Vital and Health Statistics-Series 11 No.205 

First issued as DHEW Publication No.(PHSI 78-1652 

April 1978 
Data from the 

NATIONAL HEALTH SURVEY 

Total Serum Cholesterol 

levels of Adults 18-74 Years 

United States, 19714974 

Serum cholesterol values of adults 18-74 years of age in the United 

States, 1971-74, are presented and discussed by age, sex, and race 

and are also compared with serum cholesterol vaIues of adults of 

simiIar ages in the United States, 1960-62. 

DHEW Publication No. (PHS) 79-1652 

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

Public Health Service 

Office of Health Research, Statistics, and Technology 

National Center for Health Statistics 

Hyattsville, Md. April 1978 

Series 11 

Number 205 
NATIONAL CENTER FOR HEALTH STATISTICS 

DOROTHY P. RICE, Director 

ROBERT A. ISRAEL, Deputy Director 

JACOB J. FELDMAN, Ph.D., Associate Directorfor Analysis 

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

ROBERT A. ISRAEL, Acting Associate Director for Data Systems 

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

ROBERT C. HUBER, Associate Directorfor Management 

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

PETER L. HURLEY, 14ssociute Director for Operations 

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

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

ALICE HAYWOOD, Information Officer 

DIVISION OF HEALTH EXAMINATION STATISTICS 

COOPERATION OF THE U.S. BUREAU OF THE CENSUS 

In accordance with specifications established by the National Health Survey, the Bureau of 

the Census, under a contractual agreement, participated in the design and selection of the 

sample, and carried out the first stage of the field interviewing and certain parts of the statistical processing for the Health Examination Survey. 

Library of Congress Catalog Card Number 77-13300 
CoNTENTS 

Introduction ............................................................................................................................................ 1 

Serum Cholesterol ................................................................................................................................... 2 

Collection and Storage-HES and HANES ......................................................................................... 2 

Cholesterol Determinations-HES and HANES .................................................................................. 2 

Findings-HANES ................................................................................................................................... 3 

Age Differences .................................................................................................................................. 

Sex and Age ....................................................................................................................................... ii 

Race, Sex, and Age ............................................................................................................................ 5 

Elevated Strum Cholesterol Level ...................................................................................................... 6 

Comparison With HANES and 1 ICIIOUS HES Finding ............................................................................ 9 

Findings by Sex-HANES and HES .................................................................................................... 10 

Comparison of Sex Differences by Age .............................................................................................. 11 

Elevated Serum Cholesterol Levels by Age and Sex ........................................................................... 12 

Discus&m ............................................................................................................................................... 13 

Rgc and Sex ....................................................................................................................................... 13 

Race Differences ................................................................................................................................ 13 

Response Rates and Techniques of Measurement-HES and HANES ................................................. 14 

Diet .................................................................................................................................................... 15 

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

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

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

Appendixes 

I. Statistical Notes ........................................................................................................................... 26 

II. Demographic Terms ...................................................................................................................... 30 

LIST OF FIGURES 

I. Mean serum cholesterol levels of adults aged 18-74 years, by sex and age: United States, 197 l-74...... 3 

2. Distribution of serum cholesterol levels of adults aged 18-74 years, by sex and age: United States, 

1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................ 4 

3. Selected estimated percentiles of the serum cholesterol distribution in adults aged 18-74 years, by 

sex and age: United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

4. Mean serum cholesterol levels of adults aged 18-74 years, by age and race: United States, 1971-74.... 

5. Mean serum cholesterol levels of men aged 18-74 years, by age and race: United States, 1971-74 . . . . . . . 

6. halcan serum cholesterol levels of women aged 18-74 years, by age and race: United States, 1971-74... 

7. Sclccted estimated percentiles of the serum cholesterol distribution in adults aged 18-74 years, by 

age, sex, and race: United States, 197 1-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

iii 
8. Percent of adults aged 18-74 years with serum cholesterol levels of 260 mg/lOO ml and over, by 

age and race: United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

9. Percent of black and white adults aged 18-74 years with serum cholesterol levels of 260 mg/ 

100 ml and over, by age and sex: United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

10. Mean serum cholesterol levels of men aged 18-74 years, by age: United States, 1960-62 and 

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

11. Mean serum cholesterol levels of women aged 18-74 years, by age: United States, 1960-62 and 

1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................ 

12. Mean serum cholesterol levels of adults aged 18-74 years, by age and sex: United States, 1960-62...... 

13. Mean serum cholesterol levels of adults aged 18-74 years, by age and sex: United States, 1971-74 . . . . . . 

14. Mean differences in serum cholesterol levels of men and women aged 18-74 years, by age and sex: 

United States, 1960-62 and 19 71-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .-............................-.. 

15. Percent of adults aged 18-74 years with serum cholesterol levels of 260 mg/lOO ml and over, 

by age and sex: United States, 1960-62 and 19’71-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

8 

9 

10 

10 

11 

11 

12 

12 

SYMBOLS 

Data not available--- --_-..-_ - _-_-- -_-_--___--_-_-- - - - 

Category not applicable..- __-_____ - _______ -_- --_-- . . . 

Quantity zero-------------------------------------- - 

Quantity more than 0 but less than 0.05~---- 0.0 

Figure doe:; not meet standards of 

reliability or pre&iorl_____________ ----------- * 

iv 
TOTAL SERUM CHOLESTEROL LEVELS 

OF ADULTS 18-74 YEARS 

Sidney Abraham, Clifford L. Johnson, M.S.P.H., and Mar-get D. Carroll, M.S.P.H., 

Division of Health Examination Statistics 

INTRODUCTION 

This report contains data on serum cholesterol obtained as part of the examination used in 

assessing the nutritional and related health status 

of the U.S. population aged 1 through 74 years. 

It is one of several reports of findings on health 

status obtained in the first Health and Nutrition 

Examination Survey. The findings here are 

limited to serum cholesterol levels of adults aged 

18-74 years. 

The Health Examination Survey, in which 

these data were obtained, is one of the major 

programs of the National Center for Health 

Statistics authorized under the National Health 

Survey Act of 1956 by the 84th Congress as a 

continuing Public Health Service activity to 

determine the health status of the population. 

As in previous Health Examination Survey 

programs, the U.S. Bureau of the Census cooperated in the sample design and in the initial 

visits and interviewing at selected eligible households in the 65 primary sampling units (PSU’s) 

throughout the United States. 

Field data collection operations for the first 

Health and Nutrition Examination Survey were 

started in April 197 1 and completed in June 

1974. Of the 28,043 persons selected in the 

national probability sample to represent the 194 

million persons aged l-74 years in the civilian 

noninstitutionalized population, 74 percent or 

20,749 were examined. When adjustments were 

made for the differential sampling ratios used 

for the effect of oversampling among the poor, 

preschool children, women of childbearing age, 

and the elderly, this corresponded to an effective response rate of 75 percent. Among persons 

18-74 years of age at time of interview for 

whom serum cholesterol determinations were 

made, 13,671 were examined out of the probability sample of 19,572 selected to represent the 

128 million persons of those ages in the population. This is an unadjusted response rate of 70 

percent and an effective adjusted response rate 

of 70 percent. 

The purpose of the Health and Nutrition 

Examination Survey (HANES) was to measure 

the nutritional status of the U.S. population as 

well as to ascertain certain aspects of general 

health status and medical needs in the civilian 

noninstitutionalized population of the continental United States aged 1-74 years. The HANES 

nutrition examination included a general medical examination by a physician which consisted 

of screening for nutritional deficiencies, a skin 

examination by a dermatoIogist, and a dental 

examination by a dentist. Body measurements 

were made by a trained technician; a dietary 

interview was administered that consisted of a 

24-hour recall and a food frequency questionnaire; numerous laboratory tests were performed 

on whole blood, serum, plasma, and urine. A 

description of the sampling process and HANES 

operation has been published.1 

In this report, data on serum cholesterol 

levels of the U.S. adult population are analyzed 

and discussed by age, sex, and race. The HANES 

findings are also compared with those in the 

Health Examination Survey (HES) 1960-62 report of the distribution of serum cholesterol 

levels.2 The Health Examination Survey and the 

HANES I program provide the first such data 

that are representative of the general U.S. 

population. 

1 
The analysis of serum cholesterol levels with 

variables other than age, sex, and race (i.e., 

region, urbanization, income, weight status, and 

the relationship of diet to serum cholesterol 

levels) will be presented in future reports. The 

., distribution of serum cholesterol levels of children and youths is also the subject of separate 

reports.3 t4 

SERUM CHOLESTEROL. 

Collection and Storage-HES and HANES 

A blood specimen was collected from each 

nonfasting HES examinee in a 15-cm3 Sheppard-Keidel tube. The tube was kept at room 

temperature for a minimum of 1 hour following 

venipuncture and then refrigerated for a minimum of 6 hours to assure a good clot. The blood 

clot was freed gently from the tube and the tube 

was then centrifuged for 20 minutes. An aliquot 

of 1 cm3 of serum was transferred to a 

prenumbered serum vial and frozen. Twice a 

week the accumulated vials were placed in 

Styrofoam containers, packed with dry ice, and 

shipped to the Lipid Standardization Laboratory 

of what was then the Communicable Disease 

Center (CDC), Public Health Service, Altanta, 

Ga. 

A blood specimen was collected from each 

nonfasting HANES examinee and stored in three 

1 5cm3 vacutainers. The tubes were kept at 

room temperature for clotting for 20-30 minutes 

following venipuncture. A blood clot was gently 

rimmed, from each tube and the tubes were then 

centrifuged for 10 minutes at 2,400 r/min. The 

serum from the three vials was pooled, mixed 

thoroughly, and distributed in 3-cm3 aliquots to 

prenumbered vials. Within 1 hour of venipuncture, these serum vials were placed in the 

freezer. Daily accumulations of vials were packed 

with ample carbon dioxide, put in Styrofoam 

shippers, and sent to the CDC Atlanta laboratory; no thawing occurred in transit. The vials 

were stored in freezers at -20” C until ready for 

analysis. Multiple assessments were performed 

on each 3-cm3 vial of serum. The serum to be 

used eventually for the cholesterol assessment 

was thawed at CDC for iron, u-on-binding 

capacity, and magnesium determinations. The 

remaining serum in each vial was refrigerated 

until it was packed in dry ice for shilpment to 

the CDC Lipid Laboratory at Chamblee, Ga. The 

serum remained frozen at -20” C until analyzed 

for cholesterol content. Thawing and freezing 

the serum do not affect the determination of 

cholesterol content by competent extraction 

methods.5 

Cholesterol Determinations-HES and HIANES 

Serum cholesterol determinations were made 

for HES examinees at the Lipid Standardization 

Laboratory of what was then the Communicable 

Disease Center (CDC), Public Health Service, 

Atlanta, Ga., using a modified ferric-chloride 

technique. A comparative study of methods for 

determining cholesterol levels, which was conducted by CDC during the course of the Health 

Examination. Survey, showed that wh.en compared with the reference method of Abell, Levy, 

Brodie, and Kendall,2 the ferric-sulfuric method 

in use overestimated the cholesterol concentration. Therefore the data in the HES report 

presented here are the original ferric-chloride 

values reduced by a factor of 7.6 percent to 

approximate the determinations of Abel1 et al.6 

All serum cholesterol determinations for 

HANES examinees were made in the Lipid 

Standardization Laboratory of what is now the 

Center for Disease Control (CDC), Publ:ic Health 

Service, Atlanta, Ga. The analytical method was 

based on that of Abel1 et al.,6 but it was 

modified for a semiautomated production line. 

The method, described in detail by Eavenson et 

al.,’ was made possible by the development of a 

relatively stable Liebermann color reagent and 

was designed for automatic pipetting units. 

The Lipid Laboratory at the Center for 

Disease Control compared the results obtained 

from the semiautomated method with those 

obtained from the reference method of Abel1 et 

al.6 For examining the bias of the semiautomated method, data were obtained from pools 

of sera analyzed by the reference methold and by 

the semiautomated method. For pools ranging 

from 134 to 343 mg/lOO ml, there was in 

1972 an average positive bias of 4.07 percent 

for the semiautomated method as c’ompared 

with the standard method; for 1973-74 the 

corresponding figure was a positive bias of 4.9 

2 
percent. The weighted average bias was 4.5 

percent. In this report, when the HANES 1971- 

74 data are presented alone, they are presented 

without correction for bias so that they provide 

population reference standards for determinations made by the semiautomated methodology 

now in use (tables l-6). However, when comparisons are made between HANES data and HES 

data (tables 8-ll), the HANES serum cholesterol 

data are presented with a reduction of 4.5 

percent to approximate determinations by Abel1 

and others and to make them comparable to 

HES data presented in this report. 

FINDINGS-HANES 

Age Differences 

Mean serum cholesterol levels for adults aged 

18-74 years in the United States increased 

considerably with age from 189.4 mg/lOO ml for 

young adults 18-24 years of age to 250.7 

mg/lOO ml for older adults 65-74 years of age, 

an increase of 61.3 mg/lOO ml or 32 percent 

(table 1). 

The mean serum cholesterol levels increased 

less rapidly for persons in their midsixties and 

midseventies, with the level attaining a peak for 

those aged 65-74 years. A simiIar pattern ofincrements with age is shown in table 1, with 

minimum exceptions, by selected percentiIes in 

the distributions of serum cholesterol. Table 1 

also shows that the standard deviations for 

serum cholesterol levels increased with age from 

39.0 mg/lOO ml for young adults 18-24 years of 

age to 54.2 mg/lOO ml for older adults 65-74 

years of age. However, the coefficient of variation (standard deviation/mean) showed no consistent pattern with age and varied between 20.2 

and 2 1.6 percent over the 18-74-year age span. 

The standard deviation is thus about one-fifth as 

large as the mean value at every age group. 

Sex and Age 

The lowest mean serum cholesterol level for 

men was for the youngest age group, 18-24 

years; it increased steadily with age unti1 age 

group 35-44 and it then increased by a small 

increment to a maximum level at age group 

55-64 years before declining slightly for the 

oldest age group measured, 65-74 years (table 1 

and figure 1). 

For women, the mean serum cholesterol 

levels did not parallel those of men in the same 

age groups. Mean levels for women are slightly 

higher than those for men in the youngest age 

group, 18-24 years. For each older age group, 

there was a slight but consistently higher mean 

serum cholesterol level for men than for women 

until age group 45-54 years. Thereafter, the 

means for men showed a plateau effect and a 

slight decrease, and those for women continued 

upward from ages 55-64 years to a maximum 

value at age group 65-74 years (table 1 and 

figure 1). 

The standard deviations of age and sex are 

shown in table 1, and the percent distributions 

of specific age-sex groups are shown in figure 2 

in the form of histograms. The variability within 

each age and sex group increased with age as 

indicated by the standard deviations. Though 

the differences were small, men showed greater 

variations around their mean at most age groups 

than women did. The distributions for men were 

sharply peaked and skewed to the right at ages 

under 35 years, and they became more symmetrical in older ages. The distributions for 

270 

240 

0 I I I I I 

19.24 25.34 35.44 45.54 55.54 65 74 

AGE IN YEARS 

Figure 1. Mean serum cholesterol levels of adults aged 18-74 

years, by sex and age: United States, 1971-74 

3 
30 - 18-24 years 

23.5 23.1 

20 - 

3o r 25.34 years 30 25.34 years 

I 20.6 

20 - 20 

30 18.24 years 

20 

30 r 35-44 years 

30 - 

55.64 years 

23.2 

20 - 

30 r65 74 year3 

10 - 

0 

Under’ 

100 100 120 140 160 180 200 220 240 260 280 300 320 340 360 380 

J”d 

OYW 

SERUM CHOLESTEROL (bIGi ML) 

30 r 65.74 years 

20 

10 

0 

100 100 120 140 160 180 200 220 240 260 280 300 320 340 360 380 

and 

wer 

SERUM CHOLESTEROL IMGllOO ML) 

Women 

Figure 2. Distribution of serum cholesterol levels of adults aged 18-74 years, by sex and age: United States, 1971-74 
women were quite similar in shape to those for 

men for each successive age group. Detailed data 

on the distributions in the various age and sex 

groups are given in tables 2 and 3. 

Selected percentiles of the serum cholestero1 

distribution are shown by age for men and 

women (table 1 and figure 3). The age patterns 

described previously for the mean were also 

apparent when percentiles at the upper (90th 

percentile), middle (50th percentile), and lower 

(10th percentile) points of the distribution were 

examined. A slight exception occurred in the 

326.2 

237 7 ..y----- . . . . . . . . 

227.5 .---“;s.’ 

.-........mm_eeb 

. . ..-- 

233.7 

..-’ 

231.; 

- Men. 10th QCXCUttik 

. . . . . . . Men. 50th QUCentlk 

-_- Men. 90th percenrde 

m--m Women. 10th ~ercenf~le 

..w... Women, 50th percentrle 

- _ _. Women. 90th percentlk 

0 I I I I I 

1624 25 34 35 44 45-54 55-64 65.74 

AGE IN YEARS 

lower percentile for age group 18-24 years, 

where the mean value for men exceeded that for 

women. 

Race, Sex, and Age 

The mean levels for white and black men in 

the youngest age group were slightly lower than 

the mean levels for the women of both races 

(figure 4). A crossover occurred in the levels for 

men in their midthirties and midforties after 

which the mean levels for men were consistently 

higher than those for women. After age 45, the 

mean levels for women increased more rapidly 

than the levels for men and exceeded those for 

men, particularly after age 55. 

Mean serum cholesterol levels for white men 

were consistently higher than those for black 

men in age groups 18-24, 35-44, and 45-54 

years. The differences in mean levels ranged 

from 2.3 to 6.8 mg/lOO ml. The same direction 

was not evident at ages 25-34 and 55 years and 

over, when black men had higher mean serum 

cholesterol levels than white men had. The 

differences in mean levels were still small and 

ranged from 1.0 to 4.3 mg/lOO ml (table 4 and 

figure 5). 

261.a 261 6 

236.3 

35.0 - Whtte men 

-w-- Blrk men 

a-- Whm vmrntn 

. . . . . . . Black womm 

I I I I I 

18 24 25.34 3544 45.64 55.64 65 74 

AGE IN YEARS 

Figure 3. Selected estimated percentiles of the serum cholesterol 

distribution in adults aged 18-74 years, by sex and age: 

United States, 1971-74 

Figure 4. Mean serum cholesterol levels of adults aged 18-74 

years, by age and race: United States, 1971-74 

5 
270 

260 

i 

2 240 

8 

5 

2 230 

d 

fi 220 

Lx 

Y ,o 210 

: 3 200 

FE 

180 

- White 

I- 

. . ..--. Black 

170 k 

0 I I I I I 

18.24, 25.34 3544 45-64 55.64 65.74 

AGE IN YEARS 

Figure 5. Mean serum cholesterol levels of men aged 18,.74 

years, by age and race: United States, 1971-74 

Mean serum cholesterol levels ffor white and 

black men generally increased with age. Mean 

levels for white men increased rapidly to a.ge 

group 35-44 and then continued upward at a 

slower rate of increase, reaching a peak of 239.9 

mg/lOO ml at ages 45-64, thereafter they dleclined slightly. Mean levels for black men also 

increased with age but at a slower rate; they 

were slightly higher at the older ages and peaked 

at a later age (55-64) than those for white men 

did. A slight decline in mean level occurred for 

ages 65-74 years. 

Table 5 and figure 6 show that the mean 

levels for black women were consistently high.er 

than the levels for white women in the age 

groups under 65 years. In the oldest age group, 

65-74 years, the mean levels for white wornlen 

were slightly higher than those for black women, 

a difference of 2.1 mg/lOO ml. 

The mean levels for both female rac.ial 

groups increased with age to age group 55-64 

years. Then the mean level for black wornlen 

declined slightly whereas that for white wornlen 

continued to rise less rapidly and slightly exceeded the level for black women. 

In general, interracial differences for women 

were greater at the upper end (90th percentile) 

270 

260 

250 

260.8 261.8 

191.1 

180 I- - White 

170 k- . . . . . . . Black 

Ok 

16-24 25.34 35.44 45.64 55.64 65.74 

AGE IN YEARS 

Figure 6. Mean serum cholesterol levels of wome? aged 18-74 

years, by age and race: United States, 1971-74 

of the serum cholesterol distribution than at the 

lower end (10th percentile) (table 5 and figure 

7). Such findings were not consistent for men 

(table 4 and figure 7). 

Elevated Serum Cholesterol Level 

Estimates were made of the prevalence of 

elevated serum cholesterol levels. The distributions of serum cholesterol levels were used to 

note the proportion of persons in any race-sexage group whose levels exceeded 260 mg/lOO 

ml. Within the study population group, the risk 

of developing coronary heart disease has been 

shown to increase with higher serum cholesterol 

levels. This has been documented in several 

epidemiologic studies. s-lo The risk of attack 

appears to increase progressively in relation to 

increase in cholesterol concentration, although 

there is no statistical information regarding the 

actual level of serum cholesterol that separates 

high-risk from low-risk individuals. The level of 

260 mg/lOO ml has been cited in studies to 

distinguish high risk from less high or low. 

Age and sex. -Table 6 shows the proportion 

of persons in each age group whose serum 

cholesterol was found to be 260 mg/lOO ml and 

6 
- 

MEN 

320 

313.2 

304.7 peg , ‘-s -. 

--- 

300 

298.8 

298.9* I I’,% /s*----., 301.;-----I> c’ ,- 

303.0 

291.6 0’ 

*’ ,c*’ 297.4 

: j’293.3 

.’ 

280 : 

: 

.’ 

./ 

260 

160 

t 

' i 

4 i 

,’ /*265.4 - 

: /* 

240.2;/’ 

z ,‘. 

184.6 184.3 

- White, 10th percentile 

-----.. White, 50th percentile 

-.- White. 90th percentile 

____ Black, 10th percentile 

. . . . . . . 6lack. 50th percentile 

, - -- Black, 90th percentile 

0 I I I I I 

18.24 25.34 35.44 45-54 55.64 65-74 

AGE IN YEARS 

340 r WOMEN 337.4 

320 

r, 

,’ -w 

I4 

,’ 

=,_32>4 

/=. 

- 

,+ 

310.6,*’ 

/ 

*’ 

./ 323.3 

-,-R 317.3 

260 

’ ..J *.. .** 234.5 

220 

160 - 

160 

140 

- White, 10th percentile 

. . . ..-- White. 50th percentile 

-.- White. 90thpercentile 

-w-s Black. 10th percentile 

. . . . . . . Black, 50th percemile 

e - - - Black, 90th percentile 

0 I I I I I 

18.24 25.34 35.44 45.54 55.64 65.74 

AGE IN YEARS 

Figure 7. Selected estimated percentiles of the serum cholesterol distribution in adults aged 18-74 years, by age, sex, and race: United 

States, 1971-74 

over. Among men proportions varied from a low 

of 4.0 percent for the age group 18-24 years to a 

high of 30.1 percent for the age group 45-54 

years, and then declined to about 29 percent for 

the older ages, 55 years and over. 

Among women, the lowest proportions were 

in the youngest age group, with the proportion 

increasing steadily with age until it reached a 

maximum of 49.2 percent at age group 65-74 

years. 

Table 6 shows that at the youngest ages, 

18-24 years, and at the older ages, 45 years and 

over, there were higher proportions of women 

than of men with serum cholesterol levels of 260 

mg/lOO ml and over. This pattern was not 

evident for age groups 25-34 and 35-44 years, 

where the proportions were higher for men than 

for women. In age groups 18-24 and 45-54 

years, the differences in proportions between 

the sexes were small, slightly more than 1.5 

7 
percent. These differences were much larger for 

those ages 55 years and over. Elevated serum 

cholesterol levels increased with age for women 

but showed a slight decrease for men at age 55 

years and over. 

Rates for men and women with elevated 

serum cholesterol levels (defined at 260 mg/lOO 

ml and over followed the same pattern that 

was observed when sex-age trends of mean 

cholesterol levels for men and women were 

compared (tables 4-6). The highest mean levels 

of and rates for elevated cholesterol were found 

for women 55 years and over. At ages 18-24 

years, mean levels of and rates for elevatled 

serum cholesterol were slightly higher for 

women than for men. Thereafter, both corresponding rates and means were higher for mien 

than for women until age 45, after which the 

reverse was true. 

Race, sex, and age.-There were higher proportions of white and black women than of men 

at the youngest and oldest ages (18-24 years and 

45 years and over, respectively) with serum 

cholesterol levels of 260 mg/lOO ml and over 

(table 6 and figure 8). This pattern was reversed 

for ages 25-34 and 35-44, when the proportions 

were higher for men than for women of both 

races. At ages 45-54 years, the differences in 

proportions between white men and women 

were small (0.6 percent), but those between 

black men and women were much larger (11.8 

percent). At ages 55-64 and 65-74 ‘years, the 

differences were also larger, particularly for 

white men as compared with white women16.8 and 20.5 percent, respectively. 

The proportions of white men and women 

aged 18-24 with serum cholesterol levels of 260 

mg/lOO ml and over were consistently higher 

than those presented for their black counterparts 

(table 6, figure 9). The pattern was reversed for 

ages 25-44 years, where the proporti0n.s of black 

men and women were slightly higher than those 

of white adults. Findings were not consistent in 

the older age groups. In age group 45-54 years, 

white men and black women showed a higher 

proportion with elevated serum cholesterol 

levels than black men and white women did. In 

contrast, in age groups 55-64 and 65-74 years, 

6O Iq White men 

6!Wk men 

g White women 

ml Black women 

46.2 

16.24 25-34 35.44 45.54 65.74 

AGE IN YEARS 

Figure 8. Percent of adults aged 18-74 years with serum cholesterol levels of 260 mg/lOO ml and over, by age and race: Ulnited States, 

1971-74 
- 

i Whjremen 

White r,omen 

- 

Black men 

- 

- 

- 

18.24 25.34 

36.0 

45-54 

YEARS 

46.2 

Figure 9. Percent of black and white adults aged 18-74 years with serum cholesterol levels of 260 mg/lOO ml and over, by age and sex: 

United States, 1971-74 

relatively more black men and white women 

than white men and black women had elevated 

serum cholesterol levels. 

The age patterns in prevalence rates for 

elevated serum cholestero1 IeveIs (260 mg/lOO 

ml and over) and mean levels found for men 

and women in the United States as a whole were 

also found for white men and women, and 

Negro men and women separately. White and 

bIack men showed lower values for both prevalence rates and mean levels at the younger ages 

than women did. After this age group, both 

values were higher for men than for women until 

age group 45-54 years when the values for 

women increased more rapidly and exceeded 

those for men (tables 4-6 and figures 8 and 9). 

In general, the age patterns described for the 

prevalence rates for elevated serum cholesterol 

levels for white and black men were similar 

when mean cholesterol levels were examined 

(tables 4 and 6). This observation was also 

evident for white and black women (tables 5 and 

6). 

COMPARISON WITH HANES AND 

PREVIOUS HES FINDINGS 

Serum cholesterol levels for adults aged 

18-74 years in the U.S. civilian noninstitutionalized population had been determined previously by means of the Health Examination 

Survey 1960-62.2 This was prompted by epidemiological studies associating levels of serum 

cholesterol with the risk of developing coronary 

heart disease. Since the initial report, there is 

evidence that the level of cholesterol in the 

plasma can be Iowered by dietary modificati0n.l l-l * 

Nongovernmental agencies such as the 

American Heart Association, the Inter-Society 

Commission for Heart Disease Resources, and 

the American Health Foundation in its Position 

Statemenf on Diet and Coronary Heart Disease 

have publicized the dietary risk factors and have 

recommended necessary changes in dietary control aimed at lowering serum lipid concentrati0ns.l 5-18 A task force established by the 

9 
National Heart and Lung Institute issued similar 

suggestions on diet in June 1971.19 Practical 

and palatable diets have been developed to 

reduce serum cholesterols. It is now possible to 

buy a variety of foods that are of special help to 

persons with specific dietary needs. A number of 

food industries have provided some public 

education through advertising regarding the fat 

contents of their products. The downward trend 

of mortality from diseases of the heart, particularly ischemic heart disease, is also of interestz”-death rate peaked in 1963 and bars 

declined since then. Therefore, it was considered 

time to reexamine the serum cholesterol levels in 

the population. Table 7 shows the number of 

examined persons with serum cholesterol measurements by sex and age, 1960-62 and 1971-74. 

Findings by Sex-HANES and HESa 

Men.-Table 8 and figure 10 show that in all 

age groups mean serum cholesterol levels for men 

as determined in 1960-62 were slightly higher 

(differences ranged from 1.9 to 5.9 mg/lOO ml) 

than those for men as determined in 1971-74:, 

except at age group 18-24 years, when HANES 

data were 0.4 mg/lOO ml higher than HES datar. 

None of the differences were statistically significant (P > .05). The mean levels for men in botlh 

data sets increased rapidly to age group 35-44 

years and increased less rapidly to age groups 

45-54 and 55-64 years. A slight decline occurred 

in the age group 65-74 years. 

Women.-Table 8 and figure 11 show that 

the mean serum cholesterol levels for women in 

1960-62 as determined in HES were higher than 

the levels for women in 1971-74 as determined 

in HANES for all age groups. In the age groups 

under 55 years, with the exception of ages 35-44 

years, the differences were small-l.6 to 5.1 

mg/lOO ml-and were not statistically significant 

(P > .05). In the age group 35-44 and in the 

older age groups 55 years and over, the mean 

aIn this section, all cholesterol values have been 

adjusted to approximate the values of Abel1 et al., the 

common reference method,6 by reducing the 1960-62 

data by 7.6 percent and the 1971-74 data by 4.5 

percent. 

270 r 

260 

250 t 

2 8 240 - 

225.6 

178.1 

170 b . . . . . . . ,fwJ.62 

- 1971.74 

0 I I I I I 

18-24 25.34 3544 45.54 55.64 65 and 

AGE IN YEARS over 

Figure 10. Mean serum cholesterol levels of men kged 18-74 

years, by age: United States, 1980-62 and 1971-74 

270 

250 

2 8 240 

2 

z 230 

d 

5 220 

bi 

II: 

g 210 

z 

2 200 

I 

5 190 

!i 

180 

170 c . . . . . . . 1960.62 

- 197’1.74 

k 

Of 

18-24 

I I I I 

25.34 35.44 45.54 55.64 65 and 

AGE IN YEARS o”el 

Figure 11. Mean serum cholesterol levels of women aged 18-74 

years, by age: United States, 1960-62 and 1971-74 

10 
levels in the HES sample were significantly (P < 

.05) higher than those in the HANES sample. 

The differences in mean levels were 17.1 and 

15.9 mg/lOO ml, respectively, for age groups 

55-64 and 65-74 years, and 6.8 mg/lOO ml for 

age group 35-44 years. 

The mean serum cholesterol levels for 

women from HES and HANES sets of data 

increased with age, but in a slightly different 

pattern. The mean levels for women in the HES 

sample increased to the age group 55-64 years, 

with the rate of increase more rapid for those in 

their midfifties and midsixties than for younger 

women. The rate of increase then diminished 

substantially; the mean levels attained a peak in 

the oldest age group 65-74 years. The rate of 

increase in mean levels in the HANES sample 

showed a similar pattern before age 55. The 

mean levels increased less rapidly for women in 

their midsixties and then flattened out, with 

the levels also attaining a peak in the age group 

65-74 years. 

Comparison of Sex Differences by Age 

Table 8 and figure 12 show that during 

1960-62 the mean serum cholesterol levels increased with age for each sex group, but in 

different patterns. Mean levels for men increased 

rapidly to age group 35-44; the rate of increase 

then flattened out, with levels reaching a peak at 

ages 55-64, and declined slightly thereafter. 

Mean levels were higher for women than for men 

at the youngest ages; they increased less rapidly 

for women than for men in their midthirties and 

midforties, and increased much more rapidly for 

women than for men after age 45. Thus the 

mean Ievels for women exceeded those for men 

at ages 45-54 and at all succeeding ages. 

Table 8 and figure 13 show the mean serum 

cholesterol levels in 1971-74. As in 1960-62, 

mean levels for women were higher than those 

for men in the youngest age group. After age 25, 

the mean levels in the HANES sample generally 

showed the same pattern as those observed in 

the HES sample for women and for men. Mean 

levels increased less rapidly for women than for 

men in age groups 25-34 and 35-44 years, but 

they increased more rapidly for women than for 

men after age 45. Here, the levels for women 

270 - 265.7 

262.3 ‘.’ 

260 /’ *........... 

- 

I 

/ 

250 

+.*- 

- ..** 

*.*’ 

240 - 236.8/* 

..a’ 

230 - 

220 - 

178.1 - Men 

170 - . . . . . . . Women 

J0-f I I I I I 

18.24 25.34 3544 4564 5564 65 and 

wer 

AGE IN YEARS 

Figure 12. Mean serum cholesterol levels of adults aged 18-74 

years, by age and sex: United States, 1960-62 

270 

240 

230 

220 

210 

200 

190 

160 

170 

178.5 c - Men 

. . . . . . . women 

I 

J 

OT I I I I 

18.24 25-34 3544 45 54 55-M 65 and 

I 

over 

AGE IN YEARS 

Figure 13. Mean serum cholesterol levels of adults aged 18-74 

years, by age and sex: United States, 1971-74 

11 
49 r 

1960.62 

49 r 

1971-74 

-20 - 

-24.2 

-30 - 

-40 1 -36.2 -40 L 

20 30 40 50 60 70 20 30 40 50 60 70 

AGE IN YEARS AGE IN YEARS 

NOTE: Ncgatm numberr indicate that mean serum &o,er,crol ~CM, for women ,s greucr than rh, 

for mm. 

Figure 14. Mean differences in serum cholesterol levels of men 

and women aged 18-74 years, by age and sex: United 

States, 1960-62 and 1971-74 

exceeded those for men in age group 45-54 years 

and at all older ages. The levels for men peaked 

at age group 55-64 years and then declined, but 

the levels for women continued to rise. 

Figure 14 shows the mean differences in 

serum cholesterol levels between the sexes in 

1960-62 and 1971-74. The pattern was similar in 

both surveys in that women had higher mean 

levels at the youngest ages, 18-24 years, and also 

at ages 45 years and older. Men had higher 

values in their midthirties and midforties. Differences in mean values between sexes were less in 

1971-74 than in 1960-62 except at ages 35-44 

years. 

Elevated Serum Cholesterol Levels 

by Age and Sex 

Table 9 and figure 15 show the proportion 

of persons by age group whose serum cholesterol 

levels were 260 mg/lOO ml and over in 1960-62 

and 1971-74. In 1960-62 the proportions of 

men varied from a low of 3.9 percent at ages 18- 

24 to a high of 25.7 percent at ages 45-54 years. 

Corresponding values for women in 1960-62 

were from a low of 4.6 percent at ages 18-24 to 

a high of 51.0 percent at ages 65-74 years. Men 

and women in 1971-74 had their low and high 

values in the same age groups as those observed 

in 1960-62. 

60 WOMEN 

0 

60 r MEN 

25.7 

20 

0 

18.24 25.34 3544 45.54 55.64 65.74 

AGE IN YEARS 

gj 196062 

Figure 15. Percent of adults aged 18-74 years with serum 

cholesterol levels of 260 mg/lOO ml and over, by age and 

sex: United States, 1960-62 and 1971-74 

12 
The proportions of men in each age group in 

1971-74 were consistently lower than those of 

men in 1960-62 (figure 15). The differences in 

percentages between the two periods were small, 

ranging from a low of 0.7 percent at ages 65-74 

years to a high of 3.3 percent at ages 55-64 

years. This consistent pattern was also observed 

for women. At all ages, the proportions of 

women in 1971-74 were lower than those of 

women in 1960-62. The largest differences in 

percentages between survey periods were found 

at ages 55-64 years and 65-74 years, 14.4 and 

10.3 percent, respectively, which were the only 

statistically (P < .05) significant differences between 1960-62 and 1971-74. Differences in 

other age groups were small, ranging from a low 

of 1.6 percent at ages 18-24 years to a high of 

3.4 percent at ages 45-54 years. 

For the youngest ages (18-24 years) and the 

older ages (45 years and over), there were higher 

proportions of women than of men in both the 

HES and HANES samples with serum cholesterol levels of 260 mg/lOO ml and over (table 

9). This pattern was reversed for age groups 

25-34 and 35-44 years, when the proportions 

were higher for men than for women. At ages 

45-54 years, the differences between the sexes 

from both samples were small-2.3 and 0.5 

percent, respectively. These differences were 

much larger at ages 55 years and over. The 

proportions of person whose levels exceeded 

other specific amounts are shown in table 10 for 

men and in table 11 for women. 

A similar pattern in age-cholesterol relationships for men and women in 1960-62 and 

197 l-74 was also evident in the mean serum 

cholesterol levels and in the prevalence rates for 

elevated serum cholesterol levels (tables 8 and 

9). 

DISCUSSION 

Serum cholesterol is one of the important 

high-risk factors associated with the development of coronary heart disease. Data on serum 

choIestcro1 levels collected during the 1971-74 

Health and Nutrition Examination Survey 

(HANES) of adults aged 18-74 years are presented and analyzed by age, sex, and race. These 

serum cholesterol levels are also compared with 

the earlier determinations made during the 

1960-62 Health Examination Survey (HES). In 

this comparison, the data were converted to the 

reference method of Abel1 et al. HES and 

HANES provided cross-sectional data of serum 

cholesterol levels obtained for different age 

cohorts representative of the U.S. population. 

The age trends represented mean levels for 

successive cohorts of persons of different age 

groups. 

Age and Sex 

Serum cholesterol levels of men at ages 

45-54 years showed a plateau or a flattening of 

the early increase of mean serum cholesterol 

levels with age. Although the serum cholesterol 

levels of women were slightly lower than those 

for men in their midthirties and midforties, the 

levels continued to rise after age 45 and exceeded those for men in the later years. The 

leveling off with age of the serum cholesterol 

levels of men may be due to the death of those 

with high serum cholesterol levels because a high 

incidence of coronary heart disease associated 

with a high-risk factor of serum cholesterol 

would tend to show a reduction in the serum 

cholesterol levels of the survivors. The crossover 

of mean serum cholesterol values at the end of 

the reproductive period suggests that women 

may have immunity to coronary heart disease 

during these years that disappears at about the 

age of menopause. 

The values for the proportions of men and 

women with elevated serum cholesterol levels 

followed the same pattern observed when the 

mean levels for men and women by age were 

compared. The percents of elevated serum 

cholesterol and mean levels for men were 

slightIy lower than those for women in the 

youngest age group. They were higher for men 

in their midthirties and midforties and lower for 

those in the older age groups, particularly those 

aged 55 years and over. A differential survival 

could effect such a large difference in elevated 

and mean serum cholesterol levels. 

Race Differences 

There was little difference in mean IeveIs 

between sexes of either race. Differences in 

13 
mean serum cholesterol between black and 

white women were quite small and followed the 

same age pattern observed for all women. This 

picture was also evident for black and white 

men, with a slight exception. Serum cholesterol 

levels for black men continued to rise to age 

group 55-64 years and then declined in the 

oldest age group. However, the mean serum 

cholesterol level for white men leveled off at an 

earlier age group, 45-54 years. 

Black women in all age groups except those 

ages 65-74 years showed higher mean serum 

cholesterol than white women of comparable 

ages. These differences in mean serum cholesterol levels between black and white women 

were quite small, however, ranging from 0.5 

mg/lOO ml to 4.5 mg/lOO ml. There were no 

similar consistent differences between black and 

white men of comparable ages, and all differences were small-ranging from 1.0 to 6.8 

mg/lOO ml. 

Response Rates and Techniques of 

Measurement-HES and HANES 

Comparable response rates and similar laboratory techniques for determining serum cholesterol values are necessary in order to compare 

the mean levels from the two surveys. 

The HES sample had a response rate of 95 

percent interviewed and 86 percent examined, a 

highly representative sample of the civilian 

noninstitutionalized population of the United 

States. The corresponding rates for HANES were 

over 95 percent interviewed and 70 percent 

examined. The lower examination rate in the 

HANES sample than in the HES sample might 

have biased the mean serum cholesterol level 

downward because persons with higher serum 

cholesterol might be less likely to come for 

examination. This is, however, unlikely because 

an analysis of medical histories comparing the 

nonexaminees with the examinees indicated no 

large differences between the nonexamined 

group and the examined group for the medical 

statistics compared. For example, 12 percent of 

persons examined reported having an illness or 

condition that interfered with their eating as 

compared with 10 percent of persons not 

examined. The percent of examined persons 

reporting ever being told by a doctor that they 

had arthritis was 20 percent, the percent of 

those with high blood pressure was 18 percent, 

and the percent of those with diabetes was 4 

percent. The corresponding percents for nonexamined persons were: arthritis, 18 percent; high 

blood pressure, 22 percent; and diabetes, 4 

percent. 

Both methods (1960-62 and 1971-74:) show 

positive biases relative to a common reference 

method. These biases were compared and corrected for in comparisons between the two 

surveys. 

The 1971-74 data were diminished by 4.5 

percent to make them comparable to the 1960- 

62 data which were presented already corrected 

by 7.6 percent to approximate the reference 

method. The reference method may be presumed to be stable over time, but there were no 

pools of sera which were analyzed in both study 

periods to assure that a shift in the accuracy of 

this reference method did not occur because 

such pools were not available. 

Comparing serum cholesterol levels over 

time is difficult because of changing analytic 

techniques and the lack of stable reference 

samples. These methodological problems, however, do not explain the change in older females 

found in the NCHS data. The comparative 

analysis of the HES 1960-62 and HANES 

197 1-74 data, moreover, did include appropriate 

adjustments which were developed and approved 

by CDC as explained in our report. When serum 

cholesterol is being monitored, the sampling and 

measurement methods used during the surveys 

must be the same throughout. This is an 

extremely difficult requirement to fulfill. For 

instance, mean serum cholesterol levels in the 

U.S. male population appear to have decreased 

very slightly between 1960-62 and 1971-74. This 

finding is based on data collected by two surveys 

with comparable sample design, which permits 

calculation of the differences in cholesterol 

levels that could be accounted for by sampling 

variability alone. In this instance, the difflerence 

is not statistically significant. The serum cholesterol levels were measured by the same laboratory during both surveys. However, since no 

serum cholesterol standard exists which is stable 

over 10 years, no provisions could be made in 

1960-62 to assure that subsequent cholesterol 

determinations would be completely comparable 

with the 1960-62 determinations. Therefore, for 

14 
both of these reasons, we cannot be sure whether 

or not the small measured change in mean serum 

cholesterol levels are real. The same kind of 

methodological problem would pertain in the 

analysis of data sets collected by other investigators over this time period. 

The pattern in mean levels for women by age 

between the two survey periods was similar to 

that observed for men at ages 25-34 and 45-54 

years. The mean levels at these ages showed a decrease in 1971-74 as compared with those in 

1960-62, but the decrease in mean levels was small 

and statistically not significant. The difference in 

mean levels for women between the two 

surveys-6.8 mg/lOO ml-did show a statistically 

significant but small decrease at ages 35-44 

years. This could still be attributed to differences in laboratory methods. However, there 

was a larger decrease in mean levels of the 

1971-74 data as compared with the 1960-62 

data for women at ages 55 years and olderwhich differences are large enough to be statistically significant and also large enough not to be 

attributable to differences in laboratory 

methods. 

In comparing the difference in prevalence 

rates of serum cholesterol levels by age between 

the two surveys, the 1971-74 data showed a 

consistent decrease over all age groups, though 

the decrease was large enough to be statistically 

significant only at ages 55 years and over. 

Diet 

Until 1968 the American Heart Association 

emphasized the use of prudent diet to lower 

serum cholesterol for persons with high risk of 

developing coronary heart disease and also with 

a family history of premature atherosclerotic 

disease.16 It was not until 1973 that the 

American Heart Association stated that it is 

prudent for the general population to follow a 

diet moderately restricted in saturated fat and 

cholesterol to lower serum cholesterol levels.1 7 

The Report of Inter-Society Commission for 

Heart Disease Resources issued in 1970 urged an 

immediate nationwide campaign to reduce 

serum cholesterol levels by definite changes in 

dietary habits, beginning in early childhood, in 

order to decrease the risk of coronary heart 

disease in latcc life.l5 The Food and Nutrition 

Board of the National Academy of SciencesNational Research Council and The Council on 

Foods and Nutrition of the American Medical 

Association issued a joint statement Diet and 

Coronary Heart Disease in July 1972.*l They 

recommended a reduced intake of saturated fat 

and cholesterol to lower the cholesterol in the 

plasma. The measurement of plasma lipids, 

particularly plasma cholesterol and other risk 

factors, becomes a routine part of all health 

maintenance physical examinations. 

A task force established by the National 

Heart and Lung Institute issued similar suggestions on diet in June 1971 stating that “pending 

confirmation by appropriate diet or drug triaIs, 

it therefore would appear prudent for the 

American people to follow a diet aimed at 

lowering serum lipid concentrations. . . by lowering intakes of calories, dietary cholesterol, and 

saturated fat.“lg There is not complete agreement with the Report of the Inter-Society 

Commission for Heart Disease Resources recommending a nationwide change in the feeding 

practices for infants and children. The Committee on Nutrition of the American Academy of 

Pediatrics recommended against the adoption of 

dietary changes for all children** as urged by 

the Inter-Society Commission for Health Resources. The Committee believes that such dietary intervention is warranted only in special 

situations (usually hereditary), where children 

have been diagnosed as having elevated blood 

lipids. In spite of these recommendations aimed 

at lowering serum cholesterol levels and of the 

decrease in mortality rates from coronary heart 

disease,*0 there is no evidence of a decrease for 

men in mean cholesterol levels or of a decrease 

in the prevalence of high cholesterol levels, but 

there is such evidence among women of the 

older ages. 

SUMMARY 

Serum cholesterol findings among individuals 18-74 years of age in the civilian noninstitutionalized population of the United States as 

obtained by means of the Health and Nutrition 

Examination Survey of 1971-7-l are presented 

and analyzed in this report. Age, sex, and race 

differences in serum cholesterol determinations 

are included. For this survey, a national proba15 
bility sample of 28,043 persons was selected to 

represent 194 million persons in the target 

population aged 1-74 years. Of these, 20,749 or 

74 percent were examined. The findings in thi!; 

report are limited to those for the 13,67 1 adult 

examinees 18-74 years of age. The present 

publication provides basic data on the distribution of the total U.S. adult population with 

respect to serum cholesterol determinations. 

These distributions can identify the proportion 

of persons in any age-sex group that exceeds 

some specified level. Comparisons among agesex-race subgroups provide evidence that age and 

sex are important variables influencing serum 

cholesterol levels, but race is not. Some of these 

principal findings are summarized in the following section. 

Mean serum cholesterol levels for men increased rapidly with age from 186.9 mg/lOO ml 

at 18-24 years to 231.3 mg/lOO ml at 35-44 

years. The rate of increase then showed a 

flattening or plateau effect, with the levels 

reaching a peak of 240.2 mg/lOO ml at 55-64: 

years and declining to a low of 236.2 mg/lOO ml 

at 65-74 years. 

Mean serum cholesterol levels for women 

were shghtly higher than those for men in the 

youngest age group, 18-24 years-19 1.7 versus 

186.9 mg/lOO ml. They were lower and in 

creased less rapidly than those for men at ages 

25-34 and 35-44 years. The levels exceeded. 

those for men after age 45, and then increased. 

rapidly from 242.6 mg/lOO ml at 45-54 years to 

a maximum level of 261.6 mg/lOO ml at 65-74, 

years. 

In all age groups, with the exception of 

65-74 years, black women had consistently 

higher mean serum cholesterol levels than white 

women had. This pattern in mean levels was not. 

evident for white and black men. White and. 

black women of older ages, particularly 55 years; 

and over, showed higher proportions with serum 

cholesterol levels of 260 mg/lOO ml and over 

than men of comparable ages showed. 

Comparisons with previous national estimates obtained from the Health Examination 

Survey of 1960-62 among adults are included. 

Medical interest in the distribution of serum 

cholesterol levels of the U.S. popuIation led to 

the inclusion of serum cholesterol determinations in the Health Examination Survey, 1960- 

62. This survey done by the same Division of 

Health Examination Statistics of the National 

Center for Health Statistics and the Iaboratory 

in the Center for Disease Control in Atlanta, 

Georgia, provided a baseline against which the 

values from the Health and Nutrition Examination Survey were measured. 

Similarities and differences in laboratory 

methods that may account for agreement or lack 

of agreement between the 1971-74 and 1960-62 

findings are noted. 

The mean and prevalence rates of serum 

cholesterol levels (260 mg/lOO ml and over) of 

men in 197 1-74 across the age range 18-74 years 

were slightly lower than those in 1960-62. The 

differences were not large enough to be statistically significant. 

For women, the mean values showed a 

statistically significant decrease in 1971-74 as 

compared with those in 1960-62 for ages 35-44 

and 55 years and over. This was evident onIy at 

ages 55 years and over for the prevalence rates 

of those with cholesterol levels above 260 

mg/lOO ml. 

The age trends with mean and prevalence 

rates of serum cholesterol levels found for men 

and women in 1971-74 were also found for men 

and women in 1960-62. Both values by age for 

women in 1960-62 and 1971-74 were higher 

than those for men in the youngest age group, 

18-24 years, lower than the values for men in 

their midthirties and midforties, and exceeded 

those for men after age 45 years. 

000 

16 
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1973. 

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IsAmerican Health Foundation: Position statement 

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76-l 120. Health Resources Administration. Washington. 

U.S. Government Printing Office, Feb. 3, 1976. 

21 National Academy of Sciences-National Research 

Council, Food and Nutrition Board and American 

Medical Association, The Council on Foods and Nutrition: Diet and Coronary Heart Disease. \Vashington, D.C. 

National Academy of Sciences and Xmerican Jledical 

Association, July 1972. 

22American Academy of Pediatrics Committee on 

Nutrition: Childhood diet and coronary heart disease. 

Pediatrics (49):305-307, Feb. 1972. 

17 
LIST OF DETAILED TABLES 

1. Serum cholesterol levels of adults aged 18-74 years, by sex and age: sample size, mean, standard deviation, standard error of 

the mean, and selected percentiles, United States, 1971-74. .,,,.....................................,.......................,.................,..........,...,,... 

2. Percent distribution of serum cholesterol levels of adult men aged 18-74 years, by age: United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . 

3. Percent distribution of serum cholesterol levels of women aged 18-74 years, by age: United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . 

4. Serum cholesterol levels of men aged 18-74 years, by race and age: sample size, mean, standard deviation, standard error of 

the mean, and selected percentiles, United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . 

5. Serum cholesterol levels of women aged 18-74 years, by race and age: sample size, mean, standard deviation, standard error 

of the mean, and selected percentiles, United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

6. Prevalence rates for serum cholesterol levels 260 mg/lOO ml and over among adults aged 18-74 years, by age, race, and sex, 

with standard errors: United States, 1971-74 . . . . . . . . . . . . ..I.....................................................................................~................... 

7. Number of examined persons with serum cholesterol measurements, by sex and age: United States, Health Examination 

Survey (HES) 1960-62 and Health and Nutrition Examination Survey (HANES) 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

8. Mean serum cholesterol levels and standard deviations of the population distribution of adults aged 18-74 years, by sex and 

age: United States, Health Examination Survey (HES) 196062 and Health and Nutrition Examination Survey (HANES) 

1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .: . . . . . . . . . . . . . . . . . . . . . . . . . ......................................................... 

9. Percent of adults with serum cholesterol levels at 260 mg/lOO ml and over, by sex and age: United States, Health Examination Survey (HE.51 196062 and Health and Nutrition Examination Survey (HANES) 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

10. Cumulative percent distribution of serum cholesterol levels of men aged 18-74 years, by age: United States, Health 

Examination Survey (HES) 196062 and Health and Nutrition Examination Survey (HANES) 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

11. Cumulative percent distribution of serum cholesterol Ilevels of women aged 18-74 years, by age: United States, Health 

Examination Survey (HES) 196062 and Health and Nutrition Examination Survey (HANES) 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

19 

20 

20 

21 

21 

22 

23 

23 

24 

24 

25 

18 
Table 1. Serum cholesterol levels ofadultsaged 18-74years,bysexand age: samplesize,mean,standard deviation,standard error of the 

mean,and selected percentiles;United States,1971-74 

N 

Percentile 

x SD SF 

5th 10th 25th 50th 75th 90th 95th 

Sexandage n 

Both sexes Serum cholesterol in mg/lOO ml 

18-74years .... 13,671 129,016 223.4 51.5 0.81 147.7 162.8 187.0 217.8 254.0 290.9 

Z 

314.9 

18-24 years .................... 2,296 24,677 189.4 39.0 1.41 132.0 143.6 162.4 185.0 212.6 241.5 258.4 

25-34 years .................... 2,700 26,935 206.6 43.2 1.42 144.1 158.1 177.6 202.5 230.8 261.8 280.1 

35-44 years .................... 2,328 22,268 223.6 45.3 1.50 160.2 169.6 191.8 218.1 250.6 281.8 309.3 

45-54 years .................... 1,601 23,313 241.1 49.7 1.48 165.1 182.3 207.3 235.0 269.8 305.9 331.1 

5564 years .................... 1,267 19,050 248.9 50.3 2.48 177.3 188.6 214.4 244.2 276.9 312.6 334.6 

65-74 years .................... 3,479 12,773 250.7 54.2 1.35 167.8 186.6 214.5 248.1 283.0 316.0 338.0 

Men - 

18-74 years .... 5,260 61,091 221.8 49.9 1.09 148.3 163.1 186.6 217.1 251.7 286.7 

18-24 years .................... 772 11,753 186.9 36.7 1.89 133.4 143.9 161.6 182.8 207.6 237.7 

25-34 years .................... 804 13,002 210.3 44.0 2.27 147.1 162.1 181.2 205.4 234.8 266.9 

3544 years .................... 665 10,692 231.3 45.9 2.53 164.0 174.4 198.9 227.5 260.5 294.2 

45-54 years .................... 765 11,150 239.4 47.0 2.55 163.6 181.4 208.5 235.0 268.6 304.3 

5564 years .................... 597 8,998 240.2 51.2 3.17 170.9 184.3 206.6 233.7 267.0 302.9 

65-74 years .................... 1,657 5,496 236.2 53.8 2.05 161.4 177.5 202.4 231.8 266.3 297.4 

Women 

311.4 

255.5 

287.9 

322.2 

320.0 

324.4 

320.9 

18-74years .... 8.411 67,925 224.9 52.8 0.99 147.3 162.6 187.3 218.4 256.0 294.1 317.7 

18-24 years .................... 1,524 12,924 191.7 41.0 1.92 130.9 143.3 163.4 187.5 216.8 244.5 

25-34 years .................... 1,896 13,933 203.2 42.2 1.39 142.3 154.0 175.0 198.9 226.7 256.9 

35-44 years .................... 1,663 11,576 216.5 43.5 1.37 152.9 165.9 187.5 211.9 240.9 271.2 

45-54 years .................... 836 12,163 242.6 52.0 2.36 166.6 182.8 266.2 235.0 270.7 308.2 

5564 years .................... 670 10,052 256.8 48.2 2.72 182.8 195.6 222.4 254.2 287.3 317.8 

65-74 years .................... 1,822 7,277 261.6 51.9 1.92 181.3 290.5 228.2 258.1 293.1 326.2 

NOTE: Total includes all races; n = examined persons; N = estimated population in thousands;X= mean; SD = standard deviation; 

sz = standard error of the mean. 

263.8 

274.5 

294.5 

336.0 

340.3 

348.4 

19 
Table 2. Percent distribution of serum cholesterol levels of men aged 18-74 years, by age: United States, 1971-74 

Men 

Serum cholesterol level (mg/lOO ml) 

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

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

100-119.. ............................................................................................... 

120-139 ................................................................................................. 

140-159 ................................................................................................. 

160-179 ................................................................................................. 

180-199.. ............................................................................................... 

200-219 ................................................................................................. 

220-239 ................................................................................................. 

240-259 ................................................................................................. 

260-279 ................................................................................................. 

280-299 ................................................................................................. 

300-319 ................................................................................................. 

320-339 ................................................................................................. 

340-359 ................................................................................................. 

360-379 ................................................................................................. 

380 and over.. ........................................................................................ 

NOTE: Percents may not add to 100.0 due to rounding. 

100.0 

0.1 

0.4 

2.1 

5.6 

11.5 

15.6 

16.2 

16.0 

12.0 

8.8 

4.6 

3.3 

1.7 

1.1 

0.3 

0.6 

100.0 

0.1 

1.0 

5.6 

16.4 

23.5 

23.1 

13.4 

7.4 

5.5 

2.0 

0.8 

1.0 

0.0 

0.2 

Percent distribution 

0.3 0.1 

2.8 0.8 

5.3 2.3 

15.4 9.1 

20.6 12.9 

19.9 18.1 

13.9 17.2 

9.8 14.3 

5.6 11.7 

3.4 4.8 

0.9 3.3 

0.8 3.7 

0.3 1.1 

0.4 0.0 

0.6 0.6 

100.0 

0.4 

0.3 

0.3 

3.0 

ii*: 

16:4 

20.1 

15.7 

11.3 

7.3 

6.5 

1.6 

2.9 

0.2 

0.3 

0.1 0.2 

0.0 0.3 

1.3 1.2 

1.1 2.8 

4.4 5.9 

13.6 12.3 

12.8 17.3 

23.2 16.0 

13.8 14.8 

12.7 12.7 

6.2 7.1 

5.3 4.3 

2.2 2.4 

1.2 0.8 

0.9 0.9 

1.2 1.0 

Table 3. Percent distribution of serum cholesterol levels of women aged 18-74 years, by age: United States, 1971-74 

Serum cholesterol level (mg/lOO ml) 

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

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

100-119.. ............................................................................................... 

120-139.. ......................................................................... .;. ................... 

140-159 ................................................................................................. 

160-I 79.. ............................................................................................... 

180-199.. ............................................................................................... 

200-219.. ............................................................................................... 

220.239.. ............................................................................................... 

240-259 ................................................................................................. 

260-279 ................................................................................................. 

280-299.. ............................................................................................... 

300-319.. ............................................................................................... 

320-339 ................................................................................................. 

340-359 ................................................................................................. 

360-379.. ............................................................................................... 

380 and over.. ........................................................................................ 

100.0 

0.1 

0.4 

2.2 

5.8 

10.6 

15.2 

16.2 

14.6 

11.7 

9.1 

5.6 

3.8 

2.2 

1 .o 

0.8 

0.7 

100.0 

0.3 

1.2 

6.1 

13.6 

21.1 

19.6 

14.9 

11.9 

5.7 

3.2 

0.9 

0.9 

0.4 

0.0 

0.2 

l-l 45-54 55-64 65-74 

years years years 

Percent distribution 

100.0 100.0 

0.3 0.1 

0.6 0.3 

3.1 1.3 

8.1 4.9 

16.2 11.0 

21.8 19.0 

20.6 21.5 

12.2 16.4 

8.0 11.8 

5.4 6.3 

1.6 3.2 

1.0 2.5 

0.4 1.0 

0.3 0.3 

0.1 0.1 

0.3 0.3 

100.0 100.0 100.0 

0.1 0.1 0.4 

0.6 0.2 0.8 

2.6 1.0 1.6 

5.0 2.6 2.0 

11.7 7.4 5.1 

15.4 11.8 9.1 

18.5 14.8 14.3 

14.4 16.2 17.7 

12.0 16.8 14.7 

8.1 10.8 13.6 

3.9 8.9 9.0 

3.3 4.4 5.4 

1.2 2.0 3.0 

1.7 1.9 1.8 

1.5 1.1 1.5 

NOTE: Percents may not add to 100.0 due to rounding. 

20 
Table4. Serum cholesterol levels of men aged 18-74 years by raceand age: samplesize,mean,standard deviation,standard error of the 

mean ~,and selected percentiles, United States,1971-74 

- 

Percentile 

Raceandage n N 

+ 

1 

x SD sx" 

5th 10th 25th 50th 75th 90th 95th 

White men Serum cholesterol in mg/lOO ml 

18-74 years...... 4,343 54,606 222.2 49.7 1.09 148.4 163.3 187.1 218.0 252.1 286.2 311.0 

18-24 years ...................... 625 10,271 187.3 37.2 2.07 133.5 143.8 161.3 183.1 208.7 240.2 

25-34 years..............: ....... 672 11,594 209.9 42.4 2.38 146.7 162.0 180.9 205.6 235.1 265.4 

35-44 years ...................... 570 9,532 231.5 45.5 2.49 164.4 175.2 200.8 227.7 258.8 293.3 

45-54 years ...................... 628 10,039 239.9 47.4 2.61 163.4 180.9 209.2 235.5 269.7 304.7 

55-64 years ...................... 504 8,200 239.9 50.6 3.41 170.7 184.3 206.6 233.8 266.6 301.2 

65-74 years ...................... 1,344 4,970 236.4 54.3 2.40 161.8 178.0 202.8 231.5 266.1 297.4 

256.2 

284.2 

322.2 

321.9 

332.4 

321.2 

Black men 

18-74 years ...... 847 1 5,753 218.9 52.7 1 3.41 1 148.0 1 162.0 1 182.6 1 208.7 247.8 294.4 316.6 

132 1,270 185.0 32.5 3.75 133.4 144.7 163.8 182.1 200.7 221.2 237.8 

119 1,232 214.2 57.0 9.26 147.9 161.1 180.4 202.8 231.8 291.6 345.3 

87 1,005 224.7 51.7 8.56 158.0 166.4 185.5 216.1 263.0 298.9 324.4 

130 1,057 237.1 42.2 5.61 172.6 184.6 203.5 231.7 258.2 303.0 316.0 

85 703 243.8 58.8 11.65 170.3 183.0 202.8 233.3 271.9 313.3 367.1 

294 486 237.3 48.4 3.40 154.8 174.3 198.9 237.3 270.9 298.8 321.0 

NOTE: n = examined persons; N = estimated population in thousands: F = mean; SD = standard deviation; SF = standard error of 

the mean. 

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

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

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

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

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

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

Table 5. Serum cholesterol levels of women aged 18-74 years,by race and age: sample size,mean,standard deviation,standard error of 

the mean,and selected percentiles,United States,1971-74 

Percentile 

n N ii SD sz 

5th 10th 25th 50th 75th 90th 95th 

Raceandage 

White women I I Serum cholesterol in mgll00 ml 

18-74 years ...... 6,758 60,011 225.1 53.0 1.02 147.5 / 162.6 187.4 218.3 256.5 294.6 

18-24 years ...................... 1,165 11,161 191.1 41.1 2.11 131.0 ~ 143.3 163.1 186.7 215.6 243.2 

25-34 years ...................... 1,539 12,161 202.8 42.4 1.47 142.3 154.1 174.2 198.1 226.1 256.6 

35-44 years ...................... 1,301 10,095 216.4 42.8 1.56 152.6 166.1 187.8 211.8 240.6 271.1 

45-54 years ...................... 705 10,879 242.5 52.5 2.49 166.3 183.1 205.8 234.5 270.6 308.1 

55-64 years ...................... 552 9,112 256.4 47.8 2.89 182.7 195.0 221.8 254.6 287.5 317.3 

65-74 years ...................... 1,496 6,603 261.8 52.3 2.02 181.0 200.3 228.1 258.7 293.8 326.4 

318.1 

263.7 

274.4 

293.8 

337.7 

337.2 

348.5 

Blackwomen 

18-74 years ...... 1,557 1 7,302 1 224.0 1 50.5 1 1.78 1 146.4 1 162.5 

18-24 years ...................... 329 1,578 194.7 38.9 3.33 132.2 144.3 

25-34 years ...................... 335 1,646 207.3 40.7 3.42 142.2 154.2 

35-44 years ...................... 334 1,318 216.9 42.2 3.25 155.5 165.6 

45-54 years ...................... 126 1,237 244.7 46.5 6.49 168.0 180.6 

55-64 years ...................... 115 871 260.8 52.6 5.68 182.9 210.1 

65-74 years ...................... 318 652 259.7 47.7 3.78 186.0 204.1 

289.6 316.0 

246.7 261.3 T 261.3 276.5 

270.5 292.9 

310.6 328.6 

337.4 368.7 

323.3 347.3 

NOTE: n = examined persons; N = estimated population in thousands; R= mean; SD = standard deviation; ~2 = standard error of 

the mean. 

21 
Table 6. Prevalence ratesforserum cholesterol levels 260 mg/lOO ~mland overamongadultsaged 1%74years,byage,race,and sex,with 

standard errors: United States, 1971-74 

Population 

estimate 

in 

thousands 

Standard 

error 

of 

rate 

Rate/ 

100 

PoPulation 

Sex and age 

Both sexes Serum cholesterol in mg/lOO ml 

18-74 years ......................................................................... 27,974 21.9 0.58 22.1 20.4 0.60 1.30 

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

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

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

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

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

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

Men 

- 

1,134 4.8 0.54 4.9 4.0 0.62 0.82 

2,812 10.5 0.84 10.3 12.5 0.84 3.50 

4,353 19.3 1.22 19.2 18.4 1.18 3.43 

7,289 31.0 1.61 31.2 30.2 1.69 4.58 

7,203 38.2 2.32 38.2 40.3 2.44 4.54 

5,182 40.6 1.27 40.9 38.7 1.37 3.32 

18-74 years ......................................................................... 

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

2534years .......................................................................................... 

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

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

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

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

Women 

12,358 20.4 0.87 20.6 19.0 0.92 1.87 

451 4.0 0.78 4.1 2.5 0.88 1.69 

1,538 12.1 1.46 11.7 14.9 1.54 5.10 

2,735 25.3 2.13 24.9 25.6 2.03 7.00 

3,392 30.1 2.22 30.9 24.2 2.25 5.82 

2,636 29.7 2.39 29.4 34.0 2.59 10.20 

1,605 29.2 1.38 29.2 30.3 1.57 3.38 

I B-74 years ......................................................................... 15,615 23.2 0.79 23.5 21.6 0.83 1.58 

18-24 years.. .................................................................................... .... 683 5.6 0.87 5.6 5.3 1.05 1.48 

25-34 years .......................................................................................... 1,275 9.1 0.97 9.0 10.4 0.98 2.87 

35-44 years .......................................................................................... 1,618 13.7 1.19 13.7 14.1 1.22 2.71 

45-54 years ..................................................................................... .... 3,897 31.8 2.08 31.5 36.0 2.19 6.81 

55-64 years .......................................................................................... 4,667 45.9 3.04 46.2 44.6 3.19 5.67 

65-74 years.. ................................................................................... .... 3,577 49.2 1.81 49.7 44.9 1.90 4.29 

22 
Table 7. Number of examined persons with serum cholesterol measurements, by sex and age: United States, Health Examination Survey 

(HESS 196062 and Health and Nutrition Examination Survev (HANES) 1971-74 

Sex and age 

Number of 

examined persons 

18-24 years ............................................................................................................................................................ 406 772 

25-34 years.. .......................................................................................................................................................... 661 804 

35-44 years.. .......................................................................................................................................................... 691 665 

45-54 years.. .......................................................................................................................................................... 533 765 

55-64 years.. .......................................................................................................................................................... 410 597 

65-74 years.. .......................................................................................................................................................... 262 1,657 

Women 

18-24 years.. .......................................................................................................................................................... 515 1,524 

25-34 years.. .......................................................................................................................................................... 729 1,896 

36-44 years.. .......................................................................................................................................................... 762 1,663 

45-54 years.. .......................................................................................................................................................... 679 836 

5564 years.. .......................................................................................................................................................... 426 670 

65-74 years.. .......................................................................................................................................................... 289 1,822 

L 

NOTE: The distribution of the number of persons examined by age and sex is different for HES and HANES because different 

sampling rates were applied to the subgroups, but within the subgroups, sampling rates are representative of the U.S. population at the 

time of the survey. 

Table 8. Mean serum cholesterol levels and standard deviations of the population distribution of adults aged 18-74 years, by sex and age: 

United States, Health Examination Survey (HES) 1960-62 and Health and Nutrition Examination Survey (HANES) 1971-74 

Men I Women 

Age H ES, HANES, HES, HANES, 

1960-62 1971-74 1960-62 1971-74 

Mean SD Mean SD Mean SD Mean SD 

Serum cholesterol in mg/lOO ml 

18-24 years.. .................................................................................... 178.1 40.7 178.5 35.0 184.7 47.9 183.1 39.1 

25-34 years.. .................................................................................... 205.9 44.6 200.8 42.0 197.9 41.9 194.1 40.3 

3544 years.. .................................................................................... 226.8 49.4 220.9 43.9 213.6 45.3 206.8 41.5 

45-54 years.. .................................................................................... 230.5 45.6 228.6 44.9 236.8 50.0 231.7 49.6 

55-64 years.. .................................................................................... 232.8 49.0 229.4 48.9 262.3 63.0 245.2 46.0 

65-74 years ...................................................................................... 229.5 47.3 225.6 51.3 265.7 58.8 249.8 49.6 

NOTE: SD = standard deviation. 

23 
Table 9. Percent of adults with serum cholesterol levels of 260 mg/lOO ml and over, by sex and age: United States, Health Examination 

Survey (HES) 196062 and Health and Nutrition Examination Survey (HANES) 1971-74 

H ES, 1960-62 

Men 

HANES, 

1971-74 

MenI 

Age 

Percent 

Total, 18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.6 22.7 

18-24 years ...................................................................................................................................... 3.9 4.6 

25-34 years.. .................................................................................................................................... 10.4 7.4 

35-44 years.. .................................................................................................................................... 20.2 12.9 

45-54 years.. .................................................................................................................................... 25.7 28.0 

55-64 years.. .................................................................................................................................... 23.5 49.7 

65-74 years ...................................................................................................................................... 21.6 51.0 

14.7 

i 

17.5 

2.8 3.0 

8.2 6.6 

17.1 9.6 

24.1 24.6 

20.2 35.3 

20.9 40.7 

Table 10. Cumulative percent distribution of serum cholesterol levels of men aaed 18-74 “ears. bv aae: United States. Health Examination Survev (HESS 

Serum 

cholesterol 

level 

(mg/lOO ml) 

1960-62 and Health and Nutrition Examination Su;vey (HAN-ES) 1971-74 

-- 

18-74 years 18-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65-74 years 

1960. 

62 

1960- 1971- 1960- 1971- 1960s 1971- 

62 74 62 74 62 74 

Cumulative percent distribution 

0.1 0.2 0.4 0.1 

0.8 0.9 2.9 2.4 

3.3 4.1 14.4 11.8 

9.6 12.2 33.1 31.1 

21.2 25.7 57.9 55.1 

0.6 

2.6 

10.2 

27.5 

0.1 0.1 

1.1 0.6 

4.1 1.5 

‘14.7 5.3 

32.7 14.1 

0.1 0.1 

1.7 0.3 

6.2 3.7 

17.6 9.4 

0.7 0.2 0.1 

0.7 0.7 0.1 

1.4 1.5 1.7 

6.0 4.4 3.3 

II .a 11.1 12.4 

1.3 

4.1 

10.3 

0.2 

0.7 

2.7 

6.2 

14.6 

35.7 42.3 73.8 76.6 47.7 53.6 25.4 32.8 22.6 24.2 22.1 24.2 26.5 29.8 

53.4 59.0 86.8 87.5 66.5 70.8 45.8 51.6 42.6 41 .a 36.4 42.9 43.3 47.9 

70.4 74.5 93.6 94.. 1 81.4 134.3 66.1 68.5 60.8 62.6 58.3 63.2 62.0 65.5 

82.4 85.3 96.1 97.2 89.6 91.8 79.8 82.9 74.3 75.9 76.5 79.8 78.4 79.1 

90.6 91.8 99.1 98.6 95.5 96.3 88.3 90.0 86.3 86.4 87.8 87.3 86.7 88.8 

95.3 95.9 99.4 99.8 98.0 97.9 93.0 93.8 94.7 94.4 93.0 93.3 93.9 94.3 

97.9 97.8 99.6 99.8 99.8 98.7 96.9 97.8 98.6 96.5 96.4 96.2 96.5 96.9 

98.9 99.0 99.8 100.0 99.8 99.0 97.9 99.3 99.4 98.9 98.6 97.9 98.3 97.8 

99.4 99.4 99.8 100.0 99.8 99.4 99.0 99.4 99.9 99.7 99.1 98.8 98.9 98.9 

99.6 99.6 99.8 100.0 99.8 99.4 99.6 99.7 99.9 100.0 99.3 99.1 99.5 99.1 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

L 

24 
Table 11. Cumulative percent distribution of serum cholesterol levels of women aged 18-74 years, Health Examination Survey (HES) 196062 and Health 

Serum 

cholesterol 

level 

(mg/lOO ml) 

Under 100.. .................. 0.1 0.2 

Under 120.. .................. 0.8 1.1 

Under 140.. .................. 2.8 4.5 

Under 160.. .................. 9.3 12.3 

Under 180.. .................. 20.9 24.3 

0.3 

z 

28:3 

49.4 

0.4 

2.9 

11.5 

28.9 

49.7 

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

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

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

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

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

35.2 41.4 69.8 69.5 55.8 60.4 38.3 46.3 18.1 25.7 7.7 15.3 8.8 13.0 

51.9 57.9 84.9 83.5 74.5 77.5 62.1 67.0 35.0 43.7 17.9 29.8 17.6 24.9 

64.9 71.8 91.0 92.1 86.5 88.3 76.8 80.7 53.0 61.8 29.9 47.3 31.4 42.5 

77.3 82.5 95.4 97.0 92.6 94.4 87.1 90.4 72.0 75.5 50.3 64.7 49.0 59.3 

85.5 89.4 97.5 97.9 95.7 97.5 93.0 94.7 84.7 85.0 64.1 78.9 64.8 76.0 

Under 300.. .................. 91.8 94.3 98.2 99.3 

Under 320.. .................. 95.4 97.1 99.0 99.8 

Under 340.. .................. 97.8 98.2 99.7 99.8 

Under 360.. .................. 98.8 99.2 99.9 99.8 

Under 380.. .................. 99.4 99.5 99.9 99.9 

L 

and Nutrition Examination Survev (HANES) 19 ‘1-74 

0.8 

4.4 

15.1 

33.8 

98.6 

z 

99:7 

99.9 

Cumulative percent distribution 

0.6 

1.6 

7.1 

17.4 

36.3 

0.6 

1.8 

6.5 

19.6 

0.3 

0.7 

3.2 

11.0 

23.5 

98.8 97.1 97.8 

99.1 98.4 98.9 

99.7 98.9 99.5 

99.8 99.3 99.6 

99.8 99.5 99.7 

0.6 

2.7 

7.9 

93.7 

iii:: 

0.3 

0.7 

4.8 

11.6 

0.1 

3.5 

0.1 

z 

6k 

90.8 79.1 88.1 

95.3 88.3 94.4 

96.5 95.3 96.4 

98.4 98.3 98.9 

99.0 99.6 99.4 

0.3 

0.7 

1.1 

Ei 

73.3 

iTi:;: 

94.2 

97.0 

0.6 

K 

6:0 

86.1 

92.2 

96.2 

99.3 

99.1 

25 
APPENDIXES 

CONTENTS 

I. Statistical Notes .............................................................................................................................. 27 

Survey Design ............................................................................................................................ 27 

Nonresponse .............................................................................................................................. 28 

Missing Data ............................................................................................................................... 29 

Small Numbers ........................................................................................................................... 30 

Standard Errors .......................................................................................................................... 30 

I I. Demographic Terms ........................................................................................................................ 31 

LIST OF APPENDIX TABLES 

I. Sampling rates by age-sex groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

II. Percent distrib’ution of nonresponse adjustment factors, stands l-65, Health and Nutrition 

Examination Survey (HANES): United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

III. Number of examined persons with missing serum cholesterol measurements, by sex and age: 

United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

IV. Standard errors of mean serum cholesterol levels, by sex and age: United States, Health Examination 

Survey (HPS) 1960-62 and Health and Nutrition Examination Survey (HANES) 1971-74.............. 

V. Standard errors for percent of adults with serum cholesterol levels of 260 mg/lOO ml and over, 

by sex and age: United States, Health Examination Survey (HES) 1960-62 and Health and 

Nutrition Examination Survey (HANES) 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

28 

29 

29 

SO 

30 

26 
APPENDIX I 

STATISTICAL NOTES. 

Survey Design 

The sampling plan of the Health and Nutrition Examination Survey (HANES) followed a 

highly stratified multistage probability design in 

which a sample of the civilian noninstitutionalized population of the coterminous United 

States, l-74 years of age, was selected. Excluded 

from the selection process were those persons 

confined to institutions or residing on any of the 

reservation lands set aside for use by American 

Indians. Successive elements dealt within the 

process of sampling are the primary sampling 

unit (PSU), census enumeration district (ED), 

segment (a cluster of households), household, 

eligible person, and finally, sample person. 

The starting points in the first stage of this 

design were the 1960 decennial census lists of 

addresses and the nearly 1,9 00 PSU’s into which 

the coterminous United States was divided. Each 

PSU is either a standard metropolitan statistical 

area, a single county, or two or three contiguous 

counties. The PSU’s were grouped into 357 

strata for use in the Health Interview Survey and 

subsequently collapsed into 40 superstrata for 

the Health and Nutrition Examination Survey. 

Of the 40 superstrata, 15 contained a single 

large metropolitan area of more than 2 million 

population. These 15 large metropolitan areas 

were chosen for the sample with certainty. The 

remaining 25 superstrata were formed by classifying the noncertainty strata into 4 population 

density groups within each of 4 geographic 

regions. Then using a modified Goodman-Kish 

controlled-selection technique to assure proportionate representation of specified State groups 

and rate-of-population-change classes, 2 PSU’s 

were chosen from each of the 25 noncertainty 

superstrata with the probability of selection of a 

PSU proportionate to its 1960 population. In 

this manner, a total first-stage sampIe of 65 

PSU’s or “stands” included the areas within 

which a sample of persons would be selected for 

examination. The PSU’s were scheduled to be 

sampled over a S-year period with 300-600 

persons to be examined per stand. 

Although the 1970 census data were used as 

the frame for selecting the sample within the 

PSU when they became available, the calendar 

of operations required that the 1960 census data 

be used for the first 44 locations in the HANES 

sample. The 1970 census data were used for the 

last 21 stands of the sample. 

Beginning with the use of the 1970 census 

data, the segment size was changed from an 

expected 6 households selected from compact 

clusters of 18 households to an expected compact cluster of 8 households. The change was 

made because of operational advantages, and 

research by the Census Bureau indicated that 

precision of estimates would not be appreciabIy 

affected by the change from noncompact clusters to compact clusters. 

For ED’s not having usable addresses (generally located in rural areas), area sampling was 

employed and consequently some variation in 

the segment size occurred. To make the sample 

representative of the current population of the 

United States, the address or ED segments were 

supplemented by a sample of housing units that 

had been constructed since the 1960 and 1970 

Decennial Censuses. 

Within each PSU, a systematic sample of 

segments was selected. The enumeration districts 

that fell into the sample were coded into one of 

two economic classes. The first class, identified 

as the “poverty stratum,” was composed of 

27 
“Current Poverty Areas” that had been identified by the Bureau of the Census in 1970 

(pre-1970 census), plus other ED’s in the PSU 

with a mean family income of less than $3,000 

in 1959 (based on the 1960 census). The second 

economic class, the “nonpoverty stratum,” included all ED’s not designated as belonging to 

the poverty stratum. 

All sample segments classified as being in the 

poverty stratum were retained in the sample. 

For the first 42 stands, sample segments in 

nonpoverty stratum ED’s were divided into 8 

random subgroups and one of the subgroups was 

chosen to remain in the HANES sample. Research indicated that efficiency of estimates 

could be increased by changing the ratio of 

poverty to nonpoverty segments from 8: 1 to 

2:l. Therefore in the later stands, the selected 

segments in the nonpoverty-stratum ED’s were 

divided into two random subgroups and one of 

the subgroups was chosen to remain in the 

HANES sample. The differential sampling permits a separate analysis with adequate reliability 

of those classified as being below the poverty 

level and those classified as being above the 

poverty level. 

After identification of the sample segments, 

a list of all current addresses within .the segment 

boundaries was made and the households were 

interviewed to determine the age and sex of each 

household member as well as other demographic 

and socioeconomic information required for the 

survey. If no one was at home after repeated 

calls or if the household members refused to be 

interviewed, the interviewer tried to determine 

the household composition from neighbors. 

To select the persons in sample segments to 

be examined in HANES and at the same time to 

oversample certain groups at high risk of malnutrition, all household members aged l-74 

years in each segment were first listed on ;a 

sample selection worksheet with each household 

in the segment listed serially. The number of 

household members in each of the six age-sex 

groups shown in table I were then listed on the 

worksheet under the appropriate age-sex group 

column. The sample selection worksheets were 

next put in segment-number order and a sys,- 

tematic random sample of persons in each 

age-sex group was selected to be examined using 

the sampling rates shown in table I. 

Table I. Sampling rates by age-sex groups 

Age and sex Rate 

1-5 years (men and women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l/2 

6-19 years (men and women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 

20-44 years (men) ._....................................................., II4 

20-44 years (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l/2 

45-64 years (men and women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II4 

65-74 years (men and women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 

The persons selected in the 65-stand sample 

of HANES comprised a representative sample of 

the target population and included 28,043 sample persons 1-74 years of age of whom 20,749 or 

74 percent were examined. When adjustments were made for different sampling for 

high-risk groups, the response rate became 75 

percent. 

All data presented in this report are based on 

“weighted” observations. That is, data recorded 

for each person are inflated to characterize the 

subuniverse from which that sample person was 

drawn. The weight for each examined person is a 

product of the reciprocal of the probability of 

selecting the person, an adjustment for nonresponse cases (i.e., persons not examined), and 

poststratified ratio adjustment which increases 

precison by bringing survey results into closer 

alignment with known U.S. population figures 

for 20 age, race, and sex groups as of November 

1, 1972, the approximate midpoint of HANES. 

A more detailed description of th.e survey 

design and selection technique can be found in 

“Plan and Operation of the Health and Nutrition 

Examination Survey, United States, 197 l-73,” 

Vital and Health Statistics, Series l-Number 

10a.l 

Nonresponse 

In any health examination survey, after the 

sample is identified and the sample persons are 

requested to participate in the examination, the 

survey meets one of its more severe problems, 

namely that of nonresponse. Usually a sizable 

number of sample persons will not participate in 

the examination. A further potential for bias 

results if the sample persons who do not 

participate differ from the sample persons examined with respect to the characteristics under 

examination. Intensive efforts were made in 

HANES to develop and implement procedures 

NOTE: The list of references follows the text. 

28 
and inducements that would reduce the number 

of nonrespondents and thereby reduce the potential of bias due to nonresponse. These procedures and inducements are discussed in “Plan 

and Operation of the Health and Nutrition 

Examination Survey, United States, 1971-73,” 

Series l-Number 1Oa.l 

Despite these intensive efforts, 25 percent of 

the sample persons from 65 stands were not 

examined as compared to previous surveys with 

response rates of more than 86 percent. Consequently, the potential for a sizable bias does 

exist in the 1971-74 estimates in the publication. Because more than 95 percent of the 

sample persons responded to a medical questionnaire in 197 l-74, one could examine the 

characteristics of the nonrespondents and the 

nature of nonresponse. This examination indicated that the Iikelihood of sizable bias is small. 

For instance, there was no greater proportion of 

persons with characteristics related to serum 

cholesterol who were examined as compared 

with those who were not examined. 

As was mentioned earlier, the data in this 

report were based on weighted observations, and 

one of the components of the weight assigned to 

an examined person was an adjustment for 

nonresponse. A procedure was adopted which 

multiplies the reciprocal of the probability of 

selection of sample persons who were examined 

by a factor that brings estimates based on examined persons up to a level that would have been 

achieved if all sample persons had been examined. The nonrcsponsc-adjustment factor was 

calculated by dividing the sum of the reciprocals 

of the probability of selection for all selected 

sample persons in each of five income groups 

within each stand by the sum of the reciprocals 

of the probability of selection for examined 

sample person4 in the same stand and income 

group, The five income groups were: under 

$3,000; .$3,000-$6,999; $7,000-$9,999; 

sjlO,OOO-$14,999; and $15,000 and over. For 

sample weighting purposes, income group was 

imputed for 5.6 percent of the sample persons 

using educational level of the head of the 

household. To the extent that the incomewithin-stand classes were homogeneous with 

respect to the health characteristics under study, 

the adjustment procedure was effective in reducing the potential of bias due to nonresponse. 

The percent distribution of the nonresponse 

adjustment factors computed for the 65-stand 

sample of HANES is shown in table II. 

Missing Data 

In addition to persons not examined, there 

were some persons whose examinations were 

incomplete in that there was a failure to obtain 

and record all items of information for examined persons. The number of missing data 

cases was Iow for serum choIestero1 determinations over the entire sample of examined persons 

aged 18-74 years-457 or 3.3 percent (table III). 

Any potential for bias arising from these omissions is beheved to be small. Estimates in this 

report in&de imputed values for all missing 

Table II. Percent distribution of nonresponse adjustment factors, stands l-65, Health and Nutrition Examination Survey 

(HANES): United States, 1971-74 

‘A size of 3.00 was assigned for all factors greater than 

3.00. The final poststratified ratio adjustment corrects for this 

truncation. 

Table III. Number of examined persons with missing serum 

cholesterol measurements, by sex and age: United States, 

1971-74 

I 

Age Both 

sexes Men Women 

Number of examined 

Total, 1 B-74 years . . . . . . . . . . . . 

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

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

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

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

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

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

29 
data cases. This was done by randomly assigning 

a value for the missing item from among 

examined persons similar in age, sex, race, and 

region with that item of information recorded. 

This process preserves both the expected values 

and the distribution of values of the recorded 

information. 

Small Numbers 

In some tables, magnitudes are shown for 

cells for which the sample size is so small that 

the standard error may be several times as great 

as the statistic itself. In such instances the 

numbers, if shown, have been included only to 

convey an impression of the overall story of the 

table. 

Standard Errors 

The probability design of the survey makes 

possible the estimation of standard errors corresponding to the weighted estimates presented. 

The standard error is primarily a measure Iof 

sampling variability, that is, the variations might 

occur by chance because only a sample of the 

population is surveyed. As calculated for thGs 

report, the standard error also reflects part (of 

the variation that arises in the measurement 

process. It does not include estimates of any 

biases which might lie in the data. The chances 

are about 68 out of 100 that an estimate from 

the sample would differ from a complete census 

by less than the standard error. The chances are 

about 95 out of 100 that the difference would 

be less than twice the standard error and about 

99 out of 100 that it would be less than 2 l/2 

times as large. 

Estimates of standard errrors are obtained 

from the sample data and are themselves subject 

to sampling error when the number of cases in a 

cell is small, or even occasionally, when the 

number of cases is substantial. 

Estimates of the standard errors for selected 

statistics used in this report are presented in 

Table IV. Standard errors of mean serum cholesterol levels, by 

sex and age: United States, Health Examination Survey 

(HES) 1960-62 and Health and Nutrition Examination 

Survey (HANES) 1971-74 

18-24 years.. ..... 5.10 1.80 4.10 1.83 

25-34 years.. ..... 3.07 2.17 2.79 1.32 

35-44 years.. ..... 3.01 2.42 2.83 1.31 

45-54 years.. ..... 3.25 2.43 3.14 2.25 

55-64 years.. ..... 4.37 3.03 4.01 2.60 

65-74 years.. ..... 7.45 1.96 5.60 1.63 

Standard error i in mg/lOO ml 

Table V. Standard errors for percent of adults with serum 

cholesterol levels of 260 mg/lOO ml and over, by sex and 

age: United States, Health Examination Survey (HES) 

1960-62 and Health and Nutrition Examination Survey 

(HANES) 1971-74 

Age 

18-24 iears.. ..... 

25-34 years.. ..... 

3544 years.. ..... 

45-54 years.. ..... 

5564 years.. ..... 

65-74 years.. ..... 

- 

T 2.35 0.63 

1.86 1.17 

0.93 2.08 

2.48 

2.00 

3.80 L 2.11 

3.23 

1.27 LL 2.0043 371.174882 0.8956 2900.69 1807

Men Women 

HES HANES HES 

1960-62 1971-74 1960-62 

Standard error in percent 

tables 1 and 4-6. Estimates of sampling variability for comparison of 1960-62 and, 1971-74 

data are presented in tables IV and V. These estimates have been prepared by a r8eplication 

technique which yields overall variability 

through observation of variability among random subsamples of the total sample. Again, 

readers are reminded that these estimated standard errors do not reflect any residual bias which 

might still be present after the attempted correction for nonresponse. 

000 

30 
APPENDIX II 

DEMOGRAPHIC TERMS 

The demographic characteristics of the population sampled are defined as follows: 

Age.-The age recorded for each examinee 

was the age at his last birthday on the date of 

examination. The age criterion for inclusion in 

the sample used in this survey was defined in 

terms of his age at time of census interview. 

Some of those who were 74 years old at the 

time of interview became 75 years old by the 

time of the examination. There were 20 such 

cases. In the adjustment and weighting procedures used to produce national estimates, these 

persons were included in the 74-year-old group. 

Race.-For each individual, race was recorded by observation as “white,” “black,” or 

“other races.” The last category included American Indians, Chinese, Japanese, and all races 

other than white or black. Mexican persons were 

included with “white” unless definitely known 

to be American Indian or of another race other 

than white. Blacks and persons of mixed black 

and other parentage were recorded as “black.” 

000 

31 

*U.S. GQVElU?MENT PRlNTlNG OFFICE:1918 260--337/b 
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