77.5

71.8

52.5

56.7

66.3

56.1

64.5

68.6

63.8

59.3

70.2

73.6

62.2

62.9

(0.55)

(0.60)

(1.17)

(0.57)

(1.40)

(1.17)

(0.73)

(0.73)

(0.64)

(0.61)

(0.62)

(1.38)

(0.64)

(0.61)

(0.53)

(1.10)

(1.21)

(1.62)

(0.52)

(1.44)

(2.44)

(3.24)

(2.36)

(1.61)

(1.63)

(1.49)

(1.11)

(0.90)

(0.80)

(0.55)

(1.29)

(0.54)

(2.56)

(4.51)

(0.91)

(0.70)

(1.53)

(3.57)

(1.02)

(1.12)

(0.95)

(1.18)

64.6

66.2

56.7

65.6

528

65.7

66.0

65.7

53.3

64.6

64.8

46.5

62.3

71.9

67.5

64.1

523

64.2

67.1

E4.4

53.7

51.8

52.6

55.9

60.1

63.1

69.9

75.1

74.9

63.9

51.5

64.8

65.5

56.0

627

67.6

61.6

57.3

66.3

71.9

60.6

eQ.3

(0.55)

(0.60)

(1.18)

(0.57)

(1.42)

(1.2Q)

(0.74)

(0.74)

(0.65)

(0.62)

(0.52)

(1.41)

(0.25)

(0.52)

(0.60)

(1.12)

(1.23)

(1.55)

(0.53)

(1.46)

(245)

(222)

(2.39)

(1.63)

(1.67)

(1.47)

(1.13)

(0.S3)

(0.SS)

(0.55)

(1.40)

(0.54)

(2.52)

(4.51)

(0.91)

(0.71)

(1.55)

(3.70)

(1.02)

(1.15)

(0.84)

(1.20)

627

64.7

54.5

64.8

48.2

63.2

63.8

63.8

61.4

628

627

45.6

58.9

70.3

65.7

61.6

48.5

622

65a

51.6

48.9

49.1

46.0

53.1

87.8

60.1

67.1

728

74.7

6S.0

46.0

62.8

63.5

53.7

58.4

66.2

58.6

55.8

64.6

59.7

58.0

58.3

(0.56)

(0.60)

(1.20)

(0.56)

(1.41)

(1.21)

(0.75)

(0.73)

(0.67)

(0.62)

(0.62)

(1.39)

(0.64)

(0.63)

(0.61)

(1.14)

(1.20)

(1.57)

(0.54)

(1.45)

(2.48)

(3.17)

(2U)

(1.63)

(1.61)

(1.52)

(1.15)

(0.85)

(0.83)

(0.56)

(1.41)

(0.65)

(2.54)

(4.51)

(0.84)

(0.71)

(1.51)

(4.00)

(1.12)

(1.13)

(0.85)

(1.16)

llndudeschlldmwith unknownfanriiyime andorherm-ksingdera
8 Advance Data No. 250 ● May 31,1994

Table 2. Percent (and standard error) of children In households taking scald prevention measures, by selected sociodemographic

characteristics: United States, 199f)-Con.

All 7?rerrrromeferused to

children

Tmperafure at

ffiown hot water Hot water temperature Water temperature test wafer temperature

CharacterMm

which water scalds

ages 0-17 tempamture set below 125 degrees tested appropriately in the last 12 months known by respondent

Totell . . . . . . . . . . . . . . . . . . .

Child characteristics

Race

Whiie . . . . . . . . . . . . . . . . . . .

Non-VVhiie . . . . . . . . . . . . . . .

Hispanic origin

Non-Hispanic . . . . . . . . . . . . . .

Hispanic . . . . . . . . . . . . . . . . .

Age

Less fhanlyeer . . . . . . . . . . . .

I+yeam . . . . . . . . . . . . . . . .

5-9yaaE . . . . . . . . . . . . . . . .

Morethen 10yeara . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . .

Household characteristics

Responsible adult’s education:

Leeathan 12yeers . . . . . . . . . .

12yeare . . . . . . . . . . . . . . . . .

Morethan 12yeare . . . . . . . . . .

Family structur&

Biological mother and father . . . .

6iolcgical mother only . . . . . . . .

Other. . . . . . . . . . . . . . . . . . .

Family size

2orfewer persons . . . . . . . . . .

3-5 parsons . . . . . . . . . . . . . .

6ormore persons . . . . . . . . . . .

Income

Lessthan $5,000 . . . . . . . . . . .

$5,000-$6,299 . . . . . . . . . . . . .

$7J3W-$%999.. . . . . . . . . . . .

$10,00G14,989 . . . . . . . . . . . .

$15,000-$19,998 . . . . . . . . . . .

$20,000-$24,888 . . . . . . . . . . .

$25,000+4,689 . . . . . . . . . . .

$34,999+9,999... . . . . . . . .

Greater than $60,000. . . . . . . . .

Pove~ status

Atorabove thepovarty level. . . .

Below the poverty level . . . . . . .

Geographic characteristics

Number (in

64,651

52,061

12,690

56,012

8,640

4,075

15,010

18,366

27,201

33,066

31,665

6,666

23,640

31,736

45,279

10,318

8,668

2,683

50,439

11,319

2,697

1,530

2,467

4,e65

5,667

4,697

9,872

11,372

12,667

49,550

10,466

60,240

3,617

794

19,211

31,176

13,606

656

11,602

15,633

22,725

14,291

Percent (standard error)

23.1

2e.o

11.0

24.9

11.0

20.6

21.7

24.1

23.5

23.2

22.9

12.2

20.7

26.1

27.2

11.5

15.2

14.0

24.3

20.0

9.5

10.5

13.3

18.4

19.0

23.6

26.0

30.0

30.6

26.4

13.6

22.9

26.6

17.4

16.3

25.0

27.6

32.7

23.2

26.6

22.2

20.4

(0.46)

(0.54)

(0.66)

(0.50)

(0.77)

(1.04)

(0.62)

(0.66)

(0.55)

(0.52)

(0.63)

(0.91)

(0.65)

(0.64)

(0.56)

(0.69)

(0.80)

(0.96)

(0.47)

(1.36)

(1.24)

(1.60)

(1.85)

(1.27)

(1.26)

(1.40)

(1.09)

(0.99)

(0.92)

(0.52)

(0.91)

(0.47)

(1.90)

(3.21)

(0.61)

(0.61)

(1.30)

(4.55)

(0.96)

(0.99)

(0.76)

(1.03)

9.2

10.2

5.3

9.6

5.2

9.9

10.0

9.8

6.3

9.2

9.3

5.2

7.7

11.6

10.9

5.2

5.5

6.5

9.6

6.4

4.5

4.0

4.5

7.1

7.4

9.9

11.1

12.4

11.6

10.6

5.2

9.2

10.6

6.2

6.4

10.1

11.1

10.8

9.1

10.8

9.0

6.2

(0.29)

(0.34)

(0.46)

(0.32)

(0.57)

(0.76)

(0.47)

(0.43)

(0.34)

(0.33)

(0.34)

(0.60)

(0.38)

(0.44)

(0.37)

(0.43)

(0.50)

(0.67)

(0.28)

(0.62)

(0.87’)

(1.04)

(0.95)

(0.83)

(0.63)

(0.69)

(0.75)

(0.75)

(0.65)

(0.34)

(0.54)

(0.29)

(1.28)

(2.32)

(0.36)

(0.42)

(0.76)

(2.31)

(0.64)

(0.65)

(0.48)

(0.56)

17.3

19.7

7.1

18.8

7.2

15.1

16.4

18.2

17.5

17.5

17.0

7.9

15.5

21.4

20.7

7.6

11.0

9.4

18.1

15.7

6.3

7.0

7.6

13.2

14.4

17.1

19.5

22.6

23.4

20.0

9.0

17.1

22.2

10.1

11.1

19.2

21.2

26.8

17.6

19.2

17.1

15.0

(0.44)

(0.51)

(0.53)

(0.48)

(0.66)

(0.90)

(0.66)

(0.64)

(0.51)

(0.49)

(0.50)

(0.71)

(0.62)

(0.61)

(0.64)

(0.55)

(0.69)

(0.63)

(0.43)

(1.29)

(1.06)

(1.40)

(1.31)

(1.13)

(1.18)

(1.21)

(1.03)

(0.94)

(0.65)

(0.50)

(0.79)

(0.44)

(1.87)

(2.60)

(0.52)

(0.57)

(1.30)

(4.23)

(0.93)

(0.95)

(0.71)

(1.01)

3.2

3.6

1.6

3.4

2.0

3.5

3.6

3.3

29

3.2

3.2

1.4

3.0

3.9

3.7

1.3

3.2

1.7

3.3

3.1

2.4

1.5

1.5

2.0

2.5

2.5

3.2

4.6

4.6

3.7

2.0

3.2

3.8

2.9

2.8

3.4

3.2

5.6

3.9

3.9

2.8

2.6

(0.15)

(0.17)

(0.26)

(0.16)

(0.36)

(0.51)

(0.26)

(0.23)

(0.19)

(0.17)

(0.17)

(0.27)

(0.26)

(0.23)

(0.19)

(0.23)

(0.39)

(0.37)

(0.16)

(0.46)

*(0.73)

●(0.63)

*(0.49)

(0.45)

(0.52)

(0.49)

(0.39)

(0.42)

(0.42)

(0.18)

(0.32)

(0.15)

(0.75)

●(1.31 )

(0.26)

(0.23)

(0.28)

*(1 .64)

(0.37)

(0.35)

(0.23)

(0.26)

21.5

21.7

20.9

220

16.4

24.1

23.2

22.2

19.8

20.9

22.1

i 5.5

19.2

26.1

22.3

21.1

18.4

20.4

21.9

20.1

16.4

18.4

21.9

20.2

19.8

21.6

22.8

26.1

26.6

23.1

18.8

21.8

15.9

24.4

21.8

22.4

19.0

23.1

21.6

22.1

19.6

23.9

(0.44)

(0.48)

(0.93)

(0.47)

(1.07)

(1.03)

(0.63)

(0.67)

(0.51)

(0.48)

(0.52)

(1.01)

(0.65)

(0.59)

(0.52)

(0.92)

(0.93)

(1.12)

(0.44)

(1.27)

(1.59)

(2.22)

(2.05)

(1.26)

(1.22)

(1.35)

(1.03)

(0.95)

(0.95)

(0.49)

(1.02)

(0.46)

(1.39)

(3.92)

(0.75)

(0.59)

(1.06)

(4.98)

(0.88)

(0.95)

(0.70)

(1.05)

Housing type

House, apartment, flat . . . . . . . .

Mobile home . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . .

Residential area

MSA, central city . . . . . . . . . . .

MSA, non-central city. . . . . . . . .

Non-MSA, non-fsrm. . . . . . . . . .

Non-MSA, farm . . . . . . . . . . . .

Region

Northeast . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . .

West. . . . . . . . . . . . . . . . . . .

1l~l~d~~ ~hil,j~~ ~ unkn~~ in~me and other missing da
Advance Data No. 250 ● May 31,1994 9

Table 3. Percent (and standard error) of children In households knowledgeable about polaon prevention measures, by aalected

soclodemographlc characterfstirx United States, 1990

All

children Aware of the PoiskrnGmtd Center Ipwao k~t in the

underage 10 PoisonControlCenter rrumfw availabb household

T~i . . . . . . . . . . . . . . . . . . . . . . . . . . .-,

Chitdcharaoteriatica

Raow

While . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-whiie . . . . . . . . . . . . . . . . . . . . . . . . . .

Hispanio origin

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . .

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age:

Lessthan l year . . . . . . . . . . . . . . . . . . . . . .

l-4yaars . . . . . . . . . . . . . . . . . . . . . . . . . .

-years . . . . . . . . . . . . . . . . . . . . . . . . . .

sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . .

Household characteristics

Responsible aduit’s edu~.orx

Leaathen 12yeara . . . . . . . . . . . . . . . . . . . .

12yeara . . . . . . . . . . . . . . . . . . . . . . . . . . .

Morethan 12years . . . . . . . . . . . . . . . . . . . .

Familyatruotura

Biologicalmotharandfather . . . . . . . . . . . . . .

Biologioalmotheroniy . . . . . . . . . . . . . . . . . .

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Family si=

2orfewerpscma. . . . . . . . . . . . . . . . . . . .

3-6pxs0na . . . . . . . . . . . . . . . . . . . . . . . .

6ormoreperaons . . . . . . . . . . . . . . . . . . . . .

hwOl-nw

Leaethan$5,000 . . . . . . . . . . . . . . . . . . . . .

$WW+W88...... . . . . . . . . . . . . . . . . .

$7,000-$9,888 . . . . . . . . . . . . . . . . . . . . . . .

$lo,oofJ-14,338 . . . . . . . . . . . . . . . . . . . . . .

$15,000-$19,893 . . . . . . . . . . . . . . . . . . . . .

$20,0Q0-$24,388 . . . . . . . . . . . . . . . . . . . . .

S25,000-S34,388 . . . . . . . . . . . . . . . . . . . . .

$’34,398-$49,388 . . . . . . . . . . . . . . . . . . . . .

Gmaterfhan$50,000 . . . . . . . . . . . . . . . . . . .

Poverty stew

AtOrabovethapovertykrvel . . . . . . . . . . . . . .

Selowthepoverlylavel . . . . . . . . . . . . . . . . .

Number @

thousands)

37,450

30,277

7,173

32,307

5,143

4,075

15,010

18,366

19,167

18,233

4,925

13,633

18,649

27,179

5,541

4,f3S2

1,417

28,638

6,344

1,765

860

1,501

3,021

3,412

2,719

5,637

6,465

6,873

28,342

6,518

34,712

2,342

397

11,350

18,051

7,697

352

6,301

6,808

13,034

8,607

Peroent(atarx&l error)

74.4

76.8

64.3

78.1

51.3

73.8

74.0

74.9

74.6

74.2

52.9

74.0

81.1

77.3

73.8

53.7

76.0

76.7

63.5

638

71,1

6a.1

67.5

71.7

75.6

60.1

S3.8

82.0

78.2

64.4

74.4

76.7

67.8

68.6

78.4

78.0

36.3

73.2

32.7

73.3

66.6

(0.55)

(0.80)

(1.35)

(0.55)

(1.57)

(1.06)

(0.71)

(0.64)

(0.64)

(0.67)

(1.66)

(0.89)

(0.61)

(0.59)

(1.26)

(1.47)

(1.68)

(0.54)

(1.69)

(2.60)

(2.76)

(2.65)

(1.87’)

(1.81)

(1.62)

(1.20)

(0.88)

(0.97)

(0.54)

(1.50)

(0.58)

(1.87)

(4.47)

(f.02)

(0.72)

(1.42)

(3.68)

(1.24)

(0.86)

(0.86)

(1.24)

49.7

53.3

34.1

53.0

28.0

47.7

49.6

50.2

48.6

48.7

26.6

45.7

58.1

53.9

4.2

31.7

44.6

51.8

40.7

34.8

35.3

38.4

38.4

42.8

48.5

56.9

62.2

58.9

55.3

34.9

49.9

48.0

40.2

43.1

53.9

48.3

54.4

53.0

58.7

428

47.0

(0.71)

(0.79)

(1.34)

(0.76)

(1.38)

(1.28)

(0.36)

(0.80)

(0.73)

(0.s4)

(1.64)

(1.06)

(0.63)

(0.73)

(1.50)

(1.34)

(2.05)

(0.72)

(1.81)

(2.57)

(3.23)

(2.69)

(1.83)

(1.87)

(1.87)

(1.42)

(1.34)

(1.29)

(0.75)

(1.47)

(0.71)

(2.63)

(5.26)

(1.01)

(0.89)

(1.85)

(5.27)

(1.35)

(1.33)

(1.27)

(1.41)

25.6

28.7

12.4

27.9

10.9

22.8

27.6

24.5

25.6

25.5

8.1

19.8

34.7

26.6

18.1

11.4

18.1

27.4

18.7

10.8

12.6

15.1

14.3

20.9

20.6

28.0

34.7

38.5

28.9

12.9

26.0

19.2

24.6

20.2

28.7

23.3

36.7

23.2

28.5

21.4

24.8

(0.58)

(0.66)

(0.87)

(0.64)

(0.91)

(1.11)

(0.74)

(0.63)

(0.66)

(0.69)

(0.80)

(0.77)

(0.81)

(0.70)

(1.M)

(0.97)

(1.54)

(0.64)

(1.23)

(1.56)

(2.56)

(2.05)

(1.26)

(1.57)

(1.52)

(1.26)

(1.33)

(1.31)

(0.436)

(0.36)

(0.58)

(2.16)

(4.55)

(0,85)

(0.78)

(1,54)

(4.56)

(1.21)

(1.27)

(0.33)

(1.25)

Geographic ohareoteriatioa

Housing ty~

Houae,apartment,flat . . . . . . . . . . . . . . . . . .

Mobilehorna . . . . ... . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Raaideti.alaraz

MSA,centraloity . . . . . . . . . . . . . . . . . . . . .

MSA,non-cantralcily . . . . . . . . . . . . . . . . . . .

Non-MSA,non-farm . . . . . . . . . . . . . . . . . . . .

Non-MSA,fenn . . . . . . . . . . . . . . . . . . . . . .

Region

NoWwaat. . . . . . . . . . . . . . . . . . . . . . . . . .

Miiest . . . . . . . . . . . . . . . . . . . . . . . . . . .

south . . . . . . . . . . . . . . . . . . . . . . . . . . . .

west . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

llmludasohiirenvAUrunlav-wrinonnaandothermissingdara.
Table 4. Paroent of children under age 5 ueing eelaotad oare safety praoautlona, by seleoted sociodemographic characterietiw United States, 1990

All Brought home rl-om

children hospifal in car

Charaoterkhc

Possessing a oar Ssfefy seat use r%equencyl

under age 5 Ssrbty seat seat at time of survey Never sometimeehften Afways

Number (in

thousands)

19,064

15,387

3,697

16,355

2,729

4,075

15,010

9,766

9,317

2,550

6,949

9,463

13,775

2,596

2,711

766

15,319

2,978

1,032

516

76a

1,592

1,763

1,360

3,047

3,163

3,296

Peroant (standard error)

64.6 (0.62) 0.7 (0.09) 4.4 (0.23) 59.4

61.9

48.9

61.7

45.8

78.6

54.2

58.6

60.0

40.4

56.3

67.4

63.3

46.9

51.7

50.3

61.9

49.2

43.3

46.1

48.1

49.6

56,2

57.7

64.3

66.9

69.6

(0.65)

(0.73)

(1.36)

(0.70)

(1.66)

(0.99)

(0.71)

(0.63)

(0.65)

(1.79)

(1.04)

(0.83)

(0.73)

(1.56)

(1.53)

(2.45)

(0.69)

(1.69)

(2.60)

(3.63)

(2.93)

(2.12)

(0.97)

(2.13)

(1.46)

(1.32)

(1.27)

76.0

76.3

66.3

76.3

61.9

79.1

75.1

76.1

75.7

61.5

74.0

81.9

76.6

72.7

64.7

70.7

77.6

67.9

70.5

69.4

70.7

69.1

76.6

76.5

61.6

64.3

62.7

Totalz . . . . . . . . . . . . . . . . . . . (0.59)

Child charaoferiatlc=s

Race

Whtie . . . . . . . . . . . . . . . . . . .

Non-white . . . . . . . . . . . . . . . .

Hispanic origirx

Non-l-liapani c . . . . . . . . . . . .

Hispanic . . . . . . . . . . . . . . . . .

Age:

Lessthan l year . . . . . . . . . . . .

l-4 yeara . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . .

Household charaoteriati=

Responsible adult’e education:

Lessthan 12years . . . . . . . . . .

12years . . . . . . . . . . . . . . . . .

Morethan 12yeam . . . . . . . . . .

Family structure

Biological mother and father . . . .

Biological mother only . . . . . . . .

Other . . . . . . . . . . . . . . . . . . .

Family size

2orfewer persons . . . . . . . . . .

3-5peraons . . . . . . . . . . . . . .

6ormore persons . . . . . . . . . . .

Income

Lessthan $5,0~ . . . . . . . . . . .

$5,000-$6,399 . . . . . . . . . . . .

$7,0W$9,W . . . . . . . . . . . . .

$10,000-14,999 . . . . . . . . . . . .

$15,000-$19,999 . . . . . . . . . . .

$20,000-$24,999 . . . . . . . . . . .

$25,000+ 4,9W . . . . . . . . . . .

$34,969-$49,969 . . . . . . . . . . .

Greater than$50,000. . . . . . . . .

(0.24)

(0.59)

(0.55)

(1.40)

66.6

56.5

(0.70)

(1.32)

0.7

0.9

(0.10)

(0.25)

3.9

6.5

(0.24)

(0.75)

(0.67)

(1,71)

0.6

1.5

(0.08)

(0.40)

4.0

6.9

(0.60)

(1.65)

66.3

64.4

(0.34)

(0.27)

(0.94)

(0.70)

0.4

0.8

*(0. I 8)

(0.11)

2.2

5.0

(1.02)

(0.66)

81.5

60.0

4.3

4.4

(0.29)

(0.34)

63.9

65.4

(0.60)

(0.63)

0.6

0.8

(0.11)

(0.15)

(0.72)

(0.77)

7.9

4.6

3.3

(0.79)

(0.37)

(0.29)

49.7

61.7

71.4

(1.81)

(1.00)

(0.80)

1.3

0.7

0.6

(0,35)

(0.14)

(0.12)

(1.61)

(0.95)

(0.71)

(0.11)

(0.29)

*(o. 17)

3.6

5,2

6.5

(0.25)

(0.65)

(0.71)

(0.65)

(1.62)

(1.49)

67.9

63.1

59.0

(0.70)

(1.55)

(1.58)

0.7

1.0

0.4

*(0.62)

(0.10)

(0.23)

3.9

4.1

6.0

(1.00)

(0.24)

(0.66)

(2.34)

(0.62)

(1.66)

55.7

66.7

56.2

(2.43)

(0.67)

(1.68)

1.4

0.7

0.7

6.4

7.2

7.3

5.6

7.0

6.4

4.5

3.0

2.4

(1.02)

(1.57)

(1.52)

(0.87)

(0.97)

(0,95)

(0.52)

(0.50)

(0.39)

1.1

1.4

1.0

1.1

1.2

0.9

0.5

0.6

0.5

*(0.45)

●(0.86)

*(0.48)

*(0.43)

*(0.39)

*(0.39)

*(0.18)

*(0,21)

*(0.19)

(2.46)

(3.66)

(2.93)

(1.90)

(1.60)

(1.96)

(1.30)

(1.14)

(1.16)

51.0

55.1

56.3

56.3

64.3

65.0

69.5

72.6

72.7

(2.70)

(3.92)

(2.97)

(2.17)

(1.64)

(2.09)

(1.40)

(1,26)

(1.24)
Poverty status

At or above the poverty level.... 14,231 80.1 (0.6t)

Below the poveriy level.......

59.0

3,473 66.7

(0.88) 0.6

(1.45)

(0.10)

53.3

4.0

(1.49) 1.1

(0.25) 84.3

(0.27) 6.5

(0.71)

(0.61) 46.6 (1.45)

Household respondent’s seat belt use

frequency

Never........... ..m. o.o 1,380 77.0

B0metimee40fIen...... .. m..

(2.03) 82.9

4,346 76.9

(2.08) 3.1

(1.08)

(0.88) 6.6 (1.08) 51.0

Nays..................

88.0 (t.18) 0.7 (0.21)

(2.08)

10,825 89.9 (0.52) 77.1

10.0

(0.70) 0.5

(0.70) 65.2

(0.10) 2.4

(1.26)

(0,23) 74.0 (0.73)

Geographic oharacterietksj

Housing type

House, apartment, fiat........ 17,894 75.9

Mobiehoma .,.... .. o.....

(0.61) 84.4

1,195 77.4

(0.83) 0.6

(2,23)

(0.09) 4.4 (0.24) 59.3

Other...

87.9 (2.17) 1.3 *(0.47)

(0.65)

................ 198 74.9 (5.00)

4,8 (1.00) 61.7

Residential em

~.6 (5.59) 2,6

●(2.76) 1.9

(2.40)

*(1.32) 58.1 (5.65)

MS&oentral city........... 6,121 7t.o (1.15)

MSA, non-cetirdc~. .,......

80.1

9,071 78.5

(1.10) 1.0

(0.88)

(0,20) 4.9 (0.41) 54.1

Non-MSA, non.farm..........

88.3 (0.87) 0.5 (0.11)

(1.11)

3,741 77.6 (1,37)

3.5 (0.31) 82.1

Non-MSA, fad............

67.1 (1.52) 0.7 (0.18)

(0.80)

151 79.4 (4,15)

5.5 (0.85) 80.9

Region:

81.3 (2.95) 0.0 (0.00) 6.8

(1.71)

●(2.17) 74.5 (2.96)

Nofihe~t................ 3,548 70.2

Midwest.................

(1.44) 84.8 (1.48) 0.7 *(0.23)

4,556 82,3 (1.05)

3.7 (0.49) 80.2

Sotih........... ..m....

86.3 (1.23) 0.7 (0.17)

(1.47)

6,570 75.7 (1.02)

4.4 (0.39) 61.2

West............... ..mm

83.6 (1.06) 0.9 (0,19)

(1.25)

4,412 74.4 (1.32) 84.5

4.7

(1,29)

(0.40)

0.4

58.0

*(0.12)

(1.08)

4.6 (0.80) 53.2 (1.45)

1~dudes children in hw%eholds without care or where ohild dow not rkle in

e car.

%dudeetiildmm unkminoomeen.j othwmlseingdata
12 Advance Data No. 250” May 31,1994

Table 5. Percent {and standard error) of children ages 5 and over using safety belts, by selected sociodemogrsphlc characteristic=

United States, 1990

All Seat belt use rhqusncyl

children

ToM ages 5--17 Never Scmatimesfoften Always

Tota12 . . . . . . . . . . . . . . . . . . . . . . . .

Number (in

thousands) Percent (standard error)

45,567 4.5 (0.24) 20.7 (0.46) 60.2 (0.56)

(0.84)

(1.31)

(0.61)

(1.57)

(0.86)

(0.73)

(0.67)

(0.87)

(1.37)

(0.62)

(0.70)

(0.88)

(1.16)

(1.26)

(1.30)

(0.59)

(1.45)

(2.75)

(2.95)

(2.74)

(1.75)

(1.69)

(1.80)

(1.25)

(1.07)

(1.00)

(0.61)

(1.39)

(1.57)

(0.97)

(0.55)

(0.57)

(2.55)

(5.02)

(1.04)

(0.77)

(1.47)

(5.48)

(1.15)

(1.04)

(1.04)

(1.38)

Child Charactarietics

RacO

Whiie . . . . . . . . . . . . . . . . . . . . . . . .

Non-Whtie . . . . . . . . . . . . . . . . . . . .

Hispanic origin

Non-Hispanic . . . . . . . . . . . . . . . . . . .

Hispanic . . . . . . . . . . . . . . . . . . . . . .

Age

5-9 yeara . . . . . . . . . . . . . . . . . . . . .

10years oroIder . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . .

36,674

8,892

4.3

5.2

4.1

6.9

3.3

5.4

4.7

4.3

(0.25)

(0.54)

19.3

26.3

(0.50)

(0.97)

62.5

50.4

38,657

5,910

(0.25)

(0.77)

20.0

25.1

(0.47)

(1.34)

61.1

53.4

16,366

23,573

(0.26)

(0.32)

17.5

22.9

(0.51)

(0.57)

66.3

55.4

23,319

22,248

(0.28)

(0.29)

21.3

20.1

(0.54)

(0.52)

59.4

60.9

Household characteristics

Responsible adult’s education

Laeathan 12yeare . . . . . . . . . . . . . . .

12yeare . . . . . . . . . . . . . . . . . . . . . .

Morethan 12years . . . . . . . . . . . . . . .

Family atructurw

Biological motherandfather . . . . . . . . .

Eliologicalrnotherorrl y . . . . . . . . . . . .

Other. . . . . . . . . . . . . . . . . . . . . . . .

Family siax

2orfewerperacns . . . . . . . . . . . . . . .

3-5 persons . . . . . . . . . . . . . . . . . . .

6ormoreperxxrs.. . . . . . . . . . . . . . .

Income

Leeethan$5,000 . . . . . . . . . . . . . . . .

$5)0-,999 . . . . . . . . . . . . . . . . . .

$7?OM,999 . . . . . . . . . . . . . . . . . .

$10,00G14,999 . . . . . . . . . . . . . . . . .

$15,000+19,889 . . . . . . . . . . . . . . . .

$20,000+24,888 . . . . . . . . . . . . . . . .

$25,000-$34,999 . . . . . . . . . . . . . . .

S34,988-$49,889 . . . . . . . . . . . . . . . .

Greaterthan$50,000 . . . . . . . . . . . . . .

Poverly atatu5

Atorabovethepovertylevel. . . . . . . . .

Belowthepcvertylevel . . . . . . . . . . . .

Household respondent’s seat belt use

frequenoy

Never . . . . . . . . . . . . . . . . . . . . . . .

Sometimes/Often . . . . . . . . . . . . . . . .

Always . . . . . . . . . . . . . . . . . . . . . . .

2,550

6,849

9,463

8.6

5.9

2.3

4.0

5.1

5.7

4.2

3.9

6.9

8.8

12.4

7.4

7.4

6.3

5.6

4.9

3.2

1.7

3.6

9.1

57.1

14.0

3.2

(0.89)

(0.42)

(0.21)

33.0

24.0

14.9

(1.36)

(0.89)

(0.52)

41.3

55.6

69.6

31,504

7,722

6,175

(0.27)

(0.47)

(0.62)

18.8

26.4

23.0

(0.55)

(1.02)

(1.10)

62.8

57.4

50.6

(0.83)

(0.22)

(0.74)

(1.31)

(0.45)

(1.26)

59.0

62.9

46.9

2,105

35,121

8,341

20.6

19.2

26.9

1,665

1,012

1,688

3,373

3,779

3,317

6,625

6,209

9,390

(1.26)

(2.11)

(1.40)

(0.67)

(0.91)

(0.66)

(0.60)

(0.39)

(0.28)

34.2

29.9

29.5

29.9

27.7

23.6

20.5

17.5

13.1

(2.45)

(2.66)

(2.01)

(1.64)

(1.50)

(1.41)

(0.95)

(0.90)

(0.71)

44.0

44.2

51.0

49.0

53.6

56.2

62.5

69.4

72.0

14,231

3,473

(0.22)

(0.76)

18.5

31.3

(0.50)

(1.21)

64.8

46.0

(1.81)

(1.12)

(0.44)

15.6

28.3

80.6

3,528

9,810

25,895

(2.22)

(0.72)

(0.24)

24.4

55.6

14.0

Geographic characteriatioa

Housingtype

House,apartment,flat . . . . . . . . . . . . . 4.3

Mobilehome . . . . . . . . . . . . . . . . . . . 8.3

Other. . . . . . . . . . . . . . . . . . . . . . . . 3.0

Residential area

MSA, cerdralcity . . . . . . . . . . . . . . . . 5.8

MSA, non-central city . . . . . . . . . . . . . . 2.9

Non-MSA, non-farm. . . . . . . . . . . . . . . 6.2

Non-MSA,fanm . . . . . . . . . . . . . . . . . 4.9

Region:

Northeast . . . . . . . . . . . . . . . . . . . . . 5.1

Midwest . . . . . . . . . . . . . . . . . . . . . . 4.8

South . . . . . . . . . . . . . . . . . . . . . . . 5.1

West, . . . . . . . . . . . . . . . . . . . . . . . 2.6

I Excludes children in households without as and where child does nor ride in e car.

%cludeschildren withunknownfami~ incomsendolher missing date.

(0.46)

(1.83)

(3.02)

60.6

54.2

51.7

42,546

2,422

58a

(0.22)

(1.41)

*(1.48)

20.5

24.1

15.9

13,080

22,108

9,885

505

(0.44)

(0.24)

(0.72)

*(1.67)

22.8

17.2

25.4

24.5

(0.79)

(0.62)

(1.15)

(4.42)

56.3

64.4

56.1

53.2

6,255

11,277

16,155

9,879

(0.50)

(0.45)

(0.51)

(0.32)

19.8

23.6

21.3

16.9

(0.93)

(0.92)

(0.77)

(1.08)

57.9

60.9

57.5

65.5
Advance Data No. 250

● May 31,1994 13

Technical notes

Source and description of data

The estimates presented in this

report are based on the 1990 National

Health Interview Survey (NHIS) on

Injury Control and Child Health.

Performed by the National Center for

Health Statistics, the NHIS is an

ongoing survey of the civilian,

noninstitutionalized population of the

United States. The interviews are

performed in households weekly by

personnel of the United States Bureau of

the Census.

The NHIS consists of two sectionx

the basic questionnaire, which remains

the same each year, and special topic

questionnaires, which vary from year to

year. The survey collects individual and

household data on health status and

behaviors, medical care utilization, and

individual and household characteristics.

The special topic questionnaires explore

specific areas in greater detail. In 1990,

the special topics questionnaires

included Assistive Devices, Hearing,

Podiatry, Family Resources, Health

Promotion and Disease

Prevention-which included the Injury

Control and Child Health

questionnaire-and AIDS Knowledge

and Attitudes. Further information on

the survey design and data collection

methods can be found in Current

Estimates From the National Health

Interview Survey, 1991 (16).

The interviewed sample for the

1990 questionnaire was composed of

46,476 households containing 119,631

persons. Of these persons, 33,243 were

children under the age of 17. These

children comprise the sample for this

report. The response rates for the core

questionnaire and the injury control

questionnaire were 95.5 and

86.6 perceng respectively, resulting ina

true response rate of 82.7 percent for the

Injury Control and Child Health

questionnaire.

Sampling errors

estimates based on comple% multistage

sampling designs such as the NHIS lead

to larger sampling errors than those

based on simple random samples. The

standard errors shown in tables 1-5 of

this report were calculated using

SUDAAN (SUrvey DAta ANalysis)

developed by Research Triangle Institute

for analysis of complex sample surveys.

The procedure used was CROSSTAB

and the design was UNEQWOR

(without replacement sampling with

unequal probabilities of selection at the

iirst stage).

Tests of statistical significance were

performed using the diilerence of means

tests (t-test). The standard error used for

performing this procedure was derived

from the pooled variances of the

populations being compared. Differences

between means that were at least twice

as large as the pooled standard error

were considered to be signiikant at the 5 percent level. In the case of multiple

comparisons, such as one income group

against all others,a Bonferroni

adjustment was used to determine the

appropriate level of significance. In this

procedure, the significant alpha level is

divided by the number of tests being

performed to determine the adjusted

significance level. Lack of comment

regarding the difference between any

two estimates does not mean that the

difference was tested and found not to

be statistically significant. Estimates that

do not meet the reliability criteria of

30 percent relative standard error are

marked on the table.

Since the estimates shown in this

report are based ona sample population,

they are subject to sampling error. In the

case of small estimates, sampling errors

may be relatively high. Further,
14 Advance Data No. 250 ● May 31,1994

Symbols

. . . Data not available.

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.05

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

* Figure does not meet standard of

reliability or precision

# Figure suppressed to comply with

confidentialii requirements

“U.S. Government Printing Ofiicw 1995-- !M645WC019
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 6.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics.They includedescriptionsof the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributionsto stati~”caltheory. These studies ah

include experimental tests of new survey methods and

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reports contain statistics on illness: unintentional injuries;

disabilii use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview suwey.

Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination SurveyData from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

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(2) anaiyses of trends and relationships among various

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Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

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use of health care resources including ambulatory, hospital,

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SERIES 14.

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distribution, and characteristics of health resources are now

included in Series 13.

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Compilations of Data on Natality, Mortality, Marriage,

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These include advance reports of births, deaths, marriages,

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