Vital and

Health Statistics

Advance Data

From Vital and

Health Statistics:

Numbers 21 1–220

Series 16:

Compilations of Advance Data

From Vital and Health Statistics

No, 22

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

and other variables on office visits to cardiovascular disease specialists,

characteristics of persons dying from heart and cerebrovascular diseases, use of

vitamin and mineral supplements, forearm mortality among children and youth,

and AIDS knowledge and attitudes, Estimates are based on the civilian

noninstitutionalized population of the United States, These reports were originally

published in 1989.

U,S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Publlc Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsville, Maryland

May 1995

DHHS Publication No, (PHS) 95-1881
National Center for Health Statistics

Jack R. Anderson, Acting Director

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

Jacob J. Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

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

Extramural Programs

Peter L. Hurley, Assoctite Director for Vztal and Health

Statistics Systems

Robert B. Hartford, Ph. D., Acting Associate Director for

Internatwnal 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
Office Vkits for Diabetes Mellitus: United States, 1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prevalence of Major Digestive Disorders and Bowel Symptoms, 1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National Ambulatory Medical Care Survey: 1990 Summa~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office Vkits for Otitis Media: United States, 1975–90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health Insurance and Utilization of Medical Care for Chronically Ill Children With Special Needs: Health of

Our Nation’s Children, United States, 1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..’ . . . . . . . . . . . . . . . . . . . . . . . . . . .

AJDSKnowledge and Attitudes for January-March 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Assistive Technology Devices and Home Accessibility Features: Prevalence, Payment, Need, and Trends. . . . . . . . . . .

Serious Mental Illness and Disability in the Adult Household Population: United States, 1989 . . . . . . . . . . . . . . . . . . . .

Trends in Childhood Use of Dental Care Products Containing Fluoride: United States, 1983-89 . . . . . . . . . . . . . . . . . .

Expected Principal Source of Payment for Hospital Discharges: United States, 1990. . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. 211

No. 212

No. 213

No. 214

No. 215

No. 216

No. 217

No. 218

No. 219

No. 220

...

Ill
Number 211 ● March 24, 1992

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

Office Visits for Diabetes Mellitus: United States, 1989

by Susan M. Schappert, M.A., Division of Health Care Statistics

During the 12-month period from

March 1989 to March 1990, there

were an estimated 13.2 million visits

made to nonfederaily employed,

office-based physicians in the United

States, at which the principal, or

first-listed diagnosis was diabetes

meIIitus. An additional 8.7 million

visits included diabetes mellitus as the

second- or third-listed diagnosis.

This report presents national

estimates pertaining to diabetesrelated office visits.1 These estimates

are based upon data collected in the

National Ambulatory Medical Care

Survey (NAMCS), a national

probability sample survey conducted

by the Division of Health Care

Statistics of the National Center for

Health Statistics, Centers for Disease

Control. Statistics are presented on

patient, physician, and visit

characteristics for visits with a

diagnosis of diabetes meIIitus.

A copy of the Patient Record, the

survey instrument used by

participating physicians to record

information about their patients’

office visits, is shown in figure 1. In

item 10 of the form, physicians are

‘It should bc noted that the 19S9 NAMCS

added Alaska and Hawaii to the survey population. Previous years of data cxcludcd these states.

requested to record a principal

diagnosis (the diagnosis most cIoseIy

associated with the patient’s most

important reason for visit) as well as

any other significant current

diagnoses. Up to three diagnoses are

coded and classified according to the

International Classification of Diseases,

Ninth Revision, Clinical Modification

(ICD-9-CM) (1) for each visit. This

report will focus primarily on the

estimated 13.2 million office visits in

which the patient’s principal diagnosis

was recorded as diabetes mellitus.

lt is necessary to keep in mind

that the estimates presented in this

report are based on a sample, rather

than on the entire universe of office

visits, and, as such, they are subject to

sampling variability. The technical

notes found at the end of this report

discuss briefly the sampIe design,

sampling errors, and guidelines for

use in evaluating the precision of

NAMCS estimates. Two publications

are also availabIe that summarize

general findings from the 1989

NAMCS (2,3), and additional

publications on selected topics will be

forthcoming.

Patient characteristics

More than half (57.5 percent) of

the estimated 13.2 million office visits

with a principal diagnosis of diabetes

mellitus were made by females, and

the overwhelming majority

(86.3 percent) were made by persons

aged 45 years and over (table 1).

More than three-quarters

(79.3 percent) of the visits were made

by white persons.

The overall visit rate for visits

with a principal diagnosis of diabetes

mellitus was 5.4 visits per 100 persons

per yeaq visit rates were not found to

differ significantly for males and

femaIes or for white persons and

black persons. (Statistical

comparisons with other race groups

were not possible in this survey due

to the very low estimates of visits

obtained for these groups.)

Furthermore, visit rates by age, sex,

and race were not found to differ

significantly from those reported for

visits with a principal diagnosis of

diabetes mellitus since 1975 (4,5).

Visit rates rose with age,

however, with significant increases

noted for those in the 45-64 years

category and the aggregated 65 years

and over category. (Rates were not

significantly different between those

in the age groups 65-74 years and 75

years and over.) increasing visit rates

#SSnv!cf, ,

**+ ----

/

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

●

~=

c

Public Health Service

Centers for Disease Control

5 National Center for Health Statistics (?--

Manning Feinleib, M. D., Dr. P.H., Director CENTERS

.lJLFOR DISEASE CONTROL
2 Advance Data No. 211. March 24, 1992

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1,DATE OF VISIT PATlENT RECORD

~

OMB No. 0S20-0234

NATIONAL AMBLKATORY MEDICAL CARE SURVEY Exr2ir6s B.31 -W

IPHsl MOSA

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“ RSASON(S) FOR THIS VISil fin potsen[b own worok]

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1 ❑ NONE 7 ❑ OLOOD WIESSURE C)fECK t 3 ❑ ORAL GLuCOSE TOL. ! ❑ NONE 1 ❑ NONE

2 ❑ PAP TEST B ❑ URINM-YSIS 14 ❑ CHOLESTEROL MEASURE 2 ❑ WEIGHT REOUC’710N 2 ❑ PSYCHOIHEHAPV

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4 ❑ BREAST PALPATION 10 ❑ OIGITAL HECTAL EXAM !6 ~ OTHER fELOOO TEST

4 ❑ SMOKINGCESSATION 4 ❑ AMBULATORY SUaGERY

5 ❑ MAMMOGRAM 1 ! ❑ PflOCT&lGMOIBGSCOW 5 ❑ HIV TRANSMISSION 5 ❑ PHYSIOTHERAPY

17 ❑ OTHER /3~IJz/

6 ❑ VISUAL ACUITY

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12 ❑ STOOL KOOO ExAM S ❑ BREAST SELF-EXAM

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Figure 1.

by age were observed for both

females and males (figure 2).

Age-related increases in visits for

diabetes mellitus are further

evidenced in the distribution of

physician diagnoses among older age

groups. For all office visits made by

persons aged 45-64 years and 65-74

years, diabetes mellitus was the

second most frequently reported

principal diagnosis, after essential

hypertension, accounting for

3.1 percent of the diagnoses among

those 45-64 years of age and

4.8 percent of the diagnoses among

those 65-74 years of age. For visits

made by persons aged 75 years and

over, diabetes mellitus was the third

most frequently reported principal

diagnosis after essential hypertension

and cataract and accounted for

4.3 percent of the diagnoses in this

age group (3).

Patient characteristics of visits

with a principal diagnosis of

diabetes mellitus were found to

1 ❑ NO FOLLOW.(2P PLANNEO

2 ❑ RETuRN AT SPECIFIED TIME

3 ❑ RETURN IF NEEOEO. P R.N

h ❑ T;;EN~EHE FOLLOW.UP

5 n ‘EFERREo TO OTHER PHYSICIAN

7 ❑ ADMIT TO HOSPITAL

B ❑ OTHER /SP@))

. U.S. GOVERNMENT PRINTI

—

-y

wsrr

/Time

Ocnallly

spfm with

differ in one major respect from

those characteristics noted in the

aggregate of all other visits. While

the distribution of office visits by

sex and by race was not found to

differ significantly for each of the

two groups, differences in the

proportions of visits by age

category were noted. Specifically, a

significantly higher percent of visits

with a principal diagnosis of

diabetes mellitus was made by

persons in each age category after
Advance Data No. 211 ● March 24, 1992 3

Table 1. Number, percent distribution, and rate of visits with a principal diagnosis of

diabetes mellitus to ambulatory care physicians by patient’s age, sex, and race

United States, 1989

Number of WsIfrate

vislfs Percent per 100

Patierrt characterwtlc m thousands disfrdwtfon persons’

AllvisW.. . . . . . . . . . . . . .

Age

Less than 25 years . . . . .

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

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

45-54 years . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . .

75 years And over . . . . . . . . .

Sex

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

Less than 25 years . . . . .

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

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

45-54 years . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . .

75years And over . . . . . . . . .

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

Less than 25 years . . . . .

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

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

45-54 years . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . .

75 years And over, . . . . . . . .

Race

White . . . . . . . . . . . . . . . . .

Lessthan25 years . . . . . . .

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

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

45-S4 years . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . .

75 years And over . . . . . . . . .

Black . . . . . . . . . . . . . . . . .

Lessthan25 years .

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

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

45-54 years . . . . . . . . . . . . .

55-64 years .,, ,,, . . . . . . .

65–74 years, . . . . . . . . . . . .

75 years and over . . . . . . . . .

Asian/Pac!flc Islander . , . . .

American lndian or Alaskan

Native . . . . . . . . . . . . . . . .

Unspecified . . . . . . . . . . . . .

Geographic region

Noflheast . . . . . . . . . . . . . .

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

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

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

13,237 100.0 5.4

’261 92.0 “0.3

’504 “3.8 ●1.2

1.050 7.9 2.9

1,593 12.0 6.5

2.948 22.3 13.8

4.002 30.2 22.4

2.678 21.7 25.3

7,617

“132

“297

●447

942

1,606

2,377

1,8?7

5,619

“129

“207

604

652

1.342

1,625

1.060

10.497

●253

“470

716

1,122

2.296

3,239

2.401

1.939

“8

“238

“31O

569

“482

●332

“380

“29

“391

57.5

“1.0

●2.2

+3.4

7.1

12.1

18.0

13.7

42.5

“1.0

●1.6

4.6

4.9

10.1

12.3

8.0

79.3

●1.9

●3.6

5.4

8.5

17.3

24.5

18.1

14.7

“o.1

‘1.8

●2.3

4.3

●3.6

“2.5

●2.9

‘0.2

*3.O

6.1

“0.3

●1.4

●2.4

7.4

14.2

24.0

25.3

4.8

“0.3

“1.0

3.4

5.4

13.3

20.5

25.2

5.1

“0.3

●1.3

2.3

5.3

12.2

20.3

23.2

6.5

“0.2

‘6.1

“12.0

26.8

“31.2

*36.6

.. .

. . .

. . .

2.175 18.4 4,4

3,828 28.9 6.4

4,425 33.4 5.3

2,809 21.2 4.7

‘Number otvmtsger 100personspw yew. Ba~@dOnu.s. a"rea"of thecensus Hllmates ofmecNll!8n non!n$ttiMMaltzed

WPUhl!On as Of July 1, 1989.

the age of 44 years than was true

for matching ag,ecategories for all

other visits. Similarly, significantly

lower proportions of visits with a

principal diagnosis of diabetes

mellitus were made by persons

under the age of 45 years than was

the case for all other visits

(figure 3).

Physician characteristics

Ofthe estimated 13.2 million

office visits with a principal diagnosis

ofdiabetes mellitus. -!-$.0 percent

(about 5.S million visits) were made

to general and family practice

physicians. Internal medicine

specialists rcccived21k7 percent of

the visits, whiIe ophthalmologists

accounted for 6.S percent (table 2).

Diabetes mellitus was the fourth

most frequently reported principal

diagnosis rendered by general and

family practice physicians, accounting

for 2.S percent of all visits to this

physician group. For internal

medicine specialists, diabetes was

second only to essential hypertension

as a principal diagnosis and

represented 4.S percent of all \tisits to

this specialty. Among

ophthalmologists, diabetes was found

to be the tenth most frequently

rendered principal diagnosis,

accounting for 2.3 percent of all

ophthalmology visits.

Visit characteristics

The vast majority (9U percent)

of office visits with a principal

diagnosis of diabetes me[litus were

made by patients who were making

return visits to the physician for care

of their condition. Only 5 percent of

the visits were made by new patients

(table 3).

The chronic nature of diabetes

mellitus is highlighted by the fact that

among aIl return visits for the care of

old (previously treated) problems,

diabetes was the third most

frequently recorded principal

diagnosis (table 4). (It should be

noted that the ranked order

presented in this and other tables in

this report may not be entirely

reliable since some estimates may not

be statistically different from other
4 Advance Data No, 211 ● March 24, 1992

so

25

20

15

10

5

0

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

Female

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

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

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

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

imas 45-s4 55-a4 0!3-74 75 years

ttran years

4S yeara

years years and over

patient’sage

Figure 2. Annual office visit rate by patient’s age and sex for vkits with a principal

diagnosis of diabetes mellitus: United States, 1989

Diabetes visita Aliothervisits

Figure 3. Percent distribution of office visits for diabetes mellitus and for ail other

diagnoses by patient’s age: United States, 1989

near estimates due to sampling

variability.)

The ratio of return visits to new

problem visits was nearly 12:1,

meaning that nearly 12 return visits

for continuing care of this problem

were recorded during the year for

every visit that was recorded as a

“new problem” encounter (3). New

problem encounters include those

made by new patients as well as those

made by “old” patients for the care

of new problems.

Item 7 of the Patient Record asks

the physician to list the expected

source of payment for the visit being

recorded; more than one source may

be listed by the physician. Medicare

was the expected source of payment

at 44.4 percent of visits, followed by

self-pay (33.5 percent), commercial

insurance (21.2 percent), and

HMO/prepaid plan (13.9 percent)

(table 5).

Item 9a of the Patient Record

asks the physician to record the

patient’s most important complaint,

symptom, or other reason for this visit

using the patient’s (or patient

surrogate’s) own words. These

responses have been classified and

coded using A Reason for Visit

Classijcation for Ambularo~ Care

(RVC) (6). This classification is

divided into the eight modules, or

groups of reasons, shown in table 6.

The disease module accounted for

the highest percentage of visits with a

first-listed diagnosis of diabetes

mellitus (40.6 percent); this was

followed by the diagnostic, screening,

and preventive module

(23.6 percent); the symptom module

(17.3 percent); and the treatment

module (12.8 percent).

Among visits with a principal

diagnosis of diabetes mellitus,

patients most often expressed their

reason for visit as, simply, diabetes

mellitus (38.5 percent of visits); next

was glucose level determination

(13.8 percent of visits); and general

medical examination (7.8 percent of

visits). Reasons for visit are shown in

table 7.

Of all ot%ce visits in 1989,

diabetes mellitus was the seventh

most frequently reported principal

diagnosis, and the fourth most

frequently reported morbidity-related

principal diagnosis after essential

hypertension, otitis media, and acute

upper respiratory infections (table 8).

(Morbidity-related diagnoses are

defined here as those that are

classifiable to disease or injury, in

contrast to nonillness or

noninjury-related visits. Examples of

visits with diagnoses that are not

morbidity-related would include visits

for routine pregnancy examination,

general medical examination, etc.)

The majority of visits

(68.2 percent) with a principal

diagnosis of diabetes mellitus had a

second diagnosis listed on the Patient

Record, and 25.2 percent included a

third diagnosis. Concomitant

diagnoses are shown in table 9.

Essential hypertension was the most

frequently reported second- or
Advance Data No. 211 ● March 24,1992 5

Table 2. Number and percent distribution of office visits with a principal diagnosis of

diabetes mellitus by physician special~ United States, 1989

Number of VISJE Percent

Phys!cran specialty m tfrousands drsfrlbutlon

Allvlslts . . . . . . . . . . . . . . . . . . .,, ., 13.237 100.0

General and family practice . . . . 5,818 44.0

Internal medicine. . . . . . . . . . . . . . . . . . . . . . . 3.797 28.7

Ophthalmology . . . . . . . . . . . . . . 898 6.8

General surgery . . . . . . . . . . . . . . . “417 *3.2

Cardlovasculardisease. . . . . . 9137 *1 .0

Otherspeclalties . . . . . . . . . . . . . . . . . . . . . . . . 2.170 16.4

Table 3. Number and percent distribution of office visits with a principal diagnosis of

diabetes mellitus by referral status and prior-visit status: United States, 1989

Numberofvmts Percent

Visit cfraracfer~stic m thousands distribution

AllvIsIts . . . . . . . . . . . . . . . . . . . . . . . 13,237 100.0

Referral status

Patient was referred by another physician . ●453 ●3.4

Patient was not referred byanother phys!c!an. 12,784 96.6

Prior-visit status

Newpatlent . . . . . . . . . . . . . . . . . . . . . . 658 5.0

Oldpat,ent, ............ ........... 12,578 95.1

New problem. . . . . . . . . . . “379 ●2.9

Old problem . . . . . . . . . . . . . . 12,199 92.2

Table 4. Number and percent distribution of office visits for the 10 most frequent principal

diagnoses forreturn visits forthe care of ofdproblems: United States, 1989

Numbergfwsfts Percent

Rack Prmc/pal diagnos!s and ICD-9-CM co~e. m thousands t%str(buf~on

Allreturnwsits, . . . . . . 422.207 1000

Essential hypertension. . 401 24.267 5.7

2 Normalpregnancy . . . . . . . . . V22 20.201 4.8

3 Oiabetes mellitus . . . . . . . . . . . . . . . 250 12.199 2.9

~

Suppuratwe andunsoeclf!eao t]twmeala 362 10.726 2.5

5 Health supewmonofmfantorchlld. . V20 10,059 2.4

6 General meaicalexammatlon. . . .V70 9.558 2.3

7 Allerg!crhmrt!s, . . . . . . . . 477 9.455 22

3 Neurotlcd!sorders, . 300 7.143 17

3 Other postsurglcal states V45 6,517 15

“’l Asthma ...,,.... . . . . 493 5.338 1.3

“:=S25 on the /n,ernaf,ona/c:as~,f~=,fen~~o ~ea~e~,91~Re+,s~n. C/JnKaI,,fcdi~cmjon ICD-?3-CM

Table 5. Number and percent distribution of office visits with a principal diagnosis of

diabetes mellitus by expected source of paymenk United States, 1989

Number of vwf.s Percent

Expected source of payment’ m thousands dwtrfbution

N1.-s!ts.. . .......... ....... ..... 13.237 100.0

Sef9ay .,...,.,.. . . . . . . . . . . . 4.438 33.5

L4ec:care. .,...,,., . . . . . . . . . . . . . . . .,, 5.871 44.4

P.!ezca!d, ,. .,.,,., . . . . . . . . . . . . . . . . 1.184 8.9

C:-nlerclal insuranc e..... . . . . . . . . . . . 2.802 21.2

SueCross/BlueShield . . . . . . . . . . . . . 851 64

H’.’CPrepa)d plan . . . . . . . . . . . . . . . . . 1.842 13,9

No :harge . . . . . . . . . . . . . . . . . . “178 “1.3

a~er . . . . . . . . . . . . . . . . . . . . . . . “351 “2.7

Ur~:own, . . . . . . . . . . . . . . . . . . . . . . . ●162 *1.2

.--.,

. . m3Y exceed total nwnce. ~f VIS,!S 3ecause rinse !Imn c“2 :a!egory may :? reponed per v St.

third-listed diagnosis, show’ing up at

about 3.5 million visits. or

26.5 percent ofallvisitsw’itha

principal diagnosis of diabetes

mellitus.

About 722 percent of~tisits with

a principal diagnosis of diabetes

mellitus included ablood pressure

check (table 10). This insignificantly

higher than the34.2 percent ofall

other office visits (that is, those visits

which did not list diabetes mellitus as

a principal diagnosis) that included a

blood pressure check in 19S9.

Other frequently performed

diagnostic services included ’’other”

blood test (54.8 percent), urinalysis

(17.4 percent), cholesterol measure

(9.8 percent), andvisuat acuity

examination (8.0 percent). All of

these, with the exception of the visual

acuity examination, were performed

at a significantly higher rate at visits

with a principal diagnosis of diabetes

melIitus than at all other visits. The

number of diagnostic services

performed per visit is displayed in

table 11.

Therapeutic semices orciercd or

prokfided by the physician are shown

in table 12. Weight reduction was the

most frequently reported type of

counseling’advice either ordered or

provided (X.7 percent ofvisits). In

contrast, only 5.8 percent of visits

with a principal diagnosis other than

diabetes mellitus included counseling

or advice on weight reduction.

SimiIarly,9.9 percent ofvisits witha

principal diagnosis of diabetes

mellitus included counseling advice

ordered or provided for reduction of

cholesterol, compared with about

3 percent ofall other visits.

More than three-quarters of visits

with a principal diagnosis of diabetes

mellitus (77.9 percent) included a

new or continuing medication ordered

or provided by the physician, a

significantly higher percentage than

the corresponding 59.8 percent of all

other visits. As used in the YAMCS,

the term “drug” is interchangeable

with the term “medication” and

includes prescription as well as

nonprescription preparations. The

term .’drug mention” refers to each

mention of medication on the Patient

Record. Because doctors can record
6 Advance Data No. 211 ● March 24, 1992

Table 6. Number and percent distribution of office visits with a principal diagnosis of

diabetes mellitua by patient’a principal reason for visit: United States, 1989

Number of vmts Percent

Prmc/pa/ reason for vwf and WC code’ m Ihousands djsfribuflon

Allv@s. ,. . . . . . . . . . . . 13.237 100.0

Symptom module . . . . . . . . . . . . . . .. S001-S999 2.287 17.3

Disease module. .,, ,DOO1-D999 5,376 40,6

Diagnostic, screening, and preventwe module Xl 00-X599 3,122 23.6

Treatment module . . . . ...,.,... . . . ,.. TIOO-T899 1,692 12.6

Injuries and adverse effects module JOO1-J999 “11 “0.1

Test results module.., ,. ...,. RI 00-R700 “343 ●2.6

Admmlstrative moaule, .A1OO-A14O “40 ‘0.3

OtherZ . . . ,. . U990-U999 “366 ●2.8

‘Basedon “AReasonforV!s]l Class!tcat!on tor Ambulatory Care””(WC), V/taland Uealfh S1ar!sr!m,Series 2. No. 78. Feb.

1979.

2

Includes problems and complamls not elsewhere classi!ec, entries of “none.” blanks. &r3 dleg!ble entrle$.

Table 7. Number and percent distribution of office visits with a principal diagnosis of

diabetes mellltus by the most frequent principal reasons for visiti United States, 1989

Number of visits Percent

Prmcfpal reason for visit and RVC code’ m thousands distribution

AIIvIsI!s . . . . . . . . . . . . . . . . . . . . . 13.237 100,0

Dlabetesmelltus. . . . . . . . . . . . . . . .. D205 5,092 36.5

Glucose level determmatlon. . .X31O 1,833 13.s

General med!calexammatlon . . .X1OO 1.034 7.6

Vision dysfunctions: twedness. exhaustion: vertigo.

dizziness .S305S015S225 670 5,1

Symptoms of flu!d abnormahtjes: foot and toe

symptoms: skm Ieslon. back symptoms: general

weakness S035S935,S865,S905, S020 597 4.5

‘Basedon “AReasonf orVmlClasszfcat!onfor AmtwlarOVCare’ (RVC),Vttaland Health SIafEms.Series2, No.7& Fe.b

1979.

Table 8. Number, percent, and cumulative percent of office visits by the 10 principal

diagnoses moat frequently rendered by physicians: United States, 1989

Number ot

Vlslts Percent Cunzu/ative

Rank Principal diagnow and ICD-9-CM code’ in thousands distribution percerrf

AllvIstis . . . . . . . . . . . . . . . . . . . . . . . . . . 692,702 foo.o

1 Essential hyperfenston. . . . . . . . . . . . . . . . . ...401 27,708 4.0 4.0

2 Normal pregnancy . . . . . . . . . . . . . . . . . ..V22 23,578 3.4 7.4

3 General medical examination. .V70 20,166 2.9 10.3

4 Suppuratwe and unspecified otmsmedja . . .382 20.033 2.9 13.2

5 Acute upper respwatory infections. . .465 15,765 2.3 15.5

6 Health supewmonof mfantor child .V20 15,669 2,3 17.8

7 Diabetes mellitus ...,..... . . ., .250 13,237 1.9 19.7

8 Allerglcrhlmtls, ,477 11,631 1.7 21.4

9 Bronchltrs, notspeclfied asacuteorchroruc .490 11,160 1.6 23.0

10 Acute pharyngtljs . . . . . . . . . ...462 10,958 1.6 24.6

'Based onlhelnternar!onal Class)hm!,on olDrse8ses. %hRev#ston. Chn/calMod/f@fjon,lCD-9-CM.

Table9. Number andpercent distribution of office visltsby diagnoses most frequently

associated with a principal diagnosis of diabeteamellitus: United States, 1989

Number of vcsjts Percenr

Second- or thrd- hsted dlagnos!s and ICD-9-CM code’ m thousands distribution

All vwts 13.237 100.0

Essential hyperterrsion . . . . ...401 3!510 26.5

Ofherretmal disorders 362 808 6.1

Other forms ofchronjc !schemlc heart dtsease ,414 “501 ●3.7

Dsorders ofhpotdmetabohsm . . 272 “460 *3.6

Obesity andother hyperallmentatlon .276 “276 “3.4

‘Based on me ln!ernartona,C/ass!fica!@no’Oweases, 9rh Rewston, Cl,nlcaf MOdrffcaltOn, ICD-S-CM

more than one drug per visit, the

total number of drug mentions will

generally be higher than the number

of visits. The term “drug visit” :refers

to any visit in which at least one drug

is ordered or provided by the

physician.

There were about 10.3 million

drug visits among the 13.2 million

visits with a principal diagnosis of

diabetes mellitus (78.0 percent). The

number of drugs ordered or prcwided

per visit is listed in table 13.

Approximately 30.3 percent of visits

included three or more medications,

compared with just 10.9 percent of

all visits with a principal diagnosis

other than diabetes mellitus.

In all, there were approximately

23.8 million drug mentions, or 2.3

drugs ordered or provided per drug

visit. Table 14 presents data on the

number and percent of diabetesrelated drug mentions for the most

frequently used generic substances.

Table 15 displays drug mentions

according to therapeutic classification,

based on the National DIzg Cod?

Directoq (7).

The mean duration of

physician-patient contact for visits

with a principal diagnosis of diabetes

mellitus was 17.3 minutes (with a

standard error of .73 minutes) and

does not include visits in which no

face-to-face contact with the

physician occurred. Physician-patient

contact only includes the time spent

in actual face-to-face contact between

physician and patient. Data on

duration of visits with a principal

diagnosis of diabetes mellitus are

shown in table 16.

The great majority (89.2 percent)

of visits with a principal diagnosis of

diabetes meIlitus resulted in a

scheduled return visit. Data on

disposition of visit are also shown in

Table 16.

Visits with a second or third

diagnosis of diabetes mellitus

In addition to the 13.2 million

office visits with a first-listed diagnosis

of diabetes mellitus, approximately

8.7 million office visits were made

during 1989 at which a second or

third diagnosis was listed as diabetes
Advance Data No. 211 ● March 24,1992 7

mellitus. yielding a total of about 22

million diabetes-related diagnoses

overall. Visits in which the second or

third diagnosis was diabetes mellitus

were not found to differ significantly

from visits in which the principal

diagnosis was diabetes melIitus in

terms of the age. sex, or race

distribution of patients.

In 18.7 percent of the visits in

which diabetes was the second- or

third-listed diagnosis, the principal

diagnosis \vas listed as essential

hypertension (1.6 million visits).

Table 17 displays the major

ICD–9–CM coding classes associated

with principal diagnoses for visits in

which the second- or third-listed

diagnosis was diabetes mellitus.

Table 18 presents data on the

“diagnoses reported most frequently in

conjunction with all of the

approximately 22 million diagnoses of

diabetes mellitus, whether first-,

second-, or third-listed on the Patient

Record. Essential hypertension was

reported most often in addition to a

diagnosis of diabetes mellitus. at

6.3 million visits. or 28.7 percent of

all such visits. Other common

diagnoses reported in conjunction

\vith diabetes mellitus included other

forms of chronic ischemic heart

disease, other retinal disorders.

obesity and hyperalimentation,

disorders of lipoid metabolism, and

other and unspecified arthropathies.

References

1.

2.

?. .

4.

Public Health .%mice and Health

Care Financing Administration.

International Classification of

Diseases. 9th Re\rision, clinical

modification. Washington: Public

Health Sewice. 19S().

DeLozier JE. Gagnon RO. 19S9

Summary: National ,Ambula[ory

Medical Care Survey. Advance

data from vital and health statistics; no 203. Hyattsville, \fa~land:

National Center for Health Statistics. 1991.

Schappert SM. National Ambulatory Medical C~re Survey: 19S9

Summary. National Center for

Health Statistics. Vital Health Stat

13(1 10). 1992.

Nelson C. McLemore T. The

?Ja[ional Ambulatory Medical

Care Sumey, United States.

Table 10. Number and percent distribution of office visits with a principal diagnosis of

diabetes mellitus by selected diagnostic services: United States, 1989

Drabefes LW!S’ ,4// other visks

Number of Number of

Vlsws Percent visds Percent

Selected dragnosk serwces 2 in thousands distnbutton m thousands dktnbtmon

AllvIsIts . . . . . . . . . . . . . . 13,237 100.0 679.465 100.0

None . . . . . . . . . . . . . . . . 914 6.9 264,920 39.0

Visual acuity . 1,058 8.0 44,134 6.5

Blood pressure check. . 9,552 72.2 232,347 34.2

Unnaiys m . . . . . . . . . . . . 2,300 17.4 85,416 12.6

Oral glucose tolerance. . . . 562 4.2 2,494 0.4

Cholesterol measure3 . . 1,302 9.8 23,526 3.5

Other blood test . . . 7.253 548 80,957 11.9

‘VISI!S w,th a pnnc! pal dagnos!s of d!abe!es me!l,hiS.

‘Total may exceea total number of WSIIS because more lhan one ixegory may be repOfleCf per vl$d.

3Category IS new m the 1989 NAMCS

Table 11. Number and percent distribution of office visits with a principal diagnosis of

diabetes mellitus by number of diagnostic services ordered or provided per visit: United

States, 1989

f7/aLretes visits’ M ofher visvts

Number of Number of

Number of diagnostic services t.isits m Percent W“sltsin Percent

ordered or prowded per vlsd thousa-ds dis?nbutlon thousands distribution

AllvIsIts . . . . . . . . . . . . . . . . . . . . 13.237 100.0 679,465 100.0

None,,,..............:. . . . . . 914 6.9 264,920 39.0

One, .,.. . . . . . . . . . . . . . . . . . . . 3,307 25.0 215,664 31.7

Two . . . . . . . . . . . . . . . . . . . . . . . . . 5,703 43.1 105,062 15.5

Three . . . . . . . . . . . . . . . . . . . . . . . . 1,S06 14.4 42,633 6.3

Four or more . . . . . . . . . . . . . . . . . . . 1,407 106 51,186 7.5

‘Vmts wllh a prmcl pa! duagnosts of dlabe!eS melhlus.

Table 12. Number and percent distribution of office visits by selected therapeutic

services: United States, 1989

(Mbefes vmts’ A// other VI.WS

Ntinmer of Number of

wsts m Percent visis m Percent

Se/ecfed therapeutic serwces thousanes dwfnbutlon thousands dWrbut~on

Allvwls . . . . . . . . . . . . . . . . . . . . . . 13,237 100.0 679,465 100,0

Counseling/adv[ce ordered or provlded2’3

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,656 442 429,936 63.3

Welghtreductton, . . . . . . . . . . . . . . . . . . . . . 4,324 327 39,529 5.8

Cholesterol reduction . . . . . . . . . . . . . . . . . . 1,313 9.9 20,220 3.0

Smokmg cessation . . . . . . . . . . . . . . . . . . . “409 “3.1 14.700 2.2

HIVtransmlss[on, ,.. . . . . . . . . . . . . . . . “24 “0.2 1,020 0.2

Breast self-exam . . . . . . . . . . . . . . . . . . . . . ’237 *1.6 15,542 2.3

Other Counselingladvfce . . . ., . . 3.989 30.1 189,283 27.9

‘VIsIts with a prmmpal d]agnoss of dla5e!ea me!!iLS.

2Ca!egory IS new m the 1989 NAMCS

%OWII may exceed total number of Wsts beCauSe more Ihan one ca:egoy Tay be reponed per vmt.

Table 13. Number and percent distribution of office visits with a principal diagnosis of

diabetes mellitus by number of medications ordered or provided by physician: United

States, 1989

Diabetes vmts’ A/l other vMs

Number of new or corrtmued Number of Number of

medications ordered or prowded VISI?SIn Percent vwts m Percent

by the physlclan thousands dwtrtzut]on thousands disfrh5uhors

Allvislts, . . . . . . . . . . . . . . . . . . . . . . . . 13,237 100,0 679,465 100.0

None . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.931 22.1 272,962 40.2

One . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 3.697 294 226,180 33.3

Two . . . . . . . . . . . . . . . . . . . . . . . . . . . .2.411 182 106,309 15,6

Three-five . . . . . . . . . . . . . . . . . . . . . . . . 3.596 303 73,994 10.9

‘VIsIts w!th a fzrmc!pal d!agnoss of d!aDetes melhlus
8 Advance Data No. 211 ● March 24, 1992

Table 14. Number and percent distribution of drug mentions for the five most frequently

used generic substances for visits with a principal diagnosis of diabetes mellltus: United

States, 1989

Number of ment)ons Percent

Gener!c substance m thousands d/stribufion

Total drug menttons for v!s!ts wih a prmclpal

dlagnoals of dla!zetes melktus . 23,768 100.0

Irtsul m.. . . . . . . . . . . . . . . 4,223 17.8

Glyburide . . . . . . . . . . . . . . . . . 2.345 9.9

Hydrochloroth!aziae 1,137 4.8

Fu-osem!de, . ,,, . . ,,, ,,, ,,, 989 4.2

Gk:zlde., ,.. ,. ,,,... “833 ●3,5

‘F-ecwncy cd m~?:.:. cjynb,n~~ s,ngIe.tngrec,ent agenIs Wh rnen100?s Ot me agent as an m~redent m a combmat!on Orug

Table IS. Number andpercent distribution ofdrugmentions by therapeutic classification

forvisits witha principal diagnosis ofdiabetes mellitus: United States, 1989

Number of ment/ons Percent

Therapeutic dasstfcat)on’ m thousands dwtwfion

Total drug mentions forwsdsw lthapnnc!pal

dagnosE.of citaoe!esmellltus. 23,768 100.0

Ho-mones and agents affecting hormonal

mechanisms ..,.,, .,, ,. .,,.,, 9,375 39.4

Cardiovascular-renal. 7,334 30.9

Pamrehef. . . . ,,.. ,, 1,508 6,3

Metabohcandnument 1,102 4.6

Psychopharmacol~ glc, ●893 ●3.2

Gastrointestinal. ,. . . . . . . . . . ’766 ●3.2

Ac?mlcroblal ’596 “2.5

Otherz ,. ,... 1,225 5.2

Un:lass!fled:m!scellaneous. 968 4.1

‘The-apeut!c class IS based ontheslandard drug class(ftcal!on used rnthe Nat!onal Drug Code D!recto~, 79a2Edit!on.

‘Includes lhefollowq Classlflcallons anesthetic, hemamlogtc, rad!opharmaceu! walslcon!raslmedla, lmMunOIOglC agentS,

Sklnmucousm emmane, neurolq$c, ophthalmic. Otologtc, and resp(ralory tract drugs.

Table 16. Number andpercent distribution of office visits with aprincipal diagnosis of

diabetes mellitus by duration and disposition of visit: United States, 1989

Numberofws!ts Percent

Wsit charactensflc m thousands dtstribufion

Allwstis . . . . . .

Duration ofvIsI!

Zero mmutes’ ,,.

l-5mmutes,

6-10mmutes, , ,, ...,..,,,,, .,,

11-15mmutes, . . . . . . . . . . .

16-30mmutes ,,.

More than3r)mmutes.

D!s~ositlon ofvwtz

No followup planned

Re!urna[ speclftedttme

Re:umlf needed

Te4e3hone followuD planned

Re’erred to other ohysman

Returned toreferrtng phys]c(an

Ad’n!ttohosp!tal . . .

Other. .

13,237

“212

854

3,079

4.503

3.801

787

“298

11,809

1,045

●445

● 254

*179

●103

“127

100.0

“1,6

6.5

23.3

34.0

28.7

5.9

‘2.2

89.2

79

“34

“1,9

“1,4

“0,8

*1.O

5.

6.

7.

1975-81 and 1985 trends. Na[ional

Center for Health Statistics. Vital

Health Stat 13(93). 1988.

Ezzati T. Office visits for diabetes

mellitus, National Ambulatory

Medical Care Survey :United

States, 1977. Advance data from

vital and health statistics; no 57.

Hyattsville, Maryland: National

Center for Health Statistics. 1980.

Schneider D, Appleton L,

McLemore T. A reason for visit

classification for ambulatory rare.

National Center for Health Statis.

tics. VitaIHealth Stat 2(78). 1979,

Food and Drug Administration.

National drug code directory.

Washington: Public Health

Service. 1982.

‘VsK+ofz eromlnulesa uratlOna relnose, nw~,c~lnere was mcface.lo-lace Comae! berween thepat(enl andthepnys,clan

‘Tc!zlma,{ exceed r>:a! nJmcercf ws:s Deca>se mo!e ma? one ca!egory may bereponed pervml
Advance Data No. 211 ● March 24,1992 9

Table 17. Number and percent distribution of office visits with a second- or third-listed

diagnosis of diabetes mellitus by selected diagnostic classes: United States, 1989

Number of

Principal diagnosis (ma]or ICD-9-CM VEILS Percent

coding class’) in thousands distribution

All second- and third-listed diagnoses of

diabetes mellitus 8.718 100.0

Oiseases of circulatory system .390-459 3,174 36.4

Diseases of respiratory system .460-519 1.184 13.6

Oiseases of musculoskeletal system and

connective tissue. . . . . . . ...710-739 919 10.5

Symptoms, signs, and ill-defined

conditions . . . . . . . . . . . . . . 780-799 “489 ●5.6

‘Eased on the /flfernamna/C/assu?cat,onof L3seases.9fh Rewon, ClmcafMod/fHkm (ICD-9-CM).

Table 18. Number and percent distribution of office visits by diagnoses most frequently

associated with a first-, second-, or third-listed diagnosis of diabetes meilltus: United

States, 1989

Number of

vists Percent

Concomitant diagnosts and ICD-%CM code’ in thousands distribution

All visits with a first-. second-, or third-listed diagnosis of

diabetes mellius 21,955 100.0

Essential hypeflension . . . . . . . . 401 6,303 28.7

Other forms of chronic ischemic heart disease 414 975 4.4

Other retinal disorders . . . . . . . . . . . . . . . ...362 926 4.2

Obesity and other hyperalimentation. . . . . . 276 746 3.4

Disorders of Iipoid metabolism . . . . . . . . . 272 642 2.9

Other and unspecified arthropathies. . . . . . 716 611 2.8

‘Based on the Internat!onsl Class! ficarton of Dseases. W Revtsron. Chcal MourfarlonJCD-8-CM.
10 Advance Data No. 211 ● March 24, 1992

Technical notes

Source of data and sample

design

The information presented in this

report is based on data collected by

means of the National Ambulatory

Medical Care Surwey (NAMCS) from

March 20, 1989-March 1S, 1990. The

target universe of NAMCS includes

office visits made in the United States

by ambulato~ patients to

non federally employed physicians who

are principally engaged in office

practice, but not in the specialties of

anesthesiology, pathology, or

radiology. Telephone contacts and

nonoffice irisits are excluded.

A multistage probability sample

design is used in NAMCS, involving

samples of primary units (PSU”S).

physician practices within PSU’S, and

patient visits within physician

practices. For 1989, a sample of 2.535

nonfederal. oflice-based physicians

was selected from master files

maintained by the American JMedicat

Association and American

Osteopathic Association. The

physician response rate for the 1989

NAMCS was 74 percent. Sample

physicians were asked to complete

Patient Records (see figure 1) for a

systematic random sample of office

visits occurring during a randomly

assigned l-week reporting period.

Responding physicians completed

38,384 patient records.

Characteristics of the physician’s

practice, such as primary specialt!

and type of practice, were obtained

from the physicians during an

induction interview. The U.S. Bureau

of the Census, Housing Sumeys

Branch, was responsible for the

survey”s data collection. Processing

operations and medical coding \vere

performed by the National Center for

Health Statistics, Hospital Discharge

and Ambulatory Care Survej Section,

Research Triangle Park, North

Carolina.

Sampling errors

The standard error is primarily

measure of the sampling variability

that occurs by chance when only a

sample, rather than an entire

a

unil’erse, is sumeyed. The relative

standard error of an estimate is

obtained by dividing the standard

error by the estimate itsclfi the result

is then expressed as a percent of the

estimate. Approximate relative

standard errors of selected aggregate

statistics are shown in tables I-II,

and the standard errors for estimated

percent of visits are shown in

table 111.

Adjustments for nonresponse

Estimates from NAMCS data

\vere adjusted to account for sample

physicians who were in scope but did

not pi~rticipate in the study. This

adjustment was calculated to

minimize the impact of response on

final estimates by imputing to

nonresponding physicians data from

visits to similar physicians. For this

purpose, physicians were judged

similar if they had the same specialty

designation and practiced in the same

Psu.

Test of significance and

rounding

In this report, the determl., .,un

of statistical significance is based on

the t-test. The Bonferroni inequality

\vas used to establish the critical

value for statistically significant

differences (0.05 level of confidence).

Terms relating to differences such as

‘Lgreatcr than” or “]ess than” indicate

that the difference is statistically

significant. In the tab]es, estimates of’

office visits have been rounded to the

nearest thousand. Consequently,

Table 1. Relative standard errors for

estimated number of office visits: National

Ambulatory Medical Care Survey, 191B9

Estimated number of or%ce Re/afwe sfandard

wits (m thousands) error (in percent)

200 .,.......,,. . . . 4!3.4

400, , . . . . . . . . . . . . . . . 3!5.0

547, . . . . . . . . . . . . . . . . 30.0

600 . . . . . . . . . . . . . . . . . 28.7

ado . . . . . . . . . . . . . . . . . 24.9

1.000. . . . . . . . . . . . . . . 22.4

2,000 ... . . . . . 15,1

5,000, , ,.. 106

10,000, . . . . . 00

13,000 . . . . . . . . . . . . . . . 7.3

20,000 . . . . . . . . . . . . . . . 6,4

50,000 . . . . . . . . . . . . . . . 5,1

100,000, , . ., ..,....,, 4.6

600,000 . . . . . . . . . . . . . . 4$1

Example of use of table: An aggregate est!male of 10 m!lhon

VISIIS has a relative standard error of 8,0 percenl or a

standard error of 800,000 V!SIIS (8.0 percent of 10 rwlhon),

Table IL Relative standard errors for

estimated number of drug mentions:

National Ambulatory Medical Care Survey,

1989

Estimated number of drug Re/afive standard

ment!ons (m thousands) error (in ,percent)

200 . . . . . . . . . . . . .

400 . . . . . . . . . . . . . . . . .

500 . . . . . . . . . . . . . . . . .

600 . . . . . . . . . . . . . . . . .

800 . . . . . . . . . . . . . . . . .

912 . . . . . . . . . . . . . . . . .

1,000, . . . . . . . . . . . . . . .

2,000 . . . . . . . . . . . . . . . .

5,000 . . . . . . . . . . . . . . . .

10,000 . . . . . . . . . . . . . . .

20,000 . . . . . . . . . . . . . . .

50,000 . . . . . . . . . . . . . . .

100,000 . . . . . . . . . . . . . .

600,000 . . . . . . . . . . . . . .

63.4

45.0

40,3

36.9

32.0

300

267

20.6

13,6

10.3

8.1

6.5

5.8

5.2

Example of use of table: An aggregate esttmate of 10 m!lhon

drug menmans has a relawe standard error of 103 percent

or a standard error of 1.03 million mentions (10.3 oercent of

10 mmon).

Table Ill. Standard errors for percents of estimated numbers of office visits: Nationall

Ambulatory Medical Care Survey, 19B9

Estimated percent

Base of perter (vwts m thousands) 1 or 99 5 or 95 10 or 90 20 or 80 30 or 7C) 50

Standard error m percentage points

200 . . . . . . . . . . . 4,9 10.7 14.8 19.7 22.6 24.6

500 . . . . . . 3.1 6.8 9.3 12.5 143 15.6

1,000. 2.2 4.8 6.6 8.8 10.1 11.0

2000. . , , .:::::”.::” 1,6 34 4,7 6.2 7.1 7.8

5000 10 2.2 3.0 3.9 4.5 4.9

10,000 . 07 1.5 2.1 2.8 3.2 3.5

13,000. . . . . . . . 0.6 13 1,8 2.4 2.a 3.1

20,000 05 1,1 1,5 2.0

50,000 ““”:::” ::

2.3 2.5

03 0.7 0,9 1,3 1,4 1.6

100,000 0.2 05 0.7 0.9 1.0 1,1

600,000 :’::’::::’..:” 0.1 0.2 0.3 04 0.4 0.5

Exam@e of use of table An esl!mate of 30 percent aased on an aggrega!e est]male of 13 m,lhon VISIIS has a s:andard f!rror of

2 e nercent or a relatlve ‘Aanaara error of 93 percen: {2.8 percenl d!waeo by 30 PerceW
Advance Data No. 211 ● March 24, 1992 11

estimates will not always add to Symbols

totals. Rates and percents were

calculated from original unrounded --

- Data not available

figures and do not necessarily agree . . . Category not applicable

with percents calculated from

rounded data.

Definition of terms

Arnbulatoty potient – An

ambulatory patient is an individual

seeking personal health services who

is not currently admitted to any

health care institution on the

premises.

Physician –A physician is a duly

licensed doctor of medicine (M. D.) or

doctor of osteopathy (D.O.) who is

currently in office-based practice and

who spends some time caring for

ambulatory patients. Excluded from

the NAMCS are physicians who are

hospital based; who specialize in

anesthesiology, pathology, or

radiology; who are federally

employed; who treat only

institutionalized patients; or who are

employed full time by an institution

and who spend no time seeing

ambulatory patients.

0j7ce – Offices are the premises

physicians identify as locations for

their ambulatory practice; these

customarily include consultation,

examination, or treatment spaces the

patients associate with the particular

physician.

I%ir–A visit is a direct personal

exchange between an ambulatory

patient and a physician or a staff

member working under the

physician’s supetwision. for the

purpose of seeking care and

rendering personaI health services.

Drug mention – A drug mention is

the physician’s entry of a

pharmaceutical agent–by any route

of administration —for prevention,

diagnoses, or treatment. Generic as

well as brand-name drugs are

included, as are nonprescription and

prescription drugs. Along with all new

drugs, the physician also records

continued medications if the patient

was specifically instructed during the

visit to continue the medication.

Drug visit – A drug visit is a visit

in \vhich medication was prescribed

or provided by the physician.

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 cf

reliability or precision

“U.S. Gownn’wn Priming 0f17fx 1992 — 31249WM22
12 Advance Data No. 211 ● March 24, 1992

Suggested citation

Schappefl SM. Office visits for diabetes

mellitus: United States, 1989. Advance data

from vital and health statistics; no. 211.

Hyattsville, Maryland: National Center for

Health Statistics. 1992.

Copyright information

This report may be reprinted without further

permission.
Number 212 ● March 24, 1992

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

Prevalence of Major Digestive Disorders and Bowel

Symptoms, 1989

by Felicia B. LeClere, Ph. D., Abigail J, Moss, Division of Health Interview Statistics, James E. Everhart, M. D., M.P.H.,

and Harold P. Roth, M. D., National Institute of Diabetes and Digestive and Kidney Diseases

Introduction

Digestive diseases have a

substantial impact on health and

health services in the United States.

In 1988, about 3.3 million people

were hospitalized for digestive

diseases and over 5.3 million digestive

system procedures were performed on

hospitalized patients (l). In 1989,

there were ar es bnated 26.7 million

first-listed visits for dig. ‘tive diseases

to office-based physiciai (2).

Despite the frequer,. of digestive

diseases, there are no special

population-based regi< es for

nonmalignant digesti,’e seases in the

United States nor are r. infectious

digestive diseases repon 1to State

health departments. The surveys of

the National Ceriter for Health

Statistics (NCHS) provide timely data

on the impact and trends in chronic

digestive diseases. The National

Health Interview Survey (NHIS) is

particularly useful for several reasons.

First, questions regarding digestive

conditions have been asked annually

for more than 30 years, which allows

for an analysis of long-term trends.

Second, less common conditions and

small subpopulations can also be

examined by combining multiple

years. Data are routinely gathered on

common conditions, such as

constipation and hemorrhoids, that

may not require frequent medical

attention and therefore are not

adequately covered by surveys of

medical care utilization. Fhally,

NHIS is the only continuing source of

information regarding disability and

activity restriction due to digestive

diseases.

The ongoing NHIS is limited in

its abili~ to provide accurate

information on specific diseases. The

survey utilizes a chronic condition

checklist and relies on respondents’

reports for all family members. The

National Institute of Diabetes and

Digestive and Kidney Diseases

collaborated with NCHS to develop a

special questionnaire aimed at

collecting more complete and

accurate information on digestive

disorders. Renewed interest in the

epidemiology of these diseases also

prompted the development of this

questionnaire (3-11). The NHIS

questionnaire on digestive disorders

was administered in 1989, along with

two other surveys that provide

information relevant to the

identification of digestive

conditions – the National Ambulatory

Medical Care Survey and the third

National Health and Nutrition

Examination Survey.

The data collection method for

the 1989 NHIS digestive disorders

questionnaire, which is described in

more detail later, improves the

accuracy of the reporting of chronic

digestive conditions. It may ako allow

for improved case seIection for

analytic study of these diseases. More

complex analyses of the data from the

digestive disorders questionnaire are

possible, and further exploration of

the data is encouraged.

Data and methods

This report is based on data from

the 1989 National Health Intemiew

Survey, which is a continuous

cross-sectional survey of the resident

household population of the United

States. Every year since 1957, basic

demographic and health information

# %ct~crs.o

*4+ +

#

U.S. DEPARTMENTOF HEALTHAND HUMAN SERVICES

~“ Public Health Service

:

. Centers for Oisease Control

E

>%4%.,~a Manning

National

Feinleib,

Center

M.

for

D.,

Health

Dr. P.

Statistics

H., Director

CENTERS CKFOR DISEASE CONTROL
2 Advance Data No. 212 ● March 24, 1992

has been collected from a nationally

representative sample of household

members in face-to-face interviews

using a standard questionnaire.

Additional health topics are added

the basic questionnaire. In 1989 a

special questionnaire on digestive

disorders was administered to one

randomly selected member of each

sample family in an interview

household who was 18 years of age

to

and over. Approximately 42,000”

individuals were interviewed.

The XHIS digestive disorders

(NHIS-DD) questionnaire consists

of three sections. In the first section,

respondents were asked about specific

digestive conditions: ga]]b[adder

trouble, ulcers, diverticulitis,

hemorrhoids, and colon conditions.

Functional colon conditions include

diagnostic synonyms such as irritable

bowel syndrome, functional bowel,

spastic colon, and irritable colon.

Information on the timing of onset,

medical diagnosis. and treatment of

these specific disorders was also

obtained. In the second section of the

questionnaire, data were collected on

the location and severity of

abdominal pain and the diagnosis of

associated conditions. The purpose of

this section was to examine the

prevalence of the symptoms of

irritable bowel syndrome and other

diseases of the lower digestive tract.

The final section contains information

on normative bowel habits and

identifies episodes of common boweI

complaints such as diarrhea and

constipation. Data derived from the

first and third sections of this survey

are presented in this report. A

facsimile of the digestive disorders

questionnaire is provided in ‘.Current

Estimates From the National Health

Interview Survey: United States,

1989” (12).

The “Technical notes” section

that appears at the end of this report

contains more information on the

survey design, sampling procedure,

and the NHIS questionnaire

document. Methods for constructing

approximate standard errors and tests

of significance for estimates and

percents presented in this report also

appear in these notes. The prevalence

estimates of the major digestive

disorders from the NHIS–DD are

compared with those routinely

generated from the basic NHIS

questionnaire. The reasons why these

estimates may differ are also

discussed. Unless otherwise noted,

the comparisons made within the text

are significant at the .05 level.

Tables 1 through 5 contain data

on the number and percent of

persons with selected major chronic

digestive disorders. These figures are

reported for those with the condition

in the last 12 months and those who

have ever had the condition by age,

sex, race, Hispanic origin, and poverty

status. In table 6 the prevalence of

chronic bowel complaints, such as

diarrhea and constipation, and the

use of medical care are presented.

For the purposes of this report, those

persons who report having

constipation or diarrhea most or all

of the time are classified as having a

chronic bowel complaint.

Results

Prevalence and onset

Of the major digestive disorders

reported in the NHIS–DD,

hemorrhoids were the most commonly

reported in the last 12 months and

for those ever reporting digestive

conditions. In the case of

hemorrhoids, the question of whether

the respondent ever had the

condition is worded slightly differently

from that for other conditions.

Respondents were asked if a doctor

ever diagnosed hemorrhoids, whereas

for other conditions respondents were

asked if they ever had the condition

with no mention of its medical

diagnosis. About 23 million adults

had hemorrhoids (12.8 percent of the

noninstitutionalizcd population) in

the last year, and 36 million

(20.3 percent) reported ever having

had hemorrhoids. Functional colon

conditions and ulcers were also fairly

prevalent. About 7 million peop[e had

functional colon conditions

(3.7 percent of the population), and

about 6 million people (3.5 percent)

had ulcers in the 12-month period

preceding the inter.’iew date. An

estimated 19 million people

(10.5 percent) reported ever having

had ulcers, and over 10 million

(5.9 percent) reported ever having

had functional coIon conditions.

Gallstones and gallbladder

trouble and diverticulitis affect fewer

people, although about 3 million

people had each of these conditions

in the last 12 months, About 14

mi[Iion reported ever having had

gallstones or gallbladder trouble, and

about 5 million reported ever having

had diverticulitis. In the 12 months

before the interview date, about 5.3

million people had chronic

constipation (about 3.0 percent of the

adult noninstitutionalized population)

and about 2.1 million adults had

chronic diarrhea (1.2 percent).

Among those who reportecl

having had a condition in the last 12

months, there are two major

subgroups –those for whom the

condition is ongoing and those for

whom the condition was first

identified in the last 12 months, An

estimated 1 million gallstones or

gallbladder cases \vere first diagnosed

in the last 12 months. This represents

about 39 percent of those conditions

reported in that time period. About

20 percent of those reporting ulcers,

or an estimated 1.3 million, were first

diagnosed in the previous year. An

estimated 1.3 million persons

developed functional colon conditions

in the last 12 months (18.6 percent of

persons with functional colon

conditions during that time period).

In the same period, 17.9 percent of

those persons with diverticulitis (an

estimated 476,000 persons) were first

diagnosed with the condition.

Two of the conditions reported in

the NHIS-DD represent composites

of numerous related conditions. The

ulcer group consists of gastric

(stomach) ulcer and duodenal ulcers.

Ulcers of either site may more

genera[ly be referred to as peptic

ulcers. Respondents could also report

other (excluding skin) ulcers without

further specification. For those

reporting ever having ulcers, the most

common diagnosis was a duodenal

ulcer (32.4 percent of the cases),
Advance Data No. 212 ● March 24, 1992 3

followed by peptic (27.0 percent),

gastric (19.2 percent). stomach

(12.1 percent), and other or not told

(9.3 percent).

The conditions grouped together

under the rubric “’functional colon

conditions” tend to be synonyms

rather than distinctly diagnosed

conditions. Among those persons with

functional colon conditions in the last

12 months, the most frequently

reported diagnosis was spastic colon

(39.2 percent), followed by irritable

bowel syndrome (30.6 percent),

irritable colon (14.8 percent), other

(14.0 percent), and functional bowel

(1.4 percent). The pattern of

diagnosis is similar among those who

report ever having the condition.

Sociodemographic

differences

As with most chronic conditions,

increasing age is highly related to the

lifetime prevalence of chronic

digestive conditions. The age gradient

is especially steep for gallbladder

trouble, ulcers. and diverticulitis.

Among men. the percent who ever

had @stones or gallbladder trouble

nearly doubles from 6.2 percent of

noninstitutionaIized adults aged 45-64

to 12.0 percent for those 65 and over.

Ulcers exhibit a similar pattern for

men. About 14 percent of men aged

45-64 report ever having ulcers. That

figure increases to 20.4 percent for

men 65 and over. Diverticulitis is also

much more prevalent among elderly

men and women. Nearly 10 percent

of the population 65 and over ever

had diverticulitis compared with

2.8 percent of the population of aII

ages. Among women, 4.8 percent of

those 45-64 report ever having

diverticulitis. This figure increases to

11.3 percent for those aged 65 and

over.

In general, women are much

more likely than men to report ever

having had digestive disorders and

bowel complaints, with the exception

of ulcers. See figure 1 for an

illustration of differences by age and

sex. These data support the clinical

impression and other survey data that

women have these conditions more

often than men (13-16). For nearly

all of the digestive disorders and

bowel complaints on which data were

collected, the percent of adult women

affected is nearly twice that of men.

About 11 percent of women 1Syears

of age and over ever had gallstones or

gallbladder trouble in contrast to

4.0 percent of men. Over 8 percent

of women reported ever having had

functional colon conditions, whereas

only 3.4 percent of men reported

having had these conditions. A little

over 1 percent of men reported being

constipated most or all the time in

the last 12 months in contrast to

nearly 5 percent of women.

Current digestive conditions are

especially characteristic of elderIy

women and, in fact, may be

understated, because elderly

women —especially those who are

functionally dependent – are more

likely to be institutionalized (17). Of

the noninstitutionalized female

population 65 years of age and over,

3.6 percent had gallstones or

gai[bladder trouble, 5.7 percent had

diverticulitis, 5.9 percent had

functional colon condition,

15.2 percent had hemorrhoids, and

6A percent were chronically

constipated in the last 12 months.

These percents are all significantly

higher than males in the same age

groups and some are significantly

higher than younger women.

The prevalence of chronic

digestive disorders is not consistently

related to race, ethnicity, or poverty.

In general, however, smaller

proportions of black persons and

Hispanics reported digestive

disorders; although within many of

the age categories, the estimates for

bIack persons are not statistically

reliable. Several explanations ha~’e

been offered for why black persons,

in particular, report fewer chronic

conditions (1S), First, the black and

Hispanic populations are younger

and, therefore, less likely to have

chronic conditions. Among the

statistically reliable comparisons that

can be made for all age groups,

however, a smaller proportion of

black persons are affected by these

digestive conditions. Second, a

medical diagnosis is often necessary

to identify these conditions and given

that bIack persons hat’e fewer

physician contacts than white persons,

these conditions may remain

undiagnosed (18).

One consistent difference is the

higher prevalence of chronic

constipation among black persons,

Hispanics, and the poor. Among

black persons, 4.3 percent of the

adult population were chronically

constipated in the last 12 months

compared with 2.8 percent of white

persons. Among Hispanics,

4.7 percent were constipated

compared with 2.9 percent of

non-HispanicS and among the poor,

5.4 percent compared with

3.5 percent of the nonpoor. The poor

were aIso more likely to have had

chronic diarrhea (1.9 percent of the

poor compared with 1.1 percent of

the nonpoor).

Medical diagnosis

In general, most digestive

disorders are medically diagnosed and

some form of diagnostic test is

performed when applicable. Over

95 percent of persons who reported

ever having gallbladder trouble.

ulcers, or diverticulitis were medically

diagnosed. Of those conditions,

gallstones or gallbladder trouble was

most likely to have been identified by

a diagnostic test (88.3 percent of

persons who ever had condition).

Approximately three-fourths of those

who reported ulcers and diverticulitis

also had diagnostic tests performed.

Persons who ever had functional

colon conditions are slightly less likely

to have had them medically diagnosed

(88 percent). Hemorrhoids are

medically attended in fewer cases. Of

those who ever report having

hemorrhoids, only 21 percent ever

had hemorrhoid surgery.

Medical diagnosis and testing

vary slightIy by age, race, ethnicity,

poverty status, and sex. The notable

comparisons, although not statistically

significant, are in the use of

diagnostic tests that may reflect

differences in the adequacy of health

care coverage (19). Slightly less than

70 percent of black persons who ever

had an ulcer had an upper GI series,
4 .Iirlvanrx! .. . . . .. ..- 13ata .“ -------- Nn 919- ●- March . ..-.”.. -T, 9A laa9 s“wfi

■ hlan QWoman

Qaltstonae colon Condttims

2s 12

s

a 10

if 15 8

;

s 10

e

j 4

&5

2

0 0 .

2Sr

10 1. m

8

r

Chrulic Constipedkxl

8.4

20.4

10

s

n

wets

14.1

OIJWLA

18-24

.—

2SU 45-84 8!5yaws 25-44

years years years srd Ww

18-24

years Wsrs z XCE%

Figure 1. Percent of persons 18 years of age and over who ever had selected digestive disorders by age and sex United States, 1989

upper endoscopy, or upper

gastroscopy performed as compared

with 73 percent of white persons. For

Hispanics with ulcers, 66.4 percent

had these procedures compared with

73 percent of non-Hispanics. The

comparison is similar and significant

for the poor and nonpoor. Finally,

although women are much more

likely to report ever having

hemorrhoids (24.2 percent of women

compared with 15.9 percent of men),

they are significantly less likely to

have had hemorrhoid surgery. Of

women who ever had hemorrhoids,

16.7 percent had surgeg’ in contrast

to 28.6 percent of men.

There is variation in the use of

over-the-counter remedies for

constipation by sociodemographic

groups, which parallels the prevalence

of chronic constipation. Over

14 percent of women 65 years of age

and over used stool softeners or

laxatives in the 30 days prior to the

interview. This compares with about

9 percent of men in the same age

group. Elderly black persons

(19.6 percent) also were more likely

to have used laxatives recently than

elderly white persons (11,4 percent).

The high rates of laxative use among

the general population (an estimated

10 million persons used these

remedies in the last 30 days) reported

in this study may also be a reflection

of the way in which the question was

worded. Respondents were asked

about a range of products, including

standard laxatives and also bulk and

fiber laxatives. Although they were

specifically asked about whether the

products were used to improve bowel

function, respondents may also be

using these remedies for other

reasons. Laxative use is also congruent with occasional constipation as

well as chronic constipation. An

estimated 31 million persons reported

being constipated some, most, or all

of the time in the last 12 months.
Advance Data No. 212 ● March 24, 1992 5

Comments

Digestive disorders and

gastrointestinal and bowel complaints

are often difficult to identify and

diagnose (20,21). The NHIS-DD

questionnaire provides an integrated

data source to identify not only the

specific conditions noted by the

respondent but also the sources and

nature of abdominal pain as well as a

detailed description of bowel

function. The abdominal pain and

,bowel function portions of the

questionnaire, which measure

symptoms, have proven effective in

other small-scale surveys in

identifying and discriminating among

a variety of gastrointestinal disorders

(22). The information contained in

these two portions of the NHIS–DD

\vilI be useful for both future

scientific analysis and for the

improvement of the identification and

treatment of digestive disorders (22).

In addition, further analysis can

be done on how digestive conditions

affect general health. The

NHIS-DD is linked to the basic

NHIS, which includes information on

self-assessed health status, limitation

of activity, reduced activity days, and

medical care utilization. Other

sociodemographic characteristics of

the sample individuals and their

families are also available. In addition

the NHIS-DD can be linked to

other special health topic

questionnaires in 1989. a list of which

appears in the technical notes.

A public use data file based on

the 19S9 digestive disorders

supplement is available. Information

regarding the purchase of the public

use tape and documentation may be

obtained by writing to the Systems

and Programming Branch, Division of

Health Interview Statistics, 6525

Belcrest Road, Hyattsville, MD

~~7~~.

References

1.

-.7

.3.

4.

5.

6.

7.

K

9.

10.

Graves EJ. National Hospital Discharge Sumey Annual Summary,

1988. National Center for Health Statistics. Vital Health Stat 13(106).

DeLozier JE, Gagnon RO. 1989

Summa~: National Ambulatory

Medical Cure Survey. Advance data

from vital and health statistic..; no

~03. Hvilttsville, Matylanci: Nationa]

Center- for Health Statistics. 1991.

Maurer KR, Everhart JE, Ezziiti TM,

Johannes RS, Knowler WC, Larson

DL. Sanders R, Shmvkcr TH, Roth

HP. P~evAence of gallstone disease in

Hispanic populations in the United

Sttites. Gastroen[erolog 96:487-92.

1989.

Sichieri R, Everhart JE, Roth HP.

Low incidence of hospitalization with

g~jlbladder disease among blacks in

the United States. Arn J Epidemiol

131:826-35.

JohanscmJF, Sonnenbetg A. The

prevalence of hemorrhoids [ml

chronic constipation: an

epidemiological study.

Gastroenterolo~ 9S:380-6. 1990.

Everhart JE, Go VLW, Johisnnes RS,

FitzSimmons SC, Roth HP, White

LR. A longitudinal sumey of selfreported bowel habits in the United

States. Dig Dis Sci 3.$:1153-62.1990.

Sandier RS, Jordon hfC, Shelton BJ.

Demographic and dietq

dctcrrnirmnts of constipation in the

U.S. population. Am J Public Health

so: 1S5-9. 1990.

Everhart JE, Renault PF. Irritable

bowel syndrome in ofiicc pmctice in

the United States. Gas[rocntero[ogy

100:99s-1005. 1991.

Talley NJ, Phillips SF, Twomey BB,

Zinsrneister AR. Melton LJ.

Relationship among personality and

symptoms in nonulcer dyspepsia and

the irritable bowel syndrome.

Gastroenterology 99:327-33, 199(J.

Sonnenberg A. Chtinges in physician

visits for gastric and duodenal ulcer in

the United States during 1958-S4 as

shown by National Disease and

therapeutic Index (NDTI). Dig Dis

Sci 32:1-7.1987.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

-)1-.

~’,

1

(

1

Kurta JH, Coroby ED. Current peptic

ulcer trends. An epidemiological

profle. J Clin Gastroenterol

10:259-68. 19S8.

Adams PF, Benson V, Current

estimates from the National Health

Interview Sumey, 1989. National

Center for Health Statistics. Vital

Health Stat 10(176). 1990.

Gee MI, Grace MG, Wensel RH,

Sherbaniuk RW, Thompson AB.

Nutritional status of gastroenterology

outp;itients: comparison of

inflammatory bowel disease with

functional disorders. J Am Diet Assoc

85(12):1591-9. 1985.

Johanson JF, Sonnenberg A, Koch

TR. Cliniual epidemiology of ’chronic

constipation. J C!in Gastroenterol

11(5):525-36. 1989.

Prior A, Wilson K, Whorwell PJ,

Faragher EB. Irritable bowel

syndrome in the gynecological clinic:

sumey of 798 new referrals. Dig Dis

Sci 1820-$.1989.

Sandier, RS. Epidemiology of irritable

bowel syndrome in the United States.

Gastroenterology 99(2):409-15. 1990.

Hing E, Bloom B. Long-term care for

the functionally dependent elderly.

National Center for Health Statistics.

Vital Health Stat 13(104). 1990.

Ries. P, Health of black and white

Americans, 19S5-87. National Center

for Health Statistics. Vital Health Stat

10(171). 1989.

Ries. P. Characteristics of persons

wi:h and without health care

coverage: United States, 1989.

Advance data from vital and health

stistis[ics; no 201. Hyattsvi]le,

Mtt~land: National Center for Health

Statistics. 1991.

Thompson WG, Heaton K\V.

Functional bowel disorders in

~pparcntly healthy people.

Sastroenterology :9:2S3-8. 1980.

Manning AP, Thompson lYG, Heaton

WY. Morris AF. Towards positive

iiagnosis of the irritable tm.vel. Br

Hed J 2:653-4. 197S.

ralley MJ, Phi!lips SF, Melton I.J,

\3’iltgen C, Zinsmeister AR. A patient

questionnaire to identi~ bowel

~isease. Ann Intern Med 111:671-4.

[989.
6 Advance Data No. 212 ● March 24, 1992

Table 1. Number and percent of persons 18 years of age and over with gallstones, gallbladder trouble, medically diagnosed conditions,

and diagnostic procedures performed, by selected sociodemographic characteristics: United States, 1989

Galtsmnes or Ever had Gallstones or Ever had

A// persons gal:z,adde, gallstones or Cond!tlon was Diagnostic ga//b/adder

18 years

gallstones or Condition was Diagnostic

froub e m last ga//b/adder medma//y

Characfenstic

Procedures troub/e in last ga//b/adder

and over’ 72 rnonms

ri7edica//y procedures

trouble diagnosed performec? 12 months trouble diagnosed performed

Percent of persons Percent of persons

Age Number of persons m thousands 1a yeara and over who ever had condition

18 years and over

18-24 years

25-44 years

45-64 years

65 years and over

Sex and age

Male, 18 years and over

18-24 years

2544 years

45-64 years

65 years arm over

Female

Female, 18 years and over

18-24 years

2544 years

45–64 years

65 years arm over

Race and age

White, 1.9 years and over

18-24 years ,, ..,...

25-44 years

45-64 years

65 years and over

Black, 18 years and over

18-24 years .

25-44 years

45–64 years,,, ., ,,,

65 years and over

Hlspamc ongm

Hlspanlc ..,,, .,,

Non-Hlspanlc

179,529

25.400

78796

46,114

29,219

85,257

12396

38,648

22,070

12,143

94.272

13,005

40,147

24,042

17,076

154,178

20,956

66.637

40.139

26445

19,932

3.562

9.204

4,712

2,454

13,029

166,500

16,225

149.290

2,691

“ 62

798

5-2

a59

757

-57

~45

311

244

1 934

:05

652

561

615

2435

q46

675

791

823

zoa

’16

:00

“63

“29

321

2.370

354

2,:16

13.702

303

3.257

4,790

5,352

13,411

272

3.156

4,701

5.282

12,095

213

2.825

4,406

4,651

3,399

70

516

1,358

1,455

10,303

234

2,741

3!431

3,a96

12,571

255

2,a45

4,391

5.oao

917

“48

341

294

234

869

12,833

1.543

1o.a45

3,303

“43

481

1,341

1,437

10,108

229

2,674

3,360

3.a45

12,295

224

2,746

4,310

5,015

908

“48

338

291

230

850

12,560

1,512

lo,61a

2,962

“35

401

t,226

1.300

9,134

179

2,424

3,180

3,350

11.128

165

2.469

4<071

4,424

780

“48

294

244

194

714

1I ,3al

1,322

9,651

1.5

06

1.0

1.9

29

0.9

“0.5

0.4

1.4

2.0

2.1

0.8

1,6

2.3

3.6

1.6

0.7

1.0

2.0

3.1

1.0

“0.4

1.1

●1,3

“1.2

2.5

1.4

2.2

1.4

7.6

1.2

4.1

10.4

18.3

4.0

0.6

1.3

6.2

12,0

10.9

1.6

6.6

14.3

22a

8.2

1.2

4.3

10.9

19.2

4,6

●1.3

3.7

6.2

9.5

6.7

7.7

9.5

7.3

97.9

89.8

96.9

96.1

98.7

97,2

●61 .4

93.2

96.7

96.8

98.1

97.9

97.6

97.9

9a.7

97.8

87.8

96.5

98.2

98.7

99.0

●1OO.O

99.1

99,0

98.3

97a

97.9

96.0

97.9

Poveny status

Below poverry threshold

At or above poverly

threshold.

‘Includes persons of all races and unknown pove.Ty Saws

‘tllagnostlc lesls Ioclude x-ray, Sonogram or ultrasound a.!z uflpe, G I ser,e$,

NOTE Estrmates of less than 68.000 and percents based cm qese eswnates have 30 percent or more relatwe standard error; see techmcal notes for description of the Calculation of standard errors.

68.3

70.3

86.7

92.0

86.9

87.1

“0.0

77.7

90.3

69.3

88.7

76.5

68.4

92.7

66.0

88.5

64.7

86.6

927

87.1

85.1

●0.0

66.2

63.0

82.9

82.2

66.7

85.7

89,0
Advance Data No. 212 ● March 24, 1992 7

Table 2. Number and percent of persons 18 years of age and over with ulcers, medically diagnosed conditions, and diagnostic

procedures performed, by selected sociodemographic characteristic= United States, 1989

A// persorrs Ulcers Condfbon was Diagnost~c Ulcers Condition was Diagnostic

18 years in /asr Ever had medcaily procedures in last

Characteristic

Ever had

and over’

n?adically procedures

12 months ulcers diagnosed performe$ 12 monms ulcers diagnosed performed

Age

lS years And over . . . . . . . .

lS-24 years . . . . . . . . . .

2544 years . . . . . . . . . .

45-64 years . . . . . . . . . .

65 years and over . . . .

Sex and age

Male. 18 years and over . . . .

18-24 years . . . . . . . . . .

25-44 yeara . . . . . . . . . .

45-64 years . . . . . . . . . .

65 years and over . . . . . .

Female. 1EIyears and over .

lS-24 years . . . . . . . . . .

2344years . . . . . . . . . .

45-64 years . . . . . . . . . .

65 years and over . . . . . .

Race and age

White, 18 years and over .

18-24 years . . . . . . . . . .

2544years . . . . . . . . . .

45-64 years . . . . . . . . . .

65 years and over . . . .

Black, 18 yeare and over. . . .

18-24 years . . . . . . . . . .

25+$4 years . . . . . . . . . .

45-64 years, . . . . . . . . .

65 years and over . . . . . .

Hispanic ongm

Hlspamc., . . . . . . . . . . . .

Non-Hispanic. . . . . . . . . . .

Poveny status

Below poverty threshold . . . .

At or above poverty

threshold . . . . . . . . . . . . .

Number of persons in thousands

179.529

25.400

78.796

46.114

29.219

85,257

12.396

3&648

22.070

12,143

94,272

13.005

40.147

24.044

17.076

154.178

20,956

66,637

40,139

26.445

19,932

3,562

9,204

4,712

2.454

13.029

166.500

16,225

149,290

6,295

700

2.391

1,861

1,343

2,754

286

1,120

796

!572

3,541

434

1,271

1.064

771

5,376

630

1,996

1,556

1,194

763

●42

322

252

147

397

5,897

922

4,769

18,849

1,336

6,669

5,959

4,864

9.442

476

3,37a

3.111

2,477

9.407

861

3,311

2,848

2,387

16.735

1.198

5,795

5.226

4,516

1,766

106

720

604

336

909

17,940

1,910

15,296

la,lo2

1.177

6.327

5,837

4,761

8,969

374

3,147

3,038

2,410

9.133

803

3,180

2.770

2,351

16,106

102

5,493

5,135

4,416

1,682

6:

576

333

a54

17,249

1,781

14,714

13,660

557

4,480

4,863

3,760

6,80a

144

2,236

2,492

1,928

6.860

413

2,245

2,371

1,831

12,217

512

3,644

4,352

3,508

1,230

●36

542

408

244

604

13.056

1,257

11,174

Percent of persons

18 years and over

3.5

2.8

3.0

4.0

4.6

3.2

2.1

2.9

3.6

4.7

3.8

3.3

3.2

4.4

4.5

3.5

3.0

3.0

3.9

4.5

3.8

●1.2

3.5

5.3

6.0

3.0

3.5

5.7

3.2

10.5

5.3

a.5

12.9

16.6

11.1

3.8

8.7

14.1

20.4

10.0

6.6

8.2

11.8

14.0

10.9

5.7

8.7

13.0

17.1

:;

r.a

12.6

13.7

7.0

10.8

11.8

10.2

Percent of persons

who ever had condition

96.0 72.5

88.1 41.7

94.6 67.0

98.0

97.9

95.0

78.6

93.2

97.7

97.3

97.1

93.3

96.0

97.3

98.5

96.2

8.5

94.8

96.3

97.8

95.2

82.1

95.3

95.4

99.1

93.9

96.1

93.2

96.2

81.6

77.3

72.0

30.3

66.2

80.1

77.8

72.9

48.0

67.8

63.3

76.7

73.0

42.7

66.3

83.3

77.7

69.6

‘34.0

75.3

67.7

72.6

66.4

72.8

65.8

73.1

‘ Includes persons of all races and those of unknown povetiy .slafus,

2D!agnostctestsinclude upper G.1. series or upper endoscopy or gastroscopy.

NOTE.Est]matesoflesslhan 68,0C0 arvs percents based on lhese esumateshave 30 percenf or mofe relatwe arancard arroc see lechmcal notes for descnp!mn of rhe celculatmn of slandard errors.
8 Advance Data No. 212 ● March 24, 1992

Table 3. Number and percent of persons 18 years of age and over with diverticulitis, medically diagnosed conditions, and diagnostic

procedures performed, by selected sociodemographic characteristics: United States, 1989

A!!De,so-s Dwert/cuMs Condition was Djagrrosfic Divertjcu/ifis Cond/t/on was flagnostjc

18 years m /asf Ever had rnedica//y procedures m last Ever had medics//y procedures

CharacterM/c and ewe-’ 12 months dwerncuhffs diagnosed performe$ 12 morrfhs diverlimditis d!agnosed performed

Percent of persons Percent of persons

Age 18 years arid over who ever had condition

18 years and over .

18-24 years ,., ,,, ,,,

2544 years,,.,..

45-64 years

65 years and over

Sex and age

t.lale. 1E years and over

18-24 years... ,., ,,,

2544 years

45-64 years.., ,., ,,

65 years and over

Female, 18 years and over

18-24 years

25-$4 years

45-64 years

65 years and over

Race and age

~~~hite,18 years and Over

16-24 years

2544years..I.I “.’

45-64 years

65 years and over : :

B!ack, 70 vears and over,

18-24 years

25-44 years

45-64 years

65 vears and over

Hlspan(c orlgln

Hlspamc

Non-H! spanlc,

Poverty s!atus

Below poverty threshold

R or aoove poverly

tnresnold. ., .,,.

Number of persons m thousands

179,525

25,40C

78796

46,114

29.21S

2.662

“2

259

966

1.435

5,093

“17

520

1 750

2,808

4,698

“17

446

1.698

2.738

3,791

“2

311

1.375

2,103

1,199

●o

93

442

664

2,592

“2

218

933

1,439

3,671

●2

280

1.329

2,060

94

“o

●23

●32

●39

“65

3,726

223

3,173

1.5

‘0.0

0.3

2.1

2.8

‘0.1

0.7

3.8

9.6

96.2

●1OO.O

85.8

97.0

97.5

74.4

●11.a

59a

78.6

74.9

74.2

“0.0

69.4

73.9

75.6

74.5

‘16.7

56,6

81.0

74,6

74.5

*11.8

57.6

79.1

75.1

67.1

‘0.0

“92.0

*58.2

“65.0

●58.6

74,8

71.9

74.4

4.9

65.257

12,396

38 64@

22.072

1~,143

94,272

13005

40.147

24,044

17.076

828

‘o

74

295

459

1,834

“2

165

671

976

1,615

“5

134

598

878

3.479

“12

385

1.152

1,930

1,569

*5

110

576

876

3,329

“12

336

1,120

1,862

1.0

‘0.0

0.2

1.3

3.8

1.9

‘0.0

0.3

2.7

7.2

97.2

●1OO.O

82.1

96.7

99.8

1.9

“0.0

0.5

2.6

5.7

3.7

“0.1

1.0

4.8

11.3

95.7

*1OO.O

87.3

97.2

96.5

154,178

20,956

66,637

40,139

26,445

19,932

3.562

9.20a

4,712

2,454

2,570

‘2

249

913

1,406

69

“o

“2

’39

’29

4,927

“17

486

1.680

2,744

140

“o

●25

“55

●6O

4,734

“17

412

1,631

2.674

138

“o

“25

“53

“60

1,7

‘0.0

0.4

2.3

5.3

3,2

‘0.1

0.7

4.2

10.4

0.7

●0.O

“0.3

“1.2

“2.4

96,1

‘1OO,O

84,8

97.1

97.4

98.6

‘0.0

●1OO.O

*96.4

*1 OO.O

0.3

*0.O

“0.0

“0.8

●1.2

13,029

166.500

●56

2,606

111

4.982

96

4,802

“0.4

1.6

0.9

3.0

86.5

96.4

16.225

149,290

135

2.292

310

4,266

284

4,115

0.8 1.9

2.9

91.6

1.5 96.5

1

Incluaes persons of all races ald !!xse of ununo$..- DOVe~ status.

23,agn0src tests mcluae Dar,um ene-a ana over c?: hOspMzzal,On

NOTE Est!mafes of less than 6a,000 a-e percents $ased on these eshmales have 30 percent or more retatwe standard erroc see techmcal notes for descnpt(on of the calculation of standard errors,
Advance Data No. 212 ● March 24, 1992 9

Table 4. Number and Percent of Persons 18 years of age and over with functional colon conditions and medically diagnosed conditions,

by selected Sociodemographic characteristics: United States, 1989 -

All ~ersons Colon cond!trons condit[on was Colon cond]tjons Condd;on was

18 years m /asf Ever had medJca//y in /asf Ever had

Gharacfer/stic ana over’

r77ed/Ca//y

12 rrron?hsz colon conolffons diagnosed 12 n?on:hs colon cond!~ons d)agcosed

Age

18 years Andover. . . . . . . . . . .

f8-24 years . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . .

65 years Andover . . . . . . . . . . .

Percent of persons Percent of persons

Number of persons m thousands 18 years and over who ever had condltlon

179,529

25,400

78,796

46.114

29,219

6,719 10,532

348 457

2,641 4,164

2,406 3.666

1.322 2,225

9,271

406

3,636

3,244

1.983

3.7 5.9 88.0

1.4 1.8 88.8

3.4 5.3 67.4

5.2 6.0 88.0

4.5 7.6 89.1

Sex and age

Male, 18 years and over. . . .

18-24 years . . . . . . . . . . . . . . .

2S-44 years . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . .

65yeare And over . . . . . . . . . . .

Female, 18 years and over . . . . . .

18-24 years . . . . . . . . . . . . . . .

25-$4 yeare . . . . . . . . . . . . . . .

45-64 yeare, . . . . . . . . . . . . . .

65 years And over . . . . . . . . . . .

85,257

12,396

36,648

22.070

12,143

94.272

13.005

40,147

24,044

17,076

1,668 2,934

“62 88

664 1.160

620 1,013

321 672

5,031 7.596

286 369

1,957 3,004

1,788 2,672

1,001 1,553

2.568

’60

1,020

899

589

6,704

346

2.619

2.345

1,395

2.0

*0.5

1,8

2.8

2.6

3.4 87.5

0.7 *68.2

3.0 079

4.6 88.7

5.5 87.6

5.3

2,2

4,9

7.4

5.9

8.1 88.2

2.8 938

7.5 672

11.1 87.8

9.1 896

Race and age

White, 18 years and over . . . . ,

18-24 years . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . .

45-64 years.........,,, ,.

65 years And over . . . . . . . . . . .

Black. 18 years and over . . . . .

18-24 years . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . .

45-64 years............,..

65 years And over . . . . . . . . . . .

4.2

1.6

3,7

5.8

4.9

6.5

2.1

5.8

8.8

8.3

88.2

89,4

87.7

88.0

69.1

154.178

20,956

66,637

40,139

26.445

19,932

3,562

9,204

4.712

2.454

6,411 10,070

338 444

2,452 3.898

2,330 3,544

1,290 2.184

240 355

“10 “13

143 194

%4 116

“23 “32

8.881

397

3.420

3.118

1.947

318

●9

176

105

*27

1.2

*0.3

1.6

“1,4

90,9

1,8

“0.4

2.1

2.5

“1.3

89.6

*69.2

90.7

90.5

“64 4

Hlspamc ortgm

H!spamc, . . . . . . . . . . . . . . . . ,.

Non-Hispanic . . . . . . . . . . . . . . . .

13.029

166.500

260 350

6.459 10.182

304

8,967

20 2.7 869

3.9 6.1 88.1

Poveily status

Below poverly threshold. . . . .

At or above poverty threshold . .

16,225

149,290

488 616

5,869 9,339

3.0 3.8 90.3

3.9 6.3 87.8

556

8.198

‘ ‘ficludes persons of all races and those of unknown poverty status.

“~cluc!es spasm colon. funcnonal bowel. tintable colon, and rrntaole bowel syntis~e.

NOTE. Estimates of less than 68,OOO and percents based on these esllmales have:9 percent or more re!avve standard e,.oc see !echn$al news fo. descrpl,on o! ,he ca!cu!at.on of a.afidard erro.s.
10 Advance Data No. 212 ● March 24, 1992

Table 5. Number and percent of persons 18 years of age and over with hemorrhoids and medically diagnosed conditions, by selected

sociodemographic characteristics: United States, 1989

All persons Hemorrhoids Docfor ever Ever had Hemorrhoids Doctor ever Ever had

18 yeara m last diagnosed hemorrhoid in last diagnosed hemorrhoid

CharacterMic anti over’ 12 months fremorrhofcfs surgery 12 months hemorrhoids surgery

Age

18 years And over . . . . . . . . . . .

18-24 years, . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . .

45-64 years,,,..,,,,.

65 years and over

Sex and age

Male, 18 years and over.

18-24 years . . . . . . . . . . . . . . .

25-44 years . . . . . . .

45-64 years.. . . . . . . . . . .

65 years And over... . . . . .

Female, 18 years and over .

18-24 years . . . . . . . . . . . . . .

25+4 years . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . .

65 years Andover..

Race and age

White, 18 years and over . .

18-24 years . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . .

45-64 yeara, . . . . . . . . . . . . .

65 years And over . . . . . . . . .

Black, 16 years and over . .

16-24 years . . . . . . . . . . . . . . .

25–44 years...

45-64 years, . . . . . . . . . . . . .

65yearsandovet. .

Hispamc ongm

Hispanic . . . . . . . . . . . . . . . . . . .

Non-Hlspan!c . . . . . . . . . . . . . . . .

Poverty status

Below poverty threshold .

At or above poverty threshold . .

Number of persons m thousands

Percent of persons

18 years and over

Percen: of persons

who ever had hemorrhoids

179,529

25.400

78,796

46,114

29,219

65.257

12,396

36,648

22,070

12,143

94<272

13.005

40,148

24,041

17.076

154,176

20.956

66.637

40,139

26,445

19.932

3.562

9,204

4712

2.45.4

13,029

166,500

16.225

149.290

23.016

1,481

10,291

7,143

4,101

9,173

429

3,981

3.250

1.512

13.843

1,052

6.310

3.892

2.589

20.955

1,244

9.250

6.611

3.895

1,682

199

854

448

180

1.132

21,863

2.024

19.666

36,373

1,262

14,034

12,578

8,496

13,528

213

4.506

5,466

3,343

22,844

1,049

9,528

7.112

5,155

33,164

1,053

12,526

11.529

6.076

2,740

195

1,255

922

367

1,598

34,774

2.834

31,136

7,688

73

1,382

3,059

3,175

3,872

“32

748

1.650

1,442

3,816

●4O

633

1.409

1.733

7,122

●55

1.200

2,820

3,047

470

“8

147

201

114

240

7.446

512

6,483

12.8 20.3

5.6 5.0

13.1 17.8

15.5 27.3

14.0 29.1

21.1

5.8

9.8

24.3

37.4

10.6 15,9

3.5 1.7

10.9 12.3

14.7 24.8

12.5 27.5

14.7 24.2

6.1 8.1

15.7 23.7.

16.2 29.6

15.2 30.2

13.6 21.5

5.9 5.0

13.9 18.8

16.5 28.7

14.7 30.5

8.4 13.7

5.6 5.5

9.3 13.6

9.5 19.6

7.3 15.0

8.7 12.3

13.1 20.9

12,5 17.5

13,2 20.9

28.6

“15.0

16.6

30.2

43.1

16.7

‘3.8

6.6

19.8

33.6

21.5

*5.2

9.6

24.5

37.7

17.2

“4,1

11.7

21.8

31.1

15.0

21.4

18.1

20.8

‘Includes persons of all races an~ lnose of unknown poveny status

NOTE: Eattmales of Ieaa than 68.000 and percents based on these esomates have 30 percent or n’wre reladve slandarti erroc see lechncel notes for deacriplion of lhe calculation of standard errors.
Advance Data No. 212 ● March 24, 1992 11

Table 6. Number of persons 18 years of age and over reporting bowel complaints and selected treatments, by selected

sociodemographic characteristics: United States, 1989

Used stoc:

Chronic Used stool Chronic Saw a doctor Chronic softner or Chronic Saw a doctor

All persons consflpatlon softner or diarrhea for diarrhea wnstrpatlon kwafive diarrhea for d]arrhea

18 yeara m last krxarwe m in last in last in last in last in last m [asr

Characferrstic and eve? 12 morrt& last 30 days 12 month.# 12 months 12 months 30 days 12 months 72 months

Age

18 years And over . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . .

65 years And over . . . . . . . . . . .

Sex and age

Male, 18 years and over. . . .

18-24 years . . . . . . . . . . . . . . .

25-14 years . . . . . . . . . . . . . . .

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

65 years And over . . . . . . . . . . .

Female, 18 years and over . . . . . . .

18-24 years . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . .

65 years And over . . . . . . . . . . .

Race and age

White, 18 years and over . . . . . . . .

16-24 years . . . . . . . . . . . . . . .

2544years . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . .

65 years And over . . . . . . . . . . .

Black, 18 years and over . . . . . . . .

18-24 years . . . . . . . . . . . . . . .

25-14 years . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . .

65years And over . . . . . . . . . . .

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . .

Non-hispanic . . . . . . . . . . . . . . . .

Number of persons in thousands

179,349

25,400

78,754

46.053

29.142

85.146

12.396

38.617

22.043

12.091

94.203

13,005

40.136

24.010

17.502

154.012

20.956

66.602

40.085

26.369

19.918

3,562

9,197

4,705

2,454

13,021

166,328

16,211

149.172

5.374

504

1.887

1,431

1,552

999

80

251

239

428

4,376

424

1,636

1,192

1,124

4.378

387

1,454

1,170

1,367

854

109

367

206

172

610

4,764

868

3,808

10,107

670

3.074

2.852

3.510

2.232

136

513

539

1.044

7,875

534

2.561

2.313

2.466

8,272

558

2,414

2.298

3,002

1,698

105

607

504

482

774

9,332

1,262

7,830

2.131

233

837

634

428

584

●49

211

201

123

1.547

183

626

433

304

1,922

187

748

572

415

150

●46

●51

●44

●lo

109

2,022

316

1.653

3.789

302

1,374

1,176

936

1.142

87

405

367

283

2.646

216

969

809

653

3,453

259

1,193

1,106

695

244

●35

130

“46

●33

207

3,582

397

3.160

Percent ot perscns 18 years and over

3.0

2.0

2.4

3.1

5.3

1.2

0.6

0.6

1.1

3.5

4.6

3.3

4.1

5.0

6.4

2.8

1.8

2.2

2.9

52

4.3

3.1

4.0

4.4

7.0

4,7

2.9

5.6

2.6

3.9

5.2

12.0

1.2

0.9

1.1

1.4

1.5

26

1.1

1.3

2.4

8.6

8.4

4,1

6.4

9.6

14.1

5.4

2.7

3.6

5.7

11.4

8.5

2.9

6.6

10.7

19.6

5.9

5.6

7.8

5.2

0.7

*0.4

0.5

0.9

1.0

1,6

1.4

1.6

1.6

1.7

1.2

0.9

1.1

1.4

1.6

0.8

*1 .3

“0.6

‘0.9

“0.4

0.8

1.2

1.9

1.1

Poverly statfJs

Below poverly threshold. . . . . . . . . 5.4

At or above poverty threshold . . . . . 2.6

1Includes persons Of all races and those of unknown IXIvsrly Status: excludes those who refused 10 answer bowel haimts poruon of the quesl,orma,re and thOse Fe-sons w!th Colostomies.

‘Chrome constnparmn and .aarrf tea are defined as those persons wnh consttpauon or dtarrhea most or all of the time [n [he laSt 12 mon!hs.

NOTE Eshmates of less than 68,000 and percenls based an these estimates have 30 percent or more rela!we srandard error; see Iechmcal noteS fcr descr,pt on cf ‘-e calcba!!onOfstandard errors.

2.1

1.2

1.7

2.6

3.2

1.3

0.7

1.0

1.7

2.3

2.8

1.7

2.4

3.4

3.7

2,2

1.2

1.8

2.8

3.4

1.2

●lo

●1 4

●I o

●1.3

1.6

2.2

2,4

2.1
12 Advance Data No. 212 ● March 24, 1992

Technical notes

Source and

description of data

The estimates presented in this

report are based on data from the

1989 h’ational Health Interview

Survey OJHIS), an ongoing survey of

households in the United States

conducted by the National Center for

Health Statistics. Each week. a

probability sample of the cii’ilian

noninstitutionalized population of the

United States is interviewed by

personnel of the U.S. Bureau of the

Census. Inteniewers obtain

information about the health and

other characteristics of the

households included in the NHIS

sample.

NHIS consists of two parts: (a) a

basic health questionnaire that

remains the same each year and (b)

special topics questionnaires that vary

from year to year and usually are

asked of just one person in each

family. In 1989, the special topics

included health care coverage. adult

immunization, severe and persistent

mental illness, dental health. diabetes,

orofacial pain, digestive disorders,

and acquired immunodeficiency

syndrome (AIDS) knowledge and

attitudes.

The total interviewed sample for

1~~~ for the basic health

questionnaire consisted of 45.711

households containing 116,929

persons. The noninterview rate was

5.1 percent. NHIS digestive disorders

(NHIS-DD) interviews were

completed for 4?.392 persons 18 years

of age and over. or 90.7 percent of

those NHIS–DD sample persons

identified from the basic health

questionnaire (approximately 46,756

members of families were identified).

The overall response rate for the

NHIS-DD was 86.1 percent (the

product of the response rates for the

basic and digestive disorders

questionnaires).

Sampling errors

Because estimates shown in this

report are based on a sample of the

population rather than on the entire

population. they are subject to

sampllng error. When an estimate or

the numerator or denominator of a

percent is small, the sampling error

may be relatively high. In addition,

the complex sample design of NHIS

has the effect of making sampling

errors larger than they would be had

a simple random sample of equal size

been used. Estimates and figures

based on estimates that do not meet

the reliability criteria of 3(I percent

relative standard error are marked on

the tables.

Approximate standard errors of

the estimated numbers (x) in the

tables (except for age, sex, and race

for all persons when the standard

error is assumed to be 0.0) may be

calculated using the formula

SE(.V) = ~.000021(x)z + 6,1OO(X)

For example, it is estimated that

2.691.000 persons had gallstones or

gallbladder trouble in the last 12

months (table 1). Using this formula,

the standard error for the estimated

number is

SE(2.691,000) =

~.W.N21(Z691,@ + 6,1W2691,WO)

= l~g,714

Approximate standard errors of

the estimated percents in the tables

may be calculated using the formula

SE(p) = ~ 6,100(p) (1OO-P)

Y

where p is the percent of persons and

y is the base population from which

the percent is calculated.

For example, it is estimated that

10.5 percent of the population has

ever had ulcers (table 2). Using this

formula, the standard error for the

estimated percent is

SE(10.5) = ~6,100(10.5) (100-10.5) = .18

179,529,000

Ifxl and Xzare two estimates,

then the approximate standard error

of the difference (x, -J-J can be

computed as follows:

SE(X, -xz) =

\/SE(x,)~ + SE(XJJ - 2r SE(X,)SE(XJ

where SE(X1) and SE(XJ are

computed using the appropriate

formulas previously presented in this

section and r isthe correlation

coefficient between xl and X2.

Assuming r = 0.0 willresult in an

accurate standard error if the two

estimates are actually uncorrelated. If

they are correlated, the standard

error of the difference will be

underestimated or overestimated.

These calculations can also be

performed for differences in percents

using the appropriate standard error

formulas for percents.

In this report, differences are

considered statistically significant at

the 5-percent level if the difference

between two estimates was at least

twice as large as its standard error.

Further information on how tht:

standard error parameters are

constructed is available in “Current

Estimates From the National Health

Interview Survey: United States,

1989” (12).

Comparison to basic

NHIS estimates

Prevalence estimates of digestive

disorders routinely reported from the

basic portion of NHIS are likel:y to

differ from those presented in this

report. Two survey design differences

between the basic NHIS and the

NHIS-DD may affect the

comparability of the estimates. First,

the questions from the basic NHIS

may be answered by one respondent

for all members of the family when

other members are not present,

Approximately one-third of the

responses for adults on the basic

NHIS are by prox? respondents.

However. the questions on the

NHIS-DD are ans~vered only by the

sample individual. This difference in

reporting may be especially

problematic for the less serious and

more personally sensitive conditions

such as hemorrhoids, chronic

constipation, and diarrhea as the

household respondent in the basic

NHIS may not know’ about these

conditions.

The manner in which the

conditions are identified also differs

between the basic ?SHIS and the
Advance Data No. 212

● March 24, 1992 13

NHIS-DD. In the basic NHIS,

the prevalence of chronic conditions

is estimated by dividing the entire

sample into six representative

subsamples. Respondents within each

subsample are administered one of six

condition checldists. only one of

which contains chronic digestive

conditions, and are asked if any

family member has each condition. In

the NHIS-DD-supplement, all

respondents were asked specific

questions about major digestive

disorders anda series of followup

questions on each reported condition.

Other reasons why the prevalence

estimates may differ between the 1989

basic NHIS and the NHIS-DD

include differences in nonresponse

rates and the specificity of

terminolo-g related to the condition.

In addition, the NHLS–DD asked

respondents whether they had the

particular condition in the past 12

months and whether they had ever

had the condition. The basic NHIS

queries the respondent about the last

1~ months on]y< For conditions that

are ongoing, the two-part question

may improve reporting on the

presence of the condition in the last

1~ months+ Finally, those with an

identified digestive condition in the

NHIS-DD were asked if the doctor

made the diagnosis and if appropriate

medical care had been given or

diagnostic tests performed. These

questions help assure that the

respondent had an appropriate

evaluation. although they cannot

assure that the diagnosis was correct

or the respondent remembered or

was told the appropriate diagnosis.

The reported prevalence of

digestive disorders in the basic

,questionnaire of the NHIS are

significantly lower than those

estimated from the NHIS-DD. These

comparative estimates are presented

in table 1. In the case of uIcers and

functional co[on conditions. part of

the difference is definitioncd. In the

NHIS-DD respondents are givena

Table 1. Estimated number of persons

18 years of age and over with major

digestive disorders by survey instrument

United States, 1989

Estimated Esrrrrafed

from basic from

Digestive cortdltion NHIS in NHLS-DD m the /asf 72 monfhs fhousands in thousands

Gallstones or

gallbladder trouble, 1,818 2.691

Ulcers’.......... 4,095 6.295

Divertlcuhtls.... 1,983 2.662

Functional colon

condltlonsz.... 1.328 6,719

Hemorrhoids 11,446 23,016

Constlpat10n3. 4,006 5,374

‘Ulcer defined In the basic National Health Intew[ew Stalmca

(NHIS) as gastr!c, duodenal, pepllc, gastroje]unal, and ulcer of

the esophagus ([CD 531+ and 530.2). Ulcer definsdm lhe

NHIS dlgesnve dksorders (NHIS-GD) aa gastric, duodenal,

~ePnc. stomach, and other exdudmg skin.

Functional colon conamonsm the CiasrcNHIS are defined as

rmtable bowel ememspasm, rmtab!e 00W1 syndrome. mucous

COIIIIS. and spastc colon. Functional colon conamons aefined m the NHIS-DD as Mable bowel syndrome. irritable colon,

$pasuc colon, funcuonal bowel. a“d olher svmkv condmns.

Constlpatmn IS defined as ‘“frequent”’ Const!pawanm the

baste NHIS and as consopat!on most or all of the llmem the

NHIS-DD

structured set of definitions for

identifying their condition

immediately following the query

about the condition. In the basic

NHIS, once the condition of “ulcer”

or “spastic colon” is identified, the

respondents supply information

through followup questions. The

information is then Iater used to

classify the condition according to

specific diagnosis categories.

The lower estirrates for

hemorrhoids and constipation in the

basic NHIS are to be expected given

that neither is likely to be medically

diagnosed or attended. Asa result,

proxy respondents are less likely to

know about the occurrence of the two

conditions among family members. In

addition, respondents to the basic

NHIS are asked about hemorrhoids

ina condition list that includes

cardiovascular diseases. whereas the

NHIS-DD groups them with digestive

conditions. The grouping in the basic

NHIS may lower the response rate

because respondents do not identify

hemorrhoids with heart disease or

hypertension.
Advance Data No. 212 ● March 24, 1992 15

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 standards of

reliability or precision

# Figure suppressed to comply with

confidentiality
Number 213 . April 30, 1992

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

National Ambulatory Medical Care Survey: 1990

by Susan M. Schappent, M.A., Division of Health Care Statistics

Summary

During the 12-month period from

January 1990 through December

1990, an estimated 704.6 miIIion visits

were made to nonfederally employed,

office-based physicians in the United

States, or about 2.9 visits per person.

This rate is not statistically different

from office visit rates observed since

1975 (1,2).

This report presents data

highlights from the 1990 National

Ambulatory Medical Care Survey

(NAMCS), a national probability

sampIe survey conducted by the

Division of HeaIth Care Statistics of

the National Center for Health

Statistics, Centers for Disease

Control. The data summarized here

should be considered provisional

because final editing may resuIt in

minor changes in the estimates.

Statistics are presented on patient,

physician, and visit characteristics.

Because the estimates presented

in this report are based on a sample

rather than on the entire universe of

office visits, they are subject to

sampling variabiIi~. The technical

notes found at the end of this report

give a brief overview of the sample

design used in the 1990 NAMCS, an

explanation of sampling errors, and

guidelines for judging the precision of

the estimates.

The Patient Record is used by

physicians participating in the

NAMCS to record information about

their patients’ office visits. This form

is reproduced in figure 1 and is

intended to serve as a reference for

readers as they review the sumey

findings presented in this document.

The physician sample for the

NAMCS was selected with the

cooperation of the American Medical

Association and the American

Osteopathic Association. Their

contribution to this effort is gratefully

acknowledged.

Data highlights

Patient characteristics

Office visits by patient’s age, sex,

and race are shown in table L

Females made about 60.6 percent of

all office visits during 1990, and

accounted for a higher percentage of

visits than males in alI age categories

except the youngest (under 15 years).

FemaIes also had significantly

higher visit rates than maIes did in

each age categoxy with the exception

of the youngest group (under 15

years) and the two oIdest groups

(65-74 years and 75 years and over).

Visit rates tended to increase

with age after the age of 24. Persons

aged 65–74 years and 75 years and

over had the highest visit rates of alI

age categories; rates for these two

groups did not differ significantly

from each other. The pattern,

however, was found to be slightly

different for maIes and females.

Among maIes, rates increased with

each age group after the age of 44,

with maIes aged 75 years and over

having the highest rate of 5.4 visits

per person.

Females, despite a general trend

toward increasing visit rates with age

after the age of 24, showed no

statistical difference in the rates for

femaIes aged 25=44 years compared

with those aged 45-64 years. or in the

rates for females aged 65-74 years

compared with those aged 75 years

and over.

White persons made

approximately 84.8 percent of all

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Sem<ce

Centers for Disease Control

Manning

National

Feinleib,

Center

M.

for

D.,

Health

Dr. P.

Statistics

H., Director CSNTSRS CDC FOR OISEASE CONITJOL
2 Advance Data No. 213. April 30,1992

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C.nt.I

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St.tl,tlm A

1 .DATE OF VISIT PATlENT RECORD

~

OMS No. 0!)200234

NATIONAL AMBULATORY MEDICAL CARE SURVEY

Expirw8-31-S9

[PAS)6105A

2azlPcoDE 4-SEX 5. CCI)R OR

1

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9 PATlENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER

“REASONIS) FOR THIS VISIT {In pcment’s own wordsJ

a MOST IMPORTANT

b O’7HER

&ErHNlcrTY 7.;:EX~~E~::p~j OF PAYMENT 8 WAS PATIENT

“ REFERREOFOR

THIS VISIT BY

HISPANIC 1 ❑ SELF*AY 4 ❑ ~:: fl:~ 7 ❑ NO CHARGE

‘ ❑ ORGIN

ANOTHER

PHYSICIAN?

OTHER COMMERCIAL

2 ❑ M~lCARE 5 ❑ lNSUPAf4CE 8 ❑ o&~y,

2 •l &JANK

lDYSS 2[-JNO

3 m MEOICAIO 6 m FwE-pAIo MMn,,o*,eDnPLAN

10. PHYSICIAN’S DIAGNOSES

,, F81NCIPAL DIAGNOSIS/TROSLEM ASSOCIATE WITH ITEM 9s.

b OTHER SIGNIFICANT CURRENT OIAGNOSES

I z. ;:;:~::~;jS~R:~~:d~~WCES THIS VISIT

1 ❑ NONE 7 ❑ BLOOD PRESSURE CHECK 13 ❑ ORAL GLUCOSE TOL

2 ❑ PAP TEST 8 ❑ URINALYSIS 14 ❑ CHOLESTEROL MEASURE

3 ❑ PELvIC EXAM 9 ❑ CHEST X.RAY 15 Q HIV SEROLOGY

4 ❑ BREAST PALPATION 10 ❑ OIGITAL RECTAL EXAM 16 @ OTHER BLOOO TEST

5 ❑ MAMMOGRAM 1 ! ❑ PROCT/SIGMOIDOSCOPY 17 ❑ OTHER /3L.VCV,,

6 ❑ VISUAL ACUITY 12 ❑ STOOL BLOOO EXAM

1 ❑ NONE

z ❑ WEIGHT REOUCTION

3 ❑ CHOLESTEROL REOUCTION

4 ❑ SMOKING CESSATION

5 ❑ HIV TRANSMISSION

S ❑ BREAST SELF-EXAM

7 D OTHER

15. MEOlCA~ONTH~APY[R~odallnwormntinudmdimtiomodwdorprovid&atthkvtit. U~thesome

brand name orgenm”cnome enterdon any Rxoroflce maiioinvoti. include immunizing onddesasitizhg agmts.]

IF NOME. CHECK HERE ❑

1

2

3

4

5_

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MEDICATION? IN ITEM 10.7

YES No YES NO

‘cl 2U ‘cl 20

‘o 20 ‘n 20

‘cl 20 ‘cl 20

10 20 ‘o 20

‘cl 20 ‘0 20

Figure 1. Patient record

office visits during 1990, with black

persons and Asian/Pacific Islanders

accounting for about 8.8 percent and

3.0 percent, respectively. These

percentages were not statistically

different from those reported in 1989.

While visit rates were found to be

significantly higher for white persons

than for black persons overall, these

differences were noted only among

the younger age groups (less than 15

years, 15-24 years, and 25-44 years).

No significant differences were found

between the white population and the

I 1 HAVE YOU SEEN

“ PATlENT BEFORE?

‘Ely= 21JN0

{

IF YES, FOR THE CONOMON

IN fTEM 1087

ID YES 2[~N0

1 ❑ NONE

2 ❑ PSYCHOTHERAPY

3 ❑ CORRECTIVE LENSES

4 ❑ AMBULATORY SURGERY

5 ❑ PNYslomERAPY

6 ❑ OTHER /S,-(”/

‘ 6“[%2%7:%Tp$]v’s=

1 ❑ NO FOLLOW.UP PLANNEO

2 Q RETURN AT SPECIFIEO TIME

3 ❑ RETURN IF NEEOEO, P.R.N.

TELEPHONE FOLLOW.UP

4 ❑ PLANNEO

5 ❑ ‘EFERREo TO OTHER PHYSICIAN

6 ❑ RETURNEO TO REFERRING

PHYSICIAN

7 Q ADMIT TO HOSPITAL

17, g.yl-.l-of

vtsm

[Time

.2Cruo!ly

$pem with

phystcian]

black population in the 45-64 years,

65-74 years, and 75 years and over

age groups. Visit rates by age, sex,

and race were not statistically

different from rates observed in the

1989 NAMCS.

Physician characteristics

Table 2 shows the distribution of

office visits according to physician

specialty for the 13 most visited

specialties. The largest share of visits

(29.8 percent) was made to

physicians specializing in general and

famiIy practice (GFP); this

percentage is not significantly

different from the percentage of GFP

visits in 1989. Provisional data

concerning other physician specialties

for 1990 indicates slight increases in

the proportion of visits made to

internists, psychiatrists, and

ophthalmologists compared with 1989

figures, as well as slight decreases in

the proportion of visits made !to

pediatricians, dermatologists, ~tmd

general surgeons. However, 1990 visit

rates to each of the 13 specialties
Advance Data No. 213 ● April 30,1992 3

Table 1. Number, percent distribution, and annual rate of office visits by patient’s age, se&

race, and geographic region: United States, 1990

Number of

Number of Wits per

vts”tsin Percent person~er

Patient ctraracterktic thousands distribution year

Allpatiente . . . . . . . . . . . . . . . . . . . . . .

Age

Under 15 years . . . . . . . . . . . . . . . . . . .

l&24yeers . . . . . . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . . . . . .

45-64 yeare . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . .

75 years And over . . . . . . . . . . . . . . . . .

Sex and age

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

Under 15yeere, . . . . . . . . . . . . . . . . . .

15-24 yeare . . . . . . . . . . . . . . . . . . . . .

25-44 yeara . . . . . . . . . . . . . . . . . . . . .

4H4yeara . . . . . . . . . . . . . . . . . . . . .

65-74yeare . . . . . . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . . . . . .

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

Under 15years . . . . . . . . . . . . . . . . . . .

15-24yeare . . . . . . . . . . . . . . . . . . . . .

25-44years . . . . . . . . . . . . . . . . . . . . .

45--64years . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . .

75yeareand over . . . . . . . . . . . . . . . . .

Race and age

Whtie . . . . . . . . . . . . . . . . . . . . . . . . .

Under15years . . . . . . . . . . . . . . . . . . .

~5-24yeara . . . . . . . . . . . . . . . . . . . . .

25-44years . . . . . . . . . . . . . . . . . . . . .

46-64years . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . .

75yearsend over ...,..... . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . .

Under15yeare . . . . . . . . . . . . . . . . . . .

15-24yeare . . . . . . . . . . . . . . . . . . . . .

2&$4years . . . . . . . . . . . . . . . . . . . . .

45-64yeare . . . . . . . . . . . . . . . . . . . . .

6%74years . . . . . . . . . . . . . . . . . . . . .

75years Andover . . . . . . . . . . . . . . . . .

All other races

Asian orPacific islander . . . . . . . . . . . . . .

AInerican hXfianorAl askanNative . . . . . . .

Unspecified . . . . . . . . . . . . . . . . . . . . .

Geographic region

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

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

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

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

704,604

138,427

66.918

164,195

149,786

86,422

66,856

427,151

65,229

45,165

132,163

89,697

51,529

43,349

277’,452

73,198

23,753

62,012

60,089

34,893

23,507

597,306

115.421

58,297

183,020

126,970

76,045

59,552

62.317

12,401

7,063

18,350

13,684

6,264

4,575

21,312

2,382

21.287

127,805

180,276

235,303

161,220

100.0

19.6

9.8

27.6

21.3

12.3

9.5

60.6

9.3

6.4

18.6

12.7

7.3

6.2

39.4

10.4

3.4

8.8

8.5

u

84.8

16.4

8.0

23.1

16.0

10.6

8.5

8.8

1.8

;::

El

0.6

3.0

0.3

3.0

18.1

25.6

33.4

22.9

2.9

2.5

2.0

2.4

3.2

4.8

5.7

3.4

%

3.2

3.7

U

2.3

2.6

1.4

1.6

2.7

4.3

5.4

2.9

2.6

2.0

2.4

3.1

4.7

5.6

2.1

1.5

1.4

1.9

2.9

4.0

4.9

---

---

---

2.6

3.0

2.6

3.1

‘6eaeclon U.S. Wreauof the Census esbmmes oftie Wtian, noninS!tu!!onallzti populaI!on oftie Uni@Smteaaaof Ju~l,

1890.

were not found to differ si=~ificantly

from 1989 visit rates (3).

Visit characteristics

Referral status and

prior-visit status

0nIy5.5 percent ofoffice visitsin

1990 were made astheresult ofa

referral from another physician. The

overwhelming majority of office visits

(83.8 percent) were made by patients

who had seen the physician ona

previous occasion, and more than haIf

(61.2 percent) of alI visits were made

by persons who were returning to the

physician for care of a previously

treated problem (table 3). Only

16.2 percent ofvisits were madeby

new patients. These percentages are

not significantly different from those

reportedin 1989.

Expected source of

payment

Expected sources of payment

were most often commercial

insurance (36.1 percent ofvisits) and

“seIf-pay’’( 30.4 percent of visits)

(figure 2). (The self-pay category

includes the patient’s contribution

towards ’’co-payments” and

“deductibles.”) The percentage of

visits at which commercial insurance

was expected as asourceofpapnent

was up slightlyfrom the 19891evel,

while the percentage ofself-payvisits

showed a slight decrease. Medicare

was an expected payment source at

19.8 percent ofvisitsoveraIl, up

sIightIy from the 1989 level, but was

an expected source of payment at

80.0 percent ofvisits bypersons aged

65 years and over. “HMO/pre-paid

plan’’ was mentioned at 14.5 percent

of visits, not significantly different

from the 1989 leveI. It should be

rioted that physicians were asked to

check alI of the applicable payment

categories for this survey item, with

the result that multiple pa:ment

sources could be coded for each visit.

Reason for visit

Item 9 of the Patient Record asks

the physician to record the patient’s

(or patient surrogate’s) “complaint(s),

symptom(s), or other reason(s) for

this visit in the patient’s own words.”

Up to three reasons for visit are

classified and coded from the survey

according toA Reason for Visit

Classification for Ambulatory Care”

(RVC) (4). The principal reason for

visit is the problem, complaint, or

reason listed in item 9a.

The RVC is divided into the

eight moduIes or groups of reasons

dispIayed in table 4. More than half

of all visits were made for reasons

classified as symptoms (56.8 percent).

Respiratory symptoms accounted for

11.3 percent of aIl visits while

musculoskeIetaI symptoms accounted

for 10.3 percent.

The twenty most frequently

mentioned principal reasons for visit,

representing 39.5 percent of all visits,

are shown in table 5. General

medicaI examination was the most
4 Advance Data No. 213. Arxil 30,1992

Table 2. Number, percent distribtiton, and annual rate of office visits by physician

specialty and professional identity United States, 1990

Number of

Number of visits per

V&S in Percent 100 pereons

Physician spacisffy thousands distribution per yea;

AfIvistis . . . . . . . . . . . . . . . . . . . . . . . . 704,604 100.0 286.3

General and farmfy practice. . . . . . . . . . . . 209,788 29.8 85.2

Internal medicine . . . . . . . . . . . . . . . . . . 96,622 13.7 39.3

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . 81,148 11.5 33.0

Obstetrics and gynecology. . . . . . . . . . . . 61,243 8.7 %6.3

Ophthalmology . . . . . . . . . . . . . . . . . . . 43,642 6.2 17.8

Orthopedicsurgery . . . . . . . . . . . . . . . . . 32,917 4.7 13.4

Dermatology . . . . . . . . . . . . . . . . . . . . . 24,009 3.4 9.8

Generalsurgery . . . . . . . . . . . . . . . . . . . 22,402 3.2 9.1

Psychiat~ . . . . . . . . . . . . . . . . . . . . . . 20,963 3.0 8.5

Otola~ngology . . . . . . . . . . . . . . . . . . . 17,959 2.5 7.3

Cardiovascular disease . . . . . . . . . . . . 11,240 1.6 4.6

Urologicalsurgery . . . . . . . . . . . . . . . . . 9,546 1.4 3.9

Neurology . . . . . . . . . . . . . . . . . . . . . . 6,228 0.9 2.5

All otherspecia!tles . . . . . . . . . . . . . . . . . 66,696 9.5 27.1

Processional identity

Doctorofosteopathy . . . . . . . . . . . . . . . . 39,267 5.6 18,0

Doctorofmedlcine . . . . . . . . . . . . . . . . . 665,317 94.4 270.3

‘Baaed on U.S. Sureauof me Census=tmates of the dvil!an,nomnst!tutlonal!zedpopulationof the Uni!edStatesas of July 1,

1S90.

2Basedon thefemale populsbon onfy.

Table 3. Number and percent distribution of office visits by referral status and prior-visft

status: United States, 1990

Numberof

visits in Percent

Wsit characretistic thousands d@ibm’on

Allots.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 704,804 100.0

Referraletetus

Referred byanotherphysician. . . . . . . . . . . . . . . . . . . . . . . . 38,806 5.5

Notreferred byanother physician . . . . . . . . . . . . . . . . . . . . . . 665,797 84.5

Prior visit status

Newpatient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113,962 16.2

Old patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 590,641 83.8

Newproblem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159,635 22.5

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431,006 81.2

40

=.1

30

0

z

5

3

%~

~ 14.5

e

10 8.5 9.2

0

ynmmmeel self-pay Medii HMO/ Medmkt Other/

FW#d unknovrn

rndudee

B& Cf%

(121%)

13PaCM source of payment

NOlr2T.ct81mey~loao-L9rrmwmsn Mepq aluunufbeaxparvl*

Figure 2. Office visits by expected source of payment: United States, 1990

frequently mentioned reason forvisit

overall (4.3 percent of the total),

while cough was the most frequently

mentioned reason having to do with

illness orinju~ (3.7 percent). The

top twen~ reasons for 1990 were aIso

listed as the twenty most frequently

mentioned reasons for 1989, although

in sIightly different order.

Diagnostic and

screening services

Table 6displays statisticson

diagnostic or screening services

ordered or providedby the physician

during the office visit. Alldiagnolstic

and screening categories included on

the 1990 sumey were also foundon

the 1989 survey. However, this Iistis

changed periodically toreflectth.e

changing needs of data users,

recommendations ofadvisors, and

anticipated future health data needs.

The most frequently mentioned

diagnostic service was blood pressure

check, recorded at38.5 percentof

visits. This percentage was

significantly higher than the

34.5 percent ofvisits with acheckof

blood pressure in 1989. Also, blood

pressure checks were ordered or

provided at a higher percentage of

female visits (42.9 percent) than male

visits (31.8 percent) in 1990, as was

also the case in 1989.

Other frequently mentioned

diagnostic or screening services

included “other” blood test

(13.3 percent of visits), urinalysis

(12.8 percent), and pelvic exam

(performed at 12.0 percent of female

office visits). With the exception of

blood pressure check, none of the

diagnostic or screening categories

showed significant changes from 1989

levels.

Principal diagnosis

Item 10 of the Patient Record

asks the physician to record the

principal diagnosis or problem

associated with the patient’s most

important reason for the current visit

as well as any other significant

current diagnoses. Up to three

diagnoses are coded and classified

according to thehztematiord
Advance Data No. 213. April 30, 1992 5

Table 4. Number and percent distribution of office visits by patient’s prlnclpal reason for

visk United States, 1990

Numberof

visits in Percent

Pmmpal reason for visit and RVC code’ thousands distribution

Ailvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 704,604 100.0

Symptom module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..sooI-s999 400,323 56.8

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..sooI_s099 48,395 6.9

Symptoms referable topsychological/mentai disorders . . . , . . . . . . .S100-S199 19,831 2.8

Symptoms referable to the nervous system (excluding sense

OrgaflS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S200-S259 20,537 2.9

Symptoms referable tothecardioveacular/lymphatic system . . . . . . ..S26&S299 4,351

Symptoms referable totheeyesand ears . . . . . . ,, . . . . . . . . . ..S3OU-3399

0.6

51,327 7.3

Symptoms referable tothereapiratory system. . . . . . . . . , . . . .S400-S499 79,665

Symptoms referable tothedigestwe system. . . , . . . . . . . . . . , . .S.500-S639

11.3

31,887

Symptoms referable tothegemtourinar-y system . . . . . . . . . . . . . ..S640-S82g

4.5

30,714

Symptoms referableto the skin, hair, and nails... . . . . . . . . . . . ..S630-SS99

4.4

40,92S

Symptoms referable tothemusculoskeletal system ., . , . . . . . . . .S900-S999

5.8

72,687 10.3

Drsease module, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. DooI_D999 56,121 9.4

Diagnostfckcreening, andpreventivem odule-. , . . . . . . . . . . . . .X1OO-X599 110,059

Treatment module, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..TIoGT899

15.6

69,045 9.6

kljuries andadvarse effects modu[e . , . . . . . . . . . . . . . . . . . . . . .JwI-J999 22,426 3.2

Test results module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..RIoo-FI7oo

Administrative module . . . . . . . . . . ... ... . . . . . . . . . . . . . . ..A1oo-A14o

9,021 1.3

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. U99O-U999

6,341 1.2

19,267 2.7

lBa~sdon,,~ ~~~$onfor Ws;tc/ass,fiafion for~mbU/SfOy &e'' (~vc), Whli-fewhwsm) 1979.

21~lud@~ problems and ~omplainls ~t elsswhere classified, enlnea Or aLnOrW”. blanks, and Illeglble en~e$.

Table 5. Number and percent distribution of office visits by the 20 principal reasons for

visit most frequently mentioned by patients: United States, 1990

Nurnberof Percent Percent Percent

visits in

Rank

of all of female of ma/e

Reason for visit and RVC codeT tfrousands visits vkits visits

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . 704,604 100.0 100.0 100.0

1 General medical examination. . . . . . . . . .XIIX) 30,341 4.3 4.6 3.6

Cough . . . . . . . . . . . . . . . . . . . . .,. .S440 25,740

; Routfne prenatal examination, , . . . . . . , .x205

3.2 4.3

4

25,296 :: 5.9 . . .

Symptoms referable to throat. . , . . . . . . .S455 18,866

5

2.7 2.5 2.9

Postoperative vtsit. . . . . . . . . . . . . . . . .T205 17,523

6

2.5 2.6 2.4

Earache oreermfeti”on. . . . . . . . . . . . .s355 14,633

7

2.1 1.8 2.5

Well babyexarmnation. . . . . . . . . . . . ..xI05 14,534

8

2.1 1.6 2.8

Backsymptoms . . . . . . . . . . . . . . . . ..s905 12,497

9

1.8 1.6 2.0

Stomach pain, cramps, andspa.sms . . . . .S545

10 Skin rash . . . . . . . . . . . .

12,054 1.7 1.0 1.5

. .s860

11

11,562

Fever...............:::: :::: ..soIo

1.6 1.4 1.9

11,500

12

1.6 1.3 2.1

Vision dysfunctions. . . . . . . . . . . . . . . .s305 11,397

13

1.6 1.6 1.7

Hypertension . . . . . . . . . . . . . . . . . ..,D51o 10,391

14

1.5 1,5 1.4

Headache, pain in head. . . . . . . . . . . . .SZ1O 10,203

15

1.4 1.6 1.2

Knee symptoms . . . . . . . . . . . . . . . . ..s925 9,755

16

1.4 1.2 1.7

Chest pain and related symptoms (not referable

to bodysystem) . . . . . . . . . . . . . . . ..s050 9,684

17

1.4 1.2 1.6

Head cold, upper respiratory infection

(coryza) . . . . . . . . . . . . . . . . . . . . ..s445 8,557

18

1.2 1.2 1.3

Naealcongeafion . . . . . . . . . . . . . . . ..s400

19

8,546 1.2 1.1 1.4

Blood pressure teat.’ . . . . . . . . . . . . . ..x320

20

7,922 1.1 1.1 1.1

Necksymptoms . . . . . . . . . . . . . . . . ..s900 7,006 1.0

All other reasons, . . . . . . . . . . . . . . . . . . . . 426,597 6;; 60.0 6;::

lBastion `'A Reason for L7s,t C:as,fi~t{on forAmbu/ato~ Cam'< (RVC). V;ra/Hea,’thSrat2(78) 197e.

Classification of Diseases, 9th Revision,

Clinical Modification (ICD-9-CM)

(5).

TabIe 7dispIays ofiice visits by

principal diagnosis using the major

disease categories specified by the

ICD-9-CM. The supplementary

classification, used for diagnoses that

are not classifiable to injury or illness

(for example, generai medical

examination, routine prenatal

examination, and health supervision

of an infant or child), accounted for

14.8 percent ofall office visits.

Diseases of the respiratory system

(1%2 percent) and diseases of the

nervous system and sense organs

(11.4 percent) were also prominent

on the list.

Table 8displaysthe20 most

frequently reported principal

diagnoses for 1990, categorized at the

three-digit coding level of the

lCD-9-CJM, and accounting for

36.2 percent of aIl office visits made

during theyear.Ofthese 20, 19 also

appeared on the list of the 20 most

frequent diagnoses for 1989.

The most common diagnosis

rendered by physicians at office visits

in 1990 was essential hypertension,

occurring at 3.9 percent of all visits.

Essential hypertension has been the

most frequently reported morbidi~-

related diagnosis in every survey year

since the NAIMCS began in 1973.

(Morbidity-related diagnoses are

those classifiable to iHness or injury.

N-onmorbidity related diagnoses

incIude routine prenatal examination,

health supervision of an infant or

child, and general medical

examination, among others.)

Therapeutic services

Table 9 presents data

summarized from items 13. 14, and 15

of the Patient Record which pertain

to therapeutic services ordered or

provided by the physician at the office

visit.

Medication therapy was the most

commonly mentioned therapeutic

service, reported at 60.3 percent of

office visits in 1990. Physicians \vere

instructed to record all new or

continued medications ordered or

provided at the visit, including

prescription and nonprescription

preparations, and immunizing and

desensitizing, agents. .4s used in the

NAMCS, the term “drug” is

interchangeable with the term

“medication,” and the term

“prescribing” is used broadly to mean

ordering or providing any medication,

\vhether prescription or over-thecounter. Additional drug data are

presented in tables 10, 11, and 12.

and are discussed in the ne,xt section.

Counselin~advice (defined to

incIude formal and informal

counseling, advice, and patient

education) was offered at about

37.2 percent of office visits, and

iveight reduction was the most

frequently specified catego~
6 Advance Data No. 213. April 30, 1992

Table 6. Number and percent distribution of office visits by selected diagnostic service

and sex: United States, 1990

Number of Percent Percent Percent

vwts in of all of female of ma/e

D/agnost/c and screening serwes’ thousands Wslts Vlslt.s visita

Allwsits . . . . . . . . . . . . . . . . . . . 704,604 100.0 100.0 100.0

None . . . . . . . . . . . . . . . . . . 254,305 36.1 32.5 41.6

Paptest . . . . . . . . . . . . . . . . . . . . . . . 33,898 4,8 7.9 0.0

Pelvicexam . . . . . . . . . . . . . . . . . . 51,422 7.3 12.0

Breast palpation. . . . . . . . . . . 39,509 5.6 9.2 0:0”

Mammogram. . . . . . . . . . . . . . . . . . . . 11,773 1.7 2.8

Wualacuity.. . . . . . . . . . . . .

.,.

45,291 6.4 6.2 6.6

Blooopresaure . . . . . . . . . . . . ...,,., 271.390 36.5 42.9 31.6

Urinaiys[s . . . . . . . . . . . . . . . . . . . . . . 89,904 12.8 15.2 9.0

Chest x-ray . . . . . . . . . . . . . . . . . . . . . 20,293 2.9 2.7 3.2

Digital rectalexammation . . . . . . . 25,823 3.7 3.9 3.4

Proctoscopy orslgmoidoscopy . . . . . . . . 3,057 0.4 0.4 0.5

Stool blood exam . . . . . . . . . . . . . . . . . . 17,480 2.5 2.6 2.3

Oral glucose tolerance. . . . . . . . . . 3,421 0.5 0.6 0.3

Cholesterol measure . . . . . . . . . . . . . . . 26,155 3.7 3.8 3.5

HIVserology . . . . . . . . . . . . . . . . . . . . 1,280 0.2 0.2 0.2

Otherbloodtest . . . . . . . . . . . . . . . . . 94.009 13.3 13.7 12.9

Other . . . . . . . . . . . . . . . . . . . . . . 176,390 25.0 24.6 25.6

‘Total may exceed total number o! vists because more than one aerwca may be reponed per wsit.

Table 7. Number and percent distribution of office visitsby principal diagnosis:

United States, 1990

Numberof

visits in Percent

Principal diagnosis and ICD–9-CM code’ thousands distribution

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious and parasitic diseases . . . . . . . . . . . .001-139

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..14G239

Endocrine, nutritional andmetabolic diseases andimmuni~ disorders . . .240-279

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Diseases ofthenervous syetemand sense organs . . . . . . . . . . . .320-389

Diseaaes ofthe circulatorysystem . . . . . . . . . . . . . . . . . . . . . . . ...390-459

Diseaaes ofthe respiratory system. . . . . . . . . . . . . . . . .460-519

D]seases ofthe digestive system. . . . . . . . . . . . . . . . . . . ...520-579

Diseaaes ofthegenitourinaty system . . . . . . . . .580-629

D!seases oftheskin and subcutaneous tissue . . . . . . ,66c-70g

D!aeases of the musculoskeletal system and connective tissue. . . . . .710-739

Symptoms, signs, and ill-defined conditions. . . . . . . . . . . .780-799

Injuryand poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600-999

Supplementaryclassification.... . . . . . . . . . . . . . . . . . . . . . . . ..VOI-V62

All otherdiagnosesz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknownlblank3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

704,604 100.0

27,075 3.6

21,941 3.1

29,456 4.2

29,929 4.2

80,128 11.4

55,909 7.9

100,294 14.2

26,154 3.7

41,067 5.8

36,836 5.2

47,101 6.7

27,221 3.9

51,134 7.3

104,418 14.8

10,722 1.5

15,139 2.1

'8medon the/nfemstiona/ C/ass~Gf/on of Diseases, 9tb Revision, Cling@/ ModrfimfIon (lCW%CM).

‘Includes diseases of the blood and blood-forming organs (2S0-2e9J; compl!catlons 01 prsgnancy, chddblrlh, and the puepertum

$~0-676); congemtal anomaliea (74C-759): and certain condt!ons origmatmg m the permatal period f76C-799).

Includes blank diagnoses, uncodsble dmgnoses, and illegible d!agnoses.

(6.3 percent ofvisits). More common

counseling topics, such as medical,

social, and family counseling, were

included in the ’’other” category

(28.2 percent of visits). More detailed

data on counseling and advice have

been collected inthe 1991 NAMCS.

Approximately 19.7 percent of

visits included a mention of

nonmedication therapy ordered or

provided by the physician, with the

most commonly listed catego~ being

psychotherapy (3.8 percent of visits).

knbulatory surgery ~vas ordered or

provided atabout2.O percent of

visits, not significantly different from

the 19891evel. More detailed data on

ambulatory surgery, collected in the

1991 NAMCS, will be forthcoming

later this year.

Medication therapy

As noted above, 60.3 percent or

about 424.6 million office visits

included a new or continuing

medication ordered or provided by

the physician during 1990. Visits with

one or more drug mentions are

termed “drug visits” in the NAMCS.

.+s many as five medications, or drug

mentions, could be coded per drug

visit, resulting in a total of 759.4

million drug mentions during 1990.

This yields anaverage of about 1.1

drug mentions per office visit, or 1.8

drug mentions per drug visit.

Table 10displays data on

number of drug visits and drug

mentions by physician specialty.

Cardiovascular disease specialists and

internists had the highest percentage

of drug visits, at 78.5 percent a:nd

74.5 percent, respectively.

Drug mentions are displayed by

therapeutic class in table 11. This

classification is based on the

therapeutic categories used in the

National Drug Code Directory ([6). It

should be noted that some drugs have

more than one therapeutic

application. In cases of this type, each

drug was assigned to the category for

which it is most frequently prescribed.

Antimicrobial drugs accounted for

16.5 percent of all drug mentions,

while cardiovascular-renal drugs

(14.4 percent), respiratory tract drugs

(11.4 percent), and pain relief drugs

(10.2 percent) were also frequently

mentioned.

Table 12 shows the 20 most

frequently used generic substances for

1990. In this table, drug products

containing more than one ingredient

(combination products) are included

in the data for each ingredient. For

example, acetaminophen with codeine

is included in both the count for

acetaminophen and the count for

codeine. Amoxicillin was the generic

ingredient most frequently used in

drugs ordered or provided by the

physician at office visits in 1990,

occurring in 4.9 percent of drug

mentions.

Fifteen of the 20 most used

generic ingredients for 1990 were also

on the list of the top 20 for 198!9.

Albuterol and pseudoephedrine, new

on the list for 1990, showed

substantial gains of roughly 2.5

million mentions and 3.4 million

mentions, respectively, over 1989

levels.

The NAMCS drug data base

permits classification by a wide range

of variables, including specific product

name. generic class, entry form
Advance Data No. 213. April 30, 1992 7

Table 8. Number and percent distribution of office visits by the 20 principal diagnoses

most frequently rendered by physicians: United States, 1990

Number Percent Percent Percent

of visffs in

Rank

of all of female of male

Principal diagnosis and /CD-9-CM code’ thousands visits visits visits

1

2

3

4

5

6

7

8

9

10

11

12

13

14

E

17

18

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Essential hypertension . . . . . . ., , . . . . . ...401

Normal pregnancy . . . . . . . . . . . . . . . . . . ..v22

Suppurative and unspecified otitis media. . . ...382

General medical examination . . . . . . . . . . . . .V70

Acute upper respiratory infections of multiple or

unspecified sites . . . . . . . . . . . . . . . . . ...465

Health supewision of infant or child . . . . . . . . .V20

Oiabetes mellitus . . . . . . . . . . . . . . . . . . ...250

Allergic rhinitis . . . . . . . . . . . . . . . . . . . ...477

Bronchitis, not specified as acute or shronic. . ..490

Acute pharyngitis . . . . . . . . . . . . . . . . . ...482

Chronic sinusitis . . . . . . . . . . . . . . . . . . ...473

Neurotic disordera . . . . . . . . . . . . . . . . . . ..3oo

Diseases of sebaceous glands . . . . . . . . . ...706

Disorders of refraction and accommodation . ...367

Cafaraot . . . . . . . . . . . . . . . . . . . . . . . ...366

Glaucoma . . . . . . . . . . . . . . . . . . . . . . ...365

Asthma. . . . . . . . . . . . . . . . . . . . . . . . ...493

Sprains and strains of other and unspecified parts

of back . . . . . . . . . . . . . . . . . . . . . . ...847

Other forms ofchronic ischemic heart disesse ..414

Osteoarthrosis andallied disordera . . . . . . ...715

704,604 1

27,310

23,561

21,043

20,555

18,676

15,676

15,303

12,123

12,098

11,536

11,141

9,531

8,346

7,288

7,282

7,234

7,137

6,951

6,429

6,358

10+3.0 100.O 100.0

3.9 3.9 3.8

3.3 5.5 . . .

3.0 2.3 4.0

2.9 2.9 3.0

2.7 2.4 3.0

2.2 1.7 3.0

2.2 1.9 2.6

1.7 1.7 1.8

1.7 1.6 1.9

1.6 1.6 1.8

1.6 1.6 1.5

1.4 1.5 1.1

12 1.1 1.3

1.0 1.0

1.0 1.2 ::

1.0 1.1 1.0

1.0 1.1 0.9

1.0 0.9 1.1

0.9 0.5 1.5

0.9 1.0 0.8

‘W&on tie Infematima/ C/&titimof Diwases, Wrf?etision, Clinia/ModJfimtim, lCB~M.

Tabie 9. Number and percent distribution of office visits by seiected therapeutic services

ordered orprovlded by the physician: United States, 1990

Number of

visits in Percerrt

l?rerapeutic sewrces’ thousands distnbutioh

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 704,604 100.0

Medication therap~

Drugvisits3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424,587 60.3

Number of medications ordered or provided by the physician

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280,017 39.7

L:::::::::::::::::::::: ::::::::::::::::::

230.716 32.7

110,885 15.7

3-5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83,007 11.8

Counseling and advice’

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. 442.633 62.8

Weightreduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44,378 6.3

Cholesterol reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,566 3.2

Breastseti-exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Smoking cessation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16,174 23

14,937 2.1

HIVtransmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,740 0.2

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198,607 28.2

Other nonmedication therapy’

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566,077 80.3

Psychotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,922

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.8

16,572 2.4

Ambulatorysurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,203 2.0

Corrective lenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,580

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

1.4

75,338 10.7

lTotsl may exceed Iotsl number of viwa because more than one categorf may be repcrled per wt.

2M@@ti0”s include pre$cnp!jon drugs, over-the-counter preparwons, lmmunzing a9ents. deaensdlXn9 wen*r tic.

3~mg “i~i~~ are v{s{~ at ~~ch ona or more medicatmn IS ordered or SUPPkd by the ph!=kbn.

chosen by the physician (that is,

brand name, generic name, orthe

desired therapeutic effect),

prescription status (that is, whether

the product is prescription or

nonprescription), federalIycontroHed

substance status, composition status

(that is, single or multiple ingredient

product), and therapeutic category. A

report describing the method and

instruments used to collect and

process drug information for the

NAMCS is available (7).

Disposition of visit

Nearlytwo-thirds (66.0 percent)

ofaIl office visits includeda

scheduled foI1ow-up visitor telephone

call, while another 22.6 percent

included instructions to return if

needed. OnIyaboutl.O percentof

visits resulted ina hospital admission.

Table 13displays data on office visit

disposition.

Duration of visit

Table 14 presents data on the

duration of office visits. Duration of

vkit refers to the amount of time

spentin face-to-face contact between

the physician and the patient. This

time is estimated and recordedby the

physician and does not include time

spent waiting to see the physician,

time spent receiving care from

someone other than the physician

without the presence of the physician,

or time spent by the physician in

reviewing patient records and/or test

results. In cases where the patient

received care from a“member of the

physician’s staff but did not actually

see the physician during the visit,

duration was recorded as ..zero”

minutes.

About 69.3 percent ofoffice visits

had a duration of 15 minutes or less

in 1990. The mean duration time for

all visits was 16.7 minutes,

significantly higher than the 15.9

minutes reported for 19S9.

Additional reports which utilize

1990 NAMCS data are forthcoming in

the Advance Data From Vital and

Health Statistics series. In addition,

survey data will be available on

computer tape from the N’ational
Advance Data No. 213. Awil 30,1992

Table 10, Number and percent distribution of drug visits and drug mentions by physlclan

specialty: United Statas, 1990

Number Number

of drug of drug Percent

visits’ in Percent mentions Percent dru

Physician specialty thousands distribution in thousands distribution visit$

Al! drug visits.............,.. . 424,587 100.0 759,406 100.0 60.3

General and family pracbce . . . . . . . 144,052 33.9 251,960 33.2 68.7

Internai medicine . . . . . . . . . . . . . . 71.967 17.0 149,370 19.7 74.5

Pedlatrlcs. . . . . . . . . . . . . . . . . . . 54,250 12.6 76,370 10.1 66.9

Obstetrics and gynecology . . . . . . . . 26,814 6.3 35,667 4.7 43.8

Ophthalmology . . . . . . . . . . . . . . . . 19,193 4.5 30,808 4.1 43.s

rlthc~edlc surgery . . . . . . . . . . . . . 8.586 2.0 11,035 1,5 26.1

Dermatology, . . . . . . . . . . . . . . . . 15,364 3.6 29,572 3.9 64.0

General surgery . . . . . . . . . . . . . . . 6.961 1.6 12,597 1,7 31.1

Psychiatry, . . . . . . . . . . . . . . . . . . 10,756 2.5 18,516 2,4 51.3

Otolaryngology . . . . . . . . . . . . . . . . 6,017 1.9 12,341 44.6

Cardiovascular diseaee. . . . . . . . . 8,627 2.1 25,153 ::: 78,5

Urological surgery . . . . . . . . . . . . . . 3,854 0.9 5,145 0.7 40,4

Neurology . . . . . . . . . . . . . . . . . . 4,127 1.0 7,566 1.0 66.3

All other specialties . . . . . . . 41,819 9.6 93,265 12.3 62.7

‘Drug wsts are VISJS a! which one or more drugs are ordered or suppled by the phys!cian.

2Numbef ofdrugvtsflts d!vfided ~number ofofflce vlsl&muk!pltedby 100.

Table 11. Number and percent distribution of drug mentions by therapeutic classification:

United States, 1990

Number of

drug mentions Percent

Therapeutic c/assificat/on’ in thousands distribution

All drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anfim!crooial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular-rena! . . . . . . . . . . . . . . . . . . . . . .

Respirato~tract, ...,,,.. . . . . . . . . . . . . . . . . . . . .

Pam rallef . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hormonesandreiated agents... . . . . . . . . . . . . . . . . . . . . .

Dermatoioglc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychopharmacological ..,.. . . . . . . . . . . . . . . . . . . . . . . .

Metabolicand nutnent . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gastrointestinal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ophthalmic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Immunologic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Necrologic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hematologic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherand unclassified . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

759,406

125,275

109,171

86,562

77,355

67,544

43,558

46,188

29,238

31,139

30,375

19,337

14,111

9,914

69,639

100.0

16.5

14.4

11.4

10.2

8.9

5.7

6.1

3.9

4.1

4.0

2.5

1.9

1.3

9.2

‘Therapeutic class baaed on the standard drug classif,cmon used m the Nat]onal Drug Code Dlreslo~, 1982 Edition,

Table 12. Number and percent distribution of drug mentions for the 20 most frequently

used generic substances: United States, l 990

Nurrrberof

drug mentjons Percent

Rank Generic substance in thousands’ distribution

All drug mentions....,.,,, . . . . . . . . . . . . . . . 759,406 100.0

1 Amoxicillm, . . . . . . . . . . . . . . . . . . . . . . . . .

2

37,017 4.9

Acetammophen . . . . . . . . . . . . . . . . . . . . . . . . . .

3

23,416 3.1

Erythromycm . . . . . . . . . . . . . . . . . . . . . . . . . . .

4

19,474 2.6

Hydrochlorothiezide . . . . . . . . . . . . . . . . . . . . . . .

5

15,011 2!0

Codeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,435 1.9

6 Phenylephrine . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

12,297 1.6

Ibuprofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,964 1,6

Phenylpropanolamine . . . . . . . . . . . . . . . . . . . . . 11,489

:

1.5

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,623 1.4

10 Albuterol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11

10,505 1.4

Pseudoephedrine . . . . . . . . . . . . . . . . . . . . . . . . . 10,474 1,4

12 Naproxen . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,354 1.4

13 Furosemide . . . . . . . . . . . . . . . . . . . . . . . . . 9,570 1.3

14 Chlorpnenlramine . . . . . . . . . . . . . . . . . . . . . . . 9,197 1,2

15 Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . 9,015 1.2

16 Digoxm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,924 1.2

17 Cefaclor . . . . . . . . . . . . . . . . . . 8,910 1.2

16 Guaifenesm . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,890 1.2

19 Trimethopnm,, . . . . . . . . . . . . . . . . . . . . . . . . . . 8,649 1.1

20 Sulfamethoxazole . . . . . . . . . . . . . . . . . . . 6,282 1.1

'Frequen~of mention combines sngle-!ngredlent agents w:hment[ons oftneagent as an mgred$enl macomb$natton drug

Technical Information Service at,a

nominal cost beginning about April

1992, Questions regardkg this report,

future reports, or the NAMCS may

be directed to the Ambulatory Care

Statistics Branch by calling (301)

436-7132.

References

l. ISelsonC, McLemore T. The National

Arnbulato~ Medical Care Survey .United

States, 1975-81 and 1985 trends. National

Center for Health Statistics. Vital Health

Stat 13(93). 1988.

2. DeLozier JE, Gagnon, RO. 1989

Summary National Ambulatory Medical

Care Sutvey. Advance data from vital and

health statistics; no. 203. Hyattsville,

Marjiand: National Center for Health

Statistics. 1991.

3. Schappert SM. National &nbulatory

Medical Care Survey: 1989 Summary.

National Center for Health Statistics.

Vital and Health Stat 13(110). 1992.

4. Schneider D, Appleton L, McLemore

T. A reason for visit classification for

ambulato~ care. National Center for

Health Statistics. Vital and Health Stat

2(78). 1979.

5. Public Heakh Service and Heakh Care

Financing Administration. Internaticmal

Classification of Diseases, 9th Revision,

clinical modification. Washington: Public

Health Service. 1980.

6. Food and Drug Administration.

National Drug Code Directory, 1982

Edition. Washington: Public Health

Service, 1982.

7. Koch H, Campbell W. The collection

and processing of drug information.

National Ambulatory Medical Care

Survey, 1980. National Center for Health

Statistics. Vital Health Stat 2(90). 1982.
Advance Data No. 213. April 30,1992 9

Table 13. Number and percent distribution of office visits by disposition of visiti

United States, 1990

Number of

visits in Percent

Disposition’ fhousands dkfnbution

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 704,604 100.0

Nofollc+vupplanned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88,310 9.7

Returnatspecifiedtime . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437,530 62.1

Returnifneeded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159,101 22.6

Telephonefollowr.rpplanned... . . . . . . . . . . . . . . . . . . . . . . 27,207 3.9

Referredtootherphysician . . . . . . . . . . . . . . . . . . . . . . . . . . 22,939 3.3

Returnedtorefernng physician.. . . . . . . . . . . . . . . . . . . . . . . 7,210 1.0

Admittohospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,802 1.0

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,513 1.6

‘Totelmayexceed taainumberofvisirs becsusemorerhan onedisposttionmsy bereportedperwst.

Table 14. Number and percent distribution of office visits by duration of visit

United States, 1990

Number of

visits in Percent

Duration fhousands distribution

Allvis”~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 704,604 100.0

Ominutes’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l-5 minutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8,262 1.2

83,363 9:0

S-lOminutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199,066 26.3

11-15minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217,606 30.9

16-30minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167.690 23.8

31 minutesand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46,575 6.9

lvl~~OfZerOminUteSdumti~uethose inwhichrhereway notate.t&scecontacr batweentiepatient ~dmephydciam

Symbols

--- Datanot available

. . . Category nonapplicable

. Quantity zero

0.0 Quantity more than zero but less

than O.05

z Quantity more than zero but less

than 500where numbers are

rounded tothousands

*

Figure does not meet standardof

reliability or precision
10 Advance Data No. 213. April 30,1992

Technical notes

Source of data and

sample design

The information presented in this

report is based on data collected by

means of the National Ambulatory

Medical Care Survey (NAMCS) from

January 1990 through December

1990. The target universe of NAMCS

includes office visits made in the

United States by ambulatory patients

to nonfederally employed physicians

who are principally engaged in office

practice, but not in the specialties of

anesthesiology, pathology, or

radiology. Telephone contacts and

nonoffice visits are excluded.

A multistage probability sample

design is used in NAMCS, involving

samples of prima~ sampling units

(PSU’S), physician practices within

PSU’S, and patient visits within

physician practices. For 1990, a

sample of 3,063 nonfederal, officebased physicians was selected from

master files maintained by the

American Medical Association and

American Osteopathic Association.

The physician response rate for the

1990 NAMCS was 74 percent.

Sample physicians were asked to

complete Patient Records (see

figure 1) for a systematic random

sample of office visits occurring

during a randomly assigned l-week

reporting period. Responding

physicians completed 43,469 patient

records.

Characteristics of the physician’s

practice, such as primary specialty

and type of practice, were obtained

from the physicians during an

induction interview. The U.S. Bureau

of the Census, Housing Surveys

Branch, was responsible for the

survey’s data collection. Processing

operations and medical coding were

performed by the National Center for

Health Statistics, Hospital Discharge

and Ambulatory Care Survey Section,

Research Triangle Park, North

Carolina.

Sampling errors

The standard error is primarily a

measure of the sampling variability

Table L Provisional relative standard errors

for estimated number of office visits:

National Ambulatory Medical Care Survey,

1990

Relative

Estimated number of office standard error

visita in ffrousands in percent

200 . . . . . . . . . . . . . . . . . . .

400 . . . . . . . . . . . . . . . . . . .

547 . . . . . . . . . . . . . . . . . . .

600 . . . . . . . . . . . . . . . . . . .

800 . . . . . . . . . . . . . . . . . . .

1,000 . . . . . . . . . . . . . . . . . .

2,000 . . . . . . . . . . . . . . . . . .

5,000 . . . . . . . . . . . . . . . . . .

10,000 . . . . . . . . . . . . . . . . .

13,000 . . . . . . . . . . . . . . . . .

20,000 . . . . . . . . . . . . . . . ..

50,000 . . . . . . . . . . . .. . . . .

100,000. . . . . . . . . . . . . . . . .

600,000. . . . . . . . . . . . . . . . .

49.4

35.0

30.0

28.7

24.9

22,4

16.1

10,6

8.0

7.3

6.4

5.1

4.6

4.1

Example of use of table An aggregate est!mate of 10 million

%+aiishss a relatwe standard error of 8.0 percent or a standard

error of 80Q,000 visits (8.0 percent of 10 million).

Tsble IL Provisional reiative standard

errors for estimated number of drug

mentions: National Ambulatory Medical

Care Survey, 1990

Estimated number of dN&7 Re/afive standard

mantions in thousands error in percent

200 . . . . . . . . . . . . . . . . . . . 63.4

400 . . . . . . . . . . . . . . . . . . . 45.0

500 . .. . . . . . . . . . . . . . . . . 40.3

600 . . . . . . . . . . . . . . . . . . . 36.9

800 . . . . . . . . . . . . . . . . . . . 32.0

912 . . . . . . . . . . . . . . . . . . . 30.0

1,000 .. . . . . . . . . . . . . . . . . 28.7

2,000 . . . . . . . . . . . . . . . . . . 20.6

5,000 . . . . . . . . . . . . . . . . . . 13.6

10,000 . . . . . . . . . . . . . . . . . 10.3

20,000 . . . . . . . . . . . . . . . . . 8.1

50,000 . . . . . . . . . . . . . . . . . 6.5

100,000. . . . . . . . . . . . . . . . . 5.8

600,000. . . . . . . . . . . . . . . . . 5.2

that occurs by chance when only a

sample, rather than an entire

universe, is surveyed. The relative

standard error of an estimate is

obtained by dividing the standard

error by the estimate itselfi the result

is then expressed as a percent of the

estimate. Table I shows provisional

relative standard errors for estimated

numbers of office visits in 1990, and

table II presents provisional relative

standard errors for estimated

numbers of drug mentions.

Provisional standard errors for

estimated percents of visits are shown

in table III.

Alternatively, relative standa~rd

errors for aggregate estimates may be

calculated using the following general

formula, where x is the aggregate of

interest in thousands, and A andl B

are the appropriate coefficients from

table IV.

‘S’(x) =lm”’oooo

Similarly, reIative standard errors

for percents may be calculated using

the following general formula, where

p is the percent of interest and x is

the denominator of the percent in

thousands, using the appropriate

coefficient from table IV.

Esample of uae of table An aggregate estimate of 10 millron

drug mentions has a relative standard error of 10.3 percenf or

a standard error of 1.03 mllhon visile (10.3 percent of 10

mdhon).

Table Ill. Provisional standard errors for percents of estimated numbers of office visits:

National Ambulatory Medical Care Survey, 199o

Estimated percent

8ase of percent

nsifa in thousands 1 or 99 5 or 95 10 or 90 20 or 80 30 or 70 50

Standard arror in percentage points

200 . .. . . . . . . . . . . . . . . . . 4.9 10.7 14.8 19.7 22.6 24.6

500 . .. . . . .. . . . . . . . . . . . 3.1 6.6 9.3 12.5 14,3 15.6

1,000 . . . . . . . . . . . . . . . . . . 2.2 4.6 6.6 8.8 10.1 11.0

2!000 ! . . . . . . . . . . . . . . . . . 1.6 3.4 4.7 6.2 7.1 7.8

5,000 . . . . . . . . . . . . . . . . . . 1.0 2.2 3.0 3.9 4.5 4.9

10,000 . . . . . . . . . . . . . . . . . 0.7 1.5 2.1 2.6 3.2 3.5

13,000 . . . . . . . . . . . . . . . . . 0.6 1.3 1.8 2.4 2.8 3.1

20,000 . . . . . . . . . . . . . . . . . 0.5 1.5 2.0 2.3 2.5

50!000 . . . . . . . . . . . . . . . . . 0.3 ;:; 0.9 1.3 1.4 1.6

100,000. .. . . . . . . . . . . . . . . 0.2 0.5 0.7 0.9 1.0 1.1

600,000. . . . . . . . . . . . . . . . . 0.1 0.2 0.3 0.4 0.4 0.5

Example of use of table: An esbmate of 30 percent based on an aggregate est!mste of 13 million VISIW has a standard error of 2.8

p%rcant or a relawe standard error of 9.3 percent (2a percent dwided by 30 percent),
Advance Data No. 213. April 30, 1992 11

Table IV. Provisional coefficients appropriate for determining relative standard errors by

type of estimate and physician groups: National Ambulatory Medical Care Survey, 1990

Coefr7cient

Type of estimate and physician group A B

Visits

Overall totals . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Doctors of osteopathy, general surgery, orthopedic

surgery, cardiovascular disease, psychiatry, urological

surgery, dermatology, neurology, ophthalmology,

olola~ngology . . . . . . . . . . . . . . . . . . . . . . . . . .

Pediatrics, obstetrics, and gynecology . . . . . . . . . . . .

Internal medicine, all other specialties ., . . . . . . . . . .

General and family practice. . . . . . . . . . . . . . . . . .

Drug mentions

Overall totals . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Doctors of osteopathy, general surgery, orthopedic

surge~, cardiovascular disease, psychiat~, urological

surge~, dermatology, neurology, ophthalmology,

otolayngology . . . . . . . . . . . . . . . . . . . . . . . . . .

Pediatrics, obstetrics, and gynecology. . . . . . . . . . . .

Internal medicine, all other specialties . . . . . . . . . . . .

General and family practice . . . . . . . . . . . . . . . . . . .

0.00161075

0.01798498

0.01283754

0.01498303

0.00573033

0.00258400

0.03276417

0.02355989

0.02100443

0.00717830

48.44516000

8.66482249

24.17002721

36.73205078

30.48694805

79.97392437

9.67984575

22.74292691

61.17468803

S3.4231 5388

Adjustments for

nonresponse

Estimates from NAMCS data

were adjusted to account for sample

physicians who were in scope but did

not participate in the study. This

adjustment wascalcr.dated to

minimize the impact of response on

final estimates by imputing to

nonresponding physicians data from

visits to similar physicians. For this

purpose, physicians were judged

similar if they had the same special~

designation and practiced in the same

Psu.

Test of significance and

rounding

In this report, 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

“greater than” or “less than” indicate

that the difference is statistically

significant. A lack of comment

regarding the difference between any

hvo estimates does not mean that the

difference was tested and found to be

not significant.

In the tables, estimates of office

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 from

rounded data.

Definition of terms

Ambulatory patient –An

ambulatory patient is an individual

seeking personal health services who

is not currently admitted to any

health care institution on the

premises.

Physician -A physician is a duly

licensed doctor of medicine (M. D.) or

doctor of osteopathy (D. O.) who is

currently in office-based practice and

who spends some time caring for

ambulatory patients. Excluded from

the NAMCS are physicians who are

hospital based; who specialize in

anesthesiology, pathology, or

radiology who are federal[y

employed; who treat only

institutionalized patients; or who are

employed full time by an institution

and spend no time seeingambulato~

patients.

O@ce – Offices are the premises

physicians identify as locations for

their ambulato~ practice. These

customarily include consultation,

examination, or treatment spaces that

the patients associate with the

particular physician.

Viif–A visit is a direct personal

exchange between an ambulatory

patient and a physician (or a staff

member working under the

physician’s supervision) for the

purpose of seeking care and

rendering personal health services.

Drug mention –A drug mention is

the physician’s entry of a

pharmaceutical agent–by any route

of administration —for prevention,

diagnosis, or treatment. Generic as

well as brand-name drugs are

included, as are nonprescription and

prescription drugs. Along \vith all new

drugs, the physician also records

continued medications if the patient

was specifically instructed during the

visit to continue the medication.

Drug vtiir-.A drug visit is a visit

in which medication was prescribed

or provided by the physician.
12 Advance Data No. 213 ● April 30, 1992

Suggested citation

Schappert SM. National Ambulatory Medical

Care Survey 1990 Summafy. Advance data

from vital and health statistics; no 213.

Hyattsville, Maryland: National Center for

Health Statistics. 1992.

Copyright Information

This report may be reprinted without further

permission.
Number 214 ● September 8, 1992

Advance

Data

From Vital and Health Statistics of the CENTERS FOR DISEASE CONTROUNational Center for Health Statistics

Office Visits for Otitis Media: United States, 1975-90

by Susan M. Schappert, M.A.,

Division of Health Care Statistics

During 1990, there were an

estimated 24.5 million visits made to

office-based physicians in the United

States at which the principal

diagnosis was otitis media, nearly one

visit for every 10 persons. These visits

accounted for 3.5 percent of all office

visits and represented the second

most frequent illness diagnosis. For

chiIdren under age 15, otitis media

represented the most frequent

diagnosis in physician office practices.

Since 1975, the first year these data

were colIected, the number of otitis

media visits has increased almost

150 percent (figure 1), and the

annual visit rate has more than

doubled.

This report presents nationaI

estimates pertaining to office visits

with a diagnosis of otitis media

between 1975 and 1990. These

estimates are based upon data

collected in the National Ambulatory

Medical Care Suwey (NAMCS), a

national probability sample survey

conducted by the Division of Health

Care Statistics of the National Center

for Health Statistics, Centers for

Disease ControI. Statistics on patient,

30 r

14.1

24.5

I 8.3

197s 19s0 13s5 1990

Year

Figure 1. office visits with a principal diagnosis of otitis media: United States, 1975-90

physician, and visit characteristics for

visits with a diagnosis of otitis media

are presented and compared for four

years: 1975, 1980, 19S5, and 1990.

A copy of the 1990 Patient

Record; the survey instrument used

by participating physicians to record

information about their patients’

office visits, is displayed in figure 2.

Although some changes have been

made in this form over the years. the

basic format has remained the same,

and it is hoped that this will provide

a useful reference point for readers.

In item 10 of the Patient Record,

physicians were asked to record a

principaI diagnosis (the diagnosis

most cIoseIy associated with the

patient’s most important reason for

visit) as well as any other significant

current diagnoses. Up to three

diagnoses \vere coded and, classified

for each visit. For the 1975 sumey

year, diagnoses \vere coded according

to the Eighth Revirion International

Classification of Diseases, adapted for

use in the United Stares (ICDA-S ) (l).

For survey years 19S0. 19S5. and

1990, diagnoses were coded according

to the International Classification of

Diseases, 9d1Revision, Clinical

Modification (ICD-9-CY1) (2). This

report will focus primarily on office

visits in which the patient’s principal

*+stawctr.b

*a+ G

$

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

●

: Public Health Service

s

. Centers for Disease Control

5

%.

>

National Center fo[ Health Statistics %2*,3,3 CENTERS CDC FNI DISEASE VJNTROL
2 Advance Data No, 214. September 8, 1992

Auw.no. d Codldmtld,w - All ,nl.rm, -.c - .s “,dl wo.~d m,mrt wJ.”1!14c ,110. Of.“ D.cI,runonr of H.,tth ●nd M“mSI SD,WC.S

,.dw :.!,, . OMC!IW. or ●n cslatimnme.! _ x M1O c.nild.nlml, WIN be .wa only by C..t*r* for D**.**. Control

P.r,

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other P“mcse

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u.tm..l

liblc

Cm.,

M.mnb

10. rn..tth

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St.:, stsc. A

1. DATE OF VISIT PATlENT RECORD OMB No, 0920-0234

~ NATIONAL AMBULATORY MEDICAL CARE SURVEY ExF4rss8.31 -S9

(PHSI 61oSA

2.21P CODE 4-SEX 5-:::R OR ÐNCmY 7 EXPECTED SOURCE(SI OF PAYMENT

“[Check all that apply]

8 WAS PATIENT

“REFERREDFOIR

Iaww-rs SLUE CRDSS/

THIS V3SIT BY

1 ❑ SELF.PAy 4 a ~L”E 6HlC~

1 ❑ FEMALE H!SPAN!C 7 ❑ NO CHARGE

1 ❑ OmGIN

ANOTHER

2 ❑ E!IACK PHYSICIAN?

3,0ATEOFBERTH

A31ANIPACIRC

/

2DMALE 3 ❑ ISIANDER

2 Q MEOICARE 5 ❑ ~&E~::Mac’AL B ❑ “~

f

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‘ ❑ :%’KLpRE.PAID 1=1.Ah

Mum- “m VW 3 ❑ MECNmlc 6 Q I.IMO;lPA/PDIJ

9 PAllENT% COMPLAINTIS), SYMPTOM(S), OR OTHER 1 (). PHYSICtAN”S DtAGNOSES

“REASONIS) FOR THIS VIStT [lr Nfkvrf’s own WOIU3J 17 ● p:::;;:’;:g~

, W2S7 IMFOFITANT . PRINCIPAL DIAGNOSISI?ROS4.EM AsSOCIATE WITH ITEM 9,

1 ❑ YES 2DN0

+

b. O?*ER

IF YES, FOR THE CONOITION

b OTHER SIGNIFICANT CURRENT OIAGNOSES IN lTEM 10a?

10 YES 2DN0

1 z. :$:;:;;:;:::::::d:~WCES THIS V3SIT I 3. :g:;s;y::;:;:;:m,iddl 14* yg!w%x!:;!%;

! C NONE 7 ~ 91000 PRESSURE CHECK 13 D ORAL GLuCOSE TOL 1 ❑ NONE 1 a NOtJE

2 ~ pAP TEST 8 ~ uRINALYSIS 14 D CHOLESTEROL MEASURE z ❑ WEIGHT REDUCTION 2 a 15 YCHOTHERAPY

3 C PELVIC EXAM 9 ~ CHEST X. RAY 15 ❑ HIV SEROLOGY 3 ❑ CHOLESTEROL REDUCTION 3 ❑ CORRECTIVE LENSES

4 ~ BREAST PALPATION ,, ~ CI,317AL REC,AI. EXAM 16 ❑ 0THWBLOO0,E5T 4 ❑ SMOKING CESSATION 4 ❑ AMBULATORY SURGERY

5 ~ MAMMOGRAM 5 ❑ HIV TRANSMISSION 5 a PHYSIOTHERAIW

11 ~ PR5CT)SIGMOIOOSCOPY 17 ❑ OTHER /5rJCCIJY/

6 ❑ OTHER /.$,Iw/\}/

6 ~ VISUAL ACUITY O ❑ BREAST SELF.EXAM

12 ~ S-OO1 BLOOO EXAM

7 Q OTHER —

I 5. MEDlCAnONTHWPY[R~tiall.wormnrtnutim&imtiowotitiorpmvid&.,lhtivkif. Use!hesome

brandnameorgenencn.smeewrcd onanyR.sor offiemediml mwd. Inclu&immuni.dngamfdawuirizng agsnrs.j 16“ f::m?::;%o~;$]vlsm 17. :~ti~N

Vlsrr

IFNONE. CHECK HERE ❑ m NEW b. FOH OX 1 ❑ NO FOLLOW.UP PLANNEO /Timt,

MEOICATION7 m ITEM 10.7 Ocluo,lly

YES NO YES No 2 ❑ RETURN AT SPECIFIED TIME spent wi!h

physician)

>, 10 2C! ‘e 20 3 C RETURN IF NEEOEO. P,R N

2

TELEPHONE FOLLOW-UP

10 20 10 20

4 ~ PLANNED

3.

5 tj RE=R~Eo 10 OTHER P“Ys,c,AN ID 20 ID zCI

6 E FW_ihZ_i:l:;TO REFERRING

* ID ZD ICI zCI 7 D AOMIT TO HOSPITAL

Mmu1,s —

s, _ ICI zCI ID 20 B~ OTHER [SIWCIJYJ

Figure 2. Patient Record

diagnosis was recorded as otitis

media.’

It is necessary to keep in mind

that the estimates presented in this

‘In order to compare diagnostic da~a from 1975

through 1990. i~was ncccssary to ensure the

comparability of codes used to classify

diagnoses of otitis media during th]s time. For

the purposes of this report, otitis mcd]a has

been defined to include nonsuppurativc otitis

media (l CD-9-CM cocics 3SI.O-3SI .4) as well

report are based on samples, and, as briefly the sample design, sampling

such, they are subject to sampIing errors, and guidelines for use in

variability. The technical notes found evaluating the precision of NAMC3

at the end of this report discuss estimates.

as suppurativc and unspecified otitis media

(ICD-9-CM codes 382.0-382.9). These codes

were compared with ICDA-S codes

3S1.0-3S1.9 (otitis media without mention of

mastoiditis). ICDA-8 codes for 3f32.O-3S2.3

(otitis media with mention of mastoiditis) were

also considered for inclusion in the analysis.

However, mastoiditis is classified as a separate

condition in the ICD-9-CM, which could have

lessened the comparability of these specific

codes over the years. Despite this

consideration, it was discovered that, for 1975,

there were no NAMCS visits coded with a

diagnosis in the range of 3S2, rendering tlhis a

nonissuc and limiting data comparisons to the

codes mentioned above.
Advance Data No. 214 ● September 8, 1992 3

-1975 IEEZ1lSSOK SC11SS5EZ11990

6o1- 1

I

41- 31.5 I

20

a t

47.8

Laesthan2yeara 2-5 yeara e-loyeara

PaUent’sage

Figure 3. Annual visit rates for visits with a principai diagnosis of otltls media by patient’s

age: United States, 197S-90

#h4slaElFemaie

120 r 111.3

=0 31.1

102.1

77.9

1975 laao 19s5 1290

bar

Figure 4. Annual otitis media visit rate for patients aged iess than 2 years by sex: United

States, 1975-90

Patient characteristics

Tables 1, 2, and 3 show visits with

a principaI diagnosis of otitis media

by patient’s age, sex, race, and

geographic region between 1975 and

1990. Major findings are summarized

below.

Patient’s age

During 1975-90 the majority of

visits for otitis media were made by

children. In 1975, 70.6 percent of

otitis media visits were made by

persons under the age of 15. By 1990,

that percentage had increased to

80.5 percent.

Examining this age group (under

15 years) more closely, visit rates

were found to be highest among

children under the age of 2 years for

three of the four survey years

presented here. (In 1975 visit rates

for children aged less than 2 years

and for those aged 2-5 years were

higher than visit rates for other age

groups but were not statistically

different from each other.)

Furthermore, the visit rate for

children under the age of 2 years

jumped from 31.5 visits per 100

children in 1975 to 102.1 visits per

100 children in 1990, an increase of

224.1 percent (figure 3).

Increasing visit rates were also

noted in the groups 2-5 years of age

and 6-10 years of age. Among

children aged 2-5 years, the visit rate

rose from 20.8 visits per 100 children

in 1975 to 47.8 visits in 1990, up

129.8 percent. Among those 6-10

years of age, the increase was

78.4 percent, from 10.2 visits per 100

children in 1975 to 18.2 visits per 100

chiIdren in 1990.

AIthough the visit rate for

children aged 11-14 years was 3.3

visits per 100 in 1975 and 8 visits per

100 in 1990, this difference was not

found to be statistically significant.

No significant increase was noted

between 1975 and 1990 in the visit

rate for persons in the a~e groups

15-24 years, 25-44 years, 45-64 years,

and 65 years and over.

Visit rates by age and sex

For each of the years presented

here, the Likelihood of a physician

visit for otitis media is about the

same for males and females. In 1990,

for example, males accounted for

52.5 percent of the visits and females

47.5 percent, a difference that is not

statistically significant. Annual visit

rates are not statistically different for

maIes and females, being 10.7 visits

per 100 males and 9.3 per 100

females in 1990.

Within age groups, the increases

in visit rates for males and females

from 1975 to 1990 are similar. The

visit rate for males under the age of 2

years increased dramatically from 32

visits per 100 male children in 1975 to

111.3 visits per 100 male chiIdren in

1990, an increase of 247.8 percent.

The increase was only slightly less for

females, with a visit rate climbing

from 31.1 visits per 100 female

chiIdren in 1975 to 92,7 visits per 100
4 Advance Data No. 214 ● Se~tember 8, 1992

eof1975 leeo 1ss5

Year

R Male B Female

SO.9

Figure 5. Annual otitis media visit rates for patients aged 2-5 years by sex: United States,

1975-90

19s0 10ss

Year

Figure 6. Annual otitis media visit rates for patients aged less than 15 years according to

ra;e: United States, 19B(P90

in 1990, or a difference of

198.1 percerit (figure 4).

Significant increases were also

noted among males and females aged

2-5 years between 1975 and 1990,

with the male visit rate rising from

22.6 visits to 50.9 visits per 100 males,

and the rate for females climbing

from 18.9 visits to 44.5 visits per 100

females (figure 5). Visit rates for

males and females in the age

groups 6–10 years and 15 years and

over did not appear to increase

significantly during this time period.

Estimates for the age group 11-14

years could not be compared, due to

unreliably small estimates in earlier

years.

Visit rates by race

Visit rates for a principal

diagnosis of otitis media were

significantly higher for white persons

under the age of 15 years than for

black persons in the same age group

for 1980, 1985, and 1990. The small

number of visits for otitis media made

by black persons in 1975, and by

black persons aged 15 years and over

in 1980, 1985, and 1990 made

calculation and comparison of these

rates statistically unreliable. Rates for

race categories other than white and

black persons were statistically

unreliable due to small sample size

for all data years and did not permit

comparisons.

White persons under the age of

15 years made about 25.5 visits per

100 in 1980, compared with 7.2 visits

per 100 black persons aged less than

15 years in 1980. By 1990

corresponding visit rates were 38.8

and 16.1, respectively, with both

groups showing an increase over the

time period, although the increase

was greater among white persons

than among black persons (figure 6).

Visit rates by geographic region

Visit rates for four geographic

regions of the United States

(Northeast, Midwest, South, and

West) were not found to differ

significantly from each other either in

1975 or in 1990, although substantial

increases were noted in each of these

four regions over the 1975-90 time

period. The pattern of change varied

by region (figure 7).

The overall otitis media visit rate

for the northeast region jumped from

3.9 visits per 100 persons in 1975 to

9.2 visits per 100 persons in 1980,,

making the northeastern visit rate for

1980 substantially higher than the

three other regional rates. The

northeastern visit rates for 1985 and

1990 did not change significantly from

the 1980 level.

ln the Midwestern region a

significant increase in the otitis mledia

visit rate was seen between 1980 and

1985, when the rate rose from 5.CI

visits per 100 persons to 8.2 visits per

100. Significantly higher visit rates

were found in the southern region in

1990 compared with 1985 and in the

western region in 1985 compared with

1975.
Advance Data No. 214 ● September 8, 1992 5

■ 1975 E41930 F3198S LZ1990

10.0

m

10.1

F

J

X

10.5

Nolnleast Midwest south west

GeonraMii maim

Figure 7. Annual otitis media visit rates by geographic region: United States, 1975-90

■ FWii E2General and IQ CMaryngology KI Allother

familypfsctice specialties

38.3

1975 law 1sss 1990

Year

Figure 8. Percent of otitis media visits by physician specialty: United States, 1975-90

Physician characteristics

Table 4 presents data on visits

with a principal diagnosis of otitis

media by physician specialty. Major

findings are summarized below.

Physician specialty

In 1975 the majori~ of visits with

a principal diagnosis of otitis media

were made to pediatricians

(3S.3 percent), general and famiIy

practitioners (31.2 percent), and

otolaryngologists (21.1 percent). By

1990 the distribution of visits by

physician specialty had not changed

significantI~. pediatricians received

-$7.4 percent of the total in 1990,

folIowed by general and famiIy

practitioners tvith 29.9 percent and

otolaryngo[o:ists with 14.S percent of

the totaI number of visits \vith a

principal diagnosis of otitis media

(figure S).

Visit rates to selected specialties

The visit rate for a principal

diagnosis of otitis media increased

significantly for pediatricians and

generaI and family practice physicians

between 1975 and 1990 (figure 9).

The visit rate to pediatricians

increased from 1.S visits per 100

persons in 1975 to 4.7 visits per 100

in 1990. About 1.5 visits per 100

persons were made to general and

family practice physicians in 1975,

compared with 3.0 visits per 100

persons in 1990. The rate of visits

with a first-listed diagnosis of otitis

media did not differ significandy for

otolaryngologists be~veen 1975 and

1990.

An examination of visit rates by

age to pediatricians and general and

famiIy practitioners shows that the

largest increase in visits for otitis

media occurred among visits to

pediatricians by patients aged Iess

than 2 years (figure 10). Substantial

increases in the visit rate to these

specialties were also noted for visits

made by patients aged 2-5 years

(figure 11). These findings paral[el

the changes described earlier in

overall visit rates by age.

Visit characteristics

Reason for visit

Item 9 of the Patient Record asks

the physician to record the patient’s

most important compIaint, symptom.

or other reason for this visit using the

patient’s (or patient surrogate’s) owm

\vords. Before 1977 these responses

\vere classified according to The

N-ational Ambulatory Medical Care

Survey, symptom classification (SC)

(3). From 1977 to the present,

reasons for visit have been classified

and coded according to “A Reason

for Visit Classification for Ambulatory

Care” (RVC) (4). The 10 most

frequently mentioned principal

reasons for visits with a first-listed

diagnosis of otitis media in 1990 are
6 Advance Data No. 214 ● September 8, 1992

6

r

■ 1975 E41$ao ❑ lsas IB19S0

3.0

M- Gened and family Cw=Ym@’wY

practice

Physicianspecialty

Figure 9. Annual otitis media visit rates for seiected physician specialties: United States,

197!5-90

■ 1975 Blase Elws ‘z! Iwo

a2.9 az9

pectice

Phvskian Sswcm’

Figure 10. For seiected physician specialities, annual otitis media visit rates fOr patientS

aged ices than 2 years: United States, 197S-90

displayed in table 5. They have not “old” problem (a problem that had

changed substantially since 1975. been treated previously by the

Prior-visit status

physician); 28.2 percent were made

bv. patients returning to the physician

During 1990 about 57.0 percent for care of a new problem, and

of otitis media visits were made by 14.8 percent were made by new

“old” patients (patients who had seen patients. These percentages were not

the physician on a prior occasion) statistically different from those

who were returning for care of an reported in 1975. No significant

changes were noted in prior-visit

status by age category between 1.975

and 1990.

Diagnosis and treatment

The format used on the Patient

Record to record diagnostic and

therapeutic services ordered or

provided by the physician at the office

visit has undergone considerable

revision since 1975, making

categorical comparisons difficult for

the years in question here. For 1990

about 74.1 percent of visits with a

principal diagnosis of otitis media

indicated that none of the diagnostic

services listed were ordered or

provided by the physician. In

addition, 22.2 percent of visits

included a mention of counseling

and/or advice, and 5.8 percent

included nonmedication therapy

ordered or provided to the patient.

Despite the difficulties mentioned

above in comparing diagnostic and

treatment categories, one treatment

category has remained fairly constant

on the Patient Record and shows that

the majority of otitis media visits

made during 1975-90 included a

mention of medication ordered or

provided by the physician. As used in

the NAMCS, the term “medication”

is interchangeable with the ,terrn

“drug” and refers to all new or

continuing medication ordered or

provided by the physician at the visit,

including prescription and

nonprescription preparations. In 1975,

medications were ordered or provided

at 78.5 percent of the visits with a

principal diagnosis of otitis media; the

corresponding percentage was

84.1 percent for 1990. This difference

was not found to be statistically

significant.

More specific data on drugs

ordered or prescribed by the

physician at the visit began to be

collected on the 1980 NAMCS survey.

For 1980, 1985, and 1990, amoxicillin

was the most frequently mentioned

medication (generic or brand name

product) ordered or prescribed at

visits with a principal diagnosis of

otitis media. A list of the 10 most
Advance Data No. 214. September 8, 1992 7

■ 1975 Fzllw ❑ 19S5 IXlm

3o1- 2s.0

0

R9dii General and fsmity otolaryn@Qy

prsclice

Physieii Specislty

Figure 11.For selected physician specialties, annual otitfs media visit rates for patients

aged 2-5 years: United States, 1975-90

24.3

■ 1975 ❑ 1290

50.8

27.7

11.5

m

5 minu@s or 6-10 minuteu 11-ltimisruh 18 minutes or

more

Ouration of viaii

Figure 12. Percent of otitis media visits by duration of visit: United States, 1975 and 1990

frequently utilized medications for

1990 is shown in table 6.

Duration of visit

More than half (about

63 percent) of all visits with a

principal diagnosis of otitis media

lasted 10 minutes or less in 1975 and

1990. However, a higher percentage

of visits in 1975 lasted 5 minutes or

less (24.3 percent) compared with

1990 (12.6 percent). At the same

time more visits in 1990 lasted 11-15

minutes (27.7 percent) compared

with 1975 (18.8 percent). Data on

duration of visit are dispIayed in

figure 12.

Visit duration for the two

youngest age groups appeared to

increase between 1975 and 1990.

Whereas more than one-third

(34.9 percent) of visits made by

patients under the age of 2 years

lasted less than 5 minutes in 1975, the

same was true for only 11.3 percent

of patients in this age group in 1990.

Similarly, for visits made by those 2-5

years of age, about one-quarter

(25.6 percent) lasted 5 minutes or

less in 1975 compared with just

12.7 percent in 1990.

There appeared to be a

substantially higher percentage of

visits of short duration among

younger patients (66.6 percent of

visits by patients aged 0-24 years

lasted 10 minutes or less in 1990),

compared with older patients

(38.4 percent of visits made by

patients aged 25 years and over lasted

10 minutes or less in 1990).

Disposition of visit

More than half of alI otitis media

visits resulted in a scheduled return

visit in 1975 (58.7 percent), not

significantly different than the

65.1 percent found in 1990. The

pereent of otitis media visits resuIting

in a scheduled return visit did not

appear to differ by age in 1975.

However, in 1990, persons in the two

youngest age groups (less than 2 years

and 2-5 years) were found to be

more IikeIy to have a return visit

scheduled than were those in the

aggregated 15 years and over age

group. Data on disposition of visit are

displayed in table 7.

Otitis media as a principal

diagnosis

In 1975, otitis media was the fifth

I

most frequently mentioned

morbidity-related principal diagnosis,

and the eighth most common

principaI diagnosis overall.x (It should

be kept in mind that the rank

orderings presented within this report

may not be entireIy reliable, as some

estimates may not differ statistically

%iorbidity-related diagnoses are those

classifiable to illness or injury (KIM-CM

codes 001-999). Diagnoses other than those

related to illness or injury arc classified ~y the

ICD-9-CM supplementary classification males

VO1-V82, and include general medical

examinations, routine prenatal examinations,

health supervision of an infant or child, etc.
8 Advance Data No. 214 ● September 8, 1992

from other near estimates due to

sampling variability.) By 1990 it was

the second most frequently

mentioned principal diagnosis overall.

after essential hypertension (table 8).

Furthermore, among visits made

by males in 1990. otitis media was the

most frequently reported principal

diagnosis, recorded at approximately

4.6 percent of these visits, a

significantly higher proportion than

for visits by femaies. Among females,

this diagnosis \vas listed at about

2.7 percent of visits. It was the

second most frequent morbidityrelated principal diagnosis after

essential hypertension among females

and the fourth most frequent of all

reported diagnoses among females.

Ranked diagnoses by age group

For 1975 and 1990 otitis media

was the most frequently reported

morbidi~-related principal diagnosis

among vmits made by children under

the age of 2 years, However, the

percentage of visits for otitis media

made by children in this age group

increased from 7.3 percent of all

visits made by children under age 2 in

1975 to 17.4 percent of all visits in

this age category in 1990.

Among children aged 6-10 years,

otitis media was the most frequently

mentioned morbidity-related principal

diagnosis for 1975 and 1990,

representing 6.9 percent and

10.5 percent. respectively, of visits

made by this age group.

Although it ranked 6th as a

morbidity-related principal diagnosis

among those 11–14 years of age in

1975 (2.6 percent of visits), otitis

media was the most frequently

reported morbidity-related principal

diagnosis among this age group in

1990. accounting for 5.2 percent of

all visits made by children aged 11-14

years.

In comparison, for visits made by

persons aged 15 years and over, otitis

media was listed as the principal

diagnosis at only 0.6 percent of visits

in 1975, making it the 20th most

frequently mentioned morbidityrelated principal diagnosis. For 1990

it was listed at 0.8 percent of visits in

the age category 15 years and over,

making it the 21st most frequent

morbidity-related principal diagnosis,

and the 24th most frequent of all

principal diagnoses for this age group

(figure 13).

A similar pattern was seen among Ranked diagnoses by physician

children aged 2–5 years, with visits for specialty

otitis media, the most frequently

reported principal diagnosis in this In 1975 about 1.3 percent of

age group in 1975 and 1990, jumping office visits to general and family

from 10.4 percent of the total in 1975 practitioners resulted in a principal

to 18.1 percent in 1990. diagnosis of otitis media, making

■ 1975 ❑ leeo

Lsas than

2 years

2-5

yasrs

6-10

years

11-?4

years

15 years

and cwer

o 5 10 15 20

Fercsnt of oflice vkti

Figure 13.Percent of office visits with a principal diagnosis of otltis media by patient’s

age: United States, 1975 and 1990

otitis media the 13th most frequently

listed morbidity-related principal

diagnosis among office visits to

general and family practice physicians

during that year. By 1990, however,

3.5 percent of all visits to this

specialty listed otitis media as the

principal diagnosis, making it the 3rd

most frequently mentioned

morbidity-related principaI diagnosis

among visits to general and family

practice physicians.

Among visits to pediatricians,

otitis media was the most frequently

reported morbidity-related principal

diagnosis for 1975 and 1990, but the

percentage of visits with this diagnosis

increased from 8.1 percent of the

total number of visits to pediatricians

in 1975 to 14.3 percent in 1990.

Otitis media was also the most

frequently rendered principal

diagnosis at office visits to

otolaryngologists for 1975 and 1.990,

and the proportion of visits with this

diagnosis increased from 12.8 percent

of aI1visits to this special~ in 1975 to

20.2 percent in 1990 (figure 14).

Concomitant diagnoses

About 18.2 percent of visits with

a principal diagnosis of otitis media in

1975 also listed a second diagnc)sis;

for 1990, about 31.6 percent of visits

did so. Diseases of the respiratcmy

system were mentioned at

66.3 percent of visits listing a second

diagnosis in 1975 and at 59.2 percent

of visits listing a second diagnosis in

1990.

Otitis media as a second- or

third-listed diagnosis

In addition to the 9.9 million

office visits with a principal diagnosis

of otitis media in 1975, an additional

2.9 million visits were made at which

the second- or third-listed diagnosis

was otitis media, for a total of about

12,8 million visits related to otitis

media, or 2.3 percent of all visits

made during that year. In 1990 otitis

media was listed as the second or

third diagnosis at an additional 5.9

million visits, for a total of about 30.3

million otitis media-related office

visits, or approximately 4.5 percent of
Advance Data No. 214 ● September 8, 1992 9

■ 1975 K119C0

Rdiabfca 14.3

mva 3.5

L

202

0 5 10 15 20 25

hcent of Omm*ils

Figure 14. Percent of office visits with a prlnclpal diagnosis of otltls media for selected

spoclaitles: United States, 1975 and 1990

all visits made during this 12- month

period. First-listed diagnoses for visits

with a second- or third-listed

diagnosis of otitis media were most

frequently diseases of the respiratory

system for 19?5 and 1990.

Summary and discussion

Data from the National

Ambulatory Medical Care Survey

show a steady increase in the number

and rate of physician office visits for

otitis media over the period from

1975 to 1990. The annual visit rate

during this period more than

doubled, and for children under age

15, increased 175 percent. Though

the increase is greatest for males

under age 2, there are substantial

increases for males and females

under age 15. Reasons for this

dramatic increase are not readily

apparent. Data from the National

Health Interview Sutvey (NHIS),

however, suggest that the increased

visit rate may reflect an increase in

the incidence of ear infections.

According to NHIS data, the

incidence of acute ear infections

among the U.S. population increased

by about 40 percent between 1982

and 1990, from 6.1 to 8.6 conditions

per 100 persons per year. This

compares with an increase of about

52 percent in the physician office visit

rate for otitis media, from 1980 to

1990. (Because of gaps in data

collection, it is not possible to

compare preciseiy concurrent time

periods.) The under 15 age group,

which accounts for about 80 percent

of otitis media physician office visits,

experienced a 60 percent increase in

office visit rate from 1980 to 1990.

This parallels data from the NHIS

that show a 60 percent increase in

the incidence of acute ear infections

among the under 17 age group from

1982 to 1990 (5,6). The reporting of

an acute ear infection in the NHIS

does not necessarily equate to an

incidence of otitis media, but the

parallel increases in ear infection

incidence and otitis media physician

visits are mutually supportive and

likely to be related.

References

1. National Center for Health Statistics.

Eighth Revision International

Cl&sification of Diseases, adapted for use

in the United States. Washington: Public

Health Service. 1967.

2. Public Health Sewice and Heakh Care

Financing Administration. International

Classification of Diseases, 9th Revision,

clinical modification. WashingtosxPublic

Health Service. 1980.

3. Meads S, McLemore T. The National

Ambulatory Medical Care Survey

Symptom classification.National Center

for Health Statistics. Vhal and Health

Stat 2(63). 1974.

4. Schneider D, Appleton L, ?vfcLemore

T. A reason for visit classificationfor

ambulatory care. National Center for

Health Statistics. Vital and Health Stat

2(78). 1979.

5. National Center for Health Statistics.

Current estimates from the National

Health Interview Survey, United States,

1982.National Center for Health

Statistics. Vital Health Stat 10(150). 1985.

6. Adams PF, Benson V. Current

estimates from the National Health

Interview Survey. National Center for

Health Statistics. Vital Health Stat

10(181). 1991.
10 Advance Data No. 214 ● September 8, 1992

Table 1. Number, percent distribution, and annual rate of office vlslts with s principal

diagnosis of otitis media by patient’s age and sex: United States: 1975-90

Sex and age 1975 1980 1985 1990

Both sexes

Alleges . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . .

O-l year . . . . . . . . . . . . . . .

2-5 years . . . . . . . . . . . . . .

8-10 years . . . . . . . . . . . . .

11-14 years . . . . . . . . . . . .

15years Andover..,.,,.. .

15-24 years........,.. .

25-4L years . .,, ,, . . . . . . .

45-6& years . ., .,,,.... . .

65yea-s and over, .,.....,

Female

Alleges . . . . . . . . . . . . . . . . .

Under 15 years, . . . . . . . . . . . .

o-lyea~, . . . . . . . . . . . . . .

2-5ye2:s. . . . . . . . . . . . . . .

8-10 years . . . . . . . . . . . . . .

11-14 years . . . . . . . . . . . . .

15years a~d over . . . . . . . . . . .

15-24 years . . . . . . . . . . . . .

25+4 years . . . . . . . . . . . . .

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

65 years and over . . . . . .

Male

Alleges, , .,, ,, . . . . . . . . . .

Under 15 years, . . . . . . . . . . . .

O-l year . . . . . . . . . . . . .

2-5years. . . . . . . . . . . . . . .

8-10years, . . . . . . . . . . . . .

11–14years . . . . . . . . . . . .

15years Andover . . . . . . . . . ,.

15-24years . . . . . . . . . . . . .

2.544 years . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . .

65years Andover .,..,... .

Both sexes

Alleges . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . .

O-l year . . . . . . . . . . . . . . .

2-5 years . . . . . . . . . . . . . . .

8-10 years, . . .

11–14 years, . . . . . . . . . . .

15 years and over . . . . . . . . . . .

15-24 years . . . . . . . . . . . . .

25+4 years, . . . . . . . . . . .

45-64 yeara . . . . . . . . . . . . .

65 years and over . . . . . . . .

Female

Alleges . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . .

O-l year, , . . . . . . . . . . . . .

2-5yea.s . . . . . . . . . . .

6-10 years..........,,,,

11–14 years .

15years And over . . . . . . . . . .

15-24 years....,....,,,.

25-44 years....,,,,,,,,.

45-6-l years.....,.,,,

65 years and over ,.

9,B99

6,991

1,860

2,796

1,787

548

2,907

805

1,027

698

“377

5,201

3,292

909

1,22a

872

●263

1,910

●496

697

●453

“264

4,697

3,698

951

1,569

914

+264

1,000

●31O

*331

*245

●114

100,0

70.6

18,8

28.2

18,1

5.5

29.4

61

10.4

7.1

●3,8

52.5

33.3

9.2

12.4

8.8

●2.9

19.3

5.0

7.0

●4.6

“2.7

Number of visits in thousands

14,138

11,160

4,280

3,926

2,363

571

2,979

1,051

1,052

525

●35 1

6,469

4.664

1,625

1,774

1,226

’259

1,605

5!0

629

●257

18,341

15,014

6,819

5,337

2,295

562

3,328

1,036

1,154

638

500

9,483

7,381

3,041

2,797

1,176

367

2,102

628

728

423

323

7,650 8,858

6,276

2,655

2,152

1,157

●312

1,374

541

423

●269

’141

7,633

3,779

2,540

1,119

●195

1,225

406

425

●215

’177

Percent distribution

100.0 100.0

78.9 81.9

30.3 37.2

27.8 29.1

16.9 12.5

4.0 3.1

21.1 16.1

7.4 5.6

7.4 6.3

3.7 3.5

2.5 2.7

45.9

34.5

11.5

12.5

8.7

“1,8

114

3.6

4,4

●1,8

●1 5

51.7

40.2

16.6

15.2

6.4

2.0

11.5

3,4

4,0

2.3

1.8

24,458

19,680

8,146

7,145

3,297

1,092

4,777

927

2,056

1,239

555

11,731

6,928

3,634

3,238

1,477

579

2,804

565

1,297

643

●299

12,728

10,753

4,512

3,907

1,820

●514

1,975

“362

759

597

*257

100.0

60.5

33.3

29.2

13.5

4.5

19.5

3.8

8.4

5.1

2.3

48.0

36.5

14.9

13.2

6.0

2.4

11.5

2.3

5.3

2.6

1.2
Advance Data No. 214 ● September 8, 1992 11

Table 1. Number, percent distribution, and annual rate of office visits with a principal

diagnosis of otitis media by patient’s age and sex United State= 197S-90-Con.

Sex and age 1975 1980 19.95 1s90

Male

Alleges . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . .

O-l year . . . . . . . . . . . . . . .

2-5 years . . . . . . . . . . . . . . .

6-10years . . . . . . . . . . . . . .

ll-14yeara . . . . . . . . . . . . .

15yeare And over . . . . . . . . . . .

15-24 years . . . . . . . . . . . . .

25+4years . . . . . . . . .. l..

45-64 yeecs . . . . . . . . . . . . .

65years and over . . . . . . . . .

Both sexes

All ages . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . .

O-l year . . . . . . . . . . . . . . .

2-5years . . . . . . . . . . . . . . .

6-10 years . . . . . . . . . . . . . .

ll-14years . . . . . . . . . . . . .

15yeara And over . . . . . . . . . . .

15-24 years . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . .

65years And over . . . . . . . . .

Female

Aliases . . . . . . . . . . . . . . . . .

lJrrder 15years . . . . . . . . . . . . .

O-l year . . . . . . . . . . . . . . .

2-5years . . . . . . . . . . . . . . .

6-10years . . . . . . . . . . . . . .

11-14 years . . . . . . . . . . . . .

15years And over . . . . . . . . . . .

15-24 years . . . . . . . . . . . . .

25-44 yeara . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . .

65years and over . . . . . . . . .

Male

Alleges . . . . . . . . . . . . . . . . .

Under 15years. . . . . . . . . . . . .

O-l year . . . . . . . . . . . . . . .

2-5years . . . . . . . . . . . . . . .

6-10years . . . . . . . . . . . . . .

11-14 years . . . . . . . . . . . . .

15yaara Andover . . . . . . . . . . .

15-24 years . . . . . . . . . . . . .

26-44 years . . . . . . . . . . . . .

45-64 years’ . . . . . . . . . . . . .

65years and over . . . . . . . . .

47,5

37.4

9.6

15.9

9.2

●2.7

10.1

V.1

●3.3

●2.5

●1.2

4.8

13.1

31.5

20.8

10.2

3.3

1.9

2.1

2.0

1.6

V.%

4.8

12.6

31.1

10.9

10.1

●3.5

2.3

●2.5

2.6

●2.O

*2. 1

4.7

13.6

32.0

22.6

10.3

●3.2

1.4

*1.6

●1.3

●1.2

●1.3

Parcent distribution

54.1 4s.3

44.4 41.6

18.8 20.6

15.2 13.8

8.2 6.1

*2.2 ●1.1

9.7 6.7

3.6 2.2

3.0 2.3

●1.9 ●1.2

●1.0 ●1.0

Number of visits per 100 persons per year’

6.5

22.5

64.7

31.9

14.4

4.0

1.6

2.6

1.7

1.2

●1.5

5.8

20.1

50.7

29.3

15.3

‘3.7

1.6

2.5

2.0

●1.1

●1.5

7.3

24.8

77.9

34.3

13.6

“4.4

1.7

2.6

1.4

●1.3

●1.4

7.9

28.1

93.5

37.7

14.1

4.1

1.8

2.7

1.6

1.4

1.9

7.9

22.3

84.6

40.9

14.7

5.4

2.2

3.2

2.0

1.s

2.0

7.9

28.9

102.1

34.7

13.5

●2.7

1.4

2.2

1.2

●1.0

●1.6

52.0

44.0

18.4

16.0

7.4

2.1

8.1

1.5

3.1

2.4

1.1

9.9

36.0

102.1

47.8

18.2

8.0

2.5

2.7

2.6

2.7

1.9

9.3

33.4

92.7

44.5

16.6

8.8

2.8

3.2

3.2

2.7

●1.7

10.7

38.4

111.3

50.9

19.7

7.3

2.2

2.1

1.9

2.7

●2.1

‘Sased cm U.S. Buraau of the Census estimates of tlw civiiin. nomnsmtionalued U.S. populatiair as of Ju~ 1 for e~h survey

year. SUW.Sy years 1975-19a5 did not mdudo Alsslra ●nd Hawmi, snd popuferion esttmsw for thass yesrs how besn tiikl

accordingly.
12 Advance Data No. 214 ● September 8, 1992

Table 2. Number, percent distribution, and annual rate of office visits with a principal

diagnosis of otitls media for patients aged less than 15 years according to race:

United States, 1975-90

Race and age 1975 1980 1985 1990’

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

Whl!e . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . .

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

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

Whit e...,,,......,...,,,

Black . . . . . . . . . . . . . . . . . . .

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

Total ...,......,...,,,. .

White . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . .

Other .,,,....,..,,.. . . .

6.991

6,641

●237

“113

1000

950

“3.4

“1. 6

13.1

14.9

“3 o

‘18.7

Numberofvwrts inthoussnds

11,160 15,014

10,430 14,047

544 671

“186 ’297

Percent distribution

100.0 100.0

93.5 93.6

4.9 4,5

“1.7 “2.0

Number of viwts per 100 persons per yea?

22.5 29.1

25.5 33.3

7.2 6.5

●16.9 ●20.6

19,006

17,127

1,373

“507

100.0

90.1

7.2

‘2.7

34.7

38.8

16,1

●24.9

‘The 1990 NAMCS included an “unspecrf,ed” cafego~ !mme race Item, A total 01 e75,000 VISIIS m 1SS0hawng a race catego~

Oisunspec!fled, -havebeemo m!tredf romth,stanle, Darsyears 197>19a5!mputed aracecstego~ where necessary.

2Based on US, Bureau of the Census estimates ollhec!wl,an. non6nsttiutlonal]zed~pubtion of the Uniled Slaleaasof Jukl

for each survey year. Survey years 1975-190500 “of !nclu.ae Alaska and Hawe!i, and pfjpufatton esl!ma!ea for theaa years have

been modif!eo accordingly,

Table 3. Number, parcent distribution, and annual rate ofoffice visltswith a principal

diagnosis ofotitis media bygeographic region: United States, 1975-90

Geographicreg!on 1975 1980 1985 1990

Allvieits . . . . . . . . . . . . . . . .

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

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

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

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

Allvisifs . . . . . . . . . . . . . . . . .

Northeast . . . . . . . . . . . . . . ,.

Midwest, . . . . . . . . . . . . . . . .

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

West, ...,.........,.. . .

All visits . . . . . . . . . . . . . . . . .

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

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

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

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

9,899

1,934

2.600

3.592

1,773

100.0

19.5

26.3

36.3

17.9

4,s

3,9

4.7

5.4

4.9

Numberofvisita ktthouaends

14,138 la,341

4,450 48134

2,904 4,797

4,044 5.2eo

2,731 4,120

Percent dlatrlbutlon

100.0 100.0

31.5 22.5

20.5 26.2

28.6 28.8

19.3 22.5

Number of visits per 100 persons per year’

6.5 7.9

9.2 8.3

5.0 8.2

5.7 6.6

6.9 9.3

24,458

4,491

6,001

6,466

5,501

100.0

18.4

24.5

34.6

22.5

9.9

9.0

10.0

10.1

10.5

‘Baaed on U.S, Bureau of the Census esttmataa of theclvtl!an, nonlnstfiut!onal! z&~puhtlon of the Umtti States asof Ju~l

for each auwey year. Suwey years 1975-S5 dld not Include Afaska and Hawaii, and popufebon esw’rrataa for these years hava

been modified accordmgfy.
Advance Data No. 214 ● September 8, 1992 13

Table 4. Number, percent dlstributlon, and annual rate of office visits with a principal

diagnosis of otitis media by physician special~ United States, 1975-90

Physician sp&ialty 1975 1980 1985 1990

All visits with a principal diagnosis

ofotitis media . . . . . . . . . . . . .

Pediatrics . . . . . . . . . . . . . . . .

General and fami[y practice . . . . .

Otolaryngology . . . . . . . . . . . . .

Another speciaities . . . . . . . . . .

All visita with a principal diagnosis

ofotitis media . . . . . . . . . . . . .

Pediatrics . . . . . . . . . . . . . . . .

General and famdypracfice . . . . .

Otolaryngology . . . . . . . . . . . . .

All other specialties . . . . . . . . . .

Afl visits with a principal diagnosis

ofotitismedia . . . . . . . . . . . . .

Pedatrha. . . . . . . . . . . . . . . .

General andfamily prectlce . . . . .

Otolaryngology . . . . . . . . . . . . .

All other specialties . . . . . . . . . .

9,899

3,795

3,087

2,088

929

100.0

38.3

31.2

21.1

9.4

4.8

1.8

1.5

1.0

0.4

Number of visits in thousands

14,138 18,341

7,225 9.841

3,320 5,165

2,654 2,393

939 1,142

Percent distribution

100.0 100.0

51.1 52.6

23.5 28.2

18.8 13.0

6.8 6.2

Number of visits per 1CQpersons per year’

6.5 7.9

3.3 4.2

1.5 2.2

1.2 1.0

0.4 0.5

24,458

11,581

7,301

3,620

1,956

100.0

47.4

29.9

14.8

8.0

9.9

4.7

3.0

1.5

0.8

‘Based on U.S. Bureauofthe CensusestimatesofthEc!wllan,noninsttuttontizWU,S.ppulatim Uof Ju~lforeatisuwey

——

year. Surveyyeara 197=5 did not include Alaska and Hawa!i, and population esttmates for these yeara have been modiiied

accardingiy.

Table 5. Number and percent distribution of office visits with a principal diagnosis of otitis

media bypatient’s principal reason for visit: United States, 1990

Number of

vfsita in Percent

Reason for Wit thousands distribution

Allvisits with aprincipal diagnosis ofotitis media. . . . . . . . . . . . . . 24,458 100.0

Eareche orearinfection . . . . . . . . . . . . . . . . . . . . . . . . ..s355

Other symptoms referable toears, notelsewhere classified . . . .S385

Fever . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . ..so1o

Otifismedia . . . . . . . . . . . . . . . .,.................0450

Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s440

Dischargefrom ear ..,...... . . . . . . . . . . . . . . . . . . ..s350

Head cold, upper respiratory infection (coryza) . . . . . . . . . . ..S445

Hearingdyefunctions . . . . . . . . . . . . . . . . . . . . . . . . . . ..s345

Nasalcongestion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s400

Pluggedfeeiing inear . . . . . . . . . . . . . . . . . . . . . . . . . . ..S360

Allotherreasons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9,005

3,161

2,151

1,350

1,279

828

788

781

767

624

3,724

36.8

12.9

8.6

5.4

5.1

3.3

3.2

3.2

3.1

2.5

15,9

‘Based on “A Reasonfor Vmt Cleesulsauon for Ambulatory Care”’ (RVC), V.a HeaRh Stat 12)78 1979.
14 Advance Data No. 214 ● September 8, 1992

Table 6. Number and percent distribution of office visits with a prlnclpal diagnosis of otltls

media by the 10 most frequently used generic substances: United States, 1990

Number of dNg

mentions in Percent

Generic substance’ mouaends dMribufion

All drug mentions for visita with a principal dtagnosis of otitis

media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,006 100.0

Amoxicilfin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cefaclor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Trimethopnm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulfamethoxszole ...,.... . . . . . . . . . . . . . . . . . . . . . .

Pentoxifylline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylephrme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycm, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylpropanolamine . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulfisoxazole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrocortisone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9,645

3,496

1,754

1,754

1,624

1,524

1,496

1,292

1,036

1,012

33.9

12.1

6.0

6.0

5.6

5.3

5.2

4.5

3.6

3,5

1Frequency of mentmn combines smgle-mgredtent agents wrth memmns of me agent m a combination drug.

Table 7. Number and percent distribution of office visits with a principal diagnoals of otitls

medlabydisposttion of visit according to patierst’s age: United States, 1975 and1990

Patient’s age

Numberof

vki&Sin G5 6-14 15 years

Disposition of visit mousarrds years years and over

1975 Percent dlatribtiton

Allviwts . . . . . . . . . . . . . . . . . 9,699 100.0 100.0 100.0

Return visit scheduled . . . . 5,813 60.2 56.4 58.3

Return ifneeded . . . . . . . . . . . 2,476 24.7 21.8 28.2

Nofollow-up . . . . . . . . . . . . . 1,204 11.6 ●16.1 ‘ ●9.8

Other ? . . . . . . . . . . . . . . . . 670 ●7.2 ●7.4 ●5.7

1990

Allvis”ti . . . . . . . . . . . . . . . . . 24,458 100.0 100.0 100.0

Return visit scheduled . . . . . . . 15.918 73.2 56.9 46.6

Returnifneeded. . . . . . . . . . . 5,405 17.4 24.3 35.2

Nofollow-up . . . . . . . . . . . . . 2,227 6.9 12.1 13.4

Ofhe? . . . . . . . . . . . . . . . . . 1,893 7.2 ●8.3 ●9.1

lTotal may excead total number of visits because more rhan one d!apositron IS possible per visit.

‘Includes telephone toliowup, relum to referring physlcnn, admit to hospnal, and “other”.
Advance Data No. 214 ● September 8, 1992 15

Table 8. Numbar and percent distribution of office visits by the 10 most frequently

mentioned principal diagnosem United States, 1975 and 1990

Number of

w“sitsin Percent

Prirw”pal dlagmsis and code tfrousands distrfbdon

1975’

Allvksa. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical or special examination. . . . . . . . . . . . .YOO

MedkaJorsurgical aftercare. . . . . . . . . . . . . . .YIO

Essentktl benign hypertension . . . . . . . . . . ...401

Prsnatalcare . . . . . . . . . . . . . . . . . . . . . . ..Y06

Aoute respiratoryInfection,site unspecified . . ...455

Neuroses . . . . . . . . . . . . . . . . . . . . . . . . ..3WJ

Chronic isohemlcheart disease. . . . . . . . . . ...412

Dtftlsmadla . . . . . . . . . . . . . . . . . . . . . ...381

Diabetes mellitus. . . . . . . . . . . . . . . . . . . ...250

Dthersczema anddermatitls . . . . . . . . . . . ...692

19602

Allvkita. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Easarrtla lhypertensio n. . . . . . . . . . . . . . ...401

Dtftf8madla3. . . . . . . . . . . . . . . . . . . . . . . . . .

Norrmdprsgnancy. . . . . . . . . . . . . . . . . . . ..V22

Generel medlcalexamlnatlon . . . . . . . . . . . . ..V70

Acute upper respiratoryinfections. . . . . . . . ...465

Health supervkionoflnfantorchild .. . . . . . . ..V20

Diebates mellhrs . . . . . . . . . . . . . . . . . . . ...260

AJlergforhiniti s . . . . . . . . . . . . . . . . . . . ...477

Bm~W, ~spwMdas~e wtimnlc. . . ..480

Aoutepharyngttls. . . . . . . . . . . . . . . . . . . . ..4S2

567,600

40,s53

26,782

22,s24

14,607

13,641

12,513

9,899

9,671

9,6s7

704,604

27,310

24,456

23,561

21,043

20,555

18,s76

15,303

12,123

12,G96

11,536

100.0

7.2

4.7

4.0

3.7

2.6

2.4

2.2

1.7

1.7

1.7

lCQ.O

3.9

3.5

3.3

3.0

2.9

2.7

2.2

1.7

1.7

1.6

‘O+W&-SS--SS—R—Wd~

$OIS9

Clsss/&ati cfOhOsss, adapladfor uss in the Uri+tsdStatas

noctk codas basad on rho InrunsrkmaiClssW@mn“ tiDk-&m R&W, ~WM&;Wh, flCb=M).

%afirrsd hwotoindwdoICO-W2Mcorw 3S1.0-9S1.4 (nonsuppurafhworitknwdia)and3S20-332.9 (supp.ratiw and

unspa.qfaddiih madia).
16 Advance Data No. 214 ● September 8, 1992

Technical notes

Source of data and sample

design

The information presented in this

report is based on data collected by

means of the National Ambulatory

Medical Care Survey (NAMCS) from

January 1990 through December

1990. The target universe of NAMCS

includes office visits made in the

United States by ambulatoq’ patients

to nonfederally employed physicians

who are principally engaged in office

practice, but not in the specialties of

anesthesiology, pathology, or

radiology. Telephone contacts and

nonoffice visits are excluded.

A multistage probability sample

design is used in NAMCS, involving

samples of primary sampling units

(PSU’S), physician practices within

PSU’S, and patient visits within

physician practices. For 1990, a

sample of 3,063 nonfederal,

office-based physicians was selected

from master files maintained by the

American Medical Association and

American Osteopathic Association.

The physician response rate for the

1990 hTAMCS was 74 percent.

Sample physicians were asked to

complete Patient Records (see

figure 2) for a systematic random

sample of office visits occurring

during a randomly assigned l-week

reporting period. Responding

physicians completed 43,469 patient

records.

Characteristics of the physician’s

practice, such as primary specialty

and type of practice, were obtained

from the physicians during an

induction interview. The U.S. Bureau

of the Census, Housing Surveys

Branch, was ~esponsible for the

survey’s data collection. Processing

operations and medical coding were

performed by the National Center for

Health Statistics, Hospital Discharge

and Ambulatory Care Survey Section,

Research Triangle Park, North

Carolina.

Previous NAMCS surveys

employed a statistical design that is

similar to that used for the 1990

NAMCS. Additional information

pertaining to technical aspects of the

other data years included in this

report (1975, 1980, and 1985) is

available upon request.

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 relative

standard error of an estimate is

obtained by dividing the standard

error by the estimate itselfi the result

is then expressed as a percent of the

estimate. Table I shows relative

standard errors for estimated

numbers of office visits in 1990, and

table II presents relative standard

errors for estimated numbers of drug

mentions. Standard errors for

estimated percents of visits are shown

in table 111.

Alternatively, relative standard

errors for aggregate estimates may be

calculated using the following general

formula, where x is the aggregate of

interest in thousands, and A and B

are the appropriate coefficients from

table IV.

‘SE(X)= @“lOO”O

Table 1, Relative standard errors for

estimated number of office visits: National

Ambulatory Medical Care Survey, 1990

Estimafed number of Relative standard

office visits in thousands error in percent

200 . . . . . . . . . . . . . . . 48.2

400. . . . . . . . . . . . . . . 34.2

522 . . . . . . . . . . . . . . . 30.0

600 . . . . . . . . . . . . . . . 28.0

800 . . . . . . . . . . . . . . . 24.3

1,000 . . . . . . . . . . . . . . 21.8

2,000 . . . . . . . . . . . . . . 1.S.6

5,000 . . . . . . . . . . . . . . 10.3

10,000 . . . . . . . . . . . . . 7.7

15,000 . . . . . . . . . . . . . 6.1,

20,000 . . . . . . . . . . . . . 6.7

50,000 . . . . . . . . . . . . . 4.8

100,000 . . . . . . . . . . . . 4.3

500,000 . . . . . . . . . . . . 3.8

Example of use oi table An aggregate estunate of 10 mllhon

vms has a relafwe standard error of 7.7 percent of a

Handard error O! 770.000 viska (7.7 percent of 10 mitlion).

Table IL Relative standard errora for

estimated number of drug mentiorw

National Ambulatory MedicalCare Survey,

1990

Estimated number of drug Relat;ve skv?dard

mentions in thousands error in percent

200 . . . . . . . . . . . . . . . 58.5

400 . . . . . . . . . . . . . . . 41.5

500 . . . . . . . . . . . . . . . 37.2

600 . . . . . . . . . . . . . . . 34.0

no . . . . . . . . . . . . . . . 30.0

800 . . . . . . . . . . . . . . . 29.6

1,000 . . . . . . . . . . . . . . 26.6

2,000 . . . . . . . . . . . . . . 19.1

5,000 . . . . . . . . . . . . . . 12.7

10,000 . . . . . . . . . . . . . 9.7

20,000 . . . . . . . . . . . . . 7.7

50,000 . . . . . . . . . . . . . 6.3

100,000 . . . . . . . . . . . . 5.7

500,000 . . . . . . . . . . . . 5.2

Exampleof use of table: An aggrsgate ealimate of’1 O million

drug mentions has s relatwe standard error of 9.7 percent or

a standard error of 970,000 viaita (9.7 percent of 10 million).

Similarly, relative standard errors

for percents may be calculated using

the following general fmmula, where

p is the percent of interest and x is

the denominator of the percent in

thousands, using the appropriate

coefficient from table IV.

RSE(p) =

v

B (~+). 100.(3

px

Adjustments for nonresponse

Estimates from NAMCS data

were adjusted to account for sample

physicians who were in scope but did

not participate in the study. This

adjustment was calculated to

minimize the impact of response on

final estimates by imputing to

nonresponding physicians data from

visits to similar physicians. For this

purpose, physicians were judgecl

similar if they had the same specialty

designation and practiced in the same

Psu.

Test of significance and

rounding

In this report the determination

of statistical inference is based on the
Advance Data No. 214 ● September 8, 1992 17

Table Ill. Standard errors for percents of estimated numbers of office vlslts: National Ambulatory Medical Care Survey, 1990

Estimared percent

Base of percent 1or 5 or 10 or ZWor 30 or

(visits in thousands) 99 95 90 80 70 50

Standard error in percentage points

200 . . . . . . . . . . . . . . . . . . . . 4.8 10.5 14.4 19.2 22.0 24.0

500 . . . . . . . . . . . . . . . . . . . . 3.0 6.6 9.1 12.2 13.9 15.2

1,000 . . . . . . . . . . . . . . . . . . . 2.1 4.7 6.5 8.6 9.9 10.8

2,000 . . . . . . . . . . . . . . . . . . . 1.5 3.3 4.6 6.1 7.0 7.6

5,000 . . . . . . . . . . . . . . . . . . . 1.0 2.1 2.9 3.8 4.4 4.8

10,000 . . . . . . . . . . . . . . . . . . 0.7 1.5 2.0 2.7 3.1 3.4

13,000 . . . . . . . . . . . . . . . . . . 0.6 1.3 1.8 2.4 2.7 3.0

20,000 . . . . . . . . . . . . . . . . . . 0.5 1.1 1.4 1.9 2.2 2.4

50,000 . . . . . . . . . . . . . . . . . . 0.3 0.7 0.9 1.2 1.4 1.5

100,000 . . . . . . . . . . . . . . . . . 0.2 0.5 0.6 0.9 1.0 1.1

600,000 . . . . . . . . . . . . . . . . . 0.1 0.2 0.3 0.4 0.4 0.5

-mpleot useoftabla hest!mate of30percent b%tionan aggregate estimate of13m#lfion tisiBhS atiMard emorof2.7percent orarelaWe tindardemorof9.l percent (2.7 percent

drvidad by 30 percent).

Table IV. Coefficients appropriate for determining relative standard errors by type of

estimate and physician groups: National Ambulato~ Medical CareSurvey,1990

Coefriclent

Type of estimate and physician group A B

visits

Overalltotals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Doctore ofoeteopathy, general surgery, -rdiovascuiardiseaee,

psychiat~, urologi@ surgery, dermatology, neurology,

pediatrics, ophthalmology, otolaryngology, obstetrics and

gynemlogy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Orthopedicsurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“Allother’’spacialflesgroup.... . . . . . . . . . . . . . . . . . . . .

General and famiiypractice, internal medicme. . . . . . . . . . . . .

Drugmentlons

Overalltotals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ooctore of osteopathy, orthopedic surgery, cardiovascular

disease, psychiatry, urological surgery, dermatology, pediatrics,

ophthalmology, otolaryngology, obstetdcsandgynecology. . . .

Generalsurgery, neurology . . . . . . . . . . . . . . . . . . . . . . . .

General and family practice, internal medicine. . . . . . . . . . . . .

“Allother’’s pecialtiesgroup . . . . . . . . . . . . . . . . . . . . . . . .

0.00136387

0.01664612

0.02504087

0.01820068

0.00669347

0.00259409

0.02306475

0.07521297

0.00856244

0.03885901

46.19641416

8.03232316

15.06497239

33.70580231

30.86106039

67.9417652

11.46572351

5.06446943

52.12780306

56.63244791

t-test. The Bonferroni kequalhywas

used to establish the critical value for

statistically significant differences

(0.05 level of confidence). Texms

relating to differences suchas

“greaterthan”or “lessthan’’i ndicate

that the difference is statistically

significant. Alack ofcomment

regarding the difference between any

No estimates does notmean that the

difference was tested and found tobe

nonsignificant.

ln the tables estimates of office

visits have been rounded to the

nearest thousand. Consequently,

estimates will not always add to

totals. Rates and percents were

calculated from originaI unrounded

figures and do not necessarily agree

with percents calculated from

rounded data.

Population figures and rate

computation

Population figures used in

computing annual visit ratesin this

report are based on July 1, 1990,

estimates of the civilian,

nonirqtitutionalized population of the

United States. For survey years

1975-85, data were colIected ordy for

theconterrninous United States, and

the original population estimates for

these years were modified to exclude

Alaska and Hawaii. For this reason

the 1975-85 estimates are not

considered to be official and are used

solely to provide denominators for

rate computation. Because of a recent

revision in the modification

technique, 1975-85 population

estimates used in this report may

differ slightly from those found in

earlier NAMCS reports.

Definition of terms

Ambulato~ patient –An

ambulatory patient is an individual

seeking personaI health semices who

is not currently admitted to any

heaIth care institution on the

premises.

Physician –A physician is a duIy

licensed doctor of medicine (M. D.) or

doctor of osteopathy (D. O.) who is

currently in office-based practice and

who spends some time caring for

ambulatory patients. Excluded from

the NAMCS are physicians who are

hospitaI based; who specialize in

anesthesiology, pathoIogy, or

radiolo~; who are federally

empIoyed; who treat onIy

institutionaIized patients; or who are

employed full time by an institution

and spend no time seeing ambulatory

patients.

Ojice – Offices are the premises

physicians identify as locations for

their ambulatory practice. These

customarily incIude consultation,
18 Advance Data No. 214 ● September 8, 1992

examination, or treatment spaces that

patients associate with the particular

physician.

Visit–A visit is a direct personal

exchange between an ambulatory

patient and a physician (or a staff

member working under the

physician’s supervision), for the

purpose of seeking care and

rendering personal health services.

Drug mention -A drug mention is

the physician’s entry of a

pharmaceutical agent –by any route

of administration – for prevention,

diagnosis, or treatment. Generic as

well as brand-name drugs are

included, as are nonprescription and

prescription drugs. Along with all new

drugs, the physician also records

continued medications if the patient

was specifically instructed during the

visit to continue the medication.

Drug Visit –A drug visit is a visit

in which medication was prescribed

or provided by the physician.
Number 215 . August 18, 1992

Advance

Data

From the CENTERS FOR DISEASE CONTROL/National Center for Health Statistics

Health Insurance and Utilization of Medical Care

for Chronically Ill Children With Special Needs

Health of Our Nation’s Children, United States, 1988

by Lu Ann Aday, Ph.D., Professor of Behavioral Sciences, The University of Texas School of Public Health

Introduction

This is one of a series of reports,

subtit~ed Health of Our Nation’s

Children, based on data from the

National Health Interview Survey on

Child Health (NHIS-CH), and

conducted in 1988 by the National

Center for Health Statistics. Included

in this series are reports on child care

arrangements; developmental,

learning, and emotional problems;

exposure to environmental cigarette

smoke, and heahh insurance

coverage.

Through NHIS-CH, data were

collected on a nationally

representative sample of children 17

years of age and under. The

questiomaire addressed a broad

range of health-related topics. A brief

description of the sample design and

data collection procedures are

summarized in the Technical notes. A

detailed description of the study

procedures and survey questionnaire

can be found in the 1988 edition of

the annual report “Current Estimates

From the National Health Interview

Survey” (l). The National Institute of

Child Health and Human

Development and the Matemal and

Child Health Bureau jointIy

sponsored the sumey.

The analyses reported here focus

on the insurance coverage and health

care utilization of chronically ill

children with special needs, based on

those who had one or more of the

chronic conditions included in the

NHIS-CH condition record; who were

unable to perform age-appropriate

roles; or who experienced pain,

discomfort, or being upset often or all

of the time due to the condition.

In recent years the characterization of “special populations” of

children or those with “special needs”

or “special health care needs” has

been applied quite broadly to

encompass those who may have

serious physical, cognitive, developmental, leaming, or emotional

problems or disabilities; those who

are socially or socioeconomically

disadvantaged; and those who may be

otherwise particularly “vulnerable”

poptdations of children (2-7).

Characterizations of the elderly

with special needs have tended to

focus on those with chronic illness

who experience serious limitations in

activities of daily living (personal care

tasks such as bathing or eating) or

instrumental activities of daily living

(home management tasks such as

shopping or managing money) (8-10).

No uniform definitions or estimates

of functionally impaired children are

available at the national level. Using

the same data set on which these

analyses are based, Newacheck and

his colleagues have published

estimates of the number and

prevalence of chronic conditions

among children, and how estimates of

the magnitude of impact may vary,

depending on the criteria of severity

or functional impairment employed

(11,12).

The National Center for Health

Statistics, other agencies within the

Department of Health and Human

Services, and the Census Bureau are

planning an array of surveys to

monitor the impact of the Americans

with Disabilities Act (ADA) and

other disability-related programs.

These studies will provide valuable

information on the characteristics of

chronically ill and disabled children

and nonelderly as welI as elderly

aduks.

The National Child Health

Assessment Planning Project

(NCHAPP), Albert Einstein College

W@.. N+ #

~

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

!

Public Health Service

%! Centers for Disease Control

%>

Manning

National

Feinleib,

Center

M.

for

D.,

Health

Dr. P.

Statistics

H., Director CENTERS cmFOR DISEASE CONTROL
2 Advance Data No. 215 ● August 18, 1992

of Medicine, is developing a

state-of-the-art definition and

protocol for identi&ing children with

“special health care needs,” which

will be used in connection with these

and related data gathering efforts.

The 1993-94 National Health

Interview Survey (NHIS) on

Disability will collect a subset of the

required information on a national

sample of children.

The analyses reported here focus

on a subgroup of children with

special needs- those with selected

chronic illnesses who experienced

major limitations in their usual

activities and/or serious pain and

discomfort due to these conditions.

Their insurance coverage, utilization

of physician and hospital sexvices, and

prescribed medicines are examined by

age, sex, race, ethnicity, family

structure, income, and place of

residence, The results pinpoint

chronically ill children with special

needs who may have the least access

to routine medical care.

Data and methods

These analyses focus on children

who were identified to have had one

or more of a number of childhood

conditions in the NHIS-CH condition

record. Respondents were asked

whether the child had ever had the

condition; if so, whether they had it

in the last 12 monthv and for

selected conditions, among those who

had experienced it in the last year,

whether it had lasted at least 3

months in the child’s lifetime or if the

interviewer judged it to be an

obviously permanent condition. For

conditions that met these criteria, the

respondent was asked to answer a

series of questions about whether the

child had to miss any school, stay in

bed, or otherwise limit usual

activities, as well as how much pain,

discomfort, or bother the child may

have experienced during the past 12

months due to the condition. The

respondent was also asked the

number of nights, if any, the child

had been hospitalized, the number of

times a medical doctor or assistant

was seen or talked to about the

child% condition, and if the child had

used prescribed medicines for the

condition during the past 12 months.

Chronically ill children were

identified, based primarily on the

information provided in the

NHIS-CH condition record. The

conditions included frequent or

repeated ear infections, digestive

allergies, frequent diarrhea or bowel

trouble, diabetes, sickle cell anemia,

anemia, asthma, hay fever or

respiratory allergies, epilepsy or

seizures, frequent or severe

headaches, arthritis or other joint

problems, other musculoskeletal

impairments, cerebral palsy, heart

disease, and other conditions

requiring surgery or lasting more than

3 months. This generally includes the

list of chronic conditions identified by

Newacheck and Taylor, except for

eczema or any kind of skin allergy,

deafness and hearing Ioss, blindness

and vision impairment, and speech

defects, which were excluded because

questions regarding condition-specific

activity limitation were not asked for

these conditions (1,11). Further, these

analyses were limited to conditions

the child had experienced in the past

12 months and (for selected

conditions) deemed to be relatively

permanent, based on whether the

child was reported to have had them

at least 3 months or that the

interviewer assessed to be obviously

permanent. Newacheck and Taylor

also included conditions in their

national prevalence estimates that a

panel of physician judges deemed to

ordinan-ly have a duration of more

than 3 months (11).

Chronically ill children with

special needs were those who had

one or more of the designated

conditions, who were unable to

engage in usual childhood activities

(such as playing with other children

or participating in games or sports),

or experienced pain, discomfort, or

being upset often or all of the time,

based on questions asked in the

conditions record. In addition, based

on questions asked in the main

questionnaire, children with one or

more of the chronic conditions (listed

earlier) were considered to have

special needs, including those who

reported that due to illness they were

unable to perform or were limited in

the kind or amount of their major

activity (defined as playing for

children under 5 years of age and

going to school for those aged 5 to 17

years),

Results

Overall prevalence– The highest

prevalence (and the percent amd

number) of children with chronic

illness included in the 1988 NHIS-CH

conditions record included hay fever

or respiratory allergies (9.2 percent or

5.8 million), frequent or. repeated ear

infections (9.0 percent or 5.7 million),

or asthma (4.2 percent or 2.7 million)

(table 1), Conditions experienced by

2-3 percent of children (or 1.3 to

1.8 million) included frequent clr

severe headaches (2.8 percent),

digestive allergies (2.5 percent),,

frequent diarrhea or bowel trouble

(2.0 percent), or other conditions

(2.3 percent). Conditions that

occurred in less than 2 percent of

children (or less than 1 million) were

heart disease (1.5 percent);

musculoskeletal impairments

(1.0 percent), not including arthritis

or other joint problems (0.5 percent);

anemia (1.1 percent); epilepsy or

seizures (0.7 percent); cerebral palsy

(0.2 percent); diabetes (0.1 percent);

and sickle cell anemia (0.1 percent).

Around 9.6 million (or

15.2 percent) children under 18 years

of age with these conditions were

estimated to have special needsdefined as those for whom the

condition caused problems, such as

missing school, staying in bed or

otherwise limiting their usual

activities, or experiencing pain or

discomfort often or all of the time in

the last year. The chronic conditions

for which more than half of the

children experienced these prolblems

were cerebral palsy (90.9 percent),

frequent or severe headaches

(76.3 percent), epilepsy or seizures

(65.5 percent), asthma (65.3 percent),

frequent or repeated ear infections

(63.5 percent), arthritis or other joint

problems (62.1 percent), and other
Advance Data No. 215 ● August 18,1992 3

muscuioskeletal impairments

(59.0 percent).

Subgroup prevalence -The

prevalence of chronically ill children

with special needs was higher for

males (15.8 percent) than for females

(14.5 percent) (table 2). The rates

were also higher among nonminority

than among minority children:

16 percent for white children

compared with 12.4 percent for black

children and 15.6 percent for

non-Hispanic children compared with

12.1 percent for Hispanic children.

The prevalence rates for children who

lived neither with both biological

parents nor their biological mother

(10.8 percent), as well as for children

who had neither private insurance

nor Medicaid coverage (13.1 percent),

were lower than the rates for their

counterparts. As has been reported in

studies conducted on this and other

NHIS data sets, the lower prevalence

reported for these groups, as well as

minorities, may be due to

underreporting and differential

nonresponse for children in these

categories (14-16).

Insurance coverage -About

three-fourths of the children had

private insurance coverage

(76.2 percent), 11 percent had

Medicaid coverage, and 12.8 percent

had neither private insurance nor

Medicaid coverage (table 3). Black

and Hispanic chronically ill children

with special needs were much Iess

likely to have private insurance and

more likely to have Medicaid

coverage than were white chronically

ill children. Hispanic children

(23.4 percent) were almost twice as

likely as non-Hispanic children

(12.0 percent) to have neither private

nor public insurance coverage.

Childrenin families with incomes of

less than $25,000 were much less

likely to have private insurance

coverage and substantially more likely

to be uninsured (22.6 percent)

compared with children from families

with annual family incomes of S25,000

or more (5.5 percent). Children who

lived in central cities were also less

likely to have private insurance

(67.5 percent) and more likely to be

uninsured (15.8 percent) than were

children who lived in more suburban

areas —84.1 percent and 10.1 percent,

respectively. Those who lived outside

of metropolitan areas were also less

likely to have private coverage

(71.1 percent) and more likely to be

uninsured (14.6 percent).

Physician utilization - More than 8

of every 10 (83.8 percent) chronically

ill children with special needs had

contact with a physician during the

year (table 4). Those who did

averaged about eight (7.9) visits.

Children under 5 years of age

(93.7 percent) were more likely to

have seen a physician than were

children 5 to 17 years of age (80.0

percent). Those who did not live with

a biological mother or a biological

mother and father were less likely to

have seen a doctor (75.0 percent).

Though not statistically significant,

the proportion of uninsured children

who had seen a physician

(76.8 percent) tended to be lower

than the proportion for those with

private insurance (84.3 percent).

Among children who saw a

physician, the mean number of visits

was lower for children 5-17 years of

age (7.3) compared with children

under 5 years of age (9.1), for black

(4.9) children compared with white

(8.4) children, and for children who

lived with their biological mother only

(6.2) compared with children who

lived with both parents (8.7). Mean

visits were also lower for children in

families earning less than $25,000

(6.9) compared with families earning

$25,000 or more (8.9), as well as for

children living in the central cities of

metropolitan areas (7.0) compared

with children living in more suburban

areas (8.3).

Hospital utiiizatwn –Around 9

percent of the children had been

hospitalized at least once during the

year (table 5). Children under 5 years

of age (12.3 percent) were more likely

to have been hospitalized than were

children aged 5-17 years

(7.3 percent). Though the differences

were not statistically significant, there

was a tendency for minority and

low-income children, who averaged

fewer visits to a physician in the past

year, to be more likely hospitalized.

Use of medicine – Xearly

80 percent of the children had taken

prescribed medicine for their

condition during the past year

(table 5). The percents taking

medications were higher for younger

children (89,5 percent) compared

with older children (74.6 percent), for

white children (80.1 percent)

compared with black children

(73.7 percent), and for children who

lived with a biological mother and

father (81.7 percent) or a biological

mother (75.8 percent) compared with

children who did not live with a

biological mother and father or a

biological mother (70.9 percent).

Summary

In summary, a substantial

proportion of Hispanic and lowincome chronically ill children with

special needs have neither private

insurance nor Medicaid coverage.

Those who averaged the fewest

doctor visits during the past year for

their condition (such as black or

low-income children) also tended to

be more likely to be hospitalized.

Children who did not live with a

biological mother or biological

mother and father were least likely to

have been to a physician or to be

taking prescribed medications for their

condition. These analyses pinpoint

chronically ill children with special needs

who are likely to have the least access to

routine medical care. Further research is

warranted to estimate the probable

impact of the differential nonresponse

and underreporting by minority and

low-income respondents on these

estimates.

References

1.

2.

Adams PF, Hardy AM. Current

estimates from the National

Health Interview Survey, 1988.

Nationat Center for Health Statistics. Vital Health Stat 10(173).

1989.

Aday LA. Health and health care

of vulnerable populations. San

Francisco, California: Jossey-Bass.

In press.
. .-.

..—

4 Advance Data No. 215 ● August 18,1992

3.

4.

5.

6.

7.

Division of Special Populations

Program Development. Program

overview. Rockville, Maryland:

U.S. Department of Health and

Human Services, Bureau of Health

Care Delivery and Assistance.

1990.

Institute of Medicine. Research on

children and adolescents with

mental, behavioral, and developmental disorders: Mobilizing a

national initiative. Washington:

National Academy Press. 1989.

Palfrey JS, Singer JD, Walker DL

Butler JA. Early identification of

children’s special needs: A study in

five metropolitan communities. J

of Pediatrics 111(5):651-659. 1987.

Shelton TL, Jeppson ES, Johnson

BH. Family-centered care for children with special health care

needs (2nd cd.). Washington:

Association for the Care of Children’s Health. 1989.

Stein REK, ed. Caring for children

with chronic illness: Issues and

8.

9.

strategies. New York: Springer.

1989.

Institute of Medicine. Disability in

America: Toward a national

agenda for prevention. Washington: National Academy Press.

1991.

Leon J, Lair T. Functional status

of the noninstitutionalized elderly

Estimates of ADL and IADL difficulties. National Medical Expenditure Survey Research Findings 4.

Agency for Health Care Policy and

Research. Washington: U.S. Government Printing Office. 1990.

10. Thompson-Hoffman S, Storck IF,

eds. Disability in the United

States: A portrait from national

data. New York: Springer. 1991.

11. Newacheck PW, Taylor WR.

Childhood chronic illness: Prevalence, severity, and impact. Amer J

Pub Health 82(3):364-371. 1992.

12. Newacheck PW, McManus MA,

Fox HB. Prevalence and impact of

chronic illness among adolescents.

Amer J Disease of Children

145(12):1367-1373. 1991.

13. Andersen RM, Mullner RM, Cornelius LT. Black-white differences

in health status: Methods or substance? Milbank Mem Fund Q 65

(SUPP 1): 72-99.1987.

14. Ries PW. Health of black and

white Americans, 1985-87.

National Center for Health Statistics. Vital Health Stat 10(171).

1990.

15. Zill N, Schoenbom CA. Developmental, learning, and emotional

problems: Health of our Nation’s

children, United States, 1988.

Advance data from vital and

health statistics; no 190. Hyattsvil]e, Maryland: National Center

for Health Statistics. 1990.

16. Hidiroglou MA, Fuller WA,

Hickman RD. SUPER CARP.

Ames: Survey Section, Statistical

Laboratory, Iowa State University.

1980.

Table 1. Number and percent of chronically ill children and those with special needs by condltlon: United States, 1988.

[Date are based on household intawiews of the civilian noninetiielized population. The suwey design, general qualifications, and information on the reliibilii of

the esketes are given in tha Technical notesl

Children with cundition Children wfth condition who have special needs

Number in

Conditiorr

Number in

thousands Percsnt thousands Percent

Frequent or repeated ear infections .

Digeetiie allergies . . . . . . . . . . . .

Frequent disrrhaa or bowel trouble . . . .

OJabetee . . . . . . . . . . . . . . . . . . . . . . . .

Sic~cell anemia . . . . . . . . . . . . .

Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Asthma . . . . . . . . . . . . . . . . . . . . . . . .

Hay fever or respiratory allergies. . . . .

Epilepsy oraelzures . . . . . . . . . . . . . . . . . .

Frequent or severe headaches . .

Arthrftk or other joint problems

Other musculoakeletd impairments . . . .

Cerebral palsy . . . . . . . . . . . . . . . . . . . . . .

Heafldiseasa . . . . . . . . . . . . . . .

Other conditions

5,735

1,593

1,282

84

74

703

2,700

5,830

422

1,796

290

630

112

958

1,455

9.0 (0.2)

2.5 (0.1)

2.0 (0.1)

0.1 (0.02)

0.1 (0.02)

1.1 (0.1)

4.2 (0.2)

9.2 (0.3)

Q.7 (0.09)

2.8 (0.2)

0.5 (0.06)

1.0 (0.09)

0.2 (0.04)

1.5 (0.1)

2.3 (0.1)

3,580

512

630

32

12

179

1,739

2,300

269

1,280

176

358

100

298

812

63.5 (1.4)

32.3 (2.9)

50.4 (3.5)

50.6 (13.2)

17.2 (8.1)

25.5 (5.1)

65.3 (2.1)

40,4 (1.4)

65.5 (6.2)

76.3 (2.2)

62.1 (&3)

59.0 (5.2)

90.9 (6.0)

32.2 (3.7)

57.9 (2.8)

NOTE:NumMrs m parenthesesare the SIanoard errors of th9 esnmates ‘nase eSt!MateS are based on thOSe children !ncluded m the NH13-CH mnditton record; for turther details, see the text
Advance Data No. 215 ● August 18,1992 5

Table 2. Number and percent of chronically ill children with special needs by age, sex, race, Hispanic origin, family structure, family

Income, place of residence, and Insurance coveragm United States, 1988.

[Date are based on household interviews of the civilian nomnstitutionalized population. The survey design, general qualifications, and information on the reliability of

the estimates are given in the Technical notes]

Number of children

Characteristic

Percent of

in fhousands chi/dren

Allchildren’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,636 15.2(0.3)

Age

Under 5yeare . . . . . . . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . 4 . . . . . . . . . . . . . . . ...4

Sex

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

Female

White.

Black .

..,,.. . . . . . . . . . . . . . . . . . . . . . .

Race

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

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

Hispanic . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . .

Bio@iMm otherandfather. . .

Biological motheronly . . . . . .

Another. . . . . . . . . . . . . . .

Leesthan $25,000 . . . . . . . . .

$25,0000rmore . . . . . . . . . .

MSA

Centrslcity . . . . . . . . . . . .

Noncentral city . . . . . . . . . .

NotMSA . . . . . . . . . . . . . . .

Private insurance. . . . . . . . . .

Medicaid . . . . . . . . . . . . . . .

Neither . . . . . . . . . . . . . . . .

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

Hispanic Origin

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

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

Family structure

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

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

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

Family Income

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2,868

6,768

5,126

4,510

8,199

1,213

877

8,587

5,838

3,107

692

3773

5,121

15.6 (0.6)

15.0 (0,4)

15.8 (0.5)

14.5 (0.4)

16.0 (0.4)

12.4 (0.8)

12.1(1.2)

15.8 (0.4)

15.0 (0.4)

17.1 (0.7)

10.8(0.9)

15.3 (0.6)

16.1 (0.4)

Place of residence

,...,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,745 14.5 (0.7)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,468 15.2 (0.5)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,423 15.9 (0.7)

Insurance coverage

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,969 15.7 (0.4)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,006 16.5 (1.3)

. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . 1,175 13.1 (0.9)

‘ Numbemforrespmive groupsmaynotsum totoWdue tomissingmlues.

NOTE NumbersIn parenthesesare the standarderrorsofthe eeomales,
6 Advance Data No. 215 ● August 18,1992

Table 3. Percent distribution of type of Insurance coverage for chronically Ill children with special needs, according to age, sex, race,

Hispanic origin, family structure, family income, place of residence, and Insurance coverage: United States, 1988.

:Data are based on household interwews of the civilian noninstitutlonalized population. The survey design, general qualifications, and information on the reliability of

the estmates are gtven m the Techrwal notes]

Insurance mverage

Number of

children Private

Characteristic in thousands Total insurance Medicaid Neither

Percent distribution

AfI children’.............,.. . . . . . . 9,150 100.0 76.2 (1.3) 11.0(1 .0) 12.8 (0,9)

Age

!Jnder5 years . . . . . . . . . . . . . . . . . . . .

%17 years . . . . . . . . . . . . . . . . . . . . . . .

75.3 (1.9)

76.5 (1.5)

11.9(1 .5)

10.6 (1.2)

12.8 (1.6)

12.9 (1.0)

2,713

6,437

100.0

100.0

Sex

f~ale . . . . . . . . . . . . . . . . . . . . . . . . . .

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

4,895

4,254

100.0

100.0

75.2 (1.6)

77.3 (1.5)

11.3(1 .3)

10.7(1.1)

13.5 (1.3)

12.1 (1.2)

Race

White.. . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . .

7.8 (0.8)

34.1 (4.4)

12.1 (0.9)

14.4 (2.2)

7,818

1,114

100.0

100.0

60.2 (1.2)

51.5 (4.5)

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . . . . . . . . .

100.0

100.0

53.5 (5.0)

78.2 (1.2)

23.2 (3.7)

9.8 (0.9)

23.4 (3.1)

12.0 (0.9}

784

8,198

Family Structure

10.6 (1.0)

16,2 (1.9)

17.4 (3.5)

Biological motherandfather. . . . . . . .

Biological motheronly . . . . . . . . . . . . . . .

Another. . . . . . . . . . . . . . . . . . . . . . . .

5,677

2,834

638

100.0

100.0

100.0

86.1 (1.3)

58.9 (2.3)

64.5 (4.5)

3.2 (0.7)

24.9 (1.9)

18.2 (3.8)

Famllylncome

Lessthan$25,W30 . . . . . . . . . . . . . . . .

S25,0000rm0re . . . . . . . . . . . . . . . . . .

3,414

5,003

100.0

100.0

52.7 (2.2)

93.2 (0.9)

24.7 (2.0)

1.4 (0.5)

22.6 (1.8)

5.5 (0.7)

Place of Residence

L!SA

Centrality. . . . . . . . . . . . . . . . . . .

Noncentral city. . . . . . . . . . . . . . . . . . .

Not MSA . . . . . . . . . . . . . . . . . . . . . . . .

16.7 (2.0)

5.8 (1.2)

14.3 (1.8)

15.8 (1.6)

10.1(1.2)

14.6 (1.S)

2,557

4,287

2,306

100.0

100.0

100.0

67.5 (2.3)

84.1 (1.8)

71.1 (2.0)

: Numbers for respectw’e groups may not sum to total due to mlssmg values.

NOTE Numbers m parentheses are the standard errors of the est)metes. Mo. the total number of cases in MIS table is less than the total number of children wilh special needs due to missing

values on insurance coverage.
Advance Data No. 215 ● August 18,1992 7

Table 4. Physician utilization for condition of chronically ill

children with speciai needs, according to age, sex, race,

Hispanic origin, famiiy structure, family income, place of

residence, and insurance coveragw United States, 1988.

[Data are based on household interviews of the civilian noninetiiioneliied

population. The survey design, general qualifications, and information on the

reliability of the estimates are given in the Technical notes]

Table 5. Percent of hospitai utilization and use of medicine for

condition of chronically ili children with speciai needs, according

to age, sex, race, Hispanic origin, family structure, family Income,

piace of residence, and insurance coverage: United States, 1988.

[Dath are based on household interviews of the ciwlian noninstitutionahzed

population. The su!vey design, general qualifications. and information on the

reliability of the estimates are given in the Technical notes]

Hospital Use of

Lwzarlon medicine

Children with 1 Children using

night or more mediclrre for

fir condition in condition in

Characteristic past year past year

Physician utf?ization

Children w“fh Contactsper

1contact or cfri/d per year

more rbr rbr those mm

rendition in 1 confect or

Characteristic peat year more

Percent

63.8 (0.9)

Mean number

7.9 (0.5)

Percent

Aflchildren . . . . . . . . . . . . . . . Afl children...........,.. 8.8 (0.7) 79.0 (1.0)

Age

Under 5years . . . . . . . . . . . . .

5-17yeare . . . . . . . . . . . . . . .

Age

Under 5yeere . . . . . . . . . . . .

5-17yeera . . . . . . . . . . . . . .

12.3 (1.2)

7.3 (0.9)

93.7 (1.4)

80.0 (1.2)

9.1 (0.6)

7.3 (0.7)

89.5 (1.1)

74.6 (1.3)

Sex

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

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

Sex

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

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

83.1 (1.3)

64.5 (1.2)

8.3 (0.9)

7.3 (0.5)

9.6 (1.2)

7.9 (0.6)

79.3 (1.4)

78.7 (1.4)

Race

White . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . . .

Bteok . . . . . . . . . . . . . . . . .

84.1 (1.0)

64.5 (1.9)

8.4 (0.6)

4.9 (0.6)

8.5 (0,6)

11.1 (1.9)

80.1 (1.0)

73.7(3.1)

Hlspsnicorigin

Hispanic. .. . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . .

Hispanic origin

Hispanic . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . .

81.2 (3.1)

64.0 (1.0)

6.5 (0.7)

6.0 (0.6)

11.5 (4.2)

6.5 (0.7)

75.6(3.5)

79.3 (1.0)

Family structure

13Wcgicelmotherandfather.. . .

Biologicalmofheroniy . . . . . . .

Ailother, . . . . . . . . . . . . . . .

Femiiystructure

Blologicelmotherandfather. . .

8iologicalmotheronfy . . . . . .

AIIother . . . . . . . . . . . . . . .

86.3 (1.0)

81.1 (1.8)

75.0 (3.4)

8.7 (0.6)

6.2 (0.4)

7,6 (1.0)

8.2(0.9)

9.6(1.1)

9.0 (2.1)

81.7(1.2)

75.8(2.0)

70.9 (3s)

Fami~inoome

LessthenS25,000 . . . . . . . . . .

$25,0000rmwe . . . . . . . . . . .

Family Income

Lessrhen325,0m . . . . . . . . .

WWOOormore. .. . . . . . . .

78.3 (1.6)

79.5 (1.2)

83.3 (1.8)

84.7 (1.1)

6.9 (0.5)

8.9 (0.6)

10.6(1.5)

7.4 (0.8)

Placeof residence

MA.. . . . . . . . . . . . . . . . . .

Cenfralcty . . . . . . . . . . . . .

Notcentdcky.. . . . . . . . . .

NotMSA . . . . . . . . . . . . . . . .

Place of residence

MSA

Centrelcity . . . . . . . . . . . .

Notcentralcty.. . . . . . . . .

NotMSA . . . . . . . . . . . . . . .

85.1 (1.6)

84.6 (1.4)

60.6(2.1)

7.0 (0.6)

6.3 (0.7)

6.0 (1.5)

.9.7(1.1)

8.3 (1.0)

9.8(1.5)

77.6 (1.8)

80.6 (1.4)

77.7 (2.1)

Insurancecoverage

Priveteinsurance. . . . . . . . . . .

Medicaid. . . . . . . . . . . . . . . .

Neither . . . . . . . . . . . . . . . . .

hawancacoverage

Privateinsursnce . . . . . . . . . .

Medicate . . . . . . . . . . . . . . .

Neither. .,..........,..

84.3(1.0)

85.5 (2.5)

76.6 (3.6)

8.0 (0.5)

6.9 (0.8)

8.2 (2.5)

6.0 (0.6)

13.5 (3.2)

5.4 (1.2)

79.5 (1.1)

75.7 (3.0)

77.6 (2.7)

NO~Numbws inparmrtlwsssaw thestsndardsrmrsofthomtirnstes. NOTE:Nt.mers m parenthesesare the standarderrorsofths es:mates.
8 Advance Data No. 215 ● August 18,1992

Technical notes

The estimates presented in this

report are based ondata from the

National Health Interview Survey

(NHIS), an ongoing survey of

households in the United States,

conducted by the National Center for

Health Statistics. Each week, a

probability sample of the civilian

noninstitutionalized population of the

United States is interviewed by

personnel of the U.S. Bureau of the

Census. Interviewers obtain

information about the health and

other characteristics of each member

of the households included in the

NHIS sample.

NHIS consists of two parts: (a) a

basic health questionnaire that

remains the same each year and is

completed for each household

member, and (b) speciaI topics

questionnaires that vary from year to

year and usually are asked of just one

person in each family. In 1988 the

special topics included acquired

immunodeficiency syndrome (AIDS)

knowledge and attitudes, medical

Suggested citation

Aday LuAnn. Health insurance and utilization of

medical care for chronically ill children with special

needs. Advance data from vital and health statistics:

no. 215. Hyattaviile, Maryland: National Center for

Health Statistics. 1992.

device implants, occupational health,

alcohol, and child health. These data

sets can be linked to provide

additional sources for analysis.

The totaI sample interviewed for

1988 for the basic hea[th

questionnaire consisted of 47,485

households containing 122,310

individuals. The total response rate

was 95 percent. For the National

Health Interview Survey on Child

Health (NHIS-CH), one sample child

17 years of age and under was

selected from each family with

children in that age range.

Information about the sample child

was collected by face-to-face

interview with the adult member who

knew most about the sample child’s

health, who in most cases was the

child’s mother. Interviews were

completed for 17,110 children 17

years of age and under, 95 percent of

those identified as eligible on the

basis of the basic health

questionnaire. The overall response

rate for NHIS-CH was 91 percent,

the product of the response rates for

the basic and the child health

questionnaires.

Because the estimates presented

in this report are based on a salmple

of the population, they are subject to

sampling error. Standard errors are

provided for each of the percents and

means in this report to indicate the

probable sampling errors of these

estimates. The standard errors for

this report were calculated using

SUPER CARP, a software package

designed to produce standard errors

for estimates based on complex,

multistage sample designs (16).

Persons for whom valid responses

were not available for certain items

were excluded from the analyses.

Those variables for which estimates

may be affected due to missing

observations are noted in the text.

All differences discussed in this

report are statistically significant at

the 0.05 level unless otherwise noted.

The t-test, with a critical value

determined by the number of

response categories for an individual

variable, was used to test for all

pairwise comparisons discussed.

Copyright information

This report may be reprinted without further

permission.
Number 216 ● August 21, 1992

Advance

Data

From Vital and Health Statistics of the CENTERS FOR DISEASE CONTROL/National Center for Health Statistics

AIDS Knowledge and Attitudes for January-March

Provisional Data from the National Health Interview Survey

by Ann M. Hardy, Dr. P.H., Division of Health Interview Statistics

1991

Highlights

In general,levelsof knowIedge

about acquired immunodeficiency

syndrome (AIDS), especially about

the major modes of transmission,

were fairly high in the first quarter of

1991 and patterns of knowledge levels

by sociodemographic factors were

similar to those seen in past years.

Several changes between the last

quarter of 1990 and the first quarter

of 1991 were noted including

An increase of 10 percentage

points in the proportion who felt

they knew a lot about AIDS.

An increase of 3-6 percentage

points in the percent of aduhs

stating that various forms of

casuat contact were very unlikely

or definitely not possible ways to

transmit human

immunodeficienq virus (HIV).

A increase from 6S to 77

percent in the proportion who

believe blood is routineIy tested

for HIV.

A slight increase in the

proportion who reported HIV

antibody testing, excluding bIood

donation (from 11 to 14 percent).

Some new questions were added

to the 1991 AIDS Knowledge and

Attitudes Survey. Noteworthy findings

include:

. Most of those who have never

been tested for HIV apart from

blood donation stated this was

because they were not at risk of

acquiring HIV infection.

. Half of all adults had heard of

azidothymidine (AZT). Of those,

most knew it couId deIay

symptoms and that it was not a

cure for AIDS. However, many

were unsure about other aspects

of AZT treatment.

. While 76 percent of adults

believed condoms were at least

somewhat effective in preventing

sexual transmission of HIV, only

17 percent of persons knew that

natural membrane condoms and

latex condoms were not equal in

preventing transmission of HIV

and only 26 percent knew that

oil-based lubricants could damage

condoms. For both items, about

two-thirds of adults indicated that

they did not know the answer.

Introduction

The National Center for Health

Statistics has included questions

about HIV and AIDS as part of the

NationaI Health Inte~iew Survey

(NHIS) since 1987. The purpose of

these questions is to provide

population-based data on adults’

knowledge about AIDS and

transmission of HIV and on their

experience \vith HIV antibody testing.

Such information is used to help p!m

and monitor various educational and

prevention programs. The

questionnaire used in 1991 is the

fourth version of this survey.

AIthough 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

,+$[ RW:rf

f+, *4+ $

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

.*

: Public Health Service

:

. Centers for Disease Control 5

%

>%.3C National Center for Health Statistics CENTERS CDC FOR iXSEASE CG-;-=OL
2 Advance Data No. 216 ● August 21, 1992

suney’ in Advance Dara From Pltal

and Health Statistics (l–7). In

addition, public use data tapes of the

1987–90 surveys are currently

available and more detaiIed

exploration of the data is encouraged.

The NHIS AIDS questionnaires

have been developed by the National

Center for Health Statistics and an

Interagency Task Force created by

the Public Health Service Data Policy

Committee. The Task Force includes

representatives from other centers

within the Centers for Disease

Control and from the Office of the

Assistant Secretary for Health, the

National AIDS Program Office, the

National Institutes of Health, the

Alcohol, Drug Abuse and Mental

Health Administration, 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 provisional

data for the first quarter of 1991 for

most items included in the NI-HS

AIDS questionnaire. Details about

the sample design and the estimation

procedure can be found in the

technical notes at the end of this

report. Table 1 shows percent

distributions by response categories

for the entire adult population as well

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.

When interpreting trend data,

revisions in the questionnaire,

whether in actual wording or in

context and location of questions,

must be considered. There were

several important changes and

additions to the 1991 questionnaire.

First, the series of knowledge items

that contain selected statements

about HIV and AIDS (question 5 in

the 1991 survey) had five possible

responses in earlier versions of the

questionnaire: definitely true,

probably true, probably false,

definitely false, and don’t know. In

1991 the distinction between

definitely and probably was

eliminated, leaving true, false, and

don’t know as the only possible

response choices.

Before 1991, in the section on

HIV antibody testing, an initial

question assessing whether persons

had heard of the blood test to detect

the AIDS virus infection was asked;

those who were not aware of the test

were skipped past the remainder of

this section. In 1991 this lead-in was

eliminated because of concern about

people attempting to end the sumey

prematurely. Persons who truly were

not familiar with HIV antibody

testing would still have the option of

responding “don’t know” to questions

in this section.

Several new items were added to

the 1991 survey including the

perceived likelihood of becoming

infected by receiving care from an

infected health care worker or by

donating blood. Reasons why persons

have not been tested for HIV were

assessed. Items were added to assess

respondents’ knowledge about the

HIV antibody test, about AZT, and

about the proper use of condoms.

FinaIly, a distinction between having

a co-worker with HIV or AIDS and

having other friends or relatives with

the disease was made in 1991.

Selected findings

Sources of information – In 1991

the NHIS again asked about seeing or

hearing public service announcements

(PSA’S) about AIDS. Seventy-nine

percent of adults reported seeing a

PSA on television; this is similar to

the figure obtained in 1989 (the last

time this question was asked).

Forty-two percent of adults reported

hearing an AIDS PSA on the radio,

similar to the 45 percent reported in

1989.

In terms of more general sources

of information, 85 percent of adults

reported receiving information about

AIDS from at least one source in the

month before interview, Television

programs were the most commcm;

72 percent of persons reported these

as a source of AIDS information.

Newspapers and magazines were

reported by 43 and 39 percent,

respectively. About one-third of

adults reported radio programs as a

source of information.

Two items about information

received by children aged 10-17 years

showed little change from 1990.

About two-thirds of parents reported

they had ever discussed AIDS with

their children and 74 percent

reported that their children received

instruction at school about AIDS. As

in the past, women were much more

likely to have discussed AIDS with

their children than men.

General knowledge about

AIDS–AI increase was noted from

1990 to 1991 in the percentage of

adults who said they knew a lot about

AIDS (from 19 to 29 percent). The

proportions who said they knew

some, little, or none decreased

s!ightly.

The proportion of persons who

reported having heard the AIDS virus

called “HIV” increased slightly from

79 percent in the last quarter of 1990

to 83 percent in the first quarter of

1991. Awareness of this term

remained lower among older persons,

those with less than 12 years of

education, and Hispanic adults.

In 1991 the possible responses to

the series of knowledge statements

changed from definitely true,

probably true, probably false,

definitely false, and don’t know to

true, false, and don’t know. Because

of this, the proportion with the

correct response increased for all

these questions in the first quarter of

1991 compared with the last quarter

of 1990. However, for many of the
Advance Data No. 216 ● August 21, 1992 3

questions the proportion who

responded “don’t know” also

increased.

Over 90 percent of adults knew

that anyone with the AIDS virus

could transmit it through sexual

intercourse, that an infected pre=gnant

woman could give it to her baby, and

that there is no cure for A.IDS at

present. Even among those with less

than 12 years of education, over

80 percent responded correctly to

these questions.

Many adults were also aware that

HIV decreases the body’s naturai

protection against diseases

(85 percent correct), that A-IDS is an

infectious disease caused by a virus

(81 percent), that persons with HIV

infection can look and feel well and

healthy (80 percent), and that there

is no vaccine available for AIDS or

HIV (80 percent). The responses to

these questions showed more

variation by sociodemographic

characteristics, particularly age and

education, than did those to the

questions on the major modes of HTV

transmission. Older adults (those 5’0

years of age and over) and adults

with less than 12 years of education

were less likely to respond correctly

than younger arid more educated

persons. In all groups, persons were

more likely to respond “don’t know”

to the statements rather than to give

the incorrect true-faIse response.

For other questions knowiedge

levels were lower. Sevenly-seven

percent of adults knew that a person

cotdd be infected with the AIDS virus

and not have the disease AIDS.

About two-thirds of adults were

aware that there are drugs available

that can lengthen the life of an

infected person. Just over half of

adults (56 percent) knew that AIDS

can damage the brain and that early

treatment of HIV infection can

reduce symptoms in an infected

person. Again, oIder and less

educated persons showed less

understanding of these facts about

AIDS.

Misperceptions about transmission

of AIDS and H7V-AS in previous

NHIS AIDS surveys, the 1991 survey

assessed people’s perception of the

likelihood of transmission of HIV by

various forms of casuaI and

nonintimate contact. PossibIe

response categories ranged from very

likely to definitely not possibIe. Slight

increases (of 3-6 percentage points)

in the proportion who felt that

transmission of HIV through most of

these modes was either very unlikely

or definitely not possible were noted

in the first quarter of 1991 compared

with the last quarter of 1990.

However, misperceptions about

transmission still persisted. About one

quarter of all respondents erroneously

believed sharing eating utensils with

an infected person, eating in a

restaurant where the cook was

infected, being coughed or sneezed

on by an infected person, or

mosquitoes or other insects had at

least some likelihood of transmission.

As in the past, persons with more

education, younger adults, and white

adults were more likely to perceive

these modes as unlikely to transmit

HIV.

In 1990 the first instance of HIV

transmission from an infected health

care worker to several patients was

reported (8). Followup studies of

patients of other HIV infected health

care workers conducted both before

and after the report of these cases

have not demonstrated any other

instances where transmission to

patients has occurred and the CDC

estimates that this type of event is

very rare (9). In 1991 a question was

added to this section of the NHIS

asking persons to assess the

likelihood of getting HIV by being

cared for by an infected nurse,

doctor, dentist, or other health care

worker. Over half (55 percent) of

aduIts rated this as very or somewhat

likely to transmit HIV. Only

6 percent of persons felt this would

definitely not result in transmission,

and 17 percent felt it would be very

unlikely. There were slight differences

among demographic subgroups in

perceived likelihood of transmission

for this type of contact.

Blood donation and blood

screening- Forty-three percent of

adults reported having ever donated

blood; 19 percent had doriated since

March 1985 when routine screening

of donated blood for HIV began and

7 percent had donated in the past

year. Sixty-two percent of aduhs knew

that a person could not get HIV

while giving or donating blood for use

by others, 29 percent felt they could,

and 10 percent of adults did not

know. Seventy-seven percent of adults

in the first quarter of 1991 believed

that blood donations are routinely

tested for the AIDS virus. This is an

increase from 68 percent reported in

the last quarter of 1990. Ho\vever, the

proportion who did not know the

answer to this question more than

doubled between 1990 and 1991 from

7 to 16 percent. These changes may

be due in part to the elimination in

1991 of the question that first asked if

persons were aware of the blood test

to detect HIV infection before

proceeding to other questions related

to HIV testing. Of those who donated

blood since 1985 and who were also

aware that blood donations are

screened for HIV, ordy 4 percent

reportedly donated blood at least in

part to be tested for HIV,

HIV antibodv testing– Counting

testing done for all reasons, including

blood donation, 29 percent of adults

in the United States have been tested

for antibodies to HIV. The percent of

adults tested for HIV apart from

blood donation increased slightly

from 11 percent at the end of 1990 to

14 percent in the first quarter of

1991. The remainder of this report

discussing past experience with HIV

testing is limited to testing apart from

blood donation.

The 1991 NHIS attempted to

determine why adu[ts had not been

tested for HIV. The most common

response, given by S4 percent of

those never tested (excluding

donation), was that they did not

consider themselves to be at risk for

AIDS. Very few respondents (less

than 2 percent) chose recognized

barriers to testing such as fear of

discrimination, not knowing where to

go for testing, and not trusting the

medical communi~ to keep results

confidential as reasons they had not

been tested. The remainder listed

another unspecified ieason
4 Advance Data No, 216 ● August 21, 1992

(6 percent) or said they did not kno~v

why they had not been tested

(9 percent).

For those who had been tested,

the reported reasons for HIV

antibody testing were similar in the

first quarter of 1991 to those reported

in 1990. Twenty-nine percent of those

tested did so just to find out if they

were infected. Another 7 percent

were referred by their doctor. the

health department. or their sex

partner for testing. Fourteen percent

had been tested because of a

hospitalization or surgical procedure,

10 percent to apply for life insurance.

and 7 percent for military induction

or service. While immigration was

only mentioned by 5 percent of all

adults tested, it was mentioned by

26 percent of Hispanic persons

tested.

As in 1990, most of those in the

first quarter of 1991 who reported

testing were tested at their doctor or

HMO or at a hospital, emergency

room. or an outpatient clinic

(58 percent of those tested). These

were the most commonly mentioned

sites among all the various population

subgroups examined. Seven percent

each were tested at a community

health clinic or a military induction or

service site.

As in the past, about threequarters of those tested got their

results. Of those who did not receive

results only 10 percent said they did

not want them, 21 percent said they

could not get them. and 53 percent

said there was another reason they

had not gotten their results. At least

some in this latter category may have

been persons whose results were not

yet available and \vho will ultimately

get their results. Also unchanged

from 1990 is the ~vayin which people

reported getting their results:

62 percent received their results in

person, 17 percent over the

telephone. and 14 percent in the

mail. In the first quarter of 1991.

almost all adults tested said they felt

their results were accurate

(98 percent) and that their results

were handled properly in terms of

confidentiality (95 percent).

The proportion who indicated

that the! plan to be tested in the next

year \vas 8 percent, similar to figures

reported earlier. The figure was

highest among black adults,

20 percent. Of those who plan to be

tested. 65 percent said it would be

because they wanted to know the

results. 25 percent said it would be

part of a blood donation, 7 percent

each indicated it would be to apply

for a job. to join the military, or to

apply for a marriage license.

A new question was added in

1991 to determine more about

people-s understanding of the HIV

antibody test. Seventy percent of

adults recognized that after one is

infected \vith HIV, there is a period

of time before the blood test shows

the infection; 26 percent responded

‘“don’t know” to this statement. While

the proportion with the incorrect

response was similar across

sociodemographic groups, the percent

tvho responded “don’t know” was

higher among older adults, Hispanic

persons. and those with less

education.

Awareness about AZT–The 1991

hTIIS AIDS survey also assessed

whether persons had heard of the

drug AZT, the first antiviral drug

approved for the treatment of HIV

infection. Those who had heard of

AZT were also asked a series of

specific questions about AZT. In the

first quarter of 1991, 50 percent of

adults had heard of AZT. Familiarity

with AZT increased sharply with

years of education from 23 percent

who had heard of AZT among those

with less than 12 years of education

to 68 percent for those with more

than 12 years. Black adults were

somewhat less aware of the drug than

\vhite persons (40 percent compared

\vith 53 percent); Hispanic persons

\vere less aware than either of these

nvo groups (28 percent).

Among persons who had heard of

AZT. 87 percent knew that AZT

does not cure persons with AIDS and

80 percent knew that AZT can delay

or slow down symptoms of HIV

infection. The other knowledge items

about AZT elicited fewer correct

responses. Fifty-seven percent of

adults knew that AZT has side effects

and 33 percent were aware that the

drug could only be used at certain

times during the illness. Few persons

actually gave the incorrect respcmse

to these two items; many (38 and

56 percent, respecti~’ely) responded

“don’t know.” ~most half

(49 percent) of persons were avrare

that there are other drugs to treat

AIDS-related illnesses; again a large

proportion (36 percent) said they did

not know the correct answer to this

question. This pattern of a high

proportion being unsure of the

correct answer to these three items

was seen in all sociodemographic

groups examined and few differences

in the proportion \vith correct

responses were noted.

Perceptions about condoms – In

1991 respondents were again asked to

rate the efficacy of condoms as a

means of preventing the sexual

transmission of HIV. A slight

increase in the proportion who :rated

condoms as ve~ effective was noted

between the last quarter of 1990 and

the first quarter of 1991 (from 25 to

28 percent). The proportion who

rated them as somewhat effective

dropped slightly (from 53 to

48 percent) and the proportion who

did not know how effective they were

increased slightly (from 15 to

18 percent).

The 1991 survey contained IWO

new questions to measure knowledge

about the proper use of condoms.

While three-quarters of adults i:n the

first quarter of 1991 believed

condoms to be at least somewhat

effective in preventing the spread of

HIV. far fewer \vere able to answer

the specific questions about use

correctly. Only 17 percent of aclults

correctly answered “false” to the

statement that latex condoms and

natural membrane condoms are

equally good at preventing HIV

transmission; 19 percent thought this

statement was true. hlost

(62 percent) reported that they did

not know the correct response.

Younger persons were much more

likely to give the correct response
Advance Data No. 216 ● August 21, 1992 5

than adults 50 years of age and oven

correct responses also increased by

years of education. White adults and

males \vere slightly more likely to

respond correctly than black or

Hispanic adults or females. However.

in all groups, the largest proportion

of respondents did not know which

response to choose. A similar pattern

was noted for the second knowledge

question about condoms. Twen~-sLx

percent of adults knew that oil-based

lubricants can cause latex condoms co

break, 6 percent thought this

statement was false and 66 percent

did not know. Again. correct

responses were noted more frequently

among younger persons than those 50

years of age and over, among males

than femates, and among those with

more than 12 years of education

compared with those with less than

12 years.

Risk of HIV infecrion – Eightyone percent of adults in the first

quarter of 1991 felt they had no

chance of having HIV infection; ordy

1 percent rated their chances of this

as high or medium. Similarly.

74 percent of adults said they had no

chance of getting HIV infection in

the future. Twenty-hvo percent felt

their chances were low and onI~

2 percent felt they were at high or

medium risk for getting HIV. Only

3 percent of adults reported being in

any of the behavior categories

associated with an increased risk of

HIV infection. These figures varied

little by sociodemographic

characteristics and are similar to

figures reported previously.

Kitowlea’ge of sonteone wilA

AHIS–In the past, the NHIS AIDS

survey has assessed if adults had

personally knowm someone with HIV

infection or AIDS. In 1991 the

distinction was made between having

a co-worker with HIV and kno~ving

others (friends or relatives) with the

infection. Four percent of adtdts

reported having had a co-worker with

HIV or AIDS. This figure increased

by years of education from 1 percent

of those \vith less than 12 years to

7 percent for those with more than

12 years. Nine percent of persons

reported having a friend or relative

with the disease. This also increased

with years of education.

References

Dawson DA, Thornberty OT. AIDS

lmowledge and attitudes for December 1987: Provisional data from the

National Health Intemtiew Survey.

Advance data from vital and health

statistics; no 153. Hyattsville, Matyland: National Center for Health Statistics. 19SS.

Hardy .A\f, Dawson DA. AIDS

knowledge and attitudes for

December 198S:Provisional data from

the National Health Interview Sumey.

Advance data from vital and health

statistics: no 175. HyattsvilIe,

}Iaryland: National Center for Health

Statistics. 19S9.

Hardy .Wf. AIDS kno~vledge and

attitudes for October-December 19S9:

Provisional data from the National

Health Intemiew Survey. Advance

data from vital and health statistics;

no 1S6. Hyattsville. Mqland:

National Center for Health Statistics.

1990.

4.

5.

6.

7.

3.

9.

Dawson DA. AIDS knowledge and

attitudes for January-March 1990:

Pro\’isional data from the

NationalHealth Intemiew Survey.

Advance data from vital and health

statistics; no 193. Hyattsville,

kfaryland: National Center for Health

Statistics. 1990.

Fitti JE, Cynamon hf. AIDS

knowledge and attitudes for AprilJune 1990: Provisional data from the

National Health Intemiew Sum’ey.

Ad\’ante data from vital and health

statistics: no 195. Hy:utsviIle,

Xlaqland: Xational Center for Health

Statistics. 1990.

Adams PF, Hardy AM. AIDS

knowledge and attitudes for

July-September 1990: Provisional data

from the NationaI Health Interview

Survey. Advance data from vital and

health statistics; no 198. Hyattsville,

Maryland: National Center for Health

Statistics. 1991.

Hardy AM AIDS knowledge and

attitudes for October-December 1990:

Provisional data from the NTational

Health Interview Survey. Advance

data from vital and health statistics;

no 204. Hyattsville, \faryland:

National Center for Health Statistics.

1991.

Centers for Disease Control. LTpdate:

Transmission of HIV infection during

invasive dental procedures— Florida.

MhlWR 1991; 40:377-S1.

Cemers for Disease CmttroI. Update:

Investigations of patients \vho have

been treated by HIV-infected health

care workers. Jf\lW’R 1992:41:344-6.
Advance Data No. 216 ● August 21, 1992

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

1991 National Health Interview Survey, by selected characteristics: United States, January-March 1991

[Data a-e based on household interwews of the cwilian non!nstkutionalized population. The survey design, general qualifications, and information on the reliability of

the es!:’nates are given in techrwal notes]

Race or ethnicify

Age Sex Non-Hispanic Education

18-29 30-49 50 years Less than More than

AIDS knowledge or attmde Tora/ years years and over Male female White Black Hispanic 72 years 72 years 12 years

Total, . . . . . . . . . . . . . . . . . . . . . . . . . 100

1.

2.

2a.

2b.

2C.

3.

4.

5a.

5b.

SC.

5d.

Se.

How much would you say you know about AIDS?

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

Some . . . . . . . . . . . . . . . . . . . . . .

Al;tile, . . . . . . . . . . . . . . . . . . . . . . .

Ncthmg, ,,, . . . . . . . . . . . . . ,, ..,,,,..

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

In the ~ast month have you–

Seen any Public Servce Announcements about AIDS

on televwion?

Yes, . . . . . . . . . . . . . . . . . . . . . . . . .

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

Don’l know. . . . . . . . . . . . . . . . . . .

Heara any Public Service Announcements about AIDS

on the radio?

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

Nab . . . . . . . . . . . . . . . . . . .. . . . . . .

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

Seen any Public Service Posters in airpo~

aoout AIDS?

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

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

Dcn’tknow . . . . . . . . . . . . . . . . . . . . . . . . .

In the east month, have yau received Information

aoaut AIDS from anyofthese saurces?l

Television programs, . . . . . . . . . . . . . . . . .

Racilo programs. . . . . . . . . . . . . . . . . . . . .

Magazmearflcles . . . . . . . . . . . . . . . . . . . .

Newspaperarticles . . . . . . . . . . . . . . . . . .

Streetsigns/billboards . . . . . . . . . . . . . . . . .

Stmedlsplays/stare dMributedbrochures . . .

Bws/streetcer/subwaydisplays... . . . . . . . . . .

Health department brochures . . . . . . . . . . . . .

Workplace distributed brochures . . . . . . . . . . .

Scnoal distributed brochures . . . . . . . . . .

ChJrchdMtibutedbr ochures . . . . . . . . .

Community organization . . . . . . . . . .

Friend/acquaintance . . . . . . . . . . . . . . . . . . .

AIDShatline . . . . . . . . . . . . . . . . . . . . . . . .

Dithe r . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknaw . . . . . . . . . . . . . . . . . . . . . . .

Received naAIDSinfonnatian in pest month, .

Have you heard the AIDS virus called by the name

HIV?

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

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

Darftknaw . . . . . . . . . . . . . . . . . . . . . . . .

AIDS canreduce the bady’s natural protection

agams! disease.

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

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

Dcn’t know. . . . . . . . . . . . . . . . . . . . . . . .

AIDS can damage the brain.

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

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

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

AIDS IS an infectious disease caused by a virus.

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

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

Dan’tknow . . . . . . . . . . . . . . . . . . . . . . . . .

Apersoncsn reinfected with the AIDS v!rJs and

not have thedkease AIDS.

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

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

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

ANYpersanw[fh theAIDSvlruscen paesironta

29

44

20

7

0

79

19

2

42

54

3

10

89

2

72

32

39

43

16

7

7

14

10

8

4

4

7

1

3

1

15

83

15

2

85

4

11

56

16

28

81

6

14

77

7

16

someone else thraugh sexual intercourse.

True, . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

False . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Dan’t know. . . . . . . . . . . . . . . . . . . . . . . . 4

See fcc:roles a: eno of lable.

100

33

49

16

2

80

16

1

52

45

3

12

86

2

73

38

41

38

23

10

11

19

11

14

4

4

11

1

3

1

14

88

11

1

87

4

9

47

25

26

86

4

8

78

9

12

96

2

2

lW

34

48

15

3

0

80

18

2

46

51

3

10

88

1

73

35

41

46

17

8

6

15

14

6

4

4

8

1

3

1

13

88

11

1

91

3

5

58

;

86

6

8

84

6

10

97

1

2

100

20

37

27

16

0

76

20

4

31

65

4

7

91

2

71

24

34

45

9

4

4

6

6

2

3

3

4

1

2

1

16

73

23

4

77

5

19

61

3:

69

6

24

68

6

26

92

1

7

Percent distribution

100 100 100 100

29

43

21

7

0

60

18

2

48

48

3

12

86

2

73

38

37

45

19

8

8

13

11

6

4

4

7

1

2

1

15

82

16

2

86

3

10

57

17

27

83

5

12

77

7

16

95

2

4

29

46

18

7

0

78

19

3

37

59

4

8

91

2

71

27

40

42

13

6

1:

10

9

4

3

7

1

3

1

16

83

15

2

84

5

11

56

16

26

79

6

15

77

7

16

95

1

4

29

46

18

6

0

80

18

3

42

55

4

9

69

2

72

31

40

45

15

6

5

13

10

7

3

3

6

:

1

15

85

14

2

88

3

8

55

17

28

81

6

13

80

6

14

95

1

3

26

36

24

14

81

17

2

49

49

3

11

86

1

75

38

34

37

20

10

13

18

15

10

7

6

10

2

3

1

14

81

15

4

72

9

19

60

12

26

79

8

15

68

10

22

94

2

4

100

a24

10

70

26

2

45

52

3

12

64

4

70

36

33

39

16

10

10

16

9

10

4

3

9

1

3

2

17

66

31

3

78

3

19

64

13

23

81

3

16

64

9

27

96

1

3

100

;

33

22

70

27

3

31

65

4

6

92

2

69

24

22

29

9

5

1:

3

5

3

2

8

1

2

2

22

60

35

5

66

6

28

58

6

34

67

5

27

57

8

35

91

1

8

100

25

48

22

5

0

82

16

3

44

53

4

8

91

1

74

32

36

43

14

7

1:

10

7

4

3

7

1

2

1

15

64

14

2

66

5

10

57

15

26

60

6

13

76

7

14

96

1

3

100

40

46

11

2

0

81

17

2

47

50

3

13

85

2

72

36

47

51

21

8

9

16

15

10

4

5

8

1

4

0

12

92

7

1

95

2

3

55

21

24

86

5

7

66

5

6

96

2

2
Advance Data No. 216 ● August 21,1992 7

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

1991 National Health Interview Survey, by selected characteristics: United States, January-March 1991 -Con.

[Data are baaed 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 etfrnicify

Age Sex Non-Hispanic Education

16-29 3M9 50 years

AIDS knowledge or attitude

Less than More than

Total yeara yeara and over Male Female White Black Hispanic f2 yeara 12 years 12 years

Sf.

Sg.

5h.

51.

5j.

5k.

6.

6a.

6b.

6c.

6d.

A pregnant women who has the AIDS virus can give

it to her baby.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

False . . . . . . . . . . . . . . . . . . . . . . . . . . . . I

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . 5

A person who has the AIDS virus can look and feel

well and healthy.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

False . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . 13

There are drugs available which can lengthen

the life of a person infected with the AIDS virus.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

False . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . 24

Early treatment of the AIDS virus infection can

reduce symptoms inan infected person.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

False . . . . . . . . . . . . . . . . . . . . . . . . . . . . II

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . 33

There is a vaccine available to the public that

protects a pereon tom getting the AIDS virus.

True. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

False . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . 17

There is no cure for AIDS at present.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

False . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

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

How likely do you think it is that a oerson will get

AIDSortheAIDS virus infection from –

Working near someone with the AIDS virus?

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

Somewhatlikely . . . . . . . . . . . . . . . . . . . . . 5

Somewhatunlikely . . . . . . . . . . . . . . . . . . . . 7

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . 41

Defkritelynotp ossible . . . . . . . . . . . . . . . . . . 40

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

Eating inarestaurant wherethecookhee fheAIDS

Vims?

Verytikely . . . . . . . . . . . . . . . . . . . . . . . . . 6

Somewhatlikely . . . . . . . . . . . . . . . . . . . . . 16

Somewhatunlikely . . . . . . . . . . . . . . . . . . . . 13

Veryunlikefy . . . . . . . . . . . . . . . . . . . . . . . . 35

Definitely notpossible . . . . . . . . . . . . . . . . . . 21

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . 10

Sharing plates, forks, or glasses with someone who

has the AIDS virus?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . . . 10

Somewhatlikely . . . . . . . . . . . . . . . . . . . . . 18

Somewhatunlikely . . . . . . . . . . . . . . . . . . . . 12

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . 31

Definitelynotpossible . . . . . . . . . . . . . . . . . . 20

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

Using public toilets?

Veiylikely . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatlikely . . . . . . . . . . . . . . . . . . . . . 1:

Somewhetunlikely . . . . . . . . . . . . . . . . . . . . 11

Veryunlikely. . . . . . . . . . . . . . . . . . . . . . . . 36

Definitelynotpossible . . . . . . . . . . . . . . . . . . 29

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . 8

88

0

4

84

6

10

83

12

24

55

:

4

83

13

93

2

5

1

4

6

40

45

3

4

14

16

z

s

7

16

;

27

5

5

9

12

36

34

5

97

1

3

86

6

6

72

9

19

61

12

27

3

87

10

95

2

3

2

5

7

43

42

3

5

16

13

37

23

6

10

18

::

21

6

5

9

11

38

32

5

91

:

69

9

22

83

7

30

50

8

41

4

68

28

88

3

10

3

6

6

41

33

11

7

17

11

30

17

18

11

20

11

28

15

15

7

13

10

33

22

15

93

1

6

60

7

13

67

10

23

57

::

4

81

15

92

3

5

2

5

:

39

5

5

16

13

36

21

9

10

19

13

31

2CI

6

5

10

11

37

30

7

Percent dietributionf

95

0

4

79

6

14

66

9

25

55

:

3

78

19

92

2

6

2

5

7

:0

Lo

6

6

‘6

“2

24

22

‘o

‘0

“7

:2

31

21

9

6

11

:1

35

29

9

95

0

5

82

6

11

70

8

22

56

11

32

3

82

15

94

2

4

1

5

4

41

5

5

16

13

36

21

9

9

la

13

32

20

8

4

10

11

37

30

8

92

1

7

74

9

17

56

17

27

50

;

7

69

24

87

4

10

4

6

7

40

34

10

9

19

11

31

16

14

14

19

11

28

17

11

10

12

10

33

23

11

94

1

5

63

11

27

53

14

33

47

2

6

z

86

3

11

3

5

11

32

41

6

7

12

14

30

24

12

11

17

11

26

24

11

6

12

12

30

26

13

66

1

11

60

11

29

51

10

39

40

10

50

7

z

81

4

15

3

6

8

37

30

15

9

17

11

27

15

22

13

20

10

25

14

18

11

14

9

29

20

16

95

1

4

79

9

13

65

11

25

54

X

3

61

16

93

2

4

2

5

7

41

40

4

6

10

:3

33

21

9

12

19

2

20

6

6

12

12

34

29

8

97

0

3

90

4

6

77

7

16

65

;:

8:

9

97

2

2

1

4

5

44

44

2

4

13

14

41

24

5

7

17

:

24

5

3

7

11

41

34

4

seefootnotesatendoftable.
8 Advance Data No. 216 ● August 21, 1992

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

1991 National Health Interview Survey, by selected characteristics: United States, January-March 1991- Con.

[Data are based on household ln:erwews of the c!v!han nonmstltutlonalized population, The survey design,general quahftcatlons, and information on the rehabitty of

the est(mates are gwen m tecnnlcal notes]

Race or ethnic!ty

Age Sex Non-H fspanfc Education

18–29 30-49 50 years Less than More fhan

AIDS knowledge cr attrtude Total years years and over Male Female White Black Hispanic 12 years 12 years ?2 years

6e,

6f.

6g.

6h.

6i.

7.

10.

11.

12.

13a

13b

Sharing needles for drug use with someone who has

the AIDS virus?

Very likely . 96

Somewhat hkely 1

Somewhat unhkely.. ::::::: : .::: 0

Very unlikely 0

Defmtely no!posslble . .:::::::.” :::: 0

Don’t know,.. . . 2

Being coughed or sneezed cn by someone who has

the AIDS v!rusq

Very likely . . 9

Somewhet llkely . . . . . . . . . ...”. “.:’::: 18

Somewhat unllkely . . . . . . . . . . . 13

Very unlikely, . . . . . . . . . . . . 32

Definitely notpossible . . . . . . . . . . . . . . 18

Don’t know, . . . . . . . . . . . . . . . . 11

Attending school with a chdd who haa the AIDS wrus?

Very likely . . . . . . . . . . . . . . . . . 2

Somewhat likely . . . . . . . . . . . . . 4

Somewhat unllkely . . . . . . . . . . . 7

Vey unlikely, . . . . . . . . . . . . 41

Definitely not possible 40

Don’t know, . . . . . . . . . . . . . . . . . 8

Mosquitoes or other msec!s?

Vey likely . . . . . . . . . . . . . . . . . 9

Somewhat likely... . . 17

Somewhat unhkely. . . . . . . . . 8

Veyunlikely, . . . . . . . . . . . 25

Defmtely notposs!ble. . . 21

Don’t know, . . . . . . . . . . . . . . . . 20

Being cared for by a nurse. doctor. dentist, or other

heaith care worker who has the AIDS vtrusq

Veylikely. . . . . . . . . . . . . . . . . . . . . 22

Somewhatlikely . . . . . . . . . . . . . . . 33

Somewhat unlikely . . . . . . . . . . . 13

Very unhkelv. . . . . . . . . . . . . . . . . . 17

Defmtelynotpossible . . . . . 6

Don’t know . . . . . . . . . . . . . . . . . . . . . . 8

Can a person get AIDS or the AIDS wrus InfectIon

while giving ordonatmg blood for use by othera?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

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

Don’tknow . . . . . . . . . . . . . . . . 10

Have you ever discussed AIDS with any of your

children aged 10-17?2

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

No . . . . . . . . . . . . . . . . . . . . . . 34

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

Have any or all of your chlloren aged 10-17 had

mstructton at school about AIDS?’

Yes . . . . . . . . . . . . . . . . . . . . . 74

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . 17

Have you ever given or donated blood?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

No . . . . . . . . . . . . . . . . . . . . . . . . . . 57

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

Have youdonated blood since March 1985?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 19

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

Don’t know. . . . . . . . . . . . . 1

Have you donated blood m the past 12 months?

Yes, . . . . . . . . . 7

No . . . . . . . . . . . . . . . . . . ,., . . . . 93

Don’tknow. .,.. . . . . . . . . 1

See fOOTO1eS at end ofIitk.

98

1

0

0

0

1

6

14

14

37

23

6

0

2

7

40

48

3

10

18

10

24

22

17

17

31

16

20

9

6

31

61

8

45

55

51

12

36

35

65

0

26

74

0

9

90

1

97

1

0

0

0

1

8

16

14

33

19

8

2

4

7

42

42

3

9

17

6

27

23

16

21

35

14

19

6

6

26

66

7

66

32

0

75

9

16

47

53

0

23

77

0

8

91

0

92

2

0

0

0

6

12

21

11

27

12

18

2

5

7

41

31

13

10

16

6

24

16

27

29

33

9

13

3

13

28

57

15

56

44,

76

6

15

44

55

0

9

91

1

3

96

1

95

1

0

0

0

2

8

16

14

33

17

10

2

4

7

42

39

6

10

16

2:

21

17

22

33

13

16

6

6

31

60

9

54

45

72

7

21

54

46

0

22

77

1

8

91

1

Percent distribut!onl

96

1

0

0

0

2

9

Is

12

31

16

11

1

4

7

40

41

6

9

16

8

24

21

22

23

33

12

17

6

8

26

63

10

76

24

0

76

10

14

33

67

0

16

64

0

6

94

0

96

1

0

0

0

2

8

16

13

33

18

10

1

4

7

43

40

6

8

16

8

27

22

19

21

35

14

16

5

7

25

66

9

66

31

0

73

10

17

46

54

0

20

80

1

7

92

1

91

G

o

1

0

~

13

16

11

30

37

13

3

5

9

38

35

10

15

23

6

15

17

21

26

28

9

13

9

14

45

40

14

66

34

80

4

16

37

63

0

15

65

0

4

95

0

96

1

0

0

0

2

10

19

13

28

17

13

2

5

7

32

46

8

12

18

2:

16

24

24

28

8

15

11

14

36

46

16

56

44

77

7

16

29

71

0

16

84

0

6

94

0

90

2

0

1

0

7

14

20

10

24

12

20

3

5

6

35

33

17

13

16

7

18

13

31

29

26

7

13

7

18

36

42

22

53

47

66

2:

29

71

0

7

92

0

3

97

0

96

1

0

0

0

2

10

19

13

30

18

10

2

5

8

41

40

5

10

18

6

24

20

20

26

34

12

14

6

7

31

61

9

;

o

74

9

17

40

59

0

17

63

0

6

94

1

98

1

0

0

0

1

5

17

15

36

20

6

1

3

7

45

43

2

6

16

9

30

25

14

16

36

17

22

8

4

23

72

5

73

27

76

9

15

52

46

0

26

73

1

10

90

1
Advance Data No. 216 ● August 21, 1992 9

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

1991 National Health Interview Survey, by selected characteristics: United States, January-March 1991- Con.

[Data are based on household interviews of the civilian nonmstifutionalized population. The survey design, general quahfications, and information on the reliabMy of

the estimates are gwen in technical notes]

Race or ethrriclfy

Age Sex Non-Hispanic Education

18-29 30-49 50 years Less than More than

AIDS knowledge or attitude Total years years and over Male Female White Black Hispanic 12 years 12 years 12 years

14.

15.

16.

17a.

17b.

18.

19.

20.

How many times in the past 12 months have you

donated blood?

Once . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Twice . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Three times or more. ,, .,...... . .

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

Didnot donate blood in peat 12 months . . .

To the best of your knowledge, are blood donations

routinely tested forthe AIDS vrus infection?

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

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

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

Was one of your reasons for donating blood because

youwantedtobe testedfortheAIDS vmminfection?4

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

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

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

Except for blood donations since 1985. have you had

your blood tested for the AIDS virus infection?

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

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

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

Why haven’t you been tested?l”5

Don’tconslder myself atrisk of AIDS . . . . . . . .

Don’t believe anything can be done if I am

positive . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tlike needlea . . . . . . . . . . . . . . . . . . . .

Afraid of Iosmg job, insurance, housing, friends,

family ifpeoole knew lwas postwe. . . . . . . .

Don’t trust mealcaf clinics/hosptals to keep test

resuita confldentlal, .,... . . . . . . . . . . . . .

Already know whether I have the AIDS wrus

infection . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknowwhere togoforatest . . . . . . .

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

Don’tknaw . . . . . . . . . . . . . . . . . . . . . . . . .

How many times have you had your blood tested for

the AIDS vxusmfection, not including blood

donations?

Once . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Twice . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Threetfmesormore . . . . . . . . . . . . . . . . . . .

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

Neverhadtest6 . . . . . . . . . . . . . . . . . . . . . .

How many times m the past 12 months have you had

your blood tested for the AIDS virus mfectian. not

including blooa danatrans?

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

Once . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Twice . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Threetlmes ormore . . . . . . . . . . . . . . . . . . .

Don”tknow. . . . . . . . . . . . . . . . . . . . . . . . .

Neverhaa rest6 . . . . . . . . . . . . . . . . . . . . . .

Did you have anyofthe AIDS blood te.sta:l’7

Forhos@aluationoras urgicalprocedure? . . . .

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

Toapplyfor life insurance?. . . . . . . . . . . . . . .

Foremployment? . . . . . . . . . . . . . . . . . . . . .

Toapplyfora marrlagelicense? . . . . . . . . .

Formilitary mduct!onormilitaq service? . . . . .

Forimmigratlan? . . . . . . . . . . . . . . . . . . . . .

Justtafind outifyou were infected?. . . . . . . . .

Because of referral bythe doctor? . . . . . . . . . .

Because ofreferral bythe Health Department? . .

Because ofreferrai byyaursex partner? . . . . . .

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

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

3

2

2

0

93

77

7

16

92

0

;

6

84

0

1

0

0

0

1

6

9

9

2

2

0

87

7

6

1

0

0

87

74

3

10

6

5

7

5

29

5

1

1

21

1

5

2

2

91

80

6

14

8:

0

20

76

4

76

0

2

0

0

0

2

8

14

12

4

3

0

80

10

8

1

1

0

80

11

1

7

8

6

11

5

31

7

1

1

19

0

4

2

2

92

82

7

11

95

16

79

5

85

1

1

0

0

0

1

6

8

11

2

2

0

84

9

6

1

0

0

84

14

4

11

5

6

5

5

27

4

0

1

22

1

1

1

1

0

97

68

9

24

9;

6

86

9

88

0

0

0

0

:

6

6

4

1

1

1

95

2

3

0

0

0

94

19

4

12

4

1

2

5

27

5

0

0

20

1

4

2

2

92

76

8

16

9:

0

15

79

6

83

0

1

0

0

0

1

6

10

9

3

2

0

85

8

6

1

0

0

85

10

4

12

8

6

11

5

30

3

1

1

15

1

Percent distnbutionl

3

1

1

0

94

77

7

16

9:

12

83

5

85

0

1

0

0

0

1

7

8

9

2

:

88

6

5

1

0

0

88

17

3

6

4

4

2

5

27

8

:

27

1

4

2

2

93

80

8

14

9;

o

12

82

6

86

0

1

0

0

:

6

7

8

2

2

0

89

6

5

1

0

0

89

13

4

12

5

6

8

1

26

6

0

1

22

1

2

1

1

0

96

66

10

24

11

83

22

73

5

76

0

3

0

1

0

2

8

13

13

:

1

78

9

10

2

1

0

78

16

2

3

10

2

6

4

41

6

3

1

18

3

2

1

94

64

12

25

6

92

20

75

4

77

1

1

1

2

8

14

15

3

2

0

80

11

7

2

0

80

16

:

6

:

26

25

5

1

1

21

0

2

1

0

0

97

60

10

30

6

88

11

82

7

79

0

1

0

0

1

1

6

14

8

1

1

1

69

5

5

1

0

0

89

18

2

5

6

4

1

15

26

7

1

1

23

1

3

1

1

94

77

8

15

9;

o

13

87

6

83

0

1

0

0

:

9

8

2

2

0

88

:

1

0

8:

16

3

4

7

s

9

2

30

7

1

1

20

1

:

2

90

85

5

10

3

93

16

80

5

87

0

1

0

0

0

0

7

6

10

3

2

0

65

8

6

1

:

85

10

4

16

6

6

8

3

28

4

0

1

21

0

See footnotesat end of:ade.
10 Advance Data No. 216 ● August 21,1992

Table 1, Provisional estimates of the percent of persons 18 years of age and over with selested AIDS knowledge and attitudes from the

1991National Health Intewiew Survey, by selected characteristics: United States, January-March 1991 -Con.

[Data are ~asec on househola mterwews of the civihan noninatiiutionahzed population. The survey design, general quallficationa, and information on the reliability of

me estmwes are gwen m technical notes]

Race or ethnicity

Age Sex Non-Hispanic Education

18-29 3&49 50 years Less than Mora than

A/DS lmow/euge or attrtude ToW years yaars and over Ma/a Female Whtte Black Hispanic 12 yeara 12 yeara 1,2yeara

21.

22.

23.

25.

26.

28,

29,

30.

When was your last AIDS blood test for the AIDS VMJS

ln%x!lon not mcludmg blood donation?’

.99- . . . . . . . . . . 7

.993, .,...., 40

.989. , ,,, ,, . :::::::::::::::::: 20

.985 12

.98 ?.:::::::::::::::::::::: ::::: 6

.,95 E .,, . . . . . . . . . . . . . . . . . . . 3

.9?S. ,, . . . . . . . . . . . . . . . . . . . . . . . . . 1

g~~,:know,.. . . . . . . . . . . . . . . . . . . . 7

D!= VOJ nave your last AIDS blood test:l’7

Farmwpitallzatlonc: asurg!calpr ocedure? . . . . 13

To auoly for health ms.urance? . . . . . . . . . 3

ToaxJyforliieinaurance?. . . . . . . . 10

For employ merit ?, . . . . . . . . . . . . . . . . . . 6

Toaooly foramamage license? . . . . . 4

‘or mllltary mduct)on or military service? . . 7

Forlmmigration? ..,... ,,, , . . . . . . . . ...4

Just to fmdoutif youweremfected?. 28

Because ofreferral bythedoctofl . . . 5

6ecause ofreferral bythe Health Department? 1

Because ofreferral byyoursexpartnefl . . . . . 1

Other, . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

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

No! !ncluamg a blood donation, where was your last

blcod tes! for the AIDS virus done?’

AIDS clinic/counseling/testing site . . . . . . . 1

Community health c!lmc. . . . . . . . . . . . . . . . . 7

C!:wcrun by employer ..,..... . . . . . . . . 2

Dsc?or/HMO, . . . . . . . . . . . . . . . . . . . . . . . 31

Hosmtal/emergency room/outpatient clinic . . . . . 27

STDclinlc . . . . . . . . . . . . . . . . . . . . . . . . . 1

Family planning clinic, . . . . . . . . . . . . . . . . . 0

Prenatalclinlc. ..,.,.... . . . . . . . . 1

Tuberculosis chic.. . . . . . . . . . . . . . . . . . -

Publ!cclimc. . . . . . . . . . . . . . . . . . . . . . . . 3

Otnerclmc.. ,.. . . . . . . . . . . . . . . . . . . . 2

Drugtreatmentfacilrty, . . . . . . . . . . . . . . . . . 0

MilitaWmduction/servtcesite. . . . . . . . 7

Immtgratlon site. ..,...... . . . . . . . . . . . . 1

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Don’tknaw . . . . . . . . . . . . . . . . . . . . . . . . . 0

D!d you get the results at your last test?’

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

No, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Don’t know. . . . . . . . . . . . . . . . . . . . . . . . . 1

Was this because you didn’t want the reautte or wee

it because yau were unable togettheresulta?a

Didn’!want. . . . . . . . . . . . . . . . . . . . . . . . 10

Unabletoget . . . . . . . . . . . . . . . . . . . . . . 21

Both . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Don’t know.,........,,.. . . . . . . . . . . 13

Were theresulte g~enm9ereon, bytelephone, by

ma!:, orm some other way?g

In person . . . . . . . . . . . . . . . . . . . . . . . . . . 82

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

Bymall . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

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

Do you believe the resut!. of your last teat were

accurate?g

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

No, . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Don’t know,,........,.. . . . . . . . . . 2

Do vou feel that the conf!detilahlv of the results of

you~lasttealforthe AIDS virustrifectlon wee handled

prooerly?s

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

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

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

See footnotesat ena oitable.

8

39

22

13

6

3

1

6

11

1

6

8

4

10

4

30

7

1

1

22

0

0

9

2:

25

1

1

1

4

3

0

10

1

12

82

17

0

9

32

1

47

9

83

15

16

7

98

0

2

86

2

1

8

39

20

12

7

4

2

6

13

5

12

5

5

5

4

27

4

i

22

1

1

6

2

31

27

0

0

1

2

2

0

5

0

19

0

80

19

1

12

17

1

58

12

59

18

15

8

98

0

1

94

2

4

6

42

13

11

4

1

1

11

18

4

12

4

1

2

5

27

4

0

0

24

0

1

4

3;

30

0

3

4

13

0

71

2a

1

6

14

5

53

22

67

18

9

5

96

2

3

96

1

1

7

37

19

13

7

4

:

9

4

13

8

5

11

5

29

3

0

1

17

0

1

7

3

30

21

1

0

3

3

0

11

1

17

0

79

21

0

8

27

1

50

14

58

15

19

7

96

0

2

95

;

Percent dfstribufiont

7

43

20

fl

6

2

1

5

17

3

8

4

4

2

4

27

7

1

0

2a

1

1

8

3;

34

0

1

1

2

2

0

2

0

13

ao

19

1

12

14

3

57

12

65

16

9

7

98

1

1

95

2

2

7

38

21

12

6

3

2

7

12

4

13

5

5

7

1

26

5

0

21

1

1

;

31

26

0

0

1

2

3

0

7

0

17

0

78

21

1

9

22

1

56

12

58

19

14

9

98

0

1

95

2

3

11

44

17

9

6

2

1

6

17

3

3

10

2

5

3

40

6

3

1

19

0

0

11

3:

32

0

0

1

5

2

4

0

13

81

19

1

14

15

6

36

26

84

14

16

5

97

3

96

2

2

37

22

15

9

2

0

11

12

2

9

6

1

4

23

24

4

0

21

0

2

6

3:

25

3

2

1

3

3

4

2

9

a7

13

14

34

52

81

4

13

2

99

1

0

94

3

2

6

37

15

16

5

3

0

11

16

2

5

5

4

2

14

24

7

0

0

25

1

7

38

34

2

1

4

1

;

:

0

80

18

2

9

27

7

40

18

77

15

6

2

98

2

1

5

40

22

11

5

2

2

7

16

4

4

7

4

6

1

31

7

1

1

23

1

0

9

2

27

32

0

0

1

3

2

9

0

11

0

81

16

0

12

23

46

16

62

16

16

6

9a

o

2

8

39

20

12

8

4

:

9

3

17

5

5

7

3

26

3

1

21

0

2

6

3:

21

0

0

1

2

3

0

7

0

21

78

22

0

9

18

2

62

6

56

18

18

10

98

2

96 94 96

2 3 2

2 2 2
Advance Data No. 216 ● August 21,1992 11

Table 1. Provisional estimates of the percent of persons 18 years of age and ‘over with selected AIDS knowledge and attitudes from the

1991 National Health Interview Survey, by selected characteristic= United States, January-March 1991 -Con.

[Date are based on household mtervtews of the civilian noninatiionailzed population. The survey design, ganeral qualifications, and information on the reliability of

the estimates are given in tachnical notes]

Race or e?hnicdy

Age Sex Norr-Hispan!c Education

16-29 30-49 50 years

AIDS knowledge or .3ffJtUdr?

Less than More than

Tots/ years years and owr Male Female W7ute Black Hispanic 12 years 12 years 12 years

31.

32.

33.

34.

34a.

34b.

37.

38.

38a.

38b.

Do you expect to have a blood test for the AIDS virus

infection in the next 12 months?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . 7

Tell me if each of these statements explain why you

expect to h~~e the blood test in the next

12 months.

Because it WIII be part of a blood donation. . . . . 25

Because it wtll be pail of hospitalization or

surgery youexpect to have.... . . . . . . . . . . 6

Becauseyou expect to apply for life or health

insurance . . . . . . . . . . . . . . . . . . . . . . . . . 7

Because you expect to apply for a job. . . . . . . . 7

Becausa you expect to join the miliiry . . . . . . . 4

Because you expect to apply for a marriage

license . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Because you want to know the resuits. . . . . . . . 65

Bacause it will be a required part of some other

activity that includes automatic AIDS testing . . 21

Where will you go to have a blood test for the AIDS

virus infaction?

AIDS cfinic/counseling/teeting site . . . . . . . . . . 2

Community heafth clinic . . . . . . . . . . . . . . . . . IO

Clinic run byemployer . . . . . . . . . . . . . . . . . 3

Doctor/HMO . . . . . . . . . . . . . . . . . . . . . . . . 39

Hospital/emergency morn/outpatiarrt clinic . . . . . 18

STD clinic....,.........,.. . . . . . . . . i)

Family planning clinic . . . . . . . . . . . . . . . . . . 0

Prenatal clinic . . . . . . . . . . . . . . . . . . . . . . . -

Tubercuiosls clinic . . . . . . . . . . . . ., ...,,, 0

Publlcclinic . . . . . . . . . . . . . . . . . . . . . . . . 3

Other clinic . . . . . . . . . . . . . . . . . . . . . . . . . 3

Drugtreatment facllii . . . . . . . . . . . . . . . . . . -

Miliiaiy induction/service site. . . , . . . . . . . . . . 4

Immigration site . . . . . . . . . . . . . . . . . . . . . . -

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . 5

Tell me whether you think the following statements

about the blood teat for the AIDS virus infection are

true or false or if you do not know whether they are

true or false.

Sometimes the results of a blood teat for the AIDS

virus infection can be wrong.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

False . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Don’tkrrow . . . . . . . . . . . . . . . . . . . . . . . . . 22

After a person becomes infected wtih the AIDS virus,

there can be a period of time before the test shows

theinfactlon.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

False . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Don’tknow . . . . . . . . . . . . . . . .. . . . . . . . . . 26

Have youever heard crfadrug cailed~, also

known se Zldovudine or Retrovifl

Yes, . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Don’tknow. . . . . . . . . . . . . . . . . . . . . . . . . 3

Tellmewhetheryou thinkthefollow”ng statements

about ~ are true or fatse or if you don’t know

whather they are true or false.”

A.ZTcendelayor slowdown mesymptoms ofAIDS

~“rusinferxion.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

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

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

AZT cures people with AIDS.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I

False . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

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

Seafoomorssstend oftsble.

15

76

9

24

6

9

9

6

12

76

16

3

13

1

36

17

0

1

1

4

2

5

0

7

70

2:

75

2:

46

49

3

62

1:

1

80

9

8:

6

25

7

6

:

4

55

24

1

9

3:

16

1

0

3

3

4

1

5

76

8

17

74

4

56

39

3

82

2

16

1

90

9

9:

7

27

6

4

3

0

58

27

1

6

48

23

0

4

1

;

68

2:

61

3:

42

54

4

74

2;

2

81

17

8:

7

26

5

8

8

5

6

65

22

3

10

3

36

17

:

1

1

3

i

o

6

73

2:

70

2:

51

46

3

79

2

19

a;

12

Percent distribution

8:

7

23

6

6

6

2

7

64

19

1

11

1

42

16

0

1

4

3

2

0

4

71

2;

70

3

26

49

47

4

61

1;

8:

11

6

89

5

31

6

7

7

2

8

55

22

2

6

2

41

15

:

2

3

5

0

5

74

2;

72

2:

53

43

3

so

2

18

1

88

11

20

66

14

10

7

7

6

5

6:

16

2

16

3:

21

i

1

4

1

2

7

67

2:

69

2;

40

56

4

75

2;

2

83

15

11

76

11

30

6

11

6

?

14

75

21

14

5

29

22

i

5

4

1

2

4

56

:

56

4

26

67

5

67

3

16

3

86

11

6

83

10

19

10

6

7

7

6

66

15

14

44

19

i

6

4

i

5

57

3:

54

3

43

23

72

4

69

2

29

2

79

19

8

85

7

23

7

7

9

2

9

66

23

2

12

3

37

10

0

0

;

3

2

i

:

72

2:

70

2:

45

51

4

76

2:

2

85

13

8

86

6

29

4

7

5

3

6

54

22

3

7

4

39

17

:

;

5

0

5

79

7

15

78

4

18

66

30

3

84

2

15

1

90

9
12 Advance Data No. 216 ● August 21, 1992

Table 1. Provisional estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes frclm the

1991 National Health Interview Survey, by selected characteristics: United States, January-March 1991- Con.

[Data are baaed on nouaehold mterwewa of the civilian noninstnutional!zed population. The survey design, general qualifications, and information on the reliabihty of

the estimates are gwen m technical notes]

Race or ethrvcity

Age Sex Non-h’ispanfc Education

18–29 30-49 50 years Less than

ADS krrowlecfge or attitude

More than

Tots/ years years and over Ma/e Ferns/e VWfe B/ack Hispanic 12 years 72 years 72 years

38C.

38d

38e

39.

40,

41.

42,

42a.

42b.

43.

44.

45.

46.

A.ZT haa no known side effects.

True. . . . . . . . . . . . . . . . . . . . . ,. . .

False, . . . . . .

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

~ IS approanate for a person wtth the AIDS virus

infect!on only at certamt!mes dunrrg the dlness.

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

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

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

There are other drugs available to treat AIDS-related

illneasea.

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

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

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

Did you have a blood transfusion at any time

between 197T’ and 1985?

Yes .,, . . . . . . . . . . . . . . . . . . . . . . . . . .

No, ,,, . . . . . . . . . . . . . . . . . . . . . . .

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

Dn YfJUhave fretUJent blood transfusions because of

S!ckle Cell or Chrome Anemia?

Yes, . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Howeffectwedo youthink theuseof a condom is to

pravant geffmg the AIDS wrus through sexual actwity?

Vey affectwe, . .,...,.,, . . . . . . . . . . .

Somewhat effectwe . . . . . . . . . . . . . . . . . .

Notatall effechve . . . . . . . . . . . . . . . . . . .

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

Don’t knowmethod . . . . . . . . . . . . . . . . . . .

Tellmewhetheryou thinkthefollowing statemante

aretrua or false orwhatheryou don’t know whether

they are true or false.

Latex condoms and natural membrane condoms ara

equally good at preventing transmission of the AIDS

virus,

True, . . . . . . . . . . . . . . . . . ., .,.:,,...

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

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

Don”tknowmethod . . . . . . . . . . . . . . . . . . .

Dil-based Iubricanta cancause latex condomato

break.

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

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

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

Don’t knowmethod . . . . . . . . . . . . . . . . . . .

What are your chances of having the AIDS virus?

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

Medwm, ,,, .,......,.. . . . . . . . . . .

Low, . . . . . . . . . . . . . . . . . . . . . . . . . . . .

None .,, . . . . . . . . . . . . . . . . . . . . . . . . .

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

What are your chances of getting the AIDS virus?

High, . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Low, . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nor,z . . . . . . . . . . . . . . . . . . . . . . . .

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

N/A – High chance of already having the AIDS

virus . . . . . . . . . . . . . . . . . . . . . . . . . .

Have you ever had a coworker who had AIDS or the

AIDS virus?

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

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

Never worked, never had a coworker .

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

Have you ever had a friend or relative who had AIDS

or the AIDS wrus?

5

57

38

33

11

56

49

15

36

5

94

1

0

100

0

26

4a

4

16

2

26

6

66

2

0

1

16

81

2

0

2

22

74

2

0

4

87

1

7

Yes.,,. 9

No.. . . . ...’.::.::’”::”’ 87

Don’ tknow . ...,,,... . . 4

See foa!rmteset end oftable.

6

61

33

38

12

50

46

;:

2

97

1

0

100

0

35

50

3

11

1

26

22

49

1

37

8

54

1

0

1

22

74

2

1

3

29

65

2

0

4

87

1

7

9

88

3

5

61

35

36

11

52

54

14

31

5

94

1

0

100

0

31

53

4

13

1

20

20

59

1

30

6:

1

0

1

17

80

1

0

2

24

72

2

0

6

86

0

8

12

85

3

5

49

46

24

;

42

13

44

7

92

1

0

100

0

19

43

4

29

5

11

9

76

5

14

4

77

5

0

1

9

68

3

1

13

83

3

0

3

89

1

7

6

90

4

5

57

38

33

12

55

52

14

34

4

94

1

0

100

0

32

47

3

16

2

23

19

57

2

31

7

61

2

0

1

17

79

2

0

2

24

71

2

0

4

87

0

9

6

88

4

Percent d!stributlon’

5

58

37

34

10

56

47

15

36

5

94

1

0

100

0

24

49

2:

3

15

15

67

3

22

5

70

3

0

1

14

63

2

0

2

20

76

2

0

5

86

1

6

10

87

3

5

58

37

32

11

57

51

14

36

5

94

1

0

100

0

28

50

3

16

2

18

18

62

2

27

5

66

2

0

1

16

82

1

0

2

22

74

2

0

4

88

1

7

9

88

3

8

50

42

38

10

51

41

19

40

5

95

1

1

99

0

28

39

2:

2

22

13

63

2

28

7

63

2

1

2

16

75

5

:

22

70

4

1

4

84

1

10

10

84

6

3

59

38

40

16

44

41

26

33

1

96

0

100

23

42

5

25

5

21

:

5

20

6

69

5

1

1

10

85

3

0

2

17

77

3

1

6

63

2

9

9

85

5

7

45

47

33

6

60

36

16

49

6

93

1

0

100

0

19

37

6

33

5

15

8

72

5

17

4

74

5

0

1

9

86

4

1

1

12

81

5

0

1

89

2

7

5

90

5

6

46

45

27

13

60

43

16

41

5

94

1

0

100

0

25

51

4

19

2

21

13

64

2

24

6:

2

0

1

14

82

2

0

2

19

76

2

0

3

90

1

6

8

86

4

4

65

31

37

11

53

55

14

3.1

4

95

1

0

100

0

35

51

3

10

1

18

25

56

1

33

6

59

1

0

1

20

78

1

0

2

28

68

1

0

7

84

0

8

12

65

3
Advance Data No. 216 ● August 21, 1992 13

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

1991 National Health Interview Survey, by selected characteristics United States, January-March 1991- Con.

[Data are based on household interviews of the cwilian noninstitutionalized population. The survey design, general quaiificatlons, and information on the reliability of

the estimates are given in techmcal notes]

Sate or efhfrlc~.y

Age Sex Non-Hispanic ErWcation

18-29 3049 50 years Less than More than

A/DS know/edge or attitude Total years years andover Male Female Wl?!e Black Hispanic :2years 12years 12years

47. Are any of these statements true for you?

a. Youhave hemophilia and have recewed clotting

factor concentrates since 1977.

b. Youarea manwhohas hadsexwth another

man at some time since 1977,even 1 time.

c. You have taken illegal drugs by needle at any

time since 1977.

d. 3ince 1977,you are or have been the sex par7rter

of any person who would answer yes to any of

the items above (a-c)

e. Y=&lWMd sex for money or drugs at any time Percent cistnbution’

Yestoat leaetletatement . . . . . . . . . . . . . . . 3 5 4 1 4 2 3 3 4 2 3 3

Noto all statements . . . . . . . . . . . . . . . . . . . 97 95 96 99 96 98 97 97 96 97 97 96

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . 0 0 0 0 00 00 0 0 0 0

‘Multiple responses may sum to more than 100.

2BaS~ on ~erSonS ~nSw*,,ng yes to queetmn 8, “Do you have any children aged 10 thmu9h 17

3Based on persons answenng no or don’t knowto auesf!ons12, 13a. or 13b.

4Bsaedon persons answenng yes to quest]ons 13a ana 15.

5Based ,cn pecsonS anSWerlng nO to quesuon 17a.

6Bassd on persons answenng no or don’t know to quesC,on 17a,

7Based on persons answenng yes to auest!on 17a.

~Bassd on persons answering no or don’t know TOquestmn 25.

8em0”S answering yes to quesoon 25.

‘ Based on persons answenng yes to quest!on 31.

11BaSed on pemo”s an~enng yes to questiOn 37.
14 Advance Data No. 216 ● August 21,1992

Technical notes

The National Health Interview

Survey (NHIS) is a continuous, crosssectional household interview survey.

Each week, a probability sample of

the civiIian 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 househo[d. Information on

special health topics is collected for

a[l or a sample of household

members, Tne 1991 N“ational Health

Interview Survey of AIDS Knowledge

and Attitudes is asked of one

randomly chosen adult 18 years of

age or over in each family. The

estimates in this report are based on

completed interviews with 9,983

individuals. about 87 percent of

eligible respondents.

Table I contains the estimated

population size of each of the

demographic subgroups included in

table 1 to allow readers to derive

provisional 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

1989 data from the IVHIS inflated to

national population controls by age,

race, and sex, The population

controls are based on the 1980 census

carried forward to 1989, These

estimates, therefore, may differ from

1990 census results brought forward

to the survey date. Population

controls incorporating census results

will be used for survey estimation

beginning later in the decade,

Table 11shows 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).

The estimates in table 1 and the

standard errors in table II are

provisional, They may differ slightly

from estimates made using the final

1991 data file because they were

calculated using a simplified

weighting procedure that does not

adjust for all the factors used in

weighting the final data file, A final

data file covering the entire 1991 data

collection period will be available at

the end of 1992.

Table L Sample sizes for January-March

1991 National Health Interview Survey of

AIDS Knowledge and Attitudes and estimated adult population 18 years of age and

over, by selected characteristics:

United States, 1991

.Estin7a&d

Sample population

Charactedstica size in thousands

Alladulte, . . . . . . . . . . 9,983 180,271

Age

16-29 years . . . . . . . . . 2,300 46,282

30-49 years . . . . . . . . . 4,101 71,831

50 yeara and over . . . . . . 3,582 61,157

Sex

Male .,.........,., 4,183 85,632

Female . . . . . . . . . . . . 5,800 94,636

Race and etfmicity

Non-Hlspanlc whfie. . . . . 7,746 139,440

Non-Hispanic black. , , . . 1,255 19,585

Hispanic . . . . . . . . . . . 644 14,118

Education

Iðh 12 years. . . . . 1,738 36,:782

2,069 72,418

More than”l’2’yeark: :::: 1,461 70,036

‘Estimates below the cutott points have an RSEof more than

30 percent and ara considered to be slatisticdy Unreliable.

Table IL Standard errors, expressed in percentage points, of estimated percents from the 1991 National Health Interview Suwey of AIDS

Knowledge and Attitudes, by seleoted characteri~tics: Unfied States, January-March 1991

0.5

0.6

0.6

0,6

0.6

::;

Age Sex Race and ethnic/ty Education

78-29 3W9 50 years

Esttmated percent Total

Less than 12 More than

years years and over Mate Female White Black Hispanic 12 years years 12 ydars

5or 95 . . . . . . . . . . . . . . 0.3 0.4 0,5 0.4 0.4 0.3 0.8

:.:

1.1 0.6

100r90 . . . . . . . . . . . . . 0.4 0.6

0.5 0./)

0.6 0.4

150r 85 . ., .,, .,...... 0.5 1.0 0.7 0.5 ;:;

200r80 . . . . . . . . . . . . . . 1.1 0.8 U 0.6 1.5

250r 75 . . . . . . . . . . . . . . 1.2 0.9 0.9 0.6 1.6

3oor 70 . . . . . . . . . . . . . . 1.2 0.9 0.9 0.7 1.7

350r65, . . . . . . . . . . . . . 1.3 1.0 0.9 0.7 1.7

400r60, . . . . . . . . . . . . . 1.3 1.0 1.0 0.7 1.8

450r 55 . . . . . . . . . . . . . . 1.3 1.0 1.0 0.7 1.8

50, . .,, . . . . . . . . . . . . . 1.3 1.0 1.0 0.7 1.8

0.6

0.6

0.9

0.9

1.0

1.0

1.1

1.1

1.1

0.5

:::

0.7

0.8

0.6

0.8

0.8

0.6

0.8

1.0

1.1

I::

1,3

1.4

1.4

1.4

0.6

0.8

0.6

0.9

!::

1.0

1.1

1.1

0.6

0.7

0.[) 0,$)

0,$)

1.C1

1.C1

1.C1

1.C1
Number 217 ● September 16, 1992 PARKMWN HEALTH LIBRARY

Advance

Data

From Vital and Health Statistics of the CENTERS FOR DISEASE CONTROL/National Center for Health Statistics

Assistive Technology Devices and Home Accessibility

Features: Prevalence, Payment, Need, and Trends

by Mitchell P. LaPlante, Ph. D., University of California, San Francisco, Gerry E. Hendershot, Ph. D.,

and Abigail J. Moss, Division of Health Interview Statistics

In 1990, more than 13.1 million

Americans, about 5.3 percent of the

population, were using assistive

technology devices to accommodate

physical impairments. In 1990, 7.1

million persons, nearly 3 percent of

all Americans, lived in homes that

were speciaIly adapted to

accommodate impairments. About

half of the persons with assistive

technology devices, and more than

three-fourths of those with home

accessibility features, purchased them

themselves or with the help of their

families without contributions from

third-party payers. More than 2.5

million Americans said they need

assistive technology devices that they

do not have, mostly because they

cannot afford them. Between 1980

and 1990, the number of persons

using anatomical or mobility assistive

technology devices increased at a

more rapid rate than did the general

population.

These findings are from the 1990

National Health Interview Survey on

Assistive Devices (NHIS-AD), which

was cosponsored by the National

Center for Health Statistics (NCHS)

and the National Institute for

Disability and Rehabilitation

Research (NIDRR). NCHS is one of

the Centers for Disease Control in

the Public Health Service,

Department of Health and Human

Services. NIDRR is an agency in the

Office of Special Education and

Rehabilitation Services, Department

of Education. NCHS and NIDRR

jointly planned the Survey, and the

Bureau of the Census conducted the

field work.

Background

“Assistive technology” consists of

devices and other solutions that assist

people with deficits in physical,

mental, or emotional functioning.

Assistive technology devices are items

frequently used by people with

functional deficits as alternative ways

of performing actions, tasks, and

activities.

Hundreds of assistive technology

devices are available. Mobility aids,

such as wheelchairs and walkers,

orthotics, and prostheses, are more

visible and famiIiar types of assistive

technolo~ devices. Some other

devices include microcomputers,

powered mobility devices,

myoeIectrically powered prostheses,

augmentative communication devices,

optical pointers, headsticks,

mouthsticks, and alphabet boards.

Some assistive devices, such as

myoelectrically powered prostheses

and infrared hearing systems, are

technically sophisticated. However,

many devices are “low-tech,” such as

waIkers and canes.

Assistive technology also includes

ways of controlling these devices.

Software may control ordinary

hardware systems in ways that

facilitate their use by persons }vith

functional deficits, like text-to-speech

conversion software that runs on

ordinary computers, Some assistive

technology involves extending the

range of users. For example, signs

with words can be made more legible

to everyone, not just persons with

vision impairments, by avoiding

ambiguity and providing better

contrast between Ietters and

background.

##* ‘-”’c%,

-g

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

.

~=

s

Public Health Service

s Centers for Disease Control 5

‘%

-2%,za National Center for Health Statistics CENTERS CDC FOR D!SEASE CWTI?OL
2 Advance Data No. 217 ● September 16, 1992

Another way to help people with

deficits in physical, mental, and

emotional functioning is to build or

modify the environment to be more

accessible. Accessibility often involves

accommodating assistive technology in

the design or reconfiguration of

features of buildings and

environments so they are more

useable by people with functional

deficits. Accessible design includes

reducing barriers in transportation

systems, buildings and homes, and

recreational and public areas to make

them more convenient for peopIe

with functional deficits. Some

facilitating design features are ramps

and approaches, specially configured

door openers and locks, wheelchairIifting devices, and elevating devices.

Assistive technology devices and

accessible design are interdependent.

A person who uses a wheelchair

cannot get into buildings accessible

only by stairs. A shopping mall

directoxy may be out of view or

meaningless to a person with

functional deficits. Barrier-free

universal design is increasingly

encouraged to allow all perion%

disabled or not, to move freely,

independently, and safely in their

surroundings. Assistive technology

devices and accessible environmental

design features help people regain

function, assist them in performing

activities and roies, and can often

prevent further disability or reduce

the level of disability.

Recent public policies emphasize

the societal desirability of access to

assistive technology and accessible

enw-ronmental design. The Americans

with Disabilities Act (ADA), enacted

on July 26, 1990, and now being

implemented, requires employers,

public officials, and businesses to

make accommodations for people

with functional deficits, if such

accommodations do not cause undue

economic hardship (l). Such

accommodations include special

training, flexible work schedules,

personal assistants, accessible design,

and assistive technology devices.

Public Law 100-407, the

Technology-Related Assistance for

Individuals with Disabilities Act of

1988 (the “Tech Act”), authorizes

Federal funds to States that plan and

develop consumer-responsive

statewide programs of technologyrelated assistance for individuals with

functional deficits or disabilities. This

goal can be achieved by providing

assistive technology devices and

services, by developing an information

dissemination system, by establishing

or enhancing training and technical

assistance, and by designing public

awareness projects. Important factors

determining the use of technology are

benefits and costs of squiring and

using technology. An underlying

assumption is that many people who

couId use technology do not have

access to it. The Tech Act recognizes

the need for concerted planning to

increase access to technology for

people with functional deficits,

These recent developments in

public policy emphasize the

significant contribution of assistive

technology for people with

disabilities, and the need for national

statistics on the use of that

technology. In response to that need,

NIDRR and NCHS cosponsored a

survey on assistive technology devices

and homes with accessibility features

as part of the National Health

Intem-ew Survey of 1990. This is the

first report of the results of that

survey. The survey focused on

assistive technology devices and did

not attempt to cover all aspects of

assistive technology. For the first

time, an NCHS survey included

questions about accessibility features

in homes. Even people who are not

disabled and who live in homes with

accessibility features are benefitted

because relatives, friends, and others

who are disabled can live with them

or visit them. Also, these homes will

be more practical for their owners,

should they develop a functional

deficit.

This report provides national

estimates of the number of peopIe

using assistive technology devices or

living in homes with accessibility

features in 1990, the types of devices

and features used, the sources of

pa,yment for this technology, and the

number of persons who need but do

not have assistive technolo~ devices.

Estimates are presented for the total

noninsitutionalized population of all

ages, and for broad age groups.

Statistics on the number of people

using assistive technology devices at

all ages were last obtained by the

NHIS in 1980. This report updates

these statistics collected earfier

shows trends over time for

comparable items.

Concepts and measures

and

The Assistive Devices interview

began with this preamble: ‘The next

questions are about the use of devices

to help people with physical

disabilities or impairments.” The

interviewer then asked, “Does anyone

in the family NOW use a brace of any

kind? Who is this? Does anyone eIse

now use a brace?” Similar sets of

questions were asked about specific

devices for mobility, hearing, vision,

and speech. The last question in each

set (such as mobility) asked if anyone

used any other device for that

purpose, and a final question asked if

anyone used any other special

equipment designed for persons with

disabilities or impairments. Every

device used by any person in the

family was recorded.

Any device or equipment

reported in response to these

questions is considered an “assistive

technology device” (except that

implanted devices, such as

pacemakers, were excluded when

mentioned). Some of the devices are

“high technology,” such as computers,

and some are “low technology,” such

as canes and walking sticks. Other

terms sometimes used to refer to

assistive technology are “assistive

devices,” “adaptive technology,”

“tools and equipment,” “aids and

appliances,” and “special aids.”

“Assistive technology” is now the

most widely used term and is

preferred by disability-related

organizations. The operational

definition of assistive technology u~sed

here is consistent with the definition

given by DeWitt: “In general,

assistive technology includes devices

that enhance the ability of an

individual with a disabiliv to engage
Advance Data No. 217 ● September 16, 1992 3

in major life activities, actions, and

tasks’: (2).

Although the intention of the

Assistive Devices interview was to

identi~ assistive technology used by

persons with impairments that are

permanent or long lasting, some of

the devices may have been used only

temporarily during recovery from an

injury or acute illness. This would

have occurred most often with devices

such as crutches, canes, walkers, and

wheelchairs, and not at alI with some

other devices, such as artificial limbs.

The number of persons who have

acute conditions for which they use

devices is unknown, but is assumed to

be small compared with the number

of people with long-lasting

impairments who use devices.

Nevertheless, numbers shown in this

report probably overestimate slightly

the number of chronically ill or

impaired persons using any device

and of peopIe using some specific

devices, such as crutches.

The interviewer aIso said to the

respondent, “Please tell me if this

home is equipped with any special

features designed for disabled

persons,” and handed the respondent

a printed card listing ramps extrawide doors or passages elevators or

stairlifts (not counting public

elevators); hand rails or grab bars

(other than normal hand rails or

stairs); raised toilets levers, push

bars, or special knobs on doors;

lowered counterv slip-resistant ffoor~

and other special features designed

for disabled persons. The presence of

any of these features ih the home is

considered a “home accessibility

featurel”

The statistics on home

accessibility features refer to persons

Iiving in homes with these features,

not to those homes. Persons living in

homes with accessibility features do

not necessarily have an impairment,

and, in fact, a majority are reported

not to be limited in their activi~ by

an impairment or chronic illness.

Even if none of the residents has an

impairment, they stiIl benefit horn the

accessibility features: They are better

able to accommodate visitors with

impairments, and they are prepared

shouId injury or illness cause an

impairment to themselves.

The terms “impairment”

“disabiIityJ’ and “handicap” are often

used loosely and interchangeably.

Where greater precision is needed

they must be differentiated and

defined. The International

Classification of Impairments,

Disabilities, and Handicaps (lCIDH)

(3) differentiates the terms and

defines them as follows:

“impairment” is “any 10ss or

abnormality of psychological,

physiological, or anatomical structure

or function “; “disability” is a

restriction in the ability to perform

“essential components of everyday

living,” such as pemonal hygiene or

moving about “handicap” is a

limitation on “the fuffiIIment of a roIe

that is normal for that individual.” A

“handicap” is a consequence of a

disability, and a “disability” is a

consequence of an impainnenc

however, impairments do not

necessarily lead to disabilities, nor do

disabilities necessarily Iead to

handicaps. Furthermore, handicaps

and disabilities are not necessarily

permanent.

Persons using assistive technology

may be assumed to have an

impairment, that is, some loss or

abnormality of structure or function

at the level of organ systems, but it is

not known if they have a disability or

a handicap. The use of assistive

technolo~ devices or home

accessibility features may enabIe them

to perform essential functions of

everyday living, thus preventing a

disability or it may enable them to

perform their normal roles,

preventing a handicap. This report

describes persons with impairments

who use assistive technology devices

or home accessibility features to

prevent or alleviate disabilities and

handicaps.

The prevalence of assistive

technology devices and home

accessibility features

The estimated numbers of

persons in the U.S. civilian

noninstitutionalized population who

use assistive technology devices are

shown in table 1. Altogether, more

than 13 miIlion Americans use

assistive technology devices. More

people use assistive technology

devices to compensate for mobility

impairments than for any other

general type of impairment 6.4

million use some kind of mobility

technology, and 4.4 million use a cane

or walking stick, the single most-used

assistive technology devices. Other

prevalent assistive technologies are

hearing aids (3.8 million), walkers

(1.7 million), wheelchairs (1.4

million), and back braces (1.2

million).

About 7.1 million peopIe live in

homes that have special equipment

for persons with impairments. The

most common home adaptation is

hand raik (3.4 million), followed by

ramps (2.1 million), extra-wide doors

(1.7 million), and raised toilets (1.3

milIion).

Age patterns

The percent distribution of

persons who use assistive technology

devices by age, according to the type

of technology used is shown in

table 2. Among persons who use any

assistive technology devices, the

majority (52 percent) are over 65

years of age, reflecting the higher

prevalence of impairments in that

population. However, for some

specific assistive technologies, a

significant proportion of users are

under age 25 years: foot braces

(38 percent), artificial arms or hands

(35 percent), adapted typewriters or

computers (25 percent), and leg

braces (24 percent).

The per~nt of persons who use

assistive technology devices by type of

technology used, according to age, is

shown in tabIe 3. This emphasizes

some of the age differences noted in

tab!e 2. For example, in tabIe 3 the

proportion of users of devices that

use anatomical technology decIines

significantly and regularly with

increasing age, from 62 percent

among users under 25 years of age to

ordy 7 percent among users 75 years

and over. MobiIity and hearing

technologies show the opposite trend:
4 Advance Data No. 217 ● September 16, 1992

The proportions increase regularly

with age, from lows of 23 percent

(mobility) and 15 percent (hearing)

among persons under 25 years to

highs of 67 percent (mobility) and

40 percent (hearing) among persons

75 years and over.

These age-related patterns are

also shown for the specific assistive

technologies listed, although there are

some reversals. For example, the

proportion of users who use crutches

goes down with age, not up as in the

general mobility catego~. This may

reflect the temporary use of crutches

by younger persons recovering from

injuries to the legs or feet, which are

more common among younger people

than older people.

Prevalence rates in the general

population

The prevalence of assistive

devices is described in another way in

table 4. Whereas tables 1-3 include

only persons who use some kind of

assistive technolo~ device or home

adaptation, tabIe 4 includes all

persons, whether or not they use

assistive technology devices, and

shows the users as a percent of the

total population, according to age.

Overall, 5.3 percent of the civilian

noninstitutionaIized population uses

some kind of assistive technology

devices or home adaptation. That

percent increases with age, from

about 1 percent among persons

under 25 years of age to nearly

35 percent among persons 75 years of

age and over.

Source of payment

Where an assistive technology

device or accessibility was used in a

sample household, respondents were

asked to identi@ every source of

payment for each device or feature

from a printed list of sources. The

listed sources were: no payment, gift,

self or family, private health

insurance, Medicare, Medicaid,

rehabilitation program, employer,

school system, Veterans’

Administration program, other

private source, and other pubIic

source. More than one source of

payment could be identified for each

technology or feature.

Percent distributions of persons

with assistive technology devices or

home accessibility features by the

sources of payment, according to age,

are shown in table 5. About

8 percent of these persons indicated

“no payment” or “gift” when asked

the source of payment for assistive

devices; for about one-third of people

with accessibility features in the

home, no one paid for those features.

Neither of these groups is included in

the percent distribution in table 5.

The “out-of-pocket” category includes

persons who gave only “self or

family” as the source of payment.

The “third party” category includes

persons who named only other

sources of payment, including some

not on the printed list, and unknown

sources of payment. The

“combination” category includes

persons who named both “self or

family” and other sources of payment.

Nearly half (48 percent) the

people with assistive technology

devices said they or their families

paid for them with no assistance from

third parties. More than three-fourths

of persons with home accessibility

features said they were paid for

entirely by themselves or by their

family. Third-party sources made

complete or partial payment for more

than haIf of users’ assistive technology

devices (52 percent), and for about

one-fourth of users’ home adaptation

(23 percent). The percent of assistive

technology devices paid for solely

out-of-pocket increased with age, but

the percent of home accessibility

features paid for solely out-of-pocket

did not change with age.

Unmet need

Near the end of the Assistive

Devices interview, respondents were

asked, “Does anyone in the family

NEED any special equipment that

they DONT HAVE?” If so, they

were asked who that family member

was, what equipment they needed,

and why they did not have it. Persons

identified by respondents in answers

to these questions are considered to

have an unmet need for assistive

technology devices. (Home

accessibility features were not

included in these questions.) It

should be noted that “unmet need”

and the “met need” it implies are

defined in terms of the perceptions of

a household respondent. A health

professional might reach a different

conclusion in individual cases.

The percent distributions of

persons reported to have an unmet

need for assistive technoloW devices

by the reason that they do not have

it, according to age, are shown in

table 6. More than 2.5 miIIion

persons, or about 1 percent of the

population, have an unmet need for

assistive technology devices. About

1.2 million persons of working age

(25-64 years) have an unmet need for

assistive technology devices.

Overall and in every age group

shown, the reason most often given

for not having a needed assistive

technology device is financial –people

could not afford to buy it. Overall,

three-fifths said they cou~d not aiford

the needed assistive technology

devices, with the figure being highest

(70 percent) in the population aged

25-44 years.

Poverty and assistive

technology devices

People whose ~amily incomes are

below the pover~ line are somewhat

more likely to use assistive technology

devices than those whose incomes are

above the poverty line (5.6 percent

and 5.0 percent, respectively). More

than half of poor people with assistive

technology devices had the help of a

third-party payer in obtaining devices,

compared to about one-third of

nonpoor users. Poor people were

about twice as likely as nonpoor

people to say they needed a device

they did not have (1.9 percent and

1,0 percent, respectively).

Trends in prevalence of

assistive technology devices

The 1980 National Health

Interview Survey collected data on

some assistive technology devices in a
Advance Data No. 217 ● September 16, 1992 5

manner comparable with that used in

1990. For those technologies, the

prevalence in 1990 and 1980 and the

percent change over the decade are

shown in table 7. Also shown are the

age-adjusted estimates of prevalence

for 1990, using the 1980 population as

the standard, and the percent

differences between those estimates

and the 1980 estimates. The

age-adjusted 1990 estimates can be

considered the numbers expected if

the age composition of the population

had not changed between 1980 and

1990.

The total population increased by

about 13 percent between 1980 and

1990, but use of the selected assistive

technology devices increased more

rapidly. Use of anatomical braces

more than doubled, and use of

walkers and wheelchairs nearly

doubled. The numbers of users of

canes and artificial limbs also

increased more rapidly than the

general population. Only the use of

crutches, many of which, as previously

noted, are used only temporarily

during recove~ from injuries,

increased at about the same rate as

the population.

Because the population aged

between 1980 and 1990, and because

older people are more likely than

younger people to use assistive

technolo~ devices, some of the

i~crease in the prevalence of devices

can be attributed to the aging of the

population. However, comparing the

1980 prevalence estimates with the

1990 age-adjusted estimates controIs

statistically for the aging of the

population and reveals the change in

prevalence net of aging. The last

coIumn of table 7 shows the percent

difference between the 1980 estimates

and the 1990 age-adjusted estimates.

For each type of device, the

age-adjusted percent difference is less

than the unadjusted percent

difference, indicating that the aging of

the population did indeed account for

a significant part of the overalI

increase in use of devices. However,

with the exception of artificial limbs

and crutches, the age-adjusted

differences are greater than the

13 percent growth in population,

indicating that, even alIowing for the

aging of the population, use of

assistive technolo~ devices grew

more rapidly than the population

during the decade.

Discussion

The data presented here show

that finances are a barrier to

acquiring asistive technology. For

noninstitutionalized persons, assistive

technology devices and accessibility

features in homes are often paid for

by individuals and families

out-of-pocket rather than with

contributions from other parties.

Reliance on payment by individuals

and their families reduces access to

assistive technology for persons in

poverty. Although the rate of peopIe

using assistive technology devices is

slightly higher among persons in

poverty than among those not in

poverty, poor people express more

need for these devices. Persons in

poverty are twice as Iikely as persons

not in poverty to have an unmet need

for assistive technology devices mairdy

because they cannot afford to buy

them. Medicaid, Medicare, Veterans’

Administration, and other public

programs help people in pover~ and

those over 65 to acquire assistive

technology devices, but a third or

more are purchased by poor

individuals and their famiIies without

contributions from other parties.

These programs seldom pay for

accessibility features in homes, which

are most often paid for by individuals

and families. The survey did not ask

about unmet needs for home

accessibility features.

Despite financiaI problems in

acquiring assistive technology devices,

use of devices has increased

dramatically over the past decade.

The number of users of wheelchairs

and waIkers almost doubled from

1980 to 1990, and the number of

users of Ieg, foot, and other bl aces

has more than doubled. These

increases may be due to improved

coverage by public programs, reduced

costs of technology, and improved

design, which has made devices

Iighter, safer, stronger, easier to use,

and more attractive. The aging of the

population has contributed to the

increased number of mobility devices,

but orthoses tend to be used more by

the younger population.

Nevertheless, considerable unmet

demand for assistive technology

remains: Some 2.5 million persons in

1990 stated they needed technology

devices they did not have. Some of

them need an enhanced version of a

device they already have, and others

need a device they do not have at all.

The main reason given for this unmet

need is inabiIity to pay for it out-ofpocket and it is not covered by health

insurance or programs in which they

are enroIIed.

References

1.

2.

3.

4.

West J, ed. The Americans with Disabilities Act: from policy to practice.

New York \lilbank Memorial Fund.

1991.

Dewitt JC. The role of technology in

removing barriers. ln: West J, ed. The

Americans with Disabilities Act: from

policy to practice. New York Milbank

Memorial Fund. 1991.

World Health Organization. The

international classification of

impairments, disabilities, and

handicaps. Geneva: World Health

Organization. 1980.

Adams PF, Benson V. Current

estimates from the National Health

Intefiew Survey. National Center for

HeaIth Statistics. Vital Health

Statistics 10(181). 1991.
6 Advance Data No. 217 ● September 16, 1992

Table 1. Number of persons using assistive technology devices or living in homes with accesaibillty featurea, by type of device or lfeature

and age of person: United States, 1990

Assistive technology dewce and All 24 years 25-44 46-64 65-74 75 years

home accessibi/iiy feafure ages and under yeara years yeara and over

Ae.sbsbve technology oawca Number in thousands

Any assistiie technology device . . . . . . . . . .

Anatomical technology devices:

Any anatomical technology device . , . . . . .

Leg brace . . . . . . . . . . . . . . . . . . . . . . . . . . .

Foot race . . . . . . . . . . . . . . . . . . . . . . . . . .

Arm brace, . . . . . . . . . . . . . . . . . . . . . . . . .

Hand brace . . . . . . . . . . . . . . . . . . . . . . . . . .

Neck brace . . . . . . . . . . . . . . . . . . . . . . . . . .

Backbrace . . . . . . . . . . . . . . . . . . . . . . . . .

Other brace . . . . . . . . . . . . . . . . . . . . . . . . .

Artificial legorfoot . . . . . . . . . . . . . . . . . . . . . .

Artiicial armorhand . . . . . . . . . . . . . . . . . . . .

Mobilii technology dewces:

Anymobilitechnology device. . . . . . . . . . . . . .

Crutch . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Caneorwalkingatick . . . . . . . . . . . . . . . . . . . .

Walker . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wheelchair . . . . . . . . . . . . . . . . . . . . . . . . . .

Scooter . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Othermobilitytechnology . . . . . . . . . . . . . . . . .

Hearing technology devices:

Anyhearing technology device . . . . . . . . . . . . . . .

Hearingaid . . . . . . . . . . . . . . . . . . . . . . . . . .

TDDITIY . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Specialalarm . . . . . . . . . . . . . . . . . . . . . . . . .

Otherhearingtechnology . . . . . . . . . . . . . . . . .

Vision technology devices:

Anyvisiontechnology device . . . . . . . . . . . . . . .

White cane . . . . . . . . . . . . . . . . . . . . . . . . . .

Othervisiontechnology . . . . . . . . . . . . . . . . . .

Speech technology devices:

Anyspeechtechnologydavice. . . . . . . . . . . . . . .

Other types of technology devices

Anyothertype oftechnolcgydevice. . . . . . . . . . . .

Adapted typewfterorcomputer . . . . . . . . . . . . .

Adapted automotsile. . . . . . . . . . . . . . . . . . . . .

Othertechnologydwice . . . . . . . . . . . . . . . . . .

Homeaccessibilii feature

Anytype ofhomeaccessibiliifaature . . . . . . . . . . . .

Ramps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Extra-widedoors . . . . . . . . . . . . . . . . . . . . . . . .

Elevatororsteklii . . . . . . . . . . . . . . . . . . . . . . .

Handrails . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Raisedtoilet . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adapteddoorlocks . . . . . . . . . . . . . . . . . . . . . .

Lowered muntere . . . . . . . . . . . . . . . . . . . . . . .

Slip-resistantfloors . . . . . . . . . . . . . . . . . . . . . . .

(ltherhomeaccessibiiiifeature . . . . . . . . . . . . . .

13,128 1,048 2,228 3,022 2,756 4,073

277

61

●12

●13

‘4

*I6

9a

46

●3,6

● ,2

2,73!5

84

2,01T7

957

4715

●1‘1

85

1,618

1,562

*48

●23

205

1111

●3:!

8:!

*I1

26S1

●4I

●11

257

1,667

267

263

173

I ,oa6

505

146

62

’27

330

3,732

862

186

210

208

299

1,173

849

164

“34

646

206

71

●26

●28

“27

68

241

*8

●12

1,367

266

44

a7

93

718

420

369

’28

●4

1,052

208

● 30

82

63

109

388

97

●29

●2O

“22

●27

460

146

84

●a

128

46

47

●7

6,403

671

4,400

1.667

1,411

84

254

240

“:

●34

139

●6

●I8

609

173

319

72

166

●1I

● 28

1,385

210

1,011

276

304

●la

66

1,435

137

1,032

350

324

●18

57

3,9a7

3,7a2

173

152

14a

’22

“7

“24

257

228

●23

●I7

56

61a

743

56

●24

136

1,142

1,102

●24

●5

142

261

109

177

●12

●2

‘1 o

67

43

●34

●39

“17

●24

*32

‘14

●26

%s4 ●2 ●4 ●✘

1,3-3

48

156

●12

*19

140

277

“24

71

196

333

●8

2e6

“o

2:;

211

1,138

60

289

1,395

578

397

66

425

1,272

457

333

*28

420

133

“29

47

3::

1,464

466

410

6%

285

90

59

G

1,264

321

249

97

7.102

2,109

1,651

409

3,396

1,324

410

x

86

“22

*25

293

125

57

52

● 40

313

242

212

1,595

NOTES Numbers do not add to totals because =tegones are not mutualiy exclusnw that is, a WIgle person in the tOtal may be munted in more thsn one type of device Sategwy. A ~/~ iS a

typawker-llke device for the dear that commurucales over telephone Ihws using test
Advance Data No. 217 ● September 16, 1992 7

Table 2. Percent distribution of persons using assistive technology devices or living in homes with accessibility features by age of person,

according to type of device or feature United States, 1990

Assistive technology dew”ce or All 24 yeara 2544 45-64 65-74 75 years

home accessibility feature ages and under yeara years years and over

Aasistive technology device

Any assisthre technology device . . . . . . . . . . . . . . . . .

Anatomical technology device=

Anyanatomical technology device . . . . . . . . . . . . . . .

Leg brace . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Footrace . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arm brace . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hand brace . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neckbrace . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Back brace . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherbrace . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Artificiallegorfoot . . . . . . . . . . . . . . . . . . . . . . . .

A~cialarm orhand . . . . . . . . . . . . . . . . . . . . . . .

Mobilii technology devices:

Anymobiliitechnologydevice . . . . . . . . . . . . . . . . .

Crutch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Caneorwalking stick . . . . . . . . . . . . . . . . . . . . . .

Walker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wheelchair . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sumter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

othermobiiiitechnolog y..... . . . . . . . . . . . . . .

Hearing technology devices

Anyhearfngtechnology device. . . . . . . . . . . . . . . . . .

Heanngaid . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TOD/llY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Specialalarm . . . . . . . . . . . .. . . . . . . . . . . . . . . .

Otherheeringtechnology . . . . . . . . . . . . . . . . . . . .

Vision technology dauices:

Anyvisiontachnologydw.ce.. . . . . . . . . . . . . . . . . .

Whiiecene . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Othervisiontachnology . . . . . . . . . . . . . . . . . . . . .

Speech technology devices:

Anyspeechtechnologydavice... . . . . . . . . . . . . . . .

Other types of technologydevice=

Anyothertypeoftechnologydevice . . . . . . . . . . . . . .

Adaptadtypawriterorcmmputer.. . . . . . . . . . . . . . .

Adaptedautomobile . . . . . . . . . . . . . . . . . . . . . . .

Othertachnololgydevice . . . . . . . . . . . . . . . . . . . .

HomeamassibiMy feature

Any~eofhomeacceesibilRyfsature . . . . . . . . . . . . . .

Ramps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Extra-widedoore . . . . . . . . . . . . . . . . . . . . . . . . . .

Elevatororstairlii . . . . . . . . . . . . . . . . . . . . . . . . .

Handrails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Raisedtoilet . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adapteddoorlocks . . . . . . . . . . . . . . . . . . . . . . . . .

Loweredmuntere . . . . . . . . . . . . . . . . . . . . . . . . . .

Slip-resistantfloors . . . . . . . . . . . . . . . . . . . . . . . . .

Other homeaccessibilityfeature.. . . . . . . . . . . . . . . .

100.0

100.0

100.0

100.0

100.0

too.o

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

lm.o

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Iwo

100.0

100.0

100.0

100.0

100.0

too.o

100.0

100.0

1CK3.O

100.0

100.0

too.o

100.0

100.0

100.0

8.0

17.3

24.2

38.4

13.4

t3.4

9.0

5.8

28.4

“4.3

‘35.3

lE

u

9.9

●9.4

●7.1

3.8

1:;

●9.2

4.3

●4.6

●1.8

●5.6

●23.5

11.7

“25.0

1::

19.6

27.4

24.0

16.0

12.5

9.5

13.9

21.4

18.9

19.6

Percent distribution

17.0

36.6

33.4

23.6

41.4

44.6

39.6

35.8

43.5

15.2

911.8

2:;

7.2

4.3

11.9

●t 7.3

11.0

E

13.3

22.3

10.0

25.8

39.9

19.2

●5.9

20.8

50.0

33.6

17.2

17.9

21.7

20.2

6.9

12.4

10.1

1::

19.4

19.6

23.0

28.2

24.2

16.t

29.4

30.0

36.5

39.2

17.1

34.6

*23.5

21.6

31.3

23.0

16.3

21.5

28.3

26.0

20.5

19.6

32.1

31.5

24.2

15.0

15.6

13.5

*11.8

25.0

“16.7

2S.3

25.4

20.9

23.1

24.8

11.0

20.2

21.5

22.0

24.4

37.2

21.7

21.0

10.4

11.2

15.6

1::

9.0

10.9

22:

“20.6

22.4

20.4

23.5

20.7

22.9

28.3

22.3

28.6

29.1

13.6

●6.6

25.2

12.3

●12.9

74.7

●23.5

22.2

●0.O

24.3

22.6

18.1

15.2

15.1

23.8

22.9

20.8

21.0

9.1

11.6

18.4

31.0

7.4

7.0

●6.5

●6.2

●1.9

●6.O

H

20.6

*5.9

42.7

9.6

45.6

56.7

33.8

●17.3

33.5

40.6

41.3

27.5

30.2

36.4

42.4

29.4

46.3

●32.4

20.2

●6.3

●5.2

22.6

23.5

12.6

15.9

42.2

32.0

38.1

36.1

25.7

12.7

20.7
Advance Data No. 217 ● Se~tember 16, 1992

Table 3. Percent of persons using assistive technology devices, by type of technology device and age of person, and percent of persons

living in homes with accessibility features, by type of accessibility feature, according to age: United States, 1990

Aeststwe technology device and A/l 24 yeare 25-$4 45-64 65-74 75 yeara

home accessLi/dy feature ages and under years years yeara and over

A?sistiie technology device

Anatomical technology dwices:

Any anatomical technology device . . . . . . . . . .

Leg brace . . . . . . . . . . . . . . . . . . . . . . . . . . .

Footrace . . . . . . . . . . . . . . . . . . . . . . . . . .

Arm brace . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hand brace . . . . . . . . . . . . . . . . . . . . . . . . . .

Neck brace, . . . . . . . . . . . . . . . . . . . . . . . .

Back brace . . . . . . . . . . . . . . . . . . . . . . . . .

~nerbrace . . . . . . . . . . . . . . . . . . . . . . . . . .

Arlf]cia llegorfoot . . . . . . . . . . . . . . . . . . . .

Arhfjciala rmorhand . . . . . . . . . . . . . . . . . . . .

Mobih!y technology devices:

Anymobiliitechnology device. . . . . . . . . . . .

Cw?ch . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Caneorwalking stick . . . . . . . . . . . . . . . . . . . .

Waker, . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wheelchair . . . . . . . . . . . . . . . . . . . . . . . . . .

Scooter . . . . . . . . . . . . . . . . . . . . . . . . . . . .

O,hermobiliitechnology . . . . . . . . . . . . . . . . .

Hearing technology devices:

Anyhearing technology device . . . . . . . . . .

Hearing aid . . . . . . . . . . . . . . . . . . . . . . . . . .

TDUlll’..... . . . . . . . . . . . . . . . . . . . . . . .

Specialalarrn. . . . . . . . . . . . . . . . . . . . . . . .

Otherhearmgtechnology . . . . . . . . . . . . . . . . .

Vision technology devices:

Anyvwion technology device . . . . . . . . . . . .

Whfte cane . . . . . . . . . . . . . . . . . . . . . . . . . .

Otnervisiontechnology . . . . . . . . . . . . . . . . . .

Speech technology devices:

Anyspeech technology device . . . . . . . . . .

Other types of technology devices:

Anyother type oftechnology device. . . . . . . . . .

Adapted typewriteror computer . . . . . . . . . . . .

Adaptedautomobile . . . . . . . . . . . . . . . . . . . . .

Othertechnololgy device. . . . . . . . . . . . . . . .

Home accessibihty feature

Ramps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Extra-wide doore . . . . . . . . . . . . . . . . . . . . . . . . .

Elevatororstairhft. . . . . . . . . . . . . . . . . . . . . . . .

Hand rails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Raisedtoilet : . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adapted doorlocks . . . . . . . . . . . . . . . . . . . . . . . .

Lowered counters . . . . . . . . . . . . . . . . . . . . . . . . .

Slip-reslstantfloors. . . . . . . . . . . . . . . . . . . . . . . .

Other homeaccessibilityfeature. . . . . . . . . . . . . . . .

Percent

28.4

6.6

1.4

1.8

1.8

2.3

8.9

6.5

61.7

19.9

6.8

61.4

12.9

2.0

3.9

4.2

5.3

18.8

16.6

34.8

6.9

U

2.1

3.6

15.2

14.1

3.5

6.8

●:::

*0.3

●o)l

●0.4

1.1

0.7

0.6

1.0

2.7

2.7

2.6

6.5

23.0

4.6

1.7

1.7

●0.3

2.4

4.e

2.1

●0.3

i:

“0.0

1.4

0.3

“0.8

1.1

46.6

5.1

22.9

6.3

3.0

3.2

13.3

“0.6

●1.7

27.3

7.6

45.8

6.9

33,5

9.1

10.0

‘0.6

2.2

52.1

3?4

67.2

1.6

49.3

23.5

11.7

“0.3

2.1

33.5

12.9

10.s

0.5

1.9

14.3

3.2 12.7

11.8

“0.7

2.1

7.6

90.5

1.3

39.7

36.3

1.2

::

30.4

26.0

1.3

0.6

4.3

14.5

14.1

11.5

10.2

27.1

24.6

::

4.5

41.4

40.0

‘;:

5.1

1.0

●o.e

2.5

1.2

“0.5

0.9

2.0

0.8

1.3

●1.1

‘0.2

‘1,0

3.0

1.9

1.5

1.3

*0.6

0.8

0.3 “0.8 ●0.1 ‘0.1 ●0.3 ●0.3

10.1

0.4

1.6

8.7

14.9

*1.1

●1.6

13.4

12.4

1.1

11.0

●0.3

2.0

9.5

10.7

*0.O

1.9

9.3

6.6

●0.1

●o.13

6.3

3.2

8.8

32.6

27.6

3.0

46.2

19.2

6.1

25.0

19.4

6;;

21.5

6.7

16.0

15.8

10,4

65.2

30.3

H

1.6

19.6

29.7

23.2

41.4

26.5

4.7

30.5

9.0

4.1

36.0

26.2

2.2

33.0

10.5

2.3

5.6

47.8

16.6

5.8

3.4 3.7

2;::

3.7

3.2

24.6

4.0

2X

3.0

22.5

NOTE: A lTOfllY IS a typewriter-likedevice for the deaf that communcetes over telephone has using W3.

Table 4. Percent of persons who use assistive technology devices or live in homes with accessibility features, by age of person and by

technology oraccessibility feature: United States, 1990

Assktive technobgy dewce or All 24 yeara 25--44 45-64 6S74 75 years

honreaccessiWtv feature ages and under yeara yeara yeara and over

Percent of total population

Anyassisttietechnology dewce . . . . . . . . . . . 5.3 ●1.2 2.8 6.5 15.2 ~.$)

Anyanatomical technologydewce . . . . . . . . . . . . . . 1.5 ●O.? 1.7 2.1 2.4,

Any mobility technologydewce . . . . . . . . . . 2.6 “0.3 ●0.8 HI 7.9 23.4

Anyheanng technologydevice. . . . . . . . . . . . . . . . 1.6 “0.2 ●0.3 I .e 6.3 13.el

Anyvision technology device... . . . . . . . . . . . . . . . ●0.1 “,0.0 ●O.1 *0.1 ●0.2 0.s1

Anyspeech technology device. . . . . . . . . . . . . “0.0 ●0.0 *0.O ●0.O ‘0.0 ●0.1

Anyother fypeoftechnology device . . . . . . . . . . . . . 0.5 ●0.2 ●0.3 0.7 1.6 2.3

Anytype ofhomeaccessibiktyfeature . . . . . . . . . . . . 2.9 ●1,6 1.6 3.2 7.1 14.3
Advance Data No. 217 ● September 16, 1992 9

Table 5. Number of persons with assistive technology devices or home accessibility features and percent distribution by source of payment,

according to age of person: United States, 1990

All 24 yeare 25-M 4.S64 65-74 75 yeara

Source of payment ages and under yeare years years and over

Aasiafive technology devices Number in thousands

Persons with assistiie technology device . . . . . . . . . . 13,128 1,048 2,228 3,022 2,756 4,073

Percent distribution

Allsources of payment’, . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0

Out-of-pocket . . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

4&2 34.0 37.5

Third par@ . . . . . . . . . . . . . . . . . . . . . . . . . . .

45.5 52.5

34.0

56.0

45.0 49.2 37.1 28.7

Combination ofout-of-pocket andthirdparly. . . . . . .

24.6

17.9 21.0 13.3 17.4 16.7 19.2

Home accessibitify features Number in thousands

Persons with home accessibility features . . . . . . . . . 7,102 1,395 1,272 1,484 1,284 1,667

Percent distribution

Allsources of payment’ . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0

Out-of-poc et . . . . . . . . . . . . . . . . . . . . . . . . . .

$

77.5

100.0

76.1 77.9 74.6 81.6 78.1

Third pa 15.2 17.9

Combination ofo;t;f-p;;ke; andt;rd pa&:::::: :

15.4 16.1 11.7

7.3

15.0

6.0 6.7 9.3 6.6 6.9

‘ Sxcludes persons whose device or feature was not paid for.

‘Includes persons who did not know lhe source of payment.

NOTE Sums rnsynot equal totals dueto rounding.

Table 6. Number of persons who need asslstive technology devices they do not have and percent distribution by reason for not having

them, according to age of person: United States, 1990

Reason for not having All 24 years 2544 45-64 6+74 75 years

assisfive technology devices ages and under yeara years yeara and over

Number in thousands

Pereons with unmmet need for assistive

technology devices’ . . . . . . . . . . . . . . . . . . . . . . . 2,506 178 448 760 567 556

Percent distribution

All reasons’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0

Cannot sfford . . . . . . . . . . . . . . . . . . . . . . . . . . 61.1

100.0

59.7 69.6

Another reeaons’ . . . . . . . . . . . . . . . . . . . . . .

61.6

38.9

51.6

40.3 30.4 M 38.4 48.4

‘Includes persons for wham the reason IS unknown.

Table 7. Number of persons in the population, number of persons using selected assistive technology devices and percent change from

1980 to 1990, and age-adjusted number using assistive technology devices and percent difference between 1980 and 1990: United States,

1980 and 1990

Ditiererrce

between

1980 and

Change from age-adjusted

A.w.sfive technology device 1980 1990 1980 tO )990 1990 1990

Age-adjusted

Number in number in

thousands Percent thousands’ Percent

All persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217,923 24S,099 12.9 248,099 12.9

Legorfoot brace . . . . . . . . . . . . . . . . . . . . . . . . . 472 1,048 121.9 924

Brace other than leg or foot . . . . . . . . . . . . . . . . . 1.000

95.6

2,740 174.1 2,436

Arfirlciel timb. . . . . . . . . . . . . . . . . . . . . . . . . . . 218

143.6

23.2 189

Crutch. . . . . . . . . . . . . . . . . . . . . . . . . . . ...”. K

6.6

671 14.2 590

Caneorwslking stick . . . . . . . . . . . . . . . . . . . . . 2,876

0.3

4,400 52.9 3,626

Walker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 666

26.0

1,667 94.6 1,363

Wheelchair . . . . . . . . . . . . . . . . . . . . .. . . . . . . . 720

57.4

1.411 96.1 1,185 64.6

‘Age-adjusted by the direct method. using the 1980 FopulafIcfr es standard, and age groups under 45 years, 4S54 years, 65-74 years. and 75 years and over,
10 Advance Data No. 217 ● September 16, 1992

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
Advance Data No. 217 ● September 16, 1992 11

Technical notes

The statistics in this report are

based on information collected by the

National Health Interview Survey, a

data system of the National Center

for Health Statistics (NCHS). The

information was collected by personal

interview in the homes of a nationally

representative sample of nonmilitary

persons living in households.

The interviewers were recruited,

trained, and supervised by the Bureau

of the Census under terms of an

interagency agreement with NCHS.

The interview data were keyed and

edited by NCHS.

In the 1990 NHIS3 intewiews

were conducted in 46,476 households,

or 95 percent of the eligible

households. Nearly 120,000 persons

lived in the households in which

interviews were conducted. Of these

persons, 6,310 were reported to use

assistive technology devices, and 3,239

were reported to have home

accessibility features. The sample

cases were weighted to make the

estimates of national statistics shown

in this report. The weight for each

case adjusted for several factors,

including the nonresponse of some

eligible households.

AIthough extensive quality

control measures are used at each

stage of the NHIS, both sampling and

nonsampling errors are present in the

estimates. Sampling errors arise

because the information comes from

a sample of the population, not from

the whole poptdation. Estimates

based on a sample often differ from

statistics based on a complete

enumeration. That difference, the

“sampling error,” can be measured by

a statistic called the “standard error.”

Standard errors were estimated using

the following forrrnda:

SE(x)

‘v

where x is the estimated percent, y is

the base (denominator) of the

percent and SE(x) is the standard

error of the percent. This fonm.da

was derived by estimating the

standard errors of a set of selected

statistics using Taylor Linearization

(a precise technique), then

mathematically fitting a curve to the

relationship between the estimates

and their standard errors. The

formula described the curve.

Estimates of statistics that have a

standard error that is 30 percent or

more of the estimate itself are

considered unreliable and are marked

with an asterisk.

Sampling error also affects

comparisons of estimates: If estimates

have large sampling errors, a

difference between them may have

arisen by chance. Statements about

differences among estimates have

been tested (using a two-tailed t-test)

and found to have been unlikely to

have occurred by chance (probability

less than 0.05).

Nonsampling errors can arise

from a variety of sources, and are

dillicult to measure. In most surveys,

the most serious source of

nonsampling error is inaccurate

information given by the respondent,

who may misunderstand the question,

not remember the correct answer, or

willfully give a false answer. Other

sources of nonresponse error are

mistakes in asking questions or

recording answers, and mistakes in

coding and keying interview data.

For more information on

sampling design, field procedures,

data processing, estimation

procedures, and variance estimation,

see Current Estimates j%mz the

National Health Interview Survey, 1990,

which also includes reproductions of

the Assistive Devices questionnaire

and other questionnaires used in

1990 (4).
12 Advance Data No. 217 ● September 16, 1992

Suggested citation Copyright information National Center for Health Statistics

LaPlante MP, Hendershot GE, Moss AJ. This report may be reprinted without further Director

Assistive technology devices and home permission. Manning Feinleib, M. D., Dr. P.t-1,

accessibility features: prevalence, payment,

need, and trends. Advance data from vital and

Acting Deputy Director

health statistics; no 217. Hyattsville, Maryland: Jack R. Anderson

National Center for Health Statistics. 1992.
Number 218 ● September 16, 1992

Advance

Data

From Vital and Health Statistics of the CENTERS FOR DISEASE CONTROUNational Center for Health Statistics

Serious Mental Illness and Disability in the Adult Household

Population: United States, 1989

by Peggy R. Barker, M.P.H., Divisionof Health Interview Statistics,Ronald W. Manderscheid, Ph.D., National

Institute of Mental Health, Gerry E. Hendershot, Ph.D., Susan S, Jack, M.S., Charlotte A. Schoenborn, M.P.H.,

Divisionof Health Interview Statistics,and Ingrid Goldstrom, M.SC., National Instituteof Mental Health

Introduction

Significance of the problem

Estimates of the prevalence of

serious mental iI1ness (SMI) and

information on persons with SMI in

the United States are critical to the

development of policy for this

population in a broad range of areas,

such as planning and development of

necessary mental health, health, and

social services, inclnding housing

development of disability poIicy (for

example, Supplemental Security

Income and/or Social Security

Disability Insurance eligibility); and

training, recruitment, and placement

of psychiatric and other mental heakh

staff. However, such data have not

been readily available because of the

difficulty of defining the population,

the lack of relevant operational

measures, and the lack of appropriate

survey mechanisms outside of

treatment settings. This report is

designed to address this deficit for

the civilian noninstitutionalized

population of the United States.

DeinstitutionaIization of mentally

ill persons and demographic trends in

the United States, that is, the aging

into adulthood of “baby boomers”

and the overall graying of America,

have resulted in an increase in the

absolute number of SMI persons

generally and in those living in the

community. Currently, the National

Institute of MentaI Health (NIMH)

estimates that there are between 4

and 5 million SMI persons in the

adult population of the United States,

including both institutional and

community residential settings (1).

Thus, some sense of urgency exists to

improve knowledge about this large,

disabIed population.

Definition of the population

Historically, the definition of SMI

was based principally upon psychiatric

diagnosis. Over the years this

definition has evolved to a more

refined notion, including psychiatric

disabilities. It has become increasingly

recognized that the SMI population is

a heterogeneous group with different

diagnoses, levels of disability, and

duration of disability, and therefore,

different service needs (2). At

present, a more precise definition is

being developed by NIMH to

encompass this diversity.

Because of the complexity of the

interface among psychiatric diagnosis,

type and level of disability, and

duration of the disability, SMI has

been defined for the present survey as

any psychiatric disorder present

during the past year that seriously

interfered with one or more aspects

of a person’s daily life. In this

context, specific measures of disability

and their duration represent variable

characteristics of persons in the

population rather than defining

criteria. This approach represents a

more flexible application of the

diagnosis, disability, and duration

criteria employed in the past (3-5).

Previous estimates

The most recent survey prior to

the present, the 1978 SociaI Securi~

Administration Survey of Disabili~

and Work, estimated that 1.1 milIion

persons in households were “seriously

disabled mentally ill” (6). The

definition of the popr,dation was

based on persons 20-64 years of age

who were limited in the kind or

amount of work or housework they

could do and who had been disabIed

or were expected to be so for a

SWCQ.*

●#“+ +

$

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

$* Public Health Service

a Centers for DiseaseControl ?3%

%,a>

NationalCenterfor Health Statistics CK

CENTERS FOR DIsEASE CONTROL
2 Advance Data No. 218 ● September 16, 1992

period of at least 12 months, mainly

because of mental illness or nervous

or emotional problems.

The estimate of 1.1 million

persons was known to be an

undercount of the population in the

community because data were not

collected on functional limitations

beyond the work domain, or on

limitations of a shorter duration than

1 year, that is, people with recent or

episodic disabilities. Elderly persons,

the fastest growing segment of the

population in the United States were

not included and no data were

collected on the use of mental health

seivices or participation in programs

by persons with psychiatric

disabilities.

Present survey

In 1989, NIMH collaborated with

the National Center for Health

Statistics (NCHS) on a special

supplement to the National HeaIth

Interview Survey (NHIS). The

purpose was to update previous

estimates using a more flexible

operational definition of the number

of SMI Fersons in the household

population of the United States, and

to examine the use of mental health

semices and disability program

participation of this population.

Highlights

Based on respondent-reported

information collected in the NHIS, in

1989 there were approximately 3.3

million aduIts 18 years of age or older

in the civilian noninstitutionalized

population of the United States who

had a serious mental illness in the

past 12 months, a rate of 18.2 adults

per 1,000 persons. Approximately 2.6

million, or 78.8 percent of these

adults, have one or more specific

limitations in work, school, personal

care, social functioning,

concentrating, or coping with

day-to-day stress attributed to SMI.

Approximately 1.4 million adults

between the ages of 18 and 69 were

currently unable to work (829,000) or

limited in work (529,000) because of

their SMI, and over 82 percent of

these adults have had this work

limitation for a year or longer.

Among the 390,000 adults 70

years of age and over with SMI,

about 85 percent had current

limitations in one or more of the

specific activities described above

because of SMI, and approximately

80 percent of these adults had been

limited by SMI for a year or longer.

About 703,000 adults with SMI in

the household population receive a

disability payment through a

Government program because of their

mental disorder. By race, 76 percent

of these adults are white persons and

22 percent are black persons. Almost

43 percent of black adults with SMI

receive a Government disability

payment compared with about

21 percent of white adults with SMI.

Data and methods

Design

The NHIS is a continuous

cross-sectional nationwide survey of

the resident household population of

the United States. Every year since

1957, basic demographic and health

information has been collected from a

nationally representative sample of

households in face-to-face interviews

conducted by staff of the U,S. Bureau

of the Census. Certain types of

noninstitutional group quarters, such

as small group homes and halfway

houses, are included and residents

intemiewed when these places fall

into the sampling frame. The term

“household” is used to denote all

residential places in the NHIS

sample. Information is collected on

each member of the family (or

famiiies) residing in the household, by

proxy if the person is not at home at

the time of the intemiew or is not

competent to self-respond. For the

NHIS-Mental Health, the same

respondent or respondents present

for the basic interview were asked

questions on mental health about all

family members.

Respondents

In 1989, information was

collected on about 113,000 persons

for the NHIS-Mental Health. This

represented a response rate of

97 percent of respondents for which

information was collected on the

basic questionnaire and about

92 percent of the total NHIS sample.

Nonresponse for the basic NHIS was

about 5 percent.

In the entire 1989 NHIS sample,

over 58 percent of all adults

responded for themselves, and about

68 percent of aduhs reported to have

SMI responded for themselves. As

might be expected, self-response was

lower among those persons most

seriously disabled by SMI. Of those

reported to be unable to carry out

one or more activities for a year or

longer, 52 percent responded for

themselves compared with 77 percent

of those for whom no specific current

limitations were reported.

Validity of the data

Clearly, the quaIity of these data

is dependent on the person with SMI

or a family member’s awareness of

and willingness to report both t~he

condition and the resulting disability.

Because there is still some stigma

attached to mental illness and

because this survey was not designed

to “diagnose” mental disorders, these

data are likely to underestimate the

true prevalence. In this survey, both

diagnosed and undiagnosed

conditions were reported; but among

those persons with a current

limitation due to the mental disorder,

about 95 percent reported that a

health professional had diagnosed the

disorder. Anong all persons reported

to have SMI, over 92 percent

reported that the disorder had been

diagnosed.

Methods

The three main concepts in the

NIMH definition of “serious mkntal

illness,” diagnosis, disability, and

duration of disability (3-5) were

operationalized in the survey in the

manner described below.

Information about a mental or

emotional disorder diagnosis was

determined using a checklist of

specific severe mental disorders and
Advance Data No. 218 ● September 16, 1992 3

... -.

PERSON 1

~-_4

Emu pwson numbw(d of respfmdmtisL

I

Pwc4t number(s) of raspondant(sl

-~ DmabOUtlnmaf 0ndmm0d0mldf8wdom.

18. DURING THE PAST 12 MONTHS, cNdUZVOIN in dm ftiffv --

If ‘OYcs.“’ask lb md C.

b. Whohthb?

Mark box in ●ppmpdate person’s cofumn.

C. DUnlNO THE ●AST 12 MONTHS, dkf anvmw d- fnm -

A. Sehfx~a (skit-suh.froa’-nc.-uhl? n Y.. n No

~

A. t a !lchizophronia

----- ---- —- ——— —. — --- —-----— -— ------- --- —---- --- --- -— ---— ------ --

B. ●umofd = ddtmkonal dkrd-, otfuc ihon v9dxophrmia? c1 Y*S ❑ No B. I •l P*r*noiddisordcr m

----- -- —- —- —- —- —- —- ——-—-—. . - — ------------------ --- -— ---- -. -—-— --—

C. Mmnia wlsodms w m=nfc dofmssion. ●lao ==U4 MPCJ=C dls-? n Yes (Spedfy) O No c. I ❑ Manic epimdos

L

19

7

I D Mmic depression

--——- ------- — ------ —--- ------- ------ -----—_ ---- —-. ------ -----— ——

D. M@or dafnwslon? b

D.

Rasd if ncccssmy: A dopmss.d mood ●nd km. of intwost In ●lmemt c1 Ycs ❑ No I n Major depression

d actfwftks FoR AT LEAST ?WO WEEKS.

--- —-— -—------- —- — —-------—-—-------—--—----—-- --

E. Anti-8oeIsl psrsatmfky, 0bWB8iW_CtMtltXIkiV~ PWWXIskkty.

- — --- —-—---- -—

or NW otfwr SEVERE PUDonallty dfsordor? c1 Yes O No E. k

! ❑ Parsondity disorder

--- —---- ----. .---—-— -—-—-—- ... -—--- ------------ -—- --- -------- --.”.

G.

F. Akfmhmr’, (dttZ’ h%wz} dfsoaw 0? -OW? tyP of 8dk dfmrd,t? O y-, u No F. t 0 .%mlity

----- -—-----------—- ----— ----- —-- ------- —-----

0. Akohof dzwsa dfundmr? o Y** D No G.

~

10 A!cOhOt ●buse

-—-—- ------------- -- —-—-- ------ -— --- ---- —---—.- —-- _—_— - .- —-—- —--

H. DIUS ●buso dlsordw? c1 Y*8 D N.Y

-

H. I O Orug sbuse

---—- --------------------- -..------ —--- --- —--- ------- --- . —---- .---— -— -- .-

1. Dou MVOM In tha famlfy NOW hmm mmtaf mwdatfon? a Ycs c1 No 1. tcl Mmt.lr.t.,da,J=

28. OURINfl THE PAST 12 MO flTffS. dfd 8CVW!S fn tfu family hms my

OIHEn monml or ●motkmmk dluwrWs? Incl- ONLY theso dlc~

whfch SERIOUSLY Intufwa wfth a PUWII’S 8fAfftP to work w ●tlmd

●ehoal, o? to mona@ thah dcy-to.dmy adfvftfm.

u Yos ❑ No Kflrck Itwn 1)

------------ ------- ----- ------ ----- ------- ------- --

b. Who 1, this? AnVW oW*? Mti bOX in

--------- -----

#ppmprhre parson’s Colun?n. 2b, ! o Othwr b

---------— --- —-— -—.—- -- —-_--—-—-—-----—-— -— ------

Ask /of ●SCh PCrYOJI wi?h “Oth8r’’//I 2b: ~

c. wh=twOuldyOtl aasthOdhOdOr -- fins?

c.

?❑ O* M nwfomtric

CHECK CK rnl A- For2b/c

ITEM 1

Retu to 1A -Fsnd 2WC.

1

(Cfwck Ifcm 2)

o a All othws {fIJFm

Section F9

Entu ~mrdar(s) fmm lA-Fmd 2c. 00 N0TRECORO G, H, OR L

CHECK CK

ITEM 2 2

(awckftml 3)

Iot,s

ma i2 --,. ,.-n.ln

Figure 1. Mentsl disorder checklist
4 Advance Data No. 218 ● September 16, 1992

an additional question about the

presence of “any other mental or

emotional disorder” that seriously

interfered with aperson’s ability to

work or attend school or to manage

their day-to-day activities. The

reference period for these questions

was during the past 12 months. The

mental disorder checklist appears in

figure 1.

Questions were subsequently

asked about if and when the reported

disorder was diagnosed by a health

professional, if and when a mental

health or other health professional

was last seen for the disorder, the

type of mental health professional

last seen, and the use of prescription

medication for the disorder.

Alcohol abuse disorder, drug

abuse disorder, and mental

retardation were asked on the

checklist but no followup questions

were asked about these conditions.

Persons reporting only one or

more of these disorders are excluded

from the data in this report because

they are not included in the NIMH

definition of “serious mental illness.”

These conditions were asked on the

checklist in order to avoid having

them reported as “other” mental or

emotional disorders, which wouId

have required coding before deleting

them from this analysis.

Among those with SMI, disability

was measured through a series of

questions about current limitations in

activities and functions and a series of

questions about the receipt of

Government disability payments. The

limitation questions asked whether

the person was entirely prevented

from working or limited in work, and,

for persons 18-24 years old and not

in the labor force, in attending school

or college; whether they appropriately

and adequately took care of personal

care needs (eating, dressing, bathing,

and going to the toilet) and specific

instrumental activities of daily living

(managing money, doing everyday

household chores, shopping, and

getting around outside the home);

and the degree of difficulty with

certain aspects of social and cognitive

functioning. The time reference for

the disability questions was “now,”

that is, the present time. Each of

these questions was phrased to refer

only to limitations due to the

reported mental disorder. Obviously,

to the extent that persons have

multiple health problems and cannot

parcel out disability resulting from

each, this was a difficult question to

answer. Similar questions have been

used previously by NIMH as part of

surveys of SMI in treatment settings

(7) as well as in household surveys

(8).

The duration of disability concept

was measured simply by asking how

long any identified limitation due to

the mental disorder had been

present.

The “Technical notes” section

that appears at the end of this report

contains more information on the

survey design, sampling procedure,

and NHIS questionnaire documents.

Methods for constructing approximate

standard errors and tests of

significance for estimates and

percents presented in this report also

appear in these notes. Unless

otherwise noted, the comparisons

made within the text are significant at

the .05 level.

“ This report presents estimates of

the 12-month prevalence,

demographic and socioeconomic

characteristics, current disability,

service utilization, and disability

program participation of the adult

SMI household population of the

United States. A facsimile of the

mental health questions is provided in

“Current Estimates From the

National Health Interview Survey,

1989” (9).

Results

Prevalence and demographic

characteristics

The 1989 12-month prevalence

estimate of SMI in the U.S. adult

household population is 18.2 per

1,000 persons. About 79 percent of

these persons had one or more

current limitations attributed to their

mental disorder but these estimates

varied greatly between subgroups of

the population (table 1). The rate of

SMI was generally higher in the

oldest age group than in any other.

More females than males were

reported to have SMI (20.6 compared

with 15.5 per 1,000 persons).

Neither the prevalence of SMI

nor the proportion of persons with

resulting current disability is

significantly different for black and

white persons. The prevalence rate

among “other” races is about

one-half that of black or white

persons.

Both the prevalence of SMI and

resulting disability are clearly related

to poverty status. SMI was over 2 1/2

times as likely among adults in

poverty than among those not in

poverty, and proportionally more

poor than nonpoor adults with SM1

had resulting disability.

Lower educational attainment is

strongly related to prevalence and

disability from SMI. Among adults

with less than 12 years of education,

the rate of SMI is almost twice that

among those with more than 12 years;

and the percent with disability among

the least educated group is

86.5 percent compared with

70.7 percent of thd highest educated

group.

Respondent-assessed health

status

Data on assessed health status

are acquired in the basic NHIS by

asking respondents to assess their

own health and that of family

members Iiving in the same

household as excellent, very goc~d,

good, fair, or poor. Respondentassessed health status has been shown

to be highly correlated with more

objective measures of health status

and to predict mortality (10, 11).

Table 1 shows a strong negative

correlation between reported health

status and prevalence rate of SMI,

and the same pattern holds for the

proportions of persons reporting

current limitations. Among adults

with “poor” health status, the rate of

SMI was 118.3 per 1,000 persons, or

more than six times the rate for the

totaI adult population; and almost
Advance Data No. 218 ● September 16, 1992 5

Table 1. Number and percent distribution of the adult household population, adults with serious mental [Ilness and rate per thousand,

adults currently Umlted by serious mental illness and percent limited, by selected characterlstlcs: United States, 1989

Adult household Adults curreniYy Jmited by

population .41 adults m“thserious merrtaf illness serious menkil illness

Number in Percent Number in Percent Rate per Number in

Charscteritik

Percent

thousands distribution thousands dMribti”on thousand Ihousands distribution Percent

Total’ . . . . . . . . . . . . . . . . . . .

Age’

16-24 yeara . . . . . . . . . . . . . . .

26-34 years . . . . . . . . . . . . . . .

35+4years . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . .

7C-74years . . . . . . . . . . . . . . .

75yaars Andover . . . . . . . . . . .

Sex’

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

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

Race’

White . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . .

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

Poverty Statusz

Below poverlythreshold . . . . . . .

Atorabove poverty threshold. . . .

Education*

Lessthan12years . . . . . . . . . .

12years . . . . . . . . . . . . . . . . .

Morethan 12years . . . . . . . . . .

Respondent-assessed

health status2

Excellent . . . . . . . . . . . . . . . . .

VeryGood . . . . . . . . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . .

Fair . . . . . . . . . . . . . . . . . . . .

Poor. . . . . . . . . . . . . . . . . . . .

Ioir.o

11.1

21.7

22.8

28.2

4.4

3.1

8.8

40.4

59.6

86.1

12.0

1.6

21.0

79.0

33.8

34.9

31.3

10.3

19.1

24.9

23.2

22.5

18.2 2,571 100.0

11.3

19.5

23.3

29.1

3.9

3.2

9.7

43.0

57.0

65.3

12.7

2.0

23.1

76.9

37.3

34.5

28.2

7.5

16.1

24.1

25.3

27.1

78.8

80.6

70.8

80.6

81.5

70.0

79.8

86.6

63.7

75.4

78.0

82.6

67.1

66.3

76.7

66.5

77.4

70.7

56.9

66.7

75.9

85.9

94.7

179,529 100.0 3,254

25,401

42,614

35,982

46,114

9,803

7,925

11,391

14.2 361

23.9 707

20.0 744

25.7 919

5.5 142

4.4 102

6.3 286

14.2

16.5

20.7

19.9

14.3

12.9

25.3

291

501

600

749

99

82

249

47.5 1,320

52.5 1,944

65,257

94,272

15.5

20.8

1,105

1.466

153,763

19,932

5.634

65.6 2,812

11.1 393

3.2 59

18.3

19.7

10.1

2,194

325

52

15,464

147,070

9.5 609

90.5 2.284

39.4

15.5

525

1,750

39,609

68,553

69,369

22.4 1,063

36.6 1,120

39.0 1,002

27.2

16.3

14.4

937

666

706

62,2i7

50,941

43,769

15,565

6,207

34.6 337

28.5 620

24.5 812

8.7 755

3.5 734

5.4

12.2

18.6

48.5

118.3

192

414

617

646

695

1,nclude~~amon~~,h ~nknm ~.sw status.edwsoon. and/orseti.assessedheahhsia~us.

2Percent~enomi”ator%~xc{uaepersons w!th th!S Chamcfemfk unknown.

95 percent of those adults havea

current limitation resulting from the

SMI.

Workand other limitations

hestimated~7.2 percent of

persons 18-69 years ofagewith SMI,

or l.4 million persons, were reported

to be unable towork (28.9 percent)

or limitedinwork (18.4 percent)

because oftheir mental disorder

(table 2). Byrace, more black

persons with SMI (43.4 percent) were

unable to work because of their

mental disorder than white persons

with SMI (26.8 percent).

Among SMI persons who are

unable to work, 94.1 percent

reported additional limitations, and

among those limited in work,

91.3 percent reported additional

limitations (table 3). Not surprisingly,

persons with SMI who are unable to

work or limited in work are more

likely to have one or more of the

other specific Imitations shown in

table 3 than their peers who do not

report work limitations. However,

more than one-half (58 percent) of

persons 18-69 years of age with SMI

who reported no current work

limitation, and about the same

proportion of those who reported not

working for other reasons or for

whom work limitation was unknown,

reported other limitations. For these

two groups of persons, “coping with

day-to-day stress” was the most

frequently reported limitation, (52.6

and 54.3 percent), although between

21 and 32 percent were reported to

have difficui~ making and keeping

friendships (“social functioning”) and

“concentrating long enough to

complete tasks.”

Reporting of each type of

limitation is higher for persons with

SMI who are unable to work than for

those who are limited in work, but

the differences in difficuhy “coping

with day-to-day stress” and

“concentrating long enough to

complete tasks” are not statistically

significant.

Considering the range of

limitations asked about in this survey,

persons with SMI who are unable to
6 Advance Data No. 218 ● September 16, 1992

Table 2. Number and percent distribution of adulta 18-69 years of age with serious mental Illness by current work Iimltatlon statu:$

according to race: United States, 1989

Worklimitation skttusr Total 2 White Black Total 2 Write Black

Number in thousands Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,874 2,471 345 100.0 100.0 100.0

Toral with work limitation due to serious mental illnese . . . . . . . . . . 1,356 1,116 215 47.2 45.2 52.1

Unable to work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 829 663 150 28.9 26.6 43.4

Limitad inwxk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528 454 65 18.4 16.4 18.7

Nocurrentwork limtition . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,032 934 79 35.9 37.8 23.0

Does network forother reaaons orworkllmtition *Ws unknown . . 4s5 420 51 16.9 17.0 14.6

l@wxim*W 1 P-(1 1,~) d ~* S* 10‘“u*o rO*“ w .“~MIwJ h - ware PWWS aged 1+24 ~0 We nti in UIO * fome and V& ware rawred as beii “unsbb” w %nired” b sdmor

!?’--” IrUrties ‘who? ram.

Table 3. Number of adutts 18-89 years of age with serious mentai illness by current work imitation status and percent reporting clther

imitations, and number and percent of adutta 70 years of age and over with serious mental iiiness reporting iimitationfx

United States, 1989

Personal cam Instrumental Coping with

SM12

Cwmwrtrating

Any other acttvifikx of activities of Sociaf day-t&day long enough to

Age and wvrk limitation Statusr population limitation &i/y Ilwng 3.4 daily livin~ funcfionin$ sfreaa comp~ete tasks

Numb-a-rin

thouaanda Parcent

Totaf18-68 yeare of age . . . . . . . . . . . . 2,874 74.6 2.7 22.9 46.3 67.7 416.5

Unable towork . . . . . . . . . . . . . . . . . 82S 94.1 7.7

Umtiadin Wk . . . . . . . . . . . . . . . .

46.6 70.4 66.5 72.9

52a 91.3 2.6 30.2 61.2 80.1 872

Nocurrentwork limitation . . . . . . . . . . 1,032 58.0 --- 4.6 26.6 52.6 2!1.4

Does not work for other raasone or work

fimifation etatue unknown . . . . . . . . . 485 58.7 --- 9.8 30.7 54.3 32.0

Total 70 years of age and over . . . . . . . . 390 84.8 24.3 62.3 59.6 70.8 69.8

'~m~@l~(ll.~ ~)d~me*~rn" ti@"w~ti#h tiWe~awl M4ti-tirnt itiWmMW-m~m M."~m''tifio~h _

~;==m _y ,L

31nchasmeating,dreasmg. Mhmg. md W@ to rho loi!+t

4oUesrhs almrwrscdc smlmnmbcxwwartnetsskedd - ls-64yeanef awwirhnewmk orsched WtelioN mulling fmm the sarbua mental ikwaa.

51ndudaa rnm@rw mmay, doii awtyday Iwuaahdd ~, shc@no, md g- WUJnd culside the bane.

%dwlaa fornurig @ k~ng himdshii.

Tabie 4. Number and percent distribution of adults with serious mentai iiiness by selected services, according to limitation status,, and

percent currently limited by serious mental iiineaa: United States, 1989

Total Currsnffy Ilrrdtad

Percent Percent

Selected servicaa Number disfrfbufion Number distribution Percent

Receipt of Government d-lity paymentt

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703 23.2 885 27.8 97.5

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,324 76.6 1,762 72.2 76.7

Use of prescription medication for the

mental dmrder in the past yea?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I ,a91 68.2 1,573 67.9 83.2

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S81 31 .s 744 32.1 84.5

last vfsif to a mental haatth professional

Lessthan one month . . . . . . . . . . . . . . . . . . . . . . . . . t ,035 33.e 885 35.e 86.6

Onemonth toleasthan oneyeer . . . . . . . . . . . . . . . . . . 836 27.2 663 26.4 79.3

Oneyear ormore . . . . . . . . . . . . . . . . . . . . . . . . . . . 509 16.5 436 17.4 65.7

Nave# . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 700 22.7 520 20.7 74.2

1Percanr denommalore esclude aduits with Ihw Clrarecteriattc unknewn.

‘Percent dtmonrinaiors include only adulta wtIo have war saan a doctor fof the dtsorder, and exduda adults with We charectarieLic unkmwm.

3-g ~ 7W,W ~d~ w reportedneveraaa~9 ~ m- ~~ p~ , 447,CO0, or 83.8 percent, did report seeing another doctor or health profsssiond for the mental disordar and S3.5

percent of lhese adults reporisd Gmhatioms.
Advance Data No. 218 ● September 16, 1992 7

work are the most likely to be

disabled in other activities by their

mental disorder, even more so than

persons with SMI who are 70 years of

age and over (94.1 percent compared

with 84.8 percent reporting other

limitations). However, persons 70

years of age and over with SMI were

much more likely than younger

persons to be limited in personal care

and instrumental activities of daily

living. More than three times as many

persons 70 years of age and over were

reported to be unable to take care of

their personal care needs because of

the mental disorder than SMI persons

18-69 years of age who were unable

to work.

Receipt of disability payments

About 703,000, or 23.2 percent of

adults with SMI in households

currently receive disability payments

through a Government program

because of their mental disorder.

(table 4). About 98 percent of these

persons had current limitations due

to the disorder. The discrepant two

percent is due to proxy respondents

who reported “don’t know” to the

limitation questions.

Respondents were asked whether

this payment was through Social

Security Disability Insurance (SSDI),

through Supplemental Security

Income (SS1), through the Veterans’

Administration (VA), or through

some other program. The Social

Security Administration (SSA)

administers several programs that

provide cash payments or other

benefits to persons who are, by SSA

standards, disabled. Persons with

adequate work histories usually

receive monthly cash payments as

social security benefits (SSDI), and

persons with minimal resources and

insufficient work history usually

receive a monthly payment under the

SS1 program. VA disability payments

are provided for service-incurred

disability. As shown in table 5, most

respondents with a disability payment

reported SSDI (46.0 percent) or SS1

(43.5 percent) as the source.

Data in table 6 indicate that

adults with SMI who are 35-64 years

of age, male, black, in poverty, have

Table 5. Number and percent of recipients of disability payment for mental illness, by

source of paymenti United States, 1989

Number in

Source thousands Percent’

8ocial SecurWOkabiMylnsurance.. . . . . . . . . . . . . . 323 46.0

SupplementalSecurifylnmme . . . . . . . . . . . . . . . . . . 308 .43.5

Veterans’Adminiatratkxr. . . . . . . . . . . . . . . . . . . . . . 86 12.3

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 7.s

1Percerm add to mm than 100 tmcausc of multiple eaurces of payrnenL

Table 6. Number and percent of adults with serious mental Illness who received

Government disability payment for the mental disorder, by selected characteristic= United

States, 1989

Number in

Charactensti&? thousands Percent’

Tots?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703 23.2

Age

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

2544years . . . . . . . . . . . . . . . . . . . . . . . . . .

ZS44yeara . . . . . . . . . . . . . . . . . . . . . . . . . .

46-64 year3 . . . . . . . . . . . . . . . . . . . . . . . . . .

&5years and over . . . . . . . . . . . . . . . . . . . . . .

●3B

123

~9a

●I 1.0

19.1

28.3

3s.1

9.4

288

46

Sex

402 33.3

16.6

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

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

Race

While. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ocher. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

637

156

●lo

20.5

43.8

●22.7

Poverty3fafus3

Bebwpovarty threshold . . . . . . . . . . . . . . . . . .

Atorabove povertythreshold. . . . . . . . . . . . . . .

195

406

33.6

19.2

Educafion3

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

12year3 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MoretJran12yes.m . . . . . . . . . . . . . . . . . . . . .

317

212

142

30.9

20.8

15.3

Respondent—assasedheaiihstatus3

Excellent ............................

Very good...........................

Good . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Poor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

’34

83

●11.9

16.1

18.3

27.3

35.1

140

183

241

Use of prescriptionmedication in the

paat yeer forthe merrtaJlllne5s3

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

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

S49

143

28.7

16.4

lsetaawmantsl heslthp

forthernenfal dlsorde T

Le3sthan cmemnfh . . . . . . . . . . . . . . . . . . . .

Onemonfhto iassthanone year. . . . .. . .. . . . .

Oneyearormm. . . . . . . . . . . . . . . . . . . . . .

Navar. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3W

166

82

36.7

23.2

18.9

●2S %3.6
.

8 Advance Data No. 218 ● September 16, 1992

less than a high school education,

have poor overall health status, used

prescription medication in the past

year for their mental disorder, or

have recently (past month) seen a

mental health professional, are

disproportionately likely to receive

Government disability payments. The

most striking finding in this table is

that almost 44 percent of black adults

with SMI receive disability payments

compared with about 21 percent of

white adults with SMI. Overall,

22.1 percent of adults with SMI

receiving disability payments for the

disorder were black persons, although

black adults are not significantly

overrepresented among SMI in

general or in the proportion of the

SMI population with current

limitations.

Comparing the source of

disability payments by race, table 7

shows that black adults with SMI are

more than twice as likely to report

receiving SS1 for their mental

disorder than white adults with SMI.

The higher proportions of black

adults receiving SSDI and VA

disabili~ payments are significant at

the .10 level.

These findings related to SSDI

and SS1 benefits are consistent with

those from a recent report by the

General Accounting Office (GAO)

(12). In April 1992, the GAO issued

findings from a study of racial

differences in disability decisions for

SSDI and SS1 benefits. This report

analyzed the circumstances

surrounding the lower allowance rate

for black applicants compared with

white applicants for disability

benefits. One of the findings was that

while black applicants are less likely

to be awarded benefits than white

applicants, in the general population

a higher proportion of black adults

were receiving benefits than white

adults. The report attributed this

higher rate in the population to the

fact that black adults apply at a

higher rate than white adults, and it

goes on to speculate that this maybe

due in part to poorer economic

circumstances among black persons.

Additional work is in progress to

identify factors that might account for

these racial differences.

As noted in table 2, a higher

proportion of black adults with SMI

in this survey are unable to work

because of their disorder than white

adults with SMI. Black adults are

more likely than white adults (both in

the general population and among

adults with SMI) to be in poverty, to

have less than a high school

education, and to have fair or poor

self-assessed health. Since all of these

factors are related to receipt of

disability payments, it is not

surprising that black persons with

SMI are more likely to receive

disability payments because of their

mental disorder.

Prescription drug use

Prescription drug use was highly

prevalent in the population reporting

SMI; about 68 percent of the adult

SMI population who saw a doctor or

other health professional for the

mental disorder used prescription

medication for the disorder during

the past 12 months (table 8). Taking

prescription medication was not

related to limitation status. The

lowest use of prescription medication

for the disorder during the past year

was among the youngest and oldest

age groups (table 8). The proportion

using prescription medication

generally increased with age through

the age group 65–69 years and

decreased thereafter. Persons with

Table 7. Percent of adults with serious mental Illness receiving disability payment for their

mental disorder, by race and source of payment United States, 1989

Sourea White Black

Percent

Social Security Oiaabiliilnsursnce . . . . . . . . . . . . . . . . . . . 10.0 16.7

Supplemental Serwrily income . . . . . . . . . . . . . . . . . . . . . . 8.9 20.0

Veterans’ Adrhinistration . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 7.0

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

1.6 2.7

SMI in “poor” health, those who

received Government disability

payments, and those who recently saw

a mental health professional were

most likely to have used medication.

The various types of prescription

drugs used by persons with SMI

during the past 12 months for the

mental disorders reported are shown

in table 9. Actual drug names were

obtained from respondents and then

coded by major class of drugs.

Antidepressants were used by almost

41 percent of the 1.9 million persons

using prescription medication in the

past year, and were the most

commonly reported type of drug used.

This is not surprising, since “major

depression” was reported for

approximately 45 percent of persons

reported to have SMI. Antianxiety

and antipsychotic drugs were used by

26.3 and 25.2 percent of persons,

respectively. Various other drugs, not

considered to be drugs for mental

health problems, were used for the

mental disorders by about 18 percent

of those who used prescription (drugs.

Table 10 shows that almost one-half

of all persons with SMI using

prescription medication for the

disorder during the past year used

more than one drug.

Visits to mental health

professionals

About 77 percent of the SMI

population in households (2.4 million

persons) have seen a mental health

professional for the mental disorder

reported (table 4). &nong the

700,000 persons with SMI who have

never seen a mental health

professional, most (about 64 percent)

had seen a doctor or other health

professional for the disorder. In

table 11, characteristics of the SMI

population who have seen a mental

health professional for the reported

mental disorder(s) are displayed. In

the oldest age group, only 37 percent

of persons with SMI had seen a

mental health professional for the

reported disorder but about

90 percent of this age group had

seen another type of doctor or health

professional for their disorder.
Advance Data No. 218 ● September 16, 1992 9

Table 8. Number and percent of adults with

serious mental Illness who used

prescription medication during the past

year for the mental disorder, by selected

characteristic= United States, 1989

Number in

Characteristic thousands Percentl

Total* . . . . . . . . . . . .

Age

16-24 years. . . . . . . .

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

3544yeare . . . . . . . .

4S-64yeare . . . . . . . .

65-89 years . . . . . . . .

70-74 years . . . . . . . .

75 yeara and over . . . .

Sex

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

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

Race

whita . . . . . . . . . . . .

Black . . . . . . . . . . . .

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

Poverty stetus3

Below poverty

threefold . . . . . . . . .

At or above poverty

threshold . . . . . . . . .

Education3

Lessthan12 yeara . . .

12years . . . . . . . . . .

Morethan12yeara . . .

Respondentassessed health

statua3

Excellent . . . . . . . . . .

Verygood . . . . . . . . .

Good . . . . . . . . . . . .

Fair . . . . . . . . . . . . .

Poor. . . . . . . . . . . . .

Raceiptof

Governmentdisabilii

payment3

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

No.............’.

Laetsawmental

health professional

forthemental

disorder3

Lessthsn one month . .

Onemonthto less than

oneyear .,.....,.

Oneyear or more . . . .

Never . . . . . . . . . . . .

1,890

188

347

463

636

100

62

112

732

f,156

1634

231

*25

373

1313

658

846

563

162

357

448

420

502

549

1303

649

596

201

220

68.2

55.7

61.6

69.2

76.6

82.1

75.0

50.0

67.4

68.6

86.2

70.3

“55.4

70.1

66.4

69.4

69.9

66.1

61.4

67.7

88.4

64.8

77.0

79.4

64.1

S5.o

74.2

40.2

52.5

lAllpemmrdsrmmuUlrn axclf.rdepwson$ whotuvenotsesn any

heslmpmfossional forthod&xder(246,00J. cf7.5pwxntcfxMts

wrh ssrioue mental illness and oxdudo WSOnS wth unknwrr ““usa

of presc@mn modicslmn fcf the dieordsr” (247S00,or 7.6 rxmnt

~ addt$ with senmk msnral illne-).

Percent dsncmwwlw fcf tcul indudm pefsans with unknmvn

FCWfW ststus. cd-”m, haalth SWIM. disaIxitj W, m tinw

suwx last w a nmms4 heahh @Hsimul.

3Pwcenr dorwmnmar cxclcdoe parsmm with this chamclwistic

unknown.

NOTES Estimatesotlass than 41,CO0 snd parcents based on

these estimates Iuve 30 percent or more relatiwe Standmd

error (RSS): sw Technicst notes for description of the cslcuh.

tion of standard SJrrors.Estimates with sn RSE of 30 percsnt or

more are Indicmad with an asrerisk.

Table 9. Number and percent of adults with

serious mentai illness who took

prescription drugs in the past year for

mental disorder, by type of drug: United

States, 1989

Number in

Type of drug thousands Percent

Antidepressant . . . . . . . . . . 769 40.6

Antianxiety . . . . . . . . . . . . . 497 26.3

Antlpsychotic . . . . . . . . . . . 477 26.2

Antimanic . . . . . . . . . . . . . 233 12.3

Other psychotropic drug . . . . 65 3.4

Other drug . . . . . . . . . . . . . 337 17.8

Unknown drug name . . . . . . 46 2.4

Table 10. Number and percent distribution

of adutts with serious mental iliness who

took prescription drugs In the past year for

the mental disorder, by number of drugs

reported: United States, 1989

Number in Percent

Number of drugs thousands distribution

Total . . . . . . . . . . . . . 1,890 100.0

Number of drugs

One . . . . . . . . . . . . . . 875 46.3

Two . . . . . . . . . . . . . . 478 25.3

Three . . . . . . . . . . . . . 251 13.3

Four. . . . . . . . . . . . . . 8s 4.5

Fiveormore . . . . . . . . 58 3.6

Unknown.. . . . . . . . . . 135 7.1

Persons 35-64 years of age were more

likeIy than any other age group to

have seen a mental health

professionaL

Persons who used prescription

medication for their mental disorder

during the past year and persons who

received disability payments for the

disorder were more likeIy to have

seen a mental health professional

than others with SMI.

Summary and conclusions

The major significance of the

current report is that it provides

estimates and characteristics for that

portion of the civilian SMI population

living in households. Survey resr.dts

show that approximately 3.3 million

adult Americans have mental

disorders that seriously interfere with

one or more aspects of daily life and

that about 2.6 million of these

persons are currently limited in one

or more functional areas. These

results suggest that the household

component of the SMI population is

comprised of between 2.6 and 3.3

million adults, depending upon the

criteria employed for inclusion.

Undoubtedly, both of these numbers

are consemative because of the

likelihood of underreporting in the

survey.

Placed in the context of the

entire aduit population, these findings

suggest that the SMI population can

be conservatively estimated to include

4 to 5 million adult Americans, or 2.1

to 2.6 percent of the aduh

population. In addition to the

househoId popr.dation, it is estimated

that 200,000 SMI persons are

homeless on any given day (13). M

additional 1 million to 1.1 million are

residents of nursing homes (14),

approximately 50,000 to 60,000 are

patients of mentaI hospitals, and

approximately 50,000 are inmates of

State prisons (15),

A major remaining need is to

collect sirniIar data on all SMI

persons, whether their residence is a

household, an institutional or

noninstitutional group quarter, or

some other setting, including streets

and shelters. In order to formulate

more effective national policy to

address the needs of these disabIed

Americans, a need exists to examine

the longitudinal relationship between

course of disorder and functioning as

they relate to service and program

participation.

References

1.

2.

3.

4.

5.

Unpublished estimate. Statistical Research Branch, National Institute of

Mental Health (NIMH). 1992.

Goldsmith H, Gattozzi A, Taube C.

Defining and counting the chronically

mentally ill. Hosp Community

Psychiatry 32:21-7.1981.

Goldman H, Manderscheid R.

Chronic mental disorder in the

United States. Mental Health, United

States, 1987.National Institute of

Mental Health. 87-1518:1-11.1987.

Ashbaugh J, Manderscheid R. A

method for estimating the chronic

mentally ill populations in state and

local areas. Hosp Community

Psychiatry 36(4). 1985.

Goldman H, Rosenberg J,

Manderscheid R. Defining the target

population for vocational
10 Advance Data No. 218 ● September 16,1992

—Table 11. Number and pareent of adutta

wtth aerlous mental illness who have ever

aeon a mental haatth professional, by

aeleetad chameteriatitx Unttad States,

1989

Number in

Chmeteristk nnwssnds Pecent’

Tot& . . . . . . . . . . . . . . 2,360

Age

l&24yaars . . . . . . . . . .

2s34ywua . . . . . . . . . .

35-44 yesre. . . . . . . . . .

4E-e4yeare . . . . . . . . . .

e5-69yaers . . . . . . . . . .

70-74 deem. . . . . . . . . .

75end over . . . . . . . . . .

Sex

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

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

Race

White . . . . . . . . . . . . . .

Blac k . . . . . . . . . . . . .

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

Poverty etatus3

Below pove~ threshold . .

At or above poverty

threshold. . . . . . . . . . . .

Eduoetion3

Less than 12 years . . . . .

12yeare . . . . . . . . . . . .

More than 12 yeare . . . . .

Respondent-aeaeaead

health etetus3

Excellent . . . . . . . . . . . .

Verygood . . . . . . . . . . .

Good . . . . . . . . . . . . . .

Fair . . . . . . . . . . . . . . .

Poor. . . . . . . . . . . . . . .

Use of prescription

medication for the mental

disorder’

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

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

ReeeiptofGovemm nf

disebilitypaymen J

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

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

276

503

630

719

69

70

ea

959

1,421

2,042

292

46

470

1633

76s

804

762

244

464

606

633

530

1646

667

6s5

1628

77.3

60.3

76.8

87.6

62.5

66.5

63.5

37.0

77.9

76.8

76.8

80.3

7a.7

79.1

76.1

74.9

76.4

80.3

82.6

78.7

76.2

74.4

75.6

66.2

76.7

26.4

71.3

‘A3pwtmrdmommdmmdm~wihunkrmvnbnwshm

l1518Jwam4nMlh4d61@45swd (164,000.0r5.6wrwr’ eftotd

ackllmwi!hwimlsmcnrd WMsC).

2Parwni dmornimtci hr teml ind~ ~ * W*

--.~.=-. ~*-.

8ndrudh8bHllv m.

3P4rcurr d4r10rn8ut0r adurlas proms Ml mu Chmvsuubc

Urlknowl.

4P9turd dmOmiM& llwkldamlyrmr9an9n+whm9uorsnrla

dca0rw3umrh4allh@ulblld mdmchde8wrwruvdIhlhis

duractDri3ric Unkncwn.

6.

7.

8.

9.

10.

11.

12.

13.

rehabilitation. In. ChrdielloJ,Bell

M, eds. Vocational rehabilitation of

persons with prolonged psychiatric

disorders. Baltimore and London

Johns Hopkins University Press.

19-23.1988.

Ashbaugh J, Leaf P, Manderscheid R,

Eaton W. Estimates of the size and

selected characteristics of the adult

chronically rnentatly ill population

living in U.S. households. Research in

Community Merit Health J 3:3-24.

1983.

Mulkcm V, et al. Community support

program client followup study,

executive summary. Study funded by

the National Institute of Mentrd

Health, Division of Biometry and

Applied Sciences. Prepared by

Human Services Research Institute,

Cambridge, MA5-32. 1986.

Leon J, Lair T. Functional status of

the noninstitutionalized elderly

estimates of ADL and IADL

difficulties. Research findings from

the National Medical Expenditure

Survey, Agency for Health Care

Poliq Research, Department of

Health and Human Services, 90-3462.

1990.

Adams PF, Benson V. Current

estimates from the National Health

Interview Survey, 1989. National

Center for Health Statistics. Vital and

Health Stat 10(176). 1990.

Idler EL, Angel RJ. SeM-rated health

and mortality in the NHANES-I

Epidemiologic Followup Study. Am J

Public Health 80(4):44&52. 1990.

Idler EL Kasl SV, Lcmke JH. Selfevaluated health and mortality among

the elderly in New Haven, Cmecticut,

and Iowa and Washington counties,

Iowa, 1982-86. Am J Epidemiol

131(1)91-103. 1990.

U.S. General Accounting Office.

Human Resources Division. Racial

differences in disability decisions

warrants further investigation.

Washington: U.S. General Amounting

Office. April 1992.

Manderscheid R, Rosenstein M,

Homeless persons with mental illness

and alcohol or other drug abuse:

current “research, policy, and

prospects. Current opinion in

Psychiatry 5:273-8.1992.

14.

15.

16.

17.

18.

Strahan G. Prevalence of selected

mental disorders in nursing and,

related care homes. National Institute

of Mental Health, Mental Hcahh

90-1708chapter 6.1990.

Unpublished estimate. Statistical

Research Branch, National Institute

of Mentat Health. 1992.

National Center for Health Statistics.

The National Health Interview Survey

design, 1973-84, and procedures,

1975-83. National Center for Health

Statistics. Vital Health Stat 1(18).

1985.

Massey JT, Moore TF, Parsons w

Tadros W. Design and estimation for

the National Health Intefiew !hn-vey,

1985-94. National Center for Health

Statistics. Vital Health Stat 2(110).

1989.

Moss AJ, Parsons VL. Current

estimates from the National Health

Interview Survey, United States, 1985.

National Center for Health Statistics.

Vital Health Stat 10(160). 1986.

Symbols

--- Data not available

. . . Catego~ 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 am

rounded to thousands

* Figure does not meet ststndi~rdof

reliability or precision
Advance Data No. 218 ● September 16, 1992 11

Technical notes

Source and description of data

The estimates presented in this

report are based on data from the

1989 National Health Interview

Survey (NHIS), an ongoing survey of

households in the United States

conducted by the National Center for

Health Statistics (NCHS). Each week,

a probability sampIe of the civilian

noninstitutionalized population of the

United States is intemiewed by

personnel of the U.S. Bureau of the

Census. Interviewers obtain

information about the health and

other characteristics of the

households included in the NHIS

sampIe.

NHIS consists of two parts: (a) a

basic health and demographic

questionnaire that remains the same

each year and is completed for every

household member and (b) special

topics questionnaires that vary from

year to year, some of which maybe

completed only for selected persons

in each family. In 1989, the special

topics included heaIth care coverage,

adult immunization, mental health,

dental health, diabetes, orofacial

pain, digestive disorders, and

knowledge and attitudes about

acquired irnmunodeficiency syndrome

(AIDs).

The total interviewed sample for

1989 for the basic health and

demographic questionnaire consisted

of 45,711 households containing

116,929 persons. The noninterview

rate was 5.1 percent. NHIS Mental

HeaIth (IW?IS-MH) interviews were

completed for 113,231 persons, or

96.8 percent of those interviewed on

the basic questionnaire. The overall

response rate for the NHIS-MH was

91.9 percent (the product of the

response rates for the basic and

mental health questionnaires).

Sampling errors

Because estimates shown in this

report are based on a sampIe of the

population rather than on the entire

population, they are subject to

sampling error. When an estimate or

the numerator or denominator of a

percent is small, the sampling error

may be relatively high. In addition,

the complex sample design of NHIS

has the effect of making sampling

errors Iarger than they would be had

a simpIe random sample of equaI size

been used. Estimates and figures

based on estimates that do not meet

the reliability criteria of 30 percent

reIative standard error are marked on

the tables.

Approximate standard errors of

the estimated numbers (x) in the

tables (except for age, sez and race

for all persons when the standard

error is assumed to be 0.0) maybe

calculated using the formula

SE(x) =V.0000307(X)J+ 3640(X)

For example, it is estimated that

3,264,000 aduks had a WI in the last

12 months (table 1). Using this

formula, the standard error for the

estimated number is

SE(3,2WMO) =

V.0000307(3,264,000)’+ 3640(3,264,000)

= 110,490

Approximate standard errors of

the estimated percents in the tables

may be cahxdated using the formula

sE@)=@3640@(l(H) -p)

Y

where p is the percent of persons and

y is the base population from which

the percent is calculated.

For example, it is estimated that

78.8 percent of adults with SMI have

one or more specific Imitations

resuhing from the SMI (table 1).

Using this forrmda, the standard error

for the estimated percent is

SE(78.8) =

~3640(78.8)(100 - 78.8)

3,264,000 -

= 1.86

If xl and Xz are two estimates,

then the approximate standard error

of the difference (xl -xJ can be

computed as follows:

SE(XI)2+ SE(X2)2– % SEE

where SE(XI) and SE(X2) are

computed using the appropriate

formulas previously presented in this

section and r is the correlation

coefficient between xl and Xz

Assuming r= 0.0 will result in an

accurate standard error if the two

estimates are actually uncorrelated. If

they are correlated, the standard

error of the dfierence will be

underestimated or overestimated.

These calculations can also be

performed for dtierences in percents

using the appropriate standard error

formulas for percents.

In this report, unless otherwise

noted, a difference was considered

statistically significant at the

5-percent level if the difference

(x ~-zJ was at least twice as large as

its standard error. Further

information on how the standard

error parameters are constructed is

avaiIable in “Current Estimates From

the National Health Interview Sumey

1989” (9).

Related documentation

More detailed discussion of the

sample design, estimating procedures,

procedures for estimating standard

erro~ nonsampIing errors, and

definitions of other sociodernographic

terms used in this report have been

published in V7taland Health

StahMcs, Series 1, no 18; Series& no

llQ Series 10, nos 160 (16-18) and

176 (9).

A public use data fle based on

the 1989 Mental Health Survey

questionnaire was released in April

1991. Information regarding the

purchase of the public use data tape

may be obtained by writing the

National Center for HeaItk Statistics,

Division of Health Intefiew

Statistics, 6525 Belcrest Road,

HyattsvilIe, MaryIand, 20782.
12 Advance Data No. 218 ● September 16, 1992

Suggested cltatlon Copyright Information National Center for Health Statlstlcs

Barker PR, Manderscheid RW, Hendershot This report may be reprinted without further Director

GE, et al. Serious mental illness and disability permission. Manning Feinleib, M.D., Dr. P.H.

in the adult household population: United

States, 1989. Advance data from vital and Acting Deputy Director

health statistics: no 218. Hvattsville, Marvland: Jack R. Anderson

National Center for Health Statistics. 1992.
Number 219 . November 20, 1992

Advance

Data

From Vital and Health Statwcs of the CENTERS FOR DISEASE CONTR04Nat!onal Center for Health Stakstlcs

Trends in Childhood Use of Dental Care Products

Containing Fluoride: United States, 1983-89

by Diane K. Wagener and Parivash Nourjah, Office of Analysis and Epidemiology,

National Center for Health Statistics, and Alice M. Horowitz, Epidemiology and Oral Disease Prevention Program,

National Institute of Dental Research, National institutes of Health

Introduction

The correlation between the

concentration of fluoride in

communi~ drinking water and

prevalence of dental caries (tooth

decay) observed in the early 1940’s

resulted in a public health effort to

encourage communities to add

fluoride to their water supply as a

means of preventing dental caries.

Essentially aII water contains at least

trace amounts of fluoride. Thus,

communi~ water fluoridation is the

adjustment of the amount of fluoride

that occurs naturaIIy in a community’s

water supply to the optimaI Ievel for

preventing tooth decay. In the United

States, the optimaI leveI of fluoride

ranges from 0.7 to 1.2 parts per

miIlion (ppm). ln 1945, 1.7 percent of

the American population was served

by optimally or greater than optimally

naturaiIy fluoridated drinking water

(l). A 1989 survey indicated that 54

percent of the American pubIic and

61 percent of the population on

central water systems are now being

served by optimaIly fluoridated

drinking water (2). Neither the

percent of the population served by

fluoridated drinking water nor the

percent of the population on

community water systems that

received fluoridated water has

changed since 1985 (2).

ln addition to optimalIy

fluoridated drinking water, other

sources of fluoride for public use

have been developed and marketed.

These include dietary ffuoride

supplements, fluoride toothpaste,

fluoride mouthrinse, and

professionally applied fluorides.

Dietaxy fluoride supplements are

designed for children –infants

through teen years —and are used in

communities in which the drinking

water is fluoride deficient. Dietary

fluoride supplements by prescription,

fluoride-containing toothpastes sold

over the counter, and professionally

applied fluorides have been avaiIable

for over three decades. More

recently, mouthrinses containing

fluoride have been marketed and sold

over the counter.

Early school-based fluoride

programs consisted of operatorapplied fluoride regimens. Later,

other kinds of fluoride administration

were deveIoped and used in schools.

Today, school-based, fluoride rinse

and/or tablet programs have been

implemented in most States. Fluoride

mouthrinsing is the fluoride regimen

most frequently used, foIlowed by

fluoride tablet programs.

Professionally applied fluoride

treatments are offered in only a few

school systems.

The widespread avaiIabiIily of

community water fluoridation and use

of fluoride products in the United

States have contributed to a dramatic

reduction of dentaI caries among

school-age children in recent years

(figure 1). For example, among 9 year

olds, the prevalence of dental caries

has declined from 71 percent during

1971-74 to 34 percent during 1985-86

(3). There are some groups of

chiIdren that are at higher risk than

others of developing dental caries (4).

These groups are mainly bIack and

Iive in the Northeast and Pacific

regions.

The decline in dentaI caries has

occurred at the same time that there

has been an increase in the

prevalence of dental ffuorosis. Dental

*+,Cwrcq

~+ %, ●+

~

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

g Public Health Service

s

$

Centers for Disease Control ~%.aa

>

NationalCenter for Health Statistics CSNTERS cmFOR DISXE cONTRO+
L -W. w,,”” ““.” ..”. -.” - ..-. ”. 1.”-. -“, .“” -

■ 19aa-a7 •Dn 1979-s0 m 19711-74

15

10

5

0

Years of age

SOURCES: Nml CsnWtx Neu@I ~ Ndm’!d HMkh w’d NuIIUon Er&nhatJon Sufvq 1071-73,

N8uc+W l~of Ocmml Remucfi Ndmd SWwy d WI081 l+dth dU.S. d’dldmn &# 6-17,197940. Ndbnd Survey of UwOr# Heaith otU,S. Chlidrm A@ 5-17, 108S-87.

Figure 1. Age-specific mean decayed, missing, or filled permanent tooth surfaces from three national surveys: United States, 1971-87

fluorosis is a hypomineralization of

enamel of the teeth that may range in

appearance from a few white flecks or

spots to discrete or confluent pitting

and brown staining. Dental fluorosis

occurs when children below the age

of 6 years ingest more than the

recommended amounts of fluoride. In

the early 1940’s, Dean estimated that

only 10 percent of the children who

were born and reared in communities

with optimally fluoridated water (0.7

to 1.2 ppm) would demonstrate some

signs of mild forms of fluorosis (5,6).

Recent surveys, however, indicate

that the prevalence of mild and

moderate forms of fluorosis is about

22 percent (7). This degree of

fluorosis is considered mild. which

does not call for public health

concern, although it may be

important cosmetically to individuals.

To monitor the use of fluoride

products, this report describes the

trend in the use of selected fiuoridecontaining dental products and

dieta~ fluoride supplements among

infants, children, and youth younger

than 18 years of age during the

period 1983-89.

Data and methods

The National Health Interview

Survey (NHIS) is conducted by the

National Center for Health Statistics,

Centers for Disease Control. It is

composed of two parts: (a) a general

health characteristic questionnaire

that remains the same each year and

is completed for each household

member; and (b) a special topic

questionnaire that varies from year to

year and is conducted on all o; a

sample of the interviewed individuals.

Special topics on oral health were

administered in 1983, 1986, and 1989.

The questions contained in these

surveys were developed in

collaboration with the National

Institute of Dental Research,

National Institutes of Health, and

other Federal agencies. The

information on dental care was

collected on all individuals in the

selected households. When possible,

information was obtained from ;all

adults in the household. Information

on children and members of the,

family who were not at home at the

time of the interview was obtained

from the responsible individual of the

household. These supplements
Advance Data No, 219. November 20, 1992 3

Table 1. Number of interviews, by age and selected demographic characteristics for children 0-17 years of ag= UnitedStates, 1983,

1986, and 1989

Under 2 years 24 years 5-17 years

Characteristic 1983 1986 1989 1983 1988 1989 1983 1986 1989

Total . . . . . . . . . . . . . . . . . . . 3,284 1,996 3,785 5,095 3,004 5,590 21,405 12,393 22,982

Race

Black . . . . . . . . . . . . . . . . . . . 483 420 665

White . . . . . . . . . . . . . . . . . . .

771 5a~ 1,005 3,063 2,574 4,196

2,703 I ,50a 2,997 4,167 2,326 4,361 17,737 9,443 17,956

Hispanic

Hispanic . . . . . . . . . . . . . . . . . 383 240 518 562 341 693 2,290 1,195 2,634

Non-Hispanic . . . . . . . . . . . . . . 2,902 1,756 3,267 4,533 2,663 4,897 19,115 11,198 20,346

Poverty status

Atorabove poverfy threshold. . . . 2.490 1,366 2,710 3,817 2,121 4,099 16,340 9,050 17,354

Below povetly threshold , . . . . . . 491 463 759 839 650 1,069 2,783 2,304 3,813

Education of head of household

Some college . . . . . . . . . . . . . . 1,253 922 1,626 1,874 1,452 2,720 7,472 5,580 10,995

High schml or less . . . . . . . . . . 1,967 1,065 1,929 3,174 1.538 2.83S 13,736 6,737 11,638

Region

Northeast . . . . . . . . . . . . . . . . 641 401 682

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

S73 543 661 4,355 2,433 4,082

854 460 927 1,362 757 1,431 5,669 3,162 5,847

South . . . . . . . . . . . . . . . . . . . 1,082 731 1,285 1,716 1,069 1,889 7,213 4,4J 3 7,882

West . . . . . . . . . . . . . . . . . . . 708 414 881 1,042 635 1,309 4,168 2,365 6,171

NOTE: See rhe appendw for the definition of variables.

contained questions onhome useof programs. Information about the each year by age and some selected

fluoride products (including latter fluoride regimen was collected variables aredisplayed in table I, The

toothpaste and mouthnnse), dietary only in the 1986 and 1989 surveys. corresponding estimated numbers

fluoride supplements (in the form of Information on dental visits also was that the sample represents nationally

drops or tablets, with and without assessed for individuals 2 years of age are displayed in table 2.

vitamins), and participation in and older. The numbers of individuals The present anaIyses are

school-based fluoride mouthrinse from whom an interview was obtained restricted to information obtained on

Table 2. Estimated population size in thousands, by age and selected demographic characteristics for chiidren 0-17 years of age:

United States, 1983, 1986, and 1989

Under 2 years 24 years 5-17 yeare

Chamcteristic 1983 1986 1989 1983 1986 1989 f983 1986 1989

Total . . . . . . . . . . . . . . . . . . . 7,109 7,314 7,674 10,743 10,661 11,094 44,761 44,957 45,235

Race

Black, . . . . . . . . . . . . . . . . . . 1,120 1,170 1,179 1,737 1,565 1,702 6,652 6,914 7,077

White . . . . . . . . . . . . . . . . . . . 5,780 5,881 6,1s8 8,710 8,911 6,922 36,626 36,684 36,440

Hispanic

Hispanic . . . . . . . . . . . . . . . . . S13 932 1,095 1,173 1,306 1,464

Non-Hispanic . . . . . . . . . . . . . .

4,722 4,551 5,364

6,226 6,382 6,579 9,569 9,555 9,610 40,039 40,406 39,871

Poverty status

At or above poverty threshold. . . . 5,371 5,199 5,604 8,02S 8,006 8,289 34,077 34,050 34,702

Below poverty threshold . . . . . . . 1,066 1,528 1,45s 1,7S2 2,054 2,007 6,655 7,435 7,126

Education of head of household

Somecollage . . . . . . . . . . . . . . 2,678 3,514 3.7s8

Hlghschml or less . . . . . . . . . .

3,927 5,476 5,483 15,579 20,984 22,041

4,319 3,765 3,821 S,715 5,331 5,555 2S,746 23,701 22,927

Region

Northeast . . . . . . . . . . . . . . . . 1,376 1,477 1,381

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

2,027 1,939 1,904 9,021 8,927 6,047

1,78s 1,596 1,773 2,788 2,643 2,745 11,715 11,312 11,260

south . . . . . . . . . . . . . . . . . . . 2,355 2,684 2,s81 3,673 3,899 3,673 15,218 15,626 15,852

West . . . . . . . . . . . . . . . . . . . 1,578 1,557 1.823 2,255 2,360 2,572 8,807 8,892 10,076

NOTE:See .fie appendix for the definihon of variables.
4 Advance Data No. 219. November 20, 1992

children younger than 18 years of age.

Three age groups were defined as

follows: younger than 2 years (infants

and toddlers), 24 years (preschool

children), and 5-17 years (school

children). Information regarding

dental health care was not collected

for infants and toddlers younger than

2 years of age, and information about

the use of fluoride mouthrinse in

school-based programs was collected

on 2–16 year olds but data are

reported only on school children

5-16.

In all sumeys, the use of fiuoridecontaining products is based on selfreport. The method of collecting

information on fluoride-containing

toothpaste changed between 1983 and

1986. In 1983 the respondents were

asked if the toothpaste contained

fluoride. No validation of the

respondent’s knowledge or perception

was obtained. In contrast, in 1986, the

brand frame of toothpaste was

collected. The name of the toothpaste

was then compared with brands that

were approved either by the Food

and Drug Administration or the

American Dental Association as

containing fluoride. (Brand names are

confidential information and are not

available on the computer tapes.) The

dental care supplement in 1986 also

asked questions regarding

respondent’s perception about the

presence of fluoride in their drinking

water and knowledge of the purpose

of fluoridation of the community

water supply. Therefore, data from

this year were analyzed to examine

the association of the use of fluoridecontaining dental products, with the

knowledge of the purpose of

community water fluoridation, and

whether they thought their water

supply was fluoridated.

In this report, terms such as “no

difference” or “’similar” mean there is

not a statistical significant difference.

Whereas terms like “greater,” “more

likely, “ “more frequently,” “less

likely,” or “less frequently” implies a

statistical significant difference.

Findings

Figure 2 shows the reported use

of each of the four tluoridecontaining dental products by age in

1986. The year 1986 was chosen

because this was the only year that all

four sources of fluoride were

considered, and it \vas also the

mid-year in the period evaluated in

this report. In this figure, 17 year olds

were excluded in order to have

comparable age groups across the

different panels. Panel 1 shows a

decline in reported use of dietary

fluoride supplements by children as

they age. However, participation in

school mouthrinsing programs shows

a different pattern, noticeably

increasing between children in the

age groups 5–7 and 8–10 and

(1.2 percent). The practice increases

to 1 out of 11 children 2-4 years of

age and then doubles to about 1 out

of 5 children by age 5; thereafter, the

percentage is unchanged. The fourth

panel shows that more than 90

percent of children 2 years of age and

older use a fluoride toothpaste.

Among infants and toddlers, this

proportion was 30 percent.

In the following, the changes in

these patterns of usage over the

period 1983–89 are discussed

separately for infants and toddlers

(under 2 years of age), preschool

children (ages 24 years), and

school-age children (ages 5–17 years).

decreasing thereafter (panel 2). As

shown in panel 3, the use of fluoride Infants and toddlers

mouthrinse at home is not a common Table 3 shows that among

practice among infants and toddlers children under 2 years of age, the

25

[

Fluoride supplements

20

15

10

5

0 L

25 -

Sohool fluoride mouthrinse

20

15

10 ●

5 .

jo .M

NA

Z *5r

Home fluoride mouthrinse

20

15

10

5

0

1(XJ Fluoridetmthpaste

SO

60

40

20

0

Under z 24 5-7 8-10 11-13 14-1 e

Age in years

NOTE: NA k M WPIkfda

SCURC~ NaUOMl@fXeffofHe@hStatW=, NabrNl Ham Inruvkw3WW, 1ME.

Figure 2. Percent of children using dental care products containing fluorlde by age,

fluoride supplements, school fluoride programs, fluoride mouthrinse, and toothpaste:

United States, 1971-87
Advance Data No. 219. November 20, 1992 5

consumption of fluoride supplements

had not changed significantly since

1983. It was reported that about

14 percent of these children took

fluoride supplements in 1983, whereas

15 percent took fluoride supplements

in 1989. In each year the use of

fluoride supplements was greater

among white children than black

children; among non-Hispanic

children than Hispanic children;

among children not living in poverty

than living in poverty and among

children living in households headed

by persons with some college

education than children in households

headed by persons with lower

educational attainment. In addition,

more children living in the West and

Northeast regions were reportedly

taking fluoride supplements than in

the Midwest and South. The largest

increases in fluoride supplement

usage occurred among children in the

West, among black children, and

among Hispanic children. The

statistically-significant difference

behveen Hispanic and non-Hispanic

percentages disappeared between

1983 and 1989 due to the increased

usage among Hispanic children.

The use of toothpaste containing

fluoride by infants and toddlers did

not change much between 1983 and

1986 (31 and 33 percent,

respectively). However, there was an

increase but not statistically

significant in use reported by blacks,

Hispanics, and children living in

pover~.

Figure 3 indicates that the use of

ffuoride supplements is less among

infants and toddlers of adults who

reported their drinking water was

fluoridated (32 percent versus 11

percent). Figure 4 shows that infants

and toddlers were more likely to be

receiving fluoride supplements if the

responding adults knew the purpose

of fluoridation. The use of toothpaste

containing fluoride was also more

frequent if the informant knew the

purpose of community water

fluoridation. However, neither the use

of fluoride toothpaste nor mouthrinse

was related to perception of drinking

water fluoride status.

Table 3. Percent of infants and toddlers under 2 vears of aae usina selected ffuoride-containing dental care txoducts at home. bv

selected sociodemographic characteristics: Unit6d States,; 983, 1?)86, and 1989

,.

[Standard errors are @ven in parentheses]

Fluoride supplement Mouthrinse Toofh.oaste

Characteristics 1983 1986 1989 1983 1986 1989 1983 1986 7989

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

Race

Black . . . . . . . . . . . . . . . . . . .

White . . . . . . . . . . . . . . . . . . .

Hispamc

Hispanic . . . . . . . . . . . . . . . . .

Non-liispanic . . . . . . . . . . . . . .

Poverty status

At or above poverty threshold. . .

Below poverty threshold . . . . . . .

Education of head of household

Some college . . . . . . . . . . . . . .

Highschool orless . . . . . . . . . .

Region

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

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

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

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

14.0

(0.7)

3.9

(1.0)

16.1

(0.8)

7.9

(1.4)

14.8

(0.8)

16.8

(0.9)

5.0

(1.1)

19.5

(1.2)

10.9

(0.8)

22.6

(1.9)

9.1

(1.3)

8.8

(1.0)

19.8

(1.8)

16.3

(1.3)

2.3

(0.9)

19.4

(1.6)

9.6

(2.1)

17.3

(1.4)

19,9

(1.6)

7.9

(1.7)

21.5

(1.9)

11.6

(1.3)

23.9

(2.3)

9.6

(1.8)

11.0

(1.5)

24.9

[4.7)

15.1

(0.7)

6.5

(1.2)

16.6

(0.8)

12.9

(1.7)

15.5

(0.8)

16.2

(0.9)

6.4

(1.1)

19,6

(1.2)

10.8

(0.8)

20.6

(1.7)

7.9

(0.9)

10.4

(1.0)

25.1

(2.0)

(N)

0.3

(0.3)

0.7

(0.2)

1.0

(0.5)

(R)

0.6

(0.2)

0.2

(0.2)

(:::)

(8)

0.5

(0.3)

&

(:)

0.8

(0.4)

1.2

(0.3)

1.7

(0.6)

(U)

0.7

(0.6)

(:::)

(;::)

1.2

(0.5)

1.0

(0.3)

(x)

(::)

0.7

(0.4)

;)

1.1

(0.6)

&)

2.8

(0.7)

(:)

1.4

(0.6)

(;:;)

(::;)

(:)

(H)

(;::)

(Ym

0.8

(0.4)

1.3

(0.4)

0.4

(0.2)

31.0

(0.9)

26.1

(2.1)

32.1

(1.0)

25.6

(2.3)

31.7

(1.0)

32.3

(1.0)

26.3

(2.2)

32.5

(1.3)

30.2

(1.2)

29.3

(2.0)

30.2

(1.7)

32.4

(1,6)

31.2

(2.2)

33.4

(0.1)

33.2

(2.5)

33.4

(1.3)

34.1

(2.9)

33.3

(1.4)

34.4

(1.4)

32.4

(2.7)

35.6

(1.5)

31.4

(1 .5)

36.0

(2.5)

28.0

(2.2)

34.7

(2.2)

34,2

(2.9)

---

---

---

---

---

---

---

---

---

---

---

---

---

NOTES: See the amenc x for the de finltton of wmahk?s.

unknown ISmcmae~ m ;c:al,
(2 Arivanms nata Nn 91CJ ● Nnv~mhar Xl 1992 “ -...”..”” --.- ..-. -.” - , .-.”...””. .-”,

Perceptionof fluoride status

40

Of drnking WStW

[

-Yes~No

30

25

20

15

10

5

0 I

Mouthrinsing supplerrWt TmthpIsta

SOURCE Mtbrnl ~Tof HeMI StmMlm, Ntil H-WI Iftavbw Swq, 100S.

Figure 3. Percent of infants and toddlers under 2 years of age using dental care products

containing fluoride by respondent’s perception of fluoride status of drinking watec United

States, 1986

pattern of use is similar to that of

children under 2 years of age. That is,

children who are white, non-Hispanic,

living above the poverty threshold,

and living in homes with a college

educated head of household were

more likely to use fluoride

supplements. Further, children living

in the Northeast and West were ]more

likely to have reported usage.

The differences between

sociodemographically defined

subgroups remained about the same

between the 1983-89 period because

there was almost an equal increase in

use in all subgroups.

In 1983 more black children than

white and more children living in the

South than any other region were

reported to use a fluoride-containing

mouthrinse. This practice appears to

be more common in recent years but

the degree of change is not similar

across subgroups, There is a

disproportional increase in the use of

fluoride mouthrinse among black

children, children living in poverty,

Pre-school age children usage patterns for children 2-4 years and children whose head of

Table 4 shows the

of ;ge~ The use of dieta~ fluoride

fluoride-containing dental product

supplements has increased 3.7

percent between 1983 and 1989. The

IWowledga ofpurpose

offluoridation

40

r

-YesEXlf.b

35

so

25

20

15

10

5

0 I

Moufhrinsing 6upplernent Tbothpesb

Figure 4. Percent of infants and toddlers under 2 years of age using dental care products

containing fiuoride by respondent’s knowledge of the purpose of fluoridation: United

States, 1986

household had no college education.

In recent years, when comparing the

Northeast region with other regions, a

different pattern was observed

between subgroups. In 1983 children

in the Northeast reported the Iowest

use of fluoride mouthrinse among all

regions. In 1989 the Northeast ranked

the second highest with respect to

this practice. AISOin 1989, the gap

between black and white pre-school

children with respect to their use of

fluoride mouthrinse widened. The

difference was 4 percent in 1983

compared with 8 percent in 1989.

Figure 5 indicates that the

children in households in which the

respondent thought that their

drinking water was fluoridated

reported to use dietary fluoride

supplements less frequently than

those in households in which the

respondent thought that their

drinking water was not fluoridated.

Children’s use of fluoride toothpaste

or fluoride mouthrinse did not appear

to be related to the respondent’s

perceived presence or absence of

fluoride in the drinking water.
Advance Data No. 219 ● November 20, 1992 7

Table 4. Percent of pre-school-age children (24 years of age) using selected fluoride-containingdental care products, by selected

sociodemographic characteristics: UnitedStates, 1983, 1986, and 1989

[Standard errors are given in parentheses]

Fluoride supplement Mouthrmse Toottvaste

Characteristic 1983 1986 1989 1983 1986 1989 1993 1986 1989

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

Race

Black . . . . . . . . . . . . . . . . . . .

White . . . . . . . . . . . . . . . . . . .

Hispanic

Hispanic . . . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . . .

Poverty status

Atorabave poverty threshold. . . .

Belowpovertythreshold . . . . . . .

Education of head of household

Somecollege . . . . . . . . . . . . . .

Highschoolorless . . . . . . . . . .

Region

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

Midwest, . . . . . . . . . . . . . . . .

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

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

12.7

(0.6)

3.9

(0.9)

15.0

(0.7)

8.1

(1.4)

13.3

(0.7)

14.8

(0.8)

:::)

18.8

(1.1)

(::;)

23.5

(1.7)

7.9

(1.2)

7.2

(0.9)

17.9

(1.5)

14.4

(1.3)

(R)

16.3

(1.6)

9.8

(2.1)

15.1

(1.4)

16.8

(1.5)

&1

(1.6)

18.9

(1.8)

(%

25.0

(2.8)

8.3

(1.6)

&

23.1

(4.6)

16.4

(0.6)

8.6

(1.1)

17.9

(0.7)

11.1

(1.5)

17.2

(0.7)

18.9

(0.7)

(%

21.3

(0.9)

11.7

(0.8)

27.8

(1.8)

10.1

(1.2)

10.8

(().9)

23.1

(1.4)

7.9

(0.4)

11.6

(1.2)

(:)

6.5

(1.1)

(::)

;::)

(%

(%

&

(::)

;:)

9.8

(0.8)

(%

9.4

(0.7)

13.4

(2.1)

8.6

(0.7)

6.9

(1.8)

(%

9.6

(0.7)

:::)

9.5

(0.9)

Y9)

102

(1.6)

9.0

(1.0)

10.3

(1.3)

(;::)

(H)

16.3

(1.5)

(:::)

(%

9.2

(0.5)

9.2

(0.5)

10.5

(1.4)

(:)

10.3

(0.7)

10.1

(1.2)

(;:)

12.2

(0.9)

6.3

(0.8)

91.9

(0.5)

89.2

(1.4)

92.4

(0.5)

87.0

(1.6)

92.5

(0.5)

93.7

(0.5)

87.3

(1,4)

93.8

(0.6)

91.2

(0.6)

91.6

(1.1)

91.8

(0.9)

92.7

(0.8)

91.0

(1.0)

91.2

(0.6)

89,8

(1.6)

91.7

(0.7)

94.3

(1 .4)

90.7

(0.7)

92.7

(0.7)

09.4

(1 ,4)

91.1

(0.9)

91.8

(0.8)

92.7

(1.2)

90.3

(1 .3)

91.5

(1.0)

90.3

(1 .5)

---

---

---

---

---

---

---

---

---

---

---

---

---

NOTES See the appendx for the defmmoncdwmables.

Unknown ISincluded m !otal.

Figure 6 shows that whenthe

informant knew that fluoride

provided protection against dental

caries, thepre-schooi chiIdren were

more Iikelyto be using dietary

fluoride supplements than their

counterparts. A simiIar tendency is

observed regarding the use of fluoride

toothpaste or mouthrinse. However,

the difference in usage of mouthrinse

between these two groups of children

is not statistically significant.

School-age children

Table 5 shows information on

usage among school-age children.

Participation in school-based fluoride

mouthrinse programs did not change

significantly between 19!36and 1989.

During this period, about 1 out of 10

children reported participation in a

school-based fluoride mouthrinse

program. There were, however,

substantial changes among some

subpopulations. In 1986 more

children living in pover~ or in

households with less educated

responsible aduIts reported

participation in these programs. By

1989, the gap had widened. Also by

1989, significantly more bIack children

participated in school mouthrinsing

activities than white chiIdren. In the

earlier year, the highest participation

rates were noted in the West and

Northeast. By 1989, the participation

rates in the South surpassed those of

the Northeast, which actually

decreased.

Dietary fluoride supplements was

the fluoride regimen least used by

schooI-age children. The slight change

in the percent of children using

supplements is primarily due to an

increase in reported consumption

sirq 19S6. The on[y subpopulations

to steadiIy increase the usage over the

entire period were school-age

children who were black, poor, or

from the Northeast or the West. The

remaining subpopulations primarily

increased their usage after 1986 such

that white, nonpoor, non-Hispanic, or

children living in homes with coIIege

educated heads of household were
8 Advance Data No. 219. November 20, 1992

0

%rceptkm offluoridestatus

of drrnkingwater

■ Yes RNo

MOUUwinsing .%pplerrrent Tmthwte

SOURCE: Natbrul ~ & HeMI SIBwks, NabNl He@s Irserwwf Sufvef, 1SM.

Figure 5. Percent of children 24 years of age using dental care products containing

fluoride by respondent’s perception of fluoride status of drinking water: United States,

1986

Iw

60

ao

E

E

f?

40

20

01

howfedge of purpose

offluoridation

■ Yes ❑ No

MOuthrinsing Supplernwlt Tmthpxte

SCURCE: tWmnd C4fSWfor H- S- Ntirnl He81jI lr@3rvtw Suwq, 1SE8.

Figure 6. Percent of children 2-$ years of age using dental care products containing

fluoride by respondent’s knowledge of the purpose of water fluoridation: United States,

1986

more likely to use dietary fluoride

supplements.

Approximately 20 percent of

school-age children use fluorideI containing mouthrinse and this has

increased, especially since 1986. In

1983 the use of fluoride mouthri,nse

was more often reported among

non-Hispanic and among non-pc)or

children. There was also more use by

children living in the South than any

other region. However, due to a

disproportional increase in this

activity throughout the decade, a

different pattern was observed in

1989. Black children increased their

usage more than white children,

resulting in a widening of the

1 percentage point difference

observed in 1983 to 8 percent in 1989.

Both Hispanic and poor children

reported an increase in mouthrinsing

in recent years. Consequently, in 1989

there is not much difference between

poor and non-poor and betieen

Hispanic and non-Hispanic school-age

children,

Figure 7 illustrates the use of

fluoride dental products among

school-age children in relation to the

responding adult’s perception of

fluoride status of their drinking water.

Use of fluoride toothpaste is

unrelated to perception of drinking

water status. However, use of fluoride

mouthrinse is slightly, but

nonsignificantly, more frequent

among children whose responding

adult thought that their drinking

water was not fluoridated.

Participation in school-based fluoride

mouthrinse programs and use of

fluoride supplements were more likely

to occur when adults thought that the

drinking water was not fluoridated.

As shown in figure 8, children were

more likely to use fluoride-containing

dental care products at home if the

informant knew the purpose of

community water fluoridation.

Participation in school-based fluoride

mouthrinse programs, however, was

not significantly different.

School-age children, therefore,

had four potential sources of fluoride

from dentaI-care product

usage – school programs, home

dietary fluoride supplements, home
Advance Data No. 219. November 20.1992 9

Table 5. Percent of school-age children (5-17 years of age) using selected fluoride-containing dental products, by selected

sociodemographic characteristics: United States, 1983, 1986, and 1989.

[Standarderrorsare given in parentheses]

School programs Fluoride supplement Mou!hrrnse Toothpaste

Characteristic 7983 1986 1989 1983 1986 1989 1983 1986 1989 1983 1986 1989

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

Race

Black . . . . . . . . . . . . . . . . .

White. . . . . . . . . . . . . . . . .

Hispanic

Hispanic . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . .

Poverty status

Atorabove poverty threshold. .

Below poverty threshold . . . . .

Education of head of household

Somecollege . . . . . . . . . . . .

Highschoolorleas . . . . . . . .

Region

Noflheast . . . . . . . . . . . . . .

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

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

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

---

——.

---

---

---

—--

---

---

---

---

---

---

---

72.8

(0.8)

14.4

(1.4)

12.5

(0.9)

11.5

(1.3)

13.0

(0.8)

12.0

(0.7)

16.6

(1.5)

11.3

(0.7)

14.3

(1.1)

13.8

(2.1)

10.7

(1.3)

12.2

(1.4)

15.8

(1.6)

13.9

(0,6)

19.1

(1.4)

13.0

(0.6)

12.8

(1.1)

14.1

(0.6)

12.3

(0.5)

20.6

(1.5)

11.0

(0.6)

16.9

(o.&?)

10.3

(0.8)

12.0

(1.1)

16.0

(1.2)

15.7

(1.1)

(u)

(R)

(:;)

(:::)

6.3

(0.3)

(H)

3.3

(0.6)

(;::)

4.9

(0.3)

9.7

(0.7)

3.1

(0.4)

:;)

(E)

6.2

(0.6)

3.3

(0.6)

6.9

(0.8)

5.2

(1.0)

(:)

(%

(Fm

u)

:)

10.4

(1.2)

2.9

(0.5)

;:)

10.0

(2.7)

&

(::)

(a

7.2

(0.8)

(n)

8.9

(0.4)

(n)

10.2

(0.5)

&

11.9

(0.8)

(%

5.8

(0.4)

11.2

(0.7)

16.7

(0.4)

17.4

(1.1)

16.8

(0.4)

11.4

(1.0)

17.3

(0.4)

17.5

(0.4)

14.1

(1.2)

17.6

(0.6)

16.3

(0.5)

14.5

(0.8)

16,6

(0.7)

19.0

(O 8)

14.8

(0.8)

19.2

(0.6)

19.3

(1.3)

19.3

(0.6)

16.1

(1.5)

19.5

(0.6)

20.3

(0.6)

15.0

(1.3)

19.2

(0.8)

19<3

(0.7)

21.4

(1.5)

20.1

(0.9)

19.6

(0.9)

15.0

(1.2)

25.2

(0.5)

32.2

(1.3)

24.0

(0.5)

23.0

(1.2)

25.5

(0.5)

26.3

(0.5)

24.0

(1.2)

24.8

(0.6)

26.0

(0.7)

23.5

(1.1)

24.5

(0.9)

30,0

(0.9)

19.7

(0.9)

95.1

(0.3)

92.5

(1.0)

95.9

(0.2)

92.1

(0.9)

95.5

(0.3)

96.5

(0.2)

92.4

(0.8)

96.4

(0.3)

94.8

(0.4)

95.1

(0.5)

95.9

(0.4)

94.7

(0.5)

94.8

(0.8)

93.7

(0.4)

92.7

(0.8)

93.9

(0.4)

95.1

(0.8)

93.5

(0.4)

94.8

(0.3)

92.3

(1.0)

94.5

(0.5)

93.6

(0.5)

93.8

(0.8)

93.3

(0.8)

93.8

(0.5)

93.8

(0.8)

---

---

---

---

---

---

---

---

---

—--

---

---

---

NOTES See the aDOBndlX for the de fmlon of var!ables.

Unknown !s included in total.

Children 17yeaSof ageareexcluded lnana@es ofschool mouthr!nslng programs.

mouthrinse, and toothpaste. The use

offluoride toothpaste was

rtpproximately 95percent of the

children. Therefore, many of the

children received fluoride from more

than one product. The percentof

children using at least three

fluoridated dental-care products was

4.0 percent among families for which

the responding adult thought that the

drinking water was fluoridated and

8.9 percent among families for which

the responsible adult thought that the

drinking water was not fluoridated.

Dental health care

As table 6 shows, during 1983-89,

pre-school-age children who did not

visit a dentist in the previous year

were less likely to use dietaxy fluoride

supplements than children who

visited a dentist the previous year.

Fluoride supplements can be

obtained only when prescribed by a

health provider such as a physician or

dentist, and in some States by a

pharmacist or physician assistant. In

1983 the number of dental visits \vas

related to the use of dietary fluoride

supplements. That is, the more

frequent the visits the greater the use

of dietary fluoride supplements. In

recent years, however, this association

has disappeared.

In 1983 there was a reiation

between fluoride supplement use and

the interval since the last dental visit.

That is, the shorter the intewal since

the last visit the higher the percent of

reported use of fluoride supplements.

Although the same pattern exists in

recent years, the difference in

supplement intake benveen the

children with a 6-month interval

6 months to l-year interval

disappeared.

Between 1983 and 1989,

mouthrinsing with fluoride was

or

related to having a dental visit during

the past year, the number of dental

visits, and the interval since the last

dental visit. This pattern did not

change over time. Brushing with

fluoride toothpaste was more
10 Advance Data No. 219. November 20, 1992

100

80

80

z

f!

40

20

0

perceptionof fluoridestatus

of drinkingwater

■ Yes ❑ No

Figure 7. Percent of school children using dental care products containing fluoride by

respondent’s perception of fiuorlde status of drinking water: United States, 1986

Kmwfedge of purpose

of fluoridation

■ YeS ❑ No

Figure 8. Percent of school chiidren S-17 years of age using dental care products

containing fiuoride by respondent’s knowiedge of the purpose of water fluoridation:

United States, 1986

frequently reported among children

who had a dental visit during the

previous year. However, the number

of dental visits and the interval since

the last visit did not appear to be

related to the use of a fluoride

toothpaste.

As table 7 shows, in 1986 among

school-age children, the participation

in school-based fluoride mouthrin,se

programs did not appear to be

related to dental health care

utilization. However in 1989, due to

increased participation in schoolbased fluoride mouthrinse progra)ms

among those with no dental visit or

with few dental visits, an inverse

relationship between dental health

care and participation in fluoride

mouthrinsing school program was

observed. This observation is due to

I the increase in the number of lower

income participants in these

programs. Concomitantly, lower

income groups are less likely to

report dental visits.

During this period, school-age

children who had any dental visits

reported taking fluoride supplements

more frequently than those who did

not have any dental visits. In these

children, those with two visits per

year were more likely to use dietag

supplements than those with one visit

or with three or more visits. The

length of interval since the previous

visit appeared to be related to the use

of fluoride supplements. That is, the

shorter the interval the more

frequently this activity was reported.

Similarly, mouthrinsing with a

fluoride-containing solution at home

was related to dental visits. Children

who had no visits or who had fewer

visits were less likely to rinse with

fluoride. The relation of the length of

interval since the last visit and rinsing

with ffuoride was more pronounced in

1983. In recent years, the apparent

relationship between this activity with

length of interval was diminished

among those who reported a year or

longer interval since their last dental

visit.

There was no statistically

different likelihood of participating in

school-based fluoride programs
Advance Data No. 219 ● November 20, 1992 11

Table 6. Percent of pm-school-age children (2 to 4 years of age) using selected fluoride-containing dental care products, by dentai care

variablew United States, 1983, 1986, and 1989

[Standard errors are given in parentheses]

F/uoride supp/emenf Mouthrinse Toof/rpaste

Dental care variables 1983 7988 1989 1963 1986 1989 1983 1986 1989

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

Had a dental visit in peat year

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

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

Number of visits in past year

o. . . . . . . . . . . . . . . . . . . . . .

1. . . . . . . . . . . . . . . . . . . . . .

2 . . . . . . . . . . . . . . . . . . . . . .

3ormora . . . . . . . . . . . . . . . .

Intewal since last dental visit

Lessthan 6months . . . . . . . . . .

6toll months . . . . . . . . . . . . .

lyearto2years . . . . . . . . . . . .

Never, . . . . . . . . . . . . . . . . . .

12.7

(0.6)

14.4

(1.3)

16.4

(0.6) (G 91.9

(0.5)

91.2

(0.6)

---

17.6

(1.1)

10.9

(0.6)

20.1

(1.9)

11.9

(1.3)

22.3

(1.2)

14.2

(0.7)

13.4

(1 .0)

5<8

(0.4)

15.0

(1,3)

7.1

(0.7)

14.4

(1.0)

;:;

95.8

(0.6)

90.7

(0.6)

94.0

(0.8)

91.8

(0,7)

---

---

10.9

(0.7)

15.2

(1.3)

21.4

(2.4)

22.4

(3.4)

11.9

(1.3)

18.8

(2.3)

23.8

(3.5)

18.9

(3.8)

14.2

(0.7)

21.5

(1.4)

24.4

(2.3)

21.6

(4.1)

(R)

10.9

(1.1)

15.2

(1.9)

23.9

(3.7)

&

13.1

(1.6)

17.3

(2.7)

22.6

(3.7)

(E)

11.5

(1.2)

18.6

(2.0)

23.3

(4.0)

90.7

(0.6)

95.8

(0.8)

95.2

(1.3)

97.6

(1.2)

91.8

(0.7’)

95.4

(0.9)

80.2

(2.1)

95.2

(2.4)

---

---

---

---

19.2

(1.4)

14.1

(1.9)

;)

10.6

19.2

(2.1)

20.7

(2.8)

12.0

(3.7J

11.8

22.3

(1.4)

22.2

(2.0)

14.6

(2.9)

14.2

14.3

(1.2)

11.4

(1.7)

10.7

(2.6)

5.7

14.5

(1.6)

15.8

(2.2)

&

7.1

14.7

(1.2)

14.0

(1.7’)

15.3

(2.9)

6.9

96.0

(0.7)

95.5

(1.3)

93.6

(2.1)

91.2

94.6

(1.0)

94.3

(1.4)

93.8

(3.8)

91.6

---

---

---

---

(0.7) (1.2) (0.7) (0.5) (0.8) (0.5) (0.6) (0.7)

NOTE Unknown is included in total.

between children whodidor did not

have dentaI sealants.

Discussion

TheU.S. Public Health Service

recently reviewed the public health

risks and benefits offluoridesin

drinking water and other sources (7).

The report concluded the need for

“continueduse of fluoride to prevent

dental caries and continued support

for optimal fluoridation of drinking

water.” It also recommended,

however, that “in accordance with

prudent health practice of using the

appropriate amount to achieve a

desired eflect, ... health professionals

and the public should avoid excessive

and inappropriate fluoride exposure”

(7). Since the 1940’s, when the

inverse association between fluoride

intake and dental caries was noted,

many different sources of fluoride

have become available. Therefore, it

is important to characterize the

distribution of total exposure in

individuals. Although the data

described in this report cannot

comprehensively address the issue of

total exposure, reported use of

fluoride containing products is an

important source of information

regarding fluoride exposure. Among

2-year-old children, more than

one-half of the estimated fluoride

exposure in communities with fluoride

deficient drinking water and one-third

in communities with optimally

fluoridated drinking water are

thought to be due to dieta~ fluoride

supplements, fluoride dentifrice, or

both (7).

The practice of giving children

daily dietary fluoride supplements was

developed for use in areas where

optimally fluoridated drinking water

is not available. The current

recommendations for prescribing

dietary fluoride supplements depends

on the age of the child and the

concentration of fluoride in the

drinking water (8).

In 1990 the U.S. Public Health

Service published Healthy People 2000

(9). One of the objectives contained

in this document is to increase to at

least 75 percent the proportion of

people served by community water

systems providing optimal levels of

fluoride. Another objective is to

increase the use of dietary fluoride

supplements to at least S5 percent of

those children not receiving optimally

fluoridated drinking water. The areas

currently less likely to be served by

fluoridated community water systems

include rural areas throughout the

United States and the West. In the

West in 1989, only 23 percent of the

population had access to fluoridated

public water supplies, whereas 78

percent in the Midwest, 63 percent in

the South, and 50 percent in the

Northeast had access to fluoridated

public water supplies (calculated

based on data derived from CDC

Fluoridation Census 19S9-Summarv

(2)).
12 Advance Data No. 219. November 20, 1992

Table 7. Percentage of school-age children (5 to 17 years of age) using selected fluoride-containing dental products, by selected dental

health care variables: United States, 1983, 1986, and 1989

[Standard errors are given m parentheses]

School programs F/uoride supp/emerrt Mouthrinse Tooftr?aste

Denfa/ care var/ab/es 1963 1986 1989 1983 1986 1989 1983 1986 1989 1983 1986 1989

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

Had a dental visit in past year

Yea . . . . . . . . . . . . . . . . . . . .

No, . . . . . . . . . . . . . . . . . . . .

Numbar of visits in past year

o, . . . . . . . . . . . . . . . . . . . . .

l . . . . . . . . . . . . . . . . . . . . . .

2 . . . . . . . . . . . . . . . . . . . . . .

3ormore . . . . . . . . . . . . . . . .

Interval since last dental vistt

Lessthan 6months . . . . . . . . . .

6toll months . . . . . . . . . . . .

lyearto2yaars . . . . . . . . . . . .

2yearsto 5yeare . . . . . . . . . .

5yeara ormore . . . . . . . . . . ,,

Never . . . . . . . . . . . . . . . . . . .

Had dental sealants

Yak . . . . . . . . . . . . . . . . . . . .

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

———

---

---

---

---

—--

---

-—-

———

---

---

—--

--—

——-

---

12.8

(0.8)

13,1

(0.8)

12,5

(1.1)

12.5

(1.1)

13.1

(1.0)

13.0

(1 ,0)

13,3

(1 .3)

13.8

(0.9)

12.0

(1 .0)

13.4

(1.5)

12,0

(1 ,6)

9.1

(2.3)

13.1

(1.8)

13.5

(1,5)

12,9

(0.8)

13.9

(0.6)

13.6

(0.6)

16.3

(1.0)

16.3

(1.0)

14.8

(0.7)

13.4

(0.8)

11.8

(0.6)

12.7

(0,6)

15.5

(0.8)

15.6

(1.2)

18.2

(1 6)

16,9

(2.9)

14.9

(1.5)

13.5

(0.9)

14.5

(0.6)

6.0

(0.6]

7.4

(0.3)

3.3

(0.3)

(::;)

6.5

(0.4)

9.4

(0.6)

6.6

(0,5)

8.1

(0.4)

5.9

(0.5)

3.2

(0.5)

3.4

(0,6)

0,6

(0.4)

4.1

(0.6)

---

-——

6.2

(0.6)

7.4

(0.6)

3.4

(0.4)

3,4

(0.4)

7.0

(0.6)

9.3

(1.2)

5.6

(0.7)

7.7

(0.8)

6.5

(1.0)

2.6

(0.6)

2.9

(0,7)

(1.4)

(0.9)

(:::)

10.6

(1.9)

5.9

(0.6)

6.1

(0.3)

9.6

(0.4)

5.1

(0.4)

5.1

(0.4)

(::)

11,2

(0,6)

9.4

(0.6)

10.6

(0.5)

8.3

(0.6)

5.2

(0.6)

4.4

(0.6)

3.6

(1.1)

5.7

(0.7)

13.1

(0.9)

(:)

16.7

(0.4]

18.8

(0.5)

12.5

(0,6)

12.5

(0.6)

16.2

(0.7)

16.7

(0.8)

22.5

(0.8)

20.1

(0.6)

16.4

(0.8)

14,8

(1.0)

13,4

(1.2)

10.2

(1.7)

9.8

(0.6)

---

---

19.2

(0.6)

21.8

(0.7)

13.3

(0.8)

13.3

(0.8)

19.0

(0.9)

22.7

(1.0)

25.6

(1.1)

22.9

(0.8)

19.9

(1.0)

16.6

(1.4)

12.7

(1.3)

10.3

(2.1)

11.6

(1.3)

24.8

(1.9)

18.8

(0.6)

25.2

(0.5)

27.6

(0.6)

22.2

(0.6)

22.2

(0.8)

26.4

(0.8)

25.7

(0.6)

33.0

(1.0)

28.0

(0.6)

27.5

(0.9)

26.1

(1.4)

22.9

(1.4)

24.7

(2.6)

16,7

(1.5)

29.1

(1.2)

25.4

(0.5)

95.1

(0.3)

96.7

(0.2)

93.2

(0.5)

93.2

(0.5)

96.1

(0.4)

96.9

(0.3)

97.2

(0.4)

96.6

(0.3)

96.2

(0.4)

95.6

(0.6)

95.5

(0.7)

92.8

(2.5)

90.7

(1.1)

---

---

93.7

(0.4)

94.8

(0,4)

93.9

(0.5)

93.9

(0.5)

94.8

(0.5)

94.4

(0,7)

95.4

(0.6)

94.6

(0.5)

95.2

(0.6)

94.5

(0.9)

93.9

(0.9)

92.8

(1.9)

93.6

(0.9)

95.4

(0.9)

94.2

(0.3)

---

---

---

---

---

---

---

---

—--

—--

---

---

---

---

---

NOTES Unknown is included m total.

Children 17 years at age are excluded m analyses of schc!ol mouthnnamg programs.

Children living in the West, which

has the lowest percent of the

population served byfluoridated

water systems, were the most Iikelyto

receive fluoride supplementsor

participate in school-based fluoride

mouthrinse programs. As manyas

one in four children may receive

thesein all age groups. However, in

the Northeast, which has a higher

percent of the population receiving

fluoridated water, the percent of

children receiving other types of

fluoride also wasaboutone in four,

except in school-age children for

whom there were fewer children

served by school-based programs than

in the West. In the Midwest, which

had the highest percen~ of the

population receiving fluoridated

community drinking water, the

reported use.of dietary fluoride

supplements was the lowest of all the

regions. It is not possible to

determine from the interview data

whether the children also had access

to optimally fluoridated drinking

water. Hence, the appropriate use of

dietary fluoride supplements is

suggestive only.

During the interview, the adult

informant was asked whether they

thought that their drinking water was

fluoridated. These data likely include

a great deal of false positive and false

negative information. However, this

question and the question on the

informant’s knowledge of the purpose

of water fluoridation tend to reflect

the informant’s understanding of the

public health importance of fluoride.

In both instances, the children who

use flouride supplements are more

likely to live in households where

responding adults either thought that

their water was not fluoridated or

who understood the purpose of

communi~ water fluoridation. In all

age groups, the percent of childre]~

receiving supplements from these

adults was about triple the percent of

the remainder of the children.

Knowledge is correlated with

education of the head of the

household, poverty status, and

utilization of dental health care. AS

would be expected, children of higher

educated parents, living in above

poverty level homes, and receiving

regular dental care are more likely to
Advance Data No. 219. November 20, 1992 13

receive dietary fluoride supplements

in some form. A multivariate analysis

is required to determine whether

parents are willing to continue

providing supplements if they have

appropriate knowledge of the purpose

of the supplement or knowledge of

why their children may be lacking the

optimal amount of fluoride otherwise.

The greater increase in the use of

fluorides, either dietary fluoride

supplements or school-based fluoride

rinse programs, occurred among

minority groups —either black or

Hispanic. In all age groups over these

6 years, the percent of children

receiving dietae~ fluoride supplements

increased to more than 150 percent

of the level in 1983. Children

participating in school-based rinse

programs also increased slightly.

There also were notable increases,

almost doubling, among school-age

minority groups in the use of fluoride

mouthrinse.

One issue that should be

addressed by public health officials is

the use of toothpaste among infants

and toddlers and chiIdren below

5 years of age. These data indicate

that aImost one in three of these

chiIdren are brushing with a fluoride

toothpaste. Given the propensity of

young chiIdren to swalIow toothpaste,

the impact of this practice in Iight of

other possible sources of fluoride in

the water, food, and possibly through

fluoride supplements should be

studied (10).

These data indicate that among

children there has been an increase

in use of fluoride products, in

addition to fluoride toothpaste. Use

of fluoride toothpaste is almost

ubiquitous. However, increases

occurred in all age groups for aIl

other forms of fluoride, including

dietary fluoride supplements and

fluoride mouthrinse at home and in

school-based programs. The increases

during the 6 years covered by these

surveys have been moderate or slight.

Whether all of these increases are in

accordance with prudent health

practices or whether some children

might be receiving more than optimal

exposure to fluoride should be

studied.

References

1.

2.

3.

4.

5.

Centers for Disease Control. Fluoridation Census 1985.Atlanta: Centers

for Disease Control. 1988.

Centers for Disease Control.

Fluoridation Census 1989,SummaT.

Atlanta Centers for Disease Control.

1991.

National Center for Health Statistics.

Prevention profile. Health, United

States, 1991.Hyattsville, Ma@and

Public Health Semite. 1992.

National Institute of Dental

Research. Oral health of United

States children, the Nationa[ Survev

of Dental Caries in U.S. School -

Children: 19S6-87. National and

regional findings. NIH Publication no

89-2247.1989.

Dean HT. Chronic endemic fluorosis

(mottled enamel). J Am Dent Assoc

107:1269-72.1936.

6. Dean HT. Elvove E. Further studies

7.

8.

9.

10.

11.

12.

13.

14.

.,— —

on the minimal threshold of chronic

endemic dental fiuorosis. Public

Health Rep 521249-64.1937.

Committee to Coordinate

Environmental Health and Related

Programs. Review of fluoride risks

and benefits. Washington: Public

Health Service. 1990.

American Dental &xociation.

Accepted dental therapeutics.

Chicago, Illinois: Council on dental

therapeutics. Am Dent Assoc. 1984.

U.S. Department of Health and

Human Services. Healthy people

2000: National health promotion and

disease prevention objectives.

Washington: Public Health Service.

1991.

Horowitz HS. Appropriate uses of

fluoride: Considerations for the 1990

summary.J Pub Health Dent

51:60-63.1991.

National Center for Health Statistics.

The National Health Interview Survey

design, 1978-84, and procedures,

1975-83. National Center for Health

Statistics. Vital Health Stat 1(18).

1985.

Massey JT, Moore TF, Parsons VL,

Tadros W. Design and estimation for

the National Health Interview Sumey,

1985-94.National Center for Health

Statistics. Vital Health Stat 2(110).

1989.

Survey Data Analysis (SUDAAN).

Manual. Research Triangle Institute.

U.S. Bureau of the Census. Poverty in

the United States, 1990.Current

population report$ series P-20, no

175.Washington: U.S. Department of

Commerce. 1991.
14 Advance Data No. 219 ● November 20, 1992

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
Advance Data No. 219. November 20, 1992 15

Technical notes

Source of data and sample

design

This report is based on data from

the National Health Interview Survey

(NHIS), an ongoing survey of

households in the United States

conducted by the NationaI Center for

Health Statistics. It has been

conducted continuously since 1957.

Each week, a probability sample of

the civilian noninstitutionalized

population of the United States is

interviewed by personnel of the U.S.

Bureau of the Census. Interviewers

obtain information about the health

and other characteristics of the

households included in the NHIS

samp[e.

NHIS consists of two parts: (a) a

basic health questionnaire that

remains the same each year and is

completed for each household

member and (b) special topics

questionnaires that vary from year to

year and usually are asked of selected

persons in each family. The estimates

presented in this report are based on

special oral health questions included

in the 1983, 1986, and 1989 suweys.

In 1983 the interviewed sample

consisted of 41,000 households

containing 106,000 individuals. The

total nonresponse rate was

3.3 percent; 2 percent was due to

respondent refusaI. and the

remainder was primarily due to

faiiure to locate an eligible

respondent at home qfter repeated

calls. In 1986 the number of

households interviewed was 23,838

containing 62,502 individuals. The

total nonresponse rate was

3.5 percent; 2.3 percent was due

primarily to failure to locate an

eligible respondent at home after

repeated calls. In 1989 the number of

households interviewed was 45,711

households containing 116,929

individuals. The total nonresponse

rate was 5.1 percent; 3.0 percent was

the result of respondent refusal, and

the remainder was primarily the

result of faiIure to locate an eligible

respondent at home after repeated

calls.

Special attention should be given

when comparing statistics between

survey years because the design of the

sample of the NHIS changes

following each decennial census. For

example, the sampling design in the

19S3 NHIS is different from the

sampling design used in 1986 and

1989 NHIS. The basic sampling

design for 1986 and 1989 is similar,

however, due to budgetary constraints,

only 50 percent of the original

sample was collected in 1986.

Therefore, the standard errors of the

estimates of 1986 are generally larger

than the other years. The information

on survey design and the method

used in estimation and other NHIS

specifications are published elsewhere

(11,12).

Because the estimates presented

in this report are based on a sample

of the population, they are subject to

sampling errors. Standard errors of

most estimates have been included in

the tables in parentheses. The

standard errors for this report were

calculated using SUDA%N, a

SAS-based sofhvare package designed

to produce standard errors for

estimates based on complex

multistage sample designs (13).

Definition of terms

Age – The age recorded for each

person is the age at last birthday. Age

is recorded in single years.

Education -The categories of

educational status refer to years of

school completed. Only years

completed in regular schools in which

persons are given a formal education

are included. A regular school is one

that advances a person toward an

elementary or high school diploma or

a college, university, or professional

school degree. Thus, education in

vocational, trade, or business schools

outside the regular school system is

not counted in determining the

highest grade of schooi completed.

Race -The population is divided

into three racial groups: “white,”

“black,” and “all other.” “AU other”

includes Aleut, Eskimo, or Anerican

Indian; Asian or Pacific IsIandeG and

any other races. Although the data

base identities these three groups, the

sample size for “others” is too small

to anal~ze them separately.

Characterization of race is based on

the respondent’s description of his or

her racial background.

Hispanic or non-Hispanic – A

respondent was classified as Hispanic

origin if he or she was self-identified

as Puerto Rican, Cuban, MexicanMexican, Mexican-American,

Chicano, Other Latino &nerican, or

Other Spanish. Non-Hispanic are all

other individuals.

Poverty inder-The poverty index

is based on U.S. Bureau of the

Census poverty threshold matrix. This

matrix lists poverty threshold levels by

age of the head of the household,

family size, and the number of

children. Detailed information on the

derivation of poverty threshold is

published elsewhere (14).

Geographic region –The

classification of regions in the

National Health Interview Suwey

corresponds to those used by the U.S.

Bureau of the Census. The States are

grouped into four regions as follow

●

●

●

●

Northeast – Maine, Vermont,

New Hampshire, .Massachusetts,

Connecticut, Rhode Island, New

York, New Jersey, and

Pennsylvania.

Midwest – Ohio, Illinois, Indiana,

Michigan, Wisconsin, Minnesota,

Iowa, Missouri, North Dakota,

South Dakota, Kansas, and

Nebraska.

South–Delaware, Maryland,

District of Columbia, West

Virginia, Virginia, Kentucky,

Tennessee, North CaroIina, South

Carolina, Georgia, Florida,

Alabama, Mississippi, Louisiana,

Oklahoma, Arkansas, and Texas.

West – Washington, Oregon,

California, Ne\’ada, New Mexico,

Arizona, Idaho, Utah, Colorado,

Montana, Wyoming, Alaska, and

Hawaii.
16 Advance Data No. 219. November 20, 1992

Suggested citation Copyright Information National Center for Health Statistics

Wagener DK, Nourjah P, and Horowitz A. This report may be reprinted without further Director

Trends in childhood use of dental care permission. Manning Feinleib, M. D., Dr. P.H.

‘ products containing fluoride: United States,

1983-89. Advance data from vital and health Acting Deputy Dkector

statistics: no 219. +attsville, Marviand:

Jack R. Anderson

National Center for ~ealth Statisti&. 1992.
Number 220 . November 12, 1992

Advance

Data

From Vital and Health Statistics of the CENTERS FOR DISEASE CONTROL/National Center for Health Statistics

Expected Principal Source of Payment for Hospital

Discharges: United States, 1990

by Edmund J. Graves, Division of Health Care Statistics

Introduction

In the United States during 1990,

non-Federal short-stay hospitals

discharged an estimated 30.8 miIlion

inpatients, excluding newborn infants.

Of these 30.8 million, 11.9 million

indicated private insurance as their

expected principal source of pa-ymen~

15.2 mi]lion cited Medi~a~e,

Medicaid, or other pubIic programs;

and 2.7 million wele in the “self-pay,

no charge, or other” category.

Estimates in this report are based

on the National HospitaI Discharge

Survey (NHDS), which has been

conducted annually by the National

Center for Health Statistics (NCHS)

since 1965. For the 199Q NHDS,

researchers abstracted data from the

medicaI records of approximately

266,000 patients discharged from 474

short-stay hospitals. This survey

reflects a redesign that took place in

1988. A brief description of this new

design, data collection procedures,

and the estimation process can be

found in the section entitled

“Technical notes.” A detailed

description of the original and new

designs of the NHDS have been

pubIished by the NCHS (l).

Definitions of terms used in this

report are also provided in the

TechnicaI notes, It should be noted

that “source of payment” refers to

the expected principal source of

payment. The terms “patient,”

“inpatient,” and “discharge” are used

here synonymously, and that these

terms do not refer to individual

persons. An individual may have

more than one hospitalization during

a year and thus count as more than

one patient, inpatient, or discharge.

From 1968 through 1970,

information on hospital charges and

sources of payment was colIected

Acknowledgments

from a subsampIe of the NHDS (2).

No information on charges or sources

of payment was colIected in the

NHDS from 1971 through 1976.

Beginning in 1977, data on patients’

expected principal sources of payment

and other expected sources of

payment were coIIected from the face

sheets of medicaI records in the

NHDS sampIe.

Estimates in this report are based

on what patients indicated as the

expected principal source of payment.

Data on expected source of payment

from the NHDS for 1977, 1979, and

1985 (3-5), as welI as summary data

for 1982–1990 (6-14), have been

published. Statistics in these reports,

as well as in this one, reflect only the

patients’ principaI source of payment.

The 1977 report presented

estimates of source of payment by age

and sex of patients along with

estimates for major diagnostic and

This report was prepared in the Division of Health Statistics. Jean Kozak, of the Hospital Care Statistics Branch, provided technical assistance

in developing the style and content. Maria Owens, also of the Hospital Care Statistics Branch, assisted in testing the reliability of the statistical

statements. Dorothy Graham, of the Technical Services Branch, verified the data. Charles Adams and hfalcolm Graham, also of the Technical

Services Branch, advised on the computer programming aspects. This report was edited by Margaret Avery and typeset by Jacqueline M. Davis of the

Publications Branch.

*#* -r’%,

#

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES *

$ Public Health Service

:s Centers for Disease Control 5%ttin= -2

National Center for Health Statistics CEWERS CDC FOR OISSA.SE COhTROL
2 Advance Data No. 220. November 12, 1992

surgical categories. The 1979 and

1985 reports updated these basic

estimates and provided analysis by

additional characteristics of patients

and hospitals. This report includes

estimates by source of payment; sex,

age, and race of patients; and

geographic region of hospital.

Selected diagnostic and procedure

categories are also shown by source

of payment. The survey form used to

collect these data is reproduced in

another NCHS publication (14).

According to the NHDS,

approximately 6 percent of discharges

from short-stay hospitals in 1990

indicated self-pay as their source of

payment. On the other hand, data

from the National Health Interview

Survey (NHIS) for 1989 indicated

that 14 percent of the population had

no coverage (15). This implies that

the number of the hospitalized

uninsured was proportionally smaller

than that of the hospitalized insured.

However, some individuals who

reported no health insurance at

admission may have found on being

hospitalized that they were covered

under a public program.

In 1990, the percent of hospital

discharges covered by private

insurance was 38.7 percent. This was

much lower than the 76.1 percent of

the population estimated by the 1989

NHIS (15) to have private insurance

coverage. This difference could be

attributed to several factors: Persons

with private insurance tend to be

younger and healthier than persons

under public programs and are

therefore hospitalized less frequently

public programs are often billed first

for hospital charges; and individuals

citing private coverage may be using

it as a secondary source of payment.

In some cases the expected

source of payment recorded on the

face sheet of the medical record may

not have been the actual source of

payment. For example, a patient

admitted to a hospital following an

automobile accident may have cited

Blue Cross as the expected source of

payment when, in fact, an automobile

insurance company ultimately made

restitution. Also, because of the

manner in which this variable was

collected, it was not possible to

determine the charge for the hospital

stay or the proportions of the hospital

stay and medical services covered by

the principal source of payment

indicated.

Highlights

●

●

●

●

●

●

●

●

●

In 1990, approximately

39 percent of hospitalized

patients expected private

insurance to pay for their hospital

stay, compared with 53 percent

in 1979.

In 1990 approximately 49 percent

of hospitalized patients expected

public programs to pay for their

hospital stay, compared with

40 percent in 1979.

The average length of stay for

patients expecting private

insurance to pay for their hospital

stay was 4.9 days compared with

7.8 days for public programs.

The average age of patients

expecting private insurance to pay

for their hospital stay was 35.3

years. For those expecting public

programs to pay for their

hospitalization, it was 68.6 years.

White patients were more Iikely

than black patients to report

private insurance and Medicare

as sources of payment. Black

patients were more likely than

white patients to be in the

Medicaid and self-pay categories.

About 65 percent of patients

hospitalized for benign neoplasms

expected private insurance to pay

for their hospitalization; for

malignant neoplasms, it was

35 percent.

The diagnostic categories with

high proportions of discharges

covered by Medicare (congestive

heart failure, hyperplasia of

prostate, and cerebrovascular

disease) reflected the greater age

of Medicare patients.

Medicaid was the payment source

for 12 percent of all patients, but

for 28 percent of women

hospitalized for childbirth.

Although only 6 percent of all

patients were in the self-pay

category, that catego~ accounted

●

●

●

for 22 percent of patients with

lacerations and open wounds.

Of all patients with a

hysterectomy performed,

approximately 71 percent

expected private insurance to pay

for their hospitalization.

Other government payments,

including Workers’

Compensation, accounted for

4 percent of surgeries, and fair

22 percent of excision or

destruction of an intervertebral

disc.

Medicare was the source of

payment for more than half of all

endoscopies of the small

intestine, colonoscopies and

sigmoidoscopies, and cystoscopies,

excluding those with biopsies.

Trends

Three payment categories are

shown in table 1: private insurance;

public programs; and other types of

payment (self-pay, no charge, and

other). Private insurance includes

Blue Cross, health maintenance

organizations (HMO’s), and other

commercial insurance. Public

programs include Medicare,

Medicaid, Workers’ Compensation,

and other government programs.

The number of patients expecting

to pay their hospital bills through

private insurance declined from 19.3

million (52 percent) in 1979 to 11..9

million (39 percent) in 1990. In 1979,

14.7 million hospitalized patients

(40 percent) expected to pay their

hospital bills through a public

program, compared with 15.2 million

(49 percent) in 1990. The number of

patients in the self-pay, no charge,

and other category was approximately

2.7 million, both in 1979 (7 percent

of all discharges) and in 1990

(9 percent of all discharges).

The number and proportion of

hospital days expected to be paid for

by private insurance also declinecl. In

1979, private insurance covered 113.3

million hospital days (43 percent of

all days of care), compared with only

58.5 million (30 percent) in 1990,

Public programs were the expected

source of payment for 135.5 million
Advance Data No. 220. November 12, 1992 3

Table 1. Number of Patients discharged from short-stay hospitals, days of care, average

length of stay, and average age of patient, by expected principal source of paymenk

United States, selected years 1979-90

[Discharges from non-Federal hospitals. Excludes newborn infants]

Number of Days of Average Average

Expected prjrrcipal discharges care in length of

source of payment Year

age of

in thousands thousands stay m days patient

All sources of payment . . . . . . . 1979 36,747 264,173 7.2 43.7

1985 35,056 226,217 6.5 46.7

‘1990 30,788 197,422 6.4 47.9

Private insurance. . . . . . . . . . . 1979 19,289 113,329 34.4

1985 15,726 63,031 2: 35.9

1990 11,926 58,531 4.9 35.3

Public programs . . . . . . . . . . . 1979 14,713 135,453 9.2 58.5

1965 16,231 126,920 6.2 60.2

1990 15,213 116,563 7.a 66.6

Self-pay, other sources of . . . . . 1979 2,744 15,392 5.7 29.9

payments, and no charge 1985 3,096 16,265 5.3 30.7

1990 2,657 14,675 5.5 31.2

1ln~ludes data for pahente whose expected imwal s-se of mwnt ~S not*ted.

days of care in 1979, which was

51 percent of all inpatient days. In

1990, the number of days of care in

the public category had decreased to

118.6 million, but the category

accounted for 60 percent of the total

days. The number of days of care in

the seIf-pay, no charge, and other

category was 15.4 million (6 percent)

in 1979, and 14.7 million (7 percent)

in 1990.

Patients with public programs as

their source of payment had

consistently longer average lengths of

stay than patients with private

insurance, although average lengths

of stay decreased for both groups

from 1979 to 1990. In 1990, the

average length of stay for public

patients was 7.8 days, compared with

4.9 days for private patients. This is

primarily because of .Nfedicare, which

was designed to help the elderly

defray the cost of medicaI care (older

people tend to have more chronic

ailments and Ionger hospital stays

than younger people). In 1990, the

average age of those expecting public

programs to pay for their hospital

stay was 68.6 years, compared with an

average age of 35.3 years for those

with private insurance as their

payment source. The relationship of

age and coverage underlies many of

the findings in this report.

Patients in the self-pay, no

charge, and other category had

similar average lengths of stay in 1979

(5.7 days) and in 1990 (5.5 days). The

average age of these patients was 29.9

years in 1979 and 31.2 years in 1990.

Patient characteristics

The number and percent

distribution of patients discharged

from short-stay hospitals by expected

source of payment, according to age

and sex, are shown in table 2, Private

insurance was the expected source of

payment for at least 50 percent of

discharges in all age groups except for

those 65 years of age and over.

Approximately 90 percent of

discharges 65 years of age and over

reported Medicare as their principal

expected source of payment.

Medicaid and self-pay categories

accounted for larger proportions of

discharges under 45 years of age than

for those 45 years of age and over.

Females were more likely to have

Medicaid as a source of payment

(14 percent) than were males

(8 percent).

Expected sources of payment

differed for white and black patients,

as shown in table 3. Approximately

41 percent of white patients expected

private insurance to pay for their

hospital stay, compared with

29 percent of black patients.

Medicare was an expected source of

payment for 38 percent of the white

patients, but for only 24 percent of

the black patients. In contrast,

8 percent of white patients and

27 percent of black patients indicated

Medicaid as an expected source of

payment, and the self-pay categoxy

accounted for 5 percent of white

patients and for almost 9 percent of

black patients.

The percent of inpatients with

private insurance as an expected

source of payment ranged from

42 percent in the West to 36 percent

in the Northeast. The percent of

inpatients expecting the Medicare

program to pay for their

hospitalization ranged from

36 percent in the West to 30 percent

in the Midwest.

Utilization by diagnosis

Table 4 provides the number and

percent distribution of discharges by

expected source of payment,

according to selected diagnostic

categories. Although 39 percent of all

discharges expected private insurance

to pay for their hospital stay, private

insurance was the expected source of

payment for 65 percent of discharges

with benign neoplasms and neoplasms

of uncertain behavior and unspecified

nature, 54 percent of females with

deliveries, 52 percent of discharges

with an intervertebral disc disorder,

50 percent of discharges with

noninfectious enteritis and colitis, and

49 percent of discharges with

choIelithiasis.

Thirty-five percent of hospital

discharges expected Medicare to pay

for their hospital stay. The diagnostic

categories with high proportions of

discharges covered by Medicare

reflect the older age of Medicare

discharges. For example, Medicare

was the expected source of payment

for 78 percent of discharges with

congestive heart failure, 72 percent

of discharges with cerebrovascular

disease, and 71 percent of discharges

with hyperplasia of prostate.

Of particular interest is the

contrast in sources of payment for

types of neoplasms. The incidence of

maIignant neoplasms increases with

age. As a result, among patients with

a maIignant neoplasm, 50 percent

expected Medicare to be their source

of payment, and 35 percent expected

private insurance to pay for their
4 Advance Data No. 220. November 12, 1992

Table 2. Number and percent distribution of patients discharged from short-stay hospitals by expected principal source of payment,

according to sex and age: UnitedStates, 1990

[Discharges from non-Federal hospitals. Excludes newborn infants]

A// expected Other Other payments Payment

prrncipal sources Private government and

Sex and age of payment insurance Medicare Medicaid

source not

payments Self-pay no charge stated

Both sexes

Alleges . . . . . . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . .

1544 years. . . . . . . . . . . . . . . . . . . . . . . .

45-64 years . ., .,, . . . . . . . . . . . . . .

65 years and over, . . . . . . . . . . . . . . . . . . .

Male

Alleges . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . . . . . . . . .

15+4years . . . . . . . . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . . . .

Female

All eges, . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . . . . . . . . . . .

15-44years . . . . . . . . . . . . . . . . . . . . . . .

45-64years, . ., . . . . . . . . . . . . . . . . .

65years And over . . . . . . . . . . . . . . . . . . . .

Both sexes

Alleges . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . . . . . . . . . . .

15-44years, . . . . . . . . . . . . . . . . . . . . . . .

45-64years, . . . . . . . . . . . . . . . . . . . .

65yaars Andover . . . . . . . . . . . . . . . . . . .

Male

Alleges . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . . . . . . . . . .

15-44yaars, . . . . . . . . . . . . . . . . . . . . . .

45-64yaars, . . . . . . . . . . . . . . . . . . . . . . .

65years Andover . . . . . . . . . . . . . . . . . . . .

Female

All eges . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . . . . . . . . . . .

15-44years . . . . . . . . . . . . . . . . . . . . . . . .

45-64 years. . . . . . . . . . . . . . . . . . . . . . . .

65years Andover . . . . . . . . . . . . . . . . . . .

30,788

2,412

11,799

6,244

10,333

12,280

1,362

3.330

3,115

4,472

18,508

1,049

8,469

3,129

5,861

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100,0

100.0

100.0

100,0

100,0

100.0

11,926

1,240

6,410

3,801

475

4,470

709

1,657

1,863

241

7,456

531

4,753

1,939

234

38.7

51.4

54.3

60.9

4.6

36.4

52,1

49,8

59.8

5.4

40.3

50,6

56.1

62.0

4,0

10,625

41

407

836

9,339

4,718

2::

490

3,993

5,907

1::

347

5,346

34.5

1.7

3,5

13,4

90.4

38.4

1,7

1H

89.3

31.9

;::

11.1

91.2

Number in thousands

3,582 1,006

684

2,269 6;;

497 264

133 46

967 550

381

358 3::

171 164

57 26

2,616 457

303

1.911 2%

’326 100

76 20

Percent distribution

11.6 3.3

28.4 3.8

19.2 5.1

8.0 4.2

1.3 0.4

7.9 4,5

27.9 3.7

10.8 9.3

5.5 5.3

1.3 0.6

14.1 2.5

28.9 3.8

22.6 3.5

10.4 3.2

1.3 0.3

1,786

194

1,129

382

83

8i4

103

480

193

39

974

6%

189

45

5.8

6.0

9.6

6.1

0.6

6.6

7.6

14.4

6.2

0.9

5.3

8.7

7.7

6.0

0.8

869

92

481

215

61

359

1:;

110

36

510

2.8

2.9

4.2

4.7

3.5

0.8

2.8

3.4

3.8

3.3

0.8

992

70

497

246

176

403

39

158

125

81

569

31

339

123

95

3.2

:~,g

4.2

4,0

“1.7

3.3

2.9

4,6

4.O

“1.8

3.2

3.0

4.0

3.9

1.6

hospital stay. On the other hand,

65 percent ofdischarges witha

benign neoplasm listed private

insurance as their expected source of

payment, andonly17 percent used

Medicare.

Approximately12 percent ofall

discharges expected Medicaid to

cover their hospital stay. However,

Medicaid was the source of payment

for28 percent of women hospitalized

for deliveries. Twenty-two percentof

patients diagnosed with asthma,

19 percent with some formof

psychosis, and16 percent withan

acute respiratory infection listed

Medicaid as their expected sourceof

payment.

Other government programs,

including Workers’ Compensation,

were the expected source of payment

for3 percent of all discharges,

whereas these programs paid for

22 percent of discharges with

intemertebral disc disorders,

10 percent ofthose with lacerations

and open wounds, and 6 percent of

those with fractures.

Aithoughonly6 percent of all

discharges were in the self-pay

category, this was a frequent source

of payment for lacerations and open

wounds (22 percent).

Utilization by procedures

The number and percent

distribution of procedures by

expected source of payment,

according to age and sex, are

provided in table 5. Proceduresin

this report reflect only those

procedures performed on an inpatient

basis. Many procedures are

performed in a hospital outpatient

department or in other ambulatory

care settings. Forty-one percent of aII

procedures were performed on

inpatients who expected to pay for

their hospital stay through private

insurance. Private insurance was the

expected source of payment for

37 percent ofprocedures for males

and44 percent of procedures for

females. For discharges 45–64 years

of age, private insurance was the

expected source of payment for

63 percent of procedures.

One-third of aIl procedures

performed were for discharges who

expected Medicare topay for their

hospital stay. Medicare was the

expected payment source for
Advance Data No. 220. November 12, 1992 5

Table 3. Number and percent distribution of patients discharged from short-stay hospitals by expected principal source of payment,

according to race and geographic region: United States, 1990

[Discharges from non-Federal hospitals. Excludes newborn infants]

,4//expected Other Other:pa$ments Payment

principal sources Private

Race and region of payment

government source not

insurance Medicare Medicaid payments Self-pay no charge Swad

Allpatlents . . . . . . . . . . . . . . . . . . . . . . . . 30,788 11,926 10,625

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21,376 8,722 8,135

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,611 1,O& 869

Another. . . . . . . . . . . . . . . . . . . . . . . . . . 958 168

Notstated . . . . . . . . . . . . . . . . . . . . . . . . . 4,843 1,774 1,452

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . 6,695 2,481 2,367

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . 7,620 3,104 2,756

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,173 4,222 3,972

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,100 2,119 1,530

Allpatlents . . . . . . . . . . . . . . . . . . . . . . . . 100.0 38.7 34.5

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 40.8 38.1

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 28.5 24.1

Another. . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 41.9 17.5

Notstated . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 36.6 30.0

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 36.0 34.3

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 40.7 36.2

@o:r . . . . .. # . . . . . . . . . . . . . . . . . . . . . 100.0 37.8 35.5

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 41.8 30.0

Number in thousands

3,582 1.006 1,788 869 992

?,730 ::; 1,067 533 ;::

979 320 143

222 32

651 I 84 3% 1;.! 3%

853 156 402 253 383

779 209 390 207 176

1,286 401 744 224 325

665 241 252 164 108

Percent distribution

11.6 3.3 5.8 2.8 3.2

5.0

2?; ;: 8.9 :: ::

23.1 3.4 8.7 4.0 1.3

13.4 3.8 6.6 3.2 6.4

12.4 2.3 5.8 3.7

10.2 5.1 2.7

11.5

;:

H 6.7 2.9

13.0 4.7 5.0 :: 2.1

41 percent ofprocedures onmaIes,

compared with29 percentof

procedures on femaIes. As expected,

89 percent ofprocedures performed

ondischarges65 years of age and

over had Medicare asthee.xpected

principal sourceof payment.

Medicaidwas the expected source

ofpaymentforll percent ofall

procedures performed. Approximately

26 percent of the procedures

performed on discharges under 15

years ofage, and 22 percentof

procedures for females between the

ages of15 and44, had Medicaid as

the principal expected sourceof

payment. ApproximateIy5 percentof

all procedures were in the self-pay

category, but this category accounted

for14 percent ofthe procedures

performed on males 15-44 years of

age.

The number and percent

distribution ofsurgical proceduresby

expected source ofpayment,

according to seIectedsurgicaI

categories, areshown in table 6.

Forty-six percent of all surgical

procedures were perforrnedon

discharges listing private insurance as

the expected source ofpa-yment.

Among specific surgeries, private

insurance wasthe expected sourceof

payment for71 percentof

hysterectomies,70 percent of

oophorectomies and salpingooophorectomies, and63 percent of

appendectomies. More than half of

several obstetrical and

musculoskeletal surgeries also had

private insurance as the expected

source of payment.

Twenty-nine percent of all

surgical procedures were performed

on discharges using Medicare as the

expected source of payment.

Medicare was the expected source of

payment for particularly large

proportions of discharges with

procedures on the heart or prostate.

Forexample,74 percent of surgical

operations for insertion, replacement,

removal, or revision of pacemaker

leads ordevicesand73 percent of

prostatectomies were performed on

discharges with Medicare as their

expected source of payment. Again,

these findings are consistent with the

fact that older persons are generaHy

covered under the Medicare program.

Ten percent of all surgicaI

procedures were performed on

discharges using ?vfedicaid as the

expected source of payment, but

Medicaid discharges had larger

proportions of severaI obstetric and

gynecological procedures. These

patients had32 percent of the

surgical operations for bilateral

destruction or occlusion of fallopian

tubes,27 percent ofartificial ruptures

ofmembranes,26 percent of repairs

ofobstetric laceration, and

25 percent of cesarean sections.

Other government payments,

including Workers’ Compensation,

accounted for 4 percent of all

surgeries, 23 percent of excision or

destruction of an intervertebral disc,

and 22 percent of spinal fusion. The

seIf-pay category comprised 5 percent

of aII surgeries; 12 percent of

appendectomies; 9 percent of

debridement of wounds, infections,

and bums; and 9 percent of open

reduction of fractures with internal

tixation.

TabIe 7 shows the number and

percent distribution of nonsurgical

procedures for selected procedure
6 Advance Data No, 220. November 12, 1992

Table 4. Number and percent distribution of patients discharged from short-stay hospitals by expected principal source of payment,

according to selected diagnostic categories: United States, 1990

[Discharges $crm non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code number inclusions are based on the /rrtemafiona/ C/assir%?af/on Of

Diseases, 97 Revision, C/irrica/ Mod/ficaf/orr (ICD-9-CM)]

A// expected Other

Fkaf-kted diagnosis prkrctpa/ sources

Other pamanfe P43yment

Private government

and /CD-9-CM code of paymenf

source not

insurance Medicare Medicaid payments Self-pay no charge ~;tafed

Allcondltions’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Females wtndehver!es . . . . . . . . . . . . . . . . . . . ..V27

Hearf disease . . . .391 -392.0,393-398,402,

404.410-41 6.420+29

Acute myc=rdial infarction. . . . .’. . . .’. . .410

Coronay anerosclerosis. .414.0

Other !sc?em! cheartdisease. “ :4i; tili;4i4. i4149

Cardiac c’fsrhythmias . . . . . . . . . . . . . . . . . . ...427

Congestwe heartfailure. . . . . . . . . . ...428.0

Malignant rremlasrns. . . . . . . .14C-208,230-234

M=lignant neoplasm of large intestine

and rect~m. . . . . . . . . . . . . . . . . ...153-154.197.5

Malignant ‘?eoplasm of trachea,

bronchus and lung. . . . . . . . . .182,197.0,197.3

Mahgnantneoplasmofbreast . . . . . . .174-175,198 .81

Benign nmolasms and neoplaams of uncertain

behavior and unspecified nature. . ...210-229.235-239

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . ..480+36

Fractures . . . . . . . . . . . . . . . . . . . . . . . . ...800-829

Cerebrovascu!ar disease . . . . . . . . . . . . .430-438

Psychosis . . . . . . . . . . . . . . . . . . . . . . . . ...29&299

Cholellthiasis . . . . . . . . . . . . . . . . . . . . . . . . . ...574

Acute resp!ra:ory infections. . . . . . . . . . . .460-486

Arthropath@sandr elatedd isorders. . . . . . .710-719

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Intervertebra’ disc disorders. . . . . . . . . . .722

DiabetesmeXus . . . . . . ..250

Noninfectious enteritis andcoiij; “.”.’. ’.1”, ”.”.”.55”S556,558

Diseases oftnecentral nervous system . .32C-336,34C-349

Hyperplasiacfprostate . . . . . . . . . . . . . . . . . . . ...600

Lacerations a?dotsenwounds. . . . . . . . . . ..870-904

Allconditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Femaleswitn deliveries . . . . . . . . . . . . . . . . . . . ..V27

Heartdiae~e . . . . . . . . . . . .391-392.0,393-396.402,404,

410-416,420-429

Acute myo=rdial infarction.. . . . . . . . . . . ..410

Coronary atherosclerosis. . . . . . . . . . . . . . . . . .414.0

Other lschemic heart disease. . . . .411 -413,414.1-414.9

Cardiacd~rhyfhmias . . . . . . . . . . . . . . . . . . ...427

Congestws heartfeilure. . . . . . . . . . . . . . . . . . .426.0

Maiignantnecdasms. . . . . . . . . .140-208,23G234

Malignant ceoplasm of large

intestine and rectum . . . . . . . . . . .153-154,197.5

Malignant neoplasm of trachea, bronchus,

and lung. . . . . . . . . . . . . . .162,197.0,197.3

Malignant neoplasm of breast . . . . . . .174-175,198.61

Benign neoplasma and neoplasms of uncertain

behavior andunspecified nafure. . ...210-229.235-239

Pneumonia . . . . . .’....... . . . . . . . . . . ...460-486

Fractures . . . . . . . . . . . . . . . . . . . . . . . . ...800-629

Cerebrovasculardisease . . . . . . . . . .43W38

Psychosis . . . . . . . . . . . . . . . . . . . . . . . . . ..29G299

Cholellthiasis . . . . . . . . . . . . . . . . . . . . . . . . . ...574

Acute respratory infetilons. . . . . . . . . . . . . . .460+66

Arfhropathias andrelated disorders. . . . . . . .71~;J~

Asthma

Intewertebra’ k;scdkb;dek; : : : : : : : : : : : : : : : : . .722

Dlabetesme’’zus .

Noninfectious enteritis and colifk ‘. “.“.‘. ‘. “,“.“,‘.%~556:;;~

D!seases of thecentral nervous svstem . .320-336,34G349

Hyperplasia ofprostate. . . . ..”. . . . . . . . . .600

Lacerabonsandopenwounda. . . . . . . . . . . ..670-904

30,768

4,025

3,556

675

410

870

463

701

1,571

175

231

164

393

1,052

1,017

812

812

506

487

479

476

425

420

347

342

259

240

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

11,926

2,162

932

195

163

255

130

52;

50

77

69

254

261

300

134

256

247

174

166

182

220

135

172

125

58

83

36.7

54.2

26.2

26.9

39.9

29.3

26.9

11.0

34.5

28.6

33.3

42.2

64.5

26.8

29.5

16.5

31.6

46.9

35.8

34.6

38.3

51.7

32.0

49.6

36.6

22.2

34.4

10,625

36

2,172

369

193

502

298

549

780

103

119

72

5%

427

585

282

151

176

229

115

62

174

1;:

165

20

34.5

0.9

61.1

57.7

47.0

57.6

61.6

78.4

49.8

58.7

51.2

43.8

17.4

51.9

42.0

72.0

34.7

29.6

36.1

47.8

24.1

14.6

41.4

21.6

33.3

71.2

6.3

3,562 1,006

1,112 121

129 51

21 *6

*8

A: 12

●7

;

83 3:

“6 ●

12 “5

“? ●

12

58

1a

40

79

24

103

10

49

z

●

23

●6

12

2;

Percent distribution

11.6

27,6

3.6

3.1

2.5

4.0

2.9

3.9

5.3

●3.3

5.3

*4.O

5.2

12.2

5.7

3.4

16.7

7.9

16.2

2?:;

2.4

71.7

14,7

12.6

●

9.6

3.3

3.0

1.4

●1.2

*1.9

1.4

●1.4

1.2

2.2

●

●2.2

●

●1.6

1.1

6.4

;;

2?

4.6

2$::

2.2

2.6

3.5

9.;

1,766

272

111

24

E

16

4:

●5

*6

●

X

94

25

55

24

26

;:

25

::

5;

5.8

6.7

3.1

3.6

3.5

3.0

3.2

2.2

3.1

*2.5

*3.4

●

4.0

4.3

9.3

3.0

6.7

4.6

5.4

k:

3.0

6.0

6.3

6.7

22.;

869

132

67

14

10

16

10

;:

●

*

●

15

:7

;;

17

1;

19

15

10

1:

1;

2.8

3.3

;:

2.5

k:

●1.1

2.2

●

●

*

3.7

:::

::7

3.3

$:

4.0

3.5

2.3

2.7

3.0

5.;

992

170

94

22

;:

9

1:

●6

‘7

“7

;:

36

Y

K

16

;:

19

1:

z

3.2

4.2

2<6

3.3

2.7

2.8

;:;

3.1

●3.7

●3.2

*3.2

3.6

2.2

3.6

2.2

::

2.0

3.7

3.0

2.5

4,4

2.5

4.1

*2.8

10.4

tIncludesdsta fcr diagnosticconditionsnot shownmtable.

categories, according to expected

source,of payment. Thirty-five percent

of the nonsurgical procedures,

compared with 46 percent of surgical

procedures, were perforrnedon

discharges with private insurance as

the expected source ofpayment.

Discharges with private insurance had

57 percent of fetaIEKGs and fetal

monitoring,47 percent of contrast

myelograms,43 percent of manually

assisted deliveries, and41 percentof

arteriographies and angiocardiographies.

Thirty-nine percent of all

nonsurgical procedures, compared

with29 percent of all surgical

procedures, were performedon

discharges with Medicare asthe

expected source ofpayment. Sixty

percent ofcolonoscopies and

sigmoidoscopies (excluding thosle with

biopsy),56 percent ofcystoscopies

(excluding those with biopsy),

56 percent of electrographic
Advance Data No. 220. November 12, 1992 7

Table 5. Number ancfpercent distribution of all-listed procedures for patients discharged from short-stay hospitals by expected principal

source of paYtTIent, according to sex and age: United States, 1990

[Discharges from non-Federal hospitals. Excludes newborn infants]

All expected Other Other:pa$ments Payment

principal sources Private

Sex and age of payment insurance Medicare Med!wid

!Jovw;~n~t source not

Self-pay no charge stated

Both sexes

All ages . . . . . . . . . . . . . . . . . . . . . . . . . .

Ww;:ay . .. . . . . . . . . . . . . . . . . . . .

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

45-64yearsI l . . . . . . . . . . . . . . . . . . . . . .

65yearaandover . . . . . . . . . . . . . . . . . . . .

Male

Allages . . . . . . . . . . . . . . . . . . . . . . . . . .

Under15years . . . . . . . . . . . . . . . . . . . . . .

15-44years . . . . . . . . . . . . . . . . . . . . . . . .

4&84years . . . . . . . . . . . . . . . . . . . . . . . .

65yearsand over . . . . . . . . . . . . . . . . . . . .

Female

Allages . . . . . . . . . . . . . . . . . . . . . . . . . .

Under15years . . . . . . . . . . . . . . . . . . . . . .

15-44years . . . . . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . . . . . . . . .

65yearsand over . . . . . . . . . . . . . . . . . . . .

Both sexes

Allagas . . . . . . . . . . . . . . . . . . . . . . . . . .

Under15years . . . . . . . . . . . . . . . . . . . . . .

1544yeara . . . . . . . . . . . . . . . . . . . . . . . .

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

65yearsandover . . . . . . . . . . . . . . . . . . . .

Male

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . .

Under15years . . . . . . . . . . . . . . . . . . . . . .

15-44years . . . . . . . . . . . . . . . . . . . . . . . .

4S-64yeara . . . . . . . . . . . . . . . . . . . . . . . .

65yearaandover . . . . . . . . . . . . . . . . . . . .

Female

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . .

y~gaywJera . . . . . . . . . . . . . . . . . . . . . .

45-64yearsIII:I:I:I:I::: ::::::::::

65yearsandover . . . . . . . . . . . . . . . . . . . .

40,506

1,960

16,186

9,052

13,308

15,916

1,144

3,840

4,605

6,326

24,580

816

12,346

4,447

6,962

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

16,717

1,033

9,198

5,709

776

5,853

612

1,969

2,859

412

J0,864

421

7,226

2,850

365

41.3

52.7

56.8

63.1

5.8

36.8

53.5

51.3

62.1

6.5

44.2

51.6

56.5

64.1

5.2

13,471

31

1,%

11.678

6,456

17

194

652

5,593

7.015

2X

468

6,28S

33.3

1.6

1$:

89.3

40.6

1.5

l?A

86.4

28.5

1.7

1?:

90.0

Number in thousands

4,381 1,437

517

3,035 8~

653 423

176 70

989 770

290 53

376 412

239 2%

84

3,392 867

227

2,659 4%

414 159

93 26

Percent distribution

10.8 3.5

26.4 4.5

18.8 5.3

7.2 4.7

1.3 0.5

6.2 4.6

25.3

9.8 12;

5.2 5.7

1.3 0.6

13.6 2.7

27.6 4.2

21.5

9.3 :::

1.3 0.4

2,104

162

1,350

499

93

909

5:

249

49

1,195

6!!

250

44

5.2

:::

5.5

0.7

5.7

8.2

13.5

5.4

0.8

4.9

8.3

:;

0.6

1,158

6%

312

97

461

1%

171

47

697

4%

140

50

2.9

2.9

4.4

5.0

3.7

0.7

2.8

1,237

49

63S

337

217

477

1%

171

101

760

4::

166

116

3.1

3.0

2.4

4.8

3.7

1.6

3.1

2.7

3.7

3.7

1.7

monitoring, and54 percentof

circulato~ monitoring, radioisotope

scans, andendoscopies ofthe small

intestine (excluding those with

biopsy) were performed on discharges

with Medicare as the expected source

ofpayment.

Medicaid discharges madeup

12 percent ofaIInonsurgicaI

procedures, and, as wasthe case for

surgicaI procedures, Medicaid was the

expected source ofpayment for large

proportions ofobstetrical procedures.

Thirty-three percent ofmanuaIly

assisted deliveries and27 percentof

fetal EKGs and fetal monitoring were

performed on Medicaid discharges. In

addition, Medicaid discharges had

22 percent ofspinal taps.

Othergovemment payments,

including Workers’ Compensation,

were the expected source ofpayment

for3 percent ofaIl nonsurgical

procedures and accounted for

21 percent of contrast myeIograms.

l%eself-paycategoxy accounted for

5 percent ofallnonsurgicaI

procedures and for9 percent of

spinal taps.

References

1.

2.

3.

HauptBJ,Kozak LJ.Estimatesfrom

two survey designs: National HospitaI

Discharge Survey.National Center for

HeaIth Statistics. Vital Health Stat

13(111). 1992.

Moien M. Patient charges in shortstay hospitals, United States, 1968-70.

National Center for Health Statistics.

Vital Health Stat 13(15). 1974.

Pokras R, Gardocki G. Expected

principal source of payment for

hospitaI discharges: United States,

1977. Advance data from vitaI and

health statistics; no 62. Hyattsville,

MaryIand: National Center for Health

Statistics. 1977.

4. Graves E.J, Pokras R. ExDected

5.

6.

principal source of paym~nt for

hospital discharge United States,

1979. Advance data from vital and

health statistics; no 7.5. HyattsvilIe,

Maryland: National Center for Health

Statistics. 1979.

Graves EJ. Expected principaI source

of payment for hospital discharges:

United States, 1985. Advance data

from vital and health statistics; no

144. Hyattsville, Maryland: National

Center for HeaIth Statistics. 1985.

Graves EJ. Utilization of short-stay

hospitals, United States: 1982 annual

summary. National Center for Health

Statistics. Vhal HeaIth Stat 13(78).

1984.
8 Advance Data No. 220. November 12, 1992

Table 6. Number and percent distribution of all-listed surgical procedures for patients discharged from short-stay hospitals by expected

principal source of payment, according to selected surgical categories: United States, 1990

[Discharges from non-Federal hospitals. Excludes newborn infants. Dmgnostic groupings and code number inclusions are based on the /nfernationa/ Clasajficatjon of

Diseases, 9th Revision, C/inica/ Modification (lCO-XM)]

,4/ expected Other

Procedure category

Otfrer ~;yts Payment

principal sources Private

and ICO-94M code

government source not

of payment insurance Medicare Medicaid payments Self-pay no charge stated

All surgical procedures’ . . . . . . . . . . . . . . . . . . . . . .

Episiotomy with or without forceps or vacuum

extraction . . . . . . . . . . . . .72.1,72 .21,72.31,72.71,73.6

Cardiac catheterization . . . . . . .37.21 -37.23

Cesarean section . . . . . . .74.0-74 .2.74.4,74,99

Repair occurrent otxtetric laceration . . .75.5-75.6

Artificial rupture of membranes . . . . . .73.0

Hysterectomy . . . . . . . . . . . . . . . . . . . . . ...6&66.7

Cholecystectomy . . . . . . . . . . . . . . . . . . . . . . ...51.2

Punctureofvessel . . . . . . . . . . . . . . . . . . . . . ...38.9

Oophorectomy andsalpingo-oophorecfomy. . ...65.3-65.6

Bilateral destruction or occluslon of

fallopiantubes . . . . . . . . . . . . . . . . . . . . ..66.2-S6.3

Corona~artey bypass graft.. . . . . . . . . . . . . . ...36.1

Open reduction of fracture w!thinternal fixafion . . . . . .79.3

Prostatecfomy . . . . . . . . . . . . . . . . . . . . ...60.2-60.6

Debridement ofwound, infection, or burn. . . . .86.22 .86.28

Lysisof peritoneal adhesions . . . . . . . . . . . ..54.5

Excision ordestruction ofintewertebral disc. . . .60.5

oj;;s~io:s on muscles, tendons, and

.82-63.1,63.3-63.9

Removal ofco;oha~a ~e~ob&t;u”&lon’ :. . . . . .36,0

Appendectomy, excluding incicfental. . . . . . . .47.0

Insertion, replacement, removal, and revision

of pacemaker ieadsordewce. . . .37.7-37.8

Partial excisionofbone. . . . . . . . .76.2~7i.3,77.6-77.6

Splnalfusion . . . . . . . . . . . . . . . . . . . . . . . . . ...81.0

Allsurgical procedures’ . . . . . . . . . . . . . . . . . . . . . . .

Episiotomy with or without forceps or vacuum

extraction . . . . . . . . . . . . .72.1.72.21.72.31,72.71.73.6

Cardiac catheterization . . . . . . .“. . . .’.. .37.21-37.23

Cesareansectlon . . . . . . . . . . . . .74.0-74.2,74.4,74.99

Repair occurrent obstetric laceration . . . . . . . .75.>75.6

Artiitcial ruptura ofmembranes . . . . . . . . . . . . . . . .73.o

Hysterectomy . . . . . . . . . . . . . . . . . . . . . ...68.3-66.7

Cholecysteetomy . . . . . . . . . . . . . . . . . . . . . . ...51.2

Punctureofvessel . . . . . . . . . . . . . . . . . . . . . ...36.9

Oophorectomy andsalpingo-oophorectomy. . . . .65.3-S5.6

Silateral destruction or occlusion of

fallopiantubes . . . . . . . . . . . . . . . . . . . . . .66.2+6.3

Coronaryaflerybypass graft.... . . . . . . . . . ..36.1

Open reduction otfracture with internal fixation . . . ...79.3

Prostatectomy . . . . . . . . . . . . . . . . . . . . ...60.2-60.6

Debridement of wound, infection, or burn . . . . .86.22,86.28

Lysisof peritoneal adhesions . . . . . . . . . . . . .54.5

Excision ordestruction of intervertebral disc. . . ..80.5

Operations on muscles, tendons, and

bursar . . . . . . . . . . . . . . . . . . . . . .82+3.1.63.3-63.9

Removalofcoronary afleryobstrutiton . . . . . . . . ...36.0

Appendectomy, excluding incidental. . .47.0

insertion, replacement, removal, andre&ion” “ “ “ “

of pacemaker leadsordevics, . . . . . . . . . .37.7-37.8

Partial excision of bone. . . . . . . . . . .76.2-76.3,77 .6-77.8

Spinalfusion . . . . . . . . . . . . . . . . . . . . . . . . . ...81.0

23,051

1,717

995

945

795

691

591

522

515

476

419

392

391

364

332

323

305

291

265

274

259

193

130

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

10,541

1,023

411

569

433

389

422

263

145

333

224

155

128

74

1%

163

146

127

173

44

94

64

45.7

59.6

41.3

60.2

54.5

56.3

71.4

50.5

28.2

69.9

53.5

39.5

32.9

20.4

29,9

56.6

53.4

50.2

44.6

63.2

17.1

48,8

49.2

6,679

11

426

‘8

9

9

1:!

241

59

2;:

t 50

266

136

:;

56

119

16

191

41

18

29.0

0.6

42.6

●0.8

1.1

1.3

10.4

28.9

46.6

12.4

*1 .1

51.7

36.3

73.1

40.9

27.0

12.4

20.0

41.6

6.6

73.8

21.5

14.2

Number in thousands

2,334 896

363 49

18

2:: 27

207 27

183 21

37 11

40 11

16

:: ●6

132 15

9

20 ;:

●

J 21

24

●8 6;

20 29

“7

LX ●8

●

✛✚ 23

*7 29

Percent distribution

10.1 3.9

2$.; 2.9

1.8

24:6

26.1 ;:

26.5 3.0

;:; ;::

13.0 3.1

5.9 ●1.2

31.6 3.7

●1.9

::8 7.8

●1.5

6.;

?:

●2.6 22.;

6.9 9.8

●2.2 ●2.3

6.2 ●2.9

●2.3

11.:

“::: 22.2

1,166

118

36

45

57

43

;:

:?

17

2

3;

10

*6

19

32

*5

●7

*5

5.1

::;

4.8

7.1

6.2

:::

4.2

4.6

‘::

8.8*

;:

●2.6

6.7

1:::

●1.9

*3.7

●3.7

686

51

32

::

31

22

18

1:

11

●

14

;

:;

11

1:

●

●8

●

3.0

3.0

3.2

3.0

4.2

4.5

$:

2.3

3.2

2.7

3.;

●

3:

3.7

3.7

3.3

4.1

●

*4.3

●

ir46

82

35

34

29

;:

16

;:

14

9

14

9

13

*6

‘8

●6

●6

9

*5

*7

●

3.2

$;

3.6

3.7

2.2

3.1

3.1

2.4

3.0

3.4

2.2

3.5

2.4

4.0

*1 .6

*2.7

*2.8

*2.8

3.4

●2.1

*3.5

●

‘Includes data for surgml corrdwons not shown m reble.

7.

8.

9.

Graves EJ. Utilization of short-stay

hospitals, United States 1983 annual

summaty. National Center for Health

Statistics. Vital Health Stat 13(83). 1985.

Graves EJ. Utilization of short-stay

hospitals, United States: 1984 annual

summary. National Center for Health

Statistics. Vital Health Stat 13(84).

1986.

GravcsEJ. Utilization ofshort-stay

hospitals, United States 1985 annual

summary. National Center for Heafth

Statistics. VitaI Health Stat 13(91). 1987.

10.

11.

12.

Graves E.J. Utilization of short-stay

hospitals, United States: 1986 annual

summary. National Center for Health

Statistics. Vital Health Stat 13(96).

1988.

Graves EJ. National Hospital

Discharge Survey: annual summary,

1987. National Center for Health

Statistics. Vital Health Stat 13(99).

1989.

Graves EJ. National Hospital

Discharge Survey: annual summary,

13.

14.

1988. National Center for Health

Statistics. Vital Health Stat 13(106).

1991.

Graves EJ, Kozak LJ. National

Hospital Discharge Surwy:annual

summary, 1989. National Center for

Hcakh Statistics. Vital Health Stat

13(109). 1992.

Graves EJ. National Hospital

Discharge Survey: annual summary,

1990. National Center for Health

Statistics. Vital Health Stat 13(1 12).

1992.
Advance Data No. 220. November 12, 1992 9

Table 7. Number and percent distribution of ail-listed nonsurgical procedures for patients discharged from short-stay hospitals by expected

principal source of payment, according to selected nonsurgical categories: United States, 1990

[Discharges from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code number inclusions are baaed on the Memafiarml Ckssiricafion of

Diseases, 9th Rension, Clinical Modification (ICD-9-CM)]

All expected Other

Procedure category

Other payments Payment

princtpal sources Private government and

and ICD-9-CM code of payment

source not

insurance Medicare Medicaid payments Self-pay no charge stated

All nonsurgical procedures’ . . . . . . . . . . . . . . . . . . . . .

Arferiography and angiocardiography using contrast

material, . . . . . . . . . . . . . . . . . . . . . . . ...88.4-68.5

Fetal EKG (scalp) and fetal monitoring, not

othenvise specified . . . . . . . . . . . . . . . . . .75.32,75.34

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . ...88.7

C&o&p+Werized axial tomography

. . . . . . . . . . . . . . .87.03,87.41,87.71,88.01 ,88.38

Respiratory therapy . . . . . . . . . . . . . . . . . . . . ...93.9

Endoscopy of small intestine (excludes that with

. . .45.1145.13

M%W~ akkied”deiiie”~ : : : : : : : : :::...... ..73.5

Circulatory monitoring.......,,. . . . . . . . . . ...89.6

Radiolsotopescan. . . . . . . . . . . . . . . . . . ...92.0-92.1

Cystoscopy (excludes that with biopsy) . . . . . .57.31 -57.32

SPinaltap. . . . . . . . . . . . . . . . . . . . . . . . . . ...03.31

Colonoscopy and sigmoidoscopy (excludes that

with biopsy) . . . . . . . . . . . . . . . . . . . . . .45.2345 .24

Electrographic monitoring. . . . . . . . . . . . . . . . ...89.54

Contrast myelogrem . . . . . . . . . . . . . . . . . . . ...87.21

All nonsurgical procedures’ . . . . . . . . . . . . . . . . . . . . .

Arteriography and angiocardiogrephy using contrast

material . . . . . . . . . . . . . . . . . . . . . . . ...88.4-68.5

Fetal EKG (scalp) and fetal monitoring, not othetwise

specified . . . . . . . . . . . . . . . . . . . . . . . . .75.32.75 .34

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . ...88.7

C~o&rterized axial tomography

.87.03,87.41,87.71 .88.01 ,88.38

Respira~o~~h&ap~ ”.”. ”.”...”. . . . . . . . . . . . . . . ...93.9

Endoscopy of small intestine (excludes that with

biopsy), . . . . . . . . . . . . . . . . . . . . . . . .45.11 -45.13

Manually assisted delivery , . . . . . . . . . . . . . . . ...73.5

Circulatorymonitoring . . . . . . . . . . . . . . . . . . . ...89.6

Radioisotope scan. . . . . . . . . . . . . . . . . . . . .92.o-g2.l

Cystoscopy (excludes thatwith biopsy). . . . . .57.31 -57.32

Spinaltap . . . . . . . . . . . . . . . . . . . . . . . . . . ...03.31

Colonoscopy and sigmoidoscopy (excludes that with

biopsy) . . . . . . . . . . . . . . . . . . . . . . . . .45.23-45.24

Electrographic monitoring. . . . . , . . . . . . . . . . ...69.54

Contrastmyelogram . . . . . . . . . . . . . . . . . . . ...87.21

17,455

1,735

1,377

1,608

1,506

1,164

549

754

724

603

4s5

396

393

629

213

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

6,176

709

780

494

422

286

157

321

178

160

144

148

109

171

100

35.4

40.8

56.6

30.7

28.0

24.6

28.6

42.6

24.6

26.6

29.7

37.3

27.6

27.1

46.9

6,792

745

7;:

722

571

2:;

392

324

273

81

237

349

45

38.9

42.9

4%

4s.0

49.1

53.6

5;::

53.8

56.3

20.5

60.2

55.6

21.0

Number in thousands

2,047 541

65 33

371 53

196 38

111

158 z

2::

74

52

21

89

19 ●5

44

“6 2

Percent distribution

11.7 3.1

3.7 1.9

26.9 3.8

12.2 2.4

3.6

lZ 2.9

1.8

3;:

10.3 ;::

8.6 2.4

4.3 “1.3

22.4 3.8

4.9 ●1.2

7.0

●2.9 2;:

938

67

80

88

109

67

22

57

::

;;

;?

‘7

5.4

3.8

5.8

5.5

::

4.0

H

4.8

2.5

8.9

*1.6

‘;::

472

62

45

39

49

19

;:

1:

1;

●8

*6

*7

2.7

3.5

3.3

2.4

3.2

1.6

1.8

4.4

1.3

1.9

H

*2.O

●0.9

●3.4

489

55

36

31

39

29

;:

;;

20

12

9

*:

2.8

3.2

2.6

2.0

2.6

2.5

2,8

7.0

●1.O

1.9

4.1

3.1

2.4

1.4

*2.2

‘Includes data for nonsurgical condti!ions not shown m table.

15. Rics P. Characteristics of persons

16.

17.

with and without health care

coverage: United States, 1989.

Advance data from vital and health

statistics; no 201. Hyattsville,

Maryland: National Center for Health

Statistics. 1991.

SMG Marketing Group, Inc. Hospital

Market Data Base. Chicago, Illinois:

Healthcare Information Specialists.

1989.

Shah BV. SESUDW Standard

errors program for computing of

standardized rates from sample survey

data. Research Triangle Park, North

Caroiina: Research Triangle Institute.

1981.
10 Advance Data No. 220. November 12, 1992

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

confidentiality requirements
Advance Data No. 220 ● November 12, 1992 11

Technical notes

Survey methodology

Sources of data

The National Hospital Discharge

Sumey (NHDS) covers discharges

from noninstitutional hospitals,

exclusive of Federal, military, and

Veterans’ Administration hospitals,

located in the 50 States and the

District of Columbia. Only short-stay

hospitals (hospitaIs where the average

length of stay for all patients is less

than 30 days) and those whose

specialty is general (medical or

surgical) or children’s general are

included in the survey. These

hospitals must also have at least six

beds staffed for patient use.

Beginning with 1988, the NHDS

sampling frame has comprised

hospitaIs that were listed in the April

1987 SMG Hospital Market Tape

(16), met the above criteria, and

began accepting patients by August

1987. For 1990, the sample consisted

of 542 hospitals, of which 23 were

found to be out of scope (ineligible)

because they had gone out of

business or failed to meet the criteria

for the NHDS universe. Of the 519

in-scope (eIigible) hospitals, 474

responded to the sumey.

Sample design and data

collection

The National Center for Health

Statistics (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. Within each sample

hospital, a systematic random sample

of discharges was selected.

Beginning in 1988 the NHDS

samp~e has included with certainty all

hospitals with 1,000 beds or more, or

4,000 discharges or more, annually.

The remaining sample of hospitals

was based on a stratified three-stage

design. The first stage consisted of a

seIection of 112 primary sampling

units (PSU’S) that composed a

probability subsample of PSU’S to be

used in the 1985-94 National Health

Interview Survey (NHIS). The second

stage comprised a selection of

noncertain~ hospitals from the

sample PSU’S. At the third stage, a

sample of discharges was selected by

a systematic random-sampling

technique. A detailed description of

the original and new designs has been

published (l).

Two data collection procedures

were used for the su~ey. One was a

manual system of sample selection

and data abstraction. The other, an

automated method used for

approximately 34 percent of the

respondent hospitals in 1990, involved

the purchase of data tapes from

abstracting services, State data

systems, and hospitals.

In the manual system, the sample

selection and the transcription of

information from hospital records to

abstract forms were performed at the

hospitals. The comp~eted forms, along

with sample selection control sheets,

were forwarded to NCHS for coding,

editing, and weighting. A few of these

hospitals submitted their data via

computer printout or tape. Of the

hospitals using the manual system in

1990, about two-thirds had the work

performed by their own medical

records staff, In the remaining

hospitals using the manual system,

personnel of the U.S. Bureau of the

Census did the work on behalf of

NCHS.

For the automated system, NCHS

purchased tapes containing machinereadable medical record data from

abstracting services. Records were

systematically sampled by NCHS, The

medical abstract form and the

abstract data tapes contained items

relating to the patient’s persona!

characteristics, including birth date,

sex, race, and marital status but not

name and address; administrative

information, including admission and

discharge dates, discharge status, and

medical record numbe~ diagnoses;

and surgical and nonsurgical

operations and procedures. Beginning

in 1977 data pertaining to patient ZIP

Code, expected source of payment,

and dates of surgery were also

collected. (The medical record

number and patient ZIP Code are

confidential and, therefore, not

available to the public.)

Presentation of estimates

The relative standard error

(RSE) of the estimate and the

number of sample records on which

that estimate was based (referred to

as “the sample size”) were used to

identifi estimates with relatively low

reliabili~. Because of the complex

sample design of the NHDS, the

following guidelines were used in

presenting the NHDS estimates:

If the relative standard error of

an estimate was larger than

30 percent, or the sample size

was less than 30, the estimate is

not shown. In this case, only an

asterisk ~) appears in the tables.

If the sample size was less than

60, the wdue of the estimate

could not be assumed to be

reliable. In this case, the estimate

is preceded by an asterisk (*) in

the tables.

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 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

(17).
12 Advance Data No. 220. November 12, 1992

The constants for relative

standard error cumes for the NHDS

estimates are presented in table I.

The relative standard error [RSE

(X)] of an estimate X maybe

estimated from the formula

relative standard error in percent for

the self-pay variable should be used

since it is the most conservative of

the three variables.

Estimates have been rounded to

the nearest thousand. For this reason,

figures within tables do not always

add to the totals. Rates and average

lengths of stay were calculated from

original, unrounded figures and do

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 t-test with a

critical value of 1.96 (0.05 level of

significance). Terms such as “higher”

and “less” indicate that differences

are statistically significant. Terms

such as “similar” or “no difference”

mean that no statistically significant

differences exist 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.

Definition of terms RSE(X) =~a +b/X

where X, a, and b are as defined in

table 1,

The most conservative standard

error should be used when a statistic

involves more than one variable. For

example, the number of discharges

for females 15-44 years of age

expecting to pay for their own

hospitalization was 650,000. Using the

formula

Terms relatingto

sources of payment

Private insurance – Health

insurance provided by nongovernment

sources, such as insurance companies,

private industry, and philanthropic

organizations.

Medicare (Title XWI) –A

nationwide health program providing

health insurance protection,

regardless of income, to people 65

years of age and over, people eligible

for Social Security disability payments

for more than two years, and people

with end-stage renal disease.

Medicaid –A joint Federal-State

welfare program available in virtually

all States that provides benefits for

low-income persons. Each State has

its own criteria for qualification as

“low income.”

Other government payments –

Government payments other than

those through the Medicare or

Medicaid programs, such as Workers’

Compensation (a program designed

to enable employees injured on the

job to receive financial compensation

regardless of fault), payments made

under the Title V Program, and the

Civilian Health and Medical Program

for the Uniformed Services

(CHAMPUS, which provides

coverage for civilian medical care for

family members of active-duty

uniformed service personnel and for

retired uniformed service personnel

and their families).

Self-pay – A form of hospital

payment in which the major share of

the total cost is paid by the patient or

the patient’s spouse, family, or next

of kin.

No charge-A situation where

medical services are provided free of

charge by the hospital. This category

includes hospital-sponsored welfare,

donated staff services, and hospitalsponsored special research.

RSE(X) = da +b /X. 100

the relative standard error in percent

was 4.16 for females, 4.34 for

inpatients 15-44 years of age, and

7.81 for self-pay inpatients. The

Table 1. Estimated parameters for relative standard error equations for National Hospital

Discharge Survey statistics by characteristics: United States, 1990

Number of

discharges or

first-listed Number of Number of

d!agnoses days of care procedures

Characteristic a b a b a b

Total . . . . . . . . . . . . . . . . . . . . . .. 0.00213 228.834 0.00358 452.582 0.00547 92.597

Sex

Male, . . . . . . . . . . . . . . . . . . . . . ..0.00152

Female, . . . . . . . . . . . . . . . . . . . ..0.00125

313.079

311.632

0.00293

0.00213

292.127

701.564

0.00410

0.00337

89.724

63.021

Age

Under 15 years . . . . . . . . . . . . . . . . . 0.01597

15-44 years . . . . . . . . . . . . . . . . ...0.00142

45-84 years . . . . . . . . . . . . . . . . ...0.00157

65 years and over . . . . . . . . . . . . . . . 0.00161

Region

Northeast . . . . . . . . . . . . . . . . . . ..0.00274

M,dwesl . . . . . . . . . . . . . . . . . . . . . 0.00487

South . . . . . . . . . . . . . . . . . . . . . .. 0.00375

West . . . . . . . . . . . . . . . . . . . . . ..0.00564

47.116 0.00224

299.762 0.00301

234.543 0.00920

263.223 0.00251

140.764

460.089

432.971

762.854

0.03171

0,00302

0.00491

0.00436

44.124

139.070

66.024

47.886

56.268

183.531

343.892

318.914

0.00368

0.00605

0.00540

0.01036

146.195

970.001

929.232

830.740

0.00586

0,00886

0.00781

0.01235

108.765

107.681

50.919

144.502

Expected principal

source of payment

Private insurance. . . . . . . 0.00141

Medicare . . . . . . . . . . . . . . . . . . . .,0.00233

,Medicald . . . . . . . . . . . . . . . . . . . .. 0.00542

Workers’ Compensation . . . . . . . . . . . 0.00881

Other government payments . . . . . . 0.04049

Self-pay . . . . . . . . . . . . . . . . . . . ..0.00571

Otner payments and no charge. . 0.02316

Not stated . . . . . . . . . . . . . . . . . ...004000

152.998

93.208

125.784

27.461

61.626

75.975

86.504

356.276

147.208

225.144

0.00258

0.00335

0.00918

0.021W

0.04643

0.01277

0.03494

0.05910

1,253.396

105.814

289.323

0.00370

0.00502

0.01261

0.02224

0.05825

0.01598

0,03750

0.06397

52.626

72.918

255.679

146.212

171.864

159.965

240.704

677.732

244.069

363.932 134.637

Race

White . . . . . . . . . . . . . . . . . . . . ...0.00212 298.564 0.00329 599.597 0.00426 80.500

Black . . . . . . . . . . . . . . . . . . . . . .. 0.00537 264.999 0.00838 291.219 0.01044 52.381

Allothep . . . . . . . . . . . . . . . . . . . . 0.02699 119.661 0.04485 150.121 0.04866 59.007

Not stated . . 0.02252 226.201 0.02914 634.529 0.00357 44.250

NOTE. The relatwe slandard error (RSE) far an estimate (Al csn be determined trom the equat!on RSE(XI = v’a + b I x.
Advance Data No. 220. November 12, 1992 13

Other payments -All other

nonprofit sources of payment such as

church weIfare, the United Way

(United Appeal), or the Shriners

Crippled ChiIdren Services.

Terms relating to

hospitalization

Hospitals –All hospitaIs with an

average length of stay for all patients

of less than 30 days; hospitals whose

specialty is general (medical or

surgical) or children’s general are

eligible for inclusion in the NHDS,

with the exception of Federal

hospitals, hospital units of

institutions, and hospitals with fewer

than 6 beds staffed for patients’ use.

Patient –A person formally

admitted to the inpatient service of a

short-stay hospital for observation,

care, diagnosis, or treatment. The

terms “patient,” “inpatient,” and

“discharge” are used here

synonymously.

Newborn infant -A patient

admitted by birth to a hospital.

Di.rcha~e-The formal release of

a patient by a hospital; that is, the

termination of a period of

hospitaIization by death or by

disposition to pIace of residence,

nursing home, or another hospital.

The terms “discharge,” “patient,”

and “inpatient” are used here

synonymously.

Days of care-The number of

patient days accumulated at time of

discharge. A stay of less than 1 day

(patient 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 inciuding) the date of

discharge.

Average length of stay –The

number of days of care accumulated

by patients during the year divided by

the number of these patients.

Terms relating to

diagnoses

Diagnosis -A disease or injury (or

factor that influences health status

and contact with health services that

is not itself a current illness or injury)

listed on the medical record of a

patient.

Principal diagnosis –The condition

established after study to be chiefly

responsible for occasioning the

admission of the patient to the

hospital for care.

First-listed diagnosis –The coded

diagnosis identified as the principal

diagnosis or that listed first on the

face sheet or discharge summary of

the medical record if the principal

diagnosis cannot be identified. The

number of first-listed diagnoses is

equal to the number of discharges.

Terms relating to

procedures

Procedure-A surgical or

nonsurgical operation, diagnostic

procedure, or special treatment

reported on the medical record of a

patient. The following ICD-9-CM

procedure codes are not used in the

IWIDs:

87.09,87.11-87.12, 87.16-87.17,

87.22-87.29, 87.39, 87.43-87.49, 87.85,

87.89,87.92, 87.95, 87.99,88.09,88.16,

88.19, 88.21-88.29, 88.31,88.33,88.35,

88.37,88.29, 89.01-89.09,89.11-89.13,

89.15-89.16, 89.26,89.29,89.31,

89.33-89.39, 89.7-89.8, 90.01-90.99,

91.01-91.99, 93.01-93.09, 93.11-93.19,

93.21-93.25, 93.27-93.28,93.31-93.39,

93.61-93.67,93.71-93.78, 93.81-93.89,

94.01-94.19, 94.21-94.23,94.29,

94.31-94.39, 94.41-94.49, 94.51-94.59,

95.01-95.03, 95.05-95.09, 95s4-95.15,

95.31-95.36, 95.41-95.48, 96.11-96.19,

96.26-96.28, 96,34-96.39,96.41-96,48,

96.51-96.59, 96.6, 97.01-97.04,

97.14-97.16,97.21-97.29, 97.31-97.39,

97.41-97.49, 97.51-97.59,97.61-97.69,

97.72-97.79,97.81-97.87, 97.89,

99.12-99.14, 99.16-99.18,99.26-99.29,

99.31-99.39, 99.41-99.48, 99.51-99.59.

All-listed procedures – lncIudes up

to four procedures listed on the face

sheet of the medical record.

Surgical operations –AU

procedures except those listed under

“nonsurgical procedures.”

Nonsurgical procedures –

Procedures generally not considered

to be surgery. These include

diagnostic endoscopy and

radiography, radiotherapy and related

therapies, physical medicine, and

rehabilitation. The following

ICD-9-CM codes identify nonsurgical

procedures:

01.18-01.19,03.31,03.39, 04.19,05.19,

06.19,07.19,08.19,09.19, 09.41-09.49,

10.29, 11.29, 12.29, 14.29, 15.09, 16.21,

16.29, 18.01, 18.11, 18.19, 20.31, 20.39,

21.00-21.02,21.21,21.29, 22.19, 24,19,

25.09,26.19,27.29, 28.19, 29.11, 29.19,

31.41-31.42, 31.48-31.49, 33.21-33.23,

33.29,34.21-34.22, 34.28-34.29,

37.26-37.27,37.29,38.29, 39.95, 40.19,

41.38-41,39, 42.22-42.23, 42.29,

44.11-44.13, 44.19,45.11-45.13, 45,19,

50.19,51.10-51.11, 51.19,52.19,54,21,

54.29,55,21-55.22, 55.29, 56.51, 56,35,

56.39,57.31-57.32, 57.39, 57.94-57.95,

58.21-58.22,58.29,59.29, 60.18-60.19,

61.19, 69.92, 70.21-70.22, 70.29, 71.19,

73.4, 73.51-73.59, 73.91-73.92,

75.31-75.32,75.34-75.35, 75.94, 76.19,

78.8G78.89, 80.20-80.29, 81.98, 83.29,

84.41-84.43, 84.45-84.47, 85.19, 86.19,

86.92,87-99.

Demographic terms

Age –Patient’s age at birthday.

Race -Patients are classified into

three groups: white, black, and all

other (with “alI other” including all

categories other than white or bIack).

Geographic region - Hospital’s

location; one of four regions of the

United States as defined by the U.S.

Bureau of the Census.

Region States included

h-ortheast Maine, New Hampshire,

Vermont, Massachusetts,

Rhode lsIand,

Connecticut,
14 Advance Data No. 220. November 12, 1992

New York, New Jersey,

and Pennsylvania

Midwest Michigan, Ohio, I1linois,

Indiana, Wisconsin,

Minnesota, Iowa,

Missouri, North Dakota,

South Dakota, Nebraska,

and Kansas

South Delaware, Maryland,

District of Columbia,

Virginia, West Virginia,

North Carolina, South

Carolina, Georgia,

Florida, Kentucky,

Tennessee, Alabama,

Mississippi, Arkansas,

Louisiana, Oklahoma,

and Texas

West Montana, Idaho,

Wyoming, Colorado, New

Mexico, Arizona, Utah,

Nevada, Washington,

Oregon, Califomia,

Hawaii, and Alaska

‘U.S. Governnwnt PrintingOfflcw 1995– 3SS-S52EC015
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 HeattfrStatistics.They include descriptionsof 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

daa and cantnbutionsto statisticaltheory. These studies also

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistics.These reports carry the analyses further than

the expository types of reports in the other series.

Documents and Committee Reports-These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

International Vital and Health statistics Repo~These

reports are arudyticalor descriptive repotte that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

StatiW”cesystem of the United States.

Cognition and Survey Measurement—These reports are

from the National Laborato~ for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

Date From the National Health Interview Survey-These

reports contain statistics on illness; unintentional injuries;

disability 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

continuingnational household interview survey.

Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutriiion Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributionsof the population with respect to

physical, physiological,and psychologicalcharacteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

Data From the National Health Care Survey—These

reports contain statisticson health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected diractiy

from health care providers and provider records.

SERIES 14. Data on Health Resources: Manpower and FacilitiesDiscontinued in 1990. Reports on the numbers, geographic

distribution, end characteristics of health resources are now

included in Series 13.

SERIES 15. Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

SERIES 16. Compilations of Advance Data From Vital and Health

Statistics-Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reporta in Series 10-13.

SERIES 20. Data on Mortality-These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

SERIES 21. Data on Natrdity, Marriage, and Divorc&These reports

contain statistics on natalii, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

SERIES 22. Data From the National Mortality and Nataiii SurveyaDkcontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

SERIES 23. Data From the National Survey of Family Growth—

These reports contain statistics on factors that affect birth

rates, including contraception, infertility, cohabitation,

marriage, divorce, and remarriag~ adoption; use of medical

care for family planning and infertilii and related maternal

and infant health topics. These statistics are based on

national surveys of childbearing age.

SERIES 24. Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of birIhs, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly Vi StatisticsReport (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vita/ i%afkfics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vial Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control end Prevention

Public Health Service

6525 Belcreet Road, Room 1064

Hyattsvilie, MD 20782

(301) 436-8500

E-mail: nchsquery@nchlOa. em.cdc.gov

Internet http//wwwcdc.gov/nchswww/nchshome.htm
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

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