I

NATIONAL CENTER Series 2

For HEALTH STATISTICS Numbers

VITAL and HEALTH STATISTICS

DATA EVALUATION AND METHODS RESEARCH

Reporting of Hospitalization

in the Health Interview Survey

A methodological study of several factors affecting

the reporting of hospital episodes.

DHEW Publication No. (HSM) 73-1261

Washington, D.C. July 1965

U.S. DEPARTMENT OF

HEALTH, EDUCATION , AND WELFARE Public Health Service

Anthony J. Celebrezze Luther L. Terry

Secretary Surgeon Genera I
-——

,/

/

This report was originally published in the series “Health Statistics

from the U.S. National Health Survey.” which has since ken replaced

by the “Vital and Health Statistics” series. It presents findings from

a methodological stlldy pertaining to improved techniques in data

collection in the HeAth Interview Survey. Because this material is of

continuing importance, and is relevant to data currently being released

from the Survey, the report is being reprinted in its present form.

Public HeaIth Service Publication No. 1000-Series 2-No. 6
NATIONAL CENTER FOR HEALTH STATISTICS

FORREST E. LINDER, PH. D., Director

THEODORE D. WOOLSEY, Deputy Director

OSWALD K. SAGEN, PH. D., ~ffhtant Director

WALT R. SIMMONS, M. A., ~tatistkaz ~duifor

ALICE M. WATERHOUSE, M. D., Medical Advisor

JAMES E, KELLY, D.D.S., Dental Advisor

LOUIS R. STOLCIS, M.A., ~xecutive oficer

OFFICE OF HEALTH STATISTICS ANALYSIS

IWAO M. MORIYAMA, PH. D., Chief

DIVISION OF VITAL STATISTICS

ROBERTD. GROVE, PH. D., Chief

DIVISION OF HEALTH INTERVIEW STATISTICS

PHILXPS. LAWRENCE, Sc. D., ClziC-f

DIVISION OF HEALTH RECORDS STATISTICS

MONROE G. SIRKEN, PH. D., Chief

D1V1S1ONOF HEALTH EXAMINATION STATISTICS

ARTHURJ. MCDOWELL, Chief

DIVISiON OF DATA PROCESSING

SIDNEY BINDER, Chief

COOPERATION OF THE SURVEY RESEARCH CENTER,

THE UNIVERSITY OF MICHIGAN

AND THE BUREAU OF THE CENSUS

Under legislation establishing the National Health Survey, the

Public Health Service is authorized to use, insofar as possible, the

services or facilities of other Federal, State, or private agencies.

Ihe methodological study in this report was performed under a contractual arrangement with the Survey Research Center, Institute for

Social Research, The University of Michigan. The Bureau of the Census

also participated actively in the planning and conduct of the research.

Public Health Service Publication No. 1000-Series 2-No. 6
PREFACE

The outstanding importance of reliable national statistics on hospitalization has led the U. S.

National Health Survey to give high priority to the

problem of securing such statistics. The first step

in this program was taken when plans were being

made for the Health Interview Survey in the fall of

1956. At that time hospitalization was designated

as one of the basic topics with which that Survey

should concern itself.

The Health Interview Survey is one of three

major data collection programs of the U. S. National Health Survey. Based upon sampling of households throughout the United States, it seeks to

gather by means of interviews various types of

health information from which national and regional statistics can be derived. The statistical design and procedures used in the survey are described in detail in two National Health Survey

Publications. l‘ 2 The data collected include illness

and accidental injuries, chronic conditions and impairments, disability, hospitalization, the use of

medical and dental care, and related health topics.

The information about hospitalization experience

is collected by asking about instances when persons in the household were confined to a hospital

overnight or longer within the 12-month period

ending at the beginning of the interview week.

Questions are then asked about each hospital episode, including: month of admission, length of stay

in days, diagnosis, operations performed, and

name and address of the hospital.

Since the questions cover only persons living

in the household at the time of interview, the statistical data developed from the interviews exclude

the experience of persons who would have been

lU. s. Natx onal Health Survey. The Sta.

tlstlcal Design of the Health HouseholdInter view Survey. Hea Ith Statlstlcs. Serlcs A-2. PHS Publlcafion No. 584-AZ. PublJC Health Service. Washangf on, D. C., July

1958.

Zu. s. ?iatzonal Health Survey. Concepts

and De flnlt ions In the Health HouseholdInter vzew Survey. Health Statzsfics. Series

A-3. PHS Publication No. 584-A3. Publlc

Health Servzce. I!ashzngfon, D. C., Sepf ember 1958.

living in the sampled households had they not died

in the year prior to the interview. Amethod of estimating the volume of this hospitalization of decedents has been developed and the report has been

published.s

Paralleling its programs of data collection the

U. S. National Health Sumx y has undertaken to

evaluate the reliability of its own statistics through

a series of research studies. .:ince the hospitalization information was considered to rate high in

importance, plans were made soon after the Health

Interview Survey got under way to test the reliability of reporting of hospital episodes in a series

of contract studies.

The first of these, of a preliminary nature,

made use of data collected in an earlier survey and

laid the groundwork for later studies. The results

were not published.

The second investigation was conducted as a

part of a study with broader objectives. The Health

Insurance Plan of Greater New York (H.I.P.) sampled its enrollees and, for each person in the sample, produced a chronological record of medical

services received from the Plan and of hospitalizations incurred during a period of a year. Interviews were then conducted in the households in

which the sampled enrollees lived. The interview

was the same one being used throughout the Nation

in the Health Interview Survey. Responses in these

interviews were compared with information from

the medical records, thus permitting a direct

measure of the extent of underreporting in this

particular population.

The findings with regard to underrepling of

hospitalization in the study of H.I.P. enrollees are

contained in a forthcoming publication.

Before the study of H.I.P. enrollees was completed plans were made for a study that would include a larger sample of hospitalizations and be

devoted entireIy to problems of reporting of hospital episodes in the Health Interview Survey. For

3U.S. ,~atlo”al Health survey, HosPi tal Utallzation In the Last Year of .L~fe. liealth Statistics. Series D-3. PHS Ptrblxcatlon No. 584- D3. Pub.

Iic Heal th Servzce. Washington, D. C. , JanuarY

1961.
this purpose a contract was made with the Univer -

sit y of Michigan’s Survey Research Center, Institute for Social Research, and this is the study the

results of which are described in the present report.

The relationships between the staff of the U. S.

National Health Survey and the Institute for Social

Research were very close, permitting the Survey

to gain the maximum profit from observation of

the data collection and participation in the analysis. The Bureau of the Census staff, too, concerned

as they are with the quality of data which they are

collecting for the Survey, participated in all phases

of the study. The Bureau’s participation, in ways

which will be described in the report, was also

essential in order to ensure comparability between

the interview results from the study and those obtained in the national survey. Dr. Abbott Ferris

and Mrs. Katherine Capt carried the primary responsibility for the. Bureau of the Census.

Of crucial importance in the present study was

the assistance of Dr. Vergil N. Slee, Director of

the Professional Activity Study of the Commission

on Professional and Hospital Activities, Inc. Arrangements were made by Dr. Slee for the sampling of the discharge records of hospitals participating in the Professional Activity Study (P. A.S.),

and these records formed the main basis of the

criterion source against which interview results

were checked. For those unfamiliar with the nature of the Professional Activity Study a brief description of this useful organization will be found

in Appendix 111of this report.

Also to be found in Appendix III is a list of the

hospitals participating in the P.A.S. which agreed

to allow their records to be used for the study.

Having been assured that the information from the

hospital files would be accorded confidential treatment, 21 of the 23 hospitals selected in the sample

gave their permission. This assistance is gratefully acknowledged.

* * * * *

For the “Developmental and Evaluation Studies” which are carried out at its expense but are

not directly conducted by the National Health Survey, a staff member is assigned for liaison with the

research organization doing the study. In addition

to keeping closely informed on the study progress

and conveying the National Health Survey’s viewpoint in decisions on study methodology, the liaison person edits the final research report for publication in Health Statistics, Series DI. For this

study, Mr. Earl Bryant discharged these responsibilities.
CONTENTS

Page

Preface --------------------------- --------------------------- ---- -

Introduction --------------------------- -----------------------------

Objectives and Scope of the Research -------------------------------

~eStudy &si@-------------------------------------------------

Abstracting Hospital Records --------------------------------------

CodingtheData --------- ------------------ -----------------------

MatchingHospital Record With Interview Report ------- --------------

TheTimeReference ----------------------------------------------

Definitions of Certain Terms Usedin This Report --------------------

Type of Respondent --------------------------- --------------------

Description of the Sample -----------------------------------------

Underreporting Based on a Comparison of Interview Reported and

Hospital Recorded Episodes ---------------------------- --------

Underreporting by ~ and Demographic Characteristics of

Respondents ----------------------------------------------------

Underreporting by Relationships Between Sample Person and

Respondent ---------------------------- -------------------------

Family Relationship ---------------- ---------------------------

Age Comparison --------------------------- --------------------

Sex Comparison----------------J------------------------------

Underreporting by Health Characteristics ---------------------------

Underreporting Basedon Matched Hospital Episcxies -------------------

Underreportingby Length of Stay --------------------------- --------

Underreporting by Diagnostic and Operation Classes -----------------

Underreporting by Time Interval Between Interview and Hospital

Discharge --------------------------- ---------------------------

RelationshipBetween Diagnostic Rating, Length of Stay, and Time

Between Interview and Hospital Discharge -------------------------

The Follow-up Interview --------- -----------------------------------

Inmtiuction ------------------------------------------------------

Underreportingby Characteristics of the Respondents ----------------

Reaction to the Illness and the Hospital Episode ----------------------

Reaction tothe Interview and the Interviewer ------------------------

A Discriminant Analysis of the Follow-up Interview Data -------------

Misreporting Characteristics of Hospitalizations -------- ---------------

Accuracy of Reporting the Length of Stay --------------------------- -

Misreportingof Diagnoses and Operations Causing Hospitalization -----

Appendix I: Partl: Sampling Errors ------------ ------- -------------

Part2: Analysisof Nonresponse -------------------------

Appendix II: Ratingof Diagnoses --------------------- ------- ---------

Rating of Operations --------------------------- ----------

Appendix III: Hospitals Which Co-operatedin the Study -----------------

The Professional Activity Study -------------------------

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1

3

4

4

4

5

5

5

5

8

8

14

14

15

16

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20

20

24

31

36

39

39

40

43

48

50

52

52

54

57

58

60

61

Appendix IV: Forms and Questionnaires Used in the Study -------------- 64
SYMBOLS

Magnitude of the sampling error precludes

showing separate estimates-: ------------- (*)

Percentage is greater than zero but is less

than 0.05 ---------- ------------------ ---- *
REPORTING OF HOSPITALIZATION

in the Health Interview Survey

The follo#ing research report was prepared by the Survey Research Center, Institute for Social

Research, The University of Michigan, unoer contract with the IJ.S. National Health Survey. The

finuin~s ano conclusions are those of the Survey Research Center.

Charles F. Canneil, Pn.0., directea tileproject for the Survey Research Center. He was assist.

eci by Goraon Fisner and Thomas Bakker. (Jrs.CharlotteWinter and Mrs. Doris Muehl helped to develop

coaes and supervised the coding. Leslie Kish, Ph.D., proviaed guidance ano assistance on statistical proolems.

INTRODUCTION

OBJECTIVES AND SCOPE

OF THE RESEARCH

There were three major objectives underlying this research.

1. To obtain estimates oftheamountofunderreportingof hospitalepisodes inhousehold interviews in order to provide a

rough approximation to underreporting in

theU.S.National Health Survey.

2. To analyze the types of hospitalizations

which were underreported andto investigate some of the factors relating tounderreporting.

3. To study some response errors and to

explore factors associated with these errors for hospitalizations which werereported.

As the objectives indicate, this was astudy

ofresponse error. In additionto estimates of the

type andmagnitude ofunderreporting, it included

the studyof some correlatesofunderreporting.

For example, Are the underreports characteristic of particular types of respondents? What

kind of information is most subject tounderreporting? What are some ofthe situations inwhich

underreporting islikelytooccur ?

Unlikemanystudies ofresponseerror which

are concerned with the performance of the interviewer, this study focused on the respondent.

However, many aspects of response error are

clearly the result of complex psychological forces

generated by the interaction between the interviewer and the respmdent. Some of these forces

will be examined in this report.

In this study, as in the National Health Survey household interviews, the respondent was

asked to report the hospitalizations he and other

members of his family experienced during the

year preceding the interview. He mayor may not

have reported the hospital episodes, and the information about those which he did report may

be correct or incorrect, complete or incomplete.

Several reasons can be listed for these inaccuracies ilnd omissions.

The respondent may not have known that a

hospitalization had occurred and therefore could

not report it. For example, he may nothave known

about his father’s hospitalization if his father

only recently went to live with the family. Or the

respmdent may have Imown about his mother-inIaw’s hospitalization but did not know the type of

operation which was performed.

‘The reqxmdent may not have understood

what was wanted in the question or he misunderstood the concept underlying it. Thus when the

interviewer specified that she was talking almut

the year preceding the week of tie interview, the

respondent may have thought of the calendar year,

or his “year of recollection” may have extended

several weeks or even months beyond the actual

year.

The respondent may have once known the information requested km may have forgotten it.

Minor events in the past are easily forgotten.

The respondent may have remembered the

information, but recalled it inaccurately and

therefore

distortion

nificant.ly

curacy.

reported it inaccurately. Perc*al

over time may have diminished sigthe ability to recall the event with ac1
The respondent may have remembered the

information accurately but reported it inaccurately or not at all because it was embarrassing

to him.

Two major variables underlie these potential

sources of error and are given special attention

in this report. These are memory and motivation.

Early experiments in the psychological laboratory demonstrated two principles of memory

which are important to the present study. The

first principle is that memory is better for recent events than for those having a greater time

lapse. The second principle is that events having

a great impact on the person will be remembered

better than those having only a minor impact.

Such principles coincide with ever yday experience.

In terms of this study one would expect hospitalizations occurring close to the date of tie interview to be reported more accurately and more

completely than those occurring earlier. One

would also expect longer or more serious hospitalizations to be reported more completely than

short, less serious ones.

‘lhere are some special cases of these principles in this study. In general, a hospitalization

may be expected to be less important and less

salient to a respondent who is reporting for someone else than when the hospitalization was his

own. A routine appendectomy should have much

more of an impact on the patient than on members

of his family. The patient, if he has had several

hospitalizations, is likely to remember the more

serious and forget the minor.

In general one may expect a “decaying” of

experiences over time, depending upon the seriousness of the event, and the closeness of the

event to the respondent.

But to consider memories as fixed and “lifeless” is unreal and misleading. Memory is an

active, dynamic process which follows predictable patterns.

One of the most important forces in memory

is motivation. There is a tendency to integrate

events into one’s psychological life in such a way

that they fit most comfortably with past experiences and with an image or perception of oneself and one’s world. Numerous experhnents

testify to the selectivity and distortion which

occur in the recollection of an event.

In working on consumer economics, the Survey Research Center found that if one wants to

learn respondents’ current incomes, motivation

is important. Most people know, at least approximately, what their current income iS but whether

or not they will communicate this information

depends on their willingness to do so. If one

wants to know their incomes for past years, the

problem is more difficult. However, willlng they

may be to answer, many will have forgotten and

many will “remember t1 so inaccurately that the

usefulness of the information they offer is severely restricted. Those who do answer tend to

report their earlier financial situation in a more

favorable light.

Memory, in short, is not a simPle Process

by which the events of the present recede uniformly into the past. This kind of decay does

occur, but it is modified by a number of other

factors, including the meaningfulness of the initial experience, the degree to which it was

“learned,” and the interference of other experiences. In addition, the way in which things are

remembered depends upon their congruence with

the individual’s other experience and with his

image of himself. Such factors determine whether

or not we remember at all, and in what systematic ways our recollections differ from events

as they actually occurred.

Thus far the motivational forces which are

closely related .to the psychological life of the

respondent have been discussed. They determine

whether information can be reported accurately.

There is another constellation of motives of a

different type which is also relevant, and which

influences whether the information ——will be reported accurately.

From the most elementary point of view, the

motivational level of the respondent will determine how much effort he is willing to make to

give an accurate report. In order to report accurately the respondent must relive or review

carefully his experience, constantly checking his

own memory, or he must resort to records of the

event. The farther away the event is in time or

the less inprtance it has, the greater the energy

required to recall it. Frequently respondents give

inaccurate information merely to avoid the work

required to respond accurately. Particularly

when the hospital experience has been embarrassing or unpleasant or especially threatening,

either physically or psychologically, the respondent may be unwilling to dwell on the event enough

to be able to report it accurately.

But perhaps a more serious type of problem

occurs when the. motives or goals of the respondent are served better by inaccurate reporting.

For example, the respondent who has been hospitalized for alcoholism, mental disorder, or

venereal disease may not be motivated to report

the hospitalization because of its presumed antisocial nature. Other conditions, such as breast

amputations, reproductive organ disorders, and

the like may be embarrassing to the respondent,

may threaten her self-image, or may be considered too personal to discuss. It is likely that

such hospital episodes will be suppressed.

Suppression refers to the tendency of the

respondent to withhold information which he is

2
able to report because it puts him in an unfavorable light; either because of his self-image or

because of his perceptions of others’ attitudes

toward him.

Information may be suppressed for fear that

disclosure of the information would result in an

unfavorable attitude toward him. Examples of this

are: hospitalizations for mental or nervous disorders, venereal disease, alcoholism, et cetera,

or for other disorders which are attributed to or

associated by folklore with mental or moral

deviations.

Information may be suppressed because of

embarrassment due to the personal nature of the

problem; for example, various “female troubles”

are not discussed by some segments of the population.

Information may be suppressed due to threat

to self-image. Examples: a hysterectomy may

change perception as a “complete woman”; amputation or loss of other organs may result in

changed perception of self which is psychologically

threatening and therefore suppressed.

Respondents may react to questions about

such conditions by refusing to grant an interview,

refusing to report an embarrassing condition, or

by misreporting the condition in such a way as

to make it more acceptable. ‘Ihus the respondent

may be willing to report “female troubles” when

she would not report the specific problem.

In addition to the subject matter, lowered

(motivation may also occur because of negative

reactions to the survey, its objectives and sponsorship, or to the interviewer. To participate in

an interview requires that the respondent accept

the goals of the survey and react in a positive

way to the interviewer. A negative reaction to

either may be expected to result in inaccurate

data. The effect of memory and the types of

motivation which have been discussed would be

expected to result in a net underreporting rather

than an overreporting of hospital episodes. There

are few motives whtch would be expected to lead

the respondent to overrepcrt his hospitalizations.

In summary several hypotheses about factors

leading to underreporting are as follows:

1. The 12-month period of reference used

by the National Health Survey for hospitalization data is arbitrary and the anchorage of the date, a year ago, may be

so vague that a person remembers his

hospitalization which occurred within the

12 months as having occurred earlier.

The reverse is also true. Some hospitalizations which occurred prior to the year

will be remembered as being within the

year. This type of error may be random

but it is likely that the effects of motivation will lead to misplacing a hospital2.

3.

4.

ization backwards rather than bringing it

forward.

The greater the time interval between fhe

hospitalization and the interview, the less

well it will be reported. Particularly,

minor hospital episodes are more likely

to be underreported as the time span between the hospitalization and the interview

increases.

Some hospital episodes can be expected

to be suppressed or withheld because they

place the respondent in an unfavorable

light.

Negative attitudes toward the interviewer,

the- survey, or its sponsors may result in

underreporting.

THE STUDY DESIGN

Since the study was focused primarily on

problems of underreporting of hospital episodes

rather than on overrepmxing, tie sample consisted of persons who were known to have been

in a hospital. The sample was a probability selection of persons with one or more discharges

during the period, April 1, 1958-March 31, 1959

from 21 hospitals*. Snatification by month of

discharge was used in order to obtain a proportionate number of persons discharged each month

during the sampling time interval.

The surnames, addresses, and telephone

numbers of the sample persons were assigned to

a group of experienced Census interviewers, all

of whom were regular interviewers for the Na-

~ional Health Survey.

The procedures in the field were essentially

the same as those used in the National Health

Survey’s health interview survey. The basic

questionnaire was the same; the interviewing

instructions and procedures were the same. This

was important since a major purpose of the study

was to evaluate the amount of underrepxting of

hospital episodes in the National Health Survey.

The interviewers were not told the purpose

of the study because such knowledge could cause

them to probe harder for hospital episodes, or

in some way change their usual National Health

Survey interviewing methods. The study design

was sufficiently different, however, from that of

tie National Health Survey that interviewers would

likely guess the purpose of the study in the early

stages of interviewing.

*The hospxtals part zclpatlng an the study

were members of the Professional .4ct1v1ty

Study (PAS) . A Izst of the hosp~tals and a

brief description of PAS are given In Appendix. III.

3
During the first two weeks of the study, the

interview assignments consisted of about 300

names and addresses that were chosen from the

general population in the study areas and 100 ad:

dxesses of sample persons. Thus during this period the proportion of hospitalizations reported

in the interviews was somewhat similar to that

normally reported in the National Health Survey;

consequently there was a good chance that the true

purpose of the study would be concealed. A corn.

parison of hospitalizations reported for sample

persons in these interviews was made with those

reported in interviews taken later. This comparison showed no difference in reporting rates.

The field work was carried out by 27 interviewers working in 18 primary sampling areas

located in 14 states. Interviewing started April 1,

1959 with assignments each week through June

1959.

Interviewers were instructed to follow the

standard National Health Survey procedure at

each sample address. Each adult who was found

at home was interviewed almut himself. Information for adults who were absent and for all unmarried children under 18 years of age was obtained by interviewing a responsible family member. This means that the person whose hospital

record was drawn into the sample might be interviewed about himself or another family member

might report for him.

In order to obtain additional information on

characteristics of underreporting, and, hopefully,

reasons why hospitalizations were not reported,

a follow-up interview using a specially designed

questionnaire was conducted with families who

did not report all hospitalizations of sample persons, and with a 10-percent sample of families

who correctly reported the sample persons’ hospital episodes. These interviews were conducted

by Census’ Regional Supervisors.

The sample hospitals are scattered throughout the East and Midwest of the United States

with a couple in the Mountain States. None is in

the Far West or deep South. The hospitals vary

widely in size, the smallest having 3,000 annual

discharges and the largest 28,000. The 21 sample

hospitals were chosen from some 95 participating

in the Professional Activity Study. They were

selected on a subjective basis, mostly to provide

the widest possible geographic distribution. ALSO

only hospitals were chosen which were in or near

sampling areas used on the National Health Survey where experienced interviewers were located.

ABSTRACTING HOSPITAL RECORDS

The hospitals were asked to complete Case

Abstract Forms for all discharges that sample

persons experienced between January 1, 1958

and June 30, 1959 (see Appendix IV for the form

anc questionnaires used in this study). Records,

therefore, were obtained on all discharges (depending on the thoroughness of the record search)

during the reference period of one year before

the week of interview. Obtaining records back to

January 1, 1958 made it possible to identify some

erroneo,~sly reported hospitalizations which actually occurred more than a year before the

interview.

It is not possible to know whether all the

discharge records for the sample persons were

abstracted or not. There is evidence however,

that, at most, only a very few record,s were not

abstracted. For persons who experienced only

one hospital episode during the reference year

(about 90 percent of the sample), it is known that

abstracting was complete. The results of control

methods used gives assurance that the vast majority of records for persons with multiple hospitalizations were also abstracted.

CODING THE DATA

The information reported in the original, or

basic interview, was coded by the Bureau of the

Census using standard National Health Survey

procedures, thus making the data comparable in

this respect to that obtained in the National Health

Survey.

Except for medical coding, the follow-up interviews and the Case Abstract Forms were

coded by the Survey Research Center. Coding of

diagnoses and operations reported in interviews

was done by the Bureau of the Census; medical

coding on hospital records was done by the hospitals.

MATCHING HOSPITAL RECORD

WITI-! INTERVIEW REPORT

After coding by the Bureau of the Census,

all questionnaires and Case Abstract Forms were

sent to the ‘Survey Research Center. The first

task was to match the person whose hospitalization was drawn into the sample with the same

person on the interview.

The two forms were matched, independently,

by two persons using the name, address, age,

sex, and race. In most cases the matching was

accomp~shed easily and independent matching

proved highly reliable. Fewer than 1 percent of

the attempted matches were doubtful. Final decision on the problem cases was made by two

supervisors.

Simila: Iy, it was necessary to match the

hospital episode reported in the interview with

that on the hospital abstract. Matching of episodes

was ddne on a subjective basis rather than on

4
some strict criteria. Most sample persons had

only one episode and usually for such cases this

matching was readily apparent. In cases of multiple hospitalizations, particularly where the diagnosis was the same for all episodes, matching

was more difficult.*

Undoubtedly errors were made. Some cases

were classified as. matched that were not and

others that were actually the same episode were

considered to be unmatched. For this reason, as

far as is possible, the analysis is based on all

episodes reported in the interview and all those

recorded from the hospital records. Thus the

effect of errors due to mismatching was kept to

a minimum.

THE TIME REFERENCE

Interview assignments were made for a particular week, and in most instances were completed within that week. Those which could not be

completed were taken the following week or were

reassigned to a later week. This analysis includes

hospital discharges occurring one year prior to

the Sunday of the week of assignment. Atthe time

of the analysis it was understood tiat the interviewer asked about hospitalizations during the

12 months prior to the Sunday night of the week

of assignment. This was erroneous. In fact, the

interviewers asked about all episodes during the

12 months beginning with the Sunday of the week

in which the interview was taken. Fortunately,

this difference in time periods affected only a

very few cases and were found in a special analysis to make no changes in the findings.

DEFINITIONS OF CERTAIN TERMS

USED IN THIS REPORT

Several descriptive terms used in this report

are defined as follows:

Matched case. —A matched case is one in

which IMth the interview report and the hospital

record were considered to refer to the same hospital episode and both documents indicated that

the episode occurred during the reference year.

Underreport. —A hospital episode is an underreport if the hospital record showed the episode to be within the reference year and there

was no matching episode reported in the household interview.

*Both In sampling and in matching, the

techniques and control methods were much

more elaborate than It appears from this

brief description. The reader who wishes

to know more about the methods can obtain

them by wrltzng to the National Health

Survey or to the Survey Research Center.

Overreport.-A hospital episode is an overreport if it was reported in the interview to have

occurred in a sample hospital during the reference year, and there was either no hospital record for the episode or the hospital record showed

that the episode actually occurred outside the

reference year.

All episodes. —Many of the tables in this report refer to “all episodes.” From the interview

“all episodes” were the matched cases plus the

overreports. For hospital records, “all episodes”

included the matched cases Plus the underreports.

Number of episodes ;ecorded.—l%is- term

is used throughout the reprt to—meanthe number of hospital episodes for sample persons for

which hospital abstracts were obtained.

TYPE OF RESPONDENT

In the initial interview all adults who were

found at home were interviewed about themselves.

The exceptions are adults who were ill or incompetent. Adults who were not present were reported for by another adult. All children under

18 years of age unless married were reported

for by an adult. Many of the tables differentiate

self-respondents horn others as follows:

Self-respondent. -The respondent is the

sample person.

Proxy child .—The respondent is an adult

member of the family reporting for a sample

Derson under 18 Years of age. .

Proxy adult~—The re&mndent is an adult

member of the family reporting for a sample

person 18 years of age or over.

DESCRIPTION’ OF THE SAMPLE

Interviews were completed on 1,505 sample

persons. Fourteen of these reported single episodes for which there were no corresponding

hospital records. The remaining 1,491 persons

experienced 1,833 discharges according to hospital records. In the interviews, 1,645 episodes

were reported. Of these reported episodes, .1,600

were matched with hospital records, and 45 were

not matched. There were 233 hospital-recorded

episodes that were not reported in the interviews.

The 45 episodes reported in the interviews

which could not be verified from hospital records

are considered as overreports. For each such

episode reported a second search of hospital

records was made. Nevertheless, these overreports should not be interpreted as an accurate

estimate of overreporting, even for this speciaI

sample. The respondent may have reported the

episode correctly in the interview but perhaps

misnamed the hospital, or maybe because of

other kinds of errors the episode was misclassified.

5
Based on the matched interview reports, 12

percent of the hospital episodes were not reported. When the 45 overreports are included,

the net proportion underreported reduces to 10

percent.

Some of the important characteristics of the

sample are shown in table 1. The data on hospitalizations were taken from hospital records,

thus overreports are not shown. The demographic characteristics of the sample were taken from

the interview report since these data appear to

be more appropriate for this purpose than those

contained in the hospital record.

Of particular importance is the distribution

according to the status of the respondent who reported for the sample person. Females were

more likely to be at home when the interviewer

called than males. Consequently females reported

for themselves much more frequently. Alxmt thee

quarters of the females were self-respondents

compared with one quarter of the males. In all,

58 percent of the sample persons reported for

themselves.

The only diagnostic category which represents any sizeable proportion of the total is deliveries, accounting for over one fifth of all episodes. Since people make a special attempt to

remember birth dates of their children, it can be

expected that hospitalizations for deliveries will

be reported more accurately than those for other

reasons. Because of this, and since a sizeable

proportion of all hospitalizations is for deliveries,

many of the tables in this report are divided into

two sections, one for all episodes and the second

excluding deliveries.

According to the hospital records, about 45

percent of the hospitalizations involved an operation. If deliveries are included with c)perations,

this proportion increases to two thirds. Other

than deliveries, the most frequently performed

operations were tonsillectomies, reduction of

fractures and dislocations, and for female genital

disorders.

6
Table 1. Number of sample persons and hospital episodes recorded by

Characteristic

the sample

Number of

persons

Total---------------------------------------

Sex

Male----------------------------------------------

Female--------------------------------------------

Respondent status

Self-respondent-----------------------------------

~oxy respondent for children under 18------------

woxy respondent for adults-----------------------

Type of hospitalization

Single--------------------------------------------

Multiple------------------------------------------

Operations performed

Total excluding deliveries------------------------

Deliveries----------------------------------------

Education

College graduate---------------------------------.

Some college--------------------------------------

High school graduate------------------------------

Less than high school graduation------------------

Under 14 and education unknown--------------------

Family income

Under $2,000--------------------------------------

$2,000-3,999--------------------------------------

$4,000-6,999--------------------------------------

$7,000-9,999--------------------------------------

$10,000+---”--------------------------------------

Unknown--.-.,--------------------------------------

Asze

0-1 ---------------- ------------------------ -------

1-9----------------------------------------------

10-17....--”--------------------........----------

18-34.--..-.-.-.-------:-.-... ---------------------

35-54--------------------------------------------

55-64---------------------------------------------

65-74---------------------------------------------

75+-----------------------------------------.----.-

1.491

507

984

879

302

310

1,236

255

708

358

103

127

417

565

279

120

238

623

230

196

84

18

209

77

522

405

119

102

39

characteristicsof

Number of

episodes

recorded

1,833

613

1,220

1,092

349

392

1,236

597

813

359

114

152

511

726

330

154

301

750

272

248

108

23

244

84

631

507

156

141

47

7
UNDERREPORTING BASED ON A COMPARISON OF INTERVIEW

REPORTED AND HOSPITAL RECORDED EPISODES

One question that needs to be answered is how

the infc :mation obtained in household interviews

differs from that recorded in hospitals. Is the

accuracy of reporting different for respondents or

sample persons with different characteristics ?

Do respondents of some ages report better than

those of other ages? Do men report as well as

women ?

This section compares the information as reported in the interviews with that from hospital

records. On this basis, the underreporting

amounts to 10 percent. The hospital records include all hospitalizations from the sample hospitals which occurred during the reference year.

All episodes reported as occurring in sample

hospitals within the reference year are included

whether or not they actually occurred within the

year. These are the data which would usually be

available to the analyst.

The ratios shown in this report are weighted

to adjust for unequal probabilities used in the sample selection. Sampling errors which may be attached to tiese ratios are presented in Appendix I.

Although sampling errors were computed and

frequently tests of hypotheses are made, much of

the analysis is basedon meaningful patterns which

may not pass such statistical tests because of

small numbers involved. This was done because

one of the important purposes of the study was to

develop hypotheses which may be important for

further research.

UNDERREPORTING

BY TYPE AND DEMOGRAPHIC

CHARACTERISTICS OF RESPONDENTS

As might be expected, there was a marked

difference in the amount of underreporting depending on whether the sample person reported for

himself or whether someone else reported for

him. Sample persons reporting for themselves underreported by 7 percent while the rate for both

proxy adults and proxy children was twice as high

(table 2). When deliveries are excluded the total

underreport increases from 10 to 12 percent. Only

8 fewer deliveries were reported than recorded in

the hospitals, an underreporting rate of only 2 percent. This low rate was expected since the birth of

a child is a dramatic event, and the circumstances

and dates are likely to be remembered.

‘ Since it is usually the women’s role to care

for sick or recuperating family members it would

.

be expected that women are less likely to underreport hospitalizations than men; this idea is refuted in table 2. There is little difference between

men and women in reporting either for themselves

or for other members of the family.

The second half of the table, excluding deliveries, shows that women were slightly poorer reporters for themselves than were men. for themselves. However, women reported somewhat better for other adults than did men.

Table 3 indicates that there may be a slight

tendency for underreporting to increase with increasing age of the respondent. When deliveries

are excluded, however, the level of underreporting

is raised in the age groups under 55 years of age

so that there is no general upward trend with increasing age. Ages 65-74 show a larger underreport than other ages; however the largest difference shown (10 percentage points) is not statistically significant at the five percent level. When

ages 55 and over are combined (table 4) the dif -

ference between the percentage underreporting in

this age group and that of the best reporting age

group (under 35) is statistically significant. Respondents under 35 years of age reported their

hospitalizations more often than did others because

of the large proportion in this age groujp reporting

for themselves and because of a large number of

deliveries in the group. The best response by proxy

was by persons 35-54 years of age.

An age-sex comparison revealed no statistical significance in differences in underreporting

by male and female respondents.

White respondents reported hospitalizations

more accurately than did nonwhites (ta:ble 5). This

tendency is apparent for all types of respondents

except when reporting for another adult. These

differences may well be a reflection of other variables, such as educational level and income.

The relationship between education and

amount of underreporting of hospital episodes

shows an unusual pattern. Table 6 indicates that

the res~ndents who graduated from high school or

college report more accurately than those who

have less than a high school education or who

started but failed to complete college. The same

pattern is observed for all episodes and for the

episodes exclusive of deliveries. Atenuous.hypothesis to account for this is that accurate reporting is partially a matter of motivation. Those

people who are highly motivated report more accurately than those whose motivation is low. Accomplishment in school is also related to motivation. Success in school requires diligence, re-

\

8
Table 2. Percent underreporting of hospital episodes by type and sex of respondent and sex of

Sex of respondent

and sample person

Total-------

Msle respondent---

Female respondentMale sample person-------------

Female sample

person----------

Total-------

Male respondent---

Female respondentMsle sample person-------------

Female sample

person----------

sample person, including and excluding deliveries -

Type of respondent

All respondents Proxy respondent for: Self-respondent

Number

Percent

underepisodes rerecorded ported

Children under 18 I Adults I

Number Percent Number Percent Number

episodes under- funder- episodes “episodes

recorded re- re- recordedrecorded

ported ported

Percent

under -

reported

All episodes

1,833 I 10 I 349 I 14 I 392 I 14 I 1,092 I 7

311

1,522

613

1,220

11

10

12

9

52 12 98 16 161

297 14 294 14 931

204 12 248 . 14 161

145 16 144 16 931

8

7

8

7

Excluding deliveries

1,474 12 348 14 367 15 759 10

290 11 51 12 78 19 161 8

1,184 12 297 14 289 14 598 10

613 12 204 12 ’248 14 161 8

861 12 144 16 119 19 598 10

line F~lTf?Ot3,g?S 5hown in 1hi5 table and ir t% bles 3-13 are eased on all hospital di scnarges for sampl e persons

r.vorte,d in the int%r,views to natie oeen fro= smple hospitals, znd on t-he number of discharges abstracted from ncsri -

t-,1 records. Tne percentages are appropriately weighted to reflect each individual ts chance of being selected i? tne

sanp le.

In cases of multiple episodes the personal cn?ir’1cteri5ti C5 accompany each episode. Thus the respondent cnar. cteristics are tre ;dme as the number of episodes, $ince Some. per%ons are included more than once.

Table 3. Percent underreporting of hospital episodes by age of the respondent, including and

excluding deliveries

All episodes Excluding deliveries

Age of respondent Number Percent Number Percent

episodes under- episodes underrecorded reported recorded reported

Total--------------------------------- 1,833 10 1,474 12

18-34--------------------------------------- 792 8 487 12

35-54--------------------------------------- 691 10 638 11

55-64--------------------------------------- 169 13 168 13

65-74--------------------------------------- 128 18 128 18

75+----------------------------------------- 53 14 53 14

9
Table 4. Percent underreportingof hospital episodes by age and type of respondent,including

Age of respondent

Total-------

18-34-------------

35-54-------------

551----------------

Total-------

18-34-------------

35-54-------------

55+---------------

and excludingdeliveri.ea

All reepondenta

Number

episodes

recorded

Percent

under,-

reported

1,833

T

10

792 8

691 10

350 15

Type of respondent

Proxy respondentfor: I Self-respondent

I I I 1 I

All episodes

349 j 14 I 392 I 14 ] 1,092I 7

I I I I I

176 16 108 13 508 4

164 174 11 353

9 (*;

11

110 22 231 10

Excludingdeliveries

1,474 12 348 14 367 15 759 10

487 12 175 16 16

638

225

1X

6

164 11

349 i; 9

303

(*;

12

109 22 231 10

Table 5. Percentunderreporting of hospital” episodes by race and type of respondent

Race of respondent

Total-------

White -------------

Nonwhite----------

All respondents

Number

episodes

recorded

1,833

1,723

110

Percent

underreported

10

lC

16

Type of respondent

Proxy respondentfor: Self-respcmdent

Childrenunder 18 Adults

Number Percent

Number Percent Number percent episodes underepisodes under- epiaodes under- recorded ‘recorded re- recorded ‘eported

ported ported

349 14 392 14 1,092 7

329 13 376 14 1,018

20 24 16 14 74 1:

10
Table 6. Percent underreporting of hospital episodes by education and type of respondent,

including and excluding deliveries

Education of respondent

Total-------

Less than high

school graduation------------

High school

graduate--------

Some college------

College graduate

or more---------

Unknown-----------

Total-------

Less than high

school graduation------------

High school

graduate--------

Some college------

College graduate

or more ---------

Unknown -----------

Type of respondent

All respondents proxy respondent for:

Children under 18 Adults

Number

~~t~

under -

episodes

recorded

1,833

829

646

180

155

23

1,474

698

488

149

116

23

10

13

7

16

(*;

12

14

10

18

(*;

349

141

139

42

27

0

All episodes

14 I 392

14 173

11 130

30 38

2 40

0 11’

14

20

9

11

Excluding deliveries

348 14 367 15

141 13 158 22

138 12 123 10

42 30 38 11

27 2 37

0 0 11 (:;

Self-respondent

Number

episodes

recorded

Percent

under -

reported

1,092

515

377

100

88

12

759

399

227

69

52

12

7

10

4

11

(*;

, 10

11

8

14

(*;
Education and

family income

of respondent

Total

Total--------

Under $2,000-------

$2,000-3,999-------

$4,000-6,999-------

$7,000-9,999-------

$lo,ooo+-----------

Unknown------------

High school

graduate or

less

Total--------

Under $2,000-------

$2,000-3,999-------

$4,000-6,999-------

$7,000-9,999-------

$lo,ooo+-----------

Unknown------------

Some college or

college graduate

Total--------

Under $2,000-------

$2,000-3,999-------

$4,000-6,999-------

$7,000-9,999-------

$lo,ooo+-----------

Unknown------------

Education

unknown

Total--------

Table 7. Percent underreporting of hospital episodes by education of respondType of respondent

All respondents Proxy respondent for: Self-respondent

Children under 18 Adults

Number Percent Number Percent

episodes under- Number Percent Number Percent episodes underrecorded re- episodes under- episodes under- recor,ded reported recorded rerecorded re- ported

ported ported

All episodes

~,833

154

301

750

272

248

108

1,475

146

273

641

190

137

88

335

3

27

104

80

109

12

23

10

18

13

10

8

8

14

10

18

14

8

7

9

11

11

(*)

14

12

11

(J

(J<)

349

19

50

167

48

49

16

280

19

47

145

29

25

15

69

0

3

22

19

24

1

0

14

45

12

10

18

J

13

45

7

11

12

(*;

18

(~t;

8

26

(:;

o

392

34

46

142

68

72

30

303

29

42

120

2

21

78

0

2;

18

29

7

11

14

18

26

13

10

13

16

15

18

36

11

8

(i;

13

(*;

22

16

(*;

(*)

1,092

101

205

441

156

127

62

892

98

184

376

111

71

52

188

3

21

61

43

56

4

12

7

12

10

6

3

6

10

7

12

11

6

z

11

7

(*)

16

(:;

(*;

(*)

12
ent, family income,andtype of respondent,includingand exclud~ngdeliveries

Educacionand

family income

of xesp,ondem

Total--------

Under $2,000-------

$2,000-3,999-------

$4,000-6,999-------

$7,000-9,999-------

$10,000+-----------

Unknown------------

Hi&h school

graduate

or less

Total --------

Under $2,000-------

$2,000-3,999-------

$4,000-6,999-------

$7,000-9,999-------

$lo,ooo+-----------

Unknown------------

Some collegeor

college graduate

Total--------

Under $2,000-------

$2,000-3,999-------

$4,000-6,999-------

$7,000-9,999-------

$lo>ooo+-----------

Unknown------------

Education

unknown

Total--------

Type of respondent

All respondents Proxy respondentfor: Self-respondent

Childrenunder 18 Adults

Number Percent I Number Percent

episodes mder- Number Percent Number Percent episodes wsderrecorded re- episodes under- episodes under- recorded reported recorded ‘r- ecorded ‘e- ported

ported ported

Excludingdeliveries

1,474

134

243

569

226

209

93

1,186

126

217

491

162

IL6

74

265

20

14

11

10

9

14

12

20

14

11

9

10

12

12

(*)

15

12

14

(*:

(*)

348

19

50

166

48

49

16

279

19

47

144

29

25

15

69

0

2:

19

24

1

0

14

45

9

11

18

(*;

13

45

7

13

12

(*;

18

(*;

8

26

(:;

o

367

::

127

67

70

28

281

27

39

108

49

39

19

75

0

3

L8

18

29

7

11

15

16

28

13

12

13

16

16

16

34

13

10

(:;

11

(*;

18

16

(*;

(*)

759

83

150

276

Lll

90

49

626

80

l_31

239

84

::

12L

3

19

33

25

38

3

12

Lo

15

12

10

;

Lo

10

15

11

9

7

5

12

9

(*)

18

(::

(*)

(*)
Table 8. Percent underreporting of hospital episodes by family

including and excluding deliveries

size and type of respcmdent,

Type of respondent

All respondents Proxy respondent for: Self-respondent

Family size Children under 18 Adults

Number Percent

E

Percent

under- Percent Number

episodes Number Number Percent

reepisodes underrecorded episodes under- episodes under- reported rerecorded

recorded recorded reported

ported

ported

Total--------

1----------------..

2----------------.-

3 or 4-------------

5 or 6-------------

7+------------------

Total--------

1-------- ----------

2----.-------------

3 or 4-------------

5 or 6-------------

7+-----------------

All episodes

1,833 10 349 14 392 14 1,092

r

7

75 12 0 0 75 12

316 10 3 (*; 9: 12 217 9

760 12 137 16 170 20 453 7

494 7 146 12 96 4 252 5

188 12 63 14 30 22 95 7

Excluding deliveries

1,474 12 348 14 367 15 759

r

10

75 12 0 0 0 75 12

313 10 3 (*: 96 12 214 9

598 14 137 16 161 21 300 9

354 10 145 12 86 4 123 13

134 14 63 14 24 24 47 I 7

sponsibility, ahdcompliance with authority. Perhaps these are some of the same traits required

for accurate reporting of hospitalizations.

Since a relationship exists between education

and income, the income data for all episodes and

for two educational groups are presented separately in table 7. There is a clearly observable

pattern which indicates that accuracyofreporting

increases with income, both for all episodes and

excluding deliveries. Both educational groups

demonstrate similar effects.Ofthetwo variables,

incomehas the majoreffectonthe accuracyofreporting.

Table 8 shows the mount ofunderreprting

for various family sizes. It mightbe expectedthat

thelargerthe family thelessaccurate thereport

because it is more likely that tie sample person

would be reported for by aproxy respondent.Such

does not appear to be true. Over-all, there was

little difference in accuracy between large and

small families. However, self-respondents of

larger families reported more accurately.l%is is

probably a reflection of age. One andoften twomember families arecharacteristically composed

ofpeople inthe older age groups wherereporting

tends to be worse.

14

UNDERREPORTING

BY RELATIONSHIPS BETWE!EN

SAMPLE PERSON AND RESPONDENT

In addition to the characteristics of respondents or sample persons which might be expected

to be related to how well episodes are reported

there are some relationships between these two

persons which could be expected to hlave some

bearing on how well episodes are reported. For

example, the closer the family relationship between the respondent and the sample person the

more one would expect the respondent to know

about the hospitalizations of the sample person.

The closer the ages the more accurate one might

expect the information to be. The remainder of

this section reports some of the effects of these

factors on reporting of hospital episodes.

Family Relationship

Table 9 shows that the closer the relationship

between the respondent and the sample person the

more accurately hospital episodes were reported.

Self-respondents, as the data in this report consistently show, were the most accurate reporters.
Table 9. Percent underreporting of hospital episodes by relationship of sample person

to respondent and type of respondent, including and excluding deliveries

Type of respondent

All respondents Proxy respondent for:

Children under 18 Adults

Percent I I

underreported

Relationship of sample

person to respondent Number

episodes

recorded

Number Percent Number Percent

episodes under- episodes underrecorded ‘r- ecorded ‘e- ported ported

All episodes

Total ----------------- 349 14 392 14

o

2

330

15

2

0

(*)

12

(:;

o

273

56

63

0

Self-respondent ------------- 0

Sample person is spouse of

respondent -----------------

Sample person is child of

respondent ----------------

Sample person is other

relative -------------------

Sample person is unrelated--

275 10 10

386 14 28

78

2 (:;

21

0

Excluding deliveries

Total ----------------- ‘1,474 12 348 14 I 367 [ 15

0 0 0 0

10

29

23

0

Self-respondent -------------

Sample person is spouse of

respondent -----------------

Sample person is child of

respondent~ ----------------

Sample person is other

relative -------------------

Sample person is unrelated--

759 10

255 11 1 (*) 254

385 14 330 12 55

73

2

15

2

58

0

lllchildU does not refer to a9e It means that the sample person is an offspring of the respondent.

The next most accurate group was therespondent

reporting for his spouse;respondentreportigfor

achildwas third. l%eleast accuratewas tie respondent reporting for some other relative. This

pattern also holds when deliveries are excluded.

Looking attheaccuracy ofrepordngfor offsprings, it is seen that when they arewder 18

years ofage they were reportedfor withabout the

same accuracy as were spouses. However, epiaodesfor adult offsprings wereunderreported ata

considerably higher rate. Thfs probably reflects

the greater independence ofadultoffsprings from

the family and, conversely, the greaterresponsibilityofparents for younger children.

Age Comparison

Table 10 shows age differences bemeen respondents and sample persons. Only proxy respondents are included in this table.

Thehypothesishere isthatthegreater theage

differential between therespondentand thesample

persontheless Hkelytheyareto beinclosecammunicationabout their personal lives.lldsshould

be particularly true when the sample peraonis

olderthanthe respondent.l%e tableindicates arelationship but the differences are not statistically

significant.It appearsthatthe nesrnessofthe relationshfpbetween the sampleperson andrespond15
Table 10. Percent underreporting of

hospital episodes by the age difference between respondent and

sample per son,

only

proxy respondents

Age difference

between respondent

and sample person

Total -------

Respondent is

younger by 10

years or more---

Respondent and

sample person

are within 10

years----------Respondent is

older by 10 or

more years ------

Number

episodes

recorded

741

71

255

415

Percent

under -

reported

18

15

18

20

ent is more related to accuracy ofreportingof

hospital episodes than is the age difference.

Sex Comparison

Table llahowsunderreporting ofhospitalepisodes when proxy respondents report forsample

peraons of the same or different sex.

All ofthe household interviews were takenby

women interviewers. Tlms, ifthereis aproblemof

reporting about hospitalepisodea betweenmenad

women it maybe reflected in differencesbetween

sample persons and respondents or between respondents and interviewers.

Considering all episodes, reporting wasmost

complete when both the respondent andthesample

person were male. Underreporting was highest

when the respondent was male and the sample

person female. Amanmay beembarrassedtoreport to afemale interviewer alxmt female hospitalizations. It may benoted in table 11 however,

that the differences are accounted for by ahigher

rate of underreporting for children. For adults

these tendencies are not present. Theresultsare

inconclusive andthe sexrelationship is apparently

not astrong determinant to reportinghospitalepisodes.

Table 11. Percent underreporting of hospital episodes by sex of respondent and sample

person and type of respondent, proxy respondents only

Sex of respondent and

sample person

Total -------------

Both respondent and

sample person are

male ------------------

Both respondent and

sample person are

female ----------------

Respondent is male;

sample person is

fence ----------------

Reapbndent is female;

sample person is maleAll respondents

Number

episodes

recorded

741

.

39

178

111

413

Percent

under -

reported

14

8

15

17

13

Type of respondent

Proxy respondents for:

Children under 18 Adults

Number

episodes

recorded

349

29

122

23

175

Percent Number

under - episodes

reported recorded

14

(*)

14

24

14

[

392

10

56

88

238

Percfm%””-”

und,er -

rep&ted

14

(*)

16

14

13

16
UNDERREPORTING

BY HEALTH CHARACTERISTICS

In the interview, questions were asked about

the frequency of chronic and acute conditions. It

was thought that accuracy of reporting might differ

according to whether the sample person was’ ‘very

healthy,” i.e., not suffering from chronic or acute

conditions or was “not healthy, ” suffering from

several conditions. Since the number of conditions

might be expected to increase with age, such a

comparison was made for three age groups.

Information on the number of conditions was

obtained by counting the frequency of repxt of

either chronic or acute conditions. All responses

were divided into three groups: those mentioning

no chronic or acute conditions, those mentioning

one or two conditions, and those reporting three or

more.

In table 12 a strong relationship appears to

exist betweenthenumber of chronic and acute conditions or both reported in the interview and the

accuracy of reporting hospital episodes. The fewer

conditions reported, the greater the underreporting of hospital episodes. In an attempt to understand these data, similar statistics were obtained

for the respondent. The reasoning was that if the

variable was actually related to the health of ihe

sample person then the conditions which the respondent suffered would show no rel~ionship with

accuracy of reporting hospital episodes of others.

From table 13 it is apparent that the relationship is as strong for the conditions of the respondent as it is for those of the sample person. It appears that there is some factor other than health

which is affecting the accuracy of reporting of

hospitalizations. The best hypothesis is that the

factor is motivation.

The respondent who has a low level of motivation to participate in the interview slides through

the interview in such a way as to make the least

demands on his time and energy. Thus he does not

work very hard to report his hospitalizations and

by the same process fails to report physical conditions suffered by himself and other members of

the family.

Hence, in addition to the usual problems of

forgetting hospitalizations, there may be a strong

factor of motivation accounting for some of the underreporting.

17
Table 12. Percent underreporting of hospital episodes by age of the sample person, number of

chronic snd acute conditions reported in the interview for the sample person, and type of

respondent, including and excluding deliveries

Age and number

of conditions

reported

All ages

Total-------

None--------------

1 or 2------------

3+----------------

Under 18

Total-------

None--------------

1 or 2------------

3+--------------.-

18-44

Total-------

None---------------

1 or 2------------

3+----------------

&t

Total-------

None--------------

1 or 2------------

3+----------------

All ages

Total-------

None--------------

1 or 2------------

3+----------------

Under 18

Total-------

None --------------

1 or 2------------

3+----------------

18-44

Total-------

None--------------

1 or 2------------

3t----------------

—45+

Total-------

None--------------

1 or 2------------

3+-----------...--

18

All respondents Proxy respondent for: Self-respondent

Children under 18 Adults

Number Percent

Percent under- Number Percent Number Percent

episodes Number

reunder- under- episodes underrecorded episodes

reepisodes

ported recorded re- recorded rerecorded ported ported ported

All episodes

1,833 10 349 14 392 14 1,092 7

528 15 190 16 85

945

33

8 146

253

241 9

360 4 13

561 :

(i; 66 7 278 4

351 14 349 14 0 0 2 (*)

191 16 190 16 0 0

147

1

146

(*)

(:;

o

13

0

($+

1

13 0

(*)

o 0 0

896 8 0 0 202 14 694 6

221

349 :

124 4

396 9

31 20

211 10

154 5

290 13 0 0

471

69

6

31

0 0

135

122

3 0 0 11 (*;

586 11 0 0 190 14

47 28 0 0 16

330 12

44

0 0

209

119

6

14

0 0 55 8

Excludingdeliveries

1,474 12 348 14 367 15 759 10

370 20 189 16 68

782 10

42 113

146

15

322 6

233 9

13

403

(:;

10

66 7 243 6

348 14 348 14 o 0 0 0

189 16 189 16 0 “ o

146

0 0

146

(i;

o

13

0

13 (:;

o 0

0 0 0 0

542 12 0 0 177 16 365 10

135 25 0 0

306

52 42

0

83, 13

101

114

:

192

0 ;

10

11 (*; 90 9

584 12 0 0 190 15 394 10

46 28 0 0

330

16

11

44 30

0 0

20

208

119 14

6 0

211

0

10

55 8 153 5
Table 13. Percent underreporting of hospital epiaodea by age of the respondent, nqmber of chronic and acute conditions reported in the interview by the respondent about himself, and type of

respondent

Type of respondent

All respondents Proxy respondent for: Self-respondent

Age and number

of conditions

reported

Children under 18 Adults

Percent

under -

reported

Percent

underpo%ed

Number

episodes

recorded

1,833

548

913

372

1,193

424

590

179

637

Percent

under

reported

Percent

under

po;~ed

Number

episodes

recorded

1,092

253

561

278

694

221

349

124

396

Number

episodes

recorded

349

132

174

42

308

118

151

39

41

Number

episodes

recorded

392

All ages

Tota 1 -.----

None--------------

1 or 2------------

3+-----------m----

18-44

Total-------

None --------------

1 or 2------------

3+----------------

*

Total-------

None--------------

1 or 2------------

3+----------..----

10

13

9

6

9

12

8

9

12

14 14

18

14

3

13

17

(*;

16

8

17

10

9

14

16

11

19

12

163

178

51

191

85

90

16

200

9

:

6

7

6

4

9

122

322

193

20

12

4

14

23

4

27

(*;

19

19

0

20

10

5

77

88

35

31

211

154

19
UNDERREPOF!TING

BASED ON MATCHED HOSPITAL EPISODES

Since there is a particular interest in problems of underreporting, the analysis in this section

is based on those episodes of hospitalization reported in the household interview which could be

matched with hospital records. The ratios of underreporting based on matched cases represent

the maximum percentage of underreporting. It is

entirely possible that a number of the cases reported in the interview that could not be matched

with hospital records were actually the same episodes as recorded. The matching procedure used

makes it possible for an episode to appear as an

underreport (when there was no interview report

classified as a clear match with the hospital record) and also as an overreport (when there was no

clear match for the interview in the hospital records). In fact, there were five such cases. The indications are, however, that the matching criteria

were quite good. Generally speaking, the distributions presented in the preceding section where no

matching criteria were used are about the same as

similar distributions based on matched episodes.

The following analysis is based on three factors which are likely to be related to one’s ability

to remember; namely, the seriousness of thehospitalization, the reason for hospitalization, and the

time interval between the interview and discharge

from the hospital.

In planning the analysis of these data several

measures of seriousness were considered. These

were discussed with doctors who pointed out problems in each measure contemplated. There was

general agreement that length of stay in the hospital would provide a reasonably good index of seriousness. By seriousness is meant the level of

physical threat or trauma which is involved. For

example, it is generally true that the more serious

the operation the longer the hospitalization. The

same tendency usually is characteristic of nonoperative cases. On this basis an analysis was

made comparing three lengths of stay: 1 day is

considered minor, 2-4 days is somewhat more

severe, and 5 days and over is considered to be

serious. These time periods are arbitrary but it

was thought that they would show fairly high agreement with classifications of “major” and’ ‘minort’

hospitalizations.

Diagnoses and operations were used in the investigation of the hypothesis that respondents suppress or withhold information about hospitalizations which may place them in an unfavorable

light. A test of this hypothesis requires an a priori

classification of diagnoses and operations which

differentiates between those that are embarrassing or threatening and those that are not. While in

20

the literature some discussion was found of specific diagnoses and operations which cause psychological trauma, no over-all classifications ystem was located and the writers devised their own

classification.

The dia~ostic classification was a threepoint scale based on the judgment of th[eresearchers as to what extent the diagnosis would be

threatening or embarrassing. All diagnostic classifications which, in the opinion of the raters,

would be very embarrassing or threatening were

placed in Rank 1. Rank 3 included the groups

which were judged not embarrassing and nonthreatening. Rank 2 contained a mixture of categories which were thought to be somewhat threatening, or in which some diagnoses would be

threatening and others would not. Thus Ranks 1

and 3 were kept as pure as possible, with 2 containing some of the uncertain categories. No claim

is made for the validity of this scale, nor for the

method of classification. While other people were

consulted as to the ranking of diagnoses it is based

on a subjective judgment of the authors.

A similar scale was used to rank operations.

Here, however, only Ranks 1 and 3 were used. It

was felt by the raters that operations were much

easier to rank, because of the specificity. ~us all

operations were ranked either embarrassing or

threatening, or those that were not. The ratings are

shown in Appendix II.

It was expected that these ratings would be

positively correlated with the seriousness of the

diagnosis or illness, and consequently, to some extent correlated with the length of stay in the hospital.

In devising ratings, like these, there are two

important considerations. The first is that the ordering of the items should be predomtiantly correct and the second is that the average value of

those items placed in one grouping should differ

from that of another. The rating of any one item

may be inaccurate. The main test of the usefulness

of the scales is whether or not they help to differentiate and understand the differences in reporting

hospital episodes.

UNDERRE~ORTING

BY LENGTH OF STAY

Tab?.~ 14 cle~ly indicates that underreporting

of hospitalizations is related to the length of stay

in the hospital. The only reversal of the trend is

for episodes lasting longer than a month. This re-
Table 14. Percent underreporting of hospital episodes by length of stay shown in hospital reccrds

and type of respondent, excluding overreports

Length of stay

(in days)

Total-------

1-------- -------- -

2-4---------------

- ---------------

i-i4--------------

15-21-------------

22-30--------”----

31+---------------

Unknown-----------

Type of respondent

All respondents proxy respondent for:

Number Percent

episodes under’

re- recorded ported

1

150 26

646 14

456 10

352 10

111 6

58 2

46

14 (*;

Children under 18

Number Percent

episodes under -

recorded ‘eported

85 24

141 14

64 11

43

4 (:;

3 (v

7 (*)

2 (*)

Ad{

Number

episodes

recorded

392

8

125

98

100

34

19

8

0

.t s

Percent

underreported

18

23

24

10

(*;

(*)

0

Self-respondent

T

Number Percent

episodes under -

recorded ‘eported

1,092 I 9

57 28

380 11

294 6

209 10

73 5

36

31 (*;

12 (*)

Table 15. Percent underreporting of hospital episodes by age of sample person and length of

stay shown in hospital records, excluding overreports

I Length of stay (in days)

All stays 1

Age of sample

2-4 nperson

Number Percent Number Percent Number Percent Number Percent

episodes under- episodes under- episodes under -

episodes under -

recorded re- recorded ‘r- ecorded reported ported

recorded ‘eported ported

Totall------ 1,833 12 150 26 646 14 1,023 9

0-18-------------- 351 16 85 24 143 14 121 13

18-34------------- 631 8 35 26 288 10 305 5

35-54------------- 507 13 15 33 153 18 334 11

55+--------------- 344 15 15 31 62 24 263 12

lTnere are 13 episodes frOm intervie~~re?ort~ an~ 14 from ,no32it31 record; for ,,.~ic, t.e Ien, t,, ?f ?,Tz Y ...3s ,ur,kn,~m.

Tot. ls add to 1,567 and 1,819.

Table 16. Percent underreporting of hospital episodes by age of the respondent and length of

stay shown in hospital records, excluding overreports

Age of respondent

Totall------

18-34-------------

35-54-------------

55+---------------

Length of stay (in days)

All staya 1 2-4 i%

Percent

Number Number

Percent

Number

Percent

Number

Percent

under -

episodes underepisodes under - underepisodes

reepisodes

‘eCorded po;;ed ‘eCorded p~;ed recorded ported ‘eCorded po;;ed

1,833 12 150 26 646 14 1,023 9

792 10 25 342 10 375 7

691 13 :; 24 238 16 386 10

350 15 18 37 66 28 262 13

IThere ~r,q 1~ ~~i~Ode~frO~ interview reports and 14 from nospital records for which the iengt~ Df St?j w3~ ,J~knO~n.

Totals add to 1,587 and 1, S19.

21
Table 17. Percent underreporting of hospital episodes by relationship of sample person to the

respondent and length of stay shown in hospital records, excluding overreports

Length of stay (in days)

All stays 1 2-4 .51- Relationahip of

sample person to

respondent Number

episodes

recorded

1,023

643

191

142

47

0

Percent

underreported

Percent Number

under- episodes

re- recorded

ported

Percent

underreported

Percent

underreported

9

Number

episodes

recorded

Number

episodes

recorded

Totall------ 1,833 12 150

+

14

11

16

16

35

0

Self-respondent---

Sample person is

apouae----------

Sample person is

child-----------

Sample person is

other relative--

Sample person is

unrelated-------

1,092

275

386

78

2

9

15

16

26

(*)

57

6

81

4

2

28

29

23

(*)

(*)

380

78

161

27

0

6

14

13

20

0

lThere are 15 eri?cqe: from intervi+t, rep.ort~ ano 14 from hospital records for which the length of stay $,,as unkm-;,n.

Table 18. Percent underreporting of hospital episodes by relationship of sample person to respondent and length of stay shown in hospital records, excluding overreports

Length of stay (in days)

All stays 1 I 2-4 5+ Relationship of

sample person to

respondent

-

Percent

underreported

Number Percent

episodes underrecorded ‘eported

Number Percent

episodes underrecorded ‘eported

Number Percent

episodes underrecorded reported

Number

epiaodea

recorded

Totali------ 1,833

Self-respondent---

Sample person is

apouae----------

Sample person is

child-----------

Sample person ia

other relative--

Sample person is

unrelated -------

150 I 26 I 646 I 14

1,092

275

386

78

2

9

15

16

26

(*)

57 28 380 11

6 29 78 16

81 23 161 16

4 ($,) 27 35

2 (*) o 0

643 6

191 14

142 I 13

47 20

0 0

1

There are 13 episodes from interview reoorts and 14 from nosoital records for whicn the Ienatn of stav was u:lknown.

Totals add to 1,587 and 1,81+.

22
versal is due to a difference of three episodes in

the proxy child group which happen to have large

weights associated with them.

A similar pattern is observed for each type of

respondent. The better reporting of self-respondents is again apparent and is seen for all lengths

of stay with the exception of stays of one day.

In table 15 the general increase in underreporting with age of the sample person is apparent.

However, the introduction of the additional variable of length of stay shows an interesting pattern.

In every age group the longer the stay the better

the report. It is also apparent that the effect of

length of stay on the accuracy of reporting is

greater than the effect of age of the sample person. In the 2-4 and 5 days and over stays the lowest underreporting occurs at ages 18-34 years.

This is the group with the highest number of deliveries. As other tables show, most delivery

cases appear in the categories of 2-4 days’ stays

and 5 days and over. Accordingly, these cells show

the smallest amount of underreporting.

Since length of stay is related to age, controlling for length of stay should make the age

effect more pronounced. For the 1 day and the

2-4 days’ stays the episodes of the younger persons were re~rted better than for older persons.

This tendency was not found in stays of 5 days or

longer.

Table 16 shows information based on the age

of the respondent. The pattern is similar to that

seen in table 15. The longer the stay the better the

respondent reprted lhe episode. Again it appears

that the pattern of underreporting can be understood in terms of the interaction of three factors:

age, length of stay, and better reports of deliveries.

To strengthen the idea that reporting improves with increasing lengths of stay, it can be

seen in tables 17 and 18 that almost without exception the trend is consistent with the hypothesis.

No matter how close or distant the relationship of

the sample person to the respmdent, reporting

improves with increasing length of stay. The same

is generally true for each family income group

(table 19). In the $10,000 or more group the reporting is better for l-day than for 2-4 days’

stays.

Table 19. Percent underreporting of hospital episodes by family income and length of stay shown

in hospital records, excluding werreports

Length of stay (in days)

All stays 1 2-4 5+

Family income

Number Percent Number Percent Number Percent Number Percent

episodes under- epi.sodes underepisodes under- episodes underrecorded ‘r- ecorded re- recorded ‘r- ecorded reported ported ported ported

Totall------ 1,833 12 150 26 646 14 1,023 9

Under $2,000------ 154 19 11 (*y 47 19 93 12

$2,000-3,999------ 301 17 19 35 102 13 178 18

$4,000 -6,999 ------ 750 10 73 267 12

$7,000 -9,999 ------ 272

404

11 20 z 107

$lo, boo+----------

17 143 ;

248 9 22 84 15 142

(;

6

Unknown----------- “108 16 5 39 12 63 17

lT~er&are IS~Pi~O~e~fromintervieW~~port~and 14 from nospital records for whicn the length of staY was unknown.

Totals add to 1,587 and 1,819.

23
UNDERREPORTING

BY DIAGNOSTIC AND OPERATION

CLASSES

The analysis presented in this section is

based on diagnoses and operations recorded in

hospital records. In many cases more than one

diagnosis was recorded and occasionally more

than one operative procedure was listed. lhus one

hospital discharge might list a fractured arm,

diabetes, and a heart condition. Or the description

of an operation might include a hysterectomy and

an appendectomy y.

Since all of the sample hospitals were participants in the Professional Activity Study, whose

function it is to make analyses of hospital records, all hospitals were instructed to list first the

diagnosis leading immediately to the hospitalization. Thus the first diagnosis or operation listed

in the discharge record was regarded as the primary cause of the hospitalization. ,Only the first

diagnosis or operation listed was used in the

analysis presented in this report.

For all classes of respondents nonsurgical

cases were more seriously underreported than

surgical ones (table 20). Within the surgical

groups, deliveries were reported more completely

than other surgery. Differences in reporting for

proxy children and proxy adults were not great.

The most important difference was between reporting by self-respondents and proxy respondents. The most seriously underreported episodes

were mental and personality disorders (table 21).

The probability is that this diagnosis was sufficiently embarrassing that the respondent avoided

discussing it by not reporting the episode. The next

poorest reports were for pre- and post-natal conditions, benign and unspecified neoplasms, and

“all other conditions. ” The pre- and post-natal

conditions can be accounted for by a different factor. Many of these were false labor in which the

woman was in the hospital for a short time and

then discharged, usually to return soon for the delivery. To her this short stay was probably either

considered as part of the main hospitalization or

was so minor as not to be considered an actual

hospitalization. Thus the hypotheses are that there

are two reasons for underreporting, one because

of embarrassment or threat and the other because

of the minor nature of the episode.

‘l%e best reporting was for arthritis and diseases of the gallbladder, which were reported perfectly, and deliveries. Arthritis and gallbladder

conditions are both serious, in that hospital stays

are usually long, and the disorder is physically

threatening in terms of discomfort. Yet neither

condition is embarrassing. Delivery dates are

easily remembered since they are associated with

a child’s birthday and usually the event is recalled as a happy occasion.

Table 22 shows the percent of underreporting

of hospital episodes by type of operation. The

highest rate of underreporting for any surgical

group was 18 percent, while there were several

diagnostic groups which showed a higher proportion of underreported episodes. This may reflect,

again, the importance of the seriousness of the

event. The operations for which the episodes were

reported best were deliveries, gallbladder, appendectomies, and repair of hernias. Those with the

highest underreporting of episodes were eye operations, hysterectomies, and operations on the

bladder and on the intestines.

It appears that the important factors in determining whether or not a hospitalization will be

reported are, first of all, its seriousness and,

second, how embarrassing or threatening it is.

Tables 23-27 show underreporting of episodes

by diagnostic ratings. It seems clear that reporting varies with the amount of threat represented

by the diagnosis (table 23).

The largest difference is between the most

threatening and the somewhat ,threatening groups.

This relationship holds for proxy adults and children as well as for self-respondents. The relative

drop in underreporting by degree of threat is less

for children than for the other groups.

The underreporting of episodes for the most

threatening group rises with the age of the sample

person, except for the youngest ages (table 24).

However, the somewhat threatening and the not

threatening groups do not follow a consistent pattern. This seems to indicate that the reaction to

threat is independent of the age of the sample person. Why underreporting in the middle category

drops for the ages 55 years andover is not clear.

It may reflect the fact that the middle ratings were

in part a miscellaneous grouping which did not

readily fit into one of the other two groups. Underreporting among persons in the most threatening

group was also highest for each respondent age

group (table 25).

Since all of the initial household interviews

were done by female interviewers, it was possible

to investigate whether or not reporting completeness differs for various combinations of the

sex of the respondent, sample person, and interviewer. Is a female respondent less reluctant than

a male respondent to talk about an embarrassing

type of diagnosis? Do females report certain types

of diagnoses better for female sample persons than

they do for males? Table 26 indicates that female

respondents report better for males than for females and that male respondents report better for

females, reg&rdless of the diagnosis. The evidence

is not conclusive, however, since the number of

cases in each group is small.

24
Table 20. Percent underreporting of hospital episodes by type of treatment shown in hospital

records and type of respondent, excluding overreports

Type of respondent

All respondents proxy respondent for: Self-respondent

Type of treatment Children under 18 Adulta

Number Percent Percent Percent Number

Percent

under- Number Number

episodes under- underunder -

episodea episodes episodes

‘eCorded po;;ed recorded recorded repo;;ed ported

recorded po;;ed

Total------- 1,833 12 349 16 392 18 1,092 9

Deliveries-------- 359 3 1 (*) 2.5 8 333 3

Other surgical---- 813 12 199 12 200 16 414 9

Nonsurgical ------- 661 19 149 22 167 22 345 16

Table 21. Percent underreporting of hospital episodes by diagnostic categories, excluding

overreports

Diagnostic category

Total-------------------------------------------

Infective and parasitic diseases---------------------z

Malignant neoplasms -----------------------------------

Benign and unspecified neoplasms ----------------------

Allergic, endocrine, and metabolic disorders----------

Mental and personality disorders----------------------

Intracranial lesions----------------------------------

Diseases of nervous system and sense organs-----------

Heart diseases----------------------------------------

Hemorrhoids-------------------------------------------

Other circulatory diseases----------------------------

Upper respiratory conditions--------------------------

Other respiratory conditions--------------------------

Ulcer of stomach and duodenum-------------------------

Appendicitis------------------------------------------

Hernia------------------------------------------------

Diseases of the gallbladder---------------------------

Other digestive system conditions---------------------

Female breast and genital disorders-------------------

Other genitourinary conditions------------------------

Deliveries--------------------------------------------

Pre- and post-natal conditions------------------------

Diseaaes of the skin----------------------------------

&ttiitis ---------------------------------------------

Other musculoskeletal disorders-----------------------

Fractures and dislocations----------------------------

Other current injuries--------------------------------

Observation only--------------------------------------

All other conditions----------------------------------

No dia~osis ------------------------------------------

Number episodes

recorded

1,833

19

59

60

57

25

12

85

61

23

36

127

70

;;

::

116

%?

359

89

29

:;

50

66

9

70

13

Percent underreported

12”

22

11

23

17

13

12

17

14

12

19

5

4

0

16

21

11

2;

19

0

9

17

(i;

23

0

25
Table 22. Percent underreporting of hospital episodes by type of operation, excluding

overreports

Type of operation

Total --------------------------------------------

Operations on the brain and skull----------------------

Eye operations -------.-------.-------------------------

Varicose veins -----------------------------------------

Tonsillectomy and adenoidectomy ------------------------

Operations on the stomach------------------------------

Appendectomies -----------------------------------------

Repair of hernias --------------------------------------

Operations on the intestines ---------------------------

Operations for hemorrhoids -----------------------------

Operations on the gallbladder --------------------------

Operations on the kidneys------------------------------

Operations on the bladder -------------------------------

Operations on the male genital system------------------

Hysterectomies -----------------------------------------

Other female genital operations ------------------------

Reduction of fractures and dislocations ----------------

Cesarean deliveries -------------------------------------

All other deliveries -----------------------------------

Type of operation unknown ------------------------------

No operation performed ---------------------------------

All other operations ------------------------------.----

Number

episodes

recorded

1,833

2

31

8

94

8

26

49

23

18

38

5

35

31

20

97

91

11

348

8

661

229

Percent

un~derreported

12

(*)

(i;

(:;

3

3

16

10

(*;

16

12

17

14

15

0

(*;

19

12

Table 23. Percent underreporting of hospital episodes by diagnostic rating and type of respondDiagnostic ratingl

Total--------

Most threatening---

Somewhat threatening---------------

Not threatening----

No diagnosis-------

ent, excluding overreports

Type of respondent

All respondents Proxy respondent for: I Self-respondent

Number

episodes

recorded

1,833

235

421

1,164

13

! 1

Children under 18 I Adults

12 I 349 I 16 I 392 I 18 I 1,092

21 34 22 58 32 143

14 57 16 96 19 268

10 257 234 673

(*) 1 (:; 4 (i; 8

Percent

underreported

9

16

12

(*;

lThe diagnostic rating is eased upon tne diagnosis from the hospital records. The Structure of the ratings is

shown in Appendix Il.

26
Table 24. Percent underreportingof hospital episodesby age of sample person and diagnostic

rating, excludingoverr(

Age of sample person and diagnosticrating

Under 18

Most threatening---------------------------------------

Somewhat threatening-----------------------------------

Not threatening----------------------------------------

18-34

Most threatening---------------------------------------

Somewhat threatening-----------------------------------

Not threatening----------------------------------------

35-54

Most threatening---------------------------------------

Somewhat threatening-----------------------------------

Not threatening----------------------------------------

55-64

Most threatening---------------------------------------

Somewhat threatening-----------------------------------

Not threatening------------;;;-------------------------

Most threatening---------------------------------------

Somewhat threatening-----------------------------------

Not threatening----------------------------------------

Table 25. Percent underreporting of

hospital episodes by age of respondent and diagnostic

excluding overreports

rsting,

Age of respondent

and diagnostic

rating

18-34

Most threatening--

Somewhat threatening-------------

Not threateni.ng---

35-54

Most threatening--

Somewhat threatening-------------

Not threatening---

55-64

Most threatening-Somewhat threatening-------------

Not threatening---

6&

Most threatening--

Somewhat threatening-------------

Not threatening---

Number

episoctes

recorded

80

194

513

100

162

423

26

40

101

29

25

127

Percent

underreported

19

12

8

19

18

10

21

13

13

33

16

17

34

58

258

56

181

391

89

113

298

28

;;

28

36

124

Percent

underreported

22

16

15

17

12

5

19

20

10

21

3

14

.34

14

13

Table 27 shows the diagnostic rati.ng classified byrelationship ofthe respondent to thesample person. Except for tie group ’’sample person

is other relative’’ the percentage ofunderreporting increases with increasingthreat. For’’sample

person is child,” i. e., an offspring, the rating

makes less difference inthe amountof underreporting than for other groups. ~is leadstoan interesting hypothesis that the diagnoses which are

threatening when theypertaintooneself oranother

adult are not threatening when they relate toan

offspring,especisll ychildren. Such a diagnosisis

more personal foradults, lmt csn be discussed if

it relates to a child.

Tabulations comparable to those shown in

tables 23-27 were made for the ratings ofoperations and are presented intables 28-32. lleresuits are quite similar tothoseclassifiedbydiagnostic rating except that underreporting forthese

operation groups isgenerallynot ashighasfor the

diagnostic rating groups. Aprobable reason for

this lower underreporting is that hospitalizations

involving an operation aregenerallymore serious

and more drsmatic thsnthose not involving surgery and consequently are more likely toberemembered.

Further supprt is given to the validity of the

hypothesis that underreporting is related tothe

threat of the diagnosis or operation by the fact

that a relatively larger proportion of the hosp.italizations not reported inthe interview were associated with diagnoses considered threatening

(table 33).

27
Table 26. Percent underreporting of hospital episodes by sex of sample person and respondent and diagnostic rating, excluding self-respondents and overreports

Sex of sample person and respondent

and diagnostic rating

Both male

Most threatening -------.----.---------------

Somewhat threatening ------------------------

Not threatening -----------------------------

Both female

Most threatening -----------------------------

Somewhat threatening ------------------------

Not threatening -----------------------------

SamDle Derson male and respondent female

Most threatening ----------------------------

Somewhat threatening ------------------------

Not threatening -----------------------------

Sample person female and respondent male

Most threatening ----------------------------

Somewhat threatening ------------------------

Not threatening -----------------------------

Number episodes

recorded

7

8

25

23

37

116

46

81

283

16

27

67

Percent underreported.

(*)

(*)

21

40

24

18

24

16

16

34

21

16

Table 27. Percent underreporting of hospital episodes by relationship of respondent

to sample person and diagnostic rating, excluding

Relationship of respondent to sample person

and diagnostic rating

Self-respondent

Most threatening -----------------------------

Somewhat threatening ------------------------

Not threatening -----------------------------

Sample person is child

Most ,ttieatening----------------------------

Somewhat ttieatening ------------------------

Not threatening ------------------------------

Sample person is spouse

Most threatening ----------------------------

Somewhat threatening -------------------------

Not threatening ------------------------------

Sample person is other relative

Most threatening -----------------------------

Somewhat threatening ------------------------

Not threatening -------.---------------------

Sample person is unrelated

Somewhat threatening -------------------------

Not threatening -----------------------------

28

Nuniber episodes

recorded

143

268

673

39

73

273

37

58

overreports

~ ““’

Percent underreported

16

12

6

21

19

15

31

16

176 12

16

$:

1 (*)

1 (*)

42

13

25
Table 28. Percent underreportingof hospital episodes by operationrating and type of respondent,excludingoverreports

Operationratingl

Total-------

Threatening-------

Not threatening---

Type of operation

unknown---------

Type of respondent

All respondents I proxy respondent for: Self-respondent

Childrenunder 18 Adults

Number

Percent

under- Percent Percent Number

episodes Number Number episodes

recorded ‘eunder -

episodes

under -

ported reepisodes

rerecorded

‘eCorded ported recorded ported

1,172 9 200 12 225 15 747

332 13 32 12 80 24 220

832 8 167 12 142 11 523

8 (*) 1 (*) 3 (*) 4

Percent

underreported

6

9

5

(*)

lTne operation r,ati ng is bzsed upon the operations from the ,,uspital records. Structure of the ratings is sho$. n

in A!3pendix Il.

Table 29. Percent underreporting of

hospital episodes by age of sample

person and operation rating, exeluding, overreports

Age of sample

person and

operation rating

Under 18

Threatening--- ----

Not threatening---

18-34

Threatening -------

Not.threatening- --

35-54

Threatening -------

Not threatening---

55-64

Threatening -------

Not threatening---

65+

Threatening- ------

Not threatening---

Number

episodes

recorded

32

169

94

379

137

177

%

37

52

Percent

under -

reported

Table 30. Percent underreporting of

hospital episodes by age of respondent and operation rating, excluding overreports

Age of respondent

and operation

rating

12

12

9

5

16

9

6

12

22

5

18-34

Threatening-------

Not threatening---

35-54

Threatening-------

Not threatening---

55-64

Threatening -------

Not threatening---

65+

Threatening-------

Not threatening---

Number

episodes

recorded

105

446

155

270

E

;:

Percent

under -

ceported

11

6

11

9

21

11

??

29
Table 31. Percent underreporting of hospital episodes by sex of sample person and

respondent and operation rating, excluding self-respondents and overreports

Sex of sample person and respondent

and operation rating

Both male

Threatening -------- -.----------------------------------

Not threatening-.------ --------------------------------

Both female

Threatening ----------------------------------------- ----

Not threatening--------------------------------- ----.-.-

Sanwle person male and respondent female

Threatening ---------------------------------------------

Not threatening -------------------------------------..-

Sample person female and respondent male

Threatening ---------------------------------------- -----

Not threatening ----------------------------------------

Number

episodes

recorded

3

21

20

82

70

152

19

54

Percent

u:nderrepor~ed

(*)

4

34

13

.17

10

19

17

Table 32. Percent underreporting of hospital episodes by relationship of sample person

to respondent and operation rating, excluding overreports

Relationship of sample person to respondent

and operation rating

Self-respondent

Threatening .----.,----------------------------------- ----

Not threatening ---------------------------------- --------

Sample person is child

~reatening --------------------------------------------

Not threatening -------------.-------.------------------

Sample person is spouse

Threatening ---------“------ --------------.--------- ----

Not threatening ---------------------------- -----------*-

Sample person is other relative

Threatening -------- -------------------------------------

Not threatening ------------------------ ---------.-..---

Number

episodes

recorded

220

523

46

181

13

16

27

Percent

underreported

9

5

16

13

16

8

48

12

30
Table 33. Percent distribution of hospital episodes recorded for sample persons and of episodes not reported in

interviews by diagnostic and operation

ratings

Rating

Diagnostic

Total --------

Most threatening---

Somewhat threatening---------------

Not threatening----

Operation

Total --------

Threatening- -------

Not threateninz----

All

episodes

recorded

for

sample

persons

100

12

2i

66

100

26

74

Episodes

not

reported

in

interviews

100

21

25

54

100

38

62

/

:

j

;

/

i

/

/

1

;

Episodes other than deliveries

b:

\

t ~.

: ~;

t

*

:

/

/’

,~------ -.4.

,,’

,’

All episodes

-----

01 : ;0 ;5 ;0 ;5 & & ;0 ,; ;0

NUMBER OF WEEKS BETWEEN DISCHARGE AND INTERVIEW

Figure 1. Variation in percent of hospital epi,

sodes underreported by the number of weeks between the hospital discharge and the interview,

including and excluding deliveries.

UNDERREPORTING

BY TIME INTERVAL BETWEEN

INTE’RVIEW AND HOSPITAL

DISCHARGE

The first part of this report contains a discussion of memory and motivation and specifies

some hypotheses to be testedin this analysis. One

ofthesehyptheses is thatunderrepting ofepisodes becomes greater as the lengthoftime between the hospitalization and the interview increases. This relationship is explored here.

Figures 1 and 2 show the variation in the

mesnpercent ofunderreportingl accordingtothe

number of weeks between the interview and the

hospitalization, grouped in 5-week periods. Discharges thatoccurred50 and moreweekskefore

the date of the interview have been &oupedtogether. ‘l%us, the final point on each illustration.

represents the mean value ofunderreporting for

those discharges that occurred more than 49

weeksfromthe interview.~

In theillustrations there inconsiderable instability in the trend ofthe variation inunderreporting. This may indicate some systematic influence at work. However, it is more likely that

this instability is theresultofrandom fluctuations

due to the relative sparsity of observations at

some points and the concenmationofobservations

at others? In some cases it has been necessary

to combine classifications in order to obtain

meaningful estimates. ‘IWs, abroaderclassificadon of theinterval between discharge sndinterview has been used in the tables than in the illustrations.

lThzs Statzstlc Is equz valen t to those described In the footnote In table 2.

2The =e*ponden t was asked to repOrt hO=pi tali -

za tions that occurred within 1 year from the Sunday night prior to the interview. Thus by reporting hospi talizatzons within 52 weeks from thi e

Sun day it is possible for the interval between

dischar~e and interview date (i. e.. after the

Sunday night speci fied above) to be more than 52

weeks but not greater than 53 weeks from the date

0 f interview.

3That there is only a small number of observations at some points la especially tr,ue when the

len~th of tzme between hospz tal discharge and interview Is small; rou~hly, up to 10 weeks. This

is because of the lag in time between choosing

*ample persons and interviewing someone abou t

them. Thzs group is largely made up of persons

WI th d~schar~es In Uarch 1959 who were interviewed during the third and fourth weeks of Aprx~

1959 and persons who were reacbnltted to a hoapi tal after March 1959 and discharged before the intervi ew.

31
:

i

40 - ;

/

1

:

j

n

1

F ,

E i

g 30 –

u

E

f

!!5 Proxy respondents

I

1

a I

z

3

\

/“.. !

;., ,

+ ; .,/

z .

& 20 – & :

z / ‘1 ,’

2 ‘. ..’

,’ ., ./-

,/’ ‘“

/

/

10 – ;!

,.

/<. ----/

-. /---

.-

.-. Self-respondents

o

I

5 10 15 20 25 30 35 40 45 50

NUMBER OF WEEKS BETWEEN DISCHARGE AND lNTERVIE\

Figure 2. Variation in percent of hospital episodes underreported by the number of weeks between the hospital dlscflarge and the Interview

and respondent status.

The distribution of hospital episodes during

the reference year by time interval between discharge and interview is given intable 34. Apart

from asparsity ofobservationsat thebeginningof

the reference year, that is up to the tenth week,

hospitalizations are fairly equally distributed. In

most cases, the totals for each period (usually

five weeks) are classified according totwoimportant characteristics. Figures in the text will

indicate the over-all proportion in each class

which, when combined with table 34;willgiveapproximate figures forthenumbers ofobservatinns

in each cell.

Figure lshowsthatthereisastrongtendency

for underreporting to increase as the length of

time between the interview and the hospital discharge increases. This is not surprising for the

following reasons. First, memory ispartlyafunction of time. As the period between the date of the

event and the time for recalling increases, recollection becomes weaker. Second, events may be

remembered accurately but perception of time

may be the difficulty. A person’s hospitalization

may be well known to a respondent but he may be

unable to subtract quickly to tell whether it was

more or less than 12 months before. Such a phenomenon becomes increasingly important as the

interval between hospital discharge and interview

Table 34. Distribution of hospital ep isodes by number of weeks between hospital discharge and date of interview

Number of weeks

between discharge

and interview

Total --------

1-5---------------

6-10 --------------

11-15 --------------

16-20 --------------

21-25 --------------

26-30 --------------

31-35 --------------

36-40 --------------

41-45 --------------

46-50 --------------

51-53 --------------

Number

:pisodes

:ecorded

1.833

44

70

193

233

250

209

172

167

156

208

131

Percent

distribut ion

100

2

3

10

12

14

13

9

9

9

11

8

increases, since the chances of perceiving the

hospitalization as occurring outside of tie sample

year increase. Third, neglecting for tie moment

the possibility of repression, for agiven lapse of

time between the date of occurrence and the date

for recall, recollection willdepend ontietiitial

impact. Where the impact is slight the event is

less likely to be recalled than where the impact is

strong. Finally, there istheproblem of motivation.

Quite apart from any motive to withholcl information, a disinterested respondent may not bother to

remember a hospitalization.

An important characteristic of figure 1 is the

sudden rise in underreporting during the final

period, that is, after 49 weeks. If, for example,

the reader covers up each of the final segments on

the two lines, the remainder of the estimates show

a pattern that appears to be linear. Tsking into

account each of the final segments the points give

the impression of arising from some underlying

curvilinear form.

How can the sudden rise in underreporting

during the last 2 or 3 weeks of the year be accounted for,?

Part of the answer may lie in the accuracy

with which respondents report episodes within the

correct month. If the hospitalization is recalled as

occurring earlier than is actually the case then the

episodes within 1 month of the beginning of the

sample year would be particularly affected. To

‘examine this question a comparison was made between the month of admission as reported on the

interview and as recorded on the hospital[ records.

(The only dates asked in the interview were the

month and year of admission to the !hospital.)

32
Table 35. Percent distribution

of the admission as reported

pital records and number of

for matched cases only

in

of hospital episodes

the interview and

weeks between hospital discharge and date of interview,

Number of months interview report differs

from hospital records

Total----------------------------------

Interview reports episode earlier

than the hospital records by:

7-12 months----------------------------------

2-6 months.----------------------------------

1 month--------------------------------------

Interview report and hospital record show

same month----------------------------------

Interview reports episode later

than the hospital records by:

1 month--------------------------------------

2-6 months-----------------------------------

7-12 months----------------------------------

Unknown--------------------------------------

Number of episodes---------------------------

by the discrepancy between the month

the month of admission from the hosNumber of weeks between discharge and

the interview

Total 1-20 21-40 41-53

Percent distribution

100

1

1

5

82

8

2

1

*

-1,600

100

2

1

5

82

9

1

*

o

506

100

0

1

5

82

9

1

1

1

716

100

0

1

6

83

8

2

*

*

378

Over 80 percent of the episodes were reported correctly as to month of admission. Most

ofthe discrepant reports and95 percentofthe episodes for the total group were reported plus or

minus 1 month of the actual date of admission

(table 35). Thereis no positive evidence thathospital admission dates were misplaced backward

intimeanymore frequentlythanthey werebrought

forwsrd.However ,unreporteaepisodes arenotincluded in table 35. If they could reconsidered,

such a tendency could exist and thus cause the

sudden increase in underreporting after the ‘49th

week.

A second factor which might account forthis

increase in underreporting during the last20r 3

weeks relates to the month of admission asreportedintheinterview. Iftherespondent reported

ahospitalization duringthepast 12monthsand then

reported the month of admission as a month outside ofthereference year,itmaywell depend upon

the accuracy with which the length ofstaywasreported whether or notthisepisode wasrecorded

bvthe interviewer. ForexsrnpIe, suppose anfnt&viewer referstoayearfrornMay6-mdtherespondentreportsa hospitaladmissioninAprilof

thepreviousyesrandstateshewas there3days.

Accordingtothesefiguresitisimpossibleforthe

respondenttohavebeeninthehospitalduringthe

referenceyesr.The interviewernowhasaproblem.Shemust probetodiscoverwhetherAprilis

the correctmonth,whetherlhe3daysisincorrect,or whetherthereqxmdentmade anerrorti

reportingthattheepisodeoccurredinthepast12

monlhs.Theinterviewermay assume thattherespondentgavethecorrectinformation,butincorrectlystatedthatthestaywas withinthepast12

months.Thus theepisodewouldnotrerecorded.

A thirdpossibleexplanationfortheincrease

inunderreportingisthemotivationwhichtherespondentmay havehad toavoidadiscussionofthe

epide, eitie.rbecause it was drreatening or

merely because he preferred to slide through the

interview as easily and rapidly as possible. Table

35 shows that the pattern in misplacement of the

33
month of admission is very consistent; however,

only reported episodes are shown. The pattern

for unreported episodes may be very different. By

“remembering” that an episode occurred slightly

earlier than was the case the respondent can avoid

discussing it.

A final explanation is that episodes for minor

causes tend to be forgotten and that memory

failure accelerates as time passes.

Figure 2 shows a similarity in the pattern of

underreporting for self - and proxy-respondents.

Although reporting by self-respondents is consistently better, the same end rise of underreporting is observable for both types of respondents.

Similar graphs for male and female respondents show a comparable reporting pattern. The

curve for males is not as regular as for females.

However, this is probably due to the smaller number of male respondents.

Tables 36-40 further demonstrate that the

time interval between the hospital discharge and

interview is highly related to reporting accuracy.

For each subclassification of the population- relationship of the sample person to the respondent,

family income, age of the respondent or sample

person, and whether or not the person had a single

or multiple episodes during the year—almost

without exception, the rate of underreporting increased with increasing time interval between interview and discharge.

Table 36. Percent underreporting of hospital episodes by relationship of sample person to respondent and number of weeks between hospital discharge and date of interview, excluding overreports

Relationship of

sanple person

to respondent

All respondentsSelf-respondent-----

Sample person is

child--------------

Sample person is

spouse-------------

Sample person is

other relative-----

Sample person is

unrelated----------

Number of weeks between discharge and interview

Total

Number

episodes

recorded

1,833

1,092

386

275

78

2

Percent

underreported

12

9

16

15

26

(*)

1-20

Number

episodes

recorded

540

314

122

74

30

0

Percent

underreported

5

3

8

4

18

0

21-40

Number

episodes

recorded

798

485

168

115

28

2

Percent

underreported

9

5

15

12

22

(*)

41

Number

episodes

recorded

495

293

96

86

20

0

3

Percent

underreported

24

19

30

27

45

0

34
Table 37. Percent underreporting of hospital episodes by

weeks between hospital discharge and date of intewiew,

type of hospitalization and number of

including and excluding deliveries, excluding overreports

—.

Number of weeks between discharge and interview

Total 1-20 21-40 41-53

Type of

hospitalization Number Percent

Number Percent Number Percent Percent

under- under- Number

episodes episodes episodes under- underepisodes

recorded ‘r- ecorded re- recorded ‘ereported ported ported recorded ported

Total---------

Single--------------

Multiple ------------

Total---------

Single--------------

Multiple ------------

All episodes

1,833 12 540 5 798 9 495 24

1>230 12 337 5 539 9 354 23

603 16 203 5 259 12 141 28

Excluding deliveries

1,474 15 438 6 641 12 395 28

922 15 252 7 403 12 267 27

552 15 186 6 238 13 128 31

Table 38. percent underreporting of hospital episodes by family income and number of weeks between hospital discharge and date of interview, excluding overreports

Number of weeks between discharge and interview

Total 1-20 21-40 41-53

Family income

Number Percent Number

Percent Percent

Number Number

Percent

episodes under- under- underepisodes re- episodes under

recorded reepisodes

po~ed recorded recorded re-~orted ported recorded ported

Total-------- 1,833 12 540 5 798 9 495 24

Under $2,000------- 154 19 37 4 72 19 45 29

$2,000-3,999------- 301 17 92 7 112 13 97 29

$4,000-6,999------- 750 10 213 6 346 6 191 21

$7,000-9,999------- 272 11 79 6 119 8 74 21

$10,000+----------: 248 9 105 10 64 18

Unknown------------ 108 16 : ; 44 10 24 42

Table 39. Percent underreporting of hospital episodes by age of respondent and number of weeks

between hospital discharge and date of interview, excluding overreports

Age of respondent

(in years)

All ages-----

18-34--------------

35-54--------------

55-64--------------

65-74--------------

75+----------------

Number of weeks betweel

Total I 1-20

Number Percent

Number

Percent

episodes under- underreepiaodes

recorded reported recorded ported

1,833 12 540 5

792 10 234 4

691 13 201 6

169 14 53 6

128 19 35 12

53 18 17 9

discharge and interview

21-40 I 41-53

798 9 495 24

351 7 207 21

293 10 197 25

73 14 43 23

60 13 33 39

21 18 15 22

35
Table 40. Percent underreporting of hospital episodes by age of sample person and number

between hospital discharge and date of interview, excluding overreports

of weeks

Age of sample

person

(in years)

All ages -----

0-18---------------

18-34--------------

35-54--------------

55-64--------------

65-74--------------

75+-----------------

Number of weeks between discharge and interview

Total

Number

episodes

recorded

1,833

351

631

507

156

141

47

Percent

underreported

12

16

8

14

12

15

18

RELATIONSHIP BETWEEN

DIAGNOSTIC RATING, LENGTH

STAY, AND TIME BETWEE,N

INTERVIEW AND HOSPITAL

DISCHARGE

1-20 21-40 41-53

Number

episodes

recorded

540

114

175

143

52

44

12

OF

Ithas been shown that underreporting ofhospital episodes in household interviews is related

to anumber of variables. However, themostsignificant relationships were with length of stayin

the hospital, diagnostic rating, and time interval

between thehospital discharge and the interview.

The question now is, what is the effect ofthese

variables in combination?

Table 41 shows the results of the combined

influence of length ofhospitalization anddiagnostic rating on the reporting of hospital episodes.

Over half of the hospitalizations ofl-dayduration, that were rated mostthreatening, werenot

reported, * while the episodes of5 days andover

for the least threatening diagnoseswere underreported by less than 10 percent. The number of

cases in some cells is very small, but the consistent pattern in the illustrations and the very

large difference between the extremes suggest

that thereis astrong relationship between memory, motivation, andtheamountofunderreporting.

Memory and motivation interact. The combination accounts for a greater amount of underreporting than either by itself. This is illustrated

again in table 42. Except for the group with dis-

“This percentage is based on 5 interview reports and 11 hospital records. All other cell

percentages are based on at least 25 cases.

36

1 I

1

5 798 9

10 149 14

1 293 7

5 211 10

4 59 13

9 64 5

8 22 7

495

88

163

153

45

33

13

Percent

underreported

.—

24 ——

27

16

26

20

39

44

charges within 20 weeks of the interview, reporting becomes worse as the threat ofthe diagnosis

increases. Within each diagnosticratingunderreporting increases as the timeinterval betweenthe

hospital discharge and the interview increases.

Table 43 presents an interesting pictureof

memory problems. Ithas been shown thal shortduration hospital episodes are not reported as

wellas Iong-stayepisodes, andthatreportinggenerally gets worse as the timeintervalbetweenthe

interview and the discharge increases. However,

for short-stay episodes, reporting accuracy does

not seem to be affected as this time interval increases.

For stays longer than onedaythereisonlya

slight tendency for the underreporting percentage

to increase until near the end of the reference

year. After 40weeks, underreporting of2-4days’

stays increases rapidly. For the group withstays

of 5 ormoredays, there isalarge” increase in the

rate after 50 weeks, increasing from9percentunderreporting at46-50weeks to46percentat 51-

53 weeks prior to the interview.

Table44 shows howallthree of thevariables

are related. Under allconditions ofthreat; andregardless of the length of time between thedischarge and interview, the longer the stay the better the reporting of the episodes.

This relationship tends to be intensified as the

level of threat increases, although the relationship

does not hold for all categories.

The relationship also tends to be intensified as

the time interval between the hospitalization and

the interview increases, although again the :pattern

is not entirely consistent.

For recent episodes (within 20 wee:ks) the

threat rating appears to have little effect on underreporting. If anything the most threatening ep-
Table 41. Percent underreporting

pital records,’ and

of hospital episodes by length of stay based on hosdiagnostic rating, excluding overreports

Length of stay (in days)

1-- . --- --- - - - --- - - - - - -- -- -- - - - - - - -

2-4 - -- -- -- -- - -- -- - - - - -- - -- - --- - - - -

n- ------- ------- ------- ------- ----

Niuaber.episodes recorded ----------

Diagnostic rating

I I I

Total

number Most I

Somewhat INot

episodes threatening threatening threatening

recorded Percent underreported

150 58 33 20

647 24 14 12

1,023 15 11 8

1,820 I 235 I 421 I 1,164

lE~i~~d~~ for ~hi~h inf~~~~ti~n on length of stay or diagnosis Was Unknown are ‘xcluded -

Table 42. Percent underreportingof hospital episodea by diagnosticrating and number of weeks

between hospital discharge and interview,excluding overreports

Diagnosticrating

Total-------

Most threatening--

Soraewhat threatening-----------

Not threatening---

No diagnosis------

Numl

Total

---L Number Percent

episodes underrecorded ‘eported

1,833 I 12

235 21

421 14

1,164 10

13 (*)

er of w&eks between discharge and interview

1-20 21-40 41-53

Number Percent Number Percent Number Percent

episodea under -episodes under -

episodes underr.ecorded ‘r- ecorded ‘eported

recorded ‘eported ported

540 5 798 9 495 I 24

I I 1 I I

69 3 110 20 56 44

120 8 184 16 117 24

351 5 494 7 319 21

0 0 10 ‘*)1.d._J2

isodes for this time period are more likelytobe

reported.

Under all conditions ofthreat,andregardless

of the duration of the hospitalization, the longer

the time interval betweentheepisode andtheinterview, the greater the underreporting.

Under conditions oft.hreatthisrelationship is

intensified.

Tables 41-44 provide asummaryofthe major

findings onmotivation andmemoryand theresults

can now reinterpreted inlight of the earlier discussion and hypotheses as to the effects ofthese

factors on the reporting ofhospitalizations. The

1.

2.

data suggest the following generalizations:

The threat or embarrassment ofadiagnosisstarts amotive pattern leading tosuppression, andperhaps repression,and thus

tounderreporting ofthreateningepiaodes.

‘Ihe duration of the hospital staycanbe

3.

considered afacilitating factor.Thelonger

the hospital stay, and the more serious it

is, the harderit istoforgetit.Conversely,

it is easier to forget abrief, unimportant

episode.

The elapsed time between the episode and

the inteniew provides the opportunity or

the setting for threat and duration to become effective. As time progresses, perceptions are reshaped to fit one’s total pattern of experiences. People remember selectively and the longer the time the more

important selective memory becomes.

llus it is found that the greatest underreporting is among episodes that provide the motivation and the opportunity for “forgetting,” and

this failure of recall is facilitated by the brevity

of the experience.

37
Table 43. Percent underreporting of hospital episodes by number of weeks between

hospital, discharge and interview and length of stay, excluding overreports

Length of stay (in days)

5+

Number of weeks between

+

1 I

2-4

discharge and interview

Percent Percent

under -

Number under -

reepisodesreported ‘eCorded ported

Percent

Number under -

episodes

rerecorded ported

Number

episodes

recorded

Totall --------------- 26 646 14

I-=

10

25

66

82

93

63

62

59

64

;:

1

(*)

4

6

5

6

9

17

8

26

25

(:;

1-5-----------------------

6-10----------------------

11-15----------------’------

16-20----------------------

21-25----------------------

26-30-----------------------

31-35----------------------

36-40----------------------

41-45----------------------

46-50----------------=------

51-53-------------’--------

Unknown--------------------

3

9

17

10

26

16

15

20

7

14

13

0

(*)

(*)

13

30

28

30

13

(:;

32

31

0

17

36

109

141

130

129

95

88

85

118

70

5

lThere are 13 episodes from interview tWpOrtS and 14 from hospital records for which the lenqth

of stay was unknown. Totals add to 1,587 and [,$319.

Table 44. Percent underreporting of hospital episodes by length of stay from hospital

records and number of weeks between hospital discharge and interview and diagnostic

rating3 excluding overreports

Diagnostic rating

EiJiiJi;:,-

Percent underreported

Total

Percent

under -

reported

Length of stay and number of weeks

between discharge and interview Nuder

episodes

recorded

Stay of 1-4 days

Discharge 1-20 weeks before interview-------- ----,---------------

Discharge 21-40 weeks before ir.-

terview---------------------------

Discharge 41-53 weeks before Interview ---------------------------

223

355

219

308

442

273

7

13

30

3

8

19

7

26

56

0

15

33

9

16

27

7

5

22

7

9

27

3

5

17

Stav of 5+ davs

Discharge 1-20 weeks before interview-------- ----..--------------

Discharge 21-40 weeks before interview-------- ------------------ ---

Discharge 41-53 weeks before interview---------------------------

38
THE FOLLOW-UP INTERVIEW

INTRODUCTION

A special follow-up interview was conducted

with respondents who failed to report one or more

hospital episodes of the sample person, and a

random sample of respondents who correctly reported the episodes. The purpose of the followup interview was to discover additional information about the respmdent or the hospital episode

which would help to reveal why the episode was

not reported.

The original interviews were matched against

the sampled hospital records in the Census Regional Offices. Persons with underreported hospital episodes were selected to have a follow-up

interview. In addition, a 10 percent subsample of

persons who correctly reported their episodes

was designated for follow-up interviews.

‘The follow-up interviews were taken by Census Regional Supervisors, or their assistants,

who were given special interviewing training.

In contrast with the interviewers on theoriginal survey, the Census supervisors were aware

of the purpose of tie study and knew which persons had failed to report a hospitalization. They

were told, however, not to attempt to persuade

the respondent to report an episode.

The person to be interviewed was the same

respndent as in the original interview. In this

interview, however, data were to be, collected

only concerning the sample person, not all members of the family.

The follow-up interviewers were predominantly men, in contrast with the original interviewers, all of whom were women. The interview

was usually taken a week or two following the

first interview, although in some cases more time

elapsed. Regardless of the lapse of time, the reference year was the same as during the original

interview. These procedures were not novel to

the supervisors, since they regularly take a sample of follow-up interviews in comection with the

National Health Survey. However, most of the

questions included in the questionnaire were new

and were specially designed for this study. The

follow-up questionnaire is shown in Appendix IV.

me first part of the questionnaire repeated

some of the demographic and health questions

from the original interview. The questions about

hospitalizations asked in tie first interview were

asked again. These were followed by some special questions to see whether further probing

would elicit additional reporting of hospitalizations.

Questions were devised to explore perceptions and attitudes in two areas:

1. Attitudes surrounding the hospital epi-

~.—mere were several attitudes about the

hospital episode which might be related to whether or not the episode would be repxted in the

interview. Several questions were included to

discover reaction to hospital care, present status

of the condition for which the person was hospitalized, and whether or not the condition was

disturbing or embarrassing. Questions were asked

to learn the impact of the condition, including the

length of immobilization preceding and following

the hospitalization, and the financial burden of

the illness and hospitalization.

2. Attitudes toward the interview. -In the

first section of the report, the importance of the

interview experience and the interviewer as factors in respondent motivation was mentioned.

Several questions were included to obtain reactions to the original interview.

There were 233 underreports in the original

interview. In the follow-up 170 of these were reinterviewed. Of the 63 underreports that were not

reinterviewed, 24 were noninterviews. The remaining 39 were not assigned by the Census officers for one reason or another. Some of these

latter represent matching problems, that is, the

number of episodes in the hospital records was

equal to the number reported, but the Survey

Research Center judged them to be nonmatches.

Other underrepxts were apparently overlooked.

To allow for this loss, a correction factor of

233/170, or 1.37 was assigned to the discrepant

sample. The nondiscrepant sample consisted of

137 episodes.

Of the 170 episodes not repxrted in the original interview, 106 were reported in the followup, a particularly high proportion. Of these 106

cases, 92 were reported in response to the question usually asked in the National Health Survey-

“During the past 12 months has anyone in *e

family been a patient in a hospital overnight or

longer ?“ Fourteen cases were reported in answer

to questions not usually asked in the National

Health Survey. Of these 14, all but two were repxted when asked, “Have you ever been a patient

in a hospital?” If yes, ‘WhenGG the last time

you were a patient overnight or longer?” In answering the question 10 respondents gave a month

and year clearly within the reference year. ‘IWO

said it was in 1958 but could not remember the

month.

One episode was picked up in response to.

the question, t!were you h a hosplt~ for ~Y accidents or injuries during the past 12 months?”

The other episode was reported in response

to the question, “We find that people sometimes

39
forget hospital stays for minor things or for

short periods. Is there any chance that you were

in a hospital overnight for a minor thing or for a

short period during the past 12 months, which

you may have forgotten up to now?”

If the episodes had been reported in the original interview at the same rate as in the followup and original interview combined, the rate of

underreporting would be less than half of that

obtained in the original interviews. Some hypotheses as to the reasons for the good reporting in

the follow-up are discussed later in this section.

The percentages in the tables that follow are

weighted to reflect the subsampling ratios only.

They are not, however, weighted estimates of

population parameters. A comparison of weighted

and unweighed percentages indicated that the two

are, by and large, of the same order of magnitude.

For very small numbers, however, the two percentages may be quite different. The nondiscrepant sample was given the weight of 10 since this

sample is a 10 percent subsample of the interviews that were nondiscrepant when first taken.

Ordinarily, the discrepant sample would have a

weight of one since this particular sample consisted of all discrepant cases in the original interviews.. However, a weight of 1.37 was given to

each discharge in this sample to account for the

difference between total discrepant cases and the

number on which follow-up interviews were completed.

UNDERREPORTING

BY CHARACTERISTICS OF

THE RESPONDENTS

Since the follow-up interview elicited a sizeable number of episodes that were not reported

in the original interview, responses were analyzed to see whether respondents who reported

episodes in the follow-up only were similar or

different from those who reported in the original

interview as well.

In the original interview women reported a

higher proportion of episodes than men. This

difference was probably due to the high rate at

which deliveries were reported, coupled with the

fact that most respondents were females. After

both interviews there was still a slightly larger

proportion of episodes for male respondents that

were not reported in either interview than for

female respondents (table 45).

It was shown in an earlier section that underreporting increases with the age of the respondent. However, in the follow-up interview

this trend was reversed (table 46). The net effect,

therefore, is that after both interviews there is

virtually no difference in the proportions of underreporting for the different age groups. This

Table 45. Percent of episodes reported

in the original interview, in the

follow-up, or not in either by sex of

respondent

Characteristic of

episode report

Total -------

Reported in both

original and

follow-up interview ---------

Not reported in

original but

reported in

follow-up intervfew ---------

Not reported in

either interview ------------

Number of epi,-

sodes -----------

Sex of respondent

Male ] Female

Percent

100

82

10

8

71

100

87

8

5

322

may be due to the effect of age on memory. If

one’s memory is hazy, a second interview with

the additional stimuli to remember may be effective in overcoming memory failure.

Table 47 contains information on reporting

in relation to the education of the respondent.

In the original interview, those who completed

high school and those who completed col[lege reported the highest proportion of their hospital

episodes. Here again, in the follow-up interview,

the pattern is reversed. Those who did not complete college or who had less than a high school

education reported the highest proportions of

hospitalizations. The net effect is that the educational groups are roughly the same for episodes

not reported in either interview.

The data horn the original interviews indicated that underreporting was related to the level

of the family income. Table 48 shows the reporting of episodes in the follow-up interviews by

family income groups. As indicated in the other

tables the second interview tends to reduce substantially the underreporting for each category,

and to eliminate nearly all the differences between the categories. The differences which remain after both Merviews are generally in tie

same direction as those found for the original

interview, but “the magnitude of the differences

is much smaller.

40
Table 46. Percent of episodes reported in the original interview, in the follow-up, or

not in either by age of respondent

Characteristic of episode report

Age of respondent

18-34 35-54 55+

Total ----------------------------

L

100

Reported in both original and followup interview ------------------------- 89

Not reported in original but reported

in follow-up interview --------------- 6

Not reported in either interview ------- 5

Number of episodes --------------------- 172

Percent

~

86

10

4

138

83

11

6

83

Table 47. Percent of episodes reported in the original interview, in the follow-up, or

not in either by education of respondent

Characteristic of episode report

Total ------------------------------------

Reported in both original and follow-up

interview ------------------------------------

Not reported in original but reported in

follow-up interview -------------- ------------

Not reported in either interview ---------------

Number of episodesl ----------------------------

lFor six ~~i~ode~;education of respondent Was unknown.

.

Education of respondent

I 1

High High

school school some College

or less graduate college graduate

100

83

11

6

204

Percent

+

89 88

6] 8

5 4

104 I 51

100

92

5

3

28

Table 48. Percent of episodes reported in the original interview, in the follow-up, or

not in either by famil~ income

Characteristic of episode report

Total ---------------- ------------

Reported in both original and followup interview -------------------------

Not reported in original but reported

in follow-up interview ---------------

Not reported in either interview -------

Number of episodesl----------:---------

lFor ,9 epi~~des family income was unknown.

Familv. income

Under $4,000 $4,000-6,999 I .$7,000+

Percent

100 I 100 I 100

1 1

82

11 I

7

85

91

6

91

6

3

136 I 130 I 108

41
Table49 shows theproportionofreporting

of episodesby the type of respondent.In the

originalinterviewthe superiorityof self-respondentsisseen.The gapbetweenthereporting

of proxiesand self-respondentsiconsiderably

reducedinthesecondinterview,althoughtheselfrespondentsstillhave thelowestpercentageof

underreportedepisodesaftertwo interviews.

Table 50 showsthereportingofepisodesby

therelationshipbetweenthe sample personand

the respondent.As in thelargersample,this

tableshows the superiorreportingof self-reTable 49. Percent of episodes reported in

not In either by

spondentsand thesuccessivelypoorerreporting

forchildrenandotherrelatives.,

Afterthe secondinterviewself-respondents

showed thesmallestnumber of unreportedepisodes,followedcloselyby proxy children.The

resultof the secondinterviewwas thattheresponseratesforthegroupswere broughtconsiderablyclosertogetherthanwhattheywere in

thefirstinterview.

These findingstendtoindicatethattheproblem of reportingforothersin thefamilyisnot

so much a functionoflackofinformationas itis

the original interview, in the follow-up, or

type of respondent

Characteristicof episode report

~

Total----------------------------

L

100

Reported in both original and followup interview-------------------------

Not reported in original but reported

in follow-up interview---------------

Not reported in either interview-------

Number of episodes---------------------

83

10

7

89

Percent

100

81

12

7

107

100

e

90

:

197

Table 50. Percent of episodes reported in the original interview, in the follow-up, or

not i.neither by relationship between sample person and respondent

Characteristicof episode report

Total-------------------------

Reported in both original and

follow-up interview---------------

Not reported in original but reported in follow-up interview-----

Not reported in either interview----

Number of episodes------------------

Relationship between sample person

and respondent

Spouse Child Other Self- Unrelated relative respondent

Percent

100 100 100 100 100

83 85 70 90 (*)

10 10 17 6 (*)

7 5 13 4 (*)

63 77 55 197 1

42
a matter of memory. If the interviewer can motivate and stimulate the respondent to recall, the

episodes are reported.

To summarize the findings: The follow-up

interview tended to elicit reporting of episodes

with a different pattern than the original, largely

because of the greater statistical opportunity to

pick up an unreported episode where more were

unreported. Episodes which were not reported

after both interviews generally follow the same

pattern of those unreported after the original interview. The differences between the groups are,

however, much smaller than in the original interview. The second interview reduces, but does

not eliminate, the gap between respondents of

different characteristics in how well they report

hospitalizations.

It is appropriate to consider here why the reinterview elicited a sizeable number of additional

episodes, and why the episodes unreported after

koth the original and follow-up interviews show

smaller differences in respondent characteristics.

That additional episodes are obtained by

means of a follow-up interview is not surprising.

Other studies have reported such results, even

in cases where the second interview followed the

same procedures as the first. In this study the

second interview differed in some ways from the

original, and these differences may have been

conducive to this substantial increase in reporting.

The second interview was usually taken by a male

interviewer instead of a woman, which may have

lent additional authority to the procedure. Moreover, the follow-up interviewer had more information about the purpose of the study and about

the episodes that the respondent had not reported

in the previous interview. Since these interviewers were supervisors they may have had more

experience and interviewing skill than those taking

the original interviews.

However, the researchers are inclined to

think that the major gain in reporting came about

through the fact that the respondent was encouraged once again to think about the health problems

of his family and to attempt to recall all the hospital episodes that had occurred. A second visit

was an additional stimulus to such recall. This

is substantiated in part by the fact that those

groups who reported a relatively higher proportion of episodes in the follow-up interview were

those in which one might expect memory to be the

poorest; older respondents, sample persons being

reported for by someone else, and sample persons who were more distantly related to the respondent.

The second interview may also be an added

motivational force, encouraging the respondent

to think more deeply and try harder to recall

hospitalizations. Taking a second interview must

impress the respondent with the fact that the

ag&cy conducting the survey considers it important. If it is so important to the government,

it may be worthwhile for the respondent to work

harder at his task.

As this suggests, it appears that the main

problem of reporting episodes is not that the respondent lacks knowledge of the episode, but that

considerable stimulation is frequently required

to get him to recall it.

Such speculation is of little practical value

unless it can be utilized. Here are four suggestions as to the utilization of this conclusion. First,

additional questions about hospitalizations may

help to stimulate the respondent to think about

episodes he may have overlooked. A major problem seems to be the respondent’s concept of the

12-month period prior to the interview. A solution to this might be to as.: for all hospital episodes in terms of calendar years and then to

edit out those outside rfie de. ired period. For example, if one is interviewing in 1959 ask for all

hospitalizations occurring in 1958 and 1959. Second, the interviewer should permit and encourage

the respondent to take plenty of time to consider

whether or not he has overlooked any episodes.

Third, interviewers should be provided with materials, both written and for verbal use, explaining

more about the purpose and importance of the

survey. Fourth, the technique of a partial foHowup interview might be used. When the interviewer

feels that he is obtaining uncertain responses, or

the respondent seems to be having difficulty in

recalling the information required, he might describe the information he wants and suggest that

he will call again after the respondent has had

an opportunity to think or talk with other family

members about their hospitalizations.

REACTION TO THE ILLNESS

AND THE HOSPITAL EPISODE

The questions in this section cover some of

the reactions to the illness and the hospital episode. They could be asked, of course, only for

episodes which were reported. ‘Therefore, the

only comparison which can be made is between

episodes reported in the original interview and

those not reported originally but which were included in the follow-up interview.

Table 51 shows the results of an attempt to

measure some behavior which might be expected

to correlate with underreporting of episodes.

When asked whether the sample person talked

with friends about the condition for which he was

hospitalized, two thirds answered “yes” and one

third, “no.” Of those who said they discussed the

condition, 92 percent of their episodes were reported in the first interview as compared with

43
84 percent for those who answered “no” to the

question. Some respondents qualified their answers by saying that they talked about it at the

time of the hospitalization but did not talk about

it at present because it was some time past and

there was no reason to discuss it. It may be that

part of this difference reflects the wording of the

question. However, there is at least some indication that those who are freer to talk with

friends about the condition are also freer to report the episode to the interviewer. The question

was considered as another indication of embar -

rassment or threat.

The responses to a question abut the present

status of the condition for which the person was

hospitalized are shown in table 52. It was felt

that conditions still troubling the person would be

more Likely to be reported than those which were

no longer a bother. As shown in the table only

23 or about 9 percent of the people said that the

condition was the’ same or worse than before their

hospitalization. As expected this group tended to

report more accurately on the first interview

than those whose condition was now “better:” The

chances are that this difference can be accounted

for by the fact that their conditions were more

Table 51. Percent of. episodes reported in the original interview and in the follow-up

by responses to the question: “Do you talk with friends about the condition for

which you went to the hospital?” 1

Characteristic of episode report

Talk with friends?

Yes No Don’t know

I

Percent

Total ------- -- ”---- ------- ------- 100 100 100

Reported in both original and followUP interview ------------------------- 92 84 (*)

Not reported in original but reported

in follow-up interview --------------- 8 16 (*)

Number of episodes --------------------- 160 94 8

lNot asked of delive~ie~ and only of those reportin9 an episode”

Table 52. Percent of episodes reported in the original interview and in the follow-up

by responses to the question: “How about your condition now, are YOU better or worse

now than when you went to the hospital?”l

Condition now is:

Characteristic of episode report

Better Same or worse

Percent

Reported in both original and follow-up interview ------ 88 96

Not reported in original but reported in follow-up

inteniew --------------------------------------------- 12 4

Number of episodes2------------------------------------ 229 23

lNot ~~ked of de[ive~ie~ Or episodes not reported in fol low–up,

2For ,0 ePisodes the answer to this question was not obtained.

44
serious than average.Seriousconditionsare

generallymuch betterreported.

The next three tablesrelateto diagnoses

and operations. Those who had an operation

(omittingdeliveries)were asked whetherthey

consideredtheoperationseriousor not.Table

53 shows theresultsofthisquestion.Halfofthe

respondentsconsideredtheoperationofthesample person to be not seriousand 15 percent

thoughtit was very serious.For episodesreportedin boththeoriginaland follow-upinterviews a clearpatternisobserved.Ninety-three

percentoftheepisodeswith“veryserious”operationsand 86 percentofthe“notserious”group

were reportedin theoriginaIand follow-upin.

terviews.

This findinglendssupporttothehypothesis

thateventshavinga greaterimpactwillbebetter

remembered andbetterreportedthanthosewhich

are lessserious.These resultsare alsoinline

withearlierfindingson therelationshipbetween

lengthof hospitalizationand reportingof the

episode.

Table 54 shows thediagnosticrating,and

whetheror notthe episodewas reportedinboth

theoriginalandfollow-upinterviews,inthefollow-upinterviewonly,or notreportedineither.

In thistabletheratingwas takenfrom hospital

Table 53. Percent of episodes reported in the original interview and in the follow-up

by responses to the questions: “Do you consider that the operation was serious or not

serious?” (if respondent considered it serious) “was it very seri~us or only fairly

serious?”1

I

Characteristicof episode report

Operation wks:

I I

Very Fairly Not

serious serious serious

I

Percent

Total----------------------------- 100 ] 100 100

I I

Reported in,both original and follow-up

interview------------------------------

Not reported in original but reported

in follow-up interview-----------------

93

7

92

8

86

14

Number of episodes2--------------------- 20 29 69

lllot,a~k~dof deljverie~ and includes On[.y those ,/Ji th Qper.at i<an~.

Table 54. Percent of episodes reported in the original interview, in the follow-up, or

not in either, by diagnostic rating from hospital records

Diagnostic rating

~haracteristicof episode report Most Somewhat Not

threatening threatening threatening

Total-----------------------------

L

100

Reported in both original and follow-up

interview------------------------------

Not reported in original but reported

in follow-up interview-----------------

Not reported in either interview--------

Number of episodes----------------------

75

14

11

70

Percent

100

85

9

6

113

100

90

7

3

210

45
Table 55. Percent of episodes reported in the original interview, in the follow-up, or

not in either, by type of treatment as determined from hospital records

Type of treatment

I I

Characteristic of episode report Deliveries Other

surgical Nonsurgical

Total -----------------------------

L

100

Reported in both original and follow-up

interview ------------------------------

Not reported in original but reported

in follow-up interview -----------------

Not reported i,n either interview --------

Number of episodes ----------------------

records; therefore, all episodes are included.

As was observed previously, the “most threatening” diagnoses were most poorly reported, the

“somewhat threatening” group next, and the “not

threatening” group was reported best. The follow-up interview diminishes the differences, but

the same trendis still evident. The largest proportion ofthose which were not reportedineither

interview is in the “most threatening” group and

the smallest proportion in the “not threatening”

group.

Table 55 is also based on hospital records.

It shows a comparison of episodes reported in

one of the two interviews or not reported at all,

in relation to whether or not an operation was

performed. Deliveries were so well reported that

out of 55 such episodes in the sample, 48were

reported in the original interview; 6 were added

in the follow-up, leaving only 1 delivery unreported. Certainly the birth of achildisoneof the

few types of hospitalizations which usually has

strong positive associations. Hence deliveries

represent one end on the continuum ofmotivation

toreport. Here there is not only alack of threat,

or lack of negative motivation to report,butthere

is a strong positive reaction, and presumablya

strong positive motive, to report.

Those not reported in either interview are

highest among the nonoperations group. This

probably reflects the fact that generally the nonoperation cases are less serious, less dramatic,

and shorter in duration.

The next few tables show another aspect

surrounding the hospitalization, which might be

98

2

*

55

Percent

100

86

10

4

155

100

80

11

9

183

expected to be related to memory. A previously

investigated factor is the length of thehosDitalization. -It was found that the longer the hospitalization the better the report. Other factors which

might also be expected to cause thehospitalization to have greater impact and therefore to be

better remembered are the duration of illness

before and after a hospitalization, andthe financial burden which the illness represented.

Table 56 shows ageneral trend for episodes

associated with longer immobilization periods

prior to the hospitalization to be reported better.

Sixty three percent of all episodes were reported

as having no immobilization prior tothehospitalization.

This relationship is also shown for the immobilization period following the hospitalization

in table 57. Both periods of immobilization are

related to the seriousness of the illness, of

course; These tables do, however, tend to indicate that from the standpoint of remembering a

hospitalization, not only the length ofhospitalization and the seriousness of the illness as perceived by the respondent are important, but also

the total period of immobilization.

The next table explores another aspect of

seriousness, the financial impact of thehospitalization. The question asks about the financial impact of the total cost of the episode, including

loss of pay, doctor’s bills, et cetera. As table 58

shows, the greater the financial” strain the more

likely it is that the episode was reported on the

first interview.

46
Table 56. Percent of episodesreported in the original interviewand in the follow-upby response

to the question:“Before you went to the hospital,how long were You unable to work or zo about

most of your usual activities?’!

Characteristicof episode report

Total----------------------------------

Reported in both originaland follow-up

interview-----------------------------------

Not reportedin originalbut reported in

follow-upinterview-------------------------

Number of episodes---------------------------

Immobilizationperiod after hospitalization

_G-l&-

100

89

11

202

1-4 4+ Don’t

weeks weeks know

Percent

100 I 100 I 100

88 96 95

12 4 5

42 25 41

100

(*)

(*)

9

Table 57. Percent of episodes reported in the original interviewand in the follow-upby response

to the question: “After you came home from the-hospital,how long was it before ~ou-were-able

to work or go about most of your usual activities?”

Immobilizationperiod after hospitalization

Characteristicof episode report

No 1-6 1-4 4+ Don’t

days days weeks weeks know

Total---------------------------------- 100 100

Reported in both originaland follow-up

interview---------y------------------------- 86 89

Not reported in originalbut reported in

follow-upinterview------------------------- 14 11

Number of episodes--------------------------- 75 41

Percent

100

90

10

119T

100 100

95 (*)

5 (*)

75 9

Table 58. Percent of episodes reported in the original interview and in the follow-up

by response to the q&stion: “Taking all the COS=S of this hospitalization, the hospital bills, “loss of pay, and so forth, would you say it was financially a great

strain, only a little strain, or no strain?”

Characteristic of episode report

Total .--------------- -.------ -------- --

Reported in both original and follow-up

interview-------- ------------------------ --

Not reported in original but reported in

follow-up interview ------------------------

Number of episodes ------------------------ ---

Financial strain was?

Great Little None Don’t know

Percent

100 100 100 100

__L!LH

47
It is clear from these findings, and those in

previous sections, that memory is a very important factor in the reporting of ‘hospitalizations.

Memory of episodes is heavily influenced by two

factors: recency and impact. Impact consists of

several dimensions, probably all related but all

important; the length of the hospital stay, the

seriousness of the operation, as perceived by the

respondent, the length of time the person was

immobilized before and after the hospitalization,

and the amount of financial impact on the family.

REACTION TO THE INTERVIEW

AND THE INTERVIEWER

Thus far in this report attention has been

focused on characteristics of the respondent and

the sample person as well as on the hospital episodes and factors associated with the episodes.

Another set of variables frequently found to be

related to adequacy of report in a survey involves the interaction between the interviewer

and the respondent during the interview. In this

research one aspect of respondent-interviewer

interaction was examined, using techniques which

were not designed to explore the subtleties of the

relationship, but merely to obtain some indications

of its relevance to reporting of hospital episodes.

Of particular interest is whether or not the respondent reported any negative reactions to the

interview which might reduce his motivation or

willingness to report an episode.

In the follow-up interview, questions were

asked about the respondent’s reaction to the interview and about how he thought others would

react to being interviewed. The intent of the

latter question was to encourage the respondent

to reveal his own feelings by attributing them to

others. The questions were asked in reference

to the original interview, not about the follow up.

The next tables are based on the number of episodes; that is, each respondent’s answers are

weighted by the number of episodes of the sample person.

Table 59 shows the responses to the question

as to whether or not the respondent thought any

of the questions on the first interview were too

personal or prying. Most people did not consider

the questions personal or prying. There is little

difference between how the person responded to

the question and whether or not he reported the

episode. The small difference which does show

up is in the direction which would be expected,

that the more personal or prying the questions

were considered, the poorer the response. As

would be expected the respondents who were

most concerned about the personal nature of the

questions would be among those who refused the

interview entirely.

Respondents were asked what items they

thought were too personal or prying. Some persons mentioned specific questions to which they

objected, while others gave general c~:iticisms.

The largest single criticism (15 persons) referred to questions on finances, either questions

on income or on hospital costs. Fourteen persons

said they thought the whole interview was objectionable. The remainder of the 40 who answered

yes to this question said they objected to parts of

the interview, but did not specify further,

Table 59. Percent of episodes reported in the original interview, i-n the follow-up, or

not in either by response to the question: “DO YOU fiink any of the Westions she

asked were too personal or prying?”

Response

Characteristic of episode report

Yes No

Percent

Total --------------------------------------- 100 100

Reported in both original and follow-up interview- 85 87

Not reported in original but reported in followUP interview------- -------------- --------------- 10 8

Not repor~ed in either interview ------------------ 5 5

Number of episodes 1

------- ------- ------- ------- --- 40 350

lFor ~~ree ~~js~d~~ the a,nswer to this queSt iOn was not obtained.

48
Respondents were also asked whether or not

they enjoyed the original interview (table 60).

About three fourths of all respondents reported

that they enjoyed the interview. A number of

people qualified their response by saying that

they did not enjoy the interview because discussing an illness was not particularly pleasant, but

they found the interview to be interesting. In

table 60 these responses are classified as “yes”

responses.

There is little difference in reporting between people who were positive and those who

were neutral. Persons who did not enjoy the interview were less likely to report episodes in

the original interview, and these episodes were

more Iikely to remain unreported after the follow-up interview. Whether these res~ndents did

not enjoy the interview because they felt guilty or

uneasy at not reporting the episode, or whether

they did not report the episode because the interview was unpleasant can be questioned.

Respondents were asked why they did or did

not enjoy the interview. Among both groups, tlnose

who did and those who did not enjoy the interview,

the reasons centered around the interview process, the interviewer, or to surveys in general,

rather than to problems of talking about health.

Of those who mentioned a reason for enjoying the

interview 88 percent reported the episode in the

original interview. Of those who mentioned these

factors negatively, 79 percent reported the episode in the original interview.

The content of the interview, and related

issues, was as frequently mentioned as a reason

for enjoying the interview as for disliking it.

In addition to these questions the interviewer

was asked to report any comments of the respondent which might indicate why episodes were not

reported. He was also asked to report whether

or not the respondent questioned him about the

purpose of the follow-up interview, or asked why

he had returned. It was felt that the person who

was negatively oriented to the first interview or

who had not reported accurately might be suspicious of the follow-up interview.

Table 61 shows the results of this question.

Of those who questioned the follow-up interview

74 percent reported the episode in In% interviews,

while 10 percent did not report it in either interview. A higher proportion of those who did not

question the follow-up interview reported the

episode the first time, and a smaller proportion

completely failed to regmrt it. This may mean that

the respondent was aware that he did not report

all episodes and became suspicious and uneasy

as to why a second interviewer returned asking

again abut his hospitalizations.

A final aspect of the interview investigated

was the presence or absence of other people

during the interview. The interviewer was asked

to note who was present during the follow-up interview and the extent to which they participated.

It was felt that the presence of the sample person

in an interview with a proxy respmdent might

increase the reportingof episodes if the sample

person participated. On the other hand the presence of other persons, family members or not,

might -inhibit more complete reporting, particularly if the episodes were of an embarrassing

nature.

Table 60. Percent of episodes reported in the original interview, im the follow-up, or

not at all by response to the question: “Did you enjoy the interview or not?”

Characteristic of episode report

Total-----------------.----------

Reported in both original and followUP interview -------------------------

Not reported in original but reported

in follow-up inter~iew------------r--

Not reported in either interview -------

Number of episodes ]--------------------

Enj eyed interview?

Yes

Neutral No

or mixed

Percent

100 100 100

87 89 74

8 8 15

5 3 11

288 46 54

lFor five e~i~odes the answer to this question was not obtained.

49
Table 61. Percent of episodes reported in the origimal interview, in the follow-up, or

not in either by the interviewers’ responses as to whether or not the respondent

questioned the second interview

Characteristic of episode report

Total ---------------- ----------------- ---.---

Reported in both or3.ginal and follow-up intervLewNot reported in original but reported in followUP interview “

-------- -------- -------- -------- ----

Not reported in either interview ------------------

Number of episodes -------- -------- -------- --------

Respondent questioned the

follow-up interview?

Yes No

Percent

100 I 100

I

74 88

16 8

10 4

73 320

In 50 percent of the follow-up interviews

someone else was present. In most interviews

only family members were present, but in 10

percent someone outside the family was there.

The results showed a slightly better reporting

rate in cases where others were present and

participated in the interview.

It should be remembered, however, that this

follow-up interview was taken some 2 weeks

after the first interview. Consequently, the respondent had time to discuss the matter with

other members of the household beforethefollow up. The effect therefore of the presenceof

others besides the respondent cannot be properly

evaluated with respect to how their presencemay

have affected the reporting in the original interviews. There is indication, however, that talking

to other members of the family does result in

improved reporting. This is indicated in table

50. After the follow-up interview underreporting

by proxy-respondents was not a great deal worse

than by self-respondents, especially when the

person was responding for his spouse or child.

A DISCtUMINANT ANALYSIS OF

THE FOLLOW-UP INTERVIEW DATA

The preceding parts of this report considered the influence of many factors on the reporting

of hospitai!zations, either singly, or in groups of

two or three factors at a time. Itwas found that

a number of these factors seem to be associated

wirh underreporting of hospitalization. However,

in that analysis, although some variables apparently were more important than others, it was

not possible to distinguish in a systematic way

between the more important variables and the

less important ones. To make this kind of distinction, a discriminant analysis of the follow-up

interview data was made.

In general, the findings of this analysis were

similar to those already shown, The variables

which contributed most in explaining the difference between reported and unreported hospitalizations are as follows:

1. Family income.— A respondent whose

family income was between $1,000-1,999 was

more likely to underreport; he was more likely

to report if the family income was between

$7.000-9.999.

2. ‘Type of hospitalization. —It is clearly

important to know whether or not the hospitalization was for delivery or not.

3. Enjoyment of-the interview. —Those who

did not enjoy the interview were less consistent

in reporting their hospitalizations.

4. Race of the respondent. —Nonwhite respondents were more likely to underreport hospitalizations than ‘others.

5. Time interval between discharge and interview.— The chance of reporting decreases as

the length of time between hospital discharge and

interview increases.

6. Number of ailments reported for respondent.-The more ailments the respondent

= for himself, the greater the chance that

he would report the sample person’s hospitalization.

7. Length of stay .—The longer the hospital

episode the greater the chance that it would be

reported.

50
Elsewhere in this report emphasis has been talization. The last factor was significant in the

placed on the importance of threat ratings fcm discriminant analysis. Thus the correlation bediagnoses. These ratings did not prove to be tween the ratings and the lengths of stay may

significant in the discriminant analysis. A pos - have prevented the ratings showing as significant,

sible explanation is that the more threatening the particularly since the length of stay was the first

diagnosis the more likely it is to be serious and of the two to be inserted in the regression prothe more serious, the longer the length of hospi- gram.

51
MISREPORTING CHARACTERISTICS

OF HOSPITALIZATIONS

ACCURACY OF REPORTING

THE LENGTH OF STAY

The length of stay reported in household interviews was similar to that recorded in hospital records. This may be seen in tables 62 and

63. The means from the interview reports are

slightly higher than those calculated from hospital records. One possible explanation for this

difference is that short-stay episodes are more

likely not to be reported than long ones and consequently tends to cause the average length of

stay for reported episodes to be biased upward.

The fact that the distributions are only

slightly different does not mean, of course, that

all people report accurately; it merely means

that roughly the same proportion in all groups

displace the length of their hospitalization, or

that errors in reporting length of stay tend to be

random. The pattern of variability in reporting

is shown in figure 3.

The ratios for figure 3 were calculated from

the following formula. Ratio for a stay of X days =

No. of episodes for X daysl Stay fr~ interVi* _

No. of episodes for X days! stay from hospital records

Thus for an exact report the ratio is zero. A

positive ratio indicates an overstatement of the

number of days, and the negative ones represent

understatements. Since the objective was to investigate the accuracy of reporting length of

stay for those persons who acknowledged the

hospitalization, the histogram in figure 3 is based

on matched cases only. The ratios for stays of

Table 62. Mean and median length of stay:

over 30 days are not shown because of the small

number of episodes.

The interesting phenomenon of “heaping” of

reported length of stays by logical time intervals

is demonstrated by this histogram. The’ ‘heaping”

follows two patterns. One, a rounding at 5 days

and 10 days and multiples thereof. The second

is a rounding to intervals of a week or multiples

thereof. The tendency toward rounding becomeB

greater as the number of days in the hospital

increases, The reader should note, however, that

the number of cases becomes small for the

longer hospitalizations, hence a single case has

a proportionally larger effect upon the ratio.

Although the magnitude of the rounding increases with longer stays, the proportion by

which the days are rounded does not appear to

increase substantially. That is, a rounding of 1

day in a stay of 4 days is proportionally comparable to a 5-day rounding in a 20 daysf stay.

There is about as much a tendency to round

down as to round up. The ‘heaping” for example

at 20 and 21 days seems to be accounted for by

an equal amount of understatement for 18, 19,

and 22 days. The net effect is for overstated

durations and understated durations to cancel

each other and, as has been seen, for the reports

on average length of stay from hospital records

and from interview reports to be in fairly close

agreement.

There appear to be several patterns in the

data. Tentative explanations can be advanced for

some of them. Earlier studies in rounding of reported ages in the decennial census showed a

based on interview reports and hospital

records, fo; all episodes and matched episodes

AH episodes Matched episodes

Length of stay

Reported Recorded Reported Recorded

Total l-------------------------------- 1,640 1,819 1,595 1,587

Me= nmber of daysz------------------------ 7.8 7.4 7.8 7.5

Median number OE days----------------------- 4.5 4.4 4.5 4.5

lThe lengthof stay ~a~ not obtained in 5 interview reports and 14 hospital ‘ecordso

2The standard error of the mean in each Case is 0.4 days.

52
Table 63. Percent distributionof hospital episodes by ler

hospitalrecords and interviewreports, for all el

Length of stay

(in days)

Total-----------

1----------------------

2-4-------------------

5-7-------------------

8-10------------------

11-14-----------------

15-21-----------------

22-30-----------------

31+-------------------

Unknown---------------

All episodes

,

Interview I

Hospital

reports records

Number Percentl Number Percentx

1,645 100 1,833

141 150

545 3: 646

437 27 456

181 10 212

154 9 140

5 111

:; 3 58

53 3 46

5 * 14

100

3;

25

11

:

3

2

1

;thof stay in hospital as shown in

.sodesand matched episodes

Matched episodes

Interview Hospital

reports records

Number Percentl Number PercentI

1,600 100 1,600

134 110

533 3; 547

424 27 408

176 10 193

149 9 126

5 105

B 3 55

53 3 43

5 * 13

100

7

36

26

12

lThe ~ercentage$ ~hO~” jn this table are appropriately weighted tO reflect each lndi~idual’s chance af oeing selected in the sample.

Numberof

days in

hospital

Percent understatement

Figure 3. Comparisonof lengthof stay reportedIn household interviews with that shown In nospltal records bv the ratio:

Number of episodes for x days’ stay frOM interviews

-1

Number of episodes for X days’ stay from hospital records

53
tendency to round to “logical” intervals; 10’s,

20’s, et cetera, with some less tendency to round

to 5’s and a smaller but still significant tendency

to round to 3 and 7. In figure 3 this type of rounding is noticed at 3, 5, 10, and 20 days. For reporting dates, however, a second and more powerful grouping” is natural; that of weeks. Overstatements at 1,2,3, and 4 weeks and at 1 month

may be notice~ figuring a month at 30 days.

This leaves unexplained the “heaping” at 1, 13,

and 29 days. The latter two could be accounted

for by the interviewer probing for greater accuracy. For example, suppose the respondent reports that he was in the hospital for 2 weeks. The

interviewer might subtract 1 day, for the dayhe

left the hospital and come out with a report

13 days.

MISREPORTING OF DIAGNOSES

AND OPERATIONS CAUSING

HOSPITALIZATION

of

In the interview, generally, only one diagnosis or operation was listed by the interviewer.

If more than one was listed, only one was coded

by the Bureau of the Census. This is the procedure used by the National Health Survey.

The questions on diagnosis asked of the re.

spondent were:

“What did they say at the hospital the condition was, did they use any medical terms ?“

If they did not say at the hospital what the condition was, the respndent was asked: “what did

the last doctor talked to say it was ?“

For operations the questions were:

“Were any operations performed on you

during this stay at the hospital?”

If yes, “What was the name of the operation?”

“Any other operatioim?”

As stated earlier in the report, the first

listed diagnosis on the hospital-record is the

primary reason for hospitalization. The comparisons made on diagnoses in this s ;ction are

of this diagnosis and that reported in the interview.

In making comparisons between the hospital

records and interview reports, diagnoses were

classified into groups. This was necessary because of the low incidence of most diagnostic

categories and because it would facilitate comparison between the hospital record and the interview.

The hospital record data on diagnoses were

coded by medical record personnel at the hospital using the International Classification of Diseases 1955 Revision. Information from the in-

-,

tervlews was coded by specially trained medical

coders at the Census

classification system.

Bureau, using the same

The operations from Mb the hospital record

and from the interview’ were coded by the Census

Bureau using a special two-digit code developed

by the National Health Survey for the regular

surveys.

Percentage distributions of the primary cause

of admission as reported in household interviews

and as recorded in hospital records as well as

the ratio of the number reported to those recorded

are shown in table 64. Similar distributions for

operations are shown in table 65. The data in

these tables are subject to two sources of reporting errors—nonreport of hospitalizations and

misreport of the diagnoses or operations.

In each of the tables the percentage distributions for reported and recorded episodes are

fairly similar. The largest difference is two

percentage points. (This of course is a large

relative difference if the” percentage in question

is very small.) It appears that there is little

bias in percentage distributions of diagnostic

groups or operations based on household interview repmts. However, this is not true for estimates of population aggregates. Generally, such

aggregates were underestimated. It is clear however from tables 64 and 65 that several categories

of diagnoses and operations were overstated in the

interview. Overstatements occurred if the hospital record showed one diagnosis and the respondent reported another. This might happen

if the hospital records show a more specific

diagnosis than the interview report. In this case

the magnitude of the problem might depend on

the specificity of the grouping categories used.

A glance at the listings, however, indicates that

generally this is not the case. For example, the

groups of mental and personality disorders, intracranial lesions, and diseases of the nervous

system and sense organs, might be expected to

give some problems of comparability of classification from hospital records and interview reports. If the frequency from each type of report

for the three groups are combined the result is

still an understatement. None of the three showed

an overreport. Therefore, a person who misreported one of these diagnostic groups was unlikely to have reported it as another in the same

cluster. In general, this is characteristic of other

clusters of diagnoses. They tend to be either

predominantly overreported or underreported.

A case of particular interest which shows a

different pattern is the reporting of neoplasms.

Malignant neoplasms were underreported by a

substantial amount while benign and unspecified

neoplasms show considerable overreporting.

Combining the two groups, the net effect is an

overreporting. It is reasonable to expect thatthis

54
is a case inwhichmalignanciesarereportedas nosisor perhapsbecausethephysiciandidnot

nonmalignant,perhaps because the respondent report to the patientthatthe neoplasm was

didnotwanttoreportthemore threateningdiag- malignant.

Table 64. Percent distribution of hospita1 episodes reported in interviews and recorded

in hospital records by primary cause of admission

Primary cause of admission

Total--------------------------------------

Infective and parasitic diseases-----------------

Malignant neoplasms------------------------------

Benign and unspecified neoplasms-----------------

Allergic, endocrine, and metabolic disorders-----

Mental and personality disorders-----------------

Intracranial lesions-----------------------------

Diseases of nervous system end sense organs------

Heart diseases------------------------...-...----

Hemorrhoids-------------------------------......

Other circulatorydiseases-----------------------

Upper respiratory conditions---------------------

Other respiratory conditions---------------------

Ulcer of stomach and duodenum--------------------

Appendicitis-------------------------------------

Hernia................................-----------

Diseases of the gallbladder----------------------

Other digestive system conditions----------------

Female breast and genital disorders--------------

Other,genitourinaryconditions-------------------

Deliveries---------------------------.......-----

Pre- end post-natal conditions-------------------

Diseases of the skin-----------------------------

Arthritis----------------------------------------

Other musculoskeletaldisorders------------------

Fractures and dislocations-----------------------

Other current injuries---------------------------

Observation only---------------------------------

All other conditions-----------------------------

lqodiagnosis or diagnosis unknown----------------

Reported

in

interview

Percent

100

Recorded

in

hospital

record

Percent

100

Ratio of

reported to

recorded

0.90

1.45

0.76

1.51

1.04

(*)

(*)

0.55

0.95

0.80

0.75

‘0.90

0.76

1.12

0.93

1.06

1.10

0,63

0.56

0.91

0.98

0.85

0.58

(*)

0.87

1.05

1.08

(*)

1.09

(*)

55
Table 65. Percent distribution of hospital episodes reported in interviews and recorded

in hospital records by type of operation

Type of operation

Total .---------.-------.------------- ---,_--

Operations on the brain and skull----------------

Eye operations --------.--------------------------

Varicose veins -----------------------------------

Tonsillectomy and adenoidectomy ------------------

Operations for stomach ulcers --------------------

Other operations on the stomach------------------

Appendectomies -------------------------------- ---

Repati of hernias ---------------- ----------------

Operations on the intestines ---------------------

Operations for hemorrhoids -----------------------

Operations on the gallbladder --------------------

Operations on the kidneys ------------------------

Operations on the bladder------------------------

Operations on the male genital system------------

Hysterectomies -----------------------------------

Other fe~le genital operations ------------------

Reduction of fractures and dislocations ----------

Cesarean deliveries ------------------------------

All other deliveries --.----------------.---------

Type of operation unknown ------------------------

No operation performed -------- --------”’.----------

All other operations ------.----------------------

Reported

in

interview

Percent

100

*

2

9<

6

$<

1

2

4

1

1

2

1

1

1

1

;

2;

3:

10

Recorded

hos~tal

record

Percent

100

*

2

*

6

*

1

2

3

1

1

2

;

1

;

5

2;

*

::

Ratio of

reported to

recorded

0.90

(*)

0.82

(*)

0.89

(*)

(*)

1.08

1.12

0.88

1.05

1.01

(*)

0.58

0.54

0.96

0.62

1.04

1.02

0.96

(*)

0.93

0.73

56
APPENDIX I

PART 1: SAMPLING ERRORS

Sample interview surveys, if properly conducted,

can yield valuable information and useful estimates. Such

estimates are subject to errors, however, which maybe

classified into 4 major types: sampling errors, nonresponse errors, reporting errors, and processing errors.

Attempted complete enumerations contain the same

sources of error, except for the sampling component.

The subject of this study is reporting errors as they relate to hospitalization. Processing errors were kept at

a minimum by the use of experienced personnel and quality control measures.

The errors arising from failure to complete designated interviews are known as nonresponse errors. Nonresponse is discussed in part 2 of this Appendix.

Estimates based on a sample will differ somewhat

from figures that would have been obtained if the entire

population had been interviewed, using the same survey

procedures, techniques, et cetera. If repeated samples

of the same size were selected horn the population,

some sample estimates would be smaller than the population value and some would be larger; the larger the

sample the closer on the average would be the estimates

to the population value. The sampling error is a measure of the scatter of sample estimates, such as means

and totals, horn the ~pulation value.

In general, the sampling error of one statistic is

different horn that for another statistic; even when the

two come from the same survey. However, it would be

time consuming and costly to present separately the

sampling error for each of the many estimates obtained

in this report. Sampling errors were computed for a

large number of different estimates obtained in the

study. Fortunately, most of the sampling errors showed

a fair amount of consistency, enough to warrant the

presentation of a table giving rough estimates of the

ssmpling errors of various percentages, for different

numbers of hospital discharges.

The approximate sampling errors are given in table

A. These values are 1.5 times the standard error for

simple random sampling. This formula was used since

many sample error computations, based on an empirical method of paired differences,l showed a corres~nding increase over simple random error. For most estimates shown in this report the chances are 68 in 100

that the value being estimated lies within a range equal

to the percent underreport, plus or minus the appropriate sampling error shown in table A, and 95 in 100

that it lies within a range equal to the percent underreport plus or minus twice the sampling error.

An example will illustrate the use of table A. Table

1 shows that for female respondents the estimate of underreporting is 10 percent based on 1,522 discharges.

Referring to table A, it can be ascertained that for 1,500

cases and an underreporting of 10 percent, the ssmpling error is 1.2 percentage points. Thus, the range 10

percent ~ 1.2 percent is likely to contain the population

value in about 68 cases out of every 100. The range of

10 percent ~ 2.4 percent will contain the population

value in abut 95 cases out of every 100.

Table A can also be used to determine if the difference between two percentages is statistically significant. To illustrate, it is desired to determine if the difference between the percent underreporting by male respondents a~d that for female respondents is statistically

significant. (Table 2 shows an underreport for male respondents of 11 percent based on311 discharges.) From

table A the approximate sampling errors for estimates

lKi5h

, L., and Hess, l.: On variances 0 f ratios and their differences inmultistaqe saTiPle5.

J. An. Stat. .45s. 54: 416-446, June 1’359.

Table A. Approximate sampling error of underreporting percentages shown in this report

(expressed in percentage points)

Number of discharges recorded

1,721 ---------------------------------------

1,500---------------------------------------

1,000---------.--------------------------- --

700--------------------------- ------------

500---------------------------------------

400---------------------------------------

300---------------------------------------

200---------------------------- -----------

100---------------------------------------

50

1.8

2.0

2.4

2.9

3.4

3.8

4.4

5.3

7.5

Percent underreport

30 or 70

1.6

1.8

;::

3.1

3.4

4.0

5.0

6.9

20 or 80 10 or 90

1.1

1.2

1.4

1.7

2.1

2.3

2.7

3.3

4.5

5 or 95

0.8

0.9

1.1

1.3

1.5

L 7

1.9

57
Of II Dercent (p:) basedon 31i discharges and lo Perceix(pp)basedon l,522discharges are2.7 percent and ‘[~1 - P2J =

[2.7)2 + I 1.212 = 3.0 oercentac!e pcints

i.2 percent, respectively. The standard error of thedif- The difference therefore of 1 percentage point is

~p~i~’ ‘PI

assumingpl and p2 are inciepend-

- P.2, not statistically significant at the 0.05 level.

PART 2: ANALYSIS

In any survey there are usually a certain number of

persons who camot be interviewed because they refuse

the interview, no one is found at home, they are too ill

to speak with the interviewer, et cetera. These incomplete interviews are referred to as nonresponses.

In this study the list of discharges from which the

sample was selected contained namea that were not considered as in the defined universe. These included death

discharges, persons whose addresses were outside the

study area, persons who died after discharge but prior

to the interview, persons who could not be located because they had moved to an unknown address, and persons designated for the sample whose names were not

listed in the interview. These are referred to as nonsample.

Ordinarily, estimates are made by assuming that

characteristics of persons not interviewed are similar

to those who were. There is a tendency, however, for

the characteristics of nonresponses to be different from

the characteristics of those interviewed. Thus unless the

nonresponse rate is small the results of the survey may

be biased to an important degree.

It is not alwaya pmsible to evaluate the nonreapcmse

error. However, such an evaluation was possible for this

study since characteristics of the sample are known from

hospital records. This section presents an analysis of

nonresponse. A comparison of some of the characteristics of persons interviewed and not interviewed is shown

in table B.

There were 84 persons who were not interviewed,

accounting for 95 hospital episodes according to the hospital records. This is a nonresponse rate of 5.2 percent.

‘his figure must be considered a low estimate of the

nonresponses since some cases classified as nonsample

may actually have been nonresponses. This is particularly true of cases where the sample person was not

listed by the interviewer as a member of the household

at the designated address. The interviewers were given

the address and last name of the family of the sample

person, but the person himself was not identified. After

locating the family. the interviewer listed all members

of the family living there. If the sample person was not

listed it was assumed that he no longer lived there. In

some cases this assumption may be incorrect. The absence of a sample name maybe due to failure of the respondent to list him as a member of the household.

The 84 nonresponses consist of the following types:

h

Number of Number of

people episodes

Total ------------ 84 95

Refusals --------------- 32 37

No reaponsbile person

located at home------ 51 57

Other ------------------ 1 1

OF NONRESPONSE

Table B. Percent distribution of sample persons interviewed and not interviewed by des -

ignated characteristics of the sample persona 1

Characteristic

Sex

Male --------------

Female ------------

Number of

hospitalizations

1-------- ---------

2-------- -------- -

3+------- ------- --

Age of sample

nerson

O-1 year ----------

1-9 yesrs ---------

10-17 yeera -------

18-34 years -------

35-54 years -------

55-64 yesrs -------

65-74 yesrs -------

75+ years ---------

Unknown-----------

Not Interviewed

interviewed

Percent distribution

42

58

95

3

2

0

15

:

28

16

15

12

4

90

9

1

1

16

5

35

26

8

6

3

*.

lTne ages for the two groups are not exactly

comparable since the age of the i nterviewed

group was taken from the interview report and

for the non responses from the hospital records.

The age on the hospital records may differ from

I to Z“years from that reported in the interview

because of the time lapse between occurrence and

interviewing. The other characteristics shown in

the table were taken from the hospital records.

The following can be observed intable B.

1. A larger proportfonofthenonresponses were

for males.

2. Nonreaponses were more often for persons who

had only a single hospitalization during the year.

3. Although the two distributions of ages are not

quite comparable, it is clear thatnonresponse

sample persons were generally older thanthose

interviewed. Forty-three percentoflhoaenot interviewed were55 years of age and older compared witb 17percent fortbefnterviewed group.

58
Relatively fewer sample persons in the nonresponse

group were in the hospital for delivery than were those

with completed interviews (6 percent and 22 percent, respectively). This probably reflects the age differences

already noted.

The average duration of hospitalization is greater

for the nonresponse group, the average being 8.8 days

compared with 7,4 days for the other group.

It is clear that the two groups are not alike with respect to these characteristics. PersonS in the nonresponse group tend to have characteristics of people who

were found to be poor reporters. That is, they are older

people, have few deliveries, et cetera. Since the nonresponse rate was only about five percent, even when characteristics of nonresponses differ from those of persons

responding as much as these do, estimates should not be

biased to an important degree. However, this analysis

points to the need of maintaining a high response rate in

surveys of this kind,

59
APPENDIX II

The diagnostic and operation ratings discussed in this report are structured as follows:

Rating of Diagnoses

Rating 1

Most Embarrassing or Threatening

Syphilis and its sequelae

Gonococcal infection and other venereal diseases

Spirochetal diseases, except syphilis

Neoplasm of unspecified nature

Malignant neoplasm of breast and genitourinary organs

Psychoses

Psychoneurotic disorders

Disorders of character, behavior, and intelligence

Other diseases of urinary system

Diseases of male genital organs

Diseases of breast, ovary, fallopian tube, and parametrium

Diseases of uterus and other female

Congenital malformations

Rating 2

Somewhat Embarrassing or

Tuberculosis of respiratory system

Tuberculosis. other forms

genital organs

Threatening

Infectious diseases commonly arising in intestinal tract

Other infective and parasitic diseases

Malignant neoplasm of buccal cavity and pharynx

Malignant neoplasm of digestive organs and

peritoneum

Malignant neoplasm of respiratory system

Malignant neoplasm of other and unspecified sites

Neoplasms of lymphatic and hematopoietic tissues

Benign neoplasm

Vascular lesions affecting central nervous system

Inflammatory diseases of central nervous system

Other diseases of central nervous system

Other diseases of intestines and peritoneum

Nephritis and nephrosis

Complications of the puerperium

Abortion

Delivery with specified complication

Complications of the puerperium

Symptoms referable to systems or organs

Senility and ill-defined diseases

Head injury (excluding skull fracture)

Internal injury of chest, abdomen, and pelvis

Laceration and open wound of face, neck, and trunk

Laceration and open wound of upper limb

Laceration and open wound of lower limb

Rating 3

Nat Embarrassing ar Threatening

Other bacterial diseases

Diseases attributable to viruses

Typhus and other rickettsiaI diseases

Malaria

Allergic disorders

Diseases of thyroid gland

Diabetes mellitus

Diseases of other endocrine glands

Avitaminoses and other metabolic diseases

Diseases of blood-forming organs

Diseases of nerves and peripheral ganglia

Inflammatory diseases of eye

Other diseases and conditions of eye

Diseases of ear and mastoid process

Rheumatic fever

Chronic rheumatic heart disease

Arteriosclerotic and degenerative heart disease

Other diseases of heart

Hypertensive heart disease

Other hypertensive disease

Diseases of arteries

Diseases of veins and, other diseases of circulatory

system

Acute upper respiratory infections

Influenza

Pneumonia

Bronchitis

Other diseases of respiratory system

Diseases of buccal cavity and esophagus

Diseases of stomach and duodenum

Appendicitis

Hernia of abdominal cavity

Diseases of liver, gallbladder, and pancreas

Deliver y without mention of complication

Infections of skin and subcutaneous tissue

Other diseases of skin and subcutaneous tissue

Arthritis and rheumatism, except rheumatic fever

Osteomyelitis and other diseases of bone anc[ joint

Other diseases of musculoskeletal system

Birth injuries, asphyxia, and infections of newborn

Other diseases peculiar to early infancy

Fracture of skull, spine, and trunk

Fracture of upper limb

Fracture of lower limb

Dislocation without fracture

Sprains and strains of joints and adjacent muscles

Laceration and open wounds of multiple location

Superficial injury

Contusion and crushing with intact skin surfsce

Effects of foreign body entering through orifice

Burns

60
Injury to nerves and spinal cord without kme injury

Effects of poisons

Effects of weather, exposure, and related conditions

Other and unspecified injuries and reactions

Rating of Operations

Rating 1

Embarrassing or Threatening

Treatment and tests, with operations, for mental and

nervous disorders

Operations on the brain

Operations on the skull

Operations for hernia of any abdominal site

Operations for hemorrhoids

Operations on kidney

Operations on bladder

Circumcision

Operations on prostate gland

Other operations on male genital organs

Mastectomy (complete or partial)

Other operations on breast

Hysterectomy (with or without other operations performed at the same time)

D and C

Other operations on female genital organs

Amputations of finger(s), toe(s)

Amputations of arm(s), leg(s)

Rating 3

Not Embarrassing or Threatening

Thyroidectomy

Other operations on the thyroid gland

Operations on other endocrine glands (adrenal, parathyroid, pineal, pituitary, thymus)

Operations on the spinal cord

Other operations on nervous system, except eye, ear

Operations on eye, any part

Operations on ear, any part, except mastoid involvement

Operations involving mastoid process (mastoidectomy)

Operations on heart

Operations for varicose veins

Operations on arteries, veins, capillaries, not elsewhere classified

Operations on lymph glands or nodes, lymph vessels or

channels, spleen, ?mne marrow, operations for infected lymph glands of any site

Tonsillectomy and/or adenoidectomy

Other operations on throat, pharynx, tonsils

Operations on nose

Operations on sinuses

Operations on lung and pleura

Operations on other sites of respiratory system, and

chest, not elsewhere classified

Operations on ;eeth, gums, and : aw, not eLsewhere ,

classified

Operations on other sites of buccal cavity

Operations for stomach ulcers

Other operations on stomach

Operations for appendicitis

Operations on the liver

Operations on gallbladder

Skin graft

Operation for pilonidal cyst

Other operations on skin and subcutaneous tissue

Operation$ for fractures

Operations for dislocations

Operations for knee derangements

Operations for spinal “disc” conditions

Other operations on bone

Normal delivery

Forceps delivery

Cesarean delivery

Other operations

61
APPENDIX Ill

Hospitals Which Co-operated in the Study

The hospital universe on which the study is based participants in the Professional Activity Study of the

is composed of persons discharged from the following Commission on Professional and Hospital Activities

hospitals. At the time of this study the hospitals were Inc., which is described below.

Hospital

Miami Valley Hospital

Butterworth Hospital

Blodgett Memorial Hospital

Pontiac General Hospital

Hillsdale Community

Health Center

Pawating Hospital

Syracuse Memorial Hospital

Crouse-Irving Hospital

Community Hospital

The St. Francis Hospital

The Abbott Hospital

Menorah Medical Center

General Rose Memorial

Hospital

Holy Cross Hospital

St. Peters General Hospital

Mercer Hospital

Memorial Hospital

Highland Park Hospital

Foundation

Lake Forest Hospital

Mercy Hospital

Sisters Hospital

Location

Dayton, Ohio

Grand Rapids, Mich.

Grand Rapids, Mich.

Pontiac, Mich.

Hillsdale, Mich.

Niles, Mich.

Syracuse, N. Y.

Syracuse, N. Y.

Indianapolis, Ind.

Hartford, Corm.

Minneapolis, Minn.

Kansas City, Mo.

Denver, Colo.

Salt Lake City, Utah

New Brunswick, N. J.

Trenton, N. J.

Charleston, W. Va.

Highland Park, Ill.

Lake Forest, 111.

Altoona, Pa.

Waterville, Me.

The Professional

The Professional Activity Study (PAS) of the Commission on Professional and Hospital Activities, Inc.,

has its headquarters in Ann Arbor, Michigan.

PAS serves a large number of hospitals (95 hospitals were participating in PAS when this study began) by

processing data from prescribed clinical records which

are submitted each month by the participating hospitals.

The Commission is sponsored by the American College

of Physicians, the American College of Surgeons, the

American Hospital Association, and the Southwest Michigan Hospital Council.

The main objective of PAS is to improve the quality

of patient care and treatment rendered by participating

hospitals. PAS meets this objective by furnishing to the

hospitals information about each hospital’s experience in

treating patients in relation to the experiences of the

Annual

Discharges

28,000

21,000

16,000

16,000

4,000

6,000

15,000

12,000

17,000

23,000

9,000

12,000

14,000

12,000

14,000

11,000

12,000

7,000

3,000

6,000

5,000

Activity Study

other hospitals, by providing information to individual

physicians about his patients, and by furnishing information about patient care for the entire medical staff of

the hospital. Before a hospital can belong to PAS, it must

be approved for the listing of hospitals published by the

American Hospital Association. In addition, the hospital’s

medical staff and the hospital board of trustees must

agree to participation in the study.

The PAS hospitals, therefore, should be above the

average in their professional standing, each having a

personal and vital interest in the quality of reports that

are made to PAS. Thus the use of PAS hospitals in this

study should provide an advantage by offering high quality medical records and dependable personnel to make

accurate abstracts of the hospital records.

62
APPENDIX IV

FORMS AND QUESTIONNAIRES USED IN THE STUDY

B.dut Bure.u No.68-R632-S% ApmovdExpire sJuly 31,1959

FORM NH3.S4 U.S. DEPARTMENT OF COMMERCE

[2. 16.s01

1.0 l.%mpledkchuge 2. W.ekof imterview

BURCAUOF THC CCNSUS

02 Other*

3. sr.wm:~. dischuge occurred 4. No. of~is:har.q:s inyem

CASE ABSTRACT FORM

preceding mtervzew week

DA+,. I, 19X!-MU.31, 1959

m&JUky 1,1957-Much 31,1958

5a. Nmneofp.tient* 9. Nsma u,ddfressofho spicsl I DO NOT

uSE

b. Address (Mo.:rec..ttiom) (S:r..t. cJW. c. Telephone No.

m., stat.)

10. Pacienc’s hospicslnumbeP

I

d. Age . . sex 11. Dischuge *(Wan@. day. Y*-, tin-)

o Male m Fends A.M.

5a. Nearest relative b. Relationship —P. M.

13. Admission” fmso.th. d.n Y..., th.)

c. Luestaddcess(n Same is5b) d. Tclepboac No. A.M.

(St,..t, city, Zo”* SW*) —P.M.

13. ~:::dr~ediagnoses” (u.tin.nm .d.r..ahowmcn

, I

7.. Person responsible fu bill {

b. Latest address ( o .%me as 5b) C. Telephone No.

(St,..f, City, BOn., stat.)

14. oper8t:0a**

B.. Nmme of employer

b. Address (str..t, cftr, on., s:.t.) c. Telephone No.

L

t ,

15. W*S (put of) hospitml bill psidbysny kind of ioswwce? 17. heshspit.l recmdidicste tiactiisp~c atwa= insome

n IYCS m2No. If”Yes,” indi.ate ki.d.fiuwmce* orberhospital witbim rhcls.t 12 mambs? O Yes 0!(.

o B1.c,Goss OC.rnmer.i=l 00rbcr(sP..MY~ If ‘Yes,”

I

ffospicaf

16. Coscofhospicslizntion* Amount Address

00 NOT

USE D*CC discbqed

a. Total bospital bill $

Pmid by.xchsrgedto 1S. W-pmticnt tis=buged fi=tits hospidxsomeo&er

Cilllti ● ●

b. Insurance $

(s3 ~le A) lwrween J=mUIT L l%&S;e~b 3~N~9?

c. Pub2ic or private ..*i8rmnce (S3 Sample B) between B dicchuge mad Much 31, 1959;

wencies (chuity) s

o Yen u No.

d. Patient (or person responsible

If “ Yes,” ester dischusc dstc@V

for puient) $

.. other $

I I

● (hoplete only dmse items if item 1 is cbukcd “other.”

NOTEt tit 15 mad 16 wh.n item 3 indi.mes * S~le B discharge.

Remuks

Uscowhboc 7*,SS.P

64
QUESTIONNAIRE

The items below show the exact content and wording of the questionnaire used in the household survey. The actual

questionnaire is designed for a household as a unit and includes additional spaces for reports on mmre than one person.

l%. N.ciom.l HeaIch Sweyisa.*.rizcd by P.bli. hw6520f ~eMch C.ngr.ss (7OSmt48%42U.S.C. 305). AIlinformatimwhicb

CONFIOENTIAIJ w..ld permit idc.tifi..ci.n .f tbe indi~id~l Wiu ~ held .Ui+ .~fid,.c~li ~illbe.s.d ..lybyw, . . . ..s.g.d~=df~~=

rw+... .f th. SUIV.Y. ..d will .oc ~ di..l.~.d or r.1...=d co 0~..s foI ~Y .tb.r PW..S (22 FR 1607).

Form NHS-2 U.S. DEPARTMENT OF COMNERCE 1. @-,i....~.

i4-18-S8) BUREAU OF THE CEN3US

Acums .s CollCainc k-x 10, tb.

U.S. p uBuc HEALTH sERvla

d

NATIONAL HEALTH SURVEY

Qu-~0.-2.=

2. (o) Ad&.s. wdos.ripim oflo..! ion 2. Id,.. 4. S.lb. 5. sample 6. PSI 7. .%=*., No.

code

3. ~ri.1 N=

sample Nnmbec

vcigbi

9.1sfhlsho”’. *. f.m.rramch7 . . . . . . . . . . . . . . . . . .. OY<. ONO

10. what is *h. I.lwbn. ““mb.r ho-? 11. what i. A ko.t +1m9,. ..11?

[b) Typ. .{ liv. ~m Dwelli.s unit (G) N.u.. of SWCi.1 D.mllir.& PI...

ins qnarm,,lm Dtb.,

12. A,.,h.r. ony.+h.rliwimg quwt.rs, .<..pl.dor

14. 0=s onyon. .[s. 11.1.s 1. ,!.1s b.ildr.q “.. YOUR

v.m., ,,.,hkbuRd,n g[emtim,.,) ? . . . . . . . . . . . . OY.. O No ENTRANCE l.stil. hl. IIvIw wafter.?. . . . . . . . . . .. OY.’ aN.a

A’k m .11 un’rs cxc%8. xnm,housex tN5TRt2cT10Ns

13. ls,h.r. n.yofh.r bulldl.s emlhlsprop.tiy f*p..pl. ll-Y.=- mqnescions 12, J30c 14.pplrdefi.i,ica ofxdw.lfi qtittoder.rti..

,. Ii.. In . .Ilh.r . ..v.ld ..”...=4? ., . . . . . . . . ...0 Ye’ m No

whd.er one o, mom .dd,,,oo.l q.est,onmires sho.ld be fill<d and “kkr the

Iki.s is mbe m,m,md.

15. RECORD OF CAL LSAT HOUSEHOLDS

Item 1 cam. 2 corn. 3 CoIn. 4 Coml. 5 CM9

D.,.

Emim h.uschold -. ---——— ----—- . . ------ -- —-—-- .- —— --- -

Tmm

Callbacks for I

D.,.

md,vidu.1 L%l. No. _ ~~m=

----- 7

------- - --------- -—----- --------

rcsp.andec.,s

16 REASON FOR NON-INTERVIEW

D Un.blc 10 ]0.,,= n Abed fran cbis address Comments .m Nazintemiew:

Moved to:

a No M. bOMC- ICp..2d ..11S

Resson: D Refusml

(sweet ad&e8*, City., sum)

D TempwuiIy absent

Expected due of return:

a Otbcr (SP..IW

17. S&mmuC .1 lnmview., ,s. cd.

*..,.1 m.m.., ions m .mc*

1. (.) Wh.+ i. lh. “nom of ,h. h..d of $hls h..s.h.ld? (1.n,.r nmnc in 1,.., column) L-r mm. (1)

(b) What or. ,h. nom.. cd all .,h.r 9,,s..s who 1;,. h.,.? ,1.,,, .11 p,,,... who u,.+ 1,,. he,,,

-“d ,!1 PC,,.”, ,,.Y,.K 1,,.,. who ha,< . . . ...1 ,1,., ef ,cs,dm., e ,Isewhcr.. L,., ,hcse

P., SO.S i. the Pres. r,bcd orde:. )

(=1 Do e.? (OIW 1-%.,s or ronm.rs 11”. h-.? ~;No m Y.. (Lm] _ Z

(d) 1, Ih.,. my... .1s. wh. 11... h.,. who IS now

——-—--—— ---

awoy w Lw, [n.ss? On a .!.1,7 Tomp.,.,ily in k~ No m Yes (Lm) _

a Imsptlol?

~ Pi’*’ “’m” *“J 1“1’ui

(.) 1. *h.,. ..7 . ...1.. staying h.,. n-w? in No m Yes (List) — ● -— -—-— _____ _____ -——- -—------ -—- — . ------- —---—---

(f) D. ..7.1 *Iws. P-d. hsv. a home .I..whu.?

= No (1..., en q.c,,ionnmim) ~~ Y., (If no, . b.auschold mmbe,, d<!<!. )

2. Hew .,. y.. ,.1.,.d !. lh. h..d .1 ,ha bu..held? (E”,., ,c1,cionsW,p m head, 10, <x..mplc: R.1.zim.hip

h.zd, w, f., d.tigh!$r, grand,.., myh.r-i.-l.-, p.rm.r, lcdgm, bd$.r,s wife, m.-) Hc.d

As. n Ur..k

3.How .Id w,,. you . . vu, 1.s1 blrthd.y? 1 y.=

4. R.,. (Check . . . box f., each p.r,c.n)

n Wli,c Cl Nest.

c Olk

5. %x (Check one box b etch p.,,..) a >$.1. = Fend.

6. Wh.r. w.,. k barn? (Record sta!e or foreign cmnmy) (31.,e G+fOr.n&” mlmq) —

1[ 14 y,.,. ❑ld m o..,, .-k: g Undrz 14 y,sr,

7. k. p. new morrl.d, wld.w.d, dkmd, ..p.,m.d m n+,., mawlwd?

(Ch..k on= box (=+ ..ch wm..)

~ h~icd u Divined

= wide-cd ~ .%mr.wd

CJ N“rI mmmied

N 14 y..,. old o, mm, s.k, Q Now m IMm 14 ~em

B. What IS IIW hlsh.sr .md. you ..rqdmid 1P.cheol? Elm.: 11>4S67S

(Circle highemgr.d. .mpleted or check aN.am.) N@: 1234

cell..qc 1 2 3 4 5+

65
U Male and 14 Y.=. old or o?er, ..k:

% (4 Dld Y.. ovo? am.. 1. lb. Arm.d For... .1 th. u.1,.d S,ot..?

O Fem. o, und. 14 y,..

If ‘Y.., ” .sk:

1--] y,, :.JN*

(b] A.. y.. n.- 1. lb A,m.d F.,..., ..1 ..unti.g th. ,...,..s?

—-. —_____ _-

If ‘Y..,. delete thi. pet... <cornqu..cionn.lre) b

n Yes D No

(4 W.. env ●1 Y9W -w!- dwlno 0 -., m .?=s N P.o... NM* 00I”?

II .~t,- .sk:

a w., m T.’:;,y

——. = _________

(d) Dudmgwhich . ..414 Y.V SW.? m ~:~;~h~ ~ Ww-[1

If .P...e<irc... only, ..k: m w-l n Km..n

(*) w.* -V ●f Y- wI.* ~W J..* 27, 1950 -d 1-u*v 31, 1955?

-— _______ ___

c: ye’ ~ No

If 6 ,.-S CM * . ..r. ●.k: D Undec 6 ye-.

10. (.) What -t. vw d.i.g nm.1 .f Ifu P.,1 12 m.mhs -.

~ Working

(Fm m.la. ov.r 16) w-klns, Iookl.” Iw -k, O. d.log ..m.lhl.a .1,.?

(Far fem.les .-e: 16} -rkln#, f-klns f.r *.*k, k..pl.s fm.s.. m dol.a ..m.thlw .1s.?

C2 Looki.g f., work

(For childrcr. 616) solns t. Ichc+l or d.1.o s.-hlns .1s.? 0 K..pi.E h..,.

If .S-mn.thir!s else. checked, .nN s..,... 1. 507 . . . . old or we,, ..k: U G.itw t. school

(k) A,. 7.. ,oNrod?

~,1 Something .1..

-— —--- -- —----

R

1.ter.fiew c.ch .duft pec..n fm himself for q.e.tio.. 11.26 .nd T.bl.. 1, N, ..d A, if CJ ffe.P.nded for ■lf

h. i. u honm. Enter column number of u.p.dent i. each column.

Cccl. No._ w., re,ponden,

w. .- Iti”o,,d N, .!1 kind. of If Inc.., .hmh+r ,.,1..s “ “o! - u Y,. ON.

11. W,” “.. .I.k w .ny N= LAST WEEK OR THE WEEK BEFORE?

(.) wk.+ -.s lb maw.??

(b) A.ythl.. .1s.?

12. L.’t -“k or *h. w-k kakm dli 7=. h.- ..? =ccldmt. w Mud.., .Nhor m

bn W w., h.. fun?

(*) mm w-. fby?

(b) Anf+lng .1..7

0 Yes a No

Il. D1d 7.” hot -y Ilf .%*. I.,t -k ● lb wok bofu. Imm on .c.ld.nt # n Yes O No

i.Iwy thm h.~tui b=fw. *hw NH?

(.) m- .-. lb=.. *cl.?

(b) A.ylhloq .1..?

14 L.,t voob cc ,ha -..b kdon dli P. t.k. -. modl.1.. - It-moot {of .“7 (4 PN -h- ~NI-s? n Ye.

condN1on (bo,[ do, . . . +Ith mu 1.14 mmbow)?

n No

(k) A“fihlw .1-?

1s, AT Tfw PRESENT TIME d. s.. h... w .N-ms - ..1411H that h-. l..td

(W . Ins 11-? (K ‘N..) Ev.m ,fnWh ifn” An,t bother y.. .11 *h. Nm.?

(4 What w. “tfuyi n Yes

-@L&!YtMSs ●I**?.

o N.

Dld

P.

w.,

.Ik

LA&vl

. .?

*

Tabl.”1 - ILLNESSES, IMPAIRMENTS AND ACCIDENTS

w%.) did ,ho &c$a .W I* If ● . lmwmatcm Lx If .7.

w.? -614 b ““ -7

41..1,-.,

.Ywmu ., . .Omskio. trouble

f,.- q. 13 m q. 17, of may

..k: kid

(If doctor .- t.lked t. - .N.ae .nd

6 7c*.

‘h ‘“* fi” -“** ~...? old o,

(11.ccident w iaiuv, .1.. %’

fii] T.ble A)

ind. (.) - r.cord ,e._

de-% &,cri@ca)

(If ill-of f..,. of earfier

=ccid.nc, record iff effect.

-d d’. fill Table A)

Fc8 am=ci&.t or initm7

ccc.xri~ dwiw pm 2

.C,k., .*,

ffll=swm.fffnb+.m.

b?? ff%- kind ●f +cy

w,. I*7 ~klq .1-7

(Aka, Iii] T.blc A)

(&l)

I

~ cd.

s No. Que.

m of , I-

.5 w No.

4 =Ca

(4 (b)

o Ye.

1

0 No

1 I — I

--’ f. w - NDSPITALIZATIDN DfJRING PAST 12 ~NTNS I

,..

Whrn bind of. . .smukl.

1. 1,7

Ask on17 for,

c.” A., cow i. cd. (d-l)

or (d-2)of: ,.”

,..-;.. ccmplnd

m... -wit b

J (&z) (d.>) (d-d)

Xloy-1 x

I lnN. I

Wfmtpall .1 k b+ 1. LA2T WEEK frodk”d? OR THE nm”y

Show in f.llovi.~ det.il WEEK E.E- d.7s,

for u.cmks listed below FORE dld Includ.

. . . .0”,. Iw

H-d . (skull. . ..1. or ,.” * CM k 2

id Idown- IWO.k.

M

Y* “*LWI Splmo. (u~,, tr,iddle or ~,lvl,,o, d.?

. low.,)

back

f., a. mwh

. . . d.7?

A~- (S&odder, UPF,,

elbow, lower, wrist,

Check . . .

bad) No Y..

Lss - (Hip, upper, k..e,

1.-. ankle, AYJI)

ALSO

(00

(.

If Um, 1.’, q., w ear, =.,.

.I=,c whcthe ONE w (m>

BOTN.

i

.isht ?

(4 (d) 6) (i) b) *I fl)

If.: _ n Au n v..

o Y..

f

u No

.

h —l— lx,. I-A =IUNO \ I I

I I I I I I

I

TABLE A (A ccld.nts and lniurl+ I

Liti~=No. 1. W z .f *k kod7 . . . butt? Wful bl.d .S Injury . . . I*? A.tihln. .1..?

T.bf. 1

U Accidem h.pw.ed dwi.s

P==, 2 -=.kz

, !!%.. dld it h.,pcn?

~ A.cideat h.~..d dwi.g

Yew _ (Enter -tb .1s. if At year i. 1957a 1$5s) Month P.., 2 week.

66
It. Ii., ..,=n. 1. lh. k+ - z’.., y.w-, .,.. -hd ..Y .1 ,h.. eoadlNon. !2URlffC

THE PAST 12 MONTHS?

(Rc.d C.rd A, .c..ditiom by c.mditica; r..nrd say .enditi-.

mestio.ed i. the ..IwM for che pet...)

17. D... WV... I. IfM kmlty hov. MY 4 h.. . ..4 NI*.s?

(R..d C.rd B, .onditi.. by condition; r..wd ..y condkion.

nwmion.d in k C.1U6W b the per...)

18. la) LAST WEEK OR THE WEEK BEFORE did ❑ nywna in dw I.dlv - v., VW-. .f..-lklk

4.. d..tu ● w 1.. de.sw,s .#fl.. . . <link? Ave.. d-?

]r -Y<,.

(h) HOW m..y Ii-.. d.rln, *h. Pm.t 2 ..**k*?

[.) wb.r. did,.. t.lk I. fh. 4..1..?

(d) w- m.ny Non.. .! -- (bin., .1{1.., .11.1., m..)?

(R.<md t.t.l number .1 tkas fot each type .( F.I.c4

(. H.spic.l clink. . ..l.d.. .v.r.isht .uY.]

19. (.) La.t . ..k ., *h. w..k b.f.r* dld -Y..* In th. I.mllv s. 1. ● d..,lst? A*YM* ●Is*?

[f .Y.*-

(b) H.w n..., NW. du,l.g th. ,..92 ..”ks7

20. H.- m.., tlm.. .I,agmh” i. *h. ,.s, 12 m.nth. did you ,. +. . d.ntist?

21. (.) DURING THE PAST 12 MONTHS h- my... 1. ih. 1.R41Y b... o P. N-1 In . k-,hd

. . ...1 ,h, “ 1.”,.,?

N -Yes.

(b) H.- -.”7 It-.. -of. 7.. In th. h.*,N*l?

12. (.) 0.,1., NM ,..112 m=nths b. .. Y-* 1. *h. h+ b... e P.N.m 1.. .UI.IBS hmm “

.Hll,”luml

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

(b) ff.w My thn.. war. y.. 1.. .WS1.S h.- or .-ltwlwm?

25. 0.,1., th. P.,1 12 month. 1. whl.h S,.US 414 IFI. ,~.f i...m. ,1yaw hmlly f.11, h! l.,

Y*W’ % Y=u. +, M=. ? (Show Csrd H) fncl”d. 1...-6- ●N .ar=.*, r.eh ● = w.,

..lad... -M. fraa -W>, ,M1.l .”., ful, k Al”lV.*. d

L

th. d.,?

ib)

kdw.

. . . b..,

w~ld y. k

Y=. .Mk

h.,.

k.”

[S.lns *

41..I)?

wukk,

* . lob

- bwsl-

“..’

. ..*

f“... ?

(11616

:$

(%’1”s

q!!” 1-

(i) (i)

1- ,----, “

D[d P. first mm;.. . . .

DURING THE PAST 3 MONTt

., kof.,. Nlm Nm.’f

Ckcb . . . —1.1.,,

5

*(h.

,0.

,.

..,,

(.>>

(k) —

—

—

—“,..

3

❑,h.

d

(1) —

—

—

D14... *WI

AN”, h ,*S1

2 w..k. -

k.fu. Dfml

N-?

(1I dwi~ past

2 week., .akfi

Which w-k,

I.st w+ “

lb, . ..k.

b. f-?

(d

P LnsI -et

n mck M.,.

p Bdnf. z .kL

-r.bl.II -

1

Whmi1. ,ha - d Ad,... .S tho

“r

F-c .nwlctc<

fl..,lt.l 7.” “- l“? w.. Uly .f

*h. fns,il.1

(Entcr ❑ame, + m c..nty ..d ~.te) bill pii 1“

br ..v kl.d

.{ I“mw....?

I

IC3N.

I

.L?SESSES, IMPAIRMENTS AND A

n

T. Dli ,.” first N.. Ilm.P -N.* . . . * r“.. y.”

.icw.r: DURING THE I**I

FAST 1?

N .01.

1.NI.4 *

MONTHS .{

(k] i.

. A.*

b.hr. the .- ...?

.J,,;ed, ,,*,

.d- (s3I**’

(N dwing past Cio. ,h.. 08.

12 moath., ..kfi mmnh, is 00

. ith.x Whkh -h? :U::. I.

00ec4

C8rd,

for We..)

Aer B,

mmmw,

OIkWIse I

I

:CIDENTS

0. pu

SNll lab.

mnymadf.

C* “

—

tha ?fw

&.t” pN.dbd

for...?

D,, Ss11.-

-r Al”

ho w-?

fos●I1

e most

Cfska

4=7?

n Yes n No

.—-———————.

—No. of II .*s

~

A,ho.a . . . . . . . . ..~

Ato[fic . . . . . . . . .

Ho.piul clinic . . . ._

Colnpn, m imd...y

0.., ,el.phme . . . . .

cdl- (s,.. It,, .,. .

n Ye. o N

___________

N.. .( ti m..

D cm. Cl Tk.

D T-o n Foul w m,.

0 N...

0 Y.. (Tsble 11) n N!

-—____ ____ __

—No. cddues

m Y,, (T.ble U) o N,

____________

—No. d ci-ca

(P) (a [1) (s) m (8)

n Y.. — 12V*

Igf&

n Y..

.

rfwnr. 13 N.-

I=lsh

t

DSPITALIZATION DURING PAST 12 MONTHS

,o.piulimti.mi

N ‘Nc.- to

d. (k),

..k:

Dr, by ..” kl,d.f

,1- lb

S=Y.I=?

fm.pltel

C.*t,?

m

n yo.c:y;;

n N.

+,

If ‘No- co

kmh ..1s.

(k) .A (1)

D* 70. .WOct

q.flfm

km,ltd Mll

w b pid let

by k.-.

“ aly ,kn

oftkkklndl

(-)

a Y..

o No (*4P)

NM pli

of lb

ha.,lld

bill w, (WNI

k.) MI- .-,

.f by

1“-”7

,.3 u.,-, <I*, Ct..

FOOTNDTESANOCObUSCNTS

67
Form ADXOve.4 Bud&, BureamNo, 63-R620.2. S

ON FNIENTIAL: The N.donnl l!,+h, S.W. Y,is n.thociz+ by l+bli~ Lay 652 ?1 the 84,h Comgre. s (70 ?mc. 48% 42 U.S. C. 30S). All infmn.tiom which would emit idmti.

fi..cic.n cd the md,v,d..l W,lI be held SU,.IIY m. I,deo ml, w,I1 be used mly by persons engaged m and for the p.cposes of the a.rvey, arid w,r 1 not be dkclosed o, released m ocher, for any oh., PurPoses (22 FR 1687).

oeM NHS-R.2 S1 ..5. DEPARTMENT OF COMMERCE

,.,,..0,

1. Q.=d . . ..i.. s..,.” 0, ,“, CC.*,

AC,,. . A, .0,...,,.. ..s.., ,0. ,“.

U.S. P“SL!C HEALTH SERV, CE

of

NATIONAL HEALTH Ml RVEY

SPECIAL FOLLOW-UP INTERVIEW

I Q.eszionn.ires

2. Address or description of locmim 3. I&:: 4. Sub- 5. sample 6. PSU No. 7. Scgme.t No. 8. S.,1=1 No.

sample

— weight

———._.—. t I I

9. ❑. V/b., is AM tckphme numb., here? 9. b. ‘13m. of original kmmiew

—.————------- .—— n N. phom

I

10. m (liginnlly I [f .Oz!,, =rvk.w .,,,C 10. b. OriSinal Inmrviewm

11. ‘W. hove IIs,ed ., Ilvinq ho,...

q===---- ‘c) ‘~ ~ ~~ ~ ‘“$=’)

R.l.cim. hip (W.NeS O,h.) (M c., F)

z--””--=: —.—- ..—————.

—.. -.—.-..—- ——. —----

-..-—-- ——— —.- .—

1

.1,——.h,.

..

..)—-.. . .

.-..

.1s.

.

——

.

who ..umlly live, hem who—1, away

..—now?—13. Is ih.r. ❑.yane else staying h-. now?

u No n Yes (add m lmm 11) =.No a Yes (add m item 11)

. Do any of the,. people ha,. . home .Isewhe,.?

~ No (1..,. on q.escionnair.) a Ye, (If note ho.sehold member, draw a line through the name in imrn 11)

I

FROM: 0R8GlNAL INTERVIEW

15. Name of Rcsp.amdm, (.) who rcspomded for the sample p&n 16. R.lmio.ship of sample per,.. m

,espmdem

17. Name of Sample Person

I

18. RECORD OF CALLS FOR SPECIAL FOLLOW-UP INTERV!EW 19. Noninccrvicw (gi.c ccas.an)

1 cm+. 2 Corn. 3 Corn. 4 Corn.

t.

. . . . . . ..- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -----

me

CO,Name of .$pe.id Foilov.up Lm.mimver.

ecial inscmc lions m maces:

“ SCC+4M.. . 1a,,,.
S..,1.. I - DATES OF HOSPITALIZATIONS

19. When did --- ..?., th. hospl,d (..,.1.s hc.m., s.anllmlum)?

Month —— Yew

20. How mony days w.,. --- In th. ho.plml (N, H., S), ..1 .0””!1”9 h. dr,y -. left?

Day,

21. . . Whm 4.. th. day of th. mc.nth --- .nl.r.d th. hospllal (N. H., S1?

Day D Can,, remember day

N ‘SC. OS,,em,.abez,,:

b. About how .1.s. ,.” V“ earn. to *h. dot. ?

r

.lgyt: .

(Emtm the .pproxim.t. date ~ record vcrbacim tbc

,c. c.o.dem”s mswe,)

-------- .... ......................... ......-------- ... .. .

Ve,b.tkn

22, . . %.+ w.’ !fm day of th, month . . 1.{! lb. h-orpl,ol (N.ff., S)?

Day U Can,, ,emember day

If ,qC.mVc,un, mbu>s:

b. Abe.! how .1... can you corn. m th. dot.?

r

A$~t~

( Enter th. .Dproxho.te J.te & record vcrb%tim tbe

,eqvx.dem ‘s ..S w U)

L

,- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vc,b.uu,

22. How de ye. flx ih.s. d.t.s 1. you, mind?

-. . ..-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S.cM.m 2- CHARACTERISTICS “OF HOSP1TALIZATIONS

24. What did fh~ say .* lh. h.,@ !ho c.ndl, i.. w.’ - dld ~~ “.. ony m.dl<d

lmms? If 8 they did.,, say, ..k, NM did th. 1.s? doctor ml .d to soy I* w..?,,

c“diti”~

2S. W.,. any oP,,mlons p,,form.d on --- during thi, stay O! th. hesplml (N, H., S)?

rJ Y..

. . me W..h “m. .( III* Op.r.tl.”?

b, Amy A., .,.,.*..,? n Y.- O No

If ‘, Yer,t$ .dd n.m,

c. De ye” &ensId., thin, !h, ep.,.tfon was ,.ri.u, or no, ,wI..s7

a 3etio.s U Na xcriou$

If *,Seci..sS,:

(1) w.’ It “my s.rfou, ., only {.lrly SOrlo”.?

a VW .etimt.a F.irly .crio.s

m_..No

d. Wh typo of m.dlcd w.mtnom dld thy gl,c -- 411.- w,. lhor.?

n ExceIleu a Goad m Fair = P...

FU hospitdizaticas due m ‘tdcli.my,$ do ❑ .sk q. 27, 2B w 257

!7. Hew &ul . condl,lo” new, - mm -- b.tk, ., we,,. new tfmm whn - -t to

the howdlaf (N. H., S)?

a Better a w.. f_J About chc s,rm

a Quslified fSp..ifr)

!8, 0. you ].lk wlfh frlond, &t th. cendlsfen fi, WMCA .- v/mm m A. hmpiml(N. H., 3)?

S.ction 3- COSTS OF ffOSPITAL!ZATlONS

30. . . Was any of ?h. hosp! to! bill paid for by ..Y kind of 1.,., . ...?

ff .sf40#>: o Yes a No

h. Or, by my kind of p!.. that pay, forhe,p!,.f insurance? n Y,. n No

If ‘nNo, > m Lwlh 30... =r,d 30. b.:

. . D. y.. .xp.ct any of h. hospital bill t. be paid for by

!..., . . . . o, ..Y PI.. of this kind? n Yes a No

If ‘- Y..,, w 30.,,, 30. b. o, 30...:

n Familymember(.)

D Employer

D Union, club,, .,..

D 06., (s,..,1,, I

. . How much did -- ❑, -- fnmlly ho,. m poy th.a, w.= ..+ cmddby 1...,.s...?

u Yes o No

31. What IS th. nmn. .nd cddr,.s of tie h.zpir.al -- w.,. In?

Name

(c It.) (s,.,., . .

32. B.for. --- w..t to ~h. h.qlt.l how long ‘-.,. -- u..bl. m work or g. about

“O.! of --- “’..1 ... i”l,l..~

_ Days M —Weeksm _M.mhs ., _ Y.al,

33. Afmr -- cmn. borne hum ih. hoxpl ial how long w.. it ~fc.,. -- w.,. .abl. ,.

work C+go obou! mo,t of -- .s”.1 o. NwllI .’?

a Still ..able

34. Takl. .11 th. <est. ef AIs ho, ltcdlzotion h. hospitcd bl!l, 1.., of PO and

. . f.~, -old ,.. Sq N W.= FINANCIALLY. gr..t Stmi., ..IY o Iifti

sfmin or no ,tmi”?

n Great strain n Little sa.im o N. str.i.

S.. NO” 4-- GENERAL HEALTH OF SAMPLE PERSON

35. Now hr a f.w .s,l.. s .&u, -- gon.rd hmnlth, wuld ~.w soy .-. h.ohh i,

m*mllY OX.* TI -t, good, f.lr or tm.r?

Ask qu.sti.ar.s 36 to 38 dy f.c s.mplc persum 18 year. of =s. oz O..C

36. Would you ,oy -- ihlnk -be., . . hdtb . w.., d..!, fel,ly .hon ., only

.C..st.”.lly)

o GK.t d..] O F.dy oft.. 00.1” occ-iordly u 0..,,know

37. Do -. ,olk G&u, -- h.dfh with --- fnmily ❑nd frf-d, o groa! donl, f.ltly

*r Only Occe,ie..lly?

a G,.*c de.1 i_J Fairly of,.. D !%1, occa’ionslly aDcab know

18. W..ld you s fak. ih. b.,f po,,lbi. cam of - h.altb ., could — tic

b.+,., ..,* Zf%m -,.,

s..ti.. 5. THE 0RtG4NAL INTERVIEW

I%. d W, Inmrvl.w.m mlk.d w[!h yeu r.cmtly - I hmm m fmv q~stlons .ben,

fiat 1.?9W1.W-.

39. ., Old you IhInk -y .{ lh. wu..tlon. ah. oak.d w.rc ma P.rsonsl ., Ptylq?

m No

a Ye. If C,Y, S*, ●sh Wb.1 w.,. th... qt..tlems &ut7

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b. Whet_, thin. ebewf 4h. Im!wvl.w $fw P onlwy.d {did .s! mn[oy)?

(Aik d.. for ‘Qualified in q. 40...’)

Kr-b”tx ”--.--”-” --- ”--- --- ”--------- ” ----------- ‘--” ----

Il. . . D. you Aink pql. ‘-111 s1,. .s a.cum,. lmfomelfer, akou+ !h.lr 111.”s a.d

bmpll.w,mlw, . . “.,7

n Ye. n No O Qtmfilied (ss..IfYj

b. Why d. y- fsef IMS WW?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

fcrb.cim

I

“s.-.. ,,,,,.P

69
Sm.1.l I.t.r.l.wb whenchcsunpl. person is the r.sponder,t for th. follow-up interview, . . . cheword ‘sl’o.~s whecererthe. dash.. (-.-) .pp..r in the q...tl . . . . Whenthe

Instruol.ns, samplepemon is q the r.spo.de.t, .s. the ..nx or the cel.tier,.h,p (YOUIhush..d, you so., etc.) of the sampleperson whcr. ver the threed.sh.s (...)

.ppeu i. the q..sc,o.s. i

1. Whorew.,. . . . ha,.?

If 14y..,, old o, eve,, ask:

2. Wh.a,[. !h. high.,, ~rod. --- ..qd.,.d I. ..h.ol?

(Ciicl= highest grade completed m check ,(N.ane,,)

If m.le and Id y,,,, old ., .,.,, ask,

3... Dld --. .,., s.,,. I. th. Armed For... of fh. Unltod S,0,.s7

If ‘Yesn, ask:

b. A,. --- now In th. Arnd %,..s, no, .owlng th. ,0,.w..?

(1I SW. . . .. . .. . .. ...”..”>

~ W.. o.y of ~. ,.,.1.. during ❑ w., or w., it p.. cc.-,lnmonly?

If ‘sWar,,, ,.k:

d. D.dng which W., wos II?

If ~,P.ace-tinm, >only, ask:

. . Was .ny of lh. ..,.1.. blw”. J... 27, 1950ond Jonuoty31, 1955?

If 6 years old ., ovet, ask,

4... Wh.t w.,. --- dolq nmsl of lh. post 12month, --

(Males OVC,16x Working,Ic-aklngfor work., doing ,.am.~1.s .1,.?

(Female, .,., 16), W.rkl.g, looking f., work, k.qlng h..,. o, dc.ln~

.Om.lblng .1’.?

,Chlldmn from6 w lGfi Going to .ch. ol ., d.1.s so!n.thing .1,.7

If !,some&;ng ,l.c,, .h,. k.d, ud person is SOy.. r. old .r . ..1. .Sw.

b. Am --- ,.tl,.d?

5, Wm. you sick at any llrn. d.,lng th. 2 w..k. (mm Monday

throu~ Sunday ?

o. Wh.1 w., !h. m.,,.,?

b. Anything .1,.?

6. D.,lng h... ,.nm 2 w..k, did y.. how .ny o.. id.r,,s o, I. IUN.,, .Ilh.r ., horn,

o, ❑ W.Y {mm hem.?

m Whal w.,. fb.y?

b. Any,hlng .1..?

7. Did you f..l any ill .N..f. d.ring th.s. 2 w..k. fr.m an .c.ld.m ., I.I.V that

hopp.ned b.fm, that tl,-n.?

. . Wh., w.” ~.s. ●ff..,.?

b. Any,hing .1..?

R Did y.. ,.k. . . rr,.dlcl.. or trmohnonlf., ..” condition (k+sld.s ... whl.h you

told ro. .+. o.t)Jurlng lh. s. 2 wa.k, ?

., F., who, ..a.dl,lon.?

b. Anyihtng .1,.?

9. AT THE PRESENT TIME d. y.. h... ..7 .ilnmnt. ., .ondl,i.n. that ho,.

Iast.d f., . long tlrn.?

. . What om fh.y?

b. A.ylfdnq .1,.?

,0. Ho,. you hod ..” .6 *.,. conditt.an.DURING Tff E PAST 12 MONTHS?

(Rc.d Card A, condition by condition; r.cord .ny c.a.dicio.amc.tio..d)

11. D. you ho,. ..7 of N.... .ondlff.ns?

(R..d Card B, condition by condition; rcco!d .ny condicio.. mentioned)

12.0. DURING TSfE PAST 12 MONTHS h.,. -- b.or, . P.11,”1 i. . ho.p!t.i

.v.rnigh, ❑ r long.,?

If ~,Yes,!

b. How many ,lnms w.,. -- in th. h.,plml?

13. . . ~oro-o-~~ . h.,pl,.l for any .ccld-$s or 1.IUN.S DUKING TNE PAST 12

If ,W’es$~,

L Old .-. .t.y I. th. ho.pltol overnight?

If ‘, Dv.r.ight$, in q. 13.b. and I .: m-arei. 12.b., ..L

. . W.. AIS ho.pl,.11..ti,m Imel.dod In th. ..mfmr y.. [.s1 WV. ,n.?

[f b.by underone year listed .s child of f.m.le s.nplc person(item 11, P.S. 1)

●sk:

14.0. W.. --- boby born in a ho.ptt.l ., at hem.?

If “b.aspimlm, i. 14... and 1 .ar u,oce in 12. b., ..k:

b. W.. thl, h.spimll,.,1~ Includ.d 10 1A. mumbot you lust wv, m.?

IS. a. During ffw F&t 12 month. hav, --- km a P.81.. v I. a .WSI. Q hm. m

SOnl+mf”m?

If ,, Y.S,,:

b. How many ,tm.. w.,. . ..1.. m.mlng hen,. m .ani, oriwr.?

If no hospiuliz.ti.m reportedin q, 12-14, .sk q. 16..d 17; oth.twi.e, go

!. q...ti.. 18...

16.0. H.- --- EVER bow . paeion,I. . ho.pitol?

If ,,Ye*,,:

b. Whm m. th. LAST II,n. ... w.,. . pd.., .,.,.4 h, ., Ionm,?

17.w. fl.d fh.t p.~1. ..mdinn. fnrg.t hospwol stay. far rnl.c.!IhIng. ❑ r for short

p.rf.ds. F. fh.m . . . ehan.. --- ti.,. 1.0 h..pl!.l .av.,nlght 10,. rnln., thing

or I., . .k+n p.rlod during th. past 12month., whlchyou nmyh.v. Forsotm. up

,10 now?

If . . .t.y i. . .ur.i.& bomcor ..oimrium h.s b... repmmd in q. 15, ..b

18.., H.v, -- EVER k a ~N.., 1.. n.,slng h.m. ., .ani~,lurn?

If ,.Y,’,,

b. Whw -.s h. CAST ffm. ... -w. . PON.m I.. ..,.I.g h.m. ., ..nIt.vIumv

Em.t the total ❑.mbet c.f,ovmnight h..pimliz.ti.ane and .w.in~ home., ..r.ituium

.t. ys. Ezcl.de from W,. mm] aoy entry i. 16,b. or 18,b. ealter th.. ,{ 1$58.0,

,.”M .“s. ”., s.,

o Under 14ye-s

Elem: 12345678

High 1234

College 1 2 3 4 5+

n None

o Fan. o, und. 14 ~r,

a Yes o No

------------------

a Y., o N.

o war m y:jfil

_________________

n Spin. Amer. D Ww - n

=Ww.1 a Korean

----------------

0 YCB a No

ig Yes n N.

N.. of times

n Y.. o No

u Ycs-:v& u No

_______________

O Ye. a No

n H..pit.l n H...

----------------

n Y.. D No

_ Month— Ye.

n Ye. n No

— Month —y.-

CONTINUATION OF VERBATfM

RESPDNSES FROM SECTIONS 1 AND 2

CONTINUATION OF VERBATIM

RESPONSES FROM SECTfDNS 3, 4 AN D 5

“,COMM..C ,,7,,.,

70
%NOII 6- TO BE COMPLETEO AFTER LEAVING HOUSEHOW

1... Beside. the cesp.d.ac, WK. .ny .ch.r member. of tb. hou.chcdd pmstns durin~ th. i.:cc.icw?

a Y.. a No

i

(Record CdUMn numbezs) —

(N ‘“Y.,,*V answer b.)

b. To &.t .x..,, if ..?, did b. (h., I@) .U.U.PC t. partkip.t. i. h. interview fd..mlb. 1.11.)

L Did &. re.p.nd.nc qu..ti.n y.. s. to why y.. w.,. them m . .c.w.4 ..11?

n Yes n No - N.,., .11

T. whu extent did tic r<.p..d.m rai.. such q.e.ti~ns? (Vub.titn)

3. WC,. them +*Y .peci.l pr.blcum about zhi. i.ter.ie.? Pmrti.ul+, w.* +ere my indic.cim tb=c may ho.pit.l,iz.c@.s were nti mc.ti.n:d~ Or was there ..? indicat,..

tb.c dx m.ponde.t w.. r.1..umt m ulk about ..y h..pk.l sty? (Descr,lw zbe problem(%) by citi.s the ‘p.c, ftc mcidc.r. CM&e intcrvtewl

FO07N07ES AND COMMENT3

,mu -M. ”.* ., ,,..g-,,, USc.w.c ,,,,,.P

71

* U. S. GOVE RNMENT PRINTING OFFICE :1973 5 15-214/77
.._

REPORTS FROM THE NATIONAL CENTER FOR HEALTH STATISTICS

Public Health Service Publication No. 1000

Series 1. Pmgrzms and collection procedures

No. 1. Origin, Program, and Operation of the U.S. National Health Survey. 35 cents.

No. 2. Health Suwey Procedure: Concepts, Questionnaire Development, and Definitions in the Health Interview Survey. 45 cents.

No. 3. Development end Maintenance of a National Inventory of Hospitals and Institutions. 25 cents.

No. 4. Plan and Initial Program of the Health Examination Survey.

Seriee 2. Data evaluation md methods research

No. 1.

No. 2.

No. 3.

No. 4.

No. 5.

No. 6.

No. i’.

No. S.

No. 9.

No. 10.

Series 3.

Comparison of Two-Vision Testing Devices. 30 cents.

Measurementof Personal Health Expenditures. 45 cents.

The One-Hour Glucose Tolerance Test. 30 cents.

Comparison of Two Methods of Constructing .4hridged Life Tables. 15 cents

4n Index of Health: MstbemraticalModels.

Reporting of Hoepitzliaation in the Health Interview Survey.

Health Interview Reeponses Compared With Medical Records.

Comparison of Hospitalization Reporting in Three Survey Procedures.

Cooperation in Health Examination Surveys.

Hospital Utilization,in tbe Last Year of Life.

Analytical studies ‘,

No. 1. The Change in Mortality Trend in the United States. 35 cents.

No. 2. Recent Mortality Trends in Chile. 30 cents.

Series 4. Documents and committeemporte

NO reports to date.

Series 10. Data From the HeaLtb Interview Survey

No. 1. Acute Conditions, Incidence and Associated Disability. United States, July 1961-June 1962. 40 cents.

No. 2.

No. 3.

No. 4.

No. 5.

No. 6.

No. 7.

No. 8.

No. 9.

No. 10.

No. 11.

No. 12.

No. 13.

No. 14.

No. 15.

No. 16.

No. 17.

Family Income in Relation to Selected Health Cbsrac~&tics, United States. 40 cents.

Length of Convalescence After Surgery, United States, July 1960-June 1961. 35 cents.

Disability Days, United states, July 1961-June 1962. 40 cents.

Current Estimstes From the Health Interview Survey, United StASs, July 1962-June 1963. 35 cents.

Impairment Due to Injury, by Class and Type of Accideet, Unitsd StAtes, July 1959-June 1961. 25 cents.

Disability Among Persons in the Labor Force, by Employment statue, United States, July 1961-June 1962. 40 cents.

Types of Injuries, Incidence and Associated Disability, United Statas, July 195?-June 1961. 35 cents.

kiedical Csre, Health Status, and Family Income, United States. 55 cents.

Acuts Conditions, Incidence and Associated Disability, United Stat,eS,July 1962-June 1963. 45 cents.

Health Insurance Coverage, United States, July 1962-June 1963. 35 cente.

Bed Disability Among the Chronically Limitad, United States, July 1957-June 1961. 45 cents.

Current Estimates From Me Health Intewiew Survey, Uni@rf Statee, July 1963-June 1964. 40 cents.

Ilhrese, Dtzability, and Hospitalization Among Veterans, United States, July 1957-June 1961. 35 cents.

Acute Conditions, Incidence and Associated Disability, Unitad S@We, July 1961t-June1964. 40 cents.

Health insurance, Type of Insuring Organization end Multiple cov~a~, I_fniti &.s~s, July 1962.June 1963. 35 cents.

Chronic Conditions and Activity Limitations, United States, July 1961-June 1963. 85 cents.

Series 11. Data From the Health Exmirination Survev..

No. 1. Cycle I of the Health Examination Survey: SZnrpleand Response, Uni@d States, 1960-1962. 30 cents.

No. 2.

No. 3.

No. 4.

No. 5.

No. 6.

No. 7.

No. 8.

No. 9.

Glucose Tolerance of Adults, United States, 1960-1962. 25 cents.

Binocular Visust Acuity of Adults, Unitad States, 1960-1962. 25 cents.

Blood Pressure of Adults, by Age and Sex, United States, 1960-1962. 35 cents.

Blocd Preseure of .4dults, by Race and Region, United States, 1960-1962. 25 cents.

Heart Disease in Adults, United Stmtes,1980-1962. 35 cents.

Selected Dental Findings in Adults, Unitad St.atee,1960-196% 90 cents.

Weight, Height, and Selected Body Dimensions of Adults, United Statee, 1960-1962.

Findings on the Serologic Test for Syphilis in Adults, United States, 1960-1962.

Series 12. Dats Fmm the Health Records Survey

No reports to date.

Serie#, 20. Dats on mortality

No reports to date.

.Series 21.. Data on natality, marriage, and divorce

No. 1. Natsfity Statistics Analysis, United Statee, 1962. 45 cents.

No. 2. Demographic Cbarscteristics of Persons Married f4etweenJanuary 1955 and Juno 1956, United States. 35 cents.

/-”

Series 22. Data from the pIwgrarnof sample surveys related to vital records.

No reports to date.