Total White Blood Cell 

Counts for Persons 

Ages 1-74 Years With 

Differential Leukbcyte 

Counts for Ad&s 

Ages 25-74 Years: 

United States, 1971-75 

This report presents white blood cell count 

findings for persons ages 1-74 years and 

differential leukocyte count findings for adults 

ages 25-74 years, by age, sex, and race, from 

the first National Health and Nutrition 

Examination Survey: United States, 1971-75 

Data From the National Health Survey 

Series 11, No. 220 

DHHS Publication No. (PHS) 82-1670 

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. 

January 1982 

National Center for Health Statistics

DOROTHY P. RICE, Directo~

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, LOSEE, Associate Director for Data Processing

and Services

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., Associzte Director for Research

and Methodolo~

PETER L. HURLEY, Associate Director for Vital and Health

Cizre Statistics

ALICE HAYWOOD, information Officer

Interview and Examimtion Statistics Program

E. EARL BRYANT, Associate Director

MARY GRACE KOVAR, Spectil Assistant for Data Policy

and Analysis

Division of Health Examination Statistics

ROBERT S. MURPHY, Director

SIDNEY ABR4114M, Chiefi Nutritional Statistics Branch

KURT R. MAURER, Acting Chief Survey Planning and

Development Branch

Division of Data Services

JAMES C. JACKS, Ph.D., Director

DAVID L. LARSON, ChieJ Health Examination Field

Operations Branch

Centers for Disease Control

Center for Infectious Diseases

Hematology Division

BRUCE L. EVATT, M.D., Director

O. W. VAN ASSENDELFT, M.D., Ph.D., Chief

General Hematology Branch

Cooperarl”onof the U.S.Bureau of the Census

In accordance with specifications established by the National

Center for Health Statistics, the U.S. Bureau of the Census, under a

contractual agreement, participated in the design and selection of the

sample and carried out the first stage of the field interviewing and

certain parts of the statistical processing.
Acknowledgments

The authors would like to aclmowledge the work of Carol

Williams and Laurel MacDowell, formerly of the Health Examination Field Operations Branch, Division of Data Services,

National Center for Health Statistics, for their assistance in the

preparation of this manuscript. Tne authors are also grateful

for the advice of Marguerite Candler Ballard, M-S., M.D.,

Centers for Disease Control.

..

11I
Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Source ofdata, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White blood cellcount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Smoking andthewhite bloodcell count . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Differential leukocytecount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Listofdetailed tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendixes

1. Statistical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Il. Definitions ofcertain termsused inthis repoti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111. Data collection methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lV. Quality control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Estimated mean white blood cell count bysex, age, and examination sample: United States, 197”

Estimated meanwhile blood cell count bvraceand age: Unitd States, l97l-74. . . . . . . . . . .

Estimated mean white blood cell count formales byraceand age: United States, l97l-74 . . . . .

-75 . . . . . . . . . . . . . .

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

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

Estimated mean white blood cell count for females by race andage: United States, 1971-74 . . . . . . . . . . . . . . . . . . . .

Estimated mean white blood cell count forwhite personsbysexand age: LJnited States, 1971-74 . . . . . . . . . . . . . . . .

Estimated mean white blood cell count for black persons bysexand age: United States, l97l-74. . . . . . . . . . . . . . . . .

Estimated mean percent ofsegmented neutrophils and lymphocytes byrace and age: United Statesr 1971-75. . . . . . . . .

Estimated mean number of segmented neutrophils and lymphocytes for white persons by sex and age: United Statesr

1971-75 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimated mean number of segmented neutrophils and Lymphocytes for black persons by sex and age: United States,

1971-75 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimated percent distribution of the U.S. population ages 25-74 years by mean number of segmented neutrophils:

United States, 1971-75 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. .

...

Ill

1

1

1

3

3

3

3

5

5

8

8

10

14

16

27

33

34

36

4

6

6

7

7

8:

10

11

11

12
11. Estimated percent distribution of the U.S. population ages 25-74 years by mean number of lymphocytes: United States,

1971-75 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

List of Text Tables

A. Estimated mean number and mean percent of leukocytes by type of leukocyte, according to age: United State!s,

1971-75 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

B. Percent distribution of the U.S. population by mean number of white blood cells, according to age: United State:s,

1971-74, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

C. Number of examined persons, mean number, and mean percent of white blood cells, segmented neutrophils, and lymphocytesfor adults ages25-74 years by race, sex, and smoking status: United States, 1971-75 . , , . . . , . . , . , . . . . . . . , 9

D. Number of smears and percent distribution by type of leukocyte, according to technologist number. . . . . . . . . . . . . . , 13

Symbols

--- Data not available

,,. Category not applicable

Quantity zero

0.0 Quantity more than zero b,ut less than

0.05

z Quantity more than zero but less than

500

*

Figure does not meet standards of

reliability or precision (more than

30-percent relative standard error)

# Figure suppressed tocomply with

confidentiality requirements
Total White Blood Cell Counts

for Persons Ages 1-74 Years

With Differential Leukocyte Counts

for Adults Ages 25-74 Years

by Cornelia R. McGrathr M.T. (ASCP),a Dale C. Hitchcock,b

and Onno W. van Assendelft, M. D., Ph. D.a

Introduction

Highlights

During the first National Health and Nutrition

Examination Survey, over 21,000 white blood cell

counts were performed on examinees 1-74 years of

age, and approximately 5,500 differential leukocyte

counts were performed on a subsarnple of examinees

25-74 years of age. The data obtained have been

expanded by appropriate weighting factors to represent the U.S. civilian noninstitutionalized population.

The results have been reviewed for race, sex, and

age differences.

Mean values, standard enors of the mean, and

percent distributions have been estimated for the

white blood cell counts. The white population was

found to have a higher white blood cell count than

the black population has. Children less than 6 years

of age have higher white blood cell counts than older

persons have.

Percent and absolute numbers of bands, segmented neutrophils, lymphocytes, monocytes, eosinophils, and basophils are also presented in this report.

The white population was found to have a higher

mean segmented neutrophil value both in percent and

absolute number than the black population has. This

higher neutrophil value accounts for most of the

higher total white blood cell count in the white population. Black adults have a higher mean percent of

lymphocytes than their white counterparts have.

Data collection

The National Center for Health Statistics collects,

analyzes, and disseminates data on the health of the

U.S. population. One major program is the National

Health Examination Survey, in which extensive examaCenters for Disease Control.

bDivislon of Health Examination Statisticsinations of a sample of the U.S. population are conducted, using mobile examination centers.

Between 1959 and 1970, three National Health

Examination Survey programs, or cycles, were conducted; each one airned at a specific segment of the

U.S. civilian noninstitutionalized population. Cycle I

(1959-62) was directed at the 18-79-year age group,

with a focus on certain clmonic diseases. Cycles II and

III (1963-65 and 1966-70) were concerned with children ages 6-11 years and youths ages 12-17 years,

respectively. These two pro~ams studied growth and

development by using selected tests and instruments

and screened the target populations for such conditions as heart disease, ear-nose-throat conditions, and

neuromuscular abnormalities. Descriptionsl-3 and

findings from the three programs have been published

by the National Center for Health Statistics.

In 1969, the Department of Health and Human

Services (then known as the Department of Health,

Education, and Welfare) established a continuing national surveillance system to measure the nutritional

status of the U.S. population and to monitor changes

in this status. The task of developing the program was

assigned to the National Center for Health Statistics.

Consequently, the National Health Examination Survey was expanded into the first National Health and

Nutrition Examination Survey and was redesigned to

measure aspects of the health and nutritional status

of the U.S. population.

As in the three earlier programs, the first National

Health and Nutrition Examination Survey used specially equipped mobile examination centers. The

centers served as standardized environments in which

teams of specially trained medical and technical personnel conducted the examinations. Three sets of

three trailers were constructed as mobile examination

centers. They were drawn by detachable truck tractors when moving from one sample location to

another. At each examination site, the three trailers

were set up side by side and were connected by enclosed passageways to form the mobile examination

center.

1
The field staff consisted of three elements. The

first was the team from the U.S. Bureau of the Census,

usually consisting of 8-16 interviewers and a supervisor. The Census personnel administered household

questionnaires to gather demographic information,

and they also administered medical history questionnaires used during the final phase of the survey. The

second element consisted of administrative personnel:

field operation managers, their assistants, and specially trained health interviewers employed early in

the survey to administer health history questionnaires

and to make examination appointments. These interviewers later augmented the efforts of the Census interviewers who became responsible for those tasks.

The third element was the examining staff that operated within the mobile examination center. This

group included a physician, a nurse, a dermatologist,

an ophthalmologist, a dentist, two dietary interviewers, two health technicians, one laboratory technician, and a receptionist-coordinator. Further details

regarding the mobile examination center and the field

staff have been published.4-8

The findings in this report are derived from a set

of nationwide probability samples that totaled approximately 32,000 people ages 1-74 years from the

civilian noninstitutionalized population of the coterminous United States. The survey began in April

1971, and the nutritional component was completed

in June 1974. The sample was selected so that certain

population groups thought to be at high risk of malnutrition (persons with low incomes, preschool children, women of childbearing age, and the elderly)

were oversampled at predetermined rates. Although a

major emphasis of the survey was placed on nutrition,

a subsample of persons ages 25-74 years received a

more detailed health examination. After the nutrition

survey was completed, the detailed examination given

to adults was continued through October 1975, This

extension of the survey is referred to as the augmentation portion.

Examinations were conducted in 65 diffwent

locations (referred to as “stands”) across the United

States during the nutrition phase of the surwy, and in

the augmentation phase there were an addition~al 35

stands. The differential leukocyte count findings in

this report are derived from the detailed examination

of adults in the 25-74-year age group, and the white

blood cell count findings are based on persons who

received the nutrition examination. Out of 28,043

persons selected for the nutrition examination sample, 27,753 were interviewed, and 20,749 were examined, yielding a net response rate of nearly 75

percent. For the detailed examination sample, an

initial sample of 9,881 persons, selected during both

the nutrition and augmentation phases, resulted in

9,742 intemiews and 6,913 examinations, yielding a

response rate of 71 percent. A more detailed description of the sample design and estimation procedures

is in appendix I.

Information was obtained by means of a household interview; a general medical history; a 24-hour

dietary recall interview; a food frequency interview;

a food program questionnaire; a general medical

examination; dental, dermatological, and ophthalmological examinations; anthropometric measurement; hand-wrist X-rays (ages 1-17 years only); and

24 hematological, blood chemistry, and urological

laboratory determinations.

Also, data were gathered on the detailed examination sample of adults by the following methods: a

supplemental medical history questionnaire; supplemental questionnaires concerning arthritis and respirat ory and cardiovascular conditions (when ap plicable); a health care needs questionnaire; a general

well-being questionnaire; an extended medical examination; X-rays of the chest, hip, and knee joints; and

audiometry, electrocardiography, goniometry, spirometry, pulmonary diffusion, and tuberculin tests,

along with additional laboratory determinations,

including the differential leukocyte count.

2
Source of data

Background phocytosis is an essential criterion necessary to

This report presents normative data for white

blood cell (WBC) counts and differential leukocyte

counts, based on findings from NHANES I. These

findings will be compared in a future publication,

which will present similar data from the second

National Health and Nutrition Examination Survey

(NHANES II).

The total WBC count includes several cell types;

various physiological and pathological processes

affect specific types. The WBC and differential counts

perhaps provide more information in less time at less

cost than any other laboratory test. The test results

may guide the ordering of subsequent analyses, thus

avoiding needless and often costly tests. While the

WBC count has limited vulue in screening ambulatory

patients in terms of sensitivity and specificity and has

limited predictive value, the test is valuable in detecting acute disorders such m appendicitis or for following the course of an acute disease process. When combined with patient histories and examinations, WBC

and differential leukocyte counts can add valuable

supporting evidence for the diagnoses of numerous

diseases.

Certain rare hereditary diseases, such as Alder’s

anomaly, May-Hegglin anomaly, and Chediak-Higashi

disease, have characteristic white blood cell abnormalities. A more common finding of increased neutroph%

with a shift toward less mature forms is consistent

with acute bacterial infections, toxemia of pregnancy,

and certain myeloprolifcrative disorders. Increased

nuclear lobulation of the segmented neutrophils with

macrocytosis is indicative of megaloblastic anemia,

whereas hypolobulation is indicative of the PelgerHuEt anomaly. Increased numbers of eosinophils are

found in hypersensitivity states and in parasitemia

with visceral involvement. Monitoring the eosinophil

count guides adrenocortiml steroid therapy in asthma.

Lymphocytosis with atypical lymphocytes is found in

children, especially those with tial diseases with

accompanying exanthemata. Absolute atypical lym-

~onfm the diagnosis of infectious mononucleosis.

Marked elevated WBC counts with increased lymphocytes and smudge cells in middle-aged and older

persons is highly suggestive of chronic lymphocytic

leukemia.

Procedures

Blood was drawn from exarninees by venipuncture

using evacuated tubes. h ethylene diaminetetraacidic acid-containing (EDTA) sample (1.25 mg/ml)

was used for the hematologjcal laboratory determinations. Samples were collected by fmgerstick from

those persons, primarily children ages 1-3 yearn, on

whom venipunctures were unsuccessful. Two peripheral blood smears, two white blood cell-hemoglobin

dilutions, and two hematocrit tubes were collected

from succeeding drops of blood.

White blood cell counts were determined in

duplicate in the mobile examination center’s laboratories on the Coulter Fn. The peripheral blood slides

were stained and sent to the Hematology Division

of the Centers for Disease Control for differential

leukocyte counts. Further description of the methods

are in appendix III.

Data base

Of the 6,913 adults in the detailed examination

sample, a differential leukocyte count was performed

on 5,854 slides, and the WBC count was considered

satisfactory for 6,273 persons. If either the WBC or

differential leukocyte count was missing for an

examined person, then that person was excluded

from the analysis, leaving 5,491 persons as the basis

for all differential leukocyte counts in this report.

Possible bias due to missing information is discussed

in appendix I.

Since WBC counts were also available for persons

examined in the nutrition examination sample of

NHANES I, these data were included in this report.

3
‘This means that the WBC findings presented in this

study are based on more than 18,000 sample persons,

including those under 25 years of age, instead of

being based only on the 6,273 adults from the

detailed examination sample. However, a differential

leukocyte count was not done on nutrition examination sample persons unless they also were in the

detailed examination sample. Figure 1 demonstrates

the expected similarity of the results of the WBC

counts for persons in the detailed examination sample

and in the nutrition examination sample.

For the black population in particular, the use of

the larger nutrition sample has the effect of raising

the number of persons for the WBC estimates by a

factor of 5 (from about 800 to approximately 4,CIOO),

thus increasing the reliability of the estimates for

this segment of the population.

—

-=-= Male, nutrition examination semple

_ = _ Maler detailed examination sample

. . ● . . . . . Female, nutrition examination sample

9 — — Female, detailed examination sample

14

8 — “.>●> .. 9.... ●m\ ●. . . . . .

“m>. ●m...9”””mm ~~fl

J

. ..* ~dti

m.

\\4d4@

o 7 —

x

In

=

~

;

&Ij

f

z

5 —

o

I 1 I I I I

I

10 20 30 40 50 60 70

Age in years

SOURCE: First National Health and Nutrition Examination Survey nutrition examination sample, 1971-74; detailed examination

sample, 1971-75.

—

Figure 1. Estimated mean white blood cell count by sex, age, and examination sample: United States, 1971-75
The white blood cell (WBC) and differential leukocyte count data from the nutrition examination

sample (197 1-74) and the detailed examination sample (197 1-75) are presented in tables 1-11. Table A

highlights findings for the overall target population.

The data have been weighted to represent the U.S.

civilian noninstitutionalized population in terms of

age, sex, and race. The classification of race was done

by observation; the interviewer classified exarninees

as “black, “ “white.” or “other.” A separate statistical

analysis has not been presented for people of “other”

races in this report because they were insufficiently

represented in the sample. The data have been included under the designation “white” (see appendix II for definition).

White blood cell count

There are differences in the mean WBC count between racial groups, between sexes, and among age

groups within race-sex groups (table 1). The white

population was found to have higher WBC counts

than the black population. This was observed in both

sexes at all ages (figure 2). The WBC counts for white

males were significantly higher than were counts for

black males in all age groups except for those ages

12-17 and 18-24 years (figure 3). Counts for white

females were significantly higher than were counts for

black females for those ages 12-17, 25-34, and 45-54

years (figure 4). When compared by sex, 12-24-yearold white females had counts that were significantly

higher than were those for white males of the same

age. Only at ages 65-74 years did white males have

significantly higher counts than white females had

(figure 5). Counts for black females were significantly higher than were those for black males only at

ages 55-64 years (figure 6).

Table 1 shows that children of all races who

were under 6 years old had a higher WBC count than

older persons had. The mean WBC count for the

Table A, Estimated mean number and mean percent of Ieukmytes by type of leukocyte, according to age: United States, 1971-75

Total Type of leukocyte

A.qe white blood

Total cell count Lymphocytes Monocytes Eosinophils

neutrophik T

Number of cells X 109/L

l-5years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.49 . . .

6-n years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . ..-

7,42 .-.

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . --- ---

7.27 . . .

l&24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . .

7.60 . . .

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

. . . . . . ---

7.73 4.53 2.74 0.26 0.20

45-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.50 4.40 2.64 0.26 0.19

Percent of 100 cells

l-5years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

-..

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

-.. .-. ---

. . .

..-

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

. . . . . . . . .

. . .

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

. . . . . . . . .

58.6 35.4 3.4 2.6

46-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58.7 35.2 3.5 2.5

I Neutrophil statisticscombine bandad and segmented forms.

SOURCE: First National Health and Nutrition Examination Survey. Total while blood cell count data are from the nutrition examination sample,

1971-74, and differential leukocyte data are from the detailed examination sample, 1971-75.

5
9 —

\

8 —

__.__.@”--” -----

---

--- Wh itel

J

-9--

----

m;

.-7 —

x Black

g

z

u

z

:

6 —

f

z

.

5 —

/

/ Y

o- 1 I I I I I

I

10 20 30 40 50 60 70

Age in years

1 I ncl~,je~ ~erSOnS of other races; see appendix 11.

SOURCE: First National Health and Nutrition Examination Survey nutrition examination sample, 1971-74.

Figure 2. Estimated mean white blood cell count by race and age: United States, 1971-74

9-

\

\\

8

-\\

~---

---

*\

#ti/

---

\

/@ --~ Whitel

%

---

-----

J

-\\----@ @“@4

m.

?7

x ‘\

.

.+ /-\.\ */*~ -—--”.

e =

$

\

Black

z

\

‘6 — \

f .0”

2

5 —

/

o

I I I I 1 I [

10 20 30 40 50 60 7CI

Age in years

llnclud~ ~arsons of othar races; see appendix 11.

SOURCE: First National Health and Nutrition Examination Survey nutrition examination sample, 1971-74.

Figure 3. Estimated mean white blood cell count for males by race and age: United States, 1971-74

6
9 —

8 —

J ....... ....... ● m

m;

-7 —

Black

x

.

=wu

%

S

6 —

f

5

5

/

/ /

o

I I I 1 I I I

10 20 30 40 50 60 70

Age in Vears

llnclud=per~on~af other races; see aPPendix ‘1.

SOURCE: First NaIional Health and Nutrition Examination SurveV nutrition examination sample, 1971-74.

Figure4. Estimated mean white blood celIcount for females bymce and age: United States, 1971-74

9 -

\

a

8 —

%

% .* ...*

“.\\

d@---

.* .- ●“”-.. ..9 //

*se===. = ● ““”=... ------

... --- ●.><; ““

●.*. Male

// ●. . . .

J

-------

●=...

m; -----~

●= . . 9 . . . . . . . . .

Female . . . . .

r7 —

x

.

=

E

z

ii D6

E

2

5 —

./ ,

0

I I I I I

10 20 30 40 50 60 70

Age in years

1, “clude~ ~er~ons of other races; see appendix 11.

SOURCE: First National Health and Nutrition Examination Survey nuwition examination sample, 1971-74.

Figure 5. Estimated mean white blood cell count for whitel persons by sex and age: United States, 1971-74

7
Female

~

5

0

I I I I I I I

10 20 30 40 50 60 70

Age in years

SOURCE: First National Health and Nutrition Examination Survey nutrition examination sample, 1971-74.

Figure 6. Estimated mean white blood cell count for black persons by sex and age: United States, 1971-74

white population appears to decrease with age for

both males and females, but the decrease is not statistically significant between each of the age groups

employed in this study, This decrease in the mean

WBC count is supported by previous studies.g-ll The

mean WBC count for males was significantly lower

for those ages 65-74 years than was the mean WBC

count for those ages 25-34 years. For white females,

the mean WBC count for those ages 65-74 years

was significantly lower than was the mean WBC count

for both the 25-34- and the 35-44-year age groups.

Table 1 also shows that the black population has

a significantly lower mean WBC count than their

white counterparts have, which Broun also found. 12

Black males appear to have a lower observed mean

WBC count than black females have, and the difference is greatest and statistically significant for the

55-64-year age group.

Table B shows the percent distribution of the

U.S. population whose WBC counts are in the extremes of the WBC distribution and the percent of

the population whose WBC counts fall into the broad

range of 5.0-11.4 X 10g/ L cells. Tables 2-5 show percent distributions of WBC counts for males and

females by race and age.

Smoking and the white blood cell count

Smokers were found to have significantly elevated

WBC counts for both races and both sexes (table C).

8

Table B. Parcent distribution of the U.S. population by mean nurnkr

of white blood cells, according to age: United States, 1971-74

Age

A/umber of cells X 10g/L

1-5 6-17 18-44 45-74

years years years Vews

Percent distribution

2.0-13 .0 and over . . . . . . 100.0 100,0 100.0 100.0

2.0-3 .9 . . . . . . . . . . . . . . . . . 0.8 1.1 0.8 II .3

4.0-4 .4 . . . . . . . . . . . . . . . 0.9 3.1 1,7 11.9

4.5-4 .9 . . . . . . . . . . . . . . . . . 2.0 4.6 3.6 3.7

5.0-11 .4 . . . . . . . !........ 84,0 87.6 89,0 89.5

11.5-11 .9 . . . . . . . . . . . . . 2.8 1.2 1.5 (1.9

12.0-12 .9 . . . . . . . . . . . . . . . 4.2 1.2 1.5 11.6

13. Oand over . . . . . . . . . . . . 5.2 1.2 2.0 11.2

SOURCE: First National Health and Nutrition Examination Survey

nutrition examination sample, 1971-74.

Present smokers averaged 1.0 X 10g/ L more white

cells than former smokers or persons who had never

smoked averaged (see appendix II for definitions of

these terms). Fisch and Freedman and Helmanl 3-14

have shown that the WBC count increases progi-essively with ticreasing intensity of exposure to t obaicco

smoke.

Differential leukocyte count

The differential leukocyte count data obtained

during NHANES I are presented in tables 16-9.
0-

-m

Lno

o-a

mm

mm

Lqlq

mm

mm

mm

. .

. .

u-l Loo

Ln i-m

0. 0.m

mTm mm

Z.zz

r- mm

m r-en

m-.

m. m- o

m mm

u-l mm

. . .

. .

. .

. . .

. . .

. .

* O*

m mm

.-- r-m

0 .-m m fsN

m q-.

In

m-mm

mm Lo

m“

. .

. .

. .

. .

. .

. .

. . .

. .

. .

. .

. .

. .

. .

. .

. .

. . .

. .

. .

. .

. .

. . .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. . .

. .

. . .

. .

. .

. . .

. .

. .

. . .

. .

. .

. .

. .

. .

. .

. .

. . .

. . .

,..

. .

. .

. .

. . . . .

. .

. .

. .

. .

. . .

. .

. .

. .

. .

. .

. .

m:::

~..-

A:::

. .

s:::

i:::

. .

. .

. .

9
Differential leukocyte count statistics are based on

readings of more than 5,400 peripheral blood smears

prepared from blood drawn from adults who received the detailed examination.

Two differences should be noted. First, there was

a difference in mean values with respect to both absolute numbers and percents for segmented neutrophils

between races, with the white population having significantly higher values. The black population, however, had higher lymphocyte numeric values (table 8)

and a significantly higher mean percent of lymphocytes (figure 7). Second, a difference (in terms of sex)

was observed with changes in age. Before about age

50, white females have a higher segmented neutrophil

mean and a lower lymphocyte mean than white males

of comparable age. After age 50, the mean number

of segmented neutrophils decreases for females, but

the mean for males remains relatively constant with

the increase in age. White females ages 25-34 years

have a significantly higher mean number of segmented

neutrophils than white females ages 65-74 years

(figure 8).

For the black population, the reverse of the above

relationship for the white population is seen. Males

have a higher number of segmented neutrophils than

have females up to about age 50, after which the

mean for females becomes higher and the mean for

males decreases with age (figure 9). The sex difference in the number of segmented neutrophils for each

group is not significant for either race. In the 45-54-,

55-64-, and 65-74-year age groups, white males h;ave a

mean number of segmented neutrophils that is significantly higher than the numbers for their black counterparts. White females have a significantly higher

mean number of segmented neutrophils for the age

groups 25-34 years, 35-44 years, and 45-54 years

than have black females. This relationship continues

for the older age groups, but the differences are not

statistically significant, Tables 10 and 11 show summary information about the distribution of segmented neutrophils and lymphocytes in the adult

population, and figures 10 and 11 graphically summarize this kformation.

Discussion

Much has been published over the decades about

the variability of a single 100-white-cell differential

---- Whitel male

● 9= ● D--D Whitel female

— -— Black male

65 — _ Black female

Segmented neutrophils

60 — . ...””

. ..*m . . . .. a.. ●. . . .

. . . . . .

--------------

--tie 0-- . . . .

..---- m9-

““= ” - =........ . . . .

. . . . . . .

co 55 — ,. —-—-~

= -~-~-

~-—-~. -

w

c1

o

0

; 50 —

E

8

&

n 45 Lymphocytes

c

z

40 — ~.~”- —- —-— .— -_

—-—-

--- ..=”” =~. o.. ..m .- m..

--- -9-

.- m...

. . ..O ---

. ..*..

35 — ●. . . . ●. . . . .mm . . . . . ..”~ -------

--------

/ 5

/

o

I I I I I I

25 35 45 55 65 75

Age in years

11 “c,ude~ ~er~ons of other races; see appendix 11.

SOURCE: First National Health and Nutrition Examination Survey detailed examination sample, 1971-75.

Figure 7. Estimated mean percent of segmented neutrophils and lymphocytes by race and age: United States, 1971-75

10
5.0

E

---- Male Segmented neutrophils

4.8 . . . ..D. m Female

1

...OO. = •.~.. ●. .

4.6 -:-.~m ----------------

--------- ...

4.4 ●. . . .

●=... ●..*

4.2 “*- * =. . . . . . . . . ...

J

m; 4.0

; 3,8

+ 3.6

v

z 3.4

$ 3.2

z 3.0

2,8

2.6

FLymphocytes

“-----

------- ------ -=*. O●m... . . ~“=z~. .

●.*. m. . . . . . ...””””.””...”””

-wu~

2,4

1-

2.2

t

q- 1

0

25 35 45 55 65 75

Age in years

lln=ludeS perSonsot other races; See aPPendix II.

sOURCE: First National Health and Nutrition Examination Survey detail ed examination sample, 1971-75.

Figure8. Estimatd mean number ofsagmented neutrophils andlymphocytes forwhitelpersons bysex and age: Unitad States, 1971-75

5.0 —

4.8

4.6

4.4

4.2

4.0

3,8

3.6

3.4 —

3.2 —

3.0 —

2.8 —

2.6 —

2.4

2.2

—-— Male

— Female

.

Segmented neutrophils

4-

Lymphocytes

—“—-—-~.

~-~.

\.

\-

-.

2.o~

o~

I I I

25 35 45 55 65 75

Age in years

SOURCE: First National Health and Nutrition Examination Survey detailed examination sample, l97l-75.

Figure9. Estimated mean number ofsegmented neutrophils andlymphocytes for black persons bysex and age: United States, 1971-75

11
20

15

10

5

L-II — —

—

—

—

—

1

o.5- 1.0- 1,5- 2.0- 2.5- 3.0- 3.5- 4.0- 4.5- 5.0- 5.5- 6.0- 6.5- 7.0- 7.5- 8.0- 8.5- 9.0- 9.5- 10.0

0.9 1,4 1.9 2.4 2.9 3.4 3.9 4.4 4.9 5,4 5,9 6.4 6.9 7.4 7.9 8.4 8.9 9.4 9.9 and over

Number of cells X 10g/L

SOURCE: First National Health and Nutrition Examination Survey detailed examination sample, 1971-75.

Figure lO. Estimated yrcentdistribution of the U. S.populatlon ages 25-74 years bymeannumber ofsegmented neutrophils: United States, l!)71-75

25r

0.4 0.9 1.4 1.9 2.4 2,9 3.4 3.9 4.4 4.9 5.4 5.9 6.4 6.9

Number ofcells X 109/L

SOURCE: First National Health and Nutrition Examination Survey detailed examination sample, 1971-75.

Figure 1.1. Estimated parcent distribution of the U.S. population ages 25-74 years bymean number of lymphocytes: United States, 1971-75

1:2
count. Many factors influence the observed WBC

count.1 5 Statland and Winkel published a study on

the physiological variability y of leukocytes in healthy

subjects.1 G Goldner and Mannl T published 95-percent

confidence curves, and Rumke and coworkers 8 published an article that explained the required difference in percents that must be found in counts of 100

or 200 cells for a change in counts to be regarded as

significant at a 5 .O-percent or a 2.5-percent confidence level. The present study, however, presents the

results of approximately 5,500 single 100-white-cell

differential counts.

In comparing the mean values with those found

in the literature (Bain and England,l g Cecil and

Loeb,20 Dacie and Lewis,21 Documents Geigi,zg

Gradwohl,23 Miale,24 Wintrobe,25 and Zacharski

et al.2G), the following should be noted: In the

NHANES I study, fewer juvenile neutrophils (band

forms) have been found, and the mean value for

monocytes is lower than the mean value generally indicated in the literature. The lower monocyte values

may be attributable to technical difficulties, as noted

by Dacie,zT such as excessively thick preparations or

smears that were not margin free.

Because five different technologists were involved

in performing differential leukocyte counts during

the course of the survey, the mean values each obtained have been calculated for the different cell

types. Table D shows that one technologist (number 4) counted more band forms, and another (number 3) obtained appreciably higher monocyte counts

than any of the others. On the whole, however, mean

values of all cell types obtained by all five technologists compared favorably. Promyelocytes, myelocytes,

and metamyelocytes were reported in 2, 1, and 1

smears respectively and were excluded from analysis.

A single-channel electronic cell counter that is

properly calibrated and mainttied is recognized as

the best available method for routine cell counting.28

Differences were minimal because only three instruments, operated by teams of two technicians, were

employed in the mobile examination centers, AU instruments were monitored concurrently with the

same lots of commercial control material.

White blood cell counts and differential leukocyte

counts have also been performed on examined persons in the second National Health and Nutrition Examination Survey (NHANES II), 1976-80. When data

from NHANES II are analyzed, differential leukocyte

count findings from the two surveys will be compared.

Table D. Number of smears and percent distribution by type of leukocyte, according to technologist number

Type of leukocyte

Technologist number Number

of smears Total Segmented Band

Iaukocytes Lymphocytes Monocytes Eosinophits neutrophils neutrophifs Basophils

Percent distribution

1 826 100.0 50.97

2::::::::::::::::::::;

0.14 36.09 2.53 2.18

2,466

0.29

100.0 57.95

3

0.32 37.47 2.19

973

2.05

100.0

0.32

. . . . . . . . . . . . . . . . . . . . . 58.80

4

0.16 32.57 6.08 2.04

794 100.0

0.55

. . . . . . . . . . . . . . . . . . . . . 56.80 0.48 36.95 3.49 2.19

5 795

0.32

. . . . . . . . . . . . . . . . . . . . . 100.0 59.04 0.06 36.28 2.91 1.55 0.42

SOURCE: First National Health and Nutrition Examination Survey detailed examination sample, 1971-75.

000

13
References

lNational Center for Health Statistics: Plan and initial program of the Health Examination Survey. Vital and Health

fi’tati~tics, PHS Pub. No. 1000-Series l-No, 4. Public Health

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

1965.

2National Center for Health Statistics: Plan, operation, and

response results of a program of children’s examinations. Vital

and Health Statistics. Series l-No. 5. DHEW Pub. No. (HSM)

73-1251. Health Services and Mental Health Administration.

Washington. U.S. Government Printing Office, Oct. 1967.

3National Center for Health Statistics: Plan and operation of

a Health Examination Survey of U.S. youths, 12-17 years of

age. Vital and Health Statistics. PHS No. 1000-Series l-No. 8.

Public Health Service. Washington. U.S. Government Printing

Office, Sept. 1969,

4National Center for Health Statistics: Plan and operation of

the Health and Nutrition Examination Survey, United States,

1971-1973. Vital and Health Statistics. Series 1-Nos. 10a and

10b. DHEW Pub. No. (HSM) 73-1310. Health Services and

Mental Health Administration. Washington. U.S. Government

Printing Office, Feb. 1973.

5National Center for Health Statistics: Plan and operation of

the HANES I Augmentation Survey of adults 25-74 years:

United States, 1974-1975, by A. Engle, R. Murphy, K. Maurer,

and E. Collins. Vital and Health Statistics. Series 1-No. 14.

DHEW Pub. No. (PHS) 78-1314, Public Health Service. Washington. U.S. Government Printing Office, June 1978.

6 National Center for Health Statistics: HANES, examination

staff procedures manual for the Health and Nutrition Examination Survey, 1971-1973. NCHS Instruction Manual, Part

15a. Health Services and Mental Health Administration. Washington. U.S. Government Printing Office, June 1972.

7National Center for Health Statistics: Field staff operations

manual. JVCHS Instruction Manual, Part 15b. Health Services

and Mental Health Administration. Washington. U.S. Government Printing Office, Sept. 1972.

‘National Center for Health Statistics: Examination staff procedures manual for the Health Examination Survey, 1974-

1975. NCHS Instruction Manual, Part 15c. Health Resources

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

Apr. 1975.

‘Allan R. N., and Alexander, M. K.: A sex difference in leucocyte c&nt. J. Clin. Pathol. 21 (6): 691-694, Nov. 1968.

l°Cruickshank, J. T., and Alexander, M. K.: The effect of age,

sex, parity, hemoglobin level and oral contraceptive preparations on the normal Ieucocyte count. Br. J. Haematol. 18(5):

541-549, May 1970.

llTibblin E. et al.: Hemoglobin concentrations and peripheral bloo~ cell counts in women. Stand. J. Haernatol. 22!(1):

5-16, Jan. 1979.

12Brownj G. O., Jr., and Herbig, M. S.: Leukopenia in Negroes.

N. Engl. J. Med. 275(25): 1410-1413, Dec. 1966.

13Fisch, I. R., and Freedman, S, H.: Smoking, oral contraceptives, and obesity effects on white blood cell count. J/i MA.

234(5): 500-506, NOV. 1975.

14Helman, N, and Rubenstein, L. S.: The effect of age, sex,

and smoking on erythrocytes and leukocytes. Am. J. Clin.

Pathol. 63(l): 35-44, Jan, 1975.

15Panek, E,, and Steinmetz, J.: The effect of sex, deviation

from ideal weight and sampling time on blood constituents in

presumably healthy subjects. Clin, Chim. Acts. 92(3): 343-351,

Mar. 1979.

16Statland, B. E., and Winkel, P.: Physiological variability of

leukocytes in healthy subjects, in J. A. Koepke, cd., Differential Leukocyte Counting. Chicago. College of American Pathologists, 1979. pp. 23-27.

17Goldnerj F. M,, and Mann, W. N.: Statistical error of differential white count. Guy’s Hospital Reports. 88( 1): 54-65, Jan.

1938.

18Riimke, C. L. et al.: Normal values and least significant differences for differential leukocyte counts. J. Chron, Dis. 28

(11/12): 661-668, Dec. 1975.

19Bain, B. J., and England, J. M.: Normal haematological

values: Sex difference in neutrophil count. Br. Med. J. 1(S95 3):

306-309, Feb. 1975.

20Cecil, R, L., and Loeb, R, F.: Textbook of Medicine, 13th

ed. Philadelphia. W. B. Saunders Co., 1971.

21Dacie, J. V., and Lewis, S. M.: Practical Hematology, 4th ed.

London. Churchill Livingstone, 1970.

22Documenta Geigi: Wissenschaftliche Tabellen, 7th ed. Basel.

Ciba-Geigi, 1968,

23Gradwolil: Clinical Laboratory Methods and Diagnosis, 7th

ed. St. Louis. C. V. Mosby Co,, 1970.

24Miale, J. B.: Laboratory Medicine: Hematology, 4th ed, St.

Louis. C. V. Mosby Co., 1972,

25Wintrobe M, M.: Clinical Hematology, 6th ed. Philadelphia.

Lea and Fe;iger, 1967.

26Zacharski, L. R. et al.: Leukocyte counts in healthy adults.

Am. J. Clin. Pathol. 45(2): 148-150, Aug. 1971.

27Dacie, J. v-: practical Hematology, 1st ed. London. J. & A.

Churchill Ltd., 1950.

14
28Standing Committee on Blood Counting, in Proceedings of

Advances in Haeinatology Jfethods, Calibration and Control.

Berlin. International Committee for Standardization in Hematology, 1979.

29National Center for Health Statistics: The HANES Study

Final Report, by the Institute for Survey Research. HSM-1 10-

73-376, Health Services and ,Mental Health Administration.

Philadelphia. Temple University, Apr. 1975.

30Department of Health, Education, and Welfare: A Compan”-

son and Anal.vsis of Examined and Unexamined Persons on

Jfedical History Characteristics for the First Round of the

Health and Nutrition E.rumination Study, by Westat, Inc.

HSM-I 10-73-371. Health Services and Mental Health Administration. Rockville, Md. Division of Health Examination Statistics, Jan. 1974.

3lNational Center for Health Statistics: Factors related to

response in a health examination survey: United States, 1960-

1962. Vital and Health Statistics. Series 2-No. 36. DHEW Pub.

No. (HSM) 73-1263. Health Services and Mental Health Admi.nist ration. Washington. U.S. Government Printing Office,

Aug. 1969.

32Wesley L. Schaible, Ph. D.: Memorandum to Arthur J.

McDowell, Director, Division of Health Examination Statistics. Unpublished document.

331nstruction Manual for the Coulter Counter Model Fn.

Hialeah, Fla. Coulter Electronics, Dec. 1970.

341nstruction Manual for the Coulter Diluter II. Pub. No.

4201031. Hialeah, Fla. Coulter Electronics, Apr. 1972.

350perating Manual Hems-Tek Slide Stainer Hems-Tek StainPak. Elkhart, Ind. Miles Laboratories, Inc., July 1967.

36Romanowsky, D.: Zur frage der parasitologic und therapie

der malaria. St. Petersb. Med. Wschr. 16:297 and 307, 1891.

15
List of detailed tables

1. Number of examined persons, estimated mean white blood

cell count, and standard error of the mean by examination

sample, race, sex, and age: United States, 1971-75, . .

:2. Percent distribution of white males by estimated number of

white blood cells, according to age: United States, 1971-74. .

3. Percent distribution of white females by estimated number of

white blood cells, according to age: United States, 1971-74. .

4. Percent distribution of black males by estimated number of

white blood cells, according to age: United States, 1971-74.

!5. Percent distribution of black females by estimated number of

white blood cells, according to age: United States, 1971-74.

6. Estimated meen number and mean percent of leukocytes for

white persons by type of leukocyte, according to sex and

age: United States, 1971 -75, . . . . . . . . . . . . . . . . . .

7.

17

8.

18

18 9.

19

10.

19

11.

20

Estimated standard error of mean number and mean percent

of Ieu kocvtes for white persons by tvpe of Ieukmrt% =%

andage: United States, 1971-75 . . . . . . . . t . . . . . 21

Estimated maan number and mean percent of Ieu kocytes for

black persons by type of leukocyte, according to sex and age:

United States, 1971 -75 . . . . . . . . . . . . . . . . . . . . . . . 22

Estimated standard error of mean number and mean percent

of Ieu kocytes for black persons by typa of leukocyte, sex,

andaga; United States, 1971-75 . . . . . . . . . . .. . 23

Number of examined persons, estimated mean number of seg

mented neutrophils, standard deviation, and selacted per.

centiles by race, sex, and age: United States, 1971-75 . . . , , 24

Number of examined persons, estimated mean number of

lymphocytes, standard deviation, and selected percentiles by

race, sex, and age: United States, 1971-75. . . . . . . . ~~ 25

‘16
Table 1. Number of examind persons, estimeted mean white blood cell count, and standard error of the mean by examination sample, race,

sex, and age: United States, 1971-75

Nutr;tion examination sample Detailed examirrarion sample

White 1 Black White 1 Black

Sex and age

Number Number Standard

Number Number StandardNumber Number Standard Number Numbar

of

0 f cells of of

Standard

error of of of cells error 0 f of cells

examined

error of

examined

of cells error of

x 109IL the mean X 1091L the mean

examined

persons

X 1091L the mean

examined

persons persons

x 1091L the mean

persons

Both saxes

l-74years . .

l-5years . . . . .

Gllvears . . . . .

12-17 years . .

18-24 years . .

25-34 years .

35-44 years . .

45-54 years . .

55-64 years .

65-74 years . .

Male

7-74 years , . . .

l-5years . . . . . .

13-l lyears . . . . .

12-17 years .

IB-24 years .

25-34 years . . . .

35-44 years .

46-54 years . . . .

55-64 years . . . .

65-74 years . . .

Female

l-74 years . . .

l-5 years . . . .

6-n years ., .,.

12-17 years . . .

18.24 years . . . .

25-34 years . . .

3544 yaars .

45-54 years . .

55-64 years . .

65-74 years . . .

14,820

1,835

1,385

1,437

1,608

2,050

1,704

1,207

950

2,564

6,331

953

692

723

591

627

510

56S

457

1,210

8,489

882

693

714

1,097

1,423

1,194

639

493

1.354

7.7

8.5

7.5

7.4

7.7

7.7

7.9

7.6

7.5

7.4

7.7

8.5

7.6

7.2

7,3

7.7

S.o

7,8

7.6

7.5

7.7

8,5

7.4

7.6

7.9

7.7

7,8

7.5

7.3

7.2

0.05

0.09

0.08

0,00

0.07

O.OB

0.11

0.11

0.09

0.08

0.07

0.11

0.09

0.12

0.11

0.11

0.20

0.14

0,13

0.09

0.05

0.10

0.13

0,07

0,09

0.09

0,09

0.11

0.11

0.09

3,577

612

450

445

402

403

367

227

169

502

1,460

302

225

219

116

108

76

llB

66

238

2,109

310

225

226

286

295

291

109

103

264

7.0

0.3

7.0

6.7

7.2

6.6

7.7

6.9

6.5

6.7

6.9

8.1

7.1

6.6

7,0

6.6

7,0

7.1

5,8

6.4

7.1

8.5

7.0

6.6

7.4

6.9

7.3

6.7

6.9

6.9

0.08 5,509

0.16

0.12

0.18

0.24

0.13 1,265

0.21 971

0.13 1,284

0.22 1,038

0.23 951

0.10 2,530

0,21

0.18

0,2B

0.32

0.19 550

0.32 429

0.19 590

0.28 500

0.12 461

0.10 2,979

0.23

0.16

0.17

0.2B

0.19 715

0,32 542

0,22 694

0.28 538

0,38 490

7.6

7.8

7.7

7.6

7.5

7.3

7.7

7.8

7.8

7.7

7.7

7.6

7.5

7.8

7.7

7.5

7.3

7.1

0.Q6

0.11

0.12

0.10

0.12

0.10

0,08

0.12

0.18

0.13

0.19

0.19

0.07

0.17

0.17

0.13

0.13

0.12

768

160

135

187

133

153

339

66

49

90

58

76

429

94

86

97

75

77

6.9

7.1

7.0

6.8

6.9

6.0

6.0

7.1

7.3

6.8

6.3

5,8

7.0

7.0

6.8

6.7

7.3

7.5

0.14

0.23

0.36

0.25

0.28

0.50

0.24

0.39

0.63

0.47

0.39

0,43

0.19

0.32

0.45

0.30

0.42

0.81

1,ncludes ~er~ons of other races; see appendix 11.

SOURCE: First National Health and Nutrition Examination Survey nutrition examination sampler 1971.74; detailed examination sampler 1971-75.

17
Table 2. Percent distribution of whitel males by estimated number of white blood calls, according to age: United States, 1971-74

Number of cells X 109/L

Age

7-5 6-11 12-17 18-24 25-34 3544 45-54 55-64 65-74

years years years years years years years years years

Percent distribution

l_lnder 2.0-14.0 Andover...,.. . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

:2.0-2 .9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - - 0.3 0.1

:3.0-3.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 0,5 1.1 0.7 0.3 0.4 1.3 1.3 0.9

4,0-4.9 , . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . 3.2 5.9 8,5 4.8 4.5 2.9 2.4 4.5 3.7

!5.0-5,9, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.2 18.2 23.0 19,8 15.5 13.8 13.5 13.2 15.6

(6.0.6.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.7 21.1 18.5 19.0 18.3 22.0 22.8 17.9 20.9

7.0-7,9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.3 16.3 19.7 20.7 20.7 18.1 19.3 22.1 21.3

8.0-8.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘i5.5 14.5 14.0 18.1 17.7 14.5 17.6 18.8 18.8

9.0-9.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.8 13.3 8.5 10.8 13.4 12.9 11.7 11.1 9.7

10.0-10.9, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.6 5.1 2.2 2.5 4.1 7.7 5.3 5.6 4.6

11.0-11.9, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 2.2 1.8 1.4 3.2 3.5 1.0 3.1 2.7

12.0-12.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5 0.9 1.5 1.3 1.4 2.0 3.3 1.0 0.7

13.0-13.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,7 0.6 0.6 0.4 0.4 1.1 0.5 0.8 0.5

14.0 Andover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 1.3 0.5 0.5 0.7 1.1 1.2 0.1 0.4

llncludes persons of other races; sae appendix Il.

SOURCE: First National Health and Nutrition Examination Survey nutrition examination sampla,1971-74.

Table3. Percent distribution ofwhitel females byestimated number ofwhite blood cells, according toage: United States, 1971-74

Age

Numberofce//sX 10g/L

7-5 6-11 12-17 18-24 25-34 35-44 45-54 55-64 65-74

years years years years years years years years years

Percent distribution

Under2.0-14.0and over... . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

2.0-2.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.0 0.4 - - 0.0 -

3.0-3.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.7 0.7 0.3 0.5 0.7 0.8 1.1 0.5

4.0-4.9 . . . . . . . . . . . . . ...’.. . . . . . . . . . . . . . . . . . . . . . 2.2 6.1 5.1 3.1 5.2 5.6 5.1 5.2 7.4

5.0-5.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5 17.9 10.8 11.5 13.2 12.8 16.7 17.1 19.8

6.0-6.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.7 22.1 26.2 19.2 21.0 18.3 23.6 24.8 22.2

7.0-7.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.3 20.2 17.9 22.7 19.1 19.1 19.6 19.8 20.6

8.0-8.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.9 12.6 16.5 16.4 ‘17.0 ‘17.9 13,0 15.0 15.0

9.0-9.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.4 10.9 14.2 12.1 12.0 13.1 9.4 9.8 8.9

10.0-10.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.9 3.9 5.1 6.2 4.7 4.9 5.9 2.5 2.5

11,0-11.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 3.5 1.8 4.6 3.5 3.8 2.4 2.4 1.4

12.0-12.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 0.8 1.6 1.3 1.7 1.5 2.4 1.1 0.9

13.0-13.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.0 0.8 0.0 1.7 0.7 1.1 1.0 1.3 0.2

14.0and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.0 0.6 0.2 0.9 1.1 1.3 0.1 - 0.6

ll”clude~parso”s Of Other races; see appendix ll.

SOURCE: First National Health and Nutrition Examination Survey nutrition examination sample, 1971-74.

18
Table4. Percent distribution of black males byestimated num&rof white blood cellsraccording to age: United States, 1971-74

Age

Number of cells X 1091L

7-5 6-11 72-17 18-24 25-34 35-44 45-54 55-64 65-74

years years years years years years years years years

Under 2.0-14.0 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

2.0-2.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - 1.6

3.0-3.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 1.4 4.1

4.04.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 14.4 17.5

5,0-5.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.5 19.9 22.3

6.0-6,9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.7 19.0 20.1

7.0-7.9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.9 12.1 10.4

8.0-8.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.8 14.3 14.1

9.0-9.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.5 10.4 5.8

10.0-10.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 3.6 2.1

11.0-11.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 2.8 1.2

12.0-12.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0 2.0 0.3

13.0-13.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 - -

14.0 Andover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.7 0.5

Percent distribution

100.0 100.0 100.0

3.1 4.1 1.1

8.9 10.2 15.3

20.0 33.1 22.6

33.9 17.0 23.0

8.5 11.4 5.2

10.7 13.8 17.9

3.8 7.5 9.4

5.2 1.5 0.9

3.3 1.1 -

0.4

1.6

2.5 0.2 2.8

100.0 100.0 100.0

1.9 0.4

1.0 3.2 6.1

9.0 25.9 19.9

19.2 30.2 24.4

23.4 20.2 15.1

11.8 7.4 13.6

21.5 4.7 8.6

9.5 5.2 4.7

3.1 - 4.9

1.4 - 1.9

1.2 0.2

0.2

SOURCE: First National Haalth and Nutrition Examination Survay nutrition examination sample, 1971-74.

Table5. Percent distribution of black females byestimatad number ofwhite blood cells, according to age: United States, 1971-74

Age

Numberofcells X 109/L

1-5 6-71 12-17 18-24 25-34 3544 45-54 55-64 65-74

years years years years years years years years years

Under 2,0-14.Oandover . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

2.0-2.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - -

3.0-3.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 3.8 2.9

4.0-4.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 14.2 15.0

5.0-5.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.3 23.5 77.7

6.0-6.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.7 15.1 21.3

7.0-7.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.4 15.2 17.5

8.0-8.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.8 8.0 13.3

9.0-9.9, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.9 10.0 3.8

10.0-10.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.8 4.4 6.2

11,0-11.9 . . . . . . . . . . . . 6.0 3.1 1.3

12.0-12.9.............:: :::::::::::::::::::::: 3.4 1.8 0.5

13.0-13.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0,1 - -

14.0 Andover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 0.9 0.3

Percent distribution

100.0 100.0 100.0

0.2 1.2

0.8 1.5 2.9

16.1 15.9 9.0

11.3 21.9 18.5

22.4 16.7 23.8

16.8 12.4 18.6

14.5 13.7 10.3

9.6 8.7 6.6

3.3 4.3 4.5

2.2 0.8 1.2

0.9 1.3 2.9

0.9 0.7 0.3

1.2 1.1 1.5

100.0 100.0

2.1 2.6

9.5 20.6

26.8 16.5

24.4 11.0

18.2 15.3

11.7 14.2

1.5 12.3

3.0 6.8

2.7 0.3

0.4

100.0

0.2

4.3

18,1

22.1

19.5

13.1

9.1

6.4

3.4

0.8

0.5

0.3

2.0

SOURCE: First National Health and Nutrition Examination Survey nutrition examination sampla, 1971-74.

19
Table6. Estimated mean number andmean percent of leukocytes forwhitel persons bytypeof leukocyte, according tosax and age:

United States, 1971-75

Sex and age

Type of leukocyte

Total —

leukocytes Segmented Band Lymphocytes Monocytes Ecsinophils Basophils

neu trophils neutrophils

Eothsexes, 25-74 years . . . . . . . . . . . . . . .

Male

25-74 years......,.. . . . . . . . . . . . . . .

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

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

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

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

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

Female

25-74 yaars . . . . . . . . . . . . . . . . . . . . . . .

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

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

4.5-54years, ,. .,..., . . . . . . . . . . . . . .

55-64yaars . . . . . . . . . . . . . . . . . . . . . . .

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

!30thsexes, 25-74years, . . . . . . . . . . . . . .

Male

;25-74years . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Female

25-i’4years . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

55-64yaars . . . . . . . . . . . . . . . . . . . . . . .

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

7.6

7.7

7.8

7.8

7.7

7.7

7.6

7,5

7.8

7.7

7.5

7.3

7,1

. . .

. . .

. . .

. . .

,..

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

4.51

4.54

4.48

4.47

4.61

4.61

4.59

4.48

4.68

4,71

4.47

4.23

4.16

58.9

58.5

57.1

57.9

59.2

60.1

59.6

59.2

59.1

60.9

59.4

57,5

58.5

Number ofcells X 109/L

0.02 2,69 0.22

0.02 2.74 0.24

0.02 2.86 0.24

0.02 2,75 0.24

0.02 2.72 0.24

0,02 2.68 0,22

0,03 2.56 0,24

0.02 2.65 0.20

0.03 2.74 0.20

0.02 2.56 0.18

0.01 2.62 0.21

0.01 2.73 0.22

0.02 2.58 0.20

Percent of 100 cells

0.2 35.9 2.9

0,3 35.8 3.1

0.3 37.3 3.1

0.2 36,3 3.2

0.3 35.2 3.0

0.2 34.6 2.9

0.3 34.2 3.3

0.2 35.9 2.7

0.4 35.9 2.6

0.3 34.5 2.4

0.2 35.7 2.8

0.2 37.6 2.9

0.2 36.4 2.9

0.15

0<17

0.17

0.17

0.17

0.15

0.18

0.14

0.15

0.14

0,13

0.13

0.13

2.0

2<2

2.2

2.2

2.2

2.0

2.4

1.9

2.0

1.8

1.8

1.8

1.9

O.c)l

0.(11

0.[11

0.01

0.01

0,01

0.01.

0.01

0.(11

0.(11

0.01

0.[)1

0.01

all

C1.1

Cl,l

0,1

C1.1

c),1

0.1

().1

(),1

0.1

().1

0.1

().1

‘Irscludes persons of other races; see appendix 11,

SOURCE: First National Health and Nutrition Examination Survey detailed examination sample, 1971-75.

;20
Table7. Estimated standard error ofmeannumber endmean percent ofleukocytes forwhite' parsons by type of Leukocyte, sex, and age:

United States, 1971-75

Number of .4s X 1091L Percent of 100 cells

Sex and age Total Segmented Lymphocytes Monocyres Eosinophils Toral Sqmanred

Ieukowres neutrophils leukocytes

Lymphocytes

neutrophils

Monocytes Eosinophils

Estimated standard error

Both sexes,25.74 yaars . . . . . . 0.06 0.05 0.04 0.02 0.01 . . 0.36 0.41 0.19 0.06

Main

25-74 vnOrs . . . . . . . . . . . . . . 0.00 0.06 0.05 0.02 0,01 . . . 0.40 0.52 0.19 0.09

25-34 yaars . . . . . . . . . . . . . . 0.12 0.09 0.07 0.02 0,01 0,81 O.ae 0.23 0.14

3544y0ars . %. . . . . . . . . . . . 0.18 0,15 0.0s 0.02 0.02 0,97 0.99 0.2s O.l B

45-54 v8.ars. . . . . . . . . . . . . .

. .

0.13 0,10 0.07 0,02 0.01 0.71 0.74 0.22 0,16

55-64 verb . . . . . . . . . . . . . .

.

0.19 0.12 0.12 0.02 0.02 0.86 0..E4 0.25 0,19

6574vmn . . . . . . . . . . . . . .

. . .

0,19 0.18 0.09 0,02 0.01 0.90 0.91 0.35 0.18

Female

2574vears . . . . . . . . . . . . . . 0.07 0.05 0.04 0,02 0.01 . 0.38 0.43 0.20 0.08

25-34 vcars . . . . . . . . . . . . . . 0,17 0.15 0.07 0.02 0.01 0.84 0.87 0.21 0.14

3544vears . . . . . . . . . . . . . .

. .

0.17 0.16 O.m 0.02 0.01 0.81 0.83 0.26 0.17

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

.

0.13 0.10 0.05 0.02 0.01 0.57 0.52 0.25 0,14

5564v0ars . . . . . . . . . . . . . . 0.13 0.10 0.08 0.02 0.01 o.a4 0.s3 0.25 0,14

6574vaars . . . . . . . . . . . . . .

. . .

0.12 0.10 0,07 0.02 0,01 . 0.68 0.73 0.30 0.14

1 lncl”de~ persons Of other races; sea appendix 11-

SOURCE: First National Health and Nutrition Examination Survey detailed examination sample, 1971-75.

21
Table 8. Estimated mean number and mean percent of leukocytes for black persons by type of leukocyte, according to sex and age:

United Statas, 1971-75

Sex and age

Type of leukocyte

Total —

leukocytes Segmented Band Lymphocytes Monocytes

neu trophils Eosinophils

neutroph [Is Basophils

Both sexes, 25-74 years.,..........,..

Male

25.74 years . . . . . . . . . . . . . . . . . . . . . . .

2~.34years . . . . . . . . . . . . . . . . . . . . . . .

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

4~.54years . . . . . . . . . . . . . . . . . . . . . . .

s~-gayears . . . . . . . . . . . . . . . . . . . . . . .

6~.j’4 years . . . . . . . . . . . . . . . . . . . . . . .

Female

25-74vears . . . . . . . . . . . . . . . . . . . . . .

25-34vears . . . . . . . . . . . . . . . . . . . . . . .

3544years . . . . . . . . . . . . . . . . . . . . . . .

as-sayears . . . . . . . . . . . . . . . . . . . . . .

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

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

Both sexes, 25-74years . . . . . . . . . . . . . . .

Male

25-74vaars . . . . . . . . . . . . . . . . . . . . . . .

25-34vears . . . . . . . . . . . . . . . . . . . . .

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

45-54vears ..,......,.. . . . . . . . . . . .

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

65-74vears . . . . . . . . . . . . . . . . . . . .

Female

2!j-74vears . . . . . . . . . . . . . . . . . . . . . . .

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

3!5-44&ars . . . . . . . . . . . . . . . . . . . . .

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

55-64vears . . . . . . . . . . . . . . . . . . . .

65-74vears . . . . . . . . . . . . . . . . . . . . . . .

6.9

6.8

7.1

7.3

6.8

6.3

5,8

7.0

7.0

6.8

6.7

7.3

7.5

. .

. .

. . .

. . .

,..

. .

. . .

. . .

.,.

.

. .

. . .

Number ofcells X 10g/L

3.83 0.01 2.79

3.86 0.01 2.65

3.98 0.00 2.76

4.20 0.01 2.77

3.84 0.01 2.67

3.56 0.00 2.49

3.20 0.01 2.25

3.80 0.01 2.89

3,76 0.01 2.91

3.63 0.01 2.85

3,67 0,01 2.80

4.08 0,01 2.93

4.12 0,00 3.09

Percent of 100 cells

53.9 0.1 41.0

54,9 0.1 39.8

54,9 0.0 39.1

55.6 0,1 39,5

54.3 0,2 40,5

55.1 0.0 40,3

54.4 0.2 40.0

53.1 0.1 42.1

52.8 0.1 42.3

53,5 0.1 41.8

52,9 0.1 42.6

54,1 0,1 41.0

52.7 0.1 42,4

0,20 0.14

0.20 0.15

0.23 0.19

0.21 0,15

0.18 0.15

0.18 0.10

0.17 0.12

0.19 0.12

0.19 0.15

0.19 0.10

0.17 0.12

0.23 0.10

0,20 0.13

2.8 2.0

2.9 2,3

3.2 2.6

2.7 2.1

2.6 2.2

2.7 1.8

3.0 2.3

2.8 1,8

2.5 2.2

3.0 1,5

2.6 1.7

3.2 1.5

2,8 1.9

00,1

0.01

0.01

O.ocl

0.02!

O.ocl

O.ocl

0.01

0.01

0.01

0.01

0.00

0.011

0.’1

0.’1

0.’1

0.()

(l.:?

0.0

0.()

0,’1

0.1

0.1

0.1

0.1

0.1

SIEllJRCE: First National Health and Nutrition Examination SurveVdetailed examination sample, 1971-75.
Table9. Estimated standard error ofmeannumber andmean percent of Leukocytes for black persons by type of Leukocyte, sex, and age:

United States, 1971-75

Number of.ells X 1091L Percent of 100 cells

Sex and age To raf segmented Lk’mphocvtes Monocytes Eosinophils Total Segmented

Ieukocyres

Lvmphocvtes Monocvtes Eosmophils

neutrophils leukocytes neutrophiis

Estimated standard error

Both sexes, 2.574 years 0,14 0.10 0.08 0.02 0.01 . . . 0.76 0.75 0.34 0.1 B

Male

2574 years . . . . . . . . . . . . . . O 24 0.20 0,10 0,03 0,02 . 1.19 1.15 0,43 0.26

2E-34yean . . . . . . . . . . . . . . 0.39 0.33 0,18 0.05 0.05 . . 2.15 2.12 0.77 0.49

3544years . . . . . . . . . . . . . . 0,63 0.52 0.21 0.05 0.03 . . 2.76 2.77 0.59 0.45

45-54 years . . . . . . . . . . . . . . 047 0.40 0.19 0.05 0.03 . . 2.72 2.73 0.65

5564 Years . . . . . . . . . . . . . .

0.40

0.39 0.39 0.16 0.04 0,03 . . . 3.25 2.34

65-74 vears . . . . . . . . . . . . . .

0.79 0.60

043 0.36 0,17 0.04 0.03 . . 2.39 2.25 0.65 0.62

Female

25-74 war5 . . . . . . . . . . . . . . 0.19 0.14 0:11 0.03 0.01 . 0.90 0,91 0.37 0.20

25-34 years . . . . . . . . . . . . . . 0.32 0.27 0.17 0.04 0.03 . . 2.12 1.95

3544years . . . . . . . . . . . . . .

0.42 0.44

0.45 0.20 0.21 0.05 0.02 ,.. 1.2B 1.25 0.75 0,34

4E&4vears. . . . . . . . . . . . . . 0.30 0.24 0.16 0.03 0.03 . 2.01 2.17 0.49 0,31

5564 years . . . . . . . . . . . . . . 0.42 0.35 0.17 0.08 0.03 . 1.70 1,39 1.02

65-74 vears . . . . . . . . . . . . . .

0,43

0,81 0.75 0.34 0,05 0.03 3.40 3.55 0.78 0.49

SOURCE: First National Health and Nutrition Examination Survey detailed examination sample, 1971-75.

23
Table 10. Number of examined persons, estimated mean number of segmented neutrophils, standard deviation, and selected

percentiles by race, sex, and age: United States, 1971-75

Number of Number Standard Percentile

Race, sex, and age examined of cells deviation

persons X 10g/L 5th 10th 25th 50th 75th 90th 95th

White7

Both sexes

25-34 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

55434years . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Male

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

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

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

55434vears . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-i’4vears . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female

25-34vears . ., ...,..,. . . . . . . . . . . . . . . .

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

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

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

!65-74vears . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Both sexes

;25-34yaars . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44vears . . . . . . . . . . . . . . . . . . . . . . . . . . .

,45-54vears . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

65-74vears . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male

Z25-34vears . . . . . . . . . . . . . . . . . . . . . . . . . . .

135-44yeers . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

55-64vears . . . . . . . . . , . . . . . . . . . .

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

Female

t25-34years . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

!~5.64years . . . . . . . . . . . . - . . .

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

1,095

833

1,132

895

832

484

363

510

427

399

611

470

622

468

433

146

128

172

117

141

61

47

82

53

72

85

81

90

64

69

4,58

4.59

4.54

4.40

4.34

4.48

4.47

4.61

4.61

4.59

4.67

4.71

4.47

4.23

4.16

3.86

3.89

3.75

3.86

3.73

3.98

4.20

3.84

3.56

3.20

3.76

3.63

3.67

4.08

4.12

1.65

1.73

1.44

1.41

1.58

1.44

1.57

1.38

1.43

1.95

1.82

1.85

1.49

1.36

1,20

1.50

1.59

1.64

1.59

2.61

1.35

1.83

1.73

1.36

1.37

1.61

1.32

1.57

1.70

3.18

2.40 2.79 3.52 4.37 5.46 6.54 7.30

2.42 2.79 3.41 4.31 5.45 6.71 7.54

2,56 2.86 3.48 4.36 5.34 6.41 7.14

2.41 2.77 3.42 4.18 5,22 6.26 6.78

2.54 2.86 3.36 4.09 4.99 5.97 6.65

2.39 2.72 3.48 4.31 5.46 6.45 7.06

2,54 2.80 3.30 4.14 5.24 6.46 7.56

2.75 3.00 3.63 4.47 5.33 6.32 7.03

2.62 3.01 3.59 4.47 5.51 6.36 7.06

2.70 2.97 3.49 4.21 5.24 6.04 6.94

2.52 2.80 3.54 4.40 5.44 6.72 7.67

2.22 2.65 3.54 4.46 5.62 6.92 7.50

2.40 2.78 3.34 4.28 5.36 6.53 7.34

2,34 2.65 3.34 4.05 4.94 6.07 6.72

2.51 2.78 3.29 3.98 4.76 5.82 6.56

2.01 2,20 2.60 3.67 4.62 6.54 6.32

1.82 2.15 2.73 3.72 4.77 5.56 6.13

1.53 1,89 2.55 3.40 4.56 5.98 6.83

1.85 1.94 2.50 3.64 5.25 5.82 6.49

1.65 1.79 2.35 3.11 4.42 5.88 6,50

2,32 2.38 2.84 3.75 4.81 5.62 6.34

1.54 2.17 2.89 3.94 5,32 5.57 6.59

1.80 1.89 2.57 3.40 4.66 6.49 6.87

1.69 1.88 2.37 3.25 4.35 5.38 5.78

1.70 1.72 2.11 2.70 3.93 5.12 5.60

1.97 2.01 2.48 3.53 4.54 5.20 5.63

1.83 1,97 2.67 3.52 4.24 5.21 5.79

1.38 1.89 2.53 3.59 4.51 5.31 6.04

1.86 1.91 2.52 3.77 5.36 6.00 6.71

1.53 1.92 2.44 3.38 4.78 6.16 6.55

llnclude~ persons of other races; see appendix Il.

SOURCE: First National Health and Nutrition Examination Survaydatailed examination sample, 1971-75.

24
Table Il. Number ofexamined persons, estimated mean numbarof lymphocytes, Sandard deviation, andselwtad parcentilas

byrace, sex, and age: United States, 1971-75

Number of Number Standard Percentile

R=e, sex, and age examined of cells deviation

persons X 10g/L 5tfl lotfl 25th 50th 75th 90th 95th

Whitel

Both sexes

25-34 years

3544 years

45-54 years

55-64 years

65-74 years

1,095

833

1,132

895

832

484

363

510

427

399

611

470

622

468

433

146

128

172

117

141

61

47

82

53

72

85

81

90

64

69

2.80

2.65

2.67

2.71

2.57

2.86

2.75

2.72

2.68

2.56

2.74

2.56

2.62

2.73

2.58

2.64

2.81

2.74

2.74

2.73

2.76

2.77

2.67

2.49

2.25

2.91

2.84

2.80

2.93

3,09

0.89

0.91

0.87

1.36

0.96

0.87

0.96

0.90

1.73

0.90

0.90

0.84

0.84

0.91

1,01

0.93

0,93

0.82

0.82

1.30

0.83

0,79

0.82

0.77

0.74

1.00

1.04

0.81

0.81

1.49

1.54

1.38

1.46

1.39

1.29

1.80

1.59

1.65

1.63

1.53

2.17 2.66 3.33 3.93 4.32

1.98 2.54 3.20 3.77 4.22

2.01 2.55 3.21 3.84 4,25

2.03 2.56 3.23 3.85 4.37

1.94 2.44 3.07 3.74 4.16

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

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

... ..,. . . . . . . . . . . . . . . . . . . . .

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

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

Male

25-34 years

35-44 years

45-54 ~ears

55-64 years

66-74 years

1.59

1.30

1.45

1.35

1.20

1.85

1.54

1.64

1.58

1.45

2.24 2.76 3.41 3.94 4.30

2.05 2.65 3.32 3.95 4.54

2.03 2.64 3.27 4.05 4.38

1.96 2.50 3.20 3.78 4.25

1.95 2.46 3.06 3.77 4.16

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

... ,.. . . . . . . . . . . . . . . . . . . . . .

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

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

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

Female

1.48

1.40

1.48

1.45

1.35

2.10 2.60 3.26 3.88 4,34

1.92 2.47 3.00 3.68 3.96

1.98 2.50 3.10 3.74 4.17

2.08 2.61 3.24 3.97 4.45

1.94 2.38 3.12 3.71 4,17

25-34 years

35-44 years

45-54 years

55-64 yaars

65-74 years

1.77

1.62

1.65

1.67

1.58

... ..., .,, . . . . . . . . . . . . . . . . .

... ..,. . . . . . . . . . . . . . . . . . . . .

,., ... ,. .,.. . . . . . . . . . . . . . . .

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

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

Black

Both saxes

1.49

1.18

1.55

1.65

1.25

1.83

1.71

1.73

1.79

1.43

2.26 2.55 3.43 4.35 4.53

2.21 2.75 3.30 3.91 4.45

2.12 2.61 3.33 3.88 4.24

2.12 2.60 3.32 3.78 4.13

1.83 2.42 3.31 4.24 5.23

25-34 years

36-44 years

45-54 yea rs

55-64 years

65-74 years

. . . . . . . . . . . . . . . . . . . . . . . . ,,.

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

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

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

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

Male

25-34 years

35-44 yaars

45-54 yaars

55-64 years

65-74 years

1.65

1.77

1.45

1.35

1.20

1.80

1.94

1.59

1.75

1.26

2.26 2.55 3.22 3.70 4.48

2.23 2.66 2.97 3.63 3.93

2.11 2.55 3.33 3.82 4.08

2.01 2.37 2.70 3.49 3.67

1.53 2.28 2.74 3.25 3.39

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

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

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

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

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

Famale

1.94

1.25

1.90

1.87

1.50

2.17 2.58 3.67 4.41 4.58

2.06 2.91 3.55 4.21 4.69

2.12 2.65 3.30 3.96 4.40

2.35 3.00 3.44 3.97 4.18

2.02 2.71 3.79 4.91 5.49

25-34 years

3544years

45-54years

55-64 years

65-74years

1.44

1.11

1.64

1.73

1.28

Ilncludas persons of other races; seeappandix Il.

SOURCE: First National Health and Nutrition Examination Survey detail ed examination sample, 1971-75,

25
Appendixes

.

Contents

u. Statistical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The survey design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Derivation ofestimates. ..,., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonresponse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Missing data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Small numbers.......,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reliability ofestimates, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Utilization ofstandarderrors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Il. Definitions ofcertainterms used in this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

[11. Data collection methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White blood cell counts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Peripheral blood smears: Cell-typing criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lV. Quality control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Review ofwhite bloodcell count data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Peripheral bloodsmears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List of Appendix Tables

1. Sample locations of the first National Health and Nutrition Examination Survey by region, county, and State . . , . . . . .

Il. Population estimates forexamination locationa l-65 by sex, racer and age at examination: United States, 1971-74 . . . . .

Ill, Population estimates forexamination locationa l-100 by sex, race, and age at examination: United States, 1971-75 . . . .

27

27

28

28

31

31

31

32

33

34

34

34

36

36

36

29

30

30

26
Appendix I

Statistical Notes

The survey design

The sampling plan for the first 65 stands, or locations, of the fnst National Health and Nutrition Examination Survey (NHANES I) followed a stratified

multistage probability design in which a sample of the

civilian noninstit utiomdized population ages 1-74

years of the coterminous United States was selected.

Excluded from the selection were persons residing in

Alaska and Hawaii and those within the coterminous

United States who were confined to institutions or

residing on American Indian reservation lands. Successive elements dealt with in the process of sampling

were the primary sampling unit (PSU), census enumeration district, segment (a cluster of households),

household, eligible pmsons, and finally, sample

persons.

The starting points in the first stage of this design

were the 1960 decennid census lists of addresses and

the nearly 100 PSU’S into which the entire United

States was divided by the U.S. Bureau of the Census.

Each PSU is either a st~ndard metropolitan statistical

area (SMSA), a single county, or two or three contiguous counties. The 1’SU’S were grouped into 357

strata for use in the Health Interview Survey and were

then collapsed into 40 superstrata for use in Cycles 11

and 111 of the Health Examination Survey and

NHANES I.

Fifteen of the 40 superstrata contained a single

large metropolitan are~ with a population of more

than 2 million. The 15 large metropolitan areas were

selected for the sample with certainty. The 25 noncertainty strata were classified into 4 broad population density groups in each region. Then a controlled

selection technique was used to select 2 PSU’S from

each of the 25 noncertainty superstrata with the

probability of selection of a PSU proportionate to its

1960 population. Thus, proportionate representation

of specified State groups and rate-of-populationchange classes was maintained in the sample. In this

manner a total first-stage sample of 65 PSU’S was

selected. These 65 sample PSU’S, or stands, are the

areas within which a sample of persons would be selected for examination over the 3-year survey period.

Although the 1970 census data were used as the

frame for selecting the sample of PSU’S when they became available, the calendar of operations required

that 1960 census data be used for 44 of the 65 stands

in the NHANES I sample. Census enumeration districts (ED’s) in each PSU were divided into segments

of an expected six housing units each. In urban ED’s

the segments were clusters of six addresses from the

1960 census listing books. For ED’s not having usable

addresses, area sampling was employed and, consequently, the segment size varied. To make the sample

representative of the current population of the United

States, the address or list segments were supplemented

by a sample of housing units that had been constructed since 1960.

Within each PSU a systematic sample of segments

was selected. The ED’s that fell into the sample were

coded into one of two economic classes. The fust

class, identified as the “poverty stratum,” was composed of current poverty areas that had been identified by the U.S. Bureau of the Census in 1970 (pre1970 census). plus other ED’s in the PSU with a mean

income of less than $3,000 in 1959 (based on 1960

census data). The second economic class, the “nonpoverty stratum, “ included all ED’s not designated as

belonging to the poverty stratum.

All sample segments classified as being in the

poverty stratum were retained in the sample. For

those sample segments in nonpoverty stratum ED’s,

the selected segments were divided into eight random

subgroups and one of the subgroups was chosen to

remain in the NHANES I sample. This procedure permits separate analyses with adequate reliability of

those classified as being below the poverty level and

those classified as being above the poverty level.

After the sample segments had been identified, a

list of all current addresses within the segment boundaries was made. and a person in each of the households was interviewed to determine the age and sex of

27
each household member and to gather other demographic and socioeconomic information required for

the survey.

In selecting the persons in sample segments to be

examined in NHANES I, all household members ages

1-74 years in each segment were listed on a sample

selection worksheet with each household in the segment listed serially. The number of household members in each of the six age-sex groups shown below

were listed on the worksheet under the appropriate

age-sex-group column, The sample selection worksheets were then ordered by segment number, and a

systematic random sample of persons in each age-sex

group was selected to be examined by using the

following sampling rates:

Age Sampling rate

l-5 years . . . . . . . . . . . . . . . . . . . . . . 112

6-19 years . . . . . . . . . . . . . . . . . . . . . 1/4

20-44 years (male) . . . . . . . . . . . . . . . . 1/4

20-44 years (female) . , . . . , . . , . . . . . . 1/2

45-64 veals . . . . . . . . . . . . . . . . . . . . 1/4

65-74 vears . . . . . . . . . . . . . . . . . . . . 1/1

The persons selected for the 65-stand nutrition

component of NHANES I constitute a representative

sample of the target population and include 28,043

persons ages 1-74 years, of whom 20,749, or nearly

74 percent, were examined. When adjustments are

made for differential sampling for high risk groups,

the response rate becomes 75.2 percent.

The subsample of adults ages 25-74 years who received the detailed examination in addition to the

more general nutrition examination was chosen syste matically after a random start, This group comprised one-fifth of the total sample of adults ages 25-

74 years and was selected in accordance with the

following rates:

Age

Resultant

Rate applied

to nutrition

effective

sampling

sample rate

25-44 veers (mele) . . . . , . . . 2/5 1/10

25-44 years (female) . . . . . . 1/5 1/10

45-64 years . . . . . . . . . . . . . 3/5 3/20

65-74 years . . . . . . . . . . . . . 114 1/4

The continuation of the detailed medical examination from 1974 to 1975 is referred to as the

NHANES I augmentation survey of adults. The sample design had two basic requirements: The sample

of persons selected for examination in survey locations 66-100 would constitute a national probability

sample of the target population, and, when considered jointly with those persons receiving the detailed

examination in NHANES I survey locations 1-65, the

sample would be a 100-PSU national probability

sample, Table I is a list of the sample locations at

which examinations were conducted during the

survey.

The PSU’S for the augmentation survey were

select ed by the same process used earlier at the beginning of NHANES I (described earlier4 ). The final

sampling stage involved the random selection of one

of every two adults ages 25-74 years who were eligible for the sample.

All the data presented in this report are based on

“weighted” observations. That is, data recorded for

each sample person are inflated to characterize the

subuniverse from which that sample person was

drawn.

Derivation of estimates

Because the design of NHANES I is a multistage

probability sample, complex procedures must be used

in the derivation of estimates. Three basic operations

are involved, the results of which are presented separately in tables II and III for the nutrition examination sample and the detailed examination sample,

respectively.

Inflation by the reciprocal of the probability of

selection. –The probability of selection is the product

of the probabilities of selection from each step of

selection in the design (PSU, segment, and sample

person).

Nonresponse adjustment. -The estimates are inflated by a multiplication factor calculated within

each PSU for each of five selected income groups

(less than $3,000; $3,000-$6,999; $7,000-$ 9,9!99;

$10,000-$ 14,999; and $15,000 and over). The Iuumerator of these factors consists of the sum of the

weights for sample persons resulting from the reciprocal of the probability of selection, and the denominator consists of the sum of the weights for examined

persons also resulting from the reciprocal of the

probability of selection,

Poststratification by age-sex-race. –The estimates

are ratio adjusted within age-sex-race cells to an independent estimate, provided by the U.S. Bureau of the

Census, of the population of each cell as of the mlidpoint of the survey. The effect of the ratio-estimating

process is to make the sample more closely representative of the U.S. civilian noninstitutionalized population by age, sex, and race, which thereby reduces

sampling variance.

More detailed descriptions of the survey design

and selection technique have been published.’~’5

Nonresponse

In any health examination survey, after the

sample is identified and the sample persons are requested to participate in the examination, the survey

meets one of its more severe problems: Usually, a

sizable number of sample persons will not participate

NOTE: A list of references follows the text.

28
Table 1. Sample locations of the first National Health and Nutrition Examination Survey by ragion, county, and State

Region, coun W, 7 and state

Northeast

Essex, Morris, Union, Somerset, Hudson, Middlesex, N.J.

Nassau, Queens, Suffolk, N.Y.

Bronx, N.Y.

Kings, Richmond, N.Y.

Westchester, Rockland, N. Y.: Bergen, Passaic, N,J.

Bucks, Chestar, Delaware, Montgome~, Philadelphia, Pa.

Philadelphia, Pa.: Camden, Gloucester, Burlington, N.J.

Essexr Middlesex, Norfolk, Plymouth, Suffolk, Mass.

Allegheny, Beaver, Washington, Westmoreland, Pa.

Albany, Schenectady, Rensselaer, Saratoga, N.Y.

Lackawanna, Pa.

Holyoke, Chicopee, Springfield, Mass.

Bristol, Newport, Providence, Kent, Washington, R.1.

Hartford, Tolland, Corm.

Chemung, Tioga, Tompkins, N.Y.

Mercer, Pa.

Bedford, Fulton, Pa.

Monroe, N.Y.

Blair, Pa.

Middlesexr New Haven, Corm.

Warren, N.Y.

Midwest

Lake, Porter, Cook, Will, Kane, Ill.

Cook, DuPage, Kane, Lake, McHenry, II 1.

Macomb, Oakland, Wayne, Mich.

Milwaukee, Waukesha, Wis.

Hennepinr Ramsey, Anoka, Dakota, Washington. Minn.

Lake, Cuyahoga, Ohio

Franklin, Ohio

Buchanan, Mo.

Cass, N. Dak.: Clay, Minn.

Jefferson, St. Charles, St. Louis, Me.: Madison, St. Clair, Ill.

Bay, Mich.

DeKalb-Stueben, Ind.: Branch, Mich.

Cass, St. Joseph, Mich.

Fayette, Rossr Ohio

LaPorte, Marshall, Starke, Ind.

Boone, Greene, Iowa

Howard, Iowa: Fillmore, Minn.

Cass, Clay, Jackson, Platte, Mo.

Marion, Ind.

Montgomeryr Greene, Miami, Ohio

Jackson, Mich.

Jefferson, Leavenwotihr Kans.: Platt, Mo.

Brown, Clinton, Ohio

Rusk. Wis.

South

St. Bernard, Jefferson, Orleans, La.

Washington, D. C.: Fairfaxr Arlington, Vs.: Prince Georges, Montgomery,

Md.

Richland, Lexington, S.C.

Knox. Anderson, Blount, Term.

Roanoke, Va.

Chatham, Ga.

Hillsborough, Pinellas, Fla.

Palm Beach, Fla.

Natchitoches, La.

Lamarr Marion, Miss.

Cabarrus, Stanley, Union, N.C.

Hancock, Hamblen, Hawkins, Claiborne, Term.

Barbour, Ala.

Bullock, Jenkins, Ga.

Sussax, Del.: Worcester, Md.

Fayette, W. Va.

Greenville, S.C.

New Castle, Del.

Jefferson, Ala.

Volusia, Fla.

Edgefield, Saluda, S.C.

Clay, Calhoun, Roane, W. Va.

West

Orange, Los Angeles, Calif.

Los Angeles, Cal if.

Alameda, Contra-Costa, San Mateo, San Francisco, Solano, Cal if.

ColIin, Denton, Dallas, Ellisr Tex.

Bexar, Tex.

Pima, Ariz.

Douglas, Nebr.: Pottawattamie, Iowa

San Diego, Calif.

Fresno, Calif.

Monterey, Calif.

Clallum, San Juan, Wash.

Grant, Wash.

Gila, Ariz.

Avoyal Ies, La.

Ottertail, Minn.

Adams, Arapahoe, Denver, Jefferson, Boulder, Colo.

Sacramento, Calif.

Hunt, Rains, Tex.

Mason, Thurston, Wash.

Greeley, Nance, Nebr.

Camadian, Cleveland, Oklahoma, Okla.

‘ County, parish, or borough

in the examination. Whether or not an individual participates is determined by many factors, some of them

uncontrollable, and, therefore, the outcome may

be reasonably treated as a random event with a particular probability of occurrence. If the probabilities

of participation were known and were greater than

zero for all persons, then the examined persons would

constitute a probability sample from which unbiased

estimates of the target population could be derived.

In this situation, the effect of nonparticipation would

only be to reduce the sample size, thereby increasing

the sampling errors of examination findings. In practice, however, a potential for bias due to nonresponse

exists because the exact probabilities are never

known. A further potential for bias exists if: (1) a

sizable proportion of sample persons have a zero

probability of participation, that is, they would never

agree to participate in an examination survey of the

same procedures and inducements, and (2) these persons differ from other sample persons with respect to

characteristics under examination. It is for these

reasons that intensive efforts were made in NHANES I

to develop and implement procedures and inducements that would reduce the number of nonrespondents and thereby reduce the potential of bias due to

nonresponse. These procedures and inducements are

discussed elsewhere.4

NOTE: A list of references follows the text.

29
Table 11. Population estimates for examination locations 1-65 by sex, race, and age at examination: United States, 1971-74

Estimated population

Age at examina tion Male Female

Total

All races White 1 Black All races White I Black

l-74years . . . . . . . . . . . . . . . . . . . . . 193,976,381 94,239,866 82,740,899 10,413,986 99,736,515 86,867,546 11 ,99!9,935

I year . . . . . . . . . . . . . . . . . . . . . . . . 3,313,458 1,693,074 1,401,508 280,212 1,620,384

2-3 years . . . . . . . . . . . . . . . . . . . . . .

1,327,657

6,963,162 3,553,765

257,289

2,997,707 479,362 3,409,397

4-5years . . . . . . . . . . . . . . . . . . . . . .

2,872,581 50!5,442

6,672,346 3,378,503 2,866,374 485,872 3,293,&?3

6-7years . . . . . . . . . . . . . . . . . . . . . .

2,755,016 511,134

7,193,663 3,652,322 3,060,888 573,867 3,541,341

8-9years . . . . . . . . . . . . . . . . . . . . . .

2,951,927 5716,578

7,696,597 3,880,396 3,279,649 586,419 3,816,201

10-n years . . . . . . . . . . . . . . . . . . . .

3,257,936 53!3,855

8,465,793 4,381,730 3,732,593 563,823 4,064,063 3,424,070

12-14years . . . . . . . . . . . . . . . . . . . . 12,335,321

61’7,793

6,312,519 5,397,061 879,377 6,022,802

15-17years . . . . . . . . . . . . . . . . . . . .

5,122,189 8315,252

12,318,434 6,207,169 5,311,596 812,321 6,111,265 5,233,091 85:3,294

18-19years . . . . . . . . . . . . . . . . . . . . 7,352,200 3,673,321 3,206,467 404,045

20-24years . . . . . . . . . . . . . . . . . . . .

3,678,879 3,158,930 504,417

17,325,038 8,109,775 7,094,036 866,201 9,215,263

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

7,972,486 1,07:3,358

26,936,001 13,002,514 11,594,115 1,231,793

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

13,933,487 12,160,578 1,646,337

22,268,477 10,675,731 9,515,530 1,004,953 11,592,746 10,111,458 1,3113,050

45-54years . . . . . . . . . . . . . . . . . . . . 23,313,316 11,150,110 10,039,124 1,056,837 12,163,206 10,879,167

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

1,23”7,459

19,049,001 9,072,586 8,274,948 702,647 9,976,415 9,037,157 87’1,098

165-74 years . . . . . . . . . . . . . . . . . . . . 12,773,574 5,496,351 4,969,903 486,257 7,277,223 6,603,303 65’1,579

llncl~desperaonsof mher races; see appendix Il.

NOTE: The numbars in this table constitute estimates and closely approximate the U.S. population as estimated by the U.S. Bureau of the Census as

of November 1972.

SOURCE: First National Health and Nutrition Examination Survey nutrition examination sample, 1971-74.

Table Ill. Population estimates forexamination locations l-l OObysex, race, andage at examination: United Statesr 1971-75

Estimated population

Age at examination Male Female

Total

All races White I Black All races White I Black

Z25-74years . . . . . . . . . . . . . . . . . . . . 106,639,033 50,586,997 45,303,260 4,693,184 56,052,036 49,582,632 5,963,002

;25-34Vears . . . . . . . . . . . . . . . . . . . . 28,296,796 13,663,092 12,122,508 1,302,502 14,633,704

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

12,712,842 1,736,498

22,302,278 10,761,322 9,578,852 1,023,520 ‘1T,540,956 10,003,331 1,391,510

45-54 years . . . . . . . . . . . . . . . . . . . . 23,548,824 11,288,375 10,131,455 1,095,092 12,260,449 10,921,890 1,26;!,609

!j5.64 years . . . . . . . . . . . . . . . . . . . . 19,345,852 9,191,996 8,336,468 768,237 10,153,856 9,164,012 90~,874

65-74 years . . . . . . . . . . . . . . . . . . . . 13,145,283 5,682,212 5,133,977 503,833 7,463,071 6,780,557 666,511

‘Ilnclude sper$onsof other races; see aPPendiX Il.

NOTE: The numbers in this table constitute estimates and closely approximate the U.S. population as estimated by the U.S. Bureau of the Celnsusas

of February 1974.

SOURCE: First National Health and Nutrition Examinatiorr Survey detailed examination sample, 1971-75.

Despite these intensive efforts, 26 percent of the

sample persons from the 65-location nutrition examination sample and 30 percent of the sample persons

from the 100-location detailed examination sample

were not examined. Consequently, the potential for

a sizable bias does exist in the estimates in this publication. From what is known about the nonrespondents and the nature of nonresponse, it is believed that

the likelihood of sizable bias is small.

Efforts have been made using data from NHANES

I and from an earlier sumey to examine possible

health-related differences between examined and nonexamined persons. Reasons for nonparticipation in

NHANES I were investigated29 on a sample of 325

NOTE: A list of references follows the text.

30

persons (209 examined persons, 35 persons whet had

made appointments for the examination but who

never came to the mobile examination center for the

examination, and 81 persons who refused to participate in the survey). The sample persons for this study

came from four stand locations: St. Louis, Monterey,

New York, and Philadelphia. They were asked to indicate why they did not choose to be examined. The

primary reasons given were that they had no need for

a physical (48 percent), or that the examination times

were inconvenient because of work schedules or c]ther

demands (15 percent). Only 6 percent of those persons not examined in NHANES I indicated that they

refused the examination because of sickness, and

3 percent based theix refusal on fears of possible

findings.
Data on both examined and nonexamined (but Missing data

interviewed) persons were analyzed30 by using information from the first 35 stands of NHANES I. For

the health characteristics compared, the two groups

were quite similar. For example, 20 percent of the

examined persons reported that a doctor had told

them they had arthritis, compared with 17 percent of

the unexamined persons. Similarly, 18 percent of

both the examined and the nonexamined persons had

been told by a doctor that they had high blood pressure. Twelve percent of both groups reported that

they were on a special diet, and 6 percent of both

groups said that they regularly used medication for

nerves,

A study31 of factors relating to response in a

health examination survey, based on data from Cycle

I of the Health Examination Survey,30 showed that

36 percent of the unexamined people in that survey

viewed themselves as being in exceIIent health, compared with 31 percent of the examined people. A

self-appraisal of being in poor health was made by

5 percent of the nonexamined persons and by 6 percent of those who were examined. Additionally, a

different study of Cycle I datas 2 showed that comparisons between two extreme groups-those who

participated in the survey with no persuasion and

those who participated onIy after a great deal of persuasion–indicated that differences between the two

groups generally had little effect on estimates based

on numerous selected examination and questionnaire

items. This was interpreted as evidence that no large

bias exists between the two groups for the items investigated and was offered as further support for the

belief that little bias is introduced to the findings because of differences in health characteristics between

examined and nonexamined persons.

As noted earlier, the data in this report are based

on weighted observations, and one of the components

of the weight assigned to an examined person was an

adjustment for nonresponse. Because the probabilities

of participation are not known for sample pelsons in

NHANES I, a procedure was adopted that multiplies

the reciprocal of the probability of selection of sample persons by a factor that brings estimates based on

examined persons up to a level that would have been

achieved if all sample persons had been examined.

This nonresponse adjustment factor is the ratio of the

sum of sampling weights for all sample persons within

a relatively homogeneous class defined by age, sex,

and income within each stand to the sum of sampling

weights for all responding sample persons within the’

same homogeneous class from the same stand. If

homogeneous groups can be defined that are also

homogeneous with respect to the characteristics

under study, the procedure can be effective in reducing the potential bias from nonresponse.

NOTE: A list of references follows the text.

Examination surveys are subject to the loss of

information not orLIy through the failure to examine

all sample persons, but also from the failure to obtain

and record all items of information for examined persons (item nonresponse). In the case of Laboratory

findings, missing data can result from such occurrences as equipment failure, laboratory accidents,

poor specimen preparation, and loss of specimens in

the mail between the examination locations and

testing laboratories.

Differential leukocyte count data are not available

for 1,059 persons, or 15.3 percent of the 6,913 adults

who received the detailed examination during the

100-location sample. White blood cell (WBC) counts

for 2,072 sample persons could not be reported from

the NHANES I nutrition examination sample (stands

1-65), and the counts for an additional 280 persons

were discarded during quality control procedures discussed in appendix IV.

After inspecting the age, sex, and race characteristics of that portion of the sample for whom WBC

and/or differential leukocyte count data are missing,

and after comparing these characteristics with those

of the larger portion of the sample for which data are

available, the assumption was made that the missing

data accounts for little bias because of the nonsystematic nature of the reasons for missing laboratory

data. Consequently, the weighted estimates that appear in this report as means or percents reflect an

imputation for missing data; that is, the findings are

presented as if information had been gathered for all

sample persons.

Small numbers

In tables 2-5 magnitudes are shown for cells for

which the sample size is so small that the sampling

error may be several times as great as the statistic

itself. In such instances the numbers have been included to convey an overall impression.

Reliability of estimates

Since the statistics presented in this report are

based on a sample, they will differ somewhat from

the figures that would have been obtained if the survey had been conducted on the complete population.

In other words, the statistics are subject to sampling

variability y.

The standard en-or is primarily a measure of sampling variability, but it may also include part of the

variation that arises in the measurement process. The

standard errors presented in tables 1, 7, and 9 have

been calculated by a technique referred to as balanced

repeated replication. The need for this specialized

technique for estimating standard errors arises because

of the complexity of the sample design of NHANES I.

31
Estimates of standard errors are themselves subject to

errors that may be large if the number of cases which

the estimates are based is small.

Utilization of standard errors

Two examples can illustrate the use of the standard errors presented in tables 1, 7, and 9.

The first example demonstrates the use of the

standard error in testing the difference between estimated mean white blood cell (WBC) counts for two

population groups: white males ages 65-74 years and

black males in the same age group. A z statistic will

be computed as follows:

Mean

Standard

Population group WBC

error of

(F)

mean

(o~)

White males ages 65-74 yearsl . . . 7.6 0.19

Black males ages 25-74 yearsz . . 5.8 0.43

1 From tables 6 and 7,

2From tables B and 9,

First an approximation of the standard error of

the difference between the two mean values is calculated as follows:

Standard error of difference:

m

~yl - F2 = [(0.19)+ (o.43)1~ = 0.47.

Then the z statistic is computed as follows:

21 -22

z–cr~1_y2

or

7.6- 5.8 = 383

z= 0.47 “ “

As a matter of convenience, in this study a di~fference between two means was considered signifi~cant

when z was equal to or greater than 2.00. Since z is

greater than 2.00 (z = 3.83), the difference between

mean WBC counts for white and black males ages

25-74 years is considered significant at the 95-percent

confidence limit.

In the second example, the standard error is, employed to construct a confidence interval around the

estimated mean WBC count for white males age;s 65-

74 years as follows:

Mean

Standard

Population group WBC

error of

(z)

mean

(OF)

White males ages 65-74 years . 7.6 0.19

A 95-percent confidence interval is constructlsd as

follows :

or

7.6 ~ 1.96 (0.19),

which results in a confidence interval of 7.2-8.0.

In other words, the probability that the population value for the estimated mean WBC count for

white males ages 65-74 years lies between 7.2 and 8.0

is 95 percent.

32
Appendix II

Definitions of Certain Terms

Used in This Report

Age. –Two ages were recorded for each exarninee:

age at last birthday at the time of examination and

age at the time of the census interview. The age criterion for inclusion in the sample used in this survey

was defined as age at the time of census interview.

The adjustment and weighting procedures used to

produce national estimates were based on the age at

interview. Data in the detailed tables and text of the

report are shown by age at the time of the examination, except that those few who became 75 years old

by the time of the examination are included in the

65-74-year age group.

Race. –Race was recorded as “white,” “black,” or

“other. “ “Other” includes Japanese, Chinese, American Indian, Korean, Eskimo, and all races other than

white or black. Mexicans were recorded as “white”

unless definitely known to be American Indian or of

a race other than white. When a person of mixed racial

background was uncertain about his or her race, the

father’s race was recorded. In this report people of

“other” races have been included under the designation “white.”

Smoking status. –Smoking status was derived

from questionnaire material in the following manner:4

Never smoked:

Former smoker:

Current smoker:

Examinee has smoked less than

100 cigarettes in lifetime.

Examinee has smoked at least

100 cigarettes in lifetime but

was not smoking at the time of

the NHANES I survey.

Examinee has smoked more

than 100 cigarettes in lifetime

and was smoking at the time of

the NHANES I survey.

NOTE: A list of references follows the text.

33
Appendix Ill

Data Collection Methodology

White blood cell counts

White blood cell (WBC) counts were determined

in duplicate on the Coulter Fn, operated according to

the Coulter instruction manual,33 In the Coulter Fn,

particles suspended in an electrolyte solution are

forced by a mercury siphon through an aperture of

100 microns. A current flows between an electrode

inside the aperture tube and a second electrode outside the tube. As a particle passes through the aperture, an equal volume of electrolyte is displaced, and

the resistance in the path of the current changes, This

produces a voltage drop, the magnitude of which is

proportional to the volume of the particle. The voltage pulses are fed into a threshold circuit, which differentiates them by generating count pulses for only

the particles that exceed the threshold level, thus

counting the number of particles in passage. A correction factor for coincidence must be employed for

counts over 10,000.

Forty pL of blood were aspirated by a Coulter

Diluter 1134 and dispersed into 20 UL of Isoton for a

1 :500 dilution. Six drops of Zapoglobin were added

to the 1 :500 dilution, and the instrument count for

white cells was performed. Corrections were made for

readouts above 10,000 with the Coulter coincidence

chart. The (corrected) readout was multiplied by the

appropriate factor to obtain the WBC count in N X

109 /L (or, N X 103 /pL). Duplicate dilutions were

tested, and results had to agree within a strict tolerance level. Additionally, samples with mean values

below 3.0 or above 15.0 X 109/L were retested, and

the results were called to the attention of the person’s

examining physician.

The Coulter counter was monitored daily with

commercially available control materials. Background

counts were less than 100, and maintenance was performed at each location, or stand. If the technician

had reason to suspect that the instrument was not

performing correctly (for example, because of nearby

NOTE: A list of references follows the text.

34

electrical interference) he or she was instructed. to

note this on the laboratory recording form.

Personnel from the Hematology Division, Centers

for Disease Control (CDC) visited the mobile van:s to

ensure that procedures were properly performed.

Duplicate peripheral blood smears were made from

blood presemed with EDTA by the wedge technique

within an hour after the sample was collected. Smears

were air dried and stained by using an Ames HemaTek slide stainer equipped with the Hems-Tek slain

pack;3 5 this modified polychrome methylene blue

stain is based on the original stain proposed by

Romanowsky.36 During the time span covered, five

qualified medical technologists performed the 100-

cell differential leukocyte counts. All data were reported to the National Center for Health Statistics

(NCHS) for coding and storing on computer tapes.

Abnormal results reported to NCHS were also forwarded to the examinee’s physician.

Peripheral blood smears: Cell-typing criteria

Although some degree of subjectivity on the part

of the technologist performing the differential leukocyte count cannot be denie”d, in general, the following

terms and cell-typing criteria were adhered to:

Blast (myeloblast): With a‘ large round or cwal

nucleus and nongranular dark

blue staining cytoplasm. No

nuclear folds, fine purple-red

chromatin strands, usually

one or more nucleoli.

Promyelocyte: Resembling myeloblast Ibut

with primary bluish-to-purple

granules of various sizes and

shapes in the cytoplasm.

Myelocyte: With round, oval, or flattened, nonindented, nonfolded, nonlobulated nucleus

with ill-defined chroma!tin
strands. Lightly stained red- Eosinophils:

dish secondary granules have

appeared among the darkly

stained primary ones.

Metamyelocyte: With indented or bean-shaped Basophils:

nucleus in which the chromatin is more clumped. The primary granules have disappeared.

Band forms (stab neutrophils): With nuclei in- Mono cyte:

dented but not yet clearly

separated into interconnected

lobes.

Segmented forms (polymorphonuclear neutrophds) : With clearly lobulated nuclei.

The lobes are interconnected

by means of tkeadlike fdaments or strips, within the

margins of which no nuclear

chromatin is visible. The

chromatin within the lobes is

lumped and darkly stained.

With bright red-orange spherical granules and a nucleus

segmented into two to three

lobes.

With predominantly dark

blue, densely stained granules

of various sizes, unevenly distributed and also overlying

the nucleus.

With bluish-gray cytoplasm

and numerous small dustlike

granules causing an opaque,

ground-glass-like appearance.

The nucleus may be round,

oval, indented, or lobulated,

with brairdike convolutions.

Lymphocyte: Pale to bright blue staining,

abundant or sparse cytoplasm and rounded nucleus

with dense, clumped chromatin. No within-lymphocyte

differentiation was reported,

such as atypical or reactive.

35
Appendix IV

Quality Control

Review of white blood cell count data

Mean white blood cell (WBC) counts by stands

were calculated, graphed, and examined. Mean values

at each stand were computed and examined for

plausibility and were compared with preliminary

results from NHANES II. All WBC counts less than

3.3 X 109/L or greater than 14,2 X 10g/L were

reviewed for transcription or keypunch errors. Daily

runs were evaluated in conjunction with conditions in

the mobile examination centers. Data from daily runs

were excluded if the equipment malfunctioned and

when control values were outside the limits of the

manufacturer’s expected results. Data were also excluded if manual dilutions caused shifts in the mean.

Of the 23,808 cases for evaluation, 2,292 were

missing, primarily because of equipment failure, and

280 were excluded because of questionable quality.

Peripheral blood smears

Quality control in the usual sense could not be

implemented on a daily basis because the stained

slides were accumulated at each survey location and

sent to the Centers for Disease Control (CDC) about

once a month. In CDC’S Hematology Division the

slides were classified as satisfactory and read, or they

were reported as unsatisfactory. If unsatisfactory

slides were received recurrently, additional onsite

training was given to the technicians. If differential

results were outside the accepted normal values,25 an

additional 100 whit e blood cells were classified. In

addition, the morphologic evaluations of the slides

were compared with Coulter results.

All differential results were computer checked to

ascertain that the sum of the frequencies of the different cell types totaled 100, and discrepant results

were checked for transcription or keypunch errors. If

no errors were found, the differential leukocyte count

was redone.

All results were further checked for plausibilityy

according to the following criteria. 18>25 When urlcommon cell types including blast cells, promyelclcytes, myelocytes, and metamyelocytes were reported, the results were verified. If the percents of

other cell types reported fell outside the acceptable

ranges, these results were also reviewed. The acceptable ranges are as follows:

Cell type Acceptable range

Band neutrophils . . . . . . . . . . . . . . . 0-10 percent

Segmented neutrophils. . . . . . . . . 27-85 percent

Eosinophils . . . . . . . . . . . . . . ,.. , 0-12 percent

Basophils . . . . . . . . . . . . . . . . . . . . 0-3 percent

Monocytes . . . . . . . . . . . . . . . . . . . 0-12 percent

Lymphocytes . . . . . . . . . . . . . . . . . 10-70 percent

A computer reject-listing of 65 results was obtained.

A number of transcription or keypunch errors were

found, one case of chronic lymphocytic leukemia andl

one case of chronic myelocytic leukemia were identified, and 47 results were verified– 15 by 200-celll

differential counts. Of 6,913 persons examined in the

100 stands, satisfactory slides were obtained for

5,854 persons (85 percent). The 1,059 examinees for

whom data are not presented were excluded for the

following reasons: no slide obtained, slide obtained

but not read because of poor cell distribution, slide

broken in the mail, or slide lost in the mail. The

largest IOSSwas from poor slide preparation, as mentioned earlier. This necessitated excluding all slides

from three entire stands.

NOTE: A list of references follows the text.

36
al and Health Statistics series descriptions 

SERIES 1. Programs and Collection Procedures.-Reports describing 

the general programs of the National Center for Health 

Statistics and its offices and divisions and the data collection methods used. They also include definitions and 

other material necessary for understanding the data. 

long-term care, ambulatory care, hospital care, and family 

planning services. 

SERIES 2. Data Evaluation and Metbods Research.-Studies of new 

statistical methodology including experimental tests of 

new survey methods, studies of vital statistics collection 

methods, new analytical techniques, objective evaluations 

of reliability of collected data, and contributions to statistical theory. 

SERIES 14. Data on Health Resources: Manpower end FecilitiesStatistics on the numbers, geographic distribution, and 

characteristics of health resources including physicians, 

dentists, nurses, other health occupations, hospitals, 

nursing homes, and outpatient facilities. 

SERIES 15. Data From Special Surveys.-Statistics on health and 

health-related topics collected in special surveys that 

are not a part of the continuing data systems of the 

National Center for Health Statistics. 

SERIES 3. Analytical and Epidemiological Studies.-Reports presenting analytical or interpretive studies based on vital 

and health statistics, carrying the analysis further than 

the expository types of reports in the other series. 

SERIES 4. Documents and Committee Reports.-Final reports of 

major committees concerned with vital and health statistics and documents such as recommended model vital 

registration laws and revised birth and death certificates. 

SERIES 20. Data on Mortality.-Various statistics on mortality other 

than as included in regular annual or monthly reports. 

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses; 

and statistics on characteristics of deaths not available 

from the vital records based on sample surveys of those 

records. 

SERIES 10. Data From the National Health Interview Survey.-Statistics on Illness, accidental injuries, disability, use of hospital, medical, dental, and other servrces, and other 

health-related topics, all based on data collected in the 

continuing national household Interview survey. 

SERIES 11. Data From the National Health Examination Survey and 

the National Health and Nutrition Examination Survey.- 

Data from direct examination, testing, and measurement 

of national samples of the civilian nonrnstitutionalized 

population provide the basis for (1) estimates of the 

medrcally defined prevalence of specific diseases in the 

United States and the distributions of the population 

with respect to physical, physiological, and psychological characteristics and (2) analysis of relationships 

among the various measurements wrthout reference to 

an explicit finite universe of persons. 

SERIES 12. Data From the Institutionalized Population Surveys.-Discontinued in 1975. Reports from these surveys are included in Series 13. 

SERIES 13. Data on Health Resources Utilization.-Statistics on the 

utilization of health manpowr and facilities providing 

SERIES 21. Data on Natality, Marriage, and Divorce.-Various statistics on natality, marriage, and divorce other than as 

included in regular annual or monthly reports. Special 

analyses by demographic variables; geographic and time 

series analyses; studies of fertility; and statistics on 

characteristics of births not available from the vital 

records based on sample surveys of those records. 

SERIES 22. Data From the National Mortality and Natality Surveys.- 

Discontinued in 1975. Reports from these sample surveys 

based on vital records are included in Series 20 and 21, 

respectively. 

SERIES 23. Data From the National Survey of Family Growth.- 

Statistics on fertility, family formation and dissolution, 

family planning, and related maternal and infant health 

topics derived from a periodic survey of a nationwide 

probability sample of ever-married women 1544 years 

of age. 

For a list of titles of reports published in these series, write to: 

Scientific and Technical Information Branch 

National Center for Health Statistics 

Public Health Service 

Hyattsville. Md. 20782