NATIONAL CENTER Series 2.

For HEALTH STATISTICS Number 9

PROPERW OF THE

PUBLICATIONSBRAN~H

EDITORIAL Ll~RARY

, VITAL and HEALTH STATISTICS

DATA EVALUATION AND METHODS RESEARCH

I Cooperationin

HealthExaminationSurveys

I

A study of expressed wi IIingness to accept a health

exam ination for survey purposes.

Washington, D.C. “ Juiy 1965

U.S. DEPARTMENT OF

HEALTH, EDUCATION, AND WELFARE Public Health Service

Anthony J. Ce Iebrezze Luther L. Terry

Secretary Surgeon General

,.
This report was originally published in the series “Health Statistics

from the U.S. National Health Survey, I~which has since been replaced

by the “Vital and Health Statistics” series. ~is particular report is

of continuing interest in relation to the reports now being published in

the Vital and Health Statistics reports. It provides relevant background

information for use in connection with the reports of findings. It is,

therefore, being reprinted in its present form.

Public Health Service Publication No. 1000-Series 2-No. 9

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

Washington, D.C. 20402- Price 35 cents.
NATIONAL CENTER FOR HEALTH STATISTICS

FORREST E. LINDER, PH. D., ~;?’tCtOT

THEODORE D.WOOLSEY,Deputy D;recto~

OSWALD K.SAGEN,PH.D.,~ffiftantDirtctor

WALT R.SIMMONS,M.A.,stati~fical ~dvi~or

ALICEM.WATERHOUSE, M.D.,Medical ti~vi$or

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

LOUISR.STOLCIS,M.A.,Executive O$cer

OFFICE OF HEALTH STATISTICS ANALYSIS

IWAO M. MORIYAMA, PH. D., C~icf

DIVISIONOF VITAL STATISTICS

ROBERT D. GROVE, PH. D., Cfiiej

DIVIS1ONOF HEALTH INTERVIEW STATISTICS

PHILIP S. LAWRENCE,Sc. D., Chief

DIVISIONOF HEALTH RECORDS STATISTICS

MONROE G. SIRKEN, PH.D.,Chief

DIVISIONOF HEALTH EXAMINATIONSTATISTICS

ARTEUK J. MCDOWELL, Chief

DIVISIONOF DATA PROCESSING

SIDNEY BINDER, Chief

COOPERATION OF THE BUREAU OF THE CENSUS

Under the legislation establishing the National Health Survey, the

Public Health Service is authorized to use, insofar as possible, the

services or facilities of other Federal, State, or private agencies. For

the Health Interview Survey the Bureau of the Census designed and

selected the sample, conducted the household interviews, and processed

the data in accordance with specifications established by the Public

Health Service.

Public Health Service Publication No. 1000-Series 2-No. 9
,$ ,

CONTENTS

Page

Introduction -------------------------------- 1

Design and Methodology of the Health Examination Co-operation Study ------------------ 2

Summary of Findings ----------------------- 4

Analysis of Data---------:------------------

Respondent Status ------------------------

Urban-Rural Residence and Region ---------

Race’and Sex-----------------------------

Age-------------------------------------

Major Activity ---------------------------

Education of Family Head -----------------

Income ----------------------------------

Interval Since Last Physician Visit ---------

Health Status -----------------------------

6

6

7

;

9

10

10

10

10

Detailed Tables ---------------------------- 12

Population --------------------------------- 23

Appendix 1. Technical Notes on Methods---- 29

Statistical Design of the Health Interview

Survey --------------------------------- 29

General Qualifications -------------------- 29

Reliability of Estimates ------------------- 30

Appendix II. Definitions of Certain Terms

Used in This Report ----------------------- 31

Terms Relating to Health ------------------ 31

Terms RelatingtoD inability --------------- 31

Medical Care Terms ---------------------- 32

Demographic, Social, and Economic Terms-- 32

Location of Residence Terms -------------- 32

Appendix III. The Special Supplement Form

and Questionnaire ------------------------- 35
CO-OPERATION

IN HEALTH EXAMINATION SURVEYS

INTRODUCTION

The U. S. National Health Survey has a responsibility to collect survey data on the health of

the population and on factors relating to health.

Its survey program contemplates a variety of

types of surveys, each differently ,designed according to the kinds of data to be collected and

the sources from which such data can be obtained.

A major part of the U. S. National Health

Survey Program is the collection of health data

and related facts in a continuous health household interview survey. Each week a representative sample of households in the United States is

interviewed and data on such things as illness,

disability, medical care, and hospitalization are

obtained. The results of these surveys are published in Series B and Series C of Health Statistics from the U. S. National Health. Survey. The

interview method provides a wide range of adequately reliable data relating to social, economic,

and demographic aspects of health and for such

topics as the amount of medical care and disability resulting from illnesses. However, the method

has recognized limitations in the quality of diagnostic data obtained. In addition, the interview

method cannot provide distributions of those clinical and physical measurements which must be

based on actual tests.

This report was prepared by Earl Bryant and

James T. Baird, Jr. , of the U.S. National Health

Survey staff.

Consideration has therefore been given to the

development of a survey based on a specially designed health examination given to representative

samples of the population. Before such a survey

can be instituted, however, many problems must

be solved such as standardization of procedures,

the designing of a medical history questionnaire,

logistics, and ways of getting the selected people

to be examined. The medical history problem has

been studied, and the results of the study are

published in A Study of Special Purpose MedicalHistory Techniques.1 The problem discussed in

this report is that of persuading people to cooperate in a health examination survey.

The response problem is always an important consideration in any survey, as the validity of sample estimates is dependent upon the

sample being representative of its parent population. A small nonresponse rate can be tolerated”

in most instances. For even if the characteristics being measured for nonrespondents are different from those of respondents, their biasing

effect on the estimate may not be serious. (The

amount of nonresponse that can be tolerated depends upon the subject matter. No arbitrary goal

can be set. ) Several community-wide health ex2-4. amination surveys Indicate, however, that a

large proportion of sample persons may not, for

various reasons, submit themselves for an examination. The nonresponse rates for these studies ranged from about 30 to 40 percent. The results from these studies are not sufficient evi-
dence to predict that similar nonresponse rates

would be encountered in a nationwide survey, but

they do point out the need to learn the magnitude

of nonresponse that might be expected in a national health examination survey.

To obtain certain information on how people

in the United States feel about participating in a

health examination survey, a special “supplement” question was added in January 1958 to the

questionnaire which was regularly used for the

health household interview survey. People were

asked a hypothetical question as to their willingness to participate in a health examination survey. The responses to these questions were studied ‘for population groups characterized by specific demographic and health attributes. By this

means, groups of people who may tend to be less

inclined to participate in a health examination

could be identified. Although the responses received in the survey may not completely represent what people will actually do, it is believed

. . . . .. ..’. . mat mey do lnmcate peoples attitudes towarcl

co-operating in a health examination sufficiently

well to identify groups likely to pose special problems in an actual survey. 5

DESIGN AND METHODOLOGY

OF THE HEALTH EXAMINATION

CO-OPERATION STUDY

The methds of this special study are based

largely on the procedures and techniques used in

the Health Household-Interview Survey,6 which

is a continuing survey of the civilian population

of the United States. Each week, a sample of

households throughout the United States is visited by a group of specially trained interviewers.

Information on the social characteristics and

health experience of all members of each household is recorded using standardized procedures.’

The instrument which the interviewer uses to

elicit and transcribe this information is referred

c 3

to as the health household interview questionnaire, or simply, the questionnaire. In the interview, the interviewer obtains personal particdars and demographic and economic characteristics of each person in the household. After

this, detailed information on each person’s morbidity, medical care, and hospitalization experience during the past year is recorded. In the

household interview all responsible adtits who

are at home at the time of interview are asked to

respond for themselves on questions pertaining

to health. If an individual is not available, certain

related adults may supply the necessary information. In this case, the person answering the

questions is referred to as a proxy respondent,

and the individual to whom the information relates is referred to as a ~erson with Droxv despondent. When the person replying is the subject of the questions, he is called a self-respondent. For detailed definitions of terms see Appendix 11.The information collected in this way, when

inflated by appropriate sampling weights and

otherwise processed, can be related to the entire

civilian popdation of the United States or to any

subgroup of MS population.

The mechanism of the Health Interview Survey was used for this special study of expressed

willingness to be examined in a health examination survey.

The data in this report are based on household interviews conducted during the eight-week

period, January 27-March 30, 1958. During this

time, information on willingness to participate in

a health examination was obtained for persons 18

years of age and over. This was accomplished by

appending a form containing two short questions

to the basic questionnaire. The form is referred

to as the health examination supplement (shown

in Appendix III) and the questions as the supplement questions. Interviews were completed in approximately 5,000 households comprising 11,000

persons 18 years of age and over. The population

2
c ●

covered by the sample is the civilian population

of the United States livingat thetime of thehousehold interview. This report, however, does not include persons living as inmates of resident-type

institutions although they are included in the sample. Additional information on the statistical design’ and variances for the sample statistics are

given in Appendix 1. ~

At the end of each household interview, after

a brief explanation of a health examination survey that was being planned, the respondents were

asked the supplement questions:

“If you are selected for this special free examination and the time and place are conTable A. Response pattern for health examination supplement questions

I Estimated population

Response I

Total ------- 97,970,000 I 100.0

I

Yes (favorable re -

sponse) --------- 69,550,000 71.0

Unqualified--- 65,650,000 67.0

Qualified ----- 3,900,000 4.0

No---------------- 124,420,000] 24.9

Don’t know-------- 4,040,000 4.1

venient will you be willing to come?”

If the respondent was also replying for a related

adult, he then was aske~ shows that the proportion of “don’t knows” was

“How about ..,, do you think he will be will- about five times as great among people with proxy

ing to come?” respondents as among self-respondents. This is

For definite answers of yes or no, a checkmark

in an appropriate box recorded the answer. However, if the #nswer was qualified in some way, it

was recorded verbatim. The following criteria

were used to classify the qualified answers as

t!Yes!! ox 1‘don’t know.”

Yes, qualified—answers which indicated an

affirmative attitude toward taking the health ex-

, a~ination. This includes all such verbatim answers even if the ‘‘don’t know” box on the form

was checked.

Don’t know-answers which could not be

clearly distinguished as affirmative. For example,

the answer might have been, “I wouldn’t know how

to answer, she works every day,” or “He might

come, but I’m not sure.”

The frequency of the “qualified” and “don’t.

know” responses in relation to the “unqualified”

demonstrated for both sexes.

It is obviously not feasible to provide a meaningful accounting of the very small proportions of

“don’t know’s” and “qualified” responses for subpopulation groups. The primary axis of classification in the following detailed analysis of this

report is the proportion of persons which may be

expected to participate in a health examination

survey. It therefore seems reasonable to pool the

“qualified” answers with unqualified “yes” answers. This was the approach used, with the combination of these two categories being referred

to as favorable response. The pooled result undoubtedly includes some persons who will not

participate due in part to the nature of the qualifications in their reply. On the other hand, the

complement of percentage favorable response includes the “don’t know” as well. as the “no” reyes and no responses may be examined in table A. plies. The former may reasonably be e~ected to

The “don’t know” designation, as may be ex- include a substantial number of persons who

petted, occurred largely in the case of proxy re- wotid, in fact, participate This is especially true

sponses (i.e., in instances where one member of in view of the large proportion of persons with

a family was answering for another). Table B proxy respondents in this group, shown in table B.

3
4 *

Table B. “Don’t know” responses and respondent status by sex: health exami.naEf.on supplement questions

5

Percent with

‘Idon’t know” Respondent status Percent of all

response to Percent of persons

and sex persons health examination within sex group

supplement questions

Total ------------- 100 4.1 100

Self----------------

Proxy ---------------

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

Self ------------------

Proxy -----------------

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

self ------------------

Proxy -----------------

60

40

47

18

30

53

42

10

Percents may not add to total dlje to rounding.

SUMMARYOF FINDINGS

The evidence ofthis investigationis that71

percent of the 98 million, noninstitutional population18years of age and over may be willingto

cometo ahealthexamination ifthetime and place

are convenient. On the basis of an individual’s

reply, orthe reply of”a related adult responding

for him, 67 percent were credited with unqualified willingness to co-operate. The replies indicated that 25 percent would not come in, while

4 percent of the people were in the “don’t

know’’ categoryo Theremainingfour percent were

people for whom a’;qualified” yes answer was

given.

Inaccordancewith the objectivesof thestudy

it was possible to identifycomponents of the poptiation in which favorable response differed in

degree from that of the total poptiation andfrom

other poptiation groups. This, it is felt, is a

necessarystepin plaru’dngactions to reduce overall nonresponse in ahealth examination survey.

Resdtsof the analysis ofll variables inrelation tofavorable responseare presented inthis

1.4

8.2

5.5

1.5

7.9

2.8

1.4

8.8

60

40

100

37

63

100

81

19

report. Nine of these are demographic variables.

Two are scales relating to the health of the individual. Over-all marginal totals of favorable

response forthe study variables and relative proportions of the population are shown in table C.

While some association with favorable response maybe indicated forrnost of these variables, the following may be demonstrated to a

more positive degree as some of the more im -

portant findings bearing on response to a health

examination survey.

1. Persons responding for themselves on the

household interview were more reluctant to commit others to a health examination than to commit themselves.

2. There is a decreasing rate d favorable

response with increasing population size. Stated

willingness to accept a health examination was

highest among residents of rural areas, and lowest among’ people living in large metropolitan

areas. Associated with this, to some extent, is a

regional difference. Individuals in the Northeastern part of the United States were less inclined to co-operate than people in other areas.

4
( .

Table C. Percent favorable response and population distribution by study variables

Variable

Respondent status

Self-respondents -----

Persons with proxy

respondents --------

Urban-rural

residence

Large metropolitan

areas-------L------

Small metropolitan

areas--------------

Other urban areas----

Rural areas----------

Northeast ------------

North Central--------

South----------------

West -----------------

18-24----------------

25-44----------------

45-64----------------

65-I-------------------

Race

white ----------------

Nonwhite -------------

Sex

Male:----------------

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

Family.income

Under $2,000---------

$2,000-4,999---------

$5,000-6,999---------

‘$7,00 W--------------

Percent

favorable

response

76

64

64

65

74

78

62

70

78

75

76

76

68

58

:!

70

72

66

75

:;

Percent

of population

6C

4C

24

2C

18

38

26

;:

15

:?

32

14

90

10

47

53

26

34

21

20

Variable

Maior activity

Usually keeping

house -------------

Usually working -----

Other---------------

Education of family

head

Less than 9 yeara

of school---------

9-12 years----------

:ollege-------------

Stated time interval

since last physician

visit

Less than 3 months---

3-11 months ----------

L-2 years------------

% years-------------

Health status of

individual

JO chronic conditions, no physician visit within year------------

!O chronic conditions, at least

one physician

visit within year--

it least one chronic condition, activity not limited---------------

it least one chronic condition, activity limited-----

Percent

favorable

response

77

71

73

71

72

67

72

73

73

63

66

71

74

70

Percent

of population

32

60

8

44

40

16 .

37

28

19

16

22

24

39

15

NOTE : Population percent may not add to 100 due to rounding.

lRefers to civilian noninstitutional population 18 years of age and over except for “major activityll

which refers to 18-64 years of age only.

5
3. People over 45 years of age indicate less

willingness to co-operate, especially those over

65.

4. There is a racial difference instated willingness to co-operate. Nonwhite persons indicate

a much higher degree of co-operation than white

persons.

5. People in the extreme upper and lower income groups show less favorable response rates

than those in the middle income groups.

Following the descriptive analysis of responses according to various population characteristics in the next section, a series of detailed tables presenting the results of the questioning will be found, as well as population estimates which were used in forming the ratios

shown in this publication. Sampling variances for

the data are tabulated in “Appendix 1.

ANALYSIS OF DATA

Respondent Status

The difference in favorable response by respondent status is the most easily demonstrated

and clear-cut in the study. Self-respondents were

less willing to commit others to a health examination than to commit themselves. This was true

for nearly all variables and popdation groups

studied. As indicated in table D, favorable response was about one fifth highe~ among self-respondents than among persons for whom another

person responded. This difference is statistically

significant. *

If the “don’t knows” were dis~ributed between the “yes” and “no” replies on a proportionate basis, the 12 points difference in the percentage of favorable responses shown in table D

would be reduced to about seven points, a difference which would still be statistically significant.

.

“Statements of statistical sign if icance throughout the text relate to a confidence level of 0.05.

.

Sixty percent of’ the persons includ;d in the

survey responded for themselves while 40 percent

had proxy respondents. These proportions were

substantially the same for metropolitan, other

urban, and rural areas, as well as for all sections of the United States. For some population

groups, however, the distribution of self -respondents may be quite different. For example,

table E shows that more than twice as many females as males responded for themselves. This

is, of course, an expected result in many household surveys that admit. proxy respondents.

Thus a substantial differential by respondent

status exists for both sex groups. For males, favorable response is 18 percent or about one fifth

higher among self-respondents than among persons with proxy respondents. For females, it is

nearly a third higher. In both cases the difference

is statistically significant. While similar distinctions may be made for some of the other study

variables, the general pattern is that favorable

response is substantially higher among self-respondents than among persons with proxy respondents for each population group, that is, the

trends for the two response groups are generally

similar. For this reason, respondent status is not

shown in tables 2-15, although references appear in the text where applicable.

Table D. Distribution of response by

respondent status

Respondent

status

m

Total---- 71 25 4

Self-respondenCs --------- 76

Persons with

proxy respondents -- -- 64 -L23 , 1

28 8

6
f .

Table E. Percent

sex of subjectl

favorable response by

and respondent status

Sex of

subject

I

Respondent

status I

Selfrespondents

Persons

with

proxy

respondents

Percent

selfrespondents

Male -------- 78 66 36

Female ------ 75 57 81

I I I

lSubject is the person to whom the response

applies.

Urban-Rural Residence and Region

Indications are that one of the factors thatis

most influential in determining the extent of favorable response to an invitation tobe examined

~s the size of the place of residence. The trend

toward better responseas the poptiation size decreases maybe seen intable F.

In the rural areas, which include about 38

percent of the total population, the proportion of

tIyeSTl answers was about one sixth higher than

the response rate obtainedfrom the urbanpopulation. In rural areas, people seem tobe Wore

.willingto commit someone else toan examination than they are in urban places, as”indicated

intable F. The affirmative response rate among

persons with proxy respondents isabout one fifth

higher in rural areas thanin urban places, but

only one seventh higher in the case of self-respondents.

The inverse relationship ofwillingnessto be

examined and population sizeis further demonstrated for the different urban size of place

groupings. For both self and proxy respondents,

the indications are that the best co-operation in

urban areas wodd be received in the small urban

places and the poorest in the” metropolitan centers, i.e., in urban areas composed of about

50,000 or more people.

Relatively speaking, the higher rural favorable response is somewhat more marked for the

older age groups, as illustrated in table G. For

example, favorable response for persons 18-24

years of age in rural areas is about 14 percent

or one seventh higher than in urban areas, while

for persons 65 years of age and over, it is about

24 percent or one fourth higher.

Table H shows the trend for persons 18-64

years of age specific for geographical region and

urban-rural residence.

The increase in favorable response with decreasing poptiation appears to be somewhat more

clear-cut in the South and the West. These are

the two regions with the highest over-all favorable response.

Also, there is some in~cation that the response pattern would be affected by the part of

Table F. percent favorable response by urban-rural residence by respondent status

Urban-rural residence

Respondent status

Total All Large Sma11 Other R~al

urban metropolitan metropolitan urban

Total ----------------- 71 67 64 65 74 77

Self---------------------’--- 76 72 . 70 72 77 82

Proxy ----------------------- 64 59 53 57 69 71

7
Table G. Percent favorable response by age, urban-rural residence, and respondent

status

spondent I

Urban

status

I

Total1---72

Self----

Proxy--- ::

18-24 years 25-64 years 65+ years

Percent Percent Percent

Rural relative Urban Rural relative Urban Rural relative

difference difference difference

82 14 68 79 16 53 66 24

87 10 74 84 14 59 71

78 20 61 72 18 39 54 E

Table H. Percent favorable response by urban-rural residence and region,’persans 18-64

years of age

Urban-rural residence

Region Total Large Small Other Rural

metropolitan metropolitan urban

Total-------------- 73 66 67 77 79

Northeast---------------- 65 60 56 69 75

North Central------------ 73 72 69 75

South-------------------- 79 60 69 81 ;:

West--------------------- 76 71 75 78 81

theUnitedStatesin which peoplelive.For example,peopleinthelargemetropolitancitiesof

theWest and North Centralregionsexpressed

much more willingnesstobe examinedthandid

personsofsimilarresidencestatusintheSouth

andNortheastregions.Thisis furtherindicated

by thefactthatpeopleintheNortheast,except

thoseinlargemetropolitancities,were lessco-.

operativefor anyparticularpopdationsizethan

thepeopleinotherregions.

Nosuhstantialdifferenceinurban-ruralfavorableresponsecan be demonstratedfor the

nonwhitepopdation.For whitepersons 18-64

years of age theruralfavorableresponserate

was aboutone sixthhigherthantheurban,but

thisisnot statistically significant due tothelow

frequenciesof rural individualsin the sample.

For nonwhitepersonsthetworatesareaboutthe

8

same.Furtherinformationon urban-ruralresidenceandregionisavailableintables1-10.

Race and Sex

No importantdifferencesby sexin stated

willingnesstoparticipateina healthexamination

areindicatedbythestudy.Althoughtable5shows

a slightlyhigherfavorableresponseamong females,thiscan be accountedfor by thelarger

proportionofself-respondents among them.About

78percentofthemalesrespondingforthemselves

indicateda willingnessto co-operate,which is

stightlymore thanthe75percentamong female

self-respondents(tableE).

Race, however,is apparentlyahighlyrelevantandsignificant factor.Table5 indicatesthat

theproportionoffavorablerepliesisaboutone

fifthgreateramong nonwhitethanamong white
i .

persons. This relationship varies greatly among

regions—there being almost no difference in the

West region, but in the Northeast the favorable

response rate for nonwhite persons was about 40

percent higher than for white persons. The effect

of this difference on the total response rate is

negligible, however, even in the South where about

19 percent of all persons 18 years of age and over

is nonwhite.

Age

Willingness to participate in a health examination tends to decrease with increasing age. Favorable response is higher among persons under

45 years of age. The rate of 76 percent for this

group is about one third higher than that for persons 65 years and over as shown in figure 1.

The same general age pattern shown in figure I can also be demonstrated for specific regions as well as for urban and rural areas of the

United States. Persons over 45 years of age, where

problems of obtaining co-operation in a health

examination appear to be greatest, comprise al:

most half of the total adult population. Older individuals, of course, will contribute a substantial

proportion of positive findings in a health examination. For example, 78 percent of the persons

I I I I

18 25 45 65 ,

AGE

lFlgure 1. Percent favorable response by age and

respondent status.

65 years of

those 18-24

..

age and over, but only 32 percent of

reported at least one chronic condi -

tion as defined in this study.

Maior Activity

Persons 18-64 years of age were classified

by their major activity during the 12 months preceding the household interview. The objective of

this was to delineate population groups which may

have different health problems. The methods of

classification, which are specified in Appendix 11

of this report were, therefore, not designed to be

comparable with similar classifications in official labor force statistics. The broad tabulation

rubrics were “usually working,” “usually keeping

house,” and “other.”

Favorable response rates for persons with

proxy respondents show practically no variation

among these three categories which range from

65 to 68 percent. For self-respondents, the rates

are the same for each category. It may be seen

from table I ‘that the favorable response rate for

all. persons whose major activity was “usually

keeping house” is higher than it is for the other

two categories. The reason for this is that persons who “usually keep house” are largely self -

respondents.

Table 11 shows a difference in the “major

activity” pattern by urban and rural areas.

Table 1. Percent favorable response by

major activity and respondent status,

persons 18-64 years of age

I

Major activity

Respondent

status

m

Total--- 71 I 77 I 73

I

Self ---------- 78 78

Proxy --------- ,;! 68 68

9
. ,

Education of Family Head

It may be seen in table 6 that there is no conclusive correlation between favorable response

and educational attainment of the’ family head.

There may be, however, some slight tendency

toward poorer co-operation for persons in families in which the head of the household had some

college education. This pattern is consistent for

both self-respondents and persons with proxy respondents.

Table 12 shows that a somewhat different

distribution by level of education apparently exists between urban and rural areas for persons

18-64 years of age.

‘Income

In general, the populations with either very

low or very high reported family incomes have

lower favorable response rates than people with

family incomes closer to the median. This trend

appears to be slightly greater for persons with

proxy respondents than for persons responding

for themselves. The “peaked’! distribution reflected in table J remains about the same for other population groups in the study.

The substantially lower favorable response

in the “under $2YOOO”income group may be largely

the resdt of the higher proportion of persons over

65 years of age in this group.

I

I Table J. Percent favorable response by

family income and urban-rur&l resi-

/ dence

Family

income

Total ------

Under $2,000 -----

$2,000 -4,999 -----

$5>000-6,999-----

$7,000+----------

10

Urban-rural residence

~

E

71 67 77

66 60 73

75 71 81

74 70 81

67 65 72

Interval Since Last Physician Visit

This variable refers to the elapsed interval

between the individual’s last physician visit and

. . . . . .. . . . . . . ,.

tne sate 01 tne nousenola lntervlew as statea Dy

the respondent. Although undoubtedly errors occur in respondents’ efforts to remember dates of

last physician visits, similar trends were observed for both self -respondents and persons with

proxy respondents. The favorable response rate

decreases 13 percent between the “under 3

months” and “3 years and over” groups, or from

72 to 63 percent (table 10).

The trends observed for specific age, urbanrural residence, and family income groups are

not inconsistent with the above.

Health Status

Obviously the state of a person’s health may

be an important factor influencing his desire to

participate in a health examination. It can be hypothesized that persons with recent manifest health

problems might reasonably be expected to be

more inclined to participate than people who have

not had such experiences. On the other hand,

some persons with painful chronic conditions and

activity limitation may be less willing to make

the necessary effort to undergo the examination.

In an attempt to develop a rough index of the

health status of an individual three different variables were considered collectively. These were

the respondents’ statements of:

1.

2.

3.

Presence or absence of a chronic condition

Any limitation of activity in cases where

a chronic condition was reported

Visiting a physician during the 12 months

preceding household interview

(For a precise definition of physician visit see

Appendix 11.)

This structuring provided a means,of ranking

people according to their degrees of health. In
< .

general, persons in the first category in table K

probably have the poorest health, those in the

last category, the best.

The detailed results of this classification are

shown in tables 3, 7, and 9. The pattern shown in

table K is fairly consistent for specific urbanrural residence and income groups~

Naturally, the age distribution is quite different for each of the four categories of the health

status index. For example, three percent of the

persons with chronic conditions and activity limitation were 18-24 years of age, while the corresponding figure for people with no chronic conditions and no physician visits during the past

year was 14 percent. Table K shows the trend by

health status for the expected favorable response

which would occur if the age distributions of each

health status category were the same as the age

distribution of the total population.

Table K. Index of health status and percent favorable response

Percent favorable response

Index

Unadjusted Age adjusted

1. Persons with chronic conditions

2.

, activit’y limited----

Persons with chronic conditions, activity not

limited------------------------------------"--------

3. Persons with no chronic conditions but a physician

was visited within the past year -------------------

4. Persons with no chronic conditions and no physician

visited within the past year -----------------------

70 76

74 75

71 68

66 65

.

i.

., ,.

REFERENCES

lu. S. National Health Survey. A Study of Spe- 5Borsky, P. N., and Sagen, O. K. : Ivlotivations

cial Purpose Medical-History Techniques., Health Toward Health Examinations. Am. J. Pub. Health.

Statistics. Series D-1.?ublic Health Service Pub- Vol. 49: No. 4, April 1959.

lication No. 584-D1. Public He<.b Service, Washington, D. C., Jun. 1960.’

2C2minissi0n on Chronic Illness in 1953-54.

Chronic Illness in a Large City: The BaltimOre

W (Chronic Illness in the United States, Vol.

IY) . Harvard University Press, Cambridge, ltiass.,

1957.

3Commission on Chronic Illness:Chronic Illness

in a Rural Area: The Hunterdon Study (Chronic

Illness in the United States, Vol. III). Harvard

University Press, Cambridge, Mass., 1959.

4Cabb, S.: Thompson, D. j.; Rosenbaum, J.;

I{arren, J.E.; and Merchant. W.9.: on the Measurement of Prevalence of Arthritis and Rheumatism

From Interview Data. J. Chron. Dis.

Feb. 1960.

. .

Vol. 3, No.2.

6For detailed information on the sample design

see: U.S. National Health Survey. The Statistical

Design of the Health Household-Iuterview Survey.

Health Statistics.Series A-2. Public Health Service Publication No.584-A2. Public Health Service.

Washington, D.C., July 1958.

7For sPecific~ of the complex and highly technical interviewing process and precise definitions of concepts refer to: U.S. National Health

Survey. Concepts and Definitions in the ’Health

Household-Interview Survey. Health St.atj,stics.

Series A-3. Public Health Service Publication No.

584-A3. Public Health Service. Washinatan. D.C.. ..—- —-.

Sept. 1958.

II
.

DETAiLED TABLES

Table 1. Percent distributionof response, pezsons 18 years of age and over, by respondent status and urban-ruralresidence----.------------------------.-------------

2. Percent distributionof responseby age and urban-ruralresidence--------------

3. Percent distributionof response, persons 18 years of age and over, by health

status and region------------------------------------------------------ ---.-.--

4. Percent distributionof response by age and region---.-------------.----------e

5. Percent distributionof response, persons 18 years of age and over, by race,

sex, and region-------------------------------------------------------------.--

6. Percent distributionof response, persons 18 years of age and over, by education of family head and region---------------------.-..---.------.-.----a-----

7. Percent distributionof response by health status,urban-rural residence,and

age------------------------------------------- ----s----------------------------

8. Percent distributionof response,persons 18 years of age and over, by time interval since last physicianvisit, urban-ruralresidence,and family inc~----

9. Percent distribution of response ~ Persons 18 yeara of age and over, by health

status, urban-rural residence, and family incme -------------------------------

10. Percent distribution of response, persons 18 years of age and wer, by tfie interval since last physicianvisit, urban-ruralresidence,ad age--------------

11. Percent distributionof response~ persons 18-64 years of ages by ~jor activity

and urban-ruralresidence----------------------------------.-------------------

12. Percent distributionof response,persona 18-64 years of age, by education of

family head and urban-ruralresidence----------------------------------------.-

POPWTION

13.’ Populationused in obtaining percents shown in this publicationby respondent

status, age, urban-ruralresidence,and region--------------------------- ---.--

14. Populationused in obtaining percents shown in this publication,persons 18

years of age and over, by race, sex, and region ---------------------.---.--.---

15. Populationused in obtainingpercents shown in this publication,persons 18

years of age and over, by educationof family head and region------------------

16. Populationused in obtainingpercents shown in this publication,persons 18

years of age and over, by health status, urban-rural residence, ad regi~-----

Page

13

13

14

15

16

1,7

18

19

20

21

22

22

23

24

24

25

17. Populationused .inobtainingpercents shown in this publication,persons 18

years of age and over, by health status, time interval since last physician

visit, urban-ruralresidence,and age-------------------------------------r-- 26

18. Populationused in obtainingpercents shown in this publication,persons 18

years of age and over, by health status, time interval since last physician

visit, urban-ruralresidence,and family income------------------------------ 27

19. Populationused in obtainingpercents shown in this publication,persons 18-64

years of age, by major activity and urban-ruralresidence---------------------- 28

12
T&ble I.i Percent distributionof response,persons 18 years of age and over, by respondent

status and urban-ruralresidence

[Dueto rounding, the deta.i led figures may not add to 100 percent. The survey design, general qual ifications, and information on the reliability of the estimates are given in Appendix I . Definitions of terms are given in Appendix

1,1. The supplement form and questionnaire are given in Appendix i I ~

Response and respondentstatus

Urban-ruralresidence Yes No Don’t know

Total Self Proxy Total Self Proxy Total Self Proxy

All areas:--------------- 71 76 64 25 23 28 4 1 8

All urban---------------------- 67 72 59 29 26 33 4 2 8

Large metropolitan----------- 64 70 53 33 28 39 4 2 7

Smallmetropolitan----------- 65 72 57 30 28 34 1

Other urban------------------ 74 77 69 22 22 22 : 2 ;

Rural-------------------------- 77 82 71 19 17 21 4 1 8

Table 2. Percent distributionof responseby age and urban-ruralresidence

(Seeheadnote on table I 1

Urban-ruralresidence

All areas-----------------------------

Large metropolitan--------------------------

Small metropolitan--------------------------

Other urban---------------------------------

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

All areas-----------------------------

Large metropolitan--------------------------

Small metropolitan.---------------..-..-...-

Other urban---------------------------------

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

All areas-----------------------------

Large metropolitan--------------------------

WIl metropolitan--------------------------

Other urban---------------------------------

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

Age and response

All ages 18-24 25-44

18+

45-64 65+

Yes

~

Don’t know

4 4 4 5 4

4 4 4 4

5’ 2 5 ;

4 2. : 5 5

t 6 3 4 4

13
Table 3. Percent distribution of response, pers’ons18 years of age and over, by he;lth st;tus

and rezion

[Due to rounding, the cletai led figures may not add to 100 percent. The survey design, general qualifications, and [formation on the reliabi Iity of the estimates are g iven in Appendix 1. Definitions of terms are given (n Appendfx

Il. The supplement form and questionnaire are given in Appendix 1 r ~

. .

Region

All regions----------------’

Northeast------------------------

North Central-------------------- .

South----------------------------

West-----------------------------

All regions----------------

Northeast------------------------

North Central--------------------

South----------------------------

West -----------------------------

All regions----------------

Northeast------------------------

North Central--------------------

South----------------------------

west-----------------------------

Health status and response

Persons with chxonic Persons with no chronic

conditions conditions

Activity Physician

Total

Not

Visited

Limited

Not visited

limited within within

1 year 1 year

Yes

71 70 74 71 66

62 60 66 64 57

70 66 73 72 67

78 78 82 76 73

75 75 78 75 68

No

25 28 22 25 28

33 38 29 33 36

26 31 24 25 28

18 19 15 19 21

21 23 19 22 25

Don’t know

4 3 4 4 6

2 3

: 3 : 3 :

4 3 3 5 6

4 1 3 3 7

I 14
, .

Table 4. Percent distributionof responseby age and region

‘ [Due to rounding, the detal led figures may not add to 100 percent. The survey design, general qual ifications, and information on the rel Iabl Iity ‘of the estimates are given in Appendix 1. Definitions of terms are given in Appendix

Il. The supplement form and questionnaire are given in Appendix II]

Region

All regions..----.----.-.-”-----------

Northeast-----------------------------------

North Central-------------------------------

south-----------------------------------?---

Vest--------------------------- -------------

All regions----.-----------------------

Northeast---------------------------------..

North Central-------------------------------

South---------------------------------------

West----------------------------------------

All regions---------------------------

Northeast------------------------------------

North Central-------------------------------

South---------------------------------------

West-----.------------------------------ ----

Age and response

[ 1 \ 1

All ages

18+ 18-24

I

25-44 I

45-64

I

65+

71

62

70

78

75

Yes

m

No

Don’t know

4 4 4 5 4

5 2 5 3

4 3 : 5

: 5 4 5

4 4 4 : 3

15
,

Table 5. percent distribution of response, persons 18 years of age and over, by ra;e, sex, and

region

[De to ro.ndi ng, the detai led figures may not add to 100 percent. The survey design, general qual lficatlons, and information on the reliability of the estimates are g iven in Appendix 1. Definitions of tetms are given In Appendix

Il. The supplement form and questionnaire are given in Appendix I I ~

Region

All regions------

Northeast--------------

North Central----------

South------------------

West -------------------

All regions------

Northeast--------------

North Central----------

South------------------

West -------------------

All regions------

Northeast--------------

North Central----------

South------------------

West -------------------

Race, sex, and response

Race

Race and aex

Sex

~otal White Nonwhite

White ::;;e Male Female Male Female Male Female

62 61

70 69

78 76

75 75

+

33 34

26 27

18 20

21 22

83

86

81

85

78

13

12

16

11

17

62

69 !:

77 78

73 77

No

69 I 701 82

:: II 85

;: 77

75 77 85

73 76 76

m

84

87

85

84

80

13

12

14

12

17

Don’t know

16
Tabfe 6. I?ercentdistribution of response, persons 18 years of age and over, by education of

family head and region

[Due to rounding, the detailed figures may not add to 100 percent. The survey design, general qual ifications, and in- .

formation on the reliabi 1 ity of the estimates are given in Appendix 1. Definitions of terms are given in Appendix

Il. The supplement form and quest lonnai re are given i n Appendix I i I]

Region

All regions---------------------------.-

Northeast-------------------------------------

North Central---------------------------------

South-----------------------------------------

West ------------------------------------------

All regions-----------------------------

Northeast-------------------------------------

North Central---------------------------------

South-----------------------------------------

West ------------------------------------------

All regions--------------------------- .-

Northeast-------------------------------------

North Central---------------------------------

south-----------------------------------------

Response and education of family head

I I I

All I

Less than 9-12

educational College

9 years

groups

years

Yes

62

70

78

75

25

33

26

18

21

4

:

4

4

60 67 59

69 74 66

81 75 69

75 75 76

No

m

Don’t know

5 3 3

5 4 4

4

: : 3

4 4 3

17
Table 7. Percent distribution of response by health status, urban-rural residence, a;d age

,

[Dus to rounding, the detal led figures may not add to [00 percent. The survey design, general qual 1f icitlons, and i nformat 1on on the red

I iabi 1Ity of the estimates are give” i“ Appendix 1. Definitions of terms are given in Appendix I l.- The supplement form and quest ionnaire are given in Appendix 1111

Response and health status

Persons

with

chronic

conditions

Activity

Don’ c know

J

Persons

dth

chronic

conditions

Activity

Persons

with

no

chronic

conditions

Physician

Urban-rural

residence

and age

Physician ] Activity I Physician

T

Not

visited L~-

witbin ited

1 year

-

lisited

&thin

L year

Not

isited

rithin

year

6

5

8

:

7 ——

4

9

5

1

6,

4

8

2

7

4

9

5

g

6

7

6

6

3

Not

lilsi.ted

Visited

tithin

L year

~ot

limLted

Lirsited

,iIn-

,ted

22 25 28

15 22 24

17 21 23

25 32

35 2: 42

29 35 35

18 31 42

23 29

33 ?1

46 79 :;

All areas

All ages-lS+--- 70 3

83

82

74

58

63

74

83

80

70

62

67

80

73

62

53

68

75

76

62

56

76

91

80

72’

{

59

82

87

85

79

72

71

73

75

64

49

63

64

70

58

21

64

;;

:;

78

I

76

4

83

74

57

18

82

78

74

64

66 I 28

71 16

69 17

63 24

55 39

1

1

3

3

3

5

2

3

3

3

1

3

3

3

-

i

3

3

i

:

;

4

7

2 —.

5

2

2

3

1

3

6

6

4

:

5

8

5

:

4

1

18-24-----------------

25-44-----------------

45-64-----------------

65+-------------------

Large metropolitan

All kges-lW----

1

59 34

54 40

62 26

57 26

55 50

62 35

55

73

71

47

63

43

82

64

53

69

80

80

72

59

76

95

88

79

64

2

3

5

1

5

2

5

6

5

4

2

3

5

.7

3

:

4

3

18-24-----------------

25-44-----------------

45-64-----------------

65i--------------------

Small metropolitan

All ages-lS+---- T

27 32 32

23 32 24

19 25

33 :

40 46 : _l 72 57

67 18

56

52 z

70 29

18-24-----------------

25-44-----------------

45-64-----------------

65i--------------------

Other urban

All ages-lS+---- T

20 19 23

8 22 13

17 13 16

24 21 32

34 35 36

83 20

75 20

63. 24

56 38

18-24-----------------

25-44-----------------

45-64-----------------

6%----------------: --

-1- 71 22

75 5

Rural

All ages-18+---- r

16 17 23

11 10 18

13 18 21

17 22

26 25 $

18-24-----------------

25-44-----------------

45-64-----------------

65+-------------------

73 10

70 19i

56 33,

I I

18
Table 8. Percent “ distribution of response, persons 18 years of age and over, by time interval

since last physician visit, urban-rural residence, and family income

[DIJe to rounding, the detal led figures may not add to 100 percent. The survey design, gefleral qual Ificatlons, and In-

+otmatlon on the rel Iabl I Ity of the estimates are given in Appendix 1.. Definitions of terms are given in Appendix

Il. The supplement form and quest ionnal re are gl ven in Appendix I I !

Response and time interval Gince last physician visit

Ye

Months

No

Months

Don’t

Nonths

now

Urban-rural residence Years

and family income

Years Years —

3+

—

63

—

57

67

68

61

55

—

56

58

56

50

~

44

62

65

62

64

—

:

71

68

70

—

63

74

82

67

—

—

%

—

31

—

35

28

25

32

36

—

37

38

30

39

36

—

48

31

29

32

29

—

30

30

26

26

25

—

31

22

16

27

—

—

1-2

—

1-2

Less

than

3

Less

than

3

Less

than

3

3-11 3-11 3-11 1-2 3+

All areas

All income groups-------- 72 73 73 25 23 25 3 4 4 7

Less than $2,000---------------

$2,000 -4,999 -------------------

$5,000-6,999-------------------

$7,000+--:---------------------

69

77

73

67

65

67

77

77

69

65

71

75

76

68

65

27

21

25

30

32

28

18

19

29

32

26

20

22

27

32

5

2

2

4

3

4

5

4

3

3

3

5

2

5

3

8

5

7

8

9

Large metropolitan

All income groups--------

Less than $2,000---------------

$2,000-4,999-------------------

~,~o;6,999-------------------

------------------------ a

60

66

.72

62

66

46

69

75

62

68

54

73

73

65

78

62

67

67

64

68

—

66

75

73

57

76

38

31

27

35

31

37

2

32

24

53

26

, :;

28

44

20

21

32

18

36

31

32

30

27

—

32

17

23

38

19

3

4

1

3

3

3

i

3

3

2

2

;

5

—

2

8

5

5

5

7

5

14

11

7

;

5

7

7

:

“3

1

5

3

7

6

2

4

Small metropolitan

All income groups--------

Less than $2,000---------------

$2,000-4,999---------------:---

:;::;;;6,999-------------------

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

60

73

63

65

73

Other urban

All income groups--------

Less than $2,000---------------

$2,000-4,999-------------------

;;,:):6,999-------------------

>

------------------.--.--

81

79

75

75

80

30

19

$

18

16

17

20

20

16

26

18

20

12

18

4

2

5

2

3

7

5

;

4

10

6

3

7

5

Rural

All income groups --------

Less than $2,000---------------

$2,000-4,999--------------:----

~::::;6,999-------------------

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

76

84

79

73

75

84

84

75

77

79

85

’71

18

14

21

21

18

14

13

22

20

15

14

26

6

2

1

6

7

3

3

3

3

6

2

4
Table 9. Percent distribution of response, persons 18 years of age and over, by health status, ‘uzban-r~ral

residence, and family income

~.e to rounding, the detai led figures may no= add to 100 percent.The survey design, general qual Ificatio.sr and lnrormatfon on the reIiabi Iity of the estimates are given in Appendix 1. Definitions of tefms are given i“ Appendix II. The supplement form and quest lonnaire are g.lven in Appendix I I 11

ResDonse and health status

Yes

Persons

with

no

chronic

conditions

Physician

No D 1t know

Persons

with

no

chronic

conditions

Persons

with

chronic

conditions

Persons

with

chronic

conditions

Activity

Persons

with

no

chronic

conditions

Physician

Persons

with

chronic

conditions

Urban-rural

residence

and family income

Activity Activity Physician

Not

visited

within

1 year

Not

visited

titbin

L year

+

Visited Not

aithin visited

L year

within

1 year

Not

liroited

Visited

within

1 year

Not

limited

22

26

18

19

27

29

iisited

tithin

L year

Not

limited

Limited

Limited

Limited

3

3

2

:

3

i

:

3

All areas

All income groups--

Less than $2,000------

$2,000-4,999----------

$5,000-6,999----------

$7,00W---------------

Large metropolitan

All income groups--

Less than $2,000------

$2,000-4,999----------

$5,000-6,999----------

$7,000+---------------

Small metropolitan

All income groups--

Less than $2,000------

$2,000-4,999----------

$5>000-6,999----------

$7,00W---.-----------

Other urban

70

69

71

73

65

63

63

63

66

58

63

51

69

83

64

69

74

70

78

78

70

67

—

;;

73

65

68 .

59

73

71

67

76

71

65

;:

67

63

47

66

74

59

64

59

71

63

61

78

66

60

71

70

62

59

58

61

60

55

62

;:

65

59

70

28

28

27

26

31

34

37

33

31

38

35

46

29

17

31

29

25

29

21

25

29

35

28

33

z

32

35

4

4

4

3

3

4 J

4 6

6 7

6

i 5

4 7

2 7

7

: 3

41.

64

27

30

27

37

20

.24

32

20

52

32

23

39

32

39

25

33

35

19

35

::

38

32

43

22

30

34

23

3 9

2 6

3

2

5

3

4

7

.

6

3

4

1

3

All income groups--

Less than $2,000------

$2,000-4,999----------

$5,000-6,999----------

$7,000t ---------------

Rural

All income groups--

Less than $2,000------

$2,000-4,999----------

$5,000-6,999----------

$7,000+---------------

70

80

77

72

82

78

84

87

74

77

78

79

77

78

72

84

;;

63

70

74

78

71

63

78

81

60

28

25

::

22

21

23

20

21

25

16

18

25

16

18

14

11

23

;:

16

21

17

18

12

24

17

28

24

23

17

23

30

17

17

32

20
.

Table 10. Percent distributionof response,persons 18 years of age and over, by time interval

since last physicianvisit, urban-ruralresidence,and age

[Dueto rounding, the cletai led figures may not add to 100 percent. The survey design, general qual ifications, and information on the rel labi Iity of the estimates are gi ven in Appendix I .

Il.

Definitions of terms are given in Appendix

The supplement form and quest ionnal re are given in Appendix I 1 ~

Response and time interval since last physicianvisit

Yes No Don’t know

Urban-ruralresidence Months Years Months Years

and age

Years

Less

than

3

—

1-2

—

73 —

72

78

69

64

65 —

54

71

63

63

68 —

73

80

::

76 —

81

;:

64

78 —

80

81

78

69

—

3+

63—

72

67

62

50

55—

65

58

56

39

~

57

58

58

51

64—

88

71

58

55

70—

75

76

69

52

Less

than

3

—

1-2

—

23 —

23

18

26

33

32 —

44

27

33

32

27 —

23

15

::

19 —

12

14

23

32

18 —

15

17

16

30

—

—

3t

31—

21

24

::

36—

25

;;

59

36—

34

34

:;

29—

12

L9

37

33

25—

18

18

27

44

—

1-2

—

4 —

4

4

:

3 —

2

:

6

5 —

3

5

6

6

5 —

7

:

5

4 —

5

3

6

2

—

Less

than

3

3-11 3-11 3-11 3+

All areas

All ages-18+-------------

18-24--------------------------

25-44 -------- -------- -------- -.

45-64--------------------------

65+----------------------------

Lar&e metropolitan

All ages-18+-------------

18-24--------------------------

25-44--------------------------

45-64 -------- ----.--- -------- -.

65+--------------------------- -

Small metropolitan

All ages-18+-------------

18-24--------------------------

25-44--------------------------

45-64--------------------------

65+--------------------------- -

—.Other urban

All ages-18+-------------

18-24--------------------------

25-44--------------------------

45-64--------------------------

65+----------------------------

Rural

All ages-1~-------------

18-24--------------------------

25-44--z----z-.----------------

45-64--------------------------

65+----------------------------

25

17

20

27

38

32

72 23 3 7

80

78

69

59

65

73

75

78

70

59

65

4

3

2

4

3

3

5

;

4

3

21

18

26

36

32

:

4

5

3

;

5

5

9

10

13

7

3

7

75

72

62

45

66

74

73

58

60

73

82

;

55

79

64

70

63

48

68

68

75

::

78

84

;:

63

80

20

26

34

54

31

26

26

37

38

24

17

17

24

41

18

34

;:

50

28

30

18

34

50

18

15

14

,20

3Q

16

2

4

3

2

5

9

8

6

6

7

10

6

7

5

6

:

4

1

5

3

3

1

:

4

3

6

:

4

1

3

6

8

4

7

3

:

9

15

18

25

84

82

78

67

21
. #

Table 11. Percent distribution of response, persons 18-64 years of age, by malor activity and

urban-mral residence

[Due to rounding, the detai led figures may not add to 100 percent. The survey design, general qua! if fcations, and Ind

formation on the rel iabi I ity of the estimates are given in Appendix 1. Definitions of terms are given in Appendix

Il. The supplement form and quest ionnai re are given in Appendix I I 1]

I Major accivity and response (18-64 years)

Urban-rural residence

Total Usually Keeping Other

working house

Yes

All areas------------------------------- 73 71 77 73

Urban----------------------------------------- 69 73 68

Rural----------------------------------------- 79 ;; 83 82

No

All areas-------------------------------- 23 24 21 25

Urban----------------------------------------- 27 27 25 30

Rural---,-------------------------------------- 17 18 15 14

I

Don’t know

All areaa------------------------------- 41 6[ 21 3

Urban----------------------------------------- 6 2

Rural----------------------------------------- : 5 2 :

Table 12. percent distribution of response, persons 18-64 years of age, by

head and urban-rural residence

{see headnoteon table I I )

education of family

Education of family head and response (18-64 yeara)

Urban-rural residence All Less than ‘

educational 9 years

9-12 years College

groupa

Yes

All areas------------------- 73 74 74 69

Urban----------------------------- 69 67 72 67

Rural----------------------------- 79 82 79 72

All areas-------------------

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

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

All areaa-------------------

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

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

No

23 21 23 28

27 28 25 29

17 13 18 27

Donrt know

4 5 3 3

4 5 4 4

4 5 3 2

22
. .

POPULATION

Tables 13-19 contain estimates of the civil- determining the appropriate standard errors of

ian noninstitutional popdation of the United the statistics. They are not official population esStates 18 years of age and over based on inter- timates.

views conducted by the U. S. National Health Sur- For official population estimates, see Bureau

vey during the period, January 27-March 30, 1958. of the Census reports on the civilian poptiation

These estimates have been used as denominators of the United States, in

for the percentages shown in this report. They ports: Series P-20.

are included in the publication for the purpose of

Current Population ReTable 13. Populationused in obtainingpercents shown in this publicationby respondentstatus,

age, urban-ruralresidence,and region

‘[Due toroundlng, thedetal led figures rnaynot addto teetotal. The survey design, general qualifications, a,ld information on the reliability of the estimates are given in Appendix 1. De finltlons of terms are given in Appendix

Il. The supplement form’and questionnaire are given in Appendix Ilfl

Respondent Age

status

Urban-ruralresidence Total and region Self Proxy 18-24 25-44 45-64 65+

Large

Small

Other

All areas-----------------------

k

97,970

All urban----------------------- 60,870

metropolitan-------------------- 23,260

metropolitan-------------------- 19,820

urban--------------------------- 17,790

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

r

37,110

Northeast ----------------------------- 25,400

North Central ------------------------- 30,340

South---------------- ---------------- - 27,680

West----------------------------------14,550

Populationin thousands

58,890 39,080

37,100 23,770

14,190 9,070

12,020 7,800

10,890 6,900

21,790 15,320

14,810 10,590

18,580 11,760

16,210 11,470

9,290 5,260

12,420

7,850

2,690

2,720

2>440

4,570

2,610

3,630

4,320

1,830

40;140

24,380

9,590

7,980

6,810

15,760

10,780

11,960

11,150

6,240

32.040

20,410

8,240

6,380

5,790

11.630

8,720

10,220

8,570

4,550

13,370

8,220

2,750

2,720

2,750

5,150

3,290

4,530

3,630

1,930

23
Table 14. Population used in obtaining percents shown in this publication, perso;s 18 y;ars of

age and over, byrace, sex, and region

[Due to rounding, thedetal ied figures may not add to the total. The survey design, general qualif~catlons, and information on the reliability of the estimates are given in Appendix 1. Definitions of terms are given [n Appendfx

Il. The supplement form and questionnaire are given in Appendix III]

—

Race and sex

Region White Nonwhite

Total White Nonwhite Males Females Males Femalea

All regions-----------------

L

97,970

Northeast------------------------- 25,400

North Central--------------------- 30,340

South----------------------------- 27,680

West------------------------------ 14,550

88,000

24,020

27,920

22,480

13,590

Population in thousands

9,970141,700 I 46,300 \ 4,700 j 5,270

I I

1,390 11,160 12,860 650 740

2,420 13,400 14,520 1,230 1,190

5,210 10,750 11,730 2,380 2,830

96o 6,420 7,170 440 520

I i I 1

Table 15. Population used in obtaining percents shown in this publication,

age and over, by education of family head and region

persons 18 years of

(See headnote on table 14J

-

Education of family head

Region All Less than 9-12 educational 9 years

College

years

groups

Populationin thousands

All regions---------------------------. 97,970I 43,120 [ 38,690I 16,170

Northeast------------------------------------- 25,400 10,980 10,290 4,130

North Central--------------------------------- 30,340 12,850 12,620 4,870

South----------------------------------------- 27,680 14,820 9,110 3,750

West------------------------------------------ 14,550 4,470 6,660 3,420

1 I I I

24
. .

Table 16. Populationused in obtainingpercents shok in this publication,Persons 18 years of

age and over, by health status,urban-rural,residence,and region

[Due to rounding, the detailed figures may not add tcthe total. The survey design, general qualifications, and in- ,

formation on the reliability of the estimates are given in Appendix 1. Definitions of terms are given in Appendix

Il. The supplement form and questionnaire are given in Appendix I II]

Urban-ruralresidence

and region

All areaa----------------------

All urban----------------------

Large metropolitan-------------------

Small metropolitan-------------------

Other urban--------------------------

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

Northeast----------------------------

North Central------------------------

South--------------------------------

West---------------------------------

Health status

Persons with chronic I

Persons with no chronic

Total

conditions conditions

Activity Physician

Total Visited Not visited

Limited ~$:ed within within

1 year 1 year

Populationin thousanda

53,0401 15,020

11,930

10,060

10,140

3,340

2,350

2,930

38,020/44,930 I 23,520[ 21,410

I 1

23,500 28,740 15,310 13,430

I I I

8,590 11,340 6,090 5,250

7,710 9,750 5,210 4,540

7,210 7,640 4,000 3,640

20,920 6,410 14,510 16,190 8,210 7,980

f I I I 1

12,610 3,530 9,080 12,780 6,950 5,830

17,070 4,750 12,320 13,270 6,490 6,780

14,830 4,490 10,340 12,860 6,810 6,050

8,520 2,250 6,270 6,030 3,270 2,760

25
* t

Table 17. Populationused in obtainingpercents shown in this publication,persons 18 years of

age and over, by health status, time intervalsince last physic%anvisit, urban-ruralresidence, and age

[Due torounding, thedettiiedf(gures maynotadd tothe total. The survey design, general qualifications, and information on the reliability of the estimates are given in Appendix 1. Definitions of terns are given In Appendix

Il. The supplement fom and questionnaire are given in Appendix Ill

Health status Time intervalsince last

physicianvisi,t

Personswith Personswith

chronic no chronic

conditions conditions Less

Activity Physician than 3

3-11 1-2 B

months

Not months years years

Visited

,tiited Not within visited

limited 1 year within

1 year

Urban-rural

residence

and age

Populationin thousands

All areas

All ages-18+-------- 15.020 38.020 23.520 21.410 35,870

4,210

14,010

11;870

5,780

8,710

860

3,380

3,340

1,120

6,750

27.600 18,610

2,320

7,960

6>170

2,160

4,460

580

1,860

1,580

440

3,410

15,880

1,350

5,930

6,100

2,510

3,550

24o

1,510

1,290

510

3,490

2,990

9,450

7,140

1,820

5,250

720

2,380

1,760

380

4,540

4,540

12,230

7,910

2,910

6,530

980

2,850

2,030

680

6,170

18-24---------------------

25-44---------------------

45-64---------------------

65+-----------------------

460

3,230

5,610

5,720

3,340

70

840

1,320

1,110

2,350

3,560

15,900

13,800

4,770

8,590

700

3,420

3,470

990

7,710

5,410

11,560

5,490

1,050

6,090

1,180

2,950

1,700

260

5,210

Large metropolitan

All ages-18+--------

18-24---------------------

25-44---------------------

45-64---------------------

65+-----------------------

Small metropolitan

All ages-18+--------

18-24---------------------

25-44---------------------

45-64---------------------

65+-----------------------

40

540

7,740

1,010

2,930

60

500

1,210

1,150

6,410

300

1,370

2,310

2,440

880

3,200

2,620

1,020

7,210

1,330

2,320

L,360

200

4,000

490

1,930

1,640

490

3,640

850

2,610

2,100

1,180

6,820

1,260

2,650

1,730

540

4,810

400

1,500

1,160

340

3,550

220

1,220

1,400

660

2,610

Other urban

All ages-18+--------

850

2,930

2,400

1,040

14,510

1,130

6,340

5,320

1,720

18-24---------------------

25-44---------------------

45-64---------------------

65-I------------------------

1,040

1,830

910

230

8,210

1,870

4,460

1,530

350

500

1,550

1,280

320

7,980

1,280

3,600

2,480

630

930

2,520

2,040

1>330

13.610

870

1,970

1,400

570

10,090

1,430

4,770

2,750

1,120

430

1,450

1,230

440

7,200

910

3,150

2,190

950

210

870

1,120

420

6,190

670

2,340

2,280

920

Rural

All ages-18+--------”

18-24---------------------

25-44---------------------

45-64---------------------

65+-----------------------

1,560

5,500

4,400

2,160

26
, 4

Table 18. Population used in obtaining percents shown in this publication, persons 18 years of

age and over, by health status, time interval since last physician visit, urban-rural residence. and fsmilv income

[Due toro.ndlng, thedettiledfig.res rnaynot adcito teetotal. The survey design, general qualifications, and’ In- ‘

formation on the reliability of the estimates are given in Appendix 1.

Il.

Definitions of terms are given in Appendix

The supplement form and quest ionnaire’ are given in Appendix III]

Urban-rural

residence

and family income

All areas

All income groups---

Less than $2,000----------

$2,000-4,999--------------

~;,::C);6,999--------------

------------------- 3

Large metropolitan

All income groups---

Less than $2,000----------

$2,000-4,999--------------

$5,000-6,999--------------

$7,000+-------------------

Small metropolitan

All income groups---

Less than $2,000----------

$2,000-4,999--------------

$5,000-6,999--------------

$7,000+-------------------

Other urban

All income groups---

Less than $2,000----------

$2,000-4,999--------------

$5,000-6,999--------------

$7,000+-------------------

Rural

All income groups---

Less than $2,000----------

$2,000-4,999--------------

$5,000-6,999--------------

$7,000+-------------------

Health status Time interval sLnce last

physician visit

Persons with

chronic

conditions

Activity

I

Limited Not

limited

15,020

6,420

5,080

1,980

1,550

3.340

1,010

1,240

620

460

2,350

930

860

290

280

2,930

1,150

1,020

410

350

6,410

3>340

1,970

650

460

38,020

8,650

12,570

8,810

8,010

8.590

1,350

2,550

2,270

240

7,710

1,400

2,400

2,220

1,670

7,210

1,640

2,600

1,430

1,570

14,510

4,260

5,010

2,880

2,360

Persons with

no chronic

conditions

liPhysician Less

than 3

~isited Not

visited months

within

1 year

within

1 year

3-11

months

Population in thousands

23,520

4,490

8,200

5,290

5,540

6,090

970

1,940

1,480

1,700

5,210

890

1,630

1,220

1,480

4,000

820

1,540

740

900

8,210

1,810

3,100

1,850

1,460

21,410

5,620

7,250

4,470

4,040

5.250

1,070

1,500

1,480

1,200

4,540

1,100

1,520

880

1,040

3,640

950

1,400

610

690

7,980

2,500

2,850

1,510

1,120

35,870

8,850

12,200

7,550

7,280

8,710

1,620

2,700

2,180

2,200

6,750

1,400

2,110

1,600

1,650

6,820

1,600

2,590

1>230

1,400

13,610

4,230

4,790

2,550

2,040

27,600

6,290

9,570

6,270

5,470

6,530

1,050

2,220

1,650

1,630

6,170

1,220

2,000

1,600

1,360

4,810

1,200

1,740

970

910

10,090

2,830

3,620

2,060

1,580

1-2

years

18,610

4,650

6,260

3,790

3,900

4,460

760

1,410

1,050

1,240

3,410

610

1,130

740

920

3,550

900

1,280

640

730

7,200

2,390

2,460

1,350

1,000

3+

years

15,880

5,390

5,070

2,940

2,490

3,550

970

890

990

710

3,490

1,090

1,180

680

530

2.610

850

940

360

470

6,190

2>470

2,050

910

770
. ,

Table 19. populationused in obtainingpercentsshownin this publication,persons 18-64 years of

age, by major activityand urban-ruralresidence

[Due toroundlng, thedetti led figures rnaynot addto teetotal. The survey design, general qua(fficatlons, and information on the reliability of the estimates are given in Appendix 1. Definitions of terms are given (n Appendix

Il. The supplement form and questionnaire are given in Appendix 1111

Major activity (18-64years)

Urban-rural

residence

Total Usually Keeping

working house Other

I

populationin thousands

All areas------------------------------- 84,300 50,590 27,170 6,540

Urban----------------------------------------- 52,420 32,290 15,910 4,220

Rural----------------------------------------- 31,880 18,300 11,260 2,320

28
, A

TECHNICAL

APPENDIX 1

NOTES ON METHODS

Statistical Design of the

Health Interview Survev

General plan.— The sampling plan of the survey

follows a multistage probability design which permits

a continuous sampling of the civilian population of the

United States. At the time of this study the first stage

of this design consisted of an area sample of 372 from

among approximately 1,900 geographically defined Primary Sampling Units (PSI-J’S) into which the United

States has been divided. A PSU is a county, a group of

contiguous counties, or a Standard Metropolitan Area.

With no loss in general understanding, the remaining stages can be telescoped and treated in this discussion as an ultimate stage. Within PSU’S, tien, ultimate stage units called segments are defined, also

geographically, in such a manner that each segment

contains an expected six households in the sample.

Each week a random sample of about 120 segments is

drawn. In the approximately 700 households in those

segments persons are interviewed concerning illnesses,

injuries, chronic conditions, disability, and other factors related to health.

The household members interviewed each week are

a representative sample of the population so that samples for successive weeks can be combined into larger

samples for, say a calendar quarter, or a year. Thus

the design permits both continuous measurement of

characteristics of high incidence or prevalence in the

population, and through the larger consolidated samples more detailed analysis of less common characteristics and smaller categories. The continuous collection has administrative and operational advantages, as

well as technical assets, since it permits field work

to be handled with an experienced, stable staff.

Collection of data.—The field operations for the

household survey are performed by the Bureau of the

Census under specifications established by the Public

Health Service. In accordance with these specifications

the Bureau of the Census designs and selects the sample, conducts the field interviewing acting as collecting

agent for the Public Health Service, and edits and codes

the questionnaires. Tabulations are prepared by the

Public Health Service using the Bureau of the Census

electronic computers.

Estimating methods .—Each statistic produced by

the survey—for example, the incidence of acute illnesses in a specified period—is the result of two stages

of ratio estimation. In the first of these, the ratio factor is 1950 decennial population count to estimated population for 1950 for the U. S. National Health Survey’s

first-stage sample of PSU’S. These factors are applied

for 132 color-residence classes.

Later, ratios of sample-produced estimates of the

population to official Bureau of the Census figures for

current population in 76 age-sex-color classes are computed, and serve as second-stage factors for ratio estimating.

The effect of the ratio estimating process is to

make the sample more closely representative of the

population by age, sex, color, and residence, thus reducing sampling variance.

As noted, each week’s sample represents the population living during that week and characteristics of

that population. Consolidation of samples over a time

period, say a calendar quarter, produces estimates of

average characteristics of the U. S. population for that

calendar quarter.

The interviewing and estimation procedures, as

noted earlier, are designed to reproduce the experience

in the reference period of the questionnaire for the population living at the time of interview.

‘General Qualifications

Nonresponse.— Data were adjusted for nonresponse

by a procedure which imputed to persons in a household not interviewed the characteristics of interviewed

persons in the same segment. The total noninterview

rate was 6 percen~ 1 percent was refusal, and the remainder was accounted for by all other reasons, such

as failure to find any household respondent after repeated trials.

The interview process.—The statistics presented

in this report are based on replies secured in interview of persons in the sampled households. Each person 18 years and over, available at the time of interview, was interviewed individually. Proxy respondents

within the household were employed for adults not available at the time of the interview provided the respondent was closely related to the person about whom information was being obtained.

Rounding of numbers.-The original tabt,dations on

which data in this report are based show all estimates

to the nearest whole unit. All consolidations were made

from the original tabdations using the estimates to the

nearest unit. In the final published tables the figures

are shown in thousands, although they are not necessarily accurate to that detail.

Population figures. —Some of the published tables

include population figures for specified categories.

These figures are based on the sample of households

in the U. S. National Health Survey, are given solely

for the purpose of providing denominators for rate computation and for entering the sampling error table. They

are more appropriate for use with the accompanying

measures of health characteristics than any other data

that may be available. In some instances, they will permit users to recombine published data into classes

more suitable to their specific needs. The population

figures are not official estimates, in some cases being

themselves subject to considerable variability, and as

such should be used only for the purposes stated in connection with data given in this report. For fuller details on population estimates see Bureau of the Census

reports in the P-20 series.

29
* ,

Table 1. Standard error of estimated percentages (body of table expressed in percentage points]

Population estimate

(denominator of percentage)

200,000-----------------------

500,000-----------------------

800,000-----------------------

1,000,000-----------------------

2,000,000-----------------------

3,000,000-----------------------

4,000,000-----------------------

5,000,000-----------------------

6,000,000--------------V --------

7,000,000-----------------------

8,000,000----------------------- .

9,000,000-----------------------

10,000,000-----------------------

15,000,000-----------------------

20,000,000-----------------------

25,000,000-----------------------

30,000,000-----------------------

35,000,000-----------------------

40,000,000-----------------------

45,000,000-----------------------

50,000,000-----------------------

75,000,000-----------------------

100.000.000-----------------------

Estimate of percentage willing (or unwLlli.ng) to

be examined

5 10 15 20 25 30 35 40 45

or or or or or or or or or 50

95 90 85 80 75 70 65 60 55

Standard error of percentage

10.5

6.0

5.2

4.1

3.1

2.5

2.0

1.7

1.5

1.3

1.3

L.2

1.2

1.0

0.9

0.9

0.8

0.7

0.7

0.6

0.6

0.5

0.4

L2.4

7.6

6.2

5.0

3.9

3.0

2.5

2.2

1.9

1.7

1.6

1.5

1.4

1.3

1.1

1.0

1.0

0.9

0.8

0.7

0.7

0.6

0.5

illustration of th’e use of table I .—An estimated 64 6

said they would be wil Iing to co-operate i n a health exa

4.0

8.8

7.1

5.7

4.6

3.6

2.9

2.5

2.2

2.0

1.9

1.8

1.7

1.5

1.3

1.2

1.1

1.0

0.9

0.8

0.8

0.7

0.6

.5.5

9.8

7.8

6.5

5.0

4.1

3.4

2.9

2.5

2.3

2.1

2.0

1.9

1.7

1.5

1.4

1.2

1.1

1.0

0.9

0.9

0.8

0.6

,6.9

,0.6

8.4

7.1

5.3

4.4

3.8

3.2

2.8

2.6

2.3

2.2

2.1

1.9

1.7

1.5

1.4

1.2

1.1

1.0

1.0

0.8

0.7

.8.1

.1.2

8.9

7.6

5.6

:::

3.4

3.1

2.8

2.6

2.5

2.3

2.0

1.8

1.6

1.5

1.3

1.2

1.1

1.0

0.9

0.7

.8.9

.1.6

9.3

8.1

5.8

4.9

4.2

3.5

3.2

2.9

2.8

2.7

2.5

2.2

2.0

1.8

1.6

;::

1.2

1.1

0.9

0.8

.9.3

.2.0

9.6

8.4

6.0

5.0

4.3

3.6

3.2

3.0

2.9

2.8

2.7

2.4

2.2

2.0

1.7

1.6

1.4

1.3

1.2

0.9

0.8

19.5

12.2

9.7

8.6

6.1

i::

3.7

3.3

3.1

3.0

2.9

;:;

2.3

2.1

1.8

1..7

:::

1.3

1.0

0.9

:ent of the persons iving in large metropolfi —.

lation survey. The estimated number of persons

.—

large metropol itan cities is 23,260,000 as shown in table 13. Thus, for a denominator of 23,260,000, tab)

that an estimate of 64 percent has a standard error of approximately I .9 percent.

Reliability of Estimates

Since the estimates are based on a sample, they

will differ somewhat from the figures that wotid have

been obtainedifa complete census hadbeen taken using

the sarneschedules,instructions, and interviewingperaonnel and procedures. As in any survey, the results

are also aubject to measurement error.

Thestandard error is primarily a measure Of

sampling variability, that is, the variationa that might

occur by chance because only asampIe of the population ia surveyed. As calcdated for this report, the

standard error also reflectspart ofthevanation which

arises in the measurement process. It does not include

estimatesof any biases which might liein the data. The

chances are about 68 outof 100 that an estimate from

theaamplewodd differ from acomplete cenausbyleas’

than the standard error. The chances are about 950ut

of 100that thediffexence wodd beless than twice the

standard error and about 99 out of 100 that it would be

less than 2%times as large.

The estimates of standard errors shown in table I

are approximations for the 372-area sample. TabIe I

shows the averageestimates of atandard errorsofpercentagesas obtainedfrom8 weeksof sampling. Inorder

to derive standard errors which would be applicableto

Z9.6

12.3

9,8

8.7

6.2

:::

3.7

3.3

3.2

3.1

3*O

2.9

2.6

2.4

2*2

1.9

1.7

1.6

1,4

1“3

140

0.9

cltlOs

ving fn

I shows

a wide varietv of health statistics and which could be

prepared at~maderate cost, anumberof approximations were required. Asa result, table Ishotid reinterpreted as providing an estimate of approximate

standard error rather than as the precise standard error for any specific percentage.

The standard errora shownin tablef are not directly applicable to differences between two sample

estimates. The standard error of a difference is approximately the square root of thesum of the squares

of each standard error considered separately. This

forms.da will represent the actual atandard error quite

accurately for the difference between separate anduncorreIated characteristics, although itis ody arough

approximation inmost other cases.

The reliability of unestimated rate or percentage,

computed byusingssmple data for both numerator and

denominator, depends upon both the size of the rate and

the size of the total upon which the rate is based. Generally, estimated rates are relatively more reliable

than the corresponding absolute estimates of the numerator of the rate, particdarly if the zate is high.

Table I shows approximate standard enors of estimated rates or percentages when the characteristic

used to form the numerator of the percentage or rate

isa subclass of the base or denominator.

30
.

APPENDIX II

DEFINITIONS OF CERTAIN TERMS USED IN THIS REPORT

Terms Relating to Health

Health status. -Health status is structured so as

to provide a means of ranking people, though in a crude

sense, by degrees of health. Persons in the first of the

following four categories, in general, probably have the

poorest health, and those in the last category probably

have the best health.

1. Persons with chronic conditions, activi~ limited

2. Persons with chronic conditions, activity not

limited

3. Persons with no chronic conditions, physician

visited witbin one year

4. Persons with no chronic conditions, physician

not visited within one year

Condition.-A morbidiW condition, or simply a

condition, is any. entry on the questionnaire which describes a departure from a state of physical or mental

well-being. It results from a positive response to one

of a series of “illness-recall’ Tquestions. In the coding

and tabulating process, conditions are selected or clas -

sif ied according to a number of different criteria, such

as, whether they were medically attende~ whether they

resulted in disabili~ whether they were acute or chronic; or according to the type of disease, injury, impairment, or symptom reported.

Chronic condition.-A Gondition is considered to

be chronic if (1) it is described by the respondent in

terms of one of the chronic diseases on the .“Check

List of Chronic Conditions” (see Appendix 111)or in

terms of one of the types of impairments on the “Check

List of hnpairments, !! or (2) the condition is described

by the respondent as having been first noticed more

than 3 months before the week of the interview.

2.

3.

Workers and all

other persons: inability to work at a job

or business.

Persons limited in the amount or kind of major

activity performed

Preschool children:

School-age children:

Housewives:

Workers and all

other persons:

Persons not limited in major activity but otherwise limited

Preschool children:

School-age children:

Terms Relating to Disability

Chronic activity limitation. -Persons with chronic

conditions are classified into 4 categories according to

the extent to which their activities are limited at present as a result of these conditions. Since the major

activities of preschool chtidren, school-age children,

housewives, and workers and other persons differ, a

different set of criteria is used for each group. There

is a general similarity between them, however, as will

be seen in the descriptions of the 4 categories below:

1. Persons unable to carry on majo; activity for

their Froup

Preschool children: inability to take part in

ordinary play with other

children.

School-age children: inability to go to school.

Housewives: inability to do any housework.

limited in the amount or

kind of play with other

children, e.g., need a.pecial rest periods, cannot

play strenuous games,

cannot play for long periods at a time.

limited to certain types

of schools or in school

attendance, e.g., need

special schools or special teaching, cannot go

to school fdl time or for

long periods at a time.

limited in amount or kind

of housework, e.g., cannot lift children, wash or

iron, or do housework for

long periods at a time.

limited in amount or kind

of work, e.g., need special working aids or special rest periods at work,

cannot work fdl time or

for long periods at a time,

cannot do strenuous work.

Housewives:

Workers and a~

other persons:

not classified in this category.

not limited in going to

school but limited in participation in athletics or

other extracurricular activities.

not limited in housework

but limited in other activities, such as church,

clubs, hobbies, civic proj -

ects, or shopping.

not limited in regular

work activities but limited in other activities,

such as church, clubs,

hobbies, civic projects,

sports, or games.

4. Persons not limited in activities

Includes persons with chronic conditions whose

activities are not limited in any of the ways described above.

31
Medical Care Terms

Physician visit.—A physician visit is defined as

consultation with a physician, in person or by telephone,

for examination, diagnosis, treatment, or advice. The

visit is considered to be a physician visit if the service is provided directly by the physician or by a nurse

or other person acting under a physician’s supervision.

For the purpose of this definition “physician” includes

doctors of medicine and osteopathic physicians. The

term “doctor” is used in the interview, rather than

l~physician,ltbecause of the need to keep to pop~ar

usage. However, the concept toward which all instructions are directed is that which is described here.

Physician tisits to hospital inpatients are not included.

If a physician is called to the house to see more

than one person, the call is considered to be a separate

physician visit for each person about whom the physician was consr.dted.

A physician visit is associated with the person about

whom the advice was sought, even if that person did not

actually see or consr,dt the physician. For example, if

a mother consults a physician about one of her children, the physician visit is ascribed to the child.

Interval since last physician visit.—~e interval

since the last physician visit is the length of time prior

to the week of interview since a physician was last constited in person or by telephone for treatment or advice of any type whatsoever. (See definition of ‘‘Physician visit.”)

The interval is recorded to the nearest month for

periods of a month or more but less than a year, and

to the nearest year for periods of a year or more.

Demographic, Social, and Economic Terms

Age.—The age recorded for each person is the age

at la=irthday. Age is recorded in single years and

grouped in a variety of distributions depending upon the

purpose of the table.

~. —Race is recorded as “White,” “Negro,” or

“Other.” “Other” includes American Indian, Ctinese,

Japaneae, and so forth. Mexican persons are included

with “White” urdess definitely known to be Indian or

other nonwhite race.

Income of family or of unrelated individuals. -Each

member of a family is classified according to the total

income of the family of. which he is a member. Within

the household all persons related to each other by blood,

marriage, or adoption constitute a family. Unrelated

individuals are classified according to their own income.

The income recorded is the total of all income received by members of the family (or by an unrelated

individual) in the 12-month period ending with the week

of interview. Income from all sources is included, e.g.,

wages, salaries, rents from property, pensions, help

from relatives, and so forth.

Major activity.-All persons 6 years old or over

are classified according to their major activity during

the 12-month period prior to the week of interview.

This report, however, refers ordy to persons aged 18

and over. The “major activity,! 1in case more than one

is reported is the one at which the person spent the

most time during the 12-month period.

The categories of major activity are: usually working, usually keeping house, and -. For several

reasons these categories are not comparable with som’ewhat similarly named categories in official Federal

. ,

labor force statistics. In the first place, the response~

concerning major activity are accepted without detailed

questioning, since the objective of the question is not to

estimate the numbers of persons in labor force categories but to identify crudely certain population groups

which may have differing health problems. In the second place, the figures represent the major activity over

the “period of an entire year, whereas official labor

force statistics relate to a much shorter period, usually one week. Finally, in the definitions of the specific

categories which follow, certain marginal groups are

classified in a different manner to simplify the procedures.

1.

2.

3.

Usually working includes paid work as an employee for someone els~ self-employment in

own business, or profession, or in farming; and

unpaid work in a family business or farm. Work

around the. house, or volunteer or unpaid work,

such as for church, Red Cross, etc., is not

counted as working.

UsuslLy keeping house includes any activity described as “keeping house” which cannot be

classified as “working” or “going to school.”

= in this report, includes all persons not

classified as “usually working” or “usually keeping house.”

Location of Residence Terms

Urban-rural residence. —This term refers to the

urban or rural place of residence of the interview subjects. The definition of urban and rural areas used in

the U. S. National Health Survey is the same as that

used in the 1950 Census. According to this definition,

the urban popdation comprises all persons living in

(a) places of 2,500 inhabitants or more incorporated as

cities, boroughs, and villages; (b) incorporated towns

of 2,500 inhabitants or more except in New England,

New York, and Wisconsin where “Towns” are simply

minor civil divisions of counties; (c)the densely settled

urban fringe, including both incorporated and unincorporated areas, around cities of 50,000 or more; and (d}

unincorporated places of 2,500 inhabitants or more outside any urban fringe. The remaining popdation is classified as rural.

Large metropolitan. —Refers to urban areas comprising 1,000,000 or more population.

Small metropolitan. -Ur~n areas wfth less than

1,000,000 people which are composed of central

cities of 50,000 or more.

Other urban. —This category includes the remainder of the urban popdation as defined above. In

general it includes urban populations of less than

50,000.

Geographic region. —The regions referred to In

this report correspond to those used by the Bureau of

the Census, and are composed of the following States:

Region States Included

Northeast Maine, New Hampshire,

Vermont, Massachusetts,

Rhode Island, Connecticut,

NewYork, New Jersey,

Pennsylvania

North Central Michigan, Ohio, Illinois, Indiana,

Wisconsin, Minnesota, Iowa,

Missouri, North Dakota,

South Dakota, Nebraska, Kansas

South Delaware, Maryland, District of

Columbia, Virginia,

West Virginia, North Carolina,

32
. .

South-Continued South Carolina, Georgia, West

Florida, Kentucky, Tennessee,

Alabama, Mississippi, Arkansas,

Louisiana, Oklahoma, Texas

Montana, Idaho, Wyoming,

Colorado, New Mexico, Arizona,

Utah, Nevada, Washington,

Oregon, California

33
,APPENDIX Ill

THE SPECIAL SUPPLEMENT FORM AND QUESTIONNAIRE

The supplement form and pertinent parts of the Coding of the data on the basic questionnaire was

questionnaire used in this study are shown below. The then done at the Bureau of the Census, using proce -

coding and classification of the answers to the supple- dures regularly followed for the continuing Health Inment questions were done by the National Opinion Re- terview Survey.

search Center of the University of Chicago.

A. THE HEALTH EXAMINATION SUPPLEMENT FORM

. . . . .....

ll~*lJlswpl “ . ..1

,Om OD,ro”..; . ..s., ““,,. ” . . . w“.,!

“.s 0s,..,.,”, OFcomsllcc Id,.. cod-. S.b”.m,l. .C;h, 3.,1. P9J

. . . . . . ., ,“. . . ..”s

S.mem,N.. *ri.1 N..

HEALTH EXAMINATION SUPPLEMENT

1 2 3 4

st namc—

5 6 7

.- ——— —- ——— —— —.. ________ ________ ______ _______

St n.m.~

A8c Ag= Ag. ~8. AL. A$.

e (Qucstlon 5)

Ag.

a Under 1 YCU ❑ U.de, 1 yea O Under 1 y.= ❑ Und,r 1 Y.- n U.d.r 1 Y,., aUnder 1 yea O Ur,dcr 1 y,.,

;k for all ad.ltsh As port of the Heolth Survey, the Public Health Service will provide o free he.ltk. .x.mination to some of the people w. arc i“tervicwing. As you would expect, w. cannot

Im all We nood 10 know about hooltb iust by asking questions--for %me tkfngs we need octual measurements and tests. Tbe ex.ami”.ation will involve only one visit to a nearby place.

i

m Yes o No DYCS o No n ye.

n Q.afffied

n No a Yes o No n Yes u No n Yes o No o Yes “mNo

If you ore n Qualified o Qualified n Qualified

(verbatim)

n Qualified n Qmlif ied

selocjod forthls (verbatim) (verbatim) (verbatim) (v.rbatim)

O Qualified

,Pae,a, free ,x- o Don’t know

(verb.tim)

o Do”*t know

(verbatim) (verbatim)

m Don’t know a Do”’c know m Do”’c k.ow

(V,rb.cim)

o D..SL know n DonOt know

amlnotion and the (verbatim) (verbatim) (verbatim) (verbatim) (V., bacim)

time and place

are convonlcnt,

Will yOU be Willing to ewe?

(o) Howohou!, .

(cachrel.ted

ti:ti::lr

b. willing to

come?

Who W.S the m self n s.lf n self n s.lf

respondent for

u self a self o self

question 1? CO1 No. Col. No. Cccl. No. Col. No. COI. No. Col. No. COI. No.

atnotes:

,,,... ”... ,,, =,

35
B. PERTINENT PARTS OF THE BASIC QUESTIONNAIRE USED IN THE SURVEY

3. Race (Check one hox for each Person)

U White O Negro

Cl Other

4. Sex (check one box for each person) O Hale n Female

Age

5. How old were YOU on your last birthti?

O Under

1 year

If 14 years old or over, ask: O Under 14 years

8. What is fie highest grade you -pleted in *oo1?

(Circle highest grade completed or check ‘Tone,,)

Elen: 12345878

Hiti 1234

collese: i 2 3 4 5+

m None

If 6 years old or over, ask: O Under 6 yerira

10. (a) Ubat =re you doing wti 0< tie past 1?. mnths -- 0 Working

(For males over 16): Wrking, l~ing for mrk, or doing SuIetbfng cl=? O Looking for work

(Wr females over 16): wtiing, looking for wrk, kemine house, or Ming =Mefhing el se? O Keeping hou8e

(For children 6 - 16fi WiOg ti 6chool or *ing -ething else? O Baing to school

If “something else,, checked, ad Derson is 50 years old or over, ask: ~ Wmething else

.- ..-. ------ ---

(h) Am You retired? n Yes a No

We are interested in all kinds of illne~, tiether serious or not -- 5 Yes n No

11. were YOU si& at arIY time LW WSEXOR ~ NEQ( B~~

(a) fiat was ffle ❑atter?

(b) wtbing else?

IZ. Last wefk or tie week @fore did YOU have w accid=ts or injuries, eitier at n Yes a NO

home or away fmm bcune?

(a) mat were they?

(b) Anything else?

13. fast week or the wefk before did You feel aw ill eff~cts frurn ~ earlier n yes U No

accident or injury?

(a) what were these effects?

(b) Mthing else?

14. Last week or tie week before did YOU take w ❑edicine or treatient for any O Yes O NO

condition (besides . . .nhich You told ❑e aboot)?

(a) For *at renditions?

(b) Auything else?

15. AT lNE >-T TIM do YOU have nny allmcnts or mditions that have mn- a Yes

tinued for a long time? (If ,<NO..)

O No

SVen UIo”gb they don, t bofier you afl the time?

(a) What are tiey?

(b) Anything cl-?

[6. Has axwcme in tie fmilY - you, Your--, eti. - had any of thee rnndftions fNJRfNQ ~ O Yes m No

PA67 12 MO*?

(Read card A. condition by condition; record a“y conditions

mentioned .“ the column for the Person)

17. Ooes anyone in the fmily have w of these renditions? D Yes U No

(Read Ca,d B, co”ditlo” hy condition: record any conditions

mentioned in the column for the DePSO”)

,8. (a) MT mm af lHB = B- did aoYone in the family - YOU, Your--, etc. - tilk

to a doctor or go tn a doctir’s office or clinic? Awooe else? o Yes uwoo~

1f ,’Yes,,

----- ----- ------ .

(b) HOW❑- times tiring We Past 2 weeks? No, of times

(c) Where did YOU talk to tbe doctifT ~ A

(d) How mwy times at -- (home, office, clinic, etc. )7 At h-..,.,,,,,,,,,,, _

(Record total number of times for each tyDe of place) At office .............

HmDital clinic...,.,.

Comw or i“dwtry..,

&er teIeDhOne,,.,.,..

Other (SP..I fy),...,.,

,9. ~at did you have done? 8)8) &)Dlw. or ,relltm”t

If more than one visit or telephone call: m Cl ~ Pre/mt natal care

{}

first

m n U den’1 check.uP

What did YOU have done on the o n m l~~</vwc, semnd visit(ortelephone call) ?

etc.

n n n me Exu, (glksseri)

D O 0 Other (sPa.J/Y)

!0. If ‘,No,Sto q. 18a, ask: —6!0s. or

How long has it befn since You last talked to a dactir?

—Yr%c

n Less than 1 MO. ~ Nnver

36
—

01,

0.

f

erOn

(n) —

—

INOW

Smy

dws,

includ

ing

the 2

weckwds?

(s)

DIVE

—

um -

Im

0,

(b)

—

—

)id

IOu

:ver

:alk

ba

bc -

hr

dmut

. . ?

(c)

3 Yes

~ No

—

--

Mbat did tke dootnr sw it

MS? -- did he ume CUIY

nedicsf tema?

(If doctor not talked to -

,fNo,0,in CO1. (c)- record

respondent, s description)

(If ill-effects of earlier

accident &lsO fill Table A)

For an accident or injury

occurring during Past 2

weeks, ask:

Sbat part of the bodf w=

hurt? mat kind of injury

W22 it? ~tbing else?

(Also, fill Table A)

(d-1)

[e I- ILLNESSES, IMPAIR!AENTS

If an impairment or symPtom,,esk:

Sbat was tie cause of (If eye

.,.? trouble of

any hind

(If catiselis already

,~j gryears

entered in (d-1) circle over, askx

.x,,~ith~”t ~ki”~ the

question)

:ylyou

(If accident or injury,

fill Table A)

ordinary

newzpzper

~~;e$th

Did YOU fiTSt nOtiCe ...

DURINQTRNPAST3 MffllSS

or beforethattime?

3ef0m

3

nonths

(Go

to

..1.

c.>)

(k)

—

1

check one

Did ... start

during the past

z weeks or

u:in befOre fiat

time?

onth

(If during uast

~ 2 weeks, ask):

micbweek, 122t

week or tbe

weeA befors?

=

(1) (m)

n @t o y:fo

n Week ~

berore

ND ACCIDENTS

~:t;ind of .,. truuble

(If kind of trouble

already entered in 001.

(d-1), circle “X),without asking the question)

(d-4)

x

1

TO Inter- Did You firzt

viewer: notice ...

~Iffi lllE

If Col. PAST13 HOhTSS

(k) iS or before that

checked time?

or the

condition (If d“~ing ~*st

is on either ~“e 12 months, ask)

of cards

A or B,

*i& monti?

oontinue;

otherwise.

“SIDP

hen did

(OU lzst

talk Pa a

ioctor

tiut. ..?

[Month ..<

{ear-Yea

]nly if

prior to

1956)

[0)

HO.—

fr._

~ No Dr.

oo~

t~e MY

❑edicine

or treatmrnt that

the doctir

~rssr:~d

or, follow

m advice

he ~ve?

(P)

fiat part of tie boti

was affected?

(If Part of body can be

determined from entries

i“ COIS. [d-l)throush

;d-4),circle ‘,X8,without

asking the question)

(G.

kl .

Ck))

(Q) (r) (s)

D Yes o No—DWS

, or

n No Dr.” =None I

1 ST. Durine tke nzzt 12 montis in &i& zrauD did the total inae of Your fanil~ fall. GrOuP No.

I

1--””that is, yours, your .--’s, etc. ? TShoi card H) Xnclude in-e kmm all &urces;

aati us wages, salaries, rats fmto property, pensions, help from relatives, etc. I I

37
w

Card A

NATIONAL HEALTH SURVEY

Check List of Chronic conditions

1. Asthm

2. Aw aller~

3. Tuberculosis

4. Chronic bronchitis

5. ReEted 8tticks of sinus trouble

6. ~eumztic fever

7. &rdening of the arteries

8. High blwd Dressure

9. Heart trouble

i O. Stroke

11. Trouble with varicose veins

i2. Nemrrhoids or piles

13. Wllbladder or liver trouble

14. Stmch ulcer

15. Any other chronic stomcb trouble

16. Kidney stones or other kidney trouble

17. Arthritis or rheumtism

i8. FTosfate trouble

19. Diabetes

20. 2hYroid trouble or goiter

21. SDilewx or convulsions of any kind

22. Mntal or nervous trouble

22. ReEated trouble with back or spine

24. ~mr or cancer

25. Cltronic skfn txu”ble

26. Hernia or rupture

I 1

Card c Card o

NATIONAL NEALTN SUSVEY

NATIONAL HEALTu SUSVh7 For: Nouse. ife

For:

workers and other persons except nou.ge.ives

and Chi Idren

f. C6nnot keep house at SI1 at present,

i. C=not work at all at. present

2. Can keep house but Iimitid in momt or kind of

2. CilII work but limited i“ Zmou”t or kind of work. housework.

3. W keep house but Iim.tted in out8ide activities,

3. - Work but limited in kind or munt of outside

Cctivitla.

4. Oot limited in w of these WS.

4. Not limited in w of these WWS.

Smrd s Card F

NATIONAL HEALTN SURVEY

NATIONAL HEALm SURVN

For: Children under s years old

For:

Children from S to 16 years old and others

Eoillg to school

1. Cannot go to school at all at present time.

i. &nnot take tsrt at 811 in ordinary play with other

children.

2. Can go to school but limited to certain tries of 3. Can 91W with other cbildre” but limited i“ W“”t

schoo 1s or i“ SChool atte”d~Ce. or kind of DIZY.

3. an go to school bnt limited in other activities. 4. Not limited in any of these WWS.

4. Not limited in w of these savs.

1 I

curd H

NATIONAL HEALTIi SURVEY

Family income during past IZ ■onths

1.

2.

3.

4.

5.

6.

7.

8.

9.

Under $500 (I”cludi”g loss)

$500 - $999

$i.000 - $i#999

$2.000 - $2,999

$3,000 - $3,999

$4,000 - $4,999

$5,000 - S6.999

$7.000 - $9, s99 “

$10.000 and over

38

. .

*U. S. GOVERNMENT PRINTfNGOFFiCE :1965 0- 775-6S0
.

,. .,

REPORTS FROM THE NATIONAL CENTER FOR HEALTH STATISTICS

Wlic Health Service Publication No. 1000

Series 1. Pmarams and collection procedures

No. 1. Origin, Pmgrzm, and Operation of the U.S. National. Health Survey. 35 cents.

No. 2. Health Survey Procedure: Conce@, Questionnaire Development, and Definitions in the Health Inkrview Survey. 45 cents.

No. 3. Development and Maintenance of a National Inventory of Hospitals and Institutions. 25 cents.

No. 4. Plan and Initial Program of the Health Examination Survey.

Series 2. Dats evaluation and methods research

No. 1.

No. 2.

No. 3.

No. 4.

No. 5.

No. 6.

No. 7.

No. 8.

No. 9.

No. 10.

Comparison of Two-Vision Teeting Devices. 30 cents.

Measurement of Personal Health Expenditures. 45 cenk.

The One-Hour Glu@se Tolerance Test. 30 cents.

Comparison of Two Methods of Constructing Abridged Life Tables. 15 cents.

4n Index of Health: Mathematical Models.

Repoting of Hospi tzli zation in tie Health Interview Survey.

Health Intsrview Responses Compared Witi Medical Records.

Comparison of Hospitzdization Re~rting in Three Survey Procedures.

Cooperation in Health Examination Surveys.

Hospikl Utilization in the Last Year of Life.

series 31 Analytical studies

No. 1. The Change in Mortality Trend in the United States. 35 cenk.

No. 2. Recent Mo*lity Trends in Chile. 30 cents.

Series 4. Documents and committee reports

No reporta to date.

Series 10. Data From the Health Interview Survey

No. 1. Acute Conditions, Incidence and AsecciaWd Disability, United Ststes, July 1961-June 1962. 40 cents.

No. 2.

No. 3.

No. 4.

No. 5.

No. 6.

No. 7.

No. 8.

No. 9.

No. 10.

No. 11.

No. 12.

No. 13.

No. 14.

No. 15.

No. 16.

No. 17.

Series 11.

No. 1. Cvcle I of the Health Examination Survey: .Ssmple and Response, United States, 1960-1962. 30 cents.

Family Income in Relation to Selected Health Characteristics, United States. 40 cents.

Length of Convalescence Aftsr Surgery, Uni@d States, July 1960-June 1961. 35 cents.

Disability Days, Unitad Sta@s, July 1961-June 1962. 40 cents.

Current Estimaks From the Health Interview Survey, United States, July 1962-June 1963. 35 cents.

Impairments Due @ Injury, by Class and Type of Accident, Uni@d States, July 1959-June 1961. 25 cents.

Disability Among Persons in the Lahcr Force, by Employment Status, United Stabs, July 1961-June 1962. 40 cents.

Types of Injuries, Incidence and Associated Disability, United States, July 1957-June 1961. 35 cents.

Medical Care, Health Status, and Family Income, United States. 55 cents.

Acute Conditions, Incidence and Associated Disability, United States, July 1962-June 1963. 45 cents.

Health Insurance Coverage, United States, July 1962-June 1963. 35 cents.

Bed Disability Among the Chronically Limiti, lJnited Sktes, July 1957-June 1961. 45 cents.

Current Estimates Fmm the Health In@rView Survey, United States, July 1963-June 1964. 40 cents.

Illness, Disability, and Hospitalization Among Veterans, United Ststes, July 1957-June 1961. 35 cents.

Acute Conditions, Incidence and Associated ~isability, United States, July 1963-June 1964.-40 cents.

Health Insurance, Type of Insuring Organization end Multiple Covera~, United-Ststes, July 1962-June 1963. 35 cents.

Chronic Conditions and Activity Limitations, United Stabs, July 1961 -June’1963. 35 cents.

Data Fmm the Health Examination Survey

No. 2.

No. 3.

No. 4.

No. 5.

No. 6.

No. 7.

No. 8.

. No. 9.

Glucose Tolerance of .Adults, United States, 1960-1962. 25 cents.

Binocular Visual Acuity of Adults, United States, 1960-1962. 25 cents.

f3100d Pressure of Adults, by Age and Sex, United States, 1960-1962. 35 cents.

Bleed Pressure of Adults, by Race and Region, United States, 1960-1962. 25 cents.

Heart D]sease in Adults, Uniti St*@s, 1960-1962. 35 cenb.

Selec@d Dental Findings in Adults, United States, 1960-1962. 30 cents.

Weight, Height, and Selected Body Dimensions of Adults, United States, 1960-1962.

Findings on the Serologic Test for Syphilis in Adults, United States, 1960-1962.

S*“ a 12. Data From the Health Remrds Survey

No reports to date.

Series 20. Data on mortality

No reprts @ date.

Series 21. Data on natality, marrisge, and divorce

No. 1. Natality Statistics Analysis, United Sts@s, 1962. 45 ctirrts.

No. 2. Demo~aphic Characteristics of Persons Married Rvtwecn January 1955 and June 1958, United States. 35 conls.

Series 22. Data fmm the program of sample surveys related to vital rcmrds.

No reports to date.