Total Serum

Cholesterol Levels

of Adults

20-74 Years of Age

United States, 1976-80

This report presents descriptive data on

total serum cholesterol levels by

demographic and socioeconomic variables,

and oral contraceptive use for women.

This information is from the second

National Health and Nutrition Examination

Survey, a national probability sample survey

of the civilian noninstitutiona lized

population of the United States conducted

in 1976-80.

Data From the National Health Survey

Series 11, No. 236

.._ -. ..._ .

DHHS Publication No. (PHS) 86-1686

U.S. Department of Health and Human

Services

Public Health Service

National Center for Health Statistics

Hyattsville, Md.

May 1986
Copyright information

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

reproduced or copied without permission; citation as to source,

however, is appreciated.

Suggested citation

National Center for Health Statistics, R. Fulwood, W. Kalsbeek,

B, Rifkind, et al,: Total serum cholesterol levels of adults 20-74 years

of age: United States, 1976–80. Vital and Health Statistics. Series 11,

No. 236, DHHS Pub. No. (PHS) 86–1 686. Public Health Service.

Washington, U.S. Government Printing Office, May 1986.

Library of Congress Cataloging-in-Publication Data

Total serum cholesterol levels of adults 20–74 years

of age

(Series 11, Data from the national health survey ;

no. 238) 13HHS publication ; no. (PHS) 86-1 686)

“This report presents descriptive data on total

serum cholesterol Iavels by demographic and socioeconomic variables, and oral contraceptive use for

women. This information is from the Second National

Health and Nutrition Examination Survey ., conducted in

1976–80.”

Authors: Robinson Fulwood and others.

Bibliography p.

Supt. of Dots. no.: HE20.6209:11 /236

1, Hypercholestermia—United States—Statistics.

2. Blood cholesterol—United States—Statistics.

3. Oral contraceptives—United States—Statistics.

4. Health surveys-United States, 5. United States—

Statistics, Medical. 1. Fulwood, Robinson. Il. National

Center for Health Statistics (U. S.) Ill. Series: Vital

and health statistics, Series 11, Data from the national

health survey ; no. 236, IV. Series: DHHS publication ;

no. (PHS) 88-1 6S6. [DNLM: 1. Cholesterol—blood,

2. Socioeconomic Factors. W2 A N148vk no. 236]

RA407 ,3 .A34/ no. 236 362.1’961 86-600091

[RA645. H87]

ISBN 0–8406-0337-1

For sale by the Superintendent of Documents, U.S. Go%-ernment Printing Office, Washington, D.C. 20402
National Center for Health Statistics

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

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph. D., Associate Director forAnalysis

and Epidemiology

Garrie J. Losee, Associate Director for Data Processing

and Services

Alvan O. Zarate, Ph. D., Assistant Director for International

Statistics

Peter L. Hurley, Acting Associate Director for Interview

and Examination Statistics

Stephen E. Nieberding, Associate Director for Management

Gail F. Fisher, Ph. D., Associate Director for Program

Planning, Evaluation, and Coordination

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

and Methodology

Peter L. Hurley, Associate Director for Vital and Health

Care Statistics

Alice Haywood, Information 0j7icer

Mice of Interview and Examination Statistics Program

Peter L. Hurley, Acting Associate Director

Mary Grace Kovar, Dr. P.H., Spe~a

pQ&’*”$&s& ‘“”

Division of Health Examination Statistics

Robert S. Murphy, Director

Catherine E. Woteki, Ph. D., Deputy Director

Kurt R Maurer, Chiej Survey Planning and Development

Branch

Clifford Johnson, Chief Nutrition Statistics Branch

Suzanne Haynes, Ph. D., Chiej Medical Statistics Branch

Division of Data Services

James C. Jacks, Ph. D., Director

Phillip R Beattie, Deputy Director

David L. Larson, Chief Health Examination Field

Operations Branch

Cooperation of the U.S. Bureau of the Census

Under the legislation establishing the National Health Survey, the Public Health Service

is authorized to use, insofar as possible, the services or facilities of other Federal, State,

or private agencies,

In accordance with specifications established by the National Center for Health

Statistics, the U.S. Bureau of the Census participated in the design and selection of the

sample and carried out the household interview stage of the data collection and certain

parts of the statistical pmessing,

Data Processing and Services Program

Garrie J. Losee, Associate Director
Acknowledgments

The authors acknowledge with appreciation the contributions of laboratory analysis, data collectio~ processing and

editingj and manuscript review made by the following individuals from various Government and non-Government agencies

Lipid Research Clinics, George Washington University

Phyllis Mitchell, Laboratory Teciuician

Lipid Research Clinics Central Patient Registry, University of North Carolina at Chapel Hill, Department of Biostatistic5

James D. Hosking, Ph.D., Coordinator, Data

Processing

Carol Bittinger, Research Assistant

Ken Kral, Research Assistant

National Center for Health Statistics:

Mary Grace Kovar, Dr,P.H., Special Assistant for

Data Policy and Analysis, Interview and Examination Program

Catherine E. Woteki, Ph.D., Deputy Director, Division of Health Examination Statistics

Trena Ezzati, Survey Planning and Development

Branch, Division of Health Examination Statistics

Brenda Lewis, Health Examination Field Operations

Branch, Division of Data Services

A special note of thanks goes to Lester Curtin, Ph.D., OffIce of

Research and Methodology, National Center for Health Statistics, for his invaluable comments and suggestions during the

review of the Analytic methodology section of appendix I.

...

1)1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Mean levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >. . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . 2

Prevalence levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Sources ofdata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , . . . . . . . . . . . . . . . . 3

Semm cholesterol determinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Collaborative analysis ofcholesterol data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Collection and shipping, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Laboratory analysis, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Method ofanalysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Other snalytic considerations ..,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Mean serum cholesterollevels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Prevalence ofmoderate and high risk levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Cumulative distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . , . . . . 18

Age, sex, sndrace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Oral contraceptive use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . 19

Socioeconomic status, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Listofdetailed tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Appendixes

I. Statistical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

II. Data presentation and reliability.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

III. Definitions ofdemographic andsocioeconomic terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

List of text figures

1. Mean serum cholesterol levels for adults by sex and age United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Mean serum cholesterol levels for adults by sex, race, and age United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Comparison of the 10th, 50th, and 90th percentiles of serum cholesterol levels by sex and age: United States, 1976-

80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Mean serum cholesterol levels of women 20-44 years by age and oral contraceptive use: United States, 1976-80 . . . . .

5. Mean serum cholesterollevels ofmen by age, race, sndpoverty status: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . .

6. Mean serum cholesterol levels ofwomen by age, race, andpoverty statux Uni@d States, 1976-80 . . . . . . . . . . . . . . . . . .

7. Mean semm cholesterol levels for men by age and annual family income: United States, 1976-80 . . . . . . . . . . . . . . . . . . .

8. Mean serum cholesterol levels for women by age and annual family income United States, 1976-80 . . . . . . . . . . . . . . . .

9. Age-adjusted mesn serum cholesterol Ievelsofadults for each race-sex group by annual fmilyincome: United States,

1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Mean serum cholesterollevelsofwhite men by age and educationallevel United States, 1976-80 . . . . . . . . . . . . . . . . . .

11. Mean serum cholesterol levels ofwhite women by age and educational levek United States, 1976-80 . . . . . . . . . . . . . . . .

6

7

7

8

9

10

11

11

12

12

13

v
12. Percent of adults with serum cholesterol levels at high risk by sex and age: United States, 1976-80 . . . . . . . . . . . . . . . . . . 14

13. Percent of adults with serum cholesterol levels at high risk by race, sex, and age United States, 1976-80 . . . . . . . . . . . . 15

14. Percent of adults with serum cholesterol levels at high risk by sex, age, and poverty status United States, 1976-80 . . . . 16

15. Percent of adults with serum cholesterol levels at high risk by sex, age, and educational level United States, 1976-

80. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

List of text tables

A, Hypothesis testingby selected variables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

B. Age-adjusted mean cholesterol levels of women by race and oral contraceptive use: United States, 1976-80 . . . . . . . . . . 8

C. Risk cutpoints of plasma cholesterol established by the NIH Consensus Development Conference on Lowering Blood

Cholesterol, December 1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

D. Risk cutpoints ofserum cholesterolby age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

E. Overestimates in percentage points and estimated number of adults 20-74 years with cholesterol levels at moderate and

high risk based on applying plasma versus serum cholesterol cutoff points to the second National Health and Nutrition

Examination Surveycholesterol distributionby sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

F. Mean serum cholesterol levels ofadults ages45–64years bysex, race, poverty status, armualfamilyincome, andeducationallevek United States, 1976-80. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

G. Percen4stindard error ofpercent, adestimated population inmillions ofpersons 2&74 yews with semm cholesterol

levels at high risk, by poverty status, educational levei, and sex United States, 1976–80. . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Symbols

--- Data not available

. . . Category nonapplicable

Quantity zero

0.0 (luantit yrnoreth anzerobutlessthan

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standard of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements

vi
Total Serum Choksterol

Levels of Adults

20-74 Years of Age

by Robinson Fulwood,’ William Kalsbeek,b Basil Rifkind,c

Ronette Russell-Briefel,’ Richard Muesing,d John LaRosa,d

and Kenneth Lippelc

Introduction

Serum cholesterol concentration is one of the known risk

factors for coronary heart disease (CHD). Numerous major

studies have indicated a strong and direct association between

levels of total serum cholesterol and CHD development. ‘-s The

most impressive evidence comes from prospective studies such

as the Framingham Study, 1which showed that the higher the

level of cholesterol in an individual, the greater the risk of sub

sequently developing coronary heart disease. The National Institutes of Health Consensus Development Conference on

Lowering Blood Cholesterolb has concluded (after reviewing

data from animal, epidemiological, and cltilcal studies, including the most recent results from the Lipid Research Clinics

Primary Prevention Trial) that elevated blood cholesterol is a

major cause of CHD, independent of other risk factors such as

hypertension and cigarette smoking. It also indicated that there

is sufilcient evidence to conclude that lowering elevated ch+

lesterol levels will reduce the risk of heart attacks caused by

cm.

The National Health and Nutrition Examination Surveys

are a national source for collection and analysis of data on risk

factors for CHD. This report presents findings on serum cholesterol levels collected during the second National Health and

Nutrition Examination Survey, 1976-80, a national crossaNationaI Center for Hea!th Statistics, Division of Health Examination Statistics, Nutrition Statistics Branch.

b~lPid Research Cfinics, Departmentof Biostatistics, University of North Carolina at Chapel Hill.

%Jational Hem Lung, and Blood Institute, Division of Heart and Vascular

Disease, Lipid Metabolism end Atherogenesis Branch.

dLiPid Research clinics, George Washington University.

sectional probability survey of the civilian noninstitutionalized

population of the United States.

The serum cholesterol data are shown and discussed by

age, sex, race, poverty status, amual family income, educational level, and by oraf contraceptive use for women. Estimates

of mean levels and prevalence of moderate and high risk chIesterol levels are weighted to be nationally representative. All

analyses of data presented in the text take into account the

complex design of the survey. Categorical data analysis, which

incorporates the entire variance-covariance structure (see ap

pendix I), was used to test these statistics, In some instances,

results fkom tests of hypotheses using this method may yield

ditYerentconclusions from methods that do not take the coveriance terms into account. The reliability criteria for estimates

are presented in appendix II, and all demographic and soci~

economic terms are defined in appendix 111.

Serum cholesterol distributions are provided as reference

data for use by public health and scientific otllcials in their

efforts to better understand the role of serum lipid concentrations in the development of cardiovascular disease and to monitor trends in cholesterol levels in the United States. They enable

researchers to identify subgroups of the population who are at

risk for me&cal problems and to identify distributional differences among population subgroups of epidemiological interest.

These distributions may also be used as benchmarks for international comparisons, and as possible indicators of changes in

factors known to influence serum cholesterol, such as diet.

Serum cholesterol levels of persons in the civilian noninstitutionalized population of the United States, as measured by

the National Health Examination Survey 1960-62 and the that

National Health and Nutrition Examination Survey 1971-74,

have been published.7-9
Some important serum cholesterol findingsby demographic

(age and race) and socioeconomic (defined by amual family

income, educational level, and poverty status) variables for

men and women and oral contraceptive use for women are

summarized below. Statistically significantmerences @ < 0.05)

in mean serum cholesterol levels, and the percent of adults with

serum cholesterol levels that put them at moderate or high risk

of developing corona~ heart disease (as defined by the National institutes of Health Consensus Development Conference

on Lowering Blood Cholesterol, 1984)6 are presented. Observed

differences (which may be of interest even though they may not

be statistically ,%ignificant)and descriptive statements about

the distribution of cholesterol values are also presented.

Meen Iwels

Mean serum cholesterol levels were significantly higher in

each succeeding age group until age 45–54 years for men

and until age 55–64 years for wome~ the levels declined

with age after 55–64 years for both men and women. The

overall means for men and women 20-74 years were 211

and 215 mg/dl, respectively.

Differences in mean serum cholesterol between the races

were not statistically significant for men or women.

Women using oral contraceptives were found to have

higher mean serum cholesterol levels than nonusers. This

relationship was true for each of the age groups: 20-24,

25–34, and 35–44 years. Differences, ranging from 9 to

15 mg/dl between users and nonusers of oral contraceptives

were statistically significant. Even though the cotitdence

limits for ages 25–34 years overlapped, categorical data

analysis confirmed that the differences in the mean between

users and nonusers was statistically significant when covariances were included in the test.

Generally, three socioeconomic status (SES) variables

(poverty income ratio, annual family income, and educa-

●

●

●

tion) used in the comparisons of the mean serum cholesterol levels by age, sex, and race showed that higher SES

individuals had the higher mean serum cholesterol levels.

Men and women at or above the poverty level had higher

mean serum cholesterol levelsthan those below the poverty

level. However, the only statistically significant difference

in the means was found for men 65–74 years. Men with an

annual family income of $20,000 or more per year also

had a higher mean serum cholesterol level than those with

an annual family income of less than $6,000 per year. The

differences in the means between income levels were statistically significantfor men ages 35–44 and 45-54 years.

Other comparisons by income for women and by educational level for both men and women did not show any

consistent patterns by age.

For the four race-sex groups, age-adjusted mean levels by

poverty status and annual family income generally show

higher mean cholesterol levels for the higher levels of these

SES variables. However, lower age-adjusted mean levels

were generally observed at the higher educational level.

Prevalence Iwels

. An estimated 19.1 percent of men and 21.8 percent of

women had serum cholesterol levels that put them at high

risk of developing coronary heart disease. An additional

14.6 percent of men and 14.7 percent of women had levels

that placed them at moderate risk. These percents indicate

that an estimated 27.4 million adults in the United States

in the late 1970’s had cholesterol levels that put them at

high risk for developing heart disease, and an additional

19.6 million had cholesterol levels that put them a.tmoderate risk. (NOTE: To interpret these estimates appropriately, one should read the Discussion section of this report,

which explains the impact of serum-plasma difference on

estimating the prevalence of risk cholesterol levels.)
Sources of data

The second National Health and Nutrition Examination

Survey (NHANES 11),10conducted between February 1976

and February 1980, is the most recent of a series of national

health examination surveys conducted by the National Center

for Health Statistics. 1l-ls The target population for the survey

was the civilian noninstitutionalized population of the United

States (including Alaska and Hawaii) 6 months-74 years of

age. All interviews and examinations, tests and procedures,

and laboratory determinations followed standardized protocols.

NHANES II, like previous examination surveys, consisted

of two components: interviews in the household, and physical

examinations and interviews in examination centers. The

household interview component involved collecting socioecm

nomic and demographic information on the family and sample

persons within the family and completing a medical history

questionnaire for sample persons. The U.S. Bureau of the

Census performed the initial household interviews and aided in

the scheduling of appointments for examination. The examination component was performed in mobile examination centers

specially designed for this study. Thus, environmental and

equipment contributions to differences between examination

findings from one sample location to another were minimized.

The fill-time examination teams were specifically trained to

follow the study protocols, which provided for standardization

and evaluation of their performance. The examination consisted

of a series of standardized tests and procedures that included

. A general medical examination and screening by a physician to obtain additional medical history information.

● Body measurements.

● A dietary interview.

. Selected diagnostic testa such as electrocardiogram, x ray,

speech, hearingj allergy, and pulmonary timction.

. Laboratory testa on whole blood, serum and urine specimens.

Thus NHANES II provided the opportunity to assess the

population’s health and nutritional status and also to assess

some aspects of change overtime.

The entire NHANES II sample consisted of 27,801 persons ages 6 months-74 years of which 91 percent were interviewed. Of these, 20,322 persons were interviewed and examined, resulting in a response rate of 73.1 percent. The

cholesterol sample consisted of 17,390 persons ages 20–74

years of whom 11,864 persons had blood drawn for serum

cholesterol determination, providing a response rate of 68.2

percent. More detail on the sample design and conduct of the

survey is presented in appendix I.
Serum cholesterol

determinations

Collaborative analysis of cholesterol data

The National Center for Health Statistics (NCHS) and

the National Heart, Lung, and Blood Institute agreed to jointly

collect chemically analyze, and process NHANES II serum

specimens for total and high density lipoprotein cholesterols

and serum triglyceride.’6

Succinctly, NCHS planned and directed the collection of

the NHANES II serum lipids data. The National Heart, Lung,

and Blood Institute provided support and coordinated the

chemical analysis through its Lipid Research Clinic Laboratory at George Washington University and the editing and

processing of the data through its Lipid Research Clinics Central

Processing Unit, Department of Biostatistics at the University

of North Carolina.

Collection and shipping

The collection and shipping of the serum specimens were

carefully handled according to standardized procedures. The

field laboratory staff of the mobile examination centers of

NCHS obtained blood samples from each survey participant

by venipuncture. The blood samples were allowed to clot, and

the samples were then centrifuged. The serum was recovered

from each sample, and then an aliquot was put into a plastic

screw-capped vial and placed in a freezer within 1 hour of

collection.

At approximately 2-week intervals, the laboratory technicians placed the serum specimens collected over the preceding

period in a Styrofoame shipping container with Dry ice’ and

shipped them to the Lipid Research Clinic Laboratory at

George Washington University, Washington, D.C., for chemical analysis.

Laboratory analysis

The serum cholesterol analysis was performed in a central

laboratory on zeolite-treated isopropanol extracts according to

the protocol described for the Lipid Research Clinics Program. 17

Once the samples were received in the laboratory, they were

~he use of trade names is for identification only and does not imply endorsement by the Public Health Service of the U.S. Department of Health and

Human Services.

placed in a freezer at – 15° C until analyzed usually within 2

weeks of receipt. Before analysis, the serum specimens were

allowed to thaw at room temperature and then were mixed

thoroughly by vortexing.

The zeolite-treated isopropanol extracts were analyzed on

a Technicon Autoanalyzer II,e which used a LiebermanBurcharde color reagent. Instrumental linearity response was

established at the beginning of each analytical run with cho

lesterol standards in isopropanol (100, 200, 300, and 400

mg/dl) provided by the Lipid Standardization Section of the

Centers for Disease Control. A serum calibrator was used to

automatically adjust instrumental response to reference AbellKendall cholesterol values.18Extracts of a high and low serum

cholesterol internal control pool were positioned in each sample

tray results from analyses out of the control range were rejected

and the analyses were repeated. The serum calibrator and internal control pools with assigned Abell-Kendall reference

values were provided by the Centers for Disease Control.

Mathod of analysis

To investigate the relationship of certain demographic and

socioeconomic variables to serum cholesterol levels, a weighted

least squares approach using categorical data analysis was

used. A Wald ~statistic (a modified chi-square statistic) was

used to test the hypothesis of no difference in the mean or

prevalence levels at the .05 level of signMcance.Table A shows

the variables for which hypothesis testing was performed. It is

important to note that the chi-square statistic is not invariant

across sample sizes, thus given the same difference across

subgroups, the statistic is more likely to be significant as the

sample size increases. Understanding this point is essential to

proper interpretation of some of the differences that appear to

Table A. Hypothesis testing by selected variables

Mean serum Prevalence of risk

Variable cholesterol Ieval cholesterol Iavel

Age . . . . . . . . . . . . . . . . . . . . . x x

Sex . . . . . . . . . . . . . . . . . . . . . . x x

Race. .,, . . . . . . . . . . . . . . . . . x x

Oral contraceptive (women

only) . . . . . . . . . . . . . . . . . . . . x

Poverty status . . . . . . . . . . . . . x x

Annual family incoma, . . . . . x

Educational level. ., . . . . . x x

4
be significant from inspection but are not when tested for statistical significance.

The socioeconomic comparisons performed were for poverty status defined by the Poverty Index Ratio as nonpoverty

(at or above the poverty level) if the ratio is equal to or greater

than one or poverty (below poverty) if it is less than one, for

less than $6,000 versus $20,000 or more per year of annual

family income, and for less than 12 years of education versus

12 years or more of education. (See appendix III for definitions.) The oral contraceptive use analysis compares the mean

of current (at the time of the survey) users and nonusers. Those

who did not currently use oral contraceptives but had previously

used them are included with nonusers.

For the socioeconomic analyses, the usual 10-year age

grouping was collapsed into larger age classifications for black

persons because of sample size and other reliability limitations.

Where age-specific levels are not presented, the age-adjusted

values are presented.

Other analytic considerations

1. The second National Health and Nutrition Examination

Survey (NHANES 11) measured serum levels of blood

cholesterol, which are approximately 3 percent higher than

plasma cholesterol levels.lg The Nlli Consensus Development Conference Statemend defines risk levels by blood

cholesterol level rather than by semm or plasma cholesterol level. However, because the plasma cholesterol distributions of the Lipid Research Clinics prevalence study

were used to define the risk levels, the inference is that

these risk levels refer to plasma cholesterol levels.zo

To investigate the potential differences in the prevalence estimates of moderate and high risk indkiduals using

serum cholesterol determinations based on plasma definitions, the plasma risk levels were converted to the serum

equivalent using a 3-percent adjustment factor. The results

of making such an adjustment are presented in detail in the

Discussion section. However, to be consistent in the reporting of cholesterol levels and to avoid confusion, the

NHANES H serum cholesterol levels were not adjusted

for serum-plasma differences for the reporting of results of

moderate and h@h risk cholesterol levels.

2. As is generally the case with survey data, not all sample

persons participated in the examination phase, and thus

information was not obtained on the desired number of

sample persons. However, the data were adjusted for nonresponse. The serum cholesterol data in this repent are

based on results from 11,864 inciividuals ages 20-74

years. Of this total, 2.3 percent of these values were imputed. The sample persons with serum cholesterol values

were poststratified to bring the estimate of the number in

the population into close agreement with the U.S. Bureau

of Census estimate of the number of persons ages 20–74

years in the civilian noninstitutionalized population of the

United States.

3. Finally, statistics in this report were age adjusted to permit

comparison among subgroups and to control for age confounding. The age-adjusted means and percents were calculated by the direct method and standardized to the midpoint of the NHANES II population. Descriptions of the

methods used for nonresponse adjustments, poststratification, imputation, and age adjustment are given in appendix L
Findings

*

This section contains information about the differences in

the mean serum cholesterol levels or prevalence of high cholesterol levels that were tested for statistical significance using the

categorical data analysis as described in appendix I. It also

contains observed or descriptive information about the mean,

prevalence, or distribution of serum cholesterol levels that may

be of clinical or epidemiological interest. All differences in

means or prevalence levels that were tested for statistical signitlcance are indicated throughout this section by using such

terms as “statistically different” or “statistically significant.”

All other differences were observed.

Mean serum cholesterol levels

Age, sex, and race

The mean serum cholesterol levels of men by race and

age, and of women by race and age are shown in tables 1 and 2;

figures 1 and 2 show mean levels of men and women by age.

270

r

1-

1

Women

0

---

0

/

o~

20-24 25-34 35-44 45-54 55-64 65-74

yeara yeara yeara yeara yeara years

Age

Figure 1. Mean serum cholaaterol Ievela for edulta by sex and age:

Unkted Statas, 1976-80

● The mean serum cholesterol levels were significantlyhigher

in each successive age group until ages 45-54 years for

men and until ages 55–64 years for women. The mean

values peaked at 55–64 years with a level of229 mg/dl for

men and 249 mg/dl for women. The differences in the mean

levels were larger for men in younger ages and larger for

women in the older ages (figure 1).

● The overall mean serum cholesterol levels were observed “

to be slightly higher for women than for men (215 versus

211 mg/dl), but this relationship did not hold for all age

groups. The magnitudes of the differences in the mean

between the sexes varied somewhat with age. Women had

higher levels in the youngest and oldest age groups while

men’s levels were higher in the middle age groups (tigure 1). The observed differences in age-adjusted and in

unadjusted means between men and women were about

the same.

● The mean serum cholesterol levels did not differ significantly between the races within the age groups considered

for either men or women (figure 2). The patterns over the

270 r

o~

20-24 25-34 35-44 45-54 55-64 65-74

yeara years years years years years

Age

Figura 2. Mean serum cholesterol Iavela for edulta by sex, race,

end aga: Unitad States, 1976–80

6
race-sex groups by age were essentially the same as observed in figure 1.

s The 10th, 50th, and 90th percentiles as displayed in figure

3 show the same patterns as the means. The differences by

age once again were larger for women than for men, and

the crossover occurring in the middle age groups was repeated.

. The mean levels adjusted to the age distribution of the

U, S. population at the midpoint of the second National

Health and Nutrition Examination Survey ( 1978) are as

follows for the four race-sex groups: white men, 211

mg/dl; black men, 209 mgldl; white women, 215 mg,/dl;

and black women, 214 mg/dl.

Oral contraceptive usa

The mean serum cholesterol levels for women 20–44 years

using and not using oral contraceptives at the time of the survey

? are presented in table 3 and figure 4.

● Women using oral contraceptives had higher mean serum

cholesterol levels than those not using oral contraceptives.

The differences in the serum cholesterol between users

and nonusers ranged from 9– 15 mg/dl and were statistically significant in each age category (figure 4).

● The age-adjusted means for white users and nonusers were

205 and 192 mg/dl, respectively, and 198 and 193 mg/dI

for black users and nonusers, respectively. The user-nonuser

difference was statistically significant for white women

only.

● The age-adjusted mean cholesterol for oral contraceptive

users was 7 mg/dl higher for white women than for black

women. This difference in the mean for users between the

races was not statistically significant (table B).

Poverty status

The mean serum cholesterol levels as related to the poverty

status are shown in tables 4 and 5.

● Comparison between poverty and nonpoverty levels

showed that only the difference in the means for men

65-74 years was statistically significant. Mean serum

cholesterol leveI for nonpoverty men was higher by 10

mg/dl. No statistically significant differences in the mean

were found for women (table 4).

● For the race-sex groups in table 5, the six age categories

were collapsed into three: 20–44, 45–64, and 65–74

years. The differences in the mean levels between poverty

and nonpoverty levels were statistically significant only

for white men 65–74 years. Nonpoverty white men in this

age group had the higher levels (figure 5). None of the

observed differences for black men between poverty levels

was statistically significant. Although large, the difference

in mean levels of black women 45–64 years was not statistically significant. The mean levels for white women

65-74 years did differ significantly between the poverty

levels. Women at the nonpoverty level had the higher

mean level (figure 6),

. Comparisons between the races for either men or women

within each poverty status category showed no significant

z Men—10th percentile

,- _ Women—10th percentile

. . . . . . Men—50th percentile

_ . _ Women—50th percentile

s= Men—90th percentile

325 r

.....● Wornen-90th percentile

300

275

250

225

200

175

150

125

t0

20–24 25-34 35-44 45-54 55-64 65-74

years years years years years yeers

Age

Figure 3. Comparison of the 10th, 50th, and 90th percentiles of

serum cholesterol levels by sax and sgw United States, 1976-80

differences in the mean levels for any of the age groups

(figures 5 and 6).

Annual family income

The mean serum cholesterol levels as related to annual

family income are shown in tables 6 and 7.

● The mean levels of men for each age category fluctuate as

income level increased from under $6,000 (lowest) to

$20,000 or more per year (highest). Despite the inconsistent patterns, a comparison of the means between these two

income levels showed that men with $20,000 or more per

year had consistently higher mean levels at every age group

(figure 7), These levels were statistically significant for

men 35–44 and 45–54 years.

7
❑ User

❑ Nonuser

T

20-24 25-34 35-44

years years years

Age

NOTE Confidence Iimita are the mean *1 .96 times the standard error

of the meen.

Figure 4. Mean serum cholesterol levels of women 20-44 yeers

by-age and oral contraceptive use: United Ststas, 1976-SO

●

●

8

The mean levels for women did not show a consistent relationship as income levels increased from under $6,000 to

$20,000 or more per year. No age-specific differences in

mean levels between the h@ltest and lowest income levels

were statistically significant (figure 8).

Comparisons between the lowest and highest income levels

for white persons showed significant differences in the

means for white men ages 20–44 and 45-64 years. Men

with an income of $20,000 or more per year had the higher

levels. No significant differences in the means were found

for white women.

Tabla B. Age-adjueted maan cholesterol Ievela of women by rata

and oral corvtracepthrauaa: United Btatas, 1976-80

Oral

ccmtrac eptive use

Race User Nonuser Test results

Cholesterol in

milligrams per

deciliter

White . . . . . . . . . . . . . . . . 205 192 s

Black . . . . . . . . . . . . . . . . . 198 193 NS

Test resulta. . . . . . . . . . . . NS NS . . .

NOTE S = significant at p < 0.05; NS = not aignifkant.

● Due to sample size constraints, no age-specific analysis

was done for black persons. However, a comparison of the

age-adjusted means of the four race-sex groups showed

that men (regardless of race) had significantly higher mean

levels at an income of $20,000 or more than at under

$6,000 per year. The differences of age-adjusted means

were not statistically significant for white or black women

(figure 9).

Education

The mean serum cholesterol levels as related to educational level are shown in tables 8–10.

●

●

●

●

●

The overall observed mean serum cholesterol level is inversely related to educational level for men and women

ages 20–74 years. The consistent decline in the mean was

eliminated when the levels were adjusted for the differences

in the age distributions (table 8).

Only the difference in the means for men 55–64 years was

statistically significant between those with less than 12

years and those with 12 years or more of education. The

mean for this age group was higher for those with 12 years

or more of education. No age-specitic differences in the

means were statistically significant for women (table 9).

The mean level was significantly higher for black women

20-44 years with less than 12 years than for those with 12

years or more of education (table 10). No age-specific significant differences in the means between educational levels

were found for white men or white women (figures 10 and

11). Inadequate sample size for black persons 65-74 years

with 12 years or more of education limits the comparison

for this group. The other age groups for black men did not

show statistically significant differences between these two

educational levels.

Within each educational level, the differences in the mean

serum cholesterol levels between the races for each age

group were not statistically significant for men or women

(table 10).

Comparison of the age-adjusted mean levels for each racesex group between those with 12 years or more of education

and those with less than 12 years showed no significant

differences. Those with 12 years or more of education

had the lower observed mean level except for white men

(table 10).
White Black

260

250

240 [

I

20-44 45-64

years years

NOTE Confidence limits are the mean *1 .96 times the

EslPoverty

N

Nonpoverty

-r

65-74 20-44

yeara years

Age

standard error of the mesn,

45–64

vears

IT

65-74

years

Figure 5. Mean serum cholesterol levels of men by age, race, and poverty status: United States, 1976-80

Prevalence of moderate and high Institutes of Health Consensus Development Conference on

risk levels

Age, sex, and race

The percent of adults in the U.S. population with a chIesterol level placing them at moderate or high risk of develop

ing coronary heart disease (CHD) is presented in tables 11 and

12. Moderate risk cholesterol levels are defined as values between the 75th and 90th percentiles of the cholesterol distribution, and high risk cholesterol levels as values greater than the

90th percentile. These values were established by the National

Lowering Blood Cholesterolc (table C). The values were applied

to the serum cholesterol data from the second National Health

and Nutrition Examination Survey to estimate the percent of

adults in the United States with cholesterol levels that place

them at moderate or high risk of developing CHD.

. The percent of men and women ages 20–74 years with

cholesterol levels at moderate risk were about the same

(14.6 versus 14.7 percent); however, a higher percent of

women ages 20–74 years than men had cholesterol levels

at high risk (21.8 versus 19.1 percent). The age-adjusted

9
White Black

270

260

250

240 1

230

220

1

270

200

190

180

170

0

20-44

years

NOTE Confidence limits ere the meen

c1j~.~Poverty

❑ Non poverty

T

45-64

years

65-74

years

20-44

years

Age

*1 .96 times the stsnderd arror of the meen.

IT

45-64

years

65-74

years

Figure 6. Mean serum cholesterol Isvsls of woman by 8984 rats, and Poverty atstu8 United States, 1976-SO

percents did not differ significantly from the overall UE

adjusted levels (table 11).

. The ag~specific percent for men for both moderate and

high risk cholesterol and for women at moderate risk did

not show a consistent pattern with ag%however, the percent

of women with a high risk cholesterol level increased consistently with each age group after 25–34 years (table 11).

. The greatest difference in percents by age between men

and women occurred at the older two age groups: 55–64

and 65-74 years (figure 12).

. In genera~ the percents of white persons with cholesterol

levels at moderate risk were higher than those of black

person% however, the differences in percents between the

races for each sex were not statistically significant. No

clear distinction in percents by race could be found for

persons with cholesterol levels at high risk. The unadjusted percents ranged from 19.0 for white men to 22,1 for

white women, while the adjusted levels were quite similar

(table 12).

. Above ages 20-44 years, the age-specific percents for the

four ract+sex groups indicate that a higher percent of

women than men (regardless of race) have high risk cholesterollevels. This relationship is particularly noticeable

in the oldest age group (figure 13). However, the difference

10
270

r

260

$

g

“~ 250

:

$ 240

n I $20,000or more

c.-

r

190 0“

E

~ 160

mm

170

A“

o“ ~

20-24 25-34 35-44 45-54 55-64 65-74

yeara years yeara years years years

Age

Figure 7. Mean serum cholesterolIevelafor men by ego end ennual

family incomo United Statas,197S-S0

in percents between the races for each sex group was not

statistically significant. Earlier findings of significant differences in percent for men and women with cholesterol

levels at high risk are now further confumed when these

data are stratified by race-that is, the significant difference

in percents between the men and women is apparent even

when the data are stratified by race.

Poverty ststus end educstion

In this sedom the prevalence of high risk cholesterol levels

of adults are analyzed by socioeconomic status. The percent of

adults with cholesterol levels that put them at high risk of developing CHD are shown by poverty status and educational

level in tables 13 and 14.

● The unadjusted levels show that 14.9 percent of men and

19.1 percent of women in poverty have cholesterol levels

at high risk. For nonpoverty men and women, comparable

percents are 19.6 and 22.1, respectively. The age-specific

prevalence are shown in figure 14. Age-adjusted percents

dfiered only slightly from the unadjusted (table 13). The

difference in percents was statistically significant between

270

r

F $20,000 or mora

t

ii J

170

i,

o~

20-24 25-34 35-44 45-54 55-64 65-74

years yeara yeara years yeara years

Age

Figure8. Mean serum cholaetarolIevelafor woman by age and

annualfamily income UnitedStates, 1976-SO

●

●

poverty status groups for men only, for both the adjusted

and unadjusted percents.

The overall prevalence of high risk cholesterol levels is

greater for women 20-74 years than for men, regardless of

educational level. However, the prevalence was,higher for

men with 12 years of education than for those with less

than 12 years. The opposite was true for women. No statistically significant differences in the age-adjusted percents

were found between educational levels for men or women.

The specific trends for high risk cholesterol levels for men

and women by age are shown in figure 15. There were no

statistically significant differences in percents between

educational levels for men or women for any age groups.

Cumulative distribution

The cumulative percent distributions of serum cholesterol

levels are shown in tables 15 and 16 for men and women by

age and race. The distributions are shown for selected cutoff

levels and allow the user to choose his own cutoff level for high

or moderate risk groups or simply to understand the nature of

the distribution.

11
270

r

270

260

[

❑ .ncler.$6,000

❑ $20,000or more

T

TT

White Black White Black

men men women women

NOTE Confidence limits are the mean *1 .96 times the standard error

of the mean.

t

El Leas than 12 yeara of education

260 ❑ 12 yeara ofecl.cation or more

NOTE Confidence

of the mesn.

T

20-44

years

limits are the mean

T

4!5-64

yeara

Age

*1 .96 times the

65-74

yeara

standard error

Figure 9. Age-adjusted mean serum cholesterol levels of edulta for Figure 10. Meen serum cholesterol levels of whiie men by age

aach race-sax group by annual family income United Stetea, 1976-80 endeducational levek United States, 1976-80

12
T

❑ Less than 12 years of education

Tabla C. Risk cmpointa of plaama cholesterol eetabliahed by tha

NIH Consensus Development Conferenoa on Lowering Blood

Cholesterol, Deoember19S4

Is 12 yaars of educstion or more I

Age Moderete risk High risk

Cholesterol in

milligrams per deciliter

T

TT

20-44 45-84 65-74

yaers years yeara

Age

NOTE Confidence limits are the mean *1 .96 times the standard error

of the mesn.

Figura 11. M aan serum cholastarol levels of white women by aga

20-29 yesrs . . . . . . . . . . . . . . . . . 201-220 Greatar then 220

30-39 years.....,........,.. 221-240 Grester than 240

40yesrs and over . . . . . . . . . . . . 241-260 Greater than 260

andeduoetional levek United Statea, 197S-S0

13
45

40

35

30

25

15

10

5

0

❑ . . .

❑ Women

T

20-24 25-34 35-44 45-54 55-64 65-74

yeara yeara years yeara yeara years

Age

NOTES: Confidence limits are the percent *1 .96 times the standard error of the percent,

See Discussion eection for an evaluation oftha affactof theserum-plaama diffarenceson eetimeting the percent with high riekcholeaterol Iavala. I

Figure 12. Percent of eduitewith eerum cholesterolIeveleet high rick by sex ●nd ego United Stetee,1976-80

14
4!

4(

3!

3C

25

E

;

2

2C

15

10

5

0

c1.......

s? White men

N

Black men

Ezl

White women

❑ Black women TT

20-44

years

NOTES: Confidence limits are the percsnt*1.96 times the standerd error of the percent,

see Discussion section for en evaluation of the effect of the serum-plssms differences on estimating the percent with high risk cholesterol levels,

45-64

years

Age

T

..

::::::::::

::::::::::

..........

:.:.:.:.:.

+:+:.: ::::::::::

:.:.:.:.:. .:.:.:.:.:

..........

.:.:.:.:.:

..........

.:.:.:.:.:

.:.:.:.:.:

..........

65-74

years

I Figure 13. Percent of edults with serum cholesterol levels et high risk by rece, sex, end age: United Stetes, 1976-80

15
45

40

35

30

25

E

a!

~

1%

20

15

10

5

0

T T

Men

la Poverty

~ IUonpoverty

T

Women

TT

-T

20-44 45-64 65-74 20-44 45-64 65-74

years yaars years years years years

Age

NOTES Confidence limits are the percent *1 .96 times the standard error of the percent.

See Oiscuaaion section for an evaluation of the effect of the serum-plaama differences on eatimsting the percent with high risk cholesterol levels.

Figure 14. Percent of adults with serum cholesterol Ievela at high risk by sex, age, and poverty status: United Statea, 1976-80

16
45

40

35

30

25

20

15

10

5

0

Men

El Less than 12 years of education

❑ 12 years orrnore ofeducaticm

T

Woman

TT

.T

T

20-44 45-64 65-74 20-44 45-64 65-74

yeara yeara years yeara years years

Age

NOTES Confidence limits are the percent *1 .96 times the standard error of the percent,

Sea Discussion section for an evacuation of the affect of the serum-plaama differences on estimating the percent with high risk choleatarol Iavals

Figure 15. Percent of adults with serum cholesterol Ievele et high risk by sex, ege, and educational level: United Stetea. 1976-60

.
Discussion

Data on serum cholesterol levels collected during the

second National Health and Nutrition Examination Survey

(NHANES II), 1976-80, for adults 20-74 years are presented

and analyzed by age, sex, race, oral contraceptive use, and

socioeconomic variables.

These cross-sectional data provide important baseline information on the distribution of serum cholesterol levels in the

U.S. population at a particular point in time. Because serum

cholesterol concentrations have been identified as one of the

major risk factors of coronary heart disease in the population,4,5,21-23 these kinds of reference data are essential to clinicians and epidemiologists whose primary emphasis is identifying research hypotheses and establishing intervention or

treatment levels for subgroups of the population at higher risk

of developing certain health or disease conditions. These data

should not be confused with longitudhal data.

Age, sex and race

The mean serum cholesterol levels of adult men averaged

211 mg/dl versus215 m~dl for adult women. These levels did

not differ significantly by race. The differences in mean serum

cholesterol levels by sex were more noticeable in the older age

groups than the younger. The patterns of these serum cholesterol levels are generally comparable to those of the populationbased Lipid Research Clinics prevalence study .24The prevalence of high cholesterol values in the U.S. population has

been reported previously. 7$ However, these prevalence levels

were based on an arbitrary benchmark such as above 260

mg/dl or more. Researchers, however, have used a variety of

benchmarks varying”fromconservative levels, such as 200-220

mg/dl, to much higher levels, such as 250–270 mg/dl. Thus the

estimates of “elevated” or “high” cholesterol levels varied

tremendously.

To be consistent in the reporting of the prevalence of elevated blood cholesterol levels and to relate these levels to the

risk of developing coronary heart disease (CHD), researchers

have recently established cholesterol guidelines to help physicians and public health practitioners decide when to treat

individuals. These guidelines, established in 1984 by the National Institutes of Health (NIH) ConsensusD@@wnent

Conference on Lowering Blood Cholesterol,b are shown in

table C.

The NIH Consensus Development Conference statement

does not distinguish between serum and plasma cholesterol in

the presentation of either epidetniological research or cholesterol risk levels. The practical application of the NIH guidelines is that the cholesterol risk levels are used by clinicians

and researchers as stated regardless of whether the cholesterol

level being evaluated is serum or plasma. In addition, many

automated blood batteries are routinely performed on serum.

As mentioned in the Other analytic considerations section, the

NIH plasma risk levels were inflated by 3 percent to approximate serum values. These adjusted cutoff points are shown in

table D.

For this repo% consistency in reporting and practicality

were more important than adjusting NHANES 11 serum ch~

lesterol values to plasma cholesterol values. However, it was

important to determine how serum-plasma cholesterol differences would affect prevalence estimates of moderate and high

risk cholesterol levels.

After calculating prevalence estimates using the serum

cutoff and then comparing these estimates with those calculated

using the NIH plasma cutoff, it was found that using plasma

definition levels to estimate the prevalence of moderate and

high risk cholesterol for the NHAN13S II serum data overestimates the prevalence of moderate risk cholesterol by 1.8 percentage points for men and 1.2 percentage points for women.

High risk cholesterol is overestimated by 3.6 percentage points

for men and 3.9 percentage points for women. These percentages correspond to overestimates of approximately 2.0 million

at moderate risk and 5.0 million at high risk (7.0 million adults

overall), if the NHANE S II serum cholesterol data are evaluated baaed on the plasma cholesterol risk definitions (table E).

These figures are provided so that the reader may appropriately

interpret the prevalence estimates of cholesterol levels and

easily make comparisons with other reports using serum ch~

lesterol data to estimate risk levels.

Even though the NHANES program shows that the prevalence of high risk cholesterol levels has been decreasing in the

past 20 years,2s using the NIH guidelinesto estimate risk levels

in the U.S. population, one finds that an estimated 27.4 million

adults had cholesterol levels placing them at high risk of develTable 0. Risk cutpointa of eerum cholesterol by age

Age Moderate risk High risk

Cholesterol in

milligrams per deciliter

20-29 years . . . . . . . . . . . . . . . . . 206-227 Grester than 227

30-39 yeara . . . . . . . . . . . . . . . . . 228-247 Greater thsn 247

40 years And over . . . . . . . . . . . 248-268 Greater than 268

18
Tabfe E. Overestimates in parcentsge points and estimated number

of adults 20-74 years with cholesterol Ievals at moderate and high

risk baaed on applying plasma (table C) versus sarum (tabla D)

cholesterol cutoff points to the second National Haaith and Nutrition

Examination Survey cholaaterol distribution by sex

11.federate risk High risk

Estimated Estimeted

population population

Percentage in Percentage in

Sex points thousands points thousands

Man . . . . . . . 1.8 1,145 3.6 2,290

Women . . . . 1.2 840 3.9 2,730

oping heart disease in the late 1970’s. An additional 19.6 million adults were at moderate risk.

A key research issue is whether reducing these high ch~

lesterol levels would protect these individuals from premature

death. The recently completed Lipid Research Clinics Coronary

Primary Prevention Trial at the National Heart, Lung, and

Blood Institute has established that reducing high cholesterol

levels will reduce the probability of death from CHD.26 Results

of the study indicated that by reducing blood cholesterol levels

by 9 percent, not only were heart attacks reduced by 19 percen~ but other endpoints such as angina and coronary bypass

surgery were also reduced. Observation studies prior to the

Lipid Research Clinics Coronary Primary Prevention Trial

(LRC-CPPT) did not prove that lowering total and low density

lipoprotein cholesterol would subsequently reduce the incidence

of CHD, mostly because of their design.5,27,28A consensus of

the scientific evidence available from metabolic, experimental,

epidemiological, and clinical studies indicates that lowering

blood cholesterol will definitely reduce the probability of heart

attacks caused by CHD.

Oral contraceptive use

Oral contraceptives have been identified as a potential risk

factor for cardiovascular disease because of metabolic effects

on serum lipids and lipoproteins. 29,30Although studies have

not established a direct relationship, they have indicated that

for those women who are already at risk of developing CHD,

oral contraceptives may enhance the risk of developing CHD.

The NHANES II data on women 20-44 years show a 9-15

mg/dl higher mean serum cholesterol level for users of oral

contraceptives than for nonusers. The user-nonuser difference

was statistically significant at each age level. The fact that

women taking oral contraceptives have higher mean cholesterol

levels than their nonuser cohorts suggests that the higher cholesterol level, at least in part, may be responsible for their increased risk of developing CHD. Studies have shown, however,

that lipoprotein fractions are more sensitive to oral contraceptive use than total cholesterol. Given the effect of oral

contraceptives on serum lipids, it has been suggested that oral

contraceptives should be recommended with caution for women

with known risk factors of cardiovasculw disease.29,30Results

in this report are from data collected in the late 1970’s. It is

well known that the dosage or metabolic potency of oral contraceptives has changed over the past 10 years.31Whether the

relationships found in this report hold for the 1980’s will be the

subject of future reports.

Socioeconomic status

Socioeconomic status (SES) has long been assumed to be

related to numerous health and nutrition variables, However,

there are no national studies other than NHANES 19that have

descriptively related the mean serum cholesterol levels to the

adult population’s SES. In general, NHANES II data showed

fairly consistent agreement among the three socioeconomic

variables in that higher levels of SES are associated with

higher mean serum cholesterol levels. Men and women at or

above the poverty level had consistently higher mean serum

cholesterol levels than those below the poverty level for each

successive age category. Men with an annual family income of

$20,000 per year also had consistently higher mean levels than

those with an income of less than $6,000 per year. Other agespecitic socioeconomic comparisons did not show any consistent

patterns for men or women.

An interesting finding from the socioeconomic comparison

of the mean levels for each of the four rac~sex groups is that

for the high-risk age group for cardiovascular morbidity and

mortality, ages 45–64 years, the mean serum cholesterol level

was consistently higher for higher SES white men than for

lower SES white men (table F). In fac~ all four race-sex groups

showed a higher mean level at or above the poverty level than

below the poverty level. In general, most epidemiological and

Table F. Mean serum cholastarol Ievals of adulta agea 45-64 years by sex, race, poverty statua, annual family income, and educational Iavel:

United States, 1976-SO

Socioeconomic varieble

Poverty stetus Annual femily income Educe tionel level

At Or

Below above Less then

Rece end sex

$20>000 Less then 72 Vears

poverty poverty $6.000 or more 72 years or mora

Mean eerum choieaterol in milligrams per deciliter

Whitman. ................. ................... 222 “*229 221 223 221 230

Black en . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 229 217 ●

White women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

226

240

229

240 238 240 240

Black women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 243 234 *

242 236

“Unrslisbls cell.

““Statistically significant (p < .05).

19
Table G. Percent, standard error of percent, and estimated population in millions of persons 20-74 years with serum cholesterol levels at high

risk, by poverty status. educational level, and sex: Unitad States, 1976-80

Men Women

Standard Estimated Standard Estimated

error of population error of

Poverty status and educational level

population

Percent percent in millions Percent percent in millions

Total, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.1 0.9 12.1 21.8 0.9 15.3

PoveRy ststusl

Poverty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonpoverty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Educational leve12

Less than 12yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.1

12years or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.5

4.9 1.6 0.8 19.1 2.1 1,7

9.6 1.0 10.9 22.1 0.9 12.9

1Unknown poverty atetus is axcluded.

2Unknown educational levels sre excluded.

clinical studies have concentrated on white men in an attempt

to better understand the relationship of certain risk factors to

the development of heart disease.1-5’21’22-27

Table G shows a breakdown by SES of the percent of the

population and the estimated population in millions with chIesterol levels that put them at high risk for developing CHD.

These kinds of data should prove very usefid in conjunction

with current health promotion efforts to educate the general

public about the risk associated with having high cholesterol

levels.

1.4 3.2 25.6 1.4 5.2

1.0 8.8 20.3 0.9 10.0

Because these data are from the late 1970’s, it is important

to realize that the impact of health initiatives in the 1980’s

aimed at improving the health and nutrition status of the U.S.

population have yet to be evaluated. A more concentrated look

in ffiture studies at the diet, eating patterns, attitudes, and lifestyles of the general population and of specific subgroups

within the population may help to better understand and explain some of the relationships between SES and serum chm

Iesterol concentrations.

20
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22
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Exhibit L (rev.).

23
Listof detailedtables

1. Mean serum cholesterol levels of men, standard errors of

the mean, age-adjusted values, selected percentiles, number

of examined persons, and estimated population, by race and

age United States, 1976-80...... . . . . . . . . . . . . . . . . . . . .

2. Mean serum cholesterol levels of women, standard errors

of the rneaq age-adjusted values, selected percentiles,

number of examined persons, and estimated population, by

race andage United States, 1976-80. . . . . . . . . . . . . . . . . .

3. Mean serum cholesterol levels of women, standard errors

of the mean, age-adjusted vrdues, number of examined persons, and estimated population, by race, age, and oral contraceptive use United States, 1976-80 . . . . . . . . . . . . . . . . .

4. Mean semm cholesterol levels of adults, standard errors of

the mean, ageadjusted values, number of examined persons, and estimated population, by sex, age, and poverty

status: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . .

5. Mean serum cholesterol levels of adults, standard errors of

the mean, ag+adjusted values, number of examined persons, and estimated population, by sex, race, age, and

poverty status United States, 1976-80 . . . . . . . . . . . . . . . . .

6. Mean semm cholesterol levels of adults, standard errors of

the mean, age-adjusted values, number of examined persons, and estimated population, by sex, age, and annual

family income United States, 1976-80 . . . . . . . . . . . . . . . .

7. Mean serum cholesterol levels of adults, standard errors of

the meaq ag-adjusted values, number of examined persons, and estimated population by sex, race, age, and

annual family income United States, 1976–80 . . . . . . . . . .

8. Mean serum cholesterol levels of adults, standard errors of

the meaq ag-adjusted values, number of examined persons, and estimated population, by sex, age, tmd educationallevek United States, 1976-80... . . . . . . . . . . . . . . . .

25

26

27

28

29

30

32

33

9.

10.

11.

12.

13.

14.

15.

16.

Mean serum cholesterol levels of adults, standard errors of

the mean, age-adjusted values, number of examined persons, and estimated population, by sex, age, and educationallevel United States, 1976-80 . . . . . . . . . . . . . . . . . . .

Mean serum cholesterol levels of adults, standard errors of

the me- age-adjusted values, number of examined persons, and estimated population, by sex, race, age, and

educational Ievek United States, 1976-80 . . . . . . . . . . . . . .

Percent of adults with cholesterol levels at moderate and

high nslq standard errors, number of examined persons, and

estimated population, by sex and age United States,

1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of adults with cholesterol levels at moderate and

high risk, standard errors, number of examined persons, and

estimated population, by sex, race, and age United States,

1976-80 ...,...................................,..

Percent of adults with cholesterol levels at high risk,

standard errors, number of examined persons, and estimated

population, by sex, age, and poverty status United States,

1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of adults with cholesterol levels at high risk

standard errors, number of examined persons, end estimated

population, by sex, age, and educational levek United

States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cumulative percent distribution of serum cholesterol levels

of men, according to race and age, and number of examined

persons and estimated population United States, 1976-80 . . .

Cumulative percent distribution of serum cholesterol levels

of wome~ accordkg to race and age, and number of examined persons and estimated population: United States,

1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36

37

38

39

40

41

42

46

24
Tabla 1. Maan serum cholesterol Iavels of men, standard errors of tha mean, aga-adjuated valuea, aelactad percantilaa, numbar of axaminad

persona, and astimated population, by race and age: United Statas, 1976-80

Standard Percentile

Examined Estimatad error of

Race and age persons population Mean the mean 5th 10th 15th 25th 50th 75th 85th 90th 95th

Number in

All racesl Numbar thousands Sarum cholesterol in milligrams par daciliter

20-i’ 4 years . . . . . . . . . . .

20-24 yesra . . . . . . . . . . .

25-34 yesre . . . . . . . . . . .

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

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

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

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

5,604

676

1,067

745

690

1,227

1,199

4,883

581

801

653

617

1,086

1,045

607

79

139

70

62

129

128

. . .

. . .

. . .

63,611

9,331

15,895

11,367

11,114

9,607

6,297

55,808

8,052

13,664

9,808

9,865

8,642

5,576

6,102

1,043

1,546

1,112

1,044

801

555

. . .

. . .

. . .

211

180

199

217

227

229

221

211

180

199

217

227

230

222

208

171

199

218

229

223

217

211

211

208

1.2

1.7

1.5

2.0

1.8

1.8

1.8

1.2

1.8

1,7

1.8

1.8

2.0

2.0

2.5

“3.7

●4.1

●8.3

*7.1

“4.8

4.2

1.1

1,1

2.5

144 156 165 179 206 239

202

220

244

255

254

249

258

215

240

262

271

277

265

271

227

254

275

283

288

279

291

246

275

293

303

307

301

129 136 145 155 176

141 152 159 172 194

153 166 173 187 215

159 176 182 197 223

164 176 184 198 225

153 167 175 191 217

White

145 157 166 179 207

131 138 146 155 176

144 153 161 172 194

153 166 173 187 214

160 177 181 198 222

164 178 185 199 225

153 167 175 191 217

239

202

220

244

254

255

250

258

216

239

260

271

278

266

271

229

254

272

283

289

281

20-74 years . . . . . . . . . . . 291

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

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

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

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

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

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

244

273

291

307

301

Black

238

193

226

238

261

254

244

133 146 158 171 200

●

12s 134 149 170

129 136 144 163 192

*

156 168 176 202

●

174 184 195 232

157 168 172 183 218

149 163 173 183 216

260

210

248

275

268

271

261

273

211

259

283

279

299

277

301

●

20-74 years . . . . . . . . . . .

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

25-34 yeara . . . . . . . . . . .

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

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

55-64 yaers . . . . . . . . . . .

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

301

●

●

312

299

Age-adjuated values:

All races, 20-74

years . . . . . . . . . . . . . .

White, 20-74 years. . .

81ack, 20-74 years . . .

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

:.. . . . . . . . . .

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

,..

.,.

. . .

. . .

. . .

. .

. . .

,..

. . .

1Includes data for racea not ahown separately.

25
Table 2. Meen serum cholesterol levels of women, standard errors of the mean, age-adjusted values, selected percentiles, number of axamined

persons, and estimated population, by rata and age: United States, 1976-8o

Standard Percanti/e

Examined Estimated arror of

Rata and age persons population Mean the mean 5th 10th 15th 25th 50th 76th 85th 90th 95th

All races!

20-74 years .,, . . . . . . . .

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

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

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

45-54 yeara . . . . . . . . . . .

55-64 yeara . . . . . . . . . . .

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

White

20-74 yeara . . . . . . . . . . .

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

25-34 Veals . . . . . . . . . . .

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

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

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

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

Black

20-74 years . . . . . . . . . . .

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

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

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

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

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

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

Age-adjusted values:

All races, 20-74

years . . . . . . . . . . . . . .

White, 20-74 yaars. . .

Black, 20-74 years . . .

Number

6,260

736

1,170

844

763

1,329

1,416

5,41 B

624

1,000

726

647

1,176

1,245

729

94

145

103

100

135

152

. . .

. . .

. . .

Numbar in

thouSands

69,994

9,994

16,856

12,284

11,918

10,743

8,198

60,765

8,406

14,494

10,584

10,369

9,601

7,329

7,579

1,304

1,953

1,415

1,215

959

733

. . .

. . .

. . .

Serum cholesterol in milligrams per deciliter

21!5

184

192

207

232

249

246

216

184

192

207

232

249

246

212

185

191

206

230

251

243

215

215

214

1.2

1.9

1.4

1.8

2.2

2.0

1.6

1.3

2.1

1.5

1.9

2.6

1.7

1.7

3.1

●4.9

‘4.1

84,5

*7.2

“8.0

4.2

1.2

1.2

2.7

143

132

135

147

164

180

173

143

133

135

147

166

180

174

140

●

129

143

150

178

173

,..

. .

. . .

156

140

145

15B

178

193

189

156

140

145

157

179

193

190

154

138

144

158

172

185

189

. . .

.,.

. . .

166

145

154

164

168

203

198

166

147

1!53

164

188

203

199

166

144

156

170

181

198

196

. . .

. .

179

157

164

177

199

215

214

179

159

164

177

199

215

214

176

156

167

175

200

211

211

.

,..

,..

210

160

188

202

228

242

241

210

181

188

203

228

244

242

205

178

190

194

226

233

237

. . .

,..

.

245

215

231

257

277

274

248

204

215

231

257

277

275

237

212

233

263

2B0

269

.

. . .

.

266

216

233

248

275

299

295

267

215

235

248

274

298

296

263

220

226

254

277

318

290

.,.

. . .

,..

282

230

243

260

290

314

309

262

230

244

259

290

312

309

279

237

235

274

291

336

308

. .

.,,

. . .

305

250

263

276

306

336

327

305

249

261

277

308

330

326

308

●

267

279

306

345

323

.,.

. . .

. . .

1Includesdetafor racesnot shownseparstaly.

26
Table 3. Mean serum cholaatarol Iwels of woman, standard errors of tha mean, age-adjusted valuea, number of examinad persons, end estimated

PWJlatrnn, W race. age, and 0S’S1contraceptive uso United 8tates, 1976-80

Oral contraceptive use

User Nonuser

Stendard

Examined

Stenderd

Estimeted error of Exemined Estimated

Race end age pereons

error of

population Meen the meen persons population Meen the mean

All racesf

20-44 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Whita

20-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24 yeere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Age-adjuated valuee:

Allracea, 20-44 yeare .,....... . . . . . . . . . . .

White, 20-44 yeara . . . . . . . . . . . . . . . . . . . . . .

Black, 20-44 years . . . . . . . . . . . . . . . . . . . . . . .

Number

Number in

thousands

508

233

226

49

434

198

191

45

. . .

. . .

,..

7,043

3,181

3,165

698

5,991

2,686

2,682

623

. . .

. .

. . .

Serum cholesterol

in milligrams

per deciliter Number

2(M 2.3 2,244

194 2.9 505

201 3.3 944

215 ‘4.4 795

201 2.5 1,916

194 3.2 426

203 3.6 809

217 ●4.9 681

204 2.3 . . .

205 2.5 . . .

198 “4.9 . . .

Number in

thousanda

32,092

6,814

13,692

11,586

27,495

5,722

11,812

9,961

. .

. . .

. . .

Serum cholesterol

in milligrams

per deciliter

193 1.3

179 2.2

189 1.6

206 1.9

193 1.3

179 2.1

189 1.6

206 2.0

192 1.3

192 1.2

193 2,7

1Includes data for races not shown aepsrataly.

27
ru

m

Table 4. Mean serum cholesterol levels of adults, standard errora of the mean. age-adjusted values, number of examined Persons. and eatimatad PPulation, by sex eee. and POvOIW statu=

United Statas, 1976-80

Poverty srarusl

Total Poverty Nonpoverty

Standard Standard Standard

Examined Estimated error of Examined Estimated

Sex and age

error of Examined Estimated

population

error of

persons Meen the mean persons population Mean the mean persons population Mean the mean

Men

20-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Women

20-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

35-44 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Age-adjusted values:

Men, 20-74 years . . . . . . . . . . . . . . . . . . . . . .

Women, 20-74 years . . . . . . . . . . . . . . . . . . .

Number

Numbar in

thousands

Serum cholesterol

in milligrams

per deciliter

Number in

thousands

Serum cholesterol

in milligrams

per deciliter Number

Number in

thousands

Serum cholesterol

in milligrams

per deciliter

5,394

656

1,036

721

649

1,177

1,155

6,012

715

1,144

821

737

1,259

1,336

. . .

. . .

61,184

9,032

15,461

11,016

10,383

9,221

6,071

67,468

9,663

16.478

11,920

11,539

10,115

7,752

. . .

. . .

211 1.2

160 1.7

199 1.6

218 2.1

227 1.9

229 1.8

222 1.9

215 1.2

184 1.9

191 1.5

207 1.8

231 2.3

249 1.7

246 1.7

211 1.1

214 1.1

609

112

91

63

46

129

168

953

146

162

119

82

188

256

. . .

. . .

5,478

1,369

1,106

621

645

779

759

8,919

1,838

1,997

1,543

1,115

1,181

1,245

. . .

. . .

205 2.4

181 3.7

203 4.8

211 5.1

217 8.4

224 5.2

213 3.9

209 2.6

182 4.0

188 3.6

208 4.7

227 5.7

241 4.5

239 4.3

208 2.6

211 2,2

4,785

544

945

658

603

1,048

987

5,059

569

982

702

655

1,071

1,080

. . .

. . .

55,706

7,664

14,355

10,195

9,738

8,443

5,312

58,549

7,825

14,482

10,377

10,424

6,934

6.507

. . .

. . .

212 1.2

180 1.8

199 1.6

219 2.1

228 2.0

230 2.0

223 2.1

216 1.2

185 1.9

192 1.7

207 1.9

232 2.2

250 1.7

247 1.7

212 1.1

215 1.1

1Unknown poverty status is excluded.
Table 6. Maan serum cfsolestarolIavela of adults, standard errors of the mean, age-adjuated values, number of examined paraons, and eatimstad

population, by sex. race, age, end poverty ●tatua: United Stetee, 1976-80

Poverty status’

Poverty Norrpoverty

Standard Standard

Examined Estimated error of Examined Estimated

Sex, rece, end ege

error of

persons population Mean the mean persons population Mean the meen

Sarum cholesterol

in milligrams

per deciliter

Serum cholesterol

in milligrams

per deciliter

Number in

thousande

Number in

MEN thousands

White

20-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 yeers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-B4yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Black

20-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

65-74 yeers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

WOMEN

White

20-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 yeers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 ~ears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Black

20-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-B4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6!j-74yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age-adjusted valuea:

White men, 20-74 years . . . . . . . . . . . . . . . . . .

Black men, 20-74 yeera . . . . . . . . . . . . . . . . . . .

White woman, 20-74 yeara . . . . . . . . . . . . . . . .

Black women, 20-74 yeare . . . . . . . . . . . . . . . .

Number Number

427

163

126

IIB

3,935

2,305

1,080

551

206

197

222

212

203

192

216

221

210

191

237

238

208

193

227

247

207

203

211

210

2.6

2.5

6.0

4.4

5,0

●7.2

*6.6

●9.3

3.5

3.5

4.6

4.0

3.6

*4.6

“6.7

*9.6

2.8

4.9

3.0

4.3

4,295

1,897

1,504

894

49,969

2B,592

16,524

4,853

212

200

229

223

209

199

229

218

216

195

240

248

211

193

243

244

212

211

215

215

1.2

1.3

1.3

2.4

3.5

3.4

“6.0

“4.9

163

69

48

46

1,285

765

341

179

403

202

126

75

4,399

2,727

1,325

347

673

290

186

185

6,372

3,775

1,607

980

4,546

1,999

1,564

985

52,379

26,7B7

17,624

5,967

1.2

1.2

1.6

1.B

262

12B

77

57

2,34B

1,479

640

230

423

205

137

81

4,862

3,089

1,332

440

3.8

3.2

“5.9

*3.B

1.1

3.3

1.1

3.4

. . .

. . .

. . .

. . .

.,. . . . . . .

.,.

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

1Unknownpovertystatusis axcluded.

29
w

o

Table 6. Mean swum cholesterol levels of adults, standard errore of the moan, age-adjusted values, number of axaminad parsons, and estimated population, by sax, age. and annual

family incomo United Stetas, 1976-60

Annual family incomel

Total Under $6,(XW $LWOO-$9,999

Standard Standard

Examined Estimated error of Examined Estimated

Standard

Sax and age

error of Examined Estimeted

persons population Mean the mean

error of

persons population Mean the mean pereons population Mean the mean

Men

20-74 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24 yeers . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

45-54 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Women

20-74 yesre . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24 year n. . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yesre . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yesra . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age-sdjusted valuas:

Men, 20-74 yesrs . . . . . . . . . . . . . . . . . . . . . .

Women, 20-74 yeara . . . . . . . . . . . . . . . . . . .

Number

5,396

657

1,037

721

649

1,177

1,155

6,012

715

1,144

821

737

1,259

1,336

. . .

.!.

Number in

thousands

Serum cholesterol

in milligrams

per deciliter Number

61,214

9,044

15,479

11,016

10,383

9,221

6.071

67,468

9,663

16,478

11,920

11,539

10,115

7,752

. . .

. . .

211 1.2

180 1.7

199 1.6

218 2.1

227 1.9

229 1.8

222 1.9

215 1.2

184 1.9

191 1.5

207 1.8

231 2.3

249 1.7

246 1.7

211 1.1

214 1.1

805

154

100

48

58

193

352

1,478

208

171

101

105

320

573

. . .

. . .

Number in

thousands

7,268

1,853

1,270

595

836

1,136

1,579

12,453

2,610

2,086

1,266

1,422

2,078

2,989

. . .

. . .

Serum cholesterol

in milligrams

Der deciliter

205 2.2

182 2.6

197 5.1

207 “5.8

209 “5.8

226 5.2

219 2.7

216 2.2

184 2.8

189 4.0

209 5.0

227 5.7

244 4.0

243 2.2

205 2.3

212 1.9

Number

1,111

138

197

92

83

229

372

1,348

154

202

135

137

329

391

. . .

. . .

Numbar in

thoussnds

11,857

2,035

3,160

1,453

1,200

1,819

2,191

15,357

2,385

3,178

2,247

2,260

2,720

2,587

. . .

. . .

Serum cholesterol

in milligrams

per deciliter

206 1.9

172 3.4

197 3.0

214 5.0

222 5.7

223 3.3

223 2.6

217 2.0

180 3.2

191 3.2

201 3.7

237 4.1

247 3.0

247 2.7

207 2,2

213 1.7

1Unknownannualfamily incomesare excluded.
Table 6. Mean serum cholesterol Iavals of adults, standard errors of the mean, age-sdjusted valuea, number of exsmined persons. and estimated population, by sex, age, end annual

family incoma: Unitad Statas, 1978-80-Con.

Annual family income 1—Con.

$10,000-$14,999 $15,000-$19.999 $20,000 or more

Standard Standard

Examined Estimated

Standard

error of Examined Estimated error of

Sex and age persons

Examined Estimeted

population Mean the mean persons

error of

population Mean the mean persons population Mean the mean

Men

20-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

25-34 yasrs . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

65-74 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

20-74 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

25-34 yesra . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-84 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Aga-adjustsd values:

Man, 20-74 yeare . . . . . . . . . . . . . . . . . . . . . .

Women, 20-74 yaare . . . . . . . . . . . . . . . . . . .

Number

Numbar in

thousands

1,113

145

267

138

107

246

210

1,140

139

258

180

143

229

191

. . .

. . .

11,809

1,857

3,613

1,965

1,551

1,726

1,096

12,806

1,775

3,567

2,397

2,072

1,856

1,140

. . .

. . .

Serum cholesterol

in milligram

per deciliter

208 1.9

184 3.8

196 2.6

219 4.8

222 7.0

227 2.8

219 3.2

217 2.3

185 4.2

193 3.0

210 5.2

240 4.6

252 3.4

253 4.2

210 1.7

218 2.2

Number

906

83

224

169

153

181

96

812

88

222

132

125

154

91

. . .

. . .

Number in

thousanda

11,158

1,143

3,237

2,410

2,401

1,475

491

9,827

1,141

3,185

1,816

1,903

1,252

530

. . .

. . .

Serum cholesterol

in milligrams

par daciliter

213 2.1

180 4.8

200 2.7

217 3.7

226 4.5

236 4.8

224 4.7

213 1.6

193 4.6

191 3.4

215 4.5

227 5.2

250 5.2

242 4.9

212 1.9

216 1.6

Number

1,361

137

249

274

248

328

125

1,234

126

291

273

227

227

90

. . .

. .

Number in

thousands

19,121

2,156

4,198

4,593

4,394

3,066

714

17,025

1,753

4,462

4,193

3,882

2,209

526

.

Serum cholesterol

m milligrams

per deciliter

218 7,7

183 4.1

203 2.6

221 3.6

234 3.0

233 3.4

228 4.3

211 1.6

184 2.7

192 3.0

203 2.6

227 4.5

252 3.1

245 5.1

216 1.3

214 1,6

I Unknown annual family incomss are axcluded.
Tabla 7. Moan serum cholcetarol Iavela of edulta, standard arrore of the moan, sgo-adjusted values, number of axamined persona, and estimated

population, by sax, rata, ago, and annual fsmi~ income: United 6tetoa, 1976-60

Annual family incomel

Under $6,000 $20.000 or more

Standard

Examinad

Standard

Estimatad armr of Examinad Estimated

Sax, race, and aga

error of

parsons population Mean the mean persons population Mean the mean

MEN

White

20-74 yeere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-84 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Black

20-74 yeers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 yeare . . . . . . . . . . . .. v...... . . . . . . . . . .

45-64 yeere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

WOMEN

White

20-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Black

20-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 yeare . . . . . . . . . .. q........ . . . . . . . . . .

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

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

Age-adjusted values:

White men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black en . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White women . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black women . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Serum cholesterol

in milligrams

Serum cholesterol

in milligrams

per deciliter

216 1.5

Number in

thousands

7,026

3,651

1,791

1,584

Number in

ner --––.dacilitar Number thouaenda

833 17,509

280

225

328

205

191

221

219

205

189

217

224

218

190

240

244

212

180

234

244

203

203

212

210

2.3 1,257

2.3 598

5.7 542

2.8 117

9,878

6,956

675

206 1.9

233 2.1

228 4.5

197

63

84

70

1,487

709

509

270

5.0 67

*9.2 41

“4. 1 23

●6.9 3

965

659

293

13

217 *7.8

202 *11.9

● ●

● *

1,311

398

379

534

11,467

5,284

3,274

2,808

2.7

3.0

3.4

2.2

1,136

633

420

83

15,693 212 1.8

196 2.0

236 3.0

246 5,4

9,544

5.675

474

333

132

103

98

2,849

1,528

859

462

3.9

4.6

7.4

5.8

66

43

21

2

870

629

233

8

199 *6.6

189 *5.8

* *

* ●

2.4

5.6

2.3

3.2

217 1,3

218 5.8

214 1,8

201 4.8

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. .

. . .

. . .

. . .

. . .

.,.

. . .

1Unknown annual family incomes are excluded

32
Tabla 8. Mean serum cholesterol Iavals of adulta. standard errors of tha man, age-adjusted valuoa, number of .xarninad persona, and

aatimated population, by sex, aga, and educational Iwaf: Unit.d 8tataa, 1978-80

Educational feva!ll

Tots/ O-8 years

Stendard Standard

Exuminad Estimatad arror of Ex.sminad Estimated error of

Sex end age persons population Maan the mean persons population Meen the mean

Man

20-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2!5-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Women

20-74 yeera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24 yaera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Aga-adjuated valuea:

Men, 20-74 yeara. . . . . . . . . . . . . . . . . . . . . . . .

Women, 20-74 yeara . . . . . . . . . . . . . . . . . . . . .

Number

5,557

672

1,065

735

680

1,218

1,187

6,197

733

1,164

636

759

1,309

1,396

. . .

. . .

Numbar in

thousands

63,021

9,264

15,875

11,208

10,934

9,517

6,223

69,328

9,895

16,754

12,173

11,867

10,564

8.074

. . .

. . .

Sarum cholaatarol

in milligram

per deciliter

211 1.2

180 1.7

199 1.6

218 2.0

227 1.8

229 1.8

221 1.8

215 1.2

184 1.9

192 1.4

207 1.8

232 2.2

249 2.0

246 1.6

211 1.1

215 1.2

Numbar

1,241

25

64

88

144

394

526

1,254

23

75

102

150

370

534

. . .

. . .

Number in

thouaanda

9,460

280

860

1,146

2,016

2,674

2.493

9,867

247

978

1,125

2,107

2,579

2,830

. . .

. . .

Serum cholesterol

in milligrams

Der dacilitar

218 2.3

179 ●6.8

205 6,8

217 4.8

218 4.0

224 2.8

222 3.0

232 2.7

* ●

186 “3.8

210 5.2

236 4.2

249 4,5

242 2.4

210 3.0

215 2.1

1UnknowneducationalIevelaem excluded,

33
Tabla 8. Maen ●otum choleetetd WON of -. etendetd utof@ of th@ mean, age-adjuated valuea, number of examined persons, and

estimated popuhtion. @ $ex, e@. end educational level: United Stetaa, 1976-80-Con.

Educational levelt —Con.

8-1 ? years 12 years

&8ndard Standard

Examined Estimated arror of Examined Estimated

Sax and age jwson$ population Meen

error of

the maan persons poptdetion Mean the mean

Men

20-74’ yeate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24 *eara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 feara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 @ars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-!54 fears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 faars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 fawe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

20-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24 *aars . . .. i . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 feara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-449earS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 feara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 ?ears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6S-74feare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age-adjueted values:

Man. 20-74 ?eatS. . . . . . . . . . . . . . . . . . . . . . . .

Women, 20-74 *eare . . . . . . . . . . . . . . . . . . . . .

Number

639

85

108

106

114

208

216

1,030

79

168

147

144

232

260

. . .

. . .

Number in

thousanda

8,434

1,071

1,394

1,471

1,686

1,620

1,192

10,502

1,035

2,031

2,001

2,051

1,65a

1.527

. . .

. . .

Serum cholesterol

in milligram

per deciliter

215 2.5

179 3.6

197 4.1

220 5.0

233 4.2

226 3.7

220 2.7

220 1.9

189 5.3

193 3.2

207 5.6

231 4.1

245 5.6

247 3.1

211 -2.1

215 2.0

Number

Number in

thousands

Serum cholesterol

in milligrams

per deciliter

1,671

240

355

267

222

347

240

2,230

278

481

360

309

465

337

. . .

19,908

3,268

5,007

4,052

3,533

2,752

1,296

27,333

3,703

6,911

5,405

5,102

4,099

2,113

.

. . .

210 1.5

176 2.8

199 2.5

218 2.8

225 3.6

234 3.0

224 3.7

215 1.6

183 2.8

192 1.9

206 2.3

235 3.3

251 2.3

251 2.9

211 1.4

216 1.3

1Unknown educational levels are excluded.

34
Tablo 8. Moan serum dtoleaterol ievoh of $dIMs, standard .rrors of tha rnoxtt,xga-adjuated valu.$, numb.r of ●xamhod persons, ●nd

eetimeted population, by sax age, ●nd o&Icationxl Ievek United Ststes, 1976-80-Con.

Educational level’ —Con.

13 wars or more

standard

Examined Estimated

Sex end age

ernw of

persons population Mean the mean

Men Number

Number in

thoueanda

20-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,806 25,199

20-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

322

537

274

200

268

205

4,635

8,614

4,540

3,698

2,471

1,241

Serum cholesterol

in milligrams

per deciliter

208 1.3

164 2.0

199 1.8

216 2.6

232 3.7

230 3.5

219 3.3

Women

20-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,683 21,625 205 1.4

20-24 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353 4,910 184 2.2

25-34 yeare, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440 6,635 192 2.1

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 3,642 206 2.6

45-54 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 2,607 223 4.2

55-64 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 242 2,027 246 3.4

65-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 1,604 246 3.6

Age-adjuated veluex

Men, 20-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 1.2

Women, 20-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . 213 1.3

1Unknown educational levels am ●xclude’d.

35
Table 9. Mean aarum cholesterol Iavels of adulta, standard errors of the maan, age-adjusted valuas, number of axamined parsons, and

estimated population, by sex, aga, and educational Iaval: United Stataa, 1976-80

Educational levell

Less th8n 12 yeers 12 yeers or more

Standard Standard

Examined Estimated error of Examined Estimated

Sex and ege

error of

parsons population Mean the mean parsons population Mean the mesn

Man

20-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

25-34 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

55-64 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Women

20-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Age-adjuatad valuas:

Men, 20-74 yeara. . . . . . . . . . . . . . . . . . . . . . . .

Women, 20-74 years . . . . . . . . . . . . . . . . . . . . .

Number

Number in

thousands

Sarum cholesterol

in milligrams

per deciliter

2,080

110

173

194

258

603

742

2,284

102

243

249

294

602

794

. . .

. . .

17,914

1,361

2,254

2,616

3,703

4,294

3,686

20.369

1,282

3,009

3,126

4,158

4,437

4,357

. . .

. . .

216 1.9

179 3.4

200 3.3

219 3.7

225 3.2

225 2.5

221 2.4

226 1.8

189 4.7

190 2.8

208 4.4

233 3.5

247 3.7

244 2.0

210 2.0

215 1.8

Number

3.477

562

892

541

422

615

445

3,913

631

921

587

465

707

602

. . .

. . .

Number in

thousands

45,107

7,903

13,621

8,581

7,231

5,223

2,537

48,959

8,613

13,746

9,047

7,709

6,127

3,717

. . .

. . .

Serum cholastarol

in milligrams

per deciliter

208 1.1

180 1.7

189 1.6

217 2.2

229 2.4

232 2.3

222 2.5

211 1,2

183 1.9

192 1.7

206 2.0

231 2.6

250 1.8

249 2.3

212 1.1

215 1.2

1Unknown educational levels are excluded.

36
Tabla 10. Mean serum cholesterol levels of adults, standard errors of tha mean, ega-adjusted values, numbar of examined persons, and

estimated population, by sex, race, age, and educational Iwel: United Statea, 1976-SO

Educational leve/l

Less than 12 years 12 years or more

Standard Standard

Examined Estimated error of Examined Estimated error of

Sex, race. and age persons population Mean the mean persons population Mean the mean

MEN

Whita

20-74 yasra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 yaare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Black

20-74 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . ...9

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

WOMEN

Wh ita

20-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 yeare, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Black

20-74 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Age-adjustad valuea:

Whita men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black man . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White woman . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black woman . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number

1,703

374

716

613

342

93

139

110

1,s45

469

715

661

397

111

164

122

. . .

. . .

. . .

. . .

Number in

thousands

14,733

4,951

6,6S5

3,096

2,823

1,133

1,213

477

16,494

5,636

6,967

3,669

3,342

1.356

1,379

606

.

. .

. . .

. . .

Serum cholesterol

in milligrams

Dar deciliter

217 ‘-

203

224

222

215

203

226

214

226

197

240

244

227

204

242

243

212

212

216

220

L. I

2.6

2.8

2.7

3.3

*6.7

*4.1

●4.2

1.9

2.4

2.7

2.1

3.6

*4.7

“7.3

5.1

2.1

4,2

1.9

3.4

Number

3,149

1,751

974

424

252

169

47

16

3,526

1,864

1,093

569

319

229

63

27

. . .

. .

,..

Number in

thousands

40,646

26,597

11,619

2,431

3,170

2,500

599

72

43,752

27,354

12,B4B

3,550

4,144

3,297

733

113

. . .

. . .

.

. . .

Serum cholesterol

in milligrams

par deciliter

209

199

230

221

202

194

229

*

212

194

240

249

199

190

236

248

212

210

215

211

1.2

1.4

1.7

2.6

4.3

3.3

6.4

*

1.3

1.3

2.1

2,4

3.6

3.2

●9.7

●5.9

1,1

3.7

1,3

3.4

1Unknown educational levels ere excluded.

37
Tdlall. Porcettt of edufte with 04wle$temf levels at modereta end high risk, $t@mlerd errors. number of exmkted

POPU-. by eex and age: United Stetee. 1976-60

pererww, and eatimeted

Examined PafaotM at Standani Paraons Standatwi

peraotw Eatimatad modarata anvr of ●t high

Sax ●nd oge at risk

error of

population ri8k pamant risk percent

Number in

Men Number thouamtds Peroent Peroent

20-74 yeara. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,604 63,611 14.6 0.s 19.1 0.9

20-24 yeara. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 676 9,331 13.3 1.1 12.4 1,7

25-34 Yws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,067 15,896 14.6 1.2 10.2

36-44 yeera. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 745

1.6

11,367 17.1 1.4 20.5

45-64 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 660

1.7

11,114 14,7 1.4 21.0

65-64 yeare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.8

1,227 wo7 13.6 1.1 22.0

65-74 YwO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.8

1,188 6.297 13.0 1.3 16.1 1.5

Women

20-74 yeem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,260 69,S94 14.7 0.5 21.6 0.9

20-24 yew . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 738 9,964 15.7 1.5 13.2

25-34 yaere. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.4

1,170 16.8S6 10.8 0.9 17.6

35-44 yam......... . . . . . . . . . . . . . . . . . . . . . .

1.2

644 12,264 14.0 1.6 13.4

46-64 yeere. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.1

763 11,918 17.4 1,6 22.7

55-64 yewe.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2

1,320 10,743 16.6 1.0 35.4

65-74 yeere

1.9

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,416 8,198 16.2 1.0 34.7 1.6

Age-edjrmted valuw.

Men, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.s 0.5 19.1

Women..., . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.9

. . . . . . 14.7 0.s 21.7 0.9

NOTE See Diecue$ion section for an evaluation of the effect of the serum-plasma difference on estimating the percent with moderate or high risk cholesterol levels.

38
Tabla 12. Parcantof adultawith chofestaroll~ela at moder@taWd high risk, St.nd.rd wrora, ttutttbwof~ pcnotts,~d ~im~ad

population,by aax,rqce, and agw United States, 1976-80

Examined Peqons at Standard Persons Standard

persons Estimated moder8tq error of

Sex, race, end age

et high error of

at risk population risk percent ri$k percent

MEN

White

20-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Black

20-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

WOMEN

White

20-i’ 4years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Black

20-74 yaara. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Age-adjusted values:

White men ., . . . . . . . . . . . . . . . . . . . . . . . . . .

Black en . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White women . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black women . . . . . . . . . . . ... . . . . . . . . . . . . . . .

Number

4,883

2,135

1,703

1045

607

288

191

128

5,418

2,350

1,823

1,245

729

342

235

152

. . .

. . .

. . .

. . .

Number in

thousertd$

55,808

31,724

18,508

5,576

6,102

3,701

1,845

555

80,765

33,486

19,870

7.329

7,578

4.672

2,174

733

. . .

. . .

. . .

. . .

Peroent

14.7

15.2

14.3

13.4

12.1

12.8

11.3

9.7

14.9

13.1

17.4

16.1

13.5

12.5

13.7

18.9

14.7

12.0

14.8

13.6

0.6

0.8

0.8

1.4

1.6

2.6

2.2

2.8

0.5

0.9

1.0

1,2

1.8

2.0

3.3

2.9

Percent

19.0

17.6

21.5

18.4

20.5

18.4

23.9

16.6

22.1

15.1

28.9

35.4

19.9

14.5

28.2

29.0

18.9

20.6

21.8

20.5

1.0

1.3

1.3

1.6

2.2

2.8

4.6

3.5

0.9

0.8

1.8

1.7

2.7

2.7

4.4

3.9

;::

0.9

2.6

NOTE: See Discussion section for an evaluation of the effect uf the $erum-plasms difference on e$timsting the percent with modarete or high risk cholesterol levels.

39
Tablo 13. Pwcent of sdufte with oholeeterol Iwolo et high risk, etsndard ●rrors, number of exsmirted persons, md estimated population, by

S*X, SgS, snd poverty stetus: Urtitsd 6tstes, 1976-60

Poverty stetus

Povetty Nonpovetty

Examined Persons Standard Examined Persons

Estimated

Standerd

persons at high error of persons Estimated at high arror of

Sex and aga at risk population risk percent at risk population risk percent

Number in Number in

Men Number thoussnds Percent Number thousands Percent

20-74 years . . . . . . . . . . . . . . . . . . . . . . 809 5,478 14.9 1.5 4,785 55,706 19.6 1.0

20-44 yeers . . . . . . .. . . . . . . . . . . . . . . 266 3,295 15.9 2.0 2,147 32,214 18.3 1,4

45-84 years . . . . . . . . . . . . . . . . . . . . . . 175 1,424 13.2 2.8 1,651 18,180 22.2 1.4

65-74 yeem . . . . . . . . . . . . . . . . . . . . . . 168 759 13.4 3.2 987 5.312 19.0 1.7

Women

20-74 yesrs . . . . . . . . . . . . . . . . . . . . . . 953 8,919 19.1 2.0 5,059 58,549 22.1 0.9

20-44 year n. . . . . . . . . . . . . . . . . . . . . 427 5,378 13.7 2.3 2,253 32,684 15.4 0.8

45-84 yesm . . . . . . . . . . . . . . . . . . . . . . 270 2,296 26.3 3.0 1,726 19,357 28.9 1.8

65-74 vesn . . . . . . . . . . . . . . . . . . . . . . 256 1,245 29.6 4.3 1,080 6,507 35.5 1.8

Age-adjusted velues:

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.6 1.6 . . . 19.6 1.0

Women . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . .

. . . 19.4 2.0 . . . . . . 21.9 0.9

NOTE See Discussion smtion for an evaluation of the affect of the serum-plaama diffarancaa on aatimating the parcent with high risk cholesterol levels,

40
Tabla 14. Parcant of adulta with cholaatarol Wats at h~gh risk, standard arrors, numbar of ●xaminad parsons, and astimatad population, by

sax, aga, and educational krval: Unitad Statas, 1976-80

Educational level

Less then 12 Veers 12 years or more

Exemined Persons Standard Examined Persons Stendard

persons Estimatad at high error of persons Estimatad

Sax and aga at risk

at high arror of

population risk parcant at risk population risk percent

Men

2Cf-74 years . . . . . . . . . . . . . . . . . . . . . .

20-44 yeara . . . . . . ... . . . . . . . . . . . . .

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

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

Women

20-74 yaara . . . . . . . . . . . . . . . . . . . . . .

20-44 yeara . . . . . . . . . . . . . . . . . . . . . .

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

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

Age-adjusted values:

Men . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . . . . .

Number

2,080

477

861

742

2,284

594

896

794

. . .

. . .

Numbar in

thousands Percent

17,914

6,231

7,997

3,686

20,369

7,416

6,596

4,357

. . .

. . .

18.1 1.4

17.3 2.0

19.2 1.9

17.1 1.9

25.6 1.4

16.6 1.8

29.5 2.2

33.3 2.0

17<9 1.5

22.6 1.5

Numbar in

Number thouaanda Percent

3,477 45,107 19,5 0.9

1,995 30,116 16.0 1.2

1,037 12,454 23.1 1.6

445 2,537 19.5 1.9

3,913 48,959 20.3 0.9

2,139 31,406 14.8 0.8

1,172 13,835 26.5 1.9

602 3,717 36.4 2.3

. . . . . . 19.8 0.9

. . . . . . 21.6 0.9

NOTE: See discussion section for evaluation of the effect of the serum-pleame differences on aatimoting the percent with high risk cholesterol levels.

41
Table 15. Cumulative percent distribution of serum cholesterol Iavela of man, according to race and aga, and number of examined paraona

and estimatad population: Unitad Statea, 1976-SO

Age

20-74 yeers 20-24 years 25-34 years

Number Estimeted Number Estimated Number Estimated

of population Cumu- Of population Cumu- Of population CumuRace and selected axamined in Iativa examined in Iative examined in Iative

cholesterol level cutoff persons thousands parcent persons thousands percent persons thousands percent

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

36

39

40

All racest

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

Under 100 . . . . . . . . . . . . . . . . . . .

Under 120 . . . . . . . . . . . . . . . . . . .

Under 140 . . . . . . . . . . . . . . . . . . .

Under 160 . . . . . . . . . . . . . . . . . . .

Under 180 . . . . . . . . . . . . . . . . . . .

Under 200 . . . . . . . . . . . . . . . . . . .

Under 220 . . . . . . . . . . . . . . . . . . .

Under 240 . . . . . . . . . . . . . . . . . . .

Under 250 . . . . . . . . . . . . . . . . . . .

Under 260 . . . . . . . . . . . . . . . . . . .

Under 265 . . . . . . . . . . . . . . . . . . .

Under 270 . . . . . . . . . . . . . . . . . . .

Under 280 . . . . . . . . . . . . . . . . . . .

Under 290 . . . . . . . . . . . . . . . . . . .

Under 300 . . . . . . . . . . . . . . . . . . .

Under 320 . . . . . . . . . . . . . . . . . . .

Under 340 . . . . . . . . . . . . . . . . . . .

Under 360 . . . . . . . . . . . . . . . . . . .

Under 380 . . . . . . . . . . . . . . . . . . .

White

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

Under 100 . . . . . . . . . . . . . . . . . . .

Under 120 . . . . . . . . . . . . . . . . . . .

Under 140 . . . . . . . . . . . . . . . . . . .

Under 160 . . . . . . . . . . . . . . . . . . .

Under 180 . . . . . . . . . . . . . . . . . . .

Under 200 . . . . . . . . . . . . . . . . . . .

Under 220 . . . . . . . . . . . . . . . . . . .

Under 240 . . . . . . . . . . . . . . . . . . .

Under 250 . . . . . . . . . . . . . . . . . . .

Under 260, . . . . . . . . . . . . . . . . . .

Under 265 . . . . . . . . . . . . . . . . . . .

Under 270 . . . . . . . . . . . . . . . . . . .

Under 280 . . . . . . . . . . . . . . . . . . .

Under 290 . . . . . . . . . . . . . . . . . . .

Under 300 . . . . . . . . . . . . . . . . . . .

Under 320 . . . . . . . . . . . . . . . . . . .

Under 340. . . . . . . . . . . . . . . . . . .

Under 360 . . . . . . . . . . . . . . . . . . .

Under 360. . . . . . . . . . . . . . . . . . .

5,604

7

44

206

602

1,337

2,341

3,309

4,119

4,489

4,759

4,884

4,98S

5,146

5,284

5,369

58494

5,555

5,575

5,592

4,883

7

32

166

497

1,133

2,005

2,873

3,564

3,914

4,154

4,259

4,348

4,484

4,606

4,682

4,793

4,842

4,858

4,874

63,611

60

479

2,497

7,472

16.334

28,000

38,842

47,791

51,734

54.540

55,770

56,893

58,569

60.278

61,088

62,366

63,038

63,233

63,451

55,808

60

336

2,020

6,226

14,077

24,307

34,063

41,875

45,375

47,865

48,954

49,874

51,335

52,928

53,626

54,760

55,342

55,489

55,696

100.0

0.1

0.8

3.9

11.7

25.7

44.0

61.1

75.1

81.3

85.7

87.7

89.4

92.1

94.8

96.0

98.0

99.1

99.4

99.7

100.0

0.1

0.6

3.6

11.2

25.2

43.6

61.0

75.0

81.3

85.8

87.7

88.4

92.0

94.8

96.1

98.2

99.2

99.4

99.8

676

4

16

80

207

360

491

584

631

649

658

660

661

667

669

670

674

676

676

676

581

4

11

65

171

308

420

543

559

567

569

569

575

576

577

579

581

581

581

9,331

42

193

1,052

2,828

5,096

6,843

8,111

8,750

8,987

9,103

9,124

9,132

9,206

9,235

9,247

9,299

9,331

9,331

9,331

8,052

42

134

858

2,334

4,394

5,698

6,978

7,562

7,777

7,870

7,891

7,891

7,964

7,975

7,987

8,020

8,052

8,052

8,052

100.0

0.4

2.1

11.3

30.3

54.6

73.3

86.9

93.8

96.3

97.6

97.8

97.9

98.7

99.0

99.1

99.7

100.0

100.0

100.0

100,0

0.5

1,7

10,7

29.0

54.6

73,2

86.7

93.9

96,6

97.7

98.0

98.0

98.9

99,0

99.2

99.6

100,0

100,0

100,0

1,067

1

14

56

173

365

610

795

905

980

995

1,007

1,019

1,037

1,041

1,053

1,058

1,061

1,065

901

1

8

38

138

309

513

667

764

803

827

840

852

863

878

882

891

895

897

901

15,895

12

194

757

2,427

5,190

9,011

11,829

13,464

14,145

14,584

14,828

15,000

15,179

15,485

15,542

15,687

15,762

15,817

15,861

13,864

12

120

547

2,018

4,574

7,871

10,306

11,789

12,350

12,704

12,917

13,089

13,261

13,544

13,601

13,723

13,775

13,619

13,864

100.0

0.1

1.2

4,8

15.3

32.7

56.7

74.4

84.7

89,0

91.7

93.3

94.4

95.5

97.4

97.8

98.7

99.2

99.5

99.8

100,0

0.1

0.9

3.9

14,6

33.0

56.6

74,3

85.0

89.1

91.6

93.2

94.4

95.7

97.7

98.1

99,0

99.4

99.7

100.0

1Includes data for races not shown as sepsrata categories.
Table 15. Cumulative percant distribution of swum cholesterol levels of man, wcording to race and age, and numbar of examined persons

and estimated population: United States, 1976-SO-Con.

Age—Con.

35-44 years 45-64 years 55-64 years 65-74 years

Number Estimated Number Estimated Number

of

Estimated Number

population CumuEstimated

of population Cumu- Of population Cumu- Of

examined in Iative

population

axamined in tative

Cumuaxamined in Iative examined in lative

persons thousands percent persons thousands percent parsons thousands parcent persons thousands percent

745

3

19

55

156

294

407

540

589

627

639

658

687

705

719

735

741

741

743

653

3

16

44

131

251

360

476

521

556

566

582

604

619

631

848

651

651

652

11,367

36

267

826

2,376

4,444

6,091

8,195

8,844

9,538

9,728

10,012

10,434

10,766

10,964

11,209

11,306

11,306

11,329

9,808

36

235

675

1,979

3,787

5,310

7,071

7,766

8,297

8,466

8,713

9,034

9,316

9,482

9.?05

9,772

9,772

9,765

100.0

0.3

2.3

7.3

20.9

39.1

53.6

72.1

78.7

83.9

85.6

88.1

91>8

84.7

96.5

98.6

99.5

99.5

99.7

100.0

0.4

2.4

6.9

20.2

38.4

54.1

72.1

79.2

84.6

86.3

88.8

92.1

95.0

96.7

98.9

99.6

99.6

99.8

880

11

37

98

204

328

442

507

553

571

584

615

638

652

670

883

685

689

617

10

31

86

180

297

396

453

494

510

521

548

571

583

611

612

616

11,114

202

585

1,421

3,109

5,201

7,017

7,977

6,769

9,049

9,335

9,601

10,245

10,472

10,759

10,849

10,981

11,082

9,865

179

493

1,248

2,756

4,724

6,2S0

7.097

7,809

8,063

8,247

8,863

9,107

9,283

9,562

9,726

9,733

9,643

100.0

1.8

5.3

12.8

28.0

46.8

63.1

71.6

78.9

81.4

84.0

86.2

92.2

94.2

96.8

98.5

98.8

99.8

100.0

1.6

5.0

12.7

27.9

47.9

63.5

71.9

79.2

81.7

83.6

87,8

92.3

94.1

96.9

98.6

98.7

99.8

1,227

1

6

16

54

154

333

566

785

886

962

994

1,026

1,074

1,120

13147

1,190

1,214

1,221

1,223

1,086

1

5

15

49

128

268

497

692

764

852

879

906

948

980

1,016

1,053

1,074

1,060

1,082

9,607

3

36

98

412

1,188

2,484

4,319

6.067

6,935

7,442

7,697

7,917

8,269

8,700

8,901

9,275

9,490

9,554

9,565

8,642

3

26

88

364

968

2,173

3,832

5.421

6,206

6,674

6,907

7,086

7,403

7,821

8,008

8,333

8,532

8,589

8,600

100.0

0.0

0.4

1.0

4.3

12.3

25.9

45.0

63.2

72.2

77.5

80.1

82.4

88.1

90.6

92.6

96.5

98.8

99.4

99.6

100.0

0.0

0.3

1.0

4.2

11.2

25.1

44.3

62.7

71.8

77.2

79.9

82.0

85.7

90,5

92.7

96.4

98.7

99.4

99.5

1,199

1

5

24

76

204

409

629

816

908

979

1,025

1,052

1,086

1,115

1,140

1,172

1,183

1,191

1,196

1,045

1

5

22

64

171

353

552

713

794

858

895

918

946

972

993

1,024

1,030

1,037

1,042

6,297

3

20

121

393

1,065

2,108

3,291

4,298

4,746

5,105

5,344

5.497

5,660

5.847

5,962

6,137

6,201

6,245

6,273

5,576

3

20

113

342

914

1)842

2,912

3,772

4,179

4,510

4,709

4,847

5,010

5,166

5,266

5,437

5,464

5,523

5,552

100.0 01

0.0 02

0.3 03

1.9 04

6.2 05

16.9 06

33.5 07

52.3 08

68.3 09

75.4 10

81.1 11

84.9 12

87.3 13

90.2 14

92.9 15

94.7 16

97.5 17

98.5 18

99.2 19

99.6 20

100.0 21

0.1 22

0.4 23

2.0 24

6.1 25

16,4 26

33.0 27

52.2 28

67.6 29

74.9 30

80.9 31

84.4 32

86.9 33

89.8 34

92.6 35

94.4 36

97$5 37

98.3 38

99.1 39

99.6 40

43
Table 15. Cumulative percent distribution of serum cholesterol levels of men, according to rata and age, and number of examinad paraons

and astimatad population: United States, 1976-SO-Con.

Age

20-74 yeers 20-24 years 25-34 years

Number Estimeted Number Estimated Number Estimated

of population Cumu- Of population Cumu- Of population CumuRece and selected examined in Iative examined in Iative exeminad in Iativa

cholestaml Ieval cutoff persons thousands percent parsons thousands percent persons thousands parcent

41 Total .

42 Under

43 Under

44 Undar

46 Under

Black

. . . . . . . . . . . . . . . . . . . . . 607 6,102 %00.0 79 1,043 100.0 139 1,546

00, . . . . . .. . . . . . . . . . . . .

20 . . . . . . . . . . . . . . . . . . 11 134 2.2 5 59 5.6 5 66

40. . . . . . . . . . . . . . . . . . . 39 468 7.7 15 195 18.7 17 201

60 . . . . . . . . . . . . . . . . . . . 96 1,115 18.3 33 451 43.2 33 383

46 Under 180 . . . . . . . . . . . . . . . . . . . 181 1,921 31.5 46 62B 60.2 50 525

47 Under 200 . . . . . . . . . . . . . . . . . . . 269 3,019 4!3.5 61 S16 76.2 83 898

48 Under 220 . . . . . . . . . . . . . . . . . . . 376 3,875 63.5 73 981 94.1 106 1,128

49 Under 240 . . . . . . . . . . . . . . . . . . . 454 4,646 76.1 76 1.013 97.1 117 1,247

50 Under 250 . . . . . . . . . . . . . . . . . . . 485 4,961 81.3 78 1,035 99.2 122 1,343

51 Under 260 . . . . . . . . . . . . . . . . . . . 506 5,126 S4.o 7B 1,035 99.2 127 1.403

52 Under 265 . . . . . . . . . . . . . . . . . . . 523 5,244 05,9 78 1,035 99.2 129 1,435

53 Under 270 . . . . . . . . . . . . . . . . . . . 535 5,430 89.0 79 1,043 100.0 129 1,435

54 Lhdar280 . . . . . . . . . . . . . . . . . . . 557 5,633 92.3 79 1,043 100.0 130 1,442

55 Under 290 . . . . . . . . . . . . . . . . . . . 569 5,705 93.5 79 1,043 100.0 133 1,465

56 Under 300 . . . . . . . . . . . . . . . . . . . 576 5,787 94.8 79 1,043 100.0 133 1,465

5? Under 320 . . . . . . . . . . . . . . . . . . . 567 5,6S5 96.4 79 1,043 100.0 135 1,478

58 Under 340 . . . . . . . . . . . . . . . . . . 599 5,995 98.3 79 1,043 100.0 136 1,501

59 Undar360 . . . . . . . . . . . . . . . . . . . 603 6,043 99.0 79 1,043 100.0 137 1,511

60 Under 380 . . . . . . . . . . . . . . . . . . . 604 6,054 99.2 79 1,043 100.0 131 1,511

100.0

4.2

13.0

24.6

33.9

58.1

73.0

60.7

86.9

80.7

92.B

92.8

93.3

94.8

94.8

95.6

97.1

97.8

97.8

44
Table 15. Cumulative parcent distribution of serum cholesterol levels of men, according to race and age, and number of examined persons

and astimatad population: United Stetas, 1976-80—Con.

Age—Con.

35-44 years 45-54 years 55-64 years 65-74 years

Number Estimated Number Estimated Number Estimated Numbar Estimated

of population Cumu- Of population Cumu- Of population Cumu- Of population Cumuaxamined in Iativa examined in Iative examined in Iativa examined in Iative

persons thousands parcent persons thousands parcent parsons thousands parcent persons thousands parcant

70

3

9

22

36

40

52

53

53

54

56

62

64

66

67

66

68

69

1,112

32

117

318

527

629

839

650

850

860

885

978

1,003

1,035

1,056

1,067

1,087

1,099

100.0 62

2.6 1

10.5 5

28.6 10

47.4 20

56.6 27

75.5 39

76.4 46

76.4 49

77.3 51

79.6 53

88.0 57

90.2 57

93.1 58

95.2 59

97.8 61

97.8 62

96.8 62

1,044

23

69

127

291

414

623

735

760

805

908

958

958

984

992

1,018

1,044

1,044

100.0

2.2

6.6

12,2

27.9

39.7

59.7

70.4

74,7

77.1

87.0

91.8

91.8

94.3

95.1

97.5

100.0

100.0

129

1

1

5

24

42

64

83

91

99

104

108

114

118

119

125

128

129

129

801

10

10

48

192

281

419

519

568

607

629

667

702

716

729

778

794

801

801

100.0

1.2

1.2

6.1

23.9

35.0

52.3

64.7

70.8

75.8

78.4

83.3

87.7

89.3

90.9

97.1

99.1

100.0

100.0

128

2

11

29

47

66

87

95

100

107

110

115

118

121

122

127

128

126

555 100.0 41

42

43

8 1,4 44

47 8.5 45

131 23.6 46

206 37.2 47

302 54.4 48

405 72.8 49

431 77,5 50

451 81.3 51

481 86.6 52

492 88.6 53

509 91.6 54

520 93.6 55

531 95.5 56

535 96.3 57

551 99.3 58

555 100.0 59

555 100.0 60

45
Tabla 16. Cumulative parcarrt distribution of sarum cholaetarol Iavela of woman, according to race and age, and mmbar of exami~d W~ons

and estimatad population: United Statea, 197S-S0

Age

20-74 Veers 20-24 veers 25-34 yeers

Number Estimeted Number Estimeted Number Estimated

of population Cumu- Of population Cumu- Of population CumuRace and selected examined in Iative axaminad in Iative examined in Iative

cholesterol Iavel cutoff persons thousands percent persons thousends percent persons thousands percent

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

36

39

40

All racesl

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

Under 100 . . . . . . . . . . . . . . . . . . .

Under 120 . . . . . . . . . . . . . . . . . . .

Under 140 . . . . . . . . . . . . . . . . . . .

Under 160 . . . . . . . . . . . . . . . . . . .

Under 180 . . . . . . . . . . . . . . . . . . .

Under 200 . . . . . . . . . . . . . . . . . . .

Under 220 . . . . . . . . . . . . . . . . . . .

Under 240 . . . . . . . . . . . . . . . . . . .

Under 250 . . . . . . . . . . . . . . . . . . .

Under 260 . . . . . . . . . . . . . . . . . . .

Under 265 . . . . . . . . . . . . . . . . . . .

Under 270 . . . . . . . . . . . . . . . . . . .

Under 280 . . . . . . . . . . . . . . . . . . .

Under 290 . . . . . . . . . . . . . . . . . . .

Under 300 . . . . . . . . . . . . . . . . . . .

Under 320 . . . . . . . . . . . . . . . . . . .

Under 340 . . . . . . . . . . . . . . . . . . .

Under 360 . . . . . . . . . . . . . . . . . . .

Under 380 . . . . . . . . . . . . . . . . . . .

White

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

Under 100 . . . . . . . . . . . . . . . . . . .

Under 120 . . . . . . . . . . . . . . . . . . .

Under 140 . . . . . . . . . . . . . . . . . . .

Under 160 . . . . . . . . . . . . . . . . . . .

Under 180 . . . . . . . . . . . . . . . . . . .

Under 200 . . . . . . . . . . . . . . . . . . .

Under 220 . . . . . . . . . . . . . . . . . . .

Under 240 . . . . . . . . . . . . . . . . . . .

Under 250 . . . . . . . . . . . . . . . . . . .

Under 260 . . . . . . . . . . . . . . . . . . .

Under 265 . . . . . . . . . . . . . . . . . . .

Under 270 . . . . . . . . . . . . . . . . . . .

Under 280 . . . . . . . . . . . . . . . . . . .

Under 290 . . . . . . . . . . . . . . . . . . .

Under 300 . . . . . . . . . . . . . . . . . . .

Under 320 . . . . . . . . . . . . . . . . . . .

Under 340 . . . . . . . . . . . . . . . . . . .

Under 360 . . . . . . . . . . . . . . . . . . .

Under 380 . . . . . . . . . . . . . . . . . . .

6,260

6

34

185

587

1,322

2,282

3,229

4,172

4,580

4,933

5,074

5,214

5,453

5,630

5,792

6,022

6,137

6,188

6,216

5,418

2

26

150

505

1,124

1,940

2,766

3,578

3,935

4,248

4,374

4,497

4,713

4,S67

5,011

5,207

5,309

5,354

5,382

69,994

44

505

2,605

8,025

17,714

29,379

40,071

50,074

54,210

57,775

59,203

60,451

62,752

64,350

65,703

67,855

68,966

69,390

69,659

60,785

18

404

2,347

6,966

15,203

25,161

34,514

43,033

48,770

50,004

51,293

52,391

54.446

55,841

57,074

58,909

59,912

60,258

60,527

100.0

0.1

0.7

4.0

11.5

25.3

42.0

57.2

71.5

77.4

82.5

84.6

66.4

89.7

91.9

93.9

96.9

88.5

99.1

99.5

100.0

0.0

0.7

3.9

11.5

25.0

41.4

56.8

70.8

76.9

82.3

84.4

86.2

88.6

91.9

93.9

96.9

98.6

99.1

99.6

738

8

66

183

353

511

629

690

701

708

710

711

716

723

728

734

738

738

738

624

7

53

151

297

432

535

583

583

598

600

601

608

612

616

620

624

624

624

9,994

129

994

2,566

4,922

6,961

8,626

9,334

9,481

9,582

9,600

9,610

9,677

9,758

9,817

9,934

9,994

9,994

9,994

8,406

100

793

2,116

4,109

5,881

7,318

7,861

7,992

8,072

8,091

8,101

8,188

8,230

8,273

8,348

8,408

8,408

8,408

100.0

1.3

9.9

25.7

49.3

69.6

86.3

93.4

94.9

95.9

96.1

96.2

96.8

97.6

98.2

99.4

100.0

100.0

100.0

100.0

1.2

9.4

25.2

48.9

69.9

87.0

93.5

95.1

96.0

96.2

96.3

97.1

97.9

98.4

99.3

104).0

100.0

100.0

1,170

3

17

76

227

477

744

911

1,040

1,078

1,104

1,117

1,125

1,140

1,148

1,153

1,164

1,169

1,169

1,170

1,000

2

15

64

201

409

633

778

885

919

945

956

963

975

982

986

995

999

999

1,000

16,856

26

251

1,189

3,251

7.066

10,848

13,075

14,873

15,473

15,879

16,094

16,204

16,433

16,555

16,629

16,763

16,849

16,849

16,856

14,494

18

216

1,036

2,893

6,126

8,283

11,228

12,703

13,250

13,656

13,853

13,955

14,141

14,240

14,308

14,428

14,486

14,486

14,484

100.0

0.2

1.5

7.1

19.3

41.9

84.4

77.6

88.2

91.8

94.2

95.5

96.1

97.5

98.2

98.7

99.6

100.0

100.0

100.0

100.0

0.1

1.5

7.1

20.0

42.3

64.1

77.5

87.6

91.4

94.2

95.6

96.3

97.6

98.3

98.7

99.5

99.9

99.9

100.0

llncludes dsts for races not shown as sepsrate categories.

46
Tabla 16. Curnulativa parcent distribution of sarum cholastarol lavals of woman, according to rata and aga, and numbar of axaminad persona

and astimated population: United Statas, 1976-80—Con.

Age—Con.

35-44 years 45-54 years 55-64 years 65-74 years

Number Estimated Number Estimated Number Estimeted Number Estimated

of population Cumu- Of population Cumu- Of population Cumu- Of

examined in Iativa

population Cumu -

examined in Iative exemined in Iative exemined in Iative

persons thousands percent persons thousands percent persons thousands percent persons thousands percent

844

1

2

20

93

234

411

561

676

727

758

773

7s4

810

813

821

832

838

841

842

726

1

15

82

204

351

483

581

630

657

668

677

698

699

707

716

721

724

725

12,284

10

34

344

1,368

3,332

5,847

8,010

9,747

10,545

11,022

11,240

ll,4io

11,829

11,859

11,982

12,119

12,218

12,258

12,269

10,584

24

276

1,217

2,927

4,954

6,864

8,352

9,128

9,543

9,710

9,851

10,187

10,197

10,319

10,437

10,526

10,566

10,577

100.0

0.1

0.3

2.8

11.1

27.1

47.6

65.2

79.3

85.8

S9.7

91.5

92,9

96,3

96.5

97.5

96.7

99.5

99.8

99.9

100,0

0.2

2.6

11.5

27.7

46.8

64.9

76.9

86.2

90.2

91.7

93.1

96.3

96.3

97.5

98.6

99.5

99.8

99.9

763

5

12

31

85

194

323

456

520

578

604

625

656

686

707

737

744

752

755

647

3

9

24

69

166

275

386

439

491

515

532

559

564

601

625

631

638

641

11,918

83

203

482

1,319

3,016

4,961

7,094

0,071

9,074

9,479

9,794

10,257

10,700

11,022

11,523

11,637

11,745

11,799

10,369

65

175

411

1,108

2,681

4,355

6,159

6,989

7,891

8,267

6,527

8,931

9,317

9,596

10,020

10,118

10,214

10,269

100.0

0.7

1.7

4.0

11.1

25.3

41.6

59.5

67.7

76.1

79.5

82.2

86.1

89.8

92.5

96.7

97.6

96.5

99.0

100.0

0.6

1.7

4.0

10.7

25.9

42.0

59.4

67.4

76.1

79.7

82.2

S6.1

89.8

92.5

96.6

97.6

98.5

99.0

1,329

4

26

70

189

385

627

741

867

90s

950

1,027

1,095

1,151

1,235

1,279

1,300

1,313

1,176

4

24

56

158

334

547

646

758

795

835

907

968

1,019

1,092

1,132

1,149

1,162

10,743

32

207

517

1,399

3,016

5,055

5,921

6,914

7,249

7,564

8,192

8,744

9,139

9,843

10,321

10,496

10,629

9,601

32

197

443

1,215

2,658

4,449

5,234

6,146

6,462

6,764

7,361

7,863

8,236

8,849

9,276

9,391

9,524

100.0

0.;

1.9

4.8

13.0

28.1

47.1

55.1

64.4

67.5

70.4

76,3

81,4

S5.1

91.6

96.1

97.7

98.9

100.0

0.3

2.0

4.6

12.7

27.7

46.3

54.5

64.0

67.3

70.5

76.7

81.9

85.8

92.2

96.6

97.8

99.2

1,416

2

2

7

27

103

233

420

683

813

918

962

1,019

1,102

1,165

1,232

1,320

1,369

1,388

1,398

1,245

5

23

89

200

361

596

708

799

840

889

966

1,022

1,0s2

1,159

1,202

1,220

1,230

8,198

8

8

42

153

557

1,309

2,382

3,970

4,718

5,305

5,541

5,869

6,363

6,734

7,115

7,653

7,947

8,048

8,111

7,329

34

134

1,147

2,091

3,509

4,176

4,695

4,912

5,194

5,659

5,995

6,344

6,827

7,095

7,192

7,255

100.0 01

0.1 02

0.1 03

0.5 04

1.9 05

6.8 06

16.0 07

29.1 08

48,4 09

57.5 10

64.7 II

67.6 12

71.6 13

7’7.6 14

82.1 15

86.8 16

93.3 17

96.9 18

98.2 19

98.9 20

100,0 21

22

23

0.5 24

1.6 25

6.7 26

15.6 27

28.5 28

47.9 29

57.0 30

64.1 31

67.0 32

70,9 33

77.2 34

S1.8 35

S6.6 36

93.1 37

96.8 38

98.1 39

99,0 40

47
Tabla 16. Cumulative percent distribution of serum cholesterol levels of women, according to rata and age, and number of examined persons

end estimated population: United Stetea, 1976-80—Con.

Age

20-74 years 20-24 years 25-34 yesrs

Number Estimatad Number Estimated Number Estimated

of population Cumu- Of population Cumu- Of population CumuRace and selected examined in Ietiva examined in Iative examined in Iative

cholesterol level cutoff persons thousands percent persons thousands percent persons thousands percent

41 Total

42 Under

43 Under

44 Under

45 Under

Black

...,.. . . . . . . . . . . . . 729 7,579 100.0 94 1,304 100.0 145 1,953 100,0

00 . . . . . . . . . . . . . . . . . . . 4 26 0.3

20 . . . . . . . . . . . . . . . . . . . 7 71 0.9

40. . . . . . . . . . . . . . . . . . . 29 363 4.8 9 138 10.6

60 . . . . . . . . . . . . . . . . . . . 71 904 11.9 25 343 26.3

46 Under 180 . . . . . . . . . . . . . . . . . . . 17’0 2,131 28.1 48 692 53.1

47 Under 200 . . . . . . . . . . . . . . . . . . . 294 3,520 46.4 67 906 69.5

48 Under 220 . . . . . . . . . . . . . . . . . . . 398 4,633 61.1 79 1,092 83.7

49 Under 240 . . . . . . . . . . . . . . . . . . . 509 5,783 76.3 88 1,213 93,0

50 Under 250 . . . . . . . . . . . . . . . . . . . 558 6,155 81.2 89 1,228 94.2

1

2

10

23

56

93

13

31

35

8 0.4

36 1.8

121 6.2

317 16.2

763 39.1

1,294 66.3

1,562 80.0

1,783 91.3

1.836 94,0

5; Under 260 . . . . . . . . . . . . . . . . . . . 590 6,387 84.3 91 1,249 95.8 135 1,836 94.0

52 Under 265 . . . . . . . . . . . . . . . . . . . 602 6,491 85.6 91 1,249 95.8 137 1,854 94,9

53 Under 270 . . . . . . . . . . . . . . . . . . . 617 6,615 87.3 91 1,249 95.8 138 1,661 95.3

54 Under 280 . . . . . . . . . . . . . . . . . . . 639 6,854 90.4 91 1,249 95.8 141 1,905 97.5

55 Under 290 . . . . . . . . . . . . . . . . . . . 657 6,987 92,2 92 1,268 97.2 141 1,905 97.5

56 Under 300 . . . . . . . . . . . . . . . . . . . 674 7,099 93.7 93 1,284 98.5 142 1,914 98.0

57 Under 320 . . . . . . . . . . . . . . . . . . . 703 7,330 96.7 94 1,304 100.0 144 1,946 99.6

58 Under 340 . . . . . . . . . . . . . . . . . . . 716 7,438 98.1 94 1,304 100.0 145 1,953 100.0

59 Under 360 . . . . . . . . . . . . . . . . . . . 721 7,503 99.0 94 1,304 100.0 145 1,953 100.0

60 Under 380 . . . . . . . . . . . . . . . . . . . 721 7,503 99.0 94 1,304 100.0 145 1,953 100.0

48
Table 16. Cumulative percent distribution of serum cholesterol levels of woman, according to race and age, and numbar of examined persons

and estimatad population: Unitad Statas, 1976-80—Con,

Age—Con.

35-44 years 45-54 yeers 55-64 years 65-74 yeers

Number Estimated Number Estimated Number Estimated

of

Number

population Cumu- Of

Estimated

population Cumu- Of population Cumu- Of population Cumuexamined in [ative examined in Iative examined in Iative examinad in Iative

persons thousands percent persons thousands percent parsons thousands percent parsons thousands percent

103

1

1

5

11

28

53

68

83

85

88

91

92

97

99

99

101

102

102

102

1,415

10

10

68

150

387

753

951

1,175

1,198

1,227

1,262

1,273

1,356

1,376

1,376

1,396

1,406

1,406

1,406

100.0 100

0.7

0.7 2

4.8 3

10.6 7

27.4 14

53.2 26

67.3 44

83.1 60

84.7 70

86,7 74

89,2 76

90.0 80

95.8 84

97.3 88

97.3 92

98.7 96

99,4 97

99.4 98

99.4 98

1,215

18

27

71

173

296

507

720

850

911

941

996

1,055

1,093

1,135

1,171

1,185

1,198

1,198

100.0 135

1,5

2,3

5.8 2

14.2 13

24.4 27

41.7 44

59.3 72

69.9 87

75.0 97

77,4 100

82.0 102

86.8 106

89.9 111

93.4 116

96.3 126

97.5 130

98.5 133

98.5 133

959

10

71

149

296

513

595

650

661

674

699

729

752

824

873

922

922

100.0

1.0

7.4

15.5

30.9

53.5

62.0

67.8

69.0

70.3

72.9

76.0

78.4

85,9

91.0

96,2

96.2

152 733

2 8

2 8

2 8

3 12

11 45

28 121

50 225

75 378

92 449

105 514

107 523

114 561

120 590

126 616

132 638

142 690

148 716

149 719

149 719

100.0 41

1.0 42

1.0 43

1.0 44

1,7 45

6.2 46

16.6 47

30.7 48

51.6 49

61.3 50

70.1 51

71.4 52

76.6 53

80.5 54

84.1 55

87.1 56

94.1 57

97.7 58

98.2 59

98.2 60

49
Appendixes

Contents

I. Statistical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Survey design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonresponse bias. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Imputation process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Measures ofvariability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analytic methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. Datapresentation and reliability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111. Definitions ofdemographic and socioeconomic terms . . . . . . . . . . . . . . . . . . . . . . .

List of appendix tables

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

. . . . . . .

. . . . . . .

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

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

. . . . . .

. . . . . . .

I. Sample size and responseratesfor the secondNationalHealth and Nutrition Examination Survey,by age, sex, andrace:

United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Percent ofmissing values forsemm cholesterol byage:United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

III. Mean serum cholesterol levelsof adults and standard errors of the means by sex, age, and imputation criteria United

States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51

51

51

52

53

53

53

54

55

57

58

52

53

54

50
Appendix I

Statistical notes

Survey design

The second National Health and Nutrition Examination

Survey (NHANES II) utilized a stratified, multistage design

that provided for the selection of samples at each stage with a

known probability. In hierarchical order, the stages of selection

were primary sampling units (PSUs—a PSU is a county or a

small group of contiguous counties), census enumeration districts (EDs), segments (a segment is a cluster of households),

households, and sample persons.

NHANES II is based on a subset of the sample PSUS in

the National Health Interview Survey (NHIS).32 The selfrepresenting PSU’s in NHIS were first split along county

boundaries. Within each region, each of the counties was classified as being either a self-representing or a non-self-representing PSU. The PSUS that were non-self-representing were

fimther combined into homogeneous classes or strata equal in

size to the NHIS strata containing non-self-representing PSUs.

The effect of subdividing the 156 self-representing PSUS

in NHIS and redefining the PSUS by using county boundaries

resulted in a total of 397 PSU’s, of which 198 were defined as

self-representing and 199 were defined as non-self-representing.

The latter were used to form 43 non-self-representing strata,

which were combined with the other 220 non-self-representing

PSU’S in NHIS. The average population of a self-representing

PSU was reduced from 838,000 to 584,000. The average size

of these PSU’s was reduced more than 60 percent in area, from

2,185 to 855 square miles.

These 461 first-stage units (redefined from NHIS strata)

were further stratified into a total of 64 superstrata, and one

PSU was selected from each of the superstrata using a modified Goodman-Kish controlled selection technique.33 These 64

PSUS represented the geographic locations visited by the

mobile examination centers during the survey period.

The U.S. Bureau of the Census had the major responsibility

for selecting households and sample persons within each of the

PSU’S. Three sampling frames of housing units were used to

select the sample within each of the PSUS. The list frame

consisted of all housing units based on the 1970 census of the

population.32

In the second stage, EDs within each stratum were selected

proportional to their size. An ED is a geographical area that

contains approximately 300 housing units. To oversimple persons with low incomes, the ED’s within each PSU were stratiNOTE: A list of references follows the text

fied into poverty and nonpoverty strata. The poverty strata

contained ED’s with 13 percent or more of persons below the

poverty level, and the nonpoverty strata contained ED’s with

less than 13 percent of persons below the poverty level as determined by the 1970 census. The third stage of the design

consisted of the selection of clusters of households (segments)

within EDs. To ensure sampling reliability, clusters of 16 listed

addresses were drawn from the sampling frames and then systematically subsampled at a rate of one out of two to produce a

final segment of eight household address listings. At the fourth

stage of sampling, a list of all eligible sample persons was made

within each selected segment. The sample of persons to be

examined was selected so that the younger and older age groups

were oversampled and so that approximately one person per

sample household was selected.

The sampling rates by age are as follows:

Age Rate

6months–5 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . 3/4

6–59 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/4

60-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3/4

Of the 27,801 persons included in the NHANES II sample,

25,286 (91 percent) were interviewed, and 20,322 (73. 1

percent) were interviewed and examined. The NHANES H

sample size and response data by age, sex, and race are shown

in table I. The number of examined persons and population

estimates are shown in each detailed table.

A more complete description of the sample survey design

is included in Vital and Health Statistics, Series 1, No. 15.10

Estimation procedures

Because the design of NHANES is a complex, multistage

probability sample, national estimates are derived through a

multistage estimation procedure. The procedure has three basic

components: (a) inflation by the reciprocal of the probability of

selection, (b) adjustment for nonresponse, and (c) poststratification by age-sex-race. A brief description of each component

follows.

Inflation by the reciprocal of the probability

of selection

The probability of selection is the product of the probabilities of selection from each stage of selection in the design—

PSU, segment, household, and sample person.

51
.—

Table 1. Sampla size and response rates for the second National Health and Nutrition Examination Survay, by age, sex, and rata:

Unitad Statas, 1976–S0

Irrterview arrd examination status

Sample

Age, sex, and race size lrrterviewedl Examined

Number Percent Number Percent

Total .,, , .,, .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27,801 25,2S6 90.95 20,322 73.10

Age

444

4,625

2,085

2,438

2,713

3,031

2,236

2,149

3,868

4,212

431

4,445

1,963

2,304

2,537

2,773

2,005

1,866

3,330

3,632

97.07

96.11

94,15

94,50

93.51

91,49

89,67

86.83

86.09

86.23

356

3,762

1,725

1,975

2,054

2,237

1,589

1,453

2,556

2,615

80.18

S1.34

82.73

81.01

75.71

73.80

71.06

67,61

66.08

62.09

Sex

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,395 13,122 91.16 10,339

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

71.82

13,406 12,164 90.74 9,983 74.47

Race

White. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,537 21,350 90.77 17,105

Black, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

72.67

3,653 3,389 92.77

Other, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,763 75.64

611 547 89.53 454 74.30

lCompleted medical histoty interview,

Adjustment for nonresponse

The estimates are inflated by a multiplication factor that

brings estimates based on examined persons up to a level that

would have been achieved if all sample persons had been examined. The nonresponse adjustment factor was calculated by

dividing the sum of the reciprocals of the probability of selection

for all selected sample persons within each of five income

groups (under $6,000, $6,000-$9,999, $10,000-$14,999,

$15,000-$24,999, and $25,000 and over), three age groups

(6 months-5 years, 6-59 years, and 60-74 years), four ge~

graphic regions, and within or outside standard metropolitan

statistical area by the sum of the reciprocals of the probability

of selection for examined sample persons in the same income,

age, region, and standard metropolitan statistical area groups.

The percent distribution of the nonresponse adjustment factors

is as follows:

Percent

Size of factor distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

l,OO–l .24 . . . . . . . . . . . . . . . . . . . . . . ,., ..., 26.8

1.25–1 .49....,,,.....,,,,.,.,,, 54.8

1.50-1 .74. , . . . . . . . . . . . . . . . . . . . 10.9

1.75–1.99 . . . . . . . . . . . . . . . . . . . . . . ,., .,,, 4.4

2.00–2.49 . . . . . . . . . . . . . . . . . . . . . . ,. ..,,, 2.2

2.50 -2,99 .,, , . ., . . . . . . . . . . . . . . . ...,,. 0.9

Poststratification by age-sex-rata

The estimates of the number of examined persons were

ratio adjusted within each of 75 age-sex-race cells to independent estimates, provided by the U.S. Bureau of the Census,

of the population as of March 1, 1978, approximate midpoint

of the survey. The ratio adjustment used a multiplication factor

in which the numerator was the 7U.S. population and the denominator was the sum of the weights adjusted for nonresponse

for examined persons. This ratio estimation process brings the

population estimates into close agreement with U.S. Bureau of

the Census estimates of the civilian noninstitutionalized population of the United States and, in general, reduces sampling

errors of NHANES II estimates.

Nonresponse bias

In any health examination survey conducted in a manner

similar to NHANES, there exists the potential for three levels

of nonresponse: (a) household interview nonresponse, (b) examination nonresponse, and (c) item nonresponse. Household

interview nonresponse occurs when the household medical

history questionnaire is not completed. Examination nonresponse occurs when those sample persons who respond to the

household questions do not come to the examination center for

an examination. Item nonresponse results when sample persons

do not complete some portion of either the household interview

questionnaires or the examination protocol or when the vial is

lost or destroyed after completion of the examination. Intense

efforts were undertaken during NHANES II to develop and

implement procedures and inducements that would reduce all

types of nonresponse and thereby reduce the potential for bias

in the survey estimates. These procedures are discussed in the

Plan and Operation of the second National Health and Nutrition

52
Examination Survey, 1976-1980, Vital and Health Statistics,

Series I, No. 15.10

In NHANES II there was a9-percent (table 1) medical

history interview nonresponse and, despite the intense efforts

toreduce thenumber ofexamination nonrespondents, 27 percent (table I) of the 27,801 persons selected for NHANES II

were not examined. However, a comparison of the 1976 National Health Interview Survey (NHIS) and NHANES 1134

suggests that there is not a large nonresponse bias in some

health-related variables because of the close agreement on

selected interview items in NHANE S II data with comparable

items in the 1976 NHIS data. The 1976 NHIS data were used

for the comparison because that survey included questions on

diabetes (of interest in NHANES 11) and because the nonresponse was 4 percent. It was assumed that the 4-percent nonresponse was randomly distributed.

Data from earlier studies also suggest no substantial nonresponse bias. An analysis of data on examined and nonexamined (but interviewed) persons was done using the first 35

stands of NHANES 1.3sIt was found that the two groups were

similar with respect to health characteristics being compared.

In another study of examined and nonexamined persons selected for participation in NHANES I, no differences were

found between the two groups with respect to health-related

variables. 36 In another study,37 factors relating to response in

Cycle I of the National Health Examination Survey of 1960-

62 were investigated. It was found that 36 percent of the nonexamined persons in that survey viewed themselves as being in

excellent health compared with 31 percent of examined persons. A self-appraisal of being in poor health was made by 5

percent of nonexamined persons and by 6 percent of those who

were examined.

In a different study of Cycle 1,38comparisons between two

extreme groups, those who participated in the survey with no

persuasive effort and those who participated only after a great

deal of persuasive effort, 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 there is little bias introduced

into the findings because of differences in health characteristics

between examined and nonexamined persons. As shown in

table I, there are differentials in response rates by agq however,

the number of interviewed and examined sample persons was

poststratified to the U.S. Bureau of the Census population to

account for such differences.

Missing data

Examination surveys are subject to a loss of information

not only through the failure to examine all sample persons, but

also from the failure to obtain and record all items of information for examined persons. This item nonresponse is the second

level of nonresponse, The percent of missing values for serum

NOTE: A list of references follows the text.

cholesterol in NHANES 11 is given in table II. The missing

data are the result mostly of such things as loss of blood in

shippin% broken equipmenl and laboratory values out of quality

control limits. The missing serum cholesterol values were

imputed.

Imputation process

The 272 missing serum cholesterol values were imputed

using a “hot deck” procedure. 39 The variables used in the imputation process were age, sex, and hormone/birth control pill

use. Because less than 1 percent of males in NHANES II were

taking hormones, the hormone variable was not used for imputing the missing values for males. Consequently, for males

the variable used in the imputation process is age and for

females the variables are age and birth control pill use.

The serum cholesterol file for males was sorted by age.

The serum cholesterol file for females was divided into those

who did and did not use the pill, then each file was sorted by

age. When a missing cholesterol value was encountered, the

preceding sample person’s value was substituted. If there were

consecutive missing values, an iterative process was used to

assure that the preceding value was substituted only once.

Table 111shows that there was virtually no effect of imputation

on the means and standard errors of the means. The process

was done to complete the tile. However, when comparisons are

made among data from the first National Health Examination

Survey, NHANES I, and NHANES II, the hormone variable

in NHANES 11 was not used in imputing missing values for

women because such data were not available in the first National Health Examination Survey.

Age adjustment

The age-adjusted means and percents presented in this

report were calculated by the direct method and were adjusted

to the age distribution of the civilian noninstitutionalized pop

ulation in the United States at the midpoint of NHANES II

using a computer program. ‘-42 Because age distributions dfier

by sex and race, comparisons are made using age-adjusted

values. Age-adjusted data for sex and race groups can be compared directly because the values assume identical age distributions for all subgroups. These adjusted or standardized values

are meaningful only when comparing subgroups of the population to control for confounding by age.

Table II. Percent of missing values for aertsmcholesterol by age:

Unitad States, 1976-80

Age Examined persons Missing values

Number Percent

20-74 years . . . . . . . . . . . . . .

11,864 2.3

20-24 yeara. . . . . . . . . . . . . . . 1,414 2.5

25-34 years..,...,.,,..,.. 2,237 2.1

35-44 years, . . . . . . . . . . . . . . 1,589 2,2

45-54 years, . . . . . . . . . . . . . . 1,453 1,5

55-64 years . . . . . . . . . . . . . . . 2,556 2.3

65-74 years, . . . . . . . . . . . . . . 2,615 2.8

53
Tabla II1. Mean serum cholesterol levels of adults and at.mdarderrorsOf the means by aex age, and hnputationcriteria:United Statea,

1976-SO

Mean Standard ernw of meanl

Sample

With Without With Without size for

imputed imputed imputed imputed

Sex and age

imputed

values values values values velues

Msle

20-74 years..,,....,...,..,.. . . . . . . . . . ,.,

Female

20–74 years, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

211

180

199

217

227

229

221

215

184

192

207

232

249

246

211

180

199

217

227

229

222

215

184

192

207

232

246

246

1.1

1.6

1.6

2.1

1.8

1.8

1.9

1.2

2.0

1,4

l.q

2.2

2.0

1.7

1.1

1.7

1.6

2.1

1,8

1.9

1.9

1.2

2.0

1.5

1,9

2.2

2.0

1.7

127

18

26

18

8

22

35

145

18

22

17

14

36

3s

lEstlmates of standard errors were generated using the balanced repeared replicatmn technique.

Measures of variability

Because the statistics presented in this report are based on

a sample, they may differ from the figures that would have been

obtained if a complete census had been taken using the same

survey instruments, instructions, interview and examination

personnel, and procedures. The probability design of this survey

permits the estimation of standard deviations and errors although

the techniques must take the highly clustered, multistage prob

ability sample design into account. The reader should be aware

that estimates of variances and standard errors from this type

of design are different from and generally larger than standard

errors calculated under the assumption of simple random

sampling.

Standard deviations

The standard deviation is a measure of the dispersion of

the observations in a population and is usetld in describing the

width of the distribution of the values in a population. This

measure can usually be estimated from a probability sample.

As estimated in thk report, the standard deviation also reflects

part of the variation that arises in the measurement process. If

the values follow a normal (that is, Gaussian) distribution (as

the cholesterol values do) in a population, then one standard

deviation above and below the mean encompasses approximately 68 percent of the distribution two standard deviations,

about 95 percent and 2?4 standard deviations, about 99 percent.

The estimates of standard deviations presented in the detailed tables were calculated using the pseudoreplication method,

a balanced half-sample replication technique that is based

upon variability among random subsamples of the total sample

taking into consideration the complex survey design.43-45

Standard errors of estimated means

The standard error of an estimated mean is primarily a

measure of the degree to which estimates, derived from the

many different samples that a sampling design might yield,

would vary from sample to sample. As calculated for this repo~

the standard error also reflects part of the variation that arises

in the measurement process. The possible bias of estimates is

not included.

As discussed by Landis, Lepkowski, and others,4b assuming independence of estimated statistics (zero covariance) can

be misleading, especially when analyzing data from complex

sampling designs. However, because covariances are not presented in this report, and because some users may not have

data tapes to generate covariances, an approximation could be

made by using the simple Z-test for hypothesis testing. This

test will be conservative if the covariances are positive,

Estimates of the standard errors of the means or percents

used in this report are shown in each detailed table. The standard errors of the differences (assuming independence of the

estimated means and percents) for constructing the Z-statistic

can be calculated as follows: Let sl and Sz be the estimated

standard errors of two subdomain means jl and ~2. Let d =

JI – Jz be the estimate of the difference between the two sub

population means. The standard error of ~ assuming

Cov(jl , J*) = o

is estimated by

‘a=-

Thus,

NOTE: A list of references follows the text.

54
The user is reminded that the method discussed in the next

section, however, is preferred to the above statistic for hypothesis testink because it incorporates covariances between sub

population sample means and could lead to dtierent conclusions

about the statistical significance of a difference.

The standard errors of the means and percents were calculated using the first two terms of a Taylor series expansion.m

If the higher order terms of the expansion are negligible and the

sample is of a reasonable size for the domains of interest then

this approximation provides variance estimates as reliable as

those from the pseudoreplication method.45

The need for the balanced repeated replication or linearization technique for estimating standard errors arises because

of the complexity of NI-lANES II sample survey design. It

should be noted that the estimates of standard errors are themselves subject to errors that maybe large if the number of cases

is small or if the number of strata with observations in both

paired PSUS is small. The estimated standard errors do not

reflect any residual bias that might still be present tier the

correction for nonresponse. (See appendix IL)

Anal@c methodology

Observed differences in the mean serum cholesterol levels

and in the prevalence of elevated serum cholesterol levels by

demographic and socioeconomic variables were tested for statistical significance. The method used to test differences is presented below. For the demographic variables, the effects of age

and race were nested within sex. The effects were modeled in

this manner because preliminary investigation showed interaction between sex and age in relation to serum cholesterol

levels. The oral contraceptive use variable as well as the socioeconomic variables (poverty index defined by two categories

(a) income at or above, or below poverty level and (b) educational level defined as less than 12 years and at least 12 years)

were nested within age and race.

For the most part, the following age categories were used

20-24, 25-34, 35-44, 45-54, 55-64, and 65-74 years.

When sample sizes for the above age groups were small, the

data were collapsed into the following age categories: 20-44,

45-64, and 65–74 years. The orai contraceptive analysis was

limited to women in the childbearing ages 20–44 years.

The analytic approach used was developed by Koch Freeman, and Freeman,41 and Freeman, Freeman, Brock, and

Koch.42 This approach has been used previously to analyze

NHANES data.4b’47A model for the mean difference between

educational levels with]n race and age using three age groups,

20-44, 45-64, and 65-74 years, will be used to illustrate the

approach. Assuming that the effects of age, race, and educ~

tional level on mean serum cholesterol can be expressed as a

linear combination of unknown parameters plus error terms,47

the full model can be expressed in matrix notation as

Y= X~+e (1)

where

Y=(j,,,, y112,. . .. YuY322)322) (2)

NOTE: A list of references follows the text

represents the vector of 12 subpopulation means for serum

cholesterol and

~1 if age is 20-44 years

1

i = 2 if age is 45-64 years

3 if We is 65-74 years

I

. = 1 if race is white

J

2 if race is black

k

I

= 1 if educational level is less than 12 years

2 if educational level is 12 years or more

The design matrix X, used to model the effects of age, race,

andeducational level, is as follows:

Age Race Education

~~~

—1100001000 oo—

11000000000 0

11010001000 0

11010000000 0

10100000100 0

x= 10100000000 0

10101000010 0

101,01000000 0

10000000001 0

10000000000 0

10000100000 1

—1000010000 oo—

The model parameters $ in equation(1) are estimated, using

weighted least squares, as

b=(X’V-l~-lll-lJf’y (3)

where

V-’ = a consistent estimate of the population variancecovanance matrix48-52

b =(/+, b2, . . .. b12)

bl = a baseline figure for the second educational sub

group for white persons in the last age category

b2,b3 = the weighted least squares estimates of differential age effects for the first and second age groups

b4 b~,b6 = the weighted least squares estimates of differential race effects nested within each of the three

age groups

b77”””9 b12= the weighted least squares estimates of differential educational effects nested within race and

age groups

55
Then, based on the full model of equation(1), with estimated

parameters (3), the sample means can be expressed as follows:

For example, as a first step in reducing the full model of

equation (1), it is of interest to see if each of the educational

effects is equal to zero. These individual hypotheses are then

~1]1=b1+lJ2+b7

HO:~i=O i=7, . . ..l2

jl** =b, +b2

which can be expressed, in general form, as

Thus. for

E$:f+=o

C=[oooooolooo 00]

For example, >1,, is the baseline figure plus effect for ditTerence

between first and third age group plus effect for difference between first and second educational group within the white,

20–44 years of age subpopulation group.

In this analysis, the ultimate objective could be the development of a parsimonious model that tits the data yet adequately represents the true variation displayed by the dat% that

is, a reduced form of the full model. The full model can be

reduced by examining the estimated parameters and determining

which parameters, when sampling and other variation are taken

into consideration, are not significantly different from zero.

The reduced model is then a more concise and easily recognized

representation of the true differences present in the data.

If all individual hypotheses

~:pi=o ;=7 ,...,12

are not significant, then all educational effects can be removed

from the model and the reduced model for mean serum ch~

lesterol level will contain parameters for age and race effects

only. Age and race effects in the reduced model can then be

tested in a similar fashion. When the model has been reduced

to its simplest form, the conclusions drawn on the reduced

model would be similar to those obtained from the original

data.

56
Appendix II

Data presentation and

reliability

The estimates in this report numerically describe the distribution of serum cholesterol values in certain population

groups. Among the descriptive measures are means (simple

and age adjusted), percentiles, percent-prevalence rates, and

cumulative percent distribution.

The mean value for a population group is the sum of each

value times its weight in the group divided by the sum of the

weights for that group. Age-adjusted means assume that each

group has the same age distribution thus adjusting for the effect

of age and allowing comparison of combined mean values

among population groups.

A percentile is a value that indicates the percent of people

in a population with a value less than or equal to the percentile

value. The prevalence rate for a population is the proportion of

persons believed to be at risk for a particular condition or disease in the population or who exhibit the condition of disease

or risk characteristic at a given time.

Finally, the cumulative percent distribution describes the

percent of the population with values less than or equal to certain arbitrary benchmark values, thus allowing readers to

choose their own cutoff points in estimating the prevalence of

persons with elevated cholesterol.

Estimates of two additional measures are presented in this

report. One is the standard deviation, which estimates the degree to which values vary in a population. A large standard

deviation indicates that the distribution of values is broad and

flat while a small estimated standard deviation implies a narrow, spiked distribution. The other measure is the estimated

standard error of an estimated sample mean. The standard error

is one measure of the statistical quality of an estimate, with

smaller standard errors generally indicating better estimates.

For further discussion of these measures see appendix I.

The statistical guidelines used in this document for reporting means, standard deviations, standard errors of the means,

and percentiles are as follows:

1. Means

a. If the sample size in the cell was less than 25, then the

value of the estimated sample mean is not reported.

b. If the sample size was 25–44, the sample mean is

reported with an asterisk (*) to indicate that the statistic does not meet the reliability standard.

c. If the sample size was 45 or more, the sample mean is

presented without caveat.

2. Standard deviations and standard errors of the means

3.

a.

b.

c.

If the sample size in the cell was less than 25, no

estimated values for the standard deviation and standard error of the mean are presented.

If the sample size was 25 or more and the observations were distributed among the primary sampling

units (PSU’S) so that fewer than 12 pseudostrata had

observations in both of the paired PSU’S, then the

values are presented with an asterisk to indicate that

the estimate may be unreliable.

If the sample size was 25 or more and the observations were distributed among the PSU’S so that 12 or

more pseudostrata had observations in both of the

paired PSUS, the standard deviation and standard

error of the mean are presented without caveat.

Percentiles

a. The following sample sizes were required for the

presentation of percentile estimates given in this reporb

Sample size Percentile

10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50th

20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25th and 75th

35. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15th and 85th

50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10th and 90th

100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5th and 95th

h If these minimum sample sizes were not mec there is

an asterisk in the cell.

57
Appendix III

Definitions of demographic

and socioeconomic terms

Age. Recorded twice for each examinee: age at last birthday at the time of examination and age at the time of the U.S.

Bureau of the Census interview. The age criterion for inclusion

in the sample used in this survey was defined as age at the time

of U.S. Bureau of the Census interview. The adjustment and

weighting procedures used to produce national estimates were

based on age at the interview. Data in the detailed tables and

text of the report are also shown by age at time of interview.

Race. Observed and recorded as “white,” “black,” or

“other.” Other includes Japanese, Chinese, American Indian,

Korean, Eskimo, and all races other than white and black. Persons of Mexican descent were included with “white” unless

definitely known to be American Indian or of another race.

Blacks and persons of mixed black and other parentage were

recorded as black. When a person of mixed racial background

was uncertain about his or her race, the race of the father was

recorded.

Sex. Recorded as observed by the interviewers.

Annual famiiy income. Determined by asking the respondent to select one of 12 income categories listed on a card

that represented his or her total combined family income for

the past 12 months. Respondents were asked to include income

from all sources such as wages, salaries, Social Security or

retirement benefits, help from relatives, rent from property, and

so forth. Income was not adjusted for inflation over the course

of the survey.

Poverty index. Determined by the Poverty Income Ratio

(PIR). Poverty statistics published in the U.S. Bureau of the

Census reportss3 were based on the poverty index developed

by the Social Security Administration in 1964. (For a detailed

discussion of the Social Security Administration poverty

standards, see references 54 and 55.) Modifications in the definition of poverty were adopted in 1969.56 The standard data

series in poverty for statistical use by all executive departments

and establishments has been sets’

The two components of the PIR are the total income of the

household adjusted for family characteristics (numerator), and

the total income necessary to maintain a family with the given

characteristics on a nutritionally adequate food plansg (denominator). The dollar value of the denominator of the PIR is constructed from a food plan (economy plan) necessary to maintain minimum recommended daily nutritional requirements.

The economy plan is designated by the Department of AgriNOTE: A list of references follows the text

culture for “emergency or temporary use when finds are 10W.”

For families of three or more persons, the poverty level was set

at three times the cost of the economy food plan. For smaller

families and persons living alone, the cost of the economy food

plan was adjusted to account for the relatively higher proportion of expenses that are fixed.

The denominator or poverty income cutoff adjusta the

family poverty income maintenance requirements by the family

size, the sex of the head of the family, the age of the head of the

family in families with one or two members, and the place of

residence (farm or nonfarm), Annual revisions of the poverty

income cutoffs are based on the changes in the average cost of

living as reflected in the Consumer Price Index.

The annual income considered to be the poverty level increases as the family size increases. If a family with any combination of characteristics has been designated as having a PIR

or poverty level of 1.0, then the same family with twice the

income would have a PIR of 2.0. Ratios of less than 1.0 can be

described as “below poverty,” ratios greater than or equal to

1.0 as “at or above poverty.”

Poverty thresholds are computed on a national basis only.

No attempt has been made to adjust these thresholds for regional, State, or other variations in the cost of living (except for

the farm and nonfarm difference). None of the noncash public

welfare benefits such as food stamp bonuses are included in the

income of the low income families receiving these benefits.

PIR has been adjusted by year and accounts in some part for

inflation. Tables of weighted average threshold poverty cutoffs

for 1976 through 1980 have been published.58

Birth control pill. The birth control pill question was

worded as follows:

(a) Have you taken birth control pills during the past 6

months?

Only if the answer to this question was yes, was the sample

person asked

(b) Are you taking them now?

Serum cholesterol values were obtained for 533 females ages

20–74 years who were interviewed as part of the Health History

Supplement of the Medical History for the second National

Health and Nutrition Examination Survey and who answered

“yes” to both questions.

Education level. Only grades attended in a regular public

or private school where persons were given formal education

58
during the day or night, either on a full-time or p~-time basis, system was not counted in determining the highest grade comwere included. A “regular” school advances a person toward pleted. If a person attended school in a foreign country, at an

an elementary or high school diploma or a college, university, ungraded school, under a tutor, or under other special circurnor professional school degree. Education received in voca- stances, the nearest equivalent of his or her highest grade attional, trade, or business schools outside the regular school tended was obtained

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Vital and Health Statistics

series descriptions

SERIES 1.

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SERIES 4.

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the general programs of the National Center for Health

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Data Evaluation and Mathods Research–Studies of new

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

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