FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

US. DEPARTMENT OF HEALTH, EIIJCATION, AND WELFARE j No. 5. February 22, 1977 I Public Health Service. Health Resources Administration 

A Comparison of Levels of Serum Cholesterol of Adults 

18-74 Years of Age in the United States in 1960-62 and 1971-74a 

Serum cholesterol data obtained from the justed response rate of 70 percent and an effecfindings of the Health and Nutrition Examina- tive adjusted response of 70 percent. A detaiIed 

tion Survey (HANES), 1971-74, present an op- description of the sample and response of the 

portunity to reexamine the level of serum cho- Health Examination Survey of 1960-62 has been 

lesterol of the U.S. population aged 18-74 published.c Detailed estimates of the distribuyears.] EarIier determinations of serum choles- tion of serum cholesterol Ieve]s wiII be described 

terol levels were made in the first cycle of the and analyzed in a forthcoming report in Series 

HeaIth Examination Survey (HES), 1960-62, in 11 ~ of Vital and Health Statistics. SeIected data 

order to provide reference data for the general and findings from that report on the comparison e population of the United States.z This was of Ievek of serum cholesterol in the United 

prompted by the epidemiologic studies associ- States in 1960-62 and 1971-74 are presented 

ating levels of total blood cholesterol with the here (tables 1-3 and figures 1-4). -

risk of development of coronary heart disease.3’5 

Field data collection operations for the first 

Fi9ure 1. MEAN SERUM CHOLESTEROL LEVEL OF MEN 18-74 HANES survey were started in April 1971 and YEARS BY AGE UNITED STATES, 1960-62 AND 1971-74 

completed in June 1974. Of the 28,043 persons 

aged 1-74 years who were selected in the nationaI probability sample to represent the 194 

million persons in that age group in the civilian 

noninstitutionalized population, 20,749, or 74.0	 ~ 250 

~ percent, were examined. When adjustments were E 240 

made for the differential sampling ratios used & 23ZS 

0 .. F:-o:: . . . . . . . . . . . . . . . . . . . 229.5 ... .. . ... .. .. for the effect of oversampling among the poor, ~ 230 %8 / . . ..-------’ ~8G =.4 ~ 

. . .

preschool chiIdren, women of childbearing age, : 220 ..... ~Qg 

2256 

and the elderly, this corresponds to an effective : ....” 

..... 

response rate of 75 percent. Among those 18-74 :

: 210 2059 . . .. 

.. .. 

years of age at interview for whom serum choles- z

u 

200 ..... - =! terol determinations were made, there were . ....” . . . . ..1960.62 

: — 1971.74 13,645 examined out of the probability sampIe z 190 / 

<“~ ‘ . I?as of 19,572 seIected to represent the 128 milIion = 180 ,,al 

of that age in the population. This is an unad- 170/-

0 

# I I I I I 

18.24 25.34 35-44 45454 5544 65 and 

aThis report prepared by Sidney Abraham, Clifford over 

L. .]ohnson, and Margaret D. Carroll, Division of Health AGE IN YEARS 

Exknination Statistic;. 
..

2 ackincedata 

* 

CHOLESTEROL DETERMINATIONS– 

HES AND HANES 

Serum cholesterol determinations for HES 

were made using a modified ferric-chloride technique at the Lipid Standardization Laboratory 

of the (then) Communicable Disease Center 

(CDC), Public Health Service, Atlanta, Georgia. 

A comparative study of cholesterol methods 

which was conducted by CDC during the course 

of the Health Examination Survey determined 

that the ferric- sulfuric method in use was positively biased with respect to the method of 

Abell, Levy, Brodie, and Kendall, which was 

chosen as a basis of reference for its close approximation to “true” serum cholesterol values. z The data in the HES report presented here 

are therefore the original ferric-chloride values 

reduced by a factor of 7.6 percent to approximate Abell et al. determinations. 

All serum cholesterol determinations for 

HANES were made in the Lipid Standardization 

Laboratory of what is now the Center for Disease Control, Public Health Service, Atlanta, 

Georgia. The analytical method was based on 

fi9ure 2. MEAN SERUM CHOLESTEROL LEVEL OF WOMEN 18-74 

YEARS BY AGE: UNITED STATES, 1960-62 AND 1971-74 

270 — 265.7 

262.3 . . . . . . . . . ..- ... . . . . ~~~ 

... 

~ 250 

!1 ..’.”’.”.. /@., 

246,2 

238,8 /. 

/ 

/ 

/ 23I.7 

. ....” 

~ 220 ...”. 

: 213,6/..’ 

; 2,0 . . . . . 

. ..”. ~~e~ 

: 

~ 200 ,97,9....’”./ 2 

a I ......1960.62 

% m!- ...4 —1971.74 

z 1d . . . . . . 

5 

z 180 183”1 

“--F 

170 k­

/-” 

I I I I I 18.24 25.34 35.44 45.54 55.64 65 and 

over 

AGE IN YEARS 

that of Abell et al.~ but was modified for a semiautomated production line. The method, described in detail by Eavenson et al.g was made 

possible by the development of a relatively 

stable Liebermann color reagent and was designed for automatic pipetting units. 

The Lipid Laboratory at the Center for Disease Control compared the results obtained with 

this semiautomated Abell et al. method and 

those obtained from their standardized version 

of Abell et al.s For examining the bias of the 

semiautomated method, data were obtained 

from pools of sera analyzed by the reference 

method and the semiautomated method. For 

pools ranging from 134 to 343 mg per 100 ml, 

there was in 1972 an average positive bias of 

4.07 percent for the semiautomated method 

compared with the standard method; for the 

1973-74 period, the corresponding figure was a 

positive bias of 4.9 percent. The weighted avera.qe bias was 4.5 percent. Therefore the data 

p~esented here are ‘the original values produced 

by the semiautomated method diminished by * 4.5 percent to approximate Abell et al. determinations. 

Figure 3. MEAN SERUM CHOLESTEROL LEVEL OF ADULTS 18-74 

YEARS BY AGE AND SEX UNITED STATES, 1960-82 

270 

265.7 

2623 . . . ..-

.. . . . . . ..-

260 ...’. 

/ 

250 / 

/. 

236.8. .... 240 

1 / ..... 

.. 230 

22%6 

t 

.. . . . 

. ... 200 

. . ...97.9 

. . . . . Men 

220 ... 

r / ,...” 

210 ./ ..’ 213,6 

205,9 . . 

190 E/ . 

— 

. . . . . ~ome” . .. 

. . . .. . 

160 ,,8,1 

17$ 

o~ 

18.24 25.34 35.44 45.54 S5.64 65 and 

over 

AGE IN YEARS 
..

-----

However, in the later report,T HANES 

1971-74 serum cholesterol data will be presented without correction for bias when no comparisons are made between HANES data and the 

data from HES, 1960-62. Those data will thus 

provide population reference standards for determinations made by the semiautomated 

methodology now in use. 

FINDINGS 

Figure 1 and table 2 show that in all age 

groupings mean serum cholesterol levels for men 

in the HES sample are slightly higher than those 

for men in the HANES sample except for the 

age group 18-24 years, when the HANES sample 

is 0.4 mg per 100 mI higher than that for the 

HES sample. In other age groups the differences 

range from 1.9 to 5.9 mg per 100 ml, and are 

not significant (D .05). The mean levels for men 

in both data sets increase rapidly to the age 

group 35-44 years and increase less rapidly to 

the age groups 45-54 and 55-64 years. A slight 

e decline occurs in the age group 65-74 years. 

Figure 2 and table 1 show that the mean 

levels for women in the HES sample are higher 

Figure4, MEAN SERUM CHOLESTEROL LEVEL OF ADULTS 18-74 

YEARS BY AGE AND SEX UNITED STATES, 1971-74 

243.s 

245.2 ......” . . . . . . . . . . . 

. . . . 

. . . . . 

/ 

231 .? . . . . . . 

A%7 229.4 

220.7 /.- 225,G 

/“. . . . . 2C6.8 

/.. — Men 

..=. 200.8 . . . . . 

. . . . . 

.... 

1901- / ..- .--.,94.1 V/omen 

a 1m.; z ..... “ 

* leo 178.5 

f 

“$ I I I I [ 

I 

18.24 25.34 3544 45.54 55.64 65 and 

over 

I AGE IN YEARS 

than the levels for women in the HAIIES sample 

in all age groups. In the age groups under 55 

years, with the exception of ages 35-44 years, 

the differences are small, 1.6 to 5.1 mg per 100 

ml, and are not significant (> .05). In age group 

35-44 and in the older age groups 55 years and 

over the mean levels in the HES sample are significantly higher than those in the HANES sample. The differences in mean levels are 17.1 and 

15.9 mg per 100 ml, respectively, for age groups 

55-64 and 65-74 years and 6.8 mg per 100 n-d 

for the. age group 35-44 years. 

The mean levels for women from HES and 

HANES sets of data increase with age but in a 

slightIy different. pattern. The mean levels for 

women in the HES sample increase to the age 

group 55-64 years, with the rate of increase 

more rapid for those in the midfifties and midsixties than for those in the earlier ages. The rate 

of increase then diminishes substantially, with 

the levels attaining a peak in the oldest age 

group 65-74 years. The rate of increase in the 

mean levels in the HANES sample show a simiIar 

pattern before age 55. However, the mean levels 

increase Iess rapidly in the midsixties, and then 

flatten out, with the levels also attaining a peak 

in the age group 65-74 years. 

Sex Differences by Age–HES and HANES 

Figure 3 shows that in the HES sample in 

each sex group the mean level increases with age 

but in different patterns. LeveIs for men increase 

rapidly to the decade 35-44 years. The rate of 

increase then flattens out, with levels reaching a 

peak in the decade 55-64 years and declining 

slightly thereafter. Mean levels for women are 

higher than those for men in the youngest age 

group, 18-24 years. They increase Iess rapidly 

than those for men in the midthirties and rnidforties but increase much more rapidly than 

men’s levels after age 45. Thus the mean levels 

for women exceed those for men in the age 

group 45-54 years and at all ages thereafter. 

Figure 4 shows the mean serum cholesterol 

levels in the HANES sample of adults. As in the 

HES sampIe, mean levels for women are higher 

than those for men in the youngest age group, 

18-24 years. After age 25, the mean levels in the 

HANES sample generalIy show the same pattern 

as observed in the HES sample for. women and 
4 dwlcwta 

men. The mean levels for women increase less 

rapidly thzui those for men in the age groups 

25-34 and 35-44 years but increase much more 

rapidly than men’s levels after age 45. Here the 

levels for women exceed those for men in +e 

age group 45-54 years and at all older ages. The 

levels for men peak at the age group 55-64 years 

and then decline, while the levels for women 

continue to rise. 

A comparison of proportions of persons in 

HES and HANES whose serum cholesterol values exceed any specified level may be found in 

table 2 for men and in table 3 for women. 

SUMMARY AND CONCLUSION 

Prospective as well as cross-sectional epidemiologic studies associate the level of serum cholesterol with risk of developing coronary heart 

disease. The two surveys conducted in representative samples of the U.S. population by the National Center for Health Statistics were presented and analyzed by age and sex. They 

provide cross-sectional data of serum cholesterol 

determinations of adults obtained on different 

age cohorts. The age trends present the mean 

levels for successive cohorts of persons of different age groups reflecting the effect of environmental as well as hereditary influences. The 

mean level of serum cholesterol of men in each 

age group for the HANES sample shows a slight 

decrease over that obtained for the HES sample. 

The percent decrease in mean levels ranges from 

0.8 percent in the age group 45-54 years to 2.6 

percent in the age group 35-44 years. 

* 

The actuaI differences in means of the levels ‘ 

of serum cholesterol of men from the two surveys at corresponding ages are numerically small. 

Maximum differences are 5.9 mg per 100 ml at 

age 35-44 years. At other ages the HES data 

range from 1.9 mg per 100 ml to 5.1 mg per 100 

ml greater than the HANES data. 

For women in the age groups under 55 years 

with the exception of ages 35-44 years, the 

mean levels of serum cholesterol in the HANES 

sample show a slight decrease over the levels of 

the HES sample. The maximum difference is 5.1 

mg per 100 mI at ages. 45-54 years. At ages 

18-24 and 25-34 years, the differences are 1.6 

and 3.8 mg per 100 ml, respectively. The differences at ages 35-44, 55-64, and 65-74 years are 

6.8, 17.1, tid 15.9 mg per 100 ml. Only at these 

ages were the differences significant at the O.05 

level. 

Both laboratory methods (1960-62 and 1971-

74) show positive biases relative to a common reference method. These biases can be compared and corrected for comparisons between 

the 1960-62 and 1971-74 surveys. This has been 

done in this report. The 1971-74 data are dimin- * 

ished by 4.5 percent to make them comparable 

to the 1960-62 data which were presented already corrected by 7.6 percent to the reference 

method. The reference method may be presumed to be stable over time, but there were no 

pools of sera which were analyzed in both study 

periods to assure that a shift in the accuracy of 

this reference method did not occur because 

such pools are not availabIe. 

REFERENCES 

1National Center for Health Statistics: Plan and operation of the Health and Nutrition Examination Survey, 

United States, 1971-1973. Vital and Health Statistics. 

Series I-Nos. 10a and 10b. DHEW Pub. No. (HSM) 

73-1310. Health Services and Mental Health Administration. Washington. U.S. Government Printing Office, Feb. 

1973. 

2National Center for Health Statistics: Serum Cholesterol Levels of Adults, United States, 1960-1962. Vital and Health Statistics. PHS Pub. No. 1000-Series 

1l-No. 22. Public Health Service. Washington. U.S. Government Printing Office, Mar. 1967. 

3KeY~, A-: The diet and plasma lipids in the etiology 

of coronary heart disease, in Russek, H. I., and Zohman, 

B. L., eds., Coronary Heart Disease. Philadelphia. J. B. 

Lippincott Co., 1971. p. 59. 

“4Keys, A., Taylor, H. L., Blackbum, H., Brozek, J., 

Anderson, J. T., and Simonson, E.: Coronary heart disease among Minnesota ‘business and professional men followed fifteen years. Circulation 28:381, 1963. 

5 Gordon, T., and Verter, J. I.: The Framingham 

Study: An epidemiological investigation “of cardiovascular disease. Section 23. Serum cholesterol, systolic blood e pressure, and Framingham relative weight as discrimina-
-------------------- ---

-------------------------

------

-----------------------------------

o 

tors of cardiovascular disease. Bethesda, Md. National 

Institutes of Health, 1969. 

6National Center for Health Statistics: Cycle I of the 

Health Examination Survey, Sample and Response, 

United States, 1960-1962. Vital and Health Statistics. 

PHS Pub. No. 1000-Series I l-No. 1. Public Health Service. Washington. U.S. Government Printing Office, Apr. 

1964. 

7National Center for Health Statistics: Serum cholest erol Ievels of adults 18-74 years, United States, 

1971-74. Vital and Health Statistics. Series 11. Health 

aduancedata 5 

Resources Administration, DHEW, RoclwiIle, Md. To be 

published. 

8Abe11, L. L., Levy, G. B., Brodie, B. B., and 

Kendall, F. E.: A simplified method for the estimation 

of total cholesterol in serum and demonstration of its 

specificity.]. Biol. Chem. 195:357, 1952. 

9 Eavenson, D., Grier, O. T., Cisson, J. G., and 

W1tter, R. F.: A semiautomated procedure for the determination of serum cholesterol using the AbelI-Kendall 

method. J. Amer. Oil Chem. Sot. 43: 652.1966. 

SYMBOLS 

Data not available---------— 

Category not applicable 

Quantity zero -------------------------------------------

Quantity more than O but less than 0.05 

Figure does not meet standards of reliability 

or precision 

. . . 

-

0.0 

* 

Table 1. Serum cholesterol level of adults aged 18-74 years by sex and age, with number Of examined persons, mean, and standard 

deviation: United States, 1960-62 (H ES) and 1971-74 (HAN ES) 

I i 

Men I Women I I 

Age 1960-62 1971-74 1960-62 1971-74 

?Z1 Mean S2 rsl Mean S2 nl Mean S2 ?Z1 Mean S2 

18-24 years., 406 178.1 40.7 772 178.5 35.0 515 184.7 47.9 1,524 183.1 39.1 

25-34 years.. 661 205.9 44.6 804 200.8 42.0 729 197.9 41.9 1,896 194.1 40.3 

3544 years.. 691 226.8 49.4 665 220.9 43.9 762 213.6 45.3 1,663 206.8 41.5 

45-54 years.. 533 230.5 45.6 765 228.6 44.9 679 236.8 50.0 836 231.7 49.6 

55-64 years.. 410 232.8 49.0 597 229.4 48.9 426 262.3 63.0 670 245.2 46.0 

65-74 years.. 262 229.5 47.3 1,657 225.6 51.3 289 265.7 58.8 1,822 249.8 49.6 

In denotes number of examinedPersons2s denotes standard deViation- � NOTE: The distribution of the number of persons examined by age and sex is different for HES and HANES because different sampling rates were applied to the subgroups, but within subgroups sampling rates are representative of the U.S. population at the time of 

the survey. 
.

6 advancqklta 

o 

Table 2. Cumulative percent distribution Of serum cholesterol levels Of adult males by age: United States, 1960-62 (HES) and 

1971-74 (H AN ES) 

18-74 18-24 25-34 35-44 45-54 55-64 65-74 

Serum years years years years years years years 

cholesterol 

level 1 f 

(mg/100ml) 960- 1971- 1960- 1971- 1960- 1971- 1960- 1971- 1960- 1971- 1960-

62 74 62 74 62 74 62 74 62 74 62 

Cumulative percent distribution 

Under 100 ........ 0.1 0.2 0.4 0.1 0.1 0.1 0.7 0.2 0.1 0.2 

Under 120 ........ 0.8 0.9 2.9 2.4 0.6 1.1 0.6 0.1 0.1 0.7 0.7 0.1 0.7 

Under 140 ........ 3.3 4.1 14.4 11.8 2.6 4.1 1.5 1.7 0.3 1.4 1.5 1.7 1.3 2.7 

Under 160 ........ 9.6 12.2 33.1 31.1 10.2 14.7 5.3 6.2 3.7 6.0 4,4 3.3 4.1 6.2 

Under 180 ........ 21.2 25.7 57.9 55.1 27.5 32.7 14.1 17.6 9.4 11.8 11.1 12.4 10.3 14.6 

Under 200 ........ 35.7 42.3 73.8 76.6 47.7 53.6 25,4 32.8 22.6 24.2 22.1 24.2 26.5 29.8 

Under 220 ........ 53.4 59.0 86.8 87.5 66.5 70.8 45.8 51.6 42.6 41.8 36.4 42.9 43.3 47.9 

Under 240 .. ...... 70.4 74.5 93.6 94.1 81.4 84.3 66.1 68.5 60.8 62.6 58.3 63.2 62.0 65.5 

Under 260 ........ 82.4 85.3 96.1 97.2 89.6 91.8 79.8 82.9 74.3 75.9 76.5 79.8 78.4 79.1 

Under 280 ........ 90.6 91.8 99.1 98.6 95.5 96.3 88.3 90.0 86.3 86.4 87.8 87.3 86.7 88.8 

Under 300 ........ 95.3 95.9 99.4 99.8 98.0 97.9 93.0 93,8 94.7 94.4 93.0 93.3 93.9 94.3 

Under 320 ........ 97.9 97.8 99.6 99.8 99.8 98.7 96.9 97.8 98.6 96.5 96.4 96.2 96.5 96.9 

Under 340., ...... 98.9 99.0 99.8 100.0 99.8 99.0 97.9 99.3 99.4 98.9 98.6 97.9 98.3 97.8 

Under 360 .... .... 99.4 99.4 99.8 100.0 99.8 99.4 99.0 99,4 99.9 99.7 99.1 98.8 98.9 98.9 

Under 380 ........ 99.6 99.6 99.8 100.0 99.8 99.4 99.6 99.7 99.9 I 00.0 99.3 99.1 99.5 99.1 

‘o 

Table 3. Cumulative ~ercent distribution of serum cholesterol levels of adult females by age: United States, 1960-62 (H ES) and 

1971-74 (HAN ES) 

, I 1 t I I 

18-74 18-24 25-34 35-44 45-54 55-64 65-74 

Serum years yea rs years years years years years 

cholesterol 

level 

(mg/100ml) 960- 1971- 1960- 1971- 1960- 1971- 1960- 1971- 1960- 1971- 1960- 1971- 1960- 1971-

62 74 62 74 62 74 62 74 62 7’4 62 74 62 74 

Cumulative ~ercent distribution 

Under 100 ........ 0.1 0.2 0.3 0.4 0.6 0.3 0.3 

Under 120 ........ 0.8 1.1 2.9 2.9 0.8 1.6 0.6 0.7 0.3 0.1 0.7 0.6 

Under 140 ........ 2.8 4.5 9.2 11.5 4.4 7.1 1.8 3.2 0.6 0.7 0.4 1.1 1.7 

Under 160 ........ 9.3 12.3 28.3 28.9 15.1 17.4 6.5 11.0 2.7 4.8 0.1 2.7 1.5 3.1 

Under 180 ........ 20.9 24.3 49.4 49.7 33.8 36.3 19.6 23.5 7.9 11.6 3.5 6.3 6.0 6.0 

Under 200 .... .... 35.2 41.4 69.8 69.5 55.8 60.4 38.3 46.3 18.1 25.7 7:7 15.3 8.8 13.0 

Under 220..., .... 

Under 240 ........ 

51.9 

64.9 

57.9 

71.8 

64.9 

91.0 

83.5 

92.1 

74.5 77.5 62.1 67.0 

86.5 88.3 76.8 80.7 

35.0 

53.0 

43.7 

61.8 

17.9 

29.9 

29.8 

47.3 

17.6 

31.4 

24.9 

42.5 

Under 260 ...... .. 77.3 82.5 95.4 97.0 92.6 94.4 87.1 90.4 72.0 75.5 50.3 64.7 49.0 59.3 

Under 280 ........ 85.5 89,4 97.5 97.9 95.7 97.5 93.0 94.7 84.7 85.0 64,1 76.9 64.8 76.0 

Under 300 ........ 91.8 94.3 98.2 99.3 98.6 98.8 97.1 97.8 93.7 90.8 79.1 88.1 73.3 86.1 

Under 320 .. ...... 95.4 97.1 99.0 99.8 99,3 99.1 98.4 98.9 96.3 95.3 88.3 94.4 84.7 92.2 

Under 340., ...... 97.8 98.2 99.7 99.8 99.6 99.7 98.9 99.5 98.6 96.5 95.3 96.4 91.8 96.2 

Under 360 ........ 98.8 99.2 99.9 99,8 99,7 99.8 99.3 99.6 99.5 98.4 98.3 98.9 94.2 98.3 

Under 380 ........ 99.4 99.5 99.9 99.9 99.9 99.8 99.5 99.7 99.6 99.0 99.6 99.4 97.0 99.1 

_o 
o 

TECHNICAL 

The sampling plan for the 65 preselected examination Iocations in the Health and Nutrition 

Examination Survey followed a highly stratified 

multistage probability design in which a sample 

of the civilian, noninstitutionalized population 

of the conterminous United States 1 to 74 years 

of age was selected. Successive elements dealt 

with in the process of sampling were the primary 

sampling unit, census enumeration district, segment (a cluster of households), household, eligible person, and sample person. The sampling design provided for oversampling among persons 

Iiving in poverty areas, preschool chiIdren, 

women of childbearing age, and the elderly. 

CKkincedata 7 

NOTES 

The serum cholesterol determinations are 

shown as population estimates, that is, the serum cholesterol findings for each individual have 

been “weighted” by the reciprocal of the probability of selecting the person. An adjustment 

for persons in the sample who were not examined and poststratified ratio adjustments were 

also made and so the final sampling estimates of 

the population size agree exactly with the U.S. 

Bureau of the Census independent estimates for 

the civilian, noninstitutionalized population of 

the United States as of November 1, 1972, by 

race, sex, and age. 

Previous 

No. 1 

No. 2 

No. 3 

0 No. 4 

issues of Advance Data From Vital and Health Statistics 

Blood Pressure of Persons 6-74 Years of Age in the United States 

(Issued: October 18, 1976) 

Hypertension: United States, 1974 (Issued: November 8, 1976) 

Height and Weight of Adults 18-74 Years in the United States (Issued: November 19, 1976) 

Prevalence of Dermatological Diseases Among Persons 1-74 Years of 

Age, United States (Issued: January 26, 1977) 

GPO 913-467