Vital and

HealthStatistics

Plan and Operation

of the NHANES I

Epidemiologic Followup

Study, 1986

Series 1:

Programs and Collection Procedures

No, 25

This report describes the plan and operation for the 1986 data collection

wave of the Epidemiologic Followup to the first National Health and

Nutrition Examination Survey (NHANES l). Tracing and data collection were

conducted on 3,980 persons 55–74 years of age at NHANES I who were not

known to be deceased in the 1982–84 data collection wave of the

NHANES I Epidemiologic Followup Study,

US. DEPARTMEM OF HEALTH AND HUMAN SERVICES

Public Health Setvice

Centers for Disease Control

National Center for Health Stafistks

Hyaftsville, Maryland

September 1990

DHHS Publication No. (PHS) 90-1307
Copyright information 

All material appearing III this report IS in the public domaln and may 

be reproduced or copled without permission, cltatlon as to source 

however, IS appreciated 

Suggested citation 

Flnucane FF. Freid VM, Madans JH, et al Plan and operation of the 

NHANES I Epldemlologvz Followup Study. 1986 NatIonal Center fat 

Health Statistics Vital Health Stat 1125) 1990 

Library of Congress Cataloging-in-Publication Data 

Plan and operatton of the NHANES I Epldemlo!ogic Followup Study 

1986. 

By F.F. Flnucane. [et al.] 

P cm - (Vltal and health statlstlcs Serves 1, Programs 

and collectlon procedures no 25) (DHHS publlcatlon no (PHS) 

go- 1307) 

Includes blbllographlcal references 

ISBN o-8406-0433-5 

1 Nattonal Health and Nutrltlon Examtnation Survey (U S) 

Eptdemlologlc Foliowup Study 2 Health surveys-Unlted States 

3 Unlted States-Statistics, MedIcal I Flnucane. F F 

II National Center for Health Statlstlcs (U S) III Series 

IV Series. DHHS publlcatlon no (PHS) 90-1307 

[DNLM. 1 NatIonal Health and Nutrltlon Examination Survey (L. S) 

Epldemlologlc Followup Study 2 Epldemlologlc Methods 3 Health 

Surveys-Unlted States 4 Nutrmon Surveys-Unlted States W2 A 

N148va no 25) 

RA409 U44 no 25 

IRA407 31 

362 1’0723 s- dc20 

[362 1’0723] 

DNLM/DLC 

for Library of Congress go-5727 

CIP 
National Center for Health Statistics

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

Robert A. Israel, Depu~ Direcfor

Jacob J. Feldman, Ph.D., Associate Direcfor~orAna@is

and EpidemioIogv

Gail F. Fisher, Ph.D., Asociafe Direcfor~or Planning and

iZ?ramurc71Programs

Peter L. Hurley, Associate Direc[orfor Vital and Health

Statistics SJsfems

Stephen E. Nieberding, Associafe Direcfor for Management

Charles J. Rothwell, Associate Director for Dafa Processing

and Senices

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

and Methodology

David L. Larson, Assiskwf DirecfoC A(lanta

Division of Analysis

Joel C. Klcinman, Ph.D., Director

Jennifer Madans, Ph. D., Dcpu(y Director

Jennifer Madans, Ph.D., Acting Chiej Demographic

A@ysis Stqf

Diane M. Makuc, Dr.P.H., Chiej Ana&fical Coordination

Branch

Sandra T. Rothwell, Chiej Longi[udinul Analysis Branch

Division of Epidemiology and Health Promotion

Ronald W. Wilson, Director

Patricia M. Golden, Special Assistant

Diane K. Wagener, Ph.D., ChieJ Environmental Nudies

Branch

Ronald W. Wilson, Acting ChicJ Health Status

Measurement Branch
Acknowledgments

The 19S6 data collection wave of the Epidemiologic

Followup to the first National Health and Nutrition Examination Survey (NHEFS) could not have been accomplished

without the valuable contribution and assistance of many

individuals and groups. Space does not permit the authors

to recognize all the persons who participated in the planning, development, and conduct of the 1986 data collection

wave; nonetheless, they are grateful for the support they

received, and apologize to those they have omitted.

Dr. Joan Cornoni-Huntley, Ph.D., M.P.H., of the National Institute on Aging, deserves special recognition for

the important role she has played in the development and

continuation of the study. Without her persistence as advocate for this study and her dedication in seeking financial

support, NHEFS would not have been conducted. NHEFS

was initiated jointly by the National Institute on Aging and

the National Center for Health Statistics, and has been

developed and funded by the following Federal agencies:

. National Institute on Aging

. National Center for Health Statistics

●

●

●

●

●

●

●

●

●

●

●

National Cancer Institute

National Institute of Child Health and Human

Development

National Heart, Lung, and Blood Institute

National Institute on Alcohol Abuse and Alcoholism

National Institute of Mental Health

National Institute of Diabetes and Digestive and Kidney Diseases

National Institute of Arthritis and Musculoskeletal and

Skin Diseases

National Institute of Allergy and Infectious Diseases

National listitute of Neurological and Communicative

Disorders and Stroke

Centers for Disease Control

U.S. Department of Agriculture

The 1986 survey was conducted by Westat, Inc., of

Rockville, Maryland, under a contract with the U.S. Department of Heakh and Human Services (contract No.

937-0134) and was directed by Thomas McKenna and

Diane Cadell at Westat, Inc.

,..

Ill
Contents

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

NHANESI (1971-75) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ;

1982–84 Followup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Study design and tracing activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Sludy design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Tracing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Imsttofollowllp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Interview data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Interview procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Questionnaire types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Questionnaire content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Interview nonresponse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Heahhcare facilities data collection process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Identification ofstayreports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Facility data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Matching records . . ...’..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Results of the health carefacility data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Death certificate collection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

19S6 analytic cohort .,....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Ongoing activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Appendixes

L Stuclyrnaterials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

11. Corrections and revisions tothe NHANESI baseline data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lj3

List of text figures

1. Followups of the NHANES I Epidemiologic Followup Study cohort: 14,407 subjects 25–74 years of age at

NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2. Summary of data collection inthe NHANES IEpidemiologicFollowup Study (NHEFS), 19S6 . . . . . . . . . . . . . . . . 2

3. Intewiew schedule for the NHANES I Epidemiologic Followup Study (NHEFS), 19S6. . . . . . . . . . . . . . . . . . . . . . . 10

4. Questionnaire topics in the NHANES I Epidemiologic Followup Study (NHEFS), 1986 . . . . . . . . . . . . . . . . . . . . . i 11

5. Survey period, respondent recall period, and facility abstract request period, by previous interview status:

NHANESI EpidemiologicFollowup Study (NHEFS), 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

6. Health care facility record layout: NHANES 1 Epidemiologic Followup Study, 19S6 . . . . . . . . . . . . . . . . . . . . . . . . . 16

7. Examples of matching process and record status codes: NHANES I Epidemiologic Followup Study, 1986 . . . . . . . 17

List of text tables

A. Number ofsubjects andpercent distribution ofrespondents bystatus atfollowupin theNHANES IEpiclemiologic

Followup Study, 19S6F0110wup cohort, according to race, sex, andageat NHANES I . . . . . . . . . . . . . . . . . . . . . . . 7

v
B. Odds ratios, confidence intervals, and statistical significance for selected health characteristics on loss to followup

for the NHANES I Epidemiologic Followup Study (NHEFS), 1986 Followup cohort. . . . . . . . . . . . . . . . . . . . . . . . . 8

C. Number and percent of traced members of the NHANES I Epidemiologic Followup Study (NHEFS), 1986

Followup cohort without a completed interview, by vital status at 1986 NHEFS, and by race, sex, and age at

NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

D. Number of facility stays, distribution of subjects by number of stays, mean number of stays, and percent of traced

cohort with at least one stay in the NHANES I Epidemiologic Followup Study (NHEFS), 1986 Followup cohort, by

race, sex, and age at NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

E. Number and percent of record status codes for the NHANES I Epidemiologic FoUowup Study (NHEFS), 1986

Followup cohort, byrace, sex, and age at NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

F. Number of deaths and percent of decedents without an available death certificate among the NHANES I

Epidemiologic Followup Study (NHEFS), 1986 Followup cohort, by race, sex, and age at NHANES 1 . . . . . . . . . . 20

G. Subject status at the NHANES I Epidemiologic Followup Study, 1986, compared with subject status at the

NHANES I Epidemiologic Followup Study, 1982–84, for all subjects 55 years of age and over at NHANES I . . . 21

H. Number and percent distribution of subjects by status at followup in the NHANES I Epidemiologic Followup

Study, 1986 analytic cohort, byrace, sex, andageat NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

J. Odds ratios, confidence intervals, and statistical significance for selected health characteristics on loss to followup

for the NHANES I Epidemiologic Followup Study, 1986 analytic cohort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . 22

K. Number of deaths and percent of decedents without an available death certificate among the NHANES I

Epidemiologic Followp Study, 1986 analytic cohort, by race, sex, and age at NHANES I . . . . . . . . . . . . . . . . . . . . 23

Symbols

..- Data not available

. . . Categoiy not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

* Figure does not meet standard of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
Plan and Operation of

the NHANES I

Epidemiologic Followup

Study, 1986

by Fanchon F. Finucane, M. H.S., Virginia M.

Freid, M,S., Jennifer H. Madans, Ph.D.,

Christine S. Cox, M.A., Joel C, Kleinman, Ph. D.,

Sandra T. Rothwell, M.P.H., Helen E.

Barbano, M.S.P.H., Jacob J. Feldman, Ph. D.,

Office of Analysis and Epidemiology

Background

The NHANES I Epidemiologic Followup Study

(NHEFS) is a longitudinal study that uses as its baseline

those adult persons 25–74 years of age who were examined

in the first National Health and Nutrition Examination

Survey (NHANES I) (l–3). As shown in figure 1, NHEFS

comprises a series of followup surveys, three of which have

been conducted. The first wave of data collection, the

19S2–S4 NHEFS, included all persons who were 25-74

years of age at their NHANES I examination (n =14,407).

This series report focuses on the tracing and data collection

of the second wave, the 19S6 Followup. This second data

collection wave was conducted for the members of the

cohort who were 55–74 years at their baseline examination

and not known to be deceased at the 1982–84 NHEFS

(n =3,980). The third wave of data collection took place in

1987. An attempt was made to recontact the entire nondeceased NHEFS cohort (n = 11,750) at that time. A plan to

recontact the entire nondeceased NHEFS cohort in 1991 is

currently under review.

NHANES I collected data from a national probability

1–74 years of age (l–3). The survey, which included a

standardized medical examination and questionnaires that

covered various health-related topics, took place from 1971

through 1974 and was augmented by an additional national

sample in 1974-75. NHANES I included 20,729 adult

persons 25–74 years of age, of whom 14,407 (70 percent)

completed a medical examination.

Although NHANES I provided a wealth of information

on the prevalence of health conditions and risk factors, the

cross-sectionrd nature of the original survey limits its usefulness for studying the effects of clinical, environmental,

and behavioral factors and in tracing the natural history of

disease. Therefore, NHEFS was designed to investigate the

association between factors measured at baseline and the

development of specific herdth conditions. Specifically, the

three major objectives of NHEFS are to study the

following:

. Morbidity and mortality associated with suspected risk

factors

. Changes over time in participants’ characteristics, such

sample of the U.S. civilian non-institutionalized population as blood pressure and weight

NHANES I FOIIOWUP wave

examination

1971-75 19B~-a4 1986 1967

~:( g;, - ::; +R+c

L

n = j4,4~7

Figure 1. Followups of the N HANES I Epidemiologic Followup Study cohort: 14,407 subjects 25-74 years of age at NHANES I

1
. The natural history of chronic disease and functional

impairments

While NHANES I obtained information gathered from

physical exams, laboratory tests, and interviews, NHEFS is

primarily a series of interview surveys that rely on selfreporting of medical conditions. Attempts were made, however, to supplement the followup interview information in

the NHEFS with health care facility medical records and

death certificates.

NHEFS originated as a joint project between the Nationil Center for Health Statistics and the National Institute on Aging. It has been funded primarily by the National

Institute on Aging, with additional financial support from

the following components of the National Institutes of

Health and other Public Health Service agencies: the National Cancer Institute; the National Institute of Child

Health and Human Development; the National Heart,

Lung, and Blood Institute; the National Institute on Alcohol Abuse and Alcoholism; the National Institute of Mental

Health; the National Institute of Diabetes and Digestive

and Kidney Diseases; the National Institute of Arthritis and

Musculoskeletal and Skin Diseases; the National Institute

of Allergy and Infectious Diseases; and the National Institute of Neurological and Communicative Disorders and

Stroke. All of these agencies were involved in both developing topics important to their specialty areas and designing procedures to collect data that would address these

This series report is devoted to the plan and operation

of the 1986 Followup, which collected information on

changes in health and functional status since the study’s last

contact with the older members of the NHEFS cohort. It

was restricted to those subjects (individuals examined in

NHANES I) who were at least 55 years of age at their

NHANES I examination (n = 5,677). They represent almost 40 percent of the entire NHEFS cohort. As shown in

figure 2, this portion of the NHEFS cohort included 1,697

subjects who were deceased at the time of the 1982–84

NHEFS’ and 3,980 subjects who were not known to be

deceased at the time of the 1982–84 NHEFS. Tracing and

data collection in the 19S6 Followup were undertaken only

for the 3,9S0 subjects in the latter group, regardless of their

tracing or interview status in 1982–S4. Hereinafter, they

will be referred to as the “19S6 Followup cohort.” The

remaining 1,697 subjects who were deceased at the time of

the 1!382-S4 NHEFS were excluded from additional data

collection in the 1986 NHEFS and were not included as

part of the 19S6 FoUowup cohort. For analytic purposes,

though, information collected for this group in the 19S2–84

NHEFS may be used in conjunction with the information

collected in the 19S2–S4 NHEFS and 19S6 NHEFS on

subjects who were part of the 19S6 Followup cohort.

KI’tuoughoutthisreport,the term “19S2-84 NHEFS” is synonymouswith

“19S2-84 Followup,” and the term “1986 NHEFS” is synonymous with

issues. “1986 Fdowqu” -

NHEFS, 1986 FOllOWUfl

5,677 subjects

55 years and over

at NHANES I examination

100.0 percent

~ ~

1,697 deceased in 3,980 not deceased in

1982-84 NHEFS 1982-84 NHEFS and

29.9 parcent eligible to be

recontacted in 1986

NHEFS

70.1 percent

3,767 traced 213 lost tO followup’

3,132 suruiving 635 deceased

83.1 percent 16.9 percent

-

3,027 interviewed 105 not interviewed 562 proxy Interviews 1g proxy

96.6 percent

54 death

3.4 percent with death interviews certificates

certificate only only

88.5 percent 3.0 percent 8.5 percent

2,558 participated 469 did not

in interview participate in

84.5 percent interview (intetview

conducted with proxy)

15.5 percent

‘1 10 [51.6 percenl) of 213 had been successfully traced in the 1982-84 NHEFS; 103 (4B.4 percent) of 213 were lost to followup also in Ihe 1982–S4

NHEFS.

Figure 2. Summary of data collection in the N HANES I Epidemiologic Followup Study (N HEFS), 1986

2
Tracing of subjects in the 1986 Followup began in late 1982-84 FOI]OWUP

19S4, Interview data were collected during three pretests in

1985 followed by a main survey period in 1986. As of July

28, 1986, the end of the 1986 NHEFS survey, 3,767

(94.6 percent) of the 3,980 members of the 1986 Followup

cohort had been successfully traced. Interviews were conducted for 3,608 subjects (95.8 percent of those successfully traced). In addition, 5,405 facility stay records were

collected for 2,021 subjects using information obtained

from the interview, death certificate, or some other source.

Death certificates were obtained for 616 (’37.0 percent) of

the 635 subjects who were known to have died since last

contact.

To use the 1986 Followup study data most effectively,

it is necessa~ to understand the study design and procedures of NHANES I and the 1982–84 Followup of the

NHEFS. A brief overview of these two surveys is provided

below. More detailed information on these surveys is presented in other publications (14).

NHANES I (1971-75)

NHANES I was designed to collect extensive demographic, medical history, nutritional, clinical, and laboratory

data on a probability sample of the civilian noninstituticmalized population of the United States (l–3). The survey was

a multistage, stratified probability sample of clusters of

persons 1–74 years of age. It was conducted in 1971–74 and

was extended in 1974-75 by an additional sample of adult

persons, called the “Augmentation Survey” (3). The

NHANES I survey design included oversampling of certain

population subgroups, including persons living in poverty

areas, women of childbearing age (2544 years of age), and

elderly persons (65 years of age and over). A sub sample of

6,913 adult NHANES I participants 25–74 years old, called

the “detailed sample,” consisted of a random subsample of

subjects examined in 1971-74 and all subjects in the Augmentation Survey. Persons included in the detailed sample

were examined in greater depth and provided with additional questionnaire items. More information on the sampling frame and survey instruments used for the detailed

sample may be found in the plan and operation series

reports for the NHANES I survey (l-3).

As a result of these varied design features of

NHANES I, not all of the members of the NHEFS cohort

received the same questions or examinations at baseline.

For example, while all 14,407 adults in the NHEFS cohort

received the general medical examination, only those

11,34S adults who were not in the Augmentation Survey

were administered nutrition questionnaires at NHANES I.

Similarly, the 6,913 participants included in the detailed

sample may have been administered supplementary

questionnaires (for example, arthritis, cardiovascular, or

respiratory questionnaires), depending on their responses

to screening questions.

The 1982–84 Followup was the first data collection

wave of the NHEFS series (4). It included 14,407 persons

25–74 years of age when they were examined in NHANES I

(1971-75). Tracing of subjects began in 19S1 and data

collection was conducted from 1982 to 1984. At the close of

data collection in August 19S4, 93 percent (n = 13,383) of

the study population had been successfully traced.

The basic design of the 19S2–84 NHEFS consisted of

the following components:

● Tracing subjects or their proxies to a current address

● Acquiring death certificates for deceased subjects

. Performing in-depth interviews with subjects or with

their proxies including, for surviving subjects, taking

pulse, blood pressure, and weight measurements

. Obtaining hospital and nursing home records, including pathology reports and electrocardiograms

No attempt had been made to recontact any of the

NHANES I examinees until the inception of the 19S2-S4

Followup. Thus, the first step of the Followup was to trace

and locate all subjects in the NHEFS cohort and determine

their vital status. Tracing sources included criss-cross and

city directories, telephone cent acts, direct mail, U.S. Post

Office address information requests, National Death Index

(5) checks, State department of motor vehicle listings, State

vital statistics files, and field visits to neighbors at lm.t

known address. A subject in the NHEFS cohort was considered successfully traced if he or she (or another informant, if the subject was deceased or was incapacitated iind

thus unable to be contacted) responded correctly to a set of

verification questions establishing the subject’s identity, AH

subjects whose vital status could not be determined were

considered lost to followup. A subject’s death had to be

confirmed by means of either a death certificate or proxy

interview.

The information collected during tracing relating to the

death of a subject was used to request a copy of the death

certificate from the appropriate State vital statistics office.

Death certificates were obtained for 1,935 of the 2,022

decedents by the end of the 1982–84 survey period. (An

additional 33 death certificates for 19S2–S4 NHEFS decedents were received after the closeout of the 19S2-S4 data

collection period. These death certificates are included on

the Mortality Data Public Use Tapes for followup waves

subsequent to the 19S2–S4 NHEFS. For more information,

see the 19S6 NHEFS Mortality Data Public Use Tape

Documentation.) Efforts continue to locate all missing

death certificates.

During tracing, efforts were made to obtain a current

address for surviving subjects and to identify a knowledgeable proxy respondent for deceased subjects and for surviving subjects who were incapacitated and unable to

participate in the 19S2–S4 NHEFS. Respondents (that is,

subjects or proxies who provided followup information)

who were identified and located through the tracing

3
procedure were then contacted and asked to participate in

an interview. In a few cases (n = 65), subjects who had

been traced successfully could not be relocated for the

interview. Only their vital status and the date when they

were last traced in the 1982–84 survey period are available.

An attempt was made to interview all subjects (or their

proxies) identified during tracing. Interviews were conducted wherever the subject resided, including at nursing

homes, prisons, and mental health facilities. Occasionally

interviews were conducted at some other convenient location (for example, a parent’s home). In most inslances,

however, the proxy interviews for deceased subjects were

conducted over the telephone.

The interview was designed to gather information on

selected aspects of the subject’s health history since the

time of the NHANES I examination. This information

included a history of the occurrence or recurrence of

selected medicd conditions; an assessment of behavioral,

social, nutritional, and medical risk factors believed to be

associated with these conditions; and an assessment of

various aspects of functional status. Whenever possible, the

questionnaire was designed to retain item comparability

between NHANES I and the 1982–84 NHEFS in order to

measure changes over time. However, questionnaire items

were modified, added, or deleted when necessary to take

advantage of current improvements in questionnaire methodology, Physical measurements (blood pressure, pulse

rate, and weight) were obtained from surviving subjects

near the end of the interview.

Interviews with the subject or a proxy were colIected

for 84.8 percent (n = 12,220) of the original NHEFS

cohort, or 91.3 percent of those successfully traced. Interviews were conducted for 10,523 (92.6 percent) of the

11,361 surviving subjects, of which 256 were administered

to a proxy respondent because the subject was incapacitated. Proxy interviews were obtained for 1,697

(83.9 percent) of the 2,022 deceased subjects.

Information on overnight stays in hospitals and nursing

homes was elicited during the interview for the period from

1970 to the time of the 1982–84 NHEFS. Interviewers

recorded the full name and address of the health care

facility and the approximate date of the stay. At the conclusion of the interview, respondents were asked to si~ a

medical authorization form that would be used to request

the release of information from the subject’s medical

records. These authorization forms were retained on file,

and a photocopy was sent to each health care facility that

the respondent had identified during the interview.

The health care facility data collection took place from

April 1983 through August 1984. Hospitals and nursing

homes in which stays had been reported (through interviews, death certificates, and other sources) were contacted

and asked to abstract information from their records for all

stays occurring between January 1 of the yeru of the

person’s NHANES I examination up to the date of the

followup interview. The major items requested were the

dates of admission and discharge, the discharge diagnoses

(if requesting from a hospital) or admitting diagnoses (if

requesting from a nursing home), and information on any

procedures that may have been performed.

4
Study design and

tracing activities

The 1986 Followup was conducted to extend the followup period for the older NHEFS population. The main

objectives of the 1986 Followup were as follows:

. To continue monitoring changes over time in health,

functional status, and utilization of hospitals and nursing homes

. To track the incidence of vtiious medical conditions

Because the recontact for this Follownp occurred on the

average of only 3 years after the 1982+4 Followup, the

ability to successfully retrace subjects and to have respondents accurately recall the subject’s overnight health care

facility stays since last contact was improved.

The 1986 Followup was restricted to 5,677 NHEFS

subjects who were 55 years and over at the time of their

NHANES I examination (almost 40 percent of the entire

NHEFS cohort). Tracing and data collection in the 1986

Followup were undertaken for only a portion of these

subjects, who are referred to as the 19S6 Followup cohort.

The 1986 Follownp cohort consisted of the 3,980 subjects

ages 55 years and over at IWWNES I who were not known

to be deceased in the 1982–84 NHEFS, regardless of

whether they had been successfully traced or interviewed in

1982–84. No additional interview or heilth care facility stay

information was collected in the 1986 NHEFS for the 1,697

subjects who were 55 years and over at NHANES I and

known to be deceased at the time of the 1982-84 NHEFS

even if, in 1982–84, a proxy interview had not been conducted or collection of health care facility records had not

been undertaken for the decedent.

Study design

The design and data collection procedures adopted in

the 1986 Followup were very similar to the ones developed

in the 1982–84 study Subjects (or their proxies) were

traced, subject and proxy interviews were conducted, and

health care facility abstracts and death certificates were

collected. A major difference between the 1982–84 and

1986 NHEFS waves, however, was the manner in which the

interviews were conducted. In the 1982–84 NHEFS, the

2-hour subject interview usually was conducted in person;

in the 1986 NHEFS, each interview averaged 30 minutes

and was conducted primarily by telephone. In addition,

because the questionnaire was not administered in person,

no physical measurements were made in the 1986 NHEFS.

Copies of all pertinent study materials (tracing materials, a

brochure, letters, questionnaires, authorization forms, and

health facility data collection forms) can be found in

appendix I.

Each survey component (tracing, interviewing, collecting hospital and nursing home records, and obtaining death

certificates) conducted in the 1986 NHEFS represents a

separate survey activity with its own set of procedures for

data collection, processing, and reporting. However, the

information gathered for any one survey component was

used to direct activities in other components. Thus, data

horn different survey components were intended to be used

together when appropriate. Figure 2 summarizes the results from the data collection procedures for the 1986

NHEFS. The flow chart shows the relationship behveen

each of the data collection activities (except for the health

care facility record collection) and provides information on

the number of subjects in each component.

Tracing

Tracing began in November 1984 and was conducted

on all 3,980 subjects 55 years and over at their NHANES I

examination who were not known to be deceased in the

19S2–84 NHEFS. Because the validity of longitudinal studies depends on the completeness of followup, a large variety

of tracing sources was used to trace subjects in the 1986

Followup. For example, throughout the tracing process,

periodic matches were made of all nondeceased NHEFS

participants to the National Death Index (5) and to the

enrollee file of the Health Care Financing Administration.

The majority of the tracing in the 1986 NHEFS was

conducted by dividing the 19S6 FoUowup subjects into two

groups based on their vital status in the 1982-84 NHEFS.

Subjects who had been successfully traced alive in the

19S2–S4 NHEFS underwent one set of tracing procedures

while subjects who had not been successfully traced in the

1982–84 NHEFS underwent another. The tracing procedures used for each group are discussed in the following

paragraphs. Subjects and proxy respondents who were identified and located through the tracing procedure were then

contacted by telephone or mail (if a telephone number was

not available) and asked to participate in an interview.

Retracing subjects traced successfully in

the 1982–84 NHEFS

Of the 3,980 subjects not known to be deceased in

19S2–S4 NHEFS, 3,766 had been successfully traced and

found to be alive in 19S2–S4. They include all subjects in

5
the 1982–84 NHEFS who were coded as “l” (“Alive”) on

the 1982–84 NHEFS Vital and Tracing Status Public Use

Data Tape. Of these 3,766 subjects, 3,659 (97.2 percent)

were successfully traced again in the 1986 Followup.

The first step in retracing each subject was to contact

directory assistance in the area in which the subject had

been living during the 1982–84 Followup. Subjects were

considered successfully retraced if their first and last names

and either the address or telephone number recorded in

their 1982–84 NHEFS tracing records matched the information provided by directory assistance. Subjects with

matching information on first and last name but who had a

different address and a different telephone number were

designated as “possible matches.” Information on the verification of possible matches is found later in this section.

When efforts using directory assistance failed to produce a conclusive match, other tracing sources were used.

They included post office address inquiries, submission of

the person’s Social Security Number to the Social Security

Administration, and calls to the tracing reference provided

in the 1982–84 NHEFS (typically, a person not living in the

subject’s household at the time of the 1982–84 NHEFS). In

addition, persons included in the baseline or 1982–84

NHEFS household composition lists were contacted, if

available, to locate the subject, All subjects identified

through these additional tracing sources were considered

“possible matches.”

Tracing subjects not traced successfully

in the 1982-84 NHEFS

A different set of tracing sources was used to trace the

remaining 214 subjects in the 1986 Followup cohort who

had not been successfully traced in the 1982-84 NHEFS.

This group includes all subjects who had a problematic vital

status in the 1982–84 NHEFS. It consists of 202 subjects

who were never successfully traced during the 1982–84

NHEFS (coded as “4” ~’Unknown”) on the 1982-84

NHEFS Vital and Tracing Status Public Use Data Tape)

and 12 subjects who were initially traced in the 1982–84

NHEFS but subsequently lost prior to the 1982–84 interviewing period (coded as “5” (“Traced alive but lost prior

to interview period”) on the 1982–84 NHEFS Vital and

Tracing Status Public Use Data Tape). For analytic purposes, the latter 12 subjects are considered successfully

traced in the 19S2–84 NHEFS because they were contacted

during the survey period. Because of their problematic vital

status in the 19S2–84 NHEFS, however, they were not

grouped for tracing purposes in the 1986 Followup with the

other 3,766 subjects who were considered successfid]y

traced alive in the 1982-84 NHEFS.

Of the 214 subjects, half (n = 10S) were successfully

traced in the 1986 Followup using the following prescribed

tracing procedure. The first step was to contact directory

assistance in the area where the subject had last been

known to live to determine whether he or she had returned

to that area. Other tracing sources used after the directory

assistance inquiries included motor vehicle office and credit

bureau checks for male relatives and spouses of

6

female subjects who were included on the household composition listings obtained in NHANES I. Furthermore,

criss-cross directory searching was undertaken to locate

residents living on the block where the subject was last

known to have resided. When found, these persons were

contacted to determine whether they were familiar with the

subject and, if so, whether they knew the whereabouts of

the subject. A subject identified through any of these

tracing sources was considered a possible match.

Verification of possible matches

Respondents for possible-matched subjects were contacted and administered a tracing questionnaire to veri~

the subject’s identity. A subject who was a possible match

was considered successfully traced if he or she or a proxy

respondent (in the case the subject was deceased or incapacitated and unable to be interviewed) correctly responded to a set of verification questions used to establish

the subject’s identity. (If the respondent did not have a

telephone, he or she was sent a mail update form to

complete.) Once the name of the subject was verified, the

respondent had to correctly supply at least two of the

following three items:

●

●

●

Subject’s date of birth. Date of birth was considered

verified if the subject’s month, day, and year of birth

matched exactly the information obtained at last contact (that is, either baseline or the 1982–S4 NHEFS,

depending on whether the subject had been successfully traced in the 1982–84 NHEFS). However, if only

the month and day matched, the birth year had to be

within 2 years of the year listed in the tracing records

for the date of birth to be considered verified. In some

cases, a proxy respondent was administered the questions and did not know the subject’s date of birth. This

item, however, was considered verified if the age provided by the proxy for the subject was within 2 years of

the deceased subject’s age at death or of the surviving

subject’s current age, as determined from the subject’s

tracing file. If the proxy did not know the subject’s age,

the interviewer requested the name of another proxy

respondent.

Subject’s address at time of 19S2-84 NHEFS. The address at the time of the 19S2–84 NHEFS was considered verified if the street name, city, and state reported

at last contact matched the information on record.

Street number did not need to match.

Household composition at last contact. Questions on

household composition were asked only if the subject’s

date of birth or address at the time of last contact did

not match information listed in the subject’s tracing

records. The household composition at the time of last

contact (either NHANES I or the 1982–84 NHEFS)

was considered verified if the respondent recalled the

name and relationship of at least one household member. If the respondent reported that the subject lived

alone and this agreed with the information in the

tracing records, this also was considered a match.
Lost to followup

All subjects who could not be located through the

tracing procedures were considered lost to followup in the

1986 NHEFS. In 53 cases, even though information about

the death of a subject was obtained from a former neighbor, a relative, or another tracing source, that subject was

considered lost to followup because the information was

not verified by means of a proxy interview or a death

certificate. A subject’s death had to be confumed by either a

death certificate orproq interview.

There were two groups of subjects who were considered alive for analytic purposes in the 1986 Followup but

who are assigned a special 1986 Followup vital status code.

The first group consists of 12 subjects who were initially

traced alive in the 1986 NHEFS but were subsequently lost

prior to the 1986 interviewing period, Only their vital status

and the date when they were last traced in the 1986 survey

period are available. The second group includes six subjects

for whom a direct confirmation of vital status was not

obtained, due to a failure to follow tracing procedures

properly. They are identified by a 1986 NHEFS vital status

code of “7:’ The date when they were last known alive is

the date that tracing was conducted. Aalysts may want to

consider these six subjects lost to followup. However, the

authors feel that the available data indicate that there is a

high probability that these subjects were alive at the time of

tracing in the 1986 NHEFS.

As of July 28, 1986, the end of the 1986 survey,

94.6 percent (n = 3,767) of the 3,980 subjects in the 1986

Followup cohort had been successfully traced (see

figure 2). Only 107 (2.8 percent) of the 3,766 subjects who

had been traced alive in the 1982–84 NHEFS were not

successfully traced in Lhe 1986 NHEFS, and 106

(49.5 percent) of tie 214 not successfully traced in the

1982-84 NHEFS again were not successfully traced in the

1986 NHEFS.

The success of the tracing efforts in the 1986 Followup

according to age at baseline examination, race, and sex are

given in table A (see appendix II for discussion of age,

race, and sex variables). To summarize how these demographic factors were related to tracing success, a multiple

logistic model was fitted to the cross-classification of age at

baseline examination, race, and sex, with the proportion of

Table A. Number of subjects and percent distribution of respondents by status at followup in the NHANES 1 Epidemiologic Followup

Study, 1986 Followup cohort, according to race, sex, and age at NHANES 1

Sfatus al followup

All Lost !0 All Lost iO

Race, sex, and age~ sub]eck Sui-vlvlng Deceased rollowup sub]ecls Survivlrrg Deceased foilowup

Number

All racesz

Male:

55-64 yeare . . . . . . . . . . . . . . .

65-74 yeare . . . . . . . . . . . . . . .

Female:

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

6%74years . . . . . . . . . . . . . . .

White

Bolh sexes . . . . . . . . . . . . . . . . .

Male:

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

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

Female:

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

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

Black

Bolh sexes . . . . . . . . . . . . . . . . .

Male

55-64 yeare . . . . . . . . . . . . . . .

65-74 yeare . . . . . . . . . . . . . . .

Female:

55-64 yeara . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . .

Olher

Bolh saxes . . . . . . . . . . . . . . . . .

Male:

5%64years . . . . . . . . . . . . . . .

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

Female:

55-64 yeare . . . . . . . . . . . . . . .

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

3,980 3,132 635 213

677 573 74 Xl

1,001 674 261 66

864 769 56 39

1.438 1,116 244 78

100.0 76.7 16.0 5.4

100.0

100.0

64.6

67.3

10.9

26.1

4.4

6.6

100.0

100.0

89.0

77.6

6.5

17.0

4.5

5.4

3,364 2,697 524 143 100.0 80.2 15.6 4.3

592

826

508

570

63

215

21

41

100.0

100.0

85.0

69.0

10.6

26.0

3.5

5.0

734

1,212

6EQ

960

48

198

27

54

100.0

100.0

89.B

79.2

6.5

16.3

3.7

4.5

520 414 106 6a 100.0 70.2 113.3 11.5

73

168

57

98

9

45

7

25

100.0

100.0

78.1

58.3

12.3

26,8

9.6

14.9

127

222

107

152

8

46

12

24

100.0 84.3 6.3 9.4

100.0 66.5 20.7 10.8

100.0 60.8 11.5 7.7

100.0 66.7 16.7 16.7

100.0 05.7 14.3

100.0 lm.o

100.0 100.0

26 21 3 2

12

7

El

6

2

1

2

3

4

3

4

—

1.See appendix II for a discussion of revised race, corrected sex, ard recalculated age at NHANES 1.

‘Inchdes racesOlherIhanwhileor black.

NOTE The 19Be Followup cohort conslsls of 3,eE0 sub]ecls, 55 years and over at NHANEa 1,who were MI krrown to be deceased In Ih 19B244 NHEFS.

7
subjects who were lost to followup representing the dependent variable. The analysis was limited to black and white

respondents, because there were few subjects of other races

(n = 26). Age at baseline examination was categorized into

two groups (55–64 and 65–74 years). Interaction terms

were deleted from the saturated model to develop the

simplest model that would fit the data. The smallestp value

(probability) for a deleted term was .48. The final model

included main effects for race (p < .0001), sex (p = .3811),

and age at baseline examination (p = .0676). The results

fkom the multiple logistic regression indicated that black

persons in the 1986 Followup cohort were 2.9 times more

likely to be lost to followup compared with their white

counterparts. Because the proportion lost to followup in

the 1986 Followup cohort is relatively small compared with

the proportion deceased (0.05 versus 0.16, respectively),

there should, however, be relatively little bias in mortality

findings as a result of loss to followup.

Analysis using a multiple logistic regression was conducted to determine whether those persons lost to follow-up

were at relatively high risk of death. The regression model

included six health characteristics measured during

NHANES 1 (in addition to age at baseline examination,

race, and sex) that have been established as risk factors for

mortality: high blood pressure (systolic blood pressure of

140 millimeters of mercury or higher), high cholesterol

(260 milligrams per 100 milliliters or higher), overweight

(for men, a body mass index greater than or equal to 27.8

kilograms per meter squared; for women, a body mass

index greater than or equal to 27.3 kilograms per meter

squared),b history of heart attack, history of diabetes, and

smoking status (current smoker, current nonsmoker, or

unknown).

The results of the multiple logistic regression are presented in table B. The baseline risk factors of high cholesterol, elevated blood pressure, overweight, and history of

heart attack did not have a statistically significant effect on

loss to followup. Of the six baseline risk factors, diabetes

and smoking had the strongest effect on Ioss to followup:

diabetics and current smokers were more than twice as

likely to be lost to follow-up compared with nondiabetics

and current nonsmokers (p = .0165 and p = .0055, respectively). Because both of these characteristics are associated with mortality, the results from this analysis suggest

that those subjects who were lost to followup in the 1986

NHEFS may be more likely to have died compared with

those who were successfully traced.

Table B. Odds ratios, confidence intervals, and statistical

significance for selected health characteristics on loss to

followup for the NHANES I Epidemiologic Followup Study

(NHEFS), 1986 FoI[OWUf3 cohort

95-percenl confidence interval

Odds Lower Upper

Baseline characterklks rattb bound bound p value

High blood pressure. . . . . . . . 1.10 0,80 1.50 0.5616

High cholesterol . . . . . . . . . . 0.89 0.64 1.23 0.4661

Ovetwelght . . . . . . . . . . . . . 1.13 0.84 1.53 0.4257

History of heart allack. . . . . . . 1.07 0.60 1.89 0.8220

Dlsbeles . . . . . . . . . . . . . . . 1.79 1.11 2.88 0.0165

Smoking . . . . . . . . . . . . . . . 1.90 1.21 3.00 0.0055

NOTES The 1986 Followup cohort conslsls of 3,980 subjecls, ages 55 years ati over al

NHANES I examlnallon, who were nol known to be deceased In ths 1982-S4 NHEFS. Dafa

based on mulllple Ioglsllc regression wilh race, sex, and age at NHANES I examlnatlcm

Ineludszl.

%e thresholds For ovenveight represent the sex-specific 85th percentiles

for persons 2&29 years of age (excluding pregnant women) in the

1976-80 National Health and Nutrition Examination Survey (6),
Interview data

collection

Interview procedures

An attempt was made to obtain an interview for all

subjects who were successfully traced in the 1986 NHEFS.

The procedure used to obtain interviews in the 1986

NHEFS was similar to the one adopted in the 19S2-84

NHEFS:

. An advance letter describing the FOllOWLIpStudy was

sent to a surviving subject or a knowledgeable proxy

respondent (for a deceased subject or for a subject who

was incapacitated and unable to participate in the

interview), once that person was traced and located.

● The interviewer then called the subject or proxy to

schedule an appointment for the interview.

● In contrast to the 1982–84 interview procedures, the

1986 interview was administered by telephone (in

19S2–S4, the majority of the interviews were conducted

in person). When a telephone number was not available, the respondent was sent a mail questionnaire to

complete. Any overnight health care facility stays reported during the interview were recorded on a hospital and health care facility chart.

● At the end of the interview, the respondent’s address

was reconfirmed. This was done for tracing purposes as

well as to ensure that a medical authorization form

would be sent to the proper address to be signed and

returned. This form was used to request health care

facilities to release information from the subject’s medical records to the study. It was mailed out to the

respondent for his or her signature (or to a blood

relative if the proxy respondent was not related to the

subject) when at least one health care facility stay was

reported during the interview and was listed on the

subject’s hospital and health care facility chart.

The 19S6 NHEFS interviews were conducted over the

telephone using a computer-assisted telephone interviewing

(CATI) system. CATI allows the telephone interviewer to

enter the answers supplied by the respondent directly into

the computer. Thus, editing and coding time is reduced,

and keypunching from a hard-copy questionnaire is eliminat ed. A computer program drives the questionnaire so

that the correct skip patterns are followed and the appropriate questions are displayed on the computer monitor.

The skip patterns are based on information gathered either

from previous data collection waves or from responses

provided during the interview. For example, the questions

on pregnancy and menstrual history in the 19S6 interview

were programmed to be skipped automatically if the subject was male or if the female subject had had an interview

in 19S2–S4. Edit and logic checks are incorporated into the

data collection system itself, thus improving the quality of

the data.

Interview data were collected during three pretests in

1985 followed by a main survey period in 19S6. There were

167 interviews conducted during the pretests and 3,441

interviews during the main survey. AN interview data collected from the pretests and main survey are included on

the 19S6 Followup Interview Public Use Data Tape.

Figure 3 summarizes selected characteristics of the pretests and main survey. The appendixes in the Interview

Public Use Data Tape documentation provide a comprehensive outline of the differences between questionnaire

items in the pretest and main survey questionnaires.

Each pretest consisted of a nonrandom sample of

subjects from a preselected area in Pennsylvania who had

been successfully traced by the time of the pretest. The

main purpose of Pretests I and II was to evaluate and “fine

tune” the questionnaire prior to programming the CATI

system in Pretest Ill. The interviews in Pretests I and II

were conducted over the telephone using a paper version of

the respective pretest questionnaire for traced, surviving

subjects only. Pretest I was conducted from late February

19S5 to mid-March 1985. Interviews were obtained for 50

of the 73 subjects selected from the Pretest I area. After

Pretest I, several small modifications were made to the

survey instrument. It was then retested in Pretest II during

the second week of May 1985. Interviews were conducted

for 19 of the 27 subjects selected from the Pretest 11 area.

The CATI system was tested and implemented in

Pretest 111. This last pretest was conducted in two parts.

Interviews in the first part were conducted from midAugust to mid-September 19S5 for 77 of the 12S subjects

selected from the Pretest III area who had been traced

alive. In the second part, proxy interviews were conducted

for 21 of the 26 subjects from Pretest I, II, or III who had

been identified as deceased since last contact. These interviews were conducted from mid-September to early

October 1985.

The main data collection for the 19S6 Followup began

in mid-January 19S6, 3]%months after the completion of

the Pretest III interviews, and ended late-July 19S6. Field

9
.

Number of Method of Use

1986 NHEFS Interview Respondent interviews data of

component period characteristics conducted collection CA Til Comments

Pretest I

Pretest II

Pretest Ill

Parr 1

Part 2

Main suruey

Februa~ 22-

March 19. 1985

May 7-14, 1985

August 16–

September 1S, 1985

Septembar 20-

October 4, 1985

January 13-July 28,

Surviving subjects

from 3 NHANES I

sample areaa in

Pennsylvania

Surviving subjects from

3 NHANES I sample

areas in Pennsylvania

Surviving subjects frorh 2

NHANES I semple areas

in Pennsylvania

Proxies for eub]ects

known to be deceased

es of the 1986 NHEFS

and located in either

Pretest 1, 11,or Ill

Subjects (or their proxies)

1986 not interviewed during

Pretests L 11,or Ill

7Computar-assisted telaphone intewiewing (CATI) system.

50

19

77

21

3,441

Telephone No

Telephone NO

Telephone Yes

Telephone Yes

or mail

Interview conducted using

paper version of

questionnaire

Interview conducted using

paper version of

questionnaire

CATI system implemented

Mail questionnaire sent when

telephone number not available—l 4 mail questionnaires

were received and stored on

Interview tape; 25 of 3,427

telephone interviews not fully

completad but stored on

interview tape

Figure 3. Interview schedule for the NHANES I Epidemiologic Followup Study (NHEFS), 1986

work was conducted regionally by dividing the sample into

three regions, with the first region having the largest and

the third region having the smallest sample size. Each

region contained States from each time zone. Interviews

were collected for 3,441 subjects during the main survey

period, of which 3,427 (99.6 percent) were conducted by

telephone and 14 (0.4 percent) were conducted by mail.

Questionnaire types

The 19S6 NHEFS questionnaire was designed to

gather information on events that occurred since last contact regarding the subject’s living arrangement, occurrence

and recurrence of selected chronic diseases, functional

limitations, hospital and nursing home experience, and

utilization of community services. To retain item comparability between NHANES I, the 1982-84 NHEFS, and the

1986 NHEFS, a majority of the questions included on the

19S6 NHEFS questionnaire were the same as those used in

the 1982–84 NHEFS. Ques[ions on eorona~ bypass surgery, pacemaker procedures, and the utilization of community service were new to the 19S6 NHEFS.

As in the 19S2–S4 NHEFS, two versions of the questionnaire were used in the 1986 NHEFS: the subject cluestionnaire and the proxy questionnaire (see appendix I).

Surviving subjects were always administered the subject

questionnaire. If the subject was alive but incapacitated, a

slightly modified version of the subject questionnaire was

administered to a proxy respondent. A separate proxy

questionnaire was used only when the subject was

deceased. It consisted of a subset of the questions from the

subject questionnaire, with the addition of several questions

related to the subject’s death.

Note the distinction between aproxy respondent and the

proxy questionnaire. A proxy respondent was the informant

who answered questions when the subject was not able to

participate in an interview, either because the subject was

alive and incapacitated or because the subject was deceased. The proxy questionnaire, however, was the type of

questionnaire administered only to the person who responded for a deceased subject. A total of 1,050 proxy

respondents were interviewed in the 1986 NHEFS. Of

these, 469 responded for an incapacitated subject and were

administered a modified version of the subject questionnaire and 5S1 responded for a deceased subject and, thus,

were administered the proxy questionnaire.

Nearly all 3,60S interviews collected in the 1986

NHEFS were conducted by telephone. However, during the

main survey, when a subject or proxy could not be contacted by telephone, the respondent was mailed an abbreviated questionnaire (see appendix I). The mail

questionnaire for surviving subjects was designed to collect

information on (a) tracing for future recontacts; (b) subject’s current living arrangements and medical history since

last contact; (c) name and address of hospitals and nursing

homes in which the subject had stayed since last contact

and the admission date for each stay; and, (d) if an interview had not been ob[ained for the subject in 1982-S4, the

subject’s cigarette smoking and alcohol habits, and, if the

subject was female, reproductive and hormone use history.

10
The mail questionnaire sent to the proxy respondent when

the subject was deceased was designed to obtain the

necessary information on (a) the subject’s identity, (b) the

name and address of hospitals and nursing homes in which

the subject had stayed since last contact and the admission

date for each stay, and (c) the locality of the subject’s death.

Of the 65 questionnaires mailed to respondents in the

19S6 Followup, 14 (21.5 percent) were returned. Twelve

were collected from surviving subjects and two were collected from proxies for deceased subjects. Unlike the

1982–84 NHEFS, a returned mail questionnaire in the

19S6 NHEFS constitutes an interview, and data from the

mail questionnaires are included on the 1986 NHEFS

Interview Tape.

Questionnaire content

Both the subject and the proxy telephone questicmnaires were divided into sections according to topic area.

The major topics are summarized in figure 4. Where appropriate, entire sections or specific questions in some

sections were omitted from the proxy questionnaire. In

addition, certain sections in the questionnaire were included or omitted depending on whether an interview had

been collected for the subject in the 1982-84 NHEFS.

Part A of the subject and proxy questionnaires included questions on the subject’s household composition

and marital status. The subject’s race was ascertained only

if the subject had not had an interview in the 1982–84

NHEFS.

Part B of the subject and proxy questionnaires contained a self-reported history of selected medical conditions. Specific questions were asked on arthritis, gout, h art

‘i attack, coronary bypass surgery, pacemaker procedures,

small stroke, stroke, cancer, hypertension, diabetes, hip ~nd

other bone fractures, pneumonia, flu, and other types of

surgeries. The proxy questionnaire also included sevmal

questions in part B that pertain to the subject’s place of

death,

The wording of the medical condition questions in

part B generally depended on whether the subject had had

an interview in the 1982–S4 NHEFS and, if so, whether a

specific medical condition had been reported for the

subject during that interview. If a certain medical condition

had been reported in the 19S2-84 NHEFS, the respondent

in the 1986 interview was asked to recall any recurrences of

that medical condition since the date of the 19S2–84 interview. The respondent was asked to recall whether a doctor

had ever told the subject that he or she had the medical

condition in question if (a) the condition had not been

reported in the 1982–84 NHEFS interview, (b) the condition was never asked about in the 19S2–84 NHEFS interview, (c) the subject denied that he or she had reported that

condition in the 1982–84 NHEFS interview, or (d) an

interview had not been conducted for the subject in

1982-84.

Respondents also were asked to provide information

on any overnight health care facility stays for any of the

medical conditions reported in the interview. If the subject

had had an interview in the 1982-84 NHEFS, the respondent in the 1986 NHEFS was asked to recall any overnight

hospitalizations for the medical conditions of interest since

1980. If the subject had not had an interview in the 1982–S4

NHEFS, then the interviewer asked the respondent to

recall any overnight stays since 1970. In the case where the

respondent reported that the subject was first told about

having the medical condition of interest before 19S0 and

that information contradicted information stored in the

CATI system obtained from the 19S2–84 NHEFS interview, he or she was asked to provide information on all

overnight stays since 1970 for that condition.

The beginning of the respondent recall period was

defined as either 1970 or 1980 rather than the date of the

subject’s most recent interview (that is, baseline examination or 1982–84 NHEFS) for two reasons. First, the beginning of a decade may be an easier reference point for

recalling events rather than the date of the subject’s most

recent interview. Second, given that respondents might have

difficulty recalling exact dates of facility stays, increasing

the length of the recall period maximizes the probability of

collecting information on health care facility stays that

occurred since the date of the subject’s most recent

interview.

Demographic . . . . . . . . . . . . . . . . . . . Living arrangement, household composition, marital status

Medical history . . . . . . . . . . . . . . . . . Arthritis, heart attack, stroke, diabetes, hypertension, cancer, olher chronic conditions: bone fractures

Health care facility stays. . . . . . . . . History of overnight hospital and nursing home stays since Iasl contact

Func~ional statusl . . . . . . . . . . . . . . Activities of daily living

Cigarette smokingz. . . . . . . . . . . . . . History of use

Alcoholic beverages. . . . . ., , . . . . Use in past year

,.

Weightl . . . . . . . . . . . . . . . . . . . . . . . History;z current weight

Vision andhearingl . . . . . . . . . . . . . Cataracts, correc~ive lenses: hearing acuily

Female medical history2 . . . . . . . . . Hormone use, pregnancies, births

Community servicesl . . . . . . . . . . . . Use of community programs for the elderly in past year

Death information. . . . . . . . . . . . . . . Locality of subject’s deeth

OtherI . . . . . . . . . . . . . . . . . . . . . . . . Activity level, urinary incontinence, changes in memory

llnformadon collected only if tha subject was alive at the time of tha 1986. NHEFS.

‘Information collacled only if the suh]ect had not had an intaruiew in the 1 9S2–04 NHEFS survey period.

Figure 4. Questionnaire topics ht the NHANES I Epidemiologic Followup Study (N HEFS), 1986

11
M overnight stays in health care facilities reported

during the interview were recorded onto the hospital and

health care facility chart. The full name and address of the

health care facility, date of admission, and reason(s) for the

admission were obtained from the respondent for each stay

and transcribed onto the chart.

Part C of the subject questionnaire concerned functional impairment. Several questions were first asked on

paralysis, amputation, and severe arthritis of the limbs. The

battery of functional limitation questions consisted of a

modified subset of items from the Fries Functional Disability Scale for arthritis (7), the Resow-Breslau Scale (8), and

the Katz Activities of Daily Living Scale (9). The questions

were designed to measure the subject’s level of difficulty

in doing a set of everyday activities without the help of

another person or mechanical device. Information was also

collected on whether help had been received and how this

help affected the subject’s ability to perform the activity.

Thus, this information could be used to measure the impact

of disease on functional ability as well as the actual functional level as affected by the receipt of help or use of

devices. The items could thus be grouped in different ways

to investigate different aspects of functional status. Part C

was omitted from the proxy questionnaire.

Part D consisted of questions pertaining to the subject’s smoking and drinking habits. The questions were

designed to obtain a brief histov of the subject’s lifetime

cigarette smoking behavior and an overview of the subject’s

alcohol consumption in the past year. These questions were

asked of the respondent only when a subject interview had

not been conducted in the 19S2-S4 NHEFS.

Part E contained questions for surviving subjects on

physical activity, memory 10ss, urinary incontinence, and

current body weight. A series of questions regarding the

subject’s weight history also was included in part E for

those subjects missing a 1982–S4 NHEFS interview. Part E

was not included in the proxy questionnaire.

Part F consisted of questions designed to measure the

subject’s visual and auditory abilities. Questions on cataract

surgery were also included. Part F was omitted from the

proxy questionnaire.

Part G contained questions on female medical history,

including pregnancy and menstrual history and use of birth

control pills and postmenopausal hormones. The questions

in part G were asked only of female subjects (or their

proxies) who had not had an interview in the 19S2-84

NHEFS.

Part H contained questions designed to measure the

subject’s utilization of community services, such as senior

citizen centers, visiting nurse services, and adult day care

centers. This section was omitted from the proxy

questionnaire.

Part I in the proxy questionnaire included questions

designed to facilitate the receipt of the subject’s death

certificate in each case where the death certificate had not

yet been received. It was also designed to obtain information on another person who could act as a proxy if the

current proxy was not able to answer all the questions

during the interview. Part I in the subject questionnaire

contained a question to obtain the subject’s Social Security

Number, if it had not been obtained previously in 19S2-S4.

Part J was used to confirm the name and address for

future tracing purposes of all persons who participated in

the interview (for example, subject, proxy, or assistant).

Confirmation of name and address was also done so that a

medical authorization form could be sent to the proper

address to be signed and returned. The form was used to

request health care facilities to release information from

the subject’s medical records to the study. It was sent to the

subject or proxy (if the proxy was related to the subject and

the subject was either deceased or too ill to sign the form)

to obtain his or her signature when at least one health care

facility stay was reported and listed on the subject’s hospital

and health care facility chart. When the proxy respondent

was not related to the deceased subject or to the incapacitated subject who was unable to sign the medical authorization form, an attempt was made in part J to identify a

relative who could sign the form. The section of this report

entitled “Health care facilities data collection process”

provides more detail on the medical authorization forms

and their effects on receipt of information from health care

facilities.

Part K was used by the interviewer to give his or her

impressions regarding the quality of the interview and

responses provided by the informant.

Interview nonresponse

By the end of the 19S6 NHEFS survey (July 28, 19S6),

interviews had been conducted for 90.7 percent

(n = 3)60S) of the 3,9S0 subjects aged 55 years and over at

NHANES I and not deceased in the 19S2–S4 NHEFS

(95.8 percent of those successfully traced). A total of 167

interviews were conducted during the pretest periods and

3,441 during the main survey period.

As shown in figure 2, an interview was conducted for

3,027 (96.6 percent) of the 3,132 surviving subjects, of

which 469 were administered to a proxy respondent because the subject was incapacitated. A proxy interview was

conducted for 5S1 (91.5 percent) of the 635 decedents

identified in the 19S6 NHEFS. In the 1986 NHEFS, only

3.4 percent (n = 105) of the traced, surviving subjects

were not interviewed. This nonresponse rate is one-half the

rate of 6.9 percent found among the survivors in the

19S2–84 NHEFS who were 55 years and over at their

NHANES I examination. Proxy interviews were not conducted for S.5 percent of decedents in the 19S6 NHEFS,

almost a 50-percent reduction from the 15.6 percent nonresponse rate for decedents in the 19S2-S4 NHEFS who

were 55 years and over at their baseline examination. The

shorter followup period probably contributed to the increase in response rate b~cause there was a greater likelihood of locating an appropriate proxy.

Table C shows the interview nonresponse rates for the

19S6 Followup by age at baseline examination, race, sex,

and vital status. The lower interview success rate in the

12
Table C. Number and percent of traced members of the

NHANES I Epidemiologic Followup Study (NHEFS), 19S6

Followup cohort without a completed interview, by vital status at

1986 NHEFS, and by race, sex, and age at NHANES I

SubJecis wlfhout complete Inlerviawi

Surviving Deceased

Race, sex, and agg Number Percent Number Percent

All racess

Both sexes . . . . . . . . . . . . . .

Male:

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

65-74 year3 . . . . . . . . . . .

Female:

55-64 year3 . . . . . . . . . . .

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

Whtla

Bolh sexes . . . . . . . . . . . . . .

Male:

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

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

Female:

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

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

Black

Bolh sexes . . . . . . . . . . . . . .

Male:

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

6E-74years . . . . . . . . . . .

Female:

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

65-74 yea fa . . . . . . . . . . .

105 3.4 54

17 3.0 6

26 3.9 20

23 3.0 5

39 3.5 23

86 3.2 45

15 3.0 6

20 3.5 14

19 2.9 5

32 3.3 20

17 4.1 8

2 3.5 -

4 4.1 5

4 3.7

7 4.6 3

8.5

8.1

7.7

8.9

9.4

8.6

9.5

6.5

10.4

10.1

7.4

11.1

6.5

1986 FolIowup for decedents compared with surviving subjects is apparent across the age-sex-race groups. This difference occurs partly because many of the decedents were

located from vital statistics files, and no proxy could be

identified.

To summarize how demographic factors relate to interview status, multiple logistic models were fitted to the

cross-classification of age at baseline examination, race, and

sex, with the proportion of 1986 Followup subjects without

an interview as the dependent variable. The analysis was

limited to only black and white respondents, because there

were few subjects of other races (n = 26). Age at baseline

examination was categorized into two groups (55–64 years

and 65–74 years). The final model for surviving subjects

includes only the main effect terms for race (p < .0001),

sex (p = .1877), and age at baseline examination

(P = .0045). Thus, among survivors, black persons were 2.4

times more likely than white persons and subjects 65-74

years at baseline were 1.4 times more likely than those

55-64 years not to have an interview in the 1986 Followup,

Anong decedents, there were no significant differences by

race, sex, or age at baseline examination in interview

response rates, although the numbers were quite small.

lThe19B6FOIIOV.Up COIWI COi-ISISIS01 3,e80 sub]ects, 55 years and over at NtlANEs [

examlr?allon,who were not known to ba deceased In the 1sS2-S4 NHEFS.Percents are

based on 3,1S2 survfvlng sub]ects and S35 deceased sublecls at tha Mm of 19ee NHEFS.

‘See appendix II for a discussion of revised race, correcied sex, aml recstcula[ed age al

NHANES L

‘%c!ades races olher than whl(e or black.

13
Health care facilities

data collection process

A major objective of the 19S6 NHEFS is the collection

of information on all overnight stays in health care facilities

for members of the 19S6 Followup cohort. The 19S6

Followup cohort consisted of the 3,980 subjects were who

at least 55 years of age at their NHANES I examination

and were not known to be deceased at the time of the

19S2–S4 NHEFS. Followup cohort members who have

either an interview or a death certificate on the 19S6

NHEFS data files were eligible for the health care facility

records component. The aim of this component was to

develop a complete set of health care facility (that is,

hospital and nursing home) records for each 19S6 Followup

cohort member. This was accomplished by identifying all

overnight stays in health care facilities through a series of

reporting mechanisms, Facilities were then con tatted to

obtain copies of medical records. Reports and medical

records were then linked, and the 1986 NHEFS Health

Care Facility Stay file was constructed. Critical time periods

for the collection of facility records in the 19S6 NHEFS are

illustrated in figure 5. The first panel of the fi~re pertains

to subjects with an interview in the 19S2–S4 NHEFS, the

second panel pertains to those without an interview since

NHANES I examination. The time line, the first line in

each panel of the figure, identifies the events or dates used

to define reference periods. Each line below the time line

defines the reference period for an individual aspect of the

facility data collection.

The 19S6 NHEFS Health Care Facility Stay file contains all information on overnight stays that are in scope for

the 1986 NHEFS period. The scope of the 1!3S6Follow-up

period is illustrated in the first line below the time line in

both panels of figure 5, For subjects with an interview

during the 1982-84 NHEFS, the 1986 in-scope survey

period is from the date of the 19S2–S4 interview to the date

of the 1986 interview for surviving subjects and from the

date of the 1982-84 interview to the date of death for

deceased subjects. The 1986 in-scope survey period for

subjects without an interview in the 19S2–S4 NHEFS is

from the date of NHANES I examination to the date of the

1986 interview for surviving subjects and from the date of

NHANES I examination to the date of death for deceased

subjects. Stays occurring prior to the in-scope period were

defined as out of scope for the 1986 survey, and attempts

were made to place them on the revised 19S2–S4 NHEFS

Health Care Facility Stay file if they were not already on

that file.

Identification of stay reports

Reports of overnight hospital or nursing home facility

stays were obtained from various sources. Most reports

were elicited through a series of detailed questions in parts

B and F of the interview. Generally, respondents were

asked to report all overnight facility stays since 19S0 if the

subject was last interviewed in the 19S2–S4 NHEFS or

since 1970 if the subject was last interviewed at NHANES I

examination. (See figure 5 for an example of the respondent recall period.) For respondents who provided inconsistent information during the 19S6 interview (that is,

information which contradicted the 1982-84 interview), the

respondent recall period was extended back to 1970. A

detailed discussion of inconsistent medical reports is provided in the previous section of this report.

The respondent recall period was defined to include

reports of facility stays that were technically out of scope

for the 19S6 NHEFS (that is, facility stays that occurred

prior to the date of last NHEFS interview). This was done

for two reasons. First, the beginning of the decade maybe a

more meaningful reference point for respondents than the

date of the last interview. Second, to the extent that subjects

misreport the dates of hospital or nursing home stays,

increasing the period of reporting will maximize the probability of collecting information on all in-scope 1986 facility

stays. The relationship between in-scope and respondent

recall periods is illustrated in figure 5. In addition to

interview information, data on facility stays were gathered

from other reporting sources: death certificate, tracing

sources, and other facility abstracts. At the conclusion of

the interview, authorization was obtained for permission to

contact facilities.

Facility data collection

For each stay reported during the interview, the name

and address of the facility, the reported dates of the stay,

and the reason for the stay were recorded on the hospital

and health care facility chart. (See appendix I.) A separate

log book was kept containing similar data for reports

gathered from the death certificates, tracing sources, and

other facility abstracts. All reports of facility stays were

compiled and entered into a computerized tracking system.

For each subject, the list of reported stays was checked

against the list of facilities that were contacted for the
Panel 1: Subjects with an interview during 1982-S4 NHEFS

For suwiving subjects:

Baseline 1986 NHEFS interview date (19S5-86);

examination 1982-E4 for deceased subjects

1970 1971-75 1980 NHEFS interview date of 19B6 NHEFS death

Time linO

Out-of-scope stays In-scope stays

\

1986 NHEFS survey period

/

~~or inconsistent medical 4-------------- ----------------------------------<

Respondent recall period \

reports, extended to 1970)

Abstract request period for

previously mportedfacilities *

4

Abstrect request period

forin-scopm stays *

Abstract request period for newly reported -“

facilities whan report date isin the1980”s

w

Abstract raque’st period for newly reported Facilities

4 \

when report date is in the 1970’s

Panel 2: Subjects without an interview during 1982–84 NHEFS

For surviving subjects:

Baseline 1986 NHEFS intarview date (19B5-B6);

examination for deceased subjacts:

1970 1971-75 date of 19B6 NHEFS death

Time line

Out-of-scope

stays In-scope stays

\

.

1986 NHEFS survey period

*

Respondent recall period

Abstract request period

-

Figure 5. Survey period, respondent recali period, and facility abstract request period, by previous interview status: NHANES I

Epidemiologic Followup Study (NHEFS), 1986

subject in the 1982–84 NHEFS. To avoid duplication with

the 1982–84 NHEFS Health Care Facility Stay file, reports

were deleted from the tracking system if the reported dates

of admission on the 1986 NHEFS were more than 1 year

prior to the 1982–84 NHEFS interview (that is, out of scope

for the 1986 NHEFS) and if that specific facility had been

contacted previously. This occurred when a respondent

reported being hospitalized since 1980 for a given condition

but when the reported date of admission is at least 1 year

prior to the 1982-84 interview. However, if the facility was

not contacted in 1982–84, it was contacted in 1986.

All facilities in which stays were reported were contacted by mail between September 1985 and June 1987 and

asked to review the subject’s medical records, to abstract

information on exact dates of admission, discharge, and

diagnoses, and to place the information on standard forms.

(See appendix I for copies of the facility contact letters and

the abstract forms.) Because many respondents may not

have remembered correctly the dates of hospitalizations,

the requests to the facilities did not specify the reported

dates of admission. Rather, facilities were asked to complete abstract forms for all stays since the date of last

15
NHEFS contact. In some cases, an out-of-scope report was

obtained for a facility that had not been contacted in the

1!382-84 NHEFS. When this occurred, the facility was

directed to either send all abstracts since 1980 if the

reported dates were in the 1980’s or since NHANES I

examination if the reports were in the 1970’s. The different

facility abstract request periods are illustrated in figure 5.

These procedures resulted in the receipt of previously

unobtained abstracts that were out of scope for the 1986

survey but in scope for the 1982–84 NHEFS. The revised

1982–84 NHEFS Health Care Facility Stay file will include

these records. In addition to completing abstract forms,

heakh care facilities were requested to submit photocopies

of selected sections of the subject’s inpatient record; for

example, the “facesheet,” the discharge summary, the

third-day electrocardiogram (for myocardial infarction diagnoses, code 410 in the Intemationol Classification of

Diseases, 9th Resision, Clinical ModiJcotion (lCD-9-CM)

(10)), and pathology reports (for any admission where a

new mrdignancy was diagnosed).

Matching records

As the abstracts were received, they were checked

against report information in the tracking system to determine whether the abstract “matched” any of the reported

stays. Date of admission and diagnosis were used as matching criteria but exact matches on date or diagnosis were not

required for a stay to be considered matched. Abstracts

were matched to reports if the reported date of admission

was within a year before or after the actual date of admission and if one reported reason for admission involved the

same body system as the diagnoses present on the abstract.

Because the matching rules allowed for an admission date

of up to 1 year before or after the reported date of

admission, some abstracts are present on the file with a

match record status and an out-of-scope report date. These

records are identified by a type C flag in position 199 of the

file, Cases that did not meet the matching criteria were

reviewed by National Center for Health Statistics staff and

matched when appropriate.

Each record on the file represents an overnight facility

stay. Therefore, one record or more will exist for some

1986 Followup cohort subjects, while other subjects will

have no records on the file. The structure of the data file

reflects the system used to obtain and process stay information. The record is divided into four major sections: (a) the

report section, (b) the record status section, (c) the abstract

section, and (d) the related stay section. A example of the

record layout is provided in figure 6.

The first section of the record is the report section,

which contains information from the reporting source as

well as stay identification numbers assigned by the National

Center for Hea.h% Statistics. The record status section

contains a code for the result of the abstract request—that

is, match or nonmatch status. The abstract section contains

the information obtained fi-om the facility records including

actual dates of admission, discharge, and diagnoses. The

diagnoses on the abstracts were coded using the InternationalClassification of Diseases, 9th Revision, Clinical iWodification (10) according to the medical coding specifications

detailed in the 1986 NHEFS Health Care Facility Stay file

documentation. Discharge diagnoses were coded for hospitals, while admitting diagnoses were coded for nursing

homes. The abstract section is similar to the original

1982–84 NHEFS Health Care Facility Record file released

in August 1987 while the other three sections are new

additions to the 1986 NHEFS facility tape format. (A

revised file that restructures the 1982–84 Health Care

Facility data into the current format has also been

released.) The final section of the record, the related stay

section, is used to identify stays that are contained within

other stays. This occurred most often when nursing home

residents had a brief hospital stay but then returned to the

nursing home. A detailed example of the related stay

section is contained in the introduction to the Health Care

Facility Stay file documentation.

Information will be present in one section or more of

the record depending on whether a report was obtained,

whether an abstract was received, or how the stay relates to

other stays on the file. The presence or absence of information in the first three sections results in three different

record profiles. Figure 7 illustrates these three profiles.

The first is the successfully matched stay record; that is,

where an abstract was received which matched a report.

Abstract information was added to the record for that

report and the code of MAT (match) was entered into the

Record Related

Report section status section Abstract section stay section

●

●

●

●

Faciliry identifiers ● Match or reason for nonmatch . s

Reported date of admission

Reported cause of ●

admission

Source of report

●

Ac[ual dates of admission ●

and discharga

Diagnoses (International

Classification of Diseases,

9th Revision, Clinical

Modification)

Discharge status from

hospitals and nursing

homes

Codes assigned by the

National Center for Health

Statistics to identi[y steya

contained within other stays

Figure 6. Health care facility record layout: NHANES I Epidemiologic Followup Study, 1986

16
Record sratus code

Match Report section Abstract section

——— ——— ——

I

Nonmatch: Report section No abstract received I

I ———— ___ ——

——— —_— ——

I

Additional stay found: No report section

I

Abstract section

——— ——— —

Figure 7. Examples of matching process and record status codes: NHANES 1 Epidemiologic Followup Study, 1986

record status section. Complete information is available for

these stays. The second type occurs when an abstract was

not matched to a report, and, therefore, no data are

contained in the abstract section. The appropriate nonmatch code was entered in the reeord status section. The

third type of record is one that was generated solely by the

receipt of a facility abstract. This type of record resulted

when the facili~ returned an in-scope abstract that did not

match any report on the tracking system. When this occurred, the abstract was entered on the file, stay identifiers

were assigned in the report section of the record, but no

other information is given in the report section. An ASF

(additional stay found) code was entered in the record

status section.

i

Because of the procedures instituted for maximiz ng

the collection of reports of hospital or nursing home st ys

(that is, deliberately requesting out-of-scope report information), it was necessary to devise rules for removing he

“correctly reported” out-of-scope reports from the fi!lal

version of the file. This was only possible after the facilities

submitted the abstract information. As was previously mentioned, reports of stays with a reported date of admission

more than 1 year prior to the last interview were eliminated

from the tracking system prior to contacting the facilities by

mail if the facility had been contacted in the previous

interview period. However, if the facility had not been

contacted previously, the report was kept on the tracking

system and flagged with a “D” in position 199. If an

in-scope abstract was received from the facility, it was

added onto the file with a record status code of ASF and

the type D report was deleted from the final version of the

file. If no in-scope abstracts were received from the facility,

the type D report was deleted from the file based on the

presumption that the date was correctly reported and the

stay was out of scope. In 20 cases, the type D reports

remain on the final version of the file. This occurred when it

was impossible to contact the facility or the facility submitted no information. These records for unconfirmed reports

of out-of-scope stays can be eliminated from analysis at the

analysts’ discretion. A type C flag was assigned in position

199 when a reported date of admission was within 1 year of

the previous interview. If an in-scope abstract was returned

that matched the type C report, it was assigned a record

status code of MAT (n = 73). (The matching rules permitted an admission date of up to 1 year before or after the

reported date of admission.) If no in-scope abstracts were

received horn the facility, the type C reports were removed

from the file, the assumption being that the correct date

was reported and that the stay was truly out of scope. In 10

cases it was not possible to contact the facility, and the type

C reports remain on the file. These unconfirmed reports of

out-of-scope stays are identified by a nonmatch status in

positions 60-62 and a type C flag in position 199.

Results of the health care facility data

collection

The file contains a total of 5,405 records; 4,7S4

(S8.5 percent) records are for hospital stays, 52S

(9.8 percent) for nursing home stays, and 93 (1.7 percent)

for stays in facilities of unknown types. The distribution of

stays is given in table D: 2,021 NHEFS subjects,

53.7 percent of the traced Fol]owup cohort, have at least

one stay on the file; 1,915 subjects have hospital stoys, 422

subjects have nursing home stays, and S1 subjects have

stays in facilities of unknown type.

The completeness of the data file can be assessed by

examining the codes in the record status section of the file.

Of the 5,405 records on the file, 2,S46 (52.7 percent) are

matches, 1,063 (19.7 percent) are additional stays found,

and 1,496 (27.7 percent) are nonmatch codes (table E).

The match rate decreases slightly with age from

56.3 percent for subjects under 65 years at the time of the

examination to 51.2 percent for subjects 65 years and over

at the time of NHANES I examination. Of the 1,496

records potentially missing from the file (that is, no abstract

was received from the facility which matches a report on

the tracking system), 1.9 percent (n = 28) resulted from

17
Table D. Number of facility stays, distribution of subjects by number of stays, mean number of stays, and percent of traced cohort with

at least one stay In the NHANES 1 Epidemiologic Followup Study (N HEFS), 1986 Followup cohort, by race, sex, and age at NHANES I

Number of subjects

by number of slays

Percent of traced Mean

Total Tola/ 1 2 3 stays cohorf wilh at

Race, sex, and agei

number

slays stays stay stays or more least f slay of slays

All racesz

Bolhsexes . . . . . . . . . . . . . . . . .

Male:

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

65-74 yaars . . . . . . . . . . . . . . .

Female:

5.%64 years . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . .

While

Bolh sexes . . . . . . . . . . . . . . . . .

Male:

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

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

Female

5E-64years . . . . . . . . . . . . . . .

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

Black

Bolhsexes . . . . . . . . . . . . . . . . .

Male:

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

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

Female:

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

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

5,405 2,021 705 470 766

97

53.7 2.7

143

194

72

143

46.2

63.6

41.6

56.5

2.4

2.9

740

1,699

312

595 25s

828

2,136

345

769

170

278

76

179

99

312

2.4

2.8

4,633 1,721 674 404 643 53.4 2.7

651

1,432

272

505

124

167

65

120

83

218

60

262

47.6

64.3

41.4

56.2

2.4

2.8

712

1,838

293

651

146

237

67

152

2.4

2.6

746 290 106 63 119 55.6 2.6

75

263

33

68

16

27

6

21

11

40

18

50

50.0 2.3

61.5 3.0

110

300

24

41

9

27

44.3

59.6

2.2

2.5

i See appendix II b a discussion of revised race, correcled sax, and MCalCUlalBd age al NHANESI enamlnallon.

21nchdes races olher Ihanwhile or black.

NOTE The 19s6 Followp cdmt conslsls of 3,9a0 subJecLs, 55 years and over at NH4NES I exadnallon, wha wera nol kn-cwn to b decessed In the 1S82-S4 NHEFS.Tnetraced coht

consists or 3,767 subJecIs wlm were not lost 10 followup at the time of ths 1ea6 NHEFSIniervlew.

Table E. Number and percent of record status codes for the NHANES 1 Epidemiologic Foiiowup Study (N HEFS), 1986 Foliowup cohort,

by race, sex, and age at NHANES i

Record slatus code

Total

Malch Addtiiorral slay found Norrmefch

Race, sex, and agal number Percent Number Parcent Number Percent Number Percenl

All racesz

Both sexes . . . . . . . . . . . . . . .

Male:

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

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

Female:

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

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

WhiIe

Bolh sexes . . . . . . . . . . . . . . .

Male:

55-64 yeare . . . . . . . . . . . . .

65-74 yeare . . . . . . . . . . . . .

Female:

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

6574years . . . . . . . . . . . . .

5,405 100.0

100.0

2,046 52.7 1,063 19.7 1,496 27.7

740

1,699

413

670

55.8

51.2

56.6

51.2

134

328

156

443

16.1

19,3

193

501

26.1

100.0 29.5

826

2,136

100.0

100.0

469

1,094

19.1

20.7

201

601

24.3

2&1

4.633 100.0 2,509 54.2 692 19.3 1,232 26.6

651

1,432

100.0

100.0

376

762

57.8

53.2

59.3

51.6

114

276

123

379

17.5

19.3

161

394

24.7

27.5

712

1,636

100.0

100.0

422

949

17.3

20.6

167

510

23.5

27.7

Black

Bolh sexes . . . . . . . . . . . . . . .

Male:

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

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

Female:

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

6S74yeare . . . . . . . . . . . . .

746 100.0 329 44.0 165 22.1 254 34.0

75

263

100.0

100.0

31

106

41.3

40.3

42.7

4e.3

E

32

64

22.7

19.8

36,0

39.9

110

300

100.0

100.0

29.1

21.3

31

91

28.2

30.3

1Sea appendix II for a discuss!-on or revised race, correcled sex, and recrdculaled age at NHANES 1.

‘Inchdes races olher Ihan while or black.

NOTE The 19B6 Folla+mp cohort consisls or 3,eB0 subjecls. 55 yeara ard over at NHANES I examlnatlon, who were not knwn 10ba dmsased Intha19s2-s4NHEES.

18
participants’ refusal to authorize data collection (designated by a record status code of ANO in positions 6CL62)

and 12.6 percent (n = 189) resulted from the facility’s

refusal to send abstracts (REF). Six percent (n = 90)

resulted from an inability to contact the facility because of

administrative reasons (hospital closed, subject could not

remember name of facility, facility could not be located,

and so forth) (FNC), and 18.4 percent (n = 276) resulted

from the facility’s failure to respond in any way to the

requests for abstracts (ONR). For seven stays the facility

reported that the records were lost or destroyed (XRD),

and for eight stays an administrative code of CRX was

assigned to represent a missing in-scope continuing stay.

The largest cause of failure to obtain an abstract

(60.0 percent, n = 898) occurred because the facility did

not return an abstract that matched the report. In these

cases, the facility may have responded that the subject was

never in that facility (XNH), or other abstracts may have

been returned, but no abstract matching that particular

report was obtained (XNS).

19
Death certificate

collection

Deaths identified by the National Death Index (5),

Health Care Financing Administration, or other tracing

sources were verified by obtaining the death certificate

from the vital statistics office of the State of death. These

death certificates were coded by the National Center for

Health Statistics using the Intemationd Classification of

Diseases, Nin(h Revision (ICD-9) multiple cause-of-death

codes (11).

A member of the 1936 Follow-up cohort was considered deceased only if a death certificate was received or a

proxy interview was completed to verify the death, Both a

death certificate and a proxy interview are available for 562

(88.5 percent) of the 635 subjects identified as having died

between the last contact and the 1986 NHEFS. Nineteen

(3.0 percent) of the decedents have only a proxy interview

and 54 (8.5 percent) have only a death certificate. Overall,

death certificates were obtained for 616 (97 percent) of the

decedents in the 1986 Followup cohort. Efforts continue to

locate all missing death certificates.

The percent of decedents for whom a death certificate

was not available is shown in table F, according to age at

baseline examination, sex, and race. Death certificates were

obtained for a high percent of decedents among [he agesex-race groups (from 93.3 to 100.0 percent among cells

with more than 10 deaths). Black decedents were more

than three times more likely than white decedents and men

were 54 percent more likely than women to be missing a

death certificate.

Table F. Number of deaths and percent of decedents without an

available death certificate among the NHANES 1 Epidemiologic

Followup Study (N HEFS), 1986 Followup cohort, by race, sex,

and age at NHANES I

Number of Percent wlhout

Race, sex, and agel deaths a dealh certificate

All racesz

Bolh sexes . . . . . . . . . . . . . . . . . 635 3.0

Male:

55-64 yeare . . . . . . . . . . . . . . . 74 5.4

65-74 years . . . . . . . . . . . . . . . 261 3.1

Female:

5E-64years . . . . . . . . . . . . . . . 56 1.8

65-74 years . . . . . . . . . . . . . . . 244 2.5

While

Bolhsexes . . . . . . . . . . . . . . . . . 524 2.1

Male:

55-64 years . . . . . . . . . . . . . . . 63 3.2

65-74 years . . . . . . . . . . . . . . . 215 2.3

Female:

55-64 years . . . . . . . . . . . . . . . 48

65-74 years . . . . . . . . . . . . . . . 196 2.0

Black

Bolh sexes . . . . . . . . . . . . . . . . . 10B 7.4

Male:

55-64 yeare . . . . . . . . . . . . . . . 9 22.2

65-74 years . . . . . . . . . . . . . . 45 6.7

Female:

5EA4years . . . . . . . . . . . . . . . 6 12.5

6E-74 years, . . . . . . . . . . . . . . 46 4.3

i See appmdix II for md[scussbn of revised race, corrected sex, and rect?.lculaled age at

NHANES1.

%4des races otter tkn while or black.

NOTE The 19E6 Followp cohortconsisls of 3,9SJI sub]ecls, S5 years ard over at

NHANES 1,who were ml known to be deceasd in tlh? 19E2-S4 NHEFS. Percenls are

based on the e35 d=eased subjds In he 1w NHEFS.

20
1986 analytic cohort

This document has focused on the tracing and data

collection results for those subjects 55 years and over at

baseline who were not known to be deceased in 1982-S4. In

this section the discussion is expanded to examine the

“19S6 analytic cohort,” the entire cohort of subjects who

were 55 years and over at their NHANES I examination

(n = 5,677), regardless of their vital status or interview

status at the 19S2–S4 NHEFS.

As shown in table G, definitive information on vital

status at followup, obtained from either the 1982–84

NHEFS or the 19S6 NHEFS, is available for virtually all

5,677 subjects in the 19S6 analytic cohort. Only 1.8 percent

(n = 103) of the members in the 1986 anrdytic cohort were

lost to followup in both the 1982-84 and 1986 Followups.

Approximately 41 percent (n = 2,332) of the 1986 analytic

cohort was deceased. A total of 1,697 subjects were identified as deceased in the 1982–84 NHEFS, and an additional

635 subjects were identified as deceased in the 1986

NHEFS. A death certificate is available for 2,266

(97.2 percent) of the decedents. Fifty-seven percent

(n = 3,242) of the members of the 1986 analytic cohort

have a vital status of “Alive.” This group includes 3,206

subjects in the 1982–84 NHEFS who had been successfully

traced and then were either traced alive or were lost to

followup in the 19S6 NHEFS and 36 subjects who were lost

to followup in the 1982–S4 NHEFS but were subsequently

traced alive in the 19S6 NHEFS.

The success of the tracing efforts for the 19S6 analytic

cohort is shown in table H according to age at baseline

examination, race, and sex. To summarize how these demcrgraphic factors were related to tracing success, a multiple

logistic model was fitted to the cross-classification of age,

race, and sex, with the proportion of subjects who were lost

to followup as the dependent variable. The analysis was

limited to black and white subjects, because there were few

subjects of other races (n = 45). Additional analytic

definitions and parameters used for this lost to follownp

analysis have been described previously in the section of

this report entitled “Study design and tracing activities.”

The find model included a main effect for age at baseline

examination @ = .5756) and interaction between race and

sex (p = .0153). Among white respondents, more women

were lost to followup, but among black respondents, men

had the higher rates in this catego~. The smillest p value

(probability) for a deleted term was .31. Odds ratios relative to white men are 1.6 for white women, 6.5 for black

men, and 3.8 for black women. Because the proportion lost

to followup is relatively small compared with the proportion

deceased in the 19S6 analytic cohort (0.02 versus 0.41,

respectively), there should, however, be relatively little bias

in mortali~ findings as a result of loss to fol]owup.

&alysis using a multiple logistic regression was cOnducted for black and white subjects to determine whether

those subjects lost to followup in the 1986 analytic cohort

were at relatively high risk of death. The regression model

included six health characteristics measured at NHANES I

(in addition to age, race, sex, and the interaction term for

race and sex) that have been established as risk factors for

mortality: high blood pressure, high cholesterol, overweight, history of heart attack, history of diabetes, and

smoking status. Definitions of these risk factors are described in the section of this report entitled “Study design

and tracing activities.”

The results of this multiple logistic regression are

presented in table J. The baseline risk factors of high

cholesterol, elevated blood pressure, overweight, and history of heart attack did not have a statistically significant

effect on loss to followup. Of the six baseline risk factors,

diabetes and smoking had the strongest effect on loss to

followup: Diabetics and current smokers were twice as

likely as their respective nondiabetic and current nonsmoking counterparts to be lost to followup (p = .0223 and

Table G. Subject status at the NHANES I Epidemiologic Followup Study, 1986, compared with subject status at the NHANES I

Epidemiologic Followup Study, 1982-84, for all subjects 55 years of age and over at NHANES I

Slalus al 1986 Followup

Total Alive Deceased Losl fO fO//OWU/I

Slalus af 1982-84 fo//owup Number Percerrf Number Percent Number Percent Number Percerrl

Toll .. . . . . . . . . . . . . . . . . . 5,677 100.0 3,132 55.2 2,332 41.1 213 3.8

Alive . . . . . . . . . . . . . . . . . . . 3,778 66.5 3,096 54.5 572 10.1 110 1.9

Deceased . . . . . . . . . . . . . . . 1,697 29.9 1,697 29.9

LosllofolloWUp . . . . . . . . . . . . 202 3.6 36 0.6 63 1.1 103 1.8

21
Table H, Number and percent distribution of subjects by status at followup in the NHANES I Epidemiologic Followup Study, 1996

analytic cohort, by race, sex, and age at NHANES I

Sfafus at fo//owup

All Lost tO All Losi iO

Race, sex, and age~ sub]ecls Surviving Deceased fo//owup sub]ech Suwiving Deceased followup

Number Percent distribution

Allracesz . . . . . . . . . . . . . . . . . .

Male:

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

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

Female:

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

6S74years . . . . . . . . . . . . . . .

Whfte

Bolh sexes . . . . . . . . . . . . . . . . .

Male:

5.W34years . . . . . . . . . . . . . . .

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

Female:

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

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

Black

Bolh sexes . . . . . . . . . . . . . . . . .

Male:

55-64 yeare . . . . . . . . . . . . . . .

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

Female:

5W34years . . . . . . . . . . . . . . .

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

Other

Bolh sexes . . . . . . . . . . . . . . . . .

Male:

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

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

Female:

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

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

5,677 3,242 2,332 103 100.0 57.1 41.1 1.6

.960

1,836

588

708

257

1,096

15

32

Im.o

1m.o

66.4

38.6

29.9

59.7

1.7

1.7

964

2,017

789

1,157

156

623

19

37

1m.o

lm.o

81.8

57.4

16.2

40.6

2.0

1.8

4.739 2,779 1,699 61 100.0 56.6 40.1 1.3

741

1,501

519

599

212

890

10

12

lm.o

Im.o

70.0

39.9

26.6

59.3

1.3

0.8

619

1,678

672

9.99

133

664

14

25

Im.o

100.0

82.1

58,9

16.2

39.6

1.7

1.5

893 440 411 42 103.0 49.3 46.0 4.7

105

313

59

103

41

190

5

20

Im.o

Im.o

56.2

32.9

39.0

60.7

4.8

6.4

142

333

114

164

23

157

5

12

1m.o

100.0

60.3

49.2

16.2

47.1

3.5

3.6

45 23 22 100.0 51.1 48.9

14

22

10

6

4

16

100.0

103.0

71.4

27.3

2B.6

72.7

3

6

3

4

ICH3.O

lm.o

100.0

2 66.7 33.3

1See appendix II for a discussion of revised race, correcled sex, and racalculaled age al NHANES I examlnallon.

%chdes races olher Ihan while or black.

NOTE The 19E6 analylic cohort mnsls[s of all 5,677 sub]ects, 55 years and over at NHANES I exsmlnallon.

Table J. Odds ratios, confidence intervals, and statistical

significance for selected health characteristics on loss to

followup for the NHANES I Epidemiologic Followup Study, 1986

analytic cohort

p = .0315, respectively). Because both of these characteristics are associated with mortality, the results from this

analysis su~est that those subjects in the 1986 analytic

cohort who were lost to followup may be more likely to

have died compared with those who were successfully

traced.

TabIe K gives the results for death certificate data

collection for the analytic cohort by age at their NHANES I

examination, race, and sex. Death certificates were obtained for a high percent of decedents among the age-sexrace groups (born 87.0 to 9S.6 percent). Black decedents

were twice as likely to be missing a death certificate compared with white decedents and women were slightly more

likely to be missing a death certificate compared with men.

95-p#cent conr7dence

interval

Odds Lower Upper

Easeline characferlslk ratio bound Bound p value

High blood pressure. . . . . . . . 1.09 0.71 1.67 0.7093

High cholesterol . . . . . . . . . . 0.88 0.56 1.40 0,6013

Overweight . . . . . . . . . . . . . 1.34 0.88 2.05 0.1701

History of heart altack. . . . . . . 0.91 0.43 1.91 0.7952

Diabetes . . . . . . . . . . . . . . . 1.95 1.10 3.45 0.0223

Smoking . . . . . . . . . . . . . . . 1.96 1.06 3.63 0.0315

NOTIZ The 1986 ar?.alyiic cohort mnslsls of all 5,677 sub]ects 55 years and over al

NHANES 1. Dala based on multiple Iogislic regression wilh race, sex, race-sex In[eraciion,

and age al NHANES I examlnallon Included.

22
Table K. Number of deaths and percent of decedents without an

available death certificate among the NHANES I Epidemiologic

Followup Study, 1986 analytic cohort, by race, sex, and age at

NHANES I

Number of Percenl wilfrwt

Race, sex, and agel deaths a death ceriificale

All racesz

Both sexes . . . . . . . . . . . . . . . . . 2,332 2.8

Male:

55-64 years . . . . . . . . . . . . . . 257 2.3

65-74 years . . . . . . . . . . . . . . . 1,096 2.6

Female:

55-64 years . . . . . . . . . . . . . . . 156 3.2

65-74 years . . . . . . . . . . . . . . . 823 3.2

While

Bolh sexes . . . . . . . . . . . . . . . . .

Male:

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

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

Female:

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

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

Black

Bolh sexas . . . . . . . . . . . . . . . . .

Male:

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

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

Female:

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

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

1,899

212

890

133

664

411

41

190

23

157

2.3

1.4

2.0

1.5

3.2

5.4

7.3

5,8

13.0

3.2

1See appendix II lor a discussion of rsvised race. correcled sex, and rscalculaled age at

NHANES I examination.

‘Includes races olher Ihan while or black.

NOTE: The 19ae analyllc cohort cnndsls of all 5,677 subjecrs 55 years and over at

NHANES I examlnallon. Percenls are based on the 2,332 deceased subJecls In the 1S86

analyilc cohorl.

23
Ongoing activities

Four public use data tapes containing vital and tracing

status, interview, health care facility stay, and mortality data

from the 1986 NHEFS are available fi-om the National

Technical Information Service. The Vital and Tracing Status Data Tape contains summary information on all 5,677

members of the NHEFS cohort who were 55 years and over

at their NHANES I examination, regardless of vital status

or interview status in the 1982–84 or 1986 Followups. The

Interview Data Tape contains information from 3,608 interviews (3,027 subject and 581 proxy interviews) collected

during the 1986 NHEFS pretest and main survey interviewing periods. The HeaJth Care Facility Stay Data Tape

contains 5,405 stay records. It has the same format as the

1982-84 NHEFS Revised HeaIth Care Facility Stay Data

Tape. The MortaIi& Data Tape includes information abstracted from the death certificates from both the 1982–84

NHEFS and the 1986 NHEFS for subjects 55 years and

over at the time of NHANES I who had died since

NHANES I and for whom a death certificate is available.

Of the 2,266 subjects on the Mortali@ Data File, 1,622

were deceased at the 1982–84 NHEFS and their death

certificates were obtained during the 1982–84 survey period; 28 were deceased at the 1982–84 NHEFS, but their

death certificates were obtained after the 1982-84 NHEFS

ended; and 616 were not known to be deceased until the

1986 NHEFS when their death certificates were obtained.

The 1986 Data Tapes may be used in conjunction with

the Data Tapes from the NHANES I survey and the

1982–84 NHEFS tapes to investigate the effects of baseline

measures on subsequent health status. All these data tapes

are available through the National Technical Information

Service. The study identification number, the Sample Sequence Number, can be used to link the files from any of

the Followup surveys to all NHANES I files.

Additional information on the NHEFS cohort will be

available in future years. Plans are to recontact and reinterview cohort members or their proxies, to collect health care

facility data, and to collect death certificate information.

24
References

1. Miller HW. Plan and operation of the Health and Nutrition

Examination Survey, United States, 1971–1973. National

Center for Health Statistics. Vital Health Stat 1 (lOa). 1978.

2. National Center for Health Statistics. Plan and operation of

the Health and Nutrition Examination Survey, United States,

1971-1973. National Center for Health Statistics. Vital

Health Stat 1 (lOb). 1977.

3. Engel A, Murphy RS, Maurer K, Collins E. Plan and operation of the NHANES I Augmentation Survey of Adults

25–74 years, United States, 1974-1975. National Center for

Health Statistics. Vital Health Stat 1 (14). 1979.

4. Cohen BB, Barbano HE, Cox CS, et al. Plan and operation of

the NHANES I Epidemiologic Followup Study, 1982–84.

National Center for Health Statistics. Vital Health Stat 1

(22), 1987.

5. National Center for Health Statistics. User’s Manual: The

National Death Index. DHHS Pub. No. (PHS)81-1148.

Washington Public Health Service. 1981.

6. McDowell A, Engel A, Massey JT, Maurer K. Plan and

operation of the second Health and Nutrition Examination

Surveyj 1976-80. National Center for Health Statistics. Vital

Health Stat 1 (15). 1981.

7. Fries JF, Spitz P, Krains RG, et al. Measurement of patient

outc~me in arthritis. Arthritis Rheum 23:13745.1980.

8. Resow I, Breslau N. A Guttman health scale for the aged. J

Gerontol 21(4):5569. 1966.

9. Katz S, A@om CA. Index of ADL. Med Care (5th

suppl):llfA3. May 1976.

10. Public Health Service and Health Care Financing Administration. International Classification of Diseases, 9th Revision,

clinical modification. Washington: Public Health Service.

1980.

11. 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.

25
Appendixes

Contents

1, Study materiak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Tracing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Verification questions (subject interviewed in the 1982–84NHEFS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Verification questions (subject notinterviewed in the 1982-84 CHEFS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Verification questions (proxy).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Interview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Brochure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Advance letter to subject (interview in 1982–84NHEFS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3S

Advance letter to subject (nointeniew in 1982–84NHEFS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Advance letter to proxy (interview in 1982-84 CHEFS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Advance letter to proxy (nointerview in 1982-84 NHEFS) . . . . . . . . . . . . . . . . . . . . . . . ..l . . . . . . . . . . . . . . . . . 38

Advance letter to facility administrator with request to interview subject. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3g

Advance letter to facility administrator with request to interview facili~ staffmember . . . . . . . . . . . . . . . . . . . 40

Subject telephone questionnaire (main sumey period) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Proxy telephone questionnaire (main survey period) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Questionnaire A(subject mail questionnaire) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Questionnaire A(subject mail questionnaire) supplement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Questionnaire B(pro~mail questionnaire) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Verbal authorization form to obtain information from medical records. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

Authorization forrnto obtain information frcm medical records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Hospital and health care facili& chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144

Health care facility data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

Letter to hospital administrator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

Letter to director ofmedical records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

Hospital record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

Letter to nursing home administrator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

Nursinghome/personalcarehome record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

IL Corrections and revisionsto the NHANESI baseline data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Date of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

26
Appendix I

Study materials

Tracing

ID,: m-un-n

SUBJECT NAME:

1.

2.

Y.

4.

OMB NO.: 937-0134

Approval Expires: 10/31 /S7

Date

U.S. Department of Health and Human Services

National Center for Health Statistics

National Institute on Aging

NHANES I Epidemiologic Followup Survey

VERIFICATION QUESTIONS (TO BE ASKED OF SUBJECTS)

In ( INTERVIEW YEAR) you took part in the National Health and Nutrition Examination !NHANES)

Followp Survey conducted by the National Center For Health Statistics, a part OF the

U.S. Public Health Service. I’d like to ask a few questions to veri Fy that you are the

person who participated in that Followup survey. I want to mention that the information

you give will be kept strictly confidential and will be used For statistical purposes only.

The interview is completely voluntary and is authorized by the Public Health Service Act.

mat is your Full name including your middle initiaL? (PROBE FOR MAIDEN NAME IF FEHALE.)

(IF~ CHANCED NAHE, EXPLAIN.)

NAME:

And your date of birth is (REPEAT BIRTHDATEI. 19 that correct?

YES. . . .

No’*.. .

DON’T KNOW

What is your date of birth? 131RTHDATE:

. . . . 1 (a.4)

. . . . 2 (Q.J)

. . . . 8 (CI.4)

HDNTH DAY YEAR

Were you living at (LABEL ADDRESS) in (MONTH ANO YEAR OF INTERVIEW)?

YES. . . . . . . . 1 (BOX A)

m . . . . . . . . 2 (9.5)

DON’T KNOW . . . . 8 (BOX A)

27
5. At what address were you livlng in (MONTH AND YEAR OF INTERVIEW)?

M)DRESS:

SrREET APT. #

CITY SrATE

t

INTERVIEWER

9.2 AND 0.4

Q.2 ANDQ.4

OTHER . . .

BOX A

REvIEW Q.2 AND Q.4 W C“;’!CIC ONE:

VERIFY. . . . . . . . 1 (SET UP INTERVIEW)

DO NOT VERIFY . . . . 2 (Thank you very much, I don’t belleve you

the person we are looklng for.) (TERMINA’

. . . . . . . . . . . . 3 (9.6)

are

E)

6. Can you give me the names of the people you were living with in (MONTH AND YEAR OF INTERVIEW)?

[And how was (NAME) related to you?] (PROBE FOR FULL NAME AND Relationship. )

1.

2.

3.

4.

RELATIONSHIP

OR

LIVED ALONE. . . . . . . . . . . . . .0

Thank you very much but I am not sure whether you are the person we are looklng for. I

will check the Lnformatlon you have given me against our records and WI1l call you back

if you are the. correct person. (TERMINATE)

uor[cf: - [n form. clon cOn L. Lnad an tnla rO~

wtl,ch .ould pOKlltLdmnclficmc LOn Of -y LM1-

vLdua L or mmt-lLmn-t ham ham collmccsd .lth

R quarmncam thmt lt 9111 b9 nald An 5LC1C: cOdfldmmm, WL1l b- uuad only far puronmmm stmcnd

far Lhls 3Cudy, and ●Ill not B, ‘ilsclomad nr

rmlmanmd :0 otnmrs -Lthout Lho canmw ~f Lha

Indlvldumi ar Emtcbllnmrmnt Ln =Carda=m .lth

5ect Lon JOE(d; sf thm ?uhl Lc HaaLcn 5.r. Lcm :c:

l&2 USC 242m).

28
ID,: m-m-n

SUBJECT NANE:

OMB No.: 937-0134

Approval Expires: 10/31/87

Date

US. Deparcmenc of Health and Human Services

National Center for Health Statistics

lNational Institute on Aging

NHANES I Epidemiologic Followup Survey

VERIFICATION QUESTIONS (TO BE ASKED OF SUBJECTS) - NEVER INTERVIEWED

1. In (EXAM YEAR) you took part in a medical examination survey conducted by the National Center For

Health Statistics, a part of the U.S. Public Health Service. I’d like to aak a few queatlona to

vari fy that yaI are the pereon *O participated in that survey. I want to mention that the information you give will be kept strictly confidential ard will be used far statistical purpoaea only.

me interview iH c~lotaly voluntary and ie mthorized by the Public Health service Act.

Mat is your full nm including ywr middle initial? (PRUBE FDR MAIDENNAMEIF FEHALE. )

(IF~ CHANGED M, EXPLAIN. )

r’wEx

2. H yam date of birth ie (REPEAT BIRTtOATE). Is that correct’?

KS. . . . . . . . 1 (9.4)

m . . . . . . . . 2 (a.3)

~’T KNOW . . . . B (Q.4)

3. Mat is your date of birth? BIRT~ATE: —.

//

.

NIINTH DAY YEAR

4. *m YOU living at (LABEL AmRESS) In (WNTH AMI YEAR ff LAST CONTACT)?

YES. . . . . . . ..1(SOXA)

No . . . . . . . . 2 (Q.5)

~,TK~...08(mXA)

29”
5. At what ddrem were you living in (MONTH AK) YEAR OF LAST CONTACT)?

MmEssz

STREET APT. #

CITY .“ STATE

mx A

INTERVIEWER REVIEW Q.2 M 9.4 AN) CIRCLEOK:

9.2 M Q.4 VERIFY. . . . . . . . 1 (SET UP INTERVIEW)

Q.2 ~Q.4W~T vERIFY . . . . 2 (Thank you very md, I don’t be

the person we are looking For.)

OTHER. . . . . . . . . . . . . . 3 (Q.6)

ieve you are

(TERMINATE)

6. Can yw give me the ~ of the people you wsm living with in (HONTH Am Y~.!R OF EXAM)?

[And h- - (NAME) mlatad to you?] (PROBE FOR FULL NAME m RELATIONSHIP. )

RELATIONSHIP

1.

2.

3.

4.

m

LIVEDALONk. . . . . . . . . . . . . .0

Thenk you very much but I m not sure dmther you are the pereofi we are looking for. [

will check the information you have given me againet our records and will caLL you back’

if your are the correct pemon. (TERMINATE)

.Sact:an JM(d) of Uu %OLIC thaith SmVIcmkc

(u use Zaa).

30
ID #:

PROXY NAME

m-m-n :

1.

2.

3.

4.

I would

OMB No.: 937-0134

Approval Expires: 10/31 /S7

Dato

U.S. Department of Health and Human Services

Na[ional Center for Health S=tis~ics

National Institute on Aging

NHANES I Epidemiologic Followup Survey

VERIFICATION QUESTIONS (TO BE ASKED OF PROXIES)

like to ask a few questions

to mention that the information you

For statistical purposes only. The

by the Public Health Service Act.

to verify that I have the correct person. 1 want

give me will be kept confidential and will be used

interviaw is completely voluntary and is authorized

mat (ie/was) (SUBJECT’S) Full name including middle name? (IFg CHANGED NAME, ExPLAIN)

And (hie/her) date oF.birth

(IF INCAPACITATED) What is

NAHE: _

(ie/waa) (REPEAT BIRTHDATE). Ie that correct?

YES. . . . . . . . 1 (IZ.4)

N3 . . . . . . . . 2 (Q.J)

DDN’T KNOW . . . . e (Q.1)

(his/her) (date of birth/age)?.

131RTHDATE: // OR AGE: —. .

MONTH DAY YEAR

(IF OECEASED) khat was (his/her) (date oFbirth/age at death)? [What year did (he/she) die?]

BIRTHDATE: /_/_ OR AGE AT DEATH:

HDNTHI DAY YEAR

YEAR OF DEATH:

Was (SUBJECT) living at (LABEL ADDRESS) in [MDNTH AND YEAR OF LAST CONTACT]?

YES. . . . . . . ~ 1 (BOX A)

Nn . . . . . . . . 2 (rJ.5)

DDN’T KNOW . . . ~ E(BOXA)
5. At hat address was (he/she) living in (MONTH ANO YEAR OF LAST CONTACT)?

ADDRESS :

STREET APT. #

CITY STATE ZIP CODE

BOX A

INTERVIEWER REVIEW IJ.2 AND Ci.4 AND CIRCLE ONE:

L1.2 AND U.4 VERIFY. . . . . . . . 1 (SET UP INTERVIEW; COMPLETE SUF IF APPROPRIATE)

9.2 AND Q.4 DO NOT VERIFY . . . . 2 (Thank you very much, I don’t believe we are

talking about the same person.) (TERMINATE)

OTHER. . . . . . . . . . . . . . 3 (CK6)

6. Can you remember the names of the people (he/she) was living with in (MONTH AND YEAR OF INTERvIEW/EXAM)? [And how was (NAME) related to (him/her)?] (PROBE FOR FULL NAME AND RELATIONSHIP.)

1.

2.

3.

4.

hlAME RELATIONSHIP

OR

LIVED ALONE. . . . . . . . . . . . . .0

Thank you very much but I am not sure whether (he/she) is the person we are looking For.

I will check the inF~rmation you have given me against our records and will call you back

iF (he/she) is the correct person. (TERMINATE)

32
Wdy Sct)ed[k

. Original Survey:

National Health and Nutrition Examination

Survey (1971-75)

. Initial Followup:

Lengthy personal interviews. Blood pressure

and weight measures (1982–84).

. Continued Followup:

Short telephone contacts of the elderly

(1985-88) and of the total population

(19ffi and 19B8).

F’artici/)atif]!j Ageneies

National Institute on Aging

National Center for Health Statistics

National Cancer Institute

National Institute of Mental Health

National Institute on Alcohol Abuse and Alcoholism

National Institute of Arthritis, Diabetes, Digestive

and Kidney Diseases

National Heart, Lung, and Blood Institute

National Institute of Neurological and

Communicative Disorders and Stroke

National Institute of Allergy and Infectious Diseases

Epidemiologic

FoUowup

Study

Survw

U S Department of Health and Human Services

Pubhc Health Service

National Center for Health Stahstics

National Inshtute on Aging

cl)

w
Epidemiologic

FoUowup

Study

-What Is the NHANES I

Epidemiologic Followup Study?

The National Health and Nutrition Examination

Survey Epidemiologic Fo~lowup Study is designed to

collect information about an aging population which

includes:

Illnesses that have occurred,

Habits and personal characteristics that may

affect health, such as eating patterns and

blood pressure.

The ability to carry on routine activities of

daily living such as dressing oneself or

climbing stairs.

The information will allow scientists to study many

of the factors that cause disease and disability. Data

from this study will be used by health planners,

educators, and medical experts to improve present

programs and to initiate future programs for

prevention and treatment of disease.

Why Is the Study Important?

Because the Followup Study provides data on a large

national sample, it presents a unique opportunity for

health researchers to study changes in health status

and the factors that contribute to good health as well

as illness.

It is the first U.S. investigation of its size and scope to

follow the respondents over a period of years, and the

first to have interviewers measure blood pressure on

a national basis.

Who Is Being Contacted?

Persons who participated in the NHANES survey are

king interviewed about their health status and

hospital care since the earlier study, If the original

participant cannot be interviewed because of illness

or death, relatives or close friends will be contacted.

A very short interview will be conducted by

telephone by specially trained interviewers who

will ask questions about illness and any disabiliW the

respondent may be experiencing.

Hospitals will be contacted to obtain technical

information from the hospital record. It is essential

that data be collected about all participants. No other

data can be substituted for the information desirad.

Why Is Participation Important?

Confidentiality Is Guaranteed

All information obtained in the survey will be

protected by the confidentiality requirements of the

U.S. Public Health Service Act and the Privacy Act

of 1974.

Answers will be used only by research staff working

on the survey. Each of them must sign a statement

pledging to keep confidential all information

provided by respondents. No information that would

permit identification of an individual will be released

or published. Survey results will be published only

as statistical summaries.

A Cooperative Effort

The survey is a joint effort of the National Center for

Health Statistics and the National Institute on Aging,

agencies of. the Public Health Service, U.S,

The persons who took part in the first survey made Department of Health and Human Services.

up a group that represented all types of people in all

areas of the United States. The Followup Study is

the first nationwide survey that will provide

information on the changes in health for people

from different backgrounds and regions,

Each participant represents thousands of others

with similar characteristics. Although voluntary,

participation is important so that the results will

continue to represent a tru’e scientific sample of the

U.S. population.

All queries or correspondence should be

directed to

Helen E, Barbano

NHANES I Epidemiologic Followup Study

National Center for Health Statistics

3700 East-West Highway, Room 2-27

Hyattsville, Maryland 20782

(301) 436-5975
,,s, 1.1s ,

#

Jg

k

*..

: DEPARTMENT OF HEALTH& HUMAN SERVICES Public Health Service

:

:

-n

%

“%,,,” 7

National Center for Health Statistics

3700 East-West Highway

Hyattsville, MD 20782

Dear Participant:

A5 you may recall , we have been in touch with you in recent years

concerning a national study that the National Center for Health Statistics

is conducting. You participated in the first National Health and Nutrition

Examination Survey in 1971-1975, and its Initial Followup in 1982-84. The

results of that survey have provided much needed information about the

health needs and characteristics of the American people. !Jewould like to

express our appreciation to you for your part in making that survey a

success, and we would like to have your help again.

To further use the findings from the original survey, the National Center

for Health Statistics is planning another brief interview of all the adults

who took part in that study. We have contracted with Westat, a national

research firm, to conduct the survey for us. Within the next two weeks, a

Westat interviewer will call you on the telephone to conduct a very short

interview. It should take approximately 30 minutes.

The interview will include questions about your health status and any

hospital care you may have received since our last contact. Ne would

appreciate it if you have this .information available when the interviewer

calls.

This survey is authorized by Title 42, United States Code 242k. Your

participation in the survey i: completely voluntary. There are no

penalties. for refusing to answer any question.

As in the previous survey, any information you give will be kept

confidential. No information that could be used to identify you or any

individual will be released or published. Results of this study will be

published only as statistical summaries.

Your participation is vital to the success of this survey, and your

cooperation will be greatly appre~iated.

Sincerely yours,

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

Director

Enclosure

35
~,,.vlcz. ~

# %

*.

.

Jf DEPARTMENT OF HEALTH& HUMAN SERVICES Public Heatth Service

F

:

.

-0

%

7

+, F?,za

National Center for Health Statistics

3700 East-West Highway

Hyattsville, MD 20782

Dear Participant:

As you may recall , we have been in touch with you in recent years

concerning a national study that the National Center for Health Statistics

is conducting. You participated in the first National Health and Nutrition

Examination Survey in 1971-1975. The results of that survey has provided

much needed information about the health needs and characteristics of the

American people. We would like to express our appreciation to you for your

part in making that survey a success, and we would like to have your help

again. Although you were not available to participate in the Initial

Followup in 1982-84, we hope you will be able to assist us at this time.

To further use the findings from the original survey, the National Center

for Health Statistics is planning another brief interview of all the adults

who took part in that study. We have contracted with Westat, a national

research firm, to conduct the survey for us. Within the next two weeks, a

Westat interviewer will call you on the telephone to conduct a very short

interview. It should take approximately 30 minutes.

The interview will include questions about your health status and any

hospital care you may have received since our last contact. We would

appreciate it if you have this ‘information available when the interviewer

calls.

This survey is authorized by Title 42, United States Code 242k. Your

participation in the survey is completely voluntary. There are no

penalties for refusing to answer any question. !

As in the previous survey, any information you give will be kept

confidential . No information that could be used to identify you or any

individual will be released or published. Results of this study will be

published only as statistical summaries.

Your participation is vital to the success of this survey, and your

cooperation will be greatly appreciated.

Sincerely yours,

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

Director

Enclosure

36
,+,.wms .,4

*.+

●

~

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

:

s

.

%

7

‘%, ~,,a National Center for Health Statistics

3700 East-West Highway

Hyattsvdle, MD 20782

Dear Participant:

The National Center for Health Statistics (NCHS) is conducting a national

health study, the National Health and Nutrition Examination Survey (NHANES).

participated in the first National Health and

Nutrition Examination Survey in 1971-1975, and in the first followup for

NHANES in 1982-84. The results of that survey have provided much needed

information about the health needs and characteristics of the American

people. We would like to have your help in the NHANES I Continued Followup

Survey being conducted at this time,

To further use the findings from the original survey, the National Center

for Health Statistics is planning another brief interview of all the adults

who took part in that study. We have contracted with Westat, a national

research firm, to conduct the survey for us. Within the next two weeks, a

Westat interviewer will call you on the telephone to conduct a very short

interview. It should take approximately 30 minutes.

The interview will include questions about ‘s health

status and any hospitalizations and nursing home stays he/she may have had

since 1980. We would appreciate it if you have this information available

when the interviewer calls.

This survey is authorized by Title 423 United States Code 242k. Your

participation in the survey is completely voluntary. There are no penalties

for refusing to answer any question.

As in the previous survey, any information you give will be kept

confidential. No information that could be used to identify you or any

individual will be released or published. Results of this study will be

published only as statistical summaries.

Your cooperation is vital to the success of this study.

Sincerely yours,

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

Director

Enclosure

37
9 WC:, ,,,,

,*

#

.* JigDEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

:

:

.

5

%

‘%,,. 7

National Center for Health Statistics

3700 East-West Highway

Hyattsville, MD 207E12

Dear Participant:

The National Center for Health Statistics (NCHS) is conducting a national

health studv.-. the National Health and Examination Survey (NHANES).

participated in the first- National ”Health

and Nutrition Examination Survey in 1971-1975. The results of that

survey have provided much needed information about the health needs and

characteristics of the American’ people. We hope you will be able to

assist us at this time in the NHANES I Continued Followup Survey.

To further use the findings from the original survey, the National Center

for Health Statistics is planning another brief interview of all the

adults who took part in that study. We have contracted with Westat, a

national research firm, to conduct the survey for us. Within the next two

weeks, a Westat interviewer will call you on the telephone to conduct a

very short interview. It should take approximately 30 minutes.

The interview will include questions about ‘s

health status and any hospitalizations and nursing home stays he/she may

have had since 1980. ‘Wewould appreciate it if you have this information

available when the interviewer calls.

This survey is authorized by Title 42, United States Code 242k. Your

participation in the survey is completely voluntary. There are no

penalties for refusing to answer any question.

As in the previous survey, any information you give will be kept

confidential . No information that could be used to identify you or any

individual will be released or published. Results of this study will be

published only as statistical summaries.

Your cooperation is vital to the success of this study.

Sincerely yours,

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

Director

Enclosure

38
,,*WBJ ~

**

Jf # *.

● DEPARTMENT OF HEALTH & HUMAN SERVICES Public Heatth Service

.

:

%

%

-“

>

J*,w, ,C National Center for Health Statistics

3700 East-West Highway

Hyattsville, MD 20782

Dear Administrator:

The National Center for Health Statistics has joined with the National

Institute on Aging to conduct the National Health and Nutrition

Examination Followup Survey, to study the etiology of a number of chronic

diseases.

A selected sample of the United States population participated in the

first National Health and Nutrition Examination Survey (NHANES I) in

1971-75 and in its Initial Followup in 1982-34. The results of that

survey have provided much needed information about the health needs and

characteristics of the Anerican people.

To further use the findings from the original survey, the National Center

for Health Statistics is planning another brief interview of all the

adults who took part in the study. We have contracted with !destat, a

national research firm, to conduct the survey for us.

Recently, we learned one of the participants

in the survey, is living in your facility. We’will need to interview

Mr./Mrs. in order to obtain the followup

information. Within the next two weeks, a Westat interviewer will be

contacting him/her by telephone to conduct a short interview. An initial

letter has already been mailed to him/her as well.

This survey is authorized by Title 42, United States Code 242k. All

information given will be kept c~nfidential. No information that could

be used to identify the individual or your institution will be released

or published. Results of this sfudy will be published only as

statistical summaries.

If you have any questions concer~ing this survey, please feel free to

contact Ms. Kathleen Parkes, toll free at (800) 638-8985.

Thank you in advance for your cooperation.

Sincerely yours,

a?ti

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

Director

39
,, s-c- q

#

Jig

* .* DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

~

s

.

-0

%

+%,,. 7

National Center for Health Statistics

3700 East-West Highway

Hyattsville, MD 20782

Dear Administrator:

The National Center for Health Statistics has joined with the National

Institute on Aging to conduct the National Health and Nutrition Examination

Followup Survey, to study the etiology of a number of chronic diseases.

A selected sample of the United States population participated in the first

National Health and Nutrition Examination Survey (NHANES I) in 1971-75 and

in its Initial Followup in 1982-84. The results of that survey have

provided much needed information about the health needs and characteristics

of the American people.

To further use the findings from the original survey, the National Center

for Health Statistics is planning another brief interview of all the adults

who took part in the study. We have contracted with Westat, a national

research firm, to conduct the survey for us.

Recently, we learned one of the participants in

the survey, is living in your facility. We ha;e already interviewed

in order to obtain the followup information.

However, there were some questions which he/shecould not answer concerning

health and functioning ability.

We would sincerely appreciate it if a member of your staff would be willing

to answer a few questions concerning this resident so that complete information can be obtained. A Westat interviewer will be,calling you within

the next two weeks to arrange an appointment to collect the information.

This survey is authorized by Title 42, United States Code 242k. All information given will be kept confidential. No information that could be used

to identify the individual or your institution will be released or

published.

summaries.

If you hav[

contact Ms

Thank you

Results of this study will be published only as statistical

any questions concerning this survey, please feel free to

Kathleen Parkes, toll free at (800) 638-8985.

n advance for your cooperation.

Sincerely yours,

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

Director

40
OMB: 09374134

EXPIRES: October 1987

NHANES I EPIDEMIOLOGIC FOLLOWUP STUDY

CONTINUED FOLLOWUP OF THE ELDERLY

SUBJECT/PROXY - INCAPACITATED QUESTIONNAIRE

WESTATID: I I l-l I l_l-l_l

Hello, may 1please speak to (RESPONDENT)?

■ IF RESPONDENT NOT AVAIIABLE, ASK Can you suggest a convenient time when I could reach

(him/her)? TERMINATE CONTACT AND RECORD RESULTS ON CALL RECORD.

■ IF RESPONDENT NOT AT THIS TELEPHONE NUMBER, VERIFY NUMBER AND REDIAL.

■ IF RESPONDENT AVAILABLE, CONTINUE.

My name is (YOUR NAME] and I am calling from Washington, D.C. on behalf of-the United States Public

Health Service with regard to the National Heatth and Nutrition Examination Survey. Recently you were sent a letter

from the Public Heatth Service explaining that someone would contact you. Did you receive our Iettef?

YES .................................................................. 1

NO .................................................................... 2 (BOX 1)

I would like to conduct the interview now if it is convenient.

(It will take approximately 30 minutes, In order to evaluate my performance, my supervisor may monitor this

interview.)

BOX 1

(IF RESPONDENT DID NOT RECEIVE LEITER, READ:)

Let me tell you what it says. Persons who participated in the National Heatth and Nutriiion Exa.:!mation

Survey are being recontacted at this time. A very short interview will be conducted by telephone. Questions will be

asked about illnesses, disabilities and hospitalizations. This study is authorized by the Public Heatth Service Act.

The information you give me will be kept strictly confidential and will be used for statistical purposes only. The

interview is completely voluntary and there are no penalties for refusing to answer any questions. (CHECK BOX:

l_l)

I would like to conduct the interview now if it is convenient.

(It will take approxim~ely 30 minutes. In order to evaluate my performance, my supervisor may monitor

this interview.)

41
PARTA BACKGROUND INFORMATION

TIME BEGAN: AM

PM

First, I would like to ask you a few questions about (your/SUBJECT’S) household.

A-1 AND A-2 NOT ASKED THIS VERSION.

A-3. (Do you/Does SUBJECT) currently live in a private home or apartment, a nursing home or rest home, or

(do you/does he/she) have some other arrangement?

PRIVATE HOUSE OR APARTMENT .............................. 1

NURSING OR CONVALESCENT OR REST HOME ...... 2 (flA+)

RETIREMENT HOME ..................................................... 3

BOARDING HOUSE, ROOMING HOUSE OR

RENTED ROOM ............................................................. 4

FAMILY OR FOSTER CARE HOME .............................. 5

ANOTHER HEALTH FACILITY ....................................... 6 (Q.A+)

OTHER ARRANGEMENT (SPECW) ............................ 91 (Q.A-4)

OTHER INSTITUTION (SPECl~ .............................. 92 (Q-A+)

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

42
M.

A-4a.

How many people live in (your/his/her) household including (y~urself/SUBJECT)?

ONE .................................................................. 01 ((3.A-5)

NUMBER OF PEOPLE: I I ]

.—

What relationship to (you/$ilJBJEC~ (is/are) the other person(s) who live(s) in (your/his/her) household?

[PROBE FOR SEX IF NOT OBVIOUS: Is ~PERSC)NJmale or female?]

PERSON #

1

2

3

4

5

6

7

8

9

10

SEX 1 = MALE

2 = FEMALE

SEX RELATIONSHIP

l_l l_l

l_l l_l

l_l l_l

l_l I_!

l_l I_!

l_l l_l

l_l l_l

l_l l_l

l_l l_l

l_l l_l

RELATIONSHIP: 1 = HUSBAND/WIFE

2 = FATHER/MOTHER

(INCLUDING IN-IAWS)

3 = GRANDPARENT

4 = SON/DAUGHTER

(INCLUDING IN-LAWS)

5 = GRANDCHILD

6 = BROTHER/SISTER

(INCLUDING IN-IAWS)

7 = AUNT/UNCLE/COUSIN

8 = OTHER REIATIVE

9 = FRIEND

10 = OTHER NON-REIATIVE

L5E!H_”

A-5. How long (have you/has he/she) lived alone?

NUMBER OF YEARS: I I I (QJW

m

NUMBER OF MONTHS: I I I (Q-IW

LESS THAN ONE MONTH .............................. 95 (Q.A4)

43
A&

A-6a.

These next questions are about the last household in which (you/he/she) lived. How many people lived in

(your/his/her) household including (yourself/SUBJECT)?

ONE .................................................................. 01 (Q.A-7)

NUMBER OF PEOPLE: I——I I

What relationship to (you/SUBJECT) (was/were) the other person(s) who lived in (your/his/her)

household? [PROBE FOR SEX IF NOT OBVIOUS: Is (PERSON) male or female?]

PERSON #

1

2

3

4

5

6

7

8

9

10

SEX: 1 = MALE

2 = FEMALE

SEX RELATIONSHIP

l_l l_l

l_l l_l

l_l l_l

l_l l_l

I_l l_l

l_l l_l

l_l l_l

l_l l_l

l_l l_l

l_l l_l

RELATIONSHIP: 1 = HUSBAND/WIFE

2 = FATHER/MOTHER

(INCLUDING IN-LAWS)

3 = GRANDPARENT

4 = SON/DAUGHTER

(INCLUDING IN-IAWS)

5 = GRANDCHILD

6 = BROTHER/SISTER

(INCLUDING IN-LAWS)

7 = AUNT/UNCLE/COUSIN

8 = OTHER REIATIVE

9 = FRIEND

10 = OTHER NON-REtATIVE

A-7. How long had (you/he/she) lived alone?

NUMBER OF YEARS: l_l_l

~

NUMBER OF MONTHS: l_l_l

LESS THAN ONE MONTH .............................. 95

44
A-8. ~ERllW IF ALREADY KNOWN:]

(Are you/is he/she) currently married, widowed, divorcad, separated, or (have you/has he/she) never been

married?

MARRIED ........................................................................ 1

WIDOWED ...................................................................... 2

DIVORCED ...................................................................... 3

SEPARATED ................................................................... 4

NEVER MARRIED ........................................................... 5

l_l

A-9. [READ ONLY IF CHECKED ( ):]

Which of these &tegories best describes (you/SUBJECT) – Alaskan Native, American Indian, Asian, Pacific

Islander, Black or White? Are you of Hispanic origin or descent’?

AIASKAN NATIVE OR AMERICAN INDIAN - NOT HISPANIC .... 1

ASIAN/PACIFIC ISIANDER - NOT HISPANIC ............................. 2

BIACK - NOT HISPANIC ............................................................... 3

WHITE - NOT HISPANIC ............................................................... 4

AIASKAN NATIVE OR AMERICAN INDIAN - HISPANIC ............. 5

ASIAN/PACIFIC ISIANDER - HISPANIC ..................................... 6

BIAKC - HISPANIC ....................................................................... 7

WHITE - HISPANIC ........................................................................ 8

OTHER (SPECIFY) ........................................................................ 91

TIME ENDED: AM

PM

45
PART B: MEDICAL CONDITIONS

TIME BEGAN: AM

PM

B-1. [IF SPEAKING TO SUBJECT, ASK] Would you say that your health in general is excellent, very good,

good, fair or poor?

EXCELLENT ..................................................... 1

VERY GOOD .................................................... 2

GOOD .............................................................. 3

FAIR .........a....................................................... 4

POOR ............................................................... 5

B-2, Did a doctor ever tell (you/SUBJECT) that (you have/he/she has) arthritis?

B-3. There are different kinds of arthriiis. Did a

has)?

YES .................................................................. 1

NO ..................................................................... 2 (Q. B+)

DK ..................................................................... 8 (CLB-8)

doctor ever tell (you/him/her) which kind (you have/he/she

YES ..................................................................

NO ....................................................................

DK .....................................................................

B-4. What type of arthriiis (do you/does he/she) have? (READ CATEGORIES IF NECESSARY,)

~

RHEUMATOID .,................................... 1

OSTEOARTHRITIS .............................. 1

LUPUS ................................................. 1

GOUT ................................................... 1

DEGENERATIVE ................................. 1

SOME OTHER TYPE (SPECIFY) ........ 1

1

2 (Q.B-5)

8 (Q.B-5)

w &K

2 8

2 8

2 8

2 8

2 8

2 8

B-5. (Have you/Has he/she) ever had an x-ray

joints?

for (your/his/her) atihriiis, that is, an x-ray of (your/his/her)

YES .................................................................. 1

NO .................................................................... 2 (().B-8)

46
B+. How long ago did (you/he/she) ~ have an x-ray for anhritis? [PROBE WITH CATEGORIES IF

NECESSARY.]

LESS THAN ONE YEAR AGO ......................... 1

1 TO 5 YEARS AGO ........................................ 2

5 TO 10 YEARS AGO ...................................... 3

MORE THAN 10 YEARS AGO ........................ 4

DK ..................................................................... 8

B-7. How long ago did (you/he/she) & have an x-ray for arthriiis? [PROBE WITH CATEGORIES IF

NECESSARY.]

LESS THAN ONE YEAR AGO ......................... 1

1 TO 5 YEARS AGO ........................................ 2

5 TO 10YEARS AGO .............. ....................... 3

MORE THAN 10 YEARS AGO ........................ 4

DK ...,................................................................. 8

B-8. Did a doctor ever tell (you/him/her) that (you have/he/she has) gout?

YES .................................................................. 1

NO .................................................................... 2 (Q.B-13a)

DK ..................................................................... 8 (Q.B-13a)

B-9. What year (were you/was he/she) ~ told that (you/he/she) had gout’? [DO NOT PROBE A “DON’T

KNOW’ RESPONSE.]

YEAR: 19 I I I (Q.B-11)

DK .......................................... 9B

B-10. Can you remember if it was less than a year ago, between 1 and 5 years ago, between 5 and 10 years ago,

or 10 or more years ago?

LEA THAN ONE YEAR AGO ......................... 1

1 TO 5 YEARS AGO ........................................ 2

5 TO ,10 YEARS AGO ...................................... 3

MORE THAN 10 YEARS AGO ........................ 4

DK ..................................................................... 8

B-n. What year did (you/he/she) have (your/his/her) ~ epis~e of gout? [DO NOT PROBE A “DON’T KNOW

RESPONSE.]?

YEAR: 19 l_l_l (Q.B-13)

~ HAD ONLY ONE EPISODE OF GOUT ........95 (Q. B-13)

DK ..................................................................... 9B

47
0-12.

B-13.

B-13a.

l_l

B-14.

l_l

B-15.

Can you remember if it was less than a year ago, betwean 1 and 5 years ago, between 5 and 10 years ago,

or 10 or more years ago?

LESS THAN ONE YEAR AGO ......................... 1

I TO 5 YEARS AGO ........................................ 2

5 TO 10 YEARS AGO ...................................... 3

MORE THAN 10 YEARS AGO ........................ 4

DK ..................................................................... 8

(Have you/Has he/she) ever had an attack of arthriiis that the doctor says was caused by gout?

YES ..................................................................

NO ....................................................................

DK .....................................................................

[IF YES CODED IN Q. B-2 AND/OR (2.0+, ASK]

1

2

8

Since (1900/1970), (were you/was he/she) hospitalized for (your/his/her) (arthritis/gout/arthriiis or gout)?

[PROBE: (Were you/Was he/she) there for more than a day?]

YES .................................................................. 1 (CHART’)

NO .................................................................... 2

INTERVIEWER INSTRUCTIONS: FOR EACH CONDITION IN Q.B-14 THROUGH Q. B-57,

WITHIN EACH SECTION READ FIRST CHECKED ( ) ITEM. THEN, FOLLOW

APPROPRIATE SKIPS.

[IF SUBJECT, ASK] In (MONTH/YEAR), you told us that (you/he/she) previously had a heart attack,

(sometimes called coronary thrombosis or myocardial infarction). Have you had another heart attack since

then?

[IF PROXY, ASK:] Since (MONTH/YEAR)

YES .................................................................. 1 (Q-B-I B)

NO .................................................................... 2 (Q. B-19b)

DISCREPANCY ................................................ 96 (Q. B-15)

DK ..................................................................... 8 (Q. B-19b)

has @JBJECl_) had a heart attack, (sometimes called coronary

thrombosis or myocardial infarction)?

YES ................ .................................................. 1 (Q. B-18)

NO ............................................................m...,. 2 (Cl,B-19b)

DK ..................................................................... 8 (Q. B-19b)

Did a doctor ever tell (you/him/her)

thromixmis or myocardial intirction)?

that (you/he/she) had a heart attack, (sometimes called coronary

YES ...m.............................................................. 1

NO .................................................................... 2 (Q. B-19b)

DK ..................................................................... 8 (Q. B-19b)
B-16.

B-17.

B-I8.

B-19a.

B-19b.

In what year (were you/was he/she) firsttold that (you/he/she) had a heart attack, (coronary thrombosis or

myocardial infarction)?

YEAR: 191 I I

DK .............................. ...... 96

(Have you/Has he/she) had an additional heart attack since then?

YES .................................................................. 1

NO .................................................................... 2 (CIB-19a)

DK ..................................................................... 8 (Q. B-19a)

In what year was that heart attack? [PROBE: Did (you/SUBJECTI have any others since then? PROBE

FOR ALL YEARS.]

YEAR: 19 l_l—1

YEAR: 19 I_I—l

YEAR: 191 I I

YEAR: 19 l_l_l

DK .................................... 96

Since (1960/1970), (were you/was he/she) hospitalized for (your/his/her) heart attacK? [PROBE: (Were

you~as he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

Since (1900/1970), (were you/was he/she) hospitalized for any type of heart condition (other than a heart

attack)? [PROBE: (Were youfias he]she) there foj more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

[IF CHECKED ( ) ~ IF CI.B-15 OR Q. B-19b = YES, ASK:]

l_l I

B-20a. (Have you/Has he/she) ever had coronaty by-pass surge~

YES .................................................................. 1

NO .................................................................... 2 ((). B-20c)

B-20b. Since (1960/1970), (were you/was he/she) hospitalized for coronary by-pass surge@ (PROBE: Were

you/Was he/she) there for more than a dafi]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

49
B-20c. (Have you/Has he/she) ever had a pacemaker replacement, insertion or repaif?

B-20d.

l_l

B-21 .

l_l

B-22.

B-23.

B-24.

YES .................................................................. 1

NO .................................................................... 2 (Q. B-21)

Since (1900/1 970), (were you/was he/she) hospitalized for pacemaker replacement, insertion or repaifl

[PROBE: (Were you~as he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

[IF SUBJECT, ASK] In (MONTH/YEAR), you told us that you previously had a small stroke, sometimes

known as TIA (transient ischemic attack). Have you had an additional small stroke since then?

YES .............................................................n.... 1 (Q. B-25)

NO .................................................................... 2 (Q. B-27)

DISCREPANCY ................................................ 96 (Q. B-22)

DK ..................................................................... 8 (Q. B.27}

[IF PROXY, ASK] Since (MONTH/YEAR) has (SUBJECT) had a small stroke, sometimes known as TIA

(transient ischemic attack)?

YES .................................................................. 1 (Q. B-25)

NO .................................................................... 2 ((). B-27)

DK ..................................................................... 8 (Q. B-27)

Did a doctor ever tell (you/him/her) that (you/he/she) had a small stroke sometimes known as a TIA

(transient ischemic attack)?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-27)

DK ..................................................................... 8 (~. B-27)

In what year (were you/was he/she) firsttold that (you/he/she) had a small stroke?

YEAR: 191 I I

DK .................................... 98

(Have you/Has he/she) had an additional small stroke since then?

YES .................................................................. 1

NO .................................................................... 2 (CLB-26)

DK ..................................................................... 8 ((3.0-26)

50
B-25.

B-28.

l_l

B-27.

l_l

B-28.

B-29.

,

B30.

In what year was that small stroke? [PROSE: Did (you/~UBJECT) have any others since then? PROBE

FOR ALLYEARS.]

YEAR: 191——I I

YEAR: 19 l._l_.l

YEAR: 19 l_l_l

YEAR: 191 I I

OK .................................... 98

Since (1980/1 970), (were you/was he/she) hospitalized for a small stroke? [PROBE: (Were you/Was

he/she) there for more than a dafi]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

[IF SUBJECT, ASK:] In (MONTH /YEAR), you told us that you previouslyhad a stroke. Have you had an

i@Q!@@ *r*e sin- then?

YES .................................................................. 1 (c?.Ml)

NO .................................................................... 2 (cI.B-W)

DISCREPANCY ................................................ 88 (0. S-28)

OK ..................................................................... 8 (Q.B-33)

[IF PROXY, ASK] Since (MONTH/YE AR) has (SUBJECT) had a stroke(sometimescatleda CVA)?

YES .................................................................. I

NO .................................................................... 2

DK ..................................................................... 8

Did a doctorevertell (you/him/her) that (you/he/she) had a stroke(sometimescalled a WA)?

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 8

Inwhat year (were you/was he/she) firsttold that (you/he/she) had a stroke?

YEAR: 19 l,_l_l

DK .................................... 98

(Have you/Has he/she) had an ~ditional strokesincethen?

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 8

(Q.B-31)

(0.s-31)

(Q.B-34)

(0.s-34)

(Q.B-34)

(Q.B-32)

(Q.B-32)

51
B-31 .

B-32.

B-33.

l_l

B-34.

l_l

B-35.

B-38.

In what year was that stroke? [PROBE: Did (you/SUCJECT) have any others since then? PROBE FOR

ALL YEARS.]

YEAR: 191 ——I I

YEAR: 191 I I

DK .................................... 98

Since (1880/1970), (were you/was he/she) hospitalized for a stroke? [PROBE: (Were you/Was he/she)

there for more than a day?]

(Do you/Does ~UBJECT)

you/does he/she) have ...

YES .................................................................. 1 (CHART)

NO .................................................................... 2

now have any problems as a result of (your/his/her) stroke? That is, (do

Trouble with (your/his/her) arm and leg being weak or hard to use? ......................... 1 2

Trouble walking due to (your/his/her) stroke? ............................................................. 1 2

Trouble with speech? ..................................................................................................... 1 2

Some other trouble as a resutt of (your/his/her) stroke? (SPECIFYj ........................... 1 2

[IF SUBJECT, ASK] In (MONTH/YEAR), you told us that you previously had diabetes or sugar diabetes.

Are you now taking medication for your diabetes?

YES .................................................................. 1 (Q.B-37)

NO .................................................................... 2 (Q-B-39)

DISCREPANCY ................................................ 86 (Q.B-35)

DK ..................................................................... 8 (Q. B-39)

[IF PROXY, ASK] Is (SUBJECT) now taking medication for diabetes?

YES .................................................................. 1 (Q. B-37)

NO .................................................................... 2 (Q.B-39)

DK .m..,.....,.. ....................................................... 8 (CJ.B-39)

Did a doctor ever tell (you/him/her) that (you/he/she) had diabetes or sugar diabetes?

YES .................................................................. 1

NO .................................................................... 2 (Q.B40)

DK ..................................................................... 8 (Q.B40)

In what year (were you/was he/she) first told that (you/he/she) had diabetes or sugar diabetes?

YEAR: 19 I_I—l

DK .................................... 88

52
B-37. (Are you/is he/she) now taking insulin injections for (your/his/her) diabetes?

YES .................................................................. 1 (Q. B-39)

NO .................................................................... 2

DK ..................................................................... 8

B-38. (Are you/is he/she) now taking oral medication for (your/his/her) diabetes?

YES .................................................................. 1

NO .................................................................... 2

B-39. Since (1980/1 970), (were you/was he/she) hospitalized for (your/his/her) diabetes? [PROBE: (Were

you/Was he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

l_l

B-40.

l_l

B-41.

B-42.

[IF SUBJECT, ASK:] In (MONTH/YEAR), you told us that you had high blood pressure. Has the doctor

ever prescribed medicine for your high blood pressure?

YES .................................................................. 1 (Q.B44)

NO .................................................................... 2 (CLB45)

DISCREPANCY ................................................ 96 (Q.B+l)

DK ..................................................................... B (Q. B-45)

[IF PROXY, ASK] Has the doctor ever prescribed medicine for (SUBJECT) for high blood pressure?

YES ..................................................................

NO ....................................................................

DK .....................................................................

1 (Q.B44)

2 (Q.B45)

8 (Q. B-45)

(Have you/Haa SUBJECT) ever been told

hypertension?

by the doctor that (you/he/she) had high blood pressure or

YES .................................................................. 1

NO .................................................................... 2 (Q.B48)

DK ..................................................................... 8 (CI.B4B)

In what year (were you/waa he/she) first told that (you/he/she) had high blood pressure or hypertension?

YEAR: 19 l_l_l

DK .................................... 98

53
043.

044.

B45.

l_l

B-46.

l_l

B+7.

B4B.

Has the doctor ever prescribed medicine for (your/his/tw) high blood pressure?

YES .................................................................. 1

NO .................................................................... 2 (CLB45)

DK ..................................................................... 8 (Q.B45)

(Do you/Does he/she) currently take this medicine regularlf?

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 8

Since (19B0/1970), (were you/was he/she) hospitalized for high blood pressure? [PROBE: (Were

you/Was he/she) there for more than a da~]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

[IF SUBJECT, ASK] In (MONTH/YEAR), you told us that you had cancer. Have you had any other type of

cancer diagnosed since then?

YES .................................................................. 1 (().049)

NO .................................................................... 2 (Q.B+

DISCREPANCY ................................................ w (Q.B47)

DK ..................................................................... 8 (Q. B4r3)

[IF PROXY, ASK:] Since (MONTHiYEAR) has (SUBJECT) had any type of cancer diagnosed?

YES .................................................................. 1 (Q.B49)

NO .................................................................... 2 (Q.B-4B)

DK ..................................................................... 8 (Q.B-4B)

Did a doctor ever tell (you/him/her) that (you/he/she) had cancer of any sort?

YES ..................................................................

NO ....................................................................

DK .....................................................................

1 (Q.B49)

2 (Q.B-52)

8 (~. B-52)

Since 1980, (have you/has he/she) been hospitalized for ~ wcer condition? [PROBE: (Were you/Was

he/she) there for more than a da~]

YES .................................................................. 1 (CHART. THEN

GO TO Q. B-52)

NO .................................................................... 2 (C3.B-52)

54
1ST DIAGNOSIS 2ND DIAGNOSIS 3RD DIAGNOSIS

B-49. Where was the LUNG ........................................ 1 LUNG ........................................ 1 LUNG ........................................ 1

cancer or what COLON ..................................... 2 COLON ..................................... 2 COLON ..................................... 2

type of cancer BREAST .................................... 3 BREAST...,..., ............................. 3 BREAST .................................... 3

was P SKIN (MELANOMA) .................. 4 SKIN (MEL4NOMA) .................. 4 SKIN (MELANOMA) .................. 4

[PROBE: SKIN (NON-MEMNOMA) ........ 5 SKIN (NON-MEMNOMA) ........ 5 SKIN (NON-MEIANOMA) ........ 5

(Have you/ UTERUS .................................... 6 UTERUS .................................... 6 UTERUS .................................... 6

Has he/she) PROSTATE ............................... 7 PROSTATE ............................... 7 PROSTATE ............................... 7

had any STOMACH ................................ 8 STOMACH ................................ 6 STOMACH ................................ 6

other cancer LEUKEMIA ................................ 9 LEUKEMIA ................................ 9 LEUKEMIA ................................ 9

diagnosed?] OTHER (SPECIIV) ................... 91 OTHER (SPECl~ ................... 91 OTHER (SPECl~ ................... 91

SITE: SITE SITE:

m ~ m

TYPE: TYPE: TYPE

B-5o. In what year

(were you/ YE4R 19 I II YEAR 19 l_l_l YEAR 19 l_l_l

was he/she)

firsttold DK ........................... 96 DK ......................... 96 DK ........................... 96

that (you/

he/she) had

(CANCER)?

B-51 . Since (1980/

1970), (were

you/was he/

she)

hospitalized

for (CANCER)?

[PROBE: YES ..................... 1 (CHART) YES .................... 1 (CHART) YES ..................... 1 (CHART)

(Were you/

Was he/she) NO ...................... 2 NO ..................... 2 NO ...................... 2

there for more

than a day?]

55
l_l

B-52.

l_l

B-53.

B-54.

B-55.

B-56.

B-57.

[IF SUBJECT, ASK:] In (MONTH/YEAR), you told us that you previously had a broken or fractured hip.

Have you had another tiactured hip since then?

YES .................................................................. 1 (Q. B-56)

NO .................................................................... 2 (Q. B-58)

DISCREPANCY ................................................ 96 (Q. B-53)

DK ..................................................................... 8 (Q. B-5B)

[IF PROXY, ASK:] Since (MONTH/YEARj has (SUBJECTI had a broken or fractured hip?

YES .

. ................................................................ 1 (Q. B-56)

NO .................................................................... 2 (Q. B.5B)

DK ...................................................................t. s (Q. B-513)

(Have you/Has SUBJECT) ever been told by the dootor that (you/he/she) had a broken or fractured hip?

YES .................................................................. I

NO ....

................................................................ 2 (Q. B-58)

DK ..................................................................... 8 (Q. B-513)

In what year (were you/was he/she) first told that (you/he/she) ,had a broken or fractured hip?

YEAR: 191 ——I I

DK .................................... 96

(Have you/Has he/she) had an additional fractured hip since then?

In what year did (you/he/she) have that

YES .................................................................. 1

NO .................................................................... 2 (Q. B-57)

DK ......... .

. .......................................................... 8 ((lB-57)

break or fracture of (your/his/her) hiD? [PROBE: Did

(you/SUBJECT) have any others since then? PROBE FOR ALL YEARS,] ‘ ‘ - ‘ ‘

YEAR: 19 I_l_l

YEAR: 19 l_l_l

YEAR: 19 l_l_l

YEAR: 19 l_l_l

DK .................................... 96

Since (1960/1970), (were you/was he/she) hospitalized for a broken or fractured hip? [PROBE: (Were

you/Waa he/she) there for more than a dafi]

YES .................................................................. 1 (CHART)

NO ..............................................................t..... 2

56
B-56. Since 1970, (have you/has SUBJECl_I broken or ftactured any bones (other than a hip)?

YES .................................................................. 1

NO .................................................................... 2 (Q.B+2)

DK ..................................................................... 8 (Q.B+2)

1ST BREAK/FRACTURE 2ND BREAK/FRACTURE 3RD BREAK/FRACTURE

B-59. Which bone? WRIST ....................................... 1 WRIST ....................................... 1 WRIST .................................. 1

[PROBE: LEG, KNEE, LEG, KNEE, LEG, KNEE,

(Have you/ ANKLE,FOOT ......................... 2 ANKLE,FOOT ......................... 2 ANKLE, FOOT .................... 2

Has he/she) ARM, ELBOW, ARM, ELBOW, ARM, ELBOW,

broken or SHOULDER ............................ 3 SHOULDER ............................ 3 SHOULDER ....................... 3

fractured any HAND ........................................ 4 HAND ........................................ 4 HAND ................................... 4

other bones?] BACK......................................... 5 BACK......................................... 5 BACK..................................., 5

RIBS .......................................... 6 RIBS .......................................... 6 RIBS ..................................... 6

PELVIS ...................................... 7 PELVIS ...................................... 7 PELVIS ................................. 7

OTHER BONE (SPECIIW) ........ 91 OTHER BONE (SPECIFY) ........ 91 OTHER BONE (SPECl~ ... 91

0-60. In mat year YEAR: 191 I I

YEAR 191 —— I I YEAR 191 ——I I

(was this YEAR 19 l_l_l y~ 19 l_l_l YEAR

(BONE) break YEAR 191 I I

191 I I

y~ 191 I I YEAR 191 I I

or fracture? YEAR 19 I_l_l YEAR 191 [ I YEAR: 19 l_l_l

(PROBE FOR DK .......................... 96 DK ......................... 96 DK .......................... 96

ALL YEARS)

B-61 . Since 19W3, (where you/was he/she) hospitalized for any broken or fractured bones (other than a hip)?

[PROBE: (Were you/Was he/she) there for”more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

57
B42m Since (1980/1970), (have you/has he/she) been hospitalized for pneumonia or the flu? [PROBE: (Were

you/Was he/she) there for more than a da~]

YES .................................................................. 1 (CHART)

NO ...............i.................................................... 2

B&i. (Aside from the hospitalizations you have mentioned,) (Have you/Has ~llBJECT) been hospitalized for any

surgical procedure or operation sinca (1980/1970)? [PROBE: (Were you/Was he/she) there for more than

a day?]

YES .................i................................................ 1 (CHART)

NO .................................................................... 2

B-64 AND B6 NOT ASKED THIS VERSION.

58
B-66. [1have recorded that (you were/SUBJECT was) hospitalized (READ DATES, CONDITIONS AND FACILITY

NAMES FROM CHART).]

Now, I would like you to think back over the time between (19B0/1970) and the present. (You/He/She)

would have been about ~ in (1980/1970). (Have you/Has he/she) stayed in a hospital for anv (other)

reason including tests or for obsewation since (you were/he/she was) ~? [PROBE: (Were you/Was

he/she) there for more than a day?]

YES .................................................................. 1

NO .................................................................... 2 (Q. B43!3)

CONDITION # 1 CONDITION # 2 CONDITION # 3

B47. For what condi- TESTS AND/OFl TESTS AND/OR TESTS AND/OR

tion was that? OBSERVATION........... 1 OBSERVATION .............. 1 OBSERVATION .............. 1

(PROBE: Did DIGESTIVE DIGESTIVE DIGESTIVE

(you/he/she) PROBLEMS ................. 2 PROBLEMS .................... 2 PROBLEMS .................... 2

have any other RESPIRATORY/ RESPlR4TORY/ RESPIRATORY/

hospitaliza- BREATHING BREATHING BREATHING

tions since PROBLEMS ................. 3 PROBLEMS .................... 3 PROBLEMS .................... 3

(19Bo/1970)?] INFECTIONS ...................... 4 INFECTIONS ...................... 4 INFECTIONS ...................... 4

[GO TO CHART OTHER (SPECW) ............ 91 OTHER (SPECIW) ............ 91 OTHER (SPECI17) ............ 91

AITER CODING

CONDITION.]

(CHART) (CHART) (CHART)

B-w NOT ASKED THIS VERSION,

59
B-69. Since (19S0/1970), (have you/has SUBJECT) ever stayed in a rest home, a nursing home, a mental heatth

facility, or anything like thW [PROBE: (Were you/Was he/she) there for more than a day?]

YES .................................................................. 1

NO .................................................................... 2 (Q. B-77)

B-70. To what type

of place was the

(most recent/this

admission?

B-71 . Did (you/he/she)

enter the ~

OF FACILl~

directly from

(your/his/her)

own home, from

a hospital, or

from some

other place?

B-72. In what year

did (you/he/she)

enter the ~

OF FACILITY)?

ADMISSION# 1

REST HOME ...................... 1

NURSING HOME ............... 2

MENTAL HEALTH

FACILITY ......................... 3

HEALTH CARE

REHABILITATION

CENTER ......................... 4

OTHER (SPECIFYI ............ 91

OWN HOME ...................... 01

HOSPITAL .......................... 02

NURSING HOME ............... 03

REST HOME ...................... 04

MENTAL HEALTH

FACILITY ......................... OS

HEALTH CARE

REHABILITATION

CENTER ......................... W

OTHER (SPECIW) ............ 91

y- 19 l_l_l

ADMISSION# 2

REST HOME ...................... 1

NURSING HOME ............... 2

MENTAL HEALTH

FACILITY ......................... 3

HEALTH CARE

REHABILITATION

CENTER ......................... 4

OTHER (SPECWJ ............ 91

OWN HOME ...................... 01

HOSPITAL .......................... 02

NURSING HOME ............... 03

REST HOME ...................... 04

MENTAL HEALTH

FACILITY ......................... W

HEALTH CARE

REHABILITATION

CENTER ......................... IX

OTHER (SPECIIV) ............ 91

y~’ 19 l_l_l

ADMISSION# 3

REST HOME ...................... 1

NURSING HOME ............... 2

MENTAL HEALTH

FACILllY ......................... 3

HEALTH CARE

REHABILITATION

CENTER ......................... 4

OTHER (SPECIFY) ............ 91

OWN HOME ...................... 01

HOSPITAL .......................... 02

NURSING HOME ............... 03

REST HOME ...................... 04

MENTAL HEALTH

FACILITY ......................... 05

HEALTH CARE

REHABILITATION

CENTER ......................... ~

OTHER (SPECl~ ............ 91

60
B-73. There are many

reasons why

people enter

a (lYPE OF

EK!U!xlPlease tell

me if (you/

W&K!)

entered the

(!z!xQE

!z!U!IM

for any of

the following

reasons.

(CIRCLE YES

OR NO FOR

EACH.)

B-74. Please tell me

the name of

the disease

or condition that

(you/he/she)

had at the time

of admission

that affected

(your/his/her)

ability to live

independently?

(CIRCLE ALL

THAT APPLY)

ADMISSIOW 1

Required skilled

nursing care? ............ 1

Recuperation from

surgefl .................... 1

Needed help with

bathing, eating,

or dressing? .............. 1

Required special

medical or

physical therapfl ...... 1

Too confused to live

independently? ......... 1

2

2

2

2

2

—

ALCOHOLISM .......................... 01

AIZHEIMER’S

DISEASE ................................ 02

ARTHRITIS ................................ 03

CANCER ................................... 04

DEPRESSION ........................... 05

DISRUPTIVE

BEHAVIOR ............................ w

FRACTURE OTHER

THAN HIP .............................. 07

FRAIL/OLD AGE ....................... 06

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEROSIS ........... W

HEART ATTACK (Ml) ................ 10

HIP FR4CTURE ........................ 11

INCONTINENCE ...................... 12

MENTAL ILLNESS .................... 13

NO MEDICAL CONDiTION ,...,. 14

OSTEOPOROSIS

(FRAGILE OR

SO~ BONES) ...................... 15

SENIIJW .................................. le

STROKE ................................... 17

OTHER DISEASE OR

CONDITION (SPECl~ ........ 91

ADMISSION# 2

Y~ F@

Required skilled

nursing care? ............ 1

Recu~ration from

surge~ .................... 1

Needed help with

bathing, eating,

or dressing’? .............. 1

Requirwl special

medi~ or

physical therapy ...... 1

Too confused to live

independentl~ ......... 1

2

2

2

2

2

—

ALCOHOLISM ........................... 01

AKHEIMER’S

DISEASE ................................ 02

ARTHRITIS ................................ 03

CANCER ................................... 04

DEPRESSION ........................... 05

DISRUPTKE

BEHAVIOR ............................. w

FRACTURE OTHER

THAN HIP .............................. 07

FRAJL/OLD AGE ....................... 06

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEROSIS ........... W

HEART ATTACK (Ml) ................ 10

HIP FR4CTURE ........................ 11

INCONTINENCE ....................... 12

MENTAl lLudESS .................... 13

NO MEDICAL CONDITION ....... 14

OSTEOPOROSIS

(FRAGILE OR

SOIT BONES) ....................... 15

SENIIJIY ................................... 16

STROKE .................................... 17

OTHER DISEASE OR

CONDITION (SPECIFY) ........ 91

ADMISSION# 3

Required skilled

nursing care? ..........

Recuperation from

surge@ ..................

Needed help wkh

bathing, eating,

or dressing? ............

Required special

medical or

physical therapfi ....

Too conrlsed to live

independently? .......

1

1

1

1

1

2

2

2

2

2

—

ALCOHOLISM .......................... 01

AIZHEIMER’S

DISE#S.E ............................... 02

ARTHRITIS ............................... 03

CANCER ................................... W

DEPRESSION .......................... 05

DISRUPTIVE

BEHAVIOR ............................ 06

FRACTURE OTHER

THAN HIP .............................. 07

FIWJL/OLD AGE ...................... 06

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEROSIS ........... W

HEART ATTACK (Ml) ................ 10

HIP FRACTURE ........................ 11

INCONTINENCE ...................... 12

MENTAL ILLNESS .................... 13

NO MEDICAL CONDITION ...... 14

OSTEOPOROSIS

(FPAGILE OR

SOIT BONES) ...................... 15

SENILITY .................................. 16

STROKE ................................... 17

OTHER DISEASE OR

CONDITION (SPECIIW) ........ 91

I

61
B-75. How long did

(you/he/she)

stay? (GO

TO CHART

A~ER CODING

LENGTH OF

STAY.)

B-76. Since (19B0/

1970) were there

other admissions

to a rest home, a

nursing home,

a mental health

facility, a

rehabilitation

center or any

place like that?

ADMISSION# 1

X:111

OF WKS ............... 1

MOS ............... 2

YRS ................ 3

STILL THERE ................ 94

LESS THAN

ONE WEEK ................ 95

(CHARTj

YES ......... 1 (Q. E3-70)

NO ........... 2

ADMISSION# 2

~: l_l_l

OF WKS ........<...... 1

MOS ............... 2

YRS ................ 3

STILL THERE ................ 94

LESS THAN

ONE WEEK ................ 95

(CHART)

YES ......... 1 (Q. B-70)

NO ........... 2

ADMISSION# 3

~: l_l_l

OF WKS ............... 1

MOS ............... 2

YRS ................ 3

STILL THERE ................ 94

LESS THAN

ONE WEEK ................ 95

(CHART)

YES ......... 1 (C).B-70)

NO ........... 2

62
B-77. [IF Q.A-3 IS ~ CODED 2, ASK]

What has been happening to (your/his/her) heatth during the past 12 months? Has it improved, remained

the same, gradually worsenad, or suddenly worsened?

IMPROVED ...................................................... 1

REMAINED THE SAME ................................... 2

GRADUALLY WORSENED .............................. 3 (PART C)

SUDDENLY WORSENED ................................ 4

OTHER ............................................................. 5

B-78. [IF Q.A-3 IS CODED 2, ASK]

During the month before (your/SUBJECT’S) admission to the nursing home, was there a significant change

in (your/his/her) health?

YES .................................................................. 1

NO .................................................................... 2

B-79. During the 12 months prior to that, what was happening to (your/his/her) health? Had it improved,

remained the same, gradually worsened, or suddenly worsened?

IMPROVED ...................................................... 1

REMAINED THE SAME ................................... 2

GRADUALLY WORSENED .............................. 3

SUDDENLY WORSENED ................................ 4

OTHER ............................................................. 5

TIME ENDED: AM

PM

63
PART C: ACTIVITIES OF DAILY LIVING

TIME BEGAN: AM

PM

NURSING HOME INSTRUCTIONS: CIRCLE ONE:

RESPONDENT CAN ANSWER THIS SECTION .................. 1

RESPONDENT CANNOT ANSWER THIS SECTION

ASK OF NURSING HOME STAFF .................................. 2

These next questions ask about physical problems you may have. First. , ,

c-1.

G2.

C-2a.

(RECORD NAME, ADDRESS AND

TELEPHONE NUMBER ON IS.

THEN, GO TO PART D.)

(Do you/Does SUBJECTI usually have to stay in bed for most of the day?

YES .................................................................. 1

NO .................................................................... 2 (Q,G2a)

How long (have you/has he/she) had to stay in bed?

(Do you/Does he/she) have any paralysis

(your/his/her) limbs?

NUMBER OF MONTHS: I_

m

NUMBER OF YEARS: I_

LESS THAN ONE MONTH ..............

— I GO TO C3a

AND ASK ‘

_l QUESTIONS

ONLY

,. 95

or other problem that prevents the use of one or more of

YES .................................................................. 1

NO .................................................................... 2 (Q.G3a)

C-2b. IS this due to. . .

a. Paralysis? ...................................... 1 2

b. Amputation? ................................. I 2

c. Severe arthritis? ............................ 1 2

d. Some other reason? .................... 1 2

(SPECIFY)

64
C-2C. [IF YES TO Q. C2ba, ASK:]

Which limbs are paralyzed?

a. RIGHT HAND/ARM ..................... 1 2

b. LE~ HAND/ARM ........................ 1 2

c. RIGHT FOOT/LEG ....................... 1 2

d. LE~ FOOT/LEG ......................... 1 2

C-2d. [IF YES TO Q.C-2bb, ASK]

Which limbs have been amputated?

a. RIGHT HAND/ARM ..................... 1 2

b. LEFT HAND/ARM ........................ 1 2

c. RIGHT FOOT/LEG ....................... 1 2

d. LE17 FOOT/LEG ......................... 1 2

C-2e. [IF YES TO Q.C-2bc OR C-2bd, ASK]

Which limbs are involved?

a. RIGHT HAND/ARM ..................... 1 2

b. LE~ HAND/ARM ........................ 1 2

c. RIGHT FOOT/LEG ....................... 1 2

d. LEFT FOOT/LEG ......................... 1 2

INTERVIEWER: REVIEW Q. C-2C, Q.C-2d, AND Q.C2e AND CIRCLE ONE:

ALL CATEGORIES IN Q.C-2C, Q.C2d

OR Q.C-2e ARE CODED YES ......................................... 1 (PART D)

AT LEAST ONE “C” CATEGORY Am ONE

‘d’ CATEGORY IS CODED IN Q.C-2C,

Q.C-2d AND/OR Q.C-2e .................................................. 2 (ASK* AND**

QUESTIONS ONLY)

ALL OTHERS ........................................................................ 3 (Q. C-3a)

65
INTERVIEWER INSTRUCTIONS: ASK Q,C-3 THROUGH Ct.G2B. IF ANY RESPONSE TO b = 3 OR 4 ~ ANY

RESPONSE TO a -3, ASK Q. C-3c/Q.G3d THROUGH Q.C2Bc/Q.C2Bd. IF c OR d = YES (USES HELP EITHER

FROM ANOTHER PERSON OR AN AID) ASK Q.C-W THROUGH Q.C2Ba WHERE INDICATED.

● ☛

● ☛

☛✎

☛☛

●

☛

●

6*

● *

● *

● *

● *

●

● *

● *

*

● *

a

I am going 10 read a Iisl of acrivitiee. Please tell me H [IF YES (CODE lfiN a. ASK]

(you have/sUBJECT has) ~ difficulty doing these Ihlnge (Do you/Doss ~UBJECT) have

tien (you are/~ UBJECT is) by (youreelf/himself/heraal~ some difiici.riiy,much difficiily,

and not using an aid. [PROBE, IF NECESSARY: (Do you/ or (are you/is he/she) unable 10

Does he/she) have any difficultywhen (you/he/nhe do this?

MIL!!Im

SOME MUCH

[ENTER ONE CODE FOR EACH ACTIVl~ DIFFl- DIFFl- UNABLE

1. YES (DIFFICULIY): ASK b CULTY CUL~ TO DO DK

2 = NO DIFFICULIY

3 = NEVER DOES WITHOUT HELP

4 = NEVER DOES ACTIVITY

5 = INAPPROPRIATE ACTIVITY

c-3. Dress (yoursalr/himself/her.sell), including lying

shc-ss,working zippare and doing builorm? l_l 2 3 4 B

C-4. NOT ASKED THIS VERSION.

C5. Stand up horn an armleaa straight chair (such as

a dining roam chair)? l_l 2 3 4 8

C-6. Get inlo and out of IA? l_l 2 3 4 8’

G7. Prepare mea15? l_l 2 3 4 B

C-E!. Cut (your/his/her) meaI’7 l_l 2 3 4 8

G9. Lift a full cup or glass to (your/hie/her) mouttr? l_l 2 3 4 8

C1O. Open a new milk carton? l_l 2 3 4 e

C-1 1. Walk a quarier mile (thai is, IWOorthrea block)? l_l 3 4 B

(IF CODE 2, GO TO Q.C13) (Q.:13)

C-12. Walk horn one rmm to another (on Ihe same floor)? l_l 2 3

4 e

C-13. Walk up and down al least mm sleps? l_l 2 3 4 8

C-14. NOT ASKED THIS VERSION.

C15. Get In and out of the baihlub? l_l 2 34 e

C-16. Wash and dry (your/his/her) whole body7 l_l 2 3 4 8

C-17. Gaf on and off !he Ioilat’? l_l 2 3 4 8

GI B. Comb (your/his/her) hairT l_l 2

3 4 6

C-19. Reach and get down a 5 lb. objaU (bag of sugar) from

just akve (your/hie/her) head7 l_l 2

3 4 8

C-2O. Bend dwrr and pickup dofhing from the floor? l_l 2

4 6

C21. NOT ASKED THIS VERSION.

C22. Open ]are which have bean previously opened? l_l 2 3 4 B

C23. Use a pan or pencil to tie wiih7 l_l 2

3 4 6

G24. Gal In and out of a M l_l 2 3 4 8

C25. Run errands and chop? l_l 2 3

4 B

C26. Do light choras (such as vacuuming)? l_l 2 3 4 6

C-27. Lift and ~rry a full bag of groceries7 I_l 2 3 4 B

C-28. Do heavy chores around the house or yard (such ns

waehlng windowe, walls rx firers)? l_l 2 3 4 6

.— ——. —
BOX E

INTERVIEWER: REVIEW G3a/G3b THROUGH G2Ba/G2Bb AND CIRCLE ONE:

ANY RESPONSE IN C1.G3a THROUGH C1.C2Ba = 3 ................................... 1 (Q.G3c)

ANY RESPONSE IN 0.C3b THROUGH Q.C28b -3 OR 4 ......................... 2 (0. C-3C)

ALL RESPONSES, Q.G3b THROUGH Q,C2Bb = BIANK, 2, OR 8 ............ 3 (PART D)

I 1

[IF CODE 3 IN a, ASK] [ASK ONLY IF HAVE H;LP] Wth helo hmv

You said that you never (ACTIVITY_I wfihout help. much dih5cuity (do you/doss ~UBJECT)

have (doing this activity)? (Do you/Does

[IF ~ IS SUBJECT AND CODE 3 OFI 4 IN b, ASK] he/she) have no difficulty, some dihicutly,

You said that you (have dihicuHy/are unable to) (ACTIVllYI by yourself. much difficulty, or (are you/is he/6he) unable

to do ‘W

[IF ~ IS PROXY AND CODE 3 OR 4 IN b, ASK]

You eaid Ihat (he/she) (has difficuiiy/ls unable 10) (ACTIVllYI by

(himself/herself).

c. (Do you/Doss hef

she) have help Irom d. (Do you/Does he/she) have help kom a

anolher person~ machanicsl aid or devim, such as a ~ne? NO SOME MUCH UNABLE

DIFFl- DIFFl- DIFFl- TO

YES NO YES NO CULl_Y CULTY CULTY DO

C-3.

1 2 1 2 1 2 3 4

C-4.

C-5.

1 2 1 2 1 2 3 4

C*. 1 2 1 2 1 2 3 4

G7. 1 2 1 2 1 2 3 4

ca. 1 2 1 2 1 2 3 4

G9. 1 2 1 2 1 2 3 4

G1O. 1 2 1 2 1 2 3 4

Gil.

1 2 1 2 1 2 3 4

G’12. 1 2 1 2 1 2 3 4

C-13. 1 2 1 2 1 2 3 4

C-14.

C-15. 1 2 1 2 1 2 3 4

G16. 1 2 1 2 1 2 3 4

c-l?. 1 2 1 2 1 2 3 4

C-18. 1 2 1 2 1 2 3 4

C-19.

1 2 1 2 1 2 3 4

C-20. 1 2 1 2 1 2 3 4

C-21.

C-22, 1 2 1 2 t 2 3 4

G23. 1 2 1 2 1 2 3 4

C-24. 1 2 1 2 1 2 3 4

G25. 1 2 1 2 1 2 3 4

c-26. 1 2 1 2 1 2 3 4

G27. 1 2 1 2 1 2 3 4

C-2.9.

1 2 1 2 I 2 3 4

.— ———, — -. .

TIME ENDED: AM

PM

67
PART D: SMOKING AND ALCOHOLIC BEVERAGES

BOX A I

INTERVIEWER: CIRCLE ONE:

S PREVIOUSLY INTERVIEWED .................................... 1 (PART E)

S NEVER INTERVIEWED ............................................... 2

TIME BEGAN: AM

PM

These next few questions are about (your/SUBJECT’S) smoking and drinking habits.

D-1.

D-2.

D-3.

D-4.

D-5.

Did (you/SUBJECTj ever smoke at least 1(20cigarettes in (your/his/her) lifetime?

YES ...............................a.................................. 1

NO .................................................................... 2 (C).D4)

(Do you/Does he/she) smoke cigarettes now?

YES .................................................................. 1

NO .................................................................... 2 (Q.D-5)

About how many cigarettes a day (do you/does he/she) now smoke? [IF ANSWER IS NUMBER OF

PACKS, MULTIPLY BY 20 AND VERIFY.]

NUMBER OF CIGARETTES: l_l_l_l

LESS THAN ONE A DAY .............................. 995

For how many years (have you/has he/she) smoked cigarettes?

NUMBER OF YEARS:

When did (you/he/she) stop smoking cigarettes?

l_l_l (Q.D-J3

MONTH: l_l_l

~

YEAR: 19 l_l_l

D+, During the years when (you were/he/she was) smoking, about how many cigarettes a day did

(you/he/she) smoke? [IF ANSWER IS NUMBER OF PACKS, MULTIPLY BY 20 AND VERI17.]

NUMBER OF CIGAREITES: 1111

LESS THAN ONEA DAY .............................. 995

68
D-7. For how many years (did you/has he/she) smoke cigarettes?

NUMBER OF YEARS: Ill

D-8. Now I would like to talk to you about drinking alcoholic beverages. By alcoholic beverages 1mean beer, or

wine, or liquor. (Have you/Has SUBJECT) had at least one drink of beer, wine, or liquor during the past

yeaf?

YES .................................................................. 1

NO .................................................................... 2 (PART E)

D-9. During the past year, on the average, how often (did you/did he/she) drink alcoholic beverages, that is,

beer, or wine, or Iiquofl

NUMBER OF DAYS: [——I I PER: WEEK .. ............ 1

MONTH ............ 2

MORE THAN 3 BUT LESS THAN 12 TIMES PER YEAR .............94

NO MORE THAN 3 TIMES PER YEAR ......................................... 95

D-lo. During the past year, on the average, how many cans or bottles of beer (did you/did he/she) drink per day,

week, month or year?

NUMBER OF DRINKS: l_l_l PER: DAY .................. 1

WEEK ............... 2

MONTH ............ 3

YEAR ................ 4

NONE ............................................................................................. O

D-II. During the past year, on the average, how many glasses of m-ne (did you/did he/she) drink per day, week,

month, or year?

NUMBER OF DRINKS: I——I I PER: DAY .................. 1

WEEK ............... 2

I

MONTH ............ 3

YEAR ................ 4

NONE ............................................................................................. O

D-12, During the past year, on the average, how many shots or drinks of hard liquor, either straight or in a mixed

drink, (did you/did SUBJECT) drink par day, week, month or year?

NUMBER OF DRINKS: I I I PER: DAY .................. 1

WEEK ............... 2

MONTH ............ 3

YEAR ................ 4

NONE ............................................................................................. 0

TIME ENDED: AM

PM

69
PART E: EXERCISE AND WEIGHT

TIME BEGAN: AM

PM

BOX B

INTERVIEWER: CHECK Q.Cl, Q.G2c, Q.G2d, C1.C2e, AND Q.G12 AND CIRCLE ONE:

C-1 = YES@ IS BEDRIDDEN) ~ Q.f2-12 = 4 (UNABLE TO DO) ....................... 1 (BOX C)

Q.2cc OR C-2dc OR C-2ec = YES ~ ().C2cd OR Q,C2dd OR

().G2ed = YES& UNABLE TO USE LOWER LIMBS) .................................... 2 (BOX C)

ALL OTHERS ............................................................................................................ 3

The next few questions are about physical activity.

E-1. How often (do you/does he/she) walk outside in gmd weathef? [PROBE WITH CATEGORIES IF

NECESSARY.]

NEVER ............................................................. 1 (BOX C)

LESS THAN ONCE A MONTH ........................ 2

LESS THAN ONCE A WEEK ........................... 3

1 TO 2 TIMES A WEEK ................................... 4

3 TO 6 TIMES A WEEK ................................... 5

DAILY ............................................................... 6

E-2. When (you/he/she) walk(s) in good weather, how long (do you/does he/she) usually keep at it? [PROBE

WITH CATEGORIES IF NECESSARY.]

LESS THAN 15 MINUTES ............................... 1

15 MINUTES .................................................... 2

30 MINUTES .................................................... 3

45 MINUTES .................................................... 4

1 HOUR OR LONGER ..................................... 5

BOX C

INTERVIEWER: CIRCLE ONE:

~ IS SUBJECT .......................................................................................................... 1

~ IS PROXY .............................................................................................................. 2 (Q.Eqa)

70
E-3. People find that they somdimes have more trouble remembering things as they get older. In the past vear,

about how often did you have trouble remembering things? Would you say ...

Frequently, ....................................................... 1

Sometimes , ...................................................... 2

Rarely, or .......................................................... 3

Nevef? .............................................................. 4 (Q.E+a)

E4 Compared with a year ago, do you have trouble remembering ...

More often, ....................................................... 1

Less often, or ................................................... 2

About the same? .............................................. 3

E-4a. People sometimes have difficulty controlling urination as they get older. During the past few months, how

often (have you/has he/she) lost control over (your/his/her) urine? Would you say ...

Often, ................................................................ 1

Occasionally, or ............................................... 2 (Q.E4b)

Nevefl .............................................................. 3 (Q.E4b)

E4al. Would you say that’s daily, at least onca a week, or less often?.

DAILY ............................................................... 1

AT LEAST ONCE A WEEK .............................. 2

LESS OITEN ................................................... 3

E-4b. How often (do you/does he/she) dribble, leak or lose urine when (you/he/she) laugh(s), strain(s) or

cough(s)? Would you say ...

Often, ................................................................ 1

Occasionally, or ............................................... 2

Nevkf? .............................................................. 3 (Q. E-4d)

E4c. (Do you/Does he/sha) dribble or leak urine onJwhen (you/he/she) laugh(s), strain(s) or cough(s)?

YES ..............................................s................... 1

NO .................................................................... 2

E4d. [IF Q.E4a = 1) ~ (Q,E4a = 2 AND Q.E-4b = 1 OR 2 AND Q.E4c = 2), ASK]

When (you/he/she) feel(s) the urge to pass urine, how long can (you/he/she) usually wait ...

5 minutes or more , .......................................................... 1

Less than 5 minutes but more than a few seconds ....... 2

A few seconds, or ........................................................... 3

(Do you/Does he/she) wet without warning? ............... 4

71
E+e. [IF Q.E-4a = 1) ~ (Q.EAa = 2 AND Q.E4b = 1 AND Q.E+c = 2), ASK]

E-5.

E-6.

E-7.

E-8.

Can (you/he/she) usually go more than half an hour during the day without leaking urine?

YES .................................................................. 1

NO .................................................................... 2

BOX D

INTERVIEWER: CIRCLE ONE:

~ PREVIOUSLY INTERVIEWED .................................................................................... 1

S NEVER INTERVIEWED AND R IS SUBJECT ............................................................. 2 (Q.E-6)

S NEVER INTERVIEWED AND R IS PROXY ................................................................. 3 (Q.E+I)

About how much (do you/does SUBJECT) weigh noti

NUMBER OF POUNDS: I I I I (PART F)

DK ...................................................... ‘~ (PART F)

These next questions are about your weight, height, and diet. When you were about 12 to 13 years old,

compared to other (boys/girls) of the same age, were you considered to be. . .

Skinny, ............................................................. 1

Somewhat slender , .......................................... 2

Average, ........................................................... 3

Chubby, or ....................................................... 4

Very hea~ ...................................................... 5

DK ..................................................................... 8

When you were about 12 to 13 years old, compared to other (boys/girls) of the same age, were you

mnsidered to be. . .

Ve~tall, .............................m.............................. 1

Somewhat taller than average , ........................ 2

About average, ................................................ 3

Somewhat shorter than average, or ................ 4

Veryshorl’? ....................................................... 5

DK ..................................................................... 8

How does (your/SUBJECT’$J weight now mmpare to (your/his/her) weight 6 months ago? Is it ...

At least 10 pounds more, ................................ 1

At least 10 pounds less, or .............................. 2

About the same? .............................................. 3

DK ..................................................................... 8

72
E-9. About how much (do you/does he/she) weigh now’?

NUMBER OF POUNDS: I Ill

DK ...................................................... 998

E-10. What was (your/his/her) usual weight at the age of 25?

NUMBEROFPOUNDS:I I I I

DK ......................................................

E-1 1. [IF ~ IS 41 OR OLDER, ASK] What was (your/his/her) usual weight at the age of 40?

NUMBER OF POUNDS: I

Ill

DK ...................................................... 99B

E-12. [IF ~ IS 66 OR OLDER, ASK:] What was (your/his/her) usual weight at the age of 65?

NUMBER OF POUNDS: I_l I I

DK ...................................................... 99B

TIME ENDED: AM

PM

73
PART F: VISION AND HEARING

TIME BEGAN: AM

PM

These next few questions concern (your/SUBJECT’S) vision and hearing.

F-1 .

F-2.

F-3.

F-4.

F-5.

BOX E

INTERVIEWER: REVIEW HHCF CHART AND CIRCLE ONE:

~ HAD CATARACT SURGERY ...................................... 1

OTHERWISE .................................................................,. 2 (Q.F-2)

You mentioned previously that (you/SUBJECT) had cataract surgery. What year did (you/he/she) have

(your/his/her) cataract surgery? [PROBE: Did (you/he/she) have any other cataract surgery? RECORD

ALL YEARS.]

YEAR: 19 I I I (QJW

YEAR: 19 I I I (Q-F+)

DK ..................................................................... 99 (Q.F4)

Has a doctor ever told (you/SUBJECT) that (you/he/she) had cataracts?

YES.................................................................. 1

NO .................................................................... 2 (Q. F%)

(Have you/Has he/she) ever had surge~ for (your/his/her) cataracts?

YES .................................................................. 1

NO .................................................................... 2 (Q.F4)

What year did (you/he/she) have (your/his/her) catarad surge~ [PROBE: Did (you/he/she) have any

other cataract surge~ RECORD ALL YEARS.]

YEAR: 191 I I

YEAR: 191 I I

DK ..................................................................... 9B

[IF ~ PREVIOUSLY INTERVIEWED

INTERVIEWED AND YEAR IN Q. F-4 IS

AND YEAR IN Q.F4 IS 1980 OR IATER ~ IF ~ NEVER

1970 OR LATER, ASK:]

Since (1980/1970), (were you/was he/she) hospitalized fo; (your/his/her) cataract surge~ [PROBE:

(Were you/Was he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

74
F-S. (Doyou/Does SUBJEC~wear eyeglasses orcontactlenses? [PROBE YES RESPONSE]

~EGUSSES .................................................. 1

CONTACT LENSES ......................................... 2

BOTH ............................................................... 3

NEITHER .......................................................... 4

F-7. (When wearing eyeglasses/contact lenses/eyeglasses or contact lenses,) Can (you/he/she) ~ well

enough to recognize a friend across the street?

YES .................................................................. 1

NO .................................................................... 2

F-B. (When wearing eyeglasses/mrrtact lenses/eyeglasses or contact lenses,) Can (you/he/she) ~ well

enough to recognize the letters in ordinary new%paper print?

YES .................................................................. 1

N() ...,................................................................ 2

F-9, (Have you/Has he/she) ever wwn a hearing aid?

YES .................................................................. 1 (Q-F-11)

NO ...................................................................- 2

F-lo. Can (you/he/she) usually hear and understand what a person saw if that person talks to (you/him/her) in a

normal voice from across a quiet room?

YES .................................................................. 1 (PART G)

NO ...................................................................- 2 (PART G)

F-n. Wdhout a hearing aid, can (you/he/she) usually hear and understand what a person says if that person

talks to (you/him/her) in a normal voice from across a quiet room?

YES .................................................................. 1

NO .................................................................... 2

TIME ENDED: Aft

PM

75
PARTG: PREGNANCY AND MENSTRUAL HISTORY

BOX F

INTERVIEWER: CIRCLE ONE.

~ IS MALE ....................................................................... 1 (PART H)

~ IS FEMALE AND PREVIOUSLY INTERVIEWED ........ 2 (PART H)

~ IS FEMALE AND NEVER INTERVIEWED .................. 3

TIME BEGAN: _

PM

The next few questions are about (your/~ UBJECT’S) pregnancy and menstrual history.

G-1.

G-2.

G-3.

G-4.

G-5.

G-B.

(Have you/Has SUBJECT) ever been pregnant’? Include live births, stillbirths, miscarriages and abortions.

YES .................................................................. 1

NO .................................................................... 2 (Q.G-7)

HOW old (were you/was she) when (your/her) ~ child was born? This means the first child born alive or

stillborn.

AGE: l_i_l

~

~ HAD NO BIRTHS .......................................... O (Q.G-5)

How old (were you/was she) when (your/her) ~ child was born? Include stillbirths.

AGE: Ill

How many ~ births (have yO1l/haS she) had?

NUMBER OF LIVE BIRTHS: l_l_l

~ HAD NO LIVE BIRTHS ................................. O

(Have you/Has she) ever had a miscarriage?

YES .................................................................. 1

NO .................................................................... 2 (Q.G-7)

How many miscarriages (have you/has she) had?

NUMBER OF MISCARRIAGES: l_l_l

76
G-7,

G-B.

G-9.

G-10.

G-11.

G-12.

G-13.

At what age did (you/she) have (your/her) LS period?

AGE: Ill

~ NEVER HAD PERIOD .................................. 95

Did (your/her) periods stop naturally, because of surge~, or for some other reason?

NATURALLY .................................................... 1

SURGERY ........................................................ 2

RADIATION ...................................................... 3

OTHER (SPECIFY) .......................................... 91

Did (you/she) ever take female hormone pills for reasons related to menooause, including hot flashes or

mood changes around the time (you were/she was) beginning the change of life? This would include

hormone pills taken for natural change of life or because [v our/her) periods stormed due to an operation.

YES .................................................................. 1

2 (Q.G-13)

'0.:::::::::::::::::: .................................................. B (Q.G-13)

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

DK

How old (were you/was she) when (you/she) ~ took hormone pills?

AGE: l_l_l

DK ..................................................................... 98

How old (were you/was she) when (you/she) ~ took hormone pills?

AGE: l_l_l

STILL TAKING ................................................. 95

DK ..i.................................................................. W

Altogether for about how many years (have you/has she) taken hormone pills?

NUMBER OF YEARS: l_l_l

~

NUMBER OF MONTHS: Ill

LESS THAN ONE MONTH .............................. 95

DK ..................................................................... 98

(Have you/Has she) ever taken birth control pills for any reason?

YES .................................................................. 1

NO .................................................................... 2 (PART H)

DK ..................................................................... 8 (PART H)

77
G-14. How old (were you/was she) when (you/she) ~ took birth control pills?

AGE: Ill

DK ..................................................................... 98

G-I5. How old (were you/was she) when (you/she) ~ tmk birth control pills?

AGE: Ill

STILL TAKING ................................................. 95

DK ..................................................................... 9S

G-16. Altogether for about how many years (have you/has she) taken birth control pills?

NUMBER OF YEARS: Ill

~

NUMBER OF MONTHS: Ill

LESS THAN ONE MONTH .............................. 95

DK ..................................................................... 98

TIME ENDED: AM

PM

78
PART H: COMMUNITY SERVICES

TIME BEGAN: AM

PM

Now we are going to talk about commun”~ programs for the elderly that some communities have available.

INTERVIEWER INSTRUCTIONS: IWAD COLUMN a. IF THE ANSWER TO COLUMN a IS

YES”, ASK COLUMNS b AND c. IF ‘NO”, ASK COLUMN a FOR THE NEXT SERVICE.

I I

In the past 12 months ... How many months of the paat When (you were/he/she was) using this

12 months (have youlhas he/she) sewice most heavily, how often did (you/

used this servim? [PROBE WITH he/she) use it? [PROBE WITH

CATEGORIES IF NECESSARY.] CATEGORIES IF NECESSARY.]

H-1a. Did (you/~ UBJECl_I use a senior H-lb. H-1C.

citizen’s center? 1 OR 2 MONTHS ............... 1 LESS THAN ONCE A WEEK ......... 1

3 TO 5 MONTHS ............... 2 1 OR 2 TIMES A WEEK ................. 2

YES ..................... 1 6 TO 8 MONTHS ............... 3 3 OR MORE TIMES A WEEK ........ 3

NO ....................... 2 (Q.H-2a) 9 OR MORE MONTHS ...... 4

H-2a. Did (you/he/she) use special H-2b. H.2c.

transportation for the elderlfi 1 OR 2 MONTHS ............... 1 LESS THAN ONCE A WEEK ......... 1

3 TO 5 MONTHS ............... 2 1 OR 2 TIMES A WEEK ................. 2

YES ..................... 1 6 TO 8 MONTHS ............... 3 3 OR MORE TIMES A WEEK ........ 3

NO ....................... 2 (Q.H-3a) 9 OR MORE MONTHS ...... 4

H-3a Did (you/he/she) eat meals in a H-3b. H-3c.

senior center or in some place 1 OR 2 MONTHS ............... 1 LESS THAN ONCE A WEEK ......... 1

with a special meal program for 3 TO 5 MONTHS ............... 2 1 OR 2 TIMES A WEEK ................. 2

the elderly? 6 TO B MONTHS ............... 3 3 OR MORE TIMES A WEEK ........ 3

9 OR MORE MONTHS ...... 4

YES ..................... 1

NO ....................... 2 ((3.H4a)

H4a Did (you/he/she) have meals H-4b. H-.

delivered to (your/his/her) home 1 OR 2 MONTHS ............... 1 LESS THAN ONCE A WEEK ......... 1

by an agency or organization like 3 TO 5 MONTHS ............... 2 1 OR 2 TIMES A WEEK ................. 2

Meals on Wheels? 6 TO B MONTHS ............... 3 3 OR MORE TIMES A WEEK ........ 3

9 OR MORE MONTHS ...... 4

YES ..................... 1

NO ....................... 2 (Q.H-5a)

H-5a. Did (you/he/she) use a visiting H-5b. H-5c.

nurse service? 1 OR 2 MONTHS ............... 1 LESS THAN ONCE A WEEK ......... 1

3 TO 5 MONTHS ............... 2 1 OR 2 TIMES A WEEK ................. 2

YES ..................... 1 6 TO 8 MONTHS ............... 3 3 OR MORE TIMES A WEEK ........ 3

NO ....................... 2 (Q.H+a) 9 OR MORE MONTHS ...... 4

H~a. Did (you/he/she) use a health H+b. H%c.

aide or homemaker service wI-10 1 OR 2 MONTHS ............... 1 LESS THAN ONCE A WEEK ......... 1

comes into the home? 3 TO 5 MONTHS ............... 2 1 OR 2 TIMES A WEEK ................. 2

6 TO 6 MONTHS ............... 3 3 OR MORE TIMES A WEEK ........ 3

YES ..................... 1 9 OR MORE MONTHS ...... 4

NO ....................... 2 (Q.H-7a)

H-7a. Did (you/he/she) use aduit day H-7b. H-7c.

care for the elderl~ 1 OR 2 MONTHS ............... 1 LESS THAN ONCE A WEEK ......... 1

3 TO 5 MONTHS ............... 2 1 OR 2 TIMES A WEEK ................. 2

YES ..................... 1 6 TO 8 MONTHS ............... 3 3 OR MORE TIMES A WEEK ........ 3

NO ....................... 2 (t3.H-6a) 9 OR MORE MONTHS ...... 4

H-6a Did (you/he/she) use a service H-6b.

where daily mntacts are made to 1 OR 2 MONTHS ............... 1

check on the health of elderly 3 TO 5 MONTHS ............... 2

people? 6 TO 8 MONTHS ............... 3

9 OR MORE MONTHS ...... 4

YES ..................... 1

NO ....................... 2 (PART 1)

79
PART 1: SOCIAL SECURITY NUMBER

TIME ENDED: AM

PM

l_l

1-1. [READ ONLY IF CHECKED ( ):]

As part of this survey, I’d like to have (your/S UBJECT’Q social security number. Provision of this number is

voluntary and not providing the number will not have any effect on (your/his/her) receipt of benefis from

the Federal Government. This number will be useful in mnducting future follow-up studies. It will be used to

match against future mortality remrds. This information is collected under the authority of Section 306 of

the Public Health Service Act. What is (your/SUBJECT’S) sccial securii numbet’?

SOCIAL SECURIW #: I 111-111-11111

l_l

1-2. [READ ONLY IF CHECKED ( ):]

[FEMALE ONLY, ASK:] Please tell me (your/$ UBJECT’s) father’s last name.

FATHER’S IAST NAME:

TIME ENDED: AM

PM

ao
PART J: CLOSING STATEMENTS

BOX G

INTERVIEWER: CIRCLE ONE:

~ IS SUBJECT ...................... 1

~ IS PROXY .......................... 2 (Q.J-2)

PLEASE CHECK THE HHCF CHART.

ARE THERE ANY STAYS RECORDED?

YES ....................................... 1

NO ......................................... 2 (Q.J+)

J-1. As part of this survey, 1would like to send you a form that authorizes the United States Public Health Service

to obtain information from hospital or nursing home records. To do this I need to confirm your name and

address. p/ERltW SPELLING]

NAME:

FIRST MIDDLE MST

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

And I need to confirm your telephone number.

TELEPHONE: 1 )

When you receive the form please sign your name. Then return the form in the postage paid envelope.

BOX H

INTERVIEWER: CIRCLE ONE:

~AGREES TO SIGN ............... 1 (J4)

~ REFUSES TO SIGN ............. 2 (J-B)

81
J-2. I would like to (confirm/have) @.1BJECT’S) name, addreas and telephone number.

NAME:

FIRST MIDDLE LAST

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE: J )

PLEASE CHECK THE HHCF CHART.

ARE THERE ANY STAYS RECORDED?

YES ....................................... 1

NO ......................................... 2 (CI.J-6)

J-3. As part of this survey, I would like to send you a form that authorizes the United States Public Health Service

to obtain information from hospital or nursing home records. To do this, I need to (confirm/have) your

name, address, telephone number and relationship to (SUBJECT).

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

What is your relationship to (SUBJECT)?

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER lN-LAW/MOTHER IN-LAW .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON lN-WW/DAUGHTER IN-LAW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ........................ R

BROTHER lN-blW/SISTER IN-IAW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER RELATIVE (SPECIFY) ........................ 91

OTHER NON-RELATIVE (SPECIFY) ...............92

82

\
And 1need to confirm your telephone number.

TELEPHONE: J )

J-4. Will (SUBJECT) be able to sign this form?

YES .................................................................. 1

NO (EXPLAIN) ................................................. 2 (BOX 1)

[IF YES:] When you receive the form please have @UBJECTJ sign (his/her) name. Then return the form in

the postage paid envelope. [IF ~ WANTS FORM TO GO DIRECTLY TO SUBJECT RECORD ON IS.].

I&J

BOX I

INTERVIEWER: CIRCLE ONE:

~ IS REIATIVE ...................... 1

~ IS NON-REIATIVE ............ 2 (Q.J-5)

When you receive the form please sign your name. Then return the form in the postage paid envelope.

BOX J

INTERVIEWER: CIRCLE ONE:

~ AGREES TO SIGN ............ 1 (J4)

~ REFUSES TO SIGN .......... 2 (J+)

83
J-5. Do you know a relative of @U BJECT) who could sign this authorization’?

YES .................................................................. 1

NO .................................................................... 2 (Q.J-6)

I need to have the name, address and relationship of a relative of (SU BJECTJ who could sign this

authorization. ~ERIFY ALL SPELLING.]

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE: f )

What is (RELATIVE’S) relationship to (SUBJECT)?

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER lN-LAW/MOTHER IN-LAW .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON lN-LAW/DAUGHTER IN-LAW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... 8

BROTHER lN-lAW/SISTER IN-LAW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER REIATIVE (SPECIFY) ........................ 91

OTHER NON-REIATIVE (SPECIIT) ............... 92

J%. Please give me the name, address, and telephone number of a relative or friend who would know how to

get in touch with you in case we need to contact you again and have a hard time getting ahold of you? [DO

NOT PROBE FOR APT. NUMBER OR ZIP CODE.]

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

cm STATE ZIP CODE

TELEPHONE: f )
Under what name is that telephone number likely to tM listed?

SAME AS REFERENCE NAME ....................... 1

NEW TELEPHONE LISTING

NAME, [SPECIFYl ......................................... 2

How is (REFERENCE NAME) related to you?

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER lN-LAW/MOTHER IN-LAW .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON lN-lJIW/DAUGHTER IN-LAW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... 8

BROTHER lN-lAW/SISTER IN-IAW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER RELATIVE (SPECIFY) ........................ 91

OTHER NON-RE~TIVE (SPECIFY) ...............92

PLEASE CHECK THE HHCF CHART.

ARE THERE ANY STAYS RECORDED?

YES AND ~ IS SUBJECT ..... 1 (Q.J-7)

YES AND ~ IS PROXY ......... 2

NO AND ~ IS SUBJECT ....... 3 (Q.J+a)

NO AND ~ IS PROXY ........... 4 (Q.J+b)

B

J+a. Finally, I would like to confirm your name, address and telephone number.

NAME:

FIRST MIDDLE IAST

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

And I need to confirm your telephone number.

TELEPHONE: J )

85
I

GO TO ().J-7 I

J-6b. Finally, 1would like to confirm your name, address and telephone number and relationship to (SUBJECT).

NAME:

FIRST MIDDLE LAST

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

cm STATE ZIP CODE

TELEPHONE: f

)

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER lN-L4W/MOTHER IN-IAW .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON lN-blW/DAUGHTER IN-IAW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... 8

BROTHER lN-lAW/SISTER IN-LAW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER RELATIVE (SPECllW_) ........................ 91

OTHER NON-REIATIVE (SPECIFY) ...............92

Thank you very much for taking the time to participate in this interview. (TERMINATE)

86
INTERVIEWER: CIRCLE ONE:

~ WAS SUBJECT ........... 1

~WAS PROXY ................ 2 (PART Kj

J-7. DID THE SUBJECT RECEIVE ASSISTANCE?

YES .................................................................. 1

NO .................................................................... 2 (CONCLUSION)

HOW MANY ASSISTANTS?

ONE .................................................................. 1

MORE THAN ONE ........................................... 2

RECORD NAME AND TELEPHONE NUMBER OF (EACH) ASSiSTANT AND ASK RELATIONSHIP.

ASSISTANT #l

NAME:

FIRST IAST

TELEPHONE: J )

How is (ASSISTANT) related to (SUBJECT)?

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER lN-LAW/MOTHER IN-LAW .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON lN-MW/DAUGHTER IN-LAW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... 8

BROTHER lN-LAW/SISTER IN-IAW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER RELATIVE (SPECl~ ........................ 91

OTHER NON-REIATIVE (SPECIFY) ...............92

87
ASSISTANT #2

NAME:

FIRST MST

How is (ASSISTANT) related to (SU BJECT)?

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER lN-WW/MOTHER IN-LAW .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON lN-UW/DAUGHTER IN-LAW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... E

BROTHER lN-lAW/SISTER IN-LAW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER REIATIVE (SPECIFY) ........................ 91

OTHER NON-RELATIVE (SPECl~ ...............92

Thank you very much for taking the time to pafiicipate in this interview. ~ERMINATE.]

88
PART K OBSERVATION SHEET

(TO BE COMPLETED AT CONCLUSION OF INTERVIEW)

BOX I

INTERVIEWER: IF ~ WITH ASSISTANCE, ANSWER Q.A AND Q.B; IF ~, ANSWER Q.B.

A. IF ASSISTANCE: WHO WAS THE PRIMARY RESPONDENT:

SUBJECT ......................................................... 1

ASSISTANT #l ................................................ 2

ASSISTANT #2 ................................................ 3

B. IF PROW OR ASSISTANCE: WHY WAS (PROXY/ASSISTANT) NEEDED? [CODE YES OR NO FOR

EACH CATEGORYl

m ~

HEARING PROBLEM ........................................................... 1 2

SPEECH PROBLEM ............................................................. 1 2

LANGUAGE PROBLEM (INTERPRETER) ........................... 1 2

POOR MEMORY, SENILITY, OR CONFUSION .................. 1 2

INSTITUTIONALIZED ........................................................... 1 2

AUHEIMER’S DISEASE ...................................................... 1 2

OTHER MENTAL CONDITION (SPECIFY)

...... 1 2

OTHER PHYSICAL ILLNESS AND/OR DISABILllY

(SPECIFY)

...... 1 2

OTHER NON-HEALTH (SPECIFY)

...... 1 2

OTHER (SPECIFY)

...... 1 2

89
K-1.

K-2.

K-3

K4.

K-5.

K4a.

DO YOU FEEL THAT THE INFORMATION PROVIDED BY THE (SUBJECT/PROXY) WAS

SATISFACTORY?

YES .................................................................. 1 (Q.K-3)

NO .................................................................... 2

WHY NOT?

[IF SUBJECT OR SUBJECT WITH ASSISTANCE:]

PLEASE CIRCLE THE NUMBER THAT BEST DESCRIBES THE ~U BJECT’~ AWARENESS LEVEL DURING

THE INTERVIEW.

‘-

VERY VERY

ALEFIT CONFUSED

IN REGARD TO THE QUESTIONNAIRE, DO YOU FEEL IT ...

a.

b.

c.

YES

HELD THE RESPONDENT’S AITENTION THROUGHOUT

THE INTERVIEW? .................................................................................... 1

WAS UPSElllNG OR DEPRESSING TO THE RESPONDENT? ........... 1

WAS BORING OR UNINTERESTING TO THE RESPONDENT? ........... 1

WITH REGARD TO THE (SUBJECT/PROXY), DO YOU FEEL THE .,.

~

a. RESPONDENT WAS INTELLECTUALLY CAPABLE OF

RESPONDING? .............................................................................m.......... 1

b. RESPONDENT’S ANSWERS WERE REASONABLY ACCURATE? ....... 1

c. RESPONDENT UNDERSTOOD THE QUESTIONS? ............................. 1

(IF YES TO K4b OR K4c, OR IF NO TO t(-5a, K-5b OR K.5c)

M2 UNCERTAIN

2 3

2 3

2 3

IQ UNCERTAIN

2 3

2 3

2 3

WAS THERE A SECTION THAT SEEMED To BE PARTICUhRLY UPSETTING OR PROBLEMATIC FOR

THE RESPONDENT?

YES .................................................................. 1

NO .................................................................... 2 (Q.K4b)

WHICH SECTION AND WHY’?
K-Bb. WAS THE (SUBJECT/PROXY) HARD OF HEARING?

YES ..................................................................

NO ....................................................................

K-SC. WAS THE INTERVIEW CONDUCTED IN SPANISH?

YES ..................................................................

NO ....................................................................

K-7. RECORD ANY RELEVANT COMMENTS OR IMPRESSIONS YOU MAY HAVE HAD

INTERVIEW.

1

2

1

2

ABOUT THIS
OMB: 09374134

EXPIRES: October 19B7

NHANES I EPIDEMIOLOGIC FOLLOWUP STUDY

CONTINUED FOLLOWUP OF THE ELDERLY

PROXY - DECEASED QUESTIONNAIRE

WESTAT ID: I

I l-l I I l-l_l

Hello, may I please speak to (RESPONDENT)?

■ IF RESPONDENT NOT AVAIIJ4BLE, ASK Can you suggest a convenient time when I could reach

(him/her)? TERMINATE CONTACT AND RECORD RESULTS ON CALL RECORD.

■ IF RESPONDENT NOT AT THIS TELEPHONE NUMBER, VERIFY NUMBER AND REDIAL.

■ IF RESPONDENT AVAIIABLE, CONTINUE.

My name is (YOUR NAME) and I am calling from Washington, D.C. on behalf of the United States Public

Health Service with regard to the National Health and Nutrition Examination Survey. Recently you were sent a letter

from the Public Heatth Service explaining that someone would contact you. Did you receive our Iettefl

YES .................................................................. 1

NO .................................................................... 2 (BOX 1)

I would like to conduct the interview now if it is convenient.

(It will take approximately 30 minutes. In order to evaluate my performance, my supervisor may monitor this

interview.)

BOX 1

(IF RESPONDENT DID NOT RECEIVE LEITER, READ:)

Let me tell you what it saw. In (YEAR), (SUBJECTI participated in the National Health and Nutrition

Examination Survey. At this time, we are contacting relatives (or friends) of persons who participated who are now

deceased to conduct a ve~ short interview by telephone. Questions will be asked about illnesses, disabilities and

hospitalizations. This study is authorized by the Public Heatth Service Act. The information you give me will be

kept strictly confidential and will be used for statistical purposes only. The interview is completely voluntaty and

there are no penatties fix refusing to answer any questions. (CHECK BOX: I_ I)

I would like to mnduct the interview now if it is convenient.

(It will take approximately 30 minutes. In order to evaluate my performance, my supervisor may monitor

this interview.)

92
PART A: BACKGROUND INFORMATION

TIME BEGAN: AM

PM

A-1 . First, I would like to verify (SUBJECT’S) name. (His/Her) first name was (FIRST NAME), middle name

(MIDDLE NAME), and last name was (LAST NAME).

NAME IS CORRECT ....................................................... 1

~

FIRST NAME MIDDLE NAME lAST NAME

A-2. How were you related to (SUBJECT)?

HUSBAND/WIFE/SPOUSE EQUIVALENT ................... 01

FATHER/MOTHER ........................................................ 02

FATHER lN-LAW/MOTHER IN-LAW ............................. 03

SON/DAUGHTER .......................................................... 05

SON lN-lAW/DAUGHTER IN-IAW ............................... 06

BROTHER/SISTER ........................................................ 06

BROTHER lN-LAW/SISTER IN-LAW ............................. 09

FRIEND/NEIGHBOR/ROOMMATE .............................. 12

OTHER REIATIVE (SPECIFY) ....................................... 91

OTHER RELATIVE IN-IAW (SPECIFY) ......................... 92

OTHER NON-REIATIVE (SPECIFY) .............................. 93

A-3. In the ~r prior to (SUBJECT’S) death, where did (he/she) live most of the time: in a private home or

apartment, a nursing home or rest home, or did (he/she) have some other arrangement?

HOUSE OR APARTMENT .............................................. 1

NURSING OR CONVALESCENT OR REST HOME ...... 2 (Q.A-3c)

RETIREMENT HOME ..................................................... 3

BOARDING HOUSE, ROOMING HOUSE OR

RENTED ROOM .......................................................... 4

FAMILY OR FOSTER CARE HOME .............................. 5

ANOTHER HEALTH FACILITY ....................................... 6 (CI.A-3C)

OTHER ARRANGEMENT (SPECIFY) ............................ 91

OTHER INSTITUTION (SPECIFY) ................................. 92 (Q.A-3c)

93
A-3a. Was (SUBJECT) living in a nursing home or other health care facility at the time of (his/her) death?

YES ..................................................................

NO ....................................................................

A-3b. In the -r prior to (SUBJECT’S) death, did you live in the same household with (him/her)?

YES ..................................................................

NO ....................................................................

A-3c. In the w before (SUBJECl_I died, about how frequently did you visit or talk to (him/her)?

CATEGORIES IF NECESSARY.]

EVERYDAY ......................................................

LESS THAN DAILY BUT AT LEAST

ONCE A WEEK .............................................

LESS THAN WEEKLY BUT MORE

THAN ONCE A MONTH ...............................

LESS THAN ONCE A MONTH ........................

E

BOX 2

INTERVIEWER: REVIEW Q.A-3 AND Q.A-3a AND CIRCLE ONE:

A-3 CODED 2,6, OR 8 (INSTITUTION)

M Q.A-3a CODED YES ..................... 1 (Q.A4)

ALL OTHERS (NON-INSTITUTION) .,..., 2

1

2

1 (Box 2)

2

[PROBE WITH

1

2

3

4

A-4. At the time of (his/her) death, how many people lived in (his/her) household including (SUBJECl)?

ONE .................................................................. 01 (Q.A-5)

NUMBER OF PEOPLE: I——I I
A4a. What relationship to (SUBJECT) (was/were) the other person(s) who lived in (his/her) household? [PROBE

FOR SEX IF NOT OBVIOUS: Was (his/her) (RELATIONSHIP) male or female?]

PERSON # SEX REtATIONSHIP

1

2

3

4

5

6

7

8

9

10

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

SEX 1 = MALE RELATIONSHIP: 1 = HUSBAND~lFE

2 = FEMALE 2 = FATHER/MOTHER

(INCLUDING IN-IAWS)

3 = GRANDPARENT

4 = SON/DAUGHTER

(INCLUDING IN-MWS)

5 = GRANDCHILD

6 = BROTHER/SISTER

(INCLUDING IN-IAWS)

7 = AUNT/UNCLE/COUSIN

8 = OTHER RELATIVE

9 = FRIEND

10 = OTHER NON-REIATIVE

I

GO TO Q.A41 I

A-5. How long had (he/she) lived alone?

NUMBER OF MONTHS: I I I (QJ4

S)!3

NUMBER OF YEARS: I I I (QJW

LESS THAN ONE MONTH .............................. 95 (Q.A-6)

DON’T KNOW .................................................. 96 (Q.A4)

95
A-6.

A4a.

At the time (he/she) entered the (TYPE OF FACILllY IN Q.A-3] : nursing home or rest home/heatth facility/

institution), how many people lived in (his/her) household including (&JBJEC~?

ONE .................................................................. 01 (Q.A-7)

NUMBER OF PEOPLE: I I I

What relationship to (SU BJECT) (was/were) the other person(s) who lived in (his/her) household? [PROBE

FOR SEX IF NOT OBVIOUS: Was (his/her) (RELATIONSHIP) male or female?]

PERSON #

1

2

3

4

5

6

7

8

9

10

SEX 1 = MALE

2 = FEMALE

I

GO TO Q.A-6 I

SEX RELATIONSHIP

l_l l_l

l_l l_l

l_l I_

l_l I_

l_l I_

l_l I_

l_l I_

l_l I_

l_l I_

l_l l_l

RELATIONSHIP: 1 = HUSBAND/WIFE

2 = FATHER/MOTHER

(INCLUDING lN-b4WS)

3 = GRANDPARENT

4 = SON/DAUGHTER

(INCLUDING IN-LAWS)

5 = GRANDCHILD

6 = BROTHER/SISTER

(INCLUDING IN-IAWS)

7 = AUNT/UNCLE/COUSIN

8 = OTHER REIATIVE

9 = FRIEND

10 = OTHER NON-RELATIVE

A-7. How long had (he/she) lived alone?

NUMBER OF MONTHS: Ill

m

NUMBER OF YEARS: l_l_l

LESS THAN ONE MONTH .............................. 95

DON’T KNOW .................................................. 96
A-6. [lF~lSSPOUSE, CODE IANDGOTOPARTB. OTHEFIWISE, ASK]

At the time of ($ UBJECT’S) death, was (he/she) married, widowed, divorced, separated, or had (he/she)

never been married?

MARRIED ......................................................... 1

WIDOWED ....................................................... 2

DIVORCED ....................................................... 3

SEPARATED .................................................... 4

NEVER MARRIED ............................................ 5

l_l

A-9. [READ ONLY IF CHECKED ( ):]

Which of these categories best described (SUBJECl_I - Alaskan Native, American Indian, Asian, Pacific

Islander, Black or White? Are you of Hispanic origin or desant?

ALASKAN NATIVE OR AMERICAN INDIAN - NOT HISPANIC .... 1

ASIAN/PACIFIC ISIANDER - NOT HISPANIC ............................. 2

BLACK- NOT HISPANIC ............................................................... 3

WHITE - NOT HISPANIC ............................................................... 4

AIASKAN NATIVE OR AMERICAN INDIAN - HISPANIC ............. 5

ASIAN/PACIFIC ISLANDER - HISPANIC ..................................... 6

BIJ4CK - HISPANIC ....................................................................... 7

WHITE - HISPANIC ........................................................................ El

OTHER (SPECIFY) ........................................................................ 91

TIME ENDED: AM

PM

97
PART B: MEDICAL CONDITIONS

TIME BEGAN: AM

PM

Ba. [IF ~ IS NOT REIATIVE, ASK]

Do you think you can answer questions about (his/her) medical history?

YES .................................................................. 1

NO .................................................................... 2 (Q.B&I)

DK ..................................................................... 8

B-1 NOT ASKED THIS VERSION.

B-2, Did a doctor ever say that (he/she) had afthriiie?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-14)

DK ..................................................................... 8 (Q. B-14)

B-3. There are different kinds of arlhriiis. Did a doctor every say which kind (he/she) had?

YES .................................................................. 1

NO . ... ................................................................ 2 (Q. B-13a)

DK ..................................................................... 8 (Q. B-13a)

B-4. What type of arthritis did (he/she) have? (READ CATEGORIES IF NECESSARY.)

RHEUMATOID ..................................... 1 2 8

OSTEOARTHRITIS .............................. 1 2 8

LUPUS ................................................. 1 2 8

GOUT ................................................... 1 2 8

DEGENERATIVE ................................. 1 2 8

SOME OTHER TYPE (SPECIFYj ........ 1 2 8

B-5 THROUGH B-13 NOT ASKED THIS VERSION.

B-13a, Since (1980/1 970), was (he/she) hospitalized tbr (his/her) arthriiis? [PROBE: Was (he/she) there for more

than a dafi]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

98
l_l

B-14.

l_l

B-15.

B-16,

B-17.

B-18.

B-19a.

INTERVIEWER INSTRUCTIONS: FOR EACH CONDITION IN Q.B14 THROUGH Q. B-57, WITHIN

EACH SECTION READ FIRST CHECKED ( ) ITEM. THEN, FOLLOW APPROPRIATE SKIPS.

Since (MONTH/YEARJ did (SUBJECT) have a heart attack (sometimes called corona~ thromtmsis or

myocardial infarction)?

YES .................................................................. 1 (Q-B-18)

NO .................................................................... 2 (Q.B-19b)

DK ..................................................................... 8 (Q. B-19b)

Did a doctor ever say that (he/she) had a heart attack (sometimes called coronaty thrombosis or

myocardial inhrction)?

YES .................................................................. 1

NO ..,................................................................. 2 (Q, B-19b)

DK ..................................................................... 8 (Q.B-19b)

In what year was (he/she) first told that (he/she) had a heart attack (coronary thrombosis or myocardial

infarction)?

YEAR: 191 I I

DK .................................... 96

Did (he/she) have an additional heart attack since then?

YES .................................................................. 1

NO .................................................................... 2 (Q.B-19a)

DK ..................................................................... 8 (Q.B-19a)

In what year was that heart attack? [PROBE: Did @.fBJECTI have any others sinm then? PROBE FOR

ALL YEARS,]

YEAR: 191 I I

YEAR: 191 ——I I

YEAR: 191 I I

.—

YEAR: 191 I I

DK .................................... 96

Since (1960/1970), was (he/she) hospitalized for (his/her) heart attack? [PROBE: Was (he/she) there for

more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

99
B-19b.

l_l

B-20a.

B-20b.

B-20c.

B-20d.

l_l

B-21.

~=1

.-

Since (1980/1970), was (he/she) hospitalized for any type of heart cxxtdition (other than a heart attack)?

[PROBE: Was (he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

[IF CHECKED ( ) ~ IF Q.B-15 OR Q. B-19b = YES, ASK:]

Did (he/she) have coronary by-pass surge~

Since (19B0/1970), was (he/she)

for more than a day?]

YES .................................................................. 1

NO .................................................................... 2 (Q. B-20C)

hospitalized for coronary by-pass surge~ [PROBE: Was (he/she) there

YES ..................................................................

NO ....................................................................

Did (he/she) ever have pacemaker replacement, insetiion or repair?

YES ..................................................................

NO ....................................................................

1 (CHART)

2

1

2 (Q. B-21)

Since (19B0/1970), was (he/she) hospitalized fix paoemaker replacement, insertion or repair? [PROBE:

Was (he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

Since (MONTH /YEAR) did (SUBJECT) have a small stroke, sometimes known as TIA (transient ischemic

attack)?

YES .................................................................. 1 (Q. B-25)

NO .................................................................... 2 (Q. B-27)

DK ..................................................................... 8 (Q. B-27)

Did a doctor ever say that (he/she) had a small stroke, sometimes known as a TIA (transient ischemic

attack)?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-27)

DK ..................................................................... 8 (Q. B-27)

100
B-23.

B-24.

B-25.

B-26.

In what year was (he/she) first told that (he/she) had a small stroke?

YEAR: 19 l_l_l

DK .................................... 96

Did (he/she) have an additional small stroke since then?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-26)

DK ..................................................................... 8 (Q-B-26)

In what year was that small stroke? [PROBE: Did (SU BJEC~

ALL YEARS.]

YEAR: 19

YEAq: 19

YEAR: 19

YEAR: 19

DK .........................

have any others since then? PROBE FOR

l_l_l

l_l_l

l_l_l

l_l_l

........... 96

Since (1960/1970), was (he/she) hospitalized for a small stroke? [PROBE: Was (he/she) there for more

than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

l_l

B-27. Sinca (MONTH/YEAR), did (SUBJECT) have a stroke (sometimes called a CVA)?

YES .................................................................. 1 (Q. B-31)

NO .................................................................... 2 (Q. B-34)

DK ..................................................................... 8 (Q. B-34)

l_l

B-28. Did a dtior every say that (he/she) had a stroke (sometimes called a CVA)?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-34)

DK ..................................................................... 8 (Q. B-34)

B-29. In what year was (he/she) first told that (he/she) had a stroke?

YEAR: 191 ——I I

DK .................................... 96

101
B-30. Did (he/she) have an additional stroke since then?

YES.................................................................. 1

NO .................................................................... 2 (Q. B-32)

DK ..................................................................... 8 (Q. B-32)

B-31 . In what year was that stroke? [PROBE: Did (he/she) have any others since then? PROBE FOR ALL

YEARS.]

YEAR: 19] I I

.—

YEAR: 191 I I

DK .................................... 98

B-32. Since (19W3/1970), was (he/she) hospitalized for a stroke? [PROBE: Was (he/she) there for more than a

da~]

YES .................................................................. 1 (CHART

NO .................................................................... 2

B-33 NOT ASKED THIS VERSION.

l_l

B-34.

CAN RESPONDENT ANSWER MORE QUESTIONS ABOUT SUBJECT’S HEALTH?

YES ................................................... 1

NO ..................................................... 2 (CLB43)

In the year prior to (his/her) death, was (he/she) taking medication for diabetes?

YES .................................................................. 1 ((2.0-37)

NO .................................................................... 2 (().B-W)

DK ..................................................................... 8 (Q.B39)

l_l

B-35. Did a doctor ever say that (he/she) had diabetes or sugar diabetes?

YES .................................................................. 1

NO .................................................................... 2 (Q.B-40)

DK ..................................................................... 8 (Q.B40)

B-36. In what year was (he/she) first told that (he/she) had diabetes or sugar diabetes?

YEAR: 19 l_l_l

DK .................................... 98

102
B-37. In the year prior to (his/her) death, was (he/she) taking insulin injections for (his/her) diabetes?

YES .................................................................. 1 (Q.B-39)

NO ....i............................................................... 2

DK ..................................................................... 8

B-3B. In the year prior to (his/her) death, was (he/she) taking oral medication for (his/her) diabates?

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 8

B-39. Since (1980/1 970), was (he/she) hospitalized for diabetes? [PROBE: Was (he/she) there for more than a

dam]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

l_l

B4. Did the doctor ever prescribe medicine for (him/her) for high blood pressure?

YES .................................................................. 1 (Q.B45)

NO .................................................................... 2 (Q.B45)

DK ..................................................................... 8 ((). B-45)

l_l

B-41 . Had (SUBJECT) ever been told by the doctor that (he/she) had high blood pressure or hypertension?

YES .................................................................. 1

NO .................................................................... 2 (Q.B48)

DK ..................................................................... 8 (Q.B46)

B+2. In what year was (he/she) firsttold that (he/she) had high blood pressure or hypertension?

YEAR: 19! I I

DK .................................... 98

Ba. Did the doctor ever prescribe medicine for (his/her) high blood pressure?

YES .................................................................. 1

NO .................................................................... 2 (Q.B45)

DK ..................................................................... 8 (Q. B-45)

B+ NOT ASKED THIS VERSION.

103
B+5. Since (1960/1 970), was (he/she) hospitalized for high blind pressure? [PROBE: Was (he/she) there for

more than a day’?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

l_l

B-46.

l_l

B-47.

B-48.

Since (MONTH/YEAR) did (SUBJECT) have any type of cancer diagnosed?

YES ..................................................................

NO ....................................................................

DK .....................................................................

Did a doctor ever say that (he/she) had cancer of any SOIW

YES ..................................................................

NO ....................................................................

DK .....................................................................

Since 1960, was (he/she) hospitalized for

than a day?]

1 (CI.B49)

2 (Q.B48)

8 (Q.B4B)

1 (C2.B49)

2 (Q. B-52)

8 (Q. B-52)

~ cancer condition? [PROBE: Was (he/she) there for more

YES .................................................................. 1 (CHART. THEN

GO TO Q-B-52)

NO .................................................................... 2 ((2.0-52)

104
B-49. Where was the

cancer or what

type of cancer

was it?

[PROBE: Did

(he/she) have

any other

cancer

diagnosed]?

B-50. In what year

was (he/she)

first told that

(he/she) had

(CANCER)?

B-51. Since (19S0/

1970), was

(he/she)

hospitalized

for (CANCER)?

[PROBE: Was

(he/she) there

for more than

a dafl]

1ST DIAGNOSIS

LUNG ......}................................. 1

COLON ..................................... 2

BREAST.................................... Z

SKIN (MELANOMA).................. 4

SKIN (NON-MELANOMA) ........ 5

UTERUS.................................... 6

PROSTATE ............................... 7

STOMACH ............................... 8

LEUKEMIA ................................ 9

OTHER (SPECIFY) ................... 91

SITE:

~R

TYPE

YEAR 191 I I

DK ........................... 99

YES ..................... 1 (CHART)

NO ...................... 2

2ND DIAGNOSIS

.UNG ........................................ 1

20LON .................................... 2

3REAST.................................... 3

SKIN(MELANOMA).................. 4

SKIN(NON-MEMOMA) ........ 5

JTERUS.................................... 6

‘ROSTATE ............................... 7

3TOMACH ................................ 8

.EUKEMIA ................................ 9

3THER (SPECIFYI ................... 91

IYPE:

Km 191 ——I I

2K ......................... 96

‘ES .................... I (CHART)

Jo ..................... 2

3RD DIAGNOSIS

.UNG ...................................... ~ 1

20LON ..................................... 2

3REAST.....................!.............. 3

SKIN(MELANOMA).................. 4

SKIN(NON-MELANOMA) ........ 5

JTEIWS .................................... 6

+IOSTATE ............................... 7

3TOMACH ................................ 8

-EUKEMIA ................................ 9

OTHER(SPECIFY) ................... 91

mm 191 ——I I

>K ........................... 96

‘ES ..................... 1 (CHART)

Jo ...................... 2

CAN THE RESPONDENT ANSWER MORE QUESTIONS ABOUT THE SUBJECT’S HEALTH?

YES ...................................................... 1

NO .......................................................C 2 (Q.B433)

105
l_l

B-52.

l_l

B-53.

B-54.

B-55.

B-56.

B-57.

Since (MONTH/YEAR) did (SUBJECT) have a broken or or fractured hip?

YES .................................................................. 1 (CLB-56)

NO .................................................................... 2 (Q. B-62)

DK ..................................................................... 8 (Q. B-62)

Had (SUBJECT] ever told by the doctor that (he/she) had a broken or fractured hip?

YES .................................................................. 1

NO .................................................................... 2 (Q. B452)

DK ..................................................................... 8 (Q.B+2)

In what year was (he/she) first tohj that (he/she) had a broken or fractured hip?

YEAR: 19 ]_l_l

DK .................................... 96

Did (he/she) had an additional fractured hip since then?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-57)

DK ..................................................................... 8 (Q. B-57)

In what year did (he/she) have that break or fracture of (his/her) hip? [PROBE: Did (SUBJECT have any

others since then? PROBE FOR ALL YEARS.]

YEAR: 191 ——I I

YEAR: 191 ——I I

YEAR: 191 I I

YEAR: 191 I I

OK .................................... 96

Since (1960/1970), was (he/she) hospitalized for a broken or fractured hip? [PROBE: Was (he/she) there

for more than a da~]

YES ...................................n...n.........n................ 1 (CHART)

NO .................................................................... 2

B-58 THROUGH B+l NOT ASKED THIS VERSION.

B-62. Since (1960/1970), had (he/she) been hospitalized for pneumonia or the flu? [PROBE: Was (he/she)

there for more than a day?]

YES .................................................................. 1 (CHART)

NO .......................................................o............ 2

106
B-63. (Aside from the hospitalizations you have mentioned,) Had (SUBJECT) been hospitalized for any surgical

procedure or operation since (1980/1970)? [PROBE: Was (he/she) there for more than a dafl]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

B-64 AND B-65 NOT ASKED THIS VERSION.

107
B+6. [1 have recorded that (SUBJECT) was hospitalized (READ DATES, CONDITIONS AND FACILITY NAMES

FROM CHART).] NM, I would like you to think back over the time between (19S0/1 970) and the time

(he/she) died. (He/She) would have been about ~ in (19S0/1970). Had (he/she) stayed in a hospital

for anv (other) reason including tests or for observation since (he/she) was ~? [PROBE: Was (he/she)

there for more than a da~]

YES .................................................................. 1

NO .................................................................... 2 (Q.B49)

CONDITION # 1 CONDITION # 2 CONDITION # 3

B-67. For what mndi- TESTSAND/OR TESTSAND/OFl TESTS AND/OR

tion was that? OBSERVATION........... 1 OBSERVATION .............. 1 OBSERVATION .............. 1

(PROBE: Did DIGESTIVE DIGESTIVE DIGESTIVE

(he/she) have PROBLEMS................. 2 PROBLEMS .................... 2 PROBLEMS .................... 2

any other RESPIRATORY/ RESPIRATORY/ RESPIFWTORY/

hospitaliza- BREATHING BREATHING BREATHING

tions since PROBLEMS................. 3 PROBLEMS .................... 3 PROBLEMS .................... 3

(19s0/1970)?] INFECTIONS ...................... 4 INFECTIONS...................... 4 INFECTIONS ...................... 4

[GO TO CHART OTHER (SPECIFY) ............ 91 OTHER (SPECIFW)............ 91 OTHER (SPECIW_)............ 91

A~ER CODING

CONDITION.]

(CHART) (CHART) (CHART)

B-6s. NOT ASKED THIS VERSION.

108
B-s9. Since (19S0/1970), had (SIJBJECn ever stayed in a rest home, a nursing home, a mental health facility, or

anything like that? [PROBE: Was (he/she) there for more than a clap]

B-70. To what type

of place was the

(most recent/this

admission?

B-71 . Did (he/she)

enter the ~

OF FACILITY)

directly from

(his/her) own

home, from a

hospital, or

from some

other place?

B-72. In what year

did (he/she)

enter the (lYPE

OF FACILITY)?

YES .................................................................. 1

NO ........i........................................................... 2 (Q. B-78)

ADMISSION# 1

RESTHOME ...................... 1

NURSINGHOME ............... 2

MENTALHEALTH

FACILITY......................... 3

HEALTHCARE

REHABILITATION

CENTER ......................... 4

OTHER (SPECIW) ............ 91

OWN HOME ...................... 01

HOSPITAL.......................... 02

NURSING HOME ............... 03

RESTHOME ...................... 04

MENTALHEALTH

FACILITY......................... 0!5

HEALTHCARE

REHABILITATION

CENTER ......................... 06

FRIEND/RE~TIVE’S

HOME ............................. 07

OTHER (SPECIIV) ............ 91

YEAR 19 l_l_l

DK ...................................... es

ADMISSION# 2

REST HOME ...................... 1

NURSINGHOME ............... 2

MENTALHEALTH

FACILITY......................... 3

HEALTHCARE

REHABILITATION

CENTER ......................... 4

OTHER (SPECIFY) ............ 91

OWN HOME ...................... 01

HOSPITAL.......................... 02

NURSING HOME ............... 03

REST HOME ...................... 04

MENTALHEALTH

FACILll+ ......................... 05

HEALTHCARE

REHABILITATION

CENTER ......................... ~

FRIEND/REUTIVE’S

HOME ............................. 07

OTHER (SPECIIV) ............ 91

y~191 I I

DK ...%99

ADMISSION# 3

REST HOME ...................... 1

NURSING HOME ............... 2

MENTALHEALTH

FACILITY......................... 3

HEALTHCARE

REHABILITATION

CENTER ......................... 3

OTHER (SPECIFY) ............ 91

OWN HOME ...................... 01

HOSPITAL.......................... 02

NURSING HOME ............... 03

REST HOME ...................... 04

MENTALHEALTH

FACILITY......................... 05

HEALTHCARE

REHABILITATION

CENTER ......................... 06

FRIEND/REUTIVES

HOME ............................. 07

OTHER (SPECl~ ............ 91

y~: 19 l_l_l

DK ...................................... 93

109
B-73. There are many

reasons My

people enter

a (TYPE OF

E&!UIx).

Please tell me

if (SUBJECl_I

entered the

@x!zQ

FACILINj

for any of

the following

reasons,

(CIRCLE YES

OR NO FOR

EACH.)

B-74. Please tell me

the name of

the disease

or condition that

(he/she) had

at the time

of admission

that affected

(his/her)

abilityto live

independentlfl

(CIRCLE ALL

THAT APPL~

—

ADMISSION# 1

YEJN(J

Requirwl skilled

nursing care? ............ 1

Recuperation from

surgefl .................... 1

Needed help with

bathing, eating,

or dressing? .............. “1

Required special

medical or

physical therap~ ...... 1

Too confused to live

independently? ......... 1

2

2

2

2“

2

—

ALCOHOLISM .......................... 01

AIZHEIMER’S DISEASE .......... 02

ARTHRITIS ................................ 03

CANCER ................................... 04

DEPRESSION ........................... 05

DISRUPTIVE BEHAVIOR .......... m

FRACTURE OTHER

THAN HIP .............................. 07

FFWL/OLD AGE ....................... 0S

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEROSIS ........... 09

HEART ATlACK (Ml) ................ 10

HIP FR4CTURE ........................ 11

INCONTINENCE ...................... 12

MENTAL IUNESS .................... 13

NO MEDICAL CONDITION ,,,... 14

OSTEOPOROSIS (FR4GILE

OR SOH BONES) ................ 15

SENILITY .................................. 16

STROKE ................................... 17

OTHER DISEASE OR

CONDITION (SPECIFYJ ........ 91

ADMISSION# 2

YESNQ

Required skilled

nursingcare? ............ 1

Recuperation from

surge@ .................... 1

Needed help with

bathing, eating,

or dressing? .............. 1

Required special

medical or

physical therapf? ...... 1

Too confused to live

independentif? ......... 1

2

2

2

2

2

ALCOHOLISM ........................... 01

ALZHEIMER’S DISEASE ........... 02

ARTHRITIS ................................ 03

CANCER ................................... 04

DEPRESSION ........................... C6

DISRUPTP& BEHAVIOR .......... M

FRACTURE OTHER

THAN HIP .............................. 07

FRAIL/OLD AGE ....................... 08

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEEOSIS ........... C@

HEART AllACK (Ml) ................ 10

HIP FRACTURE ........................ 11

INCONTINENCE ....................... 12

MENTAL ILLNESS .................... 13

NO MEDICAL CONDITION ....... 14

OSTEOPOROSIS (FRAGILE

OR SCH BONES) ................ 15

SENILITY ..a................................ 16

STROKE .................................... 17

OTHER DISEASE OR

CONDITION (SPECIFY) ........ 91

ADMISSION# 3

YES NO

Required skilled

nursingwe? ..........

Recuperation from

surge@ ..................

Needed help with

bathing, eti.ng,

or dressing? ............

Required special

mdd or

physid therapy? ....

Too confused to live

independently? .......

1

1

1

1

1

2

2

2

2

2

—

ALCOHOLISM .......................... 01

ALZHEIMER’S DISEASE .......... 02

ARTHRfTIS ............................... 03

CANCER ................................... 04

DEPRESSION .......................... 05

DISRUPTIVE BEHAVIOR .......... M

FRACTURE OTHER

THAN HIP .............................. 07

FPAIL/OID AGE ...................... CS

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEROSIS ........... 09

HEART AlTACK (Ml) ................ 10

HIP FRACTURE ........................ 11

INCONTINENCE ...................... 12

MENTAL ILLNESS .................... 13

NO MEDICAL CONDITION ...... 14

0!3TEOPOROSIS (FRAGILE

OR SO~ BONES) ................ 15

SENILITY .................................. 16

STROKE ................................... 17

OTHER DISEASE OR

CONDmON (SPECIIV) ........ 9t

110
B-75. How long did

(he/she) stay?

GO TO CHART

AFTER CODING

LENGTH OF

STAY.)

B-76. Since (1960/

1970) were there

other admissions

to a rest home, a

nursing home,

a mental health

facil”ky, a

rehabilitation

center or any

place like that?

ADMISSION# 1

~’ l_l_l

OF WKS ............... 1

MOS ............... 2

YRS ................ 3

LESS THAN

ONE WEEK ................ 95

DK .................................. 96

(CHART)

YES ......... 1 (Q. B-70)

NO ........... 2

ADMISSION# 2

~: l_l_l

OF WKS ............... 1

MOS ............... 2

YRS ................ 3

LESS THAN

ONE WEEK ................ 95

DK .................................. 96

(CHART)

YES ......... 1 (Q. B-70)

NO ........... 2

ADMISSION# 3

~’ l_l_l

OF WKS ............... 1

MOS ............... 2

YRS ................ 3

LESS THAN

ONE WEEK ................ 95

DK .................................. 96

(CHART)

YES ......... 1 (Q.B-70)

NO ........... 2

111
B-77 NOT ASKED THIS VERSION.

B-78.

B-79.

B-79a,

B-80,

B-81.

B-82,

During the month before (his/her) death, was there signifimnt change in (his/her) health?

YES .................................................................. 1

NO .................................................................... 2

During the 12 months prior to that, what was happening to (his/her) health? Had it improved, remainsd the

same, gradually worsened, or suddenly worsened?

IMPROVED ...................................................... 1

REMAINED THE SAME ................................... 2

GRADUALLY WORSENED .............................. 3

SUDDENLY WORSENED ................................ 4

OTHER ............................................................. 5

People sometimes have difficulty mntrolling urination as they get older. In the few months before (his/her)

death, how often did (he/she) lose ccmtrol over (his/her) urine? Would you say ...

Ofien; ...............................................................

Ocasionallw or ...............................................

Nevefl ..............................................................

Did @UBJECT) die in a hospital or nursing home?

YES ..................................n........n......a...............

NO ....................................................................

1

2

3

1 (CHARTj

2

What was the cause of (SUBJECT’S) death?

[IF Q.B-81 CODED 1 THROUGH 8, ASK]

HEART AITACK .............................................. 01

OTHER HEART CONDITION .......................... 02

SMALL STROKE .............................................. 03

STROKE ........................................................... 04

DIAB~ES ........................................................ 05

HIGH BLOOD PRESSURE .............................. 06

CANCER .......................................................... 07

PNEUMONIA OR FLU ..................................... 08

OLD AGE ......................................................... 09

OTHER ............................................................. 10 (PART D)

DK ..................................................................... 98

Did a doctor say that (CO NDITION) was the cause of death?

YES .................................................................. 1

NO .................................................................... 2 (PART D)

DON’T KNOW .................................................. 8

112
B-83. [1 have recorded that @l.JBJECT) was hospitalized (READ DATES, CONDITIONS AND FACILITY NAMES

FROM CHART).] Now, I would like you to think back over the time between (lW/1970) and the time

(he/she) died. (He/She) would have been about ~ in (19B0/1970). Had (he/she) stayed in a hospital

for anv (other) reason including tests or for obsewation since (he/she) was ~? [PROBE: Was (he/she)

there for more than a day?]

YES ....,............................................................. 1 (CHART)

NO .................................................................... 2

B-B4. Since (1980/1970), had (SUBJECT) ever stayed in a rest home, a nursing home, a mental health facihy, or

anything like that? [PROBE: Was (he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

B-B5. Did (SUBJECT) die in a hospital or nursing home?

YES .................................................................. 1 (CHART)

NO .................................................................... 2

B-86. What was the cause of (SUBJECT’S) death?

HEART AITACK .............................................. 01

OTHER HEART CONDITION .......................... 02

SMALL STROKE .............................................. 03

STROKE ........................................................... 04

DIABETES ........................................................ 05

HIGH BLOOD PRESSURE .............................. (26

CANCER .......................................................... 07

PNEUMONIA OR FLU ..................................... 08

OLD AGE ......................................................... 09

OTHER ............................................................. 10

DK ..................................................................... 9B

TIME ENDED: AM

PM

PART C NOT ASKED THIS VERSION.

113
PART D: SMOKING AND ALCOHOLIC BEVERAGES

BOX A

INTERVIEWER: CIRCLE ONE:

~ PREVIOUSLY INTERVIEWED ......... 1 (PART G)

S NEVER INTERVIEWED .................... 2

TIME BEGAN: AM

PM

These next few questions are about (SU BJECT’S) smoking and drinking habits,

Da.

D-1 .

D-2.

D-3.

[lF~ IS NOT RELATIVE, ASK]

Do you think you can answer questions about this subject?

YES .................................................................. 1

NO .................................................................... 2 (PART G)

DK ..................................................................... 8

Did (SUBJECTI ever smoke at least 100 cigarettes in (his/her) lifetime?

YES .................................................................. 1

NO .................................................................... 2 (Q. D+)

During the -r prior to (his/her) death, did (he/she) smoke cigarettes?

YES .................................................................. 1

NO .................................................................... 2 (Q.D-5)

DON’T KNOW .................................................. 8 (Q.D-11)

About how many cigarettes a day did (he/she) smoke? [IF ANSWER IS NUMBER OF PACKS, MULTIPLY

BY 20 AND VERl~.]

NUMBER OF CIGAREITES: I I I I (Q.D-7

LESSTHAN ONE A DAY .............................. 995 ((ID-7)

DON’T KNOW ............................................... 998 (Q.D-7)

D-4 NOT ASKED THIS VERSION.

114
D-5. When did (he/she) stop smoking cigarettes?

D-6.

D-7.

D-8.

D-9.

D-10.

MONTH: Ill

~

YEAR: 19 I_i_l

DK .................................... 9998

During the years when (he/she) was smoking, about how many cigarettes a day did (he/she) smoke? [IF

ANSWER IS NUMBER OF PACKS, MULTIPLY BY 20 AND VERIFY.]

NUMBER OF CIGAREITES: I I l_l

LESS THAN ONE A DAY .............................. 995

DK .................................................................. 998

For how many years did (he/she) smoke cigarettes?

NUMBER OF YEARS: Ill

DK .................................................................. 93

Now I would like to talk to you about drinking alcoholic beverages. By almholic beverages I mean beer, or

wine, or liquor. Did (SUBJECT) have at least one drink of beer, wine, or liquor during the year prior to

(his/her) death?

YES ..................................................................

NO ....................................................................

1

2 (PART G)

In the year prior to (his/her) death, on the average, how often did (he/she) drink alcoholic beverages, that

is, beer or wine, or Iiquof? I

NUMBER OF DAYS A WEEK l_l_l

NUMBER~F DAYS A MONTH: l_l_l

MORE THAN 3 BUT LESS

THAN 12 TIMES A YEAR .............................. W

NO MORE THAN 3 TIMES A YEAR ................ 95.

DK ..................................................................... 98

In the year prior to (his/her) death, on the average, how many cans or bottles of beer did (he/she) drink per

day, week, month or year?

NUMBER OF DRINKS: l_l_l PER: DAY ..................

WEEK ...............

MONTH ............

YEAR ................

NONE ............................................................................................-

DK ...................................................................................................

1

2

3

4

m

98

115
D-1 1. In the year prior to (his/her) death, on the average, how many glasses of wine did (he/she) drink per day,

week, month, or year?

NUMBER OF DRINKS: I——I I PER: DAY .................. 1

WEEK ............... 2

MONTH ............ 3

YEAR ................ 4

NONE ............................................................................................. CKI

DK ................................................................................................... 9B

D-12. In the year prior to (his/her) deti, on the average, how many shota or drinks of hard liquor, either straight

or in a mixed drink, did &UBJECT) drink per day, week, month or yeaf?

NUMBER OF DRINKS: I I I PER: DAY .................. 1

WEEK ............... 2

MONTH ............ 3

YEAR ................ 4

NONE ............................................................................................. (XI

DK ................................................................................................... 9a

TIME ENDED: AM

PM

PARTS E AND F NOT ASKED THIS VERSION.

116
PARTG: PREGNANCY AND MENSTRUALHISTORY

BOX F

INTERVIEWER: CIRCLE ONE.

~ IS MALE ............................................................................. 1 (PART 1)

s WAS FEMALE AND PREVIOUSLY INTERVIEWED ......... 2 (PART 1)

~ WAS FEMALE AND NEVER INTERVIEWED .................... 3

TIME BEGAN: _

AM

PM

These next questions are about [SUBJECT’SJ pregnancy and menstrual history.

G4. [IF ~ IS NOT RELATIVE, ASK]

Do you think you can answer questions about this subject?

YES .................................................................. 1

NO .................................................................... 2 (PART 1)

DK ..................................................................... 8

G-1. Was (SUBJEC17 ever pregnant? Include live bitihs, stillbirths, miscarriages and abortions.

YES .................................................................. 1

NO .................................................................... 2 (CJ.G-9)

G-2. How old was she when her ~ child was born? This means the first child born alive or stillborn.

AGE: l_l_l

~ HAD N&BIRTHS .......................................... O (Q.G-5)

DK ..................................................................... *

G-3. How old was she when her ~s child was born? Include stillbirths.

AGE: l_l_l

DK ..................................................................... W

G-4. How many ~ births did she have?

NUMBER OF LIVE BIRTHS: Ill

~ HAD NO LIVE BIRTHS ................................. O

DK ...,................................................................. 9B

117
G-5. Did she ever have a miscarriage?

YES .................................................................. 1

NO .................................................................... 2 (Q.G-9)

DK ..:.................................................................. 8 (Q.G-9)

G-6. How many miscarriages did she have?

NUMBER OF MISCARRIAGES: l_l_l

DK ..................................................................... w

G-7 AND G+ NOT ASKED THIS VERSION.

G-9. Did she ever take female hormone pills for reasons related to menoDause, including hot flashes or mood

changes around the time she was beginning the change of Iifb? This would include hormone pills taken for

natural change of life or because her Deriods stoDtwd due to an oDeration,

YES .................................................................. 1

NO .................................................................... 2 (Q.G-13)

DK ..................................................................... 8 (Q.G-13)

G-lo AND G-1 1 NOT ASKED THIS VERSION.

G-12. Altogether for about how many years did she take hormone pills?

NUMBER OF YEARS: Ill

QE

NUMBER OF MONTHS: l_l_l

LESS THAN ONE MONTH .............................. 95

DK ..................................................................... 99

G-13. Did she ever take birth control pills for any reason’?

YES .................................................................. 1

NO .................................................................... 2 (PART 1)

DK ..................................................................... 8 (PART I)

G-14 AND G-15 NOT ASKED’THIS VERSION.

118
G-16. Altogether for about how many years did she take birth control pills?

NUMBER OF YEARS: Ill

QE

NUMBER OF MONTHS: l_l_l

LESS THAN ONE MONTH .............................. 95

DK ..................................................................... 9s

TIME ENDED: AM

‘—PM

PART H NOT ASKED THIS VERSION.

119
PART 1: DEATH CERTIFICATE INFORMATION AND UPDATES

TIME BEGAN: AM

PM

l-l NOT ASKED THIS VERSION.

BOX 3

INTERVIEWER: CHECK PROBLEM SHEET TO SEE IF DEATH CERTIFICATE

WAS OBTAINED AND CIRCLE ONE:

DEATH CERTIFICATE ~ OBTAINED ............................................... 1 (BOX 4)

DEATH CERTIFICATE WAS NOT OBTAINED BUT SUF ~

COMPLETED RIGHT BEFORE THIS INTERVIEW .......................... 2 (BOX 4)

DEATH CERTIFICATE WAS NOT OBTAINED AND SUF WAS NOT

COMPLETED RIGHT BEFORE THIS INTERVIEW ........................... 3

l-A.

l-B.

l-c.

I-2

As part of this survey, we are contacting vital records agencies and requesting death certificates on

participants who have died. At present, we have been unable to locate (SU BJECT’S) certificate. 1would

like to reconfirm some information with you. When did (SUBJECT) die?

MONTH: l_l_l

DAY l_l_l

YEAR: 19 I_l_l

In what city, county, and state did (SUBJECT) die? [IF LOUISIANA, PROBE FOR PARISH.]

Clw

COUNIY/PARISH:

STATE:

Was (he/she) buried in the same city?

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 8

[FEMALE ONLY, ASK] Please tell me (SUBJECT’s) father’s last name.

NAME:

120
BOX 4

INTERVIEWER: CIRCLE ONE:

PROXY ANSWERED ALL QUESTIONS ........................... 1 (PART J)

PROXY COULD NOT ANSWER ALL QUESTIONS .......... 2

I-D. IS there anyone else who might be able to answer some of the questions about (SU BJECT) that you were

unable to answef?

YES .................................................................. I (PART J)

NO .................................................................... 2

I need this person’s name, address, telephone number and relationship to (SUBJECT).

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE: f )

What was (SECOND PROXY’s) relationship to (SUBJECTj?

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER lN4J4W/MOTHER IN-IAW .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON lN-LAW/DAUGHTER IN-LAW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... 8

BROTHER lN-WW/SISTER IN-LAW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER RELATIVE (SPECIFY) ........................ 91

OTHER NON-REIATIVE (SPECIFY) ............... 92

TIME ENDED:

AM

PM

121
PART J: CLOSING STATEMENTS

TIME ENDED: AM

PM

BOX G, J-1, BOX H, AND J-2 NOT ASKED THIS VERSION.

PLEASE CHECK THE HHCF CHART.

ARE THERE ANY STAYS RECORDED?

YES .............................. 1

NO ................................ 2 (Q.J-7)

BOX I

INTERVIEWER: CIRCLE ONE:

~ IS REIATIVE ............. 1

~ :S NON-REIATIVE ... 2 (Q.J-5)

J-3. Thank you very much for taking the time to participate in this survey. As part of this survey, I would like to

send you a form that authorizes the United States Public Health Service to obtain information from hospital

or nursing home records. To do this I need to (confirm/have) your name and address.

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

And I need to confirm your telephone number.

TELEPHONE: J )

When you receive the form please sign your name. Then return the form in the postage paid envelope.

J-4 NOT ASKED THIS VERSION.

BOX J

INTERVIEWER: CIRCLE ONE:

~ AGREES TO SIGN ...... 1 (TERMINATE)

~ REFUSES TO SIGN .... 2 (TERMINATE)

122
J-5. As pan of this survey, ii maybe necessary to obtain information from hospital or nursing home records. To

do this, we must have written authorization from someone related to (SUBJECT). Do you know a relative of

(SUBJECT) who could sign this authorization?

YES .................................................................. 1

NO .................................................................... 2 (Q.J-7)

I need this person’s name, address, telephone number and relationship to (SUBJECT). ~ERIH ALL

SPELLING.]

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE: J )

What was (SECOND PROXY’s) relationship to (SUBJECT)?

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER lN-blW/MOTHER IN-LAW .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON lN-LAW/DAUGHTER IN-IAW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... 8

BROTHER lN-LAW/SISTER IN-LAW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER REWTIVE (SPECIFY) ........................ 91

OTHER NON-REIATIVE (SPECIFY) ...............92

J-6 NOT ASKED THIS VERSION.

J-7. Thank you very much for taking the time to paflicipate in this interview. In case we need to contact YOU

again for some reason, I would like to confirm your name and telephone number.

NAME:

TELEPHONE: f )

TIME ENDED: AM

PM

123
PARTK: RESPONDENT AND OBSERVATION SHEET

(TO BE COMPLETED AT CONCLUSION OF INTERVIEW)

BOX I NOT ASKED THIS VERSION.

K-I. DO YOU FEEL THAT THE INFORMATION PROVIDED BY THE PROXY WAS SATISFACTORY?

YES .................................................................. 1 (Q.K-4)

NO .................................................................... 2

K-2. WHY NOT?

K-3 NOT ASKED THIS VERSION,

K4. IN REGARD TO THE QUESTIONNAIRE, DO YOU FEEL IT ...

m

a. HELD THE RESPONDENT’S ATJENTION THROUGHOUT

THE INTERVIEW? .................................................................................... 1

b. WAS UPSEITING OR DEPRESSING TO THE RESPONDENT? ........... 1

c. WAS BORING OR UNINTERESTING TO THE RESPONDENT? ........... 1

K-5. WITH REGARD TO THE PROXY, DO YOU FEEL THE ...

~

a. RESPONDENT WAS INTELLECTUALLY CAPABLE OF

RESPONDING? ...............................................................................m.......m 1

b. RESPONDENT’S ANSWERS WERE REASONABLY ACCURATE? ....... 1

c. RESPONDENT UNDERSTOOD THE QUESTIONS? ............................. 1

K4a. (IF YES TO K4b OR K4c, OR IF NO TO K-5a, K-5b OR K-5c)

N

2

2

2

m

2

2

2

UNCERTAIN

3

3

3

UNCERTAIN

3

3

3

WAS THERE A SECTION THAT SEEMED TO BE PARTICUhRLY UPSEITING OR PROBLEMATIC FOR

THE PROXY?

YES .................................................................. 1

NO .................................................................... 2 (Q.K+b)

WHICH SECTION AND WHY?

124
K-6b. WAS THE PROXY HARD OF HEARING?

YES..................................................................

NO ....................................................................

K-6c. WAS THE INTERVIEW CONDUCTED IN SPANISH?

YES ..................................................................

NO ....................................................................

K-7. RECORD ANY RELEVANT COMMENTS OR IMPRESSIONS YOU MAY HAVE HAD

INTERVIEW.

1

2

1

2

ABOUT THIS
OMB #: 0937-0134

Expires: October 31, 1987

NHANES 1 EPIDEMIOLOGIC FOLLOWUP STUDY

QUESTIONNAIRE A

A.

B.

c.

D.

E.

F.

G.

H,

PLEASE READ INSTRUCTIONS FIRST

Please complete the Following questions either by placing a check (<)

in the box next to the answer that beet fits your aiLuation or by

writing your answer in the space provided.

—

Unless the instructions tell you otherwise, check only —one box.

Some auestions have instructions next to the answer Lellina You to

skip questions which do not apply to you.

follow the skip as directed.

Please follow all instructions carefully.

letters.

IF vou are Fillina ouh this questionnaire

First check the-box, then

Instructions are in CAPITAL

For a oerson who is too ill

to ~nswer for her=elf/himsel~, when reading the questions please

substitute the participant’s name for the word “your. ” For example,

A-3 would read, “Does Mr. Uones currently live in a private home or

apartment, a nursing home or reet home, or does. ~ have some other

arrangement?”

If the person named in A-1 is deceased, do not fill out this form.

Instead fill out Questionnaire B.

—

Some penple will receive Questionnaire A Supplement. IF a Questionnaire A supplement is encloeed, please fill it out.

If you have any questions about how to fill out the

please call our toll-free number, EOO-63B-B77B, and

National HANES Survey Supervisor.

questionnaire,

ask for the

ASSURANCE OF CONFIOENTIALITY

All information which would provide identification of the individual will be

held in strict confidence, will be used only for purposes of ❑nd by persons

engaged in the survey, and will not be disclosed or released to others for

any purposes in accordance with Section 308(d) of the Public Health Service

Act (42 USC 242m).

1

126
A. GENERAL INFORMATION

A-1 . Please review the information in the box below and correct any data

that is incorrect or missing.

NAME OF PARTICIPANT:

FIRST MIDOLE LAS T

CURRENT ADDRESS:

STREET

CITY STATE ZIP

TELEPHONE NUMBER: ()

__________________________________________________________________

CORRECTIONS : (RECORD CORRECTIONS OR MISSING DATA BELOW)

NAME OF PARTICIPANT:

FIRST MIDDLE LAST

CURRENT ADDRESS:

STREET

CITY STATE ZIP

TELEPHONE NUMBER: ()

A-2 . What is your date of birth?

MONTH DAY YEAR

A-3. DO

or

1

2

you currently live in a private home or apartment, a nursing home

rest home, or do you have some other arrangement?

n Private ho.aeor 3 D Boarding house, rooming

apartment house or rented room

n Nursing or convalescent 4 m Some other arrangement

or rest home (;ESCRIBE)

A-4. Do you live alone?

1 m Yes

2 m No (SKIP TO WJESTION A-6)

A-5. How long have you lived alone?

# OF YEARS: (SKIP T~QUESTION A-7

OR # OF MONTHS: (SKIP TEIQUESTION A-7 —

A-6. What is the eex and relationship to you of the other people who live

in your household? If you do not live in a household (for example,

you-live in a nursing home), tell us who you lived with before you

entered the nureing home.

HOUSEHOLD MEMBERS (e.g., HUSBAND)

1.

2.

3.

4.

5.

6.

7.

B.

SEX (MALE OR FEMALE)

2

127
A-7. Are you currentlymarried, widowed, divorced,separated,or have you

never been married?

1 D Married 4 D Separated

2 m Widowed 5 n Never married

3 m Divorced

A-tl. Ae part OF this survey, we would like to have your social security

number. ProvisionOF this number is voluntary and not providing the

number will not have any eFfect on your receipt of benefits From the

Federal Government. This number will be useful in conductingfuture

Followupstudies. It will be used to match against future mortality

records. This informationis collectedunder the authorityof Section

306 of the Public Health Service Act. What is your social security

number?

Social Security/}: 1111-~]-11111

B, YOUR HEALTH

B-1 .

B-2 .

B-3.

B-4 .

These next questions are about your health.

Would you say that your health in general ia excellent,very good,

good, fair or poor?

10 Excellent 4 m Fair

2 m Very good 5 D Poor

3 n Good

Did a doctor ever

I n y’=

2 m No (SKIP

tell you that you have arthritis?

TO QUESTIONB-4)

en Don’t know (SKIP TO QUESTION B-4)

What type of ❑rthritisdo you have?

1 m Rheumatoid 5 m Degenerative

2 m Osteoarthritis 6 n Another type (~E5CRIBE)

3 m Lupus

4 n Gout 8 m Don’t know

Since has a doctor told you that you had any of the

following conditions, If you have, please also tell us the years

you had the condition. (CHECK ALL” THAT APPLY. )

CONDITION

1 ~ Heart attack

20— Small stroke (sometimes

known aa TIA)

Jo Stroke (sometimes called a CVA)

4 m Broken or fracturedhip

YEARS HAD CONDITION

128
B-5.

B-6.

B-7 .

B-B.

B-9.

Have you

10

20

en

Have you

10

20

Bn

ever had coronaryby-pass surgery?

Yes

No

Don’t know

ever had pacemaker replacement, insertionor repair?

Yes

No

Don’t know

Did a doctor ever tell you you have diabetes or sugar diabetes?

1 n Yes

2 m No (SKIP TO QUESTIONB-11)

8 n Don’t know (SKIP TO QUESTIONB-11)

In what year were you first told that you had diabetesor sugar

diabetes?

YEAR

Are you —now taking insulin injectionsFor your diabetes?

1 n Yes

20N0

8 m Don’t know

B-10. Are you now taking oral medication for your diabetes? —

B-11. Have you

pressure

1

2

B

B-12. In

or

Yes

No

Don’t know

ever been told by the doctor that you had high blood

or hypertension?

Yes

No (SKIP TO QUESTIONB-15)

Don’t know (SKIP TO QUESTIONB-15)

what year were you first told that you hsd high blood pressure

hypertension?

YEAR

B-13. Has the doctor ever prescribedmedicine for your high blood pressure?

2 m No (SKIP TO QUESTION B-15)

B m Don’t know (SKIP TO QUESTION B-15)

4

129
0-14.

B-1 5.

0-16.

0-17.

0-10.

Do

1

2

El

you currently take this medicine regularly?

m Yes

m No

m Don’t know

Since have you had any type OF cancer diagnosed?

2 m No (SKIP TO QUESTION 8-17)

B n Don’t know (SKIP TD

Where waa the cancer or what

were you first told that you

QUESTIDN 0-17)

type of cancer was it? In what year

had this type of cancer?

TYPE OF CANCER

Ii

L.

3. . .

YEAR FIRST TOLD

Since 1970, have you broken or fractured any bones other than a hip?

1 n Yes

2 n No (SKIP TO QUESTION B-19)

B m Don’t know (SKIP TO QUESTION

Which bones have you fractured since 1970 and in what year was the

break or fracture?

BONE YEAR BROKEN

1.

2.

3.

5
0-19, Since , have you stayed in a hospital overnight or longer For any

reason? For each stay, pleaee record the date you went to the hospital, the

reason you went to the hospital and the nams and address OF the hospital.

1

.

L

STAY #1:

STAY #2:

STAY i/3:

STAY #4:

STAY #5:

O Yes- RECORD ALL STAYS BELOW

O No (SKIP TO QUESTION B-20)

DATE OF ADMISSION: / /

MO OA YR

REASON FOR STAY:

NAME DF HOSPITAL:

ADDRESS OF HOSPITAL:

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

NAME OF HOSPITAL:

ADDRESS OF HOSPITAL:

STREET

CITY STATE

OTHER COMMENTS:

DATE DF ADMISSION: I /

MO DA YR

REASON FOR STAY:

NAME OF HOSPITAL:

ADDRESS OF HDSPITAL:

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

NAME OF HOSPITAL:

ADORESS OF HOSPITAL:

5TREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

MU DA YR

REASON FOR STAY:

NAME OF HOSPITAL:

AODRESS OF HOSPITAL: —

STREET

CITY STATE

OTHER COMMENTS:

(IF YOU HAVE STAYED IN A HOSPITAL OVERNIGHT OR LONGER FOR MORE THAN FIVE TIMES,

PLEASE CONTINUE RECORDING INFORMATION ABOUT STAYS ON A SHEET OF F’APER AND

INCLUDE IT IN THE RETURN ENVELOPE. )

6

131
0-20. Since have you ever stayed overnight or longer in a rest home,

a nurs~h=;, a menLal health facility, or anything like that? For

each stay, please record the date you went into the Facility, the

reason You went Lo the facility, the type OF Facility (e. g., nursing

home) and the name and address of the facility.

1

.

L

STAY #1:

STAY /12:

STAY #3:

STAY #4:

a Yes- RECOROALL STAY5 BELOW

m NO (SKIp TO QUESTION O-21)

DATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

TYPE OF FACILITY:

NAME OF FACILITY:

ADORESS OF FACILITY:

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

MO OA YR

REASON FOR STAY:

TYPE OF FACILITY:

NAME OF FACILITY:

ADDRESS OF FACILITY:

STREET

CITY STATE

OTI+ER COMMENTS:

OATE OF ADMISSION: / /

MO

——

DA YR

REASON FOR STAY:

TYPE OF FACILITY:

NAME OF FACILITY:

ADDRESS OF FACILITY:

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

TYPE OF FACILITY:

NAME OF FACILITY:

ADDRESS OF FACILITY:

STREET

CITY STATE

OTHER COMMENTS:

(IF YOU HAVE STAYED IN ANY HEALTH CARE FACILITY OVERNIGHT OR LONGER FOR MORE

THAN FOUR TIMES, PLEASE CONTINUE RECORDING INFORMATION ABOUT STAYS ON A SHEET

OF PAPER AND INCLUDE IT IN THE RETURN ENVELOPE. )

7

132
0-21.

B-22.

B-23.

B-24.

B-25.

B-26.

(IF YOU ARE CURRENTLY IN A NURSING HOME, ANSWER 021 ANO B22; OTHERWISE,

SKIP TO 0-23.)

During the month before your admission to the nursing home, was there

a signiFican’change in your health?

During the 12 months prior to that,

Had it improved,remained the same,

worsened?

what was happening to your health?

graduallyworsened,or suddenly

10

20

(IF YOU

SKIP TO

Improved 3 U Graduallyworsened

Remained the same 4 U Suddenlyworeened

ARE NOT CURRENTLY IN A NURSING HOME, ANSWER B-23; OTHERWISE

B-24~

What has been happening to your health during the past 12 months? Haa

it improved,remained the came, graduallyworsened,or suddenly

worsened?

1 D Improved 3 m Graduallyworeened

20 Remained the same 4 m Suddenlyworsened

As part of this survey, it may be necessary to obtain additionalinformation from hospital or nursing home records. The enclosed form entitled

!lAuthori~ationto Obtain Informationfro]mMedical Records” authorizes

the U.S. Public Health Service to obtain this information. Please read

the form and record any other namee under which hoepital or in-patient

health facilityrecords could be listed. If the records would not be

listed under any other name, check the box. Sign your name on the

signatureof subject line if:you are answeringthe questionnairefor

yourself. If you are answeringthe questionnaireon behalf of the

participantbecause he/ehe is incapacitated,please have the participant

fill out his/her name. Also, be sure to date the form.

Please return all Forms in the postage-paidenvelope.

Please give me the name, address, and telephonenumber of a relative

or friend who would know how to get in touch with you in caae we need

to contact you again and have a hard time getting hold of you.

NAME:

ADORESS: I

STREET NAME ANO NUMBER APT. NUMBER

CITY I STATE ZIP CODE

TELEPHONE : ()

How is that person related do you?

(If YOU ARE ANSWERING THIS QUESTIONNAIRE FOR -ANOTHER PERSON) :

Please record your name, addresa and telephonenumber and your

relationshipto the participant.

NAME :

ADDRESS :

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE : ( )

RELATIONSHIP TO PARTICIPANT:

Thank you very much for taking the time to participatein this

interview.

8

133
0M13#: 937-0134

Expires: October 1987

NHANES 1 EPIDEMIOLOGIC FOLLOWUP STUDY

QUESTIONNAIRE A - SUPPLEMENT

c. SMOKING AND ALCOHOLIC

c-1.

c-2.

c-3 .

c-4.

c-5.

Did you ever smoke

1 n Yes

BEVERAGES

at least 100 cigarettes in your” lifetime?

2 D No (SKIP TO WESTION C-8)

Do you smoke cigarettes now?

1 m ‘es

2 m No (SKIP TO QUESTION C-5)

About how many cigarettes a day do you now smoke?

# PER DAY

For how many years have you smoked cigarettes?

(SKIP TO C-8)

YEARS

Hhen did you stop smoking cigarettes?

~’r

C-6. During the years when you were smoking, about how many cigarettes a

day did you smoke?

.

# PER ~AY

c-7. For how many years did you smoke cigarettes?

YEARS

134
L-o

c-9.

c-lo.

C-11.

C-12.

l-t-l These next questions are about alcoholic beverages, that is, beer or

wine or liquor. Have you had at least one drink of beer, wine or

liquor during the past year?

2 U No (SKIP TO END)

During the past year, on the average, how often did you drink alcoholic

beverages, that is, beer, or wine, or liquor?

# OF DAYS =1 = Week

2 m Month

During the past year, on the average, how many cans or bottles of beer

did you drink per day, week, month or year? (IF NONE, RECORD ON LINE

BELOW .)

# OF DRINKS w 1 c1 D+’

2 m Week

3 m Month

4 = Year

During the past year, on the average, how many glasses of wine

drink per day, week, month, or year? (IF NONE, RECORD ON LINE

did you

BELOW.)

# OF DRINKS E 1 c1 Day

2 ~ Week

3 m Month

4 = Year

During the past year, on the average, how many shots or drinks of hard

liquor, either straight or in a mixed drink, did you drink per day,

week, month or year? (IF NONE, RECORD ON LINE BELOW.)

# OF DRINKS E 1 n @

2 ~ Week

3 = Month

4 = Year

135
OMB #: 0937-0134

Expires: October 31, 19E7

NHANES 1 EPIDEMIOLOGIC FOLLOWUP STUDY

QUESTIONNAIRE A - SUPPLEMENT

D. FEMALE MEDICAL HISTORY

D-1 .

D-2 ,

D-3 .

D-4 .

D-5.

D-6.

D-7 .

Have you ever been pregnant? (INCLUDE LIVE BIRTHS, STILLBIRTHS,

MISCARRIAGES AND ABORTIONS.)

2 n No (SKIP TO QUESTION D-7)

How old were you

child born alive

AGE

How old were you

AGE

when your first child was born? This means the First

or stillborn. (IF NONE , RECORD NONE ON LINE BELOW. )

when your last child was born? Include stillbirths.

How many live births have you had? (IF NONE, RECORD NONE ON LINE BELOW.)

# LIVE BIRTHS

Ha,ve you ever had a miscarriage?

1 D Yes

~ n No (SKIP TO QUESTION D-7)

How many miscarriages have you had?

# OF MISCARRIAGES

At what age did you have your last period?

AGE

136
D-8.

D-9.

D-10.

D-II.

D-12.

D-13.

D-14.

D-15.

D-16.

Did your periods stop naturally, because

reason?

1 m Naturally

2 ~ Surgery

3 n Some other reason (DESCRIBE)

of surgery, or for some other

Did you ever take female hormone pills for reasona related to menopause,

including hot Flashes or mood changes around the time you were beginning

the change of life? This would include hormone pills taken for natural

change of li~e or because your periods stopped due to an operation.

1 = Yes

2 n No (SKIP TO QUESTION D-13)

El n Don’L know (SKIP TD QUESTION D-13)

How old were you when you first took hormone pills?

AGE

How old were you when you last took hormone pills?

—OR m STILL TAKING HORMONE PILLS

AGE

Altogether For about how many years have you taken hormone pills?

# OF YEARS I

Have you

In

20

80

ever taken birth control pills for any reason?

Yes

No (SKIP TO END)

Don’t know (SKIP TO END)

l-low old were you when you first took birth control pills?

AGE

How old were you when you last took birth control pills?

—OR m STILL TAKING BIRTH CONTROL PILLS

AGE

Altogether for about how many years have you taken birth control pills?

# W YEARS

137
OMB #: 0937-0134

Expires: October 31, 19E7

NHANES 1 EPIDEMIOLOGIC FOLLOWUP STUDY

QUESTIONNAIRE B

PLEASE READ INSTRUCTIONS FIRST

Please complete the Following questions only iF the person named in thf

box below is deceased.

Pleaae complete the following questions either by placing a check (~)

in the box next to the answer that best Fits the situation or by

writing your answer in the space provided.

—

Unless the instructions tell you otherwise, check only —one box.

Some questiona have instructions next to the answer telling you to

skip queetione which do not apply to you. First check the box, then

follow the skip as directed.

Please follow all instructions carefully. Instructions are in CAPITAL

letters.

If you have any questions about how to fill out the questionnaire,

please call our toll-Free number, BOO-63EI-B778, and ask for the

National HANES Survey Supervisor.

1. Please review the information in the box below and correct iF incorrect

or missing.

NAME OF DECEASED PARTICIPANT:

FIRST MIDDLE LAST

DATE DF BIRTH: / /

MONTH DAY YEAR

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

CORRECTIONS (RECORD CORRECTIONS OR MISSING DATA BELOW)

NAME OF OECEASED PARTICIPANT:

FIRST MIDDLE LAST

DATE OF BIRTH: / /

MONTH DAY YEAR

ASSURANCE OF CONFIDENTIALITY

All information which would provide identification of the individual will be

held in strict confidence, will be used only for purposes OF and by persons

engaged in the survey, and will not be disclosed or released to others for

any purposes in accordance with Section 30B(d) of the Public Health Service

Act (42 USC 242m).

1

138
MEDICAL HISTORY

2. Since , had the participant stayed in a hospital overnight or

lonqer For any reason? For each stay, please record the date he/she

went to the hospital, the reason he/she went to ths hospital and the

name and sddress of the hospital.

1

2

STAY #1:

STAY #2:

STAY #3:

STAY #4:

STAY #5:

~ Yes - RECORD ALL STAYS BELOW

u No (SKIP TO QUESTION3)

OATE OF ADMISSION: / /

MO OA YR

REASON FOR STAY:

NAME OF HOSPITAL:

ADDRESS OF HOSPITAL:

STREET

CITY STATE

OTHER COMMENTS:

OATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

NAME OF HOSPITAL:

ADDRESS OF HOSPITAL:

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

MO OA YR

REASON FOR STAY:

NAME OF HOSPITAL:

ADDRESS OF HOSPITAL:

STREET

CITY STATE

OTFIER COMMENTS:

DATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

NAME OF HOSPITAL:

PDDRESS OF HDSPITAL:

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

NAME OF HOSPITAL:

AOORESS OF HOSPITAL:

STREET

CITY STATE

OTHER COMMENTS:

(IF HE/SHE HAD STAYEO IN A HOSPITAL OVERNIGHT OR LONGER MORE THAN FIVE TIMES,

PLEASE CONTINUE RECORDING INFORMATION ABOUT STAYS ON A SHEET OF PAPER ANO

INCLUDE IT IN THE RETURN ENVELOPE. )

2

139
3. Since , had the participant ever stayed overnight or lonqer in a

rest home, a nursing home, a mental health Facility, or anything like

that? For each etay, please record the date he/she went into the

Facility, the reaeon he/she went to the Facility, the type of Facility

(e. g., nursing home) and the name and address OF the Facility.

1

2

STAY #1:

STAY #2:

STAY #3:

m Yes - RECORD ALL STAYS BELOW

n No (SKIP TO QUE5TION4)

OATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

TYPE OF FACILITY:

NAME OF FACILITY:

ADORESS OF FACILITY:

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: —. / /

MO DA YR

REASON FOR STAY:

TYPE OF FACILITY:

NAME OF FACILITY:

ADORESS OF FACILITY:

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

TYPE OF FACILITY:

NAME OF FACILITY:

AODRESS OF FACILITY:

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

TYPE OF FACILITY:

NAME OF FACILITY:

ADDRESS OF FACILITY:

STREET

CITY STATE

OTHER COMMENTS:

(IF HE/SHE HAD STAYED IN ANY HEALTH CARE FACILITY OVERNIGHT OR LONGER FOR MORE

THAN FOUR TIMES, PLEASE CONTINUE RECORDING INFORMATION ABOUT STAYS ON A SHEET

DF PAPER AND INCLUOE IT IN THE RETURN ENVELOPE.)

3

140
4.

5.

6.

7.

B.

9.

10,

Did the participantdie in either a hospital or nursing home?

1 n Yes

2 m No (SKIP TO QUESTION 6)

B m Oon’t know (SKIP TO QUESTION 6)

Please record the name and address of the hospital or nursing home.

NAME :

ADDRESS :

What was

STREET

CITY STATE

his/her date of death?

MONTH DAY YEAR

In what city, county and state did he/she die?

CITY:

COUNTY OR PARISH:

STATE:

As part of thie survey, it may be necessary to obtain additionalinformation from hospital or nursing homa records. The enclosed form entitled

!lAuthorizationto Obtsin Informationfrom Medical Records” authorize

the U.S. Public Health Service to obtain this information. pleaae read

the form and record any other names under which hospital or in-patient

health facility records could be listed. If the records would not be

listed under any other name, check the box. Sign your rwne on the

signatureof next-of-kin line. Also record the date you signed the form

and the date, county and state of death of the participant.

Pleaae return all forma in the postage-paidenvelope.

Pleaae record your name, addresa and telephonenumber and your relationahip to the participant.

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE : ( )

RELATIONSHIP TO PARTICIPANT:

FEMALE ONLY : Pleaae record the participant‘a father’s laat name.

FATHER’ S LAST NAME:

Thank you very much for taking the time to participate in this interview.

4

141
OMB No. : 937-0134

Expires: October 1987

NHANES I EPIDEMIOLOGIC

FOLLOWUP STUDY

Verbal Authorization to Obtain Information

From Medical Records

SUBJECT

This is to certify that has verbally consented

SUBJECT NAME

to sign a

pertinent

medical authorization form thereby authorizing the release of

information regarding hospitalizations, illnesses and health

care.

INTERVIEWER’S SIGNATURE DATE

NEXT-OF-KIN

This is to certify that , who is the

RESPONDENT NAME

of 9 has verbally

RELATIONSHIP TO SUBJECT SUBJECT NAME

consented to sign a medical authorization form, thereby “authorizing the

release of pertinent information regarding hospitalizations, illnesses and

health care.

INTERVIEWER’S SIGNATURE DATE

142
PI- Rarum M NitANES-l

195Ukaaamh ❑lvd.

Raekvllla, MD 20W

OMB No: oU741J4

hpl- Juno IOU

U.S. Depa-nt of Heafth and Human Services

Natfonal Center for Health Statistics )

National Inatltute on Aging NOTICE - InformalIan canlalned on Ihh form w+lch

NHANES 1 Epldemlo16glc Followup Survey WUM permfl Idenilficatlon of my Indtidud or

eslablishmnnl has bean collected wlh a guaranka Ihd

tl Ml & bald in stfld contldenca, will k used only fOr

purposas slated La lhls sludy, md will noi h disclosed

AUTHORIZATION TO OBTAIN INFORMATION orreleased 10 olham wiihoul Iha canssnl of the

FROM MEDICAL RECORDS lndhidud or eelabllahmanl in accordmee Ah .Sadlon

m(~ of lha PubI!! Hailh SeMca Act (42 USC 242m).

In connection with the health history of given as part of the

National Health and Nutrition Examination Followup Suwey, it maybe necessa~ to obtain additional information

from records and staff of hospitals or other inpatient health facilities. I hereby authorize the release of such

information as the U.S. Public Health Semite may need to request from any of these sources. I understand that I

may revoke this consent at any time except to the extent that action has

that this authorization expires one year from the date of signature.

I understand that all information obtained will be held strictly confidential.

My records may also be listed under the followihg first and last names

already been taken. I also understand

(e.g., name change due to marriage):

OR

Check box •1 if records would not be listed under any other name.

SIGNATURE OF NEXT-OF-KIN SIGNATURE OF SUBJECT

DATE DATE

RELATIONSHIP ~

DATE OF DEATH (MO/DAY/YEAR)

COUNTY AND STATE OF DEATH

PH9-22LY

C@

143
WESTAT ID: L_l_l_[_l_l_l ,J., B No 937.0,34

APPr.v,l ExPl< c,. 10/31/87

HOSPITAL ANO HEALTH CARE FACILITY CHARr

INTERVIEWER ASK OH VEMIFYA F FOR EACH OVERNIGHT STAY RECORD BELOW I

A, Whc,, tin511,Q .,,, IBP,)II(3. 111<)qI,81.11~YPEOF FACILITY I> lPROBEFOR~-L~~_N~WEl I

0 When lwm y.,,l\v.s SUUJEC_T), nlh,s [iO,I>, I.llll~O_F_F_ACl LlTY17 IPROBE FOR DATE I

c IIF s&ME l1051,1TALNAkIE AND SAME DATE ASK ) Is t

D Whn1,5(h. ,rJ,lrc,.O1,l, #5 II,oH), I.l ILYPE OF FA~l~~_l, (

E Why lw,,Pv.,, /v, J,s_uEJEcT) ,. 11,cIhoq,,ld/TYPE OF FAI

ANu CONDITIOIJS)

—..— dins [hesmne (I, o$l>tl.l nz.lnonlst, vl YOU Ioldrncdm.1 helore7

(R ECORO STREET. CITY AND STATE I

CILITY)? (PROBE FOR ALL CONDITIONS AND REcOfl D OUESTION NUMBERS

F O,d lye,,/5~BJEcTl lhw. m” (olhcr) s.rqery dur,nq(”ou,/h,, /l,c, ) [hoso,,al,za,, on/,,a”)7 (IF YES, PROBE WIIaIwa, [heswrwr”, )

I

STAY I——I I FAcILIIyN~M~: l_l_l_l_l_l_l_l_l_ l_l_l_l_l_l_l_l_l_ l_l_l_l_l_l_l_l_l_ l-l-l-l

Mnn!l, n w

OAT[: l_]_l l_l_l 19 l_l_l NiA/t4FI U: I I I I I I l_]_]_l

AOORESS:

STREE 1

CIIY SIATE

W: l_l-l_l_[ CONOITION: I I [ I I I I I I I I I I I I I I l_l_l_l_l_l_l_l_l

W, l_l-l_l_l CONDI11ON: I i I I I I i I I l_l_l_l_l_l_[_l_]_l_l—1—l—l—l—[_l

W: l_l-l_l_l CONOIIION: I I I I I I I I I I I I I I I I I I I ] l_l_l_l_l_l

(W: l_l-l_l_l CONDITIUN: I t I I I I I I I I I I I ] I I I I I I l_l_l_l_l_l

COMMENTS:

M.,,( II Do”

OATE: [_l_l l_l_l 19 [_l_l PJIA/hlFI J: I I I ] I I l_l_l_l

ACIDR[55:

STREET

COMNINI S :

51 AYl_l_l FAcI[ITYNflM[:l I I I I I I I I I I I I I I I I I I I I I I I I l_l_l_l_l_l

,.,”,1,11 nay

OATE: l_l_[ l_\_l 19 l—l_l P14A/HFI ~: I I [ l_!_l_l_l_l_l

AOOflCS5:

STREET

COMMENTS:

NOTICE: Ir, krmam. cmm,ned m lhts form wh,ch would pmnil ,de.lvf, cadon of any md,.idwl or eslabl;shmen[ has been mlkwd wilh a g.amn lee

that II wdl b, held I. s,ricl con[,denc. by th~ c..lrmmr and NcHS, WIII be used only 1.< p.rpnws slaled I. rh, $ study, and will ..1 be dis.

closed or fel.md IO anyone olher Ihan aulh,,rlzed mall .1 NCHS, withoul lhe consent .1 the ,“d,.,d.d or .Slablishmenl in accordance w,lh

Smrior, 30B(dl .1 [he P.bl,c Health Scr.ice Act [42 U.S C. 242m).

PHS-628E
STAY l_l_l FACILITV NNE:IIIIIII —.— III Iilllll!i[llli[ l_l_l_l_l_l

Month Day

IMIE: l_l_l l_l_l 19 l–l_l NA/NFI #: I I [ I I I I l_!_l

KX)RESS:

STREiT

CITY STATE

Q~: I_ I-l——I I CONDITION: I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_l_I_l_l_l_l_l_l_l_l

Qf:l_\-l_l_l cWITIONtll\lllil!i 1111111 llllll_l_l_l

~: l_l-l_l_l UNDITION:l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l-l_l-l-l-l-l-l-l_l

~: l_l-l_l_l mwIIION: I_i_I_I_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_i_i_l

CDM4ENTS:

5TAYl_l_l FACILITYNME:I I I I I I I I I I I I I I t I i I I I I i I I I 1. I l_i_\_l

Month 0 W

oATE: l_l_l i_i_l 19 l—l–l #MA/NFIl: [ I I I [ I I l_l_l

KORESS:

STREET

CITY STATE

~: l_l-l_l_l CUh@lTION:llllllill lllil!lilll_i_l_l_l_l_l

W: l_l-l_l_l CONDITION: I I I I I I I I I I I I I I I I t I l_l_l_l_l_l_l_l

w: l_l-l_l_l mNollIoN: l_l_l_l_l_l_l_l_l_l_l_i_l_l_l_l_l_l_l_l_l_l_l_l_l_l

W! l_l-l_l_l CONDITION: I I i I I I [ I I I I I I \ I I l_l_l_l_l_l_l_l_l_l

CC+?4ENISI

STAY l_l_\ FACILITYNAME:IIIIIIII Iilllllllllli llll_l_i_l_l_\—1

M“nl17 nay

LMTE: l_l_l l_l_l 19 l_l_l fflA/NfI 1: I I -1 i I i I l_i_l

lwclREss:

STREET

CITY STATE

w: l_l-l_l_l CONDIIION:I I I I I I I I I I I 1 I i I I I I I I I I l_l_l_l

w: l_l-l_l_l mt.DITIoN: l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l

W:l_l-l_l_l CUNOITION: II II![III Illllli[lllll t_l_i_l

Q~: u—l ——I I

CONOITION:I I I I I I I I I I I I I I I I [ I I i I I l_l_l_l

CW4ENTS :

STAY I——I I FACILITY NAME: I-l-l_l-l_l-l_l-l_l-l_l-l_l-l_l-l-l-l-l-l-l-l-l-l-l_l-lAl-l_l

MontP# nay

MTE: l_l_l l_l_l 19 l_l_l iViA/NFI 1: l_l I I I I l_l_l_l

=ESS:

SIREIT

CITY STATE

w: l_\-l_[_l mtO1lIoNl l_l_l_l_l_l_l_i_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l-l-l

~: l_l-l_l_l COND1TION: l_l_l_l_l_l_l_l_l_l_l_l_l_i_l_l_l_l_l_l_i_l_l_l_i_l

W: l_l-l_l_l co~ITIoN: l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l-l_l-l_l-l_l-l_l-l_l

w! l_l-1_l—1 EIIhCMIION: l_l_l_l_l_l_l_l_l_l_l_l_\_l_l_l_l_l_l_l_l_l_l_l_l_l

CCWENTS:

*PO 917-402

145
Health care facility data collection

~%wwc~. f,,

#

Jf

,

.* DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

:

:

.

-0

7

‘+%,*, ,~ National Center for Heatth Statistics

3700 East-West Highway

Hyattsville, MD 20782

Dear Administrator:

I am writing to inform you of a request which has been made to your Medical

Records department. The NHANES I Epidemiologic Followup Study: Continued

Followup of the Elderly is being carried out by the National Center for

Health Statistics (NCHS), the National Institute on Aging, and other

components of the National Institutes of Health.

A selected sample of the United States population volunteered to participate

in the first National Health and Nutrition Examination Survey which NCHS

conducted from 1971-1975. We have recently contacted these participants to

provide new information about the etiology of chronic disease. A crucial

component of the study is a very limited hospital record data collection to

augment information obtained from these participants. Participants who have

been hospitalized have signed authorization forms to permit the release of

diagnostic information from their hospital records.

NCHS has contracted with Westat, a national survey organization, to conduct

the data collection operations of this survey. Westat has, therefore, sent

a packet to your Director of Medical Records on behalf of the patients in

the study. This survey is authorized by Title 42, United States Code 242k.

Participation in this survey is completely voluntary. There are no

penalties for refusing to answer any question. All information obtained

will be held strictly confidential. No information that could be used to

identify your hospital or any individual will be released or published.

Results of this study will be published only as statistical summaries.

The Anerican Hospital Association has endorsed this study and urges your

cooperation. Dr. Ross Mullner of the Association may be reached at (312)

280-6519 if you have any questions concerning this endorsement. If you have

any questions concerning the data collection, don’t hesitate to call

Kathleen Parkes at (301)251-4351.

Sincerely yours,

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

Director

146
,’,vlc,, ~

#

+

*.+

.

. Jd

DEPARTMENT OF HEALTH& HUMAN SERVICES PubIii Health Service

5

:

*

%

%+,*,W National Center for Health Statistics

3700 East-West Highway

Hysttsville, MD 20782

Director of Medical Records:

A new research study is being carried out by the National Center for neiiittl

Statistics (NCHS), National Institute on Aging and other components of the

National Institutes of Health.

A selected sample of the United States population volunteered to

participate in the first National Health and Nutrition Examination Survey

which NCHS conducted from 1971-1975. Me have recently reinterviewed these

participants to provide new information about the etiology of chronic

disease. A crucial component of the study is a very limited hospital

record data collection to augment information obtained from these

participants. Enclosed are signed authorization forms specifically

permitting us to obtain diagnostic data from their medical record.

This survey is authorized by Title 42, United States Code 242k.

Participation in this survey is completely voluntary. There are no

penalties for refusing to answer any question. NCHS has contracted with

Westat, a national survey organization, to conduct the data collection

operations of this survey. All information obtained will be held strictly

confidential and will be used for statistical purposes only. No

information that could be used to identify the participants or your

hospital will be released or published. Results of this study will be

published only as statistical summaries.

The American Hospital Association (AHA) has endorsed this study and urges

your cooperation. Your hospital’s participation is vital to the success of

this study. If you have any questions concerning this project, please feel

free to call Kathleen Parkes collect at (301) 251-4351.

Sincerely yours,

~-

147

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

Director

Enclosure
CM b.: 09 Y7-01Y4

brpirstion Dmte: lD/Yl/E7

No II CC: - Infer.mtno. co. k.nn. d m Mt. form

mhlch . ..ld P.rmlt tdw.tlf,cmtlm of m, troll -

vlduml or .nL*ll.hm.1 h= bmw colleclcd .llh

n ‘WafaOL*~ lhml It UI1l k hold 1. ,tr, ct ~m.

rid. n=. , 911 I b. u-d ml, r., p.rp.m.m mL.t.d

rc. r lhlm .l.dy, .nd .111 ..1 b. dlmelam.d or

t.lmm.. d 1. .lh. rm .INIo.1 lh. corn.nl or th.

Indlvid. ml or .ml*llmF=.t, 1. =x.ra.tm .Itb

S,ctia” ]m[d) .r tb PW511C H..11h 5.rvicm Act

(U Usc za2m),

❑ IPFWWATION SHUdN ~ LABEL

ACREES WITH I+DSPITAL RECORDS

•1 DTHER (SPECIFY)

RETMN TO: MIAMS I

F~LDNLIP SWIVEY

165D Research Blvd.

Roclrville, WI 20S50

U.S. Department of Fknlth md Human Services

Mtlonal Center for Health Stmtiotics

Netionnl Institute .37 Fqirq

WANES 1 Epidemloloqic Follow.ip Survey

1985/86

HOSPITAL RIICMD FORM

(TO BE C134PLETED BY MEOICAL RECORDS DEPARTMENT)

1.

2.

3.

h.

5.

PATIENT

MTE W

WAS THE

MEOICAL RECORD NLHBER

AEMISSION / /

HLMTH DAY WAR

PATIENT IN: CAROIAC INTENSIVE CARE UNIT

❑ Yee, ofly9

NU4BER

El.

DISPOSITION W PATIENT (check me)

❑

c1

❑

n

Routine dl=hnrge/discharged hanc u

Left qalnst medlcnl advice n

Diechmrged/trmn ferrcd to

fecillty or orgmnizatlon

u

another m

:

DATE ff DISCKARGE / /

MONTH OAY WAR

OTHER INTENSIVE CARE UNIT

•1 Yen, Days

NLMBER

❑ .

Diwhmrged/referred to organized

home care eervlce

Not dlechargad/mtill in Faepital

Died

Nat stated

ANY OTHER tPJSPITALS/HEALTH CARE ~ACILITIES LISTED IN AU41SSION NOTES ~ OISCHARGE SWHARY

N.wne: Year:

City: 5tmte:

Name: Year:

City: state:

(PLEASE TURN THE PAGE)

PHS.02E4

6~5

148
6.

7.

e.

9.

WIAT HERE THE DIACHOSE5 ESTABLISHED AT TIME ~ DIsCHAR~? [primipal diqnosis is the condition after

etudy chicrly rempnnlble for the Immpitnl ntay. ] (If more ❑price in needed For additional dlqnonen,

mite the dlmnoeem -d the Heetat ID nm’ber m ~ =P~r-te eheet of paper and mttech to thie form. )

Principal Dia qrroain:

1.)

Other Dimqno~ee:

2.)

Y.)

4.)

5.)

6.)

7.)

B.)

9.)

,...

f I

- [ 1,,,

—

WAT WCRE THE SWGICAL PROXDW4ES PERFEMHED CURING THIS AIM41SSIDN? ( Include all biopsy ard

mrgicml procedure dimxeued or lieted in the di=harge summary.)

SURGICAL PROCEDURES : ❑ Check i f none

1.

2.

3.

4.

5.

mmnl

dizsl 1

d311=”

PLEASE ATTACH A PHOTIXOPY DF THE THIRD DAY EKG IF MYWARDIAL IWARCTION DIAGNOSEO DWINC THIS STAY.

PLEASE ATTACH A PHOTOCOPY OF THE PATHOLOGY REPORT COff IRt41ffi THE DIAGNOSIS W CAWER !lADE OURIffi

THIS STAY. (Hrite the lleetmt, 1.0. nmber m e-h @otocopied page. )

ncLricnmmt9 Iem U-J

a. Third Day EKG

BE E

(Reaman WNA) )

b. Pntholcqy Report (Rewm M/M) )

R-EASE ATTACH A PHDT~DPY OF THE FACE SHEET AND THE DISCHARGE SIMHARY FOR THIS INPATIENT STAY.

(Write the Heetmt 1.0. nmber on each @oLocopied page. )

Attnchmntm Yee

a. Face %eet

b. Dimhnrge %’mnry E

CWPLETEO BY

Ml WA

HE

(Reaeon MJ/NA) )

(Ream. tWNA) )

OATE

●U s Q-3 lmn5.&4n l-3e4! 37050

149
*,1,. Icr,,tir

+’ *. $

,

>“ DEPARTMENT OF HEALTH& HUMAN SERVICES Public Health Service 5

:

s

%

%,+

%.,,. > National Center for Health Statistics

3700 East-West Highway

Hyattsville MD 20782

Dear Administrator:

The National Center for Health Statistics (NCHS) is conducting a followup

study of the participants in the first National Health and Nutrition

Examination Survey (NHANES I) to provide new information about the etiology

of chronic disease. We need your assistance.

A selected sample of the United States population volunteered to participate

in the first National Health and Nutrition Examination Survey which NCHS

conducted from 1971-1975. NCHS is now tracing and reinterviewing those

14,407 persons to study the relationship between physical measures (e.g.,

blood pressure or functional vital capacity), behavioral variables (e.g.,

smoking or dietary intake), and other risk factors identified in the NHANES I

Survey and subsequent disease reported by the person at followup.

A crucial component of the study is a very limited nursing home record data

collection. Diagnostic information from the nursing home record will be used

to verify and supplement each respondent’s self-reported medical history.

Each person or next of kin (in cases of death or disability) has signed a

form requesting the release of his/her nursing home care records to the

survey researchers. (Copies of these authorizations are enclosed.) Nursing

homes will be reimbursed for the cost incurred.

This survey is authorized by Title 42, IJnjted States Code 242k.

Participation in this survey is completely voluntary. There are no penalties

for refusing to answer any question. NCHS has contracted with Westat a

national survey organization to conduct the data collection operations of

this survey. All information obtained will be held strictly confidential and

will be used for statistical purposes only. No information that could be

used to identify the participants or your nursing home will be released or

published. Results of this study will be published only as statistical

summaries.

Your participation is vital to the success of this study. If you have any

questions concerning this project, please feel free to call Kathleen Parkes

collect at (301) 251-4351.

Sincerely yours,

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

Director

Enclosures

150
1.

2.

3.

4.

5.

OMB tie.: 09374134

Esplres: June 19W

~-lnrOmMMn~ UI Ihh fonm whkh muld

~il ldaMalbrl ol My hdMdusl W asWbli9hm9nl Ius

bnnmlkcldwilmmg~ Ihai II Al b Md In sIfkt

eOniW+rM, WI b Lmad only ru pup Sllld b Ii+ study.

mndwllnol bdlacbsdor~ 10 ohm wiltmul Iho

-nr of lha lndtiual or nlablkhfmnl In mcco@ara Mlh

S+clbrI z09(d) or IIW Put4k Fkallh .SAca Ad (42 USC 24Zm). I

❑ INFORMATION SHOWN ON IABEL

AGREES VVITH NURSING HOME RECORDS

❑ OTHER(SPECIFY)

U.S. Department of Health and Human services

National Cantar for Health StatisUcs

National Instihrte on Aging

NHANES I Epidemiologic Followup Survey

NURSING HOME/PERSONAL CARE HOME RECORD FORM

(10 BE COMPLETED BY MEDICAL RECORDS DEPARTMENT)

PATlENT MEDICAL RECORD NUMBER

DATE OF ADMISSION / j DATE OF D[SC~GE

~~

MONTH DAY YEAR MONTH DAY YEAR

PATlENT ADMITTED FROM: (Check One)

❑ Privahsresidence ❑ Chmnicdisease hospital (SPECIIW BELOW)

❑ P#xtecare hospital (SPECltWBELOWJ ❑ Olhernursing home (SPECIIWBELOW)

NAME OF FACIUW CilY/STATE:

OTHER HOSPITALS PROVIDING CARE DURING NURSING HOME/PEHSONAL C/WE HOME STAY

Name:

Name:

Name:

DISPOSITION OF PATlENT (Check One)

U Notdischarged/still inpatient

❑ Dxhargedto private residence/

referral to organized home care services

Transferred to another h@h care facility (SPECIFY BELOWJ

❑ Acuta care hospital facility or organization

U Ofhernursing home

NAME OF FACILITY

City/State: Yeac

City/Slate: Year

City/State: Yeac

•1

❑

•1

•1

Pl~~M R~IUWI W NHANE.W (PLEASE TURN THE PAG~

Died

Discharged to private residence/

no referral

Chronic disease hospital

Other (SPECIFYI

CITY/STATE

Epldomlolc@e Followup Sludy PHS-6217

16S0 Rotaamh Blvd.

FIochvlllq MD 20050

151
6. Wf-lAT WERE THE DIAGNOSES ESTABLISHED AT ADMISSION?

Principal Dlaqnosis at Admission :

1.

Other Maior Diseases or Conditions Present

at Time of Admission :

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7. PLEASE AITACH A PHOTOCOPY OF THE ADMISSION SHEH. (Write the Westat I.D. number on each photocopied page. If you do not

have photowpying capabilities, please transcribe the information from the admission sheet onto a separate sheet, remrd the Westat ID

Number on that sheet, and staple it to THIS form.)

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Admission Sheet Included: ❑ n

COMPI.J3ED BY DATE

152
Appendix II

Corrections and

revisions to the

NHANES I baseline

data

Three demographic data items (date of birth, sex, and

race) from the NHANES I baseline data tapes were corrected for a small number of subjects based on updated

information received during the 1982–S4 NHANES I Epidemiologic Followup Study (NHEFS). Consequently, the

1982–84 Followup and the 19S6 Followup Public Use Data

Tapes, as will all subsequent NHEFS Followup Public Use

Data Tapes, reflect the corrections noted in this section.

Date of birth

Initially, the date of birth for each NHANES I respondent was recorded during the household interview and

subsequently coded on the NHANES I data tapes. The

household interview usually was conduct ed with one member (or more) of the household providing social and demographic information for all household members. The

NHANES I sample was then drawn from these household

listings. On arrival at the Mobile Examination Center

(MEC), the subject was asked to supply his or her date of

birth, which was entered on a record and later microfilmed.

The date of birth on the MEC record was provided by the

subject but was not coded on the NHANES I data tape.

Thus, the original NHANES I date of birth is the one

obtained during the household interview.

During the field work for the Followup Study, the

MEC record (when available) was used to update the date

of birth for all Iost-to-followup respondents in the hope that

it would improve tracing results. In addition, the MEC

record was used to update the date of birth for decedents

and incapacitated subjects who had been interviewed by

proxy. Date of birth information was also updated for all

confirmed respondents who, during tracing, supplied a date

of birth that differed from the date of birth provided at

baseline. As a result, date of birth information was corrected for 677 of the 14,407 subjects in the NHEFS cohort.

The age given at baseline examination was then recalculated based on these corrected dates of birth. The recalculations of age at baseline examination resulted in 224 age

changes of 1 year or more. For 31 respondents, recalculation resulted in ages outside the designated age range of

25–74 years (two subjects were determined to be 24 years

of age, 26 were 75 years of age, one was 76 years of age,

and two were 77 years of age). Nonetheless, these respondents will continue to be included in the cohort and are

treated as 25 and 74 years of age in cases in which age is

categorized. A cross-tabulation of the recalculated age at

baseline examination by the original age at examination is

presented below.

Revised age at btxeIine mina:ion

Originalage

atbareli))e 25-34 35-44 45-54 55-64 65-74

amninafion years yews yem yem yem

25-34 yeas . . . . . . . 3,508 l--

3S43yems . . . . . . . 1 %934

45-54 yea= . . . . . . . - – %26: 1; -

55-64 ye.ms . . . . . . . - - 3 I,sru 1

65-74 yam . . . . . . . – - – 5 3,852

Information on date of birth was collected if the respondent was administered the tracing questionnaire in the

1986 NHEFS. This information, though, was not used to

amend date of birth or the age at NHANES I variables

generated from data from the 19S2–84 NHEFS. In other

words, date of birth and the age at NHANES I variables

were not revised using data collected from the 1986

NHEFS. Furthermore, these variables will never be updated from any information collected from the 19S7

NHEFS or other followups of lhe NHEFS.

Sex

The baseline sex code was changed from female to

male for one subject. The original sex code was an error in

the NHANES I data set. This subject was not included in

the cohort of NHEFS subjects who were ages 55 years and

over at NHANES I.

Race

A revised race variable was created to resolve discrepancies between the baseline interviewer-observed race and

the followup respondent-reported race. These race codes

are determined on a case-by-case adjudication of baseline

and followup ethnicity responses and, in the case of deceased subjects, race as coded on the death certificate.

Race was changed for 186 subjects. A cross-tabulation of

revised race by the original baseline race variable follows.

(For a number of subjects, however, although race was

revised, baseline race and revised race still remain grouped

in the “Other” category.)

153
Revised race an interview in the 1982–84NHEFS. This information,

Bareline race W%ife Blark O:her however, was not used to amend the revised race variable

generated from data in the 1982–84 NHEFS. In other

White . . . . . . . . . . . . . . . . 11,998 30

Bkk. . . . . . . . . . . . . . . . 11

words, the revised race variable was not updated using data

21% 10

Other . . . . . . . . . . . . . . . . 27 132 collected from the 1986NHEFS. Furthermore, this variInformation on race of the subject was collected during able will never be updated from any information collected

the interview in the 1986 NHEFS if the subject did not have

in the 1987 NHEFS or other followups of the NHEFS.

154 i? U.S. GOVERNMENT PFilNTING OFFICE. 1990 – 26 I -195 /’2 Q Q Q 7
Vital and Health Statistics 

series descriptions 

SERIES 1. Programs and Collection Procedures-Reports describing 

the general programs of the National Center for Health 

Statistics and its offices and divisions and the data collection methods used. They also include definitions and 

other material necessary for understanding the data. 

SERIES 2. Data Evaluation and Methods Research--Studies of new 

statistical methodology including experimental tests of 

new survey methods, studies of vital statistics collection 

methods, new analytical techniques, objective evaluations 

of reliability of collected data, and contributions to 

statistical theory. Studies also include comparison of 

U.S. methodology with those of other countries. 

SERIES 3. Analytical and Epidemiological Studies-Reports presenting analytical or interpretive studies based on vItaI 

and health statistics, carrying the analysis further than 

the expository types of reports in the other series. 

SERIES 4. Documents and Committee Reports-Final reports of 

major committees concerned with vital and health statistics and documents such as recommended model vital 

registration laws and revised birth and death certificates. 

SERIES 5. Comparative International Vital and Health Statistics 

Reports-Analytical and descriptive reports comparing 

U.S. vital and health statistics with those of other countries. 

SERIES 6. Cognition and Survey Measurement-Reports from the 

National Laboratory for Collaborative Research in Cognition and Survey Measurement using methods of cognitive 

science to design, evaluate. and test survey instruments. 

SERIES 10. Data From the National Health Interview Survey-Stabstics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other 

health-related topics, all based on data collected in the 

continuing national household interview survey. 

SERIES 1 1. Data From the National Health Examination Survey and 

the National Health and Nutrition Examination SurveyData from direct examination, testing, and measurement 

of national samples of the civilian noninstitutionalized 

population provide the basis for (1) estimates of the 

medically defined prevalence of specific diseases In the 

United States and the distributions of the population 

with respect to physical, physiological, and psychological characteristics and (2) analysis of relationships 

among the various measurements without reference to 

an explicit finite universe of persons. 

SERIES 12. Data From the Institutionalized Population Surveys-Dlscontinued in 1975. Reports from these surveys are Included in Series 13. 

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

utilization of health manpower and facilities providing 

long-term care, ambulaton/ care, hospital care, and family 

planning services. 

SERIES 14. Data on Health Resources: Manpower and FacilitiesStatistics on the numbers, geographic distribution, and 

characteristics of health resources including physicians, 

dentists, nurses, other health occupations, hospitals, 

nursing homes, and outpatient facilities. 

SERIES 15 Data From Special Surveys-Statlstlcs on health and 

health-related topics collected In special surveys that 

are not a part of the contlnulng data systems of the 

NatIonal Center for Health Statistics 

SERIES 16 Compilations of Advance Data From Vital and Health 

Statistics-These reports provide early release of data 

from the National Center for Health Stattistlcs’ health and 

demographlc surveys. Many of these releases are followed 

by detalled reports In the VItaI and Health Statlstlcs 

Series. 

SERIES 20 Data on Mortality-Various stattstlcs on mortality other 

than as Included In regular annual or monthly reports. 

Special analyses by cause of death, age, and other demographic vanables; geographic and time senes analyses, 

and statlstlcs on characterlstlcs of deaths not avaIlable 

from the vltal records based on sample surveys of those 

records 

SERIES 21 Data on Natality, Marriage, and Divorce-Various statlstlcs on natality, marnage, and divorce other than as 

Included In regular annual or monthly reports. Special 

analyses by demographlc vanables; geographic and time 

senes analyses, studies of fertlllty; and stattstlcs on 

charactenstlcs of births not avaIlable from the vltal 

records based on sample surveys of those records. 

SERIES 22 Data From the National Mortality and Natality Surveys0 scontlrlued In 1975. Reports from these sample surveys 

ha.ed orb vltal recoros arc Included In Series 20 and 21, 

respectively. 

SERIES 23 Data From the National Survey of Family GrowthStatlstlcs on fertlllty, family formatIon and dlssolutlon, 

family planning, end related maternal and Infant health 

topics derived ‘ram a perlodlc survey of a natlonwlde 

probabtllty sample of women 15-44 years of age. 

SERIES 24 Compilations of Data on Natality, Mortality, Marriage, 

Divorce, and Induced Terminations of PregnancyAdvance reports of births. deaths, marnages. and divorces 

are based on flnal data from the NatIonal VItaI Statlstlcs 

System and are publtshed annually as supplements to the 

Monthly VItaI Statlstlcs Report (MVSR). These reports are 

followed by the publlcatton of detalled dara In VItaI Stailstics of the Unlted States annual volumes. Other reports 

lncludlng Induced termlnatlons of pregnancy Issued penodlcally as supplements to the MVSR provide selected 

fIndIngs based on data from the NatIonal Vital Statlstlcs 

System and may be followed by detailed reports In VItai 

and Health Statlstlcs Series. 

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

reports published in these series, contact: 

Scientific and Technical Information Branch 

National Center for Health Statistics 

Centers for Disease Control 

Public Health Service 

Hyattsville, Md. 20782 

301-436-8500 
U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Public Health Service 

Centers for Disease Control 

National Center for Health Statistics 

6525 Belcrest Road 

Hyattsville. MD 20782 

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