Data from the

National Health Survey

Utilization of Short-Stay Hospitals

By Persons With Heart Disease

And Malignant Neoplasms:

National Hospital Discharge Survey

United States, 1977

Based on data obtained from a national sample of the hospital

records of inpatients &charged from non-Federal short-stay hospitals, hospital utilization by heart disease and malignant neoplasm

patients is examined. The measures of hospital utilization employed

are frequencies, rates, percents, and average Iengths of stay. Data

are provided for these two specific diagnostic categories and for aII

other patients and are tabuIated by patient age, sex, and surgical

status.

DHHS Publication No. (PHS) 81-1713

Series 13

Number 52

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

Hyattsville, Md. April 1981
,/

Library of Congress Cataloging in Publication Data

Gardocki, Gloria J.

Utilization of short-st.1) ht)spitals b> persons t~ith he:irt disc~s( .u~ct mdi,~.mt

neoplasms.

(Vital and health statistics : Series 12, l)~ta from the X:~tional IIc:dth $itlrie}- ; no. !32)

(DI~HS publication ;no. (P! IS) 81-1713)

Includes bibliographical references.

1. Hospital utilization --~nited States Statistics. 2. Ilt:.irt -- Diseases L’nitcd States --

Statistics. 3. Cancer--l?nited States -- Statistics. -!. [-nitcd States .-Statistics, \ledical.

I. Pokras, Robert, joint author. 11. Title. III. Serit’s: [’nitcd States. .Xational Center for

Health Statistics. Vital and health statistics : Series 13, I)ata J“rt)rn the X~tion~l Health

Survey, Data from the hospital discharq survey ; no. 52. 11’. Scric, : Vnitt’d States. DclJt.

of Health and Human Services. DHHS publication] ; no. (PHS) 81-1713. [DNIAI:

1. Hospitals–Utilization ---[~nited States-Statistics. 2. (lcwdiolo:g~ .[’ni[~’d States- Statistics. 3. kledical or~C(J]og>’--~l lite({” States--statis{ics. +. Piitit’nt dis( h.il-~c -Statistics.

W2 A N148vm no. 52]

RA407.3..4349 no. 52 [R.A981.J21 80-28017”

ISBX 0-8406 -0214-6 :;(;2.1’1’09;3s [’\02.1’ 9612’()()97:\l
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, llirector

ROBERT A. ISRAEL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Director for Analysis and Epidemiology

GAIL F. FISHER, Ph. D., Associate Director for the Cooperative Health Statistics System

GARRIE J. LO SEE, Associate Director for Data Processing and Semites

ALVAN O. ZARATE, Ph.D., Assistant Director for International Statistics

E. EARL BRYANT, Associate Director for Interview and Examination Statistics

ROBERT C. HUBER, Associate Director for Management

MONROE G. SIRKEN, Ph. D., Associate Director for Research and Methodology

PETER L. HURLEY, Associate Director for Vital and Health Care Statistics

ALICE HAYWOOD, Information Officer

DIVISION OF HEALTH CARE STATISTICS

W. EDWARD BACON, Ph.D., Director

MARY MOIEN, A cting Chief, Hospital Care Statistics Branch

MANOOCHEHR K. NOZARY, ChieJ Technical Services Branch

COOPERATION OF THE U.S. BUREAU OF THE CENSUS

Under the legislationestablishingthe National Health Survey, the Public Health Serviceis

authorizedto use, insofaraspossible, the servicesor facilitiesof other Federal,State, or private

agencies.

In accordance with specificationsestablishedby the National Center for Health Statistics,

the Bureauof the Census,undera contractualarrangemen~psxticipatedin planningthe survey

andcollectingthe data.

Vital and Health Statistics-Series 13-No. 52

DHHS Publication No. 81-1713

Library of Congress Catalog Card Number 80-28017
CONTENTS

Characteristics of Discharges with Heart Dkease or a Malignant Neopl=m...- ............. ..... .....................

Age and Sex .................................................." ............... ................... ..... ......... ........... ........... .......

Patients with Surgery ..................................................................... ....................... .. ........................

Trends in Wtes ................................. ........................................." ......... . ....".." .." ..... ..... ..............

Average Length of Stay .................................................. ............. ..... . . ... ..... .................................

List of Detailed Tables ........... ......... ..................... ......................... ....................... ... ..........................

Appendixes

L Technical Notes on Me&ods ......................................................................................................

IL Definitions of Certain Terms Used in This Report ..................... ............. .............................

1.

2.

3.

4.

5.

6.

LIST OF TEXT FIGURES

Percent of patients discharged from short-stay hospitals with firs@isted diagnoses of heart

disease, malignant neoplasm, or other diagnoses, by sex and age: United States, 1977 .................

Percent of patients discharged from short-stay hospitals with surgery, by fiist-liited diagnostic

category, sex, and age: United States, 1977 ..................................................................................

Rate per 1,000 civilian noninstitutionalized population of patients discharged from short-stay

hospitals, by first-listed diagnostic category, sex, and age: United States, 1977 .. ............. ...........

Average length of stay for patients dkharged from short-stay hospitals, by fiist-listed d~ostic

category, sex, and age: United States, 1977 ..................................................................................

Average length of stay for male patients dkharged from short-stay hospitals, by first-listed

diagnostic category, SUrgicalstatus, and age: United States, 1977, ................................................

Average length of stay for female patients discharged from short-stay hospitals, by first-listed

diagnostic category, surgical status, and age: United States, 1977 ................................................

1

2

2

3

3

6

7

9

11

12

17

26

4

5

6

8

8

9

...

III
SYMBOLS

Data not available---------------------------- ---

Category not applicable ------------------------ . . .

Quantity zero--—–---—---—--— --------- .

Quantity more than Obut less than 0.05---- 0.0

Figure does not meet standards of

reliabilityy or precision-------—-------— *

iv
Utilization of Short-Stay Hospitals by Persons

With Heart Disease and Malignant Neoplasms:

National Hospital Discharge Survey

Gloria J. Gardocki, Ph.D., and Robert Pokras, M. A., Division of Health Care Statistics

INTRODUCTION

This report presents 1977 national estimates

of the utilization of non-Federal short-stay

hospitals by patients with a first-listed diagnosis

of heart disease or a malignant neoplasm. Statistics on these two types of discharge are selected

for inspection and comparison with statistics on

all other discharges because of the substantive

import ante of these conditions as the two

Ieading causes of death in the United States.1

Estimates of the discharge frequency, rate

per 1,000 noninstitutionalized population, and

average length of stay per discharge are presented in tables 1-3 for the different diagnostic

categories. These statistics are further categorized by the surgical status of the patient,

controlling for age and sex. The main aspects of

these tabulations are summarized in the discussion sections that follow. AIl statistical statements referring to age-related trends have been

tested by using linear regression, that is, the

weighted least squares method. All other statistical statements refer to differences between

pairs of statistical estimates, such as rates or

regression slopes, and were tested by using the

Bonfemoni method for multiple comparisons.

Unless stated, the differences that are discussed

are statistically significant at the p <.05 level.

Similarly, any statement indicating no difference

between estimates refers to the lack of a

statistically significant difference (i.e., p > .05).

Because only the main aspects of the data are

investigated, not all significant cliff erences between statistics are included in the discussion. A

more detailed explication of the specific hypothesis-testing procedures used can be found in

appendix I.

The estimates presented are based on data

collected by means of the National HospitaI

Discharge Survey, which has been conducted

annua.Uy by the National Center for HeaIth

Statistics since 1965. Data for the survey are

abstracted from the face sheets of the medical

records for patients sampled from among all

patients discharged from specific hospitals. The

set of hospitals selected for the survey constitutes a sample of the non-Federal general and

speciaIty short-stay hospitzds in the 50 States

and the District of Columbia. Maxima of five

diagnoses and three surgical procedures are

recorded for each medical record in the patient

sample.

The medical data for 1977 examined in this

report are coded according to the Eighth Revision International Classification of Diseases,

Adapted for Use in the United States

(ICDA-8),2 with modifications. For this report,

all discharges with first-listed diagnoses of

ICDA-8 codes 390-398, 400.1, 402, 404,

410-414, and 420429 were selected to form the

group of heart disease discharges. With the

exception of the inclusion of code 400.1, these

codes conform to those used by the Division of

Vital Statistics of the National Center for Health

Statistics for publishing data on deaths with an

underlying cause of diseases of the heart. Code

400.1 specifies malignant hypertension with

1
heart involvement classifiable to codes

427.1-429 (i.e., symptom atic heart disease excluding congestive heart failure, other myocardial insufficiency, or ill-defhed heart disease). Because fewer than one thousand hospital

discharges in 1977 are accounted for by this

code, its inclusion here does not notably affect

the results of the analysis. The group of heart

disease patients, however, excludes all discharges

with first-listed diagnoses of other circulatory

diseases.

Similarly, the discharges with first-listed

diagnoses of ICDA-8 codes 140-209, which

include alI, diagnoses of neoplasms specifically

identified as malignant, comprise the group of

malignant neoplasm patients. This group excludes all discharges with first-listed diagnoses of

benign neoplasms or neoplasms of an unspecified nature. These codes also were selected so

that the information presented here would be

compatible with the mortality statistics published by the National Center for Health Statistics (NCHS). A more detailed listing of the

diagnoses included in each set of codes can be

found in appendix II.

Familiarity with the technical aspects of the

survey, includkg the precise definitions of

terms, is essential for accurate interpretation of

the data and for valid comparisons of the

National Hospital Discharge Survey (NHDS)

statistics to statistics from other data sources.

Appendix I contains a facsimile of the abstract

form used for data collection as well as summaries of the survey design, data collection

procedures, estimation procedure, sampling

error estimates, and hypothesis testing procedures. Definitions of the terms used in this

report are presented in appendix II. More

extensive coverage of these topics and a detailed

presentation of the lWDS modifications of the

ICDA-8 can be found in appendixes I and II of

“Utilization of Short-Stay Hospitals: Annual

Summary for the United States, 1977. ”3 A

separate report on the design of the NHDS also

has been published.q

HIGHLIGHTS

Of 35.9 million discharges, approximately

2.8 million had a first-listed diagnosis of heart

disease and approximately 1.7 million had a

first-listed diagnosis of a malignant neoplasm;

these figures represent 7.9 and 4.8 percent of all

discharges, respectively. A total of 262.4 million ,

days of care were used in 1977.’ Of this total,

discharges with a first-listed diagnosis of heart

disease accounted for 28.3 million days, or 10.8

percent, and discharges with a first-listed diagnosis of a malignant neoplasm accounted for

21.0 milIion days, or 8.0 percent. The disproportionate share of hospital days used by these two

types of discharge is readily apparent by comparing the differing average lengths of stay. The

discharges with a first-Iisted diagnosis of heart

disease had an average length of stay of 9.9 days,

and those with a mali&ant neoplasm had an

even longer average stay of 12.2 days. Both

averages exceeded the average length of stay of

6.8 days for all other discharges.

CHARACTERISTICS OF DISCHARGES

WITH HEART DISEASE OR

A MALIGNANT NEOPLASM

Inspection of the frequency and rate statistics for all discharges, regardless of diagnosis,

reveals a number of trends. Table 1 shows that,

of the total of 35.9 million discharges, the

majority (20.9 million) did not have surgery.

Surgery was performed on 40.4 percent of aII

male discharges and 42.8 percent of all female

discharges, proportions that are not significantly

different. Moreover, the number of female discharges exceeded that of male discharges (21.5

million compared with 14.4 million). Omission

of the 3.3 million female patients who gave birth

during their hospitalizations reduces thk difference, but it remains significant. The rates for

all discharges, presented in table 2, demonstrate

that females, for whom the rate was 196.0 per

1,000 civilian noninstltutionalized population,

,0

were hospitalized more than males were, for

whom the rate was 140.5. Omission of the

worn en who gave birth reduces the statistic for

females again, to a rate of 165.7 per 1,000

population, but the sex difference in rates

remains significant. Finally, discharges 15-44

years of age (15.2 million) outnumbered those

aDays of care are not tabulated.

2
in every other age category. This difference was

partly due both to the inclusion of women who

gave birth and to the large proportion of the

population in that age range. As the rates for all

discharges show, the trend was for the likelihood

of hospitalization to increase with age, with the

s~ope of the increase greater for females than for

males. The rates increased from 81.4 per 1,000

population for males under 15 years of age to

396.9 for those 65 years and over; for females,

the rates increased from 65.0 to 358.6. Although these summary “statistics for all discharges demonstrate some significant trends in

hospitalization, they also mask substantial differences among the heart disease, malignant

neoplasm, and other diagnosis groups.

Age and Sex

As shown in table 1, the total number of

heart disease discharges was significantly greater

than the total number of malignant neoplasm

discharges for each sex separately as well as for

both sexes together. Moreover, the residual category of other discharges constituted the majority of cases for each sex. The frequencies for the

diagnostic categories were influenced by age and

sex. A majority of the heart disease discharges

were male and a majority were 65 years of age

and over. In contrast, for the malignant neoplasm discharges no difference was found between the male and female discharge frequencies

or between the frequencies for ages 45-64 years

and 65 years and over, although each of these

latter two frequencies was significantly larger

than each frequency for the younger age groups.

Finally, a majority of the other discharges were

female, with the largest number in the 15-44-

year age group.

The combined effect of age and sex on the

diagnostic distribution is shown in figure 1. For

each sex, both the proportion of patients with a

first-listed diagnosis of heart disease and with a

first-listed diagnosis of a malignant neoplasm

increased with age. Although the trends for

these four sex by diagnosis groups were alike in

direction, they differed in slope. The proportion

of males with heart disease increased with age

faster than the proportions for the other three

groups did, and the proportion of female heart

. disease patients increased the most slowIy. The

slopes for the male and female malignant neoplasm patients were at an intermediate level and

did not differ significantly from each other.

Consequently, the proportion of patients with

any other first-listed diagnosis decreased with

age, and the rate of decrease was greater for

males than for females. Together, these trends

clearly reflect the dependence of the diagnostic

case mix in non-FederaI short-stay hospitals on

the age and sex distributions of the patient load.

Patients with Surgery

Overall, the proportion of patients on whom

surgery was performed was dependent on the

first-listed dia~osis. This proportion was

greatest for the malignant neoplasm discharges

(54.4 percent) and least for the heart disease

patients (16.9 percent), with the remaining

discharges at an intermediate level (43.4 percent ). As shown in figure 2, the combined

influence of’ age and sex on the proportion of

surgical patients also varied with the diagnostic

category. No age-related trend in the proportion

of malignant neoplasm patients with surgery was

found for either sex. For males, no age change in

this proportion was significant, although for the

females the proportion for the 15-44-year age

group (70. 1 percent) was significantly larger

than the proportions for the youngest and next

oldest age groups. Furthermore, no sex difference in the proportions of patients with

surgery was found for all malignant neoplasm

patients nor for any age group except the group

15-44 years of age. For that group, the proportion for females (70. 1 percent) was si~ificantly

~eater than that for males (47.7 percent).

The patterns among the heart disease and

other diagnosis categories were simiku-, but

differed from the pattern for the malignant

neoplasm discharges. For each sex, the trend for

the proportion of surgical patients was to

decrease with age for both the heart disease and

other discharges. Moreover, for each of these

diagnostic categories, significant sex differences

were found in these proportions for only the

45-64-year age group: among the heart disease

discharges, the proportion of male surgical discharges exceeded the female proportion for that

age group, and among the other discharges, the

female proportion exceeded that of males.

Together these findings indicate that substantial differences exist among the diagnostic

3
m .,,.,,$

n Under 15yecIrs

20

10

~ 15-44yews

, ~ 45-64,.1.

m 65wwsandover

HEART DISEASE

20

[

MALIGNANT NEOPLASM

lW

90

80

7C

6(

.

.

(

—

—

Both sexes

OTHER DIAGNOSES —

—

Male

SEX

—

—

Female

Figure 1. Percent of patients discharged from short-stay hospitals with first-listed diagnoses of heart disease, malignant neoplasm, or

other diagnoses, by sex and age: United States, 1977

4
20

0

80

60

40

20

0

6(

4C

20

0

—

—

—

—

Both sexes

HEART DISEASE

—

—

MALIGNANT NEOPLASM

—

—

OTHER OIAGNOSES

—

—

Male

SEX

m AIlages

Q .nder15wars

~ 15-44,WS

~ 46-6Ll,ears

= 65yea.andwer

—

—

—

—

Female

Figure 2. Percent of patients discharged from short-stay hospitals with surgery, by first-listed diagnostic category, sex, and age: United

States, 1977
groups in the performance of surgical procedures. A major difference by sex was found

among the patients with a first-listed diagnosis

of a malignant neoplasm; whether or not surgery

was performed was related to the age of the

females but not of the males. Furthermore, only

one female age group (15-44 years) cliff ered

from the other female age groups and it also

differed from the corresponding male age group.

One possible explanation for these variations is

that malignancies are more likely to be detected,

or are more likely to be detected at an early

(i.e., operable) stage, in these females than in

others because they obtain medical examinations that focus on, but are not limited to,

fertility control and pregnancy. For the heart

disease patients, the observed age and sex

differences in the proportion of patients with

surgery can be partly due to an age-related

decline in the proportion of patients being

treated for congenital heart defects and an

associated increase in the proportion being

treated for degenerative heart disease. For both

the heart disease and other discharges, the underlying causes of the effects of age and sex can

also include either an age-related increase in the

severity or reparability of the disease being

treated or an increase in the rejection of surgery

as a mode of treatment because of patients’

multiple medical problems or general physical

condition. The relative explanatory power of

these reasons for the variations in the proportions of patients with surgery, or of other

reasons that were not suggested here, unfortunately cannot be assessed by using these data.

Trends in Rates

The rates for the discharge statistics demonstrate a number of differences among the diagnostic groups due to the influence of age and

sex. Table 2 shows that the overall rate per

1,000 civilian noninstitutionalized population

for the residual category of other diagnoses

(147.6) was much greater than the rate for heart

disease (13.4), which was significantly greater

than the rate for malignant neoplasms (8.1).

Although this order of diagnostic rates appeared

separately for each sex, the absolute ma~itudes

of the diagnostic rates varied by sex for two of

the groups. The male heart disease rate (15.0)

was significantly greater than the female rate

(11.9), and the female rate of other discharges

(1 75.6) was significantly greater than the maIe

rate (11 7.7). Only for the malignamt neoplasm

discharges were the rates for males and females

not significantly different (7.8 and 8.5, respectively).

Figure 3 displays the age trends in rates for

each group formed by cross-classifying sex and

diagnosis. For each sex within each diagnostic

group, the trend was for the rates to increase

significantly with age. The steepest slope of

increase was that for females with other diagnoses, followed by that for males with other

diagnoses. The slopes of increase for female

malignant neoplasm patients and male heart

300

275

250

225

200

z

g

~ 175

:150

-.

u

:

: 125

~

100

50

25

0

------- Heart dwa$?, male

------ Heart disease, female

-— Malignant neoplasm, male

— Malignant neoplasm, female

— —. Other diagnoses, male i

-------- Other diagnoses, female

y

/

/

,%,

j’ ‘%, if

~\,

:

%, /7

:1

f

*\, ;//

:1 %

●, ta

~

/

1’ “1

:1

;)

#

/’

/’ /

~$ /

:

:’ //’

+’

/ ##’

! *+./”

/

J: Under 15 15-44 45-s4 65 and

over

AGE IN YEARS

Figure 3. Rate Der 1,000 civilian noninstitutional ized powlation of patients “discharged from short-stay hospitals, by

first-1 isted diagnostic category, sex, and age: United States,

1977

6
disease patients did not differ from each other,

but were smaller than those for the residual

category of other diagnoses. The smallest slopes

were those for female heart disease and male

malignant neoplasm patients (which also did not

significant] y differ from each other). Thus as age

increased, the rate of hospitalization increased

most for patients other than heart disease and

malignant neoplasm patients and least for female

heart disease and male malignant neoplasm

patients.

In addition to this comparison of age trends

in sex-specific diagnostic rates, the diagnostic

rates for specific age by sex categories also were

investigated. For each age by sex category, the

rate of discharges in the residual group of other

diagnoses was greater than both the heart disease

and the malignant neoplasm discharge rates.

Moreover, among males, the rate of heart disease

discharges was significantly greater than the rate

of malignant neoplasm discharges for each age

group except the youngest, for which no difference was found. In contrast, among females,

the heart disease dischmge rate exceeded the

maIignant neoplasm rate only for the age group

65 years and over. For the two youngest age

groups the reverse was true and for the age

group 45-64 years no difference was found

between the malignant neoplasm and heart

disease discharge rates. This uniform predominance of heart disease over malignant neoplasm

diagnoses for all males except the youngest, with

the females experiencing a reversal in predominance from malignant neoplasm to heart disease

diagnoses as a function of age, constitutes an

important sex difference.

Average Length of Stay

As noted in the introduction, patients in the

two diagnostic categories selected for inspection

differed from all other patients in their average

lengths of stay: the average, length of stay for

the malignant neoplasm discharges was significantly greater than the average length of stay for

the heart disease patients (12.2 days compared

with 9.9’ days), and both stays were significantly

greater than the average length of stay for all

other patients (6.8 days).

Table 3 shows, however, that the diagnostic

groups also differed in the effects of age, sex,

Wd surgical status on the average length of stay.

Among the heart disease patients and the residual category of other patients, the average

lengths of stay were Klghest for the groups 65

years of age and over (10.9 days for the heart

disease discharges and 10.8 days for other

discharges). In contrast, among the malignant

neoplasm discharges, the average lengths of stay

for the two oIdest groups (12.0 days for patients

45-64 years of age and 13.6 days for patients 65

years of age and over) did not differ from each

other but were the highest of the age-specific

average lengths of stay.

On the surface, the gross sex differences in

the average lengths of stay for the diagnostic

categories are equally striking. For the heart

disease patients, the average length of stay for

females was significantly greater than that for

maIes (10.5 days compared with 9.5 days), but

for the patients in the residual category of other

diagnoses, the reverse was true; the average

Iength of stay for males (7.3 days) was significantly greater than that for females (6.5 days).

Only for the malignant neoplasm diagnostic

groups were the average lengths of stay eqwd for

males (12.3 days) and females (12.1 days).

Closer inspection reveals, however, that these

differences are explained by the differing age

distributions of the males and females in each

diagnostic category. With only one exception,

no sex difference was found in the average

length of stay for any age group within any

diagnostic category. The sole exception was

patients 15-44 years of age in the category of

other diagnoses. For that group, the average

length of stay of females (4.8 days) was significantly lower than that of males (6.2 days).

Although exclusion of the 3.3 million women in

this age group who gave birth and generally

required relatively short hospitalizations increased the average length of stay for the

remaining females to 5.3 days, the difference

remained significant.

The combined effects of sex and age on the

average length of stay of each diagnostic group

are dispIayed in figure 4. For each sex by

diagnosis group, the trend was that the average

length of stay significantly increased with age.

However, few significant differences were found

among the slopes of these trends, indicating that

this effect of age varied little among the groups.

7
------ Heart d,,,,,,, male

.— .— -- Hean disease, female

-—— Mal!gnanl neoplasm, male

— Mahgnant neoplasm, female

——. Other d,agnoses, male

-------- Other d,agnoses, female

/“

// . ..---”’”

----

----

2

t

,~

Under 15 15-44 65 and

over

AGE IN YEARS

Figure 4. Average length of stay for patients discharged from

short-stay hospitals, by first-listed diagnostic category, sex,

and age: United States, 1977

The rate of increase with age of the average

length of stay was greater for females with other

diagnoses than for males and females with heart

disease; the rate of increase also was smaller for

males with heart disease than for females with

malignant neoplasms and males with other diagnoses. For each diagnosis, no sex difference was

found in the effect of age on the average length

of stay. For these diagnostic groups, age clearly

had a stronger and more consistent effect on the

average length of stay than sex had.

In addition, table 3 shows that the average

length of stay was greater for those with surgery

than for those without surgery for both the

heart disease patients (1 1.6 days compared with

9.6 days) and the malignant neoplasm paltients .

(13.6 days compared with 10.4 days). Surprisingly, the average stays of the surgical and

nonsurgical patients with other diagnoses (7.0

days and 6.7 days, respectively) did not differ

significantly.

The age trends in the average length of stay

for the diagnostic groups according to surgical

status are displayed in figures 5 and 6; figure 5

shows these trends only for males and fi~wre 6

shows them only for females. With one exception, the trend for the average length of stay to

increase with age for each sex by diagnosis group

remained significant when those groups were

------ Heart disease, with surgery

-.-. — Heart disease, without surgery

-—— Malignant neoplasm, with su!gery

Malignant neoplasm, without surgery

—— Other diagnoses, with surgery

. . . . . . . . . . . . . other diagnoses, without surgery

o~+a”d

over

AGE IN YEARS

Figure 5. Average length of stay for male patients discharged

from short-stay hospitals, by first-listed diagnostic category,

surgical status, and age: United States, 1977
16 —

14 —

12 -

10 —

8 —

6 —

4 —

2 -

_ _ _ _ e _ Heart diseam, with sury2ry

----- Heart disease, without surwry

_ Malignant neoplasm, with surgery

— Malignant neoplasm, without surgery

—— Other diagnoses, with surgery

. . . . . . . . . . . . . rJther rjiagmse$, without Surgety

o-and

over

AGE IN YEARS

Figure 6. Average length of stay for female patients discharged

from short-stay hospitals, by first-listed diagnostic category,

surgical status, and age: United States, 1977

further divided according to surgical status. The

sole exception is the group of male heart disease

discharges without surgery, for whom the age

trend was not significant. Comparisons among

the slopes of these trends for each sex reveal a

pattern, but it is not a cIear and consistent one.

For the males, all of the significant differences

among the increase slopes revolved around the

surgiczdpatients in the residual category of other

diagnoses. The slope of the age-related increase

in the average length of stay of this group of

patients was significantly greater than the correspondkg slopes for all three dia~ostic groups

of males without surgery. For the females a

similar, although not identical, view emerges.

For them also, the slope of the age-related

increase in the average length of stay was greater

for the surgical patients with other diagnoses

than for the nonsurgical patients with heart

disease or other diagnoses, but it did not differ

from the slope for the malignant neoplasm

patients without surgery. In addition, the increase slope for the malignant neoplasm patients

with surgery was significantly greater than that

for the heart disease patients without surgery.

Despite these variations, the statistical significance of alI but one of the age trends in the

average length of stay displayed in figures 4-6

clearly indicates that the influence of age on the

average length of stay was consistent, pervasive,

and remained stable when simultaneously controlling for diagnosis (as categorized in this

anzdysis), sex, and surgical status.

SUMMARY

This summary of 1977 NHDS data on

hospital discharges has concentrated on describing and comparing three diagnostic groups

of patients: those with a fiist-listed diagnosis of

heart disease, those with a first-Iisted diagnosis

of a malignant neoplasm, and all other patients.

A number of similarities and differences among

these groups appeared. The most notable are

● Of a tot~ of 3.5.9 million discharges,

those with a first-Iisted diagnosis of heart

disease (approximately 2.8 mfllion) exceeded those with a first-listed malignant

neoplasm diagnosis (approximately 1.7

million), but patients with all other diagnoses constituted the majoritv.

● The proportions of male and female

patients with a fiist-listed diagnosis of

heart disease and male and female patients

with a first-listed diagnosis of malignant

neoplasm increased significantly with age.

The rate of increase with age was greatest

for the male heart disease patients and

least for the female heart disease patients.

As a result of these increases, the proportion of all patients who had any other

first-listed diagnosis decreased with age,

9
and that decrease was greater for males

than for females.

The performance of surgery was related to

the first-listed dia~osis. Surgery was performed most frequently on malignant

neoplasm patients (54.4 percent) and

more frequently on patients in the residual category of other diagnoses (43.4

percent) than on heart disease patients

(16.9 percent).

For each sex of both heart disease patients and patients in the residual category

of other diagnoses, the trend was for the

proportion of patients with surgery to

decrease with age. No trend was found for

the proportion of patients with surgery to

change with age for either male or female

malignant neoplasm discharges.

The rate per 1,000 civilian noninstitutionalized population of male heart disease patients exceeded that of female

heart disease patients and the rate of

female patients in the residual category of

other diagnoses exceeded that of males.

For malignant neoplasm discharges, no

difference was found between the male

and female rates.

For each sex in each diagnostic category,

the trend was for the discharge rate to

increye with age. The age-related in- ‘

creases in slope from largest to smallest

were: (1) females in the residual category

of other diagnoses, (2) males with other

diagnoses, (3) female malignant neoplasm

patients and male heart disease patients;

and (4) female heart disease patients and

male malignant neoplasm patients.

The heart disease and malignant neoplasm

patients used disproportionate shares of

all hospital care days, leading to average

lengths of stay (9.9 and 12.2 days, respectively) that were significantly greater than

the average length of stay of all other

patients (6.8 days).

The trend was for the average length of

stay to increase with age. This trend

remained I statistically significant for all

but one of the groups formed by crosstabulating diagnostic category, sex, and

surgical status. The sole exception was for

the group of male patients whc) had a

first-listed diagnosis of heart disease and

who did not have surgery performed.

000

,!

10
1National Center for Health Statistics: Final mortality statistics, 1977. Monthly Vital Statistics Report.

Vol. 28-No. 1, PHS Pub. No. 1120. Public Health

Service. Hyattsville, Md., May 11,1979.

2NationaI Center for Health Statistics: Eighth Revision International Classification of Direases, Adapted

for Use in the United States. PHS Pub. No. 1693. Public

Health Service. Washington. U.S. Government Printing

Office, 1967.

3National center for He~th Statistics: Utilization

of short-stay hospitals: Annual summary for the United

States, 1977, by B.J. Haupt. Vital and Health Statistics.

PHS Pub. No. 1557-Series 13-No. 41. Public Health

Service. Washington. U.S. Government Printing Office,

Mar. 1979.

4Nationa Center for Health Statistics: Development

of the design of the NCHS Hospital Discharge Survey, by

W.R. Simmons. Vital and Health Statistics. PHS no.

1000-Senes 2-No. 39. Public Health Service. Washington.

U.S. Government Printing Office, Sept. 1970.

5National Center for Health Statistics: Development

and maintenance of a national inventory of hospitals and

institutions. Vital and Health Statistics. PHS Pub. No.

1000-Series l-No. 3. Public Health Service. Washington.

U.S. Government Printing Office, Feb. 1965.

6NationA Center for Health s~tistics: Utization

of short-stay hospitals, summary of nonmedical statistics, United States, 1965, by M.G. Sirken. Vital and

Health Statistics. PHS Pub. No. 1000-Series 13-No. 2.

Public Health Service. Washington. U.S. Government

Printing Office, Aug. 1967.

7National Center for Health Statistics: Utilization

of short-stay hospitals by characteristics of discharged

patients, United States, 1965, by M.J. Witkin. Vital and

Health Statistics. PHS Pub. No. 1000-Series 13-No. 3.

Public Health Service. Washington. U.S. Government

Printing Office, Dec. 1967.

11
LIST OF DETAILED TABLES

1. Number of patients discharged from short-stay hospitals, by age, sex, fiist-listed diagnostic category, and surgicaf status:

United States, 1977 ................................................................................................................................. .................................. 13

2. Rate per 1,000 civilian noninstitutionaliied population of patients discharged from short-stay hospitals, by age, sex,

first-listed diagnostic category, and surgical status: United States, 1977 ................................................................................. 14

3. Average length of stay for patients discharged from short-stay hospitals, by age, sex, first-listed diagnostic category, and

surgical status: United States, 1977 .......................................................................................................................................... 1.5

12
Table 1. Number of patients discharged from short-stay hospitals, by age, sex, f irst-listed diagnostic categofy, and surgical status: United States, 1977

[Excludes newborn infants and discharges from Federal and long-term hospitals]

Sex, first-listed diagnostic category, surgical status,

and ICDA code

Both sexes

All diagnoses..............................................................................................................

Without surgery .........................................................................................................................

With surgery ..............................................................................................................................

Heart disease.............................................39 O398. 400.1,402,404,410-414, 420-429

Without surgery. ........................................................................................................................

With surgery ..............................................................................................................................

Maiignant neoplasm ...........................................................................................140-209

Without surgery ............................................................................................................... ..........

With surgery ..............................................................................................................................

Other diagnoses ................................................................................................ Residual

Without surgery .........................................................................................................................

With surgery ..............................................................................................................................

—Male

All diagnoses..............................................................................................................

Without surgery. ........................................................................................................................

With surgery ..............................................................................................................................

Heart disease.............................................39@398. 400.1,402,404,410-414, 420-429

Without surgery .........................................................................................................................

With surgery ..............................................................................................................................

Malignant neoplasm ...........................................................................................l4O.2m

Without surgery . .......................................................................................................................

With surgery ..............................................................................................................................

Other diagnoses ................................................................................................ Residual

Without surgery .........................................................................................................................

With surgery ............................................................................................................................ .

Female

All diagnoses..............................................................................................................

Without surgery .........................................................................................................................

With surgery ..............................................................................................................................

Heart dsease .............................................390-398,400.1,402,404,41 0-414,420-429

Without surgery .........................................................................................................................

With surgery ..............................................................................................................................

Malignant neoplasm ...........................................................................................l402~

Without surgery .........................................................................................................................

With surgery ..............................................................................................................................

Other diagnoses................................................................................................ Residual

Without surgery .........................................................................................................................

With surgery ..............................................................................................................................

All Under 15 15-44 45-64 65 years

ages years years years and over

Number in thousands

35,902

20,888

15,014

2,847

2,366

481

1,728

788

940

31,327

17,735

13,593

14,385

8,576

5,809

1,%0

1,226

313

794

385

408

12,051

6,964

5,087

21,518

12,313

9,205

1,307

1,140

168

934

403

532

19,276

10,770

8,506

3,775

2,150

1,626

22

16

6

33

20

12

3,721

2,113

1,607

2,137

1,194

943

13

8

5

16

9

7

2,108

1,177

931

1,638

955

683

9

7

2

17

11

6

1,613

937

676

15,180

8,110

7,070

216

162

55

235

66

147

14,728

7,860

6,868

4,553

2,530

2,023

141

104

37

80

42

38

4,333

2,385

1,948

10,627

5,579

5,047

76

58

18

156

47

109

10,395

5,475

4,921

8,604

4,933

3,671

1,063

819

244

658

302

355

6,884

3,812

3,072

4,042

2,443

1,598

681

505

176

285

139

147

3,075

1,600

1,276

4,562

2,490

2,072

381

314

68

372

164

208

3,808

2,012

1,796

8,344

5,696

2,647

1,546

1,370

177

803

377

426

5,995

3,950

2,045

3,653

2,408

1,245

705

609

96

413

195

217

2,535

1,603

932

4,690

3,289

1,402

841

761

81

390

181

206

3,459

2,347

1,113

13
Table 2. Rate per 1,000 civilian noninstitutionalized population of patients discharged from short-stay hospitals, by age, sex, first-listed diagnostic

category, and surgical status: United States, 1977

[ Excludes newborn infants and discharges from Federal and long-term hospitals]

Sex, first-1isted diagnostic category, surgical status,

and ICDA code

Both sexes Rate par 1,000 population

169.2

98.4

70.8

13.4

11.2

2.3

8.1

3.7

4.4

147.6

83.6

64.1

140.5

83.7

56.7

15.0

12.0

3.1

7.8

3.8

4.0

117.7

68.0

49.7

196.0

112.2

63.8

11.9

10.4

1.5

8.5

3.7

4.8

175.6

98.1

77.5

73.3

. 41.8

31.6

0.4

0.3

0.1

0.6

0.4

0.2

72.3

41.1

31.2

81.4

45.5

35.9

0.5

0.3

0.2

0.6

0.4

0.3

80.3

44.8

35.5

65.0

37.9

27.1

0.3

0.3

0.1

0.7

0.4

0.2

64.0

37.1

26.8

159.7

85.3

74.4

2.3

1.7

0.6

2.5

0.9

1.5

154.9

82.7

72.3

98.5

54.7

43.8

3.0

2.2

0.8

1.7

0.9

0.8

93.7

51.6

42.1

217.8

114.3

103.4

1.6

1.2

0.4

3.2

1.0

2.2

212.9

112.1

100.8

198.4

113.8

64.7

24.5

18.9

5.6

15.2

7.0

8.2

158.8

87.9

70.9

195.2

118.0

77.2

32.9

24.4

8.5

13.8

6.7

7.1

148.5

86.9

61.6

201.4

109.9

91.5

16.8

13.9

3.0

16.4

7.2

9.2

168.1

88.8

79.3

374.4

255.6

118.8

68.4

61.5

7.9

36.0

16.9

19.1

269.0

177.2

91.8

396.9

.—

261.6

135.3

76.6

66.2

10.4

44.8

21.2

23.6

275.5

174.2

101.3

358.6

.—

251.4

107.2

64.3

58.1

6.2

29.8

13.9

15.9

264.5

179.4

85.1

14
Table 3, Average length of stay for patients discharged from short-stay hospitals, by age, sex, first-listed diagnostic category, and surgical status:

United States, 1977

[Excludes newborn infants and discharges from Federal and long-term hospitals ]

Sex, first-listed diagnostic category, surgical status,

and ICDA code

Heart disease...................................................39O.398. 400.1,402,404,410-414, 420-429

Without surgery ...............................................................................................................................

With surgery ....................................................................................................................................

Malignant neoplasm .................................................................................................l4O.2W

Without surgery ...............................................................................................................................

With surgery ....................................................................................................................................

Other diagnoses ...................................................................................................... Residual

without surgery ...............................................................................................................................

With surgery ....................................................................................................................................

Male

All diagnoses....................................................................................................................

Without surgery ...............................................................................................................................

With surgery ....................................................................................................................................

Heart dsease ...................................................390-398,400.1,402,404, 410-414,420429

Without surgery ...............................................................~...............................................................

With surgery ....................................................................................................................................

Malignant neoplasm .................................................................................................l4@2~

Without surgery ...............................................................................................................................

With surgery ....................................................................................................................................

Other diagnoses .................................................................................................... Residual

Without surgery ...............................................................................................................................

‘With surgery ....................................................................................................................................

Female

All diagnoses.........................................................................................+. ........................

Without surgery ...............................................................................................................................

With surgery ............................................................................................................................. .......

Haart disease...................................................39O.398. 400.1,402,404,410-414, 420-429

Without surgery ...............................................................................................................................

With surgary ....................................................................................................................................

Malignant neoplasm .................................................................................................l4&2~

Without surgery ...............................................................................................................................

With surgery ....................................................................................................................................

Othar diagnoses ...................................................................................................... Residual

Without surgary .:.............................................................................................................................

With surgery ....................................................................................................................................

All Under 15 15-44 45-64 65 years

ages yaars years years and ovar ,

7.3

7.1

7.5

9.9

9.6

11.6

12.2

10.4

13.6

6.8

6.7

7.0

7.8

7.4

8.4

9.5

9.1

10.9

12.3

10.1

14.3

7.3

6.9

7.7

7.0

7.0

7.0

10.5

10.1

12.8

12.1

10.7

13.1

6.5

6.5

6.5

Average length of stay in days

4.2

4.4

3.9

8.2

8.5

7.7

8.4

6.2

12.1

4.1

4.4

3.8

4.3

4.5

4.0

8.0

8.2

7.5

8.2

7.0

9.8

4.2

4.5

4.0

4.1

4.3

3.8

8.6

8.7

8.2

8.6

5.6

14.7

4.0

4.3

3.7

5.3

5.2

5.5

8.0

7.6

9.2

8.4

7.2

9.1

5.2

5.1

5.3

6.3

6.1

6.5

7.9

7.8

8.4

9.1

6.6

11.5

6.2

6.1

6.4

4.9

4.8

5.0

8.2

7.4

10.9

8.1

7.6

8.3

4.8

4.7

4.9

8.5

8.0

9.2

8.9

8.6

10.1

12.0

10.2

13.4

8.1

7.7

8.6

8.6

7.8

9.8

8.9

8.6

9.7

12.3

10.2

14.2

8.2

7.4

9.3

8.4

.8.2

8.7

9.0

8.6

11.1

11.7

10.2

12.9

8.0

8.0

8.1

11.1

10.2

13.1

10.9

10.5

14.5

13.6

11.6

15.3

10.8

9.9

12.5

10.8

9.7

12.8

10.4

9.8

14.3

13.1

10.9

15.0

10.5

9.5

12.2

11.3

10.5

13.3

11.4

11.0

14.8

14.1

12.3

15.7

11.0

10.2

12.8

15
APPENDIXES

I.

n.

I.

I.

n.

HI.

Iv.

CONTENTS

Technical Notes on Methods ..........................................................................................................

Statistical Design of the National Hospit.al Dischqe S.ey ...................................................

Data Collection and Processing .................................................................................................

Presentation of Estiates ..........................................................................................................

Reliability of Estimates .............................................................................................................

Hypothesis Testing ....................................................................................................................

Defiitionsof Certain Terms Used inThk Report ........................................................................

Hospitrds and Hospitrd Ch.tenstics .......................................................................................

Terms Refating to Hospitalization .............................................................................................

Terms Relating to Diagnoses .....................................................................................................

Terms Relating to Surgery ........................................................................................................

Demographic Terms ...................................................................................................................

Medical Abstract for the 1977

APPENDIX FIGURE

National Hospital Discharge Survey ..............................................

LIST OF APPENDIX TABLES

Distribution of short-stay hospitals in the universe (Nationrd Master Facility Inventory) and in

the National Hospital Discharge Survey sample and number of hospitals that participated in

the survey, by geographic region and bed size of hospital: United States, 1977 .......................

Civilian noninstitutionalized population by sex and age: United States, July 1, 1977 .................

Approximate standard errors of estimated numbers of discharges and of associated average

lengths of stay: United States, 1977 ............................................................ ..............................

Worksbeet for weighted least squares regression of average length of stay on age for male

patients discharged with a first-listed diagnosis of heart disease: United States, 1977 ...............

17

17

18

19

21

23

26

26

26

26

27

27

20

18

21

22

25

16
APPENDIX I

TECHNICAL NOTES ON METHODS

Statistical Design of the National

Hospital Discharge Survey

Scope of the sumey.–The National Hospital

Discharge Survey (NHDS) encompasses patients

discharged from hospitals located in the 50

States and the District of Columbia. Only

hospitals having six beds or more for patient use

and an average length of stay for all patients of

less than 30 days are included in the survey.

Although all discharges of patients from these

hospitals are within the scope of the survey,

discharges of newborn infants are excluded from

this report.

Sampling frame and size of sample. –The

sampling frame (universe) for hospitals in the

NHDS is the National Master Facility Inventory

of Hospitals and Institutions (NMFI). A detailed

description of how the NMFI was developed, its

contents, plans for maintaining it, and procedures for assessing the completeness of its

coverage has been published.s

The universe for the survey consisted of

6,965 short-stay hospitals contained in the

NMFI in 1963,442 hospitals that were added to

the NMFI in 1969, 223 hos~itals that were

added in 1972, and 273 hospitals that were

added in 1976. The distributions of the hospitals

in the NMFI and in the NHDS sample are shown

by bed size and geographic region in table L

The sample of hospitals for 1977 consisted

of 535 hospitals. Of these hospitals, 68 refused

to participate and 44 were out-of-scope either

because they had gone out of business or

because they failed to meet the definition of a

short-stay hospital. Thus 423 hospitals particiNOTE: A list of references follows the text.

Dated .in the survev during 1977 and Provided

approximately 224,000 ~bstracts of’ medical

records.

Sample deszgn.-illl hospitals with 1,000

beds or more in the universe of short-stay

hospitals were selected with certainty in the

sample. All hospitaIs with fewer than 1,000 beds

were stratified; the primary strata were the 24

size-b y-region classes shown in table I. Within

each of these 24 primary strata, allocation of the

sample hospitals was made through a controlled

selection teehnique so that hospitals in the

sample would be representatively distributed

regarding type of ownership and geographic

division. Sample hospitals were drawn with

probabilities ranging from certainty for the

largest hospitals to 1 in 40 for the smallest

hospitak.

The within-hospital sarnpIing ratio for selecting sample discharges varied inversely with the

probability of selection of the hospital. The

smallest sampling fraction of discharged patients

was taken in the largest hospitals, and the largest

fraction was taken in the smallest hospitals. This

compensation for the probability of hospital

selection ensured that the overall probability of

selecting a discharge would be approximately the

same for each hospitzd size class.

In nearly all sample hospitals, the daily

listing sheet of discharges was the frame from

which the subsamples of discharges were selected. The sample discharges were selected by a

random technique, usually on the basis of the

terminal digit(s) of the patient’s medical record

number—a number assigned when the patient

was admitted to the hospital. If the hospital’s

daily discharge listing did not show the medical

record numbers, the sample was selected by

17
Table 1. Distribution of short-stay hospitals in the universe (National Master Facility Inventory) and in the National Hospital Discharge

Survey sample and number of hospitals that participated in the survey, by geographic region and bed size of hospital: United

States, 1977

Bed size of hospital

All sizes

Universe ............... ........................................................................................................

Tokl smple .................................................................................................................

Number participating .............. .............................. .............................. .........................

6-49 beds

Universe ............... ........................................................................................... .............

Total sample .......... ................ .......................................................... .............................

Number participating ............ ................................................................ .......... .............

50-99 beds

Universe ....... ........ .......... .............. .............................................................. ........ ..........

Total sample .......... ...... ................................ .. .................... ........ .. .............................. ...

Number participating ........................................ ...........................................................

100-199 beds

Universe .......... .......... ...................................................... .................................... .. .......

Total mmple ........................................... .............................. ...................... ..................

Number participating ................... .. ................ ................ ...................... ........................

200-299 beds

Universe ............. ................................ .............. ................ Y.............. ................ ............

Total sample ............... ..................................................................................................

Number participating ....... ................................................ ...... .............. ........................

300499 beds

Universe ......................... ........ ........................ ............................................................ ..

Total mmple ............................................................................... ................ .......... ........

Number participating ............. .................... ........................................ ........ ..................

500-999 beds

Universe .......................................................... .............................................................

Total sample .................... ....... ................ ........................ ...................... .. ......................

Number participating ...................................................... ...... ................................ .......

1,000 beds or mora

Universe ..................................... ............................... ...................................................

Total sample ........................................................ .........................................................

Number participating .. ............................ .......... ........ .................................. .... .............

All IINorthregions east

North

Central I

South IWest

7,903

535

423

3,486

69

44

1,871

79

58

1,371

117

98

614

97

76

408

97

81

135

58

49

18

18

17

Number of hospitals

1,177

132

113

221

8

6

289

14

10

288

26

25

193

31

26

112

25

21

45

19

17

9

9

8

2,214

152

120

889

18

15

482

20

14

404

33

28

164

27

21

134

32

26

48

19

13

3

3

3

3,130

170

125

1,658

30

16

721

31

23

448

39

27

1(30

2!4

17

108

28,

i!5

29

II3

112

5

5

5

1,472

81

65

718

13

7

369

14

11

221

19

18

97

15

12

53

12

9

13

7

7

1

1

1

starting with a randomly selected discharge and ministrator, the sample selection and the trantaking every kth discharge thereafter. scription of information from the hospital

records to abstract forms were performed by the

Data Collection and Processing hospital staff, representatives - of the National

Center for Health Statistics (NCHS), or both.

Data ‘collection. –Depending on the study This task was performed by the medical records

procedure negotiated with each hospital’s ad- department in about two-thirds of the hospitals

18
that participated in the NHDS during the year.

In the remaining hospitals, this task was performed by personnel of the U.S. Bureau of the

Census acting for NCHS.

An abstract form was used to transcribe data

from hospital records. The abstract form provided space for recording demographic data,

admission and dkcharge dates, zip code of the

patient’s residence , expected sources of payment, disposition of patient at discharge, and

information on discharge diagnoses and surgical

operations or procedures (figure 1). With one

exception, all discharge diagnoses and operations

for each sample discharge were listed on the

abstract form in the order in which they

appeared on the face sheet of the medical

record. The exception was that any diagnosis

identified on the face sheet as the principal

diagnosis was always recorded as the first-listed

diagnosis.

Shipments of completed abstract forms for

each sample hospital were transmitted, along

with sample selection control sheets, to a Census

Regional Office. Every shipment of abstracts

was reviewed and each abstract form was

checked for completeness. Abstracts were then

sent to NCHS for processing.

Medical coding and edit. –The medical information recorded on the sample patient abstracts

was coded centrally by the staff of NCHS. A

maximum of five diagnostic codes was assigned

for each sample abstract; in addition, if the

medical information included surgery, a maximum of three codes for surgical operations and

procedures was assigned. Following the conversion of the data on the Medical Abstract form to

computer tape, a final medical edit was accomplished by computer inspection runs and a

review of rejected abstracts. If the sex or age of

the patient was incompatible with the recorded

medical information, priority was given to the

medical information in editing.

The basic system used for coding the diagnoses on the NHDS sample patient abstracts was

the Eighth Revision International Classification

of Diseases, Adapted for Use in the United

States2 (ICDA-8). Modifications of the ICDA-8

have been made for NHDS because of incomplete or ill-defined terminology on the abstracts.

Only one such modification affects the data

presented in this report: code 400.1, malignant

hypertension with heart involvement classifiable

to codes 427-429, was modified to include only

malignant hypertension with heart involvement

classifiable to codes 427.1-429.

The basic system for coding surgical operations and procedures was the ICDA-8 section on

“Surgical Operations, Diagnostic and Other

Therapeutic Procedures,” which was modified in

certain areas to accommodate incomplete terminology on the source documents, that is, lack of

specificity of the body site involved, of surgical

method or approach, or of other details prescribed by the ICDA-8. The following operations

or procedures were not coded: some operations

inducing or assisting delivery (75.0-75.6, 75.9),

Diagnostic Endoscopy (A4-A5), Diagnostic

Radiography (A8-A9), Radiotherapy and Related Therapies (Rl), Physical Medicine and

Rehabilitation (R4), and Other Nonsurgical Procedures (R9). Except for these omissions, the

surgical modifications employed in coding

NHDS medical data do not apply to the classifications used in this report.

Presentation of Estimates

Patient character&tics not stated.–If the age

or sex of the patient was not stated on the face

sheet of a sample discharge’s medical record, it

was imputed by assigning the patient an age or

sex consistent with the age or sex of other

patients with the same diagnostic code. Age and

sex were not stated for less than one-fourth of 1

percent of the discharges. If the dates of

admission or discharge were not given and if

they could not be obtained from the monthIy

sample listing sheet transmitted by the sample

hospital, a length of stay was imputed by

assigning the patient a stay characteristic of the

stays of other patients of the same age.

Rounded num~ers. –Estimates of the numbers of inpatient discharges have been rounded

to the nearest thousand for tabular presentation.

Therefore, detailed figures within the tables do

not always add to totals. Rates, percents, and

average lengths of stay were calculated on the

basis of unrounded figures and will not necessarily agree with computations made from the

rounded data.

Population estimates. –The population estimates used in computing rates are unpublished

19
Form Approved: O.M. B. No. 68. R062C

CONFIDENTIAL – All informat!oo whtch would perm!t identiftcatlon of an individual or of an establishment will be t=

confidential, WI II be used only by persons engaged In and for the purposes of the survey, and will not be d!sclosed or released to

ocher persons or used for any other purpose,

FORM HD5-1

—

DEPARTMENT OF HEALTH, EOUCATION, AND WELFARE

(12-13-76)

PUBLIC HEALTH SERVICE

HEALTH RESOURCES ADMINISTRATION

NATIONAL CENTER FOR HEALTH STATISTICS

MEDICAL ABSTRACT - HOSPITAL DISCHARGE SURVEY

A. PATl ENT IDENTIFICATION Month E ay Year —

1.Hospital number . I I4..ateofatlrnission.. m-m-ml

2. HDS number,,,.,., 11111 5.Date of discharge , . .In-m-m

3.Medical Record number 6. Residence ZIP Code

B. PATl ENT CHARACTERISTICS I

~ 8. Age (Complete only if

1 ❑ Years

Month Oay Year

Units

m-m-m I“ate of’irth ‘otgiv=’ ~ ml{ 2 ~ Months

7. Date of birth . 3 ~ Oays

9. Sex (Mark one) I I ❑ Male 2 ❑ Female 3 ❑ Not stated

I

—

10. Race or Color (Mark one) ~ 1 ~ white 2 ❑ Black 3 ❑ Other 4 ❑ Not stated

1

11.Marital Status (Mark one) ! I a Married 2 D single 3 ❑ widowed 4 ❑ oivorced s ❑ Separated 6 ❑ Not state(

12. Expected Source(s) of payment

Prjncipai Orher

(Mark one) (Mark a/f that app/y)

10 ❑ Self-pay

20 ❑ Workmen’s Compensation

3U U Medicare

40 n Medicaid

50 ~ Other government payments

Go U Blue Cross

70 C] Other private or commercial tnsurance

au ~ No charge

90 U Other (Specify)

100 ❑ Not stated

C. DIAGNOSES

13. Disposition of Patient (Mark ane)

1 ❑ Routine discharge/discharged home

2 ❑ Left against medical advice

3 ❑ Discharged/transferred to another

facility or organization

4 ❑ Discharged/referred to organized

home care service

s ❑ Died

s ❑ Not stated

Principal: —

Other/additional: —

m— See reverse side

D. SURGICAL AND DIAGNOSTIC PROCEDURES Date: —

Principal:

Other/additional: _

Month Day Year

M-M-ID

M-M-CD

CD-M-CD

CO-M-ED

Cn-m-cn

(_J NONE a See reverse side

=ompleted by Date

*W.. GOVERNMENTPI?INTINGOFFICE. ,,76-,,.WZ3.

Figure 1. Medical Abstract for the 1977 National Hospital Discharge Survey
Table 11. Civilian noninatitutionalizad population by sex and

age: Unitad Statasr July 1, 1977

[Population estimates consistent with Series P-25, Ctorerzt

Popsdation Reports, U.S. Bureau of the Census]

Age

Ail agas ....................

Under 15 yaars ....................

1544 yaars .........................

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

65 years and over ................

II I

Both

sexes II Male I

Female

11 I

Population in thousands

212,18211 102,399

_u- 51,481 26,260

95,060 46,231

43,357 20,704

22,284 9,204

108,782

25,220

48,828

22,653

13,080

U.S. Bureau of the Census estimates for the U.S.

civilian noninstitutionalized population on July

1, 1977. The estimates by age and sex are

presented in table II and are consistent with the

population estimates published in Current Population Reports, Series P-25. However, they are

not offlcizd population estimates of the Bureau

of the Census.

Reliability of Estimates

Estimation. -Statistics produced by NHDS

are derived through a procedure in which the

basic unit of estimation is the sample inpatient

discharge abstract. The estimating procedure

produces essentially unbiased nationaI estimates

and has three principal components: inflation by

reciprocals of the probabilities of sample selection, adjustment for nonresponse, and ratio

adjustment to fixed totals. These components of

estimation are described in appendix I of two

earlier publications.G~7

Measurement errors. –As in any survey, resuhs are subject to nonsampling or measurement

errors, which include errors due to hospital

nonresponse, missing abstracts, information incompletely or inaccurately recorded on abstract

forms, and processing errors. Some of these

errors were discussed under a previous section

entitled “Patient characteristics not stated. ”

Sampling errors. –The standard error (SE) is

primarily a measure of the variabiIit y that is

attributed to using a value obtained from a

NOTE: A list of references follows the text.

sample as an estimate of a population value. In

this report it ako reflects part of the measurement error. The value that would have been

obtained if a complete enumeration of the

population had been made w-W be contained in

an interval represented by the sample estimate

plus or minus 1 standard error about 68 out of

100 times and plus or minus 2 standard errors

about 95 out of 100 times.

The standard error of one statistic generally

differs from that of another of equal size, even

when the two come from the same survey. To

derive standard errors that would be applicable

to a wide variety of statistics and that could be

prepared at a moderate cost, a number of

approximations are required. As a result, the

figures shown in tabIe III provide general standard errors for a wide variety of discharge and

average kength-of-stay estimates rather than the

specific errors for particular statistics. Standard

errors for those values omitted from the table

can be approximated through interpolation.

The relative standard error (RSE) of a

statistic is obtained by dividing the standard

error by the estimate and multiplying the

resulting value by 100. This calculation expresses the standard error as a percentage of the

estimate. The RSE’s of the rates presented in

this report are assumed to be equiwdent to those

of the corresponding discharge estimates. Consequently, the SE for a rate can be approximated

by using the information provided in table I to

compute the RSE for the corresponding dxscharge estimate and then applying that RSE to

the rate.

The RSE’S of the percentages used in this

report can be approximated by using the

f-ormula

P&p -<RSEN2 - RSE~2

where

RSEP = the approximate relative

error of a percentage;

RSEN = the approximate relative

error of the numerator

standard

standard

used in

computing the percentage; and

RSED = the approximate relative standard

error of the denominator used in

computing the percentage.

The SE of the percentage then can be approximated by applying the RSE to the percentage.

21
Table II 1. Approximate standard errors of estimated numbers of discharges and of associated avarage lengths of stay: United States,

Number of discharges

in thousands

(bese of avarage

length of stay)

2 ........... ........ ................ ..........................................................

5 ........................ .. ............................................................... ...

lo ..................................................... ...................... ...............

20 .... ........ ................................ .......... ................ ...... ..............

40 ........... .... ...... ................ .....................................................

60 .......................... ................................ .......... ......................

so ........................... ........ .. ............................ .......... ........ .......

100 ......... .......................... ............ .........................................

3oo ....... ................................................ .................. ...............

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

l.wo ........... .................................. ........ ................ ................

5.0m .......................... .......................................... .................

lorwo ................. ....... ................. ........ ........ ................ ..........

m.wo .............................................. .. ...................................

30.m .................. ................ ...... ...... ................ .....................

1977

Approximate

standard error of

dischar~ estimate,

in thousands

0.5

1.0

1.7

2.9

4.8

6.6

8.2

9.7

22.4

33.3

57.1

204.6

357.9

628.8

878.7

2

—

0.4

0.3

0.3

0.2

0.2

0,2

0.2

0.2

0.1

0.1

0.1

0.1

0.1

0.1

0.1

Average length of stay

in days

4 6 8 10 12 l=114 16

Standard error in days

0.7

0.5

0.5

0.4

0.3

0.3

0.3

0.3

0.2

0.2

0.2

0.1

0.1

0.1

0.1

—

1.0

0.8

0.7

0.6

0.5

0.5

0.4

0.4

0.3

0.3

0.3

0.2

0.2

0.1

0.1

1.3

1.0”

0.9

0.7

0.6

0.6

0.5

0.5

0.4

0.4

0.3

0.2

0.2

0.2

0.2

1.6

1.3

1.1

0.9

0.8

0.7

0.7

0.6

0.5

0.4

0.4

0.3

0.2

0.2

0.2

1.9

1.5

1.3

k:

0.8

0.8

0.7

0.6

0.5

0.4

0.3

0.3

0.2

—

;!.2

1.7

11.5

11.2

11.0

11.0

().9

0.8

().7

().6

().5

0.4

().3

().3

.—

2.5

2.0

1.7

1.4

1.2

1.1

1.0

1.0

0.8

0.7

0.6

0.4

0.4

illustration of use of table III: As ahown in tables 1-3, an estimated 803,000 patients 65 years of age and over with a fust-listed diagnosisof a

malignant neoplasm were discharged in 1977 from non-Federal short-stay hospitals. Thisrate is equal tos rate of 36.0 dischargesper 1$00 civilian

noninstitutionalized population 65 years of age and over. This group constitutes 9.6 percent of all discharges65 years of age and over. The average

length of stay for these dischargeswas 13.6 days.

By interpolation, the standard error of the dischargeestimate is approximately 47.7 thousand discharges

‘E803,000 discharges = 33,300+

( )

803’000-500’000 X (57,100 - 33,300)= 47,722.8 1,000,000-500,000

Also by interpolation, the standard error of the associated length of stay of 13.6 daysis approximately 0.5 days

SE13.6 days, 500,000 discharges‘05+(-)

X (0.6 - 0.5)= 0.58

SE13.6 days, 1,000,000 discharges‘04+(-)

X (0.5 - 0.4)= 0.48

SE13.6 days, 803,000 disch~ges

( )

803’w0 -500’000 X (0.48 - 0.58)= 0.52

= 0“58+ 1,000,000-500,000

The standard error of the associated rate of 36.0 discharges per 1,000 civilian noninstitutionalized population is approximately 2.1 discharges

‘E803,000 discharges ()

47,700

= — X 100= 5.9 percent 803,000

SE36,0~e, fi~umnd, 803,000 discharges = 0.059 X 36.0= 2.12

Fbdly, the standard error of the 9.6 percent is approximately 0.4 percentage points

(

WI,3.M,000 discharges = 204J600 + 10000 000_ s 000000 )

8’3w’000 -5’000’000 X (357,900 - 204,600)= 307,127.0

,> >,

‘ES,344,000 discharge ‘(-)

X 100 = 3.7 percent

RSE9,6~e,cent= ~= 4.6 percent

‘E9.6 percent = 9.6 X 0.046= 0.4 percent

22
Hypoth&is Testing

Two methods of hypothesis testing were

used in this report.

Bonferroni test. – For testing the difference

between two estimates (e.g., frequencies, percentages, regression slopes), the two-tailed

Bonferroni test for multiple comparisons was

performed. The size of the test statistic computed determines whether or not the null

hypothesis that the two parameters being estimated do not differ is rejected in favor of the

alternate hypothesis that they do differ. For the

estimates Xl and X2, the null hypothesis is Ii. :

PI = P2, and the alternate hypothesis is ~* : PI

# P2, where PI and P2 are the population

parameters of which Xl and X2 are estimates.

The test statistic is equal to the difference

between the two estimates divided by the

standard error of that difference. The standard

error of the difference between two estimates is

approximated by the square root of the sum of

the squares of the standard errors of each of the

estimates. (This calculation represents the actual

standard error for the difference between

separate and uncorrelated statistics, although it

is only a rough approximation in most other

, cases.)

Thus the null hypothesis that two parameters

PI and P2 do not differ is rejected if the

probability of a type I error (i.e., the probability

of rejecting a true null hypothesis) is less than 5

percent, that is, if:

b

z=

xl- x

2/>critic~v~ue

SEX? + SEX22

The critical value increases from 1.96 to

3.291 as the total number of, possible comparisons among estimates for subdomains of a

domain increases from 1 to 50. (A domain can

consist of the entire underlying population or a

subset of the underlying population that contains all elementary units belonging to, a particular category of at least one health or

demographic variable. A subdomain is a subset

of a domain consisting of all elementary units

that Ibelong to a particukr category of at least

I one health or demographic variable other than

the variables that define the domain.)

For example, in detailed table 2, the rate per

1,000 c.ivilian-noninstitutionalized populatio~ of.

male heart disease discharges was 15.0 (Xl ), the

rate of maIe malignant neopksm discharges was

7.8 (X2 ), and the rate of zill other male

discharges was 117.7 (X8 ). The difference between the maIe heart disease and malignant

neoplasm discharge rates (i.e., If. : P1 = P2, and

HA : PI ‘# P2) is tested. For this exampIe, later

comparisons among these rates and the

corresponding rates for females (X4, X5, and

X6) are planned. Thus the domain consists of all

chscharges and the subdomains are the six sex-by

dia~osis categories. Fifteen possible comparisons among the estimates for the subdomains

exist (i.e., Xl and X2, Xl and X3, Xl and X4,

etc. ), and the critical value for the test statistic

for each possible comparison is 2.935. By using

the method presented in the preceding section

of this appendix: RSEXI = 5.000 percent; SEX ~

= 0.750; RSEX2 = 5.597 percent; and SEX ~ =

0.465. Because

z=L

15.0- 7.8

.7502 + .4652 /’

= 8.159>2.935

the male heart disease discharge rate is significantly greater than the male malignant neopIasm

rate.

Weighted least squares as a test for trend.–lf ‘

it is hypothesized that a linear relationship exists

between an independent variabIe and a dependent variabIe (e.g., age and average length of

stay), then a useful test for this relationship is to

fit a regession line to the data, determine the

slope of the line, and then determine whether or

not this slope is significantly different from

zero. That is, a regression lime of the form

is fitted to the data, where, for this example, ~~

= predicted average length of stay, Xi = age, a =

the estimated ~-intercept, that is, the estimated

average length of stay if age equals zero, and b =

the estimated slope of Y on X, that is, the

estimated rate of change in average length of

stay per unit change in age.

The data available from the National HospitaI Discharge Survey present certain basic

23
problems that discourage the use of classical

regression procedures. Among these problems

are violation of the assumptions of independence of the original observations, violation

of homoscedasticity, that is, equal variances of

the dependent variable within each category of

the independent variable, perhaps violation of

the normality assumption, and so forth. Dr. Paul

Levy, formerly of NCHS, has devised a “modified regression model which makes no assumptions about the original observations and which

makes no stronger assumptions about the sample

estimates than are made in testing whether two

means are equal when the estimated means and

their standard errors are obtained from complex

surveys. “b

The proposed model is as follows:

1.

2.

3.

4.

5.

Let ~i be the estimated mean and S7i be

the estimated standard error for the ith

group.

Let Xi be the midpoint of the independent variable for the group.

Assume SFi is based on a large enough

number of observations that it can be

assumed to be equal to aYi and thus

without sampling error.

Further assume that

E (y”) = cl+pxi

V(~.)=S$j fori=l,2, . . ..K.

where a is the true ~-intercept, ~ is the

true slope, and K is the number of

groups.

Finally, assume that the ~,’s are normally

distributed and are sta~istically independent of each other.

The weighting procedure proposed weights all

observations by the reciprocal of the variance.

That is, Wi = l~$i and the mean X = Zwi~./Zw;

and the mean Y = Zwi~;/Zwi.

b From an unpublished memorandum by Dr. Levy.

The slope is computed in a manner similar to

the classical least squares regression, by using the

following formula

This is easily computed by using

The variance of the slope is

Because Wj = l/o~i, this formula can be simplified to

Zw;(xj-X)2 ‘;=[~w~(x’j - X)2] 2 = 2W.j(Xj:X?

and computationally

Sb = J

1

2WjX~ - (ZWj)Z2

For the weighted least squares test, the null

hypothesis is that the slope of the regression line

does not significantly differ from zero, and the

zdternate hypothesis is that it does differ from

zero (i.e., Ho :j?=O, and H~:~#O). An

approximate normal deviate test of the null

hypothesis can be performed by computing z =

b/Sb and comparing the absolute value of the

result to the appropriate critical value. The

critical value for this test also varies from 1.96

to 3.291 as the number of simultaneous trends

being tested varies from 1 to 50.

As an example, the average length of stay

(~ for male heart disease discharges by age (X)

is recorded as shown in table IV. Because a test

of the relationship between age and average

length of stay is planned for each of the six sex

by diagnosis categories, the appropriate critical

24
Table IV. Worksheet for weighted least squaras regression of average length of stay on age for male patients discharged from short-stay

hospitals with a first-listed diagnosis of heart disease: United States, 1977

Midpoint Average Standard

Age of age length of error of

group stay i~ average ~i = 1/s2

length of Yi

in years days (Y)

stay (Sj+

Under 15 years ......................................................................................................... 7.0 8.0 0.805 1.643

1544 years ............................................................................................................... 28.5 7.9 0.472 4.489

45-64 yea~ ............................................................................................................... 54.5 8.9 0.379 6.962

65 years andover...................................................................................................... 75.0 10.4 0.428 5.434

value for a weighted least squares test here is ~W~~i = 166.282 Sb = 0.011

2.638. By applying the method described to the

data shown, we have:

ZwiXi2 = 55,227.290 z = 3.909

Because the z value is greater than the

ZwiXi~i = 8,748.008 ~= 50.478 critical value, a positive association between the

Zwi = 18.428 Y= 9.023 average Iength of stay and age is demonstrated

ZwiXi = 930.206 b = 0.043 for the mde heart disease discharges.

000

25
‘- APPENDIX II

DEFINITIONS OF CERTAIN TERMS USED IN THIS REPORT

Hospitals and Hospital Characteristics

Hospitals. –Short-stay special and general

hospitals having six beds or more for inpatient

use and an average length of stay of less than 30

days. Federal hospitals and hospital units of

institutions are not included. ‘

Bed size of hospital. –Measured by the number of beds, cribs, and pediatric bassinets regularly maintained (set up and staffed for use) for

patients; bassinets for newborn infants are not

included. In this report the classification of

hospitals by bed size is based on the number of

beds at or near midyear reported by the hospitals.

Terms Relating to Hospitalization

l?atient. –A person who is formally admitted

to the inpatient service of a short-stay hospital

for observation, care, diagnosis, or treatment. In

this report the number of patients refers to the

number of discharges during the year, including

any multiple discharges of the same individual

from one short-stay, hospital or more. Infants

admitted on the day of birth, directly or by

transfer from another medical facility, with or

without mention of a disease, disorder, or

immaturity are included. All newborn infants,

defined as those admitted by birth to the

hospital, are excluded. The terms “patient” and

“inpatient” are used synonym ously.

Discharge. –The formal release of a patient

by a hospital; that is, the termination of a period

of hospitalization by death or by disposition’ to

the place of residence, a nursing home, or

another facility. The terms “discharges” and

“patients discharged” are used synonymously.

Discharge rate. –The ratio of the number of

hospital discharges during a year to’ the number

,.

of persons in the iivilian noninstltutiona.lized

population July 1 of that year.

Days of care.–The total number of patient

days accumulated at time of discharge by

patients discharged from short-stay hospitals

during a year. 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 dkcharged on

different days, the number of days of care is

computed by counting all days from (and

including) the date of admission to (but not

including) the date of discharge.

Ave~age length o~stay.–The total number of

patient days accumulated at the time of discharge by patients discharged during the year,

divided by the number of patients discharged. ,

Terms Relating to Diagnoses

Discharge diagnosis. –One or more diseases

or injuries (or special conditions and examinations without sickness or tests with negative

findings) that the attending physician assigned in

the medical record of a patient. The number of

principal or first-listed diagnoses is equivalent to

the number of discharges.

Principal diagnosis.–The condition testablished after study to be ‘chiefly responsible for

occasioning the admission of the patient to the

hospital for care.

First-listed diagnosis. –The coded diagnosis

either identified as the principal diagnosis or

listed first on the face sheet of the medical

record. The number of fh-st-listed diagnoses is

equivalent to the number of discharges.

26
Heart diseases.–ICDA-8 codes 390-398,

400.1, 402, 404, 410-414, and 420-429. The

diagnoses included in these codes are: active

rheumatic fever; chronic rheumatic heart disease; malignant hypertension with heart involvement classifiable to ICDA-8 codes 427.1-429;

hypertensive heart disease; hypertensive heart

and renal disease; acute myocardizd infarction;

chronic and acute ischemic heart disease; angina

pectoris; asymptomatic ischemic heart dkease;

acute pericarditis, nonrheumatic; acute and subacute endocarditis; acute m yocarditis; chronic

disease of pericardium, nonrheumatic; chronic

disease of endocardium; cardiomyopathy; pulmonary heart disease ; symptomatic heart disease; other myocardial insufficiency; and illdefined heart disease. Other diseases of the

circulatory system that are excluded by these

codes are: malignant hypertension except with

heart involvement classifiable to ICDA-8 codes

427.1-429; essential benign hypertension; hypertensive renal disease; cerebrovascular disease;

diseases of arteries, arterioles, and capillaries;

diseases of veins and Iymphatics; and other

diseases of the circulatory system.

Malignant neofda-sms. –ICDA-8 codes 140-

209. These codes include aI1 diagnoses of a

neoplasm specified as maEgnant. Excluded are

all diagnoses of a benign neoplasm or a neoplasm

of an unspecified nature.

Terms Relating to Surgery

Discharges with surgery. —The estimated

number of surgically treated patients discharged

from non-Federal short-stay hospitals during the

year.

Operation.–One or more surgical operations,

procedures, or special treatments that are assigned by the physician to the medical record of

a patient discharged from the inpatient service

of a sample hospital. For NHDS, all terms listed

on the face sheet (summary sheet) of the

medical record under the captions “operation,”

“operative procedures,” “operations and/or

special treatments, ” and the like are transcribed

in the order Iisted.

Demographic Terms

Age. –Patient’s age refers to age at birthday

prior to admission to the hospital inpatient

service.

Geographic region. –Hospitals are classified

by location in one of the four geographic regions

of the United States delineated by the U.S.

Bureau of the

Re@”on

Northeast ........

North Central..

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

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

Census.

States included

Maine, New Hampshire, Vermont, Massachusetts, Rhode

Island, Connecticut, New

York, New Jersey, and Pennsylvania

Michigan, Ohio, IIIinois, Indiana, Wisconsin, Minnesota,

Iowa, Missouri, North Dakota,

South Dakota, Nebraska, and

Kansas

Delaware, Maryland, District

of Columbia, Virginia, West

Vii@la, North Carolina,

South CaroIina, Georgia, F1orida, Kentucky, Tennessee,

Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, and

Texas

Montana, Idaho, Wyoming,

Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon. California, Hawaii, and AIaska

000

27
VITAL AND HEALTH STATISTICS Series

Scri+w 1. I+qpv2ms and Cf2&cticin Procfrirzi-rs. – Report, Y,. .Fhich ckcrilm the ~eneral program< of the Nationul

Center ~or Health Statiztic~ and it~ of~icc~ and divicktz and d.,ts ccdktion rncthods USMIand include

definition:, and other material necewxy for undcr~tzncling the dam.

S~7ies 3. ,4nalytical Stuc!ics. –Reports presenting unaIvticaI or intwprctive ~tudim bused cm vitzl and health

statistics, carrying the analysis further than the cxpo:ntory typL.:. of reportz m the other series.

S.rics 4. Docum.wts and L’ommittw Re-ports. – Find report~ of major cornmittec~ concerned with vital and

health statistics and documents such m rccornnwmdcd model ~.,jtJI rc~i~tration IaJ.JS ~d re~i~ed birth

and dezth certif’kattx

LL.rics 10. Data Fi-om tiw Htiwlth Interz,r’ew Survey. —St:~tisticz cm iIlrsej~, accidental inluries, disability, use of

hospital, rrwdiczl, dental, and other xrvicez, and other health-related topics, all bared on data cokctrd

~n&conlinuin<$ n~tional hottxhold inte~,ic~.: ~uR~y.

S,.ri,\ II. L)OM l.rorrt tllk, HL.a[th Examination Surr]cy and thr H(ralth and i’(utr&ion E::tmnirmtion Surt~ey. —Data

from direct c:. zmination, testing, and meamwrncnt of national samples of the civilian nottinstituiiona]izcd population provide the bwis for two types of reporl~: (I) eztimates of the medicdly defined

prcv.derice of specific diseases in the United State~ and the dimributions of the population with respect

~.ophysical, physiological, and psychological charactcri~tic~ and (2) analysis of relationships among the

i,,~rinus measurements wtitiout reference to an explicit finite unb.kmx of persons.

S:rits 12. Data From th(~ Znstitutionaliz& Population Swr.IL.ys.–Discontinued cff~ctit,c 1975. Future rqmrts from

[hew s.rrtwys will be in Series 13.

SCri+,s 1.3. Data on Hcalih RCSOUrCCSUtilization. –Statisticz on the utilization of hed!th manpov,w and facilities

providing long-tmrrt cam, arnbtrlato~; care, ho:pital care, Mc! famiIy planning mwices.

S(.ric’s 14. Lkta on HcaIth Resources: ,Mvr#m wv and Faci[itics. —Statiztic~ cm the numbers, geoy,zphic rlisLribution, and clmracterktic~ of health rejourcm includin~ phyriciatw, dentists, nurses, other health

occupation~, hospitals, nur~in~ homes, mrd outpatient faciIitiw.

S~-riL.scij. t2ata on /lIurtality. —I~a.rious :,tatistic~ on mortality other than w included in re~~ar annual or monthly

reports. Special analyses by caum of cktth, age, and other demoq~aphic variables: geographic and timv

:encs analyses; and statistim on characterimic~ of dcathz not av~ikble from the vital records bas~d on

sample surveys of those records.

Serifs 21. Data on Aratality, L\iarriU~P, and Dirorcc. –Various qtatistic~ on nata!ity, marriage, and divorce other

than as included in regular annual or monthly reports. Special analyzes by demographic vwiabks;

~eographic and time series arralyms; studies of fertility; and statistics on characteristics of births not

mailable from the vital records bawd on zampk wnwyz of thor.e record~.

Series 22 Data From tJw National Mortality and ,\’utality Surw,ys. –Discontinued effective 197.5. Future reports

from these somplc surveys ba~ed on ~,itzdmcordr v:i]l be included in !ikrk 20 and 21, respectively.

.%ri,x 23. Dda From the A’ational Survey of Family Growth. –Statisticx on fertility, fami[y formation and dis-

:,olutiors, family pknning, and related maternal and infant health topics deriseci from a biennial survey

c,f a nationwide probabili~ mmple of ever-m.arritid women 15-44 :;ear~ of a,ge.

For a list or title~ of rcport~ published in the~e seriez, v;ritc to: Scientific and Technical Information Branch

National Certtcr for Health Statistics

Public Hczdth Service

EIyattwille, hid. 207S2
.

NCHS

u.S DEPARTMENT OF HEALTH AND HUMAN SERVICES

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Publ,c Health sew.,

u.S. DEPARTMENT OF H.H. S

Of f,ce of Health Rewarch, Slattmcs, and Technology

HHS 396

Nat,onal Cenler for Health Smtsttcs

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Hymswlle, Maryland 20782

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