.

NATIONAL CENTER Series 2

l??(’)p~fl~opw :

For HEALTH STATISTICS Number 33

P/j6LtCAT10mS BRANCH

EDITORIALLIB@RY

VITAL and HEALTH STATISTICS

DATA EVALUATION AND METHODS RESEARCH

International Comparisons

of Medical Care Utilization

A Feasibility Study

A study to test the feasibility of applying epidemiological

methods based tan scientific sampling survey techniques to

cross-national research on medical care utilization,

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

Health Services and Mental Health Administration

Washington, D.C. June 1969
Public Health Service Publication No. 1000-Series 2-No. 3:

For sale by the Superintendent of Documents, U.S. Government Printing Office

Washington, D. C., 20402 - Price 70 cents
NATIONAL CENTER FOR HEALTH STATISTICS ~

THEODORE D. WOOLSEY, Direczfo7

PHILIP S. LAWRENCE, SC.D., Associate Director

OSWALD K. SAGEN, PH.D.,, Assistant Director for Health Statistics Development

WALT R. SIMMONS, M.A., Assistant Director for Research and Scientific Development

ALICE M. WATERHOUSE, M. D., Medical Consultant

JAMES E. KELLY, D. D. S., Dental Advisor

EDWARD E. MINTY, Executive O//icer

MA RGERY R. CUNNINGHAM, h-z/ormation O//icer

Public Hea Ith Service Publication No. 1000-Series 2 =No. 33

Library of Congress Catalog card Number 74600474
PREFACE

This report describes an international feasibilityy study of medical care utilization, undertaken

jointly by research teams in the United States,

Yugoslavia, and the United Kingdom from 1964

to 1966. The groups involved were representatives

of the Federal Institute of Public Health, Belgrade, Yugoslavia; the Medical Care Research

Unit, University of Manchester, Manchester, and

the Institute of Community Studies, London, England; the Department of Community Medicine,

University of Vermont, Burlington, the Department of Medical Care and Hospitals, The Johns

Hopkins University, Baltimore, and the National

Center for Health Statistics, Public Health Service, U.S. Department of Health, Education, and

Welfare, Washington, D.C., United States.

The committee participants were: from the

Federal :nstitute of Public Health, Herbert Kraus,

M.D., Cedomir Vukmanovi~, M.D., M.P. H.,

Dragana Andjelkovi<, M.D., M.P. H., Petar

Macukanovi&, M.D., and Mileva Pirocanad,

Ph.D. (consultant); from the University of Manchester, Robert F, L. Logan, M.D., M.R.C.P.,

R. J. C. Pearson, M.B., M.P. H., Joyce Pearson, B,SC., John Beresford, B.SC., and John

Butler, M.A.; from the Institute of Community

Studies, Ann Cartwright, Ph.D. (consultant); from

the University of Vermont, John H. Mabry, Ph. D.,

and Thomas C. Gibson, M.B., M.R.C.P. (corisultant); from The Johns Hopkins University, Kerr L.

White, M.D., Alan Ross, Ph. D., and George A.

Silver, M.D., M.P.H. (consultant); from the National Center for Health Statistics, O. K. Sagen,

Ph. D., Margaret West, B.A., Eleanor L. Madigan,

and Charles F. Cannell, Ph.D. (consultant to the

National

Research

Center for Health Statistics, Survey

Center, University of Michigan, Ann

Arbor); and from the World Health Organization,

R. F. Bridgman, M.D. (participant observer).

Direct financial support for the study was

received from the following sources:

Liverpool Regional Hospitals Board

Milbank Memorial Fund

Nuffield Provincial Hospitals Trust

United States Department of Health, Education, and Welfare, Public Health ServiceHealth Services and Mental Health Administrateion

Research Grant CH 00158 through the

National Center for Health Services Research and Development

Special International Research Program (P.

L. 480), Research Agreement NCHS-Y2

through the National Center for Health Statistics

World Health Organization

Additional costs of travel to conferences,

consultant service, and computer work were absorbed by the National Center for Health Statistics apart from the support provided by the research agreement with the Yugoslavia Federal

Institute of Public Health. Each of the collaborative institutions contributed substantial support

to the study by furnishing personnel, facilities,

and a variety of services not financed by the

explicit grants.
CONTENTS

Preface --------------------------------------------------------------

Introduction ----------------------------------------------------------

General Planning and Survey Design -------------------------------------

Objectives ---------------------------------------------------------

Focus of the Study -----------------------------------------------

Nature of the Study -----------------------------------------------

Method of Tabulation and Analysis ---------------------------------

Organization -------------------------------------------------------

Study Areas -------------------------------------------------------

Chester ---------------------------------------------------------

Chittenden ------------------------------------------------------

Sme?derevo ------------------------------------------------------

Development of Questionnaires ---------------------------------------

Field Work -----------------------------------------------------------

Sampling Design ----------------------------------------------------

Chester ---------------------------------------------------------

Chittenden ------------------------------------------------------

Smederevo ------------------------------------------------------

Interviewing -------------------------------------------------------

Editing, Coding, and Key Punching ------------------------------------

Survey Results --------------------------------------------------------

Summary and Conclusions ----------------------------------------------

Publications of Committee for International Collaborative Study of

Medical Care Utilization ----------------------------------------------

Detailed Tables -------------------------------------------------------

Appendix I. Questionnaires -------------------------------------------

Appendix II. Technical Notes on Statistical Procedures -------------------

Standard Population and Standardized Rates ---------------------------

Estimates of Population Totals ---------------------------------------

Standard Errors of Standardized Rates --------------------------------

Standard Errors of Detailed Tables -----------------------------------

Treatment of Noninterviews -----------------------------------------

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THIS NEW REPORT from the National Centev for Health Statistics

describes a veseavch undertaking to test the feasibility of epidemiological methods in a scientific sample suvvey to &roduce datu on medical

care utilization from which valid comparisons could be made between

thvee diffevent countries having different customs, systems of medical

care, and demographic churactevistics. This study uxm conducted jointly

by veseavch teams in the United Kingdom, the United States of Amevica, and Yugoslavia Identical procedures were used to simultaneously

collect medical care utilization &tu on thvee carefilly defined populations, one community in each countvy. Utilization of services from

doctovs, dentists, nurses, and other pvoviders of care was the dependent variable, which was studied in velation to independent t.uria bles

such as demographic factors, selected measures of pevceived movbidity, the extent and accessibility of medical cave personnel and facilities, and the peoplers attitudes toward medical care. Structured

household interviews were conducted in a probability sample in each

area of approximately 300 households, comprising about 1,000 persons.

The repovt describes the conduct of the study, gives the findings and

conclusions togethev with summavy ta~les incovpovating standa~dized

vates.

In spite of substantial differences in ways of life, organization of health

services, and vepovted morbidity and disability, people in the thvee

study aveas appear to consult doctovs in much the same way, while

pattevns of hospitul utilization vavy substantially. Also, the amount of

consultation fov curative sevvices is appa~ently unvelated to the supply

of doctors in the thvee areas.

The research findings exhibit reassuring intevnal consistency. The independent validations done for cem!uin parts of the interview information indicate satisfactory consistency between the interview datu and

othev souvces. The study concludes that epidemiolo~”c methods employing household interviews ave feasible in international and regional

studies of medical cave utilization.

SYMBOLS

Data not available ------------------------ ---

Category not applicable ------------------- . . .

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

Quantity more than O but less than 0.05---- 0.0

Figure does not meet standards of

reliability or precision ------------------ *
INTERNATIONAL COMPARISONS OF

MEDICAL CARE UTILIZATION

.

A FEASIBILITY STUDY

Kerr L. White, M.D., and Jane H. Murnaghan, B.A. 1

INTRODUCTION

Although the levels of economic development

and scientific progress may be similar in a number of countries, it does not necessarily follow

that their medical care systems are also similar,

because the pattern of medical care in any one

country is ultimately determined by its unique

combination of political, social, and cultural

forces. The study and comparison of medical

care systems under differing circumstances can

be of great value to the administrators, planners,

and investigators of health services.

Comparison cannot be attempted, however,

until the systems in the respective countries or

regions have been defined in terms of an acceptable yardstick or common frame of reference.

One approach to this problem is to measure and

define the utilization pattern of a medical care

system. The utilization pattern is not only determined by the extent of need to prevent or cure

illness$ but is also influenced by economic, social,

educational, and cultural factors, as wdll as by

the methods of payment, the organization, and

the attitudes of the purveyors of medical care.

The traditional measurement of utilization

has centered on the records of health services

lDr. White is Professor of Medical Care and Hospitals and

Mrs. Murntighanie Assistant in Medical Care and Hospitals at

The Johns Hopkins University, School of Hygiene and Public

Heu’lth, Baltimore, Maryland.

facilities, such as hospitals and clinics; however, these records do not reflect the entire

range of medical services utilized by a defined

population. A household survey must be undertaken in order to obtain relatively complete estimates for large general populations. Areas which

should be surveyed are physician visits, which

are not recorded in all countries; information on

the level of “morbidity, complaints or conditions

for which medical care is sought, deferred, or

not utilized at all; and the attitudes and satisfactions associated with medical care.

Studies of medical care utilization at the

national level had been conducted in several countries in the 1950~s, w!lile active interest in research in this subject at the international level

was stimulated by the World Health Organization.

By 1963 medical care investigators in several

countries were seriously considering an undertaking that would allow international comparison,

The interest and ideas, as well as preliminary

financial commitments, were formally exchanged

at a meeting in Belgrade, Yugoslavia, in April

1964. Concrete plans were made for a feasibility

study to prepare the way for future research of

differential utilization of medical care facilities.

This report describes the main features of

the feasibility study that resulted from the Belgrade meeting. It is the work of a group known as

the Committee for the International Collaborative

Study of Medical Care Utilization, representing

20 senior investigators and eight institutions in

1
three participating countries—the United Kingdom, Yugoslavia, and the United States. The investigation was a unique experience in intense

scientific collaboration between representatives

of a variety of disciplines in several different

countries. Apart from the specific contributions,

the study paid intangible dividends in the intellectual stimulation, understanding of national and

cultural differences, and the remarkable espvit

de corps that developed within the committee.

The prime objective of the study was to ascertain whether valid, reliable, and comparable

data on the use of doctors’ and nurses’ services

and on hospitalization among a defined population

during a given period of time could be collected

simultaneously in several settings by standardized epidemiological procedures. In addition, as

a corollary to this objective, certain important

factors affecting utilization were selected and

investigated as independent variables of utilization. The principal variables chosen for this

purpose were demographic characteristics, selected measures of perceived morbidity, the

extent and accessibility of medical care personnel

and facilities, and the population’s attitudes and

satisfactions with the care received.

The compromises and decisions involved in

defining the objectives of the study and the planning and organization for achieving those objectives are described in the following section.

The principal method employed to measure

the utilization of medical care services was the

household interview administered to a probability

sample of about 300 households, or approximately

1,000 individuals, in each of three small areas in

Northwest England, Serbia, Yugoslavia, and Vermont in the United States. The sampling designs

and other aspects of the field work are summarized in the section titled “Field Work. ”

The specific information collected in the study

and the summary tables showing sample frequencies and standardized rates with their standard errors are discussed under “Survey Results”

followed by the conclusions. Twenty-three detailed tables, including population rates and additional sample frequencies, and an appendix

presenting the questionnaires conclude the report,

On the basis of the feasibility study, the

committee has concluded that epidemiological

methods employing household interviews are suitable for arriving at useful and valid international

and regional comparisons of medical care utilization. Many of the variables were found to be

comparable, although some require further refinement to achieve maximum comparability between the study areas. Encouraged by the success

of the pilot study, the committee has revised the

methods and questionnaires and expanded the

scope of its activities to encompass 11 study

areas in seven countries—Argentina, Canada,

Finland, Poland, the United Kingdom, the United

States, and Yugoslavia.

GENERAL PLANNING AND

SURVEY DESIGN

OBJECTIVES

At the first conference held in Belgrade,

April 14-20, 1964, the three countries repre -

sented-– Yugoslavia, the United States, and the

United Kingdom—agreed to undertake what was

described in the minutes as “a modest program

to permit methodological investigation and provide

preliminary data . . . as a first step towards

planning more ambitious studies.” The long-range

objective was to explore the problems in obtaining

comparable data on the utilization of medical

care in the three countries and to examine the

extent to which certain factors affecting utilization of medical care are or are not common to

all three countries, and thus, eventually to examine associations between these factors and the

methods of organizing medical care.

In order to achieve the objectives established

at the first conference and to accommodate new

participants, it was essential to come to grips

with three major issues. The fact that no one

was totally pleased or displeased with the decisions reached by the group suggests that a true

consensus was achieved by the agencies, institutions, and individuals who collaborated in the

enterprise.

Focus of the Study

The framework that guided discussions and

planning included the following elements of the

medical care process:

Need fov medical cave. —This includes “medical” needs as determined by physical examinations, screening tests, and interviews,

2
and “social” needs as determined by lay

groups and society.

Attitudes and expectations about medical

cave. —This includes the personal, familial,

and cultural factors that condition the demand

for and the acceptance of medical care.

Demand for medical cave. —The actual or

potential expressed wish or request for

medical care.

Utilization of medical cave.— The actual use

of services whether needed or not in the

eyes of the health professions, including

hospital and ambulatory care and professional, paramedical, and quasi-medical

services.

Satisfaction with medical care.

Outcome of medical cave. —End results of the

quality of care.

There was great interest on the part of

certain participants in assessing need and outcome and on the part of others in assessing

attitudes and expectations. The final compromise

placed the main emphasis on utilization with

subsidiary interest on demands, attitudes, and

satisfactions. There was little emphasis on need

or on outcome. The rationale behind this decision was that (1) the appraisal of utilization was

likely to be supported by the “hardest” data most

susceptible to validation and (2) if one could not

feel reasonably confident about the comparability

of utilization data and about the existence of true

similarities and differences between countries,

there was little basis for examining possible

explanations for any differences observed.

Nature of the Study

Three types of studies were considered--

descriptive, analytical, and hypothesis-testing.

At the descriptive level the proposed study held

little of interest for many of the participants.

Others argued that until it had been demonstrated

that reliable and comparative data could be

collected, it was premature to encourage extensive analysis of the data or to undertake a study

in which hypothesis-testing of sociological variables was a prominent consideration. At the

other end of the spectrum were those who believed

that the testing of hypotheses was the best method

to advance the field and insure rigor in the

methods used, and that a cross-national study

afforded an unusual opportunity to examine certain

hypotheses of great interest to social scientists,

particularly attitudinal and familial determinants

of medical care utilization.

In the end, the major emphasis was placed

on a modified analytical study, with the statement

of a number of hypotheses that were not to be

tested in the formal sense, but were designed to

sharpen the direction and specificity of the study

and to gain experience for later full-scale studies.

The following are some initial hypotheses developed for this purpose.

Basic Postulate

The use and nonuse of health services in a defined population varies with (1) perception of the

symptom and conditions or health situation for

which use or nonuse occurs; (2) demographic

characteristics; (3) the accessibility of physicians, nurses, other health workers, and hospital

and nursing-home beds available to that population; and (4) respondents’ selected perceptions

of, and attitudes toward, their personal physicians.

Hyfiothesis 1

The physician consultation rate per 1,000

population per unit time of a defined population

varies directly with the m~mber of physicians per

1,000 population.

Hypothesis 2

The physician consultation rate per 1,000

population per unit time of a defined population

varies inversely with the travel time required to

contact a physician.

Hypothesis 3

The proportion of persons in a defined population not consulting a physician for “certain conditions” that can be alleviated through such consultation varies directly with the degree of

coverage of medical and hospital insurance.

Hypothesis 4

The proportion of persons in a defined population not consulting a physician for “certain

3
conditions”

sultation is

that can be alleviated through correlated to the patients’ and families’

expectations about medical treatment.

Hypothesis 5

The physician consultation rate per 1,000

population per unit time varies in a different way

in the three countries and varies directly with the

amount of education received.

Finally, it was agreed that each area could

use additional short questionnaires to gather data

of particular interest to it. In point of fact this

was done in two areas.

Method of Tabulation and Analysis

The third area of discussion concerned the

extent to which the computer was to dictate the

approach to the tabulation and analysis of the

data. Under ordinary circumstances it would

have been desirable to examine the raw frequency

distributions of the responses to the questiomaire

items before deciding upon the cross-tabulations.

Such an approach would delay the analysis and

would run the risk that errors in the punched

cards both within and between countries would

only be detected late in the whole process.

An additional consideration was the extent

to which the raw sample frequencies would be

published in contrast to the population estimates

based on expansion of data for individual cells

which took into account both sampling fractions

and nonresponse. There were strong feelings

that the possibilities of further cross-tabulations

as well as the precision of the data could best

be determined if raw sampIe frequencies were

available. On the other hand, it was feIt that

because a defined population was being studied,

population estimates and rates accompanied by

their standard errors to indicate their reliability

were the most suitable and useful figures for

presentation, and further, that sample frequencies

would be misleading in cases like Chester,

England, where the nonresponse rates proved to

be relatively high and varied in different age and

sex groups. The expanded population estimates

and rates could be adjusted to allow for these

differences, but the expansion factors varied

widely for different age and sex groups; from 1

in 60 to 1 in 110, instead of the total 1 in 92

factor. Thus sample frequencies could not readily be converted to population figures, and showing two sets of figures could be confusing. In

this report both sample frequencies and population

estimates, together with certain standardized

rates and standard errors, are published.

A further policy decision concerned the

extent to which urban-rural categories should be

used in tabulating and analyzing the survey results. The difficulty arose from the fact that

the term r‘rural” did not have the same meaning

for the study populations in the United Kingdom

and the United States as it did for the population

in Yugoslavia. This was due to the fact that the

population in the United States and the United

Kingdom usually were not dependent on agriculture for their support and frequently commuted

to urban areas for their livelihood. To approach

comparability, the Chittenden unit planned originally to allocate one-third of each of their sampling units to rural farm households, rural

nonfarm households, and urban households. However, the final decision was to postpone ruralurban comparisons between the three areas until

more experience had been gained from the feasibility study.

It was agreed to structure the final tabulations

in forms that recognized traditional influences

on medical care utilization. Data would be presented by urban, rural, and total population categories, and by sex and major age breaks. Most

analyses would be done in terms of “persons” as

the basic count. Raw sample frequencies, expanded

population frequencies, rates per 1,000 for the

individual area population, and rates per 1,000

standardized to the Swedish midyear population of

1962 would be published.

Magnetic tapes were prepared at the National

Center for Health Statistics where the programming and tabulation were completed. Tapes,

printouts, and tables were made available to each

agency or institution for additional analyses.

ORGANIZATION

No formal organization was set up beyond

designating a general chairman and at least one

individual in each study area who would assume

primary responsibility and devote the major part

4
of his research efforts to the project. The entire

exercise was notable for its flexibility, permitting

the participants to consult each other directly in

any combination dictated by the problem at hand,

unhampered by a fixed chain of command or

protocol.

The study required the collaboration of experts in a number of fields; represented on the

committee were physicians, statisticians, sociologists, and psychologists, and they were assisted in the field by numerous specialists in

sampling and computer techniques. No one country

or group of experts possessed a monopoly of

skills or knowledge necessary for the study; the

project can be truly characterized as both interdisciplinary and international.

Prompt and thorough communication was

achieved through eight 1-week working conferences and six additional visits by members of the

team, together with extensive use of conference

minutes, memoranda, correspondence, reports,

numerous cables, and 10 transatlantic telephone

calls. Special mention should be made of the use

of itinerant consultants who played an extremely

important role in solving problems in the field

and in insuring comparability in the interviewing

and coding.

At the outset 1 year was thought to be enough

for preparation, field work, and analysis; in the

end over 2 years were required. Even so, a

superhuman effort was made by some of the

members and field workers to meet the schedule.

General planning, sampling procedures, and

preparation of the questionnaires and Interviewers’ and Coders’ Manuals required the better

part of a year. Field work was conducted in May,

June, and July of 1965. Punchcard layouts, dummy

tables, and the computer program were prepared

in the spring and summer of 1965. Editing, coding, key punching, and verification were completed by September 1965 and the cards sent to

the National Center for Health Statistics. Final

tabulations were examined at a conference in

April 1966; from these, the tables in this report

have been prepared.

STUDY AREAS

It was agreed by the committee that the

Stl(cly areas for the pilot project would be limited

to regions with populations in the range of 70,000

to 90,000, although it was clearly recognized that

there is an inherent disadvantage in any small

study area, especially when the health services

available to a defined population constitute one of

the variables under investigation.

The study areas agreed upon were:

United Kingdom:

United States:

Yugoslavia:

Chester, Cheshire County,

England (Population, 87,592 in

1961)

Burlington, Chittenden County,

Vermont (Population, 74,425

in 1960)

Smederevo, Smederevo Commune, Serbia (Population,

83,862 in 1961)

These communities were chosen because

they: (1) were of the appropriate size, (2) constituted medical catchmentz areas that were fairly

well circumscribed geographically, (3) had both

rural and urban components with one town of

25,000 or more, (4) contained or were close to a

medical center, and (5) were within reasonable

distance (40 miles) of the investigators’ institutions in each country.

Population estimates for the noninstitutionalized residents of the three sample areas by age,

sex, and urban- rural classification are given in

table 6.

Chester

The Medical Research Unit of the University

of Manchester was already committed to an investigation involving household surveys for the

Liverpool Regional Hospitals Board and planned

to integrate the Liverpool study with the international collaborative study. Chester City combined with Chester Rural District was the only

area within the Liverpool Hospitals Board region

meeting the agreed specifications. Chester City,

with a population of 59,268 in the 1961 decennial

census, is situated in the Cheshire plain across

~

Ageographicterritory, the great majority of whose popuIrttion obtaine its medical services within that territory

5
the River Dee from Wales and is 18 miles from

Liverpool and 38 miles from Manchester which

are both medical centers. It is surrounded by

good dairy farming country for which it acts as

a market center.

The Chester Rural District surrounds the

city for three-quarters of a mile of its perimeter,

the remaining one-quarter being adjacent to Wales

across the Dee. The maximum dimension’s of the

rural district are 12 by 10 miles. The population

in 1961 was 28,300. It is made up of 51 parishes

of which three have no inhabitants and only six

have more than 1,000 inhabitants. The district is

a local administrative one within the county of

Cheshire and has its own complement of administrative, health, and welfare people. The area is

good farming land; however, it is becoming increasingly suburbanized and its population is

growing at a faster rate than that of the city;

only 6 percent of the residential accommodation

is rated as being occupied by agricultural workers.

The city and rural districts together are

comparatively wealthy, with average individual

and household incomes well above the national

average and above the average in other parts of

the Liverpool Hospitals Board region.

Chittenden

Chittenden County, with a population of 74,425,

of which 20,838 was rural according to the 1960

census, occupies a central location on the eastern

shore of Lake Champlain in the long narrow valley

with the Adirondack Mountains to the west and the

Green Mountains to the east. It is an important

educational, agricultural, and year-round recreational center. Burlington is the major city in the

county and also its medical center. Burlington is

the largest port on the eastern shore of Lake

Champlain, is connected by ferry with the New

York side of the lake, and is the meeting point

of the main north-south route along the east side

of the lake and the route across the mountains to

the east. This strategic location has added

greatly to its industrial and commercial prosperity.

The obvious advantage of Chittenden County

as a study area was its accessibility to the unit

from the University of Vermont, which is in

Burlington. The mountainous terrain, sparse distribution of population in some areas, and a high

number of seasonal residents posed special sampling and interviewing problems.

Smederevo

The predominately urban commune of Smederevo (39,793 in the 1961 census) was combined

with its rural subregions, Saraorci and Mala

Krsna (44,069), to form the study area in Yugoslavia. Smederevo is situated on the Danube, 30

miles southeast of Belgrade, the nearest medical

center. It is a noted historical town of tourist

interest, famed for its vineyards and orchards.

In contrast to the other two study areas, the

rural population of the Smederevo area is largely

enga~ed in farming; living conditions are mi~:e

primitive and some of the remote villages are

inaccessible by vehicle during heavy rains.

The disadvantage of chosing Smederevo was

that a certain proportion of the population obtains

medical care at a neighboring town j,-ist ouL.?i5e

the study area, so that it is probably less selfcontained in this respect than the other study

areas. The advantages were that (1) it is not

atypical of the country as a whole, (2) it contains

a sufficient proportion of working population to

provide an insight into utilization of medical care

by that category of insured people (a point of

special interest to the Belgrade unit), (3) the

accessibility and distribution of health personnel

within the study area varies considerably, permitting internal comparisons of the influence of

these factors on utilization, and (4) it was close

enough to Belgrade to simplify communications

and staff problems and to keep down expenditures,

DEVELOPMENT OF QUESTIONNAIRES

The interview questionnaires drew heavily on

the experience of the U.S. National Health Survey

and on other questionnaires developed by members

of the group. A separate but similar questionnaire was constructed for children. The quest ionnaires were designed to permit two independent

coding operations on the form, except for the

coding of certain tabular material, for which

separate code sheets were used.

6
Four different approaches to the problem of

relating utilization of medical care services to

the level of morbidity of the population were

incorporated in the questionnaires: measures of

reported general morbidity in the population;

measures of more specific morbidity as reflected

by reported prevalence of certain “symptomcondition” complexes recently associated with

Ilgreat discomfort!l (table A); measures of relatively stable objective “indicators” of morbidity,

such as reported selected visual impairments;

and measures of “activity limitation” and “bed

disability.”

The utilization measures employed were

doctor consultations, nurse consultations, and

hospital and nursing home admissions. All meas -

u res were for a 2-week-recall period except those

on general morbidity and eye examination, which

were for a 12-month- recaU period, and hospitalization, which was recorded for a recall period

of 16 to 18 months but tabulated for only a 12-

month period. Related topics, such as the availability of “personal” doctors, the patients’ attitudes and satisfaction with the care received, and

the use of drugs, were also investigated.

The desire to achieve comparable data from

respondents of three different nationalities re -

quired unusually careful attention to the phrasing

of questions and to the definition of terms. The

questionnaires, together with the Interviewers’

Manual and a Coderst Manual, were translated

into Serbo-Croatian. Independenttranslations

back intoEnglishby two persons unfamiliarwith

the questionnaires,includingone unfamiliarwith

medical terminology,revealed almost complete

comparability.Two questions(Q.1.1and Q. 31.2)

had to be omitted from thefinalSerbo-Croatian

version, since the pretestingshowed that the

Yugoslav respondentsunderstood them ina differentway than originallymeant. For thesame

reason, several categories of health workers

that do not exist in Yugoslavia were omitted as

well. The inadvertent omission of part of one

“symptom-condition” complex probably resulted

in the underreporting of one condition (diarrhea)

in adults in Smederevo (table A).

Two pretests of the questionnaires in each

study area, with subsequent revisions, preceded

the final field work.

The English version of the household folder,

the adult questionnaire, and the child questionnaire are reproduced in appendix I of the report.

Appendix II presents technical notes on statistical

procedures.

Table A. Selected “symptom-condition” complexes for adults and childrent

Adults Children

1.

2.

3.

4.

5.

6.

7.

11.

12.

Rupture or hernia

Varicose veins

Unusual shortness of breath, wheezing, or cough

Frequent stomach trouble, vomit ing,

or diarrhea

Repeated attacks of backache, backstrain, lumbago, or sciatica

Repeated attacks of rheumatism, arthritis, or other joint pain

Frequent nervousness, worry, depression, or trouble sl~eping

Skin rash

Boils

Hemorrhoids or rectal bleeding

Frequent sore throats or colds

Frequent severe headaches

Rupture or hernia

i: Whooping cough

3. Unusual shortness of breath, wheezing, or cough

4. Frequent stomach trouble, vomiting,

or diarrhea

5. Measles (regular or German)

6. Chickenpox

Burn or scald

:: Skin rash

Boils

1:: Joint pain

11. Frequent sore throats or colds

12. Frequent severe headaches

~See conditions listed in adult and child questionnaires, appendix I, pages 62 and

70, table III.

7
FIELD WORK

SAMPLING DESIGN

Special requirements and local conditions,

including the availability of census and other

sampling information, “dictated the choice of

different sampling designs and sampling fractions

in each of the three study areas. The one overall

requirement w“as that the samples be true probability samples of approximately the same number of households. In Chester, a random sample

based on the real estate tax rolls was used and

the sampling fraction was 1/92; in Smederevo,

a two-stage stratified sample was drawn from

electoral rolls and a special urban household

census and the sampling fractions were 1/66 for

the urban population and 1/83 for the rura~ and

in Chittenden, area sampling was employed with

a sampling fraction of 1/66. Residents of institutions, including general hospitals, were excluded

from the sample.

Population estimates and sampling characteristics are summarized in table B.

Chester

It was agreed internationally that the sample

chosen would be a household sample and not a

sample of individuals. The best and simplest

form from which such sampling may be done in

the United Kingdom is from the rating lists of

each administrative district. A sample drawn

from the rating lists contains not only houses,

flats, and other places where people live, but

also other ratable units such as warehouses,

workshops, and garages. The proportions of each

are published annually and it is possible by taking

a large enough sample of ratable units to achieve

the number of households required.

The international agreement at the time the

sampling was drawn in Chester (in February

1965) was that 200 households would be sampled

in the urban area and 100 in the rural area. According to the latest proportions published (April

1964), 85.2 percent of the ratable units were

domestic units in Chester City and 89.2 percent

in Chester Rural District. This meant that 234

ratable units would need to be drawn to produce

200 dwelling units in the city, and 111 ratable

units in the rural district to produce 100 dwelling

units. Further allowance was made in the city

for an estimated 800 demolished ratable units

still on the lists by adding nine to the sample. In

the rural district there were practically no demolished houses on the lists, but between 200

and 300 additional houses had been added since

the 1964 count; accordingly the number of ratable

units to be sampled in the rural district was not

changed.

A systematic sample was drawn from each of

the rating lists; the sampling ratio in the city

was every 95th unit; and the sampling ratio in

the rural district was every 90th unit. Random

numbers were used to start the sampling in each

case (25 and 17, respectively). At the conclusion

of drawing, the sample had 243 ratable units in

the city and 107 in the rural district, The description of the units showed that of these, 212

in the city and 95 in the rural district should be

dwelling units.

The interviewers found that 12 units in the

city and one in the rural district had been demolished or were vacant awaiting demolition.

Table B. Noninstitutional population estimates and sample characteristics for the

stxdy areas

Sampling

fraction PercentArea Estimated Sample age

population size interUrban Rural viewed

Chester, U. K------------------------------ 81,790 1:92 1:92 890 87

Shnederevo, Bug---------------------------- 90,370 1:66 1:83 1,198 98

Chittenden, U. S. A------------------------- 73,800 1:66 1:66 1,118 97

8
I

This left 200 dwelling units in the city and 94 in

the rural district at which interviews could be

hoped for; the total in the sample was therefore

294, In addition, however, four units were vacant

throughout the time of the survey, three in the

city and one in the rural district, so that the

sample denominator used in assessment of results was 290 household units (table C).

Validation of the sample with the electoral

lists compiled in October 1964 showed that 86

percent of the adults 21 years or over in the

sample were on the lists at the same address.

The sampling frame used is readily accessible and is often chosen by the British Social

Survey (the major household interviewing organization in Britain), so that its defects have been

studied. Each ratable unit has an equal chance of

being included in the sample, and there are no

difficulties introduced by different sizes of households, as there would be if either of the other

available list sampling frames (Electoral Lists

and Executive Council Lists) had been chosen.

The disadvantages are as follows. (1) It is

not a household sample but a sample of ratable

tmits which may contain several households. The

Social Survey has developed a method to deal

with this problem which was also used in this

survey. The basic rules are that whenever a

ratable unit contains two households, both are

interviewed. Then the interviewer drops from the

sample the next one or two ratable units on the

assignment sheet that have not already been

contacted in any way (one unit when there are

two households, and two when there are three or

more). In this survey five units were dropped for

this reason. (2) Because the ratable units include

non-domestic housing units, arrangement for getting the exact number of households needed is not

possible. At one point it appeared that the sample

would be too large; but when more demolished

houses were found than expected it became clear

that in the end the sample would be tbo small.

(3) The sampling method left some responsibility

in the hands of the interviewers to discover all

the people living at the ratable units; they were

inst rutted to ask at the end of the enumeration,

“Now, is that everyone who lives in this (house),

(bungalow with garage), (first floor flat), (etc.)?”

and presumably they did so. Nevertheless this is

a possible source of error, which could not be

checked.

Table C. Sampling procedure: Chester,U. K.

Item

All ratable units ------

Domestic units ---------

Percent domes tic -------

Number needed to get

desired number of domestic units ----------

Correction for demolished units -----------

Sampling fraction of

units -----------------

Actual number drawn----

Domestic uni.ts ---------

Occupiable -------------

Esthnated total number

of domestic units -----

Final sampling

fraction --------------

Urban

22,843

19,454

85.2

234

9

1/95

243

212

200

118,353

1/92

Rural

9,819

8,759

89.2

111

1/90

107

95

94

28,667

1/92

1% ~19,454=18,3530

294

~ X 8,759=8,667.

Chittenden

The Vermont unit used the area sampling

method, along the general lines described by

Monroe and Finkner. 3 The area was divided into

two zones, town and open country. The two zones

were subdivided geographically into equal- sized,

contiguous strata. A sampling ratio of 1/66 was

applied to both zones. The allocation of sampling

units is shown in table D.

Assignment of the town zone sampling units

required the use of aerial photography, the city

directory, and cruise counts. Of the 20 sample

segments in the open country zone, 10 required

a count unit prelisting before they could be

identified, seven could be identified from Chittenden County road maps, and three from aerial

photographs.

Seasonal residents were excluded through

the use of standard U.S. Bureau of the Census

questions at the beginning of each interview. The

other exclusions were ‘those usually living in

group quarters (students, nursing home and

certain hospital inmates, etc.) and active members of the Armed Forces.

3Monroe, J. and Finkner, A. L.: Handbook of Area Sampling.

New York. Chilton Company-Book Division, 1959.

9
Table D. Allocation of sampling units: Chittenden, U.S.A.

Item Total Town

I II

Population (l96O)-------------------------------------------

Occupied dwelling units (1960)------------------------------

Strata ------------------------------------------------------

Sample units:

Per strata ------------------------------------------------

Per zone-------------------------"-------------------------

Sample segments:

Per strata ------------------------------------------------

Per zone --------------------------------------------------

Sample unit size --------------------------------------------

The chief problems encountered were : (1)

more cruising was necessary than expecte~ (2)

segment or “cluster” sampling involved an occasional interviewing problem in that after the first

interview in a segment, neighbors and other

family members anticipated the interviewer’s

coming and some interview content; and (3)

interpretation of some sketch maps proved difficult for inexperienced interviewers.

Smederevo

The Yugoslav group used a two-stage stratified sample of a relatively homogeneous population consisting of 150 urban households and150

rural ones. As a basis for sampling they used

the voting lists of the relevant area. They were

considered the most accurate sources of data,

for the elections in the whole of Yugoslavia had

been held as recently as April 1965.

In the rural subregion of Smederevo, there

were no difficulties at all in finding the sample

households by following the dwellings given onthe

voting lists. This was done by three statisticians

and took about 1 week. Using the voting lists and

consulting the heads of the so-called localoffices

(territorial administrative offices), they looked

for the sample households ineach of the villages

in the study area. It is possible tosay, therefore,

that the households from the rural subregion

were found quickly and the coverage was almost

100 percent.

In the urban region, however, the team was

faced with a number of unexpected difficulties.

The voting lists were not as accurate asinthe

rural area, and addresses of the sampled house74,425 55,075

19,724 15,677

50 40

132

6,606 5>280

Country

18,350

4,047

10

132

1,320

2

3.06;;

holds were often incorrect. Having no other

choice, they decided to engage five statisticians

instead of three and to have them and the heads

of the local offices in each town quarter check

the dwellings of the sampled households. The

checking took about 15 days. It amounted in the

end to almost a complete census of the urban

population in Smederevo and demonstrated that

the technique used in finding the sample households on the basis of the voting lists is not very

practicable so that other methods of sampling

should probably be used in future studies.

INTERVIEWING

To increase comparability, women 30t050

years of age withat least a high school education

and no medical or nursing experience were recruited as interviewers, and one of the principal

investigators visited all three areas to observe

and assist in the interviewer training. Some 10

or 11 interviewers and two supervisors were

enlisted in each area. About 10 days were devoted to instruction and practice interviewing,

following, in general, the methods of the University of Michigan Survey Research Center. Training continued in varying degrees in each area

during the course of the field work with periodic

meetings of the interviewers and supervisors to

discuss problems encountered in the field and

the errors found by the supervisors in editing

the completed questionnaires. In Yugoslavia, the

whole team spent 2 hours together every day

discussing and evaluating the previous day’s

work. The occurrence of the same questions, the

same problems, and even the same jokes in all

10
three areas makes it likely that a fair degree of

comparability was achieved through training.

The assignments of the interviewers were

randomized to cover both urban and rural households in Chittenden and Smederevo, but this was

not practicable, although admittedly desirable,

in Chester because not all interviewers had cars

at their disposal and the cost of interviewing

would have placed a great strain on the limited

budget.

Field work was conducted simultaneously in

May, June, and July of 1965. All persons 18

years and over and all married persons under

18 were interviewed individually. Two-thirds of

all respondents were interviewed privately. A

separate but similar questionnaire was used for

children, with the mother or another related,

responsible adult acting as the respondent. Except

for children and a few persons with language

barriers, proxy interviews were not accepted;

this led to some underreporting for a small

number of senile, terminally ill, or mentally

incompetent persons.

Three “call-backs” for incomplete interviews were made where necessary, and in Vermont and Yugoslavia available resources permitted additional “call-backs” in a large number

of cases. This effort explains in part the higher

response rates in those two areas—98 percent

in Yugoslavia and 97 percent in Vermont, compared with 87 percent in England.

As would be expected, the interviewing of

the agricultural population in Smederevo required

the greatest expenditure of effort. It was often

necessary to make repeated calls to reach the

adult population before 6 a.m. or late at night,

Since the working hours of the interviewers had

to be adapted to the free time of the respondents,

they were of necessity extremely long, which

tends to increase the percentage of omissions

and errors in the interviews.

In an effort to maintain a high level of

quality in the field work, informal checks of the

interviewers’ work were made by the supervisors in all three areas, and in two areas,

Chittenden and Smederevo, about 10 percent of

the respondents in the samples were reinterviewed.

Ninety-three percent of the reported hospital

admissions in Chester and Chittenden were

checked in the local hospitals and no unreported

hospital admissions were found. Validation of

physicians’ consultations was attempted, but physicians’ medical record systems were not sufficiently adequate in any of the three areas to

permit this study.

It was observed that in all three areas there

were, on the average, about 25 percent fewer

doctor consultations, persons consulting doctors,

and “activity limitation” and “bed disabilit y“

days reported for the “week before last” than

for “last week. ” “Procedures” performed, such

as injections and X-rays, did not show as marked

or consistent discrepancies between the 2 weeks.

EDITING, CODING, AND KEY PUNCHING

Comparability in the coding was increased

by having one member of the team assist in the

training of coders in the three areas. Duplicate

coding by independent coders was done on all

questionnaires; discrepancies, usually reconciled

by a supervisor, were less than 2 percent of all

coded items.

Medical coding was handled by physicians or

medical coders; it presented many problems that

were never successfully overcome.

Between-county studies of the reliability of

medical and nonmedical coding were attempted,

but the problems of observer variations proved

difficult to resolve by mail. Occupational coding

presented the greatest problem as far as comparability between the data from the three study

areas was concerned. One reason was the use of

several different classifications: the Hollingshead

scale in Chittenden and Chester, supplemented

by the English Registrar General’s Classification

of Occupations in the case of Chester; and the

Yugoslav Short List of Occupations in Smederevo.

Future plans call for the uniform use of a new

two-digit International Labor Organization code.

The key punching of every card was verified;

error rates for this operation were kept at less

than 1 percent.

The completed cards were sent to the National Center for Health Statistics where they

were put on magnetic tape. Errors and inconsistencies in the tapes were detected by the

computer in Washington and corrected from information obtained by airmail and cable.

11
SURVEY RESULTS

Since one of the objectives of the study was

to relate medical care utilization to the resources

available, it was important to estimate the ratios

of practicing doctors, active nurses, and hospital

and nursing home beds available to the defined

populations. These figures take into account the

use of doctors, nurses, and hospital beds within

the areas by both residents and nonresidents of

the areas, as well as the use of such services

outside the areas by residents of the areas. The

population ratios in each area are shown in table

E, It is apparent that the population to doctor

ratio in Chittenden is roughly half that in the

other two areas, i.e., 1:470 in contrast to 1:950

in Chester and 1:1,170 in Smederevo. There are

far fewer nurses available to the population in

Smederevo than in the other two areas, i.e.,

1:1,030 in contrast to 1:140 in each of the other

two areas. The same relationship holds for hospital beds, i.e.,’ 1:150 in Smederevo, compared

with 1:80 in”Chester and 1:90 in Chittenden.

Measurement of overall morbidity in general

populations is not easy, whether it be done by

household surveys, physical examinations,

screening tests, or doctors’ records. Several

indirect measures that are internally consistent

may be as valid as one or two direct measures

that are subject to wide observer variation. Uncertainties about “condition” frequencies in populations and difficulties in coding lay responses

to questions about morbidity provide further

complications. The questions asked in the present study about the presence or absence of 12

relatively common acute and chronic “symptomcondition” complexes for which, in all three

areas, medical care is believed to be beneficial

(table A) was an attempt to overcome some of

these difficulties. Table F shows the standardized annual rates per 1,000 population for persons

reporting that they did not recall having had any of

the 12 conditions in the previous 12 months, those

who reported having had only one of the 12 conditions, those who reported having had one or more

conditions, and the total number of conditions reported from the selected list of 12. The rates for

persons with only one condition are about the same

in the three areas. The rates for persons with

“one or more conditions” and the rates for “all

conditions” are substantially higher in Smederevo

(730 per 1,000 persons over 1 year old and 2,030

conditions per 1,000 persons over 1year old) than

in Chester (540 persons per 1,000 persons over 1

year old and 1,130 conditions per 1,000 persons

over 1 year old) and Chittenden (610 persons per

1,000 persons over 1 year old and 1,330 conditions

per 1,000 persons over 1 year old). The reverse

is true for persons reporting that they had had

none of the 12 conditions in the previous 12

months.

Rates for seven conditions in adults and for

five conditions in children were higher in Smederevo than in the other two areas (table 15). Of

Table E. Medical-care resources available for the study areas

I

Population ratios

Chester, U.K----------------------------------------- 1:950 1:140 1:80

Smederevo, Yug--------------------------------------- 1:1,170 1:;,; (): 1:150

Chittenden, U.S. A------------------------------------ 1:470 : 1:90

lIncludes osteopaths in Chittenden; similar professions not found in other two areas.

21ncludes public health nurses, visiting nurses, district nurses, office and clinic

nurses, health visitors and midwives.

31ncludes beds in psychiatric, tuberculosis and chronic-disease hospitals, and in convalescent, maternity, and nursing homes.

12
Table F. Persons 1 year of age and over reporting specific conditional and specific

conditions reported per year for the study areas

Persons without

conditions

Area

r

Sample

frequency

Chester, U.K----------------------------------- 347

Smederevo, Bug--------------------------------- 333

Chittenden, U.S.A ------------------------------ 443

Persons with

1+ conditions

’12 “symptom-condition” complexes (table A).

2 A standard errors of rates.

Standardized

rate per

1,000

persons2

Area

Sample

frequency

Chester, u.K----------------------------------- 411

Smederevo, Bug--------------------------------- 830

Chittenden, U.S.A ------------------------------ 629

the 12 conditions, lower rates were observed

only for varicose veins and hemorrhoids inadults

and for skin rashes in children. The observed

differences could, in part, be attributed to differences in perception or reporting, but they

are also compatible with basic differences in

general morbidity. If overreporting was the main

factor contributing to the higher rates reported

in Smederevo, it might be expected to$e characteristic of most conditions for both adults and

children. In fact, for those conditions reported

for both adults and children,thepatterns differed;

for example, cough in relation to breathlessness,

headaches, skin rashes, and boils.Table15 shows

that the rank order correlations between pairsof

study areas were, for the most part, high, and

the coefficients of concordance forallthreeareas

were O.94for adults and 0.84 for children.

460 *18

270 *14

390 *17

Standardized

rate per

1,000

persons2

540 *18

730 *14

610 *17

Persons with only

1 condition

StandardSample ized

fre- rate per

quency 1,000

persons2

189 250516

295 240 * 13

290 260 *13

All conditions

StandardSample ized

fre- rate per

quency 1,000

persons2

E_l_x!E

When the measures ofmorbidity are further

refined by inquiry about the presence of the 12

“symptom-condition” complexes in adults during

the previous 2-week period, the relationship

between Smederevo and the other two areas is

maintained. The same is true when the measure

is restricted to those conditions causing “great

discomfort” in the previous 2-week period; there

were410 conditions per1,000adults inSmederevo

compared with 240 per l,OOOin Chester and330

per l,OOOin Chittenden (table G).

In summary, the rates for persons reporting

only one of 12 “conditions” present are similar;

all other measures of morbidity employed, i.e.,

persons affected, number of conditions, discomfort, and prevalence of specific conditions, indicate substantially higher levels ofreportedmorbidity in Smederevo. The possibilityof cultural

13
Table G. Specific conditional and specific conditions associated with “great discomfort” in adults 18 years of age and over during a 2-week period for the study areas

Area

All conditions

Conditions associated with “great

discomfort”

Standardized

rate per

1,0002

adults

Standardized

rate per

1,000,,

adults”

Sample

frequency

Sample

frequency

Chester, U.K-----------------------------------

Smederevo, Bug---------------------------------

Chittenden, U.S.A------------------------------

417

1,084

668

840&50

1,580*72

1,080*63

122

316

207

240A 18

410+27

330&23

112 “symptom-condition”complexes (tableA),

2 &standard errors of rates.

Table H, Days of activity limitation and bed disability and persons with activity

limitation and bed disability during a 2-week period for the study areas

Days of

limitation

Days of

disability

Area Standardized

rate per

1,000

population

Standardized

rate per

1,000

populationl

Sample

frequency

Sample

frequency

Chester, U.K-----------------------------------

Smederevo, Bug---------------------------------

Chittenden, U.S.A -------------------------------

490 * 74

1,360+111

620*85

372

1,433

590

6%

.219

Persons with

limitation

Persons with

disability

I Standard- Standardized Area

Sample ized

frerate per

quency

1,000

populationl

Sample

frequency

rate per

1,000

popula- ,’

tiont

Chester, U.K-:--------------------------------

Smederevo, Bug--------------------------------

Chittenden, U.S.A -----------------------------

89 110* 12

242 220 *13

126 120 *1O

60*9

110 k 10

60 *7

,/ I

l&tandard errors of rates.

14
differences in perception and reporting cannot be

excluded. Whether this population does or does not

have higher levels of true morbidity is perhaps

less important from the viewpoint of organizing

medical care than the observation that those questioned tkink that they have a substantial amount

of morbidity.

A critical criterion for assessing the effectiveness of medical care is its capacity to improve

function or at least diminish objective disability.

Table H gives the rates for a 2-week period for

days of “activity limitation” (i.e., inability to

carry on normal daily activities because of illness), and for persons with “bed disability. ”

The differences are in the same direction for

both forms of disability; they parallel the differences observed for “all conditions” and for

those associated with “great discomfort” but are

substantially larger (table G). It is of interest

that higher rates for Smederevo are observed

both for days of activity limitation and bed disability and for persons affected in each category.

These differences are in contrast to the relative

similarity between the other two areas for all

these rates. The mean length of “activity limitation” in Smederevo is 5.9 days compared with

4.2 in Chester and 4.7 in Chittenden. Similarly

the mean length of “bed disability” in Smederevo

is 5.5 days compared with 1.9 in Chester and 3.1

in Chittenden. The higher levels in Smederevo

do not appear to be a function of “malingering”

by workers since the same patterns are observed

for children who receive no sickness insurance

benefits.

Table J. Visua 1 imps irments, eye examinations, and use of eyeglasses by adults 18

years of age and over for the study areas

Area

Chester, U. K-----------------------------------

Smederevo, Bug---------------------------------

Chittenden, U. S. A------------------------------

Area

Chester, U. K-----------------------------------

Smederevo, Bug---------------------------------

Chittenden, U. S. A------------------------------

Unable to “read

newspapers”l

without

eyeglasses

Sample

frequency

171

203

217

Standardized

rate per

1,000

adults2

350 *17

330 *15

380 *15

Eye examinations

during previous

year

Sample

frequency

1:;

168

Standardized

rate per

1,000

adults2

170 * 17

120 *11

270 *18

Unable to

“recognize

frienda” without

eyeglasses

+

StandardSample ized

fre- rate per

quency 1,000

adulta2

110 * 14

% 100 * 12

97 160 A 15

Use of eyeglasses

some or all of

time

T

StandardSample ized

fre- rate per

quency 1,000

adults2

I“Read” understood and interpreted to mean “see ordinary newspaper

_mE

print.”

2* standard errors of ratea.

15
Table K. Persons wi.t’n a personal doctor,l persons consulting doctors, and doctor and

nurse2 consultations during a 2-week period for the study areas

Item

Persons without personal doctor

Sample frequency -----------------------------------

Standardized rate per 1,000 population3------------

Persons with single doctor

Sample frequency -----------------------------------

Standardized rate per 1,000 populations ------------

Persons consulting all doctors

Sample frequency -----------------------------------

Standardized rate per 1,000 populations ------------

All doctor consultations

Sample frequency -----------------------------------

Standardized rate per 1,000 population3------------

All nurse consultations

Sample frequency -----------------------------------

Standardized rate per 1,000 population3------------

Chester,

U.K.

25

3od=7

637

830* 15

118

150*13

158

200* 20

47

70 *31

Smederevo,

Yug .

208

200=!=13

683

570 *17

168

130 *10

268

200 *18

70 i H

Chittenden,

U.S.A.

154

160*12

800

710*16

168

160 +11

239

230* 21

23

20* 12

1

Includes osteopaths in Chittenden; similar professions not found in other two

areas.

21ncludes ~ublj_c health nurses, visiting nurses, district nurses, office and clinic

nurses, health visitors, and midwives.

3&standard errors of rates.

Visual impairments were selected asheing

relatively stable, widely prevalent indicators of

disability, minimally influenced byculturalfactors, which are more readily ascertainable by

lay interviewers than other forms of disability.

Assuch,theymay indicatethepotential demandfor

medical care. This notion is supported by the

stability of the rates for adults unableto “read

newspapers” without eyeglasses and for persons

unable to “recognize friends” without eyeglasses

(table J). Both these rates were remarkably

similar in all three areas--35O in Chester, 330

in Smederevo, and 380 in Chittenden for the

former impairment; and 110 in Chester, lOOin

Smederevo, and 160 in Chittenden for the latter.

By contrast, however, the rates for persons

who had had their eyes examined during theprevious 12 months and rates for the use of eyeglasses were substantially higher in Chester and

Chittenden than in Smederevo, perhaps reflecting

differences in the availability y of ophthalmologists

and opticians. Why the rates for the use of eyeglasses should be identical in Chester and Chittenden is not readily apparent. The similarity of

patterns in the visual impairment rates and the

differences in the “eye examination” and “eyeglass use” rates suggests that the higher rates

for general morbidity, specific morbidity, activity limitation, and bed disability in Smederevo

are unlikely to be entirely explained as functions

of differential reporting in the three areas. All

the evidence from this study favors theconclusion that there is more morbidity and disability

in Smederevo than in ChesterorChittenden.

16
Table K shows therates for persons having

a single “personal doctor” and for doctor consultations. As might be expected, in Chester,

where the British National Health Service makes

a general practitioner available for everyone,

the rate (830 per 1,000 population) was substantially higher for persons who reported that they

have a personal doctor than it was in the other

two areas. Smederevo may have had a lower rate

(570 per 1,000 population) because many patients

attend health units and health centers, each

staffed by several physicians, any one of whom

a patient may see on successive visits. The

Chittenden rate (710 per 1,000 population) was

intermediate. Rates in the three areas for the

number of persons consulting doctors during a

2-week period and the rates for all doctor consultations during a 2-week period are virtually

identical, Rates for all nurse consultations were

markedly less in Chittenden. None of the consultation rates appeared to be positively correlated

with the ratio of physicians or nurses available

to the populations of the three areas.

Table L gives selected characteristics of the

personal doctors designated by the respondents.

Most patients in all three areas were within 30

minutes’ travel time of their doctor, and most

found him relatively “unhurried” and prepared

to “listen” and “explain.”

Data shown in table M reflect the propensity

of the population to consult doctors in relation

to reported levels of morbidity. Again, the proportion of all conditions for which no doctor was

consulted during the previous 12 months was

similar—a range of 22-34 percent. The tendency

for adults having one or more conditions not to

consult a doctor appeared greater in Smederevo

(69 percent) and Chittenden (66 percent) than in

Chester (41 percent). The proportion of selected

conditions in adults that caused “great discomfort” during the 2-week period but for which no

doctor was consulted was almost identical in

the three areas. In each of the three areas about

four out of five of those individuals who reported

that they had experienced “great discomfort” in

the past 2 weeks from one or more of the listed

Table L. Selected characteristics of doctor reported bv adults 18 vears of age and

over having a personal doctor $or the ~tudy areas “

Item

Adults with simzle Dersonal doctor

Number -------- ----------- --------- -----------------

Percentage -----------------------------------------

Doctor’ s office within 30 minutes travel time

Number ---------------------------------------------

Percentage -----------------------------------------

Doctor “unhurried” most of time

Number ---------------------------------------------

Percentage -----------------------------------------

Doctor “listens” most of time

Number ---------------------------------------------

Percentage -----------------------------------------

Doctor “explains” most of time

Number ---------------------------------------------

Percentage -----------------------------------------

2hester,

U.K.

493

100

3;:

346

83

373

89

322

78

Smederevo,

Mlg .

613

100

520

85

515

84

532

87

495

81

Chittenden,

U.S.A.

502

100

463

93

468

93

483

96

466

93

17
Table M. Proportion of specific

with specific conditions for

Area

Chesterj U.K----------

Smederevo,Yug--------

Chittenden, U.S.A-----

conditions1 and of adults 18 Years

which no doctor was consulted f& the

All conditions

Total Doctor not

consulted

Number Percent

670 226 34

1,829 397 22

925 256 28

of age and over

study areas

All conditions

\ll adults with one causing “great

:onditionor moreg discomfort” in

adults:l

rotal Doctor not Total Doctor not

consulted consulted

Number I

Per- 1

Number

Percent cent

309 169 41 122 96 79

602 418 69 316 271 86

398 264 66 207 163 79

112 ‘Ispptom-condi.tion”complexes (tableA).

212-monthperiod.

32-week period.

Table N. Doctor consultationsfor persons 1 year of age and over without any conditions and with one or more conditions during a 2-week period for the study areas

Area

Chester, U.K----------------------------------

Smederevo, Yug--------------------------------

Chittenden, U.S.A-----------------------------

Persons without

any conditions

consulting doctors

Sample

frequency

15

21

55

Standardized

rate per

1,000

personsl

50*8

30+4

50*7

Persons with one

condition or more

consulting doctors

Sample

frequency

103

147

113

Standardized

rate per

1,000

personsl

100 *1O

100* 9

110 * 9

I&standarderrors of rates.

12 acuteand chronicconditionsdidnotconsult (30per 1,000persons).This suggeststhatthe

a physicianduringthatinterval.

The extentto which patientsconsultedoctors for curativeservicesin contrastto preventiveservicesis indicatedin tableN. Virtuallyidenticalratesfor “personswithoutany

conditionsconsultingdoctors”were found in

Chesterand Chittenden(50per 1,000persons).

The rate for Smederevo was somewhat less

presenceof a financialbarrier to theuse ot

medical care, sometimes associatedwith the

fee-for-servicesystem,was not an important

deterrent.Doctors were consultedfor checkups and possiblepreventiveservicesas frequentlyin Chittendenas in Chester.The doctor

consultationratesfor persons withconditions

were virtuallyidenticalinallthreeareas.

18
Table O shows the use of drugs (medicine,

salves, or pills) by adults in the three areas.

About twice as many adults had taken prescribed

medicine in the previous 48 hours in Chester

(31S percent) and Chittenden (48 percent) as in

Sm~&’revo (19 percent). The same relationship

held for the proportion of persons who had taken

m~$clicines not prescribed by a doctor. In spite of

apparently higher morbidity and disability rates,

the use of drugs and self-medication was at lower

levels in Smederevo than in Chester and Chittendtm.

Table P shows the standardized annual rates

per 1,000 population for the use of all hospitals,

including psychiatric hospitals, in the three areas;

the rates are similar to the national rates for the

respective countries. The annual admission rate

per 1,000 population is much higher in Chittenden (170 per 1,000) than in Chester (90 per 1,000)

and Smederevo (100 per 1,000); the rate for persons admitted is also higher. The annual rate of

hospital days per 1,000 population is lowest in

Chester, but the standard errors are large.

Table O. Use of drugs 1 by adults 18 ears of age and over during the previous 2 days

for t~e study areas

Area

Chester, U. K--------

Smederevo, Yug ------

Chittenden, U. S. A---

Total

T

Num- ~~~~-

ber

age

514 100

776 100

627 100

Using any

drugs

197 38

147

303 ‘H

Using only Using drugs Using both

drugs pre - not pre -

prescribed

scribed by scribed by and nonpre -

doctor doctor scribed

drugs

Num- ::;;- Num- ber :::;- Num- ber

ber

age age

I I 1 1

97 19 76 15 23

94 6

172 27 I

18 2:

Percent -

age

4

l“Medicines, salves, or pills. ”

Table P. Admissions, persons admitted, and hospital days for all persona 1 year of

age and over per year and mean length of stayl for the study areas

Admissions

Area

r

Sample

frequenty

Chester, U.K-------- 69

Smederevo, Yug------ 122

Chittenden, U.S.A--- 168

Standardized

rate per

1,000

population~

90 *12

100 *11

170 *15

Persons admitted

+

StandardSample ized

fre- rate per

quency

1,000

population 2

70*9

1;; SO*8

147 140 * 12

Hospital days

I

Standardized

S;::le rate per

quency

1,000

population~

669 850 & 184

1,637 1,460*335

1,358 1,500+276

Mean

length

of

stay

11

14

8

lAverages within areas only.

‘* standard errors of rates.

19
SUMMARY AND CONCLUSIONS

In spite of substantial differences in ways of

life, in organization of health services, and in

reported morbidity and disability, people in the

three study areas in England, Yugoslavia, and the

United States appear to consult doctors in very

much the same way. Tabulations by levels of

educational achievement showed no important

contrasts between the respective study areas. The

possibility exists that there is some kind of propensity for consulting a doctor or a nurse for

curative services. This propensity seems unrelated to the number of doctors available to

the population. Different factors may influence

the use of preventive and curative services.

On the other hand, it is apparent that patterns

of hopital utilization vary substantially in the

three areas, and these differences raise interesting questions about the ways in which hospitals are organized and used in the three areas.

On the basis of this study, the Committee

for the International Collaborative Study of Medical Care Utilization has concluded that epidemiologic methods employing household interviews

are feasible for undertaking international and

regional studies of medical care utilization. The

internal consistency of the rates observed with

respect to both similarities and differences is

reassuring; most of the standard errors are

acceptable. The consistency of hospital utilization

data with national data in the three areas affords

additional support for the committee’s conclusion. Validation studies indicate that the methods

are responsive to the problem.

In the full-scale study now underway in 11

areas in Argentina, Canada, Finland, Poland,

the United Kingdom, the United States, and Yugoslavia the same general methods will be employed, including the use of identical questionnaires and manuals (translated and retranslated),

uniform training programs for interviewers and

coders, coordination of activities in the field by

traveling consultants, and communication among

the participants by means of frequent large and

small working sessions. The sample size in each

study area will be expanded to at least 1,000

households. Many changes and improvements will

be made in the questionnaires, manuals, and computer programs. The sampling design will continue to be a matter of local choice depending on

prior experience and the availability of sampling

information in each area. More refined methods

will be introduced to obtain comparability between

the study areas in the classification of occupations

and in the measurement of health personnel and

facilities. With the confidence gained from the

feasibility study that the methods are suitable,

it is now possible to progress to the examination

of some of the original hypotheses of interest and

to explore in greater depth the relationships between the availability of health personnel and

resources, the methods of organizing medical

care and paying for services, and the utilization

of medical care.

PUBLICATIONS OF COMhiITTEE FOE INTERNATIONAL

COLLABORATIVE STUDY OF MEDICAL CARE UTILIZATION

Committee for International Collaborative Study of hledical

Care Utilization: The Chronicle of a Feasibility Study, 1964-

66.82 pp., 1966 (available from Committee participants).

Mabry, J. H., and others: The natural history of an international collaborative study of medical care utilization.

Social Sciences Information (UNESCO) 5:37-55, 1966.

“ihite, K. I,., and others: International comparisons of

medical-care utilization. A~ew England J..lled. 277:516-522,

1967.

Bite, T., and White, K. L.: Factors related to the use of

health services, an international comparative study. Medics?

Cure 7:124-133, Mar. -Apr., 1969.

20
DETAILED TABLES

Table 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13,

14.

15,

16.

17.

18,

19.

20.

21.

22,

23.

Total number of persons eligible for interview, number interviewed, and number

not interviewed, by age,urban-rural classification,and sex for the study areas--

Numbers of persons consulting doctors during a 2-week period, by age and sex for

the study areas-----------------------------------------------------------------

Numbers of persons consulting health workers other than doctors and numbers of

consultations during a 2-week period, by age, sex, and type of consultation for

the study areas-----------------------------------------------------------------

Numbers of persons 1 year of age and over with selected conditions and number of

conditions, by age and sex for the study areas----------------------------------

Numbers of persons admitted to hospitals and number of admissions during a year,

by age and sex for the study areas----------------------------------------------

Population estimated from the sample, by age,urban-rural classification, and sex

for the study areas-------------------------------------------------------------

Numbers and rates for persons having a personal doctor, by age, sex, and number

of doctors for the study areas--------------------------------------------------

Numbers and rates for persons consulting doctors during a 2-week period, by age,

sex, and number of consultations for the study areas----------------------------

N;mbers and rates for consultations with doctors during a 2-week period, by age

and sex for the study areas-----------------------------------------------------

Numbers and rates for consultations with doctors during a 2-week period, by age,

sex, and place of consultation for the study areas------------------------------

Numbers and rates for procedures ordered at consultations with doctors during a

2-week period, by age, sex, and type of procedure for the study areas-----------

Numbers and rates for persons and for consultations with health workers other

than doctors during a 2-week period, by age, sex, and type of consultation for

the study areas -----------------------------------------------------------------

Numbers and rates for persons 1 year of age and over with selected conditions

during a year and number of conditions, by age and sex for the study areas------

Numbera and rates for persons 1 year of age and over who had not consulted a

doctor for selected conditions during a year and number of conditions,by age and

sex for the study areas---------------------------------------------------------

Prevalence of12 selected conditions for adults and children for the study areasNumbers and rates for persons with and without conditions consultinga doctor

during a 2-week period and number of conditions for all consultations, by age and

sex for the study areaa---------------------------------------------------------

Numbers and rates for persona with activity limitation during a 2-week period and

number of days per 1,000 persons, by age and sex for the study areas------------

Numbers and rates for persons with bed disability during a 2-week period and

number of days per 1,000 persons, by age and sex for the study areas------------

Visual acuity, use of eyeglasses, and eye examinations among adults 18 years of

age and over, by age and sex for the study areas--------------------------------

Numbers and rates of conditions among 12 selected conditions reported by adults

18 years of age and over,by degree of discomfort and whether or not a doctor was

consulted during a 2-week period for the study areas---------------------------

Hypothetical behavior for a hypothetical condition compared with actual behavior

for an actual condition for adults for the study areas--------------------------

Utilization of hospitala during a year, by age and sex for the study areas------

Numbers an~ rates for persons hospitalized during a year and number of admissions,

by age and sex for the study areas----------------------------------------------

Page

22

23

24

25

26

27

28

30

32

34

36

38

40

42

44

45

46

48

50

52

.53

54

55

21
Table 1. Total number of persons eligiblefor interview,number interviewed,and number not interviewed,by

age, urban-ruralclassification,and sex for the study areas

All ages IIUnder 18 years I

18-44 years I

45-64 years I

65+ years Area,

Urban-rural classification, and sex total I N-I Total I N-I Total I N-I Total I N-I Total I N-I

I I I 1 I #

Chester,U.K.

TOtal----------

Male-----------------

Female---------------

Number of persons

!40

.

.08

!32

.57

76

81

83

—

32

51

$72

230

242

227

.03

!24

?45

L27

118

)36

.

L64

L72

265

.

L30

L35

71

—

34

37

—

32

21

11

22

14

8

10

7

3

12

.

10

2

6

6

6

—

4

2

5

3

2

4

2

2

1

1

195

90

L05

L30

—

58

72

65

—

32

33

206

99

107

63

—

32

31

143

67

76

196

99

97

157

.

77

8C

39

—

22

17

36

.

17

19

29

16

13

7

1

6

3

.

2

1

2

1

1

1

—

1

15

.

6

9

13

—

5

8

2

1

1

—

79

.

27

52

57

—

17

40

22

10

12

94

.

37

57

31

—

11

20

63

26

37

93

.

37

56

82

—

32

50

11

5

6

35

.

14

21

28

—

10

18

7

—

4

3

6

.

3

3

3

—

1

2

3

—

2

1

7

.

3

4

7

—

3

4

.

—

-

—

890

—

413.

477

584

269

315

306

144

162

1,198

771

353

418

499

119

.

60

59

85

41

44

34

19

15

24

.

16

8

13

9

4

11

—

7

4

30

=

15

15

26

12

14

4 —

3

1

—

273 257 16

.

8

8

6

1

5

10

7

3

3

.

1

2

2

1

1

1

1

3

=

3

2

—

2

1

—

1

272

129

143

179

231 114

136

137

161

128

129

155

107

124

159

41

73

85

27

58

29

Urban ------------

74

85

72

33

39

209

Male -----------------

Female ---------------

228

271

272

125

147

1,174

78

83

112

77

78

102

90

89

Rural ------------ 93

58

54

405

51

51

402

.

219

183

199

104

95

203

115

88

463

39

54

484

14

15

100

Male-----------------

Female ---------------

Smederevo, Yug.

Total ----------

40

60

34

12

22

66

Male -----------------

Female ---------------

601

597

533

585

589

520

220

185

201

105

96

204

115

89

466

240

244

233

109

124

251

101

108

65

33

32

144

68

76

211

urban------------

259

274

665

342

323

1.118

250

270

654

Male -----------------

Female ---------------

Rural ------------

335

319

1.088

131

120

341

_

167

174

269

132

137

72

35

37

28

38

100

40

60

89

35

54

11

Male -----------------

Female ---------------

Chittenden, U.S.A.

Total ----------

566

552

889

439

450

229

127

102

551

537

863

427

436

225

254

212

361

190

171

105

64

41

251

212

359

105

106

170

Male -----------------

Female ---------------

Urban ------------

82

88

41

23

18

Male -----------------

Female ---------------

188

171

104

63

41

Rural ------------

5

6

124

101

Male -----------------

Female ---------------

1 = Interviewed.

N-I = Not interviewed.

22
Table 2. Numbers of persons consulting doctorsl during a 2-week period, by age and sex for the

study areas

~lbserved frequenciesobtsinedin the intewiews]

r

Area and number of consultations

Chester, U.K.

Total persons -----------------

..

Persons with:

No consultations ------------------

One consultation ------------------

Two consultations -----------------

Three consultations or more -------

Smederevo, Yug.

Total persons -----------------

‘Persons with:

No consultations ------------------

One consultation ------------------

Two consultations -----------------

Three consultations or more -------

Chittenden. U.S.A.

Total persons -----------------

persons with:

No consultations ------------------

One consultation ------------------

Two consultations -----------------

Three consultations or more -------

All ages

771

653

87

26

5

1,174

1,006

107

38

23

1,088

920

126

26

16

~

years Male Female Male Female Male Female

I I I I

Number of persons interviewed

257

217

32

7

1

402

328

50

12

12

463

397

51

10

5

108

100

6

1

1

230

211

10

4

5

164

143

11

6

4

132

.

105

21

5

1

242

.

198

29

12

3

172

138

31

1

2

90

76

9

4

1

99

.

91

4

3

1

99

87

10

1

1

105

87

10

7

1

107

92

9

5

1

97

80

11

4

2

27

24

3

37

37

37

29

5

2

1

52

44

6

2

57

49

5

2

1

56

46

7

2

1

~Includes osteopaths in Ckittenden; sim-i.lar professions not found in other two areas.
Table 3. Numbers

tions during

of persons consulting health workeralother than doctors and numbers of consultaa 2-week period, by age, sex, and type of consultation for the study areas

fbserved frequenciesobtained in the interviews]

Area and type of consultation

Chester, U.K.

Total persons----------------------

Number of

Number of

Number of

Number of

persons with one visit or morenurse consultations ------------

dentist consultationa ----------

other consultations ------------

Smederevo, Yug.

Total persons----------------------

Number of persons with one visit or moreNumber of nurse consultationa ------------

Number of dentist consultations ----------

Number of other consultations ------------

Chittenden, U.S.A.

Total persons----------------------

Number of persons with one visit or moreNumber of nurse consultations ------------

Number of dentist consultations ----------

Number of other consultations ------------

All

ages

771

88

47

43

46

L,174

66

89

19

38

.,088

83

23

54

29

Under

18

years

257

29

8

19

15

402

22

35

6

3

463

36

10

22

13

18-44 years

Male

108

15

2

8

6

230

8

3

3

16

164

10

5

6

5

Female

132

16

4

9

6

242

23

38

8

11

172

12

1

13

2

45-64 years

Male

90

7

5

5

4

99

5

3

5

99

7

2

2

4

Female

105

8

6

5

107

2

3

1

97

11

5

6

2

65-!-years

Male

27

4

15

2

37

2

2

1

37

3

3

1

Female

52

9

7

2

8

57

4

7

1

56

4

2

2

lIncludes public health nuues, visiting nurses, district nurses,

health visitors, and midwives.

office and clinic nurses,

24
Table 4, Numbers of persons 1 year of age and over with selected conditions and number of conditions, by age’and sex for the study areas

[Observed frequencies obtained in the interviews]

>

18-44 years 45-64 years 65+ years

All ages,

1+ years

1-18

years

Area and number of conditions

Female

132

42

90

36

21

15

10

8

210

242

47

195

46

43

33

27

46

614

172

Male ?emale

105

28

77

Male Yale Female

108

61

47

33

8

4

1

1

70

230

76

154

60

40

19

17

18

369

164

Chester, U.K.

758

347

411

189

101

62

32

27

855

1,163

244

142

102

53

28

12

6

3

185

391

90 27

14

13

Total persons, 1+ years ------- 52

Number of persons with:

No conditions -------------------

One condition or more -----------

One condition ---------------------

WO conditions --------------------

Three conditions ------------------

Four conditions -------------------

Five conditions or more -----------

Total number of conditions ----------

39

51

21

31

13

8

4

3

3

70

57

23

12

8

4

4

109

99

16

83

21

12

20

9

21

272

99

26

22

14

7

8

183

107

5

2

5

1

28

37

Smederevo, Yug.

Total persons, 1+ years-------

Number of persons with:

No conditions -------------------

One condition or more -----------

One condition ---------------------

Two conditions --------------------

Three conditions ------------------

Four conditions -------------------

Five conditions or more -----------

333

830

295

178

134

90

133

2,203

1,072

163

228

136

56

24

9

3

374

447

13

94

15

12

26

14

27

333

97

9 9

28

8

9

4

3

4

72

37

48

9

6

8

11

14

169

56

Total number of conditions ----------

Chittenden, U.S.A.

Total persons, 1+ years -------

Number of persons with:

No conditions -------------------

One condition or more -----------

One condition ---------------------

Two conditions --------------------

Three conditions ------------------

Four conditions -------------------

Five conditions or more -----------

443

629

216

231

129

58

28

8

8

402

73

91

59

113

39

60

33

64

24

16

10

7

7

152

9

28

11

7

3

2

5

71

14

42

9

14

8

5

6

125

290

160

86

42

51

1,327

53

23

5

5

5

162

41

24

22

10

16

286

23

18

10

5

4

Total number of conditions ---------- 129

25
Table 5. Numbers of persons admitted to hospitals and number of admissions during a year, by age

and sex for the study areas

[Observed frequencies obtained in the interviews]

18-44 years !5-64 years 65-I-years Under

18

years

257

19

411 Area and number of admissions

Chester. U.K.

Sale

ages

Male

108

1

Female Female Male Female

771

57

Total persons ----------------------

Number of persons with:

One admission or more ------------------

One admission --------------------------

Two admissions -------------------------

Three admissions or more ---------------

Total number of admissions ---------------

Smederevo. YLUZ.

132

25

90

5

105

4

27

1

52

2

46

10

1

69

,174

102

20

5

30

242

35

18

1

20

402

41

1

1

230

13

2

3

8

99

7

5

2

9

99

13

8

3

2

20

3

1

5

107

4

4

4

97

15

11

4

19

1

1

37

37

10

8

1

1

14

1

1

4

57

2

Total persons ----------------------

Number of persons with:

One admission or more ------------------

One admission --------------------------

TWO admissions -------------------------

Three admissions or more ---------------

Total number of admissions ---------------

Chittenden, U.S.A.

83

18

1

122

,088

147

32

9

50

463

49

12

1

14

164

12

29

5

1

42

172

37

1

1

-

3

56

11

11

11

Total persons ----------------------

Number of persons with:

One admission or more ------------------

One admission --------------------------

TWO admissions -------------------------

Three admissions or more ---------------

Total number of admissions ---------------

130

14

3

168

48

1

50

10

2

14

34

3

40

26
Table & Population estimated from the sample by sge,

the a~udy areaa

urban-rural classification, and aex for

[Estimatesof frequencies in the total population]

I I

Under

18

yeara

18-44

years

45-64

years

65rF

years

All

ages

Area, urban-ruralclassification,and sex

I I

Chester, U.K.

Total --------------------------------------------

Number of persons

81,790

37,960

43,830

53,570

24,700

28,870

28,220

25,070

—

12,500

12,570

14,740

7,150

7,600

10,330

25,050

11,870

13,180

16,470

8,280

8,180

8.580

21,200

9,830

11,370

14,560

6,790

7,770

6,640

3,040

3,600

16.220

10,470

3,770

6,700

7,800

2,480

5,320

2,670

1,290

1,380

7,710

3,110

4,600

2,250

790

1,460

5,460

2,310

3,140

6,580

Male ---------------------------------------------------

Female -------------------------------------------------

Urban ----------------------------------------------

Male ---------------------------------------------------

Female -------------------------------------------------

Rural ----------------------------------------------

Male ---------------------------------------------------

Female-------------------------------------------------

13>260

14,950

90.370

5>360

4>970

30,210

16,490

L3,71O

13,280

6,950

6,330

16,920

9,540

7,380

$0,770

3,580

5,000

36,230

—

18,130

18,100

15,390

7,210

8,180

20,830

10,920

9,910

22,510

Smederevo, yug.

Total--------------------------------------------

Male ---------------------------------------------------

Female -------------------------------------------------

Urban ----------------------------------------------

Male ---------------------------------------------------

Female -------------------------------------------------

Rural ----------------------------------------------

Male ---------------------------------------------------

Female-------------------------------------------------

45,540

44,830

35,210

17,130

18,090

55,150

28,410

26,740

73,800

7,800

8,420

4,280

2,180

2,110

11,940

5,630

6,310

13,940

Chittenden, U.S.A.

Total--------------------------------------------

Male---------------------------------------------------

Female-------------------------------------------------

Urban----------------------------------------------

Male---------------------------------------------------

Female-------------------------------------------------

Rural----------------------------------------------

Nale---------------------------------------------------

Female-------------------------------------------------

37,340

36,460

58.690

L6,780

L3,990

!3.850

11,020

11,490

17,750

8,710

9,040

4,750

6,910

7,030

11,230

5,390

5,840

2,710

1,520

1,190

2,630

3,950

5,850

2,300

3,550

730

28,970

29,720

15,100

8,370

6,730

!2,570

!1,290

6,910

4,210

2>710

2,310

2,440

330

400

NOTE: Due to rounding, detailed figures may not add to the totals.

27
Table 7. Numbers and rates for persons having a personal doctor,l by age, .sex, and number of

doctors for the study areas

[Estimates of frequencies in the total population]

Under 18-44 years 45-64 years 65+ years

All

ages

18

years Male Female Male Female Male Female

Area and

number of personal doctors

Chester, U.K.

Total persons ---------------

Persons with:

One doctor ----------------------

TWO doctors ---------------------

Three doctors or more -----------

No doctor -----------------------

Smederevo, Yug.

Total persons ---------------

Persons with:

One doctor ----------------------

TWO doctors ---------------------

Three doctors or more -----------

No doctor -----------------------

Chittenden, U.S.A.

Total persons ---------------

Persons with:

One doctor ----------------------

Two doctors ---------------------

Three doctors or more -----------

No doctor -----------------------

Number of persons

31,790 25,070 11,870 L3,180 11,370 1,770 6,700

57,660

7,290

4,250

2,590

90,370

21,340

2,330

980

410

30,210

10,000

550

770

550

18,130

10,500

1,190

790

700

18,100

7,920

770

640

500

7,800

9,100

1,300

540

430

8,420

1,370

150

260

),110

5,440

990

270

4,600

51,830

1,670

20,180

16,680

73,800

17,200

670

8,710

3,630

30,770

10,220

160

4,070

3,690

11,020

11,330

550

3,190

3,030

11,490

3,900

150

1,670

2,090

6,910

4,900

150

1,350

2,010

7,030

4,630

1,240

220

940

.,800

440

860

?,630

2,490

.

750

1,360

3,950

- - -

54,160

6,850

2,170

10,620

25,920

1,720

1,000

2,120

6,730

800

130

3,360

7,540

1,530

600

1,810

5,020

700

70

1,120

!,780

360

500

2,540

49C

14C

77C

lIncludes osteopaths in Chittenden; similar professions not found in other two areas.

NOTE : Due to rounding, detailed figures may not add to the totals.

28
Table 7. Numbers and rates for persons having a personal doctor,l by age, sex, and number of

doctors fo~ the study areas—Con.

[FstiP ~t~s d frequencies in thetotalpopulation

Under 18-44 years 45-64 years 65+ years

All

ages

18

years Male Female Male Female Male Female

Standardized rate

per 1,000

persons

Rate per 1,000 persons

1,000 1.000 1,000

800

90

60

50

1,000

1.000 1,000

890

40

70

1,000

1,000

_

810

150

40

1,000

1.000 1.000 1,000

830

90

50

30

1,000

830

90

50

30

1,000

850

90

40

20

1,000

840

50

60

50

1,000

810

80

60

50

1,000

800

110

50

40

1,000

570

20

220

180

1.000

570

20

290

120

1.000

560

10

220

200

1,000

630

30

180

170

1,000

500

20

210

270

1,000

580

20

160

24o

1,000

580

140

280

1,000

540

160

300

1,000

570

20

210

200

1,000

730

90

30

140

840

60

30

70

610

70

10

300

660

130

50

160

730

100

10

160

660

180

30

130

670

140

190

64o

120

40

190

710

100

30

160

29
Table 8. Numbers and rates for persons consulting doctors1 during a 2.week period, by age, sex,

and number of consultations for the study areas

reestimates offrequencies in the total population

18-44 years 45-64 years 65+ years

I I I I I

All

ages

Under

18

years

Area and

number of consultations

Chester, U.K.

Total persons --------------

Persons with no consultations--

Persons with one consultation

or more -----------------------

Persons with one consultation----

Persons with two consultations---

Persons with three consultations

or more -------------------------

Smederevo, Yug.

Total persons --------------

Persons with no consultations--

Persons with one consultation

or more -----------------------

Persons with one consultation----

Persons with two consultations---

Persons with three consultations

or more -------------------------

Chittenden, U.S.A.

Total persons --------------

Persons with no consultations--

Persons with one consultation

or more -----------------------

Persons with one consultation----

Persons with two consultations---

Persons with three consultations

or more -------------------------

Male Female Male Female Male Female

6,700

5,640

1,060

800

270

-

4,600

3,960

640

410

150

80

3,950

Number of persons

81,790 25,070 11,870 13,180 9,830 11,370 3,770

69,350 21,180 10,980 10,490 8,280 9,420

1.950

3,370

12,440 400

9,170

2,740

530

90.370

3,890

3,140

660

90

30.210

890

660

110

110

18,130

—

16,670

1,460

750

300

400

11.020

2,690

2,100

490

100

18,100

1.550

990

450

120

7.800

1,080

760

110

8,420

400

3,110

-

7,200

600

300

220

70

6,910

7,280

1,140

690

380

70

7,030

77,880 3,110

12,49C

8,03C

2,80C

1,65C

73.80(

24>670

5,530

3,770

93C

84C

30.77C

14,980

3,120

2,110

810

200

11,490 2,630

-

62,390

11,410

26,380 9,610 9,210 6,070 5,800 2,060 3,240

700

490

140

70

4,390 1,410 2,270 830 1,230 570

8,540

1,770

1,090

3,400

660

330

740

400

270

2,070

70

130

700

70

70

800

290

150

360

140

70

1

Includes osteopaths in Chittenden; similar professions not found in other two areas.

NOTE: Due to rounding, detailed fipres may not add to the totals.

30
Table 8. Numbers and rates for persons consulting doctorsl during a 2-week period, by age, sex,

and number of consultations for the study areas—Con.

[Estimatesof frequencies in the total population]

Under 18-44 years 45-64 years 65+ years

All

ages

18

years Male Female Male Female Male Female

Standardized rate

per 1,000

persons

Rate per 1,000 persons

1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000

850 840 920 800 840 830 890 840 850

150

110

30

10

1,000

150

120

30

1,000

70

60

10

10

1,000

200

160

40

10

1,000

160

100

40

10

1,000

920

170

90

70

10

1,000

110

110

1,000

160

120

40

1,000

150

110

30

10

1,000

860 820 920 830 860 1,000

1.000

860 870

140

90

30

20

1,000

840

180

120

30

30

1.000

80

40

20

20

1.000

170

120

40

10

1,000

800

80

40

30

10

1,000

880

130

80

50

10

1.000

140

90

30

20

1.000

130

80

30

20

1.000

860

140

870 820 780 820 840

150

120

20

20

130 200 120 170 220 180 160

110

20

10

70

40

20

180

10

10

100

10

10

110

40

20

140

50

30

120

40

20

120

20

20

31
Table 9. Numbers and rates for consultationswith doctorsl during a 2-week period, by age and sex

for the study areas

[Estimates of frequencies in the total population]

Age and sex

All ages

Both sexes------------------------------.

Under 1.8years

Both sexes-------------------------------

18-44 years

Male-------------------------------------------

Female-----------------------------------------

45-64 years

Male-------------------------------------------

Female----------------------------------------

65+ years

Male------------------------------------------

Female----------------------------------------

Standardizedrace per 1,000 persons------------

Total

number of

persons

81,790

25,070

11,870

13,180

9,830

11,370

3,770

6,700

...

Chester, U.K.

Consultations

Tota1

number

16,680

4,740

1,340

3,380

2,350

3,140

400

1,330

...

Rate per

1,000

persons

200

190

110

260

240

280

110

200

200

Rate per

1,000

persons

with 1+

consultations

1,34C

1,02C

1,510

1,260

1,510

1,610

1,00C

1,25C

...

1

Includes osteopathsin Chittenden;similar professionsnot found in other two areas.

‘NOTE:Due to rounding, detailed figures may not add to the totals.

32
I

I

I

I

I

doctorsl during a 2-week period, by age and sex

areas—Con.

Table 9. Numbers and rates for consultations with

for the study

(Estimatesorfrequencies h thetotalModulation_!

Total

number of

persons

90,370

30,210

18,130

18,100

7,800

8,420

3,110

4,600

...

Smederevo, Yug.

Consultations

Total

number

19,710

8,600

2,810

4,520

950

1,870

960

...

Rate per

1,000

persons

220

280

150

250

120

220

210

200

Rate per

1,000

persons

with 1+

consultations

1,580

1,550

1,930

1,450

1,600

1,640

1,490

...

Total

mmber of

persons

73,800

30,770

11,020

11,490

6,910

7,030

2,630

3,950

...

Chittenden, U.S.A.

Consultation

Total

number

16,270

5,790

2,620

2,670

1,180

2,030

920

1,060

...

Rate per

1,000

persons

220

190

240

230

170

290

350

270

230

Rate per

1,000

persona

with 1+

consultations

1,430

1,320

1,860

1,180

1,410

1,650

1,620

1,500

...

33
Table 10. Numbers and rates for consultationswith

and place of consultation

doctors* during a 2-week period, by age, sex,

for the study areas

[Estimates of frqucmcies in the total population]

Area and place of consultation

Chester, U.K.

Total consultations-----------

Not hospital based--------------

Office, surgery, and health center--

Home--------------------------------

School, factory, and other----------

Hospital based------------------

Outpatient clinic-------------------

Emergency and casualty--------------

Telephone-----------------------

Smederevo,Yug.

Total consultations-----------

Not hospital based--------------

Office, surgery,and health center--

Home--------------------------------

School, factory, and other----------

Hospital based------------------

Outpatientclinic-------------------

Emergency and casualty--------------

Telephone-----------------------

Chittenden,U.S.A.

Total consultations-----------

Not hospital based--------------

Office, surgery,and health center--

Home--------------------------------

School, factory,and other----------

Hospital based------------------

Outpatientclinic-------------------

Emergency and casualty------------”--

Telephone-----------------------

All

ages

16.680

13.410

8,710

3,250

1,450

2,130

1,:;;

1,140

19,710

14,580

10,030

220

4>330

5,120

3,620

1,500

16,270

11,740

10,250

750

740

2,110

770

1,340

2,420

I I I

Under 18-44 years 45-64 years 65+ years

16 I I I

yea= Male Female Male Female Male Female

4,740

—

4,080

2,060

1,350

670

180

180

480

8,600

6,160

4,350

1,816

2,440

1,340

1,100

5,790

3,470

2,930

270

270

1.000

200

800

1,330

Number of consultations

1,340I 3,380 I2,3501 3,140 I 400 I 1,330

1,220 2,690 2,040 2,060 260 1,060

1,000 1,890 1,340 1,620 130 660

110 600 470 330 130 270

110 200 230 110 - 130

110 600 310 650 150 130

110 400 310 540 150

200 - 110 - 136

100 - 430 - 130

2,810 4,520 950 1,870 - 960

m

2,620 2,670 1,180 2,030 920 1,060

2,010 1,940 1,110 1,590 780 840

1,480 1,870 1,040 1,520 780 630

130 70 - 70 - 210

400 - 70 - - -

400 200 - 440 70 -

130 - 440

406 70 - - 76 :

200 530 70 70 210

1

Includes osteopathsin Chittenden;similar professionsnot found in other two areas.

NOTE: Due to rounding,detailed figuresmay not add to the totals.

34
Table 10. Numbers and rates for consultations with doctorsl during a 2-week period, by age, sex,

and place of consultation for the study areas—Con.

[Estimate.of frequencies in the tmtal population]

I

Under 18-44 years

All

45-64 years 65+ years

ages

18

years Male Female Male Female Male Female

Rate per 1,000 consultations

1,000 1,000 [ 1,000 1.000 1.000 1.000 1,000 I 1,000

790

520

190

80

130

m

800

560

180

60

180

870 660

570

200

100

130

520

100

30

40 I 80 200

I

370 100

I

100

30

70

40 I 80 120

60

30

130 170

30

140

370

100

100

1,000 1,000 1.000 1.000

740 =!_= 760 790 660 660

510

2;:

260

640

120

240

250

540

210

620

40

330

430

230

340

180 340

80

200

40

140

70

260

70

1,000 1,000 1,000 1,000

720 600 j 770

I

730 940 780 850 I 790

500 560

50

50 l%

700

20

70

750

40

220

220

+

850 590

200

80

86

4

-t=

50

20

230 I 80 200 60 80 \ 200

35
Table 11. Numbers and rates for procedures ordered at consultations with doctors 1 during a 2-week

period, by age, sex, and type of procedure for the study areas

[Estimatesof frequencies inthetotalpopulation]

Under 18-44 years 45-64 years 65+ years

All

ages

18

wars Male Female Male Female Male Female

Area and type of procedure

Chester, U.K. Number of consultations and procedures

Total consultations ----------- 16,680

18>270

970

930

350

10,910

880

1,250

830

2,150

1,890

19,710

33.500

4,740

4.080

1,340

1,780

450

770

110

446

2,810

5,950

870

450

310

1,890

800

590

140

910

70

2,620

3,090

3,380

3,080

200

100

2,290

200

100

200

600

4,520

7.430

2,350

3,470

33;

120

1,460

120

210

120

1,130

230

950

1,710

G

220

510

390

150

1;:

1,180

1,250

3,140

3,460

2,270

220

430

430

110

110

1,870

3,310

330

200

200

1,360

570

500

140

2,030

2,680

400

660

270

260

130

920

1,360

1,330

1,730

130

130

130

1,200

130

960

1,970

150

16;

720

390

470

80

1,060

1,620

Total procedures --------------

Injection given---------------------

Blood drawn-------------------------

X-ray ordered-----------------------

Prescription given------------------

Treatment-given---------------------

Referred ----------------------------

Hospitalized ------------------------

Certificate given-------------------

390

2,660

280

290

180

280

950

8,600

3.120

No procedure performed --------

Smederevo, Yug.

Total consultations -----------

Total procedures--------------

Injection given---------------------

Blood drawn-------------------------

X-ray ordered-----------------------

Prescription given------------------

Treatment given---------------------

Referred ----------------------------

Hospitalized ------------------------

Certificate given-------------------

5,280

1,950

2,390

12,260

4,650

3,490

930

2,540

1,150

16,270

18,780

2,700

450

1,090

5,050

1,080

1,180

300

1,260

880

5,790

6,110

1,160

700

410

2,740

1,420

590

200

220

200

2,670

23670

No procedure performed --------

Chittenden, U.S.A.

Total consultations -----------

Total procedures --------------

2,060

200

260

1,260

1,130

330

400

460

930

470

200

1,3::

400

1;8

600

280

3;:

420

70

70

350

940

220

58;

730

150

70

140

430

140

210

290

220

76

210

49C

7C

5::

350

70

.

7C

Injection given---------------------

Blood drawn-------------------------

X-ray ordered-----------------------

Prescription given------------------

Treatment given---------------------

Referred ----------------------------

Hospitalized ------------------------

Certificate given-------------------

5,070

960

1,020

5,050

4,190

1,090

950

460

3,040

400

130

340

670

940

400

200

740

r

No procedure performed --------

lIncludes osteopaths in (lhittenden; similar professions not found in other two areas.

NOTE : Due to rounding, detailed figures may not add to the totals.

36
Table 11. Numbers and rates for proceduresordered at consultationswith doctorsl during a Z-week

period, by age, sex, and type of procedure for the study areas—Con.

[Estimates of frequencies in the total population]

Under I

18-44 years I

45-64 years I65+ years

All

ages

18

years Male Female Male Female Male Female

Rate per 1,000 consultations

1,00C

1,48C

1,00C

1,09C

1,000

860

1,000

1,330

1,000

910

1,000

1,100

1,00C

1,64C

1,000

1.300

6C

6C

6;:

5C

;:

130

110

1,000

1,700

80

560

::

40

60

200

1,000

1,520

340

58;

8;

336

1,000

2,120

310

160

110

670

280

210

3%

20

1,000

1,180

150

1%

260

360

150

80

280

100

100

100

900

100

1,000

2.050

140

6::

50

90

42:

100

1,000

1,800

720

1::

140

30

30

1,000

1,780

180

110

110

730

310

270

70

1,000

1,320

68;

640

320

1,000

180

1,000

1,640

270

100

120

620

240

180

1::

60

1,000

1,150

310

50

130

590

120

140

1::

100

1,000

1,050

260

150

6::

1%

230

540

410

160

70

170

1,000

1,060

150

160

750

400

490

90

1,000

1,530

1,000

1,470

310

130

40

50

40

1,000

1,000

3lC

6C

3![

26C

::

3C

19C

360

::

220

190

60

;:

160

170

70

46o

110

28;

360

;:

70

46c

160

230

310

230

8;

230

460

60

5<:

330

70

70

5%

150

20

50

220

37
Table 12. Numbers

doctors during

and rates for persons and for consultations with health

a 2-week period, by age, sex, and type of consultation for

[Estimates of frequencies in the total populatim]

Area and

type of consultation

Chester, U.K.

Total persons--------------

Persons with one visit or more---

Nurse consultations --------------

Dentist consultations ------------

Other consultations --------------

Smederevo, Yug.

Total persons--------------

Persons with one visit or more---

Nurse consultations --------------

Dentist consultations ------------

Other consultations ------------- -

Chittenden, U.S.A.

Total persons--------------

Persons with one visit or more---

Nurse consultations --------------

Dentist consultations ------------

Other consultations ---------- ----

workersl other than

the study areas

All

ages

81,790

9,560

5,750

4,520

5,040

90,370

4,890

6,610

1,390

2,9N

73>800

5,650

1,560

3,660

1,980

Under

11-

18-44 years

18

years Male Female

I I

Number of persons or consultations

25,070

2,870

780

1,870

1,440

30,210

1,660

2,640

440

230

30,770

2,390

660

1,460

870

11,870

1,650

220

890

650

18,130

610

210

230

70

11,020

670

330

400

330

13,180

1,600

390

910

590

18,100

1,630

2,670

580

1,330

11,490

800

70

870

130

3,830

820

590

590

470

7,800

370

250

360

6,910

490

140

140

280

L1,370

870

650

540

8,420

150

250

70

7,030

790

360

430

150

3,770

580

2,190

290

3,110

160

1[+~

90

2>630

220

220

70

6,700

1,180

930

270

1,050

4,600

320

580

70

3>950

280

140

140

9 visiting nurses, ]ILl~l,~despublic health n~ses~ district nurses,

health visitors, and midwives.

office and clinic nurses,

NOTE : Due to rounding, detailed figurea may not add to the totals.

38
Table 12. Numbers and rates for persons and for consultations with health workersl other than

doctors during a 2-week period, by age, sex, and type of consultation for the study areas--Con.

All

ages

1,000

120

70

50

60

1,000

50

70

10

30

1,000

80

20

50

30

[Estimatesoffrequencies inthetotalpopdat.icm]

Under 18-44 years 45-64 years 65+ years

18 -

years Male Female Male Female Male Female

1,000

110

30

70

60

1,000

50

90

10

10

1,000

80

20

50

30

Rate per 1,000 persona or consultations

1,000

140

20

70

60

1,000

30

10

10

70

1,000

60

30

40

30

1,000

120

30

70

40

1,000

90

150

30

40

1,000

70

10

80

10

1,000

80

60

60

50

1,000

50

30

50

1,000

70

20

20

40

1,000

80

60

50

1,000

20

30

10

1,000

110

50

60

20

1,000

150

580

80

1,000

50

50

30

1,000

80

80

30

1,000

180

140

40

160

1,000

70

130

20

1,000

70

40

40

Standardized rate

per 1,000

persons

1,000

120

70

50

60

1,000

50

70

10

30

1,000

80

20

50

30

39
Table 13. Numbers and rates for persons 1 year of age and

number of conditions, by age and

over with selected conditional durin~ a year and

sex for the study areas

-.

[Estimatesofheq.mmiesinthetotal~opulationl

All

~ges,

1+

rears

80,520

18-44 years 45-64 years 65+ years

1-18

years

23,800

Male

.1,870

~emale

13,180

Male ?emele

Area and number of conditions

{ale ~emale

Chester, U.K.

Total persons, 1+ years ---------------

Number of persons with:

No conditions -----------------------------

One condition or more ---------------------

One condition ---------------------------

TWO conditions --------------------------

Three conditions ------------------------

Four conditions -------------------------

Five conditions or more -----------------

Total number of conditions ------------------

Smederevo, Yug.

Total persons, 1+ years ---------------

Number of persons with:

No conditions -----------------------------

One condition or more ---------------------

One condition ---------------------------

Two conditions --------------------------

Three conditions ------------------------

Four conditions -------------------------

Five conditions or more -----------------

Total number of conditions ------------------

Chittenden, U.S.A.

Total persons, 1+ years ---------------

Number of persons with:

No conditions -----------------------------

One condition or more ---------------------

One condition ---------------------------

Two conditions --------------------------

Three conditions ------------------------

Four conditions -------------------------

Five conditions or more -----------------

Total number of conditions ------------------

See footnote at end of table.

9,830 11,370 3,770 6,700

—

2,680

4,010

1,670

1,030

530

400

380

9,090

4,600

—

730

3.880

3,030

8,340

2,810

2,380

1,520

760

870

19,820

8,420

36.610 13.900 6.710 4.190 4.170 1,920

43,910 9.900 5,160 8,980 5,660

2,510

1,320

890

470

470

12,270

7,800

L&J

710

290

710

130

3,950

3,110

20,050

10,730

6,760

3,450

2,910

91,780

89,520

—.

25,570

5,120

2,740

1,170

590

280

17,980

29,360

3,620

880

440

110

110

7,700

18,130

3,590

2,100

1,490

1,000

800

20,970

18,100

—

6,060 3,530 1,280

6.520

1,060

7.350

770

2.340

L“,140

63,940

22,740

13,70C

10,32C

6,88C

10,29C

169,63C

72,73C

17,210

10,210

4,340

1,730

680

250

28,310

29,710

L2,080

4,760

3,100

1,510

1,290

1,420

28,870

11,020

L4,560

3,520

3,180

2,500

1>960

3,400

$5,530

11,490

1,670

930

1,570

720

1,630

21,260

6,910

1,170

940

2,040

1,070

2,140

26,050

7,030

660

730

340

270

340

6,080

2,630

750

490

630

890

1,120

13,520

3,950

29,94( 980

42,79(

14,350

15,350

4,910

6,110

3,560

1,540

340

330

340

10,880

3,940

7,540

/?,730

1,600

1,470

670

1,070

19,100

2,720

4,190

1,600

1,260

700

350

280

9,000

2,400

4,630

1,740

1,16C

730

50C

50C

10,97C

630

Q(J

790

500

220

140

350

5,080

2,960

630

980

570

350

430

8,830

19,63(

10,91(

5,87(

2,88(

3,50(

90,58(

8,580

3,850

1,860

530

530

26,710

40
Table 13. Numbers and rates for persons 1 year of age and over with selected conditions’ during a year and

number of conditional by age and sex for the study areas—Con.

ktimates of frequencies in tlie total rc-ulationl

All

ages,

1+

yeara

18-44 years 45-64 years 65+ years 3tsndardized rate

per 1,000

persona

1-18

years

Area and number of conditions

Male Female

1,00C

Male Male

1,000

Fema k Female

Chester, U.K.

Total persona, 1+ years -------- 1,000 1,000

-

580

420

210

110

50

20

10

750

1,810

1,000

_

410

590

350

150

60

20

10

960

1,640

1,000

1,00C 1,000

_

420

~

260

130

90

50

50

1,250

2,170

1,000

160

840

210

120

200

90

210

2,720

3,260

1,000

1,000 1,000 —

400

600

250

150

80

60

60

1,360

2,260

1.000

1,000

Rate per 1,000 persons with:

No conditions ----------------------

One condition or more --------------

One condition --------------------

TWO conditions -------------------

Three conditions -----------------

Four conditions ------------------

Five conditions or more ----------

Total number of conditions per 1,000

persons -----------------------------

460

540

250

130

80

40

40

1,140

2,090

1,000

560

~

300

70

40

10

10

650

1,490

1,000

320

680

270

160

110

80

60

1,590

2,330

1.000

27C

730

250

210

130

70

80

1,740

2,380

1,000

130

870

140

110

240

130

250

3,090

3,540

1,000

510

490

190

80

190

30

1,050

2,140

1,000

250

750

210

240

110

90

110

1,960

2,600

1,000

46f)

540

250

130

80

40

30

1,130

...

1,000

270

730

240

150

130

80

130

2,030

...

1,000

Conditions per 1,000 persons with one

condition or more -------------------

Smederevo, Yug.

Total persona, 1+ yeara --------

Rate per 1,000 persona with:

No conditions ----------------------

One condition or more --------------

One condition --------------------

Two conditions -------------------

Three conditions -----------------

Four conditions ------------------

Five conditions cm mOre ----------

290

710

250

150

110

80

110

1,890

2,650

1,000

330

670

260

170

80

70

80

1,590

2,390

1,000

190

180

190

180

140

110

190

2,520

3,130

1,000

160

840

160

110

140

190

240

2,940

3,490

1,000

Tota 1 number of conditions per 1,000

persons -----------------------------

Conditions per 1,000 persons with one

condition cm more -------------------

Chittenden, U.S.A.

Total persona, 1+ yeara --------

Rate per 1,000 persona with:

No conditions ----------------------

One condition or more --------------

One condition --------------------

Two conditions -------------------

Three conditions -----------------

Four conditions ------------------

Five conditions or mcme ----------

Total number of conditions per 1,000

persons -----------------------------

410

590

270

150

80

40

50

1,240

2,120

480

520

290

130

60

20

20

900

1,740

440

550

32Cr

140

30

30

30

990

L,780

340

660

YG

140

130

60

90

1,660

2,530

390

610

230

180

100

50

40

1,300

2,150

340

660

250

160

100

70

70

1,560

2,370

240

760

300

190

80

50

130

L,930

2,530

250

750

160

250

140

90

110

2,240

2>980

390

610

260

160

80

40

60

1,330

...

Conditions per 1,000 persons with one

condition or more -------------------

1see cOnditiOn~ listed in adult and child quest ionnairea, appendix I, pages 62 and 70, table III.

NOTE: Due to rounding, detailed figures may not add to the totals.

41
Table 14. Numbers and rates for persons 1 year of age and over who had not consulted a doctorl for selected

conditions during a year and number of conditions, by age and sex for the study areas

[Estimatesof frequencies in the total population]

Area and

number of unattended conditions

Chester, U.K.

Total persons, 1+ yeara ----------------

Number of persons with:

One condition or more ---------------------

one c~nditi~n ---------------------------

TWO conditions --------------------------

Three conditions or more ----------------

No unattended conditions ------------------

Total number of unattended conditiona -------

Smederevo, Yug.

Total persons, 1+ years ---------------

Number of persons with:

One condition or more ---------------------

One condition ---------------------------

Two conditions --------------------------

Three conditions or more ----------------

No unattended conditions ------------------

Total number of unattended conditions -------

Chittenden, U.S.A.

Total persons, 1+ years ---------------

Number of persons with:

One condition or more ----------------------

One condition ----------------------------

Two conditions ---------------------------

Three conditions or more -----------------

No unattended conditions -------------------

Total number of unattended conditions --------

See footnotes at end of table.

All 18-44 years 45-64 years 65+ years

ages,

1+

years

80,520

1-18

Iears

?3,800

Male

11,870

?emale

L3,180

Male

9,830

?emale

L1,370

Male

3,770

~emale

6,700

—

1,660

1,030

630

5,040

2,290

4,600

—

3,060

1,070

860

1,130 ,

1,540

6,670

3,950

—

1,410

840

430

140

2,540

2,120

18,190

13,360

3,770

1,060

62,330

24,290

89,520

3,070

2,680

290

90

?0,730

3,550

?9,360

1,870

1,430

220

220

10>000

2,640

18,130

4,190

3,200

800

200

8,990

5,490

L8,1OO

2,410

1,480

820

120

7,410

3,470

7,800

4,000

2,700

860

430

7,370

5,740

8,420

990

840

150

2,780

1,130

3,110

32,620 3,820 6,550 8,920 4,200

2,170

620

1,400

3,610

8,900

6.910

4,530

2,020

1,340

1,170

3,890

9,060

7.030

1,550

18,810

7,270

6,550

56,890

57,770

72.730

2,970

850

!5,530

4,670

?9.710

4,610

1,140

800

11,590

9,820

11.020

5,370

2,030

1,520

9,180

15,340

L1.490

590

430

530

1,550

3,310

2.630

17,950 6,110

4,850

800

470

?3,590

7,910

2,890 3,470 1,400 1.660 1.000

12,660

3,580

1>710

54,790

26,390

2,150

540

200

8,130

4,160

2,470

600

400

8,010

5,410

980

350

\

70

5,510

1,880

940

430

290

5,370

3,040

430

430

140

1,630

1,870

42
persons 1 year of age and over who had not consulted a doctorl for selected

and number of conditions, by age and sex for the ‘study areas—Con.

Table 14. Number s,,and rates for

conditions- during a year

[Estimates of frequencies in the total population]

18-44 years 45-64 years 65+ years andard -

ed rate

r 1,000

rsons,

years

All

agea,

1+

years

L-18

years

Area and

number of conditions Male

1.000

Female iale

L,000

Female Male

1.000

?emale

1.000

Chester, U.K.

Total persons, 1+ years --------

Rate per 1,000 persona with:

(l-wcondition or more --------------

One condition --------------------

TWO conditions -------------------

Three conditions or mOre ---------

Nu unattended conditions -----------

Tnta 1 number of unattended

ccxtditions per 1,000 persOns --------

Unuttended conditions per 1,000 persons with one condition or more -----

Smederevo, Yu~

Total persons, 1+ years --------

Rate per 1,000 persona with:

Onu condition or more --------------

One condition --------------------

Two conditions -------------------

Three conditions or more ---------

No unattended conditions -----------

Total number of unattended

conditions per 1,000 persons --------

Llnuttended conditions per 1,000 persons with one condition or more -----

Chittenden, U. S.A,

Total persons, 1+ years --------

Rote per 1,000 persons with:

One condition or more --------------

One condition --------------------

Two conditions -------------------

Three conditions or more ---------

No unattended conditions -----------

Tots 1 number of unattended

conditions per 1,000 persons --------

Unattended conditions per 1,000 perscms with one condition or more -----

1.000 ..000 1,000 1.000 1.000

230 130 160 320 250 350 260 250 230

170

50

10

770

300

1,330

1,000

110

10

870

150

L,160

1,000

120

20

20

840

220

1,410

1,000

240

60

10

680

420

1,310

1,000

150

80

10

750

350

1,440

1,000

240

80

40

650

500

1,430

1,000

220

40

740

300

1,150

1,000

150

90

750

340

1,380

1,000

660

230

190

250

330

1,450

2,180

1.000

170

50

10

770

300

...

1,000

400

220

90

80

600

730

...

1.000

360

210

80

70

640

640

1,770

1,000

250

130

100

30

870

160

L,220

L,000

_

210

360

250

60

40

640

540

1,500

1,000

260

490

300

110

80

510

850

1,720

1,000

300

540

280

80

180

460

L,140

?,120

L,000

_

200

540

240

160

140

460

1,080

2,000

1,000

—

240

500

190

140

170

500

1,070

2,140

1.000

380 360 260

170

50

20

750

360

1,470

160

30

20

790

270

L,290

190

50

20

740

380

1,440

210

50

30

700

470

1,560

140

50

10

800

270

L,350

130

60

40

760

430

1,820

160

160

50

620

710

1,860

210

110

4(J

640

540

1,500

170

60

20

740

390

...

]Includes ~steopaths in Chittenden; similar prof easiona not found in Other twO areas.

‘See conditions listed in adult and child questionnaires, appendix I, pages 62 and 70, table 111.

NOTE: Due to rounding, detailed figures may not add to the totals.

43
Table 15. Prevalence of 12 selected conditions1 for adults and children for the study areas

Selected condition

Adults

Nervousness -----------

Arthritis-------------

Cough or breathlessness-----------------

Backache--------------

Headaches-------------

Varicose veins--------

Skin rash-------------

Hemorrhoids-----------

Stomsch trouble-------

Sore throat cm cOld---

Boils-----------------

Hernia----------------

Children

Earache---------------

Sore throat or cold---

Stomach trouble-------

Measles---------------

Cough or breathlessness-----------------

Skin rash-------------

Joint pain------------

Headaches-------------

Chickenpox------------

Whooping cough--------

Boils-----------------

Bum or scald---------

[Estimates of frequencies in the tdrd pp.le.tim-]

ank

rder

1

2

3

4

5

6

7

8

9

10

11

12

1

2

3

4

5

6

7

8

9

10

11

12

Chester, U.K.

[ut$ar

persons

in

;ample

97

81

75

68

65

60

56

47

39

38

16

8

33

32

21

20

19

19

10

.9

7

6

5

4

:stimted

lumber

of

persons

0,590

9,150

8,470

7,510

6,890

6,680

6>070

5,280

4,220

4,150

1,700

930

3,200

3,110

2,040

1,960

1,850

1,83C

97C

88C

68C

59C

49C

37C

tandardized

rates

per

1,000

ersons

180

150

150

130

120

110

110

90

70

70

30

20

130

130

80

80

80

80

40

40

3C

2C

20

2C

Lank

rrder

1

2

6

3

4

9

8

10

5

7

12

11

2

1

3

4

5

9

8

7

10

6

12

11

SmederevO, Yug.

:umber

of

persons

in

ample

317

288

138

254

213

70

73

53

174

129

20

41

54

8~

4e

4:

26

1;

1;

2(

1:

2;

L

;

Adults

Coefficient of correlation: Chester and Smederevo------ 0.82

Chester and Chittenden----- 0,90

Smederevo and Chittenden--- 0.94

Coefficient of concordance: All three areas------------ 0.94

,sti-

!sted

umber

of

persons

4,510

2,460

0,740

9,820

6,400

5,330

5,760

4,000

.3,340

9,910

1,540

3,390

4,080

6,660

3,740

3,110

1,980

1,26C

1,30C

1,53C

1,20C

1,95C

300

53C

Children

0.76

0.61

0.45

0.84

tandardized

rates

per

1,000

ersons

410

400

200

340

280

90

110

70

210

150

30

70

140

230

120

100

70

50

50

60

40

60

10

20

Chittenden, U.S.A.

nnk

rder

1

2

4

3

5

10

6

8

7

9

12

11

1

3

7

4

5

2

9

8

6

12

11

10

umber

of

persons

in

ample

171

128

93

113

86

43

71

64

67

48

14

15

73

57

29

39

33

64

1$

25

3C

4

5

14

:stiated

umber

of

persons

1>770

8,940

6,320

7,620

5,840

2,990

4,780

4,380

4,560

3,310

890

1,050

4,850

3,790

1,930

2,720

2,330

4,320

1,260

1,730

2,000

270

400

930

:tandardized

rates

per

1,000

,ersons

270

210

150

180

130

70

110

100

110

80

20

70

160

130

70

80

80

140

40

60

70

10

10

30

iSee conditions listed in adult and child questionnaires, appendix 1, pages 62 and 70, table III.

44
Table 16. Numbers and rates for persons with and without conditions consulting a doctorl during

a 2-week period and number of conditions for all consultations,

areaa

by age and sex , for the study

[Estimatesoffrequencies inthetmtalpqmlationl

Persona

consulting with:

Rate per 1,000

persons having: ;onditions

)er 1,000

persons

:onsulting

with 1+

:onditions

Tota 1

persons

with 1+

onsultations

Total

conditions

12.280

Area, age, and sex

No

conditions

1+

:onditions

No

:onditions

120

1+

.onditions

Chester, U.K.

All ages----------------- 12,440

3,890

890

2,690

1,550

1,950

400

1,060

12,490

1,510 10,930 880 1,120

1,000

1,000

1,320

1,080

1,310

1,000

1,000

1,050

Under 18 years-----------------

18;$Jteyears:

-----------.-------------

Female-----------------------

45;~~eyears:

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

Female-----------------------

6.5-I-years:

Male-------+-----------------

Female-----------------------

570

110

500

120

220

1,580

3,330

770

2>190

1,430

1,730

400

1,060

10,910

150

130

190

J:

130

850

870

810

920

890

1,000

1,000

870

3,330

770

2>880

1,550

2,270

400

1,060

11.410

Smederevo, yug.

All agea----------------- —

Under 18 years-----------------

18--~~eyeara:

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

Female-----------------------

45;~~eyears:

-----------------.-------

Female -----------------------

65+ yeara:

Male -------------------------

Female -----------------------

5,530

1,460

3,120

600

1,140

646

11,410

1,360

70

70

80

3,720

1,730

270

870

210

360

2;:

4,180

1,390

3,050

510

1,140

64;

7,690

250

50

20

140

330

760

950

980

860

1,000

1,000

670

4,380

1,470

3,190

510

1,140

736

9,190

1,050

1,060

1,040

1,000

1,000

1,13;

1,190

Chittenden, U.S.A.

All ages-----------------

Under 18 years-----------------

18-44 years:

Male -------------------------

Female -----------------------

45;~~eyeara:

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

Female -----------------------

6~a~ars:

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

Female-----------------------

4,390

1,410

2,270

840

1,230

570

700

2,660

1,140

1,400

630

870

500

490

390

190

380

250

290

130

300

610

810

620

750

710

870

700

2,800

1,410

2,000

770

940

500

780

1,050

1,230

1,430

1,220

1,080

1,000

1,580

lInclude5 osteopaths in Chittenden; similar professions not found in Other two areas.

NOTE : Due to rounding, detailed figures may not add to the totals.

45
rates for personswith activity limitationduring a 2-week period and numclays per 1,000 persons, by age and sex for the study areas

Table 17. Numbers and

ber of

[Estimatesoffrequencies h thetotalpopulation]

II I I I

Under 18-44 years 45-64 years 65+ years

All

ages 18

years Male Female Male Female Male Female

Area and duration

Chester, U.K.

Total persons ---------------

Persona with no days----------

Persons with 1 day or more----

Persons with 1-7 days-------------

Persons with 8-13 days------------

Persons with 14 days or more------

Days per 1,000 persons------------

Days per 1,000 persona with

activity limitation--------------

Smederevo,Yug.

Total persons---------------

Personawith no days----------

Persona with 1 day or more----

Persons with 1-7 days-------------

Personswith 8-13 days------------

Persona with 14 days or more------

Days per 1,000 persons------------

Days per 1,000 persons with

activity limitation--------------

Chittenden,U.S.A.

Total persona---------------

Persona with no days----------

Peraonswith 1 day or more----

Personswith 1-7 days-------------

Persons with 8-13 days------------

Persons with 14 days or more------

Daya per 1,000 persons------------

Days per 1,000 persons with

activity limitation--------------

Number of persona

81,790

—

72,410

9,380

8,020

200

1,160

...

..*

90,370

71,990

18,370

13,400

1,79C

3,180

...

...

73,80(

25,070

—

21,290

11,870 L3,180 9,830 L1,370 \,770 6,700

10,880 11,780 8,930 LO,51O ),200 5,800

3.780 990 1,400

1,400

...

...

18,100

13,710

890 870 570 890

990

...

...

18,130

16,120

2,010

1,750

26;

...

...

11,020

420

470

...

...

7,800

6,000

430

100

320

...

...

8,420

5,280

420

-

150

...

..*

3,110

2,570

760

.

130

...

...

4,600

3,590

90

90

...

...

30,210

25,270 3,040

4,940

3,790

750

400

...

...

30,77C

4.390 1.800 3.130 530 1,570

940

52:

...

...

3,950

3,520

400

470

...

...

11,490

1,030

250

520

...

...

6,910

2,200

320

620

...

...

7,030

6.010

180

366

...

...

2,630

65>230 2,140 3,520’

8,560

6,900

340

1,330

...

...

27,38C

3,39C

9>880

1,140

9>890

1,600

1,400

20;

...

...

6,420

490

420

76

...

...

1,020 &30 !

580

3%

...

...

500

220

2%

...

...

3,130

130

130

...

...

940

1;:

...

...

210

21;

...

...

NOTE : Due to rounding, detailed figures may not add to the totals.

46
Table 17. Numbers and rates

ber of days per

for persona with activity limitationduring a 2-week Deriod and num1,000 persons, by age and sex for the study

[Estimates of frequenciesin the total population]

areas-Con.

Standardized rate

per 1,000

persons

1,000

890

‘8 t=5-==- Under

years

45-64 years

==F==

65+ years

=

All

ages

Rate per 1,000 persons

1,000 1,000 1,000

870

1,000 1,000 1,000 1,000 1,000

890 850 920 890 910 920 850

110

100

16

500

4,340

1,000

150

150

460

3,020

1,000

80

80

160

1,890

1,000

110

110

240

2,280

90

40

Si

830

9,200

1,000

80

40

;;

590

7,750

1,000

150

110

4i

1,150

7,630

1,000

830

130

110

2i

750

5,590

1,000

660

340

110

100

16

490

...

1,000

780

220

1,000

790 630

210

160

%

1,220

6,010

1,000

820

160

130

30

10

880

5,390

1,000

890

110

100

10

530

4,760

1,000

760 770

240

190

20

30

1,220

5,030

230

130

30

70

1,680

7,280

1,000

370

260

40

70

2,460

6,660

1,000

170

60

110

1,920

1,170

1,000

810

200

20

120

2,690

7,900

1,000

890

150

::

1,360

...

1,000

880

1,000

900

100

880 860 930 860

120 110

100

350

3,170

140 70 140 190 110 120

80

10

10

480

4,640

120

20

640

4,610

60

10

280

3,980

80

;:

1,030

7,120

80

30

80

1,720

9,110

50

56

1,030

9,500

::

20

620

...

::

20

550

4,730

47
Table 18. Numbers and rates for persons with

days per 1,000 persons, by

bed disabilityduring a 2-week period and number of

age and sex for the study areas

[Estimates ofFmquenties inthetotalpqulation]

Area and duration

Under 18-44 years 45-64 years 65+ years

18 I I I I I

All

ages

years

I

Male I

Female Male Female Male Femalt

I I I I I I

Chester, U.K.

Total persons---------------

Personswith no days----------

Persons with 1 day or more----

Persona with 1 day----------------

Persons with 2-7 days-------------

Persons with 8-13 days------------

Persons with 14 days or more------

Days per 1,000 persons------------

Days per 1,000 persons with bed

disability-----------------------

Smederevo,Yug.

Total persons---------------

Persons with no days----------

Persons with 1 day or more----

Personswith 1 day----------------

Persons with 2-7 days-------------

Persona with 8-13 days------------

Persons with 14 days or more------

Days per 1,000 persons------------

Days per 1,000 persons with bed

disability-----------------------

Chittenden,U.S.A.

Total persons---------------

Personswith no days----------

Peraons with 1 day or more----

Persons with 1 day----------------

Persons with 2-7 days-------------

Personswith 8-13 days------------

Persons with 14 days or more------

Days per 1,000 persons------------

Days per 1,000 persons with bed

disability-----------------------

Number of persons

81,790 25,070 11,870

11,100

770

650

110

...

...

18,130

17,350

780

69;

9i

...

...

11,020

10,350

670

340

330

...

...

13,180 9,830 11,370 3,770 6.70C — - - -

77,120 23,150 12.580 9,590

230

10,620

760

3,640

130

6,43C

4,670 27C

2,680

1,880

116

...

...

90,370

1,920

1,260

660

...

...

30,210

600

400

200

...

...

18,100

16,310

110

540

11;

...

...

8,420

130

...

...

3,110

13C

13C

.

...

...

4,600

23;

...

...

7,800

80,940 6,680

9,420

1,180

6,190

1,020

1,030

...

...

73,800

26,580

3,630

7,510 2,930 3,59(

1,01(

79(

1:1

...

...

3,95C

1,790 1.13C 910 180

186

...

...

2,630

600

2,670

210

150

...

...

30,770

28,640

2,130

1,200

800

70

70

...

...

350

890

400

150

...

...

11,490

10,420

1,070

330

600

13;

...

...

17C

62C

2:[

.0.

...

6,91C

5;:

250

70

,..

...

7,030

-

69,000

4,800

2,230

2,090

418

...

...

6,630 6,590 2,490

140

3,87C

280 430 70

70

210

...

...

220

70

140

...

...

7a

.

-

-

...

...

7;

70

...

...

NOTE: Due to rounding, detailed figures may not add to the totals.

48
Table 18. Numbers and rates for persons with bed disabilityduring a 2-week period and number of

days per 1,000 persons, by age and sex for the study areas—Con.

[Estimates of frequencies in the total population]

Under 18-44 years 45-64 years 65+ years

All

ages 18

years Male Female Hale Female Male Female

Standardized rate

per 1,000

persons

Rate per 1,000 persons

1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1.000

940

60

920

80

930

70

950

50

30

20

70

1,500

1,000

900

980

20

930

70

970

30

960

40

940

60

30

20

110

...

1,000

890

30

20

.

110

1,990

1,000

900

50

30

110

1,340

1,000

880

60

10

80

1,290

1,000

960

10

50

.

270

4,010

1,000

890

30

30

1,000

1,000

940

20

20

160

4,000

1,000

770

26

60

2,500

1,000

860

100

10

;:

10

570

5,520

1,000

930

120 40 100 140 110 60 230 110

;:

10

10

570

4,740

1,000

930

;:

20

10

560

5,240

1,000

910

90

30

50

10

390

4,230

20

80

10

30

930

6,430

1,000

960

;;

30

10

650

6,070

1,000

940

10

;:

10

620

...

1.000

4;

210

4,830

1,000

940

6;

800

4,000

1,000

940

170

;:

1,390

6,330

1,000

980 940

70 70 60 40 60 60 20

20

20

1,000

60

30

30

10

210

...

30

30

10

200

3,100

40

30

160

2,290

30

30

110

1,800

10

30

90

2,250

30

10

26

340

5,440

30

30

460

8,500

49
Table 19. Visual acuity, use of eyeglasses, and eye examinations among adults 18 years of age and

over, by age and sex for the study areas

[Estinstes of frcouenties in the total population]

Area and vision characteristic

Chester, U.K.

Total adults, 18-I-years-------------

Persons unable to “read newspaper”

without glasses--------------------------

Persons unable to “recognize friend

across street” without glasses-----------

Persons using glasses---------------------

Persons without eye examination

during last 12 months--------------------

Smederevo, Yug.

Total adults, 18+ yeara-------------

Persons unable to “read newspaper”

without glasses--------------------------

Persons unable to “recognize friend

across street” without glassea-----------

Persons using glasses---------------------

Persons without eye examination

during last 12 months--------------------

Chittenden, U.S.A.

Total adults, 18+ years-------------

Persons unable to “read newspaper”

without glasses--------------------------

Persons unable to “recognize friend

across street” without glasses-----------

Persons using glasses---------------------

Persons without eye examination

during last 12 months--------------------

All 18-44 years 45-64 years 65+ yeara

ages,

18+

years Male Female Male Female Male Female

Number of persons

56,720

19,940

6,900

36,250

46,850

60,160

15,780

5,210

13,390.

52,710

43,030

15>330

6,720

25,860

31,360

11,870

870

660

3,400

9,890

18,130

750

310

940

15,260

11,020

470

1,280

3,430

7,860

13,180

890

1,300

5,000

11,780

18,100

810

480

990

16,410

11,490

1,000

1,600

5,610

9,020

9,830

4,010

910

7,820

7,790

7,800

4,860

810

3,600

6,810

6,910

3>910

560

5,300

4,820

11,370

6,930

2,170

10,180

9,310

8,420

5,160

1,570

3,930

7,220

7,030

4,780

1,520

6>300

4,850

3,770

2,930

420

3,770

2,650

3,110

2,220

590

2,040

3,030

2,630

1,640

280

1,770

1,850

6,70C

4,30C

1,44C

6,07C

5, 42C

4,600

1,990

1,450

1,900

3,970

3,950

3,520

1,480

3,450

2,960

NOTE : Due to rounding, detailed figures may not add to the totals,

50
TakIle19. Visual acuity, use of eyeglasses, and eye examinationsamong adults 18 years of age and

over, by age and sex for the study areas—con.

[Estimates of frequencies in the total population]

All

agea,

18-44 yeara 45-64 years 6.5-I- years

18+

years Male Female Male Female Male Female

Rate per 1,000 persons

1,000

350

120

640

830

1,000

260

90

220

880

1,000

360

160

600

730

1,000

70

50

290

830

1,000

40

20

50

840

1,000

40

120

310

710

1,000

70

100

380

890

1,000

40

30

50

910

1,000

90

140

490

780

1,000

410

90

800

790

1,000

620

100

460

870

1,000

560

80

770

700

1,000

610

190

890

820

1,000

610

190

470

860

1,000

680

220

900

690

1,000

780

110

1,000

700

1,000

710

190

660

980

1,000

620

110

670

700

1,000

640

220

910

810

1,000

430

310

410

860

1,000

890

370

870

750

Standardized rate

per 1,000

persons

1,000

330

,110

610

830

1,000

330

100

270

880

1,000

370

160

610

730

51
Table 20. Numbers and rates of conditions among 12 selected conditions reported by adults 18 yeara of age

and over, by degree of discomfort and whether or not a doctor2 waa consulted during a 2-week period for the

study areas -

Degree of discomfort

Total conditions reported---

Conditions with great discomfort--

Conditions with some discomfort---

Conditions with no discomfort -----

Total conditions reported---

Conditions with great discomfort--

Conditions with some diacomfort---

Conditiona with no discomfort -----

Total conditions reported---

Conditions with great discomfort--

Conditions with some discomfort---

Conditions with no discomfort -----

[Estimatesoffrequencies h thetotalpopulation]

Cheater, U.K. Smederevo, Yug. Chittenden, U.S.A.

Doctor consultations during a 2-week period

One One One

Total or None Total or None Total or None

more more more

Number of conditions

71,650

13,380

32,430

25,840

5,770 [65,8801 137,400

I I 11~

2,820 10,560 24,030 3,470 20>560 14,060

2,510 29>920 64,420 1,680 62,740 37,500

440! 25,4001 48,95011 150! 48,800111,340

4,440 58,460

—.

2,900

1,270

11,160

36,230

270 11,070

Rate of doctor consultations per 1,000 conditions

Rate of relative discomfort per 1,000 conditions

1,000

190

450

360

1,000 I 1,000 I 1,000 II 1,000 I 1,000 I 1>000

Isee conditions listed in adult questionnaire, appendix 1, Page 62, table III.

21ncludes osteopaths in Chittenden; similar professions not found in other two areas.

*

650 190

290 610

M!..b!

NOTE: Total numbers of adults 18 yeara of age and over were 56,720 in Chester; 60,160 in Smederevo; and

43,030 in Chittenden.

Due to rounding, detailed figures may not add to the totals.

52
Table 21. Hypothetical .- behavior for a hypothetical condition compared with

an actual condition for adults for the study areas

Area and condition

Chester, U.K.

Cough or breathlessness -------------------------------------

Nervousness -------------------------------------------------

Rusty nail injury -------------------------------------------

Smederevo, Yug.

(loughor breathlessness -------------------------------------

Nervousness -------------------------------------------------

Rusty nail injury-------------------------------------------

Chittenden, U.S.A.

Cough or breathleaanesa -------------------------------------

Nervousness -------------------------------------------------

Rusty nail injury-------------------------------------------

Hypothetical

condition

Number

respending

435

412

511

639

458

775

576

465

627

Percent

who

would

not

consult

doctor

6

12

4

9

6

7

10

18

5

actual behavior for

Actual condition

causing discomfort

Number

respending

50

74

2

91

227

2

78

147

2

Percent

~ho have

never

consulted

doctor

20

31

2

35

46

‘2

26

34

2

‘See appendix I, adult questionnaire, questions 17-19 on page 64 for hypothetical conditions

and table III on page 62 for actual conditions.

‘Not applicable because rusty nail injury was not one of the conditions used in the questionnaire.

53
Table 22. Utilization of hoapitala during a year, by age and sex for the study areas

[Estimates of frequencies in the total population]

Area and hospital utilization

Chester, U.K.

Total persons------------

Total number of hospital days--

Number of persona hospitalizedNumber of admissions-----------

Days per 1,000 persons---------

Mean length of stay in days----

Smederevo, yug,

Total persons------------

Total number of hospital days--

Number of persons hospitalizedNumber of admissions -----------

Days

Mean

per 1,000 persona---------

length of stay in days----

Chittenden, U.S.A.

Total persons------------

Total number of hospital days--

Number’of persons hospitalizedNumber of admissions-----------

Days per 1,000 persons---------

Mean length of stay in days----

All

ages

81,790

72,760

5,840

6,760

890

11

90,370

L32,050

7,930

9,500

1,460

14

I

73,800

93,660

10,020

11,350

1,270

8

Under

18

years

25,070

21,610

1,850

1,940

860

11

30,210

47,750

3,220

3,940

1,580

12

30,770

12,940

3,250

3,320

420

4

18-44 years

Male

.1,870

430

110

110

40

4

L.8,130

;1,350

1,010

1,090

1,180

20

L1,020

L7,020

810

880

1,540

19

Female

13,180

14,720

2,500

2,600

1,120

6

18,100

32,770

2,670

3,200

1,810

10

11,490

15,350

2,470

2,670

1,340

6

45-64 years

Male

9,830

L6,41O

560

910

1,670

18

7>800

21,610

520

680

2,770

32

6,910

18,650

910

1,390

2,700

13

‘emsle

.1,370

4,970

430

540

440

9

8,420

4,070

330

330

480

12

7,030

7,510

1,080

1,370

1>070

5

65-I-years

Male

3,770

5,110

150

150

1,360

35

3,110

2,630

7,560

720

940

2,870

8

6,700

9,500

250

510

1,420

18

4,600

4,500

170

250

980

18

3,950

14,630

780

780

3>700

19

NOTE: Due to rounding,detailed figures may not add to the totals.

54
Table 23. Numbers and ratea for persons hospitalized during a year and number of admissions, by age and

aex for the study areas

[Estimates Offrequencies in the total pcqmkttio”J

Area and number of admissions

Chester, U.K.

Total persons---------------------

Number of persons with:

One admission or more-----------------

One admission-----------------------

Two admissions----------------------

Three admissions or more------------

Total number of admissions--------------

Smederevo, Yug.

Total persons---------------------

Number of persons with:

One admisaion or more-----------------

One admission-----------------------

Two admissions----------------------

Three admissions or more------------

Total number of admissions--------------

Chittenden, U.S.A.

Total persons---------------------

Number OE persons with:

One admission or more-----------------

One admission-----------------------

Two admissions----------------------

Three admissions or more------------

Total number of admissions--------------

See note at end of table.

All

ages

81,790

5,840

4,660

1,050

130

6,760

90,370

7,930

6,440

1,410

80

9,500

73,800

10,020

8,830

970

210

11,350

Under

18

years

25,070

1,850

1,750

90

1,940

30,210

3,220

2,510

720

3,940

30,770

3,250

3,180

70

3,320

18-44 yeara

Male

11,870

110

110

110

18,130

1,010

920

90

1,090

11,020

810

670

140

880

Female

13,180

2>500

2,000

500

2,600

18,100

2,670

2,220

370

80

3,200

11,490

2,470

2,270

200

2,670

45-64 years

Male

9,830

560

210

350

910

7,800

520

—

370

150

680

6,910

910

—

560

210

140

1,390

Female

11,370

430

—

320

110

540

8,420

330

330

330

7>030

1,080

790

290

1,370

65+ years

!Ia le

3,770

150

_

150

150

3,110

_

2,630

720

580

70

70

940

Female

6,700

250

110

130

510

4,600

170

80

80

250

3>950

780

780

780

55
Table 23. Numbers and ratea for persons hospitalized during a year and number of admissions, by age and

sex for the study areas—Con.

[Estimatesoffrequenciesi“ thetotalpopulation]

Area and number of admissions

:tandard-

,zed rate

,er 1,000

persona

18-44 years 45-64 years 65+ years Jnder

18

~eara

All

ages

1,000

70

—

60

10

80

1,000

90

Male ‘emsle

1,000

190

Male ‘emale Male Female

Chester, U.K.

Total persons ------------- 1,000

70

1,000

10

1,000

60

20

40

90

1,000

70 _

50

20

90

1,000

130

1,000

40

1>000

40

1,000

40

1,000

70

Rate per 1,000 persons with:

One admission or more ---------

One admission --------------- 70

80

1,000

110

10

10

1,000

50

150

40

200

1,000

150

—

120

20

180

1,000

210

30

10

50

1,000

40

40

40

1,000

150

40

40

1,000

20

20

80

1,000

40

20

20

50

1,000

200

60

10

90

1,000

80

60

10

100

1,000

140

Two admissions --------------

Three admissions or more----

Total number of admissions

per 1,000 persons --------------

Smederevo, Yug.

Total persons -------------

Rate per 1,000 persons with:

One admisaion or more --------- —

One admission ---------------

Two admissions --------------

Three admissions or more----

Total number of admissions

per 1,000 persons --------------

70

20

100

1,000

140

120

10

150

80

20

130

1,000

100

100

110

50

60

1,000

70

60

10

80

1,000

270

Chittenden, U.S.A.

Total persons -------------

Rate per 1,000 persons with:

One admission or more --------- —

One admission --------------- 200

20

230

80

30

20

200

110

40

190

220

30

30

360

200

200

120

20

170

Two admissions --------------

Three admissions or more----

Total number of admissions

per 1,000 persons --------------

NOTE: Due to rounding, detailed figures may not add to the totals.

56
APPENDIX 1. QUESTIONNAIRES

INTERNATIONAL COLLABORATIVE STUDY OF MEOICAL CARE UTILIZATION

Feasibility Study

DIViSiOIIofMedical Care and Hospitals of

The Johns Hopkins University

Department of Epidemlolou and Commtmily Medicine of the

University of Vermont

.411i.[orm.tim which wauld permit identification o{ the ind;vidtial will be held strictly confidential,

will be used only by persons mgoged in md- for the purpose of this survey.

A HOUSEHOLD HEALTH SURVEY

April 1965

[ am from

\Ve are doing a health study in this area, Your house was chose” i“ our sample a“d we would like to talk with

you. \Ye are trying to get a picture of Lhe medical services i“ this area a“d how people use them. The information yau give us will be confidential. First I would like to ask you some q.estio”s about your living arrangements and who lives in your household.

H.us.h.ld address or description of its location

A,.. I Household numb

. M.1 Ilng .ddr.ss (if different from item 1)

. Typ* of dwelling

Detached house (including fnrmk.use). . . . . . . . . . . . 1 Residential hotel lsmall private hotel . . . . . . . . . . . . 5

Semi-dctmchcd house lduplex!mw house/terrace . . . 2 Camvan/traiIer/boat . . . . . . . . . . . . . . . . . . . . ...6

Flntmnis.nettn apart*c”t. . . . . . . . . . . . . . . 3 Other dwelli”g . . . . . . . . . . . . . . . . . . . . . . . . ...7

Ranrdi.g bousommni.~ houselbedsitters . . . . . . . 4 (Specify)

. Record of calls

Cull n.t. Hour Intcwimv IF YF.S, ASK:

No, of obtained

Who w., da,.

nay

S%. w.. In,ervlewed?

Month nay

obtained ah.., ?

Not,.

!40 Y..

I N Y

2 N Y

3 Y Y

4 N Y

5 ,V 1

6 N ~

7 \ Y

5. Find result

.411 household interviews complctcd . . . . . . . . . . ...1

I[ousch.ld interviews pmtinlly completed . . . . . . ...2

Nointcrviews obtained . . . . . . . . . . . . . . . . . . ...3

. R.ason why no Interview obtained

6.1 Rafwd (Speci[y below) . . . . . . . . . . . 1 6.2 Vacant-nonseasonal . . . . 1 6.3 Dcnm!ished . . . . . . . . . . . ..l

M mm at home after repeated calls . . . . 2 Vacant-seasonal . . . .2 [n sample by mistake. . . . ...2

Tcntporncily .bsent . . . . . . . . . . . . . . . 3 Usual residence Eliminated i“ s“bsarnple . ...3

Otbcr mason (but should be included in elsewhere . . . . . . . . . ..3 Other (but to be excluded

munplc) (Specify below) . . . . . . . . . . . 4 from sample) (Speci[y below) 4

Rcnson for nonintervieti

Ivm. Nure.r I.it.rvi. wer code I FOR OFFICE USE ONLY

ml ’32 D3 04 mS G6 m7 08

1

1

!

8

1

t

1

1

I

1

n

n

0

57
Area

B

I Household numbw

7.1 What is the name of the head of this household? (Enter name in [irst line)

7.2 What are the nomes of .11 other persons who live here? (List all persons who live here)

7.3 I hove listed (Read names). Is there onyone .1s. staying here now, such as friends,

relatives, or roomers? . .

m No UY.**

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

7.4 Hove I missed anyone who USUALLY lives here but is now away frem home? . . . . . . . . . . . .

m No UYC,*

7.5 Do any of the people in this household have a home anywhere else? . . . . . . . . . . . . . . . . . .

m NCI DYes*

7.6 Is any member of this household now in o hospital or nursing home? In an institution? . . . . 0 No aYes’

7.7 Are there my (other) babies? If so, add to list. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m No DY.s”

“%%%:;%:,

Marital Non-interview

status

I

~1

“1

>

Rclntionship $ $1

Name to head of sex Age last I

0 birthday”’ ;~jl (Specify)

household

: :’; ~[

J ~

. -s : *!,Z[

“ ~my ; .S S-:

Em v.- . S“acl

..3ss ‘; .. . .. .

$,~g:m . +., .[

Code ]’2

“ “=-.5

Last name First name

Age ;g~~~ g gacal

code 12345 1 234S]

I I

1 HEAD 1 “II F / N!l W’DS 1 HARO\

I I

2 !1F

~ ~J,~~~ , “AROI

I

13 M F NMWDS 1 HAROI

I

‘4 $1 F 1 Nhl U’DS I HARO/

I

,5 M F : i4bIKDS I HARO~

I

1

16 M F NMWDS I HARO; I

I

I I

17 M F NxIWDS I HARO[

I

1

1

18 M F / NMWDS I HARO\

I 1

19 M F I NMWDS I HARO!

I

1

I

10 M F ! NMWDS 1 HAROI

1

I

11 M F [ NMWDS I HARO~

I

I

12 M F

~ N\, w’JJs I HARo\

I

I

13 M F 1 NNWDS I HARO1

I

14 M F NMWDS I UARO~

I

15 M F I NMWDS I HARO!

‘*IIImonths [o, RELATIONSHIP CODE AGE COOE

infants under Head of how.ehold .. ....1

1 yco, 0[ O’qe;

Partcmrofhead . . . . . ...5 Under lyea, . . .00224206 . . ...06 50-54......12

SPOUSeof head. . . . . . .

2 S,,,s.l . . . . . . . . . . . ...6 1-4.....,..0125-29......07 S5 -64 . . . ...13

in years for Child /child-in-lsw / Roomer/hoarder . . . . . ...7 5-9.....,..0230-34.,....08 65-69.....,14

all other .Iepchild . . . . . . . . . . 3 Grandchild . . . . . . . . ...8 10 - 14 . . . . . .0335 -39...... 09 70-74......15

persons. Parent/parent.i.-law . . 4 Other related person. . . . . 9 15-17......0440-44. . . ...10 75.ro.er . . ..l6

18-19 . . . . . .0545 - 49 . . . ...11

1

I

I

2;1

I

Cod., I Cod.,

I

I

1

I

1

I

I

I

I

I

I

1

I

I

Em,cl-.~5

!333 26-31

I

I

I

I

I

I

I

I

I

I

EE3 .1)-A

EEEl

76-31

D33 <8-4.4

933 1 d.1- ‘1,

E@EEj .,.

58
Inlet-flew — of— Interviews

Arc. Hous.held lndlv. Rospondont

ADULTHEALTHSURVEY

FOR INTERVIEWSWITHALL ADULTS OR MARRIEDPERSONS UNDER 18 YEARS

Use a separate adult health sruwey for each individual

wson covered by this interview

L-t name

Person covered was respondent ❑ NO

Flrat name

nYes

~spondent, if different from person covered by this interview

Lm.t name Ff,.t n.m.

In tho 2 vm-ks .ndlng yost.rday (midnight)(Showmarked o&ndar) did y.. talk tc./co.sult a mmfical Joctor about your health. . .

HOWmany

.1 at hla offlc./

No Yes time.?

surgery. . . . . . . . . . ncl _

Last name.[ doctor I“ltim!. Ad+n.a

hat“am.ofdoctor rnlti.1. Addra..

,2 in o hospital cmcr.

&nW~:/’:s,ua:~ , H ~1

Name of ho,plt,, Addm..

No Yes

3 In a hospital out.

patlmnt clinic? . . . . . ncI—

Name of h.aa.oltal ., .li.fc

a

Addrea.

No Y*s

4 at wotk or at an

Industdal clinic? . . . ❑ cl_

N,iae of C-J. or clinlc Addre..

No y-s

5 at any othw clinic

or health ccntcr? , , . clcl —

Name of clfnle Admlw.

No Y*s

.6athomm? . . . . . . . . . ❑ n_ batnameofdoctor r“f tiaf, Addre,.

No Yas

.7 anywhwa .Isc?. . . . .

(Specify) ❑ el _

~,t name of doctor or place rnrtial. Addm..

No Yes

.8 ovw the tclophono?, . clu —

IA.t n.me of doctor hlftf*l* Addm..

TOTAL NUMBER OF CONSULTATIONS

f no conmdtations in question 1, skip to yuextion 4, page 3.

acord each consultation mentioned in question 1 in Table 1, page 3, using one eofwm foreach consnhtion.

!ecord any overnight stay in hospital/rmrsfng home mentioned, in question I, in Table IV, page 5.

.1 Ifdoctor was consulted in question I, skip to question 3, below.

Havo you scdconsultod a doctor obaut your health at any Nmc in tho last 12 months? UN. ❑Y.,

.2 IF NO, A.%

Whomdid yOU last s*c/conm![t a &ctor? 1 y-.. l-. th.= 3 7.-s 9 y.-.. 1... ~.. 5 Y.- 5 y.- .,=.,.

>I Do yOUhavo a pOrSOnO[ doctor YOU USUOi!y go to?

D ❑“’

,2 IF YES ASK:

who i, h-? 1.

bat MS19 Of doctw rnlthls Addrua

1.3 If more than one doctor

is mentioned, ASK:

Which orw do yOU USUally S../ 2’ s.u.t Mm of doctor

consult aboutmost of yew

rnftl.1.

-

Addma.

health pmblcma?

12s

9.

None U.t ..me of doctor rniti.t. Addre..

2]1

Cc.ds, ~ Cod.,

I

I

1

I

1

I

0!015

q @

!

go 7

I

I

I

I

I

I

I

I

I

I

I

I

I

0!0

E#n

n~n

010

1

n

n

I

E#n

I

I

C#o

I

59
60

age 2

Table 1- DOCTOR VISITS AND CONSULTATIONS MENTIONEDIN QUESTION 1

have a few more questions about your visits/consultations with the doctor.

IJ ZJ 3J

‘lace of visit. Code from question 1.

Ios that in the last 7 days or the 7 Lasc7days . . . . . . ..l

lays he for.? (Sfmwu marked calendar)

Lasc7days . . . . . . .. I Lasc7days . . . . . . ..l

7 days before that. . . . 2 7 days before that. . . . 2 7 days before that. . ..2

ihot was the main reason fur

,eelng/consulting the doctor?

:mi:gpi;$ sy.fmn was

)id you see/...s.[t him be . . . . . No Yes No Yes No Yes

m. had any syrnptmr,s/.omplaints?

F YES, ASK:

Vh.t wos it? (Sp.ci/y)

F NO, ASK:

k this o follow-up visitlconsult.ti.n No Yes No Yes No Y*S

or an ●arlier illn*ss?

F YES, ASK:

fiat was it? (Specify)

1

M that visit/... s.ltni.n did

myone .

give you an infection? No Yes No Yes No Yes

take blood for a test? No Yes No Yes No Yes

take m X-my? No Yes No Yes No Yes

suggest you J*. another doctor? No Yes No Yes No Yes

arrange for you t. g. to th. hospit.l? No Yes No Yes No Y..

9iv= y.. . ..rtiff. o+.? No Yes No Yes No Yes

give you a pr.scripticm or medicine? No Yes No Yes No Y*S

use any other treatment? No Yes No Yes No Y..

(Specify)

Did .nyone suggest that you s.. the

i.actor for that visitlc.nsult.t ion? No Yes No Yes No Y.,

IF YES, ASK: tio suggested you

ree/c.nsult the doctor . . .

the doctor himself? No Yes No Yes No Yes

another doctor? No Yes No Y*S No Yes

a friend? No Yes No Yes No Y*S

husband/wife? No Y.. No Y*S No Yes

other relative? No Yes No Yes No Yes

anyone ●Is*? No Yes No Yes No Y*S

(Specify)

h. any of this visit/c.”sultation

pnid for by your .mpl.yer, workm.n’s No Yes No Yes

compensation, ins.rant., vt.lf.m., or

No Yes

the health deptint?

IF YES, ASK, All Part All Part All Par!

Does that cover all or part of the

●xpenses? 1 2 1 2 1 2

f condition mentioned in question 3 of Table 1, record on Table III, or if condition alrcvdy listed on Table III, circle number i“

eft+znd column next to tfmt condition. I

A variation of this question was asked in Chester and Smederevo: see page 72.

I

1

Cod.,

ql

EIJl

IlJ3

q

p

I

I

I

q+cl

I

I

I

V

tp

Ep

up

QJl

p

Up

q

p

p

g

p

U#

q

Ep

Cp

q

CI$i

I

IIp

Ep

up

p

CIJl

q

q

U#

Ep

QI

UJ3

Ep

igl

Egl

Eg3

y

qp

Qp
ngc 3

No Yes Who? (Specify)

1. ths lost 2 weeks ending yesterday give you on iniection? 00

(midnight), in addition to what you

have alrmdy told me, did

a“yon. . . .

*eke blood for u *o.*? mm

take an X-my? On

During the same 2 weeks did you see/consult any of the following persons ABOUT YOUR HEALTH?

No Yes How many N. Yes How nm”y

1. Public health nurse/visiting times? times?

:Y$:(dl::i:’:;:fie””h •1 ❑ 6. Optometri.t/opticia. ❑ n

2. N.rss In doctor’s office,

.!1”1., or outpatient depart. 7. Dentist ❑ @

ment apart from o visit to a

doctor ❑ lm

8. Any other health worker

(=.g., o midwife) ❑ u

3. Chiropodist/podiotrlst nD ___ __

(specify)

4. Chiropractor ❑ n

9. Did you ask odvice from a

5. Social or welfare worker ❑ n

phormocist/druggi st/

chemist? ❑ 0

TOTAL NUMBER OF CONSULTATIONS

f no uisim/consuhtions for questions 4 or 5, skip to qwsstion 6.1, below.

lccord tack uisit/consult.tion mentione d in ques~ion 5, on ‘Table //, using one column for eack uisit/consukation.

Table 11- OTNICR VISITS OR CONSULTATIONS VENTIONED IN QUESTION 5

Type of health worker? I 2 3

(Code from question 5.)

Was Act in the last 7 days or the Last 7 days, :.... 1 [.ast7 days . . . . . . 1 Last 7 days . . . . . . 1

7 days before? 7 days before that. 2 7 days before that. 2 7 days before that. 2

.1 WJI was the main reason for seeing

. . . ?

.

.2 [f no condition or symptom wcs

mentioned, ASK:

Old you see/visit . . . becouse you No Yes No Yes No Yes

had any symptoms/complaints?

.3 IF YES, ASK:

What was it? (Specify)

Have you ever seen/consulted a No Yes No Yes No

doctor about this?

Yes

Old . . . (name health tt,cv!+cr)suggest No Yes

you samlconsult a doctor?

No Yes No Yes

f ~,>nditi.n m~nti.nrd on Table 11, r.c.,d on Table 111, or if condition already listed on Table 11[, circle number in left-hand

OIWII”ne,tt r., IM conditkm.

t.I Ourlng thislast 2 weeks since . . . were

there ,l”y days when yO” were not able to

cmrry on your “ormol doily activities

because of inn. s.? ❑ N. ❑ yes-+1, YES, ASK: ‘

How mony different day. altogether

during the 2 weeks?

HOW many of those were during the

7 days since last . . . ?

.2 Outing those 2 weeks were y.. in bed

anytkn. b.causm of illness? a N. ❑ Y=s+IF YES, ASK,

On how many different days were you

in bed all or part of the day?

.3 IF YES TO 6,1 OR 6,2, ASK,

What was the matter with you? How many of these were during the

7 days since I.xt . . ?

r t.audition mc”tio”t.d in question 6.3, record on Table 111, or if cona!tion already listed on Table III, circle number iq left-hand

ulumnnextI. &t ~o”,fi~io”.

2

coder

p

ql

I

I

I

I

I

I

I

I

1

1

coder

n

n

1

1

I

I

n :0

1

1

61
Table 111 – CONDITIONS

1

-2

:

z

.=s

..

‘c

G

—

2

—

)

—

t

—

5

—

5

.

1

—

3

—

9—

10

—

11

—

12

—

13

—

1

1

1’

1

1

62

ire’. something a little

ii fferent, although we ma

Iave talked about some o!

these problems be fora. Over

the last 12 months, have you

:nd any of these health probIe”s at any time, that IS

luring th= post year?

‘Go through list first, the”

mk all questions across I

mge [or each “Yes.”)

Rupture or hernia

Varicose veins

Unusual shortness of breath,

m wheezing or cough

Frequent stomach trouble

m vomiting, or diarrhea

Re.peoted attacks of back-

❑che, or bockstr.aln, or

I.mbngo, or sciatic.

Rep.oted attack. of rhe.ma.

tism, arthritis, or other

ioint pain

Frequent nervousness, or

worry, or depression, or

trouble sleeping

WOMEN ONLY: Unusual or

excessive ‘ ‘fema l.” bleeding or dischwge

During the past 12 months,

b. v e,.. had ti th=s. ?

Skin rash

Bolls

Piles, or hemorrhoids or

rectal bleeding

Frequent sore throats or

colds

Frequent sever. headaches

—

[0

r

● s

—

Y

—

1’

—

Y

—

Y

—

Y

—

Y

—

1

Y

—

I

Y

—

iY

—

1

Y

.

r

Y

—

1

Y

—

I

Y

—

{

F

—

N

—

N

—

N

—

n the last

! weeks hm

t bothered

,0” . . .

1234

1234

1234

1234

.1234

1234

1234

1234

1234

1234

1234

1234

123,

1231

1234

123z

123L

123,

love you ●ver seen . doctor about this?

ApcIrt from o doctor, hove you ●ver

F YES, ASK: When was the last time. . .

asked for any advice or help about

this from anyone ●Is. Iik. . nurse,

your husband, or wife, a friend,

IF NEVER, ASK: relative, etc.?

(Specify)

1234 I

I

N,

1234

Y1

“1

I

1234

NI

Y;

N;

1234

Y;

—

NI

1234

y;

I

i

NI

1234 I

yl

N;

1234

J

~:

1234

Y;

1234

NI

Y;

I

NI

1234 I

yl

I

N!

1234

Y\

I

NI

1234 I

yl \

I

1234

Nt

Y;

~1

1234

I

Y;

1234

NI

Y!

1234

I

NI

1234 1

Y;

2

cod.,

6311-1!

H16-21

6321-2

1

Cods,

n

EaI 1-15

El

16-20

6321-25

El

26-30

Elba 31-35 ~ 31-35

EiOka

36-40 : 36-40

I

5Ra 41-45 ~ 41-45

EdEiO 11-15 ; 11-15

EEim

16-XI : 1(I-2Q

Eakl

21-25 : 2!1-25

EjjQjj

I

Ea!zil 51-55 ; 51-55

I

E&MO

5643 : 56-K!
~o 5

.1 Since January lst, 1964, have you bee” i“ m hospital or nursing

home, for overnight or longer? U No ❑ Yes

IF NO: S).ip to qu.stion 9, below

.2 IF YES, ASK, H.w many time. ? . . . . . . . . . . . . . . . . .

1

Coder

o

LJ,UPLETE T.!f3LE /1’ (Enter most recent admission first!

Table fV – HOSPITAL/NURSING HOME ADii[SSIONS1

For what condition were

you there?

Did you

,.ve an

3peration?

-----

No

or

&

N

~

N

Y

N

Y

F YES, ASK: Whet is the name Wos the cost of this

Vhat was the nom.

a“d address of the admission covered hy

,f the .+eroti cm? hospital or nursing your employer, w.mkhome YOU were in? men’s compensation,

When was How

; the . . . many

: time you nights

5 entered? were

c

you

~ there?

;

E

:

!1.. Yr.

I

1

I

I

(Try to get precise

d.scriptio” or

medical name) I

inswmce, welfare or

the health department?

Pure

%rt private

3 4

3 4

3 4

3 4

3 4

3 4

3 4

3 4

co,

1

I

I %5 X3-w

la30-39

a

40-49

El

50-59

a

m-m

RI

30-39

H

40-49

13il 20->9 --t!

a

Ha40-49 N

Y H50-59

RiFl

20-29

El

30-39

N

Y

N

Y

El 40-49

I

N

— Ellail 50-59 ; 50-59

Y

ow we would like to ssk you some other questions 211

Coder I Coder

I

1

p[q

!

1

1 Can you see ordinory “ewspoper print without

>out your health. glosses?

VISION ❑ N. ❑Y=s

1 Have you hod your ● ●s tested for vision by a“y

doctor, or ophthalmo rogist/oc.list, or optometrist,

or optician in the lost 12 months?

❑No DYes

.2 IF YES, ASK:

Who did you see most recently?

2 If no and uses glasses, ASK:

Con you see ordinary newspaper print with

glasses? ❑ No ❑Yes

1

1 Can you see well enough to recognize a friend

wolking o“ the other side of the street without

glasses?

1

1

1

1 ❑ N. ❑Yes

2 If no and wears glasses, ASK:

Can you see well enough to recognize a friend

walking on the other side of the street with n~m glasses?

I

12

,1 Do y.tl use glosses at all? ❑N. ❑Yes

,2 IF YES, ASK:

Who presctlhed them for you?

(Spt.,. if) )

I

I

I

I

I

I

I

!

I

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❑ N. ❑h

if respondent can’t see ordinary newspaper print

~.

or recognize a rtend tcal!+in,g o“ rhe other side of

the street and p. not had his eyes tested for

.isio” in the past 22 montk, ASK:

HOW does it hoppen you haven’t seen anyone

about your eyes?

(Specify)

I

I

1

Last nom,. 1“!11,1s I

I

1

I

I

I

A dd,c ,.

Optorn.ttlsl. . . . . . . . . . . . . . . . . . 1

Optlcl.” . . . . . . . . . . . . . . . . . . ..z

Ophth.almo[oglst . . . . . . . . . . . . . . . 3

Oculist . . . . . . . . . . . . . . . . . . . . . 4

San...l sess . . . . . . . . . . . . . . . ..s

(Spc.ff)’)

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1 \ \:lriu\ion of this question was w!ied in Chester and S:ederevo; see page 72 63
P... . ..- 6.

FOR MOTHERSOF CHILDREN UNDER

6 MONTHSOF AGE

}.1 Where dfdyo. hove the b. by?

inahospitol . . . . . . . . . . . . . ...1

ina nursing home.. . . . . . . . . ...2

at home . . . . . . . . . . . . . . . . ...3

some other ploce . . . . . . . . . . ...4

(Specify)

?.2 Wh. helped with the baby’s delivery . . .

0 doctor ond nurse or midwife . . . . 1

adector only..... . . . . . . . ...2

a nurse or midwife only . . . . . . . . 3

anyone else? . . . . . . . . . . . . . . . 4

(Speci\y)

no on...... . . . . . . . . . . . . . . 5

1.3 Dfdyou seeadoctor ornurseor midwife at

anytime during that pregnancy apart from

the delivery?

DNo ❑ Y.s

IF YES, ASK: Did youseecmyef these

people atanytime during the. . .

1st 3 months? ON. nYes

2nd 3months? ON. OY=S

3rd 3 months? ON. DYes

‘or married women under 50, SAY:

r. ore particularly interested in fi”dingoutab.aut

w medical care received by pregnant women.

4.1 Arey.u pregnant now? ❑ N. DY.s

4.2 IF YES, ASK:

H.ve you seen adoctor, ornurse, or midwife

about this i“the2 weeks cndi”g

yesterdoy (midnight)? ON. ~Yes

4.3 IF YES, ASK:

Was this ..eofthe visit. /..l+. +i.ns.ns

you olready told me ok-out?

❑ N. ❑ Yes

Ijno, enter uisiton Tables land/orll

and complete the tables.

OTHER HEALTH PROBLEMS

5.1 Doyouat thepresent time have nny illness

orhealtb problems whicb we have not

talked about?

ON. UYes

5.2 IF YES, ASK:

What ore they?

2

Cod.,

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6.1 Todoyor yesterday have youtakenor used any

medicines, salves, or pills that were suggested

orpmcrib. d by n doctor?

UN. nYes

6.2 Hnveyou taken .rusedony medicines, or salves,

or pills, oranytbing like tbat NOT suggested or

prex, ibed by . doctor?

~No DY.s

6.S IF VES, ASK:

Who suggested that you take or use it/them?

Circle all responses

Nurse . . . . . . . . . . . . . . . . . . . . . . . ..1

Pharmacist/druggist/chemisf . . . . . . . ...2

Self . . . . . . . . . . . . . . . . . . . . . . . . . ..3

Someone else . . . . . . . . . . . . . . . . . . ...4

(Specify)

~ undue breathlessness, or wheezing, or cough

zot mentioned in Table [11, ASK:

7. Supposing youhadunusuol shortness of breoth, or

wheezing, or cough for about 2 weeks but not

necessarily continuously, what would you do

about it?

Anything else? DN.a DYes

I

IF YES, ASK, Whet would that be?

I

\

~ fregue”t ner.ous.ess, or worry, or depression,

,rtrouble sleeping not mentio”edi” Table Ill, ASK

18. Supposing you bada.onst.snt feeli.g of nervous.

ness, orwo,ry, ordepr.ssicm, or frouble sleeping

for about 3 weeks, what would you do about it?

Anything ●lse?

IF YES, ASK: What would tbat be?

19. Suppose youstepped .narusty nail and itwent

deep into your foot, wbot would you do about it?

Anything .1s=? ON. OY..

fFYES, ASK: Wbafwould that be?

!0. Ifadoctor isnotmentioned in17,0r 18,

or 19, ASK: You didn’t mention a doctor in

connection with 17, or 18, or 19, whywoul

that be?

2

Coder

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64

I

[
ba~, ‘7

21,1 lnsom. famill.s on*memhr ofth. fomIIY looks

oltwthch.alth of th. ether members of the

family.

Is that so in your family? ❑ tb ❑ ,e.

21.2 IF YES, ASK: Whowouldihat be?

22.1 If youcould have about 15mimJtesof uninterruptedtlme in ihe next 2 weeks with II doctor

you found sympathetic and understmmfing, is

thmrmanythlng you would Iiket.a cisk him about?

❑ No ❑ Yes

IF YES, ASK: Would youtellmewhat it is?

?2.2 Havoyou cvortalked toanydoctor ab.autthis?

❑ No ❑ Y..

IF YES, ASK: What h.appened?

‘F NO, ASK: Why not?

f the respondent has a doctor he usually se..

~he has nodoctorhe usual~y sees, skip m

ucstion 3.1, page 1), ask uestions 23.1–27.

?uestion 28, opposite.

?3.1 l’dllk* toaskyou oneortwo questions obo”t

the doctor you usually see.

Wh.n you visitor consult your doctor does he

take ht. tinm and not hwry you . . .

mostofthc time . . . . . . . . . . . . . . . . ...1

somdmes . . . . . . . . . . . . . . . . . . . . ...2

rot+?. . . . . . . . . . . . . . . . . . . . . . ...3

Don’t know . . . . . . . . . . . ...’.. . . . . . . 4

13.2 Docshelist.n toallthat youw.nt tosay. . .

most of thetlme . . . . . . . . . . . . . . . . . . . 1

sOmcNm*s . . . . . . . . . . . . . . . . . . . . ...2

rurqly? . . . . . . . . . . . . . . . . . . . . . . ...3

Don’t know . . . . . . . . . . . . . . . . . . . ...4

23.3 Ishcabl, toexplain things toyou fully. . .

most ofth*tlme . . . . . . . . . . . . . . . . ...1

sOm*tim*s . . . . . . . . . . . . . . . . . . . . . . . 2

rarely ? . . . . . . . . . . . . . . . . . . . . . . ...3

Don’tknow . . . . . . . . . . . . . . . . . . . ...4

2

Coder

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!4.1 Would y.” say that y.”, d.oet.ar . . .

takes a personal interest in you or . . . . . . 1

is rather impers.mal in the r.lorio”ship? . . . 2

Itdep.nds ordcm’tkn.w . . . . . . . . . . . . . . 3

!4.2 Would you perfer that the relationship b. . .

more personri l... . . . . . . . . . . . . . . . ...1

more impersonal . . . . . . . . . . . . . . . . . . ..2

as ib is? . . . . . . . . . . . . . . . . . . . . . . ...3

Other . . . . . . . . . . . . . . . . . . . . . . . . ...4

(Specify)

!5. Ny.. were worried about ap.rs.nal problem

that wosn’ta strictly medical one, such is

children getting into trouble ordiffic.lties

between husband and wife, de you think yo.

might discuss it with your doctor?

No . . . . . . . . . . ..O

Yes . . . . . . . . . ..l

It depends . . . . . . . 2

‘6. Howl.mgdoes itusuolly take youtogat to your

doctor’ so ffic. . .

less thon15mi””tes . . . . . . . . . . . . . . . . . 1

15minutes tole.s than l/2 hour . . . . . . 2

l/2hour tolessthon l hour..... . . . . . ..”3

lho.r.ar longer? . . . . . . . . . . . . . . . . ...4

7. How do you n.rnmliy getthe,e?

Walk allthewoy . . . . . . . . . . . . . . . . . ...1

P.blic transportation . . . . . . . . . . . . . . . . . 2

Priv.te ..t0/mot0cycle . . . . . . . . . . . . . . . 3

Bicycle (pedal) . . . . . . . . . . . . . . . . . ...4

Animal . . . . . . . . . . . . . . . . . . . . . . . ...5

De.t.armlways ..11s . . . . . . . . . . . . . . . . 6

Onthespot (at factory) . . . . . . . . . . . . ...7

low iust a few questions about yourself.

8. How Ionghavey.au been Iivingintbis county

.arthese..mrnunes (4)?

Less than 6 months . . . . . . . . . . . . . . . . . 1

6months, less than 2years . . . . . . . . . . . . 2

2years, less than 5 years . . . . . . . . . . ...3

5years, less thon20 years . . . . . . . . . ...4

20years0rm0r. . . . . . . . . . . . . . . . . ...5

9. Where wer. yo” born?

(spec:f~)

In this county or these comm.”es (4) . . . . . . 1

Elsewhere intbis country . . . . . . . . . . . . . . 2

In another country . . . . . . . . . . . . . . . . . ..3

0. Whet kind ofwwkdo ycw”swally do?

Main occupation . . . . . . . . . . . . . . . . . . ..1

(Specify below)

Housewife only (Specify below main

occupation ifever worked) . . . . . . . . . 2

%denfor scholar . . . . . . . . . . . . . . . . . ..3

Retired (Specify below mai” occupation) . . . 4

Unemployed(S ecifybelow main occupation

whe”employe J) . . . . . . . . . . . . . . . . . ...5

Main occupation

For what organization?

A ddres.

211

Cod., : Code,

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65
‘age 8

11.1 Doyouhav. anyklnd ofhcalth insurance for

medical ●xpenses?

❑ t+a ❑ Y.. ❑ .o.)tknow

!1.2 lFYES, ASK:

Do.s it cover all or part of your docto<s

bills wh.n you stoy i. th. hospital?

❑ No ❑ Y.s ❑ Do.’t know

11.3 Do.s itrmv.r allc.rp.rtof yc.ur other

hospital bills when you stay in th. ho~pital?

❑ N. ❑ Y.s ❑ Don’t know

11.4 Does itcover al[orpart ofy.urbllls when

you s*e/consolt thedoctorinthc office,

surg. ry, horn., orclini.?

❑ NC. ❑ Y.s ❑ Don’tk.ow

EDUCATION

32. Howmany years of sch..ling did you

complete?

(Specify)

0-8 . . . . . . . . . . . . . . . ...1

9-10 . . . . . . . . . . . . . . ...2

11 . . . . . . . . . . . . . . ...3

12 . . . . . . . . . . . . . . ...4

13 . . . . . . . . . . . . . . ...5

Not..

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Complete questions 33, 34, md3S’ below, and

questions 2,3, and 4 on face sheet, page A,

after leauing respo”dem.

33. Wasther. .anyone .lse Rr.s.ntduri”gth.

interview?

❑ N. ❑ Y.,

34. Didanyone dsecontribut.i nfo,m.atiento

this interview?

❑ N. DY.s

35. Were there anymaior distmctlonsdurlng

the intawicw?

❑ N. ❑ Y.s

iign.t.re of Mer.iewer Code

I

lateof completion

‘OR OFFICE USE ONLY

Oddhhhnd

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A variation of this question was asked in Chester and Smederevo; see page 73.
I.terview_ of_ interviews

Area Household Indiv. Responden

CHILD HEALTH SURVEY

FOR INTERVIE\VS \VITHhlOTI{ERS OR Guardians OR UN}lARRIED PERSONS UNDER 18 YEARS

WHO ARE LIVING AT HOME

Use a sefnvote child health survey for each child

;hildcovercdby tbis interview

Lam name First ..me Respondent>. Iast name First name

‘Jowl would like totolkto you about. . .

.1. the 2 weeks ending yesterday (midnight) (Show marked calendar) has a medical doctor been visii.d/cons.lted about . . . health

Ho:v many

.1 .t hi. .ffl..l~.w,? b fi :

L*s1 name of docfor Inifiel.s Addras,

Last name of doctor In flf.als Address

.Zln ahospitol etrmr- No Yes

gency roonw’casualty

deportment? clo _

Name of h.wit.l Address

.3fn ah.aspital out.

pd.”+ clinic? &lG—

N.meofhos.nital or clinic Address

No Yes

.4 at work or .t o.

industrld clinic? ❑ D—

Name of company cli.lc Address

.5 at any other clinic

Orhe.lthce.*.r? h~_

P/am. of clinic Add,,,.

No Yes

.6 at home? ❑ D—

Last name .( doctor Initial. Address

.7 at school?

No Yes

❑ n_

Last name .1 doctor I“, 1{’?1s Address

.8 anywhere .1 se?

(Spcci[y)

EEP

Last name of doc(or m place Initials Address

,9 over the telephone? hfi —

Last nnnm of doctor 1“{,,.1s Address

TOTAL NUMB ER OF CONSUL 7A TION5

f no consuhtions in question 1, skip to question 4, page 3.

?rcord each comsuitatio” mentioned in question / record in Table /, page 3, “sing one colwnn for each consutta~ ion.

?ceard any ouernight way in hospitol/”wsin6 home mentioned in q“es~ion 1, on Table IV, page 5.

t.lifdoctor u,asconsultcd i”q”estion 1, skip toque~fion3, below.

Has . . . seen/consulted Q doctor about hidher heolth ot any time in the last 12 months? ❑ N. ❑ Yes

L2 IF No, ASK:

1 Yearp When did he/sh. last see/consult a doctor? 3 years, 5 years

less thn” 3 years less than 5years or more

1.1 Does, ., have a personal doctor ;bo. ..usually sees/consult? UN. ❑ %

1.2 IF YES, ASK

Who IS h.? 1.

Last “mw of doctor Initials Add re$s

1,3 If mare thw one doctor

is mentioned, ASK

Whlcb.an. do.s. . .

2.

Last “me .< doctor

usually sdconsult about

lniti*ls Address

most of hidbar hralth

problems?

123 Nona 3.

Last name of doctor Iniliel. Address

I

2,1

Code, , Coder

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67
!ge 2

Table I – DOCTOR VISITS AND CONSULTATIONS MENTIONED IN QUESTION 1

i

I

Cod,,, Cod., Uj&3

q-~p

have a few more questions about . . visits/consultations with the doctor.

1 IJ

Iace of visit. Code [romquesLionl.

,ast7days . . . . ..l

‘days before that. . 2

as that in the last 7 days or the

days before? (Shoumarkedcalendar)

ist7 days . . . . . . . 1 Last 7 days . . . . . . 1

days before that. . 2 7 days before that. 2

bat was tbe main reoson for

teing/consulting the doctor?

‘no condition or symptom wus

enlioned, ASK:

‘Id . . . see/consult him because of

ny sympt. mslc.mplaints?

‘YES, A5K:

‘hat was it? (Specify)

No Yes

=NO, ASK:

1.s this a follow-up visit/consult.ti.n

or an earlier illness?

No Yes No Yes No Yes up

FYES, ASK:

Ihatwas it? (Specify)

No Yes

,t tbot visit/co ns.ltati.n did

nyo”e . . .

give . . . on inie.ti.n? No Yes I No Yes Dq

No Yes

No Yes

$akebl.a.d for. test? No Yes I No Yes

take an X-ray? No Yes I No Yes

suggest . . . see another doctor? No Yes No Yes No Y.. p

No Ye. Eg

No Yes

arrange for . ..to goto the hospital?

q

U&l

give. , .0 certificate?

No Yes give. . . o prescription or medicine?

.s. my other tre.atme”t? No Yes I No Yes N. Yes

(Specify)

No Yes Ig3

No Yes

No Yes

the doctor himself?

another doctor? No Ye. I No Yes

a friend? No Yes

No Yes No Yes

N. Yes No Yes

No Yes No Ye.

No Yes No Yes

All Port All Part

1 2 1 2

a r.lotive? No Yes

yourself? No Y..

anyone else? No Yes

(Specify)

No Yes

Uas any of this visit/consultati.n

paid for by . . . ●mployer, workmen’s

compensation, insu,anc*, welfar. .r

Ib. h.ohh department?

fF YES, ASK:

Does that cover all or part of the

expenses? +---i-+

ql 1/ conditions mentioned in question 3 O( Table /, record on Table Ill, or if condition already listed on Table 111, circle number

i“ left-hand column mzt to that co”diticw.

68 A variation of this question was asked in Chester and Smederevo; see page ’72.
---- .

ru~c .

Who? (Specify)

No Ye.

Llnthelast 2weeks ending esterday

(mldnlght), lnoddltion tow 1 atyo.

give. . . an iniection? 00

hovtalre.ady told tne, did.anycme. . .

‘0’= ’’00’’0’”’”’” DO

take a” X.ray? 00

i. During the some 2 weeks were any of the following health workers seen/consulted ABOUT . HEALTH?

How many :l:e:?any

.1 Publlch.olth nurse/visiting No Yes times?

nurse/district nurse,f health

visitor in the home ❑ n

6. Optmnetri .t/oPtician EG

.2 Nurs*in doctor’ sc.ffice,

clinic, .xoutpatfe”t

department apart from o

7. Dentist

❑ n

❑ o

visit to a doctor

8. School heolth nurse ❑ n

.3 Chiropodist/pc. di.atrist ❑ u 9. Anyother health worker nn

.4 Chiropractor ❑ o

(Speci\y)

.S.%.clal c.r welfare worker ❑ n

10. Oid you ask odvice from a

pharmaci st/drug gist/chemist? ❑ u

TOTAL NUMBER OF CONSULTATIONS I

[n. t,isits/consultati..s for questions 4 or 5, skip m y.es,io. 6.1 below.

?rrord rack visit/consultation mentioned in question 5, on Table /1, using one column @ each visit/consultation.

Table II - OTHER VISITS OR CONSULTATIONS h!ENTIONEf) IN QUESTION 5

L Type of hdth worker? 1 2J 3

(Code from guestion 5)

!. Was that i“ the lost 7 days or the Last 7 days . . . . . . 1 Last 7 days . . . . . . 1

7 days before?

Last 7 days . . . . . . . . 1

7daysbeforetbat. 2 7 days before that. 2 7 days before that. 2

1.1 What wasthemaln reason for seeing

the ...?

1.2 Ifrm condition orsy”ptom wasme.tioncd,

ASK:

Old, ., .ec/visit . . . because . . . had N“ Yes No Yes No Yes

ony sympt0m5/complaints?

1.3 IF YES, A3K,

Whet was it? (Specify)

L Has , . . war seen/.ons”lt.d a doctor

about this? No Yes No Yes No Yes

i. Oid . ..(n.me he.lthworker) s.ggest

you sdconsultu doctor? No Yes No Yes No Yes

lfc.ndition m.ntio.ed on Tahle H, record on T.blel/l, ori{co"ditio. alre.dy listed on T.ble/i[, circle number inthe left-hand

,.o[umn next to dint condition.

!.1 O.tl”g th{s last2 w.eks since. . . were

ther. a”y days when ... . was”.at abfe

to carry onhisihernormcd doily activities

bmcause of Illrmss? QNo ❑ Y= S-+ IFYES, ASK:

How many different days altogether

during the 2 weeks?

How many of those were during the

7 days since lost . ?

!.2 Outing th.se2 weeks was. . . in btdony

time bec.useof illness? ❑ NO •Ye*+/~ms,As~:

Onhowmany different days was . . .

in bed all .rpmtof the day?

How many of those were during the

1.3 IF YES TO 6.1 OR 6,2, ASK,

7 days since last . . . ?

What wos them.stter with , . . ?

{ccl. dilionmcntioned inquestio" 6.3, r.cord."T&le l/~ ori/conditio" .lre.dY listed on T.ble III, circle n"mb.rin left-hand

,olumn next to that ccmditiom

2;1

Coder , Code,

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69
70

age 4

Table III - CONQITIONS

[F TfIE CIIILD IS OVER 1 YEAR OF AGE, ASK THE FOLLOWING:

H.re’s something . little In the lost H.ve you ●ver seena doctor cibout this? Ap.rt from a doctor, hav. you or

different, .Ithough w. ma

}

2 weeks IF YES, ASK: When was the last time?

have talked about some o had it

has . . . . ●ver had a“y advi.s. or

help about this from anyone .Ise

~ these problems before. Over boihcred IF NEVER, ASK: like a nurse, another member of

o the lost 12 months, h.. . . . %’

5 hod any of these health

Why was thot? the fami Iy, a friend, relative, ●tc.?

No “’”’

:2s -–1

: problems .* any tire., that :g: lf more than a year ago,

~ is, during the past year? or

>E~ A-SK: I

e+r+o

:

7

No i

z

ye, 4J~{; jjg How does it happen that . . . I

(Go thru list /irst, then has not been since?

5

:>== ..*. 0, I (Specify)

ask all questions across

e

~E:: :=! :

page for each “Yes.”) 0:>= .5; : Yesl

1234 1234 I

N NI

1234 1234 I

1 Rupture or hernia

I

Y YI

N N~

1234 1234

2 Whooping cough Y Y!

N Ni

I

3 Un. s..l shortness of breadth,

1234 1234

or wheezing or c..gh Y yl

N N;

4 Frequent stomach trouble, or

1234 1234

vomiting, or diarrhea Y Y!

N NI

1234 1234

5 Measles (regular or Ge,m.n) Y Y/

N I

‘1

1234 1234

6 Chickenp.x Y YI

N NI

1234 1234

I

7 Burn or scald Y Y!

N NI

1234 1234 I

8 Eoroche or “runny’” ear Y YI

Durhg the past 12 months, - I

1

have YIM had .ny of these? j ,_-

.— .—.

J

N

NI

1234 1234

9 Skin rash Y Y!

N

NI

1234 1234

10 Boils Y yl

N

NI

1234 1234

11 Joint pain Y

yl

LN N

1

I

1234 1234

12 Frequent sore throats or

colds Y Y]

N N1

1234 1234 I

13 Frequent severe heodach.s y YI

N

I

‘1

1234 1234

14 Y YI

N N I

1234 1234 I

15 Y yl

N NI

1234 1234 I

16 Y YI

N NI

1234 1234

17 Y Y/

N N;

1234 1234 I

8 Y Y;

z~l

Cod., , Cod.,

!gn

Elm1!-15 I 11-15

I

Imtfil

16-20 I 16-20

❑l!a

21-25 I 21-25

Wi51 26-30 ; 26-30

KAza 31-35 : 31-35

EiN2il

41-45 ; 41-45

Eatza 46-50 I LVJ-W

EiOII-IS

16-20

❑21-25

•126-30

Eta 31-35

❑36-40

❑41-45

Ea

46-50

❑51-55

56-60

laII-15

la

16-Z!

H

21-25

Ea

25-X!

Ea

31-35

ti!il

36-43

la

41-45

Ii!il

46- %

la

51-55

a 56-
7.1 Since Jmnumy lst, 1964, has . . . . been in . b.spit.al .r “ursi”g home,

for overnight or longer?

El N. ❑ Y.*

(F NO: Skip 1. question 8, below

7.2 IF YES, AIK: ‘+ Howmany times? . . . . . . . . . . . . . . . . .

COUP[. ETE T4ELE [V (Enter most recent ndmission first)

Table IV – HOSPITAL JATJRSING NOME AIMISSION.S1

I

When was H.aw

the . . . . many

G NM* . . . nights

$ ●ntered? was

: . . . .

. there?

,~

n

.;

:

\l”, Yr.

>r what c.audition was

. . them?

(Try m get precise

description or

medical rime)

1

1

1

1

1

1 1

1

1

1

1

1

1

1

1

1

I

1

:1 1

1

I

I

1

1

1 1

1

1

1

1

i

I

1

1

I

1

1

i

> 1

1

1

1

1

1

1

1

I

I

1

1

I 1

Did.. .

have

an

opera.

lion?

____

Yo

Y:s

IF YES, ASK:

Nhat was the name

,f the opemti cm?

3

Cod

___--L

7

What is the nom. mnd W., the .OS+ .f +hi.

=BEPurcl!

Yam. and city Yone All Part pri.

“.1,

123 L

I 1 1 1

1112131’

-kk

Complete questions 8-11 below, and que.wi. m 2, 3, and 4 on {ace sheet, page ,4, after leaui”g respondent.

B, Was there anyone else present 2;1

during the interview? Cod., , Coder

=+--w” >. Did anyone else contribute I“formmtio”

❑ N. n Yes n~o

), Were there any moior distractions

I

during the i“t.rview? I

1

❑ NO ❑ Ye, O:n

1

1. Was th. child present during the

Intmvi.w?

1

I

❑ No ❑ ,.ss n ql

htctl

Signature of interviewer Code

Date 0[ completion

I FOR OFFICE USE ONLY

‘Odhhhhnh

2/1

Gad., , Gad,,

O:n

n~n37

1

1

1

1

!i!lj~k!i!a ?3-39

i!wi!d 30-39 1 30–?9

iEk!3 40-49 I 40-49

~ variation of this question was asked in Chester and Smederevo; see page 72.
Alternative Questions Used in Chester and Smedereva

QUESTION 6

Chester version

Was this under the National He.lth

Service orunderavtork scheme or NHS

Work PriNHSWork PriNHS

U’ork Priprivately? scheme vately scheme V.tel)’ scheme V,lt.ly

11121311121311121 3

Smederevo version

[

(>.1

(>.2

n. Ii su tro$kovi poscce (konsulcacije) @eni od

sm... socijalnog 0si8uIanja, radm organizacije

ili +tinske sk. p;rinc?

,lK1l .n.’l”, PII All E:

Jcsu Ii Ii Iro:hovi pokrive.i u celini iti dcli,nitna?

Ne n. v,, na Ne no

. c.lini dclitni&m . Ceyr. i deli,.i~no u celini delinti?no

1 “2 1 I 2 I

I

2

TABLE IV

Chester version

I

M

When was How

~ the . . . mony

time you

%

nights

~ ●ntered? were

you

:

.- there?

:

.-

E

2

!10. Yr.

1

Table IV – llOSPITAL/NURSINGHOMEADMISS1ONS

Smederevo version

For what condition were :::ey: IF YES, ASK, Whet is the name

you there?

~pera. Who+ W(I3 the name

and address of the

tire? of the operati.a”? hospital or nursing

(Try to get precise home you were in?

description or

. . .

medical mm) No

or

Code y== Code Name and city

; N

1

!

I 1

f 1

1

Y

1

——— . . a

W.S this IF NO,ASK

under the Was it

National covered by

Health i“surmce

Service? at .11?

In- Purel

No Yes sur- pri-

.“., vat.

1234

s“

:-:

G

.7

-s

.-

=

‘2

1

—

T

<da ste Kcdik

.. . . . . put ste m

,ili prim- 6i Q,

Ijcmi mo p

Veli ?

Tabela I\’ - PRIJE!dl U BOLt{lCU (SMATORIJUM)

Zbog kakve bolesti st: tamo

bi3i ?

(Poktiajte da dabijete precizni

opis oboljenja iti medic inski

na:iu)

Dasi AKO .DA” , P2TAJTE:

ste bi- od &ga sce bili operisani:

ri Opefkmli?

-——-1

Ne I

iSi

Da I h.

?e

h

Znate Ii naziv i adresu bolnicc i]i sanatorijuma 8de sc

Ie%di?

!Jaziv am

Da Ii sociialno osi8.-

ranje ili opiti”ska sk.-

pitina pla&a za @j LHJravak “ bol”ici ?

m

~i;m Sve Jedsn Ne

dco znmr

1234

72
QUESTION 31

Chester version

31,1 Apart from the National HeaJth Service, do you

have anykind ofprlvate health insurance for

medical expenses?

❑ No •~es ❑ Don*+ know

31.2 IF YES, ASK:

Does it cover all or part of your doctor’s

bills when you stay in the hospital?

DNo ❑ Y=. ❑ Don’t know

31.3 Does it cover all or part of your other

hospital bills when you stay in the hospital?

UN. UY=. ❑ Dom’t k“..

31,4 Does it cover all or part of your bills when

you sedconsult the doctor in the office,

surgery, home, or clinic?

❑ No ❑ Y.s ❑ Do”’t know

Smederevo version

31.1 Da Ii imate neku vrstu zdravstvenog osiguranja?

QI’Ie ❑ ., ❑ .=.”..

31.2 .4KO. DA”, PITAJTE:

G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a~e ❑ h ❑ N, ,nam

31.? Da Ii ono plata u p@punosti ili delimitno za va;e

bocavke u bcdnici i Ie&aje

❑ N. (J.. ❑ ,emam

31.4 Da Ii O-IOpIa6a usluge u potpunosti ili delimibo

knda poset”j ete (Icomsultuj=t=) I=k=a ~ ~rdi”aci.

ji opite prakse, kod kufe ili u specijalisti~oj

(ordinaciji) ambulauti ?

❑ N. •1 l), •1 ., ,.*.

QUESTION 32

;hester version

EDUCATION

32. At what age did you leave school?

(Specify) years of age

Deduct 5 front age and code

Less than 9 . . . . . . . . . . . . . . . 1

9 . . . . . . . . . . . . ...2

10-11 . . . . . . . . . . . . . . . 3

12 . . . . . . . . . . . . ...4

Morethan12 . . . . . . . . . . . . . . . 5

Smederevo version

I

OBRAZOVANJE

32. KolikozavrSenih godina skolovanjasa”speh~

imate ?

(Ncwedite)

0- 8 . . . . . . . . . . . . . . 1

9-10 . . . . . . . . . . . . . . 2

11 . . . . . . . . . . . . . . 3

12 . . . . . . . . . . . . . . 4

l? i~i~~ . . . . . . . . . . . . . . . 5

ooo—

73
TECHNICAL

APPENDIX II

NOTES ON STATISTICAL PROCEDURES

Standard Papulatian and Standardized Rates

Age-sex specific rates for the selected conditions,

activity limitation, visual impairments, persons with

personal doctors, doctor consultations, and hospital

utilization were amalgamated within each of three

study areas by conventional standardization. The population of Sweden in 1962 was taken as a standard.

~

n

Total, all ages- 100,000

Under 15 years ------ 21,541

15-17 years --------- 5,056

18-44 years --------- 35,676

45-64 years --------- 25,594

65 years and over--- 12,133 T

49,892 50,108

11,062 10,479

2>584 2,472

18,039 17,637

12,679 12,915

5,528 6,605

Asanexample, let r, bethesurvey estimatedrate

of disability days per person in the ith age-sex class

in Chester, U.K. Let Pi be the number of persons in

the ith age-sex class in the standard population of

100,000. Then the standardized rate per 1,000 persons

is R=(10-2)Z ~ri = 110, where the summation extends

over all 10 age-sex classes. (See table H, page 14.)

Estimates of Population Totals

Simple expansions of sample totals by the inverse

of the sampling rates were used as estimates of population totals. In Chester the sample totals were multiplied by 92 for both the urban and rural zones; for

Chittenden the multiplier was 66; and for Smederevo

urban sample totals were expanded by 66 and rural

sample totals were expanded by the factor 83.

Standard Errors af Standardized Rates

The usual approximations for estimating s~andard

errors of ratios were employed. Let h index strata

(two in Chester and Smederevoand50in Chittenden) and

let j index the selected sampling units w~thin strata.

The f~rmof the estimated rate ri is (~/Xi), where,

e.g., Y, is anestimate of thetotal nu~ber of disability

days for the ith age-sex class, and Xl is an estimate

:f the tot:l number of persons in that age-sex class.

Y, and Xl are weighted sums over strata of sample

values. The variance of r, was estimated as

where N~ and n~ are the total and sample numbers of

sampling units, respectively, of Ihe hth stratum and the

s’s are the usual within stratum mean squares and

products of numerator and denominator variables. The

variances of the standardized rates (per 1,000 persons)

were estimated by

var (l?) = (10-4) Z Pi2 var (r,), 1

and the estimated standard errors were given as -),

Standard Errors of Detailed Tables

Standard errors for the estimates shown in the

detailed tables are not presented. Estimates bssed on

10 or less observations have sampling errors of the

order of 25 percent or more for each of the three areas.

In general, estimates based on sample frequencies of

less than 50 observations should be approached with

great caution.

Treatment of Noninterviews

Based on the best internal evidence available from

interview schedules, the numbers of persons eligible for

interview in each study area were classified by urbanrural residence and age-sex classification. For analytical purposes a missing interview was represented

by average

urban-rural

values of actual data in the appropriate

age-sex category of the missing interview.

I

I!? u. S. GOVERNMENT PRINTING OFFICE: 1969—342049/s7

000

74
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH Statistics

Series 1.

Series 2.

Series .3.

Sefies 4.

Series 10.

Series 11,

Series 12.

Series 20.

Series 21.

Se rics 22.

Public Health Service Publication No. 1000

l]j.o~,rajt(s atut collecfio}i procedares.- Reports which describe the general Programs of the National

(:entcr for Hea Ith Statistics and its offices and divisions, data collection methods used, definitions,

.=

anLl ~Jther material necessary for understanding the data.

Data ~(alaa[iw uud t)letimds seseasch. —Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical

techniques, objective evaluations of reliability of collected data, contributions to statistical theory.

.!w~[j,ticai stm[ies,- Reports presenting analytical or interpretive studies based on vital md health

stilt istics, carrying the ilnnlysis further than the expository types of reports in the other series.

Docu~Hc’ufs UJM cuwmitt(~c, J.tports. — Find reports of major committees concerned with vit~ 1 .~ncl

he:llth statistics, ,lnd documents such as recommended model vital registration laws and revised birth

and ~ic,;ltll certific:ltes.

Data ,f}”wl tlM Hcalt/t ])/fL,/./iL(,(, SUJ.W_V.—Statistics on ilktess, accidental injuries. disabilit), use of

h.)spit,ll, medical< dental. :lnd other services, and other health-related topics, based on dat~ collected

in :1 cent inuin~ nmional household interview survey.

Data j; “WI theHealthE.yawi~latiou St(rLrtiy. — Data from direct exam ination. testing, and me.~sure -

rlttmt of n,ltion,ll wmples of the population provide the basis for two types of reports: (1) e~timates

~~f’the nlc,dic~lll~ defined prevalence of specific diseases in the United States and the distributions of

thL> p(]i7uli]tifm with re+pcct to physical. physiological, and psychological characteristics; ond (2)

in I[vsis OF rel.ltionships .lmong the vlrious me.wurements without reference to ~n explicit finite

[lllivL~rsc, of pL, rsons.

DataJj.o))ttheltlsfitl(tio]tal Poplilafioll Suroeys. —Statistics relating to the health characteristics nf

pers[)n> in institutions, and on medical, nursing, m-d personal care received, based on national

silnlples ,~f est.lb]ishments providing these services and samples of the residents or patitints.

.!),ttu ]jwitthe Hrxpital Dischurqe St(rt’ey .—statistics relating to discharged pati~nts in short-stay

h[wl~it:]ls, I,i!sed ,In :1 s:imple of patient records in a national sample of hcmpitals.

1).I/~1,JH IICU1lIZ~.,.su~(vce.s: man/Jowev and~aci(ities.—S[atistics on the numbers, geographic distri -

INII11111,.tnd characteristics of health resources including physicians, dcmtists, IILIr~Ls, ot17Fr health

111.IIlp[I\YLI“t]ccupati~]ns, Ilospit.lls, nursinc homes, and outpatient and other inpatient facilities.

J911tuw i)lo][a[it~.- Irarious statistics on mortality other than as included in annual or monthly

t-c1X)rrs —special analyses by cause of death, age, and other demographic variables, also geographic

;lncf time sl~ri~.s :III:IIJISCS.

.fkla w ualullfj, l)~ffj.).iaqc, and dirorce. — Various statistics on natality, marriage, and divorce other

th:ln as im-]uded in annual or monthly reports—special anal~,ses by demographic l,ariables, ~]SL)

Sc’t]gr:lphic ami time series analyses, studies of fertility.

DaIa Jj.olll tll~ ,Vatiotlal L\rata[ity atzd ,lIo).tality SarL,cys. —Statistics on characteristics of births and

d~,:lths not :IV;li l.+hle fr(ml the vital records. based on sample sur~~eys stemming frL)I_il these records,

in{.lmling such t~q~ics .1s mortality by socioeconomic class. medical ex~erience in the Imt yetu of

Iifc,, ~.ll:lrilc.te].istics of pregnancy, {t ,.

I:or .I list of titlcis of rcip[]rts published in these sc’ries. write to: Office of Information

Wtion.d Center for lie~lth St.ltistics

U.S. Public Ikalth Service

Washimgon, D.C. 2C12C)1 .