Data from the

NATIONAL HEALTH SURVEY

CardiovascularConditions

of Children6-11Years

and Youths 12-17 Years

UnitedStates,1963-1965 and 1966-1970

Prevalence of heart and other circulatory conditions of children and

youths in the United States as determined from standardized examination (diagnostic impression) findings and medical history, by age,

sex, race, geographic region, and socioeconomic background as well

as in relation to other selected findings from the Health Examination Surveys of 1963-1965and 1966-1970.

DHEW Publication No. (PHS) 78-1653

Series 11

Number 166

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

National Center for Health Statistics

Hyattsville, Md. April 1978
/

F’

Library of Congress Cataloging in Publication Data

Roberts, Jean

Cardiovascular conditions of children 6-11 years and youths 12-17 years, LTnited States,

1963-1965 and 1966-1970.

(Vital and health statistics: Series 11, Data from the National Health Survey; no. 166)

(DHEW publication; no. (PHS) 78-1653)

“Prevalence of heart and other circulatory conditions of children and youths in the

United States as determined . . . from the Health Examination Surveys of 1963-1965 and

1966 -1970.”

Includes bibliographical references.

1. Pediatric cardiology-United States–Statistics. 2. Health surveys–United States.

I. Title. II. Series: United States. National Center for Health Statistics. Vital and health

statistics: Series II, Data from the NationaI Health Survey. Data from the health examination survey; no. 166. III. Series: United States. Dept. of Health, Education, and Welfare.

DHEW publication; no. (PHS) 78-1653.

RA407.3.A347 no. 166 [RJ421] 312’.0973s

ISBN 0-8406 -0119-0 [312’.31’00973] 77-18702
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

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

GAIL F, FISHER, Ph. D., Associate Director for the C2roperative Health Statistics System

ELIJAH L. WHITE, Associate Director for Data Systems

JAMES T. BAIRD, JR., Ph.D., Assocrizte Director for International Statistics

ROBERT C. HUBER, Associate Director for Management

MONROE G. SIRKEN, Ph.D., Associate Director for Mathematical Statistics

PETER L. HURLEY, Associate Director for Operations

JAMES M. ROBEY, Ph.D., Associate Director for Program Development

PAUL E. LEAVERTON, Ph. D., Associate Director for Research

ALICE HAYWOOD, Information Officer

DIVISION OF HEALTH EXAMINATION STATISTICS

MICHAEL A. HATTWICK, M.D., Director

PETER V. V. HAMILL, M.D., ChiefMedical Adviser

JEAN ROBERTS, ChieJ Medical Statistics Bratzck

ROBERT S. MURPHY, chie~ Survey Pkmning and Development Branch

COOPERATION OF THE U.S. BUREAU OF THE CENSUS

In accordance with specifications established by the National Center for Health Statistics,

the Bureau of the Census, under a contractual agreement, participated in the design and selection of the sample, and Carned out the first stage of the field interviewing and certain parts of

the statistical processing.

Vital and Health Statistics-Series 1l-No. 166

DHEW Publication No. (PHS) 78-1653

Library of Congress Catalog Card Number 77-18702
CONTENTS

ktroduction .............................................................................................................................................. 1

Data SoUces .............................................................................................................................................. 2

Medical History ................................................................................................................................... . 2

Physical Examination ........................................................................................................................... 3

Qtilty Control .................................................................................................................................... 5

Rntin& ..................................................................................................................................................... 5

&nerd Pretience ..................................................................................................... .......................... 5

Me&cd Hlsto~ .................................................................................................................................... 6

Examination ......................................................................................................................................... 7

Medicrd H]stoW.E=tination ............................................................................................................... II

Demographic-Socioeconomic Trends .................................................................................................... 12

Comparison With Other Studies ................................................................................................................. 13

Summary ................................................................................................................................................ ... 15

References ................................................................................................................................................. 17

List of Detailed Tables ............................................................................................................................... 18

Appendixes

I. Statistical Notes ........................................................................................................................... 35

II. Demographic and Socioeconomic Terms ...................................................................................... 40

111, Medical History and Physical Examination Forms ........................................................................ 42

LIST OF TEXT FIGURES

1. Prevalence rates for cardiovascular condhions, all types and congenital, from examination diagnostic

. .

ImpressIons among cluldren m 1963-1965 and youths m 1966-1970, by age: Uruted States .............. 6

2. prevalence rates for cardiovascular conditions from examination and history (from parent) among

. .

chrldren m 1963-1965 and youths m 1966-1970, by age: Umted States..,, ........................................ 6

3. Percent distribution of youths age 12-17 years with significant cardlovascuhr conditions from diagnostic impression, by type of condition: United States, 1966-1 97 O................................................... 9

4. Percent of children in 1963-1965 and youths in 1966-1970 with point of maximum impulse of heart

felt at 4th, 5th, and 6th interspace, by age: United States ................................................................. 10

5. Percent of children in 1963-1965 and youths in 1966-1970 with point of maximum impulse of heart

felt at, inside, or outside the midclavicular line, by age: United States............................................... 10

6. Mean systolic and diastolic blood pressure among children in 1963-1965 and youths in 1966-1970

with normal and abnormal cardlovascukr diagnostic impressions from examination, by age: United

States..................o.......................4...................................................................................................... 11

7. Pr@ence rates for cardiovascular conditions from examination amongaflchiidrenage6-11 years in

1963-1965 and youths age 12-17 years in 1966-1970 and by parents’ ratings of their present health

status: United States.......................................................................................................................... 11

...

Ill
8. Prewdence rates for cardiowscular conditions from examination among all youths age 12-17 years

and by parents’ and Youths’ ratings of present health status: United States, 1966-1970 .................... I I

9. Prevalence rates for cardiovascular conditions from examination among boys and girls age 6-17 years

by parents’ rating$ of present health status and among youths age 12-17 years by self-rating of

present health status: United States, 1963-1970 ................................................................................ 12

LIST OF TEXT TABLES

A. Diagnostic impression regarding cardiovascular flmdmgs among youths age 12-17 years from regular

and replicate examinations: Health Examination Survey, 1966-1970 .............................................. 5

B. Percent of children age 6-11 years with or without—.a cardiovascular condition from diagnostic impression, by cardiovascular findings on examination: United States, 1963-1965

_.— —

............................. 8

SYMBOLS

Data not available —.—. . .

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

Quantity zero—-————— .

Quantity more than Obut less thah 0.05-— 0.0

Figure does not meet standards of

reliability or precision -_.-—.—.— *

I I

iv
CARDIOVASCULAR CONDITIONS

OF CHILDREN AND YOUTHS

Jean Roberts, Division of Health Examination Statistics

INTRODUCTION

This report presents estimates of the prevalence of heart and other circulatory conditions,

known and previously unknown, of children and

youths age 6-17 years in the noninstitutionalized

population of the United States. These are based

on diagnostic impression data from the direct,

standardized examination findings of the Health

Examination Surveys among national probability samples representative of the 23.8 million

children age 6-11 years in 1963-1965 and of the

22.7 million youths age 12-17 years in 1966-

1970. Findings are analyzed by age, sex, race,

geographic region, urban-rural residence, annual

family income, and in relation to some other

findings from the medical history and the

physical examination.

The Health Examination Survey is one of

the major programs of the National Center for

Health Statistics authorized through the National Health Survey Act, of 1956 for the

determination of the. health status of the population as a continuing Public Health Service

responsibility.1

The principal health survey programs of the

National Center for Health Statistics include the

Health Examination Survey, Health Interview

Survey, Health Manpower and Facilities surveys,

and Health Resources Utilization surveys, in

addition to those of Vital Statistics. The Health

Interview Survey, which collects health information from samples of people by household

interview, primarily studies the impact of known

illness and disability on the lives of people. The

Health Manpower and Facilities programs obtain

information through surveys of hospitals, nursing homes, other resident institutions, and the

entire range of personnel in the health occupations. The Health Resources Utilization surveys

obtain information on the extent of health

facility and serwce utilization. In the Health

Examination Survey, data are collected by

means of direct physical examinations, tests, and

measurements performed on carefully selected

nationwide probability samples of the population. This latter system, in addition to providing

the most efficient way of obtaining actual.

diagnostic data on the prevalence of specified

medically defined illness, is the only one of the

survey programs to secure information on unrecognized or undiagnosed conditions as well as on

a variety of physical, physiological, and psychological measures within the population. Medical

hktory, demographic, and socioeconomic data

are also obtained on the sample population

under study, making possible the interrelation of

these data with the examined findings for those

examined.

The Health Examination Survey is planned

as a continuous series of separate programs

called “cycles.” Each cycle is limited to certain

aspects of health within specified segments of

the U.S. population. The first cycle in 1960-1962

was designed primzmly to provide data on the

prevalence of certain chronic diseases and on the

distribution of various physical and physiological measures in a defined adult population.z,3

This report is based on findings from the

two programs of the Health Examination Survey

1
that followed the first cycle. For the second

cycle (1963-1 965), a probability sample of the

noninstitutionalized children 6-11 years of age

in the United States was selected and examined.

In the third cycle (1966-1970), a similarly

designed probability sample of the noninstitutionalized youths 12-17 years of age in the

United States was selected and examined. The

two programs were developed to obtain basic

measures of growth and development as well as

data on other health characteristics for the

entire continuum of childhood through adolescence. The questionnaire and examination content and procedures were specially designed for

each of the two age groups, taking into account

the differences in the health, mental, and behavioral characteristics of children and youths.

The examinations include those given by a

pediatrician who was assisted by a nurse, those

given by a dentist, tests administered by a

psychologist, and a variety of tests and measurements by laboratory X-ray technicians. The

survey plan, sample design, examination content, and operation of these surveys have been

described in previous reports.A>s

Field collection operations for the children’s

cycle started in July 1963 and were completed

in December 1965. Of the 7,417 children

selected in the sample, 7,119,or 96 percent,

were examined. This national sample closely

represents the 23.8 million noninstitutionalized

children 6-11 years of age in the United States

with respect to age, sex, race, geographic region,

population size of place of residence, and rate of

population change in size of place of residence

from 1950 to 1960.

In the youths’ cycle, data collection began in

March 1966 and was completed in March 1970.

For this program, 7,514 youths were selected in

the sample, and 6,768, or 90 percent of them,

were examined. This national sample closely

represents the 22.7 million noninstitutionalized

youths 12-17 years of age in the United States

with respect to the same characteristics as those

indicated for the children’s survey. The sample

design for the youths’ survey provided for use of

the same sampling areas and housing units used

in the preceding survey among children. As a

result, nearly one-third of the youths in that

study had previously been examined in the

children’s survey. The time lapse between the

two examinations ranged from 28 months to 5

years; median time lapse was about 4 years.

In each of these survey programs, examinations were conducted consecutively in 40 different locations throughout the United States.

During the single visit, each child or youth was

given a standardized examination by the examining team in the mobile units specially designed

for use in the survey. During the third cycle only,

girls whose urine specimens were found to have

bacteria on culture were brought back for repeat

urine tests. Prior to the examination, demographic and socioeconomic data on household

members as well as medical history, behavioral,

and related data on the child or youth to be

examined were obtained from the parents. In

addition, a Health Habits and History form

(appendix III) was also completed by the youth

before he arrived for the examination and a

Health Behavior form was completed by him

while in the examination center. Ancillary data

were requested from the school attended by the

child or youth which included grade placement,

teacher’s rating of behavior and adjustment, and

health problems known to the teacher. A birth

certificate was obtained for each child and

youth to verify age and to obtain information

reIative to condition at birth. Statistical notes on

the sample design, reliability of the data, and

sampling and measurement error are shown in

appendix I.

DATA SOURCES

Medical History

Children.–At the time of the initial visit to

the sample household, an interviewer from the

U.S. Bureau of the Census left with the parents a

self-administered Medical History form (appendix III) for each eligible child. This form was

picked up about a week later by the Health

Examination Survey representative, who reviewed it and assisted the parents in completing

any incomplete or inconsistent entries.

The questions from the Medical History

considered in this report were whether the child

ever had rheumatic fever, a heart murmur, or

2
anything else wrong with the heart; whether

exercise is now restricted; whether the child

takes any medication regularly; present health

status; and whether there is anything about the

child’s health that bothers or worries the parent.

Youttzs.–The Medical History for youths

obtained from the parent during the 1966-1970

survey was self-administered. Only the questions

on whether the youth ever had a heart murmur

or anything else wrong with the heart, the most

serious illness if rheumatic fever, present health

status, regular use of medication, and whether

the youth’s exercise was now restricted were

considered in this report.

The Health Habits and History form was left

in the household at the time of the Health

Examination Survey representative’s visit with

instructions that it be completed by the eligible

youth and returned to the survey before the

youth came in for the scheduled examination.

From this questionnaire, the only questions used

were the ones on whether or not the youth’s

exercise was now restricted, present use of

medication, and present health status.

Physical Examination

Children.–The examining physician with the

survey team was either a senior resident or

fellow in pediatrics who had been given special

training in the standardized physical examination used in the survey. The Medical History

filled out at home by the parent or guardian for

each child was available for review on the night

before the examination. Although it was recognized that this might tend to bias the examiner’s findings, information was needed at the

outset both regarding limitations in the child’s

ability to perform any of the tests or procedures

in the examination and regarding conditions

which might require further followup during the

examination. The examination was done according to predetermined standardized procedures;

there was no subsequent examination to clarify

the initial diagnostic impression.

The purposes of the physical examination

were: (1) to identify exarninees considered

normal within the limitations of this exwination; (2) to detect acute conditions which might

affect other parts of the examination; (3) to

identify, i&ofar as possible, examinees with

heart disease and neurological, muscular, and

joint conditions, the major results of accidents or

injuries, and observable congenital malformation; and (4) to detect fever, asthma, epflepsy,

and any other condition the examining pediatrician considered a contraindication to exercise.

The physician recorded his findings based on

his own best judgment and medical skill, without attempting to “compensate” for lack of

t-ollowup. As a result, the cases that were

“overdiagnosed” (relative to what might be

revealed by more followup evaluation) may have

been to some extent offset by cases that were, in

the same terms, “underdiagnosed.”

Included in the pediatrician’s examination

was an assessment of the general appearance of

the child with respect to tics, mannerisms, and

physical deformities; tests of the general functioning and other abnormalities of the joints and

muscles; a limited neurological and cardiovascular examination; and an examination of the eyes,

ears, nose, and throat.

The cardiovascular examination included the

pediatrician’s listening for and recording a detailed description of the heart sounds and any

murmurs, innocent as well as significant ones.

The examiner classified these murmurs as “innocent, “ “suspect significant,” or “definite significant.” Only sounds and murmurs supported by

ot$er evidence of abnormality were classified as

“suspect” or “definite significant. ” Examination

protocol specified that innocent murmurs were

to be those which became less audible or

dkappeared completely when the examinee

changed from the supine to the upright position

or during various phases of respiration. Not to

be included in the findings of murmur was a

venous hum—the soft humming sound heard in

the anterior part of the upper chest in systole or

diastole which could be made to disappear or be

slightly exaggerated by changing the position of

the head or by light compression over the

jugular vein.

Thrills were identified, if present, as to

whether evident during systole or dlastole and

whether at the base or apex of the heart. In the

examination, this identification was made by

palpation with the hand and then listening with

a stethoscope over the cardiac area of the chest,

3
first while the examinee was sitting, leaning

forward, and with breath held in full inspiration,

and again later when the child was lying on his

left side.

The point of maximum impulse (PMI) of the

heart beat was determined with the examinee in

the supine position. The examiner recorded the

intercostal interspace at which the PMI was

located and whether within, at, or outside the

midclavicular line.

The nurse routinely obtained an electrocardiogram (EKG), monitored by the physician.

The physician recorded whether the EKG was

normal or abnormal.

The physician also scanned the chest X-ray

taken by the survey technician and recorded

whether or not possible cardiac pathology was

evident.

At the time of the examination, the survey

pediatrician also obtained more specific information from the examinee on known history of

cardiovascular pathology.

The physicmn’s diagnostic impression of

heart disease was recorded together with whether

the condition appeared to be congenital or

acquired and the type of abnormal findings on

which the impression was based—history, thrill,

murmur, EKG, X-ray, or other.

Youth.–The examining physician with the

youth survey team was either a senior resident

or fellow in either pediatrics or adolescent

medicine from selected medical centers, schooIs,

or hospitals, who had been given special training

in the standardized physical examination used in

the survey.

On the day before the scheduled examination, the Medical History of Youth form completed by the parent and the Health Habits and

History-Youth form completed by the youth

were renewed by the examining physician, who

paid special attention to any entries suggesting a

limitation on the youth’s ability to perform any

of the tests or procedures and to items which

might require further followup in the course of

the examination.

The physician’s examination included an

eye, ear, nose, and throat examination, check

for goiter, musculoskeletal and neurological evaluation, cardiovascular examination, grading of

facial acne, assessment of sexual maturation on a

5-point scale, and an appraisal of nutrition.

During the examination, the nurse drew a

sample of blood (later used to determine hematocrit and hemoglobin levels, levels of cholesterol, concentration of uric acid, presence or

absence of syphilis on serological tests, testosterone levels in boys, amounts of protein-bound

iodine, and genotype of blood groups), obtained

the three blood pressure readings (supine before

the examination and in both supine and sitting

positions after the physician’s examination), and

for the female examinees completed the menstrual history questionnaire and colIected a urine

specimen for culture of bacteria.

The cardiovascular examination included

routineIy the listening for heart sounds while the

examinee was sitting and then when supine.

Palpation for thrills and the PMI were performed

with the examinee supine. The examining physician recorded location of the PMI of the heart

with respect to the intercostal interspace and

midclavicular line, the absence or presence of

thrills and, if present, whether those thrills were

systolic or diastolic and whether they were

heard at the base or apex, description of

abnormal first and second heart sounds, description and classification of murmurs as “significant,“ “possibly significant,” or “innocent,” and

description of other abnormal cardiovascular

findings. Electrocardiograms and chest X-rays

were taken routinely and available to the pediatrician for use in making his diagnostic impression, but no separate record was consistently

made of whether the findings for either were

interpreted by him as abnormal, nor was any

routine record made of additiomd information

on known cardiovascular condition obtained at

the time of the examination, as in the record for

children. Hence, it is not possible to determine

among the youth group the extent to which the

diagnostic impression was supported by these

specific findings, as can be done for the children.

However, the mediczd examiners in Cycle III

were specifically asked to make the best possible

decision using all the information available at

this one visit in distinguishing between significant (suspect or definite) and innocent murmurs.

4
Quality Control

To insure skillful examinations by the staff

physician and standardization of observations

among the many different physicians employed

during the course of the survey, two specific

training methods were employed. The senior

medical advisers of the Health Examination

Survey trained the physicians who were to

administer the standardized physical examination. Then during the tirst several days of

examinations at a location where a new staff

physician was in attendance, the senior medical

advisers were present to review procedures, to

perform replicate examinations, and to reduce

to a minimum interobserver variation in the

various components of the physical examination

and reporting.

The proportion of children with significant

cardiovascular findings on examination ranged

from O to 9.0 percent among the 36 pediatrician

examiners in the survey compared with O to

23.5 percent among youths examined by the 41

medical examiners, when the effect of age-sex

differences within each of the two groups is

controlled. Further information on the extent of

examiner variability in the diagnostic impression

data from these two survevs is included in

Table A. Diagnostic impression regarding cardiovascular findings

among youths age 12-17 years from regular and replicate

examinations: Health Examination Survev. 1966-1970

Diagnostic impression–replicate

examination

Diagnostic impres- SignifNo

sion-regu lar exam isignif -

All icant Essen- icant

nation find- cardio- cardio- tially

ings vascular vascular norfind- find- mal

ings ings

I

Number of youths

All findings ........ I 302 II 18 I 49 1 235

Significant cardiovascular findings ........ 16 9 1 6

No significant cardiovascular findings ........ 55 2 33 20

Essentially normal ........ 231 7 15 209

findings from the two examinations was 36

percent (9 of 25 youths with such findings on

both).

FINDINGS

.

appendix I.

Ten to fifteen youths selected at random General Prevalence

from among those scheduled for examination in

the first week, at each of the 40 examination

locations throughout the country were also

scheduled for a repeat examination 2 to 4 weeks

later at the same location and usually by the

same examiner. In all, replicate examinations

were obtained for 302 youths, or 4.5 percent of

all youths examined. Comparison of the findings

(shown in table A) from the original and

replicate examinations during the survey provided the senior medical advisers the basis for

identifying areas in which further quality control or retraining was needed.

Among those 302 youths examined twice,

83 percent (251 of 302 youths) were rated the

same on both examinations-essentially normal,

without significant cardiovascular findings, or

with significant cardiovascular findings. The

level of agreement on significant cardiovascular

Among noninstitutionalized children age

6-11 years in the United States, an estimated 2.4

per 100, or about 570,000, have a significantly

abnormal heart or other circulatory condition

(diagnostic impression). Among noninstitutionalized U.S. youths age 12-17 years, the

corresponding rate is nearly double—4.6 per

100–or more than 1 million with a significant

cardiovascular condition (diagnostic impression)

(table 1).

These national estimates are based on direct

examination findings from the Health Examination Survey of 1963-1965 among a national

probability sample of children and that of

1966-1970 among a national probability sample

of youths. Summary findings from the examination and health histories with comparisons of

the general methods used in the two surveys

have been published.6 More specific information

5
on the protocol for the cardiovascular parts of

the examinations is included in the section

“Data Sources” of this report. The significant

cardiovascular findings are, as indicated, limited

to diagnostic impressions from the single examination without the more detailed examination

or followup that might be needed for a definite

diagnosis. These findings are described in considerable detail so that the reader will have a

basis for understanding the extent of comparability or lack of it between the two examinations.

The trend in the prevalence of cardiovascular

conditions is not consistent across the 6-17-year

age range. The cardiovascular rates are slightly

higher at 6-8 years (2.5-2.8 per 100) than at

9-11 years (2.0-2.3 per 100), then increase

steadily from 2.3 per 100 at 11 years to 5.6 per

100 at 14 years. Among youths, the rates are

consistently nearly double those among children; they range from 3.6 per 100 at 12 years to

5.6 per 100 at 14 and 16 years (figure 1).

Among children , nearly three-fourths (71

percent) of these conditions were considered

congenital; the age-specific proportions range

from 57 percent at 7 years to 80 percent at 9

years but show no consistent age-related trend.

In contrast and possibly indicating differences in

emphasis between the two examinations, among

youths, only 9 percent of these conditions were”

shown as congenital, and the proportions ranged

from 5 percent at 16 years to 12 percent at 14

years.

All zypesP

congenital

and acquired

~

.-. z-------

---

\J Congenital

Figure 1. Prevalence rates for cardiovascular conditions, all types

and congenital, from examination diagnostic impressions

among children in 1963-1965 and youths in 1966-1970, by

age: United States

The prevalence of cardiovascular conditions

is slightIy higher among boys than among girls in

both age groups.

These diagnostic impressions and the distinction between the congenital and the acquired, as

indicated previously, are based on the physical

findings at the time of the examination and the

survey pediatrician’s evaluation of the medical

history of previously diagnosed conditions as

reported by the parent and examinee.

The following sections on findings from the

medicaI history and the examination contain an

assessment of the effect of differences, if any,

between the two studies on these trends.

Medical History

Findings from the medical history, as given

by the parent prior to the examination, show

that the history of ever having had a heart

murmur or something else wrong with the heart

is only slightly higher among youths (4.9 per

100) than among children (4.1 per 100). (See

table 1.) In comparison with present findings

from the examination, the proportion of ch;ldren with historv. of a cardiovascular condition is

nearly twice (71 percent more thfi) the proportion with a significant cardiovascular condition

as determined from the diagnostic impression at

the time of the examination; among youths

these proportions are nearly identical-the rate

from history is only 7 percent greater than that

from the present findings at examination (figure

0)

a

1111 P

// History //----1 l-’ “ J

4

2 *lLinatio.

0/6789101112 131415161716

AGE IN YEARS

Figure 2. Prevalence rates for cardiovascular conditions from

examination and history (from parent) emong children in

1963-1965 and youths in 1966-1970, by age: United

States

6
Similar to the findings at examination

among both children and youths, boys were

slightly more likely than girls to have been

reported by their parents as having a history of

a heart condition.

Information obtained from the medical history on present restriction of exercise for any

reason (only one of which would be a heart

condition) under doctor’s orders, indicates that

among youths, those with a history of cardiac

condition were substantially more likely to be so

restricted than those without such history;

among children, the relationship to the cardiac

history was less marked.

Rheumatic fever, which may impair normal

functioning of the heart temporarily or permanently, was reported on history for 0.6 per 100

children and 0.9 per 100 youths. Such positive

history was about as frequently reported for

girls as boys and shows a general increase with

age from 0.2 per 100 at 6 and 7 years to 1.6 per

100 at age 17.

Among youths whose most serious illness

was rheumatic fever, about one-fourth (28 percent) had the disease before they were 6 years

old and most of the rest had it during the 6-11-

year period (table 2). Nearly all (90 percent) had

received some medical tieatment when they

were sick with rheumatic fever. More than half

(56 percent) were reported to have had an

abnormal response to the streptococcal infection

that left some residual cardiac damage. This

information was not obtained among children.

Examination

Diagnostic findings. –For both children and

youths, the presence and significance of heart

murmurs were recorded by the examining pediatrician. The prevalence of significant or possibly

significant murmurs was greater among children

(3,5 per 100) than among youths (2.4 per 100);

the rates were similar for boys and girls within

each age group (table 3). No consistent trend

with age in this rate across the 6-17-year span is

evident.

In the children’s examination, but not that

for youths, the examiner recorded whether the

EKG and chest X-ray showed evidence of

cardiovascular abnormality and whether the

examinee had a positive cardiac history, so that

it was possible to determine the extent to which

these were used in determining the diagnostic

impression. Among all those age 6-11 years, 4.7

per 100 had positive EKG’s, 3.1 per 100 had

positive chest X-rays, and 6.2 per 100 had

positive cardiac histories. For each, the proportion was slightly higher among boys than girls.

The proportion with history of a cardiac

condition, as determined by the examining

pediatrician after reviewing the medical history

given by the parent and talking with the child

during the examination, is about 50 percent

higher among both boys and girls than when the

determination was made based on parent reports

alone. (See tables 1 and 3.)

‘l’he extent to which these positive findings

were present among those with a diagnostic

impression of a cardiovascular condition among

children is shown in table B. Nearly 80 percent

of children with significant cardiovascular conditions had a significant or possibly significant

heart murmur, more than one-third (38 percent)

had a positive EKG, more than one-fourth (29

percent) had a positive cardiac history, and

about one-fifth (18 percent) had a positive chest

X-ray. The four types of positive findings were

generally absent in children with normal cardiac

diagnostic impressions–the percent ranging from

98.6 percent without murmurs to 96.9 percent

with negative EKG findings.

Among children with significant or possibly

significant murmurs, nearly 42 percent were

considered to be essentially normal, without

significant cardiac pathology; more than threefourths (77 percent) of those children with

positive EKG’s were considered essentially normal, as were 88 percent of those with positive

history and 82 percent of those with positive

chest X-rays.

The recording of the physician in the children’s examination did not permit the identification of specific types of conditions, other than

murmurs, among those with significant diagnostic impressions of cardiovascular pathology, as

could be done for the youths.

In the examination among youths the examining pediatrician recorded a description of

the first and second heart sounds. These sounds

were later classified using the functioned system

described by Leatham,7 McKusick,8 and Nelson.g A further ,grouping of these classified heart

7
Table B. Peicent of children age 6-11 years with or without a cardiovascular condition from diagnostic immession, bv cardiovascular

findings on examination: United States, 1963-1965 -

Cardiovascular finding

All childran in group ....................................................................................................................

Murmur, significant or possibly significant ..............................................................................................

Positive EKG ...........................................................................................................................................

Positive cardiac history at examination ...................................................................................................

Positive chest X.ray .................................................................................................................................

Positiva EKG and chest X-ray .................................................................................................................

Murmur (significant or possibly significant), positive EKG and chest X-ray ............................................

Murmur (significant or possibly significant), positive EKG and history (at examination) .......................

Rheumatic fever history ..........................................................................................................................

Murmur (significant or possibly significant) positive history (at examination) and chest X-ray ...............

Positive EKG, history (at examination), and chest X-ray ........................................................................

Murmur (significant or possibly significant), positive EKG, history (at examination), and chest X-ray ...

NOTE: Figures do not add to 100.0 because of substantial overlap.

sounds was then made following the Eighth

Revision International Classification of Diseases,

Adapted for Use in the United States (ICDA), 10

From this, the prevalence of various types of

cardiovascular conditions among youths as identified in the diagnostic impression was determined. The four principaJ types of significant

heart conditions among more than three-fourths

of the youths were identified as significant

murmurs, hypertension, septal defects (atrial or

ventricular), and symptomatic heart disease

(arrhythmias and heart block), as shown in table

4 and figure 3.

From this (using groupings from the ICDA

classification 0) the estimated prevalence of

hypertensive heart disease among youths was 0.6

per 100 and of rheumatic heart disease 1.0 per

100 (table 3). If the latter group is limited to

those with known history of rheumatic heart

disease, rheumatic fever with some evidence of

heart pathology, or evidence of mitral valve

impairment, the prevalence rate for this type

would be 0.4 per 100.

Cardiovascular

condition–

diagnostic

impression

100.0

79.6

38.4

29.1

18.0

13.4

12.2

8.7

4.7

3.5

2.4

2.4

No cardiovascular condition

(diagnostic

impression)

Cardiac

findings

on

examination

100.0

41.7

77.0

88.4

81.5

. . .

. . .

.-.

.-.

. . .

.-.

. . .

No

cardiac

findings

on

examination

100.0

98.6

96.9

98.3

98.1

. . .

. . .

. . .

. . .

. . .

. . .

. . .

Only about 45 percent of those youths with

a significant cardiovascular condition (from the

diagnostic impression) showed evidence of significant or possibly significant murmur in contrast

to the 80 percent among children (tables 4 and

B). The examining pediatricians in the youths’

study also used EKG, chest X-ray, and history,

in addition to the physical evidence, in making

their diagnostic impressions. However, it was not

possible to determine the extent to which

abnormal findings from each were present

among youths with and without significant

diagnostic impressions of abnormal cardiovascular conditions, as could be done for children.

The shift in the location of the PMI of the

apical thrust or beat of the heart with age across

the 6-17-year age range would be expected to

reflect both normal physiologic development as

well as the earliest possible evidence of heart

enlargement.

In normal development, the heart is situated

somewhat higher in the chest than it is in later

years.T The extent of shift of the PMI from the

8
Significantm.rmurt ...........

{

Hypenemior! ......................

I

AtrM or ventricular

wptal defect ..............

1

Symptomatichaart

dlsema(arrhythmias,

heartblock) ................

1

COnwnltd anomalies

of circulation..................

Rheumaticfeverwith

hewt Involvement ..........

1

Aortlc valvediseate

or stenosis......................

:on~nltal heart

dlseateor anomalies ......

Mitral valveInsufflclency

or stenosis......................

ll.defined heart

dlsetta (cmdiomegaly,

vantr[cularhypertrophy,

chmcpains) ...................

llmaws of mteries

or veln$(dilated arltrles,

varicoseveins)................

)ther hecrt conditlontyPe not speclflcd .........

I I I I

I

o 10 20 30 40 N

PERCENT OF YOUTHS WITH SIGNIFICANT CARDIOVASCULAR CONDITIONS

Figure 3. Percent distribution of youths age 12-17 years with significant cardiovascular conditions from diagnostic impression, by type

of condition: United States, 1966.1970

fourth to the fifth interspace is clearly evident

across the 6-17-year age range (tables 5 and 6

and figure 4). The proportion with the PMI of

the apicaI beat felt in the fourth interspace

generally decreased from 44 percent at age 6

years to 20 percent at age 17 years; the

proportion with PMI felt in the fifth interspace

increased with age among children from 56

percent at 6 years to 70 percent at 11 years; the

proportion with PMI felt in the lowest position, the sixth interspace, generally increased

with age among youfis from 4 percent at age 12

to 11 percent at 15 years of age.

The proportion among whom the PMI of the

apical thrust of the heart was felt outside (to the

left of) the midclavicular line is 3 times as large

among youths as among children, probably

reflecting the greater heart size among the

9
— 4th interspace

---- 5th interspace

-.— 6th interspace

/,-A\

,-----

-----

/

~lL...--.”__,.”

L -*+●= .~e-*-*—*—*

.-i)-

----

.- —,- 0 1

OW7891O11 12 13 14 15 16 17 18

AGE IN YEARS

Figure 4. Percen’t of children in 1963-1965 and youths in 1966-

1970 with point of maximum impulse of heart fait at 4th,

5th, and 6th interspace, by age: Unitad States

youths--although ‘the trend with age is not

consistent across the 6-17-year range (figure 5,

tables 5 and 6).

The true prevalence rates of cardiovascukr

conditions among those with specific diagnostic

findings from the examination and history

among children and youths are shown in table 7.

The prevalence of significant cardiovascular conditions. is highest among those with significant

murmurs. The 90 percent of youths and 57

percent of children with significant murmurs

were consid-ered to have significant cardiovascular pathology on diagnostic impression. Among

—At midclavicularline

----ln$ide mid~lavi~u]arline

_._ou@ide mid~lavi~ularIi”e

==4---------”-- —

“L’= ._*-.-.-._*_. -o

● —,—o-o ----

0.’ 678910

, t

11 12 13 14 15 16 17 18

AGE IN YEARS

Figure 5. Percent of children in 1963-1965 and youths in 1966-

1970 with point of maximum impulse of heart felt at, insida, or outside the midclavicular line, by age: United

States

children, the prevalence of significant cardiac

pathology was nearly as high among those with

positive chest X-ray evidence or cardiac history

as determined during the examination, as among

those with significant murmurs; the respective

cardiovascular rates were 50 percent and 46

percent.

Blood pressure. –The prevalence of definite

hypertension–that is, the adult standard of

either systolic blood pressure of at least 160

mm. Hg or diastolic pressure of 95 mm. Hg or

more—is very low among the 6-17-year age range

of the population. National estimates from those

Health Examination Surveys of 1963-1970 and

the more recent Health and Nutrition Examination Surveys of 1971-1974 indicate thatlessthan

0.1 percent of children age 6-11 years and less

than 1 percent of youths 12-17 years old would

have that degree of elevation of blood pressure.11J1Z From the Health Examination Survey

among youths in 1966-1970 an estimated 0.6

per 100 had substantially elevated blood pressure with clinical manifestations of definite

hypertension. Disturbances of the rate and

rhythm of the heart and other types of cardiovascular pathology tentatively identifiable on

these examinations might also be expected to be

associated with Iesser degrees of elevation or of

depression of blood pressure levels.

Among children and youths, the mean systolic blood pressures of those with diagnostic

impressions of significant cardiovascular conditions are higher than the means for those with

essentially normal cardiovascular findings; the

mean differences are greater among youths (9.0

mm. Hg) than among children (2.3 mm. Hg), but

large enough among both age groups to be

statistically significant at the 5-percent probability level (table 8 and figure 6). Mean diastolic

pressures for children with and without significantly abnormal cardiovascular conditions differed no more than might be expected through

chance (0.5 mm. Hg); youths with abnormal

cardiac conditions had significantly higher mean

diastoIic blood pressures than those youths

without abnormal cardiac conditions had.

Among the youths for whom type of cardiac

pathology could be identified, those with clinical manifestation of. hypertensive heart disease

have mean systolic and diastolic pressures signifi10
~

1

““s’;/ ii” ~ T--

_ Normal cardiovascular

diagnosticimpression

60

___ Abnormal cardiovascular

diagnosticimpression

Figure 6. Mean systolic and diastolic blood pressure among children in 1963-1965 and youths in 1966-1970 with normal

and abnormel cardiovascular diagnostic impressions from

examination, by age: United Statas

cantly higher than have youths wi~ other types

of cardiac conditions or normal youths. Among

youths with nonhypertensive cardiac conditions

or with significant murmurs, mean systolic (but

not diastolic) pressures were significantly higher

than mean systolic pressures of normal youths.

Medical History-Examination

Some additional indication of the seriousness of the cardiovascular condition or the individual’s or family’s concern about it is reflected

in the rating of the present health status by the

parent for the children and youths and by the

_youths themselves (table 9 and fi~res 7-9).

Children age 6-11 years reported by their

—.

parent as being in poor health were about 6

times as likely and those rated as in fair health

slightly more likely to have a cardiovascular

condition on diagnostic impression from the

survey examination than those reported as in

good to very good health, though more than 2

percent within each health status group were

found to have a cardiovascular condition. However, none of the differences in cardiovascular

rates among those within the various gradations

of health status were large enough to be statistically significant at the 5-percent probability

level. (The respective proportions of all children

in these health status groups were 0.4 percent

poor, 4.9 percent fair, 42.9 percent good, and

51.8 percent —— very good.)6

Among youths age 12-17 years, cardiovascular morbidity rates for those considered in fair

30r AQ?%

I ia-611years!4

very Good Fair Poor Findings

good from exam.

ination

PRESENT HEALTH STATUS (PARENT REPORT)

Figure 7. Prevalence rates for cardiovascular conditions from

examination among all children age 6-11 years in 1963-

1965 and youths age 12-17 years in 1966-1970 and by

parents’ ratings of their present health status: United States

Excellent Very Gwd Fair Pcor Findings

g.aod from exam.

PRESENT HEALTH STATUS

ination

Figura 8. Prevalence rates for cardiovascular conditions from

examination among all youths aga 12-17 years and by

parents’ and youths’ ratings of present health status: Unitad

Stetes, 1966-1970

11
BOYS

❑

Parentreport-6.l 1 years

H

ParentrepOrt-12.17 years

❑ Se,f,epmt-12.17y, ars

GIRLS

Very good Good Fair Pear

PRESENT HEALTH STATUS

Very gm.d Good Fair Pc.3r

PRESENT HEALTH STATUS

Figure 9. Prevalence rates for cardiovascular conditions from examination among boys and girls age 6-17 years by parents’ ratings of

presant health status and among youths age 12-17 years by self-rating of present health status: Unitad States, 1963-1970

health were twice as high and for those in poor

health 4 times as high as those reported by their

parents to be in good, very good, or excelIent

health, though about 4 percent or more in each

health status group had a cardiac condition

identified on examination. (The respective proportions of all youths in these health status

groups were 0.3 percent poor, 3.3 percent fair,

29.5 percent good, 33.9 percent very good, and

33.0 percent excellent.)6

When youths rated their own health, those

in fair health were about 3 times more likely to

have a cardiovascular condition than those rating

themselves in poor, good, very good, or excellent health. (The respective proportions of all

youths in these health status groups were 0.4

percent poor, 4.2 percent fair, 36.4 percent

good, 32.8 percent very good, and 26.2 percent

excellent.) “

Children and youths whose parents were

worried about their offsprings’ health were more

likely than those whose parents were not worried to have a cardiovascular condition. Similarly

children and youths taking medication regularly

were more likely to have a cardiovascular condi12

tion than were those who did not take medicine

regularly.

Demographic-Socioeconomic Trends

Race. –From the history, white boys age

6-17 years and white girls age 6-11 years were

slightly more likely than were Negro boys and

girls of corresponding ages to have been reported

by their parents as having a history of a heart

condition. Among girls age 12-17 years, however, the reverse is evident, though none of the

differences are large enough to be statistically

significant (table 10). Heart condition as the

most serious illness was more likely to have been

reported among Negro girls than among white

girls and among white boys than among Negro

boys.

The prevalence of significant cardiovascular

conditions (diagnostic impression) is higher

among Negro children than among white children (4.2 per 100 compared with 2.1 per 100)

and among Negro youths than among white

youths (5.7 per 100 compared with 4.5 per

100); the difference is large enough to be
statistically significant only among the children

(table 12). The racial pattern is consistent across

the 6-1 7-year age range except at 10, 15, and 17

years, and among girk but not among boys in

both age groups.

From the examination findkgs, murmurs are

more prevalent among white youths (17.5 per

100) than among Negro youths (13.0 per 100);

among children the rates for the two races are

similar (26.7 per 100 for white children and

26.0 per 100 for Negro children) (table 10).

However, the other diagnostic findings–from

EKG, chest X-ray, and cardiac history as determined at examination-show abnormal rates that

range from 53” percent higher for Negro children

than for white children on cardiac history to

nearly 150 percent higher on chest X-ray findings (table 11).

Region. –Cardiovascular conditions are more

prevalent among children and youths living in

the South than among those living in the

Northeast, Midwest, or West, the four broad

geographic regions into which the United States

was divided in the sampling frame used in these

two studies. The cardiovascular condition rates

among youths in the South are significantly

higher than those for youths living elsewhere in

the United States. In each of the four geographic

regions, the cardiovascular condition rates

among Negro children exceed those for white

children (table 13). However, among youths this

pattern is consistent only in the Midwest and

South. Among both white and Negro youths the

prevalence rates for cardiovascular conditions

are highest in the South.

Place of Residence. –Cardiovascular conditions are more prevalent among children and

youths in rura.I than in urban areas. The differences in the rates are greater among children

(2.0 per 100 in urban areas, 3.2 per 100 in rural)

than among youths (4.3 per 100 in urban areas

compared with 5.1 per 100 in rural) and large

enough to be statistically significant only among

children.

The rural rates are consistently higher among

both the white and Negro child and youth

populations.

Income. –The prevalence of cardiovascular

conditions shows a consistent inverse association

with family income. Among both chiIdren and

youths, the cardiovascular condition rates are

highest among those with annual family incomes

of less than $5,000 and decrease with increase in

fan-dy income. The pattern is consistent among

girls but not boys in both age groups.

The association between cardiovascular condition rates and family income is more consistent among the white than the Negro groups.

Parent education. –Similar to the findings

with respect to family income there is a strong

inverse association between the prevalence rates

of cardiovascular conditions and educational

level of the head of the household. The prevalence rates for cardiovascular condhions of

chiIdren and youths are highest among those in

which the head of the household had the least

education (less than 5 years’ formal schooling)

then generally decrease as educational level

increases. For children 6-11 years the rates drop

nearly 60 percent, from 4.2 per 100 among

those whose parent had completed less than 5

years’ formal schooling to 1.7 per 100 among

those whose parent had some college education;

among youths, the decrease is slightly slower,

from 6.9 per 100 in the lowest educational level

group to 3.7 per 100 among those where the

household head had some coIlege education.

COMPARISON WITH OTHER STUDIES

Estimates of the prevalence of cardiovascular

conditions among children and youths have been

obtained through household interview and/or

examination in various community and national

studies designed primarily to determine the

impact of chronic illness on the population and

the need for care or treatment. Methods and

criteria used, and, hence, the resukmt estimates

obtained, have differed substantially; most rates

have been lower than those derived from the

present national examination surveys because

different methods and definitions were used.

National estimates based on findings from the

national probability sample of households included in the Health Interview Surveys of

1959-196113 and 197214 show cardiovascular

condition rates among chiIdren under 17 years

of age of 8.3 per 1,000 in the 1959-1961 study

and 17.4 per 1,000 in the 1972 study. Rather

than any real increase in prevalence, the apparent increase in these rates may reflect in13
I

creases ‘in availability or utilization of medical .

care as well as improvement in interviewing

methods. The estimated cardiovascular condition prevalence rates among the child population

5-16 years of age from the Health Interview

Survey would be approximately 10 per 1,000 in

1959-1961 and 21 per 1,000 in 1972 compared

with the rate of 35 per 1,000 among those 6-17

years of age from the two Health Examination

Surveys in 1963-1970. Since the Health Interview Survey information is of necessity limited

to known conditions, the prevalence rates

derived from it would be expected to be lower

than those from the Health Examination Survey,

where both known and unknown conditions

would be identified.

Among the community or more geographically limited studies in the United States

which included an examination and from which

prevalence estimates for cardiovascular conditions in the child population have been published are the study of handicapped children in

Georgia,l 5 the study from the medical records

of the enrollees in the Health Insurance Plan

(HIP) of Greater New York,] G the Chicago Area

High School Study in which tape recorded heart

sounds were used,l T and the evaluation of heart

disease screening methods among Denver

parochial school children.1 s

Wishik reports a prevalence rate for heart

conditions of 10 per 1,000 among the chiId

population under 21 years of age in two

counties of Georgia.]s In this community study,

the initial identification of children with handicapping conditions was obtained through voluntary reporting by professional workers and

citizens. A 10-percent sample of those so identified was later examined. Hence, this estimate

@l probably be limited to those with known

cardiovascular conditions.

In the HIP study, Densen et all G show

prevalence rates of 38.5 per 1,000 enrollees

among those 5-14 years of age (and 38.6 per

1,000 enrolIees among those 15-24 years of age)

receiving one or more services related to a

cardiovascular condition per year during the

1948-1951 period. As expected, these rates are

slightly higher than those for the U.S. child and

youth populations from the present study since

they would probably include a substantially

greater number in need of medical care than

would be found in a probability sample of the

population.

In their study, Smith et al.] y obtained tape

recordings of heart sounds among a stratified

rimdom sample of nearly 50,000 Chicago area

high school students. Those with abnormal heart

sounds were recalled for a complete examination

and workup. The prevalence rates of suspected

organic heart disease among these Chicago students were 17.7 per 1,000. After the more

detailed examination, the cardiovascular prevalence rates among high school students in the

Chicago area were determined to be 1.4 per

1,000 with congenital heart disease, 0.7 per

1,000 with rheumatic heart disease, and 2.1 per

1,000 with heart disease of all types combined.

Here again the prevalence rates from the Chicago

area would be expected to be lower than those

in the present national study because only a

single criterion was used for screening (the heart

sounds) and the followup examination was more

extensive than that in the present national

study.

In the Denver study, ] 8 more than 17,000

parochial school children were screened, using

four different methods. Those with suspected

heart disease were then reexamined by cardiologists at special clinics. From this study, the

rheumatic heart disease prevalence rate was

found to be 1.7 per 1,000 children, A history of

rheumatic fever was reported by 12.4 percent of

the schoolchildren and by 44.8 percent of those

determined to have rheumatic heart disease.

Here again, the prewdence rate of rheumatic

heart disease of 1.7 per 1,000 is less than half

that determined from the present national study

(4 per 1,000, using the limited criteria of known

rheumatic heart disease, rheumatic fever history

with some present evidence of heart pathology,

or evidence of mitral valve impairment) because

of the more extensive examination given in the

Denver study. The prevalence of known history

of rheumatic fever among the Denver parochial

school children (12.4 percent) was, however,

substantially higher than that reported on medical history for U.S. children (0.5 percent) and

youths (0.9 percent).

From a British longitudinal study in 1946-

1961, Pless and Douglas I9 report a cardiovascu14
lar prevalence rate of 2.5 per 1,000 among children under 16 years. In this study, a sample of

children born in England, Wales, and Scotland

during one week in March (1946) were followed

through 15 years. Information on chronic conditions was obtained through interview and examinations by school doctors. Description of the

examination methods and criteria used is not

detailed enough to permit comparison with the

present U.S. survey findings.

SUMMARY

This report contains national estimates of the

prevalence of cardiovascular conditions among

noninstitutionalized children and youths 6-17

years by age, race, sex, geographic region, urban

or rural residence, annual family income, and

education of parent. Included also is information on the extent to which the various cardiovascular findings from the examination and

medical history were present among those with

diagnostic impression of heart and other circulatory conditions.

These estimates are based on findings from

the Health Examination Surveys of 1963-1965

and 1966-1970. For these two surveys, samples

of 7,417 children 6-11 years and 7,514 youths

12-17 years were selected to represent the 23.8

million children and 22.7 million youths of

these ages in the U.S. noninstitutionalized population at the respective midsurvey points. Of

these, 7,119, or 96 percent, of the children and

6,768, or 90 percent, of the youths were

examined. The examined groups were closely

representative of the target populations from

which the samples were drawn with respect to

age, race, sex, geographic region, population size

of place of residence , and rate of change in

population size of residence from 1950 to 1960.

From the examination diagnostic impressions, an estimated 2.4 per 100, or nearly 0.6

million children 6-11 years of age, and 4.6 per

100, or more than 1 million youths 12-17 years

of age in the U.S. noninstitutionalized population, have a significant cardiovascular condition.

Among children, 71 percent of these conditions

were considered congenital compared with 9

percent among youths.

Prevalence rates for cardiovascular conditions are consistently lower among children

(ranging from 2.0 per 100 at age 9 years to 2.8

per 100 at ages 7 and 8 years) than among

youths, for whom these rates range from 3.6 per

100 at age 12 years to 5.6 per 100 at ages 14

and 16 years.

From the medical histories, the prevalence

of ever having had a murmur or anything else

wrong with the heart is only slightly higher

among youths (4.9 per 100) than among children (4.1 per 100).

Boys were slightly more likely than were

girls to have or have had a heart condition as

determined either from the examination or

history.

NearIy 80 percent of children with diagnostic impression of a cardiovascuku condition had

a significant or possibly significant heart murmur compared with only 45 percent among

youths with cardiovascular conditions.

The history of known cardiac conditions as

obtained from the medical history and from the

children by the pediatrician during the physical

examination is about 50 percent greater than

that shown from the medical history as given by

the parents alone.

Among youths, the four principal types of

cardiovascular conditions identified on examination were significant murmurs (2. 1 per 100

youths), hypertension (0.6 per 100 youths),

atrial or ventricular septal defects (0.5 per 100

youths), and symptomatic heart disease such as

arrhythmias and (incomplete) heart block (0.4

per 100 youths). From this, the estimated

prevalence of hypertensive heart disease was 0.6

per 100 and that for rheumatic hez@ disease was

1.0 per 100 (or 0.4 per 100 if only mitral valve

defects were considered without known rheumatic fever history). Recording on the children’s

examination was not given in sufficient detail to

make comparable determinations for them.

From the children’s examination but not

that among youths, determinations could be

made of the extent to which the various

cardiovascular findings were present among

those with a final diagnostic impression of

abnormal cardiac condition. The strongest association, as expected, was with the findings of

murmurs.

15
Among children and youths, mean systolic

blood pressures of those with significant cardiovascular conditions are higher than the means

for those with essentially normal cardiovascular

findings; the difference is greater among youths

than among children. Only among youths was

the mean diastolic blood pressure significantly

higher among those with a cardiac condition

than among those without a cardiac condition.

The prevalence of cardiovascular conditions

is higher among Negro children and youths than

among the white groups, among those living in

the South, among those living in rural areas,and

among those in families with annual incomes less

than $5,000 or whose parent had less than 5

years’ formal schooling.

000

16
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Public Health Service. Washington. U.S. Government

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Administration. Washington. U.S. Government Printing

Office, Sept. 1977.

13Schiffer, C. G., and Hunt, E. P.: Illness Among

Children. Data from U.S. National Health Survey.

Washington. U.S. Government Printing Office, 1963.

14National Center for Health Statistics: Prevalence of

chronic circulatory conditions: United States, 1972.

Vital and Health Statistics. Series 1O-NO. 94. DHEW

Pub. No. (HRA) 77-1521. Health Resources Administration. Washington. U.S. Government Printing Office,

Sept. 1974.

15Wishik, S. M.: Handicapped children in Georgia: A

study of prevalence, disability, needs and resources. Am.

J Public Health 46:195-204, 1956.

16Densen, P. M., Balamuth, E., and Deardorff, N. R.:

Medical care plans as a resource of morbidity data: The

prevalence of illness and associated volume of service.

Milbank Mere. Fund Q. 38:48-101, 1960.

‘ 7 Smith, J. M., et al.: The detection of heart disease

in children. Results of mass Field trials with use of tape

recorded heart sounds. III. The Chicago Area High

School Study. Circulation 32:966-976, Dec. 1965.

18 Morton, W. E., Huhn, L. A., and Litchy, J. A.:

Rheumatic heart disease epidemiology. J.A.M.A.

199(12):879-884, Mar. 1967.

] ‘Pless, I. B., and Douglas, J. W. B.: Chronic illness in

childhood: Part 1. Epidemiological and clinical characteristics. Pediatrics 47(2) :405-414, Feb. 1971.

20 National Center for Health Statistics: Sample design

and estimation procedures for a National Health Examination Survey of children. Vital and Health Statistics.

Series 2-No. 43. DHEW Pub. No. (HSM) 72-1005. Health

Services and Mental Health Administration, Washington.

U.S. Government Printing Office, Aug. 1971.

21 National Center for Health Statistics: Quality control in a National Health Examination Survey. Vital and

Health Statistics. Series 2-No. 44. DHEW Pub. No.

(HSM) 72-1023. Health Services and Mental Health

Administration. Washington. U.S. Government Printing

Office, Feb. 1972.

17
LIST OF DETAILED TABLES

1. Prevalence rates for cardiovascular conditions from examination and medical history among children in 1963-1965 and youths

in 1966-1970, by age and sex, with standard errors for totals: United Statas............................................................................... 19

2. Proportion of youths with rheumatic fever raported as their most serious illness on medical history, by age rheumatic faver

started, severity of illness, age at examination, and sex, with standard errors for totals: United States, 1966-1970, ..................... 20

3. Prevalence rates for examination findings of significant murmurs among children in 1963-1965 and youths in 1966-1970 for

major types of cardiovascular conditions from diagnostic impression among youths, and for additional cardiovascular findings

on examination among children, by age and sex, with standard errors for totals: United States................................................... 21

4. Prevalence rates for cardiovascular conditions from diagnostic impression and percent distribution of youths age 12-17 years,

by type of condition: Unitad States, 1966.1970 .......................................................................................................................... 22

5. Percent of children in 1963-1965 and youths in 1966-1970, by examination findings of lateral and vertical position of the

point of maximum impulse of the heart, severity of murmurs identified, age, and sex, with standard errors for totals: United

~ates ............................................................................................................................................................................................ 23

6. Percent distribution of children in 1963-1965 and youths in 1966-1970 by examination findings of lateral by vertical position

of meximum impulse of the heart, according to age and sex, with standard errors for totals: United States................................. 24

7. Prevalence rates for cardiovascular conditions among c~ldren in 1963-1965 and youths in 1966-1970 with specific types of

findings from examination and medical history, by age and sex, with standard errors for totals: United States........................... 25

8. Mean systolic and diastolic blood pressure (2-reading average) among children in 1963-1965 and youths in 1966-1970 with

normal and abnormal cardiovascular diagnostic impressions from examination, by age and sex, with standard errors for totals:

United States............................................................................................................................................ ............................ ........ 26

9. Prevalence rates for cardiovascular conditions from diagnostic impression among children aga 6-11 years in 1963-1965 and

youths age 12-17 years in 1966-1970, by present health status, health a worry (to parent), regular use of medicine, and sex,

with standard errors: United Statas.............................................................................................................................................. 27

10. Prevalence rates among white and Negro children in 1963-1965 and youths in 1966-1970 for selected examination and history

findings relating to cardiovascular conditions, by age and sex, with standard errors for totals: United States..., ........................... 28

11. Prevalence rates for specific abnormal cardiac findings on examination of white and Negro children, by age and sex, with

standard errors for totals: United States, 1963.1965 .................................................................................................. .................. 29

12. Prevalence rates for cardiovascular conditions from diagnostic impression among children in 1963-1965 and youths in 1966-

1970, by age, sex, race, geographic region, urban or rural place of residance, annual family income and education of parent,

with standard errors for totals: United Statas............................................................................................................................... 30

13. Prevalence rates for cardiovascular conditions from diagnostic impression among white and Negro children in 1963-1965 and

youths in 1966-1970, by geographic region, urban or rural place of residance, annual family income, age, and sex, with standard errors for totals: United States, 1966.1970 ............................................................................................................................ 31

14. Prevalence rates for major types of cardiovascular conditions from diagnostic impression among youths age 12-17 years, by

race, geographic region, urban or rural place of residence, annual family income, and sex, with standard errors: United States,

1966-1970 ........................................................................................................................................ ..................... ...................,.,, 32

15. Prevalence rates for major types of cardiovascular conditions from diagnostic impression among white and Negro youths age

12-17 years, by geographic region, urban or rural place of residence, and sex, with standard errors: United States, 1966-1970 ... 33

18
Table 1. Prevalence rates for cardiovascular conditions from examination and medical history among children in 1863-1965 and youths

in 1966-1970, by age and sax, with standard arrors for totals: Unitad States

Age and sax

Both sexas

6years ...............................................................

7 years ...............o........m..................................o...

8years ...............................................................

9 years .o.........om.................m................................

10 yaars ........................................................!....

11 years .............................................................

12 yaars ......................o......................................

13 years .............................................................

14 years .............................................................

15 years .........o....o..............................................

16 years .............................................................

17 years ..................................m..........................

6-11 years ..........................................................

12-17 yaars ........................................................

Boys

6-11 years ..........................................................

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

Girls

6-11 years ..........................................................

12-17 yaars ........................................................

Both saxes

6-11 years ..........................................................

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

Boys

6-11 years ..........................................................

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

Girls

6-11 years ..........................................................

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

Cardiovascular condition Medical history

(diagnostic impression) (from parant)

I

I I I

All Con- Acquirad Heart Rheutypes gen- or, condi- mat ic

ital unknown tion 1 feverz

I I I I

2.5

2.8

2.8

2.0

2.1

2.3

3.6

4.1

5.6

4.3

5.6

4.6

2.4

4.6

::

2.3

4.4

0.26

0,71

0.43

0.87

0.25

0.68

1.9

1.6

1.8

1.6

1.6

1.4

0.2

0.3

0.7

0.3

0.3

0.5

1.7

0.4

‘:::

1.5

0.4

0.20

0.09

0.28

0,16

0.18

0.09

0.6

1.2

1.0

0.4

0.5

0.9

3.4

3.8

4.9

4.0

5.3

4.1

0.7

4.2

0.7

4.5

0.8

4.0

0.09

---

0.13

. . .

0.12

---

History from

parent

Heart

No

heart

condi- condition tion

I

Rate per 100 persons

4.0

3.7

4.5

3.4

4.6

4.6

4.7

4.3

5.2

5.1

4.5

5.9

4.1

4.9

4.7

5.3

3.5

4.5

0.2

0.2

0.5

0.5

1.1

0.8

0.7

1.0

0.6

0.5

1.2

1.6

0.6

0.9

0.5

1.0

0.6

0.9

Standard error

0.29

0.36

0.35

0.44

0.48

0.51

0.11

0.09

0.12

0.12

0.18

0.12

Exarcise no

3.6

5.5

2.0

6.2

13.1

13.8

17.8

7.8

20.2

1.8

13.4

1.6

11.7

2.2

15.4

0.24

1.78

0.31

2.28

0.52

3.63

0.8

1.2

1.5

1.2

1.7

1.8

2.7

3.6

3.8

4.8

4.1

6.3

1.4

4.2

1.3

4.2

1.4

4.1

0.09

0.26

0.10

0.33

0.09

0.26

restricted

History from

youth

Heart No

heart

condition condition

. . .

. . .

. . .

. . .

. . .

3:0

4.7

12.5

13.1

9.5

. . .

7.4

. . .

6.2

. . .

8.9

. . .

1.04

. . .

2.41

. . .

2.43

. . .

. . .

. . .

. . .

. . .

‘ ;:0

2.2

2.3

4.2

2.6

4.6

. . .

2.8

. . .

2.5

. . .

3.1

. . .

0.23

. . .

0.30

. . .

0.36

1Includes history of murmurs.

2F~r children, history of rheumatic fever; for youths, rheumatic fever only if roost Serious illness.

19
Table 2. ‘Proportion of youths with rheumatic fever reported as their most serious illness on medical history, by aQe rheumatic fever

started, severity of illnass, age at examination, and sex, with standard errors for totals: United Statas, 1866-1970

Age and sex

Age rheumatic

fever started Seriousnessof rheumatic fever ! Lasting

Rheumatic

fever Under 6

years

6-11

years

Rate

per

100

Percent of those

with rheumatic

fever history

Rate per 100 youths

youths

Both sexes, 12-17 years ..,.,.,,., .............. 0.9 28.4 71,5 0.4 0.3 0.1 0.0 0.1 0.6

12 years................................................................

13 years................................................................

14 years................................................................

15 yaars.......................o........................................

16 years................................................................

17 years............................j...................................

0.7

1.0

0.6

0.5

1.2

1.6

1,0

0.9

100.0

58.1

74.2

69.2

68.2

69.4

69.8

73.4

0.5

0.5

0.4

0.2

0.4

0.4

0.5

0.2

0.1

0.4

0.2

0.1

0.5

0.7

0.3

0.4

0.1

0.1

0.2

0.2

0.2

0.1

0.2

0,7

0.7

0.3

0,2

0.3

0.8

0.6

0,5

0.1

0.1

41.8

25.8

30.8

31.8

30.6

30.1

26.6

0.1

0.2

0.0

0.1

Boys,12-17 years ..................................................

Girls, 12-17 years .................................................

Standard error

Both sexes, 12-17 years ........................................

Boys, 12-17 years .................................................

Girls, 12-17 years .................................................

0.09 I

5.36

0.12 7.95

0.12 9.41

5.36

7.95

9.41

. . .

. . .

.-.

-..

---

. . .

..-

. . .

---

. . . . . .

I

O.10

... 0.14

. . . 0.15

.-.

---

20
Table 3. Prevalence rates for examination findings of significant murmurs among childran in 1963-1965 and youths in 1966-1970 for

major types of cardiovascular conditions from diagnostic impression among youths, and for additional cardiovascular findings on

examination among children, by aga and sex, with standard errors for totals: United States

Aga and sex

Both sexes

6 yearn......................................................................................

7 years......................................................................................

8 years,,,...,,, ,,,,,.,.,,.. ,.,,.,.,.,,.,..,,.,, ,............................................

9 years....$......oo.........................................................................

10 years....................................................................................

11 yearso..$........o...........o..................o...............o........o...............

12 years.......o............................................................................

13 years.......................,.,..........................................................

14 years....................................................................................

15 years....................................................................................

16 years....................................................................................

17 years....o..o...o......o..l..o.o...o.................o.....o.............................

6-11 yean .................................................................................

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

Boys

6.11 years..,, ....,, ,,,,,,....,,.,,.,,,.,.,..,,,, ..........................................

12-17 yearso....o.........................................................................

Girls

8-11years .. ... . ..... . ... .. ... , !,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 yaers...............................................................................

Both sexes

6-11 years.................................................................................

12.17years.m.......o.........o...........................................................

6.11 yearn.................................................................................

12-17 vears...............................................................................

Girls

6-11 years.................................................................................

12-17 yearso..............................................................................

Murmurs

Cardiovascular condition

I

Additional cardiovascular

(diagnostic impression) findings on examination

possibly Z’m1 I I 1 1 I

Rate per 100 persons

3.7

3.5

3,9

2.8

2.8

4.5

1.7

2.0

2,7

2.2

2.9

3.1

3.5

2.4

3.5

2.5

3.6

2.3

0.38

0.30

0.65

0.40

0.37 I

0.32 I

..-

. . .

-..

. . .

. . .

.-.

0.1

0.5

0,6

0.4

1.3

0.9

-..

0.6

. . .

0.6

. . .

0.6

. . .

0.15

. . .

0.19

. . .

0.19

. . .

. . .

..-

. . .

.-.

. . .

0.8

1.0

1.0

0.8

1.4

1.1

---

1.0

.-.

1.1

. . .

1.0

..-

-..

. . .

. . .

. . .

. . .

2.5

2.3

3.3

2.8

2.6

2.1

.-.

2.6

. . .

2.8

. . .

2.4

Standard error

. . .

0.16

. . .

0.20

. . .

0.18

4.3

5.4

4.8

5.1

4.0

4.8

. . .

..-

. . .

. . .

. . .

. . .

4.7

.-.

5.5

. . .

4.0

. . .

-..

0.58

.-.

0.69

---

0,54

1.21

. . .

1.49

. . .

0.99

. . .

2,8

3,0

2.0

3.1

3.1

4.5

.-.

..-

. . .

. . .

. . .

.-.

3.1

..-

3.4

. . .

2.8

-..

0.66

.-.

0.73

. . .

0.65

..-

6.1

::;

6.9

6.4

6.2

. . .

. . .

. . .

---

---

---

6.2

.-.

6,8

---

5.6

..-

1.43

..-

1.67

---

1.44

---

21
Table 4. Prevalence rates for cardiovascular conditions from diagnostic imrxession and Dercent distribution of vouths acse12-17 Years, bv

tvpe of condition; United S~ates, 1966-1970

Type of cardiovascular condition and ICDA code

All youths, 12-17 years ....................................................................................................................

All youths, 12-17 years ....................................................................................................................

No specified type of cardiovascular findings ...............................................................................................

Cardiovascular findings specified .................................................................................................................

All youths with cardiovascular conditions ........................................................................................

Rheumatic fever with heart involvement ............................................................................................ (391 )

Mitral valve insufficiency or steno;s ............................................................................................... (394.9)

Aortic valve diseaseor stenosis ...................................................................................................... (395.9)

Atrial or ventricular septal defect ....................................................................................................... (397)

Hypertension ................................................................................................................................ ..... (401 )

significant murmurs .............................................................................................................. (401, 424.9)

Symptomatic heart diie~” E+rrhythmias, heatiblmk) .......................................................... (427.3, 427.9)

Ill-defined heart disease (cardiomegaly, ventricular hypertrophy, chest pains) ..................... (429.0, 429.9)

Diseasesof arteries or veins (dilated arteries, varicose veins) ................................................ (441 .9, 454.9)

Congenital heart diseaseor anomalies ....................................................................... (746.0, 746.2, 746.3)

Congenital anomalies of circulation ..................................................................................... (747.0, 747.3)

Other heart condition–type not specified...................................................................................................

Diagnostic impression

Significant

cardiovascular

findings 1

Other Essen- signif- tially icant

find- normal ings

Rate per 100 youths

4.6 17.2

I

78.2

c

Percent distribution

of youths

100.0

1.3

98.7

1100.0

4.5

3.1

4.4

10.1

13.4

45.1

8.5

2.6

0.5

3.9

4.8

1.3

100.0

98.5

1.5

100.0

30.7

69.3

100.0

99.4

0.6

100,0

3.5

47.4

42.8

3.1

3.2

lAdd8 to more than 100 percent because some youths had more than one tYPe of condition.

22
Table 5. Percent of children n 1963-1965 an

of maximum impulse & the heart, seve

Age and sex

Both sexes

6 years ................................................. ........

7 years .................................................. .......

8 years .,,,.,, ,..,,,,.,,,., ............................... ......

9years ..............i...$.....o.................................

10 years ...................m.........m..........................

11 years ..o...................o.................................

12 years ......................m.................................

13 years ........................................................

14 years .ti..S...................................................

15 years ........................................................

16 years ........................................................

17 years ...........m...........m................................

6-11 years .....................................................

12-17 yaars ..........................m........................

Boys

6-11 years ..$..................................................

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

Girls

6-11 years .....................................................

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

Both sexes

6-11years .....................................................

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

Boys

6-11 ~ears .....................................................

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

Girls —

6-11 years .....................................................

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

~outhsin 1966-1970, by examination findings of lateral and vertical position of the point

/ of murmurs identified, age,and sex, with standard errors for totals: Unitad States

Point of maximum impulse Murmurs present

Interspace Midclavicular line

Any Signif.

PossiNot bly lnnofelt d

pres5 6 At !n- out- icant signif- icant

side side ent icant

Percent of persons

. . .

. . .

. . .

..-

.-.

. . .

3.0

4.4

4.7

5.9

9.7

8.2

-..

5.9

.-.

4.0

. . .

7.8

---

0.80

. . .

0.55

. . .

1.21

43.8

41.9

39.5

34.5

33.6

2B.3

36.7

30.6

26.2

26.2

24.1

20.2

37.1

27.6

36.4

26.9

37.8

28.3

6.46

3.82

6.56

4.01

6.41

3.80

!55.7

57.5

59.8

64.8

65.1

69.9

56.0

5B.5

60.2

56.8

56.6

61.8

62.0

58.2

62.5

61.1

61.4

55.4

6,37

3.37

6.45

3.42

6.34

3.50

0.5

0.6

0.8

0.7

1.3

1.8

4.3

6.5

8.9

11.1

9.6

9.9

E

1.1

8.0

0.8

8.5

0.34

2,54

0.41

2.31

0.29

2.99

47.1

49.3

52.8

50.8

52.0

53.8

34.3

33.7

33.0

33,3

31.6

32.2

50.9

33.1

51.0

37.7

50,9

28.3

5,23

3.74

5.02

4.13

5.53

3.66

51.9

49.9

46.1

47.6

46.8

45.2

60.0

59.3

58.3

57.2

55.0

55.5

48.0

57.6

47.8

55.0

48.1

60.4

1.0

0.8

1.1

1.5

1.2

1.1

2.7

2.6

4.0

3.6

3.7

4.1

1.1

3.4

1.2

3.3

1.0

3.5

Standard error

5.31

4.13

5.11

4.40

5.60

4.26

0.28

0.97

0.30

0.95

0.29

1.00

29.5

26.6

27.2

24.3

25.6

26.3

18.0

18.4

16.7

16.0

15.3

16.5

26.6

16.9

26.4

17.0

26.9

16.7

2.06

1.26

2.16

1.31

2.18

1.63

0.8

0.9

0.7

0.9

0.7

0.4

0.4

0.2

0.6

0.3

1.2

0.5

0.7

0.5

O.tl

0.6

0.7

0.5

.-.

. . .

. . .

.-.

. . .

. . .

2.9

2.6

3.2

1.9

2.1

4.1

1.3

1.8

2.1

1.9

1.7

2.6

2.8

1.9

2.7

1.9

2.9

1.8

---

---

-..

-..

. . .

.-.

25.8

23.1

23.3

21.5

22.8

21.8

16.3

16.4

14.0

13.8

12.4

13.4

23.1

14.5

22.9

14.5

23.3

14.4

---

---

---

---

---

---

NOTE: 0.4 percent not felt among children, excluded from total.

23
Table 6. Percent distribution of children in 1963-1965 and youths in 1966-1970 by examination finding$of Iatarel by vertiCai Position

of maximum impulse of the heart, according to age and sax, with standard errors for totals: United States

Aga and sex

Both sexes

6 years .......................................................................

7 years .......................................................................

8 years .......................................................................

9 years .......................................................................

10 years .....................................................................

11 years .....................................................................

12 years .....................................................................

13 years ..................o..........m..................o....................

14 years .....................................................................

15 years .....................................................................

16 years .....................................................................

17 yaars .....................................................................

6-11years ..................................................................

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

Boys

6-11yaars ..................................................................

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

Giris

6-11 years ..................................................................

12-17 years .............................................................4..

Both sexes

&l 1yaars ..................................................................

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

Boys

6-11 years ..................................................................

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

Girls

6-11years ..................................................................

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

Point of maximum impulse-at interspace

4 5 6

At mid- ,n

outAt mid- ,n

clavicu- -

side side clavicu- -

tar line Iar line sida

Parcent distribution of pemonsat each interspace

55.2

55.8

57.7

55.2

54.6

62.2

29.1

28.6

24.0

30.9

29.7

24.4

55,6

28,0

56,0

32.8

55.8

23.3

7.20

7.71

6.95

8.72

7.65

7.21

47.6

43.9

41.7

44.3

44,6

37.4

70.4

71.1

75.0

68.5

69.7

75.6

43.6

71.5

43.6

66.6

43.7

76.2

7.21

7.73

6.94

8.74

7.69

7.24

0.2

0.3

0,6

0.5

0.8

0,4

0.5

0.2

1.0

0.6

0.6

0.4

0.5

0.4

0.6

0.6

0.5

0.17

0.19

0.24

0.21

0.23

0.22

43.0

45.0

50.0

48.8

50.5

50.8

40,6

40.3

39.1

38.7

37.4

41.1

48.2

39.7

48.3

43.1

48.0

35.9

Sta

6.28

3.85

6.23

4.14

6.42

3.97

55.4

z

49.1

48.1

47.8

55.0

55.9

S4.8

54.9

56,8

52,5

50.4

55.0

50.0

51.9

50.8

58.4

Idard e

6.40

4.00

6.36

4,20

6.53

4.21

1.6

1.0

1.4

2.1

1,4

1.4

4.4

3.6

6.1

5.4

5.8

6.4

1.5

5.3

1.7

5.0

1.2

5.7

or

0,44

1.43

0,49

1.44

0.44

1.46

62.6

21.6

18.9

27.1

61.4,

36.1 i

19.8

22.1

35.6

24.2

35.1

19.3

39.3

26.7

38.5

31.9

40.4

21.7

13.75

5.08

16.17

4.84

13.86

6,52

23.5

63.9

81.1

72.9

38.6 I

63.9

78.0

74.4

63.4

72.7

62.8

79.4

57.8

71.1

59.2

66.5

55.8

75.6

14.42

5.20

16.16

4.95

17.73

6.98

13.9

14.5

.

:;:

1.0

3.1

2.1

1.3

2.9

2.2

2.2

1.6

3.7

2.7

3.56

1.48

2.54

0.70

7.20

2.88

24
Table 7. prevalence rotas for cardlwascular conditions among children in 1963.1965 and youths in 1966.1970 with specific types of findings from examination and

medical history, by age and sex, with standard errors for totals: LJnitad States

Age and sex

I

Both sexes

6 years ................................ .........

7 y~ars .........................................

8 years ............................... ........ ..

9 years .................... .....................

10years .......................................

11 veals ........ .................... ..........

12years .......................................

13 years ......................... .... ..........

14years ........ .... ...........................

15 years .......... .............................

16 years ......... ................... ...........

17 years ............................. ..........

6.11 years ............................. .......

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

Boys —

6.11 year . ................ ...................

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

—Glrla

6.11 years ....................................

12.17 years ........ ..........................

Both sexes

6-11 years ................................... .

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

Boys —

6-11 years .............................. .. ....

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

Girls —

6-11 years ,., ,,,,.,.. ,.. ,,,., ,................

12-17 ywirs,..,,, .................... ....... .

Point of maximum Impulse Murmurs

I

signif -

Interspace Midclavicular line icant or

1

possibly

4 5 6 At

ln- out- signifiside side cant

POsitive

EKG

I

POsi- 1St

tive heart

chest sound

X-ray abnormal

I I 1 I 1 1 I I 1

1.8

2.1

1.6

1.2

3.1

1.5

3.5

3.2

3.2

5,0

2.4

3.9

:;:

1.9

3.5

1.9

3.8

0.46

1.40

0.60

2.75

0.57

1.26

2,8

3.2

3.6

Zg

1.6

z

3.B

6.3

4.1

6.0

5.6

2.7

5.0

2.7

5.3

2.6

4.6

0.37

0.96

1.49

.25

L45

.03

10.0

16.1

9.7

5.7

5.B

B.O

6.3

4.3

4.8

3.7

B.8

4.8

12.7

5.0

3.3

4.5

$.99

0.79

i.86

L99

i.86

1.74

4.1

3.7

2.8

1.9

2.4

3.1

4.2

3.9

7.5

4.6

5.4

5.B

3.0

5.2

3.2

5.6

2.8

4.3

0.5

2.1

2.2

0.7

1.4

1.2

3.4

3.8

4.3

3.7

4.0

4.1

1.4

3.9

1.4

3.9

1.3

3.B

L

0.44 0.33

0.97 0.B2

D.57 0.48

1.21 0.93

2.44 0.42

3.87 0.7B

Prevalence of heart condition, rate per 100 persons I

2nd

heart

Other

heart

sound abnorabnor- mality

m al

33.0

25.5

46.3

23.0

6.7

2.9

8.4

6.1

12.3

13.4

10.5

25.7

9.1

21.1

7.0

32.1

11.2

7.26

2.39

7.89

2.51

1.58

3.59

58.5

68.0

50.5

64.B

65.1

41.B

97.0

B8.7

98.0

94.6

94.7

77.2

56.B

90.3

60.0

90.0

53.8

91.0

..

. .

.. .

. . .

. . .

. . .

19.5

31.2

25.2

17.1

19.3

21.9

. . .

. . .

. . .

. . .

. . .

. . .

22.6

. . .

21.4

. . .

24.4

. . .

30.0

82.8

38.2

65.6

27.9

43.4

. . .

. . .

. . .

. . .

. . .

. . .

50.4

. . .

44.7

. . .

5B.2

. . .

Standard error

3.95

. .

4.42

. . .

6.40

. . .

9.86

. . .

14.89

. . .

9.15

. . .

.. .

.. .

. ..

. . .

. ..

. ..

lB.O

30.9

59.5

19.5

54.8

. . .

34.6

. . .

39.5

. . .

24.6

.. .

10.55

. . .

11.32

. . .

19.95

.. .

.. .

. ..

. . .

.. .

. ..

26,1

38.1

39.8

2B.1

49.5

4B.1

. . .

37.9

. . .

39.2

. . .

36.4

. ..

15.93

. ..

22.51

J

...

12.91

. ..

. ..

.. .

.. .

.. .

. ..

35.8

34.0

74.6

42.4

13.9

28.9

. . .

42.1

. . .

41.7

. . .

42.5

. . .

8.12

. . .

6.24

. . .

12.99

Heart

Positive condition cardiac

history history

(from at examination parent)l

10.2

18.7

14.5

15.5

25.7

21.2

15.1

18.9

24.2

18.9

21.2

20.3

17.8

19.6

16.5

21.0

19.6

lB.1

3.07

4.27

3.37

5.02

3.91

3.87

37.3

50.B

4B.3

51.4

52.3

38.4

-..

---

.-.

. . .

. . .

.-.

46.3

. . .

40.3

. . .

55.2

. . .

B.95

. . .

10.00

..-

9.27

. . .

lIncludes murmurs.

25
Table 8. Mean systolic and diastolic blood pressure (2-reading average) among children in 1963-1965 and youths in 1966-1970 with

normal and abnormal cardiovascular diacsnostic imrxessions from examination, bv age and sex, with standard errors for totals:

United States

Age and sex

8oth sexes

6 years ........................................

7 yaars ........................................

8 years ........................................

9 years ........................................

10years ......................................

11 years ......................................

12 years ......................................

13 years ......................................

14 years ......................................

15 years ......................................

16 years ......................................

17 years.., ...................................

6-11 yaars ...................................

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

Boys

6-11 yaars ...................................

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

Girls

6-11years ...................................

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

Both sexes

6-11 years ...................................

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

Boys

6-11 years ...................................

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

Girls

6-11 years ...................................

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

Cardiovascular diagnostic impression

I

Abnormal .

‘orma’FIFziiF

Mean systolic blood pressure (mm. Hg)

105.9

107.9

109.4

110.8

111.9

113.7

122.6

126.4

129.2

130.9

132.7

133.5

109.9

129.0

108.3

130.8

110.4

127.3

0.33

0.42

0,35

0.41

0.34

0.48

105.7

110.1

112.8

112.9

114.9

116.5

124.3

135.0

137.3

137.5

144.1

146.9

112.2

138.0

111.0

139.7

113.5

136.0

0.92

1.11

1,03

1.29

1.12

1.37

..-

. . .

. . .

-..

..-

---

158.5

148.0

148,1

149.6

155.8

168.5

..-

162.9

. . .

153.4

---

152.4

---

3.77

-..

3.39

. . .

4.83

-..

. . .

. . .

. . .

..-

. . .

124.0

133.3

135.4

135.5

139.2

142.1

. . .

134.8

.-.

136.8

. . .

132.5

..-

1.12

. . .

1.26

.-.

1.19

---

.-.

-..

. . .

. . .

. . .

124.2

135.0

134.7

137.6

143.9

144.5

..-

136,2

.-.

138.3

---

133.6

Abnormal

Normal HyparNonhyper- SignifiAll tensiva tensive cent

typas heart heart murdisease disease murs

Mean diastolic blood pressure (mm. Hg)

65.5

65,9

66.8

67.2

67.7

66.8

69.5

71.4

72.9

74.1

75.4

76.6

66.6

73.2

66.4

73.0

66.8

73.3

Standard error

--- 0.60

1.07 0.30

. . . 0.60

1.22 0.36

1

... 0.62

1.16 0.29

66.8

67.7

67.9

67.7

65.6

66.7

68.8

73.6

75.1

76.2

79.8

79.6

67.1

75.7

66.3

75.0

67.9

76.6

0,83

0.79

0.84

0.96

1.05

1.33

-..

.-.

..-

. . .

. . .

..-

79.3

87.1

92.2

87.9

92.2

89.5

..-

89.7

..-

89.6

. . .

89.9

-..

2.75

. . .

3.61

. . .

2.60

. . .

. . .

. . .

-..

. . .

. . .

68.8

70.6

72.8

73.6

75.7

76.7

. . .

73.0

-..

72.5

. . .

73.6

. . .

0.59

. . .

0.53

. . .

1.24

. . .

. . .

. . .

. . .

. . .

. . .

68.8

71.6

71.5

72.4

73.9

75.8

..-

72.2

. . .

72.0

. . .

72.4

. . .

0.86

. . .

0.53

. . .

1.86

26
Table 9. Prevalence rates for cardiovascular conditions from diagnostic impression among children aga 6-11 years in 1663-1665 and

youths aga 12-17 years in 1966-1970, by present health status, health a worry (to parent), regular use of medicine, and sax, with

standard errors: United Sti

Health status and use

of medicine

Present health status

(parent rating)

Excellent ..................................

Very good ................................

Good ........................................

Fair ..........................................

Poor ,,...............!. ......................

Present heelth status

(youth rating)

Excellent ..................................

Very good ................................

Good ........................................

Fair ..........................................

Poor .........................................

m

A worry ....................................

Not a worry ..............................

Medicine used regularly

(parent report)

Yes ...........................................

No ......................... .. .. .. .......... ...

Medicine used regularly

(youth report)

Yes...........................................

No ............................................

s

Children, 6-11 Youths, 12-17

years years

Both

Boys Girls Both

sexes

Boys Girls

sexes

Cardiovascular rate par 100 persons

. . .

2,2

2,4

3.4

19.7

. . .

. . .

. . .

. . .

. . .

3.4

2.2

5.5

2.3

,..

. . .

. . .

2.3

2.4

4.0

22.7

!..

. . .

. . .

. . .

. . .

3.4

2.4

4.4

2.4

. . .

. . .

.-.

2.2

2.4

2.9

16.2

. . .

. . .

. . .

. . .

. . .

3.4

2.1

6.7

2.2

. . .

. . .

4.0

3,8

5.3

11.9

23.8

3.5

4.2

4.8

13.5

4.0

7.1

4.2

6.6

4.5

7.1

4.4

4.9

3.9

5.0

14.4

16.7

3.9

5.3

4.5

14.6

6.9

4.6

6.1

4.8

5.9

4.8

3.1

3.7

5.5

9.5

29.1

3.1

3.1

5.1

12.7

8.9

7.4

3.9

7.2

4.2

8.1

4.0

Standard error

. . .

0.38

0.31

0.92

9.12

. . .

. . .

. . .

. . .

. . .

0.62

0.32

1.39

0.28

. . .

. . .

. . .

0.60

0.42

1.43

9.45

. . .

. . .

. . .

. . .

. . .

0.63

0.48

1.39

0.45

. . .

. . .

. . .

0.32

0.38

1.25

12.82

. . .

. . .

. . .

. . .

. . .

1.06

0.30

2.14

0.26

. . .

,,.

0.77

0.85

0.88

2.55

17.18

0,85

0.66

0.93

3.19

3.92

0.95

0.72

1.10

0.73

1.00

0.70

1.13

0.98

1.18

4.53

12.33

1.20

0.92

1.05

5.09

1.26

0.90

1.87

0.89

1,69

0.88

0.49

0.84

0.99

2.67

25.30

0.72

0.59

1.01

3.55

9.49

1.35

0.66

2.08

0.68

1.81

0.68

27
Table 10. Prevalence rates amona white and Naaro -.. children in 1863-1965 and vouths in 1966-1970 for selacted examination and historv

findings relating t; cardiova

Age and sex

Both sexes

6 years ......................................................

7 years ......................................................

8 years ......................................................

9 years ......................................................

10 yeare .o...............o..........o..................m....

11 years ....................................................

12 yeara ....................................................

13 years ..............................o.....o...............

14 years ....................................................

15 years ....................................................

16 years ....................................................

17 years ....................................................

6-11 years .................................................

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

Boys

6-11 years .................................................

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

Girls

6-11 years ............o......m..o..........................

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

Both sexes

B-11 years .................................................

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

Boys

6-11 years .................................................

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

Girls

6-11 years .................................................

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

liar conditions, by age and sex, with standard errors for totals: United States

Medical his- Heart condi- Significant

Rheumatic

Diagnostic

tory-heart

fever history

tion-most murmurs impressioncondition serious illness found on

(from parent)l

congenital

(from parent) (from parent) examination heart condition

White I Nagro I White I Negro I White I Negro ] White I Negro I White I Negro

3.7

3.8

3.6

3.7

3.8

4.4

4.4

3.9

5.6

5.3

4.8

6.2

3.B

5.0

4.5

5.6

3.2

4.4

0.26

0.39

0.33

0.45

0.47

0.55

1.4

1.0

5.8

3.8

2.8

6.3

6.1

2.2

3.6

2.7

3.0

2.5

4.1

2.1

2,6

2.9

5.5

0.69

0.77

0.76

0.65

0.76

1.12

0.3

0.2

0.4

0.5

1.2

0.8

0.7

1.1

0.6

0.5

1.4

1.7

0.6

1.0

0.6

1.0

0.6

0.9

0.13

0.12

0.15

0.13

0.21

0.17

1.0

0.4

0.9

1.1

0.5

0.7

0.4

0.4

0.1

0.3

0.6

0.5

0.23

0.24

0.13

0.23

0.43

0.32

Rate per 100 persons

-..

..-

. . .

-..

. . .

. . .

0.2

0.2

0,9

0.5

0.5

0.4

. . .

0.5

.-.

0.6

. . .

0.3

. . .

.-.

.-.

. . .

..-

-..

2.0

1.0

1.0

0.6

. . .

0,8

---

0.3

..-

1.3

Standard error

. . .

0.12

---

0.16

.-.

0.14

---

0,31

..-

0.20

. . .

0.55

31.4

25.9

27.9

23.6

25.8

25.5

18.6

19.6

17.5

17.1

15.0

17.0

26.7

17.5

26.6

17.7

26.9

17.2

2.25

1.41

2.35

1.47

2.42

1.72

19.0

30.5

23.9

27.8

23.6

31.6

15.4

11,1

11.3

9.1

17.5

13.5

26.0

13.0

25.0

11.9

26.9

14.1

2.02

1.15

1.81

1.05

3.11

1.72

1.7

1,5

1.3

1.3

1.8

1.2

0.1

0.3

0,8

0.3

0.4

0.6

1.5

0.4

1.8

0.5

1,2

0.4

0.18

0,11

0.23

0.19

0.20

0.09

3.6

1.9

4.5

3.6

0.6

2.7

1.2

0.5

2.8

0.3

2.3

3.3

0.6

0.81

0.15

1.47

0.71

0.31

lData fOr youths are limited to most serious illness.

28
T#ble 11. Prevalence rates for specific abnormal cardiac findings on examination of white and Negro children, by age and sax, with

standard errors for totals: United States, 1963-1965

Age and sex

Both sexes

6yeaw ................................................................................................................

B ~ears ,,,......4...,.,..,,, ,,.....................!.,...,,, ...........................................................

9 years ................................................................................................................

10 years ...............o....o...........................................................o.............................

11 years .........................................o............................m.o.......o...o.........................

Both saxes, 6-11 years.........................................................................................

Boys, 6-11 years..................................................................................................

Girls, 6-11 years .................................................................................................

Both sexes, 6-11 years.........................................................................................

Boys, 6-11 years..................................................................................................

Girls, 6-11 years ..................................................................................................

I

Chest X-ray

I

Abnormel carEKG findings findings disc history at

examination

White I Negro I White ] Negro I White I Negro

3.8

4.1

4.2

5.0

4.1

4.8

4.3

5.0

3.7

1.22

1.46

1.05

Rate per 100 children

7.2

13.9

9.4

:::

5.0

7.6

9.4

5.8

2.72

3.93

1.8o

1.9

2.5

2.1

2,5

2.8

4,2

2,7

3.0

2.3

9.5

7.0

1.6

8.5

6.0

7.2

6.6

6.2

7.1

Standard error

0.55

0.66

0.!52

5.1

4.8

6.3

6.7

5.8

5.9

5.8

6.4

5.1

2.01

I

1.36

2,07 1.56

2.27 1.30

12.3

9.5

5.1

8.6

9.8

8.2

8.9

8.9

8.9

2.90

2.95

2.98

I 1 I 1 1

28
Table 12. Prevalence rates for cardiovascular conditions from diagnostic imrmaaion among childran in 1963-1865 ●nd voutha in 1988-1970, bv w, sex, ram, gaogrwhlc

ragion, urban or rural place of raaidance, ●nnual familv Incoma ●nd aducation of parent, with standard errors for totals: lfnltad States

Age and sex

Both sexes

6 yeara ...............................

7 vaars ...............................

8 veara ...............................

9vears ...............................

10 veara .............................

11 kears .............................

12 years .............................

13 years .............................

14 yeara .,.., .............!.... .,.,,.

15 vears .............................

16 y’emc .............................

17 veara .............................

6.11 vears ..........................

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

f3ClJQ

6-11 years ..........................

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

Girls —

6-f 1 V@am..........................

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

Both aexea

6-11 vears ..........................

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

80VS —

8-11 vearc ..........................

12.17 years ........................

Girls —

8.11 vears ..........................

12.17 yaws ........................

Race I

“. Region

\ I

Place of

teaidenca I

Annual family incmme I

Parent education

NorthLeca Sa

?Jhlte Negro :: South west Urban ~u,al Under $5#ow- $10,000 9-12 13 psrs

east $5,000 $9,968 or ovar ~:::r. wars wars or more

Cwdkwaccuk prevalence rates per 100 parsons

2.1

2.4

2.2

1.5

2.2

2.0

z

5.4

4.4

5.2

5.0

2.1

4.5

2.4

4.9

1.7

4.0

0.27

0.68

0.40

0.88

0.27

0.63

4.2

4.6

6.2

5.1

1.4

3.7

8.1

4,7

6.5

3.5

B.9

1.9

4.2

5.7

2.7

4.9

5!8

5.5

0.65

1,27

1.51

1.29

0.91

1.44

2.2

4.2

3.4

2.6

2.2

3.4

::;

3.3

5.4

4.8

3.8

3.0

3.8

3.6

4,0

2.3

3.5

0.70

1.07

1.00

1.34

0.50

0.90

1.2

2.4

1.6

0.9

2.0

1.7

z

4.0

3.0

4.6

5.7

1.7

3.6

1.8

4.0

1.8

3.2

0.49

1.02

0.71

1.14

0.62

1.01

5.6

3.6

5.2

3.8

3.2

3.1

9.4

7.6

11.9

R

6.2

4.1

8.4

4.1

9.0

4.1

7.8

0.58

2.21

1.03

2.68

0.56

2.09

1.0

1.0

1.4

0.8

1.1

1.0

;

3.4

3.1

4.2

2.5

1.0

3.0

0.7

2,8

E

0.39

0.58

0.37

0.64

0.57

1.07

2.0

2.3

2,5

E

3.7

4.0

4.1

6.5

4.5

2.0

4.3

2.0

4,6

2.0

4.1

3.4

3.7

3.4

2.6

2.2

3.8

&

8.2

::

4.8

3.2

5.1

3.5

5.4

2.9

4.8

2.9

2.7

3.9

3.1

1.9

3.9

z

7.4

::

7.0

3.0

6.6

2.7

5.4

3.4

7.8

Stmdard error

L

0.26 0.s3 0,86

0.53 1.38 1.23

0,33 0.81 1.08

0.69 1.70 1.23

0.28 0.45 1.31

0.58 1.33 2.60

2.6

3.4

1.9

1.4

2.3

1.3

;:

6.3

4.6

5.7

2.9

2.2

4.1

?7

E

0.32

1.08

0.52

1.43

0.30

0.91

1.7

1.4

3.0

1.6

2.5

1.0

E

4.6

2.6

4.5

4.4

1.9

3.6

2.6

4.9

1.0

2.3

0.50

0.88

0.63

1.m

0.51

0.67

2.9

2.1

5.1

8.0

3.8

3.4

6,2

7.3

11.9

6.6

5.3

3.1

4.2

6.9

3.6

5.7

4.6

6.0

1.38

2.63

1.75

2.47

1.22

3.86

3.1

2.8

3.2

2.7

1.3

2.2

2.9

4.3

4.9

4.6

2.6

6.0

2.5

4.3

2.5

4,2

2.5

4,3

0.39

0.61

0.58

1.07

0.52

0.87

2.3

3,5

2.4

Y9

1.8

2

4.6

4.0

7.6

4,8

2.3

4.9

2,5

5.2

2.1

4,5

0,31

0,69

0.48

0.B9

0.26

0.69

1.6

1.3

2.2

1.7

0,7

3.0

2.0

2.9

6.1

E

3.4

1.7

3.7

1.8

4,6

1.6

2.6

0.43

1.17

0.50

1.69

0.61

0.83

30
Tzble 13. Prevalence rates for cardiovascular .w.diti.ns fmm diagnmric inmremion amona white and Nemo children in 1963-1965 and youths in 1966-1970, by geographic region, urban or rural

Age and sex

place of residence, annual family income, age, and sex. with standard error. for totals: United States

Region I Place of residence I Annual family income

Northeast Midwest South West Urban Rural Under $6,0CiI $10,OW or $5,000-69,999 ~ver

White Negro White Negro White Negro White Negro White Negro White Negro White Negro White Negro White Negro

Cardkwascular pm.deme rate per 100 persons

2.1 3.2

3.3 9.0

S.o 6.7

3.0 .

2.5 -

4.0 -

1.8 2.6

3.8 4.4

3.8 -

6.1 -

5.1 2.9

4.4 -

3.0 3.2

4.1 1.8

3.8 3.4

4.5 -

2.1 3.1

3.6 3.2

0.83

1.22

1.19

1.54

0<50

1.05

1.61

0.48

1.96

1.41

1.00

1,0

2.4

1.6

0.6

2.2

1.6

1.6

2.8

3.8

3.4

4.3

5.9

1.6

3.6

2.0

4.1

1.2

3.1

0.52

1.05

0.76

1.22

0.50

1.03

4.0

3.0

2.6

4.6

,3.5

5.s

6.0

8.1

3.8

2.6

4.1

3.7

5.7

4.6

1.40

2.02

1.94

2.99

2.44

5.7

3.1

4.2

2.4

3.3

2.3

7.-1

8.3

12.6

5.5

7.3

7.6

3.5

6.2

4.1

9.2

2.9

7.1

0.40

2.39

0.64

3,09

0.61

2.13

6.0

4.6

7.6

6.9

3.2

5.6

13.7

7.0

9.9

7.2

13.8

1.7

6.7

9.0

4.2

S,3

7.4

9.s

1.35

2.21

3,35

2.07

1.12

2.57

0.7

1.1

1.0

0.5

1.2

0.7

2.2

2.8

2.9

3.4

4.6

2.5

0.9

3.1

0.6

2.9

1.2

3.3

0.34

0.64

0.31

0.70

0.46

1.11

5.8

6.6

3.8

2.s

4.7

3.0

2.4

2.0

1.1

4.6

3.0

4.98

1.16

1.0s

8,45

2.75

2,0

1.5

1.8

1.4

2.1

1.4

.2.2

3.9

4.1

4.8

6.0

5.2

1.7

4.3

2.1

4.8

1.3

3.9

2.1

5.3

5.4

3.1

1.8

2.1

6.6,

2.9

3.9

0.6

9.1

0.8

3.3

4.5

1.6

3.8

5.1

5.2

Standard error

0.26

0.54

0.35

0.72

0.25

0.56

2.3

3,9

2.9

1.8

2.4

3.2

4.1

4.3

7.4

3.8

3.8

4.7

2+3

4.7

3.1

5.0

2.4

4.3

0.51 0.60

1.00 1.23

0.s9 0.77

1.00 1 ,6s

0.80 0.46

1.15 1.06

12.4

2.0

10.3

13.0

10.3

5.3

9.9

14.6

15.1

8.4

5.9

7.9

10.0

7.0

6.8

6.9

11.3

2.80

5.27

5.84

4.s5

1.82

5.95

2.7

1.8

2.9

1.8

1.9

3.3

5.0

4.8

7.4

5.6

5.9

9.8

2.4

6.3

2.6

5.2

2.2

7.3

0.40

1.38

0.53

1.91

0.71

1.67

3.4

5.2

6.5

6.6

2.0

5.5

12.1

6.5

7.5

4.2

12.9

1.3

4.6

7.4

3.0

6.0

6.6

S.9

2.2

3.2

1.7

1.4

2.5

1.5

3.1

3.6

5.4

5.0

6.0

2.9

2.1

4.3

2.3

4.9

1.8

3.6

5.6

4.1

3.6

1.9

1.0

2.0

1.6

0.3

39.6

2.5

1.6

1.5

2.1

3.6

1.4

1.2

1.4

3.0

1.6

2.6

1.0

1.7

4.0

4.6

2.7

4.6

4.4

1.8

3.7

2.5

5.0

1.0

2.3

I_--l

0.92 0.32 1.48 0.68

1.21 0.79 0.76 0.s4

1.40 0.38 2.4S 1.01

1.45 0.95 0.83 1.30

1.18 0.60 1.95 0.65

1.64 0.76 1.21 0.69

63.6

7.1

5.1

11.0

2.5

19.9

3.1

2.0

11.31

2.11

19.59

3.17

3.10

31
6;

Table 14. Prevalence rates for major types of cardiovascular conditions from diagnostic impression among youths age 12-17 years, by ~

race, geographic region, urban or rural place of rasidence, annual family income, and sex, with standard arrors: United States.

1966-1970

Cardiovascular condition

(diagnostic impression)

and sex

Rheumatic heart disease

Both saxes............

Boys .....................................

Girls......................................

Hypertensive heart disease

Both saxes............

Boys .,...................................

Girls......................................

Congenital heart disease

Both sexes............

Boys .....................................

Girls......................................

Other heart disease

Both sexes............

Boys .....................................

Girls......................................

Rheumatic heert disease.......

Hypertensive heart disease....

Congenital heart disease........

Other heart disease...............

Race Region Placa of

residence Annual family income

White Negro North- Mid- South West Urban Under $5,000- $10,000

east west ‘Ura’ $5,000 $9,999 or over

1.0

1.1

0.8

0.6

0.6

0.6

0.4

0.5

0.4

2.5

2.8

2.2

0.15

0.15

0.11

0.55

1.2

0.6

1.8

0.8

1.2

0.6

0.3

0.6

3.2

3.0

3.4

0.32

0.44

0.15

1.04

0.4

0.4

0.4

0,9

0,8

1.0

0.3

0.4

0.2

2.2

2.5

1.9

0.19

0.38

0.17

1.07

Rate par 100 youths

1.2 1.6 0.7 1.0 1.1

1.4 1.6 0,6 1.2

1.1 1.7 0.8 ;:: 1.0

0.7 0.7 0.2 0.7 0.5

0.6 0.9 0.3 0.8 ().3

0.8 0.5 0.2 0.6 0.6

0.6 0.4 0.2 0.3 ().5

0.5 0.2 0.4 0,3 0.6

0.6 0.7 0,1 0.4 0.4

1.2 5,5 1.7 2.3 3.1

1.7 6.0 1.5 2.5 3.3

4.9 2.0 2.0 2.8

Standard error-both sexes

Ll_lL

0.36 0.29 0.21 0.24

0.33 0.15 0.18 0.22

0.13 0.15 0.09 0.23

2.01 0.54 0.41 1.11

1.3 0.9 1.0

I 1

1.1 0.9 1,2

1.4 0,8 0,9

0.8 0.6 0.7

0.6 0.6 0.8

0.9 0.5 0,6

J-L0.2 0,1 0.6

0.9 0.2 0.1

3.9 2.5 1.6

3.4 3.0 2.5

4.4 1.9 0.7

. . . . . . . . .

. . . . . . . . .

. . . . . . . . .

. . . . . . . . .

/ -“--

32
Tabla 15. Prevalence ratas for major types of cardiovascular conditions from diamsostic impression among white and Negro youths age

12-17 years, by geographic region, urban or rural place of resiflence, and sex~with standard errors: U~ted States, 1966-1970

Cardiovascular condition (diagnostic

impression) and sex

Rheumatic heart

-

Both sexes....

Boys,,,,.,.,.,, ,..,,.,...........

Girls .............................

Hypertensive heart

diseese

Both sexes....

Boys.............................

Girls .............................

Congenital haart

disease

Both sexes....

Boys,.., .........................

Girls,..,.., ......................

Other heart disease

Both sexas..,.

Boys.............................

Girls ...................,,,. ..,,.,

Rheumatic heart

disease.......................

Hypertensive heart

disease,.,., ..................

Congenital heart

disease.......................

Other heert disease.......

Ragion Place of residence

Northeast Midwest South West Urban Rural

White Negro White Negro White Negro White Negro Whita Nagro Whita Negro

Rate per 100 youths

0.3 1.0 1.2 2.1 1.8

0.5 - 1.3 2.8 2.1

0.1 1.7 1.0 1.2 1.5

1.0 0.5 0.7 0.6 0.4

0.8 - 0.7 - 0.3

1.1 0.8 0.7 1.2 0.5

0.3 - 0.6 0.5 0.5

0.5 - 0.6 - 0.3

0,2 - 0.6 1.1 0.7

2.5 0.4 1.2 1.0 5.4

2.8 - 1.8 0.9 6.3

2.1 0.7 0.7 1.1 4.4

1

0.16 0.60

. . . 0.52

0.20 -

1.19 0.62

1.2

0.3

2.1

2.0

3.5

0.6

0.4

0.8

5.7

5.4

6.0

0.7

0.6

0.8

0.2

0,3

0.2

0.3

0.4

0.1

1.8

1.5

2.1

0.8

1.7

1.2

1.1

1.2

Standard error–both sexes

0.40 1.32 0.46 0.45 0.29 0.70

. . . 0.53 --- 1.28 --- -

0.30 0.51 0.16 0.24 0.17 -

0.45 0.67 2.12 2.12 0.59 0.61

1.0

1.0

0.9

0.7

0.8

0.6

0.3

0.3

0.3

2.4

2.7

2.0

0.22

0.19

0,10

0.40

1.1

=

0.8

1.4

0.8

=

1.0

0.7

0.4

=

0.7

2,0

=

1.8

2.2

0.30

0.42

0.13

. . .

1.0

1.2

0.8

0.4

0.2

0.7

0.6

0.7

0.5

2.7

3.0

2.4

0.20

0.23

0.25

0.97

1.8

3.7

0.9

1.7

7.3

7.1

7.6

0.72

0.90

-..

33
APPENDIXES

CONTENTS

I. Statistical Notes .............................................................................................................................. 35

Survey Design............................................................................................................................ 85

Reliability .................................................................................................................................. 36

%mpling and Memwement Emor .............................................................................................. 38

Examiner Variability .................................................................................................................. 38

Small Numbers ............................................................................................................................ 39

IL Demographic and Socioeconomic Terns ......................................................................................... 40

m. Medical Hwtory and Physical Examination Forms ........................................................................... 42

Selected Items From Medical History of Youth–Parent’s Questionnaire ................................ 42

Selected Items From Health Habits and History-Youth (Questionnaire) ............................... 44

Selected Items From the Physical Examination Fom ................................................................ 45

Diagnostic Impressions (Examination of ~dd) .......................................................................... 45

Summary of Dmgnostic Impressions (Examination of Youth) .................................................... 45

Selected Items From Chdd’s Medical History-Parent (Questionnaire) ....................................... 46

Recording and History Forms .................................................................................................... 46

LIST OF APPENDIX TABLES

I. Number of examinees by extent of selected missing items on physical examination and in the

medical hktory and by age and sex: Health Examination Surveys, 1963-1965 and 1966-1970,... 37

IL Number of examiners by percent of examinees they found with significant cardiovascular abnormality in Cycles II and III, with range, mean, median, and quartiles in the distribution of the

percent of examinees abnormal: Health Examination Surveys, 1963-1965 and 1966-1970 .......... 38

III. Number of examiners by percent of examinees they found with any significant abnormzdity and

with a cardlovaacukar abnormality in Cycles II and HI, with range, mean, median, and quartiles

in the distribution of tbe percent of examinees abnormal: Health Examination Surveys, 1963-

1965 and 1966-1970 ......................,..,. ,........................................................................................ 39

34
APPENDIX I

STATISTICAL NOTES

Survey Design

The sample designs for the first three programs (Cycles I-III) of the Health Examination

Survey have been essentially similar in that each

has been a multistage, stratified probability

sample of clusters of households in land-based

segments. The successive elements for this sample design are the primary sampling unit (PSU),

census enumeration district (ED), segment (a

cluster of households), eligible person, and,

finally, the sample person.

The same 40 sample areas and the same

segments were utilized in the design of both

Cycles II and III. Previous reports describe in

detail the sample design used for Cycle II and, in

addition, discuss the problems of and considerations given to other types of sampling frames,

cluster versus random sampling, and whether or

not to control the selection of siblings.AYZO

Requirements and limitations placed on the

design for both Cycles II and III were that:

The target population be defined as the

civilian noninstitutionalized population of

the United States, including Alaska and

Hawaii, of ages 6-11 years for Cycle II and

12-17 years for Cycle III, with the special

exclusion of children residing on reservation

lands of the American Indians. The latter

exclusion was due to operational problems

encountered on these lands in Cycle I.

The time period of data collection be limited

to about 3 years for each cycle and the

length of the individual examination within

NOTE: A list of referencesfollows the text.

the specially constructed mobile examination center be between 2 and 3 hours.

Ancillary data be collected on specially

designed household, medical history, and

school questionnaires and from birth certificate copies.

Examination objectives be primarily related

to factors of physical and intellectual growth

and development.

The sample be sufficiently large to yield

reliable findings within broad geographic

regions and population density groups as

well as age, sex, and limited socioeconomic

groups for the total sample.

The sample was drawn jointly with the U.S.

Bureau of the Census, starting with the 1960

decennial census list of addresses and the nearly

1,900 PSU’S into which the entire United States

was divided. Each PSU is either a standard

metropolitan statistical area (SMSA), a county,

or a group of two or three contiguous counties.

These PSU’S were grouped into 40 strata, each

stratum having an average size of about 4.5

million persons, m such a manner as to maximize the degree of homogeneity within strata

with regard to the population size of the PSU’S,

degree of urbanization, geographic proximity,

and degree of industrialization. The 40 strata

were than classified into four broad geographic

regions of 10 strata each and then within each

region cross-classified by four populationdensity classes and classes of rate of population

change from 1950 to 1960. Using a modified

Goodman-Kish controlled-selection technique,

one PSU was drawn from each of the 40 strata.

35
Further stages of sampling within PSU’S

required first the selection of ED’s, which are

small, well-defined areas of about 250 housing

units into which the entire Nation was divided

for the 1960 population census. Each ED was

assigned a “measure of size” equal to the

rounded whole number resulting from a “division by nine” of the number of children age 5-9

years in the ED at the time of the 1960 census.

A sample of 20 ED’s in the sample PSU were

selected by systematic sampling with each ED

having a probability of selection proportional to

the population of children age 5-9 years at the

time of the 1960 census date. A further random

selection by size of segments (smaller clusters of

housing units) within each ED was then made.

Because of the 3-year time interval between

Cycle II and Cycle III, the Cycle III frame had

to be supplemented for new construction and to

compensate for segments in which housing was

partially or totally demolished to make room for

highway construction or urban redevelopment.

Advanced planning for the examinations at

the various locations or stands provided for

about 17 days of examinations, which limited the

number of examinees per Iocation to approximately 200. When the number of eligible children or youths in the sample drawn for a

particular location exceeded this number, subsampling was done by deleting from the master

list of eligible children or youths (ordered by

segment, household order within segment, and

age within household) every nth name on the list

starting with the yth name, y being a number

between 1 and n selected randomly and n being

the extent of oversampling in the original draw.

In both Cycles II and III, twins who were

deleted in the sample selection were also scheduled for examination if time permitted, as were

youths deleted from the Cycle III sample who

had been examined in Cycle II.

In both Cycles II ana III, the sample was

selected to contain the correct proportion of

children from families having only one eligible

child, two eligibIe children, and so on, to be

representative of the total target population.

However, since households were one of the

elements in the sample frame, the number of

related children or youths in the resultant

sample is greater than would come from a design

which sampled children aged 6-11 or 12-17 years

without regard to household. The resultant

estimated mean measurements or rates should be

unbiased but their sampling variability will be

somewhat greater than those from a more

costly, time-consuming, systematic, sample design in which every kth child would be selected.

The total probability sample for Cycle II

contained 7,417 children representative of the

approximately 24 million children 6-11 years of

age in the U.S. target population at the time of

the survey; Cycle III included 7,514 youths

similarly representative of the approximately

22.7 million noninstitutionalized youths of 12-

17 years in the United States. Each of these two

samples contained approximately 1,000 children

(or youths) in each single year of age and from

25 different States.

The response rates in Cycles II and III were

96 and 90 percent, respectively, with 7,119

children and 6,768 youths examined out of the

total sample. Both groups of examinees were

closely representative of their respective samples

as well as of the population from which the

samples were drawn with respect to age, sex,

race, geographic region, population density, and

population growth in the area of residence.

Hence it appears unlikely that nonresponse

could bias the findings appreciably.

Measures used to control the quality of the

data from these surveys have been cited previously;4 ~s~z1 those additional measures specifically related to the particular examinations,

tests, or measurements are outlined in the

analytic reports describing and presenting the

respective initial findings.

Reliability

While measurement processes in the surveys

were carefully standardized and closely controlled, the correspondence between the real

world and survey results cannot be expected to

be exact. Survey data are imperfect for three

major reasons: Results are subject to sampling

error, the actual conduct of a survey never

agrees perfectly with the design, and the measurement processes themselves are inexact even

though standardized and controlled.

The first reports on Cycle 114 and 111~

describe in detail the faithfulness with which the

sampling design was carried out.

Data recorded for each sample child and
youth are inflated in the estimation process to

characterize the larger universe of which the

sample child or youth is representative. The

weights used in this inflation process are a

product of the reciprocal of the probability of

selecting the child or youth, an adjustment for

nonresponse cases, and a poststratified ratio

adjustment that increases precision by bringing

survey results into closer alignment with known

U.S. population figures by color and sex within

single years of age 6-11 for the children’s survey

and age 12-17 for the youths’ survey.

in Cycles II and III of the Health Examination Survey, the samples were the result of three

principal stages of selection–the single PSU

from each stratum, the 20 segments from each

sample PSU, and the sample children and youths

from the eligible persons. The probability of

selecting an individual child or youth is the

product of the probability of selection at each

stage.

Since the strata are roughly equal in population size and a nearly equal number of sample

children or youths were examined in each of the

sample PSU’S, the sample design is essentidy

self-weighting with respect to the target population; that is, each child 6-11 years old and youth

12-17 years had about the same probability of

being drawn into the respective samples.

The adjustment upward for nonresponse is

intended to minimize the impact of nonresponse

on final estimates by imputing to nonrespondents the characteristics of “similar” respondents.

Here “similar” respondents were judged to be

examined children or youths in a sample PSU

having the same age in years and the same sex as

children or youths not examined in that sample

Psu.

The poststratified ratio adjustment used in

the second and third cycles achieved most of the

gains in precision that would have been attained

if the sample had been draws-ifrom a population

stratified by age, color, and sex and made the

final sample estimates of population agree

exactly with independent controls prepared by

the Bureau of the Census for the U.S. noninstitutionalized population as of August 1, 1964

(approximate midsurvey point for Cycle II) by

color and sex for each single year of age 6-11;

and similarly as of March 9, 1968 (approximate

midsurvey point for Cycle III) for each single

year of age 12-17. The weights of every responding sample child and youth in each of the 24

age, color, and sex classes is adjusted upward or

downward so that the weighted total within the

class equals the independent population control

for each survey.

In addition to children or youths not examined at all, there were some whose examination was incomplete in one procedure or another. The extent of missing data for the part of

the examination and selected items in the

medical history relevant to this report is shown

in table I.

No imputation was made for those items

missing for the examined children and youths.

Table 1. Number of examinees by extent of salected missing

items on physical examination and m the medical history

and bv age and sex: Health Examination Survew.% 1963-

1965 and i966-1970

—.

Age and sex

Both sexes, 6-11 years ....

Boys, 6-11 years ........................

Girls, 6-11 years ..... .. .. .... .... .......

Both saxes, 6-11 years ....

6 years .......................................

7 years .......................... .............

8 years .......................................

9 years .................... ...................

10 years .....................................

11 years .....................................

Both sexes, 12-17 years..

Boys, 12-17 vears ... ................ ...

Girls, 12-17 years ......................

Both saxes, 12-17 years ..

12 years.. $..................................

13 years .....................................

14 years ............. ................ ........

15 years .....................................

16 years .................. .. ...... .. .. .......

17 years .....................................

Questionnaire item or

examination missing

Health

status

Health

a worry

Physical

examination

Number of examinaas

9

3

6

9

-

2

1

3

2

1

43

26

17

43

5

12

6

7

5

8

38

21

17

38 —

8

6

5

5

:

43

27

16

43

5

12

7

7

5

7

6

2

4

6 —

1

1

1

1

2

3

3

3

1

2

37
In effect, it has been assumed that the distribution of the individual characteristic is similar

among those for whom the information was

available and those for whom it was not.

Sampling and Measurement Error

In the present report, reference has been

made to efforts to minimize bias and variability

of measurement techniques.

The probability design of the survey makes

possible the calculation of sampling errors. The

sampling error is used here to determine how

imprecise the survey test results may be because

they come from a sample rather than from the

measurement of all elements in the universe.

The estimation of sampling errors for a

study of the type of the Health Examination

Survey is difficult for at least three reasons:

Measurement error and “pure” sampling error

are confounded in the data—it is not easy to find

a procedure that will either completely include

both or treat one or the other separately, the

survey design and estimation procedure are

complex and accordingly require computationa.lly involved techniques for the calculation

of variances, and from the survey are coming

thousands of statistics, many for subclasses of

the population for which there are a small

number of cases. Estimates of sampling error are

obtained from the sample data and are themselves subject to sampling error which may be,

large when the number of cases in a cell is small

or even occasionally when the number of cases is

substantial.

Estimates of approximate sampling variability for selected statistics used in this report are

included in the detailed tables. These estimates

have been prepared by a replication technique

that yields overall variability through observation of variability among random subsamples of

the total sample. The method reflects both

“pure” sampling variance and a part of the

measurement variance.

In accordance with usual practice, the interval estimate for any statistic may be considered

the range within 1 standard error of the tabulated statistic with 68-percent confidence, or the

range within 2 standard errors of the tabulated

statistic with 95-percent confidence. The latter

is used as the level of significance in this report.

An approximation of the standard error of a

difference d = x - y of two statistics x and y is

given by the formula

where SX and Sy are the sampling errors,

respectively, of x and y. Of course, where the

two groups or measures are positively or negatively correlated, this will give an overestimate

or underestimate, respectively, of the actual

standard error.

Examiner Variability

In the survey among children there were 36

physician examiners and in the survey among

youths 41 physician examiners, each following

the predetermined standardized procedures for

the respective surveys, as previously described.

The variability among examiners in the proportion of examinees they rated on diagnostic

impression as having a significant cardiovascular

Table 11. Numbar of examiners by percant of examinees they

found with significant cardiovascular abnormality in Cycles

I I and I I 1, with range, mean, median, and quartilas in the

distribution of the percent of examinees abnormal: Health

Examination Surveys, 1963-1965 and 1966-1970

Percentl of examinees

with significant cardiovascular abnormality

Cycle I I Cycle 1I I

.

Less than 1.0 percent ............................

1.0-2.9 percent ......................................

3.0-4.9 percent ......................................

5.0-6.9 percent ......................................

7.0-8.9 percent ......................................

9.0 percent or more ...............................

Range ....................................................

Mean .....................................................

Median ..................................................

P25 ........................................................

P75 ........................................................

Number of

examiners

17 5

8 14

5 6

4 6

2 4

5

Percentl of

examinees

0-9.0 0-23.5

2.4 4.6

1.5 3.5

0.5 1.5

3.5 6.4

lpercents for each examiner have been age-sexadjustedto

remove the effect of such differences among those examined by

each physician.

NOTE: 1’25 = percent below which one-fourth of examinees

fall; P75 = percentbelow which three-fourths of examinees fall.

38
Table II 1. Number of examiners by percent of exeminees they found with eny significant abnormality and tha proportion of them with a

cardiovascular ebnormd ity in Cycles 1I end II1, with renge, mean, median, and quartiles in the distribution of the parcant of examinees abnormal: Health Examination Suweys, 1963-1865 and 1866-1970

Parcentl of examineas with significant abnormality

Lassthan 10 percent .........................................................................................................

10-19 percent. ...................................................................................................................

20-29 percent ...................................................................................................................

30-39 pereent ...................................................................................................................

40-49 percant ...................................................................................................................

50-59 pament ...................................................................................................................

60 parcent end ovar ..........................................................................................................

Range ...............................................................................................................................

Madian ..............................................................................................................................

~26 .,s,,..............................................................................................................................

r76 ...................................................................................................................................

Any abnormality

I

Cardiovascular

abnormality

Cycle II I Cycle III I Cycle II I Cycle III

13

17

5

1

Number of examiners

5

14

14

5

1

1

1

Percentl

of examinaas

1

0-37.2 2.8-73.6

12.3 21.8

11.4 20.8

7.5 14.0

15.0 28.5

13 12

11 13

6 7

2 4

;

2

Proportion of

abnormals with

cardiovascular

conditions

-L

o-69.4 0-59.8

19.5 21.2

14.4 16.3

3::: 2?0

lDat* hava been age4ex adjusted to remo~ the effect of such differences among those examined by each phwicianNOTE: P25 = percant below which one-fourth of examinees fall; P75 = percent below which three-fourths of examinees fall.

abnormality is substantially greater among the

youths than the children as shown in table II.

When the effect of any age-sex differences

that may exist in the prevalence of such conditions is controlled through indirect adjustment,

the proportion of examinees with cardiovascular

conditions (on diagnostic impression) ranged

from O to 9.0 percent per examiner in the

children’; survey and from Oto 23.5 percent per

examiner in the youths’ survey. Seventy percent

of the children’s examiners rated less than 3

percent of those examined as having a cardiovascular condition compared with 46 percent of

the youths’ examiners.

While there was also greater variability

among the youths’ than the children’s examiners

in the proportion with diagnostic impression of

o

significant abnormality or any type, when the

proportion of these with cardiovascular abnormalities is considered, the extent of examiner

variability in the two surveys is generally similar

(table III).

Small Numbars

In some tables, magnitudes are shown for

cells for which the sample size is so small that

the sampling error may be several times as great

as the statistic itself. Obviously, in such instances, the statistic has no meaning in itself

except to indicate that the true quantity is

small. Such numbers, if shown, have been

included in the belief that they may help to

convey an impression of the overall story of the

table.

00

39
- APPENDIX II

DEMOGRAPHIC AND SOCIOECONOMIC TERMS

Age. –The age recorded for each child and

youth was the age at last birthday on the date of

examination. The age criterion for inclusion in

the sample used in this survey was defined in

terms of age at time of interview. Since the

examination usually took place 2 to 4 weeks

after the interview, some of those who were 11

years old at the time of the interview became 12

years and some of those who were 17 years old

at the time of interview became 18 years old by

the time of examination. There were 72 11-

year-olds who became 12 years old and 2317-

year-olds who became 18 years old in these

samples. In the adjustment and weighting procedures used to produce national estimates, the 72

such children were included with the 1l-yearolds and the 23 such youths were included with

the 17-year-old group.

Race. –Race was recorded as white, Negro,

or other. “Other” included American Indians,

Chinese, Japanese, and all races other than white

or Negro. Mexican persons were included with

“white” unless definitely known to be American

Indian or of another nonwhite race. Negroes and

persons of mixed Negro and other parentage

were recorded as “Negro.”

Geographic region. –For purposes of stratification, the United States was divided into four

geographic regions of approximately equal population. These regions, which correspond closely

to those used by the U.S. Bureau of the Census,

were as follows:

Re@”on States included

Northeast . . . . . . Maine, Vermont, New

Hampshire, Massachusetts,

Connecticut, Rhode Island,

New York, New Jersey, and

Pennsylvania.

Midwest . . . . . . .

South . . . . . . . . .

West . . . . . .

Ohio, Illinois, Indiana,

Michigan, Wisconsin, Minnesota, Iowa, and Missouri.

Delaware, Maryland, District of Columbia, West

Virginia, Virginia, Kentucky, Tennessee, North

Carolina, South Carolina,

Georgia, Florida, Alabama,

Mississippi, Louisiana, and

Arkansas.

Washington, Oregon, California, ‘Nevada, New Mexico, Arizona, Texas, O“klahoma, Kansas, Nebraska,

North Dakota, South

Dakota, Idaho, Utah, Colorado, Montana, Wyoming,

Alaska, and Hawaii.

U-ban and rural.–The definitions of urban

and rural areas were the same as those used in

the 1960 census. According to these definitions,

the population in urban areas was comprised of

all persons living in (1) places of 2,500 inhabitants or more incorporated as cities, boroughs,

villages, and towns (except towns in New

England, New York, and Wisconsin); (2) the

densely settled urban fringe, whether incorporated or unincorporated of urbanized areas; (3)

towns in New England and townships in New

Jersey and Pennsylvania that contained no incorporated municipalities as subdivisions and had

either 2,500 inhabitants or more, or a population of 2,500 to 25,000 and a density of 1,500

persons or more per square mile; (4) counties in

States other than the New England States, New

40
Jersey, and Pennsylvania that had no incorporated municipalities within their boundaries

and had a density of 1,500 persons or more per

square mile; and (5) unincorporated places of

2,500 inhabitants or more not included in any

urban fringe. The remaining population was

classified as rural.

Urban areas are further classified by population size for places within, urbanized areas and

other urban places outside urbanized areas.

Education of parent or guardian. –This was

recorded as the highest grade completed in

school. The only grades counted were those

attended in a reguku- school where persons were

given formal education in graded public or

private schools, whether day or night school,

and whether attendance was full or part time. A

“regular” school is one that advances a person

toward an elementary certificate or high school

diploma, or a college, university, or professional

school degree. Education in vocational. trade, or

business schools outside the regular school system was not counted in determining the highest

grade of school completed.

Family income. –The income recorded was

the total income of the past 12 months received

by the head of the household and all other

household members related to the head by

blood, marriage, or adoption. This income was

the gross cash income (excluding pay in kind),

except in the case of a family with its own farm

or business, in which case net income was recorded.

Parent. –A parent was the natural parent or,

in the case of adoption, the legal parent of the

child.

Guardian. –A guardian was the person responsible for the care and supervision of the

child or youth. He or she did not have to be the

legal guardian to be considered the guardian for

this survey. A guardianship could only exist

when the parent(s) of the child or youth did not

reside within the sample household.

Head of household. –Only one person in

each household was designated as the “head.”

He or she was the person who was regarded as

the “head” by the members of the household. In

most cases, the head was the chief breadwinner

of the family, although this was not always true.

In some cases, the head was the parent of the

chief earner or the only adult member of the

household.

000

41
APPE~DIX Ill

HISTORY AND PHYSICAL EXAMINATION FORMS

SELECTED ITEMS FROM MEDICAL HISTORY OF YOUTH–PARENT’S QUESTIONNAIRE

—— ._ —— . -.—.

CONFIDENTIAL - Allin/rmnation which wou[dpemit,denti/rcntio,zn/the.Individualr`;[lbebeldsfrzct[Y

confidential. wil[ be used onlv by persons engag ed in and for tbe purposes of tbe survey and will not

be disclosed or released to others /or my other purposes (2.? FJ/ 1687).

DEPARTMENT OF

HEALTH, ED1JCATION, AND WELFARE

PUBLIC HEALTH SERVICE

NATIONAL HEALTl3 SURVEY

MEDICAL HISTORY OF YOUTH Sample number

Parent’s Questionnaire

NAME OF CHILD ([.ast, First, Afidd/e) SEGMENT SERIAL COL. NO.

I I

NOTE: Please answcrthe questions hychecMng thecomect bxesorby filling in the blanks,

as required. If a question is unclear leave the answer blank and draw a line around theques-

‘@ A representativeof the Public Health Service wilI collect your filled in questionnaire

In a few days and she will help you answer the unclear questions. Thank you for your \

cooperation.

———

II. SEX 2. AGE 3. DATE UFBIR’17i (M.anzh. Day. Yea,)

lo M,le 2 ❑ hl.1.

.-. . . . . .

10. Is there anything about hisor her health that worries you now?

—-. .

1

T

Yes ZUNO

IF YES: What is it?

11. How would youdescribe hisorher prssent health?

l~Poor 2~Fair 3 ❑ Goud 4 ❑ Very Goud 5 ❑ Excellent

IF POOR OR FAIR What is the matter?

’12. Does he-or she now use any medicirie regularly (not counting oi!amins)?

1

T

Yes 20N0 3❑ Don’t know

LILXM

a. What is the name of the me&cine? *• Don’t know

b. What is jt for? 2 ❑ Don’t kmw

c. Did a doctor say he or she should use it?

1 ❑Yes 2 HNo 3 ❑ Don’t know

d. How long has be or she been using it?

42
18. Hri.s ho $r she ever h@ ((’HECK YES —. OR NO IN EVERY LINE).

a. Measles , IJ Ye,

b. Mumps , •1 Yrw

c. f’hickenpox I ❑ Yes

d. Whooping cough , •1 Yes

e. ~crIr] et fever 1 IJ Yes

f. Asthma , •1 Yes

g. Hay fever i •l Yes

h. Other allergies I •l Yes

i. Kidney kouble z ❑ Yes

j. Neart murmur or anything else wtong

with the h,eart J •l Yes

k. Fit, convulsion, ,or seizure * •l Yes

1. Pneumonia , ❑ Yes

20. Whrd 1: tbe most wrlou, illness or disease he or ehe bas ever had?

a. Howold was he or sbe when it started? years

b. What did the dotter say alxrut it?

The doctor said it was:

, ❑ a mild caee 4 ❑ 1 don’t remember what be said

2 D p moderate case 5 ❑ No doctm saw the child

3 •l s severe (critical) case

c. Dld tbe illness (disease) leave any lasting effects?

1$1 Yes ,DNo 3❑ Hard to SSy

IF YE& What were or are they?

36. Is he or she AW prevented for reasons of bealtb frnm taking part in bard exercise or PISY?

1

7

Yes x ❑ No (~, GOON TO QUESTION 37)

IF YES:

a. What sre the reasons?

b. Did tbe doctor advice this?

, •l Yee ZUNO

43
SELECTED ITEMS FROM HEALTH HABITS AND HISTORY–YOUTH (QUESTIONNAIRE)

CONFIDENTIAL - All in/onnation which would permit identification of tbe individual will be held

sftfctly confidential, will be used only by persons ●ngaged in and [or tbe purposes o/ tbe survey and

will trotbe disclosed or released to others /or any other purposes (22 Fk 1687).

DEPARTb4ENTOF

HEALTH, EDUCATION,ANDWELFARE

PUBLIC HEALTH SERVICE

NATiONAi HEALTH SURVEY

l=-=---

tiEALTHtfAB1-fsAND HISTORY- youth

NmIe (Last, Fiwt, Middle) SEGMENT SERIAL COL. NO.

/INSTRUCTIONS: On the following pages youwilI find asetofquestionsd ealingwith your

health. Since evety person is different, there are no “qtandard* answers to the questions;

just answer them as fully andhonestly as you can. Your snswers will be kept confidential.

Doyourbest topickthe.most Iikelyanswerfmm among the choices given. Only if you

really don’t know the answer check “Don’t know.” WHEN YOU HAVE COMPLf?TED THE

QUESTIONNAIRE, PLEASE MAIL IT BACK TO THE SURVEY IN THE ENVELOPE WE

LEFTWITHYOU -THERE lSNO POSTAGE NECESSARY IFYOU USE OUR ENV!lLOPE.

1. SEX 2. AGE 3. DATE OF SIRTH(Monih, Day, 3’-.,)

1 ❑ Male 2 ❑ Female

I I

,23. Have you ever been prevented for reasons of health from taking part in hard (physical)

work, exercise, or games?

1

7

Yes XDNO

U

a. Why?_

b. Did adoctoradvjsetbiS?

1 •l Yes zONo 3❑ Don’t know

c. Are you n~w forbidden to do some of thsse things?

1 •1 Yes 20No
SELECTED ITEMS FROM THE PHYSICAL EXAMINATION FORM

Diagnostic Impressions (Examination of Child)

HSALTH EXAMINATION SURVEY—II

cAD

co !!. DIAGNOSTIC 1MPRESS1ONS CARD OY-S

..—

1 9

. ..—— —.. —.. . . —..

(S4) HWRT DISEASE d yes tj No

Diagnostic I repression . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . .. . . . . . . . .. . . . . . . . . . . . . . ............-

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

1

(55) ❑ Congenital 6 Acquired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FINDINGS: ❑ History ❑ Thrill ❑ Murmur

❑ ECG ❑ X-ray ❑ Other

SUMMARY FOR MEDICAL REPORT TO PARENT OR PRIVATE PHYSICIAN:

A. ❑ None found

B. ACUTE CONDITION (Reported to parent) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .

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

C. CONDITION (To be reported to private phyalcian) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..-

(7S+01 ENDCARDC4 SIGNATURE

Summary of Diagnostic Impressions (Examination of Youth)

lEAllllEXAMIHATIDASUW1-111

SUMMARYOF DIAGNOSTIC IMPRESSIONS

X u Easantially a normal child with non. of tha findings fsalow.

List all significant findings

cardiovascular SYSTEM

1 ❑ NO FINDINGS

2 ❑ FINDINGS+ lht ond Dascrilw (i.cludo ECG and X.my fhdings if noted):

DIAGNOSTIC WRESSION

.

OTHSU SYSTEMS

1 ❑ NO FINDINGS

2 ❑ FINDINGS (Dascri&):

DIAG.

IMPRSSS.

DIAGNOSTIC IMPRESSION

45
SELECTED ITEMS FROM CHILD’S MEDICAL HISTORY–PARENT (QUESTIONNAIRE)

Recording and History Forms

CONFIDENTIAL - The Rational tiealtb Survey is authorized by Public Law 652 nf FORM APPROVEG

the 84th Congress (70 Stat. 489,’42 U.S. C. 242c). All information which wordd

❑ui2GE7 BUREAU NO. 6a. Rezo.s4,6

perwrit identification of t he individual will be held strictly confidential, wiIZ be used only by persons engaged in

and for the purposes of the survey and will not be disclosed or released to others /or my other purposes (22 FR 1687).

DEPARTMENT OF

HEALTH, EDUCATION, AND WELFARE

PU9LIC HEALTH SERVICE

NATIONAL HEALTH SURVEY

HES-25 6

[!-5)

CHILD’S MEDICAL HISTORY - Parent

NAME O F CHILD (Last, First, Miahle) SEGMIENT SISRIAL COL. NO.

(6.1 11

NOTE: Please complete this form by checking the correct boxes and/or filling in the blanks where applicable.

When you have completed it, keep it until the representative of the Health Examination Survey calls on you

within a few days. If there are some questions you do not understand, please complete the others and the person who

comes for the form wi 11help you with the ones that were unclear.

,. SEX 2. A6E r.. DATE OF SIRTH (Martb, DaY, Yem)

1,,.,.1 . .

t m Male 2 0 Female

20. NOW TURNING TO THE PRESENT TIME. HOW WOULD YOU DESCRIBE THE CHILD’S HEALTii”NOW? ““–”

I D Very good z u Good a u Fair 4 n Poor

IF FAIR or POOR, what is the trouble?

21. IS THERE ANYTHING ABOUT HIS(HER) HEALTH THAT BOTHERS YOU OR WORRIES YOU NOW?

1 n Yes ZUNO

IF YES, what is the trouble?

(591

154)

{631

—.—... . . . . .. . .

S2. HERE IS A LIST OF OISEASES THAT CHILDREN SOMETIMES HAVE. HAS THIS CHILD EVER HAO:

If yes, about how

old at the time?

A. Scarlet fever? t u Yes+ Age_ 2nNo s n Don’t know

B. Rheumatic fever? I o Yes+ Age— ZDNO ~ o Don’t know

C. Polio? 1 u Yes+ Age— 21_JN0 s u Don’t know

D. Diphtheria? , D Yes+ Age ZUNO s u Don’t know

E. Menirrgitis or I o Yes+ Age_ 2uN0 s u Dnn’t knnw

sleeping sickness ?

F. Tuberculosis? I o Yes+ Age_ ZUNO ~ o Don ‘t know

G. Diabetes or 1 u Yes- Age_ 2uN0 s n Don’t know

sugar diabetes?

H. Epilepsy? , 0 Yes + Age_ ZUNO s u Don’t know

I. Chores or t o Yes+ Age_ ZUNO ~ o Don’t know

St. Vitus dance?

J. Cerebral palaey? 1 0 Yes+ Age_ ZCINO ~ o Don’t know

K. Whooping cough? 1 u Yes+ Age— 2oN0 s u Don ‘t know

4a
s.5. HERE ARE SOME OTHER KINOS OF ILLNESSES OR CONDITIONS SOME CHILOREN HAVE. HAS YOUR CHILD

EVER HAD:

(e) A. Asthma? 1 I-J Yes 2rJN0 s o Don’t know

F Hay fever? I n Yes 20N0 s o Don’t know

~. 3 .y ~ther kinds of

, 0 Yes zoNtr s o Don’t know

a:lergies?

D. Any trouble with his I n Yes 2r3N0 s o Dnn’c know

(her) kidneys?

E. A heart murmur? 1 a Yes ZONO ~ o Don’t know

F. Anything wrong with 1 D Yes 20N0 s o Don’t know

his(her) heart?

G. A convulsion? ,UYCS 213N0 s o Don’t know

H. A fit? ! n Yes 2oNo ~ o Don’t know

S6. DOES YOUR CHILD OFTEN HAVE ❑AD SORE THROATS?

(14) t ig Yes ZONO 3 0 Don’t know

53. HAS THE CHILD’S HEALTH EVER KEPT HIM(HER) FROM HARO EXERCISE OR PLAY?

I n Yes aoNo 3 m Don ‘t know

IF YES:

A. Did ,a doctnr say he shculd be kept from doing this?

I a Yes ZONO s o Don ‘c knnw

B. What was the condition that restricted the child?

C. Is he(she) restricted this way at ptesent?

(49) I n Yes 20N0 s o Dnn’t knnw

b u, s.GOVEMMENT PRRiTmG OFFICE: 1978 260-937/12 47
VITAL AND HEALTH STATISTICS PUBLICATIONS SERIES

Formerly Public Health Service publication No. 1000

Series 1. Programs and Collection Procedures. –Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and

other material necessary for understanding the data.

Scn”es2. Data Evaluation and Methods Research.–Studies of new statistical methodology including experimental

tests of new survey methods, studies of vital statistics collection methods, new analytical techniques,

objective evaluations of reliability of collected data, contributions to statistical theory.

Series 3. Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health

statistics, carrying the anrdysisfurther than the expository types of reports in the other series.

Series 4. Documents and Committee Reports. –Final reports of major committees concerned with vital and

health statistics, and documents such as recommended model vital registration laws and revised birth

and death certificates.

Series 10. Data from the Health Interview Survey. –Statistics on illness; accidental injuries; disability; use of

hospital, medical, dental, and other services; snd other health-related topics, based on data collected in

a continuing national household interview survey.

Series 11. Data from the Health Examination Survey. –Data from direct examination, testing, and measurement

of national samples of the civilian, noninstitutionalized population provide the basis for two types of

reports: (1) estimates of the medically defined prevalence of specific diseases in the United States and

the distributions of the population with respect to physical, physiological, and psychological characteristics; and (2) analysis of relationships among the various measurements without reference to an

explicit fiiite universe of persons.

Series 12. Data from the Institutionalized Population Surveys.-Discontinued effective 1975. Future reports from

these surveys will be in Series 13.

Series 13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilities

providing long-term cme, ambulatory care, hospital care, and family planning services.

Series 14. Data on Health Resources: Manpower and Ftzcilities. –Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthly

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

series analyses; and statistics on characteristics of deaths not available from the vital records, based on

sample surveys of those records.

Series 21. Data on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, snd divorce other

than as included in regular annual or monthly reports. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not

available from the vital records, based on sample surveys of those records.

Series 22. Data from the National Mortality and Natality Surveys. –Discontinued effective 1975. Future reports

from these sample surveys based on vital records will be included in Series 20 and 21, respectively.

Series 23. Data j%om the National Survey of Family Growth. –Statistics on fertility, family formation and dissolution, family planning, and related maternal and infant health topics derived from a biennial survey of

a nationwide probability sample of ever-mamied women 1544 years of age.

For a list of titles of reports published in these series, write to: Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Md. 20782