Vital and

Health Statistics

Data Systems of the

National Center for

Health Statistics

Series 1:

Programs and Collection Procedures

No, 23

The data collection program of the National Center

for Health Statistics during the 1980’s is described in

this report. The systems are grouped by the origin of

the data — the vital statistics registration system,

provider-based surveys, and population-based surveys,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

Hyattsville, Maryland

March 1989

DHHS Publication No. (PHS) 89-1325
Copyright information 

All matenal appeanng I” this report IS in the publlc domaln and may 

be reproduced or copled wIthout permlss!on, cltatlon as to source, 

however. IS appreciated 

Suggested citation 

Kovar MG. 1989. Data systems of the National Center for Health 

Statistics. NatIonal Center for Health Statlstlcs. Vital Health Stat 

l(23). 

Library of Congress Cataloging-in-Publication Data 

Kovar. Mary Grace 

Data systems of the Nattonal Center for Health Statlstlcs. 

(Vital 8 health statistics. Series 1. Programs 

and collection procedures ; no. 23) (DHHS publication ; 

no. (PHS) 89-l 325) 

“May 1988.” 

Includes bibliographies. 

Supt. of Dots. no.: HE 20.6209:1/23 

1. Nattonal Center for Health Statistics (U.S.) 

2. Public health-InformatIon services-United States. 

3. Health statistics-united States. I. National 

Center for Health Statwtics (U.S.) II. Title. 

III. Series: Vital and health statistics. Series 1, 

Programs and collection procedures ; no. 23. 

IV. Series: DHHS publlcatlon ; no. (PHS) 89-1325. 

[DNLM: 1. Data Collection-methods. 2. Health SurveysUnited States. W2 A N148va no.231 

RA409.U44 no. 23 362.1’0723 s 88-600479 

[RA407.3] [362.1 ‘07231 

ISBN 0-84Q6-0409-2 
National Center for Health Statistics

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

Robert A. Israel, Deputy LM-ecror

Jacob J. Feldman, Ph.D., Associate DirectorforAnaljwiis

and Eptiemio[ogy

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

Extramural R-ograms

Peter L. Hurley, Associate Director for VW and Health

Statistics Systems

Stephen E. Nieberdin& Associate Director for Management

Charles J. RothweU, Associate Director for Data Processing

and Sewices

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

and Methodology

Sandra S. Smith; Public A@ks Ojiker

Office of Vital and Health Statistics Systems

Peter J. Hurley, Associate Director

Mary Grace Kovar, Dr.P.H,, SpeciaZAssistant for Data

PoIicy and Ana@k

Gloria Kapantais, Assirtant to the Director for Data Poliqy,

Planning and Analysis
The data systems of the National Center for Health

Statistics offer many ways of looking at health. They also

offer a remarkable number of opportunities for research.

Because data are usually published from each system sepb

arately, the wide range of data from the Center is sometimes not apparent. The purpose of this publication is to

introduce people to the data systems, to suggest research

opportunities, and to indicate how NCHS data are made

available.

The data systems are used to obtain information from

people, from health care providers, and from vital records.

Each method has advantages and disadvantages Lbat become apparent only when the different methods are described together in one publication. For example, a person

knows the impact a disease has on his life but may not know

the precise diagnosis; the health care provider can give the

diagnosis but may know little about the impact. Both views

are needed if we are to understand the impact of disease on

people and on the health care system and if we are to try to

understand the etiology of disease.

People who are familiar only with some of the publications from the Center may be unaware that many items are

recorded and coded consistently on the different systems.

Age is always recorded in single years or by date of birth.

Education is recorded in single years. Race is included on

all the systems and, where possible, information on Hispanic ethnicity. Causes of death and diseases are coded to

the International Classification of Diseases. Most data

systems include codes for Census regions or divisions. The

vital statistics system includes codes for States that can be

combined to form regions or divisions. This consistency

makes it possible for research using data from several

systems.

People who are familiar with only one data system may

be unaware that complementary information can be obtained horn another system. Medical care is a good example. Almost all of the systems have some information about

medical care, whether it is care for a specific disease, during

pregnancy, within a year, during the last year of life, or in

specific kinds of medical-care settings.

This brief publication will introduce you to the systems

and the opportunities. My hope is that you will learn

enough here to give you ideas. You can then read the

reports describing each of the data systems to learn more.

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

Director

Iii
Contents

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

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

Confidentialit y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data release . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vital and Herdth Statistics Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,

Data systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vital Registration System and surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nationrd Vital Statistics System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%u-veys based on registration system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National Mortality FollowbackSurvey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1988 National Matemaland I.nfant Health Suxvey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Provider-based surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . .

National Health Care Survey ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National Master Facility Inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . .

National Hospital Discharge Sumey . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . .

National Ambulatory MediealCareSumey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National Nursing Home Smey... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Longitudinal studiesbasedon provider surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National Nursing Home SurveyFollowup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Population-based surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National Health Intemiew Survey . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National Medical Care Utilization andl%penditure Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National Health Examination Surveys and National Health and Nutrition Examination Suneys. . . . . . . . . . . . . . .

Hispanic Health and Nutrition Examination Sumey..., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

L.m@udinalstudi esbased onpopul ation surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NHANES I Epidemiologic Followup Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L.qgitudinal Study of Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data from more than one system... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

...

m

1

2

3

4

5

6

6

6

;

8

8

8

9

10

10

11

11

12

12

13

14

16

17

18

18

19

20

v
Data Systems of the

National Center for

Health Statistics

Mary Grace Kovar, Dr.P.H.,

Wal and Health Statistics Systems

Introduction

The National Center for Health Statistics is one of the

major Federal statistical organizations, It has legislative

authority to collect statistics on: (a) the extent and nature of

illness and disability in the United States, including life

expectanq, the incidence and prevalence of acute and

chronic illness and disability, and infant and maternal mortality and morbidity; (b) determinants of health; (c) health

resources; (d) use of health care resources, including use of

ambulatory semices, hospital care, nursing homes, and

other long-term care facilities; (e) health care costs and

financing; and (~ family formation, growth, and dissolution.

To carry out its mission, the Center conducts many

annual, periodic, and longitudinal surveys to produce a

wide range of health statistics. It obtains the records or

computer files from States and other registration areas to

publish the national data on vital statistics. It maintains an

inventory of health facilities.

This document is designed to provide a brief description of each of the data collection systems, some of the most

important information derived from the system, references

for readers who want more detailed descriptions, and the

means of releasing information through publications and

public-use data files.

1
Confidentiality

The data-collection activities of the National Center for

Health Statistics (NCHS) are subject to the provisions of

both the Privacy Act of 1974(5 U.S.C. 552a) and the Public

Health Service Act (42 U.S.C, 242m) and its confidentiality

provisions in section 308(d). The Privacy Act covers all

federally sponsored and operated data collection that involves the creation of systems of records containing personal identillers. Section 308(d) relates only to a limited

portion of Public Health Service activities.

In keeping wkh the requirements of the Privacy Act

and with NCHS policy, each individual, household, or

establishment asked to provide information is first informed:

( 1)

( 2)

( 3)

( 4)

Of the legal authorization for soliciting the information.

Of the principal purpose or purposes (usually statistical or research) for which the information is to be

used, and how it will be used.

That providing the requested information is voluntary.

Of the effect on the respondent, if any, of not providing all or any part of the information.

When vital statistics or other data are purchased, it is

done through contracts that include similar assurances.

Section 308(d) of the Public Health Service Act makes the

following provisions for data that the NCHS is authorized

to collect:

. That no data so obtained maybe used for any purpose

other than the stated purpose for which it was collected, and

. That such information may not be published or released in any form if the particular establishment or

person supplying the information or described in it is

identifiable unless the establishment or person has

consented to such publication or release.

Thus, the Center operates under strong laws that mandate protection of the confidentiality of records.

Almost all of the data mllected by or for the National

Center for Health Statistics are obtained under a pledge to

the respondent, whether an individual or an establishment,

Lhat the information will be used only for statistical purposes and that it will not be released in such a way that

any person, household, or facility can be identified. The

NCHS never releases identifiable information on individuals or households, Information is sometimes released on

facilities, but only when the facility administrators had been

advised when they provided the data as to what items of

information would not be amorded confidential treatment.

The NCHS Staff Manual on Conjidentialig presents

and explains in detail the confidentiality policies of the

Center and ways in which they are implemented.
Data release

The National Center for Health Statistics releases data

in many ways. The two major ways are through its own

1

publications and through public-use micro-data files.

A CahzZogof Publications of the National Center for

Health Statistics is published annually. A update of recent

NCHS publications is published quarterly.

A Catalog ofPublic Use Data Tapes from the National

Center for Health Statistics is published periodically. It

contains details about the files, including the number of

records, source of the data, variables on the file, technical

characteristics of the tape, documentation, ordering instructions, and other information to help people identi~

and acquire NCHS data tapes. The catalog is supplemented

by Data Tape Updates, a publication issued several times

throughout the year.

Advance Data From Vital and Health Statistics are brief

reports of newly available data on topics of special interest

from all of the surveys.

Monthly IZtalStaMcs Repotis provide monthly data on

births, marriages, divorces, and deaths based on provisional

data. Supplements provide annuaJ summaries, the first

release of the final data, and information on selected topics.

These publications are available from the Scientific and

Technical Information Branch of NCHS at no charge.

Individuals and organizations that ask to be placed on the

mailing list receive them routinely as they are issued.

All other publications are sold through the U.S. Government Printing OffIce to individuals and are mailed

without charge only to nonprofit libraries and selected

institutions that have asked to be placed on the mailing list.

The P7tcd and Health Statistics series reports are the

primary means of releasing information from and about the

surveys. They include reports from each of the data collection systems with detailed cross-tabulations of the data.

They also include reports on the design of the systems, ,1

reports with results of methodological research, and reports

from the U.S. National Committee on Vital and Health

Statistics

VitaZStatistics of the United States is the primary means

of releasing information from and about the vital statistics

registration system. The four volumes—one for natality,

two for mortality, and one for marriage and divorce—are

published annually and contain detailed cross-tabulations

I

of data on births, deaths, marriages, and divorces. They also

contain the technical information about the vital statistics

systems. Mortality, Part A, includes annual life tables,

which are also published separately as Vital Statistics of the

United States, L~e Tables.

Health, United States is the Secretary’s annual report to

the Congress that is prepared by NCHS. It cent ains information, especially time trends, from all of the NCHS data

systems (and from other sources) on health and use of and

expenditures for health services.

Data from NCHS are also released through other

Federal publications, such as the Statistical Abstract, which

is published by the U.S. Bureau of the Census, National

Nutritional Monitoring reports, published by the Departments of Agriculture and Health and Human Services, and

proceedings of workshops and conferences.

Special tabulations are prepared to meet data requests

that cannot be filled in any other way. When special tabulations are requested, the requestor is given a mst estimate.

In addition, people on the NCHS staff write articles

that are published as chapters in books or as articles in

professional journals. Most of the recent publications are

listed in the Catalog of Publications of the National Center

for Health Statistics.

Public-use data tapes are sold primaily through the

National Technical Information Service in Springfield, Virginia. However, some files are released by the program

where the data originated. They are noted in the description of the system in this report and in the Catalog of

Public-Use Data Tapes from the National Center for Health

Statistics.

All publications, special tabulations, and data files are

reviewed carefully to ensure that confidentiality is maintained.

For more information on the data systems, publications, and public-use data tapes, or to ask to be placed on

the mailing list, contact:

Scientific and Technical Information Branch

National Center for Health Statistics

3700 East-West Highway

Hyattsville, MD 20782

(301) 436-8500.

The Scientific and Technical Information Branch provides information and user services, including a public

inquiries program that provides published and unpublished

data and reference and referral services.

3
Vital and Health Statistics

Series

Series

Number

1

2

3

4

5

6

10

11

13

14

15

16

20

21

23

24

Content

Programs and Collection Procedures.

Data Evaluation and Methods Research.

Analytic and Epidemiological Studies.

Documents and Committee Reports.

Comparative International Vital and Health

Statistics Reports.

Cognition and Survey Measurement.

Data From the National Health Interview

Survey.

Data From the National Health Examination

Survey and Lhe National Health and Nutrition

Examination Survey, Including the Hispanic

Health and Nutrition Examination Survey.

Data on Health Resources Utilization.

Data on Health Resources: Manpower and Facilities.

Data From Special Surveys.

Compilations of Advnace Data From Health

and Demographic Surveys.

Data on Mortality.

Data on Natality, Marriage, and Divorce,

Data From the National Survey of Family

Growth,

Compilations of Data on Natality, Mortality,

Marriage, Divorce, and Induced Termination of

Pregnancy.
Data systems

Vital Registration System and surveys

Death registration system

Fetal death reporting system

Birth registration system

Marriage registration system

Divorce registration system

Abortion reporting system

Surveys based on the registration system

● National Mortality Followback Surveys

● National Maternal and Infant Health Survey (including

the National Natality Surveys and the National Fetal

Mortality Surveys)

Provider-based surveys

National Health Care Survey

National Master Facility Inventory

National Hospital Discharge Survey

National Nursing Home Sumey

National Ambulatory Medical Care Survey

Longitudinal sumey based on provider surveys:

● National Nursing Home Survey Followup

Population-based surveys

National Health Interview Survey

National Medical Care Utilization and Expenditure

Sumey

National Health and Nutrition Examination Surveys

(including the National Health Examination Surveys)

Hispanic Health and Nutrition Examination Survey

National Sumey of Family Growth

Longitudinal surveys based on population surveys:

● IWL%NES I Epidemiologic Followup Study

● Longitudinal Study of Aging
Vital Registration System and

surveys

National Vital Statistics System

●

●

●

●

●

●

●

●

Btihs-demographic, maternal, and infant health information.

Deaths-demographic characteristics of the decedent,

cause of death.

lhpectation of [~e–the average length of life remaining

at any given age.

Infmt motiality-demographic characteristics, cause of

death.

Fetal death-demographic, maternal, and medical

characteristics.

Induced tenninatiun of pregnanq-demographic, patient, and medical.

Midges-characteristics of the bride and groom and

of the ceremony.

Divomes—charactenstics of the husband and wife and

of the decree.

Through the National Vital Statistics System, the National Center for Health Statistics (NCHS) colleds and

publishes data on births, deaths, marriages, and divorces in

the United States. Fetal deaths are classified and tabulated

separately fkom other deaths. The Division of Vital Statistics obtains information on births and deaths from the

registration offices of all States, New York City, the District

of Columbia, Puerto Rico, the U.S. Virgin Islands, and

Guam. Geographic coverage for births and deaths has been

complete since 1933. Registration areas for marriages and

divorces were begun in 1957 and 1958, respectively. The

marriage-registration area (MRA) expanded horn 33

States in 1957 to 42 States and the District of Columbia in

1986, and the divorce-registration area (DIU) expanded

from 14 States in 1958 to 31 States and the District of

Columbia in 1986. (Puerto Rico and the U.S. Virgin Islands

have been in the MRA since. 1957 and the U.S. Virgin

Islands in the DRA since 1958.)

Undl 1972, microfilm copies of all birth, death, marriage, and divorce certificates were received from the registration areas and processed by NCHS. Beginning in 1972,

some States began sending their data to NCHS through the

Cooperative Health Statistics System (CHSS) on mmputer

tape. Currently, the data are sent to NCHS through the

Vital Statistics Cooperative Program (VSCP), following the

same procedures as the CHSS. The number of participating

States for birtis and deaths grew from 6 in 1972 to 46 in

1984; all 50 States and the Dis~ict of Columbia participated in the VSCP beginning in 1985. For marriages, 12

States have participated in the VSCP since 1977. For

divorces, there were eight States for 1977-83 and nine

States since 1984.

The standmd certillcates of birth, death, induced termination of pregnancy, fetal death, marriage, and divorce

recommended by NCHS are modified in each registration

area to seine the area’s needs. However, most certificates

6

conform closely in antent and arrangement to the standard

certificate.

In most areas, practically all births and deaths are

registered. The - .ost recent test of the completeness of

birth registration, conducted on a sample of births from

1964 to 1968, showed that 99.3 percent of all births in the

United States during that period were registered. No comparable information is available for deaths, but it is generally believed that death registration in the United States is

at least as complete as birth registration. Provisional death

rates by cause, age, race, and sex are estimated from the

Current Mortality Sample. The Current Mortality Sample

is a 10-percent systematic sample of death certificates

received each month in the vital statistics offices in the 50

States, the District of Columbia, and the independent

registration area of New York City. All death certificates

received during the l-month period are sampled regardless

of the month or year in which the death ocxurred.

Beginning WM data year 1984, information is available

on the usual owupation and industry of the decedent for 16

reporting States.

Beginning with data year 1988, infant mortality data

are avadable in files that link the characteristics of the

infant at death as reported on the death certificate with the

characteristics of We same infant at birth as reported on the

birth certificate in a linked file of infant deaths and live

births. This provides a resource for studying infant

mortality by the characteristics of the mother and the

infant at the time of birth.

Cause of death is coded according to the International

Classification of Diseases, which is promulgated by the

World Health Organization at the most detailed (fourdigit) level. Since 1968, information has been available for

both underlying and multiple causes of death.

Data are published in Viial Stahktks of the United

States (Volume I, Natality; Volume II, Parts A and B,

Mortality; and Volume III, Marriage and Divorce),

Monthly VW Statistics Repoits and its supplements, and in

Vial and Health Statistics (Mortality, Series 20; and Natrdity, Marriage, and Divorce, Series 21).

Sumeys based on registration

system

National Mortality Followback Survey

(NMFS)

● Mortality by socioeconomic factors

. Premature deaths

. Health care and cost of health care

. Comparisons with data on death certificates

The 1986 National Mortality Followback Survey was

the fifth in a series of surveys conducted by LheCenter. The

earlier surveys were based on deaths that occurred in 1961,

1962-63, 19&l-65, and 1%6-68.

The 1961 survey had a sample size of 5,154 and

information was obttined on the utilization of hospitals and

institutions during the last year of the decedent’s life.
From the 1962-63 survey, with a sample size of 10,822,

data were obtained on household composition, education,

income, and residence of the decedent in addition to utilization of hospitals and institutions in the last year of life.

The 1964-66 survey of persons 35 years of age or over had

a sample size of 10,408 and covered the following topics:

utilization, hospital and surgical insurance coverage,

charges for hospital care and source of payment, surgeons’

bills and source of payment, household composition, and

assets and income.

The 1966-68 survey of persons 35-84 years of age had

a sample size of 19,526, and information was obtained on

utilization, family composition, and smoking habits. A

public-use data tape is available for the 1966-68 survey.

The 1986 NMFS was based on a sample of 18,500

death certificates of persons ages 25 years and over who

died in the United States in 1986. The next of kin identified

on the death certificate, or some other knowledgeable

informant, was the respondent. The survey was designed to

supplement the information on the death certificate.

Information was also obtained om

. Socioeconomic status, including family income

● Assets

● Education

. Use of health care resources in the last year of life

● Disability prior to death

● Health habits such as smoking and drinking alcoholic

beverages

The 1986 data collection was conducted in quarterly phases

by the U.S. Bureau of the Census, with questionnaires

mailed approximately 6-8 months after the sample person’s

death. Cases that did not respond after two mailings of the

questionnaire were sent to the field for followup by telephone or personal visit.

A major purpose of the 1986 NMFS was to examine

the reliability of items reported on the death certificate by

mmparing these items with the same items reported by the

survey respondent. Items to be compared included age,

race, veteran status, and oaupation and industry.

Although all 50 States granted their approval for use of

a sample of their death certificates in the NNH?S,Oregon is

not included in the NMl?S.

There was also a facility phase of the 1986 NMFS. It

involved mailing a Facility Abstract Record (FAR) to those

health facilities in which a decedent had spent at least one

night during the year prior to death. The FAR was used to

obtain the admission date, discharge date, diagnoses, and

procedures for each facility stay.

A public-use data tape from the next-of-kin or informant questionnaire was released in January 1989. A

public-use data tape that adds information horn the facility

phase of the NMFS should be available in late 1989.

Data will be published in Vital and Health Statistics,

Series 20.

1988 National Maternal and Infant Heafth

Survey (NMIHS)

. Information not on the vital records

. Fetal death ratios, pennatal mortality rates, and neonatal and postnecmatal mortali~ rates

. Demands on maternal and infant health delivery systems

. Evaluation of the quality and completeness of information on vital records

. Trends using data from previous followback surveys

The 1988 National Maternal and Infant Health Survey

(NMIHS) is the most recent of a series of related surveys.

The earlier related surveys include the National Mortality

Followback Surveys (1961-68, 1986), the National Natality

Followback Surveys (1963, 1964-66, 1967-69,1972, 1980),

the National Fetal Mortality Survey (1980), and the

Nationaf Infant Mortality Sumey (1964-66). The 1988

National Maternal and Infant Health Survey inmrporates

components from all of Lhese earlier surveys.

The 1988 NMIHS consists of three components: a

natality swey based on 10,000 certificates of live birth, a

fetal mortality survey based on 4,000 reports of fetal death,

and an infant morta.li~ survey based on 6,000 infant death

certificates, Black persons were oversampled in all three

components such that one-half of the infants are black. Low

birth weight and very low birth weight infants were oversampled in the natality component. The areas of investigation included causes of low birth weight and infant death;

barriers and facilitators to prenatal care; the effects of

maternal smokin~ marijuana and mcaine use, and drinking

on pregnanq outcome; the effects of sexually transmitted

diseases (including AIDS) on pregnancy outcome; and use

and evaluation of public programs, such as WC and

Medicaid, by mothers and infants. The 20,000 mothers

(married and unmarried) named on vital records were

contacted by mail, telephone, and/or personal interview.

Mothers were asked to ident~ all providers of health care

for their pregnancy and delivery, and to sign a consent

statement releasing their medical information. This consent

statement was used to obtain medical data about the

mothers and infants from the hospitals where they delivered their infants and where they and their infants were

hospitalized up to 6 months after delivery. Chronic disease

information, as well as medical procedures and diagnoses,

was obtained in both written form and in ICD-9. Prenatal

care providers were also contacted for information. A total

of 60,000 respondents were contacted (20,000 mothers,

20,000 hospitals, and 20,000 prenatal care providers). The

U.S. Bureau of the Census is the NMIHS data collection

contractor.
Provider-based surveys

National Health Care Survey

Inforrnallon

CMecled AtFIIWWIt In Mum

DlsctIaqas from — HosPilak + Ambulatorysurge~

Diagnoses facwes

Procedures

Lengthof slay

V&ns10 — Physlclans’ + Hospllalemergencyand

Dlegnoses ouipalkmfdeparimenb

Procedures

Drugs

Referrals

Palk3nlsof — Nutwlng + Hospkas and homa-heallh

Dlagnosas homes agencies

Funclbnal slalus

Servkee provldad

During the past decade, notable changes in the health

care delivery system have taken place. Legislation, the

desire to avoid institutionalization, and the development of

new medical techniques have led to a shift from inpatient to

outpatient, ambulatory, and home settings. The Federal

Government implemented the prospective payment system

in 1983. Private insurance companies followed suit and

changed reimbursement policies. Federal programs and

private insurance for long-term and catastrophic care are

being developed. New initiatives to provide long-term care

at home are being implemented. New facilities, and new

ways of providing care, have been developed to address

these health care markets.

In an effort to meet the data needs of a new health care

environment, the NCHS plans to integrate the providerbased surveys and expand them into the National Heakh

Care Survey (NHcS). The goals of the NHCS are to

expand data collection into alternative health care settings,

provide greater analytical capabilities by use of an integrated cluster sample, establish annual data dleetion for

each health care settin~ and provide for patient followup

studies.

●

●

●

✘

The NHCS lm.sfive basic components.

The Health Rovk?er Inventoy Component is based on

the NationaJ Master Facility Inventory. The inventory

now provides national data on facilities and is the

sampling frame for the National Hospital Discharge

Survey (NHDS) and the National Nursing Home Survey (NNHS). It is to be expanded to include providers

of ambulatory acute care and community-based longterm care.

lle Hospital and Suigical Care Component is based on

the National Hospital Discharge Sumey. This component will be enlarged to include outpatient surgixd

units and free-standing surgicenters in the survey.

l%e Ambulatory Cam Component has as its base the

National Ambulatory Medical Care Survey. This component is to be expanded initially to include hospitalbased physicians providing medical care in hospital

emergerq rooms, outpatient departments, and clinics.

When fully implemented, this component will also

cover ambulatory care provided in other settings, such

as health clinics.

l%e Long-Tam Cm Component will be based on the

National Nursing Home Survey. This survey will be

restructured and expanded to include health agencies

and hospices. The Long-Term Care Component will

provide data from smaller annual sumeys instead of

periodic surveys with larger samples.

l%e Pczient Follow-on Component, an important feature planned for the Nation~ Health Care-Sumey, will

provide information on outcomes of patient care and

subsequent use of care through periodic wntacts with

patients or patients’ families. Information on subsequent treatment, outcome of treatment, and change in

health status will be gathered either from the patient or

from the family of the patient. Data horn the followup

will be useful in assessing the utilization and financing

of health care and in developing profiles of care.

The National Health Care Survey utilizes a cluster

sample design. Providers are to be sampled from the same

geographic areas used for the National Health Interview

Survey. This cluster design has several advantages. It will be

possible to stratify areas by their characteristics, such as

income or availability of services, and to study the relationship between health care use and health status indicators

within such strata. It will also provide the opportunity for

producing statistics for some local areas, data which the

current health care surveys were not designed to produce.

The NHCS will be implemented over a period of years

as resources permit. The IWLDS was inmrporated into the

new design in 1988, with expansion to surgicenters scheduled for the early 1990’s. In 1989, the Ambulatory Care

Component will begin the office-based physician survey on

a continuing basis and, in 1990, will pretest the inclusion of

hospital outpatient clinics and emergenq rooms. It is

planned that all components of the NHCS will be conducted annually by 1993.

Data release

Many of the repxts in Series 13, such as the annual

summary of hospital discharge data will continue. However, new reports, covering health care in all settings in

each component can be anticipated. For example, a reymt

may present statistics on all aspects of long-term care

including, but not limited to, nursing homes. Aother

report may provide data on surgical procedures, regardless

of where they are performed.

National Master Facility Inventory

. Number of facilities

. Geographic spread and concentration

. Characteristics of facilities
The National Master Facility Iiwentory (NMFI) is a

comprehensive file of inpatient health facilities in the

United States. The three broad categories of facilities in the

NMFI are hospitals, nursing and related care homes, and

other custodial or remedial care facilities. To be included in

NMFI, hospitals must have at least six inpatient beds, and

nursing and related care homes must have at least three

inpatient beds.

The NMFI is kept current by the periodic addition of

names and addresses obtained from State licensing and

other agencies for all newly established inpatient facilities.

In addition, annual surveys of hospitals and periodic surveys of nursing homes and other facilities are conducted to

update name and location, type of business, number of

beds, and number of residents or patients in the facilities,

and to identi~ those facilities that have gone out of business.

From 1968 through 1975, the hospital survey was

conducted in conjunction with the American Hospital Association (AHA) Annual Survey of Hospitals. AHA performed the data collection for its member hospitals, and the

National Center for Health Statistics (NCHS) collected the

data for the approximately 400 non-AHA registered hospitals. Since 1976, however, all of the data collection has been

performed by AHA.

Hospitals are requested to report data for the full year

ending September 30. More than half of Lhe responding

hospitals used this reporting period for the 1982 survey.

The remaining hospitals used various other reporting periods. The response rate for the 1982 hospital survey was

about 90 percent.

The nursing home and other facilities sumey was conducted by NCHS in 1963, 1967, 1969, 1971, 1973, ~976,

1978, 1980, 1982, and 1986. In the 1980 and 1982 NMFI

surveys, only nursing and related care homes were revered.

In 1986, nursing and related care homes and facilities for

the mentally retarded were covered, and the survey was

called the Inventory of Long-Term Care Places. NCHS

surveyed certain types of homes that were excluded from

the State surveys.

Statistics derived from the hospital and nursing home

and other facilities surveys were adjusted for both facility

and item nonresponse. Missing items on the questionnaire

were imputed, when possible, by using information reported by the same facility in a previous survey. When data

were not available from a previous survey for a responding

facility, the data were imputed by using data from similar

responding facilities. Similar facilities are defined as those

with the same types of business, ownership, service, and

approximately the same bed size.

For more detailed information, see:

● National Center for Health Statistics, D. A. Roper.

1986. Nursing and related care homes as reported from

the 1982 NMFI survey. Vital and Health Statistics.

Series 14, No. 32. DHHS Pub. No. (PHS) 86-1827.

Public Health Service. Washington: U.S. Government

Printing Office.

. National Center for Health Statistics, A. Sirrocm

1987. The 1986 Invento~ of Long-Term Care Places:

h ovemiew of facilities for the mentally retarded.

Advance Data From Eta) and Health Statistics. No. 143.

DHHS Pub. No. (PHS) 87-1250. Public Health Sewice. Hyattsville, Md.

Data are published in Vitaland HeaZth Statistics,

Series 14.

National Hospital Discharge Survey

(NHDS)

● ‘Nventy-year trends in hospital discharges

● Diagnoses and multiple diagnoses

● Procedures and multiple procedures

● Average length of stay

The National Hospital Discharge Survey is a continuing nationtvide sample survey of short-stay hospitals in the

United States that has been conducted since 1965. The

scope of the survey encompasses patients discharged from

noninstitutional hospitals, excluding Federal hospitals, located in the 50 States and the District of Columbia. Only

hospitals having six beds or more for patient use and those

in which the average length of stay for all patients is less

than 30 days are included in Lhe survey.

The sample was selected from a frame of all (about

7,500) short-stay non-Federal hospitals in the United

States. A stratified sample design is used; hospitals are

stratified according to bed size and geographic location,

The probability of selection of a hospital decreases as the

bed size of the hospital decreases. Within each sample

hospital, a systematic random sample of discharges is selected from the daily discharge listing sheet. The withinhospital sampling ratio for selecting discharges varies

inversely with the probability of selection of the hospital, so

that the overall probability of selecting a discharge is

approximately the same in each bed-size class.

Hospitals in the survey use an abstract form to transcribe data from the face sheet of hospital ramrds. Forms

are completed either by hospital staff or representatives of

the National Center for Health Statistics.

In 1985, for the first time, an additional data mllection

procedure was used for the survey. A automated method,

used in approximately 17 percent of the sample hospitals,

involved the purchase of data tapes from commercial abstracting services. For hospitals using the automated system, tapes containing machine-readable medical record

data were purchased from commercial abstracting services.

The basic unit of estimation for the survey is the

sample patient abstract. The estimation procedure involves

inflation by the reciprocal of the probability of selection,

adjustment for nonresponding hospitals and missing abstracts, and ratio adjustments to freed totals. Of the hospitals selected for the survey, 493 were within the smpe of the

survey in 1986, and 418 participated in the survey in 1982.

Data were abstracted from about 193,000 medical records.

9
For more detailed information on the design of the

sumey and the magnitude of sampling errors associated

with the estimates, see:

. National Center for Health Statistics, E. J. Graves.

1988. Utilization of short-stay hospitals: Annual Summary, United States, 1986. Vital and HeaJth Statistics.

Series 13, No. 96. DHHS Pub. No. (PHS) 88-1757.

Public Health Serviee. Washington: U.S. Government

Printing Office.

Data are published in Mtal and Health Sfatirtics,

Series 13.

NationalAmbulatoryMedical Care

Survey (NAMCS)

w Visits to office-based physicians

● Physicians’ diagnoses

● Patients’ symptoms

. Drugs prescribed

● Referrals

The National Ambulatory Medical Care Survey is a

national probability sample of ambulatory medical encounters. The scope of the sumey covers physician-patient encounters in the offices of non-Federally employed

physicians classified by the American Medical Association

or American Osteopathic Association as “office-based, patient care” physicians. Visits to hospital-based physicians;

visits to specialists in anesthesiology, pathology, and radiology; visits to physicians who are principrdly engaged in

teachin~ research, or administration; telephone contacts;

and non-office visits are excluded from the survey.

A multistage probability design is employed. The firststage sample consists of 112 primary sampling units

(PSU’S) selected from about 1,900 such units into which

the United States has been divided. In each sample PSU, a

sample of practicing physicians is seleeted. The final stage

involves selection within a randomly assigned 7-day reporting period and the selection of samples of patient visits

during that period.

The NAMCS was conducted annually from 1974

through 1981 with samples of about 3,000 physicians each

year, The sumey was ecmducted again in 1985.

For the 1985 survey, a sample of 5,032 non-Federal,

office-based physicians was selected from masterfiles maintained by the American Medical Association and the Ameriean Osteopathic Association. The physician response rate

for 1985 was 70.2 pereent, providing data ecmcerning a

random sample of about 71,594 patient visits.

The next cycle of the NAMCS is scheduled for 1989

with a sample of 2,500 physicians. Plans are to conduct the

NAMCS annually thereafter and to include visits to hospital outpatient departments beginning in 1991.

The estimation procedure basically has three components: inflation by the reciprocal of the probability of

selection, adjustment for nonresponse, and ratio adjustment to fixed totals.

For more detailed information on the design of the

survey and the magnitude of sampling errors associated

with the estimates, see:

. National Center for Health Statistics, T. McLemore

and J. DeLmzier. 1987. 1985 summary, National Ambulatory Medical Care Survey. Advance Data From

Vital and Health MztMcs. No. 128. DHHS Pub. No.

(PHS) 87-1250. Public Health Service. Hyattsville, Md,

Data are published in Vital and Health Statistics,

Series 13.

National Nursing Home Suwey

(NNHS)

. The number of residents of nursing homes

. Functional status of residents

. People discharged from nursing homes

● Characteristics of the nursing homes

. Expenditures of nursing homes

Three sample surveys were ecmducted by the National

Center for Health Statistics to obtain information on nursing homes, their expenditures, residents, staff, and, in the

recent surveys, discharged patients. The first survey was

conducted from August 1973 through April 1974. The

second survey was conducted from May through December

1977. The most recent survey was eanducted from August

1985 through January 1986.

Data on facilities were collected by personal interviews

with administrators; facility accountants completed questionnaires on expenditures. Resident data were collected by

personal interviews with a nurse familiar with the care

provided to the resident. The nurse relied on the medical

record and personal knowledge of the resident. Employees

completed self-administered questionnaires. Discharge

data were based on information recorded in the medical

reeord. Additional data about the current and discharged

residents were obtained by telephone interviews with next

of kin.

For the survey wnducted in 1973-74, the universe

included only those nursing homes that provided some level

of nursing care. Thus, homes providing only personal or

domiciliary care were excluded. The sample of 2,118 homes

was selected from the 17,685 homes that provided some

level of nursing care and were listed in the 1971 National

Master Facility Inventory or from those that opened for

business in 1972. Data were obtained from 1,908 facilities,

about 20,620 staff, and 19,013 residents. Response rates

were 97 percent for facilities, 88 percent for expenditures,

98 percent for residents, and 82 percent for staff.

The scope of the 1977 survey encompassed all types of

nursing homes, including personal care and domiciliary

care homes. The sample of 1,698 facilities was selected

from 23,105 nursing homes in the sampling frame, which

consisted of all homes listed in the 1973 National Master

Facility Inventory (NMFI) and those opening for business

between 1973 and December 1976. Data were obtained

horn 1,451 facilities, about 13,634 staff, 7,033 residents,

10
and 5,142 discharged residents. Response rates were 95

percent for facilities, 85 percent for expenses, 81 percent

for staff, 99 percent for residents, and 97 percent for

discharges.

The scope of the 1985 NNHS was similar in that it

included all types of nursing homes, The sample of 1,220

homes was selected from a sampling frame of 20,479

nursing and related-care homes. The frame consisted of all

homes in the 1982 NMFf, homes identified in the 1982

Complement Survey of the NMFI as missing from the 1982

NMFI, facilities that opened for business between 1982 and

June 1984, and hospital-based nursing homes obtained

from the Health Care Financing Administration. Data were

obtained from about 1,079 facilities, 2)763 registered

nurses, 5,243 current residents, and 6,023 discharges. Response rates were 93 percent for facilities, 68 percent for

expenses, 80 percent for registered nurses, 97 percent for

residents, 95 percent for discharges, and 90 percent for next

of kin.

Statistics from NNHS are derived by a ratio-estimating

procedure. Statistics are adjusted for failure of a home to

respond, failure to fill out one of the questionnaires, and

failure to complete an item on a questionnaire.

For more information on the 1973-74 and 1977 surveys, see:

. National Center for Health Statistics, M. R. Meiners.

1975. Selected operating and financial characteristics of

nursing homes, United States, 1973-74 National Nursing Home Sumey. Vital and Health Statistics. Series 13,

No. 22. DHEW Pub. No. (HR4) 76-1773. Health

Resources Administration. Washington: U.S. GovernmentPrinting Office,

● National Center for Health Statistics, J. F. Van

Nostrand, A. Zappolo, E. Hing, et al. 1979. The Nationrd Nursing Home Survey, 1977 Summary for the

United States. Vital and Health Statistics. Series 13, No.

43, DHHS Pub. No. (PHS) 79-1794. Public Health

Service. Washington: U.S. Government Printing Office.

For more information on the 1985 survey see

. National Center for Health Statistics, E, Hing, E.

Sekscenski, and G. Strahan. 1989. The National Nursing Home Survey; 1985 summary for the United States.

Vital and Health Statistics. Series 13, No. 97. DHHS

Pub. No. (PHS) 89-1758, Public Heakh Service. Washington: U.S. Government Printing Office.

Data are published in Vitaland Health Statistics,

Series 13.

Longitudinal studies based on

provider surveys

National Nursing Home Survey Followup

. Nursing home utilization patterns

. Estimates of length of stay

. Change in payment sources

. Reasons for admission

The National Nursing Home Survey Followup was

designed to collect information on patterns of nursing

home and hospital use, particularly among the elderly. The

followup builds on the information collected in the 1985

National Nursing Home Sumey. Data from this survey

included information on the characteristics and nursing

staffs of a representative sample of long-term care facilities,

on the residents who were living in the facilities at the time

of the facility contact, and on those who had been discharged during the 12 months prior to the facility untact,

To supplement the information gathered on current and

discharged residents, a next-of-kin component was designed to obtain data that were not readily available from

the nursing facilities, such as information on the subject’s

health during the period immediately preceding the nursing

home admission and information on previous nursing home

utilization. The followup collects additional information on

the flow of the sampled residents in and out of long-term

care facilities and hospitals. These utilization profiles can

then be examined in relation to information on the facilities

and the residents that was obtained at the baseline 1985

National Nursing Home Survey.

The National Nursing Home Suwey Followup extends

the period of observation of these utilization patterns by

18-24 months. Information is obtained on the use of

nursing homes and hospitals since the last contact. Respondents for all subjects not known to be deceased at the time

of the National Nursing Home Survey were interviewed in

1987 (approximately 6,000 cases). ~espondents for the

surviving cohort members were recontacted in the summer

of 1988. The interviews are conducted using mmputerassisted telephone interviewing and the questionnaire includes questions concerning vital status, nursing home and

hospital utilization since the last amtact, current living

arrangements, and source of payment.

Study schedule

National Nursing Home Survey (Baseline): 1985

Natiunal Nursing Home Survey Followup, Wave 1:

1987

National Nursing Home Survey Followup, Wave 2:

1988

11
Population-based surveys

National Health Interview Survey ‘

(NHiS)

Every year the NHIS provides data on:

Doctor visits and hospital stays

Chronic and acute conditions

Health status indicators

Limitation of activities

kjuries and impairments

Work-loss and school-loss days

Selected current topics are

Health promotion and disease prevention

Knowledge of and attitudes toward AIDS

Smoking

Health insurance

Cancer risk factors

Child health

Aging

The National Health Intemiew Survey is a mntinuing

nationwide sample survey in which data are collected on the

incidence of acute illness and injuries, the prevalence of

chronic wnditions and impairments, the extent of disability,

the utilization of health care semices, and other health

related topics. The NHIS data have been collected through

personal interviews with household members by U.S. Bureau of the Census interviewers since the survey’s inception

in 1957. The questionnaires consist of two parts: (1) a set of

basic health and demographic items, and (2) one or more

sets of questions on current health topics.

The sampling plan of the NHIS follows a multistage

probability design that permits continuous sampling of the

civilian noninstitutic~alized population residing in the

United States. The survey is designed in such away that the

sample scheduled for each week is representative of the

target population, and the weekly samples are additive over

time. The res~nse rate has been around 96 percent in

recent years.

The NI-ItS sample redesign for the years 1985-94

included several important changes from the previous design. The sample was changed to be an area sample, The

number of primary sampling units (PSU’S) was reduced

from 376 to 198 for sampling efficiency. The PSU’S with

predominantly black populations were oversampkd to increase the praision of estimates for that population. The

total sample of PSU’S was divided into four panels, each of

which is representative of the U.S. population, to allow for

flexibility in total sample size without compromising the

estimates. This sample design facilitates followup studies

and provides a sampling frame for other NCHS surveys.

(See National Survey of Family Growth.)

An NkHS sample for a typical data year consists of

approximately 7,500 segments containing about 59,000 assigned households: Of bese households, approximately

10,000 are expected to be vacant, demolished, or occupied

by persons not in the target population of the survey. The

expected sample-size of 49,000 occupied households yields

a probability sample of about 122,000 persons.

Basic health and demographic items

From the basic health and demographic items on the

questionnaire, national estimates are produced annually

on:

. Disability days, including restricted activity and bed

disability days, and work-loss and school-loss days

. Physician visits in a 2-week and 12-month reference

period

. Acute and chronic conditions responsible for these

disability days and physician visits

. Lbng-term limitation of activity resulting from chronic

disease or impairments and the associated conditions

. Episodes of short hospital stays in the past year

. Demographic characteristics of the household, including information for linkage to the National Death Index

Current health topics

Questionnaires on current health topics change each

year in response to the need for data on special topics.

Examples of current health topics from recent years include

alcohol use, child health, dental care, health insurance,

cancer risk factors, vitamin and mineral use, knowledge of

and attitudes toward AIDS, health promotion and disease

prevention, issues related to aging, functional limitations,

polio survivors, adoption, medical device implants, and

occupational health.

Targeted population surveys (TPS) are followup studies of NHIS respondents who report specific conditions at

the time of the household interview or represent a certain

demographic characteristic. Examples of TPS are the PostPolio Survival Suwey, an epidemiologic study of 800 persons identified during the 1987 NHIS as being at risk for

post-polio syndrome, and the Work Injury Followback

Survey, a followback study of about 200 persons reporting

occupational injuries during the 2-week reference period

prior to the NHIS interview.

Suggestions and requests for current health topics and

targeted population surveys are solicited and received from

sources in both the private and public health sedors. Topics

are selected after consultation with agencies within the

Public Health Service and after an assessment of priority

health issues and the need for population-based data,

For a description of the survey design and procedures

through 1984, see

. National Center for Health Statistics, M. G. Kovarand

G. S. Poe. 1985. The National Health Interview Survey

Design, 1973-84, and Procedures, 1975–83. Vital and

Health Statistics. Series 1, No. 18. DHHS Pub. No.

(PHS) 85-1320. Public Health Service. Washington:

U.S. Government Printing Office.

12
For a description of the survey design implemented in

1985, see:

. National Center for Health Statistics, A. J. Moss aud

V. L. Parsons. 1986. Current estimates from the National Health Interview Survey, United States, 1985.

Pitd and HeaZth Statistics. Series 10, No. 160. DHHS

Pub. No. (PHS) 86-1588. Public Health Service. Washington: U.S. Government Printing Office.

Data are published primarily in Vitaland Health Statistics, Series 10. Public-use data tapes for the basic health

and demo~aphic questionnaire are available through the

National Technical Information Service. Public-use data

tapes for current health topics and targeted population

surveys may be ordered through the Director of the Division of Health Interview Statistics, 3700 East-West Highway, Room 2-44, Hyattsville, MD 20782.

National Medical Care Utilization

and Expenditure Survey (NMCUES)

● Use of medical services

. Charges for medical semices

● Sources of payment for medical services

● Health insurance coverage

. Access to medical care

● Conditions

The National Medical Care Utilization and Expenditure Survey was conducted in 1980 and early 1981 by the

National Center for Health Statistics and the Health Care

Financing Administration.

Data were collected on health, access to and use of

medical services, associated charges and sources of payment, and health insurance coverage for the civilian noninstitutionalized population. Data for the year 1980 were

collected in five rounds of interviews conducted at approximately 3-month intervals during 14 months of 1980-81.

The data were obtained for the full 12 months of 1980 or

for the proportion of the year that the sample persons were

part of the U.S. civilian noninstitutionalized population.

The survey consisted of three components: the National

Household Survey, the State Medicaid Household Survey,

and the Administrative Records Survey.

The National Household component included 17,123

sample persons in 6,600 participating reporting units. A

reporting unit was defined as all persons related to each

other by blood, marriage, adoption, or foster-care status

and living in the same housing unit or group quarters.

Persons living in institutions, active members of the Armed

Forces, and persons residing outside the United States were

not eligible for the sample. All persons living in the housing

unit or group quarters at the time of the first interviewer

contact were included in the survey.

In addition, unmarried students 17–22 years of age

who lived away from home were included if their parent or

guardian was included. Also, relatives who moved in from

outside the original population (that is, from an institution

or from the &me-d Forces) were included in the sumey.

The State Medicaid household component included

11,600 sample persons in 4,800 reporting units. The sample

was selected from the Medicaid eligibility files in California,

Michigan, New York, and Texas (1,200 per State). This

sample also excluded persons living in institutions, active

members of the Armed Forces, and persons residing outside the United States. Information was obtained for sample persons in the household. The administrative records

component was used to obtain information concerning

program eligibility and payments for medical care for persons receiving Medicare and Medicaid benefits.

The household and the family tapes are two public-use

data tapes that contain data from NMCUES and are

available from the National Technical Information Services.

The NMCUES household public-use tapes consist of six

files: the person, medical visit, dental visit, hospital stay,

prescribed medicines and other medical expenses, and

condition files. The person file has one record for each of

the 17,123 eligible persons. There are data describing the

person’s demographic characteristics, health care coverage,

employment, income, and usual source of canq number of

visits, hospital admissions, and other medical events reported for 1980; total charges for each category of care; and

limitations and disabilities (including identification of conditions). Data from the other five files, which have more

detailed information about events summarized in the person file, can be linked to remrds in the person file through

a unique identification number assigned to each persm.

In addition to the household public-use tapes, family

public-use tapes were constructed. The national household

sample enmmpassed approximately 6,8CQ families. Because NMCUES is a panel survey (it uwers an entire yew

with a series of four or five interviews), the mncept of

longitudinal family was developed to deal with the fact that

the composition of a family can change over time and that

families came into existence and went out of existence over

the year.

The NMCUES family public-use data tapes include

one reard for each family interviewed. Each remrd includes information on the family as a social unit, the head

of the family, the spouse of the head of the family, health

status and health conditions, use of health services, health

insurance coverage, socioeconomic and sociodemographic

data, and out-of-pocket and total expenditures for health

care. Records from the family public-use tape can be linked

to records from the person file through unique family

identification numbers found on each record.

Data from the NMCUES are published in three speckd

series of reports. There are Methodological Reprts (Series

A), Descriptive Reports (Series B), and Amlytical Reports

(Series C).

A more detailed description of NMCUES is in:

Bonham, G. S. 1983. Rocedures and Questionnaires of the

National Medical Care Utikztion and Eqenditure Survey.

National Medical Care Utilization and Expenditure Survey.

Series A, Methodological Report No. 1. DHHS Pub. No.

13
83-20001. National Center for Health Statistics, Public

Health Service. Washington: U.S. Government Printing

Office.

A detailed discussion of the concept of longitudinal

family is in: Dicker, M., and Sunshine, J. H. 1987. FamiZy

Use of Health Care: United States 1980. National Medical

Care Utilization and Expenditure Survey. Series B,

Descriptive Report No. 10. DHHS Pub. No. 87-20210.

National Center for Health Statistics, Public Health

Service. Washington: U.S. Government Printing Office.

National Health Examination

Surveys and National Health and

Nutrition Examination Surveys

(NHANES)

Heart disease

Asthma, chronic bronchitis, emphysema

Diabetes

Kidney disease and other urologic disorders

Gallbladder disease

Osteoporosis

Arthritis

Infectious disease

Dental caries and periodontal disease

Allergies

Depression

Hearing loss

Iron deficiency anemia and other nutritional

conditions

Obesity

The National Health and Nutrition Examination Surveys are designed to assess the health and nutritional status

of adults and children in the United States through interviews and direct physical examinations. The detailed interview includes demographic, socioeconomic, dietary,

and health-related questions. The examination wmponent

ansists of medical and dental examinations, physiological

measurements, and laboratory tests administered by highly

trained medical personnel in mobile examination centers.

The data are used to estimate the prevalence of major

diseases, nutritiomd disorders, and potential risk factors.

The data are also the basis for national standards for such

measurements as height, weight, and blood pressure. Data

are used in epidemiologic and health sciences research to

direct and design health programs and services.

Five surveys have been completed in this program, and

a sixth is being umducted in 1988-94. The years of data

collection for these surveys and the age ranges covered by

each are listed below.

National HeaJth Examination Sumeys:

Yae.m survey Age rangeOrsample

19ao-62 NHES I la-79 years

196s-66 NHES II 6-11 years

1W3-70 NHES Ill 12-17 years

National Health and Nutrition Examination Surveys:

Yaws Sulwy Age range of sample

?971-74 NHANES I 1–74 years

1974-75 NHANES I Augmenlakon 26-74 years

197E-aO NHANES II 6 months-74 yeare

19SS+4 NHANES Ill 2 monlhs and older

Health Examination Surveys (NHES)

The National Health Examination Surveys were nationwide sample surveys in which data for determining the

health status of the population were collected through

direct standardized physical examinations, clinical and laboratory tests, and measurements. Three were conducted in

the 1960’s.

For the first cycle of the National Health Examination

Survey (NHES I), ccmducted in 1960-62, a sample of 7,710

adults, of whom 86.5 percent were examined, was selected

to represent the civilian noninstitutionalized adults 18-79

years of age.

In the second cycle of the National Health Examination

Survey (NHES II), amducted in 1963-65, a sample of

7,417 children 6-11 years of age, of whom 96 percent were

examined, was selected.

In the third program (or cycle) of the National Health

Examination Survey (NHES III), conducted in 1966-70,

data were collected on children 12–17 years of age. There

was also a longitudinal component because some of the

children examined in cycle II were also examined in cycle

III. A sample of 7,514 youths, of whom 90 percent were

examined, was selected.

Health and Nutrition Examination Surveys

(NHANES)

In 1971, a nutrition surveillance mmponent was added,

and the name was changed to the National Health and

Nutrition Examination Survey.

In the first National Health and Nutrition Examination

Survey (NHANES I), umducted from 1971 through 1974, a

major purpose was to measure and monitor indicators of

the nutritional status of the herican people through

dietary intake data, biochemical tests, physical measurements, and clinical assessments for evidence of nutritional

deficiency. Detailed examinations were given by dentists,

ophthalmologists, and dermatologists with amassessment of

need for treatment. In addition, data were obtained for a

subsample of adults on overall health care needs and

behavior, and more detailed examination data were cdlected on cardiovascular, respiratory, arthritic, and hearing

conditions. The detailed examination sample was augmented in 1974-75 by an additional sample of adults 25–74

years of age.

The NHANES I target population was the civilian

noninstitutionalized population 1–74 years of age residing

in the coterminous United States, except for people
residing on any of the reservation lands set aside for the use

of American Indians. The sample design was a multistage,

stratified probability sample of clusters of persons in landbased segments. The survey was conducted in 65 primary

sampling units (PSU’S) selected from the 1,900PSU’S in

the coterminous United States. A subsample of persons

25–74 years of age was selected to receive the more detailed health examination. Groups at high risk of malnutrition were oversampled at known rates throughout the

process.

Household interviews were conducted for more than

96 percent of the 28,043 persons selected for the NHANES

I sample. About 75 percent (20,749) were examined.

For NHANES II, conducted from 1976 through 1980,

the nutrition amponent remained nearly identical to that

of NHANES I. In the medical area, primary emphasis was

placed on diabetes, kidney and liver function, allergy, and

speech pathology.

The NHANES II target population was the civilian

noninstitutionalized population 6 months-74 years of age

residing in the United States, including Alaska and Hawaii.

NHANES II utilized a multistage probability design that

involved selection of PSU’S, segments (clusters of households) within PSU’S, households, eligible persons, and finally sample persons. The sample design provided for

oversampling of persons 6 month*5 years of age, those

074 years of age, and those living in pverty areas.

A sample of 27,801 persons was selected for NHANES

If. Of this sample, 73.1 percent (20,322) were examined.

The estimation procedure used to produce natioml

statistics from NHANES I and NHANES II involved inflation by the reciprocal of the probability of selection, adjustment for nonresponse, and poststratified ratio adjustment

and population totals. Sampling errors also were estimated

to measure the reliability of the statistics.

Examinations and interviews are conducted in specially

equipped and designed mobile examination centers that

travel to survey locations throughout the country. The

survey team consists of a physician, dentist, medicrit and

health technicians, and dietary and health interviewers, A

large staff of interviewers conducts the household interviews.

In each location, local health and government officials

are notified of the upcoming survey. Households in the

survey receive an advance letter and booklet to introduce

the survey. Local media may feature stories about the

survey.

The survey is designed to facilitate and encourage

participation. Transportation is provided to and from the

examination center, and participants receive remuneration.

With the respondent’s permission, medical and dental findings are reported to each person’s source of health care. All

information collected in the survey is kept strictly ccmfidential. Privacy is protected by public law.

Data collection for the third National Health and

Nutrition Examination Survey began in September 1988

and will continue for approximately 6 years at 88 locations

across the country.

The sample for the survey is selected to be representative of the civilian noninstitutionalized population ages 2

months and older. Unlike previous health examination

surveys, NHANES 111has no upper age limit. In order to

produce reliable statistics for black persons and Hispanics,

these groups are oversampkd.

AI] participants receive a physical examination, body

measurements, and dietary interview. Depending on the

age of the participant, the rest of the examination includes:

●

●

●

●

●

●

●

●

●

●

●

●

Dental examination

Health interview

Cognitive and neurological tests

Blood and urine tests

Hearing tests

Vision examination

Allergy skin test

Spirometry

Electrocrudiogram (ECG)

X rays

Ultrasound examinations of the gallbladder

Measurements of bone density

In general, the older the individual, the more extensive the

examination. Selected persons who are unable to mme to

the examination center may be given a less extensive examination in their homes.

The survey is being wnducted in two 3-year segments,

with data analyzed at the end of each of the segments as

well as for the full suwey.

For more information on NHANES I, see

National Center for Health Statistics, H. W. Miller.

1973. Plan and operation of the National Health and

Nutrition Examination Sumey, United States, 1971-73.

VW and HeaZth Statistics. Series 1, Nos. 10a and 10b.

DHEW Pub. No, (HSM) 73-1310. Health Semites and

Mental Health Administration. Washington: U.S.

Government Printing Offke.

National Center for Health Statistics, A. Engel, R. S.

Murphy, K Maurer, and E. Collins. 1978. Plan and

operation of the NHANES I Augmentation Survey of

Adults 25–74 Years, United States, 1974-75. Vital and

Health Statistics. Series 1, No. 14. DHEW Pub. No.

(PHS) 78-1314, Public Health Service. Washington:

U.S. Government Printing Office.

For more information on NHANES II, see:

National Center for Health Statistics, A. McDowell,

A, Engel, J. T, Massey, and K. Maurer. 1981.Plan and

operation of the Second National Health and Nutrition

Examination Sumey, 1976-80. Vitaland Health Statktics. Series 1, No. 15, DHHS Pub. No. (PHS) 81-1317.

Public Health Service. Washington: U.S. Government

Printing Office.

Data from NHES and NHANES are published in Vital

and HeaJth Statistics, Series 11.

15
Hispanic Health and Nutrition

Examination Survey (HHANES)

In the NI-lES and NHANES programs conducted during the 1960’s and 1970’s, the numbers of Hispanics in the

samples were too small to make reliable estimates of their

health conditions, Therefore, a Hispanic Health and Nutrition Examination Suney was conducted in 1982-84 to

obtain data on the health and nutritional status of three

Hispanic groups:

. Data on Mexican Americans residing in selected counties of Texas, Colorado, New Mexico, Arizona, and

California were collected July 1982 Lhrough November

1983. There were 9,894 persons in the sample, of

whom 8,554 were interviewed and 7,462 examined.

. Data on Cuban knericans residing in Dade County

(Miami), Florida, were collected from January 1984

through April 1984. There were 2,244 persons in the

sample, of whom 1,766 were intemiewed and 1,337

examined.

. Data on Puerto Ricans residing in the New York area,

including parts of New Jersey and Connecticut, were

collected from May 1984 through December 1984.

There were 3,786 persons in the sample of whom 3,369

were interviewed and 2,834 examined.

The general structure of the HHANES sample design

was similar to that of the previous National Health and

Nutrition Examination Surveys. All of these studies have

used amplex, multistage, stratified, clustered samples of

defined populations. The major difference beiween

HHANES and the previous surveys is that HHANES was a

suney of three special subgroups of the population in

selected areas of the United States rather than a national

probability sample.

Data collection began with a household interview. Four

questionnaires used in the household were:

●

●

●

●

16

A Household Screener Questionnaire, administered at

each selected address, for determining household eligibility and for selecting sample persons

A Family Questionnaire, administered once for each

family containing sample persons, that included

sections on family relationships, basic demographic

information for sample persons and head of family,

Medicare and health insurance coverage, participation

in income assistance programs, and housing characteristics

An Adult Sample Person Questionnaire (12 through

74 years) that, depending on age, included sections on

health status measures, health services utilization,

smoking (20 through 74 years), meal program participation, and acculturation. Information on the use of

medicines and vitamins in the past 2 weeks was also

obtained

A Child Sample Person Questionnaire @ersons 6

months through 11 years) that included sections on a

number of health status issues, health care utilization,

infant feeding practices, participation in meal programs, school attendance, and language use. Information on the use of medicines and vitamins in the past 2

weeks was also obtained

At the Mobile Examination Center, two questionnaires

were used and an examination was performed. They were

. An Adult Sample Person Supplement (12 through 74

years) that included sections on almhol consumption,

drug abuse, depression, smoking (12 through 19 years),

pesticide exposure, and reproductive history.

. A Dietary Questionnaire (6 months through 74 years)

by which trained dietary interviewers collected information about “usual” consumption habits and dietary

practices and recorded foods consumed during the

24 hours prior to midnight preceding the day of the

interview.

. An examination that included a variety of tests and

procedures.

Age at interview and other factors determined which

procedures were administered to which examinees. A dentist performed a dental examination and a vision test.

Technicians took blood and urine specimens and administered a glucose tolerance test, x rays, electrocardiograms,

and uk+scmographs of the gallbladder. Technicians also

performed hearing tests and took a variety of body measurements. A physician performed a medical examination,

focusing especially on the cardiovascular, gastrointestinal,

neurological, and musculoskeletzd systems. The physicians’

impression of overall health, nutritional and weight status,

and health care needs was also recorded. Some analyses of

blood and urine specimens were performed by technicians

in the examination center; others were conducted under

contract at various laboratories.

Because the HHANES sample is not a simple random

one, it is necessary to incorfmrate sample weights for

proper analysis of the data. These sample weights are a

composite of individual selection probabilities, adjustment

for noncoverage and nonresponse, and poststratification

adjustments. Sampling errors are estimated to measure the

reliability of statistics. They are calculated to take into

account the complex sample design and the ratio adjustments used to produce the sample weights.

For more information on HHANES, see:

. National Center for Health Statistics. 1985. Plan and

operation of the Hispanic Health and Nutrition Examination Survey, 1982–84. VifaI and Health Statistics.

Series 1, No. 19. DHHS Pub. No. (PHS) 85-1321.

Public Health Service. Washington: U.S. Government

Printing Office.

Data from HHANES are published in P7tal and Health

SCafisfics,Series 11.
National Survey of Family Growth

(NSFG)

●

●

●

●

●

●

●

●

●

●

●

●

Adoption

Breastfeeding

Contraception and sterilization

Infertility

Live births and birtis expected

Low birth weight

Miscarriages and stillbirths

Prenatal care

Teenage sexual activity and pregnancy

Unmarried cohabitation

Use of family planning services

Wanted and unwanted births

Data from the National Sumey of Family Growth are

based on samples of women ages 15-44 years in the civilian

noninstitutionalized population living in the conterminous

United States. The fist and second cycles excluded women

who had never been married, except those with offspring in

the household. The third and fourth cycles include all

women ages 15-44 years, regardless of whether they have

ever been married.

The purpose of the survey is to provide national data

on the demographic and social factors associated with

childbearing, adoption, and maternal and child health.

These factors include sexual activity, marriage, unmarried

cohabitation, divorce and remarriage, contraception and

sterilization, infertility, breastfeeding, pregnancy loss, lowbirth weight, and use of medical care for family planning,

infertility, and prenatal care.

Interviews are conducted in person by professional

female interviewers using a standardized, printed questionnaire. The average interview length is about 1 hour. Black

women are sampled at higher rates dmn other women, so

that separate, reliable statistics for black women can be

computed from the survey.

Cycle I of the National Survey of Family Growth was

conducted from June 1973 through February 1974. The

munties and independent cities of the United States were

combined to form a frame of prima~ sampling units

(PSU’S), and 101 PSU’S were selected as the first-stage

sample. The next three stages produced a clustered sample

of 28,998 households within the 101 PSU’S. At 26,028 of

these households (89.8 percent), a household screener

intemiew was completed. These screeners produced a fifthstage sample of 10,879 women, of whom 9,797 were interviewed. Never-married women (except those with offspring

in the household) were excluded from Cycle L

Cycle II was cmducted from January through September 1976. The sample design was basically the same as it

was in Cycle I. The sample consisted of 27,162 households

in 79 PSU’S. Household screener interviews were completed at 25,479 of these households (93.8 percent). Of the

10,202 women in the sample, 8,611 were interviewed.

Again, never-married women (except those with offspring

in the household) were excluded from the survey for

Cycle II.

Interviewing for Cycle III of the NSFG was conducted

from August 1982 Lhrough February 1983. The sample

design was similar to that in Cycle II; 31,027 households

were selezted in 79 PSU’S. Household screener interviews

were mmpleted in 29,511 households (95.1 percent). Of

the 9,964 eligible women identified, 7,969 were interviewed.

The sample for Cycle III included black women and women

15–19 years of age at higher rates than other women. All

women ages 1544 years, regardless of marital status, were

represented in Cycle III.

In order to produce estimates for the entire population

of eligible women in the United States, data for the interviewed sample women were inflated by the reciprocal of the

probability of selection at each stage of sampling and

adjusted for both screener and interview nonresponse,

Cycles I and II estimates for ever-married women were

poststratified to benchmark population values for 12 agerace categories based on data from the Current Population

Survey of the U.S. Bureau of the Census. Cycle 111was

poststratified for 24 categories of age, race, and marital

status.

Quality control procedures for interviewer selection,

interviewer training field Iistin& and data processing were

built into NSFG to minimize nonsampling error and bias.

In addition, the nonresponse adjustments in the estimator

were designed to minimize the effect of nonrespcmse bias

by assigning to nonrespondents the characteristics of similar respondents. Sampling errors were estimated by balanced half-sample replication,

Cycle IV was conducted in 1988. Cycle IV is mmparable in scope and content to the 1982 survey. The principal

difference is procedural: The sample was obtained from the

1986 National Health Interview Survey. About 8,000 completed interviews were obtained from women 15-44 years

of age in the first half of 1988. A public-use computer tape

and the first preliminary reprts are scheduled to be published following completion of data processing in 1989.

Anew longitudinal feature has been added to Cycle IV.

A sample of respondents are being reintemiewed at approximately 13-month intervals between Cycles IV and V.

The reintewiews are done by telephone using computerassisted telephone interviews. They will focus on verifying

and updating selected items from the Cycle IV interviews

and on new data for special research in reproductive health,

For the balanced half-sample technique, summa~

sampling error charts, and detailed information on the

sample design, see

. National Center for Health Statistics, D. K. French.

1979. National Survey of Family Growth, Cycle I:

sample design, estimation procedures, and variance

estimation. Vital and Health Statistics. Series 2, No. 76.

DHEW Pub. No. (PHS) 78-1350. Public Health

Service. Washington: U.S. Government Printing Office.

. Nationrd Center for Health Statistics, W. R. Grady.

1981. National Sumey of Family Growth, Cycle II:

sample design, estimation procedures, and variance

estimation. Vitaland Health St&tics. Series 2, No. 87.

DHHS Pub. No. (PHS) 81-1361. Public Health

17
Service. Washington: U.S. Government Printing Office. Study schedule

. National Center-for Health Statistics, C. Bach~ach, M.

Horn, W. Mosher, and I. Shimizu. 1985. National

National Health and Nutrition Examination Survey I

Survev of Family Growth. Cvcle Ill Estimation nroce-

(Baseline) 1971-75

dures: weighting, and v&-i&ce estimation. Vit& and NHANES I Epidemiologic Followup Study 1982–84

HeaIth Statistics. Series 2, No. 98. DHHS Pub. No. NHANES I Epidemiologic Followup Study (Elderly

(PHS) 85-1372. Public Health Service. Washington: Cohort) 1986

U.S. Government Printing Office. NHANES I Epidemiologic Followup Study 1987

Data are published in VW and Health Sfatktics, For a description of the 1982–84 study, see:

Series 23,

Longitudinal studies based on

population surveys

NHANES I Epidemiologic Followup Study

. History and development of chronic disease and functional impairment

. Mortality and morbidity associated with suspected risk

factors

. Hospital and nursing home utilization

● Changes in selected risk factors

The NHANES I Epidemiologic Followup Study

1982-84 was jointly initiated by the National Center for

Health Statistics and the National hstitute on Aging in

collaboration with other Nationql Institutes of Health and

Public HealLh Service agencies. The primary purpose of the

study is to investigate the relationships between physiological, nutritional, behavioral, and demographic characteristics collected through the National Health and Nutrition

Examination Survey I interview (1971-75) and subsequent

morbidity or mortality from specific diseases and

conditions,

The first phase of the followup study was conducted in

1982-84. The study population included the 14,407 persons

aged 25–74 years at the time of the NHANES I survey.

Tracing was successfully completed on 93 percent of the

cohort. Personal interviews-including weight, pulse, and

blood pressure measurements-were conducted with

traced, surviving subjects. Intemiews with proxy respondents were conducted if the subject was deceased or incapacitated. Hospital and nursing home records were

collected for all subjects, and death certificates were obtained for decedents.

In 1985-86, a Continued Followup of the Elderly

NHANES I Cohort was conducted. Computer-assisted

telephone interviews were conducted with elderly participants who had been ages 55 years and over at NH.ANES I.

The interview data were augmented with health care facitity

abstracts and death certificates, In 1986-87, the NHANES

I cohort was contacted again. Telephone intetiews were

conducted, and hospital and nursing home records and

death certificates were obtained. This followup provides a

more complete profile of hospital and nursing home use,

resulting in enhanced data on mortality, natural history, and

utilization.

. National Center for Health Statistics, B. B. Cohen,

H. E. Barbano, C. S. Cox, et al. 1987. Plan and operation of the NHANES I Epidemiologic Followup Study,

1982–84. Vitaland Health Statistics. Series 1, No. 22.

DHHS Pub. No. (PHS) 87-1324. Public Health Service. Washington: U.S. Government Printing OffIce.

Longitudinal Study of Aging

. ‘Death rates by social, economic, family, and health

characteristics

. Changes in functional status

. Changes in living arrangements

. Changes in coverage by public insurance

. Use of hospitals and nursing homes by individuals over

time

The Longitudinal Study of Aging is a family of surveys

based on the Supplement on Aging (SOA) to the 1984

National Health Interview Survey. The SOA was designed

to obtain extensive information on family structure and

frequency of contacts with children; housing (including

barriers to movement, length of time in residence, ownership, and rental information); use of community and social

supports; occupation and retirement (including sources of

retirement income); ability to perform work-related functions; conditions and impairments; functional limitations

(activities of daily living and instrumental activities of daily

living) and providers of help in those activities. Information

was obtained for 16,148 persons ages 55 years and over

(96 percent of the eligible people in the interviewed households in the National Health Interview Survey). Ninety-two

percent answered all questions for themselves.

The records of the approximately 16,000 persons who

granted permission and who provided the information are

being linked with the National Death Index. As the death is

established through the linkage, cause-of-death information

is being obtained. This will make possible the study of

survival and death in relation to social, demographic, family, support, and health conditions.

Subsamples are being selected for reinterview. The first

of these was a sample of all persons ages 80 years and over,

all black persons ages 70 years and over, and one-half of all

other persons ages 70-79 yearn. Relatives of those persons

who were ages 70 years and over and living in the same

household in 1984 were also included in the sample. The

sample of 5,151 persons ages 70 years and over was interviewed again in 1986, using computer-assisted telephone

interviews. Persons without telephones and those who a

18
could not be contacted by telephone were mailed questionnaires. The status of 92 percent (4,734 persons) was ascertained through the reintemiew. Of the people who could

not be located, the status of 20 was ascertained through

matching with the 198485 National Death Index; and the

status of an additional 182 was ascertained through tracing.

Thus, the status of 96 percent (4,936 persons) of the people

selected for the 1986 interview is known.

The 1986 interview was designed to measure changes

in functioning (ability to perform work-related activities,

activities of daily living, instrumental activities of daily

living) and the provision of help; changes in living arrangements, including movement toward living alone or with

others in the community or into nursing homes; and use of

medical and nursing home care. Their records were

matched with the National Death Index to ascertain date of

death, and cause-of-death information is being obtained. In

addition, they were asked for their health insurance claim

numbers and for their permission to match their interview

records with the Medicare records maintained by the

Health Care Financing Administration. The matches have

been done, and the first information was included in the

1988 release of the public-use files.

The 1988 and 1990 interviews were designed to continue measuring the same changes. They also repeat some

questions that were asked in 1984 because conditions could

have changed over 4 (or 6) years. Beginning in 1988, the

sample size was also increased to include all persons who

were 70 years of age and over in 1984.

For information on the design and questionnaire for

the Supplement on Aging, see:

. National Center for Health Statistics, J. E. Fitti and M.

G. Kovar. 1987. The Supplement on Aging to the 1984

National Health Interview Survey. Vital and Health

Skzlistic,s. Series 1, No. 21. DHHS Pub. No. (PHS)

87-1323. Public Health Service. Washington: U.S. Government Printing Office.

For information on the design and questionnaire for

the Longitudinal Study on Aging 1986 Interview, see:

. National Center for Health Statistics, M. G. Kovar and

J. E. Fitti. 1987. The Longitudinal Study of Aging A

description of the study. WorLingPaper Series. No. 31.

Hyattsville, MD.

Data are published in Vitaland Health Statistics,

Series 10.

Public-use data tapes are released through the Division

of Health Interview Statistics, National Center for Health

Statistics.

19
Data from more than

one system

All of the data systems are designed to serve multiple

purposes. Some of the more interesting and important

measures, especially those that are unique to a

data-collection system, or for which the system is the

primary or only source, are given with the description of the

system. However, other data systems may also have information that cam be used to answer a specific research

question.

It is impossible to su~est all of the analyses that are

possible using data available from the many data-collection

systems of the National Center for Health Statistics

(NCHS). Because of the multiple sources of information,

there is information available from several systems that can

be used to address important public health issues. This

section can only provide a brief introduction to the enormous amount of information that can be obtained from the

NCHS data systems when they are used to answer substantive questions.

Having information from several systems provides different views about the subject. It provides the opportunity

for special investigations, In each case, the information is

about the population that the system is designed for; the

auxiliary information is often specific to the system. The

kind and quality of the specific items often depend on who

provides the information; some of the systems obtain information horn only one source; some systems use several

sources.

Examples of data on the use of medical care may

illustrate the complexity and possibilities.

Hospitalization

The National Hospital Discharge Survey is the primary

source of data on hospitalizations for people of all ages. It

has very detailed information about diagnoses, procedures,

and lengths of stay because the information is obtained

from the hospital discharge abstract. However, because an

abstract is the source, it cannot be used to study multiple

hospitalizations of the same person or to provide information about the person that the hospital does not have,

The National Vital Statistics Registration System is the

source of information on how many people are born and

die in hospitals and on the cause of death for decedents. It

provides a means for detailed study of local variation

because it includes all births and deaths in the United

States. However, because a registration certificate is the

source, it does not include other important information

about the person.

Both of these systems have been in existence for many

years and are extremely useful for studying time trends.

Neither the population-based nor vital-statistics-based surveys are as useful for studying trends in hospitalization

because questions and survey designs have been changed to

meet changing needs for information and because some of

them have not been conducted frequently.

However, such surveys provide information about people that supplements the information from the recordbased systems, and they permit study of multiple

hospitalizations. Some of them incorporate matching with

hospital or mortality records to take advantage of the

diagnostic detail on those records.

The National Mortality Followback Survey and the

National Maternal and Infant Health Survey supplement

the registration system by providing much more detailed

information about other events surrounding birth and

death. The National Mortality Followback Survey provides

the opportunity to study hospitalization and multiple hospitalizations during the last year of life. The National Maternal and Infant Health Sumey provides an opportunity for

detailed study of hospitalization before and during childbirth. Both also provide emnomic and other information

Lhat is not on the certificates. However, because they are

based on samples, they cannot be used to study geographic

differences in as much detail.

The National Health Intemiew Survey supplements the

National Hospital Discharge Survey and provides the opportunity to estimate the number of people with multiple

hospitalizations during a year and to investigate relationships with characteristics of the person. It is especially

useful for children past infancy and for adults under the age

of 65. It is less useful for infants and people ages 65 years

and over because it does not include people who died or

were institutionalized between the hospitalization and the

interview. The diagnostic information is less reliable and

less detailed than that from the National Hospital Discharge Survey.

L.ongitudinaJ studies, such as the NHANES I Epidemiologic Followup and the L.m@udinal Study of Aging,

overcome some of these disadvantages. They provide information on the hospitalizations of individual adults over

several years. They also include information from hospitals,

Medicare records, and death certificates that supplement

20
the information from household respondents and provide

better diagnostic data.

Data are also obtained retrospectively. The National

Health and Nutrition Examination Surveys, the Hispanic

Heilth and Nutrition Examination Sumey, and the 1981

Child Health Supplement to the National Health Interview

Survey included questions on all the child’s hospitalizations

since birth.

Physician visits and contacts

The primaq source is the National Ambulatory Medical Care Survey, which provides the best diagnostic and

.

service information. It is a survey of events, and it cannot be

used to study multiple visits by the same person. In addition, this survey includes only visits to physicians in private

ot%ce-based practice. For information on all visits for ambulato~ medical care, including visits to clinics, outpatient

services in hospitals, and freestanding ambulatory care

clinics, one must use other systems. (This limitation will be

overcome when the National Health Care Survey is fully

implemented.)

The National Health Interview Survey must be used to

study relationships between receiving (or not receiving)

care and social and health status. It provides information on

where people received ambulatory care so that one can

determine what proportion of the people are receiving care

from private physicians, and one can investigate whether

there are differences by socioeconomic status.

The National Medical Care Utilization and Exp@diture Survey provided a rare opportunity to study relationships between ambulatory care and hospitalization because

people were in the survey for a full year.

The birth-registration system contains information on

the timing of the first visit for prenatal care and the number

of visits. It is used to study changes over time in whether

mothers have received prenatal care and to investigate

geographic variation.

The National Survey of Family Growth has information

on visits for family planning made by women of childbearing age and on services given during those visits.

Nursing home use

The National Nursing Home Survey is the primary

source of data. The additional sources are more limited

than they are for other major sources of medical care

because users of nursing homes are very likely to be older

people.

Two longitudinal studies, the NHANES I EpidemioIogical Followup Study and the Longitudinal Study of Aging, provide information on the people who move from the

community into (and out of) nursing homes. They can be

used to study differences between people who become

residents of nursing homes and those who do not.

The National Nursing Home Survey Followup provides

information on people after they leave the nursing home.

The National Mortality Followback Survey provides information on use of nursing homes during the last year of life.

Systems with information on use of

medical care

Primary sources—based on records of

providers

● National Health Care Survey

● National Hospital Discharge Survey

● National Ambulatory Medical Care Survey

● National Nursing Home Survey

Other sources

● National Health Interview Survey

● Longitudinal Study of Aging

● National Medical Care Utilization and Expenditure

Survey

● National and Hispanic Health and Nutrition Examination Surveys

● NHANES I Epidemiological Followup Study

● National Nursing Home Followback Survey

● National Survey of Family Growth

● National Mortality Registration System

● National Mortality Followback Survey

● National Natality Registration System

● National Maternal and Infant Health Survey

*U.S. GOVERNMENT PRINTING OFF ICE:? 9E9-241-259IE1OO8 21
Vital and Health Statistics 

series descriptions 

SERIES 1. 

SERIES 2. 

SERIES 3. 

SERIES 4. 

SERIES 5. 

SERIES 6. 

SERIES 

SERIES 

SERIES 12. 

SERIES 

SERIES 

Programs and Collection Procedures-Reports describing SERIES 15. Data From Special Surveys-Statistics on health 

the general programs of the National Center for Health health-related topics collected in special surveys 

Statistics and its offices and divisions and the data col- are not a part of the continuing data systems of 

lection methods used. They also include definitions and National Center for Health Statistics. 

other material necessary for understanding the data. 

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 

statisticai theory. Studies also include comparison of 

U.S. methodology with those of other countries. 

Analytical and Epidemiological Studies-Reports presenting analytical or interpretive studies based on vital 

and health statistics, carrying the analysis further than 

the expositon/ types of reports in the other series. 

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. 

Comparative International Vital and Health Statistics 

Reports-Analytical and descriptive reports comparing 

U.S. vital and health statistics with those of other countries. 

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. 

Data From the National Health Interview Survey-Statistics 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. 

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. 

Data From the Institutionalized Population Surveys-Discontinued in 1975. Reports from these surveys are included in 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. 

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 16. Compilations of Advance Data From Vital and He 

Statistics-These reports provide early release of ( 

from the National Center for Health Statisttcs’ health 

demographic surveys. Many of these releases are follol 

by detalled reports in the Vital and Health Statk 

Series. 

SERIES 20. 

SERIES 2 1. 

SERIES 22. 

SERIES 23. 

SERIES 24. 

Data on Mortality-Various statistics on mortality c 

than as included in regular annual or monthly rep, 

Special analyses by cause of death, age, and other de 

graphic variables; geographic and time series analy 

and statistics on characteristics of deaths not avail 

from the vital records based on sample surveys of tt 

records. 

Data on Natality, Marriage, and Divorce-Various 

tistlcs on natality, marnage, and divorce other that 

included m regular annual or monthly reports. Spt 

analyses by demographic variables; geographic and ’ 

series analyses: studies of fertility; and statistics 

characteristics of births not available from the 

records based on sample surveys of those records. 

Data From the National Mortality and Natality Survey 

Dtscontinued in 1975. Reports from these sample sun 

based on vital records are Included in Series 20 and 

respectively. 

Data From the National Survey of Family Growl 

Statistics on fertility, family formation and dissolui 

family planning, and related maternal and infant he 

topics derived from a periodic survey of a nationv 

probability sample of women 15-44 years of age. 

Compilations of Data on Natality, Mortality, Marrii 

Divorce, and Induced Termination of PregnancyVance reports of births, deaths, marriages, and dtvo 

are based on final data from the National Vital Statk 

system and are published annually as supplements to 

Monthly Vital Statistics Report (MVSR). These reports 

followed by the publication of detailed data in Vital Sti 

tics of the United States annual volumes. Other rep 

including induced termmation of pregnancy issued per 

ically as supplements to the MVSR provide selected f 

ings based on data from the National and Health Statk 

System and may be followed by detailed reports in \ 

and Health Statistics Series. 

For answers to questions about this report or for a list of title’ 

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 

3700 East-West Highway 

Hyattsville. Mawland 20782 

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300 

ttion No. (PHS) 89-l 325, Series 1, No. 23