Vital and

Health Statistics

Advance Data

From Vital and

Health Statistics:

Numbers 251–260

Series 16:

Compilations of Advance Data

From Vital and Health Statistics

No, 26

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

and other variables on alcohol- and drug-related visits to hospital emergency

departments; hospitalizations for injury and poisoning; heaith insurance and

cancer screening among women; energy and macronutrient intakes; overviews of

home health and hospice patients and agencies; dietary intake of vitamins,

minerals, and fiber; and contraceptive use. Estimates are based on the civilian

noninstitutionalized population of the United States, These reports were originally

published in 1994.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

July 1995

DHHS Publication No, (PHS) 95-1885
——

/

Copyright Inforrnstlon

,

All material appearing in this report is in the public domain and may be

reproduced or mpied without permission; citation as to source, however, is

appraoiated.

Suggested citstion

National Center for Health statistics. Advanoe data trom vital and health

statistioq numks 251-260. National Center for Health statistics. Vi Health

Stat 16(2S). 1995.
National Center for Health Statistics

Jack R. Anderscp Acting Director

Jennifer H. Madans, 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, Associate Director for Wtal and Health

Statistics Systems

(Vacant), Associate Director for International Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

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

and Methodology
Contents

Alcohol- and Drug-Related Vkits to Hospital Emergency Departments: 1992 National Hospital Ambulatory

Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 251

Hospitalizations for Injury and Poisoning inthe Utited States. 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 252

National Ambulatory Medical Care Survey: 1992 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 253

Health Insurance and Cancer Screening Among Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 254

Energy and Macronutrient Intakes of Persons Ages 2 months and older in the United State,s Third National Health

and Nutrition Examination Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 255

An Overview of Home Health and Hospice Care Patients: Preliminary Data From the 1993 National Home and

Hospice Care Survey ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 256

Hospices and Home Health Agencies: Data From the 1991 National Health Provider Inventory . . . . . . . . . . . . . . . . . . . No. 257

Dietary Intake of Vitamins, Minerals, and Fiber of Persons Ages 2 Months and Over in the United States Third

National Health and Nutrition Examination Survey, Phase 1,1988-91 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 258

Characteristics of Elderly Men and Women Discharged From Home Health Care Services: United States, 1991–92 . . . No. 259

Contraceptive Use in the United States: 1982-90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 260

...

Ill
Number 251 ● August 10, 1994

Advance

Data

From Vi and HealthStatisticsofthe CENTERS FOR DISE4SE CONTROLAND PREVENTION/National Centerfor HeeJthStatistics

Alcohol- and Drug-Related Visits to Hospital Emergency

Departments: 1992 National Hospital Ambulatory Medical

Care Survey

by Cheryl R. Nelson and Barbara J. Stussman, Divisionof Health Care Statistics

Introduction

During the 12-month period from

January through December 1992, an

estimated 89.9 million visits were made

to emergency departments of nonFederal, short-stay and general hospitals

in the United States, about 357 visits per

1,000 persons. An estimated 4.1 million

of these emergency department visits

(4.5 percent) were alcohol related and/or

drug related, about 16 visits per 1,000

persons.

The information presented in this

report is based on emergency

department (ED) data obtained from the

1992 National Hospital Ambulatory

Medical Care Survey (NHAMCS), a

national probability survey conducted by

the Division of Health Care Statistics of

the National Center for Health Statistics,

Centers for Disease Control and

Prevention. The Iirst NHAMCS was for

1992 and will be done annually. A

report on general &dings from the 1992

NHAMCS emergency departments has

been published (l).

The Emergency Department Patient

Record form, the survey instrument

utilized by participating hospitals to

record information about patient visits,

is shown in figure 1. For this report the

4.1 million alcohol-related and/or

drug-related (ADR) ED visits (table 1)

are defined by identifying and

combining (a) 3,782,000 visits that

indicated alcohol ador drug problems

(item 14.24 in the Patient Record

form), and (b) 340,000 visits that

indicated specific ADR diagnoses (item

12 Physicians’ diagnoses).

Data highlights

Half of all ADR ED visits are made

by patients 2S+4 years old.

Males have higher rates of ADR ED

visits and the highest rates are for

black males 2544 years old.

An injury is three times as likely to

be classified as “homicide and injury

purposely inflicted” in an ADR ED

visit in comparison with all other ED

visits.

Seventy-six percent of ED visits for

suicide and self-irdlicted injuries were

alcohol and drug related.

A auarter of the ADR ED visits were

for-reasons of symptoms referable to

psychological/mental disorders (i.e.,

depression and neurotic disorders).

. The treatment and detoxification of

patients exposed to alcohol or poison

were accomplished with several

procedures and/or agents. The most

frequently used were gastric lavage,

metabolic and nutrient agents to

correct complications such as

prolonged mahmtrition (e.g.,

thiamine), and adsorption of the toxin

on activated charcoal.

Patient characteristics

ADR ED visits by patient’s age,

sew race, and ethnicity are shown in

tables 2 and 3. Mrdes accounted for

60.5 percent of these visits and their

visit rate (20 visits per 1,000 persons)

was higher than that for visits by

females (13 visits per 1,000 persons).

The percent distribution of these ED

visits was also higher for young adults.

Seventeen percent of all ED visits by

persons 25-44 yeara of age were ADR

visits (figure 2). More than half of the

ADR ED visits were by patients 25-44

years of age, with a corresponding visit

rate of 27 visits per 1,000 persons. This

tiers significantly from all other visits

to emergency departments in which

persons 75 years and older had the

highest visit rate. The ADR ED visits

by females 2544 yeara of age

(18.6 percent) and males 2544 years of

age (34.4 pxcent) also had higher

U.S. DEPARTMENTOF HEALTHAND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health statistics. CmlEl cmAmFoFlo PREv
2 Advance Data No. 251. August 10,1994

Department of Health and Human Services

Public Health Service, Cantem for Disease control

OMB No. 0920-0278

National Center for Health Statistics

Expires: 2/28/92

CDC 64.63

NOTICE - Information contained on this form which would permit identification of any indwidual or establishment has been collested with a guarantee that it will be held in

strist confidence, will be used only for purpoces statsd for this study, and will not be di$closod or released to others without the consent of the individual or the establishment

in accordance with section 308(d) of the Public Health Service Act (42 USC 242m). Public reporting burden for this phase of the suwey is estimated to average 3 minutes per

raaponse. If you haw any’ comments regarding the burden estimate or any other aspect of this survey, including suggestions for reducing this burden, send them to the PHS

Reports Clearance Officer: Attn: PRA: H HH Building, Rm. 721 -B; 200 Independence Ave., S.W., Washington, DC 20201, and to the Office of Management and Budget; PaperWOIS( Rsduction Pmjest (0920.0278}; Washington. DC 20503.

NATIONAL HOSPITAL AMBULATORY

MEDICAL CARE SURVEY

EMERGENCY DEPARTMENT

PATl ENT RECORD

l.PATIENTNAME 7

2.PATIENT RECORD NO,

-l

-—— ——— . ....————— —— —— —-.. -—. .— ——-— —— — .—— —-——

3. DATE OF VISIT 5. SEX 6. RACE 7. ETHNICITY 8. EXPECTED SOURCE(S) OF PAYMENT 9. MAJOR REA60N

I a Wh Ite (Check all that af@y) FOR THIS VISIT

~ , ❑ ~emale , Q ~lack

(Check one)

I o Hispanic I ❑ Msdicare 5 ❑ HF-lFp~{~her 1 ❑ Injury, first visit

3 ❑ Asian/Pacific 2 ❑ Medicaid 2 ❑ Injury, follow-up

4. DATE OF BIRTH Islander

2 D Male 2 H Not

a ❑ Patient paid

4 ❑ American 3 ❑ $l%nment

3 ❑ Illness, first visit

Indian/

Hispanic 7 Q No charge

4 (J Illness, folk>wwp

Eskimo/ 4aP&ta/ a ❑ Other

mmercial

Aleut

5 ❑ Other reason

I I

Month Day Year I I

10. CAUSE OF INJURY 12. PHYSICIAN’S DIAGNOSES

(Complete ifinjuy is marked

in 9. Describe cause and

place of injury.)

11. PATlENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER

REASON(S) FOR THIS VISIT (In patient’s oum words)

a. Principal diagnosis

problem associated

a. Most with item 11a. important:

b. Other:

c. Other: c. Other:

13. URGENCY OF THIS VISIT

(Check only one)

I ❑ Urgent/Emwgsnt

2 ❑ Non-urgent

15. DlAGN08TlC/SCREENING SERVICES

(Check .11 ordered or prouided.)

16. PROCEDURES (Check all provided on this ukit)

I a Nane

z ❑ Endotracheal

incubation

3 ❑ CPR

4 ❑ IV fluids

5 D NG tube/

gastric Iavaga

6 ❑ Wound sare

7 ❑ Eye/ENT care

a n Orthopedic care

9 a Bladder catheter

10 ❑ Lumbar p.nctwe

I ❑ None 7 ❑ Chect x-ray

2 0 Blood pressure chssk 9 ❑ Extremity x-ray

3 ❑ Urinalysis 10 ❑ CTsca”/MRl

4 ❑ HIV serology 11 ❑ Ot3jr#agmzstic

5 ❑ Other blaod test

12 ❑ Other (Specify)

6 ❑ EKG

14. IS PROBLEM ALCOHOLOR DRUG-RELATED?

t ❑ Neither

2 ❑ Alcohol-related

3 ❑ Orug-relatsd

4 ❑ Both

II ~ other(s) (Specify) 7 ❑ Mmtalstat.sexarn

17. MEDICATION 18. Dl: OSITION THIS VISIT 19. PROVIDERS SEEN

THIS VISIT

(Ckeck all that apply)

1 ❑ Residentfl ntern

2 ❑ Staff physician

3 a Other physician

4 ❑ Physician asaistant

s ❑ Nurs-a practitioner

6 ❑ Registered nurse

7 ❑ ~.sd practisal

a ❑ Nurse’saide

(Record all new or continued mediation ordered, administered, or prouided (Check all that apply)

at this visit. Use the some brand name or generic name entered on any Rx

or medical record. Include immunizatwna and desensitizing agents.)

❑ None

Return to ED PRN

Return to ED - appointment

Return to referring physician

Refer to other physicianlclinic

Admit to hospital

Transfer to other fccility

00A/died in ED

Left AMA

No followwp plannad

Other (Specify)

10

20

30

40

50

en

70

m

1::

1.

2.

3.

4.

5.

Figure 1. Patient record.
Advance Data No. 251. August 10,1994 3

Table1. Number,percentdistribution,andcorrespondingstandarderrorsof alcohol-anddrug-relatedvisitsto hospttalemergency

department=UnitedStates,1992

Number of visits Standard arm Percent

Wsit charsoteristic

Skvrdard etror

in thousands m thousands distribution of paroent

All EDvis”h’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38,78ti 3,202 100.0

All ADRvisits2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . .

4,122 276 4.6

Alcchol problem visits . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.2

2,459 186 2.7 0.2

Drug problem visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 886 91 1.1 0.1

AloohoI enddrug problem vWt.s . . . . . . . . . . . . . . . . . . . . . 327 44 0.4 0.0

ADRdiagncses3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340 36 0.4 0.0

Allothervisii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85,674 3,017 95.4 0.2

‘EDiaemsrgsncy da@manr.

2ADRisalcchclrakdsd andjcrdrugrelatsd.

slti&~~=~m-Ma~-~tiR~ti~~.i4.i),~*-@m~~~~h~T~~

Table2.Number,percentdiatrlbution,correspondingstandarderrom,andannualrateofviattatohospltalemergencydepartmenteby

selectedpatientcharacteristics: UnitedStates,1992

ADR ED visits’2 Afl other ED visits2

Number of

Number standard

Number of

Standal Vkitsper Stenc%ud kisits per

of w-sits error Percent error of I,ooo parsons PatCent

Selected patient drarscteriatks

error of 1,000 persons

in thousands in thousarr& distribution percssrt p9ryea? distribution pement per yea?

ADREDvie.ta’’2 . . . . . . . . . . . . . . . . . .

Age

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

15-24 yaars . . . . . . . . . . . . . . . . . . . . .

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

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

65-74 yeara . . . . . . . . . . . . . . . . . . . . .

75years endover . . . . . . . . . . . . . . . . .

6ex and age

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

Under 15yeara . . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . .

2Ef44years . . . . . . . . . . . . . . . . . . .

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

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

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

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

Under15yaars . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . .

25-44year3 . . . . . . . . . . . . . . . . . . .

45-64yaara . . . . . . . . . . . . . . . . . . .

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

75yearaandover . . . . . . . . . . . . . . . .

Raoeandage

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

Under15yeara . . . . . . . . . . . . . . . . .

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

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

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

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

75yearaandcver . . . . . . . . . . . . . . . .

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

Under15yeara . . . . . . . . . . . . . . . . .

K--24years. . . . . . . . . . . . . . . . . . .

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

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

&-74yeara . . . . . . . . . . . . . . . . . . .

75yearaandover . . . . . . . . . . . . . . . .

Ailotharraoes . . . . . . . . . . . . . . . . . . .

Asian, Paticlslender . . . . . . . . . . . . .

Amerioan lndian, Eskimo,Aletrt . . . . . . .

Ethnicily

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

Notliiepani c . . . . . . . . . . . . . . . . . . .

4,122

306

677

2,164

722

153

81

1,627

149

282

7M

316

59

%38

2,495

157

378

1,418

406

83

43

3,060

252

557

1,517

533

125

76

933

%8

97

591

173

?28

%

130

*52

98

521

3,601

276

40

74

15s

77

23

16

126

25

39

71

57

14

12

135

28

60

115

45

19

11

219

33

70

T24

66

21

15

112

13

20

75

31

11

3

37

21

30

88

245

100.0

7.4

16.4

53.0

17.5

3.7

2.0

39.5

3.6

7.3

18.6

7.7

1.4

W.9

60.5

3.8

9.2

34.4

9.8

2.3

1.0

74.2

6.1

13.5

26.8

12.9

3.0

1.8

22.6

TL9

2.4

14.3

4.2

W7

ml

3.1

*1.3

*1.9

12.6

67.4

. . .

1.0

1.4

1.6

1.3

0.6

0.4

1.8

0.7

0.9

1.4

1.2

0.4

0.3

1.8

0.7

1.3

1.6

0.9

0.5

0.3

2.3

0.9

1.4

2.2

1,2

0.5

0.4

23

0.3

0.5

1.6

0.7

0.3

0.1

0.9

0.5

0.7

23

23

16

5

m

27

15

8

7

13

5

17

19

13

6

*5

20

5

22

35

17

11

9

15

6

20

22

13

8

7

30

*4

19

60

36

~7

%

12

. . .

. . .

. . .

. . .

100.0

25.9

16.5

29.2

13.8

6.6

7.9

525

11.7

9.0

15.5

7.4

3.8

5.0

47.5

14.2

7.5

13.7

6.4

28

29

78.7

19.4

12.9

222

11.2

5.7

7.2

18.9

5.9

3.2

6.1

23

0.8

0.6

24

1.6

0.8

10.5

89.5

. . .

1.4

0.4

0.7

0.4

0.2

0.3

0.5

0.6

0.3

0.4

0.3

0.2

0.2

0.5

0.8

0.2

0.4

0.2

0.1

0.1

1.3

0.8

0.4

0.6

0.4

0.2

0.3

1.2

0.9

0.2

0.5

0.2

0.1

0.1

0.5

0.3

0.3

1.0

1.0

341

394

412

30s

243

306

551

343

365

446

321

251

323

559

333

421

375

284

235

2s6

5ss

322

370

402

281

230

288

556

515

!%9

545

528

3s8

398

511

184

. . .

. . .

. . .

. . .

‘ADRisalcctml rs!atsdsad/crdrugrelated.

2EDissmergencyds@nmnt. -

3Bassdcn U.S. Burwtitie ~us~-m~ti~tirw mksttmhd usdw@aticmofthaUnhsdStatasescfJuVl, 1S92.
4 Advance Data No. 251. August 10,1994

Table 3. Number, percant distribution, corresponding standard emora, and annual rate of visits to hospital amergency departments by

patient’s race, se% and age: United States, 1992

ADR ED visits’2 All otfrer ED visi&

Number of N(umber of

Number Standard S&ndard visits per Standard visits par

of visits errors Percent error of 1,000 parsons Percent error of

Selected patient characteristics

l,OtW persons

in tfrouaands in thousands distribution percent per yea# distribution percent per yea?

ADREDvisita’2 . . . . . . . . . . . . . . . . . .

Race, sax, and age

While . . . . . . . . . . . . . . . . . . . . . . . . .

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

Under 15yasra . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . .

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

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

s5-74yaaB . . . . . . . . . . . . . . . . . .

75yeara srrd over . . . . . . . . . . . . . .

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

Under15yeara . . . . . . . . . . . . . . . .

15-24yeara . . . . . . . . . . . . . . . . . .

2544yeara . . . . . . . . . . . . . . . .

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

65-74yeara . . . . . . . . . . . . . . . . . .

75yearaandover . . . . . . . . . . . . . .

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

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

Under15yeara . . . . . . . . . . . . . . . .

15-24yea~ . . . . . . . . . . . . . . . . . .

MyeaE . . . . . . . . . . . . . . . . . .

4S64yaara . . . . . . . . . . . . . . . . . .

S5-74yaars . . . . . . . . . . . . . . . . . .

75yaeraandover . . . . . . . . . . . . . .

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

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

15-24yaaB . . . . . . . . . . . . . . . . . .

25-44yaaffi . . . . . . . . . . . . . . . . . .

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

a5-74yaers . . . . . . . . . . . . . . . . . .

75yaarsandover . . . . . . . . . . . .

4,122

3,060

1,280

12s

241

5s6

252

46

W3

1,760

128

316

932

281

7s

43

932

304

%?2

*46

1s2

53

*14

*5

626

*17

49

428

119

*14

w

276

219

116

24

35

65

55

12

11

133

27

59

82

35

17

11

112

45

8

16

28

13

7

3

82

6

11

62

24

8

0

100.0

74.2

31.1

3.0

5.9

14.2

8.1

1.1

●0.8

43.2

3.1

7.7

22.6

6.8

1.9

1.0

22.6

7.4

W.5

*1.2

3.e

1.3

●0.3

●0.I

15.2

+0.4

1.2

10.4

2.9

*0.3

W.o

. . .

2.3

2.0

0.6

0.8

1.3

1.2

0.3

0.3

1.8

0.7

1.3

1.6

0.8

0.4

0.3

2.3

1.1

0.2

0.4

0.6

0.3

0.2

0.1

1.7

0.2

0.3

1.3

0.6

0.2

0.0

16

15

12

6

18

17

12

5

%

17

6

23

26

14

11

10

30

18

*5

*18

30

19

●I 5

%

43

*4

20

97

63

*2O

*I

100.0

76.7

41.1

8.8

6.9

11.6

5.9

3.3

4.6

37.6

10.6

6.0

10.6

5.3

2.4

2.7

18.9

10.1

2.7

2.0

3.4

1.3

0.4

0.4

6.8

3.3

1.3

2.7

1.0

0.3

0.2

. . .

1.3

0.6

0.4

0.3

0.4

0.2

0.1

0.2

0.7

0.5

0.2

0.4

0.2

0.1

0.1

1.2

0.7

0.4

0.2

0.3

0.1

0.1

0.1

0.6

0.5

0.1

0.2

0.1

0.0

0.0

341

322

328

343

430

283

237

316

56s

314

385

373

270

222

277

544

515

519

522

631

540

400

411

525

512

614

462

531

375

3s4

466

lADR is abolml ralatsd ersl/or drug related.

2EDisemergsncy departmsmt.

3BaaadonU.S. Bureau oftheCenzusaatimates ofthecivilkrnnonirratituthahed popuIaticm oftheUnited S3ataaaaofJulyl, 1s32.

Age -Males ~Females

2

75 ears

anJ’ over

4 65-74

years

7 45-64

years

11 25-44

years

6 15-24

years

1

Under 15

yeara

14 12 10 8 6 4 2 0 0 2 4 6 8 10 12 14

Pereentdiatribution

Figure 2. Percent of emergency department viaita that are alcohol or drug related:

UnitedStates,1992

percent distributions than their sex-age

counterparts of another ED visits

(15.5 percent and 13.7 percent

respectively). For ADRED visits there

was also asignificant sexdtierence

within the2544 years age group; the

percent distribution and the visit rate for

malea were 34.4pereent with 35 visits

per 1,000 and for females were

18.6 percent with 19 visits per 1,000.

White patients represented

approtiately 75 percent of the ADR

ED visits with a visit rate of 15 visits

per 1,000 persons. Black patienta

represented approximately 23percent of

the ADR ED visits, but the visit rate (30

visits per 1,000 persons) was twice that

of white patients. Other races accounted

for about 3 percent of the ADR ED
Advance Data No. 251. August 10,1994 5

■“”= ’wl-lite — 81aok

100

0

0

0- 60

20

0

Under 15 15-24 25-44 45-64 65-74 75 years

yews years years years years and over

Age

UnitedStates, 1992

visits. When these data were analyzed in

terms of race, sex, and age, the rate for

black males 2544 years of age was 97

visits per 1,000 pemons (figure 3).

The ADR ED visits by white

patients 2544 yearn of age

(36.8 percent) and black patients 25-44

years of age (14.3 percent) also had

higher percent distributions than their

race-age counterparts for all other ED

visits (22.2 percent and 6.1 percent

respectively).

visit Ststus

Over half of the ADR ED visits

were due to illness and another third

were due to injury (table 4). These

proportions were consistent with all

other ED visits. As expected, this table

also shows that 80 percent of all ADR

ED visits were a first visi~ significantly

more than the 5.8 percent for a followup

visit.

“Illness, fit visi~” was the most

frequently reported type of visit,

accounting for nearly half of all the

ADR ED visits. The second most

reported type was “injury, fimt visit,”

accounting for almost a third of the

visits. Nearly 14 percent of responses

fell into the “other” category and was

significantly greater than “other” for all

other ED visits.

Significantly more ADR ED visits

were reported as being urgent or

emergent (58.8 percent) compared with

all other ED visits. Forty-two percent of

the ADR ED visits were reported as

nonurgent. Urgent/emergent visits are

defined as visits in which the patient

requires attention for an acute illness or

injury that threatens life or function and

Table 4. Number, pereent distribution, and corresponding standard errors of vialts to hoapltal emergency dapmmnh by Visit status

United States, 1992

ADR ED visits’z ANotherEDt.isi&

Number

of visits

writ status

Pwoent

in thousanok tt%%e dkkihtkw %d ~ >d

ADREDvisits’’2 . . . . . . . . . . . . . . . . . . 4,122 276 100.0 . . . 100.0 . . .

TyIM of ViSit

Illnasavisit. . . . . . . . . . . . . . . . . . . . . . 2,203 164 53.4 1.9 5s.7 0.9

Filstwt..... . . . . . . . . . . . . . . . . . 2,C63 155 49.8 2.0 55.6 0.9

Follow-up. . . . . . . . . . . . . . . . . . . . . 150 31 3.6 0.8 3.1 0.2

Injuryvisit . . . . . . . . . . . . . . . . . . . . . . 1,351 115 328 1S 35.3 o.a

Firatvisit. . . . . . . . . . . . . . . . . . . . . . 1,261 108 30.6 1.9 31.7 0.7

Follow-up. . . . . . . . . . . . . . . . . . . . . 80 20 2.2 0.5 3.6 0.2

Firstvisit. . . . . . . . . . . . . . . . . . . . . . . 3,314 227 60.4 1.8 87.3 0.7

Follow-upvi sit. . . . . . . . . . . . . . . . . . . . 240 37 5.6 0.8 8.7 0.4

Other ?. . . . . . . . . . . . . . . . . . . . . . . 56a 84 13.8 1.8 6.0 0.6

Urgeneyof visit

Urgent/emergent. . . . . . . . . . . . . . . . . . 2,425 158 58.6 2.3 4.0 1.4

Non-urgent . . . . . . . . . . . . . . . . . . . . . 1,687 168 41.2 23 56.0 1.4

‘ADR.karwholrelstsdSrKi/ordrugrslsred.

*EDisemqersy de@msnt

‘Includesvi.?dsforotherresscmscdbknlrorinvsklreqmws.
6 Advance Data No. 251. August 10,1994

Table 5. Number, percent distribution, and corresponding standard errors of visits to hospital emergency departments by seleetod cause

of injury United States, 1992

ADR ED visita23 All orYrerED IWfa3

Number Standard standard Standard

of visits error Percent error of Peroent error of

Cause of injury and E code’ in thousands in thousands distribution percent distribution percent

ADREDvisite withan Ecodeenteredl’2’3, . . . . . . . . . . . . . . . . .

Motor vehicle accidents, traffic and nontraffic . . . . . . . . .E81 O-E825

Motor vehicle traffic accident of unspecified nature . . . . . . . .E819

Accidental poisoning by drugs, medicinal and biological

substances . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ES5D-E858

Accidental poisoning by analgesic, antipyratics, and

antirheumatice . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E850

Accidental poisoning by other drugs . . . . . . . . . . . . . . . . .E6S8

Accidental falls . . . . . . . . . . . . . . . . . . . . . . . . . . .. E660-E888

Other andunspecifiad fall . . . . . . . . . . . . . . . . . . . . . . ..E668

Other accidents . . . . . . . . . . . . . . . . . . . . . . . . . .. E91GE928

Striking against or struck aooidentally by objects or persons. . .E91 7

Accidents caused by outting and piercing inetrumanfa or

objects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E920

Adverse effects of drugs and medicinal and biological

substances in therapeutic use . . . . . . . . . . . . . . . . ..E930-E949

Other and unspecified drugs and medicinal subetancsa . . . . .E947

Suicide and seff-inflictad injury . . . . . . . . . . . . . . . . .E950-E959

Suicide and aeif-infiicted poisoning by solid or liquid

aubefancae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E960

Homicide and injury purposely inflioted by other persons. .E96C-E969

Fight, brewl, rape . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E960

Assault by other and unspecified means. . . . . . . . . . . . . . .E968

0ther4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,642 142

47

42

100.0 . . 100.0 . . .

289 15.7

10.0

22

2.1

14.0

9.1

0.5

164 0.5

224 37 12.1 2.0 0.4 0.1

0.0

0.1

0.8

0,7

0.7

0.4

74

105

20

28

28

18

37

25

4.0

5.7

11.3

5.5

13.3

6.4

1.1

1.6

1.5

1.1

1.9

1.4

*O.1

0.2

27.1

15.0

36.6

10.5

208

102

246

117

86 23 4.7 1.3 10.8 0.5

14.3

4.9

6.6

2.3

1.2

1.8

0.4

*0. I

0.1

0.1

0.0

0.0

264

91

121

40

20

36

%0

332

122

182

26

50

20

40

4.4

16.0

6.6

9.9

1.3

2.6

1.2

2.1

*0.O

4.4

1.7

2.0

17.0

0.0

0.3

0.2

0.2

159 35 8.6 1.7 0.6

‘Based on tie IrrtemationalClass#ioationof Disease+ %fr Rm”sbrr, Clirrkal Modification (ICD-S-CM).

2ADR is alco4wl related arrdlor drug related.

3ED is emergencydeparbrrenf.

41ncludesrailwayaccidents(EW3-607); other vehicle readaccidents(E82S-E829);watertmnspmt accidents (ES30-ELW3); air and space frSIWPOfi acddents (ES40-E345); vficle Wtidenfs n~

elsewhere classifiable (ES46-ES4S); accidental pohening by ether solid and liquid substances, gases, and vapors (ES60-ESSS~ misadventure to patiante during surgical and medical care (E870-

E876); surgical end medicinalproceduresse the causeC4ebnmmalr-non of or later complicationwithoutmsntiorrs of misadvarrbxe et the tires of procedure (E878-E879X accidents caused by

fire and flames (ESSO-ES89); accidents due to natural and environmental faoters (E800-E909); am”dente caused by submersion, suffocation, and foreign bcdiss (E910-E915k late effecia of

accidental injury (E92W injury undetermined whether accidental or purposely inflicted (13s0-E0S9); and injury resulting from operatiorw of war @W-EWS).

visits. “Assault” and “fight, brawl,

rape” and “striking” accounted for most

of the homicide and purposely inflicted

injuries.

“Accidental poisoning by drug8,

medicinal and biological substances”

accounted for about 12 percent of the

ADR ED visits. Seventy-six percent of

all “suicide and self-inflicted injuries”

and 71 percent of visits for “adverse

effects of drugs, medicinal and

biological substances” were alcohol and

drug related (figure 4). The likelihood of

having injuries caused by “assaults,”

“figh~ brawl, rape,” “accidental

poisoning,” or “suicide” was greater for

ADR ED visits than for all other ED

visits.

Reason for visit

The patient’s principal reason for

visit is coded and classified according to

A Reason for Viiit Classification for

Ambulatory Care (RVC) (3). The RVC

is divided into eight modules or groups

of reasons as shown in table 6. U~pto

three reasons for visit are coded in item

11 of the Patient Record form. T’lhe

patient’s complaint(s), symptom~s), or

other reason(s) for this visit is recorded

in the “patient’s own words. ”

The symptom module accounted for

more than half of the visits with

“general symptoms.” “Symptoms

referable to psychological/mental

disorders,” ‘<symptoms referable to the

digestive system,” and “symptoms

referable to the nervous system” each

accounted for 8-10 percent of the ED

visits. There were significantly more

ADR ED visits classified as “symptom

referable to psychological/mental

disorders” (9.1 percent) than those

classiEed under “all other” ED visits

(1.2 percent). The treatment module

accounted for 4 percent of the ADR ED

visits and was also significantly higher

than treatment for all other ED visits.

Thirty-four percent of ADR IED

visits were classified in the injuries

where delay would be harmful to the

patient.

Cause of injury

The causes of injury for ADR ED

visits are shown in table 5. Up to three

external causes of injury are coded and

classified according to the International

Classification of Dzkeases, 9th Revisioq

Clinical Modification (ICD-9-CM) (2).

The three cause-of-injury classifications

most often mentioned were “homicide

and injury purposely iniXcted,” “motor

vehicle accidents,” and “adverse effects

of drugs, medicinal and biological

substances. ” It is interesting to note that

although “homicide and injury

purposely inflicted” was the leading

cause of injury for ADR ED visits, it

represented the fifth leading cause of

injury classification for all other ED

visits (4.4 percent). “Homicide and

injury purposely inflicted” was also

significantly higher than the

corresponding category of all other ED
Advance Data No. 251. August 10,1994 7

Homicide and injury

purposely inflicted

by other persons

Motorvehicle

accidents

o 20 40 60 80

Percent

Figure 4. Percent of alcohol- or drug-related emergency department visits by external

cause of injury United States, 1992

and adverse effects module and the

majority of these were subclassified as

injury by type and/or location. ADR ED

visits for “poisoning and adverse

effects” (11.0 percent) were higher than

all other ED visits (0.4 percent).

The 15 most frequently mentioned

principal reasons for visit are presented

in table 7. The most frequently reported

reason for visit was “adverse effect of

drug abuse” (6.4 percent) and these

visits were significantly more than those

classfied under all other ED visits

(0.1 percent). “Abdominal pain,” “chest

psi%” and “violence” were also

prominent reasons for visit, each making

up about 3 percent of the ADR ED

visits. The percent of ADR ED visits

with a reported reason of “violence”

was more than seven times that for all

other ED visits. The percent of ADR ED

visits classhied under “other symptoms

or problems relating to psychological

and mental disorders” (2.2 percent) was

five times greater than for all other ED

visits.

Principal diagnosis

The principal diagnosis or problem

associated with the patient’s most

important reason for visit and any other

significant current diagnoses are

rendered by the provider and recorded

in item 12 of the Patient Record form.

Up to three diagnoses are coded and

classified according to the ICD-9-CM

(2).

Table 8 shows the ADR ED visits

using the major disease categories

speciiied by the ICD-9-CM. Injury and

poisoning accounted for the majority

(42.6 percent) of the visits, which is

significantly higher than the same

category in all other ED visits

(32.3 percent). Mental disorders were

reported in about a fourth of visits,

which is much greater than all other ED

visits (1.7 percent). Symptoms, signs,

and ill-defied conditions comprised

10.1 percent of ADR ED visits.

Table 9 shows the 15 principal

diagnoses most frequently rendered by

providers. Nondependent abuse of drugs

was the most common diagnosis,

Table 6. Number, percent distribution, and corresponding standard errors of visits to hospftal emergency departmsnte by the patient’s

principal reason for visifi United States, 1992

ADR ED vfsits- .41 other ED ViSifS3

Number Standard standard standard

of ki.sits error Penwnt

Principal reason rbr visit and RVC code’

m of Pemsnt error of

in thousands in thousands dktribubon pemerrt distribution percent

ADREDvisite2’3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,122 276 103.0 . . . 100.0 . . .

Symptommodule . . . . . . . . . . . . . . . . . . . . . . . . . ..S001-S989 2,160 174 53.1 2.0 72.2 0.6

General symptoms. . . . . . . . . . . . . . . . . . . . . . . .. S001%069 408 54 9.9 1.1 15.4 0.3

Symptomsreferableto psychological/mentaldisorders. . . S100-S1 99 375 66 9.1 1.3 1.2 0.1

Symptomsreferableto the nervoussystem

(excludingsense organs). . . . . . . . . . . . . . . . . . . . S2CQ-82W 320 45 7.8 1.0 5.9 0.2

symptomsreferableto the digestivesystem . . . . . . . . . S500+639 370 m 9.0 1.1 11.7 0.3

symptomsreferableto the muscu[oskeletslsystem. . . . . S800-S999 338 41 8.2 1.0 15.2 0.4

Oisaasemodule. . . . . . . . . . . . . . . . . . . . . . . . . . ..0001-0w8 143 33 3.5 0.8 3.1 0.2

Diagrroetie/scraaningand preventivemodule. . . . . . . . . . . .XIOO-599 60 14 1.5 0.4 0.8 0.1

Treatmentmodule . . . . . . . . . . . . . . . . . . . . . . . . . ..TIoo-T899 165 25 4.0 0.7 2.6 0.1

Injuriesand advetse effeotemodule. . . . . . . . . . . . . . . . JOO1-J8gg 1,436 121 34.8 1.7 19.6

lnjurybytype and/orlccstion . . . . . . . . . . . . . . . . . ..JOOl4?e9

0.6

607 6s 14.7 1.4 16.8 0.5

Injury,NOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..J60&186s 375 51 9.1 1.1 2.5 0.2

Poisoningandadverseeffeote . . . . . . . . . . . . . . . . ..J800-J869 455 51 11.0 1.0 0.4

Testresulte module . . . . . . . . . . . . . . . . . . . . . . . . .. RIoo-R700

0.1

*1o 8 Yr.2 0.2 0.2 0.0

Administrativemodule . . . . . . . . . . . . . . . . . . . . . . ..AIOO-A140 %?5 11 Xl.,

Other’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..lJggO-lJggg

0.3 0.1 0.0

94 23 2.3 0.6 1.3 0.2

‘BasedenA Re8sen for W@ Cf8eWmtkm farAnrbulsrery C%re (RVC), Vtal Heatlh Stat 2(7s). 1979.

2ADR isalcoholrelatsdordrugrs!atsd.

%D is emergawy department.

‘lncludas problems and comphinta not elsewhere clseeifisd, entries of “none: b!anks, and illegible entdes.
8 Advance Data No. 251. August 10,1994

Table 7. Number, percent distribution, and corresponding standard errors of visits to hospital emergency departments by the 15

principal reasons for visit most frequently mentioned by patients: United States, 1992

ADR ED visifsz’a All other ED visifa3

Number Standard Standard

of visits

Standard

error Percent

Principat reason rbr visit and RVC rode’

error of Percent error of

in thousands in thousands distribution percent distribution percent

ADREDvisite2’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,122 276 100.0 . . . 100.0

Adverae effect ofdrug abuse . . . . . . . . . . . . . . . . . . . . ..J910

. . .

262 37 6.4 0.6 *0.1 0.0

Abdominal pain, cramps, spasms, NOS. . . . . . . . . . . . . . . S545 150 27 3.6 0.7 5.6 0.2

CheS pain and related symptoms (not referable to a specific

bodyeystem) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S050 150 26 3.6 0.6 5.2 0.2

Violence, NOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. J815 123 30 3.0 0.7 0.4 0.0

tinvulsions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S205 110 29 2.7 0.7 0.6

Unconscious onarnval . . . . . . . . . . . . . . . . . . . . . . . . ..JwI

0.1

102 24 2.5 0.6 0.6 0.1

Accidental poisoning . . . . . . . . . . . . . . . . . . . . . . . . . .. Jgoo 101 19 2.4 0.5 0.2 0.0

Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S110 98 49 %?.4 1.2 0.4 0.0

Lacerationsandcutsfaciaiarea . . . . . . . . . . . . . . . . . ..J210 96 21 2.3 0.5 1.6 0.1

Head, neck, andfaceinju~type unspecified. . . . . . . . . . ..J505 94 16 2.3 0.4 1.1 0.1

Othereymptomsor problems relatingto peychologicaland

mentaldisordera, NEC . . . . . . . . . . . . . . . . . . . . . . . ..S1S5 89 21 2.2 0.5 0.4 0.0

Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S210 63 19 2.0 0.5 2.9

Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S530

0.2

80 23 2.0 0.5 2.1 0.2

Skinrash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..SSS0 76 16 1.8 0.4 1.4 0.1

Vertigo+tizzinees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S225 75 18 1.6 0.5 1.2 0.1

‘BasadenARasorI fert&itChs&r7csriorr forAmbu/atoiyCare (RVC),viralHealth Stsr2~8). 1979.

2ADR is akmhol related and/or drug related.

3ED is emergency department.

Table 8. Number, percent dietributlon, and corresponding standard errors of visits to hospital emergency departments by the prktcipal

diagnoses recorded by hospital staff United States, 1992

ADR ED viiifa2’3 All other ED Viaitaa

Number of Sbmdard Standard

visits

Standard

error Percent

Principal diagnosis and ICF9-CM code’

error of Percent error of

in thousands in thousands disbibution percent distribution percent

ADREDvisifa2’3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,122 276 100.0 . . . 100.0

Infectious andperasitic dieeaae . . . . . . . . . . . . . . . . ..00 I-13g

. . .

*44 19 *1.1 0.5 3.6 0.2

Mental disorders . . . . . . . . . . . . . . ., . . . . . . . . . . ..2WI9 952 102 2%3.1 1.6 1.7 0.1

Diseaeea of thenervoue syefemand seneaorgane. . . . . . .320-3S9 81 24 2.0 0.8 6.9 0.3

Diseaees of thecirculatory eyafem . . . . . . . . . . . . . . . .390-459 90 16 2.2 0.4 4.4 0.2

Diseases of therespiratory eystem . . . . . . . . . . . . . ..460-519 106 22 2.6 0.5 12.6

Diseases of thedigesttie system . . . . . . . . . . . . . . . ...5-579

0.5

206 36 5.0 0.8 6.1 0.2

Diseases of thegenitourinary ayatem . . . . . . . . . . . . . . .53U.629 34 10 0.8 0.2 4.4 0.2

Diseaaes of theskin andsubcufanaous tiseue . . . . . . . . . .6S0-709 56 14 1.3 0.4 3.0 0.2

Diseases of the musculoekeletal system and rxnnactive

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739 87 23 2.1 0.6 4.3 0.2

Symptoms, eigns, andill-dafinad condtions. . . . . . . . . . . .7S&799 416 46 10.1 1.0 11.7 0.3

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . ...800-999 1,757 132 42.6 2.1 32.3 0.7

Supplementary claeeification. . . . . . . . . . . . . . . . . . . .VOI–V82 106 17 2.6 0.4 3.4 0.2

Allofher diagnoeea4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 19 1.6 0.5 2.9 0.1

Unknown5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 21 2.8 0.5 2.5 0.2

‘Bmedmtie /mematiom/ C/Sfimtion of Dkeases, WRetisim, C/irrica/f@di17cation( lCBW3A).

2ADR is alcohol related and/or dmg related.

3ED is emergency department.

41ncludes neeplasms (f 40-2S9); endocrine, nutritional and metabolic diseases and immunity diierders (240-279~ dseaaes of the blood md blood-forming organs (280-289} complications of

pregnancy, childbirth, and the puerparium (6S0-676); congen”ka.1anomalies (740-759); end certain conditions originating in the parinatsl P“od (WJ2-779).

51ncludee blank diagnoses, uncodable diagnesss, and illegible diagnoees.

accounting for 8.2 percent of principal

diagnoses. Other frequently mentioned

diagnoses included certain adverse

effects, poisoning, alcohol dependence

syndrome, other open wound of head,

and general symptoms. Neurotic

disorders were represented in

significantly more ADR ED visits than

in all other ED visits.

Diagnostic and screening

services

Diagnostic and screening services

ordered or provided by hospital staff for

ADR ED visits are shown in table 10.

At least one diagnostic/screening service

was reported in 94.6 percent of the

visits.

Blood pressure was the most

frequently reported diagnostic anld/or

screening service, followed by other

blood tests. EKG, urinalysis, chest x ray

and mental status exam were each

mentioned in about 20 percent of the

ADR visits. Except for x rays of the

extremities, patients for ADR ED visits
Advance Data No. 251. August 10,1994 9

Table 9. Number, percent distribution, and corresponding standard errors of visits to hospital amargeney departments by the 15

principal diagnoses most fraquantiy recorded by hospitai staff: United States, 1992

ADREDvis&J .41C#W ED visi&

Number of standard S&Ward

Vlwts emu Pemsnt

Prinwpsldiagnosisand ICD-9-CM axle’

Percent

in tfroussrrtlk in thousarro3 dktdMion ad ~ =f

AOREDvisits22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,122 276 10D.O . . . 100.0 . . .

Nondependent abuse of drugs . . . . . . . . . . . . . . . . . . ...305 339 47 8.2 1.0 %.0 0.0

Certain adversa affects NEC . . . . . . . . . . . . . . . . . . . . ...995 225 32 5.5 0.9 0.6 0.1

Poisoning by other and unspecific drugs and medicinal

substances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...977 206 40 5.0 0.9 %).1 0.0

Alcohol dependence syndrome. . . . . . . . . . . . . . . . . . . ..3o3 191 26 4.6 0.6

Otharopen wound of head . . . . . . . . . . . . . . . . . . . . . ...673 155 26 3.8 0.6 2.6 0.1

Generel symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . ..76o 136 31 3.3 0.7 2.6 0.1

Oontusion of lower limb and of other and unspecified sites. . ..824 %9 38 ‘!?.4 0.9 2.0 0.1

Symptoms involving respiratory abnormaliias . . . . . . . . . ...766 86 24 2.3 0.6 3.0 0.2

Depressive di.smferNEC. . . . . . . . . . . . . . . . . . . . . . ...311 %5 48 %2.3 1.2 0.2 0.0

Intercranial injury of other and unspaciliad nature. . . . . . . ...854 95 19 2.3 0.5 0.6 0.1

Po&ming by analgesic, arrtipyratics, and entireheumatii. . ...965 95 22 2.3 0.5 m.o 0.0

Neurotic diaorder . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300 74 16 1.6 0.4 0.6 0.1

Other symptomsinvolvingabdomenand pelvis . . . . . . . . ...769 59 16 1.4 0.4 2.7 0.1

Gastriisand duodanltis . . . . . . . . . . . . . . . . . . . . . . ...535 56 14 1.4 0.4 0.5 0.1

Open wound of other end unspecikxi sites, except limbs. . ...679 64 15 1.3 0.4 1.4 0.1

‘Based WIthe hrtemationslCfssa~Sm of Disessss,#h Ravisbfr,ClinicalMcdikstien (ICD-S-CM).

2ADRis akobl Aated amJ/ordrugra!atad.

3ED k SKPWWUY c@wlmnt

Tabie 10. Number, pemant distribution, and corresponding standard errors of visits to hospitai emerganoy departments by diagnostic

and screening services ordered or provided: United States, 1992

ADR ED -w AUotherED visits3

Number of

visits error P&c&it entwof

Diagn&c and screeningand services’

enwof

h-rftrousands in fhOi&WdS d&r@tion 1==-Jt ~ -t

ADREDvisits23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,122 276 100.0 . . . 100.0 . . .

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 28 5.4 0.8 124 0.7

Blood prassure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,488 268 64.1 1.7 73.2 1.3

Other blood test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,018 168 49.0 2.1 27.8 0.6

EKG4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 679 78 21.3 1.6 12.8 0.4

urinalysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 854 80 20.7 1.4 14.9 0.4

Chastxray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 811 83 19.7 1.4 16.7 0.4

Mentelatetusexem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 772 lCG 18.7 2.0 5.3 0.9

Othardiegnosticimeging . . . . . . . . . . . . . . . . . . . . . . . . . . . !S65 64 13.7 1.4 10.3 0.4

Extremityxray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 582 88 13.6 1.2 15.1 0.4

CTscen/MR15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 40 5.7 0.9 22 0.2

HlVsarology6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●41 14 *1.0 0.3 0.3 0.1

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 822 108 19.9 2.3 19.7 1.3

‘Numbwamay rwtaddtototas becausamomthan oneaewks

2ADRkakc.tmlrelated andlordrugralsted.

may bels@rtsdpsrvisit

3EDiSemarWMICY dqmrtmant

%KGiaeleclrocardiiam.

5C7iscarnrxitadzedtarwmwhvand MRliarnaonekrewnamaimagimr. -.

8HlVishurnanimmunodsk& virus.

were more likely to receive any of these

diagnostic services or tests than were

patients for all other ED visits. This was

especiallytruefor otherbloodtests and

mental status exams. As expected,

“other blood test” waa performed at

twice the rate for ADR visits compared

with all other ED visits. However,

patients from ADR ED visits were three

times more likely to reeeive mental

status exams than were patients for all

other ED visits.

Procedures

More than half of the ADR ED

visits were administered at least one

procedure (table 11). The most

frequently reported procedures were

intravenous fluids, wound care, other,

andnsaogsstric tube/gastnclavage. In

comparison with all other ED visits,

ADR ED visits had a greater likelihood

of having naaogastric tube/gastric lavage

administered. Compared withrdl other

ED visits, ADR ED visits were also

more likely to include intravenous
10 Advance Data No. 251. August 10,1994

Table 11. Number, percent distribution, and corresponding standard errors of visits to hospital emergency departments by procedures

provided: United States, 1992

ADR ED visits2’3 All other ED visitss

Number of Standard Standard Standard

visits error Percent

Procaduresl

error of Percent error of

in thousands in thouaanda distribution percent distribution percent

ADREDvisits2’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Intravenousfluids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Woundcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nasogaetrictube/ga.striclavage. . . . . . . . . . . . . . . . . . . . . . .

Bladdercetheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Orihopediccare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Eye/ENToare4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Endotracheal incubation . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4,122

1,9s4

1,145

721

320

186

177

63

%1

347

276

149

91

89

45

36

2a

21

12

59

100.0

47.4

27.6

17.5

7.6

4.5

4.3

2.0

*0.6

6.4

. . .

1.8

1.7

1.8

1.1

0.8

0.7

0.5

0.3

0.0

100.0

58.2

13.8

12.6

0.7

2.5

8.0

2.8

0.4

8.0

. .

0.8

0.4

0.4

0.1

0.1

0.3

0.2

0.0

0.0

‘Numbersmaynotaddto totalsbesausemorerhanonepresdure maybereported@r visit.

2ADRis alcohelrelatedandor dmgrelstad.

‘ED is emergensy department

4ENTisaer, nose,andthmat.

‘lncludaeCPR (cardiopulmonwy resuscitation), lumbsr punoturs, sndothsr.

Table 12. Numbsr, percent distribution, and corresponding standard errors ofvisftstohospital emergencydepartments bymedicstion

therapyandnumbsr of medications prescribed or provided: Unitsd StatO% 1992

ADREDvisita2’3 AilotfrerEDvisitas

Number of Skurdard Standard Standard

Wkits

Madic#ontherspyl

error Percent error of Percent error of

inthouaarrds irrthouaands distribution peroant distribution percent

ADFl EDvisits2’3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,122 276 100.0 , . . 100.0 . . .

Drug visite4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,627 177 63.7 2.5 69.4 0.8

Visitawithoutmentionofmecksdion . . . . . . . . . . . . . . . . . . . . 1,495 159 36.3 25 30.6 0.8

Numberof medications prescribed orprovidad

One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,109 88 26.9 1.7 32.9 0.5

Two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 755 72 18.3 1.5 21.1 0.5

Three . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351 51 6.5 1.1 9.0 0.3

Four. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 32 5.1 0.7 3.5 0.2

Five . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 29 4.6 0.7 2.9 0.2

‘Includes preaortption dregs, over-the-eourrter prapareSona, immunizing agents, end desensitizing agents.

2ADR is alcohol related and/or drug related.

‘ED is emergensy department.

%isksat MM enee+momdruga were pmvidad or prasoribad by lhe heeith care pfovider.

fluids, wound care, andlor bladder

catheter procedures.

Drug mentions

ThemajorityofADR EDvisits

included medication therapy. One

medication was administered during

26.9 percent of the visits and two

medications were administered during

18.3 percent of the visits (table 12). In

about 10 percent oftheADR ED visits,

four or five medications were

administered to patients, which was

higher than what was administered in all

other ED visits.

Because there may be multiple

medications per visit, the total number

of drug mentions may exceed the total

number of visits. “Drugmentions’’r efer

to the total number ofmedications listed

in item 170fthe Patient Record form.

There were 5.5 million drug mentions

for ADR ED visits. This averages to 2.1

drug mentions per drug visit. “Drug

visit” refers to visits with at least one

drug prescribed or provided.

The number of drug mentions by

therapeutic classification is shown in

table 13. The classification system used

was adapted from the therapeutic

categories in the National Drug Code

Directory (NDC) (4). The largest

percent of mentions for ADR EDIvkits

were drugs used for relief of pain.

Metabolic and nutrient agents were

administered more often in ADR ED

visits than inall other ED visits.

Seventy-five percent of all antidotes

were administered during ADR ED

visits, representing 4.7percent of these

visits and significantly more than all

other EDvisits (O.l percent). Metabolic

and nutrient agents were also

administered for ADRED visits :more

often than to another ED visits.

The 15 most frequently used

generic substances in drugs mentioned

for ADR ED visits are shown in

table 14. The most frequently
Advance Data No. 251. August 10,1994 11

Table 13. Number, percent distribution, and corresponding standard errors of visits to hospital emergency departments by therapeutic

classification of dmg mantlon~ United States, 1992

ADR ED visitsw All other ED visits=

Numberof Stanokrd standard standard

Vr”sits error PsYCant envr of

l?rerapauticofassifioafion’

Percent emx of

in thousands in ttrousands disfributkrn pstumt dkbfbution @rCent

ADREDmerdions203 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugs used forraliefof pain . . . . . . . . . . . . . . . . . . . . . . . . .

Gastrointestinal agents . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anfimicrobiil agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychophsrmacological drugs . . . . . . . . . . . . . . . . . . . . . . . .

Metabolic andnutrient agents . . . . . . . . . . . . . . . . . . . . . . . .

Respiratory traotdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Necrologic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

oardiivssculw-renal drugs . . . . . . . . . . . . . . . . . . . . . . . . . .

Antidotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lmmunologicagente . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anesthetic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skin/muoousmembrane . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hormonesandrelatedagerds . . . . . . . . . . . . . . . . . . . . . . . .

Hematobgicagents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherandunclassified’ . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5,518

1,111

557

545

518

4ss

432

266

26s

261

237

130

122

105

102

394

406

115

74

57

59

53

60

36

4a

44

40

30

24

21

22

4s

100.0

20.1

10.1

9.9

9.4

a.4

7.6

4.9

4.9

4.7

4.3

2.4

2.2

1.9

1.9

7.1

. . .

1.7

1.1

0.9

0.9

0.9

0.9

0.7

0.8

0.8

0.7

0.5

0.4

0.4

0.4

0.7

100.0

30.3

4.5

17.0

4.8

1.7

11.5

2.2

8.5

0.1

3.1

2.3

3.5

3.1

1.0

a.4

. . .

0.5

0.2

0.4

0.2

0.1

0.4

0.1

0.3

0.0

0.2

0.1

0.2

0.2

0.1

0.3

%eaedorrttreatsndard drugclmsirimfbn umdintheNstional OnrgCodeDirectory,lSS5ediin.

2ADRis alcoholrelarsdand/erdrugrelated.

‘ED is emergencydepartment.

‘Includseradbpharrnaceurim!s,rmnfrssf media,oncoiytlcs,otokrgics,antipsres”ti, ephthalm.ks,and unolsaaWd/miaoellanmuadrugs.

Table 14. Number, percent distribution, and corresponding standard errofa of visits to hospital emergency departmenb$ of drug men.

tfons for the 15 most frequently used generic substance United States, 1992

ADR ED &3 .41 othw ED visits=

Number of standard Stsndald Stsrrdsni

Vfsifa anvr Percent

Generic substanse’

F?9Tent

disbibutim =d dMriMion

Snwof

in thousands in thousands

ADREDmerrtions2’3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,516 406 100.0 . . . 100.0 . . .

Acefaminophen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258 38

Thiamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.7 0.8 7.4 0.4

242 32 4.4 0.6 0.1

Ibuprofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.0

208 37 3.6 0.7 5.8 0.2

Diphenhydramine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 30 3.4 0.5 1.5 0.1

Ketorolac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 25 28 0.5 2.5 0.2

Charcoal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 26 25 0.5 W.o 0.0

Meperidine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 28 23 0.5 2.4 0.1

Phenytoin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 25 21 0.5 0.4 0.0

Magnssiumsafhartics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 20

Lidooaine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20 0.4 0.1 0.0

88 23 1.6 0.4 1.5 0.1

Tetanuetoxoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 21 1.5 0.4 0.8

Oxygen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.1

82 22 1.5 0.4 1.4 0.1

Hydroxyzine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 20 1.4 0.4 1.8

Naloxone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.1

79 18 1.4 0.3 0.0 0.0

Cephalexin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 23 ●1.4 0.4 1.4 0.1

lFrequarxyofmen&m combinesairrgle-ingredient agentswithmantbna ofrheagsntsasn ingradiiinawnbinah drug.

2ADRis almtwl mlatsdar@ordrugralatsd.

3EDisemergenoy department.

mentioned generic substances listed as

sn ingredient were acetaminophen,

thiamine, ibuprofen, and

diphenhydramine.

The 15 most frequently mentioned

medications according totheentrynrtme

ofthedrug (the actual name written on

the Patient Record form bytheherdth

care provider), whether brand name,

generic name,or therapeutic effect, are

shown intable15. TJdenol, thiamine,

andBenadrylwere thethreedrugs most

frequently provided orprexribedduriug

ADR ED visits. However, thiamine,

charcord,Dikmtin, andcharcord

activated with sorbitol are more likely

administered for ADR ED visits than for

all other ED visits. Medications not

shown in table 15—like Ipeeac, Vfium,

magnesium sulfate, and Ancef-were

also more likely to be administered for

ADR ED visits.

Disposition

The most frequent dispositions of

ADR ED visits are displayed in

table 16. Thirty-five percent of the ADR

ED visits were “referred to other

physicians or clinic,” followed by

“re~to ED pm.” “Transfertoother

filcility” was the disposition for

5.9 pereent of the ADR ED visits, which

was signiikantly higher than those for
12 Advance Data No. 251 ● August 10,1994

Table 15. Number, percent distribution, and corresponding standard errors of alcohol and drug-related visits to hoepital emergemy

depatiments of drug mentions for the 15 drugs most frequently provided or prescribed: United states, 1992

Number of Standard Standard Standard

drug mentions error Percent error of

Errtry name of drugl

Therapeutic Percent error of

in thousands in thousands distribution percent claaaificationz distribution percent

ADREDmentions3 . . . . . . . . . . . 5,518 406 100.0 . . 100.0 . . .

Tylenol . . . . . . . . . . . . . . . . . . . 247

Thiamine . . . . . . . . . . . . . . . . . .

37 4.5 0.6 Analgesic 7.2 0.3

23a 32 4.3 0.6 Vitamiwminersl WI 0.0

Benadryl . . . . . . . . . . . . . . . . . . 165 30 3.4 0.5 Antihistamine 1.5 0.1

Torsdol . . . . . . . . . . . . . . . . . . . 152 25 2.8 0.5 Antiarthritic agent

Motrin . . . . . . . . . . . . . . . . . . . .

2.5

139

0.2

33 2.5 0.6 Antiarthritic agent

Charcoal . . . . . . . . . . . . . . . . . . 126

3.1 0.2

26 2.3 0.5 Gastrointestinal agent *0.O 0.0

Demerol . . . . . . . . . . . . . . . . . . 126 26 2.3 0.5 Analgesic

Dilantin . . . . . . . . . . . . . . . . . . . 113

2.4 0.1

25 2.1 0.5 )sntimnvulsant agent 0.4 0.0

Charcoal, aotivatadwith aorbtol. . . . 106 29 1.9 0.5 Antidota *0.O 0.0

Tylenol no.3 . . . . . . . . . . . . . . . S4 25 1.7 0.5 Analgesic 2.1 0.2

Tetanustoxoid . . . . . . . . . . . . . . 63 21 1.5 0.4 Vaccine/antiserum 0.8 0.1

Diphtheriatatanuatoxoids . . . . . . . 82 21 1.5 0.4 Vaccine/antiserum

Oxygen . . . . . . . . . . . . . . . . . . . 82

1.1 0.1

22 1.5 0.4 Adjunct to anesthesia and analeptic

Naroan . . . . . . . . . . . . . . . . . . . 79

1.4 0.1

16 1.4 0.3 Antidote

Phenergan . . . . . . . . . . . . . . . . . 75

0.0 0.0

21 1.4 0.4 Nasal decongestant 2.5 0.2

ha enby madebyIha hsaithmre provideronthe pmscripticmor othermedicalrecords. TM may be a trade name, generic name, or desired iherapautic effect.

2Besad on the IVatkwfal Orug Cods Dhctory, 1SS5 edition (NIX). In roses wttere a drug had more than one tharapeulic use, it was listed under the NDC primary classification.

3ADR is almtwl relatedsnd/ordrugrelatedand ED is arnergemy dewent

Table 16. Number, percent distribution, and corresponding standard errors of visits to hospital emergency departments by dispesitioru

United States, 1992

ADR ED viiitaz’= Ail other ED Visik3

Number of Standard Standard Werrdard

visita error Percent

Disposition’

error of Percent error of

in thousands in thousands distribution percent distribution percent

ADREDviaits2’3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,122 276 100.0 . . . 100.0 . . .

Raferto other physician/clinic . . . . . . . . . . . . . . . . . . . . . . . . 1,436 115 34.8 2.2 37.1 1.4

Ratumto ED PRN4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 823 94 20.0 2.2 25.2 1.4

Admit tohospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 606 116 19.6 2.3 13.2 0.4

Return torafaning ptsyaiaan . . . . . . . . . . . . . . . . . . . . . . . . . 599 77 14.5 1.7 21.5 1.4

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364 78 9.3 1.7 4.9 0.6

Tranaferto other facilii . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 40 5.9 0.9 1.0 0.1

Return to ED-appointment. . . . . . . . . . . . . . . . . . . . . . . . . . 206 45 5.0 1.1 4.8 0.4

No follow-up planned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 23 3.8 0.6 6.1 0.6

Laft AMA5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

DOAkkdinEDE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30 3.6 0.7 1.0 0.1

%3 3 %r.1 0.1 0.3 0.0

~Numberamaynotsdd tototals bacausemorarhanonstiswMon may beremtiti mrvMa

2AOR is a!octml related and/or drug relarod.

3ED k emsrgencydepartment.

4PRN is as needed.

5AMA is against msdicel advice.

‘DOA ia deadcmarrival.

all other ED visits (1.0 percent). It

should be noted that “transfer to other

facility” includes not only other medical

facilities but also to other institutions

such as jails. The percent of visits

resulting in adiaposition of “admit to

hospital” was 19.6 pereent for ADR ED

visits, compared with 13.2percent for

all other ED visits. Dispositions of

“other” and “left against medical

advice” were

significantly more for ADR ED visits

compared with all other ED visits.

Expected source of payment

The expected sources of payment

most often mentioned were “patient

paid, “ “privatekxnnrnercial” insurance,

and Medieaid (table 17). “Patient paid”

waa considerably higher for ADR ED

visits than for all other ED visits.

“Other” forms of payment were also

higher for ADR ED visits compared

with all other ED visits. Medicare was

recorded as the source of payment in

10 pereent of the ADR ED visita and

“other government” insurance and

“HMO/other prepaid” were each

mentioned about 4 percent of the time.

Readera should note that 1)

providers were asked to check all of the

applicable payment categories for item 8

on the Patient Record form, resulting in
Advance Data No. 251. August 10,1994 13

Table 17. Number, pereent distribution, and corresponding standard errors of visits to hoapitei emergeney departments by patient’s

exrweted sources of payment United States, 1892

ADR ED vkitsw AIIothar EDvkit.s3

Number of Stsndd

Expsoted sources of payment’

W“sits P&cant error of Pamant arrorof

in thusands in th%&rda

~fiti

parsmt dlwMion -t

ADREDvisits23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,122 276 100.0 . . . 100.0 . . .

Patient psid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,078 118 26.1 2.2 13.2 0.6

Private/eommeroial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,024 97 24.8 2.0 86.5 1.1

Medi~.d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 838 86 22.6 1.6 22.7 1.1

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 60 10.0 1.4 6.7 0.5

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412 44 10.0 1.1 15.4 0.5

HMO/otherprepaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 4s 4.8 1.2 7.4 0.8

othergovamment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 31 4.4 0.8 4.5 0.5

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 17 1.2 0.4 1.7 0.3

Nocharge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘!5s 26 ●1.3 0.7 W.8 0.4

‘Numbersmaymtaddtototals bacumamamfhanoneawactadaource ofpsymentmey&s raportedpxviait.

2ADRisaWand dtugrdstad.

‘ED is smsqemy dqwbnant

Tabie18. Number, pereent distribution, andcorresponding atandarderrorsof visitetohoepitai emerganeydepertmenta bytypeofheaith

care provider and region: United States, 1882

ADR ED visits’2 Afl othw ED vkitsz

Numtw of Stsntfanf

Vi&s Pemant arrorof Pament anwof

Haalttrcsreprovider andragim in tfwsmda intfr%%ds diMMion mt mm m

ADFIEDWS1’2 . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,122 276 100.0 . . . 100.0 . . .

Heatlhoarepdders seen3

Registerednursa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,609 267 87.6 1.9 82.9 1.5

Staffphysician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,492 242 64.7 2.1 824 1.6

Residenthtem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 740 120 17.9 2.8 13.5 1.5

Nurse’saide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429 82 10.4 2.0 9.4 1.3

Otherphyaician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424 63 10.3 1.6 11.8 1.4

Lioensedprec%cal nurse . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 76 6.4 1.9 6.5 1.0

Nurwpraetitioner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 33 *1.8 0.8 1.9 0.5

Physicianassistant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~8 27 *1.9 0.7 2.0 0.4

GeoLIrsphii @on

Miieat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,217 187 28.5 3.7 28.7 1.9

south . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,060 124 26.2 3.0 33.2 1.8

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,036 133 25.1 3.0 19.2 1.5

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762 84 19.1 2.2 18.9 1.2

‘AOR”sakoholrelated sm%rdmgrelsted.

2ED is amw@ncyd~

3NumWmqtiaddmWstiwm~m-~ beseanad rsportsdpervisit

multiple payment sources for each visi~

and 2)the ’’patient paid’’eategory

includes thepatient’s contribution

toward ’’co-payments” and

“deductibles.”

Health providers

The distributionof ADRED visits

by thehealth care provider seen bythe

patient is presented in table 18.

Registered nurses and SW physicians

aeeountedforthe majorityoftheae

health care providers. Residents and

intemswere seen in 17.9 percent of the

visits. Physician aasistanta andrmrae

practitionerawere seenthelea3twith

fewer than 2 percent of the visits each.

Geographic region

ADRED visits differ bygeographic

region (table 18).Vkitainthe Midwest

were signitkantly higher than visits in

theNortheast.The percent distribution

ofADRED visita forthe South

(26.2pereent)wasleaa thanitspereent

distribution ofnon-ADR EDvisits

(33.2 pereent), For all other regions,

there w23 no signifkant difference

between pereent distriiution.s ofADR

ED visita and all other ED visits.

Additional reports that utilize1992

NHAMCSdatawiU republished.

Survey datawillsko be availableon

eomputertapeat anominaleostiiom

the NationalTechnieal Information

Mviceinthesmnruer of1994.

Queationsregarding thisrepozfuture

reports, ortheNHAMCS, maybe

direetedtotheAmbulatory Care

Statistics Branch by calling

(301) 436-7132.
14 Advance Data No. 251. August 10,1994

References

1.

2.

McCaig LF, National Hospital

Ambulatory Medical Care Survey,

1992 emergency department 3.

summary. Advance data from vital

and health statistim, no 245.

Hyattsville, Maryland Nationaf

Center for Health Statistics. 1994.

Public Health Service and Health

Care Financing Administration.

International Classification of 4.

Diseases, 9th Revision, clinical

modilkation. Washington: Public

Herdth Service. 1980.

Schneider D, Appleton L, McLemore 5.

T. A reason for visit claasilication

ambulatory care. Vital Health Stat ~

no 78. Hyattaville, Maryland

National Center for Health Statistics.

1979.

Food and Dmg Administration.

National Drug Code directory, 1985

ed. Washingtorx Public Health

Service. 1985.

Shah BV, Bamwell BG, Hunt PN, La

Vange LM. SUDAAN user’s manual,

release 5.50. Research Triangle Park,

North CarOlinrc Research Triangle

Institute. 1991.

Symbols

..- Data not available

. . . Categoty 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. 251. August 10,1994 15

Technical notes

Source of data and sample

design

The information presented in this

report is based on data collected in the

National Hospital Ambulatory Medical

Care Survey (NHAMCS) from

December 2, 1991 through December

27, 1992. The target universe of

NHAMCS includes visits made in the

United States by patients to emergency

departments (ED’s) and outpatient

departments (OPD’S) of non-Federal,

short-stay or general hospitals.

Telephone contacts are excluded. The

data were adjusted to produce annual

estimates.

NHAMCS utilizes a multistage

probability sample design that involves

samples of primary sampling units

(PSU’S), hospitals with ED’s and/or

OPD’S within PSU’S, ED’s within

hospitals and/or clinics within OPD’S,

and patient visits within ED’s and/or

clinics. For 1992, a sample of 524

non-Federal, short-stay and general

hospitals was selected from the SMG

Hospital Market Database. Of this

group, 474 hospitals were in scope, or

eligible to participate in the survey; and

437 of these sample hospitals had ED’s.

The hospital response rate for the 1992

NHAMCS was 93 percent. Hospital statl

were asked to complete Patient Record

forms (fi&re 1) for a systematic random

sample of patient visits occurring during

a randomly assigned 4-week reporting

period. Responding ED’s completed

36,271 Patient Record forms.

Characteristics of the hospital, such

as ownership and expected number of

ED visits, were obtained from the

hospital administrator during an

induction interview. The U.S. Bureau of

the Census, Housing Surveys Branch,

was responsible for the survey’s data

collection. Data processing operations

and medical coding were performed by

the National Center for Health Statistics,

Health Care Surveys Section, Research

Triangle Park North Carolina.

Sampling errors

The standard error is primarily a

measure of the sampling variability that

occurs by chance when only a sample,

rather than an entire universe, is

surveyed. The standard error also

reflects part of the measurement error,

but does not measure any systematic

biases in the data. The chances are 95

out of 100 that an estimate from the

sample di.lTersby less than twice the

standard error ftom the value that would

be obtained from a complete census.

The standard errors used in this

report were approximated using

SUDAAN software. SUDAAN

computes standard errors by using a

tlrst-order Taylor approximation of the

deviation of estimates from their

expected values. A description of the

software and the approach it uses has

been published (5). Exact standard error

estimates were used in tests of

significance in this report. Standard

errors for all estimates are presented in

each table. Standard errors for rates can

be cakmlated using the relative standard

errors (RSE) for the number of visits

(i.e., multiply the rate by the RSE for

the estimate of interest).

Adjustments for hospital

nonresponse

Estimates from NHAMCS data

were adjusted to account for sample

hospitals that were in scope but did not

participate in the study. This adjustment

was calculated to minimize the impact

of nonresponse on fial estimates by

imputing to nonresponding hospitals

data from visits to similar hospitals. For

this purpose, hospitals were judged

similar if they were in the same region,

ownership control group, and

metropolitan statistical area control

group.

Adjustments for ED and/or

clinic nonresponse

Estimates from NHAMCS data

were adjusted to account for ED’s and

sample clinics that were in scope but

did not participate in the study. This

adjustment was calculated to minimize

the impact of nonresponse on iinal

estimates by imputing to nonresponding

ED’s or clinics’data from visits to

similar ED’s or clinics. For this purpose,

ED’s or clinics were judged similar if

they were in the same ED or clinic

group.

Test of significance and

rounding

The determination of statistical

inference is based on a two-sided t-test.

The Bonferroni inequality was used to

establish the critical value for

statistically significant differences (0.05

level of confidence). Terms relating to

differences such as “higher than”

indicate that the diilerences are

statistically significant. A lack of

comment regarding the difference

between any two estimates does not

mean that the difference was tested and

found to be not significant.

In the tables, estimates of ED visits

have been rounded to the nearest

thousand. Consequently, estimates will

not always add to totals. Rates and

percents were calculated from original

unrounded figures and do not

necessarily agree with percents

calculated horn rounded data.

Definition of terms

ADR diagnosk-An alcohol-related

and/or drug-related visit is defined by

one or more of the following diagnoses

pellagra (ICD 265.2), alcoholic

psychoses (lCD 291), drug withdrawal

syndrome (ICD 292.0), acute alcoholic

intoxication (ICD 303.0), other and

unspecified alcoholic dependence (ICD

303.9), unspecified drug dependence

(ICD 304.0), alcohol abuse (ICD 305.0),

tobacco use disorder (ICD 305.1),

alcoholic cardiomyopathy (ICD 425.5),

acute alcoholic hepatitis (ICD 571.1),

alcoholic cirrhosis of liver (ICD 571.2),

other current conditions in the mother

classifiable elsewhere, but complicating

pregnancy, childbirth, or the puerperium:

drug dependence (ICD 648.3) and

mental disorders (lCD 648.4), suspected

damage to fetus from drugs (ICD

655.5), fetal alcohol syndrome (ICD

760.71), drug withdrawal syndrome in

newborn (ICD 779.5), poisoning by

opiates and related narcotics (ICD

965.0), poisoning by barbiturates (ICD

967.0), toxic effects of alcohol,

unspecified (ICD 980.9), unspecified

adverse effect of drug, medicinal, and

biological substances (ICD 995.2),

alcoholism (ICD VO1l.3), renal dialysis

status (ICD V045.1), other unspecified
16 Advance Data No. 251 ● August 10,1994

dependence on machines (ICD V046),

and radiotherapy (ICD V058.1).

Drug mention-A drug mention is

the physician’s entry on the Patient

Record form 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 specilkally instructed

during the visit to continue the

medication. Physicians may report up to

five medications per visit.

Drug visit-A drug visit is a visit at

which medication was prescribed or

provided by the physician.

Emergency department-An

emergency department is a hospital

facility that provides unscheduled

outpatient services to patients whose

conditions require immediate care and is

staffed 24 hours a day. If an ED

provides emergency services in different

areas of the hospital, all these areas

were selected with certainty into the

sample. Off-site emergency departments

that are open less than 24 hours are

included if staffed by the hospital’s

emergency department.

Hospital—All hospitals with an

average length of stay for all patients of

less than 30 days (short-stay) or

hospitals whose specialty is general

(medical or surgical) or children’s

general, are included. Federal hospitals,

hospital units of institutions, and

hospitals with fewer than six beds

staffed for patient use are excluded.

Nonurgent—A visit is nonurgent if

the patient does not require attention

immediately or within a few hours.

Trade name disclaimer

The use of trade names is for identification

only and does not imply endorsement by the

Public Health Service, U.S. Department of

Health and Human Services.

Outpatient department-An

outpatient department is a hospital

facility that provides nonurgent

ambulatory medical care under the

supervision of a physician.

Patient-A patient is an individual,

not currently admitted to any health care

institution on the premises, who is

seeking personal health services,

Urgentlemergent—A visit is

urgent/emergent if the patient requires

immediate attention for an acute illness

or injury that threatens life or function

and where delay would be harmful to

the patient.

Viiit-A visit is a direct, personal

exchange between a patient and a

physician or other health care provider

working under the physician’s

supervision, for the purpose of seeking

care and receiving personal health

services.

Suggested citation

Nelson CR and Stussman BJ. Alcohol- and

drug-related visits to hospital emergency

departments 1992 National Hospital

Ambulatory Medical Care Survey. Advance

data from vital and health statietic~ no 251.

Hyattsville, Maryland: National Center for

Health Statistics. 1994.

copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health StatMlcs

Director

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

Deputy Director

Jack R. Anderson

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

6525 Be[crest Road m!

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

To receive this publication regularly, contact

the National Center for Health statistics by

calling (301 ) 436-6500

DHHS Publication No. (PHS)94-1 250

4-1380 (8/94)
Number 252 ● October 7, 1994

Advance

Data

From Vtal and HeaJlh Statistics of the CENTERS FOR DISEASE CONTROL AND PREVENTION/National Center for Health Statistics

Hospitalizations for Injury and Poisoning

in the United States, 1991

by Margaret Jean Hall, Ph. D., and Maria F. Owings, Ph. D., Division of Health Care Statistics

Introduction

In 1991, approximately 2.8 million

Americans were hospitalized due to

injury or poisoning diagnoses (l), and

close to 150,000 persons died from

injuries (2). Apart from women giving

birth, injury was the leading cause of

hospital admissions for people younger

than 45 years of age (1) and the leading

cause of death in this same age group

(2). It has been estimated that one in

four Americans are injured annually, and

that injuries cost the United States more

than $100 billion per year due to lost

productivity and medical care (3).

Information on fatal injuries is

generally recorded on death certificates.

However, a nationwide system for

reporting information on nonfatal

injuries does not exist. Hospital

discharge data are valuable sources of

information on the injuries that require

hospitalization. Although these injuries

comprise only a small portion of injuries

as a whole, they are important to track

because they are the most costly in

terms of human suffering as well as

health care resource consumption.

A serious problem with hospital

data is the lack of complete information

on the causes of injury. Accurate and

reliable information regarding the

external causes of injury (&codes) is

critical for planning, implementing, and

evrduating injury-control programs (4).

Such information also is required to

assess our country’s progress toward

achievement of the national health

objectives for the year 2000 that relate

to the reduction of injury morbidity and

injury control interventions (5,6).

Using information from the

National Hospital Discharge Survey

(NHDS), this paper describes the

characteristics of patients hospitalized

due to an injury or poisoning and

reports on the completeness of the

E-code information in the NHDS.

Persons treated in hospital emergency

rooms, outpatient departments, or

ambulatory care clinics who were not

admitted as inpatients are not included

in this paper.

The NHDS is a continuous

voluntary survey conducted by the

National Center for Health Statistics

since 1965. This survey is one of the

principal sources of information on

patients discharged from non-Federal,

short-stay hospitals in the United States.

In 1991, data for the survey were

abstracted from medical records of

approximately 274,000 sampled patients

discharged from a sample of 484

hospitals.

A three-stage, stratied sample

design has been used in the NHDS since

1988. A brief description of this design,

data collection procedures, and the

estimation process are in the Technical

notes of this report.

Up to seven diagnoses and four

procedures were coded for each

discharge in the survey. Coding of

diagnoses and procedures was

performed according to the International

Classification of Disea.w, 9th Revisioq

Clinical Mod@cation (ICD-9-CM) (7).

For this paper injury and ~isoning

diagnoses include all of the codes in

Chapter 17 of the ICD-9-CM, namely

codes 800-994, which have been termed

“true injuries” including trauma and

poisoning, and codes 995–999, which

have been termed “medical injuries”

Acknowledgments I

This report was prepared at the Division of Health Care Statistics. Helen Christian, Technical Services Branch, veriied the data. The repoR was

edited by Gail V. Johnson and typeset by Jacqueline M. Davis of the Publications Branch, Division of Data Services.

# 5%xwc&e

*+

$

%

-g

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

c

~m

F

3

Public Health Service

* Centers for Disease Control and Prevention “o

%’

3

%< National Center for Health Statistics m ——

%&’= -,-8—u’lmsEAsE

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Arm PREwNnoN
2 Advance Data No. 252 ● October 7, 1994

including adverse effects and

complications of medical care (8). This

paper will focus primarily on “true

injuries” although data for all categories

will be included in the tables.

Discharges with a first-listed injury or

poisoning diagnosis are the focus of this

report.

To interpret data and compare them

with available data from other sources

on short-stay hospital use, one must

become familiar with the definitions

used in NHDS. Definitions of the terms

in this report are in the Technical notes.

NHDS data indicate that, in 1991,

2.8 million patients were hospitalized

due to an injury or poisoning diagnosis.

These patients comprised 9 percent of

all hospital discharges in 1991 and were

in the hospital for a total of 19.1 million

days, which was 10 percent of all

patient days (table 1). These patients had

an average of 1.6 injury and poisoning

diagnoses. Sixty-seven percent had only

one injury and poisoning diagnosis,

19 percent had two, and 14 percent had

three or more such diagnoses (figure 1).

On average, patients with a first-listed

diagnosis of injury and poisoning spent

6.9 days in the hospital; the average

length of stay for patients with other

diagnoses was 6.4 days.

In addition to the 2.8 million

persons hospitalized primarily due to

their injury or poisoning, there were an

additional 1.5 million patients who had

at least one injury or poisoning

diagnosis, but were hospitalized

primarily for other conditions. Over

one-half of these patients had first-listed

diagnoses of diseases of the circulatory,

Figure 1. Discharges with first-listed injury

and poisoning diagnoses

Table 1. Selected measures of hospital utilization for patients discharged from shor&NMsy

hospitals: United States, 1991

[Discharges from non-Federal hospitals. Excludes newborn infanta]

Injury and

All poisoning Patients with

Measure of hoapiti utilization patienta patients other diagnoses

Number of discharges in thousands . . . . . . . . . 31,098 2,766 28,330

Number of days of care in thousands . . . . . . 199,099 19,138 179,961

Average length of slay in days . . . . . . . . . . . 8.4 6.9 6.4

digestive, or musculoskeletal systems, or

neoplasms. These patients will not be

covered in this report since their injuries

were not the primary reason for their

hospitalization. According to Smith,

Langlois, and Buechner (8), who studied

hospital discharge data in Rhode Island,

these other injuries are usually minor,

are often associated with another

condition (for example, cancer), or even

may have occurred while the person was

in the hospital (for example, a fall

resulting in a hip fracture).

Highlights

● The overall hospitalization rate for

injury and poisoning diagnoses was

110.5 per 10,000 population, but it

ranged from 51.9 per 10,000 for

children under 15 to 279.6 per 10,000

for persons 65 years of age or older.

The most common injury and

poisoning diagnosis was fractures

(37 percent).

More than one-half of the group 65

years of age and over with injury and

poisoning diagnoses had

fractures-with most of these being

hip fractures.

Males had higher hospital discharge

rates than females for intracranial

injuries, lacerations and open wounds,

dislocations, burns, and internal

injuries. Females had higher rates in

the poisoning and toxic effects

category.

White and black persons had similar

overall hospital discharge rates for

injury and poisoning. But white

persons had higher rates of ftactures

than black persons, and black persons

had higher rates of lacerations and

open wounds, bums, poisonings, and

internal injuries than white persons.

Of the 15-44-year-olds, 18 percent

were in the self-pay category.

●

●

●

Only 56 percent of the elderly were

discharged home. For the younger

age groups 86-93 percent went home.

Recording of the external causes of

injuries (E-codes) continues to be

incomplete. Only 44 percent ctf the

persons hospitalized for injury or

poisoning had one or more E--odes.

Average lengths of stay for injury and

poisoning patients ranged from 3.2

days for poisoning patients to 12.3

days for burn patients.

Sex and race

Of the patients with first-listed

injury and poisoning diagnosis,

52 percent were male and 48 percent

female. Females used 53 percent of the

days of care in this category compared

with 47 percent for the males. The

average length of stay for males was 6.3

and for females it was 7.6 days. These

results are not surprising in view of the

fact that 44 percent of the female

discharges were over 65 compared with

21 percent of the male discharges.

The overall rate of injury and

poisoning for males and females did not

differ significantly (table 2). The rate of

fractures, the largest of the specific

categories of injury analyzed in this

study, also did not ditler. There were

significant differences in some of the

smaller specific categories of injuries.

The rate for intracranial injuries was

significantly higher for males than for

females. For most age groups the rates

of intracranial injuries for males and

females were not significantly di.ilerent,

but for Y5--24-year-oldmales the rate

was significantly higher. The overall rate

for males was also significantly higher

than for females in the laceration and
Advance Data No. 252 ● October 7.1994

Table 2. Number, rate, and percent distribution of patients discharged from short-stay hospitals, by eatagory of first-listed injury and

poisoning diagnoses, sex and race: United States, 1991

[DBchargesfrom non-Faderalhospitals.Excludesnewborninfants.Diagnosticgroupingsand code numberinclusionsare baaed on the InternationalClaaa”Won of

Oiaeases,9th Revision,ClinicalMcdiication (ICD-9-CM)]

Sex Race’

Category of firWis&cf

diagnosis and KD-9-CM code Total Male Female Write 13krsk All other Not Sfatad

Allinjuryand poisoning. . . . . . . . . . . . . . . . . . . . . . . . . ...600-998

Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300-629

DkWation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...630-639

Sprainsandafrains. . . . . . . . . . . . . . . . . . . . . . . . . . . . ...640-646

Intracranialinjuries(excludingthosewithskullfracture) . . . . . ...850-654

Internalinjuryof chest,abdomen,and pelvis. . . . . . . . . . . . . . .8&3-669

l-aca~”ons, open wounds,injurks to bloat vessels . . . . . . . ...870-904

LateaSacts ofinjuries andpoiaoning . . . . . . . . . . . . . . . . . ..90S409

Superficialinjuriesand contusions. . . . . . . . . . . . . . . . . . . . . 910-924

Burns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..940+49

Ofherinjury. . . . . . . . . . . . . . . . . . . . . ...655-359.928-939.950-959

Poisoningandtoxic affecta. . . . . . . . . . . . . . . . . . . . . . . ...960-989

Other effactsofenvironmentalcauses. . . . . . . . . . . . . . . . . ..99O-994

Certainadverse effectsnoteLsewherespecified. . . . . . . . . . . . . ...895

Miscellaneouscomplicationsof surgicaland medicalcare. . . . ...996-999

Allinjutyand poisoning. . . . . . . . . . . . . . . . . . . . . . . . . ...600-989

Fraoturea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600-629

Dislocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...630-639

Sprahandsf rains.. .. . . . . . . . . . . . . . . . . . . . . . . . . ...640-646

infmoranialinjuries(excludingthosewithskullfracture) . . . . . ...850-654

Internalinjuryof ohest,abdomen,and pelvis. . . . . . . . . . . . ...860-668

Lacerations,open wounds,injuriesto blcc.dvessels . . . . . . . ...870-804

Leteaffecte ofinjuryand poisoning. . . . . . . . . . . . . . . . . . ...905-909

Suparfiaal injuriesand contusions. . . . . . . . . . . . . . . . . . . . .910-924

Burn s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...840-849

Otherinjuty. . . . . . . . . . . . . . . . . . . . . ...655-359.926-939.950-959

Poisoningandtoxiceffeots . . . . . . . . . . . . . . . . . . . . . . . ...960-989

Othsrefffx teofenvironmentaloauses.. . . . . . . . . . . . . . . ...990-994

Certainadverae effectsnotelsmvherespecified. . . . . . . . . . . . . ...885

Miscellaneouscomplicationsof surgicaland medicalcare. . . . ...886-998

Allinjury andpoisoning. . . . . . . . . . . . . . . . . . . . . . . . . ...600-289

Fraofurea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600-629

Oislo-”on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..63C)-639

Sprainsandstreins. . . . . . . . . . . . . . . . . . . . . . . . . . . . ...640-646

intracranialinjuries(excludingthosewithskullfracture) . . . . . . . .850-S54

Internalinjuryofchest, abdomen,andpelvk. . . . . . . . . . . . ...860-369

Lacerations,opanwounds, injurieato bloodvessels . . . . . . . ...870-904

Lafeeffeots ofinjuryend poisoning. . . . . . . . . . . . . . . . . . ...805-909

Supanicialinjunesand contusions. . . . . . . . . . . . . . . . . . . . .910-924

Bums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...840-849

Other injury. . . . . . . . . . . . . . . . . . . . . ...655-359.926-939.950-959

Poisoningandtoxic affects. . . . . . . . . . . . . . . . . . . . . . . ...360-939

Other effectsofenvironmentalcauses. . . . . . . . . . . . . . . . . ..69O-994

Certainadverae effectsnotelsewhere specified...,. . . . . . . . . ...885

Miscellaneouscomplicationsofsurgical andmadioel care. . . . ...996-999

2,766

1,034

64

171

180

83

193

%

66

52

72

205

18

33

567

110.5

41.3

2.8

8.8

7.2

3.3

7.7

W3

3.5

2.1

2.9

8.2

0.7

1.3

22.6

100.0

37.4

23

6.2

6.5

3.0

7.0

●0.3

3.2

1.9

2.6

7.4

0.7

1.2

20.5

Numberof patienta d~ in thcuaanda

1,427 1,331 1,634 324 65

461 553 726 86 28

41 23 44 v

●

91 80 119 14 *5

106 74 106 17 %

64 19 45 18 *

137 66 102 4a %

● ● 7● ●

40 47 63 % *

36 16 28 11 *

46 25 46 12 ●

82 122 128 32 %

14 * 11 * *

13 21 19 * *

261 266 366 62 16

Rate of patientadischargedper 10,000 populaticm

118.2

39.6

3.4

7.5

8.7

5.3

11.3

●

3.3

3.0

3.8

6.7

1.1

1.0

23.1

100.0

33.5

2.9

6.4

7.4

4.4

9.5

*

2.8

2.5

3.2

5.7

1.0

0.9

19.5

103.2

42.9

1.8

6.2

5.7

1.5

4.4

*

3.6

1.2

2.0

9.5

*

1.6

22.2

100.0

41.6

1.7

6.0

5.5

1.4

4.2

*

3.5

1.2

1.9

9.2

●

1.6

21.5

87.5 105.0

34.6 28.0

2.1 %21

5.7 4.5

5.1 5.5

22 5.8

4.9 15.6

W3 *

3.0 %?.6

1.4 3.5

22 3.8

6.1 10.5

0.5 ●

0.9 *

18.5 20.0

Peroantdtibution

1W.o 100.0

39.6 26.7

24 %?.0

6.5 4.3

5.9 5.2

25 5.6

5.6 14.8

W.4 *

3.4 %2.4

1.6 3.3

2.5 3.6

7.0 10.0

0.6 *

1.0 ●

21.1 19.0

64.2

27.5

*

%3

%9

●

%2

●

●

*

*

~.8

*

*

15.6

100.0

32.7

●

%3

7.0

*

7.4

*

*

*

*

%.2

*

*

18.5

525

195

11

32

49

15

37

●

15

9

12

36

*

e

102

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

.. .

.. .

. . .

. . .

. . .

100.0

37.1

2.1

6.2

9.3

2.8

7.1

*

2.8

1.8

2.3

&9

*

1.7

19.4

‘NOTE Rates forrata categoriesmay IIS undaraatimatedbacauaarace was notrapc+tadforall d~ged patiema

open wound category. In three age

groups the differences were significant

by sex-the 15–24, 25-34, and the

35-44 age groups. Males also had

significantly higher rates than females

for dislocations, burns, internal injuries,

and other injury.

These results are consistent with

data that show the leading causes of

death for males in the young adult age

groups. Accidents, including motor

vehicle accidents, are a major cause of

death in these age groups, partieuhuly

for meles (2). In additio% Fingerhut (9)

reports high male rates of firearm deaths

for the 15–34-year-olds for each of the

years she studied (1985-90). Runyan

and Gerken (10) discuss several possible

ressons for these higher male rates,

including more driving by males, more

participation in high-risk sports (such as

football), and a greater tendency by

mslea to acquire weapons.

The only category in which females

had a signikantly higher rate than

males was the poisoning and toxic

effeets category. Femrdes had higher
4 Advance Data No. 252 ● October 7, 1994

rates in this category in the 15–24, the

3544, and the 45-64 age groups. The

poisoning and toxic effects category

includes overdoses and “wrong

substances given or taken in error” (’7).

It does not include drug dependence or

nondependent abuse of drugs. Most of

the poisonings for males and females

were caused by analgesics, antipyretics,

and antirheumatics (including aspirin

and acetaminophen)-ICD-9--CM code

965—and psychotropic drugs (primarily

antidepressants and tranquilizers)-ICD–

9-CM code 969.

The overall rates of first-listed

injury and poisoning diagnoses were

similar for white and black hospital

discharges. But there were some

dtierences between the two groups’

rates for various types of injuries and

poisoning. White persons had a higher

rate of fractures than black persons. This

is not surprising since previous research

(11–13) has found that bone density is

greater in black than in white subjects,

and, consequently, the prevalence of

osteoporosis and the incidence of

fractures is lower in black persons than

in white persons. Black persons had

higher rates of lacerations and open

wounds, bums, poisonings, internal

injuries, and other trauma. These

findings are consistent with cause of

death statistics which show that, in

1991, the homicide and legal

intervention rate among black persons

was 41.9 per 100,000 deaths compared

with 6.2 per 100,000 deaths for white

persons (2).

Age and diagnoses

Of the 2.8 million patients

hospitalized for injury and poisoning

diagnoses, the largest proportion had

fracture~ver 37 percent (table 3).

Fractures were the most common

diagnoses for patients in each of the six

age groups examined in this report, but

the percentage of flactures ranged from

28 percent of the injury and poisoning

discharges in the 35-%year-age group

to 51 percent of the 65 and over age

group. Over one-half of the fractures in

the age group under 15 were of the

bones of the skull (17 percent) and the

arm (45 percent). For the 15+4-yearolds these two categories totaled

38 percent and ankle fractures accounted

for another 17 percent. For the 45-64-

year-olds most of the fractures were of

the arm (22 percent), ankle (18 percent),

and hip (17 percent). Over 57 percent of

the elderly’s fractures were hip fractures

and only 9 percent were of an upper

limb.

In the younger age groups, other

frequent injury and poisoning diagnoses

included lacerations and open wounds,

intracranial injuries, poisoning and toxic

effects, and (with the exception of the

15–24-year-olds) miscellaneous

complications of surgical and medical

care. In the elderly, fractures and

miscellaneous complications of surgical

and medical care made up over

75 percent of those hospitalized for an

injury or poisoning diagnosis.

Miscellaneous complications of

surgical and medical care represented

21 percent of the injury and poisoning

diagnoses. The percent of cases

hospitalized due to these conditions

ranged from 5 percent of the 15–24-

year-olds to 27 percent of the elderly.

About one-half of the diagnoses in this

category involved complications of an

internal prosthetic device, implant, or

graft. Also included in this category

were postoperative infections and

postoperative shock. It is important to

note that these diagnoses cannot be used

as an indicator of substandard medical

care. Many of these conditions would be

expected considering the complexity of

the procedures undertaken, the often

fragile condition of the patient at the

time of surgery (particularly of the

elderly), and the variability of patient

response to invasive procedures.

Injury and poisoning rates

The overall rate of hospitalization

for injury and poisoning diagnoses was

110.5 per 10,000 population, but it

ranged from 51.9 for children under 15

years of age, to 279.6 for the elderly 65

or over. The elderly’s rate was more

than twice the rate for the 15–24, the

25-34, and the 45-64-year-old age

groups, more than three times the rate

for the 35-44-year-old age group, and

more than five times the rate for

children under 15.

The fracture rate was also lowest

for the under 15 age group (18.9 per

10,000) and highest for the elderly

(142.4 per 10,000). The elderly’s

fracture rate was more than four times

the rate for the second highest age

group (45-64-year-olds) and was more

than seven times the rate for children.

Other research has noted that advanced

age substantially increases the risk of

hospitalization for minor fractures (14).

The 15–24 and the 25-34-year-old

age groups had the highest rates of

lacerations and open wounds and of

internal injuries. As noted previously,

this is consistent with high young adult

(particularly male) death rates fi,om

Ilrearms and motor vehicle accidents

(1,9).

The 15–24-year-old age group also

had the highest poisoning rate, but one

of the lowest rates of sprains and

strains. Beginning with the 25-34-yearold age group, the rate for miscellaneous

complications of surgical and medical

care increased significantly for each

successive age group.

Source of payment

As shown in table 4, private health

insurance was the expected source of

payment for over one-half of the

patients hospitalized due to injury and

poisoning diagnoses in the under 15

years of age group and the 45-64-yearold age group, and for close to one-half

(47 percent) of the patients in the

1544-year-old age group. The vast

majority (87 percent) of the 65 and over

age group hospitalized due to injury or

poisoning diagnoses expected their

hospital care to be paid for by Medicare.

Only 5 percent of the elderly cited

private insurance as their expected

principal source of payment, and only

2 percent of this age group were in the

self-pay category.

Medicaid was expected to pay for

the care of 23 percent of the discharges

under 15 years old. Another 10 plercent

of the patients in this age group were in

the self-pay category-an indication of

no or inadequate health insurance.

Of the 15-44-year-olds, 18 percent

were in the self-pay category. In this age

group, over one-quarter of the patients

with diagnoses of lacerations and open
Advance Data No. 252 ● October 7, 1994 5

Table 3. Number, rate, and percent distribution of patients discharged from short.stsy hospttals, by category of ftrWisted injury and

poisoning diagnoses and age: United States, 1991

[Discharges from non-Federal hospitals. Excludes newborn infants. Oiagnoatic groupings and code number inclusions are baamd on the InternefhaJ Classification of

Diseaaea, 8th Revision, Clinical Mcdificstion (ICD-9-CM)]

Category of r5rat-/isted Ail Under 15 15-24 25-34 3544 45-64

diagnosisand lCD-9-CM code ages years years years years yews %-?’%

Allinjln yandpoisoning . . . . . . . . . . . . . . . . . . . . . . . . . ..6oo-9gg

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..60&62g

Oislocstion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...630-.839

Sprains andstrains . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..B4w

Intracranial injuries (excluding those with skull fracture). . . . . ...850-654

Internal injury of chest, abdomen, and pelvis . . . . . . . . . . . . . .860-8.68

Lacerations, open wounds, injuries to blood vessels . . . . . . ...870-804

Lateeffeots ofinjunesand poisoning.. . . . . . . . . . . . . . . . ..905-gog

sUpSIrfiChl kIjUtfeS and contusions. . . . . . . . . . . . . . . . . . ...910-924

Bums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...940-949

Other injuiy . . . . . . . . . . . . . . . . . . . . . ..&55+59.926-w9. g5Ll_959

Poisoning andtoxic effecta . . . . . . . . . . . . . . . . . . . . . . . ..g6rp93g

Other effects ofenvironmental causes . . . . . . . . . . . . . . . . ..gg&gg4

Certain adverse effects not elsewhere claastied. . . . . . . . . . . . . ...895

Miscellaneous complications of surgical and medical care . . . ...996-889

Allinjuty andpoisoning . . . . . . . . . . . . . . . . . . . . . . . . . . ..600-ggg

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600-628

Dislocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...33&639

Sprains and strains..........,.. . . . . . . . . . . . . . . . ..~~

Intracranial injuries (excluding those with skull fracture). . . . . ...850-664

Internal injury of che~ abdomen, and pelvis . . . . . . . . . . . . . . 660+@

Lacer~.ens, open wounds, injuries to blood vessels . . . . . . ...870-804

Late effecta ofinjuries and poisoning.. . . . . . . . . . . . . . . . ..g05-gog

Superficial injuries arrdcontusions. . . . . . . . . . . . . . . . . . ...910-824

Bums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...9413449

Otharinjury . . . . . . . . . . . . . . . . . . . . . ..~g.g26-~g.g5&~g

Poisoning andtoxic effects . . . . . . . . . . . . . . . . . . . . . . . ..%I)-g89

Ofharaffacta ofenvironmental causes . . . . . . . . . . . . . . . . ..gg0+g4

Certain adverse effects not eLsewhere classified. . . . . . . . . . . . . . . .gg5

Miscellaneous complications of surgical and medical care . . . ...996-868

Allinjuryand poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . ..~

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..600-B28

Dislocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..330+39

Sprains andstrains . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..64w

Intracranial injuries (excluding those with skull fracture). . . . . ...85&654

Internal injury of ch~ abdomen, and pelvis . . . . . . . . . . . ...860-669

Lacerations, open wounds, injuries to blood vessels . . . . . . ...870-904

Lateeffects ofinjuries andpoixming. . . . . . . . . . . . . . . . . ..g05-~

sUpfiCial injUriOS ad~ntWiOnS. . . . . . . . . . . . . . . . . . . . .911)-924

Bums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..g40_949

Other injuty . . . . . . . . . . . . . . . . . . . . . . ..B55-35g.9zt3439.95r&959

Poisoning andtoxic effecfa . . . . . . . . . . . . . . . . . . . . . . . ..g6&g89

Other effects ofenvironmental causes. . . . . . . . . . . . . . . . ..gg&gg4

Certain adverse affects notalsawhere clasdfid. . . . . . . . . . . . . ...885

Miscellaneous complications of surg.kal and medical care . . . . . . 896+88

2,768

1,034

1%

180

1:

●8

86

52

72

205

E

110.5

41.3

2.6

6.8

7.2

3.3

z

3.5

2.1

2.9

8.2

0.7

1.3

22.6

1ULo

37.4

2.3

6.2

6.5

3.0

E

3.2

1.9

2.6

7.4

0.7

1.2

20.5

Number of patients diaohsrged in thousands

266 367 400 336 492

104 110 115 85 15a

*

*

;: ;: : :

Xl 37 34 24 20

v 21 23 13

25 5a 50 25

●

:

* * * ●

13 11 14 13

: *6 % %

14 1: 17 % 11

32 52 43 31

*

23

* * ● *

● * * * 10

36 19 46 72 146

Rate of patients discharged per I0,CXX3ppulaticm

51.9

18.9

*

*

z

4.5

w.;

2.9

2.6

5.8

*

●

6.6

100.0

36.4

*

10.:

%?.3

8.7

&

5.5

1Y2

●

●

12.6

102.7 84.8 66.0

30.8 27.2 24.5

5.1 3.5 2.4

7.6

l= 8.1 H

5.8 3.2

14.8 lE 6.5

* ● *

2.5

;.: *1.5

3.5 4.t

14.7 10.3

* *

●

5.3 11.;

Percent di~”bulion

100.0 100.0

30.1 26.7

5.0 3.7

8.0

lti 8.5

1:: 1:;

%

w .5

8.0

●

*

18.4

100.0

26.4

lR

7.3

3.8

7.6 * * *

2.7

E *1.6 %

~ .7

lZ lK 9.3

● * *

● ● *

5.2 12.0 21.4

105.3

33.8

lti

4.3

2.6

5.2

*

26

●1.9

23

4.9

*

2.1

31.7

Im.o

32.1

21

9.8

4.0

24

4.9

*

2.6

●1.8

2.2

4.7

*

2.0

30.1

666

452

2

34

v

16

*

30

9

:

*

13

243

279.5

142.4

lti

10.8

%2.3

5.0

*

z

3.5

7.1

*

4.2

76.6

100.0

EO.9

1.0

3.9

E

1.8

●

z

1.3

2.6

●

1.5

27.4

wounds and internal injuries of the

ches~ abdomen, and pelvis; over

one-lifth of the patients with intracranial

injuries and poisonings and toxic effects;

and 19 percent of the patients with

fractures were in the self-pay category.

It is probable that many of these

patients required emergency care that

hospitsls provided regardless of their

lack of insurance.

Overall, 4 percent of persons

hospitalized in 1991 due to injury and

poisoning diagnoses expected workers’

compensation to cover the ecrst of their

hospital care. Of the 119,000 discharges

expecting this aouree of paymen~

69 percent were in the 15-44-year-old

age group. In this age group 31 percent

of the burns, 15 percent of the

dislocations, and 16 percent of the

sprains and strains were expected to be

paid for by workers’ compensation.

Another 25 pereent of the dischsrgea

expecting their hospitalization to be paid

for by workers’ compensation were in

the 45-64-year-old age group. In this

age group 16 percent of the sprains and

strains and 15 pereent of the burns had

workers’ compensation indicated as the

rtnticipated payment source.

Disposition

The dispositions of injury and

pisoning patients are shown in table 5.

Over three-quarters of the patients

hospitalized due to an injury or

poisoning diagnosis were discharged

home, but the percentage ranged from
Advance Data No. 252 ● October 7, 1994

Table 4. Number and percent distribution of patienta with injury and poisoning diagnoses

discharged from short-stay hospitals, by age and expected principal source of payment:

United States, 1991

[Discharges from non-Faderal hospkala. Excludes newborn infants]

All Under 15 15-# 45=64 65 yeara

Source of payment ages years yeara yeara and over

Number of discharges in thousands

Allaourcea . . . . . . . . . . . . . . . . . 2,768 288 1,102 492 888

Private insurance . . . . . . . . . . . . . 983

Medicare . . . . . . . . . . . . . . . . . .

150 520 265 48

893 *

Medicaid . . . . . . . . . . . . . . . . . .

45 69 775

213 67 101 34 11

Workers’ compensation . . . . . . . . . 119 62 30 %

Other Government payments . . . . . 71 ; 50 10 *

Self-pay . . . . . . . . . . . . . . . . . . . 275 28 193 40 13

Other sources . . . . . . . . . . . . . . . ag 17 53 22 7

Notskdad. . . . . . . . . . . . . . . . . 115 11 58 22 24

Percent distribution

Allaourcaa . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0

Private insurance . . . . . . . . . . . . . 35.5 52.3 47.2 53.9 5.4

Medicare . . . . . . . . . . . . . . . . . . 32.3 * 4.1 14.1 87.3

Medicaid . . . . . . . . . . . . . . . . . . 7.7 23.3 9.2 6.9 1.2

Workera’ oompenaation . . . . . . . . . 4.3 7.4 6.1 *1.0

Other Government paymenta . . . . . 2.6 3.: 4.6 2.0 *

Self-pay . . . . . . . . . . . . . . . . . . . 9.9 9.9 17.5 8.2 1.5

~ersouroes . . . . . . . . . . . . . . . 3.6 6.0 4.8 4.4 *I .0

Notatatsd . . . . . . . . . . . . . . . . . 4.2 4.0 5.3 4.4 2.7

Table 5. Number and percent distribution of patlenta with first-listed injury and poisoning

diagnoses discharged from short-stay hospitals, by age and disposition: United States,

1991

[Discharges from non-Fadera! hospitals. Excludes newborn infanta]

All lJnder15 15-4$ 43-64

Disposition

65 yeara

ages years years yeara and over

Number of discharges in thousands

Atl dispositions . . . . . . . . . . . . . . . . . 2,768 286 1,102 492 888

Routine discharge . . . . . . . . . . . . . . . 2,147 267 983 425 492

Tranaferto another short-term hospital . . 137 7 47 16 67

Tranaferto long-tenm oerainatiiution . . . 246 * 23 14 206

Other live dischargea . . . . . . . . . . . . . 158 * 47 23 81

Dead . . . . . . . . . . . . . . . . . . . . . . . 41 ●

+’9 * 27

Notatatad . . . . . . . . . . . . . . . . . . . . 40 *

13 10 15

Percent distribution

Ali dispositions . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 i 00.0

Routine discharge . . . . . . . . . . . . . . . 77.6 93.4 87.3 88.4 55.5

Tranaferto another ahort-term hospital . . 5.0 %2.4 4.3 3.2 7.6

Tranaferto long-term carainatitution . . . 8.9 ●

2.1 2.9 23.2

Other liiediachargaa . . . . . . . . . . . . . 5.6 *

4.3 4.7 9.1

Dead . . . . . . . . . . . . . . . . . . . . . . . 1.5 *

*I .0 * 3.0

Notatatad . . . . . . . . . . . . . . . . . . . . 1.5 *

1.2 2.0 1.7

68 percent of fractures to 95 percent of

dislocations. Fourteen percent

discharged to other facilities-5 percent

to short-term hospitals and 9 percent to

long-term care institutions. Of hospital

discharge with first-listed diagnoses

other than injury and poisoning,

83 percent were discharged home.

As is shown in table 5, of all

discharges with first-listed injury and

poisoning diagnoses, the elderly were

the least likely to be discharged home

(56 percent) and the most likely to be

discharged to other facilities

(31 percent). For elderly patients with

diagnoses other than injury and

poisoning, 69 percent were discharged

home and 17 percent were discharged to

other ticilities. 0fthe273,000 elderly

with injury and poisoning diagnosea

discharged to other facilities, threefourths went to long-term care

institutions and the remainder went to

other short-term hospitals. One-half of

these elderly discharged to long-term

care institutions hadhipfiactures and

another 21 percent had other fmctures.

Ttvo percent (41,000) of the

discharges hospitalized for injury and

poisoning were discharged dead. Of the

patients with injury or poisoning

diagnoses who died in the hospital,

66 percent were 65 years of age and

older. ‘l%venty-txvopercent of those who

died in the hospital had a diagnosis of

hip fracture. Patients hospitalized due

to an injury or poisoning diagnosis

made up 9 percent of hospital patients;

they represented 5 percent of all of the

deaths in the hospital in 1991.

E+odes

In instances where patients are

hospitalized because of an injury or

poisoning, information concerning the

cause of the injury should be recorded

in the medical record. This information

allows the use of E-codes (codes

E800-E999), which describe

“environmental events, circumstances,

and conditions as the cause of injury,

poisoning, and other adverse efiects”

(7). These codes provide additional

information about other diagnoses and

hence should be recorded only as a

supplementary diagnosis category.

Hospital discharge data systems are

seen by some experts as an appropriate

vehicle for gathering E-code

information for the more serious

injuries. According to Sniezek FinMea,

and Graitcer (15) “E-coded hospital

discharge data systems are potentially

one of the most effective and feaaible

means available to collect data needed

to prevent and control injuries.” There

is not a national requirement for hospitals

to record E-codes, except in those cases

where drugs or medicinal and biological

substances caused an adverse el~ect in

therapeutic use (16). Consequently, data

on external cause of injury from

discharge data systems are incomplete.

E-codes were coded in the NHDS

when the necessary information was

present on the face sheet or discharge

summary of the medical record or was

included in the automated data provided

by abstract services or State systems.

Table 6 shows the percentage of patients

with first-listed injury and poisoning

diagnoses by sex, age, race, regjon,
Advance Data No. 252 ● October 7, 1994 7

speciiic diagnoses, number of diagnoses, In 19911.2 million patients, or

hospital ownership and bedsize with one 44 percent of patients hospitalized due

or more E-ccrdes. to an injury or poisoning diagnosis, had

at least one E-code diagnosis recorded.

Table 6. Percent of patients by selected patient and hospitai characteristics with

first-iisted injury and poisoning diagnoses discharged from shorktay hospitals with one

or more extemai cause of injury and poisoning code= United States, 1991

[Dischargesfrom non-Faderalhospitals.Excludesnewborninfants.Data are for dischargeswithfirst-listed

diagnosesC4S00-888 fromthe InternationalClassificationof Diseases, 8th Rswision,ClinicalModification

(ICD-9-CM), wkh one or more externalcause of injurycodes]

Characteristic Percent with E-code’

Allinjuryand poisoningdi.scharges. . . . . . . . . . . . . . . . . . . . . . . . . .

sax

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

Female, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age

Under 5yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5-14yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3E44yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45+tyeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75yaarsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

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

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

Al[other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Notatatad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragion

Noitimaat... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Sough.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

First-liateddagnoaisandlCD-9-CMcodes

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .~2g

Dislocation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..qw

Sprainsandstrains . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..34R43

hltracranialinj uries(exduding ttwa.ewithskullfractum) . . . . . ...855354

h’ttarnelinjuryofchaat,abdoman,andptis . . . . . . . . . . . . ..8s0-3s9

Laoarations,opanwounds, injuriesto blocdvessels. . . . . . . ...870-904

LSteaffactsofinjuryandpokoning. . . . . . . . . . . . . . . . . . ..go$gog

Su@icialinjunesandcontuaions. . . . . . . . . . . . . . . . . . ...910424

Bums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~g

Otherinjury. . . . . . . . . . . . . . . . . . . . . . .. ~9.92s.g39.95M5g

Poiaoningandtoxicaffacte . . . . . . . . . . . . . . . . . . . . . . . ..~93g

Otheraffecteofm”ronmentalceu*s . . . . . . . . . . . . . . . . ..~

Certainadversa affectsnoteleawheredwifid. . . . . . . . . . . . . . ..gg5

Miscallanaoueimplications ofsurgiAandmtid we. . . . . . .9s6+M

Numbarofdiagnoaas

Sevendiagnosaa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sixdiagnosas . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fwediagnoaas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ::::

Fourdmgms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thraadwgnoaas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Twodiegnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hoapitalownelship

ChurctWxmprorif... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Propr@faty .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Governmen t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hospitalbadaiza

6-89 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100-299 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

300-W9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5000rmora . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

44.3

46.2

42.2

56.8

45.4

49.1

49.0

47.2

44.2

42.6

34.1

43.9

57.5

34.5

39.1

44.2

42.9

42.8

49.1

34.2

25.9

20.0

43.9

46.2

50.2

23.0

34.1

44.4

38.8

78.7

60.1

63.6

53.4

45.7

60.0

51.3

56.0

54.2

46.4

42.0

44.2

55.9

40.4

427

42.4

55.8

‘E-mdeisextemelcaueeofinjwyendpoisodngcode.

More males (46pcrcent) hadan E-code

reported than females (42 percent).

Children under 5 had the highest

(57 percent) E-code completion;

discharges 75years ofage andover had

the lowest (34percent) proportion

completed. For black persons, the

percent with E-codes was signit5cantly

higher (58 percent) than the percent for

whitepersons(44 percent).The

percentage of E-codes recorded in the

West was significantly higher than for

every other region (49 percent)--

probably reflecting the fact that both

California and Washington required

E-coding. There was considerable

variation among the diagnostic groupsin

completion ofE-codes. 0nly20percent

ofsprainsand strainshadan E-code

compared with 79percentofthose with

poisoning and toxic effects. The latter

category would be expected to be more

complete than others because it includes

those diagnosesin which E+odes are

mandatory.’Mo other categories with

over 50percent E-code completion were

miscellaneous complications of surgical

and medical care and lacerations and

open wounds.

AstudyofE+odes in Maryland

conducted by Marganitt etal. (17) found

that there wassystematic underreporting

of E-codes in the elderly, the severely

injured, and patients with long lengths

of stay. This was primarily due to the

fact that these groups were more likely

to have multiple chronic conditions prior

totheinjuryand/or more complications

during the hospital stay. In these

situations, the data fields available for

recording diagnoses are likely to be

~ed, thereby leaving noroom forthe

E-code. E+odes maybe considered of

lesser importance to hospitals since they

donotiniluence reimbursement. Hence,

in cases where all of the applicable

codes would not fit on the abstract

forms, E-codes would be the least likely

to be coded.

The percentage of first-listed injury

and poisoning diagnoses with at least

one E-code in1988 was40; in1990

and 1991, 44percent of these records

had E-codes. In1991, five States

(California, NewYor~ Washington,

Rhode Island, and Vermont) had

mandated E-coding ofhospital records.
8 Advance Data No. 252 ● October 7, 1994

Since that time, an additional nine States

have instituted such a requirement. As

the number of States mandating the use

of E-codes rises, the percentage

recording them on NHDS abstract forms

is expected to increase.

Data on E-codes collected in the

National Hospital Discharge Survey are

not included in this report because the

evidence cited above indicates that these

data would likely be biased and

unrepresentative of all E-codes. Since all

of the other data on injuries included in

this report, as well as information

generally reported from this survey, are

nationally representative, it was felt that

it would be misleading to report the

incomplete E-code information.

Days of care

Information about days of care is

included in table 7. The average length

of stay for the different diagnostic

categories ranged from 3.2 days for

patients with poisoning and toxic effects

to 12.3 for burns. In addition to bums,

long lengths of stay occurred for

patients with fractures, internal injuries,

late effects of injury and poisoning, and

miscellaneous complications of surgical

and medical care. Dislocations, sprains

and strains, and poisoning and toxic

effects had short lengths of stay.

Of the days of care for injury and

poisoning patients, 46 percent were for

fracture patients. This is compared with

the 37 percent of the discharges having

fractures as their first-listed diagnosis.

Of the days of care, 80 percent were for

patients with fractures, miscellaneous

complications of surgical and medical

care, intracranial injuries, and

lacerations and open wounds. Patients in

these four categories made up 71 percent

of the discharges in the injury and

poisoning category.

Summary

In 1991, 2.8 million patients were

hospitalized because of an injury or

poisoning and 1 in every 10 hospital

days were devoted to caring for these

patients. The average length of stay for

these patients was 6.9, but this ranged

from 3.2 days for patients with

poisonings to 12.3 days for burn

patients.

The overall hospitalization rate for

injury and poisoning for males and

females did not differ significantly, but

there were significant differences in

some of the specific categories of

injuries. Males had higher rates than

females for intracranial injuries,

lacerations and open wounds,

dislocations, bums, and internal injuries.

Table 7. Number and percent distribution of patients discharged from short-stay hospitals

and average length of stay, by first-listed injury and poisoning diagnoses: United States,

1991

[Discharges from non-Federal hosp”tils. Excludes newborn infants. Diagnostic groupings and code numbers

are based on the Intemationel Classification of Diseases, 9th Revision, Clinical Modflcation (ICD-9-CM)]

Days of care

Average

first-listed diagnosis and Number in Percent length of

ICD-9-CM codes thousands distribution s@y in days

All injury and poisoning. . . . . . . . . . . . S00-999

Fractures . . . . . . . . . . . . . . . . . . . . . ...800-829

Dislocation . . . . . . . . . . . . . . . . . . . . ...63&839

Sprains and strains . . . . . . . . . . . . . . . ...640-846

Intracranial Injuries

(excluding those with skull fracture) . . . . ...850-654

Internal injury of cheat, abdomen, and pelvis .. 860-669

Lacerations, open wounds, injuries to

blood veaeels . . . . . . . . . . . . . . . . . . . ..87G904

Late effects of injury and poisoning . . . . . ...905-909

Superficial injuries and contusions. . . . . . . . 91&924

Bums . . . . . . . . . . . . . . . . . . . . . . . . ...940-949

Other injury . . . . . . . . . . . 65S859,92=939,950-959

Poisoning and toxic effects . . . . . . . . . ...960-969

Other effects of environmental causes . . . . .. 980-894

Certain adverse effects not elsewhere classified. . ..995

Mkallaneous complication of surgical and

medical care . . . . . . . . . . . . . . . . . . ...996999

19.138

8,733

219

629

1,041

712

940

W6

395

639

342

644

103

144

4,521

100.0

45.6

1.1

3.3

5.5

3.7

4.9

W.4

2.1

3.3

1.8

3.4

0.5

0.8

23.6

6.9

8.4

3.4

3.7

5.8

6.6

4.9

%1

4.5

12.3

4.8

3.2

5.6

4.3

6.0

Females had a higher rate than males in

the poisoning and toxic effects category.

White persons had higher rates than

black persons for fractures, but black

persons had higher rates of lacerations

and open wounds, burns, poisoning and

toxic effects, and internal injuries.

The elderly’s rate of hospitadization

for injury or poisoning was more than

twice the rate for the 15–34 and the

45-64-year-old age groups, more than

three times the rate for the 35-44-yearolds, and more than five times the rate

for children. The 15–34-year-olds had

the highest rates of lacerations and open

wounds and internal injuries.

Fractures were the most common

injury and poisoning diagnoses for all of

the age groups, but the rate ranged from

18.9 per 10,000 for children unaler 15,

to 142.4 per 10,000 for the elderly. Most

of the elderly’s fractures were hip

fractures, while the most frequent

fractures for children under 15 were

bones of the skull and arm.

The percentage of self-pay patients

with injury and poisoning diagnoses was

high, particularly in the 1544-year-old

age group. Most of the injury and

poisoning patients were discharged

home, but a smaller portion of the

elderly were discharged home relative to

the other age groups. Of the elderly,

31 percent were discharged to other

institutions. Over three-quarters of these

went to long-term care institutions and

most of these had hip fractures.

Only 44 percent of the first-listed

injury and poisoning patients had one or

more external cause of injury codes

(E-codes). As the number of States

mandating E-codes increases, this

percentage can be expected to increase.

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explore the uncoded population. Am

J of Public Health 10(12)1463-6.

18. Simmons ~ Schnack GA.

Development of the design of the

NCHS Hospital Discharge Survey.

National Center for Health Statistics.

Vhal Health Stat 2(39). 1977.

19. Haupt BJ, Kozak LJ. Estimates from

two survey desigmx National

Hospital Discharge Survey. National

Center for Health Statistics. Vhl

Health Stat 13(111). 1992.

20. Shah, BV. SESUDN Standard

Errors Program for Computing of

Standardized Rates from Sample

Survey Data. Research Triangle Par~

North Carolina: Research Triangle

Institute. 1981.

.-.

. . .

0.0

z

*

Symbols

Data not available

Category not applicable

Quantity zero

Quantity more than zero but less

than 0.05

Quantity more than zero but less

than 500 where numbers are

roundedto thousands

Figure does not meet standard of

reliabilii or precision

Technical notes

Survey methodology

Source of data

The National Hospital Discharge

Survey (NHDS) covers discharges from

noninstitutionaI hospitals, except

Federal, military, and Veterans

Administration hospitals, that are located

in the 50 States and the District of

Columbia. Only short-stay hospitrds

(hospitals with an average length of stay

for all patients of less than 30 days) or

those whose specialty is general

(medical or surgical) or children’s

general are included in the survey.

These hospitals must also have six beds

or more sttied for patient use.

For 1991, the sample consisted of

528 hospitals. Of these hospitals, seven

were found to be out of scope

(ineligible) because they went out of

business or otherwise failed to meet the

criteria for the NHDS universe. Of the

521 in-scope (eligible) hospitals, 484

responded to the survey.

Sample design and data collection

The National Center for Health

Statistics (NCHS) has conducted the

NHDS continuously since 1965. A

report on the development of the

original NHDS was published (18).

Beginning in 1988, the NHDS

sample includes with certainty alI

hospitals with 1,000 beds or more or

40,000 discharges or more annually. The

remaining sample of hospitals is based

on a stratified three-stage design. The

first stage consists of a selection of 112

primary sampling units (PSU’S) that

comprise a probability subsample of

PSU’S to be used in the 1985–94

National Health Interview Survey. The

second stage consists of a selection of

nortcertainty 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 old and new survey

designs has been published (19).

IWO data collection procedures

were used for the survey. One was a

manual system of sample selection and

data abstraction. The second, an

automated method used for
10 Advance Data No. 252 ● October 7, 1994

approximately 33 percent of the

respondent hospitals in 1991, involved

the purchase of data tapes from

abstracting services, State data systems,

or hospitals.

In the manual system, the sample

selection and transcription of

information ii-em hospital records to

abstract forms were performed at the

hospitals. The completed forms, along

with the sample selection control sheets,

were forwarded to NCHS for coding,

editing, and weighting. A few of the

hospitals have submitted their data via

computer printout or tape in recent

years. In about two-thirds of the

hospitals using this manual system in

1991, the work was performed by their

own medical records staff. In the

remaining hospitals using the manual

system, the U.S. Bureau of the Census

personnel did the work on behalf of

NCHS.

For the automated system, NCHS

purchased tapes containing machinereadable medical record data that were

systematically sampled by NCHS.

The data collected for thu survey

included items relating to the patient’s

personal characteristics, including birth

date, sex, race, and marital status (but

not the patient’s name and address);

administrative information, including

admission and discharge dates, discharge

status, and medical record numbe~ and

medical information, including

diagnoses and surgical and nonsurgical

operations or 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 information

and are not available to the public.)

Presentation of estimates

The relative standard error (ME) of

the estimate and the number of sample

records that the estimate was based on

are used to identify estimates with

relatively low reliability. Because of the

complex sample design of the NHDS,

estimates of less than 5,000 are not

presented; only an asterisk (*) appears

in the tables. Generally, these estimates

have an RSE of more than 30 percent or

are based on a sample of less than 30

cases. Estimates of 5,000 to 9,000 are

preceded by an asterisk (*) to indicate

they should not be assumed reliable.

These estimates are usually based on

fewer than 60 cases.

Sampling errors and rounding of

numbers

The standard error is primarily a

measure of sampling variabilityy that

occurs by chance because only a sample

rather than the entire universe is

surveyed. The RSE of the estimate is

obtained by dividing the standard error

by the estimate itself. The resulting

value is multiplied by 100, so the RSE

is expressed as a percent of the estimate.

Estimates of sampling variability for

1991 data 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

(20). The constants for RSE curves for

the 1991 NHDS estimates are presented

in table I. The RSE of an estimate (~

can be estimated horn the fonmula:

R.SE(X)= 100~-

where X, a, and b are as defined in

table I.

Estimates have been rounded to the

nearest thousand. For this reason, figures

within tables do not always add to the

totals.

Tests of significance

In this report, the determination of

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” and

“no difference” mean that no

statistically significant difference exists

between the estimates being compared.

A lack of comment on the dfierence

between any two estimates does not

mean that the difference was tested and

found insignificant.

Definition of terms

Age—Patient’s age at birthday prior

to admission to the hospital.

Average length of stay-The

number of days of care accumulated by

patients discharged during the year

divided by the number of patients.

Days of care—The number of

patient days accumulated by a patient 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

horn (and including) the date of

admission to (but not including) the date

of discharge. The terms days of care,

patient days, and hospital days are

synonymous.

Diagnosis-A disease or injury (or

other factor that influences health status

and contact with health services) 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 c(oded

diagnosis identified as the principal

diagnosis or listed first on the face

sheet or discharge summary of the

medical record if the principal

diagnosis cannot be identifiecl. The

number of first-listed diagnoses is

equal to the number of discharges.

Discharge—The formal release of a

patient by a hospital, that is, the

termination of a period of

hospitalization by death or disposition to

place of residence, nursing home,

another hospital, or other location. The

terms discharge, patient, and inpatient

are synonymous.

Discharge rate—The ratio of the

number of hospital discharges during a

year to the number of persons imthe

civilian population on July 1 of that

year.

Disposition—The dispositiam of a

patient on termination of hospitalization

is classified in one of six categmies in

this repo~

. Routine discharge-Patients who

returned to their previous place of

residence after discharge.
Advance Data No. 252 ● October 7,1994 11

Table L Estimated parameters for relative standard error equations for National Hospital

Discharge Survey ststistloa, by selaeted characteristic United States, 1991

Numberof

diachqwa or

mat-llwd Number of

dia@uws days of care

Charaoteriatii a b a b

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

Sex

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

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

Age

Under15yeara . . . . . . . . . . . . . .

15+4years . . . . . . . . . . . . . . . .

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

65yearsandover . . . . . . . . . . . .

Region

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

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

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

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

Sourcaofpayment

Workers’mmperrsation . . . . . . . . .

Mediosra . . . . . . . . . . . . . . . . . .

Medicaid . . . . . . . . . . . . . . . . . .

OtherGovamment . . . . . . . . . . . .

Priiate . . . . . . . . . . . . . . . . . . .

Self . . . . . . . . . . . . . . . . . . . . .

Nochargeorothar . . . . . . . . . . . .

Notstatad . . . . . . . . . . . . . . . . .

Raoa

While . . . . . . . . . . . . . . . . . . . .

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

Another . . . . . . . . . . . . . . . . . .

Notstated . . . . . . . . . . . . . . . . .

0.00101

0.00447

0.00088

0.01766

0.00856

0.01292

0.01149

0.0Q293

0.00603

0.00247

0.00513

0.00250

0.00546

0.00346

0.0S079

0.00146

0.00244

0.02235

0.04460

0.00234

0.00569

0.02669

0.01666

546.321

213.042

442.166

65.642

111.147

44.094

25.766

243.156

331.760

547.68S

403.340

566.607

863.428

t,979.37a

177.390

760.110

662.896

407.606

639.367

927.084

273.366

260.075

427.619

0.00173

0.00518

0.00184

0.07618

0.02364

0.02949

0.01648

0.00451

0.01037

0.00400

0J30S91

0.00383

0.00456

0.00136

0.04261

0.00169

0.003s9

0.02240

0.05367

o.04)3ecr

0.00626

0.04960

0.02339

2,343.213

5,120.983

1.634.957

737.582

475.362

92.219

25.556

1,967.234

603.558

1,435.185

871.769

12,444.000

6,646.642

18,545.000

936.154

12,e06.000

5,923.664

2,779.271

3,638.362

2,067.655

1,034.092

253.439

966.602

NOTEThereisfiveerandardenw(RSE)foranmtknate (%),expsssdasapermrtorX.ccmbedetemit@ frmlrheeawdbn

RSE@ = 100 m

● Tj-an#erto anot~rshort.ter~

hospital-Patients whowere

transferred to another short-term

hospital atdischsrge.

● Tra&erto long-term care

●

●

Q

institution-Patients who entereda

nursinghomeor otherlong-term care

institution upon discharge fiomthe

hospitsl.

Other live discharges-Patients who

Ieftthe hospitalagsinst medicsl

advice, patients discharged alive with

dispositions other than routine

discharge or transfer, and patients

discharged alive whose dispositions

were not stated.

Dead—Patients who died during an

inpatient stay.

Not stated—Patients whose discharge

status, that is, alive ordea~ was not

reported at discharge.

External cause of injury codes

(E-codes)-This refera to the

International Classi@ation of Diseases,

9th Revisio% Clinical lUodij?cation

section entitled “Supplementary

Class&ation of Extemsl Causes of

Injury or Poisoning” snd includes codes

E8CUJ-E999.These codes descriie

environmental events, circumst3nce3,

and conditions S3 the cause of injury,

poisoning, and other adverse effects.

Expected princ@al source of

payment-The expeeted principal source

of payment is reported by the patient or

the patient’8 representative at the time

of admission and may differ somewhat

from the acturd source of payment as

determined after discharge. In this

repo~ payment sources sre grouped as

follows:

●

c

●

●

●

●

●

Private insurance-Insurance

provided by nongovernmental

sources, including Blue Cross and

other imwmnce companies, private

industry, and philanthropic

organizations.

Medicare—A nationwide program

providing health insurance protection

to people 65 years of age and over,

people eligible for Social Seeuri@

disability payments for more than 2

years, and people with end-stage

remd disease.

Medicati-A joint Federal-State

program that provides benefits for

people who meet their State’s

definition of “low income.”

Workers’ compensation-A progrsrn

in W States under which employees

injured on the job receive financial

compensation without regsrd to fault.

Other Government

payments-Govermuent payments

other thsn those through the Medicare

or Medicaid programs, such ss

payments made under the Title V

Progrsm, snd the Civilisn Health and

Medieal Program for the Uniformed

Services (CHAMPUS), which

provides coverage for civiIian

medical care for fsmily members of

activeduty uniformed service

personnel and for retired uniformed

service persomel and their fsmilies.

Sei’j-papPatients who expect the

costs of hospitrdization to be paid for

primsrily by themselves, spouses,

p8rent3, or next of kin.

Other source.-Includes other

nonprofit sources of paymen~ such as

church welfsre; hospitalizations for

which there was no chargq and

sources that could not be assigned to

sny other category.

● Not stated—patien~ for whom no

source of payment was indicated.

Geographic region—Hospitrds are

classfied by location in one of the four

geographic regions of the United Ststes

that correspond to those used by the

U.S. Bureau of the Census.

Region States included

Northeast Maine, New Hampshire,

Vermon$ Mesaachuse@

RhcxleIslim&Connecticut

New Yo& New Jersey, and

Penn3ylv3rda
12 Advance Data No. 252 ● October 7, 1994

Midwest Michigan, Ohio, Illinois,

Indi- W-m@ Minneso@ Iow~ Misso@ North

Dakota, South Dakota,

Neb- and Kansas

south Delaware, Marylan@ District of Giumbirq vii%

West Vigin@ North Carob south carob GeO*

Florida, Kentucky, Tennessee, Alabama, Mississippi Arkamas, Louisian&

Oldahomz and Texas

West Montan~ Idaho, Wyoming,

Colorado, New Mexico,

Arizom Ut@ Neva@

Washington Oregom califorr@ Haw@ and Alaska

Hospital—Hospitals with an

average length of stay of less than 30

days for all patients as well as hospitals

whose specialty was general (medical or

surgical) or children’s general, even if

the average length of stay of all patients

was 30 days or more. Federal hospitals,

hospital units of institutions, and

hospitals with less than six beds staffed

for patients’ use were not included.

Injury and poisoning-In this

report, injury and poisoning diagnoses

includes codes 800-999 of the

International Classification of Diseases,

9th Reviswn, Clinical Modification.

Newborn-A patient admitted by

birth to a hospital.

Patient-A person formally

admitted to the inpatient service of a

short-stay hospital for observation, care,

diagnosis, or treatment. Newborn

infants, defined as those admitted by

birth to the hospital, are excluded horn

this report. The terms patient, inpatient,

and discharge are synonymous.

Population-The U.S. resident

population, excluding members of the

Armed Forces.

Procedure-surgical or nonsurgical

operations, diagnostic procedures, or

special treatments reported on the

medical record of a patient. In the

NHDS, a maximum of four procedures

are coded.

Race—Patients are classified into

three groups, “white,” “black’” and “all

other,” with all other including all

categories other than white or black. In

addition, 21.6 percent of the patients had

no race stated on the face sheet of the

medical record.

Suggested citation

Hall MJ, Wings MF. Hospitalizations for injury

and poisoning in the United States, 1991.

Advance data from vital and health statiaticq

no 252. Hyattsville, Maryland: National Center

for Health Statistics. 1994.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Director

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

Deputy Director

Jack R. Anderson

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

6525

Hyattsville,

National

Belcrest

Center

Maryland

Road

for Health

20782

Statistics ma

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

To receive this publication regularly, contact

the National Center for Health Statistics by

celling 301-436-8500

DHHS Publication No. (PHS) 94-1250

4-1432 (10/94)
Number 253 . August 10, 1994

Advance

Data

FromVi and HealthStatisticsofthe CENTERS FOR DISEASE CONTROLAND PREVENTION/National Centerfor HealthStat&b

National Ambulatory Medical Care Survey: 1992 Summary

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

Introduction

During the 12-month period from

January 1992 through December 1992,

an estimated 762.0 million visits were

made to nonfederally employe~

office-based physicians in the United

States-about three visits per person.

This rate is not significantly dMerent

from office visit rates observed since

1985 (l-4).

This report presents data highlights

from the 1992 National Ambulatory

Medical Care Survey (NAMCS), a

national probabili& sample survey

conducted by the Division of Health

Care Statistics of the National Center

for Health Statistics, Centers for Disease

Control and Prevention. Statistics are

presented on physician, patien~ 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

variability. The Technical notes found at

the end of this report include an

overview of the sample design used in

the 1992 NAMCS, an explanation of

sampling errors, and guidelines for

judging the precision of the estimates.

The Patient Record form 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 survey 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.

Physician characteristics

The distribution of office visits

according to physician speciaIty for the

13 most visited specialties is presented

in table 1. The largest share of visits

was made to physicians specializing in

general and famiIy practice

(28.8 pereent). Compared with 1991

data, increases were noted in the

proportion of visits made to general and

family practitioners and pediatricians.

Conversely, the proportions of visits

made to internists and dermatologists

were significantly lower than in 1991.

No signiikant diEerences were found in

the distribution of visits made to

obstetricians and gynecologists,

ophthahnologists, orthopedic surgeons,

general surgeons, otolaryngologists,

psychiatrists, urologists, cardiovascular

disease specialists, or neurologists. Visit

rates to each of the 13 physician

specialties were not found to d~er

signilkmtly horn 1991 visit rates (4).

Doctors of osteopathy received 45.0

million visits during 1992, or

5.9 percent of all office visits. Visits to

this speciaity occurred at a rate of 17.9

per 100 persons, which was not

significantly different horn the 1991

visit rate.

Visits according to geographic

characteristics of the physician’s

practice are also displayed in table 1.

Vkit rates by region-Northeast,

MidwesG SoutiL and West-were not

statistically diilerent from each other in

1992. Neither had they changed from

the previous year’s rates with the

exception of the South, where the rate

was slightly higher in 1992 than in

1991. However, it is suspected that this

is due largely to sampling variability

and changes in the NAMCS survey

methodology for 1992 rather than to an

actual increase in the number of office

visits. A discussion of these changes and

the impact they may have had on the

survey results is included in the

Technical notes.

Patient characteristics

Office visits by patient’s age, sex,

and race are shown in table 2. Females

# sixvict~,ti

** +

-g

U.S. DEPARTMENTOF HEALTHAND HUMANSERVICES

$+ Public Health Service

sx Centers for Disease Control and Prevention -b

%

>+%.a National Center for Health Statistics cENr CKAmmE FoR
L nuwuauww wusu mu. -UW - nu~uu. .w, ■ wu~

Ass., . . . . -I Confidentiality-All hformatlc,n whldl would Pe,ml, ,dent,f$ca,lon of an Department of Health and Hum.. services

,“dlvldual, a Practice, o, a“ ostabl,.hrn.nt w,II be held Kmfldentlal, will be mod o“!” by Centers for Disease control

Per. . . . engaged In and for the Purposes of the survey and will not be dls.losed or PublicHealth.%,.]..

releasedto otherPersonsor used 10,my other purpose. Nat,onal Cent., for HealthStat!stlc, D

1.DATE OF VISIT

~

PATlENT RECORD OMB No. 0920-0234

NATIONAL AMBLNJXTORY MEDICAL CARE SURVEY Expires 4-30-93

Month Day CDC 64.21D

2. DATE OF BIRTH 4. COLOR OR RACE 5. ETHNICITY 6. EXPECTED SOURCE(S) OF 7. WAS PAT lENT 8. IS THIS VISIT

~

PAYMENT [Check all Ibar apply] REFERRED FOR INJURY RELATED?

1❑ White

Hispanic I ❑ HMO/other prepaid 5 ❑ ~~~~e~cial

THIS VISIT BY

1LI origin ANOTHER i ❑ Yes 2DN0

2 ❑ Black

2❑ Medicare 6 ❑ Patient paid PHYSICIAN?

3. SEX A2ian / Pacifm Not 9. DOES PATlENT

3❑ Islander 2❑ Hlspanlc 3❑ Medicaid 7 ❑ No charge 1 IJ Yes SMOKE CIGARETTES?

I ❑ Female z ❑ Male American Indian I

1DYS3

4❑ Eskimo/ Wad 4 ❑ Other 90vernment E ❑ ~her

2DN0 3❑ Unknown

2QN0

f O. PATIENT’S COMPLAINT(S), SYMPTOM(S), 11. PHYSICIAN’S DIAGNOSES 12. HAVE YOU OR 13. DOES PATlENT

OR OTHER REASON(S) FOR THIS VISIT ANYONE IN YOUR NOW HAVf2

[[II paticn!’s wn words] PRACTICE SEEN [Check 0!/ lb(lr Upp!J

a Wnc@ dltgmd.1 PATlENT BEFORE? regurdlw of any enmy

pmble. ns.sedated in ilcm 1 1/

, Most Impmmc with tiam lOa lDYSS 2DN0 I ❑ None of below

b. IMIW

2 ❑ Depression

b,Ollwc [f yes, for the cmdltmn

in item ha? 3 D Hypertension

4❑ Hypercholesterolemia

1❑ Yes

c.Onw.

2DN0

c. Cnbc 5❑ Obszlty

1.% AMBULATORY SURGICAL 15. DIAGNOSTIC / SCREENING SERVICES

[Check all ordered or providcdl

16. THERAPEUTIC SERVICES

PROCEDURE(S) lCbcckall ordered w provided. Exclude medicatlonl

{Record un~ ourpalitwl diogmmfic or I ❑ None II ❑ Pap test

tl>eruptwic procedure, For tlwfirsr,

check approprkak. bo.w.j 2 ❑ Blood pressure 12❑ strep throat test I ❑ None s ❑ Drug abuse OTHER THERAPY:

3 a Urinalysis 13❑ HIV SefOlOgy 7❑ Alcohol abuse

4❑ EKG - resting 14❑ Cholesterol measurs COUNSELING /

EDUCATION

13❑ Psychotherapy

a

5❑ EKG - exercise 15❑ Other lab test 8 u Smoking cessation 14❑ Corrective lenses

I ❑ Scheduled 3 ❑ Local anesthesia 6❑ Mammogram !6 ❑ Hearing test 2 ❑ Diet 15❑ Hearing aid

9 H Family/ social

2 U Petiormed 4❑ Regional anesthesia 7 Q Chest x-ray 17❑ VPsu31acuity 3 ❑ Exercise 16❑ Physiotherapy

5❑ Gensral anesthesia 8❑ Other radiology 18❑ Mental status exam

10G Growth / development

4 ❑ Cholesterol reduction 17❑ Other therapy ISpt.c;fjl

19 ❑ Other \SpecIxv] II ❑ Family planning

9 ❑ Allergy testing 5 ❑ Weight reduction

12 ❑ Other counseling

b. 10 l_J Spirometfy

17. MEDICATION If nons, check here ❑ a, N.~ m~,-J~atic,”? 16. DISPOSITION THIS VISIT 19. DURATION

IItccord all new Yes No

[Check all rbor OPPIJ,J

or cottltmwd

% VISIT

medicuttons I ❑ No follow-up planned [Time act!udly

ordered or

1. 10 20

spent witl,

prov(d?d al 2 ❑ Return at specified time phy.wcian]

this ww. use

the son]e brand 2. 10 20 3 ❑ Return if needed, P.R.N.

numeor gemeric

nomccnwred on

4 ❑ Telephone follow-up planned

nny Rx or offtm 3. 10 20

medical record.

5 ❑ Referred to other physician

I“cl”de imrnu”izing

and dcscnsidzing 4.

6 ❑ Retumod to referring physician

agenls.1

fn 20

7 ❑ Admit to hospital

5, ~n 20 B❑ Other ISpecifi] Minutes

-.. . . . . . . . ●gure 1. muem riecora Term

made 60.0 percent of all office visits

during 1992 and accounted for a higher

percent of visits than males in all age

categories exeept the youngest (under 15

years). Females also had significantly

higher visit rates than males in each age

category with the exception of the

youngest group (under 15 years) and the

two oldest groups (65–74 years and 75

years and over). These patterns were

also observed in the 1990 and 1991

NAMCS.

Visit rates were found to increase

with age after the age of 24. Persons 75

years of age and over had the highest

visit rate of the six age categories

analyzed, at 6.3 visits per person. The

pattern, however, was found to be

slightly different for males and females.

Among males, rates increased with each

age group after the age of 44, with

males 75 years of age and over having

the highest rate of 6.4 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 females 25-44

years of age compared with those 45-64

years of age, or in the rates for females

65-74 years of age compared with those

75 years of age and over.

The visit rate for the white

population was significantly higher (3.1

visits per person) than the rate for the

black population (2.6 visits per person)

in 1992. White persons made

85.8 percent of all office visits, with

black persons and Asians/Pacific

Islanders accounting for 10.8 percent

and 3.0 percent, respectively.

Visit rates for four of six age

groups were not statistically different

from those observed in 1991, nor were

visit rates by sex found to be

significantly different from the previous

year’s rates. Small but significant

increases were noted in the rate of ofice

visits made by persons in the age groups

under 15 years and 15–24 years. Within

the under 15 category, corresponding

increases were noted for males and
Advance Data No. 253. August 10,1994 3

Table 1. Number, percent distribution, and annual rate of office visits by aeleeted

physician praotiea charaeteristiea: United States, 19s2

Number of

Numberof Vfsiiepar

visitsin Percent Iw persons

Physicianpracticechsraoterisfic thousands distributicwl par yearl

Allvisits . . . . . . . . . . . . . . . . . . . . . . . 762,045 100.0 303.1

Physicianspecialty

Generaland familypractice . . . . . . . . . . . 219,245 28.8 87.2

Internalmedicine. . . . . . . . . . . . . . . . . . 100,273 13.2 39.9

Pediatrioe . . . . . . . . . . . . . . . . . . . . . . 88,129 12.6

Obstetricsandgynecelogy. . . . . . . . . . . . 66,367 9.0 %%

Ophthalmokgy . . . . . . . . . . . . . . . . . . . 4e,E@0 6.1 18.5

Orthopedicsurgery. . . . . . . . . . . . . . . . . 37,963 5.0 15.1

Oefrnetolcgy. . . . . . . . . . . . . . . . . . . . . 28,699 3.8 11.4

General surgery . . . . . . . . . . . . . . . . . . 24,309 3.2 9.7

Otolafyngology. . . . . . . . . . . . . . . . . . . 22,912 3.0 9.1

Psychiatry. . . . . . . . . . . . . . . . . . . . . . 19,618 2.6 7.9

Urologicalsurgary . . . . . . . . . . . . . . . . . 14,655 2.0 5.9

Oerdiovaeculardiseasw . . . . . . . . . . . . . 14,684 1.9 5.8

Neurology. . . . . . . . . . . . . . . . . . . . . . 7,70s 1.0 3.1

Allotherspecialties . . . . . . . . . . . . . . . . 60,422 7.9 24.0

Professionalidentity

Doctorofmedicine. . . . . . . . . . . . . . . . . 717,049 84.1 265.2

Doctorofosteopathy . . . . . . . . . . . . . . . 44,986 5.9 17.9

Geographicregion

Northeast . . . . . . . . . . . . . . . . . . . . . . 165,315 21.7 330.6

Midwest . . . . . . . . . . . . . . . . . . . . . . . 164,275 24.2 2S9.8

south . . . . . . . . . . . . . . . . . . . . . . . . . 236,600 31.1 260.5

West . . . . . . . . . . . . . . . . . . . . . . . . . 175,654 23.1 316.2

‘BasedcmU.S.BweeuoftheCeneusesSmatesofthecidisnncmlnetituwmliiedPJIxIlaticmofiheUniM3tS&SSSofJu&l,

1s92.

% visitrateIs52.9 w 100 femelee.

femzdes, as well as for white persons

and black persons. Inthe15-24 year

category, increases were noted for both

males and females. ’fherate was higher

for black persons, but no significant

dMerenee was noted in the rate for

white peracms in this age group betsveen

1991 and 1992.

The visit rate for the white

population was not significantly different

from the 1991 rate, but the rate for the

black population was higher in 1992

thrtnin 1991. Inaddition, thepercentof

visita made by black peraons was higher

in 1992, but it is suspected that these

findings may be largely a result of

changes in the 1992 sampling

methodology (see Technical notes).

Visit characteristics

Referral status and prior-visit

status

In general, 6.3 percent of office

visits in 1992 were made as the result of

a referral from another physician, not

significantly diiferent from the

6.2 percent noted in 1991. The majority

of office visits (85.3 pereent) were made

by patienta who had seen the physician

on a previous occasio~ and more than

half (62.2 pereent) of all visits were

made by persona who were returning to

the physician for care of a previously

treated problem (table 3). Only

14.7 percent of the visits were made by

new patients.

The proportion of visits made by

new patients was statistically lower in

1992 compsred with 1991 dat~ while a

corresponding increase was found in the

proportion of visits made by patients

who were not new to the physician but

who were seeking care of a new

problem. No ddlerence was noted in the

percent of return visits made for the

care of previously treated problems

between 1991 and 1992.

Expected sources of payment

Data on expected sources of

payment are shown in table 4.

Physicians were asked to check all

of the applicable payment categories for

this survey item, with the result that

multiple payment sources could be

coded for each visit. The patient-paid

category includes the patient’s

contribution toward “co-payments” and

“deductibles.”

Expected sources of payment were

most often private/eommerci81 insurance

(32.9 percent of visits), Medicare

(19.9 percent of visit3), HMO/other

prepaid (19.2 percent), and patient-paid

(19.1 percent). SignMeant decreases

were noted in the proportion of visits

that listed private/commercird insurance,

Medicare, and patient-paid as expected

pay sources between 1991 and 1992.

Conversely, a higher proportion of visits

showed “HMO/other prepaid” and

Medicaid as expected aoureea of

payment in 1992 as compared with

1991.

Injury-related visits

Injury-related office visits are

presented in terms of patient’s age, sex,

and race in table 5. There were an

estimated 65.6 million injury-related

office visits in 1992, representing

8.6 percent of all office visits. More than

half of these (56.7 percent) were made

by males, and 39.7 pereent were made

by persona 2544 yeSrSold.

Males had a higher injury-visit rate

than females did overall (30.4 visits per

100 males compared with 22.0 visits per

100 females), but these di5erenees were

noted only in the age groups 15-24

years and 25-44 years. hjury-visit rates

for males and females in the under 15,

45-64, 65-74, and 75 years and over

age groups were not found to differ

Statistically.

Among females, injury-visit rates

showed littIe variation between six age

groups. The only statistical difference

noted was between females under 15

years compared with those 25-44 yeara;

the injury-visit rate was significantly

lower for the former group as compared

with the latter. For msles, the injuryvisit rate was higher for persons 25-44

years than for those in three other age

categories: under 15 years, 65–74 yeara,

and 75 years snd over. Males in the age

group 45-64 years had an injury-visit
4 Advance Data No. 253 ● August 10,1994

Table 2. Number, percent distribution, and annual rate of office visits by patient’s age,

se% and racrx United Ststeq 1992

Number of

Number of visits per

visits in Percent parson

Age, sex, and race thousands distribution per year’

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

Age

Under 15yeare . . . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . . . .

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

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

6i5-74years . . . . . . . . . . . . . . . . . . . . .

75yearsand over . . . . . . . . . . . . . . . . .

Sex and age

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

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

15-24years . . . . . . . . . . . . . . . . . . .

25-44yasrs . . . . . . . . . . . . . . . . . . .

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

s5-74yasrs . . . . . . . . . . . . . . . . . . .

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

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

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

15-24years . . . . . . . . . . . . . . . . . . .

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

45-64yaars . . . . . . . . . . . . . . . . . . .

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

75yeereandover . . . . . . . . . . . . . . . .

Race and age

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

Under15yesrs . . . . . . . . . . . . . . . . .

15-24year3 . . . . . . . . . . . . . . . . . . .

X+4yeare. . . . . . . . . . . . . . . . . . .

45-64yaers . . . . . . . . . . . . . . . . . . .

65-74ysara . . . . . . . . . . . . . . . . . . .

75yeereandover . . . . . . . . . . . . . . . .

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

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

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

25-14yeara . . . . . . . . . . . . . . . . . . .

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

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

75yeereand over . . . . . . . . . . . . . . . .

All othar racee

AsianlPacific islander. . . . . . . . . . . . . . .

Ameriesnlndian/Eekimo/Aleut.... . . . . . . .

7s2.045

155,168

72,016

211,897

154,ee7

90,625

77,341

457,369

74,417

46,629

143,410

93,353

51,771

47,790

304,676

80,752

25,367

66,467

61,644

38,854

29,552

653,851

124,631

S0,758

182,245

135,756

60,673

69,787

82,599

23,207

9,345

22,4s7

13,949

7,352

6,260

22,967

2,329

100.0

20.4

9.5

27.6

20.3

11.9

10.1

60.0

9.8

6.1

18.8

12.3

6.6

6.3

40.0

10.6

3.3

9.0

8.1

5.1

3.9

65.8

10.8

8.0

23.9

17.6

10.6

9.2

10.6

3.0

1.2

3.0

1.8

1.0

0.8

3.0

0.3

3.0

2.7

2.1

2.6

3.2

4.9

6.3

3.5

2.7

2.7

3.5

3.7

5.1

6.2

2.5

2.6

1.5

1.7

2.6

4.5

6.4

3.1

2.8

2.2

2.7

3.3

4.9

6.3

2.6

2.6

1.8

2.3

2.8

4.5

6.4

——-

-—-

‘Basadon U.S.Bureau ofthecensusestimates eftheciviliannoninstitutionaliiedrwwlaticmofthe UnitadStatessa ofJulvl,

1ew

rate that was higher than those 65–74

years ofageand75 years andover. No

significant differences were noted in the

rates for males under 15 years and

15-24 years.

The injury-visit rate for black

persons (25.7 visits per 100) was not

significantly different than the injuryvisit rate for white persons (26.3 visits

per 100) in 1992. The injury-visit rate

was found to be significantly higher for

white males compared with white

females. This was not the case with

rates for black males and black females,

which showed no statistical difference

(data not shown).

Patient’s cigarette-smoking status

Results from the 1992survey

showed that 78.6 million office visits, or

10.3percent of the total, were madeby

patients who smoke cigarettes. However,

thepatient’s smoking statuswasnot

reported for 26.Opercentof office visits.

Data on visits according to patient’s

cigarette smoking status are presented in

tables 6 and 7.

Patient’s principal reason for visit

Item 10 of the Patient Record form

Aathephysicianto record the patient’s

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

symptom(s), orother 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 to the

Reasonfor VikitClassi$cation fbr

Ambulatory Care (WC) (5). The

principal reason for visit is the problem,

complain; or reason listed in item 10a.

The RVC is divided into the eight

modules or groups of reasons displayed

in table8. More than half of all visits

were made for reasons classified as

symptoms (57.9 percent). Respiratory

symptoms awountedfor 12.4percent of

all visits, and musculoskeletal s:ymptoms

accounted for 10.8percent.

The 20 DIOSt fk(pedy mentioned

principal reasons for visit, representing

40.7percentof all visits, areshmvnin

table9. General medical examination

was the most frequently mentiolued

reason for visit overall (4.5 percent of

the total), while cough was the most

frequently mentioned reason having to

do with illness or injury (4.0 percent).

Of the top 20 reasons for office visits in

1992, 19 were also listed among the20

most frequently rnentionedreasons in

1991, albeit in slightly different order. It

is important to note that the rank

ordering presented in this and other

tables in this report may not always be

reliable because near estimates may not

differ from each other due to sampling

variability.

Diagnostic and screening services

Statistic on diagnostic and

screening services ordered or provided

by the physician during the office visit

are displayed in table lO. Theliist of

diagnostic and screening services

appearing on the Patient Record form is

changed periodically to reflect the

changing needs of data users,

recommendations of advisors, and

anticipated future health data needs. The

most recent revision to this item was in
Advance Data No. 253 ● August 10,1994 5

Table 3. Number and percent distribution of office visits by patient’s referrei status and

prior-visit etetw United States, 1992

Number of

vr”sitsin Percent

Wit oharactenstic thousands distribution

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762,045 100.0

Referral status

Referred byanother physician . . . . . . . . . . . . . . . 47,976 6.3

Not referred by another physician. . . . . . . . . . . . . 714,069 93.7

Prior-visit status

Newpatient . . . . . . . . . . . . . . . . . . . . . . . . . . 112,361 14.7

Old Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . 649,664 65.3

Nawproblem . . . . . . . . . . . . . . . . . . . . . . . . 175,370 23.0

Oldproblem . . . . . . . . . . . . . . . . . . . . . . . . 474,294 62.2

Table4.Numberand pereentdhtribution ofofflcevisiteby petient’sexpeeted source(s)

ofpaymenklfnited Stetes,1992

Number of

=Pec@dsaurt=(s)of payment’

visits in Peroant

thousands disfnbution

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762,045 100.0

Priietdmmmercial insurance. . . . . . . . . . . . . . . 250,870

M@csrs . . . . . . . . . . . . . . . . . . . . . . . . . . . .

32.9

151,656 19.9

HMO/ofherprapaid . . . . . . . . . . . . . . . . . . . . . . 146,336 19.2

Patient-paid . . . . . . . . . . . . . . . . . . . . . . . . . . 145,459 19.1

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64,096 11.0

Othergovemment . . . . . . . . . . . . . . . . . . . . . . 15,622 2.1

Nocharge . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,454 1.6

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30,327 4.0

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,773 2.3

‘Numbaramaynot addtototalstmcausa momtlmnomeexp.x@ aowceofpaymmt may~mputsdpw visit.

the1991NAMC& when anumberof

categories were added that either had

never appeared on the Patient Reeord

form, orhad notbeen included for

several years. These modifierttions are

discussed inhvo previous publications

(4,6); all were retained in the 1992

NAMCS.

More than half (64.5 percent) of ali

ofiice visits included one or more

diagnostic or aereening service. The

most frequently mentioned service was

blood pressure check recorded at

43.5 percent of visits. This percent was

not significantly different from that

recorded in 1991. Blood pressure checka

were ordered or provided at a

significantly higher proportion of visits

by femalea (48.2 percent) than at visits

by males (36.5 percent).

Other frequently mentioned

diagnostic or screening services were

“other” lab test (16.7 percent of visits),

urinalysis (13.9 percent), visual acuity

(5.5 percent), and radiology (excluding

chest xray) (5.4percent). Cholesterol

measures were reported at 3.lpereent of

office visits.

Pap tests and mammograms were

reported at 6.6 percent and 3.0 percent

of visita by females, respectively. A

statistically higher proportion of visits

by males included resting EKG’s and

chest x rays than did visits by females.

Significant MYerenees by sex were also

noted in the pereent of visits with

exercise EKG’s, radiology other thsn

chest x ray, hearing tests, and visual

acuity examinations, all of which were

reported more frequently at visita by

males. Visits by females were more

likely to include urinalysis and “other”

lab tests than were visits by males.

Ambulatory surgicai procedures

In item 14 of the NAMCS Patient

Record fo~ physicians were aaked to

record up to two outpatient diagnostic or

therapeutic procedures either scheduled

or performed at the current visit. This

item first appeared in the 1991

NAMCS.

There were 50.0 million ambulatory

surgical procedures reported at

6.1 percent of all office visits during

1992. This is not significantly different

from the 1991 figure of 6.2 pereent.

Tables 11 and 12 show visits with

ambulatory surgery scheduled or

performed by patient’s age, sex, and

type of physician seen. The proportion

of ambtiato~ surgery visits was not

signikmtly different for persons in the

age groups 45-64, 65-74, snd 75 years

and over. However, each of these groups

was more likely to have an ambulatory

surgery visit than were those in each of

the three age groups under 45 years. No

statisticrd difference was noted by

patient’s sex in the pereent of visits with

ambulatory surgery scheduled or

performed. Visits to specialists in

urological surgery, orthopedic surgery,

general surgery, otolaryngology,

ophthalmology, and dermatology

represented 23.0 percent of all office

visits, but accounted for more than half

(52.7 percent) of all ambulatory surgery

visits. Procedures are classified by type

of operation in table 13; the 10

procedures most frequently mentioned

by physicians on the Patient Record

form are shown in table 14.

Physician’s principai diagnosis

Item 11 of the Patient Record form

asks the physician to record the

principal diagnosis or problem

associated with the patient’s most

important reason for the current visit 33

well as any other significant current

diagnoses. Up to three diagnoses are

coded and classified according to the

International Classification of Diseases,

9th Revisw% Clinical Mod@cation

(ICD-9-CM) (7). Displayed in table 15

are office visits by principal diagnosis

using the major disease categories

specified by the ICD-9-CM. The

supplementary classilkation, used for

diagnoses that are not cktssifiable to

injury or illne33 (for example, general

medical examination, routine prenatal

examination, and health supervision of

an infant or child), accounted for

15.4 pereent of all office visits. Diseases

of the respiratory system (14.8 pereent)
6 Advance Data No. 253. August 10,1994

Table 5. Number, percent distribution, and annual rate of Injury-related office visits by

patient’s age, sex, and race: United States, 1992

Number of

Number of visita per

visits in Percent 100 persons

Age, sax, and race tfrouearrds distribution per year’

All injury-related visits. . . . . . . 85,555 100.0 26.1

Age

LJnder15years . . . . . . . . . . . . . . 10,566 16.1 18.7

15-24 years . . . . . . . . . . . . . . . . 8,763 13.4 25.5

25-44 years . . . . . . . . . . . . . . . . 26,044 39.7 32.0

45-64 yeara . . . . . . . . . . . . . . . . 13,565 20.7 28.0

65-74 years . . . . . . . . . . . . . . . . 3,622 5.5 19.6

75years and over . . . . . . . . . . . . 2,974 4.5 24.1

Sex and age

Female . . . . . . . . . . . . . . . . . . . 28,416 43.3 22.0

Under15yeara . . . . . . . . . . . . 4,251 6.5 15.4

15-24yeare . . . . . . . . . . . . . . 3,184 4.8 18.3

2544yeara . . . . . . . . . . . . . . 10,388 15.6 25.1

45-64yeare . . . . . . . . . . . . . . 6,189 9.4 24.5

65-74years . . . . . . . . . . . . . . 2,196 3.4 21.5

75yearaarsdover . . . . . . . . . . . 2,257 3.4 29.3

Male . . . . . . . . . . . . . . . . . . . . 37,139 56.7 30.4

Under15years . . . . . . . . . . . . 6,317 9.6 21.9

15-24yeaE . . . . . . . . . . . . . . 5,599 6.5 32.7

25-44yaars . . . . . . . . . . . . . . 15,665 23.9 39.2

45-64yaars . . . . . . . . . . . . . . 7,416 11.3 31.8

65-74yeara . . . . . . . . . . . . . . 1,426 2.2 17.2

75yearaandover . . . . . . . . . . . 717 1.1 15.5

Race

Whtie . . . . . . . . . . . . . . . . . . . . 55,192 84.2 26.3

Black . . . . . . . . . . . . . . . . . . . . 8,094 12.3

Man/Pacficlslander. . . . . . . . . .

25.7

1,965 3.0 ---

Americenlndiars/Eskimo/Aleut. . . . . %03 W.5 —-

‘Bassd on U.S. Bureauofthe census estimatesofthe cMian, nminstitutionaliiadpopulationofthe UnitedStateses of July 1,

1932.

Table 6. Number and percent distribution of office visits made by patients who smoke

cigareti=, according topatient's age, sex, andrac&Unhed Stales, 1992

Numberof

visits in Percent

Age, sex, and race thousands distrib~”on

Allvisitaby patientswhosmokecigarettes. . . . . . . .

Age

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

15--24years . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

4E-84years . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Sex

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

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

Race

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

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

Asian/PacificIslander . . . . . . . . . . . . . . . . . . . . . .

AmencanlndianEskimo/Aleut. . . . . . . . . . . . . . . . .

78,618

●557

7,881

35,982

23,468

7,767

3,182

46,300

32,318

67,948

8,149

2,115

*408

100.0

‘W.7

9.8

45.7

29.9

9.9

4.0

56.9

41.1

86.4

10.4

2.7

W.5

and diseases of the nervous system and

sense organs (11.2 percent) were also

prominent on the list.

The 20 most frequently reported

principal diagnoses for 1992 are shown

intable 16. These are categorized at the

three-digit coding level of the ICD-9-

CM, andaccaunt for 36.4percent ofall

office visits made during the year. The

most tiequent diagnosis renderedby

physicians at office visits in 1992 was

essential hypertension, occurringat

3.9 percent of all visits. Essential

hypertension has been the most

frequently reported morbidity-related

diagnosis inevery survey year since the

NAMCSbeganin 1973. (Morbidityrelated diagnoses are those classifiable

to illness or injury. Nonmorbidity related

diagnoses include routine prenatal

examination, health supervision ofan

infant or child, and general medical

examination, among others.) Ofthe20

diagnoses shownin table 16,18 dlso

appeared on the list of the 20most

frequent diagnoses for 1991.

Physician’s checklist ofmedical

conditions

In addition tothe diagnostic data

reported initemll ofthe Patient

Record form, selected informatiomlon

the patient’s current health status was

collected in item 13, which appeared for

the first time in the 1991 NAMCS.

Physicians were given a list of four

common conditions-depression,

hypertension, hypercholesterolemia, and

obesity-and asked to record whether

the patient now has any of them,

regardless of what was recorded as the

current diagnosis in item 11 of the

survey form. Results from item 13 are

shown in table 17.

One-quarter (24.9 percent) of the

visits were made by patients who were

reported to have one or more of the four

conditions listed on the survey form.

Hypertension was checked most

frequently, at 13.5 percent of the total,

or 103.1 million office visits. A8 was

previously noted in the 1991 NAMCS

data, this figure is substantially higher

than the number of visits in which a

first, second, or third diagnosis of
Advance Data No. 253 ● August 10,1994 7

Table 7. Number and percent distribution of office visits by physician specialty, according

to patient’s cigarette-smoking atatu!x United States, 1992

Number of Does patient smoke cigarettes?

w“sitsin

Physician S~”dfy thousands Tots! YW No Unknown’

Percentdietrfb~”on

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762,045 100.0 10.3 83.7 26.0

General and familyprati”ce . . . . . . . . . . . . . . . . 219,245 100.0 14.3 83.8 21.8

Internalmedicine. . . . . . . . . . . . . . . . . . . . . . . 100,273 100.0 12.4 65.1 226

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . 88,128 100.0 0.6 85.9 3.5

Obstetricsandgynacology. . . . . . . . . . . . . . . . . 68,367 100.0 10.0 70.0 20.0

Ophthalmology. . . . . . . . . . . . . . . . . . . . . . . . 46,580 100.0 4.3 38.3 57.4

Orthopedicsurgefy. . . . . . . . . . . . . . . . . . . . . . 37,983 100.0 120 40.0 48.0

Dermatology. . . . . . . . . . . . . . . . . . . . . . . . . . 28,6S9 100.0 5.7 45.5 48.7

Generalsurgary . . . . . . . . . . . . . . . . . . . . . . . 24,308 100.0 12.0 48.4 39.5

Otolaryngology. . . . . . . . . . . . . . . . . . . . . . . . 22,912 100.0 8.1 63.0 28.9

Psychiatry. . . . . . . . . . . . . . . . . . . . . . . . . . . 19,818 100.0 20.0 59.3 20.8

Urologicalsurgery . . . . . . . . . . . . . . . . . . . . . . 14,955 100.0 8.2 49.0 429

Cardiovaeculardiseaeas. . . . . . . . . . . . . . . . . . 14,664 100.0 10.4 84.4 25.2

Neurolog y . . . . . . . . . . . . . . . . . . . . . . . . . . 7,708 100.0 15.8 61.7 225

Allotherapeciaities . . . . . . . . . . . . . . . . . . . . . 80,422 100.0 10.8 58.5 32.8

‘Includassmfrissof(’unknown’’srniblsnksmtrias

Tabie8. Number and parcent distribution ofofficevisftsby patient’sprincipai reason for

visti United States, 1992

Number of

W“sifsrn PenWrt

Principalreason rbr vrisitend RVC codet thousan& distribution

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

Symptomrnodule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SOOl-Sggg

Generalaymptoms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..sooI~

Symptomsreferabletopsychological/mentaldisorders. . . . . . . . . ..S100-S199

Symptomsreferabletothe nervoussystem (excludingsensaorgans) ..S200-S259

Symptomsreferabletotha oanfiiascularflymphatiosystam. . . . . . ..S260-8299

Symptomsreferabletotheayasand aars . . . . . . . . . . . . . . . . . ..Wc0+8gg

Syrnptomsreferabletotherespiratorysystem . . . . . . . . . . . . . . . ..S400-S499

Syrnptornsreferabletothedigestiiesystem. . . . . . . . . . . . . . . . ..S500-S639

Symptomsreferabletothegenitourinarysysfem . . . . . . . . . . . . . ..s640+&9

Symptomsraferabletotheskin, hair,and nails. . . . . . . . . . . . . . . .S630-S899

Symptomsraferabletothe musculoskeletalsystem . . . . . . . . . . . . .S900-8998

Diseasamodula. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..0001-0999

OiagnoW.c,scraening,andpraventive module. . . . . . . . . . . . . . . . ..X1OO-X5S9

Treatmentmodule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..TIco-T899

Injunesandadverseaffactenrodule.. . . . . . . . . . . . . . . . . . . . . . ..Joo1+

Testrasuttsmodule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..R1OIMI7OO

Administrativemodule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Awo+v40

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..U990-u888

7S2@45

441,037

49,099

21,588

23,360

4,529

53,750

84,637

35,027

34,143

42,235

62,659

66,52a

113,657

74,160

23,782

7,318

9,166

28,177

100.0

57.9

6.4

2.8

3.1

0.6

7.1

12.4

4.6

4.5

5.5

10.8

8.7

14.9

9.7

3.1

1.0

1.2

3.4

‘SSSedonAReesontiWs,tCJa Ssn%sth . rbrmlarofy are (WC) (5).

‘Includsspmblamsarrdmmpiaintsnofelsswfrwec!assh%d,enr?iesof”ncme,”b!snks,arrdilbgibleentries.

hypertension wa.sreported initemllof

the Patient Record form and suggesta

that physieiana tend tounderreport

chronic conditions initemll.

It should be noted that in item 11,

physicians are instructed to record up to

two additional current diagnoses if any,

in addition to the principal diagnosis,

whether or not they are of direct

concern to the current visit.

Therapeutic services

Data on therapeutic services

collected in items 16 and 170f the

Patient Record form eneompass both

mediation therapy andnonmediestion

therapy.

Medication tb-apy4n item 17,

physicians were instructed to record all

new or continued medications ordered

or provided at the visit, including

prescription and nonprescription

preparation, and immunizin g and

desensitizing agents. As used in the

NAMCS, the term “drug” is

interchangeable with the term

“medieation,” and the term

“prescribing” is used broadly to mean

ordering or providing any medication,

whether prescription or over-the-counter.

Visits with one or more drug mentions

are termed “drug visits” in the

NAMCS. As many aa five medications,

or drug mentions, could be coded per

drug visit.

Data on medication therapy are

shown in tables 18-22. Medication

therapy was the most eommoxdy

mentioned therapeutic servke in 1992,

reported at 486.0 million office visits or

63.8 perecnt of the total (table 18).

There were 922.6 million drug

mentions at visits to ofkc-based

physicians during 1992. This yields an

average of 1.2 drug mentions per office

visit, or 1.9 drug mentions per drug

visit.

Data on number of drug visits and

drug mentions by physician specialty are

shown in table 19, The highest

proportion of drug visits waa found

among visits to cardiovaaculsr diseaae

spccialisk 85.6 pereent of the visits

made to this specialty included at least

one drug mention.

Drug mentions arc displayed by

therapeutic class in table 20. This

clas.sitication is based on the therapeutic

categories used in the National Drug

Code Directory, 1985 edition (NDC)

(8). It should be noted that some drugs

have more than one therapeutic

application. In eases of this type, the

drug was listed under the NDC

claasiiieation that occurred with the

greatest frequency.

Cardiovascular-renal drugs and

antimicrobial agents accounted for

nearly one-third of all drug mentions

(15.8 percent each). Other prominent

categories included drugs used for relief

of pain (11.0 pereent) and respiratory

tract drugs (10.4 percent).
8 Advance Data No. 253. August 10,1994

Table 9. Number and percent distribution of office visits by the 20 principal reasons for

visit most frequently mentioned by patients and patient’s sex United States, 1992

Number of

visits in

Principal reason for visit and WC code’

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

General medical examination. . . . . . . . . . . . . . . . .XIOO

Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S440

Routine prenatal examination. . . . . . . . . . . . . . . . .X2O5

Progreee visit, notcthenvise specified. . . . . . . . . .T800

Symptoms rsferebleto throat . . . . . . . . . . . . . . . ..S455

Postoperative viait . . . . . . . . . . . . . . . . . . . . . . ..T205

Earache orearinfaction . . . . . . . . . . . . . . . . . . ..S355

Backsymptoms . . . . . . . . . . . . . . . . . . . . . . . ..S805

Vision dyafunotions . . . . . . . . . . . . . . . . . . . . . ..S305

Skin raeh . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S680

Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S010

Stomach pain, cramps, andspasrna. . . . . . . . . . . ..S545

Head mid, upperrespiratory infection (coryza) . . . . . .S445

Headache, paininhaad . . . . . . . . . . . . . . . . . . ..S210

Well-babyexarnination . . . . . . . . . . . . . . . . . . . ..X105

Kneesymptoms . . . . . . . . . . . . . . . . . . . . . . . ..S925

Naealoongeation, . . . . . . . . . . . . . . . . . . . . . ..S400

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . ..D51O

Depression . . . . . . . . . . . . . . . . . . . . . . . . . . ..S110

Allotherraasons . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient’s sex

Total Female Male

Percent distribti”on

762,045

33,973

30,226

26,036

25,771

20,639

20,060

15,292

13,899

13,414

13,379

12,790

11,985

10,966

10,854

10,799

10,630

10,538

8,718

8,344

451,513

100.0 100.0 100.0

4.5 4.7 4.1

4.0 3.7 4.3

3.7 6.1

3.4 3.4 34

2.7 2.9 2.6

2.6 2.6 2.7

2.0 1.9 2.1

1.8 1.6 2.1

1.6 1.7 1.6

1.6 1.5 2.1

1.7 1.4 2.1

1.6 1.9 1.1

1.4 1.3 1.6

1.4 1.7 1.1

1.4 1.2 1.6

1.4 1.3 1.6

1.4 1.3 1.5

1.1 1.2 1.1

1.1 1.2 1.0

59.3 57.4 61.9

‘Based cm A Resson for Wait C/assirWtion forAnrbu/story Care (RVC) (5).

Table 10. Number and percent distribution of ofFlce visits by diagnostic and screening

services ordered orprovidad: UnkadStstes, 1992

Number of Patient’s sex

visits in

Wsit characteristic thousands Total Female Male

WIVES.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of diagnostic and screening

services orderad or provided

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

One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Threeormore . . . . . . . . . . . . . . . . . . . . . . . . . .

Diagnostic and

screening servicee’

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

Blood preaaure . . . . . . . . . . . . . . . . . . . . . . . . . .

Urinalysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EKG-reeting . . . . . . . . . . . . . . . . . . . . . . . . . .

EKG-exercise . . . . . . . . . . . . . . . . . . . . . . . . .

Mammogram . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cheetxrey . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherradiology . . . . . . . . . . . . . . . . . . . . . . . . .

Allergyteating . . . . . . . . . . . . . . . . . . . . . . . . . .

Spirometry . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Paptest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Strepthroatteet . . . . . . . . . . . . . . . . . . . . . . . . .

HIVserology . . . . . . . . . . . . . . . . . . . . . . . . . . .

Choleaterolmeasure . . . . . . . . . . . . . . . . . . . . . . .

Otherlabteet . . . . . . . . . . . . . . . . . . . . . . . .

Hearingteet . . . . . . . . . . . . . . . . . . . . . . . . . . .

visual acu”~ . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mentaletatusexam . . . . . . . . . . . . . . . . . . . . . . .

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

Percent distribution

762,045

270,271

272,739

127,349

91,666

270,271

331,792

106,196

23,890

3,525

13,617

20,592

40,972

1,711

2,613

30,373

16,380

2,556

23,872

127,642

tl,llo

42,133

8,616

55,255

100.0

35.5

35.8

16.7

12.0

35.5

43.5

13.9

3.1

0.5

1.6

2.7

5.4

0.2

0.4

4.0

2.1

0.3

3.1

16.7

1.5

5.5

1.2

7.3

i 00.0

31.7

35.6

18.9

13.9

31.7

46.2

15.3

2.6

0.3

3.0

2.4

4.9

0.2

0.3

6.6

2.0

0.3

3.2

I a.o

1.0

5.1

1.1

8.1

100.0

41.2

36.1

13.4

9.3

41.2

36.5

10.3

3.9

0.7

0.0

3.1

6.1

0.2

0.5

0.0

2.4

0.5

3.1

14.9

2.1

6.2

1.2

6.0

1Numbws may not add to totals because more than one service may be reported per visit.

The 20 most frequently used

generic substances for 1992 areslhown

intable 21. Drug products containing

more than one ingredient (combination

producte) are included in the data for

each ingredient. For example,

acetaminophen with codeineis included

in both the count foracetaminophen and

the count for codeine. Amoxicillin was

the generic ingredient rnostfrequently

used in drugs ordered or providecl by

the physician at office visits in 1992 (as

well asin 1990and 1991), occurringin

4.7percent ofdrug mentions. 0fthe20

most used generic ingredients for 1992,

17 were also onthe listofthetop20

for 1991.

Table 22 presents the 20

medications most frequently mentioned

by physicians in the NAMCS, according

totheentryname ofdrng. Entry name

refers to the actual designation used by (

the physicianon the Patient Record

form and maybe atradename, generic

name, or simply a desired therapeutic

effect. Amoxicillin was the medication

most frequently reported by physicians,

with 20.6 million mentions (2.2percent

of the total). It waafollowed by Amoxil

(1.9 percent), Lasix (1.5 percent), and

Ceelor (1.0 percent). Of the top 20

preparations, 18 appeared onthe list for

1991, althoughin different order.

The NAMCS drug data base

permits classification byawide rangeof

variables, including specific product

name, generic claas, entry form chosen

by the physician (that is, brand name,

generic name, orthe desired therapeutic

effect), prescription status (that is,

whether the product is prescriptionor

nonprescription), federally controlled

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 (9).

Nonmedication therappIn item 16

of the Patient Record form, the

physician is aeked to report all

nonmedication therapies ordered or

provided to the patient at the current

visit. This item had been substantially

revised for the 1991 NAMCSto permit

physicians greater specificity in

reporting the various types of therapy

offered. These changes, all of which
Advance Data No. 253. August 1051994 9

Table 11. Number and pereent distribution of office visits by diagnostk and therapeutic ambulatory surgical proeedurea sehedulad or

performed and standard error of visits with one or more procedures sehedukd or performed, aooording to patient’s age and sex

United States, 1992

Diagnosticand tharapaufieprccaduras scheduled orparibrmed Starr&W error

of visits

Winrc?mwnwm

All No

Age and sax

Ch90rrnom prooedurw

Viaifs procedures mr= m ttrouaands’

Alivisits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age

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

15-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2Myears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-84 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75yearaand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

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

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

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

Age

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

15-24yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

65-74yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75yearaandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

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

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

Numbarofvisilsin Uxwaan&

762,045 715,888 46,179

155,188 151,871 3,497

72,016 8a,857 3,35s

211,697 199,767 12,130

154,s87 142,832 12,185

60,625 82,881 7,e84

77,341 70,278 7,064

457,389 430,952 26,410

304,676 264,S07 19,769

Pereentdtibufion

100.0 93.9 6.1

100.0 97.7 23

100.0 95.3 4.7

100.0 94.3 5.7

100.0 92.2 7.8

100.0 91.2 8.8

100.0 80.9 9.1

100.0 94.2 5.8

100.0 83.5 6.5

2,773

446

40s

915

915

723

8s0

1,737

1,35s

0.4

0.3

0.6

0.4

0.6

0.8

0.9

0.4

0.4

‘SwTechniaIInotes frxadkussimof standwdemxswd pr&jiUIOfMAMCS estknatas.

were retained in the 1992 NAMCS, are

discussed intwo earlier publications

(4,6).

Nonmedieation therapy was ordered

or provided at30.9 percent ofall office

visits during 1992 (table 23). Diet

education or counseling was mentioned

most frequently byphysicians, at

11.8 percent of the total, or 89.6 million

visits. Other prominent categories

included exercise (7.3 percent), weight

reduction (4.0 percent), and cholesterol

reduction (2.9percent). The percentof

visits where smoking cessation services

were either ordered or provided

increased significantly between 1991

and 1992, from 1.9percent (13.0 million

visits) to 2.4percent (18.3 million

visits).

Disposition of visit

Themajority ofoffice visits

(64.4 percent) included a scheduled

followup visitor telephone callin

1992, butthis percent waasignilicantly

lower than thatnoted in1991

(66.7pereent).Another 24.2percentof

officevisit sincludedinstructionsto

returnifneeded, which representa a

statistically signikant increase over the

1991 proportion (21.6percent). Isss

than lpercent ofvisits resulted ina

hospital admission in both 1991 and

1992. Table 24 displays data on

disposition of office visits.

Duration of visit

Data on the duration of office visits

ispresented intable 25. Duration of

visit refers to the amount of time spent

in face-to-face contact between the

physician and the patient. This time is

estimated and recorded by 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

ancl/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 two-thirds (66.6 percent) of

physicians’ office visits had a duration

of 15 minutes or leas in 1992. !I%emean

duration time for all visits was 17.6

minutes. Corresponding numbers for

1991 were 69.3 pmxnt and 16.7

minutes, respectively.

Additional reports that utilize 1992

NAMCS data are forthcoming in the

Advanu Data from Vkd and Health

Statistics series. Data horn the 1992

NAMCS will be available on computer

tape from the National Technical

Information Servim at a nominal cost

beghming about August 1994. CD/ROM
10 Advance Data No. 253 ● August 10,1994

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

ambulatory surgical procedures scheduled or performed and standard error of visits with

one or more procedures scheduled or performed, according to physician specialty

United States, 1992

Diagnostic and therapeutic Standard error 7.

procedures scheduled or performed of visits

All

with one or more

No One or more procedures

Physician speciaiiy visits procedures procedures in thousands’

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

General and family practice . . .

Internal medicine. . . . . . . . . .

Pediatrics . . . . . . . . . . . . . .

Obstetrics and gynecology. . . .

Ophthalmology . . . . . . . . . . .

Orthopedic surgery. . . . . . . . .

Dermatology . . . . . . . . . . . .

General surgery . . . . . . . . . .

Otolaryngolegy . . . . . . . . . . .

Psychiatry . . . . . . . . . . . . . .

Urological surge~ . . . . . . . . .

Cardiovascular diseases . . . . .

Neurology . . . . . . . . . . . . . .

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

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

General and family practice . . .

Internal medicine. . . . . . . . . .

Pediatrics . . . . . . . . . . . . . .

Obstatrica and gynecology. . . .

Ophthalmology . . . . . . . . . . .

Orthopedic surgery. . . . . . . . .

Dermatology . . . . . . . . . . . .

General surgery . . . . . . . . . .

Otolaryngology. . . . . . . . . .

Psychiatry . . . . . . . . . . . . . .

Urological surge~ . . . . . . . . .

Cardiovascular diseases . . . . .

Neurology . . . . . . . . . . . . . .

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

Number of visits in thousands

762,045

219,245

100,273

96,129

66,367

46,560

37,963

28,699

24,309

22,912

19,818

14,955

14,6s4

7,708

80,422

715,866

213,838

97,679

95,117

63,663

40,781

31,766

25,796

20,709

19,616

19,729

12,422

14,394

7,614

52,742

Percent distribution

46,179

5,407

2,594

1,012

4,704

5,779

6,217

2,903

3,600

3,296

%9

2,534

269

%4

7.660

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

93.9

97.5

97.4

96.9

93.1

87.6

63.6

89.9

85.2

S5.6

99.6

83.1

98.2

98.8

87.3

6.1

2.5

2.6

1.1

6.9

12.4

16.4

10.1

14.8

14.4

W4

16.9

1.8

*1.2

12.7

2,773 8.

915

492

277

8S8 9.

1,269

1,195

565

303

605

65

Summary. Advancs data from vitrd

and heakh statisti~, no 230.

Hyattsville, Maryland NationaI

Center for Health Statistics. 1993.

Public Health Service and Health

Care Financing Administration.

International Cla3sijication of

Diseases, 9th Revision, clinical

modi&ation. Washington: Public

Health Service. 1980.

Food and Drug Adminiatration.

National Drug Code Directory, 1982

Edition. Washingtorx Public Health

Service. 1982.

Koch H, Campbell W. The collection

and processing of drug information.

National Ambulatory Medical Care

Survey, 1980. National Center for

Health Statistics. Vkal Health Stat

2(90). 1982.

447 10. Sh~ BV, Barnwell BG, Hunt PN,

64 LaVange LM. SUDAAN User’s

29 Manurd, Release 5.50. Research 1,313 Triangle Institute. Research Triar@e

Parlq NC. 1991.

0.4

0.4

0.5

0.3

1.0

2.1

2.2

1.6

1.4

1.9

0.3

1.5

0.4

0.4

2.0

‘8s8 Technicalnotss for a discussion of standard errors and precision of NAMCS estimates.

and diskette versiona of the 1992

NAMCS data should be available in late

1994. Questions regarding this report, 3.

future reports, or the NAMCS may be

directed to the Ambulatory Care

Statistics Branch by calling (301)

436-7132.

4.

References

1.

2.

Nelson ~ McLcmore T. The

National Ambulatory Medical Care

Survey. United States, 1975-81 and 5.

1985 trends. National Center for

Health Statistics. Vital Health Stat

13(93). 1988.

Schappert SM. National Ambulatory

Medical Care Survey: 1989 6.

Summary. National center for Health

Statistics. Vital and Health Stat

13(110). 1992.

Schappert SM. National Ambulatory

Medical Care Survey: 1990

Summary. Advance data from vital

and health statistics; no 213.

Hyattsville, Maryland National

Center for Health Statistics. 1992.

Schappert SM. National Ambulatory

Medical Care Survey: 1991

Summary. National Center for Health

Statistics. Mtal and Health Stat

13(116). 1994.

Schneider D, Appleton L, McLcmore

T. A reason for visit claasikdion for

ambulatory care. National Center for

Health Statistics. Vhl and Health

Stat 2(78). 1979.

Schappert SM. National Ambulatory

Medical Care Survey: 1991
Advance Data No. 253. August 10,1994 11

Table 13. Number and percent distribution of office visits with corresponding standard errors by diagnostk and therapeutic ambulatory

procedures scheduled or performed: United states, 1992

Number of standard

Diagnostic or thempautic procedure schadukd

Shrdard

w“sitsin error in Percent

or penbnned and ICD-9-OM twde’g

enor of

ttroussnds thousands= diafriiwfion pemanf

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762,045 31,679 100.0

Visifawifh procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . .

46,179 2,773 6.1 0.4

Operations on the nervous system . . . . . . . . . . . . . ...01-05 778 212 0.1 0.0

Opersfiins onthe eye . . . . . . . . . . . . . . . . . . . . . ...06-16 6,926 1,453 0.9 0.2

Oparetions onthe ear . . . . . . . . . . . . . . . . . . . . . ...16-20 1,607 292 0.2 0.0

Operations onthenose, mouth, and pharynx. . . . . . . ...21-29 3,297 756 0.4 0.1

Operstiins onthecsrdiovsscular system . . . . . . . . . ...35-39 *1,187 415 *0.2 0.1

Oparafions onthedigastive system . . . . . . . . . . . . . ...42-54 7,755 1,081 1.0 0.2

Operations onthe urinary system . . . . . . . . . . . . . . ...55-59 2@2 361 0.3 0.0

Operations on the male genital organs. . . . . . . . . . . ...60-64 666 176 0.1 0.0

Operations on the female gen.til organs. . . . . . . . . . . . .S5-71 4,464 S36 0.6 0.1

Operations on the musouloskeletal system . . . . . . . . ...76-64 6,9S3 1,052 0.9 0.2

Operations on the integumanfary system. . . . . . . . . . ...65-66 6,717 673 0.9 0.1

Miscellaneous diagncdc end therapeutic procedures. . ...87-69 5,972 661 0.8 0.1

Otharprocedures’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,310 306 0.2 0.0

Visits without procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . 715,866 30,607 93.9 0.4

NOTE The @ure “0.0” indicsteea quantitygreeterthenzero butleasthen 0.05.

1Bssedon tie IntematienalC&ssiricsfienof Diseases, WI Reviskm, Clinkal Modik.ation(lCO-S-CM) (?).

‘Numbersmay noteddto totalsbemuse upto two prosedurssmuld be reportedper viaii There wwraan estimated50.0 m“llii ~eceduras sdaduled of pafonned inall.

3SW Teoknicalncmefora dwas.bn of atarrdsrderrorsandpredeionof NAMCSestimates.

‘Inoludesoperet!anscmtie endocrinesystem(ICD-S-CM CC&E06-07), eperatis cmthe respiratorysystem~CWM OXIee30-34), ow@WM cmttw hsmii end lymphaticsystem(lCO-6-

CM codes40+1), andobstetdcslpmceduras(ICWM males72-75).

Table 14. Number, standard error, percent distribution, and standard error of percent of office visits by the 10 diagnoetk and therapeutic

ambulatory surgical procedures scheduled or performed moat frequently: United States, 1992

Number of StarWrd

Diegmxfic or theme prooedure sohedulad

smd

visitsin error in Percent

or performed and /CD-%OM code’ 2

mof

thousands ftwaandss dwm

DercarsP

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762,045 31,679 100.0 . . .

Visits wifhprooedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46,178 2,773 6.1 0.4

Injection of therapeutic substance into joint or ligament . ...61.92 2,163 486 0.3 0.1

irrigSfiin OfeSr . . . . . . . . . . . . . . . . . . . . . . . . . . ...9&52 2,055 402 0.3 0.1

Ofher intracapsular extrati.on of Iene . . . . . . . . . . . . ...13.19 1,946 519 0.3 0.1

6iopsy of skin and subsutenwus tiesue. . . . . . . . . . . ...66.11 1,663 352 0.2 0.0

Ofhercyatoacopy . . . . . . . . . . . . . . . . . . . . . . . . . ...57.32 1,704 310 0.2 0.0

OoIonosmpy . . . . . . . . . . . . . . . . . . . . . . . . . . . ...45.23 1,676 394 0.2 0.1

Flexible sigmoidoscopy . . . . . . . . . . . . . . . . . . . . . ...45.24 1,310 262 0.2 0.0

Applicstiin ofofhsrcsst . . . . . . . . . . . . . . . . . . . . ...93.53 1,262 264 0.2 0.0

Appliostion of splint . . . . . . . . . . . . . . . . . . . . . . . . ..93.M 1,123 264 0.1

Arthroscopy, knee . . . . . . . . . . . . . . . . . . . . . . . . ...60.26

0.0

1,087 262 0.1 0.0

AII other procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33,719 2,2Q1 4.4 0.3

Vis”&without procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . 715,s66 30,E4)7 93.9 0.4

NOTG The f!gure“0.0” indiies e quentilygreaterthanzero butlessthan 0.05.

%ased M tie InternatbnalCkrssrikationof Diessses, Sfh RWsknr, Chid Mod#icatkn~CD-kJ-CM)(7).

2Numberamay net addto totalsbemuse upto two prcsxduresmukl be reportedpervW. Therewsre en ee6mated50.0 rrWbnpremduresachaduledor pmfumad inall.

3SW Teohnimlnotesfor a diemssiend standarderrws andfxecishn of NAMC3 estimates.
12 Advance Data No. 253. August 10,1994

Table 15. Number and percent distribution of office visits by physician’s principal

diagnosk United States, 1992

Number of

visits in Percent

Principal diagnosis and ICD-9-CM code’ thousands diatributi”on

Allviaits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectiousandparasificdiseases . . . . . . . . . . . . . . . . . . . . . . ...001-139

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ...140-239

Endocrine, ntifitional andm~tiotic ds~ses, andimmuni~ disorders. .240-279

Mentaldisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..2g0-319

Diseasesofthe nervoussystem and aenseorgans . . . . . . . . . .320-3w

Diseasesofthecirculatorysystem . . . . . . . . . . . . . . . . . . . . . . ..390459

Diseasesoftherespiratorysyefam . . . . . . . . . . . . . . . . . . . . . . ..460-519

Oiseasesofthedigeativesystem . . . . . . . . . . . . . . . . . . . . . . ...520-579

Diseasesofthegenitourinarysyetem . . . . . . . . . . . . . . . . . . . . . ..560-622

Diseasesoftheskin andsubcufanaoustissue . . . . . . . . . . . . . ...660-709

Oiseases of themusculoskeletal aystemand oonnecttie tissue. . . . ...710-739

Symptoms, signs, andill-defined conditions . . . . . . . . . . . . . . . . .780-7gg

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..8Wgg9

Supplementary classification . . . . . . . . . . . . . . . . . . . . . . . . . . .. V01–V82

Another diagnosesz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknowr$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

782,045 100.0

26,738 3.5

23,619 3.1

27,605 3.6

32,191 4.2

85,186 11.2

58,876 7.7

112,420 14.8

32,808 4.3

43,803 5.7

41,926 5.5

52,254 6.9

292599 3.9

57,402 7.5

117,521 15.4

9,997 1.3

10,289 1.4

'Baeedon tie\ntemationaf Classikstiorrof Dkeases, ~Retisim, ClinicalA4cdifkation(lCWM) (7).

‘Includss diseases of the blood end blood-forming ofgsns (2S0-2S9);mmpli-.one of pfegnancy, childbirth, and the pue#pm”um

$3W-S7e); congenitalanomalies(74&759); sndcertai”co”dtions originating i“the perinatslpwiod vwne).

Includes blank disgnoses, uncodsble diagnoses, and illegible diagnoses.

Table 16. Number and percent distribution of office visits by the 20 principal diagnoses

most frequently rendered byphysiclans andpatient’s sex United States, 1992

Number of Patientk sex

w“sitain

Princ@t diagnosis and ICD-9-CM code’ tfrouaanda Total Female Male

Percent distribution

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

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4oI

Normal pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V22

Actieupper respirato~ itiedons dmuMple orunspecifiedskes. ..465

Suppuretiie andunspecified otitismadia. . . . . . . . . . . . . . . ...382

Generel medical examination . . . . . . . . . . . . . . . . . . . . . . . ..wo

Health supervision ofinfantorchild. . . . . . . . . . . . . . . . . . .V20

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

~abetes meliiis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..25o

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...462

Bronchtiis, notspecified asacute orchronic. . . . . . . . . . . . . .48o

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

Oiseaaes ofsebaceous glands . . . . . . . . . . . . . . . . . . . . . . ..7oo

Contact dermatiis and other eczema . . . . . . . . . . . . . . . . . ...692

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..3oo

Sprains andstraine ofother andunspecified parte. of back. . . . . . .847

Special investigations and examinations . . . . . . . . . . . . . . . .V72

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

Osteoarthrosis and allied disorders. . . . . . . . . . . . . . . . . . . . .7I5

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .366

Othernoninfectious gastroentetis anddtis . . . . . . . . . . . . . . .558

Allotherdiagnoees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

762,045

29,844

29,358

22,444

21,814

21,116

17,749

14,547

14,254

13,671

12,257

9,740

8,913

8,406

7,943

7,769

7,752

7,621

7,521

7,469

7,066

484,769

100.0

3.9

3.9

2.9

2.9

2.8

2.3

1.9

1.9

1.6

1.6

1.3

1.2

1.1

1.0

1.0

1.0

1.0

1.0

1.0

0.9

63.6

100.0

3.8

6.4

2.6

2.4

2.8

1.9

2.3

1.8

1.7

1.7

1.2

1.1

0.9

1.1

0.9

1.3

0.9

1.1

1.0

0.9

62.2

I 00.0

4.0

. . .

3.4

3.6

2.8

3.0

1.4

2.0

2.0

1.5

1.4

1.2

1.4

0.9

1.2

0.5

1.1

0.6

1.0

1.0

65.8

‘Bssedonthektenrationd C/assifkationofDiseases,9tfrRevkiorr,C/inicd Modit/catiorr(lCO-S-CM) (7),
Advance Data No. 253. August 10,1994 13

Table 17. Number and percent distribution of office visits by selected medical conditions, according to patient’s age and sax

United States, 1992

Patiards age Patianrs aax

All agas, Under 15 l&24 254t 45-64 65-74 75 years

Medical condifion’ bofh sexes yeara years years years years and Okwr Fernak Male

Number in thousands

Allvisits . . . . . . . . . . . . . . . . . . 762,045 155,166 72,016 211,897 154,887 80,625 77,341 457,369 304,676

Hypatension . . . . . . . . . . . . . . . 103,135 *5 I 6 661 13,928 34,863 27,835 25,042 83,402 39,733

Obesity . . . . . . . . . . . . . . . . . . . 65,549 2,052 3,565 20,305 23,165 10,760 5,842 46,001 19,648

Depression . . . . . . . . . . . . . . . . 44,641 %20 1,636 17,132 13,162 6,266 5,605 31,717 13,124

Hyparcholesterolemia. . . . . . . . . . 42,135 *152 %92 5,839 16,878 11,161 7,913 25,580 16,676

Noneofthe above . . . . . . . . . . . . 572,463 152,070 65,939 165,807 93,806 51,035 44,007 335,428 237,036

Percent distribution

Allvisits . . . . . . . . . . . . . . . . . . 100.0 100.0 -100.0 100.0 100.0 100.0 100.0 100.0 100.0

Hypertension . . . . . . . . . . . . . . . 13.5 %.3 1.2 6.6 225 30.6 32.4 13.9 13.0

Obaaii . . . . . . . . . . . . . . . . . . . 8.6 1.3 5.0 9.6 15.0 11.9 7.3 10.1 6.4

Depression . . . . . . . . . . . . . . . . 5.9 W.4 2.5 8.1 8.5 6.9 7.5 6.9 4.3

Hypercholeaterolemia. . . . . . . . . . 5.5 W.1 W.8 2.7 10.8 12.3 10.2 5.6 5.4

Noneofthe above . . . . . . . . . . . . 75.1 98.0 91.6 78.2 60.4 56.3 56.9 73.3 77.8

‘Numbw’amaynetaddto tetelsbecauaemorethan ens oorwJii may be reportedperkieit

Table 18. Number and percent distribution of office vIsit8 by medication therapy and numbar of medications provided or prescribed:

United States, 1882

MJnrberof Patient’s Sax

w“sitain

Wit oharsoteristio thousands Tokrf F.mwia Mafa

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

Mediation therapy’

Drugvisifaz . . . . . . . . . . . . . . . . . . . . .

VIs”ts without mention at mediation . . . . . .

Number of medications provided

or preeoribed by physisian

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

One . . . . . . . . . . . . . . . . . . . . . . . . .

Two . . . . . . . . . . . . . . . . . . . . . . . . .

Three . . . . . . . . . . . . . . . . . . . . . . . .

Four . . . . . . . . . . . . . . . . . . . . . . . . .

Fiieormora . . . . . . . . . . . . . . . . . . . .

762,045

466,047

275,996

275,888

246,790

126,345

57,503

26,449

28,959

Percent distribution

100.0

63.8

=.2

38.2

32.4

16.6

7.5

3.5

3.8

lm.o

64.4

35.6

35.6

32.4

16.7

7.8

3.5

4.0

100.0

62.9

37.1

37.1

324

16.3

7.2

3.6

3.5

‘Includesprssc@iorrdrqx, ovwthe-coutier pwrperstioce,immunizkrgagents,end deeeneifkhgagents.

%isits at whichone or moredrugswee providedor prasMrW byths phyeioian.

Table 19. Number and percent distribution of drug VMS and drug mentions by physician specially Unltad Stataa, 1982

Number of Numbsr of Pwcent

drug V&i& Percent drug mentions Parc%rrt ~,

Physician spaoisily in thousands’ disfrr”bution in thouasnda dkiribdorr

Allspecialties . . . . . . . . . . . . . . . . . . . . 486,047 100.0 822,534 100.0 &3.8

General and family praotice . . . . . . . . . . . 165,626 34.1 315,046 34.1 76.5

Irrternslmedicine . . . . . . . . . . . . . . . . . . 79,503 16.4

Pediatrioa . . . . . . . . . . . . . . . . . . . . . .

181,804 19.7 78.3

86,275 13.6 104,256 11.3 88.9

Obstetrics andgynaoology . . . . . . . . . . . . 32,336 6.7 40,563 4.4 47.4

Ophthalmology . . . . . . . . . . . . . . . . . . . 19,081 3.9 35,530 3.9 41.0

Dermatology.. . . . . . . . . . . . . . . . . . . . 16,939 3.5 28,429 3.1 59.0

CardOvascular diseases . . . . . . . . . . . . . 12,574 2.6 40,831 4.4 35.6

Orthopedic surgery . . . . . . . . . . . . . . . . . 12,016 2.5 15,714 1.7 31.6

Otolaryngology . . . . . . . . . . . . . . . . . . . 11,48a 2.4 16,834 1.8 50.1

Psychiatry . . . . . . . . . . . . . . . . . . . . . . 11,435 2.4 20,715 2.2 57.7

General surgery . . . . . . . . . . . . . . . . . . 8,368 1.7 14,584 1.6 34.5

Urological surgery . . . . . . . . . . . . . . . . . 6,056 1.2 9,024 1.0 40.5

Neurology . . . . . . . . . . . . . . . . . . . . . . 5,038 1.0 9,662 1.0 65.4

Allotherspeciaitiea . . . . . . . . . . . . . . . . 39,366 8.1 90,179 9.8 65.2

‘Vrsitsat whichens or morsdrugswas providedor prwscfibsdby the physician.

‘Numberof drugvis”md~ad by numberof ofiicevisitsmuiiipliedby 100.
14 Advance Data No. 253 ● August 10,1994

Table 20. Number and percent distribution of drug mentions by therapeutic classification:

United States, 1992

Number of

drug mentions Percent

Therapeutic clasaification~ in thousands distribution

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

Cardiovascular-ranal drugs . . . . . . . . . . . . . . . . . . . . . .

Antimicrobial agente . . . . . . . . . . . . . . . . . . . . . . . . .

Drugs used forrelief of pain..... . . . . . . . . . . . . . . . .

Respiratory tract drugs . . . . . . . . . . . . . . . . . . . . . . . .

Hormones andagents affecting hormonal mechanisms . . . .

Psychopharmacological drugs. . . . . . . . . . . . . . . . . . . .

Sldn/mucous membrane . . . . . . . . . . . . . . . . . . . . . . .

Metabolic andnutrient agente . . . . . . . . . . . . . . . . . . . .

Gastrointeefinal agente . . . . . . . . . . . . . . . . . . . . . . . .

Immunologic agenta . . . . . . . . . . . . . . . . . . . . . . . . .

Ophthalmicdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neurologicdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hematologicagents . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherand unclassifiad2 . . . . . . . . . . . . . . . . . . . . . . .

e22,584

145,659

14S,656

101,433

96,026

77,726

56,346

44,s63

39,644

38,422

29,744

26,367

17,135

11,972

91,469

100.0

15.8

15.8

11.0

10.4

8.4

6.1

4.9

4.3

4.2

3.2

2.9

1.9

1.3

9.9

‘Ba?adonrhs etandarddrugclaeeificetionusedintheNafiorra/Dnrg CcdeDirecfory,1985 edition(NDC) (8).

‘Includes sneathaatics, antidotes, radiophermaceuticals/mntraar media, oncoiytice, otologioe, antiparaeitice,andunclaaeifiad/

miscellaneousdrugs.

Table 21. Number and percent distribution of drug mentions for the 20 moat frequently used generic substance= United States, ‘W92

Number of

drug mentions Percent Therapeutic

Generic substance in thousands’ distribution claaaiticationz

Alldrug mentions . . . . . . . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . . . . . . . . . . . .

Acetarninophen . . . . . . . . . . . . . . . . . . .

Eryfhromycin . . . . . . . . . . . . . . . . . . . .

Hydrochlorothkdde. . . . . . . . . . . . . . . .

Albuterol . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . .

Guaifenesin . . . . . . . . . . . . . . . . . . . . .

Furosemide . . . . . . . . . . . . . . . . . . . . .

Ibuprofen . . . . . . . . . . . . . . . . . . . . . . .

Phenylpropanolamine. . . . . . . . . . . . . .

Phenylephrine . . . . . . . . . . . . . . . . . . . .

Naproxen . . . . . . . . . . . . . . . . . . . . . .

Codeine . . . . . . . . . . . . . . . . . . . . . . .

ViaminA . . . . . . . . . . . . . . . . . . . . . . .

Dioxin. . . . . . . . . . . . . . . . . . . . . . . .

Pseudoephedrine . . . . . . . . . . . . . . . . . .

Ergocalciferol . . . . . . . . . . . . . . . . . . . .

Cefaclor . . . . . . . . . . . . . . . . . . . . . . .

Enalapril . . . . . . . . . . . . . . . . . . . . . . .

Pradnisone . . . . . . . . . . . . . . . . . . . . .

Allothermentions . . . . . . . . . . . . . . . . .

922,564

43,216

2S,822

19,366

17,570

15,813

15,769

15,034

14,515

13,575

13,294

12,562

11,s43

11,729

11,131

10,s63

10,907

10,326

9,818

9,415

9,197

616,697

100.0

4.7

3.2

2.1

1.9

1.7

1.7

1.6

1.6

1.5

1.4

1.4

1.3

1.3

1.2

1.2

1.2

1.1

1.1

1.0

1.0

66.8

. .

Penicillins

General analgesics

Erythromycinsand Iincoaarnidas

Diuretics

Bronchodiletors, ati”aath matioa

General analgesioe

Antitussives, axpaoforanta, mucolytica

Diuretics

Antiarthritica

Nasal daoongeatanta

Naaaldaoongeatanta

Arstiarthriica

General analgasios

Vtamins, minerals

Cardiac glyooaidaa

Nasal daoongeetante

Vimins, minerals

Cephaloeporins

Antihypertensive agents

Adranal corticoateroids

‘Frequency of mention combines singla-ingrediatM agents with mentions of the agent aa en ingredient ina combination drug.

2Besadon the Natiorra/ Drug Coda Directory, 19S5ediion(NDC) (8), lnms~where ageneric wb~cehd mmetimone tiera~Mc use, tiw~titi utiertie NMcl~sfitionfiat

occurTed with the highest frequency.
Advance Data No. 253. August 10,1994 15

Table 22. Number, percent distribution, and therapeutic classification for the 20 drugs moat frequently prescribed at office visits, by

entry name of drug: United States, 1992

Number of

drug mentions Percent

Entry nsnre of drug’

m~~

in thousands di~”bution Classilicstior?

All drugmentions. . . . . . . . . . . . . . . . 922,584 100.0 . . .

Amoxicillin. . . . . . . . . . . . . . . . . . . .

Amoxil . . . . . . . . . . . . . . . . . . . . . .

Lasix . . . . . . . . . . . . . . . . . . . . . . .

Ceclor . . . . . . . . . . . . . . . . . . . . . .

Zantac . . . . . . . . . . . . . . . . . . . . . .

Vasotec. . . . . . . . . . . . . . . . . . . . . .

Premarin. . . . . . . . . . . . . . . . . . . . .

Pradnieone . . . . . . . . . . . . . . . . . . .

Napmsyn. . . . . . . . . . . . . . . . . . . . .

Synthroid. . . . . . . . . . . . . . . . . . . . .

Tylenol . . . . . . . . . . . . . . . . . . . . . .

Seldane . . . . . . . . . . . . . . . . . . . . .

Cardizem. . . . . . . . . . . . . . . . . . . . .

Lanoxin. . . . . . . . . . . . . . . . . . . . . .

Ventolin. . . . . . . . . . . . . . . . . . . . . .

Motrin. . . . . . . . . . . . . . . . . . . . . . .

Proventil. . . . . . . . . . . . . . . . . . . . .

Allergyrelieforshote . . . . . . . . . . . . .

DipthenaTatanusToxoidsPertueeis. . . .

Xanax. . . . . . . . . . . . . . . . . . . . . . .

Another. . . . . . . . . . . . . . . . . . . . .

20,554

17,492

13,543

9,607

9,037

9,022

8,814

8,808

8,541

8,278

8,226

7,771

7,604

7,593

7,490

6,918

6,735

6,183

6,176

6,027

733,165

2.2

1.9

1.5

1.0

1.0

1.0

1.0

1.0

0.9

0.9

0.9

0.8

0.8

0.8

0.8

0.7

0.7

0.7

0.7

0.7

80.0

Penicillins

Penicillins

Diuretics

Caphabsporine

Agenteuaadindismdera ofupperGltract

Antihyperterrekeagante

Eatrogensandprogastins

Adrenal corticosferoids

Arrtiirthri6ce

Agenteueedtotraat thyniddisessa

Generalanalgssice

Antihistamines

Antkmginalagents

Cardiacglycoaides

Bronchcdilstora,antisethti”cs

Antiarihritice

Bronchodilatora,antiaeth-”=

Diagno@”ce,nonradioactiveandradiopaque

V~”nasatiantiearume

AntiiM”atyagante

. . .

‘Theenbymade bythephydden enlhepresaiption orothermsdlcal records.1’hkmsy bealradename, genwicnsme,c+ desirsdtkqeubc

23aeedentheAfafiormf DrvgCedeLMecrW, 19SSediion(NOC) (8).lncaeaewhers adrcghadme+s shenenethwapwk

. Srred.

h~hestfrequency.

. uee,itweslietedundsrthaNDC~lfmteccunwlwtihlhe

Tabie23.Numbsr andpsrcentdistribution ofofficevisitsby nonmedicationtherapy

ordered orprovided: UnitedStates,l 992

Number of Patienrssex

visits in

Nonmedioafion tfrerspy thousands Totaf Finale Male

Percentdietribution

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

Counseling, education,

and other therapy’

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

Diet . . . . . . . . . . . . . . . . . . . . . . . . . .

Exercise . . . . . . . . . . . . . . . . . . . . . . .

Weight reduction . . . . . . . . . . . . . . . . . .

Cholesterol reduction . . . . . . . . . . . . . . .

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

Family/social . . . . . . . . . . . . . . . . . . . .

Growthrdavelopment. . . . . . . . . . . . . . . .

Familyplanning . . . . . . . . . . . . . . . . . . .

Alceholabuse . . . . . . . . . . . . . . . . . . . .

Drugabuea . . . . . . . . . . . . . . . . . . . . .

OtherOxrnseling . . . . . . . . . . . . . . . . . .

Psychotherapy . . . . . . . . . . . . . . . . . . .

Correctivelensae . . . . . . . . . . . . . . . . . .

Hearingaid . . . . . . . . . . . . . . . . . . . . .

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

Othertherapy . . . . . . . . . . . . . . . . . . . .

762,045

526,282

89,560

55,261

30,133

22,462

18,327

14,966

13,390

14,866

3,161

2,079

61,484

20,477

7,592

*424

13,824

19,448

100.0

68.1

11.8

7.3

4.0

2.9

2.4

2.0

1.8

2.0

0.4

0.3

8.1

2.7

1.0

%3.1

1.8

2.6

80.0

63.4

12.3

7.3

4.2

2.9

2.3

2.3

1.9

1.5

0.3

0.2

8.6

2.7

1.0

Yr.o

1.6

2.1

40.0

70.1

10.9

7,2

3.6

3.0

2.5

1.5

1.7

0.1

0.6

0.3

7.3

2.7

1.1

W.1

2.1

3.2

‘Numbsremaynot addiototakbscause morethsnenetype ofnonmedicsition tharapymayberapnted pervisit.
16 Advance Data No. 253 ● August 10,1994

Table 24. Number and percent distribution of office visita by disposition of visit

United States, 1992

Number of

visits in Percent

Disposition’ thousands distribution

Allvisita . . . . . . . . . . . . . . . . . . . . . . . 782,045 100.0

Retumat specified time . . . . . . . . . . . . . .

Return if needed . . . . . . . . . . . . . . . . . .

Nofollowup planned . . . . . . . . . . . . . . . .

Telephone followup planned. . . . . . . .

Referred to other physician . . . . . . . .

Admitto hospitei . . . . . . . . . . . . . . . . . .

Returnad to refernngphysician . . . . . . .

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

469,155

164,144

72,881

21,202

22,445

5,385

8,097

6,408

61.6

24.2

9.6

2.8

2.9

0.7

1.1

0.8

'Numbarsmaynotadd tototals becausamorethanowtis~tion may berepflA pervisti

Table 25. Number and percent distribution of office visits by duration of visk

United Statea, 1892

Number of

visits in Percent

Duration thousands disbfbution

All visits . . . . . . . . . . . . . . . . . . 762,045 100.0

O minutes’ . . . . . . . . . . . . . . . . . 8,552 1.1

I+ minutes . . . . . . . . . . . . . . . . 56,055 7.4

8-10 minutes . . . . . . . . . . . . . . . 196,233 25.8

ll–15minutae . . . . . . . . . . . . . . 245,954 32.3

16-30 minutae . . . . . . . . . . . . . . 199,762 26.2

31 minutes And over. . . . . . . . . . . 55,486 7.3

‘Visitsintich therewas ne fete-to-fasecontestbetweenpatientendphysician
Advance Data No. 253. August 10,1994 17

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 1992 through December 1992.

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 prinmy sampling units

(PSU’S), physician practices within

PSU’S, and patient visits within

physician practices. The PSU’S are

counties, groups of counties, county

equivalents (such as parishes or

independent cities), or towns and

townships (for some PSU’S in New

England). For 1992, a sample of 3,000

nonfederal, office-based physicians was

selected from master fNes maintained by

the berican Medical Association and

American Osteopathic Association.

Physicians were screened at the time of

the survey to ensure that they were

eligible for survey participation. Of

those screened, 858 physicians were

ruled ineligible (out of scope) due to

reasons of being retke~ employed

primarily in teaching, research, or

administration; or other reasons. The

remaining 2,142 physicians were in

scope or eligiile to participate in the

survey. The physician response rate for

the 1992 NAMCS was 71.4 percent.

Sample physicians were asked to

complete Patient Record forms (figure 1)

for a systematic random sample of office

visits occurring during a randomly

assigned l-week reporting period.

Responding physicians completed

34,606 Patient Record forms.

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,

Health Care Survey Section, Research

Triangle ParlG North Carolina.

For 1992 several changes were

made in the sample design of the

NAMCS, which should be considered in

the interpretation of the survey results.

In an effort to even the precision of

estimates across each of the physician

specialty strata in the sample desi~ the

decision was made to increase the

proportion in the sample of specialist in

general surgery, psychiatry,

otolaryngology, and neurology. Although

this would result in a corresponding

decrease in the sample of the larger

physician specialties, most notably

general and family practice, internal

medicine, and pediatrics, the precision

of these estimates tended to be much

higher relative to the smaller specialties,

and it was expected that the end result

would be an acceptable balance of

precision levels across all strata.

However, the reduced numbers of

general practitioners, internists, and

pediatricians sampled in 1992, coupled

with the high percents of sampled

physicians in these specialties who were

determined to be ineligible (out of

scope) for survey participation, resulted

in low numbers of survey respondents in

these categories and a lowering of the

precision of these estimates relative to

other survey years, especially when

disaggregated by other variables such as

race. Because visits made by black

patients were often found to be clustered

among the sampled physicians and were

more likely to be made to general and

family practitioners, which were

undersampled in 1992, it is

recommended that caution be exercised

when interpreting diHerences in race

data and individual physician specialties.

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 itsel& the

Table L Approximate relative standard

errors for estimatsd numbers of ofiics

vIsW. National Ambulatory Medical Care

Survey, 1992

Rdatiw

Estimatednumberof offica standard

n-sitein tioussnds error inptwcsnt

100 . . . . . . . . . . . . . . . . . . . . . 77.2

200 . . . . . . . . . . . . . . . . . . . . . 54.7

500 . . . . . . . . . . . . . . . . . . . . . 34.8

676 . . . . . . . . . . . . . . . . . . . . . 30.0

I,ooo . . . . . . . . . . . . . . . . . . . . 24.8

2,000 . . . . . . . . . . . . . . . . . . . . 17.8

5,000 . . . . . . . . . . . . . . . . . . . . 11.8

Io,ooo . . . . . . . . . . . . . . . . . . . 9.0

20,000 . . . . . . . . . . . . . . . . . . . 7.2

50,000 . . . . . . . . . . . . . . . . . . . 5.8

Ioo,ooo . . . . . . . . . . . . . . . . . . 5.3

200,000 . . . . . . . . . . . . . . . . . . 5.0

500,000 . . . . . . . . . . . . . . . . . . 4.8

1,000,000 . . . . . . . . . . . . . . . . . 4.7

NOTES: The amallaatrdii easmatafu Viaitato

S9WS!@WJe@akies is 676,1XQvisits.Eatimataabekw this

~rwhavearelst.ive atandsrdenwgreatar han30peicmt

&md- daemd UlMBhbk3 by NCHS atsndarda.

E%amplSOfw Of@k Awlw9@e~efwmilrm

visitahaea reletivaetandani&Teref5.8pwc@era

ewniard errorof 2,W3,0LII W (5.8 pwwnt of 50 millii).

result is then expressed as a percent of

the estimate.

Relative standard errors (RSE’S) for

estimated numbers of office visits in

1992 are shown in table I, relative

standard errors for estimated numbers of

drug mentions are presented in table II.

Standard errors for estimated percents of

visits and drug mentions are displayed

in tables III and IV

Table IL Approximate relative standa~

errors for estimated numbers of drug mew

tkmw NatSonaIAmbulatory Medical Cars

survey, 1082

Rdafiw

Estimatednumber of

drugmtuMkmsin thwsands wror inpemnt

100 . . . . . . . . . . . . . . . . . . . . 84.6

200 . . . . . . . . . . . . . . . . . . . . . 67.1

500 . . . . . . . . . . . . . . . . . . . . . 42.7

1,000 . . . . . . . . . . . . . . . . . . . . 30.5

1,038 . . . . . . . . . . . . . . . . . . . . 30.0

2,000 . . . . . . . . . . . . . . . . . . . . 22.1

5,000 . . . . . . . . . . . . . . . . . . . . 14.8

10, 000 . . . . . . . . . . . . . . . . . . . 11.4

20,000 . . . . . . . . . . . . . . . . . . . 9.3

50,0ao . . . . . . . . . . . . . . . . . . . 7.7

100,000 . . . . . . . . . . . . . . . . . . 7.1

200,000 . . . . . . . . . . . . . . . . . . 6.7

Wo,ooo. . . . . . . . . . . . . . . . . . 6.5

1,000,000 . . . . . . . . . . . . . . . . . 6.5

NOTES The maliset reliabia@hats of dwE= for

e!xlr- aPac@kk l,cBs,mm@bna.

babwtMafQwe havearaietiw sMdadamxgrealar then

30 parmnt al fue deemedumeliableby NCHSahdarda.

EwWIS of useoftabk AI aggregatea-mate ef 50 mi[ri

rkugnwlwna haaars!ative standanianorc47.7pw3ntor

a stsrdsrdarrcf of3,850,008 mdons (7.7 pxcsnt ofE4

milh).
18 Advance Data No. 253 ● August 10,1994

Table Ill. Approximate standard errors of percents of estimated numbers of office visitw

National Ambulatory Medical Care Survew 1992

Estimated percent

Base of percent

(visits in thousands) 1 or 99 5 or 95 10 or 90 20 or 80 30 or 70 40 or 60 50

Standard error in percentage points

100. . . . . . . . . . . . . . . . 7.7 16.8 23.1 30.8 35.3 37.7 36.5

200 . . . . . . . . . . . . . . . . 5.4 11.9 16.3 21.8 25.0 28.7 27.2

500 . . . . . . . . . . . . . . . . 3.4 7.5 10.3 13.6 15.8 16.9 17.2

1,000 . . . . . . . . . . . . . . . 2.4 5.3 7.3 9.7 11.2 11.9 12.2

2,000 . . . . . . . . . . . . . . . 1.7 3.8 5.2 6.9 7.9 8.4 8.6

5,000 . . . . . . . . . . . . . . . 1.1 2.4 3.3 4.4 5.0 5.3 5.5

10,000 . . . . . . . . . . . . . . 0.6 1.7 2.3 3.1 3.5 3.8 3.9

20,000 . . . . . . . . . . . . . . 0.5 1.2 1.6 2.2 2.5 2.7 2.7

50,000 . . . . . . . . . . . . . . 0.4 0.8 1.0 1.4 1.6 1.7 1.7

100,000 . . . . . . . . . . . . . 0.2 0.5 0.7 1.0 1.1 1.2 1.2

200,000 . . . . . . . . . . . . . 0.2 0.4 0.5 0.7 0.8 0.8 0.9

500,000 . . . . . . . . . . . . . 0.1 0.2 0.3 0.4 0.5 0.5 0.6

1,000,000 . . . . . . . . . . . . 0.1 0.2 0.2 0.3 0.4 0.4 0.4

NOTEExampleof usecftableAneaOmafe of30percentbased onanaggregsteastimate oflOmillionvisita hasaatandard

ermrof3.5percent orarelativestandsrd errorofll.7percent (3.5 percantdividad ty30parcent).

Table lV.Approximate standard errora of percents ofestimated numbers ofdrug mention~Natfonal Arnbulato~ MedicalCareSurvey 1992

Estimated percent

Base of percent

(drug mentions in thousands) lor99 5or95 100r90 200r60 300r70 400r60 50

100 . . . . . . . . . . . . . . . . . . . . .

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

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

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

2,0+)0. . . . . . . . . . . . . . . . . . .

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

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

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

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

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

200,000 . . . . . . . . . . . . . . . . . .

500,000 . . . . . . . . . . . . . . . . . .

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

Standard error in percentage points

9.4 20.6 28.3 37.8 48.3

8.6 14.6 20.0 26.7 30.6

4.2 9.2 12.7 16.9 19.4

3.0 6.5 9.0 11.9 13.7

2.1 4.6 6.3 8.5 9.7

1.3 2.9 4.0 5.3 6.1

0.9 2.1 2.8 3.8 4.3

0.7 1.5 2.0 2.7 3.1

0.4 0.9 1.3 1.7 1.9

0.3 0.7 0.9 1.2 1.4

0.2 0.5 0.6 0.9 1.0

0.1 0.3 0.4 0.5 0.6

0.1 0.2 0.3 0.4 0.4

46.3 47.2

32.7 33.4

20.7 21.1

14.6 14.9

10.3 10.6

6.5 6.7

4.8 4.7

3.3 3.3

2.1 2.1

1.5 1.5

1.0 1.1

0.7 0.7

0.5 0.5

NOTEExampleof useoftablwAn aatimate c#30percentbasad onanaggregateestimate ofloomiliiondmg mantioneheaa

standard error of 1.4 percent or a relative atsndard error of 4.7 p%rcant (1.4 percent dwided by 30 percent).

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 V.

RSE(X)={A~Z .100

x

Similarly, relative 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 V.

RSE(p)={B~) .1OO

p.x

Estimates and percents relating to

ambulatory surgical procedures have

been presented in tables in this report

with specific standard errors calculated

using SUDAAN software (10), rather

than using the generalized variance

curves that approximate relative

standard errors for most NAMCS

estimates. The decision to provide

specific standard errors for these

estimates and percents was made

following a statistical analysis of the

data that resulted from the ambulatory

surgery survey item. The analysis

suggested that a generalized variance

curve would be of limited utility, given

the nature of the data in question.

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 simi]ar

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 repo~ 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 two estimates does not

mean that the dMerence 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. Ratea 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 persomd

health services who is not currently

admitted to any health care institution

on the premises.

Drug mention-A drug mention is

the physician’s entry on the Patient

Record form 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
Advance Data No. 253. August 10,1994 19

Table V. Coefficients appropriate for determining relative standard errore by type of estimate and physician specialty National Ambulatory Medical Care Survey, 1992 Symbols

Cc#ia”ent iv use with eti”mates in tfrorrssnds --

- Data not available

Type of estimate and

physician specialty A B

. . . Category not applicable

...

visits

— Gtuantity zero

Overall total . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Generdandfamily practice . . . . . . . . . . . . . . . . . .

Osteopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . .

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Genaralsurgery . . . . . . . . . . . . . . . . . . . . . . . . .

Obstetriosandgynecology . . . . . . . . . . . . . . . . . . .

Orthopedicsurgery . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovasculsrdiseases . . . . . . . . . . . . . . . . . . . .

Dermatology.. . . . . . . . . . . . . . . . . . . . . . . . . . .

Urologioalsurgery . . . . . . . . . . . . . . . . . . . . . . . .

Psychiaby . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . .

Otolaryngology . . . . . . . . . . . . . . . . . . . . . . . . . .

Atlotherspacialties . . . . . . . . . . . . . . . . . . . . . . .

Drug mentions

Overelltotal . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Generalandfamilyprsotice . . . . . . . . . . . . . . . . . .

Osteopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Internalmedicine . . . . . . . . . . . . . . . . . . . . . . . . .

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Generelsurgery . . . . . . . . . . . . . . . . . . . . . . . . .

Obstetricsandgynacology . . . . . . . . . . . . . . . . . . .

Orthopedicsurgery . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovasculardiseasaa . . . . . . . . . . . . . . . . . . . .

Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urologicalsurgery . . . . . . . . . . . . . . . . . . . . . . . .

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . .

Otolaryngdogy . . . . . . . . . . . . . . . . . . . . . . . . . .

Allotherspeciaiti e s........ . . . . . . . . . . . . . . .

0.002166736

0.0152s225

0.02187347

0.01430119

0.01242304

o.ot131364

0.01261294

0.01290139

0.023260s4

0.02754591

0.01745979

0.01061403

0.01 4823S5

0.01669678

0.01 636s67

0.0133434

0.004106571

0.01823822

0.02749416

0.0226460s

0.01 99ss7

0.04S1803S

0.02031 4s

0.02740476

0.0267566S

o.02wla9

0.0s60s20s

0.01646031

0.0303s956

0.04966664

0.01 6ss09

0.02639553

59.31728791

67.30S24004

15.93954664

52.12533278

37.46754366

5.s354s403

28.04967362

24.41126789

12.05944272

12.69369556

9.33525S52

10.77s86407

3.63971125

22.9295663

7.22438527

31.25167177

89.17495556

1229599

21.87363466

90.21S63157

39.77076275

5.6s7035s4

41.1 3S9S323

24.31222595

25.74429136

18.627876S4

5.36142671

14.04494475

4.7s471786

23.0S86926S

10.94330617

47.16170733

specifkallyinstructed duringthevisit to

continue the medication. Physicians may

report up to five medications per visit.

Drugvisit-Adrug visitisavisitin

which medication waspreseribed or

provided by thephysician.

Ojice-An oifke is the space

identified bya physician asa location

for his or her ambulatory practice.

Offieeseustomarily include consr.dtation,

examination, or treatment spaces that

patients associate with theparticular

physician.

Physician—A physician is a duly

licensed doctor of medicine (MD) or

doctor ofosteopathy (DO) whois

currently inoftice-based practice and

who spends some time caring for

ambulatory patients. Excluded from the

NAMCS arephysicians who arehospital

basec$ who specialize in anesthesiology,

pathology, or radiology; who are

federally employex who treat only

institutionalized patientq or who are

employed full time by an institution and

spend no time seeing ambulatory

patients.

Viit—A visit is a direct personal

exchange between an ambulatory patient

and aphysiciq orastafE member

working under the physician’s

supervision, forthepqoseof seeking

care and rendering personal health

services. Excluded horn the NAMCS

are visits where medical care was not

provided, such as visits made to drop off

specimens, pay bills, make

appointments, and walk-outs.

0.0 Quant.~more than zero but less

than 0.05

z Quant-Ry more than zero but less

than 500 where numbers are

rounded to thousands

* Figure does not meet standard of

reliabilii or precision
20 Advance Data No. 253 ● August 10,1994

Suggested citation

Schappert SM. National Ambulatory Medical

Care Survey 1992 summary. Advance data

from vital and health etatiatic~ no 253.

Hyattaville, Maryland: National Center for

Health Statistics. 1994.

Trade name disclaimer

l%e use of trade names is for identification

only and does not imply endorsement by the

Public Health Service, U.S. Department of

Health and Human Services.

Copyright information

All materiel appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Canter for Health Statistics

Director

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

Deputy Director

Jack R. Anderson

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control end Prevention

National Center for Health Statistics m

6525 Belcrest Road

Hyattaville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

To receive this publication regularly, contact

the National Center for Health Statistics by

calling 301-436-8500

DHHS Publication No. (PHS) 94-1250

4-1640 (8/94)
Number 254 ● August 3, 1994

Advance

Data

FromVi and HealthStatiti”esof the CENTERS FOR DISEASE CONTROL AND Prevention/National Centerfor Health Statistics

Health Insurance and Cancer Screening Among Women

by Diane M. Makuc, Dr.P.H. and Virginia M. Freid, M.S., Division of Health and Utilization Analysis;

P. Ellen Parsons, Ph. D., M. P.H., Division of Health Interview Statistics

Introduction

Health insurance coverage is an

important factor associated with use of

preventive health care services.

Uninsured persons use less preventive

health care than do those with insurance,

and among persons with insurance, use

of preventive care varies with the type

of coverage. The Rand Health Insurance

Experiment @IE), in which persons

were randomly assigned to insurance

plans, showed that those enrolled in

Health Maintenance Organizations

(HMOs) received more preventive

health care than did those with fee-forservice coverage, and that use of

preventive care was inversely related to

the level of out-of-pocket spending (l).

Results from the HIE also showed that

poor women with free fee-for-serviee

coverage were more likely to receive

Pap tests than those with cost-sharing

plans (2). In contrast, among nonpoor

women, there was no difference in Pap

test usage between women with free and

cost-sharing plans (2). An analysis of

data from the 1987 National Health

Interview Survey (NHIS) found that

cancer screening rates were greater for

women who reported an HMO as their

usual source of care than for those who

reported some other place as their usual

source of care (3).

The puqmse of this report is to

provide national data on the relationship

between type of health insurance

coverage and recent use of

mammography, clinical breast

examinations (CBES), and Pap tests by

women 40 years of age and over.

Objectives are to compare use of

screening between women enrolled in

HMOS and fee-for-service plans;

between women with private coverage,

public coverage, and the uninsure~ and

between women with different types of

health insurance coverage after

controlling for educational attainment.

The data presented in this report

extend previous studies by providing

recent national data on the use of

preventive care by women enrolled in a

broad range of HMOS compared with

many studies that are based on one or

two specilic HMOS. In addition, the

NHIS is sufficiently large to allow

results to be presented for subgroups of

women based on age and socioeconomic

status. Of particular interest is whether

the effect of HMO enrollment on use of

preventive measures difEersby

socioeconomic status. The 1992 NHIS

also provided more detailed information

concerning HMO enrollment than did

earlier years of the survey.

During the 1980’s there were

substantial changes in health insurance

coverage as well as use of preventive

health care in the United States.

Between 1980 and 1992 the ageadjusted percent of the U.S. population

under 65 years of age who were

uninsured increased from 12.5 to

17.2 percent (4). Over this period,

enrollment in HMOS rose from 4 to

14 percent of persons in the United

States (4). HMOS have become

increasingly complex in structure with

group, network independent practice

associations (IPAs), and preferred

provider organizations (’PPOS)making

up a rising proportion of the market (5).

HMO enrollment by Medicare and

Medicaid beneficiaries has increased in

recent years. In 1992, 6 percent of HMO

enrollees were Medicare beneficiaries

and another 5 percent were enrolled

through Medicaid (4).

The effectiveness of Pap tests in

reducing cervical cancer mortality for

women of all ages has been clearly

demonstrated (6), as has the

effectiveness of mammography

screening in reducing breast cancer

mortality for women over 50 years of

age (7-9). However, cancer screening

guidelines differ across organkations,

primarily for women 40-49 years of age

(see Technical notes for background

information on breast and cervical

cancer).

#*sE’v’Q’”~+ $

$

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

~

;

Public Health Service

Centers for Disease Control and Prevention ‘5%.

>%<+a= National Center for Health Statistics cm’llms

cm

FoRusEAsE~

mmPRmmllm
2 Advance Data No. 254 ● August 3, 1994

Healthy People 2000, a national

prevention initiative, has set 300

objectives for the Nation for the year

2000, including objectives for breast and

cervical cancer screening (10). Between

1987 and 1992 substantial progress was

made toward the Healthy People 2000

objectives for breast cancer screening

(11). The percent of women 50 years of

age and over who had both a CBE and

a mammogram within the preceding 1 to

2 years doubled, from 25 to 51 percent.

The percent of women 18 years and

over with a Pap test within the

preceding 3 years remained fairly stable

over this period, about 75 percent. Use

of mammography and other screening

services has been shown to be inversely

associated with income and educational

attainment (12,13).

Methods

This report uses data from the 1992

National Health Interview Survey, a

continuing household survey of the

civilian noninstitutionalized population

conducted by the National Center for

Health Statistics (NCHS) (14) (see

Technical notes). The NHIS

questionnaire consists of two major

sections—the basic health and

sociodemographic section, which

remains constant from year to year, and

a special topics section, which changes

each year. The 1992 NHIS included a

special topics section on Cancer

Epidemiology and Cancer Control, a

collaborative effort of NCHS and the

National Cancer Institute. The Cancer

Control section of the questionnaire was

administered to one-quarter of the NHIS

sample households (15). Questions on

cancer screening included length of time

since the last Pap test, mammogram,

and CBE.

In 1992 information on health

insurance coverage was collected from a

household respondent concerning plans

held at the time of the interview for all

household members. The health

insurance questionnaire was

administered in all of the NHIS sample

households (16). Information from the

health insurance questions include the

following data on any public coverage

and up to four private health insurance

plans: the type of health care coverage

(Medicare, Medicaid, military/

CHAMPUS/CHAMP-V& other public

assistance, or private insurance); the

plan name of each private insurance

plan and whether each private insurance

plan was an HMO; and the coverage

status for each individual in the

household. During data processing, the

plan names were matched to a preceded

list of plans that provided information

on whether a particular plan was an

HMO. Thus, information on whether a

particular plan was an HMO was

available from a preceded list of plan

names as well as from the respondent.

In this analysis, individuals were

classified as having HMO coverage if

both sources of information agreed that

the plan was an HMO. This approach

resulted in an estimate of 16 percent of

the civilian noninstitutionrdized U.S.

population having HMO coverage in

1992, a level similar to the 14 percent of

the U.S. population estimated by

InterStudy’s annual national census of

HMOS (4). Of all HMO enrollees

identified in the 1992 NHIS, only

1 percent were Medicaid beneficiaries

and 7 percent were Medicare

beneficiaries. The 1992 NHIS included a

question about HMO enrollment only

for respondents reporting private

insurance coverage. Thus, it is not

surprising that the percent of HMO

enrollees who were Medicaid

beneficiaries was lower in the 1992

NHIS than the 5 percent reported by

InterStudy (4).

In this report women were classified

into the following health insurance

categories: private coverage, specific

types of public coverage, and uninsured.

Women with private coverage were

subdivided into two groups-those with

HMO coverage and those with fee-forservice coverage. The HMO category

includes all women who reported HMO

coverage, regardless of other coverage

reported. Among women with public

coverage, the Medicaid category

includes all women who reported

Medicaid and did not report HMO

coverage, regardless of other coverage

reported. Uninsured individuals were

defined as those who did not report

private insurance, Medicare, Medicaid,

military/CHAMPUS/CHAMP-V’ or

public assistance coverage. Screening

results for women under 65 years of age

who reported only Medicare, military, or

public assistance coverage are not

shown because of small numbers.

Screening results for uninsured women

65 years of age and over who were

uninsured or who reported military or

public assistance coverage are not

shown due to small numbers.

The relationship between health

insurance coverage and use of screening

was examined for women in subgroups

based on age (40-49, 50-64, rmd 65

years and over) and educational

attainment (12 years or less and more

than 12 years) because both

characteristics are among those

associated with use of screening and

type of health insurance coverage.

Results are reported separately for

women aged 40-49 and 50-64 years

because screening recommendations

differ for these two groups. Results for

women 65 years and over are reported

separately because almost all women in

this age group have Medicare coverage

and also because screening levels are

substantially lower for older women.

Screening in the past 12 months, rather

than a longer interval, was used for the

analysis because health insurance

coverage can change over time.

However, because annual mammography

is not generally recommended for

women aged 40-49 years (see Technical

notes) the mammography results should

be interpreted with caution. Women with

hysterectomies have been included in

analyses of Pap testing because the Pap

test may be used in the detection of

vaginal cancer as well as cervical cancer

(17).

Percents and standard errors were

calculated using SUDAAN, a statistical

program for survey data analysis that

incorporates the NHIS sample weights

and complex survey design into its

estimates (18). Contingency table

analysis was carried out using

SUDAAN and weighted least squares

linear modeling to test hypotheses

regarding associations between health

insurance, educational attainment, and

use of screening (18,19). Differences

discussed in the text were statistically

significant at the 0.05 level.

Of the 3,863 women aged 40 years

and over who were asked about
Advance Data No. 254 ● August 3, 1994 3

screening in the 1992 NHIS, data on

time since the last mammogram, CBE,

or Pap test were missing for 4 to

5 percent of women; private health

insurance coverage was missing for

2 percent and educational attainment

was missing for less than 1 percent.

Persons with missing data have been

excluded from analyses involving the

missing variable.

Results

Health insurance coverage

(tabie 1)

In 1992,80percent of women

40-64 years of age had private

insurance, including 19 percent who

were enrolled in an HMO. Among

women aged 40-64 years, about

12 percent were uninsured, 5 percent had

Medicaid coverage, and the remaining

3 percent had military/CHAMPUS,

Medicare, or public assistance coverage.

Health insurance coverage for women

aged 40-64 years varied substantially

with educational attainment. Women

with 12 years of education or less were

nearly three times as likely to be

uninsured, almost five times as likely to

have Medicaid coverage, and one-third

less likely to be enrolled in HMOS as

women with more education.

In 1992 almost all women aged

65 yeara and over in the noninstitutionalized population had

Medicare coverage, and 75 percent also

had private coverage, including

11 percent who were enrolled in an

HMO. Women aged 65 years and over

with 12 years of education or less were

about one-third less likely to be enrolled

in an HMO, 77 percent more likely to

have only Medicare coverage, and

almost six times as likely to have

Medicaid coverage as women with more

education.

Screening for women 50-64 years

(table 2)

In 1992,50percent of women aged

50-64 years reported a mammogmm

within the past year, 53 percent reported

a Pap test, and 61 percent reported CBE.

Health insurance coverage and

educational attainment were strongly

associated with use of each of these

Table 1. Percent diatrlbutlon of health insurance coverage among women 40 yeere and

over, according to age and educational attainment United States, 1992

Educational atfrn”nnrent

0-12 13 years

Age and healih insurance coverage Total years or m

40-64 years

ToteI . . . . . . . . . . . . . . . . . . . . . . . . . .

Private coverage . . . . . . . . . . . . . . . . . .

HMO . . . . . . . . . . . . . . . . . . . . . . . .

Fee-for-service . . . . . . . . . . . . . . . . . .

Madia.d . . . . . . . . . . . . . . . . . . . . . . .

Ocher . . . . . . . . . . . . . . . . . . . . . . . . .

Uninsured . . . . . . . . . . . . . . . . . . . . . .

40-49 years

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

Pnvafemvarage . . . . . . . . . . . . . . . . . .

HMO . . . . . . . . . . . . . . . . . . . . . . . .

Fee-for-service . . . . . . . . . . . . . . . . . .

Medicaid . . . . . . . . . . . . . . . . . . . . . . .

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

Uninsured . . . . . . . . . . . . . . . . . . . . . .

50-64 years

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

Private ooverage . . . . . . . . . . . . . . . . . .

HMO . . . . . . . . . . . . . . . . . . . . . . . .

Fee-for-service . . . . . . . . . . . . . . . . . .

Medicaid . . . . . . . . . . . . . . . . . . . . . . .

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

Uninsured . . . . . . . . . . . . . . . . . . . . . .

65 years and over

Tonal . . . . . . . . . . . . . . . . . . . . . . . . .

Madioare and privafe coverage’. . . . . . . . .

Medioare and HMO’ . . . . . . . . . . . . . .

Medicare and fee-for-service’. . . . . . . . .

Medioareand Medicaid’ . . . . . . . . . . . . .

Medioareonly . . . . . . . . . . . . . . . . . . . .

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

Uninsured . . . . . . . . . . . . . . . . . . . . . .

Peroent distribti.on and afandard error

100.0

80.4 (0.9)

19.0 (1.0)

61.4 (1.2)

5.4 (0.5)

2.5 (0.4)

11.6 (0.7)

100.0

81.1 (1.3)

21.4 (1.5)

5s.7 (1.7)

5.4 (0.6)

1.6 (0.3)

11.9 (1.1)

100.0

79.8 (1.3)

16.7 (1.3)

63.1 (1.7)

5.4 (0.7)

3.4 (0.6)

11.4 (1.2)

100.0

74.6 (1 .3)

10.7 (1.0)

63.9 (1.5)

7.6 (0.7)

16.8(1.1)

0.7 (0.2)

0.2 (0.1)

100.0

73.6 (1.4)

15.9(1 .4)

57.7 (1.6)

7.8 (0.8)

3.1 (0.5)

15.5 (1.1)

100.0

72.7 (2.1)

17.9 (2.1)

54.8 (2.6)

8.6 (1.1)

1.8 (0.5)

17.0 (1.8)

100.0

74.2 (1.8)

14.4 (1.7)

58.9 (2.1)

7.3 (1.0)

4.0 (0.8)

14.5 (1.7)

100.0

71.1 (1.5)

9.8 (1.0)

61.5 (1.7)

9.3 (0.8)

18.6 (1.2)

0.7 (0.3)

0.3 (0.1)

100.0

90.6 (1.1)

23.8 (1.6)

67.0 (1.8)

1.7 (0.5)

1.7 (0.4)

5.8 (0.9)

Iwo

62.8 (1.4)

25.0 (1.9)

84a (2.3)

2.2 (0.6)

1.4 (0.4)

6.6 (1.2)

100.0

82.4 (1.4)

21.9 (2.4)

70.5 (2.7)

1.0 (0.5)

2.1 (0.6)

4.5 (1.1)

100.0

87.4 (2.1)

14.7 (2.9)

72.7 (3.0)

1.6 (0.8)

10.5 (2.0)

0.4 (0.3)

‘Iricludesasmellnumbsr ofpwecmawhodkfnorhaw Mediicwersge. Ofellwunen

have ?.wii Cwerage.

e6yeerssrxt 0w,3pa-carkddmt

NOES -mti~fwtiof~ NHISak M~hti M aueslhe. HMOhchvJessllmnumswhO

rwad HMO w-w, rwdbm of O* -ha rsfmrtad.%sons W hfed~ k dkl notrapt HMO & are

chssh%dse Medicaid.The cstagoiy“oth# includesmilitsryKX-lAMPUS,pd%c sewtenm ,or Medkare (fcfwofnulunrk85

years of age). Uninsuredpersonsara tlwse * didcatrepmt@vste, Medksra, MadMd, nWtsryBH4MPUS,or public

assistancemvsrsge.

procedures for women aged 50-64

years.

The percent of women reporting

each of the three procedures was lowest

for uninsured women and highest for

women enrolled in HMOS. Only

19 percent of uninsured women aged

50-64 years reported recent

mammography, 32 percent reported Pap

testing, and 38 percent reported CBE. In

contrast, 62 percent of women aged

50-64 years enrolled in HMOS reported

recent mammography, 65 percent

reported Pap testing, and 71 percent

reported CBE.

Among women aged 50-64 yeara

with 12 years of education or less,

HMO enrollees reported greater use of

each of these procedures than did

women with fee-for-service coverage.

However, among women with more than

12 years of education, HMO enrollees

and women with fee-for-service

coverage reported similar screening
4 Advance Data No. 254 ● August 3, 1994

levels. For example, among women

aged 50-64 years with 12 years of

education or less, 63 percent of HMO

enrollees and 48 percent of women with

fee-for-semice private coverage reported

recent mammography. However, among

women with more than 12 years of

education, similar levels of screening

were reported (61-64 percent). About

three of five women aged 50-64 years

who were enrolled in HMOS reported

recent use of mammography, regardless

of educational level. In contrast, among

women with fee-for-service coverage,

mammography was more likely to be

reported by those with more than 12

years of education than by women with

less education.

Women 65 years and over

(table 3)

In 1992, overall 36 percent of

women aged 65 years and over reported

a recent Pap test, 39percent reported

recent mammography, and 50 percent

reported a recent CBE. Screening levels

for these three procedures were

11–18 percentage points lower for

women 65 years and over than for

women 50-64 years, despite the higher

risk of disease among older women.

Health insurance coverage and

educational attainment were both

strongly associated with use of each of

the screening procedures. Screening

levels for each of the procedures were

highest (63 percent) for women enrolled

in HMOS who had more than 12 years

of education.

Women aged 65 years and over

with only Medicare coverage were

substantially less likely to report any of

the three screening techniques than

women with Medicare and private

insurance. Reports of recent

mammography were more than twice as

likely for women with private insurance

as for those with only Medicare

coverage (40 percent compared with

19 percent among women with 12 years

of education or less). Use of CBE and

Pap testing was about 50 percent greater

for women with 12 years of education

or less and private insurance than for

those with only Medicare coverage.

Women 65 years and over who

were enrolled in HMOS were more

Table 2. Percent of women 50-64 years who received cancer screening within the past

year, by type of procedure, health insurance coverage, and educational attainment United

States, 1992

Educatiorraf attainment

Type of procedure and Sample 0-12 1s years

health insurance ooverage size Total years or more

Mammogram

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

Private coverage . . . . . . . . . . . . . . . . . .

HMO . . . . . . . . . . . . . . . . . . . . . . . .

Fee-for-service . . . . . . . . . . . . . . . . . .

Mediosid . . . . . . . . . . . . . . . . . . . . . . .

Uninsured . . . . . . . . . . . . . . . . . . . . . .

Clinical breast examination (cBE)

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

Private coverage . . . . . . . . . . . . . . . . . .

HMO . . . . . . . . . . . . . . . . . . . . . . . .

Fee-for-service . . . . . . . . . . . . . . . . . .

Medicaid . . . . . . . . . . . . . . . . . . . . . . .

Uninsured . . . . . . . . . . . . . . . . . . . . . .

Pap test

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

Private coverage . . . . . . . . . . . . . . . . . .

HMO . . . . . . . . . . . . . . . . . . . . . . . .

Fee-for-eewice . . . . . . . . . . . . . . . . . .

Medicaid . . . . . . . . . . . . . . . . . . . . . . .

Uninsured . . . . . . . . . . . . . . . . . . . . . .

Pereent and standard error

1,171

910

190

720

80

130

1,16s

906

188

718

90

132

1,171

909

192

717

92

128

49.6 (1.8)

55.4 (2.0)

62.1 (4.0)

53.6 (2.3)

3S.3 (6.9)

19.3 (4.1)

60.8 (1 .8)

65.2 (2.0)

70.5 (3.7)

63.8 (2.1)

52.0 (7.5)

38.2 (5.9)

53.4 (1.7)

57.9 (1.9)

64.7 (3.5)

56.0 (2.2)

41.0 (7.0)

32.0 (5.9)

44.6 (2.1 )

51.0 (2.5)

62.6 (5.6)

4S.1 (2.6)

38.0 (7.1)

19.2 (4.2)

57.4 (2.2)

62.2 (2.6)

71.6 (5.7)

60.0 (2.7)

52.1 (7.6)

37.7 (6.4)

49.5 (2.1)

54.4 (2.4)

63.8 (5.0)

52.1 (26)

40.1 (7.2)

31.5 (6.2)

601.6(3.1)

63.3 (3.2)

61.0 (6.8)

64..0 (3.6)

*

*

6a.4 (2.6)

70,.7 (2.6)

66.7 (5.5)

71.3 (2.9)

*

*

62.2 (29)

64.2 (3.0)

66.1 (5.6)

63.5 (3.3)

*

*

NOTES 8sssd on the one-fourth of the NHIS samp!e that raoehecl ths cancer Control queehs. HMO includes all persons who

reported HMO coverage, regardless of otisr coverage reported. Persons with Medisaid W did mat repoft HMO oovwags are

clsssiried as Medicaid. Uninsured perwns are those who did not reporl private, Medisare, Mediid, mihsry/CHAMPIUS, or

public assistance mverage.

likely to report recent mammography

and Pap testing than women with

fee-for-service insurance. Use of each of

these two procedures was 13 percentage

points greater for HMO enrollees than

for women with fee-for-service

coverage. However, recent use of a CBE

did not differ for women in HMOS and

those with fee-for-service coverage.

Women 40-49 years

(table 4)

Overall, in 1992, 41 percent of

women age 40-49 years reported a

recent mammogram, 60 percent reported

a Pap test, and 62 percent reported a

CBE. Compared with women 50-64

years of age, women 40-49 years had a

similar level of CBE mammography

was 8 percentage points lowe~ and Pap

testing was 6 percentage points higher.

Health insurance coverage and

educational attainment were both

strongly associated with use of all three

procedures for women 40-49 yems of

age. Only 18 percent of uninsured

women reported recent mammography,

30 percent reported Pap testing, and

37 percent reported CBE. Among

women with private insurance,

45 percent reported mammography,

64 percent reported Pap testing, and

66 percent reported CBE.

Among women with 12 years of

education or less, those with private

coverage were about twice as likely to

report each of the three screening

procedures as uninsured women. Among

women with private health insumnce

coverage, those with more than 1[2years

of education reported levels of each of

the three procedures that were about

10 percentage points higher than for

those with less education.

For women 40-49 years of age,

recent use of mammography, CBE, and

Pap testing did not differ significantly
Advance Data No. 254 ● August 3, 1994 5

between HMO enrollees and those with

fee-for-service coverage.

Discussion

Despite substantial increases in

mammography use, in 1992 only half of

the women aged 50-64 years and

39 percent of women aged 65 years and

over reported a recent mammogram. Use

of screening for breast and cervical

cancer was greater for women with

more education, except among women

aged 50-64 years who were enrolled in

HMOS, providing some evidence that

HMO enrollment may improve access to

preventive services for less educated

middle-aged women. Among women

50-64 years of age with 12 years of

education or less and among older

women of all educational levels, HMO

enrollees reported higher levels of

mammography and Pap testing than did

those with fee-for-service coverage.

Among uninsured women aged

50-64, only 19 percent reported recent

mammography, about one-third the level

of HMO enrollees. Although levels for

all three breast and cervical cancer

screening procedures were extremely

low for uninsured women, the uninsured

were about twice as likely to report a

recent CBE as recent mammography (38

and 19 percen~ respectively, for women

aged 50-64 years). Among women 65

years of age and over a similarly low

level of recent mammography was

reported for those with only Medicare

coverage (19 percent). Mammography

levels may be even more tiected by

insurance coverage than CBE because

mammography usually requires an

additional visi~ whereas CBE may be

earned out as part of a routine physical

examination.

This analysis documents variability

in use of preventive services among

women with dMerent types of health

insurance coverage. However, it is

important to remember there may be

wide ranges of coverage within the

defined health insurance categories. For

example, the HMO category contains a

variety of model types (see Technical

notes), and the fee-for-service category

may be a mix of adequately insured and

underinsured persons. Further, the

proportion of women who are

Table 3. Percent of women 65 years and over who received eanear screening within the

past year, by type of procedure, health insuranoe coverage, and educational sttelnment

United States, 1992

Educaticnrsl aftairrmrrt

TW of procedure and Sample 0-12 13 years

health insurance coverage ske TW years or mom

Percentand standarderror

Mammogram

TotaL . . . . . . . . . . . . . . . . . . . . . . . . .

Madieare and private coverage’. . . . . . . . .

Medioaraand HMO’ . . . . . . . . . . . . . .

Medioara and fee-for-senke’. . . . . . . . .

Medioare and Madiw”d’ . . . . . . . . . . . . .

Medicare only . . . . . . . . . . . . . . . . . . . .

Clinical breast examination (CBE)

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

Medicareand private wveraga’. . . . . . . . .

Medioareand HMO’ . . . . . . . . . . . . . .

Medicare and fee-for-swvioa’. . . . . . . . .

Medioare and Medicaid’ . . . . . . . . . . . . .

Medicare only . . . . . . . . . . . . . . . . . . . .

Pap test

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

Mediire and private eoverege’. . . . . . . . .

Madicare and HMO’ . . . . . . . . . . . . . .

Madioara and fea-for-sewica’. . . . . . . . .

Madieare and Madieaid’ . . . . . . . . . . . . .

Medioare only . . . . . . . . . . . . . . . . . . . .

1,360

966

128

859

137

222

1,352

881

122

652

139

219

1,356

865

130

655

137

221

36.5 (1.6)

43.9 (1.9)

55.4 (5.2)

42.0 (2.0)

24.7 (4.2)

19.0 (3.2)

49.9 (1.5)

54.7 (1.8)

55.3 (5.7)

54.7 (1.9)

35.1 (4.5)

34.2 (3.9)

35.5 (1.5)

36.8 (1.8)

49.8 (4.9)

37.0 (1.9)

28.5 (4.8)

22.4 (3.4)

34.6 (1.8)

38.7 (2.2)

52.1 (6.2)

37.8 (2.2)

22.7 (4.1)

19.0 (3.4)

47.5 (1.7)

52.3 (2.1)

51.7 (6.7)

52.4 (2.2)

33.5 (4.5)

34.8 (4.2)

33.4 (1.6)

36.3 (20)

44.2 (5.7)

35.1 (2.1)

27.1 (4.7)

23.5 (3.9)

52.4 (3.3)

%.0(3.5)

63.2 (8.5)

54.5 (3.9)

*

*

56.6 (3.3)

61.9 (3.2)

83.4 (7.9)

61.5 (3.5)

*

*

42.9 (3.6)

46.0 (3.8)

62.6 (8.7)

42.6 (4.3)

*

*

‘Includesasmeli numbarofpreonswhodd nothave Madkamcwersgs. Of all

hava Madii cweraga.

Wmm8Syaar8 arMovw,3-didnot

underinsured may be higher among

women with 12 or fewer years of

education than among more educated

women. A 1992 study by the National

Opinion Research Center (NORC)

highlighted the increasing problem of

underinsured persons who are at high

financial risk due to severely limited

insurance coverage, or high deductibles

and copayments. In the NORC study,

19 percent of all persons reported

dMiculty in paying medical bills in the

past year, and 75 percent of persons who

reported difficulties had herdth insurance

(20).

The cost of preventive care is

generally covered in HMOS. However,

some fee-for-service health insurance

plans may exclude coverage for

preventive health services. Recent

legislation has sought to improve health

care coverage for cancer screening as

well as increase the use and quality of

screening. The Omnibus Budget

Resolution Act of 1990 (?PL101-508)

established Medicare coverage for

biennial mammography screening,

effective January 1, 1991. By 1992, 42

states had adopted legislation requiring

third-party payora to offer some form of

coverage for mammography in their

health insurance plans (21). However,

the extent of the coverage that was

legislated varies significantly among

States (22). The Breast and Cervical

Cancer Mortality Prevention Act (PL

101-135) of 1990 established model

breast and cervical cancer control

programs at the State level. The

programs are administered by the

Centers for Disease Control and

Prevention and target low-income,

elderly, and minority women (23). The

Mammography Quality Standards Act of
6 Advance Data No. 254 ● August 3, 1994

Table 4. Percent of women 40-49 years who received cancer screening within the past

year, by type of procedure, haaith insurance coverage, and educations attainment United

States, 1992

Educational attahment

TP of procedure and Sample 0-12 13 yeara

heafth insurance mverage size Total yeara or more

Mammogram

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

Prktecoverage . . . . . . . . . . . . . . . . . .

HMO . . . . . . . . . . . . . . . . . . . . . . . .

Faa-for-service . . . . . . . . . . . . . . . . . .

Madiid . . . . . . . . . . . . . . . . . . . . . .

Uninsured . . . . . . . . . . . . . . . . . . . . . .

Clinical breaatexamination (CBE)

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

Privatecoverage . . . . . . . . . . . . . . . . . .

HMO . . . . . . . . . . . . . . . . . . . . . . .

Fee-for-service . . . . . . . . . . . . . . . . . .

Medicaid . . . . . . . . . . . . . . . . . . . . . .

Uninsured . . . . . . . . . . . . . . . . . . . . . .

Pap teat

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

Priiatacoverage . . . . . . . . . . . . . . . . . .

HMO . . . . . . . . . . . . . . . . . . . . . . .

Fee-for-service . . . . . . . . . . . . . . . . . .

Medicaid . . . . . . . . . . . . . . . . . . . . . . .

Uninsured . . . . . . . . . . . . . . . . . . . . . .

f,llo

661

236

615

66

147

1,101

645

234

611

86

146

1,103

661

235

616

63

145

Percent and standard error

41.2 (1.8)

44.9(2.1)

50.1 (3.9)

43.0 (2.3)

34.2 (5.5)

17.9 (3.3)

61.6 (1.9)

66.1 (1.9)

67.2 (3.9)

65.7 (2.2)

52.8 (7.6)

36.6 (4.4)

59.5(1.6)

63.8(1.9)

62.7 (3.9)

64.1 (2.1)

57.4 (6.9)

30.0 (4.3)

34.5(2.4)

36.2(3.0)

42.9(6.1)

36.6 (3.4)

27.4(5.5)

19.8(4.1)

55.6 (2.5)

60.9 (2.8)

64.3 (6.0)

59.7 (3.4)

55.5 (8.2)

34.0 (5.0)

50.5 (2.5)

56.0 (3.0)

52.6 (5.7)

57.0 (3.5)

64.4 (8.0)

24.6 (4.7)

46.2 (2.6)

50.4(2.7)

55.6(4.7)

46.5(3.1)

*

*

67.6 (2.5)

70.3 (2.6)

69.4(4.8)

70.7(2.7)

*

*

66.8 (2.5)

70.2 (2.6)

70.2 (4.5)

70.2 (2.7’)

*

*

NOTESBasedon thaone-fourlh of the NHISsemplethatraceived theCsncarControl questior!s. HMOlncludas allparsonswho

re~rkdHMOmveraga, ragsrdlessofothr coveragerepci’hd Pemonsw”~Medicsid wlwdidnotreport HMOcoverageara

clssshkdasMsdicaid .Uninsursdwrsons erethosewhodid notrsooftmivate, Medissre,Msdicaid, milii/CHAMPUS, or

Publiiessktancacoversge.

1992 requires establishment of Federal

inspection of mammography facilities

and standards for equipment, personnel,

and practices.

The greater use of preventive care

among women aged 50years andover

with HMO coverage compared with

fee-for-service coverage is consistent

with other reports (1,24-26) .There are

several possible mechanisms for the

greater use of preventive care among

HMO enrollees than amongwomenwith

fee-for-service coverage. Luft postulated

that the greater use of preventive care

by HMO enrollees was the result of

lower out-of-pocket payments in HMOS

(25). Physicians may be more likely to

recommend mammography for women

with HMO coverage than fee-for-service

coverage. Women enrolled in HMOS

maybe more likely to follow their

physicians’ recommendations for

mammography because of lower

out-of-pocket costs and greater ease in

obtaining mammography. A greater

emphasis on preventive medicine in

HMOs may also partially explain the

higher levels of mammography in

HMos.

In addition to insurance coverage,

several other factors have been

identified as correlates of cancer

screening. Numerous studies have

documented that lack of a physician’s

referral and lack of knowledge about the

need for screening are key deterrents to

obtaining screening (12,27,28).

Screening utilization has been found to

be greater for patients of obstetricians

and gynecologists than of family

practitioners or internists (29) and for

patients of female physicians, especially

if the physician is an internist or family

practitioner (30).

In summary, data from the 1992

NHIS show that having some type of

health insurance coverage was strongly

associated with use of recent preventive

services for women, and that, for

women 50 yerus and over, HMO

enrollees were more likely to receive

recent preventive care than those with

fee-for-service coverage. Continued

efforts are clearly needed to attain the

goal of regularly scheduled periodic

screening for all women.

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Gcorgkx American Cancer Society.

1993.

32. Feuer EJ, Wun LM. How much of

the recent use in breast cancer

incidence can be explained by

increases in mammography

utilization? A dynamic population

model approach. Am J Epid

136(12> 14&36. 1992.

33. Miller B& Ries LAG, Hankey BF, et

al, eds. SEER Cancer Statistics

Review, 1973-1990. National Cancer

Institute. Bethesda, Maryland:

National Institutes of Health. 1993.

34. Mettlin C. Breast cancer risk factors.

Cancer 69:1904-10.1992.

35. American Cancer Society. Guidelines

for preventive screening. Affanta,

Georgi* &nerican cancer Society.

1994.

36. Woolf SH. United States preventive

services task force recommendations

on breast cancer screening. Cancer

69:1913-18.1992.

37. National Cancer Institute. cancer

facts Breast cancer screening,

December 12, 1992. National Cancer

Institute. Bethesd& Maryland

National Institutes of Health. 1993.
8 Advance Data No. 254 ● August 3, 1994

Technical notes

Source of data

Data in this report are based on the

1992 National Health Interview Survey

(NHIS), a continuing national household

survey of the civilian noninstitutionalized population (14). Data are

obtained on the personal, sociodemographic, and health characteristics

of the family members and unrelated

individuals living in these households.

The 1992 NHIS included a special

topics section on Cancer Epidemiology

and Cancer Control, a collaborative

effort of the National Center for Health

Statistics (NCHS) and the National

Cancer Institute (NCI).

The NHIS is a multistage

probability sample design that permits a

continuous sampling of the civilian

noninstitutionalized population residing

in the United States. Since 1985, the

survey has been designed to yield a

sample of about 49,000 households and

127,000 persons. Excluded from the

sample are persons residing in nursing

homes or other institutionalized settings,

members of the Armed Forces, and U.S.

nationals living abroad. The Cancer

Control section of the questionnaire was

administered to one-fourth of the NHIS

sample households. Field operations,

including the in-person household

interviews, were conducted by the U.S.

Bureau of the Census. Data were

transmitted to NCHS for preparation,

processing, and analysis.

Questions on cancer screening

In 1992 respondents aged 40 years

or older were informed that “a

mammogram is an x ray taken only of

the breasts by a machine that presses the

breast against a plate.” They were then

asked, “Have you ever heard of a

mammogram?” and “When did you

have your most recent mammogram?”

Clinical breast examinations (CBE) data

were collected by informing the

respondent “A breast physical exam is

when the breast is felt for lumps by a

doctor or medical assistant.” and “When

did you have your most recent breast

physical exam?” Pap smear information

was obtained by asking, “When did you

have your most recent Pap smear

test?” (14).

Terms relating to insurance

status

For the purposes of this report, a

woman was considered to have Health

Maintenance Organization (HMO)

coverage if the respondent provided the

name of the HMO plan to the

interviewer, the plan name was included

on an NCHS-derived list of HMOS, and

if a positive report was provided to the

interview question, “Is this (plan name)

plan a Health Maintenance Organization

or HMO?” If necessary, the respondent

could be informed that “Health

Maintenance Organizations or HMOS,

sometimes called Individual Practice

Associations or IPAs, are plans whose

members are required to use only those

health care providers who work for the

HMO or the IPA. Also, members do not

have to submit claims for costs of

medical care services.” The NCHS list

of HMOS was compiled from

information provided by the Oroup

Health Association of Ameri~

InterStudy, the Federal listing of

“qualified” HMOS, Blue Cross/Blue

Shield, Best, and other sources.

Definitions of the HMO model

types that were included in the HMO

analytic category are as follows:

Staj%4n HMO that delivers health

services through a physician group that

is controlled by the HMO unit.

Group-An HMO that contracts

with one independent group practice to

provide health services.

Individual Practice Association

(IPA)—An HMO that contracts directly

with physicians in independent practices,

and/or contracts with one or more

associations of physicians in an

independent practice, and/or contracts

with one or more muhispecialty group

practices (but the plan is predominantly

organized around solo or single

practices).

Network-An HMO that contracts

with two or more independent group

practices, possibly including a stafl

group, to provide health services.

Although a network may contain a few

solo practices, it is predominantly

organized around groups.

Mixed-Any HMO combining a

group, staff, or network model and an

IPA model. The HMO includes both

group and solo practices.

Preferred Provider Organization

(PPO)—an HMO that contracts with

networks or panels of providers.

Enrollees experience a financial penalty

if they choose to get care from a

nonafEliated provider, but the olptionis

available.

Fee-for-service coverage was

defined as private coverage other than

that in one of the six types of HMOS.

Background information on

breast cancer

Breast cancer is the most common

site of a new cancer among women and

the second to lung cancer as a leading

cause of cancer deaths among women

(31). In 1993 approximately 182,000

new cases of invasive breast cancer

were diagnosed and 46,000 deaths from

breast cancer were expected. Breast

cancer incidence increased during the

early to mid-1980’s, partially due to

increases in early detection through use

of mammography screening (32,33). The

age-adjusted death rate for breast cancer

in 1991 was the same as in 1980 (4). In

1983-90 the 5-year relative survival rate

for breast cancer was 80 percent, up

from 76 percent in 1980-82 (4).

Risk factors for breast cancer

include advancing age, family history of

breast cancer in a first-degree relative,

high socioeconomic status, Caucasian

race, early menarche, late menopause,

nulliparity, and the absence of breast

feeding (34). The majority of currently

identified risk factors are not easily

amenable to changes in a woman’s

personal health habits. Thus, the main

medical focus for breast cancer

management has been on early detection

through screening and effective

treatment of diagnosed cases.

The American Cancer Society

(ACS) recommends an annual CBE for

women over 40 years of age, a ,yearly

mammogram for women aged 50 years

and over, and a mammogram every 1 to

2 years for women aged 40-49 years

(35). The United States Preventive

Services Task Force (USPSTF)

recommends mammography every 1 to
Advance Data No. 254 ● August 3, 1994 9

2 years from age 50 to 75 unless

pathology is detected. Early screening is

recommended for women at increased

risk of breast cancer (36). In December

1993 the NCI recommended routine

screening every 1 to 2 years, with

mammography and CBE for women 50

yeara of age and over. They also

indicated that “randomized clinical trials

have not shown a statistically significant

reduction in mortality for women under

the age of 50” associated with the use

of routine mammography screening (37).

Background information on

cervical cancer

In 1993 an estimated 13,500 cases

of invasive cervical cancer were

diagnosed and 4,400 deaths were

expected (31). Between 1973 and 1990

the age-adjusted incidence rate and

mortality rate for invasive cervical

cancer declined by about 3 percent per

year. Five-year relative survival rates

have remained stable at 67-69 percent

since the mid-1970’s (33).

Risk factors for cervical cancer

include low socioeconomic status, early

age at first intercourse, multiple sex

partners, cigarette smoking, and certain

sexually transmitted diseases (31,33).

Pap testing guidelines from the ACS

and the NC!Irecommend annual Pap

testing. After a woman has had three or

more consecutive satisfactory normal

annual examinations, the Pap test may

be performed less frequently at the

discretion of the provider (35).
10 Advance Data No. 254 ● August 3, 1994

Symbols

..- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but

less than 0.05

z Quantii more than zero but

less than 500 where numbers

are rounded to thousands

* Figure does not meet standard

of reliability or precision
Number 255 . October 24, 1994

Advance

Data

FromVi and Health Statisticsofthe CENTERS FOR DISEASE CONTROLAND PREVENTION/Naiional Centerfor HealthStatistics

Energy and Macronutrient Intakes of Persons Ages 2

Months and Over in the United States: Third National Health

and Nutrition Examination Survey, Phase 1, 1988-91

by Margaret A. McDowell, M. P.H., R. D., Ronette R. Briefel, Dr.P.H., R.D., Katherine Alaimo, Ann M. Bischof, R. D.,

Clifford R. Caughman, M.S., Margaret D. Carroll, M.S.P.H., Catherine M. Loria, M.S., M.A., and

Clifford L. Johnson, M.S.P.H., Division of Health Examination Statistics

Introduction

Dietary recommendations and

long-term health objectives, including

the Dietary Guidelines for Americans

and the Year 2000 Health Objectives for

the Nation, call for Americans to reduce

intake of total fat, saturated fa~

cholestero~ and sodium, increase intake

of fruits, vegetables, grain products, and

foods rich in calcium; and moderate

intake of sugars, salt, and alcohol (l–3).

Developing nutrition policy, monitoring

progress toward achieving dietary

recommendations, and designing

nutition intervention programs to

achieve health objectives require

information about the diet of Americans.

Information about the population’s

dietary intake is collected in the

National Health and Nutrition

Examination Survey (NHANES), one of

the major national surveys in the

National Nutrition Monitoring and

Related Research Program (4-7).

The National Center for Health

Statistics (WI-IS) Health and Nutrition

Examination Surveys (HANES) are a

major source of periodic information on

the dietary, nutrition~ and health status

of the U.S. population (4-8). HANES

data play a unique role in nutrition

monitoring and epidemiologic research,

combining personal dietary interviews

with standardized health examinations

(7-9). NCHS completed three HANES

surveys between 1971 and 1984 (5,6,8).

The third National Health and Nutrition

Examination Suwey, NHANES Ill, was

conducted by NCHS during 1988-94

(5,10).

The NHANES III dietary

assessment component was designed

with input from experts in the fields of

nutrition, public heal@ biostatistics, and

epidemiology, to meet the survey’s

nutrition monitoring and nutrition

research objectives (9-12). The 24-hour

recall method was selected for use in

NHANES III to estimate detailed

quantitative nutrient intake for the

population and various subgroups and to

study diet-health relationships (7–

9,11,12). Prior to NHANES III, 24-hour

recalls were recorded on hard copy

forms and manually coded by dietary

interviewers. In 1988, NCHS contracted

with the University of Minnesota’s

Nutrition Coordinating Center (NCC) to

develop an automate& interactive

dietary interview and coding system

called the NHANES III Dietary Data

Collection (DDC) system (13-15).

NCHS, the National Heart, Lung and

Blood Institute, and the Food and Drug

Administration funded the development

Acknowledgments

The authorsgratefullyacknowledgethe technicalexpW”se and assistanceof Ms. DianeArroyoin planning,monitoring,and processingdata from

the NHANES Ill dietarycomponent,and Mr. Marco Mm”nfor excellentcomputerprogrammingsupport.The reportwas edited by Gail V. Johnson

and typeset byAnnette F. Facemire of the PublicationsBranch, Dwisionof Data Services.

*W.VJC8S.0

#

-+~ ‘ff

#

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

c

nE Public Health Service

;

%

Centers for Disease Controland Prevention

%

>

%4 National Center for Health Statistics

+aa

cmmssR
2 Advance Data No. 255. October 24, 1994

of the DDC system. The DDC system

features include: a standardized

interview format and automated probes

to obtain detailed information about

foods= including brand names, food

preparation methods, and ingredients

used in food preparation, particularly

ingredients that contribute fat and

sodium.

This report provides data for the

U.S. population’s intake of

macronutrients (the primary contributors

to energy intake, which include total

carbohydrate, total fa~ protein, and

alcohol) based on dietary data collected

in Phase 1 of NHANES III (1988-91).

National reference estimates of total

energy intake, macronutrients

contributing to total energy intake, fatty

acids (saturated fat, monounsaturated

fat and polyunsaturated fat), and

cholesterol are reported for persons 2

months of age and older. Phase 1 data

on selected vitamin, mineral, and fiber

intakes will be reported in a subsequent

Advance Data.

Daily dietary estimates are reported

by age and gender for the total

population and for three race/ethnicity

groups: non-Hispanic whites, nonHispanic blacks, and Mexican

Americans.

Highlights

NHANES HI, Phase 1 (1988-91)

provides comprehensive health and

nutrition data on the U.S. population.

NHANES data are obtained by means of

interview and examination methods. The

dietary assessment component included

a 24-hour dietary recall interview. The

U.S. population’s intake of

macronutrients-the primary

contributors to energy intake (total

carbohydrate, total fat, protein, and

alcohol), fatty acids (saturated fat,

monounsaturated fat, and

polyunsaturated fat), and cholesterol are

reported for persons 2 months of age

and older.

Mean daily intake of energy was

2,095 kilocalories (kcal) for persons 2

months of age and older.

The overall dietary pattern for the

U.S. population ages 2 months and

older was 50 percent of energy from

carbohydrate, 15 percent of energy

●

tlom protein, 34 percent of energy

from fat, and 2 percent of energy

horn alcohol. Fatty acid contributions

to energy were: 12 percent saturated

fat, 12.5 percent monounsaturated fat,

and 7 percent polyunsaturated fat, and

the mean cholesterol intake was 270

milligrams.

Energy intake patiems were similar

among the racefethnicity groups

examined, although there were some

differences by race/ethnicity within

age-gender groups.

Dietary intake findings

NHANES III, Phase 1 mean,

standard error of the mean (SEM), and

median values for energy, total

carbohydrate, protein, and alcohol and

the percent of total energy (measured as

kcal) from carbohydrate, protein, and

alcohol are shown by age, gender, and

race/ethnicity in tables 1-4 and 10-12.

Intakes of total fa~ saturated fat,

monounsaturated fa~ polyunsaturated

fat, and cholesterol and the percent of

total energy from fat and fatty acids are

shown by age, gender, and racelethnicity

in tables 5–9 and 13-16.

The mean daily intake of energy

was 2,095 kcal for persons 2 months

and older (table 1). Males had

consistently higher intakes of energy

and macronutrients than females in all

age and raceiethnicity groups.

Energy intakes peaked during late

adolescence and young adulthood and

declined thereafter. Energy intake

patterns by age and gender were similar

among non-Hispanic whites, nonHispanic blacks, and Mexican

Americans, although there were some

ditlerences by race/ethnicity within

age-gender groups. Mean energy intakes

were higher in non-Hispanic white

males compared with non-Hispanic

black and Mexican American males ages

12 years and over. Mean energy intake

was highest in non-Hispanic black

females ages 3-29 years and varied by

race/ethnicity for females 30 years and

over.

Mean total carbohydrate intake was

highest in non-Hispanic white males

(305 grams) compared with nonHispanic black males (278 grams) and

Mexican American males (280 grams).

Mean total carbohydrate levels for

females were similar among raa:l

ethnicity groups, ranging from 216-218

grams. Carbohydrate intake was highest

in males ages 16-19 years (381 grams)

and in females ages 16-19 years (254

grams). Total carbohydrates accounted

for about 50 percent of total energy

intake in the overall population.

Mean protein intakes were similar

among racelethnicity groups (88–92

grams in males and 63-66 grams in

females) (table 3). In males, protein

intake increased with age and was

highest in adolescents and young adults

and declined thereafter. Protein intakes

in females were generally lower than

males of the same age and showed a

similar pattern with age (table 3).

Protein accounted for about 10-

12 percent of total energy intake for

non-nursing infants and about 14-

16 percent of total energy intake for

persons ages 1 year and older (table 11).

Mean alcohol intakes were highest

in non-Hispanic whites, intermediate in

non-Hispanic blacks, and lowest in

Mexican Americans, for both males and

females (table 4). Mean alcohol intake

was highest in the age group 20–29

years for both males (23 grams) and

females (9 grams), accounting for

5 percent and 3 percent of total energy,

respectively (table 12). Alcohol

accounted for about 2.6 percent of total

energy in males ages 16-19 years and

0.6 percent of total energy in felmales

ages 16-19 years. Alcohol intake

estimates were very skewed. The mean

and standard error of the mean for

alcohol should be used and interpreted

with extreme caution.

Mean total fat intake ranged from

87 grams in Mexican American males to

95 grams in non-Hispanic black males

and 98 grams in non-Hispanic white

males (table 5). Mean total fat intake for

females was highest in non-Hispanic

blacks (72 grams) and similar in

non-Hispanic whites (67 grams) and

Mexican Americans (66 grams).

However, non-Hispanic black persons

had the highest percent of energy from

fat, approximately 35 percent compared

with 34 percent in non-Hispanic white

persons and 33 percent in Mexican

American persons (table 13). Tctal fat,
Advance Data No. 255. October 24, 1994 3

saturated fa~ acid, and

monounsaturated fatty acid intakes

increased with age and were highest in

males and females between the ages of

16 and 29 years (tables 5–7).

Polyunsaturated fatty acid intakes were

highest in the age group 16-39 years.

Males had higher mean levels of total

fat and fatty acid intakes compared with

females of the same age and racel

ethnicity (tables 5-8).

Mean dietary cholesterol for the

population was 270 milligrams and

higher in males compared with females.

Dietary cholesterol increased with age

and was highest in males ages 16-39

years (ranging from 372–395

milligrams) and females ages 20-49

years (ranging from 235–249

milligrams) and declined thereafter

(table 9). Mean cholesterol intakes were

lower in non-Hispanic white adults

compared with non-Hispanic black

adulta and Mexican American adults.

The overall dietary pattern for the

U.S. population ages 2 months and older

was 50 percent of enerjg from

carbohydrate, 15 percent of energy from

protein, 34 percent of energy from fa~

and 2 percent of energy from alcohol

(tables 10-13). Fatty acid contributions

to energy were 12 percent saturated fag

12.5 percent monounsaturated fa$ and

7 percent polyunsaturated fat, (tablea

14-16) and the mean cholesterol intake

was 270 milligrams (table 9).

Discussion

The NHANES III, Phase 1 data

updates previous HANES health and

nutrition data that were last collected in

1980. Baseline estimates for infants 2-5

months of age and adults 75 years of

age and older—two groups that were

excluded from previous HANF,S— are

reported in addition to other age groups.

Given the defined age groups used

in NHANES III (1988-91), mean energy

intakes peaked during adolescence and

early adulthood and declined thereafter.

This pattern was similar for both males

and females, with males reporting higher

intakes than females at all ages. In

general, mean energy intake and intake

patterns by age and gender were similar

among the race/ethnicity groups studied.

Mean energy intakes in

NHANES III are similar to those

reported in NHANES II for children

under 12 years of age (16,17). However,

mean energy intakes are approximately

100-300 kcal higher in NHANES III

(1988-91) compared with NHANES II

(1976-80) for adolescents and adults

(16-18). Increases in energy intake

between NHANES II and NHANES III

ranged from 1-13 percent in males 12

years and older and 14-17 percent in

females 16 years and over across

various age groups.

Changes in food consumption

patterns, dietary survey methodologies,

and survey food coding and nutrient

composition databases that occurred

between NHANES II and NHANES Ill

must be considered when comparing

energy and nutrient intake estimates

between surveys. During ~u

a higher percentage of the dietary recalls

were collected for weekend days. The

NHANES II 24-hour recalls were

collected on hard copy forms and

manually coded by the dietary

interviewers, whereas the NHANES III

utilized an automated dietary interview

and coding system, which provided a

standardized interview format. The

NHANES III interviewers systematically

probed for detailed information about all

foods consumed as welI as items added

at the table. Dietary interviewer training

methods and quality control monitoring

reinforced the dietary protocol and the

importance of recording detailed

information about all foods consumed. A

list of frequently omitted food items was

reviewed with all NHANES HI

respondents as a final check for

completeness.

The food coding and nutrient

composition databases used in

NHANESII and NHANESIII were

also different. For exampIe, many

brand-specific food codes were added to

the USDA Survey Nutrient Data Base

(SNDB) used for NHANES III, Phase 1

analysis (19). Hundreds of new foods

with reduced fa~ sodium, and sugar

content were added to the SNDB for

Phase 1 data analysis. A large number of

ethnic foods, particularly Mexican

American foods, were added to the

SNDB SiIlC43 NHANES D. Fintiy,

significant food composition data

changes occurred since

NHANES II. For example, in 1989, the

cholesterol content of whole eggs was

reduced by 22 percent due to updated

nutrient composition data for eggs (20).

The revised cholesterol data were

incorporated in the SNDB for

NHANEsIII.

Previous studies have documented

that food consumption is underreported

by as much as 25 percent and occurs

more often in women, overweight

persons, and weight-conscious persons

(21,22). To address underreporting in

NHANES III, ratios of energy intake

(H) to basal metabolic rate (BMR) were

calculated for adults based on previously

published formulas (22). These results

suggest a more complete reporting of

intake in -S III compared with

NHANES II, however, underreporting in

some groups, particularly females and

overweight adults, must be considered in

interpreting dietary survey data.

Comparison of current intake

to dietary recommendations

Mean intakes of energy and protein

in NHANES III were compared with the

Recommended Dietary Allowances

(RD&+) establishcxiin 1989 (23). Mean

energy intakes in NHANES III were

comparable or higher than the RDA for

energy for infants, children, young

adolescents, and adult males under 60

years of age. Mean energy intakes for

females ages 16 years and over and

males ages 60 years and over, were

lower than the RIY& and maybe

atlected by underreporting. Mean protein

intake in NHANES III exceeded the

RDA in all age and gender groups.

Mean alcohol intakes must be

interpreted cautiously considering that

most of the population reported no

alcohol on the day of the 24-hour recall,

and that alcohol intakes tend to be

underreported in dietary surveys (22).

Alcohol intake accounted for 2.6 percent

of the energy intake in adolescent males

ages 16-19 years and rose to 4-

5 percent of energy intake in the diets of

males ages 20-49 years. Alcohol intake

was lower in females than males,

although it accounted for 3 percent of

energy in females ages 2CL29 years.

Total tit contributed a lower

percentage of total energy during
4 Advance Data No. 255. October 24,1994

NHANES III—34 percent overall for

Phase 1 respondents 2 years of age and

older compared with 36 percent during

NHANES II (16-18). Although the

percent of energy from fat has declined

since the 1970’s and 1980’s, mean

values for the population are still above

the Year 2000 goal of 30 percent of

energy or less from total fat and less

than 10 percent horn saturated fat

(1,2,18,24). A shift in the types of fat

has also occurred over time;

polyunsaturated fat has increased to

about 7 percent of energy and saturated

fat has decreased to about 12 percent of

energy in the population. Mean

cholesterol intakes decreased in adults

since NHANES II (16,17); however, the

mean cholesterol intake in NHANES III

for adult males was still above the

recommended level of 300 miUigrams or

less per day (24). Additional progress is

needed to meet population targets set for

reducing mean intakes of total fat,

saturated fat, and dietary cholesterol.

Summary

Among persons ages 2 months-19

years, contributors to daily mean energy

intake (1,941* 25 kcal) were:

14.2 percent protein, 34.0 percent fat,

53.1 percent carbohydrate (figure 1), and

0.3 percent alcohol. Among adults ages

20 years and older, protein contributed

15.5 percen~ fat 34.0 percent,

carbohydrate 49.0 percen~ and alcohol

3.1 percent of total energy. Alcohol

contributed about 4 percent and

2 percent of energy in mrde and female

adults, respectively (figure 1).

Research is planned to compare

food sources of energy and nutrients

consumed by different population groups

to similar results from earlier national

surveys. The NHANES III, Phase 2

(1991-94) recalls were collected using

the same methods as those for Phase 1.

Future reports will compare the dietary

estimates obtained from both phases of

NHANES HI.

References

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U.S. Departmentof Health and

HumanServices.Dietaryguidelines

for Americans.3d ed. Washington:

U.S. GovernmentPrinting Office.

1990.

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Washington Public Herdth Service.

1988.

3. U.S. Department of Health and

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midcourse review. Public Health

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Sources and limits to interpretation.

Nutr Rev S:204-12. 1986.

5. Interagency Board for Nutrition

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Nutrition monitoring in the United

Age;92yg:ths- Ag~d~o@#s

SOURCE Ths third NationalHaalM and Ntition Ewninaticm Suway, Phass 1, 1SSS-91

NOTE Numbarsmay notadd upto 100 dus to rounding.

Figure 1. Sources of food energy United states, 1988-91

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et al. Comparison of a computerized

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Advance Data No. 255. October 24, 1994 5

16.Life Sciences Research Office,

Federation of American Societies for

Experimental Biology. Nutrition

monitoring in the United States—an

update report on nutrition monitoring

in the United States. Washington:

Public Health Service. 1989.

17. Carroll MD, Abraham S, Dresser

CM. Dietary intake source datz

United States, 1976-80. National

Center for Health Statistics. Vital

Health Stat 11(231). 1983.

18. Daily dietary fat and total foodenergy intakes-third National

Health and Nutrition Examination

Survey, Phase 1, 1988-91. MMWR

43(7):1167, 123-5.1994.

19.Human Nutrition Information

Service, U.S. Department of

Agriculture. Survey Nutrient Data

Base for NHANES HI, Phase 1.

Hyattsville, Maryland Human

Nutrition Information Service. 1993.

20. Human Nutrition Information

Service. Fact sheet. New nutrient

composition data for eggs.

WashingtoIE U.S. Department of

Agriculture. 1989.

21. Schoeller DA. How accurate is

self-reported dietary energy intake?

Nutr Rev 48:373-9.1990.

22. Bingham SA. The dietary assessment

of individuals; methods, accuracy,

new techniques and

recommendations. Nutrition Abstracts

and Reviews 57(10):705-42. 1987.

23. National Research Council.

Recommended dietary allowances.

loth ed. WashingtoIX National

Academy Press. 1989.

24. National Cholesterol Education

Program. Second Report of the

Expert Panel on Detection,

Evaluation, and Treatment of High

Blood Cholesterol in Adults.

Bethesd~ W National Heart, Lung,

and Blood Institute. 1993.

25. Ezzati ~ Massey ~, Waksberg J,

Chu & Manrer KR. Sample desigm

Third National Health and Nutrition

Examination Survey. National Center

for Health Statistics. Mtal Health Stat

X113). 1992.

26. Shah By Barnwell BG, Hunt PN,

Nileen P, Lavange LM. SUDAAN

User’s Manual, release 5.50.

Research Triangle Park North

Carolina: Research Triangle Institute.

1991.

27. Westatj Jnc. NHANES HI dietary

interviewer’s manual. Prepared for

the National Center for Health

Statistics, Hyattsville, Maryland.

1992.

28. Briefel RR, Johnson CL.

Methodologic issues and quality

control for the dietary component in

NHANES III. Abstract. A-373.

Federation of the American Societies

for Experimental Biology.

Washington. 1990.

29. Merrill AL and Watt BK Energy

value of foods~aais and derivation

U.S. Department of Agriculture

Handbook No. 74, 105 pp. 1973.

30. National Center for Health Statistics.

Editing guidelines for the 24-hr

dietary recall component of

NHANES HI, Phase 1, 1988-91.

Hyattsville, Maryland. 1993.

Symbols

. . . Data not available

. . . Category not applicable

— Quantii zero

0.0 Quant.Rymore than zero but less

than 0.05

z Quantity more than zero but less

than 500 where numbersare

roundedto thousands

* Figure does not meet standard of

reliabilityor precision
Table 1. Energy intake in kilocalories by age, sexj and race/ethrricity United States, 1988-91

Totalpopulation’ Non-H@errlc white Non-Hispsnic black Mexican Amerhrr

Standard Standard Standard Standard

Sample error of Sample error of sample

Sex and age size Mean the mean Median

error of Sample

size Mean

error of

the mean Medien size Mean the mean Median size Mean the mean Median

6oth sexes

AJlagesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-6yeara . . . . . . . . . . . . . . . . .

8-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

18-19 years . . . . . . . . . . . . . . . .

20-29 years . . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . .

4&49years . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . .

60-89years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . .

80years Andover . . . . . . . . . . . .

Male

AH ages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19yeara . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

5&-59years . . . . . . . . . . . . . . . .

6G89yeara . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearaandover . . . . . . . . . . . .

Female

All agesz . . . . . . . . . . . . . . . . . .

2–llmonthe2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

8-n years . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

18-19years . . . . . . . . . . . . . . . .

20-29yeare . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

4&49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-89yeara . . . . . . . . . . . . . . . .

7C-79yeara . . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

14,801

871

1,231

1,547

1,745

711

765

1,682

1,526

1,228

929

1,106

851

809

7,322

439

801

744

868

338

368

844

735

626

473

546

444

296

7,479

432

830

803

877

373

397

838

791

602

456

560

407

313

2,095

877

1,289

1,591

1,897

2,218

2,533

2,484

2,372

2,146

1,967

1,822

1,624

1,464

2,478

903

1,339

1,883

2,036

2,578

3,097

3,025

2,872

2,545

2,341

2,110

1,687

1,776

1,732

650

1,236

1,516

1,753

1,838

1,956

1,957

1,863

1,764

1,629

1,578

1,435

1,329

18

14

18

20

23

55

66

43

42

38

41

37

33

36

29

21

27

29

33

87

96

66

84

58

61

55

49

58

18

16

21

23

26

46

57

34

35

34

36

37

32

35

1,886

641

1,249

1,508

1,799

2,085

2,269

2,270

2,200

2,014

1,854

1,681

1,631

1,394

2,269

858

1,291

1,588

1,913

2,486

2,918

2,799

2,736

2,349

2,221

1,926

1,797

1,692

1,832

818

1,191

1,451

1,885

1,799

1,795

1,836

1,796

1,673

1,545

1,493

1,362

1,285

5,780

473

424

425

511

221

245

480

550

467

472

493

538

501

2,887

241

202

219

252

98

112

216

271

243

251

247

285

250

2,893

232

222

208

259

123

133

244

279

224

221

246

253

251

2,110

678

1,266

1,573

1,895

2,203

2,561

2,516

2,413

2,183

1,993

1,844

1,639

1,497

2,522

905

1,336

1,659

2,058

2,606

3,208

3,125

2,941

2,574

2,410

2,118

1,924

1,802

1,722

847

1,235

1,484

1,731

1,783

1,885

1,953

1,894

1,766

1,617

1,602

1,431

1,335

21

14

22

26

31

72

86

62

53

46

44

41

31

29

34

21

32

38

46

115

127

95

77

84

83

59

45

45

21

17

27

35

36

56

74

50

48

46

42

45

32

31

1,693

840

1,248

1,466

1,793

2,103

2,270

2,269

2,224

2,054

1,864

1,719

1,539

1,400

2,309

851

1,283

1,550

1,909

2,549

3,188

2,935

2,806

2,396

2,267

1,932

1,813

1,725

1,628

823

1,199

1,421

1,669

1,730

1,822

1,836

1,805

1,667

1,544

1,510

1,380

1,294

3,883

162

355

454

452

191

217

499

454

336

230

289

186

56

1,S03

78

182

210

239

95

103

245

213

176

105

141

93

21

1,860

84

173

244

213

96

114

254

241

160

125

148

93

35

2,053

682

1,350

1,702

1,905

2,231

2,584

2,510

2,235

2,046

1,767

1,608

1,468

1,383

2,371

902

1,402

1,748

1,975

2,360

3,045

3,070

2,697

2,513

1,926

1,662

1,532

*I ,562

1,776

684

1,290

1,655

1,633

2,079

2,107

2,034

1,649

1,656

1,647

1,402

1,457

1,272

23

26

32

34

36

89

100

76

66

64

56

53

59

w

40

39

47

50

60

146

188

135

113

106

94

94

84

*

23

37

40

41

46

91

83

58

59

49

58

47

76

91

1,836

861

1,300

1,607

1,819

2,030

2,336

2,263

2,027

1,882

1,669

1,478

1,334

1,250

2,156

879

1,385

1,616

1,948

2,307

2,679

2,788

2,456

2,397

1,842

1,830

1,346

*1 ,394

1,848

816

1,206

1,583

1,734

1,927

1,961

1,945

1,699

1,545

1,537

1,405

1,326

1,199

4,598

163

402

609

727

269

270

666

472

366

196

305

111

42

2,250

89

f 86

281

344

129

139

349

225

161

96

152

60

19

2,346

74

216

328

383

140

131

317

247

185

100

153

51

23

2,014

878

1,269

1,567

i ,660

2,081

2,245

2,307

2,263

2,154

1,670

1,598

1,456

●1,325

2,301

923

1,306

1,652

1,951

2,379

2,573

2,673

2,644

2,533

2,125

1,983

1,660

*1 ,460

1,712

627

1,228

1,483

1,769

1,605

1,874

t ,662

1,861

1,764

1,835

1,297

1,280

*1 ,251

24

25

29

29

31

76

78

50

56

56

64

51

61

*

36

34

43

45

46

122

115

70

86

76

94

79

111

●

27

36

38

36

42

82

90

57

58

66

76

47

110

*

1,841

849

1,203

1,472

1,767

1,895

2,037

2,114

2,106

2,074

1,828

i ,498

1,288

*I ,287

2,150

932

1,253

1,552

1,839

2,107

2,477

2,490

2,519

2,458

2,061

1,805

1,480

*1 ,464

1,609

788

1,163

1,425

1,664

1,723

1,779

1,729

1,751

1,598

1,697

1,306

1,057

*1 ,264

‘ Includss dsta for race/ethnicithygrwps not shown sepsrata4y.

2 Excludes nursing infants and children.
Table 2. Carbohydrate intake In grams by age, sex and race/ethnMy: United States, 1986-91

Totalpopulation’ Non-Hispsnic white Non-Hispanic blaok MexicanAmerisan

Standard

Sample

standard Standard Standard

error of Sample error of Sample error of Sample

Sex and age

error of

size Mean the mean Median size Mean the mean Median size Mean the mean Medisn size Mean the mean Median

8dh sexes

Allages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l-2yeara2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

S-n yeare. . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19 years . . . . . . . . . . . . . . . .

20-29 years . . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . .

4CH9years . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . .

60-69 yeara . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearaandover . . . . . . . . . . .,

Mete

Nlages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n yeare. . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . .,

50-59yeara . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . ..o.. .

70-79yeare . . . . . . . . . . . . . . . .

80yeaffiandover . . . . . . . . . . . .

Female

Allages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5yeara . . . . . . . . . . . . . . . . .

6-n yeare. . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29yeara . . . . . . . . . . . . . . . .

30-39yeara . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . .

14,801

871

1,231

1,547

1,745

711

765

1,662

1,526

1,226

929

1,106

651

609

7,322

439

601

744

668

338

868

644

735

626

473

646

444

296

7,479

432

680

803

877

373

387

836

791

602

466

660

407

313

257

115

i70

215

251

296

318

286

281

254

231

224

204

195

299

$19

176

225

272

346

381

353

386

286

266

263

231

225

217

112

163

204

229

243

254

241

228

213

189

198

166

179

2.6

2.3

2.7

2.9

3.6

8.5

9.2

5.6

5.6

6.4

5.3

5.1

4.5

5.2

4.2

3.4

3.9

4.3

5.3

14.2

13.7

8.6

8.8

8,4

7.9

7.6

7.0

8,2

2.7

2.5

3.1

3,2

3.6

6.1

8.2

4.8

4.5

4.7

5.1

5.3

4.5

5.2

233

111

164

206

234

272

282

271

258

234

213

202

197

182

274

112

173

214

258

325

248

830

312

273

246

237

217

209

203

107

158

196

219

236

283

237

213

194

187

166

179

173

5,760

473

424

425

511

221

245

460

650

467

472

483

538

501

2,357

241

202

219

252

86

112

218

271

243

251

247

265

250

2,683

232

222

206

259

123

133

244

279

224

221

246

253

251

259

117

171

215

253

301

320

300

286

258

232

226

206

i96

305

122

178

227

278

367

395

864

345

302

272

254

235

228

218

112

165

202

227

243

242

241

228

213

197

202

188

180

3.2

2.3

3.3

4.0

4.6

11.6

11.9

8.0

7.0

8.5

5.5

5.6

4.2

4.2

5.1

3.5

4.8

6.6

7.4

20.1

18,3

12,8

10.8

9.9

8,2

8.3

6.5

8.6

3.1

2.6

3.9

4.8

5.0

8.0

9.5

6.6

6.1

6.1

5.4

6.5

4.3

4.5

234

112

166

207

235

272

282

272

263

238

213

204

199

185

277

113

176

217

262

841

370

338

323

276

254

289

223

211

202

107

161

196

218

228

231

238

212

196

166

166

180

i73

3,863

162

355

464

452

191

217

488

454

338

230

289

186

66

1,903

78

182

210

239

95

103

245

213

178

106

141

93

21

1,980

64

173

244

213

86

114

254

241

160

125

146

93

35

246

114

170

220

242

281

317

287

258

232

213

195

180

*164

276

114

178

228

260

308

370

341

304

272

227

217

187

●193

218

115

162

213

236

252

267

241

220

198

203

178

175

i79

2.7

4.1

4.4

4.8

5.0

12.5

12.9

8.8

8.1

7.5

7.7

6.5

7.9

*

4.8

5.4

6.3

7.2

6.9

20.2

20.8

14.8

13.8

12.1

12.2

10.6

11.5

*

2.8

5.5

5.6

5.9

8.5

12.1

12.1

7,8

7.4

6,9

8.7

6.8

9.9

14.5

222

110

165

207

232

263

289

265

233

209

201

185

164

*160

250

105

177

207

236

282

884

316

262

250

212

196

173

*147

203

111

159

206

227

238

244

230

204

185

195

180

154

161

4,598

163

402

608

727

269

270

666

472

366

196

305

111

42

2,260

89

186

281

344

128

139

349

225

181

86

152

60

19

2,346

74

216

328

363

140

131

317

247

185

100

163

51

23

249

110

160

208

241

261

275

282

272

266

231

202

191

*169

260

116

164

223

253

295

312

323

305

292

258

242

212

*161

217

103

156

193

228

230

234

233

236

222

207

168

172

*163

4.7

4.1

4.5

4.6

5.1

10,8

10.9

6.6

7.3

7.7

10.1

7.6

11.8

*

7.3

5.4

6.2

6,8

7.2

16.6

15.6

8.8

10.9

10.3

14.7

11.7

15.3

*

5.4

5.4

6.6

5.2

6.2

11.2

11.6

7.3

7.7

9.0

11.5

7.1

15.5

*

233

102

149

194

228

251

260

265

256

242

218

187

177

143

265

115

155

207

241

272

294

3io

299

286

231

227

190

*136

208

97

145

179

215

225

223

216

230

209

204

165

148

*140

‘Includes data for mebthnk!ily groups no2shown sepamdeiy.

*&c[ude~ ““ming infams~ *ildren.
Table 3. Protein intake in grams by age, sex and race/ethnicity United Statea, 1988-91

Total population’ Non-Hisparric white Non-Hispanic black Mexican Amerioan

Standard standard

Sample

Standard Standard

arror of Sample

Sex and age

error of Sample

size Mean

error of Sampla

the mean Median size Mean

error of

the mean Median size Mean the mean Median size Mean the mean Median

Both sexes

Allagesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . .

%5years . . . . . . . . . . . . . . . . .

6-n yeara . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

2&29years . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . .

4&49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . .,

80years Andover . . . . . . . . . . . .

Male

All ages2. . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . .

3-6yeara . . . . . . . . . . . . . . . . .

&ll yeare . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

2C-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69yaars . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

All agesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5yeara . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

3C-39years . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years

80 years and over

14,801

871

1,231

1,547

1,745

711

765

1,662

1,526

1,226

929

1,106

651

809

7,322

439

601

744

666

338

368

644

735

626

473

546

444

296

7,479

482

630

803

877

373

397

838

791

602

456

560

407

313

78

26

48

57

67

76

89

89

88

61

76

73

65

58

92

27

50

59

71

69

111

110

106

96

93

64

74

89

84

25

45

54

63

82

67

69

70

67

64

64

58

52

0.6

0.7

0.6

0.8

0.9

2.0

2.5

1.7

1.6

1.6

1.6

1.5

1.4

1.6

0.9

0.9

1.1

1.2

1.3

3.0

3.6

2.7

2.4

2.3

2.6

2.4

2.2

2.5

0.6

0.9

0.9

1.0

1.1

2.0

2.2

1.5

1.6

1.5

1.7

1.6

1.6

1.7

69

22

45

53

64

68

77

77

60

75

72

67

60

54

62

23

47

54

67

62

100

96

97

90

86

78

70

64

60

20

43

50

60

58

62

66

66

64

59

60

55

49

5,780

473

424

425

511

221

245

460

550

467

472

493

586

501

2,867

241

202

219

252

98

112

216

271

243

251

247

265

250

2,693

232

222

206

259

123

133

244

279

224

221

246

253

251

77

26

47

55

66

74

90

66

69

81

79

74

65

58

92

27

49

59

69

66

114

109

106

95

95

85

75

69

63

25

45

52

62

59

66

68

70

66

64

64

57

52

0.7

0.7

0.9

1.2

1.3

2.7

3.6

2.5

2.1

1.9

2.0

1.8

1.4

1.3

1.2

0.9

1.4

1.7

1.7

4.1

5.4

4,0

3.1

2.7

3.0

2.7

2,1

1.9

0.7

1.0

1.2

1.6

1.7

2.6

3.1

2.1

2.1

1.9

2.1

2.0

1.5

1.6

69

22

45

51

63

66

76

76

81

75

73

aa

61

64

63

23

47

53

67

68

102

94

99

91

90

79

70

65

59

21

42

47

59

57

61

67

66

64

59

60

55

49

3,863

162

355

454

452

191

217

488

454

338

230

289

186

56

1,903

78

182

210

239

95

103

245

213

176

105

141

93

21

1,960

64

173

244

213

96

114

264

241

160

125

148

93

35

76

23

50

60

68

76

88

93

62

80

67

65

62

56

66

25

52

60

72

79

105

117

99

99

74

78

63

70

65

22

48

59

65

73

72

74

67

64

62

56

62

ml

1.1

1.2

1.4

1.4

1.6

3.4

3.6

3.3

2.8

3.1

2.3

2.7

2.6

5.0

1.9

1.9

1.9

i .9

2.2

5.0

5.5

5.7

4.6

5.2

3.6

4.7

3.4

*

1.1

1.4

1.7

1.7

2.0

4.1

3.4

2.4

2.5

2.4

2.2

2.3

3.5

4:5

66

19

47

57

65

68

81

61

71

70

62

57

56

49

77

21

49

57

66

72

96

103

86

84

65

67

60

*56

60

16

44

57

63

63

66

66

62

60

60

51

57

As

4,596

168

402

609

727

269

270

666

472

366

196

305

111

42

2,250

69

186

261

344

129

139

349

225

161

96

152

60

19

2,346

74

216

328

383

140

131

317

247

165

100

153

51

~~

76

27

49

57

70

79

86

91

87

83

77

66

61

50

89

29

50

60

74

93

96

106

104

98

65

78

73

%2

66

24

48

55

66

66

72

72

70

68

69

56

50

0.9

1.3

1.3

1.2

1.3

3.1

3.4

2.2

2.4

2.5

2.8

2.1

3.7

3.8

1.3

1.6

1.7

1.6

1.6

4.5

4.6

2.6

3.3

3.2

3.5

2.6

5.2

*

1.0

1.7

1.6

1.5

1.7

3.1

4.0

2.4

2.4

2.9

3.5

2.4

3.9

*

69

23

46

64

63

71

78

82

79

76

72

60

57

46

82

26

45

57

69

84

92

100

98

93

78

74

64

*6O

59

16

45

52

60

62

66

64

63

59

62

53

45

●41

‘Includes date for race/ethnlcHygroupe not ehown separately.

‘Excludes nursing infanta and children.
Table 4. Alcohol Intake In grams by age, sex, and race/ethnicity United States, 198S-91

Totalpopulation’ Norr-Hr@en!owhite Non-H@en;o black Mexican Amerioan

standard Sterrdsrd standard Standevd

Sample ever of Sample error of Sample error of Sample

Sex and age Meanz

error of

size the mean size Maam2 the mean size Mean2 the mean size Meanz the mean

6oth sexes

AlIages3 . . . . . . . . . . . . . . . . . .

2-llmonths3 . . . . . . . . . . . . . . .

l-2yeare3. . . . . . . . . . . . . . . . .

3-5yeara . . . . . . . . . . . . . . . . .

E-n years. . . . . . . . . . . . . . . . .

12-15 years . . . . . . . . . . . . . . . .

18-19 years . . . . . . . . . . . . . . . .

20-29 years . . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . .

40-49 years . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . .

80-69 years . . . . . . . . . . . . . . . .

70-79 years . . . . . . . . . . . . . . . .

80yeare andover . . . . . . . . . . . .

Male

Allages3 . . . . . . . . . . . . . . . . . .

2-n monthsa. . . . . . . . . . . . . . .

l–2years3 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

E-n years. . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

15-19years, . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59yeare . . . . . . . . . . . . . . . .

50-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . ,

80yeareandover, . . . . . . . . . . ,

Female

Nlages3 . . . . . . . . . . . . . . . ..o

2–llrnonths3 . . . . . . . . . . . . . . .

l-2yeareg. , .,..,,..,,,,,,,

3-5years . . . . . . . . . . . . . . . . .

8-n yeare. . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

EOyearaandover . . . . . . . . . . . .

14,801

871

1,231

1,547

1,745

711

755

1,682

1,526

1,226

929

1,108

851

609

7,322

439

801

744

86a

235

38a

844

735

626

473

546

444

296

7,479

432

630

803

877

373

3a7

83a

791

602

456

580

407

313

6

0

0

0

0

0

7

18

13

11

9

7

4

2

12

0

0

0

0

0

13

23

18

18

12

11

7

4

5

0

0

0

0

0

2

9

8

5

5

4

2

1

0.5

0.0

0.0

0.0

0.0

0.1

1.4

1.4

1.1

1.1

1.0

0.8

0.6

0.5

0.9

0.0

0.0

0.0

0.0

0.0

2.4

2.2

1,6

1.7

1.8

1.4

1.0

0.9

0.5

0.0

0.0

0.0

0.0

0.2

0.6

1.3

1.1

1.1

1.0

0.7

0.6

0.5

5,780

473

424

425

511

221

245

480

550

467

472

493

53a

501

2,887

241

202

219

252

98

112

218

271

243

251

247

2s

250

2,893

232

222

206

259

123

133

244

273

224

221

246

253

251

9

0

0

0

0

0

9

18

13

12

9

7

4

2

13

0

0

0

0

0

16

28

18

17

12

10

7

5

5

0

0

0

0

0

2

11

7

8

6

5

2

1

0.6

0.0

0.0

0.0

0.0

0.2

2.3

2.5

1.5

1.5

1.2

1.0

0.7

0.5

1.1

0.0

0.0

0.0

0.0

0.0

4.3

4.3

2.3

2.3

2.0

1.7

1.2

0.9

0.6

040

0.0

0.0

0.0

0.3

1.0

2.2

1.5

1.6

1.2

0.9

0.7

0.6

3,863

162

355

454

452

191

217

439

454

338

230

28a

186

56

1,803

78

182

210

239

95

103

245

213

178

105

141

93

21

1,980

84

173

244

213

96

114

254

241

160

125

148

93

35

7

0

0

0

0

0

3

11

14

12

8

5

2

0

11

0

0

0

0

0

5

20

22

21

12

10

3

0

3

0

0

0

0

0

1

4

8

4

4

1

1

0

0.5

0.0

0.0

0.0

0.0

0.1

1.0

1.4

1.7

1.8

1.5

1.2

0.8

0.0

1.0

0.0

0.0

0.0

0.0

0.2

2.1

2.6

3.0

3.4

2.5

2.5

1.5

0.0

0.4

0.0

0.0

0.0

0.0

0.0

0.4

0.8

1.7

1.0

1.6

0.7

0.5

0.0

4,598

183

402

809

727

269

270

566

472

366

196

305

111

42

2,250

89

166

281

344

129

139

349

225

181

96

152

60

19

2,348

74

216

328

363

140

131

317

247

165

100

153

51

23

8

0

0

0

0

0

5

8

12

14

7

4

1

0

10

0

0

0

0

0

6

13

20

23

11

8

1

0

2

0

0

0

0

0

1

2

5

4

4

1

1

0

0.4

0.0

0.0

0.0

0.0

0.0

1.7

1.1

1.6

1.8

1.4

0.8

0.4

0.0

0.7

0.0

0.0

0.0

0.0

0.0

3.3

1.8

2,8

3.3

2.5

1.6

0.6

0.0

0.3

0.0

0.0

0.0

0,0

0.1

0.5

1.0

1.5

1.1

1.3

0.3

0.4

0.0

1[nclud3sdata for rsos/ethhnldty WOUPS@s~ ‘-tw.

2Eetima!asofelcehol Intakearevsryskti themeanatklstandsrd enwofdwnwsn ehouldbueedand Intaipetsdwithsxlrsrne csutlon.Medianvaluss fwfdlega,sax,reca/ethnkHy grwpserezere.

s~”de~ nursing iI_If@2d ‘ildren’
Table 5. Total fat intake in grama by age, sexj and race/ethniciM United States, 1988-91

Total population’ Non-Hispanic white Non-Hispanic black Mexican American

Standard Standard

Sample

Standard Standard

error of .%rrrple error of Sample

Sex and age size Mean

error of

the mean Madian

Sample error of

size Mean the mean Median size Mean the mean Median size Mean the mean Median

!%th sexes

Nlages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2yeara2 . . . . . . . . . . . . . . . . .

3-5yeara . . . . . . . . . . . . . . . . .

Gll years. . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29yeara . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

4W9years. . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . .

60+9years . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . .

Male

All agesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2. . . . . . . . . . . . . . . .

f?-5years . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yeara . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . ,,

50-59years . . . . . . . . . . . . . . . .

60-69yeara . . . . . . . . . . . . . . . .

70-79yeara . . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

Female

All ages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5yeara . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . .

30-39yeara . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . ..c. ..c.. .

6&69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

t4,801

871

1,231

1,547

1,745

711

765

1,662

1,526

1,228

929

1,106

851

609

7,322

439

601

744

668

338

368

844

735

626

473

546

444

296

7,479

432

630

803

877

373

397

636

791

602

456

560

407

313

81

36

49

59

73

85

88

96

94

84

78

69

61

54

96

37

51

62

78

97

120

116

113

98

95

80

73

67

67

35

47

57

66

72

77

75

75

70

63

59

53

47

0.9

0.6

0.9

1.0

1.1

2.5

2.9

2.0

2.0

1.8

2.1

1.7

1.7

1.7

1.4

0.9

1.2

1.4

1.5

3.8

4.1

3.0

3.0

2.7

3.1

2.6

2.5

2.7

0.9

0.6

1.2

1.2

1.4

2.6

3.1

1.6

1.9

2.0

2.1

2.0

1.9

1.7

71

34

45

54

67

76

88

88

84

75

71

60

55

50

85

35

49

57

73

66

112

106

106

87

90

71

64

62

60

33

43

53

63

66

65

70

68

64

59

54

49

44

5,780

473

424

425

511

221

245

460

550

467

472

493

638

501

2,887

241

202

219

252

98

112

216

271

243

251

247

265

250

2,893

232

222

206

259

123

133

244

279

224

221

246

253

251

82

35

49

58

73

82

99

97

96

87

80

70

62

55

96

36

50

61

78

97

123

121

116

100

99

61

74

69

67

34

47

55

67

67

74

74

76

72

63

60

53

47

1.0

0.6

1.1

1.4

1.5

3.2

3.8

2.7

2.5

2.2

2.3

i .9

1.6

1.4

1.6

0.9

1.6

1.9

2.1

5.0

5.3

4.2

3.6

3.2

3.2

2.8

2.3

2.2

1.0

0.6

1.5

1.9

2.1

3.3

4.2

2.5

2.6

2.7

2.4

2.3

1.9

1.5

72

33

45

53

67

76

89

86

66

79

72

61

56

51

87

34

48

55

74

67

114

110

110

93

96

71

66

64

60

33

43

51

62

64

60

70

70

65

59

55

50

44

3,823

162

355

454

452

191

217

488

454

338

230

269

186

56

1,903

78

182

210

239

95

103

245

213

178

105

141

93

21

1,960

84

173

244

213

66

114

254

241

160

125

148

93

35

63

38

54

67

76

93

t06

104

89

82

66

62

59

47

95

40

56

69

79

95

127

124

106

100

73

73

59

*58

72

36

52

66

73

90

86

66

74

67

64

53

58

42

1.2

1.3

1.6

1,6

1.9

4.3

4.9

3.7

3.2

3.1

2.7

2.6

3.1

4.4

2.0

1.9

2,3

2.5

2.8

6.9

6.8

7.0

5.9

5.5

4.7

5.2

4.4

*

1,2

1.6

2.0

2.0

2.4

5.0

4.0

2.9

2.8

2.7

3.0

2.7

4.0

3.4

72

36

51

63

71

81

92

90

78

73

63

52

50

45

82

39

54

66

77

84

110

109

93

67

64

59

50

*5O

65

34

46

62

68

73

82

61

69

62

63

45

50

42

4,598

163

402

609

727

269

270

666

472

366

198

305

111

42

2,250

69

186

281

344

129

139

349

225

181

96

152

60

19

2,348

74

216

328

363

140

131

317

247

165

100

153

51

23

77

38

50

59

72

83

88

87

86

60

66

58

52

*52

87

39

52

61

75

96

101

99

100

93

76

73

59

*56

66

36

48

57

69

72

74

72

70

66

58

46

45

*5O

0.8

1.2

1.5

1.4

1.5

3.7

3.7

2.5

2.9

2.7

3.0

2.4

4.1

*

1.2

1.8

2.3

2.3

2.3

6.0

5.6

3.7

4.7

4.0

4.6

4.0

6.1

*

0.8

1.6

1.9

1.7

1.9

3.9

4.0

2.8

2.8

3.0

3.4

2.1

5.0

*

67

37

46

55

65

71

80

77

74

73

64

51

41

*49

77

37

48

57

66

78

90

90

89

86

76

62

52

*52

58

36

44

52

63

64

67

65

62

59

54

44

32

*48

‘Includes data for racelethnicity groups not shown separately.

2Excludesnursing infanls and children.
Table 6. Saturated fat intake In grams by age, sex and race/ethnlcity: United States, 1966-91

Total population’ Non-H@en/c white Non-H@m!c black Mexben American

Standard Standard Standard Standatd

Sample error of Sample error of Sample error of Sample

Sex and age size Mean the mean Mad/an size Mean

error of

the mean Median size Mean fhe mean Median size Mean the mean Median

6oth sexes

Allages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5yesrs . . . . . . . . . . . . . . . . .

6-llyesre . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

18-19years . . . . . . . . . . . . . . . ,

20-29years . . . . . . . . . . . . . . . ,

30-39years . . . . . . . . . . . . . . .,

4049years . . . . . . . . . . . . . . . .

50-59yeara. . . . . . . . . . . . . . . ,

60-69years . . . . . . . . . . . . . . . .

70-79yeara . . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . .

Male

Allages2, . . . . . . . . . . . . . . . . .

2–llmonths2. . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n years. . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

18-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years. . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

60yeareandover . . . . . . . . . . . .

Femete

Allages2 . . . .. i . . . . . . . . . . . .

2–llmonths2. , . .,, ..,,.., ,.

l-2years2 . . . . . . . . . . . ..o...

3-5years . . . . . . . . .. mm.... .

O-n yeare. . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

18-19years . . . . . . . . . . . . . . . .

20-29yeara. . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49yeara . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . .

14,601

871

1,231

1,547

1,745

711

765

1,682

1,526

1,226

929

1,106

351

609

7,322

439

ooi

744

886

338

386

844

735

626

473

546

444

286

7,479

432

530

603

877

378

397

836

791

602

456

580

407

313

26

15

20

23

27

31

36

34

32

28

26

23

21

19

34

16

21

24

29

36

44

41

39

33

31

27

25

23

23

15

19

22

25

26

27

28

26

24

21

20

18

16

0.4

0.3

0.4

0.4

0.4

0.9

1.1

0.7

0.7

0.7

0.7

0.7

0.8

0.6

0.6

0.4

0.5

0.5

0.6

1.3

1.5

1.1

1.1

0.9

1.0

1.0

0.9

0.9

0.4

0.4

0.5

0.5

0.5

1.0

1.3

0.7

0.7

0.7

0.7

0.7

0.7

0.7

25

15

18

21

25

28

3t

30

28

25

24

20

18

17

29

15

20

22

27

32

39

37

36

29

29

23

22

20

21

14

17

20

23

24

23

24

24

21

19

18

16

15

5,780

473

424

425

511

221

245

460

550

467

472

483

533

501

2,887

241

202

219

252

98

112

216

271

243

251

247

236

250

2,833

232

222

206

253

123

133

244

279

224

221

246

253

251

29

15

20

22

27

30

36

34

34

29

26

24

21

19

35

15

21

24

30

36

45

43

41

33

33

28

26

24

23

15

19

21

25

24

26

26

27

25

21

20

18

16

0.4

0.3

0.5

0.6

0.6

1.2

1.4

1.0

0,9

0.8

0.8

0.7

0.6

0.5

0.6

0.4

0.6

0.6

0.9

1.7

2.0

1.5

1.4

1.1

1.1

1.1

0.9

0.7

0,4

0.4

0.6

0.7

0.6

1.3

1.4

0.9

0,9

1.0

0.8

0.9

0.7

0.6

25

15

18

21

25

28

33

31

29

26

24

20

18

17

31

15

20

22

28

23

40

41

38

30

30

24

23

22

21

14

17

20

23

24

22

24

24

22

18

18

16

15

3,883

162

355

454

452

191

217

499

464

338

230

289

186

56

1,903

78

182

210

239

95

103

245

213

176

105

i4t

93

21

1,960

M

i73

244

213

96

114

254

241

160

125

143

33

35

28

15

21

25

27

33

37

35

29

27

23

20

19

16

32

16

21

26

29

33

44

41

34

33

23

24

20

%?0

24

16

20

24

26

31

31

29

24

22

23

17

19

14

0.4

0.6

0.6

0.6

0.7

1.6

1.6

1.3

1.1

1.1

1.0

0.9

1.0

1.6

0.7

0,9

0.9

0.9

1.1

2.5

3.1

2.4

1.9

1.8

1.5

1.7

1.5

*

0.4

0.7

0.8

0.8

0.8

1.8

1,6

1.0

1.0

0,9

1,2

0.8

1.3

1.3

25

15

19

23

25

28

32

31

25

23

21

16

16

15

28

16

20

25

27

30

36

35

29

28

21

20

18

*17

22

14

18

22

25

26

28

26

21

20

21

14

15

13

4,598

163

402

602

727

269

270

668

472

388

196

305

111

42

2,250

89

186

281

344

129

139

349

225

181

86

152

60

19

2,348

74

216

328

333

140

131

3i7

247

185

100

153

51

23

27

16

20

22

27

31

31

30

30

27

23

20

17

*19

31

17

21

23

28

36

36

34

35

31

26

25

20

%!0

23

15

19

22

26

27

27

25

25

22

20

16

15

*18

0.3

0.6

0.7

0.6

0.6

1.5

1.5

1.0

1.1

1.1

1.3

1.0

1.5

*

0.5

0.8

0.9

0.9

0.9

2.4

2.2

1.5

1.7

1.5

1.9

1.6

2,1

*

0.4

0.8

0.9

0.7

0.6

1.6

1,6

1.1

1.1

1.2

1.4

0.9

1.6

*

23

15

19

21

24

27

27

26

25

24

20

18

13

●16

26

16

19

22

25

29

30

31

31

28

22

19

16

*19

21

i4

17

19

23

24

24

22

21

19

19

13

11

*14

‘Includesdatafor racelsthnlctlygroupsnorslwm espsrately.

2ExcludesnursingInfsntsandchildren.
Table 7. Mean monounsaturated fat intake in grams by age, sex and race/ethnlcity United States, 1988-91

Total popu/afiorr’ Non-Hispanic white Non-Hispanic black Mexican American

Standard Standard Standard Standard

Sample error of .%rnple error of

Sex and age

Sample

size Mean

error of Sample

the mean Median size Mean the mean Median

error of

size Mean the mean Median size Mean the mean Median

Eoth sexes

Allagesz, . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2. . . . . . . . . . . . . . . . .

3-5 years . . . . . . . . . . . . . . . . .

E-n years . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

2&29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . ,,.

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . .,

80yearsandover . . . . . . . . . . . ,

Male

All agesz . . . . . . . . . . . . . . . .

2–llmonths2, . . . . . . . . . . . . . .

l–2years2, . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

8-n yeara . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

18-19years . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yeara . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . ,.

6LW39years . . . . . . . . . . . . . . . .

7&79years . . . . . . . . . . . . . . . .

60yeamandovar . . . . . . . . . . . .

Female

Ail ages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5yeara . . . . . . . . . . . . . . . . .

fi$-llyear a . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

18-19years. . . . . . . . . . . . . . . .

20-29yeara . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years. . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-89years . . . . . . . . . . . . . . . .

7C-79years . . . . . . . . . . . . . . . .

60yeareandover . . . . . . . . . . . .

14,601

871

1,231

1,547

1,745

711

765

1,682

1,526

1,226

929

1,106

651

609

7,322

439

601

744

668

338

368

844

735

626

473

546

444

296

7,479

432

630

803

877

373

397

836

791

602

456

560

407

313

30

9

f8

22

27

32

37

36

35

31

29

26

23

20

36

9

76

23

29

37

45

44

43

37

36

30

27

26

25

9

17

21

25

27

28

28

27

26

23

22

19

17

0.4

0.3

0.4

0.4

0.5

1.0

1.2

0.6

0.8

0.8

0.9

0.7

0.7

0.7

0.6

0.4

0.5

0.6

0.6

1.5

1.6

1.2

1.3

1.2

1.3

1.1

1.0

1.1

0.4

0.3

0.5

0.5

0.6

1.0

1.2

0.7

0.8

0.8

0.8

0.6

0.8

0.7

26

7

16

20

25

29

33

31

31

28

26

22

20

18

32

8

17

21

26

34

42

39

40

32

33

25

24

23

22

7

15

19

23

25

24

26

25

23

21

20

17

17

5,760

473

424

425

511

221

245

460

550

467

472

493

536

501

2,887

241

202

219

252

98

112

216

271

243

251

247

265

250

2,693

232

222

206

259

123

133

244

279

224

221

246

253

251

30

9

18

22

27

31

37

36

38

32

30

26

23

21

37

9

18

23

29

36

46

45

44

38

37

30

28

26

24

9

17

21

25

25

26

27

26

27

23

22

19

17

0.4

0.3

0.4

0.6

0.6

1.3

1.5

1.1

1.0

0.9

0.9

0.8

0.6

0.6

0.7

0.3

0.6

0.8

0.8

2.0

2.1

1.7

1.5

1.4

1.3

1.2

1.0

0.9

0.4

0.3

0.6

0.6

0.8

1.3

1.7

1.0

1.0

1.0

0.9

0.9

0.7

0.6

26

7

17

20

25

29

33

31

32

29

28

23

21

16

33

7

16

20

26

34

42

42

41

33

34

26

25

24

22

7

16

18

23

24

22

25

25

24

20

20

17

17

3,883

162

355

454

452

191

217

498

454

336

230

289

186

56

1,903

76

182

210

239

95

103

245

213

178

105

141

93

21

1,980

84

173

244

213

96

114

254

241

160

125

146

93

35

31

9

20

25

29

35

40

39

34

31

26

24

22

18

36

10

21

26

30

36

49

46

41

38

29

28

23

%22

27

9

19

24

28

33

32

32

28

25

24

21

22

16

0.5

0.5

0.6

0.6

0.8

1.7

2.0

1.5

1.3

1.3

1.1

1.2

1.3

1.7

0.6

0.6

0.9

1.0

1.2

2.7

3.4

2.9

2.5

2.3

2.0

2.1

1.6

*

0.5

0.5

0.6

0.8

0.9

1.9

1.5

1.1

1.1

1.1

1,1

1.1

1.7

1.4

27

8

18

24

26

30

35

34

29

27

24

20

19

16

31

7

20

24

28

32

43

40

35

33

26

22

19

*18

24

7

17

23

25

28

30

29

25

23

24

17

17

17

4,598

163

402

609

727

269

270

666

472

366

196

305

111

42

2,250

89

186

281

344

129

139

349

225

181

96

152

80

19

2,348

74

216

328

383

140

131

317

247

165

100

153

51

23

28

10

17

21

27

31

32

32

31

30

25

21

19

%!0

32

10

18

22

28

36

37

36

37

35

30

27

22

+22

24

9

16

21

25

27

27

26

25

24

21

17

16

*19

0.3

0.5

0.6

0.5

0.6

1.4

1.4

0.9

1.1

1.0

1.2

0.9

1.6

*

0.5

0.7

0.6

0.6

0.9

2.4

2.0

1.3

1.7

1.5

1.9

1.5

2.5

*

0.3

0.7

0.7

0.6

0.7

1,5

1.4

1.0

1.0

1.2

1.3

0.8

1.9

●

24

8

16

20

23

27

30

29

27

27

22

18

15

*I 6

28

9

17

20

24

29

33

33

33

33

27

23

19

*2O

21

7

15

19

23

24

23

24

22

21

19

15

11

*17

‘ Includss data for racelethnic”~ groups not shown separately.

2Excludes nursing infants and children.
Table 8. Polyunsaturated fat intake In grams by age, sex and race/ethnlcity: United States, 1968-91

Totalpopulation’ Non-H@sn[o white Non-Hispanic black Mexk?anArrrarican

Standard standard Standard

Sample

Standard

error of Sample error of Sample error of Sample error of

Sex and age size Meen the mean Mad;an size Mean fhe mean Median size Mean the mean Median size Mean the mean Median

8oth sexes

Allages2 . . . . . . . . . . . . . . . ..i

2-llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

E-n years. . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19yaars . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yaars . . . . . . . . . . . . . . . .

40+9yeara . . . . . . . . . . . . . . .,

50-59years . . . . . . . . . . . . . . .,

60-69years . . . . . . . . . . . . . . . ,

70-79years . . . . . . . . . . . . . . . .

80yearaandover . . . . . . . . . . . .

Male

All agesz. . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-llyeafa . . . . . . . . . . . . . . . . .

12-16years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29yeara . . . . . . . . . . . . . . . ,

30-39years . . . . . . . . . . . . . . .,

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years. ,, . . . . . . . . . . . . ,

70-79years . . . . . . . . . . . . . . . .

80yeafaandover . . . . . . . . . . .,

Female

All ages2. . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2yaars2 . . . . . . . . . . . . . . . . ,

3-5years . . . . . . . . . . . . . . . . .

8-llyeafa . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19yeara . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years. . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearaandover . . . . . . . . . . . .

14,801

871

1,231

1,547

1,745

711

765

1,662

1,526

1,228

929

1,106

651

609

7,322

439

601

744

666

338

368

644

735

626

473

546

444

286

7,479

432

630

603

877

373

397

638

602

456

560

407

313

16

8

8

10

13

18

19

19

19

i8

17

14

13

11

19

8

8

11

14

18

22

23

23

21

20

16

15

13

14

8

8

10

13

14

16

16

16

15

14

13

12

10

0.2

0.2

0.2

0.2

0.3

0.6

0.7

0.5

0.5

0.5

0.5

0.4

0.4

0.4

0.3

0.3

0.3

0.3

0.4

1.0

1.1

0.7

0.6

0.8

0.9

0.7

0.7

0.8

0.2

0.3

0.3

0.3

0.4

0.7

0.8

0.5

0.5

0.5

0.6

0.5

0.5

0.5

13

8

7

9

12

12

16

16

16

15

14

12

11

9

15

8

7

9

12

14

20

19

19

17

17

14

12

11

12

8

6

9

11

12

14

14

13

13

12

11

10

9

5,780

473

424

425

511

221

245

460

660

467

472

493

536

501

2,667

241

202

219

252

96

112

216

271

243

251

247

266

250

2,693

232

222

206

258

123

133

244

279

224

221

246

253

251

17

6

8

10

13

15

19

19

19

19

18

15

13

11

19

8

8

11

14

17

23

23

23

22

21

16

15

14

14

8

8

10

13

13

15

16

16

16

14

13

12

10

0.2

0.2

0,2

0.3

0.4

0.9

0.9

0.7

0.6

0.6

0.6

0.5

0.4

0.4

0.3

0.3

0.4

0.4

0.5

1.5

1.4

1.1

1.0

1.0

0.9

0.6

0.7

0.6

0.2

0.3

0.3

0.4

0.6

0,9

1.1

0.7

0.7

0.7

0.7

0.7

0.5

0.4

13

8

7

9

11

12

16

16

16

15

14

12

11

9

16

8

7

9

12

13

21

19

19

18

18

14

12

11

11

8

6

9

11

11

13

14

13

13

12

11

10

9

3,863

162

366

454

452

191

217

489

454

336

230

289

166

56

1,903

76

182

210

239

95

103

245

213

178

106

141

93

21

1,960

64

173

244

213

96

114

254

241

160

125

148

93

35

17

10

9

13

15

18

21

22

19

16

14

13

12

9

19

10

10

13

15

18

24

26

22

21

15

15

12

*12

15

10

9

12

15

18

17

19

17

15

13

12

13

8

0.3

0.4

0,3

0.4

0.6

1.0

1.0

0.6

0.7

0.7

0.8

0.7

0.8

1.1

0.4

0.6

0.5

0.6

0.6

1.3

1,9

1.4

1,2

1.3

1.1

1.3

1.1

*

0.3

0.6

0.4

0.5

1.0

1.6

1.1

0,9

0.8

0,8

0.7

0.8

1.1

0.9

13

9

9

11

13

16

17

17

16

15

11

10

10

7

15

10

9

12

14

17

22

22

19

18

12

11

10

%

12

9

8

11

12

15

15

15

13

13

11

9

10

7

4,596

163

402

603

727

269

270

666

472

366

196

305

111

42

2,250

89

166

281

344

129

139

349

225

181

36

152

60

19

2,348

74

216

328

363

140

131

317

247

165

Icnl

153

51

23

15

9

9

11

13

14

18

18

18

17

14

12

11

9

17

9

9

11

13

16

20

21

21

20

16

16

13

‘9

13

9

6

10

13

13

15

15

14

14

13

9

10

w

0.3

0.4

0.3

0.3

0.4

0.7

1.0

0.6

0.8

0.7

0.7

0.6

1.0

0.8

0.5

0.7

0.6

0.6

0.6

1.3

1.6

0.9

1.6

1.2

1.2

1.1

1.6

●

0.3

0.5

0.4

0.4

0,5

0.7

1.0

0.7

0.7

0.7

0.6

0.5

1.3

*

12

6

7

9

11

12

14

16

14

15

13

10

9

6

14

8

7

9

11

13

16

18

17

16

15

12

10

*8

11

9

7

8

10

11

12

12

11

13

11

6

7

*6

‘Includes data for rsse/athnioity groups not shown separately.

2Excludesnursing infants and ohildran.
Table 9. Cholesterol Intake In milligrams by age, eex and rsce/ethnicity United Ststee, 1988-91

Totalpopu/at/orr’ Non-Hispanic whrle Non-Hispanic black Mexican American

Standard Standard Standard

Sample

Standard

error of Sampla error of

Sex and age

Sample error of

size Maan the mean Median

Sample

size Mean

error of

the mean Median size Mean the mean Median size Mean tha mean Median

8oth sexes

Allagesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n yeara . . . . . . . . . . . . . . . . .

12–15years. . . . . . . . . . . . . . . .

16-19years, . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

5H9years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . .

Male

All ages2 . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5yeare . . . . . . . . . . . . . . . . .

&-n yeare . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

4&49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69yeara . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

Female

All ages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2yaars2 . . . . . . . . . . . . . . . . .

3-6years . . . . . . . . . . . . . . . . .

6-n yeara . . . . . . . . . . . . . . . . .

12–15yeara . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yeare . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . .

14,801

87~

1,231

1,547

1,745

711

765

1,662

1,528

1,226

929

1,106

651

609

7,322

439

801

744

868

338

368

644

735

626

473

546

444

296

7,479

432

630

603

877

373

397

838

791

602

456

560

407

313

270

79

180

194

225

249

292

319

311

285

270

257

224

203

322

79

186

196

234

293

372

395

375

338

322

312

267

257

221

78

174

192

215

202

210

244

249

235

222

210

193

174

4.0

4.3

5.7

5.4

6.1

11.0

12.3

9.7

9.7

9.1

9.3

9.5

6.0

9.7

6.6

5.1

7.5

6.6

7.7

16.4

16.4

14.6

14.9

13.5

13.1

14.4

11.6

15.7

4.3

5.7

6.9

6.9

7.7

10.8

10.6

8.4

8.8

8.6

9.9

9.2

8.6

9.6

206 5,760

473

424

425

511

221

245

460

550

467

472

493

536

501

2,887

241

202

219

252

98

112

216

271

243

251

247

285

250

2,693

232

222

206

259

123

133

244

279

224

221

246

253

251

261

74

168

175

208

222

284

301

307

281

286

252

219

200

312

73

173

179

211

262

362

378

372

329

320

306

264

253

213

75

162

171

205

161

204

230

242

232

217

204

187

172

4.8

3.9

7.0

7.2

7.7

12.1

16.3

13.2

12.0

10.7

9.7

10.5

7.5

7.9

7.9

4.7

9.3

8.7

9.2

18.1

24,6

20.9

18.2

15.2

13.3

15.8

200

53

127

132

172

183

217

3,883

162

355

454

452

191

217

301

80

205

221

256

301

318

379

6.1

8.5

8.7

7.9

10.5

20.8

19.1

17.5

15.8

18.6

15.4

16.3

14.7

32.8

224

52

165

170

198

209

246

278

241

225

219

199

221

145

264

57

171

172

216

240

310

344

300

311

233

280

225

*276

195

47

158

167

179

169

200

241

199

191

206

151

215

125

4,596

163

402

609

727

269

270

666

472

366

196

305

111

42

2,250

89

186

261

344

129

139

349

225

181

96

152

60

19

2,348

74

216

328

383

140

131

317

247

185

100

153

51

23

324

114

249

269

273

286

332

386

360

354

321

284

274

f’240

378

122

252

273

299

343

371

461

434

421

363

354

310

%?92

267

104

246

264

247

236

287

295

283

264

264

227

243

WI

4.6

12.6

11.3

10.7

10.7

19.2

19.4

16.2

18.0

17.4

22.7

16.1

27.1

●

7.6

15.2

17.0

14.9

16.7

31.5

27.4

23.9

28.8

25.6

35.6

23.8

36.8

*

5.3

16.5

11.8

12.4

10.5

16.2

20.9

14.7

15.0

16.7

20.4

15.7

31.3

*

243

54

135

150

180

189

221

237

238

226

215

193

178

154

244

57

137

153

192

224

287

291

289

271

270

237

219

191

173

50

131

145

169

162

161

194

196

183

176

164

157

134

62

211

206

206

214

262

281

262

299

247

230

227

*209

269

73

223 488

236 454 334

224

210

186

176

154

237

55

129

138

181

338 321

230 272

289 268

186

56

1,903

78

182

210

239

95

259

247

358

82

210

220

277

327

409

474

417

409

299

340

276

%38

250

76

200

222

234

275

10.4

10.8

11.4

10.6

13.5

28.9

30.7

30.0

26.5

31.7

24.1

24.3

21.9

*

209

205

225

208 252

281 103 306

275 245

213

178

369

290 322

256

271

232

217

190

168

50

123

121

348

297

296

244

*235

105

141

93

21

f ,960

64

173

244

213

96

114

254

10.5

12.4

5.2

5.5

8.9

10.2

10.7

12.3

14.4

11.3

11.2

11.5

10.9

10.3

8.5

8.5

6.4

12.1

12.5

10.9

15.1

27.4

17.1

15.3

15.0

15.5

18.3

19.0

18.4

31.7

205

53

219

206

163 191

187

219

160

154

177

194

182

173

162

154

134

232

298 225

241 264

246

201

223

214

178

220

*I 96

160

125

148

93

35

252

214

246

205

‘ hcludee dsts for racelsthnic”~ groups not shown aeparetely.

2Excludss nursing infants and children.
Table 10. Percent of calories from carbohydrate by age, sex and race/ethnlcky: United States, 196S-91

Totalpopulation’ Non-Hispsrricwhite Non-Hispanic blaok MexioenArrerioan

Standard

Sample

Standard Standanl

enw of

standard

Sample

Sex and age

error of Sample

size

envr of sample

Mean the mean size Mean the mean

errvr of

size Maen the mean size Mean the mean

13th sexes

Allagesz . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

8-n years . . . . . . . . . . . . . . . . .

12-15yesrs . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearaandover . . . . . . . . . . . ,

Male

Ailagesz. . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . ,.

3-5years . . . . . . . . . . . . . . . .

S-n years . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

15-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59yeara . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

Female

Allageaz, . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2yeara2 . . . . . . . . . . . . . . . . ,

3-5yeara . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12-15years. . . . . . . . . . . . . . . ,

16-19yeara . . . . . . . . . . . . . . . .

20-29yeare . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59yeara . . . . . . . . . . . . . . . .

50-59yearad . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yaarsandover . . . . . . . . . . . .

14,801

871

1,231

1,547

1,745

711

765

1,882

1,526

1,228

929

1,106

851

609

7,322

439

601

744

653

338

36s

844

735

626

473

546

444

286

7,479

432

630

603

877

373

397

838

791

602

465

560

407

313

50.1

52.5

53.1

54.6

53.2

54.2

51.0

46.6

48.5

47.9

48.1

50.0

51.1

53.4

49.2

52.7

53.2

54.8

53.5

54.0

49.8

47.6

47.4

46.9

46.3

48.7

49.4

51.2

51.1

52.4

53.0

54.4

52.9

64.4

52.4

50.0

49.7

49.0

49.8

51.1

52.4

64.5

0.2

0.5

0.4

0.4

0.3

0.6

0.6

0.4

0.4

0.5

0.6

0.6

0.6

0.6

0.3

0.8

0.6

0.5

0.5

0.6

0.7

0.5

0.6

0.7

0.8

0.7

0.8

0.9

0.3

0,6

0.5

0.5

0.5

0.8

0.9

0.6

0.6

0.7

0.7

0.7

0.8

0.8

5,780

473

424

425

511

221

245

460

550

467

472

493

538

501

2,887

241

202

219

252

98

112

216

271

243

251

247

285

250

2,893

232

222

206

259

123

133

244

279

224

221

246

253

251

50.1

53.2

63.9

55.3

53.7

55.4

50.9

48.7

48.5

47.7

47.9

50.0

51.2

53.2

49.2

53.8

54.0

55.3

54.2

54.8

49.4

47.3

47.5

47.0

46.0

48.7

49,3

51.1

51.1

52.8

53.7

55.3

53.1

56,0

52.5

49.9

49.5

48.4

49.6

51.1

52.6

54.4

0.3

0.5

0.6

0.5

0.5

0.9

0.6

0.8

0.6

0.6

0.6

0.6

0.6

0.5

0.4

0.6

0.8

0.7

0.8

1.1

1.0

0.8

0.7

0.8

0.8

0.8

0.7

0.7

0.4

0.7

0.7

0.7

0.7

1,2

1.2

0.8

0.8

0.9

0.8

0,9

0.8

0.7

3,8a3

162

355

454

452

191

217

499

454

338

230

289

188

56

1,203

78

182

210

239

95

103

245

213

178

105

141

93

21

1,980

64

173

244

213

96

114

254

241

160

125

148

93

35

49.0

51.8

50.8

52.2

51.3

51.0

50.1

47.0

47.6

46.6

48.8

49.4

49.4

54.7

48.0

50.5

51.1

52.5

50.9

52.5

48.8

45.7

46.0

44.3

47.0

47.0

48.8

●49.6

49.9

53.0

50.5

51.9

51.7

49.4

51.4

48.1

46.9

48.5

49.9

51.2

49.9

57.0

0.3

0.8

0.8

0,5

0.5

0.9

0.7

0.6

0.7

0.8

0.9

0.9

1.1

1.9

0.5

1.2

0.9

0.8

0.8

1.3

1.0

0.9

1.0

1.2

1.4

1.4

1.7

*

0.4

1.0

0.8

0,6

0.7

1,1

0.9

0.7

0.6

0.9

1.1

1.1

t .3

1.9

4,598

163

402

609

727

269

270

668

472

366

188

305

111

42

2,250

89

188

281

344

128

139

349

225

181

88

152

60

19

2,348

74

216

328

383

140

131

317

247

185

100

153

51

23

50.8

50.3

51.0

53,6

52.0

51,1

50.0

50.2

49.4

49.3

49.9

51.2

53.3

*51 .4

49.7

50.5

50.9

54.7

52.1

50.2

49.3

49.6

47.3

47.3

48.9

49.9

52.0

*49,7

51.5

50.0

51.2

52.4

51.8

61.9

50.7

50.9

51.6

51.4

50.8

52.2

64.5

●52.3

0.4

1.0

0.8

0.6

0.6

0.9

0.9

0.6

0.8

0.9

1.2

1.1

1.6

*

0.6

1.3

1.0

0.8

0.8

1.1

1.2

0.7

1.1

1.2

1.5

1.3

1.9

*

0.6

1.1

1.0

0.6

0.6

1.0

1,1

0.7

0.8

1.0

1.4

1.2

1.8

●

‘Indudesdatefor race/ethnidtygroups notslwmsqerately.

2Exdudee nursing infants and children,
Table 11. Percent of calories from protein by age, sexj and race/ethnicity United States, 198S-91

Total population’ Norl+f@?rlic white Non-Hispanic black Mexican Amerioen

Standard Sterrdard Standard Standard

Sample error of Sample error of

Sex and age

Sample error of Sample

size Meen the mean size Mean the mean size Mean

error of

the mean size Mean the mean

6oth sexes

Allagesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

6r389yeare . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . .

60yeareand over . . . . . . . . . . . .

Male

Allages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

4049yeers . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . .

Female

All ages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

8-llyeers . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . .

40-i9years . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-89years . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yeamandOver . . . . . . . . . . ,.

14,801

871

1,231

1,547

1,745

711

765

1,682

1,526

1,228

929

1,106

851

609

7,322

439

601

744

866

338

368

844

735

626

473

546

444

296

7,479

432

630

803

877

373

397

636

791

602

456

560

407

313

15.1

11.5

14.9

14.3

14.4

13.8

14.3

14.6

15.2

15.7

16.1

16.5

16.3

15.9

15.1

11.8

15.0

14.3

14.2

14.2

14.4

14.6

15.1

15.6

16.1

16.4

16.0

16.0

15.2

11.2

14.9

14.3

14.5

13.5

14.1

14.5

15.3

15.8

16.1

16.6

16.6

15.9

0.1

0.2

0.1

0.1

0.1

0.2

0.2

0.2

0.2

0.2

0.2

0.2

0.2

0.3

0.1

0.3

0.2

0.2

0.2

0.3

0.3

0,2

0.2

0.3

0.3

0.3

0.3

0.4

0.1

0.2

0.2

0.2

0.2

0.3

0.3

0.2

0.3

0.3

0.3

0.3

0.3

0.4

5,780

473

424

425

511

221

245

460

550

467

472

493

538

501

2,887

241

202

219

252

98

112

216

271

243

251

247

285

250

2,893

232

222

206

259

123

133

244

279

224

221

246

253

251

15.0

11.8

14.7

14.1

14.1

13.5

i 4.2

14.2

15.2

15.3

16.1

16.4

16.2

15.6

14.8

11.9

14.8

14.2

13.7

13.9

14.2

14.0

15.0

15.1

16.0

16.3

15.9

15.7

15.1

11.6

14.6

14.1

14.4

13.1

14.2

14.3

15.4

15.4

16.1

16.4

16.4

15.9

0.1

0.2

0.2

0.2

0.2

0.3

0.3

0.2

0.2

0.2

0.2

0.2

0.2

0.2

0.1

0.3

0.3

0.3

0.3

0.5

0.4

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.1

0.3

0.2

0.2

0.3

0.4

0.4

0.3

0.3

0.4

0.3

0.3

0.3

0.3

3,883

162

355

454

452

191

217

499

454

336

230

289

166

56

1,903

76

182

210

239

95

103

245

213

178

105

141

93

21

1,960

84

i 73

244

213

96

~14

254

241

160

125

148

93

35

15.0

10.2

14.9

14.1

14.4

14.0

14.1

14.8

14.9

16.1

15.7

16.7

17.2

16.5

15.2

10.8

14.8

13.8

14.7

13.6

14.5

15.2

15.0

16.4

16.1

17.2

17.1

●18,9

14.6

9.8

14.9

14.3

14.2

14.1

13.7

14.5

14.8

15.7

15.4

16.2

17.3

15.5

0.1

0.3

0.2

0.2

0.2

0.4

0.3

0.2

0.3

0.4

0.4

0.4

0.5

1.0

0.1

0.4

0.3

0.2

0.3

0.5

0.5

0.3

0.4

0.7

0.7

0.6

0.7

*

0.1

0.3

0.3

0.2

0.3

0.5

0.4

0.3

0.3

0.5

0.4

0.5

0.6

0.9

4,598

163

402

609

727

269

270

668

472

386

198

305

111

42

2,250

89

186

281

344

129

139

349

225

181

86

152

60

19

2,346

74

216

328

383

140

131

317

247

185

100

153

51

23

15.6

11.8

15.7

14.8

15.2

15.3

15.2

16.0

15.6

15.7

16.8

17.0

17.0

*1 5.2

15.6

12.4

15.3

14.6

15.3

15.8

15.1

18.0

15.8

15.6

16.3

16.5

17.8

*1 7.6

15.6

11.1

16.1

14.9

15.0

14.7

15.3

15.9

15.4

75.6

17.3

17.5

16.4

*1 3.9

0.1

0.4

0.3

0.2

0.2

0.3

0.4

0.2

0.3

0.3

0!4

0.3

0.5

*

0.1

0.6

0.3

0.2

0.2

0.4

0.5

0.3

0.4

0.4

0.5

0.4

0.7

●

0.1

0.5

0.4

0.2

0.2

0.4

0.5

0.3

0.4

0.4

0.6

0.5

0.7

*

‘Includes data for race/ethnic”ky groups not shown separately.

‘Excludes nursing infants and children.
Table 12. Percent of calorles ftom alcohol by age, sex, end race/ethnlclty United States, 1988-91

Totalpopufetiorr’ Norr-H@anic white Norr-Hisperrioblack MexioerrAmerican

standard

.9urrple

Standard

error of

standard

Safrrpfe error of

Standard

Sample

Sex and age size Mean*

enur of Sample error of

the mean size Meerr2 themean 5128 Mearr2 fhe mean size Mean* themean

Both sexes

Allageea . . . . . . . . . . . . . . . . . .

2–llmonths3 . . . . . . . . . . . . . . .

l–2yeare3 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

S-n years. . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yeara . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

Male

Allages3 . . . . . . . . . . . . . . . . . .

2-llmonths3 . . . . . . . . . . . . . . .

l-2years3 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

S-n years. . . . . . . . . . . . . . . . .

12-15yeara . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

SOyearsandover . . . . . . . . . . . .

Female

Allages3 . . . . . . . . . . . . . . . . . .

2-llmonths3. . . . . . . . . . . . . . .

l-2years3 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

(+-l lyears . . . . . . . . . . . . . . . .

12-15yeara . . . . . . . . . . . . . . . .

i6-19years . . . . . . . . . . . . . . . .

20-29years. ..,....,...,.. .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

14,601

871

1,231

1,547

1,745

711

765

1,662

1,526

1,228

923

1,106

661

609

7,322

439

601

744

666

388

366

644

735

626

473

546

444

286

7,479

432

630

603

877

373

397

638

791

602

456

560

407

313

2.3

0,0

0.0

0.0

0.0

0.0

1.6

3.9

3.3

3.3

2.7

2,3

1.7

0.9

3.1

0.0

0.0

0.0

0.0

0.0

2.6

4.9

4,3

4,9

3.4

3.2

2.7

1,5

1.6

0.0

0.0

0.0

0.0

0.0

0.6

3.0

2.4

1.8

2.1

1.5

0.9

0.6

0.1

0.0

0.0

0.0

0.0

0.0

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.2

0.2

0.0

0.0

0.0

0.0

0.0

0.5

0.4

0.4

0.5

0.5

0.4

0.5

0.3

0,2

0.0

0.0

0.0

0.0

0.0

0.2

0.4

0.3

0.3

0.4

0.3

0.3

0.2

5,760

473

424

425

511

221

245

460

550

467

472

493

536

501

2,887

241

202

219

252

86

112

218

271

243

251

247

265

250

2,893

232

222

206

259

123

133

244

279

224

221

246

253

251

2.4

0.0

0.0

0.0

0.0

0.0

2.0

4.5

3.2

3.5

2.8

2.4

1.8

1.0

3,2

0.0

0.0

0.0

0.0

0.0

3.2

6.4

4.0

4.8

3.3

3.2

2.9

1.6

1.8

0.0

0.0

0.0

0.0

0.1

0.8

3.6

2,3

2.1

2.3

1.7

1.0

0.6

0.2

0.0

0.0

0.0

0.0

0.0

0.5

0.5

0.4

0.4

0.4

0.3

0.3

0.2

0.3

0.0

0.0

0.0

0.0

0.0

0.6

0.7

0.5

0.6

0.5

0.5

0.5

0.3

0.2

0.0

0.0

0.0

0,0

0.1

0.4

0.7

0.4

0.5

0.5

0.3

0.3

0.2

3,863

162

355

454

452

191

217

499

454

336

230

289

166

56

1,903

78

182

210

239

95

103

245

213

178

105

141

93

21

1,960

84

173

244

213

96

114

254

241

160

125

148

93

35

i .9

0.0

0.0

0.0

0.0

0.0

0.6

2.7

4.1

3.4

2.6

1.6

0.7

0.0

2.9

0.0

0.0

0.0

0.0

0.0

0.9

4.4

5.8

5.5

4.8

3.4

1.4

0.0

1.0

0.0

0.0

0.0

0.0

0.0

0.2

1.3

2.6

1.6

1.4

0.5

0.2

0.0

0.1

0.0

0.0

0.0

0.0

0.0

0.2

0.3

0.5

0.5

0.5

0.4

0.4

0.0

0.3

0.0

0.0

0.0

0.0

0.0

0.4

0.5

0.8

0.8

1.0

0.8

0.6

0.0

0.1

0,0

0.0

0.0

0.0

0.0

0.1

0.3

0,5

0!5

0.6

0.3

0.2

0,0

4,598

163

402

609

727

269

270

666

472

366

196

305

111

42

2,250

89

186

281

344

129

139

349

225

181

96

152

60

19

2,348

74

216

328

383

140

131

317

247

165

100

153

51

23

1.6

0.0

0.0

0.0

0.0

0.0

1.2

2.2

3.3

3.5

2.3

1.2

0.3

0.0

2.5

0.0

0.0

0.0

0.0

0.0

1.8

3.3

4.9

5.8

3.1

2.1

0.4

0.0

0.7

0.0

0.0

0.0

0.0

0.1

0.4

0.9

1.6

1.0

1.6

0.4

0,2

0.0

0.1

0.0

0.0

0.0

0.0

0.0

0,3

0.2

0.4

0.4

0.4

0.2

0.2

0.0

0.2

0.0

0.0

0.0

0.0

0.0

0.6

0.4

0.6

0,8

0.7

0.4

0.3

0.0

0.1

0.0

0.0

0.0

0.0

0.1

0.2

0.3

0.4

0.3

0.6

0.2

0.1

0.0

‘Includesdatafor rsccdethfdty groups not sfwm aeperetely.

2Eetimetaeofperaant ofosf~”esfromrdoofvi aravewskewad; therneenendafardard erre+efthemeen eheddbeusadsnd hterpretedwitlrexlreme saution,

3Excludesnuraing hfantsanddrildren.
Table 13. Percent of calories from total fat by age, sex and race/ethniciW United States, 196s-91

Totalpopulation’ Non-H/span;owhite Non-Hispanic black Mexican American

Standard Standard

Sample

Standard

error of Sample

Standard

error of Sarrrp/e

Sex and age

error of SSrrrple error of

size Mean the mean size Mean the mean size Mean the mean size Mean the mean

Both sexes

Allagesz . . . . . . . . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . . . . . . . . .

80years Andover . . . . . . . . . . . . . . . . . . .

Male

All agesz . . . . . . . . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . . . . . . . . .

2&29yeara . . . . . . . . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . . . . . . . . .

60yearaandover . . . . . . . . . . . . . . . . . . .

Female

Allages2 . . . . . . . . . . . . . . . . . . . . . . . . .

2–ilmonths2 . . . . . . . . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . . . . . . . . .

&-5yeara . . . . . . . . . . . . . . . . . . . . . . . .

e-n years . . . . . . . . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . . . . . . . . .

70-79yeara . . . . . . . . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . . . . . . . . .

14,801

871

1,231

1,547

1,745

711

765

1,682

1,526

1,228

929

1,106

851

609

7,322

439

601

744

866

33a

368

844

735

626

473

546

444

296

7,479

432

630

803

877

373

397

636

791

602

456

560

407

313

34.0

37.2

33.7

32.9

34.0

33.4

34.5

34.0

34.4

34.4

34.7

33.0

32.9

32.0

34.1

36.9

33.5

32.8

33.9

33.1

34.6

34.0

34.6

33.9

35.7

33.3

33.8

33.3

33.9

37.6

34.0

33.1

34.2

33.7

34.4

34.0

34.2

34.9

33.8

32.8

32.3

31.3

0.2

0.4

0.3

0.3

0.3

0.5

0.5

0.3

0.4

0.4

0.5

0.5

0.5

0.5

0.3

0.6

0.5

0.4

0.4

0.6

0.6

0.4

0.5

0.5

0.6

0.6

0.6

0.7

0.3

0.6

0.4

0.4

0.4

0.7

0.7

0.5

0.5

0.6

0.7

0.6

0.7

0.7

5,780

473

424

425

511

221

245

460

550

467

472

493

538

501

2,667

241

202

219

252

98

112

216

271

243

251

247

265

250

2,693

232

222

206

259

123

133

244

279

224

221

246

253

251

34.1

36.4

33.5

32.7

34.0

32.6

34.3

34.0

34.7

35.1

35.0

33.2

32.9

32.2

34.4

35.8

33.1

32.7

33.6

32.7

34.4

34.4

34.9

34.6

36.2

33.4

33.9

33.7

33.8

37.1

33.8

32.7

34.2

32.5

34.1

33.7

34.5

35.6

33.9

33.0

32.3

31.4

0.2

0.4

0.4

0.4

0.4

0.6

0.6

0.5

0.4

0.5

0.5

0.5

0.4

0.4

0.3

0.6

0.6

0.5

0.5

0.9

0.8

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.3

0.6

0.5

0.6

0.6

0.9

1.0

0.6

0.6

0.7

0.7

0.7

0.7

0.6

3,663

162

355

454

452

191

217

499

454

338

230

289

186

56

1,903

78

182

210

239

95

103

245

213

178

105

141

93

21

1,960

64

173

244

213

96

114

254

241

160

125

146

93

35

35.3

39.0

35.6

35.2

35.6

36.4

36.5

36.4

34.5

35.0

33.9

33.5

34.1

30.3

34.9

39.8

35.2

36.2

35.6

34.9

36.6

35.5

34.1

34.6

33.2

33.4

34.1

%2.4

35.5

38.2

36.0

35.2

35.5

37.9

36.2

37.2

34.8

35.4

34.5

33.5

34.2

29.4

0.3

0.7

0.5

0.4

0.4

0.7

0.6

0.5

0.5

0.6

0.7

0.6

0.9

1.3

0.4

1.0

0.7

0.6

0.6

1.0

0.8

0.7

0.8

0.9

1.2

1.1

1.4

*

0.4

0.9

0.7

0.5

0.6

1.0

0.8

0.6

0.7

0.8

0.9

1.0

1.2

1.5

4,596

163

402

608

727

269

270

666

472

366

196

305

111

42

2,250

89

186

281

344

128

139

349

225

161

96

152

60

19

2,348

74

216

326

383

140

131

317

247

185

100

153

51

23

33.5

38.8

34.8

33.2

34.4

35.0

34.9

32.9

33.1

32.7

32.2

32.0

30.8

*34.6

33.3

38.0

35.3

32.2

34.1

35.2

34.8

32.2

33.2

32.5

32.6

32.7

31.1

33.7

33.7

39.8

34.2

34.3

34.7

34.8

35.0

33.7

33.0

33.0

31.6

31.5

30.6

*35.1

0.3

0.9

0.6

0.5

0.4

0.7

0.7

0.5

0.6

0.7

0.9

0.8

1.2

*

0.4

1.2

0.8

0.6

0.6

0.9

0.9

0.6

0.9

0.9

1.2

1.0

1.5

●

0.4

1.0

0.7

0.5

0.5

0.6

0.6

0.6

0.7

0.8

1.1

0.9

1.4

*

‘Includes data for rwelethnicity groups not shown separately.

2 Excludes nursing infants and children.
Table 14. Percent of calories from saturated fat by age, sex and race/athnlc@ United States, 1968-91

Totalpopulation’ Non-Hispanic white Non-Hispanic black Mexiosn Arnwicen

Standard

Sample

standard Standstd

anvr of

standard

Sample

Sex and age

enw of sample error of Sample

size Mesn the mean size Mean the mean size Maan

error of

the mean size Mean the mean

Both sexes

Allages2 . . . . . . . . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . .

12–15years, . . . . . . . . . . . . . . . . . . . . . .

l%19years . . . . . . . . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . . . . . . . . .

30-39years. . . . . . . . . . . . . . . . . . . . . . .

40-49yaars . . . . . . . . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . . . . . . . . .

60-69yeara . . . . . . . . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . . . . . . . . .

60yeamandover . . . . . . . . . . . . . . . . . . .

Male

iUlages2 . . . . . . . . . . . . . . . . . . . . . . . . .

2-llmonths2. . . . . . . . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . ..e . . . . . . . .

12-15yeers. . . . . . . . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . . . . . . . . .

20-29years. . . . . . . . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . . . . . . . . .

40-49yeare . . . . . . . . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . . . . . . . . .

70-79yaars . . . . . . . . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . . . . . . . . .

Female

Allages2. ,, . . . . . . . . . . . . . . . . . . . . . .

2-llmonths2. . . . . . . . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . . . . . . . . .

3-5years . .,, , . . . . . . . . . . . . . . . . . . .

O-n years, .,, . . . . . . . . . . . . . . . . . . . .

12–15yeara . . . . . . . . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . . . . . . . . .

20-29years. . . . . . . . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . . . . . . . . .

40-49yeare . . . . . . . . . . . . . . . . . . . . . . .

50-59yeare, . . . . . . . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . . . . . . . . .

60yeareandover . . . . . . . . . . . . . . . . . . .

14,601

871

1,231

1,547

1,745

711

766

1,662

1,526

1,226

928

1,106

661

609

7,322

439

601

744

m

336

36a

644

735

626

473

546

444

296

7,479

432

630

803

677

373

397

638

791

602

466

660

407

313

12.0

15.8

13.9

12.6

12.7

12.2

12,5

12.0

11.9

11.6

11.6

11.2

11.2

11.0

12.1

15.8

13.8

12.6

12,8

12.4

12.6

12.0

11.9

11.4

11.6

11.3

11.6

11.4

11.9

15.9

13.9

12.6

12.7

12.0

12.3

11.9

11.9

11.8

11.4

11.0

10.8

10.8

0.1

0.2

0.2

0.1

0.1

0.2

0.2

0.1

0.2

0.2

0.2

0.2

0.2

0.2

0.1

0.3

0.2

0.2

0.2

0.3

0.3

0.2

0.2

0.2

0.2

0.3

0.3

0.3

0.1

0.3

0.2

0.2

0.2

0.3

0.4

0.2

0.2

0.2

0.3

0.3

0.3

0.3

5,760

473

424

425

511

221

245

460

550

467

472

493

638

601

2,637

241

202

219

252

86

112

216

271

243

251

247

2&5

260

2,683

232

222

206

253

123

133

244

279

224

221

245

263

251

12,1

15.7

13.8

12.5

12.9

12.0

12,5

12,1

12.2

11.9

11.7

11.3

11.1

11.1

12,2

15.6

13.7

12.7

12,9

12.4

12.6

12.4

12.2

11.6

12.1

11.5

li.7

11.6

11.9

15.9

13.9

12.4

12.8

11.6

12.2

11.9

12.2

12!2

11,3

11.1

10.7

10.8

0.1

0.2

0.2

0.2

0.2

0,3

0,3

0.2

0.2

0.2

0.2

0.2

0.2

0.2

0.1

0.3

0.3

0.3

0.2

0.3

0.3

0.3

0.2

0.2

0.2

0.3

0.3

0.2

0.1

0.3

0.3

0,2

0.2

0.4

0.4

0,3

0,3

0.3

0.3

0.3

0.3

0.2

3,68i3

162

356

454

452

191

217

498

464

336

230

289

166

56

1,303

78

182

210

239

95

103

245

213

176

105

141

83

21

1,980

84

173

244

213

86

114

254

241

180

125

146

83

35

12,0

15.9

13.7

12.9

12.6

12.7

12,6

12,2

11.2

11.5

11.5

10.9

11.3

10.2

11.9

15.9

13.6

13.0

12,8

12.2

12.8

11.8

11.1

11.5

10.6

11.1

11.5

*I 1.0

12.1

15.6

13.9

12.7

12.5

13.3

12.7

12.6

11.3

11.5

12.1

10.7

11.2

9.8

0.1

0.4

0.2

0.2

0.2

0.3

0.3

0.2

0.2

0.2

0.3

0.3

0.4

0.5

0.1

0.6

0.3

0.3

0.3

0.4

0.3

0.3

0.3

0.4

0.4

0.4

0.5

*

0.1

0.5

0.3

0.2

0.2

0.4

0.4

0.3

0.3

0.3

0.4

0.4

0.5

*

4,598

163

402

609

727

269

270

666

472

366

186

305

111

42

2,260

69

186

261

344

128

139

349

225

181

86

152

60

19

2,346

74

216

326

363

140

131

317

247

185

100

163

51

23

12.0

16.5

14.2

12.7

12.9

13.2

12.4

11.3

11.6

10.9

10.7

10.9

10.3

*1 2.4

11.6

16.6

14.4

12.2

12.8

13.2

12.3

10.9

11.5

10.7

10.8

11.0

10.4

*I 1.6

12.1

16.4

14,0

13,1

13.0

13.1

12.5

11.7

11,6

11.1

10.7

10.9

10.2

*1 2.7

0.1

0.4

0.3

0.2

0.2

0.4

0.4

0.2

0,3

0.3

0.4

0.4

0.5

*

0.2

0.6

0.4

0.3

0.3

0.4

0,5

0.3

0.4

0.4

0.6

0.5

0.7

*

0.2

0.5

0.4

0.3

0.2

0.4

0.5

0.3

0,3

0.4

0.5

0.5

0.7

*

‘Indudss data for rsce/ethnicilygroups not skwm separately

2Excludesnursing infants andshildren.
Table 15. Percent of calories from monounaaturated fat by age, se% and race/ethniclv United States, 1986-91

Total population’ Non-H!apanlc white Non-Hispanic black Mexican Arrreriwr

Standard Standard

Sample

standard

error of Sample

Standard

error of Sample

Sex and age

error of Sample error of

size Mean the mean size Mean the mean size Mean the mean size Mean the mean

Both sexes

Allages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

O-n years . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

18-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yaars . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59yeara . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

Male

All ages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

&-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yaars . . . . . . . . . . . . . . . .

4H9yeafa . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

80-89yeara . . . . . . . . . . . . . . . .

70-79yeafs . . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

Female

Ail agea2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5yaars . . . . . . . . . . . . . . . . .

S-llyaars . . . . . . . . . . . . . . . . .

12–15yeara . . . . . . . . . . . . . . . .

16-19yeara . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yaars . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

80-89years . . . . . . . . . ..c... .

7Ct-79years . . . . . . . . . . . . . . . .

Qnveafeandover ...,, . . . . . . . “- ,

14,801

871

1,231

1,547

1,745

711

765

1,882

1,528

1,228

929

1,108

851

609

7,322

439

601

744

8W

336

386

844

735

626

473

546

444

296

7,479

432

630

803

877

373

397

838

791

602

456

560

407

313

12.5

9.2

12.1

12.1

12.6

12.5

12.8

12.5

12.8

12.7

12.9

12.3

12.1

11.9

12.7

9.2

12.1

12.1

12.6

12.5

13.1

12.7

13.1

12.6

13.4

12.5

12.7

12.7

12,4

9.2

12.2

12.2

12.6

12.6

12.6

12.4

12.5

12.8

12.4

12.1

11.7

11.5

0.1

0.2

0.2

0.1

0.1

0.2

0.2

0.1

0.2

0.2

0.2

0.2

0.2

0.2

0.1

0.3

0.2

0.2

0.2

0.3

0.3

0.2

0.2

0.2

0.3

0.3

0.3

0.3

0.1

0.3

0.2

0.2

0.2

0.3

0.3

0.2

0.2

0.3

0.3

0.3

0.3

0.3

5,760

473

424

425

511

221

245

460

550

467

472

493

538

501

2,667

241

202

219

252

98

112

216

271

243

251

247

285

250

2,893

232

222

206

259

123

133

244

279

224

221

246

253

251

12.8

9.1

12.1

12.1

12.6

12.3

12.8

12.6

12.9

12.9

13.0

12.3

12.2

12.0

12.8

9.0

12.0

12.1

12.6

12.3

12.9

12.9

13.2

12.8

13.6

12.6

12.7

12.9

12.4

9.2

12,2

12.1

12.6

12.2

12.6

12.3

12.6

13.0

12.3

12.1

11.7

11.5

0.1

0.2

0.2

0.2

0.2

0.3

0.3

0.2

0.2

0.2

0.2

0.2

0.2

0.2

0.1

0.3

0.3

0.3

0.2

0.4

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.1

0.3

0.2

0.2

0.2

0.4

0.4

0.3

0.3

0.3

0.3

0.3

0.3

0.3

3,663

162

355

454

452

191

217

499

454

338

230

289

186

56

1,903

78

182

210

239

95

103

245

213

178

105

141

93

21

1,980

84

173

244

213

96

114

254

241

160

125

148

93

35

13.2

9.2

13.1

13.1

13.4

13.7

13.8

13.7

13.0

13.3

12.9

12.9

12.9

11.6

13.2

9.6

12.9

13.1

13.4

13.3

14.3

13.5

13.2

13.2

13.0

13.0

13.1

●12.3

13.2

9.0

13.2

13.1

13.4

14.1

13.4

13.8

12.9

13.4

12.7

12.8

12.8

*11 .2

0.1

0.3

0.2

0.2

0!2

0.3

0.3

0.2

0.2

0.3

0.3

0.4

0.4

0.8

0.2

0.5

0.3

0.3

0.3

0.4

0.4

0.3

0.4

0.4

0.5

0.5

0.6

*

0.2

0.4

0.3

0.2

0.2

0.4

0.3

0.3

0.3

0.3

0.4

0.5

0.5

*

4,598

183

402

6J39

727

269

270

666

472

366

1$)6

305

111

42

2,250

89

186

281

344

123

139

349

225

181

96

152

80

19

2,348

74

216

328

383

140

131

317

247

165

100

153

51

23

12.2

9.8

12.1

12.0

12.7

13.0

12.8

12.0

12.0

12.1

11.9

11.6

11.1

●13. 1

12.2

9.9

12.5

11.6

12.6

13.2

12.9

11.8

12.1

12.1

12.4

11.9

11.4

●13.O

12.2

9.7

11.7

12.5

12,7

12.9

12.7

12.3

11.9

12.1

11.4

11.4

10.8

*1 3.2

0.2

0.5

0.3

0.2

0.2

0.3

0.3

0.2

0.3

0.3

0.4

0.4

0.6

*

0.2

0.5

0.3

0.3

0.2

0.4

0.4

0.3

0.4

0.4

0.6

0.4

0.7

*

0.2

0.6

0.3

0.2

0.2

0.4

0.4

0.3

0.3

0.4

0.5

0.4

0.7

*

‘ hcludos data for racelsthnic”w groups not shown separately.

‘Excludss riming infsnb and ohildran.
Table 16, Percent of calorles from polyunsaturated fat by age, se~ and race/ethnlcity united States, 1986-91

Totsfpopulation’ Non-Hisparricwfv’te Norr-Hispsn/c blaok Mexiosn Arrreriosn

Stsndsnl

sample

Stsrrdsrd

errw of

standard

Sample

StSrrdtud

Sex and age

error of Ssmpfe

size Meen tfre mean

em-v of

size Mesrr

Sample enur of

tie mean size Mesrr tfre mean size Meen the mean

8oth sexes

AJlagssz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

O-n years. . . . . . . . . . . . . . . . .

12-15 years . . . . . . . . . . . . . . . .

16-19 year3 . . . . . . . . . . . . . . . .

20-29 years . . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . .

40-49 years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-59years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . ,

80yearsandover . . . . . . . . . . . .

Male

All ages2 . . . . . . . . . . . . . . . . . ,

2-llmonths2. . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5ysars . . . . . . . . . . . . . . . . .

a-n years............,.. . .

12-15yeam . . . . . . . . . . . . . . . .

16-19years. . . . . . . . . . . . . . . .

20-29years, . . . . . . . . . . . . . . .

30-39years, . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . ,

50-59years. .,, ,, . . . . . . . . . ,

60-69years, 4..,....,.,,,,.

70-79years . . . . . . . . . . . . . . . ,

EOyeareandover . . . . . . . . . . . ,

Female

Allagesz. . . . . . . . . . . . . . . . . .

2-llrnonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

&5ywm, ,, .,,....,,,,,,,

6-n years. . . . . . . . . . . . . . . . .

12–15yeare . . . . . . . . . . . . . . ,,

16-i9years. . . . . . . . . . . . . . . .

20-29years, . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40+9yeare . . . . . . . . . . ..m.. .

5&59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79yeare . . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

14,801

871

1,231

1,547

1,745

7il

765

1,682

1,526

1,228

928

1,105

851

609

7,322

439

601

744

863

336

356

844

735

626

473

546

444

296

7,478

432

630

803

877

373

397

838

791

602

456

580

407

313

6.9

9.0

5.3

5.8

8.2

6.2

6.6

6.9

7.1

7.5

7.5

6.9

7.0

6.6

6.7

6,6

5.2

5.7

6.0

5.8

6.3

6.6

7.0

7.3

7.7

6,7

6.8

6.5

7.1

9.3

5.4

5.8

6.4

6.6

7.0

7.2

7.2

7.6

7.4

7.1

7.2

6,6

0.1

0.2

0.1

0.1

0.1

0,2

0.2

0.1

0.1

0.2

0.2

0.1

0.2

0.2

0.1

0.3

O.i

0.1

0.1

0,2

0.2

0.2

0.2

0.2

0.2

0.2

0,2

0.2

0.1

0.3

0.1

0.1

0.2

0.3

0.2

0.2

0,2

0.2

0.2

0.2

0.2

0.2

5,780

473

424

425

511

221

245

480

550

467

472

493

638

501

2,887

241

202

219

252

98

112

216

271

243

251

247

285

250

2,883

232

222

206

259

123

133

244

279

224

221

246

253

261

6.9

8.5

5.1

5.7

6.1

6.0

6.5

6.8

7.0

7.6

7.7

7.0

7.1

6.7

6.7

8.2

5.0

5.6

5.8

5.6

6.2

6.6

6.9

7.5

7.7

6.8

6.8

6.6

7.0

8.0

5.3

5.8

6.4

6.3

6,6

7.1

7.1

7.7

7.6

7.2

7.2

6.7

0.1

0.2

0.1

0.1

0.1

0.2

0.2

0.2

0.2

0,2

0.2

0.2

0.2

0.2

0.1

0.3

0.2

0.2

0.2

0.4

0.3

0.3

0.2

0.3

0.3

0.2

0.2

0.2

0.1

0.3

0.1

0.2

0.2

0.3

0.3

0.2

0.2

0,3

0.3

0.2

0.3

0.2

3,883

162

355

454

452

191

217

499

454

338

230

289

186

66

1,803

78

182

210

239

95

103

245

213

176

105

141

93

21

1,880

84

173

244

213

96

114

254

241

160

125

148

93

35

7.3

10.5

6.1

6.5

6.9

7.2

7.2

7.7

7.5

7,5

6.6

7.0

7.1

5.9

7.0

10.9

6.0

6.5

6.8

6.8

6.9

7.4

7.1

7.2

6.8

6.6

6.6

%.1

7.5

10.2

6.3

6.6

7.0

7.7

7.4

8.0

7.9

7.8

6.9

7.2

7.5

5.6

0.1

0.4

0.1

0.1

0.2

0.3

0.2

0.2

0.2

0.2

0.2

0.2

0.3

0.3

0.1

0.6

0.2

0.2

0.2

0.3

0.3

0.2

0.2

0.3

0.3

0.3

0.4

*

0.1

0.5

0.2

0.2

0.3

0.5

0.4

0.3

0.3

0.3

0.3

0.3

0.4

0.4

4,598

163

402

w

727

269

270

666

472

366

185

305

111

42

2,250

89

166

261

344

128

139

349

225

181

88

152

60

19

2,343

74

216

328

383

140

131

317

247

185

100

153

51

23

6.7

9.2

5.8

5.9

6.2

6.1

7.0

6.9

6.9

7.0

6.9

6.7

6.7

6.3

6.6

8.4

5.8

5.9

6.0

6.1

6.9

6.8

6.9

6.9

6.8

7.0

6.5

*59

6.7

10.2

5.8

6.0

6.3

6.2

7.1

7.0

6.8

7.1

7.0

6.4

6.9

%.6

0.1

0.4

0.1

0.1

0.1

0.2

0.3

0.1

0.2

0.2

0.2

0,2

0.3

0.4

0.1

0.6

0.2

0.2

0.2

0.3

0.4

0.2

0.3

0.3

0.3

0.3

0.5

*

0.1

0.5

0.2

0.1

0.2

0.2

0.3

0.2

0.2

0.2

0.3

0.3

0.5

●

%wiudssdatefor racesthnldtygroupsnotshowneepsrstsly.

‘Excludesnursinginfantssnd children.
22 Advance Data No. 255. October 24, 1994

Technical notes

Source of data and survey

design

The third National Health and

Nutrition Examination Suwey

(NHANES III) is a 6-year survey

comprised of two 3-year phases,

1988-91 and 1991–94. Each phase is a

random sample of the U.S. civilian

noninstitutionalized population ages 2

months and older living in households

(10). Mexican Americans, black persons,

children 5 years of age and younger,

and persons 60 years of age and over

were oversampled to provide reliable

estimates for these population groups

(25).

Phase 1 data collection occurred

between October 1988 and October

1991. Table I indicates the response

rates for the dietary component. A total

of 20,277 sample persons were

identified for the NHANES HI, Phase 1

sampl% 17,464 sample persons

(86 percent) were interviewed, and

15,630 were examined (77 percent).

Dietary interviews were completed on

15,409 examinees (99 percent). Reliable

24-hour recalls were obtained from

15,280 examinees. Respondents with

incomplete recalls (n=338) and

breastfeeding infants and children

(n=141) were excluded from all

analyse% 221 persons were not

interviewed due to 42 refusals, 21

communication problems, and 158

survey operation reasons such as lack of

time. No attempt was made to impute

missing data. The Phase 1 analytic

sample comprises 14,801 respondents

who had complete and reliable

recalls-95 percent of the examined

sample (14,801/15,630) or 73 percent of

Phase 1 sample persons (14,801/20,277).

Statistical methodology

The complex survey design was

taken into account by using appropriate

survey sampling weights and appropriate

statistical analysis to produce national

estimates. Population means, medians,

and standard errors of the mean (SEMS)

for nutient intakes based on l-day

24-hour dietary recall data are presented

in this report. Standard errors of the

mean were computed using M_JllMN, a

program that takes into account the

sampling weights and complex sample

design for calculating variance estimates

(26). Because of the relatively small

numbers of degrees of freedom in Phase

I of NHANES III, an average design

effect method (10) was used to stabilize

the standard error estimates in this

report. Estimates that are less reliable

based on statistical criteria of sample

size and coefficient of variation are

designated by an asterisk in the tables.

Some nutrient estimates are by their

nature very skewed (for example,

alcohol intake). The mean and standard

error of the mean for such variables

(which assume normality) should be

used and interpreted with extreme

caution.

Dietary data collection

methodology

Respondents reported all foods and

beverages consumed, except plain

Table L Surtrey response rates for the 24-hour dietary recall componenk NHANES Ill,

Phese 1, 198S--91

Response rafe

Response categofy Number Component Survey

Total number of sample persons . . . . . . . . . . . . . 20,277

Interviewed sample persons . . . . . . . . . . . . . . . . 17,464

Examined sample persons . . . . . . . . . . . . . . . . . 15,630

24-hour diekq recall

Total interviewed . . . . . . . . . . . . . . . . . . . . . . . 15,402

Reliable . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,280

Complete . . . . . . . . . . . . . . . . . . . . . . . . . 14,801

Nursing infanffchild . . . . . . . . . . . . . . . . . . . 141

Inmmplete . . . . . . . . . . . . . . . . . . . . . . . . 336

Unreliable . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Computer maifunotion . . . . . . . . . . . . . . . . . . 29

Total notintwiewed.. . . . . . . . . . . . . . . . . . . . 221

.. .

. ..

100

W

99

95

1

c;

(’)

1

lea

66

77

76

75

73

. . .

. . .

. .

. . .

. . .

‘ Less n-m1 percent.

drinking water, over the previous

24-hour time period (midnight to

midnight). Foods and beverages were

quantfied using food specfic units, for

example, a large-size egg or medhnnsize apple. Abstract food models, shape

charts, and measurement aids such as a

ruler and household measuring cups and

spoons were also used to quantify foods

and beverages. During Phase 1,

approximately 69 percent of all dietary

interviews were completed by the

respondent, 28 percent by a proxy

respondent, and 3 percent by the

respondent and a proxy. Proxy

respondents were utilized for infants and

children 2 months-5 years and for other

respondents who were unable to report

on their own. Children &ll years of

age were permitted to report their own

food intake (54 percent), although

22 percent were completed by pralxy and

24 percent were completed with both the

child and a proxy. Data retrieval with

day care providers and schools was

conducted as necessary to obtain

complete intakes for infants and

children.

All 24-hour recall interviews were

conducted in the mobile examination

centers (MECs); the examination

schedules included all days of the week.

The distribution of recalls by day of the

week during Phase 1 was

Sunday 8 percent

Monday 10 percent

‘fbesday 11 percent

Wednesday 19 percent

Thursday 17 percent

Friday 26 percent

Saturday 9 percent

The higher proportion of Friday recalls

was due to operational procedures that

allowed for a high frequency of

Saturday examinations to improve

response rates.

Dietary interviews were conducted

in English (86 percent), Spanish

(12 percent), and English/Spanish or

other languages (2 percent). The

NHANES III Dietary Interviewer’s

Manual provides details for all aapects

of the 24-hour recall protocol (27).

Dietary interviewers were required to

have a college degree in foods and

nutrition. A majority of the interviewers

were bilingual in English and Spanish.
Advance Data No. 255. October24,1994 23

The dietary interviewers completed a

comprehensive 2-week training course

taught by an experienced bilingual

trainer. The training course emphasized

standardized data collection and

adherence to the dietary interview

protocol, proper interviewing technique,

and efficient use of the DDC system

during the dietary interview. Interviewer

retention was excellent.

Dietary interviewer performance

was monitored using several techniques

including field monitoring of interviews

in progress and reviews of taped dietary

interviews by NCHS and Westa~ Inc.

(10,27,2S). Throughout the survey, the

dietary interviewers performed a 10

percent cross-check of printed 24-hour

recall reports. Interviewer retraining

sessions were conducted regularly. Field

memoranda and newsletters were

prepared by NCHS and Westat Inc. stti

to inform the interviewers of DDC

updates and issues concerning the

dietary interview protocol. Updated

versions of the DDC system were

installed in the MECS approximately

twice per year.

Dietary terms and calculation

procedures

Energy and nutrient intakes for

individuals were calculated using the

gram amounts of food consumed and

the USDA Survey Nutrient Data Base

(SNDB) nutrient values for the food

expressed per 100 grams of food (19).

The percentage contributions of proteiq

fat (including fatly acid components),

carbohydrate, and alcohol were

calculated.

Macronutrients-carbohydrates, fat,

protein, and alcohol are the

macronutrients of the diet and the

principal dietary sources of energy.

Total energy intake—Total food

energy intake (measured in kilocalories

or kcrd) was calculated from grams of

daily intake of protein, carbohydrate, fat,

and alcohol. The energy conversion

factors used were 4 kcal per gram for

protein and carbohydrate, 9 kcal per

gram for total fat and fatty acids, and 7

kcal per gram for alcohol (29).

Percentages of energy intake—The

total kcrd from each ener~ source was

divided by the individual’s total energy

intake and multiplied by 100 to give the

percentage contributions. Figures may

not add to 100 due to rounding.

Total carbohydrate—Total

carbohydrate includes sugars and

complex carbohydrates. Sugars include

monosaccharides such as glucose and

fructose and disaccharides such as

sucrose, maltose, and lactose. Complex

carbohydrates (polysaccharides)

comprise starches and dietary fibers.

Totalfat—Total fat includes

saturated, polyunsaturate& and

monounsaturated fatty acids, non-fatty

acid components of fat such as glycerol,

phosphoric acid aminobases of

phospholipids, sterols (including

cholesterol), and fat-soluble vitamins.

Data editing and statistical

analysis

NCHS staff reviewed and edited the

Phase 1 data files. Editing guidelines

were developed by NCHS staff in

consultation with USDA and NCC staff,

and other knowledgeable sources.

Meetings and workshops were

conducted to discuss foods, database

updates, coding procedures, and editing

decisions.

NCHS staff performed all data

review and editing tasks. NCHS

prepared guidelines to document data

editing decisions (30). Dietary

interviewers coded the quality of all

24-hour recall interviews as “reliable,”

“unreliable,” “ refusal,” or “not

interviewed” (27). NCHS reviewed all

notes recorded by the dietary

interviewers, which provided

information about the interview setting

and the interviewer’s assessment of the

respondent’s abilities and willingness to

comply with instructions-that is, was

the respondent capable of completing

the 24-hour recall? If the respondent

made a reasonable effort to complete the

24-hour recall, the recall was considered

to be reliable. On the other hand, if the

respondent was very confused or had

extraordinary dMculty recalling foods

and beverages consumed the day before,

the recall was coded “unreliable.” After

the 24-hour recall iiles were edite~ they

were merged with the SNDB nutrient

and food weight iiles for anrdysis (10).

Demographic terms

Age—Age was defined as age in

months or years at the time of the

household interview.

Race/Ethnici~Race and ethnicity

classification was based on self-reported

information. Persons were classified as

non-Hispanic white, non-Hispanic black

Mexican American, or “other.” The

“other” category is included in the total

sample counts, but is not presented

separately.
24 Advance Data No. 255 ● October 24, 1994

Suggested citation

McDowell MA, Briefel RR, Alaimo K,etal.

Energy and macronutrient intakes of persons

ages 2 months and over in the United States

Third National Health and Nutrition

Examination Survey, Phase 1, 198631.

Advance data from vital and health statisti~

No 255. Hyattsville, Maryland: National Center

for Health Statistics. 1994.

Copyright information National Center for Health Statistics

All material appearing in this report is in the Direotor

public domain and may be reproduced or Manning Feirrleib, M. D., Dr. P.H.

copied without permission; citation as to

source, however, is appreciated. Deputy Director

Jack R. Anderson

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics Ed

6525 Belcrest Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

To receive this publication regularly, contact

the National Center for Health statistics by

calling 301-436-6500

DHHS Publication No. (PHS) 95-1250

4-1957 (10/94)
Number 256 ● July 22, 1994

Advance

Data

FromVi and HealthStatisticsofthe CENTERS FOR DISE4SE CONTROL AND Prevention/National Centerfor HeatlhStatistics

An Overview of Home Health and Hospice Care Patients:

Preliminary data From the 1993 National Home and

Hospice Care Survey

by Genevieve W. Strahan, Division of Health Care Statistics

Introduction

This report presents preliminary

statistics on an estimated 1.5 million

current patients and 3.9 million

discharges from about 8,400 home and

hospice care agencies in the United

States. These estimates are results from

the 1993 National Home and Hospice

Care Survey (NHHCS). The 1993

NHHCS, a segment of the long-term

care component of the National Health

Care Survey (l), is the second in a

series of annual surveys of home health

agencies and hospices and their current

patients and discharges. The National

Center for Health Statistics instituted

this nationwide sample survey in 1992,

in response to the rapid growth in the

number of these agencies throughout the

United States. This growth resulted in

the need to access the availability and

utilization of these services.

The efforts to control health care

cost can be seen as one reason for the

massive growth in the health care

industry. The average cost of a home

care visit is considerably less than a day

in a hospital or a day in a skilled

long-term care facility. The steady

increase in the elderly Medicare

population, about 1.9 percent per year

over the past decade, plays a part in this

growth (2). Elderly patients tend to

prefer to recover from illnesses at home

rather than in a hospital or nursing

home.

The data included in this report are

preliminary because further editing of

the data may produce estimates that are

slightly different from the ones shown

here. The 1,500 agencies included in the

1992 survey were selected from a

universe of 8,036 agencies classified by

the 1991 National Health Provider

Inventory (NHPJj as agencies providing

home health and hospice care. Also

included in the universe was a sample

of potentially new agencies identified

between the time the 1991 NHPI was

conducted and June 1992. These same

places were revisited during the 1993

Survey. Excluded in the 1993 survey

were 42 agencies that had merged with

other agencies, that were determined to

be duplicate of other agencies, or were

out of scope for the survey.

Data collection for the 1993

NHHCS was conducted between

September and December 1993. Detailed

information on sample design, data

collection procedures, and sampling

errors is included in the Technical notes

and in a forthcoming report (3).

Home health care agencies and

hospices are usually defied in terms of

the type of care they provide. Home

health care is provided to individuals

and families in their place of residence

for promoting, maintaining, or restoring

herdti, or form aximking the level of

independence while minimizing the

effects of disability and illness,

including terminal illness. These

agencies are often referred to today as

“hospitals without walls,” because

advances in technology allow dozens of

complex illnesses once treated almost

exclusively in the hospital to be treated

at home. Hospice care is delined as a

program of palliative and supportive

care services providing physical,

psychological, social, and spiritual care

for dying persons, their families and

other loved ones. Hospice seMces are

available in both the home and inpatient

settings.

The focus of this report is on

characteristics of patients receiving care

from agencies that provide home health

care and hospice services. For these two

types of agencies, estimates are

presented for current patients who were

on the rolls of the agency as of

midnight on the day immediately before

the date of the survey, and for

#“’xv’c’’”~+ ** $

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

c

nf

Public Health Service

Centers for Disease Control and Prevention 5

>

‘%*aa National Center for Health Statistics .

CENTERSu
2 Advance Data No. 256 ● July 22, 1994

Table 1. Numbar, percent, and percent distribution of home health care agencies and hospices by type of agency, according to

ownership, certification, and geographic region: United States, 1993

Type of agency

Home

Characteristic Total health care Hospice

Allagenciae . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Ownership

Proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Voluntarynonprofit. . . . . . . . . . . . . . . . . . . . . . . .

Governmentandother . . . . . . . . . . . . . . . . . . . . .

Region

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

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

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

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

Certification

CertiriedbyMedicare . . . . . . . . . . . . . . . . . . . . . .

Certbiedby Medicaid . . . . . . . . . . . . . . . . . . . . . .

8,400

100.0

33.1

48.5

18.4

21.8

28.3

35.7

14.3

82.0

80.7

Number

7,400

Percentdiatribution

100.0

37.1

42.5

20.5

22.4

28.1

36.0

13.5

Percent

63.5

63.0

1,000

100.0

3.6

93.9

2.4

17.0

29.8

33.3

19.9

70.6

63.2

discharged patients who had been

removed from therolls of the agency

(including those whose episode of care

ended because ofdeath) during a

designated month that wasrandorrdy

selected for that agency. These estimates

are presented by agency, demographic,

and diagnostic characteristics.

Agency characteristics

The 1993 preliminary estimate of

8,400 home care agencies (home health

and hospice) represents a 5-percent

increase in the number of agencies since

1992 (4). This continuing growth was

sparked in 1965by enactment of the

Medicare law, which paid for certain

home health services, thereby making

them more available to the elderly. The

growth was further enhanced when, in

1973, certain disabled younger

Americans also qualified as Medicaid

recipients of care from this industry.

According to the preliminary

estimates from the 1993 survey, about

84 percent of the estimated 7,400 home

health care agencies were Medicare and

83 percent were Medicaid certified.

Medicare added hospice benefits in 1983

to their coverage, andin 10 years the

number of hospices increased by several

hundred percent (5). In 1993 about

71 percent of the estimated 1,000

hospices were Medicare certified and

63 percent were Medicaid certitied. This

marks an increase in the number of

hospices certified since 1992 (4).

About the same percent of home

health care agencies were privately

owned (37 percent) as were owned by

nonprofit organizations (43 percent).

Estimates from the survey show that

almost all (94 percent) of the hospices

were owned by voluntary nonprofit

organizations. About 4 percent of the

hospices were privately owned. The

remaining 20 percent of the home health

care agencies and 2 percent of the

hospices were owned by government

agencies.

Almost two-thirds of all hospices

and home health care agencies are

located in the South and the Midwest.

There were 36 percent of home health

care agencies and 33 percent of hospices

in the Southern States. Fewer home

health care agencies were located in the

West than in the other three regions and

fewer hospices were located in the

Northeast and the West than in the

Midwest or the South (table 1).

Patients by agency

characteristics

Table 2 shows that the number of

current patients receiving home care is

greater in the South and the Northeast

than in the West and Midwest.

According to the 1993 survey,

68 percent of the 1.5 million current

home health care and hospice patients

were located in the Southern and

Northeastern States.

Most current patients and discharges

received home and hospice care from

voluntary nonprofit agencies. In 1993

nonprofit agencies provided care for

about 59 percent of all home health care

patients and 91 percent of all hospice

patients. Nonprofit home health care

agencies provided care to 66 pereent of

all discharged home health care patients,

while nonprofit agencies provided care

to 91 percent of all discharged hospice

patients. At least 90 percent of all

current and discharged patients receiving

home health care received that care

from home health care agencies that

were certified by Medicare andlor

Medicaid. The increase in the perlcent of

hospices certified by Medicare and

Medicaid is reflected in the nmnber of
Advance Data No. 256 ● July 22, 1994 3

Table 2. Number, percent, and percent distribution of current patienta receiving home health and hospice care by type of agancy,

according to ownership, certification, and geographic region: United States, 1993

Type of agency

Home

Characteristic Total heatth care Hospice

Number

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,498,900 1,448,800 50,100

Ownership

Proprietary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Voluntarynonprofit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Govemmerrtarrdother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3a6,800

901,500

382,600

856,102

200,100

4,200

45,400

500

Region

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

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

south. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

517,500

281,200

488,000

201,200

505,700

268,400

462,100

192,700

11,800

12,800

17,000

8,500

Certtication

CertifiedbyMedicere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Certh%dbyMedicaid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,350,100

1,358,800

1,S02,500

1,313,800

47,600

45,900

Percantdiatributiorr

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

ownership

Proprietary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Volurdarynonprofit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Governmentandother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26.5

60.1

13.4

27.1

5%1

13.8

8.3

80.7

0.9

Ragion

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

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

south . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

34.5

18.8

33.3

13.4

24.9

18.5

33.3

13.3

23.7

25.6

83.9

16.9

Percent

CertiFmdbyMedioare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CertifiedbyMedicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$)0.1

eo.7

89.9

W.7

e5.o

91.6

NOTE F~ures may not add to totals because of muting.

patients receiving certified care. At least

90pereent of theeurrent anddischarged

hospiee patients received their care from

hospices certMed byMedicareand/or

Medicaid (tables2and 3).

health care patients were 65 yearsor

older. More women (66pereent) were

receiving home health eare services than

weretheirmale (34pereent) counter

parts, partlybeeause women outlive

mrdes. Married and widowed patients

receiving home health care accounted

for 67pereentofall patients, about

22 percent were divorced, separated,

single,ornevermarried, andthemarital

statusoftheremaining llpereentwas

unknown (table 4). The distribution of

3.7 million discharges shown in table 5

by age, sex, race, and marital status was

similartothedistribution ofeurrent

patienta, exeept for marital statns.

Atthetime of the 1993 survey,

1,000 hospices were serving 50,100

patients. Like home health care patients,

hospice patients currently receiving care

were elderly more than 71pereent were

65yearsof ageor oIder. UnIike home

health patients, however, hospice

patients were nearly as likely to be male

as female. Most current hospice patients

werewhiteandmarried. The256,900

hospice patients who hadbeen

discharged from care (usually because

they died) haddemographic

characteristics similar to current patients

(table 5).

Patients by diagnoses

Irrformation on the primary and

other diagnoses at the time of admission

Patients by demographic

characteristics

As in 1992, the 1993 preliminary

estimates show that the 1.4 million

current patients receiving home health

care were elderly, female, white, and

married or widowed. The likelihood of

using home health services increases

with age because usually functional

status declines with age (6). In 1993

about 75percent of all current home
4 Advance Data No. 256 ● July 22, 1994

Table 3. Number, percent, and percent distribution of discharged petienta who received home health and hospice care by type of

agency, according to ownership, certification, and geographic region: United States, 1993

T~e of agenoy

Home

Characteristic Total healthcare Hospicw

Number

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,929,600 3,672,700 256,9(HD

Ownership

Proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 923,600 304,100 19,50D

Voluntarynonprofti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,653,200 2,419,1C0 2S4,10D

Governmentandother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352,800 349,500 3,3CHD

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,316,200 1,251,800 64,400

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 766,800 721,900 66,9(XJ

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,045,900 964,500 81 ,413D

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 778,600 734,400 44,100

CertifiedbyMadicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,774,000 3,536,000 239,000

CertitiedbyMedicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,669,300 3,438,300 231,000

Percerrt distribution

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 1C@.o 100.0

Ownership

Proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Voluntarynonprofd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Govemmentandother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region

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

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

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

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

23.5

67.5

9.0

33.5

20.1

26.6

19.6

24.6

65.9

9.5

34.1

19.7

26.3

20.0

7,6

91.1

1.3

25.1

26.0

31.7

17.2

Percent

Certification

Certifiedly Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96.0 36.3 93.0

Certifiedly Madiceid . . . . . . . . . . . . . . . . . . . . . . . . . . 93.4 93.6 89.9

NOTEFiguresmay notaddtototalsbacau seofrounding.

was collected from the medical records

for each home herdth care and hospice

patient inthe 1993 survey. Diagnoses

were coded according to the

International Classijicatwn ofDiseases,

9th Revision, Clinical Modification

(ICD-9-CM) (7). The first-listed

diagnosis at admission for home health

care and hospice patients who are

currently receiving care is shown in

table6, grouped by ICD-9-CM chapter.

About 26percent of thel.4miIlion

home health care patients had conditions

that are in the ICD-9-CM chapter,

“Diseases of the circulatory system”

(390459). Persons with heart disease,

including congestive heart failure, made

up49percentof all conditionsin this

group. Stroke, diabetes, and

hypertension were also frequent

admission diagnoses for current home

health care patients.

Most hospice patients (71 percent)

had afirst-listed diagnosis ofneoplasms

(140-239). Cancer of the lungs, breaat,

colon, and prostate accounted for nearly

60percent of allneoplasms. Thesecond

largest group-diseases of the

circulatory system with congestive heart

failure-accounted for about 9 percent

of the admission diagnoses for this

group. Hospice patients with human

immunodeficiency virus (HIV)

diagnoses were the total of the

ICD-9-CM chapter on infkct.ious and

parasitic diseases. Because hospice care

is provided to patients whoare in the

terminal stage of their illness, it is not

unexpected that theee patients would

have a first-listed admission diagnosis of

a serious illness.
Advance Data No. 256 ● July 22, 1994 5

Table 4. Number and percent distribution of current pstienta receiving home health and hospice care by type of care received, according

to age, sex, race, and marital status at admission: United States, 1993

Tp of care rsoeivd

Home

Characteristic Tti heekb care Hospice

Number

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,498,800 1,446,800 50,100

4,300

3,200

6,200

35,800

5,400

9,100

8,400

7,500

7,300

*

20,600

29,500

40,200

4,600

5,300

23,800

15,700

2,700

5,2Q0

2,700

100.0

6.5

6.4

12.3

71.5

10.8

18.2

12.9

15.0

14.6

*

41.1

56.9

60.2

9.1

10.7

47.5

31.4

5.4

10.4

5.3

Age

Under 45yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65yearsand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-6ayaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

60-64yaaffi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknovm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

187,300

61 ,QOO

124,400

1,114,700

144,600

217,200

233,500

240,500

276,600

11,500

163,00JJ

57,600

118,300

1,078,900

139,4Q0

206,1 Qo

227,100

233,000

271,300

10,800

Sex

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

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

513,500

965,400

492,8CXI

956,800

Race

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

Slack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otharorunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,026,300

203,100

269,W0

966,100

196,600

264,100

Mar.ti StStUS

Marnad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Widowed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DMmedorseparsted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nevermsrriad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

449,400

560,600

76,600

256,300

155,800

425,600

544,600

74,1 m

261,1Q0

153,100

Percentdistribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0

Age

Under45years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

65yaarsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S5-69yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

70-74y6er3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-78yesB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

80-84yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65yaaraandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.5

4.1

8.3

74.4

9.7

14.5

15.6

16.0

18.6

0.8

12.6

4.0

8.2

74.5

9.6

14.4

15.7

16.1

18.7

0.7

8ex

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

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

34.3

65.7

34.0

66.0

Race

While . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Otherorunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

66.5

13.6

18.0

66.1

13.7

18.2

Marii status

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Widowed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Divorcedorseparstad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nevermarned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30.0

37.4

5.1

17.1

10.4

29.4

37.6

5.1

17.3

10.6

NOTEF~uresmsy notaddtototals twcauseofrounding.
6 Advance Data No. 256 ● July 22, 1994

Table 5. Number and percent distribution of discharges by type of care received, according to age, sex and marital status at admission:

United States, 1993

Type of care received

Home

Characteristic Total health care Hospice

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

Age

Under 45years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

65yesrsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

66-69yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S5yeareandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

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

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

Race

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

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

Otherorunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mariil status

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

widowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Divorcedorseparatsd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nevermarried . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Age

Under45years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

65yearsand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-69years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80-64yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65yearaandover . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

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

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

Race

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

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

Otherorunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Marital status

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Widowad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Divorcedorseparated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Never married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,929,600

552,600

165,600

370,500

2,794,400

402,700

5s8,400

607,900

572,800

624,600

26,300

1,483,900

2,465,700

2,681,400

363,100

665,100

1,515,500

1,238,700

182,800

575,800

417,000

100.00

14.1

4.7

9.4

71.1

10.2

14.9

15.5

14.6

15.9

0.7

37.3

62.7

68.2

9.7

22.0

38.6

31.5

4.6

14.7

10.6

3,672,700

530,900

169,900

335,300

2,611,200

361,600

538,400

571,600

546,500

592,900

25,400

1,339,700

2,333,000

2,479,800

357,500

635,300

1,371,700

1,179,900

164,700

546,400

409,900

Percentdietribution

100.00

14.5

4.6

9.1

71.1

9.8

14.7

15.6

14.9

16.1

0.7

38.5

83.5

67.5

9.7

22.7

37.3

32.1

4.5

14.9

11.2

256,900

21,700

15,900

35,200

163,300

41,200

46,000

36,100

26,300

31,700

*

124,2001

132,700

201,500,

25,6001

29,800

143,70CI

56,800

17,800

29,400

7,000

8.41

6.2!

13.7

71.:1

16.()

18.7’

14.()

10.2

12.3

it

46.4

51.6

78.4

10.0

11.6

5543

22.9

7.0

11.5

2.7

NOTEFiguresmay notaddtototakkuse ofmunding.
Advance Data No. 256 ● July 22, 1994 7

Table 6. Number of current home health care and hospice patients by first-listed diagnosss et admiaaion: Unitsd States, 1993

he%zre

lCD-8-CM prooeduro category and oode

m

patienis patients

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,448,800 !Y3,1OO

lnfaotious andparasitic disaaeas . . . . . . . . . . . . . . . . . . . . . . . ...001-139 17,500 1,400

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239 84,900 35,eoe

Endocrine, nutritional and metabolic, and immunity disorders. . . . . . . . . 240-279 128,600 ●

Diseases of the bled and blood-forming organs . . . . . . . . . . . . . . . . 280-289 38,700 *

Mentsl disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..29E-319 48,60a *

Oisesaes of the netvous system and sense organs. . . . . . . . . . . . . . . 3X)-389 93,800 2,100

Disesaas of thecirculatory system . . . . . . . . . . . . . . . . . . . . . . ...390-453 361,400 4,700

Disessas of theraspirstoty system . . . . . . . . . . . . . . . . . . . . . . . ..4S0--519 87,100 3,100

Oisaaaes of thedigeatiie system . . . . . . . . . . . . . . . . . . . . . . . . ..5S0-S79 54),600 *

Uw~esoftie genitourinay sySem . . . . . . . . . . . . . . . . . . . . . . . 580+329 35,100 *

Diseases of the skin and subeutanaous tissue. . . . . . . . . . . . . . . . . . 680-709 44@0

Diseases of the musouloskeletsl system and

eonnactive tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 710-739 122,200 *

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...740-759 9,8Q0 *

Certain mnditiona originating in the parinetsl period . . . . . . . . . . . . . . 760-779 12,7WI ●

Symptoms, signs, and ill-defined oondiions . . . . . . . . . . . . . . . . . . . 780-798 102,100 ●

Injury andpoiaoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-893 132,200 ●

Allotheror unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53,300 *

.,-— -- ..... –—.. .. ....- ...... ,.—-....-.........

References

1. Institute of Medicine. Toward a

national health care swey, a data

system for the 21st century.

Washington National Academy

Press. 1992.

2. Bishop C, Skwara KC. Reeent

growth of Medicare home health,

Health MI 95-110.1993.

3. Haupt B. Development of the

National Home and Hospice Care

Survey. National Center for Health

Statistics. WaI Health Stat (ii

preparation). 1993.

4, Strahan GW. Overview of home

health and hospice care patientx

Preliminary data from the 1992

National Home and Hospice Care

Survey. Advance data from vital and

health statistics; no 235. Hyattsville,

MaryIand National Center for Health

Statistics. 1992.

5. National Association for Home Care.

Basic statistics about home care.

Information sheet. 1992.

6. Hing E, Bloom B. Long-term care

for the functionally dependent

elderly. National Center for Health

Statistics. Vital Health Stat 13(104).

1990.

7. Public Health Serviee and Health

Care Financing Administration.

International Ck.ssifieation of

Diseases, 9th Revision, Clinical

Modifiestion. WashingtoIX Public

Health Serviee. 1980.

8. National Center for Health Statistics

Development and maintenance of a

national inventory of hospitals and

institutions. VW Health Stat 1(3).

1965.

9. Bureau of the Census. Summary

report for the 1991 National Health

Provider Inventory. Unpublished

memo prepared by the Health

Sweys Branch. 1992.

10. Massey JT, Moore TF, Parsons ~

Tadros W. Design and estimation for

the National Herdth Interview

Swey, 1985-94. National Center for

Health Statistics. Vital Herdth Stat

2(110). 1989.

11. HotYmanK SF.X&stions for

selecting NHHCS sample home

herdth agencies and hospices.

Unpublished memo. 1992.

12. Shah By Barnwell BG, Hunt PN,

LaVange LM. SUD.&4N user’s

manual, release 5.50. Research

Triangle Park North Carolinrc

Research Triangle Institute. 1991.

Symbols

--- Data not available

. . . Category not applicable

Quantityzero

0.0 Quant”~ morethan zero but

lessthan 0.05

z Quantity morethan zero but

lessthan 500 where numbers

are rounded to thousands

* Figure does not meet standard

of reliability or precision
8 Advance Data No. 256 ● July 22, 1994

Technical notes

Source of data

The sample for the 1993 National

Home and Hospice Care Survey

(NHHCS) was the same basic sample

used in the 1992 survey with few

exceptions. The 1993 sample contained

1,458 agencies. About 40 agencies were

removed from the 1992 sample because

they had merged with other agencies in

the sample, they were determined to be

duplicates of other agencies in the

sample, or they were considered out of

scope for the survey. The original

sample was taken from a frame that

consisted of all home health care

agencies and hospices identified in the

1991 National Herdth Provider Inventory

(NHPI) and all agencies opened for

business behveen 1991 and June 30,

1992, as identified through the Agency

Reporting System (8). The NHPI is a

comprehensive census of nursing and

related care homes, residential care

homes, home herdth care agencies, and

hospices conducted periodically by the

National Center for Health Statistics (9).

Sample design

The sample design for the 1993

NHHCS is a stratied three-stage

probability design. Primary Sampling

Units (PSUS) are selected at the first

stage, agencies are selected at the

second stage, and current residents and

discharges are selected at the third stage.

The first stage utilized the selection

procedures that obtained the 198 PSUS

used for the Nationrd Health Interview

Survey (NHIS), a survey of the civilian

noninstitutionalized population of the

United States (10). The PSUS are

counties, groups of counties, county

equivalents (such as parishes or

independent cities), or towns and

townships (for some PSUS in New

England). Home health agencies and

hospices were selected within the same

PSUS included in the NHIS to minimize

data collection costs and to establish

linkage between the two surveys,

allowing future research on availability

and use of services (9).

The second stage involved the

selection of agencies within six primary

strata of agencies. These strata were

formed in the 1992 sampling frame on

the basis of type of agency (hospices

versus home health care agencies and

mixed agencies-providing both types

of care or unknown) and type of PSU

(self-representing (SR) versus nonselfrepresenting (NSR), and within nonselfrepresenting PSUs—Metropolitan

Statistical Aea (MSA) versus nonMSA). MSA is a metropolitan statistical

area defined by the U.S. Office of

Management and Budget on the basis of

the 1990 Census. Within these sampling

stratum, agencies were arrayed by four

regions, five types of ownership, two

types of certification status, and finally

by the number of the patients currently

being served by the agency. The number

of agencies selected from each sampling

stratum was based primarily on results

of research into the optimum sample

design for the 1992 NHHCS. Hospices

in the nonself-representing PSUS and

home health care agencies and mixed

agencies in the non-MS& nonselfrepresenting PSUS were selected with

certainty. Hospices in the selfrepresenting PSUS and home health care

agencies and mixed agencies in the

MS& nonself-representing PSUS and

the self-representing PSUS were selected

with probability proportional to the

current patient size (as reported in the

NHPI sampling frame). A total sample

of 1,500 agencies was selecte~ 384

were hospices, and the balance was

home health care agencies or mixed

agencies (11). In 1993 there were 1,458

agencies in the sample.

The final stage is a systematic

random selection of six patients being

currently served by the agency and six

patients discharged from care during a

designated month from October 1.992to

September 1993. The designated month

was randomly selected for each agency.

Therefore the coverage for discharges

was the 12-month period from October

1992 to September 1993.

Data collection procedures

Data collection for the 1993

NHHCS began with a letter sent to all

1,458 sampled agencies, informing the

administrator of the authorizing

legislation the purpose and content of

the survey. Within a week to 10 days

after the letter was mailed, the

interviewer assigned to conduct the

survey for a particular agency made

telephone contact to discuss the survey

and to arrange an appointment with the

administrator or person designated by

the administrator.

Three questionnaires and two

sampling lists were used to collect the

data. The Agency Questionnaire was

Table L Standard errors for number, percent, and percent distribution of home health

care agencies and hospices by type of agency, according to ownership, certification, and

geographic region: United States, 1993

Type of agency

Home

Characteristic Tots/ heafth care Hospice

Number

All agencies . . . . . . . . . . . . . . . . . . . . 254 227 “113

Ownemhip Percent’

Proprietary . . . . . . . . . . . . . . . . . . . . . 1.9 2.1 0.7

Voluntary nonprofit . . . . . . . . . . . . . . . . 1.9 1.9 1.1

Govemmentand other . . . . . . . . . . . . . . 1.8 0.2 0.6

Cattiieation

Certified by Medicare . . . . . . . . . . . . . . . 1.7 1.6 7.0

Certified by Medicaid . . . . . . . . . . . . . . . 2.1 2.1 6.6

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . 0.9 0.1 2.4

Midwest . . . . . . . . . . . . . . . . . . . . . . . 1.3 1.4 4.2

South . . . . . . . . . . . . . . . . . . . . . . 1.6 1.7 4.6

West . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 0.1 7.2

‘standarderrors for percents are based on an approximationby a mukinomialdiatribti”on.
Advance Data No. 256 ● July 22, 1994 9

Table Il. Standard errors for numbar, pereantj and percent distribution of currant patients raeaivlng home health and hospice ears by

typa of ageney, aeeording to ownership, eertIfleatIon, and geographic regiom United Stetae, 1993

Home heaith eats Hospice oare

Chamoteristk Total Peroent’ Total Percent’ Tdel Percent’

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52,376 . . . 52,126 . . . 3,612 . . .

Proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,266 1.9 26,203 2.0 919 1.6

Volurrtary nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4s,737 2.3 46,375 2.4 3,536 1.9

Govemmentandothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,593 1.6 25,582 1.8 114 0.2

Carlirication

CertifiedbyMedicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52,3S2 1.3 52,0S9 i.4 3,619 1.5

OertifiedbyMediiaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53,005 1.2 52,731 1.2 3,647 1.8

Census region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41,434 2.2 41,312 2.2 2,081 3.6

Mkiwes t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,626 1.2 15,63a 1.2 1,362 2.6

couth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,513 1.7 24,357 1.7 2,219 3.6

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,4s9 1.0 13,159 1.0 1,378 2.6

‘Sfandswlsrmrsfor pementasrsbssed orrsnsppmximstionbyamut!homisldklriburiom

Tableiil.standard errorafornumbar, pereen$andpereant diatributionofdieehargad patiantawhomeeived homeheatthand hoepke

eerebytypeof agency,aeeording toownerahip,certifieation, andgaegraphlc raglon:UnitadStetes, 1993

Honleheanheam Hospioe mm

Charaoteristk Total Peroerrt’ Total Perc3nt’ Total Percent’

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128,678 . . . 126,641 . . . 19,345 . . .

ownership

Proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65,620 1.7 65,3s0 1.9 3,s2s 1.5

Voluntaryncmpmfit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120,35S 2.0 117,723 21 19,719 1.6

Govemmentandothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44,582 1.2 44,491 1.3 1,040 0.4

CertifiedbyMedicsre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128,466 0.7 127,663 0.7 16,825 2.6

CertiriedbyMedicsid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129,625 0.9 127,782 0.9 18,330 2.6

Oensus region

Norlhesst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80,602 1.9 60,167 20 11,72a 3.9

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52,25S 1.3 51 ,35s 1.4 6,61 f 2.6

couth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60,811 1.5 5s,704 1.6 11,807 3.6

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43,810 1.2 42,57s 12 8,657 3.1

‘Sbwchrdwmrsfor psmentssrebawrl onsnappfmdmaliont-yamultinomiafdisbfburbn.

completed with the administrator or

designee. ’lleintewiewer would next

ecrmplete the Current Patient Sampling

List (CPSL) and Discharged Patient

Ssmpling List(DPSL). The interviewer

used theCPSL to list allpatients on the

register ofthe agency on the evening

before the day of the survey. The DPSL

wasusedtolist alldisehargesfkom the

agency for their designated month.

Samplingofcurrent patientsand

dischargedpatients within agencies was

aceomplishedby using tables showing

setsofsample linenumbersfor each

possible count of current patient and

discharged patient in the agency. The

interviewer drew asampleof up to six

current patients and up to six discharges.

After the samples had been

selected, the Current Patient

Questionnaire and Discharged Patient

Questionnaire were completed for each

sampled person by interviewing the staff

member most familiar with the are

provided to the patient. The respondent

was requested to refer to the medieal or

other records whenever necessary.

Sampling errors

Because the statistics presented in

this report are based on a sample, they

will di.fEersomewhat from figures that

would have been obtained if a complete

census had been taken using the same

sehedule~ instructions, and procedures.

The standard error is primarily a

measure of the variability that oeeurs by

chance because only a sample, rather

than the entire univeme, is surveyed.

The standard error also reflects part of
10 Advance Data No. 256 ● July 22, 1994

Table IV. Standard errors for number and percent distribution of current patients receiving home health end hospice care by type of care

received, according to age, 86A race, and marital atstus et admission: United Statea, 1993

Home health care Hospice care

Characteristic To@l Percent’ Total Percerrtl Total Percent’

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

Age

Under 45years . . . . . . . . . . . . . . . . . . . . . . . . .

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

55-84years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . . . . . . . . . . . . .

65-69years . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74years . . . . . . . . . . . . . . . . . . . . . . . . . .

75-76years . . . . . . . . . . . . . . . . . . . . . . . . . .

SO-84years . . . . . . . . . . . . . . . . . . . . . . . . . .

S5yearsandover . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

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

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

Race

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

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

Otherorunknown . . . . . . . . . . . . . . . . . . . . . . . .

Marital status

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Widowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oivorcedorseparafad . . . . . . . . . . . . . . . . . . . . . .

Nevermanied . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

52,376 . . . 52,126 100.0 50,100 100.0

13,500

5,210

10,345

39,695

6,823

20,776

12,100

12,412

13,200

3,275

0.8

0.4

0.6

1.0

0.6

1.4

0.8

0.s

0.9

0.2

13,470

5,180

10,285

39,508

8,78S

20,723

1&04s

12,344

13,367

3,238

0.6

0.4

0.6

1.1

0.7

1.2

0.8

0.6

1.0

0.2

720

758

978

3,016

799

1,539

750

1,300

1,100

*

22@o 1.0 23,000 1.0 1,645 :~.5

36,300 1.0 38,000 1.0 2,567 :2.5

34,200 1.7 33,900 1.6 3,200 2.5

19,300 1.1 19,200 1.2 340 1.7

22,100 1.3 22,000 1.3 1,100 :~ml

17,800 1.3 17,500 1.3 2,300 :~.7

27,600 1.1 27,600 1.2 1,800 :~.6

6,700 0.5 6,700 0.6 500 0.9

14,700 0.9 14,700 0.9 S80 ‘1.7

13,400 0.8 13,400 0.8 700 ‘t .4

‘3tandarderrorsforpercantsarebased orranapproximationbyamuitinomisldktributicm.

the measurement error, butit does not

measure sny systematic biases in the

data. The chances are 95 of 100 that an

estimatefiomthe sampledblerafrom

thevaluethatwould beobtainedfrom a

complete census by less than twice the

standard error.

Thestandarderrors usedinthis

report were approximated using

SUDAANsoftware. SUDAAN

computes standard emorsby usinga Z-test, with a0.05 level of significance,

firW-order Taylor approximationof the was used to test all comparison

deviation of estimates from their mentioned in this report. Notall

expected values. Adescriptionof the observed differences were tested, so lack

software and the approach it uses has ofcommentin thetext doesnot mean

been published (12). Exact standard that the difference was not statistically

error estimates were usedin tests of significant.

significance inthis report.Standard

errors for all estimates presented in this

report are presented in tables I–VI. The
Advance Data No. 256 ● July 22,1994 11

TableV.Standarderrorefor numberandparcentdistributionof dischargesby typeof caremcelvad,accordingby age,sq rata,and

maritalstatusatadmiselomUnitedstates,1993

Homeheatihcan? Hos@oam

Characteristic Total Percent’ Total Percent’ T& Percent’

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

Age

Under 45yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 yaeE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-84 yaars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65yearaand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-66yesra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74ywars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-78yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

60-64yesra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85yaarsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

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

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

Race

While . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bleak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otharorunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Maritalstatus

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Widowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dmrcedorsapamtad . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neverrnsrried. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

128,700 . . . 126,600 . . . 20,000 100.0

37,000

14,800

22,900

101,400

24,300

38,800

31,700

33,700

35,300

5,100

0.9

0.4

0.6

1.0

0.6

0.8

0.7

0.7

0.7

0.1

37,000

14,700

2Z300

98,800

23,100

35,800

31,300

33,400

5,100

0.9

0.4

0.6

1.1

0.6

0.9

0.8

0.8

0.8

0.2

4,000

2,600

5,400

15,700

6,600

6,100

4,600

4,700

5,000

●

1.5

1.1

1.6

21

2.2

2.0

1.6

1.5

1.8

*

58,200 1.0 57,000 1.1 10,800 2.5

91,800 1.0 80,700 1.1 12,800 2.5

97,200 1.5 84,800 1.5 16,700 2.4

30,700 0.8 30,000 0.8 5,300 1.8

59,WJ0 1.4 59,700 1.5 4,800 1.8

85,800 1.1 84,600 1.1 12,900 3.0

53,200 1.0 52700 1.1 6,500 2.3

16,200 0.4 15,800 0.4 3,300 1.2

35,300 0.9 34J?O0 0.9 7,800 2.7

35,400 0.9 35,400 1.0 2@oo 0.8

TableVLStandarderrorsofnumberoccurrenthomehealthcereandhospicepstkntsbyflrst-listeddiegnoaesatsdmlesdon:

UnitadStates,1993

Mnnehtdth

lC5%-CMpmctrdure cst~ and cd patianfs

v

-

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Z128 3,612

InfactioussndpamsiticdIsesees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lyJ1-13g Z612 304

Neoplasm%. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-~ 9,868 3,077

Endoorina,n@ritionelandmetabolii,andimrnunitydisordera. . . . . . . . . . . . . . . . 240-278 7,881 *

Disaesssofthebloodsndblocd-forming mgsns . . . . . . . . . . . . . . . . . . . . ...260-239 4,2S1 *

Medaldiscs’dara... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~19 5,107

Diaeesesofthenw0ussyatemand5an5a0rg~. . . . . . . . . . . . . . . . . . . ...320-383

*

7,587 m

DiSeasesofthecirouletorysyatem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~ 18,842 856

Diseesesofthereapiratory@em. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4@j_519 5,845 851

Diseaaesofthedigastivesystem.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 520+78 4,587 ●

iXa8ses0fthe@tourinsrysy@ern . . . . . . . . . . . . . . . . . . . . . . . . . . . ...580-828 3,828 *

Disessesoftheskinandrjutjcw+neomm. . . . . . . . . . . . . . . . . . . . . . . ..83tp70g 4,220 *

l)isessesofthemusouloakel~~ern arxlconnactivatiaaua . . . . . . . . . . . . . . 710-739 8,888

Congenitalanomeiiea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74.o-75g

●

2,042 *

Cartainoondiisotigiti.nginthe perinstalpenod.. . . . . . . . . . . . . . . . . . . . 780-778 2,458 *

SYrnptoms,aignsjandilldefinedoondiions . . . . . . . . . . . . . . . . . . . . . . . . .. 760-799 9,809

Injuryendpoisoning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......-.oo_ggg

*

14,731 *

Allotherorunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,271 *
12 Advance Data No. 256 ● July 22, 1994

Suggested citation

Strahan G. An overview of home health and

hospice care patients Preliminary data from

the 1993 National Home and Hospice Care

Survey. Advance data from vital and health

statistics; no 256. Hyattsville, Maryland

National Center for Health Statistics. 1994.

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health statistics

6525 Beicrest Road

Hyattsville, Maryland 20782

Copyright information National Center for Health Statistics

Ail material appearing in this report is in the Director

public domain and may be reproduced or Manning Feinleib, M. D., Dr. P.H.

copied without permission; citation as to

source, however, is appreciated. This report Deputy Director

may be reprinted without further permission. Jack R. Anderson

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

To receive this publication regularly, contact

the National Center for Health Statistics by

calling 301-436-8500

BULK IWTE

POSTAGE & FEES PAID

PHS/NCHS

PERMIT NO. G-21N

DHHS Publication No. (PHS) 94-1250

4-0437 (7/94)
Number 257 ● November 3, 1994

Advance

Data

FromVi and Health Statisticsofthe CENTERS FOR DISEASE CONTROLAND PREVENTION/Naijonal Centerfor HealthStatistics

Hospices and Home Health Agencies: Data From the 1991

National Health Provider Inventory

by Adrienne L. Jones, Division of Health Care Statistics

Hospices and home health

agencies

This report presents information on

the characteristics of hospices and home

health agencies in the United States. The

data are from the 1991 National Health

Provider Inventory (NHPI). The NHFI

was a mail survey of nursing homes,

board and care homes, home health

agencies, and hospices. However, the

discussions in this report are limited to

home health agencies and hospices.

The NHPI was formerly called the

National Master Facility Inventory

- and the Inventory of Long-Term

Care Places (IZTCP) (l). Before the

inclusion of hospices and home health

agencies, the inventory had been limited

to inpatient facilities. Because of its

recent expansion to include hospices and

home health agencies the name was

changed to NHPI.

The U.S. Bureau of the Census

conducted the 1991 NHPI under an

interagency agreement with the National

tinter for Health Statistics (WI-E).

The primary purposes of the NHPI were

to provide a sampling frame for selected

sample surveys and to provide national

Table 1. Number and percent distribution of home health agencies and hospices by type of ownership, oertifleation, and geographic

regiom Unit6d !Wtea, 1991

TW of agenoy

Agency ChWtWt8tf@iC Tofal Home heatttr ac?ancv Hoaoim

Number Peroent Number Percent Number Percent

AUagenoiaa. . . . . . . . . . . . . . . . . . . . . . . . . 7,804 100.0 6,653 100.0 851 1W.o

Type of ownership

Proprietary. . . . . . . . . . . . . . . . . . . . . . . . . . . 2,827 36.2 2,779 40.6 48

Nonprofit. . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.0

3,353 43.0 2,515 38.7 8s8

Govemmentand other . . . . . . . . . . . . . . . . . . .

88.1

1,824 20.0 1,559 22.7 84 6.7

Certification

Madiirecerlifiad . . . . . . . . . . . . . . . . . . . . . . 6,242 80.0 5,608 al .8 833

Mediidcettifiad . . . . . . . . . . . . . . . . . . . . . . .

88.6

6,193 79.4 5,855 82.5 5s8 58.6

Gacgraphicregion

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,428 18.3 1,271 18.5 157 16.5

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,257 28.9 1,864 28.7 293

south . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30.8

3,002 38.5 2,891 32.3 311 32.7

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,117 14.3 827 13.5 190 20.0

NOTEPercartsmay cd ~d mtotalskcausa ofroundii.

Swlce.ti #

&

$

G

~

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

E Public Health Serviee

: Centers for Disease Control and Prevention YJJ

%.> National Center for Health Statistks CEmE cmAmPRm
2 Advance Data No. 257 ● November 3, 1994

data on the number, type, and

geographic distribution of providers of

long-term care.

Although the mailing list of home

health agencies and hospices used for

the NIWI contained over 14,000

records, the number of in-scope places

were found to be 7,804. The data in this

report will be limited to those agencies.

Source of data, survey methods, and

definitions are given in the technical

notes at the end of the report.

Agency characteristics

In 1991 there were 7,804 hospices

and home health agencies in the United

States (table 1). The majority

(88 percent) were home health agencies.

Of the 6,853 home health agencies,

2,779 (41 percent) were proprietary,

2,515 (37 percent) were nonprofit, and

1,559 (23 percent) were government and

some other type of ownership. On the

other hand, only 5 percent of the 951

hospices were proprietary owned,

88 percent were nonprofit, and the type

of ownership for 7 percent was

government or other.

Most of the hospices and home

health agencies were certified by

Medicare and Medicaid; 6,242 were

Medicare certified and 6,193 were

Medicaid certified. Of the 6,853 home

health agencies, about 82 percent were

Medicare and Medicaid certified.

Substantially fewer of the 951 hospices

were certified; 67 percent were certified

for Medicare and 57 percent were

certiiied for Medicaid.

The majority of agencies were

located in the South and Midwest

regions; 39 percent were in the South

and 29 percent were in the Midwest,

compared with 18 percent in the

Northeast and 14 percent in the West. A

fleater percent of home health agencies

(39 percent) than of hospices

(31 percent) were in the South;

relatively more hospices (20 percent)

than home health agencies (14 percent)

were in the West. The percent of home

health agencies and percent of hospices

in the other two regions were close;

19 percent of home health agencies and

17 percent of hospices were in the

Northeast, and 29 percent of home

Table 2. Number of home health agencies and hospices by StsW United States, 1991

All Home heaith

states agencies agencies Hospioas

AI States . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Aricanaes . . . . . . . . . . . . . . . . . . . . . . .

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

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

Connecticut . . . . . . . . . . . . . . . . . . . .

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

Diatrict of Columbia . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

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

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

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

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

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

Maaaeohusetta . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

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

New Jersey . . . . . . . . . . . . . . . . . . . . .

New Mexim . . . . . . . . . . . . . . . . . . . . .

New Yori( . . . . . . . . . . . . . . . . . . . . . .

North Carolina . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Rhode Island . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

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

West Virginia . . . . . . . . . . . . . . . . . . . .

Wisconsin . . . . . . . . . . . . . . . . . . . . . .

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

health agencies and 31percentof

hospices were in the Midwest.

About athird (34 percent) of the

home health agencies were locatedin

California, Florida, Ulinois, NewYorL

Pennsylvania, and Texas (table2). Texas

hadthe most home health agencies

(557) followed by New York (410),

Florida (413), Pennsylvania (317),

California (333), and Illinois (309). Of

7,804

146

15

80

144

418

120

119

22

21

447

88

26

40

35a

163

180

176

131

191

50

121

192

253

226

117

18s

61

81

30

73

130

48

445

203

72

291

86

85

345

48

114

87

273

599

57

26

221

92

76

179

47

Number

6,S53

127

10

71

133

333

101

110

19

18

413

70

18

26

309

150

155

153

112

180

35

96

166

196

196

116

173

49

75

26

60

111

45

410

155

70

252

75

71

317

43

101

80

262

657

53

19

193

61

64

155

41

951

19

5

9

11

63

19

9

3

3

34

16

8

~4

49

13

25

:?2

19

“11

15

:!5

26

57

23

1

15

12

6

2

13

“i9

3

35

46

2

39

“13

I 4

26

5

“13

7

’11

41

42

7

28

11

“12

:24

6

the remaining States, Ohio and

Tennessee each had more than 250

home health agencies. Eleven States and

the District of Columbia each hadlfewer

than 50 home health agencies.

About athird(33percent) of the

hospices were also located in six States

California, Illinois, Michigu North

Carolina, Ohio, and Texas. California

had the greatest number of hospices
Advance Data No. 257 ● November3, 1994 3

Table 3. Number and pereent distribution of home health ears and hospice eara clients by type of ears reeelved aeeording to type of

ownership, certifleation, and geographic region: United States, 1991

TP ofcererecefwd

Iionremcem m- Heemrerrdtraspbe cere

Agenoyoherectm”etk Number Permrrt Number di%%i%i% Number disidbutkm Nurnbw (&%%&

AllageM”ee . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,2S3,704 100.0 1,1s8,4s4 100.0 43,4s7 100.0 20,7S3 100.0

Type of OWIWShip

Pmpnetary . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Govemmentend other . . . . . . . . . . . . . . . . . . . .

349,s63

70S,871

204,970

27.7

56.1

18.2

333,480

657,ss1

18s,103

28.0

55.3

18.7

7,003

X3,738

2,74S

16.1

77.6

6.3

9,3s0

17,251

4,122

30.5

56.1

13.4

certification

Medicerecerlified . . . . . . . . . . . . . . . . . . . . . . .

Medicaid certified. . . . . . . . . . . . . . . . . . . . . . . .

28,399

26,559

S5.8

38.4

1,128,5S5

1,128,522

89.1

88.1

1,062,453

1,063,225

68.3

88.4

37,706

25,73s

35.7

322

Geographic region

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

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

south . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

west. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

402,077

276,120

443,884

141,843

31.8

21.9

35.1

11.2

3s0,807

281,840

416,001

130,618

320

220

35.0

11.0

9,74s

8,514

17,135

8,082

22.4

18.6

39.4

18.6

11,424

5,666

10,52s

3,135

37.1

18.4

34.2

10.2

NOTEPwenfsrnay mtadd~totalskcause ofrmmding.

(83), followed byMichigan (57), Illinois

(49), North Carolina (48), Texas (42),

and Ohio (39). I?loridq kfirmesot~ and

New York each had more than 30

hospices. Fifteen States and the District

of Columbia each had fewer than 10

hospices.

Hospiceand home health

clients

More than onemillion clients were

provided home heslth and hospice care

inthe United States in 1991 (table 3).

Three types of clients are included in

this reporC clients who received only

home health services (home health

clients); clients who received only

hospice services (hospice clients); and

clients who received home health care

as well as hospice care services. Of the

1,263,704 home health and hospice care

clients, 1,189,464 (94.1 percent)

received only home health care, 43,487

(3.4 percent) clients received only

hospice care, and 30,753 (2.4 percent)

received both types of care.

Most of the clients who received

only home health care were served by

nonprofit agencies proprietary agencies

provided care to 28 percent of these

clients and 17 percent were served by

government agencies and agencies with

other types of ownership. In contrast,

78 percent of hospice clients were

provided care by nonprofit agencies,

16 percent were served by proprietary

agencies, and 6 percent were sewed by

government and other agencies. Of the

30,753 clients that received home health

and hospice care 17,252 or 56 percent

were served by nonprofit agencies and

31 percent were cared for by proprietary

agencies.

Medicare certiiied agencies

provided care to 1,126,565 clients, and

Medicaid certiiied agencies accounted

for nearly the same number of clients,

1,125,522. Eighty-nine percent of all

home health clients were served by

Medicare- and/or Medicaid-certiiied

agencies. The comparable percents for

hospice clients are 87 and 82 percent.

Similarly, 86 percent of clients who

received both types of care were served

by certified agencies.

Over 400,000 hospice and home

health clients were located in the

Northeaat (40Z077) or South (443,664)

regions. The Midwest and West regions

combined account for 417,963 clients. A

comparison of clients by region

according to type of care received show

some interesting d=erences. There was

only a 3-percent dMerence in the

percent of clients who received home

health care in the Northeast and South

regions (32 and 35 percent), but clients

who received hospice care in these two

regions diilered by 17 percent

(22 percent in the Northeast compared

with 39 percent in the South). The

opposite pattern occurred for clients in

the Midwest and West regions. In these

region6, there was an n-percent

difference in clients who received home

health care but only a l-percent

difference in hospice care clients.

The number of clients provided

home health and hospicx care in the

United States during 1991 by type of

care provided for each State are shown

in table 4. As expected, most of the

clients in every State were home health

clienks. The remaining clients received

either hospice care only or home health

and hospice care. The number of clients

that received both types of care was

greater than the number that received

only hospice care in 11 States

(Arkansas, Connecticut Illinois,

Louisian% Massachuaetta, Missouri,

New Jersey, North Dako@ Temessee,

Texas, and Virginia).

The number of clients by type of

care received for the 10 States with the

largest numbem of total clients are

shown in table 5. These 10 States also

served the largest number of home

health clients. Fifty-four percent of all

clients as well aa 54 percent of home

health clients were provided care by

these 10 States. Fourteen percent of all

home health and hospice clients

(181,454) were served in New York
4 Advance Data No. 257 ● November 3, 1994

Table 4. Number of active home health and hospice clients by type of care received and Statw United States, 1991

Type of care

All

State

Home Home health

cfients heatttr Hospice and hospice

All States . . . . . . . . . . . . . . . . . . . . . . . 1,263,704 1,189,464 43,487 30,753

Alabama . . . . . . . . . . . . . . . . . . . . . . . 26,578 25,328 644 406

Alaska . . . . . . . . . . . . . . . . . . . . . . . . 784

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

727 34 3

10,392 9,790 532 70

Arkansas . . . . . . . . . . . . . . . . . . . . . . . 11,052 10,336 308

California . . . . . . . . . . . . . . . . . . . . . . .

408

76,175 66,902 4,641

Oolorado . . . . . . . . . . . . . . . . . . . . . . .

2,632

9,277 8,361 378

Connecticut . . . . . . . . . . . . . . . . . . . . .

18

29,716 28,123 393 1,200

Delaware . . . . . . . . . . . . . . . . . . . . . . . 5,730 5,590 139 1

DiabfctofOoIumbia . . . . . . . . . . . . . . . . 4,631 4,563 68

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

0

67,277 60,908 5,376

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

993

27,500 28,571 529 400

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . 1,051 808 127 16

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . 2,338 2,111 210 17

Illinois. . . . . . . . . . . . . . . . . . . . . . . . . 52,303 46,927 1,500 1,876

Indiana . . . . . . . . . . . . . . . . . . . . . . . . 21,639 20,656 597 566

lowa . . . . . . . . . . . . . . . . . . . . . . . . . . 20,665 19,647 676 162

Kansas . . . . . . . . . . . . . . . . . . . . . . . . 8,518 7,528 562 428

Kentuc~ . . . . . . . . . . . . . . . . . . . . . . . 26,466 24,747 1,238

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

501

26,037 24,363 750 804

Maine . . . . . . . . . . . . . . . . . . . . . . . . . 11,862 11,141 513 8

Maryland . . . . . . . . . . . . . . . . . . . . . . . 15$63 14,110 1,328 526

Massachusetts . . . . . . . . . . . . . . . . . . . 52,622 47,650 1,808

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

2,964

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

41,698 40,325 1,346 23

29,365 28,442 733

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

190

24,532 24,444 86 0

Missouri . . . . . . . . . . . . . . . . . . . . . . . 22,658 20,720 630 1,208

Montana . . . . . . . . . . . . . . . . . . . . . . . 6,362 6,121 157 104

Nebraska . . . . . . . . . . . . . . . . . . . . . . . 7,398 7,056 232

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

110

2,167 1,978 184 5

NewHampshire . . . . . . . . . . . . . . . . . . 9,294 8,884 366 34

NewJersey . . . . . . . . . . . . . . . . . . . . . 34,574 29,093 1,360 4,121

NewMexim . . . . . . . . . . . . . . . . . . . . . 2,961 2,759 217 5

NewYork . . . . . . . . . . . . . . . . . . . . . . . 181,454 177,547 2,346 1,561

North Carolina . . . . . . . . . . . . . . . . . . . 36,038 34,443 1,325 270

North Dakota . . . . . . . . . . . . . . . . . . . . 7,521 7,360 59 102

Ohio. . . . . . . . . . . . . . . . . . . . . . . . . . 42,673 40,461 1,307

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

885

7,663 7,661 154 46

Oregon . . . . . . . . . . . . . . . . . . . . . . . . 9,512 8,644 714

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

1s4

62,190 56,766 2,220 1,204

Rhode Island . . . . . . . . . . . . . . . . . . . . 14,971 14,075 564

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

332

19,570 18,739 491 340

South Dakota . . . . . . . . . . . . . . . . . . . . 3,097 3,026 69 2

Tennessee . . . . . . . . . . . . . . . . . . . . . . 43,961 42,612 463 666

Texas . . . . . . . . . . . . . . . . . . . . . . . . . 65,131 59,258 2,354 3,519

Utah . . . . . . . . . . . . . . . . . . . . . . . . . . 4,652 4,701 136

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

15

5,594 5,418 176 0

Virginia . . . . . . . . . . . . . . . . . . . . . . . . 27,058 24,429 1,286 1,848

Washington . . . . . . . . . . . . . . . . . . . . . 14,638 13,642 712 64

WestVirginia . . . . . . . . . . . . . . . . . . . . 8,237 7,659 374 4

Wisconsin . . . . . . . . . . . . . . . . . . . . . . 18,167 17,572 501 84

Wyoming . . . . . . . . . . . . . . . . . . . . . . . 1,314 1,252 50 12

State alone. Referring to table 2, it can

be seen that these clients were served in

the 445 hospices and home health

agencies that were located in New Yorlq

these agencies made up 6percentofrdl

the hospices and home health agencies

in the United States in 1991. California

reported the second highest number of

clients receiving home care (76,175 or

6percent ofall clients in the United

States). These clients were served in

5percent(416)of the Nation’shospiees

and home health agencies. Texas, the

State with the largest number of

agencies (599,0r 8percent ofall

agencies), served 65,131 (5percent)of

all clients,

Most States provided care to fewer

than 1,000 hospice clients (table 4). The

number olhospiee clients by State

ranged from34 inAlaskato 5,376 in

Florida. Seven States provided care to

47percent of the hospice clients

(PloridA Califomiz Texas, New York

Pennsylvania, Massachusetts, and
Advance Data No. 257 ● November 3, 1994 5

Table 5. Number of home health and hospice ewe clients by type of eere for the 10 States with the Iargeat number of clienbx

United States, 1991

TW of CSt_8

Tots/ Home Home health

States olienta health HosP.ba and hospioa

Naw York. . . . . . . . . . . . . . . . . . . . . . . 181,454 177,547 2,346 1,561

California . . . . . . . . . . . . . . . . . . . . . . . 78,175 68,902 4,641 2,632

Florida . . . . . . . . . . . . . . . . . . . . . . . . 87,277 60,903 5,378 993

Texas . . . . . . . . . . . . . . . . . . . . . . . . . 65,131 59,253 2,324 3,519

Pennsylvania . . . . . . . . . . . . . . . . . . . . 62,190 58,766 2,220 1,204

Massachusetts . . . . . . . . . . . . . . . . . . . 52,622 47,850 1,306 2,864

Illinois. . . . . . . . . . . . . . . . . . . . . . . . . 52,303 48,927 1,500 1,876

Tennessee . . . . . . . . . . . . . . . . . . . . . . 43,961 42,612 433 666

Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . 42,673 40,481 1,307 385

Michigan . . . . . . . . . . . . . . . . . . . . . . . 41,686 40,325 1,346 23

Illinois). These States are all included in

tabIe5. Of theremaining 7 States that

served more than 1,000 hospice clients

in 1991, Onlyone (Ohio) is included in

table 5. These 7 States are New Jersey

(1,360), Michigan (1,348), Maryland

(1,328), North Carolina (1,325), Ohio

(1,307), Viginia (1,286), and Kentucky

(1,238). Alaska, the District of

Columbia, Mississippi, North Dakota,

South Dakota, and Wyoming served

fewer than 100 hospice clients each.

Average number of clients per

agency

The number of home care agencies,

the number of home care clients, and

the average number of clients per

agency for all agencies are shown in

table 6. The average number of clients

per agency ranged from a low of 28 in

Wyoming to a high of 408 in New York.

A mentioned in a previous section,

most agencies andlor clients were in

CslifomiL Texas, Florida, Illinois,

Pennsylvania, New Yor& and

Massachusetts. Among these seven

States, only two averaged more than 200

clients per agency. New York reported

that 445 agencies provided care to

181,454 clients, an average of 408

clients per agency, and Massachusetts

reported that 192 agencies provided care

to 52,622 clients, an average of 274

clients per agency. Texas, which had the

most agencies overall (599), had an

average of 109 clients per agency.

States that averaged more than 200

clients per agency were New York

Comectieu$ Delaware, Rhode Island,

Georgia, Massachusetts, New Jersey,

Mississippi, the District of Columbi%

Kentucky, Maine, and Vermont.

Although some of these States had a

relatively low number of agenci~ home

health care and hospice care serviees

were in demand. For example, Rhode

Island and Georgia each had fewer than

100 agencies, but provided care to

14,971 and 27,500 clients, an average of

312 and 313 clients per agency.

Delaware, Vermon~ and the District of

Columbia each had fewer than 30

agencies overall, but their average

number of clients are 260, 215, and 221.

In comparison, Massachusetts and

Illinois provided care to nearly the same

number of clienti, however,

Massachusetts averaged 274 cfients per

agency while Illinois averaged 146.

Illinois had 166 more home care

agencies than Massachusetts.

With the exception of New York all

the States that averaged more than 200

clients also had fewer than 200 agencies

overall.

References

1.

2.

SirroccoA. Nursinghome

characteristic-x1986 Inventoryof

Long-TermCarePlaces.National

Centerfor HealthStatistics.Vhal

HealthStat 14(33). 1989.

Ekhmd D. The agency reporting

systemfor maintainingthe national

inventoryof hospitalsand

institutions.NationalCenter for

HealthStatistics.Wal HealthStat

1(6). 1968.
6 Advance Data No. 257 ● November 3, 1994

Table 6. Number of home care agencies and home care clients and average number of

clients by Ststw United Stste~ 1991

Home care Home care Average number

states agencies cliem% of clients

All States . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Caliirnia . . . . . . . . . . . . . . . . . . . . . . .

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

Connecticut . . . . . . . . . . . . . . . . . . . . .

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

DiatrictofColumbia . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mis.?aun . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

NewYoA . . . . . . . . . . . . . . . . . . . . . .

North Carolina . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

SouthOerolina . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Vkginia. . . . . . . . . . . . . . . . . . . . . . . .

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

West Virginia . . . . . . . . . . . . . . . . . . . .

Wisconsin . . . . . . . . . . . . . . . . . . . . . .

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

7,804

146

15

80

144

416

120

119

22

21

447

86

26

40

358

163

180

176

131

191

50

121

192

253

229

117

188

61

61

30

73

130

46

445

203

72

291

88

85

345

48

174

87

273

599

57

26

221

92

76

179

47

1,263,704

26,578

764

10,392

11,052

76,175

9,277

29,716

5,730

4,631

67,277

27,500

1,051

2,336

52,303

21,639

20,665

6,518

26,466

26,037

11,662

15,983

52,622

41,636

28,385

24,532

22,656

6,362

7,398

2,167

9,294

34,574

2,981

181,454

36,036

7,521

42,673

7,663

9,512

62,190

14,971

19,570

3,097

43,961

65,131

4,852

5,594

27,056

14,638

8,237

16,167

1,314

162

182

51

130

77

183

77

250

260

221

151

313

40

56

146

134

115

46

202

136

233

132

274

165

128

210

122

105

91

72

127

266

62

406

178

104

147

90

112

160

312

172

36

161

109

85

215

122

159

108

101

26
Advance Data No. 257 ● November 3, 1994 7

Technical notes

Source of data

This report is based on information

collected in the 1991 National Health

Provider Inventory (NHPI). All agencies

providing home health and hospice care

were included in the survey without

regard to Iicenaure or to certification

status under Medicare and/or Medicaid.

The universe for the 1991 NHPI

consisted of approximately 87,000

health care providers approximately

14,000 home and hospice care agencies,

and 73,000 nursing and board and care

homes.

The U.S. Bureau of the Census,

under an interagency agreement with the

National Center for Health Statistics

(NCHS) was responsible for conducting

a mail survey with a telephone follow

up of nonrespondents. Data collection

began in April 1991.

Survey methods

The Agency Reporting System

(ARS) (2), an ongoing system designed

to update constantly the NHPI listings,

was used to construct a mailing file of

names and addresses for 14,000 home

and hospice care agencies. The mailing

file of the NHPI was created by the

Long-Term Care Statistics Branch

(ETCSB) of NCHS.

All home herdth agencies and

hospices were mailed a questionnaire,

and about a week later, a reminder

postcard. Six weeks after the initial

mailing, all providers who had not

returned a completed questionnaire were

mailed the questionnaire a second time.

Mter a second 6-week period, providers

still remaining as nonrespondents were

mailed a third questionnaire. At the end

of the mailing cycle, each nonresponding provider was contacted by

telephone. A minimum number of

questionnaire items were sought through

the telephone interviews either until the

information was collected or the

interviewer received a Ilrm refusal. Only

116 of the home health agencies and

hospices refused to provide any

information.

The mailing file of home health Region

agencies and hospices contained over

14,000 records. After refusals, the Northeast

out-of- business, temporarily closed, and

otherwise out-of-scope places were

eliminate~ the total number of places

Was 7,804.

Definition of terms

Terms relating to agencies Midwest

Home health—Health services are

provided to individuals in their places of

residence for the purpose of (a)

promoting, maintaining, or restoring

healm or (b) maximizing the level of south

independence, while minimMng the

effects of disability and ilh.wss

(including terminal illness).

Hospice—Hospices are specialized

services for terminally ill people and

their families including medical services,

social and emotional support for patients

and families, volunteer suppo~ and

bereavement services for families

following the death of the patient. west

Ownershi@wnership designates

the type of organization by which the

agency operates. Proprietary agency

indicates control by an individual,

partnership, or corporation. Nonprofit

States included

Comecticut, Maine,

Massachusetts, New

Hampshire, Rhode

Iskmd,Vermon; New

Jersey, New York

Pennsylvani~ Illinois,

Indiana

Michigw Ohio,

and

Wkco-isin, Iowz KSilSaS,

Minnesota, Missouri,

Nebrask% North Dakota,

and south Dakota

Delaware, District of

Columbia, Florid%

Georgi% Maryland, North

carob% south Carolin%

vii% West Viginia,

Alabam% Kentucky,

Mississippi, Temessee,

Arkansas, Louisian%

Oklahoma, and Texas

Arizon% Colorado, Idaho,

Montan& Nevad% New

Mexico, Utah, Wyoming

Alasb Californi%

Hawaii, Oregon, and

Washington

agency includes ownership by a

religious group or by a nonprofit Term relstlng to clients

organization.

Certi”@atio*Facility certification

Active clients-Active clients are

by Medicare andlor Medicaid.

clients on the agency’s roll at the time

Medicare—The medicrd assistance

of the survey.

provided in title XVII of the Social

Security Act. Medicare is a health

insurance program administered by the

Social Security Administration for

persons 65 years of age and over and

for disabled persons who are eligible for

benefits.

Medicati-The medical assistrum

provided in title XIX of the Social

Security Act. Medicaid is a State

administered program for the medically

indigent.

Geographic re@”ons—Agencies are

classified by geographic area by

grouping the States into regions. These

regions correspond to those used by the

U.S. Bureau of the Census.
8 Advance Data No. 257 ● November 3, 1994

Suggested citation Copyright information

Jones A. Hospices and home health agencies All material appearing in this report is in the

Data from the 1991 National Health Provider public domain and may be reproduced or

Inventory. Advance data from vital and health copied without permission; citation as to

statiatic~ no 257. Hyattsville, Maryland: sourca, however, is appreciated.

National Center for Health Statistics. 1994.

National Center for Health statistics

Director

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

Deputy Director

Jack R. Anderson

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

6525 Belcrest Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

To receive this publication regularly, contact

the National Center for Health statistics by

calling 301-436-6500

mid

DHHS Publication No. (PHS) 95-1250

4-2310 (1 1/95)
Number 258 ● November 14, 1994

Advance

Data

FromVital and HealthStatisticsofthe CENTERS FOR DISEASE CONTROLAND PREVENTION/Natkmal Centerfor HealthStatkt&

Dietary Intake of Vitamins, Minerals, and Fiber of Persons

Ages 2 Months and Over in the United States: Third National

Health and Nutrition Examination Survey, Phase 1, 1988-91

by Katherine Alaimo, Margaret A. McDowell, M. P.H., R. D., Ronette R. Briefel, Dr.P.H., R. D.,

Ann M. Bischof, R. D., Clifford R. Caughman, M.S., Catherine M. Loria, M.S., M.A., and

Clifford L. Johnson, M.S.P.H., Divisionof Health ExaminationStatistics

Introduction

Dietary guidance, food fortification,

nutrition intervention programs, and

nutrition policy aimed at improving the

American diet depend on knowledge of

what Americans eat. The concrete link

between food and health has been well

documented by numerous studies and

reports describing the impact of dietary

intake on disease prevention and health

promotion (l-3). This report on the

micronutrient consumption of

Americans, including minerals, vitamins,

and dietary fiber, is based on

information collected in the third

National Health and Nutrition

Examination Suwey (NHANES III),

conducted by the National Center for

Health Statistks (NCHS), Centers for

Disease Control and Prevention (CDC).

As a major component of the

National Nutrition Monitoring and

Related Research Program, the Health

and Nutrition Examination Surveys

(HANES) are an important source of

periodic information on the dietary,

nutritional, and health status of the U.S.

population (4-8). HANES data play a

unique role in nutrition monitoring and

epidemiologic research, combining

personal dietary interviews with

standardized health examinations (7–9).

NCHS completed three HANES surveys

between 1971 and 1984 (5,6,8).

NHANES ID was conducted in two

3-year nationally representative phases

covering 1988-94 (5,10). Data for the

Iirst phase, 1988-91, are presented here.

The NHANES III dietary

assessment component was designed to

meet the survey’s nutrition monitoring

and nutrition research objectives (9,10).

The 24-hour recall method was selected

for use in NHANES III to estimate

nutrient intake for the population and

various subgroups and to study diethealth relationships (7–9,11-13). Prior to

NHANES III, 24-hour recalls were

recorded on hard-copy forms and

manually coded by dietary interviewers.

In 1988, NCHS contracted with the

University of Minnesota’s Nutrition

Coordinating Center to develop an

automatti interactive dietary interview

and coding system called the

NHANES III Dietary Data Collection

(DDC) system (14-16). NCHS, the

National He@ Lung and Blood

Institute, and the Food and Drug

Administration funded the development

of the DDC system. Features of the

DDC system have been previously

described (10,11,14-16) and are

summarized in the Technical notes.

This report provides national

reference estimates of minerals,

vitamins, and dietary fiber for pemons

2 months of age and over. Daily dietary

estimates are reported by age and

Acknowledgments

The authorsgratefullyacknowledgethe technicalexpertiseand assistanceof Ms. DianeArroyoin planning,monitoring,andprocessingdata from

the NHANES 111dietaty component,and Mr. Marco Marinfor excellentcomputerprogrammingsupport.The reportwas ediied by Gail V. Johnson

and typeset by Zung Le of the PublicationsBranch,Divisionof Data Services.

# swlct~.ti

& %

-g

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

;+ Public Health Service

s

* Centers for Disease Controland Prevention ‘6‘%atima >

National Center for Health Statistics cmmRalW?usE4sEcoNmol.

CK

&Nomlswm—lm
2 Advance Data No. 258 ● November 14,1994

gender for the total population and for

three race-ethnic groups: non-Hispanic

whites, non-Hispanic blacks, and

Mexican Americans. Intakes of

macronutrients were previously

reported (11).

Selected dietary intake findings

NHANES III, 1988-91 values for

means, standard errors of the means

(SEM), and medians are shown by age,

se~ and race-ethnicity for minerals

(tables 1-8), vitamins (tables 9-19), and

dietary fiber (table 20). Findings for

selected nutrients and fiber are discussed

in the following text.

Interpretation of the NHANES III

nutrient data requires some

qualifications. Because data are not

age-adjuste~ race-ethnic comparisons

used only age-specific estimates. In

addition, sample sizes of non-Hispanic

blacks and Mexican Americans are

small for some older age categories and

estimates may not be stable. These

estimates are marked in tables 1-20

with an asterisk (*). Some nutrient

estimates are by their nature very

skewed (for example, copper, iron, zinc,

vitamin & carotenes, vitamin B12, and

vitamin E). This is because food and

nutrient intake varies from day to day.

Consumption of certain nutrients may be

very high or very low for some

individuals on a specific day, influencing

population distributions. For nonnormally distributed variables, the

means and standard errors of the means,

which assume normality, should be used

and interpreted with caution.

Mean iron intakes averaged 15.5

milligrams in non-breastfed infants,

were lower among children ages

1–2 years, increased again through

adolescence and young adulthood, and

leveled off until the oldest age group

(table 3). Non-Hispanic black nonbreastfed infants had slightly higher

intakes (18 milligrams) than nonHispanic white (15 milligrams) and

Mexican American infants

(14 milligrams). Mean iron intakes in

adolescents and adults were consistently

higher in males than in females,

coinciding with a similar pattern

observed in mean total energy intakes

(11). Among males ages 6 years and

over, mean iron intakes were slightly

higher in non-Hispanic whites than in

non-Hispanic blacks and Mexican

Americans. Age-specific mean iron

intakes in females were generally

similar in all three race-ethnic groups.

Comparison of national nutrient

intakes to the Recommended Dietary

Allowances (RIMs), standards

developed by the Food and Nutrition

Board of the National Research Council,

is a practical screen to identify potential

public health concerns (17). When used

in conjunction with information about

dietary and health behavior, nutritional

biochemistries, and anthropometry,

determination of the nutritional status of

the population can be made (16,1’7).

Age-specific mean and median iron

intakes met or exceeded the RDA for

infants and children ages 3-11 years of

all race-ethnic groups, but not for

children ages 1–2 years. While all

adolescent and adult males’ mean and

median intakes met the RD& this was

not true for most of the female groups.

Some studies have shown that

calcium intake plays a role in colon

cancer, high blood pressure

(hypertension), and kidney stones, and is

instrumental in the prevention of

osteoporosis (18, 19). Recent literature

has identified the importance of

consuming adequate calcium while

bones are still forming to maintain peak

bone mass and throughout life (20,21).

The RDA for calcium is 1,200

milligrams for adolescents and adults up

to age 25 and 800 milligrams for

children and adults over age 25 (17).

Both mean and median intakes of

calcium were higher for males compared

with females (table 1). Osteoporosis is

more prevalent in women; mean and

median calcium intakes were lower than

the RDA for almost all female raceethnic groups above 12 years of age.

Age- and sex-specific intakes were

generally similar for non-Hispanic

whites and Mexican Americans and

were lower in non-Hispanic blacks. In

males, calcium intakes were highest

during adolescence (16-19 years of age)

and lower in subsequent age groups,

whereas in females, the highest intakes

were observed during childhood

(6-11 years of age) and began to decline

during adolescence.

Mean sodium intakes from food

sources were higher in males compared

with females at all ages and highest in

adolescence and early adulthood,

corresponding to a similar pattern in

mean energy intakes (table 7) (11). For

males, mean sodium intakes were ;about

600 milligrams during infancy, increased

to about 4,800 milligrams in late

adolescence and early adulthood, and

declined to about 2,900 milligrams in

the oldest age group. For females, mean

intakes were about 500 milligrams

during infancy, increased to about 3,100

milligrams in late adolescence and early

adulthood, and then dropped to about

2,200 milligrams in the oldest age

group. Overall, adult mean sodium

intakes were similar among nonHispanic whites, non-Hispanic black,

and Mexican Americans. Mean soclium

intakes in the population exceeded the

minimum requirements of healthy

persons, and the recommended intake of

2,400 milligrams set for adults in 1989

by the National Research Council (17).

The NHANES III data for children

show a trend toward slightly higher

mean sodium intakes for non-Hispanic

black children compared with nonHispanic white children and Mexican

American children in all age groups.

The mean sodium intake is consistently

higher for non-Hispanic black children

in each age group, 300 milligrams

higher in children 1–2 years of age, 400

milligrams higher in children 35 years

of age, 300 milligrams higher in

children 6-11 years of age, and 200

milligrams higher in adolescents 1%15

years of age. This trend continued with

adolescents 16-19 years of age but not

with adults.

Dietary guidance, including the

Dietary Guidelines for Americans, have

recommended increasing the amount of

fruits, vegetables, grains, and legumes in

the diet (1,22). These plant foods

contain dieta~ fiber and several

nutrients such as carotenes, vitamin C,

and folate, which are thought to be

protective against many diseases (1,2).

The mean intake of dietary fiber

was 17 grams for males and 13 grams

for females (table 20). Corresponding

median intakes were 15 grams and 11

grams, respectively. Intakes were higher

for males compared with females for all
Advance Data No. 253 ● November14, 1~ 3

race-ethnic groups. In adults less than

70 years of age, intakes were highest in

Mexican Americans, followed by

non-Hispanic whites and non-Hispanic

blacks. Mean intakes were generally

higher for adults compared with children

and adolescents. The National Cancer

Institute (NCI) has recommended that

adults consume 2(L3O grams of fiber

daily (23). The only groups whose mean

intakes reached the NCI goal were

Mexican American males ages 16-69

years (ranging from 20-26 grams) and

non-Hispanic white males ages 30 –39

years (20 grams). The median intakes of

dietary fiber for adults were 12–14

gmms, indicating that a large portion of

the U.S. population did not meet the

NCI goal for dietary fiber intake on the

day prior to their examination.

Age-specific mean and median

intakes of carotenes were also higher in

males than in females and differed

among the race-ethnic groups studied

(table 11). Adults generally had higher

mean intakes of carotenes than children

and adolescents. Mean vitamin C

intakes were also higher in males

(115 mil@uns) than females

(95 milligrams) but were similar among

all three race-ethnic groups (table 18).

The mean intake of folate was

275 milligrams for persons 2 months of

age and over (table 16). Males had

consistently higher intakes of folate than

females in all age and race-ethnic

groups. Age-specific mean folate intakes

were generally higher in non-Hispanic

whites and Mexican fiencans and

lowest in non-Hispanic blacks for both

sexes. The highest folate intakes

occurred during late adolescence and

young adulthood and declined thereafter.

Recent studies have demonstrated

that supplementation of folic acid by

women reduces their risk of having

children with spina bifida or other

neural tube defects (24,25). CDC has

recommended that women of

childbearing age consume 0.4

milligrams of folic acid per day (26).

Mean and median intakes from food for

women of childbearing age were below

this recommendation.

Summary

Intervention strategies aimed at

reducing the prevalence of nutritionrelated diseases, including designing

nutrition policies and nutrition education

and assistance programs, require

effective monitoring of what Americans

are eating. Nutrient reference data from

the third National Health and Nutrition

Examination Survey provide essential

information to achieve these gords.

Mean and median iron intakes were

adequate in males of all race-ethnic

groups but were generally low in

females and young children. Mean and

median calcium intakes were also higher

in males than in females and were lower

than recommendations in adolescents

and in women of all ages. Mean sodium

intakes for all age, se% and race-ethnic

groups exceeded the minimum

requirements of healthy persons and

were higher in non-Hispanic black

children and adolescents than in

non-Hispanic white and Mexican

American children and adolescents.

Mean fiber intakes also did not meet

recommendations in most subgroups and

were higher in Mexican American adults

followed by non-Hispanic white adults

and non-Hispanic black adults.

Further research is planned to

compare the food sources of energy and

nutrients consumed by different

population groups in NHANES III to

similar results flom earlier national

surveys. NHANES III, Phase 2

(1991–94) recalls were collected using

the same dietary method as those

collected in Phase 1 (1988-91), and

other analyses will compare findings

from both phases of NHANES III.

References

1. Committee on Diet and Health, Food

and Nutrition Boar& Commission on

Life Sciences, National Research

Council. Diet and health

Implications for reducing chronic

disease risk. WashingtorE National

Academy Press. 1989.

2. U.S. Department of Health and

Human Services. The Surgeon

General’s report on nutrition aud

health. Washington U.S. Government

Printing Office. 1988.

3. Life Sciences Research Office,

Federation of American Societies for

Experimental Biology. Nutrition

monitoring in the United States an

update report on nutrition monitoring

inthe United States. Washington

Public Health Service. 1989.

4. Woteki CE. Dietary survey datx

Sources and limits to interpretation.

Nutr Rev S204-12. 1986.

5. Interagency Board for Nutrition

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Nutrition monitoring in the United

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Wright JD, ed. Hyattsville, Maryland

Public Health Service. 1992.

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7. Bnefel RR. Assessment of the U.S.

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National collaborative efforts and

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59(suppl)M4s-7s. 1994.

8. Woteki CB, Bnefel RRj Kuczrnarski

R. Contributions of the National

Center for Health Statistics. Am J

Clin Nut.r 4%320-8. 1988.

9. Woteki C.E, Bnefel RRj Hitchcock D,

et al. Selection of nutrition status

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NHANES III design. J Nutr

1201440-5. 199Q.

10. Plan and operation of the third

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~ et al. Energy and macronutrient

intakes of persons ages 2 months and

over in the United Statex Third

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1988-91. Advance data ti’om vital

and health statistis, No 255.

HyattsvilIe, Maryland National

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National Health and Nutrition

Examination Survey. National Center

for Health Statistics. Wtal Health Stat

4(27). 1992.

13. Sempos CT, Briefel RR, Flegal KM,

Johnson CLj Murphy RS, Woteki

CE. Factors involved in selecting a

dietary survey methodology for

national nutrition surveys. Aust J

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1992.

14. McDowell M, Briefel RR, Wmren

~ Buzzard IM, Feskanich D,
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Gardner SN. The dietary data

collection system. An automated

interview and coding system for

NHANES III. Proceedings of the

14th National Nutrient Databank

Conference. Ithaca, New York

CBORD (hOUp, hlC. 1990.

15. Feskanich D, Buzzard IM, Welch BT,

et al. Comparison of a computerized

and a manual method of food coding

for nutrient intake studies. J Am Diet

ASSOC 88:126>7.1988.

16. Feskanich D, Sielaff BH, Chong ~

and Buzzard WI. Computerized

collection and analysis of dietary

intake information. Computer

Methods and Programs in

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Recommended dietary allowarus.

loth ed. Washington National

Academy Press. 1989.

18. Office of Medical Applications of

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Skin Diseases, National Institutes of

Health. NH-IConsensus Development

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Intake. June 6-8, 1994.

19. Johnson CC, Miller JZ, Slemenda

CW, et al. Calcium supplementation

and increases in bone mineral density

in children. N Engl J Med 327:82–7.

1992.

20. Sandier RB, Slemenda C, La Porte

R, et al. Postmenopausal bone

density and milk consumption in

childhood and adolescence. Am J

Clin Nutr 42270-4.1985.

21. Arnaud CD, Sanchez SD. The role of

calcium in osteoporosis. Anmr Rev

Nutr 10397414.1990.

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for Americans. 3rd ed. Washington

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1990.

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MuMvitarnin/folic acid

supplementation in early pregnancy

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use of folic acid to reduce the

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other neurrd tube defects. MMWR

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28. Shah BV, Barnwell BG, Hunt PN,

Nbm P, Lavange LM. SUD.&4N

User’s Manual, release 5.50.

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Carolina: Research Triangle Institute.

1991.

29. Westat, Inc. NHANES III dietary

interviewer’s manual. Prepared for

the Nationrd Center for Health

Statistics, Hyattsville, Maryland.

1992.

30. Briefel ~ Johnson CL.

Methodologic issues and quality

control for the dietary component in

NHANES III. Abstract. A-373.

Federation of the Arnencan SOcielies

for Experimental Biology.

Washington. 1990.

31. Human Nutition Information

Service, U.S. Department of

Agriculture. Survey Nutrient Data

Base for NHANES HI, Phase 1.

Hyattsville, Maryland Human

Nutrition Information Service. 1993.

32. National Center for Health Statistics.

Editing guidelines for the 24-hr

dietary recall component of

NHANES III, Phase 1, 1988-91.

Hyattsville, Maryland, 1993.

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

* Estimate is less reliable based

on statistical criteria of sample

size and coefficient of variation
Table 1. Calcium intake In milligrams by age, sex, and rata-ethniclty United States, 1988-91

Totalpopulation’ Non-Hispanic white Non-H@wric black Mexican Arrreriosn

Standard standard Standard Standard

Sample error of Sample enw of Sanrple error of Sarrrple error of

Sex and age size Mean the mean Median size Mean tire mean Median size Mean the mean Median size Msen the mean Median

13athsexes

Allagesz . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l–2yeafe2 . . . . . . . . . . . . . . . . .

3-5yeafe . . . . . . . . . . . . . . . . .

6-llyeafs . . . . . . . . . . . . . . . . .

12-15 years . . . . . . . . . . . . . . . .

18-19 years . . . . . . . . . . . . . . . .

20-29 years . . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . .

40-49 yeare . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

60yeareandover . . . . . . . . . . . .

Male

AUages2 . . . . . . . . . . . . . . . . . .

2-llmonlhs2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5yeare . . . . . . . . . . . . . . . . .

5-n yeare. . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years. . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yeafe . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69yeare . . . . . . . . . . . . . . . .

70-79years, . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

Female

Allagesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l-2yeare2 . . . . . . . . . . . . . . . . .

3-5yeafe . . . . . . . . . . . . . . . . .

6-llyeaffi . . . . . . . . . . . . . . . . .

12–15years. . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-89years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

i4,80i 857

87i 759

1,231 635

1,547 655

1,745 836

711 971

765 1,050

1,662 924

1,526 693

1,228 756

929 747

1,106 787

651 706

509 659

7,322 976

439 764

501 652

744 694

658 t ,007

338 1,136

368 1,274

644 1,075

735 1,049

626 634

473 654

546 876

444 606

286 721

7,479 744

432 732

630 617

803 815

877 667

373 786

397 822

638 778

791 753

602 665

456 651

560 711

407 636

313 826

11

18

17

16

16

31

38

21

24

20

23

23

22

23

17

26

24

23

22

46

61

32

38

31

36

34

34

31

12

20

20

18

20

33

34

22

22

22

23

26

24

28

742

665

800

798

878

888

871

766

756

649

631

673

605

561

658

688

788

634

855

1,053

1,102

942

915

726

720

722

671

834

852

623

600

756

614

665

745

640

649

575

557

625

571

531

5,760

473

424

425

511

221

245

460

550

467

472

483

53a

501

2,667

241

202

219

252

86

112

216

271

243

251

247

265

250

2,683

232

222

208

258

123

133

244

278

224

221

248

253

251

6a5

789

652

876

980

934

1,125

966

953

765

775

814

728

671

1,016

810

860

928

1,041

1,179

1,373

1,142

1,122

651

802

895

832

742

784

765

843

827

879

801

868

806

766

717

650

743

651

623

11

18

20

22

22

42

51

30

30

24

24

26

21

18

18

27

29

31

30

63

83

46

49

35

37

37

31

25

13

23

26

27

28

45

46

33

29

29

26

32

24

24

774

686

817

822

891

923

880

659

8i 3

698

663

701

830

578

801

743

609

649

894

1,076

1,234

889

984

756

785

734

668

671

669

652

819

773

822

744

787

647

878

614

559

660

568

544

3,863

162

355

45-4

452

191

217

488

454

338

230

289

13%

56

1,903

78

182

210

239

95

103

245

213

178

105

141

83

21

1,980

64

173

244

213

96

114

254

241

160

125

148

93

35

686

655

717

742

794

804

886

756

646

609

550

534

574

493

776

682

732

757

634

670

1,076

875

733

703

533

608

608

*5I 2

626

650

688

727

755

737

725

656

574

530

564

477

549

464

10

27

24

21

22

41

49

28

24

24

26

25

32

51

16

41

32

28

29

56

74

44

39

36

38

42

47

*

12

32

33

29

30

54

51

30

25

25

31

26

40

63

564

604

656

670

719

662

752

619

516

513

452

423

465

413

654

623

720

713

761

717

807

712

554

592

418

480

516

*467

536

592

631

829

668

613

620

582

492

442

502

399

436

347

4,598

163

402

608

727

289

270

685

472

368

186

305

111

42

2,250

89

186

281

344

129

139

349

225

181

86

152

80

19

2,346

74

216

328

363

140

131

317

247

185

100

153

51

23

890

754

653

662

888

899

982

805

923

797

724

710

630

●506

977

791

872

894

1,037

1,135

1,126

1,028

895

880

749

637

673

*626

799

712

632

829

958

872

816

754

847

701

701

806

*593

*595

27

47

35

30

31

62

6a

36

47

42

53

42

54

*

41

54

45

36

36

82

66

48

59

50

65

53

65

*

34

55

36

34

37

56

63

36

50

46

56

42

*

*

776

655

778

778

930

910

609

778

750

674

586

591

533

*472

656

663

807

630

966

1,020

953

870

654

774

614

810

558

●476

684

590

762

724

680

780

676

653

667

567

575

494

*511

●436

‘ Includssdsfsforrsce+Umlcgroupsmi shownseparately.

2Excludes nursing infants and children.
Table 2. Copper intake in milllgrame by age, eex, and race-ethnicity Unitad Statea, 1988-91

Total population’ Non-Hispanic white Non-Hispanic black Mexiosn American

Standard Standard

Sample

Standard Standard

error of Sample error of Sample

Sex and age size Mean

error of Sample

the mean Median size Mean the mean

error of

Median size Mean the mean Median size Mean the mean Median

8oth sexes

Ailages2 . . . . . . . . . . . . . . . . . .

Z-llmonthsz . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12–15 years . . . . . . . . . . . . . . . .

16-19 years . . . . . . . . . . . . . . . .

20-29 years . . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . .

4049 years . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . .

60-f39years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

Male

All ages2 . . . . . . . . . . . . . . . . . .

2-llmonths2, . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12–15years. d . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

2C-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59yeara . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . ,

80yearsandover . . . . . . . . . . . .

Femala

AJlages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l-2yeara2 . . . . . . . . . . . . . . . . .

3-5yeara . . . . . . . . . . . . . . . . .

5-n yeare . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59yeara . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

Wyaiai.s ..-A -.,-. at,” “vu, . . . . . . , . . . . ,

14,601

871

1,231

1,547

1,745

711

765

1,662

1,526

1,226

929

1,106

851

609

7,322

439

601

744

866

338

366

844

735

626

473

546

444

296

7,479

432

630

603

877

373

397

636

791

602

456

560

407

3$3

1.26

0.77

0.69

0.87

1.03

1.16

1.34

1.36

1.45

1.35

1.31

1.26

1.15

1.01

1.45

0.76

0.73

0.91

1.08

1.33

1.56

1.63

1.74

1.56

1.52

1.45

1.30

1.18

1.07

0.75

0.65

0.63

0.69

1.03

1.12

1.13

1.17

1.13

1.11

1.11

1.04

().s2

0.01

0.02

0.01

0.01

0.02

0.04

0.06

0.03

0.03

0.03

0.04

0.03

0.03

0.03

0.02

0.03

0.02

0.02

0.02

0.05

0.10

0.05

0.05

0.05

0.06

0.06

0.05

0.05

0.02

0.02

0.01

0.02

0.03

0.05

0.05

0.03

0.03

0.03

0.04

0.03

0.03

0.03

1,09

0.73

0.65

0.60

0.94

1,03

1,13

1.20

1.25

1.16

1.12

1.10

1.03

0.93

1.27

0.74

0.66

0.83

1.01

1.19

1.36

1.46

1.55

1.45

1.29

1.24

1.16

1.10

0.96

0.73

0.62

0.74

0.87

0.68

0.96

0.99

1.06

1.05

0.96

1.00

0.93

f)~~

5,760

473

424

425

511

221

245

460

550

467

472

493

536

501

2,867

241

202

219

252

96

112

216

271

243

251

247

265

250

2,893

232

222

206

259

123

133

244

279

224

221

246

253

,25~

1.27

0.76

0.66

0.66

1.02

1.17

1.32

1.36

1.49

1.37

1,34

1.29

1.16

1.03

1.46

0.79

0.72

0.90

1.08

1.34

1.56

1.63

1.80

1.62

1.57

1.47

1.32

1.21

1.07

0.73

0,65

0.81

0.97

0.88

1.07

1.11

1.19

1.13

1.12

1.14

1.04

~.~~

0.02

0.02

0.01

0.02

0.03

0.05

0.05

0.04

0.04

0.04

0.05

0.04

0.03

0.03

0.03

0.03

0.02

0.03

0.03

0.07

0.08

0.05

0.07

0.06

0.07

0.07

0.05

0.04

0.02

0.02

0.02

0.03

0.05

0.07

0.06

0.04

0.04

0,04

0.05

0.04

0.03

AA. U.U.J

1.10

0.72

0.64

0.79

0.92

1.02

1.11

1.20

1.28

1.21

1.15

1.13

1.04

0.94

1.29

0.74

0.68

0.83

1.01

1.21

1.39

1.49

1.63

1.52

1.30

1.26

1.17

1.13

0.97

0.71

0.62

0.73

0.66

0,65

0.94

1.00

1.09

1.07

1.03

1.03

0.94

.-.. .

!s.0 I

3,863

162

355

454

452

191

217

499

454

338

230

289

186

55

1,903

76

182

210

239

95

103

245

213

176

105

141

93

21

1,960

64

173

244

213

96

114

254

241

160

125

146

93

35

1.16

0.79

0.72

0.92

1.07

1.20

1.34

1.39

1.23

1.15

1.10

0.99

0.99

0.92

1.31

0.79

0.76

0.95

1.09

1.27

1.57

1.69

1.47

1.35

1.19

1.05

1.06

9.79

1.03

0.79

0.67

0.68

1.05

1.13

1.12

1.13

1.04

0.98

1.04

0.95

0.92

- -. -U.wu

0.02

0.03

0.02

0.02

0.04

0.06

0.11

0.07

0.05

0.05

0.06

0.04

0.05

0.12

0.04

0.04

0.03

0.03

0.04

0.07

0.19

0.11

0.08

0,08

0.07

0.06

0.08

*

0.02

0.04

0.03

0.03

0.06

0.06

0.07

0.07

0.05

0.05

0.06

0.05

0.06

*

0.97

0.77

0.66

0.84

0.96

1.06

1.11

1.12

1.03

0.96

0.89

0.87

0.66

0.74

1.09

0.78

0.71

0.67

0.99

1.14

1.30

1.40

1.27

1.11

1.02

0.90

0.94

*0.66

0.66

0.76

0.65

0.63

0.92

0.93

0.99

0.92

0.91

0.66

0.83

0.84

0.63

*--- U.fa

4,596

163

402

609

727

269

270

666

472

366

le6

305

111

42

2,250

89

186

281

344

126

139

349

225

181

96

152

60

19

2,346

74

216

326

363

140

131

317

247

165

100

153

51

23

1.24

0.76

0.73

0.89

i .04

1.18

1.42

1.40

1.45

1.36

1.23

1.11

1.11

*0.84

1.43

0.77

0.76

0.94

1.10

1.40

1.72

1.62

1.70

1.60

1.39

1.36

1.20

*1 .01

1.04

0.76

0.69

0.64

0.98

0.98

1,08

1.14

1.16

1.10

1.09

0.91

1.03

w. 74

0.03

0.03

0.03

0.02

0.02

0.06

0.19

0.04

0.07

0.05

0.05

0.05

0.10

*

0.05

0.04

0.04

0.03

0.03

0.09

0.31

0.05

0.11

0.06

0.07

0.08

0.10

*

0.02

0.05

0.03

0.03

0.03

0.05

0.07

0.04

0.06

0.05

0.06

0.04

0.17

*

1.07

0.76

0.67

0.80

0.95

0.96

1.15

1.25

1.25

1.18

1.15

1.00

0.92

*0.76

1.25

0.76

0.66

0.63

1.01

1.18

1.32

1.46

1.51

1.43

1.29

1.32

1.16

*0.84

0.92

0.76

0.62

0.77

0.68

0.69

1.00

1.02

1.06

0.96

1.00

0.87

0.81

‘0.63

‘Includes dsts for rats-ethnic groups not shown separately. 2Excludss nursing infants and children.

NOTE Estimates of aopperintake are very skewed; means and standard smorsof tha msans should be used end interpreted with oaution,
Table 3, Iron intake in milligrams by age, sex, and racwhhnlc~ United States, 1968-91

Totalpopulation’ Non-H@errlc whr?e Non-Hisparrloblack Mexican Amerloan

Standanl Stanow

sample emu of sample er-mrof sample

Sex and age

error of Sample

size Mssn

envr of

the mean Median ake Mean the mean Median size Mean the mean Median size Mean the mean Median

8oth saxes

Allages2. .,, . . . . . ..m. m....

2-llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

tl-llyears . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29yeare . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59yeare . . . . . . . . . . . . . . . .

50-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

Male

Allages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . .. m. . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n years, . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years. . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years, . . . . . . . . . . . . . . .

60-69years. ..,,,,,,,,,,,,,

70-79years . . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

Female

Allages2 . . . .. m. . . . . . . . . ..m

2-llmonths2. .,......,,,.. .

l–2years2 . . . . . . . . . . . . . . . . .

3-5yeare . . . . . . . . . . . . . . . . .

13-l lyears . . . . . . . . . . . . . . . .

12-15years. ... ... . .. c.....

16-19years, . . . . . . . . . . . . . . .

20-29yaars. . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

14,601

871

1,231

1,547

1,745

711

765

1,662

1,526

1,228

928

1,106

651

608

7,322

439

601

744

666

336

366

644

735

626

473

546

444

286

7,479

432

680

603

877

373

397

638

791

602

456

560

407

313

14.70

15.50

9.53

11.66

13.76

15.98

15.61

15.12

15,91

15.05

14.4i

14.64

14.06

13.31

17.17

15.89

9.74

12.47

14.54

19.51

16.64

17.87

19.16

18.18

17.25

16.69

15,84

16,22

12.37

15.10

9.28

11,23

12S8

12.26

12.52

12.43

12.73

12.05

11.64

~2.97

12.77

11.76

0.19

0.50

0.24

0.26

0.30

1.17

0.57

0S3

0.43

0.39

0.47

0.44

0.46

0.57

0.31

0.73

0.35

0.37

0.41

2.21

0.86

0.49

0.72

0.63

0.78

0.62

0.66

0.96

0.19

0.60

0.30

0.32

0.36

0.54

0,60

0.36

0.36

0.34

0.40

0.54

0.54

0.62

12.25

14.40

8.46

10.31

11.66

13.03

13.04

13.01

13.46

12.69

12.04

12.08

11.33

10.55

14.66

15.01

6.61

10.45

13.02

14S3

16.75

16.06

16.17

16.14

13,98

14,31

13.08

13,22

10.63

14.08

6.22

9.98

10.70

10.17

10.26

11.11

10.66

11.06

10.59

10.41

10.26

9.55

5,780

473

424

425

511

221

245

480

650

467

472

498

588

601

2,687

241

202

219

252

98

112

216

271

243

251

247

285

250

2,883

232

222

208

258

123

138

244

278

224

221

246

253

251

14.84

15.17

9.54

11.80

13S6

16.38

15.64

15.04

16.39

15.42

14.80

14.83

14.25

13.46

17.59

15.86

9.56

12.48

14.84

20.50

19.22

17.66

19.63

18.64

17.94

16.84

16.10

16.65

12.45

14.39

9.51

11.29

13.06

12.13

11.90

12.43

13.01

12.15

11.85

13.23

12.80

11.60

0.23

0.50

0.27

0.36

0.42

1.81

0.75

0.48

0.55

0.49

0.51

0.49

0.42

0.47

0.39

0.78

0.36

0.52

0.60

3.64

1.19

0.73

0.85

0.78

0.84

0.68

0.60

0.80

0.22

0.81

0.38

0.54

0.57

0.72

0,78

0.55

0.48

0.45

0.46

0.67

0.55

0.5s

12.43

14.11

8.50

10.12

12.14

13.08

12.93

12.60

13.88

12.61

12.12

12.26

11.37

10.74

15.00

15.13

8.76

10.33

13.16

15.30

17.47

15.68

16.64

16.28

14.40

14,71

13.24

13.27

10.72

13.44

8.30

9.83

10.68

10.06

9.50

11.11

11.07

11.23

10.74

10.68

10.26

9.57

3,663

162

355

454

452

191

217

499

454

336

230

269

186

56

1,803

78

162

210

239

95

103

245

213

178

105

141

93

21

1,980

64

173

244

213

96

114

254

241

160

125

148

93

35

13.33

18.16

9.79

12.26

12.66

13.66

15.23

14.63

13.50

13.08

11.74

11.76

12.37

12.03

15,26

17.68

10.56

12.40

13.81

14.56

17.6a

18.02

16.50

15.89

12S4

13,24

13.49

*10.46

11.63

18.41

8.87

12.13

11.69

12.79

12.69

12.12

11.00

10.74

10.63

10.64

11.55

*12.73

0.19

0.91

0.36

0.35

0.33

0.70

0.63

0.50

0.51

0.53

0.60

0.53

0.67

1.27

0.32

1.13

0.50

0.50

0.47

0S0

1.24

0.80

0.64

0.84

0,81

0.82

1.60

*

0.21

1.31

0.45

0.45

0.42

0.98

0.95

0.46

0.46

0.50

0.54

0.60

0.69

●

11.36

16.34

8.73

10.68

11.54

11.76

12.76

12.66

11.51

10.67

9.66

9.66

9.87

9.04

13.00

16.03

9.46

10.56

12.16

13.23

14.27

15.16

13.97

13.71

11.21

10.59

9.76

%.66

10.04

16.65

7.70

10.99

10.68

9.76

10.39

10.67

9.68

9.72

9.53

9.28

9.89

%4.15

4,596 14.06

163 14.43

402 9.46

608 11.60

727 13.55

269 14.68

270 15.16

666 15.30

472 15.17

386 13.89

198 13.53

305 12.41

111 12,67

42 *I 0.07

2,250 15.93

88 14,13

166 9.50

281 12.88

344 14.59

128 17.44

139 17.61

349 17.45

225 17.19

181 15.92

98 15.50

152 14.65

60 14.31

19 *12.69

2,348 12.09

74 14.76

216 9.40

328 10.31

363 12.50

140 12.14

131 12.38

317 12.68

247 13.03

165 11,80

100 11.72

153 10.56

51 11,26

23 *6.62

0,30

0.92

0.44

0.36

0.40

0.85

0.91

0.43

0.55

0,44

0.66

0.56

1.27

*

0,47

0.90

0.59

0.54

0.59

1.25

1.33

0.56

0.73

0.56

0.92

0.81

1,58

*

0.35

1.56

0.57

0.37

0.44

0.89

0.64

0.50

0.66

0.50

0.74

0.66

1.73

*

12.05

14.07

7.92

9.96

11.60

12.05

12.37

13.11

13.25

12.47

12.02

10.33

9.58

*8.14

13.84

15.11

7.75

10.79

12,50

14.25

13.64

15.70

15,28

14.59

13,95

13.50

11.52

●11.69

10.46

12.08

6.02

9.09

10.53

10.15

10.23

10.80

11.09

10.67

10.65

8.66

6.32

●6.76

‘Includesdataforraw+thnio @oupenorehownseparately. ‘Exdudssrwi~ irsfanteendshildrsm

NOTIZEstimstssofimn intakesreveryekewed;msansandstanderrlmofthemeaneeheuld beussdendinterpretedw+thcaurbn
Table 4. Mamesium intake in millimms by a9e, sex and rats-ethniciw: united States, 198*91

Total Population’ Non-Hispanic white Norr-Hispanic black Mexioan American

standard Standard Standard Standard

Sample error of Sample

Sex and age

error of Sample error of Sample error of

size Mean the mean Median size Meen the mean Median size Mean the mean Median size Mean the mean Median

Seth sexes

Allages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

S-n yeara . . . . . . . . . . . . . . . . .

12–15yeara . . . . . . . . . . . . . . . .

16-19 years . . . . . . . . . . . . . . . .

20-29 years . . . . . . . . . . . . . . . .

3wi39years . . . . . . . . . . . . . . . .

40-49 years . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . .

60-89 yeara . . . . . . . . . . . . . . . .

70-79 years . . . . . . . . . . . . . . . .

80years and over . . . . . . . . . . . .

Male

Allagesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

W3years . . . . . . . . . . . . . . . . .

S-n years . . . . . . . . . . . . . . . . .

12–15yeara . . . . . . . . . . . . . . . .

i8-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-89years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

60yeaffiandover . . . . . . . . . . . .

Fsmale

Allagesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

S-n yeara . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

18-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yeare . . . . . . . . . . . . . . . .

44k19years . . . . . . . . . . . . . . . .

50-59yeare . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79yaare . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

14,601

871

1,231

1,547

1,745

711

765

1,862

1,526

1,228

929

1,106

851

609

7,322

439

801

744

888

338

368

844

735

626

473

546

444

296

7,479

432

830

803

877

373

397

838

791

602

456

580

407

313

279

120

182

208

231

250

286

295

317

2e2

296

2eo

267

239

321

125

169

219

243

291

340

351

375

349

343

328

300

276

238

114

174

197

218

206

230

240

261

251

253

257

244

220

2.7

3.1

3.1

3.5

3.7

7.8

9.1

5.9

6.9

6.3

7.4

7.f

6.6

7.0

4.3

4.3

4.5

4.9

4.9

11.7

13.0

8.5

10.5

8.0

11.2

11.1

9.8

10.7

3.0

3.7

3.6

4.1

4.6

7.6

9.2

5.8

8.3

6.3

7.0

7.1

7.3

7.5

249

106

174

195

214

231

245

262

282

271

271

265

241

223

290

112

180

206

229

275

305

315

336

323

313

2a9

272

258

219

102

189

184

198

183

188

220

241

233

229

236

224

210

5,760

473

424

425

511

221

245

460

550

467

472

493

538

501

2,S87

241

202

219

252

98

112

216

271

243

251

247

285

250

2,823

232

222

206

259

123

133

244

27e

224

221

246

253

251

266

124

163

208

231

251

291

298

329

311

306

2e7

272

242

332

129

190

221

245

299

353

358

391

361

358

333

308

282

243

118

176

195

217

201

227

243

268

259

259

265

247

221

3.0

3.2

3.8

5.0

5.1

11.2

12.2

8.4

8.6

7.7

8.0

8.1

6.2

5.7

4.7

4.4

5.3

6.7

6.6

17.1

17.9

12.3

13.1

10.4

11.5

12.1

8.9

8.6

3.2

4.0

4.6

6.5

6.6

10.5

11.5

6.3

8.3

8.3

8.0

8.6

7.2

6.5

257

111

176

194

215

227

246

265

296

280

278

269

246

228

300

119

182

204

233

279

313

326

359

333

327

306

282

283

224

104

172

179

196

179

186

223

248

242

239

245

226

211

3,883

162

355

454

452

191

217

489

454

338

230

269

186

56

1,903

76

182

210

239

95

103

245

213

178

105

141

93

*2I

1,9s0

84

173

244

213

86

114

254

241

160

125

146

93

35

234

108

174

204

216

232

257

262

251

240

224

224

220

200

265

110

182

207

221

252

303

320

297

286

242

246

222

●

207

107

165

200

211

211

213

213

213

201

211

208

219

205

4.1

4.9

5.0

5.0

5.6

10.5

11.8

9.2

8.1

9.4

9.2

9.2

11.3

18.0

6.7

6.6

6.7

6.8

7.0

15.4

18.1

14.3

12.5

15.3

14.4

14.0

15,5

%20.5

4.7

6.1

6.3

6.4

7.7

11.9

11.8

9.0

6.2

8.0

10.3

10.5

14.4

22.8

1Includes data fOr race-ethnic groups not show sewt~y.

2Excludes nursing infants and children.

204

97

166

lee

201

204

222

223

221

208

191

195

195

175

232

97

177

197

203

226

273

280

272

246

206

205

198

173

187

94

150

193

198

195

175

160

166

180

186

189

193

174

4,598

163

402

609

727

269

270

666

472

388

196

305

111

42

2,250

89

186

281

344

129

139

349

225

181

es

152

80

19

2,348

74

216

328

3s3

140

131

3i7

247

185

100

153

51

23

275

116

186

214

246

251

282

314

316

298

284

254

235

%209

313

123

193

225

257

265

323

386

384

346

312

299

274

%263

236

108

182

203

235

219

235

250

288

247

257

216

201

*176

6.0

6.3

5.8

5.1

5.4

10.7

13.3

8.5

10.3

9.5

12,4

9.9

14.8

●

9.5

7.4

8.7

7.2

6.9

15.0

17.7

11.1

14.8

12.2

15.6

13.3

i7.6

*

6.7

8.4

5.6

5.5

6.7

11.2

13.9

8.4

9.4

9.8

14.9

10.3

17.8

●

247

106

174

199

229

Z27

246

277

281

288

275

227

205

*173

287

110

173

218

244

261

282

341

343

332

307

273

244

W6

218

86

175

186

218

208

197

229

251

226

256

200

169

*154
Table 5. Phosphorus intake in milllgrame by age, sex, and race-ethnlcity: United States, 1988-91

Totalpopulation’ Non.Hispanicwhite Non-Hisparr!cbleck MexicanAnrerican

Standard standard

Sample

Standard standard

errvr of Sample error of sample error of Sample enur of

Sex and age size Mean the mean Median size Maan tire mean Median size Meen the mean Medhrr size Mean ti7emean Median

13dhsexes

Allages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2yaare2 . . . . . . . . . . . . . . . . .

3-5yeara . . . . . . . . . . . . . . . . .

O-n yeare. . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59yeara . . . . . . . . . . . . . . . .

60-89yeara . . . . . . . . . . . . . . . .

70-79yaars . . . . . . . . . . . . . . . .

60yeansandover . . . . . . . . . . . .

Male

Allages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2yeara2 . . .. m. . . . . . . . . . . .

3-5yearS! . . . . . . . . . . . . . . . . .

6-n yearn . . . . . . . . . . . . . . . .

12-15yaars . . . . . . . . . . . . . . . .

16-19yaars . . . . . . . . . . . . . . . .

20-29yeam . . . . . . . . . . . . . . . .

30-39yeare . . . . . . . . . . . . . . . .

40-49yeare, . . . . . . . . . . . . . . .

50-59yeare . . . . . . . . . . . . . . . ,

60-89years . . . . . . . . . . . . . . . .

70-79years. . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

Female

Al[ages* . . . . . . . . . . . . ..m.. .

2-llrnonths2 . . . . . . . . . . . . . . .

l–2yaanr*. . . . . . . . . . . . . . . . .

3-5yaars . . . . . . . . . . . . . . . . .

O-llyears, , . . . . . . .. m......

12–15years, .,.....,....,..

13-19yeare . . . . . . . . . . . . . . . .

20-29yeare . . . . . . . . . . . . . . . .

30-39yeare . . . . . . . . . . . . . . . .

40-49yeara . . . . . . . . . . . . . . . .

50-59yeare . . . . . . . . . . . . . . . .

80-89years . . . . . . . . . . . . . . . .

70-79yeara . . . . . . . . . . . . . . . .

80yearsandovar . . . . . . . . . . . .

14,801

871

1,231

1*547

1,745

711

785

1,882

1,526

1,226

929

1,106

851

809

7,322

439

601

744

888

338

388

844

735

626

473

646

444

296

7,479

432

830

803

877

373

397

838

791

602

456

580

407

313

1,266

831

841

1,054

1,204

1,303

1,492

1,421

1,395

1,255

1,208

1,200

1,071

976

1,479

858

975

1,112

1,274

1,517

1,325

1,712

1,888

1,452

1,418

1,378

1,230

1,147

1,069

504

904

333

1,132

1,079

1,152

1,137

1,130

1,067

1,018

1,048

957

888

10

15

15

16

17

34

43

26

26

23

28

26

24

26

16

21

21

23

22

49

65

39

41

33

43

41

35

38

10

19

18

18

22

35

38

24

24

23

27

28

27

30

1,149

641

900

888

1,148

1,138

1,311

1,275

1,263

1,189

1,112

1,083

976

897

1,2-46

563

843

1,034

1,234

1,416

1,641

1,571

1,533

1,374

1,336

1,259

1,146

1,083

994

519

870

942

1,072

1,024

1,082

1,048

1,068

1,012

963

363

887

812

5,780

473

424

425

511

221

245

480

550

487

472

483

636

501

2,887

241

202

219

252

88

112

216

271

243

25i

247

285

250

2,883

232

222

206

253

123

133

244

273

224

221

246

253

261

1,287

855

952

1,062

1,206

1,288

1,544

1,434

1,437

1,273

1,236

1,224

1,088

889

1,512

677

887

1,138

1,282

1,529

1,916

1,751

1,728

1,462

1,471

1,395

1,259

1,167

1,076

831

917

964

1,130

1,058

1,164

1,141

1,151

1,081

1,025

1,074

882

895

11

16

19

23

22

45

59

37

34

27

30

30

23

21

17

22

27

32

30

68

92

56

52

38

45

45

33

31

11

21

24

28

31

48

52

35

33

31

31

35

27

27

1,182

655

903

883

1,152

1,183

1,360

1,283

1,313

1,188

1,134

1,134

830

914

1,379

575

980

1,031

1,230

1,416

1,631

1,590

1,697

1,387

1,388

1,283

1,168

1,032

1,006

638

834

922

1,076

1,044

1,057

1,053

1,106

1,026

974

898

800

831

3,888

162

355

454

452

191

217

489

454

33a

230

288

188

58

1,803

78

182

210

239

95

103

245

213

178

105

141

93

21

1,880

M

173

244

213

86

114

254

241

160

125

148

33

35

1,132

552

888

999

1,127

1,193

1,376

1,326

1,176

1,113

976

952

925

829

1,290

573

895

1,016

1,163

1,275

1,833

1,613

1,390

1,333

1,028

1,111

848

%204

995

534

2S6

883

1,081

1,108

1,134

1,082

897

928

936

832

808

785

17

26

25

24

30

53

60

47

38

40

35

38

42

75

28

37

33

32

35

77

93

79

61

85

54

85

57

*

19

30

31

30

41

80

56

37

35

32

33

243

53

87

1,012

476

829

869

1,057

1,034

1,193

1,171

1,033

1,010

891

357

303

785

1,149

513

876

978

1,104

1,159

1,506

1,431

1,231

1,166

eo2

1,005

825

*898

908

464

761

845

1,021

970

1,041

889

918

857

880

772

785

727

4,598

163

402

609

727

269

270

666

472

366

196

305

111

42

2,250

89

166

261

344

129

139

349

225

181

96

152

60

19

2,348

74

216

328

383

140

131

317

247

185

100

153

51

23

1,322

836

970

1,071

1,276

1,345

1,446

1,504

1,456

1,337

1,223

1,090

982

*8a5

1,501

587

987

1,115

1,347

1,551

1,680

1,748

1,678

1,549

1,336

1,296

1,126

*I ,047

1,135

582

951

1,026

1,204

1,155

1,203

1,207

1,222

1,118

1,117

919

859

w

27

37

28

26

28

59

68

41

46

43

52

41

56

●

41

44

39

34

35

82

89

52

61

53

67

52

88

*

31

45

29

30

33

58

66

40

46

46

59

43

64

*

1,183

531

806

1,008

1,203

i ,257

1,230

1,331

1,302

1,255

1,192

1,025

924

’804

1,382

601

916

1,069

1,284

1,370

1,462

1,662

1,615

1,514

1,276

1,193

1,018

*871

1,042

475

393

951

1,137

1,126

1,030

1,080

1,113

883

1,098

878

818

%’31

‘Indudaadsteforrws+lhnbgroup8rr0tdxwn8ewstdy.

2ExdudesnurslnglnfentS sMc+Illdren.
Table 6. Potassium intake in miiligrama by age, sex, race-ethnicity United Statea, 1986-91

Total population’ Non-Hispanic white Non-Hispanic black Mexican American

Standard Stendud

Sample

Standard Standard

error of Sample error of Sample

Sex and age

error of Sample

size Mean the mean Median size Mean

error of

the mean Madian size Mean the mean Median size Mean the mean Madian

3oth sexes

Ailages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n yeara . . . . . . . . . . . . . . .

t2-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

7W79years . . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . .

Male

All agea2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . .

l–2yeara2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years. . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

3&39years . . . . . . . . . . . . . . . .

40-49yeara . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

80-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandovar . . . . . . . . . . . .

Female

Allagesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2yeara2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

O-n years . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-89yeara . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

14,801

871

1,231

1,547

1,745

711

765

1,662

1,526

1,228

929

1,106

661

609

7,322

439

601

744

888

338

368

644

735

626

473

646

444

296

7,479

432

630

803

877

373

397

638

791

602

456

560

407

313

2,652

1,313

1,900

2,040

2,223

2,397

2,713

2,764

2,860

2,816

2,823

2,605

2,594

2,351

3,029

1,366

1,962

2,110

2,361

2,791

3,208

3,280

3,451

3,263

3,240

3,107

2,899

2,595

2,286

1,256

1,832

1,968

2,060

1,984

2,208

2,260

2,480

2,368

2,446

2,547

2,375

2,221

25

30

32

33

34

72

86

54

60

56

66

83

60

61

39

41

44

46

46

105

125

79

89

81

97

92

6a

86

28

35

37

39

40

70

87

49

57

55

66

69

66

71

2,414

1,195

1,834

1,934

2,102

2,192

2,37f

2,522

2,646

2,566

2,622

2,613

2,409

2,257

2,754

1,232

1,922

1,996

2,225

2,627

2,978

3,038

3,133

3,063

2,982

2,681

2,704

2,458

2,145

1,149

1,746

1,880

1,947

1,745

1,965

2,104

2,269

2,246

2,267

2,422

2,204

2,129

5,780

473

424

425

511

221

245

480

550

467

472

493

536

501

2,887

241

202

219

252

98

112

218

271

243

251

247

285

250

2,883

232

222

208

259

123

133

244

279

224

221

246

253

251

2,722

1,356

1,893

2,030

2,212

2,394

2,738

2,800

3,100

2,929

2,934

2,872

2,651

2.382

3,136

1,413

1,943

2,111

2,367

2,679

3,289

3,353

3,627

3,368

3,397

3,f45

2,978

2,835

2,348

1,292

1,841

1,946

2,056

1,891

2,162

2,289

2,582

2,465

2,515

2,630

2,412

2,247

28

31

39

47

47

102

113

78

79

70

72

71

57

50

43

42

52

62

63

163

171

117

113

98

101

98

79

62

31

40

50

60

59

23

101

71

80

72

76

86

67

63

2,482

1,224

1,835

1,916

2,076

2,152

2,397

2,554

2,791

2,708

2,709

2,692

2,470

2,312

2,860

1,266

1,922

1,970

2,231

2,643

3,175

3,097

3,344

3,209

3,084

2,924

2,760

2,505

2,208

1,174

1,754

1,859

1,901

1,862

1,936

2,134

2,356

2,366

2,342

2,495

2,221

2,146

3,6433

162

355

454

452

191

217

499

454

338

230

289

186

56

1,eo3

78

182

210

239

95

103

245

213

178

105

141

93

21

1,980

64

173

244

213

96

114

254

241

160

125

146

93

35

2,251

1,165

1,659

2,031

2,136

2,298

2,586

2,517

2,304

2,245

2,119

2,100

2,119

2,013

2,547

1,182

1,924

2,074

2,219

2,429

3,061

3,105

2,710

2,654

2,247

2,260

2,209

*2,023

1,992

1,151

1,784

1,989

2,055

2,183

2,133

2,019

1,985

1,903

2,023

1,964

2,052

1,976

35

48

54

53

53

102

124

86

73

81

77

78

98

171

57

66

72

69

71

144

192

140

116

128

117

126

143

*

38

55

66

66

64

116

114

6a

67

71

84

76

113

187

2,028

1,059

1,815

1,934

2,040

2,133

2,196

2,234

2,037

1,965

1,956

1,955

1,667

1,690

2,295

1,084

1,908

1,979

2,049

2,192

2,872

2,885

2,444

2,394

2,103

2,083

1,961

●I ,766

1,828

1,041

1,734

1,827

1,972

1,641

i ,682

1,658

1,756

1,755

1,692

i ,650

1,777

1,585

4,598

163

402

609

727

269

270

666

472

388

166

305

111

42

2,250

89

166

281

344

128

139

349

225

181

96

152

60

19

2,348

74

216

328

363

140

131

317

247

165

100

153

51

23

2,540

1,319

1,947

2,117

2,346

2,389

2,570

2,644

2,799

2,674

2,622

2,362

2,250

●1,968

2,641

1,404

1,975

2,181

2,471

2,726

2,871

3,263

3,153

3,075

2,841

2,747

2,591

2,225

1,220

1,917

2,053

2,224

2,078

2,227

2,333

2,424

2,262

2,421

2,048

1,957

*1 ,794

47

62

51

50

50

107

118

75

83

84

111

66

136

*

72

73

70

66

61

150

145

92

108

100

141

107

156

*

56

63

60

61

67

110

146

87

96

102

138

104

176

*

2,316

1,200

1,834

1,997

2,188

2,148

2,346

2,563

2,586

2,561

2,533

2,214

2,237

*1 ,944

2,651

1,291

1,846

2,092

2,26%

2,448

2,579

3,021

3,049

3,019

2,624

2,629

2,406

*2,073

2,041

1,044

1,824

1,941

2,079

1,945

1,944

2,052

2,223

2,013

2,369

1,686

1,607

●1,678

‘Includes data for race-ethnicgroups net shown separately.

2Escludes nursing infants and children.
Table 7. Sodium intake in milligrams by age, sex, end raceethnicity United States, 1988-91

Total pO@Vrb12 ‘

. ..- L-. . . . . .. . . . . . . . . .

Non-Hiapan/cwnrre NOfFHLS@lfllC OIWK MeM”CSt2 AmeriI-%w

Standard

sample envf of

Sex and age size Meerr the mean Median

standard standard

Sarrrole envf of sample error of

the mean

sample

Median

em of

size Meen size Mean the mean Median size Meen the mean Median

Both sexes

Allagesz . . . . . . . . . . . . . . . . . .

2-limonths2 . . . . . . . . . . . . . . .

l-2yeare2 . . . . . . . . . . . . . . . . .

3-5yeare . . . . . . . . . . . . . . . . .

8-n years. . . . . . . . . . . . . . . . .

i2-15yeare . . . . . . . . . . . . . . . .

18-19 years . . . . . . . . . . . . . . . .

20-29 yeare . . . . . . . . . . . . . . . .

30-39 yeara . . . . . . . . . . . . . . . .

40-49 yeara . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . .

80-69years . . . . . . . . . . . . . . . .

70-79yeare . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

Male

Allages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2yeera2. . . . . . . . . . . . . . . . .

3-5yeare . . . . . . . . . . . . . . . . .

e-llyeers . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

18-19yeare . . . . . . . . . . . . . . . .

20-29yeare . . . . . . . . . . . . . . . ,

30-39years . . . . . . . . . . . . . . . ,

40-49yeara . . . . . . . . . . . . . . . .

60-59yeare . . . . . . . . . . . . . . . .

80-69years . . . . . . . . ..m . . . . .

70-79years . . . . . . . . . . . . . . . .

80yeamandover . . . . . . . . . . . .

Female

Aliages2 . . . . . . . . . . . . . . . . . .

2-ii months2, . . . . . . . . . . . . . .

l-2years2, . . . . . . . . . . . . . . . .

3-5yeara . . . . . . . . . . . . . . . . .

O-n yeare. . . . . . . . . . . . . . . . .

12-15yeare . . . . . . . . . . . . . . . .

t8-19years . . . . . . . . . . . . . . . .

20-29yeara . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49yeare . . . . . . . . . . . . . . . .

60-59yeare . . . . . . . . . . . . . . . .

80-69years . . . . . . . . . . . . . . . .

70-79yeare . . . . . . . . . . . . . . . .

80yearaandover . . . . . . . . . . . .

14,801

871

1,231

1,547

1,745

711

765

1,882

1,526

1,228

929

1,108

651

809

3,289

575

1,938

2,631

2,398

3,487

3,646

3,621

3,703

3,429

3,082

2,860

2,717

2,481

33

28

33

43

45

101

124

79

77

79

77

70

83

71

52

37

63

63

59

150

180

120

115

108

114

102

98

114

38

31

45

48

58

100

120

88

72

91

76

74

73

75

2,899

337

1,853

2,288

2,750

3,203

3,430

3,230

3,2e7

3,052

2,828

2,736

2,457

2,266

3,395

369

1,958

2,388

2,891

3,864

4,451

4,126

3,683

3,732

3,278

3,140

2,973

2,726

2,488

312

1,767

2,230

2,808

2,615

2,683

2,759

2,867

2,840

2,382

2,373

2,233

2,172

5,780

473

424

425

511

221

245

480

560

467

472

493

53a

501

3,288

580

1,912

2,480

2,845

3,333

3,980

3,653

3,744

3,388

3,104

40

25

45

59

62

127

170

114

68

87

62

77

85

80

64

32

80

82

77

183

241

170

136

119

114

104

89

80

42

32

58

67

61

123

168

94

91

89

78

88

71

85

2,921

346

1,870

2,252

2,661

3,213

3,414

3,295

3,386

3,070

2,863

2,782

2,482

2,316

3,480

384

1,983

2,276

2,830

3,630

4,670

4,267

4,104

3,784

3,355

3,205

3,883

162

355

454

452

191

217

499

454

338

230

289

166

58

1,303

78

162

210

239

95

103

245

213

176

105

141

93

21

1,980

64

173

244

213

96

114

254

241

160

126

i46

93

35

3,266

519

2,210

2,884

3,222

3,581

4,107

3,976

3,470

3,285

2,788

2,504

2,370

2,033

3,744

588

2,350

2,922

3,320

3,688

4,933

4,801

4,145

4,039

3,041

2,679

2,804

%V337

2,847

458

2,050

2,607

3,123

3,563

3,320

3,277

2,307

2,672

2,583

2,221

2,200

2,008

39

53

74

75

82

186

191

144

124

123

117

115

126

179

86

88

105

108

111

226

300

257

210

200

204

200

188

*

41

52

85

87

101

203

171

103

106

88

107

102

138

181

2,834

280

2,016

2,809

2,988

3,179

3,629

3,466

3,005

2,625

2,422

2,263

1,986

1,800

3,250

306

2,270

2,805

3,091

3,287

4,300

4,151

3,540

3,625

2,674

2,490

2,422

*1,739

2,556

267

1,779

2,616

2,872

2,864

3,089

2,956

2,671

2,540

2,388

2,030

1,894

1,854

4,598

183

402

608

727

269

270

688

472

386

138

305

111

42

2,260

89

188

281

344

129

139

349

225

181

98

152

54)

19

2,346

74

216

328

383

140

131

317

247

185

100

153

51

23

3,082

685

2,001

2,475

2,922

3,286

3,369

3,446

3,320

3,220

3,089

2,555

2,514

‘2,260

3,454

804

2,048

2,832

3,059

3,853

3,750

3,924

3,792

3,673

3,465

3,138

3,038

%2,839

41

62

62

61

62

15a

148

93

83

111

146

102

186

*

64

87

92

95

85

252

207

133

148

168

208

144

264

*

48

73

75

67

80

138

173

102

109

132

179

112

212

*

2,725

379

1,779

2,214

2,677

2,639

2,988

3,032

3,009

2,983

2,750

2,272

2,114

3,008

2,722

2,438 %?,056

7,322

439

801

744

886

338

388

844

736

826

473

646

444

296

3,853

624

2,cf31

2,675

3,138

4,016

4,783

4,869

4,445

3,980

3,840

3,409

3,142

2,881

2,887

241

202

219

252

88

112

216

271

243

251

247

285

250

3,688

683

2,013

2,616

3,rB3

3,974

4,949

4,780

4,520

3,833

3,713

3,428

3,182

2,912

3,105

524

1,767

2,359

2,790

3,204

3,225

3,429

3,486

3,388

3,221

2,628

2,712

%!,4!?9

2,367

304

1,825

2,132

2,522

2,549

2,533

2,497

2,629

2,475

2,470

1,601

1,612

%?,003

2,987

2,767

2,484

317

1,758

2,147

2,682

2,562

2,485

2,772

2,657

2,672

2,378

2,427

2,248

2,182

7,479

432

830

803

877

373

397

838

791

802

466

680

407

313

2,756

524

1,838

2,383

2,852

2,927

3,087

3,002

2,977

2,919

2,575

2,578

2,411

2,248

2,883 2,721

527

l,6i0

2,283

2,795

2,730

2,887

2,998

2,980

2,835

2,563

2)834

2,373

2,274

2,852

232

222

208

263

123

133

244

279

224

221

248

263

261

547

1,950

2,316

2,783

2,766

2,937

2,fM3

2,620

2,755

2,704

2,076

2,013

‘2,051

.

‘Indudssdate for rsce-erhnk groups rid shown sepsmkiy,

‘Excludes nursing hfente ad children.
Table 8. Zinc Intake in milligrams by aga, se~ and race-athniciw United States, 19S8-91

Totsf population’ Non-Hispanic wtdfe Non-Hispan;c blaok Mexisan American

Standard standard

Sample error of SSrrrple

Standard

error of Sample

Standard

Sex and age size Mean the mean Median

error of Sample

size Maan the mean Median size Maan

error of

the mean Median size Mean the mean Madian

8oth sexes

Allagesz . . . . . . . . . . . . . . . . . .

2–ltmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-llyeare. c c, . . . . . . . . . . . . .

12–15yeafs. . . . . . . . . . . . . . . .

16-19 years . . . . . . . . . . . . . . . .

20-29 years . . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . .

40-49 years . . . . . . . . . . . . . . . .

5C-59years . . . . . . . . . . . . . . . .

60-89 years . . . . . . . . . . . . . . . .

70-79years. . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

Male

Allages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2yeare2. . . . . . . . . . . . . . . . .

2-5yeare . . . . . . . . . . . . . . . .

E-n yeare . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

Female

Allagss2 . . . . . . . . . . . . . . . . . .

2–llmonihe2 . . . . . . . . . . . . . . .

l-2yeara2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-llyeafs . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

~~~syears........ . . . . . . . .

80yearsandover . . . . . . . . . . . .

14,801

671

1,231

1,547

1,745

711

765

1,662

1,526

1,228

928

1,106

651

608

7,322

439

601

744

686

336

36a

644

735

626

473

546

444

28a

7,479

432

530

803

877

373

397

636

791

602

456

560

4Q7

313

11.39

6.02

6.67

6.04

9.96

12.26

12.95

12.40

12.77

11.58

11.64

11.24

10.11

8.82

13.63

6.16

6.96

8.43

10.40

14.86

16.24

15.19

15.96

13.84

t 4.45

13.09

12.05

10.72

9.26

5.87

6.37

7.64

9.54

9.52

9.59

9.67

9.64

9.42

9.49

9.66

6.72

7.82

0.14

0.11

0.12

0.15

0.32

0S0

0.80

0.27

0.36

0.27

0.66

0.35

0.40

0.32

0.23

0.15

0.16

0.20

0.24

1.57

1.60

0.38

0.59

0.39

0.96

0.52

0.65

0.49

0.14

0,13

0.16

0.18

0.57

0.52

0.43

0.28

0.26

0.26

0.73

0.40

Q~~

0.37

9.36

5.72

6.04

7.20

8.59

9.76

10.76

10.86

10.69

10.04

9.50

9.28

6.50

7.56

11.42

5.87

6.57

7.53

9.25

11.42

13.22

13.12

13.32

12.21

11.55

11.26

10.03

8.87

7.91

5.53

5.71

6.76

7.86

8.16

8.47

8.45

8.62

8.35

7.87

7.70

7.16

6.63

5,780

473

424

425

511

221

245

460

550

457

472

493

638

501

2,667

241

202

219

252

98

112

216

271

243

251

247

265

260

2,683

232

222

206

259

123

133

244

279

224

221

246

2.53

251

11.53

5.90

6.56

7.84

9.97

12.70

12.69

12.20

13.15

11.74

12.33

11.52

10.24

8.69

13.94

6.04

6.86

8.32

10.32

16.03

15.79

15.22

16.63

13.95

15.27

13.38

12.24

10.89

9.27

5.75

6.31

7.34

9.61

9.24

9.44

9.41

9.74

9,51

9.67

9.86

8.79

7.83

0.17

0.11

0,14

0.22

0.54

1.49

0.56

0.39

0.49

0.36

0.79

0.44

0.40

0.28

0.26

0.16

0.18

0.31

0.36

2.78

0.77

0.59

0.81

0.50

1.15

0.65

0.66

0.43

0.18

0.13

0.20

0.29

0.88

0.77

0.63

0.37

0.35

0.37

0.93

0.52

0.37

0.33

9.50

5.57

6.10

6.89

8.26

10.03

1o.8a

10.63

10.92

10.43

9.72

9.40

8.67

7.65

11.55

5.59

6.67

7.28

9.02

11.62

13.43

13.14

13.66

12.25

12.27

11.52

10.34

9.05

7.93

5.55

5.65

6.48

7.70

8.07

8.38

8.41

8.78

6.65

7.84

7.71

7.18

6.59

3,653

162

355

454

452

191

217

489

464

336

230

289

186

56

1,803

78

182

210

239

95

103

245

213

178

105

141

93

21

1,960

64

173

244

2f3

88

114

254

241

160

125

148

93

35

10.56

6.15

7.03

6.62

9.73

10.39

13.65

12.76

11.05

10.39

9.25

8.96

9.19

6.01

12.39

6.33

7.47

8.62

10.40

10.47

17.47

15.76

13.73

12.91

10.10

10.45

10.73

*8.09

6.96

5.99

6.52

8.62

9.05

10.32

10.01

10.24

8.81

8.27

8.61

7.87

8.07

7.97

0.16

0.21

0.23

0.23

0.27

0.53

2.08

0.49

0.64

0.43

0.42

0.40

0.70

0.91

0.35

0.31

0.34

0.30

0.40

0.71

4.32

0.81

1.07

0.73

0.70

0.67

1.28

●

0.14

0.26

0.27

0.32

0.33

0.74

0.66

0.49

0.36

0.39

0.47

0.42

0.63

1.17

8.65

6.06

6.30

7.76

6.66

8.66

10.45

10.66

6.87

6.52

7.68

7.59

6.88

6.63

9.83

6.28

6.74

8.13

9.17

8.91

12,26

12.90

10.77

10.55

8.40

6.77

7.84

V.04

7.66

5.60

5.69

7.47

8.12

8.53

9.37

8.66

7.55

7.16

7.01

6.93

6.37

5.92

4,598

163

402

609

727

269

270

666

472

366

196

305

111

42

2,250

89

186

281

344

129

139

349

225

161

96

152

60

t9

2,346

74

216

328

383

140

131

317

247

185

100

153

51

23

11.46

6.37

7.05

8.19

9.93

11.40

i 5.62

13.00

12.75

11.99

10.42

9.40

6.86

6.94

13.34

6.56

7.16

8.72

10.55

13.13

%20.35

14.99

14.82

14.65

11.87

10.64

9.99

*8.81

9.49

6.15

6.93

7.66

9.32

9.80

10.24

10.58

i 0.56

9.25

9.09

8.36

7.90

*5.91

0.27

0.21

0.30

0.21

0.24

0.56

3.42

0.37

0.44

0.47

0.56

0.37

0.69

0.60

0.51

0.31

0.41

0.33

0.35

0.66

*

0.60

0.62

0.73

0.82

0.54

0.95

●

0.15

0.25

0.40

0.24

0.29

0.66

0.56

0.46

0.54

0.42

0.67

0.47

0.91

●

‘Includes dsts for rats-ethnic groups not shown separately. 2Escludaenursing infants and children.

NOTi3 Estimatesof zinc intake are vary skewacLmeans and standard srrora of ths maana should be used and interpretedwith ca~”on.

9.18

5.99

5.75

7.42

8.67

9.29

10.54

11.10

i 0.25

9.98

8.82

7.61

7.14

6.28

10.86

6.32

5.81

7.80

9.27

10.46

*1 2.04

13.27

13.19

12.35

9.73

8.71

8.13

7.74

7.68

5.89

5.72

6.79

8.07

8.65

8.62

6.80

8.39

7.80

6.13

6.80

6.42

*5.26
Table 9, Vitamin A intake In international unlta (NJ)by age, sex, and race-athnicity: United Statee, 1988-91

Total ppulation’ Non-Hieprr/c white Non-H@snic black MexloarrAmerfsm

.Starrdard

Ssmpk

standard Standard

envr of Sample em7rof Sample

Sex and age size Mean

etnu of Sample

the mean

anwof

Madisn size Mean themean Median size Mean the mean Median g“ze Mean the fnaafr Wian

Both sexes

Allages2 . . . . . . . . . . . . . . . . . .

2-llrnonths2 . . . . . . . . . . . . . . .

l-2yeara2 . . . . . . . . . . . . . . . . .

3-5years, . . . . . . . . . . . . . . . .

E-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19 years . . . . . . . . . . . . . . . .

20-29 yeare . . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . .

40-49 years . . . . . . . . . . . . . . . .

60-59 years . . . . . . . . . . . . . . . .

80-89 yeafe . . . . . . . . . . . . . . . .

70-79 years . . . . . . . . . . . . . . . .

El fJyeama ndove r.........,..

Male

Allages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l–2yeara2 . . . . . . . . . . . . . . . . .

3-5yeam, . . . . . . . . . . . . . . . .

a-llyeers, . . . . . . . . . . . . . . . .

12-15 yeafs. . . . . . . . . . . . . . . .

18-19yeafs . . . . . . . . . . . . . . . .

20-29yeare . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49yaars . . . . . . . . . . . . . . . .

60-59yeafs . . . . . . . . . . . . . . . .

80-59yeare . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yaarsandover . . . . . . . . . . . .

Female

AJages2 . . . . . . . . . . . . . . . . . .

2-llmonlhs2 . . . . . . . . . . . . . . .

l-2years2. . . . . . . . . . . . . . . . .

3-5years, . . . . . . . . . . . . . . . .

Gllyears. a m. . . . . . . . . . . . . .

12-15yaars. . . . . . . . . . . . . . .. .

18-19yeara . . . . . . . . . . . . . . . .

20-29yeara . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

50-89yeara . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

14,801

871

1,231

1,547

1,745

711

765

1,532

1,526

1,228

929

1,106

851

509

7,322

439

801

744

88a

338

388

844

735

626

473

546

444

296

7,479

432

630

803

877

373

397

836

731

502

456

650

407

313

6,143

5,112

3,702

4,275

4,845

5,058

5,070

5,613

6,303

6,888

6,526

7,858

7,919

7,199

6,736

5.352

8,820

4,524

4,644

6,069

4,982

6,623

7,782

7,768

7,047

8,306

6,104

7,331

5,532

4,860

3,675

4,017

+139

4,014

5,179

4,626

6,044

5,594

6,055

7,435

7,786

7,129

131

258

164

174

188

469

432

288

397

401

414

466

474

699

203

365

239

273

239

781

381

464

630

535

605

887

723

359

166

327

200

191

284

442

713

291

431

423

638

545

566

756

3,590

3,204

2,538

3,030

3,300

3,201

3,203

3,349

3,349

3,602

3,792

4,517

4,825

4,311

3,342

3,338

2,740

3,193

3,688

3,804

3,501

3,973

4,345

4,241

4,250

4,885

4,608

4,312

3,269

3,069

2,621

2,303

3,0a4

2,679

2,717

2,366

3,380

3,080

3,510

4,430

4,928

4,233

5,780

473

424

425

511

221

245

460

560

467

472

493

62a

501

2,887

241

202

219

252

9a

112

216

271

243

251

247

265

250

2,693

232

222

206

259

123

133

244

279

224

221

248

263

251

6,283

5,393

3,791

4,385

4,595

4,93a

5,433

5,527

7,102

6,749

6,848

7,846

7,982

7,237

6,949

5,933

3,383

4,654

4,890

6,402

4,926

6,588

6,065

7,949

7,443

8,108

6,205

7,363

5,670

4,797

3,698

4,105

4,298

3,416

5,972

4,537

6,155

5,534

5,930

7,613

7,619

7,170

174

285

222

277

283

58a

67f

360

639

520

462

473

453

503

272

414

345

433

352

1,261

487

671

855

824

551

703

722

750

216

344

252

301

406

366

1,136

362

683

520

557

576

668

846

3,742

3,275

2,728

3,143

3,316

3,223

3,338

3,386

4,123

3,567

3,934

4,753

4,807

4,377

4,144

3,550

2,714

3,301

3,603

4,033

3,622

4,131

48488

4,376

4,353

4,734

4,561

4,417

3,376

2,957

2,730

2,960

3,058

2,376

2,789

2,974

3,627

3,087

3,607

4,684

5,077

4,358

3,8a3

162

355

464

452

191

217

499

454

338

230

289

186

56

1,903

78

182

210

239

95

103

245

213

178

105

i41

93

21

1,980

84

173

244

213

96

114

254

241

160

125

146

93

35

5,188

4,050

3,442

3,884

4,303

48435

3,933

5,458

4,964

5,837

6,843

6,335

7,516

6,577

5,466

3,774

3,716

3,810

4,520

4,508

4,419

6,986

5,412

6,438

5,800

5,751

7,155

●4,28$

4,eo5

4,230

3,126

3,918

4,034

4,257

3,47i

4,161

4,591

4,915

7,530

6,882

7,779

7,634

159

331

202

193

272

515

312

594

416

504

754

784

721

1,721

240

484

252

266

311

640

476

970

550

778

820

795

398

*

212

417

296

269

430

760

363

615

473

570

1,136

1,239

659

*

2,767

3,067

2,575

2,801

3,013

2,787

2,764

2,892

2,404

2,987

2,920

2,742

4,183

2,647

2,961

2,808

2,745

2,833

3,142

2,613

3,132

3,154

2,618

3,353

3,013

2,767

3,439

%?,434

2,659

3,216

2,272

2,746

2,812

2,766

2,397

2,097

2,203

2,506

2,883

2,674

4,432

%2,556

4,598

163

402

603

727

253

270

855

472

386

198

306

111

42

2,260

83

186

281

344

126

133

349

225

161

98

152

60

19

2,343

74

216

328

363

140

131

317

247

165

100

163

51

23

5,672

4,710

3,722

4,504

4,722

5,608

4,850

6,079

6,888

6,164

5,736

5,753

8,080

%5,190

6,085

4,e49

3,531

4,798

5,C92

6,413

5,394

6,692

6,876

6,695

6,234

7,025

8,263

%,531

5,241

4,434

3,756

4,211

4,351

4,670

4,232

5,454

6,901

5,722

5,278

4,705

7,888

*4,394

213

447

304

237

242

633

422

34a

589

488

5S7

507

1,495

●

301

594

367

317

322

1,145

657

462

858

585

912

836

1,640

*

301

651

416

238

303

625

513

422

852

531

691

440

2,038

*

1Indude$ dafs for rata-etfmic Orow Ild ShOVM~~tdv. 2Exdud=nursina infsntssnddiildmn.

NOIEEetimateeof vftsminA&e&yskewe@ m&stiefendard errersofthim-&ne afwuldbeusadand intarpratedwtthcrwtien.

3,370

2,980

2,859

3,102

3,237

3,151

3,341

3,48a

4,081

3,642

3,398

3,167

4,035

%960

3,780

3,348

2,553

3,513

3,452

3,717

3,300

3,924

4,360

4,591

3,730

3,684

4,017

3,232

3,033

2,733

2,788

2,794

3,134

2,763

2,503

3,260

3,557

2,908

3,127

2,603

3,653

?2,601
Table 10. Vitamin A intake in retinol equivalents (RE) by age, eex, and race-ethniciw United States, 1966-91

Totalpopulation’ Non-Hispanic white Non-Hispanic black Mexican American

Standard Standard Standard

Sample

Standard

error of Sample error of Ssmp/e

Sex and age

error of

size Maan

Sample

the mean Median size Mean the mean

error of

Median size Me&m the mean Madian size Mean the mean Median

6oth sexas

Allages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

O-n years . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49yeara . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80 yeara and over

Male

All agesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

8-n years . . . . . . . . . . . . . . . . .

12-15yeara . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29yeara . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-59years . . . . . . . . . . . . . . . .

70-79yeare . . . . . . . . . . . . . . ,.

60yeareandover . . . . . . . . . . . .

Female

All ages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

S-n years . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29yeafa . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40+9years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

50-69years . . . . . . . . . . . . . . . .

70-79yesrs . . . . . . . . . . . . . . . .

60yes~andover . . . . . . . . . . . .

t 4,801 997

871 922

1,231 887

1,547 802

1,745 876

711 881

765 888

1,682 905

1,526 1,075

1,228 1,026

929 1,C06

1,106 1,193

851 1,225

609 1,126

7,322 1,115

439 950

601 700

744 860

668 931

338 1,231

368 959

844 1,026

735 1,245

626 1,231

473 1,085

546 1,306

444 1,322

296 1,207

7,479 884

432 692

630 674

803 742

877 823

373 738

397 816

836 786

791 809

602 629

456 934

560 1,097

407 1,155

313 1,063

20

27

22

24

26

102

51

45

56

63

58

55

66

76

34

38

32

36

37

180

61

65

97

116

63

63

101

114

23

33

25

26

33

73

74

54

52

4s

69

66

77

93

660

769

576

643

707

636

632

616

675

649

677

615

862

766

747

610

573

679

747

738

742

712

745

753

736

680

692

837

612

781

5al

606

w

516

516

550

600

567

610

778

861

734

5,780

473

424

425

511

221

245

4&l

550

467

472

493

538

501

2,867

241

202

219

252

96

112

216

271

243

251

247

265

250

2,693

232

222

206

259

123

133

244

279

224

221

246

253

251

1,031

945

710

837

899

1,019

959

892

1,123

1,064

f ,03+3

1,203

1,241

1,130

1,167

1,007

710

907

962

1,349

992

1,031

1,313

1,265

1,151

1,301

1,348

1,237

903

875

711

764

635

676

925

765

936

841

935

1,116

1,163

1,073

28

30

26

36

38

161

76

46

79

93

65

61

65

63

48

45

42

5a

53

315

65

77

136

164

59

94

104

106

28

36

35

42

50

66

121

55

68

60

104

72

75

72

715

601

594

672

734

659

706

632

720

688

714

667

914

779

784

697

578

707

762

846

774

740

780

771

797

914

916

851

643

767

602

626

683

501

567

565

626

592

636

616

903

754

3,863

162

355

454

452

191

217

499

454

338

230

289

186

56

1,803

76

162

210

239

95

103

245

213

176

105

141

93

21

1,980

64

173

244

213

96

114

254

241

160

125

148

93

35

670

834

626

718

765

616

705

884

630

697

980

940

1,126

1,162

947

601

675

726

679

339

833

1,175

860

1,059

866

914

1,165

*693

803

862

570

708

680

763

563

823

722

761

1,066

959

1,101

*i ,376

30

38

30

35

48

119

57

134

35

106

121

104

113

343

46

54

42

48

74

106

96

195

143

161

139

114

176

*

36

51

36

48

51

215

52

173

80

91

167

165

137

*

515

742

506

553

623

526

521

494

423

502

473

471

653

455

583

705

516

565

693

552

553

556

489

605

449

551

543

*455

479

763

486

536

546

512

477

429

362

444

508

431

710

●451

4,596

163

402

609

727

269

270

666

472

386

196

305

111

42

2,250

89

186

26~

344

129

139

349

225

161

96

152

60

19

2,346

74

216

328

363

140

131

317

247

165

100

153

51

23

670

893

700

791

646

955

610

857

984

617

761

920

1,321

●675

936

922

743

850

926

1,147

931

924

959

671

656

1,171

1,167

’767

802

859

652

731

766

778

672

775

1,010

761

712

714

*I ,453

*6I 3

31

50

53

30

33

130

69

49

95

67

75

93

331

*

46

67

83

41

47

233

101

70

115

65

107

161

315

*

40

66

47

39

40

63

76

55

140

91

20

72

*

*

591

776

542

633

639

591

547

575

597

546

544

523

598

*4S0

650

794

543

725

697

698

666

617

645

605

567

613

583

%95

538

726

535

578

610

470

434

509

565

462

441

435

*577

●480

‘ Indudss data for rsss-atfmic groups not shwm sspsrata!y. 2Exdudes nursing infants and children.

NOTE Estimates of vitaminA are vw skswad; mwns and standard erroreof ths mssns should ba usad and infafpretadwith caution.
Table 11. Carotenes intake in rat[nol equivalents (M) by age, sex, and race.ethnlci~ United States, 1968-91

Tofalpopulation’ Non-Hkpanic while Non-Hispenio black Mexioan American

standard Standard

Sample

standard starrdarri

error of sample error of Sample error of Sample

Sex and age size Mean the mean Median size Meen

envr of

flra mean Median sue Mean tie mean Median size Mean the mesn Median

B2th sexes

Allageez . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2yearsz. . . . . . . . . . . . . . . . .

3-5yaara . . . . . . . . . . . . . . . . .

O-n yeara. . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29yeara . . . . . . . . . . . . . . . .

30i39years. ., . . . . . . ..c . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

Male

Allages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2yeare2 . . . . . . . . . . . . . . . . .

3-5years, . . . . . . . . . . . . . . . .

O-llyaars. . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . ,

i6-19years. .,, ,, . . . . . . . . . .

20-29yeare, . . . . . . . . . . . . . . .

30-39years. a m. . . . . . . . . . . . .

40-49years. . .,, ,,, ,. .,....

50-69yeare . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79yeare. a m. . . . . . . . . . . . .

80yearsandover, . . . . . . . . . . ,

Female

Allages2 . . . . . . . . . . . . . . . . . .

2-llmonths2, ,,, . . . . . . . . . . .

l-2years2. . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

E-n years. , . ., . .,, ,, .,....

12-15years, . . . . . . . . . . . . . . .

15-19yeara, . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yeara . . . . . . . . . . . . . . . .

40-49yeare . . . . . . . . . . . . . . . .

50-69yeara . . . . . . . . . . . . . . . .

60-69yeara . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

14601

871

1231

1547

1745

711

765

1662

1526

1226

929

1106

661

609

7322

439

601

744

666

338

366

644

735

626

473

646

444

296

7479

432

630

603

877

373

397

636

791

602

466

650

407

313

452

346

222

266

278

290

363

430

532

522

495

606

583

534

487

375

234

270

263

323

307

534

564

536

534

622

656

513

419

319

203

246

275

255

400

328

481

452

453

592

613

646

12

27

16

17

19

32

46

26

38

36

38

44

44

56

19

37

22

26

22

46

39

47

57

52

47

65

65

60

16

34

19

19

28

40

77

25

45

42

56

53

55

72

173

126

86

114

121

130

136

164

232

203

229

249

276

216

189

164

104

li7

132

161

147

204

249

225

250

243

218

198

160

104

89

109

105

119

126

151

193

180

204

251

311

224

5760

473

424

425

511

221

246

450

550

467

472

483

636

501

2667

241

202

219

252

86

112

218

271

243

251

247

265

250

2693

232

222

206

258

123

133

244

279

224

221

246

263

251

448

363

225

263

256

251

366

404

526

507

493

597

590

635

463

436

241

263

272

310

272

600

662

662

653

692

570

500

415

320

208

242

244

191

448

314

471

431

439

601

606

554

15

30

22

26

27

36

67

37

50

45

42

45

44

50

23

43

35

42

32

66

42

65

76

66

52

66

66

70

20

36

24

27

40

34

113

32

58

51

60

55

63

64

174

155

94

110

116

121

134

162

237

186

232

262

277

219

193

202

95

113

127

145

141

186

256

216

256

245

217

203

162

116

68

106

100

89

128

163

164

173

203

275

312

226

3363

162

366

464

452

191

217

489

464

336

230

289

166

56

1903

78

162

210

239

95

103

245

213

178

105

141

93

21

1980

64

173

244

213

36

114

264

241

160

125

146

83

35

368

217

210

236

267

270

266

363

340

420

645

500

566

405

36s

192

227

230

252

266

274

601

342

487

464

421

495

Y297

350

239

191

242

263

264

286

236

33a

363

614

560

621

*464

14

35

19

19

24

35

50

44

33

41

65

77

67

106

21

46

22

27

19

55

39

76

47

57

67

76

80

*

20

43

29

23

42

34

82

26

38

49

95

117

92

*

140

55

114

129

130

126

134

150

121

162

184

150

222

125

150

47

137

131

139

109

152

185

126

165

250

109

199

W6

132

71

86

124

120

148

120

100

li4

159

163

190

255

*I 29

163

402

603

727

269

270

666

472

366

186

305

111

42

2250

89

166

261

344

128

139

349

225

181

36

152

60

19

2346

74

216

328

363

140

131

317

247

166

100

153

51

23

582

266

220

345

363

460

528

701

795

766

563

501

624

%36

636

306

180

360

360

517

562

793

619

87i

661

634

666

%41

523

262

252

330

346

406

470

530

769

696

511

391

572

*526

38

48

26

31

30

77

83

66

94

86

96

60

126

*

59

61

21

39

41

114

105

97

120

123

135

102

159

*

47

63

43

40

37

64

109

61

121

95

110

43

165

*

191

62

114

136

145

152

168

233

274

305

203

229

265

●151

212

91

105

148

157

172

193

253

304

434

208

243

310

*170

171

39

129

119

130

142

140

215

256

210

193

224

196

*146

‘Includesdalefor rwsthnio groupsIW etmvmeeperatdy. 2~dU&321Wrdng Msntaandd)lldren.

NO’WEstimatasofcamtsneslmakesmveryskewed:rnaanaendetsndardamxaof2hemasnadmuldLwusad.smllnfmed wfdIceuScm.
Table 12. Thiamin intake in milligram by age, sex, and rac~ethnicity: United States, 1963-91

Total population’ Non-Hispanic white Non-Hispanic black MexicanAmerfosrr

Standard Standard Standard standard

Sample error of Sample error of Sample

Sex and age

error of .%rnple error of

size Mean the mean Median size Meen the mean Median size Mean the mean Median size Mean fhe mean Median

8oth sexes

Allagesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2yesrs2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

4G49yeara . . . . . . . . . . . . . . . .

5C-59years . . . . . . . . . . . . . . . .

6&89years . . . . . . . . . . . . . . . .

7&79years . . . . . . . . . . . . . . .

80yeaffiandover . . . . . . . . . .

Male

All ages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

E-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years. . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yaars . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

5G59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . .

Female

All agesz. h i . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5yeara . . . . . . . . . . . . . . . . .

E-n yeare . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yeara . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years. h i . . . . . . . . . . . . .

80yearaandovar . . . . . . . . . . . .

14,801

871

1,231

1,547

1,745

711

765

1,682

1,528

1,228

929

1,106

851

609

7,322

439

601

744

888

338

366

844

735

626

473

546

444

296

7,479

432

630

603

677

373

397

836

791

602

456

560

407

---

313

.63

.19

.08

.38

.56

.62

1.67

1.76

1.71

1.61

1.55

1.60

1.47

1.42

1.91

1.20

1.12

1.45

1.67

2.31

2,26

2.11

2.06

1.91

1.64

1.61

1.69

1.65

1.36

1.17

1.05

1.31

1.45

1.31

1.46

1.43

1.37

1.33

1.26

1.42

1.31

i .30

0.02

0.03

0.02

0.02

0.03

0.11

0.07

0.04

0,04

0.04

0.04

0.04

0.04

0.05

0.03

0.05

0.03

0.04

0.04

0.20

0.10

0.06

0.06

0.06

0.07

0.06

0.06

0.07

0.02

0.04

0.02

0.02

0.03

0.05

0.06

0.04

0.04

0.04

0.04

0.05

0.04

0.05

1.43

i .06

1.02

1.26

1.44

1.55

1.56

1.55

1.53

1.46

1.37

1.39

1.33

1.27

1.66

1.05

1.06

1.28

1.59

1.90

2.06

1.85

1.60

1.69

1.66

1.62

1.56

1.48

1.22

1.06

0,96

1.23

1.34

1.21

1.20

1.29

1.23

1,22

1.18

1.22

1.16

1.15

5,760

473

424

425

511

221

245

480

550

467

472

493

538

501

2,887

241

202

219

252

98

112

216

271

243

251

247

285

250

2,693

232

222

206

259

123

133

244

279

224

221

246

253

25i

1.63

1.15

1.06

1.36

1.55

1.83

1.87

1.74

1.73

1.61

1.66

1.63

1.48

1.43

1.93

1.16

1.06

1.44

1.67

2.40

2.35

2.11

2.10

1.60

1.69

1.83

1,72

1.67

1.35

1.12

1.05

1.26

1.43

1.24

1.37

1.40

1.37

1.32

1.27

1.46

1.31

i .30

0.02

0.03

0.02

0.03

0.04

0.17

0.09

0.06

0.05

0.05

0.05

0.05

0.04

0.04

0.04

0.05

0.03

0.05

0.05

0.32

0.14

0.09

0.07

0.07

0.07

0.07

0.05

0.06

0.02

0.04

0.03

0.04

0.04

0.06

0.08

0.05

0.05

0.05

0.05

0.07

0.04

0.0.5

1.43

1.04

1.02

1.24

1.43

1.54

1.52

1.54

1.57

1.47

1.35

1.41

1.36

1.27

1.70

1.04

1.06

1.26

1.59

1.60

2.22

1.88

1.85

1.66

1.66

1.66

1.61

1.50

1.22

1.04

0.94

1.23

1.30

1.19

1.16

1.28

1.23

1.21

1.15

1.26

1.19

l.iei

3,663

162

355

454

452

191

217

439

454

338

230

289

186

58

1,903

78

162

210

239

95

103

245

213

176

105

141

93

21

1,960

84

173

244

213

96

lt4

254

241

lea

125

146

93

S5

1.56

1.35

1.19

1.45

1.58

1.64

1.M

1.76

1.55

1.47

1.38

1.33

1.32

1.34

1.78

1.33

1.27

1.47

1.67

1.74

2.21

2.13

1.69

1.79

1.52

1.52

1.43

*I .41

1.36

1.36

1.10

1.43

1.60

1.55

1.57

1.48

1.27

1.20

1.26

1.16

1,24

t .3<

0.02

0.06

0.03

0.03

0.04

0.07

0.10

0.06

0.05

0.05

0.05

0.05

0.06

0.12

0.03

0.08

0.05

0.05

0.05

0.10

0.16

0.11

0.09

0.09

0.09

0.09

0.14

*

0.02

0.09

0.04

0.05

0.05

0.10

0.09

0.05

0.05

0.04

0.05

0.05

0.07

0,15

1.37

1.20

1.11

1.37

1.45

1.49

1.53

1.53

1.37

1.31

1.26

1.15

1.06

1.15

1.54

1.20

1.21

1.37

1.51

1.58

1.60

1.65

1.66

1.52

1.41

1.30

1.19

*1.10

1.23

1.20

0.96

1.36

1.42

1.32

1.30

1.34

1.16

1.15

1.22

1.06

1.03

1.16

4,596

163

402

608

727

269

270

6E6

472

366

186

305

111

42

2,250

69

186

281

344

129

139

349

225

161

96

152

60

19

2,346

74

216

328

383

140

131

317

247

1s5

10Q

153

51

23

1.56

1.17

1.08

1,34

1.57

1.72

1.84

1.89

1.67

1.55

1.51

1.30

1.29

*1.12

1.77

1.11

1.09

1.47

1.88

2.10

1.64

1.93

1.69

1.76

1.74

1.55

1.51

*I .39

1.35

1.24

1.06

1.21

1.46

1.37

1.41

1.39

1.45

1.33

1.30

1.10

1.11

●o.e6

0.03

0.07

0.04

0.03

0.04

0.10

0.08

0.05

0.08

0.05

0.07

0.05

0.09

*

0.05

0.07

0.05

0.05

0.05

0.16

0.11

0.07

0.09

0.07

0.11

0.08

0.14

*

0.04

0.11

0.05

0.04

0.04

0.09

0.09

0.05

0.07

0.07

0.07

0.06

0.11

*

1.37

1.05

0.96

1.19

1.42

1.46

1.47

1.47

1.41

1.39

1.34

1.15

1.00

%.97

1.55

1.01

0.95

1.38

1.54

1.74

1.64

1.72

1.68

1.56

1.46

1.45

1.33

*1 .35

1.19

1.17

0.96

1.08

1.29

1.18

1.16

1.24

1.25

1.12

1.24

0.95

0.93

W.60

‘ Inoludss dsta for rats-sthnic groups not shown separately.

‘Excludes nursing infants end children.
Table 13. Riboflavin intake in milligram by age, sex, and race-ethnicity: Unlt6d Statee, 1966-91

Total population’ Non-Hispen;c white Non-Hispen!c black Mexiosn Amerioarr

standard

Sample

standard Standard Standard

error of Sample error of

Sax and age

Sample error of

size Mean tfre mean Median size Meen themean

Sample

Median

errvr of

size Meen the mean Median size Mean the mean Median

Both sexes

Allageez . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

O-llyasrs . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19yeare . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

4049yeara. . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69yeara . . . . . . . . . . . . . . . .

70-79yeare . . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

Mete

Nlages2 . . . . . . . . . . . . . . . . . .

2-llrnonthe2. . . . . . . . . . . . . . .

l-2yeara2 . . . . . . . . . . . . . . . . .

3-5yssre . . . . . . . . . . . . . . . . .

6-n years............,.. . .

12-15years. . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yaare. . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . .. m......., . .

60-69yeare . . . . . . . . . . . . . . . .

70-79years. . . . . . . . . . . . . . .,

60yearsandover . .,,,...,, ,.

Female

Allagea2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l-2yeara2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . ,.

6-n years, . . . . . . . . . . . . . . .,

12-15yeare . . . . . . . . . . . . . . . .

16-19yeare . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

4f3-49years . . . . . . . . . . . . . . . .

50-59yeara . . . . . . . . . . . . . . . .

60-69yeara . . . . . . . . . . . . . . . .

70-79yeare . . . . . . . . . . . . . . . .

80yeaffiandover . . . . . . . . . . . .

14,601

87+

1,231

1,547

1,745

711

765

1,682

1,526

1,226

929

1,106

851

609

7,322

439

601

744

668

338

368

844

735

626

473

546

444

296

7,479

432

630

803

877

373

397

638

791

602

456

560

407

313

1.97

1.68

1.62

1.61

2.03

2.24

2.25

2.07

2.05

1.67

1.84

1.84

1.78

1.71

2,30

1.71

1.68

1.91

2,16

2.77

2.77

2.45

2.47

2.17

2,17

2.21

2.06

1.95

1.67

1.64

1.58

1.71

1.68

1.8a

1.73

1.71

1.64

1.59

1.54

1.71

1.5a

1.59

0.02

0.04

0.03

0.03

0.03

0.13

0.08

0.04

0.05

0.04

0.05

0.05

0.05

0.06

0.04

0.05

0.04

0.05

0.05

0.24

0.12

0.06

0.08

0.06

0.06

0.08

0.07

0.08

0.02

0.04

O.CQ

0.03

0.04

0.06

0.07

0.04

0.04

0.04

0.05

0.06

0.05

0.06

1.75

1.61

1,55

i,70

1.92

1.92

1.91

1.62

1.63

1.69

1.66

1.70

1.60

1.52

2,05

1.64

1.50

1.76

2.45

2.46

2.23

2.21

1.98

1.95

1.89

1.66

1,77

1.51

1.57

1.48

1.62

1.76

1.47

1S3

1.53

1.50

1.47

1.42

1.61

1.40

1.40

5,780

473

424

425

511

221

245

460

550

487

472

483

533

501

2,837

241

202

219

252

83

112

216

271

243

251

247

285

250

2,893

232

222

206

259

123

133

244

279

224

221

248

253

251

2.03

1.53

1.63

1.83

2.07

2.32

2.36

2.12

2,t4

1.84

1.90

2.00

1.82

1.74

2.3a

1.73

1.65

1,86

2,22

2,95

2.84

2.56

2.60

2.23

2.28

2,26

2.11

1S9

1.68

1.62

1.61

1.70

1.91

1.67

1.74

1.72

1.70

1.64

1.56

1.77

1.61

1.60

0.03

0.03

0.03

0.04

0.04

0.19

0.10

0.06

0.06

0.05

0.05

0.06

0.04

0.05

0.04

005

0.05

0.07

0.08

0.33

0.16

0.09

0.10

0.06

0.03

0.08

0.07

0.07

0.03

0.04

0.04

0.05

0.06

0.06

0.06

0.06

0.05

0.05

0.05

0.07

0.05

0.05

1.61

1.61

1.56

1.67

1.95

2.01

2.01

1.86

1.80

1.76

1.73

1.76

1.64

1.55

2,13

1.65

1.60

1.77

2,07

2.53

2.67

2.31

2,35

2.03

2.02

2,04

1.90

1.76

1.55

1.57

1.49

1,58

1.83

1.45

1.55

1.54

1.59

1.50

1.46

1.57

1.41

1.41

3,883

162

356

454

452

191

217

489

454

33a

230

288

166

56

1,903

78

182

210

239

95

103

245

213

178

105

141

93

21

1,980

34

173

244

213

96

114

254

241

160

125

146

93

35

1.75

1.70

1.55

1.73

1.35

1.88

2,12

1.84

1.70

1.62

1.47

1.48

1.58

1.55

2.01

1.59

1.60

1,76

1.97

2.04

2.50

2S3

2,05

1.83

1.55

1.74

1.73

●1.63

1.53

1.71

1.49

1.70

1.73

1.71

1.75

1.61

1.40

1.32

1.41

1.28

1.43

1.52

0.02

0.06

0.04

0.04

0.05

0.08

0.11

0.07

0.06

0.06

0.06

0.08

0.09

0.15

0.03

0.09

0.06

0.05

0.06

0.11

0.16

0.10

0.09

0.09

0.09

0.08

0.15

*

0.03

0.09

0.06

0.05

0.06

0.11

0.13

0.07

0.05

0.05

0.07

0.07

0.08

0.20

1.53

1.61

1.51

1.67

1.73

1.61

1.75

1.66

1.45

1.46

1.27

1.27

1.34

1.28

1.74

1.61

1.60

1,70

1.65

1.80

2,17

2.08

1.67

1.77

1.30

1.54

1.42

*1.46

1.36

1,61

1,41

1.60

1.59

1.45

1.51

1.44

1.23

1.27

1,26

1.12

1.32

1.19

‘Includesdataforrsce-eltmicgroupsnotshownseparately.

*~~udss numingInfantsarxl cmdren.

163

402

609

727

268

270

666

472

366

196

305

111

42

2,250

69

166

261

344

128

139

349

225

181

88

152

60

19

2,348

74

216

328

383

140

131

317

247

185

100

153

51

23

1.83

1.73

1.71

i .86

2.06

2.17

2.02

1.98

1.88

1.82

1.72

1.62

1.55

*1.37

2.17

1.75

1.75

1.83

2.22

2.62

2.35

2,25

2,22

2.08

1.34

1.eo

1.67

*1.51

1.68

1.71

1.67

1.73

1.95

1.76

i .65

1.64

1.74

1.54

1.51

1.40

*1.45

●1.28

0.04

0.06

0.06

0.05

0.05

0.13

0.11

0.06

0.06

0.06

0.08

0,07

0.11

●

0.06

0.09

0.07

0.07

0.07

0.21

0.15

0.08

0.10

0.08

0.12

0.10

0.13

*

0.05

0.13

0.07

0.06

0.06

0,12

0.12

0.07

0.10

0.08

O.to

0.09

*

*

1.72

1.67

1,52

1.72

t .94

i .67

1.77

1.72

1.72

1.62

1.58

1.48

1.34

*1.30

1.97

1.70

1.53

1.66

2.10

2.21

2,12

2.02

2.08

1.98

1.74

1.66

1.53

*1.48

1.49

1.65

1.49

1.62

1.60

1.65

1.45

f .48

1.44

1,35

1.36

1.17

*1.27

*1.22
Table 14. Niacin Intake In milligram by age, sex, and rata-ethnicftw United Statee, 1988-91

Total population’ Non-Hispanic white Non-Hispan!c black Mexican American

Standard Standard

Sample

standard Standard

error of Sample error of Samp/e error of

Sex and age

Sample error of

size Mean the mean Median size Mean the mean Median size Mean the mean Median size Mean the mean Madian

Both sexes

Nlages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

13-l lyeara . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79yeara . . . . . . . . . . . . . . . .

80yearaandovar . . . . . . . . . . . .

Male

All ages2. . c . . . . . . . . . . . . . . .

2-llmonths2. . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19yesrs . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39yeara . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

Female

Allagesz . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2yeara2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

O-ii years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

i6-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

4049years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-7t?yesrs . . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . .

14,801

871

1,231

1,647

1,745

711

765

1,662

1,528

1,228

929

1,106

661

609

7,322

439

601

744

668

336

368

544

735

626

473

546

444

296

7,479

432

630

803

677

373

397

538

791

602

456

660

607

313

22.24

12.21

12.08

16.00

19.15

22.48

24.37

24.96

24.36

23.69

22.86

21.94

19.75

18.51

26.35

12.57

12.43

16.89

20.42

27.61

30.29

30.40

29.71

28.31

27.47

25.16

22.47

21.43

16.35

11.83

11.70

15.07

17.84

17.08

18.34

19.64

19.18

19.25

18.69

19.20

17.80

16.96

0.19

0.34

0.27

0.29

0.33

1.34

0.85

0.53

0.53

0.51

0.62

0.56

0.55

0.64

0.31

0.52

0.36

0.44

0.48

2.46

1.31

0.83

0.81

0.75

0.94

0.64

0.83

1.03

0.19

0.36

0.31

0.31

0.37

0.64

0.72

0.48

0.46

0.46

0.57

0.80

0,58

0.67

19.38

11.19

11.08

14.49

17.37

18.63

20.03

21.63

21.89

21.56

20.51

19.36

17,87

16.05

23.23

11.43

11.29

14.99

16.79

22.91

26.09

27.41

27.36

25.22

23.91

22.92

19.81

18.93

16.52

10.60

10.72

13.75

16.11

15.23

16.30

17.64

16.66

17.63

17.14

17.25

16.52

14.66

5,780

473

424

425

511

221

245

480

550

467

472

493

538

501

2,867

241

202

219

252

98

112

216

271

243

251

247

285

250

2,893

232

222

206

259

123

133

244

279

224

221

246

263

251

22.60

12.20

11.95

15.86

19.20

22.66

24.61

25.06

24.69

24.07

23.54

22.51

20.04

16.67

27.00

12.72

12.17

16.88

20.56

28.00

31.49

31.12

30.40

28.65

28.62

25.59

22.66

21.54

18.47

11.60

11.72

14.80

17.64

16.53

17.82

f9.47

19.46

19.41

18.95

19.78

17.97

17.14

0.23

0.36

0.32

0.42

0.47

2.11

1.19

0.77

o.6a

0.61

0.66

0.66

0.52

0.54

0.38

0.56

0.44

0.62

0.68

4.11

1.64

1.24

1.03

0.88

1.00

0.84

0.76

0.85

0.23

0.39

0.41

0.47

0.55

0.86

1.03

0.65

0.64

0.59

O.oa

0.76

0.61

0.61

19.66

11.20

11.13

14.36

17.33

18.61

19.31

21.79

21.88

21.87

20.88

19.84

18.19

16.20

23.76

11.63

11.35

14.66

18.97

23.76

26.96

28.64

26.16

25.81

24.69

23.61

20.12

19.35

16.65

10.47

10.74

13.62

16.03

14.52

15.01

17.65

17.37

18.05

17.20

17.52

16.57

14.78

3,663

162

355

454

452

191

217

499

454

338

230

289

186

56

1,803

76

162

210

239

95

103

245

213

178

105

141

93

21

1,880

84

173

244

213

96

114

254

241

160

125

148

93

35

20.86

12.86

13.49

17.23

19.06

20.46

24.76

25.47

22.64

21.66

18.49

17.40

17.42

17.34

24.63

12.80

14.28

17.35

20.37

21.44

28.81

32.36

28.08

26.52

21.10

20.55

16.69

%20.44

17.75

13.01

12.58

17.11

i7.74

19.48

19.96

19.63

18.10

17.62

16.63

15.oi

18.49

15.92

0.29

0.60

0.43

0.45

0.46

0.95

1.27

0.80

0.74

0.81

0.71

0.73

1.02

1.66

0.50

0.76

0.59

0.57

0.62

1.23

1.96

1.42

1.12

1.23

1.16

1.12

1.85

*

0.30

0.81

0.53

0.61

0.56

1.26

1.19

0.74

0.70

0.74

0.70

0.76

1.05

1.63

18.11

11.23

12.03

15.35

17.71

17.73

21.15

21.47

19.66

18.06

16.54

15.28

15.10

14.50

21.03

11.35

13.00

15.33

18.43

19.49

24,37

26.64

26.59

23.38

18.43

17.94

15.62

●15.43

16.06

10.96

11.19

15.39

17.30

17.29

16.85

17.14

16.84

16.13

15.80

13.98

14.89

12.98

4,598

163

402

609

727

269

270

6~

472

366

186

305

111

42

2,250

89

186

261

344

129

139

349

225

181

86

152

60

19

2,348

74

216

328

363

140

131

317

247

165

I(UI

153

51

23

19.47

11.05

11.61

14.86

17.77

20.54

20.37

21.47

22.48

20.82

20.01

16.66

15.74

*12.17

22.30

10.97

11.76

16.25

19.00

24.19

23.22

24.98

26.32

24.50

22.41

19.05

18.20

*14.14

16.50

11,14

11.44

13.47

16.54

17.16

17.13

17.18

18.42

17.03

17.79

14.70

13.63

fil 1.09

0.34

0.57

0.48

0.41

0.47

1.08

1.04

0.62

0.83

0.75

0.94

0.75

1.23

*

0.53

0.63

0.65

0.58

0.69

1.55

1.47

0.84

1.19

1.02

1.32

1.02

1.55

*

0.36

0.92

0.65

0.49

0.54

1.25

1.16

0.67

0.93

0.67

1.12

0.96

t .70

*

16.60

10.37

10.31

13.69

15.97

16.66

17.28

19.07

19.24

18.17

18.21

14.05

12.69

●12.00

19.55

10.80

10.52

15.61

16.66

20.34

19.11

22.61

23.59

23.09

21.11

16.54

15.13

*13.24

14.33

9.34

10.28

12.25

15.33

14.86

14.46

15.25

15.82

14.33

16.66

12.57

10.80

%.98

‘Includesdatefor raw-sthniogroupsnotshownseparately.

2Excludesnursing infants end children.
Table 15, Vitamin Be inmke in milligrams by age, sex, and raceethnlciw Unftad States, 1968-91

Toi%lpopulation’ Norr.Hispsnic white Non-Hispanic black MexioenArrrerfcerr

Standard

Sample

Standeld

error of SSnrple

S@ldanf standard

envr of

Sex and age

Sample enur of

size Mears #e mean Median w.ze Mean the mean

Sample error of

Median a.ze Mean themean Medisrs size Mean fhemean Median

8oth sexes

Allageaz . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l–2yeare2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n yeare. . . . . . . . . . . . . . . . .

12-15 year3. . . . . . . . . . . . . . . .

16-19 years . . . . . . . . . . . . . . . .

20-29 years . . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . .

40-49 years . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . .

60-69 years . . . . . . . . . . . . . . . .

70-79 yaars . . . . . . . . . . . . . . . .

80years andover . . . . . . . . . . . .

Mate

Allages2 . . . . . . . . . . . . . . . . . .

2-llrrmnths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-llyear3, . . . . . . . . . . . . . . . .

12-15yeare . . . . . . . . . . . . . . . ,

l&19years . . . . . . . . . . . . . . . .

20-29years. . . . . . . . . . . . . . . .

30-39year3 . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . .. m...... .

70-79yeara . . . . . . . . . . . . . . . ,

80yaarsandover, . . . . . . . . . . .

Female

Allages2. . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n years. . . . . . . . . . . . . . . . .

12-15years. . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30+9years . . . . . . . . . . . . . . . .

40-49yeare . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69yeare . . . . . . . . . . . . . . . .

70-79years. . . . . . . . . . . . . . . .

80yearsendover . . . . . . . . . . . .

14,801 1.77

871 0.78

1,231 1.21

1,547 1.42

1,745 1.58

711 1.64

765 1.91

1,662 1,89

1,526 1.88

1,228 1.79

929 1.79

1,106 1.82

851 1.73

808 1.88

7,322 2.07

439 0.81

801 1.22

744 1.49

888 1.63

338 2.28

366 2.36

844 2.28

735 2.27

826 2.16

473 2.12

546 2.05

444 1.92

296 1.91

7,479 1.47

432 0.76

630 1.20

803 1.35

877 1.47

373 f.36

397 1.45

638 1.50

791 1.50

802 1.43

456 1.48

560 1.63

407 1.59

313 1.65

0.02

0.02

0.03

0.03

0.03

0.13

0.07

0.04

0.05

0.04

0.08

0.05

0.05

0.07

0.03

0,03

0.04

0.04

0.05

0.26

0.12

O,(M

0.07

0.07

0.09

0.08

0.08

0.10

0.02

0.02

0.03

0.03

0.03

0.08

0.07

0.04

0.04

0.04

0.06

0.08

0.06

0.07

1.52

0.71

1.08

1.28

1.43

1.56

1.59

1.66

1.63

1.56

1.51

1.57

1.51

1.47

1.80

0.72

1.10

1.30

1.55

1.64

2.08

2.04

1.32

1.92

1.84

1.76

1.67

1.71

1.30

0.70

1.06

1.26

1.35

1.11

1.14

1.32

1.36

1.23

1.25

1.39

1.35

1.32

5,780

473

424

425

511

221

245

460

560

467

472

493

536

501

2,887

241

202

219

252

88

112

216

271

243

251

247

286

250

2,893

232

222

206

258

123

133

244

273

224

221

246

253

251

1.78

0.78

1.20

1.41

1.58

1.88

1.92

1.88

1.92

1.82

1.85

1.87

1.76

1,70

2.12

0.82

1.19

1.49

1.71

2.44

2.43

2.30

2.32

2.20

2.22

2.03

1.86

1.83

1.48

0.74

1,21

1.32

1.46

1,31

1.40

1.47

1.52

1.44

1.52

1.67

1.62

1.57

‘Includesdateforram-elhnicWUPS no2shownsepsrs2aly.

‘Excludesnursinginfantsandchildren.

0.02

0.02

0.03

0.04

0.04

0.20

0.10

0.06

0.06

0.05

0.06

0.06

0.05

0.05

0.04

0.03

0.05

0.08

0.07

0.41

0.16

0.09

0.03

0.08

0.10

0,08

0.07

0.08

0.02

0.02

0.04

0.05

0.05

0.07

0.09

0.06

0.08

0.05

0.07

0.07

0.08

0.08

1.53

0.70

1.08

1,25

1.42

1.59

1.56

1.66

1.66

1.59

1.54

1.50

1.56

1.50

1.84

0.73

1.08

1.26

1.56

1.88

2.08

2.08

2.07

1.96

1.91

1.63

1.71

1.75

1.31

0.67

1.08

1,23

1.35

1.10

1.12

t .32

1.39

1.30

1.25

1.44

1.36

1.%27

3,663

162

355

454

452

191

217

423

454

336

230

288

188

5a

1,803

76

182

210

239

95

103

245

213

178

105

141

83

21

1,980

64

173

244

213

88

114

254

241

180

125

146

93

35

1.80

0.76

1.26

1.47

1.55

1.65

1.89

1.87

1.67

1.54

1.38

1.39

1.50

1.52

1.87

0.76

1.31

1.49

1.85

1.85

2.25

2.33

2.06

1.92

1.54

1.52

1.85

*1.72

1.37

0.75

1.20

1.46

1.45

1.47

1.54

1.45

1.34

1.23

1.26

1.29

1.36

1.43

0.03

0.03

0.04

0.04

0.04

0.08

0.10

0.07

0.06

0.06

0,06

0.06

0.10

0.15

0.04

0.04

0.05

0.05

0.06

0.10

0.16

0.10

0.09

0.08

0.09

0.06

0.16

*

0.03

0.04

0.05

0.05

0.06

0.10

0.10

0.06

0.05

0.05

0.06

0.07

0.08

0.18

1.38

0.66

1.21

1.36

1.35

1.39

1.56

1.58

1.47

1.34

1.21

1.21

1.22

1.17

1.80

0.66

1.24

1.38

1.45

1.56

1.86

2.08

1.87

1.60

1.43

1.33

1,20

*I .38

1.20

0.70

1.11

1.36

1.30

1.35

1.24

1.20

1.19

1.14

1.10

1.16

1.23

0.98

4,596

163

402

608

727

288

270

688

472

366

186

305

111

42

2,250

89

188

261

344

128

139

349

225

161

88

152

80

19

2,348

74

216

328

363

140

131

317

247

185

100

153

51

23

1.71

0.79

1.27

1.50

1.W

1.65

1.74

i .98

1.69

1.72

1.71

1.47

i .46

*1.07

1.95

0.84

1.28

1.61

1.72

1.91

1.95

2S0

2.16

2.06

1.92

1.88

1.67

*1.24

1.47

0.73

1.25

1.39

1.49

1.41

1.51

1.56

1.61

1.37

1.52

1.30

*1.27

%3.38

0.05

0.04

0.06

0.05

0.05

0.11

0.10

0.07

0.09

0.07

0.10

0.08

0.15

*

0.08

0.05

0.07

0,08

0.07

0.13

0.12

0.06

0,10

0.08

0.13

0.09

0.17

*

0,06

0.04

0.08

0.06

0.05

0.11

0.12

0.07

0.10

0.08

0.10

0.09

*

*

1.46

0.72

1.11

1.37

1.44

1.42

1.52

1.70

1.56

1.59

1.56

1.25

1.20

*0.97

1.74

0.76

1.13

1.46

1.56

1.62

1.66

2.01

1.94

1.97

1.79

1.47

1.26

*1.14

1.26

0.65

1.06

1.27

1.31

1.16

1.31

1.34

1.34

1.16

1.35

1.13

%.98

W.91
Table 16. Folete Intake in micrograms by age, sex, and race-ethnicit’y United States, 19S6-91

Total population’ Non.Hispanio white Non-Hispsnio black Me~”san Ameriosn

Stmdard standard

Sample

Standard

error of

Standard

Semp/e error of Sample error of %rrrple error of

Sex and age size Mean the mean Median size Mean the mean Median size Mean the mean Median size Mean the mean Median

8oth sexes

Allagesz . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

S-n yeara . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19 years . . . . . . . . . . . . . . . .

20-29 years . . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . .

40-49 years . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . .

60-69 years . . . . . . . . . . . . . . . .

70-79 years . . . . . . . . . . . . . . . .

80yeam andover . . . . . . . . . . . .

Male

Allageez . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

18-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69yeara . . . . . . . . . . . . . . . .

70-79yeara . . . . . . . . . . . . . . . .

60yearaandover . . . . . . . . . . . .

Female

Allages2 . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2yaars2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

O-n yeara . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . ..- .

?O-?gyeare . . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

14,601

S71

1,231

1,547

1,745

711

765

1,8a2

1,526

1,226

929

1,106

851

809

7,322

439

601

744

886

336

368

644

735

626

473

546

444

298

7,479

432

630

603

677

373

397

838

791

802

456

560

407

313

275

180

162

227

257

303

284

276

297

286

277

303

285

272

317

180

183

238

276

382

333

323

359

317

318

331

303

304

236

160

182

214

235

220

234

230

237

220

239

279

272

255

4.2

4.1

4.5

5.2

5.9

26.7

12.3

7.1

9.2

7.9

9.3

9.9

9.8

11.9

7.0

6.0

6.0

6.1

8.7

50.2

19.0

10.8

14.8

12.4

14.7

14.0

14.4

16.9

4.4

4.9

5.9

5.6

6.9

11.8

12.9

7.8

9.0

7.6

9.5

12.4

12.1

13.9

226

143

164

203

229

241

217

226

243

224

231

249

243

219

266

142

164

206

244

289

264

274

307

265

270

295

261

249

195

143

164

200

206

181

186

186

188

165

207

225

233

204

5,780

473

424

425

511

221

245

460

550

467

472

493

538

501

2,837

241

202

219

252

68

112

216

271

243

251

247

285

250

2,893

232

222

208

259

123

133

244

279

224

221

246

253

251

262

154

182

226

260

319

289

273

309

276

265

309

289

275

327

157

179

239

284

417

345

322

377

327

330

335

310

310

239

151

186

212

236

217

230

227

242

224

244

285

274

256

5,1

4.2

5.1

7.1

8.1

42.4

16.2

9.9

12.1

9.6

10.0

11.2

9.1

10.0

6.6

6.4

6.8

11.0

12.2

84.3

25.9

15.5

19.2

15.1

15.7

16.0

13.1

15.9

5.2

5.2

7.4

6.2

10.0

15.6

17.1

11.2

12.5

10.2

11.0

15.0

12.2

12.4

234

136

169

207

236

252

229

222

254

232

242

256

247

224

274

138

169

206

253

305

261

277

315

278

274

302

266

261

200

133

168

205

210

160

183

183

194

188

216

229

236

205

3,883

162

355

454

452

191

217

499

454

33a

230

289

166

58

1,903

78

162

210

239

95

103

245

213

178

105

141

93

21

1,980

84

173

244

213

96

114

254

24i

160

125

i46

93

35

238

170

188

235

244

227

263

252

236

224

229

248

244

243

271

167

203

234

265

246

309

308

287

274

246

259

257

?205

209

174

171

236

224

208

219

204

192

182

216

240

234

%260

3.8

6.9

7.3

8.5

9.4

13.3

16.9

11.0

11.1

12.5

13.6

15.2

19.1

28.0

6.4

9.2

10.7

11.6

13.3

16.6

30.9

18.0

16.6

21.4

21.2

18.8

33.1

*

4.4

9.5

8.8

11.4

11.9

19.0

18.9

10.8

10.3

10.1

16.2

22.0

19.0

*

186

157

163

204

198

189

187

196

162

173

165

186

187

173

213

155

166

203

218

199

212

247

213

211

212

218

167

●I 70

163

157

155

204

181

176

150

148

155

154

152

174

165

*174

4,598

183

402

608

727

269

270

666

472

388

186

305

111

42

2,250

69

166

281

344

129

139

349

225

181

98

152

60

19

2,346

74

216

328

383

140

131

317

247

165

100

153

51

23

280

178

197

253

275

288

293

318

288

267

274

261

227

%?04

316

176

194

275

296

313

340

366

333

315

311

327

244

%61

240

179

200

230

253

227

239

258

262

218

239

207

212

*173

6.4

9.1

10.6

8.9

9.4

17.5

19.5

11.5

14.2

11.9

19.2

15.3

19.9

*

13.0

12.3

12.1

12.4

13.0

23.7

25.9

14.9

16.0

15.7

26.4

21.2

21.4

*

10.2

9.3

14.2

9.3

10.0

18.9

20.2

12.0

16.9

12.3

20.3

15.0

27.6

*

229

164

161

217

235

219

229

261

240

2%29

220

214

179

*176

265

146

160

231

256

254

263

304

299

276

250

266

197

●234

201

182

162

201

216

i 62

190

214

208

201

204

173

147

*150

‘Includes data for race-athnlcgroupe not shown separately.

2Excludsanursing Infants and children.
Table 17. Wmln B,, inbkein mlcrwrams byage,8ex, andm*ethnlcW Unitd%tes, lWl .-

Tofal~pulation’ NrmHispanio white NorFH@anio black Mexiaan Amarhan

standard standard standard Stendeld

sample armr of Sample anw of Sample

Sex and age

envr of sample ertvr of

size Mean the mean Ms&m eke Meerr the mean M&lien size Maarr tire mean Median size Mean tie mean Median

Both sexes

Allageez, . . . . .. m. . . . . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . . . . . . . . . . . . . .

l–2yaafa* . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3-5yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n yearn . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-19years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-29years. . . . . . . . . . . . . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . . . . . . . . . . . ..O

50-59year8 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

60-59years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . . . . . . . . . . . . . .

Male

Allagesz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-llmonths2. . . . . . . . . . . . . . . . . . . . . . . . . . .

l-2yeare2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3-5yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyeacs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-15years. . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-19yeam . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-29yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30-39yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40-49years, . . . . . . . . . . . . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-79yeara. ., . . . . . . ..m... . . . . . . . . . . . . .

80yeacsandover . . . . . . . . . . . . . . . . . . . . . . . .

Female

Allages2 . . . . . . . . . . . . . . . ..o . . . . . . . . . . . .

2-llmonths2. . . . . . . . . . . . . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . . . . . . . . ...1..

3-5years . . . ..o . . . . . . . ..m . . . . . . . . . . . . .

&llyears. d o . . . . . . . . . . . . . . . . . . . . . . . . . .

12-15years, . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-29yeer3 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40-49yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

60-69yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80yeareandover . . . . . . . . . . . . . . . . . . . . . . . .

14,601

871

1,231

1,547

1,745

711

765

1,682

1,526

1,228

929

1,106

651

603

7,322

439

601

744

66a

338

366

644

735

626

473

548

444

296

7,479

432

630

603

677

373

397

638

791

602

456

560

407

313

5.07

3.03

3.18

3.70

4.32

5.46

5.38

5.31

5.99

5.28

5.01

5.08

4.30

4.30

6.15

3.09

3.32

4,02

4.37

6.77

6,80

6.58

7.34

6.63

6.81

6.13

528

5.66

4.04

2S6

3.02

3.36

4.26

4.09

3.93

3.97

4.67

3.79

4.28

4.19

3.59

3.45

0.10

0.07

0.06

0.12

0.11

0.45

0.31

0.28

0.30

0.34

0.28

0.24

0.26

0.36

0.16

0.09

0.12

0.20

0.14

0.74

0.42

0.45

0.44

0.58

0.32

0.35

0.39

0.66

0.10

0.08

0.03

0.11

0.16

0.34

0.37

0.24

0.34

0.21

0.40

0.27

0.28

0.30

3.59

2.63

2.87

3.06

3.61

3,65

4.15

3.65

3.87

3.50

3.55

3.53

3.04

2.98

4.38

2.68

2,97

3.22

3.62

4.72

5.15

4.97

4.89

4.49

4.39

4.4a

3.95

3.74

3.00

2S3

2.73

2.99

3.36

3.19

3.11

3,10

3.06

2.82

2.65

2.96

2.61

2.66

6,760

473

424

425

511

221

245

450

550

467

472

493

538

501

2,8437

241

202

219

252

96

112

218

271

243

251

247

235

250

2,693

232

222

206

259

123

133

244

27a

224

221

248

253

251

5.11

2,99

3.12

3.59

4.36

5.68

6.41

5.19

6,19

5.30

5.17

5.10

4.29

4.27

6.32

3.05

3,22

3.69

4,27

7.24

6.95

6.77

7.74

6.88

6.07

6.25

6.36

6.12

3.98

2.93

3,01

3,29

4.45

4.06

3.79

3.72

4,67

3.7i

4.36

4.08

3.50

3,29

0.12

0.07

0.08

0.13

0.17

0.68

0.30

0.41

0.41

0.44

0,32

0.28

0.25

0,30

0.21

0.10

0.12

0.19

0.17

1.27

0.46

0.77

0.61

0.77

0.36

0.44

0.40

0.62

0.11

0.10

0.11

0.17

0.30

0.36

0,31

0.21

0.50

0.25

0.52

0.33

0.28

0.19

‘ Inohdesdataforrsow4hnk groupsnotshow sapamdsly. ‘Exdudasnursiw Infanfsendchildmrh

N07PEstimatsaof vftaminB12arev2xyskewad;maansandstandfmlarmisofllm mennsshouldbsusadandh2srpmfsdwlUIcsulfon.

3.66

2.66

2.87

3.03

3.46

3.95

4.24

3.77

4.11

3.73

3.70

3.74

3.07

3.07

4.51

2.36

2.95

3.27

3.50

4.64

5.16

5.04

5.30

4.66

4.77

4.51

4.00

3.63

3.05

2.91

2.66

2.84

3.40

3.36

3.41

3.05

3.27

3.07

3.00

3.01

2.64

2.60

3,2a3

152

355

454

452

191

217

499

454

338

230

268

185

56

1,803

78

162

210

239

95

103

245

213

178

105

141

83

21

1,860

64

173

244

213

96

114

254

241

160

125

146

93

35

4.66

2.96

3.17

3.55

405

4.56

5.60

6.16

5.24

4.97

4.15

4.41

4,43

*4JKI

5.53

306

3.44

3.56

4.6a

4.57

6.27

7.16

6.78

6.21

4.45

5.18

4.68

%2.69

4.21

2.30

2.87

3.55

3.41

4.76

4S5

5.30

3.86

3.82

3.92

3.62

4.10

%82

0.18

0.14

0.12

0.15

0.21

0.61

0.77

0.60

0.44

0.51

0.51

0.39

0.48

*

0,26

0.20

0.19

0.20

0.35

0.51

0.80

0.79

0.74

0.87

0.65

0.50

0.69

*

0.24

0.20

0.15

0.24

O.i7

1.15

1.33

0.90

0.47

0.47

0.77

0.60

0.67

*

3.25

2.73

2.79

3.00

3.36

3.30

3.87

3.96

3.25

3.18

2.71

2.84

2.82

%?.19

3.80

2.79

2.89

2.98

3.56

3.77

4.95

4.84

4.13

4.08

3.08

3.43

3.30

%2,50

2.85

2.65

2.62

2.98

2.91

2.90

3.08

3.30

2.82

2.55

2,54

2.19

2.55

%?.12

4,598

163

402

609

727

269

270

666

472

366

196

305

111

42

2,250

69

186

281

344

129

139

349

225

181

96

152

60

19

2,348

74

216

328

383

140

131

317

247

185

100

153

51

23

4.60

3.33

3.65

3.61

4.25

5.14

5.76

5.34

5.32

4.59

3.89

4.85

5.73

2.74

5.55

3.44

3.95

3.s2

4.53

6.41

7.25

6.30

5.30

5.56

4.43

6.12

*4.63

%.26

4.00

3.20

3.32

3.60

3.92

3.97

4.07

4.17

4.70

3.58

3.36

3.44

%,80

Y2.46

0.15

0.14

0.25

0.12

0.13

0.62

0.82

0.30

0.42

0.30

0.29

0.43

1.65

0.30

0.24

0.19

0.43

0.15

0.20

1.15

1.41

0.42

0.53

0.43

0.41

0.75

*

*

0.16

0.19

0.20

0.17

0,15

0.33

0.40

0.37

0.66

0.39

0.38

0.35

●

*

3.56

3.19

2,92

3.11

3.56

3.78

3.95

3.92

3.72

3.71

2.94

3.02

2.33

2,19

4.11

3.19

3.08

3.12

3.80

4.23

4.69

4.76

4.46

4.53

3.16

3,57

%?.49

?2,47

3.07

3.17

2,71

3.09

3.35

3.41

2.97

3.31

2.96

2.84

2.78

2.37

%?.23

*1.63
Table 18. Vitemin C Intake in milllgreme by age, sex, and rata-ethnicity United Statea, 198S-91

Totalpopulation’ Non-Hispsrrlc whfte Non-H/sparricblack Mem”canAmerican

Standard Stendard Standard

Sample error of SSrrrple

Standard

error of Sample

Sex and age

error of Sarrrp/e

size Mean

error of

the mean Median size Mean the mean Median size Mean the mean Median size Mean the mean Median

I%th sexes

Allages2 . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2yeers2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

8_ll yearn ... . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

18-19years . . . . . . . . . . . . . . . .

20-29yesra . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59yeara . . . . . . . . . . . . . . . .

60+9years . . . . . . . . . . . . . . . .

70-79yeare. . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

Male

r4!lages2 . . . . . . . . . . . . . . . . . .

2-llmontha2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

>5years . . . . . . . . . . . . . . . . .

8-n yeare . . . . . . . . . . . . . . . . .

12-15years . . . . . . . . . . . . . . . .

18-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49yeara . . . . . . . . . . . . . . . .

50-59yeare . . . . . . . . . . . . . . . .

60-89years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

Female

Allagesz . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

3-5yeare . . . . . . . . . . . . . . . . .

L1-llyears . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . ..i... .

16-19yeara . . . . . . . . . . . . . . . .

20-29yeara . . . . . . . . . . . . . . . .

30-39yeara . . . . . . . . . . . . . . . .

40-49years . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69yeara . . . . . . . . . . . . . . . .

70-79yeara . . . . . . . . . . . . . . . .

60yearaandover . . . . . . . . . . . .

14,601

671

1,231

1,647

1,745

711

765

1,682

1,526

1,228

929

1,106

851

809

7,322

439

801

744

886

338

366

644

735

626

473

546

444

286

7,479

432

630

803

877

373

397

636

791

802

456

580

407

313

105

137

88

102

101

111

10S)

104

110

102

103

109

100

102

115

138

eo

104

110

129

116

121

123

115

114

107

102

97

95

136

87

100

91

91

101

87

99

88

%3

111

96

105

2.4

4.6

3.3

3.1

3.1

6.0

6.9

4.4

4.3

4.5

5.0

4.5

4.3

5.0

3.8

5.6

3.9

4.1

4.5

6.4

8.9

6.5

5.6

6.6

6.9

5.3

5.4

5.6

2.9

5.7

4.3

3.6

3.1

6.2

8.4

4.3

5.1

4.5

5.4

5.9

5.5

6.7

76

126

69

65

79

83

71

70

60

75

76

67

61

64

84

122

72

66

60

98

80

76

93

83

64

81

85

62

73

130

65

84

78

66

65

61

71

66

72

69

77

86

5,780

473

424

425

511

221

245

480

550

467

472

493

538

501

2,887

241

202

219

252

98

112

216

271

243

251

247

285

250

2,893

232

222

208

259

123

133

244

279

224

221

246

253

251

102

133

85

97

95

105

94

95

111

102

108

109

99

103

112

136

65

97

107

129

99

109

125

116

118

106

102

98

93

130

84

97

84

79

90

81

97

68

94

112

97

106

2.6

4.6

3.8

3.8

4.2

8.0

6.6

5.9

5.4

5.6

5.4

5.0

3.9

4.2

4.4

6.3

4.8

4.8

6.4

12.1

8.5

9.4

7.2

8.2

7.5

5.8

5.0

4.6

3.4

5.6

4.9

4.6

3.9

7.3

8.0

5.2

6.2

5.4

6.0

6.7

4.9

5.6

77

119

67

82

74

77

83

84

81

75

79

67

82

85

83

121

70

81

74

97

67

70

96

83

89

62

88

82

71

116

85

84

73

53

61

58

72

68

71

89

76

87

3,883

162

355

454

452

191

217

499

454

338

230

269

188

m

1,903

78

162

210

239

95

103

245

213

178

105

141

93

21

1,980

84

173

244

213

88

114

254

241

180

125

148

93

35

113

156

108

121

116

120

143

127

104

96

87

97

96

91

127

143

109

124

120

131

170

155

124

119

97

87

96

100

167

106

118

112

109

117

103

88

81

60

105

100

94

2.5

6.2

5.5

5.2

4.6

8.2

12.0

6.7

5.9

6.4

5.8

5.9

7.0

10.9

4.0

10.8

6.7

7.7

6.9

13.4

20.7

10.9

9.7

10.7

10.4

6.1

11.2

●

3.0

11.2

6.1

6.6

5.6

8.8

11.6

7.2

6.4

6.3

5.9

7.8

8.1

i 3A

83

149

67

88

96

98

98

80

59

88

62

73

76

71

83

126

89

105

98

102

113

109

66

82

59

58

72

●83

73

159

79

98

98

20

64

69

50

56

65

66

76

80

4,598

183

402

608

727

269

270

666

472

388

198

305

111

42

2,260

89

188

281

344

129

139

349

225

181

98

152

80

19

2,348

74

216

328

383

140

131

317

247

185

100

153

51

23

113

136

65

111

104

111

120

131

114

113

95

96

105

*62

121

138

84

115

108

125

126

143

115

129

100

111

127

●43

104

135

86

106

100

98

114

116

112

96

90

84

86

72

3.6

7.5

4.2

4.7

4.1

7.7

9.7

6.5

6.3

7.9

7,7

6.6

14.4

*

5.5

11.0

5.6

6.7

6.4

12.0

14.5

9.2

8.1

12.3

10.6

11.3

24.6

*

4.6

6.2

5.3

5.7

4.2

8.1

10.4

7.4

8.3

8,1

9.5

6.3

11.5

*

61

131

69

65

85

60

61

64

64

75

67

74

88

%9

87

125

69

89

82

90

62

92

89

88

79

79

67

w

73

135

84

77

67

72

76

70

85

80

80

84

58

*5O

‘ Includss dsta for rece-ethnic groups not shown sepsratdy.

2Excludes nursing infsnle end childran.
Table 19. Vitamin E Intake in milligrams alpha-tocopherol equivalents by age, sex, and race-ethnlcfty: United States, 19SS-91

Totalpopulation’ Non-H@ank white Non-Hispanic black MexicanAmerican

Standad

Sample

Stendatti standard standard

errvr of sample

Sex and age

envr of Sample error of

size

Sanrple

Maan the mean Median size Mean ttremean Median

error of

size Mean the mean Median size Meen the mean Median

Both sexes

Allages2 . . . . . . . . . . . . . . ..mm

2-llmonths2 . . . . . . . . . . . . . . .

l-2yeaffi2 . . . . . . . . . . . . . . . . .

3-5yeare . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12-15 years . . . . . .. m........

i6-19yeara . . . . . . . . . . . . . . . .

20-29 years . . . . . . . . . . . . . . . .

30-39 yeara . . . . . . . . . . . . . . . .

40-49 years . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . .

60-69 yeare. . . . . . . . . . . . . . . .

70-79 years . . . . . . . . . . . . . . . .

60years and over . . . . . . . . . . . .

Male

Allagesz . . . . . . . . . . . . . . . . . .

2-llmonths2 . . . . . . . . . . . . . . .

i-2year32 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

6-n year n . . . . . . . . . . . . . . .

12-15 years . . . . . . . . . . . . . . . .

16-19 years, ., . . . . . . . . . . . . .

20-29years. .,..........,,,

30-39years. a m. . . . . . . . . . . . ,

40-49years. ... ... ., c,,,.. ,

50-59years. .,, . .,, ,, . . . . . .

60-69years. . . . . . . . . . . . . . . ,

70-79years . . . . . . . . . . . . . . .,

80yearaandover, . . . . . . . . . . .

Female

AJlagas2, . . . . . . . . . . . . . . . . .

2-llmonthe2. .,, . . . . . . . . . . ,

l-2years2. .,, ,, . . . . . . . . . . .

3-5year3 . . . . . . . . . ..m. m...

8-n yeare . . . . . . . . . . . . . . . . .

12-15years. .,..,...,.,.,..

16-19years, . . . . . . . . . . . . . . .

20-29years . . . . . . . ..mm.m. . .

30-39years . . . . . . . . . . . . . . . ,

40-49yeare. . . . . . . . . . . . . . . .

50-59yeare . . . . . . . . . . . . . . . .

80-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

14,601

871

1,231

1,547

1,745

711

755

1,662

1,526

1,228

928

1,106

651

509

7,322

438

601

744

666

336

366

644

735

526

473

546

444

285

7,479

432

630

603

877

373

397

636

731

602

466

660

407

313

8.76

11.08

4.75

5.89

6.30

10.94

9.19

8.87

9.87

8.75

9.32

8.98

8.16

8.06

10.00

11.01

4,63

6.03

7,03

14.74

10.12

10.08

11.60

10.04

11.32

9.77

8.91

9.21

7.67

11,16

4.66

5.75

6.76

6.93

8.24

7,70

8.19

7.50

7.51

8.32

7.62

7.44

022

0.31

0.17

0.20

0.24

2.34

0.44

0.25

0.37

0.28

0.54

0.45

0.46

0.66

0.40

0.43

0.22

0.26

0.28

4.30

0.45

0,35

0s6

0.41

0.90

O.M

0.65

0S0

0.18

0.37

0.22

0.25

0.41

0.67

0S0

0.37

0.31

0.42

0,61

0.66

0.66

6.59

11.62

3.77

4,97

5.71

6.33

7.57

7.16

7.64

7.f7

6.95

6.57

5.34

5.55

7.53

11,75

3.66

6.17

5.92

6S9

9.07

8,41

9.16

6.15

8.57

7.33

6.47

6.30

5.30

11.s0

3.65

4.78

5.54

5.87

6.91

6.34

6.36

6.00

5.87

6.97

5.68

5.16

5,760

473

424

425

511

221

245

460

5s0

467

472

483

536

601

2,667

241

202

219

252

86

112

216

271

243

251

247

285

250

2,633

232

222

2Q6

259

123

133

244

273

224

221

246

263

251

6.36

10.59

4.66

5.87

6.72

*11.51

9,24

8.66

10.25

9.13

9.78

9.37

6.28

8.28

10.36

10.62

4.56

6.06

6.34

*16.43

10.30

10.19

12,24

10.43

11.89

10.06

8.91

9.45

7.67

10.64

4.66

5.64

6.49

6.44

6.12

7.64

6,28

7.62

7.79

6.74

7.81

7.66

0.27

0.32

0.17

0.28

0.27

*

0.62

0.34

0.49

0.36

0.62

0.54

0.42

0.48

0.51

0.46

0.22

0.39

0.37

*

0.62

0.46

0.76

0.51

1.01

0.66

0.64

0.75

0.20

0.41

0s24

0,39

0.39

0.42

1.03

0.45

0.49

0.44

0.54

0.81

0.62

0.61

6.77

11.43

3.74

4.33

5.60

*6.16

7.50

7.25

7.84

7.62

7.20

6.82

6.08

5.78

7.75

11.13

3.76

5.12

5.86

●6.81

9.27

8.72

9.70

8.56

8.87

7,49

6.60

6.49

5.99

11.46

3.62

4.76

5.46

5.64

5.76

6.41

6.52

6,21

6.02

6.31

5.74

6.43

3,863

162

355

454

452

191

217

438

454

338

230

289

166

56

1,903

78

182

210

239

95

103

245

213

178

105

141

83

21

1,980

84

173

244

213

86

114

254

241

160

125

146

93

36

6.01

12.52

5.16

6.32

7.81

8.60

9.23

9.19

8.26

7.65

7.02

6.40

7.65

5.22

6.60

12.52

5.46

5.97

7.34

6.49

10.46

10.97

9.32

9.20

7.77

6.66

9.28

*4.82

7.31

12,52

4.8t

6.67

8.28

6.72

8.06

7.66

7.37

6.72

6.46

6.03

6.47

5.40

0.16

0.48

0.26

0.27

0.57

0.57

0.61

0.43

0.34

0.41

0.46

1.12

1.12

0.25

0.71

0.36

0.28

0.40

0.62

0.82

0.82

0.58

0.74

0.65

0.57

2.36

*

0.21

0.64

0.37

0.44

1.05

0.92

0.66

0.35

0.36

0.36

0.44

0.50

0.61

1.57

6.23

12.39

4.33

5.48

5.92

7.07

7.55

7.20

6.76

6,31

5.64

4.64

4.34

3.92

6.79

12.23

4.72

5.60

5.56

7.45

9.16

8,64

7.70

7.10

5.57

5.43

4.66

%77

5.78

12,38

3.91

5.40

5.92

6.77

6.26

6.15

6.16

5.93

5.48

4.46

5.02

3.79

4,598

163

402

609

727

269

270

656

472

366

196

305

111

42

2,250

89

166

281

344

123

139

349

225

181

86

152

50

19

2,348

74

216

328

353

140

131

317

247

165

100

153

51

23

6.52

11.65

6.31

6,53

7.47

8.76

6.90

9.45

10.23

6.15

7,46

6,71

6.50

●5.11

9.29

11.44

6,16

6.98

8.24

9.79

9.64

10,51

10.28

9.46

8.71

7.61

6.85

*4.95

7.72

11.89

6.47

6.06

6.70

7,81

6.07

8.16

10.19

6.81

6,31

5.97

6.20

*5.19

0.36

0.67

0.56

0.35

0.45

0.95

0.61

0.50

0.76

0.41

0.66

0.64

0.78

*

0.64

0.80

0.69

0.53

0.74

1.34

0.72

0.65

0.66

0.56

1.12

0.64

0.74

*

0.53

0.78

0.74

0.37

0.37

1.09

0.63

0.59

1.21

0.42

0.42

0.73

1.22

*

6.35

12.16

4.12

5.07

6.46

5.49

7.02

7.34

7.13

7.00

6.14

5.41

4.56

*4.76

7.17

12.66

4.15

5.42

5.64

6.69

7.74

8.32

6.03

7.33

6.77

6.60

5.30

*4.63

5.51

11.89

4.08

4.65

5.25

5.02

6,10

5.75

6.43

6.10

5.50

4.21

4.08

*4.71

‘Includes date for rata-athnlc grcups not shawn aaparateiy. %dudesnurdng infsnrsandchlldmn.

NOIEEsllmatescd vi2arnlnEhtalreara vstyakmmaans andstandardermra ofUremeanadrould beuaedandhtwpreted wtthcautien,
Table 20. Fiber intake in grama by age, sex, and rata-ethnicity United States, 198S-91

Tofa/ population’ Non-Hispanic white Non-Hlspsnic black Mexioen American

Standsrd Standard

Sample

Standard Standard

error of Sample error of Sample error of

Sex and age

Sample error of

size Mearr the mean Madian size Mean the mean Median size Mean the mean Median size Mean the mean Madian

Seth saxes

AtIagesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l-2years2 . . . . . . . . . . . . . . . . .

W5 years . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . .

12-15yeara . . . . . . . . . . . . . . . .

16-19yeara . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

3&39years . . . . . . . . . . . . . . . .

40-49yeara . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69yaars . . . . . . . . . . . . . . . .

70-79yeara . . . . . . . . . . . . . . . .

80yearsandover . . . . . . . . . . . .

Male

All agasz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . .

l–2yeaffi2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

&ll years . . . . . . . . . . . . . . . . .

12–15years . . . . . . . . . . . . . . . .

16-19yaars . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . . . . . . . . . . . . . . .

40-49yaara . . . . . . . . . . . . . . . .

50-59years . . . . . . . . . . . . . . . .

60-69years . . . . . . . . . . . . . . . .

70-79years . . . . . . . . . . . . . . .

60yearsandover . . . . . . . . . . . .

Famale

AIIagesz . . . . . . . . . . . . . . . . . .

2–llmonths2 . . . . . . . . . . . . . . .

l–2years2 . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . .

S-n years . . . . . . . . . . . . . . . . .

12–15yaara . . . . . . . . . . . . . . . .

16-19years . . . . . . . . . . . . . . . .

20-29years . . . . . . . . . . . . . . . .

30-39years . . .. c . . . . . . . . . . .

40-49yeara . . . . . . . . . . . . . . . .

50-59yeara . . . . . . . . . . . . . . . .

60-89yeara . . . . . . . . . . . . . . . .

70-79yeara . . . . . . . . . . . . . . . .

Wyearsandover . . . . . . . . . . . .

14,801

671

1,231

1,547

1,745

711

765

1,662

1,526

1,228

922

1,106

651

609

7,322

439

601

744

666

338

36a

644

735

626

473

546

444

296

7,479

432

830

803

877

373

397

638

791

602

458

580

407

313

14.62

4.42

6.52

10.72

12.49

13.32

15.03

15.59

16.72

15.35

15.69

16.06

15.69

13.99

17.01

4.73

9.01

11.18

13.14

15.09

17.44

18.74

19.97

18.01

16.29

17.60

17.17

16.55

12.75

4.10

8.00

10.24

11.81

11.45

12.57

12.51

13.53

12.61

13.71

14.74

14.63

12.64

0.17

0.18

0.21

0.22

0.24

0.44

0.51

0.37

0.39

0.39

0.46

0.45

0.46

0.48

0.27

0.26

0.31

0.30

0.33

0.66

0.78

0.59

0.62

0.60

0.72

0.69

0.75

0.33

0.19

0.23

0.24

0.27

0.30

0.49

0.56

0.35

0.36

0.40

0.48

0.52

0.55

0.50

12.63

3.82

7.69

9.76

11.06

11.32

12.63

13.10

14.32

13.77

14.14

13.70

13.33

12.45

14.73

4.15

7.92

10.35

12.00

13.60

15.81

15.98

17.62

16.70

16.35

15.27

14.41

14.56

11.24

3.54

7.13

9.40

10.28

10.04

9.68

10.93

12.45

11.80

12.45

12.79

12.53

f f ,43

5,780

473

424

425

511

221

245

460

550

467

472

493

53a

501

2,667

241

202

219

252

98

112

216

271

243

251

247

265

250

2,893

232

222

206

259

123

133

244

279

224

221

246

253

14.94

4.62

6.61

10.50

12.29

12.98

14.73

15.15

16.95

15.60

16.06

16.39

15.95

14.30

17.24

5.28

9.16

11.02

13.09

15.06

17.38

16.22

20.29

1e.36

16.73

17.77

17.65

17.08

12.78

4.33

8.06

9.97

11.47

10.61

11.96

12.31

13.66

12.81

13.66

15.17

14.72

12.81

0.20

0.20

0.27

0.31

0.33

0.80

0.67

0.52

0.51

0.49

0.51

0.54

0.48

0.42

0.32

0.26

0.40

0.40

0.46

0.86

1.05

0.64

0.79

0.75

0.78

0.81

0.75

0.71

0.23

0.25

0.32

0.43

0.44

0.84

0.69

0.51

0.51

0.51

0.54

0,65

0.55

0.46

12.s6

4.29

7.71

9.77

10.97

11.29

12.35

12.96

14.50

13.97

14.26

13.68

13.66

12.61

15.12

4,74

7.93

10.32

12.22

13.60

16.16

15.243

18.68

17.30

16.49

15.31

14.73

15.07

11.43

3.a8

7.33

9.20

9.70

9.98

9.66

10.71

12.59

12.27

12.47

13.44

12.92

1i .70

1lnclud~~ tj~~ forrsse-sthnlogroups IlOt ShOVM SSP~t~Y.

2Exsludesnursinginfsnlsandshlldren.

3,ea3

162

355

454

452

191

217

469

454

33a

230

238

166

56

1,eo3

78

162

210

239

95

103

245

213

176

105

141

93

21

1,960

64

173

244

213

85

114

254

241

160

125

146

93

35

13.00

3.52

8.55

11.45

12.36

13.14

14.05

14.21

13.86

12.66

13.61

13.18

13.06

10.95

14.68

3.31

9.17

11.60

12.75

14.23

16.13

16.09

16.40

14.96

14.46

13.69

12.93

woo

11.54

3.71

7.84

11.30

11.96

12.02

12.08

10.91

11.73

11.10

12.98

12.64

13.19

11.64

0.23

0S3

0.30

0.34

0.36

0.66

0.74

0.54

0.52

0.52

0.72

0.64

0.79

1.05

0.36

0.43

0.45

0.50

0.51

0.96

1.14

0.92

0.82

0.60

1.07

0.96

0.88

●

0,26

0.46

0.35

0.42

0.46

0.77

0.81

0.43

0.56

0.55

0.66

0.76

1.10

1.i8

10.92

2.67

7.94

10.43

11.21

11.06

11.51

11.49

11.57

10.99

11.44

11.34

10.68

8.46

12.34

2.50

8.61

10.66

11.23

12.31

13.50

14.63

14.05

12.36

12.46

12.25

10.31

*8.73

9.98

3.19

7.05

10.09

10.89

10.08

9.46

9.88

9.94

9.49

10.56

11.04

11.02

9.96

4,598

163

402

809

727

269

270

666

472

366

196

305

111

42

2,250

69

166

261

344

129

139

349

225

181

96

152

60

19

2,348

74

216

326

363

140

131

317

247

185

100

153

51

23

17.62

4.10

9.32

12.57

14.92

15.21

16.30

21.95

20.46

19.66

19.61

16.91

15.31

●13.69

20.56

4.43

9.05

13,39

15.66

17.44

21.16

26.28

23.73

22.81

21.77

20.66

17.99

*1 9.75

14.94

3.72

9.62

11.75

14.17

13.14

15.06

16.68

17.05

16.41

17.62

13.66

13.01

*1 0.34

0.53

036

0.39

0.40

0.44

0.79

1.11

0.76

0.s3

0.s4

1.11

0.66

1.24

●

0.65

0.46

0.53

0.59

0.61

1.21

1.60

1.08

1.21

1.21

1.45

1.31

1.62

*

0.56

0.49

0.52

0.46

0.57

0.35

1.24

0.74

0.92

o.a4

1.K1

0.66

1.84

*

14.31

3.14

7.92

i 0.57

12.76

13.16

13.91

17.59

16.54

16.63

16.68

14.06

12.63

979

16.70

3.56

7.77

10.95

13.55

14.63

15.96

21.49

20.79

18.89

19.10

16.15

16.64

*13.12

12.36

2.77

8.22

9.46

12.04

10.45

11.34

13.61

14.40

14.85

14.75

11.72

11.22

*6.91
Advance Data No. 258 ● November14,1994 25

Technical notes

Source of data and survey

design

The third National Health and

Nutrition Examination Survey

(NHANES III) is a 6-year survey

comprised of two 3-year phases,

1988-91 and 1991–94. Each phase is a

representative sample of the U.S.

civilian noninstitutionalized population

ages 2 months and over living in

households (10). Mexican Americans,

black, children 5 years of age and

younger, and persons 60 years of age

and over were oversampled to provide

more reliable estimates for these

population groups (27).

Phase 1 data collection occurred

between October 1988 and October

1991. Table I indicates the response

rates for the dietary component. A total

of 20,277 sample persons were

identified for the NHANES IIf, Phase 1

sample; 17,464 sample persons

(86 percent) were interviewed, and

15,630 were examined (77 percent).

Dietary interviews were completed on

15,409 examinees (99 percent). Reliable

24-hour recalls were obtained from

15,280 examinees. Respondents with

incomplete recalls (n=338) and

breastfeeding infants and children

(n=141) were excluded horn all

analyses; 221 persons were not

interviewed because they refused (42),

had communication problems (21), or

for survey operation reasons such as

lack of time (158). No attempt was

made to impute missing data. The Phase

1 anrdytic sample is made up of 14,801

respondents who had complete and

reliable recalls-95 percent of the

examined sample (14,801/15,630) or

73 percent of the total sample

(14,801/20,277).

Statistical methodology

The complex survey design was

taken into account by using appropriate

survey sampling weights and statistical

methods to produce national estimates.

Population means, medians, and

standard errors of the mean (SEMS) for

nutrient intakes based on l-day, 24-hour

dietary recall data are presented in this

report. Standard errors of the mean were

computed using SUDAAN, a program

that takes into account the sampling

weights and complex sample design for

calculating variance estimates (28).

Because of the relatively small numbers

of degrees of freedom in Phase 1 of

NHANES III, an average design effixt

method (10) was used to stabilize

standard error estimates shown in this

report. Estimates that are less reliable

based on statistical criteria of sample

size and coefficient of variation are

designated by an asterisk in the tables.

Some nutrient estimates are by their

nature very skewed (for example,

copper, iron, zinc, vitamin ~ carotenes,

vitamin Blz, and vitamin E). This is

because food and nutrient intakes varies

from day to day. Consumption of certain

nutrients may be very high or very low

for some individuals on a specilic day,

Table L Survey response rates for the 24-hour dietary recall component NHANES Ill,

Phaee 1, 198S-91

Response rate in percent

Response category Number Oomporrent survey

Totalnumbsrofsample psrsons . . . . . . . . . . . . . 20,277 . . . 100

interviewedsample persons. . . . . . . . . . . . . . . . 17,464 . . . as

Examinedsample persons. . . . . . . . . . . . . . . . . 15,630 100 77

24-hour diets~ recall

Total intewiawed. . . . . . . . . . . . . . . . . . . . . . . 15,409 29 76

Reliable . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,260 !38 75

Complete. . . . . . . . . . . . . . . . . . . . . . . . . 14,601 95 73

Nursinginfsnt/child. . . . . . . . . . . . . . . . . . . 141 1

Inmmplete . . . . . . . . . . . . . . . . . . . . . . . .

. . .

338

Unreliable. . . . . . . . . . . . . . . . . . . . . . . . . .

. . .

100 (t

Oomputermatfunotion. . . . . . . . . . . . . . . . . .

. . .

29 (’)

Totalnotintewiewed. . . . . . . . . . . . . . . . . . . . .

. . .

221 1 . . .

‘Lessthan1 percsnt.

infnencing population distributions. For

non-normally distributed variables, the

means and standard errors of the means

for such variables, which assume

normality, should be used and

interpreted with caution.

Dietary data collection

methodology

Respondents reported all foods and

beverages consumed, except plain

drinking water, over the previous

24-hour time period (midnight to

midnight). Foods and beverages were

quantified using food speciiic units, for

example, a large-sixe egg or mediumsize apple. Abstract food models, shape

charts, and measurement aids such as

rulers and household measuring cups

and spoons were also used to quantify

foods and beverages. During Phase 1,

approximately 69 percent of all dietary

interviews were completed by the

respondent, 28 percent by a proxy

respondent, and 3 percent by the

respondent and a proxy. Proxy

respondents were utilized for infants and

children 2 months-5 years and for other

respondents who were unable to report

on their own. Children 6-11 years of

age were permitted to report their own

intake (54 percent), although 22 percent

were completed by proxy and 24 percent

were completed with both the child and

a proxy. Data retrieval with day care

providera and schools was conducted as

necessary to obtain complete intakes for

infants and children.

All 24-hour recall interviews were

conducted in the mobile examination

centers (MECs); the examination

schedules included all days of the week

The distribution of recalls by day of the

week during Phase 1 wax

Sunday 8 percent

Monday 10 percent

Tuesday 11 percent

Wednesday 19 percent

Thursday 17 percent

Friday 26 percent

Saturday 9 percent

The higher proportion of Friday recalls

was due to operational procedures that

allowed for a high frequency of

Saturday examinations to improve

response rates.
26 Advance Data No. 258 ● November 14, 1994

Dietary interviews were conducted

in English (86 percent), Spanish

(12 percent), and English/Spanish or

other languages (2 percent). The

NHANES III Dietary Interviewer’s

Manual provides details for all aspects

of the 24-hour recall protocol (29).

Dietary interviewers were required to

have a college degree in foods and

nutrition. A majority of the interviewers

were bilingual in English and Spanish.

The dietary interviewers completed a

comprehensive 2-week training course

taught by an experienced bilingual

trainer. The training course emphasized

standardized data collection and

adherence to the dietary interview

protocol, proper interviewing technique,

and efficient use of the Dietary Data

Collection system (DDC) system during

the dietary interview. Interviewer

retention was excellent.

Dietary intemiewer performance

was monitored using several techniques

including field monitoring of interviews

in progress and reviews of taped dietary

interviews by NCHS and Westat, Inc.

(10,29,30). Throughout the survey, the

dietary interviewers performed a

10-percent cross-check of printed

24-hour recall reports. Interviewer

retraining sessions were conducted

regularly. Field memoranda and

newsletters were prepared by NCHS and

WestaL Inc., stzdlto inform the

interviewers of DDC updates and issues

ccmceming the dietary interview

protocol. Updated versions of the DDC

system were installed in the MECS

approximately twice per year.

Dietary terms and calculation

procedures

Nutrient and dietary fiber intakes

for individuals were calculated using the

gram amounts of food consumed and

the USDA Survey Nutrient Data Base

(SNDB) nutrient values for the food

expressed per 100 grams of food (31).

Micronutrients<arotenesRepresents vitamin A activity derived

from beta-carotene and other provitamin

A carotenoids expressed as micrograms

of retinol equivalents (RE).

Dietary Jiber-Represents total

dietary fiber-including both the

insoluble fraction (cellulose,

hemicellulose, and lignin) and the

soluble fraction (for example, gums in

cereal grains and pectin in fruits and

vegetables).

Folate—Represents total folate

activity.

Niacin—Represents nicotinic acid

and nicotinarnide present in foods. Does

not include potential niacin that could

be converted from dietary tryptophan, a

niacin precursor, in the body.

Macronutrients-carbohydrates,

fats, and protein are the macronutrients

of the diet and principal sources of

energy.

Sodium-Includes naturally

occurring sodium, sodium contributed

by compounds used in food processing,

and a calculated amount of sodium used

for food preparation. Excludes sodium

from salt added at the table.

Total energy intake—Total food

energy intake (measured in kilocalories

or kcal) was calculated from grams of

daily intake of protein, carbohydrate, fat,

and alcohol. The energy conversion

factors used were 4 kcal per gram for

protein and carbohydrate, 9 kcal per

gram for total fat and fatty acids, and

7 kcal per gram for alcohol.

Wtawzin E —Represents vitamin E

activity derived from alpha-, beta-, and

gamma-tocopherol and alpha-tocopherol

expressed as milligrams alphatocopherol equivalents (alpha-TE). One

alpha-tocopherol equivalent equals

1 milli~am of alpha-tocopherol,

2 milligrams of beta-tocopherol,

10 milligrams of gamma-tocopherol,

3.3 milligrams of alpha-tocotrienol.

Data editing and statistical

analysis

or

NCHS staff reviewed and edited the

Phase 1 data files. Editing guidelines

were developed by NCHS staff in

consultation with U.S. Department of

Agriculture (USDA) and Nutrition

Coordinating Center (NCC) stti, and

other knowledgeable sources. NCHS

staff performed all data review and

editing tasks. Meetings and workshops

were conducted to discuss foods,

database updates, coding procedures,

and editing decisions. NCHS prepared

guidelines to document data editing

decisions (32). Dietary interviewers

coded the quality of all 24-hour recall

interviews as “reliable,” “unreliable,”

“refusal,” or “not interviewed” (29).

NCHS reviewed all notes recorded by

the dietary interviewers; the notes

provided information about the

interview setting, the interviewer’s

assessment of the respondent’s abilities

and willingness to comply with

instmctions; that is, Was the respondent

capable of completing the 24-hour

recall? If the respondent made a

reasonable effort to complete the

24-hour recall, the recall was considered

to be reliable. On the other hand, if the

respondent was very confused or had

extraordinary difficulty recalling foods

and beverages consumed the day before,

the recall was coded “unreliable.”

A “reliable” recall may result in

unusually high or low intakes for

various nutrients. For example, a

12–15-year-old non-Hispanic white male

consumed a large quantity of a highly

fortified cereal resulting in an extremely

high intake value for vitamin E and

some other nutrients. Data for this

person are included in the reference

tables shown in this report because the

recall data were determined to be

correct and “reliable.” There may be

situations where it would be appropriate

to exclude this or other outliers because

of the effect it would have on the

overall analysis and conclusions,

especially when sample sizes are small.

Demographic terms

Age—Age was defined as age in

months or years at the time of the

household interview. Infants are under

1 year of age.

Race-ethnicity-Race and ethnicity

ckissiiication was based on self-reported

information. Persons were classified as

non-Hispanic white, non-Hispanic black

Mexican American, or “other.” The

“other” category is included in the total

sample counts but is not presented

separately.
Number 259 . March 20, 1995

Advance

Data

FromVi and HealthStatisticsofthe CENTERS FOR DISEASE CONTROLAND PREVENTION/National Centerfor Health statistics

Characteristics of Elderly Men and Women Discharged From

Home Health Care Services: United States, 1991-92

by Achintya N. Dey, M.A., Division of Health Care Statistics

Introduction

Today’s modem medical technology

allows health care professionals to

deliver quality health care services at a

much lower cost in the patient’s home

than in institutional settings. Services

such as physical therapy, intravenous

infusion of medications, speech therapy,

and other “high-tech” services such as

around-the-clock intravenous antibiotic

therapy for difiicult infections were

mostly cordined to hospitals. These

services and others like them are now

available at home through home health

care agencies. Today, these agencies are

referred to as “hospitals without walls.”

The enactment of the Medicare law in

1965 authorized payment for certain

home health care services, thereby

making them more available to the

elderly. This has resulted in a rapid

increase in the number of home heaIth

care agencies (l). Government programs

such as Medicare, as well as private

insurance plans, recognize that it is less

expensive to provide care at home,

especially post-hospitalization care, than

in an institution. The average home

health care visit cost about $66 in 1993,

compared with about $1,500 in

Medicare charges for an average day in

the hospital (2). Today, these agencies

are the fastest growing segment of the

U.S. health care system (3). Currently,

there are an estimated 7,000 home

health care agencies in the United

states(l).

The changing age structure of the

population, that is, the increasing

number of elderly members in the total

population, also influences the need for

home health care service. Recent

statistics indicate that 3 of every 4 home

health care patients were 65 years and

over (l). Older patients generally prefer

recovering from an illness at home

instead of in a hospital or a nursing

home (4).

This report presents findings on

service utilization, primary diagnosis at

admissio~ types of aids used at the time

of discharge or immediately prior to

discharge, and disposition status of

elderIy men and women home health

care discharges. The advantage of using

discharge data is that it will enable

health care researchers to review the

complete episode of care, that is, from

admission to discharge. A discharge may

be due to either an improvement or

stabilization or a worsening of a

condition that leads to admission to a

hospital or nursing home or to death.

Service utilization is discussed in terms

of (a) services received to perform

activities of daily living and

instrumental activities of daily living at

the time of discharge or immediately

prior to discharge, (b) types of service

received during the last billing period,

and (c) the length of service in days

from admission to discharge. Activities

of daily living include bathing, dressing,

eating, transferring from a bed or chair,

walking, and using the toilet room.

Instrumental activities of daily living

include doing light housework

managing money, shopping for groceries

or clothes, using the telephone,

preparing meals, and taking medications.

Acknowledgments

This reportwas preparedin the Long-Ten_nCare StatisticsBranchof the Dwisionof Health Care statistics. I wouldlike to thank Evelyn

Mathis and Genevieve Strahanfortheir helpfulcomments.This reporlwas edited by KlaudiaCox and typeset by MargaretAvery ofthe

PublicationsBranch,Dkision of Date Se~.ces.

* Swrccs,o$

#,

#

-#

U.S. DEPARTMENTOF HEALTHAND HUMANSERVICES

g Public Health Service

ss Centers for Disease Controland Prevention 5%

>

++< +m~ National Center for Health Statistics Cent cmAwl FoRm PFrE
2 Advance Data No. 259. March 20, 1995

The data in this report are from the

1992 National Home and Hospice Care

Survey (NHHCS), a segment of the

Long-Term Care Component of the

National Health Care Survey (5). The

1992 NHHCS is the first annual survey

of home health care agencies and

hospices, their current patients, and

discharges. The National Center for

Health Statistics (NCHS) began this

nationwide sample survey in response to

the rapid growth in the number of these

agencies in the United States (6). The

1,500 agencies included in the survey

were selected from a universe of 8,859

agencies classified by the 1991 National

Health Provider Inventory (NHPI) (7) as

agencies providing home health or

hospice care. Also included in the

universe was a sample of potentially

new agencies identified between

November 1991 (when the 1991 NHPI

was completed) and June 1992. Detailed

information on sample design, selection

methods, data collection procedures, and

sampling errors is included in the

Technical notes.

Estimates in this report are based on

the discharged patient sample.

Discharges are defined as patients who

were removed from the rolls of the

agency during a 12-month period ending

on the last day of the month prior to the

month of the survey. Discharges also

include patients whose episode of care

ended because of death. Discharges

represent discharge events, not

discharged patients. The same patient

could be included more than once if that

person had more than one episode of

care that ended during the year. The

extent of multiple episodes of care by a

single person in the discharge sample is

unknown.

Data were collected by interviewing

the staH person most familiar with the

medical records for the sample

discharges. Although the survey

included patients of all ages from

hospices and home health care agencies,

data presented in this report are limited

to home health care patients aged 65

years and over. The estimates are based

on responses for 3,654 discharges.

Demographic characteristics

During 1991–92 there were an

estimated 3.1 million discharges from

estimated 7,000 home health care

agencies in the United States (8). Of

these discharges, about 2,278,300 or

74 percent were 65 years of age and

over. The characteristic of these elderly

home health care discharges, by sex, are

shown in table 1. Elderly discharges

75–84 years comprised the largest group

(46 percent), followed by those 65-74

years (34 percent) and 85 years and over

(21 percent). There were more women

discharges than men discharges. Women

constituted 66 percent of all elderly

discharges and, on an average, were 2

years older than elderly men (79 years

vs. 77 years). Elderly white people

constituted 71 percent of all discharges,

elderly black people constituted

8 percent, and other and unknown races

constituted the remaining 21 percent.

(Other was 1 percent and Unknown was

20 percent.)

In 1991–92, there were 71 patients

discharged from home health care out of

every 1,000 civilian noninstitutionalized

persons 65 years and older (table 2).

The ratio of number of discharges from

home health care services for elderly

women was 78 per 1,000 population and

for elderly men, 60 per 1,000. For both

sexes, the use of services dramatically

increased with advancing age. Among

elderly men, the use of services

increased from 36 per 1,000 of those

aged 65–74 years to 146 per 1,000 of

those 85 years and over—an increase of

306 percent. Among elderly women, the

use of services increased from 45 per

1,000 of those aged 65–74 years to 144

per 1,000 of those 85 years and

over—an increase of 220 percent.

Half of the elderly women

discharges were widowed and only onefourth were married at the time of

discharge (table 1). For every 100

married women, there were 122 married

men. However, there were only 20

widowers for every 100 widows.

Moreover, elderly men were more likely

to be living with their family than their

female counterparts. In 1992, 72 percent

of all discharged men lived with their

family compared with 51 percent of

women. The percent of elderly women

living alone was almost double that of

elderly men (41 percent vs. 22 percent).

There is a similar distribution in the

an general population of elderly women

living alone compared with elderly men

(9). In the 75-84 years age group, the

percent of women who lived alone was

more than two times higher than men

and, in the 85 and over age group, the

percent of women who lived alone ‘was

nearly three times higher than men

(figure 1).

Use of services

Help with functional activities

A functional orientation to the

health of elderly people is an important

dimension of their health status. Any

impairment of functional status reduces

their ability to maintain an independent

existence and affects their quality of life.

Moreover, the inability to perform

activities of daily living are also

associated with a shortened life

expectancy (10).

In this report, the ADL’s, which

reflect an individual’s capacity for self

care, refer to six sociobiological

functions bathing, dressing, eating,

transferring, walking, and toileting. The

IADL’s, which involve more complex

tasks that enable an individual to live

independently in the community, are

doing light housework managing

money, shopping for groceries or

clothes, using the telephone, preparing

meals, and taking medications. This

report focuses on the ADL’s and

IADL’s where the help was provided by

home health care agencies. It does not

include ADL’s and IADL’s where h~elp

was provided by other sources.

Table 3 shows the percent, by sex,

of elderly home health care discharges

who received help and the number of

ADL’s and L4DL’s for which help was

received. A significantly greater pencent

of elderly women than elderly men were

reported as receiving assistance in

bathing or showering (49 percent and 40

percent, respectively). Of all elderly

women discharges, 44 percent were

reported as receiving help in dressing,

and 40 percent reported as receiving

help in walking. One-third of elderly

women were reported as receiving help

in transferring in or out of beds or

chairs. Fifty-eight percent of elderly

women were reported as receiving help

in at least one ADL. Twenty-eight
Advance Data No. 259. March 20, 1995 3

Table 1. Number and percent distribution of elderly discharges 65 yeara and over from home health care agencies by demographic

characteristics, according to sex: United States, 1991-92

Both sexes Finale Male

Percent Percent Percent

Demographic charaotetistie Number distribution Number distribution Number distribution

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

Age

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

75-a4years . . . . . . . . . . . . . . . . . . . . . . .

S5yearsand over . . . . . . . . . . . . . . . . . . .

Race

While. . . . . . . . . . . . . . . . . . . . . . . . . . .

Black andother . . . . . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . . . . . . .

Marital status at discharge

Manfed. . . . . . . . . . . . . . . . . . . . . . . . . .

Widowed. . . . . . . . . . . . . . . . . . . . . . . . .

Oivoroadorseparated . . . . . . . . . . . . . . . . .

Navermanied . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . .

Living arrangement

Familymembers . . . . . . . . . . . . . . . . . . . .

Nonfamilymembers . . . . . . . . . . . . . . . . . .

8othfarniiyandnonfamily members . . . . . . . .

Alone . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . .

2,278,300 100.0 1,508,800 100.0 768,700 100.0

762,900 33.5 46a,70il 31.0 294,200 33.3

1,043,600 45.8 701,800 46.5 341,800 44.5

471,800 20.7 339,100 22.5 132,600 17.3

1,616,300 70.9 1,085,000 70.6 551,300 71.7

202,600 8.9 125,S00 8.3 76,800 10.0

175,200 7.7 112,800 7.5 62,300 8.1

459,400 20.2 318,700 21.1 140,700 18.3

857,100 37.6 335,900 25.6 471,300 61,3

909,000 39.9 757,700 50.2 151,300 19.7

82,400 3.6 80,500 4.0 21,800 2.8

63,600 3.7 51,000 3.4 32,700 4.3

346,200 15.2 254,800 16.9 91 ,60D 11.9

1,319,600 57.9 76S,000 50.9 551,600 71.7

136,300 6.0 99,600 6.6 36,500 4.8

● ● * ● * ●

783,700 34.4 61a,ooo 40.9 165,700 21.6

33,000 1.4 22,200 1.5 ● *

Table2. Numbar ofciviiian noninstitutionaiizad paopieage65yeara and ovarandnumbar

ofdischargad home heaithcare patienta per l,WOpopuiation 65yearsofage and overby

sexandage: Unitad States, 1992

IW2 dvilian Number ot 1992

noninstitutionaked home health care

population disdwyedpatiarrts

Sex and age in thousarrdsr par 1,000 pqruIation

Tota165yaars Andover. . . . . . . . . . . . . . 32,283 70.6

60USaexae

6S74yeara . . . . . . . . . . . . . . . . . . . . . 18,480 41.3

75-84years . . . . . . . . . . . . . . . . . . . . . 10,585 S3.8

85yearsandover . . . . . . . . . . . . . . . . . 3,258 144.8

Male

65-74years . . . . . . . . . . . . . . . . . . . . . 8,128 38.2

75-34year3 . . . . . . . . . . . . . . . . . . . . . 4,010 86.2

85yearsandover . . . . . . . . . . . . . . . . . 910 145.7

Female

6S74years . . . . . . . . . . . . . . . . . . . . . 10,3% 45.3

75-84yeara . . . . . . . . . . . . . . . . . . . . . 6,555 107.1

65yearsandover . . . . . . . . . . . . . . . . . 2,349 144.4

%ourswU.8.Bureau oftheC+msus,Cwrent PopulatiorsRepomPZ5-1OS5SMP25-1 104sndunpwblii data.

percent ofelderlywomen were reported

as receiving help in 1-3 ADL’s and 30

percent were reported as receiving help

in 4 or more ADL’s.

The most frequent help received by

elderly menin ADL’s were bathing or

showering (40 percent), walking (37

percent), dressing (36 percent),

transferring in or out of bed or chair

(35 percent), using toilet room

(24 percent), and eating (12 percent).

F@-one percent of elderly men were

reported asreeeiving help inat least one

ADL. One-fourth of elderly men were

reported 86 receiving help in 1–3ADL’s

and 26 pereent received help in 4 or

more ADL’s (table 3).

A significantly greater percent of

elderly women than men were receiving

help doing light housework (38 percent

vs. 30 percent). However, these

differences may be the result of

diiTerences in social roles. ~pically

men perform fewer household chores

than women do and therefore may have

needed Iesa frequent help. Of all elderly

women, 30 percent were reported to

have received help in taking

medications, 29 percent received help in

prepsring meals, and 20 percent received

help with shopping for groceries or

clothes. Over one-fourth of elderly men

received help in taking medications and

less than one-fourth were reported as

having reeeived help in preparing meals.

Every 1 of 5 elderly men was reported

as having received help in shopping for

groceries or clothes. Half of the elderly

men and women did not receive help in

IADL’s. Thirty-five percent of elderly

women received help in 1–3 IADL’s

and 15 percent received help in 4 or
4 Advance Data No. 259 ● March 20, 1995

- Makr = Female

20

5

0

85-74 75-84 85 years

years years and over

Age group

SOURCE Centers for Disease Oontrol, National Center for Health Statistics, National Home end

Hospice Osre Survey, 1891-92.

-.. -

Hgure 1. Percent of elderly men and women home health care discharges who Ihre alonw

United States, 1981-92

Table 3. Number and percent of elderly home health care discharges by activities of daily

living end Instrumental activities of daily living and percent distribution by number of

functional activities for which help was received, according to sex United States, 1991-92

Help with ADL’s arrd MIX’S Bour Femafe Male

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

Received personal help with the following ADL

Bathing orshowering . . . . . . . . . . . . . . . . .

Dressing. . . . . . . . . . . . . . . . . . . . . . . .

EatingI . . . . . . . . . . . . . . . . . . . . . . . . . .

Transfernng in or out of beds or chairs~. . . . . .

Walking . . . . . . . . . . . . . . . . . . . . . . . . . .

Using toilet roomi . . . . . . . . . . . . . . . . . . .

Received persanal help with the number of ADL

Alldepandencies . . . . . . . . . . . . . . . . . . . .

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

One . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Two . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Three . . . . . . . . . . . . . . . . . . . . . . . . . . .

Four. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Five . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sk . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received personal help with the following IADL

Doing lighthousework . . . . . . . . . . . . . . . .

Mansgingmoney . . . . . . . . . . . . . . . . . . . .

Shopping forgrocenes orclothes. . . . . . . . . .

Usingtelephone . . . . . . . . . . . . . . . . . . . .

Preparingmeals . . . . . . . . . . . . . . . . . . . .

Taking medications . . . . . . . . . . . . . . . . . . .

Received personal help with the number of IADL

Aildependencies . . . . . . . . . . . . . . . . . . . .

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

One . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Two . . . . . . . . . . . . . . . . . . . . . . . . . . .

Three . . . . . . . . . . . . . . . . . . . . . . . . . . .

Four. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Five . . . . . . . . . . . . . . . . . . . . . . . . . . . .

six . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,278,300

45.9

41.4

13.5

35.0

39.0

26.8

100.0

44.4

5.6

12.8

9.1

7.5

11.3

9.5

35.4

8.7

20.1

7.1

27.6

28.7

100.0

51.1

17.4

8.9

8.7

6.6

3.7

3.5

1,509,600

Percent

48.8

44.3

14.3

34.8

39.8

27.9

Percentdi~”bution

100.0

42.2

6.0

12.5

9.8

6.0

11.2

10.3

Percent

38.0

9.1

20.3

7.9

29.4

30.0

Percent distribution

100.0

50.0

16.6

9.8

8.5

7.5

4.0

3.7

768,700

40.0

35.7

12.1

36.4

37.3

24.5

100.0

48.7

4.8

12.8

7.6

6.5

11.4

8.1

30.2

7.8

19.9

5.6

24.1

28.3

100.0

53.3

18.9

7.2

9.2

5.0

3.2

3.2

1Includes “unable to do/didn’t do.”

NOTE ~LisaM~tidti~ rting. lADLki~menM atistidai~rMng,

more IADL’s. For elderly men,

35 percent received help inl-31ADL’s

and 11 percent received help in40r

more MIX’s (table 3).

Table 4 shows the percent of elderly

menandwomen homehealthcare

discharge using aids regularly at the

time of discharge or immediately prior

to discharge. The aids most frequently

usedby elderly men and women, other

than eyeglasses, were walkers

(36 percent of men and 41 percent of

women) and canes (21 percentof men

and24percentof women). Even with

aide, one-fourth ofelderly men and

women were reported as having

difficult yinseeing, andone offive

elderly men and women reportedly had

difhdtyinhearing.

Typesofservice

In1992, the most frequent home

health care services used by elderly

discharge (during the Iaat billing

period) were skilled nursing services.

Eighty-five percent ofwomen and

88 percent of men used this service

(table 5). Personal care (41 percent of

women and 35 percent of men), physical

therapy (27 percent of women and

25pcrcent of men), and social services

(12 percent for both sexes) were the

next most frequently used services, by

elderly discharges. All other services,

such aa administering medication,

homemaker and/or companion services,

and occupational and/or vocational

therapy, were less frequently used. There

is apotential inconsistency between the

percent of elderly men and women

reported using peraonal care services

and the percent receiving help with

ADL’s. A smaller percent of elderly

people were reported to have used

personal care services than received help

in ADL’s. The cause of this

inconsistency is not known and should

be investigated.

Length of service

The length of service reeeived by

elderly men and women may reflect the

severity of illness snd the length of time

needed to recover from these illnesses.

Table 6 indicates that for episodes of

care of 4 week or more, there were

significantly more women than men
Advance Data No. 259. March 20, 1995 5

Table 4. Number and percent of elderly discharges 65 years and over from home health

care agencies by functional status and sex United States, 1991-92

Fu&”onal StSfUS1 Female Male

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

Noaids used . . . . . . . . . . . . . . . . . . . . . .

Eyeglasses (including contact lenses) . . . . . . .

Wheelchair . . . . . . . . . . . . . . . . . . . . . . . .

Cane . . . . . . . . . . . . . . . . . . . . . . . . . . .

Walker . . . . . . . . . . . . . . . . . . . . . . . . . .

Crutches . . . . . . . . . . . . . . . . . . . . . . . . .

Brace(anytype) . . . . . . . . . . . . . . . . . . . .

Oxygen . . . . . . . . . . . . . . . . . . . . . . . . . .

Hospitaibed . . . . . . . . . . . . . . . . . . . . . . .

Oommoda . . . . . . . . . . . . . . . . . . . . . . . .

Otheraidsordavicas . . . . . . . . . . . . . . . . .

1,509,600

6.5

92.8

14.9

23.5

41.1

1.2

1.4

5.6

8.3

15.0

12.6

766,700

Percent

7.9

91.8

17.3

21.1

36.0

3.0

●

6.9

12.2

11.2

16.7

Oiicuityinseeing . . . . . . . . . . . . . . . . . . . 24.5 23.8

OiicuHyinhearing . . . . . . . . . . . . . . . . . . . 19.3 23.2

lTypaofakleuead attimeofdxga ofimnrad?atalyprior tad-.

Tabie5.Number and percentofelderly discharges65years andoverfromhome health

csreagenciesby servicesracaived duringthe lastbilling periodandsex: United States,

1s91+2

Servieereceived Female Male

Number

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,509,600 766,700

Skillednumingservices . . . . . . . . . . . . . . . .

Persmalcsre. . . . . . . . . . . . . . . . . . . . . .

Sociilservices . . . . . . . . . . . . . . . . . . . . .

Counseling . . . . . . . . . . . . . . . . . . . . . . . .

Madiions . . . . . . . . . . . . . . . . . . . . . . .

Physicaltharspy . . . . . . . . . . . . . . . . . . . .

Homemaker/companionseM”oas. . . . . . . . . .

Reepitecsre . . . . . . . . . . . . . . . . . . . . . . .

Referralservices . . . . . . . . . . . . . . . . . . . .

Dietaryand nutritionalsewicas. . . . . . . . . . .

Phys”~nsarvices . . . . . . . . . . . . . . . . . . .

Hightechcsre . . . . . . . . . . . . . . . . . . . . .

Ow@ioMltkmW-tionaltiemW . . . . .

Spaechtherapy/audiology . . . . . . . . . . . . . .

Tranefxvtation. . . . . . . . . . . . . . . . . . . . . .

Entarostomaitherapy . . . . . . . . . . . . . . . . .

Mealsonwhsels . . . . . . . . . . . . . . . . . . . .

Otharsewices . . . . . . . . . . . . . . . . . . . . .

65.1

41.2

11.9

3.7

6.7

27.2

5.5

*

1.8

1.8

1.6

●

4.4

2.1

●

●

●

1.4

Percent

87.8

35.2

12.4

3.9

5.5

24.8

2.6

*

2.4

2.0

2.6

●

6.9

2.6

●

●

●

*

Table6. Number and parcentofelderly dIscharges65years and overfrom home health

careagenclesby Iengthofstay, according tosexandstendard erro~United Ststes,

1991-92

Lengthof.stay Female (standarderrw) Male (sandanferrq)

Total . . . . . . . . . . . . . . . . . . . . . . . . . ..1.E08.600 766,700

Averagelength ofstay (days) . . . . . . . . . . . . 102 (6.6) 81 (5.8)

Percantdistribution . . . . . . . . . . . . . . . . . . 100.0 100.0

o-2weeks . . . . . . . . . . . . . . . . . . . . . . . . 17.4 (1.2) 18.9 (1.6)

24weeks . . . . . . . . . . . . . . . . . . . . . . . . 15.6 (1.0) 20.0 (1.8)

4-6weeks . . . . . . . . . . . . . . . . . . . . . . . . 16.6 (1.3) 15.8 (1.5)

6-6waeks . . . . . . . . . . . . . . . . . . . . . . . . 13.0 (1.9) 10.5 (1.3)

8wseksand more . . . . . . . . . . . . . . . . . . . 37.4 (1.8) 34.9 (1.9)

(67percent vs.61percent). The average thatmen generally had3weekaof

length ofsemice for menwas81 days shorter episodes ofcare than women.

and for women it was 102, indicating However, these shorter episodes ofcare

for older men may be the consequences

of their marital statua or living

arrangement. Aa shown earlier, a higher

percent of older men were married or

lived with others. Therefore, they may

have received help from their spouses or

from others and thus needed less help

from the home health care agency.

Primary diagnosis at admission

There were differences between

elderly discharged men and women in

the ranking of primary diagnosis at

admission. Table 7 presents the six most

iiequent primary diagnoaea at admission.

For discharged womew they were

di3ease8 of the circulatory system

(33 percent~ injury and poisonings

(14percentJ diaeaaes of the

musculoskeletal system and connective

tiaaue (11 percfmt~ malignant neoplasms

(8 percent~ endocrine, nutritional, and

metabolic diaeaaea and immunity

disorders (8 percent); and diseaaes of the

respiratory system (7 percent). For

discharged mem they were diseases of

the circulatory system (30 percent~

di8ea8e8 of the respiratory system

(12 percent) malignant neoplasms

(10 percent); injury and poisonings

(10 percent~ endocrine, nutritional, and

metabolic diaeaaea and immunity

disorders (10 percent] and diseases of

the muaculoskeletal system and

connective tissue (8 percent). A

si@cantly higher percent of elderly

men than women were diagnosed as

having diseases of the respiratory

system 88 the primary diagnosis at

admisaion (12 percent vs. 7 percent).

Disposition status

In 1991-9293 percent of older

women and 90 percent of older men

were alive at the time of discharge.

F@-five percent of the older women

and 50 percent of the older men were

discharged becauae they recovered

ancUorstabilized. ‘llventy percent of the

elderly discharges were transferred to

hospital or nursing homes because of

deterioration of their health status. The

fatality rate among older men discharges

was 3 percent higher than older women

discharge (figure 2).
6 Advance Data No. 259 ● March 20, 1995

Table 7. Number and percent distribution of elderly discharges 65 years and over from home health care agencies by primary disgnosis at admission, according to sex United States, 1991-92

ICD-9-CM pmcadura categoiy and code Female Male

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,509,600 768,700

Percent distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0

Infacfious andparasitic diseasea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..00 I–139 * *

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..ILIo+w 8.0 ‘10.6

Malignantnsoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208. 230-234 7.8 10.2

Endocrine, nutritional, sndmetabolic disessesand immunityrfisorders. . . . . . . . . . . . . . . . . . . . . . . . . . ..240-279 7.8

Dabetasmellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..=O

9.5

5.7 6.6

Oiseasesofthebloodandblood-forrning organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..230-289 ● *

Mentaldisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..290+19 1.9 *

Diseasesofthenervoussystemand senseorgans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..320-s89 1.9 4.1

Diseaaesofthecirculatorysystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..390+59 33.3 29.5

Easenfialhyperfension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4oI 4.6

Heartdisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.0

. .391-392.0,3-98, 402, 404,41&n 6,420-429 16.2

Cerebrovasculardiseeae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4~

17.2

7.4 5.1

Oisesaesoftherespiratotysyatem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4so+19 6.9 12.2

Chronicobafrutilvepulmonarydiseaee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..42W126 3.5 6.4

Diseasesofthedigeatiiesystem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ...520-579 5.6 3.6

Diseaaesofthegenitourinarysyatem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...580-629 2.9 3.7

Oiseaaesoftheskinandsubcufanaoustissue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..66rI.-7O9 2.6 3.0

Diseasesofthemusculoakelefalsyafem andoonntiietissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..71o-739 11.1 8.4

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74&75g * *

Symptoms, slgns,and illdefinad condition s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..7sLw799 2.1 *

Injuryandpoisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-9w 13.5 “10.1

Supplementsryclassificafionor unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

* *

m Male ~ Female

10.4

0

Recwered/ Hosp”kalized N#sseg Deceased

stabilized

transfer

SOURCE:Centers forDiseaseControl, NstionalCenterfor HeaithStatistica, NationeJHomeand

HospiceCareSurvey, 1991-92.

Figure 2. Disposition ofelderly men and women home heaith csredischarae~

U~tedStates,1991-92 -

Conclusion

The overall results suggest that

although there are forewomen

discharges than men discharges in each

group, the utilization rate for both sexes

was about the same, particularly in the

85 yeare and over age group. In 1992,

the average length of service for elderly

women was significantly higher than for

their male counterpart3. These longer

episodes of care for elderly women may

be partly related to their living

arrangements. Becauseolderwomen are

more likely than older men to live

alone, they may depend more on home

health care agencies to provide services

for a longer period oftime following an

illness. Consistent with previous

research, this report also found that men

receive fewer services involving ADL

and IADL activities. For example, fewer

elderly men than women received help

withbathingor showering from home

health care agencies. However, this

apparent advantage ofelderly men may

notbetheresult oftruefunctional

differences between gendeq itmaybe

the consequencesof the type ofliving

arrangements. Because more men were

married, they may have received help

from their spouses. Therefore, sex

differences for discharges from home

health care must always be evaluated in

relation to other factors such as living

arrangement and marital status.

References

1.

2.

3.

StrahanGW.Gverviewof home

herdthand hospicecare patienta:

preliminarydata from the 1992

NationalHome and HospiceCare

Survey.Advancedata from vital and

health statistics;no 235. Hyattsvillle,

Maryland NationalCenterfor Health

statistics. 1993.

BrauaP.Whenmom needs help.

AmericanDemographics16(3)38-

47.1994.

Esther H. Characteristicsof elderly

home health patients preliminary

data from the 1992NationalHome

and HospiceCareSurvey.Advance
Advance Data No. 259. March 20, 1995 7

4.

5.

6.

7.

8.

9.

data from vital and health statistiw,

no 247. Hyattsville, Maryland

National Center for Health Statistics.

1994.

Strahan GW. An overview of home

health and hospice care patients

preliminary data from the 1993

National Home and Hospice Care

Survey. Advance data from vital and

health statistic no 256. Hyattsville,

Maryland: National Center for Health

Statistics. 1994.

Institute of Medicine. Toward a

national health care survey, a data

system for the 21st century.

Washington, D.C.: National Academy

Press. 1992.

National Association for Home Care.

Basic statistic about home care.

Information sheet. 1992.

Sirrocco A. Nursing homes and

board and care hom~ data from the

1991 National Health Provider

Inventory. Advance data from vital

and health statisti~, no 244.

Hyattsville, Maryland: National

Center for Health Statistics. 1994.

Haupt BJ, Hing E, and Strahan GW.

The National Home and Hospice

Care Survey 1992 summary.

National Center for Health Statistics.

Vital Health Stat 13(117). 1994.

U.S. Bureau of the Census. Statistical

abstract of the United States: 1993

(l13th edition). Washington, D.C.

1993.

10. Gurrdnik JM, LaCroix AZ, Branch

LG, Kasl SV, and Wallace RB.

Morbidity and disability in older

persons in the years prior to death.

Am J Public Health 81(4}443-447.

1991.

11. Ekhmd D. The agency reporting

system for maintaining the national

inventory of hospitals and

institutions. National Center for

Health Statistics. Mtal Health Stat

1(6). 1968.

12. Massey J’T,Moore IF, Parsons ~

Tadros W. Design and estimation for

the National Health Interview

Survey, 1985-94. National Center for

Health Statistics. Vhal Health Stat

2(110). 1989.

13. Hoffman K. Specifications for

selecting NHHCS sample home

health agencies and hospices.

Unpublished memo. 1992.

Technical notes

Source of data

The sampling frame consisted of

8,859 home health care agencies and

hospices that were identified iu the 1991

National Health Provider Inventory

~~ and the agency reporting system

(ARS). Those agencies that opened for

business before 1991 were identified

through the NHPI and those agencies

that opened for business after the 1991

NHPI survey and before June 30, 1992,

were identiiled through the ARS (11).

The 1991 NHPI is a comprehensive

census of nursing and related care

homes, residential care homes, home

health care agencies, and hospices

conducted periodically by the National

Center for Health Statistics (7).

The sample consisted of 1,500

home health and hospice care agencies.

Of these agencies, 141 refused to

participate, 3 could not be locate& 68

were considered out of scope because

they were not providing hospice or

home health care services to patients at

the time of the survey, and 42 were

either duplicates of other sampled

agencies or had merged with another

hospice or home health care agency at

the time of the survey. A total of 1,246

home health and hospice care agencies

participated in the survey.

The sample design for the 1992

NHHCS is a stratified three-stage

probability design. Primary sampling

units (PSU’S) are selected at the tit

stage, agencies are selected at the

second stage, and current patients and

discharges are selected at the third stage.

The first stage consists of the 198

PSU’S that were used in the 1985-94

National Health Interview Survey

(NHIS), a survey of the civilian

noninstitutionalized population of the

United States (12). The PSU’S are

counties, groups of counties, county

equivalents (such as parishes or

independent cities), or towns and

townships (for some PSU’S in New

England).

The second stage involved the

selection of agencies within six primary

strata of agencies. These strata were

formed in the 1992 sampling frame on

the basis of type of agency (hospices

versus home health care agencies and

mixed agencies (providing both types of

care or unknown)), and type of PSU

(self-representing (SR) versus nonselfrepresenting (NSR), and within NSR

PSU’S: metropolitan statistical area

(MSA) versus non-MSA). (MSA is a

metropolitan statistical area detied by

the U.S. Office of Management and

Budget on the basis of the 1990

Census.) WNin these sampling stra@

agencies were arrayed by four regions,

five types of ownership, two types of

certification status, and the size of the

patient population currently being served

by the agency. The number of agencies

selected horn each sampling stratum

was based primarily on results of

research into the optimum sample

design for the 1992 NHHCS. Hospices

in the NSR PSU’S and home health care

agencies and mixed agencies in the NSR

PSU’S were selected with certainty.

Hospices in the se~-representing PSU’S

and home health care agencies and

mixed agencies in the MS& nonaelfrepresenting PSU’S and the selfrepresenting PSU’S were selected with

probability proportional to the current

patient population size (as reported in

the NHPI sampling hue). A total

sample of 1,500 agencies was

selected-384 were hospices and the

balance were home health care agencies

or mixed agencies (13).

The final stage is a systematic

random selection of six patients

currently served by the agency and six

patients discharged horn care during the

last complete 12-month period.

Data collection procedures

The data collection for the NHHCS

began with a letter sent to all 1,500

sampled agencies informing the

administrator of the authorizing

legislation, purpose, and content of the

survey. Within a week to 10 days after

the letter was mailed, the interviewer

assigned to conduct the survey for a

particular agency made telephone

contact to discuss the survey and to

arrange an appointment with the

administrator or person designated by

the administrator.

Three questionnaires and two

sampling lists were used to collect the

data. Fira~ the Agency Questionnaire

was completed with the administrator or

designee. Then, the interviewer

completed the Current Patient Sampling

List (CPSL) and Discharged Patient

Sampling List (DPSL). With the CPSL,
8 Advance Data No. 259. March 20, 1995

the interviewer listed all patients on the

register of the agency on the evening

prior to the day of the survey. The

DPSL was used to list all discharges

from the agency during the 12 full

months prior to the month of the survey.

Sampling of current patients and

discharges within agencies was done by

using tables showing sets of sample line

numbers for each possible count of

current patients and discharges in the

agency. The interviewer drew a sample

of up to six current patients and up to

six discharges.

After the samples had been

selected, the Current Patient and

Discharged Patient Questiomaires were

completed for each sampled person by

interviewing the stti member most

familiar with the care provided to the

patient. The respondent was requested to

refer to the medical or other records

whenever necessary. No patient was

interviewed directly.

Sampling variability

The standard error is primarily a

measure of the sampling variability that

occurs by chance when only a sample,

rather than art entire universe, is

surveyed. The relative standard error of

an estimate is obtained by dividing

Suggested citation

Dey AN. Characteristics of elderly men and

womendischargedfrom home health care

services: United States, 1991 –92. Advance

data from vital and health statistic no 259.

Hyattsville, Maryland: National Center for

Health Statistics. 1995.

thestandard error by the estimate itself.

The result is expressed as a percent of

the estimate. Relative standard errors for

estimated length of service used are

shown in table 6. Relative standard

errors for other 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 I:

RSE(X) = A + #

Similarly, relative standard errors

for percents 100p (O< p c 1)maybe

calculated using the following general

formula, where 100p is the percent of

interest, X is the denominator of the

percent, and B is the parameter B in the

formula for approximating the RSE(X).

The values for B are given in table I.

B (l-p)

RSE(p) = ~

The tests of significance are based

on the Bonfenoni multiple comparisons

using the Z-test with an overall 0.05

level of sigrMcance to test all

comparisons mentioned in this report.

The critical value of the Z for each test

was determined by the number of

Copyright Information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

variables being compared. Not all

observed differences were tested, so lack

of comment in the text does not mean

the difference was not statistically

significant.

Table L Parameters used to compute

relative standard arrors by type of estimate

Parameters

Type of estimate A B

Home heeith care

agencies

Discharge . . . . . . . . 0.001 Ieo 1310.00

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

National Centar for Health StWsties

Acting Director

Jack R. Anderson

Acting Deputy Oirector

Jennifer R. Madans, Ph.D.

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health statistics m

6525 Belcreat Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALW FOR PRIVATE USE, $3OO

To receive this publication regularly, contact

the National Center for Health Statistics by

calling 301-436-6500

DHHS Publication No. (PHS) 95-1250

5-0165 (3/95)
Number 260 “ February 14, 1995

Advance

Data

FromVi and HealthStatisiks ofthe CENTERS FOR DISEASE CONTROLAND Prevention/Naiional Centerfor Healthstatistics

Contraceptive Use in the United States:

by Linda S. Peterson, M.A., Division of Vital Statistics

Highlights

In the period from 1988 to 1990,

the proportion of women 1544 years of

age in the United States whose partners

were using the condom for their current

method of birth control increased (from

9 to 11 percent), continuing the trend

observed between 1982 and 1988. The

proportion that used the pill declined

slightly horn 1988 to 1990 (from 19 to

17 percent). These trends occurred

disproportionately among young women,

the never-married, and black women.

For example, among never-married

contraceptors, the proportion using the

condom increased from 20 to 30 percent

and the proportion using the pill

declined from 59 to 51 pereent.

Among women 15–19 years of age,

32 percent were using contraception in

both 1988 and 1990. However, among

sexually experienced teens, current

contraceptive usc declined slightly, from

61 to 58 percent. Also, the proportion of

sexually experienced teens who were

sexually active in the past month

without using contraception increased

dramatically (from 8 to 22 percent),

while the proportion that was not

sexually active in the past month

declined dramatically (from 23 to

10 percent). Among U.S. women 15+.4

years of age, in general, there was an

apparent increase in such risk-taking

from 1988 to 1990: the noncontraceptors

as a proportion of women at risk of an

unintended pregnancy increased from 7

to 12 percen~ a trend that occurred

mainly among relatively young women,

never-married women, and white

women.

Data

The lindings in this report are based

on the 1982 and 1988 National Survey

of Family Growth (NSFG) and the

1990 NSFG Telephone Reinterview.

The NSFG is conducted by the

National Center for Health Statistics.

The interview obtains information on a

number of topics related to childbearing,

family planning, and related aspects of

maternal and child health for women

15-44 years of age. For the 1990 NSFG

Telephone Reintemiew, 5,686

women in the noninstitutional

population of the United States were

interviewed by telephone between July

23 and November 5, 1990. Of these,

5,359 were previously interviewed in

1988. The remaining 327 women were

interviewed for the fist time in 1990

because they had turned 15 since March

15, 1988. The design of the 1990 survey

and estimates of sampling variability are

discussed in the Tedmical notes and in

the report by Goksel, Judkins, and

Mosher (l). The methodolo~ for the

NSFG Cycles III (1982) and IV (1988),

which used cross sectional samples is

described in detail in separate reports

(2,3).

Trends in contraceptive status and

in method choice for U.S. women are

important because methods vary in

effectiveness. It is useful to know the

proportion of women who attempt to

prevent pregnancy with both reliable

and less reliable methods. For example,

the average annual failure rate for the

pill is 8 percent, for the condom,

15 percen~ and for periodic abstinence,

26 percent (4). In the NSFG, if a woman

is using more than one metho@ she is

classified as using the one that is most

effective for preventing pregnancy. The

priority order for classification ix

female sterilization%male sterilization,

pill, IUD, diaphragm, condo% foam,

periodic abstinence, withdrawal, douche,

and other.

In this repo~ three different

denominators are used to eakxdate

percentx

1. Percent of all women 1544 years of

age-Estimates of current

contraceptive status are based on

denominators that include all women

15-44 years of age, including those

who have never had sexual

intercourse and those who have

never used a contraceptive method.

It is useful to compare these

pereentagea with similar percentages

from other sources.

~SWICZS.ti

#

*,*

-%

~

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

g Public Health Service

5* Centers for Disease Controland Prevention ‘5%

>

National Center for Health Statistics cm

%!!

%WJ

C~M-m~E#Xl’SOL
2 Advance Data No. 260 ● Februarv 14, 1995

2.

3.

Percent of women at risk of

unintended pregnancy-This group

includes women 1544 years of age

who are using contraception, as well

as women who are not using

contraception who have had

intercourse recently and are not

pregnant, post partum, seeking

pregnancy, or sterile for

noncontraceptive reasons. It is

helpful to track the percentage of

“at risk” women who are not using

a method, since the confounding

effects of changes or differences in

other percentages are removed (for

example, proportions of women who

are pregnant or post partum, seeking

pregnancy, sexually inexperienced,

sexually inactive, or

noncontraceptively sterile).

Percent of contraceptors-The

denominator includes only women

who are cumently using a

contraceptive method. This type of

percentage is useful for analyzing

trends in method choice, without the

confounding effects of different

percentages of women pregnant or

postpartum seeking pregnancy,

sexually inexperienced, sexually

inactive, or noncontraceptively

sterile. The percentages of

contracepting women using each

type of method vary dramatically by

demographic characteristics such as

age, parity, and marital status, as

women’s priorities change over the

life course. For example, young

women are much more likely to use

the pill than older women.

The reported use of contraceptives

does not imply that the methods were

used correctly or consistently. Women

who reported using a method of

contraception were coded as using,

regardless of how consistently they used

it.

Data in this report are shown by

race and Hispanic origin in some of the

tables. Differences between white

women and black and Hispanic women

are often due to lower income and

educational levels of minority women,

their limited access to health care and

health insurance, the neighborhoods in

which they live, and other factors. The

causes of these differences merit fiulher

investigation in future research.

For ease of writing, the phrase

“women used condoms” is sometimes

used in the following text, although it is

clear that their male partners were using

the condoms.

Findings

In 1990, 59 percent of U.S. women

15-44 years of age were using

contraception. The increase in the

percent using contraception that

occurred from 1982 to 1988 (horn 56 to

60 percent of women) did not continue

through 1990. The estimated number of

U.S. women currently using

contraception in the United States also

stayed about the same horn 1988 to

1990, 34.9 million and 34.5 mi~lon,

respectively (table 1) (5). The number or

percent of women “using contraception”

is obtained by adding the

“contraceptively sterile” and the

“nonsurgical contraceptors” in table 1.

Use of the condom continued to

increase between 1988 and 1990 (from

9 to 11 percent), while overall use of

male and female sterilization did not

change significantly and use of the pill

declined (from 19 to 17 percent)

(table 1). In 1990, the leading methods

of contraception among U.S. women

remained female sterilization

(18 percent), the pill (17 percent), and

the condom (11 percent) (table 1).

Information on the use of three new

methods-NORPLANT, the vaginal

pouch (female condom), and DepoProvers—is not available, since the

survey was conducted before they were

introduced in the United States.

About 41 percent of women were

not currently using contraption in

1990. Nonusers include women who

were pregnant or who had been

pregnant less than 2 months before the

interview (pregnant or postpartum,

5 percent), those seeking pregnancy

(4 percent), those who were sterile for

noncontraceptive reasons (7 percent),

and those who were not using

contraception for other reasons (other

nonusers, 24 percent). The category

“other nonusers” includes:

. women who have never had sexual

intercourse (9 percent)

. sexu~ly experienced women who had

not had intercourse in the 1 month

prior to the interview (7 percent)

. women who had had sexual

intercourse in the 1 month prior to

the interview while not using a

method (8 percent).

During the period from 1988 to

1990, the proportion of women 15-44

years of age who had never had sexual

intercourse continued to decline (from

12 to 9 percent). The proportion that

were nonusers of contraception while

sexually active in the month before the

interview increased from 5 to 8 percent,

mainly due to increases among young

women, the never-mamied, and white

women (tables 1–3).

Among current users of

contraception, there was a small increase

in condom use between 1988 and 1990

(from 15 to 18 percent), continuing the

increase from 1982 to 1988 (table 4).

The increase during 1988-90 was

steepest for black women (from 10 to

19 percent). Small increases among

contracepting white and Hispanic

women were not statistically significant

at the 0.05 confidence level. Moreover,

the increase in condom use occurred

mainly among women 15–24 years of

age (for example, from 33 to 44 percent

among contraceptors 15–19 years of

age), and it occurred mostly among

women who had never been married

(from 20 to 30 percent of never-married

contraceptors) (table 4). Thus,

continuing a 1982–88 trend (5), between

1988 and 1990 the use of the conclom

for protection against unintended

pregnancy increased most among groups

most at risk of contracting sexuall:y

transmitted diseases, that is, among

young women, black women, and

never-married women (6).

In addition, among users of

contraception, condom use increased

only within the lowest socioeconomic

group during 1988-90. Among

contracepting women living below

150 percent of the poverty leve~ the

proportion using the condom increased

from 10 percent in 1988 to 15 percent in

1990 (table 5). Condom use also

increased mainly among less educated

women and among childless women

(table 5). Overall, however, the choice
Advance Data No. 260 ● February14,1995 3

Table 1. Number of women 15-44 yearn of age and percent distribution by current contraceptive status and method, according to race

and origin: United States, 1982, 1988, and 1990

[statistics are based on samples of the female population of the United states. See Technical notes for -“metes of sampling variabilii and definitions of terms]

Ail racws end orig!ns’ Hispanic Non-Hispsnic white Non-Hiaparric black

Contraceptive status

and method 19d 1986 1982 1890 1988 1982 1990 1988 1982 1990 1988 1982

Allwomen . . . . . . . . . . . . . . . . . .

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

Steril e . . . . . . . . . . . . . . . . . . .

Surgically sterile . . . . . . . . . . . .

Ccmtrsoeptively sterile . . . . . . .

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

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

Noncontraceptively sterile . . . . .

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

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

Nonsurgically sterile . . . . . . . . . .

Pragnantor postpartum . . . . . . . . .

Seeking pregnancy . . . . . . . . . . . .

Ofhernonuser . . . . . . . . . . . . . . .

Never had intercourse. . . . . . . . .

No intercourse in lest 1 months . . .

Had intermural in last 1 month3 . .

Nonsurgical mntraceptors. . . . . . . .

Pill . . . . . . . . . . . . . . . . . . . . .

IUD . . . . . . . . . . . . . . . . . . . .

Diaphragm . . . . . . . . . . . . . . . .

Condom . . . . . . . . . . . . . . . . .

Periodic abstinence’. . . . . . . . . .

Natural family planning . . . . . .

Wthdrawsd . . . . . . . . . . . . . . . .

Other mathods . . . . . . . . . . . . .

58S61

100.0

32.1

30.2

25.0

17.5

7.5

5.2

5.2

0.0

1.9

5.4

4.0

24.2

9.4

7.0

7.8

34.3

16.9

0.8

1.7

10.5

1.8

W.2

0.8

2.3

57,900

100.0

28.6

28.3

23.6

16.6

7.0

4.7

4.7

0.0

1.3

4.8

3.8

25.1

11.5

9.1

4.5

36.6

18.5

1.2

3.5

8.8

1.4

0.4

1.3

1.9

Number in thousands

54,099 5,500 5,557 4,393 42,966

Percent diatribti.on

100.0 100.0

27.1 27.5

25.6 23.9

t 9.0 20.7

12.9 17.3

6.1 3.4

6.6 3.2

6.3 3.2

*0.3 0.0

1.5 3.6

5.0 7.7

4.2 5.1

26.9 28.3

13.6 16.4

8.3 5.1

5.0 6.8

36.7 31.7

15.6 16.4

4.0 *1.0

4.5 ‘0.8

6.7 8.9

2.1 ●I .9

W3 0.0

1.1 *0.4

2.7 %?.3

100.0

23.2

21.7

18.2

16.0

2.2

3.5

3.5

0.0

*1.5

5.7

4.6

34.3

15.0

12.5

8.8

32.2

16.6

25

w .2

8.9

w .2

●0.3

2.3

w .3

100.0

20.5

18.4

14.0

11.7

%?.3

●4.4

*4.4

0.0

?2.1

7.3

6.4

29.2

14.7

7.7

6.8

36.7

15.3

9.7

%2.4

3.5

%.0

0.0

●I .3

%.5

100.0

32.9

31.2

25.8

16.5

9.3

5.4

5.4

0.0

1.7

5.2

3.7

23.6

8.7

7.2

7.7

34.6

17.3

0.8

1.8

10.3

1.6

W.2

0.6

2.2

42,575

100.0

31.3

29.9

25.1

16.1

9.0

4.8

4.8

0.0

1.4

4.6

3.5

22.7

10.6

8.7

3.4

37.8

16.6

1.0

4.1

9.5

1.4

0.4

1.3

1.9

41,279 7,510

100.0 100.0

28.4 34.0

26.9 31.4

20.0 24.9

12.6 24.1

7.4 W.8

6.9 6.5

6.5 6.4

W.4 WI

1.5 2.6

4.6 5.5

3.8 4.7

25.9 22.1

13.8 7.0

8.2 7.5

3.9 7.6

37.2 33.8

15.1 16.7

3.3 %8

5.3 +t .0

7.5 11.4

2.2 W.7

+Q.4 0.0

1.2 +0.4

2.6 2.8

7,406

100.0

29.4

27.6

21.9

21.4

W.5

5.7

5.7

0.0

1.8

5.2

3.9

26.7

9.7

8.9

8.1

34.9

21.7

1.8

1.1

5.8

1.2

w.1

0.8

2.5

6,825

100.0

23.9

22.3

16.3

15.5

%).8

6.0

6.0

0.0

1.6

5.6

5.5

28.8

10.4

8.7

10.7

35.4

19.5

4.8

1.7

3.3

1.6

W.1

W.7

3.8

‘Inoludss othsr races nat shown sspsrately.

‘For 0.3 percent et h female pepulatbn in 1SS0, contraceptive ststus $+’ssnet aecwtsinsd and imputatbn wss rwt perbmed. Thii group wscspropdorate~ dtibuted acmes sJI cstegofise.

me 3-mOnth clase-hkztion could nc4 be uesd in this snalyeis because the neceswy questions were not ssksd in the 1S93 swvey.

%cludse natural famiiy p!anning and other types of periodii ebsfirtemcs.

of the condom in 1990, as in 1988, was

strongly associated with higher levels of

education and income (table 5).

In 1990, female sterilization and the

pill were the most frequently chosen

methods among contracepting women.

And they were about equally favored,

with 30 percent using female

sterilization and 29 percent using the pill

(table 4). In 1990, approximately 10

million women were contraceptively

sterilizecl-this number did not differ

significantly from the estimate in 1988

(table 1). Female sterilization is most

widely used among older women who

have completed their childbearing. In

1990, over one-half of contraceptors

4044 year8 of age were sterilize~

while only 8 percent of the contraceptors

20-24 yeara of age were sterilized

(table 4). The continued aging of the

baby boom generation (born 1946-64

and 26-44 years of age in 1990) will

probably raise the prevalence of

sterilization as a method choice among

U.S. women in the coming decade.

Women 35-44 yesrs of age as a

proportion of all U.S. women of

reproductive age (15-44) rose from

26 percent in 1982 to 33 percent in 1990

(tables 1 and 2).

Age

The age pattern of method choice

reflects other characteristics that vary by

age, such as marital status and parity.

For example, never-married women

comprise a large portion of women

15–24 years of age, so use of reversible

methods such as the condom and the

pill is more common among women in

this age group than is the use of male or

female sterilization. The prevalence of

condom use for birth control increased

significantly between 1988 and 1990 for

women 15-24 years of age (from 10 to

14 percent) while pill use among this

age group declined (from 30 to

24 percent). For women 25 years of age

and over, there was little change in the

proportions using the pill, the condom,

or sterilization (table 2).

Among women 15-19 years of age,

32 percent were using contraception in

both 1988 and 1990. The data suggest

that there was a rise in the proportion of

teenagem 15–17 years of age who were

u3ing contraception (horn 20 to

24 pxcent) while there was a decline in

use among teenagers 18-19 years of age

(from 50 to 41 percent) (table 4). The

proportion of women 15–19 yeara of
4 Advance Data No. 260 ● February 14, 1995

Table 2. Number of women 15-44 years of age and percent distribution by current contraceptive status and method, according to ege:

United States, 1982, 1988, and 1890

[statistics are based on samples of the female population of the United States. Sea Technical notes for estimates of sampling vanabilii and definitions of terms]

15-24 years 25-34 years 35-44 yeara

Contraceptive siWfs

arrd method 1990’ 1988 1982 18W 1888 1932 1990 1966 1982

Allwomen . . . . . . . . . . . . . . . . . .

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

Steril e . . . . . . . . . . . . . . . . . . .

Surgicaliyaferfle . . . . . . . . . . . .

Contraceptivelyaterile . . . . . . .

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

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

Noncontraceptively aterf[e . . . . .

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

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

Nonsurgicallyaterile . . . . . . , .

Pregnantorpoatpartum . . . . . . . .

Seeldngpregnancy . . . . . . . . . . . .

Othernonuser’ . . . . . . . . . . . . . . .

Neverhad irrtercourae. . . . . . . . .

Nointercourae inlaatl monthz . . .

Hadintercourae inlaatlmonth2 . .

Nonsurgicalcontraceptors. . . . . . . .

Pill . . . . . . . . . . . . . . . . . . . . .

IUD . . . . . . . . . . . . . . . . . . . .

Diaphragm . . . . . . . . . . . . . . . .

Condom . . . . . . . . . . . . . . . . ,

Perfadicabatinences. . . . . . . . . .

Natural family planning. . . . . .

Wdhdrawal . . . . . . . . . . . . . . . .

Otharmathods . . . . . . . . . . . . .

17,637

100.0

3.8

3.1

2.8

2.3

m.5

W).3

%.3

0.0

YL7

7.0

1.8

46.4

26.4

7.7

12.3

41.2

23.9

KL2

W.2

13.9

1.0

WI

W6

1.4

18,592

100.0

3.1

2.4

2.2

1.6

%6

W.2

%3.2

0.0

0.7

5.0

2.7

45.7

30.0

11.4

4.3

43.5

29.7

W.1

1.3

9.5

06

W2

1.5

0.8

20,150

100.0

3.3

2.6

2.4

1.3

*1.1

*0.2

●0.2

0.0

W.7

6.3

3.5

46.6

32.5

10.6

5.5

36.4

23.5

1.4

3.7

5.5

1.2

*o.1

1.2

1.9

., —–L –....

rwmuer mmouaenas

21,728 21,726 19,644

Percent distribution

100.0 100.0 100.0

26.4 27.0 27.9

24.8 26.0 26.4

22.1 23.3 21.5

18.2 16.6 14.8

5.9 6.7 6.7

2.7 2.7 4.9

2.7 2.7 4.6

0.0 0.0 *0.3

1.6 1.0 1.5

7.9 7.6 6.5

7.6 5.6 6.2

17.1 16.6 14.3

2.8 3.6 2.7

7.1 8.2 7.1

7.2 4.8 4.5

41.3 43.0 45.2

22.0 21.6 17.1

*0.4 1.4 6.5

2.3 4.8 6.8

11.0 9.1 7.6

2.0 1.7 2.8

*0.4 *0.5 ‘0.6

*0.6 1.9 1.2

3.0 2.5 3.2

19,016

100.0

64.6

61.1

4S.6

32.9

15.7

12.5

12.5

0.0

3.5

1.2

2.0

12.0

1.3

8.4

4.3

20.1

4.7

1.6

2.4

6.7

1.6

*0.2

*0.5

2.4

17,562

100.0

61.3

58.6

46.7

32.5

14.2

11.9

11.9

0.0

2.7

1.1

2.4

13.5

1.6

7.7

4.2

21.7

3.0

2.1

4.1

7.7

1.8

Yt.4

1).6

2.4

14,305

100.0

60.0

57.2

39.0

26.8

12.2

18.2

17.4

*0.8

2.8

*1.0

2.5

13.6

2.0

6.7

5.1

22.5

2.3

4.2

2.4

7.0

2.6

TI.3

*0.8

3.2

‘The 2-month classification could not be used in this analysis because the necessary que40ne were not asked in the 1990 survey.

‘includes natural famiiy planning and ofher types of periodic sbstinsmse.

age who had ever had sexual intercourse

rose tlom 53 to 55 percent, although this

change was not statistically significant.

Among sexually experienced teens,

current contraceptive use declined

slightly (from 61 to 58 percent).

Meanwhile, the proportion of sexually

experienced teens who were sexually

active in the past month without using

contraception increased dramatically

(from 8 to 22 percent) while the

proportion that was not sexually active

in the past month declined dramatically

(from 23 to 10 percent). These data are

consistent with vital statistics: birth rates

have taken an upward turn for young

unmarried women in the United States

since 1987 (7).

Race

The proportion of U.S. women

currently using the condom as their

most reliable birth control method

increased between 1988 and 1990 (from

9 to 11 percent). Increased use by black

women was mostly responsible for this

overall rise. Condom use among black

women increased from 6 to 11 percent

during 1988-90. Small increases among

white women and Hispanic women were

not statistically significant (table 1).

The data suggest that a larger

proportion of black women were using

female sterilization in 1990 than in 1988

(24 versus 21 percent). The percent

using female contraceptive stenli2ation

remained significantly higher among

black women than among white women

in 1990 (24 versus 17 pereent).

However, the overall prevalence of

contraceptive sterilization-including

both male and female sterilization—

among black and white couples was

very similar, given the more widespread

use among white couples of vasectomy

as a method of birth control. In 1!990,

9 percent of white women reported that

their partners were currently using

vasectomy while only 1 percent of black

women reported this (table 1).

The relative size of the group that

was not using contraception but had had

intercourse in the past month increased

significantly among white women (from

3 percent in 1988 to 8 percent in 1990)

but among black women and Hispanic

women it remained constant (about 8

and 7 percent, respectively) (table 1).

Marital status

Changes in contraceptive status

during 1988-90 were concentrated

mainly among never-married women.

The proportion of never-marned women

who had never had sexual intercourse

decreased horn 32 percent in 1988 to
Advance Data No. 260 ● Februarv 14,1995

Table 3. Number of women 15-44 years of age and percsnt distribution by current contraceptive status and method, according to marital

status: United States, 19S2, 1968, and 1990

[statistics are based on samples of the female population of the United States. S~ Technical notes for estimates of sampling variability and definitions of terms]

Wdowed, dimmed,

Never married Curmntiy mw”ad or separated

Contramptive status

and method 1990’ 1988 1282 1990 1988 1982 19S0 1988 1282

Allwomen . . . . . . . . . . . . . . . . . .

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

Sterile . . . . . . . . . . . . . . . . . . . .

Surgically aterfle . . . . . . . . . . . .

Contraceptively sterile . . . . . . .

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

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

Noncontraceptively sterile . . . . .

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

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

Nonsurgioslly sterile. . . . . . . . .

Pregnsntor postpartum . . . . . . . . .

%akingp mgnsncy. . . . . . . . . . . .

Other nonuser’ . . . . . . . . . . . . . . .

Never had intercourse. . . . . . . . .

No intercourse in last 1 monfhz . . .

Had intercourse in last 1 month2 . .

Nonsurgiesl contraceptors. . . . . . . .

Pill . . . . . . . . . . . . . . . . . . . . .

IUD . . . . . . . . . . . . . . . . . . . .

Oiiphragm . . . . . . . . . . . . . . . .

Condom . . . . . . . . . . . . . . . . .

Periodic abstinensa3 . . . . . . . . . .

Natural family planning . . . . . . .

W~rawal . . . . . . . . . . . . . . . .

Other mathxis . . . . . . . . . . . . .

20,766

100.0

7.1

5.7

4.6

4.1

W.5

1.1

1.1

0.0

1.4

3.4

1.1

50.0

26.4

12.5

tl.1

38.5

2t .7

$04

f’o.3

13.0

0.8

0.0

0.7

1.6

21,058

100.0

5.3

4.3

3.4

2.7

0.7

0.9

0.9

0.0

1.0

2.4

1.3

52.5

31.5

16.0

5.0

36.5

24.7

0.6

2.1

8.2

0.6

*0.1

1.1

1.2

t9,164

100.0

3.2

2.6

1.9

1.3

*0.6

%3.7

*0.7

0.0

*0.6

2.5

1.2

59.7

36.4

15.7

5.6

33.3

t 8.7

1.9

4.7

4.1

*0.9

*0.1

1.2

1.8

Number in thousands

30,561 28,147

Percent distribution

100.0 100.0

46.0 44.0

43.9 42.4

37.3 36.3

23.7 23.4

13.6 12.9

6.6 6.1

6.6 6.1

0.0 0.0

2.1 1.6

7.3 7.1

6.6 6.0

6.6 4.8

0.0 0.0

0.6 0.8

6.0 4.0

33.3 33.0

14.5 15.1

1.0 1.5

2.9 4.6

9.9 10.6

2.4 2.0

W.4 0.6

0.5 1.7

2.1 2.6

28,231

100.0

40.8

33.6

29.5

18.7

10.8

9.3

8.7

W.6

2.0

7.2

6.7

5.0

0.0

W8

4.2

40.0

13.4

4.8

4.5

9.8

3.2

%1.6

~ .2

3.1

7,033

100.0

45.2

42.3

31.4

29.6

*1.6

10.9

10.9

0.0

2.9

3.1

*I .5

24.4

0.0

18.9

5.5

25.8

12.8

●1.4

W.5

5.6

W.4

0.0

W.1

5.0

7,695

100.0

42.6

41.0

31.3

28.2

2.1

9.7

9.7

0.0

1.6

25

2.0

26.6

0.0

21.7

4.9

26.3

14.5

2.1

3.0

3.4

●I .1

m.2

Tr.4

1.8

6,704

100.0

33.1

36.2

21.7

21.8

*1.9

12.5

12.5

0.0

*1.9

%2.6

%?.1

25.6

0.0

19.1

6.5

31.8

15.8

6.4

%7

W8

●I .3

“’0.1

K).3

%3.5

lFor o.7 pWCSmofihS IWSMEWiSd women in lmr ~ “ mswmmt~Adh-wti@ti.m~pm~

~Tha3-m@h clssslfcaticmccwldnotba usedin lhis analysisbecsussths

“ rslydkrrhtsd suoss all csregwb.

nmssaryquestkxrs wersrmtaskal inrhalwoswvsy.

26 percent in 1990. At the same time,

the proportion of never-marned women

who were not using contraception but

were having intercourse increased from

5 percent in 1988 to 11 percent in 1990

(table 3). (See section, Women at risk of

unintended pregnancy.) This

noncontracepting “at risk” group also

increased slightly among the currently

married (tlom 4 to 6 percent).

Mesnwhile, pill use among

never-married women declined from 25

to 22 percent while condom use

increased from 8 to 13 percent. Condom

use among the never-married tripled

from 1982 to 1990 (from 4 to

13 percent).

Women at risk of unintended

pregnancy

In assessing trends in contraceptive

use, the subpopulation “women at risk

of unintended pregnancy” is often

analyzed. This group includes women

who are using contraception as well as

women who are notusing contraception

who have had intercourse recently and

are not pregnan~ post partum, seeking

pregnancy, or sterile for

noncontraceptive reasons. In table 1, the

“at risk” population includes

nonsurgical contraceptors, the

contraceptively sterile, and other

nonusers who had had intercourse in the

last 1 month. Thus, in 1990, 67 percent

of women ages 1544 were at risk of

unintended pregnancy. Taking this “at

risk” group 83100 percent, 12 percent

were not using contraception (that is,

other nonusers who had had intercourse

in last 1 month) (table 1). The nonusers

in the “at risk” group sre considered to

be most in need of family planning

services and have been targeted for

programmatic purposes.

In previous analyaes of

contraceptive trends, other nonueera who

were sexually experienced have been

classified according to whether they had

had sexual intercourse in the previous 3

months rather than in the previous 1

month (5,8,9). However, the 3-month

clasaitlcation could not be used in this

analysis becauae the necessary questions

were not asked in the 1990 survey.

Since information on the incidence of

sexual intercourac in the month prior to

interview is available from all three

surveys (1982, 1988, and 1990), the

l-month criterion is used in this report

for comparative purposes.

It should also be noted that the

question on incidence of sexual

intercourse in the past month is asked

differently in 1990 than it was in 1982
6 Advance Data No. 260 ● February 14, 1995

Table 4. Number of women 15+4 years of age, percent using any method of contraception, and percent distribution of contraceptors by

method, according to age, race and origin, and marital statu= United States, 19S6 snd 1990

[statistics are based on a sample of the female population of the United States. See Technical notes for astimates of sampling variability and definitions of terms]

Number of

Number of women Percent

Age, race, end women in using using any ,4// Feme/e Msfe Periodic

marital status thousands a method method methods sterilization sterilization Pill LID Diaphragm Condom abetinenoal Other

19902

All women . . . . . . . . . . . . . . . . . .

Age

15-19 . . . . . . . . . . . . . . . . . . . .

15-17 . . . . . . . . . . . . . . . . . . .

18-19 . . . . . . . . . . . . . . . . . . .

20-24 . . . . . . . . . . . . . . . . . . . .

25-29 . . . . . . . . . . . . . . . . . . . .

30-34 . . . . . . . . . . . . . . . . . . . .

35-39 . . . . . . . . . . . . . . . . . . . .

4044 . . . . . . . . . . . . . . . . . . . .

Race and origin

Hispanic, . . . . . . . . . . . . . . . . . .

white non.Hispanic . . . . . . . . . . . .

Black non.Hlspanlc . . . . . . . . . . . .

Marital status

Currently mamied . . . . . . . . . . . . .

Oivorced, separated, widowad . . . . .

Never marriad . . . . . . . . . . . . . . .

1980

All women . . . . . . . . . . . . . . . . . .

Age

15-19 . . . . . . . . . . . . . . . . . . . .

15-17 . . . . . . . . . . . . . . . . . . .

1s-19 . . . . . . . . . . . . . . . . . . .

20-24 . . . . . . . . . . . . . . . . . . . .

25-20 . . . . . . . . . . . . . . . . . . . .

30-34 . . . . . . . . . . . . . . . . . . . .

3.%39 . . . . . . . . . . . . . . . . . . . .

40-44 . . . . . . . . . . . . . . . . . . . .

Race and origin

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

Whitenon-l+ispanic. . . . . . . . . . .

Black non-Hispanic. . . . . . . . .

Marital status

Currerdiymamied . . . . . . . . . . . . .

Divorced, separated, w”dowad . . . .

Nevermarriad . . . . . . . . . . . . . . .

58,381

8,463

4,944

3,539

9,154

10,637

11,081

10,111

8,905

5,500

42,86S

7.510

30,561

7,033

20,788

57,eoo

9,179

5,404

3,775

9,413

10,796

10,930

9,5s3

7.889

5,557

42,575

7,408

29,147

7,695

21,058

34,516

2,623

1,165

1,45s

5,065

6,385

7,344

7,13s

5,862

2,856

25,928

4,412

21,606

4,026

8,862

34,912

2,950

1,076

1,874

5,550

6,967

7,437

6,726

5,282

2,799

26,799

4,208

21,657

4,42s

8,826

59.3

31.5

24.3

41.2

55.3

60.0

66.2

70.6

66.9

52.2

60.5

58.7

70.7

57.3

43.0

60.3

32.1

19.9

49.6

59.0

64.5

S6.o

70.2

66.0

50.4

62.9

56.8

74.3

57.6

41.9

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

100.0

1Oi).o

100.0

29.5

0.0

0.0

0.0

8.0

17.4

32.7

44.2

52.0

33.1

27.3

41.0

33.5

62.1

9.6

27.5

*1.5

0.0

%?.4

4.6

17.0

32.5

44.9

51.1

31.7

25.6

37.8

31.4

50.7

6.4

12.6

0.0

0.0

0.0

~ .8

5.0

13.0

19.8

26.5

6.4

15.5

*1.3

19.2

%!.8

*1.1

11.7

%32

0.0

%.4

*1.8

6.0

14.0

19.7

22.2

4.3

14.3

Yr.9

17.3

3.8

1.8

28.5 1.4

52.0 0.0

41.1 0.0

60.7’ 0.0

55.4 W.8

47.3 KL4

23.9 W.9

10.6 3.3

*2.2 *1.8

31.4 ●1.9

28.5 1.3

28.5 ●1.4

20.6 1.4

22.4 %?.5

50.5 %).8

30.7 2.0

58.8 0.0

53.3 0.0

61.9 0.0

68.2 W.3

44.5 ‘1.3

21.5 2.9

5.2 %?.7

3.2 3.7

33.4 5.0

29.5 1.5

38.1 3.2

20.4 2.0

25.3 3.6

59.0 *1.3

2.8

0.0

0.0

0.0

*0.6

2.3

4.7

3.3

3.8

1.5

3.0

*1.6

4.1

*0.9

‘0.6

5.7

*1.0

*0.7

*1.2

3.7

5.5

8.9

7.7

3.9

%?.4

6.6

2.0

6.2

5.3

4.9

17.7

44.0

51.9

37.6

25.3

19.0

15.9

10.3

9.2

17.1

17.0

19.4

14.0

9.7

30.1

14.6

32.8

40.4

28.4

14.5

15.6

12.0

11.8

10.5

13.6

15.2

10.1

14.3

5.9

19.6

2.7

*1.0

%?.2

0.0

2.8

2.7

3.5

3.4

~ .6

3.7

2.7

*I .2

3.5

%6

1.8

2.3

W.6

%).9

‘W.8

*I .7

2.4

2.7

3.0

%2.2

?!?.5

2.3

2.1

2.8

*1.9

*1.3

llncludes nstural famiivdannina and other tvossof oeriodicabtiner-ma

4.6

%0

●4.7

*1.7

5.3

5.9

5.4

5.2

2.9

5.1

4.7

5.8

3.8

9.0

5.5

5.4

4.8

●4.7

●4.9

5.2

7.6

5.5

5.1

3.2

7.1

5.0

5.9

5.6

3.8

5.7

‘Percentages for 1S90-ware cakulated sxcl&ing cases fcs whom contraceptive #atus was rmt szcertained. Overall, mnfrscaptive status was rot ascertained for emiy0.3 pwcanf of U.S. women in

1990.

and 1988. In 1990 respondents were About once aweek . . . . . . ...3 of the NSFG, the following question on

asked the following direct question: Less than once a week . . . ...4 periods of nonintercourse was used to

In the last month, how frequently, on Ornotat all? . . . . . . . . . . . ...5 create the category

average, did you have intercourse? Noncontracepting respondents who For never-pregnant respondents in

Would you say... answered 14 were coded as nonusers 1988:

Five or more times a week. ..1 who had had intercourse in the past Many women have times when they

Two to four times a week. . ..2 month. In contrast, for previous cycles are not having intercourse at all,
Advance Data No. 250 cFebruarv 14,1995 7

Table 5. Number of women 1544 years of age, percent using any method of contraception, and percent distribution of contrsceptore by

method, according to years of school completed, poverty status, and future birth intentions: United States, 196S and 1990

[statisticsare based on a sample of the female population of the United States. See Technical notes for esffrnstes of sarnpIing variability and definitions of terms]

Number of

Number of women Percent

Age, race, and women in using using any Ferrrafe Male Periodk

marital status thousands a method metiod All methods sferikkafion sterili~”on PI! IUD Diaphrsgm Condom abstinence’ Other

19902

Allwomen . . . . . . . . . . . . . . . . . .

Inmme (percent of

poverly level)3

0-149 . . . . . . . . . . . . . . . . . . . .

150-289 . . . . . . . . . . . . . . . . . . .

3C0andover . . . . . . . . . . . . . . . .

Education (yesrs)3

0-11 . . . . . . . . . . . . . . . . . . . . .

12 . . . . . . . . . . . . . . . . . . . . . . .

13andover . . . . . . . . . . . . . . . . .

Children ever born

o . . . . . . . . . . . . . . . . . . . . . . .

1 . . . . . . . . . . . . . . . . . . . . . . .

2 . . . . . . . . . . . . . . . . . . . . . . .

3and over . . . . . . . . . . . . . . . . .

Fertility intentions

Morechildren . . . . . . . . . . . . . . . .

No more children . . . . . . . . . . . . .

19a8

Aflwomen . . . . . . . . . . . . . . . . . .

Income (pereent of paerty level)3

0-148 . . . . . . . . . . . . . . . . . . . .

150-288 . . . . . . . . . . . . . . . . . . .

300 andover . . . . . . . . . . . . . . . .

Education (years)3

0-11 . . . . . . . . . . . . . . . . . . . . .

12. . . . . . . . . . . . . . . . . . . . . . .

13and over. . . . . . . . . . . . . . . . .

Children ever born

o . . . . . . . . . . . . . . . . . . . . . . .

1 . . . . . . . . . . . . . . . . . . . . . . .

2 . . . . . . . . . . . . . . . . . . . . . . .

3and over . . . . . . . . . . . . . . . . .

Fertilii intentions

Morechildren . . . . . . . . . . . . . . . .

Nomore children . . . . . . . . . . . . .

58,381

8,350

13,191

26,368

5,525

17,507

26,631

24,205

10,927

13,385

9,884

25,119

29,405

57,900

10,115

12,134

26,472

7,103

17,564

24,024

25,128

9,906

13,237

9,628

25,374

29,440

34,516

4,958

8,734

16,672

3,351

11,598

16,930

10,451

6,0&3

9,910

8,089

11,770

20,545

34,912

6,081

8,137

17,734

4,276

11,880

15,608

11,057

5,962

10,275

7,598

12,480

20,854

59.3

59.4

66.2

64.0

60.6

66.2

63.1

43.4

55.6

74.0

82.0

47.0

69.9

60.3

60.2

67.1

67.0

60.2

67.5

65.8

44.0

60.4

77.6

78.9

49.1

70.6

100.0

100.0

i 00.0

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

29.5

47.2

38.5

25.1

58.0

38.4

22.3

3.3

13.0

42.3

80.0

Wf.7

49.1

27.5

42.6

34.5

23.5

51.9

34.3

20.7

2.6

14.8

40.5

58.4

0.0

46.1

12.6

6,2

11.8

16.4

6.8

15.7

13.7

4.7

9.6

17.6

19.2

W.2

21.1

11.7

5.2

13.1

15.1

6.9

15.0

12.6

4.6

8.2

16.5

17.8

W.1

19.3

28.5 1.4

24.8 ●1.1

28.6 2.5

27.3 1.0

18.4 ?.7

28.8 ~.1

28.0 1.7

53.0 ‘0.8

34.9 “1.7

16.9 1.7

6.1 *1.5

52.9 W.6

12.5 1.7

30.7 2.0

31.3 3.3

28.6 24

27.8 1.7

22.5 3.8

29.4 1.7

28.7 22

57.9 W.9

37.6 3.0

15.1 22

7.0 26

56.7 1.0

12.9 25

2.8

W.6

1.9

4.2

WL2

1.7

4.6

2.1

4.5

3.7

*1.5

3.0

2.5

5.7

2.3

5.0

8.0

w .3

2.8

10.0

6.6

8.8

5.3

27

7.6

3.7

17.7

14.9

12.9

16.6

11.7

11.0

19.3

28.2

20.7

12.3

8.3

30.8

8.8

14.6

10.2

11.4

14.5

6.4

10.7

16.4

20.2

15.9

12.0

9.0

22.4

9.7

2.7

*1.7

2.3

3.5

*1.1

20

3.7

27

4.1

2.6

*1.7

3.9

1.7

2.3

*1.8

1.7

3.0

*1.6

1.7

3.2

1.8

3.6

2.7

1.6

29

1.6

4.8

3.6

3.5

5.7

%?.2

3.3

6.7

5.2

11.4

3.0

*1.6

7.9

2.5

5.4

3.2

5.3

6.3

5.6

4.4

6.3

5.4

8,1

5.7

3.0

7.4

4.0

‘Includesnaturalfamiiyplanningandothertypeeof pmkdii abstinence.

2Pemsntagesfo+IWO ware caku!atsd excludiwgcases fw wf-iom contraqztive ezatuswas not aecsrWW .evarau, mn&acspwasretus wasnetaw@shsd foronlyo.3 p2rceriofu.s. wmantn

lew.

3Datson sducationandkoine patain on$rto warren 20-44 yearsof age (3ss Osrinkionofterme).

for example, beeause of separatio~ not intercourse at all for one month or

dating anyone, illness, or other more.

reasons. Starting with the most recent For ever-pregnant respondent

time since (January 1982/your first Since your (last pregnancy/

intercourse), please tell me the times, January 1982), were there any

if any, when you were not having times when you were not having

intercourse at all for one month

or more, for example, because of

pregnancy, separatio~ not dating

anyone, illness, or other reasons?

Yes . . . . . . . ..l

No . . . . . . . ...2
8 Advance Data No. 260 ● February 14, 1995

Starting with the most recent time,

what months and years were those?

Responses were entered in the

following type of chart:

From To

f I

Imimr- Y&iv mimli-i?im-

/ I

lmiiili-Y&ir mali-EiF-

/ /

Tmiim-T&F -mimiTzzY

When the month of interview was

recorded as the ending month of a

period of nonintercourse, then the

woman was coded as not having had

sex in the previous one month.

Otherwise, she was coded as having had

sex in the past month. Different question

wordings can bias results, and this issue

deserves further attention.

From 1988 to 1990 there was an

increase in risk-taking among women at

risk of unintended pregnancy: the

proportion of “at risk” women who

were not ccmtracepting increased from 7

to 12 percent. A small decline from1982

to 1988 (from 8 to 7 percent) was barely

significant at the 0.10 confidence level.

The recent increase in risk-taking

has not been uniform across marital

status, age, and race-origin groupings.

Risk-taking has increased most among

the relatively young, the never-married,

and white women. Among never-married

women, the proportion of at-risk women

not using contraception increased from

11 percent in 1988 to 20 percent in

1990. There was liffle change among the

currently married or the formerly

married (computed from table 3).

Among women 15–24 years of age, the

proportion of “at risk” women not

contracepting more than doubled, from 9

to 22 percent (computed from table 2).

While there was little change in

risk-taking for black or Hispanic women

during 1988-90, the proportion of “at

risk” white women who were not using

increased from 5 to 11 percent

(computed from table 1). In 1990 the

level of risk-taking was similar for

black white, and Hispanic women.

Contraceptors

Age, race, marital statris-The

percent of teenaged contraceptive users

who chose the condom rose from 33 to

44 percent between 1988 and 1990

(table 4). The increase amounted to

12 percentage points for teens 15–17

years of age and 10 percentage points

for teens 18-19 years of age, increases

that were significant only at the 0.10

(10 percent) confidence level. At the

same time, pill use declined from 53 to

41 percent for teens 15–17 years of age

(significant at the 0.10 level) while not

changing significantly for those 18-19

years of age. Almost all contracepting

teenagers (96 percent) were using the

pill (52 percent) or the condom

(44 percent) in 1990 (table 4). It is

important to note, however, that oral

contraceptives must be taken as directed

in order to be effective and condoms

must be used consistently and correctly.

Teenagers often do not do so. An

estimated 26 percent of teen users

experience a contraceptive failure during

the first 12 months of use (4). The

estimates in this report do not measure

consistency or correctness of use.

Studies of the consistency of use in

various demographic groups would be

useful.

Among black contracepting women,

female sterilization was the leading

method by far in 1990 and the pill was

second (41 and 29 percent, respectively)

(table 4). Among white contracepting

women, female sterilization and the pill

were equally popular (27 and

29 percent, respectively). Use of the pill

by black women declined sharply from

1988 to 1990, from 38 percent to

29 percent of contraceptors, as condom

use increased from 10 to 19 percent of

black women who were contracepting.

The data for white contraceptors suggest

a slight rise in condom use during the

period, from 15 to 17 percent. Among

Hispanic contraceptors, there were no

significant changes in the proportions

that were using the condom or the pill.

However, the data do suggest that IUD

use declined among Hispanic

contraceptors (from 5 to 2 percent)

(table 4), continuing the sharp decline

from 1982 to 1988 (table 1).

A relatively high proportion of

married women were using

contraception in 1990 (71 percent).

About one-third of married

contraceptors were using female

sterilizatio~ and most of the remainder

were using the pill, male sterilization, or

the condom (table 4). Only 43 percent of

never-married women 1544 years of

age were contracepting in 1990-about

one-half with the pill and another

30 percent with the condom. Among the

never-married contraceptors, there was a

clear trend toward more widespread use

of the condom (from 20 to 30 percent)

and a decline in pill use (from 59 to

51 percent) from 1988 to 1990 (table 4).

Education and income—Educational

attainment is associated with women’s

choice of birth control methods. Among

contraceptors, more educated women are

more likely to use the pill, condom, or

male sterilization, and far less likely to

have had a tubal ligation (table 5). A

variety of factors contribute to these

differentials. More educated women are

more likely to delay childbearing and

are therefore less likely to have had all

the children they want at an early age.

They are therefore more likely to be

using a reversible method such as the

pill. Less educated women are more

likely to have had all the children they

wanted at relatively younger ages, and

thus more likely to choose a more

permanent method of birth control, such

as female sterilization. Interestingly, a

significant increase in condom use

occurred only among the less educated

(that is, those with less than a high

school education) (table 5).

In addition, pill use declined

significantly only among low-income

contraceptors (those whose income was

less than 150 percent of the official

poverty level) while condom use only

increased significantly within this same

group, from 1988 to 1990 (table 5).

Parity and irztent-Preferred

methods of contraception vary by the

parity of the woman and whether she

intends to have a baby in the future. In

1990, 43 percent of childless women

were contracepting, and this percentage

rises with the number of children ever

born, Of women who had had two

children, 74 percent were contracepting.

From 1988 to 1990, a decline in the use

of contraception occurred for women

with one and two children. The

proportion of single-pari~ women who

were contracepting declined from

60 percent in 1988 to 56 percent in
Advance Data No. 260 ● February 14,1995 9

Table 6. Number of women 1644 years of age who had first pramaritsl intercourse at 16-19 years of age during 1960-62,1963-66, and

1966+0, and percent distribution by contraceptive method used at first lntercoursw United States’

Numberof

Race and originand womenin used any Periodio

timingof firstintercourse thousands method Pill condom Wmrawal ahstinencez Other

All races and ongins3

19acl-32......... .......... 3,740 52.9 14.1 28.0 7.5 +0.3 %0

1963-May 1988 . . . . . . . . . . . . . . 8,603 67.5 10.8 45.6 9.2 %5 *I.3

June 1936-Nwember 1990. . . . . . . 3,428 71.2 10.5 55.0 %2.6 %?.4 +’0.7

Wie non-Hispanic

1960-62 . . . . . . . . . . . . . . . . . . . 2,698 54.9 14.0 26.3 8.3 W.3 %.0

1983-May 1988 . . . . . . . . . . . . . . 4,829 71.6 9.6 49.3 10.2 W.5 *1.7

June 1933-Novembsr 1990. . . . . . . 2,409 75.7 10.9 58.2 K3.6 %.4 W.5

Black non-Hispsnic

1960-62 . . . . . . . . . . . . . . . . . . . 593 57.2 21.1 28.7 *4.4 W.3

1963-May 1968 . . . . . . . . . . . . . .

*1.7

1,023 60.3 20.1 36.0 %3.3 %).9 0.0

June 1933-November 1860. . . . . . . 506 63.8 *I 2.9 47.8 W.6 0.0 %2.5

Hispanic

1930-62 . . . . . . . . . . . . . . . . . . . 2ai 31.8 %9 q6.8 %.2 0.0 %2.9

19S3-May 1988 . . . . . . . . . . . . . . 587 46.9 *4.3 34.6 *10.0 0.0 0.0

June 1968-Novembw 1960. . . . . . . 332 67.3 %).1 58.2 0.0 0.0 0.0

‘Data for 19s0-s2 end 1SSS-SS we from Cyc!e IV. Dsts for 1SSS-90 srs from the lSEOTelepkms Reh3smAew.

‘Includes natural fsrniiy phmicg and orher types of pedodii abstinsmcs.

3AII recee and oifgins Includes non-Hwio worsen of other races.

1990; for two-parity women, the decline

was from 78 to 74 percent. The use of

contraception increased among women

with three or more children, from 79 to

82 percent, The larger the woman’s

family, the greater the propensity for her

to be using more permanent methods

such as female or male sterilization for

contraception and the less likely she is

to be using the pill or the condom

(table 5). Condom use increased

significantly for both childle~ and

single-parity women during 1988-90

(table 5).

The most important determinant of

method choice is fertility intentions. Of

women who did not intend to have any

more births, 70 percent were using

contraception in 1990; more than

two-thirds of these were using either

female or male sterilization. Of women

intending more children, the picture is

extremely different. Only 47 percent

were contracepting at all, and among

these, more than one-half were using the

pill and almost a third were using the

condom (table 5).

Use of contraception at first

intercourse among teens

The use of contraception at first

intercourse has increaaed significantly

since the early 1980’s. Among women

having their tirst intercourse premaritally

at 15–19 years of age during 1988-90,

71 percent reported using a method.

This compares with 53 percent of

women who had their fist intercourse

premaritally at 15–19 years of age

during 1980-82. This increase in the use

of contraception at first intercourse is

mainly attributable to rising condom

use, from 28 to 55 percent.

Concomitantly, the proportion of women

who used the pill, withdrawal, and other

barrier methods declined slightly

(table 6).

A large increaae in condom use at

first intercourse occurred among blat@

white, and Hispanic women during the

1980’s, but was most pronounced for

Hispanic women. Among Hispanic

women having their first premarital

intercourse at 15–19 years of age during

1980-82, only 17 percent used a

condom, among similar Hispanic

women having their iirst intercourse in

1988-90, 58 percent reported condom

use, more than a threefold increase.

Among women having their tirst

intercourse in 1988-90, white and

Hispanic women reported higher levels

of condom use at ii-at intercourse (both

58 percent) than black women

(48 percent), but the difference between

Hispanic and black women was not

statistically signilkant. The difference

between black and white women was

only significant at the 0.10 level of

confidence (table 6).

Some caution should be used in

interpreting these data when they are

collected at two different pointe in time.

Cognitive survey research has shown

that some respondents will incorrectly

report a behavior in order to appear to

have behaved in a socially acceptable

manner. In the latter half of the 1980’s,

the benefit of using the condom as a

preventive measure against the spread of

the AIDS virus and other sexually

transmitted diseases was widely

publicized. Thus, perceived social

desirability of using a condom for

diseaae protection may have increased.

A cohort approach to analyzing the 1982

and 1988 NSFG data acts provides some

evidence that condom use at first

interccmme may have been overreported

in 1988. For black women whose first

premarital intercmuse occurred during

the period 1980-82, the reported level

of condom uae was higher in the NSFG

Cycle IV (1988) than in Cycle III

(1982). A similar difference was found

for black women whose fist intercourse
10 Advance Data No. 260 ● Februarv 14, 1995

occurred 1975–79 (10). In table 6 of the

present report, the estimates for 1980-82

and 1983-88 are based on the data

collected in 1988 (Cycle IV), while the

estimates for 1988-90 are based on data

collected in 1990 (telephone

reinterview). It is possible that the

amount of social desirability bias may

have increased between 1988 and 1990,

so comparisons of condom use among

black women between the 1988 and

1990 survey should be interpreted with

caution.

Consistency of use

Whether or not a method is

effective in preventing pregnancy or

sexually transmitted diseases depends on

the consistency and correctness of use

of the method, as well as the

effectiveness of the method given

perfect use. Information on the

consistency of condom use for

pregnancy prevention and disease

prevention has been published in a

previous Advance Data (11). In 1990,

respondents who reported that they had

used condoms to avoid getting sexually

transmitted diseases in the last 3 months

in which they were having intercourse,

were asked:

Did you and your partner use condoms

to avoid getting diseases such as

genital herpes, gonorrhea, or AIDS

every time you had intercourse, on

most occasions, about half the time, or

less than half of the time?

A similar question was also asked of

respondents who reported using the

condom or other coitus-dependent

method for contraception in the past

month:

Did you (and your partner) use

[METHOD] every time you had

intercourse, on most occasions, about

half of the time, or less than hrdf of

the time?

It was found that over one-half of

sexually active women 1544 years of

age who were using condoms for

contraception in 1990 used

inconsistently-that is, not every time

they had intercourse. Among users of

the condom for disease prevention,

almost two-thirds used inconsistently.

Thus, condom use was apparently more

consistent when the purpose of use was

contraception. Considering current users

of the condom for either contraception

or disease prevention, an estimated

56 percent reported not using it every

time they had intercourse. Race and

marital status are more important

predictors of condom use for disease

prevention than condom use for

contraception. Black women and

unmarried women are much more likely

to be using the condom for disease

prevention than other women (11).

An examination of women in 1990

who used only the condom for birth

control in the past month showed that

44 percent of condom users used them

inconsistently. About 42 percent of

women using a single coitus-dependent

method (for example, condom,

diaphragm, jelly-cream, foam,

suppository) in the past month used

them inconsistently (12).

Comparisons with other data

Some of the results on contraceptive

use among U.S. women from the 1990

NSFG telephone reinterview differ

substantially from published results of

the Ortho Annual Birth Control Survey

conducted by Ortho Pharmaceutical

Corporation (13-16). There are

methodological reasons for the

differences, starting with sample

selection. While the NSFG uses a

nationally representative sample, the

Ortho study does not. It uses a listing of

households that agreed to respond to

periodic surveys conducted by a

marketing research firm. The Ortho

study especially underrepresents women

with incomes over $50,000, minority

women, and unmarried women (15).

Interviewing procedures and survey

response rates vary markedly in the two

surveys. The Ortho survey uses mailed

questionnaires. In 1992, 63 percent of

the sample respondet 79 percent of

married women and 50 percent of

unmarried women (about 7,000 women

altogether) (15). In 1991, the response

rate was similar at 62 percent (13). The

NSFG has traditionally sent interviewers

into the homes of respondents for

in-person interviews. In the 1988 NSFG,

in-home interviews were completed with

8,450 women, representing a response

rate of 80 percent. For the 1990 NSFG

telephone reinterview, the 1988

respondents were reinterviewed by

telephone and a sample of teens 15-17

years of age was interviewed for the

first time by telephone. The response

rate for the reinterview sample was 69

percent, while the response rate overall

was 67 percent, reflecting the lc~werrate

for teenagers 15–17 years of age.

The NSFG estimates reflect

adjustments for nonresponse bias, while

the Ortho survey estimates do not.

Sample weights in the 1990 NSFG were

adjusted for nonresponse, using

information available on the

characteristics of the

nonrespondents-including mobility

status, race, Hispanic origin, education,

income, marital status, parity, and other

socioeconomic characteristics (3). The

weights were subsequently adjusted to

U.S. population control figures provided

by the U.S. Bureau of the Census. In the

Ortho survey, responses were weighted

to reflect the age, marital status, and

geographic distributions of U.S. women

according to Census Bureau estimates

(15). Thus, the NSFG estimates should

be representative of the U.S. female

population while the Ortho survey

estimates may not be adjusted for

response bias by such important factors

as parity, race, education, and income.

Finally, the percentage distributions

from the two surveys are not directly

comparable because of different

approaches to coding current

contraceptive status. The NSFG measure

of “current contraceptive status, ” which

is used to track national trends in

contraceptive use, is based on a priority

scheme for coding methods according to

“effectiveness.” In the NSFG, when a

woman is using more than one method,

only the most effective method is

assigned to her. For instance, iEthe

woman is using the pill and thle

condom, she would be coded as a pill

user since the pill is more effective for

preventing pregnancy than the condom

(4). The priority scheme for all methods

in the NSFG is as follows: female

sterilization, male sterilization, pill,

IUD, diaphragm, condom, foam,

rhythm, withdrawal, douche, and other.

The Ortho study, on the other hand,

presents tabulations of multiple method

use. A respondent using the pill and the
Advance Data No. 260 ● February 14, 1995 11

condom is coded both as a condom user

and a pill user, and the percentage

distribution of contraceptors, by method,

sums to over 100. In the 1992 Ortho

study, current contraceptors were using

1.3 different methods on average (15).

This difference in coding practice will

particularly raise proportions of women

using the condom and other coitusdependent methods in the Ortho survey

relative to levels in the NSFG, but

should not much affect levels of use of

the pill or sterilization since they were

given priority coding in the NSFG.

Key differences in the results of the

two surveys are:

1.

2.

l%e pro~rtion of women at risk of

unintended pregnancy is lower in the

NSFG-The NSFG shows a smaller

proportion of women at risk of

unintended pregnancy (67 percent in

the 1990 NSFG and 65 percent in

the 1988 NSFG compared with

77 percent in the 1992 and

72 percent in the 1987, Ortho

survey). The difference is due to

smaller proportions of women in the

Ortho study who have never had

sexual intercourse, who are pregnant

or seeking pregnancy, and who have

intercourse so infrequently that they

claim they do not need a method

(the counterpart of the NSFG

category “no sex in the past month”

in table 1). These differences are

largest for unmarried women for

whom the response rate in the Ortho

survey was just 50 percent

(computed from tables 1 and 3) (15).

The propo~”on of “at risl? women

who were not using contraception

was higher in the NSFG-The Ortho

survey produces a lower estimate of

the proportion of “at risk” women

who are not contracepting. The 1992

estimate in the Ortho survey is

6 percent (15). According to the

1990 NSFG, 12 percent of “at risk”

women were noncontraceptors, when

“at risk” noncontraceptors is defied

as women who had intercourse in

the past month while not

contracepting, who were neither

pregnan$ nor postpartum, nor

seeking pregnancy, nor sterile for

noncontraceptive reasons (computed

from table 1).

3.

4.

5.

Lower levels of condom use in the

NSFG, especially among the

unmarried—About 25 percent of

women at risk of unintended

pregnancy were using the condom in

the Ortho survey in 1992, either by

itself or with another method (15).

The percent of “at risk” women

whose partners used the condom in

the 1990 NSFG telephone

reinterview was 16 (computed from

table 1). This dilTerence in condom

use is most pronounced for

unmarried women (computed from

table 3). Some of the dfierence

would be attributable to the diiTerent

coding schemes for current method

as described previously.

Lower levels of oral contraceptive

use in the NSF&In the Ortho

survey, pill use increased from 1988

to 1990 (from 24 to 26 percent of

women 15-44 years of age,

amounting to an estimated 14.9

million pill users in 1990) (16).

However, the NSFG finds lower

levels of pill use and a flat or

slightly downward trend in pill use

during 1988-90, from 19 to

17 percent (or 9.9 million women in

1990) (table 1). Data on pill use

among unmarried women from the

two surveys are especially divergent.

The 1990 NSFG estimates that

40 percent of never-married and

20 percent of formerly married

women at risk were using the pill

(computation based on table 3). In

the Ortho survey in 1992,52 percent

of unmarried “at risk” women were

pill users (15). The divergent coding

schemes for current contraceptive

method would have little impact on

the estimates of pill use from the

two surveys in the NSFG, only the

few pill users who were also using

male or female sterilization would

notbe coded as pill users. Due

almost entirely to the other

methodological differences described

previously, the NSFG shows much

lower levels of pill use than the

Ortho survey.

l%e proportion of oral contraceptors

at%o using the condom is ibwer in

the NSFG-Apparently, 29 percent

of pill users in the 1992 Ortho

survey said they were also using the

6.

condom (15). In the 1988 NSFG,

only 3 percent of current pill users

reported that they were also using

the condom (data not shown in

tables). Although condom use among

pill users is likely to have increased

between 1988 and 1992, the

percentage is not likely to have

increased tenfold.

Higher rates of female sterilization

in the NSFG-The 1990 NSFG

shows a greater prevalence of female

sterilization among “at risk” women

than does the 1992 Ortho survey (26

versus 19 percent); most of this

diiYerenceis attributable to higher

rates among the unmarried in the

NSFG, especially the formerly

married (computed tlom tables 1 and

3) (15),

References

1.

2

3.

4.

5.

6.

7.

Goksel H, Judkins DR, Mosher WD.

Nonresponse adjustments for a

telephone followup to a national

in-person survey. J Officiat Stat

8(4):417-31. 1992.

Bachrach CA Horn MC, Mosher

WD, Shimizur I. National Survey of

Family Growth, Cycle IIk Sample

design, weighting, and variance

estimation. National Center for

Health Statistics. MM Health Stat

2(98). 1985.

Judkins D~ Mosher WD, Botman S.

National Survey of Family Growth:

Design, estimation and inference.

National Center for Health Statistics.

Vital Health Stat 2(109). 1991.

Jones EF, Forrest JD. Contraceptive

failure rates based on the 1988

NSFG. Family Planning Perspectives

24(1):12-9. 1992.

Mosher WD, Pratt WF. Contraceptive

use in the United States, 1973-88.

Advance data from vital and health

statistiw, no 182. Hyattsville,

Maryland: National Center for Health

statistics.1990.

Ad SH, Holmes KK. Epidemiology

of sexual behavior and sexually

transmitted diseases. k Holmes K&

Cates W, Lemon S~ Stamm WE,

eds. Sexually transmitted diseases. 2d

cd. New York McGraw-Hill. 1990.

National Center for Health Statistics.

Advance report of iinal natality

statistics, 1991. Monthly vital

statistics repo@ VOI42 no 3 Supp.
12 Advance Data No. 260 ● February 14, 1995

8.

9.

Hyattsville, Maryland: Public Health

Service. 1993.

Mosher WD. Contraceptive practice

in the United States, 1982-88.

Family Planning Perspectives

22(5):19&205. 1990.

Bachrach CAj Mosher WD. Use of

contraception in the United States,

1982. Advance data from vital and

health statistics; no 102. Hyattsville,

Maryland: National Center for Health

Statistics. 1984.

10. Unpublished table horn the 1982 and

1988 Nationaf Survey of Family

Growth. National Center for Health

Statistics. 1992.

11. Mosher WD, Pratt WF. AIDS-related

behavior among women 15-44 years

of age: United States, 1988 and

1990. Advance data from vital and

health statistis, no 239. Hyattsville,

Maryland National Center for Health

Statistics. 1993.

12. Peterson L-S,London IQ Abma JA.

Determinants of inconsistent use of

coitus-dependent contraceptives

among U.S. womerx 1990. Paper

presented at the annual meeting of

the Population Association of

America, May 7, Miami. 1994.

13. Wrdl Street Joumrd. Use of birth

control pill surges in U.S. Section:

Technology and Health. 1991.

14. Mishell DR Jr. Contraceptive use,

preferemxs, rmd attitudex Results of

a recent study. In: The Best of

Dialogues in Contraception. Los

Angeles: University of Southern

California School of Medicine and

Ortho Pharmaceutical Corporation.

1992.

15. Forrest JD, Fordyce RR. Women’s

contraceptive attitudes and use in

1992. Family Planning Perspectives

25(4). 1993.

16. Ortho Pharmaceutical Corporation.

1991 TWenty-l%ird Ortho Annual

Birth control Study. 1991.

17. U.S. Bureau of the Census. Poverty

in the United States, 1987. Current

population reports; series P-60, no

163. Washington: U.S. Department of

Commerce. 1989.

18. U.S. Bureau of the Census. Poverty

in the United States, 1988 and 1989.

Current population reports series

P-60, no 171:354-6, especially

tableA-3. Washington U.S.

Department of Commerce. 1991.

Technical notes

Survey design

The National Survey of Family

Growth (NSFG) is a periodic survey

conducted by the National Center for

Health Statistics (NCHS) to collect data

on fertility, infertility, contraception and

related aspects of maternal and infant

health. Fieldwork for Cycle IV was

conducted in 1988 and the NSFG

telephone reinterview was conducted in

1990. The contractor for the 1988 and

1990 surveys was Westat, Inc., of

Rockville, Maryland.

For the 1988 NSFG, personal

(face-to-face) interviews were conducted

between January and August of 1988

with a national sample of women who

were 1544 years of age as of March

15, 1988. Interviews were completed

with 8,450 women in 1988, including

2,771 black women, 5,354 white

women, and 325 women of other races.

The sample for the 1988 NSFG was

selected horn households that had

participated in another NCHS survey,

the National Health Interview Survey

(NHIS) between October 1985 and

March 1987. Respondents were

interviewed by trained female

interviewers.

The interviews covered the

woman’s pregnancy history; her past

and current use of contraception, her

ability to bear children; her use of

medical services for contraception,

infertility, and prenatal care; marriage

and cohabitation; and a wide range of

social, economic, and demographic

characteristics. More detailed

information on the procedures used in

selecting the sample, weighting the data

to make national estimates, and

estimating sampling errors may be

found in two other publications (1,3).

For the 1990 NSFG telephone

reintewiew, 5,686 women were

interviewed by telephone between July

23 and November 5, 1990. Interviews

were conducted by telephone with 5,359

women who were previously

interviewed in 1988 and with 327

first-time respondents who had become

15 to 17 years of age in the 2 years

since the main study. The response rate

for the initial interviews of the teens

15–17 years of age was 53 percent. The

response rate for the 1744-year-olds

initially interviewed in 1988 was

69 percent of those originally

interviewed in 1988. Overall, the

response rate was 67.5 percent. The

most common causes of nonrespcmse in

1990 were inability to locate or contact

the respondent became she had moved

and inability to contact her because she

had no telephone or had an unpublished

telephone number. The 1990

reinterviews lasted an average of 20

minutes.

The 1990 sample was divided

equally into two “half-samples” which

were administered some core questions

in cornmou as well as selected modules

of questions that were limited to one or

the other half sample. This report is

based on the results of the two half

samples combined. The data have been

weighted to be representative of the

population of the United States.

Weighted estimates of the percentage

distribution of U.S. women by current

contraceptive status, based on each half

sample alone, were obtained as an

indicator of the reliability of estimates

of variables that are available from a

single half sample. The separate

estimates are similar. For example,

based on Half Sample I alone,

17.3 percent of U.S. women were using

female sterilization in 1990. According

to data from Half Sample II,

17.5 percent of U.S. women were using

this method.

In this repor4 women 15-19 years

of age are excluded from tabulations by

education because it generally takes

until about age 19 to reach the “ 13

years or more” education categctry.They

are also excluded from tabulations by

income because it is generally difticult

Table L Estimates of the parameters A and

B for estimating standard errors for

psrcente of women, by race, from the Full

Sample of the 1990 National Survey of

Family Growth Telephone Relntenriew

Parameter’

Race A B

All races . . . . . . . . . -.0002244 13,100

Whie or other. . . . . . -.0002592 13,100

Black . . . . . . . . . . . -.000W 77 7,200

‘A. interceptand B = slope.
Advance Data No. 260 ● Februarv 14.1995 13

Table IL Standard errors for pereenta of women of all races: 1980 National Survey of

Family Growth Telephone Reinterview-Full Sample

Estimated percent

Base of persant 5 or 95 19 or 90 20 or 80 30 or 70 400r80 50

500,000 . . . . . . . . . . . . . . . . . . . %.5 ●4.9 ●6.5 7.4 7.9 8.1

1,000,000 . . . . . . . . . . . . . . . . . . %?.5 %4 4.6 5.2 5.6 5.7

5,000,000 . . . . . . . . . . . . . . . . . . 1.1 1.5 2.0 2.3 2.5 2.6

10,000,000 . . . . . . . . . . . . . . . . . 0.8 1.1 1.4 1.7 1.8 1.8

30,000,000 . . . . . . . . . . . . . . . . . 0.5 0.6 0.8 1.0 1.0 1.0

50,000,000 . . . . . . . . . . . . . . . . . 0.4 0.5 0.6 0.7 0.8 0.8

Table Ill. Standard errora for percents of black women: 1990 National Survey of Family

Growth Telephone Reinterview-Fuli Sample

Estimated pement

Base ofpemant 5W95 190r S@ 2oorso alor70 400r80 50

100,000 . . . . . . . . . . . . . . . . . . . %.8 %0 *1 0.7 *1 2.3 *1 3.1 13.4

500,000 . . . . . . . . . . . . . . . . . . . %?.6 %3.6 4.8 5.5 5.9 6.0

1,000,000 . . . . . . . . . . . . . . . . . . *1.8 2.5 3.4 3.9 4.2 4.2

5,000,000 . . . . . . . . . . . . . . . . . . 0.6 1.1 1.5 1.7 1.9 1.9

7,500,000 . . . . . . . . . . . . . . . . . . 0.7 0.9 1.2 1.4 1.5 1.5

for teenagers to accurately report the

income of their parents and because

income was not collected from the

young women (15–17 years of age) in

the 1990 Telephone Reinterview Teen

Supplement.

Reliability of estimates

Because the statistics presented in

this report are based on a sample, they

may difter from the statistics that would

result if all 58 million women

represented by the survey had been

interviewed. The standard error of an

estimate (for example, a percent) is a

measure of such di3!erences. The

standard error of an estimated number

or percent is calculated by substituting

the appropriate values of A and B from

table I in the following equations:

SE(N) <(A+13/N’)”iV’

and

SE (P)= d (B”P’” (loo -P’)/x’)

whereN‘ - the number of women

P‘ - the percent

X‘ - the number of women in the

denominatorof the percent

The parameters shown in table I

were used to generate table If, which

shows estimates of standard errors for

percents of women of all races, and

table HI, which shows the standard

errors for black women. The chances are

about 68 in 100 (about 2 out of 3) that a

sample estimate would Ml within one

standard error and about 95 in 100 that

it would fall within two standard errors

of a statistic computed from a complete

count of the ~pulation represented by

the NSFG.

Unless otherwise specified,

differences between percents discussed

in this report were found to be

statistically significant at the 0.05 level

using a two-tailed normal deviate test

(z-test). This means that in repeated

samples of the same type and size, a

difference between the percents in the

population as large as the one observed

would occur in only 5 percent of the

samples if there were, in fac~ no

difference. Statements using the phrase

“the data suggest” indicate that the

difference was significant at the 0.10

level (10 percent) but not the 0.05 level

(5 percent). Lack of comment in the text

about any two statistics does not mean

that the difference was tested and found

not to be significant.

Statistical differences between

NSFG 1988 and 1990 percentage

estimates were teated assuming that the

estimates were not correlated, although a

positive correlation likely occurs as the

1990 NSFG sample was a followup of

the 1988 sample. In this situation the

statistical test is conservative.

The relative standard error (or

coefficient of variation) of a statistic is

the ratio of the standard error to the

statistic and usually is expressed as a

percent of the estimate. In this report,

percents and other statistics with relative

standard errors of 30 percent or huger

are indicated with an asterisk (*). These

estimates may be viewed as unreliable

by themselves, but they may be

combined with other estimates to make

comparisons of greater precision.

Statistics in this report may also be

subject to nonsampling error, that is,

errors or omissions in responding to the

iuterview, in recording answers, and in

processing data. The data have been

adjusted for nonresponse and adjusted to

independent control totals obtained from

the U.S. Bureau of the Census. These

adjustments reduce most types of

nonsarnpling error. Other types of

nonsampling error were eliminated by a

series of quality control procedures.

Definition of terms

Current contraceptive status

Steril+A currently married woman

was classified as sterile under the

current contraceptive status classification

if she reported that it was impossible for

her to have a baby, or her husband to

father a child for any reason, including

sterilization operations or other causes.

An unmarried woman was classified as

sterile if she reported that it was

impossl%le for her to have a baby or if

her current method of contraception was

male sterilization.

Nonsurgr.cal-A woman or couple

was classified as nonsurgically sterile if

she reported that it was impossible for

her to have a baby, or impossible for her

husband to father a child, for any reason

other than surgical sterilization.

Nonsurgical reasons for sterility include

menopause, stefity from accident,

illness, congenital cause3, or

unexplained inability to conceive.

Surgical-A woman (or couple)

was classified as surgically sterile if she

or her husband were completely sterile

due to an operation.
14 Advance Data No. 260 ● February 14, 1995

Surgical sterilizations were

classified as contraceptive or

noncontraceptive because, while most

are obtained because of their

effectiveness in preventing pregnancy,

some are obtained for therapeutic

reasons. This classification in successive

cycles of the survey has been tiected

by changes in the wording of questions.

In the 1973 (Cycle I) survey, a

sterilizing operation was classified as

contraceptive if the respondent answered

“yes” to the question “Was the

operation done at least partly so that

you would not have any more

children?” However, since all

sterilization operations are contraceptive

in effect, though not by intention, this

question was ambiguous; for example,

this question classified many

hysterectomies as “contraceptive.” In

1976 the question was revised to reflect

more clearly the motive of family

limitation, asking: “Was one reason for

the operation because you had all the

children you wanted?” This question

resulted in a lower proportion of

hysterectomies reported as contraceptive,

but it also resulted in lower proportions

of other operations reported as

contraceptive-because it excluded

women who would have liked more

children, but for whom pregnancy would

be a health risk. This problem was

investigated in the 1982 survey and

rectified in the 1988 survey. The figures

for 1982, 1988, and 1990 are highly

comparable. In this report,

noncontraceptive operations in 1982 and

1988 are those for which the respondent

reported that the main or only reason for

the operation was “medical problems

with my female organs (such as

infections, cancer, etc.). ” All other

operations were classified as

contraceptive, in its literal sense, to

prevent pregnancy, regardless of why

she wanted to prevent pregnancy.

Reasons for contraceptive operations in

1982, 1988, and 1990 included the

following: she had all the children she

wanted, or wanted none; her husband

wanted no more; a pregnancy would

have been dangerous to her health; she

could not carry the pregnancy to terny

she could not afford or take care of

more children; or she did not like her

previous method of birth control. The

data on the contraceptive intent of

sterilization operations for 1973 may not

be perfectly comparable to those in

1982, 1988, and 1990 because the later

surveys contained these explicit answer

categories for reasons for sterilizations

while the 1973 question did not. It is

not clear how women who had

operations because pregnancy would be

dangerous to their health would have

answered the question in 1973.

It should be noted that the estimates

of male contraceptive sterilization show

the number of women relying on this

method, and not necessarily the number

of men who have been sterilized for

contraceptive reasons.

Pregnant-A woman was classified

as pregnant if she answered “yes” to

the question, “Are you pregnant now?”

or for those in doubt, “Well, do you

think you are probably pregnant or

not?” However, a woman who reported

that the onset of her last menstrual

period was within the last 30 days

before the interview was automatically

classified as not currently pregnant.

Seeking pregnancy-A woman was

classified as seeking pregnancy if she

reported that she was not using a

method at the date of the interview

because she wanted to become pregnant

as soon as possible.

Post partim-A woman was

classified as post partum if she reported

that she was not currently using a

method, was not trying to become

pregnant, and her last pregnancy had

terminated within 2 months before the

date she was interviewed.

Other nonusers—Women (or

couples) who reported that they were

currently using no contraceptive method

and could not be classified in any of the

preceding categories of noncontraceptors

were classified here. Included are

women who had never had intercourse,

women who had not had intercourse in

the last 1 month and women who had

had intercourse in the last 1 month but

were indifferent to the chances of

pregnancy. Nonusers who had had

intercourse only once were classified

according to the timing of that

intercourse: if it occurred within that

past month, they were coded as having

intercourse in the past month; if not,

they were coded as having no

intercourse in the past month.

Never had intercourse—A woman

was classified as never having had

intercourse if she was not currently

using a method and she had never

had sexual intercourse at any time

up to the date of interview, or if she

had had sexual intercourse but not

since her menstrual periods began.

No intercourse in the last month—A

woman was classified as not having

had intercourse in the last month if

she was not currently using a

method and reported not having

sexual intercourse at all in the last 1

month preceding the interview.

Intercourse in the last month-A

woman (or couple) was classified as

having intercourse in the last month

if she was not currently using a

method and was having sexual

intercourse currently or in the

month preceding the interview.

Contraceptors-A woman (or

couple) who reported using a method at

the date of interview was classified

according to the specific method used.

When more than one method was

currently being used, they were coded

using the following priority orde~

female sterilization, male sterilization,

pill, IUD, diaphragm, condom, foam,

periodic abstinence, withdrawal, :and

other. Methods used by extremely small

proportions of the population, such as

jelly, cream, suppositories, or

abstinence, not in combination with any

other methods, were grouped into the

category “other.”

Demographic terms

Age—Age is classified by the age

of the respondent in completed years as

of August 15, 1990, for the 1990 survey

and as of March 15, 1988, for the 1988

survey. These dates are the approximate

midpoints of reviewing, respectively. In

the 1982 survey, age is classified by the

age of the respondent at her last

birthday before the date of interview.

Education-This refers to the

number of years of regular schooling the

woman had completed as of the date of

interview in 1990. In this report, the

following categories are used 0-11

years, meaning that the woman did not
Advance Data No. 260 ● February 14,1995 15

complete high school; 12 years, meaning

that she obtained a high school diploma

or a GED, but did not complete a full

year of college; and 13 years or more,

meaning that she completed at least 1

year of college. In table 5, women under

the age of 20 are excluded from

tabulations by education because it

generally takes until at least age 19 to

reach the “ 13 years or more” category.

Hispanic origin—Each woman was

asked, “Which of the (following) groups

best describe your national origin or

ancestry?” Using a list of 15 groups, a

woman was classified as being of

Hispanic origin if she reported that her

only or principal national origin was

Puerto Rican, Cuban, Mexican

Arnericu Central or South American,

or other Spanish. Origin is therefore

classified independently of race, and

Hispanic women may be of any race.

Marital sWus-In this report,

women were classified according to

their legal marital status-married,

widowed, divorced, separate~ or never

legally married. Cohabiting women who

are not legally married are classified

accordingly as widowed, divorced,

separated, or never married, whichever

is the legal status. In all NSFG surveys,

women who were married but separated

horn their spouse were classified as

separated if the reason for the separation

was marital discord, and as currently

married otherwise.

Poverty level income—This is the

ratio of the total family income to the

poverty level threshold for a family of

specified size, as published by the U.S.

Bureau of the Census. In the 1988

survey, 1987 poverty level thresholds

were used (17). In the 1990 survey,

1989 Census Bureau weighted average

thresholds for householders under age

65 were used. The 1989 thresholds used

for 1990 data were $6,451 for 1 person,

$8,343 for a family of z $9,885 for a

family of 3, $12,674 for a family of 4,

up to $25,480 for a family of 9 or more

(18). Thus, if a family of 4 had an

income of $25,000, their poverty level

income would be $25,000 divided by

$12,674, or 197 percent. In the 1990

NSFG, family income was not collected

from the 327 women 15–17 years of age

who were interviewed for the first time

in 1990. In table 5 of this report, data

not report the income or poverty level

of their families.

.-.

Race—Race refers to the race of the . . .

woman interviewed. Each woman was

asked, “Which of the (following) groups –

best describe your racial background?” 0.0

The categories include blacz white,

Asian or Pacific Islander, and Alaskan ~

Native or American Indian. Because of

small sample sizes, the last two

categories are often combined and called

“other.” *

#

are not shown for those women who did Symbols

Data not available

Category not applicable

Quantity zero

Quantity more than zero but less

than 0.05

Quantity more than zero but less

than 500 where numbers are

rounded to thousands

Figure does not meet standard of

reliabilii or precision

Figure suppressed to comply with

confidentiality requirements

‘U.S. Gmmmnt Printing CXficm 1995 — 3SS—952EcC@
16 Advance Data No. 260 ● February 14, 1995

Suggested citation

Peterson LS. Contraceptive use in the United

States 1982-90. Advance data from vital and

health statisti~ no 260. Hyatleville, Maryland:

National Center for Health statistics. 1895.

Cooperating agencies

The 1988 and 1990 National Surveys of

Family Growth were supported in part by the

National Institute of Child Health end Human

Development, and the Office of Population

AfFsira, both of the U.S. Department of Health

and Human Services. These agencies also

participated in the design of the 1988 and

1990 questionnaires.

Copyright information National Center for Health statistics

All material appearing in this report is in the Acting Director

public domain and may be reproduced or Jack R. Anderson

copied without permiasiom citation as to

source, however, is appreciated.

Acting Deputy Director

Jennifer H. Madens, Ph.D.

U.S. DEPARTMENT OF HEALTH AND BULK RATE:7

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Vital and Health Statistics

series descriptions

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SERIES 5.

SERIES 6.

SERIES 10.

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SERIES 12.

SERIES 13.

Programa and Collection Procedures—These reports

describe the data collection programs of the Ntilonal Center

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usad to collect and process the data, definitions, and other

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techniques, objective evaluations of reliability of collected

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include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

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present analytical or interpretive studies baaad on vital and

health statktks. These reports cany the analyses furtherthan

the expository typea of reports in the other series.

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statistics and documents such as recommended model vital

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International Vital and Heelth Statistics Reports-These

reporta are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

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Data From the National Hesfth Interview Survey-These

reports contain statistics on illness; unintentional injuries;

d~tlii; use of hospital, medical, end 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 Heafth Examination Survey, the

Natfonal Heefth snd Nutrition Examination Surveys, and

the Hlapanlc Health and Nutrftion Exsminatfon 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,end psychologicalcharactariatks, and

(2) analyses of trends and relationships among various

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Data From the Institutionalized Population Surveys—

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reports contain statisticson health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services baaed on data collected directly

from health care providers and provider records,

SERIES 14.

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SERIES 21.

SERIES 22.

SERIES 23.

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Date on Heelth Resources: Manpower and Facllitie>

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information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

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contain statistics on natality, 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 indudad.

Data From the National Mortality and Nstality SurvayaDiscontinued in 1975. Reports from these sample surveys,

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rates, including contraception, infertility, cohabitation,

marriage, divorce, and remarriage; adoption; use of medical

care for family planning and infetiility; and related maternal

and infant health topics. These statistics are based on

national surveya of childbearing age.

Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Wal

Statistics System that were published as supplements to the

MorriYr/yVi StaWcs Repmi (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vita/ Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings baaed on final data from the National Vial Statistics

System and may be followed by detailed reports in Series 20

or 21.

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