Vital and

Health Statistics

Advance Data

From Vital and

Health Statistics:

Numbers 131–1 40

Series 16:

Compilations of Advance Data

From Vital and Health Statistics

Nor 14

Data in this report from health and demographic surveys present statistics by age

and other variables on nursing home characteristics, acute conditions and

restricted activity during the 1985-86 influenza season, physical abilities of people

ages 65 and ove~ utilization of drugs in medical office practice, highlights of

osteopathic office practice, health care coverage, and the declining utilization of

hospitals, Estimates are based on the civilian noninstitutionalized population of the

United States, These reports were originally published in 1987.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsville, Maryland

April 1995

DHHS PubllcatlonNo, (PHS)95-1873
Copyright information

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

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

appreciated.

Suggested citation

National Center for Heailh Statistics. Advance data from vital and health

statistics; number 131–1 40. National Center for Health Statistics. Vital Health

Stat 16(14). 1995.
National Center for Health Statistics

Jack R. Anderson, Acting Director

Jennifer H. Madans, Ph.D., Acting Depu~ Director

Jacob J, Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Peter L. Hurley, Associate Director for Etal and Health

Statistics Systems

Robert A. Israel, Associate Director for International

Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology
Contents

Nursing Home characteristics: Preliminary Data From the 1985 National Nursing Home Survey . . . . . . . . . . . . . . . . . .

Acute Conditions and Restricted Activity During the 1985-86 Influenza Season. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aging in the Eighties: Functional Limitations of Individuals Age 65 Years and Over . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Highlights of Drug Utilization in Office Practice: National Ambulatory Medical Care Survey, 1985 . . . . . . . . . . . . . . . .

Use of Nursing Homes by the Elderly: Preliminary Data From the 1985 National Nursing Home Survey . . . . . . . . . . .

Aging in the Eighties, Ability to Perform Work-Related Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diagnosis-Related Groups Using Data From the National Hospital Discharge Survey: United States, 1985 . . . . . . . . . .

Highlights of Osteopathic Office Practice, National Ambulatory Medical Care Survey, 1985 . . . . . . . . . . . . . . . . . . . . . .

Health Care Coverage by Age, Sex, Race, and Family Income: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Recent Declines in Hospitalization: United States, 1982–86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. 131

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No. 140
From Vital and Health Statistics of the National Center for Health Statistics Number 131 . March 27, 1987

Nursing Home Characteristics

Preliminary Data From the

1985 National Nursing Home Survey

by Genevieve Strahan, Division of Health Care Statistics

Introduction

The National Nursing Home Survey (NNHS) is a nationwide (excluding Alaska and Hawaii) sample survey of nursing

and related care homes, their residents, their discharges and

their staff conducted periodically by the National Center for

Health Statistics. Preliminary data on nursing home characteristics from the 1985 NNHS are presented in this report. Because the estimates in this report are preliminary, they may

differ slightly from estimates published in future 1985 NNHS

Eports due to further editing of the data. The 1985 NNHS is the

third in a series of periodic surveys conducted between August

1985 and January 1986. The first NNHS survey was conducted

between August 1973 and April 1974; the second survey was

conducted from May through December 1977. For convenience,

this report will use the terms “nursing and related care homes,”

“nursing homes,” and ‘“facilities” interchangeably.

The focus of this report is facility characteristics and will

include trend data about the characteristics of facilities from all

three surveys and national estimates on the following topics

from the 1985 survey:

● Facility characteristics (number of homes and beds by

ownership, certification, bed size, region, and aflliation).

● Utilization data (number of current residents, discharges,

admissions, admissions per bed, and occupancy rates ).

● Employees (number and rates per 100 beds of fill-time

equivalent employees by occupational category according

to selected facility characteristics).

. Nursing home per diem rates (data on basic amount

charged private pay patients by level of care and per diem

rates for medicare/medicaid patients by certification status

according to ownership and location of the facility).

Background

The foundation for the 1985 NNHS sampling frame was

the 1982 National Master Faciii~ Inventory (NMFI) Survey.[

Facilities in the NMFI are homes with three beds or more and

with available nursing or personal care to the residents. Added

to this 1982 NMFI list of over 17.000 nursing and related care

homes were homes identified by the Agency Reporting Systemz

as having opened between the time of the 1982 NMFI Survey

and June 1, 1984 (the cutoff date for the sampling frame),

homes located by the 1982 Complement Sumey,3 and hospitalbased nursing facilities certified by the Health Care Financing

Administration. The final sampling frame consisted of about

20,500 nursing and related care homes in the conterrninous

United States.

The 1985 NNHS is similar in scope to that of the 1977

survey that included nursing care homes, personal care homes

(with and without nursing), and domiciliary care homes. The

two later surveys represent a broadening in scope over that of

the 1973–74 survey, which excluded facilities providing only

personal care or domiciliary care. Because personal and domiciliary care homes constitute such a small proportion of the

197? and 1985 surveys. no special adjustments will be made

when comparing the three surveys.

The sample design~ for the 1985 NNHS was a stratified

two-stage probability design. The first stage was the selection

of 1,220 facilities. The second stage allowed for a maximum

selection of five current residents, six discharges, and four registered nurses from each of the 1,220 facilities.

Six questionnaires were used to collect data in the 1985

survey. Data on characteristics of the facility were collected on

the Facility Questiomaire by interviewing the administrator.

With the permission of the administrator, cost data were colU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Publlc Health Sewlce
2 atkncedata

lected on the self-administered Expense Questiomaire returned

by mail from the facility’s accountant or bookkeeper. A recent

financial statement, if available, was acceptable as a replacement for the completed expense questiomaire. Information to

complete the Current Resident Questionnaire and Discharged

Resident Questionnaire was obtained by interviewing the staff

person most familiar with the medical records of the resident.

Additional information about the residents was obtained in a

telephone interview using a Next-of-Kin Questionnaire. Registered nurses were asked to complete a self-administered

Nursing Staff Questionnaire and return it to the interviewer or

mail it to the data processing headquarters. Additional employee data were collected on the Facility Questionnaire for all

categories of full-time and part-time workers.

Estimates of admissions, admissions per 100 beds, and

occupancy are for 1984. Discharge estimates cover 1 year prior

to the day of the survey. Because all estimates are based on a

sample of nursing homes rather than a complete enumeration,

they are subject to sampling variability. Information on sampling variability is presented in the Technical notes.

Separate Advance Data reports on current residents and

discharges are plamed for publication this year.

Facility characteristics

Survey estimates for 1985 indicate that there were 19,100

nursing homes with 1,624,200 beds. This represents a 22-

percent increase in the number of nursing homes since the

1973–74 survey and a 38-percent increase in the number of

beds (table 1).

There continue to be significantly more proprietary homes

than nonprofit or government-owned nursing homes. Proprietary homes accounted for an overwhelming 75 percent of all

nursing homes in the 1985 NNHS. Homes owned by nonprofit

organizations made up 20 percent of the total while the remaining 5 percent were operated by Federal, State. and local governments. As would be expected, homes operated for profit

had the largest proportion of beds (69 percent). Nonprofit and

government homes were larger in size than proprietary homes

by 24 and 68 percent, respectively (table 2).

An important classification of nursing homes is according

to certification status. Nursing homes are classified as follows

by Social Security’s medicare and medicaid programs:

. Skilled nursing facilities (SNF”S) by medicare (Title XVIII).

● Skilled nursing facilities ( SNF’S) by medicaid (Title XIX).

● Intermediate care facilities (ICF’S) by medicaid (Title

XIX).

Since SNF regulations are identical under medicare and

medicaid, a skilled nursing home may have dual certification

status. In addition, a nursing home could be certified as both an

SNF and an ICF. This is accomplished by allocating a specific

number of beds to each certification status. The proportion of

homes certified as both an SNF and an ICF increased significantly from 24.3 percent of the total homes in 1977 to 29.8

percent of total homes in 1985.

A nursing home may not meet certification criteria or may

choose not to participate in the program and therefore be classified as not certified.

More than 75 percent of all nursing homes in the 1985

NNHS were certified as an SNF by medicare or medicaid, an

ICF by medicaid, or certified as both an SNF and an ICF.

Although homes that were not certified made up 25 percent of

the total number of homes, they had only 11 percent of the

total beds and averaged only 39 beds per home (table 2!).

Of a total 14,400 homes with some form of certification,

about 40 percent were certified as both SNF’S and ICF’S.

Homes certified as both SNF’S and ICF’S had the largest

proportion of beds (50.2 percent) and had the largest average

bed size (127 beds per home). Homes providing interrnediate

care only constituted 37 percent of all certified homes, had

28.4 percent of the total beds and an average bed size of 77

beds. The “SNF’S only” group of certified homes constituted

24 percent of all certified homes. 21 percent of the beds, and

had an average bed size of 88 beds per home. The majority (73

percent) of the 14,400 certified homes were operated for profit

(table 3).

Chain atlliation describes those homes that are members

of a group of facilities operating under one general authority or

general ownership. Fewer homes were operated as pzu-t of a

chain in 1985 than were operated independently. However.

Table 1. Facility characteristics and measures of utilization for nursing homes: United States, 1973–74, 1977, and 1985

Facility characrermtics Measures of utilization

Full-r/me

equwalent FTE’s1 Adrrxwons

emoloyees per Current per

SurveV year Homes Beds (FTE’s)l 100 beds residents Discharges Admissions 100 beds Occupancy

Number Ratez

——

1985. . . . . . 19,100 1,624.200 7’93,600 48.9 1,491,400 1,223.500 1,299,200 80.5 91.6

1977. ,,, ., ..,,...., 18,900 1,402,400 647.700 46.2 1,303,100 1,117,500 1,367,400 98.4 89.0

1973 -74 . . . . . . . . . . . 15,700 1.177,300 485.400 41,2 1,075,800 1,077,500 1,110,800 95.3 86.5

7Includes onlv thosa providing direct patient care: Admtmstratjve, medical. and therapeutic staff: regwtered nurses: licensed pract!cal nurses: nurse s a(des; and

orderlles. The FTE s are calculated by dlvldjng part-ttme hours w 35 and adding the results to full.time employees.

*Occupancv ,ate = ~ Aggregate ri.mber of days of care prowcea to restdents n year prior to survev year X 100

~ Est,mated number of bees n year prior to survey year X 366

NOTE Adm!sslons, admjsstons per 100 beds, and Ihe occuoa-cf rates are for Ihe calendar year prior to the sumev year
aciuancedata 3

Table 2. Number and percent distribution of nursing homes and beds and beds Per nursing home by selected nursing home characteristics:

United States, 1985

Nursing homes Nursing home beds

Percent Percent Beds per

Facility characteristic Number distribution Number distribution nursing home

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ownership

Proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Voluntary nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Certification

Certified facllitiea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing facility only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing facility and intermediate care facility. . . . . . . . . . . . . . . . . .

Intermediate care faciiity only..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non certified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Less than 50 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50-99 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100–199 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200 beds or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Census region

Nonheast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Affiliation

Chain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Independent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19,100 100.0 1,624,200

1,121,500

370.700

131,900

1.441.300

307.900

724,000

409,400

182.900

151,100

444.300

702.100

326,700

371.100

531,700

488,300

233,100

800,000

680,700

131,900

11.600

100.0 85.0

14.300

3,800

1,000

74.9

19.9

5.2

69.0

22.8

8.1

78.4

97.6

131.9

14,400

3,500

5,700

5,300

4,700

75.8

18.3

29.8

27.7

24.6

88.8

19.0

44.6

25.2

11.3

99.4

88.0

127.0

77.2

38.9

6.300

6,200

5,400

1.200

33.0

32.5

28.3

6.3

9.3

27.4

43.2

20.1

23.9

71.7

130.0

272.3

4,400

5,600

6,100

3,000

23.0

29.3

31.9

15.7

22.8

32.7

30.1

14.4

84.4

94.9

80.0

78.6

7,900

10,000

1,000

●loo

41.4

52.4

5.2

“0.5

49.3

41.9

8.1

0.7

101.5

68.1

131.9

116.0

NOTE: Figures may not add to totals due to rounding,

Table 3. Certification status of nursing homes by ownership and affiliation: United States, 1985

Cert!hed homes

Skilled

Skilled nutsing Intermediate

nursing facility and care

facility intermediate faclhty Not

Ownarship and affiliation Total Total only care fa ctlily only certif!ed

Number

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,100 4.400 3,500 5,700 5,300 4,700

Ownership

PrOprleta~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VoluntaV nonprofit . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14,300

3,800

1,000

0,500

3,000

900

2,800 3,900

500 1.400

200 400

3,800

1,100

300

3,800

700

100

Afflliatlon

Chain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Independent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.900

10,000

1,000

●loo

7,400

6,000

900

1,300 3,200

2.000 2.100

200 400

2,900

1.900

300

500

4,000

100

100

NOTE: Figures may not add to totals due to rounding,
4 advancedata

chain homes had a larger share of the total number of beds and

a larger a~erage bed size of 101.5 beds per home compared with

68.1 beds per home for independently owned facilities (table

2). There has also been a significant increase in the number of

chain homes since the 1977 NNHS survey. Chain homes increased from 28 percent of total homes in 1977 to 41 percent

of total homes in 1985.

Significantly more chain homes have some form of certification than do independently operated homes. Almost 94 percent of the total chain homes were certified in 1985 while 60

percent of the total independently operated were certified

(table 3).

Table 2 also shows homes and beds and beds per home by

bed size and U.S. Bureau of the Census region.

Utilization

The procedures for collecting certain measures of utilization differed by method and time period. The reader should

consider these differences, as explained in the text that follows,

when making comparisons.

Probably the single most important measure of nursing

home utilization is occupancy rate, which estimates that nursing

homes operated at about 92 percent of capacity in 1984. The

rate for 1984 represents a significant increase over the 1972

rate of 85.6 percent. The 1.5 million residents served in 1985

were counts for the night before the survey. The number of

residents in 1985 had increased 14 percent since the 1977 survey and 39 percent since the 1973–74 survey. The ratio of

residents 65 years and over in nursing homes to those in the

general population has remained virtually unchanged. Over the

past 12 years, nearly 50 of every 1.000 persons 65 years and

over continue to reside in nursing homes. In other words, nursing home usage by residents in the 65 years and over age group

has kept pace with the increase in the elderly population.

There was a significant decrease of 2.8 beds per 1,000

population 65 years and over between 1977 and 1985 (table

4). Although there is much discussion about the ratio of beds

per 1,000 elderly, no consensus exists on the appropriate number. Hence, it is difficult to interpret what this decrease in

number of beds means in terms of availability of nursing home

beds to potential elderly residents.

The number of admissions was determined by directly

asking the administrator for this information for calendar year

1984. Admissions were down from the 1.4 million in 1977 to

1.3 million in 1985. The admissions per 100 beds rate in 1985

was also down significantly from 1977 (98.4 to 80.5, table 1).

The 1.2 million discharges were estimated from a sample

of all events in which a person was discharged alive or dead

during the 12 months ending on the day prior to the facility’s

survey date (table 1).

Employees

Employee data presented in this report are in terms of fulltime equivalent (FTE) employees. The FTE’s are computed to

neutralize the variations between facilities that hire part-time

workers to cover the number of hours of a full-time worker.

Thirty-five hours of part-time work ae taken to equal that of

one full-time employee. Full-time employees and part-time

hours are com’erted to FTE employees by dividing part-time

hours by 35 and adding the result to full-time employees. The

procedure used to coliect employee data differed slightly in

each of the survey years. In 1973–74, all employees were listed

for each sample facility, and a sample was taken from each

listed category. However, in the 1977 survey, estimates were

based on a sample of employees from each sample facility. In

the 1985 survey, total counts for employee categories were

asked of the facility’s administrator. These differences should

be considered when comparing FTE’s for different survey years.

The 1985 survey included individuals employed full time

and part time along with the number of part-time hours worked

for each category of part-time workers. All employees providing

direct or indirect services to nursing home residents were included in the survey. Unlike previous surveys, clerical, food

service. housekeeper, and maintenance persomel. as well as

other employees providing indirect services to residents,, were

included in the 1985 survey. However, to provide a credible

comparison of FTE’s in previous surveys with 1985, FTE’s

presented in table 1 for 1985 exclude those FTE’s providing

indirect patient care.

Table 4, Beds per 1,000 population 65 years and over, residents 65 years and ovar per 1,000 population, total population, and standard errors

of the rates. United States, 1973-74. 1977, and 1905

Res/dents 65 years and

Beds per 1,000 over per 1,000

population 65 population 65

years and over years and over

Standard Standard ‘ Tots/ U.S.

Survey year Number error Number error residen f population

Number In thousands

1985, ,, ,. .,, .,, ,, 56.9 0.70 46.0 1.00 28,5301

1977, ,. .; ::;;;:, ; ;:::;::::”’.,,,,,,,,, ,., ., 59.7 0.48 47.9 0.71 23,4942

1973-74 ,,, ..,, ., .,.,,.,. . . . 55.2 0.33 45,1 0.38 21,3292

‘U S Bure.a. of The Census Est(mates of the population of the Unned States, by age, SeX, and race 198o to 1985 Current Popu/at/on Repons. Series P-25, No. 985.

Waah, nglor u S Government Pr, nltng Office 1986

2U S Burea. of the Census Est,males of the Dopulat,on of the Un)led States, by age, sex. and race 1970 m 1977 Cwrenr Popu/.?rfonRepotis, SWleS P-25, No. 721.

Was., nglo - U S Government Pr, nt!ng Off,ce 1978
d9medaa5

The total number of FTE’s and selected groups of FTE’s

working in nursing homes are presented in table 5. In 1985

almost 1.2 million FTE’s were providing direct and indirect

services to nursing home residents. Those employees providing

some form of nursing or personal care accounted for over

700,000 of the total FTE’s, averaging about 43 FTE’s per 100

beds. Nurse’s aides and orderlies were by far the largest group

(71 percent) of those employees providing nursing care or personal care. This group ako accounted for over 40 percent of

the total FTE’s.

There is a direct relationship between certification status

of the nursing home and FTE’s per 100 beds. SNF’S (medicare

and medicaid) and facilities with both SNF and ICF certification had significantly more FTE’s per 100 beds than facilities

certified as ICF’S only or those not certified. The facilities

certified SNF only had a rate of total 80.4 FTE’s per 100

beds, znd those facilities certified as both SNF and ICF had an

FTE rate per 100 beds of 76.8. These two rates compare with

64.1 for ICF’S and 51.2 for not-certified facilities. The greatest

difference in FTE’s per 100 beds by certification is in registered

nurses (RN’s). The ICF’S and not-certified facilities employ

fewer than one-half the number of FTE RN’s per 100 beds

than the other two certification groups (table 5).

Information on RN’s was collected as a separate component

of the NNHS. Estimates of RN’s were made from a maximum

sample of four RN’s selected from each sample facility. Future

statistical reports will present more detailed information on

RN’s working in nursing homes.

routine care. Rates were collected for private pay residents and

for medicare and medicaid residents. Rates differ because of

different services provided. especially to medicare/medicaid

patients. These rates are not to be confused with charges to

residents after care has been received. Charges include the per

diem rate plus fees for additional services not covered in per

diem rate.

. Prisate pay—The average daily rates for private pay increased as would be expected as the level of care increased.

Skilled care had the highest average daily rate ofS61 per

day. The average rates decreased to $48 for intermediate

care and down to S31 per day for residential care. By region,

homes in the Northeast tend to have higher rates than the

other regions for skilled and intermediate ievels of care but

about the same rates for residential care (table 6).

● Medicare and medicaid—A nursing home’s certification

status directly affects the per diem rates that are set for

routine care. Skilled care has a requirement, for instance,

that art RN be on duty 24 hours per day. Rates for medicare

and medicaid skilled homes are higher than rates for medicaid intermediate. Table 6 shows the average per diem

rate for each certification status of homes in the 1985

survey by ownership of the home and region.

Nursing home rates by ownership are also presented in

table 6. Further analysis by other facility characteristics of per

diem rates for private pay and medicare and medic aid residents

will be presented in a future publication from the 1985 NNHS.

Nursing home per diem rates

In 1985. for the first time, the NNHS was designed to

collect data on per diem rates set by the nursing homes for
Table 5. Number and rete per 100 beds of full-time equivalent employees by occupetiorral catego~ end selected nursing home characteristics: United Stetes, 1986 —

Occupational category

All full-tmw

Nursing

Adrrtinistratwe,

equwalent medical, and Licensed practical

employees

Nurse’s a)de

therapeutic Total Registered nurse nurse and orderly All other staff

Rate Rate Rate Rate Rate Rate Rate

per 100 per 100 per 100 per 100 per 100

Fact[(ty charac[er[st[c Number beds Number beds

per 100 per 100

Number beds Number beds Number beds Number beds Number beds

Total. . . . . . . .

Ownr!rshlp

Propnetaw . . . . . . .

VOlunta~ nonprofit . . .

Government. . .

Certlflcatlon

Skilled nursing facility only

Sk!lled nursing facll, ty and

intermediate care faclllty

Intermediate care faclllty

only. . . . . . . . . . . . . . . . .

Notcertlfted . . . . . . . . . . . . .

Bed size

Less than 50 beds..... . .

50–99berfs. . . . . . . . . .

100-199 herbs . . . . . . . . . . . . .

200 beds or more.. . . . . .

Census region

Nr)rtht?ast . . . . . . . . . . . . . . . . .

North Central . . . .

South, . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . .

1,159,700

733,300

310.800

115,600

247,400

556,100

262,500

93,700

92,400

317,700

489,800

259,BO0

286.100

3B0,000

323,900

169,800

71.4

654

B3.B

B7.6

80.4

76,8

64.1

51.2

61.1

71.5

69.8

79.5

77.1

71.5

66.3

72.8

89,400

55.700

25,100

8,500

19,200

3B,900

19,700

11,600

14,500

24.500

32,300

18,100

22,800

28,700

24.600

13.300

Note. Fjgures may not adrt 10 lolals due to round!ng.

5.5

5.0

6.8

6.5

6.2

5.4

4.8

6.3

9,6

5.5

4.6

5.5

6.1

5.4

5.0

5.7

704,300

461,000

175,100

68,100

152,800

344,000

160,900

46,600

48,600

194,700

307,400

153,600

166,500

231,300

200.200

106,300

43,4

41.1

47.2

51.6

496

47.5

39.3

25.5

32.1

43.8

438

47.0

44.9

43.5

41.0

45.6

83,300

48,600

24,900

9,800

21,900

45,500

11,000

4,900

5,100

20,500

35,700

22,000

26,800

28,300

14,700

13,500

5.1 120,000

4.3 80,100

6.7 28.500

7,4 11,300

7.1 24,600

6.3 58,500

2.7 30,500

2.7 6,300

3.4 7,900

4.6 33,000

5.1 53,100

6.7 25,900

7.2 26,700

5.3 35,200

3.0 41,000

5.B 17,100

7.4

7.1

77

8.6

8.0

B.1

7.4

3,4

5.3

7.4

7.6

7.9

72

6.6

8.4

7.3

501.000

332,300

121.700

47,100

106,200

240,000

119,300

35,500

35,500

141.200

218,600

105,700

113.000

167,800

144,500

75,700

30.8

29.6

32.8

35.7

34.5

33.1

292

19.4

235

31.8

31 1

32.4

30.5

31.6

29.6

32.5

366,100

216,600

110,600

38,900

75,500

173,200

82,000

35,400

29,300

98.500

150,100

88,100

96,BO0

120,000

99,100

50,200

225

193

29.8

295

245

23.9

20.0

19.4

194

22.2

21.4

27.0

26.1

226

20.3

21.5
aduancedata 7

Table 6. Average per diem rates for private paY patients by level of care and for medicare/medicaid petients by certification status, ownership,

and region: United Statea, 1985

Level of care Cerrtficatton status

Medtcaid

Ownership and region Skilled

Medica!d

Intermediate Residential Medicare skilled /nrermediare

Per dtem rate

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $61.01 $48.09 $30.71 $62.02 $49.93 S39.57

Ownership

Proprleta~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58.67 47.28 28.69 60.76 47,54 38.58

Volunta~ nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.37 50.57 35.82 63.97 55.18 41.88

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68.27 48.25 41.51 71.64 57,87 42.50

Census region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79.65 63.33 29.73 58.24 63.93 48.87

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57.06 46.01 35.84 63.89 47.70 38.33

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.19 43.83 29.63 58.13 42.95 35.47

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58.22 47.44 28.52 68.41 46.49 43.02
8 adwncedata

References

1Nationa] Center for Health Statistics: Development and maintenance

of a national inventory of hospitals and institutions. Viral and Zfeal!h

Sfafisfics. Series 1, No. 3. PHS Pub. No. 1000. Public Health Service.

Washington. U.S. Government Printing Oflice, Feb. 1965.

2National Center for Health Statistics: The Agency Reporting System

for Maintaining the National Inventory of Hospitals and Institutions.

Vital and Health Sraristics. Series 1, No. 6. PHS Pub. No. 1000,

Public Health Sewice. Washington. U.S. Government Printing Office,

Apr. 1968.

3], M, Shimizu: IdentiNing and obtaining the Ye]]ow pageS fOr a national area sample. Proceedings of the Sunej Research Secfion.

American Statistical Association. 1983, pp. 558-562.

41, M. Shimizu: The National Nursing Home SUtVeYDesign. PaPer

presented at the 1986 Annual Meeting of the American Statistical

Association. Chicago, 1986.

SN”ational Center for Health Statistics, P. J. McC~hy: Replication,

an approach to the analysis of data from complex surveys. Viral and

Health Srafistics. Series 2. No. 14. PHS Pub. No. 1000, Public Health

Service. Washington. U.S. Government Printirtg Oflice, Apr. 1966.

‘National Center for Health Statistics. P. J. McCarthy: Pseudoreplication. Further evaluation and application of the balanced hsdf-sampie

technique. Vital and Health Statistics. Series 2. No. 31. DHEW

Pub. No. (HSM) 73-1270. Health Services and Mental Health Administration. Washington. U.S. Government Printing OffIce, Jan. 1969.
acklncedata 9

Technical notes

Because the statistics presented in this report are based on

a sample, they will differ somewhat from figures that would

have been obtained if a complete census had been taken using

the same schedules, instructions, and procedures. The standard

error is primarily a measure of the variability that occurs by

chance because only a sample, rather than the entire universe,

is surveyed. The standard error also reflects part of the measurement error, but it does not measure arty systematic biases in

the data. The chances are about 95 out of 100 that an estimate

from the sample differs from the value which would be obtained

from a complete census by less than twice the standard error.

Standard errors used in this report are approximated using

the balanced repeated replicated procedure. This method yields

overall variability through observation of variability among

random subsamples of the total sample. A description of the

development and evaluation of the replication technique for

error estimation has been published.5.6

Although exact standard error estimates were used in tests

of significance for this report, it is impractical to present exact

estimates of every standard error for statistics used in this report. Hence, a generalized variance function was produced for

each class of aggregate statistic by fitting the data presented in

this report into curves using the empirically determined relationship between the size of an estimate X and its relative variance (rel var X). This relationship is expressed as

b

.~+—

x

where a and b are regression estimates determined by an iterative procedure.

Preliminary estimates of relative standard errors are presented in figure I for estimated numbers of beds; total full-time

equivalent (FTE) employees; administrative, medical, and

therapeutic FTE employees: registered nurse FTE employees;

licensed practical nurse FTE employees; nurses aide FTE

employees; and facilities. Preliminary standard errors for per

diem rates are presented in table I.

The relative standard error of an estimate is the standard

error of the estimate divided by the estimate itself and is expressed as a percent of the estimate. In this report, an asterisk

is shown for any estimate with more than a 30-percent relative

standard error. Because of the relationship between the relative

standard emor and the estimate, the standard error of an estimate can be found by multiplying the estimate by its relative

standard error. For example, curve A of figure I shows the

relative standard error for beds. Table 2 gives the total number

of beds in all facilities with less than 50 beds as 151,100. The

NOTE: A list of references follows the text.

relative standard error corresponding to this estimate on curve

.4 of figure I is approximately 10 percent. The standard error is

151,100 (0.09)= 13,599.

The approximate standard error of ratios such as FTE employees per 100 beds can be calculated as in the following

example: Suppose the standard error (mR,)for the ratio of total

FTE employees per 100 beds is desired for nursing homes with

less than 50 beds. In table 5 the total FTE employees per 100

beds for homes with less than 50 beds is 61.1. which is equal to

a total of 92.400 FTE employees divided by 151,100 beds

times 100. The relative standard error of 92,400 total FTE

employees in homes with less than 50 beds is (from figure I,

curve B) approximately 8.6 percent, and the relative standard

error of151, 100 beds (from figure I, curve A ) is approximately

10 percent. The square root of the sum of the squares of these

two relative standard errors minus their covariance provides an

approximation for the relative standard error of the ratio. In

other words, if Vr is the relative standard error of number of

total FTE employees, VY is the relative standard error of

number of beds. r is the sample correlation coefficient between

total FTE employees and beds (conservatively estimated to be

0.5), and V“ is the relative standwd error of the ratio R’ = X’/

Y, then

~;, = ~,~, + J7;, – Zrp-r ~r

= (o.086)~+ (o.1)~ – 1.00(0.086x 0.1)

= 0.0074+0.01– 0.0086

VR.= Jmmiil

= 0.0938

The approximate standard error of the ratio of total FTE

employees per 100 beds may now be obtained by multiplying

the relative standard error by the ratio as done below:

UR.= R’ X k~r

= 61.1 XO.0938

= 5.73

The sample correlation coefficient r for calculating the

standard error estimates of the ratios presented in this report is

assumed to be zero except in the cases of FTE employees per

100 beds and the occupancy rate estimates where the correlation coefllcient used was 0.5.

The Z-test with a 0,05 leveI of significance was used to

test all comparisons mentioned in this report. Because all

observed differences were not tested, lack of comment in the

text does not mean that the difference was not statistically

significant.
100

90

80

70

60

50

40

30

20

1:

8

7

6

5

4

3

2

1

09

08

07

06

05

0.1

03

02

L)i

A 2 3456789A

100 1,000

Curve A Becfs

b

3

Curve B. Total full-t!me equivalent (FTE) employees and nurse”a aide FTE employees

CUIW C Admtnistraltve, medlc~l, and thcrapeut)c FTE employees; registered nurse FTE employees; Ilcen$

(llrve ~. FdCllltleS

9A 2 3 4567B9A 2 3 4567 B9A”

00,000 1,000,000 10,000,000

~d practical nurse FTE employees; and all other staff

Figure 1. Provisional relatwe standard errors for estimated numbers of beds, full-time equivalent employees, and facilities: United States, 1985
dvamedata 11

Table i. Preliminary standard errors of per diem rates for private pay and medicare/madicaid patiants by ownership and region:

United States, 1985

Standard errors of per diem rares

Level of care Certification srarus of

for private pay patients facilities for routine serwces

Medtcaid Med/caid

Ownership and region Skilled intermediate Residential Medicare skilled intermediate

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.92 0.59 1.16 1.93 2.13 1.98

Ownership

Proprleta~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 0.81 1.46 2.48 2.26

Voluntary nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.51

1.90 1.92 1.79 4,44 5.33

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.57

5.08 3.30 9.35 6.99 6.65 8.33

Census region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.18 1.94 3.08 6.40 6.24 6.38

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.05 0.61 3.38 3.28 3.17

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.08

1.13 0.71 2.20 2,85 3.48 6.51

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.86 2.80 4.96 6.81 10.29 7.78

Symbols

. . . Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
From Vital and Health Statistics of the National Center for Health Statistics Number 132s March 27, 1987

Acute Conditions and Restricted Activity

198&66 Influenza Season

by Patricia F. Adams, Division of Health Intewiew Statistics

During the

The incidence rate of influenza increased 32.7 percent,

from 19.9 per 100 persons to 26.4 from the first quarter

(January through March) of 1985 to the first quarter of 1986

(table l). According to the Center for Disease Control, the

influenza B epidemic that peaked in February of 1986 was

the largest influenza B epidemic in the United States since

the 1968-69 influenza season. ‘ This report describes acute

illness and its impact on work and other activities during

that period.

In tables 1 and 2 national estimates are presented on

the incidence and incidence rate of acute conditions and activity

restriction due to acute conditions for the first quarter of

1986 and the four quarters of 1985. The data are derived

from the results of the National Health Interview Survey

(NHIS), an interview survey conducted annually by the National Center for Health Statistics whose respondents embody

a representative sample of the household population (see technical notes). A description of the survey design, methods

used in estimation, and general qualifications of the data obtained from NHIS are available in Viral and Healrh Yatisfics,

Series 10, No. 160.2

Incidence and incidence rate of acute

conditions by quarter

According to NHIS, an acute condition is defined as

an illness or injury that ordinarily lasts less than 3 months.

was first noticed less than 3 months before the reference

date of the interview, and was serious enough to have impact

‘Center for Dk.ease Contxol: MorbidiW and Morrafify Weekly Report.

Vol. 35, No. 29. U.S. Department of Health and Human Services. Public

Health Service. U.S. Government Printing Office. July 25, 1986.

~NationaI Center for Health Statistics. A. J. Moss and V. L. Parsons: Current

estimates from the National Health Interview Survey. United States, 1985.

Viral and Health Stufisfics. Series 10, No. 160. DHHS Pub. No. (PHS)

8&l 588. Public Health Service. Washington. U.S. Government Printing

Office, Sept. 1986.

on behavior. Two types of impact are considered: whether

the illness or injury caused the person to cut down for at

least half a day on the activities he or she usually performed.

and whether the person contacted a physician regarding his

or her illness or injury. Because some illnesses are forgotten

after a period of time, the incidence of acute conditions is

calculated by including only those conditions whose onset

occurred within the 2 weeks prior to interview.

The incidence rate of acute conditions in the first quarter

of 1986 (table 1) was 64.6 per 100 pexsons compared with

58.0 for 1985. The rate for most categories was higher in

1986 than in 1985, including infective and parasitic (6.7 compared with 5.1 ) and respirato~ (39.9 compared with 36.0):

however, not ail differences were statistically significant. The

only decrease that occurred between the 2 years was the

rate for digestive system conditions ( 1.7 in 1986 compared

with 2.1 in 1985), but this difference was not statistically

significant.

Respiratory conditions accounted for over 60 percent of

all acute conditions in the iirst quarters of 1986 and 1985.

Influenza is the largest contributor to the respiratory category

and accounted for 66 percent of all respiratory conditions

in the first quarter of 1986 and 55 percent in the first quarter

of 1985. As mentioned earlier, the incidence rate of intluenza

was 32.7 percent higher in the first quarter of 1986 (26.4)

than in the first quarter of 1985 (19.9). Although not shown

separately, other subcategories that are included in the respiratory conditions category are the common cold, acure bronchitis.

and pneumonia.

Overall the incidence of acute conditions decreases in

the spring and summer months and rises in the faI1 and winter

months. In 1985 the most noticeable seasonal variation was

observed in respiratory conditions, which decreased from 36.0

px 100 persons in the first quarter of 1985 (January through

March) to 13.5 in the second quarter (April through June)

and rose again to 25.2 in the fourth quarter (October through
2 advmcedata

Table 1. Number of acute conditions per 100 persons per year and number of acute ooncfitiorw by type of condition and qusrtec United Sfates, 19S6,

19s6

[Data are bssed on household tnterwews of the c,whan nonmstmmnahzad popula!mn]

Quarrer

1985 1986

Condmon Jan.–Mar. Apr -June Ju/y-Sept. Oct.-Dee. Jan.-Mar.

Number per 100 persons

Allacute conditions .,..... . . . . . . . . . . . . . . 5&o

Infectwe and parasmc dtseases . 5.1

Respiratory condmons., ..,., . . . . . . . ., 36.0

Influenz a . . . . . . . . . . . . . . . . . 19.9

Dlgestwe system condtlons . . . . . . . . . . . . . 2.1

Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8

Allotner acute conditions . . . . . . . . . . . . . . . . . 9.0

Allacute condtbons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135,031

lnfectwe andparasmcdi senses... . . . . . . . . . . . . . . . . . . . . 11,867

Respiratory conditions . . . . . . . . . . . . . . . . . . . . . . . 83,905

Influenza, . . . . . . . . . . . . . . . . . . . . . 46,442

Digestwe system conditions . . . . . . . . . . . . . 4,827

Injures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,538

Allotner acute cond!tlons . . . . . . . . . . . . 20,893

35.9

5.5

13,5

5.9

i .7

7.3

6,0

83,873

12,772

31,429

13,846

4,071

16,979

18,621

34.3

4.1

12.4

5.2

1.8

8.0

7.9

Number m thousands

80.270

9,662

29,067

12,072

4.267

18.749

16,525

47.1

5.8

25.2

9.4

1.3

6.3

8.5

110,423

13.528

59,089

22,049

3,133

14,754

19,920

64.6

6.7

39.9

26.4

1.7

6.2

10.2

152,214

15,720

93,925

62,218

3,974

14,601

23,994

NOTE tindtilons #nmtv:ng neither medical aHention noradlv#w resttimn areexclti& from these ti#mates.

Table 2. Number of days per 100 persons per year and number of days of activii restriction due to acute condtins, by type of restrk%on and quarter:

United States, 1985, 1986

[Data are based on household interwews of the cw,han nonmsttuttonaltzed populatmn]

1985 7986

Restriction Jan.-Mar. Apr.-June July-Sept. Oct.-Dee. Jan.-Mar.

Number of days per 100 persons

All types (restricted-actiwty days) . . . . . . . . . . . . . . 238.1 138.2 139.2 172.1 275.2

Bed days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108.5 60.6 57.6 75.9 138.2

Work-loss days’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102.2 69.0 65.8 72.8 113.6

Number of days in thousands

Alltypes (restncted-activityd ays) . . . . . . . . 554,734 322,600 325,691 403,580 648,263

%edctays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252,752 141,425 134,852 178,059 325,651

Work-loss days’, .,....... . . . . . . . . . . . . . . . . . . . . 109,122 74,950 70.912 78,213 124,462

‘Worm $oss days are snownior currently employed persons 18 yaarsof age and eve!

December). On the other hand, injuries rose in the spring

and summer months. The injury incidence rates per 100 persons

for the first and fourth quarters of 1985 were 5.8 and 6.3,

respectively. compared with 7.3 and 8.0 for the second and

third quarters. respectively. This increase may be associated

with more outdoor activity and sports participation in the

warmer months.

Activity restriction by quarter

Four types of health-related activity restriction are measuredbymeansof NHIS: beddays. work- loss days. scho~l-]oss

daj>. and cut-down day>. A work-loss day is one on which

a currently employed person 18 years of age or over was

absent from a job or business for mom than half the day.

.4 bed day is one durin: which a per+on stayed in bed for

mm-: thtin ha]? the (.kiy bwauw of ilineis or inju~, A hospital

da> for an inp~tient IS con~ldwd a hcd da> even it’ the

patient was not in bed for more than half the day. A school-loss

day is one on which a student 5–17 years of age missed

more than half the day from the school in which he or she

was currently enrolled. A cut-down day is one on which

a person cuts down for more than half the day on the activities

he or she usually performs.

The number of restricted-activity days is the number of

days a person experienced at least one of the four types

of activity restriction just described. A single restricted-activity

day may involve both a bed day and a work-loss or school-loss

day. However. a cut-down day cannot overlap with any of

these three types of disability days. Thus. each re:strictedactivity day is counted as only one restricted-activity day

even if more than one type of activity restriction was involved.

Table 2 shows the number and rate per 100 persons of days

of all types of activity restricti(m, bed days. and work-loss

days. Sch(x)l-loss days. although not shown separately. are

included in the total.
acivancedaa ———— ...—. 3

The number of days per 100 persons per year for all

types of activity restriction, bed days, and work-loss days

follows the same pattern as the incidence of acute conditions.

The rates were higher in the fall and winter months and

lower in the spring and summer. The rate per 100 persons

for restricted-activity days was 275.2 in the first quarter of

1986 compared with 238. I in 1985, an increase of 15.6 percent. Bed days showed the largest increase, 27.4 percent,

from the first quarter of 1985 to the first quarter of 1986

(108.5 compared with 138.2).

From the first quarter of 1985 to the first quarter of

1986 the number of restricted-activity days increased from

approximately 550 million to 650 million days and a higher

proportion of these were bed days. The proportion of all

restricted-activity days which were bed days was 45.6 percent

for the first quarter of 1985 and 50.2 percent for the first

quarter of 1986. The higher rates of restricted-activity and

bed days may be attributed to the higher incidence of influenza.

In 1985 the annual rates of restricted-activity and bed days

for all acute conditions were highest for respiratory conditions

in general and highest for influenza among the subcategories. 3

Technical notes

The National Health Interview Survey (NHIS) is a continuous, cross-sectional, nationwide survey conducted by household interview. Each week a probability sample of households

in the civilian, noninstitutionalized population is interviewed

by personnel of the U.S. Bureau of the Census to obtain

information on the health and other characteristics of each

member of the household.

During 1985, the sample consisted of 36.399 eligible

households. The total nonintetwiew rate for the basic health

and demographic household questionnaire was about 4 percent,

about 2 or 3 percent of which was due to respondent refusal

and the remainder due primarily to an inability to locate an

eligible respondent at home after repeated calls. Information

was obtained for all household members for the basic questionnaire, a sample of 91,531 persons. The sample for the first

quarter of 1986 consisted of 6.28 I households containing

15,496 persons. A description of the survey design, methods

used in estimation. and general qualifications of NHIS data

was published previously.~

The estimates shown in this report are based on a sample

of the civilian noninstitutionalized population rather than on

~National Center for Health Statistics. A. J. Moss wrd V. L. Parsons: Current

estimates from the Nationrd Health Interview Survey. United States, 1985.

t’iral and Heahh Sradstics. Series 10. No. 160. DHHS Pub. No. (PHS)

86-1588. Public Health Service. Washington. U.S. Government Prhrting

Office, Sept. 1986, pp. 31 and 43.

%tiond Center for Heatth Statistics, M. G. Kovar and G. S. Poe: The

National Health Interview Survey design, 1973-84, turd procedures, 1975-83.

\“ira/ und Health .Srafisrics. Series 1, No. 18. DHHS Pub. No. (PHS) 85-1320.

Public Health Service. Washington. U.S. Government Printing Office. Aug.

1985.

the entire population and therefore are subject to sampling

error. When an estimate or the numerator or denominator

of a rate is small. the sampling error may be relatively high.

Approximate standard errors for the estimates in this report

may be calculated using the formula

for numbers of events where x is the estimated number. and

a and b are given in table A. and the formula

SE(P)= ,=

x

for rates where p is the estimated rate. and u and b are

given in table I.

In this report, terms such as “similar” and the “same”

mean that no statistically significant difference exists between

the statistics being compared. Terms relating to difference

(for example, “-qeater” or “less”) indicate that differences

are statistically significant (unless otherwise stated). The r-test

with a critical value of 1.96 (0.05 level of significance) was

used to test all comparisons that are discussed. Lack of comment regarding the difference between any two statistics does

not mean the difference was tested and found to be not

significant.

Tsbla L Estimated standard error parameters for sefected ehssraetenstics

Est!mafad parametem

Charactenktic a b

Number of acute eond!bons . . . . . . . . 0.00019626 85,166.5

Days of restricted actmy

or bed days . . . . . . . . . . . . . . . o.000&t540 622,840.3

Dayslostfrom work . . . . . . . . . . . . . -0.00008666 529,550.2

Symbols

--- Data not available

. . . Category not applicable

. Quantify zero

0.0 Quantify more than zero but less than

0.05

z Quantify more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality reqtxrements
From Vital and Health Statistics of the National Center for Health Statistics Number 133 ● June 10, 1987

Aging in the Eighties

Functional Limitations of

Individuals Age 65 Years and Over

by Deborah Dawson, Ph. D., and Gerry Hendershot, Ph. D., Division of Health Interview Statistics,

and John Fulton, Ph. D., Brown University

Introduction

As a cohort ages, the prevalence of fictional limitations

increases; that is, an increasing proportion of its members have

dif?lculty performing personal care or home management activities. Whereas the increase in the prevalence of t%nctional

limitations tends to occur in all aging cohorts, its pace may

differ among subgroups of the population and may change over

time. The prevalence of functional limitations is an important

indicator of quality of life and of the need for health and social

services in the aging Wpulation. It is important, therefore, that

the levels, differentials, and trends in prevalence of fictional

limitations be remeasured periodically.

The National Center for Health Statistics (NCHS) has

measured the prevalence of functional limitations in several of

its surveys. 1 The data presented in this report, which come

from the 1984 National Health Interview Survey (NHIS), will

be discussed in greater detail in a future NCHS publication.

The NHIS is a continuing nationwide survey of the civilian

non institutionalized population of the United States. Each

year, people in about 40,000 households are interviewed by

the U.S. Bureau of the Census to obtain information about

their health and use of health care. Demographic information

needed to interpret the data is also obtained. The interviewers

on this survey have special training in addition to their regular

training. Response rates are high-about 97 percent.

The 1984 NHIS included a special questionnaire, the

Supplement on Aging (SOA), aimed at elderly people living in

tne community. The SOA was designed to collect information

abut physical limitations, chronic conditions, housing, retirement status, interactions with family and organizations, use of

community services, and other health-related information about

middle-aged and older people. The SOA sample consisted of

16,148 persons age 55 years and over—4,651 age 55-64

years and 11,497 age 65 years and over. Detailed descriptions

of the sample, survey operations, and field procedures are presented in The Supplement on Aging to the National Health

Interview Survey. 2 Selected results of the SOA have been

published in numerous NCHS publications.3-7

Background

This report describes the functional limitations of persons

age 65 years and over in terms of their performance of selected

daily activities. Two measures of limitation are presented (a)

The proportion of persons who have difllculty performing each

activity and (b) the proportion of persons who receive help with

each activity. All estimates are based solely on persons living

in the community; institutionalized individuals, such as those

in nursing homes, are excluded. To the extent that the institutionalized elderly have more functional limitations than

their noninstitutionalized counterparts,s the data in this report

underestimate the extent of functional limitation for the tots!

elderly population.

Seven of the 13 activities discussed in this report involve

personal caret Bathing, dressing, eating, getting in and out of

bed and chairs (designated as “transferring” in tables 1-8),

walking, getting outside. and using the toile~ sometimes known

as “activities of daily living” or ADL’s.9 The remaining six

activities. which concern home management. elsewhere have

been termed “instrumental activities of daily living” or IADL’s.10

Home management activities are preparing meals. shopping for

personal items, managing money, using the telephone. doing

heavy housework, and doing light housework.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ~l. DIIc ~5alth Service
2

For this rqport, persons are classified as having difficulty

with an activity if they responded positively to the question,

“Because of a health or physical problem, do you have difficulty _ ing’!” Persons who did not perform certain activities for reasons unrelated to health, such as men who did

not cook because their wives did so, were included in the

groups whose total numbers formed the denominators of the

proportions of persons having difficulty with each activity. Had

the analysis been restricted to individuals who routinely performed each activity. that is, to those at risk of health-related

problems in their performance, the proportions of persons experiencing difficulty would have been higher. Numbers of persons who refused or were unable to say whether they had

health-related problems performing personal care and home

management activities were also included in the denominators

for proportions of persons having difficulty with those activities. Such individuals made up approximately 1 percent of

the elderly population. Because some of the individuals in

these two groups may have had unreported problems performing the activities in question, percents in tables 1–8 are

conservative estimates of the extent of functional disability,

and the proportions of persons with no difficulty performing

any of the activities are slightly overstated.

In this report, persons were classified as receiving help

with an activity if they responded positively to the question,

“Do you receive help from another person in _— ing?~y

Only those individuals who reported having health-related difficulty with an activity were asked if they received help with

that activity. Thus, this measure excludes persons who may

have received help with an activity despite &ing able to perform the activity without assistance. Among those excluded

are persons who may have received help with activities for

which they were not at risk of having health-related problems,

for example, activities not performed for cultural reasons.

Finally, numbers of persons who refhsed or were unable to

answer the questions on receiving help with various activities

were included in the denominators of the proportions of persons receiving help, further reducing those percents. The net effect of the counting procedures used was that the percents of individuals with functional limitation based on numbers receiving

help with various activities are conservative.

Difficulties with personal care activities

Of 26.4million persons age 65 years and over living in the

community, 4.9 million or 19 percent had difficulty walking

(table l). The elderly were more likely to have problems with

walking than with any other personal care activity. Difficulty

bathing and difficulty getting outside were each experienced by

10 percent of persons age 65years and over. Eight percent had

Table 1. Percent of persons 65 years of age and over who have dtilculty performing selected personal care activities by sex and age:

United States, 1984

Personal care activity

Sex and age Bathing

Getting Using

Dressing Eating Transferring Walking outside toilet

Both sexes

65years snd over . . . . . . . . . . . . . . . . . . . . . .

65-74 y’ears . . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . . . . . . .

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over. . . . . . . . . . . . . . . . . . . . . .

Male

65 years and over . . . . . . . . . . . . . . . . . . . . . .

65-i’ 4 years . . . . . . . . . . . ?. . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . . . .

75-84 years . . . . . . . . . . . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . .

85yeers and over . . . . . . . . . . . . . . . . . .

Female

65 years and over . . . . . . . . . . . . . . . . . . . . . .

65-74 vears . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . .

70-74 vears . . . . . . . . . . . . . . . . .

75-64 vears . . . . . . . . . . . .

75-79 years . . . . . . . . . . . .

80-84 vears. .

85 veam ano over

9.8

6.4

5.2

7.9

12.3

9.8

16.8

27.9

7.6

5.7

5,3

6.1

9.2

7.8

12.3

23,1

112

6.9

5.1

9.1

14,2

11,1

192

3C ,

6.2

4.3

3.9

4,8

7.6

6.4

9.7

16.6

5,8

4,4

4.1

4.9

7,3

6.7

8.5

14.1

6.5

4,2

3.7

4,8

7,7

6.2

10,2

177

1.6

1.2

1.2

1.1

2.5

2.1

3.2

4.4

2.0

1.5

1.7

1.4

2.5

2.3

3.0

4.3

1.7

0.9

0.9

1.0

2.4

3.3

34

44

Percent

8.0

6.1

5.3

7.1

9.2

7.5

12.4

19.3

5.6

4.8

4.7

5.0

6.0

4.7

8.7

12.7

9.7

7.0

5.7

8.6

11.2

9.3

14.3

22.2

18.7

14.2

12.2

16.6

22.9

19.5

29.0

39.9

15.5

12.9

11.5

14.9

18.3

15.6

24.2

32.2

20.9

15.1

12.9

17.0

25.7

22.2

31,4

43.3

9.6

5.6

4.9

6.6

12.3

9.9

16.8

31.3

6.3

4.5

4.3

4.7

7.5

6.3

10.2

21.9

11.8

6.5

5.3

8.0

15.3

12.3

20.2

35.4

4.3

2.6

2.2

3.0

6.4

4.1

7.8

14.1

3.1

2.4

2.3

2.4

3.6

2.7

5.6

10.0

5.1

2.7

2.2

3.4

6.5

5.0

9.0

15.9

SOURCE Pwa: oral Healrh Intew!e* Suweb \aI, onal Cenlerfc, Health Stat, st(cs
achancecbta 3

difllculty getting in and out of bed and chairs (transfernng), and

6 percent experienced difficulty dressing themselves. Only 4

percent had any degree of difficulty using the toilet, including

getting to the toilet. Eating was the personal care activity least

often causing a problem. Only 2 percent of all persons age 65

years and over living in the community had difilculty eating.

More than three-fourths of the elderly, 77 percent of those

age 65 years and over, did not have difilculty performing any of

the seven personal care activities discussed in this report (table

2). Nine percent had difficulty performing one of the seven

activities. 5 percent had dii%culty with two activities,. and 3

percent had difficulty with three activities. Six percent of all

persons age 65 years and over living in the community had difficulty performing four or more of the seven personal care activities.

The proportion of elderly persons experiencing difficulty

with each personal care activity increased with age. For example, 12 percent of persons age 65–69 years living in the

community had difllculty walking, compared with 40 percent

of those 85 years and over. Whereas 85 percent of persons age

65–69 years had no difficulty with any of the seven personal

care activities described in this repofi. almost half, 49 percent,

of those 85 years and over had difiicuky with one or more activities. The order of difficulty of the seven personal care activities, as indicated by the proportions of elderly experiencing

problems in their performance, varied sligMly by age: however,

at all ages. walking was the most diflicult and eating the least

diflicult.

A greater proportion of women than of men had difficulty

bathing, transfernng, walking, getting outside, and using the

toilet. There were no statistically significant differences by sex

in the percents of elderly persons who experienced difficulty

dressing and eating. Twenty-five percent of women age 65

years and over had difficulty performing at least one of these

seven personal care activities, compared with 19 percent of

men age 65 years and over. When all persons age 65 years and

over are considered, sex differentials in difllculty with personal

care activities may reflect the fact that the women in this age

group are older, on average, than the men. When more narrowly

restricted age groups were considered, many of the differentials

by sex were not statistically significant. For persons age 65–69

years, for example, there were no statistically significant differences between men and women in the proportions of individuals with dfilculty performing any of the seven personal

care activities described in table 1.

Table 2. Percent distribution of persons 65 years of age and over

by number of personal cere activities that are diticult, according to

sex and sgw United States, 1984

Number of personal care actnoties

that are difficult

Sex and age Total None 1 2 3 4-7

Both sexes

65 yeara and

over . . . . . . . . . . . .

65-74 years. . . . . .

65-69 years. . . .

70-74 years. . . .

75-84 years. . . . . .

75-79 yeara. . . .

80-84 years. . . .

85 years and

over . . . . . . . . . . . .

Male

65 years and

over. . . . . . . . . . . .

65-74 years. . . . . .

65-69 years. . . .

70-74 years. . . .

76-84 years . . . . . .

75-79 years ., . .

80-84 years. . . .

85 years and

over . . . . . . . . . . . .

Female

65 years and

over. . . . . . . . . . . .

65-74 years. . . . . .

65-69 years. . . .

70-74 years . . . .

75-84 yeare ., . . . .

75-79 years. .,

80-84 years. . . .

85 years and

over . . . . . . . . . . . .

Percent Difficulties with home management

activities

100.0

100.0

100.0

100.0

100.0

100.0

100.0

77.3

82.9

85.3

79.9

72.2

75.9

65.6

9.2

7.8

6.8

9.1

11.2

10.8

12.1

4.7 2.8

3.7 1.9

3.1 1.5

4.4 2.4

5.4 3.7

4.3 3.3

7.4 4.6

5.9

3.7

3.2

4.2

7.4

5.7

10.4

About 6.3 million persons age 65 years and over living in

the community had difficulty with heavy housework. Almost

one-fo@ 24 percenq of eiderly individuals experienced problems with this aspect of home management (table 3). This

proportion is more than twice as great as for any other home

management activity. In comparison, 11 percent of individuals

age 65 years and over living in the community experienced

dif?lculty managing money and using the telephone.

Twenty-seven percent of the population age 65 years and

over had ditllculty with at least one of the six home management activities described above (table 4). As ageincreased, so

did the proportion of elderly who had difficulty with these

activities. Less than one-fifth (18 percent) of persons age 65 –

69 years had difficulty with one or more home management

activities, compared with more than half (55 percent) of those

age 85 years and over. At all ages, the elderly experienced

somewhat more difficulty with these sixactivities than with the

seven personal care activities discussed previously.

Women of age 65 years and over were significantly more

likely than men in the same age range to have difficulty performing most home management activities. For two activities,

managing money and using the telephone, the differentials by

sex were not statistically sign~:cant at most ages 65 years and

over. For the other activities—preparing meals, shopping, and

doing heavy and light housework—elderly men experienced

fewer problems than women at almost all ages 65 years and

over. These differentials may reflect, in pa~ the fact that for

cultural reasons many elderly men do not routinely perform

100.0 51.2 12.8 10.2 6.7 19.2

100.0

100.0

100.0

100.0

100.0

100.0

100.0

81.3

84.6

86.5

82.1

77.6

80.3

71.8

8.8

7.6

6.6

9.0

10.6

10,1

11.6

3.5 2.0

2.7 1.8

2.1 1.5

3.6 2.2

4.2 2.2

2.9 2.4

7.2 1.9

4.5

3.2

3.2

3.1

5.4

4.4

7.6

100.0 60.1 13.2 8.3 3.5 14.9

6.9

4.0

3.2

5.0

8.6

6.6

11.9

100.0

100.0

100,0

100.0

100.0

100.0

100.0

74.6

81.6

84.4

78.3

68.9

73.0

62.4

9.5

7.9

7.0

9.1

11.6

11.2

12.3

5.6 3.4

4.4 2.0

3.9 1.5

5.0 2.6

6.2 4.7

5.4 3.9

7.5 5.9

100.0 47,2 12.6 11.1 8.1 21.1

NOTE F!gures may not add to 100.0 because of rounding.

SOURCE: National Health Intetwew Sutvev, Nat!onal Center for Health StatMcs.
4 acklncedata

Table 3. Percent of persons 65 years of age and over who have difficulty performing selected home management activities by aex and age:

United States. 1984

Home management activity

Doing

Preparing

Doing

Managing Using heavy Itght

Sex and age meals Shopping money telephone housework housework

Both sexes Percent

65 years and over . . . . . . . . . . . . . . . . . . . . . 7.1 11,3 5.1 4.8 23.8 7.1

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0 6.4 2.2 2.7 18.6 4.3

65-69 years . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 5.4 1.9 2.1 16.4 3.8

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . 4.7 7.7 2.6 3.4 21.3 5.0

75-84 years...............,.. . . . . . . . . . . 8.8 15.0 6.3 6.0 28.7 8.9

75-79 years . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 11.8 5.2 5.0 25.7 7.1

80-84 years . . . . . . . . . . . . . . . . . . . . . 11.9 21.0 8.2 7.8 34.0 12.0

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . 26.1 37.0 24.0 17.5 47.8 23.6

Male

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . 4.7 7.3 4.4 5.6 13.7 4.9

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.0 4.6 2.8 3.5 11.2 3.5

65-69 years . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 4.1 2.6 3.0 9.8 3.5

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 5.3 3.1 4.3 13.0 3.4

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . 6.0 9.6 5.4 7.9 15.9 6.2

75-79 years . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 7.6 5.2 6.3 14.6 5.2

80-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . 7.8 13.9 5.8 11.3 18.9 8.2

85yaars andovar . . . . . . . . . . . . . . . . . . . . . . . . 18.5 26.8 19.0 18.4 33.3 15.2

Female

65 years and over . . . . . . . . . . . . . . . . . . . . . . . 8,7 14.1 5.5 4.2 30.8 8.7

65-74 years.... . . . . . . . . . . . . . . . . . . . . . . . 4.8 7.8 1.8 2.0 24.3 5.0

65-69 years . . . . . . . . . . . . . . . . . . . . . . . . . 4,2 6.4 1.4 1.3 21.8 4.0

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . 5.5 9.4 2.3 2.8 27.3 6.2

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.5 18,4 6.8 4.8 36.4 10.5

75-79 years . . . . . . . . . . . . . . . . . . . . . . . . . . 8.3 14.5 5.2 4.1 33.2 8.4

80-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . 14.0 24.7 9.3 6.0 47.7 14.0

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . 29.5 41.6 26.2 17.1 54.2 27.4

SOURCE. Nat!onal Health lnterv!ew Survey, National Center for Health Stat! sI!cs.

home management activities. Thus, they are at reduced risk of

having health-related dif%culties in their performance.

Help with personal care activities

Of elderly persons age 65 years and over living in the community, 1.6 million or 6 percent received help with bathing

themselves (table 5). As noted previously, these numbers exclude persons who may have received assistance not related to

health-related problems with bathing themselves. Five percent

each received help getting outside and walking, and 4 percent

got help dressing, The proportions who received assistance

with transferring, using the toilet, and eating were 3, 2, and 1

percent, respectively. At the oldest ages, 85 years and over, the

proportion of individuals receiving help with personal care increased sharply, reaching 21 percent each for bathing and getting outside, 15 percent for walking, and 13 percent for dressing.

Only 25 percent of the elderly individuals who had difficulty walking received help with that activity. (This proportion was estimated by comparing the percents who had difficulty and received help with walking. ) In contrast, 70 percent

of those who had difficulty dressing received help, as did

roughly 60 percent each of persons who experienced difllculty

bathing and eating. The numbers of persons receiving help

using the toilet and getting outside represented 52 and 56 percent, respectively, of those who had difficulty performing those

activities. Thirty-five percent of elderly persons whc} had difficulty transferring received help with that activity. The proportion of persons in need of assistance who received help with

personal care increased with age for each of the seven activities

examined in this report. For example, of persons having difficulty bathing, 75 percent of those age 85 years and over

received help, compared with 56 percent of those age 65-69

years.

Overall, 10 percent of persons age 65 years and over living

in the community were functionally limited in the sense that

they received help with one or more personal care activities

(table 6). This proportion increased with age from 5 percent of

individuals age 65–69 years to 31 percent of those age 85

years and over. Of persons age 65 years and over who had difficulty with one or more aspects of personal care, 4:2 percent

received help with at least one activity.

There were no statistically significant differences by sex in

the proportions of persons 65 years and over receiving help

with dressing, eating, or using the toilet. When all ages 65

years and over were considered, women were significantly

more likely than men to receive help bathing and transfemng.

However, these differences were a function of the ditierent age
adumc@m5

Table 4. Percant distribution of persons 65 years of aga and over

by number of home management activities that are difficult,

according to sex and age: United States, 1984

Number of home management actiwt!es

that are difficult

Sex and age Total None 7 23 4-6

Both sexes

65 years and over. . .

65-74 years , . . . . . .

65-69 years . . . . .

70-74 years ., . . .

75-84 years . . . . . . .

75-79 years . . . . .

80-84 years . . . . .

85 years and cwer. . .

Male

65 years and over. . .

65-74 years . . . . . . .

65-69 years . . . . .

70-74 years . . . . .

75-84 years . . . . . . .

75-79 years. . . . .

80-84 years . . . . .

85 years and over. . .

Female

65 years and over. . .

65-74 years . . . . . . .

65-69 years.. . . .

70-74 years... .

75-84 years . . . . . . .

75-79 years . . . . .

80-84 years... . .

85 years and over. . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

7OQ.o

100.0

100.0

100.0

100.0

73.1

79.5

81.9

76.3

67.0

70.8

60.0

44.8

81.9

86.8

87.5

83.5

77.8

80.8

71.3

56.8

67.0

74.6

77,4

71,3

60.3

64.1

54.2

39.5

Percent

14.3

13.0

11.5

14.8

16.6

15.9

17.9

15.2

9.7

8.6

7.4

10.1

11.7

10.3

14.8

12.5

17.4

16.3

14.9

18.0

19.6

19.7

19.4

16.4

4.3

2.9

2.5

3.4

5.8

4,8

7.5

9.3

2.5

1.9

1.6

2.1

3.0

2.2

4.5

8.1

5.4

3.7

3.1

4.3

7.5

6.6

9.1

9.8

2.4

1.5

1.3

1.7

3.2

2.6

4.1

6.6

1.5

1.1

0.8

1.4

2.0

1.9

2.2

4.9

3.0

1.9

1.8

2.0

3.9

3.1

5.1

7.4

6.0

3.2

2.B

3.7

7.5

5.8

10.6

24.2

4.3

2.7

2.6

2.8

5.5

4.7

7.3

17.8

7.2

3.6

2.9

4.4

8.7

6.6

12.2

27.0

NOTE Flguresmaynot add to 100, Obecauaeof rounding.

SOURCE: Nauonal Health lnterv!ew Suwey, Nat!onal Center for Health Statistics.

structures for men and women and were not statistically significant within narrower age groups. Women were more likely

than men to receive help walking within all 5-year age groups

at age 75 years and over and to receive help getting outside

within all age groups at age 70 years and over.

Of elderly persons who experienced difficulty bathing,

dressing, eating, transfernng, and using the toilet, the proportions receiving help with those activities were higher for men

than women. For example, 77 percent of the men age 65 years

and over who had difficulty dressing received help with that activity, compared with 65 percent of the women who had difficulty dressing. With respect to walking and getting outside,

the situation was reversed, with women who had difficulty performing these activities more likely than men to receive help

with them.

Help with home management

activities

Of persons age 65 years and over living in the community,

5.1 million or 19 percent received help with heavy housework

as a result of health-related problems performing that activity

(table 7). This proportion increased with age, from 13 percent

of individuals age 65-69 years to 44 percent of those age 85

years and over. Smaller proportions of the elderly received

health-related assistance with other aspects of household management. Eleven percent got help with shopping, 6 percent

each with doing light housework and preparing meals, 5 percent with managing money, and 3 percent with using the telephone. For all these activities, the percent of individuals receiving help in their petfomance increased with age.

As shown in table 8, 22 percent of persons age 65 years

and over received help in at least one home management

activity, whereas 78 percent were independent in all activities.

The proportion of individuals receiving help with at least one

aspect of household management increased from 14 percent of

persons age 65–69 years to 51 percent of those age 85 years

and over.

The majority of older individuals who had difficulty with

home management activities received help with those chores.

of persons age 65 years and over who experienced problems

using the telephone, 62 percent received help with this activity.

More than 80 percent of individuals who had difficulty preparing meals, shopping managing money, and doing heavy and

light housework received help with those aspects of their lives.

There were no statistically significant differences in the

overall proportions of men and women age 65 years and over

who received help managing money and using the telephone.

When all ages 65 years and over were combined, women were

more likely than men to get help with preparing meals and

doing light housework however, these differences were not

significant within 5-year age categories. At all ages, however,

women were more likely than men to receive help with heavy

housework, and they more frequently got help with shopping

within all 5-year age groups at age 70 years and over.

When only individuals who had difllcuity with home

management activities were considered, men got help with preparing meals and doing light and heavy housework more often

than did women, while women were the more likely to get help

using the telephone. Men and women in need of assistance with

shopping and managing money were equally likely to get help

with those activities.

Conclusion

When the prevalence of functional limitations was measured by the proportion of individuals who had any difficulty in

performing personal care activities, about 23 percent (6 million)

of the noninstitutionalized Americans 65 years and over were

functionally limited. Whereas difficulty in performing a personal care activity may indicate some loss in the quality of life,

it does no~ indicate, necessarily, a present or imminent need for

health and social services. A better measure of that need is the

proportion who receive help with a personal care activity, a

subset of those who have difficulty with the activity. According

to this measure of prevalence, about 2.5 million persons or 10

percent of all noninstitutiontized Americans 65 years and

over were functionally limited.

If the prevalence of functional limitations is measured by

the proportion of persons who experience any difficulty in performing home management activities. about 27 percent (7

million) of the noninstitutionalized Americans 65 years and
6 a&mx?&b

Table 5, Percent of persons 65 years of age and ovar who recaive help performing selected personal care activities by sex and age:

Umted Statas, 1984

Personal care actwity

Sex and age Barhrng

Getting Using

Dressing Eating Transferr)rrg Walk!ng outavde toiler

Both sexes Percent

65 years And over... . . . . . . . . . . . . .,, ,, 6,0 4,3 1.1 2,8 4.7 5.3 2.2

65-74 years ,. ...,.. . . . . . . . . . . . . . . 3.3 2.9 0.6 1.8

65–69 years . . . . . . ,, ... 2.9

2.9 2.7

24 0.6

1.2

1.5

70-74 years . . . . . . . . . . . . . . . . . . . . . . . 3.8

2.7 2.4

3.5 0.7

1.1

2.1

75-84 years,....,,,,,.,,,.. . . . . . 7.7

3.2 3.1

51 1.5

1.4

3.6

75-79 years, .,, ,., ,, . . . ,, ..,,, 5.9

5.7 6.9

4.4 1.3

2.9

2.9

80-84 years . . . . . . . . . . . . . . . . . . . . . .

4.6

10,9 64

5.4 2.3

1.9 4,7

85 years and over. , . ...,..... . . . . . . . .

7.8

21,0

9.6

13.3

3.8

2.7 9.0 16.3 21.2 8.2

Male

65vears and over, , . . . . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years.......,.....,.. . . . . . . .

70-74 years, . . . . . . . . . . . . . . . . . . . . .

75-84 years, . . . . . . . . . . . . . . . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . . . . .

85yeara and over..,......,.. . . . . . . . . . .

Female

65y’ears and over. . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . . . . . .

70-74 years, ,, . . . . . . . . . . . . . .

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . .

85vears and over . . . . . . . . . . . . . . . . . . . .

5.1

3.3

3.3

3.3

6.6

5.5

8.9

18.4

6.5

3.3

2.6

4.2

8.4

6.2

12.0

22.1

4.5

3.3

2,9

3,8

5.7

5.4

6.2

12.6

4.3

2,7

2.1

3.4

4.7

3.7

6.5

13.5

1.2

0.9

0.9

0.8

1.8

1.6

2.1

2.4

1.0

0.6

0.4

0.6

1.4

1.2

1.8

2.9

2.3

1.7

1.9

1.6

2.7

2.3

3.7

6.7

3.2

1.8

1.2

2.6

4,1

3.4

5.2

9.9

3.4

2.8

2.8

2.8

3.7

3.0

5.2

9.0

5.5

2.9

2.6

3.4

6.9

5.6

9.0

18,0

3.2 1.9

2.2 1.4

2.3 1.4

2.1 1.3

3.7 2.3

3.3 2.1

4.6 2.7

11.8 5.6

6.8

3.1

2.5

3.8

8.8

6.8

12.1

25.4

2.5

1.1

0.8

1.5

3.2

2.5

4.4

9.3

SOURCE: Naoonal Health Intewlew %wev, Nattonal Center for Health Stattstlcs,

O; er were functionally limited. The proportion of noninstitutionalized Americans 65 years and over who received help with

a home management activity was 22 percent, or about 5.9 million persons. If doing heavy housework had been eliminated

from the list. the overall prevalence of functional limitation

would have been substantially reduced. Regardless of which

measure of functional limitation was used. its prevalence increased with age. Women were more likely than men to be

limited in these acti~’ities. in part because of their older age

distribution. Also. because men do not perform many of these

activities for cultural reasons, they were at reduced risk of having difficulty or receiving health-related help with them.

Most older persons who had difficulty with various aspects

of home management received help with those activities. They

were slightly less likely to receive assistance w&h personal care

activities that posed problems for them, especially wal!lcing and

getting into and out of chairs.

The ability or inability of the elderly to get help with difficult activities may be an important factor in determining

which individuals are able to remain in the community and

which must enter nursing homes or other institutions for

needed care and assistance. Comparison of the data presented

in this report with data for the institutionalized elderly may

prove helpful in developing programs to aid older persons in

their attempts to remain active and independent for as long

as possible.
ac%ancedaa 7

Table 6. percent distribution Of persons 65 years of age and over by number of personal care activities for which help is recaived, according to

sex and age: United States, 1984

Number of personal care acrwmes for winch helD IS rezewed

Sex and age Total NOn e 7 2 3 /.S- 7

Both sexes Percent

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female

65 years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-84 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

100.0

90.4 3.9

94.0 2.8

94.7 2.4

93.2 3.2

88.1 4.5

90.5 3.3

83.6 6.7

68.9 10.9

92.2 3.3

94.2 2.6

94.6 2.3

93.7 3.1

90.6 3.6

91.5 3.1

88.6 4.7

76.6 9.0

89.1 4.3

93.9 2.8

94.8 2.5

92.8 3.3

86.5 5.1

89.8 3.4

81 0 78

65,5 11.7

1,9

1.1

1.0

1.2

2.4

2.0

3.2

6.2

1.4

1.0

0.9

1.2

1.8

1.9

1.6

4.1

2.2

1,1

1.0

1.2

2.7

2.0

40

7.2

1.1 2.8

0.6 1.5

0.7 1.2

0.6 1.9

1.5 3.5

1.4 2.8

1.7 4,8

3.1 10.8

0.8 2.3

0.5 1.6

0.5 1.7

0.6 1.5

1.0 3.0

1.1 2.3

0.7 4.4

2.4 7.9

1.3 3.1

0.7 1.5

0.8 0.9

0.6 2.2

19 3.8

1.6 3.2

2,3 4.9

3,5 12,1

NOTE: Figures may not add ro 100.0 because of rounding.

SOURCE: National Health Imerwew Survey, Nat[onal Center for Health Statmt!cs.
8

Table 7. Percent of persons 65 years of age encl over who receive help perh?rming selected home management activities by aex and a{~e:

United States, 1984

Home management activity

Doing

Preparing

Doing

Managing Using

Sex and age

heavy light

meals Shopping money telephone house work housework

Both sexes

65 years and over, . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . . .

75-84 years........,..,.,.. . . . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . .

Male

65 years and over . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . . .

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . . . . . . . . .

60-84 years . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . .

6.0

3.3

2,9

3.8

7,1

5.9

10.9

23.7

4.4

2.8

2,4

3.4

5.4

4.6

7.0

17.7

Female

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . 7.1

65-i’4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7

65–69 years . . . . . . . . . . . . . . . . . . . . . . . . . 3,3

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . . 4.1

10.5

5.8

4.9

6.9

14,1

10.9

19.8

35.9

6.9

4.3

3.9

4.9

8.9

7.1

12.7

26.4

4.8

2.1

1.7

2.5

5.8

4.8

7.5

23.5

4.2

2.6

2.3

2.9

5.0

4,9

5.2

19.0

3.0 5.2

6.9 1.7

5.7 1.3

8.2 2.1

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.2 17.2 6.3

75-79 years . . . . . . . . . . . . . . . . . . . . . . . . . . 6.6 13.4 4.8

80-84 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . 10.8 23.4 8.7

85 years and over . . . . . . . . . . . . . . . . . . . . . . . 26.3 40.1 25.6

Percent

3.0

1.5

1.2

1.9

3.9

3.3

5.0

11.7

3.3

2.0

1.7

2.4

5.0

4.3

6.5

10.9

2.7

1.1

0.7

;::

2.7

4.2

12.1

19.3

14.5

12.8

16.6

23.1

20.5

27.8

44.1

11.4

9.3

8.4

10.4

12.7

11.4

15.5

30.0

24.7

18.5

16.3

21.0

29.4

26.6

34.0

50.3

6.2

3.6

3.2

4.2

7.6

6.0

10.4

21.6

4.5

3.2

3.3

3.1

5.7

4.7

7.8

14.4

7.3

4.0

3.1

5.0

8.7

6.9

11.7

24.8

SOURCE: Nstlonal Health Interv)ew Survev. National Center for Health SWwtlcs.
ackncedata 9

Table 8. Percent distribution of persons 65 years of age ●nd ovor by number of horn. management activities for which help is received, according

to sex and age: United Statoa, 1984

Number of home management actwities

for which help is recewed

Sex and age Total None 7 2 3 4-6

Both sexes

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female

65years ancf over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

-r5-a4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1000

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1OQ.o

100.0

100.0

100.0

100.0

100.0

100.0

77.8

83.9

85.9

81.4

72.4

75.7

66.3

48.6

85.4

88.6

89.7

87.1

82.6

84.9

77.9

61.4

72.5

80.3

82.8

77.4

66.1

69.6

60.3

42.8

Percent

11.4

9.8

8.6

11.3

13.9

13.4

14.8

14.6

7.2

6.5

5.8

7.4

8.4

7.4

10.5

10.4

14.3

12.3

10,9

14.0

17.2

17.4

17.0

16.5

3.5

2.3

2.0

2.7

4.7

3.8

6.4

8.7

2.0

1.5

1.4

1.6

2.3

1.8

3.5

7.2

4.6

3.0

2.5

3.5

6.2

5.2

7.9

9.4

2.4

1.6

1.5

1.7

3.0

2.3

4.3

6.2

1.6

1.2

1.0

1.4

1.9

2.0

1.7

4.5

2.9

1.9

1.8

1.9

3.7

2.5

5.6

6.9

5.0

2.4

2.1

2.9

6.0

4.8

8.2

22.0

3.8

2.3

2.2

2.5

4.8

4.0

6.4

16.5

5.8

2.5

2.0

3.2

6.8

5.3

9.2

24.4

NOTE F@resmaynotaddto 100, O because of rounding.

SO URCE:Natlonal Haaith lntarview Suwey, National Center for Health Statlst!cs.
10 ackncedata

References

lNa~io~~]c~~t~~forHea]tiStatistics, B. A. Feller Americans

needing home care, United States. Viral and Healfh .!Uafistics. Series

10, No. 153. DHHS Pub. No. (PHS) 86-1581. Public Health

Service. Washington. U.S. Government Printing Office, Mar. 1986.

‘National Center for Health Statistics, J. Fitti and M. G. Kovar The

Supplement on Aging to the 1984 National Health Interview Survey.

Viral and Healfh Srafisrics. Series 1. No.21. DHHS Pub. No. (PHS)

87– 1323. Public Health Service. DHHS, Hyattsville, Md. In prep

aration.

sNatjona] Center for Health Statistics, M. G. Kovar Aging in the

eighties, Preliminary data from the Supplement on Aging to the

National Health Intemiew Survey, United States, January-June

1984. Adt’ante Da!a From Vital and Health Statistics. No. 115.

DHHS Pub. No. (PHS) 86-1250. Public Health Service. Hya~sville,

Md., May 1, 1986.

4Natjonal Center for Health Statistics, M. G. KOV~ Aging in the

eighties. Age 65 years and over and living alone, contacts with family,

friends, and neighbors, Preliminary data from the Supplement on

Aging to the National Health Interview Survey, United States, Jsnuary-

.lune 1984. Advance Data From Vital and Health Statistics. No.

116. DHHS Pub. No. (PHS) 86-1250. Public Health Service.

Hyattsville, Md., May 9, 1986.

5Nation~ Cenkr for He~th statistics, T. Hams: Aging ti the eighties>

Prevalence and impact of urinary problems in individuals age 65 years

and over. Preliminary data from the Supplement on Aging to the

National Interview Survey, Umted States, January-June 1984. Advance Data From Vital and Health Statistics. No. 121. DHHS Pub.

No. (PHS) 86-1250. Public Health Service. Hyattsville, Md., Aug.

27, 1986.

6Nationa1 Center for Health Statistics, R, Stone: Aging in the eighties,

Age 65 years and over—Use of community services. Prelitrukmry data

from the Supplement on Aging to the National Health Interview Survey, United States. January-June 1984. Advance Data From Vital

and Health Statistics. No. 124. DHHS Pub. No. (PHS) 86-1250,

Public Health Service. Hyattsville, Md., Sept. 30, 1986.

TNational Center for Health Statistics, R. J. Havlik: Aging ~ ‘he

eighties, Impaired senses for sound and light in persons age 65 years

and over. Preliminary data from the Supplement on Aging to the

National Health Interview Survey, United States, January-June

1984. Advance Data From Vital and Health Statistics. No. 125.

DHHS Pub. No. (PHS) 86-1250. Public Health Service. Hyattsvilie,

Md., Sept. 19, 1986.

8Natjona] Center for Healti Statistics, E. Hing Use of nursing homes

by the elderly. Preliminary data from the 1985 National Nursing

Home Survey. Advance Data From Vital and Health Statistics. In

preparation.

9S. Katz T. D. Downs, H. R. Cash, and R. C. Grotz: Progress in the

development of the index of ADL. The Gerontologist 10( I ):20-30,

1970.

Iocenkr for the Study of Aging and Human Development: ~uf/idimensional Functional Assessment: The OARS Methodology. Index. Durham, N.C. Duke University, 1978.

11National center for Health Statistics, p. w. Rks: current estimates

from the National Health Interview Survey United States, 1984.

Viral and Health Statistics. Series 10, No. 156. DHHS Pub. No.

(PHS) 86-1584. Public Health Service. Washington. U.S. GovernmentPrinting OffIce, July 1986.
adwmdaa 11

Technical notes

Data presented in this report were obtained horn household

interviews of the 1984 National Health Interview Survey

(NHIS). These interviews were conducted among a probability

sample of the civilian noninstitutionalized population of the

United States. During 1984, approximately 105,000 persons

living in about 41,000 households were included in the sample.

The total noninterview rate for the NHIS was 3.6 percent.

The Supplement on Aging (SOA) was designed to be administered to all individuals of age 65 years and over who were

included in the 1984 NHIS sample, and to one-half of the individuals of age 55 –64 years. Interviewers strongly encouraged

the people selected to answer the SOA questions to respond for

themselves. As a result, 90 percent of the responses to the

SOA were, completely self-responses. A negative result of the

added emphasis on self-response in the SOA was that no information was collected for some individuals even though other

household members had provided information for them on the

core NHIS questionnaire. Fortunately, this defect occurred

infrequently the effective response rate for the SOA was 93

percent of the NHIS sample. Interviews were conducted for

4,651 persons of age 55-64 years and 11,497 persons of age

65 years and over.

This analysis was restricted to persons of age 65 years and

over. The 11.497 NHIS sample cases represented a national

population of 26.4 million persons. The distribution of this

population by sex and age is shown in table I.

The estimates in this report are based on a sample rather

than the entire population of age 65 years and over. Therefore,

the estimates are subject to sampling error. In addition, the

complex sample design of the NHIS has the effect of making

the sampJing errors larger than they wotdd be had a simple

random sample of equal size been used. Standard errors for

percents (x~v ) where the denominator (y) is all men, women,

Table 1. Estimated number of persons 65 ysars of age and over by

sex and age. Unitad States, 1984

Sex

All

Age persons Male Female

Number !n thousands

65 years And over . . . . . . . . . . . . . . . . 26,433 10,787 15,645

65-74 years . . . . . . . . . . . . . . . . . . . . . 16,288 7,075 9,213

65-69 years ., . . . . . . . . . . . . . . . . . 9,088 4,081 5,007

70-74 years . . . . . . . . . . . . . . . . . . . 7,200 2,994 4,206

75-84 years . . . . . . . . . . . . . . . . . . . . . 8,249 3,128 5,121

75-79 years . . . . . . . . . . . . . . . . . . . 5,320 2,137 3,183

80-84 years,..,,...........,,, 2,929 991 1,938

85 years And over . . . . . . . . . . . . . . . . 1,897 585 1,312

SOURCE Nattonal Health Intem,ew SWVey4 Natl~nal c.en[~r for Health StaOStlc~,

or persons of age 65-74 years or 65 years and over can be

calculated using this formula:

() SE ; =;–0.0000184 +

3.691.285

x

Standard errors for percents (xzv) where the denominator

(y) is some other population group, for example, all persons of

age 85 years and over, can be calculated using this formula

() SE z = 3.691 .285.Y/.v(l – .YZV)

y y

The values ofy are presented in tables 2,4,6, and 8. Values of

x can be derived by multiplying the y values by the percents

presented in tables 1, 3, 5, and 7.

To better understand the limitations of the estimates presented in this report, data users are encouraged to familiarize

themselves with the survey design, the method used in estimation, and the general qualifications of the data, which are described in appendix I of Current Estimates From the National

Heaith Interview Surve-v: Unifed Slates, 1984.11 The questiomaires for the 1984 core suwey and the SOA are presented

in appendix III of the report.

Also important for interpreting the data presented in this

report is a thorough understanding of what this. or any other.

cross-sectional survey can provide. There are two issues—one

important for any cross-sectional analysis and the other for

analysis of older people.

First, the NHIS is a point-in-time study. Associations at

one point in time do not necessarily indicate causaiity. The differences among the age groups. for example, could be the result

of aging or, alternatively, they could be the result of different

cohorts moving through time. Based on external knowledge, a

difference in the proportions of persons experiencing ditliculty

with a specific activity could be interpreted as the result of

aging, but the data from a cross-sectional survey may not enable one to make that distinction.

Second, this is a study of people who were living in the

community at the time they, or proxy respondents. were interviewed. All of the elderly people who had left the population

through institutionalization are excluded. The exclusion of

these individuals, who may be expected to have demonstrated

a different level of functional limitation than the SO.+ respondents, creates a bias in the estimates that must be borne in mind

when interpreting the survey results.

NOTE: A list of references follows the text.
mmhlklll

From Vital and Health Statistics of the National Center for Health Statistics Number 134 ● May 19, 1987

Highlights of Drug Utilization in Office Practice

National Ambulatory Medical Care Survey, 1985

by Hugo Koch, M. H.A., Division of Health Care Statistics, and Dee A. Knapp, Ph. D., University of Maryland at Baltimore

Prescribed or provided at three of every five visits, dregs

are the most commonly used weapons in the therapeutic arsenal

of the office-based doctor. This finding, along with other

highlights of drug utilization that appear in this report, emerged

from the National Ambulatory Medical Care Survey

(NAMCS), a year-long sample survey of the Nation’s officebased physicians, conducted in 1985 by the National Center

for Health Statistics. General findings from the 1985 NAMCS

~ave been published.’

The data-collection instrument used in the survey, the

Patient Record, appears as figure 1. Item 14 of the Patient

Record required responding physicians to enter the names

of up to five of the specific drugs that they prescribed or

provided in the course of the office visit. (Drugs ordered

through telephone contact were not included. ) This resulted

in an estimated 693.4 million drug mentions, an average of

1.1 drug mentions for each of the 636.4 million office visits

made during the survey year. Physicians were asked to report

nonprescription as well as prescription drugs. to distinguish

between new and continued medications, and to indicate

whether the drug was intended for the principal diagnosis

associated with the visit or used for some other reason.

The overall importance of drug therapy is made graphically

evident in tlgure 2. An estimated 61 percent of all office

visits were “drug visits”’; that is. visits during which one or

more drugs were prescribed or provided. Furthermore. in a

sharply prominent 72 percent of these 389.5 million drug visits.

drug therapy was the only form of treatment used.

Table I detines certain basic dimensions of the drug data

base. Among the key findings are the following:

‘~ii[lolld centerfor Hea]th stati~tic~, T. ~fc~mom and J. DeLo~iec ] 985

~mmary, National Ambulatory Medical Care Survey. Advance ~afa prom

.’Ifaf umf i-ledrh Stari.rfics. NO. 128. DHHS Pub, No. (PHS ) 87- i 250.

Public Health Service, Hyattwille, Md., Jan. 23.1987.

●

●

●

●

The great majority (77 percent) of the drug mentions

were applied to the principal diagnoses.

A respectable tendency toward generic prescribing is

suggested by the finding that 19 percent of drug entries

use the generic name of the drug.

About one of every five drug mentions was a fixed-ratio

combination drug. Combinations have the adtrantage of

offering more convenience to the patient but the off-setting

disadvantages of a usually higher cost and of less flexibility

in dosage adjustment due to their fixed-ratio composition.

A small but critical propoflion (8 percent) of drug mentions

were controlled drugs. Controlled medications h&e significant potential for addiction or habituation. Because of

this potential, they are under the regulatory control of

the Drug Enforcement Agency (DEA), an agency of the

Department of Justice. In table 1, drugs are characterized

by their DEA control level (“schedule”). Each successive

schedule, from II through V. reflects a decreasing potential

for addiction. With a membership consisting chietly of

the minor tranquilizers tdiazepam and alprazolam. for

example), the Schedule It? drugs command the highest

frequency of mention.

Tables 2 and 3 offer ranked listings of the 50 drugs

most frequently prescribed or provided by the office-based

practitioner. Table 2 uses ent~ names. that is. the trade or

generic names entered by the physician on the prescription

or other medical record. Table 3, because its list is based

on the generic ingredients of the drugs (whether in single-entity

or combination form), provides a more complete perspective

of drug utilization in the doctor’s office. The 50 drugs listed

are present in almost two-thirds of the 693.4 million drug

mentions.

Another useful overview of 1985 drug utilization appears

in table 4. The 693.4 million drug mentions are classified

here by the chief therapeutic effect that each was intended

U S DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Serwce
2 advancedata

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1. LXATE OF VISIT 4

&

PATlENT RECORD 2V3kc0937-014

NATIONAL AMBULATORY MEDICAL CARE SURVEY ~mres9’30!6,(PHsl 6105.1

2. !&;EHoF 3m SEX

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IF NONE, CHECK HERE •1

—.—.

—.—

————z

--. ....— ___ —

....—_____

YES

‘cl ‘B

‘cl ‘cl

‘cl ‘cl

‘cl 2(II

‘u ‘n

I

I

I

I

I

I

i

I

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b

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❑ ‘cl

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1 OMOKJL’OW.UPRANNEO

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3 D RETuRN IF NEEDEO PR N

4D YELEFliONE FOLLOW UPFtAMNE:

5 ❑ ‘EFEBREO TO OTFIER FHYs,c,AN

6 U RETURNED TO REFERRING fflWICIAN

7 ❑ AOMIT TO 140SPITAL

8 DOTHER b, ,f, — —

— M,nu1es

F@ure 1. National Ambulatory Medical Care Survey Patient Record
— _— .__.@mcedata ———- —. _ 3

I

1

J,, . j,..

.,,,->,,

,.,: ,,)..; , Drug therapy

T/l:1;,), the only form

~:,,, . . ,<;.-, of treatment \

[44 percent] I

/

“.-’’’’’’=’” -::;’ t] >1 Drug

... . . .

:::y ?;/ therapy

m conjunction

7 with nondrug

❑ 13rugtherapy

❑ Altematwestodr.gtherapy

Fgure2. Percent diatrfbufion ofoWevisti bytreatrnentmoda~~

United State$ 19S5

to produce. Clearly apparent is the preeminent role played

by three therapeutic categories: antibiotics. cardiovascularrenal agents, and analgesics. Together they account for about

40 percent of all drug mentions.

The remaining numbered tables reveal the relationship

between drug utilization and certain key variables in officebased care: the principal diagnosis (table 5). age and sex

of patient (table 6), race and ethnicity of patient (table 7),

and characteristics of the attending physician (table 8).

Of the numerous ways to measure drug utilization, tables

5–8 make use of four

. One—the literal number of drug mentions for a given

variable, the most exact measurement of overall solumre

of utilization.

. Twu--the proportion of visits during which one or more

drugs were prescribed or provided, a useful insight into

thefrequency of drug use.

. Three-the proportion of visits during which two or more

drugs were prescribed or provided, an indicator of the

infensiiy of gse.

. Four—the Drug Utilization Index, an artifactuai indicator

of frequency plus intensity formed by combining proportions two and three above.

Diagnosis

Proper evaluation of the patterns of drug utilization requires that the data user look first to the morbidity that the

drugs were intended to prevent, diagnose, or treat. The most

direct and frequent linkage occurs here. In rational prescribing,

a drug is seldom if ever utiIized for the sole reason that

the patient is over 65. or black, or female; or that the physician

is an internist or a general practitioner. When variations in

the substance and rhythm of utilization occur, they usually

reflect differing patterns of morbidity.

It is fundamental, then. to first examine office-based drug

utilization in terms of its diagnostic comelates. Table 5 makes

this exploration, using the drug data specific to the first-listed

[principal) diagnosis associated with each otYice visit (figure 1, item [ 1a). It is readily evident that two major diagnostic

groups—respirato~ disease and circulato~ diseme-dominate

the world of office-based drug utilization. a dominance that

is evident in all the various measures of utilization.

. The respiratory and circulatory disease diagnostic groups

account for the highest respective proportions of total

drug mentions (20 percent for respiratory disease and

16 percent for circulatory).

c They lead the other major diagnostic groups in the proportion of office visits during which one or more drugs

Table 1. Pemant distribution of drug mentions by selectsd dimensions of the drugs utifized United States, 196S

Drug

Drug dimension mentions

Allmentions (693.3!li5.~) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ico.o

Neworcontinued status

New medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.9

Continued medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52.6

Undetermmed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5

Therapeutic target

Pmlcipal diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77.1

CXherproblem(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19.5

Undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.4

Entw statusf

Generic name

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Trade name. . . .

18.6

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73.6

Undetermined . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.8

Drug

Drug dimens[on menttons

Preacnphon status

Prescription dtug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.9

Nonprescription drug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.2

Undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9

Composition status

Single-ingredient drug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.9

Combination drug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . z&2

Undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.9

Federal control status

Controlled dtug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5

.%hedule lldrug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6

Schedule llldrug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.8

Schedule lVdrug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1

Scheduie Vdruo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.0

Noncontrolled drug I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85.8

Undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7

1~Mcs ‘espo~l~ usedthesameformof entry-genertc or trade name—that ttwy used on the patient’s msdcal record andior on any prescrmwx that !“*w wrote
Table 2 The S3 dregs mostfrequently utilized in office practice by 9eneric in9r~ient% number of mentions, rank and therapeuticuse Unifed States, 1985

Number of

mentions

in

Entry name of drug’ thousands Rank Therapeutic use

Alldrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldomet (methyldopa). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxlcillm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxil(amoxicillin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ampticlllln . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin or A.S.A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benadryl (diphenhydramme) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ceclorlcefaclor) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Coumaaln (warfarin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Darvocel-N (propoxyphene, acetammophen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabmese (clorpropamide) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Digox!n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dlmetapp (bromphenlramme, phenylpropanolamine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

D)phthena tetanus toxoids pertussis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dyezide (tnamterene, hydrochlorothmzide) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E.E.S. (erythromycm) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Eryfhromycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Feldene(piroxlcam) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothmzideo rHCIZ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inderal (propranolol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indocin (mdomethacin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Influenza virus vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Isordil (isosorbide dinitrate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Keflex(cephalexin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lanoxm(dlgoxin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Las!x(furosemide) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lopressor(metoprolol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Materna(multivitamin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Motrin (ibuprofen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Naldecon (phenylephrine, phenylpropanolamine, phenyltoloxamine, chlorpheniramine) . . . . . . . . .

Naprosyn (naproxen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitroglycerin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

O~h&novum (norethindrone, estradiol ormestranol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pen-Va+K (penicillin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I%santine( dipyridamole) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FWiovaccme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pradnisone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Premarm (estrogens) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prenatal wtarnins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Synthrold (levothyroxine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tagamet (cimetidine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

T.B. Tinetest (tuberculin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tenormm fatenolol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.Tetracyclme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Theodur(tkophylline) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Timopt!c (timolol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol (acetaminophen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenoi No.3(acetammophen, cOdeme) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vahum(d@zepam) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Xanax(aiprazolam) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

693.355

3,888

10,959

7,858

6.557

5,224

4,028

3.783

2,631

3.610

3.03$

3.76$

3.145

5.805

9,304

4,791

4,494

3,572

5,636

7.844

3.177

2.M9

2.568

2.921

6,255

8308

10.654

3,761

2.534

7,295

3,2SE

6,489

3,164

3,176

3,577

4,295

4,122

6.454

4,292

2,911

3,001

5,205

3,257

5.443

5,474

4,652

3.931

5.082

3.909

3,672

4,071

29

1

5

0

16

26

30

48

34

43

31

42

12

3

m

21

38

13

6

39

47

w

45

11

4

2

32

49

7

38

9

41

40

35

22

24

10

23

46

44

17

37

15

14

19

28

18

27

33

25

Antihypertenswe

Antibiotic

Antibiotic

Antibiotic

Analgesic, antipyretic, antiinflammatory

Antihistaminic

Antibiotic

Anticoagulant

Analgesic

Hypoglycemic agent

Cardiotonic

Antihistaminic, decongestant

Immunization

DiurrWc, antihypertensive

Antibiotic

Antibiotic

Nonsteroidal anti-inflammatory agent

Diuretic

Arrhythmia. angina pectoris,

hypertension, migraine

Nonsteroidal anti-inflammatory agent

Immunization

Hypoglycemic agent

Vasodilator

Antibiotic

Cardiotonic

Diuretic. antihypertensive

Hypertension, angina pectoris

Prenatal supplement

Nonsteroidal anti-inflammatory agent

Antihistaminic, decongestant

Nonsteroidal anti-inflammatory agent

Vascdilator

Oral contraceptive

Antibiotic

Angina pectoris

Immunization

Steroidal anti-inflammatory agent

Estrogen replacement therapy

Prenatal supplement

Thyroid replacement

Duodenal or gastric ulcer

Tuberculosis skin tee.t

Antihypertensive, angina pectoris

Antibiotic

Bronchodilator

Glaucoma

Analgesic

Analgesic

Anxiety disorders

Anxiety dmorders

lThe tradeor genericnameusedby the phys!clan on the prescription or other m+dcal resords. The use of trade names IS for ldent!ftcabon only and oces not tmply endorsement by the Public Health

Service Orthelf.S WpaflmntOf Health and Human *mlces, Wauseof !tsnonsWiflc nature, theentry'"Allergy relleforshots; with 7.W7.~mentlons, isomltt@.

were prescribed or provided (83 percent for respiratory Patient

disease and 75 percent for circulato~’).

● They lead the other groups in the proportion of visits

Along the continuum of patient age there were two peak

at which multtple drug mentions appear.

in drug utilization: this was true regardless of the method

● For each, therefore. the Drug Utilization Index. the comof measurement employed. There was a minor peak in the

blned indicator of frequency and intensity, well exceeds

youngest age group. due largely to the more than average

the Index for any other diagnostic group.

use of antibiotics and immunizations. and a major pddk in
advancedata 5

_.. ----—

Table 3. The 50 drugs mOSt frequently utilized in OffiCe practice by generic ingredients, number of mentions, rank, and therapeutic use United States, 1985

— Number of

mentions

m

Generic ingredient thousands’ Rank Therapeutic use

Alldrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Acetaminophen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amitriptyline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Atenolol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Atropine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bacitracin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Brompheniramine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Caffeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cephalexin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chlorpheniramine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cimetidine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(hdeine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dexamethasone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oigoxin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diphenhydramine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dipyridamoie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estradiol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estrogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Furosemide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Guaifenesin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

+ydrocortisone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ibuprofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Isosorbide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methyldopa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Naproxen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neomycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitroglycerin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Norethindrone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... .,,, .,

Phenylephrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylpropanolamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rdymyxin B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prednisolone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Predrrisone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Promethazine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Propoxyphene. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Propranolol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pseudoephedrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulfamethoxezole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Theophylline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Timolol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triamcinolone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triamterene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tnmethoprim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

693,355

22,520

4,255

19,204

7,293

13,797

5,443

5,294

6,050

4,393

5,259

6,255

12,644

5,231

13,211

Iim

5,049

4,930

17,930

6,922

4,747

10844

7,141

23,676

7.328

9,429

5,913

4.095

5,670

7,567

6,635

8,083

5,S40

12,393

14.395

12442

7,443

4.035

6,702

4.436

4,786

8,792

9.699

9,353

6,913

9.312

4,851

5,167

9.402

9,476

2

4a

3

25

6

35

36

31

47

37

30

8

38

7

41

11

40

42

4

27

4s

12

26

1

24

15

32

50

33

22

20

21

34

10

5

9

23

49

29

46

44

19

T3

17

28

18

43

39

16

14

.. .

Analges!c. antlpyretic

Antidepressant

Antlblottc

Antibiotic

Analgesic, anttpyretlc, antiinflammatory

Antlhypertenswe, angina pectoris

Anticholmerglc

Antlbiot!c

Antlh!stammic

Stimulant

Antibiot Ic

Antihistammic

Duodenal or gastric ulcer

Analgestc. antituswe

Steroidal anti-inflammatory agent

Cardiotomc

Antihistammic

Angina pectoris

Antibiotic

Estrogen replacement therapy, oral

contraception

Estrogen replacement therapy, oral

contraception

Diuretic. ant!hyperfensive

Expectorant

Diuretic, anhhypertensive

Steroldal anti-inflammatory agent

Nonstero[dal antwtflammatory agent

Hypoglycemic

Vascdator

Antlhypertensive

Nonstero[dal antkmflammatory agent

Anbbiotic

Vasodlator

Oral contraceptwe

Antlblotic

Sympathormmetlc

Sympathomrmet Ic

Antibiotic

Sferoldal antmflammatory agent

SIeroidal antwtflamrnatory agent

Ant!h[stammic

Analgeslc

Arrhythmia, angina pectons.

hypertension. m)grame

Sympathomimet!c

Ant[biot!c

Ant[b[ot!c

Bronchcalator

Glaucoma

Stero!dal anti-inflammatory agent

Diuretic. antlhypertensive

Antibiotic

lCc+nbkms mentions as the generic form of singk.ingmdient dregs with its mentions as an mgredtent of combmat!on drugs. Wtarmns. mmerals. and vaccnes are om, ttti.

the oldest age group, resulting largely from the presence-at

times Ccrncomitant+f the chronic diseases that afflict the

aging. It is noteworthy that these oldest patients, though tiey

made up only 12 percent of the population, accounted for

20 percent of office visits and nearly 30 percent of all drug

mentions (table 6).

The relationship between the sex of the patient and drug

utilization requires careful evaluation: A gender comparison

based on simple enumeration of drug mentions should be

treated with caution. It is true that drug mentions for female

patients substantially outnumber mentions for males—in a

ratio of roughly 6 to 4. But this ratio also holds for office

visits in general, where it is influenced to a pronounced extent

by the presence of conditions and needs that are unique to

the female and by the demographic fact that. in 1985. females

outlived males by an average of 7 Years, producing more
6 advancedda

Table 4. Number and percent distribution of drug mentions by therepati!c categories United States, 1985

Number

of rrrermorrs Percent

Ttrerapeurm cafegoyl in thousands distribution

Alldrugs .,...................,.. . . . . .

Antt-infectwe agents (systemic) . . . . . . . .

Antibiotics. . . . . . . . . . . . . . . . . . . . . . . . ,.

Cephalosporins . . . . . . . . . . . . . . . . . .

Erythromycins . . . . . . . . . . . . . . . . .

Ftmicillins . . . . . . . . . . . . . . . . . . . . . . .

Tetracychnes, . . . . . . . . . . . . . . . . . . . . .

.%lfonamldes . . . . . . . . . . . . . . . . . . . . . . . . .

All other anti-infective agents ., . . . . . . . .

Antineoplastlc agents . . . . . . . . . . . . . . . . . . . . .

Autonomic drugs..,..,........,.. . . . . . . . .

Antlcholinergic agents . . . . . . . . . . . . . . . .

Sympathomlmetic (adrenergic) agents . . .

Skeletal muscle relaxants ., . . . . . . . . . . . . . .

Blood formation and coagulation . . . . . . . .

Anti-anemia drugs . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . .

Cardiac drugs . . . . . . . . . . . . . . . . . . . . . . . . .

Antihypertensive agents . . . . . . . . . . . . . . . . .

Vasodilatmg agents . . . . . . . . . . . . . . .

Analgesics and anttpyretics . . . . . . . . . . . . . . .

Nonsteroidal anti-inflammatory agents . . . .

psychotropic drugs . . . . . . . . . . . . . . . . . . .

Anxiolytlcs. sedatives, and hypnotics . . .

Antidepressants . . . . . . . . . . . . . . . . . . . . . . .

Major tranquilizers and antlmamc drugs . . . .

Electrolytic, caloric, and water balance ., . . . . .

Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Replacement solutions . . . . . . . . . . . . . . . . . .

693,355 1Cs).o

101,723 14.7

85,299 123

12,661 1.8

17.334 2.5

B.869 5.6

10,707 1.5

10,453 1.5

5,971 0.8

5,393 0.8

25,388 3.7

8,543 1.2

9,526 1.4

6,241 0.9

8,176 1.2

5,317 0.7

80.237 11.6

31.931 4.6

29,231 4.2

18,338 2.6

67,831 9.8

42,803 6.2

41,934 6.0

22,826 3.3

12,057 1.7

7,051 1.0

51,549 7.4

34,784 5.0

13,2U8 1.9

Number

of ment)ons Percent

TheraPeuf/c category’ m thousands dwtribution

Antihistamines, antitusslves, expectorants, and

mucolytlc agents . . . . . . . . . . . . . . . . . . . . . . . .

Eye, ear, nose, and throat preparations ., . .,

Anti-infectives . . . . . . . . . . . . . . . . . . . . . . . . .

Antibiotics, . . . . . . . . . . . . . . . . . . . . . .

Anti-inflammatory agents . . . . . . . . . . . . .

Mlotics. . . . . . . . . . . . . . . . . . . . . . . . . .

Gastromtestmal drugs . . . . . . . . . . . . . . . . . . . .

Antacids andabsorbents . . . . . . . . . . . . . . .

Cathartics andlaxatives . . . . . . . . . . . . . . . . .

Emetics and anti-emetics . . . . . . . . . . . . . . .

Mwcellaneous GI drugs (used chiefly in

treating duodenal ulcer) . . . . . . . . . . . . . . . .

Hormones and synthetic substances. ., . . . . . .

Adrenals . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contraceptives . . . . . . . . . . . . . . . . . . . . . . . .

Estrogens . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antidiabettc agents . . . . . . . . . . . . . . . . . . . . .

Insulins . . . . . . . . . . . . . . . . . . . . . . . .

Thyroid andantithyrold, . . . . . . . . . . . . . . . . .

Serums, toxoids, and vaccines . . . . . . . . . . . . . .

Skm and mucous membrane agents . . . . . . . .

Anti-infectives . . . . . . . . . . . . . . . . . . . . . . . . .

Fungicides . . . . . . . . . . . . . . . . . . . . . .

Anti-inflammatory agents . . . . . . . . . . . .

Keratolyhca gents . . . . . . . . . . . . . . . . . . . . .

Smooth muscle relaxants . . . . . . . . . . . . . . . . . .

Vitamins ...,...,..,,.......,.. . . . . . . . . . .

Vitamin Bcompiex . . . . . . . . . . . . . . . . . . . . .

Multivitamm preparations . . . . . . . . . . . . . . .

Other orundetermined . . . . . . . . . . . . . . . . . . . .

47,892

30,589

9,910

6,349

5,488

6,052

28,847

4,174

4,731

3,922

9,980

52,642

16,998

7,596

7,268

8,965

5,906

5,113

20,649

41,481

17,548

5,759

12,587

3,136

11,675

16,873

5,089

11,494

60,908

6.9

4.4

1.4

0.9

0.8

0.9

3.8

0.6

0.7

0.6

1.4

7.6

2.5

1.1

1.0

1.3

0.9

0.7

3.0

6.0

2.5

0.8

1.8

0.5

1.7

2.7

0.7

1.7

8.7

>Basedofi Amer]can Hospital FormularySwlce Classlf!cat!on System,Drug Product Irrtormat/on F!/e. TheAmerican DruggmtBlue Book Data Center.San Bruno. Calif., 1985.

Table 5. Number and percent distribution of office visits and drug mentionq percent of office visits during which 1 drug or multiple drugs were used, and Dmg

Utiliifion index, by principal diagnoses and ICD-9-CM codes: United States, 1985

Otf/cevisits Drug ment/ons2 Drug visits Drug

Number m Percent Number in Percent 1 drug or 2 drugs or U1’i/ization

Principal diagnosis and ICD-9-CM code’ thousands distribution thousands distribution more used2 more used2 /rrde#

Percent of all visits3

Allprincipal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectlousand parasitic diseases . . . . . . . . . . . . . . . . . . ...001-139

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l23939

Endocrine, nutritional and metabolic diseaaes,

andlmmunity disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240-279

Diseases ofendocrineglands . . . . . . . . . . . . . .,.....,240-259

Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...276

Diseases of blood and blood-forming organs . . . . . . . . . ...280-289

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Nonpsychotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . ...303-316

Diseases of nervous system and sense organs . . ...320-389

Dweases of central nervous system . . . . . . . . . ...320-349

Eyedisorders . . . . . . . . . . . . . . .,..,.......360-379

Otltismedla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...382

Diseases ofclrculatory system ., . . . . . . . . . . . . . . . . . . . ...390-459

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Ischemic heart dk?,ease . . . . . . . . . . . . . . .,...,.....,..,410-414

838.386

24,889

19,998

Zv80

15,554

3,345

3,&1

25,988

ml%

88.852

4,827

35.000

15,807

55.953

26.049

10.249

100.0

3.9

3.1

3.5

2,4

0.5

0.6

4.1

3.2

11.0

0.8

5.5

2.5

8.8

4.1

1.6

22,051

9,717

21,901

15,603

3,470

2.971

20,835

12.428

52,995

5,382

21,045

16.428

85.552

39,011

21.930

1Cif.o

4.1

1.8

4,1

2.9

0.6

0.5

3.9

2.3

9.9

1.0

3,9

3.1

16.0

7.3

4.1

54.2 20.0

88.2 16.9

29.4 11.6

61.3 21.6

84.9 20.5

59.0 27.6

80.8 11.6

52.3 19.2

45.0 12.5

.53.0 77.4

68.3 27.8

39.7 14.5

78,6 23.1

74.7 42.8”

81.2 42.5

82.2 64.7

74

83

41

83

85

87

72

72

58

70

96

54

102

118

124

147

Seefootnotes at end of table
advancdata 7

__————

7@e5. Num&randy~nt~stnbution ofofficevisits anddmgrnention% ~mentofofficevisits dunngwhich ld~ormultiple dmgswreusd, and~g

~~tion index, by pf’mc~paldiagnoses and ICD-9-CM c~e~ unlt~ State% 1965-CCM.

Off/cc wstfs Drug menttonsz Drug w.wts Drug

Number m Percent Numberm Percent 1drug or 2 drugs or fJt///zaonon

Principal diagnosis and ICD-9-CM code’ thousands dfstr)butlon thousands distribution moreuse~ moreusedz /ndex3

Percent of all vIsits3

Diseases ofrespiratowsystem . . . . . . . . . . . . . . . . . . . . . ...460-519

Acute upper respiratory infection . . . . . . . . . . . . . . . . . . . . . . . . 465

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

Oiseases ofdigestive system . . . . . . . . . . . . . . . . . . . . . . . ...5273-579

Diseases of genitourinaty system . . . . . . . . . . . . . . . . . . . ...560-629

Male genitourinary system . . . . . . . . . . . . . . . . . . . . . . . . ..e03-6JJ6

Female genitourinaV system . . . . . . . . . . . . . . . . . . . . . . ..6l4-6=

Diseases ofskirt andsubcutaneous tissue . . . . . . . . . . . . . ..66O-7fM

Diseases of musculoskeletai system . . . . . . . . . . . . . . . . . . . . 710-739

Arthropathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 711-716

Symptoms, signs, and illdefined conditions. . . . . . . . . . . ...760-799

Injury andpaisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..6CKf-9W

Normal pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..-. .W2

Health supervision ofinfantorchild . . . . . . . . . . . . . . . . . . . . . . ..V2U

Other orundetermirted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

n,m

14,691

6,9J3

27,222

36,S99

5,365

17,682

26,1S6

45,054

12,172

22,469

52,743

24,182

17,066

7~414

12.1

2.3

1.0

4.3

6.1

0.8

0.8

5.7

7.1

1.9

3.5

8.3

3.8

2.7

11.4

106,636

19,472

12,915

21,70U

26,932

3.097

12,557

36.046

36,944

14,14s

16,C66

27,6S3

10,932

6,153

25,112

20.0

3.6

24

4.1

5.0

0.6

2.3

7.1

7.3

2.6

3.0

5.2

2.0

1.2

4.7

62.7 39.2

835 2a.7

6a.5 55.2

54.0 19.0

54.0 12.1

48.2 8.1

54.0 13.3

65.5 27,1

59.7 18.1

74.0 25.2

47.8 15.3

42.7 8.6

26.3 8.4

24.4 10.3

,.. . . .

122

122

144

73

M

56

67

93

78

99

63

51

45

35

. . .

1Basedonthe Memarior?al C/ass~ficationof Diseases,9th rlwsiorr, C/inisa/Modtfc.?l{on(ICD-9-CM).

‘Includes only those drug mentions that were specifically intended for the pnnctpal (first.tisted) dragncms Drug ment;ons a~tated with other. hsted d!agnoses or uhhzed for any other reason are

not msludsd.

3A compzsde indicator of the frequency and intensify of drug utlfizstion, formed by adding the percent of ws!ts with 1 drug ment!on or more to the percent of vmts with multlple drug ment!ons and

rounding to the nearest whole integer.

_J’8b Ja6. N.mbarand petcent distribution of office visits and drug mentions percent of office visits during which 1 drug or multiple drugs were used, and Drug

zetion Index, by age and sex of patient United States, 1985

Office w.wts Drug mentions Drug vi.svts Drug

Number m Percent Number m Percent 1 drug or 2 drugs or Lftd/zation

Age and sex thousands distribution thousands dtstributlon more used more used krdexl

All patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age

Under 15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

65years andover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

sex

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex and age

Female

Under 15yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2W4yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45+4 years

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65years andover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male

‘hder15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1~-X4years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Zc-*4years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

+%yeam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

~yaarsa ndover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

636.2a6

118,766

73,964

175,724

137,391

130,538

337,461

246,905

5s,175

46,663

118,557

62,331

79,535

W,5E?4

2!5,061

57,167

55,060

51,CQ4

100.0

18.7

11.6

27.6

21.6

20.5

509

39.1

693,355

107,018

50,268

156,234

171,234

196,%2

426.653

266,702

100.0

15.4

8.7

22.5

24.7

28.6

61.5

38.5

Percent of all visits

61,2 27.7

62.0 21.7

56.4 18.6

55.7 222

83.4 33.1

66.2 40.3

61.8 28.1

60.2 27.2

89

64

75

78

97

109

90

87

9.1 53,107 7.6 62.7 21.8 65

7.7 40,255 5.8 5a.4 18.3 77

18.6 107,079 15.4 56.4 22.6 78

12.9 103,173 14.9 64.2 33.6 96

12.5 123,040 17.7 66.8 41.3 110

9.5 53,911 7.8 61.3 21.6 63

3.9 2Q.034 29 52.7 19.0 72

9.0 49,155 7.1 54,3 21.3 76

8.7 58,C61 9.8 62.1 32.4 9-S

8.0 75,542 10.9 67.2 36.7 106

‘A c~voslte md!cator of the frequency and intensdy of drug utilizatmn, formed by adding the percent of wslts with 1 mug mentmn or more 10 me cercenl of ~,sjts with muitm[e drug mentions and

rour?dtng to the nearest whole integer.
8 advancedata

Table 7. Number and percent distribution of office visits and drug mentions; percent of office visits during which 1drug or multiple drugs were used, and Drug

Utilization Index, by race and ethnicity of patient United States, 1985

Off/cc WSWS Drug ment!ons Drug ws)ts Drug

Number m Percen f Number m Percent 1drug or

Race and erbnic)ry

2 drugs or Urihzwon

thousands d(stnbution thousands djstnb”tjon more”sed more used Index’

percent of all vIsIts

Allpattents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 636,286 Ico.o 693,355 1KJ.o 61.2 27.7 89

Race

White . . . . . . . . . . . . . . . . ,., ,,, . ,,, 572.507 900 614,565 88.6 80.6 27.1 86

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52,143 8.2 68,394

Othe? . . . . . . . . . . . . . . . . . . . . . . . .

9.6 67.2 34.4 102

11,736 1.6 12,376 1.6 62.8 29.4 92

Ethnlcit y

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.o,o@ 6.4 43.325 6.2 62.9 27.5 w

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . 595,777 93.6 650,030 93.8 61.1 27.8 89

7A composite mdlcator of the frequency and lntensNy of drug ut!lmahon, formed by adding the percent of VISIIS ..wth 1 drug mention or more to the percent of vmts with multiple drug mentions and

rounding to the nearest whole integer.

2As!an, I%cjftc Islander, American Indian, or Alaskan natwe

Table8. Num&rand pementdistribution ofofticevisits anddmgmention& ~untofoffm tisitsdunng Wichldmg ormultiple dmgswereusd, and Dmg

Utilization Index,byphysicianidentityandspecialty UnitedStates,1985

Offme WSJ2S Drug ment)ons Drug visits Drug

Number m Percerrr Numberm Percenf 1 drug or 2 drugs or

Phys/c/an identfty and spec/a/ty

Mhzation

thousands d!s’tnbut!on thousands dlstnbutlon more”sed more used Index’

Percent of all wits

All physicians . . . . . . . . . . . . . . . . . . . . . .

Professional identity

Doctor ofmdlcme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Doctor ofostaopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Specialty

General or family practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Internal medicme . . . . . . . . . . . . . . . . . . . . . . .

pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Obstetrics andgynecology . . . . . . . . . . . . . . . .

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Orthopedic surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General surgery, . . . . . . . . . . . . . . . . . . . . . . .

Dermatology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otolaryngology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urological surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,. .

Another specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

636386

603.514

35,872

193,995

73,727

72,693

58.642

40,082

31,482

29,m

24,124

17.989

16,097

11,699

10,617

4,992

52,406

1W.o

94.4

5,6

30.5

11.6

11.4

8.9

6.3

4.9

4.7

3.8

2.8

2.5

1,8

1,7

0,8

82

693.355

6W,353

43,032

250,119

126.219

68,856

33.632

25,820

12.080

18,774

29,253

14,826

10,761

6,737

26,812

4,884

84,602

100.0 61.2 27.7 89

93.8 80.8 27.4 68

6.2 68.1 32.8 101

36.1

18,2

9.9

4,9

3.7

1.7

2.7

4.2

2.1

1.6

1.0

3.9

0.7

9.3

72.7

77.4

88.8

45.1

40.8

27.4

38.5

86.0

46.3

45.5

46.7

80.9

57.4

80.7

33.6

45.7

21.9

12.2

16,4

7.5

15.3

34.1

4.5

17.0

9.1

ffi.3

25.1

32.7

108

123

89

57

57

35

54

102

51

83

56

147

63

93

‘A Composite mdlcalor of the frequency and mlens!ty of drug util!zat, on, formed by add!ng the percent of VISItSw!lh 1 drug me”t)o” or more tO the percent of vmts with multtple drug mentions and

rounding to the nearest whole integer,

female visits at the oldest end of the age spectrum. On the

other hand, from the perspective of the Drug Utilization Indexes, the gender difference in average frequency and intensity

of drug utilization is not very great. To be fair, contrasts

between male and female drug utilization should be based

on average tendencies, should be diagnosis-specific within

common age groups. and should control for agents that are

unique to either sex. This subject will be explored further

in future reports from the NAMCS drug data base.

Contributing to the significantly higher Drug Utilization

Index for office visits by black patients (table 7) is the fact

that black patients favor the general practitioner more than

their white counterparts do. General practitioners, as a reference to table 8 will reveal, utilize drug therapy with a frequency

and intensity that exceeds that of most of the more specialized

physicians.

Physician

In comparing the Drug Utilization Indexes, it is cle~

that Doctors of Osteopathy as a group exceeded Doctors of

Medicine in the average extent to which they utilized drug

therapy (table 8). This may be chiefly because the clear majority of their members engage in general practice, and general
advancedata ..9

__.. ._. .-—.. .——— .—— — .-—.-—. —...—

nmctitioneN —as the specialty findings in table 8 make evident—lead most of the other specialists in the tempo and

~lume of their drug utilization.

Every method of measuring drug utilization offers strong

evidence of the prominent roles played by three primary care

providers: general practitioners, family physicians, and internists (table 8). As a group they account for a majority (54

percent) of all drug mentions, and their indicators of utilization

are higher than those of any other specialists except physicians

whose primary focus is limited to cardiovascular disease.

Noteworthy contrasts between 1985

and 1981 drug findings

Prior to the 1985 survey, NAMCS was last fielded in

1981. A comparison of the drug findings between the two

survey years reveals that

●

●

●

●

●

Although the absolute number of drug mentions increased

over the period in rough parallel with the increased number

of office visits, the average utilization patterns, as

measured by the Drug Utilization Index, did not change

significantly (89 for 1985; 90 for 1981).

In 1985, the proportion of combination drug mentions—20

percent of all drug mentions-declined substantially from

the 1981 proportion of 26 percent.

Among age groups. the most noteworthy change in absolute number of drug mentions. an increase of about 20

percent over the 1981 number, occurred with patients

65 years old and over. For the first time since NA\lCS

began gathering drug data in 1980, this oldest age group

accounted for the largest single proportion of ail mentions.

Among the drug classes the following changes in mention

number are worthy of note:

Percefrf change

Drug class 1981 to 1985

Cardiovascular drugs (espeaally antihypertenswe

agents and vasodilators) . . . . . . . . +17

Analgesics and antlpyretms (espeaally

nonsteroidal anti-inflammatory agents) . . . . . +15

Antidepressants . . . . . . . . . . . . . . . . . . . . + 22

Anxiolytce. sedattves, and hypnotics . . . . -17

EENT preparations (chiefly anb-mfectwes

andmiotics) . . . . . . . . . . . . . . . . . . . . . +30

Systemic cortcosteroids . . . . . . . . . . -18

Skm and mucous membrane agents . . . . . . -15

Movement of specific agents within the drug classes is

apparent from the findings in tables 9 and 10. They generally support the changes noted above for their parent

classes: note, for example, the marked increase in mention

number found for the nonsteroidal anti-inflammatory

agents “ibuprofen” and “naproxen. ” In the case of the

systemic antibiotics. however. although no notable change

in total utilization occurred between 198 I and 1985. there

was dramatic movement of agents within the class. The

amoxicillins, for example, advanced prominently in mention number at the expense of the other antibiotics.

Readers interested in learning more about the NANICS

drug data base may direct their inquiries to:

Hugo Koch

National Center for Hetilth Statistics

Center Building 2, Room 243

3700 East-West Highway

Hyattsville, MD 20782

Telephone: (301 )436-7132

Tabfe 9. The 10 generic ingredients with the greatest increase in offict+based

utilidion from 1981 to 198S United States, 19S5

@im&l 10theagentsl@?dm table3]

Generic Percent

ingredient Therapeutic use increase”

Acetaminophen . . . . . . . .Analgeslc, antlpyretic

Amoxicillin . . . . . . . . . . . .Antibiotic

Atenolol . . . . . . . . . . . . . .Antihyperfensive, angina pectoris

Oipyridamole . . . . . . . . . .Angina pectoris

Estrogens . . . . . . . . . . . . .Estrogen replacement therapy,

oral contraception

Ibwprofen . . . . . . .Nonsterotdal ant!-mflammatory agent

Naproxen . . . . . . . . . . . . .Nonstero!dal antmflammatory agent

Nitroglycerin . . . . . . . . . . .Vasochlator

Norethindrone . . . . . . . . .Oral contraceptive

Timolol . . . . . . . . . . . . . . .Glaucoma

51

55

>Im

>103

65

5a

33

59

37

> Im

lBasedon tdume ofdrugmermons.

Table 10. The 10 generfc ingredients with the greatest decrease in office-based

utifiitiwr from 19S1 to 1985 United States, 1985

[Limkedtothe agentsk.ted mtable3]

Gener/c Percent

ingredient Therapeutic use decrease

Ampicillin . . . . . . . . . . .Ant!blotlc

Brompheniramme . . . . . .Antlh[stamm[c

Methyldopa . . . . . . . . . . . ,Antlhypertenswe

Penicillin . . . . . . . . . . . . .. Antib!otlc

Phenylpropanolamme . . .Sympathomlmetlc

Promethszine . . . . . . . . . .Antlhslammic

Propranolol . . . . . . . . . . . .Arrhythm!a. angina pectorls.

hypertension, mlgrame

Pseudoephedrine . . . . . . .Sympalhom!metlc

Tetracycline . . . . . . . . . .Ant!blot!c

Triamcinolone . . . . . . . . . .Steroidal anti-inflammatory agent

29

.%

27

27

24

25
N–.– advancedata _ —.—___ . —— . —

Technical notes

Source of data and sample design

The information presented in this report is based on data

coIlected by means of the 1985 National Ambulatory Medical

Care Survey (NAhlCS) during the period from March 1985

through Februa~ 1986. The target universe of NAMCS comprises office visits made within the coterminous United States

to non-Federal phj’sicians who are principally engaged in office

practice, but not in the specialties of anesthesiology, pathology.

or radiolog~. Telephone contacts and nonoffice visits are

excluded.

NAMCS uses a multistage probability sample design that

involves samples of primary sampling units (PSU’S), physician

practices within PSU’S, and patient visits within physician

practices. For 1985. a sample of 5,032 non-Federal. officebased physicians was selected from master files maintained

by the American \ledical Association and the American Osteopathic Association, The physician response rate was 70.2

percent. Sampled physicians were asked to complete Patient

Records (figure 1J for a systematic random sample of their

office visits over a randomly assigned 1-week reporting period,

Responding physicians completed 71,594 Patient Records,

Table 1. Approximate relativa standard errors of estimated numbers of office

visits baaed on all physician apecialtiex NAMCS, 1965

Re/atwe

standard

Est)matad number of office error m

wits m thousands percent

203. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.8

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.1

I,eoo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.2

2,W3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.5

5,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5

10,000................................................. 6.6

20,C00. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4

$3),000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5

Iomoo... ...................... ...................... 4.2

603,0C0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9

Exarnp/eof use of tab/e. An aggragate eshmale of 15JXXI.CCOvisits has a ralatlvestandard

error of 6.0percent. or a stanaard errorof SOIDY3vmts (6,0percent of 15DWKO)

Characteristics of the physician’s practice. such as primarv

specialty and type of practice. were obtained during an indvction interview. NORC (formerly known as the National Op;+

ion Research Center), under contract to the National Center

for Health Statistics, was responsible for the survey’s data

collection and processing operations.

Sampling errors

The standard error is a measure of the sampling variability

that occurs by chance when only a sample, rather than an

entire universe, is surveyed. The relative standard error of

an estimate is obtained by dividing the standard error by

the estimate itselfl the result is then expressed as a percent

of the estimate. These measurements are applied to office

visits in tables I and 11; in tables HI and IV they are applied

to drug mentions.

Rounding of numbers

Estimates have been rounded to the nearest thousand.

For this reason detailed figures within tables do not always

add to totals. Rates and percents were calculated from original,

unrounded figures and therefore will not necessarily agree

precisely with rates or percents calculated from rounded data.

Definitions of terms used in this report

A visit is a direct personal exchange between an ambulatory patient seeking health care and a physician or staff member

working under the physician’s supemision who provides that

care.

A ~ru~ rnerzrkm isthe physician’s entry of a pharmaceutical agent prescribed or provided—by any route of adnninistration—for prevention, diagnosis, or treatment. Generic names

as well as brand-name drugs are included. as are nonprescription as well as prescription drugs. Along with all new drugs,

the physician also records continued medications, if the patient

was specifically instructed during the visit to continue the

medicaticm.

Table Il. Approximate standard errors of percents of estimated numbers of office visits based on all physician specialties NAMCS, 1985

Estimafed percent

Base of percent 1 or 5 or 10 or 20 or 30 or

(number of office vis[ts m thousands) 99 95 w 80 70 50

Standard error m percentage points

200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.7 8.2 11.3 15.0 17.2 18.8

5C0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 5.2 7.1 9.5 10.9 11.9

I,ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.7 3.7 5.0 6.7 7.7 8.4

2,m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.2 2.6 3.6 4.8 5.4 5.9

5.0C0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07 1.6 2.3 3.0 3.4 3.8

Io,ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

05 1.2 1.6 2.1 2.4 2.7

20,000, . . . . . . . . . . . . . . 04 0.8 1.1 1,5 1.7 1.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.

WK700 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.5 0.7 1.0 1.1 1.2

100,000...... .... ... ..... ...................... .. .. ... 0.2 0.4 0.5 0.7 0.8 0.8

603,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.1 0.2 0.3 0.3 CI.3

Example oluse of fable A- es!nmaleof 2QPercentbased on an aggregate est,mate Of15W OCOVISIIShas a standard error of 18 Percent.or a refatjve standard errOrOf9.0 Percent

(1,8parcent -20 percant
ii&h3 MQlllll

From Vital and Health Statistics of the National Center for Health Statistics Number 135 ● May 14, 1987

Use of Nursing Homes by the Elderly: Preliminary

Data From the 1985 National Nursing Home Survey

by Esther Hing, Division of Health Care Statistics

Introduction

Most elderly people are not in nursing homes. Of an estimated 28.5 million Americans aged 65 years and over in the

United States, only 5 percent were residents of nursing homes

on any given day from August 1985 through January 1986.

This finding from the 1985 National Nursing Home Survey

(NNHS) is consistent with findings from previous National

Nursing Home Surveys conducted in 1973-74 and 1977.1 In

these surveys also it was found that about 5 percent of the

elderiy were residents of nursing homes.

Differences, however, exist in the use of nursing homes by

age, sex, and race subgroups. In this report, these differences in

use rates are examined. Differences in the health and socioeconomic characteristics of elderly nursing home residents by

age, sex, and race are also discussed. The health and socioeconomic characteristics examined in this report are functional

dependencies in the basic activities of daily living—bathing,

dressing, using the toilet room, transferring from a bed or chair,

continence, and eating cognitive fimctioning (disorientation or

memory impairment and seniIe dementia or chronic organic

brain syndrome); marital status at admission; whether residents

had living children; living arrangements prior to admission to

the nursing home; and primary source of payment at admission.

The focus of this report will be a compmison of the characteristics of the elderly who reside in nursing homes with characteristics of those who reside in the community.

The data presented in this report are from the 1985 National Nursing Home Survey, a nationwide sample survey of

nursing homes, their residents, discharges, and staff conducted

by the National Center for Health Statistics. The survey, which

was conducted from August 1985 through January 1986, was

one third of a continuing series of nursing home surveys. The

first survey was conducted from August 1973 through April

1974, and the second was conducted from May through December 1977.

Facilities included in the 1985 NNHS were nursing and

related care homes in the conterminous United States that had

three or more beds setup and staffed for use by residents and

that routinely provided nursing and personal care services. A

facility could be free standing or could be a nursing care unit of

a hospital, retirement center, or similar institution as long as

the unit maintained financial and employee records separate

from the parent institution. Places providing only room and

board were excluded, as were places serving only persons with

speciilc health problems (for example, mental retardation or

alcoholism).

The sanipling frame for the 1985 NNHS consisted of the

following components:

●

●

●

●

The 1982 National Master Facility Inventory (NMFI)?

a census of nursing and related care homes conducted by

the National Center for Health Statistics.

Homes identiled in the 1982 Complement Survey of the

NMFI as “missing” from the 1982 NMFI.

Nursing homes opened for business from 1982 through

June 1984.

Hospital-based nursing homes identified in records of the

Health Care Financing Administration.

The resulting frame contained 20,749 nursing homes. In this

repo~ the terms “’nursing homes” and “nursing and related

care homes” are used interchangeably.

Estimates in this report are based on a sample of 4.646

elderly residents of the 1,079 nursing homes participating in

the survey. A fixed sample of five or fewer residents per sample

facility was selected. Residents included in the sample were

those on the nursing home’s roster the night before data collection began. Data were collected by interviewing knowledgeable

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Publtc Health Se-/Ice
2 dmcecaa

nursing home staff members, who referred to the residents’

medical records when necessary. Additional followup information on the sample residents was collected by telephone interview with the residents’ next of kin. (A resident’s guardian or

friends were contacted if there was no next of kin.) Data collected from tire next of kin focused on the circumstances and

reasons for the resident’s nursing home admission. In this report,

only data obtained from the nursing home staff are presented.

In later reports estimates from the next-of-kin component will

be included.

Data presented in this report are preliminary and may differ

sli-titl} from estimates presented in later reports because of

further data editing. Another report presenting preliminary estimates of nursing homes and utilization characteristics of homes

has already been pub!ished.3

Although data on residents reported by the nursing home

staff were collected in a similar manner in earlier National

Nursing Home Surveys as in the 1985 survey, note should be

taken of some differences. First, personal care and domiciliary

care homes were excluded from the scope of the 1973-74

NNHS but included in the two later surveys. The effect of this

difference, however, is small because only about 2 percent of

all nursing homes in 1973 were personal care or domiciliary

care homes and they housed only about 1 percent of the beds

and residents.4 Second, certain variables presented in this and

later reports were not available from the previous surveys. Data

on some variables discussed in this report-marital status at

admission, the presence of living children, ability to transfer in

or out of a bed or chair, and primary source of payment at

admission—were not collected in the earlier surveys. Third,

race and ethnicity were collected as a single item in the 1973-

74 and 1977 surveys but as separate items in 1985. This difference should be considered when comparing data by race

from the 1985 NNHS and previous surveys.

Because data in this report are national estimates based on

a sample, they are subject to sampling errors. Information on

sampling variability is presented in the Technical notes.

Utilization rates

In 1985 an estimated 1,491,400 residents lived in 19,100

nursing homes nationwide. Of these residents. 1,315,800, or

88 percent. were 65 years of age and over. The number of

elderly residents in nursing homes increased 17 percent from

1977 to 1985. Residents aged 85 years and over comprised the

larges: age group (45 percent), followed by those aged 74-85

years (39 percent) and 65–74 years (16 percent). Because of

the preponderance of the very old in nursing homes, those aged

85 years and over accounted for 76 percent of the increase in

elderly residents from 1977 to 1985. The proportion of elderly

residents who were aged 85 years and over increased from 40

percent in 1977 to 45 percent in 1985.

Not only were nursing home residents typically very old

but they also tended to be female and white. Seventy-five percent

of elderly residents were female. Similarly. 93 percent of elderly

residents were white. Only 6 percent were black. and less than

1 percent were other races (a catego~ that includes AsIan and

Pacitl; Islanci:rs. American Indians. and .41aska Natives). On

the average, elderly females were older than their male counterparts (84 versus 81 years). Elderly white residents, who had an

average age of 83 years, also tended to be slightly older thaf

elderly black residents (8 1 years) and other residents (80 years).

As measured by the percent of elderly residing in nursing

homes. the patterns of nursing home utilization mirrored the

distributions of residents by age, sex, and race. On any given

day during the survey period, 5 percent of the population aged

65 years and over resided in nursing homes (table 1). The rate

of nursing home use increased sharply from 1 percent of those

aged 65-74 years to 22 percent of those 85 years and over.

Elderly females were twice as likely as elderly males to be

residents of nursing homes. Six percent of elderly females were

in nursing homes, compared with 3 percent of elderly males.

Although use of nursing homes increased with advancing age

for both sexes, women used nursing homes at significantly higher

rates than men did regardless of the age group. Greater use by

women was especially true in the oldest age group. One in four

women 85 years of age and over resided in nursing homes,

compared with one in seven men of the same age (figure 1).

This greater utilization by elderly women than men is a reflection of women’s longer life expectancy.5 It is also a reflection

of a greater tendency among persons without spouses iimdwith

poor health to enter nursing homes.

Elderly white persons are more likely to reside in nursing

homes than black persons and those of other races are. l[n 1985,

5 percent of the elderly white population, compared with 4 and

2 percent of the population of black and other races, respectively

resided in nursing homes, The greater likelihood of elderly whit,

people to reside in nursing homes was particularly true in the

oldest age group. Of the population 85 years and over, 23 perTable 1. Number, percent distribution, and rate of nursing home

residents 65 yeare of ege and over by age, sex, and race:

United States, 1985

Number of

residents per

1,000

population

Number Percent 65 years

Age, sex, and race of re.wdents dtsrriburion and overl

Total . . . . . . . . . . . . . . 1,315,800 100,0 46.1

Age

65–74 years ., . . . . 212,100 16.1 12.5

75-84 years ., . . . . 509,000 38.7 57.7

85 years and over ., 594,700 45.2 21:9,4

Sex

Male . . . . . . . . . . . . . 334.000 25.4 29.0

Female ,,, ,, ...,,. 981,900 74.6 57.7

Race

Wane ...,... ,,. 1,224,900 93.1 47,6

Black, .,,,., . . . 82.000 6.2 35.0

Other. . . . 8,900 0.7 20.1

1Popula!, on data usecl to compute rates are ‘-em—U.S. Bureau of the Census:

Est,ma.?s of lhe pop.lal,on of the United Stales by aga sex. and race. 1980

TO 1985 Currenr Poou/ar,on Reoons Sertes P-25 No 985 Washington US

Go.er. ~enl Pr,.?, nG Ow,ce Apr 1986
adAnc4ata 3

c

0

,-

5

a

a

0

a

0

0

0.

250

200

150

100

50

0

248 9

D:3 Male

EN Female

65 and over 65-74 75-84 85 and over

Age m years

Figure 1. Number of nursing home residents per 1,000 population 65 years of age and over, by sex and age: United States, 1985

cent of white people, compared with 14 percent of black people,

resided in nursing homes.

This lower use by elderly black people and those of other

races may result from substitution of informal care at home for

formal nursing home care. According to data from the 1982

Long-Term Care Survey, a higher proportion of elderly black

people and people of other races than elderly white people were

functionally impaired and remained in the community. Overall,

29 percent of the noninstitutionalized elderly who were of black

or other races were functionally impaired in the activities of

daily living or home management activities for at least 3 months,

compared with only 19 percent of white peoples Thus, elderly

persons who were of black or other races were overrepresented

among the noninstitutionalized most at risk of needing nursing

home care. This finding suggests “the use of a more extended

SUppOrt system among black persons than among white persons.”e Other studies have shown that elderly black persons

are more likely than elderly white persons to receive care at

home.7

The proportion of the elderly residing in nursing homes

has not changed since the period 1973-74, when the first

NNHS was conducted (figure 2). An exception to this trend is

the increase in the propo~ion of elderly black persons using

nursing homes. During the period 1973–74. 2 percent of the

elderly black population resided in nursing homes: in 1985, the

proportion was nearly 4 percent. In contrast. the proportion of

the elderly in nursing homes did not change from 1973-74 to

1985 for persons who are white or of other races. About 5

percent of elderly white persons and 2 percent of elderly persons

of other races were residents of nursing homes throughout this

period. The percent of elderly males and females as well as the

prcent of the elderly aged 65-74 and 75–84 years who resided

in nursing homes also remained the same. The percent of persons 85 years and over, however. decreased: 25 percent of

persons aged 85 years and over resided in nursing homes in the

pericd 1973-74, compared with 22 percent in 1985.

Functional dependencies

Because of the preponderance of ve~ old residents in

nursing homes, it is not surprising that many residents required

assistance in performing or did not peti-orm the basic activities
4 duancedata

49,7

1973-74 1977

Yea,

El ...

:~ All races

IN White

El

Black

Ez?

Other

47,6

1985

Figure 2. Number of nursing home residents per 1,000 population 65 years of age and over, by race: United States, 1973-74, 1977, and 1985

of daily living (ADL’s), which are needed for independent living.

The ADL’s are bathing, dressing, using the toilet room, transferring in and out of a bed or chair, continence, and eating. In

1985, 91 percent of elderly residents required assistance in

bathing: 78 percent required assistance in dressing 63 percent

required assistance in using the toilet room: 63 percent required

assistance in transferring from a bed or chair 55 percent were

incontinent (bowels. bladder. or both): and 40 percent requ]red

assistance in eating (table 2). These findings are consistent

with earlier studies by Katz and Apkom. in which it was shown

that loss of independence is most likely to occur in bathing and

least likely to occur m eatin~.’

In general, elderly residents in nursing homes were more

dependent in performing the ADL’s in 1985 than in 1977. A

larger propofion of elderly residents required assistance or had

difficulty with bathing, using the toilet room. continence, and

eating in 1985 than 1977 (tables 2 and 3). The exception to

this trend was for dressing. The proportion of elderly residents

requiring assistance in this ADL remained the same in both

years. (Information about transferring from a bed or chair is

not available from the 1977 NNHS. )

A partial explanation of the increased level of functional

dependency is the shifl in the age distr:kmtion of nursing home

res]dents to the very old age group (85 years and over), noted

I
ac?bancedata 5

Table 2. Percent of nursing home residents 65 years of age and over, by type of dependency in activities of daily living, percent distribution

by number of dependencies, and average number of dependencies, according to age, sex, and race: United States, 1985

Age Sex Race

65-74 75-84 85 years

Dependency status Total years years and over Male Female Wh/te Blat< Other

Type of dependency Percent

90.3 94.1 86.9 92.6 90.9 94.2 91.5

75.9 81.9 71.5 79.7 77.3 83.7 72.9

Requires assistance in bathing. . . . . . . . . . . . . . . . . . . . . .

Requires asswtance in dressing. . . . . . . . . . . . . . . . . . . . .

Requires assistance in using toilet room. . . . . . . . . . . . . .

Requires assistance in transferring. . . . . . . . . . . . . . . . . .

Continence—difficuky with bowel and/or bladder

control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Requwes assistance id eating . . . . . . . . . . . . . . . . . . . . . . .

91.2

77.7

63.3

62.7

54.5

40.4

100.0

7.6

11.0

9.9

7.8

13.5

19.8

30.4

3.9

84.8

70.2

56.6

52.1

42.9

33.4

100.0

13.2

14.0

11.2

7.3

13.8

16.6

23.9

3.4

60.3

59.7

68.2 56.2 65.7

69.0 55.3 65.2

62.9

62.2

68.6

70.2

61,4

60.9

55.0

39.1

58.1 51.9 55.3

44.0 34.8 42.3

54.1

40.0

59.9

47.9

47.6

32.1

Number of dependencies Percent distnbutton

100.0 100.0 100.0

4.8 11.8 6.2

9.4 12.5 10.5

9.6 10.0 9.8

7.2 8.6 7.5

13.9 12.6 13.8

21.3 18.7 20.2

33.8 25.7 32.0

100.0

8.6

11.6

9.6

8.7

12.8

19.4

29.2

100.0

7.8

11.3

10.0

7.6

13.4

19.9

30.1

100.0

4.8

6.5

8.0

11.4

14.4

18.9

35.9

100.0

*8.5

●1 5.8

*8.8

“5.5

●16.6

*1 8.6

*26.3

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1..............................................

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -.

6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Average number

Average number of dependencies . . . . . . . . . . . . . . . . . . . 3.8 4.2 3.6 4.0 3.9 4.2 3.7

1Transfemng refers to getting in or out of a bed or chatr.

Table 3. Percent of nursing home residents 65 years of age and

over, by age and type of dependency in activities of daily living:

United States, 1977

increased from 85 percent for residents b5-Td years to 94 percent for residents 85 years and over. Similarly. difficulty with

bowel or bladder control increased from 43 percent for residents

65–74 years to 58 percent for residents 85 years and over.

Because female residents were older, on the average, than male

residents, they tended to require assistance in ADL’s more

oflen than males did. A greater proportion of female than maie

elderly residents needed assistance in bathing, dressing, using

the toilet room, transferring from a bed or chair. and eating.

There was no statistically significant difference in the percent

incontinent by sex. Elderly black residents also needed assistance in ADL’s more often than elderly white residents did.

This was the case in five of the six ADL’s. There was no statistically significant difference in the percent incontinent by

race.

The six activities of daily living maybe summarized into a

single measure of ADL dependency by summing the number of

activities in which a resident required assistance.s In 1985, 30

percent of elderly residents required assistance in all six .A.DL”s.

and only 8 percent were independent in all six activities. The

mean number of dependencies was 3.9. The mean number of

ADL dependencies increased with age from an average of 3.4

dependencies among residents 65-74 years to 4.2 dependencies

among those 85 years and over. Females tended to be more

functionally dependent than males. Overall, elderly females

had an average of 4.0 ADL dependencies. and elderly males

had an average of 3.6. Elderly black residents also tended to be

more functionally dependent than elderly white residents. The

average number of ADL dependencies was 4.2 among elderly

black residents, compared with 3.9 among elderly Ivhite residents. Thus, the data show a greater need for care in nursing

homes among female and black residents. In the case of females.

All ages

65 years 65-74 75-84 85 years

Type of dependency and over years years and over

Percent

Requires assistance in

bathing . . . . . . . . . . . . . . 88.6 81.2 88.9 91.7

Requires assistance in

dressin g. . . . . . . . . . . . 77.7 61.2 72.5 75.8

Requwes assistance in

using toilet room . . . , . . 64.8 46.9 54.3 59.0

Continence—difficulty

with bowel andjor

bladder control. . . . . . . . 47.3 37.6 47.1 52.2

Requires assistance tn

eating .,, ,,, . . . . . . . . . 33.6 27.1 33.8 36.5

earlier. However, as tables 2 and 3 show, the proportion of

residents functionally dependent in each ADL was generally

higher in 1985 than in 1977 even when age was held constant.

For example, a larger proportion of residents aged 85 years

and over were dependent in bathing, dressing, using the toilet

room, continence, and eating in 1985 than in 1977. Another

explanation is the impact of medicare policy on nursing home

care. Under the medlcare prospective payment system, instituted in 1983, hospi~ls me enmuraged to reduce patient length

of stay. Patients released earlier tmcier this new system may

require a higher level of care in the nursing home than they

would have needed if they had stayed longer in the hospital.g

In general. dependency in ADL’s increases with age. In

1985, the percent of residents requiring assistance in bathing
6 advancedata

this is correlated with higher use of nursing homes. This is not

the case. ho~ ever. for elderly black persons.

Although it is possible that nursing home policy may preclude the resident from performing ADL’s without assisuutce.

the ovemhekning need for assistance in ADL”s among nursing

home residents su~eests that this dependency may have been a

reason for entering the nursing home. (The importance of functional status as a reason for nursing home admission was also

found in a study of medicare recipients. 10)In contrast, the need

for such assistance is minimal among the noninstitutionalized

elderly. According to data from the Supplement on Aging to

the 1984 Na~ional Health Interview Survey, 6 percent of the

noninstitutionalized elderly received assistance in. bathing 4

percent. in dressing; 2 percent, in using the toilet room: 3 percent, in transferring from a bed or chak, and 1 percent, in eating

(table 4). Data from the 1982 Imng-Term Care Survey, which

covered noninstitutionalized medicare enrollees most at risk of

needing long-temt care (people functionally impaired in ADL’s

or the instrumental activities of daily living for at least 3 months),

indicate a lower need for assistance in ADL’s than was found

among nursing home residents. In 1982, 42 percent of the elderly

impaired living in the community required assistance in bathing, 20 percent required assistance in dressing, 21 percent required assistance in using the toilet room, 26 percent required

‘assistance in transferring from a bed or chair, and 6 percent

required assistance in eating.b Additional insights should be

provided on the reasons for admission when data from the nextof-kin component are available.

Cognitive impairment

Another reason for nursing home placement that is cited in

the literature is deteriorating cognitive functioning. 1] In 1985,

63 percent of elderly residents were disoriented or memory

impaired to such a degree that performance of the basic ADL’s,

mobility. and other tasks were impaired nearly every day. Disorientation or memory impairment was defined as being unable

to remember dates or time, unable to identify familiar locations

or people, unable to recall important aspects of recent events,

or unable to make straightforward judgments. Major causes

Table 4. Percent of persons 65 years of age and over, by whethar

nursing home resident or noninstitutionalized and type of dependency

in selected activities of daily living: United States, 1984 and 1985

Nursing home Non/nst/tutmnaltzed

Type of dependency resldenrs, 1985 population, 1 1984

Requires assistance In: Percent

Bathing, ., 91.2 6.0

Dressing . . . . . -)7,7 43

Using to[let room. . 63.3 2,2

Transferrlng~ 627 2.8

Eat!ng 404 11

lData are from the Nallonal Cemer for Health Stat! stlcs, D Dawson, G Hendershot

anti J Fulton: Agng !n lne etg~tles. functional Iimtitaltons of Indwldu. slsage 65

years and over +la(ance Date From V(fa/ and Hea/rh StafMrIcs No 133DHHS

Pub No IPHSI 87-1250 Publlc Health Sew!ce Hyalls. !lle Md Apr,l 30 19S7

Percent of the no., ?st!lut!onaltzed elderly dependent In act!v(lles of da,ly I!vtng

IS a measure of lhose who rece, ved help rather lhan those needing tt

2Transferr, ng refers 10 gelr!ng rn or ouf of a bed or cha!r

of disorientation or memory impairment in the elderly are senile

dementia and chronic organic brain syndrome. In 1985, 47

percent of elderly residents were reported to have at least onr

of these conditions (table 5). Sixty-six percent of elderly residents who were disoriented or memory impaired were also reported to have senile dementia or chronic organic brain syndrome.

In general, disorientation or memo~ impairment increased

with age: 56 percent of residents 65–74 years of age had memory impairment or disorientation, compared with 67 percent of

those 85 years and over. Elderly female residents were memory

impaired or disoriented more often than elderly male residents

were—64 percent and 59 percent, respectively. This finding

may be related to females’ greater longevity. Although it ap

pears that elderly black residents were memory impaired more

often than elderly white residents were (70 percent, compared

with 62 percent of elderly white residents), the difference was

not statistically significant. Similar patterns were also found

for residents with senile dementia or chronic organic brain

syndrome when examined by age, sex, and race.

Marital status at admission

The marital status of residents may have influenced the

decision to enter the nursing home because persons without

spouses may not have anyone living with them to provide personal care services that would allow them to stay in the community longer. In 1985 the majority of elderly residents were

without spouses at the time of admission to the nursing home,

65 percent were widowed. 6 percent were divorced or separated,

and 14 percent had never married (table 6). In contrast, ordy

16 percent of elderly residents were married at the time of admission. The likelihood of being widowed increased with age,

and the proportion who were married decreased with age. In

Table 5. Percent of nursing home residents 65 years of ag,~and

over, by whather they had disorientation or memory impairment and

senile dementia or chronic organic brain syndroma, aga, sex, and

race: United States, 1985

Senile dementia

Disortantation or chronic

or memory organic brain

Age, sex, and race impairment syndrome

Total ..,....., . . . . . . . . . . . .

Age

65-74 years . . . . . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . .

Sex

Male. . . . . . . . . . . . . . . . . . . . . . .

Female, . . . . . . . . . . . . . . . . . . . . .

Race

Whire. ,,, . . . . . . . . . . . . . .

Black ... . .

Other. . . . . . . . . . . .

62.6

55.7

60.8

66.6

58.8

63.9

62.2

69.5

562

Percent

47’,0

34..0

46.4

52.9

42,1

48,6

46.8

51.4

*35.2
achncedata 7

Table 6. Percent distribution of nursing home residents 65 years of age and over by marital status at admission and percent with living

children, according to age, sex, and race: United States. 1985

Martral status ar aum]ssion

Dworcea or Never Propoc on wttn

Age, sex, and race Total Married Widowedl separated rrrarr(ed /iv/rig :?/ldren

Percent distribution Percent

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100,0 16.4 64.2 5.9 13.5 63.1

Age

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 22.8 35.9 14.2 27.2 50.1

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 19.2 60.9 6.5 13.4 62.2

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 11.8 77.2 2.3 8.6 68.6

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 32.5 36.7 10.1 20.6 55.7

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 11.0 73.6 4.4 11.0 65.7

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 16.6 64.4 5.6 13.3 64.5

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 13.8 61.9 9.8 14.5 41.8

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 ●14.9 64.9 “20.2 68.1

1A small number of persons of unknown marital status are included.

the group 65-74 years, 36 percent of residents were widowek

77 percent of residents 85 years and over were widowed. Elderly

female residents were more likely to be widowed (74 percent)

than elderly male residents (37 percent). Elderly males were

more likely to be married (33 percent) than elderly female residents (1 I percent).

The tendency of persons without spouses to enter nursing

homes is highlighted by comparing the marital status of the

functionally impaired elderly living in the community with that

of elderly nursing home residents. The propofion married was

larger among the functionally impaired elderly living in the

community (44 percent) than among elderly nursing home residents (16 percent). Thus, 84 percent of the elderly in nursing

homes were without spouses, compared with 56 percent of the

fictionally impaired living in the comrnunity.G

Presence of living children

Data on whether nursing home residents had living children

were collected for the first time in the 1985 NNHS. Among elderly nursing home residents. the majority (63 percent) had living children. The proportion of residents with children increased

with age and was greater for female residents (66 percent) than

male residents (56 percent). The trends among residents with

children mirror the increasing utilization rates by age and the

greater nursing home use by elderly women. Additionally, these

trends appear to contradict the notion that the lack of children,

which is a proxy measure for the lack of a social support network, is a risk factor for nursing home institutionalization. The

finding that most elderly residents had children does not explain

by itself why people enter nursing homes because this variable

onfounded by several factors. First, it is not known whether

%e residents’children lived close enough to provide care and,

if they did, whether they were physically able to provide care.

Although 69 percent of residents 85 years and over had children,

their children were probably in their sixties and may not have

been physically able to care for their aging parents. Furthermore, for many residents, admission to the current nursing home

was not from the community but from another health institution.

As will k-s discussed in the next section, more than one-half of

elderly residents were transferred to the nursing home from

another health facility. For these residents, obtaining appropriate continuing care was a deciding factor in entering the

current nursing home. Their children may not have been able

to provide adequate informal care in the home. Further insights

on this issue should be gained when the next-of-kin data on the

sample residents are available.

There was one exception to this trend. Only 42 percent of

elderly black residents had children, compared with 65 percent

of elderly white residents. In the 1982 Long-Term Care Survey

it was found that noninstitutionalized elderly black persons

who were functionally impaired were more likely to live with

children than fictionally impaired elderly white persons were.c

Living arrangements prior to nursing

home admission

The living arrangements of residents prior to admission

reflect both the amount of support given in the environment in

which they previously lived and their health. A majority of the

residents (57 percent) were transferred from another health

facility (table 7). The most common type of health facility

transferred from was a short-stay hospital (39 percent). Only

12 percent of residents were transferred from another nursing

home, and 3 percent were transferred from some type of mental

facility (mental hospital, facility for the mentally retarded, psychiatric unit of a short-stay hospital, or mental health center).

The proportion of elderly residents admitted from a short-stay

hospital in 1985 (39 percent) was a significant increase from

the proportion in 1977 (34 percent). This finding may also be

related to the introduction of the medicare prospective payment

system, under which hospitals have a strong incentive for early
8 ackmeddt

Table 7 Percent dtstributton of nursing home residents 65 yaers of age snd over by living arrangement prior to admission, eccording to age,

sex, and race: United States, 1985

Age Sex Race

65-74 75-84 86 years

Living arrangement pr!or to admiss!on Total years years and over Male Female White Black Other

Percent distribution

Alllivlng arrangements .,..... . . . . . . . . . . . . . . . . . . . . . 100,0 100.0 100.0 100,0 100.0 100.0 100.0 100.0 100.0

Prwate or semiprivate residence . . . . . . . . . . . . ., 40.0 29,2 40,5 43.3 36.3 41.2 40.5 31.9 35.6

Alone . . . . . . . . . . . . . . . . . . . . . . . . . 14.7 8.2 14.7 17.0 11.6 15.8 15.2 6.9 “15.5

Wlthfamll ymember a.. . . . . . . . . . . . 18.9 16.0 19.8 19.2 19.3 18.8 18.9 19.0 *15.5

Wlthnonfam tly members . . . . . . . . . . . . . . . . . . . . 3.4 “3.1 3.3 3.5 3.2 3.4 3.3 3.9 “2.0

Unknown tfwlthmhers . . . . . . . . . . . . . . . . . . . . . . . . . . 3,0 1.8 2.7 3.7 2.2 3.3 3.1 ●2.1 “2.5

Another health fac!lny. ,, . . . . . . . . . . . . . . . . . . . . . . . . . . 57.0 67.7 56.5 53.6 60.4 55.9 56.5 65.2 59.0

Another nursing home . . . . . . . . . . . . . . . . . . . . . . . . . . 12.2 12.9 12,6 11.5 13.1 11.8 12.4 9.2 ●9.7

General orahort-stay hosp!tal’. . . . . . . . . . . . . . . . . . . . 38.7 39.5 38.2 38.9 35.2 40.0 37.9 49.5 49.4

Mental facilityz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.0 7.6 3.2 1.1 5.0 2,3 3.1 *1.8

Veterans hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,4 4.6 0.9 0.7 6.4 “0.0 1.5 “0.9 -

Other health facility or unknown . . . . . . . . . . . . . . . . . . 1.9 3.3 1.9 1.4 1.9 1.9 1.8 ●3.8 -

Unknown orother arrangement . . . . . . . . . . . . . . . . . . . 2.9 2.9 2.7 3.0 3.1 2.8 2.9 ●2.9 “5.4

1Psych)atnc units of hospnals are excluded

‘Mental hospitals, facllmes for the mentally retarded, general or short-stay hospnal psych!atnc umts. and mental health centers are Included.

discharge of patients needing long-term care services.g Further

analysis of this issue will be presented in a later report.

The increasing proportion of residents transferred from

short-&y hospitals to nursing homes also reflects the increasing

role hospitals play in the provision of care to tie elderly. For

example, in the 1985 NNHS it was found that 22 percent of

elderly residents were hospitalized for acute episodes of illness

while still a resident of the nursing home. Thirteen percent of

elderly residents had only one hospitalization, and 9 percent

had two or more hospital stays (table 8). Hospitalizations of

elderly residents were less likely among those who were admitted to the nursing home from a short-stay hospital, only 14

percent of whom had a subsequent hospitalization while a resident. In contrast, 27 percent of elderly residents not admitted

from a short-stay hospital were hospitalized while a resident of

the home.

When examined by age, the proportion of elderly residents

transferred from a short-stay hospital or nursing home did not

vary. Elderly female residents. however, were more likely to be

admitted from a short-stay hospital (40 percent) than elderly

male residents were (35 percent). In addition, a higher proporTable 8. Percent distribution of nursing home residents 65 yaars

of age and over by number of hospital admissions while a resident,

according to whether admitted from a short-stay hospital:

United States, 1985

Adm/rred Nor admtrred

from from

fiumber of hosp{tal stays short-srey shorr-stay

wh//e a resldenf Total hosp]fal hosp{tal

Percent d!strlburton

Tota~, ,. ..,. ,. 1000 1000 1000

None”. , .-. ,. 7? 7 85.5 72.8

1. ,,, ,, .,, 131 9,2 156

2 or more 91 5,2 116

4 srr3 nurnn t-, c< r.exor$ .. !- L,. hno... - num Der o+ hcso,:al Slaks are

,rlc!!-lc!e:

tion of elderly black residents (50 percent) than elderly white

residents (38 percent) were transferred from a short-stay hospital. These findings appear to be correlated with the generally

more dependent fictional status of elderly women and black

residents.

Forty percent of elderly residents were admitted from a

private or semiprivate residence; 15 percent had lived alo he

prior to the nursing home admission, 19 percent lived with fad)y

members, and 3 percent lived with persons who were not family

members. Residents 75 years and over were more like] y than

those 65–74 years to have lived alone prior to being admitted

to the nursing home. Elderly female residents were more likely

to have lived alone ( 16 percent) than elderly male residents ( 12

percent). Elderly black residents were less likely (7 percent)

than elderly white residents (15 percent) to have lived alone

prior to admission. This may result from the tendency of functionally impaired elderly black people to “draw on a more extended range of relationships in their living arrangement than

white persons.”c

Primary source of payment at admission

Data on sources of funds used to pay for nursing home

care provide a rough measure of residents’ income sources because public funds for nursing home care under certain governmentprograms are available only to those who cannot afford to

pay for such care. The medicaid program. for example, is a

joint Federal-State program providing medical benefits to persons who qualify for welfare and to some of the ‘“medically

needy.’ (those who would be on welfare if their incomes were a

little lower). The State-set criteria for medicaid eligibility vary

from State to State but cover most poor people in the United

States .12

Information on the payment sources used during the morif%

of admission was collected for the fwst time in the 1985 NNHS.

Table 9 shows the prima~ payment source used by elderly

residents in the home 1 month or more. One-half of elderly
advamedata 9

Table 9. Percent distribution of nursing home residents 65 years of sge and over by primsry source of payment at admission, according to

age, sex, and rece: United States, 1985

Prfmary scurce of paymerrr a? admms, ~n

Mad/ca!d paymenr for— Orher

government

Own income or Skilled Inrermedtare assistance or All other

Age, sex. and race All sources famtfy suppofl Medtcare nursing care welfare sources

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 49.8 4.9 13.9 26.2 2.7 2.5

Age

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100,0 39.0 4.7 13,9 31.5 5.5 5.4

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 51.2 5.2 13,5 25.3 2.6 2.3

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . 100.0 52.4 4.6 14.3 25.1 1.9 1.7

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 50.9 4.8 11,9 23.7 4.0 4.8

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 49.5 4.9 14.6 27.0 2.3 1.7

Race

Wane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 52.2 4.9 13.2 24.6 2.6 2.5

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 17.1 “5.0 21.1 49.3 *5.3 “2.2

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 ‘32.0 39,3 “28.7

NOTE: Data cover only persons who were restdenls for 1 month or more.

residents relied primarily on their own income or family support

to pay for the first month in the nursing home, and 40 percent

relied primarily on the medlcaid program to pay for care.

“ Medicaid finances both skilled nursing and intermediate care

services in nursing homes. At the time of admission, 26 percent

of eIderly residents received intermediate care and 14 percent

received skilled nursing care through the medicaid program.

Only 5 percent of elderly residents relied on medicare. Extended care benefits under medicare are limited to 100 days

following a hospital stay of at least 3 days. Three percent of

elderly residents relied on other government assistance or welfare, and another 3 percent relied on other payment sources.

Overall, 48 percent of elderly residents relied on some form of

public funds to pay for their stay at the time of admission.

There were differences in primary payment source by age.

Residents 75 years of age and over were more likely to use

their own income or family support for primary payment than

were residents aged 65–74 years. Of residents 75–84 years

and 85 years and over, 51 and 52 percent, respectively, relied

on their own income or family support to pay for care. compared

with 39 percent of residents 65-74 years. Medicaid was the

primary payment source for a larger proportion of residents

65-74 years (45 percent) than residents aged 75-84 years (39

percent) or 85 years and over (39 percent). The primary payment source also varied by sex. A larger proportion of elderly

females (42 percent) than elderly males (36 percent) relied on

medicaid for payment.

There were major differences in the patterns of payment at

admission by race. Elderly black residentx were almost twice

u likely to use medicaid as the primary source of payment (70

fwcent) as elderly white residents were (38 percent). Conversely, &jerly white reSi&nK were more likely to use their

ow’rtincome or family support as their primary payment source

(5 ~ percent) than elderly black residents were (17 percent).

The differences in payment source by sex and race reflect the

generally lower income of elderly women and elderly black

people in the noninstitutionalized population.’ 3 and in particular among the functionally impaired elderly living in the

community. In 1982, 46 percent of elderly femaIes who were

functionally impaired and living in the community had family

incomes of less than $7,000, compared with 31 percent of their

male counterparts. Similarly, 61 percent of functionally impaired elderly black persons had family incomes of less than

S7,000, compared with 37 percent of functionally impaired

elderly white persons. (Family income included income of the

functionally impaired individual and all members living with

him or her.)6

Conclusions

On any given day during the survey period for the 1985

NNHS, about 5 percent of the elderly were residents of nursing

homes. Use of nursing homes increased with age for both sexes

but was greater for females than for males. especially in the

older age groups. Use of nursing homes was lower for elderly

persons who were black or of other races than for white persons. These trends have remained constant since the period

1973-74, when the first NNHS was conducted. with the exception of an increase in the use of nursing homes by elderly

black persons and a decrease in use by those aged 85 years and

over.

Examination of some health and social characteristics revealed that dependency in ADL’s was widely prevalent among

elderly nursing home residents but much rarer among the noninstitutionalized elderly. The lack of available caregivers may

have been a confounding factor for the preponderance of persons without spouses in nursing homes. The role of the residents’ children or their living arrangements prior to admission
10 adwncedata

in the decision to enter a nursing home is not clear from the

data examined. The need for continuing care in a nursing home

and the availability and willingness of the residents’ children to

provide informal home care are issues that need further examination before conclusions can be drawn. These issues will

be examined in future reports in which data from the next-ofkin component are presented. The lower use of nursing homes

by elderly black persons appears to be related to a greater substitution of informal care at home for formal nursing home care.

In this report, data on the primary source of payment for

care used by residents during the month of admission were also

presented. The data show that in 1985 one-half of elderly resiReferences

lNational Center for Health Statistics, E. Hin& Characteristics of

nursing home residents, health status, and care received, National

Nursing Home Survey, United States, May-December 1977. Viral

and Efealfh Statistics. Series 13, No. 51. DHHS Pub. No. (PHS) 81-

1712. Public Health Service. Washington. U.S. Govermnent Printing

Oftice, Apr. 1981.

2Nationa1 Center for Health Statistics, D. Roper Nursing and related

care homes as reported from the 1982 National Master Facility Inventory Survey. Vital and Health Statistics. Series 14, No. 32. DHHS

Pub. No. (PHS) 86-1827. Public Health Service. Washington. U.S.

Government Printing Oflice, Sept. 1986.

sNationa] Center for Health Statistics, G. Strahan: Nursing home

characteristics, preliminary data from the 1985 National Nursing

Home Suwey. Advance Data From Vita[ and Health Statistics. No.

131. DHHS Pub. No. (PHS) 87-1250. Hyattsville, Md., Mar. 27,

1987.

lNational Center for Health Statistics, A. Sirrocco: InPatient health

facilities as reported from the 1973 MFI Survey. Vital and Health

Statistics. Series 14, No. 16. DHEW Pub. No. (HRA) 76-1811.

Health Resources Administration. Washington. U.S. Government

Printing OtTce, May 1976.

sNationa] Center for Health Statistics: Advance report, final mortalitY

statistics, 1984. Monrh[v Vital Statistics Repo~. Vol. 35, No. 6 Supp.

2. DHHS Pub. No, (PHS) 82-1120. Public Health Sewice. Hyattsville, Md., Sept. 26, 1986.

6c Macken: A profile of functionally impaired elderly Persons living

in the community. Health Care Financing Review. Vol. 7, No. 4.

HCFA Pub. No. 03223. Office of Research and Demonstrations,

Health Care Financing Administration. Washington. U.S. GovernmentPrinting OffIce, Summer 1986.

dents relied primarily on their own income or family support to

pay for the first month in the nursing home, and 40 percent

relied primarily on the medicaid program to pay for care. RQ;.

dents 75 years of age and over were more likely to use th

own income or family support to pay for care at admission than

residents aged 65–74 years were. Residents aged 65-74 years

were more likely to use medicaid. Elderly black residents were

almost twice as likely as elderly white residents to use medicaid

as the primary payment source at admission. Overall, 48 percent of elderly residents relied on some form of public funds

(medicaid, medicare, other government assistance, or welfare)

to pay for their stay at the time of admission.

T~stitute of Medicine Racial Differences in US6! of Nursini; Home

in Health Care in a Context of Civil Rights. Washington, D.C. National Academy Press, 1981.

SS Ka~ and C. A, Akporn Measure of primary sociobiological frJnctions. Int. J. HeaIth Sem. 6(3):493–508, 1976.

‘M. Meiners and R. Coffey: Hospital DRGs and the need for longtemr care services, an empirical analysis. HeaIfh Serv. Res. 20( 3):359-

384, Aug. 1985.

loM Cohen E, Tell, and S. Wa]lack Client-related risk factors of

nursing home entry among elderly adults. J. GeronroL 20(6): 185–792,

NOV. 1986.

1lR. Kane, R. Matthias, and S. Sarnpsom The risk of p[acernent in a

nursing home after acute hospitalization. .14ed. Care 21(11 ):1055-

1061, NOV. 1983.

IZK. Davis and C. Schoem Health and the War on poverty, .4 i“enYear Appraisal. Washington, D.C. The Brookings Institution. 1978.

13u.s. Bureau of the Census: Characteristics of the population below

the poverty level, 1982. Curren~ Population Reports. Series P–60.

No. 144. Washington. U.S. Government Printing Otlice, 1984.

14National Center for Health Statistics, P. J. McCarthy: Replication,

an approach to the analysis of data from complex surveys. J‘“italand

Health Statistics. Series 2, No. 14. PHS Pub. No. 1000. Public Health

Service. Washington. U.S. Government Printing Office, Apr. 1966.

IsNational Center for Health Statistics, P. J. McCarthy: Pseudore

cation, further evaluation and application of the balanced ha]f-mm,

technique. Vital and Health Statistics. Series 2. No. 31. DHEW Pub.

No. (HSM) 73-1270. Health Services and Mental Health Administration. Washington. U.S. Government Printing OtTice, Jan. 1969.
ackmedata 11

Technical notes

Because the statistics presented in this report are based on

sample. they will differ somewhat from figures that would

have been obtained if a complete census had been taken using

the same schedules. instructions, and procedures. The standard

error is primarily a measure of the variability that occurs by

chance because only a sample. rather than the entire universe,

is surveyed. The standard error also reflects part of the measurement error, but it does not measure any systematic biases in

the data. The chances are 95 out of 100 that an estimate from

the sample differs from the value that would be obtained from a

complete census by less than twice the standard error.

The standard errors used in this report were approximated

using the balanced repeated-replication procedure. This method

yields overall vanability through observation of variability

among random subsarnples of the total sample. A description

of the development and evaluation of the replication technique

for error estimation has been published. ““15

NOTE: A list of references follows the text.

Table 1. Standard errors of percents for residents

Although exact standard error estimates were used in tests

of significance. it is impractical to present exact standard error

estimates for all statistics used in this report. Thus, a generalized

variance function was produced for aggregated resident estimates by fitting the data presented in this report into a curve

using the empirically determined relationship between the size

of an estimate X and its relative variance (rel var X). This

relationship is expressed as:

s~. b

relvar X=-=a+~

x“

where a and b are regression estimates determined by an iterative procedure. Preliminary estimates of standard errors for the

percents of the estimated number of residents are presented in

table I.

The Z-test with a 0.05 level of significance was used to

test all comparisons mentioned in this report. Not all observed

differences were tested, so lack of comment in the text does not

mean that the difference was not statistically significant.

Estimated percent

Base of percent (resldenrs) 1 or 99 5 or 95 100r90 20 or 80 40 or 60 50

Standard errors m percentage points

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.84 6.22 8.56 11.41 13.97 14.26

70,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.01 4.40 6.05 8.07 9.88 10.09

30,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.16 2.54 3.49 4.66 5.71 5.82

50.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.90 1.97 2.71 3.61 4.42 4.51

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.63 1.39 1 91 2.55 3.12 3.19

200.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.45 0.98 1,35 1.80 2.21 2.26

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.32 0.70 0.96 1.28 1.56 1.59

600.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.22 0.49 068 0.90 1.10 1.13

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.20 0.44 0.61 0.81 0.99 1.01

1,491 ,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.16 0.36 0.50 0.66 0.81 083

Symbols

.-. Data not available

. . . Catego~ not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standard of

reliability or precision

*

Figure suppressed to comply with

confidentiality requirements
From Vital and HealthStatistics of the National Center for Health Statistics Number 136 ● May 8, 1987

Aging in the Eighties,

Ability to Perform Work-Related Activities

Data From the Supplement on Aging to the National Health Interview Survey:

United States, 1984

by Mary Grace Kovar, Dr.P.H., Office of Vital and Health Statistics Systems,

and Andrea Z. LaCroix, Ph. D., Division of Health Examination Statistics

Introduction

At least three factors influence the exodus from paid

-npIoyment among oIder Americans public policy affect-

“ retirement, the ability to perform work-related activitie~. and the desire on the part of the older worker to

continue working or, alternatively, to enjoy leisure. The

U.S. Congress has recently enacted two new laws that may

influence the age at which Americans will choose to retire

from active employment in the future. The first is an

amendment to the Social Security Act implemented in

April 1983 that wiII raise the minimum age of retirement

for the receipt of full social security benefits from 65 to 67

years of age among persons born in 1960 or thereafter

(Public Law 98-21). The second Iaw amends the Age

Discrimination in Employment Act of 1967 by eliminating a

mandatory retirement age for most occupational groups

(Public Law 99-592). Approved in October 1986, this law

effectively extinguishes forced retirement at age 70. Thus,

current Federal policy encourages Americans to retire at

oIcler ages than previously and now makes it legally possible

for d] older workers to remain employed, regardless of

their chronological age, for as long as they possess the

abiIity and desire to work.

The desire to continue working into the later years of

life reflects a complex interplay among financial need and

rewwd, gratification attained through work, and the functional capacity to meet job demands. This report is conceriied primarily with the last of these forces—the physical

‘Iity to perform cert~”n tasks associated with work.

Source of data

The National HeaIth Interview Survey (NHIS) is the

National Center for Health Statistics’ large continuing survey of the civiiian noninstitutionalizeci population of the

United States. Each year people in about 42,000 households are interviewed by U.S. Bureau of the Census interviewers to obtain information about their health and use of

health care. Demographic information that is needed to

interpret the data is also obtained. The interviewers have

special training on this survey in addition to their regular

training and response rates are high—about 97 percent.

The only item with a relatively low response rate is family

income.

In 1984 a special supplement was added to the questionnaire to obtain information about okler people who

were Ii\ing in the community. This supplement, the Supplement on Aging (SOA ), was designed to collect inform ~tion

about physical limitations. chronic conditions, housing, retirement status, interactions with family and organizations.

use of community services, and o[hcr healih-related and

social information about middle-aged and older people. AM

household members age 65 years and over and a one-half

sampie of those 55-64 years of age were asked the questions on the supplement themselves when possible. Another

household member was interviewed only when the seIected

person was unable to answer either because of physical or

mental problems or because of being away from the household for a longer period than the interviewer wouId be in the

area. Response rates to the SOA were also high; 95 percent

U.S. DEPARTMENTOF HEALTHAND HUMAN SERVICES Public Health Service
2 advancedata

of the people selected from the hHIS sample had complete

intemiews to the SOA. Of the people ages 55-74 years, 93.0

percent responded for themselves.

The purpose of this report is to provide information

about a particular segment of this population, people ages

55-74 years who had worked at some time since they were

age 45. These people are of particular interest because of

an impending or relatively recent change in their labor

force participation. By virtue of their age and midlife active

empl~yment. such people are either approaching retirernen:. postretirement, or in transition between these two

states. Information on work-related activities from the SOA

makes it possible to describe the ability of these Americans

to perform several activities that are basic and common to a

varie~ of occupations. The intent is not to study the precise

and detailed functional requirements of numerous individual occupations, but rather to describre a limited set of

physical abilities among older workers in the ages surrounding retirement.

The estimates are based on a sample, and they will

differ from estimates based on a complete census in which

exac[iy the same questions and interviewing techniques are

used. The authors have taken care not to make statements

about differences unless it is likely that the same differences would be found using the same techniques in a

complete census. The reader should use the material in the

technical notes before deciding that differences not mentioned in the text are likely to be statistically significant.

Biases that result from the way that the questions are

worded, the lack of understanding by a respondent, or the

difficulties inherent in asking people to think about themselves and report accurately will remain in any case.

The estimates of the prevalence of disability are based

on responses of ‘yes.” If for some reason there was no

response, the response was not recorded, or the answer was

unknown, data are treated as if the answer were “no.” The

impact of this procedure on the estimates is small. Usually

less than 1 percent and never more than 2 percent of the

sample had such responses.

Background

The SOA included questions to determine the ability to

perform 10 work-related actit~ities. The 10 items covered a

wide range of abilities that involve mobility (walking onequarter of a mile and walking up 10 steps without resting),

end urance for confined movement (standing on feet for 2

hours and sitting for 2 hours), lower and upper body

strength (stooping, crouching, or kneeling and lifting or

carving 25 or 10 pounds), freedom of movement (reaching

up o~er head and reaching out to shake hands), and fine

motor skills (-grasping wi[h fingers). Participants were first

asked if they currently had any difficulty performing each

activity. For the subset of persons with any difficulty, the

amount of difficulty (some or a lot) was ascertained, including the inability to perform the activity in question. Data on

the proportion of persons \vitll any difficulty for each

activity and the subset unable to perform each activity are

presented in this report.

Of the 38.3 million Americans 55-74 years of age, 3f

milIion or 95 percent, had been employed at some tire.

during their lives. Virtually all men had been em:ployed, as

had a high proportion of women. An estimated 32.3 million, or 84 percent, had worked at some time since the age

of 45. However, while almost all men had worked at some

time since age 45, only about three-quarters of the women

had worked after their 45th birthday, as shown in the

following table.

Work stafus Both sexes Men women

Total . . . . . . . . . . . . . . . . . . . . . . . 100,0 100.0 100.0

Overworked... .. ..... .. ... 95.3 99.6 91.7

Worked since age 45 . . . . . . 64.3 97.6 73.2

The data in this report pertain to the people 55-74

years of age who continued to work or returned to, work for

at least some time during their middle years. These individuals ccmstitute the population who must decide whether

and when to retire as they achieve older ages.

The report is focused on differences in the ability to

perform 10 work-related activities among 4 age groups and

3 employment groups (\vorking, retired because (of health,

and retired for other reasons). Examination of differences

among these subgroups of people employed since age 4“

can shed light on the proportion of older Americans WI

still maintain the work-related functional abilities commolt

to many jobs. It can also reveal the ability to work among

people this age who have retired, those people who might

remain in the work-force under the new retirement laws.

Differences by age and sex

Overall, of the 10 work-related activities studied, stooping, crouching, or kneeling caused difficulty for the largest

proportion of the people, 28 percent (table 1). A substantial proportion also experienced difficulty lifting or carrying

25 pounds (23 percent), standing on their feet fo:r 2 hours

(22 percent), walking one-quarter of a mile (18 percent),

and walking up 10 steps without resting (15 percent). Very

few people in this age range had any difficulty reaching out

to shake hands and very few were unable to lift 10 pounds.

In general, a greater proportion of women than men

had difficulty performing the work-associated activities.

The sex difference was largest for the proportion with

difficulty lifting or carrying 25 pounds (31 percent of the

women, compared with 16 percent of the men). %x differences of a smaller magnitude were evident for the ability to

\valk Up 10 steps; stoop, crouch, or kneeL and lift or carry

10 pounds. For these four activities, the sex differcncrwere most pronounced in the oldest age category. Twenl

five percent of the women 70-74 years of age had difficulty

walking up 10 steps WidlOLlt resting, inc]uding lC~percent

who were unable to do so. In comparison, 18 percent of the
advancedata 3

men this age had difficulty walking Up 10 steps, including 9

~erccnt who m’cre unable to do so.

Among people who had worked since the age of 45, a

~efini[e increment from younger to older age groups was

obsemed in both the proportion of people with any difficul~. and the proportion unable to perform several of the

actmties assessed. Increases !vi[h age were especially apparent for five activities that reilect mobility and musculoskeletal strength: walking one-quarter of a mile; walking up

10 steps; standing on feet for 2 hours; stooping, crouching,

or kneeling; and lifting or carrying 25 or 10 pounds. For

each of these activities, people in the youngest age category

(55-5!) years) had the Iow-est proportion reporting any

difficulty, and that proportion was nearly doubled among

peopIe in the oldest age category (70-74 years). For example, 12 percent of the peopIe 55-59 years of age had

difficulty walking one-quarter of a mile, compared with 25

percent of those ages 70-74 years.

The same kind of pattern was observed in the proportion of people unable to perform these activities. Nine

percent of the people ages 55-59 years were unable to

stoop, crouch, or kneel, compared with 17 percent of those

ages 70-74 years. Differences in ability among age groups

were absent or subtle for the other four activities (sitting

for 2 hours, reaching up over head, reaching out to shake

hands, and grasping with fingers).

.mployment status

Fewer than one-half of the peopIe 55-74 years of age

who had worked since their 45th birthday were presen@

employed—49 and 42 percent of men and women, respectively (table 2). The proportions changed dramatically

across the age span. Nearly 4 out of 5 people 55-59 years of

age were presently employed, compared with about 1 in 10

ages 70-74 years. Even among people who had worked in

midIife, women exited the work force earlier than men. A

lower proportion of women remained active in the labor

force at each age, and the difference was especially notable

at the youngest ages.

The percent of the peopIe who attributed their retirement to their health was greatest at ages 65 and over, 20

percent or more of each sex in each age group. Among

those who had retired, however, a greater proportion of

people in the younger than the older age groups had retired

because of their health.

Differences among employment groups

The older age of people who were retired must be kept

in mind when interpreting differences among the three

employment-status groups. Nevertheless, there are major

differences among the groups even within this relatively

Irrow sge range. These differences are important when

msidering the impact of changes in retirement Iaws.

People who were presen[ly employed were Ie’sslikely

than retired people to have difficulty performing each of

the 10 work-associated activities (table 3). For the majority

of the activities, the proportion with difficulty was two to

three times higher among people who had retired than

among those who maintained employment. For example, 17

percent of the people who were presently employed had

difficulty stooping, crouching, or kneeling, and 1!) percent

were unable to do so. in contrast, 37 percent of [he retired

population had this difficulty, and 15 percent were unable

to stoop, crouch, or kneel. About 10 pm-mnl of presendy

employed people had difficulty standing on their feet for 2

hours, compared with about 32 percent of those \vho had

retired.

People who had retired because of their health \vcre

the most likely of the three groups to have difficulty \vith

each of the activities. The proportion \viLh difl~culty was

highest for the activities associated wilh mobility and

strength, such as walking one-quarter of a mile (54 percent); walking up 10 steps w-ithout resting (4S percent);

standing on feet for 2 hours (63 percent); stooping, crouching, or kneeling (65 percent); and lifting or curging 25

pounds (62 percent).

In generaI, the proportion wi[h difficulty for each

activity was somewhat higher among the people ~vho had

retired for reasons other than their health than among

people who were presently employed. However, people

who had retired for reasons other than their health were

more similar to the presently employed than they were to

people who had retired because of their health. The pattern

of the lowest percents among the presently employed,

intermediate percents among people Jvho had rs[ired for

reasons not attributed to their hetiith, and th: highest

percents among those retired because of their health \vas

present and similar for both sexes.

Differences by age within employment

groups

Age-specific data for the three employment groups me

shown for four activities in tabIe 4. Generally, the proportion with difficulty was higher in successive age groups for

both the presentIy employed and those who had re[ircd for

reasons other than their health. For example, among presently employed people, 7 percent of those 55-59 ::ems of

age had difficuhy walking one-quarter of a mile compared

with 11 percent at 70-74 years of age. Among ~cnple who

had retired for reasons not related to their he~ith, the

percents were 7 and 1S, respccrively. The one exce~tion was

in difficulty walking up 10 steps without resling; [here was

no age difference among the presently employed. Age

patterns similar to those for both sexes combined were

observed for each sex in these two employment-status

groups.

A much higher proportion with difficulty was obsemed

in every age category of people who had retired because of

their health than for other retired persons or the presently

employed. The number of retired people in the ::oun~:st

age group in the sample was small, estimates are less

precise than for other age-specific groups. and I<*.Ydifferences are statistically significant. Hmvever, there did appear

to be a different pattern by age among those ‘.vho had

retired because of their heaith: thr most activities, the
4 advancedata

proportion with difficulty was highest among the youngest

people. This was parucular]y noticeable for men in the

youngest age category for activities related to mobility. For

example, 71 percent of the men 55-59 years of age who had

retired because of their health had difficulty walking onequarter of a mile, compared with about one-half of such

men in the other age groups.

Commentary

Overall, 58 percent of the people ages 55-74 years who

had worked at some time since their 45th birthday had no

difficulty with any of the 10 work-related activities. The

proportion w’as highest among those still working (73 percent) followed by those who had retired for reasons other

than their health (60 percent), and it was lowest among

those who had retired because of their health (14 percent).

Potentially, many of the peopIe who had retired for reasons

other than their health could have remained in the labor

force.

When retired people were asked if they could work at a

job or business if such an opportuni~ were available, about

two-thirds of the people who had retired for reasons other

than health answered affirmatively although only about 1:

percent of them expressed a desire to work. Among peep

who had retired because of their health, only 28 percem

said that they could work if a job were available, and only

about 10 percent wanted to do so, as shown in the following

table.

Retired &L2?LlsJ3of!

Totaf Other

Employment potential retired Heatth reasons

Nolimtiations . . . . . . . . . . . . . . . . . . 45.9 13.7 60.2

Could work f job available . . . . 52.8 27.7 64.0

WanttoworR . . . . . . . . . . . . . . . . . . 11.2 10.2 11.6

Thus, the majority of those who were retired for reasons other than health were not impaired. They also said

that they could work if a job were available. However, very

few of these potential workers wanted to be employed. The

majority of those who had retired because of their health

had at least one limitation and said that they could not

work. Therefore, whether the recent changes in retirement

laws will actuaIly change the age at which people retire

remains to be seen.
advancedata 5

Table 1. percent of people 55-74 years of age who have worked since age 45 with difficulty or unable to perform specified activities by

sex, age, and activity United States, 1984

Sottrsexes Men Wornen

55-59 60-64 6S69 70-74 55-59 60-64 65%9 70-74 55-59 60-64 65-69 70-74

Actiwiy Total years years years years Total years years years years Tot& years years years years

Number

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,205 2,000 1,958 3,285 2,552 5,11XI 1,036 1,087 1,731 1,266 4,705 984 901 1,554 1,286

Number in thcueands

Esttma!ed population . . . . . . . . . . . . . . . . 32,305 9,645 9,235 7,561 5,884 16,936 5,023 5,037 3,989 2,907 15,368 4,622 4,197 3,592 2,957

Waking % mile

Dffiiulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Walking up 10 steps

Dltflculty . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standing on feet for 2 hours

Diffhxtfy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sttting for 2 hours

Dtffbulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stooping, crouching, or kneeling

Dfftculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reaching up over head

Wfbully.. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reaching out to shake hands

Dttflculfy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Graspingwiihfkrgere

Dtrfiiulfy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lfilng or carfylng 25 pounds

Dfftculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lifting or carrying 10 pounds

Dtfkutly... . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17.6

7.6

15.2

6.9

22.0

9.0

9.7

5.9

27.6

126

11.5

6.4

1.8

1.0

7.8

5.0

23.1

6.9

7.3

26

12.4

5.4

10.9

5.2

15.1

6.5

8.3

5.3

ml

9.4

9.0

4.6

1.8

1.0

6,4

4.2

17.0

6.2

5.0

2.2

16.5

8.0

14.5

6.9

20.7

8.3

10.6

6.5

27.0

12.5

11.2

6.7

1.6

1.1

7.4

5.0

22.5

6.0

6,9

2.5

20.0

8.7

16.9

7.4

26.1

10.9

10.4

8.4

30.9

13.7

13.1

7.3

1.8

1.0

8.7

5.2

24.8

7.3

8.2

2.7

25.0

9.5

21.4

9.5

30.1

11.6

9.7

5.5

37.8

16.5

14.2

7.7

2.0

1.2

9.5

5.9

32.0

9.1

10.5

3.0

Percent of population

17.4 12.3

7.6 5.0

12.8 9.5

5.6 3.8

20.6 13.5

8.1 5.2

8.4 7.0

4.9 4.2

24.6 18.0

11.4 8.3

10.5 9.0

5.7 3.9

1.6 1.5

1.0 0.8

6.3 4.5

4.0 2.6

15.9 11.6

4.8 3.5

5.3 3.7

1.9 1.6

17.0

7.9

12.1

5.3

18.9

7.2

8.9

5.4

23.4

11.1

9.9

6.3

1.3

0.9

6.0

4.0

15.4

3.8

5.4

1.9

-ml

9.4

14.2

6.0

26.5

10.6

9.9

5.7

27.7

12.5

12.4

6.9

1.8

1.1

7.1

4.5

16.6

5.6

6.6

2.2

23.3

8.7

17.9

8.7

28.9

11.5

7.9

4.1

33.7

15.9

11.6

6.0

2.0

1.0

8.8

5.4

23.1

7.5

6.3

1.7

17.9 12.6

7.7 5.8

17.9 72.4

8.4 6.7

23.5 16.8

9.9 7.8

11.2 9.6

7.1 6.4

31.4 22.4

13.9 10.7

12.7 9.1

7.2 5.4

2.0 22

1.1 1.2

9.4 8.5

6.1 5.8

31.1 22.9

9.3 9.1

9.4 6.4

3.3 2.8

15.8

8.0

17.4

8.8

22.8

9.7

12.7

7.9

31.3

14.2

12.8

7.1

1.9

1.2

9.0

6.2

31.0

8.7

8.7

3.3

19.9

7.9

19.7

8.8

28.7

11.3

10.9

7.2

34.3

15.0

13.8

7.7

1.8

0.8

10.5

6.1

33.8

9.3

9.9

3.3

26.6

10.2

24.8

10.2

31.2

11.6

11.6

6.9

41.7

17.2

16.6

9.5

2.0

1.4

10.2

6.3

40.8

10.7

14.6

4.3
6 advancedata

Table 2. Percent distribution of people 55-74 years of age who have worked since age 45 by employment status, according to sex and

age: United States, 1984

Employment status

Reason for retrement

Est/maled

Number m popu/at/on Oftrer ffmrr

Sex and age samp/e m fffoUSafrds Total Wor)itng Total health Health

Both sexes Percent distrlbul On

55-7~.52rs,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.805 32.305 100.0 45.7 54.3 37.6

55-5: years

16.7

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.000

6C-E: years

9,645 100.0 78,7 21.3 12.0 9.3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.968 9,235 100.0 52.4 47,6 31.4

65-E; yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16.2

3,285 7,561 100.0 21.4 78.6 56.5 22.1

70-7: years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,552 5,864 100.0 12.6 87.4 65.0 22.4

Men

55-7.tvsars,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,100 16,936 100.0 48.9

55.5"&years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .

51.1 33,7 17.4

1,036 5,023 100.0 83.0 17.0 8.3 8.7

60.& yearn .. ..... .. ..... . .... .. .. ... . ... ... .. ... . ... ... 1.067 5,037 100,0 55.5 44.5 27.1 17,4

6S+9 yearn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,731 3,969 100.0 22.0 78.0 54.0 23,9

70.7:yeaE . . . . . . . . . . . . . . . . . . . . ..+ . . . . . . . . . . . . . . . . . . . . . . 1,266 2,907 100.0 15.2 84.8 61.1 23,7

Women

55-74 vsars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,705 15,368 1OQ.o 42.3 57.7 41.9 15.8

55.59 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 964 4,622 100.0 73.9 26.1 16.0 10.0

60.64 yearn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 901 4,197 100.0 46.6 51.4 38.7 14.8

65.69 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,554 3,592 100.0 20.6 79.4 59.2 20.2

70.7L yea= . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,286 2,957 100.0 10.1 69.9 66.8 21.1
advancedata 7

Table 3. Percent of people 55-74 years of age who have worked since age 45 with difficulty or unable to perform specified activities by

~mployment status, sex, and activity: United States, 1984

Reason for refirem%nt

OtRer than

ActMY Total Working Total Irealth Health

BOTH SEXES

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimated population . . . . . . . . . . . . . . . . . . . . . . . . . .

Walking JAmile

Difficully . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Walktng up 10 steps

Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standing on feet for 2 hours

Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stting for 2 hours

Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stooping, crouching, or knwling

Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reaching up over head

Ifflcully . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reaching out to shake hands

Dfflculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Grasping with fingers

Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lifting or carrying 25 pounds

DMiiuity . . . . . . . ...<. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lilting or carrying 10 pounds

Diftlculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MEN

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimated population . . . . . . . . . . . . . . . . . . . . . . . . . .

Walking X mile

Dtfflculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Walking up 10 steps

Diffkmlty.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standing on feet for 2 hours

JMllty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S~lngfor2houts

Dlfficutty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9,805

32,305

17.6

7.6

15.2

6.9

22.0

9.0

9.7

5.9

27.8

12.6

11.5

6.4

1.8

1.0

7.8

5.0

23.1

6.9

7.3

2.6

5,100

16,938

17.4

7.6

128

5.6

20.6

8.1

8.4

4.9

8.4

5.1

6.6

4.2

10.2

5.9

5.4

3.9

17.0

9.7

6.0

4.1

0.5

0.3

4.1

3.1

11.8

5.2

24

1.1

2034

8,262

7.9

4.7

4.6

2.5

8.6

4.9

4.2

3.0

Number

3,626 6,179

Number in !Rousancts

14,777 17.527

Percent of popu!at:wr

25,4

9.8

22.5

9.2

31.9

11.6

13.4

7.6

36.9

15.0

16.2

8.3

2.8

1.7

10.9

6.6

32.7

8.4

11.4

3.8

Numt@r

3,066

Numberinthousands

8,654

Percentofpopulatmn

28.5

10.3

20.7

8.5

32.0

11.3

12.4

6.7

4,375 1,604

12.146 5,382

12.8

6.7

11.0

6.0

18.2

9.3

6.8

4.7

24.4

13.2

8.0

5.2

1.1

0.6

5.9

4.2

19.9

7.2

5.1

20

2,076

5,704

11.9

6.6

53.9

16.6

48.4

16.4

62.6

16.7

28.3

14.2

65.2

19.3

34.7

15.5

6,8

4.0

22.1

1~.8

61.8

11.1

25.6

7.8

990

2,950

54.8

17.5

8.1

4.7

18.1

8.9

5.3

3.7

45.1

15.9

62.7

15.7

26.0

12.5
8 advancedata

Table 3. Percent of people 55-74 years of age who have worked since age45 with difficulty or unable to perform specified activities by

employment status, sex, and activity: United .%eies, 1984—Con.

Reason for retirement

AcMy

Other than

Total Working Total health Heatth

MEN–Con.

StOoplng, crouching, or kneeling

DtffICufty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reaching up over head

Dlfficufty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reaching out to shake hands

Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Grasping wlh fingers

Difflculfy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Liftlngorcarrying 25pounds

Oifficutty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lifting or cerryng 10 pounds

Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

WOMEN

.%mpte . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimated population . . . . . . . . . . . . . . . . . . . . . . . . . .

Walklng 1Amile

DHIcufty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Walking up 10 steps

Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S!andmgonfeetfor 2hours

Difficulty ,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Smmgfor2hours

DffIcuily . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stooping, crouching, or kneeling

Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reaching up over head

Dtfflculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reaching out 10 shake hands

DmIcully . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Grasping wlih fingers

Difficulty, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ltfmg or canyng 25 pounds

DIffIcu’ly ,,.. . . . . . . . . .

Urmle. ., ,, , .,..,,,..,.,,,

Litim~vcawtr; 10 pounds

DY:..’,

L;. .: .-.

24.6

11.4

10.5

5.7

1.6

1.0

6.3

4.0

15.9

4.8

5.3

1.9

4,705

15,366

17.9

7.7

17.9

&4

23.5

9.9

11.2

7.1

31.4

13.9

12.7

7.2

2,0

1,1

94

6.1

311

9.3

~:

::

14.3

8.5

5.4

3.5

0.4

0.3

2.7

2.0

5.9

2.6

1.3

0.7

1,6e2

6,495

9.1

5.5

9.3

6.4

12.2

7.2

6.9

5.1

20.3

11.3

6.7

4.8

0.7

0.3

5.8

4,4

193

8.5

38

17

Percentofpopulafion-Con.

34.4

14.2

15.4

7.8

2.7

1.6

9.7

5.8

25.6

6.8

9.2

3.0

Number

3,113

Number in Ihousands

8,873

Perc8nt of population

24.4

9.3

24.2

9.9

31.8

11.9

14.4

8.5

39.4

15.8

17.0

6.9

2.9

1.8

12.1

7.3

39.7

10.0

135

45

19.8

11.8

5.8

3.6

0.9

0.5

4.0

3.1

10.9

5.0

29

1.2

2,299

6,442

13.6

6.6

13.6

7.2

20.0

9.6

8.0

5.6

26.5

14.4

10.0

6.6

1.2

0.7

7.6

5.2

27.8

9.2

7,1

2.7

02.6

‘16.9

:33.9

‘15.8

6.2

3.6

20.7

111.0

50.8

10.3

21.5

6.5

814

2,431

52.9

15.9

52.4

17.1

63.0

17.9

31.1

16.3

68.3

19.7

35.6

15.1

7.4

4.5

23.9

12.6

71.5

12.1

35.5

~:

.—
advancedata 9

Table 4. Percent of people 55-74 years of age who have worked since age 45 with difficulty or unable to perform selected activities by

~ge, activity, and employment status: United States, 1984

55-59 60-64 65-69 70-74

Ac!iwiy and employment status Tote/ years years years years

Walldng M mile

Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ret!recl: ofherthan health.. . . . . . . . . . . . . . . . . . . .

Re[lred: Heallh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Walking up 10 StepS

Workin g. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reltred: Other than health . . . . . . . . . . . . . . . . . . . . .

Rellred: HealttI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standing on feet for 2 hours

Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Retired: Other !hanheaith . . . . . . . . . . . . . . . . . . . . .

Relired: Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stooping, crouching, or kneeling

Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rellred: Other U’ranhealth. . . . . . . . . . . . . . . . . . . . .

Retired: Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Walking M mile

Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Retired: Other than health . . . . . . . . . . . . . . . . . . . . .

ReIired: Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Walking up 10 steps

Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Retired: Other than health . . . . . . . . . . . . . . . . . . . . .

Rellred: Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standing on feet for 2 hours

Orkmg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rellred: Other lhan health . . . . . . . . . . . . . . . . . . . . .

Retm+i’:Hea lIh ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stooping, crouching, or kneeling

Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Retired: Other fhan health . . . . . . . . . . . . . . . . . . . . .

Rellred: Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of population wth difficulty

9.3

9.8

52.5

7.2

8.8

49,3

10.5

15.4

63.8

17.8

21.8

67.0

Percent of papulafion unable

6.1

5.4

18.9

4.7

5.3

16.9

5.9

77

17.4

9,9

116

228

8.4

12.8

53.9

7.2

6.5

64.3

10.1

11.9

50.4

11.1

18.1

52.8

6.6

11.0

48.4

6.2

7.4

54.5

7.0

9.9

4.$.1

6.1

15.0

48.7

10.2

18.2

62.8

9.4

10.9

68.5

11.5

18.0

60.9

13.9

22.8

60.4

17.0

24.4

65.2

15.4

16.4

64.8

18.1

22.1

65.6

24.9

31.6

62.9

5.1

6.7

16.8

3.9

4.2

19.6

6.4

6.7

15.8

7.3

8.4

13.8

4.2

6.0

16.4

3.9

3.6

18.2

4.8

5.4

14.8

4.0

8.0

16.8

5.9

9.3

16.7

5.5

5.0

16.4

6.7

100

17.2

7.5

11.0

15.5

9,7

13.2

19.3

8.7

6.1

17.2

11,4

.-r .-

:92

14,8

168

16.7
10 advancedata

Technical notes

Each week a probability sample of households in the

LTnited States is visited by LT.S. Bureau of the Census

inten~iewers to obtain a wide range of information about

the health and health care characteristics of the people

living in those households. A description of the survey

design, methods used to make the national estimates, and

general qualifications of the data are provided in a report in

the Wal and Healfh Statistics series.

There was a special supplement for people age 55 and

over to the NHIS in 19S4, the Supplement on Aging

(SOA). A report on the SOA design and procedures that

contains the questionnaire is in press.’ Two deviations from

usual hTHIS practice that are of importance for this report

should be noted. First, although everyone age 65 and over

in the hWIS households was included in the SOA sample,

only one-half of the people 55-64 years of age were included. Second, extensive efforts were made to have each

person answer the questions on the SOA personally regardless of \vhether he or she had been a self-respondent to the

regular NHIS intemiew.

There were 11,744 people with responses to the SOA

who were 55-74 years of age; 93 percent answered all

questions for themselves (table I). There was little variation

in whether people were self-respondents by age within this

age range, but men were less likely to answer for themselves than women were, usually because the men, especially younger men, were a~vay from home.

Table 1. Response status of sample of people 55-74 years of age

All

response Not Percent

Age and sex statuses Self self self

Total . . . . . . . . . . . . . . . . . . . .

Age

55.59 years, . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . .

Sex

Men . . . . . . . . . . . . . . . .. . . . . . .

Women . . . . . . . . . . . . . . . . . . . .

Number

11,744 10.927 617 93.0

2,341 2,150 191 91.8

2,310 2,134 176 92.4

3,956 3,70+3 2.50 93.7

3,137 2,937 20) 93.6

5,233 4,694 539 89.7

6,511 6,233 276 95.7

The estimates in this paper are based on a sample

rather than on the entire popukltion of people 55-74 years

‘N.l~lonal Center for Hcal!!I S[atislix. h{. G. Kovar and G. S. Poe: The

ti.~tlmrdl Health In!erww Survev desl~n, IQT3.S4. and procedures,

1Q-5.s; I ;rti; and / icd!;h Srarisrir.s. Serius 1, Nc,, 1S, DIIIIS PuII. No.

(t’IIS) S5-132(!. Puhtic Health Scmlcc, M ashingon. U.S. Government

Prlnling Ofi-ICe, Aug. 19S5.

2Notional Center fnr Ilealth Statistics. J. Fitti and M. G. Krwax The

$ur~lement on .4gmg. des]gn and procedure~ J’71u/and }Iealrh S/arisrics

Ser],.s 1. h.. 21 DIIIIS ?uh. Nr. (P IISi S7-1320. Public lIe:!lth Scrwce,

W’ashlngon. U.S. Government Printtn: Office In press.

of age in the civilian noninstitutionalized populatio’

Therefore, they are subject to sampling error. In additiol.

the sample had a complex design which has the effect of

making the sampling errors somewhat larger 1han they

would be from a simple random sample of the same size

using the same procedures.

Most of the tables in this report show the number of

people in the sample. and table H provides some average

design effects to enabl: the user to estimate sampling

errors that incorporate the complex sample design.

Table IL Average design effects for estimates of percent with

difficulty

Square root

Desvgn of Ues/gn

Popu/atior7 effect effecf

Tonal., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,2326 1.11

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3409 1.15

&omen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2791 1.13

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9770 0.99

65-74 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1759 1.08

To estimate the sampling errors, convert the percent to

a proportion, calculate the variance of a proportion assure

ing simple random sampling, multiply that variance by t]

design effect to allow for the complex sample, then com

pute standard errors, confidence intervals, or significance

tests.

For example, there were 1,592 women 55-74 years of

age in the sample who \vere working. Twenty percent had

difficulty stooping, crouching, or kneeling. Therefore,

Variance (simple random sample) = ~

= %l%PJ

= 0.000102.

The average design effect for women is 1.2791.

Variance (complex sample) = (0.000102)(1.2791)

= 0.000130.

Standard error = (0.000130)’”

= 0<0114.

~~-percent confidence intcma] = 20.3 Z (1.96)(1.14)

= ~().~ z ~.~ pcrcen[,

It should be noted that this exomple gives a conscmt

tive estimate. Bccauw of the half-sample of people ages

55-64 years. t]lcre is lj[[]e c]tlstcrjng in hoL!sc]lo]ds for

people of that age and the cfcsign effects tire so small that

the complex sample design has little impact on the variance.
advancedata 11

Table Ill. Confidence intervals for selected estimates of percent

with difficulty

95percent

Cunfldence mlerva/

Estimated Lower Upper

ActMy and sex percent bound bound

Walking I,i m[le

Buth sexes . . . . . . . . . . . . . . . . . . . . . . . .

glen, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

,vomen . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Walhmgup 10stepswrthout

resting

Both sexes . . . . . . . . . . . . . . . . . . . . . . . .

?.len . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standing for 2 hours

Bolh sexes . . . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

‘Women . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sitlmg for 2 hours

Seth sexes . . . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

‘Women . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sfocpmg, crouching, or kneeling

Bolh sexes,....................,..

‘glen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.“Jomen . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reaching up over head

-m sexes . . . . . . . . . . . . . . . . . . . . . . . .

%fen .

;Vomen” . .”””””””’””””’”’”””””’””””’” . . . . . . . . . . . . . . . . . . . . . . . . . .

Reaching out to shake hands

Both sexes . . . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Grasping wth fingers

Both sexes . . . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lrffing or carrying 25 pounds

BoIh sexes . . . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lifting orcarrying 10 pounds

Bothsexes . . . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17.6

17.4

17.9

15.2

12.6

17.9

22.0

20.6

23.5

9.7

8.4

11.2

17.8

24.6

314

11.5

10,5

12.7

1.8

1.6

2.0

7.8

6.3

9.4

23.1

15.9

31.1

7.3

5.3

9.4

16,8

16.1

16.8

14.4

11,6

16.8

21.0

19.3

22.1

9.0

7.5

10.3

16.8

23.4

29.7

103

9.6

117

1.5

12

1.6

7.1

5.5

8.3

22.2

14.6

29.5

6.8

4.7

8.5

18.5

18.7

19.0

16.0

13,8

19,2

23.0

21.9

24.9

10.4

9.3

12.1

18,8

25,8

33,0

12.2

11.4

13,6

2.0

1,9

2.4

8.4

7.1

10.5

24.1

17.3

32.7

7.8

6,0

10.4

Also, because the sample is w large, the stand:lr~

errors are relatively small despite the complex wmplc.

Confidence intervals are shcwm for t:ich functional Clisfillility for both sexes m-d for men tind w’omen in tuhlc III for

people who \vish to use thcrn.

Perhaps more important for inlcrpre(ation than s;lmplingerrors, howmw,isathorough undcrsttinding of~vll:lt

data from this, or any other, cross-sec[i[)n:d sumcy can

provide.

The XHIS isapoint-in-tinle study .Associations:it one

point in time should not be interpreted as causality. The

diffmmccsin ftlnctional distibility :inl(~ngtlle Cmploj”mcnt

groups, for exwnpk, shoukl not be interpreted to metin thtit

these specific disabilities caused the people to retire because of health. .-l specillc disability coukl have begun

before or after retirement; data from a cross-sectional

survey do not enable one to make that distinction. iNor can

the data from across-sec[ional sumqbe used to estimate

the total number of people ivho have done any specific

thing in the past such as the number Jvho retired because of

health; there may have been differential mortality prccccling the interview. The data sent only to point out that

when they w’erc int cmicw’cd, people \vIlo had ret ircd, and

especially those who had reLired because of health. ~verc

more likely than those who \vcre sli[l \vorking m report any

of the clisabili[ies that ~vere inves[igutcd.

This may be enough to suggest, Ilo\vcver, that data

based sokly on \vorking populati~jns we nut sutlkicnt for

investigating age-related clmngcs in [ht proportion uf people with dillicuhy or inabili[y to pcriorm a specified task.
From Vital and Health Statistics of the National Center for Health Statistics Number 137 ● July 2, 1987

Diagnosis= Related Groups Using Data From the

National Hospital Discharge Survey: United States, 1985

by Edmund J. Graves, Division of Health Care Statistics

Introduction

Diagnosis-related groups (DRG’s) are used by the Health

Care Financing Administration, some States, and some thirdparty payers as the basis for reimbursing hospitals for inpatient

care, 1 The Federal application of DRG’s is the prospective

vayment system for kledicare inpatients. The necessary patient

information (diagnoses, procedures. age. and dischasge status)

to generate national estimates on hospital utilization for these

categories is collected for the National Center for Health Statistics by means of the National Hospital Discharge Sumey

(NHDS ). This report presents selected estimates for 19S5

from NHDS on patients discharged from non-Federal short-stay

hospitals by DRG.

In an attempt to control rising Medicare costs, the Health

Care Financing Administration changed the basis for determining how hospitals are reimbursed for inpatient care. Under

the Tax Equity and Fiscal Responsibility Act of 1983,2 reimbursement for inpatient care changed from fee-for-setvice to

a prospective payment system. Under this system a hospital

is reimbursed a preestablished amount based on a series of

calculations used to compute the average cost of care for

patients with similar conditions and treatments. These similar

conditions and treatments are defined as a set of mutually

exclusive categories called diagnosis-related groups, or

DRG’s.

The prospective payment system using DRG’s was implemented on October 1. 1983. Individual hospitals started

in the system beginning with their first tlscal year after this

date. Therefore. by September 30. 1984, all hospitals designated to be under DRG reimbursement were in the system.

Two previous reports on DRG’s published by the National

;enter for Health Statistics- ~.4 included data on the most frequent DRG”s. A more detailed report on DRG’s was published

in a series 13 Vitu[ atui Health .$[atistics report. 2

DRG’s were developed at the Yale School of Organization

and Management under the guiding principle that “The primaty

objective in the construction of DRG’s was a definition of

case type. each of which could be expected to receive similar

outputs or services from a hospital. “b Initially there were

470 DRG’s used in the prospective payment system. each

with an associated relative cost weight used to establish the

prospective payment for a patient in euch DRG. This ~pproach

to health care reimbursement operates on the premise that

patients with similar medical conditions should recei~e similar

care and use approximately the same resources. Therefore.

although there is a variation in resource consumption among

patients within a DRG, this variation is expected to balance

out across the range of all patients.

A detailed description of the development and construction

of DRG’s is availabie.b and current DRG-S and relative cost

weights are published in the Federal Register. DRG’s and

the relative cost weights are subject to modification for a

number of reasons. Therefore, it is important for anyone using

DRG data to examine changes in the system that could affect

their analysis.

The statistics in this report are based on data collected

by the National Center for Health Statistics by means of

the National Hospital Discharge Sumey INHDS ). which is

a continuous voluntary suwey conducted since 1965. The

data for the survey are obtained from a sample of inpatient

medicaI records from a national sample of short-stay general

and specialty hospitals located in the United States. A detailed

report on the design of NHDS was published in 1970.7 In

1985, for the tirst time, two data collection procedures were

used in NHDS. The traditional procedure involves a manual

system of data abstraction in the hospitals: the new procedure

is an automated method that involves the purchase of data

tapes from commercial abstracting semices. The new procedure is used in 17 percent of the hospitals.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ‘ubhc Health Serwce
2 advancedata

Approximately 194.800 medical records from 414 hospitals were included In the 19X5 survey, The relevant variables

requ]red to produce DRG’s (diagnose~. procedures. sex. age,

and other vmables) v,ere abstracted from the Pdce sheet of

each sampled medical record, and NHDS data thereby could

be used [O produce nat]ona] estimates of DRG’s. These estima[es ma: be of value for hospitals to comp,m their experience

with that oi other hosp]tals. For this reason. stat]stws in this

report are frequency est]mates and associated a~erage length

of stay for DRG”s b: I_’S. [otals. h(>spital size, and region

of the counm

Highlights

The frequency and avera:e length of stay for the most

common DRG’s are presented by age. region of the country,

and hospttal size in tables I--4, Age is dichotomized as under

65 years of a:e and 65 years of age and over, This allows

a c{mpanson with the A!edicare population because Medicare

c{n ers mc~st hospital costs for approximately 95 percent of

dlschw:e~ 65 years of age and over. Tables 1 and 2 provide

rc:i(>na] data. and tables 3 and 4 provide bed-size data for

these DRG”>. Tables I and 3 contain findings for patients

under 65 year~ of age. and tables 2 and 4 include the survey

results for patients 65 year< of age and over,

B> defini[lon, some DRG’s are onlj for patients in a

specific age range. In such a case the DRG title and the

table title (tables 14) together define the age group of the

estimate. That is, the most restrictive case of either the table

or DRG tide determines the age group of the estimate. For

example. “’diabetes, age 36 or over” in table 2 refers only

to patients 65 years of age and over because of the table

title: “simple pneumonia and pleurisy. age 70 or over and/or

substantial comorbidity and complication’” in table 2 would

not include a patient under 70 years of age because of the

restriction in the DRG title.

The most common DRG for patients under 65 years of

age was “vaginal delivery without complicating diagnoses”

(table 1). with an estimated 2.6 million discharges in 1985.

“Cesarean section without substantial comorbidity andlor complication.” with 761,000 discharges. and “medical back problems.” with 741.000 discharges, also were among the most

frequent DRG’s in this age group. For patients 65 years of

age and older (table 2 ) “’heart fi~ilure and shock’” was the

most common DRG (469,000 discharges), and “simple

pneumonia and pleurisy. age 70 or over and/or substantial

comorbidlty and complication’” and “specific cerebrovascular

disorders except transient ischemic attacks.” with 357,000

and 350.000 discharges respectl~elj. were the next most common DRG’s for the elderly.

The average length of stay for specific DRG’s in the

four regions of the country generally reflected the pattern

found for all patients. Regional length-of-stay differences were

greater for patients 65 years of age or over than for younger

patients. The Northeast had an average length of stay of

6. I days for patients under 65 years of age. and the West

had an average length of stay of 4.7 days. a difference of

1.4 days. or 30 percent greater. For older patients, however,

the Northeast had an average length of stay 3.8 days greater

than for the elderly patients in the West ( 11.0 versus 7.2

days). a difference of 53 percent.

Overall there was a tendency for length of stay to increase

with hospital size (tables 3 and 4) for patients under 65 }’ears

of age as well as for older patients H~Jw,e\cr. tht; average

length of stay in small and medium-size hospitals for some

of the individual DRG’s is equal to or greater than the average

length of stay in large hospitals (500 or more beds).

The average length of stay associated with a DRG (tables 1-4) allows hospitals to compare their experience with

that of other hospitals. Though comparison is tenuous on

a case-by-case basis. an administrator of a h~lspital with an

average length of stay 2. 3. or more dtiys longer than the

national average for a specific DRG may want IO examine

why the hospital is so fw froni the norm. Thi\ kind of comparison may be worthuhilc as a stwtin: point. bu[ it is important

to remember that. even within a DRG. avemge IIength of

stdy is not an exact measure of resource consumption.

When making these comparisons of average IIength of

stay, the general downward trend in the lengths of hospital

\’isits for the previous 16 years should be noted. There has

been a steady decline in average length of stay in all regions

of the country since 1970, with a more precipitous fall in

the last 5 years. s That is, although average length of stay

for all patients aged 65 and over declined 2.6 days during

the 11-year period 197&8 1, an average drop of 0.24 days

per year, the drop from 1981 through 1985 was 1.8 days,

or 0.36 days per year.

One of the expected outcomes of the prospective payment

system was an overall reduction in length of sta:y. Given

the existing trend it may be difficult to evaluate the effects

of DRG’s on average length of stay because it clecreased

significantly before the DRG program and because there is

a threshold effect for this variable. That is, at a certain point,

length of stay cannot be further reduced. The data in table 5 give the year-to-year percent change in length of stay

from 1980 through 1985. It is evident from this table that

in 1984 there was a larger reduction in average length of

stay than in previous years for patients 65 years of age and

over—patients most affected by changes in the Medicare system. However, the change in average length of stay was

not significant in 1985 when compared with 1984 fo:r patients

under 65 years of age. and it is possible that further reduction

in avera:e length of stay maybe difficult to obtain,
advancedab 3

Table 1. Number of discharges and average length of stay of patients under 65 years of age discharged from short-stay hospitals, by selected diagnosisrelated groups and geograph= region: United States. 1985

%.charges ‘WIT Pen. Pederal shorr.stay bosimials Excludes newbm infants]

All All

D/agnoss-related group reg!ons NoHheast Mdwest South West regions Northeast Mdwest South West

All discharges

Vaginal del!very without compllcat!ng dKXJflOSeS

Cesarean sect!on wrthout sub?danttal

comorbrdlfy and or comphcatton

Medcal back problems . .,, ,.

Nonradical hysterectomy, age less than

70 years without substantial COrtIOrbidtty

andorcomphcatlon .

Psychoses .,......,,.. . .

Esophagms, gastroenterms.. and miscellaneous

digestwe disease age 16-69 w!thout substantial

comorbldty and. or comphcatton . .

Unrelated operating rcem procedure . .

Alcohol and substance+ nduced orgamc

mental syndrome . . . . . . . . . . . . . . . .

Bronch!tls and asthma age under 18.

Back and neck procedures age under 70 without

substantial comorbldity and!or comphcallon . .

Esophagitis, gastroentent!s, and miscellaneous

dlgestwe dtsorders age under 18 . . . .

Angmapectons . . . . . . . . . . . . . . . . . . .

Other antepartum diagnoses wih

med!cal comphcatlons . . .

Vaginal dehvery with sterhzation and or dilation

andcurettage of uterus.,..

Abortion w[th dilat{on and curettage of uterus

Uterus and adenexa procedure for non-malignancy

except tubal mterruptlon . .

%ophagms. gastroenterms. and m!scedaneous

d!gestwe disease age 70 or over and or substantial

comorbldty and or comphcal[on .,

Simple pneumoma and pleurisy age under 18, ~ j .

Clrculatov d!sorders except acute myccardlal

rrfarctlon, w!th card!ac cathetenzat!on

wlthoul complex dragnosls . . .

Foot procedures .,,,...,, ,,, . . .

Ingumal and femoral herma procedures

age 16-69 without substantial comormdity

andor comphcatlon . .

Bronchltls and asthma age 18-69 w!thout substantial

comorbtdtty and or compkcat[on

Cmculatow disorders with acute myocardlal

infarction wihout cardiovascular Compl!catrons,

discharged ahve .

Vaginal dehvery with comphcatmg dtagnoses

Appendectomy w!thout complicated pnnc?pal

dlagnosls age under 70 without suostant!al

Comorbtdlty and or cornphcat[on

Tonsdlectomy and or adeno!dactomy only,

age under 18 ,,

Other factors mifluencmg health status

Number m thousands

24.548

2,552

761

741

503

478

412

317

310

302

273

268

234

230

222

221

217

216

211

211

211

202

t 94

192

190

189

187

186

‘4,L37 b

463

133

123

w

125

62

58

132

54

35

46

63

37

32

81

44

34

25

38

28

49

41

40

29

35

33

39

---- 6.288 8,930 4,514

638

181

171

115

144

104

89

92

80

65

77

49

60

44

38

53

52

59

70

50

52

47

44

49

49

54

44

853

277

316

221

119

201

115

51

130

114

114

83

88

106

72

75

94

102

73

92

67

73

?7

70

63

75

59

599

170

131

107

90

46

55

35

38

60

31

39

45

39

30

45

37

25

31

40

34

34

31

42

43

27

45

Average length of stay m days

55

2.6

5.0

5.6

5.9

t 5.5

3.5

I 0.4

9.9

3.5

8.9

3.3

4.0

3.6

3.2

1.6

5.0

4,7

4,2

2.8

3.1

28

45

77

35

3.7

15

38

6.1

3.0

5.8

6.9

68

19.0

3.8

12.7

9.3

3.3

10.0

3.0

46

4.3

3.5

1.7

5.2

49

4,5

2.9

3.5

27

49

91

42

41

20

42

5.9

2.9

5.3

5.8

6.2

159

3.6

10.1

12.8

3.9

8.6

3.4

4,1

3.7

3.5

1.6

4.9

5.1

44

2.7

3.7

2.7

42

87

36

38

13

45

52

2.6

49

56

61

13,6

3.5

10.3

7.3

3.6

9.3

3.7

3.9

3.5

32

15

5.4

47

40

33

29

33

.$8

73

37

37

16

31

4,7

2.0

4,4

3,8

4,9

12.4

2.8

8.5

8.2

2.8

7.7

2.3

3.0

2,9

2.8

1.4

4.3

4,0

4,5

2.0

2.9

17

36

65

2,7

3.4

1,1

36
4 advancedda

Tabk 2. Number of dkcharges and average length of stay of pdenta 65 years of age and over discharged from short-stay hospitals, by selected

diagnosis-related groups and geographic region: United Stateq f 965

[Drscnargest,om non-Federal short-stay hospttals Exc.des newborn mlants]

All All

D:zgnos(s-related group regtons Northeast Midwest South Wesf regions Northeast M/dwest South Wesf

All discharges . . . . . . . . . .

Heart fa(lure and shock

Simple pneumonta and pleurisy age 70

or over and or substantial comorbldlty

and comp!!cat)on

Speclfrc cereorovascular disorders except

transient mchem!c attacks

Angina pectorls

Esophag![!s. gastroenterltm and miscellaneous

d!gestwe d!sease age 70 or over and or

substantm comorbldiy and comphcat!on

Cnromc obstructwe pulmonary disease

Cardiac arrhythmia and conduction disorders

age 70 or over and or substantial

comorbldKy and compltcatton

Nutrttlonai and miscellaneous metabolic dE.orders

age 70 or over and,or substantial

comorbldty and comphcat!on .

Unrelated operating room procedure

Bronchitis and asthma age 70 or over and/or

substantial mmorbldlty and comphcatton

Transient Ischemlc attacks

Atherosclerosis age 70 or over and or

substantial Comorbldtty and comphcatlon

Circulatory d!sorders w!th acute myocardtal

mfarct!on wtthout cardiovascular comphcatlons,

d!schargedahve. . . . . . . . .

Transurethral prostatectomy age 70 or over and or

substantial comorbldlty or comphcatlon

Kidney and urinary tract mfecttons age 70

or over and or substantial comorbldity or

comphcatlon . . . . . . . . . . . . . . . .

Major )omt procedures

Medical back problems . . . . . . . . . . .,,

Gastromtestmal hemorrhage age 70 or over andfor

substantial mmorbldity and complication

HIP and femur procedures except maJor

joint age 70 or over and:or substantial

comorbldtty and compltcatlon . . .

Respiratory neoplasms . . .

Lens procedures . . . . . . . . . . . . . . . . .

Diabetes age360r over . . . . . . . . . . .

Cwculatofy dlsordera with acute

myocard!al mfarcbon and cardiovascular

comphcations, discharged ahve

Major small snd large bowel procedures

age 70 or over and or substantial

comorbldtly and comphcatlon

Red blood cell d!sorders age 18 or over

Number m thousands

10,508 2,353 2.823 . . . . ---

357

350

316

296

257

248

217

196

188

184

179

172

169

166

168

158

153

148

139

138

137

134

123

106

123

74

75

78

63

60

56

42

57

41

42

43

38

33

32

33

33

36

34

33

49

35

34

26

24

128

98

87

75

79

53

67

57

51

45

52

38

41

48

42

59

42

39

41

35

44

35

32

34

26

3344

142

117

120

107

110

92

77

76

52

68

58

67

62

57

70

38

51

47

40

49

18

w

47

39

32

1,YW

76

68

68

55

45

52

49

42

36

34

33

30

31

31

25

37

31

31

33

21

26

18

22

24

24

Average length of stay in days

8.7 11.0 8.6 8.2 7.2

7.9

9.2

120

5.2

6.2

8.2

5.9

7.4

16.1

7,0

5.7

70

8.9

7.0

7.7

14.9

7.7

6.9

15,8

7.9

1.8

7,7

11.2

16.3

6.6

9.7

11.7

17.1

6.0

8,1

10.3

7.1

8.8

21.0

7.8

8.4

10.2

11.1

9.3

10.4

19.3

10.2

8.2

22.5

10.4

1.9

9.6

13.1

18.8

8.8

8.0

9.0

12,4

5,1

6.3

8.7

5.7

7.2

15.5

6.4

5.3

6.0

9.1

6.7

7.3

14.0

6.7

7.1

13.6

7.4

1.9

7.4

11,8

15.8

6.8

7.1

8.3

10.5

5.3

5.5

7.5

5.8

74

15.0

7.4

5.2

6,4

&2

7.0

7.0

14.7

8.3

6.9

13.7

7.4

1.9

7.6

9.8

15.7

6.1

6.7

8.2

8.3

4.0

4.7

6.4

5.2

6.2

11.1

6.0

3.9

4.8

7.6

4,8

6.7

12.7

5.3

5.3

14.2

5.9

1.3

4.9

10.1

15.3

4.8
advmcedata 5

Tab~ 3. Num~r of discharges and average iengfh of stay of patients under 65 yeare of age discharged from short-stay hospdals, by selected diagnosisrelated groups and hospital bed size untied Sfate% 1985

.cvS~haqeSffam ren.Fecera, shOrl-Stay hosptals Excludesnewbornmfanrs]

,4// 6-99 105199200-299 30C-#995C0 beds ,4!/ &-gL? 10G VW 2?2>299 3CC-t99 500 beds

Dfagnos)s-related group hosp!tals beds beds beds beds or more hospitals betis bscs beds beds or more

Number m thousands

P.Ildlscharges . . . . . . . . . . . . 44.545

. . . .>----------- -.----- .— -

Vaginal delwe~ without comphcatmg

dlagtIOSeS . . . . . . . . . . . . . . . .

Cesarean section without substantial

comorbldfty and or comphcaoon .

Medical back problems

Nonradical hysterectomy, age less than

70 years without substantial comorb!d]ty

and, or complication . . . . . . .

Psychoses, . . . . . . . . . .

EsophagW, gastroenlerms. and miscellaneous

d!gestwe d!sease age 18-69 wlthobt substantial

comorb!dlty and or comphcat!on. . . .

Unrelated opera!mg room procedure . . . . . . .

Alcohol and substance-reduced orgamc

mental syndrome,...,.. . . . . . . . . . .

Broncht!s and asthma age under 18. . . . .

Back and neck procedures age under 70

w!thout substantial comorbldlty

andorcompl!catlon . . . . . . . . . . . . . . .

Esophag!t!s, gestroenterlbs, and miscellaneous

dlgestwe disorders age under 18 . . . . . . . . .

Angmapectorts . . . . . . . . . . . . . . . . . . . .

Other antepatium d!agnoses w!th

mechcal complications . . . . . . . . . . . . . . . .

Vaginal delwery wtth stenhzatron and, or

dilation and curettage of uterus . . . .

Atnx’ton with ddat!on and

curettage ofuferus . .,. ,, ... .,

Uterus and adenexa procedure for non-malignancy

except tubal mterruptlon . . . . . . . . .

Esophagms, gastroententcs, and miscellaneous

digestive disease age 70 or over and or

substantial comorbldty and or comphcallon . .

Simple pneumoma and pleurisy age under 18. .

cirCW3tOry disorders except acute my~ardlal

infarction. w!th card!ac catheterization

w}thout complex diagnosw . . . . , . . . .

Foot procedures, . . . . . . . . . . . . . . .

Ingumal and femoral hernia procedures

age 1&69 w!thout substantial Comorbldlty

andorcomphcat!on . . . . . . . . . . . . . . . . .

Bronchlt\s and asthma age 16-69

w!lhout substantial comorb!djty

andorcomphcatlon . . . . . . . . .

Crcuiatory disorders with acute myocard[al

mfarct(on without cardiovascular

Compl!catlons, discharged ahve . .

Vaginal dehvery with comphcatmg diagnoses

Appendectomy without complicated prmcwal

Clagnosts age under 70 w!thout substantial

comorbld!ty and or comphcatlon . . .

Tonsdlectomy and or adenoldectomy only.

ageunder 18,.,..,,,, . . . . . . .

Cther factors mfluencmg health status . . .

2.552

761

741

503

478

412

317

310

302

273

268

234

230

222

221

217

216

211

211

211

202

194

192

190

189

187

186

.5,53U

355

81

130

65

67

94

21

100

50

25

42

49

35

42

22

28

54

57

48

32

36

W

25

37

29

18

$.oa

437

137

170

123

78

87

48

36

63

44

64

54

44

47

36

49

41

57

“8

82

37

46

34

31

36

50

28

4,b18

440

130

166

96

71

82

59

51

M

54

53

55

33

37

39

38

47

40

39

28

44

42

44

32

37

40

38

3,Yud

690

212

147

112

142

81

64

80

55

57

57

45

58

44

54

50

44

27

63

32

49

34

43

49

46

43

47

>,ffa

630

201

127

106

121

69

105

43

50

94

53

30

60

53

70

51

30

30

101

21

-to

36

28

54

32

26

55

Aver?ge length of s!ay ]n days

5.5

2.6

5.0

5.6

5.9

15.5

3.5

10.4

9.9

3.5

8.9

3.3

4.0

3.6

3.2

16

5,0

47

4.2

2.8

3.1

2,8

45

77

35

3.7

1,5

3.8

4,5

2.1

45

6.1

56

170

28

6.4

8.8

3.3

9.8

2.6

3.4

2,7

30

15

48

40

3.5

27

20

42

%0

~~

39

“.$

40

49

2.5

4,7

52

58

16,0

3.4

9.0

88

3.4

7,9

3.2

3.8

3.1

3.1

15

49

50

44

.25

25

33

45

!3 1

35

35

15

32

5.3

2.5

4.8

5.0

5.9

13.1

3.6

10.5

11.3

3.9

8.5

3.0

4.2

3.3

3.2

16

46

5.1

44

24

32

2.5

-$4

81

32

35

13

5.1

5.7

2.7

5.1

6.2

61

13.9

3.9

10.0

11.3

3.3

9.5

3.5

4.3

3,8

33

1,7

52

4.6

44

2.6

35

26

44

77

35

3a

1,8

3.1

6.4

2.9

5.6

5.5

6,3

17.6

3.8

12,0

8.7

3.6

8.9

4.2

4,7

4.3

3.4

1.5

5.3

5.4

48

32

5.8

2.8

49

85

42

3,9

1,4

3.7
6 advancedaa

Table 4. Number of discharges and average length of stay of patienta 65 yeare of age and over discharged from short-stay hosptils, by selected

diagnosis-related groups and hospital bed size: United State% 1965

[Discharges from nonfederal shon.slay hospitals Excludes newborn miants]

All 6-99 1W199 200-299 300-f99 500 beds All 6-99 100-199200-299300-499 500 beds

D/agnosts-related group hospftals beds beds beds beds or more hospttak beds beds beds beds or more

Number m thousands

All discharges .- r-e.- m. .”.” ------ ------

.

Heart failure and shock

Simple pneumonia and pleurwy age 70

or over and or substantial

comorbld[ry and comphcatlon

Specific cerebrovascular d!sorders except

transient Ischemlc attacks

Angmapectorls, ,,, ,,. . . . .

Esophagllls, gastroententls, and miscellaneous

dlgestwe disease age 70 or over and or substantial

comorbldtty and comphcatlon

Chronic obstructwe pulmonary disease

Cardiac arrhythmia and conduction disorders

age 70 or over and or substantial

comorbld(ty and comphcabon . . .

Nutrltlonal and mlscellanwus metabolic disorders

age 70 or over and)or substantial

comorb!dty and comphcatton . . .

Unrelated operating room procedure . .

Bronchms and asthma age 70 or over and,or

substantial comorbld]ty and complication

Transient Ischemlc attacks . . . .

Atherosclerosis age 70 or over and!or

substantm comorbldlty and mmphcatlon .

Cvculatory disorders with acute myocardlal

mfarctlon wtthout cardiovascular

comphcatlons, discharged ahve . . .

Transurethral prostatectomy age 70

or over and or substantial comorb!d!ty

orcompllcatlon . . . . . . . . . . . . . . . . . . .

Kidney and urinary tract mfecflons age 70

or over and or substantial Comorijdify

orcompllcatlon, . . . . . . . . . . . . . . . . .

Major ]olnt procedures . . . . . . . . .

Medical back problems .,...... . . . . . . . .

Gastrointestmal hemorrhage age 70

or over and or substantial

comorbidty and comphcation . .

HIP and femur procedures except major

joint age 70 or over and/or substantial

comorbldity and comphcabon . .

Respirato~ neoplasms . . . .

~ens procedures . . . . . . . . . . . . . . .

Diabetes age360r over . . . . . . . . . . .

Cwculato~ disorders with acute myocardlal

mfarctlon and card! ovaacular comphcabons,

discharged ahv e . . . . . . . . . .

Ma]or small and large bowel procedures

age 70 or over andor substantial

comorbldtty and cornphcatlon .

Red blood cell disorders age 1B or over

Iu, cluo

469

357

350

316

296

257

248

217

196

188

184

179

172

169

168

166

158

153

148

139

138

137

134

123

106

1,/01

103

103

65

76

77

54

49

51

15

41

37

36

32

19

45

12

33

32

20

14

14

31

24

20

20

I.ulu

91

59

61

64

59

57

47

40

33

32

36

31

31

32

29

30

29

29

28

23

25

26

24

24

15

L,J43

106

75

82

75

61

58

57

48

47

47

42

46

42

41

34

41

34

33

34

31

30

24

28

30

27

Z.bw

107

74

81

65

60

60

61

50

59

39

43

43

34

46

36

50

39

34

41

39

40

32

40

27

27

1,Ysu

62

46

62

35

39

28

34

28

42

26

26

23

32

31

25

34

23

25

25

31

29

24

18

23

17

Average length of stay m days

8.7

7,9

9.2

12.0

5.2

6.2

8.2

5.9

74

16,1

7.0

5.7

70

8.9

7.0

7.7

14,9

7.7

6.9

15.8

7.9

1.8

7.7

11.2

16.3

6.6

66

6.6

6.1

8.5

4.1

5.0

6.6

4.8

6.4

16.0

61

44

5.0

7.0

5.6

5.9

13.8

6.3

5.6

12.4

6.7

1.2

5.6

8.8

13.7

4.6

7.9

7.8

8.0

9.6

5.2

5.6

7.3

5.6

7.5

13.7

7.1

4.8

6.4

6.9

6.8

7.2

13.4

7.3

6.5

15.2

7.4

1.7

6.7

10.4

16.6

5.5

69 ‘“

84

9.6

14.3

5.0

7.0

8.7

6.0

7.5

16.0

7.4

6.2

7.5

9.0

6,1

9.5

15.2

8.6

6.4

15.7

7.9

1.9

8.7

12.4

15.4

7.2

Y.4

8.6

10.3

12.4

6.0

7.3

6.7

6.3

7.5

16.8

6.6

6.4

7.8

9.9

7.9

7.7

15.5

7.6

8.5

15.9

7.5

1.8

8.3

11.6

17.4

7.6

10.3

8.7

10.8

14.3

6.2

6.3

11.1

7.3

6.5

17.4

8.1

7.1

8.3

9.7

7.6

8.9

15.4

8.7

7.2

19.0

9.2

2.0

9.5

12.4

18.4

7.0
advancdata 7

Table 5. Annual percent change in average length of stay by age and

regwn, United States. 1980-65

“Discharges from non-Federal short-slay hospitals Excludes newoorn infants]

Year

Age arrdregforr 7980 1987 1982 1983 1984 1985

Under 65 years Percent

Northeast . . + 0,27 -1,73 -1.88 -3.10 -2,64 -0.32

Midwest . . . . . . . +1.84 -2.22 + 1,20 -2.72 -2,12 -1,40

South ...,.... -0.56 -0.04 -2.17 -0.54 -6,23 -0.34

West . . . . . . . . + 1.92 -0.35 -2.76 -1.75 -022 -5.67

65 years and over

Northeast . . . -0.59 -0.46 -6.16 -1.32 -6.57 -2,88

Midwest ...,... + 1.50 -2.56 -2.30 -6.42 -9.68 -1.63

South, . . . . . . . -0.99 -0.39 -4.38 -3.41 -8.05 -2.71

West . . . . . . . . -4,37 – 3.49 -0.52 -2.87 – 7.81 -2.25

.-.

. . .

0.0

z

*

#

Symbols

Data not avadaDie

Category not apphcable

Quantity zero

Quantity more than zero but less than

0.05

Quantity more than zero but less than

500 where numbers are rounded to

thousands

Figure does not meet standards of

reliability or precision

Figure suppressed to comply with

confidentiality requirements

References

‘J. Alsofrom: Playing

1983, pp. 38-55.

2Tax Equity and Fiscal

September 3, 1983.

the numbers. Med. WorM News. Oct. 24.

Responsibility Act. United States Congress,

‘National Center for Health Statistics, R. Pokras: Diagnosis-related

groups using data from the National Hospital Discharge Survey,

United States, 1981. Advance Duta From Vital and Heu[th Sraristics.

Wo. 98. DHHS Pub. No. (PHS) 84-I 250. Public Health Semite.

rymts\lllc, \ld.. July 20, 19s4.

4National Center for Health Statistics. R. Pokras and K. K. Kubishke:

Diagnosis-related groups using data from the NationaI Hospital Discharge Survey, United States, 1982. Advance Dara From Vizal and

Heulfh .Wristics. No. 105. DHHS Pub. No. (PHS) 85-1250. Public

Health Service. Hyattsville, k!d., Jan. 18, 1985.

‘National Center for Health Statistics. R. Polwas: Utilization of shortstay hospitals by diagnosis-related groups. United States. 1980-S4.

$’its! wrd Health Statistics. Series 13, No. )37. DHHS pub. &lo.

(PHS) 86-1748. Public Health Service. Washington. U.S. GovernmentPrinting Oftice, July 1986.

6R. B. Fetter, S. Youngsoo, J. L. Freeman. et al.: Case mix definition

by diagnostic related groups. ,tfed. Cure 18(2), Supplement.

(Copyright 1980: Used with the permission ot’.Lfedicul Cure. )

‘National Center for Health Statistics, W, R. Simmons and G. A.

Schnack: Development of the design of the NCHS Hospital Discharge

Survey. Vita/ and Health Szaristics. Series 2. No. 39. DHEW Pub.

No. (HRA) 77- I 199. Health Resources Administration. Washington.

U.S. Government Printing Office. \lay 1977.

‘National Center for Health St.it~stics. \t G. Sirhcn: Utilization

of short-stay hospitals. summary of nonmedical statistics. L’nited

States. 1965. ~’im[ wrd Heulrh Stuflsrics. Series 13. No. 2, PHS

Pub. No, 1000. Public Health SCn ice. \Vashmgton. L’,S. Government

Printing Office. Aug. 1967.

‘?ktional Center for Health Statistics, \l J. Witlwn: L’tilizatmr

ofshort-stay hospmds by characmr]suc~ ofdiwhargcd ptiticnts. L’nmd

States, 1965. Lriral und HtYIIIh SIUIISWA %ies 13. No. 3. PHS

Pub. No. 1000. public Health .%mtce. W’ashlngton. U.S. Go\emmcnt

Printing Office. Dec. 1967,
8 advzUxx!&b

Technical notes

Survey methodology

Source of data

The National Hospital Discharge Survey (NHDS) encompasses patients discharged from short-stay hospitals, exclusive

of milita~ and Veterans Administration hospitals, located

in the 50 States and the D]strict of Columbia. Only hospitals

with six bed~ or more and an a~erage length of stay of less

than 30 days for all pa[ients are included in the survey. Discharges of newborn infants are excluded from this report.

The universe of the survey consists of 6.965 short-stay

hospitals contained in the 1963 Master Facility Inventory of

Hospitals and Institutions. New hospitals were sampled for

inclusion in the survey in 1972. 1975, 1977, 1979, 1981.

1983. and 1985. In all. 558 hospitals were sampled in 1985.

Of these hospitals. 82 refused to participate. and 62 were

OUIof scope, The 414 participating hospitals provided approximately 194.800 abstracts of medical records.

Sample design and data collection

All hospitals with 1.000 beds or more in the universe

of short-stay hospitals were selected with certainty in the

sample. All hospitals with fewer than 1.000 beds were

stratified, the primary strata being 24 size-by-region classes.

Within each of these primary strata. the allocation of the

hospitals was made through a controlled selection technique

so that hospitals in the sample would be properly distributed

with regard to type of ownership and geographic division.

Sample hospitals were drawn with probabilities ranging from

certainty for the largest hospitals to I in 40 for the smallest

hospitals. The within-hospital sampling ratio for selecting sample discharges varied inversely with the probability of selection

of the hospital.

In the 1985 survey, two data-collection procedures were

used for the first time. One was the traditional manual system

of sample selection and data abstraction. The other was an

automated method used in approximately 17 percent of the

sample hospitals, involving the purchase of data tapes from

commercial abstracting services,

In the manual hospi[als. sample discharges were selected

uiing the dail} listing sheet of discharges as the sampling

frame. These dischm-ges were selected by a rdndom technique,

usuall> on the basis of the terminal digit or digits of the

patient’s medical record number. The sample selection and

Atrwt]on of data from the face sheet and discharge summary

of the medical records were performed by the hospital staff

~]rim reprewntative~ of the Nutional Center for Health Statistics

(XCHS ]. The completed fm-m~ were forwarded to NCHS for

c{ding. edlr]ng. and wclghting procedures.

For the automawd hcliplta}~. tapes containing machinerewkible medical rec(wJ dam were purchased from commercial

~h,tr.l<[ln: ,c~lce,. These [tipei are sublec[ tf~ NCHS sampj]n:, CLII!:P:. tind w:]gh[]n: pn~:edures A detailed descrip-

[,Ifi~~; :hc ~L:{,)m~[cd procts. I\ I,) L-Wpuhllshed,

The Nfedical Abstract Form and the abswact service data

tapes contain items relating to the personal characteristics

of the pa~lent. including birth date. sex. race. and marital

status but not name and address: administrati~e information,

including admission and discharge dates. discharge status,

and med]cai record number: and medical Information. including diagnoses and surgical and nonsurgical operation~ or procedures. Since 1977, patien[ zip code. expected source of pa~-

ment. and dates of surge~ also have been collected. (The

medical record number and patient zip code are considered

confidential infomnation and are not available to the public. )

Presentation of estimates

Statistics produced by NHDS are derived by a complex

estimating procedure. The basic unit of estimation is the sample

inpatient discharge abstract. The estimating procedure used

to produce essentially unbiased national estimates in NHDS

has three principal components: inflation by reciprocals of

the probabilities of sample selecticm. adjustment for nonresponse. and ratio adjustment to fixed to[als. These components

of estimation are described in appendix I of two earlier publication~.8.9

Based on consideration of the complete sample design

of NHDS, the following guidelines are used for presenting

NHDS estimates in this report.

● If the sample is less than 30, the value of the estimate

is not reported. Only an asterisk (*) is shown in the

tables.

. If the sample size is 30-59, the value of the estimate

is reported but should be used with caution. The estimate

is preceded by an asterisk (*) in the tables.

Diagnosis-related groups

The DRG’s to which this report refers were produced

usin~ the DRG program available in the summer of 1983

and are identical to those in the Friday. August 3 i. 1984,

issue ot’ the Federal Register. This is a computer program

that groups patier[ts into DRG’s based on diagnostic,, surgical,

and patient information. The actual program used to produce

estimates in this report was obtained from the Health Care

Finwtcin~ Administration. The entire NHDS file, including

outliers. was used to produce estimates. No”data w’ere excluded

or trimmed because of abnormal length of sta).

In publications from the National Center for Health Statistics using NHDS data. several schemes ha\ e been used to

gr(mp patients into cvttegorks based on either their diagnose

or the procedures performed. These group> were develope~

to repon general purpose Statistics 10 the man} users of NHDS

dwa. and an> similarit> ktween the titles of those cmegories

and DRG titles IScoincidcn(al.
advamxxkda 9

Sampling errors and rounding of numbers

The standard error is a measure of the sampling variability

lat occurs by chance because only a sample, rather than

an entire universe. is surveyed. .The relative standard error

of the estimate is obtained by dividing the standad error

by the estimate itself and is expressed as a percent of the

estimate. Table I shows 1985 relative standard errors for discharges. The standard errors for average Iengths of stay are

shown in table H. Estimates have been rounded to the nearest

thousand. For this reason detailed figures within tables do

not always add to the totals.

Table 1. Approximate relative standard errors of estiiated number of

discharges and first-listed diagnoses IJnfied states I gs5

Relatfve

Size of estimate standard error

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.6

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7

100,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7

300,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4

500,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0

1,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5

4.000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1

Tabiell. Approximate standerd emmsofaver~k n@sofsbyby

number of dwharges: United Stateq 1985

Average length of stay m days

Number of discharges 2 6 10 20

StandarderrorIndays

10,000 . . . . . . . . . . . . . . . . . . . . 0.4 0.9 1,5 27

50,000 . . . . . . . . . . . . . . . . . . . . . 0,2 0.6 1,0 18

100,000. . . . . . . . . . . . . . . . . . . . . 0.2 0.5 0,8 16

500,000 . . . . . . . . . . . . . . . . . . . . 0.1 0.4 0.6 1,1

1,000,000 . . . . . . . . . . . . . . . . . . . . 0.1 0.3 0.5 10

5,000,000. . . . . . . . . . . . . . . . . . 0.1 0.3 0.4 0.8

Tests of significance

In this report. the determination of statistical inference

is based on the two-tailed Bonferroni test for multiple comparisons. Terms such as “higher” and “less” in relation to differences indicate that the differences are statistically significant.

Terms such as “similar’” or “no difference” mean that no

statistically significant difference exists bet~veen the estimates

being compared. A lack of comment on the difference between

any two estimates does not mean the difference was tesled

and found to be not significant.

Definitions of terms used in this report

Pariwtf—.A person who is formal]] admitted to the inpatient semice of a short-stay hospital Ftw obsemation, care,

diagnosis. or treatment is considered u patient. In this repot-t

the number of patients refers to the number of discharges

during the year, including tiny multiple discharges of the

same individual from one short-stay ho>pitul or more.

Discharge—Discharge is the formal release of a patient

by a hospital: that is. the termination of a period of hospitalization by death or by disposition to place of residence. nursing

home. or another hospital. The terms ‘“discharges”” and ‘“patients discharged” are used synonymous:;.

Arera,qe length ofsta~-The average length of way is

the total number of patient days accumulated at time of discharge by patients discharged during the year divided by the

number of patients discharged.

Age—Patient’s age refers to age at binhday prior to admission to the hospital inpatient service.

Geo.eraphic -. re.gion—Hoscritals . are classified by Iocation

in one of the four

that correspond to

Census. “

Rag:on

Northeast . . . .

M!dwest

South, . . . . .

West . . . . . . .

geographic regions of the United States

those used by the U.S. Bureau of the

States included

Maine, New Hampshire, Vermont, Massachusetts. Rhode Island. Connect[cut. New

York, New Jersey. and Pennsywama

M[ch!gan. Oh!o. Illinms, Indiana. Wwconsm. Minnesota. Iowa, Missouri, Norm Dakota, South

Dakota. Nebraska, and Kansas

Delaware, Maryland. D)stnct of Columbla. Vrgm[a, West Virgima. North Carolina, South

Carolina. Georgia, F!cnda. Kentucky, Tennessee, A[abama, MISSISSIPPI,Arkansas. Loumana.

Oklahoma, afld Texas

Montana. Idaho. Wyommg, Colorado, New

Mexico, Arcona, Ulah. Nevada, Washington,

Oregon, Cahfomla, Hawam and Alaska

Hospi/a/s—Short-stay special and general hospitak have

six beds or more for inpatient use and an average length

of stay of less than ~0 da}s. Federal hospitals and hospital

units of institutions are not included.

Bed .si:e of hmpifal-Size is measured by the number

of beds. cribs, and pediatric lws>lnet~ regularly maintained

(set up and staffed for use) f{v paticn[~: b.i. .Ineti for rtew born

infants are not ]ncluded. In this rep, Irt Irie clmslfication of

hospitais by bed size is bawd (m Ik number of beds at

or near midyear reported by [he ho~pitd~.
From Vital and Health Statistics of the National Center for Health Statistics Number 138. September 18, 1987

Highlights of Osteopathic Office Practice,

National Ambulatory MedicaI Care Survey, 1985

by Hugo Koch, M. H.A., and Tommy McLemore, M.S. P.H., Division of Health Care Statistics

Introduction

In this report. the tlndin:s of the National Ambulatory

Medical Care Sur\’ey (NAMCS ) are used to describe the ambulatory cm-e provided in the ofkes of osteopathic physicians

~wer the period from ,March 19S5 through February 1986.

The National Center for Health Statistics. which periodically

conduc[s the survey, obtains the NAMCS data base from

d sample of non-Federal physicians selected from the doctors

of medicine and osteopathy who are primarily engaged in

office-based practice throughout the coterminous LTnited

States. Anesthesiologists. radiologists, and pathologists are

not included in the sample. Further excluded are telephone

contacts (including prescription retllls) and all nonoffke visits

to patients. General tlndin:s from the 1985 survey have been

published. 1

Osteopathic medicin~ackground facts

(Based on information supplied by the American Osteopathic Association. )

. Osteopathic physicians are licensed for the full practice

of medicine and surgery in all 50 States and the District

of Columbia.

. Osteopathic medicine uses all uccepted methods of preventing. diagnosing. and treating illness and injury. including the appropriate use of drugs and wge~.

. Central to the philosophy tmd practice of osteopathic

medicine is the musculoskeletal system and its importance

to a patient”s total well-being. Doctors of osteopath

(D.O. “s) are especially trained in the use of palpatory

‘?ktional Center for Hmith Statistics, T. McLemore and J. DeLozie~

1985 Summary. National Ambukiton \lcdical Care Survey. Afwmce

Dutu From Vi[ul und Heuhh S[utistics. No. 12S, DHHS Pub. No.

(PHS) 87-1250. Public Health Service. Hyattsvilk. Md.. Jan. 23.

1987.

techniques to diagnose underlying problems and in manipulative therapy as an aid to correcting structural problems

such as poor posture. slight dislocations, and limited

mobilily.

. At the time the 1985 NAMCS sample was selected, about

ZI ,000 D.0,’s \vere professionally active in the United

States. two-thirds of them in office-based practice. (A

universe of 1I .776 physicians was identitled as falling

within the NA\lCS scope. ) S[ron: c(mcentration> were

found in klichigan. Pennsylvania. Ohio. New Jersey,

Florida. Texas. and ilissouri. About 86 percent of D. O. “s

were prima~ care physicians. predominantly in general

or family prxtice. The remaining 14 percent were certified

in [S other medical or surgcal specialties. notably tinesthesiology. emerym+’ medicine, generul surgen. osteopathic manipulative treatment. orthopedic surge~. psy -

chiat~. and radiology.

Data base

The data base for this report is the estimmd 35,9 million

office visits made over the year-long period to ~~steopiithic

physicians within the NAklCS scope and the 43.0 million

drug mentions associated with these visits. The follow ln:

tables otYer statiswd detail about wdient features ofo>tenputhic

office care. In most of the tables. D.O. cure is contmsted

with overall otlke cure and with the specific porti~m I~t’[hat

care proi ided by doctors of medicine (\l. D. “s) in general

or family practice.

Table 1 — SpeclaIty and type of practice

Tabk 2 — Patients’ most frequent reasons for visiting

the D.O.

Table 3 — Diagnostic procedures

Table -1 — \lost frequent principal diagnoses

Table 5 — \lajor diagnostic groups

Table 6 — Patient age and sex

Table 7 — Patient race and ethnicity

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUC c Hea :“ Ser/lce
Table 8 --– Rc!crral .ttitui and prl(x \ ]sit status

Table 9 — Drug ullllzation lnd]ca[ors

Table 10— Speclflc dru~s mos[ frequently utillzed

Table 11— Drug utilization by drug clas~

Table 1? — Nonmed]cat]on therap>

Table 13— Dlsposltton

Table 14— Duration

Because the estimates presented In this report are based

on a sample rather than on the entire universe of office visits

or drug menti(ms. the data arc subject to sampling variabilm.

The technical notes at the end {it’Ihe reptm. ai(}ng with suppl~ -

ing a briet’ descr]pti(ln of the wnpic de~lgn. provide guidellne~

tojudge the precision ofthe estlmtites.

Data highlights

From March 1985 through February 1986. an estimated

35.872.000 visits were made to the offices of osteopathic

physicians. comprising about 6 percent of the 636.386.000

office visits made to all physicians within the NALICS scope.

Physician characteristics

The findings in table 1 reinforce the emphatic preference.

noted earlier. that D.O.’S show for primary care in general

and for general or Family practice in particular. a preference

that is compatible with their avowed concern for holistic

medicine. D.O.’s in general practice arrangements accounted

for nearl~ 8 of everj’ 10 office visits. Thus, they contrast

sharply with M.D. ‘s. among whom general or family physicians accounted for fewer than 3 of e~’ery 10 visits.

Visit distribution by type of practice indicates the D.O. “s

tendency to favor solo practice over the multiple-member

forms (table I). The tendency, however. is not a pronounced

one. There is evdence that osteopathic physicians. like their

counterparts amortg the M.D. .s. are being increasingly drown

to multiple-member ar-rmgements. especially to partnerships

and small-group practices. Indeed, according to the NAMCS

findings for all office-based physicians. the visit share claimed

by solo practitioners declined from 60 percent in 1975 to

5 I percent in the current survey.

Patients’ reasons for visiting the D,O.

Table ? offers a ranked listing of the 20 most frequent

rcavmt that patienti gti~e for vis]tlng [he osttx)pathic physician.

contru~tlng them with a similar li~tin~ for M.D. general or

familj physicians (kl, D. GFP’s} The data illustrtite the folloving sulient features ot’osteopathic office care.

● The ~enerttlist nature of D.0, ctire i~ demt)nstrmd by

the sheer di~ ersity of the rei.iwn~ that motivti[ccl patients

to seek that cure. w-d by the fiict that 16 of the ?0

rctison~ are shared by D. O.’\ v,lth their M.D. countuparts

in gencrul (w t’timily pructice

. The D.(),’s ipeclul concern for the muwuloskelettd system

IS eiidcnt in thr fincflng tha[ h~ick synlp[om~ led [he

Ii\t in tublc ? tind that back and neck iymptomi alone

motivated about 1 of even 10 visits to the osteopathic

physician.

. The presence on the top-20 list of general, pre-natal.

and well-baby examinations. along with such specific

procedures as ““pap smear’” and “blood pressure test.. bears

partial witness to the D.O. s involvement with the preventive and screening functions of health care.

Diagnostic procedures

Table 3 supplies data on the diagnostic or screening procedures that DO,’s provided or ordered in the course of their

office \ isits. At 65 percent of the visits. D, O.’S used one

or more of these probative mechanisms. Most of the procedures

were understandably applied tit that 40 percent of visits where

the patient presented a new problem. and the physician needed

to forge a chain of clinical e~ idence that would assess the

presenting symptoms and produce an appropriate diagnosis,

At other visits. the procedures were used to monitor the course

of a known morbidity or-largely at rtonillness visits—to act

as preventive or screening mechanisms. The exact extent of

this mortitoring or preventive activity is ir-npossib]e to quantify.

The data in table 3 invite the following comments:

● M.D. GFP’s somewhat exceeded D.O.’s in their total

utilization of the diagnostic mechanisms and in their use

of most of the specific procedures. One exception lay

in the D.0, “sspecialized use of palpatot-y diagnostics.

● In view of an above-average involvement withl musculoskeletal disease and inju~ (see table 5), the ID.O.’S re1iwtce on x my ptwcedures (‘“other radiology”) s,eems consemative. Apparently. the use of palpatory techniques

reduced the neeci for x ray in many cases.

Diagnoses

The clinical core of ostet)pathic office practice lies in

the formal ditignoses thut D.O.’s rcmkr. Tables 4 and 5

describe this core, table 4 by listing the 20 principa! (firstIisted) diagnoses most frequentl} assigned at D.O. office ~isits.

and table 5 by gathering these specific diagnoses into their

ciiagnostic classes.

[n both tables. the broad rtinge and diversity of the diagnoses further underscore the general ized nuture of osteopathic office care.

A c(~mpuris(m bctwten D.O. .s and MD. GFP”s (table 5 ) shows a [marked similarity between the two in

the clinical conwnt of their (~ftlcc care.

Predwttibly. DO.’s exceeded the overall norm and the

norm for hl. D. GFP”s in their treatment of irljuries and

of mu~culoskclcttil disease. .About one of every four principul diagnows uus assigned t{)these diagnostic clw+es.

Visit\ for m)nillncss ctire (-”supplemental classification”)

were rcltiti~ely fewer for D. O.’s than they v+erc t-or oftlcebawd ph)slcitin~ in general {lr for M.D. GFP’\ in pw_ticuIar: obicr~cl>. it mtiy be said that ~)steoputhic c)fficc care

tcnd~ to bc ~omew hut mtn-c illnes+(wientul than the office

care to which it is compared In table 5.
adwm?&a3

Patient characteristics

.Again accenting the generalist nature c)f their office pracnce. D.O.’S treated patients of all ages (table 6). Visits by

female patients outnumbered visits by males in a rutio of

h to 4. a disproportion also typical of office prtictice in general

m-i of \l. D. GFP practice in particular. Between D.O. am-i

\l. D. GFP practice, however. signitlcant differences in visit

\ l~lume were apparent among two patient groups along the

tige continuum. Visits by oldest patients (65 years and over)

u ere relatively less frequent among D.O. practitioners: visits

@ patients from the 25[h through the 44th year were relatively

more frequent. These tlndings are compatible with the fact

that D.O.’s focus to a greater extent on the treatment of

musculoskeletal injuries. problems that are generally most

troublesome in the 254-I age interva].

Though the difference was a modest one, D.O.’s reported

a fmction of visits by black patients that exceeded both the

comparable proportion found in all office practice and that

found among M.D. GFP’s (table 7). To some extent, the

difference may be explained by the D.O. “s special focus on

musculoskeletal disease and injury. problems that were proportionately more troublesome among black office patients. The

infrequent presence of Hispanic patients in the office of the

osteopathic physician probably has more to do with the geo-

~graphic concentrations of D.O. practitioners than with wry

clinical considerations.

New patients accounted for 12 percent of the visits to

osteopathic physicians (table 8). Of these new-patient visits.

about 1 of every 5 was a referral by another physician. The

remainder resulted either from voluntary walk-in or by referral

t’rom a source other than u fellow physician.

By far the greater body of D.O. visits (S8 percent) wwre

made by continuing patients, testimony to a ve~ stable practice

base. Indeed. referral to more specialized colleagues occurred

at ~~nly4 percent of D.O. \risits (see table 13).

.Not oniy did the D.O.’s office practice chietly involve

encounters with continuing patients. the largest proponi[>n

~It’vlsi[s (60 percent) required the management of continuing

prt~blems as well (table 8 ). Many of these continuing problems,

t~t’c~mrse. were chronic diseases of the musculoskeletal system.

The D. O.’s involvement with new problems. ulthough it occurred at a considerable 40 percent of visits, was less than

that t}f M.D. GFP’s, ~~ho encountered a new problem tit

roughly every ~therone Oftheir visits.

Drug therapy

The importance of drug therapy in osteopathic office prtictice is made graphically evident in tlgure 1. An estimated

68 percent of al] visits were “drug visits’.—that is. visits

w u hich (me t~r more drugs were prescribed or provided.

Furthermore. at a sharply prominent 72 percent of these 24.4

million drug visits. drug therapy was the only form of treatment

U\Cd.

In the frequency and intensity of their drug utilization.

D. O. “s exceeded the gener~l norm for oftlce-based practitioners [[able 9). This noteworthy reliance on drug therapy. howFqure 1. Percent distribution of ofke visits to osteopath physicians

by treatment modaEty United States 1985

ever, was not unique to osteopathic medicine as a profession.

Rather it is a feature of primary care practice in general

and of general practice in particular. 2 As the indicators in

table 9 reveal. it was matched and even somewhat exceeded

by the X1.D. in yeneral or family practice.

Tables 10 and 11 show the range and dit’ersity of the

dtugs utilized in osteopathic ofilce practice. table 10 by a

ranked listing of the 25 genertc familie~ that were most frequently mentioned. und table 11 by classifying the 43 million

drug mentions according to the therapeutic effect thu[ each

was intended to produce. Ylost of the drugs prescribed or

provided by office-based D .0.’s couki be grouped into four

therapeutic classes: antibiotics. cwdiovwxdar-renul drugs.

analgesics. and respiratory it~ents. To:ether these classes accounted for 51 percent of the D.O. ”>drug mentions. Between

the D.O. m-d \l. D. GFP. there was fuirly close agreement

in the utilization of the drug CIUSW (table 11 ). When they

differed signitlcantly. as with the use ~f cmiiovuscular drugs,

the disparity could usually be expl~lned by a reference to

the diagnostic correlates shown in [able 5. It is arresting

to note. then. that the D.O. ”$ use of analgesics did not e~ceed

their use by the N1.D. GFP. After tall. D.O.’s were more

focally involved with injuries and musculoskeletal disease.

conditions which. ticcording to past N. AAICSstudies. were

among the most likely to be associated with symptomatic

2National Center for Health Statistics. H. Koch and D, Knapp: Highlights of Drug L’tilim[ion in Ofticc Prxtnx. National Ambulatory

Medical care Survey. 19S5. ,&,fI,tmle D(UU Fr,vn }’ifd wtd Health

Sfufisfic$. No. 134. DHHS Pub. No. (PHS) S7-1250. Public Health

Scmice. Hyattsville, Nld.. Nla> 19. IYX7.
4 advamedata

pain,’i .<ppurcn[l! . alth(mgh to an unknown extenl. the use

of nlanlpuluti\e therapy reduced the perceived need for pain

medicatlcm,

Nondrug therapy

In sheer volume. the role of nont.iru,g therapy in osteopathic

office practice i~ b} no means as ]mposin: a~ that played

b> drug thempj. This isupptirenlfrorn figure 1. which shcrws

that nondru: procedures were pr[~vided or ordered during 32

percent <JI’ D.O vl~lt$. m(]rc thtin one-htilf ot’ which also

in~ (~lvcd drug thcrap> Pred]ctabl}. mtinipulative therapy was

[he nondrus procedure m(Mt fai(md try the DO. (table 12).

E\ccpt t’c)rthi~ \pcciallzed emphasii. there was little si~nlficant

dltt’crence belween D.O.’S and kl.11. GFP’s in their utilization

ot mmdrug thertip>.

Disposition

In their dispo~ition

\isi[. D. O.’S and N1.D

to lvhich [he] reliml on

instructloni at the end of the office

GFP”\ i.t:reed in the limited extent

[elephonc followup. referred patients

t<> ~(~l]etigues. or ~dmi[tcd them to the hospi[ai (table 13).

The n(~ttible d]ffercncc between the two professional groups

la! in (he degree t)t’\pecit’ici[> used in w-runging fu[ure personal

c~~n[act with the patient. Probabl\ because of a greater need

tc~provide closel] moni[ored mai~tenance therapy. especially

f[>r chronic. musculoskeletai problems. D.O. “s tended to

schedule speclfw followup visits more frequently than M.D.

GFP’s d]d. The relatively :reater use by M.D. GFP’s of

the more tenta[ive ““return if needed”” probably signaled the

mtinagernent of more ca~es of acute. short-term morbidity.

‘\ationd Center for Health Sumstics. D, Knapp and H, Koch: The

hlmv+cmcn[ of Ncu Patn In Office-bawd ,Amhultitory Cam. National

Amhulutor) Mo-fictil Care Survcj. ,Adwncc DUIII From t’im/ wd

/-fru/th .$ru~is~ics, No, 97. DHHS P~b, No, (PHS)W-125[).Public

Hctilth Scr~]cc. Hya[t\villc. Md..Junc 13.1984.

4XationaI Center for Hctilth Statistics. H, Koch: The h4anagcmcnt

of Chronic Pain !n Off]cc-based Ambulakrry Care. National Ambulator> Medical Care Survey Ad\wKv Lhml From Viru/ urrd Htdfh

.SIWI.J[K-.$ No 123. DHHS Pub. No. (PHS) 86-1250 Public Health

.%rvlce. H>attswllc. Nld.. Aug. 29.1986.

wIlh which [he physician was helped substantially by the

self-restorative capacities of the body.

Duration

Measured by face-to-face contact between physician and

patient. the avemge visit to the office of the D.O. lasted

between 13 and 14 minutes (table 14). Thus, D.O. visits

were somewhat shorter than office visits in general or visits

to M.D. GFP’s in particular. Probably this was due in part

m the D.O. “sless intensive use of certain diagnostic procedures

(table 3).

Conclusion

Although office-based D.O.’s gave ample e\idence of

their prominent concern with the musculoskeletal system. this

concern did not appear to dominate their office practice. The

closest counterpart to osteopathic office care was found in

the care provided in the offices of M .D.’s in general or Family

practice. Most D.O.’s in office practice were best characterized

as generd]isti wh{) brought the added dimension of a specialized

philosophy and training to the conduct of their professional

ta~lis.

---

. . .

0.0

z

●

#

Symbols

Data not available

Category not applicable

Quantity zero

Quantity more than zero but less than

0.05

Quantity more than zero but less than

500 where numbers are rounded to

thousands

Figure does not meet standards of

reliability or precision

Figure suppressed to comply with

confidentiality requirements

Table 1. Percent distribution of office wits to doctors of osteopathy and doctors of medwine by physician specialty and type of practice:

Umted States, 1985

Doctors Of Doctors of

Physic/an specjahy and type of pracf~ce osteopathy med!cme

A! wsits 100.0 100,0

Specialty

P~lmary care specialties .,, 89,0 60.7

General O(tamdy rxachce .,, ., 78,1 27.6

In:ernal meotc!ne ., 3.8 120

Pedlatrlcs 4,0 11.9

05slelrlcs and gynecology 31 92

,& other Speclaltles 11.0 393

TyDe of practice

solo 52.6 508

hL :,~le member 47,4 49.3
advmcedata 5

Table 2. Percent and cumulative percent of the 20 most frequent reasons that patients gave for visiting doctors of osteopathy (D. O.’S) and doctors of

medicine in general or family practiie (M.D. GFP’s) (in rank orderx United State.% 1985

Patients” most frequent reasons for Cumu/af/ve

Rank wsmng the D. 0, Percent percent

Allvmts[35,872.000]. . . . . . . 100.0 46.0

1 Back symptoms [upper and lower] . . . . . 6.6 6.6

2 Symptoms referable to throat . . . . 4.5 11.1

3 General medical examination . . . . . 3.7 14.8

4 Neck symptoms, . . . . . . . . . . . . . . . . . 3.2 18.0

5 Cough . . . . . . . . . . . . . . . . . . . . . . . 2.8 20.8

6 Prenatal exammatlon. routine . . . . . . . . 2.4 23.2

7Blood pressure test . . . . . . . . . . . . . . . . 2,3 25.5

8 Head cold, upper respiratory infect!on . . . 2.1 276

9 Headache .,, . ...,..... . . . . . . . . 20 29.6

10 Hypertension, estabhshed dlagnos!s . . . . 1.9 31.5

llSkm rash . . . . . . . . . . . . . . . . . . . . . . 1.8 23.3

12 Chest Pam . . . . . . . . . . . . . . . . . . . . . 1.6 34.9

13 Abdommal Pam . . ...’.... . . . . . . . . . . 1.5 36.4

14 Pap smear . . . . . . . . . . . . . . . . . . ...1.4 37.8

15 Earache . . . . . . . . . . . . . . . . . . . . ...1.4 39.2

16 Well babyexaminaoon . . . . . . . . . . . . . . . 1.4 40.6

17 Knee symptoms . . . . . . . . . . . . . . . . . . 1.4 42,0

18 Fever . . . . . . . . . . . . . . . . . . . . . . . . 1.3 43,3

19 Progress vwt, nototherwtse specified . . . . . . 1.2 44,5

20 Shoulder symptoms . . . . . . . . . . . . . . . 1.1 45,6

Paoerrfs’ most frequent reasons for Cumularwe

Rank wsttmgthe M,D. GFP Percent percent

AIIvIWS[165.987,000] . . 1000 ‘$4 o

1 Symptoms referable to throat 4.5 45

2 General medmelexammatlon . . 44 89

3 Cough . . . . . . . . . . . . . . . . . . . . . . . 3.5 124

4 Backsymptoms [upparand lower]. . 3.3 157

5Blood pressure test . . . . . . . . . . . . . . . . 3,1 188

6 Prenatal exammatlon. routine . . . . 2.8 216

7 Head cold, upparresp!ratory mfectlon . 2.6 242

8 Earache . . . . . . . . . . . . . . . . . . . . . 2,2 264

9 Headache . . . . . . . . . . . . . . . . . 2.1 285

10 Hypertension, estabhsheddlagnosls. . 2.0 305

llSkm rash . . . . . . . . . . . . . . . . . . . . . . 1.8 323

12 AMommalpam . . . . . . . . . . . . . 1.6 339

13 Fever . . . . . . . . . . . . . . . . . . . . . 1.5 35.4

14 Chest pain . . . . . . . . . . . . . . . . . . ...14 36,8

15 Well babyexammat!on. . . . . . . . 1,3 38.1

16 Vertigo . . . . . . . . . . . . . . . . . . . . . . . 1.3 39.4

17 Diabetes, estabhsheddlagnosw . . . . . . . . . . 1.2 40.6

18 Progress vmt, nototherwqse speaf!ed . . 1,1 41,7

19 Leg symptoms . . . . . . . . . . . . . . . . . . 1.1 42,8

20 Allergy medtcat/on . . . . . . . . . . . . . . . . 1.0 43,8

Tabla3. Perc~tof office v&titoati ph~tians to~tors ofost~thy (D.O.'s), and@ dtiomof m@beingeneml or fmi~~ke(M.D. GFPs),

bydiagnostic procedures ordered orprovkfad: United Stataa, 196S

Diagnostic procedure ordered or prowded All physvc!ans D.O k MD GFPs

None . . . . . . .

Breast examination

Pelvlc examination

Rectal examination

V)sualacuty .

Urinalysis . .

Hematology . .

Blood chem@ry. .

Paptest. . . .

Other lab test .

Blood pressure test

Electrocardiogram

Chest xrey . . . .

Other radiology . .

Ultrasound .

Other . . . . . . .

Percent of vmts

34.5

3.7

5.7

2.3

19

99

6.5

8.1

3.5

74

46.6

25

2.6

49

15

q 5

30.8

5.2

6.3

4,7

19

162

10.0

7,9

3.7

8.2

52.7

3.1

32

53

0.5

72

‘Includespalpatorydtagnostcs
6 advmcedata

Table4. Percent andcumulative per~ntof the20principal dmgnoses moat tiquentiy rendered atviatis todtiom ofostqthy (D. O.'s)(in ralnkotier~

Urrifed States, 1985

Rank Most common pnrmpal d{agnoses and ICD-9-CM codes 1 Do. s

Number of wslts m thousands

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Allprmclpal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allpnnc)pa ldlagnose s,.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Essential hypertension.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.. . ..4o1

Acute upper respiratory mfectlons of multlple orunspecdledsltes 465

Spramsand stramsofotherand Unspeclfled partsofback . 847

General medlcalexammat!on. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V70

Diabetes melhtus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Acute pharyngltl s.. . . . 462

Normal pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . ..V22

Suppuratwe andunspecif\edotms med!a .,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382

Sprainsand s:ramsofsacro!hac region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 846

Health aupervwonof mfantorchdd ,. ..,... ,,,,. . . . . . . . . . . . . . . . . . . . . . . . . ..V20

Otherdlsordersofsoftbssues., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...729

Bronchitis, notspectfled asacute orchron!c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490

Osteoarthrosls andallieddlsorders 715

Otherand unspecifreddlsordersof back ., . . : : ::::::..: ::.:::::.:::::::::: :::::: 724

Chronicsmus!hs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..473

Neurotlcd!sorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,. ,...3oo

Othernonmfecttous gastroenterms andcolms., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 556

Certamadverseeffects notelsewhere class!f,ed2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 995

Nonallopathtc lesions, noteisewhere classdled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 739

Allergicrhmltls . . . 477

35.872

Percent

100.0

6.0

3.7

3.2

2.4

2.4

2.4

2.2

2.1

1.9

1.5

1.4

1.4

1,3

1.3

1.3

1.2

1.2

1.2

1.1

1.0

35,872

Cumulative

percent

.—

40.0

6.0

9,7

12,9

15.3

17.7

20.1

22.3

24.4

26.3

27.8

29.2

30.6

31.9

33.2

34.5

35.7

36.9

38.1

39.2

40.2

‘Based onthe/rrtemaf/ona/ C/asslficaoon o/ O/seases, S7h Revmorr Cfin(ca/ Mti/ficat(on [lC&YCM]

2Primanly allergy, unspec!l)ed

Tabie5. Percent distribution ofofficeviaita toallphysicians, to dootors ofosteopathy (D.O.’s), andtodoctors ofmWlcine ingeneral orfamilypractice

(M. D. GFPs), bypnncipl dmgnoses Onmajor dmgnostic groups): United Steteq 1985

A//

Pnncipa/ diagnosis and ICC-9-CM code’ [m major diagnostic groups] physicians D.O. k M.CI. GFPs

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious andparasitlc dtseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neoplasm. ,, .,..,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enticfine, nulr!tional andmetaboltc diseases. andlmmuni~ disorders. . . .

Mental disorders,.,,,. . . . . . . . . . . . . . . . . . . ...,....,.,,,,,,.

Diseases ofthe nervoussystem andsenseorgans. . . . . . . . . . . . . . . . . . . . . . .

Dtseases ofthec!rculatorysystem ,.,. . . . . . . . . . .

D!seases oftheresptratorysystem . .,, ,,, ,. .,.,... . . . . . . . . . . . . . . . . .

Dweases ofthedlgestwe system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

D(seases ofthegenltounnarysystem ,, . . . . . . ,. . . . . . . . . ,,.

Dlseasesoftheskm andsubcutanaous ttssue ., ., . . ,.

Diseases of themusculoskeletal system andconnetitve tissue, .

Symptoms. signs, anddl-defmed condmons

Injuryandpotsonmg . . .

Supplemental classlflcatlon2. . . . . . . . . . . . . . . . . . . . . . . . . .

Otherorunknown . . . . . . . ,, .,.,,..,,,

. . . .

001-139

14C-239

240-279

2LW319

320-389

390+59

460-519

520-579

580-629

68C-709

710-739

780-799

800-999

Vo 1-V82

Number of visits m thousands

836,386 35,872 165,987

Percent distribution

100.0 100.0 100.0

3.9 3.8 5.1

3.1 1.9 1.2

3.5 5.2 5.5

4.1 2.8 2.2

11.0 6.1 6.5

6.6 9.8 11.7

12.1 15.9 16,6

4.3 4.7 4,8

6.1 4.6 5.6

5.7 4.2 4.7

7.1 11.2 7.1

3.5 3.1 4.2

&3 13.1 9.7

15.3 10.7 12,3

3.1 2.8 2.6

‘Based on the Intema?!onal Classifcaf,on 01 D!seaaes,9th Revmon, Clinical Mod!cat!on [ICCW-CM]

2Ch!e fly non-dlness csrc
advancedaa 7

Tabie6. Percent tistnbMtin ofofice vK!tsto aIlphystians todtiom ofost~athy (D. O.'s), andtodtiors ofmeaic[ne ingeneral or fami~pmctice

(M. D. GFP’s), bysgeand sexofpatiersk United Steteq 1985

Pat/errt chararxensffc All phys]ctans 00s MD GFP’s

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age

Under 15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-44years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

65yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mean patlentage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

All ages . . .

Under 15 years

15-24 years .

25-44years

45-64yeare .

65 yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .’ . . . . .

Male

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l+24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2544years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4$64yeara . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

636.386

Number of vmts m thousands

100.0

18.7

11.6

27.6

21.6

20.5

39.6 years

60.9

9.1

7.7

18.6

12.9

12.5

39.1

9.5

3.9

9.0

8.7

8.0

35.872

Percent dlstnbutlon

100.0

15.2

13,5

31.6

22,7

17,0

39.0 years

60.2

7.7

6.3

t 9.4

14,2

10.6

39.8

7,5

5.2

122

6.5

6.4

165.987

100,0

15.6

13.5

28.4

22.5

20,0

40.3 years

60.7

7,7

8.6

18.3

13,7

12.4

39.3

7,9

4,9

10.1

8.8

76

TaMe7. Percentdistnbution ofofticevieii toallphyaicianq todoctoraofosteopathy (D.O.’s), andtodoctoreof medicine ingeneral orfamiiypracdce

(M. D. GFP’s), byraceand ethnicityofpatienk United StateS 1985

Patierrt characfemtlc All Dhys/c/ans DOS MD GFPS

Number of vIsds m thousands

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 636.386 35.872 165,987

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

Wane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EthntcKy

Hmpamc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent d[stributlon

. . . . . . . . . . . . . . . . . . . .,, 1000 1000 1fx,r)

. . . . . . . . . . . . . . . . 90.0 878 a8 7

. . . . . . . . . . . . . . . . . . . . 82 11.7 39

. . . . . . . . . . . . . . . . . . . .,, 1.8 “0.5 2,4

. . . . . . . . . . . . . . . . . . . ,., 64 2.9 6.9

Non-Hlspan!c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93.6 97.1 93.1

‘Awn, PaclfrcMander.Amerman fnd!an. Alaskan native.
8 advmcedata

Table8. Percent distnbtibn ofoffice vtstislo allphy*mns, to*omof ostmpathy(D.O.'s). andtodoctora ofrnedcin eingenem lorfamirypradce

(M. D. GFP”s), byreferral status andpnorvisitshtus: United States, 1985

Vwt characfer{soc All phystctans D,O. s M.D. GFPk

Number of wslts m thousands

Total ...,.... .,, .,, ,,, ,. 636,386 35,872 165,987

Percent distribution

Total .,,,,.. ,,, ,. ... ,,. . ,,, 100.0 100.0 100.0

Referral status

Referrec! by another phys!clan ,, ,,, ,. ,,, ,,, 56 2.5 17

Not referred by another physlc!an

.

., . . ... , ,,, ,,. 944 97.5 98.3

Prior ws[l status

New pa:!ent . . ,., ,,, ,. . . . ,,, ,. ,,, , ,,, ,, ... 16.9

Oldpahent, . . . . . . . . . .

12.1 14.7

83.1 87.9 85.3

Newproblem, ,,,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.7

OldproWm., . . . . . . . . . . . . . . . . . . . . . . . .

27.7 33.1

604 60.2 52.2

Table 9. Percent of office visits with at least 1 drug mention; percent of visits with multiple drug mention~ and Drug Utikation Irrde!& by selected

physician groups: United States, 1985

Percerrt of or%ce Percent of oflice

wsffs with f or visits with 2 or Drug Utilization

Phys:cfan group more drug mentions more drug mentions Index’

Allphyslc(ans .,...,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61.2 27.7 89

Doctors ofosteopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68.1 32.8 101

M.D.kln general orfamdypract!ce ,... .,, ,.,,.. 72.7 33.6 106

‘A compos!le Imdlcator of the frequency and mtenslty of drug Whzatlon, formed by add!ng the percent of vmts wnh one or more drug menmrrs to the percent of vmts with multiple drug meneans

ano muncmg to the nearesl whole mleger

Table 10. ~e25dmgs msttieq@n@ pr~crib40r protied intkofice pratice ofd~om of osteopathy, by fheirgenenc ingredenta, number of

mentions, rank, andtherapeuf”muse: United Statea, 1965

Number of

Gener/c mentions

Rank mgred(ent m thousands’ Therapeutic use

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

All drugs . . . . . . . . ,, ..,..,,,,,,.,

Hydrochloroth(az! de....,,,, ,, .,, ,, .,. . . . . . . . . .

Acetammophen . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erylhromycm . . . . . . . . . . ,,, .,,,..,.,,,,.. . . .

Codeine. . . . . . . . . . . . . . . . . . . . .

Phenylpropanolam!ne . . . .

Chlorphamramme . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxlclllm . .

Phenylephnne . .

Asp!nn . . . .,,, ,,,,, ,,,

Pseudoephedrlne . .

Cephalexm, ,..,.. . . . . . . . . . . . . . . . . . .

Caffein e,...... . . . . . . . . . . . . . . . . . .

Ibuprofen, ,, ...,,.. . . . . . . . . . . . . . . . ...,,,

Amptclllm, ,,, . . . . .

Theophyllme

Guatfenesm, ,,, ,.

Penlctllm Vpotasswm

Methylpredmsolone

Promethaztne,

Narzroxen

Atroome

Tnamterene

Dlgoxm

Neomycin

%lfamethoxazole

63.094

1.670

1,646

1,385

1,334

1,324

1,302

1,297

1.251

1,043

1,004

706

692

682

Diuretic, antihyperfensive

Analgesic, antlpyrellc

Antiblollc

Analgesic, antitussive

Sympathomimetic

Antihistaminic

Antibiotic

Sympathomimetic

Analgesic, antlpyretlc, anti-inflammatory

Sympathomimettc

Antlblobc

Stimulant

Nonsteroidal anti-inflammatory agent

. . . . ..,,, 678 Antibiotic

. .,,, 659 Bronchod!lator

. . . . ,. 575 Expectorant

. . . . ..,,, 555 Antlb!otlc

,,,.. . . 541 Steroldal anti-inflammatory agent

. . . ., 520 Antlhstamtmc

. . . . ,. 513 Nonsteroldal anti-inflammatory agent

., ,,., 478 Antlchohnerglc

. . . .,., 467 Dturetic, antihypertenswe

466 Cardlotonlc

,, 462 Ant! blobc

452 Antlblotlc

‘conmmes mentlo. saslkgr?nenclormol Snngle-rngreolenl drugs w!th IIsmenllons asanmgredlent ofcombmaoooowgs Vltamms, mmerats, andvaccmes are ommed
advancdata 9

Tsbie 11. Percent distribution ofdrugmenfions by#physi&s. bydoctors ofosteopathy (D.O.’s). and bydoctors ofmedkine in general

or famifypractice (M. D. GFP’s), bydrugclas6 Unifed Stateq 1985

Drug c/ass’ A// physwarrs Do s MD GFPs

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Systemic antl-mfectwe agents . . . . . . . . . . . . . . . . . . .

Ant!blottcs. . . . . . . . . . . . . . . . . . . . . . . .

.

. . . . . . .

. . . . . . . . . . . . . . .

. . . . . . . . .

Autonomlcdrugs, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antlcholmergicagents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sympathomlmetlc [adrenerglc] agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skeletal muscle relaxants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovasculardrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardlacdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antlhypertenswe agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vasodllatmg agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analgesics andantipyretlcs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonsteroldal anti-inflammatoryagents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychotropic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anxiolyt!cs, sedatwes, andhypnotce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Electrolytic. calor!c, andwaterbalance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dturet!cs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Replacementsolutlons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ant!histammes. armtusswes. expectorants. and niucolylc agents . . . . . . . . . . . . . . . .

Eye, ear, nose, andthroatpreparatlons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gastromtestmal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hormones andsynthetrcsubstances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Systemic comcostenods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estrogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antdiabetlcagents .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Serums. toxoids, andvaccmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skmandmucuous membraneagents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Smc@th musclerelaxants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vltamms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CXherorundeterrnined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Numberof

drug ment!ons m thousands

693.355 43.002 214.281

Percent dlstnbutlon

100,0 100.0 100,0

147 178 18,1

12.3 15.8 15.8

3.? 6.1 3.9

1,2 1.9 1,3

1,4 2.1 1,1

09 2.0 1,3

116 8.4 11,4

4.6 2.7 3.9

4,2 3.6 5.3

2.6 2.0 2.1

9.8 116 11.2

6.2 7.3 7.1

6.0 5.7 5,5

3.3 3.5 3.3

1.7 1.2 1.4

7.4 7.2 8.8

5.0 5.0 6,1

1.9 1.4 2.0

6.9 10.1 8.4

.$.4 18 1.6

3.8 3.2 4,3

7.6 6.9 7,7

2.5 2.4 2.5

1.0 0.9 0.9

13 1,6 2.2

3.0 2.4 2.1

6.0 45 4.3

17 18 1.4

2.7 35 2.3

10,7 9.0 9.0

‘Baaed on American Hosptal FormularyServwe Classf=fton System,Drug Roducf hrforrnarmnF//e, The American Drugg!st Blue BOCKDala Center San Srurm Callfomla. 1985

Table 12. Percent of office visii to all physician% to doctors of osteopathy (D.O.’S), and to doctors of medicine m general or family practice (M.D. GFP’s),

by nonmed~tion therapy ordered or provided United States 1985

Nonmed/catfon therapy ordersd or prowded All phys!ctans DOS MD GFPs

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 689

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .lZ

Ambulatorysurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Psychotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Famdyplannmg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Dletcounselmg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Olhercounsehn g........ . . . . . . . . . . . . . . . . . . . . . . 93

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.0

Percent of wslts

678

’129

5.0

15

17

7,2

58

1.8

72.2

41

5.5

1.1

1,6

9.1

85

1.1

‘Chle!ly lechrvques of ostaocathm man,pulatwe therapy
10 advamedata

Table 13. Percent of office viaiis to all physicians, to doctors of osteopathy (D. O.’S), and to doctors of medicine in general or family practice (M.D.GFP’s),

by disposition of the visits: United States, 1985

Dqms(t!on All phys!c!ans D. 0. b M.D. GFP>

Percent of visits

No followup planned . . . . . . . . . . . . . . . . . . . 9.8 11.4 12.3

Retuma! specifledt!me . . . 61.5 57.9 50.0

Retumtf needed, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.9 242 32.3

Telephone followupplanned . . . . ,,, 4.0 34 3.7

Referredtoother phys{c!an. ., . 3.2 4.3 4.2

Admttohospltal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,.. 1.6

Other.

“0.7 0.9

,,. . . ..,,, ,,,,, 1.3 1.1 0.5

Table 14. Percent distrfbufiin ofdrugmentions byallphysitins, bytiors ofosteo~thy (D. O~s), and byd~tors ofmednine ingeneral or family

practice (M. D. GFPs), bydurationofvisk United Steteq 1985

Durat/on A// physmans D.O. k M.D. GFPi

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . ,,. . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

Ommutes’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 2.4 3.2

l–5mmutes. . 10.3 10.4 8.7

6-10 mmutes, ,., .,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28,5 33.6 33.9

11-15mmutes . . 30,0 31.7 31.5

16-30 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.7 19.3 20.0

31 mmutes andlonger . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 2.4 2.6

Meanduratlonofv@2 . . 16,1 minutes 13.5 mmutes 14.(5 mmutes

‘Vmtsat wh!chthere wasnoface-to-face contact beWeenphyslclan and palwmt

2Excludes ‘0 mmutes vmts

Technical notes

Source ofdata and sample design

The information presented in this report is based on data

collected by means of the National Ambulatory Medical Care

Survey (NAMCS) from March 1985 through February 1986.

The target universe of NAMCS includes office visits made

within the coterminous United States by ambulatory patients

to nonfederally employed physicians who are principally en-

~aged in office practice, but not in the specialties of anesthesiology. pathology, or radiology. Telephone contacts and

nonofficevisits areexcluded.

The NAMCS utilizes a multistage probability sample design that involves samples of Primary Sampling Units (PSU’S).

physician practices within PSU’S. and patient visits within

physician’s practices. Physician specialty was used as a stratification variable. For 1985. a sample of 5.03? nonfederal.

office-based physicians was selected from master files maintained by the American Medical Association and American

Osteopathic Association. Of the 4,104 inscope physicians.

70percent responded tothe1985NAMCS.

Forthe 1985 study, doctors ofosteopathy (D.O.’s) were

included as a separate sampling strata. From this strata 511

osteopathic physicians were selected. 427 were inscope. and

094 responded to the study. a response rate of 69 percent.

The 1985 NAMCS sample design was different from that

used in earlier NAMCS cycles where doctors of osteopathy

were sampled along with doctors of medicine according to

their proportional distribution in nine major specialty groups,

The ]ncrctiw in physician sample size and the modification

of the sample design in 1985 had the effect of improving

reliability of survey estimates relative to earlier data years.

Sample physicians were asked to complete Patient Records

(figure I) for a systematic random sample of office visits

taking place during a randomly assigned one-week reporting

period. Responding physicians completed ‘71,594 Patient

Records. Of these Patient Records, 7,375 were completed

by responding D.O. ‘s. Characteristics of the physician’s practice, such as primary specialty and type of practice, were

obtained duringan induction interview. The National Opinion

Research Center, under contract to NCHS, was responsible

forthesurvey’sdata collection andprocessing operations.

Sampling errors

The standard error is primarily a measure of the sampling

variability that occurs by chance because on]y a sample, rather

than an entire universe. is surveyed. The relative standard

error of an estimate is obtained by dividing the standard error

by the estimate itself and is expressed as a percent of the

estimate. Approximate relative standard errors of aggregate

estimates based onallspecialties have been published. Approximate relative standard errors for aggregate estimates of visits

to D.O. ”S and to M.D. general and family pmctitinners are

shown in table 1. Approximate relative standard errors for

aggregate estimates of drug mentions for D.O.’s and for M.D.

general and family practitioners are shown in table 11.
9A #9n#—aAda 14 Cauva —us II

ASW,MI.. .t ~hdml,*,w-w .Wmatton *c. w.2.m Defmd m.t,l,-t,.. ~f a.

,nd,.ldua, . ~,ac,, cp :, J. ,s,ao,,snmenl w m held mnf,denl,a! w,,f be used m,f

Ceoa.hne.t 0! *w. ..0 .mv. Sa..,ce3

W=monsenq.qea . ma lo, ‘.e c.moses 31

>.U,C H.a,ll! Se,,,ce

.-e suf.ev and *III not be mscnseu >? B 467339 rel.?a$ed !O,x”,rC.,s-.$w,S,djar*..O,*ef =b,:cx

+,alo, ”a,-c.%? ID ,14*8,,” S,a!,shrs

1. ~TEOFVISIT PATlENT RECORD OMBNO 0937.0141

& NATIONAL AMBULATORY MEDICAL CARE SURVEY

Exmres 9 30’S6

(PHS) 6105. B

456-232

Z- y;;HOF 3. SEX 4, ;~;F40R 5. EfHNICiTY & EXPECTED SOURCE(S) OF PAYMENT

L h,, ~ J/[ thti( J/1~/, 7. $gEp;;:NT

~❑ ,,H,,,

‘ cl-“’ 4❑ l&::::%’ 7D NCC?IAFWE

FOR ~

, (-J 6EV.ILE , ❑ BLACK ‘ •1 %INC

Vl!w SY

ANOTHER

&S!ANPA.CIFIC

3 ❑ ISLANOER 2 •1 ‘ED’CA’E 5 •1 $&&2:ME”c’A’ ‘ c1 O;.::, ,

4 cl:l’%wtw%t

2DNorH,sPwc

PHYSICIAN?

-_-&_&

2❑ ‘ALE

3DMEO!CAID 6DHMCI.WE.PA!DPLAN 1(-JVES *UN.

ENTX3 COMPLAINT(S), SYMPTOM(S), OR OTHER 89 :&ofJ(~) FOR~“!s VISIT ,/), P{[,tw \ {JWJIW,WIAI

9m :;:UJ:SE 10= OTHER DIAGNOSTIC SERVICES THIS VISIT

—

THIS VISIT

L hcxh .dl ortlt.rd w prttk detlI

a MOST IMPORTANT ;,:;:d::; 1❑ .0., So URINALYSIS IID SLGOCI~ESS”REC=EO(

pw Lrdecl [ 2 ❑ BREAST EXAM 7D HEMATOLOGY 12U ,*G

1❑ NCNE t ❑ FSLVIC EXAM ,f-JEIUJoLXHEMtsTRY 13DCFESTX.RAY

2 ❑ BICQO

4 ❑ RECTALU4M ‘3DPAP,EST 14DOTHERI?AD!OLCG”

b OTHER

5 ❑ VISLUL ACUITV !ODOTHERUS7EST ,5DuLTRASOUND

3 ❑ URINE ,6D0,HERSER,CE S,.,,,,,

4 ❑ ORAL

11- PHYSICIAN’S DIAGNOSES 12. &;yE&o::;&? 13. NON-htEDIcATION THERAPY

j(“h,,,i LIll%e.,,,.e, r,,tktd [,rp,,,, ,Jtd rh,, ,,,,()

2 MINCIPAL DIAGNOSISIPUOWEM ASSCUATED

WITH 17EM 8.

11-JvEs *HW 1❑ NONE 5❑ PsYcHOrHEQAlw 30 CCRRECTIVE LENSES

1

2 ❑ F!WS!OTHEF?APY 6 ❑ FAMILYFUNNING !,DOTHER k,,,,

.—— IF YES FOR

b OTHER SIGNIFICANT CURRENT OIAGNOSES THE C5NG!110N IN

ITEM lTa? 3❑ AMBuuTORW SURGERY T❑ olsTcouNssLw3

T❑ “ES ,0.0 4URAD,A,,0N, HERAW SD OTI.I,R<3WSEI.!NG

14, MEDICATION THERAPY R8L .wJ till neti cw .,mtmud mtdt, J[t,,n, ,,rthrtd ,. pr,tt,~td ,,, (h,, t(WIi w[he WJme hnd numr ,,r tynt.m ndme c,nk.rid t,n .un R~ <v<,?ti,,,IWI!I, d n.<wl I

I 5= ?W.y::,ly,:’sn 16. ;:l~;;;; ‘F

IF NONE. CHECK HERE •1 ~❑ NO FCUCW IJ9~ANNFD

~)me .3’1u211L

a 5

punl with

NEW

I

rhi ,f.-un

FQR C!X > Q WTIIIWM 4T SWC FIE5 ‘ME

MEDICATION~ ?,,TEU . ..3

YES

1 .——

n ,: !’fi ,’~

g ::::::::::;:.< A...,,

‘cl ?0 ‘cl ‘cl , ❑ .,FE=QEn,cfl-H,. M.cc.M

p —.

3 ___ _ ‘cl cl ‘cl ‘cl *DE. G 1! ,PNED 7:! R: CCi7RWb .W.I. SC!AN

4_ ‘cl ‘cl ‘ “cl cl , (J Awm”’.ww . . ..—

‘cl ~cl ‘cl :1-J !D7”,R -,

v>””,, %

5—

Fgure L Patient Record Form

Table L Approximate relative standard errors of estimated numbers of

office visits to doctors Of osteopathy and to M.D. general and famity

practitioners NAMCS, 1985

Est/mated number of ofhce Relawe standard

vc+ts m thousancs error m percent

200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.3

500 . . . . . . . . . . . . . . . . . . . . . . . . 25.5

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 18.8

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,4

5.000 . . . . . . . . . . . . . . . . . . . . . . 108

10.000 . . . . . . . . . . . . . ..,, 94

20,000 85

50,000..::...::::.:. . ..”..”:,:: 80

100.000, . . . . . . . . . . . .,, ,. .,,,,.. 78

150,000 . . . . . . . . . . . . . . . . . . . . . 7,7

. . ---

Example 01 use of tanle Anaggrega!e esrnateof “500000 uwtstoaoctorsof w.t..cma!t~

has a relawe standard error of 10 1 percerl m a standard error of 757500 VIS,15 1 a 1

percent 0[ 75000001

Table Il. Approximate relative standard erroraof estimated numbers of

drug mentions based on visits to doctors of osteopathy and to M.D.

general and famiiypractitione~ NAMCS, 1985

-—

Estimated numter of Zrug ~e/atn e srandanj

menf(ons m thousdnas error rn percent

200 . . . . d4 2

500. 287

1.000 . 21,1

2.000 160

5,000 120

10000 .03

20000 93

50.000 07

100.000 95

200000 33

ExmDe of use d ,me A- w-:,. . .s~w”,fP 7-. <P,a ., :.. z . . . . . y., .: .=,,Ts m

k.! ~ yneq and lIm” ‘, ‘I W- ‘!5 4 . .. .,! I.” h,,, ,.1 . . . . .

. . -?,- ?-1 <#r .3

51arda7d e,.sr fif 3 EL :LI 8 3 me .- + -, .1 A I?
12 advancdata

Rounding of numbers

Estimates of office visits have been rounded to the nearest

thousand. For this reason. detailed figures within tables will

not always add to totals. Rates and percents were calculated

on the basis of original unrounded figures and will not necessarily agree with percents calculated from rounded data.

Definitions of terms

Ambulatory patient—An ambulatory patient is an individual seeking personal health services who is not currently

admitted to any health care institution on the premises.

Physician—A physician is a duly licensed doctor of

medicine (M.D. ) or doctor of osteopathy (D. O. ) who is currently in office-based practice, and whose major professional

effort is devoted to caring for ambulatory patients. Excluded

from NAMCS are physicians who are hospital-based; who

specialize in anesthesiology, pathology, or radiology; who

are federally employed; who treat only institutionalized patients; who are employed full time by an institution, or who

Recent Issues of Advance Data

No. 137. Diagnosis-Related Groups Using Data From the National

Hospital Discharge Suwey: United States, 1985 (Issued July 2, 1987)

No. 136. Aging in the Eighties: Ability to Perform Work-Related

Activities (Issued May 8. 1987)

No. 135. Use of Nursing Homes by the Elderly: Preliminary Data

From the 1985 National Nursing Home Survey ([ssucd .May 14,

1987)

Suggested citetion

National Center for Health Ststis!!cs, H. Koch: Highlights

of osteopathic office practwe, National Ambulatory

Medical Care Survey, 1985. Advance Data From 14ta/

arrd /fea/fh Sfafcsrica, No. 138. DHHS Pub. No. (PHS)

87-1250. Pubhc Health Serwce, Hyattswlle, Md.,

Sept. 18, 1987.

either spend no time seeing ambulatory patients or whose

care of ambulatory patients is secondaty to another major

professional function.

O@ce—Offices are premises identitled by physicians as

locations for their ambulatory practices; these customarily include consultation, examination, or treatment spaces the patients associate with a particular physician.

Visit—A visit is a direct personal exchange between an

ambulatory patient and a physician or a staff member working

under the physician’s supervision, for the purpose of seeking

care and rendering personal health services.

Drug tnenfion—A drug mention is the physician’s entry

of a pharmaceutical agent prescribed or provided—by any

route of administration—for prevention, diagnosis. or treatment. Generic names as well as brand-name drugs are included.

as are nonprescription as well as prescription drugs. Along

with all new drugs, the physician also records continued medications, if the patient was specifically instructed during the

visit to continue the medication.

From Vital and Health Statistics

No. 134. Highlights of Drug Utilization in Office Practice: National

Ambulatory Medical Care Survey. 1985 (Issued May 19, 1987)

No. 133. Aging in the Eighties: Functional Limitations of Individuals

Aged 65 and Over (Issued June 10. 1987)

Copyright Information

This report may be reprinted w!thout further

permmon
mmisin 4-

From Vital and Health StatMcs of the National Center for Health Statistics Number 139 ● September 18, 1987

Health Care Coverage by Age, Sex, Race, and

Family income: United States, 1986

by Peter Ries, Division of Health Interview Statistics

Introduction

This report on the health-care coverage of the civilian

noninstitutionaiized population residing in the United States

during 1986 presents estimates of coverage under private health

insurance. Medicare. public assistance. and military-Veterans

Administration (hereafter military-VA) health benefits. The

estimates for each of these forms of coverage are shown

by age. sex. race. and family income. Persons are also classified in relation to whether they are covered by none or by

at least one of these four types of health-care plans, and

their coverage status is described in terms of the same

sociodemographic characteristics.

The main purpose of this report is to update the 1984

estimates shown in another report.’ The 1986 data in this

report were collected with the same questionnaire and procedures used for the 1984 data. The more detailed discussion

of the meaning and limitations of the data included in the

1984 report should be consulted to better understand the 1986

estimates included in this report.

The coverage of persons under each of the four forms

of coverage named above are described in the following sections. Persons then are described in terms of whether they

are covered by at least one of the four forms of coverage

or by none of them (the so-called “uninsured population”).

Private health insurance coverage

Household respondents were asked whether any family

member was covered by a health insurance plan that paid

any part of a hospital bill or of a doctors or surgeon’s bill

for operations. The names of all plans were listed for which

‘National Center for Health Statistics. P. Ries: Health care coverage by

sociodcrnographic and hwlth chmscteris[ics. United States. 1984. Viral ad

Heulth SrurI$Iic.f. .%riu 10. No. 162. DHHS Pub. No. [PHS) 87-1590.

Public Health Service. Washington. U.S. Government Printing OtYice, In

press,

a positive response was obtained to either of these questions.

Questions then were asked for each plan that covered at least

one family member. Included were questions about whether

the plan was obtained through an employer or union. the

type of coverage associated with the plan, and the status

of each family member’s coverage in relation to each of

the plans. In tabulating the data, persons were classified as

“covered by private health insurance” if they were covered

by at least one plan. and as “not covered” if they were classified

as “not covered” under all of the plans listed for the family.

They were classified as “unknown” if their coverage was

not determined for at least one plan and if they were not

covered by any of the other plans (if any) listed for the

family.

Table 1 shows that about 76.6 percent of the civilian

noninstitutionalized population was covered by private health

Table 1. Percent distnbutiin and number of persons by private health

insurance ooverage statuq aacmfi~ to * United States. 1988

Coverage status

Acre All’ Covered Not covered

Alleges, . . . . . . . . . . .

Under 18 years. . . . . .

18-24 years ...,..... . .

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

-KS-64year s . . . . . . . . . .

65 years and over . . . . .

Alleges ...,..,......,..

Under 18 years . . . . . . . . . . . . .

18-24 years . . . . . . . . . .

2S44 years . . . . . . . . . . . . .

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

65years and over . . . . . .

Percent dlslnbul!on

100.0 76.6 23.4

100.0 72,7 273

100.0 68.2 31.8

100.0 79.7 20.3

100.0 63.2 16.6

100.0 75.3 24.7

Number in thousands

236,348 179,470 54,696

83,132 45,429 17,101

26,721 18,017 8,405

74.260 58.654 14.977

4d 698 36.834 7,460

27538 20,535 6,752

‘Percent dmtnbulm excludes unknown coverage status frecwency includes unknown

coverage status

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Serwce
2

Table 2. Percent and number of persons, by private health insurance coverage status age, se% race, and family income: United States, 1966

Covered AJof covered Covered Not covered

All Under 65 65 years All Under 6565 years All Under 6565 years All Under 6565 years

Sex. race and famdy income ages years and over ages years and over ages years and over ages yeara and over

Percent’ Number m thousands2

All persons3

Sex

Male . . . . . . . . . .

Female ...,..... .,

Race

White .,.....

Black . . . . . . . . .

Other . . . . . .

Fam!ly income

Less than S5.000 . . .

$5.000-59.999 : : : : :

SIO.000-S19!999 : : :

$20.000-S34,999

$35.000-s49,999 . . . . . . .

$50,0000 rmore

766 768 75.3

772 773 766

761 76,4 74.3

799 800 790

55.7 572 385

70.2 71.0 595

329 32.1 37.3

39,9 317 64.4

68.8 660 83.2

885 68.5 87.8

92.9 93.2 85.6

949 954 851

234 23.2

22.6 22.7

23.9 23.6

201 200

44,3 42,8

29.8 29,0

67.1 67.9

601 663

31.2 34.0

11,5 11.5

7,1 68

5.1 4,7

24.7

234

25.7

21,0

61.5

40.7

62.7

356

16.8

12.2

14.3

14.9

179.470

87.484

92.008

156,427

15.758

5,285

4.300

8,108

30,857

55,116

34.612

24,832

158,935

78.820

80,115

139.058

14,879

4,999

3,561

4,800

24,579

50,724

33.280

23,920

20,535

8.844

11.891

19,369

879

287

739

3,308

6,276

4,391

1,331

913

54.696

25.815

28,881

39.914

12.542

2,240

6.765

12.193

13.961

7.195

2.842

1,327

47,944

23,174

24,770

34.761

11.138

2,044

7,523

10,384

12,690

6.584

2,420

1,167

6,752

2.641

4,111

5,153

1,404

196

1.242

1,829

1,271

611

222

160

‘Excludes unknown coverage status

2Numberot persons covered and not covered da not equal total Populatcm because unknown coverage slaiusis not mcludad See table Ill forpopulat!on estimates

3includes unknown Iamiy income

insurance in 1986. This is almost identical [o the 1984 estimate

of the percent covered (76.4 percent). In relation to age,

the highest percent of coverage was for persons 45-64 years

of age (83.2 percent) and the lowest percent of coverage

was for persons 18–24 years of age (68.2 percent).

It should be noted that the nature of the private health

insurance plans for persons under 65 years of age and for

persons 65 years and over is quite different. For almost all

persons 65 years of age and over the private plans are a

secondary form of insurance intended to supplement Medicare

coverage (the so-called “Meal-Sup”” plans). For most persons

under 65 years of age the private plans are their primary

or only source of coverage.

Table 2 shows that black persons had the lowest percent

of coverage of the three racial groups shown (55.7 percent

compared with 79.9 percent for white persons). Family income

has an even larger impact on coverage status. with the percent

covered t-mging from 32.9 percent for persons in families

with an annual income of less than .$5.000 to 94.9 percent

for persons in families earning more than S50.000 per year.

Table 3. Percent and number of persons 65 yeara and over, by Medicare

coverage statuq sex race, and family income: United States 1986

Sex. race. and Not Not

?amdy income Covered covered Covered covered

Allpersons3 . . . . . . . . . . . .

Sex

Male, . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . .

Fam!ly income

Less than $5,000 . .

$5,000-$9,999

$10,000-$19,999 .

$20,00@S34.999 .

$35.oofH49.999

S50,0000rmore . . .

Percentf Number in thousands

95.0 5.0 25,970 1,370

94.8 5.2 10,683 589

95.1 4.9 15,287 781

95.6 4.2 23,550 1,041

88.2 11.8 1,995 267

87.4 “12.8 425 62

93.1 7.0 1.850 139

95.9 4.1 4.924 209

96.5 3.5 7.316 284

93.9 6.1 4,702 306

91.4 8.6 1.424 134

93.6 ‘6.4 1,006 69

Medicare coverage

Household respondents were asked whether anyone in

the family was covered by Medicare. and. if so. to indicate

which persons were covered. Those classified as covered were

then asked whether they were covered by the types of benefits

that pa] for hospital bills (part A). physic~an care (part B).

or both. Because almost eve~tme covered by either part is

co~ erecI by the other part. the estimates of h~edlcare covemge

shown in this report include persons colered by either part

A or part B, or by both part A and pan B.

In 1986 about 12.1 percen[ of the civilian noninstitutionalized population were cotereci b} hledictire [data

‘Excludes unknown coverage StatUS

‘Number of persons covered and not wvered do not eaual total population bec%use

unknown coverage status IS not included Sss table HI for populabon estimates

31ncludes unknown family !ncome

not shown). This estimate is about the same as the 1984

estimate of 12.0 percent. Because ve~ few persons under

age 65 were reported to be covered by Medicare ( 1.2 percent).

table 3 shows Medicare coverage for persons 65 years of

age and over On]y.

Almost all persons 65 years of age and o~rer (95.0 percent)

were covered b)’ Medicare. The percent of this age group

covered \aried little from 95 percent in different sex or familyincome groups. With regard to race. the percent of white
persons covered (95.8 percent) was higher than that for black

persons (88.2 percent) or for persons of rxes other than

white or black (87.4 percent).

Table 4. Percent distribution and number of persons by publii-aesistence

health-care coverage status, according to age: United States. 1986

Coverage status

Aae All ‘ Covered Not covered

Public assistance health care

The 1986 NHIS questionnaire included several questions

related to eligibility for public assistance health care. Among

these were qu&tions on the receipt of Aid to Families with

Dependent Children (AFDC) and Supplemental Security income (SS1), whether the person had a valid Medicaid card.

and whether he or she was covered by any public assistance

program that’ paid for medical care. In this report coverage

b} pubIic assistance is ascribed to the person if a positive

response was obttiined to any one of these questions. Persons

we classified as ‘-not covered” by public assistance for medical

care if a negative response was obtained for aIl four questions.

It should be noted that “public assistance” as used in

this report is not synonymous with “Medicaid coverage. ” This

is because those classified as “covered” only on the basis

of an affirmative response to the questions about public assistance coverage may or may not have been covered by Medicaid.

However, since three of the four criteria noted above relate

to Medicaid coverage (“categorical” coverage associated with

the receipt of AFDC or SS1, and possession of a valid Medicaid

card), it is highly likely that almost all of the persons classified

in this report as covered by public assistance are in fact

covered by Medicaid. But, because of the ambiguity for a

relatively small number of cases noted above. the more general

term ‘public assistance” will be used to describe this type

of coverage.

Because the criteria for Medicaid coverage are defined

by each of the States. and because many people are not

ware of the criteria used in their State. it is difficult to

{~btain point-prevalence estimates of this population based on

a household survey using a national rather than a State sampling

frame. Two important implications of this fact are that

( 1) national household surveys based on only one interview

tend to underestimate the prevalence of this type of coverage.

tind (2) the persons who are identified tend to have more

illness. impairments, and injuries than persons in the noninst]tutionalized population who are not identified. This follows

from the tkct that many persons become aware that they

are covered by Medicaid (or other forms of public assistance)

tmly after they become ill or disabled and seek medical help

for their problem.

Given these considerations. extreme caution should be

used in comparing the results described in this section with

{~ther sources of estimates on the number and characteristics

l~f the >Iedicaid or public assistance population. Arty such

comparison should focus on the criteria used to detlne this

type of coverage and the procedure used to collect the data

that serves as the basis ofthe estimates.

On the basis of the NHIS data collected during 1986.

approximately 5.9 percent (table 4) of persons in the civilian

noninstitutionalized population were eligible for public assistance for health care. This is compared with the 1984 estimate

of 6.0 percent. The percent covered was highest for persons

under 18 years of age.

Percent dtstrlbutlon

Alleges . . . . . . . . . . . . . . . . . 100.0 5.9 941

Under 18 years . . . . . . . . . . . . 100,0 10.4 89,6

16-24 years . . . . . . . . . . . . . 100,0 5.0 95.0

25-44 years . . . . . . . . . . . . . . . 100,0 3.8 96.2

45-64 years . . . . . . . . . . . . . . . 100,0 3.1 96.9

65 years and over . . . . . . . . . . . . 1000 6.6 93,4

Number m thousands

Alleges . . . . . . . . . . . . . . . . . . 236.348 13,801 220.285

Under 18 years . . . . . . . . . . . . . . 63.132 6.440 55,675

16-24 years . . . . . . . . . . . . . . 26,721 1.319 25,141

25-44 years . . . . . . . . . . . . . . . 74.260 2,837 70,955

45-M years . . . . . . . . . . . . . . 44.698 1,396 43.047

65 years and over . . . . . . . . . . . . 27,538 1.809 25.467

‘ Perceru d!stnbuuon excludes unlmmwr coverage status, tequency includes unknown

coverage status

Table 5 shows that the percent of persons covered by

public assisutnce was highest for females (7.2 percent). black

persons ( 18.8 percent). and not unexpectedly for persons with

low annual famiiy income (34. I percent for persons with

an annual family income of less than S5 ,000).

Military-Veterans Administration health care

coverage

As was the case with public assistance health-care plans.

coverage for civilians under military or VA health benetits

is much more difficult to define than coverage under private

health insurance or Medicare. This is especially so in the

case of VA health benet%s which operate for most veterans

and their eligible dependents under a system of priority eligibility. Veterans with a certified service-connected disability are

almost certain to receive care. However, those who may qualify

for care on the basis of other criteria may or may not receive

care depending on the capacity of the VA facilities in their

area. Therefore, the estimates presented in this section ~hould

be considered in terms of the types of information collected

in NHIS on this topic rather than as a detlnitive statement

of the number and characteristics of veterans and their family

members who are covered by military-VA health benefits.

In this repofl persons are classified as covered by military’-

VA health benefits if it was determined that ( 1) they receive

a Militaw or VA pension, (~) they Were covered by

CHAMPUS, CHAMP-VA. or any other program that provides

health care for military dependents or survivors of military

persons, or (3) they received compensation for a disability

from VA. Other circumstantial criteria by which a person

might qualify for militaty-VA health-care benefits (such as

advanced age or low income) are not included among the

criteria used to define eligibility.

Finally, it should be noted that even Ihough the mditary

and VA health-care systems are administratively di>tinct.

coverage by one or both of these is considered as a single

form of health-care covera:e in this report. The main reason
4 adVmCe&ita

Table 5. Perc~t and number of person% by public-assistance heattkare coverage statue age, sex race, and famityincome: (.lnitedstste~ 19s6

Covered Nof cuvered Covered Not covered

All Under 65 65 years All Under 6565 yeara All Under 6565 years

Sex. race. and fam]ly mcume

All Under 6565 years

ages years and over ages years and over ages years and over ages years and over

Percent’ Number in thousendsz

Allpersonss . . . . . . . . . . 5.9 5.8 6.6 94.1 94.2 93.4 13,801 11,992 1,809 220,285 194,811) 25,467

Sex

Male . . . . . . . . . . . . . . . . . . . . . 4.6 4,6 4.2 95.4 95.4 95.8 5,184 4,693 471 106,242 97,409 10,834

Female . . . . . . . . . . . 7.2 7.0 8.4 92.8 93.0 91.6 8,836 7,299 1,337 112,043 97,409 14,6S4

Race

White ,. ...,,. .,. . . . . 40 3.9 5.0 960 96.1 95.0 8.014 6,784 1,230

Black. . . . . . . . . . . . 16.6 18.3 23.9

190,951 167,627 23,324

81.2 81.7 76.1 5,192

Other, . . . . . . . . . .

4,655 537 22,486 20,777’

8.0 7.9 ‘8.6 92.0 92.1

1,709

91.2 595 553 .41 6,648 6,414 434

Famdylncome

Lessthan$5,000. . ,, ...,,.,., 34.1 34.9 29.9 65.9 65.1

$5,00&$9,999

70.1 4,335 3,751

22.6

584

26.6

8,374 7,007 1,367

$10,000-$19,999.:::::::’: :::::

11.0 77.4 73.4 89.0 4,472 3,909 564 15,310 10,764

5.3 5.7 3.4 94.7

4,546

94.3 96.6 2,364

$20,000-$34.999 . . . . . . . . . . . . .

2,110 254

1.3

42,231

1.1 2.6 98.7 98.9

34,934 7,297

97.4 784

$35.000-$49,99s . 0,6

652 131

0.5

61,714 56,842

‘1.9 994

4,873

99.5 98.0 212

$50.000 ormore . . . . . . . . . . .

182

0,4 0.4

“30 37,112 35,588

“1.7 99.6 99.6

1,524

98.3 113 95 “18 26,177 25,122 1,058

‘Excludesunknowncoverage status

2Numbarof parsons coverad and not covered do W! equal total pqwlatmn bacause unknown caverage statua Isnotmclu&M. .%a tab+? !11forpopuiation estimates

31nclud+s unknown family mrnrne

for this is that the NHISquestions onthis topic do not allow

for a clear distinction between these two forms of coverage.

According to the criteria used in this report, table 6 shows

that about 3.0 percent of persons in the civilian noninstitutionalized population were covered by military-VA health

benefits during 1986. This is similiar to the 1984 estimate

of 3.4 percent. Because of the relatively large proportion

of retirees and of veterans and their dependents whose rights

derive from service during World War II and the Korean

War, two important age groups to consider for this type of

coverage are those under 45 years of age and those 45 years

of age and over. As may-be noted, the percents of coverage

were similiar for persons 45-64 years of age (5.8 percent)

and persons 65 years of age and over (5.0 percent); and

these were much higher than for the younger age groups

(for instance, 1.8 percent for persons 25-44 years of age).

Table 7 shows that the percent of persons covered was

somewhat higher for persons in families with an annual income

in the middle of the income range (from $10,000 to $49,999).

Regarding sex and race, the percent covered by this type

of health-care plan was highest for males (3.7 percent) and

lowest for black persons (2.6 percent).

The four forms of coverage combined

Prewous sections have described the characteristics of

persons in terms of a single form of health-care coverage.

In this section estimates of coverage under private health

insurance. Medicare, public assistance. and military-VA health

benefits are cross-classified. and persons are characterized

in terms of whether they had at least one of these four forms

of coverage or none of them. (Relatively few persons classified

as not covered by any of the four plans were reclassified

Table 6. Percent distributionand number of persons by miliiry-Veterans

Admrnktrstiin heattkare coverage status, according to age: United

States, 1986

Coverage status

Age All ‘ Covered N,M covered

Percent distribution

Alleges . . . . . . . . . . . . . . . . . . 100.0 3.0 97.0

Under 18 years . . . . . . . . . . . . . . 100.0 2.2 97.8

16-24 years . . . . . . . . . . . . . . 100.0 1.9 98.1

25-44 years . . . . . . . . . . . . . . . 100.0 1.8 98.2

4S84 years . . . . . . . . . . . . . . 100.0 5.8 94.2

65 years and over . . . . . . . . . . . . 100.0 5.0 95,0

Number in thousands

All agea . . . . . . . . . . . . . . . . 236,348 7,139 227,384

lJncier 18 years . . . . . . . . . . . . 63,132 1,410 61,690

18-24 years . . . . . . . . . . . . . . 26,721 496 26,095

25-14 years . . . . . . . . . . . . . . . 74,260 1,326 72,248

45-S4 years . . . . . . . . . . . . . . . 44,696 2.545 41,462

65 years and over . . . . . . . . 27,538 1,363 25,689

‘Percent dtstnbutlcm excludes unknown coverage status: frequency includes unknown

coverage status

as covered because, in response to questions not discussed

in this report, they had indicated that they were covered by

some type of health-care plan. ) Also, the focus will shift

from describing the characteristics of persons covered by a

specific health-care plan to describing the characteristics of

persons not covered by any of the four plans.

Table 8 shows that about 13.3 percent of persons in

the civilian noninstitutionalized population were not covered

by health-care plans during 1986. This is similar to {he 1984

es~imate of 13.0 percent. A previously published report on

health-care coverage during 1978 estimated that about 1I percent of the civilian noninstitutionalized populatiorl lacked
advamedata 5

Table 7. Percent and number of person% by miliiary-Veterens Administration health-care coverage status, age, se~ race, and family income:

United States, 1986

Covered Nor covered Covered Not covered

All Under 6565 years All Under 6565 years All Under 6565 yeaffi Ail Under 65 65 years

Sex, race, and family income ages years and over ages years and over ages years and over ages years and over

Percent’ Number m thousands

Allpersons3, . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . .

Family income

Lessthan$5.000 . . . . . . . . . . . . . . .

S5!O00-$9.999 . . . . . . . . . . . . . . . .

$10,000-$19,999 . . . . . . . . . . . . . . .

S20,000-$34,9S 9 . . . . . . . . . . . . . .

S35!O00-849!999 . . . . . . . . . . . . . . .

$50,0000rmore . . . . . . . . . . . . . . .

3.0 2.8 5.0 97.0

3.7 3.1 9.0 96.3

2.5 2.5 2.2 97.5

3.1 2.8 5.1 96.9

2.6 2.5 3.9 97.4

2.9 2.9 “4.2 97.1

2.3 1.8 4.6 97.7

2.6 2.0 4.2 97.4

3.3 2.9 5.2 96.7

3.6 3.2 7.5 96.4

3.1 2.9 7.2 88.9

3.2 3.2 .3.2 96.8

97.2

96.9

97.5

97.2

97.5

97.1

98.2

9&o

97.1

96.8

97.1

96.8

95.0

91.0

97.8

94.9

96.1

96.0

95.4

95.8

94.8

92.5

92.6

96.8

7.139

4,125

3,014

6.184

734

221

295

521

1.454

2,225

1,137

842

5.776

3,120

2,656

4,930

645

201

205

305

1,067

1,851

1,025

808

1,363

1,005

357

1,254

89

.20

91

216

387

373

112

.34

227,384

108.641

118,743

192,502

27,597

7,285

12.796

19,736

43,220

59,924

35,985

25,229

201,495

98,503

102.992

169.258

25.408

6,829

10.892

14,825

36,115

55,329

34,549

24,186

25.889

10,138

15,751

23.244

2,189

456

1,904

4,910

7,106

4,594

1,436

1,043

1Excludes unknown wverage status.

2Numberof persons covered and rxxcovere ddonoteqvd total po@ation beceuseunkmwn cweragestatusta not MwAIded. S~tSble Ill fOrpOpUlafPM SSIIMateS.

31ncludesunkrmwn family income,

Table8. Percentdietributionandnumberofpereonsbycoverageatafus

underprivateheatthinsursnce, Merkare, pubiic-a~”stsncehealthcare,

ormiiiity-Veterans Administration health eare, aceordingtoa~

United Statea 1968

Coverage status

Age All 1 Coveredz Notcoverads

Percent distribution

Alleges . . . . . . . . . . . . . . . . . . 100.0 86.7 13.3

Under 18years . . . . . . . . . . . . . . 100.0 85.4 14.6

16-24years . . . . . . . . . . . . . . . 100.0 75.3 24.7

2%14years . . . . . . . . . . . . . . . 100.0 85.2 14.8

45-84years . . . . . . . . . . . . . . . 100.0 90.0 10.0

65yearsandover . . . . . . . . . . . . 100.0 99.3 0.7

Numbermthousands

Alleges . . . . . . . . . . . . . . . . . . 236,346 201,830 31,010

Under18 years . . . . . . . . . . . . . . 63,132 52,862 9,071

18-24years . . . . . . . . . . . . . . . 26,721 19,751 6,488

2544years . . . . . . . . . . . . . . . 74,260 82,382 10,853

4+64years . . . . . . . . . . . . . . . 44,698 39,708 4,418

65yearsandover . . . . . . . . . . . . 27,536 27,126 202

‘Percent distnbubon excludes unknown coverage status frequency includas unknown

coverage status.

‘Covered by al least one of the four heallh-sare plana.

3Not Soveredunderanyol the four health-care plans.

coverage under the four types ofplans included inthisreport.2

The age group with the highest percent of noncoverage was

18–24years ofage (24.7 percent) and thecrne with the lowest

percent of noncoverage wasthe65 years and overage group

(0.7 percent).

Table 9 shows that proportionately more males (1-1.3

percent), black persons (19.6 percent), and persons in low

annual family-income groups lacked any form of health-care

coverageduring 1986.

‘Xatiwral Center for Healrh SIJIMICS: HAth care covwdge under prl~.zte

hdh inwrimcc. Medic~re. hlcthtaid. und nldlrq or Vcwrm\ ,%.lmlnl. mi-

[!LVI hmkh bcnctits. L’nited Siam. 1978 kfrmu,c Dt{ru From l’frti/ dnd

Hwlfh S[urrwcs. No, 71. DHHS Pub. No. [PHS) S1-1250. Public Hcxil[h

Service. Hya[tsville. Wi..June29. 1981.
6 advancecaa

Table9. Permntand numkrof ~wn%bymvewe atatusunder ptiateka~insumnce, Medkere, publii-aseiatenoe health care, ormifiiiy-Veterens

Administration health csre, age, serq race, and fernily income: United States, 19S6

Covered Not covered Covered Not covered

All Under65 65years All lJrrder65 65years All Under65 65years All

Sex, race, and family income ages years

Under65 65years

and over ages years and over ages years and over ages yearn and over

Percent’ Number in thousands

Allpersons3 ..,.......,,.. . . . 867

Sex

Male . . . . . . . . . . . ,,. . 857

Female . . . . . . . . . . . . . . . . . . 87.6

Race

Wh!te. . . . . . 876

Black . . . . . . . . . . . . . . . 80,4

Other . . . . . . . . . . . . 84.5

Familymcome

Lessthan $5.000 . . . . . . . . . . . . . . . 74,4

$5,000-$9,999 . . . . . . . . . . . . . . . . 71.8

$10,000-$19.999 . . . 78.9

$20,000-$34,999 . . . . . . . . . 921

$35,00G$M9,999 . . 95.2

$50,0000r more . . . . . . . . . . . . . . . 96.8

85.0

842

85.6

86.0

79.0

83.6

70.2

62.2

74.6

91.4

95.0

96,6

99.3

992

99.3

995

96.6

98.3

97.3

99.3

99.6

997

99.4

99.6

13,3

14.3

12.4

124

19.6

15.5

25.6

28.2

21.1

7.9

4.8

3.2

15.0

15.8

14.2

14.0

21,0

16.4

29.8

37.8

25,4

8,6

5.0

3.4

0.7

0.8

0.7

0.5

“3.4

“1.7

.2.7

“0.7

“0.4

.0.3

“0.6

“0.4

201,830

96.526

105.304

173.238

22.299

6.294

9.559

14.263

35,141

57,316

35,457

25,309

174,704

85,333

89,371

148,766

20,115

5,822

7,619

9,200

27,596

52,316

33,906

24,236

27,126

11,193

15,933

24,471

2,184

471

1,940

5,083

7,545

4,999

1,551

1,073

31,010

16,096

14.914

24,422

5,436

1,152

3,294

5,621

9,414

4,910

1,779

846

30,808

16,004

14,803

24,304

5,360

1,144

3,240

5,584

9,38”1

4.896

1,769

842

202

91

111

118

“78

.80

’54

“37

●33

’15

“lo

“4

‘Excludes unknown coverage status

2Numberof persona coverad and notcovered do not equal lotal~ulallon k~useunkmm coverage atatuars not included Seerable Ill farpopulat!on estlmale.s,

31ncludes unknown family income,

Symbols

--- Data not available

. . . Category notappiicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are roundedto

thousands

.

Figure does not meet standardsof

reliability orpreclsion

# Figure suppressed to comply with

confidentiality requirements
advancdata 7

Technical notes

The estimates shown in this report are based on data

obtained in household interviews in a continuing nationwide

survey. Each week J probability sample of households is

interviewed by pers~nnel Of the U.S. Bureau of the Census

to obtain inftm-na[ion about the health and other chamcteristics

of the civilian noninstitutionalized population of the United

states.

During 1986. interviews were conducted in approximately

24.700 households containing about 62.000familymembers

and unrelated individuals. The total noninterview rate was

about 3.4 percent. The weights of interviewed persons in

the segments containing sample households for whom data

were not obtained were intlated to compensate for household

nonresponse.

All persons 17 years of age and over were asked to

participate in the interview. When this was not possible. proxy

Table L Standard errors of estimates of aggregates

Standard error

size of estimafe in thousands in thousands

35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

300 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

500 . . . . . . . . . . . . . . . . . . . . . . . . . . 61

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

5.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298

20.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454

30.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 594

150.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.087

Table Il. Standard error$expressed inpercentage points, of estimated

percents

Estimated percents

2 or 5or lOor 200r

Base of percents in thousands 98 95 90 80 50

100 . . . . . . . . . . . . . . . . . ...3.8 6.0 8.2 10.9 13.7

300 . . . . . . . . . . . . . . . . . . ..2.2 3.4 4.7 6.3 7.9

500 . . . . . . . . . . . . . . . . . . . . 1.7 2.7 3.7 4.9 6.1

1,000 . . . . . . . . . . . . . . . . . . . 1.2 1,9 2.6 3.5 4.3

5,000 . . . . . . . . . . . . . . . . ...0.5 0.8 1.2 1.5 1.9

10.000 . . . . . . . . . . . . . . . ...0.4 0.6 0.8 1.1 1.4

20,000 . . . . . . . . . . . . . . . . ..0.3 0.4 0.6 0.8 1.0

30.000 . . . . . . . . . . . . . . . ...0.2 0.3 0.5 0.6 0.8

150.000 . . . . . . . . . . . . . . . ...0.1 0.2 0.2 0.3 0.4

responses were accepted from Family members meeting the

NHIS respondent rules. ?.11 information on persons under

17 years of age was obtained tYGm adult family members

or guardians.

The appendixes of Viral urzdHealth Statistics, Series 10,

No. 164. should be consulted fora more detailed discussion

of the sample design and weighting procedures (appendix I) and for acopyof the questionnaire used during 1986?

Approximate sampling errors for typical estimates contained

in this report are shown in table I (aggregates) and table II (percents).

The population estimates for tables 2. 3. 5. 7, and 9

are shown in table 111.

Table ill. Population estimates bysezrace, and family income:

United Sfateq 1986

Sex. race,andfamtly income Number m thousands

Total’ . . . . . . . . . . . . . . . . . . . . 236,348

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . 114,330

Female . . . . . . . . . . . . . . . . . . . . . . . . . 122,018

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . 200,247

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,549

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.552

Familymcome

Lessthan 35.000, . . . . . . . . . . . . . . . . 13.123

S5,0CW-$9.999. . . . . . . . . . . . . . . . . . . . . 20,363

S10!OOG$19.999 . . . . . . . . . . . . . . . . . . . . 45.033

S20.000-S34.999 . . . . . . . . . . . . 62,620

S35,000-S49.999 . . . . . . . . . . . . . . . . . . . . 37.412

.S50,0000rmore . . . . . . . . . . . . . . . . . . . . 26.310

‘Inc!udes unknown famnly meome

3National Cwner for Health Statistics. D. A Dawwm: Current estimates

from the Nm]onal Health Inkm’iew Sufiey. Umted Stme\. 1986. Viruf and

Heolfh SIunSrIcS. Scritx 10. No. 164. DHHS Pub. ‘it] IPHS) 87-1592.

Public Heal[h Serwce. Washington. U.S. Go\emmcnt Prtntmg OftIce. In

press.
From Vital and Health Statistics of the National Center for Health Statistics Number 140. September 24, 1987

Recent Declines in Hospitalization: United States, 1982-86

Data From the National Health Interview Survey and the National Hospital

by Abigail J. Moss, Division of

Introduction

Throughout the 1970’s, the rate

Discharge Survey

Health Interview Statistics, and Mary A. Moien, Division of Health Care Statistics

of hospitalizations for

short-stay hospitals steadily increased for all persons. Based on

data from the Nation~ Hospital Discharge Survey (NHDS),

between 1970-79 the hospital discharge rate (that is, the number of hospital discharges per 1,000 civilian persons) increased

from 144.3 to 164.8 discharges per 1,000 persons. The greatest increase during this period occurred among the elderly

where the discharge rate rose about 23 percent for those persons 65 years of age and over. However, substantial dMerences

in the hospital discharge rates were also observed for persons

under 65 years of age, amounting to about a 10-percent increase between 1970 and 1979. By age group, the hospital

discharge rates increased about 7 percent for children under 15

years and about 21 percent for persons aged 45-64 years. although among those 15–44 years of age, the overall rate remained about the same. I

While the hospital discharge rate was gradually climbing

during this period. a different trend was occurring in another

hospital use measure, the average length of a hospital stay.

Between 1970 and 1979, the average number of days per hospital stay based on NHDS estimates declined 8 percen~ from

7.8 to 7.2 days. This reduction in the average length of time

people were spending in the hospital for each stay occurred

among ail age groups. The largest percent of decline, though,

was found again among the hospitalized elderly, where an

average stay dropped from 13.1 to 10.8 days, an 18-percent

reduction.j.z

The changes in hospital utilization during the 1970’s were

‘~eresult of several phenomena. Implementation of the medare program in July 1966 provided greater access to inpatient

hospital care for the majority of elderly individuals. Lubitz and

Deacon state that “most of the increase in the discharge rate

among the aged was associated with an increase in the percentage of persons using the hospital rather than with an increase in the rate of multiple hospitalizations.”4

Increases in numbers of hospitalizations of shorter duration contributed to the decrease in average length of stay and at

the same time to the increase in discharge rates during this

pericd. Technical improvements in selected surgical procedures

ako had an effect on both of these trends. The average length

of stay for cataract operations, for example, dropped significantly during the 1970’s while the number of these procedures

increased substantially.s The development of new materials for

prostheses and new cements in the field of orthopedics and

advances in cardiology, including bypass surgery and heart

pacemakers, also contributed to increased hospitalizations involving surgery for this period.4

In an attempt to contain the medicare costs for hospital

treatrnen~ which have continued to escalate since the onset of

the program, the Health Care Financing Admirustration (HCFA)

of the Department of Health and Human Services initiated a

new system of hospital payment in 1983. Under the Tax Equity

and Fiscal Responsibility Act of 1983,6 reimbursement for inpatient care for medicare patients changed from a fee-for-service system to a prospective payment system. The phasing in

of thk system began on October 1, 1983, and by September

30, 1984, all designated hospitals were in the system.

Under thk cost-containment system, hospitals are reimbursed a preestablished amount based on calculations of the

average cost of care for medlcare patients with similar conditions and treatments. These mutually exclusive categories of

similar conditions and treatments are referred to as diagnosisrelated groups or, more commonly, DRG’s.7

Average costs of treatment have been established for about

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Publlc Health Serwce
2 athncedata

467 DRG’s, and hospital payments are determined by the

DRG group to which the patient’s illness is assigned. Because

treatment costs for a given illness vary by ~pe of hospital (for

example, university teaching hospitals are more costly to operate than community hospitals), the system compensates for

this variation by adjusting the fixed DRG reimbursement rates

according to the ratio of medical residents to hospital beds.g

DRG’s are now also being used by some States and some other

third party payers to reimburse hospitals for inpatient care of

the non-medicare population on a prospective basis.g

Just as medicare in the late 1960’s subsequently brought

about dramatic increases in hospitaJization rates for the elderly,

the major changes in the financing of medical care as just

described also appear to have significantly altered the pattern

of hospital utilization, but in the opposite direction. Between

1980 and 1983, the overall hospital discharge rates showed

little change, fluctuating between 167 and 169 discharges per

1,000 population based on NHDS estimates (figure 1). However. in 1984, after the HCFA prospective payment system

based on DRG”s begart to be phased in, the NHDS hospital

discharge rate declined 5 percent, from 16’7.0 discharges per

1.000 persons in 1983 to 158.5 discharges in 1984.]0 A similar

rate of decline is found in the hospital discharge estimates ob

tied from the National Heahh Interview Survey (NHIS).l 1”]2

This marked the first year since the onset of medicare that the

discharge rate declined. In 1985, the downward trend continued

with the discharge rates from both the NHDS and the NHIS

declining another 7 to 8 percent from the 1984 rates.13.]4

While the 1986 NHDS hospital discharge rates are still

incomplete at this printing and the NHIS rates for this period

have only recently become available, preliminary indications

are that the rate of decline has subsided. Based on NHIS

quarter 1 estimates, during the first 3 months of 1986, the

●,.* ●***m **m. . ...=-

NHIS

1980 1981 1982 1983 1984 1985 1986

F!gure 1. National Hospital Discharge %wey (NHDS) and National

Health Imerwew Survey (NH IS) short-stay hospttal discharge rates:

United States, 1980-86

downward trend in hospital discharges appeared to be continuing (table 1). However, when the NHIS hospital discharge rates

for the remaining three quarters of 1986 were reviewed, they

more closely resembled the rates in the last two quartera of 1985.

Changes in hospital utilization as measured by the average

length of a hospital stay also have occurred during the last

several years. Between 1980 and 1983, estimates of the average

length of a hospital stay continued the gradual decline characteristic of the 1970’s, from 7.6 to 7.3 days according to the

NHIS and from 7.3 to 6.9 days according to the NHDS (figure

2). However. upon implementation of the prospective payment

system in 1983, the rate of decline appeared to accelerate.

Between 1983 and 1985. the average length of a hospital

stay declined about 8 percent for the NHIS (to 6.7 days) and

about 6 percent for the NHDS (to 6.5 days). However, between October 1985 and December 1986, except for one 3-

month period, the NHIS quarterly estimates for average length

of stay remained at about the same level—6.3 to 6.4 days. The

1986 NHIS amual estimate of 6.6 days per hospital stay is

similw to its 1985 estimate. While it now appears that the

initial effects of this recent cost-containment system on hospital utilization as measured by hospital discharge rates and

average length of stay estimates have subsided, it is still too

soon to conclude that further declines will not occur.

Differences between the NH DS and

the NHIS

The NHDS obtains its information directly from hospital

records of inpatients discharged from short-stay hospitals, exclusive of Federal hospitals, located throughout the 50 States

and the District of Columbia. Information is abstracted each

year from approximately 200,000 records in over 400 shortstay non-Federal hospitals. The NHIS, in contrast, obtalins its

information through personal interviews. In a typical year, the

NHIS interviewed sample consists of approximately 40,000

households containing about 105,000 persons. Persons sampled

in the NHIS represent the U.S. civilian noninstitutionalized

population living at the time of interview. Unlike the NHDS,

their reported hospitalization estimates include discharges from

Federal hospitals, over one-half of which are Veterans Administration hospitals. (Discharges from Federal hospitals

constitute approximately 3 percent of the total reported hospitalizations.)

There are a number of differences in the definitions of

hospital utilization as measured by the two surveys and the

NHDS estimates of utilization and diagnostic and procedure

data are usually accepted as the more accurate. The NHDS

includes patients who die in the hospital as well as admissions

from nursing homes. two areas not included by NHIS. ‘These

result in noticeably higher hospitalization estimates, particularly

among patients 65 years and over. In addition, hospitalizations

of inpatients for durations of less than 1 day are included in the

NHDS, but not the NHIS. Further, NHDS information is ob

tained directly from hospital records, thus minimizing underreporting, which is characteristic of inten’iew surveys. sulch as

the NHIS. that rely on respondent repor:s of events. In contrast. the advantage of the NH IS is that it collects extensive
dvancedata 3

Table 1. Number of discharges from shosl-stay hospitals per 1,000 parsons and average length of stay, by qusrter. age, and sex based on

data from the National Haalth Interviaw Survey and the National Hospital Discharga Survey United Statea, 1984-86

7984 1985 1986

Jan, - Apr.– Jul. - oc?.- Jan.- Apr. - Jul. - oc?.- Jan. - APr, - Jul.- ocr. -

Age and sex Mar. Jun. Sept. Oec. Mar. Jun. Sept. Dec. Mar. Jun. Sept. Dec.

Natlonai Health Interwew Survey

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 65 years . . . . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . . . . . . . .

15-44 years . . . . . . . . . . . . . . . . . . . . . .

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

65 years and over . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female, Including deliveries. . . . . . . . . . . .

Female, excluding deliveries . . . . . . . . . .

National Hospttal Discharge Survey

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 65 years . . . . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . . . . . . . .

15-44 years . . . . . . . . . . . . . . . . . . . . . .

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

65 years and over . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National Health Interview Survey

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 65 years . . . . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . . . . . . . .

15-44 years . . . . . . . . . . . . . . . . . . . .

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

65 years and over . . . . . . . . . . . . . . . . . . .

Male, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female, Including delwenes. . . . . . . . . . . .

Female, excluding delwenes . . . . . . . . . . .

National Hospital Discharge Survey

Alleges, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 65 years . . . . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . . . . . . .

15-44 years . . . . . . . . . . . . . . . . . . . . . .

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

65 years And over . . . . . . . . . . . . . . . . . . .

Male, . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . .

34,3

28.1

17,8

27.8

40,6

83.0

30.0

38.3

31.5

41.5

32.8

17.7

33.4

48.8

106.2

34.8

47.7

7.4

6.8

5.1

6.0

8.8

9.2

8.2

6.9

7.6

6.9

5.7

4,5

5.1

7.4

9.4

73

6.5

33.1

26.8

15.8

27.7

37.5

82.2

273

38.5

31.7

40.2

31.6

15.5

32.8

47,1

103.5

33,3

46.6

7.0

6.4

6.8

5.7

7.5

8.7

7.5

6.7

7.4

6.6

5.5

43

4.9

7.1

8.9

7.0

6.3

332

27.7

15.1

27.9

41,8

75,9

28,5

37,6

30.4

38,9

31.2

14.1

34.0

43.8

95.9

31.6

45.7

7.2

6.4

4.8

5.9

8.0

9.5

8.8

6.1

6.7

64

5.4

45

47

7,0

8.7

68

6.1

33.0

27.3

12.4

28.9

40.7

76.9

26.3

39.2

32.2

37.7

29.9

14.6

31.7

43.3

95.3

31.7

43.4

7.2

6.4

5.3

5.1

9.1

9.3

8.0

6.7

7.4

6.5

5.6

4.6

4,9

7.2

8.7

6.9

6.2

Dwcharge rate per 1,000 persons

32.0 31.1 30.2 30.4

25.9 26.6 25.4 25.1

11.8 14.1 13.6 11.9

26.1 25.8 25.4 26.2

41.9 43.2 39.4 37.6

78.7 65.8 66.6 70,4

28.0 26.0 25.2 263

35.8 36.0 34.9 34.1

30.1 28.7 28.0 26.2

37.9 37.2 36.9 35.9

29.7 29.6 29.8 28.6

15.4 13.8 13,7 14.3

30.7 31.6 32,4 30.4

44.0 42.9 42.0 40.6

97.7 92.4 89.1 89.2

32.0 30.9 30.6 30.1

43.5 43.0 42.9 41.3

Average !ength of stay

7.3 6.6 6.6 6.4

6.8 5.9 6.0 5.5

6.4 5.0 5.0 4.8

5.3 5.2 5.1 44

9.2 7,1 7.9 7,6

8.4 9.0 8.5 9,0

8.2 7.4 7.4 6.5

6.6 6.1 6.1 6.4

7,2 6.8 6.8 7,2

6.7 64 6.3 6.4

5.6 5.5 5.4 5.5

45 47 4.5 4.4

49 49 4.8 4.8

73 6.9 6.9 7.1

9.0 8.6 8,6 8.6

70 6.8 6,8 69

6.5 6.2 6.0 6.0

28.1

24.9

12.0

26.8

35.1

52.6

23.3

32,6

24.6

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

64

6.0

5.8

51

7.8

79

73

58

6.5

. . .

. . .

. . .

. . .

..-

. . .

. . .

. . .

30.2

23.3

10.0

24.8

347

83.1

25.6

345

27.1

. . .

. . .

.-.

. . .

. . .

. . .

. . .

. . .

6.4

5.7

7.2

44

75

8.0

69

61

6.9

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

29.5

239

12.7

244

355

72.4

260

32.8

25.7

. . .

. . .

. . .

. . .

. . .

-..

-..

. . .

7,1

6.0

62

59

60

10.0

7.9

65

7.5

. . .

. . .

. . .

. . .

. . .

. . .

.-.

. . .

30.2

25.3

13,4

26.3

36.6

67.2

26.4

33.7

26.6

. . .

. . .

-..

. . .

. . .

.-.

. . .

..-

63

5.7

5.1

5.7

59

8.1

66

61

6.8

-..

-..

-..

. . .

. . .

. . .

. . .

. . .

demographic and other health-related information not available

from hospital records.

Data highlights

This report presents the latest available estimates of hospital disch=ges and average days per hospital stay from the

NHDS and the NHIS. Estimates produced from both surveys

when viewed together provide a more complete description of

the changes in hospital utilization that have recently taken

place among the hospitalized population.

Table I contains NHIS and NHDS quarterly estimates of

hospital discharge rates and estimates of average length of stay

per discharge by age and sex, begiming with the JanuaryMarch 1984 period and including the most recent quarterly

estimates available from each survey. Table 2 covers the period

from 1982-86 ( 1985 for the NHDS) and includes estimates

from both surveys of hospital discharge rates by age and sex. In

table 3, unadjusted and age-adjusted hospital discharge rates

for the years 1982-86 based on the NHIS are shown by sex,

race, family income, poveny level, respondent-assessed health

status, and geographic region. These estimates are only for

persons under 65 years of age, however, because of the previously mentioned underreporting problems associated with

the NHIS hospitalization estimates for the older populations.

Table 4 is included for comparative purposes only, showing

1983 and 1985 NHIS hospital discharge rates and estimates of

average length of stay for the population 65 years and over by

sex, race, family income, poverty level, respondent-assessed

health status, and geographic region. Table 5 shows 1982-36
8.0

r

,~

1980 1981 1982 1983 1984 1985 1986

Figure 2. National Hospital Discharge Survey (lVHDS) and National

Health Interview Survey (NH IS) average Iengthofstayinshon-stay

hospitals: United States, 1980-86

NHIS estimates and 1982-85 NHDS estimates of average

length of stay per hospitalization by age and sex. Table 6 contains unadjusted and age-adjusted NHIS 1982-86 estimates oh

average number of days per hospital stay for persons under the

age of 65 years by sex, race, family income, poverty level.

respondent-assessed health status, and geographic region.

The “Technical notes”’ contain a brief description of the

sample design, the methods used in estimation, andl general

qualifications of the data for both surveys. The definitions of

terms used in this report can also be found in this section. A

detailed discussion of these items and the survey forms used to

collect the data from both surveys have been published.15-17

The 1986 NHIS hospital discharge rates and average length

of stay estimates are presented in tables 1–6, and the ‘text primarily focuses on a comparison between the 1983 and 1985

estimates. The 1985 estimates are highlighted instead of the

1986 figures because the 1985 estimates are available from

both surveys.

Table 2. Number of discharges from short-stay hospitsls per 1,000 persons per yesr by sex and aga baaed on data from the National Health

Interview Survey and the National Hospital Discharge Survefi Unitad States, 1982-86

National Health Inrerview Survey Nat!onal Hosp\ral Dtscharge Survey

Sex and age 1982 1983 1984 1985 1986 1982 1983 1984 ?985 1986

Both sexes

All ages... . . . . . . . . . . . ,,. . . . . . . . . .

Under 15 years.. . . . . . . . . . . . . . . .

Under 5 years,. . . . . . . . . . . . . . . . . . . . . . . . . . .

5-14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-44 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-44 years, ., . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 years, ,,, . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years.... . . . . . . . . . . . . . . . . . .

65 years and over. ., ., . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . .

75 years and over. . . . . . . . . . . . . . . . . . . . . . .

Male

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5-14 years,.....,,,,,,...,,,, . . . . . . . . . .

15-44 years,......,...,...,,. . . . . . . . . .

15-24 years...,....,....,.. . . . . . . . .

25-44 years..,. .,, , ...,,..,..,,,..,,,,.

45-64 years,,.. . . . . . . . ,, .,, .,, .,,.,,

45-54 years, ,., ... ... ..,. . . ,,, ,.. .,

55-64 years. . . . . . . . . .

65 years and over . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . .

75 years and over. . . . . . . . . . . . . . . .

Female

All ages. . . .

Under 15 years. . . . . . . . . . . . .

Under 5 years,,. . . .

5-14 years.. .

15-44 years, ,.. . . . . . . . . . . .

15-24 years. . . ,. .

25–44 years. . .

45-64 years.. . ,,. .

45-54 years,. .

55-64 years... .

65 years Andover.. ,. . ,, .,.,

65-74 years.

75 years and over. .,

139,8

59.4

91,4

43.0

125.1

113.1

1323

176.6

152.7

200.8

299.6

265.1

356.7

119,6

65,1

106.6

43.7

82,8

69,9

907

176.2

139.3

215.0

330,0

302.0

364.7

1584

534

753

423

1656

1551

1718

1769

T653

1884

2786

2368

3406

140.3

58.2

90.1

41.3

122.7

115,2

127.0

172.8

139,3

206.6

321.7

280,7

388.5

117,9

66.9

1074

45.4

73.9

686

770

1786

1334

225.7

344.7

312.3

407.1

61.2

49,1

72,0

37,0

696

608

74,6

1676

144,9

189.8

3059

2564

3778

133.6

61.0

96.7

41.7

112.2

107.1

115.1

160.6

141.5

179.8

318.0

277.7

382,6

112.1

66.2

107.1

44,1

651

58.2

690

1757

152,2

200.3

334.6

2996

401.3

153.5

55.6

857

39,4

1577

1550

1591

1470

1316

162,0

306.5

2609

371 7

Discharge rate per 1,000 persons

123.7

51.3

81.4

35.3

103.5

92.7

109.3

162.2

141.6

183.0

281.5

247.4

336.5

105.5

60.6

99.1

40.0

57.6

41.5

66,3

176.6

150,0

204,4

309.7

273.4

379,5

1408

41.7

62.8

30.4

147,6

1427

150,2

149.1

133.8

164.1

261.8

227,1

311.5

118.0

48.1

73.6

34.2

102.3

94.5

106.2

142,0

110.6

174.2

275.3

236.8

337.3

101.4

50.7

85.8

31.8

62.2

48,4

69.2

161.1

118.7

2061

298.0

264.6

362.6

336

453

61.2

36.8

41.0

39.6

41,7

124,6

103,1

146.0

259.4

2149

3227

167.9

71,2

115.9

48.3

145.0

133.8

151,9

195.6

174.3

217.0

398,8

324,2

511.4

139.4

79.9

132.9

52.8

87.4

71.3

97.3

196.3

163.9

230,1

428,1

3533

566.8

194,5

62.0

983

435

201.0

1956

2042

1948

183.9

205.5

3791

301 9

481 2

167.0

70,8

116.8

46.6

140.3

129,1

146.9

192.2

167.0

217.5

412,7

334.2

529.4

138.8

79.0

132.2

50.8

84.3

68.0

94.0

196.6

160.3

234,3

437.2

361.4

575.8

193.2

62.3

100.6

42.1

194,8

1896

197,8

188.3

173.3

202.9

396.3

313.3

503,9

158.5

62.0

101.5

41.2

132,2

121.4

138.1

183.3

158.3

208,4

400.4

319.6

520.1

131.6

69.2

114.8

45.2

79.6

63.7

88.5

185.8

153,5

219.4

424.8

345.2

571,2

183,6

545

678

37.1

183.1

178.2

1858

1809

162.8

1986

3839

299.8

492.3

147.9

57.2

94.7

37.3

125.1

116.7

129.5

169.5

146.2

193.1

368,3

294.9

476.5

123,5

63.8

107.3

40.8

75,4

599

83.8

176.2

146.1

207.6

393.2

319.9

528.2

170,7

50.2

81 5

33.6

1734

172.7

1738

1634

146.3

180.2

351.4

275.2

448.5

. . .

. . .

. . .

.-.

. . .

-..

. . .

..-

---

-..

. . .

..-

. . .

.-.

---

-..

..-

. .

. . .

. . .

. . .

.-.

. . .

. . .

..-

. . .

. .

. .

. .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. .

. . .
achancedata 5

Tabla 3. Unadjusted and age-adjusted number of discharges from short-stay hospitals per 1.000 persons per year under 65 years of age. by

selected characteristics based on data from the National Health Interview Survay (N HIS): United States, 1982-86

Unadjusted discharges Age-adlusred discharges

Characterkt)c 1982 / 983 1984 1985 1986 1982 7983 ?984 1985 1986

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Family income

Under $10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under $5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$5<000-$9.999 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$10,000-$ 19,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S10,000-$14,999 . . . . . . . . . . . . . . . . . . . . . . . . . .

S15,000-$19,999 . . . . . . . . . . . . . . . . . . . . . . . . . .

S20,000-$34,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S20,000-S24,999 . . . . . . . . . . . . . . . . . . . . . . . . .

S25,000-$34,999 . . . . . . . . . . . . . . . . . . . . .

S35,0000r more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S35,000-$49,999 . . . . . . . . . . . . . . . . . . . . . .

S50,0000r more . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NHIS poverty index

Below poverty hne. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Above poverty line . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Assessed health status

&jtcellent orgood . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Excel lent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fair or poor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Poor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Geographic region

Northeast. ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonh Central/Midwest, . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

92.5

137.0

113.2

131.9

159.4

173.8

150.5

118.1

125.0

112.1

102.5

107.3

99.7

95.7

93.5

100.4

154.2

110.4

89.4

75.2

133.7

438.1

309.2

843,0

99.3

119.1

1350

936

94.0

139.8

116.7

126.5

153.2

155.4

151.7

117.9

119.8

116.2

112.5

111,5

113.2

96.2

99.5

89.6

140.1

114.8

90.9

73,9

143.1

410.9

301.9

728.2

105.3

122,5

133.0

96.8

88.4

130.6

09.7

19.4

46.1

44.6

47.1

25.8

36.4

16.3

02.6

11.9

97.4

86.0

86.7

84.7

145.6

105.2

83.5

66.1

136.7

403,0

297.3

734.9

101.2

117.1

117.7

96.1

Discharge rate per 1,000 persons

83.2

122.4

103.3

110.4

139.3

138.5

139.9

117.4

122.7

113.0

102.5

106.3

100.5

80.6

85.3

73.5

128.5

100.7

79.5

63.0

132.7

391.5

274.7

721.4

96.2

105.7

113.3

89.3

79.7

114.4

96.9

104.9

131.2

130.9

131.5

112.3

122.5

103.6

96.2

104.1

92.4

78.2

78.1

78.3

128.5

92.6

75.2

61,0

120,6

372.9

253.0

718.0

87.2

98.9

112.3

80.2

97.4

139.5

116.2

142.9

173.4

187.7

164.3

125.1

133.2

118.2

106.5

112.1

103.2

95.4

93.7

98.6

177.1

113.6

91.4

77.0

133,6

422.0

310.6

376.8

101.1

123.9

140.4

96.6

95.2

140.7

16,8

36.1

62.9

65.9

60.1

20.8

22.7

19.3

14.5

13.9

14.9

94.4

98.9

85.7

61.0

15.3

92.7

75.9

142.2

388.2

303,7

215.5

I 04.1

124.3

135.0

98.6

89.6

131.2

109.7

127.8

154.2

154.8

154.5

128.8

139.3

119.4

104,7

113.4

99.7

84.8

86.6

80.4

165.4

105.2

85.0

67.5

135,2

393.8

310.7

255.8

100,8

118,3

119.6

97.6

84.4

123.0

03.4

18.5

48.0

49.9

47.1

21.1

26.1

16.8

05.8

10.5

03.3

79.5

85.2

71.0

50.4

00.8

81.1

64.4

81.2

114.8

97.1

111.4

140.5

140.0

140.6

115.9

127.5

106.0

98.1

105.3

94.8

77.5

78.4

76.3

148.1

92.2

76.3

62.6

1300 120.4

355.3 338.9

265.2 243.2

221.5 196.4

95.1 86.3

106.9 99.9

115.4 114.5

910 81.2

1ASe aojusted by the dwect method to the age dmtnbuuon of the 1980 total ctwlran non!nst!tutmnaltzed populatmm of the Umted States Iunder 15. 15-24, 25-44,

ana 45-64 years).

Terms used in this rept such as “similar” and “the same”

indicate that no statistical significance exists between the statistics being compared. Terms that relate to differences (such

as ‘greater” or “less”) indicate that differences are statistically

si-tifican~ The r-test with a critical value of 1.96 (0.05 level of

significance) was used to test all comparisons that are discussed.

Lack of comment regarding the difference between any two

statistics does not mean that the difference was tested and

found to be not significant.

Hospital discharges

In the 2-year period since HCFA introduced its prospecf’~uepayment system for medimre patients, the overall hospital

$scharge rate from short-stay non-Federal hospitals dropped

from 167.0 discharges per 1,000 civilian population in 1983 to

147.9 discharges in 1985, a decline of about 11 percent according to NHDS figures (table 2). The discharge estimates

from the NHIS, although lower, show about a 12-percent decline over this same period.

Although the prospective payment system based on DRG’s

was initially developed for the population covered by medicare,

it was introduced during a period of time of substantial hospital

utilization decreases for each of the four major age groups.

Indeed, for children there was about a 19-percent reduction in

the discharge rate between 1983 and 1985 (from 70.8 to 57.2

discharges per 1,000 population under 15 years of age), the

largest decrease of any age group. The discharge estimates for

persons 65 years of age and over and all other age groups declined at about the same rate (from 10 to 12 percent).

The overall hospital discharge rate is always higher for

females than for males because of the large number of women

in their childbearing years (15 –44 years of age) who are hospitalized for deliveries and other obstetrical conditions. Nevertheless, proportionately the rate of decline in discharges for

males and females during this period was also about the same
6 adwncedata

Table 4, Number of discharges from short-stay hospitals per 1,000

persons per year and average length of stay for persons 65 yaars and

over, by selected characteristms based on data from tha National

Health Interview Survey (N HIS): Unitad States, 1983 and 1985

Days per

All discharges hosp!tal stay

Character(st!c 1983 ?985 1983 7985

Sax

Male .,

Female .,

Race

White ,. . . . . . . . . . . .

Black, .,., ,. . . . .

Fam(ly income

Under $l0,000

$10.000-$79.999 ,. ... :::::’

S20,000-$34,999 .,.,. ,,.

$35.000 or more ., . . . . . . . . . . .

NHIS poverty index

Below poverty llne, ,. ,,

Above povenyllne . . . . . . . . . .

Assessed health status

Excel lent Osgood.,,...,,,,.

Excel lent.. . .

Good . . . . . . . .,....:::::::

Fatr or poor, , ., . .,, , . . . . . . . . .

Fair, ,, . . . . . . . . . . . . . . . . .

Poor, ,.. . . . . . . .

Geographic region

Northeast. . . . . . . . . .

North Central/Midwest ., ,. ...,,

South . . . . . .

West, ,, . . . . . . . . . . . . . . . . . . .,

D}scharge rate

per 1,000

persons

—

3447

305.9

316.9

384.1

3645

299.8

2399

300.1

367.0

314.6

198,8

1599

244.0

5698

383.0

940.7

275.3

323.9

367.6

2973

3097

261 8

2828

280.5

295.3

275.8

261 2

268.7

321.2

272.2

177.0

141.9

216.1

508.5

339.7

876,9

265.5

280.1

306.8

254.,3

Average

length of

stay

97 84

92 9.0

9.4 8.6

10.3 10.0

93 9.5

96 8,5

83 7.5

7,9 7.5

101 11,6

91 8.0

80 8,6

7.5 7.4

84 9.5

104 8.8

9,5 8.2

11.2 9.2

11.7 9.9

8.9 8.9

9.3 8.8

7.9 6.6

(from 138.8 to 123.5 and from 193.2 to 170.7 discharges per

1,000 males and females, respectively). Hospital dischmges

also decreased between 1983 and 1985 at about the same rate

for men and women aged 65 years and over (437.2 to 393.2

and 396.3 to 351.4 discharges per 1,000 persons, respectively).

Table 3 shows the unadjusted and age-adjusted number of

short-stay hospital discharges per 1,000 persons for selected

sociodemographic and health-related characteristics. Because

the age distributions in the groups shown may differ considerably, comparisons should be made by using the adjusted rates.

Age-adjusted data can be compared directly because the rates

assume identical distributions in broad age categories for all

groups. However, these adjusted or standardized rates do not

describe any actual population. They are meaningful only in

comparing other similarly adjusted rates. The unadjusted rates

are the actual ones, which should be used when describing the

hospital rates for the civilian noninstitutionalized population.

The procedure for the age adjustment by the direct method is

described in the “Technical notes. ”

Table 3 contains hospital discharge data from the NHIS

only because, as previously mentioned, much of the sociodemographic and health-related information contained in the table

is not available t?om the hospital records used by the NH.DS to

obtain its information. Mce, while available from both surveys

is included only IYom the NHI S. The NHD S cautions its us,

because race is not stated on approximately 9 percent of all of

the medical records the NHDS uses to obtain its information.

Data in table 3 are further limited to persons under 65

years of age because hospitalizations for persons 65 years of

age and over are not well reported in the NHIS. Elderly persons

are more likely to die or transfer to a long-tetm-care institution

between the hospitalization and the scheduled interview, and

as a result are not part of the population represented by the

NHIS household sample. In contrast, most persons under 65

years when discharged from the hospital return to a household,

and thus are part of the population whose experience is covered

by the NHIS household sample. Also, if a sample hcusehold

member is hospitalized at the time of the survey, other household members are less likely to be found at home to interview,

and the hospitalization is not represented in the survey. Although this problem occurs for hospitalizations at all a,ges, it is

greater for hospitalized persons 65 years and over, because

there are usually fewer persons in their households to be potential survey respondents.

The hospital discharge rate for black persons under 65

years exceeded that for white persons in all years. The rate of

decline in hospital discharges for black and white persons between 1983 and 1985 was similar, approximately 12.7 percent

and 11.5 percent, respectively (from 126.5 to 110.4 discharges

per 1,000 black persons and from 116.7 to 103.3 discharges

per 1,000 white persons).

Data for the 5 years covered in table 3 show a distinct

pattern of lower rates of hospital discharges associated with

higher levels of family income. In 1985, for instance, the ageadjusted hospital discharge rate was about twice as high for

persons with family incomes under $10,000 compared with

family incomes of $50,000 or more (148.0 and 71.0 discharges

per 1,000 persons aged under 65 years).

Between 1983 and 1985, the (unadjusted) hospital discharge rate declined about 9 percent for persons with family

incomes under $10,000 and about 18 percent for persons with

incomes of $50,000 or more. The differences between the

estimates over this 2-year period for most of the inctividual

income categories shown in table 3, however, are not statistically significant.

The NHIS determinants for classi~ing persons above or

below the poverty level include three var-iables-familly size,

number of children under 18 years of age, and family income.

The “Technical notes” contain a description of this variable.

The change in the hospital discharge rates between 1983 and

1985 for the two poverty status categories included in table 3

mirrors the change found by family income categories.

Data on assessed health status result from asking respondents to assess their own health and that of other family members as excellent, very good, good, fair, or poor. The fmdinr

that hospital discharges among persons considered in fair c

poor health far exceed the rate for persons in excellent cr gooa

health is not surprising. Between 1983 and 1985, hospital discharges (unadjusted) for persons aged under 65 years assessed

in excellent or good health declined about 13 percent. While
advancedata 7

Table 5, Average length of stay for parsons discharged from shost-stay hospitals by sex and age based on data from tha National Health

Intetview Survey and the National Hospital Discharge Suwey United Statas, 1982-86

National Health Interwew Survey National Hosp)tal D!scharge Survey

Sex and age 1982 7983 1984 1985 1986 1982 1983 1984 1985 1986

Both sexes

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5-14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5-14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5-14 years, ,,, ,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-.L$y ears....,,,..,,.,.. . . . . . . . . . . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

45-64 years, . .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years,,,,........,,., ,,, . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75vears and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Average length of stay

6.7

5.3

5.1

5.5

5.0

43

5.3

8.0

7,0

8.7

8,7

8.4

9.1

7.4

5.4

5.0

6.0

5.9

5.2

6.2

8.5

6.9

9.8

8.4

8.6

8.1

6.3

5.0

5.2

4,7

4,7

41

5.0

74

71

7.6

9.0

8.2

9.9

6.6

6.0

7,6

4,2

5.3

4,0

5.8

6.8

6.5

7,0

8.5

8.7

8.3

7.2

4.7

4.9

4.4

6.9

5.2

7.5

7.2

6.8

7.4

8.5

9.4

7.1

6.1

7.5

11.6

39

45

3.6

5.0

6.3

6.1

6.5

86

8.1

9.1

7.1

4.6

5.0

4.1

5.1

4.5

5.5

7.9

7.3

8.3

0.1

9.6

0.6

7.5

7.3 6,9

6.0

6.7

5.1

5.5

4.4

6.1

8.4

7.7

8.9

9.4

9.1

9.9

8.2

6.0

7.0

4.6

7.3

5.4

8.3

8.5

8.2

8.7

9.7

9.6

10.0

6.7

6.0

6.3

5.7

4.8

4.0

5.2

8.3

7.3

9.1

9.2

8.6

9.8

7,2

5.5

6.2

4.6

5.7

4.5

6.3

8.4

7.6

8.9

9.2

9.1

9.3

8.2

4.9

5.3

4,4

7.4

4.8

8.7

9.1

7.5

10.4

9.5

9.6

9.3

6.6

6.2

7.3

5.0

5.0

44

5.3

7,6

7.8

7.4

9.0

8.7

9.3

6.6

4.5

4.8

4.0

49

4,2

52

72

6.8

7.5

8.9

8.5

9.3

7.0

4,4

4.6

4.1

6.0

5.6

6.2

7.1

6.7

7,4

8.8

8.4

9.3

6.3

46

52

39

44

38

48

72

69

75

90

85

93

6.5

46

4,9

4.1

4,8

4.2

5.1

7,0

6.6

7,4

8.7

8,2

9.2

6.9

4.5

4.7

4.3

6.1

5.7

6.2

6.9

6.5

7,3

8.4

8.1

8.8

6.2

46

53

38

43

37

4.6

71

6.7

7.5

90

83

94

7.4

6.4

6.8

6.0

5.8

4.8

6.3

8.4

8.0

8.8

9.6

9.8

9.4

8.0

5.0

4.7

5.4

7.2

5.8

7.8

8.5

7.6

9.1

0.1

0.2

0.1

7.0

8.2

9.8

6.6

5.1

4.3

5.6

8.4

8.3

8.5

9.2

9.4

9.0

46

5.0

4,0

5.0

44

54

7.6

7,1

8.0

9.7

9.2

10.2

--

. .

. .

. .

. .

-.

. .

. .

.-

. .

. .

. .

7,4

4.5

. .

4.6

5.0

4.1

6.3

6.0

6.4

7.8

7.3

8.1

9.8

9.4

10.3

. .

4.9

4.0

6.2

5.8

6.3

7.6

7.1

7.9

9.6

9.1

10.2

6.6

46

5.T

41

46

39

5.0

76

70

81

9.8

93

102

. .

.-

. .

. .

. .

. .

-.

. .

. .

. .

. .

6.8

4.6

5.1

4.0

. .

. .

-.

. .

. .

. .

4.6

40

5.0

8.0

7,3

8.5

10.3

9.7

10,8

. .

. .

. .

. .

.-

.-

. .

the rate of hospital discharges appeam lower for persons in fair

health in 1985 than in 1983, this difference may be due to

sampling variation. Similarly, hospital discharges did not decline significantly for persons under age 65 years who were

considered to be in poor health.

The distribution of hospital discharge rates by region is

quite similar for 1983 and 1985: that is, the discharge rates

were higher in the North Central or Midwest and the South

regions in both years. The hospital discharge rates for the regions with tie highest rates declined about 14 percent between

1983 and 1985. The apparent difference in the hospital disc barge rates for the same period for the West and Northeast

regions, in contrast were within sampling variation.

Although it is recognized that the NHIS hospital discharge

estimates for older persons reflect a substantial undercount,

selected NHIS hospital discharge estimates for the older population group are nevertheless shown in table 4 to enable a

comparison between the 1983 and 1985 estimates for persons

under and over 65 years of age. Among persons 65 years and

over living in the community. the hospital discharge rates between 1983 and 1985 declined about 11 percent for white persons and about 27 percent for black persons while for persons

under 65 years. the decline was similar for white and black

persons. about 12 percent. Hospital discharge rates for persons aged 65 years and over with family income under $10.000

declined about 19 percent while rates for persons of similar age

with incomes of $35.000 or more declined about 11 percent. In

contrast, among persons under 65 years of age the hospital

discharge rate for persons with family income under $10.000

declined about 9 percent and for those with family incomes of

S50.000 or more. the hospital discharge rate declined about 18

percent.
8

Tabla 6. Unadjusted and age-adjusted average Iangth of stay for all discharges from short-stay hospitals among persons under 65 yaars Of age,

by selected characteristics based on data from tha National Haalth Interview Sunray (N HIS): Unitad States, 1982-86

Unadjusted average length of stay Age-adjustefl average length of stay

Characteristic 1982 ?983 7984 1985 1986 1982 7983 1984 1985 1986

Sex

Male, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

Wh!te .,. . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Family Income

Under $10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Undar $5.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$5,000-$ 9.999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.s10,000-$19,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$10,000-s 14,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$15,000-s 19,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S20,000-S34,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S20,000-S24,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.S25.000-S34,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$35.000 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$35,000-s49,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$50,0000 r more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NHIS poverty index

Below poverry lin e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Above poverty lin e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Assessed health status

Excel lent or good . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Excellent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fair or poor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Poor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Geographic regon

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

North Central/Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West ...,., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.1

62

6.3

7.5

5.8

6.3

8.4 7.9

7,8 7.5

7.2 8.2

B.3 7,1

6.6 6.6

6,1 6.8

7.0 6.5

6.1 5.5

6.2 5.7

6.1 5,4

5.5 6.2

5.3 6.4

5.9 5.9

7.3 7.4

6.4 6.2

5,3 5.4

4.6 5.0

6.6 6.0

9.7 9.4

8.2 8.2

11.4 10.8

7,4 7.0

6.7 7.0

6.4 6.2

5.8 6.0

7,6

5.8

6.2

8,5

8.3

7.6

8.7

6.9

7.2

6.5

5.4

5.3

5.4

5.1

5.2

4.9

7.0

6.2

5.2

4.6

6.0

9.5

9.4

9.7

7.1

6.7

6.6

5.2

7.0

5.4

5.9

7.1

7.7

7.7

7.7

6.0

5.6

6.4

5.5

5.6

5.5

5.3

5.2

5.3

6.5

5.9

5.0

4.4

5.8

8.6

8.3

9.0

7.0

6.3

6.0

4.7

Days per hospital stay

6.7

5.3

5.6

7.6

5.5

6.1

5.0

6.6

6.2

7.0

5.8

5.6

5.9

4.8

4.7

4.9

5.5

5.7

4.7

4.3

5.5

8.5

6.7

10.4

6.0

6.0

5.8

5.4

6.9

6.6

6.1

8.7

7.9

7,0

8.4

6.6

6.1

6.9

6.1

6.3

6.0

5.3

5.1

5.7

7.4

6.4

5.5

4.7

6.9

9.1

8.0

10.8

7.4

6.4

6.4

6.0

7.2

5.B

6.0

7.7

7.3

8.1

6.8

6.3

6.6

6.1

5.5

5.5

5.4

6.1

6.3

5.6

7.6

6.1

5.4

5.1

5.8

9.1

8.1

10.6

6.6

6.6

6.0

6.0

7,2

5.9

5.8

8.4

8.0

7.8

8.1

6.5

6.6

6.3

5.1

5.0

5.1

5.1

5.2

4.8

7.0

5.9

5.2

4.7

5.8

9.1

9.0

9.4

6.7

6.6

6.3

5.1

6.3

5.3

5,5

6.8

6.9

7.2

6.6

5.8

5.3

6.3

5.3

5.1

5.4

5.0

5.0

5.1

6.3

5.6

5.0

4.5

5.7

7.5

7.6

7,5

6.7

6.0

5.6

4.4

6.5

5.6

5.5

7.7

5.5

62

5.0

6,4

5.7

7,1

5.9

5.7

61

4.7

4,5

5.2

5.6

5.7

4.8

4.3

5.5

9.8

6.6

15.3

5.8

6.0

5.7

5.6

lAge adjusted by the direct method to the age d!stnbutlon of the 1980 total cwillan nontnstwtlonal!zed population of the United States (under 15, 15-24, 25-44,

and 45-64 years).

Langth of hospital stay

Table 5 contains the NHDS and NHIS estimates of average lengths of hospital stay by age and sex. Although the

NHDS and the NHIS data sets produce somewhat different

results for specific age and sex groups, both data sources reveal

longer stays among the older age groups and shorter stays for

females of childbearing age compared with males in the same

age group.

As mentioned previously, the overall average length of

stay for hospitalized patients has gradually declined since the

early 1970’s. The year-~year differences, which are relatively

small, however, are seldom statistically significant. This is illustrated in the 1983-85 period as well.

While the 1985 NHDS estimate of 6.5 days per hospital

discharge is significantly lower than the 6.9-day-per-stay average in 1983 (about 6 percent), the apparent decline in NHIS

corresponding length of stay estimates during this 2-year period

is not statistically significant. Both the NHDS and the NHIS

length-of-stay estimates were significantly lower in 1985 than

in 1983, however, for males 45-54 years, 65 years and over,

and 75 years and over.

Although there is a high level of general agreement between

the two surveys, Within the specific age and sex groups there

are some different findings. Based on the NHIS, hospital stays

for children under 5 years of age were significantly shorter, for

example, declining from 6.7 days in 1983 to 5.1 days in 1985.

The NHDS length-of-stay estimates for children these ages,

however, did not indicate a significant decline. Differences

were also noted in the NHDS and NHIS length-of-stay estimates among males 15 –44 years of age. According to NHIS

figures, the average length of a hospital stay among males these

ages declined about 19 percent between 1983 and 1985; the

corresponding NHDS rates remained virtually unchanged.

Table 6 shows unadjusted and age-adjusted average lengths

of stay per hospital discharge for selected sociodemographic
achncedaia 9

and health-related characteristics. The table is similar to table 3

in that it only contains data from the NHIS for persons under

15 years. This table shows an inverse relationship between

mily income and length of hospital stay even after adjusting

for age. In 1985, for example, the age-adjusted figures show

that persons under 65 years of age with family incomes under

$10,000 averaged 6.9 days per hospital stay while those with

family incomes at $35,000 or more averaged 5.0 days. Between

1983 and 1985, the (unadjusted) average-length-of-stay estimates were about the same for persons these ages whose family

income was less than $10,000 while for persons reporting incomes at $35,000 or above, the rates declined about 15 percent.

An inverse relationship is also found in the len~h-of-stay

estimates by respondent-assessed health status. The length-ofstay estimates for persons in poor health declined about 17

percent between 1983 and 1985. from 10.8 to 9.0 days. This is

the only health status category in which the 1985 estimate was

significantly lower than the 1983 estimate. ,%rnilarly, the West

was the only region of the country where the 1985 estimate for

average length of a hospital stay was significantly different

from the 1983 estimate. Specifically, the length-of-stay estimates for the West region declined over 20 percent during this

period, from 6.0 to 4.7 days per hospital stay.
10 achancedata

References

1Nationa] Center for Health Statistics, R Pokras and L. J. KOZ*

Adjustment of hospital utilization rates, United States. 1965-80. Viral

and Heulrh S/ufisfics. Series 13, No. 81. DHHS Pub. No. (PHS) 85-

1742. Public Heahh Service. Washington. U.S. Government Printing

Office, Dec. 1984.

zNational Center for Health Statistics, B. J. Haupt Utilization of

short-stay hospitals, Amual summary for the United States, 1979.

Vital and Health .SrcuLrtics, Series 13, No. 60, DHHS Pub. No.

(PHS) 82-1721. Public Health Service. Washington. U.S. Government Printing OffIce, Dec. 1981.

3National Center for Health Statistics, E. W. Gordon: Utilization of

short-stay hospitals, Summary of nonmedical statistics, United States,

1970. I’ita[ and Health Statistics. Series 13, No. 14. DHEW Pub.

No. (HR4) 74-1765. Health Resources Administration. Washington.

U.S. Government Printing Otlice, Aug. 1973.

4J, ~bitz and R Deacon The rise in the incidence Ofhospitalizations

for the aged, 1967 to 1979. Health Care Financvrg Review 3(3):2 1-

40, 1982.

5R po~as and M, Moiety Lens extraction: 1965– 1980 Data from

the National Hospital Discharge Survey. Paper presented at the Annual M.xting of the American Public HeaJth Association. Washington,

NOV. 1985.

6Tax Equity and Fiscal Responsibility Act. United States Congress,

Sept. 3, 1983.

TNationa] Center for Healti Statistics, R Pokras: Utilization of shoflstay hospitals by diagnosis-related groups. United States, 1980-1984.

Vifal and Healrh Statistics. Series 13, No. 87. DHHS Pub. No. (PHS)

86-1748, Public Health Service. Washington. U.S. Government Printing OffIce. July 1986.

8Sick system (new medicare payment system). Sci. Am. 253:68-69,

1985.

‘J Also from: Playing the numbers. Medical World News, Oct. 24,

1983, pp. 38-55.

loNation~ Center for Health Statistics, E. J. Graves: Utilization of

short-stay hospitals, United States, 1984 annual summary. Vital and

Health Scafistics. Series 13, No. 84. DHHS Pub. No. (PHS) 86-

1745. Public Health Service. Washington. U.S. Government Printing

Office, Mar. 1986

11Nation~ Center for Hea]ti Statistics, Staff of Division of Hdtit

Interview Statistics: Current estimates from the National Health Interview Surve}, United States, 1983. Viral and Health Sfafisfics.

Series 10. No. 154. DHHS Pub. No. (PHS) 86-1582, Public Health

Service. Wfi.hing~on. U.S. Government Printing Office, June 1986.

lzNational Center for Health Statistics, P. W. ~es: CutTent estimak

from the National Health Intemiew Survey, United States, 1984,.

vital and Health Statistics. Series 10, No. 156. DHHS Pub. No.

(PHS) 86-1584. Public Health Service. Washington. U.S. GovernmentPrinting Ofilce, July 1986.

IgNational Center for Healti Statistics: 1985 summary. National

Hospital Dischasge Survey. Advance Data From Viral and Health

Sratisrics. No. 127. DHHS Pub. No. (PHS) 86– 1250. Public Health

Service. Hyattsville, Md.. Sept. 25.1986.

lQNationa] Center for Health Statistics, A. J. MOSS and V. L. p~sons:

Current estimates from the National Health Interview Survey. United

States, 1985. Vital and Health Statistics. Series 10. No. 160. DHHS

Pub. No. (PHS) 86-1588. Public Health Service. Washington. U.S.

Government Printing Otlice. Sept. 1986.

15Nationa] center for Health Statistics, W. R Simmons and G. A.

Schnack: Development of the design of the NCHS Hospital Discharge

Survey. 1‘i[al and Health Sraris[ics. Series 2. No. 39. DH[EW Pub.

No. (HRA) 77– 1199. Health Resources Adsninistration. W ashirtgton.

U.S. Government Printing Office. May 1977.

lsNationai Center for Health Statistics, E. J. Graves and B. J. Hauw

Utilization of short-stay hospitals, United States. 1981 annual summary. t “ifal and Health Starisrics. Series 13, No. 72. DHHS Pub.

No. (PHS) 83-1733. Public Health Service. Washington. U.S. Government Printing OffIce, Aug. 1983.

1TNational Center for Health Statistics, M. G. KOVaS ~d (~. S. Poe:

The NationaJ Health Interview Survey desi.m, 1973-84, and proce

dures, 1975-83. Vita/ and Health Statistics. Series 1, No. 18. DHH_$

Pub. No. (PHS) 85-1320. Public Health Service. Washington. U.S.

Government Printing Oflice, Aug. 1985.

IsNaUona] Center for Health Statistics, M. G. Sirkem Utilization of

short-stay hospitals, summary of nonmedical statistics. United States,

1965. I“ifa/ and Health Statistics, Series 13, No. 2. PHS Pub. No.

1000. Public Health Service. Washington. U.S. Government Printing

Office, Aug. 1967.

lgNational Center for Health Statistics, M. J. Witkirr Utilization of

short-stay hospitals by characteristics of discharged patients, United

States. 1965. Vilal and Hea/th Statistics. Series 13, No. 3. PHS Pub.

No. 1000. Public Health Service. Washington. U.S. Government

Printing Office. Dec. 1967.

zoNational Center for Health Statistics: Reporting of hospitalization in

the Health Interview Survey. I‘ital and Health Statistics. Series 2.

No. 6. PHS Pub. No. 1000. Public Health Service. Washington. U.S.

Government Printing Oflice. July 1965.
advancedata 11

Technical notes

National Hospital Discharge Survey methodology

Source and description of data

The National Hospital Discharge Survey (NHDS) samples

the records of inpatients discharged from noninstitutional hospitals, exclusive of military and Veterans Administration hospitals, located in the 50 States and the District of Columbia.

Only hospitals with six beds or more for patient use and those

in which the average length of stay for all patients is less than

30 days are included in the survey. Discharges of all patients

from Federal hospitals are excluded. In this report, discharges

of newborn infants are also excluded.

The Master Facility Inventory of Hospitals (MFI) is the

universe from which the NHDS sample is drawn. The original

universe for the survey consisted of 6,965 short-stay hospitals

contained in the 1963 MFI. New hospitals were sampled for

inclusion in the survey in 1972, 1975, 1977, 1979, 1981, 1983,

and 1985.

The number of hospitals participating in the survey varies

from year to year, as do the number of abstracts of medical

records provided by participating hospitals. This is because

each year some of the sampled hospitals refuse to participate in

the survey or are found to be out of scope either because they

have gone out of business or fail to meet the definition of a

short-stay hospital. In all, 558 hospitals were sampled in 1985.

Of these hospitals, 82 refused to participate, and 62 were out

of scope. The 414 participating hospitals provided approximately 194.000 abstracts of medical records.

The medical record data consist of items relating to the

personal characteristics of the patient, including birth date,

sex, race, and marital status but not name and address; administrative information, including admission and discharge

dates, discharge status. and medical record number and medical information, including diagnoses and surgical and nonsurgical operations or procedures. Sire-e 1977. patient zip code.

expected source of payment, and dates of surgery have also

been collected.

Sample design

All hospitals with 1,0@3 beds or more in the universe of

short-stay hospitals are selected with certainty in the sample.

All hospitals with fewer than 1,000 beds are stratified, the

primary strata being 24 size-by-region classes. Within each

primary strata, the allocation of the hospitals is made through a

controlled selection technique so that hospitals in the sample

are properly distributed with regard to type of ownership and

geographic division. Sample hospitals are drawn with probabilities ranging from certainty for the largest hospitals to 1 in

40 for the smallest hospitals.

Until 1985, all sample discharges were selected using the

daily listing sheet of discharges as the sampling frame. These

discharges were selected by a random technique, usually on the

basis of the terminal digit or digits of the patient’s medical

record number. The within-hospital sampling ratio for selecting

sample discharges varied inversely with the probability of selection of the hospital. The sample selection and abstraction of

data from the face sheet and discharge summary of the medical

records were performed by the hospital staff or by representatives of the National Center for Health Statistics (NCHS ),

after which the completed forms were fonvarded to NCHS for

coding, editing, and weighting procedures.

In 1985, there were two data collection procedures used

by the NHDS. The first was the traditional manual system of

sample selection and data abstraction previously described.

The second was an automated method used in approximately

17 percent of the sample hospitals that involved the purchase

of data tapes from commercial abstracting sem’ices. For the

automated hospitals. tapes containing machine-readable medical record data are subject to NCHS sampling, editing, and

weighting procedures. A detailed description of the automated

process is to be published.

Presentation of estimates

Statistics produced by NHDS we derived by a complex

estimating procedure. The basic unit of estimation is the sample

inpatient dkcharge abstract. The estimating procedure used to

produce essentially unbiased national estimates in NHDS has

three principal components inflation by reciprocals of the

probabilities of sample selection, adjustment for nonresponse.

and ratio adjustment to fixed totals. These components of estimation are described in appendix I of two earlier publications.18.19

As in any survey, results are subject to nonsampling or

measurement errors, which inchtde errors resulting from hospital nonresponse, missing abstracts, information incompletely

or inaccurately recorded on the abstract forms, and processing

errors. For example, the age and sex of the patient are not

stated onthehospital records for about one-half of 1 percent of

the discharges. Imputations of these missing items are made by

assigning the patient an age or sex consistent with the age or

sex of other patients with the same diagnostic code.

If the dates of admission or discharge are not given and

cannot be obtained from the monthly sample listing sheet transmitted by the sample hospital, a length of stay is imputed by

assigning the patient a length of stay characteristic of the stays

of other patients of the same age. About one-tenth of 1 percent

of the records are missing the date of admission or discharge.

National Health Interview Survey methodology

Source and description of data

The NationaI Health Interview Survey (NHIS) is a continuous, cross-sectional. nationwide suney conducted by household interview. Each week a probabili~y sample of households

is interviewed by personnel of the U.S. Bureau of the Census

(as agents for NCHS) to obtain information on the health and

other characteristics of each member of the household.

The population covered by the N’HIS is the civilian. resident. noninstitutionalized population of the United States living

NOTE: A IISIofreferencesfollowsthe text.
12 achncedata

at the time of interview. The sample does not include persons

residing in nursing homes. members of the Armed Forces, institutionalized persons, or U.S. nationals living abroad.

The completion rate for the survey has been between 96

and 98 percent over the years. The interviewed sample for

1985 was composed of 34,844 households containing 91,531

persons. The total noninterview rate for the basic health and

demographic household questionnaire was 4.3 percent—2.6

percent was due to respondent refusal and the remainder was

primarily due to an inability to locate an eligible respondent at

home after repeated calls.

The NHIS questionnaire contains two major parts: The

first consists of topics that remain the same from year to year.

Among these topics are the incidence of acute conditions, the

prevalence of chronic conditions, pemons limited in activity due

to chronic conditions, restriction in activity due to impairment

or health problems, and utilization of health care services involving physician care and short-stay hospitalization. The second part consists of questions on special health topics that

change each year.

Sample design

The sample of the NHIS follows a multistage probability

design that permits a continuous sampling of the civilian noninstitutionalized population residing in the United States. The

survey is designed so that the sample scheduled for each week

is representative of the target population and the weekly ssmples are additive over time. In 1985, the NHIS adopted several

new sample design features although, conceptually, the sampling plan remained the same as the previous design. The

major changes included (a) reducing the number of primary

sampling locations from 376 to 198 for sampling ei%ciency,

(b) overssrnpling the black population to improve the precision

of the statistics, (c) subdividing the NHIS sample into four sep

arate representative panels to facilitate linkage to other NCHS

surveys, and (d) using an all-area frame not based on the decennial census to facilitate NCHS survey linkage anct to conduct NHIS followback surveys.

The first stage of the sample design consists of drawing a

sample of primary sampling units (PSU’S) (376 prior to 1985

and 198 PSU’S afterward) from the universe of 1,900 PSU’S.

Begiming in 1985, the 52 largest PSU’S, referred to as selfrepresenting PSU”S, are selected into the sample with certainty.

The other PSU’S. referred to as non-self-representing PSU’S,

are clustered into 73 strata, and 2 sample PSU’S are chosen

from each stratum with probability proportional to size.

For purposes of this discussion, the remaining stages can

be combined. Ultimately, these “second stage” units, or segments, are defined so that within each, all occupied households

are targeted for interview.

Prior to 1985, three types of segments were used (a) area

segments. which are defined geographically; (b) list segments,

using 1980 census registers as the frame: and (c) permit segments, using updated lists of building permits issued in sample

PSU’S since 1980. In the 1985 design, only two types of segments within a PSU are used: area segments. containing an

expected eight households, and permit segments. containing an

expected four households.

Presentation of estimates

Because the design of NHIS is a complex multistage pro~

ability sample, it is necessary to reflect these complex pro

cedures in the derivation of estimates. The NHIS estimates

presented in this report are based upon sample person counts

for each year weighted to produce national estimates. The

weight for each sample person is the product of four component

weights: probability of selection, household nonresponse adjustment within segnent, first-stage ratio adjustment, and poststratification by age, sex, and race.

The main effect of the ratio-estimating process is to make

the sample more closely representative of the target population

by age. sex, race. and residence. The poststratification adjustment helps to reduce the component of bias resulting from

sampling frame undercoverage; furthermore, this adjustment

frequently reduces sampling variance.

Because NHIS estimates are based on a sample, they may

differ somewhat from the figures that would have been obtained

had a complete census been taken using the same survey and

processing procedures. To the extent possible, sampling and

nonsampling errors are kept to a minimum by methods built

into the survey procedures.

NHIS hospital discharge data are based on hospital discharges reported to have occurred within 6 months of the week

of interview. Analysis has shown that there is an increase in

underreporting of hospitalizations with an increase in the time

interval between the discharge and the interview. The underreporting of discharges within 6 months of the week of interview is estimated to be about 5 percent.20 Because hospitalization is common in the period immediately preceding death or

institutionalization and older persons are much more likely to

die than younger ones, the underrepresentation for this specific

NI-HS estimate of elderly persons in particular maybe sizable.

Descriptive material on data collection, field procedures,

and questionnaire development in NHIS have been published

as well as a detailed description of the sample design, estimation procedure, and qualifications of the data. 14,]7

Age-adjusted rates

This report includes data that have been adjusted by the

direct method to the age distribution of the selected standard

population, in this case the 1980 total civilian noninstitutionalized population of the United States. Age adjustment by the

direct method is accomplished by multiplying the age-specific

rate for each age group by the population for the corresponding

age group in the standard population. The cross products of the

multiplications are summed and divided by the total of the

standard population to obtain the age-adjusted rate. Four age

groups were used for the age adjustment in this report: under

15, 15-24.25-44, and 45–64 years.

Sampling errors

The standard error is a measure of the sampling variability

that occurs by chance because only a sample, rather than aI

entire universe. is surveyed. The chances are about 68 out of

NOTE A list of references follows the text.
advancedata 13

100 that an estimate from the sample would differ from a com- of less than 30 days. Federal hospitals and hospital units of

plete census by less than the standard error. The chances are institutions are not included.

bout 95 out of 100 that the difference would be less than twice . ~%’HIS-.@ institution that is named in the listing of

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

than 2?4 times as large. The relative standard error of the

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. Relative standard errors of estimated numbers of hospital discharges

are shown in table I. The standard errors for average lengths of

stay are shown in table II. Table III contains estimated numbers

of discharges based on the NHDS and the NHIS to enable

interested readers to derive approximate standard errors of the

rates presented in this report.

Definitions of terms

Hospital

NHL)S— Short-stay special and general hospitals having

six beds or more for inpatient use and an average length of stay

Table 1. Approximate relative standard errors (in parcant) of

estimated numbers of hospital discharges based on data from the

National Hospital Discharge Survay and tha National Haalth

Interview Survey Unitad Statas. 1983 and 1985

National National

Hospital Health

Discharge Interview

Survey Survey

Size of estimate 7983 r 985 7983 1985

Relatwe standard error

5000000 . . . . . . . . . . . . . . . . . . . . . . 4.8 4.0 11.5 13.0

1.000,000, . . . . . . . . . . . . . . . . . . . . 4.2 3.5 8.2 9.2

7,500,000 . . . . . . . . . . . . . . . . . . . . . 3.9 3.3 6.7 7.5

2,000,000 . . . . . . . . . . . . . . . . . . . . . 3.7 3.1 5.8 6.5

3.000,000 . . . . . . . . . . . . . . . . . . . . . 3.5 2,9 4.7 5.4

4,000,000 . . . . . . . . . . . . . . . . . . . . . 3.3 2.8 4.1 4.7

5.000,000 . . . . . . . . . . . . . . . . . . . . . 3.2 2.7 3.7 4.2

10.000,000 . . . . . . . . . . . . . . . . . . . . 2.9 2,4 2.7 3.0

15,000,000 . . . . . . . . . . . . . . . . . . . . 2.8 2,3 2.2 2.5

20.000,000 . . . . . . . . . . . . . . . . . . . . 2.7 2.2 1,9 2.2

30,000,000 . . . . . . . . . . . . . . . . . . . . 2.5 2.1 1.6 1,8

40,000,000 . . . . . . . . . . . . . . . . . . . . 2.5 2.1 1,4 1.6

hospitals maintained by the American Hospital Association as

a general hospital: maternity hospital: eye, ear, nose, and throat

hospitak children’s hospitak or osteopathic specialty hospital.

Hospital departments of an institution maybe included.

Patient/inpatient

NHDS—A person who is formally admitted to the inpatient service of a short-stay hospital for observation. care.

diagnosis, or treatment. Infants admitted on the day of birth.

directly or by transfer from another medical facility. with or

without mention of disease. disorder, or immaturity. are included.

Hospital discharge

NHDS—The formal release of a patient by a hospitak that

is, the termination of a period of hospitalization by death or by

disposition to place of residence, nursing home, or another

hospital.

NHIS—The completion of any continuous period of stay

of 1 night or more in a hospital as an inpatient.

In this report, all newborn infants, defined as those admitted by birth to the hospital, are excluded from the NHDS

estimates whereas all well newborn infants admitted by birth to

the hospital are excluded from the NHIS estimates.

Hospital discharge rate

NHDS—The ratio of the number of hospital discharges

during a year to the number of persons in the civilian population on July I of that year.

NHZS—The ratio of the number of hospital discharges

during a year to the average number of persons in the civilian

noninstitutionalized population of the United States for that

year.

Length of hospital stay

NHDS—The total number of days accumulated by a patient at time of discharge. For patients admitted and discharged

Table Il. Approximate standard errors of average lengths of stay by number of discharges based on data from the National Hospital Discharge

Survey and the National Health Interview Survey United States. 19a3 and 1985

NHDS average length of stay NHIS average length of sray

4 6 8 10 4 6 8 10

Number of dtsctrarges days days days days davs days days days

1983

500.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2

5,000 .000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2

10,000,000, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2

30,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0,1 0,1

1985

JO.OOO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2

1,000 .000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2

5.000 .000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 0.1

10,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.1

30.000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 01

0.3

0.3

0.2

0.2

0.2

0.3

0.2

0.2

0.2

0,1

Standard error m day’s

0.4 08

0.3 0.6

0.3 0.3

0.2 0,2

0.2 0.1

0.3 0.8

03 06

0.2 04

0.2 03

02 03

1,0

07

0.3

02

01

09

08

05

05

05

12

08

0.4

0.3

0.2

12

09

05

06

05

1,3

0.9

0.4

0.3

0.2

1,4

11

0.8

0.8

0.8
14 advancedata

Table Ill, Number of discharges from short-stay hospitals by sex and age basad on data from the National Haalth Intewiaw Survey and the

Nat;onel Hospitel D/scharge Survey: United Statas, 1982-86

Narfonal Health Interwew Survey Nationa/ Hospjtal Dmcharge Suwev

Sex and age 1982 1983 1984 7985 7986 1982 1983 7984 ?985 1986

Both sexes

Alleges, ,,. ,,. . . .

Under 15 years

Under 5 years

5-14 years ,.

15-44 years

15–24 years. ,. ,

25-44 yeaw .

45-64 years . .

45-54 years. . . .

55–64 years. .

65 years and over

65-74 years . .

75 years And over . . . . . .

Male

All ages. . . . . ,.

Under 15 years . . ,, ..., .,

Under 5vears ... .,, .,,

5-14 years.... . . . . . . . . . . . . . . . . .

15–44 years ,,, ,, . . . . . .

15-24 years... . . . .

25-44 years,.....,.. . . . .

45-64 years, . . . . .

45-54 years.,, . . . . .

55-64 years .,. . . . . .

65 years and over. . . . . ,,. . ,,

65-74 years ,.. . . . . .

75 years And over..... . . . .

Female

Alleges, . . . . . . . . . . . . . . . . . .

Under 15 years ., . . . . . . . . . . . . . .

Under 5vears ...,....,..

5-14 years . . . . . . . . . .

15–44 years . . . . . . . . . . .

15-24 years . . . . . . . . . . . .

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

45-64 years,,,.....,,,.,,., . . . . . . . . .

45-54 years, . . . . . . . . . . . . . . . .

55-64 years...

65 years Andover.. . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . .

75 years Andover...,.. . . .

31 746

3,040

1,583

1,458

13,297

4,548

8749

7,801

3,401

4,400

7,607

4,197

3,410

13,125

1,703

945

757

4,310

1,388

2,922

3,690

1,494

2,196

3,422

2,074

1,348

18,621

1,338

637

701

8,987

3,160

5.827

4,111

1,907

2,204

4,184

2,123

2,062

32,176

3,000

1,609

1,391

13,212

4,566

8.646

7,634

3,089

4,545

8.330

4,504

3,826

13,051

1,762

981

781

3,902

1,346

2,556

3,742

1,426

2,316

3,644

2,176

1,468

19,125

1,238

628

610

9,310

3,220

6,090

3,891

1,663

2,229

4,686

2,328

2,358

30,931

3,146

1,747

1 399

2,267

4181

8,086

7,113

3,146

3,966

8,405

4.523

3.881

2,542

1,746

991

755

3,494

1,126

2,367

3,692

1,632

2,060

3,610

2.120

1,490

18,389

1,401

756

645

8,774

3,055

5,719

3,420

1,514

1,907

4,795

2,403

2,391

28,917

2.657

1,465

1,192

11,430

3,561

7,869

7,219

3,168

4,051

7,612

4,129

3,483

11,903

1,604

913

691

3.114

787

2,326

3,747

1,624

2,123

3,439

1,999

1,440

17,014

1,053

552

501

8,316

2,773

5,543

3,473

1,545

1,928

4.173

2,130

2,043

Number!n thousands

27,895

2,499

1,341

1,158

11.469

3;580

7,888

6,345

2,507

3,838

7,582

4,023

3,559

11,589

1,350

798

551

3,423

906

2,517

3,432

1,301

2.132

3,384

1,982

1,402

16,306.

1,150

543

607

8,046

2,674

5,371

2,913

1,206

1,707

4,198

2,041

2,157

38,593

3,654

2,014

1,640

15,554

5.439

10,115

8,688

3,893

4,795

10,697

5,231

5,466

15.470

2,098

1,181

917

4,615

1,441

3,173

4,143

1,768

2,375

4,614

2,475

2.139

23,123

1,556

834

723

10,939

3,997

6,942

4,545

2,125

2,420

6,083

2,757

3,327

38.783

3,654

2,082

1,57?

15,269

5,167

10,102

8,558

3,725

4,833

11,302

5,468

5,834

15,573

2,084

1,206

878

4,524

1,356

3,167

4,159

1,728

2.431

4,806

2,568

2,238

23,210

1,570

S76

694

10,745

3,810

6,934

4,400

1,997

2,402

6,496

2,901

3,595

37,162

3,208

1,809

1,399

14,533

4,762

9,771

8,195

3,545

4,650

11,226

5,353

5.874

14,899

1,831

1,046

785

4,305

1,241

3,064

3,964

1,666

2,298

4,799

2,526

2,274

22,263

1,377

764

614

10,228

3,521

6,707

4,231

1,879

2,352

6,427

2,826

3.600

35>056

2,972

1,708

1,264

3,966

4,521

9,445

7,61C)

3,298

4,312

0,508

5,011

5,497

14,1 6CI

1,698

990

708

4,153

1,153

3,000

3,776

1,596

2,179

4,533

2,389

2,145

20,896

1,274

718

556

9,813

3,368

6,445

3,834

1,701

2,132

5,975

2,623

3,352

.-

.-

--

.-

. .

. .

. .

. .

. .

. .

.-

-.

. . .

---

..-

.-.

---

. . .

. . .

. . .

. . .

. . .

. . .

..-

. . .

. . .

. . .

. . .

. . .

---

. . .

. . .

. . .

. . .

. . .

..-

. . .

---

indifferent days. it includes alldaysfrom (and including) the

date of admission to (but not including) the date of discharge.

Astayof less than 1 day(patient admission and discharge on

the same day) is counted as 1 day.

NHIS—The duration in days, exclusive of the day of discharge. of a hospital stay. Stays for patients admitted and

discharged on the same day are not counted.

Average length of stay

hHDS and NHIS- The total number of hospital days

accumulated at time of discharge by patients discharged. divided by the total number of hospital discharges.

Age

iVHDS— The patient”s age on the birthday prior to admission to the hospital inpatient semice.

NHLS—The person’s age on the birthday prior to the interview.

Race

NHIS—The population is divided into three racial groups;

“white. “ “black.” and “all other.” “AI] other” includes Aleut,

Eskimo, or American Indian; Asian or Pacific Islanden and

any other races. Race characterization is based on the re:spondent’s identification of his or her racial background.

Income of family or of unrelated individuals

NHIS— Each member of a family is classified according

to the total income of the family of which he or she is a member.

Within the household, aH persons related to each other by

blood. marriage. or adoption constitute a family. Unrelated

individuals are classified according to their own incomes.
ackimedata 15

The income recorded is the total of all income received by

members of the family (or by an unrelated individual) in the

-month period preceding the week of interview. Income from

sources— for example. wages. salaries, rents from property,

pensions. and help from relatives— is included.

Respondent-assessed health status

.VHIS— The categories related to this concept result from

asking the respondent, “’Would you say _ _ _. ‘s health is

excellent. very good. good. fair. or poor?” As such, it is based

cm a respondent’s

evidence.

Poverty

opinion and not directly on any clinical

.VHIS— Families and unrelated individuals are classified

as being above or below the poverty level using the poverty

index originated at the Social Security Administration in 1964

and revised by Federal Interagency Committees in 1969 and

1980. The poverty index is based solely on money income and

does not reflect the fact that many low-income persons receive

noncash benefits such as food stamps, medicaid, and public

housing. The index is based on the Department of A@culture’s

1961 economy food plan and reflects the different consump

tion requirements of families based on their size and composition. The poverty thresholds are updated every year to reflect

changes in the Consumer Price Index. Because NHIS data on

family income are collected by income categories rather than

specific amounts of money, the NHIS estimates of persons

living in poverty will vary slightly from the Current Population

Survey estimates.

Geographic region

NHIS—The States are grouped into four regions that correspond to those used by the U.S. Bureau of the Census as

follows:

Reg/on

Northeast.

North Central or

Midwest. ., . .

South . . . . . . . . .

West . . . . . . . . . .

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.05

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

*

Figure does not meet standard of

reliability or precision

States mcludedMame, Vermont, New Hampshire, Massachusetts, Connecticut, Rhode Island,

New York. New Jersey, and Pennsylvania.

Ohio, Illinois, Indiana, Michigan. WIsconsln, Minnesota, Iowa, Mlssoun.

North Dakota, South Dakota, Kansas,

and Nebraska.

Delaware. Maryland, Dlstrtct of CoIumb]a, West Vlrgmla, Vwgm!a. Kentucky,

Tennessee, Nonh Carollna, South Carolina, Georg!a, Flor!da, Alabama. Mississippi. Loumana, Oklahoma, Arkansas.

and Texas.

Washington, Oregon, Cahfornla, Nevada,

New Mewco, Arizona, Idaho. Utah. Colorado. Montana, Wyoming, Alaska, and

Hawar!.

# Figure suppressed to comply with

confidentiality requirements

●U.S.GoverrxrtentPr&rtlrtgOHbx 199S— SSS—9SXUCOS
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 6.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics.They include descriptionsof the methods

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

material necessary for understanding the data.

Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributionsto statisticaltheory. These studies also

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistics.These reports carry the analyses fbrther than

the expository types of reports in the other series.

Documents and Committee Reports-These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

International Vital and Health Statistics Reports-These

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

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

Cognition and Survey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

Data From the National Health Interview Survey-These

reports contain statistics on illness; unintentional injuries;

disabili& use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributionsof the population with respect to

physical, physiological,and psychological characteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

Data From the National Health Care Survey—These

reports contain statisticson heaith resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14.

SERIES 15.

SERIES 16.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

SERIES 24.

Data on Health Resources: Manpower and Facilities—

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

Compilations of Advance Data From Wal and Health

Statistics-Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

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

Data on Mortality-These reports contain statistics on

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

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

demographic variables, and geographic and trend analyses

are included.

Data on Natality, Marriage, and Divorcc+These reports

contain statistics on natalii, marriage, and divorce that are

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

analyses by health and demographic variables and

geographic and trend analyses are included.

Data From the National Mortality and Natality SurveysDiscontinued in 1975. Reports from these sample surveys,

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

Data From the National Survey of Family Growth—

These reports contain statistics on factors that affect birth

rates, including contraception, infertility, cohabitation,

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

care for family planning and infertili~ and related maternal

and infant health topics. These statistics are based on

national surveys of childbearing age.

Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly Vial Statistics Reporf (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United Sfafes. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

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

in these series, contact

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

Public Health Service

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782

(301) 436-6500

E-mail: nchsquery@nchl Oa.em.cdc.gov

Internet http://w.cdc.gov/nchsw/nchshome.htm
DEPARTMENT OF

HEALTH AND HUMAN SERVICES

Public Health Serwce

Centers for Disease Control and Prevention

National Center for Health Statistics

6525 Belcrest Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

m

DHHS Publication No. (PHS) 95-1873, Series 16, No. 14

5-1109 (4/95)