Series 3, Number 36 June 2014

Prevalence of Incontinence

Among Older Americans
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appreciated.

Suggested citation

Gorina Y, Schappert S, Bercovitz A, et al. Prevalence of incontinence among

older Americans. National Center for Health Statistics. Vital Health Stat 3(36).

2014.

Library of Congress Cataloging-in-Publication Data

Centers for Medicare & Medicaid Services (U.S.), author.

Prevalence of incontinence among older Americans / U.S. Department of

Health and Human Services, Centers for Disease Control and Prevention,

National Center for Health Statistics.

p. ; cm. — (Vital and health statistics. Series 3, analytical and epidemiological

studies ; Number 36) (DHHS publication ; no. 2012-1420)

Includes bibliographical references.

Summary: This report presents national estimates of incontinence prevalence

in the United States using data source specific definitions of incontinence

among persons aged 65 years and over by sociodemographic characteristics

during 2007–2012. The prevalence of incontinence is evaluated for noninstitutionalized persons, those living in residential care facilities, and home

health and hospice care recipients.

ISBN 0-8406-0666-4

I. Title. II. Series: Vital & health statistics. Series 3. Analytical and

epidemiological studies ; no. 36. 0886-4691 III. Series: DHHS publication ; no

2012-1420. 0276-4733

[DNLM: 1. Urinary Incontinence—epidemiology—United States. 2. Aged—

United States. 3. Fecal incontinence— epidemiology—United States. W2 A

N148vc no.36 2014]

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Printed on acid-free paper.
Series 3, Number 36

Prevalence of Incontinence

Among Older Americans

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsville, Maryland

June 2014

DHHS Publication No. 2014–1420
National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate Director for Science

Office of Analysis and Epidemiology

Irma E. Arispe, Ph.D., Director

Division of Health Care Statistics

Clarice Brown, M.S., Director

Division of Health and Nutrition Examination Surveys

Kathryn S. Porter, M.D., M.S., Director
Contents
 

Abstract .................................................................................................. 1 
 

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

Methods .................................................................................................. 2 
 

Data Sources and Subpopulations............................................................................ 2 
 

Definitions .............................................................................................. 2 
 

Error Measures and Statistical Testing ........................................................................ 2 
 

Noninstitutionalized Population: NHANES, 2007–2010 .......................................................... 3 
 

Residential Care Facility Residents: NSRCF, 2010 .............................................................. 4 
 

Home Health and Hospice Care Patients: NHHCS, 2007......................................................... 4 
 

Nursing Home Residents: MDS, 2009 ........................................................................ 4 
 

Results ................................................................................................... 5 
 

Noninstitutionalized Population (NHANES) ................................................................... 5 
 

Residential Care Facility Residents (NSRCF) ................................................................. 6 
 

Recipients of Home Health Care (NHHCS) ................................................................... 7 
 

Recipients of Hospice Care (NHHCS)........................................................................ 9 
 

Difficulty Controlling Bladder and Bowels Among Persons Receiving Home Health and Hospice Care by Type of

Residence (NHHCS) ..................................................................................... 10 
 

Nursing Home Residents (MDS) ........................................................................... 10 
 

Discussion ............................................................................................... 11 
 

Study Limitations.......................................................................................... 11 
 

References ............................................................................................... 12 
 

Appendix. Technical Notes .................................................................................. 24 
 

Figures

1.	 Age-adjusted incontinence among noninstitutionalized persons aged 65 and over, by type of incontinence and sex:
 

National Health and Nutrition Examination Survey, 2007–2010 ............................................... 6 
 

2.	 Incontinence among noninstitutionalized persons aged 65 and over, by age and sex: National Health and Nutrition
 

Examination Survey, 2007–2010 ........................................................................ 6 
 

3.	 Age-adjusted incontinence among residential care facility residents aged 65 and over, by type of incontinence and sex:
 

National Survey of Residential Care Facilities, 2010 ........................................................ 7 
 

4.	 Incontinence among residential care facility residents aged 65 and over, by age and sex: National Survey of Residential
 

Care Facilities, 2010.................................................................................. 7 
 

5.	 Age-adjusted incontinence among home health care patients aged 65 and over, by type of incontinence and sex: National
 

Home and Hospice Care Survey, 2007 ................................................................... 8 
 

6.	 Incontinence among home health care patients aged 65 and over, by age and sex: National Home and Hospice Care
 

Survey, 2007 ........................................................................................ 8 
 

iii
7.	 Age-adjusted incontinence among hospice care discharges aged 65 and over by type of incontinence and sex:
 

National Home and Hospice Care Survey, 2007............................................................ 9 
 

8.	 Age-adjusted incontinence of bladder or urinary catheter use among hospice discharges aged 65 and over, by residence:
 

National Home and Hospice Care Survey, 2007............................................................ 9 
 

9.	 Incontinence among hospice discharges aged 65 and over, by age and sex: National Home and Hospice Care Survey,
 

2007.............................................................................................. 10 
 

10.	 Age-adjusted incontinence among nursing home residents aged 65 and over, by type of incontinence and length of stay:
 

Long Term Care Minimum Data Set, 2009............................................................... 11 
 

Detailed Tables

1.	 Continence and incontinence definitions by data source .................................................... 14 
 

2.	 Incontinence among noninstitutionalized persons aged 65 and over, by selected characteristics: National Health and
 

Nutrition Examination Survey, United States, 2007–2010 ................................................... 15 
 

3.	 Age-adjusted percentage with bladder incontinence among noninstitutionalized persons aged 65 and over, by severity
 

level and sex: National Health and Nutrition Examination Survey, United States, 2007–2010 ...................... 16 
 

4.	 Severity of bladder incontinence among noninstitutionalized persons aged 65 and over, by selected characteristics:
 

National Health and Nutrition Examination Survey, United States, 2007–2010 .................................. 17 
 

5.	 Incontinence among persons aged 65 and over living in state-regulated residential care facilities, by selected
 

characteristics: National Survey of Residential Care Facilities, United States, 2010 .............................. 18 
 

6.	 Incontinence among home health care patients aged 65 and over, by selected characteristics: National Home and
 

Hospice Care Survey, United States, 2007 ............................................................... 19 
 

7.	 Incontinence during hospice stay among hospice discharges aged 65 years and over, by selected characteristics:
 

National Home and Hospice Care Survey, United States, 2007............................................... 20 
 

8.	 Percentage with incontinence among home health care patients aged 65 and over, by residence: National Home and
 

Hospice Care Survey, United States, 2007 ............................................................... 21 
 

9.	 Percentage with incontinence among hospice patients aged 65 and over, by place of residence at the end of
 

hospice care: National Home and Hospice Care Survey, United States, 2007 ................................... 22 
 

10.	 Incontinence among nursing home residents aged 65 and over, by selected characteristics: Long Term Care Minimum
 

Data Set, United States, 2009 ......................................................................... 23 
 

iv
Acknowledgments
 

The authors gratefully acknowledge

Alayne D. Markland, University of

Alabama at Birmingham; Elena M.

Fazio, Administration for Community

Living; Naveen K. Gupta, M.D.;

Robert J. Sher, M.D.; and Mitch Loeb,

National Center for Health Statistics for

their contributions to this report.

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Page 1

Objective

This report presents national

estimates of incontinence prevalence in

the United States using data sourcespecific definitions of incontinence

among persons aged 65 and over by

sociodemographic characteristics during

2007–2010.

Methods

Data are from the 2007–2010 National

Health and Nutrition Examination Survey

(NHANES), the 2010 National Survey of

Residential Care Facilities (NSRCF), the

2007 National Home and Hospice Care

Survey (NHHCS), and the 2009 Long

Term Care Minimum Data Set (MDS).

Findings are based on face-to-face

interviews with 2,625 noninstitutionalized

respondents (NHANES) and reports

provided by designated facility or agency

staff members for 6,856 residential care

facility (RCF) residents (NSRCF), 3,226

current home health care patients

(NHHCS), 3,918 hospice discharges

(NHHCS), and 2,416,705 nursing home

residents (MDS). Response rates for

incontinence questions were 84% among

noninstitutionalized persons (NHANES),

98% among RCF residents and home

health and hospice care patients (NSRCF

and NHHCS), and 99% for nursing home

residents (MDS).

Results

This is the first report presenting

national estimates on incontinence for

subpopulations of older persons sampled

in the Centers for Disease Control and

Prevention’s National Center for Health

Statistics surveys and the Centers for

Medicare & Medicaid Services’ Long Term

Care Minimum Data Set. Because a

different definition of incontinence is used

by each data collection system, it is not

possible to make data comparisons

between them or to summarize results

across all surveys. Accordingly, only

survey-specific results are presented.

Including recent data from all of these

data collection systems facilitates a

multidimensional picture of incontinence,

while underscoring the need for a

standardized definition.

Keywords: bladder incontinence •

incontinence of urine • bowel

incontinence • incontinence of feces

Prevalence of Incontinence

Among Older Americans

by Yelena Gorina, M.S., M.P.H., Office of Analysis and Epidemiology;

Susan Schappert, M.A. and Anita Bercovitz, Ph.D., M.P.H., Division

of Health Care Statistics; and Nazik Elgaddal, M.S. and Ellen

Kramarow, Ph.D., Office of Analysis and Epidemiology

Introduction
 

This report uses data from the

Centers for Disease Control and

Prevention’s National Center for Health

Statistics (NCHS) and the Centers for

Medicare & Medicaid Services (CMS)

to present national estimates of

incontinence prevalence among persons

aged 65 and over. The estimates are

based on data collected for

noninstitutionalized persons, residents of

residential care facilities (RCFs),

patients of home health and hospice care

agencies, and nursing home residents.

Data are presented by place of residence

(noninstitutionalized persons, residential

care facility residents, and nursing home

residents) and by services received

(recipients of home health or hospice

care). This is the first report to present

national estimates of incontinence for

subpopulations of older persons sampled

by NCHS surveys and the CMS Long

Term Care Minimum Data Set. Because

a different definition of incontinence is

used by each data collection system, it

is not possible to make data

comparisons between surveys or to

summarize results across all surveys.

In older persons, incontinence is

associated with multiple interacting

factors, including chronic conditions

such as diabetes and stroke, cognitive

impairment, and mobility impairment.

Bladder incontinence may be caused by

conditions such as age-related changes

in the lower urinary tract, urinary tract

infection, and conditions not directly

related to the genitourinary system, such

as diabetes, cancer, stroke, cognitive

impairment, and mobility impairment

(1–11). Risk factors for bowel

incontinence include chronic diarrhea,

inadequate fiber and water intake and

chronic constipation, diabetes, stroke,

neurologic and psychiatric conditions,

cognitive impairment, and mobility

impairment (12–16). Use of certain

medications and polypharmacy are also

associated with incontinence (6,16,17).

Incontinence presents a significant

financial burden to the individual and to

society. In the United States, the cost of

bladder incontinence among adults in

2000 was estimated at $19.5 billion,

with $14.2 billion incurred by

community residents and $5.3 billion by

institutional residents (18). A majority

(50%–75%) of the costs are attributed to

resources used for incontinence

management or ‘‘routine care’’ such as

absorbent pads, protection, and

laundry (19). The 2010 average annual

cost for fecal incontinence was

estimated at $4,110 per person for

patients who had fecal incontinence for

more than 1 year with at least monthly

leakage of solid, liquid, or mucus stool:

$2,353 for direct medical and

nonmedical expenses, and $1,549 for

indirect costs associated with

productivity loss (20). Greater

incontinence symptom severity was

associated with higher annual direct

costs.

Individuals who are incontinent may

carry an emotional burden of shame and

embarrassment in addition to the

physical discomfort and disruption of

their lives that occur with episodes of

incontinence (21). Bladder and bowel

incontinence significantly impact quality

of life even after adjusting for

comorbidities and demographic

differences (12,22–26). This impact
Page 2 [ Series 3, No. 36

increases with greater severity of

incontinence. Research has found an

association between incontinence and

declining mental health (26) and

increased risk of the onset of

psychological distress (27) and

depressive symptoms (28). Incontinence

is a predictor of functional

limitations (29) and is associated with an

increase in falls, which may result in

injuries and mobility impairment

(30–32). Incontinence adds to the

psychological and physical burden of

caregivers (33–35) and can be a risk

factor for nursing home placement,

hospitalization, and death (36–39).

Incontinence refers to the

involuntary loss of bladder or bowel

control. In survey research, incontinence

is operationally defined using many

different measures, making comparisons

across populations and settings difficult.

For example, measures of incontinence

may include frequency of loss of

bladder control (e.g., daily, weekly, or

monthly), magnitude (e.g., drops or

splashes), and type of loss of bowel

control (e.g., mucus, solid stool, or

liquid stool). Urinary incontinence may

also be categorized by activity when the

incontinence occurs (e.g., stress or urge

incontinence).

Methods

Data Sources and

Subpopulations

The estimates in this report are

based on data for persons aged 65 and

over. Data for the civilian

noninstitutionalized population are from

the National Health and Nutrition

Examination Survey (NHANES); data

for residents of RCFs are from the

National Survey of Residential Care

Facilities (NSRCF); data for home

health care patients and hospice

discharges are from the National Home

and Hospice Care Survey (NHHCS);

and data for nursing home residents are

from the Long Term Care Minimum

Data Set (MDS).

The sampling frames for NHANES,

NSRCF, and NHHCS were constructed

differently. For the civilian

noninstitutionalized population

(NHANES), the sample was chosen

from selected counties, blocks,

households, and individuals within the

household. In contrast, the sampling

frame for residents of RCFs and home

health and hospice patients was based

on the provider and then a sample of

residents and patients from the provider.

The MDS contains detailed information

about health status for all residents in

Medicare- or Medicaid-certified nursing

facilities.

While the residence status of the

noninstitutionalized population (sampled

by NHANES) and the nursing home

population (MDS) is mutually exclusive,

the residents of some RCFs may be

included in the NHANES sampling

frame. Home health and hospice care

patients are defined by the services they

receive from the respective agency and

may reside in the community, RCFs,

nursing homes, or hospitals.

The age groups presented in this

report differ across the surveys because

of the difference in the age composition

within the populations sampled and the

higher percentage of persons aged 85

and over among RCF and nursing home

residents and among home health and

hospice care recipients compared with

NHANES respondents. Unless otherwise

noted, prevalence estimates are

age-adjusted to the 2000 U.S. standard

population using the age groups 65–74

and 75 and over (NHANES); and

65–74, 75–84, and 85 and over

(NSRCF, NHHCS, and MDS).

Definitions

For the purposes of this report,

unless otherwise specified, the general

term ‘‘incontinence’’ refers to the

presence of either bladder or bowel

incontinence as defined for each data

system. When bladder incontinence is

mentioned, the person may be

incontinent of bladder only, or of both

bladder and bowel. Similarly, bowel

incontinence may include incontinence

of both bowel and bladder.

As noted, there is substantial

variation among surveys in the

measurement of bladder and bowel

incontinence (Table 1). For example,

NHANES collects self-reported

information on different types and

frequency of bowel incontinence

episodes, while NHHCS asks if the

patient has difficulty controlling his or

her bowels. The reference period for

incontinence varies from 7 days in

NSRCF to 1 year in NHANES. Answers

provided by facility or agency staff

members may differ from answers that

would be provided by the patient or

resident him- or herself.

Presence of a urinary catheter or

ostomy may not be related to

incontinence and can be used to change

urine and feces evacuation patterns for

another reason (e.g., surgical removal of

the large intestine). In this report,

persons with a catheter or ostomy were

considered continent. Data on ostomy

and catheter use were not collected in

NHANES, and were collected in

NSRCF, NHHCS, and MDS in different

ways. Therefore, NHANES estimates of

incontinence are irrespective of the

presence of a catheter or ostomy, while

RCF and nursing home residents and

home health and hospice care patients

with ostomies or catheters, as they were

defined in each data system, were not

considered incontinent.

Such variations in data collection

methods result in disparate definitions of

incontinence and make cross-survey

comparisons impossible. To underscore

these differences, data are always

discussed in this report with reference to

the particular survey they were derived

from or to the definition of incontinence

in the survey, e.g., ‘‘difficulty

controlling bladder’’ for estimates

derived from NHHCS.

Error Measures and

Statistical Testing

Estimates with relative standard

errors (RSEs) of 30% or more or based

on fewer than 30 unweighted records

are considered unreliable and are not

shown. Estimates based on 30 or more

but less than 59 unweighted records and

with an RSE less than 30% are

considered of low reliability and are

shown with a preceding dagger.
Series 3, No. 36 [ Page 3

Standard errors for the 100% MDS

sample are negligible and are not

shown.

Trends and differences between

survey estimates were tested for

statistical significance using two-tailed z

and t tests with a level of significance

of 0.05. Terms such as ‘‘higher than’’

and ‘‘lower than’’ indicate a statistically

significant difference. Odds ratios with

95% confidence intervals (CIs) were

used to indicate significant differences

between estimates; 95% CIs that

exclude the value 1.0 were considered

statistically significant.

Noninstitutionalized

Population: NHANES,

2007–2010

Data for the civilian

noninstitutionalized population are based

on face-to-face interviews with 2,625

NHANES respondents. NHANES is a

nationally representative sample of

civilian noninstitutionalized residents of

the United States (http://www.cdc.gov/

nchs/nhanes.htm). The survey is unique

in that it combines interviews and

physical examinations. The NHANES

interview includes demographic,

socioeconomic, dietary, and healthrelated questions. NHANES provides the

only self-reported data presented.

Multiple years of data (2007–2010)

were combined to increase estimate

reliability.

Bladder incontinence was defined

using the bladder incontinence severity

index (ISI), also known as the Sandvik

scale (40). The ISI is based on two

questions included in NHANES, ‘‘How

often do you have urinary leakage?’’ and

‘‘How much urine do you lose each

time?’’ The ISI is the product of the

frequency category of incontinence

episodes multiplied by the category of

the amount of urine lost per episode.

Categories for frequency in NHANES

(with the numerical value used in scale

calculation in parentheses) are:

never (0); less than once a month (1); a

few times a month (2); a few times a

week (3); and every day and/or

night (4). Categories for amount of urine

lost (with the numerical value used in

scale calculation in parentheses) are:

drops (1); small splashes (2); and

more (3). The ISI is calculated as a

frequency (five levels) multiplied by the

amount of leakage (three levels). The

resulting index values (ISI values 0–12)

are further categorized into five levels

of incontinence: none (ISI value 0),

slight (ISI values 1 and 2), moderate

(ISI values 3–6), severe (ISI values

8–9), and very severe (ISI value 12).

Thus, a person with very severe bladder

incontinence would have to have urinary

leakage every day and/or night

(frequency level 4) and more than drops

or small splashes (amount level 3). Less

severe levels of incontinence would be

based on varying levels of frequency

and amount. In this report,

noninstitutionalized persons who

answered ‘‘never’’ to the question about

frequency of incontinence episodes were

defined as continent of bladder; all

others who answered the question were

defined as incontinent of bladder (or

bladder incontinent). This definition

includes slight and more severe levels of

incontinence (ISI values 1–12). Severity

of incontinence is assessed using a mean

value of ISI scores and percentages with

mutually exclusive categories of slight,

moderate, and severe or very severe

levels of ISI. NHANES respondents

with missing information on bladder

incontinence were excluded from the

calculations (15.4% in 2007–2010).

Bowel incontinence was defined

using the questions, ‘‘How often during

the past 30 days have you had any

amount of accidental bowel leakage that

consisted of gas? ...of mucus? ...of

liquid stool? ...of solid stool?’’ Possible

answers to each of these questions were:

2 or more times a day, once a day, 2 or

more times a week, once a week, 1–3

times a month, or never. In this report,

persons who answered ‘‘never’’ to the

three questions about leakage of mucus,

liquid stool, and solid stool, including

those who reported accidental leakage of

gas only, were defined as NHANEScontinent of bowel; all others who

answered the questions were defined as

incontinent of bowel (or bowel

incontinent). Severity of bowel

incontinence was assessed by using a

mean value of the fecal incontinence

severity index (FISI). The FISI scale

was developed by Rockwood et al. (41)

using subjects’ perception of symptom

severity for each incontinence type (gas,

mucus, liquid stool, or solid stool) by

leakage frequency, and ranges from zero

(total continence) to 61 (complete

incontinence of solid stool on a daily

basis). In addition, this report presents

percentages by incontinence type

(mucus, liquid, and solid stool).

NHANES respondents with missing

information on bowel incontinence were

excluded from the calculations (16.8%

in 2007–2010).

Persons who reported urinary

leakage and/or accidental leakage of

mucus, liquid stool, or solid stool are

defined as incontinent of bladder or

bowel (or incontinent). Those with

missing information on either condition

were excluded from the calculations

(14.7% in 2007–2010).

Information on ostomy and catheter

use was not available in NHANES. In

the other surveys described in this

report, persons with ostomies or

catheters were considered continent, but

this distinction is not possible with

NHANES data. Therefore, the

assessment of continence among

noninstitutionalized persons is based

solely on the description above.

Race and ethnicity in this report

were recoded combining ethnicity

(Hispanic or Latino or not) and race

categories as reported by the NHANES

respondent. Percentage of poverty level

was calculated using the ratio of family

income to poverty level. Marital status

was recoded into two categories:

married (married, living with the

partner) and not married. Not married

includes those who were never married,

widowed, separated, or divorced. Level

of education was recoded from

NHANES data into three categories: no

high school (8th grade or less, or grades

9 to 11 and 12th grade with no

diploma); high school (high school

graduate or general educational

development [GED] high school

equivalency diploma); and some college

or more (combining some college or

associate’s degree and college graduate

degree or higher).
Page 4 [ Series 3, No. 36

Residential Care Facility

Residents: NSRCF, 2010

Data on residents of RCFs are

based on the 2010 NSRCF. 2010

NSRCF data are nationally

representative of state-regulated RCFs,

such as assisted living communities,

where residents receive housing and

supportive services because they cannot

live independently but generally do not

require the skilled level of care provided

by nursing homes (http://www.cdc.gov/

nchs/nsrcf.htm) (42). Only facilities that

were licensed, registered, certified,

listed, or otherwise regulated by their

state; served primarily an adult

population; had at least one current

resident; had four or more licensed,

certified, or registered residential care

beds; and provided room and board with

at least two meals a day, around-theclock on-site supervision, and help with

personal care such as bathing and

dressing, or health-related services such

as medication management, were

eligible to participate in NSRCF.

Facilities that exclusively served the

severely mentally ill, the intellectually

or developmentally disabled, or both

were ineligible.

Resident information is based on

in-person interviews with facility staff

members, who were asked to refer to

the sampled residents’ records to answer

the survey questions. In the

questionnaire, residents with ostomies,

catheters, or other devices were skipped

out of questions on continence. Presence

of a device was assessed by the

question, ‘‘Does the resident have an

ostomy, an indwelling catheter, or

similar device?’’ RCF residents who had

devices (2.2%) were included as

continent in the analyses. For residents

without devices, the questions to assess

continence were, ‘‘Has the resident had

any episode of urinary incontinence

during the last 7 days?’’ and ‘‘Has the

resident had any episode of bowel

incontinence during the last 7 days?’’ A

‘‘yes’’ response was used to categorize

the resident as incontinent of bladder or

bowel, respectively. Residents with

unknown device or incontinence status

were excluded from the calculations

(less than 1%).

Race and level of education are

presented using the same categories as

reported by the RCF representatives

with no recoding. Marital status was

recoded into two categories: married

(currently married) and not married. Not

married includes those who were never

married, widowed, legally separated, or

divorced.

Home Health and Hospice

Care Patients: NHHCS,

2007

The NHHCS collected data on

home health care patients and hospice

discharges who received care from

nationally representative samples of

home health and/or hospice care

agencies either certified by Medicare or

Medicaid or licensed by a state to

provide home health or hospice care

services (http://www.cdc.gov/nchs/

nhhcs.htm). Agencies that provided only

homemaker services or housekeeping

services, assistance with instrumental

activities of daily living, or durable

medical equipment and supplies were

excluded from the survey.

Data on current home health

patients and hospice discharges were

collected through in-person interviews

with agency directors and their

designated staff members; no interviews

were conducted directly with patients or

their families or friends.

In the NHHCS questionnaire,

patients and discharges with ostomies,

catheters, or other devices were not

eligible for questions on continence.

Presence of a device was assessed by

the questions, ‘‘Does/Did the patient

have a urinary catheter?’’ and

‘‘Does/Did a patient have a colostomy

or ileostomy for bowel elimination?’’

Among home health care patients, 9.1%

used a urinary catheter (13.2% of men

and 7.1% of women) and 3.0% had a

colostomy or ileostomy. Among hospice

discharges, 38.8% used a urinary

catheter (37.5% of men and 40.5% of

women) and 2.8% had a colostomy or

ileostomy during their hospice stay. For

home health care patients and hospice

discharges without devices, the

questions to assess continence were,

‘‘Does/Did the patient have difficulty

controlling his/her bladder?’’ and

‘‘Does/Did the patient have difficulty

controlling his/her bowels?’’ Those with

difficulty were defined as incontinent of

bladder or bowel, respectively. Patients

with unknown device or incontinence

status were excluded from the

calculations (fewer than 3%).

Home health and hospice care

patients are defined by receipt of

services rather than type of residence.

Among patients receiving home health

care, 90.8% received care at a private

home or apartment, while 9.2% received

care in an RCF or nursing home.

Among hospice discharges at the end of

hospice care, 51.2% of patients received

care in a private home or apartment,

30.9% in an RCF or nursing home, and

17.9% in a residential hospice, hospital,

or other facility.

Race is presented using the same

categories as reported by the home

health and hospice care agency’s

representative with no recoding. Marital

status was recoded into two categories:

married and not married. Not married

includes those who were never married,

widowed, separated, or divorced.

Nursing Home Residents:

MDS, 2009

Data on nursing home residents are

derived from the 2009 Long Term Care

Minimum Data Set (MDS), Version 2.0.

The MDS is a standardized,

comprehensive screening and assessment

tool of health status. It is collected for

all residents of long-term care facilities

certified to participate in Medicare or

Medicaid by the Centers for Medicare &

Medicaid Services. The MDS captures

data on resident demographics, and on

physical, psychological, and

psychosocial functioning at admission

and on a quarterly and annual basis. The

information in the MDS is based on

reports about the nursing home residents

as assessed by staff members. MDS data

for 2008 were used to determine length

of stay and demographic characteristics

for residents who were discharged in the

first quarter of 2009.

In this report, estimates for nursing

home residents are presented based on
Series 3, No. 36 [ Page 5

the length of the nursing home episode.

Short-term residents typically enter a

nursing home following a hospital stay

and need skilled nursing care or

rehabilitation before being able to return

to the community. Medicare either

partially or entirely covers costs for up

to 100 days of a beneficiary’s

posthospitalization stay in a skilled

nursing facility. Long-term residents

require chronic care for extended

periods and typically do not return to

the community, with nursing home costs

generally covered by self-pay, private

insurance, or Medicaid (43). For the

purposes of this report, short-term

residents are defined as residents with

no annual MDS assessment and with an

assessment at admission only, or one

quarterly assessment only, or with a

length of stay of 100 days or fewer.

Long-term residents are defined as those

with at least two quarterly MDS

assessments, or an annual assessment, or

with a length of stay of 101 days or

more. The latest available assessment

was used to derive incontinence

estimates.

MDS questions used to assess

bladder and bowel continence were

based on functioning during the 14 days

prior to assessment and the presence of

an indwelling catheter or ostomy. Level

of control of urinary bladder function,

with appliances or continence programs

if employed, was defined as follows:

continent (complete control, includes use

of an indwelling urinary catheter that

does not leak urine); usually continent

(incontinent episodes once a week or

fewer); occasionally incontinent

(incontinent episodes two or more times

a week but not daily); frequently

incontinent (tended to be incontinent

daily, but some control present); or

incontinent (multiple daily incontinent

episodes). Level of control of bowel

movement, with appliance or bowel

continence programs if employed,

includes the following: continent

(complete control, includes use of an

ostomy device that does not leak stool);

usually continent (incontinent episodes

less than weekly); occasionally

incontinent (incontinent episodes once a

week); frequently incontinent

(incontinent episodes two to three times

a week); or incontinent (incontinent

episodes all or almost all of the time). A

separate MDS question asked about the

presence of an indwelling catheter or

ostomy.

For the purposes of this report,

nursing home residents with an

indwelling catheter (13.9% of short-term

and 7.3% of long-term residents) or

without an indwelling catheter and in

complete control of urinary bladder

function are defined as continent of

bladder. Residents without an indwelling

catheter and not in complete control of

their bladder are defined as bladder

incontinent. Residents with ostomy

(2.8% of short-term and 2.5% of

long-term residents) or without ostomy

and in complete control of bowel

movement are defined as continent of

bowel. Those without ostomy and not in

complete control are defined as

incontinent of bowel. Those with

unknown bladder or bowel MDScontinence status were excluded from

the calculations (less than 1%).

Sociodemographic variables were

also derived from the MDS. Race and

ethnicity in this report are presented

using the same categories as in the

MDS with no recoding. Marital status

was recoded into two categories:

married and not married. Not married

includes those who were never married,

widowed, separated, or divorced. Level

of education was recoded from MDS

data into three categories: no high

school (no schooling, 8th grade or less,

or grades 9 to 11); high school (high

school); and some college or more

(combining technical or trade school,

some college, bachelor’s degree, and

graduate degree).

Results

Noninstitutionalized

Population (NHANES)

Of noninstitutionalized persons aged

65 and over, 50.9% reported a urinary

leakage and/or accidental bowel leakage

of mucus, liquid stool, or solid stool;

of them, 43.8% reported a urinary

leakage, and 17.3% reported an

accidental bowel leakage (Figure 1,

Table 2). Among those who reported an

incontinence episode, the majority

reported urinary but not accidental

bowel leakage, while 10.6% of

noninstitutionalized persons reported

both urinary and bowel leakage

(Figure 1).

More than one-half of

noninstitutionalized women and more

than one-quarter of noninstitutionalized

men aged 65 and over reported a

urinary leakage (Table 2). About 12% of

women had severe or very severe ISI

scores of bladder incontinence, while the

rest of women and almost all of the men

who reported urinary leakage had slight

or moderate ISI scores (Tables 3 and 4).

Restricting the definition of bladder

incontinence to include only moderate,

severe, and very severe levels of

incontinence reduced the percentage

with bladder incontinence among

noninstitutionalized men and women

from 43.8% to 24.0%. When only

severe and very severe levels were

considered, the percentage with bladder

incontinence was 8.1% (Table 3).

Among non-Hispanic white women,

the percentage with urinary leakage was

1.8 times (95% CI 1.4, 2.1) higher

compared with non-Hispanic black

women (58.3% compared with 33.4%)

(Table 4). Observed differences in

urinary leakage rates among

noninstitutionalized persons by age

group (Figure 2), poverty level, level of

education, or marital status were not

statistically significant (Table 2).

The average bladder ISI was 1.7

[standard error (SE) 0.1, ISI scale from

0 to 12]. The average ISI score was 2.5

times (95% CI 2.0, 3.0) higher among

noninstitutionalized women compared

with men, with average ISIs equal to 2.3

and 1.0, respectively (Table 4). Among

noninstitutionalized women, non-Hispanic

white and Mexican-American women had

higher ISI scores than non-Hispanic black

women. Persons aged 75 and over had

higher ISI scores than those aged 65–74;

and unmarried persons had higher ISI

scores than married persons.

Observed differences in accidental

bowel leakage rates by sex, age, race

and Hispanic origin, poverty level,

education, and marital status were not

statistically significant (Figure 2,

Table 2). Among those with accidental
 

 

Page 6 [ Series 3, No. 36

0 

10 

20 

30 

40 

50 

60 

70 

None1 Urinary or bowel 

leakage2 

Urinary leakage only3 Urinary and bowel 

leakage4 

Bowel leakage only5 

All Men Women 

95% confidence interval. 

1

Persons who answered "never" to each question about frequency of urinary leakage and accidental bowel leakage of mucus, liquid stool, or solid stool. 2

Persons who reported a urinary leakage or accidental bowel leakage of mucus, liquid stool, or solid stool. 

3

Persons who reported a urinary leakage and answered "never" to each question about frequency of accidental bowel leakage of mucus, liquid stool, or solid stool. 4

Persons who reported a urinary leakage and accidental bowel leakage of mucus, liquid stool, or solid stool. 

5

Persons who answered "never" to the question about frequency of urinary leakage and reported accidental bowel leakage of mucus, liquid stool, or solid stool. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2010. Percent (age-adjusted) 

Figure 1. Age-adjusted incontinence among noninstitutionalized persons aged 65 and over, by type of incontinence and sex:

National Health and Nutrition Examination Survey, 2007–2010

bowel leakage, 29.3% reported and 29.2% had had accidental leakage

accidental leakage of mucus, 76.0% had of solid stool, with 29.5% reporting two

had accidental leakage of liquid stool, or three of these types of accidental

0 

10 

20 

30 

40 

50 

60 

70 

Men 

Urinary leakage1 Bowel leakage2 

Women Men Women 

95% confidence interval. 

1

Persons who reported a urinary leakage. 

2

Persons who reported accidental bowel leakage of mucus, liquid stool, or solid stool. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2010. Percent 

65–74 75 and over 

Figure 2. Incontinence among noninstitutionalized persons aged 65 and over, by age and

sex: National Health and Nutrition Examination Survey, 2007–2010

bowel leakage (data not shown). In

addition, 74.9% of those with accidental

bowel leakage of mucus, liquid stool, or

solid stool reported accidental leakage

of gas (data not shown).

The average FISI value was 5.98

(SE 0.21, FISI scale from 0 to 61).

Among non-Hispanic white

noninstitutionalized persons, the average

FISI value was 6.2 (SE 0.2), 1.4 times

(95% CI 1.2, 1.7) higher compared with

the average FISI value among

non-Hispanic black persons (4.3, SE

0.4), while observed differences in

average FISI scores by other selected

characteristics were not statistically

significant (data not shown).

Residential Care Facility

Residents (NSRCF)

Among RCF residents, 39.0% had

had an episode of urinary and/or bowel

incontinence during the 7 days prior to

the survey, with 36.6% reported to have

had an episode of urinary incontinence

and 20.4% reported to have had an

episode of bowel incontinence (Figure 3,
 

 

Series 3, No. 36 [ Page 7

0 

10 

20 

30 

40 

50 

60 

70 

None1 Urinary or bowel 

incontinence2 

Urinary incontinence only3 Urinary and bowel 

incontinence4 

95% confidence interval. 

1

Residents who were reported as having an ostomy, indwelling catheter, or similar device or as having no episode of urinary or bowel incontinence during the last 7 days. 

2

Residents who were reported as not having an ostomy, indwelling catheter, or similar device and with an episode of urinary or bowel incontinence during the last 7 days. 

3

Residents who were reported as not having an ostomy, indwelling catheter, or similar device and with an episode of urinary incontinence but no episode of bowel incontinence during the last 7 days. 

4

Residents who were reported as not having an ostomy, indwelling catheter, or similar device and with an episode of urinary incontinence and an episode of bowel incontinence during the last 7 days. 

NOTE: Percentages of residents who were reported as having an episode of bowel incontinence but not bladder incontinence during the last 7 days are not reliable and not shown. 

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010. 

All Men Women 

Percent (age-adjusted) 

Figure 3. Age-adjusted incontinence among residential care facility residents aged 65 and over, by type of incontinence and sex: National

Survey of Residential Care Facilities, 2010

Table 5). About one-half of RCF

residents who had had an incontinence

95% confidence interval. 

1

Residents who were reported as not having an ostomy, indwelling catheter, or similar device and with an episode of urinary 

incontinence during the last 7 days. 

2

Residents who were reported as not having an ostomy, indwelling catheter, or similar device and with an episode of bowel 

incontinence during the last 7 days. 

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010. 

0 

10 

20 

30 

40 

50 

Men Women Men Women 

Urinary incontinence1 Bowel incontinence2 

Percent 

65–74 75–84 85 and over 

Figure 4. Incontinence among residential care facility residents aged 65 and over, by age

and sex: National Survey of Residential Care Facilities, 2010

episode were incontinent of bladder but

not of bowel and about another one-half

were incontinent of both bowel and

bladder (Figure 3).

Women were 1.2 times more likely

than men (95% CI 1.03, 1.4; 39.4%

compared with 32.7%) to report a

urinary incontinence episode, while

there was no significant difference by

sex in bowel incontinence (Figure 4,

Table 5). Compared with unmarried

residents, those who were married or

living with a partner were 1.4 times

(95% CI%1.2, 1.7; 48.7% compared

with 34.4%) more likely to have had an

episode of urinary incontinence and

about 2 times (95% CI 1.5, 2.4; 35.1%

compared with 17.9%) more likely to

have had an episode of bowel

incontinence (Table 5). There were no

significant differences in rates of

incontinence by age, race, and education

(Figures 3 and 4, Table 5).

Recipients of Home Health

Care (NHHCS)

Irrespective of place of residence,

45.4% of recipients of home health care
 

 

Page 8 [ Series 3, No. 36

95% confidence interval. 

1

Patients who were reported as having a urinary catheter or without difficulty controlling their bladder; and with a colostomy or ileostomy or without difficulty controlling their bowels. 

2

Patients who were reported as not having a urinary catheter and with difficulty controlling their bladder; or without a colostomy or ileostomy and with difficulty controlling their bowels. 

3

Patients who were reported as not having a urinary catheter and with difficulty controlling their bladder; and with a colostomy or ileostomy or without difficulty controlling their bowels. 

4

Patients who were reported as not having a urinary catheter, a colostomy or ileostomy, and with difficulty controlling both their bladder and bowels. 

5

Patients who were reported as not having a colostomy or ileostomy, and with difficulty controlling their bowels; and with a urinary catheter or without difficulty controlling their bladder. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 

0 

10 

20 

30 

40 

50 

60 

70 

None1 Difficulty controlling 

bladder or bowels2 

Difficulty controlling 

bladder only3 

Difficulty controlling 

bladder and bowels4 

Difficulty controlling 

bowels only5 

All Men Women 

Percent (age-adjusted) 

Figure 5. Age-adjusted incontinence among home health care patients aged 65 and over, by type of incontinence and sex: National Home

and Hospice Care Survey, 2007

were reported to have difficulty

controlling their bladder and/or bowels;

95% confidence interval. 

* Figure does not meet standards of reliability or precision. 

1

Patients who were reported as not having a urinary catheter and with difficulty controlling their bladder. 

2

Patients who were reported as not having a colostomy or ileostomy and with difficulty controlling their bowels. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 

0 

10 

20 

30 

40 

50 

60 

70 

Men Women Men Women 

Difficulty controlling bladder1 

* 

Difficulty controlling bowels2 

Percent 

65–74 75–84 85 and over 

Figure 6. Incontinence among home health care patients aged 65 and over, by age and sex:

National Home and Hospice Care Survey, 2007

of them, 40.2% were reported to have

difficulty controlling their bladder and

14.2% were reported to have difficulty

controlling their bowels (Figure 5,

Table 6). About one-third (30.8%) of

incontinent home health care patients

had difficulty controlling their bladder

but not bowels, while 9.8% had

difficulty controlling both bladder and

bowels (Figure 5).

Female home health care patients

were 1.7 times (95% CI 1.3, 2.1) more

likely than male patients to have

difficulty controlling their bladder

(46.5% compared with 27.6%)

(Figure 6, Table 6). The percentage of

male patients with difficulty controlling

their bladder doubled from 22.3% for

the 65–74 age group to 45.0% for those

85 and over. Among female patients, the

observed differences in the percentage

of bladder incontinence by age were not

significant (Figure 6, Table 6). There

were no significant differences in

difficulty controlling bladder by race

and marital status (Table 6).

The percentage of recipients of

home health care with difficulty

controlling their bowels increased with
 

Series 3, No. 36 [ Page 9

age, from 13.1% for the 65–74 age differences in difficulty controlling

group to 20.8% for those 85 and over bowels by sex, race, and marital status

(Table 6). There were no significant (Table 6).

Recipients of Hospice Care

(NHHCS)

Among persons receiving hospice

care, irrespective of place of residence,

62.1% were reported to have difficulty

controlling their bladder and/or bowels

(Figure 7, Table 7); of them, 36.0% were

reported to have difficulty controlling

their bladder, and 49.0% were reported

to have difficulty controlling their

bowels. About 10% (9.9%) of hospice

patients had difficulty controlling their

bladder but not their bowels, while

24.0% had difficulty controlling their

bowels but not their bladder, and 28.0%

had difficulty controlling both bladder

and bowels (Figure 7). More than

one-third of both male and female

hospice patients (37.5% and 40.5%,

respectively) were reported to have a

urinary catheter (Figure 8), and 2.8% of

hospice patients had a colostomy or

ileostomy (data not shown). The lower

percentage of hospice patients with

difficulty controlling their bladder may

be a result of the high proportion with

urinary catheters.

The reported rate of difficulty

controlling bladder among female

hospice patients aged 85 and over was

95% confidence interval. 

1

Patients who were reported as having a urinary catheter or without difficulty controlling their bladder; and with a colostomy or ileostomy or without difficulty controlling their bowels. 

2

Patients who were reported as not having a urinary catheter and with difficulty controlling their bladder; or without a colostomy or ileostomy and with difficulty controlling their bowels. 

3

Patients who were reported as not having a urinary catheter, a colostomy or ileostomy, and with difficulty controlling both their bladder and bowels. 

4

Patients who were reported as not having a colostomy or ileostomy and with difficulty controlling their bowels; and with a urinary catheter or without difficulty controlling their bladder. 

5

Patients who were reported as not having a urinary catheter and with difficulty controlling their bladder; and with a colostomy or ileostomy or without difficulty controlling their bowels. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 

0 

10 

20 

30 

40 

50 

60 

70 

None1 Difficulty controlling 

bladder or bowels2 

Difficulty controlling 

bladder only5 

Difficulty controlling 

bladder and bowels3 

Difficulty controlling 

bowels only4 

All Men Women 

Percent (age-adjusted) 

Figure 7. Age-adjusted incontinence among hospice care discharges aged 65 and over by type of incontinence and sex: National Home and

Hospice Care Survey, 2007

60 

50 

70 

100 

90 

80 

Urinary catheter use 

Difficulty 

controlling bladder1 

Percent (age-adjusted)

40 

30 

20 

All Private RCF Hospital, 

home or or nursing residential 

apartment home hospice 

1

Patients who were reported as not having a urinary catheter and with difficulty controlling their bladder.
 

NOTES: Estimates are by residence at the end of hospice care. RCF is residential care facility.
 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 


Figure 8. Age-adjusted incontinence of bladder or urinary catheter use among hospice

discharges aged 65 and over, by residence: National Home and Hospice Care Survey, 2007

0 

10 
 

Page 10 [ Series 3, No. 36

2 times higher (95% CI 1.5, 2.7)

compared with the 65–74 age group

(57.5% compared with 28.1%) (Figure 9,

Table 7). There were no significant

differences in the percentages with

reported difficulty controlling their bladder

by age group among male discharges, or

among all discharges by race and marital

status (Figure 9, Table 7).

The percentage with difficulty

controlling their bowels among hospice

care recipients aged 85 and over was

higher than among those aged 65–74:

63.2% compared with 47.6%. Observed

differences in difficulty controlling their

bowels by age and race were not

significant (Table 7).

Difficulty Controlling

Bladder and Bowels

Among Persons Receiving

Home Health and Hospice

Care by Type of Residence

(NHHCS)

Persons receiving home health care

in RCFs or nursing homes were 1.4

times (95% CI 1.1, 1.8; 58.0%

compared with 40.0%) more likely to be

reported as having difficulty controlling

their bladder and 2.5 times (95% CI 1.4,

3.7; 32.7% compared with 12.9%) more

likely to be reported as having difficulty

controlling their bowels compared with

those who received care in a private

home or apartment (Table 8).

A similar pattern was seen for

persons receiving hospice care. The

percentage with difficulty controlling

their bladder among persons receiving

hospice care in an RCF or nursing

home (50.9%) was higher compared

with those who received care in a

private home or apartment (35.8%) or in

a residential hospice or hospital (26.4%)

(Figure 8, Table 9). The lower percentage

with difficulty controlling their bladder

among hospice care recipients in

residential hospices or hospitals may be

explained by the higher percentage with a

urinary catheter (68.1%), which is about 2

times higher than among those receiving

care in a private home or apartment

(31.4%) or an RCF or nursing home

(35.4%) (Figure 8).

Patients receiving hospice care in a

private home or apartment were less

likely to be reported as having difficulty

controlling their bowels (41.2%)

compared with those receiving care in

an RCF or a nursing home (66.3%) and

residential hospice or hospitals (69.8%)

(Table 9).

Nursing Home Residents

(MDS)

Almost one-half (46.1%) of

short-term nursing home residents and

three-quarters (75.8%) of long-term

nursing home residents were not in

complete control of urinary bladder

function or bowel movement during 14

days prior to the interview (Figure 10,

Table 10). More than one-third (36.7%)

of short-term residents and 70.3% of

long-term residents were not in

complete control of their bladder and

one-third (33.1%) of short-term and

60.0% of long-term residents were not

in complete control of their bowels.

Almost one-quarter (23.6%) of

short-term residents and more than

one-half (54.4%) of long-term residents

were not in complete control of both

bladder and bowels (Figure 10).

The percentage of those who were

not in complete control of urinary

bladder function or bowel movement

among nursing home residents aged 85

and over compared with those aged

65–74 was 1.5 times higher for

short-term residents (60.3% compared

with 40.2%) and 1.2 times higher for

long-term residents (82.2% compared

with 72.0%) (Table 10).

Among short-term nursing home

residents, about the same percentage of

men and women were not in complete

control of urinary bladder function

(36.5% and 36.7%, respectively), but a

higher percentage of men were not in

complete control of bowel movement

compared with women (37.1%

compared with 30.6%). Among

long-term residents, a higher percentage

of women were not in complete control

of urinary bladder function compared

with men (73.5% compared with

64.9%), while the percentages of men

and women not in complete control of

bowel movement were about the same

(59.1% and 60.7%) (Table 10).

Non-Hispanic black residents had a

higher prevalence of not being in

complete control of urinary bladder

function or bowel movement (66.7%)

than non-Hispanic white or Hispanic

residents (56.0% and 59.4%,

respectively). This pattern was observed

for both urinary bladder function and

95% confidence interval. 

1

Patients who were reported as not having a urinary catheter and with difficulty controlling their bladder. 

2

Patients who were reported as not having a colostomy or ileostomy and with difficulty controlling their bowels. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 

0 

20 

40 

60 

80 

Men Women Men Women 

10 

30 

50 

70 

Percent 

Difficulty controlling bladder1 Difficulty controlling bowels2 

65–74 75–84 85 and over 

Figure 9. Incontinence among hospice discharges aged 65 and over, by age and sex:

National Home and Hospice Care Survey, 2007
Series 3, No. 36 [ Page 11

bowel movement, but the differences

were more pronounced among

short-term compared with long-term

residents.

Among short-term residents, the

prevalence of not being in complete

control of urinary bladder function or

bowel movement decreased with

increasing levels of education, from

50.3% among residents with no high

school diploma to 42.2% among

residents with at least some college

education. In contrast, the percentage of

long-term residents not in complete

control of urinary bladder function or

bowel movement slightly increased with

increasing levels of education, from

74.9% for those with no high school

diploma to 78.3% for those with at least

some college.

A greater percentage of married

short-term and long-term residents were

not in complete control of urinary

bladder function or bowel movement

compared with unmarried residents

(47.1% compared with 44.7% of

short-term residents, and 82.2%

compared with 73.8% of long-term

residents, respectively). This pattern

held true for urinary bladder function

among long-term residents (75.0% of

married residents and 68.7% of

unmarried residents) but not among

short-term residents (36.2% of married

residents and 36.0% of unmarried

residents). The prevalence of not being

in complete control of bowel movement

among married residents was higher

compared with unmarried residents

among both short-term (34.7%

compared with 31.0%) and long-term

residents (69.0% compared with 57.0%)

(Table 10).

Discussion

Bladder and bowel incontinence are

conditions affecting older persons that

can have serious implications for quality

of life, caregiving, and service delivery.

To date, little attention has been given

to summarizing incontinence data across

multiple national data sources. This

report presents comprehensive and

detailed data on the prevalence of

incontinence from four large national

data systems: NHANES, NSRCF,

NHHCS, and MDS. These are rich data

sources containing numerous indicators

of health status, functional status, and

other variables that can be used to

examine the association of incontinence

with other health conditions of older

persons. Generally, the incontinence

definitions in each data system reflect

the needs of each residential or care

setting, e.g., severity of incontinence

among the noninstitutionalized

population, hospice caregiver burden, or

nursing home quality assessment.

However, as this report demonstrates,

the lack of standardized operational

definitions for bladder and bowel

incontinence makes it difficult to

compare results.

Study Limitations

The difference in the years of data

collection and lack of consistency in the

definition of incontinence across the

four data sources used for this report

affect the comparability of the results.

The data from the provider-based data

surveys (NSRCF, NHHCS, MDS) were

supplied by facility or agency staff

Percent (age-adjusted) 

80 

All residents Short-term residents Long-term residents 

70 

60 

50 

40 

30 

20 

10 

0 

None1 Not in complete control 

of bladder or bowel2 

Not in complete control 

of bladder and bowel3 

Not in complete control 

of bowel only4 

Not in complete control 

of bladder only5 

1

Residents who were reported as having an indwelling catheter or in complete control of urinary bladder function; and with an ostomy or in complete control of bowel movement.
 2

Residents who were reported as not having an indwelling catheter and not in complete control of urinary bladder function; or without ostomy and not in complete control of bowel movement.
 3

Residents who were reported as not having an indwelling catheter and without an ostomy and not in complete control of both urinary bladder function and bowel movement.
 4

Residents who were reported as not having an ostomy and not in complete control of bowel movement; and with an indwelling catheter or in complete control of urinary bladder function.
 5

Residents who were reported as not having an indwelling catheter and not in complete control of urinary bladder function; and with an ostomy or in complete control of bowel movement.
 

SOURCE: Centers for Medicare & Medicaid, Long Term Care Minimum Data Set, Version 2.0, 2009. 


Figure 10. Age-adjusted incontinence among nursing home residents aged 65 and over, by type of incontinence and length of stay:

Long Term Care Minimum Data Set, 2009
Page 12 [ Series 3, No. 36

members, while the data from NHANES

were based on self-report. In addition,

NHANES does not collect data on the

presence of an ostomy or catheter, while

NSRCF does not distinguish between

persons with ostomies and urinary

catheters. If a person had such a device,

NSRCF did not ask the question on

incontinence. As a result, if a person

with a colostomy was bladder

incontinent, he or she was defined as

continent. However, this definition

should not affect the results significantly

because only 2.2% of RCF residents

were reported as having a device.

Different designs and approaches to

incontinence in the data systems did not

allow harmonization of the incontinence

definition and direct comparison of

incontinence rates across residential

settings.

Because home health and hospice

care agencies may provide services in

any residential setting and the residents

of small RCFs may be included in the

scope of the population sampled by

NHANES, the results from these

surveys in this report are not mutually

exclusive.

Although NHANES provides data

on the severity of incontinence, these

data were not available from other data

sources.

Records with missing incontinence

status were excluded from the analysis.

The extent of data missing varies across

the data systems and was less than 1%

in NSRCF and MDS, less than 3% in

NHHCS, and about 15% in NHANES.

Some residential care facilities

either do not admit persons with

incontinence or will discharge residents

after they become incontinent. These

policies may affect the results. Estimates

of the percentages of incontinent RCF

residents were calculated including

facilities that do not admit persons with

bladder or bowel incontinence (10% and

20% of sampled facilities, respectively;

data not shown) and those that discharge

persons after they become bladder or

bowel incontinent (5% and 13% of

sampled facilities, respectively; data not

shown).

References
 

1. Vaughan CP, Goode PS, Burgio KL,

Markland AD. Urinary incontinence in

older adults. Mt Sinai J Med

78(4):558–70. 2011.

2.DuBeau CE, Kuchel GA, Johnson T

2nd, Palmer MH, Wagg A.

Incontinence in the frail elderly: Report

from the 4th International Consultation

on Incontinence. Neurourol Urodyn

29(1):165–78. 2010.

3.Townsend MK, Curhan GC, Resnick

NM, Grodstein F. The incidence of

urinary incontinence across Asian,

black, and white women in the United

States. Am J Obstet Gynecol

202(4):378.e1–7. 2010.

4.Shamliyan TA, Wyman JF, Ping R, Wilt

TJ, Kane RL. Male urinary

incontinence: Prevalence, risk factors,

and preventive interventions. Rev Urol

11(3):145–65. 2009.

5.Sarma AV, Kanaya AM, Nyberg LM,

Kusek JW, Vittinghoff E, Rutledge B,

et al. Urinary incontinence among

women with type 1 diabetes—how

common is it? J Urol 181(3):1224–30.

2009.

6.DuBeau CE. The aging lower urinary

tract. J Urol 175(3 Pt 2):S11–5. 2006.

7.Potosky AL, Davis WW, Hoffman RM,

Stanford JL, Stephenson RA, Penson

DF, Harlan LC. Five-year outcomes

after prostatectomy or radiotherapy for

prostate cancer: The prostate cancer

outcomes study. J Natl Cancer Inst

96(18):1358–67. 2004.

8.Luber KM. The definition, prevalence,

and risk factors for stress urinary

incontinence. Rev Urol 6 Suppl 3:S3–9.

2004.

9.Vogel SL. Urinary Incontinence in the

elderly. Ochsner J 3(4):214–8. 2001.

10.Brown JS, Vittinghoff E, Wyman JF,

Stone KL, Nevitt MC, Ensrud KE,

Grady D. Urinary incontinence: Does it

increase risk for falls and fractures?

Study of Osteoporotic Fractures

Research Group. J Am Geriatr Soc

48(7):721–5. 2000.

11.Gelber DA, Good DC, Laven LJ,

Verhulst SJ. Causes of urinary

incontinence after acute hemispheric

stroke. Stroke 24(3):378–82. 1993.

12.Alsheik EH, Coyne T, Hawes SK,

Merikhi L, Naples SP, Kanagarajan N,

et al. Fecal incontinence: Prevalence,

severity, and quality of life data from

an outpatient gastroenterology practice.

Gastroenterol Res Pract 2012:947694.

2012.

13.Nurko S, Scott SM. Coexistence of

constipation and incontinence in

children and adults. Best Pract Res Clin

Gastroenterol 25(1):29–41. 2011.

14.Hayden DM, Weiss EG. Fecal

incontinence: Etiology, evaluation, and

treatment. Clin Colon Rectal Surg

24(1):64–70. 2011.

15.Tariq SH. Fecal incontinence in older

adults. Clin Geriatr Med 23(4):857–69.

2007.

16.Quander CR, Morris MC, Melson J,

Bienias JL, Evans DA. Prevalence of

and factors associated with fecal

incontinence in a large community

study of older individuals. Am J

Gastroenterol 100(4):905–9. 2005.

17.Talasz H, Lechleitner M. Polypharmacy

and incontinence. Z Gerontol Geriatr

45(6):464–7. 2012.

18.Hu TW, Wagner TH, Bentkover JD,

Leblanc K, Zhou SZ, Hunt T. Costs of

urinary incontinence and overactive

bladder in the United States: A

comparative study. Urology 63(3):461–

5. 2004.

19.Subak LL, Brubaker L, Chai TC,

Creasman JM, Diokno AC, Goode PS,

et al. High costs of urinary

incontinence among women electing

surgery to treat stress incontinence.

Obstet Gynecol 111(4):899–907. 2008.

20.Xu X, Menees SB, Zochowski MK,

Fenner DE. Economic cost of fecal

incontinence. Dis Colon Rectum

55(5):586–98. 2012.

21.Landefeld CS, Bowers BJ, Feld AD,

Hartmann KE, Hoffman E, Ingber MJ,

et al. National Institutes of Health

state-of-the-science conference

statement: Prevention of fecal and

urinary incontinence in adults. Ann

Intern Med 148(6):449–58. 2008.

22.Khatutsky G, Walsh EG, Brown DW.

Urinary incontinence, functional status,

and health-related quality of life among

Medicare beneficiaries enrolled in the

program for all-inclusive care for the

elderly and dual eligible demonstration

special needs plans. J Ambul Care

Manage 36(1):35–49. 2013.

23.Minassian VA, Devore E, Hagan K,

Grodstein F. Severity of urinary

incontinence and effect on quality of

life in women by incontinence type.

Obstet Gynecol 121(5):1083–90. 2013.

24.Kwong PW, Cumming RG, Chan L,

Seibel MJ, Naganathan V, Creasey H,

et al. Urinary incontinence and quality

of life among older communitydwelling Australian men: The CHAMP

study. Age Ageing 39(3):349–54. 2010.
Series 3, No. 36 [ Page 13

25. Bartlett L, Nowak M, Ho YH. Impact

of fecal incontinence on quality of life.

World J Gastroenterol 15(26):3276–82.

2009.

26. Ko Y, Lin SJ, Salmon JW, Bron MS.

The impact of urinary incontinence on

quality of life of the elderly. Am J

Manag Care 11(4 Suppl):S103–11.

2005.

27. de Vries HF, Northington GM, Bogner

HR. Urinary incontinence (UI) and new

psychological distress among

community dwelling older adults. Arch

Gerontol Geriatr 55(1):49–54. 2012.

28. Dugan E, Cohen SJ, Bland DR,

Preisser JS, Davis CC, Suggs PK,

McGann P. The association of

depressive symptoms and urinary

incontinence among older adults. J Am

Geriatr Soc 48(4):413–6. 2000.

29. Dunlop DD, Manheim LM, Sohn M-W,

Liu X, Chang RW. Incidence of

functional limitation in older adults:

The impact of gender, race, and chronic

conditions. Arch Phys Med Rehabil

83(7):964–71. 2002.

30. Oliver D, Healey F, Haines TP.

Preventing falls and fall-related injuries

in hospitals. Clin Geriatr Med

26(4):645–92. 2010.

31. Chiarelli PE, Mackenzie LA,

Osmotherly PG. Urinary incontinence

is associated with an increase in falls:

A systematic review. Aust J Physiother

55(2):89–95. 2009.

32. Parsons JK, Mougey J, Lambert L, Wilt

TJ, Fink HA, Garzotto M, et al. Lower

urinary tract symptoms increase the risk

of falls in older men. BJU Int

104(1):63–8. 2009.

33. Gotoh M, Matsukawa Y, Yoshikawa Y,

Funahashi Y, Kato M, Hattori R.

Impact of urinary incontinence on the

psychological burden of family

caregivers. Neurourol Urodyn

28(6):492–6. 2009.

34. Collins JW, Wolf L, Bell J, Evanoff B.

An evaluation of a ‘‘best practices’’

musculoskeletal injury prevention

program in nursing homes. Inj Prev

10(4):206–11. 2004.

35. Durrant J, Snape J. Urinary

incontinence in nursing homes for older

people. Age Ageing 32(1):12–8. 2003.

36. Dobbs D, Meng H, Hyer K, Volicer L.

The influence of hospice use on

nursing home and hospital use in

assisted living among dual-eligible

enrollees. J Am Med Dir Assoc

13(2):189.e9–189.e13. 2012.

37. Morrison A, Levy R. Fraction of

nursing home admissions attributable to

urinary incontinence. Value Health

9(4):272–4. 2006.

38. Friedman SM, Steinwachs DM,

Rathouz PJ, Burton LC, Mukamel DB.

Characteristics predicting nursing home

admission in the program of

all-inclusive care for elderly people.

Gerontologist 45(2):157–66. 2005.

39. Isaacs B, Gunn J, McKechan A,

McMillan I, Neville Y. The concept of

pre-death. Lancet 1(7709):1115–8.

1971.

40. Sandvik H, Espuna M, Hunskaar S.

Validity of the incontinence severity

index: Comparison with pad-weighing

tests. Int Urogynecol J Pelvic Floor

Dysfunct 17(5):520–4. 2006.

41. Rockwood TH, Church JM, Fleshman

JW, Kane RL, Mavrantonis C, Thorson

AG, et al. Patient and surgeon ranking

of the severity of symptoms associated

with fecal incontinence: The fecal

incontinence severity index. Dis Colon

Rectum 42(12):1525–32. 1999.

42. Caffrey C, Sengupta M, Park-Lee E, et

al. Residents living in residential care

facilities: United States, 2010. NCHS

data brief, no 91. Hyattsville, MD:

National Center for Health Statistics.

2012.

43. Report to Congress: Plan to implement

a Medicare skilled nursing facility

value-based purchasing program.

Washington, DC: U.S. Department of

Health and Human Services, Centers

for Medicare & Medicaid Services.

2012. Available from: http://www.cms.gov/

Medicare/Medicare-Fee-for-ServicePayment/SNFPPS/Downloads/SNFVBP-RTC.pdf.
ce definitions by data source

Bladder incontinence Bowel incontinence

Year(s) Population Continent Incontinent Continent Incontinent

2007–201020102007

2009

Noninstitutionalized

persons

Residents of residential

care facilities

Home health and hospice

care patients

Nursing home residents

Person who answered‘‘never’’ to thequestion aboutfrequency ofurinary leakage.

Resident reported as

having an ostomy, anindwelling catheter,or similar device or

with no episode ofurinary incontinenceduring 7 days prior

to the interview.Patient reported as

having a urinarycatheter or with nodifficulty controllinghis or her bladder.

Resident reported as

having an indwellingcatheter or in

complete control ofurinary bladderfunction during14 days prior tothe assessment.

Person who answered

‘‘less than once amonth,’’ ‘‘a few timesa month,’’ ‘‘a few timesa week,’’ or ‘‘every day

and/or night’’ to thequestion about frequencyof urinary leakage.Resident reported as

not having an ostomy,an indwelling catheter,or similar device and with

an episode of urinary

incontinence during 7 days

prior to the interview.Patient reported as nothaving a urinary catheterand with difficulty controllinghis or her bladder.Resident reported as not

having an indwelling catheterand not in complete control ofurinary bladder function during14 days prior to the assessment.

Person who answered

‘‘never’’ to questionsabout frequency ofaccidental leakage of

mucus, liquid stool,

or solid stool.Resident reported as

having an ostomy,an indwelling catheter,or similar device or

with no episode ofbowel incontinenceduring 7 days prior

to the interview.Patient reported as

having a colostomyor ileostomy for bowelelimination or withno difficulty controllinghis or her bowels.Resident reported as

having an ostomy or

in complete control of

bowel movement during

14 days prior to the

assessment.

Person who answered

‘‘2 or more times a day,’’‘‘once a day,’’ ‘‘2 or moretimes a week,’’ ‘‘oncea week,’’ or ‘‘1–3 timesa month’’ to questions

about frequency of

accidental leakage of

mucus, liquid stool, or

solid stool.

Resident reported as

not having an ostomy,an indwelling catheter,or similar device and

with an episode of bowelincontinence during 7 daysprior to the interview.Patient reported as not

having a colostomy or

ileostomy for bowelelimination and withdifficulty controlling hisor her bowels.Resident reported as not

having an ostomy and not

in complete control of bowelmovement during 14 daysprior to the assessment.

Page 14[ Series 3, No. 36
stitutionalized persons aged 65 and over, by selected characteristics: National Health and Nutrition Examination Survey, United States,

1 

of persons

usands)

Urinary leakage or accidental bowel leakage

of mucus, liquid stool, or solid stool2 Urinary leakage3

Accidental bowel leakage of mucus,

liquid stool, or solid stool4

Women Total Men Women Total Men Women Total Men Women

d Standard

Number error

Standard Standard Standard

Percent error Percent error Percent error

Standard

Percent error

Standard

Percent error

Standard

Percent error

Standard Standard Standard

Percent error Percent error Percent error

. . .

21,230

10,768

10,462

16,838

1,899

771

2,138

6,144

10,857

6,0786,157

8,993

9,995

11,235

. . .

. . .

. . .

. . .

. . .

. . .. . .

200

261

308

465268

437365

365

50.9

50.6

48.4

53.6

53.0

40.843.240.9

50.7

51.4

51.049.2

51.949.0

53.5

1.5

1.5

2.0

1.7

1.6

2.43.53.6

2.0

2.1

2.42.2

1.81.9

1.9

38.0

37.5

34.1

42.4

39.6

35.1

†26.4†26.0

38.0

40.0

36.535.4

39.937.2

41.1

1.9

2.0

2.4

2.1

2.2

4.5

†3.8†4.3

3.0

2.8

3.53.2

2.42.1

2.6

61.2

61.2

60.6

61.9

63.6

44.5

57.550.6

58.6

62.2

61.258.2

63.364.0

58.0

2.0

2.0

2.6

2.3

2.2

3.2

4.34.0

2.7

2.5

2.53.2

2.82.6

2.3

43.8

43.5

41.4

46.4

46.0

32.2

35.933.2

43.9

44.3

43.943.7

43.842.1

46.3

1.7

1.7

2.0

1.8

1.8

2.2

3.23.5

1.9

2.3

2.42.3

1.91.9

2.1

29.9

29.4

26.0

34.1

30.6

†30.4

**

28.9

31.8

29.327.9

30.929.9

30.3

2.0

2.1

2.4

2.3

2.3

†4.3

**

2.7

3.2

2.83.1

2.72.2

3.2

54.8

54.8

54.3

55.4

58.333.449.043.0

53.3

56.0

54.054.2

56.058.1

52.0

2.1

2.1

2.7

2.6

2.23.54.94.0

3.0

2.6

3.13.3

2.62.4

2.4

17.3

17.2

16.7

17.9

17.8

†15.3†16.4†13.7

18.1

17.0

18.014.2

18.716.9

17.5

1.1

1.1

1.4

1.3

1.3

†1.6†3.2†2.2

2.1

1.3

1.91.2

1.81.4

1.8

14.9

14.7

13.7

16.2

15.8

***

†14.9

15.8

†11.6

†14.1

16.814.3

†16.8

1.3

1.3

1.6

1.8

1.6

***

†2.7†1.7†2.2†1.5

2.01.3

†2.6

19.2

19.2

19.2

19.2

19.4

†17.1

**

20.018.222.6

†14.2

20.620.117.7

1.4

1.5

1.9

1.8

1.7

†2.4

**

2.41.82.4

†1.5

2.72.12.2

0 and 59).

ecision.

65 and over. The population estimates by sex, age, and race and ethnicity are calculated by combining populations for NHANES 2007–2008 and NHANES 2009–2010. The population estimates by

calculated by multiplying the weighted percentage of NHANES 2007–2010 participants in the category by the population.

leakage that consisted of mucus, liquid stool, or solid stool.

asked, ‘‘How often do you have urinary leakage?’’ Those who answered ‘‘never’’ are defined as continent. Persons with unknown bladder incontinence status are excluded (15.4% in 2007–2010).

sted of mucus, liquid stool, or solid stool. Respondents were asked, ‘‘How often during the past 30 days have you had any amount of accidental bowel leakage that consisted of mucus? ...of liquid

all three questions are defined as continent. Persons with unknown bowel incontinence status are excluded (16.8% in 2007–2010).

ng two age groups: 65–74 and 75 and over.

separately and missing or unknown responses for poverty level, education, and marital status.

high school equivalency diploma.

on Examination Survey.

poverty

stool?

Series 3, No. 36[ Page 15
Page 16 [ Series 3, No. 36

Table 3. Age-adjusted percentage with bladder

sex: National Health and Nutrition Examination

incontinence among noninstitutionalized

Survey, United States, 2007–2010

persons aged 65 and over, by severity level and

Total Men Women

Severity of bladder incontinence1,2 Percent3

Standard

error Percent3

Standard

error Percent3

Standard

error

4 Slight, moderate, severe, very severe . . .

Moderate, 5 severe, very severe ........ 6 Severe, very severe ..............

43.8

24.0

8.1

1.7

1.5

0.8

29.9

13.2

†

3.1

2.0

1.1

†

0.5

54.8

32.5

11.9

2.1

2.0

1.4

† Estimate of low reliability (sample size between 30 and 59).

1Defined as a leakage of urine. Respondents were asked, ‘‘How often do you have urinary leakage?’’ Those who answered ‘‘never’’

incontinence status are excluded (15.4% in 2007–2010).

2Assessed by incontinence severity index (ISI, Sandvik 1999) and categorized as mutually exclusive categories of slight (ISI values

very severe (ISI value 12).

3Age-adjusted to the 2000 standard population using two age groups: 65–74 and 75 and over.

4ISI values of 1–12.

5ISI values of 3–12.

6ISI values of 8–12.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

are defined as continent. Persons with unknown

1 and 2), moderate (ISI values 3–6), severe (ISI

bladder

values 8–9), and
Series 3, No. 36

[ Page 17

nence among noninstitutionalized persons aged 65 and over, by selected characteristics: National Health and Nutrition Examination Survey,

er incontinence1 Percentage with slight Percentage with moderate Percentage with severe or very severe

score (ISI scale)2,3 incontinence on ISI scale4 incontinence on ISI scale4 incontinence on ISI scale4

Men Women Total Men Women Total Men Women Total Men Women

Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard

ean error Mean error Percent error Percent error Percent error Percent error Percent error Percent error Percent error Percent error Percent error

.0 0.1 2.3 0.1 19.8 1.0 16.7 1.3 22.3 1.7 15.9 1.2 10.1 1.0 20.7 1.7 8.1 0.8 †3.1 †0.5 11.9 1.4

.9 0.1 2.3 0.1 19.9 1.0 16.5 1.3 22.5 1.8 15.9 1.2 9.9 1.0 20.7 1.8 7.7 0.9 †2.9 †0.5 11.6 1.4

.7 0.1 2.0 0.1 20.8 1.4 15.5 1.7 25.3 2.5 16.0 1.8 9.2 1.4 21.8 2.7 4.6 0.6 * * †7.2 †1.1

.2 0.1 2.7 0.2 18.6 1.3 18.1 1.8 19.1 1.6 15.9 1.4 11.1 1.4 19.4 1.8 11.9 1.3 †2.9 †0.5 16.9 2.0

.9 0.1 2.4 0.2 21.2 1.2 17.5 1.4 24.2 2.1 16.7 1.4 10.0 1.3 21.9 1.9 8.2 1.0 * * 12.2 1.6

.1 0.3 1.5 0.2 †12.2 †1.2 * * †11.9 †1.8 †14.1 †1.7 * * * * * * * * * *

.7 0.2 2.5 0.3 †12.5 †1.6 * * * * †14.5 †3.1 * * †21.4 †4.7 * * * * * *

.6 0.1 2.4 0.2 †11.2 †2.3 * * * * †11.4 †2.7 * * * * †10.6 †1.5 * * †15.8 †2.6

.9 0.1 2.4 0.2 18.4 1.9 †15.1 †2.6 20.4 3.0 16.9 1.6 †10.9 †1.8 20.7 2.5 8.7 1.0 * * †12.2 †1.8

.0 0.1 2.2 0.2 21.4 1.4 18.5 2.0 24.1 2.4 15.7 1.5 10.1 1.4 21.0 2.3 7.2 1.2 * * †10.9 †1.8

.0 0.1 2.7 0.2 14.7 1.3 14.3 1.9 14.8 1.9 19.8 1.9 †12.6 †2.2 24.7 2.4 9.4 1.1 * * 14.5 1.6

.0 0.2 2.2 0.2 18.4 1.4 †15.2 †2.3 20.5 2.4 17.7 1.4 * * 23.7 2.0 †7.6 †1.1 * * †10.0 †1.9

.9 0.1 2.2 0.2 23.2 1.7 18.5 2.3 28.0 3.2 13.0 1.4 †9.4 †1.1 16.3 2.4 7.6 1.0 * * †11.7 †1.9

.0 0.1 2.2 0.2 20.2 1.1 16.4 1.4 24.9 2.0 15.9 1.6 10.4 1.2 23.1 2.7 5.9 0.7 * * †9.7 †1.7

.0 0.1 2.4 0.2 19.2 1.8 †17.6 †2.3 20.0 2.4 16.5 1.5 †9.2 †1.6 19.1 1.9 10.6 1.2 * * 13.0 1.5

0 and 59).

ecision.

asked, ‘‘How often do you have urinary leakage?’’ Those who answered ‘‘never’’ are defined as continent. Persons with unknown bladder incontinence status are excluded (15.4% in 2007–2010).

ntinence severity index (ISI, Sandvik 1999).

tinent are included in the calculation.

mutually exclusive categories of slight (ISI values 1 and 2), moderate (ISI values 3–6), severe (ISI values 8–9), and very severe (ISI value 12).

ng two age groups: 65–74 and 75 and over.

separately and missing or unknown responses for poverty level, education, and marital status.

high school equivalency diploma.

on Examination Survey.
ns

aged 65 and over living in state-regulated residential care facilities, by selected characteristics: National Survey of Residential Care

of residents1

ousands) Urinary and/or bowel2 incontinence Urinary3 incontinence Bowel4 incontinence

Women Total Men Women Total Men Women Total Men Women

d Standard

Number error

Standard Standard Standard

Percent error Percent error Percent error

Standard Standard Standard

Percent error Percent error Percent error

Standard Standard Standard

Percent error Percent error Percent error

. . .

476.9

. . .7.4

39.039.9

1.30.9

36.137.4

1.91.4

41.140.8

1.71.0

36.638.5

1.30.9

32.735.5

1.91.4

39.439.6

1.71.0

20.420.9

1.00.7

21.422.0

1.71.2

20.120.5

1.30.8

35.5

143.2298.2

2.3

4.66.3

38.9

38.640.7

2.2

1.41.1

33.8

39.237.4

3.3

2.51.9

42.8

38.341.7

3.1

1.61.2

35.9

37.239.5

2.2

1.41.1

29.2

37.036.4

3.2

2.41.9

40.9

37.340.6

3.0

1.61.2

19.2

22.520.4

1.7

1.10.8

18.8

25.820.6

2.7

2.21.6

19.5

21.220.3

2.2

1.30.9

456.6

12.2

7.41.4

39.533.2

1.44.4

36.2

†33.2

2.1

†6.3

41.9

†33.7

1.9

†5.8

36.9

32.4

1.4

4.4

32.4

†33.2

2.0

†6.3

40.2

†32.3

1.9

†5.8

20.9

†14.1

1.1

†2.6

21.7

*

1.8

*

20.7

*

1.4

*

241.5157.5

6.2

5.4

40.4

40.1

1.8

2.2

38.6

36.9

2.9

3.3

41.4

42.6

2.4

3.0

38.2

38.1

1.8

2.2

34.8

34.4

2.8

3.2

40.1

41.1

2.4

3.0

22.1

18.9

1.5

1.6

21.1

22.4

2.4

2.6

22.9

16.7

1.9

1.8

38.6

432.0

2.3

7.1

51.5

36.7

3.7

1.3

48.8

32.7

5.1

2.1

54.2

39.2

5.2

1.8

48.7

34.4

3.7

1.3

43.4

29.9

5.1

2.0

53.5

37.3

5.2

1.8

35.1

17.9

3.5

1.0

37.7

17.3

5.0

1.5

33.0

18.5

4.7

1.4

ecision.

ncluding those with a catheter or ostomy (about 2.2%, standard error 0.4 among RCF

el incontinence during the last 7 days and not using a catheter or having an ostomy.

nence during the last 7 days and not using a catheter or having a urostomy.

ence during the last 7 days and not having a colostomy or ileostomy.

ng three age groups: 65–74, 75–84, and 85 and over.

and missing or unknown responses for education and marital status.

ntial Care Facilities, 2010.

residents). Residents with unknown bladder or bowel incontinence status are excluded (less than 1% in 2010).

Page 18[ Series 3, No. 36
health care patients aged 65 and over, by selected characteristics: National Home and Hospice Care Survey, United States, 2007

of patients

usands)1 Difficulty controlling bladder and/or bowels2 Difficulty controlling bladder3 Difficulty controlling bowels4

Women Total Men Women Total Men Women Total Men Women

d Standard

Number error

Standard Standard Standard

Percent error Percent error Percent error

Standard Standard Standard

Percent error Percent error Percent error

Standard Standard Standard

Percent error Percent error Percent error

. . .

686.1

. . .

41.6

45.4

48.8

2.7

2.5

35.9

39.3

2.7

2.7

50.1

53.1

3.4

3.0

40.2

44.3

2.6

2.5

27.6

32.4

2.5

2.7

46.5

49.8

3.3

3.0

14.2

16.0

1.2

1.3

15.0

16.2

2.0

1.8

13.8

15.9

1.6

1.5

170.8

285.7229.6

15.6

21.716.7

41.9

46.457.4

3.5

3.03.0

32.2

35.951.6

4.1

4.14.7

47.0

51.559.6

4.6

3.43.6

36.2

43.652.0

3.3

2.93.1

22.3

30.945.0

3.8

4.04.7

43.4

49.654.6

4.5

3.43.7

13.1

14.120.8

1.8

1.72.1

†14.8

13.421.9

†3.2

2.53.7

12.2

14.420.4

2.4

2.02.5

565.2107.1

36.9

14.3

46.6

43.4

3.0

4.8

36.3

†38.6

3.1

†6.8

51.6

46.2

3.7

6.1

41.2

38.2

2.8

5.2

27.2

†32.6

2.8

†6.4

48.2

41.5

3.6

6.1

15.0

13.0

1.5

2.4

15.7

*

2.3

*

14.8

†12.1

1.8

†3.2

154.0430.4

12.829.6

40.449.9

3.23.5

34.535.9

3.54.3

46.953.4

4.54.1

34.145.1

2.93.6

26.327.4

3.14.2

42.749.6

4.24.1

14.714.4

1.91.7

15.1

†15.3

2.6

†3.4

14.2

14.1

2.4

2.0

ecision.

ed 65 and over, including those with a catheter or ostomy (15.7%, standard error

d not using a catheter) or bowels (and not having a colostomy or ileostomy).

d not using a catheter.

not having a colostomy or ileostomy.

ng three age groups: 65–74, 75–84, and 85 and over.

and missing or unknown responses for marital status.

e Care Survey, 2007.

1.9 among men; 10%, standard error 1.7 among women). Patients with unknown bladder or bowel incontinence status are

Series 3, No. 36[ Page 19
e stay among hospice discharges aged 65 years and over, by selected characteristics: National Home and Hospice Care Survey, United States,

of patients

usands)1 Difficulty controlling bladder and/or bowels2 Difficulty controlling bladder3 Difficulty controlling bowels4

Women Total Men Women Total Men Women Total Men Women

d Standard

Number error

Standard Standard Standard

Percent error Percent error Percent error

Standard Standard Standard

Percent error Percent error Percent error

Standard Standard Standard

Percent error Percent error Percent error

. . .

493.3

. . .

24.0

62.1

68.6

2.2

1.6

60.9

64.1

3.1

2.6

62.9

72.0

3.0

1.9

36.0

44.6

2.1

1.6

36.6

39.9

2.8

2.3

34.7

48.2

2.5

2.0

49.0

57.2

2.6

2.1

46.6

52.6

3.2

2.9

51.3

60.7

3.5

2.3

78.1

154.6

260.6

9.1

10.9

17.1

57.4

64.2

76.1

3.4

2.6

2.0

58.2

61.7

70.0

5.2

3.8

3.9

56.6

66.6

79.4

4.8

3.3

2.3

32.7

39.6

53.0

3.1

2.4

2.3

36.8

37.3

44.6

4.8

3.1

3.8

28.1

41.9

57.5

3.9

3.4

2.7

47.6

54.1

63.2

3.5

2.7

2.6

45.2

50.9

58.8

5.1

3.8

4.3

50.3

57.4

65.6

5.0

3.5

2.9

462.0

22.9

23.2

5.1

62.1

63.2

2.2

7.3

60.4

62.2

3.3

9.4

63.6

59.7

3.1

10.6

35.8

37.8

2.2

7.4

36.7

†35.8

3.0

†9.5

34.5

36.5

2.6

9.8

48.4

58.1

2.6

7.1

45.3

56.4

3.3

8.9

51.2

57.5

3.7

10.5

98.6

359.5

8.1

21.0

60.562.2

3.03.0

59.063.8

3.65.0

63.960.7

4.84.1

34.537.7

2.52.8

35.139.2

3.25.1

33.435.9

3.93.4

49.250.4

3.13.3

47.546.5

3.65.3

52.651.7

5.14.3

and over, including those with a catheter or ostomy (about 40% among men

d not using a catheter) or bowels (and not having a colostomy or ileostomy).

d not using a catheter.

not having a colostomy or ileostomy.

ng three age groups: 65–74, 75–84, and 85 and over.

and missing or unknown responses for marital status.

e Care Survey, 2007.

and women). Discharges with unknown bladder or bowel incontinence status are excluded (2.7% in 2007).

Page 20[ Series 3, No. 36
ce among home health care patients aged 65 and over, by residence: National Home and Hospice Care Survey, United States, 2007

Number of patients (in thousands)1 Difficulty controlling bladder and/or bowels2 Difficulty controlling bladder3 Difficulty controlling bowels4

Private home

or apartment

RCF or

nursing home

Private home RCF or

or apartment nursing home

Private home RCF or

or apartment nursing home

Private home RCF or

or apartment nursing home

Standard

mber error

Standard

Number error

Standard Standard

Percent error Percent error

Standard Standard

Percent error Percent error

Standard Standard

Percent error Percent error

. . .

05.1

. . .

49.1

. . .

91.7

. . .

10.7

44.5

47.5

2.8

2.6

63.1

63.9

6.7

5.1

40.0

43.5

2.7

2.6

58.0

55.3

6.5

5.4

12.9

14.0

1.1

1.1

32.7

36.3

7.1

5.2

44.6

89.2

71.3

18.726.2

18.5

*

34.7

44.0

*

6.6

6.6

40.7

46.2

55.5

3.7

3.0

3.2

*

49.8

72.4

*

9.3

5.7

34.8

44.0

50.6

3.4

3.1

3.3

*

38.5

63.3

*

7.9

6.6

12.1

12.5

17.7

1.7

1.7

2.0

*

*

41.2

*

*

7.3

80.6

24.5

20.040.6

35.256.5

5.67.5

34.049.4

2.73.5

54.071.5

11.1

6.6

26.7

46.4

2.4

3.5

47.3

67.7

10.9

6.4

13.3

12.7

2.1

1.4

*

36.1

*

10.8

ecision.

cluding those with a catheter or ostomy (15.7%, standard error 1.9 among men;

d not using a catheter) or bowels (and not having a colostomy or ileostomy).

d not using a catheter.

not having a colostomy or ileostomy.

ng three age groups: 65–74, 75–84, and 85 and over.

e Care Survey, 2007.

10%, standard error 1.7 among women). Patients with unknown bladder or bowel incontinence status are excluded (1.4% in

Series 3, No. 36[ Page 21
ce among hospice patients aged 65 and over, by place of residence at the end of hospice care: National Home and Hospice Care Survey,

atients (in thousands)1 Difficulty controlling bladder and/or bowels2 Difficulty controlling bladder3 Difficulty controlling bowels4

Hospital,

RCF or residential

rsing home hospice

Hospital,

Private home RCF or residential

or apartment nursing home hospice

Hospital,

Private home RCF or residential

or apartment nursing home hospice

Hospital,

Private home RCF or residential

or apartment nursing home hospice

Standard Standard

mber error Number error

Standard Standard Standard

Percent error Percent error Percent error

Standard Standard Standard

Percent error Percent error Percent error

Standard Standard Standard

Percent error Percent error Percent error

. . .

4.5

. . .

19.0

. . .

153.4

. . .

15.2

53.1

58.4

2.7

2.2

77.0

82.4

4.5

2.1

74.1

74.2

3.9

3.2

35.8

39.9

2.2

2.0

50.9

62.9

6.4

3.2

26.4

26.3

3.9

3.0

41.2

45.9

2.7

2.4

66.3

69.3

5.2

3.0

69.8

69.6

4.2

3.8

0.1

7.8

6.6

4.2

8.0

14.1

32.1

54.9

66.3

5.3

8.0

7.6

48.7

54.2

68.5

4.4

3.4

3.1

71.7

82.4

83.6

8.0

3.7

2.4

76.1

70.2

76.6

6.0

5.5

4.9

32.6

36.1

48.1

3.6

3.0

3.5

43.6

55.5

68.8

10.8

4.7

3.4

25.9

27.4

25.7

6.1

5.7

4.9

37.7

41.4

55.4

4.3

3.4

3.4

61.1

73.3

68.5

8.7

4.3

3.6

70.5

68.8

69.9

6.3

5.6

5.3

6.7

7.8

8.2

15.2

68.1

85.3

9.6

9.1

50.7

55.4

3.6

3.7

79.7

73.3

6.3

7.3

77.9

70.3

5.5

5.3

35.3

35.8

3.2

3.2

55.8

44.3

7.3

7.2

28.0

24.8

6.2

4.5

38.0

44.7

3.4

3.9

64.2

67.7

7.8

7.6

72.5

66.9

5.9

5.5

and over, including those with a catheter or ostomy (about 40% among men

d not using a catheter) or bowels (and not having a colostomy or ileostomy).

d not using a catheter.

not having a colostomy or ileostomy.

ng three age groups: 65–74, 75–84, and 85 and over.

e Care Survey, 2007.

and women). Discharges with unknown bladder or bowel incontinence status are excluded (2.7% in 2007).

Page 22[ Series 3, No. 36
Series 3, No. 36 [ Page 23

Table 10. Incontinence among nursing home residents aged 65 and over, by selected characteristics: Long Term Care Minimum Data Set,

United States, 2009

Number of Residents not in complete

residents1 control of urinary bladder Residents not in complete Residents not in complete control

(in thousands) function or bowel movement2 control of urinary bladder function3 of bowel movement4

Short­ Long­ Short­ Long­ Short­ LongAll term5 term6 All term5 term6 All term5 term6

Short- LongCharacteristic term5 term6 Percent Percent Percent

65 and over, age-adjusted7,8 ...... . . . . . . 57.5 46.1 75.8 49.6 36.7 70.3 43.4 33.1 60.0

65 and over, crude8 ........... 1,356.3 1,060.4 64.3 52.3 79.8 56.8 42.4 75.4 48.3 37.3 62.2

Age

65–74 .................... 271.9 150.9 51.5 40.2 72.0 43.4 31.1 65.5 39.2 29.1 57.4

75–84 .................... 531.2 339.2 61.4 50.0 79.4 53.6 40.3 74.4 46.1 35.5 62.9

85 and over................. 553.2 570.3 71.4 60.3 82.2 64.4 49.9 78.5 53.3 43.2 63.2

Sex

Men 7,8 aged 65 and over ........ 472.7 282.6 57.1 48.1 72.3 47.0 36.5 64.9 45.2 37.1 59.1

65–74 ................... 112.6 68.2 52.0 42.3 68.1 42.6 31.7 60.6 41.7 33.0 56.0

75–84 ................... 194.6 106.6 61.0 52.4 76.6 50.5 40.2 69.2 48.2 40.1 62.9

85 and over ............... 165.5 107.8 67.3 60.2 78.1 56.1 46.5 70.8 52.0 45.7 61.8

Women 7,8 aged 65 and over ...... 883.3 777.8 57.6 44.9 78.1 50.8 36.7 73.5 42.1 30.6 60.7

65–74 ................... 159.3 82.7 51.2 38.7 75.2 44.0 30.7 69.6 37.3 26.3 58.5

75–84 ................... 336.5 232.6 61.7 48.6 80.6 55.2 40.3 76.7 45.1 32.8 62.8

85 and over ............... 387.6 462.5 72.8 60.4 83.1 67.1 51.4 80.3 53.8 42.1 63.5

Race/ethnicity7

Non-Hispanic white ............ 1,164.9 870.5 56.0 44.9 75.5 48.1 35.6 69.8 41.1 31.2 58.5

Non-Hispanic black ............ 109.4 123.9 66.7 55.5 78.7 58.6 44.8 73.1 55.8 45.4 66.9

Hispanic ................... 47.8 42.0 59.4 49.1 73.9 51.6 38.9 69.1 49.6 40.2 62.8

Education7

Unknown .................. 63.3 440.5 76.5 64.5 72.4 70.7 54.0 73.2 62.0 53.0 63.4

No high school diploma ......... 300.9 213.2 58.5 50.3 74.9 50.3 40.2 67.2 44.0 36.7 56.3

High school ................. 588.5 266.0 53.2 45.3 75.4 44.7 35.8 68.9 39.0 32.1 58.1

Some college or more .......... 403.5 140.7 49.4 42.2 78.3 41.0 33.2 68.8 35.8 29.4 59.1

Marital status7

Married ................... 437.1 189.9 56.2 47.1 82.2 46.4 36.2 75.0 43.7 34.7 69.0

Not married ................. 875.6 815.8 57.3 44.7 73.8 50.3 36.0 68.7 42.4 31.2 57.0

. . . Category not applicable.

1Nursing home residents aged 65 and over, including those with a catheter or ostomy (17% among short-stay and 9.5% among long-stay residents). Persons with unknown bladder or bowel

incontinence status are excluded (less than 1% in 2009).

2Defined as having at least one incontinence episode in the past 14 days or ostomy leaking a stool or urostomy leaking urine. Estimates for bladder incontinence exclude those with an indwelling

catheter but may include those with another type of catheter leaking urine.

3Defined as having at least one bladder incontinence episode in the past 14 days and not having an indwelling catheter. Estimates for bladder incontinence may include persons with other types of

catheters or a urostomy leaking urine.

4Defined as having at least one bowel incontinence episode in the past 14 days, including an ostomy device leaking stool.

5Residents with a length of stay of 100 days or fewer. The data are for those with admission or first quarterly review assessments only or with a length of stay of no more than 100 days.

6Residents with a length of stay of more than 100 days. The data are for those with annual or quarterly review assessments after the first 100 days of the stay.

7Age-adjusted to the 2000 standard population using age groups: 65–74, 75–84, and 85 and over.

8Includes other racial and ethnic groups not shown separately and missing or unknown responses for education, and marital status.

SOURCE: Centers for Medicare & Medicaid, Long Term Care Minimum Data Set, Version 2.0.
Page 24 [ Series 3, No. 36

Appendix. Technical Notes

The data sources used in this report

are described briefly below.

National Health and

Nutrition Examination

Survey

Description: Designed to assess the

health and nutritional status of the U.S.

noninstitutionalized civilian population

through direct physical examinations,

laboratory tests, and interviews. The

interview includes demographic,

socioeconomic, dietary, and healthrelated questions. The examination

component consists of medical, dental,

and physiological measurements, as well

as laboratory tests administered by

highly trained medical personnel.

Source and contact information:

Centers for Disease Control and

Prevention, National Center for Health

Statistics, http://www.cdc.gov/nchs/

nhanes.htm.

National Survey of

Residential Care Facilities

Description: Designed to produce a

general database on residential care

facilities, their residents, and staff

members. It is a first-ever survey of

residential care providers including

assisted living residences; board and

care homes; congregate care-enriched

housing programs; homes for the aged;

personal care homes; and shared

housing establishments that are licensed,

registered, listed, certified, or otherwise

regulated by a state. Data are collected

on facility characteristics, such as size,

ownership, staffing, certification status,

and services provided; and resident

demographics, health and functional

status, involvement in activities, services

used, and charges.

In-person interviews were

conducted with residential care

administrators, caregivers, and staff

members.

Source and contact information:

Centers for Disease Control and

Prevention, National Center for Health

Statistics, http://www.cdc.gov/nchs/

nsrcf.htm.

National Home and

Hospice Care Survey

Description: Designed to provide

descriptive information on home health

and hospice care agencies, their staff

members, their services, and their

patients. Data are collected on

demographic characteristics of home

health care patients and hospice

discharges, services received, length of

time since admission, diagnoses,

medications taken, advance directives,

and other items.

Source and contact information:

Centers for Disease Control and

Prevention, National Center for Health

Statistics, http://www.cdc.gov/nchs/

nhhcs.htm.

Long Term Care Minimum

Data Set, Version 2.0

Description: Standardized, primary

screening and assessment tool of health

status for comprehensive assessment for

all residents of long-term care facilities

certified to participate in Medicare or

Medicaid. The Minimum Data Set

(MDS) contains data on resident

demographics; and physical,

psychological, and psychosocial

functioning. The MDS plays a key role

in the Medicare and Medicaid

reimbursement system and in monitoring

the quality of care provided to nursing

facility residents.

Source and contact information:

Centers for Medicare & Medicaid

Services, http://www.resdac.org/cmsdata/files/mds-2.0.
Vital and Health Statistics

Series Descriptions

ACTIVE SERIES

Series 1.	 Programs and Collection Procedures—This type of report

describes the data collection programs of the National Center

for Health Statistics. Series 1 includes descriptions of the

methods used to collect and process the data, definitions, and

other material necessary for understanding the data.

Series 2.	 Data Evaluation and Methods Research—This type of

report concerns statistical methods and includes analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. Also included are

experimental tests of new survey methods, comparisons of

U.S. methodologies with those of other countries, and as of

2009, studies of cognition and survey measurement, and final

reports of major committees concerning vital and health

statistics measurement and methods.

Series 3.	 Analytical and Epidemiological Studies—This type of

report presents analytical or interpretive studies based on vital

and health statistics. As of 2009, Series 3 also includes

studies based on surveys that are not part of continuing data

systems of the National Center for Health Statistics and

international vital and health statistics reports.

Series 10.	 Data From the National Health Interview Survey—This

type of report contains statistics on illness; unintentional

injuries; disability; use of hospital, medical, and other health

services; and a wide range of special current health topics

covering many aspects of health behaviors, health status, and

health care utilization. Series 10 is based on data collected in

this continuing national household interview survey.

Series 11.	 Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

In this type of report, data from direct examination, testing,

and measurement on representative samples of the civilian

noninstitutionalized population provide the basis for (1)

medically defined total prevalence of specific diseases or

conditions in the United States and the distributions of the

population with respect to physical, physiological, and

psychological characteristics, and (2) analyses of trends and

relationships among various measurements and between

survey periods.

Series 13.	 Data From the National Health Care Survey—This type of

report contains statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

Series 20.	 Data on Mortality—This type of report contains statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

Series 21.	 Data on Natality, Marriage, and Divorce—This type of

report contains statistics on natality, marriage, and divorce

that are not included in regular, annual, or monthly reports.

Special analyses by health and demographic variables and

geographic and trend analyses are included.

Series 23.	 Data From the National Survey of Family Growth—These

reports contain statistics on factors that affect birth rates,

including contraception and infertility; factors affecting the

formation and dissolution of families, including cohabitation,

marriage, divorce, and remarriage; and behavior related to

the risk of HIV and other sexually transmitted diseases.

These statistics are based on national surveys of women and

men of childbearing age.

DISCONTINUED SERIES

Series 4.	 Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents. The last Series 4 report was

published in 2002. As of 2009, this type of report is included

in Series 2 or another appropriate series, depending on the

report topic.

Series 5.	 International Vital and Health Statistics Reports—This

type of report compares U.S. vital and health statistics with

those of other countries or presents other international data of

relevance to the health statistics system of the United States.

The last Series 5 report was published in 2003. As of 2009,

this type of report is included in Series 3 or another series,

depending on the report topic.

Series 6.	 Cognition and Survey Measurement—This type of report

uses methods of cognitive science to design, evaluate, and

test survey instruments. The last Series 6 report was

published in 1999. As of 2009, this type of report is included

in Series 2.

Series 12.	 Data From the Institutionalized Population Surveys—

The last Series 12 report was published in 1974. Reports

from these surveys are included in Series 13.

Series 14.	 Data on Health Resources: Manpower and Facilities—

The last Series 14 report was published in 1989. Reports on

health resources are included in Series 13.

Series 15.	 Data From Special Surveys—This type of report contains

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics. The last

Series 15 report was published in 2002. As of 2009, reports

based on these surveys are included in Series 3.

Series 16.	 Compilations of Advance Data From Vital and Health

Statistics—The last Series 16 report was published in 1996.

All reports are available online, and so compilations of

Advance Data reports are no longer needed.

Series 22.	 Data From the National Mortality and Natality Surveys—

The last Series 22 report was published in 1973. Reports

from these sample surveys, based on vital records, are

published in Series 20 or 21.

Series 24.	 Compilations of Data on Natality, Mortality, Marriage, and

Divorce—The last Series 24 report was published in 1996.

All reports are available online, and so compilations of reports

are no longer needed.

For answers to questions about this report or for a list of reports published

in these series, contact:

Information Dissemination Staff
 

National Center for Health Statistics
 

Centers for Disease Control and Prevention
 

3311 Toledo Road, Room 5419
 

Hyattsville, MD 20782
 

Tel: 1–800–CDC–INFO (1–800–232–4636)
 

TTY: 1–888–232–6348
 

Internet: http://www.cdc.gov/nchs
 

Online request form: http://www.cdc.gov/cdc-info/
 

requestform.html

For e-mail updates on NCHS publication releases, subscribe

online at: http://www.cdc.gov/nchs/govdelivery.htm.
U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

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DHHS Publication No. 2014–1420, Series 3, No. 36

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