Vitaland

HealthStatistics

Advance Data

From Vital and

Health Statistics:

Numbers 21–30

Series 16:

Compilations of Advance Data From

Vital and Health Statistics

No, 3

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

age and other variables on food consumption profiles; ambulatory medical

care; utilization of selected medical practitioners; contraceptive efficacy

among married women; health characteristics of minority groups; and a

comparison of nursing home residents and discharges, Estimates are based

on the civilian noninstitutionalized population of the United States. These

reports were originally published in 1978,

U.S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

Hyafisville, Maryland

May 1990

DHHS Publication No. (PHS) 90-1862
National Center for Health Statistics

Manning Feinleib, M.D., Dr.P.H., Director

Robert A. Israel, Deputy Director

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

and Epidemiolo@

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

Extramural Programs

Peter L. Hurley, Associate Director for Vital and Health

Statistics Systems

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

Division of Vital Statistics

John E. Patterson, Director

James A. Weed, Ph. D., Deputy Director

Robert Bilgrad, Special Assistant to the Director

Robert J. Armstrong, Actuaiial Adviser

Harry M. Rosenberg, Ph.D., ChieJ Mortality Statistics

Branch

Robert L. Heuser, M.A., ChieJ Natality, Mam”age and

Divorce Statistics Branch

George A. Gay, Chie$ Registration Methods Branch

William F. Pratt, Ph.D., Chiej Family Growth Survey

Branch

Ronald Chamblee, ChieJ Technical Services Branch

Mabel G. Smith, Chie$ Statistical Resources Branch

Joseph D. Farrell, ChieJ Systems and Programming

Branch

Paul J. Placek, Ph.D., Chiej Followback Survey Branch
Selected Finding* Food Consumption Profiles of White and Black Persons 1-74 Years of Age in the United

States, 1971–74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office Visits by Persons Aged 65 and ove~ National Ambulatory Medical Care Survey, United States, 1975 . . .

Office Visits to General Surgeons: National Ambulatory Medical Care Survey, United States, 1975 . . . . . . . . . . .

Utilization of Selected Medical Practitioners United States, 1974 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office Visits to Doctors of Osteopathy National Ambulatory Medical Care Survey, United States, 1975 . . . . . . .

Contraceptive Efficacy Among Married Women 15-44 Years of Age in the United States, 1970-73 . . . . . . . . . . .

Health Characteristics of Minority Groups, United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office Visits for Hypertension, National kbulatory Medical Care Survey United States, January

1975–December 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...’. . . . . . . . . . . . . . .

A Comparison of Nursing Home Residents and Discharges born the 1977 National Nursing Home Swey

United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1976 Summary National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. 21

No. 22

No. 23

No. 24

No. 25

No. 26

No. 27

No. 28

No. 29

No. 30

3
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service I Number 21. June 26,1978

Selected Findings: Food Consumption Profiles of White and

Black Persons 1-74 Years of Age in the United States, 1971-741

Information on each sample person’s usual

pattern of food intake was obtained during the

first national Health and Nutrition Examination

Survey (HANES). The survey was conducted by

the National Center for Health Statistics during

April 197 l-June 1974 from a national probability sample of persons aged 1-74 in the U.S.

civilian noninstitutionalized population. These

selected dietary findings, based on the HANES

food frequency data, are directed to a quantitative assessment of food pattern profiles of the

white and black populations, both combined

and separately, excluding other races.

Of the 28,043 sample persons seIected to

represent 194 million persons aged 1-74 years in

the U.S. population, the program examined

20,749 persons, or 74 percent of the sample.

This is an effective response rate of 75 percent

when adjustment is made for the effect of oversampling among preschool children, women of

childbearing age, the poor, and the elderly.

The dietary interview consisted of a 24-hour

recall of food consumption and a food frequency questionnaire and was conducted by

professional dietary staff. The nutrition examination also included a general medical examination by a physician for indicators of nutritional deficiencies, a skin examination by a

dermatologist, and a dental examination by a

dentist. Body measurements were taken by a

trained technician and numerous Laboratory

tests were performed on whole blood, serum,

plasma, and urine. A description of the sampling

1T’his report prepared by Connie hf. Villa Dresser,

R. D., hl argaret D. Camoll, hl.S.P.H., and Sidney

Abraham, Division of Health Examination Statistics.

process, HANES operation, and response rates

has been published.z

The frequency of consumption of the 19

food groups ingested daily and/or weekly over

the 3-month interval prior to the nutrition interview will be described and analyzed in forthcoming reports in the Vital and Health Statistics

senes.374 Eight of the 19 food groups with

similar nutritional characteristics are presented

here by age, race, and sex. The food frequency

interview accounted for alI regular meals, as welI

as for between-meal foods or snacks, eaten

during the week, including special occasions and

holidays. The food frequency method served as

a quality control technique -for the 24-hour

recaII method of obtaining data, while depicting

diet profile patterns over a longer period of

time.

The frequency of consumption of food

items is reported in six categories: 4 times or

2National Center for Health Statistics: Plan and operation of the Health and Nutrition Examination Survey,

United States, 1971-73 by Henry W. Miller. Vital and

Health Statistics. Series I-Nos. 10a and 10b. DHEW Pub.

No. (HSM) 73-1310. Health Services and Mental Health

Administration. Washington. U.S. Government Printing

Office, Feb. 1973.

3National Center for Health Statistics: Food consumption profiles of the white and black U.S. population ages 1-74 years: 197 1-74–graphic and tabular

findings. Vital and Health Statistics. Series 11. Public

Health Service, DHEW, Hyattsville, Md. To be published.

4National Center for Health Statistics: Supplemental

report-Food consumption profiles of the white and

black U.S. population ages 1-74 years: 1971 -74–analysis

and discussion. Vital and Hea[th Statistics. Series 11.

Public Health Service, DHEW, Hyattsville, Md. To be

published.
2

more a day, 3 times a day, 2 times a day, once a

day, 1-6 times a week, and seldom or never con-

&med. The category 1-6 times a week consists

of foods consumed at least once a week but not

more than 6 times a week.

The cross-sectionaI data of food frequency

intake of subjects were obtained on different age

cohorts. The age trends show percentage values

for successive cohorts of different age groups

and reflect the effect of different environmental

influences. The limitations of cross-sectional

data are recognized in considering group age

changes.

sJEuxmED F! NDINGS

Whole milk including 2-percent fat milk. –

Table 1 shows that 21 percent of the white and

Mack U.S. population drink milk once daily, 22

percent drink milk at least 1-6 times a week, and

mother 21 percent seldom or never drink milk.

Generally, there is little difference between the

races in the percent of persons reporting milk

consumption.

Table 2 ShOWS mat a slightly higher percentage of males of both races reported consuming milk than females did.

Table 1. Percent distribution of persons of all ages 1-74 years by frequency of intake of selected food groups, according to race: United States, 1971-74

Race and food group

Both races

Whole milk -----------------

Meat and poultry -----------

Fish and shell fish---------

Eggs-----------------------

F&~d; and vegetables, all

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

Cereals --------------------

Desserts -------------------

Salty snacks ---------------

White

Whole milk -----------------

Meat and poultry -----------

Fish and shell fish---------

Eggs -----------------------

Fruits and vegetables, all

kinds---------------------

Cereal s--------------------

Desserts -------------------

Salty snacks ---------------

Black

Whole milk -----------------

Meat and poultry -----------

Fish and shellfish ---------

Eggs-----------------------

Fruits and vegetables, all

kinds ---------------------

Cereals --------------------

Desserts -------------------

Sslty snacks ---------------

Frequency of intake

.

4 times or more 3 times 2at;&l Owe a day 1-6 times Seldom or

, a day a day a week never

.

Percent distribution

H

0.0

0.0

4.3

0.1

::!

6.2

0.2

0.0

0.1

4.4

0.0

0.4

0.1

3.4

0.4

O.c

O.c

3.5

0.2

0.3

0.2

14.0

;:;

0.1

17.7

0.1

::;

14.5

1.6

0.0

0.0

18.4

0.1

;:!

10.0

3.9

0.0

0.1

12.7

0.1

:::

16.5

30.5

0.1

0.2

37.1

0.6

8.6

1.0

16.8

30.0

0.1

0.2

38-1

0.6

8.8

0.9

14.5

34.1

0.1

0.4

29.2

0.9

7.2

1.9

21.2

51.7

0.9

15.4

31.4

15.9

30.2

10.1

21.2

52.5

0.9

14.6

30.8

16.2

30.4

9.6

21.3

44.7

2;::

35.9

13.8

28.8

14.8

21.9

15.2

54.2

66.6

9.1

44.8

46.5

51.5

21.0

15.1

53.5

67’.3

8.0

44.6

46.2

51,7

29.3

16.3

59.4

61.5

17.9

46.8

48.1

50.2

0.4

38.5

12.7

37.1

20.3

4!::

17.8

0.4

38.5

12.5

37.7

0.7

38.2

14.1

32.4
dmcedda3

Table 2. Percent distributionof white and black persons of all ages 1-74 years by frequency of

intake of selected food groups, according to sex: United States, 1971-74

Sex and food group

Whole milk -----------------

Meat and poultry -----------

Fish and shellfish ---------

Eggs-----------------------

F;;cd: and vegetables, all

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

Cereals --------------------

Desserts -------------------

Salty snacks---------------

Female

Whole milk-----------------

Meat and poultry -----------

Fish and shellfish ---------

Eggs-----------------------

Fruits and vegetables, all

kinds ---------------------

Cereals--------------------

Desserts -------------------

Salty snacks---------------

Frequency of intake

4 times or more 3 times 2 times Once a day 1-6 times Seldom or

a day a day a day a week never

Percent distribution

n

0.0

0.1

M

0.5

0.1

4.9

0.1

%:

4.8

0.0

::;

16.4

::;

0.1

16.2

0.2

::?

11.8

$:

0.0

19.1

0.1

M

Table 3 presents thedata byrace and sex.

Tables 4-9show adecline of milk consumption with age. One-third of the children and

youths aged 1-11 years reported consuming this

food 3 times a day, whiIe 22 percent of the

youths 12-17 years reported this frequency; 9

percent of the 18-44 age group and4percentof

adults aged 45-65 andover areso classified. Onethird of the persons in age groups 45-64 years

and 65 years and over reported seldom or never

consuming milk.

Meat &d poultry excluding organ meats,–

Most Americans derive an”abundant amountof

nutrients from the meat and poultrygroup. The

food frequency data from HANES reinforce the

fact that America is a nation of “meat-eaters.”

Table 1 shows that approximately hzdf of the

white and black U.S. population eat meat or

poultry once daily. Another31 percent consume

these foods twicea clay, and approximately 2

percent consume foods from this group 3 times

17.9 22.0

35.1 47.7

::; 1::;

36.6 32.6

0.8 17.5

9.3 30.8

1.2 11.3

15.2 20.5

26.1 55.4

::; 1::;

37.6 30.2

0.4 14.4

29.7

H 9.0

I

20.8

13.6

53.1

67.2

10.3

W

53.9

23.0

16.8

5--.;

4:::

46.7

49.3

16.1

4::;

15.7

3::;

11.2

33.3

0.3

40.2

14.1

40.6

a day. Less than 1 percent of all age groups reported that they seIdom or never eat meat or

poultry.

Table 2 shows relatively more white and

black females than males reported consuming

these foods once a day, but relatively more

white and black males than females reported

consuming meat and poultry 2 times a day or

more. Table 3 shows a higher percentage of

white persons than bIack persons consume these

foods once a day. However, relatively more

black persons than white persons consume these

foods 2 times a day or more.

Tables 4-9 show the percent ofpersons consuming meat and poultry once a day remains

generalIy constant for all ages. The percent of

persons consuming these foods twice a day

increases with age until age 45 and then decreases in the remaining age groups.

Fish and shellfish . –Fish and shellfish can be

used as an alternate for the meat and poultry
4 —

Table 3. Percent distribution of persons all ages 1-74 years by frequency of intake of selected

food groups, according to sex and race: united States, 1971-74

Sex, race, and food group

~

White

Whole milk -----------------

Meat and poultry-----------

Fish and shellfish ---------

Eggs-----------------------

Fruits and vegetables, all

kinds ---------------------

Cereals--------------------

Desserts-------------------

Salty snacks---------------

Black

Whole milk -----------------

Meat and poultry-----------

Fish and shellfish---------

Eggs-----------------------

F&~~~ andvegetables, all

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

Cereals--------------------

Desserts~------------------

Salty snacks---------------

FEMALE

White

Whole milk-----------------

Meat and poultry -----------

Fish and shellfish ---------

Eggs-----------------------

Fruits andvegetables, all

kinds---------------------

Cereals--------------------

Desserts -------------------

Salty snacks---------------

Black

Whole milk -----------------

Meat and poultry -----------

Fish and shellfish---------

Eggs-----------------------

Fruits and vegetables,all

kinds ---------------------

Cereals--------------------

Desserts -------------------

Salty snacks---------------

—

Frequency of intake

—

4 times or more 3 times 2 times Once a day 1-6 times Seldom or

a day a day a day a week never

—

Percent distribution

7.3

:::

0.1

3.7

0.0

0.5

0.1

0.0

0.3

5.2

0.1

0.0

0.0

5.0

0.0

0.3

0.1

3.6

17.2

:::

0.1

16.8

0.2

2.0

0.0

10.0

5.4

0.0

0.0

11.8

0.1

1.2

0.7

12.0

0.8

0.0

0.0

19.9

0.1

::;

10.0

;::

0.1

13.5

0.2

;:;

18.0

35.1

0.1

0.2

37.6

0.8

9.5

1.1

17.0

35.4

0.0

0.5

28.2

1.4

7.6

2.1

15.6

25.2

::;

38.6

0.4

8.2

0.6

12.4

33.1

0.1

0.3

30.1

0.6

6.9

1.6

21.9

48.3

1.1

15.8

32.3

17.8

31.1

11.0

22.6

42.9

2::;

35.0

14.8

28.9

14.4

20.6

56.6

“0.7

13.5

29.3

14.6

29.8

8.2

20.2

46.3

2%:

36.7

12.9

28.7

15.2

19.7

13.3

52.8

67.7

42::

46.1

54.1

29.4

15.5

55.4

62.8

20.7

47.3

48.2

52.1

22.1

16.8

54.2

66.9

4::7

46.5

49.4

29.1

17.0

62.8

60.3

15.5

46.3

48.0

48.5

16.0

().7

46.0

16.1

().5

36.8

10.9

33.7

17.2

0.3

43.2

1;!.5

1..0

36.1

13.6

30.4

24.5

0.5

45.0

1$).4

0.3

40.2

lfp.1

41..5

25.2

0.7

36.5

1$).2

().5

40.0

14.6

34.2
admcecw5

group. Table 1 shows that about 45 percent of

the white and black U.S. population seklom or

never eat fish or shelIfish. For the population

consuming these foods, 54 percent re orted !’

their consumption to be 1-6 times a week.

Less than 1 percent of the white and black

population consume fish and shellfish once

daily.

Table 3 shows a consistent pattern of fish

and shellfish consumption between the sexes

and races. A slightly higher percentage of black

females than males reported consuming fish and

sheIlfish, and relatively more black persons

reported eating these foods than white persons.

Eggs. –Table 1 shows that 18 percent of the

white and black U.S. population reported they

seldom or never consume eggs. For the remainder of the white and black poptdation who

do eat eggs, approximately 67 percent reported

eating this food less than once daily but at least

1-6 times a week.

Table 2 shows a slightly higher percentage of

males than females of both races consume eggs

once a day. TabIe 3 shows relatively more bIack

persons than white persons of both sexes consume this food once a day.

Tables 4-9 show the percent of persons consuming eggs once daily decreases with age until

Table 4. Percent distribution of persons aged 1-5 years by frequency of intake of selected food

groups, according to race: United States, 1971-74

Race and food group

Both races

Whole milk-----------------

Meat and poultry -----------

Fish and shellfish ---------

Eggs-----------------------

Fruru:: and vegetables, all

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

Cereals--------------------

Desserts-------------------

Salty snacks---------------

White

Whole milk-----------------

Meat and voultrv -----------

Fish and shellfish ---------

Eggs-----------------------

F?m’itsand.vegetables, all

kinds---------------------

Cereals--------------------

Dessert s-------------------

Salty snacks---------------

Black

Whole milk-----------------

Meat and poultry-----------

Fish and shellfish---------

Eggs-----------------------

Fruits and vegetables,all

kinds---------------------

Cereals--------------------

Desserts-------------------

Salty snacks---------------

——

Frequency of intake

4 tim;sd; more 3 times 2 times Once a day 1-6 times Seldom or

a day a day a week never

Percent distribution

19.6

~.3

0.0

0.0

:::

0.6

0.0

20.2

0.3

0.0

0.0

:::

0.7

0.0

15.5

0.5

:::

0.1

33.7

$::

0.0

22.8

0.5

:::

34.3

1.7

0.0

0.0

24.2

0.4

:::

29.6

4.7

0.0

0.1

14.6

0.8

;:;

21.1

29.1

:::

34.6

1.8

15.3

1.8

20.8

28.4

9.1

0.4

3:.;

15:9

1.8

22.9

33.1

0.0

0.6

32.8

1;:;

1.9

11.6

53.9

1;::

27.1

32.6

40.0

12.6

11.0

55.4

1;:;

25.9

32.1

39.4

10.7

15.2

45.7

Ii::

34.1

35.2

43.4

24.0

J:;

51.7

69.8

5::;

36.9

65.3

1;:;

50.2

69.6

52:;

36.9

64.9

11.9

15.9

60.0

71.0

13.4

55.9

36.9

67.3

.———

::;

47.5

12.4

0.5

8.4

3.8

19.9

:::

49.0

12.9

0.6

8,7

2;::

4.9

3::;

9.7

0.0

H

6.7
6

Table 5. Percent distribution of persons aged 6-11 years by frequency of intake of selected food

groups, according to race: United States, 1971-74

Frequency of intake

Race and food group

Both races

Whole milk-----------------

Meat and poultry -----------

Fish and shellfish---------

Eggs-----------------------

Fruits andvegetables, all

kinds---------------------

Cereals--------------------

Desserts -------------------

Salty snacks ---------------

White

Whole milk-----------------

Meat and poultry-----------

Fish and shellfish---------

Eggs-----------------------

F~m;; and vegetables,all

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

Cereals--------------------

Desserts-------------------

Salty snacks---------------

Black

Whole milk -----------------

Meat and poultry -----------

Fish and shellfish---------

Eggs-----------------------

F&~d~ and vegetables,all

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

Cereals--------------------

Desserts-------------------

Salty snacks---------------

4 times or more 3 times 2 times 1-6 times Seldom or

a day a day a day Once a day a week never

Percent distribution

11.8

R)

0.0

4.2

0.0

0.3

0.2

13.2

0.4

0.0

0.0

4.4

:::

0.1

:::

0.0

0.1

3.6

0.1

0.1

0.8

32.7

::;

0.0

18.8

0.2

::;

3;.;

0:0

0.0

18.9

0.3

3.2

0.2

19.1

::;

0.1

18.0

0.0

1.9

0.1

25.1

30.0

0.1

0.1

40.6

1:::

1.9

24.6

28.5

:.;

.

41.7

1.7

15.8

1.6

28.4

39.1

0.0

0.8

33.8

1;:!

4.0

19.1

56.8

0.7

9.7

29.5

28.8

44.8

19.6

17.4

5:.;

8:7

28.7

29.2

44.5

18.6

28.9

48.3

1.6”

16.2

34.2

26.1

46.6

26.1

1:::

56.1

74.3

6;:;

34.4

66.0

1::;

54.8

75.2

6!:;

33.6

66.6

17.3

9.8

64.3

68.5

10.4

63.8

39.2

62.6

age group 12-17 years, and increases in age

groups 18years ancl over.

Fruits and vegetables.–Table 1 shows that

less than 1 percent of the white anclblack U.S.

population reported they seldom or never consume fruits and vegetables. Four percent

reported consuming these foods 4 times a day;

18 percent, 3 times a day; 37 percent, twice

daily; 31 percent, at least once a day;and 9

percent reported consuming these foods 1-6

times a week. Relatively more black persons

than white persons of all ages reported consuming these foods once a day. However, a

higher percentage of white persons than black

persons reported eating these foods 2 timesor

more aday.

Table 2showsthat, regardless ofage orrace,

more males than females consume these foods

once a day. However, generaIIy more femalesof

both races reported consuming these foods 2

times adayor more.

Tables 4-9 show that the percent ofpersons

consuming these foods once a day increases

from ages 1 through 44and declines from ages
dmtxb&i7

45 through 74, Fcw each age group, a generally

greater percentage of per:om consume these

foods twice daily rather than once daily.

Breakfast cereals. –Table 1 shows that 39

percent of the \vhite and black I-J.S. population

reported seldom or never consuming cereal,

while only 16 percent reported consuming this

food once daiiy. Forty-five percent of this population did report consuming cereal at least 1-6

times a week. There k little difference between

the races in the percent of persons reporting

cereal consumption.

TabIe 2 shows relatively more males than

females of both races consume cerezd once a

day, and table 3 shows a slightly higher percentage of white persons consume cereaI than

black persons.

While 8 percent of the chiIdren aged 1-11

reported they seldom or never eat cereal (tables

4 and 5), 3 I percent of the youths aged 12-17

(table 6) and an average of 44 percent of adults

aged 18-74 (tables 7-9) are so classified.

Tables 4-9 show that the once-daily frequency of cereal consumption decreases with

Table 6. Percent distribution of persons aged 12-17 years by frequency of intake of selected food

groups, according to race: United States, 1971-74

Race and food group

$oth races

Whole milk-----------------

Meat and poultry-----------

Fish and shell fish---------

Eggs-----------------------

Fruits andveget Jbles, alI

kinds---------------------

Cereals --------------------

Desserts -------------------

Salty snacks---------------

White

Whole milk -----------------

Meat and poultry-----------

Fish and shellfish ---------

Eggs-----------------------

Fruits and vegetables, sII

kinds ---------------------

Cereals --------------------

Desserts -------------------

Salty snacks---------------

Black

Whole milk -----------------

Meat and poultry -----------

Fish and shellfi~h---------

Eggs-----------------------

Fruits andvegetables, all

kinds ---------------------

Cereals --------------------

Desserts -------------------

Salty snacks---------------

Frequency of intake

4 times or more 3 times 2 times once a day 1-6 times Seldom or

.sday a day a day a week never

Percent distribution

I&.;

$!

.

4.4

0.2

0.8

0.2

12.6

0.1

0.0

0.1

4.8

0.0

0.7

0.2

4.1

::8

0.0

2.3

1.1

1.5

0.3

——

22.2

;:;

0.1

16.5

0.2

2.6

0.4

24.1

/!::

0.1

17.3

0.3

M

10.1

Hl

0.0

11.2

0.0

2.7

2.5

22.9

34.3

0.0

0.1

37.1

1:::

1.9

23.1

33.6

0.0

0.1

37.4

1;:;

.

21.8

38.7

0.0

0.4

35.2

J:;

4.7

.—

20.1

48.6

0.9

8.7

30.8

16.0

32.9

15.8

18.0

49.6

13.8

7.7

30.6

16.6

33.4

14.4

33.3

42.2

1.1

14.9

31.8

12.2

29.9

24.0

15.7

14.4

49.9

65.3

10.8

51.8

47.1

65.8

14.3

14.5

:;.;

.

5::?

46.7

66.1

24.5

14.0

54.4

63.7

18.9

58.4

49.5

63.4
8

Table 7. Percent distributionof persons aged 18-44 years by frequency of intake of selected food

groups, according to race: United States, 1971-74

Race and food group

Both races

Whole milk-----------------

Meat and poultry-----------

Fish and shellfish---------

Eggs-----------------------

Fruits and vegetables, all

kinds---------------------

Cereals--------------------

Desserts-------------------

Salty snacks---------------

White

Whole milk-----------------

Meat and poultry-----------

Fish and shellfish---------

Eggs-----------------------

Fruits and vegetables, all

kinds---------------------

Cereals--------------------

Desserts-------------------

Salty snacks---------------

Black

Whole milk-----------------

Meat and pocltry-----------

Fish and shellfish---------

Eggs-----------------------

F~l~d; and vegetables, all

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

Cereals--------------------

Desserts-------------------

Salty snacks---------------

—— . ..—

Frequency of intake

4 times or more 3 times 2 times Once a day 1-6 times Seldom cw

a day a day a day a week never

2.7

::;

0.0

::;

0.2

0.1

?):? 0.0

0.0

3.2

1.2

:::

0.0

3.5

):

0.0

age regardless of race until age 45 and then

increases in the remaining age groups. The percents of persons consuming cereal in the age

group 45-64 and those 65 years and over are

very similar to those for age groups 12-17 and

6-11, respectively.

Desserts includes cakes, pies, cookies, puddings, ice cream, etc.–TaMe 1 shows that about

one-third ofthe white andblack U.S. population

consume desserts once daily, and more than 45

percent eat these foods atleast l-6times aweek.

Percent distribution

8.5

:::

0.1

15.1

0.0

::;

8.8

i:;

0.1

15.7

0.0

0.9

0.1

5.4

6.1

0.0

0.1

9.6

0.0

1.2

0.3

15.0

35.1

0.0

0.2

35.6

0.1

H

15.9

34.7

0.0

0.2

36.6

0.1

6.6

0.7

3;:?

0.1

0.3

27.6

H

0.9

22.4

49.1

1:::

35.8

2;::

9.6

22.9

49.9

1::;

35.5

2::$

9.6

18.3

42.4

2:::

38.8

2!::

9.2

27.4

12.6

54.6

66.3

3:::

;;.;

.

26.0

12.6

54.2

67.4

3::;

52.9

56.0

38.5

12.4

58.3

56.9

19.7

36.2

53.2

51.7

24.0

CI.5

44.3

17.3

CI.4

53.8

14.6

34.0

23.4

C1.s

44.7

17’.4

5%:

14.2

33.6

29.3

4?::

16.4

0.9

57.7

18.1

3;7.8

Table 3 shows a slightly higher percentage of

white persons than black persons consume desserts either once or tWiceaday.”Tables 4-9 show

that dessert consumption generally declines with ,

age.

Salty snack foods excluding nuts. –Table 1

shows that 10 percent of the white and black

U.S. population consume salty snack foods once

daily, while more than 50 percent consume

these foods 1-6 times a week. Thirty-seven per’

cent reported that they seldom or never con-
akmdata9

sume these foods. Relatively more bIack persons

than white persons reported eating these foods

once a day.

Table 2 shows that a slightly higher percerit

of males than females of both races consume

salty snack foods once or twice a day. Table

3 shows a higher percentage of black persons than white persons consume saIty snack

foods once daily and, for the same category,

almost twice as many bIack females as white females consume these foods.

TabIes 4-6 show that salty snack foods are

consumed most frequently by children and

youths of ages 1-17, with only an average of 16

percent reporting they seldom or never eat these

foods. An average of 16 percent of these ages

consume salty snack foods once daily, while

another 66 percent reported eating these foods

at least 1-6 times a week. on the other hand,

tables 7-9 show that an average of 5 percent of

the adults of ages 18-74 reported consuming

salty snack foods once daily, 36 percent reported 1-6 times a week, and 58 percent stated

they seldom or never consume these foods.

Table,8. Percent distribution of persons aged 45-64 years by frequency of intake of selected food

groups, according to race: United States, 1971-74

Race and food group

Both races

Whole milk-----------------

Meat and poultry-----------

Fish and shellfish--------Eggs-----------------------

F~~~s and vegetables, all

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

Cereals--------------------

Desserts-------------------

Salty snacks---------------

White

Whole milk-----------------

Meat and poultry-----------

Fish and shellfish---------

Eggs-----------------------

Fruits and vegetables,.all

kinds---------------------

Cereals-------------------

Desserts -----------------

Salty snacks---------------

Black

Whole milk-----------------

Meat and poultry----------

Fish and shellfish---------

Eggs-----------------------

F~;m~; and vegetables, all

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

Cereals--------------------

Desserts-------------------

Salty snacks---------------

Frequency of intake

4 times or more 3 times 2 times Once a day Z-6 times Seldom or

a day a day a day a week never

Fercent distribution

1.1

:::

0.1

4.9

0.0

0.4

0.0

:::

0.0

0.1

5.0

0.1

::;

0.6

RI

0.0

4.0

%;

0.0

4.0

0.8

0.0

0.0

19.9

0.0

0.7

0.1

4.2

N

0.1

20.3

0.0

::?

1.3

;::

0.0

15.6

::;

0.0

10.7

25.1

0.0

0.2

3:.:

5:3

0.1

11.0

25.2

::!3

40.0

H

0.1

8.0

23.7

0.0

0.2

21.4

::;

0.1

23.4

53.7

1.1

18.7

28.0

13.2

27.2

4.1

24.3

54.2

27.1

13.8

27.9

3.8

14.6

48.8

2:::

36.4

2;::

.

28.1

19.7

57.7

65.0

4:::

45.9

32.3

27.4

19.1

57.2

65.4

4:::

45.5

33.1

35.6

25.8

62.5

60.0

21.6

40.9

50.1

23.6

32.7

4!:;

16.0

4::$

20.6

63.4

32,0

4:::

16.0

4%$

19.8

62.8

39.9

3%;

15.7

1.1

50.7

28.7

69.6
10

Table 9. Percent distribution Of persons aged 65 years and over by frequency of intake of selected food groups, according to race: United States, 1971-74

Race and food group

Both races

Whole milk-----------------

Meat and poultry -----------

Fish and shellfish ---------

Eggs-----------------------

Fruits and vegetables, all

kinds---------------------

Cereals--------------------

Desserts-------------------

Salty snacks---------------

White

Whole milk-----------------

Meat and poultry -----------

Fish and shellfish ---------

Eggs-----------------------

Fruits and vegetables, all

kinds---------------------

Cereals--------------------

Desserts -------------------

Salty snacks---------------

Black

Whole milk -----------------

Meat and poultry -----------

Fish and shellfish ---------

Eggs-----------------------

Fruits and vegetables, all

kinds ---------------------

Cereals--------------------

Desserts -------------------

Salty snacks---------------

Frequency of intake

times or more 3 times 2 times

once a day 1-6 times Seldom or

a day a day a day a week never

Percent distribution

0.6

0.1

0.0

0.1

3.7

0.0

0.1

0.0

0.6

0.1

0.0

0.1

:::

0.1

0.0

H

0.0

0.0

1.9

::;

0.0

4.1

0.6

0.0

0.0

19.9

H

0.1

?):2

0.0

0.0

20.8

0.1

0.7

0.1

:::

0.0

0.1

10.4

0.0

0.0

0.6

10.8

17.4

0.1

0.4

38.8

0.6

5.9

0.4

11.1

17.7

0.1

0.4

39.8

0.5

%;

1::$

0.0

0.2

28.0

H

0.0

25.7

53.6

2:.-:

27.0

25.4

27.2

2.5

26.3

54.6

2::;

26.2

26.5

28.0

2.6

20.2

43.0

2;::

35.5

13.1

19.1

1.3

26.0

26.8

47.7

58.8

4::!

44.9

21.4

25.7

25.6

;;.:

.

28.9

39.3

56.5

50.3

21.6

37.3

51.1

16.0

32.8

5::2

19.3

3;::

21.2

75.6

2.6

48.9

25.2

82.1
dwmedda 11

TECHNICAL NOTES

The sampling plan of ihe Health and Nutrition Examination Survey (HANES) folIowed a

highIy stratified multistage probability design in

which a sampIe was selected of the civilian noninstitutionalized population of ages 1-74 of the

coterminous United States. Successive elements

dealt with in the process of sampling were the

primary sampling unit, census enumeration

district, segment (cluster of households), household, eligible person, and, finally, sample person.

The sampling design focused speciaI attention on

groups of people known to be at greater risk of

malnutrition by oversampling these groups—

preschool children, women of childbearing ages,

the poor, and the elderly.

The food frequency intake values are shown

as population estimates, that is, the dietary

intake findings for each individual have been

“weighted” by the reciprocal of the probability

of selecting the person. An adjustment for

persons in the sample who were not examined

and poststratified ratio adjustments were also

made so that the final sampling estimates of the

population size are brought into closer alignment with the independent U.S. Bureau of the

Ce nS U S estimates for the civilian noninsti.

tutiomdized population of the United States as

of November 1, 1972, by race, sex, and age.

SYMBOLS

Datanot availabIe——-- ——.---— - . -

Category not applicable——-——— . . .

Quantity zero -- _-

Quantity more than Obut less than 0.05— 0.0

Figure does not meet standards of

reliability or precision——-——------ *
Office Visits by Persons Aged 65

National Ambulatory Medical Care Survey,

and Over:

United States, 1975’

In 1975 there were an estimated 93 million

visits made to office-based physicians by persons

aged 65 years and over. This represents an annual rate of 426 visits per 100 persons per year.

These and other preliminary data about

visits by persons 65 years and over are presented

in this report from the 1975 National Ambulatory Medical Care .Survey (NAMCS). NMvICS is

a probability sample survey conducted by the

Division of Health Resources Utilization Statistics of the NationaI Center for Health St@istics.

A complete description of the background and

survey methodology is available in an earlier report entitIed “National Ambulatory Medical

Care Survey: Background and hlethodology,

United States, 1967 -72.”2

The reader may find it useful to refer to the

facsimile of the “Patient Record”, figure 1, in

Advance Data No. 12 as selected aspects of the

survey findings are discussed. The “Patient Record” was used by participating physicians to

record information about their office encounters.

IThis report prepared by Raymond 0. Gawont Di~rision of Health Resources Utilization Statistics.

2Nationa1 Center for Health Statistics: National Ambulatory Medical Care Survey: Background and Methodology, United States, 1967-72, by J. B. Tenney and

others. Vital and Health Statistics. Series 2-No. 61.

DHEW Pub. No. (HRA) 76-1335. Health Resources

Administration. Washington. U.S. Government Printing

office, ilpr. 1974.

DATA

HIGHLIGHTS

Dunrm 1975 there were art estimated 568

million patient visits to the offices of all physicians wi-tiin the scope of NAIWCS. Persons aged

65 years and over accounted for 93 miI1ion, or

16 percent, of these visits.

From tab~e 1 the reader can compare office

visits made by persons in various age-sex groups.

The visit rate increased considerably with age for

both sexes, yet the difference between the sexes

decreased in the oldest age groups.

It should be noted that in this report the

descriptors “elderly,” “aged persons, ” and “persons aged 65 years and over” are used synonymously.

Tables 2-9 describe visits mad: by persons

aged 65 years and over according to seIected

characteristi~s of the visitor and of the physician. For each characteristic, the visit experience

of aged persons is compared with that of persons

under 65. The data show that the visit experience of aged persons differed markedly from

that of persons under 65, Compared with

younger patients, the elderIy

● Had more return visits for the same

problems.

● \lrere t~vice as likely to ha~~e a chronic

condition.

● l~isited internists more frequently.
2

Table 1. Annual rate of visits to office-based physicians by age and sex of visitors:

United States, 1975

Age

\

Sex

Under 65

years of

All ages Under 15 15-24 25-44 45-64 65 years age

years years years years and over

1. Number of visits per 100 persons”per year

.

Both aexes ------- 273 189 222 275 343 426 255

Male ------------------- 222 198 150 191 284 399 205

Female----------------- 322 180 294 356 396 445 305

lThe base populations used in computing the rates are national estimates published

by the U.S. Bureau of the Census for the civilian noninstitutionalized population as

of July 1, 1975, in Series P25 and P26 of Current Population Reports.

●

●

●

●

Had asubstantiilly greaterproportion of

Vi;its when the problem was reportedly

the physician as being serious or very

serioqs.

Had amuchsmaller proportion,of visits

when no followup was planned.

Had an EKG or blood pressure check

more often.

Had a much greater proportion of visits

for diseases of the circulatory system.

Table 2 shows visits for the two age groups

in terms of sex, prior visit status, and nature of

the problem or reason for thevkit. Statkticson

prior visit status reflect more return visits for the

same problems among the older group. For persons under 65 years of age, 84 percent of the

visits were return vkits and 70 percent of these

were for the same problem. Forpersons 65years

or older, 92 percent of the visits were return

visits and 83 percent of these were for the same

problem.

Also accompanying anincrease in age was an

increase in the prevalence of chronic conditions.

It is apparent from table 3, where visits for acute

and chronic conditions are distributed among

several age groups, that the proportion of visits

for chronic conditions increases dramatically

with age. In addition table 2 shows that the na~-

ture of the problem for aged persons was considered to be chronic in 62 percent of the visits;

for persons under age 65, the problems were

considered to be chronic in only 31 percent Of

the visits.

Table 4 shows visits by persons 65 and over

and persons under 65 according to physician

specialty and type of practice. The two distributions are very similar except for the proportion

of visits to internists. For persons 65 and over, 1
dHlcdda3

Table 2. Number and percent distribution of office visits made by persons 65 years

and over and percent distribution of office visits made by persons under 65 years by

~~sex of visitor, prior visit status, and nature of the problem: United States, 1975

Sex of visitor, p-riorvisit status, and

nature of the problem

All visits----------------------------

Sex of visitor

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

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

Prior visit status

Patient seen for first time-----------------

Patient seen before:

New problem-------------------------------

Old problem-------------------------------

Nature of problem

Morbid condition:

Acute condition:

Initial visit----------------------------

Followup.-------------------------------

Chronic condition:

Routine-------.-------------------------

Flareup-------------------------------.--

Other problem or reason for visit -----------

Office visit

65 years and

over

Number in thousands

93,061

57>339

35,721

7,857

14,889

70,314

19,603

11,254

43,151

14,694

4,358

Percent

distribution

100.O

61.6

38.4

8.4

16.0

75.6

21.1

12.1

46.4

1:.;

.

11OO.O

60.2

39.8

16.2

24.9

58.9

33.7

12.4

21.8

2;:2

lBased on an estimated 474,540,000 visits.

Table 3. Percent of visits to office-based physicians by age of visitor and selected

reasons for visit: United States, 1975

I

Age of visitor

Reason for visit

All ages Under 15 15-24 25-44 45-64 65 years

years years years years and over

Percent

Acute conditions----------------- 43.9 57.7’ 46.3 44.1 39.8

Chronic conditions--------------- 36.4 15.6

33.2

20.6 30.5 49.1 62.2
4

Table 4. Number and percent distribution of office visits made by persons 65 years and

over and percent distribution of office visits made by persons under 65 years by physician specialty and typz of practice: United States, 1975

Physician specialty and type of practice

All visits ----------------------------

Physician specialty

General and family practice -----------------

Internal medicine -------------------------- -

General surgery -----------------------------

Ophthalmology -------------------------------

Cardiovascular diseases ---------------------

Urology-------------------------”------------

Otolaryngology ------------------------------

Dermatology ------.-------------.------------

Orthopedic surgery --------------------------

Obstetrics and gynecology -------------------

Other specialties ---------------------------

Type of practice

solo - - -- - - - - - - ---- - - -- - -- - - - - - - - - - - - - -- -- - --

0ther2-------------------------------- ------

out of every 5 visits in 1975 was made to an

internist compared with about 1 out of 11 for

persons under 65.

Table 5 contains data on seriousness ofproblems and disposition and duration of patient

visits. Seriousness refers to the physician’s clinical judgment as to the extent of the patient’s

impairment that might result if no care were

available. About 29 percent of the visits by persons 65 years and over were reported by the

physician as being serious or very serious compared with 17 percent of the visits by persons

under 65 vears.

Office visit

65 years and

over

Number in thousands

93,061

42

17

7

,343

,925

,335

,429

,177

,175

,231

.173

1;750

1,132

5,388

60,677

32,383

65 years

and over

Under

65 years

Percent

distribution

100 ● o

45.5

19.3

;:;

3.4

N

2.3

R

5.8

65.2

34.8

11OO.O

40.5

9.3

M

0.9

M’

2.5

3.7

1;::

58.8

41.2

lBased on an estimated 474,540,000 visits.

21ncludes partnership and grouP PracticesDisposition refers to &e physician’s disposition of the visit in terms of the seven specific

alternatives listed in item 11 on the patient

record. The only differences between the age

groups 65 and over and under 650ccurred when .

the final disposition was either “retumataspecified time” or “no followup planned.” For the

group 65 and over the final instruction to “return at a specified time” occurred in 7 out of

every 10 visits compared with 6 out of 10 visits

for those under 65. On the other hand, ’’no followup planned” was the final instruction in 6

percent of the visitsby persons 65andover; for
admcdda5

Table 5. Number and percent distribution of office visits made by persons 65 years and

over and percent distribution of office visits made by persons under 65 years by se- .

riousness of the problem and disposition of the patient visit: United States, 1975

Seriousness of the problem and disposition

of the patient visit

All visits ---------------------------

Seriousness of problem

Not serious --------------------------------

Slightly serious -----------.---------------

Serious or very serious --------------------

Disposition of vi.sit2

ReCurn at specified time -------------------

Return if needed ---------------------------

No followup planned ------------------------

Telephone followup planned -----------------

Referred to other physician agency ---------

Admitted to hospital -----------------------

Returned to referring physician ------------

Duration of visit3

No face-to-face encounter with physician ------------------------------ ------

1-5 minutes --------------------------------

6-10 minutes -------------------------------

11-15 minutes ------------------------------

16-30 minutes --..------------- -------- ------

31 minutes or more -------------------------

Office visit

65 years and

over

Number in thousands

93,061

32,560

33,111

27,389

5;615

2,836

2,753

2,510

1,291

11,083

25,078

28,495

22,545

4,568

zzzlzEE

Percent

distribution

100.II

35.0

35.6

29.4

70.1

19.2

::!

3.0

2.7

1.1

1::2

27.0

30.6

24.2

4.9

11OO.O

51.5

31.7

16.8

57.1

22.9

14.5

3.8

$::

0.9

M

32.1

26.0

1;.:

.

‘Based on an estimated 474,540,000 visits.

2Percents will add to more than 100 because some patients required more than one

disposition.

3Time spent in face-to-face encounter between physician and patient.

persons under 65, itwas the final instructionin 65 years of age. Six out of 10 visits by the

15percent of the visits. eIderly lasted 11 minutes or more compared

Duration of visit refers to the time the physi- with 5 out of 10 visits for persons under 65

cian spent in face-to-face contact with the years of age. The mean duration ofvisit for the

patient. For the aged the duration ofvisit was elderly was 16 minutes; for those under 65 the

not much different from that of persons under mean was 15 minutes.
I

6

Table 6. Number and percent of office visits made by persons 65 years and over and

percent of office visits made by persons under 65 years by diagnostic and therapeutic services most frequently ordered or provided: United States, 1975

Diagnostic and therapeutic services most

frequently ordered or provided

Diagnostic services

Limi’ted history, exam -----------------------

Blood pressure check ------------------------

Clinical lab test ---------------------------

General history, exam -----------------------

X-ray ---------------------------------------

EKG-----------------------------------------

Vision test ---------------------------------

Endoscopy -----------------------------------

Hearing test --------------------------------

Therapeutic services

Drug prescribed -----------------------------

Injection -----------------------------------

Medical counseling --------------------------

Office surgery ------------------------------

Immunization, desensitization ---------------

Psychotherapy, therapeutic listening --------

Physiotherapy --------------------------------

1

Based on an estimated 93.061.000 visits.

‘Based on an estimated 4.74,540,000 ViSitS.

Table 6 contains data on the diagnostic and

therapeutic services provided. The distribution

of visits by diagnostic and therapeutic services

for persons 65 years and over was not unlike

that for persons under 65 except fortwoprocedures. Theblood pressure check was rendered to

persons 65 and over in about half the visits compared with athird of the visits forpersons in the

age group under 65. In addition, an EKG was

providedat 7percent of the tisitsbytheelderIy

compared with 3 percent of the visits by persons

under 65.

Data on the diagnosis associated with each

timbulatory visit are shown in table 7 by classes

o f the Eighth Revision in ternationul Classification oj’ Diseases, fldaptcd for Use in the iJnit~’d

Office visit

Number in thousands

51,200

44,812

23.133

11;039

7,007

6,155

5,620

1,765

912

44,289

15,654

11,220

5,833

2,603

2,346

2,285

Z!EzE!E

Percent

55.0

48.2

24.9

11.9

:::

6.0

1.9

1.0

47.6

16.8

12.1

n

2.5

2.5

50.6

30.2

22.5

16.5

;:;

4.4

1.0

1.4

43.7

13.2

12.3

N

4.6

2.2

States (ICDA).3 Although the diagnoses renered to persons 65 years and over covered a

broad spectrurnof conditions, fourof theICDA

classes accounted for more than half (53 percent) of all visits. These are shown in figure 1.

Diseases of the circulatory system accounted for

1 out of every 4 visits by older persons compared with 1 out of every 15 visits for persons

under 65 years.

3Nationa1 Center for Heafth Statistics: Eighth Revi-

~ion International Classification of Diseases, Adapted for

Use in the United States. PHS Pub. No. 1693. Public

Health Sewice. Washington. U.S. Government Printing

office. 1967.
7

Table 7. Number and percent distribution of office visits made by persons 65 years

and over and percent distribution of office visits made by all persons by physician

diagnoses in diagnostic groups: United States, 1975

ICDA group and code for diagnosis

All diagnoses -------------------------

Infective and parasitic diseases-----136-l36

Neoplasms ---------------- -------- ----140-239

Endocrine, nutritional, and metabolic

diseases -------. -------- -------- ----240-279

Diseases of blood and blood forming

organs----------------------~-------28O-289

Mental disorders---------------------29O-3l5

Diseases of nervous system and sense

organs ------------------------------320-389

Diseases of circulatory system-------39O-458

Diseases of respiratory system-------46O-5l9

Diseases of digestive system---------52O-577

Diseases of genitourinary system-----629-629

Diseases of skin and subcutaneous

tissue------------------------------68O-7O9

Diseases of musculoskeletal system

and connective tissue ---------------710-738

Symptoms and ill-defined conditions--78O-796

Accidents, poisoning, and violence---8O99999

Special conditions and examinations

without illness ---------------------YOU-Y13

D~n~ia~: given as “none” or diagnosis

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

All other categories~ -----------------------

Office visit

65 years and

over

Number in thousands

93,061

1,909

3,862

5,895

1,809

2,353

8,709

24,134

7,776

4,463

5,074

3,346

8,647

3,457

4,191

6,399

879

*15 7

E

Percent

distribution

100.0

2.1

4.2

6.3

;:;

2%:

:::

5.5

3.6

H

4.5

6.9

0.9

0.2

2100:0

4.4

2.0

3.9

0.6

4.8

M

1.5.3

3.3

6.9

5.3

M

7.7

19.9

1.1

0.7

lDiagnostic groupings and codes are based on the Eighth Revision International Classification of”Diseases Adapted for Use in the United States.

~d 474,540,000 visits.

3Blank diagnosis; noncodable diagnosis; illegible diagnosis.

4280-289, Diseases of the blood and blood-forming organs; 630-678, Complications of

pregnancy, childbirth,and the puerperium; 740-759, Congenital anomalies; 760-779, Certain causes of perinatal morbidity and mortality.
8

igure 1. DIAGNOSES ACCOUNTING FOR 53 PERCENT OF VISITS

TO OFFICE-BASED PHYSICIANS BY PERSONS 65 AND OVER:

UNITED STATES, 1975

30

[

201--

g

z.%

10

0bD!$eases of

nervous system

and $en= organsD:’

Diseases of

crc.latory

system

o

~,

DI$easesof

respmatorv

system

-n.,

Dkedses of

muwuloskeleial

sysrem

Table 8 contains more specific information

on diagnoses, listing the 20 most frequent ICDA

three-digit categories of the principal diagnosis

sons 65 years and over. The most frequently

rendered diagnoses are essential benign hypertension, chronic ischemic heart disease, and diabetes mellitus, accounting for 20 percent of all

the diagnoses. These diagnoses accounted for

only 5 percent of the visits by persons under 65.

Table 9 presents data on the most frequent

problems, complaints, or symptoms presented

by persons 65 years and older to office-based

physicians. These data reflect the reasons for 1

seeking care in the patients’ own words. The

most frequent reasons given by older people for

visit ing office-based physicians were lower

extremity problems, surgical aftercare, fatigue,

back problems, and high blo~d pressure.

Together these reasons accounted for 20 percent

of all visits by persons 65 and over compared

with 14 percent of the visits for persons in the

age group under 65.

given by the physician during visits made by perTable 8. Number, percent, and cumulative percent of office visits made by persons 65

years and over by the 20 most frequent ICDA three-digit categories of principal diagnosis: United States, 1975

20 most frequent diagnoses and ICDA codes 1

5.

6.

7.

s.

9.

10.

11.

12.

13.

14.

15.

16.

17.

Essential beni~n hypertension----------------4Ol

Chronic ischemlc heart disease ---------------4l2

Diabetes mellitus ----------------------------250

Medical and surgical aftercare---------------YlO

Osteoarthritis and allied conditions ---------7l3

Symptomatic heart disease --------------------427

Arthritis, unspecified -----------------------7~5

Cataract -------------------------------------374

Medical or special exam ----------------------YOU

Neuroses -------------------------------------300

Glaucoma-------------------------------------375

Other and unspecified anemias----------------285

Emphysema ------------------------------------492

Other eczema and dermatitis------------------692

Synovitis, bursitis, and tenosynovitis-------731

Arteriosclerosis -----------------------------440

Acute upper respiratory infections of

multiple or unspecified site----------------465

Other diseases of eye ------------------------378

Bronchitis, unqualified ----------------------490

Refractive errors ----------------------------370

Number

of visits

in

thousands

7,756

6,988

4,195

3,883

2,811

2,128

1.896

1:424

1;341

1,336

1,127

1,113

1.108

1;091

989

983

952

879

816

774

Percent

of

visits

8.3

::;

4.2

3.0

2.3

2.0

1.5

1.4

1.4

1.2

1.2

1.2

1.2

1.1

1.1

k:

0.9

0.8

Cumulative

percent

20.3

24.!5

27.5

29.8

31.8

33.3

34.7

36.1

37.3

38.5

39.7

40.9

42.0

43.1

44.1

45.0

45.9

46.7

‘Diagnostic categories and code numbers are based on the Eighth Revision International Classification of Diseases, Adapted for Use in the United States.
9

Table 9. Number, percent, and cumulative percent of office visits made by persons 65

years and over by the 20 most frequent patient problems: United States, 1975

20 most frequent patient problems and NAMCS codes*

Progress visits --------------.-----------980,985

Problems of lower extremity------------------4OO

Surgical aftercare---------------------------986

Fatigue --------------------------------------004

Problems of back-----------------------------4l5

High blood.pressure ---------------- -------- --205

Pain in chest -------- -------- -------- -------- 322

Abdominal pain-------------------------------54O

Vertigo --------------------------------------069

Shortness of breath--------------------------3O6

Problems of upper extremity------------------4O5

Vision dysfunction, except blindness---------7Ol

General physical examination-----------------9OO

Visit for medication-------------------------9lO

Eye examination -------- -------- -------- ------ 908

Cough ------- -------------- ------- ------- -----311

Arthritis-rheumatism-------------------------427

Headache ----------------------- ------- ------- --056

Problems of face, neck-----------------------4lO

Diabetes mellitus----------------------------99l

Number of

visits in

thousands

13,482

5,049

3,939

3,875

2,795

2,711

2,653

2,570

2,464

2,453

;,;;;

1:759

1,691

1,586

1,582

1,278

1,257

1,157

1,107

Percent

of

visits

14.5

::;

4.2

3.0

;::

2.8

2.7

2.6

;:;

1.9

1.8

1.7

1.7

1.4

1.4

1.2

1.2

Cumulative

percent

14.5

19.9

24.1

28.3

31.3

34.2

37.1

39.9

42.6

45.2

47.4

49.4

51.3

53.1

54.8

56.5

57.9

;;.;

61:7

lSymptomatic categories and code number inclusions are based on a symptom classification developed for use in NAMCS.

SYMBOLS

Data notavailable—---–—------—--—-—— ---

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

Quantity zero—------–----—---— -------- -

Quantity more than Obutlessthan0.05—— 0.0

Figure does not meet standards of

reliability orprecision–----—--------——–– *
10

TECHNICAL NOTES

SOURCE OF DATA: Data presented in this report were obtained during 1975 through the

Nat ion al Ambulatory Medical Care Survey

(NAMCS). The target population of NAMCS encompasses office visits within the conterminous

United States made by ambulatory patients to

physicians who are principally engaged in office

practice.

SAMPLE DESIGN: The 1975 NAMCS utilized a

multistage probability design that involved samples of primary sampling units (PSU’S), physician practices within PSU’S, and patient visits

within practices. Within the 87 PSU’S composing

the first stage of selection, a sample of approximately 3,500 physicians was selected from master files maintained by the American Medical

Association and the American Osteopathic Association. Sampled physicians, randomly assigned

to 1 of the 52 weeks in the survey year, were

requested to complete Patient Records (brief encounter forms) fo[ a systematic random sample

of office visits taking place within their practice

during the assigned reporting period. (A facsimile of the Patient Record used is shown in a

previous issue of Advance Data From Vital and

Health Statistics, No. 12, October 12, }977.)

Additional data concerning physician practice

characteristics such as primary specialty and

type of practice were obtained cluring an induction interview.

A complete description of the survey’s background and development has been presented in

an earlier publication in Series 2 of Vital and

Health Statistics (No. 61. DHEW Pub. No.

(HRA) 76-1335. Health Resources Administration. Washington. U.S. Government Printing

Office, Apr. 1974). A detailed description of the

1975 NAMCS design and procedures will be

presented in future publications.

SAMPLING ERRORS: Since the estimates for

this report are based on a sample rather than the

entire universe, they are subject to sampling variability. The standard error is primarily a measure

of sampling variability. The relative standard error of an estimate is obtained by dividing the

standard error of the estimate by the estimate

itself and is expressed as a percent of the estimate. Relative standard errors of selected aggreTable 1. Approximate relative standard errors Of estimeted numbers of office visits ——

Estimate Relative standard

in error in

thousands percentage points

—

500 .......................................... 30,1

1,000 ....................................... :!1.4

2,000 ....................................... 1!5.3

5,000 ....................................... 10.0

10,000 ..................................... 7.5

30,000 ...............!. ..................... 5.1

100,000 ................................... 4.0.,

550,000 ................................... 3.5

Example of use of table: An aggregate of 80,000,000 has a

relative standard error of 4.3 percent or a standard error of

3,440,000 (4,3 percent of 80,000,000).

Table 11. Approximate standard errors of percentages for eatimsted numbers of office visits

Base of percentage

(number of visits

in thousands)

1,000.....................

3,000 .....................

5,000 .....................

10,000 ...................

6Q,000” .................

100,000 .................

500,000 .................

Estimated percentage

T

Ior 5or

99 95

2.1 4.6

1.2 2.7

0.9 2.1

0.7 1.5

0.3 0.7

0.2 0.5

0.1 0.2

10or

90

6.3

3.7

2.8

2.0

0.9

0.6

0.3

!0 or

80

8.5

4.9

3.8

2.7

1.2

0.8

0.4T

10or so—“

70

—

9.7 10.6

5.6 6.1

4.3 4.7

3.1 3.3

1.4 1.5

1.0 1.1

0.4 0.5

Example of use of table: An estimate of 30 percent based on

an aggregate of 75,000,000 has a standard error of 1.2 percent.

The relative standard error of 30 percent is 4.0 percent (1.2 percent+30 percent). “

gate statistics are shown in table I. The standard

errors appropriate for the estimated percentages

of office visits are shown in table IL

ROUNDING: Aggregate estimates of office visits

presented in the tables are rounded to the nearest thousand. The rates and percents, however,

were calculated on the basis of original, unrounded figures. Due to rounding of percents,

the sum of percentages may, not equal 100.0 per~’

cent.
ackmeaa 11

DEFINITIONS: An ambulatory patient is an individual presenting himself for personal health

services who is neither bedridden nor currently

admitted to any health care institution on the

premises.

An office is a place that the physician identifies as a location for his ambulatory practice.

Responsibility over time for patient care and

professional services rendered there generally resides with the individual physician rather than

an institution.

A vz”w”tis a direct person~ 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 health services.

Af+wician is a duly licensed doctor of medicine (M.D.) or doctor of osteopathy (D.O.) currently in practice who spends time in caring for

ambulatory patients at an office location. Excluded from NAMCS are physicians who specialize in anesthesiology, pathology, radiology;

physicians who are FederaI1y employed; physicians who treat only institutiomdized patients;

physicians employed fuII time by an institution;

and physicians who spend no time seeing ambulatory patients.
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service I Number 23. March 24,1978

Office Visits to General Surgeons: National

Ambulatory Medical Care Survey, United States, 1975’

In 1975 there were an estimated 41.3 million visits made to office-based physicians specializing in general surgery, resulting in an

average of 20 visits per 100 persons per year.

These and other preliminary data about visits to general surgeons are presented in this brief

report from the 1975 National Ambulatory

Medical Care Survey (NAMCS). NA.MCS is conducted by the Division of Health Resources Utilization Statistics of the National Center for

Health Statistics. The sampling frame for the

survey is a list of licensed physicians in “officebased, patient care” practice compiled from files

that are classified and maintained by the American Medical Association (AMA) and the American Osteopathic Association (AOA). NAMCS

currently excludes physicians practicing in

Alaska and Hawaii as well as physicians specializing in anesthesiology, pathology, or radiology

and all physicians who are FederalIy employed.

A complete description of the background

and survey methodology is available in an earlier

report entitled “National Ambulatory hledical

Care Survey: Background and hlethodology,

United States, 1967 -72.”2

1This report prepared by Raymond O. Gagnon, Division of Health Resources Utilization Statistics.

2 National Center for Health Statistics: Nationaf

Ambulatory Medical Care Survey: Background and

Methodology, United States, 1967-72, by J. B. Tenney

and others. Vital and IIealth Statistics. Series 2-No. 61.

DHEW Pub. No, (HRA) 76-1335. Health Resources

Administration. Washington. U.S. Government Printing

Office, Apr. 1974.

DATA HIGHLIGHTS

The 41.3 million patient visits to generaI surgeons in 1975 represent about 7 percent of the

total 567.6 million visits made by Americans to

all physicians engaged in office-based patient

care. From table 1 the reader can compare visits

to general surgeons with those made to physicians in the other largest specialties.

Table 1. Nunsberand rate of visits per

100 persons per year, by selected specialties: United States, 1975

Number Number of

Physician of visits per

specialty visits in 100 Persons

thousands per year 1

All special ties-- 567,600 273

General and family

practice ---------- 234,661)

Internal medic ine-- 62,117

Obstetrics and

gynecology -------- 48,076

Pediatrics --------- 46,684

GENERAT. SURGERY ---- 41,292

Psychiatry --------- 14,806

113

30

23

22

20

7

IThe base populations used in computing

the rates are national estimates published

by the U.S. Bureau of the Census for the

civil ian non institutionalized population

as of July 1, 1975, in Series p-25 and

P-26 of Current Population Reports.
2 advancedata

01” the 41.3 million paticnl \isils to gcncml

surgeons, 64 percent \\’cre m;~{[c to solo” practitioners and 36 percent were made to surgeons in

other types of practice (table 2). The data in

table 2 also sho~v that 6 of cver}r 10 \’isits to

general surgeons were made by females. The largest proportion of visits (about one-third) \vas

made by persons in the 45-64 year age group.

As shown in tables 2 and 3, patient visits to

surgeons in standard Imctropolitan statistical

areas outnumber those to surgeons in nonmetropolitan areas by almost 3 to 1 (72 to 28 percent,

respectively). As with other specialties, the distribution of visits by location of practice parallels the distribution of physicians (table 3).

Table 4 lists–in order of frequency–the 15

most common patient problems, complaints, or

symptoms encountered by the general surgeon

in his office practice. 3 This information represents the patient’s reason for seeking care as expressed in the patient’s own words. These 15

problems accounted for more than half of the

visits to general surgeons. The primary need of

patients visiting general surgeons in 1975 was

“surgical aftercare,” which accounted for 21 percent of the visits. Surgical aftercare includes cast

and/or suture removal or inspection as well as

other types of care which come under the general heading of postoperative care.

Table 5 distributes office visits to general

surgeons by seriousness of the patient’s problem,

prior visit status, and duration of the visit. Seriousness refers to the physician’s clinical judgment as to the extent of impairment that might

result if care were not available to the patient.

About half the problems presented to general

surgeons were considered “not serious” by the

surgeons, and 18 percent were “very serious” or

“serious. ” Concerning prior visit status, about

84 percent of the visits were made by patients

who had been seen before, and three-fourths of

these. had been seen for the same problem.

Data on duration of visit show that the typical encounter between patient and general surgeon lasted 13 minutes. In this survey duration

means the amount of time the physician spent in

face-to-face contact with the patient. The data

3 Excluded from the table are progress visits for followup care other than surgical aftercare.

Table 2. Number and percent distri”>ztiz?s

of office visits to general sur~sans ‘3:.-

selected variables: United States, L9T5

Selected variable

All visits---

Type of practice

solo---------------

Otherl-------------

T.ocat ion of

nractice

Metrouolit an

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

Nonmetropolit an

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

Sex of patient

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

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

Age of patient

Under 25 years -----

25-44 years --------

45-64 years --------

65 years and

over --------------

Number of

visits in

thouszxds

hl,~gz

26,241

15,051

29,803

11,489

16,394

24,898

8,039

11,863

14,055

7,335

percent

distribution

63.5

36.5

72.2

27.8

39.7

60.3

19.5

28.7

34. [)

17.8

‘Includes partnership and group prac -

tices.

also show that 56 percent of the visits Iasted

under 11 minutes.

In NAMCS diagnoses are coded according 10

the Eighth Revision International Ck.rsificatio n

of Diseases, Adapted for Use in the Lhzited

States4 (ICDA). Table 6 presents data on the

nine most common diagnoses rendered by general surgeons, which accounted for about

one-third of their total visits. The most frequent

diagnoses were “medical and surgical aftercare”

and “essential benign hypertension. ” Together

4 National Center for Health Statistics: Eighth Reui-

~.on Intematioml Classificationof Diseases, Adapted for

Use in the United States. PHS Pub. No. 1693. Public

Health Service. Washington. U..S. Government Printing

Office, 1967.
dumceaa3

Table 3. Number and percent distributions of visits to office-based physicians by location of practice, according to selected specialties: United States, 1975

Selected physician specialty

All physicians------------------

General surgery-----------------------

General and family practice-----------

Internal medicine---------------------

l?ediatrics-----------------------------

Obstetrics and gynecology-------------

Number in

thousands

567,600

41,292

234,660

62,117

46,684

48,076

Location of practice

Metropolitan NonTotal area

metropolitan

area

Percent distribution

==4 100.0 73 27

100.0

100.0

100.0

100.0

100.0

72

58

Table 4. Number, percent, and cumulative percent of office visits to general surgeons,

by the 15 most frequent patient problems, complaints, or symptoms: United States,

1975

15 most frequent patient problems,

complaints, or symptoms,and NAMCS codesl

Surgical aftercare2------------------------986

Problems of lower extremity----------------4OO

Abdominal pain-----------------------------54O

Swelling or mass of skin-------------------ll5

Problems of upper extremity----------------4O5

Lump or mass of breast---------------------680

Wounds of skin-----------------------------ll6

Weight gain--------------------------------OlO

Problems of back---------------------------415

Abdominal swelling-------------------------542

Anus, rectal problems----------------------560

Throat soreness----------------------------520

Fatigue------------------------------------OO4

Pain in chest------------------------------322

High blood pressure------------------------2O5

Number of

visits in

thousands

8,486

2,048

1,895

1,651

1,448

1,094

1.092

’929

837

762

751

660

647

576

538

Pertent

of visits

20.6

R

4.0

3.5

2.7

;::

2.0

1.8

!::

1.6

:::

Cumulative

percent

20.6

25.6

30.2

34.2

37.7

40.4

43.0

45.3

47.3

;;.;

52:5

54.1

55.5

56.8

*Symptomatic groupings and code number inclusions are based on a symptom classification developed for use in NAMCS.

21ncludes:- cast-change or removal; suture removal or inspection.
4

Table 5. Number and percent dlstrtbutions of office visits to general surgeons by seriousness of problem, prior visit status, and duration of visit: United States, 1975

I

Seriousness of problem, prior visit status,

and duration of visit

All visits -----------------------------------

Seriousness of problem

Serious and very serious-’--------------------------

Slightly serious -----------------------------------

Not serious ----------------------------------------

Prior visit status

New patient ----------------------------------------

Return patient:

New problem --------------------------------------

Old problem --------------------------------------

Duration of visit

Less than 6 minutes ---------~-------- --------------

6-10 minutes ------- ---------..--------- -------------

11-15 minutes --------------------------------------

16 minutes or more ---------------------------------

Number of visits

in thousands

41,292

7,442

11,883

21,967

6,538

7,881

26>874

9,034

13,928

10,747

7,583

Percent

distribution

100.0

18.0

28,,8

53<,2

15,,8

19,,1

65.1

21.9

33.7

26.0

18.4

Table 6. Number, percent, and cumulative percent of office visits to general surgeons,

bythe9 most frequent ICDA 3-digit categories

United States, 1975

containing the principal diagnosis:

—

Number of Cumulative

9 most frequent diagnoses and ICDA codesl Percent visits in of visits percent of

thousands visits

I I I

I

;:

2:

5.

6.

;:

9.

—

Medical and surgical aftercare--------------ylo 6,992

J

16.9 16.‘9

Essential benign hypertension---------------4Ol 1,242 3.0 19.‘9

Chronic cystic disease of breast------------6lO 957 2.3 22.2

0besity-------------------------------------277 926 2.2 24.4

Inguinal hernia without mention of

obstruction ------------------------------- -550 874 2.1 26.5

Acute upper respiratory infection-----------465 734 1.8 28.3

Diseases of sebaceous glands----------------7O6 680 1.6 29.9

[7aricose veins of lower extremities---------454 656 1.6 31.5

Synovitis, bursitis, and tenosynovitis------73l 621 1.5 33.0

‘Diagnostic groupings and code number inclusions are based on the Ei~hthRevision International Classification of Diseases, Adapted for Use in the United States.
a&medaa5

these two diagnoses accounted for 8.2 million

patient visits to general surgeons.

In table 7 the k~sits to all physicians and

general surgeons are distributed according to the

major diagnostic categories of the ICDA. For the

categories shown, general surgeons’ practices

were quite similar to the practices of physicians

in general; however, a few differences may be

worthy of mention. The proportions of visits

diagnosed as mental disorders, diseases of the

nervous system, and diseases of the respiratory

system were dightly lower for general surgeons

than for all physicians. On the other hand, the

proportions of visits for neoplasms, diseases of

the digestive system, and accidents, poisonings,

and violence were somewhat higher for general

surgeons than for all physicians.

Table 8 distributes office visits to general

surgeons by diagnostic and therapeutic services

ordered or provided and disposition of the visit.

The provision of a Iimited history and/or exam

was the most frequendy provided service being

rendered at 47 percent of the patient visits. Data

on disposition of visit show that the final advice

or instruction given by the physician in the majority of patient visits (62 percent) was to

“return at a specified time. ”

Table 9 compares general surgeons with all

physicians in terms of three selected diagnostic

and/or therapeutic services provided. It is evident that fewer drugs were prescribed or dispensed by general surgeons than by all physicians and that fewer laboratory tests were

performed. Drugs were provided at 44 percent

Table 7. Number and percent distributions of office visits to all physicians and general surgeons by princiDal diagnosis: United States, 1975

PrinciDal diagnosis classified by ICDA

category and ICDA codel

All diagnoses --------------------------------

All diagnoses --------------------------------

Infective and Parasitic cIiseases------------OOO -l36

NeoDlasms-----------------------------------l4O-239

Endocrine, nutritional, and netabolic

diseases -----------------------------------24O-279

?4ental disorders ----------------------------29O-3l5

Diseases of nervous system and sense

organs --------------- ---------------------- 320-3.39

Diseases of circulatory system-------------- 390-458

Diseases of respiratory system--------------46 O-5l9

Diseases of digestive system----------- .---- 52O-577

Diseases of genltourinary system------------ 58O-629

Diseases of skin and subcutaneous tissue----67097O9

Diseases of musculoskeletal system------ ----7lO-738

S:.’mptomsand ill-defined conditions---- -----78O-796

Accidents, poisonings, and violence---------8OO-999

Special conditions and examinations without

illness -------- ---;------------------ ------YOO-Y13

All other diagnoses ------------ ------ ------------ -

All Physicians General surgeons

1

Number in tho”~sands

567,600 I41,292

Percent distribution

100.0

4.0

2.4

4.3

4.4

7.9

1?:?

2:2

5.0

2::

7.2

17.8

2.5

100.0

2.6

7.6

4.9

*100

23.4

2.4

lDiagnostic groupings and code number inclusions are based on the Eighth Revision

International Classification of Diseases, Adapted for L!se in the LTnited States.

‘The category “all other diagnosesrf

blood-forming

includes 280-289,

organs: 630-678,

Diseases of the blood and

Complications of pre~nancy, childbirth, and the puerperium: 740-759, Congenital anomalies; 760-779, Certain causes of perinatal rm>rbidity

and mortality; blank diagnosis, noncodable diagnosis, illegible dia~n~sis and diagni)sisgiven as “None.” >
6 —

Table 8. Number and percent distributions of office visits to general surgeons by diagnostic and/or, therapeutic services ordered or provided, and disposition of visit:

United States, 1975

Diagnostic andlor therapeutic services ordered

or provided, and disposition of visit

All visits -------------------------------------

Diagnostic and/or therapeutic

services ordered or provided~

None -------------------------------------------------

Limited history andlor exam --------------------------

General history andlor exam --------------------------

Clinical lab test ------------------------------------

Blood pressure check ---------------------------------

EKG--------------------------------------------------

Office surgery ---------------------------------------

Drug prescribed ---------------------------------------

X-ray ------------------------------------------------

Injection --------------------------------------------

Med%cal counselin

7

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

Psychotherapy and or therapeutic listening -----------

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

Disposition of visitl

. No followup planned ----------------------------------

Return at specified time -----------------------------

Return if needed -------------------------------------

Telephone followup planned ---------------------------

Referred to other physician andlor agency ------------

Returned to referring physician ----------------------

Admitted to hospital ---------------------------------

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

Number of

visits in

thousands

41,292

3,120

19,235

4,532

4,853

9,531

862

6,844

11,272

2,993

6,034

4,839

775

5,044

4,320

25,414

7,503

689

1,180

*435

2,;;;

Percent

distribution

100.0

4:::

l:L.O

11.8

23.1

2.1

16.6

27’;3

7.3

14.6

11:7

1;:?

10.5

61.6

18.2

1.7

2.9

>’Cl,1

5.8

2.2

lPercents will add to more than 100 because many patients received more than one

service and some patient visits had more than one disposition.

Table 9. Percent of office visits to all

physicians and general surgeons, by selected diagnostic andlor therapeutic

services: United States, 1975

I I I

Drug

All physicians pre -

clin- ofical fice

and general scribed lab

surgeons

sur -

or dis- test pensed

gery

I

Percent

All physicians---- 44.3 22,9

General surgeons-- 27.3 11.8 1:::

of the visits to all physicians compared with 27

percent of the visits to general surgeons. Lab

tests were ordered at 23 percent of the visitsto

all physicians andat 12 percent of the visits to

surgeons. As expected, general surgeons provided office surgery considerably more often

than did all physicians. Office surgery was provided at 17 percent of the visits to general surgeonsascomparecf with 7pcrcent of the visitsto

all physicians. These latter differences are perhaps reflective of the large proportion of visits

to gcnerfil surgeons (21 percent), where the primary need of the patient was surgical aftercarc

(table -1).
dmcedda7

TECHNICAL NOTES

SOURCE OF DATA: Data presented in this report \vere obtained during 1975 through the

h’a t io n al Ambulatory Medical Care Survey

(NA\lCS). The target population of NAMCS

encompasses office visits \vithin the conterminous United States made by ambulatory patients

to physicians who are principally engaged in

o’ffice practice.

S.4LIPLE DESIGN: The 1975 IYAIICS utilized a

multistage probability design ,fhat involved samples of primary sampling units (PSU’S), physician practices within PSU’S, and patient visits

tvithin practices. Within the S7 PSU’S composing

the first stage of selection, a sample of approximately 3,500 physicians was selected from master files maintained by the American hledical

Association and the American Osteopathic Association. SampIcd physicians, randomly assigned

to 1 Jof the 52 weeks in the survey year, were

requested to complete Patient Records (brief

encounter forms) for a systematic random sample of office visits taking place within their practice during the assigned reporting period. (A

facsimile of the Patient Record used is shown in

a prev]ous issue of ..1ch.mnce Data From l~ital and

Health Statistics, No. 12, October 12, 1977.)

Additional data concerning physician practice

characteristics such as primq specialty and

type of practice were obtained during an induction intervie~v.

A complete description of the survey’s background and development has been presented in

an earlier publication in Series 2 of Vital and

Hralth Statistics (No. 61. DH13M7 Pub. No.

(HRA) 76-1335. Health Resources Administration, \Vashington. U.S. Government Printing Office, Apr. 1974). A detailed description of the

1975 NAiilCS design and procedures wiII be

presented in future publications.

SAhiPLING ERRORS: Since the estimates for

this report are based on a sample rather than the

entire universe, they are subject to sampling variability. The standard error is primarily a measure

of samplins variability. The relative standard error of an estimate is obtained by dividing the

standard error of the estimate by the estimate

itself anti is expressc’d as a pcrccnt of the estimate. Relative standarc[ errors of sciccted aggresotc statistics are shown in table I. The standard

Table 1. Approximate relative standard errors of estimated

numbers of office visits

I

Estimate Relative standard

in error in

thousands percentage points

500 .......................................... 30.1

1,000 ....................................... 21.4

2,000 ....................................... 15.3

5,000 ....................................... 10.0

10,000 ..................................... 7.5

30,000 ..................................... 5.1

100,000 ................................... 4.0

550,000 ................................... 3.5

Example of use of table: An aggregate of 80,000,000 has a

relative standard error of 4.3 percent or a standard error of

3,440,000 (4.3 percent of 80,000,000).

Table II. Approximate standard errors of percentages for

estimated numbers of office visits

1

-FBase of percentage

(number of visits

in thousends) 1 or

99

1,000 .....................

3,000 .....................

5,000 .....................

70,000. ..................

50,000 ...................

100,000 .................

500,000 .................

2.1

1.2

0.9

0.7

0.3

0.2

0.1

Estimated percentage

5 or

95

.

4.6

2.7

2.1

1.5

0.7

0.5

0.2

—

lOor

90

6.3

3.7

2.8

2.0

0.9

0.6

0.3

mate

?0 or

80

8.5

4.9

3.8

2.7

1.2

0.8

0.4

T

30 or 50

70

9.7 10.6

5.6 6.1

4.3 4.7

3.1 3.3

1.4 1.5

1.0 1.1

0.4 0.5

Example of use of table: An es 30 percent based on

an aggregate of 75,000,000 has a standard error of 1.2 percent.

The relative standard error of 30 percent is 4.0 percent (1.2 percent +30 percent).

errors appropriate for the estimated percentages

of office visits are sho~vn in table II.

ROUNDING: Aggregate estimates of office visits

presented in the tabIes are rounded to the nearest thousand. The rates and percents, however,

were calculated on the basis of originaI, unrounded figures. Due to rounding of percents,

the sum of percentages may not equal 100.0 percent.

DEFINITIONS: An am bulato~ patient is an individual presenting himself for personal health

services who is neither bedridden nor currently

admitted to any health care institution on the

premises.
8

An o~fice is a place that the physician identi- physicians who are Federally employed; physifies as a location for his ambulatory practice. cians who treat only institutionalized patients;

Responsibility over time for patient care and physicians employed full time by an institution;

professional services rendered there generally re- and physicians who spend no time seeing ambu-

~ides with the individual physician rather than

an institution.

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 health services.

A physician is a duly licensed doctor of medicine (M. D.) or doctor of osteopathy (D. O.) currently in practice who spends time in caring for

ambulatory patients, at an office location. Excluded from NAMCS are physicians who specializ e in anesthesiology, pathology, radiology;

latorj patients.

I

SYMBOLS

Data not available--—-----–--------——-- ---

Category not applicable----------–-–--—- . . .

Quantity zero–-–--------------——- -

Quantity more than Obut less than 0.05— 0.0

Figure does not meet standards of

reliability or precision---------—-——— *
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER,FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service I Nurilbar ,4 @ March 24, f~i%

Utilization of Selected Medical Practitioners:

United States, 1974’

Some ambulatory medical care is provided

each year by a wide variety of nonphysician

health care personnel, referred to in this report

as “me di cal practitioners. “z ~3 This report

presents estimates from the 1974 Health Interview Survey on the number and percent of the

U.S. civiIian noninstitutionalized population

who consulted a chiropractor, a podiatrist/

chiropodist, or physicial therapist during a

12-month reference period. Further details on

the survey design are given in the TechnicaI

Notes.

Data on the use of chiropractors and podiatrists were collected previously in the Health Interview Interview Survey during 1963-64. (See

footnote 2.) It should be noted, however, that

the data from these two surveys are not strictly

comparable. Different questions were used in

each survey period. Moreover, the 1963-64 questions were asked on a household basis for each

household member, and proxy responses as well

as self-responses were accepted. The 1974 items

were asked on a self-respondent basis. In addition, the 1963-64 questions were asked as part “

of a special supplement on medical specialists

and practitioners. The 1974 items were asked as

part of a special supplement on sources of and

barriers to medicaI care.

According to responses to a special question

in the 1974 Health Interview Survey on medical

practitioners, an estimated 3.6 percent of the

population (7.5 million persons) used the services of a chiropractor; 2.4 percent (5.0 miIlion

persons) consulted a podiatrist or a chiropodist;

and 1.6 percent (3.2 million persons) used the

services of a physical therapist. (See chart on

page 2.) Contact with each of these practitioners

was, with some exceptions, proportionately

more prevalent among older and white persons

than it was among younger persons and persons

in all other color groups. A more detailed discussion on the. use of these medicaI practitioners

among various groupings of the population is

given.

1This report prepared by Lonnie Jean Howie, Division of Health Interview Statistics.

2Nationa1 Center for Health Statistics: Characteristics

of patients of selected types of medical specialists and

practitioners, United States, July 1963-June 1964. Vital

and Health Statkh”cs. PHS Pub. No. 1000-Senes 10-No.

28. Public Health Service. Washington. U.S. Government

Printing Office, May 1966.

3 Schach, E., Kalimo, E., and Crawford, J.: Use of

selected nonphysician health care personnel services, in

R. Kohn and K. L. White, eds., Health Care: An

International Study. New York. Oxford University Press,

1976. ~p, 329-350.

USE OF CHIROPRACTORS

An estimated 3.6 percent of the population

consulted a chiropractor at least once during the

12 months preceding the interview (table 1).

There was some variation in the use of chiropractors among the various categories of the

population, ranging from 0.7 percent for children under 6 years of age to 6.6 percent for

farm residents.

Among persons under 65 years of age, the

likelihood of consulting a chiropractor was
2

greater for each older age group. During the survey year 0.7 percent of children under 6 years of

age and 6.2 percent of adults aged 45 to 64

years consulted a chiropractor. However, the utilization rate drops to 3.9 percent for persons 65

years of age and over.

Use of chiropractors was greater among

white persons (4.0 percent) than among persons

in all other color groups (1.0 percent). Proportionately, for families with an annual income of

less than $15,000, there was a tendency for utilization to increase as family income increased.

The rate decreased to 3.5 percefit for families

with higher incomes, which is similar to the proportion for all persons. Contact with a chiropractor was also greater among persons living in

the West (5.0 percent) and North Central Regions (4.2 percent) than among persons living in

the other geographic regions. Contact with a chiropractor was more prevalent among persons residing outside standard metropolitan statistical

areas (5.1 percent) than among persons living

within such areas (3.0 percent). Within standard

metropolitan statistical areas (SMSA’S), central

city dwellers consulted a chiropractor less often

(2.4 percent) than did SMSA residents outside

the central city (3.4 percent). Outside SMSA’S

the percent of persons who received scn’ict’s

from a chiropractor clunng the sLlrvey year \I”as

higher among residents in farm areas (6.6 percent) than among residents in nonfarm areas

(4.9 percent).

Differences also occurred among usual activity status groupings, with proportionately more

persons who were working, keeping house, or

retired than persons in the other activity ‘status

groupings seeing a chiropractor (table 1).

Whereas the overall estimate of percents for

males is slightly higher than that for females, the

differences can be accounted for by sampling

variability, as is the case with the differences by

sex for the selected sociodemographic variables.

USE OF PODIATRISTS

An estimated 2.4 percent of the population

saw a podiatrist at least once during the 12

months preceding the interview (table 2). As few

as 0.8 percent of persons living in farm areas

outside of SMSA’S and as many as 7.0 percent of

persons 65 years and over consulted a podiatrist

during the 12-month reference period. Proportionately more white persons (2.5 percent) saw a

podiatrist than did persons in all other color

grou~)s ( 1.7 percent).

The LLSCr~f pociiatrists also varied sc}mcwhat

‘11110[1,< :l:<C> Sex, famil>’ income, llsua.1 activity
admmdaa3

Tablel. Number and percent of persons who received services from a chiropractor during

the year preceding time of interview, by sex and selected characteristics:

States, 1974

United

Characteristic

All personal-------------------

Age

Under 6 years------------------------

6-16 years---------------------------

17-24 years--------------------------

25-44 years--------------------------

45-64 years--------------------------

65 years and over--------------------

Color

White--------------------------------

All other----------------------------

Family income

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

$2,000-$3,999------------------------

$4,000-$6,999------------------------

$7,000-$9,999------------------------

$10,000-$14,999----------------------

$15,000 or more----------------------

Usual activity statusz

Going to school----------------------

Working------------------------------

Keeping house------------------------

Retired------------------------------

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

Geographic region

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

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

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

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

Place of residence

SMSA---------------------------------

Central city-----------------------

Outside central city---------------

Outside SMSA-------------------------

Nonfarm----------------------------

Farm-------------------------------

Both I

Male

sexes

Female

Number of persons who

received service in

thousands

7,527

130

533

966

2,345

2,650

812

7,252

275

208

506

1,064

1,086

2,115

2,229

837

4,058

1,856

497

148

1,645

2,353

1,657

1,871.

4,266

1,531

2,735

3,260

2,760

ql)n

3,811

3%

478

1,229

1,326

374

3,680

132

1:;

504

494

1,111

1,303

486

2>669

...

482

105

837

1,156

818

1,001

2,189

794

I,394

1,623

1,340

~8~

3,715

1$;

488

1,206

1,325

438

3,;:;

156

314

559

592

1,005

927

352

1,389

1,856

H

808

1,198

839

870

2,078

737

1,341

;*:;:

’218

Both

sexes IIMale I

Female

II I

Percent of persons

who received service

3.6

0.7

::;

4.8

6.2

3.9

:.;

.

2.8

3.1

3.7

:::

3.5

;::

4.7

5.3

2.8

::;

2.5

5.0

3.0

2.4

H

4.9

6.6

3.8

0.7

H

H

4.4

4.2

1.1

2.0

3.0

3.7

::;

4.1

H

...

5.6

3.3

;::

5:5

;:;

H

4.8

7.2

3.5

0.6

0.9

;::

3:6

3.8

1.0

3.3

3.2

3.6

;::

3.0

1.3

::;

2.0

2.1

::;

::2

::!

:::

4.9

6.0

‘Includes unknobm income.

‘Excludes children under 6 years of a):e.
4

Table 2. Number and percent of persons who received services from a podiatrist during

the year preceding time of interview, by sex

States, 1974

and selected characteristics: United

Characteristic

Under 6 years ------------------------

6-16 years ---------------------------

17-24 years --------------------------

25-44 years --------------------------

45-64 years --------------------------

65 years and over --------------------

Color

White --------------------------------

All other ----------------------------

Family income

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

$2,000-$3,999------------------------

$4,000-$6,999------------------------

$7,000-$9,999--------------’----------

$10,000-$14,999----------------------

$15,000 or more ----------------------

Usual activity status2

Going to school ----------------------

Working ------------------------------

Keeping house ------------------------

Retired ------------------------------

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

Geographic region

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

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

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

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

Place of residence

SMSA ---------------------------------

Central city -----------------------

Outside central city ---------------

Outside SMSA -------------------------

Nonfarm ----------------------------

Farm -------------------------------

Both Male Female

sexes

II I

Number of persons who

received service in

thousands

4,978

239

339

330

801

1,747

1,460

4,526

452

205

468

728

551

988

1,688

489

1,902

1,747

425

176

1,932

1,429

863

754

3,988

1,96C

2,029

99C

931

55

1,629

127

208

153

304

463

373

1,460

170

44

2::

207

401

578

241

854

...

335

71

559

528

317

225

1,230

590

640

399

377

22

3,349

112

191

177

498

1,285

1,087

3,066

283

160

387

474

344

587

1,110

248

1,048

1,747

1%

1,373

;;;

529

2,758

1,370

1,388

591

554

37

Both I Male

,exes

Female

~.

Percent of persons

who received service

2.4

1.2

0.9

1.1

:::

7.0

2.5

1.7

2,8

2.9

2.5

2.0

::?

0.9

:::

4.5

3.4

3.9

2.6

;::

2.8

;.;

1:5

:::

1.6

1.3

1.0

1,1

H

4.3

1.7

1.4

1.7

1.3

1.9

1.6

1.5

1.8

0.9

1.7

...

3.9

2.2

2.4

2.0

1.0

1.2

1.8

2,0

1.6

1.3

;::

3.1

.—

1.2

0.9

;::

::;

3.3

2.0

3.4

3.9

3.1

2.5

2.3

3.6

().9

3.6

4.4

12.0

5.2

5.3

3.2

1..6

2.8

::;

1:8

1.9

1,0

‘Incl~ldesunknown income.

2Exclules chtldren under 6 years of age,
admcdda5

status, place of residence, and geographic region

groups. Proportionately more females (3.1 percent) saw a podiatrist than did males (1.6 percent), The likelihood of consulting a podiatrist is

greater among older persons. During the survey

year 1.2 percent of children under 6 years of age

and 7.0 percent of adults 65 years of age and

over consulted a podiatrist. Among persons with

family incomes of less than $15,000, there was a

slight inverse relationship between income and

the use of podiatrists. The usual activity categories that had the greatest percent of persons

consulting a podiatrist were persons keeping

house and retired persons. Contact with a podiatrist was proportionately less frequent among

persons living in the South (1.3 percent) and in

the West Regions (2.0 percent) than among persons living in the other two regions. Proportionately more persons residing within SMSA’S (2.8

percent) consulted a podiatrist than did persons

residing outside SMSA’S (1.5 percent). Within

SMSA’S, central city residents consulted a podiatrist more often (3. 1 percent) than did residents

outside the central city (2.5 percent). Outside

SMSA’S, the percent of persons who received

services from a podiatrist was higher among nonfarm dwellers (1.6 percent) than it was among

farm dwelIers (0.8 percent).

While there were some exceptions among the

sociodemographic groups, these differences in

the use of podiatrists also occurred for each sex

considered separately. Among females, however,

the differences were usually more pronounced.

For instance, among the age groups the range for

females was from 0.9 percent to 8.9 percent,

while for males a much smaller range was found,

from 1.0 percent to 4.3 percent.

USE OF PHYSICAL THERAPISTS

An estimated 1.6 percent of the population

saw a physical therapist at least once during the

12 months preceding the interview (table 3).

There was less variation in the utilization rates

of physical therapists among categories of the

population compared with the use of chiropractors and podiatrists. The range was from 0.4 percent for children under 6 years of age to 3.2

percent for retired persons.

The differences for sex, color, and place of

residence groups with respect to the utilization

of physical therapists were within the range associated with the sample variation of the estimates. However, substantial differences in the

use of physical therapists occurred among age,

family income, usual activity status, and geographic region groups. The likelihood of contacting a physical therapist tended to increase with

age. During the survey year 0.4 percent of children under 6 years of age and 2.3 percent of

adults 45-64 years of age consulted a physical

therapist. The slight difference between the percents shown for persons 65 years of age and over

and for persons 45-64 years is within the sampling variability of the two estimates. Persons with

family incomes of Iess than $4,000 and persons

in the income range of $7,000 to $9,999 consulted a physical therapist proportionately more

often than did persons in other family income

groups. Proportionately more persons keeping

house and retired persons consuhed a physical

therapist; however, the “other” usual activity

group also had a relatively large percent (5.8) of

persons who consuIted a physical therapist

(table 3). Contact with a physical therapist was

more likely among persons living in the \\Test

(1.9 percent) and North Central Regions ( 1.7

percent) than among persons in the other two

geographic regions.

The data for males and females sho~t-n in

table 3 indicate only one notable difference between the sexes in the use of physical therapists;

retired females (7.8 percent) consuIted a physical therapist proportionately more often than

did retired males (2.8 percent).
6

Table 3. Number and percent of persons who received services from a physical therapist

during the year preceding time of interview, by sex

United States, 1974

and selected characteristics:

‘~~

Characteristic

All personal -------------------

Under 6 years -------------------------

6-16 years ---------------------------

17-24 years --------------------------

25-44 years --------------------------

45-64 years --------------------------

65 years and over --------------------

Color

White --------------------------------

All other ----------------------------

&

Family income

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

$2,000-$3,999------------------------

$4,000-$6,999------------------------

$7,000-$9,999------------------------

$10,000-$14,999----------------------

$15,000 or more ----------------------

Usual activity statusz

Going to school ----------------------

Working ------------------------------

Keeping house -------------------------

Retired ------------------------------

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

Geographic region

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

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

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

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

Place of residence

SMSA ---------------------------------

Central city -----------------------

Outside central city ---------------

Outside SMSA -------------------------

Nonfarm ----------------------------

Fa~-------------------------------

Both IIMale !exes Female

II I

[umber of persons who

received service in

thousands

3,242

2;:

383

1,034

984

460

2,869

372

145

377

464

501

680

889

417

1,325

811

298

305

701

954

870

715

2,268

1,029

1,239

973

891

83

1,581

1:?

213

567

419

149

1,384,

197

45

143

274

217

382

458

246

861

.,.

239

182

342

457

434

348

1,048

470

578

533

&76

57

—.

1,660

1;;

171

467

565

311

1,485

175

100

234

190

285

297

430

171

465

811

12;

359

498

436

367

1,220

559

661

440

415

26

Both Male Female ;exes

Percent of persons

who received service

1.6

0.4

0.7

;::

2.3

2.2

1.6

1.4

2.0

2,3

1.6

1.9

1.3

1.4

0.8

:::

3.2

5.8

1.4

1.7

1.3

1.9

1.6

1.6

1.5

1,5

1.6

1.1

1.6

0.5

0.8

;::

2.1

1.7

1.6

1.6

;:;

2.0

1.6

:::

0.9

1.7

i:i

5.7

1.5

H

1.9

1.5

1.6

1.5

1.7

1,7

1.5

1.5

0.4

0,,5

1<,1

::!?

2.6

1.6

1.2

2.1

2.4

1.2

2.1

;::

0.6

1.6

2.0

7.8

6,13

1.4

1,7

1.3

1.9

1.6

1.7

1.6

l.?,

::;

lIncl~des unknown income.

2Excludes children under 6 years of age.
ackmeMa7

TECHNICAL NOTES

The data presented in this report were obtained from household interviews in the Health

Inten’iew Survey. These interviews were conducted throughout 1974 in a probability sample

of the civilian noninstitutionalized population of

the United States. During that year approximately 116,000 persons living in about 40,000

households were included in the sample. The

questions on utilization of medical practitioners

were asked of each household member who was

identified as a “sample person. ” This sub sample

included approximately 37,062 persons.

For a detailed discussion of the limitations

and qualifications of data collected in the Health

Interview Survey, see an earlier report entitled

“Current Estimates from the Health Interview

Survey, United States, 1974,” Vital and Health

Statistics, Series 10, No. 100, DHEW Publication

No. (HRA) 76-1527.

The sampling pattern for sample person selection was based on the totzd number of related

and unrelated household members. Sample persons (a one-third subsample of the actual Health

Interview Survey sample) were selected by the

interviewer at the time of interview. To determine which household member(s) to designate

as a sample person, the interviewer referred to a

preselected flashcard after listing all related and

unrelated persons in the household on the questionnaire. The flashcard contained, for each

household size, one or more person numbers

that were to be identified as the sample person(s).

Since the estimates shown are based on a

sample of the population rather than on the entire population, they are subject to sampling

error. Standard errors appropriate for the estimates of the number of persons are shown in

table I; standard errors appropriate for percentages are shown in table II.

In this report, terms such as “similar” and

“the same” mean that no statisticzil significance

exists between the statistics being compared.

Terms relating to differences (i.e., “greater,”

Table 1. Standard errors of estimates of aggregates

Size of estimata Standard error

in thousends in thousends

70 .................... ......................... 21

100 ............................................ 25

300 ............................................ 43

500 .......................... .................. 55

700 ............................................ 65

1,000......................................... 78

5,00fJ ......................................... 173

10,000....................................... 243

20,000 ....................................... 337

30,000 ....................................... 405

50,000 ....................................... 501

100,000..................................... 626

Table 11. Standard errors, expressed in percentage points, of

estimated percentages

Estimatad percentega

Base of percentage

in thousands

70 ..........................................

100 ........................................

mo ........................................

........................................

1,000 .....................................

5,000 .....................................

10,000...................................

20,000 ...................................

30,000 ...................................

50,000 ...................................

100,000 .................................

.02

:8

4.1

3.5

2.0

1.5

1.3

1.1

0.5

0.3

0.2

0.2

0.2

0.1

.05 10

;5 :

6.4 8.9

5.4 7.4

3.1 4.3

2.4 3.3

2.0 2.8

1.7 2.3

0.8 1.0

0.5 0.7

0.4 0.5

0.3 0.4

0.2 0.3

0.2 0.2

11.8

9.9

5.7

4.4

3.7

3.1

1.4

1.0

0.7

0.6

0.4

0.3

50

14.8

12.4

7.1

5.5

4.7

3.8

1.7

1.2

0.9

0.7

0.6

0.4

“less,” etc.) indicate that differences are statistically significant. The t test with a critical value

of 1.96 (0.05 level of significance) was used to

test alI comparisons which 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.
8

SYMBOLS

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

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

Quantity zero-–-----------–-— - -

Quantity more than Obutlessthan 0.05-- 0.0

Figure does not meet standards of

reliability or precision--—-——------- *.,
FROM VITAL”& HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, EDIJCATION, AND WELFARE ■ Public Health Service I Number 25 = March 22,1978

Office Visits to Doctors of Osteopathy: National

Ambulatory Medical Care Survey, United States, 1975’

Using data from the National Ambulatory

Medical Care Survey (NAMCS), this report

describes an estimated 46.9 million visits made

by ambulatory patients to the offices of osteopathic physicians in 1975.

The NAMCS is a sample survey designed to

explore the provision and utilization of ambulatory medical care in the offices of physicians

practicing within the conterminous United States.

It is conducted yearly by the National Center

for Health Statistics. The survey sample is

selected from doctors of medicine and osteopathy (M.D.’s and D. O.’s) who are primarily

engaged in office-based, patient-care practice. It

excludes physicians whose specialties are anesthesiology, pathology, and radiology and all

physicians in Federal service. The 1975 sample

consisted of 3,507 physicians, of whom 141

were doctors of osteopathy. For the week of

their participation in the NAhICS, physicians

collected information on a sample of their office

visits. Participants averaged about 30 visit reports per physician. Response rate was about 80

percent among eligible doctors of osteopathy.

FINDINGS

When reference is made to an “overall” average or experience, it will refer to the characteristics of the 567.6 million visits made in 1975 to

all physicians (M.D.’s and D.O.’s) within the

1This report prepared by Hugo Koch, Division of

Health I?,,wurces Utilization Statistics.

NAMCS scope. Overall estimates for 1975 are

available in an earlier report. z

Table 1 describes office visits to osteopathic

physicians in terms of age, sex, and prior visit

2National Center for Health Statistics: Ambulatory

medlcaJ care rendered in physicians’ offices, United

States, 1975, by Hugo K. Koch and Norma Jean

Dennison. Advance Data Frons Vital and Health Statistics, No. 12. DHEW Pub. No. (HRA) 77-1250. Health

Resources Administration. HyattsviIIe, Md. Oct. 12,

1977.

Table 1. Nurrixr and percent distributions of office visits to

osteopathic physicians by age, sex, and prior visit status of

patient: United States, January-December 1975

Age, sex, and prior visit

status of patient

All visits .................... ......... ........

&&

Under 15 years ............ .....................

15-24 years ......................................

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

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

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

—Sex

Female . ...... ........................................

Male ......... .........................................

Prior visit status

New patient ................................. .....

Old patient, new problem ..................

Old patient, old problem ..................

Number

of visits

in

thou -

sands

46,872

5,246

6,621

11,465

14,795

8,745

27,551

19,322

5,535

11,251

30,087

Percent

distribution

100.0

11.2

14.1

24.5

31.6

18.7

58.8

41.2

11.8

24.0

64.2
2

status of patients. Total visits 1>~ fem<tlcs (Jutnumberecf visits by males in a ratio of’ 6 I() 4, ;I

finding that agrees closely with the o~cr.ill ratio.

~Tnderscoringthe generalistnatureof”their office

practice, D.O.’S treated patients of all agcs. .-411

estimated 51 percent of visits, ho~ve~er, were

made by patients over 44 years of age. In overall

office-based practice, about 42 percent of \’isits

fell in this age category. The data on p~ior visit

status show that few patients were visiting the

osteopathic physician for the first time; about

88 percent of visits were made by patients who

had visited the office before. Not only did the

D.O.’S office practice chiefly involve encounters

with continuing patients, the largest proportion

of visits (almost two-thirds) required the treatment of continuing problems as well. New problems were encountered in about 1 of every 3

visits. For the average new problem presented to

the D. O., there were roughly 1.8 return visits in

the course of the year.

Table 2 lists by rank the 15 most common

patient problems, complaints, or symptoms that

the osteopathic physician encountered in office

practice. Symptoms and code numbers appear in

a symptom classification developed for use in

X.nlcs.; ~’his inform~lion ~cplTSellt5 the reason for w~’king care expressed .]s nearl:” :1s p[J:-

sible in the patient’s otrn ~t.ordj. The cfat.1 oftc!”

distinct e~icicnce of the functions] speci.dizdtion

assi~ciatrd rvith osteopathic medicine. For

example, in a substantial 17 percent of c)ffice

visits, patients presented problems of the face or

neck, the back, or the ex~remitics. Back problems clearl>” exceeded all other patient cr~nlplaints. The data also testif~” to the generalist

nature of osteopathic office practice in that

D.O.’S shared 11 of the 15 most common problems encountered in the overall 567.6 million

visits. Further supportive of their generalist role

is a marked diffuseness of clinicaJ range. evident

from the finding that, though a substantial 15

most common problems are listed, they still

account for only about one-half of all the D.O.’S

3National Center for Health Statistics: The national

ambulato~ medical care survey: symptom classification,

United States, by Sue Meads and Thomas McLemore.

Vital and Health Statistics. Series 2-No. 63. DHEW Pub.

No. (HRA) 74-1337. Health Resources Administration.

Washington. U.S. Government Printing Office, May

1974.

Table 2. Number, percent, and cumulative percent of office visits to osteopathic physicians, by the 15 most common patient problems,

complaints, or symptoms: United States, January-December 1975

[Symptom titles and code numbers come from a symptom classification developed for use in the NAMCS]

15 most common patient problems,

Ran k

complaints, or symptoms

t

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

Pain, swelling, injury of back region .................... ......................-.41 5

Physical examination .......................................... .................9oo.9ol

Fatigue ................... ......... ................................................... ........ 004

Flu ................................................................................... ........... 313

Pain, swelling, injury of lower extremity ........... ..................... ... 400

Weight gain ........................................................ ..... ......... ............O10

Pain, swelling, injury of upper extremity ........ ........................... 405

Sore throat ............... ............ ............... ................ ... ................... 520

Headache ..... ..... ................... ...... .................. ........................ .......O56

Pain, swelling, injury of face and neck region ............................ 41O

Abdominal pain ....................................... ..................................

Visit for medication ................................................. ........ .... .......E.

Cough ............................. .......................................................... .. 311

Allergic skin reaction ......................................... ... ... ................. .. 112

Wounds of skin ..... ............................................ ...........................116

Number of

visits in

thousands

3,919

2,080

1,775

1,680

1,599

1,442

1,422

1,383

1,221

1,175

1,153

1,170

1,140

1,044

911

Percent

of

visits

8.4

4.4

3.8

3.6

3.4

3.1

3.0

3.0

2.6

2.5

2.5

2.5

2.4

2.2

. 1.9

Cumulative

percent

of visits

8.4

12.8

16.6

20.2

23.6

26.7

28.7

32.7

35.3

37.8

40.3

42.8

45.2

47.4.

49.3
3

Table 3. Number and percent distribution of office visits to osteopathic physicians by principal diagnosis classified by major ICDA

groups: United States, January-December 1975

[ Diagnostic groups and code number inclusions are based on the Eighrh Revision International C&zssification of Diseases, Adapted for

Use in the United States]

Principal diagnosis classified by

major ICDA groups

All principal diagnoses . .................................. .... ......................................

Infective and parasitic diseases . .............................. ................................... OOO.l36

Endocrine, nutritional, and metabolic diseases ....... ...................................24O-279

Diseases of the blood and blood-forming organs .........................................28 O.289

Mental disorders ........................................................ ............ .....................29 O.3l5

Diseases of the nervous system and sense organs ........................................320-389

Diseases of the circulatory system ............................................................ 390-458

Diseases of the respiratory system ......... ...... ............ .. ............ .. .............. ...460-519

Diseases of the digestive system ............. ....................................................52O.577

Diseases of the genitourinary system ..........................................................58 O.629

Diseases of the skin and subcutaneous tissue ........................................... .. 680-709

Diseases of the musculoskeletal system and connective tissue ....................71 O-738

Symptoms and illdefined conditions .. ............ ............ ...... .........................78 O.796

Accidents, poisonings, and violence .. .............. ...........................................8OO.999

Special conditions and examinations without sickness ...............................YOO-Yl 3

Residual ...................................................................... .............. ..............................

46,872 !100.0

1,404

3,830

820

1,529

2,057

4,955

8,238

1,418

3,122

1,861

5,432

1,147

4,840

5,103

1,116

3.0

8.2

1.8

3.3

4.4

10.6

17.6

3.0

6.7

4.0

11.6

2.5

10.3

10.9

2.1

office visits. Problems presented to office-based Tables 3 and 4 present data on the diagnosis

D.O.’S were about equally divided between the associated with each office visit to an osteoacute and the chronic, i.e., persisting probIems pathic physician. Table 3 uses broad diagnostic

u-ith an onset of 3 months or more before the classes to express the D.O.’S total diagnostic

current visit. Overall visit experience showed a effort. Table 4 offers more specific diagnostic

dominance of acute problems (in 55 percent of information by listing the 15 dia~noses most

visits) over chronic (in 45 percent). commonly rendered by the physician. Diagnosable 4. Number, percent, and cumulative percent of office visits to osteopathic physicians, by the 15 most common principal diagnoses

rendered: United States, January-December 1975

[ Diagnoses and codes me based on the Eighth Revision International Classification of Diseases, Adapted for Use in the United States]

Rank

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

15 most common principal diagnoses

Essential benign hypertension ........... ...... ................................... .......4Ol

Influenza, unqualified ..................................................................... 470

Medical or special examination ...................... ............ ............... .......YOO

Arthritis ....... .............. ........ .. .....................................................7l3.7l5

Obesity not specified as of endocrine origin .................................... 277

Acute upper respiratory injection, multiple and unspecified sites ....465

Other nonarticular rheumatism .................. ................ .................... 717

Medical and surgical aftercare ...... ..... ................................................Yl O

Sprains and strains of sacroiliac region .............................................846

Diabetes mellitus ..............................................................................25O

Other eczema and dermatitis .................. ........ ................... ...............692

Neuroses ............. ...... ......... ....... .................... ...... ................ ........... ..3oo

Sprains and strains of other and unspecified parts of back ................847

Prophylactic inoculation and vaccination .................... ....................Y02

Cystitis ........................................................ ............. .......................595

Number of

wwts in

thousands

2,642

2,381

2,163

1;993

1,857

1,630

1,356

1,297

1,162

1,151

1,048

973

946

836

749

Percent

of

visits

5.6

5.1

4.6

4.3

4.0

3.5

2.9

2.8

2,5

2.5

2.2

2.1

2.0

1.8

1.6

Cumulative

percent

of visits

5.6

10.7

16.3

19.6

23.6

27.1

30.0

32.8

35,3

37.e

40.0

42.1

44.1

45.9

47.5
4

tic groups and code number inclusions are based

on the Eighth Revision Int emu tio nal Classification of Diseases, Adapted for use in the

United Stat es.

The data in the tables are in relatively close

agreement with the most common reasons for

visits expressed by patients (table 2). The generalist nature of osteopathic office practice is

evident from the range and diversity of the diagnoses that the D.O. rendered. It requires 14

major diagnostic classes to express the breadth

and variety of the D.O.’S clinical activity (table

3). On the other hand, the functional specialization expected of the D.O. is evident in the

finding that the 15 specific conditions most

frequently diagnosed prominently include

arthritic conditions, rheumatism, and sprains or

strains of the back region (table 4).

Table 5 shows that, as with all office-based

physicians, the diagnostic procedures most

favored in osteopathic office practice were the

limited examination, blood pressure check, and

laboratory test. The three therapeutic procedures that the D.O. most often ordered or provided were treatment by prescription drug, treatment by injection, an d treatment by manipulative therapy. The D.O.’S reliance on drug

4National Center for Health Statistics: EighthRevz_-

sion Interns tional Classificationn of Diseases, Adapted for

Use in the United States. PHS Pub. No. 1693. Public

,Health Service. Washington. U.S. Government Printing

Office, 1967.

therapy–in 54 percent of visits–exceeded the

overall average by 10 percent. Perhaps more

noteworthy was the 34 percent of visits in which

the D.O. used injection therapy–a usage that

exceeded the overall average by 20 percent.

Table 5 also presents data on the severity of

patient problems. These data express the dactor’s judgment of the extent of impairment that

might result if no care were available. Clearly,

most osteopathic practice centered on the treatment of problems which ranged in severity from

slightly serious to not serious. The D.O. agreed

wit h the average office-based physician in

judging only about 1 in 5 problems as serious or

very serious in prognosis.

Data on disposition (table 5) show that

scheduled followup is the rule with office-based

D. O.’s, as it is with all office-based practitioners.

D.O.’s also shared the tendency of other generalist practitioners to provide most of the care

that their patients required; led than 2 percent

of visits to D.O.’s resulted in referral to another

physician. Admission to the hospital was also a

rare event in the D.O.’S office practice; it

occurred in only 1 percent of visits.

The duration of visit (the portion of an

office visit that involves face-to-face contact

between patient and doctor) was under 16 mirlutes for 2 out of 3 office visits to D. O.’s.

Agreeing closely with the average for all officebased practitioners, the average face-to-face

encounter between D.O. and patient was estimated at about 15 minutes in duration.
dwwedaa5

Table 5. Nutier and percent of office visits to osteopathic physicians by services ordered or provided, seriousness of problem, disposition, and duration of visit: United States, January-December 1975

Service ordered or provided, seriousness of problem,

disposition, and duration of visit

Service ordered or provided

No service ........ ........................... .. .................................................................. ........

Diagnostic service: 1

Limited history and/or examination ................................ .. ...... ..........................

General history and/or examination .............................. .....................................

Clinical laboratory test ....................................................... ...............................

X-ray .. ................ ...................... ..................................... ........... ............ .............

Blood pressure check .... ............ .......... ..............................................................

EKG ... ....................... .................. ......................................................................

Hearing and/or vision test .......................... .. .................... .............................. ....

Endoscopy .................... .............. ........................ .................. ................. ...........

Therapeutic service: 1

Drug prescribed ..................... .. ........ .............................................. ....................

Injection .. .... ............ .............................................................. .............. ............ ..

Immunization and/or desensitization .................................................................

Office surgew . ............ .............. ................ ................................ ..........................

Physiotherapy .... ................ .......................................................... .....................

Medical counseling ............... .................... .........................................................

Psychotherapy and/or therapeutic listening ....................... ........ .................. .....

Other services .................... ......................................................................................

Seriousness of problem

Serious or very serious .. .. ........ ................................................ ...............................

Slightly serious . .. .... ........ ...... ..................................................................................

Not serious ....... .................... ................................................................ .... ........ ......

Disposition (selected actions)l

No followp ......... ...... ........................ ............................................. ........................

Return at a specified time ... ............................ .............. ............ ........................... ...

Return if needed .. .... ................................ ............................. ..................................

Telaphone followup .. .... .... .. ........ ............................ ...... .. .......... .. ...... .................. ...

Referred to other physic!an or/agency . .... .................................. ...... ........ ..............

Admitted to hospital ......................................... ...................................................

Duration of visit

Less than 1 minute (no face-to-face contact with physician) .............. ...... .............

1-5 minutes ... .......... .............. .................. ........................................ ......... ..............

6-10 minutes ....... .............................................................. ...... ........ ...... .... .. ...........

11-15 minutes . .................... .............. ............................ .................. .................. .....

16-30 minutes ...... .. .............................................................. .... ..............................

31 minutes or more ............. .................... ............................ ...... .............................

Number

of visits

in

thousands

BIO

21,603

4,673

6,35B

2,051

14,761

559

952

447

25,217

15,705

799

2,581

4,954

4,944

3,580

4,6B9

8,791

18,692

19,388

5,083

24,593

16,653

1,326

831

491

383

6,680

12,909

12,028

13,677

1,196

Percent

of

visits

1.7

46.1

10.0

13.6

4.4

31.5

1.2

2.1

1.0

53.8

33.5

1.7

5.5

10.6

10.6

7.6

10.0

18.8

39.9

41.4

10.8

52.5

35.5

2.B

1.8

1.1

0.8

14.3

27.5

25.7

28.2

2.5

lSince more than one service and disposition were possible per visit, estimates wiII not add to tntal number of visits (46,872,000).
6 ZKkncedata — — —

TECHNICAL NOTES

SOURCE OF DA’rA: Data presented in this report were obtained during 1975 throu~h the

National Ambulatory Xledical Care Surve;

(NAN!CS). The target population of N.JJ{CS encompasses office visits ~vithin the conterminous

United States made by amb~datory patients tu

physicians who are principally engaged in office

practice.

SAhlPLE DESIGN: The 1975 NAhlCS utilized a

multistage probability design that involved

samples of primary sampling units (PSU’s),

physician practices within PSU’S, and patient

visits within practices. Within the 87 PSL-’S composing the first stage of selection, a sample of

approximately 3,500 physicians was selected

from master files maintained by the American

Medical Association and the American Osteopathic Association. Sampled physicians, randomly assigned to 1 of the 52 weeks in the survey year, were requested to complete Patient

Records (brief encounter forms) for a systematic

random sample of office visits taking place within their practice during the assigned reporting

period. (A facsimile of the Patient Record used

is shown in a previous issue of Advance Data

From Vital and Health Statistics, No. 12, October 12, 1977.) Additional data concerning physician practice characteristics such as primary

specialty and type of practice were obtained

during an induction interview.

A complete description of the survey’s background and development has been presented in

an earlier publication in Series 2 of Vital and

Health Statistics (No. 61. DHEW Pub. No.

(HRA) 76-1335. Health Resources Administration. Washington. U.S. Government Printing

Office, Apr. 1974). A detailed description of the

1975 NAMCS design and procedures will be presented in future publications.

SAMPLING ERRORS: Since the estimates for

this report are based on a sample rather than the

entire universe, they are subject to sampling variability. The standard error is primarily a measure

of sampling variability. The relative standard

error of an estimate is obtained by dividing the

standard error of the estimate by the estimate

itself and is expressed as a percent of the estimate. Relative standard errors of selected aggreTable 1. Approximate relative standard errors of est!mated numbers of office visits

—

Estimate R? a;”,,e standard

in e.ro~ in

thousands ps~centage points

500..........................................

1,000.......................................

2,000.......................................

5,000.......................................

10,000.....................................

30,000.....................................

100,000...................................

550,000...................................

30,1

21.4

15.3

I 01))

7.5

5.1

4.0

3.5

Example of use of table: An aggregate of 80,000,000 has a

relative standard error of 4.3 percent or 3 standard error of

3,440,000 (4.3 percent of 80,000,000).

Table i1. Approximate standard errors of Percentages for e$timated nu tiers of office visits

Base of percentage

(number of visits

in thousands)

1,000 .....................

3,000.....................

5,000 . .... .. .... .. ... .. . ..

10,000...................

50,000 ... .... .. .. .. .. ....

100,000.................

500,000.................

Estimated percentage

t

I or 5 or

99 95

2.1 4.6

1.2 2.7

0.9 2.1

0.7 1.5

0.3 0.7

0.2 0,5

0.1 0.2

10or

90

6.3

3.7

2.8

2.0

0.9

0.6

0.3

T) or

80

8.5

4.9

3.8

2.7

1.2

0.8

0.4

10 or

70

9.7

5.6

4.3

3.1

1.4

1.0

0.4

50

10.5

6.1

4.7

3.3

1.5

.1.1

0.5

—.

Example of U* of table: An estimate of 30 percent baaed on

an aggregate of 75,000,000 has a standard error of 1.2 percent.

The relative standard error of 30 percent is 4.0 percent (1.2 percent+30 percent). ‘

gate statistics are shown in table I. The standard

errors appropriate for the estimated percentages

of office visits are shown in table II.

ROUNDING: .4ggregate estimates of office visits

presented in the tables are rounded to the nearest thousand. The rates and percents, however,

were calculated on the basis of original, unrounded figures. Due to rounding of percents,,

the sum of percentages may not equal 100.0 percent.
dEmdata7

DEFINITIONS: An ambulatory patient is an individual presenting himself for personal health

services who is neither bedridden nor currently’

admitted to any health care institution on the

premises.

An office is a pIace that the physician identifies as a location for his ambulatory practice.

Responsibility over time for patient care and

professional services rendered there generally

resides with the individual physician rather than

an institution.

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 health services.

A physician is a duly Iicensed doctor of

medicine (M.D.) or doctor of osteopathy (D.O.)

currently in practice who spends time in caring

for ambulatory patients at an office location.

ExcIuded from NAMCS are physicians who

specialize in anesthesiology, pathology, radiology; physicians who are federally employed;

physicians who treat only institutionalized

patients; physicians employed full time by an

institution; and physicians who spend no time

seeing ambulatory patients.

SYMBOLS

Data not available-—-——-——— ---

Category not applicable—–—-— . . .

Quantity zero——————–———

Quantity more than Obut less than 0.05—- 0.0

Figure does not meet standards of

reliabilityy or precision—-——---— *
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service I Number 26 ■ April 6, 1978

Contraceptive Efficacy Among Married Women 1544

Years of Age in the United States, 1970-731

In the 3-year period 1970-73, 7.3 percent of

U.S. married women who sought to delay their

next wanted child became unintentionally pregnant while using contraception within 1 year following initiation of use (table 1). Only 3.7 percent of those who had decided to terminate

childbearing failed to achieve that goal during

the first year of contraception after deciding to

prevent future births. While these rates may

imply acute problems for the individuals who

did experience contraceptive failure, they are an

indicator of the high degree of effectiveness of

contraceptive use considered in the aggregate.

The data presented here are extracted from a

forthcoming report on contraceptive use effec-

“tiveness in the United States. They are based on

Cycle I of the National Survey of Family

Growth (NSFG), conducted by the National

Center for Health Statistics. The NSFG was designed to provide information about fertility,

family planning intentions and activity, and

other aspects of maternal and child health which

are closely related to childbearing. Data on each

of these topics were collected in personaJ interviews with approximately 9,800 women aged

15-44 years who had ever been married or who

had children of their own living in the household. Interviews were conducted between Iuly

1973 and February 1974; the midpoint was Sep1This report was prepared by Kathleen Ford, Ph.D.,

Division of L’ital Statistics. The information in this report was extracted from the report “Contraceptive Efficacy Among Married Women in the United States,

1970 -1973,” by Barbara Vaughan, James Trussell, .Janc

Menken, and E1ise k’. Jones, which will be published in

Series 23 the lrital and Health Statistics series.

Table 1. First year contraceptive failure rates per 100 married

vmmqn aged 1544 years, by whether contraception was intended to prevent or delay pregnancy, with corresponding

standard errors Urj ited States, 1970-73

Intention of Failure rate Standard

contraception per 100 women errorl

Prevent ............... ... 3.7 0.5

Delay ............ ......... 7.3 0.7

lThe~e are provisional e~tim~tes of standard err~r~. see Tech.

nical Notes.

tember 13, 1973. Respondents were selected by

a multistage, area probability, cross-sectional

sample of households in the conterminous

United States. It should be emphasized that the

statistics reported here do not pertain to a sampIe of all contraceptors but rather to a sample of

women who were both married and contraceptive users for at least 1 month during the 3-year

period, t~uly 1, 1970, through,July 1, 1973.

The contraceptive failure rates for the various methods reported here are the probabilities

of a c~ntraceptive failure during the first year a

method was used. They were computed using a

multiple-increment, muItipIe-decrement Iife

table procedure. A contraceptive failure occurred if the onset of pregnancy was reported as

occurring prior to the termination of contraception. For the calculation of use effectiveness

during the 3-year period prior to the survey, all

intervals of contraceptive use (including sterilization) occurring during a continuous marriage

w~ere considered. It should be kept in mind that

these rates of use effectiveness (Jf contraceptive

methods reilect patient misuse as well as method

failure.
2

The particular method of contraception has

long been observed to affect failure rates. Sterilization was by far the most successful method,

with no failures recorded (table 2). The failure

rate for the pill was 2.0, representing 2.0 failures

per 100 women in the first year of use. Failure

rates for the IUD (4.2), condom (10.1), and

diaphragm (13.1 ) follow in order of decreasing

use effectiveness.

These rates are standardized by the intention

of use (those seeking to delay their next wanted

birth and those seeking to prevent any further

births). Since intention has been found to influence success with a method and different

methods attract varying proportions of couples

seeking to delay or prevent the next pregnancy,

such standardization was necessary for proper

comparison of method failure rates.

Table 2. First year contraceptive failure rates per 100 married

mmen agad 15-44 years standardized by intention of corltraception, by type of contraceptive used, with corresponding standard errors: United States, 1970-73

Type of

contraceptive

used

Sterilization ......... ..

Pill ...................... ...

IUD, ......................

Condom ...... ..........

Foam, cream, or

jelly .......... ..........

Diaphragm .............

Rhythm ...... ...........

All other

methods .............

Failure rate

per 100 women

0.0

2.0

4.2

10.1

149

13.1

19.1

10.8

Standard

errorl

0.4

1.2

1.7

2.1

3.8

4.0

2.9

‘These are provisional estimates of standard errors. See Technical Notes.

TECHNICAL NOTES

DESIGN OF THE SURVEY: The National Survey of Family Growth (NSFG), initiated in

1971, was designed to provide data on fertility,

family planning, and related aspects of maternal

and child health. Fieldwork for Cycle I was

carried out by the National Opinion Research

Center in 1973 and early 1974, with September

13, 1973, as the midpoint of the interviewing.

A multistage probability sample of women

in the noninstitutional population of the conterminous United States was used. Approximately 33,000 households were screened to

identify the sample of women who would be

eligible for the NSFG, i.e., women aged 15-44

years who were either currently married, previously married, or never married but with natural children presently living in the household.

In households with more than one eligible woman, a random procedure was used to select only

one to be interviewed. Since the interviews were

always conducted with the sample person, the

term “respondent “ is used throughout this report as synonymous with sample person. InterMews were completed for 3,856 black women

and for 5,941 women of other races. A detailed

description of the sample design is presented in

“National Survey of Family Growth, Cycle I:

Sample Design, Estimation Procedures, and Vti!-

ance Estimation,” Series 2, No. 76 in the Vital

and Health Statistics series.

The interviews were highly focused on the

respondents’ marital and pregnancy histories, on

their use of contraception and the planning status of each pregnancy, on their intentions regarding the number and spacing of future births,

on maternity and family planning services, and

on a broad range of social and economic characteristics. While the interviews varied greatly in

the time required for their comp~etion, they

averaged about 70 minutes. Quality controI procedures were applied at all stages of the survey.

These included a verification of listing completeness with unlisted dwelling units being brought

into the sample, a preliminary field review of

completed questionnaires for possible missing

data or inaccurate administration, a 10-percent

sample recheck of all households screened in the

survey, observation of interviews in the fiekl,

and an independent recoding of a 5-percent subsample of completed interviews.

RELIABILITY OF ESTIMATES: Since the statistics presented in this report are based on a

sample, they may differ somewhat from the figures that would have been obtained if a com -
dmce&da3

plete census had been taken using the same questionnaires, instructioris, interviewing personnel,

and field procedures. This chance difference between sample results and a complete count is

referred to as sampling error. In addition, the

results are subject to nonsampling error due to

respondent misreporting, data processing mistakes, and nonresponse. It is very difficult, if not

impossible, to obtain accurate measures of nons&mpling errors. These types of error were kept

to a minimum by the quality ‘control procedures

and other methods incorporated into the survey

design and administration.

Sampling error, or the extent to which samples may differ by chance from a compIete

count, is measured by a statistic called the

standard error of the estimate. The standard errors presented in this report are provisional estimates based on variances calculated for other

life table estimates from this survey.

The chances are about 68 out of 100 that an

estimate from the sample would differ from a

complete census by less than the standard error.

The chances are about 95 out of 100 that the

differences between the sample estimate and a

complete count would be less than twice the

standard error.

DEFINITIONS OF TERMS

Contraceptive use effectiveness.–In this report, use effectiveness is defined as the effectiveness of a method when it is being used.

Contraceptive failure, the type of method termination which was the focus of this study, occurred if the “date of stopping contraception

came aft er the month a pregnancy began, and

the respondent said she had not stopped at the

time she became pregnant. Periods of time when

the respondent was not maxried as well as

periods of time when the respondent was married but reported that she was not having intercourse were excluded from the calculations.

Intention. —A method use interval was classified as a delay interval if the woman’s motive for

using a contraceptive was to delay her next pregnancy. If her intentions were to have no more

children, the interval was classified as a prevent

interval.

SYMBOLS

Data not avaiIable——— —--- .

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

Quantity zero-–— -—---—--—---—- .

Quantity more than Obut less than 0.05— 0.0

Figure does not meet Standards of

reliabilityy or precision–—--––--——-— *
Health Characteristics of

United States,

Minori~ Groups,

1976P

There is increasing interest in the health

characteristics of the minority groups in the

population of the United States, especially those

of the two largest minority groups, the black

population and the population of Spanish origin.

Since its inception in 1957, the Division of

Health Interview Statistics, by means of the

Health Interview Survey (HIS), has collected

data on the race of respondents in order to present estimates of health variables by racial group.

Beginning in 1976, information on respondents’

national origin or ancestry has been obtained in

the HIS, primarily in an effort to identify persons of Spanish background. This report presents, statistics on several health characteristics

for four population groups: the total United

States civilian noninstitutionalized population,

those of Spanish origin, the black population,

and all others. “Spanish origin” refers to those

persons aged 17 years and over who, regardless

of race, were reported as being of Central or

South American ancestry, Chicano, Cuban,

Mexican, Nfexicano, Mexican-American, Puerto

Rican, or other Spanish origin. Data for children

under the age of 17 are stated in accordance

with the race and reported origin of their parents. (See Technical Notes. ) The approximately

495,000 persons reported to be of Spanish origin and classified as black by the interviewer

were counted in both of these minority categories.

The tables present data for the four population groups by age and income. The age distri1This report prepared by Claudia S. Jloy and

Charles S. J\’iIcier, Di\,ision of Health Interview Statistics.

butions of the four population groups are quite

different, with large; p;oportio;s of-the Sp&ish

and black groups than of the total population

being under the age of 17. Approximately 41.3

percent of the Spanish population was under 17

years of age, 37.0 percent of the black population was under 17, and only 28.9 percent of

the total U.S. population was under 17 years of

age. Because of these differences in the age distributions, comparisons should be made vvithin

age groups or by using age-adjusted percentages.

Table 1 shows the crude rates and the ageadjusted (by the direct method) rates for the

various health characteristics that are presented

in detail in tables 2-5. The age-adjusted data can

be compared directly since the rates assume

identical age distributions of all groups. However, the unadjusted percentages are the actual

ones, and any quotation of percentages and agespecific rates should be of the crude rates rather

than of the adjusted data.

Statistics for six health characteristics and

population figures are shown in tables 2-5. The

total population for the four population groups

and the percent of the population with limitation of activity are sho~~m in table 2. Table 3

presents the proportion of the population with a

doctor visit in the year preceding the interview

and the proportion with a short-stay hospital

episode during the year before the interview. Jn

table 4, the number of days of restricted activity

and days of bed disability per person per year

are shoum. The number of currently employed

persons aged 17 years and over and the number

of days lost from tvork per person per year are

shown in table 5.
2 acwncedata

Table 1. Unadjusted and age-adjusted percentages or rates of selected health characteristics, by national origin or race and family income: United States. 1976

Characteristics and family i;come

Limitation of activity

due to chronic conditions

All incomes . ........ .... ...... ...... ... ... .. .....

Less than $5,000 ........ ......... . ...... ...... ... ......

$5.000.$9 .999 .... ... ...... ... ... ... ... ... ...... . ...... ..

$lo.ooo414999 ... ... ...... ...... ............. ... ... ...

.$15,000 or more ... .... ...... .... ........ . ... .... .. .... .

Doctor visit in past year

All incomes3 ........ ...... ........ .. ..... .. .... .....

Less than $5,000 ..... ... .. .... ... ... ... ....... ... ... ...

$5.000.$9 .999 ...... ... ... .... ... .. ... .... ... ... ... ... ...

$lo.ooo.$l 4999 .. ... .... ........ ...... ....... .. .... ....

$15,000 or more ... .. .... ....... ... ...... ...... .........

Short-stay hospital

episode In past year

All incomes3 .................... ... ......... .........

Less than $5,000 .... .... ..... ... ... .......... .. .... ... .

$5.000* $99 ..... .. .... ... ... .......... ... ..... .... ... ..

$lo.ooo.$l 4.999 .... ... ............. ...... ... ....... ....

$15,000 or more .... ............ ..... .... ............ ... .

Days of restricted actwity

per person per year

All incames3 .......... ... ... ... ...... . ......... .. ....

Less than $5,000 ... .. . ... ...... .... ...... .... .. ... .... ..

$5.00049 .999 .... ... ............... . ... .. .... ... .... ... ..

$10,000-$14,999 ... .............. .. ... ... . ... ...... .....

$15,000 or more .. ........ .... ... ... .... ..... .... ... .....

Days of bed disability

per person per year

All incomes3 ........ ........... ... ... ... .......... ...

Less than $5,000 ......... .... .. ...... .... ...... ... ... ...

$5,000-$9,999 ...... ................ ......... .. .. .........

$lo.ooo414.999 ... ....... .. .... .. .... .. ........ .. .. .. ..

$15,0000 rm0re .... ....... ... ...... ... ............. . .. ..

Days lost from work per currently

employed person per year

All lncomes3 ... ...... .... ............ .... .. ..........

Less than $5,oOO ... ...... .... .. .... .... ........... ......

$5.000.$9 .999 .... ....... .. ......... .... .... ... .. .........

$lo.ooo.$l 4.999 ..... ..... ... ... ... ... .... ... ... ... .....

$15,000 or more .............. .. .... ...... ....... .. ... .

Total Spanish

Blackl Other

Total Spanish

population origin 1 population originl Blackl Other

Unadjusted percentage m rate I

Age-adjusted2 percentage 6r rate

14.3 9.5 14.8 14.6 14.3 13.5 17.4 14.0

28.8 17.2 24.9 31.3 23.1 19.7 24.9 .

17.1

23.0

9.5 12.3 19.0 16.3 13.4 16.0

11.3

16.6

6.6 9.7 11.8 13.2 12.3 13.3 13.3

8.6 6.1 7.1 9.0 10.8 ● 12.1 10,4 10.8

75.5 69.5 73.5 76.2 75.5 70.4 74.2 76.2

76,7 70.6 75.7 77.8 76.0 70.7

73.8

76.5

67.7

77.0

70.1 75.3 73.6 66.8 71.7

75.1 70.2

?4.8

74.4 75.5 75,5 72.2

77.3

75.5 75.8

73.1 78.5 77.4 77,6 73.8 78.2 77.7

10.6 9.3 10.0 10.8 10,6 10.4 10.6 10.6

14.0 11.1 12.7 14.7 12.8 11.7 13.7

11.8 10.2

12.6

9.0 12.7 11,7 11.4 9.9

10.4 8,5

12.0

9.4 10.7 11.0 ●9.B 10.6 11.1

9.1 7.6 9.0 9.1 9.7 “9.1 9.0 9.7

18.2 17.1 20.6 18.0 18.2 20.3 23.3 17.6

32.5 26.5 30.7 33.8 28.4 29.2 31.2

20.3

28.1

18.4 17.4 21.1 19.8 21,0

15.7

21.2 19.7

14.8 15.4 15.8 16.8 19.0 17.6

12.8

16.7

10.0 13.7 129 13.9 ‘1 3.2 14.9 13.8

7.1 8.4 9.0 6.8 7.1 9.3 9.9 6.6

12.1 14.9 12.3 11.7 11.0 16.3 12.8 10.1

EL2 8.1 7.7 8.4 8.0 8.8 9.2

59

7.8

7.0 5.9 5.9 6.3 ●6.4 5.9

5.1

6.2

4.8 7.5 4.9 5.7 ‘4.2 ●B.5 5.5

5,3 4.9 7.4 5.1 5.3 5.0 7.4 5.1

5.8 “5.7 7.4 5.5 ●

7.2

6.1

5.5

5.1 7.1 6.0 ::; ●5.4 7.1

5.5

6.1

5.9 6.2 5.4 5.5 ‘5.6 ‘6.0

4.7

5.4

3,6 8.4 4.5 4.6 ●

8.2 4.4

ll+rsonsrepcwtedss both nt’ Spanish origin and b13ck are included in both categwies.

2Adjusttdby tl]udirc~t ~ctl)od tOthe~ge di~trihuti(,” ~)fthe~ivilia” ~Qnf”~tit”tiOnalized p~pu]~ti~nortt,:! ,, Cthe currently employed population.

3111cIucIL%unknown income.
ackmeda3

Table 2. Population and percent of population with limitation of activity due to chronic conditions, by national origin or race, family income, and age:

United States. 1976

Family income and age

All incomes2

All ages .... . .... ... ..... .. .......... ... .... ... .,.. ,

Under 17 years ..... .. ... .......... ... .... ... .... ... ......

1744 yearc .. ...... .... ....... ....... ... ... ...... .. .... .. ...

45-64 years ........ .... .... .. ..... ...... .. . ....d. .. .. ...... .

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

Less than $5,000

All ages .. ... ... .... ....... .... .... ...... ... ... .. .. .. ....

Undar 17 years ..... .. ..... ... ... . ... ... .. .. ... ..... .. ....

7744 years .... ... .... ....... ... ... .... ... .... ... ... .... ... .

45.64 yearn .. ...... ... . .. ... ....... ... ....... ... .... ....... .

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

$5,000-$9,899

All ages .. ... . ... .. .. .. ....... . .... .. .... .... ... ....... ..

Under 17 years .. .... ... ... ..... .. .... ..... ... . .... . ......

1744 years . .. .... ....... .... ... ... .... .... ... ... .... .......

4564 Vears ... .. ..... ... . ... ... .... ... ... .... ... ....... .....

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

$10,000-$14,999

All ages .... .. .. .. . ... .... ... .... ... .. .. ... .... ....... ...

Under 17 years ..... ....... .... .. .... ........... ...... ... .

1744years ... .. .... .. ...... .. ..... ..... .... ...... .. .. .... ..

45434 years ....... ...... .... ... .. ... .............. .... .. ....

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

$15,000 or more

Under 17 years .... ..... .. .... ... ... ....... ........ .. . ....

1744 years .. .... .. ... .. ...... .. .. ..... .......... ... ... ... ..

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

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

Total I

Spanish

copulation I

Black 1

origin 1

I

Other

II I I

Number of Dersons in thousands

210,643

60,891

84,701

43,253

21,799

28.987

6,547

9,789

4,876

7.775

42,543

12,202

16,383

7,84i

6,136

44,47+

14,12E

19,533

8,506

2,30&

75,797

22,511

33,20i

17,443

2,641

12,218

5,041

4,970

1,669

538

2,206

641

851

303

211

3,614

1,447

1,491

504

173

2,744

1,213

1,141

330

60

2,486

1,006

1,100

345

35

24,863 I 174,057

9,206 46,945

9,666 70,199

4,110 37,519

1,682 19,394

T

6,841 20,099

2,436 3,366

2,213 6,764

1,138 3,455

1,054 6,514

T

6,698 32,324

2,722 8,090

2,641 12,261

983 6,361

353 5,612

T

4,216 37,615

1,560 11,423

1,841 16,574

697 7,468

119 2,130

4,092 I 69,307

1,368 20,176

1,925 30,213

714 16,395

86 2,524

lPerscmsreportedm both of Spanish odgin andhlackme included in both cstcgnric~.

Zlncludes unknown income.

It I I

Total I

Spanish I

Blackl

origin 1

I

Other

population

11 1 ,

Percent of popukxion with limitation of activity

14.3

3.7

8.9

24.3

45.4

28.8

5.3

14.9

49.0

53.4

17.7

4.1

10.4

31.3

43.1

11.3

3.6

8.6

22.5

38.6

8.8

3.3

6.5

15.7

38,7

t

9.5 14.8 14.6

2.8 3.7 3.9

7.7 10.5 8.7

23.5 32,3 23.4

45.9 52.8 44.6

tt

17.2 249 31.3

6.3 4.8 5.7

13.6 16.7 14.5

37.3 51.8 49.0

46.0 59.4 52.7

IT9.5 12.3 19.0

‘2.0 4.1 4.5

7.0 10.0 10.8

27.6 29.1 31.9

42.2 46.5 42.9

IT6.6 9.7 11.8

‘2.1 2.8 3.9

6.4 8.1 8.8

14.8 24.4 22.6

58.3 41.2 39.0

NOTE: Fnrolfici.d population estimates for mrxegcneral use, see U.S. Bureau rjffhe Ce”<usreparts <,”thz civilian population of the [lnited Statwinc%r.

rent Population Rcporrs, %riw P-20, P-25, and P-60.
4 advancedata

Table3. Percent of population with adoctorvislt or short.stay hospital episode in thet?ast year. by national oriain orrace. familv income. and aae:

tinited States, 1976

Family income and age

Tots I Spanish

population Originl Black] Other

All incomes2 I

Percent of population with a

doctor visit in past year

All ages, . ... .. .. .. .. .. ...... .. ... .. ...... ...... .. .. 75.5 69.5 73.5

Under 17 years ........... .... ...... ... .... .... ........... 74.2 67.6 67.6

1744 years .... ... .......... .. .. .. .......... .... .. .......... 7!5.4 69.6 76.9

45-84 years ........ .... .. ... ..... .. ... ...... ........ ....... . 75.2 71.2 76.1

65 years and over ........ . .... .. ...... .......... ..... .... 80.0 79.4 78.8

Less than $5,004

All ages ... ... ... .. .. .... . .. .. ...... .... ... ... ... ... ... .. 76.7 70.6 75.7

Under 17 years .... .. .... ......... ... .... ...... .... .. .... . 71.6 69.6 68.2

1744 years ... . .. ...... .......... ......... .. ............ ... . 78.3 70.3 80.6

45.64 years .. .. ..... ......... .. ... ... ... ... ... ... ...... .... . 75.8 69.6 78.2

65 years and over .... .. ..... ... .. ..... ..... .. .... ... ..... 79.7 77.7 80.3

$5,000-$9,999

All ages .... ... .... ... . .. ...... ..... .. ... ... .......... ... 73.8 67.7 70.1

Under 17 years .. .. .... ... . ....... .. ... ............... .... 69.7 88.0 62.3

1744 years ..... .. ....... . .. .... ... ......... ..... .. .... .. ... 75.0 66.9 75.6

45-W years .... .. .... .... .... ... ... .. ........ ... ... ... ... .. . 72.7 69.8 73.4

65 years and over .. ....... ... ... . .. ....... ... ... ... ...... 80.6 82.1 79.9

$10,000-$14,999

All ages .. ... ... ... . ... . .. . ...... ... .. ........... ... .... . ;5.1 70.2 74.4

Under 17 years ... ... . ...... ...... ... ............. ... .... . 74.3 54.2 68.5

17434 years .. ....... ... ...... . ... .. .... ... ....... ... ...... .. 75.8 75.4 79.3

45-64 years ............ .... .. ... . ...... ... .... ... ...... ..... 73.5 72.4 73.3

65 years and over ... . ...... ... .. .... ....... ...... ... ... .. 81.2 81.7 84.9

$15,000 or more

All ages ... .. ....... . .... .... .. . ........ .......... .. .... . 77.3 73.1 78.5

Under 17 years .. .. ....... .. .... ..... .... . ... ... ... .. .... . 78.0 73.6 77.9

17-44 years .... ...... .. .... ...... .. ............... ...... .. .. 76.1 71.8 78.3

45-84 years .. .. ... ....... .... .. .. ....... ... ....... ..... .. ... 78.3 75.1 81.0

65 years and over .... ...... . ... .. .... .... .... .. ... ... .. .. 81.2 “80.0 73.3

76.:

76.:

75.(

75:

80.:

77.2

74.;

78.;

75.f

79.;

75,:

72.<

75.t

72.S

80.E

75.5

76.C

76.4

73.5

81.1

77.4

78.:

76.1

78.3

81.5

., .

Total Spanish

population originl 81ackl Other

Percent of population with a short-stay

hospital episode in past year

1

10.6 9.3 10.0 10.8

5.5 5.4 4.7 5.7

11.4 12.0 13.5 11.0

12.5 10.8 12.0 12.6

18.3 17.1 ‘ 12.9 18.8

14.0 11.1 12.7 14.7

6.7 6.5 6.3 7.1

13.7

16.C

18.S

11.9

5.9

13.0

13.7

16.4

13.3 18.5 12.2

13.9 14.8 17.5

●16.1 13.3 19.9

II10.2 9.0 12.7

5.4 4.3 6.6

13.1 12.3 13.1

12.9 11.2 14.2

●18.5 13.9 18.7

9.1 II 7.6 I 9.0 I 9.1

4.7

9.9

11.5

19.2

3.7 2.9 4.9

10.3 12.6 9.7

‘8.7 11.1 11.6

“20.0 ●8.1 19.6

lPersons reported w both t)f Spunish origin cjnd bluck arc t“cl”ded in both mteguries,

21nclude~ unknown income.
— 5

Table 4. Days ofrestricted activity or beddim&lity perperson peryear, bynational origin orrace, family imome, and age: United States, 1976

Family income and age

Total Spanish

Blackl Other

Total Spanish

population originl population originl Blackl Other

All incomes2

Days of ra$tricted activity

per person per year .-

All ages ....... . ...... .... ... .. .......... ..... ...... 18.2 17.1 273.6 18.0 7.1

Under 17 years ... .. .. .. ....... ......... .. ....... .. ....... 11.0 14.3 7.6 11.3 5.1

1744 years .... . ... ... .... ... ... . ...... ... ....... ....... .... 14.2 12.9 19.1 13.6

45-64 years ......... .. .... ... ....... .... .... ..... ..... .. .... 25.4 26.5 39.1 23.8 z

65 years and over .. ....... ... ... ... ....... ....... .. ..... . 40.0 53.1 52.5 38.4 15.1

Less than $5,000

All ages ...... ... .... .... .. .. .. ... ...... . .... .. . ... ...... 32.5 26.5 30.7 33.8 12.1

Under 17 years ...... ... ...... . ... ...... .... ... ..... .. . .. 12.2 16.4 8.5 13.7 6.5

1744 years .. .... .. ..... .. .. ..... ... .... .. ....... .... ... ... 21.6 19.1 25.7 20.6 8.6

45-64 years .. .... .. ....... ... .. ........... .... ... .. .. ... . .. 53.6 49.5 57.7 52.5 18.9

65 years and over .. ... ... ........ .. .... ... ... .... ...... 50.3 84.2 63.3 47.8 16.9

$5,000-$9,888

All agm . . ... ... ... .... ..... .... .. ....... ... ... .... ..... . 20.3 18.4 17.4 21.1 8.2

Under 17 years . .... ... ..... .. ....... ...... ... .... .. .. .. . 11.2 15.6 6.7 11.8 5.1

17-44 ymrs ......... .. .... ... ........... .. .... ... .... ... .... 16.1 13.5 17.7 16.1 6.5

45-64 years .... ..... .. ... . ... ... ... ... ....... .... ... .... .... 30.6 34.0 36.7 29.4 11.8

65 yaars and over ... ..... ..... .. .. ....... ..... ... .... ... . 36.4 39.2 44.4 35.8 14.6

$10,000-514,999

All ~es ... ... ....... ........ ..... .... .. .. .... ....... .... 15.7 14.8 15.4 15.8 5.9

Under 17 years ..... .... ........ .......... ....... ... .. .. .. 11.0 13.2 8.2 11.1 4.6

1744 years . .... .. .... .. ... ...... ... ... ....... .. ... ... .. ... 14.4 13.1 16.8 14.3

45-84 years ... ....... ... ...... .... .. ..... ... .... ... ... .... ..

5.5

22.3 17.9 25.5 22.2

65 years and over ... . ... ...... ...... .. .. .... .. ... ..... ... 31.5

7.6

● 60.7 “31 .4 30.7 11.4

$15,000 or more

All ages ............ .. ....... ... ... ... .... . ... ...... .... . 12.8 10.0 13.7 12.9 5.1

Under 17 years ........ ... .......... .. .... .. .. .. .. ... ... . . 10.5 10.7 5.5 10.8

17-44 years ....... .... .. .... ... ....... ...... .... .. ..... .....

4.9

10.8 8.2 15.8 10.6

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

4.2

17.5 ●9.7 22.7 17.4

65 years and over .... ...... ........ .. ... . ... ......... .... 28.0

5.8

●46 .2 ●21 .9 27.9 13.1

I Persons reported as both of Spanish origin and black are included in both categories.

Zlncludes unknown income.

Days of bed disability

per person per year

8.4 9.0 6.8

I I

7.8 5.0

7.0 :: 5.1

10.5 16.9 8.0

20.5 18.5 14.6

II14.9 12.3

10.3 5.0

10.2 11.7

27.8 22.3

33.5 19.7

11.7

6.7

7.5

16.9

15.9

IT8.1 7.7 8.4

7.1 3.5 5.3

7.3 7.5 6.1

● 10.0 15.4 11.4

●1 7.4 19.7 14.2

m

7.0 5.9 5.9

6.8 3.5 4.5

7.6 6.5 5.3

●6.2 10.6 7.3

“0.8 ‘0.9 12.3

7.5 I 4.9 m
6 —

Table 5. Currently employed population 17 years and over and days lost from work per currently employed person per year, by national origin or race, familv

Family income and age

All into mesz

All ages,17 wars and war...............

17-44 wars .................................................

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

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

Lessthan $5,000

All wes, 17 years and cwer...............~....

1744 vears.......................................... ......

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

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

$5,000-$9,999

All ages, 17 yeara and over....................

1744 years.................................................

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

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

$10,000-$14,999

All ages,17 years and over....................

1744 years.................................................

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

65 veara and over........................................

$15,000 or more

All ages, 17 years and over ...................

17-44 Veara.................................................

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

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

incoma, and age: United States, 1976

Spanish

Population Blackl Other Population Spaniah

origin 1

!31ackl Other originl

Currently employed persons Days lost from work per currently

in thoueands

87,119 [{ 3,976 8,394

t

57,268 2,977 5,68:

26,974 939 2,42

2,887 60 28:

6.891 I 493 1,27{

4,631 364 75(

1,603 105 40(

657 “23 11:

15,603 1,118 2,26[

_lLL 10,491 826 1,578

4,234 274 619

876 ●18 71

19,748 987 1,796

13,734 763 1,279

5,625 217 489

389 “8 “28

am

employed parson per year

74,838 5.3 4.9 7.4 5.1

=

48,661 5.0 4.6 7.7 4.8

23,630 6.1 6.1 7.2 6.0

2,547 4.0 ●3.7 ‘4.0 4.0

ti

5,137 5.8 ‘5.7 7.4 5.6

3,523 5.0 “4.8 6.3 4.8

1,097 7.6 ●9.6 8.9 6.9

517 7.5 “2.0 ●9.6 7.3

16,986 5.5 5,9 6.2 5.4

11,704 5.6 6.2 7.1 5.4

4,929 5.6 *5.O ‘4.3 5.8

353 “1.9 +. ●. ●2.1

35,101 4.7 3.6 8.4 4.5

22,581 4.2 ‘3.0 8.5 3.9

11,973 5.8 ●5.8 8.6 5.7

646 “0.8 ●- ●.

‘0.8

lPersons reported as both of Spunish origin tind block are included in both cutegorit!s.

21”~[ude~ “nk”~~v” income.

NOTE: I:or officiul population estimates for more general use, see U.S. 8ureau of the Census reports on the civilian popul~tiun of the United States in Cur’-

rent Population Reports, Series P-20, P-25, and P-60: and U.S. Bur&au uf Labor Statistics monthly report, .Emptoyment and Earnings.

SYMBOLS

I

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

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

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

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

Figure does not meet standards of

reliability or precision ------------------------------

*
akmdata7

TECHNICAL NOTES

SOURCE OF DATA: The data presented in all

tables in this report were derived from household interviews of the Health Interview Survey.

These interviews were conducted in a probability sample of the civilian noninstitutionalized

population of the United States. During 1976

approximately 113,000 persons living in a total

of 40,000 households were included in the

sample. A more detailed description of the

sample design and a copy of the questionnaire

used in collecting the information are shown in

“Current Estimates From the Health Interview

Survey: United States, 1976,” Vital and Health

Statistics, Series 10, No. 119. The health characteristics presented are defined there also.

Other definitions are presented in Series 1, No.

11 of Vital and Health Statistics.

SAMPLE: Since the estimates shown are based

on a sample of the population, they are subject

to sampling error. Table I shows the standard

Table 1. Standard errors of estimates of aggregates

I

I

Standard error in thousands

I I

Size of estimate Reatrictedin thousands activity

Population and beddisability

days

70 ............ ...................

100.............................

.............................

1,000..........................

5,000 ..........................

10,000 ........................

20,000 ........................

50,000 ........................

100,000 ......................

200,000 ......................

500,000 ......................

1,000,000 ...................

2,000,000 ...................

15

18

40

57

125

174

237

325

550

. . .

. . .

. . .

. . .

. . .

. . .

. . .

685

1,554

2,199

3,113

4,935

7,009

9,998

16,205

24,000

36,000

Work-loss

days

. . .

. . .

. . .

551

1,233

1,745

2,472

3,929

5,603

8,054

. . .

. . .

. . .

errors of aggregates of persons and disability

days, and table II shows standard errors of percentages of persons.

Table Il. Standard errors, expressed in percentage points, of

estimated percentages for population estimates

.

500 ..............

1,000 ..........

2,000 ...........

5,000 ...........

10,000.........

20,000.........

30,000 .........

50,000 .........

100,000 ......

1.1

0.8

0.6

0.4

0.3

0.2

0.1

0.1

0.0

1.E

1.2

o.~

O.c

0.4

0’.-

0.2

0.2

0.1

2.4

1.7

1.2

o.~

0.5

0.4

0.3

0.2

0.2

3.5 4.0

25 2.9

1.8 2.0

1.1 1.3

0.8 0.9

0.6 0.6

0.5 0.5

0.4 0.4

0.2 0.3

National Origin of Persons

Under 17 Years of Age

If both parents were of the same origin, this

origin was assigned to the chiIdren.

If origin of parents differed and one was of

Spanish origin, the Spanish origin was assigned

to the children; if neither parent was of Spanish

origin, the origin of the mother was assigned to

the children.

If only one parent or other relative was in

the household, the origin of that person was assigned to the children.

In other cases, unknown origin was assigned.
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STA T!STiCS

US. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ● Public Health Service

-—

I Number 28 = April 28,1978

Office Visits for Hypertension, National Ambulatory Medical

Care Survey: United States, January 1975-December 1976a

According to data collected in the NationaI

Ambulatory Medical Care Survey (NAMCS), an

estimated 46.1 million visits with a principal

diagnosis of essential benign hypertension (EBH)

were made to office-based physicians during the

two-year period January 1975 through

December 1976.

N Ahl CS is a sample survey conducted

annually by the Division of Health Resources

Utilization Statistics in the National Center for

Health Statistics. The estimates in this report are

based on information recorded by participating

physicians on the “Patient Record” during

sampled office encounters. A facsimile of this

encounter form may be found in an earlier

report. 1 A brief description of the sample design

and an explanation of the sampling errors associated with selected aggregate statistics may be

found in the Technical Notes of this report.

Visits for which EBH was the principal, or

first-listed, diagnosis comprised 4 percent of the

over 1.1 billion estimated visits made in calendar

years 1975 and 1976 and ranked first among

visits for all morbidity related principal diagnoses. While many of the estimates presented in

this report deal chiefly with visits for which

EBH was the principal diagnosis, it is important

to note that for an additional 28.6 million visits,

EBH was the diagnosis listed second or third in

order of importance at that encounter. In addition, there were clearly more visits in w’hich

EB1I was a disabling factor than are reflected by

the visits in which EBH was a listed diagnosis.

“I’his report WdS prepared by Beulah K. Cypress,

Ph. D., Division of IIealth Resources Utilization Statistics.

For example, of the 26 million visits reported

for chronic ischemic heart disease that are not

included in this report, over one-third were recorded by the physician as chronic ischemic

heart disease with hypertensive disease. Moreover, another 1.6 million visits for some cardiovascular sequelae of EBH, such as hypertensive

heart disease and angina pectoris with hypertensive disease, are not incIuded in this report

although hypertension is clearly a factor in these

diagnoses. Therefore the estimates only reflect

visits wherein the organic consequences of prolonged or untreated hypertension, for example,

hypertensive heart disease, had not yet manifested themselves to the degree that the principal diagnosis of hypertension was superseded

by its cardiovascular or cerebrovascular sequelae.

The coexistence of EBH with obesity, diabetes mellitus, neuroses, osteoarthritis, arthritis,

arteriosclerosis, bronchitis, emphysema, and

asthma is suggested by the visit data. Table 1

indicates the frequency of coincidence of these

diseases listed as second or third diagnoses when

EBH was listed first by the physician, and the

frequency of their assiL~ment to principal diagnosis when EBH was the diagnosis listed second

or third. In both cases, these diseases appeared

as the most frequent in combination with EBH.

For example, obesity ~~as the diagnosis listed

second or third in o~~er 10 percent of all visits

where EBH ~vas listed as the principal diagnosis.

On the other hand, obesity was the primary

diagnosis in 5 percent of dl visits where EBH

was listed as a second or third diagnosis. Diabetes mellitus figured as a,n additional diagnosis

in about 5 percent of all EBH visits. \Vhen EBH

was a condition listed seconcl or third, a striking
2

Table 1. Number and percent of office visits for essential benign hypertension listed as principal and second or third diagnosis, by other

most frequent d iagnow: United States, January 1975-December 1976

Dia9n05is and ICDA codel

Obesity ........................................................ ..............................277

Diabetes men it us.. ... .............................. ............................... ..... 250

Neuroses ................. ......................... ..............................a...........3oo

Arthritis, unspecific ............................................................ .....7l5

Osteoarthritis and allied conditions ...........................................7l3

Arterioxlerosis ..........................................................................44O

Bronchitis, emphysema, asthma ..........................................49o-493

Hypertension as

principal diagnosis

Number of I

visits in

thousands Percent

for. second or

of visits2

third diagnosis

4,674

2,054

1,380

992

845

649

576

10.1

4,5

3.C

2.2

1.E

1.4

1’..

=

Hypertension as second

or third diagnosis

Number of

visits in

thousands

for principal

diagnosis

1,425

4,038

1,125

1,017

1,328

‘ 343

843

1 Based on E@hth Revj~jon [nrer~ti~na[ c&$~jf@tio~ of Qiseases, Adapted for Use in the United Stc7teS (] CDA).

2percent~ based on total number “f visits \vhere hypertension was listed as the principal diagnosis, 46,128,000.

3percents based on total number of \.jsjts w,here hypertension was ]isted as second or third diagnosis, 28,590,000.

14 percent of those visits were diagnosed primarily as diabetes mellitus.

Figure 1 reveals the dramatic differences in

proportions of visits with a principal diagnosis of

EBH by race and sex within selected age groups.

Fqure 1. PERCENT OF OFFICE VISITS FOR HYPERTENSION, BY

SEX, RACE, AND AGE: UNITED STATES, JANUARY 1975-

DECEMBER 1976

- Whitefermle ~ White male

~ Bfacka~OthQr~ma’e _ EOa*a~Othe’ male

2,8 1.9

Lessthan 45 45.54 5564 6574 75 and over

AGE IN YEARS OF VISITING PATIENT

—

Percent

of visits3

5.0

14,1

3.9

3.6

4,,7

+’1,,2

3.3

Visits by white females dominated other race

and sex combinations in all age groups over 45

years, with visits by white males second. The

reader is cautioned that the frequency of visits

for members of the black race is comparatively

small, and therefore sampling error is increased..

Furthermore, there is evidence that members of

the black race avaiI themselves of ambulatory

medical care rendered in hospital clinics and

emergency rooms, settings not included in

NAMCS, at a higher rate than do members of

the white race. According to data from the

Health Interview Survey (HIS), about 9 percent

of ambulatory medical care visits by white persons were to hospital clinics or emergency

rooms, whereas 21 percent of visits by members

of other races were in similar settings.2

Visit rates for both sexes by age are illustrat ed in figure 2, There is a marked difference

in visit rate by sex beginning at about age 44,

with the female rate peaking in age group 65 to

74 years, about 10 years later, than the highes~

rate for males. The Health and Nutriticm Exa.m.

ination Survey (HANES) revealed that hypertension was more prevalent among women aged

65 to 74 years than among men of the same age.a’

Data from HIS indicate that females 65 years of

age and older were the highest proportion of hypertensive in the population.4 The higher female

visit rate in N’AMCS is the~efore consistent with”

the higher EBH prevalence rate among females.
admm&&13

Figure2. VISIT RATE PER 100 PERSONSFOR ESSENTIAL BENIGN

HYPERTENSION,BY SEX ANO AGE UNITED STATES, JANUARY

1976-DECEMBER1976

60 r

50 -

F8nn190

40 -

% -

‘m -

10-

0

SS44 4S.64 ma

ttnn Ss

SS-74 76 mcr

Owr

AGE IN YEARS OF VISITING PATlENT

The advanced female age at visits as opposed

to the younger male age at visits maybe related

to greater susceptibility of males to other cardiovascular diseases which preempt EBH as primary

diagnosis. The Framingham Study demonstrated

that for persons with definite hypertension the

incidence rates of diseases such as coronary

heart disease, myocardial infarction, and congestive heart failure were substantially higher for

males than for females of the same age.5 Therefore, while the diagnosis may remain EBH as

females age, a principzd diagnosis of EBH for

male visits may have been supplanted earlier by

other diagnoses.

The results of HIS and HANES studies in

conjunction with visit data from NAMCS provide some insight into the utilization of ambulatory medical care resources by those in need of

treatment. According to the findings of HANES,

an estimated 23.2 million adults aged 18-74

years had definite hypertension, 23.4 million

had borderline hypertension, and 81.4 million

were normotensive. However, HANES dSO

showed that of the borderline and normotensive

groups 89 percent and 2.0 percent, respectively,

took regular medication for high blood pressure,

leading to an assumption in the HANES report

that an additional 3.7 million adults had controlled hypertension, or a totdl EBH prevalence

of 26.9 million. NAMCS estimates for 1975 and

1976 show 74.7 million visitsby patients aged 18

to 74 years with EBH as a diagnosis listed first,

second, or third, that is, EBH was a recognized

and diagnosed condition regardless of the principal reason for the visit. If 37.3 million (onehalf of 74.7 rnilIion), the average yearly visits in

which EBH was a diagnosis is divided by the

HANES EBH prevalence of 26.9 million, there

was an estimated average minimum visit rate of

1.4 visits to office-based physicians per year for

each person aged 18 to 74 years in the population who has hypertension. This utilization

rate provides a model and a benchmark for estimating and evaluating utilization of physiciari

resources by the segment of the population

needing treatment for EBH. One reason for the

low rate of utilization may weII be due to the

fact, shown in HANES, that 55 percent of the

population estimated to have definite hypertension were never diagnosed as hypertensive. As

consumer education reduces this number, the -

rate of utilization may increase.

Since EBH, is a chronic condition requiring

continuous care and maintenance therapy, it is

not surprising that over 89 percent of visits were

made by returning patients with EBH as a principal and recurring problem. Nor is it unexpected, in view of the high proportion of

return visits, that in responding to the item on

the Patient Record which caIIs for the chief

complaint as nearly as possible in the patient’s

own words, 40 percent of all EBH visits were

designated as “progress Visits)’b and an additional 27 percent as abnormally high blood pressure (table 2). Both of these reasons given by the

patient are an indication of his prior awareness

of the condition. Headache, vertigo, and fatigue,

which are sometimes symptomatic of EBH, motivated another 14 percent of visits for EBH.

bAccording to the symptom classification developed for use in NAhlCS, “progress visit” was the

appropriate category if the patient stated that the reason

for visit was “hypertension check” or “blood pressure

check. ” It does not necessarily represent all followup

visits which may be otherwise coded.
4

Table 2. Number and percent distribution of hypertension

diagnosed office visits by patient’s principal problem, compiaint, or symptom: United States, Januarv 1975-Dmmber

1976

Patient’s principal problem, Number of

complaint, or symptom and Percent visits in

NAMCS code 1 thousands

of visits

All principal problems ........... 46,128 100.0

Progress visits . ....... ........... 980,985 18,336 39.8

Abnormally high blood pressure ..205 12,582 27.3

Heedache ...................................O56 2,759 6.0

Vertigodizziness ....................... 069 2,471 5.4

Fatigue ...... ...................... ..........004 ‘1,216 2.6

General medical exam ............... 900 973 2.1

Nervousness .......... .................... 810 696 1.5

All other problems . ........................ 7,096 15.4

1 Based on ~ symptom classification developed for use in

NAMCS.

2CategorY 980, progress visit-specified condition includes

“check for hypertension”; Category 985, progress visit-unspecified

condition, includes “blood pressure check. ” These categories do

not necessarily reflect the total number of followup visits for

hypertension, which may be otherwise coded.

S]ncludes 1.3 mtilion visits coded “none” or “unknown. ”

Periodic blood pressure measurement is

important both in treating EBH and as a

screening device for hypertension detection and

control.6 The degree to which this diagnostic

technique was used, as well as the number of

types of diagnostic and therapeutic services rendered during EBH visits, are shown in table 3.

About 80 percent of EBH visits included a blood

pressure check. This may be an underestimate

due in part to measurement error in that visits

for hypertension often include a limited or general examination in which blood pressure is routinely measured but not separately recorded.

Drugs were the most frequent form of therapy

(61 percent of EBH visits), while medical counseling was an aspect of treatment in almost 15

percent of EBH visits.

Since detection of hypertension as early as

possible is crucial to its control, investigation of

the use of the sphygmomanometer or other

measuring device during visits for conditions

other than EBH is revealing. According to the

data given in table 4, one-third of all physician

iisits included blood pressure checks. lIowever,

as a pr( portion of EBH visits only, blood pressure checks increased considerably, as would be

Table 3, Number and percent of office visits for principal

diagnosis of essential benign hypertension, by diagnostic and

therapeutic services ordered or movided: United States.

January 1975-December 1976

Diagnostic and

therapeutic service

All vtsitsl ...... .........................

Diagnostic services

Limited history -exam.., ....................

General history -exam .......................

Clinical laboratory test ................... ..

X.ray .............................. ..................

8100d pressure check .......................

Electrocardiogram ............................

Therapeutic services

Drug administered or prescribed . ...

injection .. ....................d...... ..... ........

Immunization ..................................

Medical counsel ing ...........................

Psychotherapy or therapeutic

listening ........................................

Other services provided .... ................

Number of

visits in

thousends

46,128

25,301

5,919

9,483

2,167

36,861

3,540

28,141

3,691

834

6,747

901

1,931

—

Percent of

visits

‘100.0

54.9

12!.8

20.6

4..7

79.9

7.7

61.0

8.0

1.8

14.6

2.0

4.2

1 Figures wil] not add to totals, since more than one service

might he provided.

21ncIudes prescription and nonprescription drugs.

expected. It is interesting to note that in those

specialties that treated few or no cases of hypertension, such as neurology, urological surgery,

and ophthalmology, blood pressure checks were

made in a fair percentage of visits. It is not unexpected to , find that specialists in cardiovascular diseases made more frequent use of the

blood pressure check (72 percent of visits) than

did any other specialist. Blood pressure was also

measured in about 60 percent of visits to both

internists and obstetrician-gy necologists.

Table 5 lists number and percents of visits for

principal diagnosis EBH by visit status, seriousness of the patient’s principal problem, and disposition. Because most visits for EBH were

return visits and because EBH is so often asymptc]matic, it is reasonable that although EBH is a

condition requiring continuous medical care,

only 22 percent of visits yere judged “serious”

or “very serious” by the physician. The highest
5

Table 4. Number and percent of blood pressure checks made during office visits for all diagnoses and for vis!ts wnh hypertension as first,

second, or third diagnosis, by selected spec(altles: United States, January 1975-December 1976

Specialty

All blood pressure checks .......... ................................ .... ....... .

General and family practice ............................. ............ .............. ..... .

Internal medicine ........................ ......... ........ .... ............................... .

General surgery ............. ................. ................................................. .

Obstetrics.gynecology ......................... ........................ ............... ..... .

Cardiovascular diseases ..................................... ...............................

Pediatrics ......................................................... ............................... .

Orthopedic surgery ..................................... ........... ..........................

Urological surgery ......................... ...................................................

Psvchiatw .. ................................................................. .................... .

Neurology ................................................... .....................................

Ophtblmlogy ... ...... ..... ............................ .............................. ........

~olaryngology ................................................................................

All other specialties ............. ....... ...................... ................................

All diagnoses

Blood

pressure

checks In

thousands

383,359

190,139

77,859

17,732

57.920

9;679

9,712

680

2,797

1,639

848

1,094

496

12,754

Percent

of

visits

33.2

41.3

59.7

23.0

59.7

71.6

9.1

1.5

13.5

5.4

22.4

2.0

1.8

7.4

Hypertension diagnosis

Blood

pressure

checks In

thousands

58,865

34,431

16,674

2,618

973

1,840

●

●

*

●

●

●

●

1,406

Percent of

hypertension

visits

78.5

79.6

80.5

73.8

74.9

82.7

●

●

*

●

.

●

●

66.6

Table 5. Number, percent distributions, and mean duration in minutes and standard error of mean duration of hypertension diagnosed

off ice visits by visit status, seriousness of problem, and disposition: Unitad States, January 1975-Decemtxv 1976

Visit status, degree of

seriousness, and disposition

All visits ............ ....................................................................

Visit status

New patient ...... ...................................................... .................... .... .

Returning patient:

New problem ........ ............................ ..................................... .....

Recurring problem ................................... .................................. .

Degree of seriwsness

Very serious .................................................. ....................... ......... ...

Serious ....................................... ......................................................

Slightly serious ............................................... ................ ..................

Not serious ...................................................... .......... .......................

Disposition

No followup piannd ........................ ................................................

Return visit:

%x=if ied time ......... ........ ........................................................... .

If neded ....................................... .............................. ............. ...

Referral to another physician or agency ...... ................................... .

0ther2 ........................................................ ..... .................................

Number of percent

visits in distributions

thousands of visits

46,128 100.0

2,254

2,708

41,165

765

9,479

21,373

14,51C

1,189

39,708

4,734

832

1.161

4.9

. 5.9

89.2

1.7

20.6

46.3

31.5

2.6

86.1

10.3

1.8

2.5

Mean duration

in minutes

14.3

24.0

18.7

13.5

17.8

14.9

14.0

14.3

. . .

. . .

. . .

. . .

. . .

Standard

error of

mean duration

.28

1.62

1.12

.28

1.84

.42

.43

.42

. . .

. . .

. . .

. . .

. . .

1 Figures MII not add to totals because more than one disposition w3S possible.

Zlnc]udes telephone fo[]ow,up, returned to referring physician, and admitted to hospital.
6

proportion (46 percent) were considered “slightly

serious, ” with 32 percent assigned to the “not

serious” cat egory.

While the average visit for EBH lasted about

14 minutes, which is about the same as the average duration of all physician visits in NAMCS,

“ duration of EBH visits was affected by the status

of the problem. When EBH was presented as a

new problem to the physician, either during an

initial encounter or by a patient the physician

had seen before, the visit lasted longer (24.0

minutes and 18.7 minutes, respectively) than did

visits involving returning patients with EBH as a

recurring problem (13. 5 minutes). The duration

of the new patient encounter was significantly

longer than that of the returning patient with a

new problem. This may be due to the need for

more intensive workup in new patient visits.

For example, 57 percent of all initial visits for

EBH included a general examination as opposed

to 23 percent of return visits for a new problem

and only 10 percent of visits for an old problem.

Seriousness did not significantly affect visit duration.

The instruction by the physician to return at

a specified time, which was given in 86 percent

of EBH visits, was no doubt heeded by the patient, since it very closely reflects the proportion

of return visits made. An additional 10 percent

were told to return if needed, and 2 percent

were referred to another physician. In only 3

percent of EBH visits was no followup planned,

and most of these visits were “not serious. ”

Attesting to the chronic and asymptomatic naFigure 3. PERCENT DISTRIBUTION OF OFFICE VISITS FOR

ESSENTIAL BENIGN HYPERTENSION BY SPECIALTY VISITED:

UNITED STATES, JANUARY 1975-DECEMBER 1976

or

Cardiovasculard

Generalsurgery

. .-

ture of most EBH visits, the disposition of very

few visits was admittance to a hospital.

Most EBH visits (87 percent) took place in

the office of either the general and family practitioner or the internist, with the remaining 13

percent distributed among the practices of

specialists in cardiovascular diseases, general surgery, and other diseases (figure 3).

Table 6 displays EBH visits by region, Iocation, and type of practice. While office-based

physicians in the least poptdated West Region

had the fewest visits for hypertension, visit rates

were substantially alik’e for aIl regions. Division

of visits for EBH by metropolitan or nonmetropolitan areas was parallel to the average for all

NAMCS visits.

Hypertension patients tended to visit physicians in solo practice more frequently than did

patients presenting all diagnoses combined (70

percent of hypertension visits were to physicians

in solo practice as opposed to 60 percent for all

other diagnoses).

Table 6. Number of office visits and percent distributions and

average annual visit rate for essential benign hypertensiorl by

location and twre of Dractice: United States, Januery 1975-

December 1976

Location and type

of practice

All visits ......................

LOCATION OF PRACTICE

Region

Northeast.., .... ............. ..........

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

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

West.., ...................................

Type of area

Metropolitan .............. ...........

Nonmetropolitan ..... .............

TYPE OF PRACTICE

solo ......................! ...............

Other . ...... ...........................

T

Number

Percent of visits in

thousands of visits

46,128 100.0

12,456 27.0

13,376 28.0

12,894 28.0

7,402 16.1

33,079 71.7

13,049 28.3

Annual

rate per

100

perscmsl

!1.1

————

12.8

11.8

9.7

10.2

11,7

9.8

.,.

.,.

.

national estimates published by the U.S. Bureau of the Census

for the civilian rroninstitutionalizcd population as of July 1, 1975,

in Series P-25, No. 614, and as of July 1, 1976, in Series P-25,

Nos. 643 and 646, of Current Popuratiot] Reports.

2111 CIUde S partnerships ~nd ~roup Practiws.
damdata7

REFERENCES

lNational Center for Health Statistics: Ambulatory

medical care rendered in physicians’ offices: United

States, 1975, by H. Koch and N.J. Dennison. Adr.!ance

Data From Vital and Health Statistics, No. 12. DHEW

Pub. No. (HRA) 77-1250. Health Resources Administration. Hyattsville, Md., Oct. 12, 1977.

2National Center for Health Statistics: Physician

\isits: Volume and interval since last visit, United

States-l 971, by K.M. Danchik. Vital and Health Statistics. Series 1O-XO. 97. DHEW Pub. No. (HRA) 75-1524.

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

1975.

3h’ational Center for Health Statistics: Blood pressure levels of persona 6-74 years, United States,

1971-1974, by J. Roberts and K. Maurer. Vital and

Health Statistics. Series 1l-No. 203. DHEW Pub. No.

(HRA) 78-1648. Health Resources Administration. Washington. U.S. Government Printing Office, Sept. 1977.

4 Na tional Center for Health Statistics: ‘Hypertension: United States, 1974, by A. hfoss and G. Scott.

Adoarxe Date From Vital and Health Statistics, No. 2.

DHEW Pub. No. (HRA) 77-1250. Health Resources

Administration. Rockville, Md., Nov. 8, 1976.

5Nation~ Institutes of Health: Some characteristics

related to the incidence of cardiovascular disease and

death: Framingham Study, 16-year follow-up, by D.

Shurtleff in Karmel, W.B., Gordon, T. eds, The Framingham Study. Pub. No. 74-599. Public Health Service.

Washington. U.S. Government Printing Office, 1974.

6h’ational Heart, Lung, and Blood Institute: Report

of the Joint h’ational Committee on detection, evaluation, and treatment of high blood pressure. DHEW Pub.

No. (NIH) 77-1088. National Institutes of Health.

Bethesda, Md.

SYMBOLS

Datanot available...........................j................ ---

Category not applical)le ......... ......................... . . .

Quantity zero ............... ............ .... ...................

Quantity more than O but less than 0.0 S......... O.;

Figure does not meet standards of reliability

or precision ................................ ............ ....... *

TECHNICAL NOTES

SOURCE OF DATA: The information presented

in this report is based on data collected in the

Nat ion al Ambulatory Medical Care Survey

(NAMCS) during 1975 and 1976. The target

population of I%4MCS encompasses office visits

within the conterminous United States made by

ambulatory patients to physicians who are principally engaged in office practice.

S.\\lPLE DESIGN: IWMCS utilized a multistage probability design that involves samples of

prim~ sampling units (PSU’S), physician practices within PSU’S, and patient visits within practices. Each year a sample of practicing physicians is selected from master files maintained by

the .+merican Xledical .%sociation and the

.%merican Osteopathic Association. These physicians are requested to complete Patient Records

fbrief encounter forms) for a systematic random

sample of CJf~lCe \isits takng place \\-ithin their

practice during a randomly assiLgned \veekly reporti~,g period. (.A facsimile of the Patient

ReCCJK~used is shoun in a pre~ious issue of. lc/-

~au ct’ .D(ZtQ Fi-CI HZ 1‘ital a}zd Hlwltlz Statistics, SO.

12. October 12, 197’7. ) Characteristics of the

physicim.s practice, such as primary specialty

.md type <J: practice, are obtained during an

lHCILICtIL~II inttr~ieli”. .-\ detailed desc~iption of

:hc X.MICS desi~n :mcl procedures has be-t-n in

Sc.:ics 15. X.;I:IIII;I 5S, ot I ‘itfzi a)lfi Iif”altlz Sta-

,..’ “,1”<.

SAMPLIING ERRORS: Since the estimates for

this report are based on a sample rather than the

entire universe, they are subject to sampling variabilityy. The standard error is primarily a measure

of sampling variability. The relative standard error of an estimate is obtained by dividing the

standard error of the estimate by the estimate

itself and is expressed as a percent of the estimate. Relative standard errors of selected aggregate statistics are shown in table I. The standard

errors appropriate for the estimated percentages

of office visits are shown in table II.

ROUNDING: Aggregate estimates of office visits

presented in the tables are rounded to the nearest thousand. The rates and percents, however,

Table 1. Approximate relative standard error of estimated

numbers of office visits, NAMCS 1975-76

Estimate Relative standard

in error in

thousands percentage points

600 ..........................................

1,000.......................................

2,000 ........ ...... ........ .... ...... .. .....

4,000 ....................... ... ........ .... .

10,000 ... .... .. .... ...... .. .... .......... ..

40,000 ........ ..... .. ........... ...... .....

200,000 .. .... ............ ..... ........... .

1,000,000 ....... ... .......... ....... ... ..

30.2

23.5

16.7

12.0

8.0

4.8

3.4

3.1
8

Table II. Approximate standard errors of percentages for

estimated numbers of office visits, NAMCS 1975-76

Basa of percentage

(number of visits

in thousands)

600 ........................

1,000.....................

2,000 ........ ....... ......

4,000., ...................

10,000 .... ...............

40,000 ...... ...... ...... .

200,000 ........ .........

1 ,000,000 ..............

Estimated percentage

1 or 5 or 10or 20 or 30 or so

99 95 90 80 70

Standard error in percentage points

3.0

2.3

1.6

1,2

0,7

0.4

0.2

0,1

—

6.5 9.0

5.1 7.0

3.6 4.9

2.5 3.5

1.6 2.2

0.8 1.1

0.4 0.5

0.2 0.2 1

12.0 13.8

9.3 10.7

6.6 7.5

4.7 5.3

2.9 3.4

1.5 7.7

0.7 0.8

0.3 0.3

15.0

11.6

8.2

5.8

3.7

1.8

0.8

0.4

Examnle of use of table: An estimate of 20 percent based

on an aggregate estimate of 80,000,000 visits has a standard

error of 1.3 percent. The relative standard error of 20 percent is

6.5 (1.3 percent + 20 percent)

were calculate d on the basis of original, unrounded figures. Due to rounding of percents,

the sum of percentages may not equal 100.0 percent.

DEFINITIONS: An ambulatory patient is an individual presenting himself for personal health

services who is neither bedridden’ nor ctirrently

admitted to any health care institution on the

premises.

An o~~ice is a place that the physician identifies as a ~ocation for his ambulatory practice.

Responsibility over time for patient care and

professional services rendered there generally

resides with the individual physician rather than

an institution.

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 health services.

A physician is a duly licensed doctor of

medicine (M.D.) or doctor of osteopathy (D.0.)

currently in practice who spends time in caring

for ambulatory patients at an office location.

Excluded from NAMCS are physicians who

specialize in anesthesiology, pathology, radiology; physicians who are federally employed;

physicians who treat only institutionalized

patients; physicians employed full time by an

institution; and physicians who spend no time

seeing ambulatory patients.
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE B Public Health Service I Number 29 . ‘da, 17’278

A Comparison of Nursing Home Residents and Discharges

from the 1977 National Nursing Home Survey: United Statesl

This report, comparing nursing home residents and discharges, presents provisional estimat es from the 1977 lNational N’ursing Home

Survey (NhTHS) conducted by the National

Center for the Health Statistics. It is a nationwide sample survey of nursing hom,es describing

the facilities and their costs and the characteristics of the residents, the discharges, and the

staff.

The survey is the second in an ongoing

NNHS system. The first survey was conducted

between August 1972 and April 1974. The data

for the 1977 NNHS were coIlected from 31ay

through December 1977 with a midpoint of

August 1977. The estimates are provisional,

since they are based on a subsample of about

340 of the 1,700 facilities in the national survey.

Nursing homes included in the survey were

nursing care homes, personal care homes (with

and without nursing), and domiciliary care

homes as classified by the 1973 Master Facility

Inventory2 In addition, all nursing homes that

opened for business between 1973 and December 1976 were included. Another Advance Data

presenting provisional estimates of facility and

staff characteristics will be published shortly.

Data presented in this report include a

demographic description of the resident and discharged populations and a discussion of selected

1This report was prepared by Esther Hing and Aurora

Zappolo, Division of Health Resources Utilization Statistics,

2National Center for Health Statistics: Inpatient

health facilities as reported from the 1973 MF1 Survey,

by A. Sirrocco. Vital and Health Statistics. Series 14-No.

16. DHEW Pub, No. (HRA) 76-1811. Health Resources

‘Administration. Washington. U.S. Government Printing

Office, May 1976.

heaIth status measures. The data alsn include 3

discussion of selected measures rela~ed to &e

utilization of nursing homes such as prior living

arrangements, length of stay, living arrangements

after discharge, source of payment, and charges

for care. The resident data are based on a sample

of all residents on the nursing home”s roster the

night before the data collection began. Consequently, they may be considered a “’snapshot”

of nursing home residents on any gi~.en day

between Llay and December 1977. Similar daa

were collected in the 1973-74 XNHS.

The discharge data, in contrast, are based on

a sample of all discharges from the facility during the calendar year 1976. Discharge data not

coIlected in the earlier survey were added to the

NNHS design to provide information on duration of stay in nursing homes and on the characteristics of persons who spend a relatively short

time in the facility.

The discharge data therefore differ from the

resident data in several major areas. First, the

universe is all discharges from the facility during

the entire year 1976, while the uni~~erse for the

residents is aIl persons on the roster for a singIe

night during the data collection period (May

through December 1977). Second, the discharge

data represent 1976 characteristics, in contrast

to the resident data which represent 1977 characteristics. Jloreover, the discharge data were, of

necessity, limited to information recorded in the

medicai record, whereas the resident data include personaI knowIedge of a careg-iver \\’hen

the information was not available in the record.

Finally, there is a theoretical difference in the

universe, since the discharge sample could have

included the same person more than once if he

or she was discharged more than once from a
nursing home during 1976, while the resident

sample precludes any’ chance of persons falling

ihto the sample more than once.

For this report’s purposes, residents refers to

persons residing in the nursing home at the time

of the survey (May to December 1977), and discharges refers to persons formally discharged

from the nursing home during 1976. Both terms

characterize the same pool of patients receiving

c“me in nursing homes measured at different

points in time.

Information on sampling variability is presented in the Technical Notes. ,

DEMOGRAPHIC CHARACTERISTICS

On any given day during the period May

through December 1977, there were about

1,287,400 nursing home residents in 18,300

nursing homes. This provisional estimate is a

20-percent increase over the 1,075,800 residents

estimated by the 1973-74 NNEIS. This increase

is slightly exaggerated, since the 1977 NNHS inc Iuded nursing and personal care facilities,

‘ whereas the 1973-74 NNHS included only facilities providing some level of nursing care. The

number of residents in facilities that provide no

nursing care, however, is small. According to the

1973 Master Facility Inventory, about 1 percent

of all nursing home residents were in such facilities. s An increase in the number of persons in

nursing homes is expected, since the elderly

population in the United States is increasing.

For example, between 1970 and 1980 the number of persons 65 years and over in the population is projected to increase by 22 percent.A

Nevertheless, the 1,097,900 residents 65 years

of age and over represent the same proportion of

the United States population aged 65 and over

as was found in the 1973-74 NNHS—about 5

percent.

3National Center for Health Statistics: The Nation’s

Use of HeaJth Resources, 1976 Edition. DHEW Pub. No.

(H RA) 77-1240. Health Resources Administration.

Washington, U.S. Government Printing Office, 1977. p,

73.

4U,S. Bureau fo the Census: Demographic Aspects of

Aging and the Older Population in the United States.

Current Population Repovts. Special Studies. Series P-23,

No. 59. Washington. U.S. Government Printing Office,

May 1976.

The survey found that the estimated number

of persons discharged from nursing homes during 1976 was about 973,100. Because the

methodology to count discharges differed from

that used in earlier surveys, comparisons qf

figures are not valid, and therefore trend statements are not presented.

Table 1 shows that in 1977 nursing home

residents were elderly (median age”80), primarily

female (71 percent), widowed (58 percent), and

white (92 percent). Table 2 shows that discharges in 1976 were also elderly (median age

80) and primarily female (64 percent). The distribution on the basis of marital status, on the

other hand, shows a greater proportion of dkcharges who were married (20 percent compared

to 13 percent of the residents) and fewer who

Table 1, Provisional number and percent distribution of nursing

home residents by age, sax, race, marital status, and median

length of stay: United States, 1977

Selected resident characteristics

All residents ...........................0.

Aae

Under 65 years .................................

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

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

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

Sex —

Male ........... .... ........ .................... ......

Female .... ........ .................................

Race

Whitel ........................................ .....

All other races or ethnicities ............

Current marital status

Married ............................................

Widowed ................ ...... ....................

Divorced or separated ......................

Never married ... .................... ..........

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

Median length of stay

Number of days.., ................. .........

1 ~xclud~s spanish-American.

Nursing home residents

Number

1,287,400

189,500

202,000

470,600

425,300

369,400

918,000

1,180,300

107,100

160,800

743,700

87,600

265,900

●

582

.

Percent

istribution ,

I

loo.o~

14.7

15.7

36.6

33.0

,.

28.7

71.3

91.7

8.3

I 2,5

57,.3

6.8

20.7

@

. . .
aamce&a3

1

Table 2. Provisional number of discharges from nursing homes

and percent discharged alive by age, sex, and marital status:

United States, 1976

Selected characteristics

of discharges

All residents...............................

—Age

Under 65 years.................................

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

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

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

Male .................................................

Female .............................................

Marital status at discharge

Married ............................................

Widovted ................................... .. ..

DWorcad or separeted ......................

Never married ..................................

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

Discharges from

nursinry homes

Number

973,1OC

135,4m

161,200

381,800

294,700

349,700

623,400

192,100

552~

84,700

108,300

37,700

Percent

Discharged

alive

74.2

89.9

73.4

75.9

65.3

74.8

73.$

80.1

71.8

86,2

58.4

●

were never- married (11 Percent comrmred to 21

percent of the residents}. However, & propor:

tions of discharges who had other marital

statuses were no~ statistically different from

those for residents.

Ultimately, the outcome of nursing home

cme may be characterized by. whether the discharge is dive or dead. Overall, about 3 out of 4

(74 percent) of the discharges were alive (table

2). Age was related to whether a discharge was

alive or dead. Younger discharges were more

Iikely to be discharged alive; 90 percent of those

under 65 years of age were discharged alive compared to 75 percent of those 65-84 years of age

and 65 percent of those 85 years and older. Sex,

on the other hand, had no bearing on outcome.

The proportion of females discharged alive (74

percent) was simihr to that of males (75

percent).

HEALTH STATUS

For this report, the health status measures

selected were primary diagnosis and the ability

to perform activities for daily living. The resident’s primary diagnosis \Yas that provided by

the physician at the time of the last, i.e., most

recent, examination. In order to examine the

relationship bet~veen eventual outcome and

health status at admission the pnmq diagnosis

for discharged persons \vas the diagnosis made at

the time of admission. Any comparisons

between the diagnoses of residents and of discharges should take into account the difference

in the time of measurement (most recent examination versus admission) as w-en as the

potential differences in the quality of the

diagnoses at each of these points.

Table 3 shows the most recent primary

diagnosis for residents, with about 37 percent

having diseases of the circulatory system, 22 perTable 3. Provisional number of nursing home residents and rate

per 1,000 residents by primary diagnoses at last examination:

United States, 1977

Primary diagnosis at

last examination

All residents .............. ...............

Diseasesof the circulatory

system ........................................

Congestive heart failure ....................

Arterlosclorosis ................................

Hypertermhn . .................................

swk ..............................................

Other dheeses of the circulatory

system............................................

Mesttel disorders md senility

without psychosis . ....................

Psychosis, including servile................

Chronic brein syndrome ...................

&nillty wfthout psychosis ...............

Mantel retardation ...........................

Naurosls, alcoholism, drug

eddiction, s+ndother

mantel disorders.............................

Othar diagnoses .. ..........................

Diebetes ...........................................

Fr=tures ..........................................

Diseasesoft% nervous system.........

Arthritis or rheumatism ...................

Center ..............................................

Other or unknowm ...........................

Nursing home residents

Number

1,287,400

477,400

57,100

235,800

4s,300

102,3CRl

37,0CNJ

287,600

85,~

91,600

59,&

*

486,200

77,200

40,900

50,7(m

57,1m

●

228,100

Rssteper

1,000

residem

1.OCXLo

3X).8

44.4

mz.o

35.2

79.5

28.8

223.4

66.1

71.2

*

45.2

●

3n.7

50.0

31.8

47.1

44.3

●

175.6
I

4

Table 4. Provisional number of discharges from nursing homes

and percent discharged alive by selected primary diagnoees at

admission: United States, 1976

Selected primary diagnosis

at admission

All discharges ...........................

Diseases of the circulatory

system ................................... .... .

Congestive heart failure .... .......... ......

Arteriosclerosis ................................

Stroke ... ........... ................................

Mental disorders and senility

without psychosis ......................

Chronic brain syndrome ........ ...........

Other diagnoses ......... ..................

Diabetes ....................... ....................

Fractures ....................... ...................

Gnmr..............................................

Discharges from

nursing homes

Number

973,100

428,300

53,500

191,400

115,600

118,300

51,600

426,500

49,800

71,500

75,800

Percent

Discharged

alive

74.2

72.4

●

73.0

71.1

73.5

56.9

76.3

80.5

84.6

60.7

cent havirw a mental disorder or senility without

psychosis, and 38 percent having some other

problem. \Vithin each of these groups, only the

larger categories of diagnoses are shown. For

example, the most frequent (18 percent of the

residents) primary diagnosis was arteriosclerosis,

which is the “Diseases of the circulatory system” group.

Table 4 shows the primary admitting diagnosis by outcome for the sample of discharges.

Preliminal~ analysis suggests that discharges admitted with diagnoses requiring short-term or

recuperative care were more likely to be discharged alive than those admitted with diagnoses

which can usually only be controlled or monitored. For example, discharges admitted with

fractures \rere more likely to be discharged alive

(85 percent) than those admitted for chronic

brain syndrome (57 percent) or cancer (61

percent),

Fiqurc 1 sho~vs the ability of’ residents to

perf(~rm selected activities for daily living. A

lar:d mtijt)lity (86 percent) required assistance in

bathin~. LISlldI)” (III the part of another person

r.i[her thin by the use of special cqtliprncnt.

Fiiure 1. PERCENT DISTRIBUTION OF NURSING HOME RESIDENTS

BY LSVEL OF DEPENDENCY IN PERFORMING SELECTEO ACTIVITIES OF OAILY LIVING: UNITED STATES, 1977

LEVEL OF DEPENDENCY

&!mE

Indepmdznt] .... .. . .............. ...... ~ 74.S

@?ms

‘~,~::~:::::d:d::..wa7, !ndqmndem] ...... .......... .............

Usirnl todes room

lndependentl ..... ............................

Rawire8 UP- . .........................

DOOSnot M 10W roam ................ ~&4

Bx!!!Y

Walks in&tndentlyl ......................

E

.. ’.,= ,

.,

Walks with assi$wme..,,., .................. 27.4

Cornineme

No difficulty cmmrolli~ bowel

F

,,, ,

,,,,.,

or bladder ....................................

54.6

.,

Diff!culsy with bowel mntrol .......... B.5

Diffkulty with bladder mntrol ........ 3.2

Difficulty With COilVO! Of both

P

.:.:.:+:+:.:+: .

:.:::::.:.=.:.: .’~ .,

bowd and bladctsr ....................... . . .

Ossomy patimr .............................. 5.a

Eating

- -“’2

Independent] ...................... ..........

Requires assissanca [includei fed by

tub or intrzwmo.slvl ......... .....

I 1 I I I ( I 1 I 1 I

o 20 40 50 80 10U

~ewer, but still a majority (68 percent), required

some assistance in dressing or did not dress. Less

than half, on the other ha;d, required assistance

with either using the toilet (42 percent) or eating (32 percent).

Information on activities for daily living for

discharges is limited to those activities , mobility

and continence, which are described in the medical record. Figure 2 shows the proportion of discharges who had problems with mobility or

continence. A far greater proportion of discharges than residents (figure 1 ) were bedfast:

Twenty percent of the discharges were bedfast,

compared to only 5 percent of the residents.

The proportions of residents and discharges having any difficulty with continence, however,

\vcre the same (45 percent). These :Ind other
akmdata5

Figure 2 PSRCENT DISTRIBUTION OF DISCHARGES FROM NURSINI

HOMES BY L!SVW OF DEPENDENCY IN PERFORMING SELECTE

ACTIVITIES OF DAILY LIVING: UNITED STATES, 1976

LEVEL OF Dependency

MobiliIy

walks, Wirh or Wichwz

F

Zzimxre . . . . :. ., 435

Cllairhsr..... ........... . ..--- .. 26.1

PDF*. . . ... ...........,— ... ... .... 19.8

Unk--- ......... ..... . .... ~ 10,6

Caltimnce

!40 diffmky cmmlliq bomel 49.3 w bklc&- . .......... ..--... -.-...

oiffiwlry wirrlboWiff L!4ubdn

mnvuL_.. . . . . . . . . . . . . . . . .. . .

Oirfiilry Wiul Camml 0s bob

hawal =?4 bWcbr. . . . . . . . ..

osrmY@=m.... . ..”—...

U*- .. . ... ....... . .. ...

H ‘“’

1 t I I 1 1 I I I I I

o 20 40 Eo So lCO

PERCENT

comparisons in heakh status from the fuII

nati&al sample will be explored in future

rep orts in Series 13 of Vital and Health

Statistics.

UTILIZATION OF NURSING HOMES

This section presents a brief profile of the

process of nursing home utilization in terms of

the primary reason for admission and living arrangements prior to admission; length of stay

and charges for care; and the place to which a

Iive discharge tvas transferred.

Poor physical health was cited for 76 percent of nursing home residents as the primary

reason for being in the facility. In contrast, lack

of social or economic resources, disruptive

behavior, or other reasons w-ere cited as reasons

for 12 percen~ of the residents, mentaI illness

was cited for 7 percent, and mental retardation

for only 5 percent of the residents.

The poor physical health of the majority of

residents tvas reflected in their living arrangements prior to admission. .About half (54 percent) of the residents were admitted from a

health facilit}. This ,group was composed mainly

of those admi~ted from a genera] or short-stay

h~~spir.d (32 percent) m-id those transferred from

~n~)the: nursi:?z hornc ( 13 percent). Forty-one

p~:rccn~. h{)~tc~.;r, h.d moved from A pri~”;i(t’ (Jr

Table 5. Provisional number and percent distribution of nursing

home residents by living arrangements prior to admission and

primary reason for care: United States, 1977

Living arrangement prior

to admission and primary

reason for care

Living arrangement

prior to admission

All residents .. ...................... .....

Private or semiprivate residence .......

With others .. ........ ......................... .

Alone ........................................... .

Unknowm if wkh others ................

Another health facili~l ............ .......

Another nursing home ........ .........

General or short~y hospital ......

Mental hospital ................ ... .........

Other health facility or

unknowr type ............................

Unknown or other arrangement .......

Primary reason for care

All residenta ................. .. ..........

Poor physical health .... .....................

Mental illness ......... ..........................

Mental retardation ...........................

Social, economic, behavioral,

or other reason ...............................

—

Nursing home residents

Numbar

1,287.400

529,100

325,000

154,100

49300

694,800

164,600

405,700

80,000

44,500

63,500

1,287,400

983,100

91,000

64,400

148,800

Percent

Distribution

100.0

41,1

25,2

12.0

3,9

54.0

12.8

31.5

6.2

3.5

4.9

100.0

76.4

7.1

5.0

11.6

1347300 of these residents, admitted from amtk healtfr

facility, ;ad gone to that facility. from a private or semiprivate

residence.

semiprivate residence , ,where they had usuaHy

lived with others. (table 5).

Table 1 shows that the median length of stay

for residents–the time interval between the last

admission date and the survey date—was 582

days, or 1.6 years. Figure 3 shows that nearly a

third of the residents (32 percent) had been in

the facility for 1 to 3 years with another third

(31 percent) being in the facility for 3 years or

more. The sun’ey methodology for residents has

the capacity only to measure the time the resident has been in the facility, not the length of

time that wmuld ultimately be spent in the facility. Such information on the entire duration of

stay in the f:~cility is onc of the unique features

of the dischar,gc ciata. Since the median length of

stay f[~r r-esidcnts tiws 1.6 years, the entire dura-
6

Figure 3. PERCENT DISTRIBUTION OF NURSING HOME RESIDENTS

IN 1977 AND DISCHARGES DURING 1976 BY LENGTH OF STAY.

UNITED STATES

eo—

ml~=~’’’$””

70 — mR=id,n?$1977

g w—51.8

~ 50 — ,,,

E ,.::

1- ,:

:: 940 ,,

. . .

;

,..

... 32,3 31,3

8 30 . . . . .

K .. :.:

&

:: :..

20 — ::

.:, .

12.0 11.3

10 — ::

9.8

::,

.

:::,

0

L.ESthan 3 to less 6 to less 1 to less

than than than 3 years

3 months 6 months 12 month% 3 Vmra ‘r ‘0’8

LENGTH OF STAY1

1Fmrmidmlsm 1977tbncintervalbchwn admssiondatef.r ach retldentandWWY date.

tion of stay for discharges might be expected to

be considerably longer: However, this- was not

the case. Rather than a longer stay, the discharge

sample had significantly shorter median duration-84 days or 12 weeks. Fifty-two percent of

the discharges had been in the facility for less

than 3 months in contrast to only 13 percent of

the residents (figure 3).

The disparity between the residents’ and the

discharges’ length of time in the facility suggests

that there are two separate groups of persons

who use nursing homes: those admitted for

relatively long periods of time because there is

little chance of their chronic problems improving, and those admitted for relatively short pe

riods of time because recuperative care is,

needed. The resident and discharge samples in-’

eluded both types of users. The resident sample,

however, was more likely to include the longterm users, since the resident sample included

only residents in the nursing home on the night

before the survey. The discharge sample, in contrast, included a larger proportion of the shortterm users, since it included all discharges dwz”ng

calendar year 1976.

An important example of the short-term

user of nursing home care is the Medicare recipient. Medicare provides skilled nursing care for a

maximum of 100 days following hospitalization,

but the length of stay for recipients was far

under the limit. In 1976, the median time spent

in the facility by discharges using Medicare for

their primary payment source was 24 days (table

6); 12 percent of the discharges relied primarily on Medicine for payment of care.

Discharges receiving skilled nursing care

under Medicaid (17 percent) and those receiving

intermediate care under Medicaid (19 percent)

tended to have longer stays than those using

other sources of payment. The median stays

for discharges who had received skilled or

intermediate care paid for by Medicaid were 176

and 220 days, respectively, compared to median

stays of 24-85 days for the remaining payment

sources (table 6). Nevertheless, the median stay

for both Medicaid discharge groups for 1976

were still significantly shorter than the median

stay for residents in 1977 (582 days).

The effect of the difference in the health

status between the discharged and the resident

Table 6. Provisional number and percent distribution of discharges from nursing homes, median duration of stay, and average total

monthly charge by primary source of payment: United States, 1976

Number of Percent Madian

discharges

Average

Primary source of payment distribution duration

from nursing of stay total monthly

homes of discharges in days

charga

All primary sources of paymant .................... 973,100 100.0 & $816

Own incoma or family support ............................ .. 402,100 41.3 59 846

Medcare ....... ......................................................... 119,800 12.3 24 1,292

Medicaid:

Skilled care .................. .................... ................ ... 166,000 17.1 176 845

Intermediate care ................ .................. .............. 185,700 19.1 220 598

All other sources ... .............................................. 99,500 10.2 85 461
a&me&ta7

populations can also be seen in the comparison

of the average monthly charge. Overall, the average charge for residents in 1977 ($669) and for

discharges in 1976 ($8 16) were each significantly higher than monthly charges for residents

reported in pre~ious surveys of nursing homes;

the average charge for residents was $186 in

1964, $328 in 1969, and $479 in 1973-74. The

average charge for discharges in 1976 ($8 16),

however, was significantly higher than the average charge for residents in 1977 ($669). This

difference in charges is related to the differences in care received by the resident and discharge populations. The poor health of many in

the discharged population is reflected in the findings that 25 percent of all discharges died in the

nursing home and 45 percent of all live discharges were transferred to a general or shortstay hospital, presumably to receive more intensive care (table 7). Residents, in contrast,

tended to require less intensive care. For example, only 5 percent of the residents were bedfast compared to 20 percent of the discharged

population.

Resident’s average total monthly charge

1977 . . . . . . . . . . . . .. $669

1973 -74 . . . . . . . . . . .. $479

1969 . . . . . . . . . . . . .. $328

19 EM . . . . . . . . . . . . .. $186

Information on the places to which live dischwges were transferred shows that they were

more likely to receive continued care after discharge than to return to a private or semiprivate

residence. The proportion of live discharges sent

to another health facility (62 percent) was

Table 7. Provisional number and percent distribution of live

discharges from nursing homes by living arrangements after

discharge: United States, 1976

Discharges from

Living arrangement

nursing homes

after discharge

Number

Percent

distribution

All arrangements for live

discharges .......................... ..... 722,400 100.0

r I

Private or semiprivate residence .......

Another health facility .... ......... .......

Another nursing home ....... ..........

General or short-stay hospital .......

Mental hospital ........................ .....

Other health facility or

unknown type .............. ..............

Unknown or other arrangement ...... .

240,800

1448,100

96,200

322,700

●

●

●

33.3

62.0

13.3

44.7

*

1 1

I ~~.. percentwere know to have did here.

higher than that sent to a private or semiprivate

residence (33 percent ). Thus the high proportion

of live discharges was not necessarily due to improved heaIth status ; some persons were discharged to another facility because of deterioration of health and the need for more intensive

care. This is further reflected in the prop~ -tion

of discharges to another health faciIity who we, *

known to have subsequently died in that facility. Of the 448,100 persons discharged to

another “health facility, 19 percent died there.

Further analysis of the nursing home utilization process, from the inital admission into

the faciIity through eventual outcome, wilI be

presented in subsequent reports.

TECHNICAL NOTES

Since the statistics presented in this report twice the standard error. Provisional estimates of

ue based on a sample, they \\ill differ some~vhat standard errors for percentages of residents and

from figures tha~ w-ould ha~~e been obtained if a discharges m-e provided in table I; the provisional

complete census had been taken using the same standard errors for average monthly charges are

scheduIes. instructions. and procedures. The provided in table II.

stmd~rd error is plimariIy a measure of the The relative standard error of an estimate is

variability that occurs by chance because only a the standard error of the estimate divided by

s~mple, rather than the entire universe, is sur- the estimate itself and is expressed as a pcr-

}eyed. The standard error also reflects part of centage of the estimate. In this report, an .asterthc me.isurernen~ error, but it does not measure isk is sho}tm for any estimate with mot-c than a

JI1}” s)”j[cmatic hisses in the &ta. The chances 25-pcrccnt rclati\’e standard cm-or.

are tib~>u~95 out of 100 that an estimate from In this report, terms ,SUC1]w “similar” :Ind

?he .imple r!iffcrs from the t“aluc \vhich ivoulcl “the same” mean that any oh.wrvcd difference

hc lh[.~i:lcc! fr[)m a complele ~’t’nsus by less than b~’t~vwn t~vo cstinl:itcs being (x)mparc(l is )10/
8 amcedah’

Table 1. Provisional standard errors of percentages of residents

and discharges

Number of residents,

discharges

(base of percent)

50,000 ........................

100,000 ......................

200,000 ......................

400,000 ......................

800,000 ......................

1,000,000 ...................

1,200,000 ...................

Table II. Provisional standard errors of average monthly charges

Estimated percent

~

Standard error in percentage points

2.03 4.44 6.12 8.16 9.99 10.19

1.43 3.14 4.33 5.77 7.06 7,21

1.01 2.22 3,06 4.08 4.99 5.10

0.72 1.57 2.16 2.88 3.53 3.60

0,51 1.11 1.53 2.04 2.50 2.55

0.45 0.99 1.37 1.82 2.23 2.28

0.47 0.91 .1.25 1.66 2.04 2.08

Number of

residenta,

discharges

(base of ratio)

90,000 .......... ...

100,000 ...........

200,000 ...........

400,000 .. .........

600,000 . .. .......

800,000 .. .........

1,000 ,000 ...,....

1,200,000 ........

statistically significant. Terms such as “greater,”

“less,’.’ “larger, “ and “smaller,” indicate that any”

observed difference is statistically significant.

The normal deviate test with a 0.5 level of significance was used to test all comparisons. Since

all observed differences were not tested, lack of

comment in the text does not mean that the

difference was not statistically significant.

—

84

80

56

40

32

28

25

23

—

Average monthly charge

~

Standard error in dollars

M

100 116 131 147 162

95 110 124 139 154

67 77 88 98 109

47 55 62 69 76

38 44 50 56 62

33 38 43 49 54

30 34 39 43 48

27 31 35 39 43

SYMBOLS

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

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

Quantity zero .......... ............ ............................

Quantity more than O but less than 0.0 S. ........ 0.;

Figure does not meet standards of reliability

or precision ... ...................................... .......... ●

178

168

119

84

68

59

52

48
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service [ Number ~ ■ ,U,y 13,1978

1976Summary:

National Ambulatory Medical Care Surveyl

The estimates in this report highlight the

findings of the 1976 National Ambulatory Medical Care Survey (NAMCS), a sample survey

designed to explore the provision and utilization

of ambulatory care in the physician’s office—the

setting where most Americans seek heakh care.

The survey is conducted yeady in the coterminous United States by the Division of Health

Resources Utilization Statistics. The survey

sample is selected from doctors of medicine and

osteopath y who are principally engaged in

office-based, patient-care practice. In its current

scope, NAMCS excludes physicians practicing in

Alaska and Hawaii; physicians whose specialty is

anesthesiology, pathology, or radiology; physicians in Federal service.

Figure 1 is a facsimile of the Patient Record

used by participating physicians to record information about their office visits in both the 1975

and 1976 survey years. The reader may find it

useful to refer to figure 1 as selected aspects of

the survey findings are presented.

Since the estimates presented in this report

are based on a sample rather than the entire universe of office-based, patient-care physicians,

they are subject to sampling variability. See

“Technic~ Notes” at the end of this report for

an explanation and for guidelines in judging the

relative precision of the estimates presented.

1This report was prepared by Hugo Koch, Raymond

O. Gagnon, and Trena Ezzati, Division of Health Re.

sources Utilization Statistics.

DATA HIGHLIGHTS

Physician Characteristics

Among the 12 most visited specialists, primary care providers led the other specialists in

the provision of office-based, ambulatory care;

two of these providers, general/family physicians

and internists, accounted for one-half of all

visits. In a ratio of about 3 to 2, visits to SO1O

practitioners clearly outnumbered visits to

physicians in multiple-member practice. (See

table 1.)

Patient Characteristics

Number of office visits per person per year

generally increased in a direct parrdlel to advancing age; the rate for persons aged 65 years and

over was more than double the rate for persons

under 15 years. Females reported more visits to

the physician’s office than males did; for every 2

visits made by maIes, there were about 3 visits

by femaIes. This 2-to-3 ratio also prevailed for

annuzd. visit rates between the sexes. The data in

table 2 reveal that visits by females outnumbered visits by males in every age interval

above 14 years of age.

Clinical Characteristics

Reasu n for visit.–The information in item 5

of the Patient Record represents the reasons for

visiting the ph ysician’s office as expressed by
2

patients in their own words. The terms and

codes applied to the patient’s symptoms, complaints, or other problems come from a symptom classification developed for use in

NAMCS.2 Table 3 confines itself to “symptomatic” reasons for the visit, listing in rank order

the 25 complaints or symptoms most frequently

presented. “Nonsymptomatic” reasons such

as physical examinations and visits for medication are excluded from the tabulation.

Principal dsizgnosis. –Table 4 lists the 25

most common principaI diagnoses that were provisionally or finally assigned to office visits by

the physician. Table 5 shows the classification of

all principal diagnoses by the major diagnostic

groups. The diagnostic terms and codes are those

established in the Eighth Revision International

Classification of Diseases, Adapted for Use in the

United States, 1968 (ICDA). The considerable

effort that office-based physicians devote to

preventive and maintenance care–as opposed to

care that is primarily morbidity related—is evident in the finding that 18 percent of visits

center on examinations without illness and on

such special conditions as immunizations, prenatal and postnatal care, and medical and surgical aftercare (table 5).

Dia~ostic and therapeutic services. –The

limited examination was the diagnostic tool

most frequently used in office-based practice;

drug therapy was the most frequent form of

treatment. The finding that blood pressure was

taken in about one-third of visits may cast some

doubt on the general employment of this proc edure as a routine detection mechanism.

“Counseling” was checked by the physician only

when it constituted a major part of the treatment provided during the visit. The overall use

of such an intangible service is almost impossible

to quantify. Certainly, the finding that counseling was prominent in only 14 percent of visits

understates the actual extent of this important

aspect of the physician’s office practice.

2 ,National Center for Health Statistics: The National

Ambulatory Medical Care Survey: Symptom Classification, United States. Vital and Health Statistics. Series

2-No. 63. DHEW Pub. No. (HRA) 74-1337. Health

Resources Administration. Washington. U.S. Government Printing Office, May 1974.

Other Visit Characteristics

Data about prior-visit status (table 7) reveal

that the average office-based physician dealt

chiefly with patients that he had seen before

(“old” patients). New patients accounted for

only 1 of every 7 visits. Furthermore, the physician dealt chiefly with problems for which he

previously had treated the patient (“old” problems). Only about 1 of every 4 visits by an old

patient concerned a new problem. New problem

encounters (i.e., any problem presented by a

new patient or a new problem presented by an

old patient) accounted for about 37 percent of

all visits. The remaining visits (i.e., old problems

presented by old patients) offer a rough estimate

of the average number of return visits made during the year for any given new problem. Thus,

for a typical new problem presented in 1976,

there was an average of 1.7 return visits in the

course of that year.

Data on seriousness (table 7) express the

physician’s judgment as to the extent of impairment that might result if no care were available

for the given problem. Office-based ambulatory

care does not center on the treatment of problems that bear a “serious and very serious”

prognosis. Only about 1 of every 5 visits belonged in this category. The largest proportion

-of visits (an estimated 48 percent) was given a

“not serious” evaluation. This is due in large

degree to the substantial amount of preventive

care and routine maintenance care provided in

the physician’s office, and to the relatively high

prevalence of acute, self-limiting conditions encountered there.

Some form of scheduled followup was the

rule in office-based practice (see findings on disposition, table 7). In about 61 percent of visits

the patient was directed to return at a specified

time. Only 2 percent of visits resulted in hospital

admission, a finding that reflects the nonserious

character of most visits made to office-based

physicians.

Duration of visits (table 7) is based on the estimated time spent in face-to-face encounter between patient and physician. The average encounter lasted about 15 minutes. Visits of 0-minute

duration are those where there was no contact

between physician and patient. These chiefly involved visits during which, the patient was pro-’

tided care by a member of the physician’s staff.
ackmdaa3

Figure 1. PATlENT RECORD

ASSURAfECF OF CONFIDENTIALITV AIl .F!f,mmor. *h,ch wmzd mm.. .dm:dmlm. of an md.vti.31,

a

,.Uw~cl,ce, ~U,pdW, 0..f

●

lh.

M.hhshm..t

s.my ..,j

wit

WII

b.

no!

MC

lx c

c7.fKIml.

:C!,,..ld .,,

J:,

rdc..

v.,!!

scd

be .,ws+

m r Ih,$,

o.lv

;m,.ms

b, rkrs..s

or used

engaged

for any

m

cdher

●nd fcr

purpose. C532201

~. ISATE OF VISIT PATIENT RECORD

;&,-+- NAT!ONAL AMBULATORY MEDICAL CARE SURVEY

2. DATE OF BIRTH 4. COLOR OR 5. ?ATIENT’S PFNF4CIPAL PROBLEM(S} 6. SERIOUSNESS OF 7. HAVE YOO EVER SEEN

RACE COMPLAINT(S). OR SYMPTOM(S) ~ VISIT PROBLEM IN lTEM 5a TINs PATIENT BEFORE?

~7’%-7+ ~ —

(h m:;efif’$ own Hods] (Check one)

. G WHITE ,2 YES

I ~! NEGRO/

. z VERY SERIOUS

zONO

3. SEX

a MOST t

BLACK IMPORT;NT , Z SERfOUS If YES. for the problem

. ~ FEMALE J L OTHER I z SLIGHTLY SERIOUS

indicated m ITEM 5a?

. .-l MALE . E UNKNOWN b OTHER . a NOT SERIOUS a YES 21JN0

8. MAJOR REASON(S) FOR THIS VISIT [C4eck.//ma/or re.sxnl 9. PHYSICIAN-S PRINCIPAL OIAONOSIS ~ VISIT

.

a DIAGNOSIS ASSOCIATED WITH ITEM 5a ENTRY

m ACUTE PROBLEM . C wELL ADULT: CHILG EXAM

. z ACUTE PRCBLEM, FOLLOW-UP r 7 FAMILY Pi.ANWNG

—.

. c CHRONIC PROBLEM, ROUTINE 71 COUNSf Lli4G AOVICE

J ~) cHRONIC ‘ROB. EM, FLARE-LI? .: IMMUNIZATION

s ~ PRENATAL CARE J REFiiIREC BY OTif F.R PHYSf.iGENCY b OTHER SIGNIFICANT CURRENT OIAGNOSES

s ~ POSTNATAL CARE :: ADMINISTRATIVE PuRPOSE (In order of importance)

: POSTOPERATIVE CAfSli

7

~ OTHER (Spscvfy)

— .—

(~PCMtlV8 procedure)

10. OIAGIEOSTIC,THERAFEUTIC SERVICES OROEEEEO/FFEOVIOEO TEEIS VISIT (C/wk#//th#r#y) II. DISPOSITION ~ VISIT 12. OURATION OF

01 0 NONE 11 ❑ DRW PRESCRIBED (Chtck ●llthat ●pply) ~S VISIT (Tim

02 ❑ LIMITEO HISTORYfEXAM

aciual~ spaat with

:2 ❑ X.E2AY

03 ❑ GENERAL HISTORY/EXAM

physician)

13 ❑ INJECTION I n NO FOLLOW-UP PLANNED

04 ❑ CLINICAL LAB. TES7 14 ❑ iMMUNIZATION/DESENSITIZATION Y ~ RETURN AT SPECIFIEO TIME

0S ❑ 8LOO0 PRESSURE CHECK 15 0 PHYSIOTHERAPY

G2 ❑ EKG

$ ~ RETURN IF NE EOEO, P R N

16 ❑ MEDICAL COUNSELING ~ 0 TELEpHONE FOLLOW. UP PLANNED

07 0 HEARING TEST 17 ❑ PBYCHOTHERAPYI’THERAPEUTIC $ 0 REFERRED TO OTHER ..—MfNUTES

OD O VISION TEST LISTENING PHYSICIAN/AGENCY

09 n ENOOSCOPY IS ❑ OTHER (Spoci/yl $ ❑ RaURNED TO REFERRING

10 ❑ OFFICE SURGERY

PHYSICIAN

> ❑ ADMIT TO HOSPITAL

I G OTHER (Spec#y)

4 RA-34-6 DEPARTMENT OF HEALTH, EOUCATION AND WELFARE

?EV. B-75

0.M.B. %0.S72106

WBLIC HS.4LTH 2.ERVICE

HEALTH R5SOURCfS ADMINISTRATION

NATIONAL CENTER FOR HEALTi+ statistics
4

Table 1. Number and percant distribution of offica visits and mean number of office visits per week, by selected physician characteristics: United States, January-December 1976

Physician characteristic

All visits ............................................... .............

Specialty

General and family practice ... .................... ..............

Internal madicine ........ ............... ............... ..............

Pediatrics .................... ........................ ....... ..............

Obstetrics and gynecology .......................................

General surgery ................................. ......................

Ophthalmology ...... ........ ................. ...... ..................

Orthopedic surgew ............... ...................................

Dermatology ......................... ...... ............................

Psychiatry ....... .. ................................ ......................

Otolaryngoiogy .. ....... .................................... ......... .

Urology ... ......................................... .... ...................

Cardiovascular disease .......................... ...................

All other special ties ....... ...................... ........ ............

Type of practice

solo... ...... ......... ...... ........................ ........ .......*.... ....

Otherz ............. ............................ ........ ......... ...........

Number

of visits

in

thousands

588,300

225,637

68,249

60,400

48,994

35,967

29,302

27,837

21,627

15,811

10,837

9,896

5,861

27,782

353,854

234,446

Percent

distribution

100.0

38.4

11.6

10.3

8.3

6.1

5.0

4.7

3.7

2.7

1.8

1.7

1.0

4.7

60.2

39.8

Mean

number of

office visits

per vwekl

78

111

62

113

:

86

64

140

29

77

53

39

. . .

7a

77;

lApplies o nl y to sampled physicians who actively treated patients during the week of their participation.

z~ncludes partnership and grOuP Practice-
ackmedh5

Table 2. Number and percent distribution of office visits and number of vistts per person per year, by patient’s age and sex:

Unit

Age and sex of patient

All visits ..... .................. .................... ....... ..... .....

—Age

Under 15 years ................ ............ ........... ............ .....

15-24 years .. ...... .......... ...... ..... ..... .. ............... ...........

25J14 years .. ...... .......... ...................... .............. ........

45-64 yea fi .......... ............ .... ....................................

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

Sex and age

Female ................. ........................... ..... ...............

Under 15 years . .............. . .............. ............ ..... ........

15-24 years ........... .. .. ............ .......... .........................

2544 years ....................... ...... .... .............................

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

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

Male .............................. .. ....................................

Under 15 years ......r ... ............ ...... ............................

15-24years ............................. ............... ..................

2544 years ......... ... .... .............. .... ...... ...... ................

45-64 years .. .......... ...... ..l ......... ......................... .......

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

d States. Januarv-Dacember 1976

Number

of visits

in

thousands

588,300

109,995

88,403

151,107

144,708

84.087

354,831

52,240

57,768

99,367

86,794

58,661

233,470

57,756

30,635

51,740

57,913

35,426

Percent

distribution

100.0

18.7

15.0

25.7

24.6

16.0

60.3

8.9

9.8

16.9

14.8

10.0

39.7

9.8

5.2

8.8

9.8

6.0

Number

of visits

per person

par year

2.8

2.1

2.3

2.8

3.4

4.3

3.3

2.0

2.9

3.6

3.9

4.6

2.3

2.2

1.6

2.0

2.8

4.0

NOTE: Rates are based onthecivilian noninstitutionalized population, exclu&ing A1aska and Hawaii.
6

Table 3. Number and percent of office visits, by most common complaints or symptoms classified by NAMCS code in rank order:

United States, January-December 1976

Most common symptom or complaint

Rank expressed by patient

and NAMCS code

1 Pain, swelling, injury–lower extremity ..............4OO

2 Pain, swelling, injury-back region .... .................41 5

3 Sore throat ................ .............. ...... ....................52O

4 Pain, swelling, injury-upper extremity ......... ....405

5 Abdominal pain ........................ ....... ...... ...... .. .. ..WO

6 Cough ................................ ....... ..... ....................3l 1

7 Cold ... ....... .... .............. ...... ................................3l2

8 Allergic skin reactions .................. ......... ...... ......1 12

9 Headache ...........................................................O56

10 Pain in chest ................................... ...................322

11 Fatigue ............ ..................................................oo4

12 Pain, swelling, injury-face and neck ,................410

13 Vision dysfunction, except blindness ................701

14 Fever .......... ..... ........................................... .......OO2

15 Wounds of skin ..... ............................................1 16

16 Abnormally high blood pressure .................. ......2O5

17 Earache ........ .................................... .......... .......735

18 Weight gain ........................... ....... ......................Ol O

19 Vertigo .................... ............ ............. ...... ...........O69

20 Nasal congestion .... ............................................3Ol

21 Acne or pimples .... ....................................... .....l OO

22 Swelling or mass of skin ....................................1 15

23 Shortness of breath ..... ................. .....................306

24 Depression ................... .......... ............................8O7

25 Vaginal discharge .. ........... ...... ...... ......................662

Number

of visits

in

thousands

21,178

16,932

16,168

15,902

14,590

13,099

10s44

10,679

9,908

9,564

9,468

9,122

8,569

8,535

8,492

7,518

7,487

6,956

6,703

6,488

6,310

5,855

5,843

4,377

4,377

Percent

of

visits

3.6

2.9

2.8

2.7

2.5

2.2

1.8

1.8

1.7

1.6

1.6

1.6

1.5

1.5

1.4

1.3

1.3

1.2

1.1 ‘

1.1

1.1 ~

1.0 ~

1.0

0.7 ;

0.7
a&medaa7

Table 4. Number and percent of office visits, by most common principal diagnoses classified by ICDA code in rank order: United States,

Rank

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

January-December 1976

I

Number

Most common principal diagnosis of visits

and ICDA code in

thousands

Medical or special examination ............... ...... .... YOO

Medical and surgical examination ....... ......... .....Y1O

Essential benign hypertension ...........................407

Prenatal care ......................... ............................ ‘f06

Acute upper respiratory infection .... ........... ......465

Chronic ischemic heart disease .......... .......... ......412

Neuroses .. .. ............ .............. ..... ........... ..............300

Otitis media ................... ..... ................ .. .............38l

Other eczema and dermatitis ....... .... ........-......692

Diabetes mellitus ......... ............... ..... ..... ......... ...250

Hay fevar ........................ .. ........................... .....5o7

Refractive errors ................................................37O

Acute pharyngitis .. ...... ........ .......... .. ......... .........462

Diseases of sebaceous gland ... ........... .......... .......706

Obesity ....... ..................... ............. .....................277

Bronchitis, unqualified ............................ ..........490

Osteoarthritis and allied conditions ...................71 3

Sprains and strains of other and

unspecified parts of back ........ ....... .... ..... .........847

Asthma ................... ...... ........ ............ .................493

Acute tonsillitis ....... ........ ...... ............................463

Synovitis, bursitis, tenosynovitis .......................73?

Other viral diseases .................... .... ....................079

Diarrheal diseases .............................. ....... .. .......oo9

Arthritis, unqualified ...-. ............. ...... .... ...... .......71 5

Observation, vvithout nead for

further medical care ...... .................. ...... .... ...... 793

44,736

29,598

23,303

21,426

18,841

13,507

12,058

10,715

9,744

9,605

9,337

9,052

8,883

8,719

8,288

7,248

7,012

6,520

6,319

6,168

5,661

5,659

5.448

4,781

4.353

Percent

of

visits

7.6

5.0

4.0

3.6

3.2

2.3

2.1

1.8

1.7

1.6

1.6

1.5

1.5

1.5

1.4

1.2

1.2

1.1

1.1

1.1

1.0

1.0

0.9

0.8

0.7
8

Table 5. Number and percent distribution of office visits, by principal diagnosis classified by major ICDA group: United Statas,

January-December 1976

Principal diagnosis classified by major

diagnostic group and ICDA code

All principal diagnoses ... ....................................

Infective and parasitic diseases ........ ...... .....000-136

Neoplasms ......... ......... ........... .....................l4O.239

Endocrine, nutritional, and

. .

metabollc diseases ....................................240-279

Mental disorders .........................................2W-31 5

Diseases of the nervous system

and sensa organs .......................................320-389

Diseases of the circulator system ..............3W~58

Diseases of the respiratory systam .......... ....460-51 9

Diseases of the digestiva system ...... ........ ....520-577

Diseases of the genitourinary system .... ......580-629

Diseases of the skin and

subcutaneous tissue .............. ....................68 fJ-7~9

Diseases of the musculoskeletal

system ............................................ ..........710-738

Symptoms and ill-defined conditions .........780-796

Accidents, poisonings, and violence ............8W-999

Special conditions and examinations

without sickness ......... .......................... .. Yoo-’fl 3

Residual 0...................... .... .......................................

Numbar

of visits

in

thousands

568,300

25,327

12,346

24,724

23,446

49,220

54,259

83,276

18,235

34,743

33,088

33,151

27,549

43,985

108,578

16,973

Percent

distribution

100.0

4.3

2.1

4.2

4.0

8.4

9.2

14.2

3.1

5.6

5.6

5.6

4.7

7.5’

18.S

2.$
dmmdata9

Table 6. Number and percent of office visits, by diagnostic and

therapeutic services Provided: United States, JanuarvDecember 1976

Diqnostic and therapeutic

services provided

(selected procedures)

Diagnostic services

Limited history or examination ...... ...

General history or examination ........ ..

Clinical lab test ..................................

x-ray ....... ............................ ...............

Blood pressure check . ...... .................

EKG .... ..................... ..... .....................

Hearing test .................... ....................

Vision test ...................... .... ......... .... ...

Endoscopy .........................................

Therapeutic services

Drug prescribed ...................... .......... ..

Injection .................. ...... ....................

Immunization or desensitization .. ......

Office surgery .................... .......... ..... .

Physiotherapy .............. ......................

Medical counseling .... . .. ... ........ ..........

ychotherapy and therapeutic

stening .............. ..... ..... ...................

T

Number

Percent of visits

in of

tiousands visits

. 305,231

99,309

133,598

45,527

195.179

19,370

7,873

30.684

6,809

251,970

73,309

31,287

41,497

17,590

79,920

51.9

16.9

22.7

7.7

33.2

3.3

1.3

5.2

1.2

42.8

12.5

5.3

7.1

3.0

13.6

24,249 ] 4,1

Table 7. Number and percent distribution of office visits, by

selected visit characteristics: United Stetas, January-December

1976

Selected visit characteristic

All visits ...... ......................... ...... ..

Prior-visit status

New patient ........................ ............ ...

old Patient, new problem ..................

Old patient, old problem ........ ...... ......

Seriousness of problem

Serious and very serious .....................

Slightly serious ... .............. ...... .... ........

Not serious..., ... ..................................

Dispositonl

No followup ........... ................... .........

Return at specified time ............... ......

Return if needed .. .......................... ....

Telephone followup ...........................

Referred to other physician

or agency ............................ .......... ...

Returned to referring physician .. .......

Admit to hospital ....... ................. .......

Duration of visit

O minute (no face-to-face

encounter ~-th physician) ................

1-5 minutes .... ....................................

6-10 minutes ............................ ..........

11-15 minutes ....................................

16-30 minutes ......... .... .......................

31 minutes or more ............... .............

+=

Number

of visits Percent

in distribution

thousands

588,300 100.0

83,606

135,107

369,587

114,909

189,886

283,506

67,598

361.149

128,283

19,142

16,281

4,800

12,222

13,580

83,106

186,802

154,894

117,894

31 /943

14.2

23.0

62.8

19.5

32.3

48.2

11.5

61.4

21.5

3.3

2.8

0.8

2.1

2.3

14.1

31.8

26.4

20.0

5,4

l~jll not add to tota~ since more than one disposition ‘as

possible.
10 amcdata

1

TECHNICAL NOTES

SOURCE OF DATA: Data presented in this

report were obtained during 1976 through the National Ambulatory Medical Care Survey

(NAMCS). The target population of NAMCS encompasses office visits within the coterminous

United States made to physicians who are principally engaged in office practice.

SAMPLE DESIGN: The 1976 NANICS utilized a

multi stage probability design that involved

samples of primary sampling units (PSU’S),

physician practices within PSU’S, and patient

visits within practices. Within the 87 PSU’S composing the first stage of selection, a sample of

approximately 3,000 physicians was selected

from master files maintained by the American

Medical Association and the American Osteopathic Association. Sampled physicians, randomly assigned to 1 of the 52 weeks in the survey year, were requested to complete Patient

Records (figure 1) for a systematic random

sample of office visits taking place within their

practice during the assigned reporting period.

Additional data concerning physician practice

characteristics such as primary specialty and

type of’ practice were obtained during an induction interview.

A complete description of the survey’s background and development has been published in

Series 2, No. 61, of Vital and Health Statistics,

DHEW Pub. No. (HRA) 76-1335, Health Resources Administration, Washington, U.S. Government Printing Office, Apr. 1974.

SAMPLING ERRORS: Since the estimates for

this report are based on a sample rather than the

entire universe, they are subject to sampling variability. The standard error is primarily a measure

of sampling variability. The relative standard

error of an estimate is obtained by dividing the

standard error of the estimate by the estimate

itself and is expressed as a percent of the estimate. Relative standard errors of selected aggregate statistics are shown in table I. The standard

errors appropriate for the estimated percent of

office visits are shown in table II.

ROUNDING: Aggregate estimates of office visits

presented in the tables are rounded t{) the

nearest thousand. The rates and percents, h(J\vever, \were calculated on the basis o f originai,

Table 1. Approximate relative standard errors of estimated numbers of office visits

I Relative

Estimate in thousands

standard error in

percentages

points

5oo .......................................................... 30.1

1.ooo....................................................... 21,4.

2.000....................................................... 15.3

5.000....................................................... 10.0

1o.ooo ..................................................... 7.5

30.000 ..................................................... 5.1

loo.ooo ................................................... 4.0

550.000 ................................................... 3.5

Example of use of table: An aggregate of 80,000,000 has a

relative standard error of 4,3 percent or a standard error of

3,440,000 (4.3 percent of 80,000,000).

Table II. Approximate standard errors of percents for estimated

numbers of office visits

:

I

I Estimated percent

Base of percent

(number of visits , or

5 or 10or 20 or 30 or ;

in thousands) 99 95 go

80 70

I

Standard error in percentage points

1,000..................... 2.1 4.6 6.3 8.5 9.7 10.6

3,000 ..................... 1.2 2.7 3.7 4.9 5.6 6.1

5,000 ..................... 0.9 2.1 2.8 3.8 4.3 4.7

?O,OOO................... 0.7 1.5 2.0 2,7 3.1 3<,3

50,000 ................... 0.3 0.7 0.9 1.2 1.4 1.5

100,000 ................. 0.2 0.5 0.6 0.8 1,0 1.1

500,000 ................. 0.1 0.2 0.3 0.4 0.4 r3.5

Example of use of ruble: An estimate of 30 percent based on

an aggregate of 75,000,000 has a standard error of 1.2 percent.

The relative standard error of 30 percent is 4.0 percent (J .2

percerrt+30 percent).

unrounded figures. Due to rounding of percents,

the sum of percentages may not equal 100.0.

DEFINITIONS: An am. bulatoi-y patient is an individual presenting himself for personal health

services who is neither bedridden nor currently

admitted to any health care institution on the

premises.

An office is a place that the physician identifies as a location for his ambulatory practice.

Responsibility over time for patient care and

professional services rendered there generally

resides !vith the individual physician rather thins

an institution.
adwmdaa 11

A visit is a direct personaI exchange between ExcIuded from NAMCS are physicians practicing

an ambulatory patient and a physician or a staff in Alaska and Hawaii; physicians who specialize

member working under the ph ysician’s super- in anesthesiology, pathology, or radiology;

vision for the purpose of seeking care and physicians who are federally employed; physirendering health services. cians who treat only institutionalized patients;

A p%ysician is a duly licensed doctor of physicians empIoyed

medicine (hI.D.) or doctor of osteopathy (D.O.) and physicians who

currently in practice who spends time in caring bulatory patients.

for ambulatory patients at an office Iocation.

fulI time by an institution;

spend no time seeing amSYMBOLS

Data not available -----

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

Quantity zero ———-—--—--

Quantity more than Obut less than 0.05 —-- 0.0

Figure does not meet standards of

reliability or precision .— *

* U.S. GOVERNMEW PRINTING OFFICE: Iwo –2 6 I -195 f 20005
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.

SERIES 14.

Programs and Collection Procedures—Reports describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the data collection methods used. They also include deflnmons and

other material necessary for understanding the data.

Data Evaluation and Methods Research—Studies of new

statistical methodology Including experimental tests of

new auwey methods, studies of wtal statistics collection

methods, new analytical techniques, objective evaluations

of reliability of collected data, and contributions to

statistical theory. Studies also Include comparison of

U.S. methodology with those of other countnes.

Analytical and Epidemioiogical Studies—Reports presenting analytical or interpretive studies based on vital

and health statistics, carrying tha analysls further than

the expository types of reports in the other series,

Documents and Committee Raports-Final reports of

major committees concerned with wtal and health statistics and documents such as recommended model wtal

registration laws and rewsed birth and death certtf!cates.

Comparative International Vital and Health Statistics

Repo~s—Analytical and descriptive reports comparing

U.S. vital and health statistics with those of other countries.

Cognition and Survey Measurament— Reports from the

National Laboratory for Collaborative Research In Cognition and Survey Measurement using methods of cognmve

science to design, evaluate, and test survey Instruments.

Data From tha National Health Interview Suwey—Stat]stlcs on illness, accidental Injuries, dcsabll!ty, use of hospital, medical, dental, and other services, and other

health-related topics, all based on data collected In the

continuing national household Interwew survey.

Data From tha National Health Examination Suwey and

the National Health and Nutrition Examination Suwey—

Data from direct examination, testing, and measurement

of national samples of the cwillan noninst!tutiona lized

population provide the basts for (1) estimates of the

medically defined prevalence of specific diseases In the

United States and the distributions of the population

with respect to physical, physlologlcal, and psychological characteristics and (2) analysls of relationships

among the various measurements without reference to

an expliclt finite universe of persons.

Data From tha Institutionalized Population Surveys-Discontinued in 1975, Reports from these surveys are included in Series 13.

Data on Health Resources Utilization— Statlstlcs on the

utilization of health manpower and facilities prov!ding

long-term care, ambulatoy care, hospital care, and family

planning sew]ces.

Data on Health Rasources: Manpower and Facilities—

Statistics on the numbers, geographic dwtnbutlon, and

characteristics of health resources Including physlclans,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

SERIES 15,

SERIES 16,

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

SERIES 24.

Data From Special Surveys-Statistics on health and

health-related topics collected in special surveys that

are not a part of the continuing data systems of the

National Center for Health Statistics.

Compilations of Advance Data From Vital and Health

Statistics—These reports provide early release of data

from the National Center for Health Statistics” health and

demographic suweys. Many of these releases are followed

by detailed reports in the Vital and Health Statistics

Series.

Data on Mortality-Various statistics on mortality other

than as Included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses;

and statistics on characteristics of deaths not available

from the vital records based on sample surveys of those

records.

Data on Natality, Marriage, and Divorce—Various statwtics on natallty, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

series analyses; studies of fertility; and statistics on

characteristics of births not available from the vital

records based on sample surveys of those records.

Data From the National Mortality and Natality Survays—

Discontinued in 1975. Reports from these sample surveys

based on vital records are included in Series 20 and 21,

respectively.

Data From tha National Survey of Family Growth—

Statwttcs on fertillty, family formation and dissolution,

family plannlng, and related maternal and Infant health

topics derived from a periodic survey of a nationwide

probability sample of women 15-44 years of age.

Compilations of Data on Netality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—Advance reports of births, deaths, marriages, and divorces

are based on final data from the National Vital Statistics

System and are published annually as supplements to the

Monthly Vital Statistics Report (MVSR). These reports are

followed by the publication of detailed data in Vital Statistics of the United States annual volumes. Other reports

Including induced terminations of pregnancy issued periodically as supplements to the MVSR provide selected findings based on data from the National Vital Statistics

System and may be followed by detailed reports in Vital

and Health Statistics Series.

For answers to questions about this report or for a list of titles of

reports published In these series, contact:

Scientific and Tachnical Information Branch

National Center for Health Statistics

Centers for Disease Control

Public Health Service

Hyattsville, Md. 20782

301 –436-8500
U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

3700 EastWest Highway

Hyattsville, Maryland 20782

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