Data from the

NATIONAL HEALTH SURVEY

Total Serum Cholesterol levels

of Children4-17 Years

United States, 1971-74

Total serum cholesterol values of children 4-17 years of age, are presented and discussed by age, sex, and race. Data are from the Health

and hktrit ion Examination Survey, United States, 1971-74.

DHEW Publication No. (PHS) 78-1655

Series 11

Number 207

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

Public Health Service

National Center for Health Statistics

Hyattsville, Md. 1978
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A, ISRAEL, Deputy Director

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

GAIL F. FISHER, Ph. D., A$sociate Director for the Cooperative Health Statistics Systems

ELIJAH L. WHITE, Assc)ciate 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 A4czthenwtical Statistics

PETER L, HURLEY, Associate Directorfor Operations

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

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

ALICE HAYWOOD, Information Officer

DIVISION OF HIEALTH IEXAMINATION STATISTICS

MICHAEL A. W. HATTWICK, M.D., Director

SIDNEY ABRAHAM, Chief, Nutrition Statistics Branch

ROBERT S. MURPHY, Chiej Survey Pbsning and Development Branch

COOPERATION OF THE U.S. BUREAU OF THE CENSUS

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

the Bureau of the Census, under a con[tr-actual agreement, participated in the design and

selection of the sample, and carried out th,e first stage of the field interviewing and certain parts

of the statistical processing.

Vital and Health Statistics-Series 11-No. 207

DHEW Publication No. (PHS) 78-1655

Library of Congress Catalog Card Number 78-2963
Library of Congress Cataloging in Publication Data

Abraham, Sidney.

Total serum cholesterol levels of children, 4-17 years, United States, 1971-1974.

(Vital and Health statistics: ‘cries .) 11, Data from the National Health Survey; no. 207)

(DHEW publication; (PHS) 78-1655)

Bibliography: p.

1. Blood cholesterol–United States–Statistics. 2. Children–Medical examinations–

United States–Statistics. 3. Health surveys–United States. I. Johnson, Clifford L., joint

author. II. Carroll, Margaret D., joint author. III. Title. IV. Series: United States. National

Center for Health Statistics. Vital and health statistics: Series 11, Data from the National

Health Survey, Data from the health examination survey ; no. 207. V. Series: United States.

Dept. of Health, Education, and Welfare. DHEW publication; (PHS) 78-1655.

RA407.3.A347 no. 207 [RJ423] 312’.0973s

ISBN 0-8406 -0125-5 [312.6] 78-2963
CONTENTS

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

Serumcholesterol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Serum Collection and Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cholesterol Determinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DefinitionofVariables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ageand Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prevalence ofHighChoIesterol Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

List ofDetailed Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendixes . . . . . . . . , . . . . . . . . . . . . . . , . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . .

1.

2.

3.

4.

5.

6.

7.

8.

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

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

LISTOFFIGURES

Mean serumcholesterollevels ofchildren, bysexandage: United States, 1971-74 . . . . . . . . . . .

Selected estimated percentiles of the serum cholesterol distribution in children, by sex and age:

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

Mean serum cholesterol levels of boys, by race and age: United States, 1971 -74 . . . . . . . . . . . . .

Mean serum cholesterol levels of girls, by race and age: United States, 1971-74 . . . . . . . . . . . . .

Selected estimated percentiles of the serum cholesterol distribution in white and black boys, by

raceandage: United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Selected estimated percentiles of the serum cholesterol distribution in white and bIack girls, by

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

Mean serum cholesterol levels of chiIdren aged 1-17 years and adults aged 18-74 years by age and

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

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

74. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

2

2

2

2

3

3

3

6

7

11

11

12

13

15

33

34

38

4

5

6

7

8

9

10

11

...

Ill
TOTAL SERUM CHOLESTEROL LEVELS

OF CHILDREN 4-17 YEARS

Sidney Abraham, Clifford L. Johnson, M.S.P.H., and lMargaretD.

Division of Health Examination Statistics

INTRODUCTION

Serum cholesterol Ievels of children 4-17

years of age in this report were obtained as part

of the Health and Nutrition Examination Survey

(HANES). HANES is a program of the NationaI

Center for Health Statistics in which measures of

nutritional status are collected for a scientifically designed sample representative of the civilian non institutionalized population of the

United States in the broad range of ages 1-74

years.1

This Health Examination Survey, by means

of 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.

The HeaIth and Nutrition Examination Survey was also used to obtain some limited information on the general health status of the entire

age group as well as further information on the

health status and medical care needs of those

aged 25-74 years in the civilian noninstitutionalized population. A detailed description of

the specific content and plan of operation,

incIuding the sample design, has been

published.1

As in previous Health Examination Surveys,

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 throughout the United

States. Additional

Carroll, M.S.P.H.,

household visiting, interviewing, history taking, and an explm-ation of

the examination procedures were undertaken by

members of the fieId staff of the mobiIe examination center. The seIected sample persons for

whom an appointment could be made were

brought into the specially constructed mobile

e xam in at io n centers which were centrally

Iocated in each of the primary sampling units.

The teams which traveled to the various survey

locations throughout the country included professional and paraprofessional medical and dental examiners aIong with technicians, interviewers, and other staff.

Field data collection operations for the first

H~TES survey were started in ApriI 1971 and

completed in June 1974. Of the 28,043 persons

aged 1-74 years who were selected in the national probability sample to represent the 194

milIion persons in those age groups in the civilian noninstitutionalized population, 20,749, or

74.0 percent, were examined. When adjustments

were made for the differential sampling ratios

used for the effect of oversampIing among the

poor, preschool children, women of childbearing

age, and the eIderly, this corresponds to an

effective response rate of 75 percent. Among

chiIdren 4-17 years of age at interview for whom

serum cholesterol determinations were made,

there were 5,334 examined out of the probability sample of 6,356 selected to represent the

56 miIlion of these ages in the population. This

is an unadjusted response rate and an effective

adjusted response rate of 84 percent. However,

1
interview data relating to the demographic,

socioeconomic, and medical characteristics were

collected on more than 99 percent of the 6,356

children in the probability sample.

SERUM CHOLESTEROL

Serum Collection and Storage

A nonfasting blood specimen was collected

from examinees and stored in three 15-ems

vacutainers. The tubes were kept at room

temperature for clotting for 20-30 minutes following venipuncture. The blood clot was gently

rimmed from the tube and the tubes were then

centrifuged for 10 minutes at 2400 r/rein. 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. Packed with ample carbon dioxide,

styrofoam shippers containing the daily accumulation of vials were sent to the Center for Disease

Control ( CDC) laboratory in Atlanta; 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-cma vial of serum. The serum to be used

eventually for the cholesterol assessment was

thawed at CDC for iron, iron binding capacity,

and magnesium determinations. The remaining

serum in the 3-cm3 vial was then refrigerated

until packed in dry ice for shipment to the CDC

Lipid Laboratory at Chamblee, Georgia. The

serum remained frozen at -200 C until analyzed

for cholesterol content. Thawing and freezing

the serum do not affect the determination of

cholesterol content by competent extraction

methods. z

Cholesterol Determinations

All serum cholesterol determinations were

made in the Iipid Standardization Laboratory

of the Center for Disease Control, U.S. Public

Health Service, Atlanta, Georgia. The analytical

method was based on that of Abell, et al. s but

was modified for a semiautomated production

line. The method, described in detail by

Eavenson, et al.,A was made possible by the development of a relatively stable Liebermann

color reagent, and was designed for automatic

pipetting units.

The Lipid Laboratory at CDC compared the

results obtained with this semiautomated Abell

method and those from the reference method of

Abell, et al.3 For examining the bias of the

semiautomated method, data were ob,tained

from pools of sera analyzed by the reference

method and the semiautomated method. For

pools ranging from 134 to 343 mg per 100 ml,

there was in 1972 an average positive bias of

4.07 percent for the semiautomated method as

compared to the standard method; for the

1971-74 period the corresponding figure was

a positive bias of 4.9 percent. The weighted average bias was 4.5 percent. In this report, the

1971-74 data are presented without correction

for bias so that they provide population reference standards for determinations made by the

semiautomated methodology now in use.

Definition of Variables

In this report, data on the distribution of

serum cholesterol levels of children in the U.S.

population aged 4-17 years are analyzed and

discussed by age, sex, and race. The unweighed

sample data of ages 1-3 years are only shown,

but are not analyzed, because of possible bias

due to missing values (see appendix I). Tlie analyses of serum cholesterol levels with variables

other than age, sex, and race will be presented in

future reports.

Age.–The age is the year attained at the last

birthday. The mean age of each category approximates the midpoint of the whole year,

e.g., the 5-year-oId male group consists of a 1

year cohort whose mean age is 5.51 years? while

the corresponding female sample average’s 5.52

years. The age criterion for inclusion in the

HANES sample was defined as age at time of

census interview. The adjustment and weighting

procedures used to produce national estimates

were based on the age at interview.

Race. –Race was recorded as white, black,

and other races (appendix II). White children

were 74.54 percent of the total children (5,355)

examined of ages 4-17 years; blacks were 24.69

percent, which reflected the sampling design to
overrepresent the poor in HANES. Other races

are included only when the total subjects are

used but are not included in the white-black

breakdown.

The estimated populations shown in each

table, along with the numbers of sample persons,

are presented only to give a general indication of

the size of the population which the data do

characterize. These are produced from the sampIe weighting process and so will vary somewhat

from census figures. The final sampling estimates

of the population size were brought into closer

alignment with the independent U.S. Bureau of

the Census estimates for the civilian noninstitutionalized population of the United States as of

November 1, 1972, by race, sex, and age.

RESULTS

Age and Sex

Percent distributions of boys and girlsby age,

according to their serum cholesterol levels, are

presented in tables 1 and 2. Tables 3 and 4 present basic statistics of serum cholesterol distributions for these children by age and sex. In

addition to listing the number of children examined, their mean age, and the estimated number

in the population, the tables include the mean,

standard deviation, standard error of the mean

as defined through replication (discussed in variance estimations in appendix I), and the values

for seven percentiles from the 5th through the

95th. All were derived from the weighted sample

sizes.

The mean serum cholesterol levels of boys in

the younger ages 4-11 years tend to increase

with age to a high average value of 181.8 mg per

100 ml at ages 9-11 years. Another pattern in

mean values is observed from 12 through 17

years, when the mean values consistently

declined to a low mean value of 167.5 mg per

100 ml at age 17 years (table 3, figure 1). TabIe

4 and figure 1 also show that the mean values of

girls were relatively stable at ages 4-7 years,

174.7 to 177.1 mg per 100 ml, with the mean

values increasing ab&ptIy to 186.5 mg per

ml at age 8. From age 8 through age 13

mean levels consistently decreased from

100

the

the

peak at age 8 to 170.4 mg per 100 ml at age 13

years, a decrease in mean level of 16.1 mg per

100 ml. This direction is not evident at ages 14

through 17 years, when the mean levels

increased irregularly each year from 172.8 mg

per 100 ml at age 14 to 180.6 mgper 100 ml at

age 17 years.

OveraIl, the mean serum cholesterol levels

for girls increased from 174.7 mg per 100 ml at

age 4 years to 180.6 mg per 100 ml at age 17

years, an increase of 5.9 mg per 100 ml. The

decrease in mean levels between similar ages for

boys is slightly less, 3.8 mg per 100 ml.

Gi rIs had higher observed mean serum

cholesterol levels than boys of the same age for

10 of the 14 age groups considered. The exceptions were for those ages 7, 11, 12, and 13 years.

However, the differences in mean serum cholesterol levels between girls and boys, by age, were

not significant at the .05 level using the sign test.

Percentiles of the serum cholesterol distributions are shown by age for boys and girls

(tables 3 and 4). For each age-sex group the

mean serum cholesterol level was aIways greater

than the median, which indicates that the serum

cholesterol distribution was skewed to the right,

positive skewness. This skewness was more evident for boys than for girls.

The differences in age patterns between boys

and girls described previously for the mean were

also apparent when the percentile at the upper

90th, Iower 10th, and middle 50th ends of the

distribution were examined (figure 2).

In general, sex differences were greater at

the upper end of the distribution than at the

lower end (figure 2).

Race, Age, and Sex

Percent distribution of serum cholesterol levels is given for white and black children by age

and sex in tables 5-8. Tables 9-12 present the

basic statistics for these distributions by age,

sex, and race.

The main serum cholesterol patterns

observed previously for the total male population aged 4-17 years were similar to those

observed for white boys separately (table 9, figure 3). Mean cholesterol levels of white boys

were highest at ages 9-11 years and decreased

3
26o

[

250 - —0<,”s

---Gwls

240

23o

t

220

210

z

~

200

a

k

E 190 -. ,865 ,*5T

g ,-----

,., 4

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/

‘ ------ ,,4 , 175, /

:s~--~’: __

:

-----

/’

V 170 — ,,63 ,704 ,89, ,@8 ,68,8 ,e7,5 ;

u ,6.(1

5 160

2

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<

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140

130

t

120

[,

o

I I I I I I I I I I I 1 I I [ I

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ?6 17

AGE IN YEARS

Figure 1. Mean serum cholesterol levels of (children, by sex and age: United States, 1971-74

with age to a low value of 166.9 mg per 100 ml

at age 17 years. For black boys, the peak in

values was at ages 7-12 years, with the exception

of a drop in mean value at age 10 years and then

a decline in mean value from 184.1 mg per 100

ml at age 12 years to a low of 161.8 mg per 100

ml at age 14 years. From 14 years on, the mean

levels increased rapidly to 178.7 mg per 100 ml

at age 16 and then declined (table 10 and figure

3).

At every age except ages 10, 13, and 14

years, black boys had higher mean serum cholesterol values than white boys. However, the

differences in mean serum cholesterol levels

between black and white boys were not significant at the .05 level using the sign test.

The age-cholesterol pattern for girls in the

total population was generally found for white

and black girls separately. The mean serum

cholesterol values of white girls increased irregularly from an average value of 173.5 mg per

100 ml at ages 4-5 years to the highest mean

value of 183.6 mg per 100 ml at ages 8-9 years

and then declined to 168.3 mg per 100 ml at age

13 years. Thereafter with age, there was a general increase in mean level to 180,3 mg per 100

ml at age 17 years (table 11 and figure 4).

The mean levels of black girls also increased

4
260

[

— eoys

25o

--- ~i,j~

240

}

90thPERCENTILE

I 2324

230 –

220 –

210 —

203 –

190 —

180 —

170 —

160 —

50th PERCENTl&

1877

,P-

,790 /

1783 ,,8s

,G21

L————=—

,5, 3 1512

150 ,%

,442 -.-,48,

l“-.

1428 /’ - --- ,40, 7432

140

1as

/’ VL-las.r

1381 /

--

,,, 0 142? -.,

-+-- ,,2, ,,7, ,,5B ,/

/’ ,33,

--&3;5 ~----l;,: ’37”

7380 .~43#@------ 1348 ,

130 I2) ;) 1347 1338

-.

1313 ,325 1331 1326 ,3,2

1?7,2 12B3

$, 120 1229

0

I I I I I I I I I I 1 I I I I I

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

AGE IN YEARS

Figure 2. Selected estimated percentiles of the serum cholesterol distribution in children, by sex and age: United States, 1971-74

irregularly each year from 177.1 mg per 100 ml

at age 4 to a peak of 202.8 mg per 100 ml at age

8. From this highest mean level at age 8, there is

a decrease in mean values through age 12 and

then a general increase to 194.5 mg per 100 ml

at age 15. At ages 16 and 17 years, the mean

cholesterol levels declined from those at age 15

(table 12 and figure 4).

At each age, with the exception of ages 6, 11,

and 12 years, black girls had higher mean serum

cholesterol levels than white girls. These results

were not significant using the sign test, at the

.05 level.

White and black girls generally had higher

mean cholesterol levels than their male counterparts. However only the differences in mean

serum cholesterol Ievels between white g-hisand

white boys were significant at the .05 level using

the sign test. With the exception of those at ages

7 and 12 years white girls had higher mean

serum cholesterol levels than white boys of the

same age group. The differences in mean levels

between white and black children were greater

for girls than for boys. The average differencix

between the mean levels of white and black children over age 14 was 7.1 mg per 100 ml for girls

and 3.8 mg per 100 mI for boys.

In general, interrackd differences for boys

were greater at the upper end of the distribution

(90th percentile) than at the lower end (lOth

5
260

250

1

_ White

--- Black

240

230 —

220 –

2

g 210 –

K

k

200

F

z

: 29o

0

,85, ,,!60 ,e45

.

1E57 ,@ ,

, --------- ,829 -----

: !786

/~

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180 ,,6, ,~ \

V !755 H.O---J~.~ 1743 -..,y

\

j ----- ~,,5 ‘“0 ‘y’ “0’ 179.0 \ :;’ ,,,, ,6g>,.:~~+-::

v 170

z

,mo 7705 ,mo ,=7

-. ~

2

160 ,C3 I

167,2 -4Y ,=,3 1672 ,66.9

:

z

161,8

a

s

150

140

130

120

[,,,,,,,,,,,,,,,,

o 1

2 3 4 5 6 7 e 9 10 11 12 13 14 16 16 17

AGE IN YEARS

Figure 3. Mean serum cholesterol levels of boys, by race and age: United States, 1971-74

percentile) (figure 5). The pattern was reversed

for girls (figure 6).

DISCUSSION

The level of serum cholesterol has been identified as one of the multiple risk factors in the

development of coronary heart disease. The

results of epidemiological studies based on adult

data from longitudinal studies such as the

Framingham Heart Studyb have demonstrated

that persons with elevated serum cholesterol

values developed coronary heart disease with

great frequency. Similar longitudinal data

obtained from adolescents that relate serum

cholesterol levels in younger ages to future morbidity or mortality are not available. There is

‘some evidence, however, that atherosclerosis frequently manifested by coronary heart disease

may originate in childhood. Holman and others

reported finding evidence of atherosclerosis in

post mortem examinations of children,G Enos

and others reported gross evidence of coronary

atherosclerosis in 77 percent of American

soldiers, with an average age of 22 years, killed

in the Korean War.’

Reference data of levels of children 4-17

years of age have been presented and analyzed

by age, sex, and race because of the medical

interest in such data. There are no such previous

data for the general population of ages 4-17

6
250

I

_ Whiw

--- Black

240

230

t

220

210

202

190

180

170

160

1

2028

,A

,,941 ,$22

,/

1945

1s0.3

=. -_

!878 1869

\HH#-.

1749

1744 :733

1651 W6 1660

150

t

140 L

},,,,,, ,,,,,,,,,,,

130

120

0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

AGE IN YEARS

Figure 4. Mean serum cholesterol levels of girls, by race and age: United States, 1971-74

selected segments of the population and special

study groups. These estimates could not be generalized to the U.S. population. HANES, on the

other hand, provided cross-sectional data of

serum cholesterol levels obtained on different

age cohorts representative of the U.S. population. The age trends represented mean levels

for successive cohorts of persons of different age

groups. The limitations of cross-sectional data

are recognized in considering group age changes

because they reflect effects of environmental as

well as developmental and hereditary influences.

Age and Sex

Mean serum cholesterol levels of girls and

boys were stable in the younger years, within

years. Such data as are avaiIabIe are taken from the range of 174.7 -177.1 and 168.9 -175.8 mg

per 100 mI at ages 4-7 years. The mean levels of

ghis of ages 8-17 years showed two distinct

patterns in contrast- to those for boys in the

older ages. Mean Ievels of girls decreased from

186.5 mg per 100 ml at age 8 years to 170.4 mg

per 100 ml at age 13 years and then increased to

180.6 mg per 100 ml at age 17 years. Boys show

a consistent decrease in mean levels with age at

ages 9 through 17 years. The mean leveIs of girIs

at aII ages, with the exception of ages 7, 11, 12,

and 13, had higher values than those of boys.

The difference in mean values between girls and

boys in the 4-17 age group averaged 3.7 mg per

100 ml, and ranged from 0.2 to 13.1 mg per 100

ml.

The estimates from HANES with respect to

sex and age can be compared with other studies

7
260 —

250 –

240 –

230 –

220 –

210 –

200 —

190 —

180 —

170 -

160 –

150

140

130

120 1

60th PERCENTILE 185,0 !85,0

,766

,70,, “33 ’72”

173.7

/

16, 4

1376

122.6

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

AGE IN YEARS

Figure 5. Selected estimated percentiles of the serum cholesterol distribution in white and black boys, by race and age: lJnited Statesr

1971-74

of cholesterol in children and youths. In the

Tecumseh Community Health study

(Michigan), which was conducted in 1959 and

1960, serum cholesterol determinations were

made on 6,788 children and adults;~ no blood

specimens were obtained from persons under 4

years of age. Unfortunately for our purposes,

the study findings were presented for the

combined age groups 4-9, 10-14, and 15-19,

which precludes a more detailed comparison. In

each of these age groups, females had consistently though slightly higher serum cholesterol

levels than males. The findings were consistent

with HANES data with the exception of ages

11-13, in which ages the HANES data showed

that boys had higher levels than girls had.

Other studies on children and youths in the

United States have also found that girls have

higher serum cholesterol levels than boys. In survey data on 1,000 healthy boys and girls in New

York City, girls of ages 3-17 have higher serum

cholesterol levels than boys of comparable

ages.g

In a longitudinal study of 152 girls and 169

boys in Utah of single years of age 7 through 17,

girls had higher mean serum cholesterol levels

than boys.1 0

Clarke and others reported serum cholesterol

levels on male and female volunteer and nonvolunteer subjects of 12-18 years of age who

were students attending public and parochial

schools in Burlington, Vermont. 11 The analysis

8
270 r

m5 I

200 —

190

180

170 —

160

150 —

140

130

120

110 ;

a?? 9

50th PERCENTILE 197 I

/ >-- J9:6

lm. ~

-.

)

1905

!85,2

1662 1668

Im 1 1643 ~653 ,647 ~~s

ll)th PERCEhlTl LE

,502

1452

1419

126.0

IN

1,,~

& I I 1 I I I I I I I I I I I I I I

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

AGE IN YEARS

Figure 6. Selected estimated percentiles of the serum cholesterol distribution in white and black girls, by race and age: United States,

1971-74

by single years of age showed that females from

age 14 to 18 years had higher mean levels than

males of comparable ages. At age 12 males had

higher mean levels than females, while at age 13

the corresponding levels were about equal.

The report of serum cholesterol values of

youths aged 12-17 years obtained from findings

of Cycle III of the Health Examination Survey

(HES) showed that except for age 12, female

youths in each age group had higher mean serum

cholesterol levels than males of comparable

ages .12 However, in studies conducted in

Claxton, Georgia, of schoolchildren of single

years of age from 6 to 18 years, no consistent

difference in mean serum cholesterol levels

between males and females was found.1s Similarly in the Muscatine Study conducted in Iowa

of children and youths of single years of age

from 6 to 18 years, there was little difference

between the mean levels of serum cholesterol in

males and femaIes.14

The relationship between serum cholesterol

level and age in various children study groups

has been reported in the literature, and there

appears to be no consistent pattern regarding the

relationshi~ in re~orted studies. The Health

Exarninati& Surv;yl z

mean serum cholesterol

showed a decrease in

levels among adolescent

9
males of ages 12-16. This relationship of serum

cholesterol levels and age was also observed in a

survey among boys of ages 11-18 years conducted in Sydney, Australia.l 5 In the New York

City survey, 9 mean serum cholesterol levels

among girls did not change significantly from

ages 2 through 17, though there appeared to be

a slight decrease in the mean level by age. Mean

serum cholesterol levels among boys rem~ned

relatively constant during comparable ages. The

Muscatine, Iowa, Studyl 4 reported similar mean

serum cholesterol levels among children of both

sexes of ages 6 through 18. Female adolescents

in the Health Examination Surveyl 2 showed

little if any change in mean serum cholesterol

levels from ages 12-16. At age 17 there was an

increase of 6.4 mg per 100 ml from that

observed among females at age 16. In the Utah

Studyl O age did not affect mean serum cholesterol levels among both boys and girls of ages

7-17. In the Burlington, Vermont Studyl 1 mean

serum cholesterol levels among males decreased

from ages 12 to 14 years and then increased to

age 17, while those among females increased

from ages 13 to 17.

In the Claxton, Georgia,l 3 and Busselton,

Australia,l 6 studies among boys and girls of ages

6-17, serum cholesterol levels increased with age.

The U.S. estimates of serum cholesterol levels of children ages 4-17 years can be compared

with those reported in HANES for adults ~of ages

18-74. Table 13 shows the mean serum ~cholesterol levels of children and adults, obta$ed in

HANES for 1971-74, by age and sex vnth the

standard deviations of the population. distribution. Figure 7 shows the adult mean levels as a

continuation of the mean levels of those presented for children of individual ages of 4-17

years from HANES.

Males show a mean serum level of 167.5 mg

per 100 ml at age 17 after a consistent decline

from a mean level of 182.5 mg per 100 ml at age

9. The mean levels for adults in age group 18-24

is 186.9 mg per 100 ml, an increase of 1.9.4 mg

2?0 r 281,6

Zen — — MalIJ 25S8

~zz--

~.. -

--- Female ,~”~

250 —

,/

//~

24?.6 //

240 —

,HH

//

240,2

239,4

230 —

//”

236,2

/

220—

/

210—

,.

200—

~ :&T””””;:’”’””””’’;””’

lea

o’

1 5 10 15 20 25 Zn 35 40 45 50 55 ao 65 70

AGE IN YEARS

*

Figure 7. Mean serum cholesterol levels of children aged 1-17 years and adults 18-74 years, by age and sex: United States, 1971-74

10
per 100 ml, or 11.6 percent from the mean level

at age 17. The mean levels for mzde adults increase rapidly to age group 35-44 years, and

then increase less rapidly in the age groups 45-54

and 55-64 years, A slight decline occurs in the

age group 65-74 years.

A similaranalysis of the mean level at age 17

for girls with that at ages 18-24 years for females

also shows a rise in mean levels. The mean level

increases to the age group 45-54 years and then

increases less rapidly in the later age groups. The

rise in mean level among men does not start

until the early adult ages, 18-24 years, whereas

in women the risebegins earlier.

The mean levels for women are higher than

those for men in the youngest age group, 18-24

years. The mean levels for women increase less

rapidly than those for men in the age groups

25-34 and 35-44 years but increase much more

rapidly than men’s levels after age 55. The mean

levels for women are about the same as those for

men in the age group 45-54 years. The mean

levels for men peak at the age group 55-64 years

and then decline, while the mean levels for

women continue to rise.

The mean levels in adults are consistently

higher than those in children of ages 4-17 years.

Table 13 also shows that the distributions have

greater variability in adults than in children of

ages 4-17 years.

Race

Black children of both sexes showed higher

mean serum cholesterol levels than white children of comparable age and sex. The differences

in mean levels between white and black children

are greater for females than for males. The average differences between the mean levels of white

and black children over the 14 ages was 7.1 mg

per 100 ml for females and 3.8 mg per 100 ml

for males.

In the HANES survey of U.S. adults, black

femaIes had a slightly but generally higher mean

level than white females of comparable age. The

average difference over all six age groups in

mean levels between white and black females

was 2.2 mg per 100 ml. This pattern is not

observed between white and black males. Mean

270 —

2648 =:6

260 – ... .;...” <...

.“ F 2507

..’”/ 2564

?

. . . /

25o – ... /

g

.. /

244.~,;/ 2438

a

240 –

242,:.* ,m~aa<+b~ =, ~

?

?

.? Nim,,, ‘9~6=

< 230 -

{

?31.5

A

2.747 #

g

,0

P’ t

g

220 – i

‘/

214 y

216.9 f

?

g 210

m 94 . . ..7’+”6A

/ #.. /

o

, ,-2073

z

200 .. “,/+S — White me.

2

,9 p.”.

E

.-. ~,~~,. men

2

19?.1/

<

/

190 — ,872~

.-. white WOmen

%

,85,0 180-

-----Black v/Omen

!(

18.24 25.34 SS44 4s.54 55.64 65.74

AGE IN YEARS

Figure 8. Mean serum cholesterol levels of adults aged 18-74

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

serum levels for white males are higher than

those for black males in the age groups 18-24,

35-44, 45-54 years. The differences in mean levels range from 2.3 to 6.8 mg per 100 ml. At ages

25-34 and ages 55 years and over, black males

have higher mean levels than white males; the

differences in mean Ievels are small and range

from 1.0 to 4.3 mg per 100 ml (figure 8).

Other studies have shown racial differences

in mean cholesterol levels. A study of serum

cholesterol levels in Southwestern and Midwestern American Indians and white persons

showed lower cholesterol leveIs among the

Indians.1TYIg Surveys of children ~d adolescents among white, Bantu, and Cape colored populations showed findings of higher cholesterol

levels in the white children than in either the

Bantu or Cape colored chiIdren.19

Prevalence of High Cholesterol Levels

No effort was made to classify serum cholesterol values according to standards. This involves

Iooking at the reference distributions of serum

cholesterol levels and considering the proportion

of children in any age-sex group which exceeds

11
some specified level. At present, there is no generally agreed upon point at which levels should

be considered “high.”

Frederick and associates set the upper limit

of normal at the 95th percentile; a serum cholesterol level over 230 mg per 100 ml in children

would be abnormal. z 0 There are others who

prefer normal levels based on epidemiological

studies rather than on statistical cutoff points.

They indicate that the U.S. population’ generally

tend to have elevated serum cholesterol levels

and would not use the upper 5 percent of the

serum cholesterol distribution. They suggest that

the risk of premature coronary artery dkease is

not likely below the level of 180 and 200 mg per

100 ml in childhood.zl~zz Kannel and

Dawberzs advocate that infants and children

whose plasma cholesterol levels exceed 160 mg

per 100 ml should be periodically monitored for

blood cholesterol and for diet and weight control.

SUMMARY

Total serum cholesterol findings among children 4-17 years of age in the civilian noninstitutionalized population of the United States as

obtained in the Health and Nutrition Examination Survey, 1971-74, are presented and

analyzed in this report. Age, sex, and race differences in total serum cholesterol determinations

are included.

For HANES, a national probability sample

of 6,356 persons was selected to represent 56

million persons in the population aged 4-17

years. Of these 5,355, or 84 percent, were examined.

The present report provides basic data on

the distribution of children of ages 4-17 years

with respect to total serum cholesterol determinations. These distributions should aid in

identifying the proportions of children in any

age-sex-race group which exceeds some specified

level. Some of these principal findings are

summarized below.

For boys of ages 4-8 years, the mean values

varied only slightly among the five age gp-oups

within the range of 168.9 -175.8 mg per 100 ml.

A similar pattern was evident for girls of ages 4

through 7 years; however, the mean values were

higher among girls than among boys. After age 9

there was a difference between sexes in regard to

the variation of mean levels with age.

Among older boys, mean serum cholesterol

levels decreased with age from 182.5 mg per 100

ml at age 9 to 167.5 mg per 100 ml at age 17, a

decrease of 8.2 percent.

Among older girls, mean serum chculesterol

levels decreased with age from 186.5 mg per 100

ml at age 8 to 170.4 mg per 100 ml at age 13, a

decline of 8.6 percent and then increased to

180.6 mg per 100 ml at age 17, an increase of

6.0 percent.

Girls in the U.S. population had higher mean

serum cholesterol levels than boys in 10 of the

14 age comparisons. The differences in mean levels between sexes in these ages averaged 4.7 mg

per 100 ml and ranged from 0.2 mg per 100 ml

to 13.1 mg per 100 ml.

Black boys and girls in the U.S. population

had higher mean serum cholesterol levels than

their white counteq?arts. The differences in

mean levels between white and black children

were greater for girls (7. 1 mg per 100 ml) than

for boys (3.8 mg per 100 ml).

The mean serum cholesterol level obtained

for males of age 17 years is consistent with the

finding that serum cholesterol levels rise shaqiy

with age for young men. Similar analysis of the

mean cholesterol level for females of age 17

years with those of females aged 18-24 years

shows that the mean values rise less rapidly than

those of males. The increase in mean cholesterol

levels observed in the data for females between

the ages of 16 and 17 years is followed by an

increase during the age group 18-24 years and a

continued rise in serum cholesterol level among

females in the age groups 25-34 and 35-44 years.

In adult males the rise is not only more rapid

but it begins earlier. Not only are the mean

serum cholesterol levels higher in adults than in

children, but also the distributions have greater

variability in adults than in children aged 4-17

years.

12
REFERENCES

1National Center for Health Statistics: Plan and operation of the Health and Nutrition Examination Survey,

United States, 1971-1973, Vital and Health Statistics.

Series 1, Nos. 10a and 10b. DHEW Pub. No. (HSM)

73-1310. Health Services and Mental Health Administration. U.S. Government Printing Office, Feb. 1973.

2Per&al communication 9/13/76, Dr. M.J. Kuchrnali,

Lipid Standardization Laboratory, Center for Disease

Control, Atlanta, Georgia.

3AbelI, L.L., Levy, G. B., Brodie, B.B., and Kendall,

F.E.: A simplified method for the estimation of total

cholesterol in serum and demonstration of its specificity.

J. Biol. Chem. 195:357, 1952.

4 Eavenson, D., Grier, O.T., Cisson, J. G., and Witter,

R. F.: A semi-automated procedure for the determination

of serum cholesterol using the AbelI-Kendall method. ~.

Am. Oil Chem, Sot. 43:652, 1966.

5Kannel, W.B., Castelli, W.P., Gordon, T., and

McNarnara, P.M.: Serum cholesterol, liproproteins, and

the risk of corormy heart disease. Ann. Intern. Med.

74:1-12, 1971.

6HoIman, R.L., McGill, H.C., Strong, J. P., Geer, J.C.:

The natural history of atherosclerosis: The early aortic

lesions as seen in New Orleans in the middle of the 20th

Century. Am. J. Pathol. 34:209-235, 1958.

7Enos, WJ., Holmes, R.H., and Beyer, J.: Pathogenesis of coronary heart disease in American soldiers

killed in Korea. JAMA 158:912-914, 1955.

8Johnson, C.J., Epstein, F.H., and Kjelsberg, M.O.

Distributions and familial studies of blood pressure and

serum cholesterol levels in a total community, Tecumseh,

Michigan. J. Chronic Dk 18:147-160, 1965.

‘Adlersberg, D., Schaeffer, L., Steinberg, A. G., and

Wang, C.I.: Age, sex, serum lipids and coronary atherosclerosis. JAMA, 162 (7): 619-621, 1956.

10Milligan, A. C., WIICOX, E.B., and Galloway, L. S.:

Serum cholesterol and physical characteristics of preadolescents and adolescents. J. Am. Diet. Assoc.

49:309-315, 1966.

11 Clarke, R. P., Merrow, S.B., Morse, E.H., and Keyser,

D. E.: Interrelationships between plasma lipids, physical

measurements and body fatness of adolescents in

Burlington, Vermont. Am. J. Clin. Nutr, 23

(6):754763, 1970.

1‘National Center for Health Statistics: Total serum

cholesterol levels of youths, 12-17 years, by P.S. Levy,

P.V.V. Hamill, F.P. HeaId, and M. Ronkmd, Vital and

Health Statistics. Series 11-N’o. 156. DHEW Pub. No.

(HRA) 76-1638. Health Resources Administration.

Washington. U.S. Government Printing Officej May

1976.

13Hames, C.G., and Greenberg, B.C.: A comparative

study of serum cholesterol levels in school children and

their possible relation to atherogenesis. Am. ]. Public

Health. 51, 374-385, 1961.

14Lauer, R.hf., Connor, W.E., Leaverton, P.E., Reiter,

M. A.,and Clarke, W.R.: Coronary heart disease risk

factors in school children: The Muscatine Study. J.

Pediatr. 86, 697-706, 1975.

15Hickie, J. B., Sutton, J., Russo, P., Ruys, J., and

Kraegen, E.W.: Serum cholesterol and serum triglyceride

levels in Australian adolescent males. Med. J. Aust.

825-828, 1974.

16Godfrey, R. C., Stenhouse, N.S., Cullen, K.J., and

Blackman, V.: Cholesterol and the child: Studies of

cholesterol levels of Busselton school children and their

parents. Au.rt. Paedfatr. j. 8, 72-78, 1972.

17Abraham, S., and MiIler, D.C.: Serum cholesterol in

American Indians. Pub. Health Rep. 74 (5): 392-398,

1959.

18Sierers, hLK.: Serum cholesterol levels in southwestern American Indi~s. ]. Chyonic Dfi. 21, 107. I 15,

1968.

19DuPlessis, J.P., Vhier, F.D., and DeLang, D.J.: The

Biochemical evaluation of the nutrition status of urban

school children aged 7-15 years serum cholesterol and

phospholipid levels and serum and urinary arnylase activities. S. Afi. Med. ]. 41, 1216-1221, 1967.

20 Fredrickson, D.S., Levy, R.I., and Lees, R.S.:

(Medical Progress) Fat transport in Iipoproteins-An

integrated approach to mechanisms and disorders. N.

Engl. J. Med. 276: No. 3, 148-156, 1967.

21 mash, ~, md Hengstenberg, F.: The identYlcation of

risk factors in normal chiIdren in the development of

arteriosclerosis. Ann. CL%. Lab. Sci. 2, 348-, 1972.

22 Condor, W.E., and Connor, S.L.: The key role of

nub-itional factors in the prevention of coronary heart

disease. Prev. Med. 1:49-83, 1972.

73
23 Kannel, W.B., and Dawber, T, R.: Atherosclerosis as 25 National Center for Health Statistics: Plan and opera Pediatric problem. ]. Pediatr. 80:N0. 4, Part I, ation of a health examination survey of U.S. youths,

544-554, 1972, 12-17 years of age. Vital and Health Statistics. PHS

24National Center for Health Statistics: Plan, oper- Pub. No. 1000-Senes l-No. 8. Public HeaIth Service.

ation, and response results of a program of children’s Washington. U.S. Government Printing Office, Sept.

examinations. Vital and Health Statistics. PHS Pub. No. 1969.

1000–Series l-No. 5. Public Health Service. Washington.

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

14
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

LIST OF DETAILED TABLES

Percent distribution of serum cholesterol levels of boys by age: United States, 1971-74 . . . . . . . .

Percent distribution of serum cholesterol levels of girls by age: United States, 1971-74 . . . . . . . .

Serum cholesterol levels of boys 1-17 years of age, mean age, number examined, estimatad number

in the population, mean, standard deviation, standard error of the mean, and selected percentiles,

byage:United States, 1971 -74..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Serum cholesterol Ievelsof girls l-17years ofage, mean age, number examined, estimated number

in the population, mean, standard deviation, standard error of the mean, and selected percentiles,

byage:United States,1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distribution ofserum cholesterol levels ofwhiteboys by age: United States, 1971-74.. . .

Percent distribution ofserum cholesterol levels of black boys by age: United States, 1971-74 . . . .

Percent distribution ofserum cholesterol levels of Mite girls by age: United States, 1971-74 . . . .

Percent distribution ofserum cholesterol leveIsof black girls byage:United States, l97l-74 . . . .

Serum cholesterol levels of white boys 1-17 years of age, mean age, number examined, estimated

number in the population, mean, standard deviation, standard error of the mean, and selected

percentiles, byage: United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Serum cholesterol levels of black boys l-17 years of age, mean age, number examined, estimated

number in the population, mean, standard deviation, standard error of the mean, and selected

percentiles, byage:United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. Serum cholesterol Ievelsof white girls 1-17 years of age, mean age, number examined, estimated

number in the population, mean, standard deviation, standard error of the mean, and selected

percentiles, byage:United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. Serum cholesterol Ievelsof black girls 1-17 years of age, mean agernumber examined, estimated

number in the population, mean, standard deviation, standard error of the mean, and selected

percentiles, byage:United States, 1971-74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13. Serum cholesterol levels of males and females 15-74 years of age, number examined, mean, and

standard deviation, byage: United States, 1971 -74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16

18

20

21

22

24

26

28

30

31

31

32

15
Table l. Percent distribution ofserum cholesterol levels of boys by age: United States, 1971-74

Serum

cholesterol

level

(Mgper100m1)

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

Less than 100 .. ......................................

100-1 09 ............................................... ..

110-11 9 ..... .................................. ..........

120-1 29 ................... ..............................

130.139 .................................................

140.149 .................................................

150.159 ............ .....................................

160-1 69 ........................................ .........

170.179 .................................................

180.189 ............. .................... ................

190.199 ........ ..........................m..............

200.209 .................. ...............................

210-21 9 .................................................

22 0.229 .................................................

230-239 .................................................

240.249 ..... ............................................

250.259 ..................................... ............

260.269 .................................................

27 0.279 .............. ...................................

28 0.289 ............... ..................................

290.299 .................................................

300 or more ..........................................

Number of boys examined ......................

Estimeted boys in population

in thousands ... .....................................

1 2 3 4 5 6 7

year years years years years years years

Percent distribution

100.0

3.0

0.8

3.8

5.3

11.3

11.3

12.0

15.0

9.0

8.3

3.8

6.8

1.5

3.0

2.3

0.8

1.5

0.8

100.0

1.8

0.6

2.4

1.8

5.4

10.1

12.5

14.9

14.9

11.3

7.7

3.6

4.8

2.4

1.8

0.6

0.6

1.2

1.8

100.0

_l- 133

(1) -L168

(1)

0.4

2.7

4.0

7.6

10.3

14,7

13.8

12.9

10.7

7.6

4.9

3.6

1.8

2.2

2.2

0.4

100.0

1.6

0.7

1.1

3.6

6.0

8.7

10.3

13.4

18.4

15.6

6.3

6.3

3.7

1.3

0.9

2.2

0.1

100.0

0.4

0.7

1.8

9.0

6.6

10.2

14,9

13.8

9.4

7.7

6.7

9.2

3.5

2<0

1.0

0.9

1.3

0.7

0.5

224 304

(1) 1,815

273

1,563

100.0

0.7

2.6

7.5

9.1

18.8

11.8

21.4

9.7

7.5

7.1

1.5

0.6

0.4

0.2

1.2

100.0

0.1

1.3

1.7

2.4

14.0

8.9

14.0

19.2

9.8

10.6

5.1

4.9

4.3

3.5

0.1

0.2

179 164

1,673 1,979

lU s ~oPulation ~5timates not included because of possible bias due to missing values.

. .

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

16
Table 1. Percent distribution of serum cholesterol levels Of boys by age: Unitad States, 1971-74-Con.

8 9 10 11 12 13 14 15 16 17

years years years years years years years years yea rs years

Percent distribution–Con.

100.0

1.8

1.4

3.0

4,8

5.4

12.4

20.3

13.3

12.5

10.1

3.3

7.0

2.3

2.2

0.3

0.4

152

1,861

100.0

0.6

2.3

6.4

7.1

10.8

8.1

12.4

14.6

12.5

13.8

3.9

2.2

0.2

0.1

1.5

0.1

0.7

1.4

1.3

169

2,019

100.0

0.5

2.1

1.4

4.8

9.7

14.0

19.2

12.8

13.9

7.7

6.2

3.0

2.9

1.8

0.1

100.0

0.5

1.9

7.3

9.4

8.8

8.6

14.2

11.2

8.2

8.7

6.3

8.7

2.8

M

0.7

0.7

184

I

178

2,205 2,177

100.0

0.2

1.9

1.0

4.4

9.5

10.1

16.9

10.1

13.3

11.4

5.9

4.7

4.8

1.6

0.4

1.8

0.1

0.4

1.3

100.0

0.2

1.0

0.3

6.1

9.2

11.3

14.8

10.3

10.5

10.7

3.4

7.6

6.0

3.4

1.1

2.0

0.2

2.2

Number-Con.

200

I

174

2,304 1,978

100.0

0.3

3.0

1.9

5.3

12.2

9.3

11.5

12.4

8.3

13.3

5.1

5.6

3.2

2.6

1.5

1.7

1.3

0.1

0.2

0.7

0.6

100.0

0.3

0.2

2.7

3.9

8.5

9.1

15.5

17.2

11.7

13.4

6.9

4.4

1.0

0.7

0.4

1.8

0.8

0.6

1.0

100.0

0.2

2.8

13.2

17.3

9.9

12.4

17.4

6.1

9.8

1.6

2.1

3.3

0.7

3.3

0.7

0.3

100.0

0.1

2.3

5.1

10.9

15.9

10.0

12.3

9.5

9.9

4.4

6.3

7.6

0.7

3.1

0.9

174 171 169 176

2,030 2,093 2,019 2,094

17
Table 2. Percent distribution of serum cholesterol levels of girls by age: United States, 1971-74 *

Serum

cholesterol

level

(Mgper100m1)

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

Less than 100 ............................ ............

loo.lo9 .................................................

110-1 19 ...... ....m... ......... ..........................

120.129 ................................ .................

130.139 .................................................

14@149 ........................ ......... ................

150.159 .................................................

16@169 ................. ................................

17@179 .................................................

180.189 ........ .........................................

190.199 ......... ......................... .... ...........

20@209 ....... ................... .......................

210-21 9 ........ .......... .............. ...... .......... .

220.229 .................................................

23 0.239 .. ................................ ...............

240.249 .................................................

25 W259 ... ..................................... .........

26 0.269 .................................................

27 0.279 .................................................

28 0.289 .................................................

29 0.299 .................................................

300 or more .................................... ......

Number of examined girls .....................

Estimated number Of girls in

population in thousands ..... .................

1

year

100.0

1.8

0.9

1.8

6.4

8.3

11.0

9.2

9.2

17.4

11.0

11.0

5.5

2.8

1.8

1.8

2

years

100.0

0.6

0.6

3.8

0.6

6.3

13.3

10.8

13.9

16.5

7.6

12.0

4.4

4.4

1.9

0.6

1.3

0,6

0.6

J3

years

4 5 6 7

years yea rs years years

Percent distribution

100.0

0.5

0.5

1.0

2.9

6.4

7.8

8.3

14.7

12.3

13.2

10.8

6.4

4.4

4.4

1.5

2.0

1.5

0.5

0.5

0.5

100.0

1.3

0.4

0.3

1.8

11.2

7.2

7.1

18.0

9.8

12.8

7.7

9.5

3.9

5.9

1.0

1.9

0.1

0.3

Number

100.0

1,1

3.0

4.9

6.4

7.5

9.0

12.6

14.2

14.4

6.4

4.2

2.8

7.5

0.6

1.0

0.5

2.1

0.7

0.6

0.6

0.1

100.0

2.0

0.8

4.0

7.4

7.0

9.4

8.2

17.8

10.1

5.4

11.3

5.3

7.0

3.4

0.9

100.0 ——

0.3

0.2

3.8

10.9

9.8

8.9

10.9

14.3

10.9

9.1

6.1

5.8

0.9

3.8

2.1

1.4

0.3

0.3

0.2

1581 204 I 281 I 314 ] 176

I

169

(1) (1) 1,599 1,695 1,787 1,754

—

1 U.S. ~oPulation ~5timate5 not included because of possible bias due to missing values.

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

18
Table 2. Percent distribution of serum cholesterol levels of girls by age: United States, 1971 -74–Con.

I

8 9 10

years years years

11

years

12 I

13 I14

years years years

1 I

Percent distribution-Con.

100.0

1.4

1.0

1.8

1.9

2.0

9.0

11.5

15.1

7.4

18.7

9.9

8.9

2.7

4,1

1.6

1.6

0.4

1.1

100.0

2.7

0.9

1.2

7.6

10.3

10.4

13.5

12.5

9.2

12.5

3.3

4.5

5.0

3.0

1.0

0.2

0.9

1.2

100,0

2.8

0.8

2.0

2.0

9.8

5.3

10.6

19.7

12.3

10.0

6.7

6.0

6.1

1.8

1.1

0.2

0.9

0.8

1.3

100.0

1.5

3.1

1.4

4.6

5.7

12.4

17.1

10,9

10.0

9.6

11.4

3.7

1.3

2.5

2.8

1.4

0.4

0.1

0.2

100.0

0.1

2.1

1,0

3.0

10.5

10.4

23.4

10.5

9.3

8.5

10.6

5.6

2.3

0,2

2.3

0.2

100.0

1.4

3.3

2.1

6.7

13.0

13.4

13.8

12.3

10.6

9.2

5.3

3.5

2.6

0.3

0.2

0.4

0.6

0.1

0.5

0.7

100.0

0.6

3.0

3.5

3.7

10.8

18.6

12.4

11.4

6.5

11.5

6.0

3.0

4.0

2.4

1.2

0.8

0.2

0.7

15

years

100.0

0.9

3.6

8.6

10.3

6.6

12.4

14.5

16.3

4.8

4.8

6.7

4.4

1.4

1.5

0.1

3.0

16 17

years years

100.0

0.8

5.9

2.5

2.9

13.6

5.0

16.2

13.1

11.5

8.7

6.0

6.3

2.1

0.3

2.0

2.4

0.6

0.2

100.0

1.8

0.8

6.4

9.8

12.4

11.1

11.0

13.9

8.8

6.0

4.9

3.3

1.3

3.9

0.2

2.5

0.2

1.1

0.7

Number–Con.

152 171

I

197 166 177 198 184 171 I

175

I

157

1,799 2,017 2,173 1,911 1,812 2,175 2,036 2,163 2,144 1,804

19
Table 3. Serum cholesterol levels of bays 1-17 vears of age, mean age, number exam,ned, estimated number in the population, mean, standard deviation, standard error of the

Age Mean

age

1.56

2.47

3.49

4.52

5.51

6,48

7.47

8.44

9.48

10.48

11.46

12.54

13.49

14,47

15,46

16.49

17.48

mean, and selected percentile. by age: United States, 1971-74

n

133

168

224

304

273

179

164

152

169

184

178

200

174

174

171

169

i 76

N

P)

(1)

(1)

1,815

1,563

1,673

1,979

1,861

2,019

2,205

2,177

2,304

1,978

2,030

2,093

2,019

2,094

Mean

165,0

174.2

169.7

171.3

168.9

170.1

175.8

173.4

182.5

181,4

181.4

179.9

173.3

169.1

168,8

168.6

167,5

.———

Stimdard

de’!iation

37,8

38.9

29.9

28.7

35.8

26.8

28.1

27.6

36.6

25.4

32.4

37.0

40.4

36.8

33.9

29.3

30.9

tandard

error

of the

mean

P)

(1)

(1)

1.97

2.66

2.07

4.45

2.63

3.43

2.43

3,16

3.95

4.45

2.80

3.08

2.89

3.18

5

108.4

120.6

123.1

124.3

122.1

132.1

136.7

125.7

133.0

142.0

133.2

133.8

125.3

118.3

124.0

132.0

123.0

lVariances fm means and U.S. pqmlatio” estimates not included bemwe of possible bias due to missing values.

10

122.9

133.9

131.3

134,7

127.2

138.1

142.8

137.4

141.0

151.2

140.3

142.3

132.5

128,3

133.1

134.8

131.3

25

140.8

151.0

147.8

153.0

145.8

152.5

155.5

156.4

157.2

164.2

156.0

157.1

146.7

142.4

150.2

144.6

143.2

Percentile

50

162.1

169.9

167.3

172.3

154.2

168.6

173.6

170.8

181.4

178.3

178.5

175.3

188.4

164.8

165.2

164.8

163.5

z=76 90

185.8 215.0

190.7 216.2

188.8 211.6

186.8 206.5

190.9 208.EI

182.9 201.2

193.1 216.5

190.4 212.6

200.2 213.5

196.8 215.8

205.0 224.9

196.0 221.1

192.3 217.3

187.4 216.3

184.0 201.38

183.3 211.6

187.2 212.8

85

231.8

235.2

228.0

217.8

225.8

207.6

226.5

220.2

260.8

228.5

223.4

234.1

233.6

236.7

223.7

228.9

218.8

NOTE: n = examined boys; N= estimated papulatio” i“ thousands.

20
Table 4. Serum chcdesmml levels of airls 1-17 vears of aae. ..- mean aae. number examined. estimated number in the vom!lation, mean. standard deviation, standard error of the

Age

1 year ...............................................

2 years .............................................

3 years .............................................

4 years .............................................

5 years ....................................... ......

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

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

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

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

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

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

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

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

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

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

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

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

-1- Mean

age n

1.54 109

2.45 15s

3.51 204

4.53 281

5.52 314

6.50 176

7.55 169

1

8.47 152

9.49 171

10.47 197

11.55 166

12.50 177

13.51 198

14.47 184

15.47 171

16.55 175

17.47 157

wan, and selected percentiles, by a! United States. 1971”-74

N

(1} (1)

F)

1,599

1,695

1,787

1,754

1,789

2,017

2,173

1,911

1,812

2,175

2,036

2.163

2,144

1>8C!4

Mean

166.3

181.4

178.4

174.7

176.0

177.1

175.0

186.5

185.2

181.6

176.8

175.0

170.4

172.8

177.8

174.0

180.6

Standard

deviation

29.5

33.9

35.2

31.7

36.1

32.5

33.4

31.2

33.8

38.2

33.0

27.9

35.2

32.4

35.9

34.3

35.7

$tandarc

error

of the

mean

(1)

P)

P)

3.52

2.80

3.93

2.95

3.14

3.00

4.24

3.49

3.51

3.18

2.82

4.12

3.04

3.44

5

120.5

136.0

126.2

131.1

121.7

124.9

130.6

133.7

140.2

126.3

122.9

135.3

121.2

123.6

130.5

116.5

133.4

1Variances for means and U.S. pop”kition estimates not included became of possible bias due to missing values.

10

127.0

144.2

136.4

135.1

131.5

133.8

IM.8

151.9

146.1

142.2

138.0

143.2

134.2

137.1

135.8

132.6

140.9

25

145.4

158.7

156.1

153.7

152.2

153.6

150.1

166.2

161.9

162.0

158.4

157.2

147.9

151.7

152.2

148.6

154.5

50

167.5

179.0

175.9

172.6

173.6

175.6

173.3

187.7

182.4

177.6

173.5

168.8

166.6

167.2

174.8

172.2

176.4

75

187.7

201.1

196.3

186.1

192.9

m2.3

195.0

m4.7

204.8

198.8

197.9

194.9

187.7

193.6

193.4

193.7

198.1

90

204.4

218.4

222.5

217.0

224.4

221.7

217.6

224.7

232.4

223.1

215.8

210.8

207.1

216.5

221.0

215.6

228.8

95

215.9

233.5

238.7

228.3

245.1

228.1

237.5

238.3

243.9

235.2

238.7

218.9

221.2

230.7

236.9

241.0

248.4

NOTE: H = examined girls; N = estimated population in thousands.

21
Table 5. Percent distribution of serum cholesterol levels of white boys by age: United States, 1971-74

Serum

cholesterol

level

(Mg per 100 ml)

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

Less than 100 ........................................

lo@lo9 ................................. ....#...........

110-1 19 ................... ............... ...............

120-1 29 .................................................

130.139 .... .................. ..................... ......

140-1 49 ...................................... ...........

150-1 59 .................. ...............................

160-1 69 .................................. ............ ...

170-1 79 .................................................

180.189 .................................................

190.199 .............. .................................. .

200.209 .................... .............................

210.219 .............................. ...................

220-229 .................................................

23 0.239 .................................................

240-249 .................................................

25 0.259 .......... ....... .. ........ ......................

260.269 .................................................

27 0.279 .................................................

28 0.289 .................................................

290-299 ............... .................................

300 or more .......................... ................

Number of examined white boys ..........

Estimated number of white boys in

population in thousands .......... .............

1 2 3 4 5 6 7

year years yea rs years years years years

Percent distribution

100.0

4.1

1.0

2.1

5.2

15.5

11.3

9.3

11.3

10.3

8.2

4.1

7.2

1.0

3.1

3.1

1.0

1.0

1.0

100.0

1.6

2.4

2.4

4.CI

9.7

14.5$

15.3

12.9

12.9

6.5

4.0

4.8

2.4

2.4

0.8

0.8

2.4

100.0

0.6

2.9

4.1

8.2

10.0

12.9

16.5

12.9

10.6

7.1

5.3

4.1

1.8

2.4

0.6

100.0

1.8

0.8

1.1

3.5

7.0

8.4

8.4

14.3

20,2

15.4

6.4

6.0

2.4

1.5

0.8

2.3

100.0

0.5

0.8

1.2

9.4

6.8

10.3

14.9

15.2

8.9

8.3

6.9

8.1

3,4

1,6

0.7

0,4

1,5

0.8

0.6

124

(1)

207

1,319

100.0

170 229

(1) 1,547

i 1 I

0.7

2.9

7.1

9.2

21.2

13.0

21.7

8.6

8.0

4.1

0.9

0.8

0.4

1.5

126

1,343

100.0

.———

1.5

1,8

2.8

14.9

9.2

13.3

19.5

9.2

9.9

5.4

5.4

3.9

3.1

0.1

125

1,718

I U.S. ~opulatjon e~timate5 not included because of possible bias due to missing values.

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

22
Table 5. Percent distribution of serum cholesterol Iavals of white boys by age: Unitad States, 1971 -74–Con.

I

J

8 11 12 13 14 15 16 17

years 5--E years years years years years years years

Percent distribution-Con.

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

0.2

1.6

0.8

5.0

9.4

10.0

18.1

11.5

13.0

11.2

5.2

4.8

3.4

1.6

0.5

2.1

1.6

0.2

2.8

3.7

10.0

9.4

16.6

15.3

11.5

15.4

5.3

4.9

7.0

0.7

0.5

1.2

0.9

0.7

2.0

1.3

3.4

5.5

5.9

11.5

20.7

14.0

13.2

11.2

7.6

2.4

1.2

0.3

0.8

2.5

7.4

6.1

10.7

9.0

10.0

16.0

12.5

12.5

4.8

2.3

0.3

1.9

0.2

0.9

1.8

0.3

0.2

2.2

1.6

3.5

7.4

14.4

20.5

14.3

13.5

7.4

6.7

2.9

3.3

2.1

0.1

0.6

1.9

7.2

9.1

9.5

9.2

14.4

10.5

7.7

8.9

7.2

7.5

3.3

1.2

1.1

0.8

0.9

0.3

6.9

8.2

10.5

14.0

9,9

10.5

11.6

3.5

8.0

7.0

3.8

1.2

1,3

0.3

2.0

3.5

2.2

5.0

9.6

9.3

11.3

12.7

9.3

15.2

4.3

6.0

3.6

1.7

1.8

2.0

1.4

0.1

0.8

0.2

0.2

3.0

13.1

19.2

70.9

11.0

17.7

4.9

9.9

2.0

3.0

0.5

3.8

0.8

1.1

2.7

4.6

11.7

16.5

?0.7

10.5

10.1

9.6

4.6

5.5

7.9

0.4

3.4

0.7

Number–Con.

116 117

1,644 1,636

148

1,909

132

1,823

124

1,728

128 139

1,752 1,831

152 128 134

1,970 1,697 1,730

23
Table 6. Percent distribution of serum cholesterol levels of black boys by age: United States, 1971-74

Serum

cholesterol

level

(Mg per 100 ml)

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

Less than 100 ........................................

loo.lo9 .................................................

110-1 19 .................................................

120.129 .................................................

130.139 .................................................

140.149 .................................................

150.159 .................................................

160.169 .................................................

170.179 .................................................

180-189 .................................................

190.199 .................................................

X0.209 .................................................

210-21 9.................................................

220.229 .................................................

Z0.239 .................................................

24 0.249 .................................................

250.259 .................................................

260-269 .................................................

270-279 .................................................

28 0.289 .................................................

290.299 .................................................

300 or more ..........................................

Number of examined black boys ...........

Estimated number of black boys in

population in thousands .......................

1

year

100.0

8.3

5.6

11.1

19.4.

25.0

5.6

8.3

2.8

5.6

2.8

2.8

2.8

Percent distribution

100.0

2.4

2.4

7.1

11.9

7.1

14.3

21.4

7.1

11.9

2.4

4.8

2.4

2.4

2.4

100.0

2.1

2.1

4.2

10.4

16.7

6.3

14.6

12.5

10.4

4.2

2.1

2.1

2.1

10.4

100.0

1.5

0.7

4.1

11.0

23.3

7.5

7.2

14.1

5.2

8.7

12.5

2.0

1.7

0.5

1

Number

-_ll__lJ!14

100.0

5.7

7.1

6.1

5.8

16.1

5.7

13.1

3.8

6.0

17.5

0.8

4.6

3.2

4.2

100.0

0.7

1.7

9.6

8.9

6.4

7.3

21.1

14.1

5.4

19.8

4.2

0.8

100.0

1-

0.9

1.4

5.1

7.0

18.7

17.6

13.9

15.6

2.9

1.9

7.0

6.7

1.4

Iu.s. ~oPulation ~~timates not included because of possible bias due to m~ing values.

A L

NOTE: Percents may not add to 100.0 due to rounding.
Table 6. Percent distribution of serum cholesterol levels of black boys by age: United States, 1971 -74–Con.

8 9 10 11 12 13 14 15 16

years years years years years years years years years

100.0

2.1

1.9

19.0

16.0

8.5

8.1

2.2

28.3

3.7

1.1

6.1

3.0

100.0

1.4

2.1

10.9

11.2

4.4

21.8

10.2

12.3

18.9

1.7

0.6

5.5

+

2.7

1.8

8.1

29.7

8.1

12.5

3.8

14.5

11.2

3.5

4.2

100.0

2.3

9.1

13.0

0.8

6.0

8.6

17.5

12.5

8.5

1.9

15.0

4.9

Percent distribution-Con.

100.0

4.1

2.2

0.9

10.3

11.7

10.3

1.8

16.0

7.9

10.6

4.5

13.8

2.0

1.0

3.0

100.0

1.1

1.1

1.5

15.3

15.5

19.5

12.7

10.4

4.7

2.8

5.4

0.9

6.1

2.9

Number–Con.

33 52 33 43 47 45

203 383 251 313 316 281

100.0

1.9

7.6

29.0

9.3

13.7

11.1

2.6

2.5

10.3

3.4

1.1

1.5

1.1

1.6

3.1

39

282

100.0

1.1

1.5

2.7

4.4

0.9

4.5

11.6

31.6

15.4

3.7

12.2

2.1

0.9

1.1

5.5

0.8

100.0

1.4

13.4

4.5

2.5

22.1

15.0

6.3

8.9

13.0

2.9

5.6

2.2

2.3

17

years

100.0

9.8

5.9

12.1

5.3

17.3

6.3

13.5

3.3

13.2

5.6

3.4

1.3

2.9

43 41

I

35

310 267 235

25
Table 7. Percent distribution of serum cholesterol levels of white girls by age: Unitad States, 1971-74

Serum

cholesterol

level

(Mg per 100 ml)

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

Less than 100 ........................................

100-109 .................................................

110-1 19 .. ...............................................

120-1 29 .................................. ...............

130.139 .................................................

140.149 ................ ............. .. ..................

150.159 ................. ...................... ..........

160.169 ................. ....................... .........

170-7 79 .......................... .......................

180.189 ..................... ............................

190.199 ....... .......... ...... ..........................

200.209 .......................... .......................

210-21 9 ... ................ ..............................

220.229 ..... .................................... ...... ..

23 0.239 ...... ................ ...........................

240.249 .. ...... .. .................... .............. .....

25 0.259 .................................................

26 0.269 ................................................ .

27 0.279 .......... .......................................

280.289 ............ .. ............... ....................

29 0.299 ............. .......... ..........................

300 or more ............................... ...........

Number of examined white girls ..........

Estimatad number of white girls in

population in thousands .....................

1 2 3 4

year yaars years years

100.0

2.5

2.5

7,4

8.6

11.1

9.9

9.9

14.8

12.3

9.9

3.7

3.7

1.2

2.5

81

(1)

100.0

0.8

4.2

4.2

14.2

10.0

16.7

16.7

7.5

12.5

4.2

3.3

2.5

0,8

1.7

0.8

Percent distribution

100.0

0.6

0,6

1.3

3.2

5.8

9.1

9.1

16.2

11.0

12.3

12.3

5.2

3.9

3.2

1.9

1.9

0.6

0.6

0.6

100.0

1.5

0.4

0.3

2.1

12.2

7.0

8.2

16.4

9.1

12.3

8.9

10.1

2.1

5.9

1.2

2.0

0.1

0.3

Number

5 6 7

years years years

100.0

1.4

2.9

5.8

7.4

8.1

10.5

12.2

12.2

14.5

6.9

3.6

2.8

5.7

0.4

1.2

0.6

2.6

0.6

0.7

224

1,416

100.0

2.5

0.8

4.5

3.9

5.5

9.7

8.2

20.5

12.2

4.3

11.5

6.7

5.6

4.1

100.0

. 0.3

3.4

11.9

11.4

10,0

13.0

15.0

9.3

6.0

6.0

6.4

2.9

2.5

1.1

0.3

0.4

0.2

120 154 204

(1) (1) 1,339

1 1

125 122

1,445 1,507

lU s ~oPulation ~s.timates not included because of possible bias due to m~sing values.

. .

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

26
Table 7. Percent distribution of serum cholesterol levels of white girls by age: Unitad States, 1971 -74–Con.

8 9 10 11 12 13 14 15 16 17

years years years years years years years years yaars years

Percent distribution-Con.

100.0

1.7

1.1

2.1

1.8

2.3

10.3

13.2

13.8

7.2

19.2

10.9

8.8

1.5

3.1

1.3

0.4

1.3

117

1,507

100.0

3.1-

1.0

0.9

8.4

10.9

11.3

13.0

13.6

8.7

11.2

3.1

4.6

4.1

2.8

1.0

1.0

1.4

128

1,751

100.0

3.3

1.0

2.3

2.1

11.1

5.6

10.9

19.7

11.5

9.2

5.7

6.9

4.5

2.1

0.9

1.1

0.9

1.5

148

1,855

100.0

1.8

0.4

0.3

4.2

6.6

13.5

16.4

11.7

9.8

10.8

11.3

4.5

1.5

2.9

1.9

1.7

0.5

0.3

100.0

1.0

1.0

1.5

9.6

10.6

24.7

9.4

10.1

10.2

10.6

5.9

2.6

2.8

100.0

1.6

3.8

2.2

7.4

13.1

14.7

13.7

13.3

11.2

5.5

4.8

4.1

2.1

0.3

0.2

0.4

0.1

0.6

0.8

Number–Con.

122 128

1,569 1,506

153

1,886

100.0

0.7

2.4

3.7

4.1

11.3

18.3

12.7

11.8

6.4

12.6

5.8

3.5

3.9

0.7

1.4

0.8

132

1,731

100.0

1.1

3.9

10.2

10.7

7.5

12.6

11.4

19.3

5.1

4.7

7.5

1.8

1.7

2.6

125

1,752

100.0

0.6

6.2

2.5

3.2

14.7

5.1

15.4

13.2

11.1

9.1

5.3

6.1

2.3

0.3

1.7

2.4

0.7

0.2

100.0

1.8

0.9

5.9

10.9

13.0

9.9

11.5

13.8

8.1

6.4

4.5

3.4

1.5

4.0

2.7

1.0

0.8

141 116

1,933 1,524

27
Serum

cholesterol

level

(Mg per 100 ml)

Table 8. Percent distribution of serum cholesterol levels of black girls by age: United States, 1971-74

1 2 3 4 5 6 7

1

year yea rs years yea rs years years years

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

Less than 100 .. ....... ............................ ...

loo.lo9 .................................................

110-11 9.................................................

120-1 29 .................... .............................

130.139 .................................................

140.149 ...................... ..... ......................

150.159 .................................................

160.169 .................................................

170-1 79 ............................ .....................

180.189 ....... ...... ............... .....................

190-1 99 ................................... .. ............

200.209 .............. .............................. .....

210-21 9 ............... ..................................

~0.229 ....... ..........................................

23 0.239 .............. ......... .... .. .............. ......

24 0.249 ....... .......... ................................

25@259 ....... ................ .................... ......

Z0.269 ...................................... ...........

270.279 ........ .............................. ...... .. ...

28 0.289 ....... ..........................................

290.299 ........ .......... ...............................

300 or more ..........................................

Number of examined black girls ............

Estimated number of black girls in

population in thousands ........................

100,0

4.2

4.2

8.3

8.3

8.3

29.2

4.2

16.7

12.5

4.2

100.0

2.:B

2.8

2.s

13.9

11.1

11.1

5.15

16.7

8.3

11.1

5.(5

5.6

2.[3

24

--L

(1)

Percent distribution

100.0

8.3

2.1

6.3

10.4

16.7

16.7

6.3

10.4

6.3

8.3

2.1

4.2

2.1

100.0

7.3

8.7

2.1

27.3

14.3

13.7

1.5

6.7

13.6

4.9

Number

100.0

3.5

0.4

1.7

1.9

2.3

13.5

24.5

14,9

4.2

7.1

3.2

16.5

1.4

1.0

3.7

0.3

100.0

1.0

2.5

19.0

12.9

8.4

8.4

7.8

2.2

9.7

10.9

12.0

1.1

4.3

36 48 73 88

(1) (1) 246 265

100.0

1.7

5.8

5.5

1.6

3.7

11.0

17.1

26.0

6.9

2.3

5.8

9.0

0.8

3.0

50 46

336 241

1 u s ~oPulation est jmate~ not included because of possible bias due to missing ~lues.

. .

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

28
Table 8. Percent distribution of serum cholesterol levels of black girls by age: United States, 1971 -74–Con.

16 17

years years

13

yea rs

14

years

15

years

Percent distribution–Con.

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

2.5

2.7

2.6

2.2

3.3

22.7

11.7

16.8

3.8

14.3

9.7

5.8

2.0

2.0

10.1

3.1

9.3

19.9

2.0

15.6

13.8

3.9

7.3

3.3

3.3

1.7

1.4

1.7

1.7

0.9

7.6

1.5

10.5

8.3

10.2

18.9

16.8

6.2

11.8

4.4

1.0

1.2

1.0

2.6

1.7

1.9

22.6

8.5

16.0

4.7

9.6

9.2

9.5

10.4

3.3

3.8

2.6

6.9

4.6

18.8

5.1

13.3

24.4

4.9

3.8

4.9

4.4

1.0

1.6

1.7

1.9

3.9

9.2

16.1

17.9

15.2

13.5

16.8

2.6

1.4

17.1

7.3

6.8

1.4

8.2

19.7

7.6

11.8

4.2

7.0

0.7

7.6

0,8

1.4

2.1

11.9

5.6

14.6

6.0

6.8

33.1

8.9

5.3

2.6

1.9

7.5

2.9

1.7

8.9

22.7

12.1

10.8

2.7

6.4

7.9

0.8

5.2

3.5

6.0

1.2

2.4

0.1

8.0

2.3

11.1

29.6

1.8

3.6

5.4

3.0

17.0

8.8

0.8

5.3

Number-Con.

41 48 42 47 44 50 46 33 40

247 303 315 264 287 265 411 203 263

I

35

293

29
Table 9. Serum cholesterol levels of white bays 1-17 years of age, mean age, number emmined, estimated number in the population, mean, standard deviation, standard error

of the mean, and selected Percentiles, by age: lJ”ited States, 1971.74

Mean Standard

deviation

Xandarc

error

of the

Percentile

Mean

age

N

T

25 50

136.4 161.4

151.4 170.3

147.6 167.2

152,9 172.2

145.6 163,7

152.2 166.3

153.8 173.0

156.5 169.0

156.9 181.9

166.3 180.2

156.1 177.9

157,1 173.8

Age n ——

90

——

217.3

216.6

208.3

204.5

207.7

19(5.4

214.0

211.7

21,4.5

21 (;.8

224.7

21 ‘7,6

217,3

21:3,9

19[3.6

210.0

21:2.8

——

5 10 75

167.5

191.9

187.3

185.7

187,7

178.7

192.5

187.4

199.0

197.3

205.1

194.3

195,5

187.2

183.2

178.9

186.7

mea” 95 —

(1I 105.4

(1) 122.9

(1) 122.3

2.27 123.9

2.69 122.5

(1)

P)

(~)

1,547

1,319

1,343

1,718

1,644

1,636

1,909

1,623

1,970

1,697

1,730

1,723

1,752

1,631

1,57

2.48

3.49

4.52

5.52

6.46

7.48

8,45

9.46

10.47

11.45

12.54

13.50

14.48

15,46

16.48

17.47

97

124

170

229

207

126

125

116

117

148

132

152

129

134

124

128

139

165.0

175,5

168,0

170.5

166.0

168.7

174.5

171.5

182.0

182.9

180,8

179.0

174.3

169.6

166.3

167.2

166.9

40.3

40.3

28.6

28.4

35.7

26.9

27.6

26.8

35.9

25.1

31,7

37.2

40.2

35.8

28.1

28.8

30.8

122.6

137.6

130.0

133,9

127.3

138,2

142.3

135.5

138.2

153.1

140,5

142.2

132.1

127.8

133.0

134.7

131.2

233.1

235.2

216.4

217.4

222.7

206.0

224.7

217.7

260.2

231.4

233.8

234.3

228.7

236.3

208.8

230.9

218.5

2.41

4.&f

3.15

4.07

2.57

3.49

4,34

5,14

3.17

2.70

131.9

135.3

124.5

132.1

142.7

133.2

434,2

124.9

116.1

124.4

147.4

144.6

146.0

144.1

142.7

168,3

166,4

164.3

162.9 3-E! 162.3

‘Variances for means and U.S. pmpuiat ion estimates not included because of possible bias due to missing values.

NOTE: n = examined white boys; N = estimated population in thousands,

Table 10. Serum cholesterol levels of black boys 1-17 vears of age, mean age, number examined, estimated number in the population, mean, standard deviation, standard error

of the mean, and selected percentiles, bv am: United States. 1971.74

Mean

age

1,54

2,41

3.49

4.50

5.49

6.54

7.39

8.42

9.53

10.60

11.53

12.58

13.41

14.45

15,50

16.55

17,56

Mean

165.1

173.1.

178,6

175.6

174.3

176.3

165.1

186.0

164.5

172.0

185.7

164.1

167.2

161.6

169.7

178,7

173.6

Standard

deviation

30.5

33.4

33.1

30.5

36.2

25.7

29.9

28.5

39.1

26.2

36.9

36.1

41.1

40.7

29.4

30.7

32.2

;tandan

error

of the

mean

(1)

(1)

(1)

5.50

8.64

6.15

6.21

4.97

6.89

5.58

8.04

6.61

7.80

6.66

3.49

5.62

7.92

Percentile

Age 4-- n N

5 10 25 50 75 90

——

20g.9

211.4

240.8

214.9

223.9

206.7

226.6

221.7

206.0

207.2

225,%+

226.4

206.7

204.9

201 .%

220.1

215.2

——

95

36

42

46

74

64

52

38

33

52

33

(1)

(11

P)

260

226

321

253

203

383

251

313

316

281

262

310

267

236

111.4

120.6

128.9

126.3

117.6

132.5

144.8

150.5

141.2

140.6

132.4

123.9

130.7

123.6

118.2

132.5

‘124.6

125.7

133.9

141.2

143.1

125.2

137.2

153.3

152.6

145.4

145.2

136.9

142.5

133.7

130.1

133.6

135.8

130.3

146.9

153.1

151.7

153.0

160.1

155.9

165.1

161.1

158.5

153.8

148.9

155.8

143.4

134.8

157.7

161.3

146.9

163.5

170.1

173.3

172.4

172.3

176.6

178.7

182.7

178.2

166.6

185.0

185.0

157.1

151.4

166.7

173.7

156.8

179.0

188.3

195.6

200.5

202.7

196.7

196.0

205.8

200.8

195.2

205.3

2Q8.5

177.1

178.0

183.3

200.7

201.0

223.6

237.1

249.9

218.5

236.6

210.0

234.2

236.1

354.9

217.1

226.9

234.6

245.6

256.4

242.1

228.2

226.9

43

47

45

39

43

41

35

1Variances for meam and U.S. population estimates not i“cl”ded because of possib]e btis d“e to mfising ml”e$.

NOTE: H = examined black boys; N= estimated population in thousands.

30
Table 11. Serum cholesterol levels of white girls 1-17 years of age, mean age, number examined, estimated number in the population, mean, standard deviation, standard error

of the mean, and selected percentiles, by age: United States, 1971-74

,tandard Percentile

error

of the

Mean

age

1.54

2.46

3.51

4.54

5.51

6.49

7.55

8.48

9.49

10.47

11.52

12.49

13.51

14.45

15.47

16.56

17.47

Standard

deviation

30.3

29.0

35.4

32.6

35.6

31.7

32.8

30.5

33.9

39.8

31.3

26.9

35.7

30.8

33.6

34,4

35.8

N

F)

(1)

(1)

1,339

1,416

1,446

1,507

1,507

1,751

1$55

1,5s9

1,50s

1,886

1,731

1,752

1,933

1,524

Age n

81

120

154

204

224

125

122

117

129

146

122

128

153

132

125

141

116

Mean

165.1

181.5

176.0

173.8

173.2

177.8

172.8

183.6

183.6

179,9

179.0

177.1

168.3

171.4

174.4

173.3

180.3

10

126.0

145,2

135.5

134.2

128.9

135.1

134.8

150.8

145.4

141.2

144.5

146.1

132.8

137.1

134.5

131.9

141.2

25

143.6

161.2

153.9

151.6

148.4

157.3

147.5

163.8

160.6

158.6

157.8

160.5

146.8

151.4

146.3

147.7

153.8

5

120.1

139.0

125.0

130.4

121.2

123.4

131.0

130.2

140.0

123.1

135.4

141.4

117.9

124.7

130.1

116.4

133.5

50

166.2

179.0

174.0

171.9

171.4

176.6

170.1

184.6

181.0

176.4

175.3

171.6

164.7

166.7

173.2

171.6

176.0

75

187.1

ml .0

193.8

195.7

190.2

202.3

191.3

201.9

203.5

197.5

198.7

196.2

184.2

192.6

188.2

193.0

?98.2

mean 90 95

P}.

(11

P)

3.83

3.35

3.86

3.44

3.35

3.46

4.83

3.34

4.19

3.52

3.03

3.55

3.50

3.93

1yur ...........................................<...

2 years ............................................ .

3 years . ...........................................

4 years ......... ......... ...........................

5 years .............................................

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

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

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

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

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

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

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

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

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

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

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

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

202.9

218.1

217.1

217.0

222.9

216.6

215.3

216.6

230.9

221.8

216.5

211.9

206.6

210.6

214.3

215.5

230.1

215.7

233.6

235.0

226.9

245.5

227.5

237.4

233.4

244.1

236.0

236.9

221.3

218.2

224.1

225.4

240.1

247.9

1 Variances for means and U.S. population estimates not included because of possible bias due to missing values.

NOTE n = examined white girls; N = estimated population in thousands.

Table 12. Serum cholesterol levels of black oirls 1-17 vears of aoe. mean aae. number examined. estimated number in the mmmlat ion. mean. standard deviation. stan&rd error

Mean

age

::;

3.51

4.53

5.56

6.53

7.51

6.43

9.52

10.51

11.65

12.56

13.46

14.50

15.44

16.47

17.44

..-

of the mean, and selected percemiles, ~ age: United States, 1971-74”

n

24

36

48

73

88

50

46

35

41

48

42

47

44

50

46

33

40

N

[1)

(1)

(1)

246

265

336

241

293

247

303

315

2s4

287

265

411

203

283

Mean

174.9

180.3

187.8

177.1

190.3

175.3

186.8

202.8

194.1

192.2

164.6

166.0

183.6

175.1 ;

194.5

182.4

16S.3

Standard

deviation

23.7

47,1

33.0

25.4

35.9

35.2

34.5

29.7

29.5

25.0

38.7

31.1

28.9

38.0

41.5

31.7

36.3

~tandard

error

of the

mean

(1)

(1)

(1)

5.03

6.46

6.60

6.82

7.52

5.71

5.18

10.29

7.50

5.98

7.58

12.36

8.44

7.10

Percentile

25

159.0

152.7

155.9

162.3

170.6

141.9

175.5

177.5

173.4

174.7

130.9

144.9

162.6

151.6

170.1

164.7

160.3

50

172.7

179.0

185.2

173.0

181.4

166.8

191.3

197.1

195.6

188.7

164.3

165.3

190.5

164.8

177.7

161.3

182.1

Age

5

4(

131.4

127.6

131.4

136.2

135.8

130.8

125.1

163.5

144.2

153.4

112.6

114.9

141.2

116.0

141.9

118.4

132.7

10

141.9

141.3

143.8

142.8

160.1

133.1

134.1

171.5

154.7

162.5

115.3

130.0

145.0

127.8

147.5

150.2

137.1

75 90 95

1year .. ... .... .. ... .. .... .. ... ... ... ... .. .. .... ... ..

2 years ... ......... .................................

3 years .............................................

4 years .............................. ........... ....

5 years .............................................

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

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

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

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

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

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

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

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

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

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

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

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

191.4

199.0

2U9.5

200.3

212.9

202,7

203.6

227.3

207.4

206.2

185.4

180.6

197.3

198.2

223.7

2Q4.3

198.6

210.1

217.1

235.2

215.6

227.0

225.5

232.8

243.2

233.4

225.8

207.8

207.1

208.7

231.6

265.1

216.9

228.6

217.7

231.4

25%1

21:.9

270.2

233.8

237.8

247.6

244.0

228.5

244.0

215.1

228.1

263.3

290.5

244.3

258.0

1 Variances for means and U.S. population estimates not included because of possible bias due to missing values.

NOTE. n = examined black girlv N = estimated population in thousands.

31
Table 13. Serum cholesterol levels of males and females 15-74 years of age, number examined, mean, and standard deviation, by age:

United States, 1971-74

Age

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

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

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

18.24years ............................................ ................

18 years ........... ............. .......................................

19 years .................... ...........................................

20 years .... ................ ...........................................

21 years .................... ...........................................

22 years .................... ...... .....................................

23 years .................... ...........................................

24 years .......................................... .....................

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

3544 years.. m.........................................................

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

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

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

n

171

169

176

772

124

135

104

112

107

94

96

804

665

765

597

1,657

Ma Ies

Mean

168.8

168.6

167.5

186.9

178.6

174.4

183.1

186.2

190.7

200.5

195.4

210.3

231.3

239.4

240.2

236.2

Standard

deviation

33.9

29.3

30.9

36.7

29.2

36.4

35.7

34.4

38.3

34.1

39.6

44.0

46.9

47.0

51.2

53.8

n

.—

171

175

157

1,524

144

137

236

257

249

253

248

1,896

1,663

836

670

1,822

Females

Mean

177’.8

174.0

180.6

191.7

175.4

186.3

188.6

198.1

197.9

198.0

196.7

203.2

216.5

242.6

256.8

261.6

Standard

deviation

.—

35.9

34.3

35.7

41.0

34.1

36.9

38.2

45.8

40.1

44.3

39.6

42,2

43.5

52.0

48.2

51.9

—

NOTE: n = examined persons.

32
APPENDIXES

I. Statistical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Nonresponse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

M~sing Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Standard Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. 37

Standards of Reliability and fiecision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

11. Demographic and Socioeconomic Terns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Appendix I

STATISTICAL NOTES

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 noninstitut u i o n alized population of the coterminous

United States, 1-74 years of age, was selected.

Excluded from the selection process were those

persons confined to institutions or residing upon

any of the reservation lands set aside for use of

American Indians. Successive elements dealt

with in the process of sampling were 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 1,900 primary sampling

units 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 super strata for HANES.

Fifteen of the 40 super strata contained a

single large metropolitan area of more than

2,000,000 population. These 15 large metropolitan areas were chosen into the sample with

certainty. The remaining 25 super strata were

formed by classifying the noncertainty strata

into four population density groups within each

of four 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, two PSU’S were chosen from

each of the 25 noncertainty super strata with

the probability of selection of a PSU proportionate to its 1960 population. In this manner a

total first stage sample of 65 PSU’S or “stands”

are the areas within which a sample of persons

would be selected for examination. The PSU’S

are scheduled to be sampled over a 3-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 PSU

when they became avaiIable, the calendar of

operations required that the 1960 census data be

used for the first 44 locations in the IMNES

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 U.S. Bureau of the Census indicated that precision of estimates would not be

appreciably affected by the change from noncompact clusters to compact clusters.

For E D‘s not having usable addresses

(generally located in rural areas), area simpling

was employed, and consequently some wiriation

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

which fell into the sample were coded into one

of two economic classes. The first class:, identified as the “poverty stratum,” was complosed of

“Current Poverty Areas” that had been identi34
fied by the U.S. 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 1960 census). The second

economic class, the %onpoverty stratum,”

included all ED’s not designated asbelonging 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 eight

random subgroups and one of the subgroups was

chosen to remain in the HANES sarnpIe.

Research indicated that efficiency of estimates

could be increased by changing the ratio of poverty to nonpoverty segments from 8 to 1 to 2 to

1. 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 asbeing 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 the sample segments

to be examined in HANES and at the same time

to oversimple certain groups at high risk of malnutrition, all household members aged 1-74

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 below 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 systematic random sample of persons in each age-sex

group was selected to be examined using the following sampling rates.

Age Rate

1-5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/2

6-19 years .................................................... M

20-44 years (male) ....................................... %

2044 years (female) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y2

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

65-74 years .................................................. 1

The persons selected in the 65-stand sample

of HANES comprised a representative sample of

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

or 74.0 percent, were examined. When adjustments are made for differential sampling for

high risk groups, the response rate becomes 75.0

percent.

Among those 4-17 years of age at interview

for whom serum cholesterol determinations

were made, there were 5,334 examined out of

the probability sample of 6,356 selected to represent the 56 million of that age in the population. This is an unadjusted response rate and

an effective adjusted response rate of 84 percent.

Data of chikh-en of ages4-17 years presented

in this report are based on “weighted” observations. That is, data recorded for each sample

person are inflated to characterize the subuniverse from wh]ch 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

a poststratified ratio adjustment which increases

precision 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 the survey

design and selection technique can be found in

“Plan and Operation of the Health and Nutrition

Examination Survey, United States, 1971 -73,”

Vital and Health Statistics, Series 1, No. 10a.1

Nonresponse

In any Health Examination Survey, after the

sample is identified and the sample persons are

NOTE: The list of references folIows the text.

35
requested to participate in the examination, the

survey meets one of its 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 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 Series 1, No. 10a.1

Despite these intensive efforts, 16.0 percent

of the sample persons from 65 stands were not

examined; previous surveys had response rates of

96 percent of children 6-11 and 90 percent of

youth 12-17 years of age.z4 ~z5 Consequently,

the potential for a sizable bias does exist in the

1971-74 estimates in this publication.

Because more than 99 percent of the sample

persons responded to a medical and demographic

questionnaire in 1971-74, one could examine the

characteristics of the nonrespondents and the

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

As was mentioned earlier, the data in this

report are based on weighted observations, and

one of the components of the weight assigned to

an examined person was an adjustment for nonresponse. A procedure was adopted which multiplies the reciprocal of the probability of selection of sample persons who were examined by

a factor which brings estimates based on examined persons up to a level which would have

been achieved if all sample persons had been

examined. The nonresponse adjustment factor is

calculated by dividing the sum of the reciprocals

of the probability of selection for all 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 persons

in the same stand and income group. The five

income groups are: less than $3,000,

$3,000-$ 6,999,$7,000-$9,999,$10,000-$14,999,

NOTE: The list of references follows the text.

Table 1. Percent distribution of nonresponse adjustments factors,

stands 1-65, 1971-74 HANES

Size of factor

Percent

distribution

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

}

100.0

.—

1.00-1 .24 ................. ..............................................

l.25.1.49 .......... ..................... ................................

1.50-1 .74 ...............................................................

1.75-1 .99 ............... ................................................

2.00.2.49 ...............................................................

2.50.2.99 ........ .......................... .............................

32.6

38.5

18.2

7.4

2.8

0.3

3.00 ....................................................................... 0.3

1A sizeof s-. ~s assigned for all factors greater than 3.0. The

final post stratified ratio adjust ment corrects for this truncation.

and $15,000 or more. 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 income-within-stand classes are homogeneous with respect to the health characteristics under study, the adjustment procedure is

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 I.

Missing Data

Examination surveys are subject to tlhe loss

of information not only through the fail[ure to

examine all sample persons but also frc~m the

failure to obtain complete examination for

examined persons. More than 80 percent of the

children 1-17 years old selected for examination

were examined (table II). For ages 1-3 years,

however, the percentages of sample children

with serum cholesterol values were 37, 4:8, and

61 percent, respectively. The missing serum

cholesterol values for children who were examin e d were due primarily to difficulties in

obtaining blood samples, with pin-prick rather

than venipuncture methods providing an

inadequate quantity of blood.

Estimates in this report include imputed

values for all examined children 4-17 years old

36
Table II. Number of children selected for examination, percent

examined, and percent with serum cholesterolmeasurements

Age

Ages 1-17

yeers ...................

1year .........................

2 years ........................

3 years ........................

Ages 4-17

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

4 years ........................

5 years ........................

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

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

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

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

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

11 years .....................O

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

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

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

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

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

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

Number of

children

selected

for

examination

8,471

711

704

700

6,356

703

712

404

394

360

414

447

396

439

444

436

399

416

392

~

Percent

xamined

83.9

84.1

82.7

84.3

83.9

84.2

83.0

80.7

85.8

83.9

84.6

83.0

83.8

86.8

84.7

83.7

85.0

82.9

83,2

Percent

with serum

ch01estrol

measurement

69.8

36.9

48.4

61.2

76.7

67.4

71.2

72.0

78.9

75.3

78.5

78.1

78.0

82.9

81.5

78.7

81.2

80.5

79.6

with missing cholesterol values. This was done

by random~ assigning a value for the missing

item from among similar children with that item

of information recorded. Results shown in this

report for ages 1-3 years are based on weighted

sample wdues but do not include imputed values

for missing measurements. United States population estimates and variances for means have

not been included in the text tables for these

ages because of possible bias due to missing

values. Special caution should be exercised when

interpreting estimates for these ages.

Standard Errors

The probabdity design of the survey makes

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

The standard error is primarily a measure of

sampling variability, that is, the variations that

might occur by chance because only a sample of

the population is surveyed. As calculated for this

report, the standard error also reflects part of

the variation which 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?4

times as large.

Estimates of standard errors are obtained from

the sample data and are themsekes 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

tables 3-4 and 9-12. These estimates have been

prepared by a replication 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.

Standards of Reliability

and Precision

All means and variances appearing in this

report met defined standards before they were

considered acceptably precise and reliable.

The rule for reporting means and percentiles

consisted of the following two basic consecutive

criteria: that a sample size be at least five, and

that the estimated coefficient of variation [i.e.,

the standard error of the mean divided by the

mean, or (sx/X), be less than 25 percent]. Thus

if the sample size was too small, or if, given

adequate sample size, the variation with respect

to the mean was too large, then the estimate

was considered

enough to meet

publication.

neither precise nor reliable

the standards established for

—ooo —

37
Appendix II

DEMOGRAPHIC AND SOCIOECONOMIC TERMS

The demographic and socioeconomic 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 vears old at the

dures used to produce national estimates, these

persons were included in the group 74 years old.

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 k~own

to be American Indian or of another race other

time of interview became 75 ~ears old by the than white. -” “

“..

time of the examination. There were 20 such black and

cases. In the adjustment and weighting proce- “black.’y

Black persons and persons of”lrnixed

other parentage were recorded as

—ooo —

* U. S. GOVERNMENT PRINTJNG OFFICE :1978 26o -937/17

38
VITAL AND HEALTH STATISTICS Series

Series 1. Programs and Collection Procedures. –Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions and data collection methods used and include

definitions and other material necessary for understanding the data.

Series 2. Data Evaluation and Methods Research. –Studies of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, new analytical

techniques, objective evaluations of reliability of collected data, and contributions to statistical theory.

Serks 3. Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health

statistics, carrying the analysis further than the expository types of reports in the other series.

Series 4. Documents and Committee Reports. –Final reports of major committees concerned with vital and

health statistics and documents such as recommended model vital registration laws and revised birth

and death certificates.

Series 10. Data From the Health Interview Survey. –Statistics on illness, accidental injuries, disability, use of

hospital, medical, dental, and other services, and other health-related topics, all based on data coIlected

in a continuing national household interview survey.

Series 11. Data From the Health Examination Survey and the Health and Nutrition Examination Survey. –Data

from direct examination, testing, and measurement of national samples of the civilian noninstitutionalized population provide the basis for two types of reports: (1) estimates of the medically defined

prevalence of specific diseases in the United States and the distributions of the population with respect

to physical, physiological, and psychological characteristics and (2) analysis of relationships among the

various measurements without reference to an explicit finite universe of persons.

Series 12. Data Fro m the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports from

these surveys will be in Series 13.

Series 13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilities

providing long-term care, ambulatory care, hospital care, and family planning services.

Series 14. Data on Health Resources: Manpower and Facilities. –Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health

occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthly

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

series analyses; and statistics on characteristics of deaths not available from the vital records based on

sample surveys of those records.

Series 21. Data on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, and divorce other

than as included in regular annual or monthly reports. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not

available from the vital records based on sample surveys of those records.

Series 22. Data From the National Mortality and Natality Surveys. –Discontinued effective 1975. Future reports

from these sample surveys based on vital records will be included in Series 20 and 21, respectively.

Series 23. Data From the National Survey of Family Growth. –Statistics on fertility, family formation and dissolution, family planning, and related maternal and infant health topics derived from a biennial survey

of a nationwide probability sample of ever-mamied women 15-44 years of age.

For a list of titles of reports published in these series, write to: Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, hid. 20782
I

Forpidmt,<ms J,, the

b,zt.1 .nd Ild.lrlt .Tt. tisttcs

Sm\c, call 301 -436 -NC1[S. I