Data Systems of 

the National Center 

for Health Statistics 

Each of the data collection programs of the 

National Center for Health Statistics is described. For each program the background, 

purpose, scope, sample design, data collection procedures, content of data collection 

forms, method of data release, and uses of 

data are presented. 

Programs and Collection Procedures 

Series 1, No. 16 

DHHS Publication No. (PHS) 82-1318 

U.S. Department of Health and Human 

Services 

Public Health Service 

Office of Health Research, Statistics, and 

Technology 

National Center for Health Statistics


Hyattsville, Md.


December 1981

Library of Congraaa Cataloging in Publication Data 

National Cantar for Haalth Statistics (U.S.) 

Data systems of the National Centar for Health Statistics. 

(Vital and health statistics. Serias 1, Programs and collection procaduras ; no. 16) (DHHS publication ; no. (PHS) 82-1318) 

Prepared by: Nancy D. Pearca. 

Supt. of Dots. no.: HE 20.6209:1/16 

1. National Centar for Health Statistics (U.S.) 2. Public health– 

United Statas–Statistical services. 3. Madical cara-United Statas– Statistical services. 4. Unitad States-Statistics, Madical. 1. Pearca, 

Nancy D. 11. Title, Ill. Serias. IV. series: DHHS publication ; no. 

(PHS) 82-1318. [DNLM: 1. Data collation. 2. Health survays– 

Unitad States. W2 A N146va no. 16] 

RA409.U44 no. 16 [RA407.3] 312’.0723s 81-607874 

ISBN O-641B02324 AACR2 

For sale by the Superintendent of Documents. U.S. Government Printing Offlee, Washington, D.C. 20402 
National Center for Health Statistics 

DOROTHY P. RICE, Director 

ROBERT A. ISRAEL, Deputy Director 

JACOB J. FELDMAN, Ph.D.,Assoczkte Director for Ana@is 

and Eptiemiology 

GAIL F. FISHER, Ph.D., Associate Director for the 

Coopemtive Health Statistics System 

GARRIE J. LOSEE, Associate Director for Data l+ocessing 

and Services 

ALVAN O. ZARATE, Ph.D., Assistant Director for 

International Statistics 

E. EARL BRYANT, Associate Dz7ectorfor Interview and 

Examination Statistics 

ROBERT C. HUBER, Assoctite Director forManqement 

MONROE G. SIRKEN, Ph. D., Aswwiate Director for 

Research andMethodo@-y 

PETER L. HURLEY, Associate Director for Vital and Health 

CareStatistics 

ALICE HAYWOOD,Information Officer 
Foreword


. 

This brief, semitechnical description of the various data 

systems of the National Center for Health Statistics has been 

created to serve a variety of needs. The greatest need is for a 

single publication to bring together different descriptive materials under one cover. For the user who needs more detailed, 

technical knowledge of these systems, this is available in separate publications for the individual programs. It is expected 

that this summary publication will serve the needs of many 

visitors to the Center, as well as the needs of those at the Federal, State, and local levels who wish to understand the structure and scope of Center programs. 

One feature that should be carefully noted is the flexible 

nature of many of these surveys. While subject to the need for 

standard measurement over time, the surveys are also able to 

change with the demands for new data. Systematic reviews 

lead to careful revisions and additions as needs are identified. 

When necessary, new survey activities are designed and fielded. 

Thus, this report is a cross-sectional description of the current 

data collection program of the Center. 

Dorothy P. Rice 

Director 

... Ill 
Contents


. 

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Confidentiality ofdata. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Datacollection mechanisms.,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Morbidity andmortality datacoding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Data release mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Descriptive, methodological, andother related reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Vital statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Basicvital statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Vital statistics followback surveys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . 

National Survey ofFamilyGrowth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

General population surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Health InterviewSurvey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Medical Care Utilization and Expenditure Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Health and Nutrition Examination Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Health resources utilization statistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Hospital DischargeSurvey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Nursing HomeSurvey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Health resources statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Master Facilitylnventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National health professions inventories and surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Appendixes 

Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

1. Definition of certain terms used in this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

11. Listingof reports relatedto specific programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

List of text tables 

A. Sample size and total response rate (percent) for each of the vital statistics followback surveys: United States, 1961 -80.. 

B. Response rates for National Nursing Home Surveys, by type of questionnaire used (percent): United States, 1973-74 

and 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

... 

Ill 

1


1


1


2 

2 

2 

3 

4 

4 

6 

8 

11


11 

14 

16 

20 

20 

21 

23 

26 

26 

27 

30 

31 

34 

7 

25 

v 
Symbols 

. . . Data not available 

. . . Category not available 

Quantity zero 

0.0 Quantity more than zero but less than 

0.05 

z	 Quantity more than zero but less than 

500 

* Figure does not meet standards of 

reliability or precision (more than 

30-percent relative standard error) 

# Figure suppressed to comply with 

confidentiality requirements 

vi 
Data Systems of the National 

Center for Health Statistics 

by Nancy D. Pearce, Office of the Center Director 

Introduction 

Background 

The National Center for Health Statistics is one of 

the major Federal statistical organizations. It operates 

a diverse survey and inventory program with legislative authorization to collect statistics on the following: 

The extent and nature of illness and disability of 

the population of the United States, including life 

expectancy, maternal morbidity, and mortality. 

The impact of illness and disability of the 

population on the economy of the United States 

and on other aspects of the well-being of its 

population. 

Environmental, social, and other health hazards. 

Determinants of health. 

Health resources, including health professionals 

by specialty and type of practice; and the supply 

of services by hospitals, extended care facilities, 

home health agencies, and other health institutions. 

Utilization of health care, including utilization of 

ambulatory health services, services of hospitals, 

extended care facilities, home health agencies, 

and other institutions. 

Health care costs and financing. 

Family formation, growth, and dissolution. 

This report provides brief descriptions of each of 

the data systems operated by the National Center for 

Health Statistics. Each project description contains a 

statement of the purpose of the data system, the 

contents of the data collection forms, an overview of 

the data collection process, and an indication of the 

availability of the data to the public. Although this 

report is nontechnical in nature, it does include some 

technical terms, a limited glossary of which is 

included as appendix I. For the purposes of many of 

the Center surveys, however, many terms have highly 

specialized definitions. No effort has been made here 

to provide a comprehensive series of such deftitions. 

Each analytic report in series 10 through 23 (see 

“Data release mechanisms”) includes in its own 

appendix the definitions of certain specialized terms 

used. 

Confidentiality of data 

Data collection activities of the Center are subject 

to the specific provisions of both the Privacy Act of 

1974 (Public Law 93-579) and the Health Services 

Research, Health Statistics, and Health Care Technology Act of 1978 (Public Law 95-623). The Privacy 

Act covers all federally sponsored and operated data 

collection that involves creation of a system of 

records containing unique personal identifiers, while 

the latter constitutes legislative authorization for a 

portion of the Public Health Service. 

In keeping with the requirements of the Privacy 

Act of 1974 and Center policy, each individual, 

household, or establishment asked to provide data for 

the Center is informed in writing of the following: 

o The authorization for soliciting the information. 

� That disclosure of such information is voluntary. 

�	 The principal purpose or purposes (usually statistical or research) for which the information is 

intended to be used. 

�	 The routine uses (as published in the Federal 

Register) which may be made of the information. 

�	 The effects on the recipient, if any, of not 

providing all or any part of the requested information. 

The Center is also bound by the provision of its 

authorizing legislation that the information obtained 

in the course of its statistical activities may not be 

1

used for any purpose other than that for which it was 

supplied. Such information may not be published or 

released in other form if the particular establishment 

or person supplying the information or described in it 

is identifiable, unless such establishment or person 

has consented to its publication or release in other 

form. Thus, the Center assurance to respondents that 

data will be kept confidential has a legal basis. 

Almost all data collected by the Center are 

requested under a pledge to the respondent (either an 

individual or an establishment) that the information 

will be used only for statistical purposes and will not 

be released in such a way that individual persons, 

households, or facilities will be identifiable. The 

Center never releases information that would identify 

an individual or a household. Some information is 

released that identifies individual facilities, however. 

When it is planned to release such information, 

facility administrators are informed at the time they 

provide the data which, if any, items will not be 

accorded confidential treatment, 

The NCHS Policy Statement on Release of Data 

for Individual Elementary Units and Special Tabulations presents and explains in detail the confidentiality policy. 

Data collection mechanisms 

The Center does not have a large data collection 

staff of its own, It collects most of its data through 

interagency agreements with the U.S. Bureau of the 

Census or through contracts with non-Federal organizations. 

It has, for a number of years, been Center policy 

to increase the capacity at the State level to collect 

and utilize data. As in the case of vital statistics data, 

the Center also tries to identify instances when it is 

possible to unduplicate the collection of data by 

having it collected at the most appropriate point 

(Federal, State, or local) and then making it available 

to others who have need for it. While vital statistics is 

currently the only area in which the Center relies on 

this method of data collection and sharing for the 

production of national data, it is hoped that in the 

years to come other types of data may be collected 

through a national data-gathering system operating on 

the State level, the Cooperative Health Statistics 

System. 

Morbidity and mortality data coding 

The Center collects a wide range of information 

about illness and the health problems of the population of the United States. In order to enhance the 

comparability of international statistics and of morbidity and mortality estimates from such diverse 

sources as household respondents and health care 

provider records, these data are coded to appropriate 

adaptations of the International Classification of 

Diseases (ICD). ICD is a system for classification of 

diseases and injuries for statistical purposes and is 

revised under the auspices of the World Health 

Organization every 10 years. 

All Center mortality and morbidity information is 

classified according to the most recent revision of 

ICD. Data for the approximately 10-year period prior 

to January 1, 1979, are coded to the Eighth Revision 

International Classij7cation of Diseases, Adapted for 

Use in the United States (ICDA-8). Mortality data for 

the period beginning in January 1979 are classified 

according to the ninth revision of the International 

Classification of Diseases (ICD-9), and morbidity data 

are classified using the clinical modification of ICD-9 

(ICD-9-CM). 

Data release mechanisms 

The Center releases its data in several ways. The 

Vital and Health Statistics series contain detailed 

reports on the design of the various data collection 

systems, findings of methodological studies, and 

detailed cross-tabulations of data. Advance Data 

reports are timely but brief (4-1 2 pages each) 

summaries of newly available data on topics of special 

interest. These reports have replaced supplements to 

the Monthly Vital Statistics Report for all survey 

programs except the natality and mortality followback surveys. All these reports are distributed without 

charge, as issued, to libraries, medical colleges, 

schools of public health, and other selected institutions that have requested to receive all issues in the 

series. Other organizations and individuals receive 

publication notices and information to purchase 

copies from the Government Printing Office. The 

annual Catalog of Publications of the National Center 

for Health Statistics contains a cumulative list of 

these reports, and the quarterly Publication Note is 

issued to provide the latest information. 

The Center also releases an annual booklet that 

describes public use data tapes available for purchase. 

This program, begun in 1969, permits researchers to 

perform their own analyses of data. Tape availability 

and contents, along with information on ordering the 

tapes, are detailed in each year’s Chtalog of Public 

Use Data Tapes From the National Center for Health 

Statistics. The majority of these data tapes are now 

sold by the National Technical Information Service 

(NTIS) and are not available from the Center. 

Eventually, all Center public use data tapes will be 

available from NTIS. The order form in the back of 

the catalog gives the address and instructions for 

ordering from NTIS or, in a few instances, from the 

National Center for Health Statistics. 

Many requests for unpublished data are filled 

regularly using tabulations that have been previously 

compiled. In addition, many special tabulations are 

2 
prepared each year to meet data requests that cannot 

be fulfdled in any other way. When special tabulations are necessary, the requester is given a cost and 

time estimate. Tabulations and public use data tapes 

are carefully reviewed to ensure that confidentiality is 

maintained. 

Descriptive, methodological, and other related reports 

In addition to the reports from each program that 

are issued in the analytic series designated in the 

“release of data” section in each program description, 

there are reports in other Vital and Health Statistics 

series that are directly related to the programs. These 

include program descriptions, methodological reports, 

and reports that are in-depth analysis or contain 

policy recommendations. A listing of these reports, 

by program, is presented in appendix II. 

Requests for publications and information or 

inquiries concerning data tapes, special tabulations, 

and other assistance should be directed to the 

Scientific and Technical Information Branch. 
Vital statistics 

Basic vital statistics 

Background. –Basic vital statistics come from 

records of live births, deaths, fetal deaths, induced 

terminations of pregnancy, marriages, and divorces or 

dissolutions of marriages. Registration of these events 

is a local and State function, but uniform registration 

practices and use of the records for national statistics 

have been established over the years through cooperative agreements between the States and the National 

Center for Health Statistics and its predecessor 

agencies. 

Purpose and scope. –The purpose of the basic 

vital statistics program is to formulate and maintain a 

cooperative and coordinated vital records and vital 

statistics system, promoting high standards of performance. The program is nationwide in scope, 

covering the entire population of the United States. 

Data collection procedures. –Both provisional and 

final vital statistics are derived from the registration 

system. The provisional data are obtained from 

counts of vital records registered without reference to 

the date the event occurred; the final data are 

obtained from the record and its contents, processed 

by date of occurrence of the event. 

The civil laws of every State provide for a 

continuous and permanent birth, death, and fetal 

death registration system. In general, the local registrar of a town, city, county, or other geographic place 

collects the records of births and deaths occurring in 

the area; inspects, queries, and corrects if necessary; 

maintains a local copy, register, or index; and 

transmits them to the State health department. There 

the vital statistics office inspects the records for 

promptness of filing and for completeness and consistency of information; queries if necessary; numbers, indexes, and processes the statistical information for State and local use; and binds the records for 

permanent reference and safekeeping. Microfilm 

copies of the individual records or machine-readable 

data are transmitted to the National Center for 

Health Statistics for use in compiling the final annual 

national vital statistics volume. 

The system for collecting national data on marriages and divorces is not as well developed as the 

system for births and deaths is. All States have 

marriage and divorce laws; but, as of January 1, 1981, 

three States did not have a central file of marriage 

records, and four States did not have a central fde of 

divorce records. Forty-two States and the District of 

Columbia are in the designated marriage-registration 

area, and 30 States are in the divorce-registration area. 

These registration-area States provide the Center 

microfilm copies of their marriage and divorce certificates or machine-readable data from which the 

Center derives data on characteristics of marriages 

and divorces and the persons involved. States not in 

the registration areas provide only counts of marriages by month and counts of marriages and divorces 

by county. For States without central registration, 

final counts are collected from individual counties 

either by the State vital statistics office or by the 

Center. In these instances some counties report only 

marriage licenses issued and divorce petitions filed 

rather than marriages performed and divorces 

granted. 

Most States submit microfilm copies of vital 

certificates or machine-readable data tapes prepared 

from the certificates to the National Center for 

Health Statistics within 90 days following the end of 

each data month. Special arrangements for less 

frequent shipments are made with smaller registration 

areas. Relevant information derived from answers to 

State queries about the original certificates and 

received by the State after shipment of the certificates to the Center are filmed and submitted with 

the first shipment following their receipt by the 

State. 

Provisional vital statistics are collected and published monthly and summarized annually. They are 

derived from monthly reports from the States to the 

Center giving the number of certificates accepted by 

4 
each State for fding between two dates a month 

apart, without regard to actual date of occurrence. 

These reports to the Center are mailed on or before 

the 25th of the month following the data month. 

They are the source of the provisional vital statistics 

published in the Monthly Vital Statistics Report and 

its Annual Summary. Provisional data also include a 

10-percent sample of death certificates. the Current 

Mortality Sample, which provides provisional causeof-death data on a monthly basis. The Current 

Mortality Sample is selected by the Center from the 

regular data file of deaths for those States submitting 

their entire month’s file by the end of the following 

month. Otherwise the State is asked to provide a 

sample of records on a current basis. The sample is 

selected by including each record with a given last 

digit in the certificate number. 

Collection forms. –To promote uniformity in the 

statistical information collected from States and local 

areas for national statistical purposes, the National 

Center for Health Statistics recommends standard 

certificates or reports for birth, death, fetal death, 

induced termination of pregnancy, marriage, and 

divorce. The standard certificates and reports are 

developed cooperatively with the States and local 

areas and the Center and its predecessor agencies, 

taking into account the needs and problems expressed 

by the major providers and users of the data. They 

are reviewed about every 10 years to ensure that they 

meet to the fullest extent feasible current needs as 

legal records and as sources of vital and health 

statistics. Although the use of standard certificates 

and reports by States is voluntary, and their form and 

content may vary according to the laws and practices 

of each State, the certificates and reports in most 

States closely follow the standard. 

The Series 4 report “The 1968 Revision of the 

Standard Certificates” outlines the history and basic 

principles of the standard certificates and the major 

objectives of the 1968 revisions; the report also 

contains copies of the standard certificates and 

describes the principal additions, modifications, and 

deletions of items. A similar report in preparation 

describes the 1978 revision of the standard certificates. 

Data processing methods. -Machine-readable data 

are accepted from States participating in the Cooperative Health Statistics System, Data from all other 

States are coded and entered on magnetic tape. 

All death and fetal death records are processed. 

For States not participating in the Cooperative Health 

Statistics System, a 50-percent sample of live births is 

processed by selecting records with image numbers 

terminating in an even number, For States in this 

cooperative system the entire birth fde is used. In 

general, all States in the marriage and divorce 

registration areas that do not submit these data under 

the system send microfflm copies of all their marriage 

or divorce certificates to the Center, where a sample 

of the records is selected and processed. 

Release of data. –Vital statistics data reach the 

public through the Monthly Vital Statistics Report 

and its supplements, Vital Statistics of the United 

States (bound volumes issued annually), public use 

data tapes (issued annually), and Vital and Health 

Statistics series reports and special reports. Data on 

mortality are published in Series 20; and data on 

natalit y, marriage, and divorce are published in Series 

21. Unpublished tabulations may also be available 

upon request. 

The Monthly Vital Statistics Reports containing 

provisional monthly counts are published within 

about 2 months following the end of the data month. 

Provisional cause-of-death information from the Current Mortality Sample are published about 3 months 

after the data month, and the Monthly Vital Statistics 

Report advance supplements releasing final annual 

statistics are published in about 18 months after the 

data year. Public use data tapes are released to the 

National Technical Information Service within 

month after publication of the advance supplements; 

series and special reports are issued as resources 

permit; and the annual Vital Statistics of the United 

States are soon expected to be distributed with about 

a 36-month lag, 

For vital records, names and addresses are not 

coded and never appear on data tapes or tabulations. 

Certificate numbers are never released without written permission from the States whose records are 

involved, and data tapes including data from localities 

having less than 250,000 population are classified to 

reflect population size without revealing specific 

geographic areas. 

Uses of data. –When vital statistics data have been 

collected, processed, and made available for public -, 

use, they serve a variety of purposes. They are used in 

making population estimates and projections, in 

assessing the health of the U.S. population, in 

pinpointing health problems, and in measuring progress made by national health programs. They are also 

used in epidemiological studies; in marketing research; in demographic, sociological, and economic 

studies; in studies of the family; and in other 

numerous and varied aspects of research aimed at 

understanding our society and its problems and 

progress. 

Among the principal users of the data are other 

parts of the Public Health Service, such as the Centers 

for Disease Control, the Food and Drug Administration, and the National Institutes of Health; other 

Federal agencies, such as the Bureau of the Census, 

Federal Reserve Board, Bureau of Labor Statistics, 

and Departments of Agriculture, Defense, and Transportation; members of the United States Congress; 

State and city governments; public and private 

research institutions; life insurance companies; the 

5 

1 
faculty and students of universities; newspaper reporters and feature writers; and physicians and 

workers in health information and education groups. 

Vital statistics followback surveys 

Background. –National natality and mortality surveys are periodic data collections based on samples of 

registered deaths and births occurring during a calendar year. Mortality surveys were conducted annually 

from 1961 through 1968, and natality surveys from 

1963 through 1969 and again in 1972. A National 

Infant Mortality Survey was also conducted from 

1964 to 1966. For 1980, a National Natality Survey 

was conducted that was expanded to include fetal 

mortality. 

Purpose and scope. –The national followback 

surveys extend for statistical purposes the range of 

items normally included on the vital records. They 

provide national estimates of births and deaths by 

characteristics not available from the vital registration 

system. They also serve as a basis for evaluating the 

quality of information reported on the vital records. 

Sample design. –The birth or death record serves 

as the sampling unit, and samples of these units are 

selected from a frame of records representing births 

or deaths registered during a given period, usually a 

calendar year. 

The sampling frame for the National Mortality 

Survey is the Current Mortality Sample, the 10-

percent systematic sample of death certificates received each month by the National Center for Health 

Statistics from the registration areas in the United 

States. The sample for the National Mortality Survey 

is a sample subselected monthly from the Current 

Mortality Sample. The sampling frame for the National Natality Survey is the fde of birth certificates 

from each of the registration areas of the United 

States. Each registration area assigns a fiie number to 

each birth certificate, and these fde numbers run 

consecutively from the first to the last birth occurring 

in that area during that year. The samples for the 1980 

survey are based on a probability design that makes 

use of these certificate numbers. For the sample of 

live births each 500th birth certificate record was 

systematically selected; for the sample of fetal deaths 

each 4th fetal death certificate was systematically 

selected. The sample size and the total response rate 

for each of the surveys are shown in table A. 

Data collection procedures. –Data for all the 

followback surveys are collected primarily by mail. In 

the natality surveys, from addresses given on the birth 

certificates, questionnaires are sent to the mother, the 

physician who delivered the baby, and the medical 

facility where the baby was born. In addition, the 

1980 surveys obtained data from the medical sources 

who the woman named as having given her radiation 

treatment or examination in the year prior to the 

delivery. 

In the mortality surveys, a questionnaire is sent to 

the person who provided the funeral director with the 

decedent’s personal information for recording on the 

certificate. This questionnaire requests socioeconomic 

information about the decedent as well as the names 

and addresses of hospitals and institutions that might 

have provided care to the decedent at any time during 

his or her last year of life. If the death occurred in a -

hospital or institution, a hospital questionnaire is sent 

directly to the hospital or institution asking for 

information about the care provided and for the 

names and addresses of other medical facilities , 

providing care. 

Content of questionnaires. –The questionnaires 

for past National Mortality Surveys have contained 

questions concerning the patient’s last year of life. 

The 1961 survey included questions on hospital 

utilization, diagnoses, operations performed, institutions in which hospitalized, number of hospital stays, 

place of death, income, and whether working or 

retired during most of the last year of life. The 

1962-63 questionnaire included a few questions on 

hospital and institutional care in the last year of life, 

household composition, education, and income, with 

detailed questions on place of residence of the 

decedent. The 1964 and 1965 questionnaires included questions on health insurance, place of hospital and institutional care, the charges of hospital 

care and who paid them, operations performed, how 

much of the surgeon’s bill was paid by insurance, 

household composition, assets, and income. The 

1966-68 survey also included questions on the smoking habits of the deceased and questions regarding the 

household and income. 

The questionnaire for the 1964-66 National Infant Mortality Survey included questions on hospitalization of the infant who died, information about 

other children of the mother, household composition, 

income, employment of mother, education of mother 

and father, and health insurance. 

The National Natality Surveys collect information 

from mothers who had live births during a given year. 

The 1963 survey gathered information on the medical 

and dental care and radiological treatment of the 

mother, employment and education of mother and 

father, and family income. The 1964-66 survey 

gathered information on pregnancy history, expectations of having more children, household composition, income, whether this was a first or later 

marriage, date of first marriage and date of this 

marriage, whether mother was employed and when 

during her pregnancy she stopped working, education, and health insurance. The 1967-69 survey dealt 

with the medical care and smoking habits of the 

mother, breast feeding, information on earlier pregnancies, expectations of having more children, 

6 
Table A. Sample size and total response rate (percent) for each of the vital statistics followback surveys: United States, 1861.80 

Survey Sample size Response 

rate 

National Mortality Survey, 1961: 

Hospitals and institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 outof330deeths 98 

Informants providing names of hospitals end institutions . . . . . . . . . . . . . . . . . . . 1 out of 330 deaths 93 

National Mortality Survey, 1964.65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 out of 330 deaths 91 

National infant Mortali~Suwey, 1964%5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 out of 110 infant deaths 88 

National Natelity Survey, 1963: 

Mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 out of 1,000 births 86 

Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 out of 1,000 births 

Medical fecilitias ..,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 out of 1,000 births ; 

Dentists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 out of 1,000 births 97 

National NatalitySurvey, 1964-66. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 out of 1,000 births 89 

National NatalitySurvey, 1967... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 out of 1,000 births of 91 

white infants and 1 out of 

500 births of all other infants 

Nationel NatalitySurvey, 1968-69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 outofl,OOO birthsof 87 

whita infants and 1 out of 

500 births of all othar infants 

National MortalitySurvey, 1966-f38. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 out0f2600f all deaths of 92 

persons 35-84 years of age 

National NatalitySurvey, 1972: 

Mothers, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 outof500 births 72 , 

Physicians, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 out of 500 births 72 

Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 outof500 births 85 

National NatalitySurvey, 1980: 1 outof350births, including Provisional 

Mothers, ,, ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . anoversampling oflowbirth rates are 

Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . weight infants and 2 out of 5 all 75-80 

Hospitals and other medical sources providing X-ray fetal deaths of 28 waeks 

andultrasoundornuclearmedicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . gastation or more 

whether this was her first marriage, dates of first and maternal and infant health indicators, occupation of 

present marriages, education and religious preference - mother and father, and ethnicity. Furthermore, there 

of husband and wife, information on household 

composition, work history, and income. The 1972 

survey covered sources of medical care, health status 

of mother and infant, health insurance, outcomes of 

all pregnancies, whether pregnancy was wanted and 

expectations of having more children, whether the 

mother had an operation to prevent future pregnancies, whether this was the first marriage, dates offirst 

and present marriages, education of mother and 

father, information about the household, and family 

income. 

The 1980 national natality survey wasbroadened 

to include fetal mortality. It included many of the 

same or similar questions asprevious surveys in order 

to allow trend studies in the areas of smoking habits, 

marriage and pregnancy history, education, income, 

health status of mother and infant, sterilization, 

radiological treatment, employment, childbearing expectations, and breast feeding, Many new areas of 

study were added, such as alcohol consumption, 

electronic fetal monitoring, amniocentesis, additional 

was an oversampling of low birth weight infants in 

the natality survey, which will enable more in-depth 

study of this high risk grOUP. 

Copies of the data collection forms for the 

various surveys are included as an appendix in each 

analytic report based on data from a particular 

survey. 

Data processing methods. –After all methods of 

obtaining complete questionnaires have been exhausted, the data are edited and coded. Basic range 

edits are edits made to eliminate some coding errors. 

Computer processing includes consistency checks, 

estimation or assignment of weights, and imputation 

of missing data. 

Release of data.–As with the basic vital statistics 

provided through the registration system, the followback survey data are released through the Vita/ and 

Health Statistics series reports, supplements to the 

Monthly Vital Statistics Report, and public use data 

tapes, as the data become available. Series reports 

issued prior to 1975 were published in Series 22, 

7 
“Data from the National Natality and Mortality 

Surveys”; since 1975 reports from these sample 

surveys based on vital records have been included in 

Series 20, “Data on Mortality,” and Series 21, “Data 

on Natality, Marriage, and Divorce,” as appropriate. 

The privacy and confidentiality of study participants 

are carefully maintained. 

Uses of data.–Data from the followback surveys 

are in demand by all major users of vital statistics 

data. They help meet the expanding needs for 

natality and mortality data in public health, medical 

research, epidemiology, demography, and other related fields. Data provided through the natality 

surveys are used by agencies and individuals responsible for or studying maternal and child health care 

programs, and by researchers and others studying 

social and demographic issues. 

National Survey of Family Growth 

Background. –The National Survey of Family 

Growth (NSFG) is a multipurpose statistical survey 

that provides a wide range of information serving 

needs of persons and organizations concerned with 

the dynamics of population change, family planning, 

and maternal and child health. Developmental funds 

and necessary positions were provided for establishing 

NSFG in the National Center for Health Statistics in 

fiscal year 1971. Fieldwork for the fust cycle of the 

survey was begun in July 1973 and completed in 

January 1974. The second cycle began in January 

1976 and was completed in September 1976. A third 

cycle is expected to begin in January 1982. 

Purpose and scope. –NSFG is designed to produce 

data on factors influencing trends and differentials in 

fertility, family planning practices, sources from 

which family planning advice and services are obtained, the effectiveness and acceptability of the 

various methods of family planning, and those aspects 

of maternal and child health that are most directly 

related to fertility and family planning. The survey is 

based on personal interviews with women of childbearing ages selected from a nationwide area probability sample of households and group quarters, exclusive of the institutional population and women 

living on military bases. 

Sample design. –Cycles I and II of the National 

Survey of Family Growth were based on a crosssectional sample of women in the conterminous 

United States, 15-44 years of age, who were married, 

who had been married, or who had never been 

married but who had offspring of their own living 

with them in the household. Excluded from the 

sample were women living in group quarters (that is, 

five or more unrelated persons 18 years or older, 

unrelated t6 the head of the household, who live and 

eat together, or six or more unrelated adults who live 

and eat together–as, for example, in college dormitories, barracks, or long-term care institutions) and 

never-married women without children. 

NSFG is designed as a multistage area probability 

sample. In the fmt cycle of this survey, the first-stage 

primary sampling units included 101 standard metropolitan statistical areas, counties, parts of counties, 

and independent cities. Secondary sampling units 

consisted of enumeration districts or block groups 

within selected primary sampling units. Where feasible, secondary units were subdivided into third-stage 

listing units with a probability of selection proportional to estimated housing. In the fourth stage, 

housing units within the third-stage listing units were 

chosen by systematic sampling. A fifth level of 

sampling among eligible women within a household 

was required to obtain one and only one interview in 

each household with at least one eligible respondent. 

To ensure sufficient precision for presenting intragroup comparisons on various fertility variables, the 

black population was oversampled. 

The overall sample design called for 10,000 

completed interviews, including approximately 4,000 

black women and 6,000 women of white and other 

racial groups. The response rate was an overall 81 

percent. The final number of interviews was 9,797, 

consisting of 3,856 black respondents and 5,941 

respondents of white and other races. 

For Cycle II of NSFG a multistage area probability design based on 79 primary sampling units was 

developed. The remaining stages were broadly similar 

to those of the fmt cycle, except that a stratum for 

new housing (housing built since 1970), sampled 

from building permit listings, was added. Overall 

expected sample size remained at 10,000, with 

comparable racial composition. After a certain level 

of effort was completed in the fieldwork, remaining 

nonrespondents were subsampled at a rate of 1 in 2. 

The response rate for Cycle II was an overall 83 

percent. The actual number of completed extended 

interviews was 8,611, composed of 3,009 black 

respondents and 5,602 respondents of white and 

other races. 

For Cycle III the sample design is broadly the 

same as for Cycle II, but with adjustments to 

accommodate the more inclusive universe of women 

of any marital status, 15-44 years of age. The sample 

of 7,300 women will include women in group 

quarters such as college dormitories and boarding 

houses with more than five unrelated persons. As in 

the previous cycles of the survey, military bases and 

the institutional population will not be sampled. 

Data collection procedures. –Data collection for 

NSFG is conducted by private contractors according 

to Center specifications. Personal, in-depth interviews 

are conducted with women identified as eligible for 

extended interviews by means of a household screening interview. 

The questionnaires used for data collection in8 
I 

I€

elude a household screener designed to obtain household composition data and to identify eligible 

extended-interview respondents in the sample households. For Cycles I and II, two different versions of 

the questionnaire were used for the extended interview-a “currently married” questionnaire for women 

who were married at the time of the interview and a 

“post-married” questionnaire for women who were 

widowed, divorced, or separated or who had never 

been married but had their own children living in the 

household. The differences between the two versions 

were a result primarily of rewording the questions and 

of deleting questions related to husbands in order to 

make the “post-married” questionnaire appropriate 

for respondents not married at the time of the 

interview. Throughout the questionnaires, interviewer 

instructions were used to skip respondents over 

questions, or entire questionnaire sections, that were 

not applicable to their individual situations. Cycle III 

of the survey involves a screener questionnaire similar 

to that used in the previous cycles and two separate 

questionnaires for the extended interviews, one for 

women under 25 years of age and one for women 25 

years of age and over. The construction and format of 

the questionnaires are modeled on those of the 

previous cycles. 

Standardized interviewer training programs, 

which provide in-depth training on the questionnaires 

and on NSFG concepts and procedures, are conducted in several different locations in the country. 

In addition to successfully completing training, interviewers are required to conduct, for review and 

approval, several practice interviews prior to beginning their field assignments. Only women are employed as interviewers and observers in NSFG. Field 

supervisors receive the same in-depth training as the 

interviewers, in addition to intensive training in field 

procedures. 

Several quamy control procedures were developed in Cycle I and refined in Cycle II to ensure the 

quality of the collected and processed data: a 

systematic field edit of selected interview items and a 

validation of a sample of each interviewer’s work (a 

sample recheck) were performed throughout the 

fieldwork. Data preparation was validated through a 

5-percent sample recode of all questionnaires, in 

addition to systematic verification of each coder’s or 

keyer’s work. A comprehensive legal-code and consistency cleaning program was developed and used for 

the data tapes. Similar quality control procedures are 

specified for Cycle 111, 

Content o.f questionnaires. –In Cycles I and II, the 

NSFG questionnaires covered marital history, a detailed pregnancy history, fecundity and expected or 

intended future births, pregnancy planning practices 

and utilization of specific contraceptive methods, the 

source and financing of family planning services, and 

a broad range of socioeconomic and demographic 

characteristics. Cycle 111will collect information on 

sex education and the sexually active population as 

well as on the topics covered in Cycles I and II. 

In the first cycle of the survey, the average length 

of an interview was 73 minutes; in the second cycle 

the average length of an interview was reduced to 

about 56 minutes; in the third cycle interviews will 

again be kept within an hour, on the average. 

A copy of the Household Screener questionnaire 

for Cycle I is contained in appendix III of Series 2, 

No. 76; the screener for Cycle II is in appendix II of 

the comparable report for Cycle II, Series 2, No. 87. 

Relevant portions of the extended interview questionnaires are reproduced in appendixes of Series 23 

reports. The “currently married” questionnaire for 

Cycles I and II is reproduced in appendix III of Series 

4, No. 18. 

Release of data. –The publication program for 

NSFG includes advance reports issued in Advance 

Data, methodological reports and in-depth substantive analyses in Series 2 and 23 of Vital and Health 

Statistics, and public use data tapes. Publications 

from the fiist cycle were issued beginning in 1976; 

the public use data tape for this cycle was released in 

1977. Advance reports from the second cycle were 

issued beginning in 1978, and later the public use 

data tape became available in two parts: the fmt part, 

containing characteristics of respondents, including 

summary fertility characteristics, was released in 

April 1979; and the second part, containing characteristics relating to each birth, became available in 

1980. A public use data tape for Cycle III is 

expected to be available by the spring of 1984. 

Uses of data. –The rapidly growing need for 

collection of data on trends and differentials in the 

birth rate, family planning, and related aspects of 

maternal and child health has been recognized by the 

President and Congress. Attention has been directed 

toward studying population trends, assessing the 

implications of future population growth, making 

appropriate policy recommendations, and helping to 

educate the Nation regarding the consequences of 

population growth. More information is needed than 

is currently available from the regular data collection 

programs and occasional surveys of the U.S. Bureau 

of the Census and the National Center for Health 

Statistics. NSFG has been developed to provide, on a 

periodic basis, detailed data on factors influencing 

fertility, such as desired family size, birth spacing 

intentions, and family planning practices, in order to 

interpret current trends in the birth rate and to 

prepare more realistic projections of future population growth. In addition, for more effective planning, 

management, and evaluation of the expanded family 

planning programs, new information is being provided 

concerning the social and economic characteristics of 

couples who are either unable to limit their pregnancies, or who are unable to have all the pregnancies 

9 
that they want. The nature and severity of the approximately one-fourth of total births in the few 

problems these couples face and the extent to which years immediately following Cycle III of the survey. 

efforts to help them are succeeding are important Jn expanding the sample for Cycle 111to include all 

aspects of the survey. A major limitation of the women 15-44 years of age, the survey will provide 

survey has been the exclusion from Cycles I and II of data on the sexually active population as a whole and 

single women who do not have offspring living with will fill a significant gap in the need for detailed data 

them. Single women make a significant contribution on the problems of adolescent pregnancy. 

to the nation’s annual fertility, and they will produce 

. 

. 

10 
General population surveys 

National Health Interview Survey 

Background. –The National Health Interview Survey (NHIS) is a principal source of information on 

the health of the civilian, noninstitutionalized population of the United States. The National Health Survey 

Act of 1956 provided for a continuing survey and 

special studies to secure on a volunta~ basis accurate 

and current statistical information on the amount, 

distribution, and effects of illness and disability in the 

United States and the services rendered for or because 

of such conditions. The survey referred to in the Act, 

now called the National Health Interview Survey, was 

initiated in July 1957. In its early years the survey 

was known to many as the National Health Survey, 

the name now given to a broader program of surveys 

in the National Center for Health Statistics. 

Purpose and scope. –The purpose of the survey is 

to provide national data on the incidence of acute 

illness and accidental injuries, the prevalence of 

chronic conditions and impairments, the extent of 

disability, the utilization of health care services, and 

other health-related topics. A major strength of this 

survey lies in the ability to display these health 

characteristics by selected demographic and socioeconomic characteristics of the U.S. civilian, noninstitutionalized population. 

Because NHIS data are obtained during household 

interviews from the people themselves, the statistics 

measure health status and experiences and reflect the 

social and economic dimensions of health as reported 

by individuals–the extent and impact of illness and 

disability and the resulting uses of health care services 

by the people experiencing them. 

Interviews are conducted each week throughout 

the year in a probability sample of households. The 

interviewing is performed by a permanent staff of 

carefully trained and supervised interviewers of the 

U.S. Bureau of the Census under detailed specifications established by the National Center for Health 

Statistics. Data collected over the period of a year 

form the basis for the development of annual 

estimates of the health characteristics of the population and for the analysis of trends in those characteristics. 

The survey covers the noninstitutionalized, civilian population of the United States. Because of 

technical and logistical problems, several segments of 

the population are not included in the sample or in 

the estimates from the survey. Persons excluded are 

patients in long-term care facilities (data are obtained 

on patients in some of these facilities through the National Nursing Home Survey of the Center); persons 

on active duty with the Armed Forces (though their 

dependents are included); U.S. nationals living in 

foreign countries; and persons who died during the 

calendar year preceding the interview. 

Sample design. –The National Health Interview 

Survey is a cross-sectional household interview survey. The sampling plan follows a multistage probability design that permits the continuous sampling of 

households. The first stage consists of a sample of 

376 primary sampling units drawn from approximately 1,900 geographically defined primary sampling units that cover the 50 States and the District of 

Columbia. A primary sampling unit consists of a 

county, a small group of contiguous counties, or a 

standard metropolitan statistical area. Within primary 

sampling units, smaller units called segments are 

defined in such a manner that each segment contains 

an expected four households. The sampling plan is 

designed to yield national estimates, but some estimates can be obtained separately for the four 

geographic regions. 

The households selected for interview each week 

are a probability sample representative of the target 

population. Each calendar year, data are collected 

from approximately 40,000 households, including 

about 110,000 persons. The annual response rate of 

NHIS is usually at least 95 percent of the eligible 

households in the sample. The 5-percent nonresponse 

is divided equally between refusals and households 

where no eligible respondent could be found at home 

after repeated calls. 

11

Data collection procedures. –Data are collected 

through a personal household interview conducted by 

interviewers employed and trained by the U.S. 

Bureau of the Census according to procedures specified by the National Center for Health Statistics. 

All adult members of the household 17 years of 

age and over who are at home at the time of the 

interview are invited to participate and to respond for 

themselves. The mother is usually the respondent for 

children. For individuals not at home during the 

interview, information is provided by a responsible 

adult family member (19 years of age or over) 

residing in the household. Between 65 and 70 percent 

of the adults 17 years of age or over are selfrespondents. On occasion, a random subsample of 

adult household members is selected to respond to 

questions on selected topics. There are also instances 

in which followup supplements are completed either 

for the entire household or for individuals identified 

as having particular health problems. As required, 

these supplements are either left for the appropriate 

person to complete and return by mail, or the 

interviewer calls again in person or by telephone to 

secure the information directly. 

Nationally there are approximately 110 interviewers, trained and directed by health survey supervisors 

in each of the 12 Census Bureau regional offices. The 

supervisors are career civil service employees whose 

primary responsibility is the National Health Interview Survey. The interviewers are part-time employees, selected through examination and testing. Interviewers receive thorough training Lnbasic interviewing 

procedures and in the concepts and procedures 

unique to NHIS. 

On the average, the interviews require about 45 

minutes in the household. Depending upon the family 

size and the nature and extent of health conditions of 

family members, the length of interview ranges 

between 15 and 90 minutes. 

Content of questionnaire. –The questionnaire 

consists of two basic parts: a core set of health, 

socioeconomic, and demographic items; and one or 

more sets of supplementary health items. The core 

items constitute approximately 70 percent of the 

questionnaire and are repeated each year. The arrangement of rotating and single-time supplements 

allows the survey to respond to changing needs for 

data and to cover a wide variety of topics, while the 

core items provide continuous information on fundamental topics. Series 1, No. 11, “Health Interview 

Survey Procedures, 1957-74,” describes changes during that period in survey concepts and questions. 

The questionnaire now provides for the following 

types of core data: 

�	 Basic demographic characteristics of household 

members, including age, sex, race, education, and 

family income. 

� Disability days, including restricted activity and 

12


bed days, and work- and school-loss days occurring during the 2-week period prior to the week 

of interview. 

�	 Physician and dental visits occurring during the 

same 2-week period. 

�	 Acute and chronic conditions responsible for 

these disability days and doctor visits. 

�	 Long-term limitation of activity resulting from 

chronic disease or impairment and the chronic 

conditions associated with the disability. 

�	 Short-stay hospitalization data, including the 

number of persons with hospit~ episodes during 

the past year and the number of discharges from 

short-stay hospitals. 

�	 The intervals since the last doctor and dental 

visits. 

The questionnaire also includes six lists of chronic 

conditions. Each condition list concentrates on a 

group of chronic conditions involving a specific 

system of the body (for example, digestive, skin and 

musculoskeletal, circulatory, and respiratory). The 

body systems approach to chronic conditions was 

adopted because it was found that organizing questions around a particular body system resulted in 

more thorough reporting and increased the number of 

conditions for which estimates of prevalence could be 

made. Beginning in 1978, each of six representative 

subsamples has been asked questions based on one of 

the six lists of chronic conditions. In this way 

national estimates on each of the six body systems 

are obtained during the same interview year. Prior to 

1978 only one condition list was asked each year. 

The supplements to the questionnaire change in 

response to current interest in special health topics. 

Supplements for 1979 were included on immunization, smoking, home health care, eye care, residential 

mobility, and retirement income. In 1980 the supplements on home health care, residential mobility, and 

retirement income were continued and a supplement 

on health insurance added. Throughout 1981 a child 

health supplement was included. 

Suggestions and requests for special supplements 

are solicited and received from many sources. These 

include university-based researchers, administrators of 

national organizations and programs in the private 

and public health sectors, and specialists from other 

parts of the Department of Health and Human 

Services (for example, the National Institutes of 

Health and the Centers for Disease Control). Although it is not possible to include all of the 

suggested topics, every effort is made to be responsive 

to the data needs of such groups. A leadtime of at 

least 1 year is required to develop and pretest 

questions for new topics to be included as special 

supplements. For example, supplements selected in 

1981 will be developed and pretested in 1982 and 

I 
implemented in 1983 or 1984. Relevant portions of 

the questionnaire are included in an appendix to each 

Series 10 report, and each year’s questionnaire is 

reproduced in its entirety in the annual “Current 

Estimates” report, 

Data processing and quality control methods. – 

Throughout the data collection and processing phases 

there are extensive quality control activities. Each 

intewiewer edits all completed work before returning 

it to the regional supervisor, and in the regional office 

there is a preliminary edit of all questionnaires. As 

part of the quality control program, interviewers are 

provided feedback on their errors. In addition, a 

sample of households is reintewiewed by a supervisor 

or senior interviewer. 

The Census Bureau regional offices forward the 

questionnaires to the National Center for Health 

Statistics for coding and data processing. Each questionnaire is checked again at the Center for completeness of field coverage, omissions, and other errors. 

Illnesses, diseases, and injuries reported by the households are coded to a modified version of the 

International Classification of Diseases. All coding is 

subject to recoding on a sample basis to ensure a high 

level of accuracy. 

Thus, potential nonsampling errors such .as those 

in reporting, processing, and nonresponse, which are 

inherent in any sample survey, are kept to a minimum 

by methods built into the survey procedures. In 

addition, with regard to sampling error, standard 

error charts are created and provided so that a user 

can calculate the variations in the estimates that 

might occur because only a sample of the population 

is surveyed. 

Release of data. –Data release occurs in several 

forms, such as publications, tabulations by various 

sociodemographic characteristics, and public use data 

tapes. The earliest reports containing National Health 

Interview Survey data were issued in Series B and C 

of Health Statistics from the U.S. National Health 

Smwy. About 50 reports were. published in these 

series before they were replaced by the Vital and 

Health Statistics series. More than 140 reports from 

NHIS have been published in Series 10 of Vital and 

Health Statistics. Publication of a year’s data begins 

in about October of the year following completion of 

data collection and extensive computer editing of the 

data to ensure quality and reliability. 

The first report, “Current Estimates,” is followed 

by 8 to 10 other Series 10 publications. Since not all 

possible cross-tabulations can be analyzed and published in Series 10 reports, many unpublished tabulations are routinely generated and made available upon 

request, In addition, these data are published in a 

number of related special analyses prepared by the 

Analysis and Epidemiology Program of the Center. 

Another medium for data release is public use 

data tapes. A public use tape is usually available for 

distribution within about 2 years after completion of 

data collection. This time lag is due primarily to the 

need for staff to work with the data in order to 

ensure completeness and reliability of data obtained 

from the questionnaire supplements and to permit 

development of adequate documentation for the 

tapes. The data tapes, available since the 1969 data 

collection year, have been widely used by universities 

and Federal, State, and local governmental agencies. 

Uses of data. –Generally, uses of NHIS data can 

be broadly classified into the following areas: program planning and evaluation, public health education and health promotion, epidemiological research, 

and market research. 

NHIS data on morbidity (prevalence estimates) 

and associated disability (limitation of activity, disability days, and so forth) are used in Federal, State, 

and local program planning in the assessment of the 

extent and impact of public health problems. NHIS 

estimates on trends in incidence, prevalence, and 

disability are also used extensively in the evaluation 

of the effectiveness of therapeutic and preventive 

programs. 

Estimates of health problems and resultant access 

to health care services by various age, sex, occupational, and income subpopulations help identify gaps 

in the provision and receipt of needed services. 

Statistics on the prevalence of chronic disease, incidence of injuries, and disability are used in considering the cost of or extending the scope of medical 

care insurance or compensatory insurance of various 

types, Estimates of health problems and resultant 

utilization of health care services were used in 

formulating the legislation for both the Medicare and 

Medicaid programs and for making estimates of 

potential costs of the programs. NHIS data on 

out-of-pocket health care expenditures and the extent 

of coverage under private health insurance and public 

health care programs have been used by the Congressional Budget Office, the Office of Management and 

Budget, the Office of the Assistant Secreta~ for 

Health, and the Social Security Administration to 

evaluate programs covering the civilian, noninstitutionalized population. 

NHIS statistics are used by public, private, and 

voluntary agencies and organizations for the purposes 

of public health education and health promotion. For 

example, NHIS statistics on health characteristics of 

smokers and nonsmokers appeared in the Surgeon 

General’s reports on Smoking and Health in 1964, 

1979, and 1980. In addition, widespread and frequent use of NHIS statistics in newspaper articles, 

television news spots, popular magazines, and professional journals contributes to the American public’s 

awareness of their health status. This awareness 

ultimately leads to further individual and organizational health promotion and prevention efforts. 

NHIS morbidity statistics are used in the epidemi­

,> 13 

) 
ological analysis of associations between the prevalence of various diseases and sociodemographic characteristics (such as age, sex, and occupation) and in 

the identification of high-risk subgroups in the 

population. Identification of geographic patterns in 

the distribution of diseases can lead to clues for 

persons researching etiological factors. Researchers 

also use NHIS data in studies relating to disease to 

estimate direct costs (for example, expenditures for 

physician visits and hospitalizations) and indirect 

costs (for example, economic loss due to premature 

death, disability, and work loss) due to illness. 

Estimates of the number of persons with particular conditions as well as basic sociodemographic 

attributes are frequently used by private industry not 

only for estimating potential and current markets for 

new products or drugs but also for designing advertising campaigns targeted to the affected groups. 

Specifically, NHIS data on prescription drugs, special 

aids, corrective lenses, and hearing aids have been 

used in and of themselves and also in conjunction 

“with the NHIS data on injuries, chronic and acute 

conditions, and impairments and their impact in 

terms of limitation of activity and mobility. 

About 2,000 data requests are answered annually 

by the Divisiod of Health Interview Statistics. More 

than two-fifths of the data requests are from private 

industry and foundations; ahnost two-fifths are from 

Congress and Federal, State, and local government 

agencies; and the remaining fifth is divided among 

persons affiliated with educational institutions and 

private citizens interested in health data. 

National Medical Care Utilization and 

Expenditure Survey 

Background. –The National Medical Care Utilization and Expenditure Survey (NMCUES) is a unique 

source of detailed national estimates on the utilization and expenditures for various types of medical 

care. This survey builds on the experience of the 

National Health Interview Survey, the National Medical Care Expenditure Survey, and the former Current 

Medicare Survey. The first cycle of the survey was 

conducted to cover calendar year 1980. A second 

cycle of the survey is planned for the mid-1 980’s. 

Purpose and scope. –NMCUES is designed to be 

directly responsive to the continuing need for statistical information on the health care expenditures 

associated with health services utilization for the 

entire U.S. population. Cycle I was designed and 

conducted in collaboration with the Health Care 

Financing Administration to provide detailed utilization and expenditure data for persons in the Medicare 

and Medicaid populations. NMCUES will produce 

estimates over time for evaluation of the impact of 

legislation and programs on health status, costs, 

utilization and illness-related behavior in the medical 

care delivery system. 

Cycle I was composed of several related surveys. 

The household portion of the survey consisted of a 

national survey of the civilian noninstitutionalized 

population and a separate survey of the Medicaideligible populations of the States of New York, 

California, Texas, and Michigan. These two surveys 

each consisted of five interviews over a period of 

about 15 months to obtain information on medical 

care utilization, expenditures, and other healthrelated information. A third survey, an administrative 

records survey, was designed to verify the eligibility 

status of the household survey respondents for the 

Medicare and Medicaid programs. It also checked 

insurance cliaims filed with the national Medicare 

program and Medicaid programs in each of the four 

States for persons in the sample of Medicaid eligibles. 

Sample design. –The national Cycle I household 

survey comprised persons residing in about 6,000 

households. The sample for this survey was a multistage area probability sample drawn from 106 primary sampling units representing the 50 States and 

the District of Columbia. The State Medicaid household survey sample consisted of about 1,000 families 

in each of the four States; these families were selected 

with a known probability of selection from the State 

Medicaid enrollment lists. Thus, the total sample for 

the survey was about 10,000 households. 

An overall response rate of 89.4 percent was 

achieved in the first interview for both household 

surveys in Cycle I: for the national survey the 

response rate was 91.4 percent, and for the State 

Medicaid survey the rate was 86.7 percent. Attrition 

over the course of interviewing resulted in final 

response rates of 84.9 percent for the National 

household survey and 76.1 percent for the State 

Medicaid household survey. 

Data collection procedures. –NMCUES is a panel 

study. Interviews in Cycle I were conducted with 

each household at approximately 3-month intervals, 

with interviewing beginning in February 1980 and 

ending in March 1981. The first two interviews were 

conducted by personal visit of the interviewer to the 

household, the next two were conducted by telephone (if a telephone was available and acceptable to 

the household), and the final interview was conducted in person. Each round of interviewing asked 

about the period following the preceding interview 

except the first round, which asked about the period 

of time following January 1, 1980. 

Collection of data from the households was 

facilitated by the use of a calendar and a summary. 

At the time of the first interview, the household 

respondent was given a calendar on which to record 

information about health problems and health services utilization and to assemble physician and other 

provider bills between interviews. Following each 

household interview, information about health provider contacts and the payment of charges associated 
with them was used to generate a computer summary 

of information provided. This summary was then 

printed out in a simple format and mailed to the 

household for their review for accuracy and completeness prior to the next interview. At the subsequent interview, the interviewers reviewed this information with the household respondent to ensure 

accuracy and to obtain information not available 

during a previous interview. 

The administrative records survey of Cycle I was a 

check of the eligibility and claims records of persons 

reported as covered by Medicare or Medicaid. The 

supplementary and confirmatory data on Medicaid 

and Medicare enrollees provided information from 

the administrative records of the programs for comparison with that reported by the household respondents; the survey was designed specifically to meet the 

needs of the Health Care Financing Administration 

for programmatic data that is not otherwise available. 

For those individuals identified in the surveys as being 

enrolled in either the Medicare or Medicaid programs, 

identifying information was collected sufficient to 

allow the Health Care Financing Administration to 

flag incoming claims for services paid by Medicare, to 

allow the State Medicaid agencies in the four States in 

the State Medicaid survey to abstract data from 

claims, and to permit all State Medicaid agencies to 

confirm eligibility and type of eligibility under their 

State Medicaid program. 

Content of questionnaires. –Questionnaires for 

the household surveys were designed to obtain some 

information on a repeated basis throughout the 

survey and some information only one time. The 

repetitive core of questions for Cycle I included 

health insurance coverage, episodes of illness, the 

number of bed days, restricted activity days, hospital 

admissions, physician and dental visits, other medical 

care encounters, and purchases of prescribed medicines. For each contact with the medical care system, 

data were obtained on the nature of the health 

conditions, characteristics of the provider, services 

provided, charges, sources, and amounts of payment. 

Questions asked only once included data on access to 

medical care services, limitation of activities, occupation, income, and other sociodemographic characteristics. 

Data processing and quality control methods. – 

Data collection and processing phases incorporated a 

number of quality control activities, including a 

~ detailed edit by each field interviewer and, immediately upon receipt at the central office, a premachine 

edit of all key linkage variables. Errors discovered in 

this premachine edit and in further edit of a sample 

of all items provided feedback to interviewers and 

supervisors. 

Illness conditions, operations performed, specialties of medical providers not preceded on the 

questionnaire, and the industries in which persons 

were employed were coded prior to data entry. 

Quality control samples provided continuous monitoring of each coder, with retraining of interviewers 

and recoding of data, as appropriate, to ensure high 

levels of accuracy. Data entry through key to disk 

minicomputers provided a further level of editing for 

valid ranges and codes. Check digits embedded in key 

identifying numbers kept miskeyed linkage numbers 

to an absolute minimum. 

Release of data. –Data from Cycle I of NMCUES 

will be released in several forms. The publications 

program is a collaboration between the National 

Center for Health Statistics and the Health Care. 

Financing Administration. Preliminary data will be 

published in Preliminary Data reports, similar to the 

Center Advance Data reports. More detailed series 

reports based on the survey findings will be issued in 

a joint series with the Center preparing reports 

pertaining to the population as a whole and the 

Health Care Financing Administration preparing reports specific to the Medicare and Medicaid populations. A public use data tape is planned with release 

targeted for late 1982. The tape will actually be 

several sets of files including the national household 

data and the State data for each of the four States in 

the administrative records survey. Each set of files 

will contain data on the family, the individual, and 

the health care visit, pertaining to expenditures, 

utilization of services, and measures of health. In 

addition, unpublished tabulations will be made available; and, as resources, permit, special tabulations will 

be prepared upon request. 

Uses of data. –The National Center for Health 

Statistics has the responsibility for meeting the data 

needs of the Department and other users for expenditure and utilization data. The NMCUES data provide 

a statistical base for major health policy decisions on 

key issues such as health care financing and cost 

containment. Data are available for the Medicare and 

Medicaid populations and non-Federal beneficiaries 

so that comparisons can be made. Also, some data 

were collected on the State level for Medicaid 

beneficiaries because of the high degree of variability 

of eligibility requirements and service coverage in the 

State-managed Medicaid progams. 

In 1979 national health care expenditures 

amounted to $212.2 billion, about 9 percent of the 

gross national product; and the figures have been 

growing steadily for several decades. Of this $212.2 

billion, 43.1 percent was paid from public sources in 

1979. These figures, compiled by the Health Care 

Financing Administration, are aggregates. NMCUES is 

designed to provide statistics on the effects of health 

care utilization and expenditures at the individual and 

family level. In gross terms, who is using what types 

of medical care, how much is it costing them, and 

how is the bill being paid? 

NMCUES provides a unique source of extremely 

15


$ 
detailed health care utilization and financing information, which will enable detailed measurement of 

utilization and expenditures for different subgroups 

of the population. Specific items of service are 

identified that can be related to chronic and acute 

illness, disability, work-loss days, and limitation of 

activity. Such data are essential to the measurement 

of the impact of legislation and health insurance 

programs on the charges for and financing of health 

services and insurance. This survey will be the 

principal source of ongoing data needed to monitor 

changes over time in the impact on individuals and 

families of private and public programs. Specific uses 

of the data include the following: 

�	 Providing a statistical base for the health care cost 

monitoring efforts of the Department of Health 

and Human Services. 

�	 Providing updated, comparable measures of utilization and expenditures for the design and 

monitoring of health insurance proposals. 

�	 Providing data on trends and costs of health care 

services for different population subgroups over 

time. 

National Health and Nutition 

Examination Survey 

Background. –The first National Health and Nutrition Examination Survey, referred to as 

NHANES I, was initiated in 1970, with data collection beginning in April 1971. NHANES I was a 

modification and expansion of the Health Examination Survey (HES), which had been initiated a decade 

earlier and had carried out three separate programs. 

The restructuring and modification of HES reflected 

the assignment to the National Center for Health 

Statistics of an additional specific responsibility-the 

measurement of the nutritional status of the population and the subsequent monitoring of changes in 

that status over time. Upon completion of 

NHANES I, data were collected for a second National 

Health and Nutrition Examination Survey 

(NHANES 11) beginning in February 1976 and finishing in February 1980. A special health and nutrition 

examination survey directed to persons in families 

having one or more members of Hispanic origin or 

descent who live in areas with a high concentration of 

Hispanics has been planned for the period between 

completion of NHANES II and the beginning of 

NHANES III (now planned to begin data collection in 

1987). Pretesting for the Hispanic HANES began in 

1981, and data collection will begin in 1982. 

Purpose and scope. –NHANES and its predecessor, HES, share a common purpose-the collection 

and utilization of data that can be obtained best or 

only by direct physical examination, clinical and


laboratory tests, and related measurement proce­


dures. This information, which cannot be furnished


by the people themselves or by the health profes­


sionals who provide their medical care, is of two


kinds. Prevalence data are collected for specifically


defined diseases or conditions of ill health; and


normative health-related measurement data are collec­


ted that show distributions of the total population 1

with respect to particular parameters such as blood


pressure, visual acuity, or serum cholesterol level.


The surveys use probability samples of the U.S. 

r population to provide representative national data 

that are analyzed and made available in a series of reports. Successive surveys in the HES and NHANES 

programs have been directed to different segments of 

the population and have had different sets of target 

conditions. Thus, the first Health Examination Survey, or “cycle,” involved examining a sample of 

adults with the focus primarily on selected chronic 

diseases. The second and third cycles of HES were 

directed respectively to children between the ages of 

6 and 1land to youths between the ages of 12 and 17. 

Both of these surveys emphasized growth and development data and sensory defects. The nutrition component of the first NHANES program was directed to 

a probability sample of people in the broad age range 

1 to 74 years, while the detailed health examination 

component focused on the population between ages 

25 and 74. NHANES II was again directed to a broad 

population aged 6 months to 74 years, and the data 

on nutrition that were collected will be used in conjunction with the earlier NHANES I data to monitor 

changes in nutritional status over time. 

Sample design. –The samples for all of the HES 

and NHANES programs have been multistage, highly 

clustered probability samples. All of the samples were 

stratified by broad geographical region and by population density grouping. Within the strata, the sampling stages employed have been the primary sampling unit, the census enumeration district, the 

segment, the household, and lastly the individual 

person. Until the household stage was reached, all 

sampling was carried out centrally in conjunction 

with the U.S. Bureau of the Census. 

The next stage of the sampling was conducted in 

the field in the particular chosen area. It involved 

interviewer visits and questionnaire completion at 

each one of the selected households, with the final selection of individuals included in the sample being dependent upon information elicited by the household 

interview questionnaire. The size of the sample in the 

survey program has varied. In each of the three HES 

programs, the sample size was approximately 7,500 

persons. In NHANES I the sample selected for the 

major nutrition components of the examination contained approximately 28,000 people and yielded 

about 21,000 examined persons. A sample compara16 
ble in size for NHANES II again yielded approximately 21,000 examined persons. 

Data collection procedures. –Household interviewing during NHANES II was conducted by Bureau 

of the Census personnel. This represented a departure 

from previous surveys in which Center employees 

served this function. However, Center employees did 

the rest of the interviewing, as well as the history taking, examining, testing, and measuring in the mobile 

examination centers. Data collection teams consisted 

of specially trained interviewers and examiners, including physicians, nurses, dentists, dietitians, and 

medical, laboratory, and X-ray technicians. 

The examinations take place in the survey’s specially constructed mobile examination centers, each 

consisting of three truck-drawn trailers. These trailers 

are interconnected and provide a standardized environment with equipment for the performance of specific parts of the examination. This standardized environment is necessary for such components of the 

examination as audiometry, which requires hearing 

chambers within which the ambient noise level conforms to the American Speech Association standards 

for acoustical measurements. 

The general pattern of data collection has meant 

that each survey has been conducted over a period of 

3 or 4 years. This is due to the limitations on the 

number of persons examined in a given time span (for 

example, the number of field teams and the number 

of sample areas). The kinds of data to be collected are 

also limited, since conditions that might show marked 

year-to-year variation or seasonal patterns cannot be 

included. However, many important chronic diseases 

and health-related measurements are not subject to 

such changes in prevalence within shortrun periods. 

The distribution of the population according to 

unassisted visual acuity levels and the prevalence of 

such conditions as diabetes or hypertensive heart 

disease may vary over long periods of time, but not 

so rapidly as to prevent data collection over a 3- or 

4-year period from giving a correct picture of the 

population levels during or at the midpoint of that 

period. 

Voluntary sample surveys present a problem if no 

data are collected on a large fraction of the selected 

sample because individuals selected to participate in 

the program are not willing to do so. In the HES and 

NHANES program there has always been and continues to be much attention devoted to the question of 

the response rate, the proportion of sample persons 

who are actually examined. In NHANES there have 

been, as anticipated, more problems in the area of response than had been encountered in the earlier HES 

programs. The difficulties faced have led to a variety 

of innovative measures, including a policy of remunerating examined persons. As a result, both 

NHANES programs succeeded in obtaining household 

interview data on about 99 percent of the sample 

population. More detailed health data appear in the 

medical history questionnaires; these were completed 

for 88 percent of the selected sample persons in 

NHANES I and for 91 percent of the selected sample 

persons in NHANES II. Finally, in NHANES I, 74 

percent of the sample persons selected for the 

nutrition component and 70 percent of the persons 

selected for the detailed health component were given 

the standard examinations and tests; in NHANES II 

the overall response rate for the examination component was 73 percent. There is considerable ancillary 

information on most of the persons in the sample 

population who were not examined, and it is possible 

to make use of that data in the process of imputation 

and analysis of nonresponse bias. There is, moreover, 

some evidence that data obtained through examinations, tests, and measurements such as those used in 

these surveys are less susceptible to potential bias 

from a given rate of nonresponse than are data 

provided by the individuals themselves. 

Content of questionnaires, tests, and examinations. –The kinds of information collected in the 

NHANES and other examination survey programs are 

so varied and extensive that they are only illustrated 

here. With respect to nutrition, four types of data are 

included: 

�	 Information concerning dietary intake-taken 

from 24-hour recall interviews and food frequency questionnaires, both administered by an 

interviewer who has been a trained dietitian. 

�	 Hematological and biochemical tests–a sizable 

battery of such tests, with processing at the mobile examination centers where necessary, but for 

the most part at a central nutrition laboratory established at the Centers for Disease Control. 

�	 Body measurements–an especially important battery in connection with infants, children, and 

youths, where growth may be affected by nutritional deficiencies. 

�	 Various signs of high risk of nutritional deficiency–based on clinical examinations. 

The health (as distinguished from nutrition) component of the NHANES program includes detailed examinations, tests, and questionnaires, which have 

been developed to obtain a measure of prevalence 

levels of specific diseases and conditions, These vary 

with the particular program and have included such 

conditions as chronic rheumatoid arthritis and hypertensive heart disease. Important normative healthrelated measurements, such as height, weight, and 

blood pressure, are also obtained. 

A major element in the health component of 

NHANES I was an assessment, using index conditions, of unmet health needs. For the index conditions the examination established whether or not 

emphysema or another chronic respiratory disease 

17


—— 
was present. At the same time, information was obtained from the examined person with respect to 

self-perceived health needs and actions taken in 

seeking medical care. Analytic plans call for the 

interrelating of these two kinds of information to 

produce measures of unmet health care needs. 

In NHANES II the nutrition component remained 

nearly identical to that fielded previously. From an 

early analysis of the NHANES I data, it was decided 

to focus the nutritional examination elements on an 

anemia-related assessment approach. This involved 

the addition of certain medical history items and a 

more tailored set of laboratory determinations. Less 

was done in the area of health care needs. However, 

the emphasis placed on the effects of the environment upon health will probably be continued in 

future programs. Data were gathered to measure the 

levels of pesticide exposure, the presence of certain 

trace elements in the blood, and the amounts of carbon monoxide present in the blood. In the medical 

area, primary emphasis in NHANES II was placed on 

diabetes, kidney and liver functions, allergy, ~d 

speech pathology, 

The time required for the examination varies with 

the content of the examination and the age of the examinee. The time constraint included among planning 

factors has been that the total examination time not 

exceed 2-2Y2hours. Much attention is given in the 

planning process and in the actual pretests of a survey 

to the actual flow of examinees through the examination center, and every effort is made to streamline 

this process in order to reduce the time burden on 

the sample person. Additional respondent burden 

arises from the interview, from the completion of 

forms and questionnaires in the household, and 

from the varying time required to travel to the 

examination site. Data collection forms used in 

HES I, II, and III, NHANES I, the NHANES I 

Augmentation Survey, and NHANES II are reproduced in Series 1, reports numbered 4, 5, 8, 10b, 

14, and 15, respectively. 

Data processing methods. –The data collected in 

NHANES require a variety of data processing methods. X-rays must be interpreted; blood and other laboratory specimens must be processed through the appropriate laboratory operations. Certain data, such as 

electrocardiographic tracings, record directly onto 

magnetic tape and must undergo appropriate processing to be translated into digital tape form and subsequently to be interpreted. Examination record 

forms and interview and questionnaire data must be 

coded and put onto magnetic tape. 

Methods for handling specific examination elements are chosen on the basis of appropriateness. The 

program makes use of preceded forms, marked-sense 

record forms, self-administered forms, intervieweradministered forms, automatic recording devices, 

photographs, and so forth. Throughout whatever 

process is chosen, constant emphasis is placed on 

quality control measures such as editing, verifying, 

and replicating. Finally, outside consultants frequently collaborate in the analysis and reporting of 

the resultant data. 

Release of data. –Findings from NHANES programs traditionally are presented primarily through 

publication of individual reports in the National Center for Health Statistics Vital and Health Statistics, 

Series 11. In order to make NHANES findings more 

rapidly available to consumers, a program has been 

initiated to release basic descriptive summary tables 

in what are called “basic data publications.” These 

publications are an adjunct to the other Serie4 11 

reports for selected topics. Additionally, some 

NHANES data appear in abbreviated preliminary 

reports from Advance Data. 

Data are also released through appropriate scientific journals, separate monographs, special reports, 

and data tapes. Because of the voluminous amount of 

data collected in NHANES I and the need for disseminating data as expediently as possible, a policy shift 

was made that allows for the simultaneous release of 

data tapes to in-house analysts and sale of these tapes 

to the public as soon as fiial editing has been performed and documentation prepared. Data tapes 

from NHANES II are also being released upon completion of final editing and preparation of documentation. 

Published reports are not issued on a set frequency but rather made available as completed, The 

reports are organized on a topical basis with, for example, one report presenting data on periodontal diseme, another on auditory acuity, and so forth. 

Generally, the first reports produced are descriptive 

in nature while later reports become more analytic 

and may’ be interdisciplinary in approach. 

Uses of data. –The diverse nature of the data attracts a wide variety of users. In addition to policy 

makers and planners in Federal, State, and local 

health agencies, users of NHANES data include large 

numbers of health workers in the fields of nutrition, 

child health, pediatrics, anthropology, medical education, and health research, who have requested reports 

on body measurements, growth, and development. 

Data on body measurement have also been used by 

many industrial groups, including automobile manufacturers. Since some of the primary users of 

NHANES and HES data have been authors of text 

and reference materials used in medical schools and 

by health workers, these normative data reach a vast 

audience. 

The sale of data tapes from this program has increased greatly during the past few years, with known 

data users numbering in the hundreds. Several colleges and universities have purchased data tapes to 

be included in their computer tape libraries. Some of 

the users are medical research institutions and individ18

I 

ual researchers who wish to explore in detail specific sumption of food items for marketing studies, small I elements of the data. Projects currently underway scale or local health surveys that use the NHANES 

using NHANES data tapes include research on the ef- data as norms, and epidemiological studies that exfects of alcohol intake on health, research on the con- amine geographic patterns in morbidity. 

19

Health resources utilization statistics


National Hospital Discharge Survey 

Background. –The National Hospital Discharge 

Survey (NHDS) is the prkipal source of information 

on inpatient utilization of short-stay hospitals. Data 

collection began in 1964 and has been continuous 

since then. 

Purpose and scope. –The purpose of NHDS is to 

produce statistics that are representative of the experience of the U.S. civilian population discharged 

from short-stay hospitals, Specifically, the survey provides information on characteristics of patients, 

lengths of stay, diagnoses, surgical operations, and 

patterns of use of care in hospitals of different size 

and ownership in the four major geographic regions 

of the country. 

The scope of NHDS is limited to discharges from 

non-Federal hospitals in the 50 States and the District 

of Columbia. Only hospitals with six or more beds 

and an average length of stay for all patients of less 

than 30 days are included in the sample. 

Sample design. –The unit of enumeration in the 

survey is a hospital discharge. The sample plan is basically a two-stage stratified design. The first stage is a 

sample of about 10 percent of the short-stay hospitals, excluding Federal hospitals, listed in the 

National Master Facility Inventory (the sampling 

frame-see section “National Master Facility Inventory”). The primary stratification variables are bed 

size and geographic region. Hospitals are selected in 

direct proportion to size so that hospitals with 1,000 

or more beds are selected with certtity, and hospitals with less than 50 beds are sampled with a probability of approximately 1 in 40. Growth in the inventory of hospitals is represented in the survey by 

a sample of hospitals selected from a special universe 

of new hospitals. 

The second stage of the design is a systematic 

sample of the discharges from the sampled hospitals. 

The sampling frame in nearly all hospitals is the 

daily listing of discharges. The size of the withinhospital sample varies inversely with the size of the 

hospital, from about 1 per 100 discharges in hospitals with 1,000 or more beds to 4 per 10 discharges 

in hospitals with less than 50 beds. The overall sampling rate for each bed-size group is about 1 per 100 

discharges, the product of the first- and second-stage 

sampling rates. 

In 1979 the sample consisted of 544 hospitals 

from a universe of approximately 8,000 short-stay 

hospitals. Of the 496 hospitals in the scope of the 

survey, information was collected from 416 participating hospitals (an approximately 84-percent response rate) on approximately 215,000 discharges. 

Data collection procedures. –The U.S. Bureau of 

the Census, acting as the data-collecting agent for the 

National Center for Health Statistics, inducts sample 

hospitals into NHDS. After induction, hospitals are 

visited at lea,st once a year by a representative of the 

Bureau of the Census. At that time survey procedures 

are reviewed, and information about the hospital is 

updated. 

Discharge data are collected throughout the year. 

Sample discharges are systematically selected, usually 

on the basis of the final digit or digits of the patient’s 

medical record number. For each sample discharge, 

an abstracter records personal, administrative, diagnostic, and surgical information from the face sheet 

of the patient’s medical record onto a medical abstract form. Data collection frequency depends on 

the arrangement made with the hospital. In about 35 

percent of the participating hospitals, a representative 

of the Bureau of the Census visits the hospital every 2 

months, completes the abstract forms for records selected during the previous visit, and selects records 

for abstracting at the next visit. This allows time for 

records to be completed and properly filed (or pulled 

from file) prior to the visit. In about 65 percent of 

the hospitals, the same forms are completed by members of the hospital medical record department. All 

completed forms are forwarded to one of the Census 

regional offices for review and then to the National 

20 
Center for Health Statistics for coding and data processing operations. 

Content of medical abstract form. –The medical 

abstract form contains items relating to the personal 

characteristics of the patient, including date of birth, 

sex, race, and marital status, but not name and address; administrative information, including admission 

and discharge dates, discharge status, and medical 

record number; and medical information, including 

diagnoses and surgical operations or procedures. It is 

estimated that medical record personnel can sample 

and complete each form, on the average, in about 5 

minutes. 

The contents of the medical abstract forni did not 

change from the inception of the survey until 1977, 

when modifications were made so that it more nearly 

parallels the Uniform Hospital Discharge Data Set. 

The items added to the abstract at that time are residence of patient (zip code), expected source of payment, disposition of patient, and dates of procedures, 

In 1968-70 actual hospital charges by service and payments by source were recorded on a ledger abstract 

form for approximately one-third of the sample discharges. A copy of the medical abstract form is 

included as an appendix in Series 13 reports based on 

data from NHDS. 

Data processing methods. –After transmittal from 

the hospital, abstract forms are subject to two reviews, two machine edits, and two quality control 

procedures. Forms are reviewed for completeness at 

the Census regional offices and either forwarded to 

the National Center for Health Statistics or returned 

to the hospital for more information. On receipt at 

the Center forms are again checked and, if necessary, 

returned to the hospital. After review, up to seven 

diagnoses and four operations are coded according to 

the clinical modification of the International Classification of Diseases–ICD-9-CM. Coded information is 

then keyed from abstract to disk, and a preliminary 

machine-edit program checks for missing, invalid, 

and inconsistent codes. The information is corrected, 

if necessary, and then transferred from disk to computer tape. For 1970-78 data, up to five diagnoses 

and three operations were coded according to the 

eighth revision of the International Classification of 

Diseases–ICDA-8. 

Re/ease of data. –Annual data are published in 

Advance Data and in the Center’s Vital and Health 

Statistics Series 13. The publication program is, at a 

minimum, to update nonmedical, medical, and surgical data for characteristics of patients and hospitals. 

Special reports on average length of stay, patient 

charges, geographic utilization, and methodology are 

also published. 

Unpublished data are available on request from 

the Hospital Care Statistics Branch, which receives 

about 1,000 requests per year, usually for specific 

diagnostic and surgical listings in the International 

Classification of Diseases. In addition, data for the 

years from 1970 to the present are available on public 

use data tapes. 

The names of the participating hospitals and all 

information related to individual patients are confidential. No data are released in published, unpublished, or tape form that could identify hospitals or 

patients. 

Uses of data. –The National Hospital Discharge 

Survey is the principal source for national data on the 

characteristics of patients discharged from short-stay 

hospitals. The data are used for a variety of planning, 

administrative, and evaluative activities by governmental, professional, scientific, educational, and 

commercial institutions, as well as by private citizens. 

The users include Federal agencies such as the National Institutes of Health, the Centers for Disease 

Control, and the Indian Health Service; universities 

and medical schools; professional organizations such 

as the American Medical Association, American Hospital Association, and World Health Organization; 

hospitals; medical research laboratories; pharmaceutical and medical supply manufacturers; publishing 

houses; market research groups; and insurance 

companies. 

National Ambulatory MedicaI Care Survey 

Background. –In May 1973 the National Center 

for Health Statistics inaugurated the National Ambulatory Medical Care Survey (NAMCS) on a continuing 

basis to gather and disseminate statistical data about 

ambulatory medical care provided by office-based 

physicians to the population of the United States. 

The need for such a system had been recognized 

many years before, having been pointed out as early 

as 1953 by the Subcommittee on National Morbidity 

Surveys of the U.S. National Committee on Vital and 

Health Statistics. During a 5-year feasibility study 

period beginning in 1967 three major national pilot 

studies and several small area studies, combined with 

extensive consultation with experts in various areas of 

medical care delivery, were employed in developing 

the current NAMCS instruments and procedures. 

Through this process the current NAMCS materials 

and procedures have been refined to request only information considered essential to describe adequately 

the utilization of ambulatory services and to require a 

minimal amount of time for the participating physicians. 

Purpose and scope. –The purpose of NAMCS is to 

meet the needs and demands for statistical information about the provision of ambulatory medical care 

services in the United States. Ambulatory services are 

rendered in a wide variety of settings, including physicians’ offices, neighborhood health centers, and hospital outpatient facilities. It is expected that NAMCS 

will eventually encompass all of these settings and 

21

that appropriate survey instruments and methodology 

will be developed as resources permit. Currently, the 

NAMCS target population consists of all office visits 

within the conterminous United States made by ambulatory patients to non-Federal physicians who are 

in office-based practice and engaged in direct patient 

care, Excluded are visits to hospital-based physicians; 

visits to specialists in anesthesiology, pathology, and 

radiology; and visits to physicians who are principally 

engaged in teaching, research, or administration. Telephone contacts and visits other than office visits are 

also excluded. Since about 7(? percent of all direct 

ambulatory medical care visits occur in physicians’ 

offices, the current NAMCS design provides data on 

the majority of ambulatory care services. 

Sample design. –The most objective and reliable 

sources of data about physicians’ services rendered to 

ambulatory patients during office visits are the physicians themselves and members of their office staff. 

The sampling frame is a list of licensed physicians in 

“office-based, patient care” practice compiled from 

files that are classified and maintained by the American Medical Association and the American Osteopathic Association. These fdes are continuously updated by both associations, making them as current 

and correct as possible at the time of sample selection. 

NAMCS uses a modified probability-proportionalto-size sampling procedure using separate sampling 

frames for standard metropolitan statistical areas and 

for nonmetropolitan counties. ,ifter sorting and stratifying by size, region, and demographic characteristics, each frame is divided into sequential zones of 1 

million residents, and a random number is drawn to 

determine which primary sampling unit from each 

zone is included in the sample. The NAMCS final 

first-stage sample contains 87 primary sampling units, 

corresponding to individual counties or small groups 

of contiguous counties across the country. 

The second-stage sample is selected from the list 

of physicians located in the sample primary sampling 

units, ordered by major specialty categories so that 

the overall probability for including any individual 

physician is approximately constant. The present 

annual sample consists of approximately 3,000 physicians. The sample physicians are randomly distributed 

across the 52 weeks of the year so that the resulting 

data reflect any seasonal variations. Since the assignment of the reporting week is an integral part of the 

sample design, each physician is required to report 

during his predetermined period, and no substitute 

reporting periods are permitted. Approximately 75 

percent of the eligible physicians in the sample participate in the survey. From this size physician sample, information is secured from about 50,000 patient 

visits a year. Samples for subsequent years exclude, 

with certainty, sample physicians included in the previous 2 years of the study. 

The final stage involves sampling patient visits 

within a physician’s practice. The sampling rate, 

which is determined at the time of the interviewer’s 

appointment, is dependent on the number of days 

during the reporting week that the physician is in 

practice and the number of patients expected to be 

seen. In actual practice, the sampling procedure is 

handled through the use of a Patient Log (see “data 

collection procedures”). 

Field procedures, –To maximize participation 

levels and minimize data reporting burden in the physician’s office, NAMCS field procedures have been designed to accommodate the circumstances of individual physicians. Each physician is contacted by several 

means, including mail, telephone, and personal interview. Initially, each physician in the sample is sent an 

introductory letter from the Director of the Center. 

The physician is then telephoned by an informed and 

trained interviewer who explains the survey briefly 

and arranges a personal appointment to relate more 

detailed instructions. During this appointment, the 

interviewer verifies the physician’s eligibility for participation in the survey, delivers survey materials with 

printed instructions, provides detailed verbal instructions, and assigns a predetermined 7-day (Monday 

through Sunday) reporting period. Also, during this 

appointment data concerning basic practice characteristics, such as the physician’s specialty and staff 

makeup, are collected for use in analysis. 

At the beginning and again during the physician’s 

assigned reporting week, the interviewer contacts the 

sample physician to answer possible questions and to 

ensure that procedures are going smoothly. At the 

end of the week, the participating physician mails the 

fiiished forms to the interviewer, who edits them for 

completeness before transmitting them for central 

data processing. 

Data collection procedures. –The actual data collection for the National Ambulato~ Medical Care 

Survey is carried out by the participating physician, 

aided by office assistants when possible. The physician completes a Patient Record for a sample of his 

patients seen during his assigned reporting week. 

Based on the physician’s own estimate of patients expected to visit during the survey period, the physician 

is assigned to use an “every-patient” or a “patientsampling” procedure. These sampling procedures are 

designed so that Patient Records are completed each 

day of practice for, at most, 10 patient visits. Physicians expecting 10 or fewer visits per day record 

data for all of them, while those expecting more than 

10 visits per day record data after every second, third, 

or fifth visit, using a random start and observing the 

same predetermined sampling interval continuously. 

These procedures minimize the workload of data 

collection and maintain equal reporting levels among 

sample physicians, regardless of the size of their 

practice. Each form requires 1 to 2 minutes to 

22 
complete, so that approximately 15 minutes are 

required on days when patients are attended in the 

physician’s office. 

I Two data collection forms are employed by the 

participating physician: the Patient Log and the Patient Record. The Patient Log is a sequential listing of 

I	 patients that serves as a sampling frame to indicate 

which visits data should be recorded for. The Patient I Record varies slightly from year to year, but it generally contains items of information about the visit 

such as its date and duration; the patient’s date of 

birth, sex, race, ethnicity, and reason for visit; 

whether the patient had been seen for the particular 

problem before and whether the patient was referred 

by another physician; the length of time since onset 

of the problem; diagnoses; diagnostic and therapeutic 

services; and disposition. Periodically, supplementary 

items are added to the basic Patient Record to investigate specific health conditions or other aspects 

of ambulatory care. For example, questions about 

specific medications were added for 1980-81, and 

questions about accident- or product-related illnesses 

were added for 1979. A copy of the Patient Record is 

included in the annual “Summary: NAMCS” Advance 

Data report and as an appendix in Series 13 reports 

based on NAMCS data. 

Data processing methods. –Initial edits for completeness of the Patient Record are done by the interviewer as the forms are received from the participating physician. These forms are then sent to central 

processing, where they are clerically edited for consistency. The two medical questions are then coded: 

the patient’s reasons for visit are coded using the 

NAMCS “Reason for Visit Classification” (described 

in Series 2, No. 78) and the physician’s diagnoses are 

coded using the International Classification of Diseases. The data are then keyed onto magnetic tape, at 

which time additional machine edits and consistency 

checks are run. 

Release of data. –NAMCS results in the form of 

summary statistical tabulations of national and regional estimates for number of visits, percent distributions, and population rates of use are published as 

soon as possible after each annual cycle is complete. 

More detailed tabulations and analyses follow, which 

present visit characteristics by major physician specialty groups, patient groups, diagnostic categories, 

treatment provided, and disposition. Crosstabulations of less common visit characteristics are 

published when sufficient data about them are available to meet practical standards of precision. These 

data are released through the Center’s Advance Data 

and Vital and Health Statistics Series 13 reports. 

Other publications, including the various journals and 

newsletters of the NAMCS endorsing organizations, 

also provide a means of releasing data to the medical 

community. In addition, public use data tapes are 

made available approximately 1 year after the end of 

data collection, when documentation of the data is 

complete and its validity is checked. 

As part of the procedures designed to protect the 

identity of the patients, the Patient Logs containing 

the names of the patients are detachable from the Patient Records. At the end of the reporting period the 

Patient Logs, and thus the names of the patients, are 

retained by the physician. Sample physicians are 

further assured that all information that would permit identification of an individual, a practice, or an 

establishment will be held confidential. All findings 

are released in the form of summary statistics that 

preclude any individual identification, and all identifying data are destroyed as soon as data processing 

operations are complete. 

Uses of data. –NAMCS provides a wide range of 

data on the characteristics of the users and providers 

of ambulatory medical care. These baseline data, 

together with trend data as the survey progresses, provide new insights into ambulatory mediczil care and 

stimulate further research on the use, organization, 

and delivery of ambulatory care. 

The manner in which ambulatory care is actually 

dispensed, as described by the survey, can be related 

to arrangements for educating and training physicians 

and other health personnel to provide ambulatory 

medical care, particularly primary care. Such comparisons suggest useful new directions and emphases 

that can be incorporated in the curricula, helping to 

make medical education more responsive to the shifting requirements and health problems of the population. NAMCS information is useful to health planning 

agencies; managers of health delivery systems; and 

others concerned with planning, monitoring, and 

managing health care resources. It is valuable to those 

who develop and evaluate new and modified health 

care systems and arrangements. The continuing nature of the survey permits observation and measurement over time of different modes for managing and 

treating patients’ problems, and it provides general information on the etiology and epidemiology of selected conditions. It also provides valuable information about the speed and effectiveness with which 

certain advances in medical practice are adopted by 

the basic source of medical cme, the office-based 

physician. 

National Nursing Home Survey 

Background.–Between 1963 and 1969 the National Center for Health Statistics conducted surveys 

of nursing homes and their residents on an ad hoc 

basis. With the implementation of the Medicaid and 

Medicare programs, the increased utilization of nursing homes, and the projected increases in the aged 

population, those who set standards for, plan, provide, 

and assess long-term care services needed comprehensive national data on a continuing basis. To meet their 

23 
needs, the National Nursing Home Survey was developed in 1972, with the initial survey conducted in 

1973-74 and the second conducted in 1977. 

Purpose and scope. –This periodic data collection 

system is a series of nationwide sample surveys of 

nursing homes, their residents, and staff. The purposes of the surveys are as follows: 

�	 To collect national baseline data on characteristics of the nursing home, its services, residents, 

and staff for all nursing homes in the Nation, regardless of whether or not they are participating 

in Federal programs such as Medicare or Medicaid. 

�	 To collect data on the costs incumed by the facilit y for providing care by the major groupings— 

labor, fixed, operating, and miscellaneous costs. 

�	 To collect data on certification for participation 

in the Medicare and Medicaid programs (such as 

the utilization of certified beds and the health of 

residents receiving program benefits) so that all 

data can be analyzed by certification status. 

�	 To provide comparable data for valid trend analyses on a variety of topics. Such analyses can, for 

example, identify the impact of legislative changes 

in standards and in reimbursement on the growth 

of facilities, and of the impact of institutionalization on the health of the aged. 

�	 To interrelate facility, staff, and resident data to 

reveal the relationti-ps that exist between utilization, services offered, charges for care, and the 

cost of providing care. 

For the initial survey conducted in 1973-74, the 

universe included only those nursing homes that provided some level of nursing care, regardless of 

whether or not they were participating in the Medicare or Medicaid programs. Thus, homes providing 

only personal or domiciliary care were excluded. 

Beginning with the 1977 survey, the universe was 

expanded to include all nursing, personal care, and 

domiciliary care homes, regardless of their participation in Medicare or Medicaid. Homes that provide 

room and board only are excluded. In both surveys, 

homes in the universe included those that were 

operated under proprietary, nonprofit, and government auspices. The universe also included homes that 

were units of a larger institution (usually a hospital or 

retirement center). 

Sample design. –The National Master Facility Inventory (NMFI) listing is the universe from which the 

sample homes are selected. The NMFI listing, maintained by the Center, contains the basic information 

about each home (such as name, address, size, ownership, number of residents, and number of staff) that 

is needed to design efficient sampling plans. 

Resident data are collected by reviewing medical 

records and questioning the nurse who usually provides care for the resident. Residents are not inter24 

viewed directly. The initial National Nursing Home 

Survey, conducted from August 1973 to April 1974, 

had a nationally representative sample of 2,100 nursing homes, with a subsample of 25,100 staff and 

19,400 residents. The second survey, conducted from 

May to December 1977, had a total sample of 1,700 

nursing homes, with a subsample of 16,800 staff, 

7,100 residents, and 5,300 discharged residents. 

Data collection procedures and questionnaire 

content. —The survey system uses several questionnaires. The facility questionnaire includes questions 

on number of beds and residents, services provided, 

certification status, and various utilization measures. 

The expense questionnaire includes questions on the 

facility’s expenses by the major groupings-labor, 

freed, operating, and miscellaneous. The staff questionnaire includes questions about the employee’s 

demographic characteristics, work experience, education, and salary. The residents questionnaire includes 

questions about the resident’s demographic characteristics, health status, functional status, participation in 

social activities, monthly charge, and source of payment. Included in the 1977 survey was a questionnaire for discharged residents. This included some of 

the same items as the questionnaire for current residents, items selected on the basis of their availability 

in the medical record. 

The survey has a number of respondents in each 

nursing home and is a combination of personal interview and self-administered questionnaires. Facility 

information is secured through a 20-minute personal 

interview with the administrator. Expense data are 

collected on a self-administered questionnaire, requiring about 30 minutes to answer, completed either by 

the facility’s accountant under authorization from 

the administrator or by the administrator. Sampled 

staff members complete a brief form that requires 

about 5 minutes to complete. Information on sample 

current residents is secured by the interviewer in a 

personal interview with the nurse who provides care 

to the resident and who refe~ to information from 

the medical record. About 15 minutes is required for 

each sample resident. For the 1977 survey, information on the sample discharged residents was secured 

by the interviewer in a pemonal interview with the 

nurse who was most familiar with the medical records 

and who referred to them for replying to all 

questions. 

All survey questionnaires for the 1973-74 survey 

are included in Series 13, No. 22; and the questionnaires used in the 1977 survey are contained in Series 

13, No. 43. Selected questionnaires from the surveys 

are found in other Series 13 reports based on the 

National Nursing Home Survey. 

The 1977 survey included several modifications 

of the 1973-74 survey design and methodology. 

.€ It collected data on discharged residents, especially in the areas of health status, length of stay, 
discharge status, and where the resident was to go 

after discharge. 

. It collected data on the revenues of the facility as 

well as on its expenses. 

�	 It produced estimates for the five States with the 

largest proportion of nursing home residents. 

.	 It limited respondent reporting by limiting subsamples of residents and discharges to a maximum 

of 8 per facility, and of staff to 23 per facility. 

The response rates for the surveys differed 

according to the type of questionnaire used, as presented in table B. 

Data. processing methods. –All data items are 

edited to ensure that all responses are accurate, 

logical, and complete. Those items left unanswered 

are imputed by assigning a value from a responding 

unit with major characteristics identical to those of 

the nonresponding unit. 

Release of data. –National estimates are available 

to requesters in the form of tabulations, Center publications, and data tapes. Tables are aggregated so that 

no one respondent can be identified. Similarly, no 

identifying information concerning the facility, staff, 

or residents is contained on the data tapes, although a 

pseudoidentification number allows linkage of data 

among the various fries. 

A report analyzing provisional tabulations is available 6 months after data collection ends. Selected 

fiial tabulations are released 6 months later. Data are 

analyzed and presented in the Center Advance Data 

reports and in Vjtal and Health Statistics Series 13 

and 14. These reports present data on facilities (utiliTabla B. Rasponse rates for National Nursing Home Surveys, by typa 

of questionnaira used (percent): Unitad States, 1973-74 and 1977 

Response rate 

Questionnaire 1977 1973’-74 

survey survey 

Facility . . . . . . . . . . . . . . . . . . . . 95 97 

Expense . . . . . . . . . . . . . . . . . . . 85 88 

Staff . . . . . . . . . . . . . . . . . . . . . 81 

Residents. . . . . . . . . . . . . . . . . . . 99 E 

Discharges . . . . . . . . . . . . . . . . . . 97 . . . 

zation, expenses, and services), residents (demographic characteristics, health status, services received, and charges), discharged residents, and staff 

(number, training, and experience). Once data have 

been reviewed and analyzed, data tapes are available 

for release to requesters. 

Uses of data. –Nursing homes are the most rapidly 

expanding sector of the health care industry. Federal 

and State funds spent for nursing home care have 

been increasing each year. Thus, national data on the 

costs and characteristics of the nursing home, its residents, discharged residents, and staff, are needed on a 

continuing basis by the Department of Health and 

Human Services for program planning and the setting 

of national policies. Congress needs information on 

the interrelationships among facility-resident-cost 

data in order to draft legislation on standards and 

reimbursement. In addition, these data are needed by 

professionals who conduct epidemiological research . 

and those who plan, provide, and assess long-term 

care services at State and local levels. 

25 
Health resources statistics 

National Master Facility Inventory 

Background. –The National Master Facility Inventory (NMFI) is a comprehensive fde of the 33,000 

facilities in the United States that provide medical, 

nursing, personal, or custodial care to groups of 

unrelated persons on an inpatient (at least overnight) 

basis. Facilities in NMFI are categorized into three 

broad types: hospitals, both short- and long-stay; 

nursing and related care homes; and other custodial 

or remedial care facilities, including homes or resident 

schools for the deaf, blind, mentally retarded, emotionally disturbed, and other neurologically impaired 

or physically handicapped; resident treatment centers 

for alcohol and drug abusers; orphanages or homes for 

dependent children; and homes for unwed mothers. It 

is the most comprehensive file of inpatient health 

facilities available in the United States. 

Purpose and scope. –NMFI has two basic purposes. It is an important national source of statistics 

on the number, type, and geographic distribution of 

inpatient facilities in the United States. In addition, it 

serves as the universe from which probabilityy samples 

are selected for conducting sample surveys. 

Data collection procedures. –NMFI was first 

assembled in 1962-63 by collating the fdes of four 

Federal agencies that contained the names and 

addresses of facilities, the directories of national 

associations and organizations, and State licensure 

files. 

Two mechanisms are used to keep the data in 

NMFI as current as possible. For all facilities except 

hospitals, the National Center for Health Statistics 

conducts a series of mail surveys, fnst, to ensure that 

the data on fde on the basic characteristics of the 

facilities are accurate and, second, to identify and 

then delete those facilities that have gone out of business or are no longer eligible for inclusion. These 

surveys are conducted approximately once every 2 

years. 

In addition, at regular intervals State licensure 

agencies, national voluntary associations, and other 

. 

appropriate sources send to the Center their most 

recent directories or lists of new facilities. These lists 

are then clerically matched with the most current 

NMFI file, and facilities not already included are 

added. 

For hospitals, data were gathered annually in a 

joint survey of the American Hospital Association 

and the Center. The contractual arrangement, which 

in effect merged the hospital portion of NMFI with 

the American Hospital Association’s annual survey of 

hospitals, began in 1968. Through 1975 the American 

Hospital Association performed the data collection 

(from October through January each year) for its 

member hospitals, while the Center performed the 

data collection for the approximately 400 hospitals 

that were not registered with the American Hospital 

Association. The American Hospital Association processed both portions of the survey according to the 

same edit and processing specifications and delivered 

to the Center two edited tapes, one for American 

Hospital Association hospitals and one for nonmember hospitals. In 1976 and 1977 the American 

Hospital Association surveyed all hospitals as part of 

its annual survey. The contractual relationship with 

the American Hospital Association ceased in 1978. 

Since that time the Center has purchased hospital 

data tapes annually from the American Hospital 

Association, tapes which are solely for the Center’s 

internal statistical use. 

During the period 1976-80, under the health 

facilities component of the Cooperative Health Statistics System (CHSS), health facilities data for some 

States were collected and processed by the State 

CHSS contractor as a byproduct of the licensure 

renewal process. Edited data were then provided on ‘ 

computer tape by each CHSS State to the Center, 

and these data were merged into NMFI. Data for all 

facilities, except hospitals, in States not participating 

in CHSS continued to be collected by the Center 

every 2 years as part of NMFI. The next NMFI survey 

is planned for 1982. 

Content of data collection instruments. –The fol26 
lowing types of data are collected for the three 

categories of facilities found in the National Master 

Facility Inventory-hospitals, nursing homes, and 

other facilities: 

Hospitals: Ownership; major type of service offered; whether various facilities and services are 

offered; number of beds, admissions, inpatient 

days of care, and discharges; patient census; 

number of bassinets, live births, and newborn 

days of care; outpatient utilization; number of 

surgical operations; revenue, expenses, and assets; 

and staffing. 

Nursing homes: Ownership; major type of service; 

licensed and staffed beds; beds certified for 

Medicare and Medicaid; admission policy with 

regard to age, sex, and various conditions; patient 

census by age and sex; inpatient days of care; 

number of admissions, discharges, and deaths; 

staffing; who is in charge of nursing care; number 

of patients receiving nursing care; services routinely provided; basic monthiy charge; and operating expenses. 

Other facilities: Ownership; major type of service; 

licensed and staffed beds; beds certified as intermediate cam beds; admission policy regarding age 

and sex; patient census by age and sex; inpatient 

days of care; number of admissions, discharges, 

and deaths; staffing; basic monthly charge; and 

operating expenses. 

A copy of the data collection instruments is included 

in Series 14 reports based on NMFI data. 

Data processing and quality control. –As already 

stated, NMFI is considered to be the most comprehensive file of inpatient health facilities available in 

the United States. In order to measure statistically 

the extent of its coverage, a “complement” survey 

was developed. It is an application of a general 

technique often called a “multiframe survey.” In this 

application there are two frames-the National Master 

Facility Inventory and a geographic area sample list. 

From a probability area sample, all institutions found 

in the sample areas are identified, and the probability 

with which each comes into the sample is determined. 

Those inpatient health facilities found in the area 

sample survey (the complement survey) are matched 

against the NMFI list of facilities for that area. Any 

facility discovered within the scope of the sample 

survey but missed by NMFI constitutes undercoverage, and an appropriate weight is assigned to the 

omitted facility. 

Data for nonresponding facilities, as well as data 

for questions not answered on the returned questionnaires, are obtained through various types of imputation procedures. Whenever possible, data from the 

previous NMFI survey are used to replace missing 

data. For those responding facilities that omitted data 

that are not available from a previous survey, an 

imputation method is used. In this method, all 

facilities of the same type are stratified by predetermined variables such as bed size groups, ownership 

categories, and major types of service. Missing data 

for a facility are then supplied by using the data from 

a facility of like characteristics. When a responding 

facility fails to answer any of the major questions (regarding, for. example, bed size, ownership, type of 

facility, or number of patients), a followup questionnaire containing the questions omitted is sent to the 

respondents and they are asked again to answer. 

Release of data. –Data from NMFI surveys are 

published in various Center reports. The biennial 

editions of Health Resources Statistics contain the 

most curcent available data (often preliminary estimates) from these surveys. Final data are published in 

Series 14 of Vital and Health Statistics and in two 

special reports (one for hospitals and one for nursing 

homes) showing data by county and standard metropolitan statistical area. Directories of facilities for the 

mentally retarded and of nursing homes have been 

published from NMFI survey data. Methodology 

reports appear in Series 1 and 2 of Vital and Health 

Statistics. 

NMFI data are also released in the form of special 

tabulations prepared specifically for individual requests, computer tapes available through the Center’s 

data tape release program, and special printouts or 

listings from the data tapes. Approximately 45-50 

tape copies are purchased annually by such organizations as drug companies, State agencies, other Federal 

agencies, private contractors working on projects for 

other government agencies, universities, and national 

hea.Ith care organizations. 

Only the fiiancial data from the hospital data 

tapes prior to 1977 are confidential; all other 

information is available for individual hospitals. However, beginning with the 1977 hospital data tape, the 

data release agreement between the American Hospital Association and the Center has limited the 

availability of hospital data. Portions of the nursing 

home and other health facility data are collected 

under a pledge of confidentiality and can be released 

only in statistical a~egates or with all identification 

items stripped. 

National health professions inventories and surveys 

Background. –The National Center for Health 

Statistics first embarked on a health professions 

statistics program in 1964, when an ongoing program 

involving the compilation of secondary data on eight 

health occupations was transferred from the Division 

of Public Health Methods to the Center. As an 

adjunct to secondary source data, various surveys of 

facilities and health occupations were conducted in 

subsequent years. In 1974 the Center’s health professions program was further enhanced by the transfer 

27 

I 
of various surveys from the Bureau of Health Manpower (now the Bureau of Health Professions) to the 

Center. 

Purpose and scope. –The primary purpose of the 

Center’s health professions data collection is to 

produce reliable statistics on distribution; availability; 

and demographic, educational, and professional characteristics of persons employed in the health occupations. Under the health professions component of the 

Cooperative Health Statistics System for the 13 

health occupations that are licensed in all of the 50 

States and the District of Columbia, data were 

collected in the late 1970’s on an inventory basis 

covering all licensees in participating States. The 13 

health occupations covered were doctors of medicine, 

doctors of osteopathy, pharmacists, chiropractors, 

dentists, dental hygienists, registered nurses, licensed 

practical nurses, nursing home administrators, optometrists, physical therapists, podiatrists, and veterinarians. Data can be obtained on the nonlicensed health 

occupations largely through special surveys of facilities or of other employers. Special surveys are 

required because of the large number of employers of 

health workers, the limited use of licensure in the 

health field, the large and rapidly growing numbers 

and types of health workers, and the inadequate data 

base. 

Data collection procedures. –Recent health professions inventories were conducted principally 

through the mechanism of the Cooperative Health 

Statistics System. Those States that participated in 

CHSS collected and processed the data according to 

specifications provided by the Center. They then 

provided the Center with data tapes. For those States 

not participating in CHSS, data for three professions 

(pharmacists, optometrists, and registered nurses) 

were collected by the national organizations representing these professions, under contract to the 

Center. The Center then merged data from these 

various sources to obtain national data for the three 

professions. 

Data collection was performed in conjunction 

with each State’s licensure renewal mechanism, either 

on an annual or on a biennial basis as dictated by the 

licensing procedures in each State. The licensure 

mechanism offers a number of distinct advantages for 

the development of a data system for the production 

of timely, accurate, and complete statistics on health 

professionals, Licensure data provide accurate counts 

and distributions by geographic areas of licensed 

health personnel and contain the necessary information for contacting all persons employed in a health 

profession in order to obtain additional detail. 

Data were obtained by means of a selfadministered questionnaire, which was either mailed 

out as an attachment to the application for license or 

enclosed as a separate form. Both mail and telephone 

followup procedures were used with nonrespondents. 

Approximately 10 minutes was required for the 

completion of a questionnaire. Item completion rates 

of at least 90 percent were generally achieved, and 

coverage approached 100 percent of the universe. 

The national health professions surveys conducted by the Center have been of two types: 

censuses of facilities (such as the National Master 

Facility Inventory) to gather headcount data for 

detailed lists of health occupations employed in such 

facilities as hospitals, nursing homes, group practices, 

and clinics; and surveys of facilities to gather detailed 

information about specific types of health workers, 

such as nursing personnel in hospitals, health care 

administration personnel, and public health personnel. 

The mail questionnahe represents the primary 

method of data collection for most of these surveys. 

Both mail and telephone followup procedures were 

used. Time required for completion of the questionnaire varied, depending on the content of the 

particular survey. Response to these surveys generally 

exceeds 80 percent. 

Content of questionnaire. –For the health professions invent ories conducted through CHSS, 

occupation-specific minimum data sets were established for some of the 13 occupations. Each minimum data set consisted of standard core items basic 

to all 13 health professions and additional data items 

unique to each specific occupation. The following 

items were generally included for all occupations: 

Administrative data: Licensing State, occupation, 

type of licensure action, name, and mailing 

address of licensee. 

Education and training: Location of school of 

graduation, year of graduation, and total years of 

education or highest degree. 

Demographic c?zaracteristics: Date of birth, sex, 

marital status, race and ethnicity. 

Employment characteristics: Occupational specialty, years active in the occupation, weeks 

worked in the past 12 months, current activity 

status, geographic location of place of practice 1 

year ago, geographic location of current primary 

place of work, principal setting of primary activity, and number of hours usually spent per week 

by type of activity. 

The Center’s health professions surveys vary in 

content and purpose. At a minimum, the censuses of 

facilities obtain information on full- or part-time 

status and credentialing status. The sample surveys 

generally are designed to obtain data on personal 

characteristics, educational background, specialty, 

practice setting, and location. 

Data processing procedures. –The data from the 

inventories and surveys are generally processed by the 

agency or organization responsible for the data 

28 
I 

I 

collection. Standardized coding, editing, and imputation procedures are developed by the Center and 

provided to the contractor for purposes of ensuring 

both the quality and comparability of the data. The 

Center unduplicates the edited data in order to 

account for persons licensed by more than one State. 

In addition, the Center performs considerable verification and cross-checking of the data against other 

lists and sources of health personnel data. 

Release of &ta. -The unduplicated data are summarized and disseminated by the Center to all 

participating agencies in a manner that is comparable 

among State and local areas in terms of content, 

definitions, and format. The data appear in the 

following Center publications: Vital and Health Statistics Series 14; Health Resources Statistics; and 

various State reports. Special tabulations are available 

on request, and copies of many of the data tapes may 

be purchased. The data tapes are stripped of all 

identifiable tiformation pertaining to individuals. 

Uses o.f data. –Analysis of the data is intended to 

fulfill the following purposes: to assess current health 

personnel capabilities relative to the needs for health 

services at the local, State, and national levels; to 

project future demands on the supply of health 

professionals; to increase the efficiency of such data 

collection efforts; and to reduce the effort and costs 

involved in disseminating and using health professions 

information. The inventories can also be used as a 

sample frame for special surveys designed to obtain 

more detailed or specialized information. 

29 
Appendixes


Contents 

1.Definition ofcertain terms usedin this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31


Terms relatingto population andgeography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31


Termsrelatingto health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31


Terms relating tosampling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32


Terms relating todata processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33


II.	 Listing of reports related to specific programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34


Basic vital statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34


Vital statistics followback surveys. . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3!5


National Survey of Family Growth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35


National Health Interview Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35


National Health and Nutrition Examination Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36


National Hospital Discharge Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37


National Ambulatory Medical Care Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37


National Nursing Home Suwey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37


National Master Facility Inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37


Appendix figure 

Regions anddivisions of the United States asdefined bythe U.S. Bureau of the Census . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Appendixl. Definitionof certain


terms used in this report 

Brief definitions of some of the technical or 

specialized terms used in this report are provided. 

These are simplified definitions of what are often 

complex procedures, and the definitions are somewhat general in nature. For detailed definitions of the 

terms as they are used in the context of specific 

surveys, a reader should refer to the definitions 

contained in the appendix of the appropriate reports 

for each survey. 

Terms relating to population and geography 

Resident population. –The resident population is 

the population living in the United States. This 

includes members of the Armed Forces stationed in 

the United States and their families as well as 

foreigners working or studying here; it excludes 

foreign military, naval, and diplomatic personnel and 

their families located here and residing in embassies 

or similar quarters as well as Americans living abroad. 

The resident population is often the denominator 

when calculating birth and death rates and incidence 

of disease. 

Civilian population. –The civilian population is 

the resident population excluding members of the 

Armed Forces. Families of members of the Armed 

Forces are included, however. 

Civilian noninstitutionalized population. –The 

civilian noninstitutionalized population is the civilian 

population not residing in institutions. Institutions 

include correctional institutions, detention homes, 

and training schools for juvenile delinquents; homes 

for the aged and dependent (for example, nursing 

homes and convalescent homes); homes for dependent and neglected children; homes and schools for the 

mentally or physically handicapped; homes for unwed mothers; and psychiatric, tuberculosis, and 

chronic disease hospitals and residential treatment 

centers. 

Household. –All persons occupying a single housing unit are referred to as a household for sampling 

purposes. 

Family. –A family is two or more persons living in 

the same household who are related by blood, 

marriage, or adoption. All persons living in a household who are related to each other are regarded as 

one family. 

Group quarters. –Group quarters are quarters 

occupied by five or more persons unrelated to the 

head of the household; quarters with no designated 

head but with six or more unrelated persons are also 

group quarters. Also included are some quarters 

occupied by only one or two persons (for example, 

one to five persons occupying a surgical ward of a 

general hospital who have no usual residence elsewhere); also included are quarters occupied by 

persons in military barracks and college dormitories. 

Registration area. –The United States has separate 

registration areas for birth, death, marriage, and 

divorce statistics, in which data are collected annually 

from States whose registration data are at least 

90-percent complete. 

Region and division. –The 50 States and the 

District of Columbia are grouped for statistical 

purposes by the U.S. Bureau of the Census into nine 

divisions within four regions as shown on the map 

provided. 

Terms relating to health 

Condition. –A health condition is a departure 

from a state of physical or mental well-being. 

Conditions are coded by the Center to the most 

recent revision of the International Classification of 

Diseases. 

Incidence. –Incidence is the number of cases of 

disease having their onset during a prescribed period 

of time; it is often expressed as a rate (for example, 

the incidence of measles per 1,000 children 5-15 

years of age during a year). Incidence is a measure of 

morbidity or other events that occur within a 

specified period of time. 

Prevalence.–Prevalence is the number of cases of 

a disease, infected persons, or persons with some 

31

Regions and divisions of the United States as defined by the U.S. Bureau of the Census 

other attribute present during a particular interval of curity Income program and other people deemed 

time. It is often expressed as a rate (for example, the medically needy in a participating State. States also 

prevalence of diabetes per 1,000 persons during a determine the benefits covered, rates of payment for 

year). providers, and methods of administering the program. 

Medicare (Title XVIII). –Medicare is a nationwide Inpatient facility. –An inpatient facility is, in 

health insurance program providing health insurance general, one in which residents or patients are 

protection to people 65 years of age and over, people admitted for overnight stay for care. Included are


eligible for social security disability payments for hospitals, nursing homes, and various custodial and


more than 2 years, and people with end-stage renal rehabilitation facilities.


disease, regardless of income. The program was Outpatient facility. –An outpatient facility is, in


enacted July 30, 1965, as Title XVIII, Health kw- general, a place which treats patients without admit­


an.ce for the Aged, of the Social Security Act, and ting them for an overnight stay. Included are physi­


became effective on July 1, 1966. It consists of two cians’ offices, neighborhood health centers, and


separate but coordinated programs: hospital insur- hospital outpatient departments.


ance (Part A) and supplementary medical insurance


(Part B).


Medicaid (Title XIX). –Medicaid is a federally Terms relating to sampling 

aided but State operated and administered program. Target popzdation. –The target population is the 

It provides medical benefits for certain low-income population about which information is wanted. 

persons in need of medical care. The program, Sampling frame. –A sampling frame is a complete 

authorized in 1965 by Title XIX of the Social list of empirical cases that constitute the universe (or 

Security Act, categorically covers participants in the total population) of cases that correspond to the 

Aid to Families with Dependent Children program as conceptual universe to which findings of a sample 

well as some participants in the Supplemental Se- survey are generalized. 

32 
Probability sample. –The distinguishing characteristic of this type of sample is that every unit iu the 

frame must have a known, but not necessarily equal, 

probability of being included in the sample. 

Stratified sample. –All individual units in the 

sampling frame of a stratified sample are divided into 

groups or categories that are defined in such a way 

that each unit appears in one and only one stratum. 

Independent samples are selected within each group 

or stratum. The object is to arrange the population 

into strata that differ as widely as possible from each 

other but are as homogeneous as possible within each 

stratum. 

Area probability sample. –An area probability 

sample is a procedure for demographic surveys of the 

population in which the initial frame consists not of 

individuals but of geographic areas. The sampling 

progresses through a series of stages in which fnst 

areas, then dwelling units, and finally the individuals 

themselves are selected. 

Primary sampling unit. –In multistage samples, a 

primary sampling unit is the first level of sampling; in 

area probability sampling the United States is often 

divided into groups of counties, each group of which 

is a primary sampling unit. 

Sampling error. –Sampling error is that part of the 

error of an estimate that is due to the fact that the 

estimate is obtained from a sample rather than from a 

100-percent enumeration using the same procedures. 

Nonsampling error. –Nonsampling error is the 

error in an estimate arising at any stage in a survey 

from such sources as varying interpretation of questions by enumerators, unwillingness or inabdity of 

respondents to give correct answers, nonresponse, 

improper coverage, and other sources exclusive of 

sampling error. 

Response rate. –The response rate for a survey is 

the percent of an eligible sample for whom information is obtained. For an interview survey the numerator of the formula is the number of completed 

interviews. The denominator is the total sample size 

minus noneligible respondents, that is, minus those 

not meeting the criteria for a potential respondent as 

defined for a particular study. 

Terms relating to data processing 

Coding. –Coding is a technical procedure for 

converting verbal information into numbers or other 

symbols that can be more easily counted and tabulated. 

Coding error. –Coding error is the assignment of 

an incorrect code to a survey response. 

Editing. –Editing is a preliminary step in data 

handling in which the responses are inspected, corrected, and sometimes preceded according to a fixed 

set of rules. 

Imputation. –Imputation is the process of developing estimates for missing or inconsistent data in a 

survey. Data obtained from other units in the survey 

are usually used in developing the estimate. 

Quality control. –Quality control is any observation or procedure used in any operation of a survey in 

order to prevent or reduce the effect of nonsampling 

errors. It includes many types of data editing and 

recoding. 

33 
Appendix Il. Listing of reports 

related to specific programs 

This list of reports from the National Center for 

Health Statistics relating to each of the data collection programs is provided to facilitate identification 

of reports about each program; the list excludes 

analytic reports from the programs. Information 

about the availability of these publications can be obtained from the Center’s Scientific and Technical 

Information Branch, Division of Data Services. 

Copies of all Center reports are typically available 

at large municipal libraries, medical libraries, and 

libraries of schools of public health. Review of publications at these places would assist in determining 

whether a particular report is of interest. 

Basic vitalstatistics 

Series 2 

No. 83	 Comparability of Reporting Between the 

Birth Certificate and the National Natality 

Survey. 44 pp. 

No. 81	 A Methodological Study of Quality Control 

Procedures for Mortality Medical Coding. 

40 pp. 

No. 79	 Vital Registration Systems in Five Developing Countries: Honduras, Mexico, Philippines, Thailand, and Jamaica, 159 pp. 

No. 66	 Comparability of Mortality Statistics for 

the Seventh and Eighth Revisions of the 

International Classification of Diseases, 

United States. 93 pp. 

No. 46 Vital Signs Present at Birth. 19 pp. 

No. 34	 Comparison of Marital Status, Race, Nativity, and Country of Origin on the Death 

Certificate and Matching Census Record, 

United States, May-August 1960.47 pp. 

No. 30	 Comparison of the Classification of Place 

of Residence on Death Certificates and 

Matching Census Records, United States, 

May-August 1960.60 pp. 

No. 29 

No. 20 

No. 4 

Series 3 

No. 19 

No. 18 

No. 16 

No. 15 

No. 6 

No. 4 

No. 1 

Series 4 

No. 18 

No. 12 

No. 8 

Comparability of Age on the Death Certificate and Matching Census Record, United 

States, May-August 1960.53 pp. 

Variance and Covariance of Life Table 

Functions Estimated From a Sample of 

Deaths. 8 pp. 

Comparison of Two Methods of Constructing Abridged Life Tables by Reference to 

a “Standard” Table. 11 pp. 

National Estimates of Marriage Dissolution 

and Survivorship. 31 pp. 

Geographic Patterns in the Risk of Dying 

and Associated Factors, Ages 35-74 Years, 

United States, 1968-72.120 pp. 

Cohort Mortality and Survivorship: United 

States Death Registration States, 1900-68. 

36 pp. 

Trends in “Prematurity,” United States, 

1950-67.51 pp. 

International Comparisons of Perinatal and 

Infant Mortality: The United States and 

Six West European Countries. 97 pp. 

Infant and Perinatal Mortality in the 

United States. 87 pp. 

The Change in Mortality Trend in the 

United States. 43 pp. 

Statistics Needed for National Policies Related to Fertility. 154 pp. 

Needs for National Studies of Population 

Dynamics: A Report of the U.S. National 

Committee on Vital and Health Statistics. 

31 pp. 

The 1968 Revision of the Standard Certificates. 47 pp. 

34 
No. 3	 Report of the International Conference on 

the Perinatal and Infant Mortality Problem 

of the united States. 21 pp. 

No. 2	 National Vital Statistics Needs: A Report 

of the U.S. National Committee on Vital 

and Health Statistics. 51 pp. 

No, 1	 Fertility Measurement: A Report of the 

U.S. National Committee on Vital and 

Health Statistics. 26 pp. 

Vital Statistics of the United States Annual Volumes 

Volume I, Natality


Volume II, Mortality, Part A


Volume II, Mortality, Part B


Volume III, Marriage and Divorce


Vital statistics followback surveys 

Series 2 

No, 83	 Comparabfity of Reporting Between the 

Birth Certificate and the National Natality 

Survey. 44 pp. 

No, 56	 Completeness and Quality of Response in 

the North Carolina Marriage Follow-Back 

Survey. 42 pp. 

National Survey of Family Growth 

Series 2


No. 87 National Survey of Family Growth, Cycle


II:	 Sample Design, Estimation Procedures, 

and Variance Estimation. 36 pp. 

No. 76	 National Survey of Family Growth, Cycle I: 

Sample Design, Estimation Procedures, and 

Variance Estimation. 32 pp. 

Series 3 

No. 17	 Patterns of Aggregate and Individual 

Changes in Contraceptive Practice, United 

States, 1965-1975.23 pp. 

Series 4 

No. 18	 Statistics Needed for National Policies Related to Fertility. 154 pp. 

No. 12 Needs for National Studies of Population 

Dynamics: A Report of the U.S. National 

Committee on Vital and Health Statistics. 

31 pp. 

National Health Interview Survey 

Series 1 

No. 11	 Health Interview Survey Procedure, 

1957-74.153 pp. 

No. Z Health Survey Procedure: Concepts, Questionnaire Development, and Definitions in 

the Health Interview Survey. 66 pp. 

series 2 

No. 82	 Small Area Estimation: An Empirical Comparison of Conventional and Synthetic 

Estimators for States. 19 pp. 

No. 75	 Synthetic Estimation of State Health Characteristics Based on the Health Interview 

Survey. 22 pp. 

No. 69	 A Summary of Studies of Interviewing 

Methodology. 78 pp. 

No. 57	 Net Differences in Interview Data on 

Chronic Conditions and Information Derived From Medical Records. 58 pp. 

No. 54	 Quality Control and Measurement of Nonsampling Error in the Health Interview 

Survey. 53 pp. 

No. 52	 Reliability of Estimates with Alternate 

Cluster Sizes in the Health Interview Survey. 17 pp. 

No. 50	 Optimum Recall Period for Reporting Persons Injured in Motor Vehicle Accidents. 

31 pp. 

No. 49	 Reporting Health Events in Household Interviews: Effects of an Extensive Questionnaire and a Diary Procedure. 80 pp. 

No. 48	 Interviewing Methods in the Health Interview Survey. 86 pp. 

No. 45	 Reporting Health Events in Household Interviews: Effects of Reinforcement, Question Length, and Reinterviews. 70 pp. 

No. 41	 Effect of Some Experimental Interviewing 

Techniques on Reporting in the Health 

Interview Survey. 62 pp. 

No. 38	 Estimation and Sampling Variance in the 

Health Interview Survey. 28 pp. 

No. 37	 Development and Evaluation of an Expanded Hearing Loss Scale Questionnaire. 

42 pp. 

No. 26	 The Influence of Interviewer and Respondent Psychological and Behavioral Variables 

on the Reporting in Household Interviews. 

65 pp. 

No. 23	 Interview Data on Chronic Conditions 

Compared With Information Derived From 

Medical Records. 84 pp. 

No. 18	 Interview Response on Health Insurance 

Compared With Insurance Records, United 

States, 1960.43 pp. 

No. 16	 Identifying Problem Drinkers in a Household Health Survey. 46 pp. 

35 
No. 12	 Methodological Aspects of a Hearing Ability Interview Survey. 19 pp. 

No. 10	 Hospital Utilization in the Last Year of 

Life. 30 pp. 

No. 8	 Comparison of Hospitalization Reporting 

in Three Survey Procedures. 48 pp. 

No. 7	 Health Interview Responses Compared 

With Medical Records. 74 pp. 

No. 6	 Reporting of Hospitalization in the Health 

Interview Survey. 71 pp. 

No. 2	 Measurement of Personal Health Expenditures. 59 pp. 

Series 3 

No. 7	 Selected Family Characteristics and Health 

Measures Reported in the Health Interview 

Survey. 26 pp. 

National Health and Nutrition Examination Survey 

Series 1 

No. 15 

No. 14 

No. 10 

No. 8 

No. 5 

No. 4 

Series 2 

No. 86 

No. 74 

No. 73 

No. 72 

36 

Plan and Operation of the Second National 

Health and Nutrition Examination Survey, 

1976-80.144 pp. 

Plan and Operation of the HANES I Augmentation Survey of Adults 25-74 Years, 

United States, 1974-75.110 pp. 

Plan and Operation of the Health and Nutrition Examination Survey, United States, 

1971-73. Part A, 46 pp. Part B, 77 pp. 

Plan and Operation of a Health Examination Survey of U.S. Youths 12-17 Years of 

Age. 80 pp. 

Plan, Operation, and Response Results of a 

Program of Children’s Examinations. 56 pp. 

Plan and Initial’ Program of the Health Examination Survey. 43 pp. 

Computer Assisted Spirometry Data Analysis for the National Health and Nutrition 

Examination Survey. 48 pp. 

The Construction and Utility of Three 

Indexes of Intellectual Achievement–An 

Intellectual-Development (ID) Index, a 

Socio-Intellectual$tatus (S1S) Index, a 

Differential-Intellectual-Development (DID) 

Index–U.S. Children and Youths, 6-17 

Years. 26 pp. 

A Concurrent Validational Study of the 

NCHS Well-Being Schedule. 53 pp. 

Methodologic Programs in Children’s Spirometry. 43 pp. 

No. 71 

No. 67 

No. 62 

No. 60 

No. 59 

No. 58 

No. 47 

No. 44 

No. 43 

No. 40 

No. 36 

No. 35 

No. 27 

No. 25 

No. 24 

No. 22 

No. 21 

No. 15 

No. 9 

No. 3 

Development of the Speech Reception 

Test. 16 pp. 

A Study of the Effect ;f Remuneration 

Upon Response in the Health and Nutrition Examination Survey, United States. 

23 pp. 

Language and Adjustment Scales for the 

Thematic Apperception Tests for Youths 

12-17 Years. 84 pp. 

The Rationale, Development, and Standardization of a Basic Word Vocabulary 

Test. 71 pp. 

Vision Test Validation Study for the 

Health Examination Survey Among Youths 

12-17 Years. 36 pp. 

Language and Adjustment Scales for the 

Thematic Apperception Test for Children 

6-11 Years. 70 pp. 

Subtest Estimates of the WISC Full-scale 

IQ’s for Children. 42 pp. 

Quality Control in a National Health Examination Survey. 22 pp. 

Sample Design and Estimation Procedures 

for a National Health Examination Survey 

of Children. 40 pp. 

Loudness Balance Study of Selected Audiometer Earphones. 37 pp. 

Factors Related to Response in a Health 

Examination Survey, United States, 1960-

62.48 pp. 

Comparison of Timed and Untimed Presentation of the Goodenough-Harris Test of 

Intellectual Maturity. 16 pp. 

Development of the Brief Test of Literacy. 

29 pp. 

Orthodontic Treatment Priority Index. 

49 pp. 

A Study of the Achievement Test Used in 

the Health Examination Surveys of Persons 

Aged 6-17 Years. 60 pp. 

Three Views of Hypertension and Heart 

Disease. 43 pp. 

Calibration of Two Bicycle Ergometers 

Used by the Health Examination Survey. 

10 pp. 

Evaluation of Psychological Measures Used 

in the Health Examination Survey of Children Ages 6-11.67 pp. 

Cooperation in Health Examination Surveys. 38 pp. 

The One-Hour Oral Glucose Tolerance 

Test. 34 pp. 
I 

I 

No, 1 Comparison of Two Vision-Testing Devices. 

I 33 pp. 

Series 3 

I No. 14 Height and Weight of Children in the 

I United States, India, and the United Arab I Republic. 51 pp. 

National Hospital Discharge Survey 

Series 2 

No. 88 

No. 80 

No. 68 

No. 55 

No. 39 

No. 28 

No. 19 

No. 13 

Series 4 

No. 14 

No. 11 

The Status of Hospital Discharge Data in 

Denmark, Scotland, West Germany, and 

the United States. 58 pp. 

The Status of Hospital Discharge Data in 

Six Countries. 77 pp. 

Quality Control in the Hospital Discharge 

Survey. 41 pp. 

The Prediction Approach to Finite Population Theory: Application to the Hospital 

Discharge Survey. 31 pp. 

Development of the Design of the NCHS 

Hospital Discharge Survey. 29 pp. 

Pilot Study on Patient Charge Statistics. 

59 pp. 

Partici~ation of Hospitals in the Pilot 

Study - of the Hospit;l Discharge Survey. 

55 pp. 

Computer Simulation of Hospital Discharges. 34 pp. 

Uniform Hospital Abstract, Minimum Basic 

Data Set: A Report of the U.S. National 

Committee on Vital and Health Statistics. 

17 pp. 

Use of Hospital Data for Epidemiologic and 

Medical-Care Research: A Report of the 

U.S. National Committee on Vital and 

Health Statistics. 9 pp. 

National Ambulatory Medical Care Survey .’ 

Sen”es 2 

No. 78	 A Reason for Visit Classification for Ambulatory Care. 63 pp. 

No. 63	 The National Ambulatory Medical Care 

Survey: Symptom Classification. 35 pp. 

No. 61	 National Ambulatory Medical Care Survey: 

Background and Methodology, United 

States, 1967-72.76 pp. 

Series 4 

No. 16	 Ambulatory Medical Care Records, Uniform Minimum Basic Data Set: A Report 

of the U.S. National Committee on Vital 

and Health Statistics. 16 pp. 

National Nursing Home Survey 

Series 1 

No. 7	 Design and Methodology for a National 

Survey of Nursing Homes. 37 pp. 

National Master Facility Inventory 

Series1 

No. 12	 Development of the National Inventory of 

Family Planning Services, United States. 

43 pp. 

No. 9	 Design and Methodology of the 1967 

Master Facility Inventory Survey. 30 pp. 

No. 6	 The Agency Reporting System for Maintaining the National Inventory of Hospitals 

and Institutions. 19 pp. 

No. 3	 Development and Maintenance of a National Inventory of Hospitals and Institutions. 25 pp. 

37 
Vital and Health Statistics series descriptions


SERIES 1.	 Programs and Collection Procedures. -Reports describing long-term care, ambulatory care, hospital care, and family 

the general programs of the National Center for Health planning services. 

Statistics and its offices and divisions and the data col- SERIES 14. Data on Health Resources: Manpower and Facilitiee.­

lection methods used. They also include definitions and Statistics on the numbers, geographic distribution, and 

other material necessaty for understanding the data. characteristics of health resources including physicians, 

SERIES 2. Data Evaluation and Methods Research. -Studies of new dentists, nurses, other health occupations, hospitals, 

statistical methodology including experimental tests of nursing homes, and outpatient facilities. 

new survey methods, studies of vital statistics collection SERIES 15. Data From Special Surveys. -Statistics on health and 

tistical theory. Center for Health Statistics. 

SERIES 3. Analytical and Epidemiological Studies.-Reports pre- SERIES 20. Data on Mortality.-Various statistics on mortality other 

senting analytical or interpretive studias based on vital than as included in regular annual or monthly reports. 

and heelth statistics, carrying the analysis further than the Special analyses by cause of death, age, and other demoexpository types of reports in the other series. graphic variables; geographic and time series analyses; and 

SERIES 4. Documents and Committee Reports. -Final reports of statistics on characteristics of deaths not available from 

major committees concerned with vital and health sta- the vital records based on sample surveys of those records. 

methods, new analytical techniques, objective evaluations health-related topics collected in special surveys that are 

of reliability of collected data, and contributions to sta- not a part of the continuing data systems of the National 

tistics and documents such as recommended model vital SERIES 21. Data on Natality, Marriage, and Divorce.-Various staregistration laws and revised birth and death certificates. tistics on natality, marriage, and divorce other than as 

SERIES 10. Data from the National Health Interview Suwey.–Statis- included in regular annual or monthly reports. Special 

tics on illness, accidental injuries, disability, use of hos- analyses by demographic variables; geographic and time 

pital, medical, dental, and other services, and other series analyses; studies of fertility; and statistics on 

health-related topics, all based on data collected in the characteristics of births not available from the vital 

continuing national household interview survey. records based on sample surveys of those records. 

SERIES 11.	 Data From the National Health Examination Survey and SERIES 22. Data From the National Mortality and Natality Surveys. -

the National Health and Nutrition Examination Survey.– Discontinued in 1975. Reports from these sample surveys 

Data from direct examination, testing, and measurement based on vital records are included in Series 20 and 21, 

of national samples of the civilian noninstitutionalized respective y. 

population provide the basis for (1) estimates of the 

SERIES 23. Data From the National Survey of Family Growth.-

medically defined prevalence of specific diseases in the 

Statistics on fertility, family formation and dissolution, United States and the distributions of the population with 

family planning, and related maternal and infant health 

respect to physical, physiological, and psychological topics derived from a periodic survey of a nationwide 

characteristics and (2) analysis of relationships among the 

probability sample of ever-married women 1544 years of 

various measurements without reference to an explicit 

age. finite universe of persons. 

SERIES 12.	 Data From the Institutionalized Population Surveys. -Dis- For a list of titles of reports published in these series, write to: 

continued in 1975. Reports from these surveys are in- Scientific and Technical Information Branch 

cluded in Series 13. National Center for Health Statistics 

SERIES 13. Data on Health Resources Utilization. -Statistics on the Public Health Service 

utilization of health manpower and facilities providing Hyattsville, Md. 20782