PROPERWOFI’M? NATIONAL CENTER Series 2 

For HEALTH STATISTICS INumber 23 

PUBLICATtON$
 EMAN8~


EDUOWU UBfi.#iY 

VITAL and HEALTH STATISTICS 

DATA EVALUATION AND METHODS RESEARCH 

Interview Data on ChronicConditions 

Compared With Information 

Derived From Medical Records 

A methodological study of the completeness and accuracy with which 

chronic conditions are reported by health plan enrollees in household 

interviews as compared with information recorded by physicians. 

Washington, D.C. May 1967 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION, AND WELFARE Public Health Service 

John W. Gardner Wil Iiam H. Stewart 

Secretary Surgeon General 
. 

* 

Public Health Service Publication No. 1000-Series 2-No. 23 

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

Washington, D.C., 20402 - Price 55 cents 
NATIONAL CENTER FOR HEALTH STATISTICS 

FORREST E. LINDER, PH. D., Director 

THEODORE D. WOOLSEY, Deputy Dzrector 

OSWALD K. SAGEN, PH. D., Ass.zstant Director /or State Relations


WALT R. SIMMONS, M.A., Statistical Advisor


PIHLIP S. LAWRENCE SC.D., Pluming O//icer


ALICE M. WATERHOUSE, M.D., Medzcal Consultant


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


LOUIS R. STOLCIS, M. A., .Execzftzve O//zcer


DONALD GREEN, in/orrnation O//zcer


OFFICE OF HEALTH STATISTICS ANALYSIS 

I WAOM. MORIYAMA,PH. D., l)ifec~o~ 

DIVISION OF VITAL STATISTICS 

ROBERT D. GROVE, PH. D., ~irec~o~ 

DIVISION OF HEALTH INTERVIEW STATISTICS 

ELIJAH L. WHITE, A.M., Director 

DIVISION OF HEALTH RECORDS STATISTICS 

MONROEG. SIRKEN, PH. D., Direct-r 

DIVISION OF HEALTH EXAMINATION STATISTICS 

ARTHUR J. MCDOWELL, Director 

DIVISION OF HEALTH RESOURCES STATISTICS 

SIEGFRIED A. HOERMANN, Director 

. 

DIVISION OF DATA PROCESSING 

LEONARD D. MCGANN, Director 

Public Health Service Publication No. 1000-Series 2-No. 23 

Library of Congress Catalog Card Number 67-60023 
I


FOREWORD


I A continuing concern and effort of the National 

Center for Health Statistics has been to better r 

assess the effectiveness of its survey data collection mechanisms. Through the means of household I

&	 interviews, examination surveys, and record surveys, a large variety of data, some of it o~er -

lapping, has been collected. Program plans and 

objectives have made it imperative that research 

be conducted to evaluate the strengths and weaknesses of the various surveys and thus to concentrate the efforts on those objectives best performed in each particular survey. 

Important questions with respect to interview 

surveys have continued to be: How complete is 

the reporting of chronic conditions by household 

respondents? and What is the value of condition 

data collected by household interviews? A large 

scale study was conducted in collaboration with 

the Health Insurance Plan of Greater New York 

to compare the information collected in household 

interviews with that found in existing medical 

records. (See Health Inteyview Responses Compared With Medical Records, PHS Pub. 1000-Series 2, No. 7.) This study probed many facets of the 

agreements and disagreements to be found in such 

comparisons. It also indicated the need for a more 

sophisticated study plan which would utilize a 

prospective record source designed to control 

for differences in communication between physician and patient, for the duration of the condition, 

and for some measures of the impact of the condi0 tion as correlates of the measures of completeness 

of reporting in health interviews. 

Such a study was planned as a contract project with the extensive collaboration of the Stan­ * 

ford Research Institute, the Kyiser Foundation 

Hcolth Pl:in (Southern California Region), Southern 

California l?errnanente Medical Group (SCPMG), 

the Bureau of the Census, and the National Center 

for Health Statistics. This report is a description 

of the study in which the chronic illnesses and 

impairments reported by a sample of persons in 

household interviews were compared with the 

chronic illnesses and impairments found in specially prepared medical records. The study population consisted of a sample of members of a 

prepaid medical and hospitalization plan. 

The general objectives of the study were: 

1.	 Ascertaining the extent of reporting by 

respondents in household interviews of 

conditions for which medical care was 

sought over a period of 12 months. 

2.	 Relating the extent of reporting of conditions to some measures of communication 

benveen physician and patient; to the 

relative impact of the condition, such as 

duration, number of physician visits; and 

to type of treatment. 

3.	 Experimenting with different versions of 

the health interview questionnaire. 

Dr. William G. Madow of the Stanford Research Institute served as project officer for this 

study and was responsible for the preparation of 

this report. Mrs. Louise BOUOserved as nosologist, and Mrs. Geraldine Gleeson performed 

major editorial service in preparing the report 

for publication. The author’s acknowledgments at 

the end of this report indicate the large-scale 

cooperation necessary to carry out a project 

of this magnitude. 

Elijah L. White, Director, 

Division of Health Interview 

Statistics 

i 
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CONTENTS


Page 

Fore\vord


Introduction


Background and Objectives


Summary of Conclusions and Recommendations


Perspectiveon Conclusions and Recommendations


Reporting ofChronicConditions


Content of Questionnaires


~eRespondent


Differences in Reporting


~e Physician -


Record-Check Studies ­


~eStudy Desi~-----------------------------------------------------­


~eRespondent


h4edical Records andQuestiomaires


N1edical Records


The Questionnaires


Obtaining the Medical Records and Questiomaires


Concepts and Measurements


Introduction -


Sources of Information on Chronic Con&tions


Definition ofa Chronic Condition


The Measurement ofChronicConditions


Reporting of ChronicConditions


Overview


Differences in Reporting ofChronicConditions--


Questionnaires


DemographicCharacteristics


Communication Between Physician andPatient


Frequency and Recency ofPhysicianVisits


Attitudes of theRespndent


Impact oftheCondition


Class of Chronic Conditions andChecklist Status


Acknowledgments


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CONTENTS—Con. 

Page 

Detailed Tables 26 

Appendix I. Questionnaires, PVR, and PVRS --------------------------- S3 

Appendix II. Diagnostic Recode Number 3------------------------------ 79 

Appendix III. Sampling Desi~----------------------------------------- 82 

Introduction 82 

Family Account Numbers and Medical RecordNumbers at KFHP 82 

Population 82 

Selection and Assignment to Interviewers of the Interview Sample 82 

Interview Sample forwhich PVR’s Were Notl.Jsed 84 

I Category nonapplicable . . . I 

Quanti~ zero -

I Quantity morethan O but less tban O.05---- ().() I 

Figure doesnot meet standards of * reliabilityor precision 
I 

THIS ISA REPORT Jwcpaveci by the Stanfor~ Reseavch Institute aescvibing the plan, conuuct, ana findings of a contract veseaych study designed to mea.wwe the accuyacy and completeness of the vepovting of 

chronic conditions in a health inteniew. 

The sample population was selected from membe?w of the Kaise~ Fownaation Health p~an, a large prepayment medical plan pYoviding medical 

se?wices thvough the SoutheYn California PeYmanente Medical GYoup 

(SCPMG) and hospitalization .tJwough the KaiseY Plan. In the study meaica~ Yecovds were compayed with responses made in interviews foy the 

same persons as those foy whom the recoyds weve rnaintainea. 

In oYciev to GOndUCt this vecord-check study on a prospective basis, 

?nedica~ veto?’ds weve c?’eated especially foy the study thvough the use 

of We Physician Visit Record (P VR), a fo~m which was completed by the 

attending physician aftey each patient visit duying a 12-month peyiod. 

Information recoyaed on the foym included the communication between 

the patient and the physician, the physician~s estimate of the onset and 

it?tpact of conditions, as well as the type of medical t~eatrnent gien. 

In the inteyview phase of the study, thyee altevnate foyms of a health 

questionnaire we~e used. Although the questionnaires me~e diffeYent in 

seve~al important Yespects, the overall differences in the Yepovting of 

conditions inch,tded in the medical Yeco?’ds weye not large enough to be 

important. 

Fi?zdings in the stwty inuicate that Yespomzents in a health intevview tend 

to vepovt comtitions that aye impoytant to them—i. e., conditions that aye 

seveye, costly, OY ~equiye tveatment. DifleYences in YepoYting of conditions in the inteyview weYe associated with difleyences in communication between physician and patient. The numbey and Yecency of medical 

visits foy a condition weye factoys closely Yelatett to the YepoYting of 

conditions. Recent impact of a condition, such as pain, emotional styess, 

or days in bed, had a gyeatey effect on Yepo?7ing than did the moye geneVa~ tJpeS of impact— e.g., routine medication OY Restrictions in diet. 

Analysis of reporting Differences is p?’esented in this study by demographic chayactevistics of Yesponaents as well as by behavioral and 

attitudinal vayiables. 
INTERVIEW DATA �N CHRONIC CONDITIONS


COMPARED WITH INFORMATION DERIVED 

FROM MEDICAL RECORDS 

William G. Madow, Ph. D., Staff Scientist, StanfovU Research Institute 

INTRODUCTION 

Background and Objectives 

Background. -4 the National Health Survey 

Act of 1956, Congress authorized a continuing 

program of health surveys to be carried on by the 

Public Health Service to provide reliable and comprehensive statistical information on the health 

conditions of the U. S. population and related socioeconomic circumstances and problems. The act 

refers specifically to surveys by household interview methods and explicitly instructs the Public 

Health Service to conduct special studies for 

improving survey methodology and for developing 

new techniques and other types of health surveys. 

Since July 1, 1957, the National Health Survey 

of the National Center for Health Statistics has, 

week by week, conducted “a household interview 

survey that covers 36,000 to 42,000 households 

annually. The inhabitants of these households constitute a probability sample representative of the 

civilian, noninstitutional population of the United 

States. Interviews in these households provide the 

National Health Survey with the data on illness, 

disability, and accidental injury that are necessary 

for making and publishing national estimates on the+ 

prevalence of disease and associated disability 

together with pertinent health care and socioeconomic information. 

Because of the importance of morbidity and 

disability due to chronic conditions in modern 

public health programs, the ability of the National 

Health Survey to measure morbidity and disability 

is obviously a matter of particular concern: It has 

been long recognized that only limited accuracy 

and completeness in reporting chronic conditions 

can be achieved in an interview survey. Some 

chronic conditions have considerable effect on the 

person who has them and tend to be well reported 

while other chronic conditions have little effect 

and tend to be rather poorly reported. In 

order to improve the reporting of conditions, it is necessary to know how well the 

reporting is done ancl what factors affect it. In 

spite of all these problems, the reporting of 

chronic conditions in an interview survey provides not only indicators of prevalence and changes 

in prevalence but also a means of investigating the 

association of chronic conditions with personal, 

social, or economic variables related to an individual or his family. To this end, the National 

Health Survey commissioned the Health Insurance 

Plan of Greater New York (HIP) to do a contract 

study 1 in which the problems of household interview reporting of chronic disease would be 

studied through the comparison of responses of a 

representative sample of the membership who had 

1

National Center for Health Statistics: Health interview 

responses compared with medical records. Vital and Health 

Statistics. PHS Pub. 1000-Series 2-No. 7. Public Health Service. Washington. U.S. Government Printing Office, July 1965. 
been given a household interview survey with information on the medical records at HIP for the 

same sample of persons. While this study yielded 

valuable information, it was desirable both to 

confirm its findings with a different population 

and to study additiemal related topics which were 

outside the scc@e of the HIP study. 

With these objectives, the National Health 

Survey contracted with Stanford Research Institute to do a study on responses to health interviews 

as compared with medical records. The study was 

planned as a prospective record-check study —i.e., 

a study in which entries in records are compared 

with responses made in interviews by the same 

persons for whom the records are’ obtained. 

The medical records were to be created especially for the study through the use of a form— 

the Physician Visit Record (PVR) (Appendix I)— 

that was to be filled out by the physician after each 

physician-patient interview. Information recorded 

on the form was to include a resum~ of the 

communication between the patient and the physician, the physician’s estimate of the onset and 

impact of conditions, as well as the type of medical treatment given. 

The population used for this study was a 

sample of the members of the Kaiser Foundation 

Health Plan (KFHP), Southern California Region— 

a large prepayment medical plan providing medical services through the Southern California Permanence Medical Group (SCPMG) and hospitalization through Kaiser Foundation Hospitals. To be 

included in the sample, members must: 

Have been members of the Kaiser Foundation 

Heal~h Plan during the period January through 

June 1960 

Have been members during the period for 

which the medical records were prepared 

and not to have moved out of the service 

area of KFHP before the interviewing period 

started 

Not have been in hospitals or institutions 

during the interviewing period 

Not have been employees or members of the 

families of employees of KFHP 

In summary, they must have been members of 

KFHP throughout the period on which the sample 

was based as well as during the study year and the \ 

following period in which interviewing took place, I in accordance with the requirements listed above. 

Specific objectives. —The specific purposes 

for which the current study was conducted were as 

follows: 

To provide information on the completeness 

and accuracy with which chronic conditions 

for which the patient had received medical 

advice and treatment were reported in interviews 

To learn why conditions were not reported 

and to what extent nonreporting was related 

to such factors as the following: 

1.	 The information provided to the patient 

by the physician 

2. The nature of the condition 

3.	 Whether or not the condition resulted 

in any inconvenience or discomfort to 

the patient or required him to take 

special steps such as specific treatment, medication, or diet 

To determine the comparative efficiency of 

three versions of the interview questionnaire 

in improving the reporting of chronic conditions 

SUMMARY OF CONCLUSIONS AND 

RECOMMENDATIONS 

Perspective on Conclusions and 

Recommendations 

In all of the record-check studies sponsored 

by the National Health Survey it has been difficult 

to replicate the procedures and population composition of the interview survey. For this reason, 

recommendations based on these studies must be 

tested under the conditions of the survey itself before a complete evaluation of their efficiency can 

be made. 

The present record-check study is no exception. Although the recommendations are stated 

2 
I 

I 

1. 

1. 

positively, this is done more to be specific than 

to imply that evidence from a single record-check 

study can be conclusive. 

One major difficulty in studying the reporting 

of chronic conditions in interviews is that in contradistinction to other problems of definition the 

layman’s notion of a chronic condition is, perhaps, 

more appropriate than the medical definition. Indeed, one might guess that a layman would report 

a condition in an interview only if it was in some 

sense important to him while the medical record 

would include many minor conditions that are relatively easy to live with—conditions which are 

recognized when brought to one’s attention but 

which remain very much in the background in the 

absence of an acute episode. 

Another factor in any record-check is the 

content of medical records. In any visit, the physician will list on a patient’s chart the conditions 

that are active, and he may or may not list other 

conditions that are present but inactive at the time. 

Among the latter are conditions that have never 

been problems for the patient. The words “same 

as” followed by a previous date of visit entered 

on medical records may not really mean that all 

the conditions were active on each date. Physicians 

will differ considerably in the completeness and 

consistency of the entries they make on medical 

records as well as in the thresholds they use in 

claiming that a patient has a condition. 

For all these reasons, instructions for 

record-check studies of medical conditions should 

state precisely what conditions are to be recorded 

or what characteristics a condition must have for 

inclusion in the medical record. In the present 

study it was in some instances necessary to decide 

during the coding of the medical records whether 

or not a condition was chronic. 

Reporting of Chronic Conditions 

The concept of a chronic condition embraces 

such a great variety of conditions that even if the 

total number of chronic conditions appears to be 

well reported, it is necessary to determine 

whether certain types of chronic conditions are 

well reported and whether other types are’ poorly 

reported. 

The reporting of chronic conditions should be 

studied on the basis of a number of variables that 

describe the impact of the conditions rather than 

studied as a single entity -e.g., the total number 

of chronic conditions. Listed below are some of 

these variables. 

1. Type of condition 

2.	 Number of visits to a physician for the 

condition 

3.	 Effects of conditions on behavior and 

emotions 

4. Costliness of condition 

5. Seriousness of condition 

6.	 Understanding by the respondent that he 

should repor~ conditions even though they 

are relatively unjrnportant 

7. Willingness to repor~ chronic conditions 

The reporting of these auxiliary variables 

would in itself be subject to error, but the variables could be used to da&ify the reported conditions. 

The adoption of the point of view stated above 

would have several effects on questionnaire construction. More space would be allocated on 

questionnaires for variables associated with reporting such as those mentioned akove. Changes 

in the levels of and the relationships between 

auxiliary variables and chronic conditions over 

time might serve as signals indicating possible 

changes in the numbers or types of chronic conditions or in the reporting of chronic conditions. 

It will be noted that this report emphasizes 

the study of how well conditions in the medical 

records are reported in interviews. It does not, 

however, consider conditions reported in the interview but not on the medical records. Thus, 

only gross rather than net differences between 

medical records and interviews are estimated. 

To estimate the net differences, it would be necessary to study separately the sample persons 

who received only SCPMG medical and hospital 

services. 

It is difficult to determine if respondents are 

consciously underreporting when they report 

3 
having seen a physician in the past 12months for 

only 90 percent of the chronic conditions which, 

according to the records, had been medically attended during that period. On the other hand, even 

among persons who used only SCPMG services, 

there were many chronic conditions reported in 

the interview questionnaire for which the respondent said he had seen a physician in the past year, 

but these conditions were not found in the medical 

records. 

Content of Questionnaires 

Although the three alternate forms of the 

questionnaires used in the interview phase of the 

study (see Appendix I) were different in several 

important respects, the overall differences in the 

reporting of conditions included on the medical 

records were not large enough to be important. 

Furthermore, when additional questions designed 

to elicit the reporting of conditions were asked 

before the checklist of chronic conditions (see 

Appendix I) were read, the major effect was to 

reduce the number of conditions reported in response to the checklists with the result that the 

total percentage of nonreporting, although somewhat less, was not greatly reduced. 

From the findings of the study, it is recommended that consideration be given to a questionnaire that would embody the following concepts: 

1.	 Since respondents tend to report conditions that are important to them-conditions that are severe, costly, or require 

many visits and treatment-a checklist 

that contains these conditions is sufficient 

to elicit them from the respondent. 

2.	 The respondent should be made aware that 

the survey covers all conditions even if 

they are unimportant, or not troublesome, 

or may seem to have ceased or even to 

have been cured. 

Respondents seem willing to state the conditions they know about and that they believe the survey would want to know about. 

But the borderline between the respondent’s knowing and not knowing that he has 

a condition that should be reported is 

vague. Cues to improve memory and to 

indicate that unimportant conditions 

should also be reported are likely to improve such reporting; at the same time 

the reporting of more important conditions 

should improve. 

It must also be recognized that responsibility for the nonreporting of conditions 

of lesser importance lies to some extent 

with the interviewers. When respondents 

complain about the questionnaire and assert that the y have no chronic conditions, 

there is a tendency for interviewers not 

to press the respondents. 

3.	 An attempt should be made to collect 

auxiliary information pertinent to conditions, such as visits to doctors for the 

condition and impact of condition. 

Since information relative to conditions 

might be obtainable only from persons 

interviewed for themselves (persons to 

whom the information refers), consideration should be given to a questionnaire 

providing for additional information to be 

obtained in this manner for a random subsample of members of the households, 

Information relative to the number of extra 

calls necessary to interview specified 

persons indicates that the number of such 

calls is not unusually large. 

4.	 A classification of diagnostic codes to replace or supplement Recode 3 should be 

undertaken based on some formal criteria such as seriousness or costliness of 

the condition. The classification might be 

a combination of major condition groups 

with a minor group for each condition 

according to seriousness of the condition. 

Recode 3 is a summary list of chronic 

conditions consisting of 47 disease categories that is used in the tabulation of 

material collected in the Health Interview 

Survey. For inclusions in Recode 3, see 

Appendix II. 

At present the checklists are mixtures of 

conditions that are well reported and 

4 
conditions that are poorly reported. The 

coding of conditions in this study makes it 

difficult to investigate reporting within 

these checklists. It would have been pref ­

erable if the coding of the source of 

conditions in table C- 1 of the questionnaire 

(see Appendix 1) could have included some 

clue to the location of the condition in the 

checklists—e.g., the numerical order in 

which the conditions appear rather than 

only whether or not the condition is on 

the checklist. It was helpful that the 

checklists used in two of the questionnaires had Checklists A and B coded 

separately even though the experiment 

which necessitated this detail in coding 

did not prove to be useful. 

The Respondent 

It seems evident that so far as the reporting, 

of chronic conditions is concerned the biases of 

reporting are larger than the sampling errors. 

The reduction of such biases by use of at least 

a subsample in which each person reports for 

himself and provides additional information, as 

suggested above, would seem to merit further investigation within the regular survey sample. 

Because respondents seem more likely to err 

through misreporting than through refusing toreport, an effort should be made to analyze the data 

of this study to see what proportion of the chronic 

conditions not reported in the interview was among 

persons who said that they had not seen a physician when the medical records indicated that a 

physician had been seen. 

Differences in Reporting 

Although the differences in reporting seemed 

.	 to .be logical in terms of the differences among the 

three types of questionnaires used in the study, the 

magnitude of the differences were not large enough 

to indicate that a substantial improvement in re- m porting would result from choosing the questionnaire yielding the best results. 

Differences in reporting were associated to 

some extent with differences in communication 

between physician and patient. However, communication between physician and patient seems to 

have a greater influence on the accuracy with 

which the patient describes his condition rather 

than on whether or not the patient will report his 

condition in the interview. If a patient sees a physician often, communication as it becomes cumulative is likely to be adequate. 

The number of chronic conditions a respondent has in his medical record does not seem to be 

closely related to how well his conditions are 

re~rted. Usually, people have only a few conditions that are serious or important to them, and 

these are the conditions that tend to be most completely reported. 

The number and recency of medical visits for 

a condition are factors closely related to the 

reporting of conditions. This is not surprising 

since these factors are related to memory as well 

as to the importance of the condition. Consideration should be given to basing supplementary 

estimates of prevalence of chronic conditions on 

conditions asserted to have been symptomatic 

recently—say, in the preceding 2 weeks or month— 

with adjustments based on the number of visits 

for these conditions. The use of estimates based 

on recent occurrence could only be “undertaken on 

some average basis since relatively few conditions 

will have led to visits in the past 2 or 4 weeks. The 

analysis by number of visits is primarily based on 

visits for a specified condition rather than on visits 

by the respondent for all his conditions. (Preliminary findings in this study indicate that the latter 

is not as closely related to reporting as the 

former.) 

There are some respondents who do not wish 

to report their conditions. This unwillingness is 

not reflected in a high refusal rate since few 

respondents refuse to participate and few terminate an interview once it has begun. Rather, 

their unwillingness takes the form of pretending 

to cooperate. In the present study, there was one 

indication of willingness to cooperate that was 

probably closely related to the accuracy with which 

the respondent felt he had reported-namely, the 

willingness to sign an authorization for the 

examination of his medical records by the National 

Health Survey. The relatively few who did not 

sign the authorization reported more poorly than 

those who did sign. (By deleting names and 

addresses and by using only codes it was possible 

to make this comparison without identifying the 

respondents.) 

5 
If a respondent has a condition which has 

caused him to eliminate certain kinds of foods or 

beverages from his diet, has required medication 

or treatment, has caused him pain or discomfort 

or if he has a health problem that worries him or 

his family or limits him in his work, such a 

condition is more likely to be reported in the 

interview than one which has had none of these 

“impacts.” However, the effects of these impacts 

are not large unless more than one of them 

have o~curred. The number of such people as well 

as the number of conditions they have is small. 

Similar results occur when conditions are 

classified by whether the respondent according to 

the physician, ,has pain, emotional stress, days in 

bed, or some other impact of a condition during the 

week preceding the visit on which the physician is 

reporting. Recent impact of the condition seems to 

have a greater effect on reporting than ddthe more 

general types of impact described in the preceding 

paragraph. 

The Physician 

Practically all of the physicians at SCPMG 

participated in this study. The study took little of 

the individual physician’s time, even at the maximum accidental heaping of visits that might occur 

for persons in the sample. 

A high proportion of physicians cooperated 

fully throughout the project. Yet when the Physician Visit Records (PVR’S) were examined and 

when small samples were checked against the 

entries made by ph~sicians in the patient charts, 

it was clear that the instructions to the physicians 

were not being carried out as fully as desired. 

It might have been desirable to have had an 

advisory committee of the physicians meeting 

from time to time with the project personnel 

(at least in the early phases of the study) to discuss problems of mutual concern. 

Record-Check Studies 

Record-check studies are difficult but useful 

endeavors. They require, however, extensive 

periods of planning, especially when records are 

to be created for the purposes of a study. Unless 

the records can be viewed as accurate, their 

variability and bias must also be reflected in the 

design. When records are available and when no 

better method of evaluating interview data is 

available, record-checks should be undertaken 

if they are feasible. Whatever the definitions and 

procedures used, the record-check study does 

help to solve some of the problems involved in the 

survey method. 

THE STUDY DESIGN 

The study design includes such factors as the 

respondent and sample, data obtained for each 

member of the sample, and procedures used in 

obtaining the data. 

First, the choice of the respondent is discussed. Next, the data obtained for each respondent 

in the main portion of the study are outlined. Finally, the steps in obtaining the data for the respondent are. given. ”The selection of the sample is 

discussed in Appendix III. 

The Respondent 

The sampling unit in this study was the person, 

not the household. Special medical records were 

created for the persons in the sample. Each person 

in the interview sample was to be interviewed 

concerning his own health; no proxy respondent 

was accepted for the questions dealing with the 

health of the sample person. 

At one stage in the planning of the study, 

interviews were contemplated that would include 

data not only for the sample person but also for 

other members of the household of the sample 

person. It was decided at the end of the pretest, 

however, that it would be preferable to conduct a 

study in which each sample person would be 

interviewed for himself only. There were two 

reasons for this choice: (1) a person should know 

his own cortditions better than a proxy respondent 

would and (2) it was believed that data obtained 

from a person responding for others as well as for 

himself would be poorer. For these reasons, information on illness was obtained only for the sample 

person.. 
I MEDICAL RECORDS AND 

I QUESTIONNAIRES 

I Medical Records , 

A form-the Physician Visit Record (PVR)– 

was filled out by the physician for each person in ~ the sample after each visit to SCPMG during the 

I study year. (House calls were excluded from the 

study. ) Also, a modified PVR was filled out for ~ each overnight stay, terminating during the study 

I year, in a Kaiser Foundation Hospital. The 

development of the PVR was the subject of a report 

i by Blumberg.2 

I I?VR’S filled out during the study year were 

summarized at the end of the year for each person 

I in the sample. This summary is called the 

I Physician Visit Records Summary (PVRS). (The 

PVR and PVRS are reproduced in Appendix I.) I Thus if a person made eight doctor visits to 

SCPMG and had two overnight hospital stays at a 

Kaiser Foundation Hospital, he would have 10 

PVR’S but only one PVRS. 

For each condition at each visit, the diagnosis 

made by the physician was entered on the PVRS 

at that visit. This was called the visit diagwosis. 

When the PVRS’S were reviewed at the National 

Center for Health Statistics (NCHS), one of the 

steps was to decide what chronic conditions the 

respondent had according to the PVRS. These 

conditions were called final diagnoses. Thus, the 

decisions on final diagnoses were made by the 

medical coding staff at the National Health Survey, 

not by the SCPMG physicians. 

All diagnoses entered by the physicians on the 

PVRS at each visit to SCPMG, were then examined 

in order to determine which visit diagnoses were 

to be associated with each of the final diagnoses. 

For example, at one visit there might be the visit 

a diagnosis hypertension; at another there might be 

~Blumhcrg, M. S.: Development and Testing of a Physician 

Visit Reco~d (PT~R) Form, Report No. 1. SRI Project No. 

w ESU-3G20. Stanford Research Institute. Menlo Park, Calif., 

@ct. 1966. 

the visit diagnosis heart disease. The final 

diagnosis might be hypertensive heart disease, and 

both visit diagnoses would then be associated with 

the final diagnosis. 

The method of showing the association was 

through the assignment of 4-digit diagnostic codes 

using the National Health Survey adaptation of the 

International Classification of Diseases (ICD) 

codes. A 4-digit code was assigned to each 

diagnosis made at each visit and entered in a 

specified column of the PVRS for that diagnosis 

at that visit. 

The visit diagnostic codes were entered for all 

conditions, chronic or acute. However, only 

chronic final diagnoses were identified and used 

in analysis. The 4-digit NHS-ICD code of the final 

diagnosis was entered in a column of the PVRS 

that was different from the column used for the 

visit diagnosis. That same 4-digit NHS-ICD final 

diagnosis code was entered in the final diagnosis 

column for each visit diagnosis identified as a 

visit for the condition represented by the final 

diagnosis code. 

Thus, each diagnosis at each visit was identified as chronic or acute, and, if chronic, was 

associated with a specific final diagnosis. A single 

final diagnosis code mignt thus be associated with 

several visit diagnosis codes. 

The Questionnaires 

Three questionnaires were used in the study. 

The questionnaires, each of which was used in the 

interviewing of one-third of the sample, differed 

for the most part in the format and administration 

of the sections relating to chronic conditions. 

The basic questionnaires are reproduced in Appendix I. In the following description, the excerpts 

shown exemplify the principal variations in the 

three versions of the questionnaire. 

Questionnaire l.– The initial illness-recall 

auestions and table C-1 in Questionnaire 1 ‘were 

quite sirnjlar to comparable sections on the form 

used in the Health Interview Survey. 

7 
9.	 Were you sick ot any time LAST WEEK OR THE WEEK BEFORE? (That is, the m Yes n No
 2-week period which ended this past Sunday night.)


a. What was the matter?


b. Anything eise?


10. Last week or the week before did you take any medicine ar treatment for any a Yes u NO


condition (besides . . . which you tald me about)? 

a. For what conditions?


b. Anything else?


11. Last week or the week before did you have any accidents or iniuries? ~ Yes m No


a. What were they?


b. Anything else?


12.	 Did you ever have an (any other) accident or iniury that still bothers you or n Yes n No


affects you in any way?


a. In what way does it bother you? (Record present effects)


b. Anything else?


m Yes m No 

13. Have you had any of these conditions DURING THE PAST 12 MONTHS?


(Read Card A, condition by condition; record any conditions mentioned.) 

Card A 

1. Asthma 15. Stomach ulcer


2. Tuberculosis 16. Any other chronic stomach trouble


3. Chronic bronchitis 17. Kidney stones or chronic kidney trouble


4. Repeated attacks of sinus trouble 18. Arthritis or rheumatism


5. Rheumatic fever 19. Mental illness


6. Hardening of the arteries 20. Diabetes


7. High blood pressure 21. Thyroid trouble or goiter


8. Heart trouble 22. Any allergy


9. Stroke 23. Epilepsy


10. Trouble with varicose veins 24. Chronic nervous trouble


11. Hemorrhoids or piles 25. Cancer


12. Hay fever 26. Chronic skin trouble


13. Tumor, cyst or growth 27. Hernia or rupture


14. Chronic gallbladder or liver trouble 28. Prostate trouble


1 

n Yes D No 

14. Do you have any of these conditions?


(Read Card B, condition by condition; record any conditions mentioned.) 

8 
Deafness or serious trouble with hearing 

Serious trouble with seeing, even when 

wearing glasses 

Cleft palate 

Any speech defect 

Missing fingers, hand or arm—toes, 

foot, or leg 

Palsy 

Paralysis of any kind 

Card B 

8. 

9. 

10. 

11.


12. 

13. 

14. 

15. 

16. 

1. 

2. 

3. 

4. 

* 5. 

6. 

a 7. 

—-

Repeated trouble with back or spine


Club foot


Permanent stiffness or any deformity of


the foot, leg, fingers, arm, or back


Any condition present since birth


Loss of one or both eyes


Loss of breast


Loss of kidney


Loss of lung


Mental deficiency or retardation


I

15.	 AT THE PRESENT TIME do you hove any other ailments, conditions or problems 

with your heolth? 

I o.	 What is the condition? (Record condition itself if still presenq otherwise record 

present effects. ) 

b. Any other problems with your health? 

18.	 a. Have you been in a hospital at any time during the past 12 months? 

If “Yes,” ask: 

b. How many times were you in the hospital during thot period? 

19.0.	 Have you been a potient in a nursing home, rest home, or any similar place 

during the past 12 months? 

If “Yes,” aslc 

b. HOW many times were you in a nursing home or rest home during that period? 

= Yes n NO 

m Yes m No 

No. of times 

n Yes a No 

No. of times 

n Responded for self 

o5P

the information on hosgroup of supplementary 

9 

R 

On the 

administered 

* mation on 

18 and 19 

For non-sample persons 17 years old or over, show who 

~~~$~ & ~e~ll. .
 For Wsons 

[ 

completion of table C-1, table H was 

in order to obtain additional inforhospitalizations elicited in questions 

shown above. Table P, which on 

under 17 show who 

Questionnaire 1 followed 

pitalization, included a 

illness-recall questions. 
----

.“.,., 

—. TABLE C-1 (For SP ONLY): Fill oneline of Table C-1 for each con&ion reported in Questions 9-17 for the .%mple Person. 

:.1.	 Que S- Name of condition as Did YOU Ask for all illnesses and 

of 

perNo. y-17 ::m:y (a) If doctor talked to: 

son talk to What did the doctor say 

I&:tm it was? . . . did he give it 

a medical name? 

.4 . . . ? (b) If doccor not talked to: 

tion reported in Quesrions EVER present effects of old injuries: 

required. 

Ask fox ill injuries dtuing 

past 2 weeks: 

What part of the body was 

hurt?


What; kind of iniury WCM it?


Anything else?”


!!(a) !(b)l (c) I (d) ! (e-1) 

Ask oply for: How many 

Impairments and injuries day: did l=!’ha’l%:~:yif in 

Ask 

is: I < . .. . . . Cd. (e-z] 

t includes the words 

An impairment, and blindor mess, p.., Allergy” ~~n;ition, 

a Symptom ::ioll:,ll- ~=p *’Disea.sel* 

‘Trouble” 

if the entry in Col. (~ 1) ~ ‘n’y lA&bfn~~ntryin ~ 

see well What kind of 

enough *Fc
 to read *~~<


ordinary


newspaper Maw An.. ,h
 ... ...0 allergy I 1.xint “with (stroke) affect YOU? 

I 1; glasses?

I (e-2) I (=-3) I (*4) 

past 

“. . ““” . RR” ‘“ ‘d (ik t,.. wh!ch applies) . . . -.-. ”.. Enter moqth During the 

and. year If past 12 

during past months shout 

12 months; how many 

otherwise timer hove 

check you seen or 

“before 12 talked to o 

months” or doctor 

“neverS] obout . . . ? 

box 

m’ ‘-- ‘- ‘---’ ~DaYs1Non.~JJws ‘None [ DaY~ Nonel Yes I NoI Yesho ! (k) I (1) I(ldll x I I I I , l_J l,SC 2 wks, I_J before M/Y_ 

I i 

I 

i 

I 

I 

1 

i U 2 wks.-3 mo. 12 m B. 12 MO. 

D 312 monzbs rmantbs a— Never No. of times , 

~ 

x I 

, 

i I I i n Past 2 V&. m before M/Y—_—___ 

I I I O 2wks.-3m.. 12 0 B. 12 m.. 

I I I I I 03-12 months months a Never No. of times 

g~y ;~$:d~ ::;,:$..: 

::::.’::? fi’st if “Yes’ in ~oL (Check [be first box talk to a diuing 

12

the 

doc~ about 

1 

1 

t 

Qtiestionnaiye 2. —In addition to the changes on 

the checklist which are discussed below, the main 

thrust of Questionnaire 2 was to help the respondent remember conditions by asking in question 

12 whether he had seen a doctor during the past 

year. Questions 13 and 14 asked about the impact 

of the conditions, Question 13 is related to 

question P-1 of table P, a question that asked about 

smoking m addition to food and beverages, and 

question 14 asks whether the person had ever had 

to make any change in his way of doing things because of his health. This is a reinforcement of 

emphasis as compared with question P-5 of 

table P, which asks whether there is a current 

limitation with respect to work for the male and 

with respect to housework for the female. It mav 

10 

I 

2 
---- ----

TABLE P Name of Sample Person 

P-1.	 Have you ever been advised by a doctor to limit the amount or to avoid entirely m Yes n No certain kinds of food or beverages? 

If “yes,” ask: 

o.	 For what reason or condition? a Yes m No b. Are you sti II fallowing this advice? 

P-2. At the present time are you regularly taking any medicine or treatment 

condition? 

for any n Yes m No 

If “Yes,” ask: 

a, For what condition? 

P-3. Do you have any cand}tian which often causes you pain or discomfort? m Yes n No 

If ‘~Yes, ” ask: 

a. What is the condition? 

P-4.	 Da you have any health problem which is a source of worry to you or other members of n Yes n No your family? 

If “Yes, ‘t ask: 

a. What is the problem? 

P-5. (For males): Are you Iimited in any way in the amount or kind of work you can do m Yes a NO 

because of your health? 

(For females): Aro you limited in any way in the amount or kind of hausework you can 

do because af your health? 

If “Yes,” ask: 

a. What condition causes this? 

m Excellent m Good 

P.6. in general, wauld YOU say your health is excellent, good, fair, or poor? m Fair m Poor 

be remarked that the main observable effect of and to a lesser degree to questions 13 and 14 on€

these queptions was that many conditions that Questionnaire 2, which occurred before the check-€

first appeared on the checklist in Questionnaires lists.€

1 and 3 first appeared in response to question 12€

9.	 Were you sick at any time LAST WEEK OR THE WEEK BEFORE? (~hat is, the ‘m Yes m No 2-week period which ended this past Sunday night.) 

a. What was the matter? 

b. Anything else? 

10.	 Last week or the week befare did you take any medicine or treatment far any D Yes n NO 

condition (besides . . . which you told me about)? 

a. For what conditions? 

b. Anything else? 

11. Last week or the week before did you have any accidents or iniuries? a Yes n No 

a, What were they? 

b. Anything else? 

12.	 DURING THE PAST 12 MONTHS, have you seen or talked to a dactar about a Yes a No yourself? —-

If “Yes,” ask: 

a. For what conditions? 

b. Any other conditions? 

11 
--- -- ------

-- -------

--- ----- --

----- -----

13.	 Have you ever had to chonge yaur eating, drinking or s’moking hobits because of ~ Yes m No 

same health condition? -— 

If “yes,” i%Sk 

0.	 Whet condition caused this chonge? 

Record ONLY if not previously recorded and ask 

b. Do you still have this condition? 

14.	 Have you ever had to make any other change in your way of doing things 

because of some health condition? 

If “Yes,” ask 

a. What condition caused this change? 

Record ONLY if not previously recorded and ask 

b. Do you still have this condition? 

—-. -_ 

~ Yes n No (Defete) 

m Yes n No -— 

__ 

D Yes D No (Diet@ 

1s.	 Have you ever had any other illness or inirtry which bothers you or affects you m Yes ~ No in any way? 

o. What are the present effects? 

Hand respondent conditions cnrd with “A” side up sad pencil, then say: D All NO’S 

16.	 Have you EVER had any of the conditions listed on this card? Please check 

“Yes” or “No” for each one listed. O Yes’s (One or more) 

Ask respondent to turn card over (to ‘“B” side), then say: D AH No’s 17.	 Have you had an of these conditions DURING THE PAST 12 MONTHS? 

Please check ‘“#es”’ or “No” for each one listed. m Yes’s (One or more) 

i 

The question relating to Checklist A (Forms check “yes” or “no” for each of the listed —. NHS-S- 13-4 and 5) was “Have you EVER had any conditions. ‘l’he arrangement of the conditions 

of the conditions listed on this card?” The Checklist A of the Questionnaire 2 version 

respondent was given a card with instructions to quite different from that in Questionnaire 

on 

was 

1. 

. 

* 

Card A (Questionnaire 2) 

2: 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

11. 

12. 

— 

Asthma


Tuberculosis


Rheumatic fever


Hardening of the arteries


High blood pressure


Heart trouble


Stroke


Arthritis or rheumatism


Diabetes


Epilepsy


Cancer


Deafness or trouble with hearing


in one or lxith ears 

13. 

14. 

15. 

16. 

17. 

18. 

19. 

20. 

21. 

22. 

Trouble seeing with one or both eyes


even when wearing glasses


Eye cataracts


Glaucoma


Missing fingers, hand or arm


Missing toes, foot or leg


Paralysis of any kind


Permanent stiffness of the foot, leg,


fingers, arm or back 

Any deformity of the foot, leg, fingers, 

arm or back 

Hay fever 

Any allergy 

12 

1 
In Questionnaire2, thequestion referring to bers and Form 5 in households with odd serial 

Checklist (lists of conditions printed on Forms numbers.


NHS-S-13-4 and5) was “Haveyouhadanyo fthese Questions P-2, P-3, P-4, and P-6 were asked


conditions DURING THE PAST 12 MONTHS?” in table P in the same format as that shown for


The respondent was told to check “yes” or “no” Questionnaire 1.


for each one listed. Two versions of Checklist B Qwstionnaiye 3. — This version of the ques­


(shown below) were used Form 4 was admin- tionnaire agreed almost entirely with Question­


istered in households with even serial num- naire 1 except that the checklists and their


Card B (Questionnaire 2) 

Version used in households with even serial numbers (Form 4) 

1. Trouble with varicose veins 14. Intestinal trouble 

2. Hemorrhoids or piles 15. Kidney stones or other kidney trouble 

3. Anemia 16. (Men only) Prostate trouble 

4. Chronic bronchitis 17. (Women only) any trouble or disease of 

5. Attacks of sinus trouble the breast 

6. Chronic colds 18. Speech defect 

7. Chronic tonsillitis or sore throat 19. Serious nervous trouble 

8. Tumor, cysts, or growths 20. Thyroid trouble or goitre 

Q. . Corns, callouses or other foot trouble 21. Migraine headaches 

10. Chronic skin trouble 22. Chronic ear trouble 

11. Hernia or rupture 23. Athlete’s foot (itching feet) 

12. Hepatitis or other liver trouble 24. Chronic back trouble 

13. Stomach ulcer 

Version used in households with odd serial numbers (Form 5) 

1. Trouble with varicose veins 14. Chronic gastritis 

2. Hemorrhoids or piles 15. Kidney stones or other kidney trouble 

3. Swelling of legs due to poor circulation 16. (Women only) Menstrual or menopausal 

4. Other trouble due to poor circulation trouble 

5. Chronic bronchitis 17. Mental illness 

,.6 Attacks of sinus trouble 18. Serious nervous trouble 

7. Tumor, cysts or growths 19. Thyroid trouble or goitre 

8. Rashes or infections of the skin 20. Chronic headaches . 9. Any other chronic skin trouble 21. Chronic eye trouble 

10. Hernia or rupture 22. Any fungus infections


11, Gall bladder trouble 23. Pain or trouble moving hips, legs or


12, Stomach ulcer arms


13. Chronic constipation


13

-------

-------

-------

-------

-------

-------

lead-in questions were the same as Questionnaire 

2. The initial recall questions (questions 10-19) 

in table C-1 and table P were identical to those in 

Questionnaire 1, with the following exceptions: 

(1) Checklists A and B were self-administered 

rather than the interviewers reading the list of 

conditions to the responden~ (2) the lead-in 

questions to Checklists Aand Bandthechecklists 

themselves were of the format described for 

Questionnaire 2. 

Variations in the format and content of the 

questionnaires were included inthestudy so that 

independent estimates of the interview method of 

data collection would be available. Thesimilarity 

‘of Questionnaire 1 tothestandard formusedin the 

Health Interview Survey was retained for two 

reasons: (1) data on conditions elicited in the study 

(excluding table P) would be comparable to data 

obtained in the regular survey and as such would 

serve as baseline estimates for the measurement 

of the yield from the other versions of the study 

questionnaires; and (2) the effectiveness of the 

illness impact questions (table P) in eliciting 

chronic conditions could be evaluated, and the 

total improvement if any could be assigned to the 

addition of these questions. 

Questionnaire 2 represented a new approach 

to the illness-recall problem. Practically all of the 

innovations introduced in this version-e. g., the 

asking of whether and for what condition a doctor 

had been seen during the past 12 months and the 

integrating of impact questions with the standard 

probe questions, the self-administered checklists, 

and the rewording of the checklists—were in contrast to the standard Health Interview Survey 

questionnaire. 

Questionnaire 3 retained the basic approach 

of Questionnaire 1 except for the checklists and 

used the same version of the checklists as 

Questionnaire 2 because that version seemed 

more effective in eliciting conditions from the 

respondents. 

Obtaining the Medical Records 

and Questionnaires 

The population from which the sample was 

selected consisted of members of the Kaiser 

Foundation Health Plan in the Southern California 

Region, together with the participating persons 

in their families who were 17 years of age or 

older at the time of the hv.wehold interviews 

in June 1960 and who had” been members of the 

Health Plan for the 6-month period January 

through June 1960. (The sampling “procedure is 

described in Appendix II.) 

The Kamer Foundation Health PIan, Southern 

California Region, is a large prepayment medical 

plan, providing medical services through a medical group, the Southern California Permanence _ 

Medical Group (SCPMG), and nospitalization 

through the Kaiser Foundation Hospitals. At the 

time of the study there were four Kaiser Foundation Hospitals; since then a fifth hospital has been * 

added. 

The sample drawn from this population consisted of 5,988 persons 17 years and over; the 

distribution of these persons by sex and age is 

shown in the following table. 

Age	 Both Male Female sexes 

All ages---- 5,988 l==&7 

17-24 years 794 434 360 

25-34 years 878 432 446 

35-44 years 1,712 818 894 

45-54 years ‘1,251 641 610 

55-64 years 863 428 435 

65-74 years 4;: 219 211 

75 years and over- 29 31 

For each visit to an, SCPMG physician and for 

each overnight stay in a Kaiser Foundation 

Hospital during the study year, a PVR or modified PVR was filled out by the physician for a 

physician visit and by the survey staff for a 

hospital stay. The information for each diagnosis 

on each PVR was transferred to three punch cards, 

a procedure which permitted the alphabetical “ 

tmnchin~ of diagnoses. 

Besides the entries usually made on the 

patient’s charts by the physicians at SCPMG, * 

such as diagnoses and treatments, the PVR 

included such items as the terms used bv the 

patient in informing the physician of his ai~ent, 

the terms used by the physicians in discussing 

the condition with the patient, the time when the 

patient first became aware of the condition, the ex14 
tent to which the patient had had inconvenience or 

suffering during the week preceding the physicianpatient interview, and the emphasis given by the 

physician to the patient’s condition during the 

physician-patient interview. Finally, information 

was recorded on specific categories of actions 

that the physician took, recommended, or considered. 

An overaH check on the completeness of 

filling out the PVR’S for each patient visit to a 

* physician was provided by the Clinic Processing 

Record (CPR). The CPR, which included the 

Medical Record Number, was filled out at the 

‘?	 receptionist’s desk in each clinic when the patient 

entered for a visit. The CPR’S were punched on 

cards, and listings of all CPR’S for persons in the 

PVR sample were made each week. The PVR’S 

und CPR’S listings were matched each week to 

insure that the PVR’S were being filled out. 

Because of the time required for processing the 

CPR’S, this check was usually made during the 

third week after the week for which the comparison was made. If a PVR was missing on the basis 

of the CPR check, an effort was made to have the 

PVR filled out, usually from entries in the patient 

charts, 

At the conclusion of about 11 months of the 

year’s record keeping, the Physician Visit Records were summarized for each patient. The 

number of visits made to SCPMG was used to 

select a stratified sample of approximately 2,000 

persons to be interviewed. (Data from the remaining part of the 12-month period were later 

added for processing in the study. ) 

The interviews were conducted by the Bureau 

of the Census which acted as collecting agent for 

the National Health Survey. 

The questionnaire and the corresponding 

PVRS for the patients were sent to the Division 

of Health Interview Statistics, National Center � for Health Statistics, where the demographic and 

medical coding of the approximately 2,000 pairs 

of records was undertaken. Transcription sheets 

*	 to be used in punching cards were prepared, 

and the chronic conditions on the questionnaire 

and the PVRS were identified, compared, and 

matched. 

Once the chronic conditions had been identified, they were assigned the 4-digit NHS-ICD 

diagnostic codes. Matching was done on the basis 

of a summarization of the 4-digit codes into a 

classification of 47 categories called Recode 3, 

with each of the 47 classes consisting of conditions 

having specified ICD-NHS codes. (See Appendix II.) 

If a chronic condition on the Physician Visit 

Record Summary and a condition on the questionnaire had 4-digit ICD-NHS codes within the same 

Recode 3 class, the conditions were assigned 

match- code A. 

If a chronic condition on the PVRS and a 

condition on the questionnaire had 4-digit ICD- NHS 

codes that were not within the same Recode 3 

class but the conditions appeared to be associated, 

the conditions were assigned match-code B. 

(It is recognized that code B is not sharply 

defined. ) 

If a chronic condition on the PVRS was not 

assigned either match-cede A or match-code B, 

it was assigned code C. A chronic condition on the 

PVRS assigned code C had no associated condition 

on the questionnaire. 

If a chronic condition on the questionnaire was 

not assigned match-codes A or B, it was assigned 

code D, meaning that there was no associated 

condition on the PVRS. Code D conditions for 

which the respondent claimed to have seen or 

spoken to a physician about in the preceding 12 

months were analyzed separately. They were 

called ‘D1z conditions. 

‘After coding and matching and preparing the 

forms for the transferring of the data to punch 

cards, the records were returned to Stanford 

Research Institute for card punching and tabulating. 

For each interviewed person the following 

punch cards were prepared: a person card, a 

condition card for each chronic condition on the 

questionnaire, a hospitalization card for each 

hospitalization on the questionnaire, and a card 

for each diagnosis visit on the PVRS. (A diagnosis 

visit is a single diagnosis reported by a physician 

for a visit by the patient to SCPMG. Thus a single 

visit to SCPMG could produce several diagnosis 

visits. ) The punched cards were summarized into 

condition records; one condition record contained 

information on all of the chronic conditions the 

person had, either according to the questionnaire 

or the PVRS or both. For A, B, or C match 

conditions the condition record consisted of 10 

punch cards. For D match conditions the condition 

15 
record consisted of four punch cards. Later, die 

condition records were summarized into person 

records, each person record co~lsisting of four 

punched cards. 

Modified condition and person records were 

constructed for personswhowerenotinterviewed. 

CONCEPTS AND MEASUREMENTIS 

Introduction 

In order to discuss the completeness and 

accuracy of reporting chronic conditions, it is 

necessary to discuss the concept that is being 

measured, the methods that can be used in its 

measurement, and the criteria according to which 

completeness and accuracy will be determined. 

First, however, it is desirable to discuss possible 

sources of information on chronic conditions. 

Sources of Information on Chronic Conditions 

Possible sources of information on the health 

of the U.S. population are (1) personal interviews 

in which a person or a member of his household 

responds to questions concerning his health, (2) 

medical records of physicians, hospitals, and 

other persons or organizations that may diagnose 

or treat conditions, and (3) health examinations 

made for the purpose of providing the information. 

Each of these sources has its advantages and 

disadvantages. 

Many studies indicate that the reporting of 

illness and associated disability in household interviews is incomplete as compared with the 

records of physicians. For chronic conditions 

the omitted information has been shown to be 

extensive. On the other hand, personal interviews 

do consolidate information on illness that may be 

scattered in the records of several doctors or in 

other medical records. Also, they provide socioeconomic information related to the illnesses. 

Finally, they record the information that the 

person knows or recalls or is willing to provide 

on his health. On the whole, the conditions people 

omit have less importance than those they mention. 

fhe records maintained by physicians may 

not be uniform and may not provide complete information on the illnesses and associated disabilities of their patients, and, in some instances, 

may list conditions which do not represent firm 

diagnoses and which have been included only for 

the completeness of the records. Physicians use 

varied methods and levels of record keeping. The 

thoroughness of physical examinations and the 

thresholds at which conditions are diagnosed vary 

widely from physician to physician. Even though a 

physician performs a thorough examination at first 

visit, it may be updated rather than repeated in 

subsequent years, so that the medical records of a 

physician may be inaccurate or muxnplete. 

Medical records as represented by patient 

charts are created by the physician according to 

his own interpretation of whatever rules may have 

been formulated for making such entries. Basically, the physician will tend to include only 

those conditions of which he is aware and which 

in his judgment should be entered in the medical 

record. 

Hospital records are subject to many of the 

shortcomings found in physicians’ records. In 

addition to the varied methods of record keeping, 

hospital records are usually limited to the 

diagnosis that led to the admittance of the person 

and to other diagnoses related to the treatment 

provided. Even though diagnoses made while 

the person is a patient may be entered in the 

hospital record, it is seldom that a complete 

physical examination is made. 

The amount of pertinent demographic information entered in either physician or hospital 

records is usually quite limited. When records of 

this kind are used as a source of statistical aata, 

it is usually necessary to develop from other 

sources an appropriate exposed-to-risk population. 

Physical examinations made solely for the 

purpose of providing health records are costly 

and time consuming. Because of the difficulty in 

detecting the presence of c??rtain conditions in 

a survey setting, the amount of diagnostic information that can be obtained is necessarily limited, 

Despite the concern over health conditions, 

the gradation between having and not having a 

condition is in many instances a matter of degree 

rather than of kind. Thus in a sense, low or high 

levels of reporting of chronic conditions may reflect not only the reporting of the patient concerning the conditions that he has but also the reporting 

of the physician concerning the conditions he either 

* 

* 

16 
( is aware of or thinks are important enough to 

1 record. For this reason, unless the physicians 1

I making up medical records for a study have 

I accepted identical criteria and have been subjected 

to test and scrutiny during the course of the study 

to maintain accuracy in the conditions or symptoms they enter in the records, it would seem 

hazardous to compare different studies with 

respect to the percentage of chronic conditions 

not reported. Each such comparative study would 

� probably lead to the same qualitative but not 

quantitative conclusions. 

In view of the physicians’ willingness to co­

*	 operate in the present study, it was not deemed 

practicable to supervise the recording of conditions on the PVR’S for completeness and consistencey among physicians. For a small number of 

PVR’S, a quality-control comparison was made 

every 2 weeks between the PVR and the material 

entered by the physician in his medical records 

for a patient on the same day on which he had 

filled out the PVR. This comparison indicated that 

there was some underrecording on the PVR as 

compared with the patient charts and a lesser 

amount of underrecording on the patients’ charts. 

In view of the inherent variability of the medical records themselves, it is felt that the main 

purposes of the present study were not seriously 

affected because some physicians did not follow the 

instructions to include on the PVR, as a minimum, 

ever y condition they entered on the patient charts. 

Definition of a Chronic Condition 

A condition is called chronic according to the 

PVRS if at least one of the following criteria is 

satisfied: 

1.	 The name of the condition is on a list or 

conditions that are defined as “chronic, 

regardless of date of onset” 

2. According to the PVRS, the condition has 

.	 lasted more than 3 months, as indicated by 

diagnostic entries made by the doctor 

3.	 According to the information recorded on 

at least one PVR, the patient has known for 

at least 3 months that he has the condition 

A condition is chronic according to the interview questionnaire if at least one of the following 

is satisfied: 

1.	 The name of the condition is on a list of 

conditions that are defined as “chronic, 

regardless of date of onset” 

2.	 According to the questionnaire, the condition has lasted more than 3 months or is a 

recurrent condition 

The conditions that are chronic regardless of 

date of onset are conditions that are certain to last 

more than 3 months. Conditio~ that recur annuall y 

or at shor~er intervals are also chronic. 

Thus bunions are chronic conditions and so is 

heart disease. Athlete’s foot M a chrome condition 

and so is cancer. In the present study the two 

conditions obesity and pregnancy, neither of which 

is considered as a “condition” in the absence 

of complications, have been excluded from the 

comparisons. 

Terms used to describe conditions will vary 

among doctors and between doctor and patient. The 

condition entered on medical records may be in 

medical terminology and described in detail or in 

layman’s language or symptoms. It is unlikely 

that a patient will know the medical terminology 

to use to describe his condition, and if a period of 

time has passed since he last saw a doctor for 

the condition, he may remember symptoms rather 

than diagnoses. If the patient has seen a physician 

or physicians for more than one condition, the 

recollections may even be conflicting. A condition 

that does not currently trouble a patient may be 

viewed by him as having ceased or at least as 

having ceased being a cause of possible trouble, 

whereas the physician may be checking on the 

condition without even discussing it. An illustration might be a mild case of high blood 

pressure which is measured by the physician 

routinely. Similarly, the physician may enter 

a condition such as “anxiety” without explicitly 

mentioning the condition to the patient. These 

examples illustrate some of the reasons why 

a condition listed on a person’s medical record 

is either not mentioned at all during the interview or is described in such vague terms that 

it cannot be identified with a medical record 

entry. 

17 
THE MEASUREMENT OF CHRONIC 

CONDITIONS 

The definition of a chronic condition given in 

the preceding section makes it clear that chronic 

conditions are varied in nature and also in their 

impact on the person who has them. For example, 

according to this definitions a stroke is no more 

a chronic condition than is a wart if the wart lasts 

3 months or more; an amputation of a leg is no 

more a chronic condition than is an annual bout 

with mild hay fever. 

Similarly, a condition for which a person has 

had no medical care for 1 year or more is as much 

a chronic condition as is one for which the person 

has had to obtain a large amount of medical attention during that period because of the recent onset 

of the condition. A self-diagnosed condition may 

meet the definition of a chronic condition. For 

example, many people feel able to diagnose 

arthritis or hay fever as they would frequent or 

recurrent colds, anxiety, nervousness, or depression. 

A physician will enter in medical records 

chronic conditions of many different levels of 

severity. He may not enter many chronic conditions that could be found by a more detailed 

clinical examination. When does a condition cease 

to be a normal deviation and become a condition 

to be entered in medical records? When does a 

condition cause some concern? When should a 

condition be treated? The answer to all of these 

questions may vary from physician to physician 

or even in a single physician over time. 

In addition to the nature of the chronic condition itself, there was some evidence in this study 

concerning the variability of the concept of a 

chronic condition. As shown in table 1, 6,140 

conditions were classified as chronic according 

to the PVRS medical records. Of these, 3,081 

(or approximately 50 percent) were conditions for 

which only one visit had been made to SCPMG 

or for which only one entry had been made on the 

medical records. For an additional 20.9 percent 

of the conditions, the doctor had made an entry 

indicating the presence of this condition during 

two visits, and in an additional 10.5 percent the 

doctor had made an entry for the condition during 

three visits. 

In interpreting these data, it should be kept 

in mind that on some of these visits the entry 

the doctor made for the visit diagnosis was not 

the same as that finally considered as enconlpassing the various visit diagnoses. As an illustration, it might be that the final diagnosis was 

something like hypertensive heart disease whereas on a particular visit only the entry of hypertension was made. To some extent, the data on 

number of visits for a condition also reflect the 

patient’s concern about the condition. It might be 

that the physician would have wished the patient 

to make more visits for the condition or in some 

cases fewer visits. 

A second indicator of the variability of the 

concept of a chronic condition is the number of 

hospitalizations required for the condition. For 

approximately 92 percent of the 6,140 conditions 

shown in table 2, no hospitalization was required. 

For 426 (or approximately 7 percent) of the 

chronic conditions, however, one hospitalization, 

overnight or longer, was required and 71 of the 

conditions (over 1 percent) had two or more overnight hospital stays. 

Another indicator of the nature of the chronic 

condition may be found in the various concerns or 

activities the person may have undertaken because 

of it. In table 3 is a list of questions referring to 

such impacts that were asked the respondent as 

part of the interview. This table also shows the 

number and percent of persons who answered 

“Yes” to each of the specific questions for a least 

one condition. 

It will be noted that the number of persons for 

whom the questions were applicable varies.. This 

is because certain of the questions did not appear 

on Questionnaire 2, and consequently the number 

of persons for whom these questions were applicable is the number of persons whose responses 

were recorded on either Questionnaire 1 or 

Questionnaire 3. Clearly, it follows from table 

3 that the proportions of people who had been or 

who were subject to the limitations stated or who 

were concerned about chronic conditions are 

large. Also as indicated by comparing the percentage of chronic conditions with the percentage 

of people involved, the persons who were subject 

to these limitations or requirements tended to 

have more chronic conditions than those who were 

not. 

18

� 

I 

[ 

I Communication between physician and patient 

seemed to vary considerably from condition to 

condition. Often in the discussion, reference is 

made to the fact that something was or was not 

entered during the visits at which the physician 

reported the condition on the PVRS. These statements and the tables on which they are based 

should be interpreted in light of the fact that the 

more visits made for a condition the more opportunities for any specific event to occur. 

For 31.3 ~ercent of the 6.140 conditions re­ * 

corded on the PVRS, the physician stated that dyring no visit during the study year had he told the 

patient the actual diagnosis or a diagnosis codeable . to the actual diagnosis (table 4), Similarly, for 

about 51 percent of the conditions the physician 

stated that during no visit had the patient told him 

either the actual diagnosis or used a term codeable 

to the actual diagnosis -i.e., neither a formal diagnostic statement, lay terms, nor symptom statements related to the diagnosis had been used by 

the patient during his visits to the phyqician. 

Sometimes in-speaking to a patient u physician 

emphasizes the condition from which the patient 

is suffering and sometimes he does not. For 54 

percent of the conditions, according to table 4, 

the physician claimed that during no visit had he 

made a particular point of the diagnosis in discussing the condition with the patient. 

The physician was asked to enter on the PVR 

whether the patient reported having pain or 

emotional stress or spending oat least 1 day in 

bed during the week prec&%ng the patient’s 

visit. According to table 4, approximately 70 

percent of the conditions were such that at no 

visit did the physician indicate on the PVR that 

the patient had had pain or emotional stress during 

the preceding week. For about 10 percent of the 

conditions (table 4 ), the physician stated that the 

patient had said he had spent at least 1 day in 

bed during the preceding week. 

According to table 4, conditions differ considerably in the actions physicians take with 

regard to them. FOYapproximately 90 percent of 

* the conditions one or more of the listed actions 

was	 ordered, performed, or mentioned during 

at least one visit for that condition. Also for each 

of the listed actions, the percentage of the condition 

in which the action was ordered or performed during at least one visit is stated. These percentages 

vary from almost 3 percent for bed rest or change 

in smoking habits to almost 57 percent. for 

medication. 

Conditions also differ considerably in their 

relative frequency and severity. Shown in table 5 

is the distribution of the conditions recorded on 

the PVRS’s according to the categories that consti ­

tute Recode 3. 

Some of the categories including the largest 

numbers of conditions are vaguely defined; in any 

case, the numbers of conditions in the groups 

primarily reflect the scope of the definitions used. 

The groups do differ with respect to the severity 

of the conditions they include. 

REPORTING OF CHRONIC 

CONDITION~ 

Overview 

In the interviews respondents answered que? 

tions concerning illnesses and impairments, mafi> 

if not all of which should have been entered in 

medical records prepared by physicians afte f.­

physician-patient discussions. 

The purpose of this section is to identifi 

which sources —~esponaent, questionnaif”e, inte )­

vzewer, chyonic conaition, or physician-patie v{ 

relationsJaifi- account for the unaerreporting in in ­

terviews of chronic conditions that the physician 

had entered in the medical records (PVRS’S). 

Making the comparison with medical records 

is not intended to imply that underreporting of 

conditions that have been entered in the medical 

records is evidence of poor reporting by the 

respondent. As has been indicated earlier, the 

concept of a chronic condition is very broad, and 

instead of using the simple total of all conditions 

called chronic as a criterion it is preferable to 

consider the reporting of various classes of 

chronic conditions or a weighted total of total 

conditions—the weights being related to the severity, costliness, or demands on medical facilities or whatever other properties are important. (It should be recalled that an unweighed 

total arbitrarily gives equal weight to the re19 
porting of all conditions—a cancer in an unweighed total is equivalent to a bunion or wart.) 

Furthermore, whatever a physician enters 

in the medical records is more likely to reflect 

current symptoms than the conditions that could 

be detected only by a thorough current physical 

examination. Likewise, updating an earlier physical examination usually is not equivalent to a 

current, thorough physical examination. 

It is suggested that while all of the major 

sources of underreporting may contribute to 

underreporting, the chronic condition itself seems 

to be responsible for the major part of it, 

especially if the condition has influenced the behavior of the respondent, either through leading 

him to make more medical visits or through 

restricting his activity or causing him pain or 

undue concern. 

In the following pages, the emphasis is on 

the completeness with which conditions in the 

PVRS’S are reported in interviews. Little attention is given at this time to conditions recorded 

on the questionnaire but not in the medical records 

because to evaluate this aspect of the study it 

would be necessary to limit the analysis to respondents who were attended only by SCPMG physicians. The effects of potential sources of underreporting are summarized below, followed by a 

fairly detailed analysis of each of the factors 

examined: 

1.	 Differences in reporting on the three versions of the questionnaire and according 

to demographic characteristics of respondents were small and unimportant. 

2.	 When respondents were classified according to communication between physicians and patient—i.e., by the information concerning the diagnoses that the 

physician had given the patient or that 

the physician said the patient had mentioned during the physician-patient interview—the differences in reporting were 

also relatively small and unimportant. 

3. While the number of chronic conditions 

a person has is unrelated to reporting, 

the number of visits for a condition and 

the time between the date of last visit for 

a condition and the date of interview are 

related to reporting. 

Many of the apparent, relatively small 

differences cited above are due to the relationship of the above variables to the 

number of medical visits made for the 

condition. For example, the more visits 

a person had made for a condition the 

more likely it was that the physician had 

told the person the name of the condition 

and also the more likely it was that the 

condition was reported. 

4.	 The questionnaires had only two indicators of the attitude of, the respondent 

toward reporting. However, some reconciliation interviews—reinterview of the . 

respondent in which an attempt was made 

to account for discrepancies between the 

PVRS and the household interview—were 

also conducted. While the evidence has 

not been fully analyzed, the attitude of the 

respondent seems to be related to reporting. 

Despite a relatively low noninterview rate 

in the study, there is evidence that cooperation with the interviewers was not 

uniformly high. Once interviews have begun, they are rarely broken off. To some 

extent, however, the high rate of completion only masks the more serious effects of noncooperation on the part of the 

respondent. Anyone who has participated 

in interviewing knows that when a respondent begins to show hostility there is a 

tendency for the interviewer to attempt 

to reduce the tension. In doing so, however, the interviewer often obtains less or 

questionable information. 

5.	 When respondents are classified by 

whether some chronic condition has had 

an impact on them—such as causing them 

to limit food or drink, or to take medicine, or to have pain or discomfort, or 

to worry or have members of their 

families worry, or to be limited in their 

activities because of health—the differences in reporting the conditions are 

large, especially when more than one of 

these “impact” characteristics are present. 

20 
� 

6.€The nature of the condition, such as its 

symptoms, prognosis, andrecencyof onset, is closely related to reporting. 

DIFFERENCES IN REPORTING OF 

CHRONIC CONDITIONS 

Questionnaires 

The three versions of the questionnaire are 

compared in two ways. First, the reporting of the 

chronic conditions on the PVRS’S is compared 

with that on the questionnaire. Second, for conditions reported on the questionnaires, the parts . of the questionnaire in which the conditions were 

first mentioned are compared. 

Table 6 suggests that whatever the differences 

may be among the questionnaires, they did not 

seriously affect the reporting of chronic conditions 

by the respondent. It also indicates that the differences in the average number of chronic conditions 

recorded in the medical records were not very 

large among persons who were interviewed on the 

three different versions of the questionnaire. 

For conditions found both in the PVRS’S and 

on the questionnaires, table 7 shows the distribution of these conditions according to that section of the questionnaire where they were first 

reported by the respondent. There are differences 

among the questionnaires (see table 7) largely 

attributable to the wording of the questions on 

Checklist A (“Have you EVER had any of~he conditions listed on this card?”) and Checklist B 

(“Have you had any of these conditions DURING 

THE PAST 12 MONTHS?”) and to question 12 of 

Questionnaire 2, which refers to physician visits 

for conditions, a question not included in Questionnaires 1 and 3. 

In table 8 are presented data on the questions 

in the answers to which conditions were first 

found. All of these questions appear before table 

C-1 on the three versions of the questionnaire 

used in the study. 

Perhaps the most striking result of this � analysis is that so far as conditions recorded on 

PVRS’S are concerned, the main effect of differences among questionnaires seems to be not 

whether a condition in the medical records is reported in interview but where it is reported. A 

further difference among the questionnaires was 

in the number of code D conditions they contain— 

i.e., conditions reported in interview that were 

not recorded iy the medical records. However, 

this difference is not analyzed here because the 

number of these conditions depends to some extent on whether the respondent reported that he 

used only SCPMG for medical services. 

Demographic Characteristics 

Generally speaking, the differences in reporting of chronic conditions by demographic 

characteristics were relatively small and seemed 

to be related to the seriousness of conditions. It 

is possible that an analysis which took into account the reporting of conditions according to the 

three versions of the questionnaire might reveal 

more significant reporting differences by demographic characteristics. 

The percentage of conditions in the medical 

records that were not reported (percentage unreported) in the interviews was about 44 percent 

for males and 46 percent for females (table 9). 

The percentage of unreported conditions by 

age was 47.5 for those aged 25 to 44, 46.4 for 

those aged 45 to 64, and 36.5 for those aged 65 

and over (table 10). The reporting among females 

aged 65 and over was considerably higher than 

that among males in this age interval. 

The percentage unreported by race was about 

45 for white, about 51 for Negro, and about 49 for 

all other, but the sizes of sample for Negro and 

all other were small (table 11). 

The percentage unreported did not vary much 

by relationship to head of household (table 12). 

The head of household, spouse, and child had 

percentages unreported of approximately 46, 45, 

and 43, respectively. Those having “other” relationship to head of household had a lower percentage of unreported conditions (33.8), but these 

persons were so small a part of the sample that 

differences of this magnitude could easily occur; 

in addition, the class “other” tends to include 

older people—a population group for which the 

match rate was comparatively high. (Differences 

in reporting cannot be attributed to the use of 

“proxy” respondents since each respondent was 

interviewed only for himself.) 

21 
Over half of the sample persons had had some 

education but no college education. For these 

persons the percentage of unreported conditions 

was about 44.1 percent, whereas for those with 

some college education the percentage unreported 

was 48.5 percent (table 13). 

When sample persons were classified by the 

education of the head of household (table 14), 

much the same results occurred. For those 

living in families where the head of household 

had some education but did not have any years of 

college the percentage unreported was 42.6 while 

for those in households where the head had some 

college education the percentage unreported was 

It was unusual to find those with some college 

education reporting more poorly than those without any college education. However, the differences were small and could not explajn any am 

preciable part of underreporting related to heal~h. 

(The small number of those with no education at 

all made it possible that any differences for this 

group may have been attributable to sampling 

error.) 

The percentage unreported did not vary appreciably by marital status (table 15) or by 

family income (table 16)—1ow family incomes in 

a large city are often associated with old age. 

When classified by usual activity (table 17), 

the differences in the percentage of unreported 

conditions’ were minor except that those who were 

retired had low percentage unreported (about 

33), a not unexpected result in view of better 

reporting among old persons. 

When classified by activity during the 2 

weeks preceding the interview (table 18) or by 

the number of workers in the household (table 

19), the differences in the percentage of unreported conditions were minor except for males 

not in the labor force (39 percent) or sample 

persons in households with no workers (36 percent). 

Communication Between Physician 

and Patient 

Several questions on the Physician Visit 

Record dealt with the terms used by physician 

and patient in discussing the patient’s condition, 

with emphasis on the diagnosis by the physician 

in communicating the diagnosis to. the patient. 

Analysis of responses to these questions in 

relation to the degree of underreporting indicates 

that the greater the communication between patient and physician the smaller the percentage 

of conditions not reported. The differences because of the degree of communication seem to 

affect the ratio of the number of A matches to 

the number of B matches more than the magnitude of the percentage not reported—i.e., even with 

poor communication the patient is likely to have 

a vague (B match) idea of the condition provided 

he has made enough medical visits for it or has 

had some effects from it. 

Question 2 on the PVR asked the physician 

to record the terms he had used in describing 

the condition to the patient during the visit for 

which the PVR was completed. 

On the PVRS each condition was assigned a 

code to indicate whether during at least one visit 

the physician stated that he had used a term that 

was either codeable to the same Recode 3 category as the condition itself or represented a 

diagnosis of the condition. For conditions for 

which the physician had used a term that was 

codeable to the same Recode 3 category as the 

final diagnosis, the percentage unreported was 

about 44 (table 20). Of the 6,058 conditions for 

which this question was asked, approximately 72 

percent had been described to the patient in terms 

codeable to the same recode category as the final 

diagnosis. When conditions for which no codeable 

reply was given were excluded, the proportion 

became 83 percent. 

Question 3 on the PVR was similar to question 2 except that the physician stated the terms 

that the patient had used to him in describing 

the condition rather than the term the physician 

had used in speaking to the patient. For conditions which during at least one visit the patient 

used a term codeable to the same Recode 3 as 

the final diagnosis, the percentage unreported 

was a little over 42 (table 21). Such conditions 

represented almost 56 percent of all conditions 

on the PVRS for which there was at least one 

physician visit. After excluding conditions for 

which the question was never answered, the 

proportion was about 68 percent, 

In interpreting the responses to questions 2 

and 3 of the PVR, it is useful to recall that the 

more visits made for a condition the more likely 

the occurrence of meaningful communication ber 

* 

22 

50.4 
,

) ~ween physician and patient. From tables 20 and 

21 it seems clear that, according to the physician, 

the diagnoses recorded on the PVR were frequently not mentioned to the patient, or at least 

not in terms that could be coded to the same Recode 3 category as the condition itself. But the 

proportion of conditions thus affected, while large 

from the point of view of communication between 

physician and patient, is small from the point 

of view of their effects on the percentage of 

unreported conditions. The effects of communication are greater on the proportion of conditions 

with B matches as compared with those with A 

matches than on the percentage unreported. It 

seems consistent with the finding that the seriousness of the condition is closely related to 

reporting to learn that physician-patient communication is more closely related to how accurately the patient reports a condition he thinks 

he has than to whether he realizes he has a condition that should be reported. 

Question 5 on the PVR asked the physician 

to state whether he had “made a point” of the 

diagnosis during the specific visit for which the 

PVR was being fiiled out. According to table 22 

whether the physician did or did not emphasize 

the diagnosis had some effect on how well the 

patient reported the condition, but the effect was 

not great. 

Frequency and Recency of Physician Visits 

The percentage of chronic conditions not reported in the interview seems to be unrelated 

to the number of such conditions the respondent 

had according to the PVRS (table 23). However, 

the percentage not reported seems to be fairly 

closely related to the number of visits made to 

SCPMG for the condition (table 24). 

It is worth noting that for approximately 

half of the conditions the physician indicated that 

in only one visit was the condition considered 

during the year. In this group would be conditions 

that either had an acute episode that could be 

handled in one visit or conditions that were 

checked on during the year rather than conditions 

currently serious for the respondent at any time 

during the year. Of the remaining 50 percent of 

the conditions for which the doctor noted at least 

two visits in the year, slightly less than 35 percent were not reported in the interview. 

Table 25 is based on table 24 and shows 

that the conditions not reported in the interview 

are conditions for which fewer visits were made 

to SCPMG than were made either for conditions 

with match code A or conditions with match 

code B. 

The longer the interval between the date of 

last visit for the condition and the date of interview, the greater the percentage unreported 

(table 26). Obviously, there is a relationship between this interval and the number of visits made 

during the year. Without the study of this relationship, little can be deduced from table 26 concerning the results of interviewing the same 

person, say, monthly. However, one can conjecture that the percentage not reported would 

be less than when a single interview occurs. 

Attitudes of the Respondent 

Each respondent was asked for a selected 

list of conditions how freely he thought others 

would speak of these conditions if they or some 

member of their household had the condition. 

Preliminary indications (table 27) were that this 

attitudinal question did not serve too well as an 

indicator of percentage of unreported conditions. 

This could be because the major part of the failure to report conditions is due to reasons unrelated to how people feel about discussing health 

or more likely because those consciously not reporting conditions also consciously answered this 

question to obscure the relationship to unreported 

conditions. Further insight into attitudinal differences can be obtained by relating this information to that presented in the following paragraphs. 

The last item on the questiomaire was a 

request that the respondent sign an authorization 

for the Census Bureau (National Health Survey) 

to examine the medical records of the person. 

Approximately 91 percent of the respondents 

signed the authorization. 

For the 9 percent that did not sign the 

authorization it was possible, through the cooperation of SCPMG, to make a gross comparison of 

the data in the medical records with the data on 

the questionnaire. Names and addresses of the 

persons involved were seen only by the staff of 

SCPMG. Thus, these records were not identified 

with any specific persons. 

23 
It became clear during the interviewing process that the percentage of those signing or not 

signing the authorization was very dependent on the 

attitude of the interviewer to that particular 

question.Intuitively, it would be expected that 

relatively few people who have given complete 

and accurate information on their health would 

refuse authorization for the examination of their 

medical records. They would already have given 

the information and would have little reason, 

other than concern for the physician, to object to 

making the information more complete and accurate. Thus, the refusal to give authorization seems 

likely to be related to the completeness of reporting. This conjecture was to some extent confirmed. For those who did not sign the authorization, the percentage of conditions not reported 

in the interview was almost 62 as compared with 

a percentage of less than 44 for those who did 

sign the authorization. 

This result again suggests the possibly 

greater importance of behavioral variables such 

as the signing” of the authorization rather than 

attitudinal variables in explaining nonreporting. 

It would have been very useful to have had questions that might have led to various levels of behavior related to nonreporting rather than the 

single choice of whether to sign the authorization. 

No attempt has yet been made to combine the 

attitudinal and behavioral variables discussed 

above in relation to the percentage of conditions 

not reported. 

Impact of th’e Condition 

Table P of Questionnaires 1 and 3 consisted 

of six questions relating to the impact of chronic 

conditions on activities- or way of life (see table 

28). In Questionnaire 2 two of these questions 

(P-1 and P-5), as described earlier in this report, were revised and were asked with the initial 

illness-recall questions. 

Before considering questions P-1 through 

P-5 let us consider question P-6 which relates 

to a self-evaluation of general health, and its 

format is consistent on all three questionnaires. 

From table 29 it is apparent that the level of reporting of chronic conditions was markedly higher 

among persons who considered their general state 

of health as fair or poor than for those who stated 

their health was excellent or good. However, the 

apparent inconsistency may be related to the 

seriousness and the number of chronic conditions. 

There has been no opportunity as yet to make 

this analysis in any detail. It is desirable to do 

so at least to determine whether and to what extent self -evaluation of health may be used as an 

indicator of the percentage of unreported conditions. The lower percentage of reported conditions for those with excellent or good health 

suggests that not only did they have fewer conditions but also their conditions were relatively 

unimportant to them. This group of persons 

accounts for about 85 percent of all persons 17 

years of age and over in the population studied, 

and they have about 72 percent of all chronic 

conditions. 

Clearly, tables 30 to 37 slow that the answers 

to questions P-1 to P-5 are all related to the percentage of conditions not reported. Again, they 

indicate that where the behavior of the respondent 

or a matter of concern to the respondent is involved the reporting of chronic conditions is more 

complete. However, the improvement due to any 

one of these impact variables does not reduce 

underreporting substantially. 

The reporting of chronic conditions by respondents having various combinations of replies 

to questions P-1 to P-5 is considered in table 

36. While the analysis is not complete, it is apparent that the “impact” variables are related to 

reporting. The difficulty in their use is largely 

that as soon as more than one limitation or other 

“impact” is used as a severity criterion the 

proportion of chronic conditions is sharply reduced. 

In question 6 of the PVR, the physician was 

asked to report at each visit for each diagnosis 

whether the patient had said he had had pain or 

emotional stress or spent days in bed during the 

preceding week because of that diagnosis. 

The answers to question 6 of the PVR are 

summarized in table 37. Again, it is clear that 

the conditions that had an impact on the respondent according to the physician were better reported than the other chronic conditions. However, 

the proportion of such conditions was not high. 

When each of the impact measures (pain, stress, 

days in bed) was considered separately, its 

presence was associated with a marked increase 

24 
in the percentage of conditions reported. Further 

analysis of this material is needed to determine 

if the combined effect of the presence of two or 

more of these impact measures will increase the 

percentage of reported conditions to an even 

greater extent. 

Class of Chronic Conditions and 

Checklist Status 

v The conditions identified as chronic according 

to the medical records were classified into one of 

three classes. 

* 

CLass 1.,—Certain of these conditions were 

chronic regardless of how long the patient had the 

condition, Such conditions are called chronic regardless of onset. 

Class 2. —Other conditions were called 

chronic because there was evidence on the PVRS 

that the condition lasted more than 3 months or 

was recurrent. Visits for the condition over a 

period of over 3 months or references to the 

chronic or recurrent nature of the condition were 

taken as evidence. 

Class 3. —Except for a few conditions, all 

other chronic conditions were so identified because the physician stated in response to question 

4 of the PVR that during at least one visit the 

patient had become aware of the condition over 3 

months before the date of the visit. 

It should be emphasized that Class 2 

conditions provided fairly convincing evidence of 

duration of over 3 months, whereas the evidence 

for a Class 3 condition could be far more subject to error in the information deemed by the 

physician adequate for him to make the required 

response to question 4 on the PVRS. No attempt 

has been made to check these replies for inconsistencies at different visits. 

From table 38 it follows that about 60 percent of all chronic conditions in the medical 

records were chronic regardless of onse~ that 

less than 10 percent were called chronic because 

they lasted more than 3 months according to the 

PVRS; and that about 30 percent were called 

chronic because the physician had asserted on 

the PVR for one visit or more that the patient 

had first become aware of the condition over 3 

months before that visit. 

Table 38 also indicates that the conditions 

chronic regardless of onset and the conditions 

that had lasted more than 3 months according to 

the PVRS are more completely reported than the 

other conditions. 

Acknowledgments 

In a study such as this, the number of persons whose Bureau of the Census: 

work and counsel have been very helpful is too large for all Harold Nisselson (no longer at Census) 

to be listed. Our apologies are offered those omitted. Katherine G. Capt (no longer at Census) 

George F. Kearns, Chief, .Health Statistics Branch 

Southern (California Permanence Medical Group: 

Raymond hf. Kay, M.D., Medical Director Stanford Research Institute: 

Fre dericli H. Scharles, IM.D., Associate Medical Director Mark S. Blumberg, M.D. (no lcnger at SRI) 

Herman Weiner, M.D., Associate Medical Director Gertrude D. Peterson 

,John A. Croft, Business Manager Harry V. Kincaid 

Miss Yvonne Van Asten, Coordinator at SCPMG for the Donald G. Woodworth 

survey Norman Breslow (Summer, 1963) 

James D. Knoke (no longer at SRI) 

Kaiser Foundation Health Plan: William Pierskalla (Summer, 1963) 

Arthur Weissman, Director of Medical Economics Kent Quieel (no longer at SRI) 

E. E. McCreery, Statistical Analyst 

Our thanks are especially due to John A. Croft, Elijah L. 

National Center for Health Statistics, Public Health Service: White, Theodore D. Woolsey, Gertrude D. Peterson, and Mark S. 

Theodore D. Woolsey, Deputy Director Blumberg. 

O. K. Sagen, Assistant Director for State Relations


Elijah L. White, Director, \Division of Health Interview


Statistics


James T. Baird (no longer at the Center)


25 
------------------------------------------------------------------------

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

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

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

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

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

� 

DETAILED TABLES 

Page


Table 1.


2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

11. 

12. 

13. 

14. 

15. 

Number and percent distribution of conditions classified as chronic according.to


the PVRS, by number of visits to SCPMG for the conditions-----------------------


Number and percent distribution of conditions classified as chronic according to


the PVRS, by overnight hospital stays for the conditions at a Kaiser Foundation


hospital


Number and percent of chronic conditions , and number and percent of persons sub­


ject to specified limitations or requirement because of these conditions--------


Number and percent distribution of chronic conditions according to physician-


patient interview, by various characteristics


Number and percent distribution of chronic conditions, by Recode 3--------------


Number and percent distribution of persons interviewed and average number of


chronic conditions per person, and number and percent distx~bution of conditions


reported in the medical records (PVRS) and proportion reported in interviews, by


type of match code, according to questionnaire used


Number and percent distribution of conditions reported in th~ medical records


(PVRS) and in interviews, by section of questionnaire elicit.tng the response,


according to questionnaire used and type of match code--------------------------


Number and percent distribution of conditions reported in medical records (PVRS)


and in interviews, by question eliciting the response, according to questi~n­


naire used and type of match code-----------------------------------------------


Number and percent distribution of conditions reported in medical records (PVRS)


and proportion reported in interviews, by type of match code, according to sex-­


Number and percent distribution of conditions reported in medical records (PVRS)


and proportion reported in interviews, by type of match code, according to sex
 and age-------------------------------------------------------------------------


Number and percent distribution of conditions reported in medical records (PVRS)


and proportion reported in interviews, by type of match code, according to sex


and race------------------------------------------------------------.-----------


Number and percent distribution of conditions reported in medical records (PVRS)


and proportion reported in interviews, by type of match code, according to re­


lationship to head of household


Number and percent distribution of conditions reported in medical records (PVRS)


and proportion reported in interviews, by type of match code, according to edu­


cation of each sample person


Number and percent distribution of conditions reported in medical records (PVRS)


and proportion reported in interviews, by type of match code, according to edu­


cation of head of household


Number and percent distribution of conditions reported in medical records (PVRS)


and proportion reported in interviews, by type of match code, according to sex
 and marital status--------------------------------------------------------------


29 

29 

30 * 

31 

32 

33 

33 

34 

35 

35 

36 

36 

37 

37 

38 “ 

26

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

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

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

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

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

---------

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

DETAILED TABLES-Con. 

II;IkIle 16. 

17. 

18. 

* 

19. 

20. 

21. 

22. 

23. 

24. 

25. 

26. 

27. 

28. 

29. 

30� 

31. 

32. 

33. 

Number and percent distribution of conditions reported in medical records (PVRS) 

and proportion reported in interviews, by type of match code, according to family income----------------------------------------------------------------------

Number and percent distribution of conditions reported in medical records (PvRS) 

and proportion reported in interviews, by type of match code, according to sex and usual activity status-------------------------------------------------------

Number and percent distribution of conditions reported in medical records (PVRS) 

and proportion reported in interviews, by type of match code, according to sex and employment status-----------------------------------------------------------

Number and percent distribution of conditions reported in medical records (PVRS) 

and proportion reported in interviews, by type of match code, according to number of workers in family--------------------------------------------------------

Number and percent distribution of conditions reported in medical records (PVRS)

and proportion reported in interviews, by type of match code, according to best 

term used in physician-to-patient communication---------------------------------

Number and percent distribution of conditions reported in medical records (PVRS)

and proportion reported in interviews, by type of match code, according to best 

term used in patient-to-physician communication 

Number and percent distribution of conditi~st;:orted in medical records (PVRS)

and proportion reported in interviews, of match code, according to 

emphasis given to the diagnosis 

Number and percent distribution of conditions reported in medical records (PVRS)

and proportion reported in interviews, by type of match code, accocding to number of chronic conditions present 

Number and percent distribution of conditions reported in medical records (PVRS)

and proportion reported in interviews, by type of match code, according to number of visits to SC~G 

Percent distribution and cumulative percent of conditions in medical records 

(PVRS), by number of visits to SCPMG, according to type of match code-----:-----

Number and percent distribution of conditions reported in medical records (PvRS)

and proportion reported in interviews, by type of match code, according to number of days since last visit to SCPMG 

Number and percent distribution of persons, by.how freely.resp~ndenc thinks most 

other people would talk about conditions in an interview according to specified 

conditions----------------------------------------------------------------------

Table P of Questionnaires 1, 2, and 3-------------------------------------------

Number and percent distribution of conditions reported in medical records (PVRS)

and proportion reported in interviews, by type of match code, according to general state of health 

Number and percent distribution of conditions repor;;dm$cadical records (PVRS)

and proportion reported in interviews, by type code, according to 

whether the person has ever had limitations involving food or beverages 

Number and percent distribution of conditions reported in medical records (PVRS) 

and proportion reported in interviews, by type of match code, according to 

whether the person has current limitations involving food or beverages----------

Number and percent distribution of conditi~t::or;:d~cedical records (Pv&)

and proportion reported in interviews, code, according to 

whether the person is currently receiving medicine or treatment-----------------

Number and percent distribution of conditions reported in medical records (PvRS)

and proportion reported in interviews, by type of match code, according to 

whether the person often has pain or discomfort 

Page 

39 

39 

40 

41 

41 

42 

42 

43 

43 

44 

44 

45 

46 

46 

47 

47 

48 

48 

27 
-----------------------------------

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

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

DETAILED TABLES-Con.


Page 

Table 34.	 Number and percent distribution of conditions reported in medical records (PVRS)


and proportion reported in interviews, by type of match code, according to


whether health problems are a source of worry 49


35.	 Number and percent distribution of conditi~st;:orted in medical records (PVRS)


and proportion reported in interviews, of match code, according to


whether limitation of work or housework is present 49


36.	 Number and percent distribution of conditions reported in medical records (PVRS) 

and proportion reported in interviews, by type of match code, according to 

various combinations of replies to questions P-1 through P-5-------------------- 50 

*


37.	 Number and percent distribution of conditions reported in medical records (PVRS) 

and proportion reported in interviews, by type of match code, according to class 

of chronic condition------------------------------------------------------------ 50 

38.	 Number and percent distribution of conditions reported in medical records (PVRS) 

and proportion reported in interviews, by type of match code, according to characteristic during week preceding visit to SCPMG (PAR) 51 

. 

28

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

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

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

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

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

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

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

Table 1. Number and percent distribution of conditions classified as chronic according to the


PVRS, by number of visits to SCPMG for the-~onditions


Number Percent


Number of visits to SCPMG of of


conditions conditions


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


visit-----------------------------------------------------------------


visits----------------------------------------------------------------


visits----------------------------------------------------------------


visits----------------------------------------------------------------


visits----------------------------------------------------------------


6,14!) 100.0 

3,081 5!).2


1,281 20.9


643 10.5


376 6.1


263 4.3


369 6.5


70 1.1


27 0.4


1 

* 2


3


m	 4


5


6-10 visits


11-15 visits


16 visits or more


Table 2. Number and percent distribution of conditiCn_s_. classified as-,_qh~onic.
 according to the


PVRS, by overnight hospital stays for the conditions at a Kaiser Foundation hospital


W~mber of stays


Total


0 stay--------------------------------------------------------------------------

1 stay..!--------

2 stays--------------------------


3 stays-------------------------------------------------------------------------
 .


/+s~;t/J.----"------------------------------------------------------------------­


5 stays 87c~nore


1 overnight hospital stay would b= coznted for each chronic condition for which the


Coxditionsl


Number Percent


6,140 100.0
 —


5,643 91.9


426 6.9


48 0.8


20 0.3


1 0.0


2 0.0


Tilr SLVJK! 

diagnosis was entered in the hospital records.

Table 3. Number and percent of chronic conditions, and number and percent of persons subject to


specified limitations or requirement because of these conditions


Chronic condijersons answer- tions of 

ing “Yes” persons answerWmber ing “Yes” 

Question to respondent


P-1.	 Have you ever been advised by a


doctor to limit the amount or to


avoid entirely certain kinds of


food or beverage?----------------------


a.	 If “Yes”: For what reason


or condition?


b.	 Are you still following this


advice?----------------------------


P-2. At the present time are you regularly


taking any medicine or treatment for


any condition?-------------------------


a. If “Yes”: For what condition?


P-3.	 Do you have any condition which causes
 you pain or discomfort?----------------


a. If “Yes”: What is the condition?


P-4.	 Do you have any health problem ;hich


is a source of worry to you or other


members of your family?----------------


a. If “Yes”: What is the problem?


P-5. (For males): Are you limited in any


way in the amount or kind of work you
 can do because of your health?---------


(For females): Are you limited in any


way in the amount or kind of housework


you can do because of your health?


a.	 If “Yes”: What condition


causes this?


Number of


of :hronic


persons :ondi­


appli- ‘ercent tions


cable )f all 3ppli-


Tumber )ersons zablel Number


appli­


cable


3,968 1,333 33.6 3>937 1,876


3,968 753 19.0 3,937 1,146


5>988 1,460 24.4 6,140 2,588


5,988 1,599 26.7 6,140 2,363


5,988 568 9.5 6,140 1,088


3,968 572 14.4 3,937 1,010


Percent


of all


chronic


condi­


tions .
 appli­


cable


47.6


29.1


42.2


38.5


L7.7


25.6


lQuestions P-1 and P-5 did not appear on Questionnaire 2; therefore, the data for persons and


conditions applicable for these two questions represent the summations for Questionnaires 1 and 3.


30

- -

--------

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I 

Table 4. Number and percent distribution of chronic conditions according to physician-patient interview, by various characteristics -

Percent


Chronic conditions and characteristics Number distri­


bution


All conditions------------------------------------------------------------


Chronic conditions for which the physician stated that during no visit did he


tell the patient the actual diagnosis or a diagnosia codeable to the same


diagnosis----------------------------------------------------------------------


ChronLc conditions for which the physician stated that during no visit did the


patient tell him the actual diagnosis or a diagnosis codeable to the same
 diagnosis----------------------------------------------------------------------


Chronic conditions for which the physician stated that during no visit did he


make a point of the diagnosis in his discussions with the patient--------------


Chronic conditions for which the physician stated that during no visit did the


patient report he had pain from the condition during the preceding week


Chronic conditions for which the physician stated that during no visit did the


patient report he had emotional stress because of the condition during the


preceding week


Chronic conditions for which the physician stated that during no viait did the


patient report he had apent at least 1 day in bed because of the condition


during the preceding week


Chronic conditions for which the physician stated that during at least one
 vi,aitsome action was ordered, performed, or mentionedl


Chronic conditions(other than those for which no action was taken) for which 

the physician sta~ed that during at least one visit the action listed below 

was ordered or performed: 

a.


b.


c.


d.


e.


f.


a.


h.


i.


j.


k.


Medication


Laboratory test


X-ray examination


Future visit to this doctor


Referral to other doctor


Future hospitalization


Future amgery


Change diet or drinking


Change in smoking


Bed rest


Other change in activity


6,140 100.0 

1,923 31.3


3,123 50.9


3,336 54.3


4,271 69.6


4,336 70.6


5,634 91.8


5,460 90.1


3,479 56.7


1,888 30.7


1,129 18.4


3,074 50.1 

1,122 18.3 

251 4.1 

420 6.8 

463 7.5 

175 2.8 

165 2.7 

444 7.2 

lIn calculating percents for this characteristic, 82 of the 6,140 conditions were omitted-79 

because the only record of a visit occurred in a hospitalization and 3 because one PVR waa not


tabulated. -


31

05

10

15

20

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

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

---------

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

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

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

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

25

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

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

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

30 ----------------------------------

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

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

35 -----------------------------------------

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

40 ----------------------------------------

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

45

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

50

Table 5. Number and percent distribution of chronic conditions, by Recode 31


Percent


Chronic conditions Number distri­


bution


01


02


03


04


%


08


09


::


13


14


:;


18


19


All chronic conditions------------------------------------------


Tuberculosis (active), (inactive), all sites----------------------


Other chronic infective and parasitic diseases


Nalignant neoplasms


Benign and unspecified neoplasms


Hay fever, without asthma-----------------------------------------


Asthma (with or without hay fever)--------------------------------


Other allergic disorders, NEC .----------------------------


Diseases of thyroid gland, NSC------------------------------------


Diabetes (mellitus)-----------------------------------------------


Anemia and other chronic blood disorders, MC---------------------


Vascular lesions of central nervous system------------------------


Headache and mi~aine-ckOnic------=-----------------------------


Mental illness, specified types, NBC------------------------------


Ill-defined mental or nervous trouble> _~C-chrogi~r


Heart diseases and symptoms, NEC (chronic rheumatic)


(arteriosclerotic)(h pertensive)-------------------------------­


Hypertension, NEC, wit 1%
out heart involvement


Varicose veins


Hemorrhoids-----------------------:-z::-::::=z==--=:=------------


Rheumatic fever; arteriosclerosis NEC; and other chronic


circulatory conditions----------------------------:-:- ---------&-


Chronic sinusitis-------------------------------------------------


21 Chronic bronchitis------------------------------------------------


22 Other chronic diseases and symptoms of the respiratory


system, ~C------------------------------------------------------


23 Ulcer of stomach and duodenw


24 Hernia (abdominal cavity)-----------------------------------------


Diseases of gallbladder-ctionic--------L-------------------------


26 Other chronic digestive system diseases and symptoms, NEC---------


27 Menstrual disorders


28 Menopausal disorders, except psychosis


29 Ur_inar~calculi, prostate disorders; other chronic genitourinary


disease”eand s~ptms


Chronic skin diseases, NBC----------------------------------------


31 Arthritis and chronic rheumatism


32 Other chronic musculoskeletal diseases and symptoms, NEC----------


33 Fractures, old (3 mos.+), no residual specified


.34 Injuries except fracture, dislocation, sprains, strains, old


(3mos.+), no-residual sp5c~Yied


Severe visual impaiments


36 Other visual "impaiments


37 Hearing bpairments -----------------------------------------------


38 Speech defects----------------------------------------------------


39 Paralysia, complete or partial------------------------------------
 Absence, fingers, toes, only--------------------------------------


41 Absence, major extremities


42 Impa&ments, _wC1,&ack or spine-----------------------------------
 43 Impairments, NECI upper extre@tiea_a~d shoulders


44 Impairments, NEC= lower extremities an~~--------=-----------


I~pairments, NE_C,~Lmb, back, trunk (multiple) (ill-defined), NEC-


46 Other impairments (mental deficiency) (deformity), teeth,


skull, jaw)


47 Other chronic conditions, NSC, not impairments and not in


Recodes 48-50----------------------------------------------------


48 Chronic diseases of eye, not impairments--------------------------


49 Chronic diseaaes of ear, not impairments-------------------------­
 ~Onic organic nervous system conditions-------------------------


6,140 100.0 . . . — — 

17 0.3 43.0


100 1.6 23.5


3;.; .
 3:; R- 184 12:0 

;:; 35.0 

1:; 2.2 16.0 

72 1.2 29.5 . 1:: 20.5 

k: 34.0 

38 0.6 37.5 

1.6 23.5


4% 7.3 2.0


101 1.6 23.5


276 4.5 6.0 

250 4.1 

1.5 2::!+ 

1;; 2.5 14.0 

35 37.5 

22 %: 41.0 

35 0.6 37.5 

171 2.8 13.0 

124 18.0 

103 ::: 20.5 

40.0 

2;: 

189 

::: 

3.1 1::: 

112 1.8 19.0 

439 3.0 

505 

219 

M 

3.6 k; 

194 3.2 10.0 

13 0.2 45.0 

4 0.1 47.5 

3 0.1 47.5 

1.5 26.5 

% 31.5 ;:: 47*5 

3: 37.5 

4 ::! 47.5 . ;;.; 

146 

18 ::: 43:0 s 

29.5
 E M 33.0


16 0.3 43.0 

28.0 

2;; ;:; 7.0 

130 17.o 

99 1:6 23.5 

lRecOde 3 iS a summary list of chrOrdC conditions consisting of 47 disease categories that is 

used in the tabulation of material collected in the Health Interview Survey. For inclusions in 

Recode 3, see Appendix II.

--

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

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

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

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

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

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

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

Table 6. Number and percent distribution of persons interviewed and average number of chronic


conditions per person, and number and percent distribution of conditions reported in the medi­


cal records (PVRS) and proportion reported in interviews, by type of match code, according to


questionnaire used


All


persons conditions Conditions reported


interviewed 

Chronic in (PVRS’s) in interview Conditions


not reported


condi- in interview


tions


per


person


{PVRS’S) tiumber Per- ~
 cent Per-
 Number ~~n~ Number cent


+ 1 I 

Total-- 5,988 100.0 21,025 6,140 100.0 

1---!-,----- 1,919 32.0 1.015 1,948 100.0 646 33.2 321 16.5 981 50.4 

2---------- 2,020 33.7 1.091 2,203 100.0 871 39.5 426 19.3 906 41.1 

3 -------- T 2,049 34.2 0.971 t 1,989 100.0 

I 

789 39.6 306 I 15.4 894 1 

45.0 

=4== -


‘See page 14 of text for definitions of match codes A and B. 

~The 1.025 chronic conditions per person entered in medical recor$s (PVRS’S) for persons in


the sample 17 years of age or over compares with 0.83 chronic condit~ons per person entered in


medical records for persons 15 years of age or over in the HIP study. The difference of about 20


percent would be somewhat reduced if both tables related to the same age group.


Table 7. Number and percent distribution of conditions reported in the medical records (PVRS) and


in interviews, by section of questionnaire eliciting the response, according to queationnaire


used and type-of-match code


Conditions reported


All in interview


matched


conditions


Source of response Match code A Match code B


I 

Per- Per-
 Number Number
 cent cent


Questionnaire 1


Total 9671 100.0 646 100.0 

Table c-l----------------------------------------- 1,271 98.0 857- 98.4 414 97.2 

Table H 11 0.9 5 0.6 6 1.4 

Table c-l----------------------------------------- 588 89.4 

Table H 3.4 

Table P------------------------------------------. ;$ 7.2 

Other source of response 1 0.1 1 

Questionnaire 2 

Total 871 100.0 426 100.0 

Table P------------------------------------------- 15 1.2 9 -1- 1.0 6 1.4

Other source of response


Questionnaire 3


Total--------------------------------------. 789 100.0 306 100.0 

Table c-l----------------------------------------- 1,044 95.3 764 96.8 280 91.5 

Table H 1.0 

Table P---.--------------------------------------. ;: M 1? 2.2 2: ::; 

Other source of response-------------------------” 1 0.1 1 1 0.3 

33 
---------------------------------------

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

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

Table 8. Number and percent distribution,
of conditionsreported in medical records (PVRS)and in


interview%by question elicitingthe response,accordingto questionnaireused and type of match


code


Conditionsreported


All in interview


matched


conditions


Question Match code A !latchcode B


Number	 Per- Number Per- Number Per-
 cent cent cent


Questionnaire1


Total 967 100.0 646 100.0 321 100.0 

Were you sick at any time LAST WEEK


OR THE WEEK BEFORE?------------------------------ 116 12.0 85 13.2 31 9.7 

Last week or the week before did you take any 

medicine or treatmentfor any conditLon?--------- 166 17.2 114 17.6 52 16.2 

Did you ever have an (any other) accident or injury that still bothera you or affects you 

in any way?-------------------------------------- 87 9.0 58 9.0 29 9.0 

Have you had any of these conditionsDURING THE 

PAST 12 MONTHS?---------------------------------- 379 3;.; 250 38.7 129 40.2 

Do you have any of these conditions?-------------- 75 . 46 7.1 29 9.0 

AT THE PRESENT TIME do you have any other ailmenta, conditions,or problemswith your health?- .53 5.5 36 5.6 17 5.3 

Have you been in a hospital at any time during 

the past 12 months?------------------------------ 5 0.5 4 0.6 1 0.3 

Questionnaire2 

Total 1,297 100.0 871 100.0 426 100.0 

Were you sick at any time LAST WEEK


OR THE WEEK BEFORE?------------------------------ 104 8.0 80 9.2 24 5.6 

Last week or the week before did you take any 

medicine or treatmentfor any condition?--------- 218 16.8 122 14.0 96 22.5 

DURING THE PAST 12 MONTHS, have You seen or talked to a doctor about-yourseif?--------------- 417 32.1 305 35.0 112 26.3 

Have you ever had to change your eating, drinkiqg, or smokinghabits becauae of some health 

condition?--------------------------------------- 22 1.7 15 1.7 7 1.6 

Have you ever had to make any other change in 

your way of doing things becauae of some health 

condition?--------------------------------------- 8 0.6 6 0.7 2 0.5 

Have you ever had any other illness or injury 

which bothera you or affecta you in any way?----- 59 4.5 38 4.4 21 4.9 

Have you EVER had any of the conditionsIiated on this card?------------------------------------ 183 14.1 128 14.7 55 12.9 

Have you had any of these conditionsDURING THE 

PAST 12 MONTHS?---------------------------------- 260 20.0 163 18.7 97 22.8 

Have you been in a hospital at any time during 

the past 12 months?------------------------------ 2 0.2 2 0.5 

Questionnaire3 

Total -------. 1,095 100.0 789 100*O 306 100.0 

Were you sick at any time LAST WEEK 

OR THE WEEK BEFORE?------------------------------ 137 12.5 105 13.3 32 10.5 

Last week or the week before did you take any 

medicine or treatmentfor any condition?--------- 164 15.0 127 16.1 37 12.1 

Did you ever have an (any other) accident or injury that still bothers you or affects you 

in any way?-------------------------------------- 56 5.1 17 2.1 39 12.8 

Have you EVER had any of the conditionslisted on this card?------------------------------------ 311 28.4 227 28.8 84 27.4 

Have you had any of these conditionsDURING THE 

PAST 12 MONTHS?---------------------------------- 333 30.4 254 32.2 79 25.8 

At the present time do you have any other ailments, conditions,or problemswith your health?- 44 400 34 4.3 10 3.3 

Have you b$en in a hospital at any time during 

the paat 12 months?------------------------------ 2 0.2 2 0.2 

34

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Table 9. Number and percent distribution of conditions reported in medical records (PvR8) and 

prOpOIXiOII reported in interviews, by type of ~tch code, according to sex 

All


conditions Conditions reported


in interview Conditions
 in (PVRS’S) not reported


in interview


Sex Match code A Match code B


Number	 Per- Number Per-


cent cent


Total 2,306 37.6 1,053 17.1 2,781 45.3


Male-------------------------------2,559 100.0 1,006 39.3	 432 16.9


Female 3,581 100.0 621 17.3
 -t-1,300 I 

36.3 -1- X?!l-E 

Table 10. Number and percent distributionof conditions reported in medical records (PVRS)and 

proportion reported in interviews, by type of match code, according to Sex and age 

All


conditions Conditions reported


in interview Condition~
 in (PVRS’S) not reported


in interview


Sex and age Match code A Match code B


Per-
 Number
 cent


Number Per- Number Per- Number Per-


cent cent cent


Both sexes


Total 6,140 100.0 2,306 37.6 1,053 17.1 2,781 45.3
 — _


17-24 years 306 100.0 123 40.2 12.1 146 47.7 

25-34 years 683 100.0 252 36.9 1;; 16.8 316 46.3 

35-44 years 1,390 100.0 478 34.4 243 17..5 669 48.1 

45-54 years 1,596 100.0 591 37.0 284 17.8 721 45.2 

55-64 years 1,206 100.0 425 35.2 202 16.7 579 48.0 

65-74 years 816 100.0 368 45.1 151 18.5 297 36.4 

75-89 years 143 100.0 69 48.3 21 14.7 53 37.1 

m


Total 2,559 100.0 1,006 39.3 432 16.9 1,121 43.8 

17-24 veals 124 100.0 50.0 15.3 34.7 

2%34 ~ears----------------------- 213 100.0 % 28.6 22.5 1;: 48.8 

35-44 years----------------------- 475 100.0 169 35.6 16.8 226 47.6 

45-54 years----------------------- I 690 100.0 287 41.6 18.4 276 40.0 

55-64 years----------------------- 528 100.0 198 37.5 13.6 258 48.9 

65-74 years 441 100.0 190 43.1 16.6 178 40.4 

75-89 years----------------------- 88 100.0 39 44.3 14.8 36 40.9 

Female


Total 3,581 100.0 1,300 36.3 17.3 1,660 46.4 

17-24 years 182 100.0 33.5 9.9 103 56.6 

25-34 years 470 100.0 1$: 40.6 :; 14.3 212 45.1 

35-44 years 915 100.0 309 33.8 163 17.8 443 48.4 

45-54 years 906 100.0 304 33.6 157 17.3 445 49.1 

55-64 years 678 100.0 227 33.5 130 19.2 321 47.3 ;;-;: years 375 100.0 178 47*5 78 20.8 119 31.7 

years 55 100.0 30 54.5 8 14.5 17 30.9 

35

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

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

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

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

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

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

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

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

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

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

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

Table 11. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to sex and race


Sex and race


Both sexes


Total


White


Negro


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


Male


Total


White


Negro


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


Female


Total


White


Negro


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


All


conditions Conditions reported


in interview Conditions
 in (PVRS’s) lot reported


in interview


Match code A Match code B


Per- Number cent 

Number Per- Number ‘er- iumber ?er­ cent :ent :ent 

6,140 100.0 2,306 37.6 1,053 17.1 2,781 45.3
 — — - —


5,739 100.0 2,194 38.2 966 16.8 2,579 44.9


323 100.0 90 27.9 69 21.4 1;$ 50.8


78 100.0 22 28.2 18 23.1 48.7


2,559 100.0 1,006 39.3 432 16.9 1,121 43.8 

2,408 100.0 961 39.9 399 16.6 1,048 43.5 

138 100.0 36 26.1 31 22.5 71 51.4 

13 100.0 9 69.2 2 15.4 2 15.4 

3,581 100.0 1,300 36.3 621 17.3 1,660 46.4


3,331 100.0 1,233 37.0 17.0 1,531 46.0 185 100.0 54 29,2 20.5 93 50.3 

65 100.0 13 20.0 24.6 36 55.4 

Table 12. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to relationship to head of


household


Relationship to head of household


Total


Head of household


Spouse-----------------------------


Child------------------------------
 Other------------------------------


All


conditions Conditions reported


in interview Conditions
 in (PVRS’S) not reported


in interview


Match code A Match code B


Number ~n;


Number ~n; Number ~; Number :g;


37.6 I 1,053 17.1 2,781 45.3


I I I I 

2,940 100.0 1,079 36.7 507 ;;.; 1,354 46.1 

2,828 100.0 1,070 37.8 477 1,281 45.3 

233 100.0 102 43.8 32 13;7 42.5 

139 100.0 55 39.6 37 26.6 :? 33.8 

36

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

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

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

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

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

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

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

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

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

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

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

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

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

Table 13. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to education of each sample


person


Years of education


Total


Less than college------------


1-4 years


5-8 years


9-12 years


Some college-----------------


1-2 years


3-4 years


5 years or more


No education-----------------------


Education unknown


All


in (PVRS’S) in interview Conditions 

not reported 

in interview 

Match code A Match code B 

PerNumber cent Per- Per- Number Number cent cent 

Per- Number cent 

conditions Conditions reported


6,140 100.0 2,306 37.6 1,053 17.1 2,781 45.3 

4.245 100.0 1.643 38.7 729 17.2 1.873 44.1 

1,0:? 

100.0 

100.0 4:; 

32.6 

40.4 1;; 20.7 

17.7 42; 

46.7 

41.9 

3,072 100.0 1,176 38.3 519 16.9 1,377 44.8 

1,735 100.0 602 34.7 291 16.8 842 48.5 

852 100.0 319 37.4 146 17.1 387 45.4 

516 100.0 182 35.3 14.1 261 50.6 

367 100.0 101 27.5 ;: 19.6 194 52.9 

119 100.0 44 37.0 29 24.4 46 38.7 

41 100.0 17 41.5 4 9.8 20 48.8 

Table 14. Number and percent distribution of conditions reported in medical records (PVRS) and 

proportion reported in interviews, by type of match code, according to education of head of 

household


All


conditicms Conditions reported


in interview
 in (PVRS’S)


Years of education
 Match code A Match code B


Per-
 Number


Total


Less than college


1-4 years


5-8 years--------------------------


9-12 years


Some college


1-2 years


3-4 years


5 years or more


No education-----------------------


Education unknown


cent


Number Per- Number Per-


cent cent


6,140 100.0 2,306 37.6 1,053 17.1 

3,869 100.0 1,541 39.8 681 17.6 

110 100.0 30.9 20 18.2 

1,151 

2,608 

100.0 

100.0 

4;: 

1,033 

41.2 

39.6 

207 

454 

18.0 

17.4 

2,040 100.0 684 33.5 328 16.1 

851 100.0 295 34.7 156 18.3 

640 100.0 224 35.0 80 12.5 

549 100.0 165 30.1 92 16.8 

114 100.0 46 40.4 23 20.2 

117 100.0 35 30.0 21 17.9 

Conditions


not reported


in interview


2,781 45.3


-t-1,647 42.6 

50.9


4% 40.8 

1,121 I 43.0 

1.0281 50.4


45 39.5


61 52.1


37

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

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

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

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

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

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

------

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

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

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

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

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Table 15. Number and percent distributionof conditionsreported in medical records (PVRS)and


proportionreported in interviews,by type of match code, accordingto sex and marital status


All


conditions Conditionsreported


in interview Conditions
 in (PVRS’s) lot reported


Ln interview


Sex and marital status
 Match code A [atchcode B


Per­ !Wumber cent


Number ?er- [umber ‘er- W.unber Per­

:ent :ent cent


Both sexes


Total 6,140 100.0 2,306 37.6 1,053 17.1 2,781 45.3 .
 ——


Married 5,068 100.0 1,923 37.9 864 17.0 2,281 45.0 

Widowed 387 100.0 124 32.0 71 18.4 192 49.6 

Divorced 245 100.0 109 44.5 34 13.9 102 41.6 

Separated -----.------”---- 48 100.0 10 20.8 8 16.7 30 62.5 

Never married 384 100.0 140 36.5 72 18,8 172 44.8 

Marital status unknown 8 100.0 4 50.0 4 50.0 

Male


Total 2,559 100.0 1,006 39.3 432 16.9 1,121 43.8 

Married 2,241 100.0 857 38.2 386 17.2 998 44.5 

Widowed 61 100.0 18 29.5 12 19.7 31 50.8 

Divorced 72 100.0 39 54.2 5 6.9 28 38.9 

Separated 20 100.0 7 35.0 1 5.0 12 60.0 

Never married 157 100.0 85 54.1 24 15.3 48 30.6 

Marital status unknown 8 100.0 4 50.0 4 50.0 

Female


Total 3,581 100.0 1,300 36.3 621 17.3 1,660 46.4 

Married---..--------..-----” - 2,827 100.0 1,066 37.7 478 16.9 1,283 45.4 

Widowed 326 100.0 106 32.5 59 18.1 161 49.4 

Divorced 173 100.0 70 40.5 29 16.8 74 42.8 

Separated 28 100.0 3 10.7 7 25.0 18 64.3 

Never married 227 100.0 55 24.2 48 21.2 124 54..6 

Marital etatus unknown . -

38

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

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

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

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

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

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

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

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

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

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

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

� 

I 

I 

Table 16. Number and percent distribution of conditions medical records (FVRS) and 

I proportion reported in interviews, by type of match 

reported in 

code, according to family income


All 

conditions Conditions reported

I in (PVRS’S) in interview Conditions 

Family income Match code A


I Per- Number cent Per- Per- Number cent cent 

Total 6,140 100.0 2,306 37.6 1,053 17.1 2,781 45.3
 _


Under $3,000----------------------- 639 100.0 291 45.5 118 18.5 230 36.0 

‘h	 3,000- 4,999---------------------- 962 100.0 368 38.3 147 15.3 447 46.5 

5,000- 6,999---------------------- 1,373 100.0 491 35.8 228 16.6 654 47.6 

II 7,000- 9,999---------------------- 1,586 100.0 574 36.2 288 18.2 724 45.6

10,000 and over 1,437 100.0 522 36.3 244 17.0 671 46.7 

Income unknown 143 100.0 60 42.0 28 19.6 55 38.5 

Table 17. Number and percent distribution of conditions reported in medical.records (PVRS) and


proportion reported in interviews, by type of match code, according to sex and usual activity


status


All


conditions Conditions reported


in interview Conditions
 in (FVRS’S) not reported


in interview


Sex and usual activity Match code A Match code B


Per-
 Number
 cent Per- Per- Per-
 Number Number Number
 cent cent cent


Both sexes


Total 6,140 100.0 2,306 37.6 1,053 17.1 2,781 45.3 

Working 3,221 100.0 1,090 33.8 555 17.2 1,576 48.9 

~;~~~ house 2,180 100.0 856 39.3 380 17.4 944 43.3 -.-.---..---------.--.------ 495 100.0 256 51.7 15.6 1:; 32.7 

Other 1;: 100.0 80 44.9 X 18.5 36.5 

Activity unknown 100.0 24 36.4 8 12.1 34 51.5 

Male


Total------------------------ 2,559 100.0 1,006 39.3 432 16.9 1.121 43.8 

Working 2,015 100.0 733 36.4 348 17.3 93; 46.4 

&e;~~~ house 100.0 26.3 26.3 47.4 

3;; 100.0 20: 51.8 5; 14.0 135 ;:.; 

Other------------------............ 104 100.0 50 ;;.; 24 23.1 30 

Activity unknown 27 100.0 14 . 13 48:1


Female


Total 3,581 100.0 1,300 36.3 621 17.3 1,660 46.4
 .


Working .........---------.........- r,206 100.0 357 29.6 207 17.2 642 53.2 

l@;@~ house 2,161 100.0 851 39.4 375 17.4 935 43.3 --------........------------ 101 100.0 52 51.5 22 21.8 26.7 

Other 100.0 30 40.5 12.2 :; 47.3 

Activity unkno~------------------- K 100.0 10 25.6 ; 20.5 21 53.8 

39

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

---------

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

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

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

---------

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

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

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

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

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

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

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

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

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

Table 18. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code,according to sex and employment status


All


conditions Conditions reported


in interview Conditions
 in (PVRS’s) not reported


in interview


Sex and employment status Match code A fetch code B


Per-
 Number
 cent Per- Per- Per-
 Number cent (umber :ent Number cent


Both sexes


Total 6.140 100.0 2.306 37.6 1.053 17.1 2.781 45.3 

Worked during last 2 weeks 2,780 100.0 965 34.7 444 16.0 1,371 49.3 

Was on layoff or looking for job 

during last 2 weeks 109 100.0 41 37.6 14 12.8 54 49.5 

Has a re~lar job or business but 

was looking for work or on layoff 

during last 2 weeks 13 100.0 9 69.2 4 30.8 

Has regular job or business; 

neither worked nor looked for work 

nor was on layoff during last 

2 weeks--------------------------- 106 100.0 43 40.6 24 22.6 39 36.8 

Did not work during last 2 weeks,


has no regular job or business,


and was not looking for work


during last 2 weeks 3,132 100.0 1,248 39.8 571 18.2 1,313 41.9


Total------------------------ 2,559 100.0 1,006 39.3 432 16.9 1,121 43.8 

Worked during last 2 weeks 1,665 100.0 603 36.2 290 17.4 772 46.4 

Was on layoff or looking for job 

during last 2 weeks 66 100.0 31 47.0 3 4.5 32 48.5 

Has a regular job or business but 

was looking for work or on layoff 

during last 2 weeks 11 100 .C 7 63.6 4 36.4 

Has a regular job or business; 

neither worked nor looked for work 

nor was on layoff during last 

2 weeks 71 100.C 31 43.7 15 21.1 25 35.2 

Did not work during last 2 weeks,


has no regular job or business,


and was not looking for work


during last 2 weeks 746 100 .C 334 44.8 124 16.6 288 38.6


Female


Total 3,581 100 .C 1,300 36.3 621 17.3 1,660 46.4 

Worked during last 2 weeks--------- 1,115 100 .C 362 32.5 154 13.8 599 53.7 

Was on layoff or looking for job 

during last 2 weeks 43 100 .C 10 23.3 11 25.6 22 51.2 

Has a regular job or business but 

was looking for work or on layoff 

during last 2 weeks 2 100 .C 2 100.0 

Has a regular job or business;


neither worked nor looked for work
 nor was on layoff during last


2 weeks 35 100 .[ 12 34.3 9 25.7 14 40.0 

Did not work during last 2 weeks, 

has no regular job or business, 

and was not looking for work 

during last 2 weeks 2,386 100 .( 914 38.3 447 18.7 1,025 43.0 

40 
---------------------

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

Table 19. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to number of workers in


family


All


conditions Conditions reported


in inteview Conditions
 in (PVRS’s) not reported


in interview


Number of workers Natch code A Match code B


Per-
 Number
 cent
 Per- Per- Per-
 Number Number
 cent cent cent


Total------------------------ 6,140 100.0 2,306 37.6 1,053 17.1 2,781 45.3


No workers------------------------- 639 100.0 291 45.5 118 18.5 230 36.0 

1 worker--------------------------- 962 100.0 368 38.3 147 15.3 447 46.5 

2 workers-------------------------- 1,373 100.0 491 35.8 228 16.6 654 47.6 

3-5 workers------------------------ 1,586 100.0 574 36.2 288 18.2 724 45.6 

5 workers and over----------------- 1,437 100.0 522 36.3 244 17.0 671 46.7 

Number unknown 143 100.0 60 42.0 28 19.6 55 38.5 

Table 20. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to best term used in physi­


cian-to-patient communication


All


conditions Conditions reported


in interview Conditions
 in (PVRS’s) not reported


in interview
 Best terml used by physician


to patient Match code A latch code B


Per-
 Number
 cent Per- Per- Per-
 Number Wsber Number
 cent cent cent


Total------------------------ 26,058 100.0 2.272 37.5 1,045 17.2 2,741 45.2 

Best term used in PVR in same Recode 3 Category as final codeable 

diagnosis------------------------- 4,377 100.0 1,796 41.0 669 15.3 1,912 43.7 

Terms codeable but not to same Recode 3 Category as final 

diagnosis------------------------- 887 100.0 256 28.9 216 24.4 415 46.8 

No codeable term used 794 100.0 220 27.7 160 20.2 414 52.1 

‘If for at least one visit for a condition the physician entered in question 2 of the PVR a


diagnostic term codeable to the same Recode 3 Categ~ as was the final diagnosis for that condi­


tion, then the best term is said to be in the same Recode 3 Category as the final diagnosis.


~Question 2 of the PVR could not be answered for 82 conditions for which the only visit to


SCPMG was to a hospital.


41

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

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

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

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

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

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

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

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

Table 21. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews,by type of match cod~ according to best term used in patient­


~o-physician communication


All


conditions Conditions reported


in interview Conditions
 in (PVRS’S) not reported


in interview
 Best term* used by


patient to physician Match code A Match code B


l?er- I 

cent 

Number Percent Number ~~~ Number Percent 

, I I I 

Total 2,272 37.5 1,045 17.2 2,741 45.2 

Best term used in PVR in same Recode 3 Categoryas final diagnosis- 3,408 100.0 1,477 43.3 490 14.4 1,441 42.3 

Terms codeable but not to same Recode 3 Categoryas final diagnosis- 489 30.2 379 23.4 753 46.5 

NO codeable term used w 306 29.7 176 17.1 547 53.2 

lIf for at least one visit for a s~ecified cond :ion the physicj m entered in question 3of the


PVRa diagnostic term codeable to the-same Recode Category as was the final diagnosts for that


condition, then the best term is said to be in the same Recode 3 Category as the fins% diagnosis.


‘Question 3 of the PVR could not be answered for 82 conditions for which the only visit to


SCPMG was to a hospital


Table 22. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to emphasis given to the


dia-~osisl


All


conditions Conditions reported


in interview Conditions
 in (PVRS’S) not reported


in interview


Emphasis given diagnosis Match code A Match code B


Per-
 Number cent Per- Per- Per-
 Number Number Number
 cent cent cent


Total 26,058 100.0 2,272 37.5 1,045 17.2 2,741 45.2 — _ — — 

‘lfadea point of it”


On at least one visit 2,433 100.0 1,036 42.6 399 16.4 998 41.0 

At no visit 3,625 100.0 1,236 34.1 646 17.8 1,743 48.1 

“Played it down”


On at least one visit 1,529 100.0 607 39.7 253 16.5 669 43.7 . At no visit 4,529 100.0 1,665 36.8 792 17.5 2,072 45.8 

Neither of the above responses


On at least one visit 3,374 100.0 1,366 40.5 576 17.1 1,432 42.4 

At no visit 2,684 100.0 906 33.8 469 17.5 1,309 48.8 

Of all the visits made for a condition only thoseinwhich the visit diagnosis was the same as


the final diagnosis were considered for this table.


~Question 5 of the PVR could not be answered for 82 conditions for which the only visit to 

SCPMG was to a hospital. 

42

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

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

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

Table 23. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to number of chronic condi­


ti.cmsl
present


All


conditions Conditions reported


in interview Conditions
 in (PVRS’S) not reported


in interview


Number of chronic conditions
 Match code A Match code.B


Per-
 Number
 cent
 Per- Per- Per-
 Number Number Number
 cent cent cent


Total 6,140 100.0 2,306 37.6 1,053 17.2 2.781 45.3 — . 

1 condition------------------------ 1,404 100.0 505 36.0 285 20.3 614 43.7 

2 conditions 1,749 100.0 654 37.4 276 15.8 819 46.8 

3 conditions----------------------- 1,294 100.0 501 38.7 213 16.5 580 44.8 

4 conditions----------------------- 920 100.0 345 37.5 151 16.4 424 46.1 

5 conditions and over-------------- 773 100.0 301 38.9 128 16.6 344 44.5 

#


Table 24. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to number of visits to SCPMG


All


conditions Conditions reported


in interview Conditions
 in (PVRS’S) not reported


in interview


Number of visits to SCPMG1
 Match code A Match code B


Per-
 Number
 cent Per- Per- Per-
 Number Number Number
 cent cent cent


Total 6,140 100.0 2,306 37.6 1,053 17.1 2,781 45.3 — — 

1 visit....................-------- 3,081 100.0 821 26,7 543 17.6 1,717 55.7 

2 Visits 1,281 100.0 495 38.6 181 14.2 605 47.2 

3 visits 643 100.0 288 44.8 132 20.5 223 34.7 

4-5 visits 639 100.0 359 56.3 114 17.8 166 26.0 

6 visits and over 496 100.0 343 69.0 83 17.0 70 14.0 

‘For a relatively small number of conditions for which large numbers of routine visits were


being made, such as injections for allergy, the condition was noted only once on the PVR.


43

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

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

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

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

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

--------

Table — 25. Percent distribution and cumulativePercent of conditionsin medical records (PVRS).
 . . bv number of visits to S( [G,>ccordingto type of match code


Conditionsreported in interview Conditionsnot 

Total reported in 

Number of visits Match code A I Match code B interview 

to SCPMG 

Percent Cumula- Percent Cumula- Percent Cumula- ?ercent Cumula-


Of tive of tive of tive Of tive


visits percent visits percent visits percent ?isits percent


a

+ 

Total 100.0 I 100.0 I 100.0 100.0 

visit 50.2 50.2 35.6 35.6 51.6 51.6 6?..8 61.8 

visits 20.9 71.1 21.5 57.1 17.2 68.8 21.8 83.6 

visits 10.5 81.6 12.5 69.6 12.5 81.3 91.6 

visits 87.7 8.6 78.2 8.1 89,4 :;! 94.9 

visits ::; 92.0 6.7 84.9 2.3 91.7 2.6 97.5 

6-10 visits 6.5 98.5 11.3 96.2 6.8 98.5 2.4 99.9 

11-15 visits 1.1 99.6 2.7 98.9 0.7 99.2 0.1 100.0 

16-25 visits 0.4 100.0 0.7 99.6 0.4 99.6 0.1 100.1 

26 visits and over 0.1 100.1 0.2 99.8 0.0 0.0 

1 I 

Table 26. Number and percent distribution of conditionsreported in medical records (PVRS)and


proportionreported in interviews,by type of match cod~ accordingto number of days since last


Visitto SCJ?MG


All conditions 

in (PVRS’S) Conditionsreported in interview Conditionsnot 

reported in 

Number of days Match code A Match code B interview 

Number Percent 

Number Percent ?umber Percent Number Percent


Total 6,140 100.0 2,306 37.6 1,053 17.2 2,781 4503 

1-7 days 116 100.0 69.0 22.4 10 

8-14 days--------------- 218 100.0 1:; 63.8 8.7 60 2;:2 

15-28 days 440 100.0 245 55.7 20.4 105 23.9 

29-56 days-------------- 683 100.0 280 41.0 17.4 284 41.6 

57-84 days 574 100.0 236 41.1 22.0 212 36.9 

85-112 days 513 100.0 210 40.9 16.8 217 42.3 

113-140 days------------ 476 100.0 176 37.0 17.9 215 45.2 

141-168 days 355 100.0 123 34.6 19.2 164 46.2 

169-224 days 372 100.0 98 26.3 17.2 210 56.5 

225-280 days 1,232 100.0 411 33.4 14.8 638 51.8 

281-364 days------------ 1,078 100.0 287 26.6 15.8 621 57.6 

365 days or more 71 100.0 13 18.3 22.5 42 59.2 

No days or days unlcnown- 12 100.0 8 66.7 8.3 3 25.0 

44

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

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

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

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

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

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

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

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

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

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

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

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

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Table 27. Number and percent distribution of persons,~ by how freely respondent thinks most other


people would talk about conditions in an interview according to specified conditions


How freely respondent thinks most other


people would talk about the condition


Condition Very Quite Somewhat


freely freely freely


Per- Per- Per-
 Number Number Number
 cent cent cent


Asthma --”-------------------------. 2,751 45.9 1,680 28.1 840 14.0 

Heart disease-------------------------------------- 2,232 37.3 1,439 24.0 1,258 21.0 

. Arthritis or rheuatism 2,800 46.8 1,652 27.6 948 15.8 

High blood pressure 2,518 42.1 1,563 26.1 1,122 18.7 

Blindness------------------------------------------ 1,953 32.6 935 15.6 1,024 17.1 

Chronic nervous trouble---------------------------- 1,287 21.5 944 15.8 1,220 20.4 

Cancer-------------------------.--------------.---- 1,051 17.6 822 13.7 889 14.8 

Oveweight 1,939 32.4 1,158 19.3 1,125 18.8 

Mental illness------------------------------------- 559 440 514 

Missing hand, arm, foot, or leg-------------------- 1,305 2?:: 768 1;:; 1,110 1,::2 

Deafness 1,240 2:.; 993 1:.; 1,318 22.0 

Venereal disease 398 291 254 4.2 

Stomach ulcer 1,951 32:6 1,663 27:8 1,542 25.8 

Paralyses 1,379 23.0 1,251 20.9 1,254 20.9 

Tonsillitis---------------------------------------- 3,330 55.6 1,385 23.1 522 

Diabetes 2,026 33.8 1,448 24.2 1,233 2::; 

-


How freely respondent thinks most other


people would talk about the condition


Condition Not v Not freely Unknown fret Y at all 

Per- Per- Per-
 Wmber :ent Number cent Number cent


Asthma 393 6.6 175 149


Heart disease-------------------------------------- 622 10.4 289 c?: 148 H


Arthritis or rhematism 

High blood pressure 

259 

394 

4.3 190 

245 2: 139 

146 

2.3 

2.4 

Blindness 1,039 1%: 879 14.7 158 2.6 

Chronic nervous trouble 1,540 25.7 858 14.3 139 2.3 

Cancer 1,528 25.5 1,550 25.9 148 

Ovemeight 1,005 16.8 612 10.2 149 $:; 

Mental illness------------------------------------- 1,525 25.5 2,796 46.7 154 2.6 

Missing hand, arm, foot, or leg-------------------- 1,294 21.6 1,351 22.6 160 2.7 

Deafness 1,350 22.5 932 15.6 155 2.6 

Venereal disease 959 16.0 3,935 65.7 151 2.5 

Stomach ulcer 446 223 163 2.7 

Paralysis 1,026 1;:? 924 1$: 154 

Tonsillitis 204 370 6.2 177 ;:: Diabetes 640 1;:; 474 7.9 167 2.8 

; 

lTotal persons iS 5,988 for every row;the percentages shown for each condition totals 100 Per-


cent.


45

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

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Table 28. Table P of Questionnaires1, 2, and 3


P-1..	Have you ever bee? advisedby a doctor to limit the amount or to avoid entirklycertainkinds of food or beverages? _ Yes — NO 

If “yes,” ask:


a. For what reason or condition?


b. Are you still followingthis advice? — yes — NO


P-2.	 At the present time are you regularlytaking any medicine or treatmentfor any condition? _ Yes — NO 

If “yes,” ask:


. a. B’orwhat condition?


P-3.	 Do you have any conditionwhich often causes you pain or discomfort? _ Yes — NO 

If “yes,” ask:


a. What is the condition?


P-4	 Do you have any health problemwhich is a source of worry


to you or other members of your family? _ Yes — NO


If “yes,” ask:


a. What is the problem?


P-5. (ForMales): ire you limited in any way in the amount m kind of work you can do because of 

yourhealth? _ Yes — NQ 

(For Females): he vou limited in anv wav in the amount m kind of housework ~ou ;an do because 

of your health? _ Yes — No 

If “yes,” ask:


a. What conditioncauses this?


P-6. In general,would you say that your health is excellent,


good, fair, or poor? _ Excellent _ Good
 _ Fair _ Poor


Table 29. Number and percent distribution of conditionsreported in medical records (PVRS)and


proportionreported in interviews,by type of match code.. according.- to general state of health


All


conditions Conditionsreported


in interview Conditions
 in (PVRS’s)


General.state of health Match code A


Number ~~;


Number I-TPer-


cent 

-

1 1 

Total 4= 2,306 37.6 1,053 17.1 I 2,781 45.3 — f I I


Excellenthealth 1,572 100.C 414 26.3 209 13.3 949 60.4 

Good health 2,856 100.C 1,049 36.7 526 18.4 1,281 44.9 

Fair health 1,381 100: c 661 47.9 269 19.5 451 32.7 

Poor health 309 100.C 172 55.7 43 13.9 9: 30.4 

State of health unknown 22 100.C 10 45.5 6 27.3 27.3 

1 I 
--------

Table 30. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to whether the person has
 ever had limitations involving food or beverages


. 

All


conditions Conditions reported


in (PVRS’s) not reported 

Ever had limitation Of food in interview 

Match code A Match code B 

Number ~n’ 

in interview Conditions


or beverage a * 

3,937 100.0 15.9 1,875 47.6 

1 1 

Had limitations-------------------- 1,876 100.0 18.7 724 38.6 

Had no limitations----------------- 2,061 m 100.0 6341 30.81 276 13.4 1,151 55.8 

Total-----------------------­


‘Based on replies to question P-lb of Questionnaires 1 and 3.


Table 31. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to whether the person has


current limitations involving food or beverages


All


conditions


in (PVRS’S)


Current limitation of food


or beverage


Per-
 Number
 cent


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

-L

1,876 100.0 

Current limitations---------------- 1,146 100.0 

No current limitations------------- 586 100.0 

Current limitations unknown 144 100.0 

Match code A Match code B I 

Per- Number T cent ‘Uder T

801 42.7 351 18.7 724


502 43.8 234 20.4 410 

247 42.2 94 16.0 245 IT 

52 36.1 23 T16.0 69 

Per-


cent


38.6
 —


35.8


41.8


47.9


‘Based on replies to question P-lb of Questionnaires 1 and 3.


47

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

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

----------

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

Table 32. Number and percent distribution of conditions reported in medical records (PVR8) and


proportion reported in interviews, by type of match code, according to whether theperson is


currently receiving medicine or treatment


All


conditions


in (PVR8’s)


Receiving medicine or treatment Match code A Match code B
 I 1 I 

Per- Per-
 Number ~~ Number Number
 cent cent


I 

Total------------------------ 6,140 100.0 2,306 37.6 1.053 17.1 2,781 45.3


Receiving medicine or treatment---- 2,588 100.0 1,200 46.4 547 21.1 841 32.5


Not 

treatment

receiving 

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

medicine or -1-

3,552 100.0 

+ 

1,106 31.1 506 T14.2 1,940 54.6 

Unknown----------------------------
 I 

lBased on replies to question P-2 of Questionnaires 1> 2S and 3-

Table 33. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to whether the person often


has pain or discomfort


—. 

All


conditions Conditions reported


in interview Condition:
 in (PVRS’s)


Pain or discomfort
 Match code A


Per-
 Number ~; Number


cent
 +
 , 

Total 6,140 100.0 2,306 37.6 1,053


Has pain or discomfort 2,363 100.0 1,112 47.1 444 *

Has no pain or discomfort 3,764 100.0 1,190 31.6 607 16.1 1,967 52.3


Unknot T13 100.0 

T

4 30.8 2


lBased on replies to question p-3 of Questionnaires 1, 2, and 3.


4$

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

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

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

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

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

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

Table 34. Number and percent distribution of conditions reported in medical records (PVRS) and 

proportion reported in interviews, by type of match code, according to whether health problems 

are a source of worryl 

All 

conditions Conditions reported 

in interview Conditions in (PVRS’S) not reported 

I in interview 

Worry Match code A Iiatch code B 

1 Per- I Number cent Per -
 Number€ Per- Number Number Per- cent cent cent 

Total 6,140 100.0 2,306 37.6 1,053 17.1 2,781 45.3

u Health problems source of worry---- 1,088 100.0 550 50.6 219 

i=l=

20.1 319 29.3 

Health problems not a source 

of worry-------------------------- 5,019 100.0 1,743 

-1

34.7 832 16.6 2,444 48.7

Unknown 33 100.0 13 39.4 2 6.1 -1-_L18 54.5 

lBaaed on replies to question P-4 of Questionnairea 1, 2, and 3. 

Table 35. Number and percent distribution of conditions reported in medical records (PVR@ and 

Proportion reported in interviewa, by type of match code, according to whether limitation of 

tiorkor housework is present~

* 

All 

conditions Conditions reported 

in (PVRS’S) in interview Conditions 

.— not reported 

in interview 

Limitation of work or housework Match code A Match code B 

PerNumber cent 

Number :n; Number€ Per- Number Percent cent 

I --1-

Total 1,435 36.4 627 15.9 1,875 I 47.6 

Has limitation of work or housework 1,010 100.0 510 50.5 209 20.7 291 28.8 

Has no limitation of work or 

housework 2,927 100.0 925 31.6 418 14.3 1,584 54.1 

Unknown 

lBased on replies to question P-5 of Questionnaire 1 and 3. 

a 

49 
---------------------

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

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

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

Table 36. Number and percent distribution of conditionsreported in medical records (PVRS)and


proportionreportedin interviews,by type of match code, according to various combinationsof


replies to questionsP-1 through P-5


All


conditions Conditionsreported


in interview Conditions
 in (PVRS’s) not reported


Summary	of replies to questions in interview


P-1 through P-5 Match code A Match code B


Numbex Per-


cent


Number Per- Number 1Per- Number Per-


cent cent cent 0
 -


All conditionsin medical


records 6,140 100.0 2,306 37.6 1,053 17.1 2,781 45*3 .
 —


All conditionsin medical


records (Questionnaires1 and 3)-- 3,937 100.0 1,435 36.4 627 15.9 1,875 47.6


A reply of “yes” to at least one
 of the questionsP-la, P-2 through


P-5 for at least one condition


(Questionnaires1 and3 only)----- 2,946 100.0 1,249 42.4 544 18.5 1,153 39.1


A reply of “yes“ to at least one
 of the questionsP-lb, P-2 through


P-5 for at least one condition


(Questionnaires1 and3 only)----- 2,670 100.0 1,174 44.0 510 19.1 986 36.9 

A reply of “yes“ to at least one of the questionsP-2, P-3, or P-4 

(all questionnaires)-------------- 3,695 100.0 1,653 44*7 736 19.9 1,306 35.3 

A reply of “yes” to all of the 

questionsP-2, P-3, and P-4 

(all questionnaires)--------------- 565 100.0 312 55.2 112 19.8 141 25.0 

Table 37. Number and percent distribution of conditionsreported in medical records (PVRS) and


proportionreported in interviews,by type of match code, accordingto class of chronic condi­


tion


AL1


conditions


in (PVRS’S)


Class of chronic condition
 Katch code A Match code B
 I 

I 

Number Percent 

Number Per- Number Per- Number Percent cent cent I 

Total 6,140 100.0 37.5 1,053 17.2 2,781 45.3 

-tRegardlessof onset 3,713 100.0 1,603 43.2 596 16.0 1,514 40.8 

After duration of more than 

3 months (PARS)------------------- 583 100.0 258 44.3 111 19.0 214 36.7 

After duration of more than 

3 months (PAR)-------------------- 1,820 100.0 437 24.0 337 18.5 1,046 57.5 

Conditionchroniq


Other 24 100.0 8 33.3 9 37.5 7 29,2 

2,306 T1 

50

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

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

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

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

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

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

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

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

Table 38. Number and percent distribution of conditions reported in medical records (PVRS) and


proportion reported in interviews, by type of match code, according to characteristic during


week preceding visit to SCPMG (PVR)


Characteristic in week preceding


visit to SCPMGl


Total


Pain


For no visit


For at least one visit


Emotional stress


For no Visit


For at least one visit


Days in bed


For no visit


For at least one visit


Other


For no visit-----------------------


For at least one visit


All


conditions Conditions reported


in interview Conditions
 in (PVRS’s) not reported


in interview


Match code A Match code B


Number	 Per-


cent


Number	 Per- Number Per- Number Per-


cent cent cent


26,058	 — 

100.0 2,272 37.5 1,045 17.2 2,741 45.4 — —


4,271 100.0 1,484 34.8 718 16.8 2,069 48.4 

1,787 100.0 788 44.1 327 18.3 672 37.6 

4,336 100.0 1,552 35.8 700 16.1 2,084 48.1


1,722 100.0 720 41.8 345 20.0 657 38.2


5,634 100.0 2,029 36.0 961 17.1 2,644 46.9


424 100.0 243 57.3 84 19.8 97 22.9


5,253 100.0 1,859 35.4 869 16.5 2,525 48.1


805 100.0 413 51.3 176 21.9 216 26.8


——


lThe characteristic categories are IIOt Mutually eXChlsiVe.


‘Excludes 82 conditions for which only visit to SCPMG was to a hospital


51. 

I 
----

APPENDIX 1 

QUESTIONNAIRE, PVR, AND	 PVRS 

. . . ..—..— , mm ,WT,,OVCCI:Bud&t L+Ore.U No. WK6ZJ-F9. 1 

permit idencffication of the individual will he held strictly confidential, wifl he used only by pcrcons engaged in sad for the pwpo.es c.f the 1 survey �nd will not be dijwlosed cmreleased to otbeta fot may ether pugo.es (22 FR 1,5s7). 

FORM NNS.S.13.1 [0.4..21 US. DEPARTMENT OF COMMERCE 1. Questionnaire 

BUREAU OF THE CENSUS 

AcTtN.a AS COLL?SCTIN= AGENT FOR THE 

The Nationsl Health SUCVey i. authorized by Pnblic Law 652 of the 84th Ccmgre.s (7o Stat. 4SX 42 U.S.C. 305). All information which would 

U.S. PUELIC HEALTH SERVICE of 

NATIONAL HEALTH SURVEY Questionnaires 

a. Address or description. of location 3. Assignment No. ‘, ADDRESS 

h. Mailing address if meshown in (r+ Include city and .%te 4. S&ml 

Which of th.s. income gr..~ represents your total family in.onm for the post 12 months, th.t i% Y..r”s, your- -%, 

t.? Show Card H). Include i“e.m. from all sour..., such as wages, s.1.ri.s, rents from property, pensions, 

h.lp i rem ,dlltt”-, etc. 

Telephone No. , What IS th. td.ph.n. number hr.? 

‘. If smnpk person has not been intemiewed but iatemiew hag been completed for other related members, ask 

As I nmttlc.”.d .arli.r, in .a.h haus.h.ald w. ask some .pa.l.l q..stions about one pemo” for himself 

only. 1“ *IS ml.., N Is (SampIe person). What IS ~he .mxli.s? Nrne 1 

would b. obl. to s.. blm (o, h.,)? 

‘OOTNOTES 

No. 

Group 

n None 

L 

USCOMM-DC 

53 
----- ----- ----- ----- ----- -----

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

1. . . What IS the name of th. head of this household? (Enter n.mc i“ npproprime Last name @j Last name w c,,lunm) 

b.€ What are the nom.. of .11 other persons who 11.. her.? (List .11 persons who .—— —— —————— . ——— ——, T ———— - Iir. here) 

. . Is there any... else who lives here who is now ~- No ~ ~=~ ~L,=t) First name .“d initial Fir.t name and tnttial 

temp. rarilyinahosplt.l? . . . . . . . . . . . . . . . . . . 

d.€ Away .. business? . . . . . . . . . . . . . . . . . . . . . . . . m No m Yes (LI.O 

.. On Ovislt? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D No a Yes (L1.0 

f. IS there . . . . . . else staying here now? . . . . . . m No ~ Yes (Li. O 

2.€ How ore You related to the head of the household? (Enter relationship to Relati.”ship Rel.cicmsbip 

head, for example: head, wife, daughter, 8randson, mother-in-law, etc.) 

3. Ho” old were you on your lost birthday? Age 

n Under 1 year 

Ase 

U Under 1 year 

m White u Negro D Other a White n N.~m a Other 4. Race (Check one box for each person) 

n Male ~ Male 

5. %x (Check one b+. for each person) n Female a Female 

~ “ad=, ~f;Yd If 17 years old or over, ask: l_J Mammal ~Marr~und=’ ~S&at.sd 

6.€ Are y.. now married, widowed, divorced, separated, or never married? a Widowed a Widowed n ~cvcd 

(Check one box for each person) n Divorced Married n D,vorccd 

If 17 years old or over, ask a Under 17 years @ ~u.cler l,y.ars Q 

7.	 a. What IS the high.st grade you attended !. school? Elem: 12345678 Elem: 12345678 

(Circle highest &rade attended or check “None”) High 1234 High 1234 

CoIIege: 12345+ College: 12345+ 

a None m None 

b. Dldyouflnlsh !he--grade(yaar)? a Yes n No n Yes m No 

If 17years oldoro,er, as~ a Under 17 years nU.der 17ycars 

8. . . Wh.tw.r. yo. d.ingmo.tofth. p.st 12 months - m Working n Worki”E 

(For mc,IesX w.,kl”g .rd.l.g s.methl.g.ls.? n Keeping house n Keeping house 

(For fem.les> keeping ho..e, working, ordolng .omethlng else? n Something else m Something else 

If ‘%methi”g CIS. +Bchecked, and person i. 45 years O1d or over. ..~ 

b. Ar. you retired? n Yes ON o a yes m No 

NOTE:€ Beglnnlng with Question 9, you must interview the sample person for him. n Sample Person home and available - ask SAMPLE PERSON Q. P-19 

self. Check the mpprc.priote k-ax .md follow the hdl.ated order of asking n Sample Person not at borne or ncx available - continue interview for the questions. 

9.	 Were you sick at any time LAST WEEK OR THE WEEK BEFORE? (Thot IS, the n Yes n No n yes a No 2-w.ek period which ended this p.sf Sunday night.) 

m What was the matter? 

b. Anything else? 

10.€ Las+ week or th. week b.for. did y.. take any medicine or treatment for any n Yes m No n Yes U No 

.ondlNon (besides . . . which you told m. about)? 

a. For what condltlons? 

b. Anything else? 

11. Last week or the week before did you hove onY .c.id.nt. or Inl.rt.s? n Yes n No n Yes n No 

a. What were they? 

b. Anything .[..? 

12.€ Oid you ever have an (any oth.r) accident ar ln@y that still bothers you or f-J Yes m No affects you [n any woy? 

., In whm way does It bother you? (Record present effects) 

b, Anything else? 

n Yes a NO 

13. Hav. y.. hod any of these conditions OURING THE PAST 12 MONTHS? 

(Read Card A, condition by condition; record any ~~ndici..s mentioned.) . . —. —.— _l, I

a Yes n No 

14. Oo you have any of these conditions? 

n 

I

15.€AT THE PRESENT TIME do you have any other ailments, conditions or problems n Yes with your health? 

e.	 Whm i. the c.a.ditlcm? (Record condition itself if stiIl present; otherwise record 1 

pr=nt effects.) 

b. Any other problems with your health? 

18.	 a. Have you been 1. a hospltol at any Nm. during the past 12 m.nfh~? f-J Yes m No 

If “Yes,” ask 

b, How many times were you in fhc hospital during thot period? No. of times 

19.€a. Ha.. you been n P.N..t In a n.r.lng home, rest home, or any similar place o Yes a No 

d.rl.g the post 12 months? ., If “Yes,’) ask 

b. HOW m.”y thn.. w... you i“ . ..r’lng horn. or rest hem. during that period? No. of times 

a Responded for self a Responded for seIf 

R Foc non-sample persons 17 years old or over, show who 

~$~~ ~ ~e~jl. FOrr@.ons undm IT bow who @ Co,._vasresp.andenc ~ 1. 

.- —.—— 

54 
----- ----- ----- ----- --- -----

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

Last name Last name Last name @ q q“’”’”’~ 

-———— ____ ___ . ..— — —————- - ————————____ _____________ First name and inicial First name and initial First name and initial Ficst “am. and initial 

Relr.ti.mship 

m Male 

u Female 

~ fdarriep ‘nd~~&%d 

a Widowed n Never 

D Divorced Married 

~c~:nder 17 years 

12345678 G 

Htgh: 1234 

college: 1234 5+ 

n None ~.f=;---.nNo -

m Under 17 years — 

D Wdillg 

O Keeping house 

n %methi”g else 

________________ 

n Yen m No 

and Tables G 1, H and P for bimse 

non-sample persons only. 

_,—— .. — 

. 

. 

n Responded for self 

CoI.—was respondent E 

Relationship ReIatiomsbip Relationship 

Age Age J&= 

a Under 1 ye= n Under 1 year n Under 1 year 

m White n Negro n Other I ~Wbit= CIN.SIO ~Other lmwhit= nN=gm nether 

I I 

m Male I_J Male n Male 

m FemaIe 0 Fend. m Female 

1 il S&.aratcd 

cd Married n Divorced Married ~ Divorced Married 

f—.. nl— a Under 17 years 

Elem: 1234,678 ~l~~;’;;zri,, 

High 1234 

c.alle~e: 12345+ 

n No”, D No”, ---, U Yes D No ~-Y.s U No 

a Under 17 y,@.5. m Under 17 y,’=. 

H Working D Working 

a Keeping b.... 

a Something else ~ SOm;ch;ng else I I_”l something eIse 

-1 _____________ _-~=--- -

n Yes a No n Yes D No m Ye. n No 

. THEN ask Q. P-11 and Table C-2 for mx-sample persons. 

55 

1 
--

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

TABLE C-1 (For SP ONLY): Fill one line of Table C-1 for 

g;. Ques- Name of condition as Did you Ask for all illnesses,apd Ask if the entry in C.1. (* 1) *k 0“’7 Ask for any entry in 

tion reported in Questions EVER present effects of old injuries: is: 6 Yc.lS Cd. (c- 1) or Cd. (c-2h ~,d ~c ~vec that includes the words of No. p-17 at any (.) If doctor talked CO: An Imp.irme.c, P,r- tinl. and bliml­ so” talk to What did the doctor soy 

about 

. . . ? 

a medicol name? 

(b) If doctor not talked to: 

* Sympto” vision, or 

=y, trouble 

of any kind 

ASI~S “Disc asel’ f=Y~~ 

g,:~e; “Trouble” 

Record original entry and What was the c.... of . . . ? 

~ 

ask. (C-2) - (*5) s. qwred. 

co” y,u 

so- well What kind of . . . i. ii? 

.-

: Ask for dl injuries during 

p,st 2 weeks: 

.nough 

to read 

ordinary 

‘For an .llery.y or 

stroke aslc 

a doctor it was? . . . did he #VO It or ness, poor Allergy’ ~~titiom, 

.4 What port c.f the body W.. newspaper ffow d-= & rjlf.,gy 

hurt? print with (strok.) affect yOU?
 What kind of i.Iury was it? glm.s.s?


A“ythlng .!s.?


(.) (b) (.) (d) (c-l) (C-2) (,-3) (e4) 

n Y. s x a Yes ‘ x 

m No n No 

1 @ 

n Ye s = n Yes x x 

l-J No 

2 @ ‘N” 

* n Ye s x I-J Yes x 

a No n No 

3 @ 

I-J Ye s x I-J Yes x x 

a No I_J No 4 @ 

~ Ye s x nYes x x 

n No U No 

5 @ 

n Ye s x D Yes x x 

D No n No 

6 @ 

x n Ye s x D Yes x 

a No n No 

‘ @ , 

TABLE H (For SP ONLYh Fillon= lin= Of Ta~lc 2i_for each hospi@izmcion 

&l. ~n. Yousaid that you wem 1. the hospital How ~O”y Cmnplete from entries in Columns (c) Fe, what .ondhlon did ~W �ntmr th. 

NO. (C.”.., twice, etc.) during the p..? y.., nights W.r. and (c$ ~, S~W ..l..d= ad =k th. h.spit.al -. do you know th. m.dlcal 

of “ nam.? 

j P.=: When did you enter the hospital (tho l%!::: “qu=s’’ons - (If medical name n?t @own, enter 

6 last time)? (If exact How mony of f&m..:y of were you respc.r.dent’s descrtpcmn) 

number “ot ~hex= - - SNII in the z (Enter month, day a“d year; if exact known nights were nights wer. ho*pl,a, ~“ (E.c% muse show “C.use,ll ‘Xiqd, ” 

.CCCP[ besr ~~~; last week w last Sunday and pm Of b~y” in s~m= det*ll = .-

: date no%known, .aLxaim estimate.) estimate) $o;o;~;k night? required in T.ble G 1) A 

4 (Cj —— (d) 

—-- (e) _- Jf~__ -~g__. -

(a) (b) Month / Day I Year Nights Nights Nights iNone Yes I No (b) 

I I I I

i 1 I 1 o SP I I : I 

1 I 

I I 1 I

i I I 1 2 o 5P I I I

I / 

I	 I I 1 

I I I I 

I I I 3 @ I I I I 

,oR~ ~H,.,., 3.! 1s-4-821 

56 
--

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

.— . . each condition reported in Questions 9.17 for the SampIe Person. 

A.L Llnly [m: 

Impairments and injuries 

During thot Ask ONLY if Ask When did you first 

And fuc period how checked in 

Ah.ccsscs In fhmmmtio” Aches 

Illt.cding Neuritis l{lnmf Clot Pains 

IIoils .%res cut down Lancer Soreness “ BEFORE did for OS cyst Tumor Enter number If a“y . . . C.”*. you much O. Growth ulcers to cutdov.m on o day? In fcctiu” Wemkncss e“cered i. the things you 

What port of the bcdy is affected? 

Show detail fot: 

Ear or eye . (one or hmh) 

anklc,[~-~; one or hoch) 

x I I I I I mlast2wks. =before 

I I I I I l=12wks.-3mo. 12 

I I I I I 03-12 m0nchs months 

x I I I I I Dlastzwks. Ob,fore 

I I ! I 1 02wks.-3mo. 12 

I I I I I a 3-12 months months 

x I I t I I mlasr2wks. Obefo,e 

DOES ~ NOT I I I I n2wks.-3mo. 12 

I I I I 03-12 months months 

x 

AP;P LY I 

I 

I 

I 

I 

I 

I 

I 

Olastzwks. =bcforc 

U2wks.-3rno. 12 

I I I I I 0312 mamhs nmmbs 

x I I I I I Ulasc2wks. Dbefore 

I I I I I D2wks.-3mo. 12 

I I I 03-12 months momhs 

I x I 

1 

I 

I 

I 

I 

I 

, 

I 01ast2wks. Dbefo,e 

I I I I I m2wks.-3 m.. 12 

I 1 I I I m 3-12 mombs month, 

x 1 

I 

1 

I 

I 

I 

1 

I 

1 

I Dlast2wka Dbefo,e 

I I I I 1 02wks.-3mo. 12 

I I I I D 312 months mods 

I 

reported in Questions 18 or 19. (IfnOhOspitalizatiOn Iepo~ed.gO tOWle p) 

Were on operations per formed on you What i. the name ond cddmss of the hospital you were i.?
 durlngt 1 Isstoyat theh.aspltal?


If “}’.
S,”ask: (Encerfull ”ameofhospitalt s.treec orhigbway onwhicbicis 

a.	 What WO’ thenmne of the located, city and Statq ifc,ty”oc known, enter councy.) 

.aperatlon? 

b, Anyothar opemtl.ans? 

---. _-__ -Q______ _ ___________________ .Q-__–. –-____ –.––– 

Yes	 I If “Yes, ” name ofopcration, etc. N: Name of hospital I Mdress 

1 , sm.,, I fy I I City and 

I I state 

I ] Street I l--------------------- I I C,ty and 

I I state 1 ;SCreet I ,--------- --------——---

,City and 

1, , Sc.ace 

When did you Ask only if 10.? see or doctor seen Mk ?. a duriq, che 

doc~ about past U 

. . . months: 

Enter month During the and year if past 12 during past months about 

12 momhs; how mony 

.arherwisc times have 5 

check Y.. seen or 2 “before 12 talked too : ::,:,” 0, doctor ,, .ab.xn . . . ? ,-z 

box A 

(1) (m) 

f.vY_


=B. 12u,0.No ~ftime~ ~


O Never . 

M/Y_ 

U B. 12 m.. ~. 2 

D N,.., . 

~y— 

D B. 12mo. No ~fth,, ~ 

m Never “ 

w~ 

DB. 12m.a. — 

m N,,,, No. of times 4 

M/Y_ 

D B. 12 m.. 

Q Never No. of times 5 

hvY_ 

0 B. 12mo. — a Never No. of times 6

M/Y_ 

a B. 12 m.. 

o Never No. of times 7 

NOTE 

TO 

lNTERVfEWER 

After 

Completing 

Tahlc H 

goco 

Table P 

USCOMM-DC


57 
TABLE G2FORNON.SAMPLE PERSONS ONLY: “Fillonelincof 

Col. Ques. Ask forslliffnesses and Ask if the enay in Cal. (~ 1) Ask Ody ik Askfcx �nyemr~in 

No. tion Nuneof condition as ??!%” present effects of old injuries: is: 6yeam old C-al. (e-1) 01 cd. (e-2) 

c.rovermnd that illChldCS the words: of No. reported in Questions at any (s) fi doctor tafked to: An Impairment, Nm* blindness,

per- 911 yy: . Whet did tho doctor .Oy N or p~r &iO~, AJ:x&* Tumor 

son was? ..dldho [W It . Symptom oree l(Conditionr~ 

Ohe.ut . In. dical “am. ! crou 1 Ie of $Y&=* ::po~::: 

. . . ‘f �ny Kind. 

(b)	 sf doctor not talked to: What wasthecausaof . . . ? 

Record original entry and canyou What klnd.f. . .l, lt? 

ask (e-Z) -(c-S) aS Sam WON Vi; �n allergy.ar stroke ~ required. ..ough 

to mad Ask for .11 injtuies during g past 2 weeks: ordinary Hewdo.sth. all.r y 4 “*wspop”r (stroke) off-et yOU? ~jha; pati of th. body wat print wiih 

glas. as? 

What kind of [niury was it? 

Anything .Ise? 

(a) (b) (c) (d) (-1) (C-2) (*3) (=-4) 

x u Yes x DY.. = 

1 a No Ig No 

x Ig Yes ‘ I-JY=S x 

z a No I_J No 

—x n Ye. x r-JYcs x 

) n No a No 

x D Yes. ‘ UY.S = 

i I_J No O No 

2 I_J Yes x UY,S = 

} n No O No 

I I-J Yes x lqYes x 

5 I_J No n No 

1 U Yes x mYes x 

7 a No m No 

, I-J Yes x UY.S x 

B a No O No 

z (-g Yes ‘ i_JYes x 

9 U No I_J No 

, a Yes x UYCS x 

10 n No I___JNo 

GO TO FRONT 0,# qUEStlON.NAIRE 

FOOTNOTES 

58 
T_able C-2 for each c:gdition r:ported for each Non-Sample Person 

Ack Only for: If 616 years If 17 years D.rln thst Ask ONLY if Ask only if When did YO. Impairments andinjuties oId F==h ;;&Or mOr= 2 we. 1 “’None*, checked “’Y,.** Ill first notice 

Aod for: porlod how in cOIumns (f) or column (i) . ..? 

&$aes fnflamrqtion %:jc%: How many mOIIy days (g) and (h) Did you havo Neur#fiI* (Check the first days did did . . . LAST WEEK DR to cut down 

for .s much box which 

%NCL $,-T &&&+ ;:; p.’ !:%$% ., ~g~J&F!jld .’0 day? epplies) 

Boilo week or th~ ~OSt of the . . . Cg”’. you Clmcec soreness wmk bdor,? ;::.{.;s. day? to cut down .“ cyst Tumor the things o. Growth Ulcers Enter number O, the week If any “days” “=uaily do$ 

fnf.ction Weakness of days or b. fere? muered in 

Cols. (g)rx If “’Yesor checked What Parf of tho body IS aff.ct.d? check *qNonen$ Enter number (b) skip to and skip to ask Cd. (j). If Show detail for: Cd. (h) of days or Cd. (k) “No!$ .skipto Ear or my9 . (one or both) cbcck 

H&-(skufl, Sqllp f.c=) ,, None!) Col. (k) 

and ask 

Am-$&j;t$&~&$,or Ccl. (h) 

L.g. (Hip, upper, knee, lower, 

ankle, foq one orkath) (f) (g) (h) (i) (j) -— -—-- . .- ——-— . .-- —--- .——-__ —-. _______ 

(C-S) Days \ None DaysI None Days / None Yes 1 No Ye. 1 No (k) 

x I 

I I 

I 

I 

1 

I 

I 

I 

I 

1 

I 

u last 2 wks. O 

O 2 wks.-3 um. 

Ig 3-12 months 

before 

12 

months 

x I 1 1. ! D last 2 wk~ m before 

I 

I I 

I 

I 

I 02wks.-3u,o. 

n 3.12 months 

12 

mooch, 

x I 

I 

I 

1 I 

1 ! 

I 

a last 2 wk.. n 

o 2wk..-3mo. 

hef.re 

12 I I 1 03-12 months months 

x I 1 I = last 2 wh O befo,e 

I : 02 wks.-3 m.. 12 

I	 .; I I 0312 months mcmtbs I I 

x 1 

1 I 

I 

I 

I 

I 

I I O last 2 wks. m 

02wks.-3mc.. 

before 

12 

I I I I 1, 03-12 months ,nc,mh, 

x 1 

I 

I 

, 

I 

I 

I 

I 

I 

1 

t 

1 

I 

I 

o last 2 wk.. a 

02 wks.-3m.a. 

rg 3-12 months 

before 

12 

months 

. I 

I 

I 

1 

I 

I 

I 

r 

1 

1 

I 

m 1.s! 2 wks a 

U 2wks.-3 mn. 

03-12 months 

before 

12 

months 

x I 1 

I 1 I m last 2 wks. = before 

I	 I I I I 02wks.-3nm. 12 

I / 1 n 3-12 months months 

x I I t 1 I = last 2 wk.. m before I 

I I I I 02 vrks.-3 m.. 12 

I U 312 months U’.amfls 

x I 1 I I O last 2 wks. m before I I n 2 wks.-3m.a. 12 

I I

I I I I l_J 512 months mom b% 

. 

59 
-----------------------

--

--

---

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

TABLE P Name of Sample Person 

I 

p. .1. H.av. y.. .v.r ban advised by a doctor to Ilmit the mount or to avoid entlra!y I--J Yes I-J No cert.in kinds of food or b.v.r.~.s? 

If “Y..,” .Sk 

., For whet r.ason or condition? n Yes U No b. Are you .Nll followl.g ihlr .dvic.? 

P-:.2. At the present time am you r.gularly taking any mad!ctne or treatment for any 

condition? a Yes m No 

If “Ye.,” .sk: 

m, For what c.ndlN.n? 

P.:.3. Do you h.v. any condition which eft.n caum. you pain or dizeomfort? n Yes a No 

If “Yes,” ask 

., What 1. ih. .ondltlon? 

P-.4. Do you hove any health probl.m whi$h IS o s..rc. of worry to you or o+her members 

you, fmlllly? 

of n Yes n No . If “Yes,” ask: 

o. What is the problem? 

P.!.5. (For m.lesk Are you hmit.d in any way In th. amount or kind of work you can do n Yes a No because of y.., health? 

(For females> Are yov limited i. my w.y 1“ the .nm..t or kind of housework you . . . 

d. b.c.use of YOU, health? 

If “’Yes,” ask 

., What condition =a.’.. this? 

a ExceIlcnt m Good 

P-8.6. 1. general, would You say your health is excellent, good, fair, or POW? n F.k m Poor 

HA AND RESPONDENT CARD TO P-7 (FORM NHS-S-13-6)

P-.7,	 List.d on this card are several conditions. Please place an ‘“X” o P.site each c.ndNi.n which indicates how fre.1 y.. think most .th.r people would talk obout ..ch condltio” 1“ an Interview like ibis t [ at IS, If they or some other member of their faml r y hod th. condition. 

P..8. . . Did YOUwork at any Nm. during the past 2 weeks? n Yes n No — ------------------- If “No, ” ask P-8-b and P-s-c: 

b. Even though you did not work during that time do you have a lob or busin.s.? a Yes I-J No 

c. Were y.. looking for work or . . layoff from . lob? U Yes U No 

Namk and address 

P--9. Whet IS the nom. and address of the doctor or clinic you .s..IIY go to for mm 

medlco[ advice or treatment? 

— ------------------ --------------------------—---—--------

a. During the past 12 .nths abou how many Nm.. did YOU s*. Or visit (d..t. r Number of times 

or eIi.I. named)? .& XQd 

b.€Besides (the doctor or clinic named above) did ye. s.. or visit any other doctor n Yes n No (OO to P-10)

during the past 12 month.? 

Name �nd address 

If “Yes,” ash Who w.. this? (Enter n.m. ..d .ddr. =.) 

_____ _-________ — — ----------------------- ---—- ~ — ---------------

Number of txmes c. How many Nm.s did you se. him during the past 12 month.? 

d. Did y.. see any other doctors during the past 12 months? n Yes n No (0. to P-10> 

Name and address 

If “Yes,” ask! Who w.. thi.? (Enter ..m. �nd .dd . . ..~ 

- — --------------------

Number of times . . How many Nm.s did you see him during the past 12 month.? 

P1.1O. 1. co. iunc N.” tith this survey w. s.m.tlm.. need to obtain addltl...l i“fcwm. N.m MEDICAL AUTHORIZATION FORM 

frem medical o.d hospital records. 1. case you ore selected a. on. of the.. person. 

for whom we wish to obt.in .dd!tlonal information will you pleas. sign this form n Signed 

(present release - Form NHSS 1?-7) which allows .s to consult your health records 

to obtain this information. D Refuswk (En:., r.a..an) 

— 

NIOTE TO INTERVIAVER: ff l.terv+ew net yet completed for non-son+de persons, go kack 10 Quest].” 9 (cm inside of questlomaire) and ask 

Q>.estims 9-11 for nomsample per.ms. Othewfs., g-a to fro”+ of q.estionmlre. 

FORM NH5-S-l S-2 (9.4-32) 

60 

I 
The Nmi.n.l Hemkh Sum.Y i8 authorized by PubSic Lsw 652 of the 84th Congress (7o Scat. 

permit identification of the individual will be held strictly confidential, will he used only 

survey and wiSl mot be disclosed or relessed to othem for my other purposes (22 FR 1687). 

FORM NHs.s.13g {*.4.C4] U.S. DEPARTMENT OF COMMERCE 

BUREAU OF THS CENSUS 

ACTIMS AS COLLECTING A~lM4T FOR THE 

U.S. PUBLIC HEALTH SERVICE 

NATIONAL HEALTH SURVEY 

� Address ordescziptionof location 

b. Mailing address if not shown in (ah fnclude city ad State 

* 

1 

Form Appmv.& Budget Bwe.u No. d&R620-F9. 1 

4s% 42 U.S.C. 305). All fafornmtion wbfcb wonfd 

by persons engaged in and for the pwpoces of the 

1. Qaestionn.ire 

of 

Quescic.r.asfres 

3. Assignment No. 

4. .%*1 No. 

I Which ef th.s. Inc.m. group repr.’.nts your tosal family l“corm for the past 12 month., that is, your%, your--%, GIOUP .w? Show Card H). In=l.de income from all so.rc.s, such as wag.., sal.rl.s, rents from Pr.pmty, P*.slons, 

h.lm i cornrelativ.s. .tc. 

. Telephone No. t, What IS th. t.1.phom nwtdmr h-r.? I n None 

‘. If sample person has not hce. fntemiewcd but intemiew has been completed for other related members, *sk 

As I m.nNon.d .adl.,, III .ach hausohold W. ask Sema spdal questions about o.. PO,SOll for hlmsdf 

only, In rhls cm., It Is (Smrple person). What is tho �arliost timo I 

would b. abl. te s.. hlm (., h.r)? 

D.ce Time 

@nt.. bW8t the tO C.YfI). . . . . 

1, RECORO 

OF 

CALLS 

AT 

HOUSE. 

HoLDS 

L REASON TYPE A TYPE B I TYPE Z 

FOR 

NON- m Refusal D qr:~o ..4., Sam:f:tgrily D Snccrvi.w not obtained If.x 

INTER. — n No one at home - repeated calls smrple Person s VIEW a: D Temporarily absent [Sp..lly ,.a..r,j 

n Other (sn.cifYj 

I 

I 10.	 Signmu >f intemiewec 11.Code 

I 

FOOTNOTES 

USCOMM-DC 
‘under 

--

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

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

--

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

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

----------

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

O, What i. the nom. of the heed of this ho. seh.ld? [Enter name in appr.priace Last “am, @ Last name 

COl”mil) 

b. What or. the name. of al I other per..”. who live here?. (list .11 persons who . ..— — ——— ———. ——. ——————— - live here) First “am. a“d i“icial Firm name a“d initial . . IS there any... else who lives her. who is now ~ No ~ ~es ~L,=t) 

t.mporori lyi”aho. plt.l? . . . . . . . . . . . . . . . . . . 

d.	 Away o. b.sln.ss? . . . . . . . . . . . . . . . . . . . . . . . . a No n Yes (L].:) 

.. Onav;sI,? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ONO OY.S(L1.O 

f. IS there .mm.e else stayinq here now? . . . . . . n No n Yes (L1.O 

How W. y.. related to the hod of the h..s.h.ld? (Enter relacio”ship to Relationship Rel.ciouship 

head, for example: head, wife, daughter, grandson, mother-in-law, etc.) 

How old were Y.. on your last birthday? 

Age n Under 1 y== 

Age 

n Under 1 yeu 

n White n Negro a Ocher a White a Ne.sIo n Other Race (Check one be. for each person) 

D Male n Male Sex (Check o.. box for each person) D FemaSe n Female 

If 17 years old or over, ask: n Married ~+ ~MarI~u’’d=r ~N~;ted 

Are you now married, widowed, divorced, separated, or never married? a Widowed n Widowed 

(Check one box for each person) n Divorced Manied n Divorced Maied 

If 17 years old or over, ask n Under 17 ,2345678 years @) l--Jdwy:;y5678 ~

c. What IS the highest grad. you attended 1. school? Elem: 

(Ckcle	 highest grade actcnded or check “None”) High 1234 High 1234 

college:1234 5+ College: 1234 5+ 

n None a None 

b. Did you finish the grade (Yenr)? I-J Yes D No ---------lR:---” n Yes 

If 17 years old or over, asfc D Under 17 years n Under 17 yCUS 

a. What We,* y.” doing mostof the pOSt 12 monqhs - n Working n Wdiq$ 

(FrJr males> working .r doing something else? n Keeping house m Keeping house 

(For femalesh keeping house., working, or doing som.th!.g .1s.? n .Smmthiog .1s. a Something .1s. 

----. ——-. If “Something else” checked, and person i. 45 ye~s Old or over, ask 

b. Are y.. rat!rad? n Yes .ONO a Yes n No 

IOTE:	 B=9i.n;.g with Q..s*iP. 9, YOIJmust I.f.W;=w fh= sample p=rsOn for h;~ D SIImple Personkgme and avaiIable - ask SAMPLE PERSON Q. 9-19 

self. Check the =Pproprht. tox and fallow the hdicoted order of ask ins o .%npl. Pewannoc at bane .x not available - conci”.e interview for the quest!ons. 

I.	 Were You sick at any time LAST WEEK OR THE WEEK BEFORE? (That is, the m Yes a No u Yes n No 2-week period whlcb ended this post Sunday night.) 

o. What was the matter? 

b. A“ythlng else? 

10.	 Last week or the week before did you take a“y medicine or tr.otmen? for any a Yes n No I-J Yes a No 

c.mdltl.m (besides . . . which you fold m. ataut)? 

a. For what conditions? 

b. Anything else? 

11, Last week or the week before did YOU have any . ..id.nts or Inluries? = Yes D No a Yes m No 

a. Whgt were *hey? 

b. Anytb[ng else? 

12. OURING THE PAST 12 MONTHS, have y.. seen .x talked to a d.=t.r .b..t I-J Ye. D No 

yourself? 

If “Ycs,” ash 

a. For what condition.? 

b. A“y other . ..dhlons? 

13. Have . . ever had to change y.”r eating, drinking or smoking habits b....se of n Yes nNo~ 

. 

, 

some i ..lth condition?


If “yes,” SS!C


. . What condNio. caused this change?


Record ONLY if not previously recorded and aslc 

b. 0. YLWstill have this condition? 

14.	 Hove Y.. ever hdd to make any other change In your way of doing thl.gx 

because of sm. health condition? 

If “Yes,” eslc 

a.	 What condition caus.d this change? 

Record ONLY if not previously recorded and ask 

b. Do y.” still bava this condition? 

—.-

n Yes a No [Delete) 

I-J Yes a No —----

a Y=, n No (Del.M 

13.	 Hove you ever had any other [11..ss or l.[ury which b.ath.rs y.” or effects you n Yes u No 

In a“y way? 

. . What are the present .ff.cts? 

. Hand respondent conditions card with “A” side up and pencil, then SIIV a All No’s 

16.	 tla.s~o. EVER hod any of the condNfo.. listed on this ..rd? pi.... che.k n Yes~s (One or more) or ‘“No” for eoch we listed. 

Ask respondent to cum card over (to ‘“B” side), then say: a All t++. 

17.	 Hove Y.. had a. of those conditions DURING THE PAST 12 MONTHS? 

Please check ““J.*$’ or “No” for e..h one listed. n Yes’s (One or more) 

- —— 

18. a. Have you been [“ a ho.pltal at any tire. during the past 12 months? (-J Yes � No 

If “Yes,” ask 

b. How many times were you in the hospital during thet period? No. of Cilll,. 

19, a,	 Have you been a poti.”t in a nursing home, rest home, or any similar place m Yes a No d“ri”g tbe past 12 months? 

If “Y..,” ask 7 

b. How trm”y Nme.s were y.. i. . ““rsing horn. or rest home d“rl”g thot period? No. of times 

R For man-sample persons 17 years old or over, show who m Responded for self I_J Respmded for self 

~~&$j & $&”. For P,Isons under 17 show who @ Co,.–w’z.slqm”dr!,[ Q 

62 
-- ------ ----- ----- ---- ----- ----- ---

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

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

Last name o 2 Last name Last nem, 4’ Last name

@ G 

——— —— —-- _—— _—— —— —————— - ——_— ——— ———_— -——————-————. First mime and initial First name and initial First name and initial First name and initial 

Relationship Relationship Relationship Relationship 

Age Ag= J@. m Under 1 year m Under 1 year a Under 1 Y.= 

m White n Negro n Other Inwhi,, ~Neu. l_JOther I ~Whit= mNegm CIO&r 

I 1 

n Male a Male O Male 

D Female D Female I_J Fem.le 

i_JbfarriJ?und~l&&&l ~Marrie!?””&&%%d OM=.~undti’$Z=d— 

m Widowed n Never � Widowed n Never a Widowed m Never 

n Divorced Married a Divorced Married D Divorced Married 

a Under 17 yeas m Under 17 years 

ElenN ,234567, @ cm: g::d” :’;y5 ,,8 ~ @under ;7;;~ ,,8 ~ 

Elcm: ,234,678 

High 1234 ffigfx 1234 Htgix 1234 Higix 1234 

college: 1234 s+ College: 1234 5+ College: 1234 5+ college: 12345+ 

n None a Ncy~ QNorIe n None 

a f,; m No “ ~-Yes a No ‘n Yes n No n Yes U No 

m Under 17 years n Under 17 years a Under 17 years m Under 17 years 

n Working n Working a Working m Working 

Q Kecpi”g b.mse m Keeping house a Keeping ho... a Keeping h-use 

m Something else a Somecbi.g else m .%mething else D %metbing AC 

--------------— ---——--------—— ---—--------——-

I--J Yes n No n Yes n No a Yes m No 

md T.blcs G 1, H and P for himself. THEN ask Q. Y-11 and Table G2 for noresarcple persons. 

Ion-sample persons only. 

Q Yes I_J No 

n Yes D No ig Yes n No m Yes u No 

I . 

I I 

I 

O Reqxmded f., self l_J Responded for self m Responded for s,If n Responded for self


Col.—w.s respondent Col.—was respondent a CoI. —was rcsmxdenr @ Col—w.s res.ondenr c


C 
--

-------

. . TABLE C-1 (For SP ONLY): Fill one line of Table C-1 for 

yol. Ques- Name O( condition as Did YOU Ask for .11 illnesses and Ask if the entry i. Cd. (e 1) A,k if: only Ask for .ny entry in

Ci.o. Cd. (e- 1) or cd. (c-2fi rcpcaed in Q.estions EVER present effects of old injuries: is: 6 years of “ ho. that includes the words

P=- 9.17 :;m:y (a) If doctor talked to: An Inqxziru,enr, old or over 

son	 talk to What did the doctor say and bIi.d­

. doctor lt we.? . . . dfd he give it or n=.., poor j~~hrg~” Tumor 

abouf a medical rmme? * symptom vision, or “’Condition 

. . . ? .ye trouble cYst “Discsscll 

(b)	 If doctor noc talked to: of any kind GrO~h “TIouble” 

Record .ari~in.l entry and Whet was ghe . ..s. of . . . ? Stroke* 

ask. (e2) - (*5) as G“ you ~ rqured. sea well What kind of . . . is it? 

Ask for all injuries during enough �For an .llerEy .x 

.-

: past 2 weeks: to read stroke .sk: ,4 ordinary What port of the body we. n..w.p. p.r How dims fh. allergy hurt? P,,n* wNh (stroke) affect ~ou? What kind of ini.ry w.. it? g!.%...? 

Anything else? 

(a) (b) (c) (d) (e-l) (C-2) (.-3) (-4) 

n Yes ‘ I-J Yes x x 

a No n No I @ 

m Yes = n Yes x x 

m No n No 

2 @ 

n Yes x n Yes x x 

a No n No 3 @ 

n Ye% x a Yes x x 

m No n No 4 @ 

m Yes x D Yes x x 

D NO n No 5 @ 

I-J Yes , a Yes x x 

n No n No 6 @ 

x n Yes x n Yes x 

7 SP D No n No o — 

TABLE H (For SP ONLY): Fill one line of Table H for each hosni=zation 

cd. Q,”.+ You sold thot y.. W.~Inthe hospital Hew many Complete from entries in Columns (c) For what conditlen did you ent.r ih. 

No. 

of ~ (...., *wI.*, et..) during *h. PO.+ year - nights were and (4x or, show calendar and ..k the hospital do y.. know the m.dlc.l 

nom.? 

~ P& When did you enter th. ho.pitol (the l%;::? ‘“’s’’””= - (If medical name mat known, enter 

-- lost time)? (If exact How many of HO:em-a:y of w.,. y.” rcspoadent% description) : number notthes. still in the 

(Enter month, day tmd yea~ if =xacc known “Ights we,. nights were ho~p,,a, O. (Ent~ m“sc show “@se,,, ‘Kind, ” 

.F: date not known, obtain estimate.) .CC@ best in *h= POS* lost week or faa~~doy and Parr of bcdy$, m same detail as 

d estimate) 12 mcmths? the week required i“ Table Gl) 

h. fore? 

(a) (b) Month I 

I 

Day I 

I 

Year Nights Nights Nigh. IN... 1 Yes I No 

1 

(b) 

I I I I 1 0

SP I I 

I I I 1 

-l-_ (c) -___ —____ _____(d) . ______(e) - -_<fL ___ -_ I@___ 

I I I I

1 I ( I 

2 o 5P I

I

I I 

I 

I I 1 I 

t I I I 

3 SF’ I I I I o ,1 I 

64 

I 
--

--

each condition reported in Qnestions 9.17 for the Sam Ie Person. 

Ask only for: D.rln that Ask ONLY if Ask Vhen did y.a. first When did y.” Ask only if 

Impairments and injuries 2 w.. t “N.wxYI ONLY ,Otice . . . ? last see or doctor seen 

period how checked in if “Yesr t.olktc. a during [Check tbe fkst &JX doc~ about past 12

the And for: many day. Cols. (g) and in COL Abscesses Inflammation wbicb appIies) did . . . (bh (i} . . . months: Aches NeuralEia . .


Bleeding Ncuricis or business keep y.. LAST WEEK f/~&y;~ Enter month D“rktg the
 I. bed Blood Clot &inn OR THE and year if post 12

we .11 or most WEEK Boils cut down dwi.g past months about

cancer pos ‘fthed0y7 T
 BEFORE did for as 12 months; hew m..y

Growth Ulcers !!day .,? to .ut down on a day? check YOU . . . . Or 

Infection Weakness 

Mhatpart of th. body is affected? ‘ 

entered in the thl”g= y.”

cd.. (g) V.”’dly do? 

x (b) skip 

“before 12 

~~vt$’ or ,, 

talked to . 

doctor 

about . . . ? 

Show detail for: :. Cd.(k) box 

Ear or .ye - (one or both) 

:;.;& f&#$&L, 

lower, wrist, anh one 

or both) L.. . (Hip, upper, knee, lower, _ jf~ _ _ ~g~ __ (h) -——-—----—— (i) (i) ———. ‘-” ankle, &~j one or botb) [! Davs I NorIe Duvs !N.ne D?.yd None Yes I No YCSfNO 

cyst Enter numbe [f any ... cause you much ~S otherwise times hove


1111 &+31as12wks. nbefore hvL...___ I I I _J2wks.-3 m.. 12 ~ B. 12 tn.. ~- 2 

I I I -J 3-12 months nmntbs D Never . 

, b 

x I I I I I ~ !.s, 2 wks. O before M/Y— 

DOES ; NOT I 

I 

I I I _J2wks.-3mo. 12 

g 312 m’ar,,hs ,wantbs 

OB. IZmo, 

Q Never 

No. ~f ~ime~ 3 

x I ~1.sczwks. Obef.re w~ 

AFjPLY 

1 

1 

I 

_J2vrk,.-3mo. 12 

~ 3-12 months mw.th* 

n B. 12nw. 

n Never 

— 

No. of times 4 

x I I _Jlasr2wks. mbefo,e M/Y_ 

I I ~2wks.-3mo. 12 0 B. 12 � . . 

I I -’J 3-12 Iw.,!bs months o Never N.. of times 5 

, I x I I 

1 1 

I 

I I 

1111 I

I

I 

I

I 1’/ 

zeportcdin Que*ucI”s 18 or 19. (If no hospicalizationrepc.reed go co Table P) — 

Whet Isil,ena~and oddress of thehosp[tal you were I.? 

NOTE (Enter full ”ameofhospir.lt street or bighwayon wbichit is 

a. What was the name of the lc.caced, city and Statq if cny”c.r k“.mm, er.terco”ncy.) TO 

operation? iNTERb. Anyc.thw operations? VIEWER 

(i) .-- —- —--- —-- ———————--— —--- —-—------— After 

Yesllf”Yes ‘“amcofopcration, etc. No Name of hospital Address Complecins t Street 

i–:––-–-–––--–––––--–- Table 11 h I Cityand ! sate go to 

H I street Table P


I ------ - _ — _________ .


I Cityand


~St,. et - —---- . —--------- . !Eiw ad 

USCOMM.OC 

65 
--

TABLE C-2 

01. Ques0. ticm Name of condition as 

[ No. reported in Qucstion$ 

er- S-11 

m 

(=) (b) (c) 

FOOTNOTES 

lid au Ask for all ill . . . . . . @ 

:V~R present effects of old mpuies: 

t any (a) If doctor mfked m: 

,~keto a What dfd th. doctor ..y 1? octir was? dld h. iv. it bout a mmdle.al nom. ! . . ? 

(b) M doct.x nott.lked to: 

Record original entry and Ssk (C-2) - (e-s) as 

T re.auired. 

Ask for .11 injuries during


past 2 weeks:


Whoi part of ih. body was


hurt?


what kind of ln[ury wcs N?
 Anything .!s.?


(d) (e- 1) 

is: 

ArIImpmirmenc, 

or


, symptom


What w.’ the =.”S. of . . . ? 

Cm you what kind of. . . IS N? 

**. W.11 

�o.gh ~;r m a31ergy or stroke

to r.ad 

ordinary How do*z *h. .I1.r y 

‘ewsf’aper print with (strok*) affect you ? 

gla’..s? 

(e-2) (-3) (c-4) 

. 

x x n Yes x 

n No 

x x I_J Yes = 

D No 

---E++ 

‘	 DY.. x x 

n No 

= a Yesx x 

n No 

.GO TO–FRONT, OF QLfEStiONNAlkE 

66 
----- ------

for each condition reported fot 

A,k Ody for: 

fmtmirments end iniuries 

InflammMion 

~J#&is 

Pains 

Sores 

soreness 

Tumor 

ulcers 

Wenkness 

What part of tha body is affe.t.d? 

Sfmw detail for: 

&J’:”u&%Ji&:=f) 

Arm .\;;O&dee.pper’, i elbow, 

ist, hmnh one or 

both) 

L.g - (Hip, upper, knee, lower, 

ankle, foo~ one or both) 

(e-5) 

---+ 

each Non-Sam] e Person 

.sk Ollfy if i%a dld YOU 

Yes’” * irst ;ofle* 

Dhlmn(Ik . . 

Ild YoU havo


> cut down Cback.tbe first


M as much ox yhch 

s o cloy? ,pphes) 

(i) 

Ye. : NoI (k) 

I o Isst z T&. o before 

02 wks.-3mo. 12 

03-12 nvmtbs momh, 

o last 2 wk’. o before 

I	 02 !rks.-3 m.. 12 

03-12 month= months 

o l,SC 2 mka, o before /	 o 2wks.-3 m.. 12 

m 3-12 month’ months 

1- 0 last 2 W& m before 

O 2wks.-3 ma. 12 

03-12 m.amb, momh. 

I_J 1.x 2 wks. m before 

O 2wks.-3 MO. 12 

03-12 months months 

o 1.s 2 +5. lg before 

O 2+s.-3 =.. 12 

% 0 *12 months m..antbs 

336.16 ye-s 

old ash 

How many 

dnyc did 

. . . k..p 

you from 

school last 

womk or tho 

T w..k b. for.? 

Enter number 

of days or 

check ‘*None’ and skip to 

C& (h) 

(f) 

Days ~None 

II I 

x I 

I 

x 

I 

1 

I 

I 

I 
---------------------------------------

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

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

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

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

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

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

TABLE P Name of sample Persca 

P-L (Do.. “01 .PPW 

‘.2.	 At th. pr..gnt tlm. W. ymv r.@uly taking any nmdi.hm or trgatm.nt fcw any 

condition? 

If “Yes,” ask 

a. For whof condltlon? 

*-3. Da you hav. any condition which oh.n cm.s*s you pain or discomfort? 

If ‘“Ye..** .sk 

a. What i, th. condltiem? 

‘.4. Da YOUhovs any hwdth 

your fomlly? 

problmm which is a source of wow to you or s!har mamb.rs of n Yes m No 

If “Yes,” ask 

m Wlmt 1, th. probl.m? 

‘-5. (Do.. not .wty) 

% In ganeral, would you s.y your h.alth is .xc.11.M, good, fair, or poor? 

1 

iAND RESPONDENT CARD TO P.? (FORM NHS5-13-d) 

‘.7.	 Ltst.d o. this card are several conditions. P1.a.. pla.. on ““X” o posit. .a.h condhlon which Indl..te. how fr..l yo. think most .th.r 

P.OPI. w..ld t.lk .b-.t . ..h condltl.n in an interview Ilk. this - tEat 1s, if thy or s.rn. oth.r m.mb. r of th. ir f.mi ry had th. condition. 

‘-8. a. Did you work at any tlm. during the past 2 wmeks? Ig Yes OF If ‘*No,” ask FW?-b and P-8-c: 

b. Even though youdldnet wo,kd"ring that tire. deyo"ha,. oiob.rb"s[ness? n Yes n No 

. . W.r. ye. Iookt.gforw.rk or.n layoff from a lob? I-J Yes D No 

Name and address 

W What la th. nom. and address oith. doetororcllnlc youusuallygo to for YOU 0~ 

mcdlcal advkm or treatment? 

a,	 During th. past 12 m.nt s about how many tlrn.. did you s.. or visit (doctor Number of times 

or clink ..nwd)? i’or goms~~ 

b, B.tides. (the doctor or .1[.1= nmn.d akv.) . did you . s.. or visit a“” other doctor

dwlng th~ past 12 months? 

Name and address 

If “Yes,” dC Who was this? (Ent., name .nd .d.fr...J 

Number of times c. How many Nm.. did ye. s.. him during the p-a’t 12 months? 

d. Did y.. s.. any oth.r d.=tors during ih. p.a’t 12 months? n Yes n No (0. f. P-1OJ 

Name and .d&ess 

If “Yes,” ask Who was this? {Enter n.me ..d ..fdr...) 

Number of times . . How many Nmas did You sae him durino ths wst 12 months? 

‘-10.	 In cc.niunctlon vifh this s.w.y w. som.tim.s n..d to obtain .dditiorml Informmlon MEDICAL AUTNORIZATION FORM from rned[csl end h..pttal records. In co.. YOU at. s.1.ct.d as one of *h... P.rso.. 

for whom we wish to obtain additional information will you pleas. sign this form m 3igned 

(present release - Form NHS+ 13-7) whl=h .11.”’ .s to .c..s.h your h.ahh r..ords
 to obtain *hi’ infemmNmt. a Refused: (Ent.r r...onj


Wesilons 9-11 for non-sompl. prsons. Oth&vls., “W to i+ont of que&w”n&e. -

FORM NH S. S- IS.2 [S-4-S2) 

68 
-.. ---- . .. —.–.- FOtm .lwrOV.d: Bltdg,t Bue.m No. =K6DF9. 1

The National Health Survey is authorized hy Public Law 652 of the 84th Congress (7o scat. .48% 42 U.S.C. 305). Ml fnfotmatioa which would 

permit identification of the individual will be held strictly confidential, will be used only by persons engaged in �nd for the pqoses of tbe 

survey �nd will mot be disclosed or released to others for �ny other pmp.mes (22 FR 1687). 

~&I#S&IS.S 1. Questionnske U.S. DEPARTMENT OF COMMERCE 

BUREAU OF TME CENSUS 

ACTINS AS COLLECTING AOEN7 FOR 7“= 

U.S. PUBLIC HEALTH SERVICE of 

NATIONAL HEALTH SURVEY Qu..cimtuites 

� . Addcesa ocdescxiptionof location 3. Ass fgnmentlk% ADDRESS 

b. Maiffag address if not shown in (.} 2nclude cicyand Stmte 4. Secisl No. 

Which d th.s. Income g,..+ reppenis your total family in.or- for *h* st 12 months, that is, ~ou,%, your..%, Group 

.tc?(Show Grd H). Includ. income from all sources, such as wages, so raria., =.9s from PrOP.IW, p.n. km=, 

h+ from ddVOS, etc. 

Telepbo.c No. What is th. tdsphon. n.mb.r h.re? m None 

If sample person has not been fntemiewed but inte=iew has been completed for other related members, ask 

As I rn.ntton.d ..,1[.,, in ..ch houi.hold w. ask some SPO.klt que.fions abouf on. person for hfmdf 

.“IY. t. thl, ..s., It is (Sample person). What i. the e.rll.st Nm. I 

would he qhl. to SC6 him (or ho?)? 

00TNOTES 

69 
---------------

1 

1. a. what is the name of tht had of this housahold? (Enter’name in armrooriace Last name @ Last name . . 

column) a 

b.	 Whet .r. th. nom.. of all oth.r p.r.ons who Nv* h.ra? (List all persons who ..— —— ——————. ——— .—— ——— —- I I live here) 

.,	 IS th.r. anyone els. who Nv.. hero who is now ~ No ~ ~=s ~LjmtJ First name and inkird First name and initial 

t.mp.r.rl lylnahosplta!? . . . . . . . . . . . . . . . . . . 

d. Away .nhu.hmss? . . . . . . . . . . . . . . . . . . . . . . . . a No D Yes {Li.r) 

.. On Ovls N?...... . . . . . . . . . . . . . . . . . . . . . . . . . n No I_J Yes (Lf.1) 

f. 1. ther. .nyo.e else staying h.re now? . . . . . . m No (1 Yes (Li.O 

1. HOW at. YOU r.1.t.d t. th. head of the household? (Enter relationship to Relationship Relationship 

head, for exmnple: head, wife, daughter, .qandsom, mother-blaw, etc.) I 

L How old were you on your last blrfhdoy? Age n Under 1 yeas 

1 

.%= a Under 1 year 

L Race (Check one bax for each person) 

;. =x (Check one tmx for each person) 

If 17 years old or over, ask 

5. Are y.. now married, widowed, divorced, separated, or never married? 

(Check one box for each person) 

If 1? YcUS old .1 .X.,, .Sk n Under 17 yearn @ ~Under17 years ~ 

?. e. What 1. the highest grad. ye. attended in school? Elerm 12345678 Elem: 12345678 

(Circle highest grade attended .s check *’None”) nigh 123’s Higfx 1234 

College: 1234 5+ College: 

n None b. Did You flnlsh the.. grade (year)? 

If 17 years old or over, ash 

1. a. What were you doing most of the past 12 months -

(For males) working or doing something else? m Keeping house 

(For females> keeping h...., working, or doing sometblng else? n something eIse 

If ‘Something else” checked, and person is 45 years old or over, ask +---------------’ 

b. Are you retired? O’Yes n Nom Yes I_J No 

VOTE: Begl.ni.9wNh Question 9, wumustintewiew thesmwle person for him n Sample Person home mad avaiIable - ask SAMPLE PEWON Q. >19 

self. Check theapprojxiofe hoxondfollowthe Indlc.fedoderof asking n Sample Pers.annot at home or mat avaifablc - continue intmvimv f.’ the quesNons. 

9.	 War. e. sick af anytime LAST WEEK OR THE WEEK BEFORE? (That is, th. 2-wee L p.rlodwhlcb andedthi. pasf Sunday night.) Ig No

. . Whet w.. the mott.r? 

b. Anything.lse? 

10.	 Last week orthewe.k be fore didyo. tekeany madicina ortraatment for any cmditic.. (hesld.s. . . which youtoldmeoho. t)? 

o. For what =ondition.? 

b. Anything els.? 

11. La.twe.k .rthoweek b. foredid youhave anyaccident` orin[url.s? 

a. Wbatw.r. they? 

b. Anything alse? 

12.	 Didy.uev.r hove a"(anyother) a=cldent orinluv lhatstIll bothers yo. or 

aff.ctsyo. i. anyway? 

a. 1. what way d... it b.th.ryo.? (Record presem effects) 

b. Anything else? 

n All No’s 

Hand respondent conditions card with “A” side up and pencil, then safi 

13. Have you EVER h.ada.y of theco.dlNons listed onthis.ard? P1..s. che.k n Yes’s (One or more) 

“Y..” or “No” for each one listed. 

. . I 

I_J All No$s 

Askre,spondent to tumcard .aver(co’”B” side), then safi 

14, Have you hod any of those conditions DURING THE PAST 12 MONTHS? m Yes’s (One or more) 

Please ehack”’Yes’’ or’’Nforemc hone one listed, 

15. Atthepr.sent time d.youhave anyother ailments, c.nditlm., orpr.b!emswIth 

yourheoltb..besldes any youmayhave checked onthe.ard oranythaty.a. t.ld D Yes ~ No me about? 

a.	 What is the =ondlt f.”? (Record condition itself if stiSlpmsen~ othwwise 

record c.resent effects) 

b. Anyother probl.mswltb y.vrbaolth? i 

lg. a. Hav. ycw been in aho’prtdet o“ytim.d.,ln gth.past 12m.”ths? a Yes D No Sf “Yes,J1 ask . 

b. How many times were you in ibe hospital durfng that period? No. of times 

19.0.	 Have. you been .p.aN.ant Inanurslng home, r.sth.me, oranysimll.rplac. I-J Yes m No during th. pa’t 12nmmbs? 

If “Yes,’) as!+ 

b. Howm.”ytim.. wer. yo. lnm”.rstng heme.rr.st hem. d”rl.gthotp.riod? No. of times 

Fornorrs.mple persons I?years oldorover, show wh.a m Responded for self ~ Responded for self 

R respondedfoz . Y1l. Forper.sons under 17 show wbo 

responded for t em. @ 01.—W~S respondent a 

70 
------ ------ ------ ------ ---- ---- ------ ---- ------ ------ ----

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

Last mune ti ‘“S’ ”-’ @ ‘a” “mf 

-——————— ———— —.——— —————- - ———————————- ————————————-

First name and initial First name and initial First name and initial First name and initial 

Xelati.anship Relationship Relationship ReIationsbip 

ige A%. Ag= & m U~der 1 yea, o Under 1 year U Under 1 year a Under 1 year 

~ White n Negro n Other n White a Negro m Other n Whit. m Negro D Other n White n Negro m Other 

,* J 

~ 

Male 

Female 

m Mafe 

m Female 

a Male 

n Female 

m Male 

a Female 

~ J~dUndc~l~j;.jced 

= .arrie!? ‘ndfil;e~&d ~ bfamiep ‘“G ~~~%d I-J bl=r~ ‘ndfi’::x=.d 

~ Widowed D Never a Widowed n Never D Widowed m Never n Widowed m Never 

1, ~ Divorced Married n Divorced Married n Divorced Married n Divorced Mamied 

~ Under ,23456,8 17 years @ nUnder 17years ~ ~Under17 years ~ ~Und~r 17 Y..=s Elem: Elem: 12345678 Elenx 1234 S678 Elan: ,234,678 0 

ntgh 1234 High 1234 High 1234 Higix 1234 

cOIIegc: 1234 5+ college: 1234 5+ College: I 234 5+ c.lle& 12345+ 

~ None n None ~-Nome m None 

~ T.; I-J No n Yes m No n Yes a No n Yes U No 

n Under 17 years n Lhider 17 years D Under 17 years n Under 17 years 

~ Working D Working m Working D Working 

~ Keeping house n Keeping house a Keeping house D.Keeping ho”sc 

~ Something C18. n something else n %methiog else a something .1s. 

-.-----------.- --. —— 

� Yes n No n Yes O No n Yes m No D Yes n No 

md TahIes G 1, H and P for himself. THEN ask Q. P-11 and Table C-2 for non-sample persons. 

hoc-sample persons only. 

� Yes m No a Yes n No D Yes n No n Yes l-l r No 

~ Yes U No m Ye. m No D Yes D No n Yes n No 

~ Yes I-J No n Ye, o No m Yes n No n Yes a No 

.,-.. . _ ,. ,,, ,,, ,,, ,. .,,. . ....... ... ,.,,,.., ,. . 

[ 

FILL ITEM R, THEN FILL TABLE C-2 FOR CONDITIONS REPORTED FOR NON-SAMPLE PERSONS 

-— . . .. ..-— .—. . . . 

. .. —-- . . . . . . 

,., . 

. ,, 

. .- . . .. .- . . . . . . . . ... —...—— ———. 

/ 

) . 

1. x 

1 

n Responded for self a Responded for self n Responded for self m Responded for self 

Col.—was respondent Col.—was respondent @ Co,._wasrespond,nt @ Co,_was,espond,n, @ 

71 
--

-- --

--

---

cd. ., s- me of codkion .s )id yo, Ask for aN illnesses.a~d Ask if the entry in C.I. (-e 1) Ask i~ only Ask for any entry in

No. Cd. (e-l) orCol.(C-2) on :pc+c.d in Questions :VER present effect. of .Id ,rquties: is: 6 ye=. that in. lude s tbe words of c..


per- P-17 \t*aeny [.) If doctor talked to: An Impairment, old or ove


and blind- son .Ik to What did the doctor say or ll~s.s, p.., Allergy* Tumor , d.cto, it wa.? . . . did h. give it VAs,on, or Asthma “Condition ,bout a medical nom.? a Symptom eye troubl, cyst llDise. sell . . ? (b) If doctor qo~ talked to: of anykim Growth “Trouble” 

Record or.gmal entry and What was the cause of . . . ? Siroke* 

ask (*2) - (~j) as c.” you 

+j required. s.* well What kind o} . . . is it? 

Ask for all injuries during anough �For an allergy or *Oread 3 past 2 weeks: ordinary stroke ask : .. 

,4 Whet part of the body W.S “ewspflp*, How does the allergy hurt? print with (stroke) affect YOU?
 What kl.d of i.[.ry W.. it? glass..?


Anything el.e?


(.)	 (b) (c) (d) (c-l) (C-2) (=-3) (*4) — x ~ Ye ‘n Yesx J No a No ,1 Q — a D Ye ‘my..’ 

m No I n No 

2 @ — 

x l-J Yes x , 

I_J No 

3 Q — 

x UY.. x 1 

m No 4 @ — 

5 @ — 

6 @ — 

, 

-10

SP 

...”.-- . . ,. -. -. .-.,. . . . .. —.. —. -. –.– –.– —r_–___–. __—__=––. 

in the hospitol f+.w nm”y Complete from entries in Columns (c) For what co.ditton dld you .nt.r the &l. f&. Y.. ..id that youw.m

(o..., twice, .tc.) during tb. past Y.., night. were .nd (!x .1, s ~~ ca~d= ad ask tbc ho.ptt.l do y..know ih. m.dlcal 

of “ No. name? 

g ::; When did You enter the hospital (the K;f%% ‘Uest’ons -

last Nm.)? (If exact How many of p.:vm-a:y of W.,*you (If medical nsme rqt @wn, enter 

still respondent’s description) 

~ number not thes* .- in the 

(Enter nmnc~ day and yeaq if exact known nights wer. nIght’ were hospital O“ (Er,tr# must show “Cjause,*’ ‘Kkd,” 

# date mc known, oLx.in estimate.) ~t$sc fi~~~j la.? week or lost S..day and pm Of b~y” ~ s-= d=t*ll *S & w..k night? required im Table G 1) 4 b. fore? (c) (d) __(f)__ (f) —-- L@ ______ 

- fii~b~ - Nigbts Nubts I

I

Non= Yes i No (h) (m) (b) - idZZ--_i-Lin~-F--Y;;-- I 1 1 1 I I I 

1 0

SP ! 

I I 1 

I I / I 2 o

SP 1 

I 

1 

I I 

I I 1 1 

I I I 

I 1 I I 3 @ I 

i I I 

FOlw N“s.s-!a.a [9-442) 

72 
condition reported in Questions 9-17 for the SaIllDk I —.. 

Ask .nly [w: If S-16 yrs. During that Ask ONLY if Ask When did you first When did you Ask .nly if knp,,irme.tx and injuries 2 week “No..+’ ~NLy~, notice . . . ? last see ., doctor seen 

Ad for: period how checked in “ talk to o duriog the 

.4h, ceas, s Inflrmmmtion m.”y days & (g) and in Cd. (C&ck the, first box dock,, ob.aut pmx 12 did ... . . . ? mombs: 

Bleeding Neuritis


Ache s Neura[g ia . . or business ;Yb:p LAST WEEK %+,.. ‘h’ch’pp’’e’) Enter month During the
 Blood Clot Pains


Boils Sarcs we .11., m.,, ~Q/+E hove to and year if past 12


cut down cluing past months about Cm”cec S.rc”css .f the d.y? ~~~oRE did for .* 12 mon~hs; how many cyst Tumor Enter numb. If any . . . cause YOU much as otherw,se times have Growth Ulcers !.&y*,, to cut down . . . day? C heck you men w Infccti.n W..knc.s .nteced i. the thing, you ‘‘before 12 talked to a cd.. (g) u,udly de? ;:”:,, $ 0, doctor m (h) skip ,> about . . . ? m CoI.(k) box 

or 

ankle, foot; one m both !’_J (c-s) Dayd No”, Yes I No Yes h. (k) (1) (m) 

I I I I I a last 2 wks. m before fd/Y_ 

I I I I I O 2wks.-3mc.. 12 0 B. 12 me. ~~ 

I I I I I 03-12 months months O Never . 

I I I I I 01.,,2 wk.. u before M/Y__ 

I I I I 1 02 wks.-3 m.. 12 m B. 12mo. — 

t I 1 I I m 3-12 nmnths months = Never NcJ.of t:mes 

, 

I I $ I I m 1.s, 2 wks. D before fJ/~— 

)OES : NOT : f 

I 

I 

I 

I 02 wks.-3nm, 

I O 312 months 

12 OB. 12u,0. 

months O Never 

No of ,im=~ 

“ 

bed,) 

Leg . (Hip, upper, knee, Iowe, _Y2__l___f2__l_ II 

I I I O last 2 wks. O before M/Y_ A~P LY I I I O 2wks.-3mo. 12 0 B. 12uI0. — 

I I I = 3-12 mombs Lr,olmhsm Newt No. of times 

I O Iast 2 wks. U b,fo,e M/Y TIT 02 wks.-3mo. 12 0 B. 12mo. I

I

,

I 

I

,

I

I

I 

I

I

I 

03-12 m.ambs months m Never No. of rimes _rtr I m last 2 wk.. m befote M/Y_

I I O 2wks.-3nm. 12 0 B. 12 m.. 

I I I I I 03-12 mombs Ir,Or,th, m Never No. of rimes


I 1 I 1 1 I


I I 1 I I m lax 2 wk.s, m before M/Y_


I I I I I I 02 wks-3 � . . 12 m B. 12 m.. 

I 1--- I_ I I I 03-12 m.ntbs morxbs a Never No. of times 

- n Questions 18 or 1 (If no hospcdi	 tionr< orted go to Table P) —— 

Were on operations porf.wned on you What is the “am. and odd,... of the hospitaf you we,. 1.? I during t{ 1s stay at the hospital? NOTE II “Yes,” Gsk: (ELWCXfull “me of hospital, street .x highway on which it is 

m	 What was the name of the located, city and Statq if city “m kmmvn, enter county.) TO 

operation? lNTERb.	 Any other .apermtlons? VIEWER 1 

(i) -.----- ________— _ ____________________u~ _______________ After 

Yea IIf ‘Yes, ” name of operxion, etc. No Completing 1 

I Table N I I go Co 

I ==3E==l Table P I l-–-–---––-----–––-––- I I C@ and
 I I state


I


I ; street
 ——-—-------—————-——- I ! & and 

73 
TABLE C-2 FOR NON-SAMPLE PERSONS ONLY: Fill one line of Table C-: 

COI. @es. Dld w Ask for all ilfnesses @ Ask if the entry in COL (~ 1) Ask only if: Ask for .ny entry in 

No. tion Name of condition s. EV~R present effects of old mguries: is: 6 yCUS old Cd. (cl) orcd. (e-2) or over and tbm includes the words: of No. reported in Questions at any (s) ff doctor talked to: An Impairment, hlffdness, 

*r- 9-11	 time 

m a or pOr~i&~, Aflergy* Tumor 

son doetm 

akaut 

. . . ? 

W.IS? .-dldho 

? 

[V- N 

a modlcal nam. 

� Symptom troll { 1, of 

,my kfnd. 

*k=* :;~u;::: 

(h) If doctoc qo~ talked to: 

Record orx.grul entsy and 

Whotwos +hocnuso of.. . . ? 

canyou What kind of.. . [sit? 

SSW. (e-2) -(c-5) as 

required. 

S** W*1I 

�ncugh ;;;:ran allergy or stroke

Ask for all injuries during to r-od 

ordinmy Howdocsthsaller y 

talk What did the doctor xOY N ore. Astbnm 4$C0aditi0n” 

past 2 weeks: 

n*w’papar (smoko) affmet y.u ? Whet par! of tho body wm print with 

hurt? glas’.s? 

What kind of b[.ry was N? 

Anything wIs*? 

(a) (b) (c) (d) (e-1) (-2) (=-3) (e-4) 

, 

u Yes x nYes = 

a No I_J No 

x 

n Yes x OY.. x 

I-J No a No 

1 

I-J Yes x uYes x 

n No I_J No 

x 

n Yes ‘ aYes ‘ 

n No I_J No 

n Yes x i_JYes = J 

n No n No 

n Yes x OY.. x , 

n No m No 

I-J Yes x mYes = 1 

a No I_J No 

> 

n Yes x UY.S x 

a No I_J No 

n Yes x a Yes x 

a No n No 

I-J Ye. x l_JYes x 

o n No I_J No 

GO TO FRONT OF QUESTIONNAIRE 

FOOTNOTES 

\’ 

74 
------ -------

for each condition reported for 

Ask .+ly for: 

fmpsuments and injwies 

And for: 

Abscesses In fImmmmtiOn A.bes Neucmfgi8 

Blecdin Neuritis 

Blood C! ot Pains Boils Sores 

C.ncer Sareness 

cyst Tumor Growth ulcers 

Mectiom Weakness 

What WIrf.af the body i. aff.ct.d? 

Sbaw detail for:


Eor w .y. - (one or botb)


H-ad . (5kufl, scalp fsce)


Brick . Upper, middle, lower)


Am. +#=I:i~;P;~;/~~o, 

both) 

each Non-Sample Person 

ff d-16 YI?US If 17 yews hen did you 

How mony ask . . 

. 

days 

. 

did 

. k..p p: nJa;Y Check the fksc 

you ffm 

school kt 

., . keep 

you from 

m. which 

,pplies) 

w..k or the your 10b 

w..k Mm.? or bus!n.ss 

old asfc .Id or more 1,.* ~tic. 

IO’* w..k Enter number or ,ho ~eek 

of days or b. fora? check “None *
 and skip co Enter rntmbe.


Cd. (h) .&:Js or


“None” 

amd ask 

Cd. (b) 

Log . (Hip, upper, knee, lower, m 

ankle, f.wq one or b-atb) I m I (s) 

----FFF


I i 

x I I I I 

I I 

x I 1 

I I 

{ 

I I 

x I r 

1 

I I 

I 

x I o 

I 

I I 

I 

x 1 I 

I 

I I 

I 

, I 1 

I	 I 

I 

I I 

(b) (i) (j) -——----- Days / None Yes 1 NQ Yes 1 No (k) 

t I I o last 2 tis. o befote 

I I O 

O 

2 wks.-3 m.. 12 

3-12 months momh, 

I I O last 2 wks. m before 

I I O 

Q 

2 vks.-3mo. 12 

312 months mc.mths 

I 1 1 0 ],S1 2 wk.. I_J before 

! I I ~ 2 wks.-3mo. 12 

I I O 3-12 months months 

I I [ o last 2 +s o before 

I O 2wks.-3 m.. 12 

I 

I 

I 

I O 312 months months 

I I 1=1 last 2 As. O before I 

I O 2wk..-3a.a. 12 

I I 0312 lMdlS months 

O last 2 wks. m before I m 2 wk..-3m0. 12 

I O +12 months months 

I t m last 2 W& o before 

O 2tis.-3 nm. 12 I I 03-12 months months 

: a 1,s 2 wks. m befa, 

I 

I 

n 2 wks.-3Ic0. 

m 3-12 monrbs 

12 

months 

I I m hwt 2 Wk. n before 

D 2 wks.-3 mm 12 I I m 3-12 months months 

I t o 1.s 2 Wk= r-J kf.are 

02 wk=-3m’a. 12 I 

I I O 312 months months 

I 

I 

. 

I 

75 
----------------------

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

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

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

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

TABLE P Name of sample Per.-

.1.	 Hovm you � ver bean advised by a doctor to Nil? the amount or to avoid wMrely 

cwt.in kind. of food or beverages? 

If “Yes,” msh


. . For what meson or c.nditio.?


b. Ar. you SNll foil.wl.g this .dvl..? m Yes n No 

.2.	 At the present tire. are you regularly ttrklng my mrdiclne or traatme.t for any n Yes m No condition? 

ff “Yes, ” ask: 

a. For whet condition? 

.3. De you hav. my c.ndltio. which dt.n ceus.s ye. pain or discomfort? I-J Yes O No 

K “’Yes,” ask 

a. what IS the condition? 

.4,	 D. you have anY health problem which 1. a sour.. of worry to YOUor oiher m.mbers of D Yes I_J No your f.ml IY? 

If “Yes,” ash. 

e. What is the probl.m? 

.5. (For males) Am you limited I. .ny way in the amount or kind of work you can d. 

becouse of ;.Dur health? I-J Yes U No 

(For femalesh Ar. YW Iimlted in .ny way in the amount or kind of housework you con 

do because of yOU, health? 

ff “Yes,’$ ask 

m What .mtdltton cause. this? 

.6. In general, would YOU say your he.lth is excell.nt, good, fair, or poor? I n 

m 

Excell.nt 

Fsir 

n 

n 

Good 

Poor 

AND RESPONDENT CARD TO P.7 (FORM NHS-S-134) 

-7. Listed on t!ais card are ..v.rc.l c.nditi.”s. Please place cn ‘“X” o posit. .ach conditlo. which indicates how fr..l You think most other Peopla would talk about each condition In an [ntewt.w Ilk. this . . , [ ~+ I., If +hey or some other member of their fami ry had th. condition. 

.8.	 . . Did You work at any time during the past 2 weeks? n Yes m No 

If “No,” ask Ws-b and P-S-C: 

b. Even though you did not work during that time do YOU have a 10b or bu.in.ss? a Ye, n No 

. . War. you leaking for work or on I.yoff from o lob? m Yes i_J No 

Name and address 

-9. what is th. name ond address of the doctor or clinic you usually go to for YOUI 0W12 

medical advlcm or treatment? I 

Number of times m.	 During the past 12 months about how many Nnms did y.. . . . or visit (doctor 

or clinic ..m.d)? for yourself 

b.	 Besid.s (the doctor or .!1.1. nm-n.d akov.) did ye. .*. or visit omy o+hw doctor n Yes a No <0. ,. P-10) 

during tho past 12 months? 

Name and address 

M “Ycs,” ash Who w.. this? fEntern.m. �nd .ddr...) 

Number of times 

G How many times did YOU s.* him during tfm p+st 12 months? 

d.	 Did you . . . anY other doctor. during th. past 12 month.? a Yes n No (o. 1. P-10) 

I 

Name and .ddsess 

If “Yes,” ask Who wcs thi.? [Eni.r n.m. ..d .~,.=.) I 

I 

Number of times 

c. H.YWmany Nmcs did you sca him during the, put 12 months? 

a-lO.	 In .onl.ncti.. v.fih this surv.y w. .om.tim. s n.d to obtain .dditi.ncd Inf.rm.t!nn MEDICAL AUTHORIZATION FORM 

from medical and hospital r.cords. III Gas. YOU are sol-tied as mm of these p.rsans 

for whom we wish to obtain additic+tol Infarmatlon will you plods- sign this fwm n Signed 

(present release - Form NHS-S- 13-?) which allow. u. to consult your h.alth r.cords


to obtain this information. n Refused: (.%1.z r.....)


I 

I 

‘fOTE TO INTERVIEWER: If interview not y=t ..ampletad for non-sampf. Wrsons, w back fo Q... N.. 9 (on Inside of qu..flonnair.) and ask 

2u9stio.s 9-11 for n.n-..mpl. p.=rso.s. Otfmwl.., @ * tit .f qm.fi~mi-. 

FORM NHI-5.1>2 [S-4-62) 

76 
---- -----

----

---

?Hs 37m PHYSICIAN VISIT RECORD — NATIONAL HEALTH SURVSY M*1 km.%%&dssas.5 h“. w.] 

. M.nt!or. If Pc.saiblq Complete Quesfi.an A Before Pat!.nt Is Seen By Doctor 

A. P.t!.”t,, L.,t Nom. H,,, N... M.dk.l K.wrd Numb., 

— DoLI.f. N... C!l.rc 

DOCTOR: Complete One Column of Questions 1 through 8 for: 

—Each Separate Diagnosis [Condition ) or Impression (LE., Diabetes, Hypertension, etc.) and 

—Sach Separate Symptom (Joint Pain, Skin Rash, etc. ) Not a Part of Diagnosis (Conditio~or Impression, 

Provided That the Diagnosis (Condition ), Impression, or Symptom Was Considered, Noted in Record, or Mentioned 

Today By Either You or the Patient. 

If More Than 2 Columns Are Needed, Use the Continuation Sheet 

If Th.r. Is No Diagnosis [Condifion), Impression, or $ymplom for Ihe Pall..!, Chwk 

— = 

end Ptlnl k.asm for This Vlslf, _ Tb.n, Skip to Question 8. 

Column 1


P,]., M.dlcd ,.rrn


( 1].	PRINT mm. of dlmg.osis (cond[tlo”), Impr.ssi, 

or symptom (IIW&Jl terms N rw,sibl. ) 

YES ~ NO ~ YES ~ NO ~ (2 I . was fhe di.ag”ods (candif i.”) , Imp,.sslo”, 0, Mm lam u-d ?,lnf Mm “,,d 

symptom mentioned by you today? 

If ye,, PRINT term used , 

(3]. Was the dlagn.als (condillon], Impression, ., YES ~ NO ~ 

symptom mention.d by lh. rmtlenl today? P,!”, t.m used ?dnt l.rm .,.d 

[f yes, PRINTterm used , 

[4). Wh.n d. y.. !hlnk the p.at!.nf Ilr.t bwam. Ch.ck o“. box G.& .“. b.. .’+/.,. of the dl,sn.a,l, fcondlllo”] , lmPrnslo. 

or symptom specified i“ Q..Nlon !.?_ — .— .“ “m . . over 3 months ago .. __ 

b. During pas! 3 months but before today - b. = 

c. Today .—-— c“ “~ d.~ Orh.r d. r J 

(5) . ffow much emphcisls did you give Iodq 1. the ~ M=.. point of it 

di.agno,k [eandlllon) , lmPr.s,lon, e, symP!om ~ Played i! down 

spedfl.d 1“ Q..sllon 1? ~ Neither of Ih.se 

(6) . At some lime during Ihe pd w.ek ‘.$,’ this 

diagnosb (condition], Impresslom or symptom 

.,sodot.d with Y& 

Chockon. b.. I. cd l!n, 

~ DON8T KNOW ~ 

Ch.& o.. 

~ 

h. I. .a<h ho 

DON,T KNoW 

a. Marked o, rndd.,ale pain .0. ..0.. b. Marksd or mod.rofe emollorml stress n _.__a __ e 0.. or mar. days in b.d El __._D__ d. Olh.r thong. 1“ .divlly Q---- –!-----­ e. Other trouble [PRINT) , e. 

[7) . A,tloII l-k.. today r.lal.d to Ih. .N.wIo,;, ~ N. odi.. token Iodey ~ N. action take. I.day 

{condi!lon], Impression, or symplom sp.dffed 

In 9..,11..1. (0. ..1..1., .cI1o., fmk.n aN 

for purpose, of a ram”. phy,lcal .xam!mtion Chwk adcnbl. h,., auk mmlknbl. box., 

M.nti.n.d, b,l 

“d .rd.r.d 

Adten ., umfmm.d — 

I a. Madloafion -n 

b. laboratory !,,1, “–D 

c. X.rq .X flmlnrlfio” ._” Ea 

d. Future visit to you ~..:.– .-

e.	 Refwrol to olh.r M.D. ..= 

f.	 Future ho’p[tallxofio” Q 

g. Ful,,e surgery -.l= _.. 

h. Change In dl.f or drink ._m_______ 

L change in snwklng 0 

1, Bed red .= 

k, Olher chan~e I. activity m..”:. 

L OIher .,11., (PRINT) -

( 8), D.+afls Signature not. of visit 

Mw,,h my Y-, -1 

D.f. form compl.t.d if differ.nl from ob.v ~.— 

Day Y.., 

77 
NATIONAL HEALTH SURVEY PHYSICIAN VISIT RECORD


M.D. A CARD


CODE H LOO, DATE RET. DIAG. NO. ANSWERS


BORN /98 ‘ SEX M’ 9 VISITS IN 1960 SURVEY


525 04 12-18-1 1 0 OF O 1 REFERRED BY COLLEGE OF OPTOMETRY 

2 9 NONE 

9 NONE 

Q. 4-; 999999999999 99999999 

ABCDE ABCDEFGHIJKL 

210 01 02-05-2 0 1 OF 1 1 ANGINAL SYNDROME 

2 1 CHEST PAIN 

3 1 CHEST PAIN


Q. 4-7 111333991991 99911199


ABCDE ABCDEFGHIJKL


210 01 03-30-2 0 1 OF 1 1 ANGINAL SYNDROME


2 1 ANGINA


1 CHEST PAIN


Q. 4-; 13132299119 199999919


ABCDE ABCDEFGHIJKL


210 01 05-03-2 0 1 OF 1 “1 ANGJ.NAL SYNDROME 

2 2 NONE 

1 CHEST PAIN 

Q. 4-: 121222991991 99999919 

ABCDE ABCDEFGHIJKL 

210 01 06-14-2 0 1 OF 1 1 ANGINAL SYNDRQJE 

2 1 ANGINA 

3 1 CHEST PAIN 

Q. 4-7 23222299199 199991999


ABCDE ABCDEFGHIJKL


210 03 07-30-2 0 1 OF 2 1 ARTERIO SCLEROTIC HEART DISEASE ANGINAL SYNDROME


2 1 CHEST PAIN


1 ANGINA


Q. 4-; 131122991991 99991999


ABCDE ABCD.EFGHIJKL


210 03 07-30-2 0 2 OF 2 1 OSTEOARTHRITIS LUMBAR SPINE 

2 2 NONE 

3 2 NONE 

Q. 4-7 13222299999 199999999 

ABCDE ABCDEFGHIJKL 

210 03 08-29-2 1 1 OF 2	 1 ANGINA PECTORIS


2 1 CHEST PAIN


3 1 CHEST PAIN


Q. 4-7 132122999991 99999999


ABCDE ABCDEFGHIJ.KL


! 

! 

SAMPLE OF PVRS


78


I 
----

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

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

----------

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

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

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

-----------

---------

----

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

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

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

APPENDIX II


DIAGNOSTIC RECODE NUMBER 3


Recode


3


number


01 

02 

03 

04 

05 

06 

07


08


09


10


11


12


13


14


15


16


17


Title 

Tuberculosis (active) (inactive), all sites 

Other chronic infective and parasitic 

diseases 

Malignant neoplasms 

Benign and unspecified neoplasms 

Hay fever, without asthma 

Asthma (with or without hay fever) (bronchial) 

(NOS) 

Other allergic disorders, NEC-------------

Diseases of the thyroid gland --------------

Diabetes (mellitus)-----------------------

Anemia and other diseases of the blood and 

blood-forming organs, Amos+-------------

Vascular lesions of the central nervous 

system 

Headache and migraine, chronic -

Specified mental disorders, NEC--

Ill-defined mental and nervous trouble,.NEC, 

Amos+----------------------------------

Diseases of the heart, NEC (chronic rheumatic) (arteriosclerotic) (hypertensive) 

Hypertension, NEC, without heart involvemerit ------------------------------------

Varicose veins 

Hemorrhoids 

Rheumatic fever; arteriosclerosis, NEC: 

other chronic diseases of the circulatory 

system 

ICD inclusions as modified byNHS 

001-007,008,009-S, 010-012, 0i4-019 

020-029, 031-034, 036-039; 040-056, 057 excl. 057.1;


058-064; 070-074; 080, 082, 083.0, 084-0!36.8; 096.X,


100-138


140-205


210-239


240


241


245 (242-244,246-S notused) 

250-254


260


290-299


330-334


354, 791


083.1,083.2,300-324, excl. 318.3 

327-S, (318.3, 326.3,326.4,790.0, 790.2) 

410-443 (782.1, 782.2, 782.4) 

444-447


460, 462


461


400-402, 403-S; 450-456, 463-468 ; 782.0, 782.3, 782.5-


782.8, 782.X


79

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

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

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

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

-------

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

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

----------

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

----------

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

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

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

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

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

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

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

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

-----------

Kecode 

3 

number 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

Title 

Chronic sinusitis 

Chronic bronchitis 

Other chronic diseases of the respiratory 

system 

Ulcer of stomach and duodenum 

Hernia (abdominal cavity)-----------------

Diseases of the gallbladder, chronicOther chronic diseases of the digestive 

system 

Disorders ofmenstruation 

Menopausal symptoms, except psychosis----

Urinary calculi; prostate disorders; other 

chronic genitorurinary conditions 

Chronic skindiseases


Arthritis and chronic rheumatism


Other chronic musculoskeletal disorders---


Fractures, 3mos .+, no residual specified---

Other injuries, 3 mos.i-, no residual 

specified* 

Blindness 

Other visual impairment 

Hearing impairments 

Speech defects 

Paralysis 

Absence, fingers, toes, only ---------------

Absence, major extremities 

Impairments (except paralysis and absence), 

back or spine 

Impairments (except paralysis and absence), 

upper extremities and shoulders 

ICDinclusionsas modified byNHS 

513 

502 

510.0, 512, 514-517, 523-526; (480-493, 3 mos+; 511, 

518-522,527,783, if3mos+) 

540-542 

560,.561 

584-586 

Anvin 530-539. 543-545. 551-553.570,572-583,587, 

78~.5-784.7, 78’5.0-785.3:785.5, 785.7 :785.X (784.0: 

784.4, 784.8, 785.4, 785.6) 

634 

635 

602, 604, 610-612; 620, 592, 594, 623; 591, 593,600, 

601, 603, 605-609, 613-617, 621, 624-633, 636, 637, 

786, 789, if 3 mos.+ 

690-716, - if 3 mos.+ except 694 

725 (720-724 not used), 726.0, 726.1,726.3, 727 

730.1, 730.2, 744; - ~31-733, 735,738,740-743, if 

3 mos.+] 

800.9-829.9 

850.9-999.91 

lunspecified residu~ls, Srnos.+, ofdislocations, sprains>strains, areC0ded@X70.g-X7g.gtW site. 

80 
-------------------------------------

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

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

Nmxkie 

3 Title ICD inclusions as modified by NHS 

number 

44	 Impairments (except paralysis and absence), 

lower extremities; and hips with any other 

site 

45	 Impairments (except paralysis and absence), 

multiple NEC, and ill-defined, limbs, back, 

trunk 

46 Other impairments 

47	 Other chronic conditions except impairments 

(gout) (multiple sclerosis) (paralysis agitans) 

(epilepsy) (refractive errors) (cataract)


(glaucoma) (congenital malformations not in


X-Code) (senility) (etc.)------------------- All other ICD code numbers which may be chronic


conditions 

81 
APPENDIX Ill 

SAMPLING DESIGN 

Introduction 

The sampling design consists of the selection of 

the sample of respondents, the allocation of the sample 

to interviewers, and the procedures used in calculating 

the estimates. 

Family Account Numbers and Medical Record 

Numbers at I(FI-IP 

The main devices used in selecting the samples 

were the Family and Medical Record Numbers, which 

are now discussed. 

On enrollment in KFHP, a new subscriber is assigned a seven-digit number called the Family Account 

Number. There is ‘one Family Account Number for the 

subscriber and the covered members of his family. 

For the subscriber the Family Account Number is 

also his Medical Record Number. Other members of his 

family are also assigned individual Medical Record 

Numbers which are in sequence after the Family Account Number for all members covered when the subscriber joins and which are the next higher numbers 

for those joining the covered membership—e.g., newborn infants at a later time. Thus, the Family Account 

Numbers are the Medical Record Numbers of the subscriber, and each member of KFHP, subscriber or not, 

has his own seven-digit Medical Record Number. The 

records for each person include both his Family Account Number and his Medical Record Number. 

Population 

For purposes of this study the population consisted 

of all members of KFHP that met the following requirements: 

(1)	 They were members during the 6-month period’ 

January through June 1960 and during the study 

itself. 

(2)	 They were at least 17 yeara of age at the date 

of interview. 

(3)	 They were not members of the Culinary 

Workers Union. 

Selection ond Assignment to Interviewers 

of the Interview Sample 

kt~oduction. —The two main samples in the study 

were the PVR Sample, for which medical records were 

prepared, and the Interview Sample, a subsample of the 

PVR Sample for which interviews and comparisons with 

the medical records were made. 

In this section the selection of these two samples, 

the weights of the elements of the Interview Sample, the 

interviewers’ assignments, and the dates of beginning 

and terminating interviews are discussed. 

PYeliminavy Sample. -The population from which 

the Preliminary Sample was drawn consisted of all subscribers to KFHP and the covered members of their 

families 15 years of age and over who were members 

of KFHP during the 6 months January through June 

1960 and who were not members of the Culinary Workers 

Union. 

The Preliminary Sample consisted of those with 

terminal digits 2, 5, or 7, and thus included approximately 30 percent of the population. 

Physician Visit RecoYd (PVR) Sample—allocation _____ to jive waves ov se~ences. —Using the data on number 

of visits to SCPMG of each person in the Preliminary 

Sample for the 6 months January through June 1960, 

the Preliminary Sample was classified into two strata— 

those who had made O, 1, 2, 3, or 4 visits to SCPMG 

during the 6-month period and those who had made 5 or 

more visits during that period. 

The PVR Sample consisted of an approximately 

10-percent. sample from the first stratum and an approximately 20-percent sample chosen from the second 

stratum. selected as indicated in tables I and H. 

Table I. Sampling procedure for those making 

O through 4 visits during January-June 1960 

Of those whose “seventh 

digit (Medical Record 

Number) is------------- 0123456789 

Include in the sample 

those whose fifth ,digit is--------------------- 2468075913 

I 

* 

* 

82 

. 

, 
I 

I 

I 

I Table 11. Sampling procedure for those making 

5 or more visits during January-June 1960 

Of those whose seventh 

digit (Medical Record 

Number) is------------- 0123456789 

Include in the sample

those whose fifth digit

is--------------------- 2468075913 

or-------------------- 6035748291 

P 

Eor convenience in initiating the PVR record 

keeping and in the interviewing, the sample was randomlyallocated to five wavesor sequences ofapproximately equal sizes (see table III). Record keeping began at 3-week intervals for the five waves. 

The PVR Sample thus selected consisted of 4,922 

names. These were allocated tofivesequencesorwaves 

according to the sixth digits of the Medical Record 

Numbers as stated in table HI. The staggered beginnings 

of the waves facilitated both the operations of record 

keeping at SCPMG and the interviewing by the Bureau 

of the Census later on. 

Table III. Allocation of sample to sequences


The sequence or wave 

having identification 

number 

1 

2 

3 

4 

5 

or waves 

Consists of I€

all persons The date on€

in the PVR which PVR’S


sample having began to be 

sixth digit filled out for 

(Me::~l the sequence or 

wave wasNumber) 

2or5 October 15, 1961 

lor8 November 5, 1961 

6or9 November 26, 1961 

Oor4 December 17, 1961 

3or7 January 7, 1962 

Ivttevvk?w Sample- detey?)litmtion of ?oeights. -Approximately 11 months after the beginning of each wave, 

the number of visits of each person on the PVR Sample 

9 was tallied from the PVR’s for that person. Using those 

data on number of visits, the Interview Sample was selected from the PVR Sample in accordance witita~le 

IV. Also, in table IV are given the weights resulting 

from the combination of the 1960 visit strata and the 

study year visit strata. 

Table IV. Sampling ratios and weights for interview sample 

Number of visits 

January-June 

Ap=~ely Sampling 

ratio weight 

1960 months of 

study year 

0-4 o 1 in 10 20 

0-4 1 lin3 

0-4 2-5 lin2 4 

0-4 6 and over All 2 

5 and over o L in 10 10 

5 and over 1 and over All 1 

AlLocation of the Interview Sawz@e among aveas 

anti mtemieweys-dates of inte?wiezoing. -Witi minor 

modifications, the service area of the Kaiser Foundation Health Plan was divided into four areas, three 

of which were in Los Angeles and the fourth which 

contained Fontana and nearby areas. The four areas 

arethose of the present study. 

After the Interview Sample was selected for a 

given wave, tie addresses of its members were located 

and the sample was thus distributed among the four 

areas. 

For each of the four areas, the Interview Sample 

was allocated atrandomamongtietireequestionnaires. 

Because of problems of cost and administration, however, interpenetrating samples were not used for interviewer assignments within all areas. In the three Los 

Angeles areas, the interviewers shifted from area to 

area in different waves. In the Fontana area, the interviewers were the same in all waves. 

One year after the beginning of the PVR record 

keeping for a wave, the PVR record keeping terminated. 

Interviewing of that wave then began and continued for 

2 to 3 weeks afterwards. The only change from the 

original plans occurred in Waves 4 and 5 in orderto 

avoid the possibly higher noninterview rates between 

Christmaa and New Year. The dates are given in table 

v. 

83


6 
Table V. Scheduled and actual interviewing dates, by wave 

Wave 

i 

2 

3 

4 

5 

Scheduled dates 

Begi.nni.ng Ending 

October 22, 1962 November 10, 1962 

Navember 5, 1962 November 24, 1962 

November 26, 1962 December 15, 1962 

December 17, 1962 January 5, 1963 

January 7, 1963 January 26, 1963 

Actual dates 

Beginning Ending[ 

As scheduled 

As scheduled 

As scheduled 

December 12, 1962 December 22, 19622 

January 3, 1963 January 16, 1963 

. 

L1n some cases, intemiewing occurred after the stated ending date, but these were few in ‘umber. 

‘The change in dates for Wave 4 was primarily to reduce the amount of interviewing during the 

Christmas season. 

Final changes in the sawzple.—During data processing, two changes were made in the sample to be 

tabulated. These were as follows: 

(1)	 All persons under 17 years ofageon the date 

of interview were eliminated. 

(2)	 It had been decided earlier that only one person would be interviewed in any household. 

Consequentlyif anyhouseholdhad twomembers 

or more selected for the sample, all but one 

were eliminated from the Interview Sample, 

but the information for the sample person not 

eliminated was duplicated and inone instance 

triplicated. 

Interview Sample for Which PVR’S 

Were Not Used 

In any record-check study for which special records 

such as the PVR’S are beingprepared, thereare always 

the possibilities that tbese special records areincomplete or inaccurate or that the respondent has become 

aware ofthe study sufficientlytoinfluence hisreporting. 

Consequently a further sample, called Wave 6, was selected as follows: 

(1) The Wave 6 %rnplew asselectedfrompersons 

in the Preliminary Sample who had not been 

selected for the PVR Sample but who had as a 

sixth digit of their Medical Record Numbers 

either O, 3, 4, or 7—i.e., the sixth digits 

corresponding to Waves40r 5. 

(2)	 A 10-percent sample was selected from those 

with O, 3, 4, or 7 as the sixth digit of their 

Medical Record Numbers in accordance with 

tabIe VII. 

Table VII. First-stage 10-percent sample from 

those having sixth digits identifying sequences or waves 4 and 5 

Of those whose seventh 

digit (Medical Record 

Number) is------------- 0123456789 

Include in the first 

stage sample those 

whose fifth digit is--- 45 9 0 3 2 17 6 8 

(3)	 The resulting sample, called the PC Sample, 

then consisted of a subsample of one in six 

of those selected in item 2 who had made O 

to 4 visits to SCPMG during January-June 

1960 and a sample of one in three ofthose 

who had made 5 visits or more to SCPMG 

during January- June 1960. 

For the PC, or Wave 6Sample, medical recorals (PC) were obtained by using the patient 

charts (PC)the study year, The persons in the 

PC Sample were not in the PVR Sample, and 

no indication of their being in the PC Sample 

could have reached the physicians and,through 

them, the patients, because physicians were 

not involved in the preparation of the medical 

records (PC). 

(4) The medical records (PC) were t.hen usedto 

select an Interview Sample that consisted of all 

persons in the PC Sample who had made at 

least one visit to SCPMG during the study year, 

and a sample of 1 in 10 of those was selected. 

Thus the weights for Wave 6 are 3, 6, 15, and 

30. 

84

OUTLINE ut KtruRT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publication No. 1000 

Series 1.	Pvog~arns and collection @ocedures.- Reports which describe the general programs of the National 

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, 

and other material necessary for understanding the data. 

Series 2. Data evaluation and methods Yesearch. —Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical 

techniques, objective evaluations of reliability of collected data, contributions to statistical theory. 

Seyies 3. Analytical studies. —Reports presenting analytical or interpretive studies based on vital and health 

statistics, carrying the analysis further than the expository types of reports in the other series. 

Sevies 4.	 Documents and committee veports. — Final reports of major committees concerned with vital and 

health statistics, and documents such as recommended model vital registration laws and revised birth 

and death certificates. 

Series 10. Data from the Health Interview Suvvey. —Statistics on illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other health-related toPics ~ based ‘n data cO1lected 

in a continuing national household interview survey. 

Series 11.	 Data from the Health Examination Szm’vey.—Data from direct examination, testing, and measurement of national samples of the population provide the basis for two types of reports: (1) estimates 

of the medically defined prevalence of specific diseases in the United States and the distributions of 

the population with respect to physical, physiological, and psychological characteristics; and (2) 

anal ysis of relationships among the various measurements without reference to an explicit finite 

universe of persons. 

Seyies12,	 Data from the Institutional Population Su?weys. —Statistics relating to the health characteristics of 

persons in institutions, and on medical, nursing, and personal care received, based on national 

samples of establishments providing these services and samples of the residents or patients. 

SeVies13. Data from the Hospital Dischavge Survey. —Statistics relating to discharged patients in short-stay 

hospitals, based on a sample of patient records in a national samPle of hospitals. 

Series20.	 Data on movtality. —Various statistics on mortality other than as included in annual or monthly 

reports— special analyses by cause of death, age, and other demographic variables, also geographic 

and time series analyses. 

A Series21.	 Data on natality, marriage, and divoyce. —Various statistics on natality, marriage, and divorce other 

than as included in annual or monthly reports — special analyses by demographic variables, also 

geographic and time series analyses, studies of fertility. 

SeYies22.	 Data from the National Natality and Mortality Surveys. —Statistics on characteristics of births and 

deaths not available from the vital records, based on sample surveys stemming from these records, 

including such topics as mortality by socioeconomic class, medical experience in the last year of 

life, characteristics of pregnancy, etc. 

For a list of titles of reports published in these series, write to: Office of Information 

National Center for Health Statistics 

U.S. Public Health Service 

Washington, D.C. 20201