Vital and 

Health Statistics 

Development, Methods, 

and Response 

Characteristics of the 

1986 National Mortality 

Followback Survey 

Series 1:


Programs and Collection Procedures


No, 29


This report describes the methods employed in the 1986 National Mortality 

Followback Survey, This survey is based on information obtained from relatives 

of decedents and from health care facilities used by the decedents in their last 

year of life, 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


Public Health Service


Centers for Disease Control and Prevention


National Center for Health Statistics


Hyaftsville, Maryland


May 1993


DHHS Publication No, [PHS) 93-1305

Copyright Information 

All material appearing in this report is in the public domain and may be 

reproduced or copied without permission; citation as to source, however, is 

appreciated. 

Suggested Citation 

Seeman 1, Poe GS, Powell-Griner E. Development, methods, and response 

characteristics of the 1986 National Mortality Followback Survey, National 

Center for Health Statistics, Vital Health Stat 1(29). 1993. 

Library of Congress Cataloging-in-Publication Data 

Development, methods, and response characteristics of the 1986 National 

Mortality Followback Survey. 

p. cm. – (Vital and health statistics. Series 1, Programs and collection 

procedures;	 no. 29) (DI-IHS publication; no. (PHS) 93-1305) 

“January 1993.” 

Includes bibliographical references. 

ISBN 0–8406–0471 -8 

1. National Mortality Followback Survey (U.S.) 2, Health surveys – 

United States–Statistical methods. 1. National Center for Health Statistics (U.S.) 

11,Series. Ill. Series: DHHS publication; no. (PHS) 93-1305. 

[DNLM: 1. National Mortality Followback Survey (U.S.) 2. Data 

Collection –methods. 3. Mortality. W2 A N148va no. 29] 

RA409.U44 no. 29 

[RA407,3] 

362.1 ‘0723 s–dc20 

[304.6’4’0723] 

DNLM/DLC 

for Library of Congress 92+8960 

CIP 

For sale by the U.S. Government Printing Office


Superintendent of Documents


Mall Stop: SSOP


Washington, DC 20402-9328

National Center for Health Statistics 

Manning Feinleib, M.D., Dr. P.H., Director 

Jack R, Anderson, Acting Deputy Director 

Jacob J. Feldman, Ph. D., Associate Director for Amdysi.s 

and Epidemiolo~ 

Gail F. Fisher, Ph. D., Associate Director for Planning and 

Extramural Programs 

Peter L. Hurley, Associate Director for V2al and Health 

Statistics Systems 

Robert A. Israel, Associate Director for International 

Statistics 

Stephen E. Nieberding, Associate Director for 

Management 

Charles J. Rothwell, Associate Director for Data 

Processing and Services 

Monroe G, Sirken, Ph. D., Associate Director for Research 

and Methodology 

David L. Larson, Assistant Director, Atlanta 

Office of Vital and Health Statistics Systems 

Peter L. Hurley, Associate Director 

Division of Vital Statistics 

John E, Patterson, Director 

James A, Weed, Ph. D., DepuLy Director 

James A, Weed, Ph. D., Acting ChieJ Followhack SLwVcy 

Branch 

Mabel G. Smith, Chie$ Statistical Resources Branch 

Joseph D. Farrell, ChieJ Systems and Programming 

Branch 
. . 

Contents


, 

, 

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

Background of the 1986 NationaI Mortality Followback Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Availability ofdata and findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Development ofthe survey..,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Selecting the foci ofthe1986 survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Participation ofcosponsors and advisory groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Pretest procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Comment5 from informants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Main survey methods and procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . 

Questionnaire design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Sample design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Sources of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Collection of survey data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Data processing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Current Mortality Sample death certificates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Multiple Causeof Death File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 

Informant questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Decedent Control Record. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . ., . . . . . . . . . . . . . 

Facili~ Abstract Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Reinterview questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Final preparation of thepublic-use data tapes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Estimation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Sampling error.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Estimation of standard error... . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 

Standard error approximation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Standard error applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Testing differences in the National Mortality Followback Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Nonsampling error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Reinterview, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Response characteristics, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Response from informants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Response from facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

List of detailed tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Appendixes 

1. Definitions ofcertain terms used in the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

H. U.S. Standard Certificate of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

111. Inventory of National Mortality Followback Survey forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

IV. National Mortality Followback Survey Informant Questionnaire (NMF– 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

1


1


3 

4 

4 

4 

4 

8 

11 

11 

11 

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19 

19 

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... 

111 
List of text tables 

A. Major subjects covered in the five NCHS National Mortality Followback Surveys, by year of survey: 

United States, 1961-68 and 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

B. Strata selected with certainty for causes of death by sex, age, and race: National Mortality Followback Survey, 

1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

c. Number and cumulative percent distribution of informant identification by method of inquiry, accordingto 

State of death: National Mortality Followback Survey pretest, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

D. Number and percent distribution of informants by relationship of informant to decedent as reported on the 

questionnaire: National Mortality Followback Survey pretest, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

E. Number and percent distribution of decedents 25 years of age and over by sex, race, and age, according to the 

1986 National Mortality Followback Survey pretest sample and 1984 deaths: United States. . . . . . . . . . . . . . . . 

F. Number and percent distribution of results of mailing by type of response, according to whether “Don’t know” 

box was included: National Mortality Followback Survey pretest, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

G. Number and percent distribution of questionnaires in mailing phase by type of response, according to 

questionnaire length: National Mortality Followback Survey pretest (Wave B), 1986 . . . . . . . . . . . . . . . . . . . . . . 

H. Number and percent distribution of questionnaires after final results by method of response, according to 

questionnaire length: National Mortality Followback Survey pretest (Wave B), 1986 . . . . . . . . . . . . . . . . . . . . . . 

J. Number and percent distribution of second-mailing questionnaires by type of response, according to method of 

mailing: National Mortality Followback Survey pretest, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

K.	 Number and percent of questionnaires after final results by method of response and use of certified versus 

first-class mail: National Mortality Followback Survey pretest, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

L.	 Number and percent distribution of inquiries by type of final response, according to method of inquiry: 

National Mortality Followback Survey pretest, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

M.	 Number and percent distribution of cases assigned to the field by final response status and final method used, 

according to method of followup, for Illinois and Virginia: National Mortality Followback Survey pretest, 

1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

N,	 Weighting and sampling strata definitions, by reciprocal of the probability of sample selection, age group, 

number of cases in survey, and response rate: National Mortality Followback Survey, 1986 . . . . . . . . . . . . . . . . 

o. Parameters used to approximate the relative standard errors for estimates of decedents, by race and age: 

National Mortality Followback Survey, 1986. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

P. Gross error rates of items included in the reinterview: National Mortality Followback Survey, 1986 . . . . . . . . 

Q. Number and percent distribution of decedents with Facility Abstract Record by number of facilities used in last 

year oflife: National Mortality Followback Survey, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

R.	 Number and percent distribution of decedents with Facility Abstract Record by number of episodes of care in 

last year oflife: National Mortality Followback Survey, 1986, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

2 

2 

6 

6 

6 

7 

8 

8 

9 

9 

9 

10 

18 

20 

24 

28 

29 

.- -

. . . 

— 

0.0 

* 

Symbols 

Data not available


Category not applicable


Quantity zero


Quantity more than zero but less than


0.05 

fi9ure does not meet standard of 

reliability or precision (100 or fewer 

estimated deaths; relative standard 

error of 30 percent or more) 
Development, Methods, 

and Response 

Characteristics of the 

1986 National Mortality 

Followback Survey 

by Isadore Seeman, M. P.H., formerly with the Office 

of Vital and Health Statistics Systems; Gail S. Poe, 

M.P.H., Division of Vital Statistics, and Eve 

Powell-Griner, Ph. D., formerly with the Office of Vital 

and Health Statistics Systems 

Introduction 

This report describes the development process, the 

methods empIoyed, and the response characteristics for 

the 1986 NationaI Mortality Followback Survey (NMFS). 

This introduction provides a brief overview of the origin, 

purposes, nature, and contents of the survey. The next 

section describes the process used in the development of 

the survey and significant aspects of the results of the 

pretest. The third section describes the main survey: 

sampling of death certificates, the collection and processing of survey data, the production of national estimates, 

the approximation of sampIing errors, the nature of nonsampling errors, and quality control measures employed. 

The fourth section examines response rates for informants 

and for facilities, by relevant characteristics. 

Background of the 1986 National Mortality 

Followback Survey 

Mortality statistics in the United States are based on 

information coded by the NationaI Center for Health 

Statistics (NCHS) from copies of the original death certificates received from State registration offices, and on 

state-coded data provided to NCHS through the Vital 

Statistics Cooperative Program (VSCP) (l). These data 

are invaluable in understanding mortality characteristics 

and trends. To expand on these data, NCHS periodically 

conducts mortality followback surveys. NCHS developed 

NOTE This report was prepared in the Division of Vital Statistics. 

Steven Botman, Office of Research and Methodology, provided guidance 

in the design of the sampling procedure and the information on sampling error and estimation; Arlene Siller, Office of Vital and Health 

Statistics, provided guidance on computer programming George Wolfe, 

Division of Health Care Statistics, provided guidance on table preparation; Betty Smith, Statistical Resources Branch, Division of Vital Statistics, provided content review. This report was edited by Margaret Avery 

and typeset by Jacqueline M. Davis, Publications Branch, Division of 

Data Ser-vices. 

the mortality followback survey methodology in the 1960’s 

out of its interest in Iearning more about mortality than is 

available from death certificates, its interest in evoIving 

useful statistical methodologies, and its unique access to 

the total universe of deaths in the United States (2). 

The followback surveys colIect information on a variety of subjects, including the use of heaIth services during 

the last year of life, patterns of lifetime behavior that may 

affect longevity, socioeconomic circumstances of the decedent, environmental influences on heaIth, and other 

aspects of life style that may influence the cause and 

timing of death. This information is secured from the next 

of kin or some other person familiar with the decedent’s 

life history. The followback survey is a cost-effective 

method for obtaining useful information for the study of 

the epidemiology of disease, demographic trends in mortaIity, and other heaIth issues. The sampling universe is all 

resident deaths in the United States in a given year. 

Information on the decedent can be sought by mail 

questionnaire and by telephone or personal interview. 

The four mortaIity foIIowback surveys conducted during the 1960’s by NCHS produced national data on characteristics of decedents, including many characteristics not 

available from other sources (tabIe A). The 1961 survey 

secured information on the use of hospital and institutional care in the last year of life (3,4). The 1962–63 survey 

obtained information on socioeconomic differentials in 

mortality (5). The 1964-65 survey provided data on 

expenditures for heaIth care during the last year of life, 

sources of payment, and health insurance coverage of 

decedents (6,7). The 1966–68 survey provided evidence 

from a national probability sample of deaths on the Iink 

between smoking and cancer mortaIity (8,9). 

The 1986 NMFS is the fifth mortality followback 

survey conducted by NCHS. It focused on a nationality 

representative sample of aduIts 25 years of age or over 

who died in 1986. While all 50 States and the District of 

Columbia granted their approval for use of a sample of the 

1 
Table A. Major subjects covered in the five NCHS National 

Mortality Foilowback Surveys, by year of survey United States, 

1961-68 and 1986 

Subject 1961 1962-63 1964-85 1966-68 1986 

Days of hospital care, last year 

of life . . . . . . . . . . . . . . . . . . . x x Place of death, . . . . . . . . . . . . . x x Family income, in year prior to death x x x x x Sources of income........,.. x x x x Highest grade of school completed, x x x 

Institutional care (other than 

hospital) . . . . . . . . . . . . . . . . . x x x 

Whether person died in hospital. . . x x x 

Household of decedent . . . . . x x x x 

Hospital insurance . . . . . . . x Insurance for surgeon’s bill, . . x 

Amount of hospital bill. . x 

How much insurance paid x 

Amount paid by children . . x Out-of-pocket expenses. x 

Operations performed . . . x x x Diagnoses . . . . . . . . . . . . . . . . x x 

Family assets . . . . . . . . . . . . . . x x x 

Smoking practices x x 

NOTE: NCHS is National Center for Health Statistics 

death certificates in the NMFS, Oregon is not included in 

the NMFS due to that State’s respondent consent requirements. The data are therefore representative of deaths of 

adult residents in the United States excluding Oregon. 

The universe for the 1986 NMFS was composed of all 

death certificates for 1986 decedents 25 years of age or 

older filed in the United States. The sampling frame 

comprises death certificates selected from the 1986 Current Mortality Sample (CMS). The CMS was a 10-percent 

systematic sample of death certificates received by the 

state vital statistics offices and transmitted to NCHS about 

3 months after the deaths occurred (See “Data processing”). CMS records were selected for each month of the 

year. To meet specific research needs, 2,274 of the sampled death certificates were selected with certainty (table B). Selected populations in the remaining CMS 

certificates were oversampled so that reliable numbers of 

deaths in these important cohorts could be obtained. 

Black decedents were oversampled 2.9 times, and decedents under age 55 were oversampled 3,1 times. 

The 1986 NMFS focused on four subject areas: 

. Socioeconomic differentials in mortality 

. Prevention of premature death by inquiring into the 

association between risk factors and cause of death 

. Health care services provided in the last year of life 

. Correspondence between certain items reported on 

the death certificate and those reported on the informant questionnaire 

Information was secured from two sources: the next of 

kin of the decedent or some other person familiar with the 

decedent, and the health care facilities used by the 

decedent in the last year of life. Questionnaires were 

mailed to a sample of 18,733 persons identified as informants on the death certificates of individuals who died in 

the United States in 1986, If, as in a small number of 

cases, no informant could be identified from the death 

certificate, efforts were made to locate the next of kin of 

the decedent. In addition, brief questionnaires were 

mailed to all hospitals, nursing homes, and other health 

care facilities decedents were reported to have used in 

their last year of life. 

The 1986 NMFS differed in several respects from the 

four previous mortality followback surveys. First, the number of deaths included in the sample was greater than in 

any previous NMFS. The sample size was nearly 1 in 100 

deaths, compared with 1 in 260 to 1 in 330 in previous 

surveys. Second, the subject areas covered by the survey 

were considerably broader than those in prior surveys so 

that the questionnaire was much longer than its four 

predecessors, Third, as described in “The formal pretest,” 

the pretest included several methodological experiments. 

Fourth, a consent form to permit the release of information from health care facilities was included to increase 

Table B. Strata selected with certainty for causes of death by sex, age, and race: National Mortality Followback Survey, 1986 

Cause of deah’r and /CO-9 code 

Cardiovascular deaths 

Ischemic heart disease, . . . . . . . . . . . . . . . . . . . . . . . . . 

Ischemic heart disease, . . . . . . . . . . . . . . . . . . . . . . . . . 

Sex Age Race 

. . ..410+14 Male 25-44 years All 

. . ..410+14 Female 25–54 years All 

. . .147 Male and female 25-64 years White 

. ..152 Male and female 25–74 years White 

.155 Female 25–49 years All 

sinuses. .160 Male 25-74 years White 

. . . . ...175 Male 25-74 years All 

and 

. . . .193-194 Male and female 25-64 years White 

. . . . ...493 Male and female All All 

American Indians, 

Cancer deaths 

ofnasopharynx . . . . . . . . 

of small intestine, including duodenum . 

of liver and intrahepatic bile ducts . . 

of nasal cavities, middle ear and accessory 

ofmale breast... . . . . . . . . . . . . . . . . 

of thyroid gland and other endocrine glands 

Malignant neoplasm 

Malignant neoplasm 

Malignant neoplasms 

Malignant neoplasms 

Malignant neoplasm 

Malignant neoplasms 

related structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Asthma deaths 

Total . . . . . . . . . . . . . . . . . . . . . . ,, . . . . . . . . . . . . . . 

All deaths 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Male and female All Aleuts, and Eskimos 

NOTE: ICD–9 is the Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death, based on the recommendations of the Ninth Revision 

Conference, 1975 (Geneva: World Health Organization, 1977), 

2 
. 

facility response. Fifth, this project involved active participation by a number of other Federal agencies. Finally, in 

addition to mailed questionnaires and personal interviews 

used in previous surveys; the data collection process included telephone interviews. Still, a number of subject 

areas covered in the prior surveys were also included in 

the 1986 study to maintain maximum comparability and to 

permit some trend analysis (table A). 

In addition to the main survey described, a special 

study was incorporated in the 1986 survey at the request of 

the National Cancer Institute, one of the cooperating 

agencies in the survey. Approximately 1,500 records of all 

deaths in the year 1985 from specific cancer sites with rare 

occurrences were drawn and surveyed. Data from these 

cases are not included in the 1986 NMFS Public-Use Data 

Tape, and are not included in the discussion that follows. 

The 1986 NMFS was developed collaboratively by 

NCHS and other agencies. Guidance on content and 

methods was furnished by an NCHS Work Group 

composed of representatives of 10 offices of the Center 

(See “Participation of cosponsors and advisory groups”), 

Other agencies of the Public Health Service, the Department of Health and Human Services, and the Veterans’ 

Administration participated in planning the survey and 

providing funding through ‘NCHS’S Reimbursable Work 

Program. 

Availability of data and findings 

A 1986 National Mortality Followback Survey PublicUse Data Tape (PB 90-5011800) with accompanying 

documentation may be purchased from the National 

Technical Information Service, U.S. Department of Commerce, 5285 Port Royal Road, Springfield, Virginia 22161. 

Analyses of the 1986 NMFS are being published as NCHS 

reports and as journal articles, and are being presented at 

meetings of professional organizations. 

3 
Development of the 

survey 

Selecting the foci of the 1986 survey 

Criteria for selecting the subject matter foci of the 

1986 National Mortality Followback Survey (NMFS) included (1) the relevance of the proposed subject to broad 

public health concerns and to the policy and programmatic issues and interests paramount in the Public Health 

Service (PHS) and the Department of Health and Human 

Services (DHHS); (2) capitalizing on the uniqueness of 

the population; (3) the likelihood of the results being 

valid, reliable, and generally useful; (4) the impact of the 

nature, length, complexity, and sensitivity of the content 

on response rates; and (5) maintaining some continuity 

with prior mortality followback surveys. Particular attention was paid to disease prevention, one of the major 

health policy issues of concern to the PHS and the DHHS, 

as reflected in two reports describing the PHS initiative on 

health promotion and disease prevention (Healthy People 

(10), and Promoting Health/Preventing Disease: Objectives 

for the Nation (11)). 

Out of these considerations and after consultations 

with two advisory groups to the sumey, agreement was 

reached on four subject areas: (1) socioeconomic differentials in mortality, (2) prevention of premature death by 

inquiring into the association between risk factors and the 

cause of death, (3) health care services provided in the last 

year of life, and (4) the reliability of certain items reported 

on the death certificate. 

Participation of cosponsors and advisory 

groups 

Recognizing the 1986 survey’s potential for providing 

data useful to a variety of missions and interests, a number 

of Federal agencies participated in a Consulting Group 

(listed below) to discuss the project. Of these agencies, 

eight (designated by double bullets) agreed on a plan for 

cosponsorship and funding: 

. Administration on Aging, DHHS


� Alcohol, Drug Abuse, and Mental Health Administra­


tion, Office of Planning, Policy Analysis, and Legislation, DHHS 

. Centers for Disease Control, DHHS 

. Food and Drug Administration, DHHS 

� . Health Care Financing Administration, DHHS 

� 0 Indian Health Service, DHHS 

�	 Office of the Deputy Assistant Secretary for Health, 

Health Promotion, and Disease Prevention, DHHS 

� 0 National Cancer Institute, DHHS 

� 0 National Heart, Lung, and Blood Institute, DHHS 

�	 National Institutes of Health, Office of the Director, 

DHHS 

� 0 National Institute on Aging, DHHS 

� National Institute on Alcohol Abuse and Alcoholism, 

DHHS 

� National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases, DHHS 

� 0	 National Institute of Child Health and Human Development, DHHS 

� National Institute on Drug Abuse, DHHS 

� 0 National Institute of Mental Health, DHHS 

� Social Security Administration, DHHS 

� * Veterans Administration 

A ninth sponsor, the Office of the Assistant Secretary 

for Planning and Evaluation in the Office of the Secretary 

of DHHS, provided funding as the survey progressed, 

A decision was also reached to formalize the process 

for involvement of other units of the National Center for 

Health Statistics (NCHS) in the development and execution of the survey. An NCHS Work Group was formed for 

consultation and for coordination of the NMFS with other 

relevant NCHS surveys, including common wording of 

items on the 1984 Supplement on Aging of the National 

Health Interview Survey and clarification of common 

interests with the 1985 National Nursing Home Survey. 

Pretest procedures 

Several pretest procedures were determined to be 

essential, particularly in light of the long period since the 

last NMFS was conducted. These included a pilot test of 

the questionnaire with a bereavement group, a minitest, 

and a formal pretest, described below. 

Survey design is enhanced when, at an early stage, a 

sample of persons who correspond to the potential respondents react to the ideas being considered. For the 

1986 NMFS, this step was taken through a discussion held 

at a hospice in Northern Virginia with nine members of a 

4 
bereavement group who met regularly following the death 

of a family member. Group members filled in and discussed an early draft of the questionnaire and reviewed 

proposed procedures. This process provided valuable 

guidance at an early stage in the survey design. 

A minitest was held after further planning but prior to 

the formal pretest. The purpose of the minitest was to 

assess the reactions to the proposed study instrument and 

procedures by respondents most similar to those to be 

surveyed. Interviews with the next of kin of recent decedents were conducted in the Washington, D. C., area. 

These decedents were identified from death certificates in 

the manner that would be followed in the pretest and the 

main survey. The informant was handed a questionnaire 

by a Census Bureau interviewer and asked to complete it 

as though it had come in the mail, while the interviewer 

waited. The interviewer then discussed the completed 

questionnaire with the respondent to learn how the respondent reacted to the questions and the procedures. 

Members of the survey staff and of the NCHS Work 

Group attended many of these interviews. A detailed 

analysis of responses to specific questionnaire items assisted in the revision of the instrument. 

The formal pretest 

The formal pretest was designed to fulfill three purposes: (1) To select the most appropriate means of identifying and tracing the appropriate informant, (2) to test 

procedures for achieving a high level of response, and (3) 

to test the questionnaire content and format. 

The U.S. Bureau of the Census conducted the data 

collection both for the pretest and for the main survey. 

Four States –I1linois, New Mexico, Vermont, and 

Virginia– were selected for the pretest to provide geographic, racial, and ethnic diversi~. The registrars in these 

!	 States approved the followback on the death certificates 

from decedents in their States. A sample of adult deaths 

in September and October 1984 was selected for survey 

about 6 months after the death. Deaths of black decedents 

were oversampled 1.8 times the sampling for white dece­

~ dents, and, because oversampling of heart disease deaths

was planned for the main survey, all deaths from Ischemic 

heart disease at ages 25-44 were selected. A total of 1,363 

records was selected, of which 3 were inadvertently 

dropped from the pretest before the mailing. 

The person designated as the “informant” on the 

death certificate was the preferred primary source of 

information about the decedent. This individual (usually 

the next of kin) provides the personal facts about the 

decedent to the funeral director who completes the death 

certificate (except for the medical certification). Of the 

1,363 pretest sample certificates, 618 (or 45.3 percent) 

contained the name and address of an informant. However, there were six States in which the death certificate 

form did not provide a space for the address of the 

informant, making contact with this person difficult, One 

such State, Virginia, was deliberately included in the 

pretest so that tracing techniques could be tested. It was 

also discovered during the pretest that ‘many certificates, 

particularly in Illinois, listed a medical or hospital record 

as the informant rather than the name and address of the 

person who gave the information to the facili~. Inspection 

of these certificates showed that on 244 the name of a 

surviving spouse was listed elsewhere on the record (table C). In such cases, a decision was made to mail the 

questionnaire to the surviving spouse at the usual residence of the decedent. 

The primary procedure used to secure the names and 

addresses still missing was to telephone the funeral director or write to him or her if he or she request=d- the 

inquiry in writing. There were 501 records (or 36.8 percent) of the sample to be queried. Response was received 

from the funeral director for 401 records. This process 

identified a person to receive the questiorinaire for 

92.7 percent of the sample certificates. For the remaining 

100 cases, the questionnaire was addressed to “Next of 

Kin” of the named decedent at the decedent’s usual 

address. 

The procedure used for the pretest consisted of the 

following steps: 

1, About 6 months after the death, a questionnaire and a 

cover letter were mailed by first-class governmentpaid mail to the informant named on the death 

certificate, the surviving spouse, or other informant as 

described above. A postage-free return envelope was 

included, 

2. Ten days later letters were mailed to informants, 

thanking them if they had returned the questionnaires 

and reminding them to do so if they had not. 

3.	 One month after the initial mailing, a second copy of 

the questionnaire was mailed to nonrespondents, 

4.	 Four weeks after the second mailing a telephone call 

or personal interview was attempted to reach nonrespondents in the two large States in the sample, 

Illinois and Virginia. In the two smaller States, New 

Mexico and Vermont, only the telephone was used to 

reach nonrespondents. 

In the pretest, the informant ~n the questionnaire was 

a close relative of the decedent in 82.8 percent of the cases 

(table D). A spouse was listed for 34.2 percent of the 

decedents, and a divorced spouse on 0.3 percent. The 

informant was a son or daughter for another 30.4 percent. 

The information was furnished by a decedent’s sibling in 

9.6 percent of the records and by a decedent’s parent in 

8.6 percent. Other relatives responded in 13.5 percent of 

the inquiries, and a nonrelative in 2.4 percent. The relationship was not stated for 1.0 percent of the replies. 

Although the pretest sample was a stratified, systematic, random sample of all deaths for the chosen months in 

the four States surveyed, it was not designed to be a 

probability sample of all adult deaths in the United States. 

Nevertheless, a comparison was made between the deaths 

in the sample and all adult deaths in the United States for 

1984 (table E). It showed that the proportion of all deaths 

in the sample did not differ significantly from U.S. deaths 

5 
Table C. Number and cumulative percant distribution of informant Identification by method of inquiry, according to State of death: 

National Mortality Followback Survey pretest, 1986 

Funeral Funeral 

director director Total 

Total in Original Spouse Required response response adequate 

State of death samp/a complete Identified query by phone by mail identification 

Number 

All informants...,,,....,,. .,, 1,363 618 244 501 359 42 1,263 

Illinois . . . . . . . . . . . . . . . . . . . . 843 505 111 227 107 31 754 

New Mexico . . . . . . . . . . . . 85 83 1 1 1 85 

Vermont . . . . . . . . . . . . . . . . . . . 35 30 3 2 1 34 

Virginia . . . . . . . . . . . . . . . . ,., 400 129 271 250 11 390 

Cumulative percent 

All informants, . . . . . . . . . . . . . . . 100.0 45,3 63.2 . . . 89.6 92.7 92.7 

Illinois ...,,,.,....,,,.. 100.0 59.9 73.1 . . . 85.8 89.4 89.4 

New Mexico,,.......,,. . 100.0 97.6 98.8 . . . 100.0 100.0 100.0 

Vermont . . . . . . . . . . . . . . . . . 100.0 85.7 94.3 97.1 97.1 97.1 

Virginia . . . . . . . . . . . . . . . . 100.0 32.3 . . . 94.8 97.5 97.5 

interms ofsex orage. However, there was alarger percent 

of black decedents in the pretest sample, primarily because of the selection of Virginia and Illinois as pretest 

States, both having larger-than-average black populations, 

Methodological experiments in the pretest 

An important decision made early in the planning for 

the survey was to seek the means to achieve maximum 

response and to increase general knowledge of survey 

techniques by conducting four methodological 

experiments: 

. The inclusion or omission of “Don’t know” response 

boxes 

. A long and a short version of the questionnaire 

. The use of certified or first-class mail for the second 

mailing 

. Field followup on nonrespondents by telephone or 

personal interview 

In the analysis of the pretest results discussed below, 

three code categories– “complete interview,” “fail-edit,” 

and “partial interview” —are considered to be adequate 

responses or completed questionnaires. 

Table D. Number and percent distribution of informants by 

relationship of informant to decedent as reported on the 

questionnaire: National Mortality Followback Survey pretest, 

1986 

Relationship of Percent 

informant to decedent Number distribution 

Total . .,, , . . . . . . . . . . . . . . . . 1,158 100.0 

Informant was decedent’s -

Husband orwife. , . . . . . . . . . . . . 396 34.2 

Son or daughter . . . . . . . . . . . . . . 352 30.4 

Father or mother . 100 8.6 

Brother orsister . . . . . . . . . . . . . . 111 9,6 

Divorced spouse . . . . . 3 0.3 

Other relative . . . . . . . . . . . . . . . 156 13.5 

Nonrelative . . . . . . . . . . . . . . . . 28 2.4 

Not stated . . . . . . . . . . . . . . . . . 12 1,0 

6 

(1) The effect of “Don’tknow’’boxes-Sincem uchof 

the information sought required knowledge and recall of 

lifelong habitsof the decedent, itwas expected that many 

respondents would eithernot know ornotbe ableto recall 

requested information. One experiment was devised to 

measure the effect on the quality of the data of inclusion 

of response boxes that permitted the informant to check 

“Don’t Know” (DK) incompleting the questionnaire. 

Table E. Number and percent distribution of decedents 25 years 

of age and over by sex, race, and age, according to the 1986 

National Mortality Followback Survey pretest sample and 1984 

deaths: United States 

Decedents Decedents 

in pretest u.s. in pretest Us. 

Sex, race, and age samp/e deaths sarnp/e deaths 

Number Percent distribution 

All decedentsl 1,363 t ,944,000 100.0 100.0 

Male . . . . . . . . . . . . . . 699 1,015,415 50.6 52.2 

Female . . . . . . . . . . . . 664 928,585 49.4 47,8 

White 

Total . . . . . . . . . . . . . . 1,035 1,709,978 84.6 88.0 

Male . . . . . . . . . . . . . . 514 887,699 41.9 45.7 

Female . . . . . . . . . . . . 521 822,279 42.8 42.3 

Black 

Total . . . . . . . . . . . . . . 318 215,027 14,5 11.1 

Male . . . . . . . . . . . . . . 177 116,506 8.1 6.0 

Female . . . . . . . . . . . . 141 98,521 6.4 5.1 

Other races 

Total, . . . . . . . . . . . . . 10 18,995 0.6 1.0 

Male . . . . . . . . . . . . . . 8 11,210 0.7 0.6 

Female . . . . . . . . . . . . 2 7.785 0.2 0.4 

Age 

25-34 years . . . . . . . . . 50 49,928 3.3 2,6 

35-44 years . . . . . . . . . 52 62,556 3.4 3.2 

45–54 years . . . . . . . . . 82 117,213 5.8 6.0 

55–64 years, ,, . . . . . . 185 287,355 13.4 14.8 

65-74 years, ,. ..,... 363 476,570 26,0 24,5 

75-84 years, . . . . . . . . 371 550,912 28,0 26.3 

85 years and over 260 399,466 19.9 20.5 

lThree cases were dropped before the first mailing. 

NOTE: Percents may not add to totals due to rounding. 
A split-sample test was designed with half of the 

questionnaires containing DK boxes for aImost all of the 

questions. For the forms without such boxes, the instructions called for putting a question mark in the answer 

space if they did not know the answer. 

The results of the DK test are shown in table F. There 

was no significant difference between the two forms in the 

percent of mailed questionnaires returned compIeted – 

58.8 percent that contained the DK boxes and 58.2 percent that did not (a critical value of 1.96, a 0.05 level of 

significance, was used to test comparisons discussed in this 

report). However, the average percent of items with a DK 

response was significantly higher for the questionnaire 

version with the DK boxes at 7.1 percent, compared with 

1.9 percent for the version without DK boxes. The average 

percent of items left blank was a little higher, but not 

significantly so, for the version without DK boxes: 

13.3 percent compared with 11.3 percent. For several specific questions, the presence of a DK box appeared to 

make an appreciable difference in the volume of substantive responses. For example, for the question on the 

number of cigarettes smoked, on the forms without a DK 

box, 87.7 percent had a substantive response, compared 

with 69.7 percent where a DK box was present. 

On the basis of these results, it was concluded that 

there would be more advantages than disadvantages in 

omitting DK boxes” in the questionnaire for the main 

survey. Omitting the DK response boxes made the questionnaire simpler, briefer, and less cluttered and did not 

materially affect the usefulness of the responses, A more 

complete report of this experiment is described by 

Poe (12). 

(2) Questionnaire length– The second experiment 

dealt with the length of the questionnaire. The participation of many agencies, each of which desired to include 

specific questions and areas of inquiry relevant to their 

interests, produced a questionnaire containing 193 response items. Concern about the effect of this magnitude 

on response IeveIs resulted in agreement to use a split 

Table F. Number and percent distribution of results of mailing by type 

included: National Mortality Followback Survey pretest, 1986 

With 

“Don’t know” 

Type of response Total box 

Number 

Questionnaires mailed . . . . . . . . . . 1,360 699 

Questionnaires returned. . . . . . . . . 874 448 

Positive response.........,.. . 796 411 

Completed . . . . . . . . . . . . . . . . 755 391 

Fail-edit . . . . . . . . . . . . . . . . . . 41 20 

Notinformedl . . . . . . . . . . . . . . . 16 

Newlnformant . . . . . . . . . . . . . . . 5 ; 

Informant deceased. . . . . . . . . . . . 5 

Refused . . . . . . . . . . . . . . . . . . . 31 16 

Postmaster return. . . . . . . . . . . . . 16 

Nonext of kin . . . . . . . . . . . . . . . 5 : 

No response . . . . . . . . . . . . . . . . 486 251 

1Informant had inadequate information to respond. 

NOTE Percents may not add to totals due to rounding. 

sample to test the effect of questionnaire length on response rates. Half of the informants were mailed the full 

questionnaire; the other half received a shorter version 

containing 135 items. For administrative reasons, this test 

was conducted only on the second wave (Wave B) of the 

pretest mailing. After the mailing phase there was a 

significant difference in response rates for the two forms, 

with 53.6 percent responding to the long form and 

61.2 percent returning a completed short form (table G). 

However, after the fieId work interviews, there was no 

difference in response rates; the long and short forms each 

had a response rate of 85 percent (table H). The final 

questionnaire for the main survey contained 158 response 

items on 24 pages. 

(3) Method of nzailing-The use of certified maiI has 

been demonstrated to be cost effective in mail surveys. On 

the one hand, the use of certified maiI conveys a sense of 

the importance of the document, since the mail carrier 

must ‘obtain a signature from someone in the household in 

order to deliver the envelope. On the other hand, there 

was concern that the use of certified mail might alienate 

respondents who had to visit the post office after an 

unsuccesstl.d attempt at home deIive~. 

A split-sample test was therefore conducted for the 

second mailing of the questionnaire when no response was 

received from the initiaI mailing. The difference in response foIlowing the mailing phase was significant (table J). Substantive responses to the second mailing were 

received from 37.6 percent of the certified deliveries and 

from 24.9 percent of the first-class mailings. The refusal 

rate was aIso higher for the certified group at 4.3 percent, 

compared with 1.0 percent for the first class. It is important to observe, however, that the positive effect of using 

certified mail evaporated following the field work phase of 

data collection. For the cases sent by certified maiI, the 

finaI response rate after teIephone and personal interviews was 83.4 percent, and for those sent by first-class 

mail it was 87.2 percent (table K). This experiment is 

discussed by Poe (13). 

of response, according to whether “Don’t know” box was 

Without With Without 

“Don’t know” “Don’t know” “Don’t know” 

box Total box box 

Percent distribution 

661 100.0 100.0 100.0 

426 64.3 64.1 ‘ 64.4 

385 58.5 58.8 58.2 

364 55.5 55.9 55.1 

21 3.0 2.9 3.2 

9 1.2 1..4 

2 0.4 z 0.3 

5 0.4 0.8 

15 2.3 2.3 2.3 

8 1.2 1.1 1.2 

2 0.4 0.4 0.3 

235 35.7 35.9 35.6 

7 
Table G. Number and percent distribution of questionnaires in mailing phase by type of response, according to questionnaire length: 

National Mortality Followback Survey pretest (Wave B), 1986 

Type of response Total Long form Short forml Total Long form Short fermi 

Questionnaires mailed, Wave B 

Questionnaires returned 

Positive response 

Completed . . . . . . . . . . . . . . . . 

Fail-edit . . . . . . . . . . . . . . . . . . 

Notinformed2 . . . . . . . . . . . . . .


New informant . . . . . . . . . . . . . . .


Informant deceased.


Refused . . . . . . . . . . . . . . . . . .


Postmaster return.


Nonexlof ah,........,,,..


No response, ,, . . . . . . . . . . . . .


Number 

812 405 

508 237 

468 217 

447 207 

19 10 

10 4 

5 1 

1 1 

15 7 

6 4 

5 3 

304 168 

lTheahort form was used only in Wave B. 

21nformant had inadequate information to respond 

NOTE: Percents may not add to totals due to rounding 

The decision was made to use only first-class mail in 

the main survey, since there was less risk of alienating 

potential respondents that way. The higher rate of refusals 

by certified mail would require more field followup with its 

greater expense, so the total survey cost would be somewhat higher, but not significantly so. 

(4) Merhod of field followLlp – Of the total of 1,360 

questionnaires mailed, 796 were completed and returned 

by mail, a 58.5 percent mail response rate (table L). The 

fourth experiment tested the method of field followup for 

nonrespondents, by comparing telephone interviews and 

personal interviews. This experiment was conducted for 

decedents in Illinois and Virginia only, since no personal 

interviews were conducted in the pretest in New Mexico 

and Vermont, the two smaller States. Nonrespondents to 

the two mailings were split into two groups: half assigned 

to telephone followup and half to personal followup. 

However, if those assigned to telephone interview could 

not be reached by phone, the interviewer was instructed to 

attempt a personal interview. If the primary method was a 

personal interview, and several attempts were unsuccessful, the interviewer was instructed to attempt a telephone 

inquiry. In both cases no personal interview was attempted 

Table H. Number and percent distribution of questionnaires after 

final results by method of response, according to questionnaire 

length: National Mortality Followback Survey pretest (Wave B), 

Long Short Long Short 

Method of response form form~ form forml 

Both mailings Number Percent distribution 

Number mailed . . . . . . . . . . . . 405 407 100,0 100,0 

Positive response. 217 249 53.6 61.2 

Field interview 

Number assigned . . . . . . 168 132 100.0 100,0 

Positive response. 126 97 75,0 73.5 

Total positive response 343 346 84.7 85.0 

lThe short form was used only in Wave B. 

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

Percent distribution 

407 100,0 100.0 100,0 

271 62.6 58.5 66.6 

249 57.4 53.6 61.2 

240 55,0 51.1 59.0 

9 2.3 2.5 2.2 

6 1.2 1.0 1,5 

4 0.6 0.2 1,0 

— 0.1 0.2 

8 1.8 1,7 2,0 

2 0.7 1,0 0,5 

2 0,6 0,7 0.5 

136 37,4 41,5 33.4 

if the respondent lived more than 50 miles from the 

interviewer’s residence. 

The response rates for both methods were very similar, with rates of 76.8 percent for the telephone and 

75.4 percent for personal interview (table M). Based on 

these results and on cost considerations, the procedure 

selected for the main survey was for a telephone interview 

to be attempted first, with personal interviews to be used 

for unsuccessful telephone attempts, 

The final pretest response rate after all attempts to 

contact the informant was 87.1 percent. Refusals accounted for 4.4 percent, and 8.5 percent failed to respond. 

The final response rates by method of inquiry are shown in 

table L. 

Comments from informants 

In a further effort to learn of the reactions of the 

persons asked to complete the questionnaire, the last page 

of the form provided space for “Additional answers or 

comments, ” with a section headed “Please add any comments or suggestions that you think can help in this 

study, ” 

All of the 796 completed and 31 of the refusal pretest 

questionnaires returned by mail were examined for the 

content in this comment section. Some entry was made on 

the comment page on a total of 142 questionnaires, 

17.2 percent of the mail respondents. The most frequent 

and generally the most eloquent comments dealt with the 

health care received by the decedent; this was usually 

critical of the type of care provided during the last illness. 

Other comments either explained the nature of the 

relationship of the informant to the decedent (often the 

fact that, because of a limited relationship, the respondent 

was unabIe to provide all of the information requested); 

described the nature of the illness experienced by the 

decedent, with details about symptoms, the pain experienced, and special problems; or explained why the respondent refused to participate in the survey. 

8 

1986 
Table J. Number and percent distribution of second-mailing questionnaires by type of response, according to method of mailing: 

National Mortality FoHowback Survey pretest, 1986 

Certified 1%.st-claas Certified First-class 

Type of response Total mail mail ToW mail mail 

Number Percent distribution 

Questionnaires mailed . . . . . . . . . . . . . . . . . 780 391 389 100.0 100.0 100.0 

Questionnaires returned . . . . . . . . . . . . . . . . 300 186 114 38.5 47.6 29.3 

Positive response . . . . . . . . . . . . . . . . . . . . 244 147 97 31.3 37.6 24.9 

Completed . . . . . . . . . . . . . . . . . . . . . . . 228 139 89 29.2 35.5 22.9 

Fail-edit . . . . . . . . . . . . . . . . . . . . . . . . . 16 8 8 2.1 2.0 2.1 

Notinformedi . . . . . . . . . . . . . . . . . . . . . . 11 4 7 1.4 1.0 1.8 

Newinformant . . . . . . . . . . . . . . . . . . . . . . 5 5 0.6 1.3 — 

Informantdeceased. ..,..... . . . . . . . . . . 2 1 1 0.3 0.3 0.3 

Refused . . . . . . . . . . . . . . . . . . . . . . . . . . 21 17 4 2.7 4.3 1.0 

Postmasterreturn . . . . . . . . . . . . . . . . . . . . 16 12 4 2.1 3.1 1.0 

Nonextofkin . . . . . . . . . . . . . . . . . . . . . . 1 1 0.1 0.3 

Noresponse . . . . . . . . . . . . . . . . . . . . . . . 480 205 275 61.5 52.4 70.7 

1Informant had inadequate information to respond. 

NOTE Percents may not add to totals due to rounding, 

Table K. Number and percent of questionnaires afterfinal results by method of response and use of certified versus first-class mail: 

National Mortality FollowbackSurvey pretest, 1986 

Certified First-class Certified F/rst-c/ass 

Method of response mail mail 

Second mailing (split sample) Number 

Numbermailed . . . . . . . . . . . . . . . . . . . . . . 391 389 

Positiveresponse . . . . . . . . . . . . . . . . . . . . 147 97 

Field intetview 

Numberassigned . . . . . . . . . . . . . . . . . . . . 211 276 

Positiveresponse . . . . . . . . . . . . . . . . . . . . 145 219 

Totalmailed . . . . . . . . . . . . . . . . . . . . . . . . 681 679 

Total positive response 

Firstmailing (allfirat class). . . . . . . . . . . . . . . 276 276 

Second mailing(split sample) . . . . . . . . . . . . . 147 97 

Fieldintewiew . . . . . . . . . . . . . . . . . . . . . . 145 219 

Total response . . . . . . . . . . . . . . . . . . . . . . 568 592 

mail mail 

Percent 

. .. . . . 37.6 24.9 

. . . . . . 68.7 79.3 

. . . . . . 

. . . . . . . . . . . . . . . . . . 

83.4 87.2 

Table L. Number and percent distribution of inquiries bytype offinal response, according tomethod of inquiry: National Mortality 

Followback Survey pretest, 1986 

Method of inquityl 

Telephone or Telephone or 

Type of response Total Mail personal visit Total Mail personal visit 

Number Percent distribution 

All inquiriesz . . . . . . . . . . . . . . . . . . . . . . . 1,360 1,360 512 100.0 100.0 100.0 

Completed . . . . . . . . . . . . . . . . . . . . . . . 1,184 796 388 87.1 58.5 75.8 

Refused, . . . . . . . . . . . . . . . . . . . . . . . . . 60 31 29 4.4 2.3 5.7 

0thernonresponse4 . . . . . . . . . . . . . . . . . . 116 533 95 8.5 39.2 16.6 

l~nal methodof inquiry attempted, nottheinitfally assigned method. 

Zlnc[udes inqui~ to staff persons in facilities where a decedent died, for 25 decedents who were identified as having no fiVing neXf Of kin. 

Slncludes completed and fail-edit returns that provided some pOSitiVereSpOnSe. 

4Cases of nonresponse by mail were assigned to telephone or personal visit followup. Therefore, these cases are duplicated in the mail and telephone or personal visit 

columns, and the columns do not add across. The total columns represent the net outcome after the field followup attempts. 

NOTE Percents may not add to totals due to rounding. 

9 
Table M. Number and percent distribution of cases assigned to the field by final response status and final method used, according to 

method of followup, for Illinois and Virginia: National Mortality Followback Survey pretest, 1986 

Method of fo//okvup 

Both methods Te/ephone Persona/ visit 

Fins/ response status Percent Percent Percent 

and fins/ method used Number distribution Number distribution Number distribution 

Cases assigned..,,.......,,,. 448 100.0 241 100.0 207 100.0 

Positive responses 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . 341 76.1 185 76.8 156 75,4 

Telephone . . . . . . . . . . . . . . . . . . . . . . . 209 46.7 182 75.5 27 13,0 

Personal visit...,,.,,..,.,.. ,., ..,,. 132 29.5 3 1.2 129 62.3 

Refusals 

Total . . . . . . . . . . . . . . . . . . . . . . .,, ,,. 6 1.3 4 1.7 2 1,0 

Telephone ., . . . . . . . . . . . . . . . . . . . 5 1.1 4 1.7 1 0.5 

Personal visit . . . . . . . . . . . . . . . . ...,,, 1 0.2 1 0.5 

Other nonintewiews 

Total ..,,..,...,.,...,,,., ,. ...,, 101 22.5 52 21,6 49 23,7 

Telephone . . . . . . . . . . . . . . . . . . . . 59 13.2 51 21.2 8 3.9 

Personal visit . . . . . . . . . . . . . ,,, . 42 9.4 1 0.4 41 19.8 

NOTE: Percents may not add to totals due to rounding 

10

Main survey methods 

and procedures 

The results of the pilot study at the hospice, the 

minitest in the Washington, D. C., area, and the formal 

four-state pretest were carefully evaluated in designing 

the questionnaire and the procedures for the main survey 

for 1986. Consultations were held with the cosponsors, 

and the National Center for Health Statistics (NCHS) 

Work Group and the interagency Consulting Group expressed their views. 

Questionnaire design 

Two basic questionnaires were used in the 1986 National Mortality Followback Survey (NMFS): the informant questionnaire (NMF–l; see appendix) and the 

facility abstract record (W-6). The final informant 

questionnaire requested information on the four major 

topics described in “Selecting the foci of the 1986 NMFS.” 

The basic informant questionnaire used for the mailing 

was modified for two other uses: a form adapted for the 

telephone and personal interview (NMF-4) and a shortened form for use when no relative of the decedent could 

be located and a telephone interview was conducted with 

a staff person in a nursing home (NMF–5). 

A Facili~ Abstract Record (NMF–6) was used to 

collect information on the use of health care facilities in 

which the decedent spent at least one night during the last 

year of life. Identification of facilities used by the decedent came from the death certificate, from inquiry to the 

informants, and through inquiry about other relevant 

facilities from each facility contacted. A letter requesting 

information was sent to the administrator (NMF-61[L]) 

and to the medical record librarian of each facili~ 

(NMF-60[L]), and a Facili~ Abstract Record (FAR) was


sent to the record librarian (NMF–6). The American


Medical Record Association endorsed the survey, and a


copy of this letter (NMF-62&]) was sent to the medical


record specialists. The FAR sought information on the


following topics:


. The dates of each admission and discharge following


January 1, 1985, a date specified to assure reports 

during the last year of life 

. The diagnoses for each discharge 

. The medical procedures administered 

. Information on other facilities used by the decedent 

In each case where the informant had completed the 

Authorization to Obtain Information from Medical 

Records, a copy of this form was sent to the facility with 

the inquiry. This completed form was available for 

75.5 percent of the survey records. 

Details on the facility survey procedure are found 

under “Data processing.” 

Sample design 

The 1986 NMFS was a national probability sample of 

all deaths of residents of the United States 25 years of age 

and over, occurring in the United States, except Oregon, 

in the year 1986. The sampling frame was the Current 

Mortality Sample (CMS), with a sample of death certificates drawn each month of the year (See description of 

the CMS under “Data processing”). Oversampling of 

selected groups was done to assure adequate analytic 

capability, especially for issues of concern to participating 

agencies. The CMS certificates drawn with certainty were: 

alI death certificates for deaths from Ischemic heart disease in males 25-44 years of age and in females 25-54 

years of age; all deaths due to Asthma; all deaths from 

specified cancer sites according to selected race/sex/age 

classes; and all deaths of American Indians, AIeuts, and 

Eskimos (table B). To fulfill these analytic needs, 2,274 

death certificates were selected. In addition, black decedents were oversampled 2.9 times the rate for decedents 

who were not black, and decedents under 55 years of age 

were oversampled 3.1 times the rate of older decedents. 

The total survey sought information on 18,733 deaths in 

1986. 

Sources of information 

The death certificates in the Current Mortality Sample file provided the initial source of information. Demographic data included date of death, age at death, date of 

birth, sex, race, marital status, usual residence, usual 

occupation and kind of business or industry, and service in 

the Armed Forces. These certificates also provided information on the cause of death, the place of death, the 

name and address of the inforniant, and the name of a 

surviving spouse. 

After the data gathering was completed, the final file 

of information from death certificates, referred to as the 

Multiple Cause of Death File, was accessed, and pertinent 

data entered onto the survey data tape. Thus the final 

11

recorded cause of death could be examined in relation to 

the survey data. 

The informant (generally the decedent’s next of kin) 

provided the basic survey data on the informant questionnaire. If the person to whom the questionnaire was mailed 

was unable to furnish the information sought, a request 

was included to identify a person who might know more 

about the decedent, and a questionnaire was mailed to 

that individual. However, only one questionnaire response 

for each decedent was used even if more than one was 

returned. The most complete response was accepted. 

If no next of kin could be identified and the death 

certificate revealed a death in a nursing home, an interviewer telephoned the nursing home, and attempted an 

interview with a staff person who had known the decedent. 

An abbreviated Staff Questionnaire was used for these 

interviews. (NMF–5; see appendix). Staff Questionnaire 

interviews for 245 decedents (1.3 percent of the total 

sample) were attempted, and all were completed. 

Information was also sought from all health care 

facilities used on at least an overnight basis by the decedent in the last year of life. These facilities, including 

hospitals, nursing homes, hospices, and other health care 

resources, were identified from the death certificates, 

reports by the informants, and reports by other facilities 

used by the decedents. 

Collection of survey data 

The U.S. Bureau of the Census served as the data 

collection agent for NCHS, both in the pretest and in the 

main survey. Questionnaires were mailed on a quarterly 

basis. All the forms used are listed in this report (See 

appendix III). 

Informant survey 

the 

1. 

2. 

3. 

The informant data collection procedure consisted of 

following steps: 

Approximately 6 months after the death, a 24-page 

informant questionnaire —with a cover letter from the 

Director of NCHS and brief instructions for completing the form – was mailed by government-paid mail to 

the person named on the death certificate as the 

informant (NMF–1; see appendix). When no informant could be identified, the questionnaire was 

mailed to “Next of Kin” of the named decedent at the 

decedent’s usual residence. A postage-paid return 

envelope was included. A reply within 5 days was 

requested. 

Ten days after the first mailing, letters were sent to 

informants thanking them if they had returned the 

questionnaire and requesting that they do so if they 

had not yet completed the form (NMF-30[L]). 

In cases where it appeared that families might have 

moved or broken up following a death, the post office 

was requested to furnish a forwarding address for the 

informant, and a questionnaire was sent to the new 

address. When an addressee could not be located in 

this way, efforts were made through telephone 

directories, city directories, and other means to locate 

the informant. 

4.	 About 4 weeks after the initial mailing, an identical 

questionnaire form and a revised cover letter were 

mailed to nonrespondents using first-class government-paid mail (NMF-2). 

5.	 About 1 month after the second mailing, field interviews were attempted for those not responding to the 

two mailings. A telephone interview was the primary 

mode for field followup. If this effort failed, a personal 

visit to the home was made if the informant lived 

within 50 miles of the interviewer’s residence 

(NMF-4). 

6,	 For questionnaires returned, an edit check was made 

on 21 key items identified by the survey staff. If three 

or more of these key items failed the edit check, the 

case was referred to the field for telephone followup 

to complete these items and the entire questionnaire. 

(See “Clerical processing of the informant 

questionnaire.”) 

7.	 If a refusal was received from a spouse or a person 

residing at the decedent’s address, either by mail or in 

the telephone or personal inquiry, no further effort to 

secure information was made, and the record was 

coded as a refusal. However, if another informant was 

interviewed and that person refused, inquiry was 

made as to whether some other family member or 

other person might be contacted. 

8.	 For a sample of the responses that passed the edit 

check, a reinterview by telephone w~s conducted at 

least 2 weeks after the original response or interview. 

In the reinterview, the same informant was asked a 

limited number of the questions on the original 

questionnaire. 

Exceptions to these procedures, as noted below, were 

followed at the request of some States. 

In Pennsylvania, no mailings were made in the first 

quarter of the survey because clearance arrangements had 

not yet been completed. In the second quarter of mailings, 

a special form was included that permitted the respondent 

to refuse (NMF–llPa; see appendix). Because this form 

produced such a high rate of refusals, it was revised for 

use in the third and fourth quarters (see NMF–llRIPa]). 

In the second quarter, no personal visits were permitted. 

In the third and fourth quarters personal visits were 

permitted if the respondent stated on the form that it was 

acceptable. 

In Idaho a cover letter from the State Registrar was 

included in the first mailing. 

Michigan requested a list of the sampled death certificates for comparison against their “active” file to see if 

there should be any substitutions. 

12

Facility survey 

For the facility phase of the survey, the following 

procedures were used: 

1. A letter was sent to the administrator of each facility 

reported (NMF-61[L]), and a letter and questionnaire 

(NMF-60&] and NMF-6) were sent to the Director 

of Medical Records of the facility. If the informant 

had completed a form authorizing contact with the 

facility, this form was enclosed, but if no form was 

compIeted, the Facility Abstract Record was mailed 

nevertheless. Exceptions to this procedure were followed at the request of Pennsylvania and Vermont, 

where no facility inquiry was made without a consent 

form. NCHS secured .an endorsement letter from the 

American Medical Record Association, and a copy of 

the letter was sent to the medical record librarian. 

The Indian Health Service sent a letter to all of their 

hospitals urging cooperation with the survey. The 

Department of the Army did the same. 

2. Up to three phone calls were made to facilities that 

failed to respond or that had returned forms that 

failed the edit check. 

3.	 In cases where the facility requested reimbursement 

of copying expenses, reimbursement of up to $5.00 

was made for each copy of a medical record. Few 

requests were made for reimbursement. A Census 

Bureau representative assisted in completion of the 

questionnaires in one hospital that had a limited staff. 

13

Data processing


There were four prima~ sources of information on 

decedents in the 1986 National Mortality Followback 

Survey (NMFS): the Informant Questionnaires, the Current Mortality Sample (CMS) death certificates, the Multiple Cause of Death File, and the Facility Abstract 

Records (FAR). In addition to these four primary sources 

there was an important quality-control document, the 

Reinterview Questionnaire (NMF-8). All five of these 

sources for each decedent required clerical and computer 

processing as described in the sections below. 

A CMS death certificate record was included for all 

18,733 decedents in the 1986 NMFS. Data are avai[abIe 

from the informant questionnaire for 16,598 decedents 

(88,6 percent) and from the Multiple Cause of Death File 

for 18,707 decedents (99.9 percent). 

During data processing, data reported by one responding source was not changed because it was inconsistent with information from another source, since it was 

impossible to determine which source was correct, The 

decision to retain the inconsistent responses allows flexibility in the analyst’s choice of data items and also permits 

certain methodological studies. 

Missing data were not imputed in the informant 

questionnaires. The decision not to impute was made after 

lengthy consultation with data users. The majority opinion 

of data users was that imputation could potentially cause 

more errors than it could eradicate and that it was 

therefore preferable to leave the decision as to whether or 

not to impute and the method of imputation to the data 

analysts. 

It is National Center for FIea[th Statistics @CHS) 

policy that public-use data tapes for elementary units 

(persons, events, and health facilities and services) be 

released in a manner that will not compromise the confidentiality guaranteed the respondents who supply the 

original data. The measures taken to protect confidential 

information on NMFS decedents and respondents follow 

the practices of NCHS. Personal names and addresses and 

certificate numbers of vital records do not appear on the 

public-use data tapes. In addition, because of the amount 

of information about each decedent obtained from the 

informant questionnaire, and the linking of multiple 

sources of data for each decedent, no geographic information below the State level is shown on the files. 

Current Mortality Sample death certificates 

The detailed specifications for the routine processing 

of the Current Mortality Sample (CMS) death certificates 

are outlined elsewhere (14). Briefly, the CMS included 

death certificate record information for all 50 States, plus 

New York City and Washington, D.C. The registration 

areas were requested to submit copies of a 10-percent 

sample. of their regular death file for the CMS by the end 

of the month foI1owing the month in which they receive 

the certificates. Key-to-disc processing was the primary 

mode of data entry; data were keyed directly into a 

minicomputer. Interactive with key entry, the computer 

software performed valid code field edits and selected 

interfield dependency edits where applicable, The results 

of the edits were displayed on a screen for immediate 

resolution by the key entry operator or referral to the 

supervisor, if necessary. There was a consistency edit 

among age, sex, and cause-of-death code assignment, The 

key entry of each CMS record was 100-percent verified 

through an independent key verification process. 

To facilitate administrative control of the 1986 NMFS 

sample file by the Census Bureau, NCHS selected the 

sample records and prepared a master file tape containing, for each record, the death certificate number, a 

unique control number, the name of the decedent, and the 

name and address of the informant. In addition, two 

photocopies of the death certificate were sent to the 

Census Bureau. This process continued until June 1987 in 

order to obtain virtually all certificates for 1986 deaths 

that were filed late into 1987. 

At a later date, the full CMS file was accessed to 

obtain data for each NMFS decedent including age, sex, 

race, and underlying cause of death. This information was 

merged with the above-described file. 

Because the industry and occupation items were not 

contained on the CMS file, these items from the death 

certificates were coded by Census Bureau coders based on 

the “1983 Procedures Manual for Industry and Occupation Coding for Death Certificates” (15). This file was 

later merged with the other CMS information on the 

decedent. 

14

The Multiple Cause of Death File 

The Multiple Cause of Death File contains information from the death certificate on all deaths occurring in 

the 50 States, the District of Columbia, Puerto Rico, the 

Virgin Islands, Guam, American Samoa, and the Trust 

Territory of the Pacific Islands. Whereas the CMS file only 

contains the underlying cause of death —defined as 

“(a) the disease or injury which initiated the train of 

events leading directly to death, or (b) the circumstances 

of the accident or violence which produced the fatal 

injury” (16) —the Multiple Cause of Death File contains 

codes for all medical “conditions that are reported on the 

death certificate regardless of whether the condition contributed to death. The Multiple Cause of Death File is 

considered more complete and accurate than the CMS 

because in some cases a death certificate is amended after 

the CMS record is filed. 

All States and the District of Columbia provided 

NCHS with the demographic parts of the death certificate 

already coded on magnetic tape. Twenty-two States provialed cause-of-death coding on computer tapes according 

to NCHS specifications. NCHS keyed the medical information for the balance of the areas. As with demographic 

data, mortality medical data were also subject to quality 

control procedures against errors of both coding and data 

entry. (The detailed processing specifications can be found 

in publications listed in references 17–19.) 

The Multiple Cause of Death File information for the 

sampled decedents was merged with the other decedent 

information from the CMS and the informant questionnaire. Twenty-six records (0,1 percent) have no matching 

Multiple Cause of Death File information. 

Informant Questionnaire 

The information from aI1 informant questionnaire 

forms (NMF-1, NMF–2, NMF-4, and NMF–5) was processed by the U.S. Bureau of the Census as described 

below. 

Clerical processing of the informant 

questionnaire 

Upon receipt of a ,mailed questionnaire, an edit was 

performed on 21 key questionnaire items. If three or more 

of these key items were blank or illegible, a telephone 

followup was made. In the telephone followup, the interviewer went through the entire questionnaire (not just the 

21 items) to make necessary additions and corrections. 

The questionnaires were further hand coded to prepare the form for data keying (for example, converting 

written entries to numeric equivalents, reducing ranges 

and fractions to whole numbers, etc.). Detailed editing and 

coding instructions were given for specific question items 

such as reclassifying or recoding “other” entries based on 

NCHS specifications. 

In addition, facilities where decedents stayed during 

the last year of life were identified from the completed 

questionnaires and corresponding death certificate during 

the clerical processing, and Decedent Control Forms 

(NMF-6A) and Facility Control Forms (NMF-6B) were 

completed. (See section below.) 

Before data keying, the first 100 edited and coded 

questionnaires each quarter were sent to NCHS for review. Revisions and clarifications were made to some 

editing instructions to account for situations that were not 

anticipated. 

A “source code” method was used in data keying 

each response item on the questionnaires had a unique 

source code. Identical response items across questionnaire 

types had identical source codes. If a response item was 

blank, nothing was keyed for the source code. The level of 

detail on the questionnaire was retained during keying (in 

other words, no response codes were grouped during 

keying, which would have resulted in a 10SSof detail). 

Computer processing of the informant 

questionnaire 

A “pre-edit” was performed that invoIved matching 

the informant file to the master file containing the case 

management information on each sample case. Inconsistencies, such as duplicates, mismatched data file and 

master file records, and out-of-sequence source codes, 

were rejected and manually inspected. The majority of the 

rejects were duplicate records. The second most common 

reject involved missing records, most of which were late 

receipts that had not been “check-in keyed.” Corrected 

rejects were recycled and verified. 

After pre-editing, the following edits and reformatting were completed: 

File formatting –The questionnaires were keyed by 

source code. The keyed file was reformatted to contain only fixed-length fields. Each reformatted data 

fde record was then appended to the corresponding 

master file record. 

Item reformatting– Certain items, such as multiple 

entry items, required reformatting. 

Range checks –These checks identified valid and outof-range entries for each item. A “Not Ascertainable” 

(NA) code was used for each blank or out-of-range 

entry. 

Consistency edit –These edits were performed to ensure that responses to specific items in the questionnaire were consistent or equivalent to other items in 

the questionnaire. These were a “forward” type of 

edit, in that if a subsequent item was inconsistent with 

a previous entry, the previous entry was retained and 

the subsequent entry was changed to an NA code. For 

example, if the response to the question “During his 

or her entire life, was the person ever admitted to a 

nursing home?” was “No” and the entry for the 

subsequent question “What was the total amount of 

time the person spent in a nursing home over his or 

her entire lifetime?” was “Less than 3 months,” the 

response to the latter question was changed to an 

“ 

15

out-of-universe code. However, if a previous entry was 

blank and reasonable data followed, the previous 

blank was changed to a “Yes” or “No” to be consistent. For example, if the response to the question 

“During his or her entire life, was the person ever 

admitted to a nursing home?” was blank, and the 

entry for the subsequent question “What was the total 

amount of time...” was “Less than 3 months,” the 

entry for the previous question was changed to “Yes.” 

.	 Blanking edit – Fields not requiring entries were 

blanked out, so that the universe for each item was 

well defined. Each blanked field was filled with “9,” 

“99,” “999,” and so forth to indicate to the file user 

that the item was out of universe. 

Finally, certain data items such as age, industry and 

occupation, and payment sources for health care were 

recoded to assist data users. The original codes were also 

retained for all recoded items. 

A review of item counts called the “universe verification, ” was performed after processing each quarter of data 

to verify that the above edits were properly applied to the 

file. 

The informant questionnaire file was merged with the 

CMS file and the file containing the industry and occupation codings from the death certificates prior to sending 

the file to NCHS. 

Decedent Control Record (NMF–6A) 

The facilities used by a decedent during the last year 

of life were identified from the informant questionnaire, 

from the death certificate, and from facilities themselves. 

A Facility Control Record (NMF-6B) was completed for 

each facility identified. A Decedent Control Record 

(NMF-6A) was completed for each decedent using a 

facility. The Facility Control Record listed all decedents 

identified as using that facility and the facility’s name, 

address, and telephone number. The Decedent Control 

Record listed all facilities used by that decedent and the 

facility control numbers. Keying the Decedent Control 

Record information created a file which was merged with 

the informant questionnaire information. The merging 

process also involved editing the final status codes for the 

Decedent Control Records, correcting inconsistencies between the informant questionnaire final status code and 

the Decedent Control Record, and eliminating duplicate 

Decedent Control Records. 

Facility Abstract Records (FAR) 

The FAR’s were reviewed by the NCHS Data Processing Branch for problems prior to data keying. In 

addition, data from facilities that sent medical record 

facsimiles rather than completed FAR’s were transferred 

to the FAR prior to data entry. In the review of the 

FAR’s, dates and the final status codes were checked for 

consistency. 

In keying a FAR, the data keyer first entered the 

decedent’s control number. The data entry computer 

program brought up a reference file consisting of the 

decedent’s control number, date of death, date of birth, 

age, and sex, This information was used as the first part of 

the FAR record. 

The quality control procedure for data entry consisted 

of drawing a 5-percent sample and performing an independent verification. The data entry supervisor and senior 

data entry personnel adjudicated any differences and 

tallied errors. The quality control procedure for the transfer of facsimile information to the FAR was a dependent 

verification conducted manually by the data entry supervisor and senior data entry personnel. For each keyer, the 

first 50 FAR’s for which transfers were made were 100-

percent verified. After the error rate was determined to be 

minimal, this verification was reduced to 5 percent. 

As part of the data entry program there were computer edits that included consistency checks on dates, age, 

sex, medical condition, and procedure codes. Inconsistencies were resolved during the data keying by the data 

keyer in consultation with the keying supervisor. 

Reinterview questionnaire 

The clerical processing and computer processing of 

the reinterview questionnaires (NMF–8) were similar to 

those of the informant questionnaire except that there was 

no key item edit. A pre-edit was performed on the 

reinterview status item. The code range checks, consistency checks, etc. were identical to those for the informant 

questionnaire for those items contained on the reinterview. The reinterview information is not contained on the 

public-use data tapes but is summarized and presented in 

the section “Nonsampling error. ” 

Final preparation of the public-use data 

tapes 

In the final preparation of the public-use data tapes, 

confidential information was removed (as described 

above), the file was reformatted, and weights were entered 

on the file. For a discussion of the weights, see 

“Estimation.” 

16 
Estimation


National Mortality Followback Survey (NMFS) data 

must be weighted in order to prepare nationally representative estimates. Unweighed NMFS data usually cannot 

be used for analysis because use of unweighed estimates 

ignores the NMFS disproportionate sampling. Probabili~ 

sampling allows the NMFS data to be weighted to produce 

national estimates for the United States, excluding Oregon. It aIso allows approximation of the sampling errors. 

The NMFS weights were prepared by a poststratified 

ratio estimation procedure (table N). The weight for each 

sample decedent is based on a product of three component weights: 

. Probabilip of selection –The basic weight for each 

sample decedent is the reciprocal of the probability of 

sampIe selection. 

� A@tnzent for nonresponse —To reduce nonresponse 

bias, the NMFS sampling weights are adjusted for 

informant nonresponse. This adjustment was implemented within subsets of the sampling strata and was 

the reciprocal of the response rate within the subset. 

This adjustment reduces nonresponse bias to the 

extent that informant data for a nonrespondent is 

similar to data for respondents in these adjustment 

classes. 

. Poststratification ~y age, Sq and race —Within 28 poststrata defined by decedent age, sex, and race (table N), the NMFS estimates were ratio-adjusted to 

counts for the number of deaths reported to the 

National Center for Health Statistics (NCHS) for the 

United States, excluding Oregon. This adjustment 

makes the weighted sample more representative of 

the target population by age, sex, and race. 

An important issue in estimation is that the NMFS 

represents the universe of resident deaths in 1986 among 

adults 25 years of age and over (excluding Oregon). It 

therefore cannot be used to calculate probabilities of 

death unless a population base (the denominator) is 

obtained. There are several possible sources of denominator data: the 1986 Current Population Survey (CPS), 

conducted by the Bureau of the Census; the National 

Health Interview Survey (NHIS), conducted by NCHS; 

and the 1985 National Nursing Home Survey (NNHS), 

conducted by NCHS. None of these sources corresponds 

exactly with the NMFS. For example, the NHIS covers the 

civilian noninstitutionalized population, as opposed to the 

coverage of the whole population by the NMFS. However, 

persons may be classified as institutionalized or not in the 

NMFS. For this purpose it is recommended that source 

code 051 be used, with a code of 2 or 3 indicating that the 

person was institutionalized for half or more of 1986. In 

addition, the civilian status of decedents may be determined from source code 146. For use as denominator data 

with the 1986 NMFS, the 1986 NHIS included supplemental items on longest occupation and industry. 

17

Table N. Weighting and sampling strata definitions, by reciprocal of the probability of sample selection, age group, number of cases in 

survey, and response rate: National Mortality Followback Survey, 1986 

Recipmca/ Response 

of the Number of rate 

Weighting 

stratum Samp/ing stratum 

11 1, All causes, American Indian, Eskimo, and Aleut 

12 

13 

14 

15 

16 

17 

21 

22 

23 

24 

25 

31 

32 

33 

41 

51 

52 

61 

62 

71 

8f 

91 

100 

110 

121 

122 

131 

132 

141 

142 

151 

152 

161 

162 

171 

172 

180 

1. All causes, American Indian, Eskimo, and Aleut 

1. All causes, American Indian, Eskimo, and Aleut 

1. All causes, American Indian, Eskimo, and Aleut 

1. All causes, American Indian, Eskimo, and Aleut 

1. All causes, American Indian, Eskimo, and Aleut 

1. All causes, American Indian, Eskimo, and Aleut 

2. Specified heart disease, black 

2. Specified heart disease, other than black 

2. Specified heart disease, other than black 

2, Specified heart disease, black 

2. Specified heart disease, other than black 

3. Specified asthma, black 

3. Specified asthma, other than black 

3. Specified asthma, other than black 

4. Specified cancer, all races except American Indian, Eskimo, and Aleut 

5. Not external causes, black 

5. External causes, black 

6. Not external causes, black 

6. External causes, black 

7. All causes, black 

6. All causes, black 

9. All causes, black 

10. All causes, black 

11. All causes, black 

12. Not external causes, other than black 

12. External causes, other than black 

13. Not external causes, other than black 

13. External causes, other than black 

14. Not external causes, other than black 

14. External causes, other than black 

15. Not external causes, other than black 

15. External causes, other than black 

16. Not external causes, other than black 

16. External causes, other than black 

17. Not external causes, other than black 

17. External causes, other than black 

18, All causes, other than black 

probabi/ify cases in per 100 

of selection Age survey cases 

10.00 25-34 years 55 87.27 

10.00 35-44 years 63 68.89 

10.00 45–54 years 80 85.00 

10.00 55–64 years 77 9351 

10.00 65–74 years 85 91.76 

10.00 75-84 years 112 91.07 

10.00 85 years and over 68 97.06 

10.00 25–44 years 147 88.44 

10.00 25–34 years 76 86.84 

10.00 35-44 years 603 89.05 

10.00 43-54 years 94 88.30 

10.00 45-54 years 349 86.25 

10.00 25 years and over 61 90.16 

10.00 25–64 years 77 89.61 

10,00 65 years and over 182 92.86 

10,00 25 years and over 145 91,72 

32.45 25-34 years 209 84.21 

32.45 25–34 years 188 84.57 

36.76 35-44 years 283 84.48 

36.78 35-44 years 99 84.85 

52.86 45-54 years 405 84.44 

52.86 55–64 years 767 88,68 

52.86 65-74 years 1,013 88.90 

52.86 75-84 years 940 91.70 

52.86 85 years and over 543 92.63 

32.45 25-34 years 532 84.59 

32.45 25-34 years 702 82.97 

36.78 35-44 years 868 85.37 

36.78 35–44 years 412 81.31 

79.08 45–54 years 941 87.67 

79.08 45–54 years 147 60.27 

185.12 55–64 years 1,208 89.07 

185.12 55–64 years 50 80.00 

185.12 65–74 years 2,205 88.39 

185.12 65–74 years 65 87,69 

185.12 75–84 years 2,703 90.12 

185.12 75-84 years 58 94.83 

185.12 85 years and over 2,116 92.20 

NOTES: A certificate was assigned to the first stratum for which it was eligible. A certificate was classified as an external cause of death if the cause was coded 

E800–E999, according to ICD-9 (World Health Organization, Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death, based on the 

recommendations of the Ninth Revision Conference, 1975. Geneva: World Health Organization, 1977), Each weighting stratum is a subset of a sampling stratum, 

18 
. ,, ,;. . .. 

Sampling error 

Because the National Mortality FolIowback Survey 

(NMFS) estimates are based on a sample, the estimates 

may differ from figures that would have been obtained in a 

survey of all death certificates for decedents in 1986 who 

were 25 years of age and over, using the same data 

collection instruments and procedures. Probability sampIing in the NMFS aIlows approximation of the sampling 

error. 

The standard error of an estimate is primarily a 

measure of the variability that occurs by chance (the 

sampling error) because a sample of the population rather 

than the total population is surveyed. Although the standard errors calculated for the NMFS estimates reflect 

some of the random variation inherent in the measurement process, they do not measure any systematic error. 

The relative standard error (RSE) of an estimate is 

obtained by dividing the standard error of the estimate by 

the estimate itself and is sometimes expressed as a 

percent. 

In repeated samples using the same questionnaires 

and procedures, the chances are about 68 in 100 that an 

estimate from the sample differs by less than one standard 

error from the corresponding figure that would be obtained through a survey of all death certificates for decedents 25 years of age and over. The chances are about 95 

in 100 that an estimate from the sample differs by less 

than two standard errors from the figure that would be 

obtained through a survey of all death certificates for 

decedents 25 years of age and over. 

The standard error of a statistic depends not onIy on 

the sampling design but also on the statistic itsel~ the 

standard error is higher for measurements that are highly 

variable from one sample unit to another and Iower for 

measurements that are less variable. Because the standard 

errors for survey statistics are estimated from sample data, 

they are themselves subject to sampling error, which may 

be large in some cases. 

Estimation of standard error 

The standard errors for the NMFS were estimated by 

a balanced-repeated-replication procedure using 20 replicate half samples. This procedure estimates the standard 

errors for survey estimates through the observation of the 

variability of estimates based on replicate haIf samples of 

the total sample. This estimation procedure was developed and described by McCarthy (20,21). 

Standard error approximation 

The balanced-repeated-replication procedure can be 

used to calculate directly the standard error and the 

relative standard error for all estimates from the NMFS. 

However, this procedure is not practica~ or feasible for all 

users of these data. The baIanced-repeated-replication 

procedure was therefore used to develop a generalized 

procedure for approximating the relative standard errors 

for NMFS estimates. 

Relative standard errors were calculated using the 

balanced-repeated-replication procedure for several thousand estimates from the overall NMFS analysis plans. 

Samples of 100 NMFS aggregate estimates were selected 

from domains defined by the decedent’s race, age, and sex. 

Each sample was then used to caIcuIate the parameters 

for the formula: 

RSE(X) = @-

Eighteen pairs of A and B parameters for this forrrnda 

were adequate to approximate the relative standard error 

for aggregate NMFS estimates (table O). The standard 

error of an estimate can be obtained by multiplying the 

relative standard error of the estimate by the estimate 

itself. 

Standard error applications 

Standard errorfor aggregateestimates–The approximate standard error of an estimated number of decedents 

with a particular characteristic, x, is calculated by 

RSE(X) =~Aand SE(X) = x oRSE(X) 

where x = estimated number of decedents 

Afl,= parameters from table O 

RSE(X) = relative standard error of x 

SE(x) = standard error of x 

These forrmdas are not appropriate for estimates of 

the total number of decedents in a poststratification celI or 

19 
Table O. Parameters used to approximate the relative standard 

errors for estimates of decedents, by race and age: National 

Mortality Followback Survey, 1986 

Parameters 

Race and age A B 

All races 

Total . . . . . . . . . . . . . . . . -0.000088 173.472799 

25-34 years. . . . . . . . . . . . -0.000725 40.250787 

35-54 years . . . . . . . . . . . . -0.000308 57.187500 

55-69years . . . . . . . . . . . . -0.000325 189.139047 

70-64years . . . . . . . . . . . . -0.000219 200.749692 

85 years And over . . . . . . . . –0.000430 181.208646 

Black 

Total . . . . . . . . . . . . . . . . -0.000250 57.315899 

25–34years . . . . . . . . . . . . -0.002721 36.923295 

35-54years . . . . . . . . . . . . -0.001278 48.863512 

55-69years . . . . . . . . . . . . -0.000863 64.860422 

70-84years . . . . . . . . . . . . -0.000668 59.820841 

85years And over. ..,,... -0.001911 54.630073 

All other races 

Total . . . . . . . . . . . . . . . . -0.000106 184.663690 

25–34yeare, . . . . . . . . . . . -0.000948 39.640859 

35-54years. . . . . . . . . . . . -0.000419 62.024666 

55–89 years . . . . . . . . . . . . –0.00041 1 214.015461 

70-84years. .,, . . . . . . . . -0.000253 211.433987 

85 years And over . . . . . . . . -0.000484 190.261795 

NOTE: The sample consisted of 18,733 decedents; completed questionnaires 

were obtained for 16,598 persons. 

in a combination of such cells, because these estimates 

have negligible error. Since each poststratum total of the 

number of death certificates for decedents who were not 

black is dominated by the number of death certificates for 

white decedents, consider the number of death certificates 

for white decedents in one or more other-than-black 

postrata as being subject to negligible error. 

Example: Based on the NMFS, it is estimated that 

254,540 decedents 70–84 years of age had been admitted 

to a nursing home. 

The standard error of this estimate is calculated as 

follows: 

RSE (254,540) = ~--0.0002l9 + (200.749692/ 254,540) 

= 0.024 

and SE (254,540) = 254,540.0.024 = 6,109 

Standard errorfor ratio or proportions where the denominator k assumed to have negligible error—Where the denominator of a ratio is the estimated total number of 

deaths in a poststratification cell or in a combination of 

such cells, the relative standard error of the ratio is the 

relative standard error of the numerator. Thus, the approximate standard errors may be calculated using the 

formulas 

RSE(r) = RSE(X / y) = RSE (x) 

and SE(r) = r. RSE(X) 

where r = ratio or proportion 

x = numerator of the ratio 

y = denominator of the ratio with 

negligible error 

RSE(r) = relative standard error of r 

SE(r) = standard error of r 

RSE (x) = reIative standard error of x 

Example; An estimated 30.4 percent (254,540) of decedents 70-84 years of age (836,443) had ever been 

admitted to a nursing home. The number of decedents 

70–84 years of age is a combination of the poststratification cells specified in table N. Therefore, 

RSE(30.4) = RSE(254,540 / 836,443) 

= RSE(254,540)


= 0.024 (from the prior example)


SE(30.4) = 30.4 “0.024 = 0.7 

Standard errors for percentage estimates where both the 

numerator and the denominator are subject to sampling 

emor—The formulas used to approximate the standard 

error for a percentage estimate where both the numerator 

and the denominator are subject to sampling error are: 

RSE@) = RSE(1OO X /JJ) = U(B /p) “(100 -P) /y 

and SE(p) = p . RSE(p) 

where B= parameter from table O p. 100” x /y, the estimated percentage, 

x= estimated number of deaths in the numerator of the percentage 

estimated number of deaths in the denominator of the percentage 

RSE@)	 = relative standard error of p 

SE(p) = standard error ofp 

Example: An estimated 80.7 percent of all decedents 

who ever smoked (1,088,094) smoked for 10 years or more. 

RSE(80.7)	 = ~(173.472799 / 80.7) “(100-80.7)/ 1,088,094 

= 0.006 

and SE(80.7) = 80.7 “0.006 = 0.5 

This approximation of the absolute or relative standard error of a percentage is valid if either the relative 

standard error of the denominator is less than 5 percent 

(22), the relative standard errors of the numerator and the 

denominator are both less than 10 percent (23), or both. 

Standard errorfor ratios (r = x/y) where the numerator 

is not a subclass of the denominator– The standard error of 

a ratio may be approximated as 

RSE(r) = RSE(X / y) = vRsE2 (X) + RSE2( y ) 

and SE(r) = r oRSE (r) 

where	 x= numerator of the ratio y= denominator of the ratio 

RSE(r) = relative standard error of the ratio r 

SE(r) = standard error of the ratio r 

20 
RSE(X) = relative standard error of the 

numerator x 

RSE@) = relative standard error of the 

denominator y 

This approximation of the absolute or relative standard error of a ratio is valid if either the relative standard 

error of the denominator is less than 5 percent (22), the 

reIative standard errors of the numerator and the denominator are both less than 10 percent (23), or both. 

Testing differences in the National Mortality 

Followback Survey (NMFS) 

The standard error of a difference between two statistics is approximately the square root of the sum of the 

squares of the standard errors of the individual statistics. 

This formulation of the standard error of the difference of 

two statistics quite accurately approximates the standard 

error for the difference between uncorrelated statistics; 

however, it only roughly approximates the standard error 

in most other cases. 

Although the exact number of degrees of freedom in 

the NMFS sampling variances is not known, the number 

of degrees of freedom may be approximated by the 

number of pseudo strata used in the balanced-repeatedreplication procedure. Accordingly, hypotheses about 

differences between estimates are tested using 20 degrees 

of freedom for the 1- or 2-tailed t-test as appropriate. 

Example: 12.0 percent of the 878,281 decedents who 

smoked for 10 years or more died of Malignant neoplasms 

of respiratory and intrathoracic organs, and 1.2 percent of 

the 827,899 decedents who never smoked died of MaIignant neoplasms of respiratory and intrathoracic organs. 

To test whether this diilerence is significant at the 

0.05 level, compute 

t= 12.0- 1.2 

V(12.O “RSE(12.0) )2 + (1.2. RSE(l.2) )2 

= 10.8 

~(12.O . 0.038)2 + (1.2. 0.131)2 

= 22.4 

The 2-taiIed 0.05 critical value for a t-statistic with 20 

degrees of freedom is 2.086. Accordingly, the difference 

is significant at the 0.05 level. 

21 
Nonsampling error


Estimates based on the 1986 National Mortality Followback Survey (NMFS) are subject to nonsampling as 

well as sampling error. Sources of nonsampling error 

include incomplete coverage, ambiguity in the wording of 

questions, incomplete or inaccurate responses, and errors 

in data reduction and processing. Although the extent of 

such nonsampling errors was generally not measured, the 

survey procedures in the NMFS were designed to minimize the introduction of such error. 

Undercount of deaths is considered negligible; it is 

believed that more than 99 percent of the deaths occurring 

in the United States are registered. A number of studies of 

quality of medical certification on the death certificate 

have been done, In general, these have been for relatively 

small samples and for small geographic areas, for example, 

a city or a State. A bibliography, prepared by the National 

Center for Health Statistics (NCHS) (24), covering 128 

references over a period of 23 years, indicates that no 

definitive conclusions have been reached about the quality 

of medical certification on the death certificate. There is 

no well-defined program for systematic assessment of the 

quality of medical certifications reported on death certificates or for measuring the error effects on the levels and 

trends of cause of death statistics in the United States. 

One index of the quality of reporting causes of death 

is the proportion of death certificates coded as “Symptoms, signs, and ill-defined conditions” (ICD-9 Code 

780–799, Ninth Revision), Although there are cases for 

which it is not possible to determine the cause of death, 

this proportion indicates the care and consideration given 

to the certification by the medical certifier. It may also be 

used as a rough measure of the specificity of the medical 

diagnoses made by the certifier in various areas. In 1986, 

1.5 percent of all reported deaths in the United States 

were assigned to ill-defined or unknown causes. However, 

this percentage varied among the States, from 0.3 percent 

to 4.0 percent (25). 

The coding error rate in 1986 for the medical information on the death record was just above 4 percent for 

the 22 States processing this information and about 3 percent for the areas processed by NCHS. The estimated 

average error rate for all demographic items in 1986 was 

0.25 percent (25). 

As for the Current Mortality Sample (CMS), complete information concerning the cause of death is 

sometimes not available in the State offices when the 

sample is drawn but is available later when copies of the 

final death certificates are processed. AS a result, estimates based on sample counts for certain causes are 

biased estimates of final counts. A more complete discussion of these biases can be found in the publication listed 

in reference 26. 

Data errors may have been introduced in the survey if 

the respondent was unwilling or unable to respond, To 

avoid problems such as ambiguous or unclear wording of 

an instruction, question, or response category, NCHS staff 

thoroughly pretested the NMFS questionnaires. Questions 

with high “Don’t know” rates and high gross error rates 

(as measured by a pretest reinterview program conducted 

on 22 percent of the interviews) were not included in the 

main survey. (See “The formal pretest.”) Furthermore, 

interviewers and supervisors underwent thorough training 

and only experienced Census Bureau interviewers were 

used. 

Extensive efforts were made to find suitable respondents and to get interviews from them in an effort to 

minimize the nonresponse bias. As explained in “Collection of survey data, ” if a mail return was not received, 

telephone and personal attempts were made. If the interviewer could not reach the informant listed on the death 

certificate, attempts were made to secure another knowledgeable respondent. For decedents who had spent much 

or all of their last year living in a health care institution 

and for whom a knowledgeable relative was unattainable, 

a staff member at the institution was interviewed. 

A very stringent clerical edit of mail returns was used 

to minimize errors arising from the difficulty some respondents had in completing the self-administered questionnaire. (See description in “Data processing.”) This 

stringent edit resulted in a fail-edit rate of 10.2 percent. 

Of those questionnaires failing edit, 86.2 percent were 

followed up by telephone. The interviewer went through 

the entire questionnaire resolving missing information and 

inconsistencies. The main reason that 13.8 percent of the 

fail-edits were not followed up was that there was no 

telephone, and cost considerations prevented personal 

visits. 

The reinterview served the purpose of providing a 

measure of the simple response variance component of 

the survey error for those items included on the 

22 
reintemiew. It also ensured that an interview had actually 

taken place for those cases in which an interviewer had 

filled in the questionnaire. (See “Reinterview.”) 

The quality control during data processing as described in the section on “Data processing” was very 

stringent in order to minimize error in the data. Data 

keypunching for the informant questionnaire was 100-

percent verified. There was extensive clerical and computer editing of documents. 

The purpose of the weighting was to reduce further 

the error in the data, Selection weights were used to adjust 

for unequal probability of selection for the survey. Adjustment for nonresponse was made to correct for differential 

rates of response. Poststratification weights were applied 

to compensate for coverage gaps and to ensure the consistency between population counts and the NMFS estimates 

for primary domains of study, 

In summary, extensive efforts were made in every 

aspect of survey planning, design, data collection, and data 

processing to minimize potential nonsampling errors. 

23 
Reinterview 

A reinterview was conducted with the original respondent 2 or more weeks following the original completion of 

the questionnaire for a sample of the returns with a 

complete or partial complete status and, in the case of the 

mailed questionnaires, only for those that passed the key 

item edit check. The reinterview questionnaire (NMF–8) 

contained a subset of 32 response items from the original 

form. Five percent of all decedents were identified as 

possible candidates for inclusion in the reinterview. Cases 

were selected according to the last two digits of the 

control number. Cases for which a complete or partial 

original interview status was not obtained, those that 

failed the key item edit or that used the staff questionnaires (NMF–5), and those where informants had no 

telephone were excluded from the reinterview. 

The “No phone, “ “Informant deceased,” and “Informant incapable” cases were considered out of scope. The 

total response rate for the reintemiew was 77 percent. 

Administrative problems were primarily responsible for 

the lower reinterview response rate. There were 507 

reinte~iews with a status of partial or complete, resuIting 

in a partial or complete reinterview for 3.1 percent of the 

original 16,598 responses with a status of partial or complete. Of the 507 reinterviews, 480 (94,7 percent) had a 

complete reinterview status. Of these same 507 reinterviews, 405 (79.9 percent) were originally completed by 

mail, 44 (8.7 percent) had a personal original interview, 

and 152 (30.0 percent) had a telephone original interview, 

and for 6 cases (1.2 percent) the type of original interview 

was not ascertained. 

The reinterview process provides a measure of the 

reliability of the survey items. The simple response variance contribution to the total survey error may be calculated by comparing the original interview responses to the 

responses to the same questions asked in the reinterview 

(27). The simple response variance, also called the “gross 

error rate, “ is calculated by dividing the number of cases 

in which reinterview response differs from the original 

response by the total number of reinterview cases. Table P 

contains the gross error rates for the items contained on 

the reinterview. 

Items were selected to be on the reinterview for one 

of four reasons. A few items, such as marital status, were 

included because of their analytical value and likelihood 

of being reported with the highest level of accuracy. A few 

items were included in the reinterview because they were 

Table P. Gross error rates of items included In the reinterview: 

National Mortality Followback Survey, 1986 

Gross error 

Item and source code in questionnaire rate 

Ever had a stroke . . . . . . . . . . . . . ..073 10.0 

Ageatfirst strokel . . . . . . . . . . . . . ..074 23.5 

Cancer was main condition leading to 

death . . . . . . . . . . . . . . . . . . . . . .081 5.4 

Time before death that cancer was first 

diagnosed., . . . . . . . . . . . . . . . ..082 20.3 

Ever near death but lived on .091 20,3 

When near death but lived on .092 27,4 

Activities in hour before death. .095 

Con fined to bed or chair .,,.... . . . . . 33.0 

Working . . . . . . . . . . . . . . . . . . 8.5 

Quiet recreation . . . . . . . . . . . . . . . 13,1 

Active recreation . . . . . . . . . . . . . . 8,5 

Sleeping . . . . . . . . . . . . . . . . . . . 22,7 

Comatose . . . . . . . . . . . . . . . . . . 19.1 

Eating . . . . . . . . . . . . . . . . . . . . . 7.4 

New or sharply increased problem 

in hour before death . . . , .096 42.1 

At least 12 drinks of alcohol in 

adult life . . . . . . . . . . . . . . . . . ...129 14.7


Frequency of drinking . .130 41.5


Drinks per day . . . . . . . . . . . . . . . ..131 50.5


Frequency of vigorous exercise .132 27.8


Ever worked at a paying job


or business, . . . . . . . . . . . . . . ...133 5.0


Longest occupation3 . . . . . . . . . . . . 31.9


Longest industry3 . . . . . . . . . . . . 26.7


Marital status, . . . . . . . . . . . . . . ...161 5.4


Number of different spouses .164 6.7


Spouse (any) ever smoked . . . .166 78.6


Number of cigarettes a day, spouse .167 54.7


Year of father’s birth .168 27.2


Father’sage at death ~ .169 35.8


Father ever had heart attack .172 21,1


Father’s age at heart attack. .173 23.8


Number of brothers .176 22,6


Number of brothers who had


heart attacks . . . . . . . . . . . . . . . ..177 20,3


Ages of brothers at heart attacks4 .178–183 29.2


1Responses were considered in agreement if ages differed by 5 years or fewer.


2Responses were considered in agreement if times differed by one year or less.


3Based on the recodes: refer to appendixes B, E, and F of Public-Use Data Tape


Documentation (1990 National Ambulatory Medical Care Survey. Hyattsville,


Maryland: National Center for Health Statistics, 1992).


4Responses were considered in agreement if ages or years differed by 10 years


or fewer.


included in the survey after the pretest and were not 

tested, Some other items were included in the reinterview 

because either they underwent substantial change after 

the pretest or they presented problems in the pretest (for 

example, high “Don’t know” rates). Finally, some items 

were included in the reintemiew simply because they were 

necessary screener items (for example, it was necessary to 

24 
include the question on the number of different spouses in 

order to include the questions on the number of spouses 

who smoked and how much). 

In general, rates below 10.0 percent may be considered low. Items with rates between 10.0 and 20.0 percent 

should be analyzed with caution, and items with rates 

above 20.0 percent should be analyzed with extreme caution. High rates may be an indication that improvements 

are needed in the methods used to collect these data, the 

concept itself may not be measurable, or respondents are 

not able to provide accurate information to the detail 

desired. 

Items with low gross error rates included whether 

cancer was the main condition leading to death (5.4 percent), whether the decedent had ever worked at a job or 

business (5.0 percent), marital status (5.4 percent), and 

the number of different spouses (6.7 percent). The item 

used to determine whether the decedent had ever drunk 

alcoholic beverages had a somewhat higher error rate 

(14.7 percent). Among the items with high error rates 

were frequency of drinking alcoholic beverages (41.5 percent), number of drinks per day (50.5 percent), whether 

the decedent was sleeping at the time of death (22.7 percent), and whether the decedent’s father ever had a heart 

attack (21.1 percent). 

The type of response categories may affect the rate: 

items with more response categories usually will have 

higher response error rates, in part because there is more 

room for error. It maybe useful to compute the error rates 

with response categories grouped into a smaller number of 

responses and to use grouped responses in data analysis so 

that the effect of errors is Iessened. 

Several examples illustrate this point. The error rate 

for the item querying the time before death when the 

decedent was near death but lived on (source code 092) 

was 27.4 percent when four categories were used, but the 

error rate was 10.5 percent when the response categories 

were grouped into two categories: less than 1 year and 1 

year or more. The error rate for the item on frequency of 

drinking alcoholic beverages (source code 130), “was 

41.5 percent when five categories were used, but when the 

categories were grouped into at least once a week and less 

than once a week, the error rate was 18.8 percent. The 

error rate for number of alcoholic drinks consumed was 

50.5 percent for six detailed categories, but was 22.7 percent for the two grouped categories of “less than 5“ and 

“5 or more.” For the item on number of cigarettes the 

spouse smoked (source code 166), when the response 

categories are grouped into fewer than 25 and 25 or more, 

the error rate remained quite high at 34.3 percent. For the 

item on the time before death that cancer was first 

diagnosed, the error rate was 11.9 percent, when the 

responses were considered as not different if the time 

difference was 3 years or less. 

25 
Response 

characteristics 

The responses received in the pretest were classified 

into the following categories: 

�	 Complete interview-A questionnaire returned by mail 

or completed by telephone or personal interview, with 

essentially all of the items containing a response 

�	 Fail-edit –A questionnaire returned by mail containing substantial responses but failing to pass the rigorous edit check (See “Data processing.”) 

e	 Partial interview –A questionnaire completed in the 

field with substantial but incomplete responses 

�	 Refised-A response by maiI or field contact which 

specifically refused to provide information on the 

suwey (See “Collection of survey data.”) 

�	 Cannot contact, outside prima~ sampling unit – A referral to the field, with the informant residing more 

than 50 miles from the interviewer’s location 

�	 Cannot contact, other reason – A referral to the field in 

which contact could not be made with the informant, 

for example, failure to reach by telephone, or not at 

home after repeated attempts for personal 

interview, etc. 

� Cannot loca[e– A referral to the field with the informant not located 

� Other noninterview – A referral to the field with no 

interview possible for other reasons 

�	 NO infomzant identjjied-Inability to mail the questionnaire- because no ‘informant co-uld be identified, for 

example, if the informant was reported to have died, 

moved without a forwarding address, etc., and no 

other informant could be identified 

The number and percent of responses received in the 

survey for each catego~ of response are shown in table 1. 

In the following discussions the terms “response” or 

“completed” include complete interviews, fail-edit mail 

returns, and partial field interviews, 

The death certificates included in the survey sample 

contain demographic and other characteristics of the decedents. Using these data as the universe of the sample, 

and hence as the denominator, it is possible to calculate 

response rates according to these characteristics of the 

decedent. It is important to observe, however, that no 

demographic information on the informants (respondents) 

was sought, so all response characteristics discussed here 

refer to those of the decedent. 

Response from informants 

The total survey response rate was 88.6 percent. This 

is the standard measure of response, namely the number 

of completed replies divided by the number of eligible 

reporting units in the sample. In view of the broad scope 

and volume of the information sought, the 1986 survey 

compares favorably with the prior National Center for 

Health Statistics (NCHS) mortality followback surveys, 

which produced response rates ranging from 91 to 

93 percent. 

Younger decedents and black decedents, two population groups oversampled in the 1986 survey, yielded lower 

response rates than other groups of decedents surveyed. 

The weighted completion rate, which is an estimate of the 

result if aIl deaths in the United States had been surveyed 

without oversampling, was 88.5 percent. 

Another useful measure of survey response, designed 

to reveal the level of cooperation from the population 

surveyed, merits examination. This measure deletes from 

the denominator those cases in which no informant was 

reached and therefore no reply could be expected. In the 

mail phase of the survey, no response was possible for 58 

decedents for the following reasons: 

� No informant could be identijed –50 cases 

. It was learned that the informant was deceased, and no 

new informant could be identified —8 cases 

Thus, with 16,598 questionnaires completed, out of potential replies from 18,675 informants reached, a completion 

rate of 88.9 percent is observed. 

Age of decedent 

The percent of completion of the questionnaires increased directly as the age of the decedent increased. The 

response rate for decedents 85 years of age and over was 

92.4 percent, compared with a rate of 85.1 percent for 

those 25–44 years of age. For each age group in between, 

the response was better as the age increased (table 2). 

Sex of decedent 

The response rate for female decedents was higher 

than that for males, with a completion level of 89.7 percent and 87.7 percent, respectively. Refusals were higher 

26 
for male decedents, 8.1 percent, compared with 6.7 percent for femaIes (table 2). 

Race of decedent 

The highest response rate among the racial groups 

was found in the American Indian, AIeut, and Eskimo 

population, with 90.7 percent completing the questionnaires. Black decedents were reported on at a rate of 

88.7 percent and white decedents at 88.5 percent. The rate 

for other races was 87.0 percent (table 2). 

Cause of death 

External causes of death, including Accident, Suicide 

and Homicide, accounted for 11.0 percent of the sample 

studied. Informants for these decedents responded substantively for 83.8 percent of these inquiries, a lower rate 

than the 89.2 percent response for natural causes of death, 

and lower than for any other major cause (table 3). Refusals for external causes were 9.3 percent, compared with 

7.1 percent for natural causes. Two characteristics of the 

external causes of death may account for the Iower response rate. These causes include Suicides and Homicides, and relatives may have been reluctant to discuss the 

death. Furthermore, deaths from extemal causes are usually sudden, unexpected, and early in life —characteristics 

that may have increased family reluctance to respond to 

an inquiry about the death. 

When the response rates for 11’major natural causes 

of death are examined, the rates vary within a generally 

narrow range. Of the 11 causes, only 3 faI1 more than 

‘2 percentage points above or below the survey average of 

88.6 percent response. 

Geographic area 

The most significant variation in response by State 

occurred for Pennsylvania, where personal visits were 

restricted to informants who provided written consent for 

such a visit. (See discussion under “Survey procedures.”) 

Pennsylvania is a populous State, with 5.9 percent of all 

deaths in the United States in 1986. Completed responses 

for decedents who were residents of Pennsylvania were 

returned for only 55.3 percent of the Pennsylvania sample, 

compared with 88.6 percent for the total survey. The 

refusal rate for Pennsylvania was 33.4 percent, compared 

with a rate of 7.5 percent for the total survey. 

If the deaths in Pennsylvania had been excluded 

because of the restricted survey procedure, the response 

rate for the general survey would be 90.5 percent. 

Because of the low Pennsylvania response, the completion rate for the Northeast region was 77.5 percent. 

The rate for the other three regions of the country were 

90.3, 91.3, and 92.6 percent. 

Response by veteran status 

The death certificate reported that the decedent was a 

veteran of the United States Armed Forces for 16.8 percent 

of the decedents in the survey sample. Nonveteran status 

was reported on 57.8 percent of the certificates. The 

veteran status was unspecitled on 25.5 percent of the 

certificates. The response rate for veterans was 88.4 percent, essentially the same as for nonveterans 

(88.9 percent). 

Response by marital status 

Married decedents constituted 47.2 percent of the 

sample; substantive responses were received for 88.8 percent of them (tabIe 4). Widowed decedents represented 

29.0 percent of the sample and had a response rate of 

90.8 percent. Never-married status was reported for 

12.8 percent of the decedents; completed questionnaires 

were received for 85.1 percent of these decedents. Divorced persons composed 10.2 percent of the survey sample, and had a response rate of 87.4 percent. The marital 

status was unspecified in 0.6 percent of the death certificates; responses were received for 64.5 percent of these 

decedents. 

Response by relationship of informant to 

decedent 

The relationship specified was that of the informant to 

the deceden~ for example, “son or daughter” means that 

the informant was the son or daughter of the decedent. 

Two sources of the relationship of the informant to the 

decedent were examined: the relationship reported on the 

death certificate and that reported on the questionnaire. 

The outstanding feature of the death certillcate relationship was the large number of unspecified relationships, 

35.1 percent (table 5). A spouse was reported as the 

informant on the greatest number of death certificates, 

37.6 percent of the sample records. The informant was the 

parent of the decedent on 7.5 percent of the certificates, 

the son or daughter on 10.8 percent, a sibling on 3.8 percent, another relative ,on 2.8 percent, and a nonrelative on 

2.4 percent. 

The only means of examining the response rates by 

relationship of the informant to the decedent is to use the 

death certificate report of that relationship as the denominator. This measure has limitations because the relationship as reported by the informant on the questionnaire 

may differ from the death certificate record. However, 

using this measure yields response rates of 88.5 percent 

for records mailed to a spouse, 86.6 percent for a parent, 

90.6 percent for a son or daughter, 88.1 percent for a 

sibling, 93.3 percent for other relatives, 86.8 percent for 

nonrelative, and 88.4 percent for unspecified relationship (table 4). 

Results of a comparison of the relationship of the 

informant to the decedent, as recorded on the death 

certificate, with the relationship as reported by the informant on the questionnaire are shown in table 5. Differences in the two sources do not necessarily mean that 

there are true discrepancies, since the person competing 

the questionnaire may be a different person from the one 

27 
addressed in the initial mailing or an informant identified 

by the funeral director or hospital after the survey began. 

The following differences were observed: 

For a spouse, 37,6 percent on the death certificate and


35.3 percent on the questionnaire


For sons or daughters, 10.8 percent on the certificate


and 27.4 percent on the questionnaire


For parents, 7.5 percent on the death certificates and


9.5 percent on the questionnaire


For siblings, 3.8 percent on the certificates and


9.8 percent on the questionnaire


For other relatives, 2.8 percent on the death certifi­


cate and 11.3 percent on the questionnaire


For nonrelatives, 2.4 percent on the certificate and


4,5 percent on the questionnaire


For the unspecified category, 35.1 percent on the


certificate and 0.8 percent on the questionnaire. This


means that an informant was identified later, usually


by contacting the funeral director or hospital.


The 245 interviews completed by a staff person in a 

nursing home could have no such entry on the death 

certificate. 

Response by autopsy status 

The performance of an autopsy was reported on 

18,1 percent of the death certificates in the sample, with 

70.7 percent stating that no autopsy was performed and 

11.2 percent with unspecified status. The response rate for 

decedents on whom an autopsy was performed was 

84,6 percent, compared with 89.4 percent when no autopsy 

was recorded. Those with unspecified status had a response rate of 90.0 percent. 

Autopsies are generally performed by medical examiners in cases of external causes of death, and, as noted 

above, these deaths showed a lower response rate. 

Response by survey method 

Of the 16,598 completed records in the survey, 9,458 

(57.0 percent) were returned by mail. Telephone interviews yielded 30.2 percent of all completed responses, and 

personal interviews accounted for 12.4 percent of the 

completions. The method of completion of the questionnaire was not ascertainable for 74 decedents. 

Authorization statements from informants 

Of the 16,598 completed questionnaires, an Authorization to Obtain Information from Medical Records was 

signed by informants or approved by proxy respondents on 

14,152 records (85.3 percent). 

Response from facilities 

A total of 17,668 Facility Abstract Record (FAR) 

forms was prepared for mailing. Information to enter on 

these forms was obtained from three sources: the 

informant questionnaire, the death certificate, and another facility used by the decedent in the last year of life. 

Of these forms, 1,238 were not mailed for administrative 

reasons, largely because Pennsylvania prohibited mailings 

to facilities in that State when no authorization was 

received from the informant. Thus, 16,430 FAR’s were 

mailed in an attempt to secure facility data. 

In four cases, no adequate address for the informant 

could be found when the initial mailing was returned by 

the post office. Eliminating these 4 cases leaves 16,426 

FAR’s for which a reply could be expected. 

Through clerical error, the Census Bureau, which 

conducted the data gathering, failed to record on the 

control form a final response status for 2,272 cases. A 

record was made that no response was received for 1,048 

FAR’s, Thus the control record shows that a response was 

received for 13,106 FAR’s. Given the unknown response 

status for 2,272 records and assuming the worst case – that 

none of these replied – the response rate would be 

79,8 percent. 

Of the 13,106 FAR’s replies received, the Census 

Bureau reported that 11,814 respondent facilities sent 

completed forms; 1,290 responded that there was no 

record of the decedent in that facility; and 2 sent unacceptable facsimile records, 

The edited public-use data tape contains 30,165 episodes of care for the survey decedents. As seen in table Q, 

among the decedents with at least 1 FAR, 8,437 decedents 

(68.7 percent) had one completed FAR on the tape, 3,066 

(25.0 percent) had 2; and 772 (6.3 percent) had 3 or more. 

\.Table R shows that, among those decedents with at 

least 1 completed FAR, 5,046 (41.1 percent) had 1 episode of facility care in the last year of life; 2,779 (22.6 percent) had 2; 1,790 (14.6 percent) had 3; 1,080 (8.8 percent) 

had 4; 730 (5.9 percent) had 5; and 850 (6.9 percent) had 6 

or more. 

The public-use data tape also includes information on 

the length of stay, the diagnoses, and the procedures used. 

Because the public-use data tape does not have 

weights to adjust for nonresponse from facilities, caution 

must be exercised in analyzing and interpreting these data. 

A summary of the significant findings of the 1986 

National Mortality Followback Survey (NMFS) was published by NCHS as Vital and Health Statistics, Series 

20, Number 19 (28). 

Table Q. Number and percent distribution of decedents with 

Facility Abstract Record by number of facilities used in last year 

of life: National Mortality Followback Survey, 1986 

Percent 

Number of Number of distribution 

facilities used decedents of decedents 

Total . . . . . . . . . . . . . . . . . . . 12,275 100.0 

1 .,, . . . . . . . . . . . . . . . . . . 8,437 68.7 

2 ..,..,.,........,.,.. 3,066 25,0 

3, . . . . . . . . . . . . . . . . . . . . 659 5.4 

4, . . . . . . . . . . . . . . . . . . . . 90 0.7 

5 . . . . . . . . . . . . . . . . . . . . . 2a 0.2 

6 . . . . . . . . . . . . . . . . . . . . . 3 0.0 

28 
1

2

3

4

5

6

7

8

9

Table R. Number and percent distribution of decedents with 

Facility Abstract Record by number of episodes of care in last 

~year of life: National Mortality Followback Survey, 1986 

Percent 

Number of Number of distribution 

epkodes decedents of decedents 

Total . . . . . . . . . . . . . . . . . . . 12,275 100.0 

. . . . . . . . ..!... . . . . . . . 5,046 41.1 

. . . . . . . . . . . . . . . . . . . . . 2,779 22.6 

. . . . . . . . . . . . . . . . . . . . . 1,790 14.6 

. . . . . . . . . . . . . . . . . . . . . 1,060 8.8 

. . . . . . . . . . . . . . . . . . . . . 730 5.9 

. . . . . . . . . . . . . . . . . . . . . 360 2.9 

. . . . . . . . . . . . . . . . . . . . . 237 1.9 

. . . . . . . . . . . . . . . . . . . . . 109 0.9 

61 0.5 

lo:::::::::::::::::::: 32 0.3 

11 . . . . . . . . . . . . . . . . . . . . 15 0.1 

12 . . . . . . . . . . . . . . . . . . . . 13 0.1 

13 . . . . . . . . . . . . . . . . . . . . 7 0.1 

14 . . . . . . . . . . . . . . . . . . . . 7 0.1 

75 . . . . . . . . . . . . . . . . . . . . 3 0.0 

16 . . . . . . . . . . . . . . . . . . . . 2 0.0 

17 . . . . . . . . . . . . . . . . . . . . 2 0.0 

18 . . . . . . . . . . . . . . . . . . . . — 

19 . . . . . . . . . . . . . . . . . . . . 

20 . . . . . . . . . . . . . . . . . . . . 2 0.0 

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

29 
References 

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final mortality statistics, 1986. Monthly vital statistics report; 

vol 37 no 6, suppl. Hyattsville, Maryland: Public Health 

Service. 1988. 

2, Sirken MG, Pifer JW, Brown M. Survey procedures for 

supplementing mortality statistics. Am J Public Health: vol 

50.1960. 

3.€Sutton GF. Hospitalization in the last year of life, United 

States, 1961. National Center for Health Statistics. Vital 

Health Stat 22(l). 1965. 

4.€Wunderlich GS, Sutton GF. Episodes and duration of 

hospitalization in the last year of life: United States, 1961. 

National Center for Health Statistics. Vital Health Stat 

22(2). 1966. 

S. Mathis ES. Socioeconomic characteristics of deceased persons: United States, 1962–1963. National Center for Health 

Statistics. Vital Health Stat 22(9). 1969. 

6.€Timmer EJ. Health insurance coverage of adults who died 

in 1964 or 1965: United States. National Center for Health 

Statistics. Vital Health Stat 22(10). 1969. 

7.€Timmer EJ, Kovar MG. Expenses for hospital and institutional care during the last year of life for adults who died in 

1964 or 1965. National Center for Health Statistics. Vital 

Health Stat 22(11), 1969. 

8.€Enstrom JE, Godley FH. Cancer mortality among a representative sample of nonsmokers in the United States during 

1966-68. JNCI 65:1175-83.1980. 

9.€Godley FH. Cigarette smoking and differential mortality: 

new estimates from representative national samples. [Paper] 

Seattle, Washington: Population Association of America 

meeting, April 17-19, 1975. 

10.€U.S. Department of Health, Education, and Welfare. 

Healthy people: the Surgeon General’s report on health 

promotion and disease prevention. Washington: Department of Health, Education, and Welfare. 1979. 

11.€U. S~Department of Health and Human Services. Promoting 

health/preventing disease: objectives for the nation. Washington: U.S. Government Printing Office. 1980. 

12.€Poe GS, Seeman I, McLaughlin J, et al. “Don’t know” boxes 

in factual questions in a mail questionnaire: eflects on level 

and quality of response. Public Opin Q 52(2):212-22. 1988. 

13. poe GS, Seeman I, McLaughlin J, et al. Certified versus 

first-class mail in a rriixed-mode survey of next-of-kin respondents. J Otlicial Stat. 6(2): 157–64. 1990. 

14.€National Center for Health Statistics. Instruction manual 

part 5: data preparation of the Current Mortality Sample, 

1986. Hyattsville, Maryland: U.S. Department of Health and 

Human Services. 1985. 

15.€National Center for Health Statistics. Instruction manual part 19: 

industry and occupation coding for death certificates, 1984. 

Hyattsville, Matyland: Public Health Service. 1984. 

16.€World Health Organization. Manual of the International 

Statistical Classification of Diseases, Injuries, and Causes of 

Death, based on the recommendations of the Ninth Revision Conference, 1975. Geneva: World Health Organization, 1977. 

17.€National Center for Health Statistics. 1986 Vital statistics. 

Demographic classification and coding instructions for *’ 

death records. NCHS instruction manual part 4. Hyattsville, 

Maryland: Public Health Service. 1985. 

18.€National Center for Health Statistics. Instructions for classifying multiple causes of death, 1986. NCHS instruction 

manual part 2b. Hyattsville, Maryland: Public Health Service. 1985. 

19, National Center for Health Statistics. Non-indexed terms, 

standard abbreviations, and state geographic codes used in 

mortality data classification, 1986. NCHS instruction manual 

part 2e. Hyattsville, Maryland: Public Health Service. 1985. 

20.€McCarthy PJ. Replication: an approach to the analysis of 

data from complex surveys. National Center for Health 

Statistics. Vital Health Stat 2(14). 1966. 

21.€McCarthy PJ. Pseudoreplication: further evaluation and 

application of the balanced half-sample technique. National 

Center for Health Statistics. Vital Health Stat 2(31). 1969. 

22.€Hansen MH, Hurwitz WN, Madow WG. Sample survey 

methods and theory VOI1. New York: John Wiley and Sons. 

1953. 

23.€Cochran WG. Sampling techniques. New York: John Wiley 

and Sons. 1953. 

24.€Gittleson A, Royston PN. Annotated bibliography of causeof-death validation studies, 1958–80. National Center for 

Health Statistics. Vital Health Stat 2(89). 1982. 

25. National Center for Health Statistics. Vital Statistics of the 

United€States, 1986, VOIII, mortality. Hyattsville, Maryland: 

Public Health Service. 1986. 

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births,€marriages, divorces, and deaths: United States, 1986, 

provisional data. Monthly vital statistics report; VOI25 no 13. 

Hyattsville, Maryland: Public Health Service. 1987. 

27. Koons DA. Quality control and measurement of nonsampling error in the Health Interview Survey. National Center 

for Health Statistics. Vital Health Stat 2(54). 1973. 

28.€Seeman 1, The National Mortality Followback Survey, 1986 

summary, United States. National Center for Health Statistics: Vital Health Stat 20(19). 1992. 

30 
List of detailed tables 

1. Number and percent distribution of informant re­

;	 sponses by response status: National Mortality Followback Survey, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

2.	 Number and percent distribution of informant responses by response status, according to sex, race, and 

age of decedent: National Mortality Followback Survey, 

1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

3.	 Number and percent distribution of informant responses by response status, according to cause of death 

of the decedent: National Mortali~ Followback Survey, 

1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

4.	 Number and percent distribution of informant responses by response status, according to decedent’s 

32 marital status and relationship of informant to decedent: National Mortality Followback Survey, 1986.... 34 

5. Number and percent distribution of informants as reported on the death certificate and on the informant 

32	 questionnaire, by relationship of the informant to decedenti National Mortality Followback Survey, 1986.... 35 

34 

31 
Table 1. Number and percent distribution of informant responses by response status: National Mortality Followback Survey, 1986 

Percent 

Response statusl Number distribution 

All responses, . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,733 100,0 

Completed responses .,, ,. . . . . . . . . . . . . . . . 

Complete. , . . . . . . . . . . . . . . . . . . . . . ,,.. 

Fail-edit (mail).,....,,,,,., . . . ,. 

Partiallycompleted (field),,,,,, . . . ,. 

Refused ...,,,.,..,.,,, . . . . ,,..,,.


Cannotcontact–beyond 50miles.


Cannotcontact–other reason,, . . .,.,,


Cannot locate (field)..,,.,,,,.. .,, .,,..,.,,.....,,,,,..


Othernoninterview, .,,,,,, . . . . ...,,,


No informant (mail) .,, ,....,, . . . . ,,,


lFor the definitions of these terms, see “Responsec haracteristics,”


NOTE: Percents may not add to totals due to rounding,


16,598 88,6 

15,539 82,9 

747 4.0 

312 1,7 

1,400 7.5 

59 0,3 

258 1,4 

301 1.6 

67 0.4 

50 0.3 

Table 2. Number and percent distribution of informant responses by response status, according to sex, race, and age of decedent: 

National Mortality Followback Survey, 1986 

Response status 

No No No No 

Sex, race, andage of decedent Total Comp/eted Refused response informant Tofa/ Cornp/eted Refused response Informant 

Both sexes Number Percent distribution 

Allraces, 25 years and over, 18,733 16,598 1,400 685 50 100.0 88.6 7.5 3.7 0.3 

25-44years .,, ,. . . . . . . . ,,, . . . . . . 4,299 3,658 366 253 22 100.0 85.1 8.5 5.9 0.5 

45–64years .,,...,..,.. . . . . . . 4,280 3,753 325 194 8 100.0 87.7 7.6 4.5 0.2 

65–74years .,, ,, .,..,... 3,496 3,104 276 105 11 100.0 86.8 7,9 3.0 0.3 

75–84years .,,,,....,.. . . . . . . . 3,895 3,530 285 76 4 100.0 90.6 7.3 2.0 0.1 

85 years Andover, . . . . . . . ,,, . . . . 

White, 25yearsandover. . . . . . . . . 

25-44years, ,,, ,. ...,,. . . .


45–64years . .,, ,, .,.,... . . .


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


75-84years, ,,, ,. ...,..


85years andover, ,, . . . . . .


Black, 25years Andover. .,.,,


25–44years, ,,, ,,, .,....


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


65–74years . ., . . . . . . . . . . .


75–84years .,, ,,, . . . . . . . .


85years andover . . . . . . . . . .


American lndian, 25yearsandover


25–44years .,, ,,, . . . . . . . . .


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


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


75-84years ., . . . . . . . . . . . . . . . . . .


85years Andover ..,,.... . . . . . . .


Otherraces, 25yearaand over.


25–44years, ., .,, ,,,..,.


45–64 years,,,,,...,,,,, . . .


65–74 years, , .,.,,,... . . . . .


75-84 years .,, , .,,,...., .


85 years andover . . . . . . . . . . .,, ,,, ,...,,


2,763 2,553 148 57 5 100.0 92.4 5.4 2.1 0.2 

13,303 11,771 1,102 397 33 100.0 88.5 8.3 3.0 0.2 

3,169 2,708 293 172 16 100.0 84.9 9.2 5.4 0,5 

2,803 2,461 241 96 5 100.0 87.8 6.6 3.4 0.2 

2,363 2,093 207 57 6 100.0 88.6 6.6 2.4 0,3 

2,818 2,546 233 36 3 100,0 90.3 8.3 1,3 0.1 

2,130 1,963 128 36 3 100.0 92.2 6.0 1.7 0.1 

4,759 4,223 273 250 13 100.0 68.7 5.7 5.3 0.3 

943 804 66 68 5 100.0 85.3 7.0 7.2 0.5 

1,292 1,128 76 86 2 100.0 87.3 5.9 6.7 0.2 

1,031 918 65 44 4 100,0 89,0 6,3 4.3 0,4 

946 866 47 33 100,0 91,5 5.0 3.5 

547 507 19 19 2 100,0 92.7 3.5 3.5 0.4 

540 490 18 29 3 100,0 90.7 3.3 5.4 0,6 

118 104 4 9 1 100.0 88.1 3.4 7.6 0.8 

157 140 6 11 — 100.0 89.2 3.8 7.0 

85 76 3 3 1 100.0 91.8 3.5 3.5 1.2 

112 102 4 5 1 100.0 91.1 3.6 4,5 0.9 

68 66 1 1 100.0 97.1 1.5 1.5 

131 114 7 9 1 100.0 87.0 5.3 6.9 0.6 

49 42 3 4 100.0 85.7 6.1 8.2 

28 24 2 1 1 100.0 85.7 7,1 3.6 3.6 

17 15 1 1 100.0 88.2 5.9 5.9 

19 16 1 2 100.0 84.2 5.3 10.5 

18 17 1 100.0 94.4 5.6 

32 
Table 2. Number and percent distribution of informant responses by response status, according to sex, race, and age of decedent: 

National Mortality Followback Survey, 1986-Con. 

Response status 

No No No No 

Sax, race, and age of decedent Total Completed Refused response hformant Total Completed Rerised response informant 

Male Number Percent distribution 

fwraces,zbyearsan aover.. , . . . . . . . . . . . . 1U,zw 8,976 831 390 39 100.0 87.7 8.1 3.8 0.4 

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . 3,033 2,565 266 183 19 100.0 84.6’ 8.8 6.0 0.6 

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . 2,393 2,099 201 85 8 100.0 87.7 8.4 3.6 0.3 

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . 1,961 1,731 156 65 9 100.0 88.3 8.0 3.3 0.5 

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . 1,901 1,713 147 40 1 100.0 90.1 7.7 2.1 0.1 

65years andover . . . . . . . . . . . . . . . . . . . . . . 950 870 61 17 2 100.0 91.6 6.4 1.8 0.2 

White, 25 years And over . . . . . . . . . . . . . . . . . . 7,339 6,412 673 229 25 100.0 67.4 9.2 3.1 0.3 

25-44 years..............,.. . . . . . . . . . 2,286 1,932 216 124 14 100.0 84.5 9.4 5.4 0.8 

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . 1,570 1,374 150 41 5 100.0 87.5 9.6 2.6 0.3 

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . 1,369 1,200 130 34 5 100.0 87.7 9.5 2.5 0.4 

75-84yeara . . . . . . . . . . . . . . . . . . . . . . . . . . 1,390 1,243 126 21 100.0 89.4 9.1 1.5 

85years Andover . . . . . . . . . . . . . . . . . . . . . . 724 683 51 9 1 100.0 91.6 7.0 1.2 0.1 

Black, 25yearsandover . . . . . . . . . . . . . . . . . . 2,533 2,236 143 143 11 100:0 88.3 5.6 5.6 0.4 

25-44years . . . . . . . . . . . . . . . . . . . . . . . . . . 633 530 47 51 5 100.0 83.7 7.4 8.1 0.8 

45-84years . . . . . . . . . . . . . . . . . . . . . . . . . 718 630 46 40 2 100.0 87.7 6.4 5.6 0.3 

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . 538 482 23 30 3 100.0 69.6 4.3 5.6 0.6 

75-84years . . . . . . . . . . . . . . . . . . . . . . . . . . 454 420 16 16 100.0 92.5 4.0 3.5 

85yearsand over . . . . . . . . . . . . . . . . . . . . . . 190 174 9 6 1 100.0 91.6 4.7 3.2 0.5 

American lndian, 25 years and over. . . . . . . 289 261 11 15 2 100.0 90.3 3.8 5.2 0.7 

25-44years . . . . . . . . . . . . . . . . . . . . . . . . . . 81 74 1 6 100.0 91.4 1.2 7.4 — 

45-64years . . . . . . . . . . . . . . . . . . . . . . . . . . 93 84 5 4 100.0 90.3 5.4 4.3 

85-74yeara . . . . . . . . . . . . . . . . . . . . . . . . . . 44 40 2 1 1 100.0 90.9 4.5 2.3 2.3 

75-84years . . . . . . . . . . . . . . . . . . . . . . . . . . 46 40 2 3 1 100.0 87.0 4.3 6.5 2.2 

85yearsandover . . . . . . . . . . . . . . . . . . . . . . 25 23 1 1 100.0 92.0 4.0 4.0 — 

Otherraces, 25yearsandover. . . . . . . . . . . . . . 77 89 4 3 1 100.0 89.6 5.2 3.9 1.3 

25-44years . . . . . . . . . . . . . . . . . . . . . . . . . . 33 29 2 2 100.0 87.9 6.1 6.1 

45-84years . . . . . . . . . . . . . . . . . . . . . . . . . . 12 11 — — 1 100.0 91.7 — 8.3 

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . 10 9 1 — 100.0 90.0 10.0 — 

75-84years . . . . . . . . . . . . . . . . . . . . . . . . . . 11 10 1 — 100.0 90.9 9.1 — — 

85yearsand ovar . . . . . . . . . . . . . . . . . . . . . . 11 10 1 — 100.0 90.9 9.1 

Female 

All races,25yearsand over,... . . . . . . . . . . . . 8,495 7,620 569 295 11 100.0 69.7 6.7 3.5 0.1 

25-44years . . . . . . . . . . . . . . . . . . . . . . . . . . 1,266 1,093 100 70 3 100.0 86.3 7.9 5.5 0.2 

45-84years . . . . . . . . . . . . . . . . . . . . . . . . . . 1,887 1,654 124 109 100.0 87.7 6.6 5.8 

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . 1,535 1,373 120 40 2 100.0 89.4 7.8 2.6 0.1 

75-84years . . . . . . . . . . . . . . . . . . . . . . . . . . 1,994 1,817 138 36 100.0 91.1 6.9 1.8 0.2 

85yearsand over . . . . . . . . . . . . . . . . . . . . . . 1,813 1,683 87 40 : 100.0 92.8 4.8 2.2 0.2 

White,25yearsand over..... . . . . . . . . . . . . . 5,964 5,359 429 168 8 100.0 89.9 7.2 2.8 0.1 

25-44years . . . . . . . . . . . . . . . . . . . . . . . . . . 903 776 77 48 2 100.0 85.9 8.5 5.3 0.2 

45–64years . . . . . . . . . . . . . . . . . . . . . . . . . . 1,233 1,087 91 55 100.0 88.2 7.4 4.5 — 

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . 994 893 77 23 Y 100.0 89.8 7.7 2.3 0.1 

75-84years . . . . . . . . . . . . . . . . . . . . . . . . . . 1,428 1,303 107 15 3 100.0 91.2 7.5 1.1 0.2 

85yearsand over . . . . . . . . . . . . . . . . . . . . . . 1,406 1,300 77 27 2 100.0 92.5 5.5 1.9 0.1 

Black,25yearsand over . . . . . . . . . . . . . . . . . . 2,226 1,987 130 107 2 100.0 89.3 5.8 4.8 0.1 

25-44years . . . . . . . . . . . . . . . . . . . . . . . . . . 310 274 19 17 100.0 88.4 6.1 5.5 

45-64years . . . . . . . . . . . . . . . . . . . . . . . . . . 574 498 30 46 100.0 86.8 5.2 8.0 

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . 493 436 42 14 1 100.0 88.4 8.5 2.8 0.2 

75-84years . . . . . . . . . . . . . . . . . . . . . . . . . . 492 446 29 — 100.0 90.7 5.9 3.5 — 

85yearsand over . . . . . . . . . . . . . . . . . . . . . . 357 333 10 ;; 1 100.0 93.3 2.8 3.6 0.3 

American lndian, 25yearsandover . . . . . . 251 229 7 14 1 100.0 91.2 2.8 5.6 0.4 

25-44years . . . . . . . . . . . . . . . . . . . . . . . . . . 37 30 3 3 1 100.0 81.1 8.1 8.1 2.7 

45-64years . . . . . . . . . . . . . . . . . . . . . . . . . . 64 56 1 7 100.0 87.5 1.6 10.9 

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . 41 38 1 2 — 100.0 92.7 2.4 4.9 — 

75–84years . . . . . . . . . . . . . . . . . . . . . . . . . . 66 62 2 2 — 100.0 93.9 3.0 3.0 

85yearsand over . . . . . . . . . . . . . . . . . . . . . . 43 43 — — — 100.0 100.0 — — — 

Otherraces, 25yearaandover. . . . . . . . . . . . . . 54 45 3 6 100.0 83.3 5.6 11.1 

25-44years . . . . . . . . . . . . . . . . . . . . . . . . . . 16 13 1 2 — 100.0 81,3 ..6.3 12.5 — 

45-84years . . . . . . . . . . . . . . . . . . . . . . . . . . 16 13 2 1 — 100.0 81.3 12.5 6.3 

65-74years, . . . . . . . . . . . . . . . . . . . . . . . . . 7 6 — 1 —. 100.0 85.7 14.3 

73-84years . . . . . . . . . . . . . . . . . . . . . . . 8 6 2 — 100.0 75.0 25.0 

85yaarsand over . . . . . . . . . . . . . . . . . . . . . . 7 7 — 100.0 100.0 

NOTE These data are unweighed. Percents may not add to totals due to rounding. 

33 
Table 3. Number and percent distribution of informant responses by response status, according to cause of death of the decedent: 

National Mortality Followback Survey, 1986 

Response status 

No No No No 

Cause of death and /CD–9 code Total Completed Refused response informant Tots/ Comp/efed Refused response irrformant 

Number Percent distribution 

Allcausesl, . . . . . . . . . . . . . . . . . . . . . . . . 18,707 16,577 1,376 685 49 100,0 88.6 7,5 3.7 0.3 

Infectious and parasitic diseases. . ,001–139 323 278 29 15 1 100,0 86.1 9,0 4,6 0.3 

Malignant neoplasms. . . . . . . ,140-208 4,000 3,562 304 130 4 100,0 89,1 7,6 3.3 0.1 

Diabetes mellitus . . . . . . . . . . . . . . . . . . ...250 351 311 26 14 100,0 88,6 7,4 4.0 

Major cardiovascular diseasesz. . . . . . .390-446 8,164 7,343 548 255 18 100.0 69.9 6.7 3.1 0.2 

Diseases of heartz. . . .390–396,402,404-429 6,680 5,987 465 211 17 100,0 89.6 7.0 3.2 0,3 

Ischemic heart disease . . . . . . .410-414 4,729 4,249 336 134 10 100.0 89.9 7.1 2.6 0.2 

Cerebrovascular diseases. . . . . . . . ...430-438 1,122 1,018 67 37 100.0 90.7 6.0 3.3 

Pneumonia and influenza . . . . . . . .46W87 519 466 36 10 5 100.0 90.2 6.9 1,9 1.0 

Chronic obstructive pulmonary diseases and 

allied conditions . . . . . .490-496 768 709 57 20 2 100.0 90.0 7.2 2.5 0.3 

Chronic liver disease and cirrhosis. .571 300 253 27 16 4 100.0 84.3 9.0 5,3 1.3 

Nephritis, nephrotic syndrome, and 

nephrosis . . . . . . . . . . . . . . ... . . ..560–569 165 161 19 5 100.0 67.0 10.3 2.7 

External causes of injury and 

poisoning, . . . . . . . . . . . . . .E800–E999 2,056 1,723 191 132 10 100.0 63.8 9.3 6.4 0.5 

Accidents and adverse effects .E600-E949 1,143 962 96 60 5 100.0 65.9 8,4 5.3 0.4 

Suicide . . . . . . . . . . . . . . . . . . .. E95O-E959 465 401 54 29 1 100,0 82,7 11.1 6.0 0.2 

Homicide and legal intervention .E960-E978 383 308 33 39 3 100,0 60.4 6.6 10.2 0.8 

All other causes..,.......,,, . . . . . . . . 2,426 2,139 183 99 7 100,0 88.1 7.5 4,1 0.3 

lThe informant questionnaire and the death certificate could not be matched for 26 records. The total sample included 18,733 records, 

‘Includes figures for subcategories not shown separately. 

NOTES: These data are unweighed. Percents may not add to totals due to rounding, 

Table 4. Number and percent distribution of informant responses by response status, according to decedent’s marital status and 

relationship of informant to decedenti National Mortality Followback Survey, 1986 

Response status 

Decedent’s marital status and No No No No 

relationship of informant to decedent Total Completed Refused response informant Tofa/ Comp/eted Refused response informant 

Marital status of decedent Number Percent distribution 

All decedents . . . . . . . . . . . . . . . . . . . . . . . 18,733 16,598 1,400 665 50 100,0 88.6 7.5 3.7 0.3 

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,851 7,662 706 276 5 100.0 88.8 8.0 3.1 0.1 

Widowed . . . . . . . . . . . . . . . . . . . . . . . 5,424 4,923 324 173 4 100.0 90.8 6.0 3.2 0.1 

Divorced . . . . . . . . . . . . . . . . . . . . . . . . . . 1,916 1,674 138 97 7 100.0 87.4 7.2 5.1 0.4 

Never married . . . . . . . . . . . . . . . . . . . . . . 2,406 2,047 215 128 16 100.0 65.1 8.9 5.3 0.7 

Notstated, . . . . . . . . . . . . . . . . . . . . . . . . . . 110 71 13 9 17 100,0 64.6 11.6 8.2 15.5 

Record notmatched. ..,,.... . . . . . . . . . 26 21 4 1 100.0 80.6 15.4 – 3,6 

Relationship of informant to decedent 

Informant was decedent’s – 

Husband orwife . . . . . . . . . . . . . . . . . . . . . 7040 6,228 596 214 2 100.0 68.5 8.5 3,0 0.0 

Fatherormother . . . . . . . . . . . . . . . . . . . . . 1,411 1,222 124 64 1 100.0 86.6 6,8 4.5 0.1 

Son ordaughter ., . . . . . . . . . . . . . . . . . . . . . 2,018 1,828 112 78 — 100.0 90,6 5.6 3,9 

Brotherorsister, ,, . . . . . . . . . . . . . . . . . . . 713 628 51 34 100,0 66,1 7,2 4,8 

Otherrelative . .,, .,...... . . . . . . . . . . . 523 486 19 16 100,0 93,3 3.6 3.1 

Nonrelative . . . . . . . ...’.. . . . . . . . . . . . . . . . 455 395 30 25 5 100,0 86.8 6.6 5.5 1.1 

Notstated . . . . . . . . . . . . . . . . . . . . . . . . . 6,573 5,809 466 254 42 100,0 86.4 7.1 3.9 0.6 

NOTES: These data are unweighed. Percents may not add to totals due to rounding. 

34 
Table 5. Number and percent distribution of informants as reported on the death certificate and on the informant questionnaire, by 

relationship of the informant to decedent National Mortaiity Foilowback Survey, 1986 

Relationship of Death Informant 

informant to decedent certificate questionnaire 

Percent Percent 

Number distribution Number distribution 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,733 100.0 16,598 100.0 

Informant was decedent’s – 

Husband orwife . . . . . . . . . . . . . . . . . . . . . . . . . . 7,040 37.6 5,653 35.3 

Son ordaughter . . . . . . . . . . . . . . . . . . . . . . . . . . 2,018 10.8 4,548 27.4 

Father or mother . . . . . . . . . . . . . . . . . . . . . . . . . 1,411 7.5 1,577 9.5 

Brother orsister . . . . . . . . . . . . . . . . . . . . . . . . . . 713 3.8 1,623 

Otherrelatlve . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523 2.8 1,872 In 

Nonrelative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 2.4 747 4.5 

Staff person in a nursing 

home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — 245 1.5 

Notspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,573 35.7 133 0.8 

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

35 
Appendixes


Contents 

I. Definitions ofcertain terms used in the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...37


II. U.S, Standard Certificate of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...38


III. Inventory of National Mortality Followback Survey forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...39


IV. National Mortality Followback Survey Informant Questionnaire (NMF-1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40


36 
I 

.J1 Appendix 1 

Definitions of certain 

terms used in the survey 

~.., 

.

I


Age –The age of the decedent at the time of death as 

recorded on the death certificate or as reported by the 

informant on the questionnaire. 

Current Mortali~ Sample –A systematic 10-percent 

sample of death certificates filed with the State vital 

statistics registrars and forwarded to the National Center 

for Health Statistics each month. This file is the universe 

from which the survey sample was drawn. 

Decedent –An individual for whom a death certificate 

was fled in the office of the vital statistics registrar of the 

State in which the death occurred. 

Don’t know –This classification indicates that the informant failed to provide a usable response to an item. 

The instructions to the informants asked them to put a 

question mark or write “Don’t know” if they did not have 

the information on a question. Such responses were coded 

into three categories: “Multiple answers,” “Refused,” and 

“Don’t know.” 

Facility Abstract Record (FM) –The questionnaire 

form mailed to hospitals, nursing homes, and other health 

care facilities used by the decedent in the last year of life. 

Health care facility –Acute care and chronic disease 

hospitals, mental hospitals, drug and alcohol treatment 

centers, nursing homes, hospices, and other health service 

institutions providing overnight care. Excluded are personal care homes, homes for the aged, board and care 

homes, and other facilities not providing nursing care or 

other health services. 

Hispanic –This is not a racial classification, but a 

category of origin or descent. The questionnaire included 

this question about the decedent: “Was of Spanish or 

Hispanic origin or descent?” 

Hospice –This term applies to both at-home and institutional care. It represents health and personal care 

services provided to dying persons. 

Informant or respondent –In this report, this is the 

individual who responded to the survey questionnaire. 

This individual may or may not have been the informant 

listed on the death certificate who provided the personal 

information about the decedent to the funeral director 

who filed the death certificate. The questionnaires were 

mailed to the informants listed on the death certificates, but sometimes another person completed the 

questionnaire. 

Interview –The completion of a questionnaire by a 

representative of the U.S. Bureau of the Census, either by 

telephone or by in-person contact with the informant. 

Last year of life –The full calendar year prior to the 

date on which the death occurred. 

Living will–A document executed by an individual to 

express his or her preferences with regard to care and 

treatment, ‘such as life-sustaining equipment or procedures, to be provided or to be withheld or withdrawn in 

the event that the individual has a terminal illness or other 

condition from which recove~ is not expected. 

Medicare –The medical assistance provided in Title 

XVIII of the Social Security Act. Medicare is a health 

insurance program administered by the Health Care Financing Administration for persons 65 years old and over 

and for disabled persons who are eligible for benefits. 

Mult@le Cause-ofiDeath File –The final file of death 

certificates compiled by NCHS after the close of the year, 

including records on which additional information or corrections have been entered after the Current Mortality 

Sample (CMS) certificate was filed, 

Out-oj%niverse –This code was entered when the item 

did not apply to the decedent. It. reflects primarily skip 

patterns. This code would be entered, for example, in the 

item on duration of angina if the informant responded 

that the decedent did not have angina, and it would apply 

to males in a female-specific question such as use of birth 

control pills. 

Race –The race of the decedent as recorded on the 

death certificate or as reported by the informant on the 

questionnaire. The classifications used are the four race 

classifications defined by the U.S. Office of Management 

and Budget. These are: white; black; American Indian, 

Aleut, and Eskimo; and other races. 

Refkral– If a spouse or other person residing at the 

decedent’s address refused, no further effort was made. If 

another informant refused, some other family member 

was sought, 

37 
Appendix II 

U.S. Standard Certificate 

of Death 

[PHYSICIAN, MEDICAL EXAMINER OR CORONERI Form AW2W8d U.S. STANDARD oMB No. 68R 1901 

LOCAL FILE NUMBER CERTIFICATE OF DEATH STATC FILE NUMBER 

TYPE 

OR ~[lNT DECEDENT-NAME FIRST MIDDLE LAST SEX DATE OF OEATH 1.WO.,DEY, W,] 

PEnF4::ENT 1. 2. I3. 

FOR 

lNSTR&TIOtiS 

RACE-[e.g., White. Slxk, Am,;.,. AGE-~r:.3inhday 

Indian. ,,..) ,Ss-.ir,l 

UNDER 1 YEAR I tJN9ER t rmy 

MOS. 1 DAVS HOURS r MINS. 

OAT E OF B1RTH (M... D.,. Y,.) COUNTY OF DEATH 

HANDBOOK 4 5a. 5b. ! 5C. I 6. 7*. 

C!TY, TOWN OR LOCATION OF DEATH HOSPITAL OR OTHER lNSTITUTlON-Nama Nfnot 1. ,fth,r, ,1”, dm,f md ““mb,r] IF HOSP. OR INST. lndicnla 90A, 

OP/Emef, Rm., Inpmion< IS. WOVY1 

7b. 7C. 7d. 

STATE OF BIRTH	 0(”.,1” U.S.A. C1T12EN OF WHAT COUNTFIY MARRIED. NEVER M,4RR!ED, SURVIVING SPOUSE (1/ We. ,1”, nm{d.. “mm,) WAS DECEOENT EVER IN U.S. ..,”. country, WIDOWED, DIVORCED (S.mdf,) ATIMED FOFICES7 

OCCURRED IN 8. 9. 10. 11. 

INSTITUTION. 

SEE HANOSOOK 

REGARDING 

SOCIAL SECURITY NUMBER USUAL OCCUPATION [G(W kind Wwark do”. durl”z nw,t of XINO OF BUSINESS OR INDUSTRY 

work{., Iv,, ,“,” v Wired) 

COMPLETION OF 

RESIDENCE ITEMS, 13. 

RESIDENCE-STATE COUNTY 

14a. ] 14b. 

CITY, TOWN OR LOCATION STREET ANO NUMBER INSIDE CITY LIMITS (sp,cffr Y.. o?NOJ 

~[ 15a. 15b. 15C. 15d. 150. 

FATHER-NAME F,RST M,00LE LAST MOTHER-MAIDEN NAME FIRST MlODLE LA5T 

... 47

IF DEATH ypry yes 0, N.) 

,,. INFoRMANT-NAME (T,P, or Print] MAILING ADDRESS STREET OR R.F.O. NO. CITY OR TOWN STATE ZI* 

lSb. 

BURIAL. CREMATION, REMOVAL. OTHER (.SP,WV,J CEMETERY OR CR EMATORy-NAME LOCATION CITV OR TOWN SIATf. 

19s, 19b. 19C. 

FUNERAL SERVICE LICENSEE 0, pcmo. ACGq AS s.ch NAME OF FACILITY ADDRESS OF FACILITY (Sk..,.,., 

20b. 20C. 

.> Q 

%: 

awe{, ) stated. dam md place and due 1.3the ewe(s) .: > .uz~ ,SK“.!”,. .nd Tiff,) b g~D /S1,”.l ”,, end TNI,J � 

st.trd. 

%%2 OATE SIGNED (MO.. DnY. Yr.J HOUR OF DEATH :< K DATE SIGNED (hi.,. Day, Y,.J 

Ex. HOUR OF OEATH 

Ew~ 

:;0 Zlb. ZIG. M 8: u 22b. 22C. M .* 

gg NAME 06 ATTENDING PHYSICIAN IF OTHER THAN CERTIFIER (T,,. 0. PUntl s E 8 p,q~NolJNcE13 OL=.W3(al.?.. D.y, Y,., ~~: PRONOUNCED DEAD (How, 

8 z “21d. 22d. OtA 229. AT M 

NAME AND ADDRESS OF CERTIFIER IPHYSICIAN, MEDICAL EXAMINER OR CORONERI ,2’YPC.. PN.lJ 

21,. TO the bQslof my knowledw. death occu,,ed at the ti,n,, date and P1act,nd due to the 2~a. On the basisof ewnination mdlof Investigation,In my opinion death omxmd al TheIWIW, 

OATE RECEIVED BY REGISTRAR (M.,, Day, Y,.) 

i [b)

,,{

L 

[,) 

DUE TO, OR AS A CONSEQUENCE OF: , Interval bslwoen o.wt mifdmth 

PART 

CONDITIONS 

,F ANY 

� 24b. 

wHICH GAVE 

RISE TO f 

IMMEDIATE CAUSE IENTER ONL Y ONE CAUSE PER LINE FoR (,1, lb), AND (c).) , Intewd b+hwen 00%Mmd d#mh 

IMMEDIATE PART ,,, i 

CAUSE 1 

STATING THE 

UNDERLYING .-

DUE TO, OR AS A CQNSEOUENCE Ofi l“,,w,I b+lwen o“wt ad d,,,h 

CAUSE LAST 8.OTHER SIGNIFICANT CONDITIONS-Cc.tition% contrihuti.o m dea!h but ..1 ro!.md I. care gi..n in PART I [a) AUTOPSY (S,,elf, Y,, WAS CASE REFERRED 

; 

TO MEDICAL 

n a NO) EXXe~/,N;~ :RC~RONEFl 

26. 21, 

ACC,, SUICIDE. HDM., UN DET., DATE DF INJURY (M.., Day, Y,, ) HOUR OF INJURY DESCRIBE HOW INJURY’OCCURRED 

OR PENDING INVEST. ,Spoci(,, 7 28a. 28b. ‘26c. M 28d.

INJURY AT WORK (SP,,I(, Y,. PLACE OF INJURY-A, horn,, I,,m. ,,,tat. fac,orf, Wk. building. LOCATION STREET OR R.F.D. N.. CITY OR TOWN STATE or NoJ . m. f.w..dr>)

HRA-162-1 

Rev. lf78 28e. 2SI. 2sg. 

38 
Appendix Ill 

Inventory of National 

Mortality Followback 

Survey forms 

NMF-1	 First mailout, self-response informant 

questionnaire 

NMF-10(L) ID	 State of Idaho endorsement letter for 

all Idaho deaths 

NMF-11 (PA) Pennsylvania consent forms 

NMF-2	 Second mailout, self-response informant questionnaire for nonrespondents to NMF-1 mailout 

NMF-30(L)	 Reminder/Thank you letter sent to all 

informants 10 days after NMF-1 mailOut 

NMF-4	 Field followup questionnaire for nonrespondents to the NMF–1 and 

NMF-2 mailouts 

NMF-4A	 Proxy Consent Statement for fail-edit 

followup with informants who failed to 

sign the original statement 

NMF-40(L)	 Introductory letter used in field folIowup with informants who did not 

receive the NMF–1 or NMF–2 

questionnaires 

NMF-41 Flashcard Booklet used in personal 

visit interviews 

NMF-5 Staff questionnaire used in field fol- ‘ 

Iowup for informants who were staff 

members of facilities 

NMF-50(L) Administrator Letter sent to administrators who requested information 

about the suivey during an NMF–5 

interview 

NMF-6 Facili~ Abstract Record completed by 

facilities 

NMF-6A 

NMF-6B 

NMF-60(L) 

NMF-61(L) 

NMF-60(L) ID 

NMF-61(L) ID 

NMF-62(L) 

NMF-63(L) 

NMF-7 

NMF-70(L) 

NMF-71(L) 

NMF-8 

Decedent Control Form used by Census Bureau in the facility phase to list 

facilities used by a sample decedent 

Facility Control Form used by Census 

Bureau staff in the facility phase to list 

the decedents who stayed in a particular facility 

Letter sent to Medical Records Administrator to request participation in 

the facility phase 

Letter sent to administrators to request participation in the facility phase 

Medical Record Letter and 

Administrator 

Endorsement letter from State of 

Idaho for Idaho deaths 

American Medical Records Association Endorsement Letter for the facility phase 

American Hospital Association Endorsement Letter for facility phase 

Address Request Form for use when 

informants’ names and addresses 

could not be obtained by telephone 

Cover Letter for the ‘NMF-7 requests 

to funeral directors 

Cover Letter for the NMF-7 to 

sources other than funeral directors 

Reinterview questionnaire 

39 
.P 

o


“a.. * m 

‘2 

7’ 

w 

*+-,*s *W,,,,

-.+ .+*

,$ DEPARTMENT OF HEALTH& HUMAN SERVICES :

:. Public Health Servica 

% National Center for Haalth Statistics 

“*, < 

+%.,O \

FROM THE DIRECTOR 

You can help the U.S. Public Health Service to learn more about waya to prevent 

illness andtoimprove cerefor sick and dying persons. Youora relative provided 

soma of the information that was included on the death certificate for the pereon 

named above. This information is helpful in understanding about deathe from 

various causea. Still, weneedto learn more sothatwe canaesure the best health 

care for ill persons and prevent early death when poesible. We are therefore 

havhtgthe Bureau of the Census conducta survey for us, and have randomly 

selacteda sample of deaths inthe United Statesin 19 B5 and 19B6, Weaek you 

to complete thie questionnaire about the life and death of the person named 

above, even if the person died from old age or an accident. 

We know that this reminder of the person who died recenlly may be painful, but 

we behevethat youwill wanttohelp others, andyour answarewill dothat, Some 

of the questions may be difficult to answer, end you may not know the answers to 

all of them. Many questione may not apply to the person because we are using 

thesame form forallpersons in the study. We ask youtorecall, tothe best of 

your ability, andanswer allthat you can. Afewgeneral instructions appear on 

page 2. 

Allofyour answers areetrictly confidential. Theidentity ofindividttals willnotbe 

discloeed by either the Bureau of the Census or the Public Health Service without 

yourwritten approval. Wewillnot include enyinformation that could identify an 

individual inthastatistics we release. Thie survey involuntary and is authorized 

by the Public Health Sarvice Act (Title 42, United States Code, Section 242k). To 

add to our knowledge, we are requesting your authorization to secure medical 

information from hospitals or other health care facilities used by the person in the 

last year of life, 

Although there are no penalties for failing to reply, each unanswered queation 

substantially leseens the accuracy of the final deta. The success of this study 

depends onreceiving information oneve~questionnaire wesend out. Yourreply 

is extremely important. Please mail the completad form to the Bureau of the 

Census wittin5DAYS intheenclosed envelopa wMchrequires nopostage. Your 

prompt attention to this request is appreciated. 

Sincerely yours, 

Msnning Feinleib, M.D., Dr. P.H. 

-–,,- aria-l m.”. . .--.- ..-, C...-, ___ r-. -—--L_- 0. .“, 

U.S. DEPARTMENT OF COMMERCE SUREAUOF THE CENSUS ACTING ASCOLLECTINGAGENTFORTHE 

U.S. IWBLIC HEALTH SERVICE 

1986 NATIONAL MORTALITY FOLLOWBACK SURVEY 

I (f7ease corract any error h name and address including ZIP Code.) 

NOTICE - Information contained on this form which would permit identification of ,any 

individual or establishment has baan collacted with a guarantee that it will be bald in strict 

confidence, will ba used only forpurpoaas stated for this study, and will not be disclosed or 

raleasad to others without theconsantof theindividual or the establishment in accordance with 

Sactiorr 308[d) of the Public.Haalth Sarvica Act (42 USC 242m). 

Bureau of the Census 

1201 East Tenth Street 

JsrffersonvWe, Indiana 47132 
INSTRUCTIONS 

l. Several items onthisform refer totheperson's lastyear of life. This means thetime 

stafling oneyear before thedate ofdeath andending ontheday of death. Exampla: If 

the date of death was January 5, 1986, the period referred to as the “last year of life” is 

January 5, 1985, to January 5, 1986. 

2.	 Please answer each question to the best of your ability. in some cases you may wish to 

refer to records or ask other persons. Some questions ask for the amount of time before 

death that an event occurred, for example, the amount of time before death that the 

person last worked. If you do not know the exact amount of time, please give your best 

estimate or a range. Example: 12 to 14 years; or 2 to 3 months. 

3.	 Since some questions will not apply in all cases, instructions for which question to answer 

next are printed after some of the answer categories. If there is no instruction after the 

answer, go to the very next question. 

4.	 If the answer does not fit one of the printed answer categories, mark the “other” box and 

write in the answer. If there is no “other” category, write in the answer without marking 

a box. 

5.	 If you still don’t know the answer to a question, put a question mark (?) or write “Don’t 

know” in the answer space. 

6.	 Ignore the numbers which appear in rectangles (for example ~ ) and any areas 

marked “OFFICE USE ONLY. ” These are for processing purposes only. 

7.	 We welcome any additional information you’wish to provide. Use the space on the last 

page of the questionnaire. 

PLEASE BEGIN WITH PARTA BELOW. 

PART A – BACKGROUND INFORMATION 

1. How old was the parson at tha tima of death? ~ 005 

Age in years 

z. t$;o;~as tha parson who died re[atad 006 j 

The person was – 

Mark (X) only one box. I � My husband or wife 

2 � My father or mother 

3 � My son or daughter 

4 � My brother or sister 

5 � My neighbor or friend 

6 � Someone else – Specify ~ 

3.	 Did you evar live in the sama home with tha 007 

person I � Yes — Go to next question since the person became 25 years old? 

2 � No — Skip to question 7 in Part B on page 3 

Do not count visits at the person’s ho”me while 

you had a home somewhere else. 

4. Since the person became 25 years old, ooe ‘ I � Less than one year

how many years ALTOGETHER did you 2 � 1 year to less than 5 years live with him or her? 3 � 5 years to less than 10 years 

Mark (X) only one box.	 4 � 10 years to less than 20 years 

5 � 20 years or more 

FORM NMF-1 [5-2-8 

41 
PART B – CARE IN THE LAST YEAR OF LIFE 

, During his or her entire life, was the person ever I 009 

admitted to a nursing home? I � Yes — Go to next question 

2 � No — Skip to question 3 

!, What was the total amount of time the person spent I 010 

in a nursing home over his or her entire lifetime? 1 � Less than 3 months 

Mark (X) only one box. 2 H 3 months to less than 1 year 

3 � 1 year to less than 5 years 

I 4 � 5years or more 

~. AT ANY TIME DURING THE LAST YEAR OF LIFE, 011 I 

was the person an overnight patient in a hospital or I � Yes — Go to next question 

a resident in a nursing home? 2 � No — Skip to question 6 on page 4 

~. What were the names and addresses of all hospitals and nursing homas in which the person stayed at 

least one night DURING THE LAST YEAR OF LIFE? (Please give as much of the address as you cam) 

____________ ——— ——___— ——— ——— ——___— —~ml_Q&roTtiaFgz;ti;ti:----------------

Hospital or nursing home name 

@ l@ 

Address (Number and street) Address (Number and street) I 

I 

City or Post Office City or Post Office 

I 

{ Stete ZIP Code State ZIP Code 

I 

——— ——— ——— ——— ——— ——— ——— ——— ——— ——— ——— — _________ —______— —— .. ———-— ——— . 

Hospital or nursing home neme ~–––––Hospital or nursing home name 

Q @ 

Address (Number and street) Address (Number and street) 

City or Post Office	 I City or Post Office 

I 

State ZIP Code I State ZIP Code 

_—— ——___________ ——— ——— —__ ——— ——— ——— L––––––––––––.– ––––––––––– ––––-–––--’ Hospital or nursing home name Hospital or nursing home name 

@ I@ 

Address (Number and street) Address (Number and street) 

City or Post Office City or Post Office 

I 

State ZIP Code I State ZIP Code 

________ ———_______________ —_ —__— —— L–––––––––––––– ––––––––-–-–––– -–---

NOTE: If more room is needed to list more hospitals or nursing homes, please continue on the last page of this questionnaire, 

;. DURING THE LAST YEAR OF LIFE, how Number of nights during year before death 

many total nights did the person spend in 

hospitala and nursing homes? m Nights in hospital(s) 

NOTE: If you are unsure, please give your best 

estimate. m Nights in nursing home(s) 

FORM NMF-1 (5-2-86) 

42 
PART B – CARE IN THE LAST YEAR OF LIFE – Continued 

6. During the last year of life, did the person I 015 

stay overnight in any other type of facility I � Yes — Go to next question providing health care? 

2 � No — Skip to question 9 on page 5 

Include places known as hospices, mental 

hospitals, drug and alcohol treatment centers, and 

so forth. A hospice gives care to dying persons. 

7. What were the names and addresses of all these other facilities in which the person stayed during the 

last year of life? (Please give as much of the address as you can.) 

---.l;fi;FpG=--..---.-.----.--------}=LlN;;~Tia::_______________________ 

~@ 

Address (Number and street) I Address (Number and street) 

I 

City or Post Office I City or Post Office 

I 

I State ZIP Code State ZIP Code 

I 

————————— ——————————_______________ L–––___________________________–____

Name of place Name of Dlace 

@ I 

Address (Number and street) Address (Number and street) 

I 

I 

City or Peat Office City or Post Office 

I 

I 

State ZIP Code I State ZIP Code 

,—— ——— ——— — _________________________ I ——— ——— ——— ——— ——— ——— ——— ——— ——— —— . 

Name of place ~ ‘— ——–Neme of olace 

@ @ 

Address (Number and street) I Address (Number and street) 

I 

J 

City or Post Office City or Post Office 

I 

I 

State ZIP Code ,, [ State ZIP Code 

I 

t _____________________________________________________________________ . 

NOTE: If more room is needed to list additional facilities, please con.tnue on the last page of this questionnaire. 

~.	 How many nights during the last year of 

life did the person spend in each of the 

places listed above? 

NOTE: If you are unsure, please give your 

best estimate. 

m 

m 

EEl 

@!J 

EEl 

Eizl 

Number of nights during year before death 

Nights in first place 

Nights in second place 

Nights in third place 

Nights in fourth place 

Nights in fifth place 

Nights in sixth place 

If more than 6 praces, continue on last page of 

this questionnaire. 

FORMNMF-I(5-2-aal 

43 

0 
--------- -------

PART B – CARE IN THE LAST YEAR OF LIFE – Continued 

9.	 During the last year of life, did the person 023 I 

receive hospice care at home? I iJ Yes 

Include only care provided by an organized 20No hospice agency, one that gives special 

attention to dying persons. 

024 10.	 During the last year of life, about how many 

times did the person see a medical doctor? o � None 

Include all types of doctors such as dermatologists, 101


psychiatrists, and ophthalmologists, as well as


general practitioners and osteopaths. zD2—4


305—9 

Do NOT count doctors seen while an overnight 4010—14 

patient in a hospital, nursing home, or s015—24 

other institution. 

6025—49 

Mark (X) only one box. 7 � 50 or more 

11. During the last year of life, did the parson see a I 025 

psychiatrist, psychologist, or any other mental I •l Yes
 health professional about any personal,


emotional, behavioral, or mental problem? 20No


Do NOT count visits while an overnight patient in 

a hospital, nursing home, or other institution. 

I z.	 At any time during the last year of life, was 1 026 

the person on a waiting list to go into a I � Yes — Go to next question nursing home? 2 � No — Skip to question 74 

—__ —...-———-————- ———————-———— —————— ————— ——— —--- . .

1s,	 After being on the waiting list, did the ----12EzJ1 � yes 

person get into a nursing home before he 

or she died? 2DN0 

IQ.	 During the last year of life was the person 1 028 

on a waiting list to get hospice care either I � Yes — Go to next question 

at home or in a facility? 2 � No — Skip to question 16 

.______— —————.-—————————————————— 

-EEZJ--------------------------”-’””-----’ 15, After being on the waiting list, did the 

person get hospice care before he or 

she diad? 

030 16. During the last year of life, was the 

person on a waiting list to get 

homemaker service? 

.————-—————————————————————————— 

17.	 After being on the waiting list, did the -Em 

person get homemaker service before 

he or she died? 

18. During the last year of life was the I 032 

person on a waiting list to get visiting 

nurse service? 

-__________ ———_____________ ——___ 

7 II Yes 

20No 

1 � Yes — Go to next question 

2 � No — Skip to question 78 

—————————————————— ———-.————————-

I •l Yes 

20No 

I � Yes — GO to next question


2 � No — Skip to question 20 on page 6


19. After being on the waiting list, did the -lIET---”-------------------”---’----”--­

person get visiting nurse service 1 � Yes 

before he or she died? 20No 

FORM NMF-1 (5-2-861 

-44 
PART B — CARE IN THE LAST YEAR OF LIFE — Continued 

As part of this survey we would like to learn about I 034


how much Medicare helps pay for health care. I � Yes — Go to next question


Zo. Was the person coverad by Medicara? 2 � No — Skip to question 22 

.—— ——— ————________________ 

21. What was tha person’s Medicare claim number? E1----”----------l-~= J-----------” 

Provision of this number is voluntary and failure to Medicare claim number


provide the number will not have any effect on the


receipt of any benefits. The information we receive will mz-m-mn-m


be used only for statistical purposes. Data from this This number may be found on the person’s


survey will be linked with data supplied by the Health Medicare card which is white with a red and blue


Care Financing Administration. This information is stripe. The number may also be found on the


collected under the authority of Section 306 of the Explanation of Medicare Benefits Forms that are
 Public Health Service Act. sent after each service used.


22.	 During the last year of life, what sources were I 037 

used to help pay for health care in hospitals, * I � The person or other family members nursing homes, physician services, or care in living with the person the home? 2 � Family members not living with the person 

30 Medicare 

Mark (X) all that apply. 4D Medicaid 

5 � A prepaid health maintenance organization 

60 Private health insurance 

~ I � veterans Administration 

* 2 � Indian Health Service 

3H Other government program – Specify ~ 

40 Other — Specify 

o � Didn’t have any payments — Skip to question 24 

?3.	 Which source marked in question 22 paid 039 1 

MOST of the costs of health cata during the 

last year of life? 

Name of source 

~o. What was the total amount of the person’s 040 1 Person’s OWN money. NOT total bill. 

own money that was paid for tha person’s


medical care during the last year of life? 1� Less than $200


AISO includa payments made by related 20 $200– $499


persons living in the same household.
 30 $500– $999 

homes, dental, optical, medicines, and other 

health expenses. 50 $2,000– $2,999 

Also include payments made TO Medicare and Go $3,000— $4,999 

any other health insurance. 7CI $5,000– $9,999 

Include expenses for doctors, hospitals, nursing 4CI $1,000— $1,999 

Do not include any amounts paid by or received 13fi $10,000—$14,999 

from insurance, Medicarer or Medicaid. 90 $1 5,000–$19,999 

If you are unsure, please make your best estimate. 100 $20,000—$24,999 

Mark (X) only one box. 11 � $25,000 or more 

— FORM NMF-1 [5-2-I 

45 
----

- --

PART B – CARE IN THE LAST YEAR OF LIFE – Continued 

041 ‘5. At any time during the last year of life did the 

person receive help from others in WALKING OR I � Yes — Go to next question 

use special equipment in WALKING? 2 � No — Skip to question 27 

Mark “Yes” if the person couldn’t walk. 

(Special equipment includes canes, walkers, 

wheelchairs, handlebars, etc. ) 

——— ———.—. ——— —————— ——— ——— ——— ——— ———— —— 

!6.	 How long was the person unable to walk or @z_l--------------------------’--”­

did the person receive help in WALKING or 

use equipment in WALKING during his or her 

entire life? Length of time 

(For example, 5 years or 1 week) 

~7,	 At any time during the last year of life did the 043 

person receive help from others in EATING OR I � Yes — Go to next question 

use special equipment in EATING? 2 � No — Skip to question 29 

_______ ——— ———_———————_—_______ 

28.	 How long did the person receive help in lzElEATING or use special equipment in EATING 

during his or her entire life? 

(For example, 5 years or 1 week) 

29,	 At any time during the last year of life did the 045 I 

person receive help from others in BATHING OR 

use special equipment for BATHING? 

.——————————— —————— ——— ——— ——— ——— ——— ——

30.	 How long did the person receive help in IEElBATHING or use equipment in BATHING during 

his or her entire life? 

(For example, 5 years or 1 week) 

31. At anytime during the last year of life did the 047 J 

person receive help from others in DRESSING 

OR use special equipment in DRESSING? 

.———————— ————————— ——— ——— ——— ——— ————— 

——— ——— ——— ——— ——— ——— ——— ————— 

Length of time 

I � Yes — Go to next question 

2 � No — Skip to question 37 

——— ——— ——— ——— ——— —-——— ——— —-——

Length of time 

I � Yes — Go to next question 

2 � No - Skip to question 33 

32.	 How long did the person receive help in m-----------------------------” 

DRESSING or use equipment in DRESSING 

during his or her entire life? 

Length of time 

(For example, 5 years or 1 week) 

33.	 At any time during the last year of life did the 049 ] 

person receive help from others in using the I � Yes — Go to next question TOILET OR use special equipment in using 

the TOILET? 2 � No — Skip to question 35 on page 8 

.————— ———————————— ——. ——— ——— ——— ——— ——— —

34.	 How long did the person receive help in using the m------------------------------

TOILET or use equipment in using the TOILET 

during his or her entire life? Length of time 

(For example, 5 years or 1 week) 

FORM NMF-1 (5-2-86) 

46 
PART B — CARE IN THE LAST YEAR OF LIFE – Continued 

35.	 For how much of the Iast vear of life was the I 051 

person in a nursing home-or other health o � None — Go to next question 

facility or any other type of institution? I � At least one night but less than half of 

Mark (X) only one box. the last year —“Go to next question 

2 � At least half but not all of the 

last year – Go to next question 

3 � All of the last year — Skip to question 39 

36,	 During the last year of life, did the person 

052 

receive help AT HOME from other persons in I •l Yes 

walking, eating, bathing, dressing, or using 

tha toilat? 20N0 

-/ 

053 37.€ During the last year of life, did anyone help 

the person AT HOME in giving medicines, 1•l Yes 

pills, shots, injections, in changing 

bandages, or by providing nursing care? 2DN0 

If you marked No in both questions 36 AND I 055

37, skip to question 39. * 1 � Husband or wife


38.	 Who helpad the person AT HOME during 2 � Son 

the last year of life? 3 � Daughter 

Mark (X) all that apply. 4 � Other relative — What relation? ~ 

= 5 � Neighbor or friend 

*	 6 � Visiting nurse 

7 � Visiting homemaker 

s � Other — Specify 

39,€ During the last year of life, how often did ] 057 

the person have trouble understanding I � All or most of the time 

where he or she was? 

2 � Some of the time 

Mark (X) only one box. 3 � Only in last few hours or days before death 

4 � Never or hardly ever 

40.	 During the last yaar of life, how often did tha I 05s 

person have trouble remembering what year I � All or most of the time 

it was? 2 � Some of the time 

Mark (X) only one box. 3 � Only in last few hours or days before death 

4 � Never or hardly ever 

] 059 

$1. During the last year of life, how often did the 

person have trouble recognizing family 1 � All or most of the time 

members or good friends? 2 � Some of the time 

Mark (X) only one box. 3 � Only in last few hours or days before death 

4 � Never or hardly ever 

42.	 Did tha parson ever sign a paper stating NOT 1 060 

to use life-sustaining equipment or procedures 1 •l Yes 

if the person was definitely dying? 2DN0 

This paper is sometimas called a “living will.” 

FORM NMF-1 (5-2-861 

47 
PART B – CARE IN THE LAST YEAR OF LIFE – Continued 

061 43.	 During the LAST THREE YEARS OF LIFE, 

did anyone have any problems in finding a I � Yes — Very serious problem 

nursing home for the person or getting the 

person into a nursing home? 2 •l Yes – Somewhat serious problem 

3 � No — Not a problem or not applicable 

44.	 During the LAST YEAR OF LIFE, did anyone 062 

have any problems in getting help to care for 1 •l Yes – Very serious problem 

the person at home? 2 � Yes — Somewhat serious problem 

3 � No — Not a problem or not applicable 

45.	 During the last year of life, did anyone have I_W-l 

any problems in paying the medical bills for 1 n Yes — Very serious problem 

the person? z � Yes — Somewhat serious problem 

30No – Not a problem or not applicable 

064 46.	 During the last year of life, did anyone have 

any problems in finding and getting I •l Yes – Very serious problem 

treatment from a doctor for the person? 2 •l Yes – Somewhat serious problem 

30No — Not a problem or not applicable 

Continue with Part Con the next page. 

48 
------------

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

-- ----

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

------

----

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

PART C – LIFE STYLE AND HEALTH 

1,	 AT ANY TIME IN THE PERSON’S LIFE, 065 I 

did he or she ever have high blood I � Yes — Go to next question 

pressure (hypertension)? 2 � No — Skip to question 5 

.—— —--- _._. —_-. __. __— ——- —--- ————-— 

2.	 How Iong”before-de;th was the high blood l..IKI 

pressure (hypertension) first noticed? 

(For example, 3 years or 2 weeks) Time before death 

-— ———- ———————————————— 

3, Did a doctor prescribe medicine for the UIZJ 

high blood pressure? I � Yes — Go to next question 

2 � No — Skip to question 5 

. . . . --.—--———————————————— 

4, On the average over the time prescribed, m------- ”----’------------------ ”­

did the person take the medicine 1•l Very regularly regularly? 2 � Not very regularly 

(If more than one medicine was prescribed, did 3 � Hardly at all or never the person take all or most of them regularly?) 

s. At any time in the person’s life, did he or 1 069 

she ever have a heart attack? I � Yes — Go to next question 

2 � No – Skip to question 7 

——. .-- ——-— ————————————————————— 

6. How long before death did the person IZ!Z!ZJ--------------------------”----”--” 

have the FIRST heart attack? 

(For example, 3 years or 2 weeks) Time before death 

7.	 At any time in the person’s life, did he I 071 

or she ever have angina pectoris? 1� Yes — Go to next question 

2 � No – Skip to question 9 

-———— —————————————————————— 

8.	 How long before death was the angina m--------------------------------” 

pectoris first noticed? 

(For example, 3 years or 2 weeks) Time before death 

ci73 

9.	 At any time in his or her lifer did the person 

have a stroke in which any resulting 1 � Yes — Go to next question 

conditions (such as paralysis, loss of 2 � No — Skip to question 71 

vision or speech] lasted AT LEAST ONE 

DAY OR LONGER? 

-—-. ——————————————————————————— 

O.	 How old was the person when he or she had -E@IJ 

the first stroke in which there were resulting 

conditions lasting at least one day? Age in years 

If not sure, give approximate age. 

075 1, AT ANY TIME IN THE PERSON’S LIFE, did 

a doctor say that the person had 1 � Yes — Go to next question 

Alzheimer’s disease, chronic brain 2 � No — Skip to question 73 on page 77 

syndrome, dementia, senility, or any other 

serious memory impairment? 

—.--- ——————————————————————————— 

m-------------------------------- 2, How long before death was this diagnosis 

first made? 

Time before death 

(For example, 3 years or 2 months) 

—---- . 

——. 

FORM NMF-1 [5 
-------------

PART C – LIFE STYLE AND HEALTH – Continued 

13. At any time in the person’s life, did he or she I 077 

have any OTHER mental, nervous, or I � Yes — Go to next question

emotional health problem? 2 � No — Skip to question 15 

——. ——. ————. ——— ——— ———.——— ——— ——— ——— —

14.	 How long before death was the other mental, E!zE1-----”-------’------’----------­

nervous, or emotional health problem first 

noticed? 

Time before death 

(For example, 3 years or 2 months) 

15.	 At any time during the person’s life, did he or I 079 

she have diabetes? I � Yes — Go to next question 

2 � No — Skip to question 17 

.___________ ———_____— ————-———— 

16.How long before death was the diabetas -----EEl-------’-------------”-”-------” 

first noticad? 

(For example, 3 years or 2 months) Time before death 

17,	 Was cancer the main condition leading I._!WJ 

to death? I � Yes — Go to next question 

2 � No — Skip to question 19 

._______________ ——______ ——— ——————__ 

18.Iiit::d;g
 befora daath was this cancer first El---------------------------’-’--­

– Skip to question 27 

Time before death 

(For example, 3 years or 2 months) 

083 

19.	 At any time during the person’s life, did ha 

or she have cancer of any kind, axcept I � Yes — Go to next question

skin cancer? 2 � No — Skip to question 27 

._______________ ——_____ ——— ——————___ 

20.	 How long before death was cancer, except @Cl------------------’-----------’ 

skin cancer, first noticed? 

Time before death 

(For example, 3 years or 2 months) 

21. At any time during the person’s life, did he I 085 

or she have asthma ? 1 � Yes — Go to next question 

2 � No — Skip to question 23 

.————— —————— ————————— —————————————— - —- ——— —————— ——— ————————————-——-— —— 

22. li:t~c:d;g before death was the asthma f irst IJ2z!-1 

Time before death 

(For example, 3 years or 2 months) 

087 I 23.At anytime during the person’s life, did he 

or she have any other lung condition such I � Yes — Go to next question 

as emphysema or bronchitis lasting 2 � No — Skip to question 25 on page 12 

3 months or longer? 

.________ ——— —___ ——— ——— ——————__ 

@FEl-”---------------” 

24’ ~~n~#~~ $#n:~~e$,was tha first lung 

Time before death 

(For example, 3 years or 2 months) 

)RM NMF-1 [5-2-86) 

50 
----------------------------------

PART C – LIFE STYLE AND HEALTH – Continued 

25.	 At any time in the person’s life, did he or 089 

she have cirrhosis of the liver ? I � Yes — Go to next question 

20No – Skip to question 27 

--—. .. -—. ———————....——————————————— —— 26, licicy~i:::p death was the cirrhosis -Ew?_r . 

(For example, 3 years or 2 months) Time before death 

27, Was there ever a time in the person’s life that ~ 

he or she was thought to be extremely near lUYes — Go to next question to death but lived on? 

2 � No — Skip to question 29 

————— .. —..——— —————— ——— ——— ——— ——— ——

28. When was this time in the person’s life when 

he or she was thought to be extremely near 

to death but lived on? 

(If there was more than one time, please answer 

for the first time.) 

Mark (X) only one box. 

29. Where did the person die? 

Mark (X) only one box. 

30.	 At anytime during the hour before death 

were you with the person? 

31. ~e~h~as the person doing an hour before 

Mark (X) all that apply. 

32. Within the hour before death, did the 

person start having a new or sharply 

increased problem such as chest pain, 

difficulty breathing, or fainting? 

m---------------------------------” 

I � Less than 3 months before actual death 

2 � 3 months to less than a year before death 

3 � 1 year to less than 5 years before death 

4 H 5 years or more before death 

093 

I � in a hospital emergency room 

2 � In a hospital, not in emergency room 

3 � On the way to a hospital 

4 � In a nursing home or personal care home 

5 H in his or her own home 

6 � In some other place — Specify ~ 

094 1 

1 •l Yes 

20No 

095 

* I � Confined to bed or chair because of illness or injury 

2 � Working 

3 � Quiet recreation such as watching TV or 

playing cards 

4 � Active recreation such as yard work, exercise 

or sports 

5 •l Sleeping 

6 � Other — Specify ~ 

1 096 

1•lyes


20No 

FORM NMF-1 (5-2-86) 

51 
-----------

--

PART C – LIFE STYLE AND HEALTH – Continued 

IF THE PERSON WAS A MALE, SKIP TO 

QUESTION 42. 

IZxK1’ ]3. Did she EVER regularly take birth control pills? 

I � Yes — Go to next question 

2 � No — Skip to question 36 

.—-. —————.————————————————————————— 

~~. Altogether, about how long did sha take m-----------------”-----”---’------’” 

birth control pills? 1 � Less than one year 

2 � 1 year but less than 5 years 

3 � 5 years but less than 10 years 

4 � 10 years or longer 

-——— ——. ———. ————————————————————————— 

35. At what age did she start taking birth control pills? CiET-------------------’ 

If not sure, give approximate age. Age in years 

36. How many LIVE BIRTHS did she evar heve? 

101 

Please includa children who died vary young. Number of live births 

37. Did she evar have a hysterectomy? I 102 

(An operation to remove the uterus.)	 I � Yes — Go to next question 

2 � No — Skip to question 40 

-——. 

"----------------------------------m--------------------------- 38. How old was she when she had the 

hysterectomy? 

Age in years if unsure, give approximate age. 

.________ ———————______ .._——.—. ———————.. —— —— —.. ——————————————-— ————-- ——-— ———

39. Before the hysterectomy, had her menstrual C@l_lperiods already ended due to menopause or lCIYes — Skip to question47 the “change of life”? 

2 � No — Skip to question 42 

I 105 

40. Had her menstruaI periods ever endad due to 

menopause	 or the “change of life”? 1 � Yes — Go to next question 

2 � No — Skip to question 42 

.—— ———————————————————————————————— ——————————————————.—- —————-­

al.	 ::d~::d was she when har menstrual pariods m 

. Age in years 

If unsure, give approximate age. 

ANSWER FOR BOTH MALE AND FEMALE I-wJ 

42. Did the person ever have an operation to be 1 � Yes — Go to next question 

sterilized? 2 � No — Skip to question 44 on page 14 

(For males, a vasectomy. For females, “tubes tied” 

or tubal ligation. ) 

-—.. ——.——. ——————————————————————————— 

43.	 How old was the person when he or she had an EI!K1-------------------------’---’--

operation to be sterilized? 

Age in years

If unsure, give approximate age. 

.1 (5-2-86) 

52 
-----

PART C – LIFE STYLE AND HEALTH – Continued 

In these next questions, we are interested in the 

person’s usual practice, not in any possible recent 

change because of a health problem. 

DURING MOST OF HIS OR HER ADULT LIFE, 

on the average, how often did the person 

usually eat the following foods — 

m 14. Red meat, such as beef, pork, Iamb, or I ❑ Every day 

hamburger? 2 •l 3 to 6 times a week 

Mark (X) only one box. 3 ❑ 1 or 2 times a week 

4 ❑ 1 to 3 times a month 

5 ❑ Less than once a month 

6 ❑ Never —-—- —————————————————————————————— --—-

15. ::gs:el;iry products, such as milk, cheese, m-l-~ ;;;.-~;;-------------”’ 

, 2 ❑ 3 to 6 times a week 

Mark (X) only one box. 3 ❑ 1 or 2 times a week 

4 ❑ 1 to 3 times a month 

5 ❑ Less than once a month 

6 ❑ Never ——————————————— ——————————————————— ———————————————————————— —————- ——-

16, Fruit? ~ I ❑ Every day 

2 H 3 to 6 times a week Mark (X] only one box. 

3 H 1 or 2 times a week 

4 ❑ 1 to 3 times a month 

5 ❑ Less than once a month 

6 •l Never —- ———————————————————————————————— 

17, Vegetables? m;-~;;;.-~;;------------------”----

2 ❑ 3 to 6 times a week 

Mark (X) only one box. 3 ❑ 1 or 2 times a week 

4 H 1 to 3 times a month 

5 ❑ Less than once a month 

6 ❑ Never —- ———————————————————————————————— ———————————————————————— ——————

18.	 Foods prepared by salt-curing or smoking, such ~ , ❑ Every day 

as bacon, hot dogs, or smoked fish? 2 ❑ 3 to 6 times a week 

3 ❑ 1 or 2 times a week 

Mark (X) only one box.	 4 ❑ 1 to 3 times a month 

5 ❑ Less than once a month 

6 ❑ Never 

!9,	 During MOST of his or her adult life, was the person I 114 

I ❑ Very overweight 

overweight, underweight, or just about right? 2 ❑ Somewhat overweight 

Mark (X) only one box. 3 ❑ Only a little overweight 

4 ❑ Underweight 

8 ❑ About right 

—————————————————————————————————— 

jo, On the average, approximately what was the m------------------------------­

person’s usual adult weight? Pounds 

—- ———————————————————————————————— 

IzIC1------------------------------- j 1, What was the person’s adult height? Feet 

Enter both feet and inches, such as”5 feet and 

AND 6 inches. ” If no inches, enter “0,” 

m Inches 

. . . .. . ..- . ..” 

53 
---

--

PART C – LIFE STYLE AND HEALTH – Continued 

52.	 Did the person smoke at least 100 118 I 

cigarettes in his or her entire life? I � Yes — Go to next question 

(There are usually 20 or 25 cigarettes in a pack.) 2 � No — Skip to question 57 

.———————— ——————-_— ——_______________ 

~3t How long did he or she smoke cigarettes m-----------------------------­

regularly? 

Years Go to next question 

Enter years or mark (X) a box. x � Less than 1 year } 

o � Never smoked regularly — Skip to question 55 

.————-———— ——— —————— ——— ——— ——— ——— ——— — ——— —————— —————— ——— ——— ———————- ——-

54,	 During the period he or she smoked most, on ~ , � Less than 5 cigarettes a day 

the average, about how many cigarettes a day 

did the parson usually smoke? 20 5—14a day 

3 � 15 —24 a day Mark (X) only one box. 40 25 —34 a day 

5 •l 35–44a day 

6 � 45 or more a day 

.———————— ————————— ——— ——— ——— ——— ————- _—— —___ ——___— —____ —__ —- —___ —__

Ss. Did the person stop smoking and not ~ I � Yes – Go to next question 

start again? 2 � No — Skip to question 57 

.—. ——— ——— ————————— —————— ——— ——— ————— ——__________________ —___ -___ ——. _ 

56. How long before death did the person stop w 

smoking? 

Time before death (For example: 3 years or 2 months) 

~7. Did the person ever regularly.use chewing tobacco? I-!.zU 1 � Yes — Go to next question 

2 � No — Skip to question 60 

,————-— ————————————————————————————-— ——-— ———-— ———-— ————- ——————————— 

58.	 How long did he or she regularly use chewing IxS_l 

tobecco? Years 

Enter years or mark (X) the box. x � Less than 1 year 

.—————————————— —————— ———-————-————— —— ——————————————————-————--— ——

59.	 When he or she was regularIy using chewing ~ , � 5 ormoretimes a day 

tobacco, on tha average, how often did the 2 � 3—4times a day person use it? 

30 l—2 times a day 

Mark (X) only one box. 4 � 3—6 times a week 

5 � 1 or 2 times a week 

6 � ~ to 3 times a month 

7 � Less than once a month 

60. Did the person ever regularly use snuff? I 12e 

I � Yes — Go to next question 

2 � No — Skip to question 63 on page 76 

,—— ——____— ___ ————_ ——————————_ —————— 

ET------------------------------ 61. How long did he or she ragularly use snuff? 

Enter years or mark (X) the box. Years 

x � Less than 1 year 

.————-___— ____ —___ —___ ——_————__———- ——___—__———__————————————- -— ——-. 

62.	 When he or she was regularly using snuff, on wlm~ or more times a day 

the average, how often did the person use it? 20 3–4times a day 

Mark (X) only one box. 30 l—2times a day 

4 � 3—6 times a week 

5 � 1 or 2 times a week 

6 � 1 to 3 times a month 

7 � Less than once a month 

TJRM NMF-1 (5-2-86) 

54 
------------------

PART C – LIFE STYLE AND HEALTH – Continued 

;3.	 In the person’s entire adult life, did he or E&l 

she have at least 12 drinks of any kind of I � Yes — Go to next question 

alcoholic beverage, such as beer, wine, 2 � No — Skip to question 66 or liquor? 

-. —————— ————————___— ———____—____ —__ 

;4,	 On the average, during adult life, how often m-----------------------------­

did he or she drink any alcoholic beverages, I � Every day 

such as beer, wine, or liquor? 2 � 3 to 6 times a week 

Mark (X) only one box. 3 � 1 or 2 times a week 

4 � 1 to 3 times a month 

5 � Less than once a month 

—————— ————————— ——-———— ——— ——— ——— ———

;5.	 On the days that the person drank, how m:-;;--;-:;;:: 

many drinks did he or she have on the 

average, per day? 2 II Seven to eleven 

Mark (X) only one box. 3 � Five or six 

4 H Three or four . 

5 � Two 

6 II One 

;6, Over the last 10 years (and not counting the I 132 

last illness), did the person exercise vigorously 

at least three times a week, for at least 20 I � Very regularly 

minutes each time? 2 � Not very regularly 

(For example: running, swimming, bicycling, 3 � Hardly at all or never 

walking briskly, aerobic exercise, etc. ) 

Mark (X) only one box. 

55 
PART D – CHARACTERISTICS OF PERSON 

!. Did the person EVER work at a paying job or a 133 I � Yes — Go to next question 

business full or part time? 2 � No — Skip to question 8 

z. Of all the PAiD jobs or businesses the person ever W 

had, what KIND OF WORK did he or she do the 

longest? (For example, electrica/ engineer, stock 

clerk, typist, farmer, in Armed Forces, etc.) 

___----___ ---_ -:--___ -_--__ :.:----m-;i-L:;:;a;iie-yiir__________________ 

3. Fokio;,many years did the person do thm kmd 

Mark (X) only one box. 

4.€In this occupation, what KIND OF BUSINESS OR 

INDUSTRY did he or she work in the longest? 

Describe the activity at the location whare 

employed. (For example: TV and radio 

manufacturing, retail shoe store, State Labor 

Department, farm, Armed Forces, etc.) 

5.€Was the person employed at a paying job or 

business up until the time he or she died? 

.——————————— —————— ——— —- ——— —————— ———

6. Why did the person stop working? ~ 

Mark (Xl only one box. 

—————————————————— ——— ——— ——— ——— ——— —

2 � 1 to less than 5 years 

3 � 5 to less than 10 years 

4 � 10 to less than 20 years 

5 � 20 to less than 30 years 

6 � 30 to less than 40 years 

7 � 40 years or more 

136 j 

137 I I � Yes — Skip to question 8 

2 � No — Go to next question 

——————————————————— - . . ..-- ——-—-----

1 � Because of a health problem or disability 

2 � Because of loss of job 

3 � Normal retirement 

4 � Other reason — Specify ~ 

7. How long before death was the last time the 

person worked at a paying job or business 

(full or part time)? 

(For example: 3 years or 2 months) 

8. Did the person’s husband or wife ever work at 

a paying job or business full or part time? 

if married more than once, answer for 

most recent husband or wife. 

9.€Of ail the PAID jobs or businesses the person’s 

husband or wife ever had, what KIND OF WORK 

did the husband or wife do the longest? (For 

example, electrical engineer, stock clerk, typist, 

farmer, in Armed Forces, etc.) 

.———————___________ ———_____________ 

! 0.€In this occupation, what KIND OF BUSINESS OR 

INDUSTRY did the husband or wife work in the 

longest? Describe the activity at the location 

where employed. (For example, TV and radio 

manufacturing, retail shoe store, State Labor 

Department, farm, Armed Forces, etc.) 

IRM NMF-1 (5-2-86) 

m--------------------------------

Time before death 

140 

1 � Yes — Go to next question


20No

3 � Never married } 

Skip to question 77 on page 78


] 141 I 

___________________________________ 

M 
PART D – CHARACTERISTICS OF PERSON – Continued 

11. What was the size of the family during most of II!@ 

1985? (Include the person and all of his or her o ❑ Person lived in nursing home, other health 

re[atives living in the same household.) facility, or other institution during most 

Mark (X) only one box. 

Iz. What was the family’s income in 1985? 

(Pleaseincludethe person’s income and the 

income of all other relatedpersonsliving in 

the same household as the nerson. Include 

money from jobs, social se;urity, retirement 

income, unemployment payments, public 

assistance;etc.Also includeincome from 

interest,dividends, net income from 

business,farm, or rent, and any other 

money income received.) 

Mark (X) only one box. 

of 1985 

I ❑ One (Person either lived alone or 

with unrelated persons) 

2 ❑ Two 

3 ❑ Three 

4 ❑ Four 

5 ❑ Five 

6 ❑ Six 

7 •l Seven 

8 ❑ Eight 

9 ❑ Nine or more 

.. 144 

1 ❑ Less than $5,000 

20 $5,000 — $6,999 

30 $7,000 – $8,999 

40 $9,000 — $10,999 

50$11,000 — $12,999 

6D $13,000 – $14,999 

7U $15,000 — $16,999 

SD $17,000 — $18,999 

9D $19,000 — $21,999 

100$22,000 – $24,999 

11 ❑ $25,000 and over 

13. Was the person ever on active duty in I_K_l 

the U.S. Armed Forces? I ❑ Yes — Go to next question 

2 ❑ No — Skip to question 15 

NOTE – Mark “No” if all of the active duty service 

was related to training in the National 

Guard or military reserve. 

—————— ——————————————— ——— ——— —————— — —— 

14. At the time of death, was the person on’full-time EiK-r;-;:s-------------------”-------­

active duty with the Armed Forces? 

20No 

15. Which category BEST represents I_MZ_J 

the person’s race? I ❑ American Indian, Aleut, or Eskimo 

2 ❑ Asian or Pacific Islander 

Mark (X) only one box. 3 ❑ Black 

4 ❑ White 

150 [6. Was this person of Spanish or Hispanic 

origin or descent? I •l Yes 

20No 

FORM NMF-1 (5-2-8 

57 
PART D – CHARACTERISTICS OF PERSON — Continued 

151
 17. M&oc&he person live with at the time I � Lived alone — Go to next question . 2 � Lived with other persons (List relationship for 

(If the person was living in an institution at each other person below, for example, the time of death, who did he or she live 

with BEFORE entering the institution?) 

If more room is needed to list additional 

persons, continue on the last page of 

this questionnaire. 

18.	 What was the highest grede or year of 

regular school the person ever completed? 

Mark (X) only one box. 

! 9,	 At the time of his or her death, what was 

the marital status of the person? 

husbend/wife, son, friend, etc.) ~ 

Person I Relationship 

H

i 152 11 

1 

153 2[ 

I 154 3 Ii 

41 

u156 5!

u157 6!

I 1581 7! [ I 

u
159 8;

160


I � Less than 5 years 

2 II 5-7 years 

3 � 8 years 

4 •l 9-11 years


5 � High school graduate


6 El 1-3 vears of colle9e


T•l 4 years of college or more


161 

I � Married – Skip to question 21 

2 � Widowed — Go to next question 

30 Divorced 

Skip to question21 40 Separated } 

50 Never married — Skip to question 26 on page 20 

162


20. About how long before the person’s death did 

the person’s husband or wife die? 

(For example: 3 years or 2 months) 

21,	 Counting all marriages which tha person 

may have had, for how many years 

ALTOGETHER was he or she married? 

Enter number or mark (X) the box. 

22.	 How many different persons was he or she 

ever married to during his or her entire life? 

23. What was the highest grade or year of 

regular school completed by the person’s 

husband or wife? 

If the person was married more than once, 

answer for the most recent husband or wife. 

Mark (X) only one box. 

)RM NMF-1 (5-2-86) 

Time before person’s death 

163


Years 

x � Less than 1 year 

I 164 

Number of different husbands or wives 

165


1� Less than 5 years 

2 II 5-7 years 

3 � 8 years 

40 9–1 1 years 

5 � High school graduate 

6 � 1 –3 years of college 

7 •l 4 years of college or more 

58 
————

PART D – CHARACTERISTICS OF PERSON – Continued 

166 J 24. While the person was married, did his or 

her husband or wife smoke at least , � Yes – Go to next question 

100 cigarettes? 2 � No — Skip to question 26 

If the person was married more than once and 

any of the husbands or wives smoked at least 

100 cigarette, mark “Yes”. 

25. On the average, how many cigarettes a I 167.1 

day did the person’s husband or wife 1 � Less than 5 cigarettes a day 

smoke? 20 5—14 aday 

If the person was married more than once, 3D I!j-zaaday 

answer for the most recent husband or 4~zs—sbaday 

wife who smoked. 5 � 35—44 a day 

6 � 45 or more a day 

26, In what year was the person’s natural [ 166 

father born? I I I I I 

If unsure, please give approximate year. I I Year of father’s birth 

169
 27. If the person’s natural father has died, how 

old was the father when the father died? 

Father’s age at death 

Give age or mark (Xl the box. 

x � Still living 

28. :o:::;:;7was the person’s natural 

170 I 

Year of mother’s birth If unsure, please give approximate year. 

29. if the person’s natural mother has died, how L!U-l 

old was the mother when the mother died? 

Mother’s age at death 

Give age or mark (X) the box. x � Still living 

30. I)):h:t::&kn’s natural father ever have a 1 172 

I � Yes — Go to next question 

2 � No — Skip to question 32 

,———————————————————— ——— ———~———____ 

B-------------------------------- 31.	 About how old was the person’s natural father 

when he had his first heart attack? 

If unsure, please give approximate age. Age of father 

32. ::$:~~e::$:a~wal mother ever I 174 1 

1 � Yes — Go to next question 

2 � No — Skip to question 34 on page 27 

————. —————————.————— ———————------ -—— 

33.	 About how old was the person’s natural mother m-------------------------------­

when she had her first heart attack? 

If unsure, please give approximate age. Age of mother 

FORM NMF-1 (5-2-861 

59 
----------------------------------------------------------------

PART D – CHARACTERISTICS OF PERSON — Continued 

]4, How many brothers who lived to be 25 yeers old 176 

or older did the person have? Number of brothers — Go to next 

(Do not include half, step, or adoptiva brothers.) question 

Enter number or mark (X) the box. o � None — Skip to question 37 

.—— ————————_______________________ 

]5. :::a;~tiya::~he person’s brothars aver had m-----------------------------’-

Number who had 

(Count only brothers who lived to ba at a heart attack – Go to next question 

least 25 years old.) o � None — Skip to question 37 

Enter number or mark (X) the box. 

-——- -. 

16. :Ia;ol::;: these brothers when they had a 

. 

For each brother who had a heart attack, 

enter that brother’s age when he had the EEl Brother’s age at time of heart attack 

first heart attack. 

m Brother’s age at time of heart attack 

If unsura, give approximate ages. 

m Brother’s age at time of heart attack 

m Brother’s age at time of heart attack 

m Brother’s age at time of heart attack 

m Brother’s age at time of heart attack 

]7. How many sisters who lived to be 25 years I 184 I 

old or older did the person hava? 

Number of sisters – Go to next 

(Do not include half, step, or adoptive sisters.) question 

Enter number or mark (X) the box. o � None — Skip to question 40 on page 22 

—————————————————————————————————— 

18. How many of the person’s sisters ever m---------------------------’--’ 

had a heart attack? Number who had 

(Count only sisters who Iivad to be at a heart attack — Go to next question 

least 25 years old.) o � None — Skip to question 40 on page 22 

Enter number or mark (X) the box. 

_____________________________________________________________________ 

39.	 ~iay::dc:: these sisters when they had a 

. 

For each sister who had a heart attack, 

enter that sister’s age when she had the m Sister’s age at time of heart attack 

first heart attack. 

If unsure, give approximate ages. 

H Sister’s age at time of heart attack 

m Sister’s age at time of heart attack 

m Sister’s age at time of heart attack 

m Sister’s age at time of heart attack 

m Sister’s age at time of heart attack 

RM NMF-1 (5-2-861 

60 
PART D – CHARACTERISTICS OF PERSON – Continued 

192 10.	 At the time of death, what was the total value 

of things (including a home if any) owned by o� Zero net worth (or loss) 

tha person (and husband or wife)? ICI $1 – 44,999 

Subtract any debts and mortgages. Include cash in 

bank accounts, stocks, bonds, cars, jewelry, 

business interests, etc. 

If unsure, please make your best estimate. 

Mark (X) only one box 

!1.	 Is there anyone eke who might be able to add to 

the information you gave on this questionnaire? 

!2.	 Sometimes particular questions are not clear to 

the person answering them. Would you plaase 

give us your name and telephone number so that 

we can call you in case we have some 

questions? 

20 $5,000– $24,999 

3 � $25,000— $49,999 

4 � $50,000— $99,999 

5 � $1 00,000—$249,999 

6 � $250,000—$499,999 

7 •l $500,000 or more 

� Yes –	 What is his or her name, address, 

and telephona number? 7 

� No – Go to next question J 

~Name 

I 

I Address (Number and street) 

I 

I City or Post Office 

I 

j State ZIP Code 

I 

Area code Telephone number 

Un Un-urn 

� No telephone 

/ Your name 

I 

Area code Telephone number 

m Un-m 

� No telephone 

Please go to tha next paga, read and complate the authorization. ~ 

1 193 

I 

1 194 

I 

I 

196 I 

I 197 

FORM NMF-1 (5-2-S6) 

61 
AUTHORIZATION TO OBTAIN INFORMATION 

FROM MEDICAL RECORDS 

1 hereby give my consent for hospitals, nursing homes, 

and other medical sources that maintain records on the 

person named below to provide the required information 

to the National Center for Health Statistics through the 

U.S. Bureau of the Census. I understand that the 

National Center for Health Statistics will use this 

information only for statistical purposes and no 

information which identifies me, the person named 

below, or the medical source will ever be released or 

published. 

(Today’s date) (Your signature) 

(Relationship to the deceased) 

(Name of the deceased. Please print) 

This authorization expires one year from date of signature. 

Please return this antire quastionnaira to the 

Bureau of the Census in the envelope provided. 

THANK YOU VERY MUCH FOR YOUR COOPERATION. 

FORM NMF-1 [5-2-86) 

62 
Reviews of


New Reports


From the CENTERS FOR DISEASE CONTROL AND PREVENTION/National Center for Health Statistics


The National Mortality Followback Survey: 

1986 Summary for the United States 

Series 20, No. 19 

(PHS) 92-1856 

Authofi Seeman, 1, 

For information contact: 

Kathi Brannan


Scientific and Technical Information Branch


6525 Belcrest Road, Rm. 1064


Hyattsville, MD 20782


Tel: (301) 436-8500


The National Center for Health 

Statistics has just released a report 

that provides national estimates of 

the incidence of significant 

characteristics of adults who died in 

the United States in 1986. The 

report, “National Mortality 

Followback Survey: 1986 Summary, 

United States” presents data on the 

use of health services, disabilities, 

lifestyle practices that may affect 

health and mortality, and 

socioeconomic circumstances for the 

adults that were studied, 

Selective information from this 

survey has been weighted and is 

presented in 81 comprehensive tables. 

The data have been arranged into 

three categories: health care in the 

last year of life, lifestyle and heakh, 

and socioeconomic characteristics of 

decedents. 

~$ w.wcr$, 

According to the section on 

health care, some institutional care in 

the last year of life – in either a 

hospital or nursing home –was 

required for 81.1 percent of the 

decedents. Medicare covered 72.9 

percent of all decedents and 92,3 

percent of those age 65 and over. 

Even with coverage, about 12 percent 

of the elderly had somewhat serious 

to very serious problems with 

payments of medical bills, 

In the section on lifestyle, the 

incidence of heart attacks at some 

time during a lifetime was reported 

for 29.2 percent of the decedents; 

whereas, the incidence of Alzheimer’s 

disease and other memory 

impairments was 11.2 percent. 

According to the study, approximately 

55.6 percent of the decedents smoked 

at least 100 cigarettes and 71.9 

percent drank at least 12 alcoholic 

drinks in a lifetime, Approximately 

16.9 percent of the decedents had 

exercised vigorously at least three 

times a week for at least 20 minutes 

each time, while 66.4 percent of the 

decedents hardly or never exercised. 

According to the section on 

socioeconomic characteristics, 27,2 

percent of the decedents lived alone; 

“forwomen it was 35.9 percent and for 

men 19.1 percent. Educational 

attainment was at the elementary 

school level for 32.5 percent of the 

decedents; the high school level for 

42.1 percent; and the college level for 

17,7 percent. Approximately 86.2 

percent of the decedents worked at 

some time during their lifetime, and 

13.1 percent of the decedents worked 

until the time of death. 

The data presented in this report 

are from the fifth survey in a series of


National Mortality Followback


Surveys (NMFS) conducted by


NCHS, The 1986 NMFS data were


collected from 16,598 informants; 81


percent of whom were the next of kin


or another close relative of the


decedent. Information about the


decedent secured from informants


was supplemented by data collected


from hospitals, nursing homes, and


other health care facilities in which


the decedent spent at least one night


during the last year of life.


Copies of the report can be 

purchased from the U.S. Government 

Printing Office by completing the 

order form on the back of this 

release, 

‘U.S. Government Prlnllng office 1993 — 242-327/80006 

~+ %.. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

g’ Public Health Service 

$s $ Centers 

National 

for Disease 

Center for 

Control 

Health 

and 

Statistics 

Prevention CDC cwrEiw FOR 0t5EAsE CONTROL ‘%,2 AND PREVENTION 
------------------------------------------------------------------------------------------------------ --------------

Mail to: Publication Order Form Superintendent of Documents 

Government Printing Office 

Washington, D.C. 20402 

� YES,€ please send me copies of 

GPO Stock Number 017-022-01170-1 Price $15.00 

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PERMiT No, G-281 
Vital and Health Statistics 

series descriptions 

SERIES 1. 

SERIES 2. 

SERIES 3. 

SERIES 4. 

SERIES 5. 

SERIES 6, 

I SERIES 10, 

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I 

I 

SERIES 11. 

SERIES 12, 

SERIES 13. 

Programs and Collection Procedures –These reports 

describe the data collection programs of the National Center 

for Health Statistics. They include descriptions of the 

methods used to collect and process the data, definitions, 

and other material necessary for understanding the data. 

Data Evaluation and Methods Research-These reports 

are studies of new statistical methods and include analytical 

techniques, objective evaluations of reliability of collected 

data, and contributions to statistical theory. These studies 

also include experimental tests of new survey methods and 

comparisons of U.S. methodology with those of other 

countries. 

Analytical and Epidemiological Studies-These reports 

present analytical or interpretive studies based on vital and 

health statistics. These reports carry the anaiyses further than 

the expository types of reports in the other series. 

Documents and Committee Reports–These are final 

reports of major committees concerned with vital and health 

statistics and documents such as recommended model vitai 

registration laws and revised birth and death certificates. 

International Vital and Health Statktics Reports –These 

reports are analytical or descriptive reports that compare U.S. 

vital and heaith statistics with those of other countries or 

present other international data of relevance to the health 

statistics system of the United States. 

Cognition and Survey Measurement–These reports are 

from the National Laboratory for Collaborative Research in 

Cognition and Survey Measurement. They use methods of 

cognitive science to design, evaluate, and test survey 

instruments. 

Data From the National Health Interview Survey-These 

reports contain statistics on illness; unintentional injuries; 

disability: use of hospital, medical, and other health services; 

and a wide range of special current health topics covering 

many aspects of health behaviors, health status, and health 

care utilization. They are based on data collected in a 

continuing national household interview survey, 

Data From the National Health Examination Survey, the 

National Health and Nutrition Examination Surveys, and 

the Hispanic Heaith and Nutrition Examination Survey– 

Data from direct examination, testkg, and measurement on 

representative samples of the civilian noninstitutionalized 

population provide the basis for (1) medically defined total 

prevalence of specific diseases or conditions in the United 

States and the distributions of the population with respect to 

physical, physiological, and psychological characteristics, 

and (2) analyses of trends and relationships among various 

measurements and between survey periods. 

Data From the Institutionalized Population Surveys – 

Discontinued in 1975. Reports from these surveys are 

included in Series 13. 

Data From the Nationai Health Care Survey–These 

reportscontain statisticson health resourcesand the public’s 

use of health care resources including ambulatory, hospital, 

and iong-term care services based on data collected directly 

from heaith care providers and provider records. 

SERIES 14.	 Data on Heaith Resources: Manpower and Faciiities– 

Discontinued in 1990. Reports on the numbers, geographic 

distribution, and characteristicsof health resources are now 

inciuded in Series 13. 

SERIES 15.	 Data From Special Surveys-These reports contain 

statistics on health and health-reiated topics coiiected in 

speciai surveys that are not part of the continuing data 

systems of the National Center for Heaith Statistics. 

SERIES 16.	 Compilations of Advance Data From Vital and Health 

Statistics –Advance Data Reports provide eariy reiease of 

information from the Nationai Center for Health Statistics’ 

health and demographic surveys. They ara compiled in the 

order in which ttiey are pubiished. Some of these reieases 

may be foiiowed by detaiied reports in Series 10-13. 

SERiES 20. Data on Mortaiity–These reports contain statistics on 

mortaiity that are not inciuded in regular, annuai, or monthly 

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

demographic variabies, and geographic and trend analyses 

are inciuded. 

SERiES 21.	 Data on Nataiity, Marriage, and Divorce-These reports 

contain statistics on nataiity, marriage, and divorce that are 

not inciuded in regular, annuai, or monthiy reports. Speciai 

anaiyses by heaith and demographic variabies and 

geographic and trend anaiyses are inciuded. 

SERIES 22.	 Data From the Nationai Morfaiity and Natallty Surveya– 

Discontinued in 1975. Reports from these sample surveys, 

based on vital records, are now pubiished in Series 20 or 21. 

SERiES 23.	 Data From the Nationai Survey of Famiiy Growth –These 

reports contain statistics on factors that affect birth rates, ‘ 

inciuding contraception, infertility, cohabitation, marriage, 

divorce, and remarriage; adoption; use of medical care for 

family planning and infertili~ and related maternai and infant 

health topics. These statistics are based on national surveys 

of childbearing age. 

SERIES 24.	 Compilations of Data on Natailty, Mortaiity, Marriage, 

Divorce, and induced Terminations of Pregnancy– 

These include advance reports of births, deaths, marriages, 

and divorces based on final data from the Nationai Vital 

Statistics System that were pubiished as supplements to the 

Mont/r/y Vita/ Statistics Report (MVSR). These reports provide 

highlights and summaries of detaiied data subsequently 

published in Vita/ Statistics of the United States. Other 

supplements to the MVSR published here provide seiected 

findings based on final ‘data from the Nationai Vital Statistics 

System and may be followed by detailed reports in Series 20 

or 21. 

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

in these series, contact 

Scientific and Technicai information Branch


National Center for Health Statistics


Centers for Disease Controi and Prevention


Public Health Service


6525 Balcrest Road, Room 1064


Hyattsviiie, MD 20782


(301) 436-8500

,.. .,. -

,,’ 

DEPARTMENT OF


HEALTH &HUMAN SERVICES


Public Health Service


Centers for Disease Control and Prevention


National Center for Health Statistics


6525 Belcrest Road


Hyattsville, Maryland 20782


OFFICIAL BUSINESS


PENALTY FOR PRIVATE USE, $300


1 

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m I 

DHHS Publication No. (PHS) 93-1305, Series 1, No. 29