Series 13

No. 137

Ambulatory Health Care Visits

by Children: Principal

Diagnosis and Place of Visit

May 1998

Vital and

Health Statistics

From the CENTERS FOR DISEASE CONTROL AND PREVENTION / National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
Copyright Information

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

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

appreciated.

Suggested citation

Freid VM, Makuc DM, Rooks RN. Ambulatory health care visits by children:

principal diagnosis and place of visit. National Center for Health Statistics. Vital

Health Stat 13(137). 1998.

Library of Congress Cataloging-in-Publication Data

Freid, Virginia M.

Ambulatory health care visits by children : principal diagnosis and place of

visit.

p. cm. — (Vital and health statistics. Series 13, Data from the National

Health Survey ; no. 137) (DHHS publication ; no. (PHS) 98-1798)

By Virginia M. Freid, Diane M. Makuc, Ronica N. Rooks.

‘‘April 1998.’’

ISBN 0-8406-0546-3

1. Ambulatory medical care for children—Utilization—United

States—Statistics. 2. United States—Statistics, Medical. I. Makuc, Diane M. II.

Rooks, Ronica N. III. National Center for Health Statistics (U.S.) IV. Title. V.

Series. VI. Series: DHHS publication ; no. (PHS) 98-1798.

[DNLM: 1. Ambulatory Care—in infancy & childhood—United States

statistics. 2. Ambulatory Care—in adolescence—United States—statistics. 3.

Ambulatory Care Facilities—utilization—United States. 4. Office

Visits—utilization—United States. W2 A N148vm no. 137 1998]

RA407.3.A349 no. 137

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for Library of Congress 98-15148

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For sale by the U.S. Government Printing Office

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Printed on acid-free paper.
Ambulatory Health Care Visits

by Children: Principal

Diagnosis and Place of Visit

Series 13:

Data From the National Health

Survey

No. 137

Hyattsville, Maryland

May 1998

DHHS Publication No. 98-1798

Vital and

Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jack R. Anderson, Deputy Director

Jack R. Anderson, Acting Associate Director for

International Statistics

Lester R. Curtin, Ph.D., Acting Associate Director for

Research and Methodology

Jennifer H. Madans, Ph.D., Acting Associate Director for

Analysis, Epidemiology, and Health Promotion

P. Douglas Williams, Acting Associate Director for Data

Standards, Program Development, and Extramural Programs

Edward L. Hunter, Associate Director for Planning, Budget,

and Legislation

Jennifer H. Madans, Ph.D., Acting Associate Director for

Vital and Health Statistics Systems

Stephen E. Nieberding, Associate Director for Management

Charles J. Rothwell, Associate Director for Data Processing

and Services

Office of Analysis, Epidemiology, and Health Promotion

Jennifer H. Madans, Ph.D. Acting Associate Director

Diane M. Makuc, Dr.P.H. Director, Division of Health and

Utilization Analysis

John L. Kiely, Ph.D. Chief, Infant and Child Health Studies

Branch

Diane M. Makuc, Dr.P.H. Acting Chief, Analytic Studies

Branch
Contents

Abstract ................................................................................................ 1

Introduction............................................................................................. 1

Methods................................................................................................ 2

Results................................................................................................. 3

All Visits ............................................................................................ 3

Visits by Principal Diagnosis............................................................................. 4

Well-Child Visits....................................................................................... 4

Middle Ear Infection Visits .............................................................................. 4

Injury Visits........................................................................................... 5

Asthma Visits ......................................................................................... 6

Attention Deficit Disorder Visits .......................................................................... 6

Discussion .............................................................................................. 6

References.............................................................................................. 8

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Principal Diagnosis Category and Population Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Figures

1. Ambulatory care visit rates among children under 15 years of age by place of visit and age: United States, average

annual 1993–95 ..................................................................................... 3

2. Ambulatory care visit rates among children under 15 years of age by place of visit and race: United States, average

annual 1993–95 ..................................................................................... 4

3. Ambulatory care visit rates among children under 1 year of age by principal diagnosis and race: United States, average

annual 1993–95 ..................................................................................... 4

4. Ambulatory care visit rates among children 1–4 years of age by principal diagnosis and race: United States, average

annual 1993–95 ..................................................................................... 5

5. Ambulatory care visit rates among children 5–14 years of age by principal diagnosis and race: United States, average

annual 1993–95 .................................................................................... 5

6. Ambulatory care visit rates among children under 15 years of age by place of visit, principal diagnosis, and race:

United States, average annual 1993–95 .................................................................. 5

List of Detailed Tables

1. Ambulatory care visits among children under 15 years of age by place of visit, age, sex, and race: United States,

average annual 1993–95 .............................................................................. 9

2. Ambulatory care visits among children by age and principal diagnosis category: United States, average annual

1993–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

3. Ambulatory care visits among children under 15 years of age by sex and principal diagnosis category: United States,

average annual 1993–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

4. Ambulatory care visits among children under 15 years of age by race and principal diagnosis category: United States,

average annual 1993–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

5. Ambulatory care visits among children under 15 years of age by selected principal diagnosis category, age, and race:

United States, average annual 1993–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

iii
6. Ambulatory care visits among children under 15 years of age by place of visit and principal diagnosis category:

United States, average annual 1993–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

7. Ambulatory care visits among children under 15 years of age by place of visit, race, and selected principal diagnosis

category: United States, average annual 1993–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

8. Injury visits among children under 15 years of age by place of visit and principal injury diagnosis category:

United States, average annual 1993–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Appendix Tables

I. Principal diagnosis categories and ICD–9–CM codes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

II. Principal injury diagnosis categories and ICD–9–CM codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

III. Civilian noninstitutionalized population by age, sex, and race: United States, average annual 1993–95 . . . . . . . . . . . . . 23

iv
Objectives

This report presents national

estimates of ambulatory health care use

by children under 15 years of age

according to principal diagnosis, place

of visit (physician office, hospital

outpatient department, and hospital

emergency department), and patient

characteristics (age, sex, and race).

Methods

Data were from the National

Ambulatory Medical Care Survey and

the National Hospital Ambulatory

Medical Care Survey. Data were from

1993–95.

Results

In 1993–95 children under 15 years

of age made 165.3 million visits per

year (289 visits per 100 children). Visit

rates were highest among infants and

varied inversely with age. Visit rates

were 43 percent higher among white

children than black children.

Three-quarters of ambulatory visits

occurred in physician offices, 8 percent

in hospital outpatient departments, and

14 percent in hospital emergency

departments. Visits by white children

were more likely to occur in physician

offices than visits by black children

(81 percent and 54 percent).

Conversely, visits by black children

were more likely to occur in hospital

outpatient departments (19 percent and

7 percent) and hospital emergency

departments (28 percent and

12 percent) than visits by white

children.

The following principal diagnoses

accounted for almost 40 percent of

visits: well-child visit, 15 percent; middle

ear infection, 12 percent; and injury,

10 percent. Rates for well-child visits

were almost 80 percent higher among

white infants than black infants.

Continued monitoring of these

differences in use of ambulatory care

among children are needed, particularly

in view of the possible impact of

changes in the health care system on

these differences.

Keywords: well-child visits c

physician office visits c hospital

outpatient department c hospital

emergency department

Ambulatory Health Care Visits

by Children: Principal

Diagnosis and Place of Visit

Virginia M. Freid, M.S.; Diane M. Makuc, Dr.P.H.; Ronica N. Rooks,

M.A., Division of Health and Utilization Analysis

Introduction

A mbulatory health care services

are important for maintaining

good health in children by

providing preventive services and

treatment of illness and injuries.

Population-based data from the National

Health Interview Survey (NHIS) and

National Medical Expenditure Survey

show that ambulatory health care

utilization among children varies

considerably by family income,

race/ethnicity, and health insurance

coverage. Poor children, minority

children, and uninsured children have

lower levels of health care utilization

than their more advantaged counterparts

(1–6). Uninsured children and those in

families with low income are at elevated

risk of reporting unmet health care

needs and are less likely to have a usual

source of health care (7). In addition,

data from the NHIS document changes

in health insurance coverage among

children over the past decade. Between

1984 and 1995, the proportion of

children with private coverage declined

from 73 to 66 percent, the proportion

with Medicaid coverage increased from

12 to 21 percent, and the proportion of

children without health insurance

coverage remained between 13 and 15

percent (6). During this period, the

average number of physician office

visits per child remained fairly stable

among children under 15 years of age

(6,8) while the rate of inpatient days of

care declined by one-third (5,9).

Data from medical-records-based

surveys such as the National

Ambulatory Medical Care Survey

(NAMCS) and the National Hospital

Ambulatory Medical Care Survey

(NHAMCS) complement information

obtained from population-based surveys

by providing record-based data on the

physician’s diagnosis and on the type of

place where the ambulatory visits

occurred among those who gain access

to the health care system. Collection of

data on these items in population-based

interviews may be subject to bias due to

inaccurate recall and lack of knowledge

by the respondent.

The objectives of this report are to

provide national data on the principal

diagnosis and place of ambulatory care

visits among children and to examine

how these vary by the age and race of

the child. This report presents

information about ambulatory care visits

for three of the major places that

provide such care (physician’s offices,

hospital outpatient departments, and

hospital emergency departments) and

provides estimates of ambulatory care

use for all three places combined. Data

on ambulatory care visits are presented

This report was prepared in the Division of Health and Utilization Analysis (DHUA). The assistance and

expertise of the following persons, who contributed to this report, is gratefully acknowledged. Alan J.

Cohen, TRW, provided computer expertise. Lois Fingerhut, Office of Analysis, Epidemiology, and Health

Promotion, provided assistance with injury categorization. Kenneth C. Schoendorf, DHUA, provided

assistance with ICD–9–CM diagnosis categorization. Jennifer D. Parker, DHUA, provided comments on

the paper. Catharine W. Burt, Division of Health Care Statistics, provided comments on the paper and

expertise on the data sets. Iris Shimizu and Wayne E. Johnson, Office of Research and Methodology,

provided methodological assistance. The report was edited by Klaudia M. Cox and typeset by

Annette F. Holman, Division of Data Services.

Page 1
for a set of clinically significant

pediatric diagnosis categories. The data

in this report complement previous

analyses of ambulatory care visits in

physician office, hospital outpatient, and

emergency department sites (10–20) by

presenting combined estimates for all

three sites, focusing specifically on

utilization among children, and

presenting visits according to diagnosis

categories specifically designed for

children. Diagnosis categories of

particular public health interest for

children include well-child visits, middle

ear infection, injury, asthma, and

attention deficit disorder.

Methods

This report uses data from two

surveys conducted by the

National Center for Health

Statistics (NCHS). Data on physician

office visits are from the 1993, 1994,

and 1995 National Ambulatory Medical

Care Survey (NAMCS) (10–12), a

national probability sample survey of

office visits made in the United States to

non-Federally-employed physicians who

are principally engaged in office

practice, excluding the offices of

anaesthesiologists, pathologists, and

radiologists. Visits to physicians

engaged in prepaid practices (health

maintenance organizations (HMO’s),

independent practice organizations

(IPA’s), and other prepaid plans) are

included in NAMCS. Sample physicians

were asked to complete Patient Record

Forms on a systematic random sample

of office visits occurring during a

randomly assigned 1-week reporting

period. Physicians were directed to

record the principal diagnosis for the

visit that relates to the patient’s

complaint, symptoms, or other reason

for the visit. The physician response rate

for NAMCS was 70–73 percent for the

years of interest.

Data for hospital outpatient and

emergency department visits are from

the 1993, 1994, and 1995 National

Hospital Ambulatory Medical Care

Survey (NHAMCS) (13–18, 21).

NHAMCS is a national probability

sample of visits to outpatient and

emergency departments of non-Federal,

short-stay, or general hospitals,

excluding Federal, military, and Veterans

Administration hospitals. Only

outpatient department clinics under the

supervision of a physician were included

in NHAMCS. In NHAMCS, hospital

staff were asked to complete Patient

Record Forms for a systematic random

sample of patient visits occurring during

a randomly assigned 4-week reporting

period. Hospital staff were directed to

record the physician’s principal

diagnosis for the visit that relates to the

patient’s complaint, symptom, or other

reason for the visit. The hospital

response rate was 94–95 percent for the

years of interest.

In this report, a visit was defined as

a direct personal exchange between a

patient and a physician for the purpose

of seeking or receiving health services.

Visits in NAMCS included office visits

with nonphysician providers (for

example, nurse practitioners, physician

assistants, and registered nurses)

working under the direct supervision of

physicians who were solo practitioners.

Nonphysician provider visits for

physicians in group practices or HMO’s

were excluded. However, visits in

NHAMCS included visits with

nonphysician providers. Telephone

contacts, purely administrative contacts,

or off-site visits (for example, home

visits) were excluded from both surveys.

The physician’s principal diagnosis,

associated with the patient’s stated

reason for this visit, was collected from

NAMCS and NHAMCS Patient Record

Forms and coded by NCHS to the

International Classification of Diseases,

Clinical Modification (ICD–9–CM) (22).

The principal diagnosis was missing for

1.9 percent of visits. Data presented in

table 1 include all visits and data in

tables 2–8 exclude visits without a

principal diagnosis. In addition to

principal diagnosis, the Patient Record

Form for NAMCS and NHAMCS

permitted the recording of second and

third diagnoses. Among children, a

second diagnosis was present in

30 percent of records and a third

diagnosis was present in 6 percent of

records.

In this report, three principles

guided the construction of a set of 20

clinically significant pediatric diagnosis

categories based on ICD–9–CM codes

for the principal diagnosis. (See table I

for clinical diagnoses and ICD–9–CM

codes that define principal diagnosis

categories.) First, categories were

designed to be inclusive of clinically

similar and difficult to differentiate

principal ICD–9–CM codes. The cold,

cough, runny nose category includes

codes for both nasopharyngitis and acute

upper respiratory infection because these

conditions are clinically similar. Cough

is also included in this category because

it is often associated with cold and

runny nose symptoms. For example, a

child with a cold and cough might be

characterized as having a principal

diagnosis of ‘‘cold’’ by one provider and

‘‘cough’’ by another provider. Grouping

together diagnoses that are often

concurrent avoids the problem of

slightly different clinical impressions

regarding the ‘‘principal’’ diagnosis.

Second, categories were constructed

only for conditions that are common

among children. Third, categories were

constructed to differentiate between

diagnoses for which treatment and

followup needs differ. For example, sore

throat is not combined with

streptococcal sore throat due to the clear

need for antibiotics in the latter case.

Middle ear infection is not combined

with external ear infection (although

both cause ear pain) due to different

treatment methods and followup needs.

Injury visits were defined as all

visits with a principal diagnosis in the

injury chapter of the ICD–9–CM (codes

800–999). Because external causes of

injury information (E-codes) were not

collected in the 1993 and 1994

NAMCS, injury categories in this report

were based solely on the ICD–9–CM

codes. E-coded data were collected in

NHAMCS beginning in 1992 and

NAMCS beginning in 1995 (23, 24).

(See table II for a listing of clinical

diagnoses and ICD–9–CM codes that

define clinical injury categories.)

Demographic variables were

obtained from the Patient Record Form

based on information in the child’s

medical record. This report includes

visits by children under 15 years of age.

Many results are reported separately for

infants (under 1 year of age),

Page 2 [ Series 13, No. 137
preschoolers (1–4 years of age), and

school-age children (5–14 years of age)

because use of ambulatory care differs

for these three age groups. In addition,

data are also presented by race of child

because of large differences in use of

ambulatory care by race.

Race of child (white, black) was

collected from the patient’s record. For

the 9 percent of records with missing

data on race, NCHS imputed the

information using a hot deck approach.

Total figures include children of races

not shown separately. Numbers were

unstable for Asian and American Indian

children and were not included as

separate categories. Due to a high

proportion of missing and imputed

records, data by Hispanic origin of child

were not presented.

Data for 3 survey years (1993,

1994, and 1995) were combined to

increase the stability of estimates.

Average annual numbers of visits, visit

rates per 100 children, percent

distributions of visits, and standard

errors were calculated using SUDAAN

(25), a statistical program for survey

data analysis that takes into account the

NAMCS and NHAMCS sample weights

and complex survey design. Annual

sample weights were divided by 3 to

calculate average annual estimates for

the 3-year period. Relative standard

errors were calculated as the standard

error divided by the point estimate

expressed as a percent. Population

denominators for rates are the U.S.

civilian noninstitutionalized population

averaged for 1993, 1994, and 1995. (See

table III). Assuming that the

denominators of the rates have a

negligible error, the standard errors for

rates were calculated as the rate

multiplied by the relative standard error

of the numerator. Estimates with relative

standard errors between 30–50 percent

are marked with asterisks, and estimates

with relative standard errors greater than

50 percent are not shown.

Differences discussed in the text

were tested for statistical significance

using the two-sided t-test with a critical

value of 2.57 (0.01 level of

significance). The 0.01 level of

significance was used because of the

increased probability of finding a

difference when one does not exist due

to the large number of tests carried out

and the large sample sizes for some

comparisons.

Results

All Visits

I

n 1993–95 children under 15 years

of age made a total of 165.3 million

ambulatory visits per year (table 1).

Among children, visit rates varied

inversely with age with the rate among

infants under 1 year of age 4 times the

rate among school-age children 5–14

years of age (815 and 204 visits per 100

children per year) (figure 1). Utilization

of ambulatory care visits was similar for

boys and girls (299 and 280 visits per

100 children per year). The visit rate

among white children was 43 percent

higher than among black children (307

compared with 215 visits per 100

children per year).

More than three-quarters of visits

among children occurred in physician

offices, 8 percent in hospital outpatient

departments, and 14 percent in hospital

emergency departments. The distribution

of ambulatory care visits among these

three sites of care was similar for boys

and girls and there were small

differences in this distribution among

infants, preschool, and school-age

children. However, use of the three

ambulatory care sites varied

considerably among white and black

children. The proportion of all

ambulatory care visits by white children

that occurred in physician offices was

substantially higher (81 percent) than

those by black children (54 percent). In

contrast, 19 percent of visits among

black children occurred in hospital

outpatient departments compared with

7 percent of visits among white children.

Twenty-eight percent of ambulatory care

visits by black children took place in

hospital emergency departments

compared with 12 percent of visits

among white children. Although black

children used the hospital outpatient and

emergency departments for ambulatory

care disproportionately to their numbers,

white children still made the vast

majority of visits that occurred in these

sites, accounting for more than

70 percent of the visits in each of these

settings.

The differential use of the three

ambulatory care sites by race of child is

also reflected in the visit rates for each

place (figure 2). The average annual

physician office visit rate for white

children (248 per 100 children) was

more than twice the rate for black

children (115 per 100 children). In

contrast, the hospital outpatient

department and hospital emergency

department visit rates were lower for

white children than for black children.

The average annual visit rate in hospital

outpatient departments was about half as

high for white children as for black

children. Hospital emergency department

visit rates were one-third lower for

Figure 1. Ambulatory care visit rates among children under 15 years of age by place of visit

and age: United States, average annual 1993–95

Series 13, No. 137 [ Page 3
white children than for black children

(38 compared with 60 visits per 100

children per year).

Visits by Principal

Diagnosis

Tables 2–8 and accompanying text

focus on the 162 million ambulatory

care visits with a principal diagnosis

coded, and exclude 1.9 percent of visits

without a principal diagnosis.

Well-Child Visits

Well-child visits accounted for

15 percent of all ambulatory care visits

provided to children (table 2). Well-child

visits accounted for one-third of

ambulatory care visits among infants

compared with 14 percent of visits

among preschoolers and 8 percent of

visits among school-age children

(figures 3–5). The well-child visit rate

among infants (256 visits per 100

infants per year) was 5 times the rate

among preschool children and the rate

among preschool children was almost 3

times as high as for school-age children

(49 and 17 visits per 100 children).

Rates for well-child visits were the same

for boys and girls, and were 66 percent

higher for white children than for black

children (tables 3 and 4). Rates for

well-child visits were almost 80 percent

higher for white infants than for black

infants (table 5, figure 3).

The most common site for

well-child visits was physician offices

(91 percent) (table 6). Eight percent of

well-child visits occurred in hospital

outpatient departments and less than

1 percent of well-child visits occurred in

hospital emergency departments.

Although well-child visit rates were

substantially higher in physician offices

than hospital outpatient departments,

well-child visits accounted for

15–17 percent of all visits provided in

physician offices and hospital outpatient

departments.

Use of well-child visits in physician

offices and hospital outpatient

departments varied substantially by race.

In physician offices, well-child visit

rates were twice as high among white

children as black children (42 visits

compared with 18 visits per 100

children). In contrast, well-child visit

rates in hospital outpatient departments

were 3 times as high among black

children as white children (9 and 3

visits per 100 children) (table 7,

figure 6). Additional analyses (not

shown) indicated that conclusions

regarding the use of well-child visits by

white and black children were

unchanged when second- and third-listed

diagnoses of well-child visits were

considered.

Middle Ear Infection Visits

Middle ear infection (otitis media)

was the principal diagnosis for

12 percent of ambulatory care visits

provided to children under 15 years of

age (table 2). Visit rates for middle ear

infection were similar among boys and

girls, but nearly 2 times as high among

white children as black children

(tables 3 and 4). Visit rates for middle

ear infection were substantially higher

among infants and preschoolers (110

and 65 visits per 100 children per year)

than older children (15 per 100

children). Visit rates for middle ear

infection were about 70 percent higher

among white infants than black infants

and among white preschool children

than black preschool children (table 5,

figures 3 and 4). Middle ear infection

was the most frequently occurring

principal diagnosis among preschool

children, accounting for 18 percent of

ambulatory care visits provided to

preschool children. Although the most

common site for visits with a principal

diagnosis of middle ear infection was

physician offices (81 percent), 13 percent

Figure 2. Ambulatory care visit rates among children under 15 years of age by place of visit

and race: United States, average annual 1993–95

Figure 3. Ambulatory care visit rates among children under 1 year of age by principal

diagnosis and race: United States, average annual 1993–95

Page 4 [ Series 13, No. 137
of visits with a principal diagnosis of

middle ear infection occurred in hospital

emergency departments and 6 percent in

hospital outpatient departments (table 6).

Middle ear infections accounted for

similar proportions of visits by children

in physician offices and hospital

emergency departments (12–13 percent).

Middle ear infection visit rates for the

three places of ambulatory care varied

substantially by race. Visit rates were 3

times as high among white children as

black children in physician offices (33

and 11 visits per 100 children); similar

in hospital outpatient departments; and

higher among black children than white

children in hospital emergency

departments (7 and 4 visits per 100

children) (table 7, figure 6).

Injury Visits

During 1993–95 visits with a

principal diagnosis of injury accounted

for 10 percent of ambulatory care visits

among children under 15 years of age

and 15 percent of visits among schoolage children (table 2). Two-thirds of

injury visits occurred among school-age

children, 28 percent among preschoolers,

and 4 percent among infants. Rates for

injury visits were about one-third higher

among boys than among girls (33 and

25 visits per 100 children) and among

white school-age children than among

black school-age children (tables 3 and

5, figure 5).

Injury visits were approximately

equally divided between physician

offices and hospital emergency

departments. Forty-seven percent of

injury visits took place in physician

offices, 47 percent in hospital emergency

departments, and 6 percent in hospital

outpatient departments (table 6). The

provision of ambulatory care services

for injury was a major component of

visits provided by hospital emergency

departments, accounting for about

one-third of visits by children to

hospital emergency departments. Rates

for injury visits in physician offices

varied by race with rates among white

children twice as high as among black

children (16 and 7 visits per 100

children). However, in hospital

outpatient and emergency department

sites, injury visit rates were similar

Figure 4. Ambulatory care visit rates among children 1–4 years of age by principal

diagnosis and race: United States, average annual 1993–95

Figure 5. Ambulatory care visit rates among children 5–14 years of age by principal

diagnosis and race: United States, average annual 1993–95

Figure 6. Ambulatory care visit rates among children under 15 years of age by place of

visit, principal diagnosis, and race: United States, average annual 1993–95

Series 13, No. 137 [ Page 5
among white and black children (table 7,

figure 6).

More detailed diagnosis information

for injury visits are presented in table 8.

(Detailed injury diagnosis data for age

subgroups are not presented because

two-thirds of injury visits occurred

among school-age children.) The three

most common injury categories (open

wounds; fracture of upper or lower

extremity; and scrape, bite, blister, and

bruise) accounted for almost two-thirds

of injury visits among children.

Injury visits involving open wounds

as the principal diagnosis accounted for

nearly one-quarter of injury visits

among children under 15 years of age.

Open wound visits were more likely to

occur in hospital emergency departments

than other places, with two-thirds of

visits for open wounds occurring in

emergency departments. These visits

were a major component of injury visits

provided by hospital emergency

departments, accounting for one-third of

injury visits among children to hospital

emergency departments.

Twenty percent of ambulatory care

injury visits among children involved

extremity fractures. Visits for fractures

were twice as likely to take place in

physician offices as in hospital

emergency departments (64 compared

with 28 percent). Almost half of injury

visits to physician offices for fracture of

the upper or lower extremity were for

followup purposes. (Analysis available

upon request).

Visits with a principal diagnosis of

scrapes and bruises (superficial injury

and contusion with intact skin surface)

accounted for 20 percent of all injury

visits among children. Visits for scrapes

and bruises were almost equally likely

to occur in physician offices and

hospital emergency departments, with

50 percent occurring in hospital

emergency departments and 45 percent

occurring in physician offices. Scrapes

and bruises were a major component of

injury visits provided by all three sites

of care, accounting for 22 percent of

emergency department visits and

17–19 percent of visits to the other two

sites.

Asthma Visits

Asthma accounted for almost

3 percent of visits by children (table 2).

The average annual visit rate for asthma

(7 visits per 100 children) was similar

for infants, preschool, and school-age

children. Asthma visit rates were

42 percent higher for boys than girls and

similar among white children and black

children (tables 3 and 4). About

three-quarters of visits with a principal

diagnosis of asthma took place in

physician offices, with an additional

15 percent in hospital emergency

departments and 11 percent in hospital

outpatient departments (table 6). Visits

for asthma made up a similar proportion

of ambulatory care services provided by

physician offices, hospital outpatient

departments, and hospital emergency

departments (2–4 percent of visits). In

physician offices and hospital outpatient

departments, asthma visit rates were

similar among white and black children.

By contrast, in hospital emergency

departments, asthma visit rates were

almost 4 times as high among black

children than white children (2.8 and 0.7

visits per 100 children) (table 7,

figure 6).

Attention Deficit Disorder Visits

The average annual visit rate for

attention deficit disorder (ADD) was 4

visits per 100 children, accounting for

1 percent of all ambulatory care medical

visits provided to children (table 2).

Visit rates for ADD were nearly 4 times

as high among boys as girls (table 3).

Visit rates were similar among white

and black children (table 4). Visits for

attention deficit disorder were heavily

concentrated among school-age children.

Ninety-four percent of visits with a

principal diagnosis of ADD occurred

among school-age children (table 2).

Attention deficit disorder accounted for

3 percent of ambulatory care visits

among school-age children. Ninety

percent of visits for ADD occurred in

physician offices (table 6). (Not included

in this analysis of ADD are visits to

nonphysician providers such as

psychologists, clinical social workers,

and physical and occupational

therapists.)

Discussion

Physician’s offices remained

the primary site of ambulatory

care for children in 1993–95 with

about three-quarters of visits occurring

there. However, a more complete picture

of ambulatory care use is also gained by

considering visits to hospital outpatient

and emergency departments. Visits to

hospital outpatient and emergency

departments were particularly prevalent

among black children.

Although a small proportion of

overall visits (8 percent) occurred in

hospital outpatient departments, they

accounted for almost 20 percent of visits

by black children. One-third of wellchild visits among black children

occurred in hospital outpatient

departments. In addition, hospital

outpatient departments were the site of

care for 13 percent of visits for ‘‘all

other diagnoses,’’ (table I) a category

that includes serious and less common

types of health problems. A higher

proportion of visits in hospital outpatient

departments than in physician offices

and emergency departments were for

‘‘all other diagnoses’’ (44 compared

with 24–26 percent of visits).

The emergency department

accounted for 14 percent of visits by

children overall, but 28 percent of visits

among black children and 47 percent of

all visits for injuries. About a third of

children’s visits to emergency rooms

were for injuries. However, the

proportion of emergency department

visits for conditions such as middle ear

infection (12 percent) and respiratory

illnesses were similar to the proportions

of visits in physician offices for those

conditions. This indicates that hospital

emergency departments may be used for

some apparently routine ambulatory care

for children.

Children access the health care

system for three broad reasons—

preventive care (15 percent of visits),

illness care (75 percent of visits), and

injury care (10 percent of visits). Visits

for preventive care provide an

opportunity for assessing growth and

development as well as to provide child

safety information and routine

immunizations. The strong inverse

Page 6 [ Series 13, No. 137
association of the ambulatory care visit

rate with age in part reflects the

recommended schedule of well-child

visits. Although prevention activities can

occur during other types of visits, these

services may not be as in-depth because

the primary focus of the visit is for

diagnosis and treatment of illness or

injury. Well-child visit rates for black

children were lower than rates for white

children, especially during infancy and

school-age years. Even if full well-child

services occurred during other visits,

black children received fewer of these

services because visit rates among black

children were lower than visit rates

among white children of the same age

group. Data from the 1994 National

Health Interview Survey, which provides

information on all ambulatory care

received regardless of the place of care,

show a similar relative difference in

physician contacts between white and

black children as in this report (5).

Another measure of preventive

services received by preschool children

is vaccination status. In 1996, 79 percent

of non-Hispanic white children 19–35

months of age compared with 74 percent

of non-Hispanic black children had

completed a combined series of vaccines

(four doses of diphtheria-tetanuspertussis vaccine, three doses of polio,

one dose of a measles-containing

vaccine, and three doses of Haemophilus

influenzae type b (Hib) vaccine) (26).

However, there was no difference in

vaccination status by race after

controlling for poverty status. The

percent of poor non-Hispanic black

children who were vaccinated was

similar to the percent of poor nonHispanic white children with

vaccinations, and poor children in both

groups had lower vaccination rates than

their nonpoor counterparts.

The lower rates of overall

ambulatory care use and well-child

visits among black children compared

with white children may be attributed to

financial as well as nonfinancial barriers

to care. In 1995, 42 percent of black

children compared with 16 percent of

white children under 18 years of age

lived in families with incomes below the

poverty threshold (5). In 1996, the

likelihood of black children living in a

two-parent family was less than half the

likelihood for white children (33 and

75 percent). This impacted on income

level as well as access to

employer-based private health insurance

coverage and the amount of time

available for health care visits (27). In

1994–95 among non-Hispanic children

under 18 years of age, black children

and white children were about equally

likely to be uninsured (14 and

12 percent) (unpublished data from the

NHIS). However, the type of coverage

differed by race, with black children

more likely than white children to have

Medicaid coverage (44 and 13 percent)

and black children less likely than white

children to have private coverage (40

and 74 percent).

The sites where care was received

may differ between black and white

children for several reasons. Although

Medicaid provides financial access to

care, the health care providers available

to those with Medicaid and those with

private coverage differ because not all

health care providers accept Medicaid

coverage. Other factors contributing to

racial differences in site of care may

include differences in the types of health

care providers located in the

neighborhoods where black children and

white children reside, and a greater need

for accessing the health care system

during evenings and weekends among

children in single-parent families. A

cross-sectional survey of patients in 56

hospital emergency departments found

that half the patients interviewed

(patients arriving by ambulance were

excluded) cited at least one nonfinancial

barrier to care as an important reason

for coming to the emergency department

(28). These included such reasons as

unable to go during the hours open,

nowhere else to go, and unable to get an

appointment soon enough.

Some caveats should be kept in

mind when interpreting the results of

this report. Visit rates should not be

interpreted as incidence or prevalence

rates but rather are a measure of the

total use of ambulatory care services

during a year. Visits captured in the

sampling include a combination of

initial and followup visits. In addition,

children without visits do not contribute

to the visit rate. Variation in visit rates

among groups reflect a number of

factors including underlying incidence

and prevalence of illness and injury,

severity of the condition, access to care,

and decisions about use of health care

such as whether to seek care for the

condition and number of followup visits.

The reader should exercise caution

in interpreting the necessity of an

ambulatory care visit based on the

principal diagnosis categories. Diagnosis

categories used in this report are based

on the physician’s principal diagnosis

assigned after the physician performed

an examination of the patient and

possibly received results from diagnostic

tests and laboratory studies. Thus, the

principal diagnosis may differ

significantly from the physician’s first

clinical impression as to the type of

illness. For example, a visit with a

principal diagnosis of a cold may have

initially been considered a possible case

of pneumonia or other more serious

respiratory illness.

Results presented in this report

should not be interpreted as providing

information regarding the

appropriateness of the place of visit,

especially for emergency department

visits. An emergency department may be

the appropriate location for treatment of

an apparently nonurgent diagnosis when

time of day and limitations of access to

other places are considered.

An additional limitation is that

broad diagnostic groupings, especially

for injury visits, were used due to

sample size considerations. Several

injury categories were collapsed in order

to obtain more stable estimates. A final

concern is the inability to capture the

severity of an illness in the principal

diagnosis or the ICD–9–CM coding.

Although comparisons of the same

category across three sites are possible,

they may be somewhat misleading due

to the potential for combining varying

severities of diagnosis within broad

categories. For example, injury visits in

emergency departments may be more

severe in nature than injury visits in

other sites.

In summary, data from 1993–95

show that the amount of care received

and the place of ambulatory care

services for children varied by age and

race. Utilization was higher among

infants than among children of other age

Series 13, No. 137 [ Page 7
groups, primarily due to high rates of

well-child visits among infants. Black

children received fewer visits overall

and fewer visits primarily dedicated to

well-child services than white children.

Black children were more likely to

receive ambulatory care in hospital

outpatient and emergency departments,

while white children were more likely to

use physician office services. Continued

monitoring of these differences in use of

ambulatory care among children are

needed, particularly in view of the

possible impact of changes in the health

care system on these differences.

References

1. Newacheck PW, Hughes DC, Stoddard

JJ. Children’s access to primary care:

differences by race, income, and

insurance status. Ped. 97(1):26–32.

1996.

2. Overpeck MD, Kotch JB. The effect of

US children’s access to care on medical

attention for injuries. AJPH

85(3):402–04. 1995.

3. Weissman JS, Epstein AM. Falling

through the safety net. Johns Hopkins

University Press. Baltimore, Maryland.

1994.

4. U.S. General Accounting Office.

Health, Education, and Human Services

Division. Health Insurance: Coverage

leads to increased health care access for

children. Washington, D.C. 1997.

5. National Center for Health Statistics.

Health, United States, 1996–97.

Hyattsville, Maryland: 1997.

6. National Center for Health Statistics.

Health, United States, 1998.

Hyattsville, Maryland: (forthcoming).

7. Simpson G, Bloom B, Cohen RA,

Parsons PE. Access to health care. Part

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Hyattsville, Maryland: Public Health

Service. 1991.

9. National Center for Health Statistics.

Health, United States, 1995.

Hyattsville, Maryland: Public Health

Service. 1996.

10. Woodwell DA, Schappert SM. National

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health statistics; no 270. Hyattsville,

Maryland: National Center for Health

Statistics. 1995.

11. Schappert SM. National Ambulatory

Medical Care Survey: 1994 summary.

Advance data from vital and health

statistics; no 273. Hyattsville,

Maryland: National Center for Health

Statistics. 1996.

12. Woodwell DA. National Ambulatory

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statistics; no 286. Hyattsville,

Maryland: National Center for Health

Statistics. 1997.

13. Stussman BJ. National Hospital

Ambulatory Medical Care Survey: 1993

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Maryland: National Center for Health

Statistics. 1996.

14. Stussman BJ. National Hospital

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emergency department summary.

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Maryland: National Center for Health

Statistics. 1996.

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Maryland: National Center for Health

Statistics. 1997.

16. Lipkind KL. National Hospital

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outpatient department summary.

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Maryland: National Center for Health

Statistics. 1995.

17. Lipkind KL. National Hospital

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outpatient department summary.

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Maryland: National Center for Health

Statistics. 1996.

18. Lipkind KL. National Hospital

Ambulatory Medical Care Survey: 1995

outpatient department summary.

Advance data from vital and health

statistics; no 284. Hyattsville,

Maryland: National Center for Health

Statistics. 1997.

19. Burt CW, Knapp DE. Ambulatory care

visits for asthma: United States,

1993–94. Advance data from vital and

health statistics; no 277. Hyattsville,

Maryland: National Center for Health

Statistics. 1996.

20. Schappert SM. Ambulatory care visits

to physician offices, hospital outpatient

departments, and emergency

departments: United States, 1995.

National Center for Health Statistics.

Vital and Health Statistics 13(129).

1997.

21. McCaig LF, McLemore T. Plan and

operation of the National Hospital

Ambulatory Medical Care Survey.

National Center for Health Statistics.

Vital and Health Statistics 1(34). 1994.

22. Public Health Service and Health Care

Financing Administration. International

classification of diseases, 9th revision,

clinical modification. Washington:

Public Health Service. 1989.

23. Fingerhut LA, Warner M. Injury

chartbook. Health, United States,

1996–97. Hyattsville, Maryland:

National Center for Health Statistics.

1997.

24. Burt CW, Fingerhut LA. Injury visits to

hospital emergency departments: United

States, 1992–95. National Center for

Health Statistics. Vital Health Stat

13(131). 1998.

25. Shah BV, Barnwell BG, Bieler GS.

SUDAAN user’s manual: software for

analysis of correlated data, release 6.40.

Research Triangle Park, North

Carolina: Research Triangle Institute.

1995.

26. Centers for Disease Control and

Prevention. Vaccination coverage by

race/ethnicity and poverty level among

children aged 19–35 months: United

States, 1996. MMWR 1997;

46(41):963–969.

27. Federal Interagency Forum on Child

and Family Statistics. America’s

children: key national indicators of

well-being. 1997.

28. Young GP, Wagner MB, Kellermann

AL et al. Ambulatory visits to hospital

emergency departments: Patterns and

reasons for use. JAMA 276(6):460–5.

1996.

Page 8 [ Series 13, No. 137
Table 1. Ambulatory care visits among children under 15 years of age by place of visit, age, sex, and race: United States, average annual

1993–95

Age, sex, and race All places

Physician

office

Hospital

outpatient

department

Hospital

emergency

department

All

places

Physician

office

Hospital

outpatient

department

Hospital

emergency

department

Number of visits in thousands Standard error

All races1 ...................... 165,299 128,416 13,828 23,055 5,966 5,051 1,524 986

Age

Under 5 years ................... 88,958 68,862 7,488 12,608 3,624 3,151 795 571

Under 1 year .................. 31,533 24,886 2,792 3,854 1,461 1,349 289 197

1–4 years .................... 57,425 43,976 4,695 8,754 2,313 1,959 522 397

5–14 years ..................... 76,340 59,554 6,340 10,447 2,659 2,299 790 449

Sex

Male ......................... 87,280 67,508 7,213 12,560 3,284 2,818 796 555

Female ....................... 78,018 60,908 6,615 10,495 2,852 2,414 739 452

Race

White ........................ 139,426 112,593 9,814 17,018 5,523 4,813 1,224 815

Black ......................... 19,090 10,232 3,542 5,316 1,095 859 408 322

Number of visits per 100 children per year

All races1 ...................... 289.4 224.8 24.2 40.4 10.4 8.8 2.7 1.7

Age

Under 5 years ................... 452.8 350.5 38.1 64.2 18.4 16.0 4.0 2.9

Under 1 year .................. 815.2 643.4 72.2 99.6 37.8 34.9 7.5 5.1

1–4 years .................... 363.9 278.7 29.8 55.5 14.7 12.4 3.3 2.5

5–14 years ..................... 203.7 158.9 16.9 27.9 7.1 6.1 2.1 1.2

Sex

Male ......................... 298.5 230.9 24.7 43.0 11.2 9.6 2.7 1.9

Female ....................... 279.8 218.4 23.7 37.6 10.2 8.7 2.6 1.6

Race

White ........................ 307.4 248.2 21.6 37.5 12.2 10.6 2.7 1.8

Black ......................... 215.2 115.3 39.9 59.9 12.3 9.7 4.6 3.6

Percent distribution

All races1 ...................... 100.0 77.7 8.4 14.0 . . . 1.1 0.8 0.6

Age

Under 5 years ................... 100.0 77.4 8.4 14.2 . . . 1.2 0.8 0.7

Under 1 year .................. 100.0 78.9 8.9 12.2 . . . 1.3 0.9 0.7

1–4 years .................... 100.0 76.6 8.2 15.2 . . . 1.1 0.8 0.7

5–14 years ..................... 100.0 78.0 8.3 13.7 . . . 1.2 1.0 0.6

Sex

Male ......................... 100.0 77.4 8.3 14.4 . . . 1.1 0.8 0.6

Female ....................... 100.0 78.1 8.5 13.5 . . . 1.1 0.9 0.6

Race

White ........................ 100.0 80.8 7.0 12.2 . . . 1.1 0.8 0.6

Black ......................... 100.0 53.6 18.6 27.9 . . . 2.7 1.8 1.6

. . . Category not applicable.

1Includes all other races not shown separately.

NOTE: This table shows data for all visits, including 1.9 percent of visits without a principal diagnosis coded, and differs from data shown in tables 2–8.

Series 13, No. 137 [ Page 9
Table 2. Ambulatory care visits among children by age and principal diagnosis category: United States, average annual 1993–95

Principal diagnosis category

Under

15 years

Under

1 year

1–4

years

5–14

years

Under

15 years

Under

1 year

1–4

years

5–14

years

Number of visits in thousands Standard error

Total ......................... 162,072 30,851 56,354 74,867 5,850 1,439 2,268 2,613

Well-child visit ................... 23,896 9,899 7,758 6,239 1,370 702 462 500

Injury ......................... 16,579 708 4,618 11,253 666 72 228 492

Selected respiratory conditions

Cold, cough, runny nose ............. 13,805 3,145 6,168 4,493 771 224 406 391

Sore throat, tonsillitis ............... 8,445 448 2,745 5,253 595 85 262 394

Hayfever, sinusitis ................. 5,321 *237 1,436 3,649 405 75 150 337

Bronchitis ...................... 4,232 700 1,597 1,936 395 108 198 209

Asthma ....................... 4,109 249 1,251 2,609 286 47 151 197

Pneumonia ..................... 2,299 715 891 693 243 101 128 109

Streptococcal sore throat ............ 1,870 * 498 1,362 212 . . . 99 160

Croup . . . . . . . . . . . . . . . . . . . . . . . . 822 105 510 207 108 25 89 51

Selected ear conditions

Middle ear infection ................ 20,127 4,272 10,256 5,600 1,140 353 622 355

External ear canal infection ........... 1,006 * 150 831 136 . . . 38 129

Selected eye conditions

Infectious conjunctivitis .............. 2,093 307 882 904 180 63 108 117

Correctable vision ................. 1,821 *70 572 1,179 337 24 150 199

Selected other conditions

Viral syndrome ................... 3,756 884 1,596 1,276 306 109 142 172

Eczema ....................... 3,192 654 942 1,596 238 103 91 158

Attention deficit disorder . . . . . . . . . . . . . 2,113 * *131 1,979 258 . . . 39 253

Bladder infection .................. 1,035 *63 352 620 115 20 60 88

Gastroenteritis . . . . . . . . . . . . . . . . . . . 651 85 347 219 90 18 61 52

Chicken pox . . . . . . . . . . . . . . . . . . . . 631 *80 239 312 97 27 46 78

All other diagnoses ................ 44,270 8,196 13,415 22,658 1,754 439 626 987

Number of visits per 100 children per year

Total ......................... 283.7 797.6 357.1 199.8 10.2 37.2 14.4 7.0

Well-child visit ................... 41.8 255.9 49.2 16.6 2.4 18.1 2.9 1.3

Injury ......................... 29.0 18.3 29.3 30.0 1.2 1.9 1.4 1.3

Selected respiratory conditions

Cold, cough, runny nose ............. 24.2 81.3 39.1 12.0 1.4 5.8 2.6 1.0

Sore throat, tonsillitis ............... 14.8 11.6 17.4 14.0 1.0 2.2 1.7 1.1

Hayfever, sinusitis . . . . . . . . . . . . . . . . . 9.3 *6.1 9.1 9.7 0.7 1.9 0.9 0.9

Bronchitis . . . . . . . . . . . . . . . . . . . . . . 7.4 18.1 10.1 5.2 0.7 2.8 1.3 0.6

Asthma . . . . . . . . . . . . . . . . . . . . . . . 7.2 6.4 7.9 7.0 0.5 1.2 1.0 0.5

Pneumonia . . . . . . . . . . . . . . . . . . . . . 4.0 18.5 5.7 1.8 0.4 2.6 0.8 0.3

Streptococcal sore throat . . . . . . . . . . . . 3.3 * 3.2 3.6 0.4 . . . 0.6 0.4

Croup . . . . . . . . . . . . . . . . . . . . . . . . 1.4 2.7 3.2 0.6 0.2 0.7 0.6 0.1

Selected ear conditions

Middle ear infection ................ 35.2 110.4 65.0 14.9 2.0 9.1 3.9 0.9

External ear canal infection . . . . . . . . . . . 1.8 * 1.0 2.2 0.2 . . . 0.2 0.3

Selected eye conditions

Infectious conjunctivitis . . . . . . . . . . . . . . 3.7 7.9 5.6 2.4 0.3 1.6 0.7 0.3

Correctable vision . . . . . . . . . . . . . . . . . 3.2 *1.8 3.6 3.1 0.6 0.6 0.9 0.5

Selected other conditions

Viral syndrome . . . . . . . . . . . . . . . . . . . 6.6 22.8 10.1 3.4 0.5 2.8 0.9 0.5

Eczema . . . . . . . . . . . . . . . . . . . . . . . 5.6 16.9 6.0 4.3 0.4 2.7 0.6 0.4

Attention deficit disorder . . . . . . . . . . . . . 3.7 * *0.8 5.3 0.5 . . . 0.2 0.7

Bladder infection . . . . . . . . . . . . . . . . . . 1.8 *1.6 2.2 1.7 0.2 0.5 0.4 0.2

Gastroenteritis . . . . . . . . . . . . . . . . . . . 1.1 2.2 2.2 0.6 0.2 0.5 0.4 0.1

Chicken pox . . . . . . . . . . . . . . . . . . . . 1.1 *2.1 1.5 0.8 0.2 0.7 0.3 0.2

All other diagnoses ................ 77.5 211.9 85.0 60.5 3.1 11.4 4.0 2.6

Page 10 [ Series 13, No. 137
Table 2. Ambulatory care visits among children by age and principal diagnosis category: United States, average annual 1993–95—Con.

Principal diagnosis category

Under

15 years

Under

1 year

1–4

years

5–14

years

Under

15 years

Under

1 year

1–4

years

5–14

years

Percent distribution Standard error

Total ......................... 100.0 100.0 100.0 100.0 . . . . . . . . . . . .

Well-child visit ................... 14.7 32.1 13.8 8.3 0.6 1.5 0.6 0.6

Injury ......................... 10.2 2.3 8.2 15.0 0.3 0.2 0.4 0.5

Selected respiratory conditions

Cold, cough, runny nose . . . . . . . . . . . . . 8.5 10.2 10.9 6.0 0.4 0.7 0.6 0.5

Sore throat, tonsillitis . . . . . . . . . . . . . . . 5.2 1.5 4.9 7.0 0.3 0.3 0.4 0.4

Hayfever, sinusitis . . . . . . . . . . . . . . . . . 3.3 *0.8 2.6 4.9 0.3 0.3 0.3 0.5

Bronchitis . . . . . . . . . . . . . . . . . . . . . . 2.6 2.3 2.8 2.6 0.2 0.3 0.3 0.3

Asthma . . . . . . . . . . . . . . . . . . . . . . . 2.5 0.8 2.2 3.5 0.2 0.2 0.3 0.3

Pneumonia . . . . . . . . . . . . . . . . . . . . . 1.4 2.3 1.6 0.9 0.1 0.3 0.2 0.2

Streptococcal sore throat . . . . . . . . . . . . 1.2 * 0.9 1.8 0.1 . . . 0.2 0.2

Croup . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.3 0.9 0.3 0.1 0.1 0.2 0.1

Selected ear conditions

Middle ear infection ................ 12.4 13.9 18.2 7.5 0.5 0.9 0.7 0.4

External ear canal infection . . . . . . . . . . . 0.6 * 0.3 1.1 0.1 . . . 0.1 0.2

Selected eye conditions

Infectious conjunctivitis . . . . . . . . . . . . . . 1.3 1.0 1.6 1.2 0.1 0.2 0.2 0.2

Correctable vision . . . . . . . . . . . . . . . . . 1.1 *0.2 1.0 1.6 0.2 0.1 0.3 0.3

Selected other conditions

Viral syndrome . . . . . . . . . . . . . . . . . . . 2.3 2.9 2.8 1.7 0.2 0.3 0.2 0.2

Eczema . . . . . . . . . . . . . . . . . . . . . . . 2.0 2.1 1.7 2.1 0.1 0.3 0.2 0.2

Attention deficit disorder . . . . . . . . . . . . . 1.3 * *0.2 2.6 0.2 . . . 0.1 0.3

Bladder infection . . . . . . . . . . . . . . . . . . 0.6 *0.2 0.6 0.8 0.1 0.1 0.1 0.1

Gastroenteritis . . . . . . . . . . . . . . . . . . . 0.4 0.3 0.6 0.3 0.1 0.1 0.1 0.1

Chicken pox . . . . . . . . . . . . . . . . . . . . 0.4 *0.3 0.4 0.4 0.1 0.1 0.1 0.1

All other diagnoses ................ 27.3 26.6 23.8 30.3 0.6 1.1 0.7 0.8

Percent distribution

Total ......................... 100.0 19.0 34.8 46.2 . . . 0.4 0.5 0.6

Well-child visit ................... 100.0 41.4 32.5 26.1 . . . 1.6 1.1 1.5

Injury ......................... 100.0 4.3 27.9 67.9 . . . 0.4 0.9 1.0

Selected respiratory conditions

Cold, cough, runny nose ............. 100.0 22.8 44.7 32.5 . . . 1.5 1.6 1.9

Sore throat, tonsillitis ............... 100.0 5.3 32.5 62.2 . . . 1.0 2.0 2.2

Hayfever, sinusitis ................. 100.0 *4.4 27.0 68.6 . . . 1.4 2.5 2.8

Bronchitis ...................... 100.0 16.5 37.7 45.7 . . . 2.2 2.7 2.8

Asthma ....................... 100.0 6.1 30.5 63.5 . . . 1.1 2.7 2.8

Pneumonia ..................... 100.0 31.1 38.8 30.1 . . . 2.9 3.9 3.8

Streptococcal sore throat ............ 100.0 * 26.7 72.9 . . . . . . 4.1 4.1

Croup ........................ 100.0 12.7 62.1 25.2 . . . 3.1 6.1 5.4

Selected ear conditions

Middle ear infection ................ 100.0 21.2 51.0 27.8 . . . 1.1 1.3 1.2

External ear canal infection ........... 100.0 * 14.9 82.6 . . . . . . 3.8 4.1

Selected eye conditions

Infectious conjunctivitis .............. 100.0 14.7 42.1 43.2 . . . 3.0 3.9 4.0

Correctable vision ................. 100.0 *3.9 31.4 64.7 . . . 1.2 3.6 4.0

Selected other conditions

Viral syndrome ................... 100.0 23.5 42.5 34.0 . . . 2.3 2.8 3.1

Eczema ....................... 100.0 20.5 29.5 50.0 . . . 2.8 2.6 3.0

Attention deficit disorder ............. 100.0 * *6.2 93.7 . . . . . . 1.9 1.9

Bladder infection .................. 100.0 *6.1 34.0 59.9 . . . 2.0 4.6 4.7

Gastroenteritis ................... 100.0 13.0 53.3 33.7 . . . 2.7 6.3 6.1

Chicken pox .................... 100.0 *12.7 37.9 49.4 . . . 4.1 6.9 7.8

All other diagnoses ................ 100.0 18.5 30.3 51.2 . . . 0.7 0.8 0.9

. . . Category not applicable.

* Estimates with a relative standard error between 30–50 percent are shown with an asterisk. Estimates with a relative standard error greater than 50 percent are not shown.

NOTE: This table excludes 1.9 percent of visits without a principal diagnosis coded, and differs from data presented in table 1. See appendix table I for definitions of principal diagnosis categories and

ICD–9–CM codes.

Series 13, No. 137 [ Page 11
Table 3. Ambulatory care visits among children under 15 years of age by sex and principal diagnosis category: United States, average

annual 1993–95

Principal diagnosis category

Both

sexes Males Females

Both

sexes Males Females

Number of visits in thousands Standard error

Total ................................ 162,072 85,699 76,373 5,850 3,234 2,789

Well-child visit .......................... 23,896 12,127 11,769 1,370 782 724

Injury ................................ 16,579 9,623 6,956 666 435 325

Selected respiratory conditions

Cold, cough, runny nose .................... 13,805 7,047 6,758 771 441 441

Sore throat, tonsillitis ...................... 8,445 4,253 4,192 595 339 327

Hayfever, sinusitis ........................ 5,321 2,805 2,516 405 250 217

Bronchitis ............................. 4,232 2,452 1,781 395 281 182

Asthma .............................. 4,109 2,451 1,658 286 182 171

Pneumonia ............................ 2,299 1,207 1,093 243 166 126

Streptococcal sore throat ................... 1,870 843 1,027 212 129 136

Croup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 822 432 390 108 75 73

Selected ear conditions

Middle ear infection ....................... 20,127 10,844 9,283 1,140 692 548

External ear canal infection .................. 1,006 542 464 136 92 73

Selected eye conditions

Infectious conjunctivitis ..................... 2,093 1,057 1,035 180 123 106

Correctable vision ........................ 1,821 886 935 337 160 189

Selected other conditions

Viral syndrome .......................... 3,756 1,796 1,960 306 157 194

Eczema .............................. 3,192 1,875 1,316 238 165 127

Attention deficit disorder . . . . . . . . . . . . . . . . . . . . 2,113 1,684 428 258 208 78

Bladder infection ......................... 1,035 225 810 115 49 104

Gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . . . 651 372 279 90 65 50

Chicken pox . . . . . . . . . . . . . . . . . . . . . . . . . . . 631 300 331 97 57 77

All other diagnoses ....................... 44,270 22,878 21,392 1,754 982 895

Number of visits per 100 children per year

Total ................................ 283.7 293.1 273.9 10.2 11.1 10.0

Well-child visit .......................... 41.8 41.5 42.2 2.4 2.7 2.6

Injury ................................ 29.0 32.9 24.9 1.2 1.5 1.2

Selected respiratory conditions

Cold, cough, runny nose .................... 24.2 24.1 24.2 1.4 1.5 1.6

Sore throat, tonsillitis ...................... 14.8 14.6 15.0 1.0 1.2 1.2

Hayfever, sinusitis . . . . . . . . . . . . . . . . . . . . . . . . 9.3 9.6 9.0 0.7 0.9 0.8

Bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 8.4 6.4 0.7 1.0 0.7

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 8.4 5.9 0.5 0.6 0.6

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0 4.1 3.9 0.4 0.6 0.5

Streptococcal sore throat . . . . . . . . . . . . . . . . . . . 3.3 2.9 3.7 0.4 0.4 0.5

Croup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 1.5 1.4 0.2 0.3 0.3

Selected ear conditions

Middle ear infection ....................... 35.2 37.1 33.3 2.0 2.4 2.0

External ear canal infection . . . . . . . . . . . . . . . . . . 1.8 1.9 1.7 0.2 0.3 0.3

Selected eye conditions

Infectious conjunctivitis . . . . . . . . . . . . . . . . . . . . . 3.7 3.6 3.7 0.3 0.4 0.4

Correctable vision . . . . . . . . . . . . . . . . . . . . . . . . 3.2 3.0 3.4 0.6 0.6 0.7

Selected other conditions

Viral syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . 6.6 6.1 7.0 0.5 0.5 0.7

Eczema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6 6.4 4.7 0.4 0.6 0.5

Attention deficit disorder . . . . . . . . . . . . . . . . . . . . 3.7 5.8 1.5 0.5 0.7 0.3

Bladder infection . . . . . . . . . . . . . . . . . . . . . . . . . 1.8 0.8 2.9 0.2 0.2 0.4

Gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 1.3 1.0 0.2 0.2 0.2

Chicken pox . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 1.0 1.2 0.2 0.2 0.3

All other diagnoses ....................... 77.5 78.3 76.7 3.1 3.4 3.2

Page 12 [ Series 13, No. 137
Table 3. Ambulatory care visits among children under 15 years of age by sex and principal diagnosis category: United States, average

annual 1993–95—Con.

Principal diagnosis category

Both

sexes Males Females

Both

sexes Males Females

Percent distribution Standard error

Total ................................ 100.0 100.0 100.0 . . . . . . . . .

Well-child visit .......................... 14.7 14.2 15.4 0.6 0.7 0.7

Injury ................................ 10.2 11.2 9.1 0.3 0.4 0.4

Selected respiratory conditions

Cold, cough, runny nose . . . . . . . . . . . . . . . . . . . . 8.5 8.2 8.9 0.4 0.4 0.5

Sore throat, tonsillitis . . . . . . . . . . . . . . . . . . . . . . 5.2 5.0 5.5 0.3 0.3 0.4

Hayfever, sinusitis . . . . . . . . . . . . . . . . . . . . . . . . 3.3 3.3 3.3 0.3 0.3 0.3

Bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 2.9 2.3 0.2 0.3 0.2

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 2.9 2.2 0.2 0.2 0.2

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 1.4 1.4 0.1 0.2 0.2

Streptococcal sore throat . . . . . . . . . . . . . . . . . . . 1.2 1.0 1.3 0.1 0.1 0.2

Croup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.5 0.5 0.1 0.1 0.1

Selected ear conditions

Middle ear infection ....................... 12.4 12.7 12.2 0.5 0.6 0.5

External ear canal infection . . . . . . . . . . . . . . . . . . 0.6 0.6 0.6 0.1 0.1 0.1

Selected eye conditions

Infectious conjunctivitis . . . . . . . . . . . . . . . . . . . . . 1.3 1.2 1.4 0.1 0.2 0.1

Correctable vision . . . . . . . . . . . . . . . . . . . . . . . . 1.1 1.0 1.2 0.2 0.2 0.3

Selected other conditions

Viral syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 2.1 2.6 0.2 0.2 0.2

Eczema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.0 2.2 1.7 0.1 0.2 0.2

Attention deficit disorder . . . . . . . . . . . . . . . . . . . . 1.3 2.0 0.6 0.2 0.2 0.1

Bladder infection . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 0.3 1.1 0.1 0.1 0.1

Gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.4 0.4 0.1 0.1 0.1

Chicken pox . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.4 0.4 0.1 0.1 0.1

All other diagnoses ....................... 27.3 26.7 28.0 0.6 0.7 0.7

Percent distribution

Total ................................ 100.0 52.9 47.1 . . . 0.5 0.5

Well-child visit .......................... 100.0 50.8 49.3 . . . 1.4 1.4

Injury ................................ 100.0 58.0 42.0 . . . 1.1 1.1

Selected respiratory conditions

Cold, cough, runny nose .................... 100.0 51.1 49.0 . . . 1.6 1.6

Sore throat, tonsillitis ...................... 100.0 50.4 49.6 . . . 1.8 1.8

Hayfever, sinusitis ........................ 100.0 52.7 47.3 . . . 2.3 2.3

Bronchitis ............................. 100.0 57.9 42.1 . . . 2.9 2.9

Asthma .............................. 100.0 59.7 40.3 . . . 2.7 2.7

Pneumonia ............................ 100.0 52.5 47.5 . . . 3.7 3.7

Streptococcal sore throat ................... 100.0 45.1 54.9 . . . 4.5 4.5

Croup ............................... 100.0 52.5 47.5 . . . 6.2 6.2

Selected ear conditions

Middle ear infection ....................... 100.0 53.9 46.1 . . . 1.3 1.3

External ear canal infection .................. 100.0 53.9 46.1 . . . 4.9 4.9

Selected eye conditions

Infectious conjunctivitis ..................... 100.0 50.5 49.5 . . . 3.6 3.6

Correctable vision ........................ 100.0 48.6 51.4 . . . 2.6 2.6

Selected other conditions

Viral syndrome .......................... 100.0 47.8 52.2 . . . 2.4 2.4

Eczema .............................. 100.0 58.8 41.2 . . . 2.7 2.7

Attention deficit disorder .................... 100.0 79.7 20.3 . . . 2.7 2.7

Bladder infection ......................... 100.0 21.8 78.2 . . . 4.4 4.4

Gastroenteritis .......................... 100.0 57.1 42.9 . . . 5.8 5.8

Chicken pox ........................... 100.0 47.5 52.5 . . . 7.7 7.7

All other diagnoses ....................... 100.0 51.7 48.3 . . . 0.8 0.8

. . . Category not applicable.

NOTE: This table excludes 1.9 percent of visits without a principal diagnosis coded, and differs from data presented in table 1. See appendix table I for definitions of principal diagnosis categories and

ICD–9–CM codes.

Series 13, No. 137 [ Page 13
Table 4. Ambulatory care visits among children under 15 years of age by race and principal diagnosis category: United States, average

annual 1993–95

Principal diagnosis category

All

races1 White Black

All

races1 White Black

Number of visits in thousands Standard error

Total .............................. 162,072 136,849 18,623 5,850 5,420 1,042

Well-child visit ........................ 23,896 20,166 2,376 1,370 1,225 216

Injury .............................. 16,579 14,032 2,109 666 616 163

Selected respiratory conditions

Cold, cough, runny nose .................. 13,805 11,292 1,764 771 716 184

Sore throat, tonsillitis .................... 8,445 7,359 840 595 548 98

Hayfever, sinusitis ...................... 5,321 4,688 344 405 391 71

Bronchitis ........................... 4,232 3,786 325 395 369 77

Asthma ............................ 4,109 3,155 760 286 259 90

Pneumonia .......................... 2,299 1,959 289 243 216 60

Streptococcal sore throat ................. 1,870 1,640 *186 212 208 57

Croup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 822 747 *63 108 106 24

Selected ear conditions

Middle ear infection ..................... 20,127 17,636 1,800 1,140 1,054 139

External ear canal infection ................ 1,006 936 * 136 136 . . .

Selected eye conditions

Infectious conjunctivitis ................... 2,093 1,773 285 180 174 58

Correctable vision ...................... 1,821 1,638 *115 337 310 41

Selected other conditions

Viral syndrome ........................ 3,756 3,088 380 306 267 57

Eczema ............................ 3,192 2,337 609 238 206 100

Attention deficit disorder . . . . . . . . . . . . . . . . . . 2,113 1,871 230 258 238 60

Bladder infection ....................... 1,035 856 *140 115 104 45

Gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . 651 541 96 90 83 27

Chicken pox . . . . . . . . . . . . . . . . . . . . . . . . . 631 519 83 97 91 22

All other diagnoses ..................... 44,270 36,832 5,770 1,754 1,596 385

Number of visits per 100 children per year

Total .............................. 283.7 301.7 209.9 10.2 11.9 11.7

Well-child visit ........................ 41.8 44.5 26.8 2.4 2.7 2.4

Injury .............................. 29.0 30.9 23.8 1.2 1.4 1.8

Selected respiratory conditions

Cold, cough, runny nose .................. 24.2 24.9 19.9 1.4 1.6 2.1

Sore throat, tonsillitis .................... 14.8 16.2 9.5 1.0 1.2 1.1

Hayfever, sinusitis . . . . . . . . . . . . . . . . . . . . . . 9.3 10.3 3.9 0.7 0.9 0.8

Bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 8.3 3.7 0.7 0.8 0.9

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 7.0 8.6 0.5 0.6 1.0

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0 4.3 3.3 0.4 0.5 0.7

Streptococcal sore throat . . . . . . . . . . . . . . . . . 3.3 3.6 *2.1 0.4 0.5 0.7

Croup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 1.6 *0.7 0.2 0.2 0.3

Selected ear conditions

Middle ear infection ..................... 35.2 38.9 20.3 2.0 2.3 1.6

External ear canal infection . . . . . . . . . . . . . . . . 1.8 2.1 * 0.2 0.3 . . .

Selected eye conditions

Infectious conjunctivitis . . . . . . . . . . . . . . . . . . . 3.7 3.9 3.2 0.3 0.4 0.7

Correctable vision . . . . . . . . . . . . . . . . . . . . . . 3.2 3.6 *1.3 0.6 0.7 0.5

Selected other conditions

Viral syndrome . . . . . . . . . . . . . . . . . . . . . . . . 6.6 6.8 4.3 0.5 0.6 0.6

Eczema . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6 5.2 6.9 0.4 0.5 1.1

Attention deficit disorder . . . . . . . . . . . . . . . . . . 3.7 4.1 2.6 0.5 0.5 0.7

Bladder infection . . . . . . . . . . . . . . . . . . . . . . . 1.8 1.9 *1.6 0.2 0.2 0.5

Gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . 1.1 1.2 1.1 0.2 0.2 0.3

Chicken pox . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 1.1 0.9 0.2 0.2 0.2

All other diagnoses ..................... 77.5 81.2 65.1 3.1 3.5 4.3

Page 14 [ Series 13, No. 137
Table 4. Ambulatory care visits among children under 15 years of age by race and principal diagnosis category: United States, average

annual 1993–95—Con.

Principal diagnosis category

All

races1 White Black

All

races1 White Black

Percent distribution Standard error

Total .............................. 100.0 100.0 100.0 . . . . . . . . .

Well-child visit ........................ 14.7 14.7 12.8 0.6 0.6 0.9

Injury .............................. 10.2 10.3 11.3 0.3 0.4 0.7

Selected respiratory conditions

Cold, cough, runny nose . . . . . . . . . . . . . . . . . . 8.5 8.3 9.5 0.4 0.4 0.8

Sore throat, tonsillitis . . . . . . . . . . . . . . . . . . . . 5.2 5.4 4.5 0.3 0.3 0.5

Hayfever, sinusitis . . . . . . . . . . . . . . . . . . . . . . 3.3 3.4 1.9 0.3 0.3 0.4

Bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 2.8 1.7 0.2 0.3 0.4

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 2.3 4.1 0.2 0.2 0.4

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 1.4 1.6 0.1 0.1 0.3

Streptococcal sore throat . . . . . . . . . . . . . . . . . 1.2 1.2 *1.0 0.1 0.1 0.3

Croup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.6 *0.3 0.1 0.1 0.1

Selected ear conditions

Middle ear infection ..................... 12.4 12.9 9.7 0.5 0.5 0.6

External ear canal infection . . . . . . . . . . . . . . . . 0.6 0.7 * 0.1 0.1 . . .

Selected eye conditions

Infectious conjunctivitis . . . . . . . . . . . . . . . . . . . 1.3 1.3 1.5 0.1 0.1 0.3

Correctable vision . . . . . . . . . . . . . . . . . . . . . . 1.1 1.2 *0.6 0.2 0.2 0.2

Selected other conditions

Viral syndrome . . . . . . . . . . . . . . . . . . . . . . . . 2.3 2.3 2.0 0.2 0.2 0.3

Eczema . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.0 1.7 3.3 0.1 0.1 0.5

Attention deficit disorder . . . . . . . . . . . . . . . . . . 1.3 1.4 1.2 0.2 0.2 0.3

Bladder infection . . . . . . . . . . . . . . . . . . . . . . . 0.6 0.6 *0.8 0.1 0.1 0.2

Gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.4 0.5 0.1 0.1 0.2

Chicken pox . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.4 0.5 0.1 0.1 0.1

All other diagnoses ..................... 27.3 26.9 31.0 0.6 0.7 1.1

. . . Category not applicable.

* Estimates with a relative standard error between 30–50 percent are shown with an asterisk. Estimates with a relative standard error greater than 50 percent are not shown.

1All races includes races not listed separately.

NOTE: This table excludes 1.9 percent of visits without a principal diagnosis coded, and differs from data presented in table 1. See appendix table I for definitions of principal diagnosis categories and

ICD–9–CM codes.

Series 13, No. 137 [ Page 15
Table 5. Ambulatory care visits among children under 15 years of age by selected principal diagnosis category, age, and race:

United States, average annual 1993–95

Age and race

All

visits

Selected diagnoses

Wellchild

visit

Middle

ear

infection Injury

Cold,

cough,

runny nose

Sore throat/

tonsillitis Asthma

Under 15 years Number of visits per 100 children per year

All races1 ...................... 283.7 41.8 35.2 29.0 24.2 14.8 7.2

White ....................... 301.7 44.5 38.9 30.9 24.9 16.2 7.0

Black ....................... 209.9 26.8 20.3 23.8 19.9 9.5 8.6

Under 5 years:

All races1 ..................... 443.9 89.9 73.9 27.1 47.4 16.3 7.6

White ...................... 469.3 96.1 80.7 28.6 48.2 18.1 7.5

Black ...................... 340.6 59.5 47.5 23.3 39.4 10.2 9.4

Under 1 year:

All races1 .................. 797.6 255.9 110.4 18.3 81.3 11.6 6.4

White ................... 836.7 276.2 121.4 18.9 79.9 12.2 6.4

Black ................... 628.6 156.4 73.0 16.5 82.6 8.9 6.5

1–4 years:

All races1 .................. 357.1 49.2 65.0 29.3 39.1 17.4 7.9

White ................... 379.5 52.1 70.8 31.0 40.4 19.6 7.8

Black ................... 270.3 35.8 41.3 24.9 28.8 10.5 10.2

5–14 years:

All races1 ..................... 199.8 16.6 14.9 30.0 12.0 14.0 7.0

White ...................... 214.3 17.5 17.1 32.1 12.8 15.2 6.7

Black ...................... 140.0 9.3 5.7 24.0 9.5 9.1 8.1

Under 15 years Standard error

All races1 ...................... 10.2 2.4 2.0 1.2 1.4 1.0 0.5

White . . . . . . . . . . . . . . . . . . . . . . . 11.9 2.7 2.3 1.4 1.6 1.2 0.6

Black . . . . . . . . . . . . . . . . . . . . . . . 11.7 2.4 1.6 1.8 2.1 1.1 1.0

Under 5 years:

All races1 ..................... 18.1 5.4 4.5 1.3 2.7 1.5 0.8

White ...................... 20.9 6.0 5.3 1.6 3.1 1.8 1.0

Black ...................... 20.6 5.9 3.7 1.9 4.0 1.8 1.5

Under 1 year:

All races1 .................. 37.2 18.1 9.1 1.9 5.8 2.2 1.2

White ................... 41.7 20.1 10.7 2.2 6.4 2.3 1.5

Black ................... 45.7 20.5 9.1 2.4 11.3 3.8 1.5

1–4 years:

All races1 .................. 14.4 2.9 3.9 1.4 2.6 1.7 1.0

White ................... 16.9 3.5 4.6 1.7 3.0 2.0 1.2

Black ................... 17.5 4.4 3.6 2.1 3.9 2.1 1.7

5–14 years:

All races1 . . . . . . . . . . . . . . . . . . . . . 7.0 1.3 0.9 1.3 1.0 1.1 0.5

White . . . . . . . . . . . . . . . . . . . . . . 8.2 1.5 1.1 1.5 1.2 1.2 0.6

Black . . . . . . . . . . . . . . . . . . . . . . 8.6 1.4 0.9 2.3 1.8 1.4 1.2

1All races includes races not listed separately.

NOTE: This table excludes 1.9 percent of visits without a principal diagnosis coded, and differs from data presented in table 1. See appendix table I for definitions of principal diagnosis categories and

ICD–9–CM codes.

Page 16 [ Series 13, No. 137
Table 6. Ambulatory care visits among children under 15 years of age by place of visit and principal diagnosis category: United States,

average annual 1993–95

Principal diagnosis category

All

places

Physician

office

Hospital

outpatient

department

Hospital

emergency

department

All

places

Physician

office

Hospital

outpatient

department

Hospital

emergency

department

Number of visits in thousands Standard error

Total .............................. 162,072 125,968 13,457 22,647 5,850 4,957 1,492 969

Well-child visit ........................ 23,896 21,825 1,997 74 1,370 1,304 213 12

Injury .............................. 16,579 7,856 1,006 7,717 666 442 165 330

Selected respiratory conditions

Cold, cough, runny nose .................. 13,805 11,509 772 1,524 771 741 130 96

Sore throat, tonsillitis .................... 8,445 6,980 443 1,022 595 558 89 72

Hayfever, sinusitis ...................... 5,321 4,854 265 202 405 409 53 24

Bronchitis ........................... 4,232 3,587 119 527 395 389 26 43

Asthma ............................ 4,109 3,029 469 611 286 272 106 46

Pneumonia .......................... 2,299 1,747 103 449 243 231 25 43

Streptococcal sore throat ................. 1,870 1,607 100 163 212 206 25 24

Croup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 822 595 *34 193 108 103 14 23

Selected ear conditions

Middle ear infection ..................... 20,127 16,310 1,172 2,646 1,140 1,077 151 152

External ear canal infection ................ 1,006 846 *50 110 136 136 16 17

Selected eye conditions

Infectious conjunctivitis ................... 2,093 1,688 131 273 180 177 23 28

Correctable vision ...................... 1,821 1,661 *159 * 337 332 60 . . .

Selected other conditions

Viral syndrome ........................ 3,756 2,668 157 931 306 282 26 86

Eczema ............................ 3,192 2,613 240 338 238 222 41 34

Attention deficit disorder . . . . . . . . . . . . . . . . . . 2,113 1,887 220 *5 258 252 49 2

Bladder infection ....................... 1,035 753 84 198 115 115 16 20

Gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . 651 428 37 186 90 84 9 24

Chicken pox . . . . . . . . . . . . . . . . . . . . . . . . . 631 500 25 106 97 94 7 15

All other diagnoses ..................... 44,270 33,027 5,873 5,370 1,754 1,335 694 267

Number of visits per 100 children per year

Total .............................. 283.7 220.5 23.6 39.6 10.2 8.7 2.6 1.7

Well-child visit ........................ 41.8 38.2 3.5 0.1 2.4 2.3 0.4 0.0

Injury .............................. 29.0 13.8 1.8 13.5 1.2 0.8 0.3 0.6

Selected respiratory conditions

Cold, cough, runny nose .................. 24.2 20.1 1.4 2.7 1.4 1.3 0.2 0.2

Sore throat, tonsillitis .................... 14.8 12.2 0.8 1.8 1.0 1.0 0.2 0.1

Hayfever, sinusitis . . . . . . . . . . . . . . . . . . . . . . 9.3 8.5 0.5 0.4 0.7 0.7 0.1 0.0

Bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 6.3 0.2 0.9 0.7 0.7 0.1 0.1

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 5.3 0.8 1.1 0.5 0.5 0.2 0.1

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0 3.1 0.2 0.8 0.4 0.4 0.0 0.1

Streptococcal sore throat . . . . . . . . . . . . . . . . . 3.3 2.8 0.2 0.3 0.4 0.4 0.0 0.0

Croup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 1.0 *0.1 0.3 0.2 0.2 0.0 0.0

Selected ear conditions

Middle ear infection ..................... 35.2 28.6 2.1 4.6 2.0 1.9 0.3 0.3

External ear canal infection . . . . . . . . . . . . . . . . 1.8 1.5 *0.1 0.2 0.2 0.2 0.0 0.0

Selected eye conditions

Infectious conjunctivitis . . . . . . . . . . . . . . . . . . . 3.7 3.0 0.2 0.5 0.3 0.3 0.0 0.1

Correctable vision . . . . . . . . . . . . . . . . . . . . . . 3.2 2.9 *0.3 * 0.6 0.6 0.1 . . .

Selected other conditions

Viral syndrome . . . . . . . . . . . . . . . . . . . . . . . . 6.6 4.7 0.3 1.6 0.5 0.5 0.1 0.2

Eczema . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6 4.6 0.4 0.6 0.4 0.4 0.1 0.1

Attention deficit disorder . . . . . . . . . . . . . . . . . . 3.7 3.3 0.4 * 0.5 0.4 0.1 . . .

Bladder infection . . . . . . . . . . . . . . . . . . . . . . . 1.8 1.3 0.2 0.3 0.2 0.2 0.0 0.0

Gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . 1.1 0.7 0.1 0.3 0.2 0.1 0.0 0.0

Chicken pox . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 0.9 0.0 0.2 0.2 0.2 0.0 0.0

All other diagnoses ..................... 77.5 57.8 10.3 9.4 3.1 2.3 1.2 0.5

Series 13, No. 137 [ Page 17
Table 6. Ambulatory care visits among children under 15 years of age by place of visit and principal diagnosis category: United States,

average annual 1993–95—Con.

Principal diagnosis category

All

places

Physician

office

Hospital

outpatient

department

Hospital

emergency

department

All

places

Physician

office

Hospital

outpatient

department

Hospital

emergency

department

Percent distribution Standard error

Total .............................. 100.0 100.0 100.0 100.0 . . . . . . . . . . . .

Well-child visit ........................ 14.7 17.3 14.8 0.3 0.6 0.7 1.1 0.1

Injury .............................. 10.2 6.2 7.5 34.1 0.3 0.3 0.7 0.7

Selected respiratory conditions

Cold, cough, runny nose . . . . . . . . . . . . . . . . . . 8.5 9.1 5.7 6.7 0.4 0.5 0.6 0.3

Sore throat, tonsillitis . . . . . . . . . . . . . . . . . . . . 5.2 5.5 3.3 4.5 0.3 0.4 0.4 0.3

Hayfever, sinusitis . . . . . . . . . . . . . . . . . . . . . . 3.3 3.9 2.0 0.9 0.3 0.4 0.2 0.1

Bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 2.9 0.9 2.3 0.2 0.3 0.1 0.2

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 2.4 3.5 2.7 0.2 0.2 0.6 0.2

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 1.4 0.8 2.0 0.1 0.2 0.1 0.2

Streptococcal sore throat . . . . . . . . . . . . . . . . . 1.2 1.3 0.7 0.7 0.1 0.2 0.1 0.1

Croup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.5 *0.3 0.9 0.1 0.1 0.1 0.1

Selected ear conditions

Middle ear infection ..................... 12.4 13.0 8.7 11.7 0.5 0.6 0.5 0.4

External ear canal infection . . . . . . . . . . . . . . . . 0.6 0.7 0.4 0.5 0.1 0.1 0.1 0.1

Selected eye conditions

Infectious conjunctivitis . . . . . . . . . . . . . . . . . . . 1.3 1.3 1.0 1.2 0.1 0.1 0.1 0.1

Correctable vision . . . . . . . . . . . . . . . . . . . . . . 1.1 1.3 *1.2 * 0.2 0.3 0.4 . . .

Selected other conditions

Viral syndrome . . . . . . . . . . . . . . . . . . . . . . . . 2.3 2.1 1.2 4.1 0.2 0.2 0.2 0.3

Eczema . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.0 2.1 1.8 1.5 0.1 0.2 0.2 0.1

Attention deficit disorder . . . . . . . . . . . . . . . . . . 1.3 1.5 1.6 * 0.2 0.2 0.3 . . .

Bladder infection . . . . . . . . . . . . . . . . . . . . . . . 0.6 0.6 0.6 0.9 0.1 0.1 0.1 0.1

Gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.3 0.3 0.8 0.1 0.1 0.1 0.1

Chicken pox . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.4 0.2 0.5 0.1 0.1 0.0 0.1

All other diagnoses ..................... 27.3 26.2 43.6 23.7 0.6 0.7 1.8 0.5

Percent distribution

Total .............................. 100.0 77.7 8.3 14.0 . . . 1.1 0.8 0.6

Well-child visit ........................ 100.0 91.3 8.4 0.3 . . . 0.9 0.9 0.1

Injury .............................. 100.0 47.4 6.1 46.6 . . . 1.7 0.9 1.5

Selected respiratory conditions

Cold, cough, runny nose .................. 100.0 83.4 5.6 11.0 . . . 1.4 1.0 0.9

Sore throat, tonsillitis .................... 100.0 82.6 5.3 12.1 . . . 1.6 1.1 1.1

Hayfever, sinusitis ...................... 100.0 91.2 5.0 3.8 . . . 1.4 1.2 0.5

Bronchitis ........................... 100.0 84.8 2.8 12.5 . . . 1.7 0.7 1.4

Asthma ............................ 100.0 73.7 11.4 14.9 . . . 3.1 2.5 1.4

Pneumonia .......................... 100.0 76.0 4.5 19.6 . . . 3.0 1.2 2.5

Streptococcal sore throat ................. 100.0 86.0 5.3 8.7 . . . 2.2 1.5 1.5

Croup ............................. 100.0 72.4 *4.1 23.5 . . . 4.2 1.8 3.6

Selected ear conditions

Middle ear infection ..................... 100.0 81.0 5.8 13.1 . . . 1.4 0.8 0.9

External ear canal infection ................ 100.0 84.1 *5.0 10.9 . . . 3.5 1.9 2.2

Selected eye conditions

Infectious conjunctivitis ................... 100.0 80.7 6.3 13.1 . . . 2.5 1.2 1.7

Correctable vision ...................... 100.0 91.2 *8.7 * . . . 3.5 3.5 . . .

Selected other conditions

Viral syndrome ........................ 100.0 71.0 4.2 24.8 . . . 2.8 0.8 2.5

Eczema ............................ 100.0 81.9 7.5 10.6 . . . 2.0 1.2 1.2

Attention deficit disorder .................. 100.0 89.3 10.4 *0.3 . . . 2.6 2.6 0.1

Bladder infection ....................... 100.0 72.7 8.1 19.2 . . . 4.0 1.8 2.9

Gastroenteritis ........................ 100.0 65.7 5.7 28.6 . . . 5.3 1.6 4.5

Chicken pox ......................... 100.0 79.3 *4.0 16.7 . . . 3.9 1.3 3.3

All other diagnoses ..................... 100.0 74.6 13.3 12.1 . . . 1.5 1.3 0.6

. . . Category not applicable.

0.0 Quantity more than zero but less than 0.05.

* Estimates with a relative standard error between 30–50 percent are shown with an asterisk. Estimates with a relative standard error greater than 50 percent are not shown.

NOTE: This table excludes 1.9 percent of visits without a principal diagnosis coded, and differs from data presented in table 1. See appendix table I for definitions of principal diagnosis categories and

ICD–9–CM codes.

Page 18 [ Series 13, No. 137
Table 7. Ambulatory care visits among children under 15 years of age by place of visit, race, and selected principal diagnosis category:

United States, average annual 1993–95

Principal diagnosis category

All places Physician office Hospital outpatient department Hospital emergency department

White Black White Black White Black White Black

Number of visits per 100 children per year

Well-child visit ........................ 44.5 26.8 41.9 17.8 2.5 8.8 * *

Middle ear infection ..................... 38.9 20.3 32.6 10.6 2.0 2.8 4.3 6.9

Injury .............................. 30.9 23.8 15.5 6.8 1.6 2.8 13.8 14.1

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.0 8.6 5.6 4.1 0.7 1.7 0.7 2.8

Attention deficit disorder . . . . . . . . . . . . . . . . . . 4.1 2.6 3.8 *2.0 0.4 0.6 * *

Standard error

Well-child visit . . . . . . . . . . . . . . . . . . . . . . . . 2.7 2.4 2.6 2.1 0.3 1.1 . . . . . .

Middle ear infection . . . . . . . . . . . . . . . . . . . . . 2.3 1.6 2.2 1.3 0.3 0.4 0.3 0.6

Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 1.8 0.9 1.2 0.3 0.6 0.6 1.1

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 1.0 0.6 0.8 0.1 0.4 0.1 0.3

Attention deficit disorder . . . . . . . . . . . . . . . . . . 0.5 0.7 0.5 0.7 0.1 0.2 . . . . . .

. . . Category not applicable.

* Estimates with a relative standard error between 30–50 percent are shown with an asterisk. Estimates with a relative standard error greater than 50 percent are not shown.

NOTE: Data shown for selected diagnostic categories only. See appendix table I for definitions of principal diagnosis categories and ICD–9–CM codes.

Series 13, No. 137 [ Page 19
Table 8. Injury visits among children under 15 years of age by place of visit and principal injury diagnosis category: United States, average

annual 1993–95

Principal injury diagnosis category All places

Physician

office

Hospital

outpatient

department

Hospital

emergency

department

All

places

Physician

office

Hospital

outpatient

department

Hospital

emergency

department

Number in thousands Standard error

Total .............................. 16,579 7,856 1,006 7,717 666 442 165 330

Open wound ......................... 3,910 1,107 183 2,620 214 135 40 125

Fracture of upper, lower extremity ............ 3,401 2,160 307 935 221 195 58 57

Scrape, bite, blister, bruise ................ 3,381 1,513 167 1,701 184 147 44 84

Dislocations, strains, sprains of joints .......... 2,128 1,162 103 863 150 122 20 61

Fracture of skull or intracranial injury . . . . . . . . . . 768 310 30 427 83 70 10 35

Poisoning or toxic effect . . . . . . . . . . . . . . . . . . 539 208 25 305 80 69 7 30

Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440 204 35 201 55 47 12 24

All other injury ........................ 2,012 1,192 156 665 139 119 31 50

Number of visits per 100 children per year

Total .............................. 29.0 13.8 1.8 13.5 1.2 0.8 0.3 0.6

Open wound . . . . . . . . . . . . . . . . . . . . . . . 6.9 1.9 0.3 4.6 0.4 0.2 0.1 0.2

Fracture of upper, lower extremity . . . . . . . . . . . . 6.0 3.8 0.5 1.6 0.4 0.3 0.1 0.1

Scrape, bite, blister, bruise . . . . . . . . . . . . . . . . 5.9 2.7 0.3 3.0 0.3 0.3 0.1 0.2

Dislocations, strains, sprains of joints . . . . . . . . . . 3.7 2.0 0.2 1.5 0.3 0.2 0.0 0.1

Fracture of skull or intracranial injury . . . . . . . . . . 1.3 0.5 0.1 0.8 0.2 0.1 0.0 0.1

Poisoning or toxic effect . . . . . . . . . . . . . . . . . . 0.9 0.4 0.0 0.5 0.1 0.1 0.0 0.1

Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.8 0.4 0.1 0.4 0.1 0.1 0.0 0.0

All other injury . . . . . . . . . . . . . . . . . . . . . . . . 3.5 2.1 0.3 1.2 0.2 0.2 0.1 0.1

Percent distribution

Total .............................. 100.0 100.0 100.0 100.0 . . . . . . . . . . . .

Open wound ......................... 23.6 14.1 18.2 34.0 0.9 1.5 1.9 0.9

Fracture of upper, lower extremity ............ 20.5 27.5 30.5 12.1 1.0 2.0 3.6 0.5

Scrape, bite, blister, bruise ................ 20.4 19.3 16.6 22.0 0.9 1.8 2.3 0.7

Dislocations, strains, sprains of joints .......... 12.8 14.8 10.2 11.2 0.7 1.3 1.3 0.6

Fracture of skull or intracranial injury . . . . . . . . . . 4.6 4.0 3.0 5.5 0.5 0.9 0.9 0.4

Poisoning or toxic effect . . . . . . . . . . . . . . . . . . 3.3 2.7 2.5 4.0 0.5 0.9 0.6 0.3

Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 2.6 3.5 2.6 0.3 0.6 0.9 0.3

All other injury ........................ 12.1 15.2 15.5 8.6 0.7 1.4 1.6 0.5

Percent distribution

Total .............................. 100.0 47.4 6.1 46.6 . . . 1.7 0.9 1.5

Open wound ......................... 100.0 28.3 4.7 67.0 . . . 2.5 1.0 2.4

Fracture of upper, lower extremity ............ 100.0 63.5 9.0 27.5 . . . 2.6 1.6 1.9

Scrape, bite, blister, bruise ................ 100.0 44.8 4.9 50.3 . . . 2.8 1.3 2.5

Dislocations, strains, sprains of joints .......... 100.0 54.6 4.8 40.6 . . . 2.9 1.0 2.7

Fracture of skull or intracranial injury .......... 100.0 40.4 3.9 55.6 . . . 5.8 1.4 5.5

Poisoning or toxic effect .................. 100.0 38.7 4.7 56.6 . . . 7.7 1.4 7.1

Trauma ............................ 100.0 46.3 8.0 45.7 . . . 6.7 2.6 5.8

All other injury ........................ 100.0 59.2 7.7 33.1 . . . 3.0 1.5 2.5

. . . Category not applicable.

0.0 Quantity more than zero but less than 0.05.

NOTE: This table excludes 1.9 percent of visits without a principal diagnosis coded, and differs from data presented in table 1. See appendix table II for definitions of principal injury diagnosis

categories and ICD–9–CM codes.

Page 20 [ Series 13, No. 137
Appendix

Principal Diagnosis

Category and Population

Tables

Table I. Principal diagnosis categories and ICD–9–CM codes

Principal diagnosis category Definition of ICD–9–CM code

Well-child visit

V20.2 ................. Routine infant or child health check

V70.0 ................. Routine general medical exam

V70.5 ................. Health exam of defined subpopulations

V70.9 ................. Unspecified general medical exam

Injury

800–999 ................ Injury and poisoning

Cold, cough, runny nose

460.0 .................. Acute nasopharyngitis

464.0 .................. Acute laryngitis

465.9 .................. Acute upper respiratory infection, unspecified site

472.0 .................. Chronic rhinitis

786.2 .................. Cough

Sore throat, tonsillitis

462.0 .................. Acute pharyngitis

463.0 .................. Acute tonsillitis

472.1–472.2 ............. Chronic pharyngitis/nasopharyngitis

474 . . . . . . . . . . . . . . . . . . . Chronic diseases of tonsils and adenoids

475 . . . . . . . . . . . . . . . . . . . Peritonsillar abscess

Hayfever, sinusitis

461 . . . . . . . . . . . . . . . . . . . Acute sinusitis

473 . . . . . . . . . . . . . . . . . . . Chronic sinusitis

477 . . . . . . . . . . . . . . . . . . . Allergic rhinitis

Bronchitis

466.0 .................. Acute bronchitis

490 . . . . . . . . . . . . . . . . . . . Bronchitis, not specified as acute or chronic

491 . . . . . . . . . . . . . . . . . . . Chronic bronchitis

Asthma

493 . . . . . . . . . . . . . . . . . . . Asthma

Pneumonia

466.1 .................. Acute bronchiolitis

480 . . . . . . . . . . . . . . . . . . . Viral pneumonia

481 . . . . . . . . . . . . . . . . . . . Pneumococcal pneumonia

482 . . . . . . . . . . . . . . . . . . . Other bacterial pneumonia

483 . . . . . . . . . . . . . . . . . . . Pneumonia due to specified organism

484 . . . . . . . . . . . . . . . . . . . Pneumonia in infectious disease

485 . . . . . . . . . . . . . . . . . . . Bronchopneumonia, organism unspecified

486 . . . . . . . . . . . . . . . . . . . Pneumonia, organism unspecified

487.0 .................. Influenza with pneumonia

Streptococcal sore throat

034.0 .................. Streptococcal sore throat

034.1 .................. Scarlet fever

Croup

464.1–464.4 ............. Acute tracheitis, laryngotracheitis, epiglottitis, and croup

Middle ear infection

381.0–381.4 ............. Nonsupprative otitis media

382 . . . . . . . . . . . . . . . . . . . Supprative and unspecified otitis media

Series 13, No. 137 [ Page 21
Table I. Principal diagnosis categories and ICD–9–CM codes—Con.

Principal diagnosis category Definition of ICD–9–CM code

External ear canal infection

380.1–380.16 ............ Infective otitis externa

380.2–380.23 ............ Other otitis externa

Infectious conjunctivitis

077.9 .................. Viral conjunctivitis, not otherwise specified

372.0–372.05 ............ Acute conjunctivitis

372.1–372.14 ............ Chronic conjunctivitis

372.30 ................. Conjunctivitis, unspecified

372.39 ................. Other conjunctivitis

372.9 .................. Unspecified disorder of conjunctiva

Correctable vision

367.0 .................. Hypermetropia

367.1 .................. Myopia

367.2 .................. Astigmatism

367.3 .................. Anisometropia and aniseikonia

367.4 .................. Presbyopia

367.5 .................. Disorders of accomodation

367.8 .................. Other disorders of refraction and accomodation

367.9 .................. Unspecified disorder of refraction and accomodation

378.0–378.9 ............. Strabismus and other disorders of binocular eye

movements

Viral syndrome

054.2 .................. Herpetic gingivostomatitis

054.9 .................. Herpes simplex without mention of complication

057.0 .................. Erythema infectiosum

057.8 .................. Other viral exanthemata (Fourth disease, roseola etc).

057.9 .................. Viral exanthem, unspecified

074.0 .................. Herpangina

074.3 .................. Hand, foot, and mouth disease

074.8 .................. Other diseases due to Coxsackie virus

075.0 .................. Infectious mononucleosis

079.0 .................. Adenovirus

079.1 .................. ECHO virus

079.2 .................. Coxsackie virus

079.3 .................. Rhinovirus

079.8 .................. Other specified viral infections

079.9 .................. Viral infection, not otherwise specified

487.1 .................. Influenza with other respiratory manifestations

780.6 .................. Pyrexia of unknown origin

Eczema

691 . . . . . . . . . . . . . . . . . . . Atopic dermatitis and related conditions

692 . . . . . . . . . . . . . . . . . . . Contact dermatitis and other eczema

693 . . . . . . . . . . . . . . . . . . . Dermatitis due to substances taken internally

708 . . . . . . . . . . . . . . . . . . . Urticaria

Attention deficit disorder

314.0 .................. Without hyperactivity

314.01 ................. With hyperactivity

Bladder infection

595.0 .................. Acute cystitis

595.9 .................. Cystitis, unspecified

599.0 .................. Urinary tract infection, site not specified

Gastroenteritis

008.6 .................. Enteritis due to specified virus

008.8 .................. Other organism, not elsewhere classified

009.0 .................. Infectious colitis, enteritis, and gastroenteritis

009.1 .................. Gastroenteritis of presumed infectious origin

009.2 .................. Infectious diarrhea

009.3 .................. Diarrhea of presumed infectious origin

Chicken pox

052 . . . . . . . . . . . . . . . . . . . Varicella, with and without complications

All other diagnoses ......... Includes all other diagnoses not mentioned in

the above categories, excluding missing

diagnoses

NOTE: ICD–9–CM code numbers include currently existing subcategories. For example, code 367.2 includes 367.20–367.22.

Page 22 [ Series 13, No. 137
Table II. Principal injury diagnosis categories and ICD–9–CM codes

Principal injury diagnosis category Definition of ICD–9–CM code

Open wound

870–879 ..................... Open wound head, neck, trunk

880–887 ..................... Open wound upper limb

890–897 ..................... Open wound lower limb

Fracture of upper, lower extremity

810–819 ..................... Fracture upper limb

820–829 ..................... Fracture lower limb

Scrape, bite, blister, bruise

910–924 ..................... Superficial injury, contusion with intact skin surface

Dislocations, strains, sprains of joints

830–839 ..................... Dislocation

840–848 ..................... Sprains and strains of joints and adjacent muscles

Fracture of skull or intracranial injury

800–804 ..................... Fracture of skull

850–854 ..................... Intracranial injury, excluding those with skull fracture

Poisoning or toxic effect

960–979 ..................... Poisoning by drugs, medicinals and biological substances

980–989 ..................... Toxic effects of substances chiefly nonmedicinal as to source

Trauma

958–959 ..................... Certain traumatic complications and unspecified injuries

All other injury ................. Includes all other injury diagnoses (ICD–9–CM codes

800–999) not mentioned in the above categories

NOTE: ICD–9–CM code numbers include currently existing subcategories. For example, 872 includes 872.00–872.9.

Table III. Civilian noninstitutionalized population by age, sex, and race: United States, average annual 1993–95

Age

All

races Male Female White Black

Number in thousands

Under 15 years of age .............. 57,123 29,236 27,887 45,364 8,870

Under 5 years ................... 19,647 10,052 9,594 15,541 3,092

Under 1 year .................... 3,868 1,978 1,889 3,053 607

1–4 years ...................... 15,779 8,074 7,705 12,488 2,485

5–14 years ..................... 37,476 19,183 18,293 29,823 5,778

NOTE: All races includes races not shown separately. All estimates are consistent with the 1990 census as enumerated, without adjustment for undercoverage.

Source: U.S. Population Estimates, by age, sex, race, and Hispanic origin: 1990–1994 Civilian noninstitutionalized population. PPL-21 Appendix D. U.S. Population Estimates by age, sex, race, and

Hispanic origin: 1990–1996. PPL-57. Populations Projection Branch, U.S. Bureau of the Census.

Series 13, No. 137 [ Page 23
Vital and Health Statistics

series descriptions

SERIES 1. Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

SERIES 2. Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies also

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

SERIES 3. Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistics. These reports carry the analyses further than

the expository types of reports in the other series.

SERIES 4. Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

SERIES 5. International Vital and Health Statistics Reports—These

reports are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

SERIES 6. Cognition and Survey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

SERIES 10. Data From the National Health Interview Survey—These

reports contain statistics on illness; unintentional injuries;

disability; use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

SERIES 11. Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributions of the population with respect to

physical, physiological, and psychological characteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

SERIES 12. Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

SERIES 13. Data From the National Health Care Survey—These

reports contain statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14. Data on Health Resources: Manpower and Facilities—

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

SERIES 15. Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

SERIES 16. Compilations of Advance Data From Vital and Health

Statistics—Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10–13.

SERIES 20. Data on Mortality—These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

SERIES 21. Data on Natality, Marriage, and Divorce—These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

SERIES 22. Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

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

These reports contain statistics on factors that affect birth

rates, including contraception, infertility, cohabitation,

marriage, divorce, and remarriage; adoption; use of medical

care for family planning and infertility; and related maternal

and infant health topics. These statistics are based on

national surveys of women of childbearing age.

SERIES 24. Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly Vital Statistics Report (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782-2003

(301) 436–8500

E-mail: nchsquery@cdc.gov

Internet: www.cdc.gov/nchswww/
DHHS Publication No. (PHS) 98-1798, Series 13, No. 137

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