Vital and

Health Statistics

Advance Data

From Vital and

Health Statistics:

Numbers 121-130

Series 16:

Compilations of Advance Data From Vital

and Health Statistics

No, 13

Datain this reportfrom healthand demqraphic surveys presentstatisticsby

age and othervariables on ambulatorymedical care; prevalenceand impact

of urinatyproblems; use of dentalservices; impaired senses of sound and light;

visitsto office-basedphysicians; and prevalenceof knowndiabetes, Estimates

are based on the civilian noninstitutionalizedpopulationof the UnitedStates,

These reportswereoriginallypublished in 1986 and 1987,

LLS. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Sewice

Centers for Disease Control and Prevention

Notional Center for Heatth statistics

Hyattsville, Ma~and

December 1993

DHHS Publication No. [PHS) 94-1872
..— —.. ..—

Copyright information

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

reproduced or copied without permiaaion; citation aa to source, however, is

appreciated.

Suggested citation

National Center fOr Health Statistics. Advance data from vital and health

statistics: numbers 121–1 30. National Center for Health Statistics. Vital Health

Stat 16(13). 1993.
National Center for Health Statistics

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

Jack R. Anderson, Deputy Director

Jacob J. Feldman, Ph. D., Associate Dlirectorfor AnaZysis

and Epidemiology

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

Extramural Programs

Peter L. Hurley, Associate Director for P7tal and Health

Statistics Systems

Robert A. Israel, Associate Director for International

Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

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

and Methodology

David L. Larson, Assistant Directoq Atlanta
Aging in the Eighties, Prevalence and Impact of Urinary Problems in Individuals Age 65 Years and Over,

Prelimina~ Data From the Supplement on Aging to the National Health Interview Survey: United States,

January-June 1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Useof Dental Services: United States, 1983.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The Management of Chronic Pain in Office-Based Ambulatory Care: National Ambulatory Medical Care

Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aging in the Eighties, Age 65 Years and Over–Use of Community Services, Preliminary Data From the

Supplement to the National Health Interview Survey United States, January-June 1985 . . . . . . . . . . . . . . . . . . .

Aging in the Eighties, Impaired Senses for Sound and Light in Persons Age 65 Years and Over, Preliminary

Data From the Supplement on Aging to the National Health Interview Survey: United States, January-June

1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health Promotion Data for the 1990 Objectives, Estimates From the National Health Interview Survey of

Health Promotion and Disease Prevention: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1985 Summary: National Hospital Discharge Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1985 Summary National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visits to Office-Based Physicians by Hispanic Persons: United States, 1980-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prevalence of Known Diabetes Anong Black hericans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. 121

No. 122

No. 123

No. 124

No. 125

No. 126

No. 127

No. 128

No. 129

No. 130

...

Ill
From Vital and Health Statistics of the National Center for Health Statistics Number 121 . August 27, 1986

Aging in the Eighties,

Prevalence and Impact of Urinary Problems in

Individuals Age 65 Years and Over

Preliminary Data From the Supplement on Aging to the

National Health interview Survey United States, January-June 1984

by Tamara Harris, M. D., M. S., Office of Analysis and Epidemiology Program

Introduction

The National Health Interview Survey is the large continuing survey of the civilian noninstitutionalized population of

the United States conducted by the National Center for Heakh

Statistics. Each year people in about 42,000 households are

interviewed by U.S. Bureau of the Census interviewers to obtain

information about their health and use of health care. Demgraphic information needed to interpret the data is also obtained.

The interviewers have special training on this survey in addition

to their regular training, and response rates are high-about 97

percent. The only item with a relatively low response rate is

family income.

In 1984 a special supplement was added to the questionnaire to obtain Information about elderly people living in the

community. This supplemen~ the Supplement on Aging (SOA),

was designed to collect information about physical limitations,

chronic conditions, housing retirement status, interactions with

family and organizations, use of community services, and other

health-related information about middle-aged and older people.

All household members aged 65 years and over and a half

sample of those 55-64 years of age were asked the questions

on the supplement themselves where possible. Another household member was interviewed only when the selected person

was unable to answer either because of physical or mental prot+

lems or was going to be away from the household for a longer

period than the interviewer would be in the area. Response

rates to the SOA were also high. Of the 5,982 people aged 65

years and over who were in interviewed households in JanusryJune 1984,95 percent had complete interviews and 92 percent

answered the questions on the SOA for themselves. Of these

5,637 responded to the items regarding urinary problems,

The data in this report are from the 5,637 interviews completed during the first 6 months of 1984, which contain information on urinary problems. The data are preliminary because

only one-half of the year is included and because the data from

the SOA have not been edited. Including the Ml year will double

the size of the sample and make estimates more reliable, It will

also eliminate any possibility of bias because of seasonality.

Editing will change some of the estimates from the SOA in the

text because information from other parts of the questionnaire

or from other family members will be used to comect missing or

inconsistent information,

The preliminsuy data about people aged 65 years and over

are being published because the need for information about the

elderly is critical, and 5,637 people is a large enough sample to

make estimates that are reliable for many purposes. The reader

should use the material in the “Technical notes” before deciding

that differences not mentioned in the text are likely to be statistically significant. fie number of people in the sample is given

in each table in addition to the national population estimates

that are the base of the percent to make that sample.

‘Thepurposes of this report are to provide information about

the prevalence of urinary incontinence in a community-based

population of individuals aged 65 years and older and to delineate the impact of the incontinence on quali~ of life and utilization of medical services.

The information is presented separately for those aged

65-74 years and for those aged 75 years or older. These advance

data should be interpreted cautiously because the number of

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service
2

individuals with urinary problems is still relatively small. When

the full data are available for the SOA, more detailed analyses

by age, gender, and severity of urinary problem will be possible.

Background

Surveys in the United Kingdom and the United States have

shown urinary incontinence to be a common medical problem

among older individuals. Estimates of prevalence vary from

5-15 percent in elderly persons in the community] and range to

40-50 percent for hospitalized and institutionalized persons.2’3

These estimates vary widely depending on whether the definition of incontinence includes aspects of chronicity, frequency,

intensity, timing, or costs and whether those whose incontinence is related to immobility are included in the incontinent

population. Data from those 65 years of age and over in the

SOA were a.alyzed to provide an estimate of self-reported

prevalence of urinary incontinence and to assess whether urinary

incontinence may influence health care utilization and quality

of life for those individuals in a national sample of communitydwelling elders.

On the SOA, four questions were asked to ascertain continence focused on control of urination and frequency of difficulty controlling urination. These questions were as follows:

1. Do you have difficulty controlling urination?

2. How frequently do you have this difficulty: Daily, several

times a week, once a week, or less ‘than once a week?

3. Do you have a urinary catheter or a device to help control

urination?

4. Do you need help from another person in taking care of

this device?

Of all those aged 65 years and older living in the community, 9 percent had difficulty controlling urination. Of those with

difficulty, 74 percent had this difticuhy more than once a week

and of these 78 percent had this difficulty daily. Less than 1

percent of the population over age 65 years responding to tiis

survey had a catheter or a device to control urination.

For the purposes of this report, the following definitions of

urinary problems were used

. Those with no difficulty controlling urination and without

a catheter were considered continent of urine.

. The group with dif%culty controlling urination includes those

with any degree of dlffkulty controlling urination as well

as those with catheters.

These’preliminary analyses are presented for persons in

two age groups only: Ages 65–74 and ages 75 years and over.

Demographic characteristics

There were over 15 million noninstitutionalized individuals aged 65–74 years in the United States in 1984; 94 percent

had no dfilculty controlling urination (table 1). Of the 6 percent

who had a problem, 69 percent had a problem more than once

a week For over 9 million noninstitutionalized individuals aged

75 years or over, 87 percent reported no difficulty controlling

urination. Of the 13 percent who had a problem, 78 percent

had a problem more than once a week. Prevalence of urinary

problems increases with age, and the proportion reporting a

severe problem increases as well.

Women were only slightly more likely to report problems

controlling urination than men, even with increasing age, despite

Table 1. Percent distribution of people aged 65 yeers and over with difficulty controlling urinetion by severity of problem, according to

age and sex

65 years and over 65-74 years 75 years and over

Sample, estimated population, and urinary status Total Male Female Total Male Female Total Male Female

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimated population . . . . . . . . . . . . . . . . . . . . . . .

Urma~ status

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

No d!fflculty controlling urination . . . . . . . . . . . . . . .

Difficulty controlling urination. . . . . . . . . . . . . . . . . . . . .

Sample with difficulty controlling urination . . . . . . . . . .

Esomated population with dtfhculty controlling

urtnatlon, ..,,,.....,,., . . . . . . . . . . . . . . . . . . . . . .

Frequency of problem for those with problem

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

Daily, several times a week, or using catheter. . . . .

Once aweek or less . . . . . . . . . . . . . . . . . . . . . .

15,637

24,738

100.0

91.0

9.0

498

2,197

100.0

74.0

26.0

2,291

10,043

100.0

93.0

7.0

172

751

100.0

76.0

24.0

3,346

14,695

100.0

90.0

10.0

326

1,446

100.0

73.0

27.0

Number

3,516 1,522 1,994

Number in thousands

15,289 6,610 8,679

Percent distribution

100.0 100.0 100.0

94.0 94.0 93.0

6.0 6.0 7.0

Number

230 90 140

Number m thousands

986 390 596

Percent dlstrlbuttion

100.0 100.0 100.0

69.0 72.0 67.0

31.0 28.0 33.0

2,121

9,449

100.0

87.0

13.0

268

1,212

100.0

78.0

22.il

769

3,433

100.0

89.0

11.0

82

361

100.0

80.0

20.0

1,352

6,017

100.0

86.0

14.0

186

851

100,0

77.0

23.0

I. Samplepopulatmn responding to Items on urinary problems
adwm&ta3

the fact that the age distribution for women aged 75 years or

over was shifted toward older ages in comparison with the men.

Of those aged 65-74 years, 6 percent of all men and 7 percent

of all women reported having difficulty controlling urinatio~

72 percent of the men with a urinary problem and 67 percent of

the women with a urinary problem had difficulty more than

once a week. For those aged 75 years and over, 11 percent of

all men and 14 percent of all women reported a problem controlling urinatio~ 80 percent of the men with a uMary problem

and 77 percent of the women with a urinary problem had difficulty more than once a week,

With whom did those with urinary problems live? If problems controlling urination reflect increasing frailty in an elder,

it is likely that the proportion living with relatives other than a

spouse or living with nonrelatives might be higher for these

individuals than for those without urinary problem. Fifteen

percent of those aged 65-74 years with urinary difficulty

versus 11 percent of those in the same age strata with no uMary

problems and 29 percent of those aged 75 years or over versus

18 percent of those in the same age strata with no urinary problems (table 2) lived with relatives other than a spouse or nonfamily.

Social activities

Six questions were drawn from the larger pool of materkd

on social activities to estimate social participation among those

with and without urinary problems. These questions include

making telephone contacts with fiends or relatives, getting together with friends or relatives, and getting out to attend religious services or other church-atlliated activities or to participate in a purely recreational activity such as a movie, sporting

event, or class.

Within each age strain those with urinary problems had

lower participation in all social activities than those with no

urinary problems (table 3). DiiYerences between those with and

those without urinary diflicu]ty were least for contact with relatives (either getting together or talking with them on the telephone) with over 70 percent of all individuals aged 65 years or

over having some form of contact with relatives in the 2 weeks

prior to the survey. Of the continent group aged 65-74 years,

54 percent attended church in the 2 weeks prior to the interview,

compared with 42 percent of the group with urinary problems.

Although almost half of the continent group aged 75 years or

over had attended a church in the prior 2 weeks, only 31 percent

Table 2. Percent distribution of people aged 66 years and over by living arrangement, according to age and dticuky controlling urination

65-74 years 75 years and over

No urinary Any urinary No urinary

Sample, estimated population, and living arrangement Total

Any urinary

difficulty difficulty Total difficulty difficulty

Number

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,516 3,286 230 2,121 1,853 268

Number in thousands

Estimated population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,289 14,303 986 9,449 8,238 1,212

Percent distribution

Total. . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0

Live alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Live with spouse

26.0 25.0 31.0 40.0 41.0 37.0

......... c........ . . . . . . . . . . . . . . . . . . . . . . . . . . . 63.0 64.0 54.0

Lwew!th someone other than spOuse. . . . . . . . . . . . . . . . . . . . . . . . . . . .

40.0 41.0

11.0

34.0

11.0 15.0 20.0 18.0 29.0

Table 3. Percent of people aged 65 years and over by social participation, age, and difficulty controlling urination

65-74 years 75 years and over

No urinary Any urinaty No urinary Any urinary

Sample. estimated population, and social participation Total difficulty difficulty Total difficulty difficulty

Number

Sample. . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,516 3,286 230 2,121 1,853 268

Number in thousands

Estimated population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,289 14,303 986 9,449 8,238 1,212

Social participation m past 2 weeks Percent

Gottogether wnh friend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.0 73,0

Talked onthephone with friend... . . . . . . . . . . . . . . . . . . . . . . . .

62.0 65.0

83.0

67.0

83.0

57.0

GOttOgether with relative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .....

. . . . . 75.0 78.0 79.0

78.0 79.0

65.0

Talked onthephOne with relative. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.

72.0 73.0 73.0

88.0 89.0

70.0

Went to church . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

82.0 82.0

53.0

84.0

54.0

72.0

. . . . . . . . . . . . . . 42.0

Attended recreational event such as movie or sporting event. . . . . . . . .

47.0

3 IJ)

49.0

32.0

31.0

17.0 21.0 22.0 12.0
4

of those who were incontinent had attended. The form of social

activity least attended by those who were continent was the

purely recreational eventi 32 percent attending of those 65–74

years and 22 percent attending of those aged 75 years or over

without urinary problems. Participation for those who had urinary problems was even less: 17 percent of those aged 65-74

years and 12 percent of those aged 75 years or over.

Even among those who have a problem controlling urination, there is evidence of a relatively high level of social participation. However, this is less than the involvement of the continent population of the same age. Whether this can be attributed

to the urinary problems only or to the set of conditions that

covary with the incontinence remains to be investigated.

Health status and health care utilization

Thosewith problems controlling urination in both age strata

were more likely to report themselves as being in fair or poor

health (61-62 percent) compared with the group that was continent (30-3 1 percent) (table 4), and those with problems controlling urination were more likely to report their health as deteri~

rated in the past year. Only one-quarter of those with urinary

problems in either age group reported no limitation of activity

27 percent of those aged 65-74 years and 36 percent of those

aged 75 years or over were unable to perform their major activity compared with 10 and 7 percent of those who were continent

in each age strata.

Those with urinary problems were more likely to ]report

themselves as being in poor heal~ health status measures such

as number of medical condhions or bed days supported this

perception (table 4). Thirty-three percent of those who were

continent (aged 65–74 years) had no medical conditions, versus

only 7 percent of those of the same age group with urinary

problems. Of the group with urinary problems, 57 percent had

more than three medical problems. These proportions were

similar for those aged 75 years or over, In addition, those with

urinary problems had a much lower proportion with no bed

days eithef at home or in hospital for the past year.

Individuals with problems controlling urination were also

heavier users of physician services (table 5). Over 50 ptircent

of those with urinary problems in each strata had five or more

visits in the past year to physicians versus approximately onethird of those without urinary problems, Interestingly, approximately 10 percent of those with urinary problems had nc) physician visits in the past year.

Those with uMary incontinence used hospital services more

Table 4. Percent distribution of people aged 65 yaws and over by health statua, according to age and difficulty controlling urination and

parcent with no bed days in paat yaar by age and difficulty controlling urination

65-74 years 75 years and over

No urinary Any urinary No urinary Any urinary

SamDie. estimated Dowlation, and health status Total difficulty difficulty Total difficulty difficulty

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. . . . . . . . . . . .

Estimated population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Perceived health statua

Very good orexcellent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Poor or faw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health better or worse In past yearl

Better . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Worse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Same . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Limitation of actiwty

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Outside actwltles only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Kmdoramount of activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unable toperfcwm usual actwW. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reported number of conditions

None. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No beddays m past year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,516

15,2B9

100.0

36.0

33.0

31.0

13.0

13.0

74.0

61.0

15.0

13.0

11.0

32.0

43.0

25.0

64.0

3,286

14,303

100.0

37.0

33.0

30.0

13.0

12.0

75.0

63.0

14.0

12.0

10.0

33.0

44.0

23.0

66.0

Number

230 2,121

Number in thousands

9B6 9,449

Percent distribution

100.0

16.0

23.0

61.0

15.0

26.0

59.0

27.0

23.0

23.0

27.0

7.0

36.0

57.0

100.0

35.0

31.0

34.0

10.0

18.0

72.0

57.0

17.0

15.0

11.0

26,0

43.0

31.0

Percent

45.0 62.0

1,853

8,238

100.0

37.0

32.0

31,0

10,0

17.0

73.0

62.0

16.0

16.0

7.0

29.0

44.0

27.0

65.0

268

1,212

1Clo.o

17.0

2!1.0

62.0

6.0

:11.0

61.0

2!5.0

17.0

2!2.0

36.0

6.0

38.0

56.0

39.0

‘ Based onlv on self respondents.
aance@a5

Table 5. Percent of people agad 65 yeara and over by health care utilization, age. and difficulty controlling urination

65-74 years 75 years and over

No urinary Any urinary No urinaw Any urinary

Sample, est!mated population, and health care utilization Total difficulty difficulty Total difficulty difficulty

Number

Sample. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,516 3,286 230 2,121 1,853 268

Number in thousands

Estimated population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,289 14,303 986 9,449 8,238 1,212

Percant

Nophysician visits past year.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.0 20.0 10.0 17.0 18.0 11.0

Atleast 5physlcian visits past year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.0 30.0 54.0 34.0 32.0 50.0

Nohospltalizations reported past year . . . . . . . . . . . . . . . . . . . . . . . . . . . 82.0 83.0 73.0 76.0 78.0 62.0

At least 2 hospltahzations reported paat year. . . . . . . . . . . . . . . . . . . . . . 5.0 5.0 10.0 7.0 5.0 17.0

Of those hospitalized. Dercent with at least 8 hosDital days. . . . . . . . . . 52.0 50.0 74.0 52.0 50.0 62.0

frequently and had a higher proportion with longer stays than

those who were continent. However, even among those who

were incontinent, hospital use was relatively low. Of those who

were continent, over 76 percent reported no hospitalization in

the past 12 months, compared with 73 percent of those aged

65-74 years who had a urinary problem or 62 percent of those

aged 75 years or over with urinary problems. Of those with a

urinary problem who were hospitalize~ 74 percent of those

aged 65-74 years and 62 percent of those 75 years or over had

more than eight hospital days in the past yew compared with

50 percent of those with no urinary problems.

Discussion

Nine percent of community-dwelling persons aged 65 years

or over have problems controlling urination as ascertained by

the SOA. These problems were relatively severe with urinary

difficulty occurring at least several times a week in more than

70 percent of those with urinary problems. These problems

appear to increase with age and are more common in women.

Although those with urinary problems had lower levels of

social participation than dld those who were continen~ many

remain active. Over 57 percent had had contact with friends or

relatives by telephone or in person in the 2-week period prior to

the interview. However, they were less likely to participate in

other activities outside the home, such as church activities or

other social events.

The group with urinary problems was more likely to report

their health as fair to poor and to report that their her&h had

deteriorated over the past year. They were more likely to suffer

activity limitations and had more medical conditions on average

than their peers. Despite a Imge percent who used no hospital

services (greater than 60 percent in both age groups), those with

urinary problems who had used hospital services had a distribution skewed toward more use and longer stays in hospitals.

These data suggest a mixed picture. Urinary problems ap

pear to delineate a group with higher health care use and poorer

health status as evidenced by the number of medicrd conditions,

hospital use, and personal ratings of health status. Despite this,

a substantial proportion of the group with urinary problems had

no hospitalizations during the previous year and one quarter

had no limitation in any activity. These findings suggest that

those with self-reported urinary problems are a heterogeneous

group with deficits ranging from severely disabling to none, and

point to a need for firther information on the types of incontinence and impact of these types. This suggests that the impact

of urinary incontinence should be examined in the framework

of the other medical illnesses and limitations of the individual.

The problem of urinary incontinence needs to be identified,

diagnosed and treated4 as per current standards of practice.

Further research should be directed toward assessing whether

urinary incontinence itself acts as a marker for medical or functional problems that may be amenable to intervention if recognized earlier.
6

References

1J. W. Ymeil md A. S. St. I..agec The prevalence, severity and fa~

tors associated with urinary incontinence in a random sample of the

elderly. Age Aging 8:81-85, 1979.

‘J. Ouslander, R Kanes, and I. Abrasx Urinary incontinence in elderly

nursing home patients. JAMA 248:1194-1198, 1982.

3G, Wmhaw, J. Moore, S. Fnedma, et al.: Functional dlssiblhty in

the hospitalized elderly. J.4MA 248:847-850, 1982.

4N. Resnick ~d S. Yallz Management of urinary imxmtinence in the

elderly. N. Engl. J. Mea! 313:800-805, 1985.

sNational Center for Health Statistics, M. G. KOV~ and G. $. Poe:

The National Health Interview Survey design, 1973-84, and procedures, 1975-83. Vital and Health Statistics. Series 1, No. 18. ]DHHS

Pub. No. (PHS) 85-1320. Public Health Service, Washington. U.S.

Government Printing Oflice, Aug. 1985.

CM. G. Kov~ Health of elderly people iiving in the community in

1980. Milbank Memorial Fund Quarterly Vol. 64(1), Feb. 19186.

7Nationa1 Center for Heakh Statistics, J. Lubitz and R. Prihoda Use

and costs of Medicare services in the last years of life. Heult~ (United

States 1983. DHHS Pub. No. (PHS) 84-1232. Public health Service.

Washington. U.S. Government Printing Otlice, 1983.

Symbols

. . . Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantny more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standard of

reliability or precision

# Figure suppressed to comply with

confldentlallty requirements
dmcedaa7

Technical notes

Each week a probability sample of households in the United

States is visited by U.S. Bureau of the Census interviewers to

obtain a wide range of information about the health and health

care characteristics of the people living in those households. A

description of the sumey design, methods used to make the

national estimates, and general qualifications of the data are

provided in Series 1, No. 18.5

During January-June 1984 there were about 21,000 households in the sample. The total noninterview rate was about 3

percent—mostly because the interviewer was unable to locate

an eligible respondent despite repeated calls.

The rules for the survey are that all adults who are in the

household when the interviewer calls are asked to join in the

interview and to respond for themselves. People aged 65 yeas

and over are likely to be at home and are, thus, more likely to

respond for themselves to the questions on the basic, or core,

questionnaire. During the first 6 months of 1984, 84 percent

answered the questions themselves.

The estimates in this report are based on a sample rather

than on the entire population of people aged 65 years and over

in the civilian noninstitutionalized population. Therefore, the

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

had a complex design that has the effect of making the sampling errors somewhat larger than they would be from a simple

random sample of the same size using the same procedures.

A conservative estimate is tha~ on the average, the variance

for estimated proportions from this sample is 20 percent larger

than it would have been from a simple random sample of the

same size using the same procedures.

Perhaps more important for interpretation than sampling

errors, however, is a thorough understanding of what data from

this, or any other, cross-sectional survey can provide. There are

two issues—one important for any cross-sectional analysis and

the other of special importance for older people.

The National Health Interview Survey is a point-in-time

study. Associations at one point in time should not be interpreted as causality. The differences among the age groups, for

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

could be the result of different cohorts moving through time.

Based on external knowledge, one could interpret a difference

in health status as the result of aging and a difference in educational status as the result of cohort differences, but the data

from a cross-sectional survey do not enable one to make that

distinction.

The second is that this is a study of people who were Iiving

NIoTE A list of referencesfollows the text.

in the community at the time they, or proxy respondents, were

interviewed. All of the elderly people who had left the population, either through death or institutionalization, are excluded.

Thus, the estimate that 20 percent of the elderly people had

been hospitalized during the preceding year should not be interpreted to mean that only 20 percent of all elderly people had

been hospitalized during the year. Hospitalization rates are

high during the year preceding death or institutionalization, b.7

and the experience of those people is not included in these

estimates.

To estimate the sampling errors, convert the percent to a

proportion, calculate the variance of a proportion assuming

simple random s~pling, multiply that variance by 1.2 to allow

for the complex sample, then compute standard errors, confidence intervals, or significance tests.

For example, the estimate is that 10 percent of the

14,695,000 women aged 65 years and over have difficulty controlling urination. There were 3,346 women in the sample aged

65 years and over. Therefore,

Variance (simple random sample) = ~

= (0.9)(0.1)

3,346

= 0.00002

Variance (complex sample) = (0.00002)(1.2)

= 0.00003

Standard error = (0.00003)1/2

= 0.0055

95 percent confidence interval= 10 k ( 1.96)(0.55)

=1O*I

Because the estimation procedure includes post.straWlcation to independent U.S. Bureau of the Census estimates, there

is no sampling error for the number of people aged 65 years

and over—either for the total or for either sex.s The only sampling error is in the numerator. Therefore, the sampling errors

for those groups are somewhat smaller than estimated by this

method.
Use of Dental Services: United States, 1983

by Susan S. Jack, M. S., Division of Health Interview Statistics

In 1983 Americans went to dentists more than 430 million These data are from the 1983 National Health Interview

times, an average of almost two visits per person. Nearly Survey (NHIS), which contained special questions on the

one-half of all Americans, however, did not visit a dentist dental visits of the civilian noninstitutionalized population.

in 1983. Persons having higher family incomes were much This report contains selected statistics based on those questions.

more likely to have seen a dentist than those with lower The complete questionnaire is published in “Current Estimates

incomes (see figure). horn the National Health Interview Survey: United States,

I

i

4.0

3.0

2.0

1.0

0

02 10 20 30 40 so 60 70 75 80

Age

Figure. Number of dental visits per perwn (2 years to 75 years) per year, by age and family income United Stat= 19S3

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service
2

1983,” Series 10, Number 154.1 A microdata public use data

tape containing all of the information collected can be purchased from the National Center for Health Statistics, Division

of Health Interview Statistics, Computer Systems and Programming Staff.

The 1983 dental questions were an expanded version of

the dental questions included regularly in NHIS in earlier

years.z Additional questions were included in the 197 I NHIS,

and some questions are included again in the 1986 NH IS.

In 1983 survey questions addressed the issues of the interval

since last dental visit. the number of dental visits made in

the year prior to the interview, the dental services provided,

and the type of dentist seen. Also included were questions

on the use of dental fluoride products and on edenttdousness

(toothlessness).

The National Health Interview Survey is a cross-sectional

household interview survey conducted annually by the National

Center for Health Statistics. It is based on a multistage area

probability sample representing the civilian noninstitutionalized population of the United States. Population

statistics estimated from the sample are subject to sampling

variability. Tables showing standard errors of estimates are

included in the technical notes. (A more complete description

of the 1983 NHIS design may be found in Series 10,

Number 154.’)

Interval since last visit

Of primary interest to dental practitioners and health planners are persons with unusually frequent dental visits, indicating dental problems. and those who appear to be underserved

by the dental care system. Although dental authorities suggest

getting b-regular professional care,” they do not specify the

exact interval. However, many dentists recommend at least

one or two dental visits annually for examination and cleaning.

For the purposes of this report, one visit per year will be

used as the standard.

Table 1 indicates the extent to which this standard may

have been met. The proportion of the population 2 years

1National Center for Health Statistics: Current estimates from the National

Health Interview Sumey, United States, 1983. Vifal and Heaffh .Wui.wits.

Series ]0. No. 154. DHHS Pub. No. (pHS) 86-158~. Public Healtlrse~ice.

Washington, U.S. Government printing Office. June 1986.

%ee National Center for Health Statistics: Current estimates from the Health

Interview Survey. 1969-81. Vifal and Heahh SfaJi.$fic.s. Series 10, Nos.

63, 72, 79, 85, 95, 100, 119, 126, 130, 136, 139, 141. Public Health

Service. Washington. U.S. Government FMnting Office. National Center

for Health Statistics, C. S. Wilder Dental visits, volume and interval since

last visit. United States, 1969. Viral and Heafrh Sfa/i.wic.$. Series 10. No.

76, DHEW’ Pub. No, (HSM) 72-1066. Health Services and Mental Health

Administration. Washington. U.S. Government Printing Office. July 1972.

National Center for Health Statistics, C, S. Wilder Dental visits, volume

and interval since last visit. United States, 1978 and 1979. Vira/ and Heaffh

Swi.uic.s. Series 10. No. 138. DHHS pub. No. (PHS) 82– 1566. mblic

Health Serwce. Washington. U.S. Government Printing Offlcc, Apr. 1982.

National Cemer for Health Statistics, C. E. Burnham: Edcntulous persons.

United States. 1971. Vrfaf and Heullh Skm.wfcs. Srrles 10, No, 89. DHEW

Pub. No. (HRA) 74-1516. Health Resources Admimstration. Washington.

U.S. Government Printing Office, June 1974.

of age and over with one or more dental visits in the year

prior to interview varies by age from a high of about two-thirds

among children 5– 17 years of age, to a low of less thar.

one-third among those 75 years of age and older.

Overall, 45.0 percent of the population (or 100 million

persons) had not seen a dentist in over a year and were,

by current standards of dental practice, a medically undeserved

population. A majority of children 2A years of age (64.2

percent, or 6.899.000) and a significant proportion of children

5– 11 years of age ( 13.1 percent, or 2,978,000) had never

been to a dentist. Even in the older age groups where a

substantial proportion of the population was edentulous (22.3

percent of those 55-64 years of age, 34.0 percent of those

65–74 years, and 45.2 percent of those 75 years and over),

a substantial number of persons with teeth had not received

dental care within the year.

For every age group 12 years and over, females were

more likely than males to have seen a dentist in the year

before the interview. However. although the levels are different, the overall pattern of dental care is similar in both sexes.

The largest percent difference between the sexes in recent

(within I year) dental visits occurred among persons in the

age group 18–34 years, in which 61.9 percent of the females

and 51.8 percent of the males had seen a dentist.

In every age group, white people were more likely than

black people to have had a recent dental visit. Overall, 57.0

percent of white persons and 41.8 percent of black persons

visited dentists within the previous year. The difference between the races was greatest among persons 12– 17 years

and 55 years and oldec 70.2 percent of white adolescents

(aged 12- 17) and 48.4 percent of black adolescents had recent

visits. This is attributable in part to the greater percent of

white adolescents receiving orthodontic treatment. In addition,

black persons were more likely to report never having seen

a dentist.

The proportion of the population with a visit in the previous

year increased significantly with higher income. Less than

two-fifths (38.8 percent) of persons with a family income

below $10,000 had recently visited dentists, compared with

about three-fourths (74.0 percent ) of those with a famil:y income of $35,000 or more. The positive relationship between

the proportion with recent visits and income persists through

virtually all age groups.

In terms of the standard of a minimum of one dental

visit per year, roughly 25 million persons in each of the

three lower income groups and more than 10 million persons

in the $35,000 or more category did not meet this standard.

(In addition, another 14 million persons whose income was

not reported did not have a recent visit. ) In the older age

groups. some of these people were edentulous, a condition

that is also highly associated with income (data not shown),

but the prqkwtion of each age and income category without

teeth is far lower than the proportion with no visits. Even

in the highest income category, of those 65 years and over

20.8 percent were edentulous. but 34.2 percent reported no

visits in the previous year.
dmcdata3

Tabie 1. Number and percentdmtribution of parsons 2 yeara of age and over by “Wervaf ainoe last dental viai4

inconw Unitad State% 1983

accordhg to age sexj race, and famity

[Data are bsaadon Irousetmkdintewiewsof fha awlii nminsbfufiiafiksd PoFu!ation.The awvey d.ss4gn,generalquafif=bons, am .fonmwon on fhs rehbdily of tie estimates are gnm m the

Tdrmcal notes.]

Interval since last dental vis!t

Leas than 1 year

All All Less than 6-71 1-2 2-5 5 years

Charactedstic persons’ intervals 2 Tota13 6 months months years years or more Never

Number in

All pereons thousands

All ages . . . . . . . . . . . . . . . . . . . . .

24 years . . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . .

16-34 yeara . . . . . . . . . . . . . . . . . .

18-24 yeare . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . .

35-54 yeara . . . . . . . . . . . . . . . . . .

35-44 yeafs . . . . . . . . . . . . . . . . .

45+54y ears . . . . . . . . . . . . . . . . .

55-84 years . . . . . . . . . . . . . . . . . .

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

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

75 years Andover . . . . . . . . . . . . . .

Male

Alleges . . . . . . . . . . . . . . . . . . . . .

24 years . . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . . . . .

%lly ears . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . .

18-34 yeara . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . .

3.5-54 yaars . . . . . . . . . . . . . . . . . .

3%44years . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . .

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

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

75 years And over . . . . . . . . . . . . . .

Female

Alleges . . . . . . . . . . . . . . . . . . . . .

24years . . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . . .

12-17yeara . . . . . . . . . . . . . . . . .

18-34years . . . . . . . . . . . . . . . . . .

l&24yeara . . . . . . . . . . . . . . . . .

25-34years . . . . . . . . . . . . . . . . .

35-54years . . . . . . . . . . . . . . . . . .

35-Wyeafa . . . . . . . . . . . . . . . . .

45-54yeara . . . . . . . . . . . . . . . . .

%-E4years . . . . . . . . . . . . . . . . . .

“85yearsandover . . . . . . . . . . . . . . .

85-74years . . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . . .

222,212

10.743

44,761

22,668

22.088

67,710

28,561

39,149

51,101

28,933

22,168

22,004

25,892

16,045

9,847

107,030

5,467

22,838

11,512

11,326

33,133

13,990

19,144

24,757

14,087

10,690

10,261

10,573

6,S67

3,806

115,183

5,276

21,923

11,154

10,770

34,577

14,57’2

20,005

28,344

14,888

11,478

11,743

15,319

9,078

6,241

Percentdistributl on

100.0

100.0

lCKLO

1OQ.o

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

10Q.O

ltxl.o

100.0

100.0

100.0

Iwo

100.0

100.0

100.0

100.0

100.0

100.0

10Q.O

100.0

lm.o

100.0

100.0

100.0

lm.o

lfM.o

100.0

100.0

100.0

100.0

100.0

55.0

28.4

67.0

67.2

6&7

57.0

55.5

58.0

57.4

59.4

54.8

51.3

38.6

43.2

31.1

63.0

29.1

66.1

67.6

84.6

51.8

50.1

52.9

55.3

58.9

53.4

50.4

37.9

42.1

29.9

56.9

27.8

67.9

66.9

86.9

61.9

80.7

82.8

59.4

61.9

58.1

52.1

39.1

44.1

31.8

36.0

19.2

45.2

44.3

46.1

34.9

33.3

36.1

37.8

39.2

36.0

35.6

26.9

30.1

21.6

33.9

20.2

43.7

43.7

43.6

30.6

28.8

32.0

35.7

36.9

34.1

34.2

28.1

28.5

21.3

37.9

18.2

48.8

44.9

48.7

39.0

37.6

40.0

39.8

41.4

37.7

36.8

27.4

31.4

21.7

17.7

8.4

20.1

21.2

16.9

20.6

20.8

20.5

18.4

19.0

17.6

14.7

10.9

12.2

8.9

17.8

8.1

20.7

22.0

19.3

20.0

20.1

19.8

18.5

18.8

18.0

15.2

11.0

12.5

8.2

17.6

8.7

19.4

20.3

18.5

21.3

21.4

21.2

18.3

19.2

17.2

14.2

10.8

11.9

9.3

11.3

2.8

11.7

10.7

12.7

14.4

15.4

13.7

11.5

11.9

11.0

9.2

7.5

7.6

7.3

11.6

2.6

11.7

10.5

13.0

15.0

16.4

14.0

11.8

12.4

10.9

9.1

7.5

8.0

6.6

11.0

3.0

11.6

10.6

124

13.9

14.5

13.4

11.3

11.4

11.2

9.2

7.5

7.4

7.7

13.5

1.0

8.9

6.9

11.0

16.7

16.7

16.8

15.4

15.4

15.4

14.5

13.2

13.8

12.2

14.2

1.2

9.3

6.8

12.0

18.5

18.3

18.7

15.9

15.9

15.9

14.7

13.4

13.8

125

12.8

“0.8

8.4

7.1

9.9

15.0

15.1

15.0

15.0

15.0

15.0

14.3

13.1

13.8

12.1

12.6

2;

0.9

3.4

8.1

7.7

6.4

13.3

11.0

16.4

22.4

38.0

33.1

48.1

13.0

2.4

1.0

3.9

10.1

9.4

10.6

14.5

12.3

17.4

22.6

38.3

33.6

47.3

12.3

. . .

1.9

0.8

2.9

6.2

6.0

6.3

12.3

9.7

15.6

22.0

37.9

32.7

45.4

5.8

64.2

8.9

13.1

4.5

1.8

2.3

1.4

0.7

0.9

0.6

0.7

0.9

0.6

1.0

6.3

63.9

9.0

13.1

4.8

2.2

2.9

1.7

0.9

1.0

0.8

0.6

1.0

0.9

1.1

5.3

64.6

8.8

13.2

4.3

1.3

1.7

1.0

0.6

0.7

0.4

0.5

0.8

0.7

0.9

6eefmfmfeaatend ortsbfa.
4 advmcedata

Table 1. Number and percent distribution of persons 2 years of age and over by interval since last dental vim according to age, aq race, and family

income United State% 1963-Con.

[Oataare basedon household mterv!ewa of the avdlan nomnattiuttonalrzed population. The surveydesgn, generalquahfiifions, and irrformatkm on the reliibllity of the estimates are ghfenm the

Tachrwal notes.]

Interval since last dental vtsit

Less than 1 year

All All Leas than 6-11 1-2 2-5 5 years

Characterrst!c persons’ intewal~ Total’ 6 months months years years or more Mever

Number in

White thousands

Alleges . . . . . . . . . . . . . . . . . . . . .

2~ years . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . .

18-34 years . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . .

35-54 years . . . . . . . . . . . . . . . . . .

35-44 yeare, . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . .

5E-64years . . . . . . . . . . . . . . . . . .

65yearsandover . .’ . . . . . . . . . . . . .

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

75yearsandover . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . .

24years . . . . . . . . . . . . . . . . . . . .

5-17 years . . . . . . . . . . . . . . . . . .

FiIl years . . . . . . . . . . . . . . . . . .

12-17years . . . . . . . . . . . . . . . . .

18-34 years . . . . . . . . . . . . . . . . . .

18-24years . . . . . . . . . . . . . . . . .

25-34years . . . . . . . . . . . . . . . . .

35-54years . . . . . . . . . . . . . . . . . .

3544years . . . . . . . . . . . . . . . . .

4%54years . . . . . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . . .

65 years Andover . . . . . . . . . . . . . . .

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

75yearsandover . . . . . . . . . . . . .

Less than $10,000

Alleges . . . . . . . . . . . . . . . . . . . . .

24years . . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . . . . .

!5-Ilyear s,, . . . . . . . . . . . . . . .

12-17.yeare, . . . . . . . . . . . . . . . .

18-34years . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . .

35-54yeare . . . . . . . . . . . . . . . . . .

3544years . . . . . . . . . . . . .

46-54years . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . . .

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

75yearsandover . . . . . . . . . . . . . .

190,668

8,710

36.826

18,630

18,196

57,536

24,025

33,511

44,476

25,104

19,371

19,696

23,423

14,465

8,938

26,173

1,738

6,652

3,403

3,249

8,427

3,819

4,808

5,260

2,998

2,250

1,964

2,135

1,348

789

40,694

2,356

7,684

4,143

3,521

12,480

6,839

5,541

5,498

3,139

2,359

3,615

9,061

4,965

4,116

Percent distribution —

‘100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

10Q.O

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

57.0

29.2

69.9

69.7

70.2

59.0

57.9

59.9

59.2

61.3

56.4

53.4

40.5

452

33.0

41.6

25.4

51.2

53.8

48.4

44.0

42.2

45.6

44.1

45.8

41.9

33.2

19.0

23.6

11.2

36.6

23.5

53.1

54.8

51.1

46.1

52.0

43.1

34.8

37.1

31.8

28.7

24.3

26.0

22.2

37.9

20.1

46.3

46.9

49.6

36.5

35.3

37.4

39.6

41.2

37.5

37.4

26.5

31.9

23.1

23.5

15.7

29.0

30.9

27.1

24.7

22.1

26.8

24.3

24.5

24.0

19.3

10.4

12.8

6.2

22.9

14.0

30.4

31.7

28.8

27.9

30.5

24.7

20.2

21.7

18.3

17.9

15.4

16.1

14.5

17.8

8.3

20.0

21.2

16.8

21.2

21.2

21.1

18.4

18.9

17.7

14.9

11.1

12.4

9.1

16.5

6.9

20.0

20.5

19.5

17.3

17.8

16.9

18.1

19.7

15.9

13.0

6.1

10.0

“4.9

14.8

8.4

21.1

21.6

20.5

19.0

20.2

17.6

13.6

14.5

12.3

10.5

7.9

8.6

7.1

11.0

2.9

11.1

10.3

11.9

14.2

15.1

13.5

11.2

11.5

10.8

8.7

7.4

7.4

7.4

13.7

2.5

15.2

13.0

17.5

15.8

16.8

15.0

13.9

15.0

12.4

14.1

8.6

10.4

6.2

11.5

3.1

13.4

12.9

14.0

15.3

14.8

15.9

11.1

11.9

10.1

9.7

7.7

7.9

7.6

12.9

0.9

8.0

6.2

9.8

16.2

16.1

16.3

14.7

14.8

14,5

14.0

12.6

13.3

11.5

17.3

“1.5

13.7

10.5

17.0

20.3

20.3

20.3

20.6

19.3

22.3

19.0

19.4

18.9

20.4

17.0

“1.3

13.9

10.5

17.6

19.6

17.6

22.1

24.3

23.4

25.3

17.8

15.3

16.6

13.7

12.4

. . .

1.8

0.8

2.8

7.5

7.0

7.9

13.0

10.6

16.2

21.5

37.2

32.3

45.2

14.4

4.1’

1.6

6.6

12.3

12.5

12.1

16.8

14.7

19.5

30.0

46.6

41.1

56.0

22.7

. . .

3.6

1.8

6.2

11.9

10.1

+.1

25.9

23.1

29.7

41.5

49.6

46.9

53.2

5.1

ti3.6

8.0

‘12.1

3.8

1.4

1.9

1.0

0.6

0.6

0.5

0.6

0.7

0.6

0.7

9.6

66.4

13.3

18.6

7.6

3.6

4.1

3.2

1.5

2.0

“0.8

“1.2

3.1

“2.9

“3.5

8.6

69.7

14.7

19.1

9.6

3.5

3.5

3.4

2.4

!3.0

“1.6

1.4

1.4

t .5

‘1.3

%efootnotaaatend oftabfe,
adwmxMa5

Table 1. Number and percent dmtnbution of persons 2 yeara of age and over by interval since last dentsl VM according to age, se- raoe, and fam~y

incorrw United Ststeq l~n.

{Dataare basedon househo!dmterwswsof the avdii nonmsmutmnallzedPOPUWJO.The surveydeStgft gsnsral qualkabfma. and mformat!mon tha rel!abdii@fthe eslmates are gwsnm the

*nCal nmes.1

Interval since last dental twit

Less than 1 year

All All Less than 6-11 1-2 2-5 5 yeara

Characteristic persons’ interva/S Tota13 6 months months yeara years or more Never

$10.000-$19,999

Alleges . . . . . . . . . . . . . . . . . . . . .

24 years . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . .

18-34 years . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . .

25-34 yeare . . . . . . . . . . . . . . . . .

35-54 years . . . . . . . . . . . . . . . . . .

3544years . . . . . . . . . . . . . . . . .

45-54 years, . . . . . . . . . . . . . .

55-64 yeare . . . . . . . . . . . . . . . . .

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

65-74 yeare . . . . . . . . . . . . . . . . .

75years And over . . . . . . . . . . . . . .

$20,00G834,999

All ages . . . . . . . . . . . . . . . . . . . . .

24years . . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . . .

12-17years . . . . . . . . . . . . . . . . .

,18-34years . . . . . . . . . . . . . . . . . .

16-24years . . . . . . . . . . . . . . . . .

25-34years . . . . . . . . . . . . . . . . .

3%54years . . . . . . . . . . . . . . . . . .

3544years . . . . . . . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . . .

65years Andover . . . . . . . . . . . . . . .

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

75yearsandover . . . . . . . . . . . . . .

Numberin

thousands

50,109

2,654

9,684

5,298

4,386

16,829

6,672

9,956

8,631

5,131

3,699

5,124

6,968

4,777

2,211

635,000 or more

Alleges . . . . . . . . . . . . . . . . . . . . .

24years . . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . . . . .

Shy ears . . . . . . . . . . . . . . . . . .

12-17years . . . . . . . . . . . . . . . . .

18-34years . . . . . . . . . . . . . . . . . .

18-24years . . . . . . . . . . . . . . . . .

25-34yeara . . . . . . . . . . . . . . . . .

35-54years . . . . . . . . . . . . . . . . . .

35-44years . . . . . . . . . . . . . . . . .

4%54yeam . . . . . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . . . .

65-74yeara . . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . . .

61,987

3,246

13,452

7,064

6,388

20,333

6,868

13,445

15,726

9,241

6,485

5,705

3,526

2,490

1.035

42,223

1,556

9,145

4,073

5,071

11,195

4,636

6,658

14,397

8,070

6,328

4,107

1,823

1,261

562

Percent d@r!button

1W.o

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

10Q.O

100.0

100.0

100.0

100.0

100.0

100.0

10Q.O

100.0

100.0

100.0

100.0

lCCO

100.0

100.0

100.0

100.0

lCQ.O

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1OQ.o

100.0

100.0

47.5

23.3

56.8

57.5

55.9

51.5

50.2

52.3

44.4

46.5

41.5

43.2

41.4

44.6

34.6

61.4

31.1

72.6

73.9

71.6

61.3

57.3

83.3

59.8

62.7

55.5

58.0

58.8

61.5

52.4

74.0

40.4

84.5

647

84.4

71.2

69.3

72.4

74.0

75.1

72.6

74.3

65.6

73.7

48.0

29.9

15.6

35.6

35.6

36.1

30.6

29.6

31.2

28.6

29.9

26.8

28.3

28.0

30.0

23.7

40.8

21.5

50.4

50.0

S3.8

38.3

34.7

40.2

39.2

41.2

38.5

41.1

43.3

45.4

3a.5

51.3

28.5

62.4

60.9

63.7

45.0

42.4

48.7

50.6

51.4

49.7

53.8

523

59.6

35.6

16.5

7.0

19.6

20.6

18.4

19.5

19.3

19.6

14.8

15.4

13.9

13.9

12.6

13.9

10.4

19.2

8.8

20.5

21.9

18.9

21.6

21.3

21.7

19.3

20.4

17.6

15.6

15.1

75.7

13.7

21.3

10.3

20.4

21.9

19.2

24.6

25.1

24.2

22.2

22.5

21.8

18.7

12.5

13.0

11.4

12.5

2.6

15.0

13.5

16.6

15.2

15.6

14.9

13.6

14.5

12.3

9.6

7.4

7.6

6.8

11.6

2.8

10.9

9.3

12.7

14.6

17.6

13.0

12.2

12.2

12.2

9.1

6.7

6.9

6.0

9.1

“2.1

7.4

6.4

8.3

12.1

14.0

10.6

9.3

9.7

9.0

7.7

7.1

6.6

6.2

16.0

“0.9

11.2

8,8

14,1

19.9

20.6

19.5

19.7

20.5

18.5

17.3

13.0

14.0

10.9

125

“1.0

7.4

5.3

9.8

15.3

15.6

15.2

15.2

14.9

15.6

13.8

11.3

12.0

9.5

8.5

“0.5

4.6

3.6

5.4

11.5

11.7

11.4

9.7

9.7

9.7

7.8

8.8

7.9

10.9

15.6

2.9

1.0

5.1

10.2

9.6

10.6

20.3

16.1

26.1

27.9

36.9

32.5

46.4

8.5

. . .

1.5

0.6

2.5

6.7

6.3

6.9

11.9

9.2

15.7

17.8

22.7

19.0

31.6

5.0

. . .

0.7

“0.2

1.0

4.0

3.5

4.3

6.3

5.1

7.6

9.1

17.7

11.8

31.5

7.2

69.5

13.1

18.3

6.7

1.9

2.4

1.5

1.1

1,3

“0,6

0.9

0.9

0.9

“0.9

5.1

61.8

6.7

10.2

2.9

0.9

1.7

0.6

0.3

“0.4

“0.3

“0.4

“0.3

“o.1

“0.7

2.6

53.7

2.3

4.5

“0.5

0.4

“0.5

“0.4

“0.1

.. . .

“0.1

“0.2

.0.3

“0.2

“0.5

‘Imludesotherracaandunknawn inmma.

%ciudss unk- mlerfals.

31ncludespsra0mswrthwsttm pastyear. unknownexast mterfal,

NOTE: EsfmtesforMtitienmmtwhmarektishtitiemolmehmWwmtae*M*an~.
6 advalwedda

Number of visits in past year

The distribution of the population by the number of reported dental visits in the previous year is shown in table 2. Among those who did make a visit. most were reported

to have had either one or two visits. The proportion with

only one visit was highest in the age group 2-4 years, in

which over 60 percent of all children with visits had only

one. Mm-e than 10 percent of the population 12– 17 years

of age, in contmst, had more than five visits. Of those adolescents with visits. just over 20 percent had five or more visits.

As mentioned earlier, not only were females of almost

all ages more likely than males to have had a dental visit

in the past year. they were also more likely to have had

multiple visits. The highest proportion with multiple visits

for both sexes was in the group aged 12– 17 years, primarily

for orthcxkmture. where about one-fourth of the girls and

one-fifth of the boys had three or more visits.

Not all subgroups of adolescents. however, had an equally

high rate of visits. About 25 percent of white adolescents

( 12–17 years of age) had three or more dental visits, and

about 15 percent had five or more visits; in contrast,, only

about 12 percent of black adolescents had three or more visiu

in the previous year, about the same proportion as black

children 5– 11 years of age.

There were also large differences in dental care use frequencies among the various income groups. With increasing

income, not only did the proportion of persons with at least

one visit in the prior year increase, but the proportion with

three or more visits also increased. The usage difference associated with income was particularly great among persons

65–74 years of age. In this age group. only about 8 percent

of persons in the lowest income category had three or more

visits compared with about 14 percent and 20 percent in

the middle income categories, and about 29 percent of those

with an income of $35,000 or more. Much, but nalt all

of the difference may be attributed to a substantially greater

rate of edentulousness among persons in lower income

categories.

Tabte 2. Percent distribution of persons 2 yeare of age and over by dental visits in pest year according to age, sex, race, and family income:

United States, 1983

[Data are based on household mte!wiews of the civilian noninslitutnmalized popular!on The suwey desgn, general quahksbons, and mformat!on on the relrabiiity of the estimates are given tn the

Techmcal notes]

Number of visits in past year

Characteristic Total* None 1 2 3 4 S-12 13 or more

All persons

Allagesz . . . . . . . . . . . . . . . . . . .

2-4 years . . . . . . . . . . . . . . . . . . .

5-17 years . . . . . . . . . . . . . . . . . .

S-Ii years . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . .

16-34 years, . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . .

25-34 years, . . . . . . . . . . . . . . .

35-54 years . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . .

45-54 years, . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . .

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

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

75 years And over . . . . . . . . . . . . .

Male

Alleges . . . . . . . . . . . . . . . . . . . .

2-4 years . . . . . . . . . . . . . . . . . . .

5-17 years . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . .

18-34 years . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . .

35-54 years . . . . . . . . . . . . . . . . .

35+4 years . . . . . . . . . . . . . . . .

4S.54 years . . . . . . . . . . . . . . . .

56-64 years . . . . . . . . . . . . .

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

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

75 years and over . . . . . . . . . . . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

44,6

71.3

32.7

32.5

32.8

42.7

44.1

41.7

42.1

40.1

44.7

48.0

60.9

56.4

66.4

46.6

70.6

33.4

32.1

34.8

47.9

49.4

46.7

44.2

42.8

46.1

48.9

61.6

57.5

69.6

21.8

17.7

27.0

29.9

24.0

24.3

25.2

23.6

20.9

21.9

19.4

16.8

13.9

15.3

11.6

21.6

17.9

27.6

30.9

24.2

23.2

24.8

21.9

20.2

21.0

19.2

16.2

14.2

15.4

11.8

Percent distribution

17.1 5.7

7.2 1.7

20.6 6.2

22.0 6.5

19.2 5.9

17.2 5.6

15.7 5.2

18.3 5.8

18.2 6.3

19.0 6.5

17.1 6.1

17,3 6.5

12.7 4.6

14.0 5.3

10.6 3.5

16.5 5.5

7.8 1.6

20.6 5.9

21.8 6.3

19.5 5.5

15.4 5.0

13.4 4,6

16.8 5.3

17.6 6.5

18.2 8.7

16.9 6.3

17.1 6.8

12.2 4.6

13.5 5.3

9.7 3.4

3.4

0.6

3.5

3.4

3.5

3.2

2.9

3.3

4.2

4.4

4.0

4.1

3.0

3.5

2.3

3.2

“0.7

3.4

3.5

3.3

2.7

2.4

2.9

4.0

4.2

3.7

3.9

3.0

3.3

2.3

5.8

0.8

7.3

4.4

10.3

5.7

5.3

6.0

6.8

6.6

7.1

5.6

3.7

4.4

2.6

5.2

“0.6

6.2

3.9

6.6

4.6

4.2

5.2

6.2

6.0

6.5

5.6

3.3

3.9

2.3

0.9

●.

2.0

0.6

3.3

0.7

0.8

0.7

0.6

0.8

0,,7

0.5

0.3

0.5

“0.,2

0.7

●.

1.7

0.5

2.9

0.5

0,4

0.5

0.5

0.5

0.5

0.5

“0.3

“0.4

“0.2

see footnotes at end o! Iable
ammecMa7

Tebfe2. Percantdiatrihth ofperaons 2yeeraof ageendover bydentsM viaitein paatyear accordirrgtoege, seq rece, and farnilyincorne:

Unitad State% 198342MI.

lDala are based on household interviews of the OVIlii mimtifutmnshzed populabon. Ths survey dssgn. general qusftf=fmns. and mformatm .x tie rehabhty of ths estmrates are gwen m the

Tachmcal notss]

Number of vistts in past year

Characteristic Total’ None 1 2 3 4 5-12 13 or more

Female

Alleges . . . . . . . . . . . . . . . . . . . .

24 yeara . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . . . .

.5- Ilyear s . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . .

16-34 years . . . . . . . . . . . . . . . . .

l&24 years . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . .

35-54years . . . . . . . . . . . . . . . . .

35-44years . . . . . . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . .

5S64years . . . . . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . . .

65-74yeare . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . .

24years . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . .

12-17years . . . . . . . . . . . . . . . .

16-34yeara . . . . . . . . . . . . . . . . .

16-24years . . . . . . . . . . . . . . . .

25-34yeare . . . . . . . . . . . . . . . .

35-54years . . . . . . . . . . . . . . . . .

35-44yeara . . . . . . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . .

56+4years . . . . . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . . .

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

75yearsandover . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . .

2-4years . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . .

12-17years . . . . . . . . . . . . . . . .

16-34years . . . . . . . . . . . . . . . . .

18-24years . . . . . . . . . . . . . . . .

25-34yeare . . . . . . . . . . . . . . . .

35-54years . . . . . . . . . . . . . . . . .

35-44years . . . . . . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . .

5544yeare . . . . . . . . . . . . . . . . .

65yearsendover . . . . . . . . . . . . . .

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

75yearsandover . . . . . . . . . . . . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

42.7

72.0

31.8

32.9

30.8

37.8

39.0

36.9

40.2

37.6

43.5

47.2

60.4

55.5

67.6

42.6

70.6

29.7

30,0

29.4

40.7

41.7

39.9

40.4

36.3

43.1

45.9

59.0

54.4

66.4

57.7

74.2

46.3

45.8

E41.8

55.3

57.3

53.6

55.2

53.4

57.6

66.4

80.7

76.0

66.8

21.9

17.5

26.3

28.9

23.7

25.3

25.6

25.1

21.5

22.8

19.7

17.4

13.7

15.2

11.5

22.1

18.0

27.3

30.3

24.3

24.9

25.7

24.3

21.2

22.1

19.9

17.1

14.4

15.9

121

19.4

16.9

25.0

27.6

222

20.4

21.9

19.1

17.6

19.5

15.1

15.1

8.3

9.9

5.6

Percent distr!butlon

17.7

6.6

20.6

222

19.0

19.0

17.9

19.7

18.7

19.6

17.4

17.5

13.0

14.3

11.1

18.1

7.7

22.1

23.6

20.6

18.2

16.9

19.1

19.1

20.2

17.7

18.6

13.5

14.9

11.3

+0.3

5.2

13.3

13.4

13.1

11.0

9.5

122

11.5

10.7

12.7

5.7

4.1

4.8

“3.0

5.8

1.8

6.5

6.7

6.2

6.1

5.8

6.3

6.1

6.3

5.9

6.3

4.6

5.3

3.5

5.8

1.7

6.2

6.5

6.0

5.7

5.5

5.9

6.5

6.7

6.2

6.7

4.9

5.6

3.8

4.6

“1.4

6.2

6.9

5.4

4.7

3.5

5.6

4.9

5.0

4.6

4.6

“1.5

“2.2

“0.5

3.6

“0.5

3.5

3.4

3.6

3.6

3.5

3.8

4.4

4.5

4.2

4.2

3.1

3.6

2.4

3.6

0.6

3.7

3.7

3.7

3.2

2.9

3.5

4.3

4.5

4.1

4.3

3.2

3.6

2.6

2.4

“0.2

2.1

1.9

2.3

2.8

3.3

2.5

3.3

3.8

2.7

2.1

“1.7

“2.7

..

6.4

1.0

8.4

4.8

12.0

6.5

6.3

6.7

7.3

7.1

7.6

5.9

4.0

4.8

2.8

6.1

0.7

7.9

4.5

11.3

5.9

5.7

6.1

7.0

6.8

7.3

5.8

3.8

4.5

2.6

3.9

“1.3

3.4

3.1

3.7

4.0

2.6

5.2

5.3

5.1

5.6

5.0

2.6

3.4

“1.4

1.1

2.2

0.7

3.8

1.0

1.2

0.8

1.0

1.1

0.9

0.5

0.4

0.5

“0.1

1.0

. .

2.3

0.7

3.9

0.8

0.9

0.7

0.8

0.8

0.8

0.6

0.4

0.5

“0.2

0.4

..

“0.3

“0.2

.0.4

“0.4

“0.4

“0.3

“0.7

“1.0

“0.4

“0.2

“0.2

“0.4

. .

800f00tnotaaatacd oftatde.
8 advancdata

Table 2. Percent distributionof persons 2 yeara of age and over by dental visits in past year acccdmg to age, serGraoe, and family income

United States, 19834Am.

[Data are based on househo!d mtew.sws of the avikn rmcmsi!lutmnahzed population Tha survey desugn, general qualrfatcas, and mfonnation en UP?rehabdlty of the estimates are gwen m the

Tachncal notes]

Number of visi.%in past year

.

Characteristic Tora~ Norra 1 2 3 4 5-12 73 or more

Under $10,000

Alleges . . . . . . . . . . . . . . . . . . . .

2-4 years . . . . . . . . . . . . . . . . . . .

5-17 years . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . .,

12-17 years . . . . . . . . . . . . . . . .

16-34 years . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . .

2R34y ears. . . . . . . . . . . . . .

35-54 years . . . . . . . . . . . . . . . . .

3M4 yeara . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . .

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

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

75 years and over . . . . . . . . . . . . .

$10,000-$19,999

Alleges . . . . . . . . . . . . . . . . . . . .

2-4 years . . . . . . . . . . . . . . . . . . .

5-17 years . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . .

12-17years . . . . . . . . . . . . . . . .

16-34years . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . .

2K34y ears . . . . . . . . . . . . . . . .

35-54 years . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . .

65yearsand over . . . . . . . . . . . . . .

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

75yearsandover . . . . . . . . . . .

$20,000-634,999

Alleges . . . . . . . . . . . . . . . . . . . .

2-4years . . . . . . . . . . . . . . . . . . . .

5-17 years . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . .

16-34years . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . .

35-54 years . . . . . . . . . . . . . . . . .

35-44years . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . .

65 years Andover . . . . . . . . . . . . . .

6E-74 years . . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . .

100.0

100.0

100.0

1oa.o

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

61.1

76.5

46.9

45.2

48.9

51.9

47.9

56.8

65.0

62.9

67.8

71.3

75.6

73.8

77.6

52.3

76.6

42.9

42.3

43.7

48.4

49.6

47.5

55.4

53.3

58.4

56.6

58.6

55.4

65.4

38.5

68.6

27.1

26.0

28.3

36.5

42.5

36.5

40.2

37.1

44.5

41.9

41.2

38.5

47.6

17.7

15.6

24.5

26.4

22.2

22.4

24.2

20.0

15.2

15.7

14.5

11.6

10.1

10.9

9.2

19.7

13.6

24.8

27.0

22.2

22.3

22.4

22.3

17.1

16.5

15.2

15.7

15.0

15.7

13.6

23.5

19.2

28.6

31.9

25.1

24.7

24.9

24.6

21.4

22.6

19.5

18.1

19.1

20.3

16.4

Percent dtstributlon

10.0

4.9

12.8

12.6

13.1

12.6

14.4

10.9

8.4

9.0

7.7

8.2

6.9

6.6

6.9

13.6

5.6

15.9

16.6

15.1

14.3

13.3

15.0

12.2

13.0

11.0

13.4

13.4

14.6

10.9

19.5

8.4

23.8

26,1

21.2

18.8

16.4

20.0

16.7

19.4

17.7

19.6

20.8

21.2

19.6

4.2

“1.1

7.0

7.6

6.2

4.8

5.1

4.4

3.7

4.5

2.8

3.3

2.7

2.9

2.4

4.9

2.1

5.7

6.0

5.4

5.2

4.9

5.4

4.6

5.0

4.5

4.8

4.7

5.3

3.3

6.6

1.7

6.4

6.8

6.0

6.6

6.1

6.8

6.8

6.9

6.8

8.3

8.2

8.4

7.7

2.1

“0.5

2.8

3.4

2.2

2.4

2.6

2.3

2.4

2.7

1.9

1.5

1.6

1.9

1.2

3.2

“0.7

3.3

3.6

2.9

3.4

3.4

3.3

3.6

3.7

3.4

3.6

3.2

3.5

2.4

3.8

‘0.5

3.7

3.4

4.0

3.7

3.3

3.9

4.5

5.1

3.7

4.3

4.9

5.0

4.6

3.8

..

5.0

4.2

5.9

4.5

4.5

4.5

4.4

4.7

4.0

3.4

2.5

2.9

2.0

4.9

“0.8

5.3

3.4

7.5

5.2

4.9

5.4

5.6

5.3

6.1

5.0

4.1

4.4

3.6

6.6

“1.0

7.5

4.5

10.8

6.6

5.7

7.7

7.3

7.5

7.0

6.9

5.3

5.9

“3.8

0.4

.-

“0.5

“0.4

“0.7

0.6

0.6

0.5

“0.3

“0.4

“0.2

“0.2

“0.2

“0.4

●.

0.7

“0.1

0.9

“0.3

1.7

0.7

0.8

0.7

0.8

“0.8

“0.B

‘0.5

0.6

“0.7

“0.4

1.1

“o.1

2!5

0.13

4.:3

0.”7

0.”7

0.[3

0.13

1.{3

0,6

“0.7

“0.:3

“0.4

..

See kmtnotes at end 01 tabla.
admme@a9

Table2. Wrcentd~ribtin ofpwns2yeam of~and~er @*nMtitis tipstyear aw@lngto~, seq raee, and famifyincormx

United States, 1963-Corr.

[Data are based on Imusefwkl mtefvtews of ths cawhan rwm.stlubonalued ~!abon Tfw survey dssgn. gsneral qualkatmns, and mfonnstmn cm ths rehatslly of ths est!mates are gwen m the

Techmcal notes]

Nwrrber of wsfts m past year

Characteristic Totm# Norfa 1 2 3 4 5-12 13 or more

$35,000 or more

All ages . . . . . . . . . . . . . . . . . . . .

24years . . . . . . . . . . . . . . . . . . .

5-17years . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . .

16-34 years . . . . . . . . . . . . . . . .

16-24 years, . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . .

35-54years . . . . . . . . . . . . . . . . .

3544yeers . . . . . . . . . . . . . . . .

46-54years . . . . . . . . . . . . . . . .

5S64years . . . . . . . . . . . . . . . . .

65yearsand over . . . . . . . . . . . . . .

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

75yearsandover . . . . . . . . . . . . .

100.0

100.0

100.0

1W.o

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

lCQ.O

100.0

25.9

59.6

15.3

15.1

15.5

28.7

30.6

27.4

25.8

24.8

27.1

25.5

34.2

26.4

52.0

26.1

24.5

29.2

33.9

25.5

29.1

31.3

27.6

24.9

26.1

23.3

20.4

16.2

17.1

14.2

Percent distribution

25.7 7.3

12.6 “1.3

28.2 6.6

32.6 6.5

24.7 6.6

24.8 6.2

21.5 5.5

27.1 6.6

25.6 8.3

26.5 8.3

24.5 8.4

28.7 9.1

24.8 9.8

27.7 11.5

18.5 “6.2

4.8

“0.9

4,6

4.2

4.9

3.5

3.0

3.8

5.3

5.1

5.4

7.1

8.1

9.0

“6.2

8.3

“0.4

12.0

6.6

16.2

6.5

6.6

6.4

8.6

8.0

9.4

7.8

6.1

7.9

“2.3

1.5

. .

3.7

“0.7

6.1

0.9

1.1

0.6

1.0

0.9

1.1

“0.8

“0.4

“0.6

‘Includes unknown number of VIsns,

‘Includes other races and unknown mccmra,

NOTE: Estimates {orwhii thenumerator hsSarelStwe standSrdemOrof nwrethsn 30psrcent areindm@cfWhsnas tensk.

Average number of visits

Overall, Americans made an estimated 422.043,000 visits

to dentists in 1983, an average of 1.9 visits per person (table 3). Taking the population as a whole, the average rate

was highest for adolescents aged 12–17 years. The rate was

lower in the young adult years (]8–34), higher for those

35-64 years of age, and lower among persons aged 65 and

over. To some extent, the decline over age 65 is attributable

to an increasing rate of edentulousness with age and less

need for dental services.

There were significant differences, however, between the

racial groups in the rates of dental visits. Among black persons,

the highest average rate occurred not in the 12–17-year age

group, but in the 45–54-year age group ( 1.8 visits per person

per year).

The relationship of age to the use of dental services is

affected by family income. The effect was greatest among

persons 65 years of age and over and 12–I 7 years. In all

income groups, dental visits in the older age groups declined;

however, the age at which the decline occurred differed by

income group The rate of dental visits began to decline at

a higher age for. those with higher income. For those with

a family income of more than $20,000, the rate of dental

visits for adults increased through the age group 65-74 years

and only declined among those 75 years of age and over.

For all income groups combined, adolescents made significantly more visits than those in other age groups. The high

rate of visits for adolescents, however, was almost entirely

among those with family incomes of more than $20.000.
Tabfe 3. Number of denlef viaiia and viaita per pareon 2 yeara of age and over per year by ege according to sex, race, and family income United Statea, 1983

[Data are based on household mlew!ews of Ihe aviltan nonmstmdmnahzed fmpulatmn The survey design, general quafihcatmns, and mformalton on the rehabihly of (he eslrmates are gwen in lhe Techmcal @es ]

Race Fare//y income

All Sex

All Less than $1o,ooo- $20,000-

Characteristic persons Male

$35.000

Female White Black other $10,000 $19,999 $34,999 or more

All agea’ . . . . . . . . . . . . . . . . . .

2-4 years . . . . . . . . . . . . . . . .

5-17 years . . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . .

12–17years . . . . . . . . . . . . . . . . .

18-34 years . . . . . . . . . . . .

18-24years . . . . . . . . . . . . . . . . .

25–34years . . . . . . . . . . . .

35–54years . . . . . . . . . . .

35-44years . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . .

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

75 years Andover . . . . . . . . . . . . . .

Allagesl . . . . . . . . . . . . . . . . . . . .

2-4 years . . . . . . . . . . . . . . . . . . . .

5-17yeare . . . . . . . . . . . . . . . . . . .

5-n years . . . . . . . . . . . . . . . . . .

12–17yaars . . . . . . . . . . . . . . . . .

18–34yaars . . . . . . . . . . . . . . . . . .

18–24years . . . . . . . . . . . . . . . .

25-34years . . . . . . . . . . . . . . . . .

35-54 yaare . . . . . . . . . . . . . .

35--14yaars . . . . . . . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . . .

55-84years . . . . . . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . . . .

65-74yaars . . . . . . . . . . . . . . .

75yearsandover . . . . . . . . . . . . . .

422,043

7,166

110,630

47,268

63,362

113,147

44,344

68,603

106,408

61,133

45,275

45,118

35,574

28,496

11,078

1.9

0.7

2.6

2.1

2.9

1.7

1.6

1.8

2.1

2.1

2.0

2.1

1.5

1.8

1.1

182,584

3,764

50,170

22,364

27,807

46,636

17,734

26,902

46,763

26,963

19,780

20,021

15,229

11,541

3,688

1.7

0.7

2.2

1.9

2.5

1.4

1.3

1.5

1.9

1.9

1.9

2.0

1.4

1.7

1.0

239,459

3,402

60,460

24,904

35,556

66,511

26,610

39,901

59,645

34,150

25,495

25,097

24,345

16,955

7,390

2.1

0.6

2.8

2.2

3.3

1.9

1.8

2.0

2.3

2.3

2.2

2.1

1.6

1.9

1.2

381,746

6,067

99,967

41,266

58,701

100,726

39,766

60,960

95,036

55,423

39,613

42,008

37,942

27,040

10,902

2.0

0.7

2.7

2.2

3.2

1.8

1.7

1.8

2.1

2.2

2.0

2.1

1.6

1.9

1.2

Number of visits m Ihoueands

31,307 8,990

’941 ●157

7,707 2,957

4,798 1,205

2,909 1,752

10,114 2,307

4,038 ’540

6,076 1,767

8,883 2,510

4,752 “959

4,111 1,551

2,474 “635

1,207 “424

i ,088 “366

’119 ’56

Number per person per yeer

1.2 1.7

‘0.5 “0.5

1.2 2.3

1.4 1.9

0.9 2.7

1.2 1.3

1.1 “0.8

1.3 1.7

1.7 1.8

1.6 ‘1.2

1.8 2.9

1.3 ‘1.8

0.6 “1.3

0.8 “1.7

“0.2 “0.5

50,487

1,307

10,254

5,767

4,467

18,130

11,345

6,785

7,486

4,451

3,035

4,844

8,466

5,468

2.998

1.2

0,6

1.3

1.4

1.3

1.5

1.6

1.2

1.4

1.4

1.3

1.3

0.9

1.1

0.7

77,512

1,430

16,085

9,384

8,701

24,205

8,936

15,269

14,141

8,820

5,320

9,084

10,567

8,136

2,431

1.5

05

1.9

1.8

20

1.4

1.3

1.5

1.6

1.7

1.4

1.8

t .5

1.7

1.1

139,563

3,137

39,150

17,444

21,706

39,521

11,249

28,272

36,279

22,583

13,696

12,567

8,S08

6,804

2,104

2.3

1.0

2.9

2.5

34

1.9

16

2.1

2.3

2.4

2.1

2.2

2..5

2.7

2.0

112,453

1,027

33,664

11,370

22,494

21,692

8,203

13,489

38,073

20,173

17,90G

11,638

5,959

4,464

1,474

2.7

0.7

3.7

2.8

4.4

19

1.8

2.0

26

2.5

2.8

2.9

3.3

3.6

2.6

‘Includes unkrmwn number olvislls.

‘Includes unknown incoma.

NOTE: Estimates lWwNwhtie nMeraIor hasarelalivs ataMrderror otmre~an W~rmnlare tidmatW w}thw asterisk.
advmcam 11

Technical notes

The National Health Interview Survey (NH IS) is a continuous, cross-sectional, nationwide survey condu~ted by household interview. Each week a probability sample of households

in the civilian noninstitutionalized population is intemiewed

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

information on the health and other characteristics of each

member of the household.

During 1983, the sample consisted of approximately

40,900 households. The total noninterview rate was about

3 percent-about 2 percent of wttich was attributable to respondent refusal, and the remainder resulted primarily from an

inability to locate eligible respondents at home after repeated

calls. Information was obtained for ail household members

for the core section of the questionnaire, a sample of approximately 106,000 persons. The dental questions were contained

in a separate booklet. Dental information was obtained for

all but 438 of the 105,620 people for whom core information

was obtained, an additional non-response rate of 0.4 percent.

A description of the survey design, methods used in estimation,

and general qualifications of NHIS data was published

previously.x

The estimates shown in this report are based on a sample

of the (civilian noninstitutionalized) population rather than

on the entire population and are therefore subject to sampling

error. Some tables in this report contain cells in which the

estimate is small for a given characteristic. When an estimate

or the numerator or denominator of a rate is small, the sampling

error nay be relatively high. Approximate standard errors of

estimates of selected percents are shown in tables I and H.

Additional information on standard errors for all statistics

presented in this report is available from the author.

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

mean that no statistically significant difference exists between

the statistics being compared. Terms relating to difference

~NationalCenter for Health Statistics, M. G. Kovar and G. S. Poe: The

National Health Interview Survey design, 1973-84, and procedures. 1975-g3.

ViralurrdHeal/h .Wfi.wits. Series 1, No. 18. DHHS Pub. No. (PHS) 85-1320.

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

1985.

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

are statistically signitlcant. The r-test with a critical value

of i .96 (0.05 level of significance) was used to test all comparisons that are discussed. Lack of comment regarding the difference between any two statistics does not mean the difference

was tested and found not signiflcmt.

Tabte L Standard errors, espressed in percentage poin& of estimated

percen~ 1963 Nstionst Health Interview Survey dental aupplemenc

dentsd visits

Bass of percent

Estimated percent

in thousands of visits 2 or 98 5 or 95 10 or 80 20 or 80 50

50 . . . . . 19.0 29.6 40.8 54.4 68.0

70 . . . . . 16.1 25.0 34.5 45.9 57.4

100 . . . . . 13.5 20.9 28.8 36.4 48.1

300 . . . . . 7.8 12.1 16.6 22.2 27.7

500 . . . . . 6.0 9.4 12.9 17,2 21.5

700 . . . . . 5.1 7.9 10.9 14,5 16.2

1,000 . . . . . 4.3 6.6 9.1 12.2 15.2

5,000 . . . . . 1.9 3.0 4.1 5.4 6.8

10,000 . . . . . 1.3 2.1 2.9 3.8 4.8

20,000 . . . . . 1.0 1.5 2.0 2.7 3.4

30,000 . . . . . 0.8 1.2 1.7 2.2 2,8

50,000 . . . . . 0.6 0.9 1.3 1.7 2.1

100,000 . . . . . 0.4 0.7 0.9 1.2 1.5

400,000 . . . . . 0.2 0.3 0.5 0.6 0.8

TtWe IL Stsndard em- espressed in fwoen@e pointq of estimated

percerrk 19S3 National Health Interview Survey dentst supptemen~

Base ofpment

in thousands Estrmatad pefcent

(jx7pulation) 2or98 5or95 10rY90 Zt70r80 50

60 . . . . . 3.9 6.0 6.3 11.1 13.8

70 . . . . . 3.3 5.1 7.0 9.4 11,7

100 . . . . . 2.7 4.3 5.9 7.8 9.8

300 . . . . . 1.6 2.5 3.4 4.5 5.6

500 . . . . . 1.2 1.9 2.6 3.5 4.4

700 . . . . . 1.0 1.6 2.2 3.0 3.7

I,ooo . . . . . 0.9 1.3 1.9 2.5 3.1

5,000 . . . . . 0.4 0.6 0.8 1.1 1.4

10,000, . . . . 0.3 0.4 0.6 0.8 1.0

20,000 . . . . . 0.2 0.3 0.4 0.6 0.7

30,000 . . . . . 0.2 0.2 0.3 0.5 0.6

50,000 . . . . . 0.1 0.2 0.3 0.3 0.4

100.OOO . . . . . 0.1 0.1 0.2 0.2 0.3

200,000 . . . . . 0.1 0.1 0.1 0.2 0.2
From Vital and Health Statistics of the National Center for Health Statistics Number 123 ● August 29, 1986

The Management of Chronic Pain in

Office-Based Ambulatory Car=

National Ambulatory Medical Care Survey

by Hugo Koch, Division of Health Care Statistics

Introduction

The management of chronic pain is one of the most unrewarding tasks of the physician. New pain, with its attendant

fear of an unknown threat, can be sharply distressful to the

sufferer, but it also may produce certain beneficial effects. For

example, probably more than any other symptom, it motivates

the sufferer to visit a doctor. Also, the location and nature of

the new pain are helpful clues to the physician in the discovery

of the appropriate diagnosis. Added to these positive effects is

the assuring fact that mwt new pain is transient, that is, associated with acute conditions that largely correct themselves or

yield readily to short-term therapies. Chronic pain, on the

other hand, is almost wholly malefic in its effects. For the most

part, its diagnostic linkages have already been established, too

often to impairments that offer little or no hope of complete

cure. Unable to consummate the healing function, physicians

are denied their deepest professional satisfaction. Patients afflicted with chronic pain may become the prey of increasing

hopelessness and pain-centered disability. Pain may become

the center of their universe, conditioning most of their life responses and leading, in sort-w, to the creation of the chronic

pain syndrome.

Furthermore, the treatment of chronic pain in the ambulatory setting presents a challenge different from that found in the

inpatient environment. This is chiefly due to a lack of control

over outpatients and the fact tha~ unlike the sheltered inpatient,

the outpatient usually must carry on with the demands of dayto-day living. This report will focus on the presentation and

management of chronic pain in one ambulatory setting—the

physician’s office. It uses the findings of the National Ambulatory Medical C=e Survey (NAMCS), an annual sample survey

of ofllce-based physicians conducted from 1973 through 1981

by the National Center for Health Statistics. Its data base is

composed of 72,374,000 chronic pain visits made to the offices

of non-FederaI, oflice-based physicians practicing in the coterminous United States over the 2-year span from January

1980 through December 1981. A chronic pain visit is distinguished by the following characteristics:

● The condition under treatment was a problem of 3 months’

duration or longer (subitems 1 and 2 of item 7 on the data

collection form, figure I).

● The most important reason the patient gave for visiting the

physician was a compIaint or symptom of pain (item 6a,

figure I).

It is readily acknowledged that, with its focus on a first-listed

pain symptom, this type of analysis does not account for aIl the

chronic pain met with in oflice practice. For exampie, it patently

excludes the visits at which chronic pain appeared as a secondor third-listed reason for visiting the physician (item 6b, figure 1). Inclusion of these visits, while probably increasing the

data base by about 40 percenk would have obscured direct

correlations between the pain symptom and other aspects of

office-based care, such as the physician’s diagnosis and treatment mechanisms.

The data presented here are estimates, based on a sample

of otllce visits rather than the actual number, and thus are

subject to sampling variability. The smaller an estimate, or any

percent or rate based on that estimate, the more imprecise it is

likely to be. An asterisk preceding any estimate indicates that it

exceeds 30 percent relative standard error. Guidelines for

judging the precision of estimates are provided in the Technical

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Sewice
2

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&

PATlENT RECORD

NATIONAL AMBULATORY MED{CAL CARE SURVEY

z :J~HOF 3mSEX 4. COLOR OR RACE 5= ETHNICITY & PATIENTs COMPLAINTIS), SYMPTOMS), OR OTI+ER

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I

a. FomPRINCIPAL OIAGNOSES IN tTEr,r*

1

b. FOR ALL OTHER REASONS

1

t

16 vES, FOR lME

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I

2 2

ITEM *?

14 4

PATIENT

I i “- REFERRED

IT

I

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Figure 1. National Ambulato~ Medical Care Survey Patient Record, 1980 and 1981

notes at the end of the repfi along with a brief description Tables 2 and 3 d~ect attention to the impairments assoof the survey design.

Data highlights

Of the 72,374,000 chronic pain visits that form the data

base for this report, all but a handlid were motivated by the 25

complaints or symptoms listed in table 1. A dominant 52 percent

of the visits were caused by the first five symptoms on the list

back pain, headache, chest pain, abdominid pain, and knee

pain. These five symptoms led the list for both male and female

sufferers. Their relative proportions, however, varied between

the sexes (figure 2). Headache, for example, was nearly twice

ss evident at chronic pain visits made by female patients, while

back and chest pain were clearly more troublesome among

males.

ciated with chronic pain symptoms, as the principal (first-listed)

diagnoses rendered by the attending physicians. From the pain

symptoms listed in table 1, it comes as no surprise that by far

the largest proportion (34 percent) of these impairments ,were

diseases of the musculoskeletal system. Indee~ a dominant 64

percent of ail chronic pain visits fell into only four diagnostic

groups:

Chronic

Diagnostic group pain visits

Percent

distribution

Musculoskeletal disease. . . . . . . . . . . . . . . . . . 34.0

Circulatorv disease . . . . . . . . . . . . . . . . . . . . . . 12.7

Digestive disease . . . . . . . . . . . . . . . . . . . . . . . 8.4

Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.4
admceaa3

Table 1. Number of chronic Dain visits, and Percent distribution and cumulative distribution of chronic pain visits by the 25 Dain symrXoms

that most frequently motivated the visit United States. 1980 and 1981

. . .

Pain symptoms most frequently

Rank motivating chronic pain visits Chronic pa(n visits

Number in thousands

. . . Allpatlents . . . . . . . . . . . . . . . . . . . 72,374

Percent Cumulatwe

distribution distribution

. . . All patients . . . . . . . . . . . . . . . . . . . 100.0 . . .

1 Back pain (upper or lower) . . . . . . 17.8 17.8

2 Headache . . . . . . . . . . . . . . . . . . . . 11.5 29.3

3 Chest pain . . . . . . . . . . . . . . . . . . . 9.3 38.6

4 Abdominal pain . . . . . . . . . . . . . . . 7.6 46.2

5 Knee pain . . . . . . . . . . . . . . . . . . . . 6.0 52.2

6 Shoulder pain . . . . . . . . . . . . . . . . . 4.3 56.5

7 Leg pain . . . . . . . . . . . . . . . . . . . . . 4.1 60.6

8 Neck pain................,.. . 4.0 64.6

9 Generalized pain. site

unspecified. . . . . . . . . . . . . . . . . . 3.6 68.2

10 Throat pain. . . . . . . . . . . . . . . . . . . 3.5 71.7

11 Palnof unspecified joints . . . . . . . 3.3 75.0

lRtb pare, sldeorflankpaln, groin pain, and facial pain.

Pain symptoms most frequently

Rank motivating chronic pain visits Chronic pain visits

Percent Cumulative

distribution distribution

12 Stomach pain . . . . . . . . . . . . . . . . . 2.8 77.8

13 Earache . . . . . . . . . . . . . . . . . . . . . . 2.7

pain, site not referable to a

80.5

14

specific body systemy . . . . . . . . . 2.6 83.1

15 Hip pain . . . . . . . . . . . . . . . . . . . . . 2.5 85.6

16 Foot and toe pain . . . . . . . . . . . . . . 2.4 88.0

17 Hand and finger pain . . . . . . . . . . . 1.6 89.6

18 Painful urination. . . . . . . . . . . . . . . 1.6 91.2

19 Arm pain . . . . . . . . . . . . . . . . . . . . . 1.3 92.5

20 Eye pain . . . . . . . . . . . . . . . . . . . . . 93.5

21 Breast pain . . . . . . . . . . . . . . . . . . . ::; 94.2

22 Pelvic pain . . . . . . . . . . . . . . . . . . . 0.7 94.9

23 Ankle pain . . . . . . . . . . . . . . . . . . . 0.7 95.6

24 Elbow pain . . . . . . . . . . . . . . . . . . . 0.7 96.3

25 Wrist pain . . . . . . . . . . . . . . . . . . . . “0.6 96.9

. . . Other chronic pain symptoms. . . . 3.1 100.0

25

[

22.0

20

15

10

5

0

El ~ Femaie patients

R

Male patients

Back patn Headache Chest pain Abdominal pain Knee pam

Figure 2. Percent ofchronic pain visits forthe5 most frequent symptoms, according tosex of patient United States, 1980 and 1981
4

Table2. Numbarof chronic pain visits, andpercent distribution andcumulative distribution of chronic pain visits. bythe25 principal

(first-listed) diagnoses most frequently associated with the visits: United States, 1980 and 1981

Rank Most common princtpal diagnoses and ICD-9-CM code’ Chronic pam visits

. . .

.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

All diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

All diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Osteoar-throsis andallieddmorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...715

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Other andunspeclfted disordeffi of back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...724

Other andunapecified arthropathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...716

Rheumatoid arthritis and other inflammatory polyarthropathies . . . . . . . . . . . . . . . . . . . . . . . . . ...714

Sprains andstrains, other and unspecified parts of back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...847

Intervertebral disc disordera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...722

Other forms ofchronic ischemic heati disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...414

Peripheral enthesiopathies and allied syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-....726

Spondylosis andalhedd isordera.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...721

Other dmorders ofsoft tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...729

Sprains andstraina, sacroiliac region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-....846

Symptoms involving head and neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...784

Functional digestive dworders, not elsewhere classified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...564

Migraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-.....................346

Angina pectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...413

Pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -...-...--.--..........462

Suppurative andunspecified otitis media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...382

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-..............300

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . . . . . . . . ...-...-.........789

Special symptoms or syndromes, not elsewhere classified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...307

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .--....-.......-.......473

Other disorders ofaynovium, tendon, and bur’aa . . . . . . . . . . . . . . . . . . . . . . . . . ...-...........727

Other andunspecified disordemof joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-......719

Gastritis andduodenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-....-535

Number in thousands

72,374

Percent Cumulative

distribution distribution

——

100.0 . . .

6.0 6.0

4.1 10.1

4.0 14.1

3.8 17.9

3.1 21.0

3.1 24.1

3.1 27.2

2.6 29.8

2.5 32.3

2.5 34.8

2.3 37.1

2.0 39.1

2.0 41.1

1.7 42.8

1.4 44.2

1.4 45.6

1.3 46.9

1.3 48.2

1.2 49.4

1.2 50.6

1.1 51.7

1.0 52.7

1.0 53.7

1.0 54.7

0.9 55.6

ITerrmnology and codes are those of the international Claswftcatton of Diseases, 9th Rebwon, Clirvcal Mod/f/cation (ICO-9-CM).

Table 3. Number of chronic pain visits. and percent distribution of chronic pain visits by the principel diagnoses associated with each

United Stetes, 1980 and 1981

Chronic

Diagnostic group and ICD-9-CM code’ pain visits

Alldtagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

All diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious and parasitic dtsesses. . . . . . . . . . ...001-139

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Endocrine, nutritional. and metabolic dmeases

and tmmumty disorders . . . . . . . . . . . . .. 240-279

Diseases of endocrine glands . . . . . . . . . . ...240-259

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Nonpsychottc mental disorders . . . . . . . . . ...300-319

Oweases of the nervous system and sense

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

Diseases of the central nervous system . . ...320-349

Eyed! sorders . . . . . . . . . . . . . . . . . . . . . . . . ...360-379

Otmsmedla .. . . . . . . . . . . . . . . . . . . . . . . . . . . . ...382

Number in

thousands

72,374

Percent

dtstnbution

100.0

0.7

1.9

1.8

1.0

3.1

3.0

6.5

1.9

1.1

1.3

Chronic

Diagnostic group and ICD-9-CM code’ pain visits

Percent

distribution

Diseases of the circulatory system. . . . . . . . . ...390-459 12.7

Essential hypertension . . . . . . . . . . . . . . . . . . . . . ...401 4.1

Ischemic heart disease . . . . . . . . . . . . . . . . . ..41 O-414 4.5

Diseases of the respiratory system . . . . . . . . ...460-519 6.1

Dlaeases of the digestwe system. . . . . . . . . . ...520-579 8.4

Dweases of the genitourinary system . . . . . . ...580-629 6.2

Diseases of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 680-709 1.1

Diseases of the musculoskeletal system and

connectwe twsue . . . . . . . . . . . . . . . . . . . . . . . . 710-739 34.0

Arthropathies and related disordem. . . . . . ...710-719 13.0

Symptoms, signs, and ill-defined

conditions . . . . . . ... . . . . . . . . . . . . . . . . . . . ...780-799 5.6

Inpyandpoisoning .. . . . . . . . . . . . . . . . . . . ...800-999 8.4

Other and unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5

1Based on prmclpal (first-lwted) diagnoses classlf(ed by the /nrernar/ona/ Class] f)cat,on of Lkeases. 9zh Rev/s/on. Clm:cal Modrfrcatton (ICO-9-CM).

Although most chronic pain can be readily traced to discarders or Symptoms, signs, and ill-defined conditions. This I

somatic disease or injury, it is also instinctive to consider the 9 psychosomatic/symptomatic proportion varied considerably>

percent of chronic pain visits that were not clearly linked to a depending on the pain symptom under study. For example, it

known physiological impairment. Specifically, these were was well below average for musculoskeletrtl symptoms such aa

visits assigned by the physician to the diagnostic classes Mental back or knee pain (2 percent or less), and most pronounced
achweda5

among three nonmusculoskeletal complaints-chest pain ( 14

percent), abdominal pain (15 percent), and headache (a sharply

prominent 33 percent). It is illustrative that of the six specific

diagnoses most frequently associated with chronic headache,

three belonged to this psychosomatic/symptomatic category

(table 4).

The 72,374,000 visits chiefly motivated by chronic pain

produced an average rate of 62 chronic pain visits per 1,000

office visits. The extent to which this average rate fluctuated

with patient age, sex, race, and Hispanic origin is shown in

table 5.

The findings reveal that chronic pain visits were most frequent among middle-aged patients in the age-group 45–64 years,

increasing in that interval to a rate of about 95 per 1,000 oflice

visits. The me~tient age at chronic pain visits was about 50

years, exceeding by 11 years the mean of 39 years found for all

oflice patients. IrI mean age and average rate per 1,000 office

visits, females presenting chronic pain did not differ much from

their male counterparts. However, though their average visit

rates were about the same, there were important rate differences

between the sexes at two points along the age continuum a findingmade graphically apparent in figure 3. One of these points

is the age interval from the 25th through the 44th year, during

which time the male rate of chronic pain visits significantly

exceeded the female rate. The chronic impairments chiefly

responsible for this disparity were injuries (markedly more

prevalent among males of this age than females) and musculoskeletal disease (which, largely in the form of rheumatoid

arthritis, made an earlier appearance among males than among

females) (table 6). Among patients aged 65 years and over, on

the other hand, it is the female rate of chronic pain visits that

somewhat exceeds the male rate. In large paz this is due to the

fact that musculoskeletal disease-notably, osteoporosis and

the osteoarthropathies-persists at a higher level of activity

among older females than among older males (table 6).

Gender and age differences are also apparent in the presence

of psychosomatic/symptomatic pain (table 6). It is noteworthy

that this kind of pain was most evident among patients under

45 years of age and was more often presented by female patients

than by males. It was most apparent among female patients in

Table 4. Percent distribution of visits for chronic headache by the

6 principal diagnoses most frequently associated with it

United States, 198(3 and 1981

Principal diagnoses and ICD-9- CM codes 1 Visits for

mosr frequently associated with visits chronic

for chronic headache headache

Percent

distribution

Alldlagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . ..4oI 20.4

Symptoms mvolvmg head and neck . . . . . . . . . . ...784 15.8

Mlgralne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...346 11.8

Special (psychopathological] symp!oms or

syndromes, not elsewhere class! fted. . . . . . . . . ...307 8.6

Chromes musltls . . . . . . . . . . . . . . . . . . . . . . . . . . ...473 5.8

Neurotic dworders . . . . . . . . . . . . . . . . . . . . . . . . . ...300 “3.8

Cumulatwe subtotal . . . . . . . . . . . . . . . . . . . . . . . . 66.2

1Based on International Classif!cat!onof Diseases,9th RevIs/on. Chwcal

Afod/f/cat/on(lC&9-CM).

Table 5. Number of chronic pain visits, and percent distribution

and number of chronic pain visits per 1.000 office visits by selected

cheracteriatics: United States. 1980 and 1981

Patient characteristic Chronic pain visits

All patients . . . . . . . . . . . . . . . . . . . . . . . .

Ali patients . . . . . . . . . . . . . . . . . . . . . . . .

AGE

Under 15 yeara . . . . . . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . . . . . .

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

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

65yeara and over . . . . . . . . . . . . . . . . . . .

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

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

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

SEX

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SEX AND AGE

Female

Under 15 yeare . . . . . . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Male

Under 15 yeara . . . . . . . . . . . . . . . . . . . . .

15-24 yeara . . . . . . . . . . . . . . . . . . . . . . .

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

45-84 yeas . . . . . . . . . . . . . . . . . . . . . . .

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

RACEl

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HISPANIC ORIGIN

Hispanic. . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

72.374

Percent

distribution

100.0

5.4

7.0

27.0

34.9

25.7

15.5

8.6

1.5

60.7

39.3

3.0

4.4

15.7

21.0

16.6

2.4

2.6

11.3

13.9

9.1

86.6

12.6

6.0

94.0

Number

per 1,000

office viaits

62

62

18

37

63

95

89

90

92

77

63

62

21

30

55

97

95

15

35

79

93

81

60

82

81

61

1Because of thew very mmor representst!on m the database(0.9 percent},

otherracesareommed from thts study.

their 25th throu@ 44th year, where it accounted for 17 percent

of their chronic pain visits.

The chronic pain visit rates for black and Hispanic patients

were modestly higher than those found among their white or

non-Hispanic counteqxuts (table 5). The reasons for these

disparities are open to conjecture, but they may lie partly in the

findings that black oflice patients suffered more frequently than

white patients from injuries and circulatory diseases, while

Hispanic patients seen in the doctor’s oflice suRered somewhat

more than non-Hispanic patients ftom the musculoskeletal

diseases. Neither of these minority groups exceeded the average

in their presentation of psychosomatic/symptomatic pain.

A study of the forms of treatment applied in the management of chronic pain can be helptid in understanding the nature
6

100

90

80

70

60

50

40

30

20

10

0

iP I Percent of chroniiiain visits, one or rn~.d rugs were ordered

\

\

\

and effects of this kind of pain. Clearly. the use of drugs was

the therapeutic approach most frequently documented. At 72

\

/

I

I

/

/

/

/

/

/

1

_ Female patients

/

- =- Male patients

I I I I I

I

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

15 yeara years years years and over

Age of patient

Figure 3. Number of chronic pain visita per 1,000 office visits by

sex and age of patient United Statea, 1980 end 1981

or provided (table 7), averaging about two drugs per visit. Most

of the drugs (for example, antacids, vasodllators, anti-inflammatory agents, and muscle relaxants) were not aimed directly

at conquest of pain but, rather, at the treatment of its cause or,

as in the case of psychotropic drugs, at the relief of its effects.

Table 8 documents the use of analgesic agents, the drugs

aimed directly at pain reduction. By dividing the analgesic

class into its opioid and nonopioid subclasses, the findkgs

support inferences about the severity of the chronic pain encountered in office practice. (It is assumed that opioids are

most effective for relieving pain that is moderate to severe,

Table 7. Percent of chronic pain visits and of all office visits, by

selected classes of agents used in drug therapy United States,

1980 and 1981

Drug ViSiI’Sl

Percent ,P~rc~frt

of chronic of all

Drug class pain visits office visits

Alldrug clasaes . . . . . . . . . . . . . . . . . . . . . . 72.0 62.0

Autonomic drugs . . . . . . . . . . . . . . . . . . . . . 9.2 3.7

Cardiovascular-renal drugs . . . . . . . . . . . . . 30.3 16.6

Analgesic agents . . . . . . . . . . . . . . . . . . . . . 34.4 8.8

Psychotropic drugsz . . . . . . . . . . . . . . . . . . 11.9 6.0

Hormones . . . . . . . . . . . . . . . . . . . . . . . . . . 14.2 8.3

Adrenal corticosteroids. . . . . . . . . . . . . . 8.0 2.9

Gaatrointestirsal drugs. . . . . . . . . . . . . . . . . 8.2 3.6

lVtsits at whmh 1 or more members of a drug class were ordered or provaded.

‘Includes antianxiety agents, sedatives, hypnotics, antidepressants, and

antipsychotlc drugs.

Table 6. Number of chronic pain visits by sex and aga of patient, and parcent distribution of chronic pain visits by associated diagnosee,

according to sex and age of patient United States, 1980 and 1981

Chronic pain visits

Female petients Male patients

All Under 45-64 65 years All Under 45-64 65 years

Diagnostic group and ICD-9-CM codel ages 45 years years and ovar ages 45 years years and over

Number in thousands

Allprmclpal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438945 16,372 15,193 12,020 28,429 11,771 10,087 6,57Q

Percent distribution

Allprlnclpal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Neoplesms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.0-239 1.6 ●1.3 ●2.5 ●1.1 2.4 *0.5 ●2.2 *6.2

Mental dworders . . . . . . . . . . . . . . . . . . . . . . . ...290-319 4.0 6.4 3.4 *1.6 1.7 “3.0 *1.2 “0.3

Dweases of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320-389 6.6 10,3 4.7 4.2 6.2 9.7 *4.1 *3.2

Diseases of the c!rculatow system . . . . . . . . ...390-459 12,2 4.3 13.4 21.3 13.4 4.0 15.7 26.9

Diseases of the respiratory system . . . . . . . . ...460-519 6.0 9.3 5.3 “2.5 6.2 8.0 *3.6 7.0

Dweasea of the dlgestwe system . . . . . . . . . ...520-579 7.9 9.0 8.2 6.1 9.1 9.0 9.2 9.4

Dseases of the gen!tourlnery system . . . . . . ...580-629 7.7 14.1 4.3 “3,4 3,9 5.4 *2.3 “4.0

Oweases of the musculoskeletal system and

connectwe tissue . . . . . . . . . . . . . . . . . . . . . . . . 710-739 34.1 20.6 40.2 46.0 33.8 31.2 40.4 28.6

Symptoms, signs, and 111-defmed condmons ., .780-799 6.0 9,4 4.4 *3.6 4.9 5.9 “4.1 *4.3

Injury andpotsonmg . . . . . . . . . . . . . . . . . . . . ...800-999 7.0 9.6 6.7 4.1 10.5 14.6 9.9 ●4.3

Other and unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9 5.7 6.4 6.1 7.9 8.7 7.3 5.7

1Based on lnrernattonai Class!f!car!on of Dmeases. 9th Rewsmn, Clmtcal Mod:flcar!on (ICCMLCM).
admncedata 7

Table 8. Number of chronic pain visits by patient characteristics, most frequant pain symptoms, and selected principal diagnoses, and percent

of chronic pain visits that involved the use of 1 or more analgesic agents or 1 or more psychotropic drugs, by patient characteristics, most

frequent pain symptoms, and selected principal diagnoses United States, 1980 and 1981

Analgesic visirsl Psychotropic

v)sits:2

Chronic Percent Percent

pain of chronic Opioid Nonopioid of chronic

Patient characteristic, most frequent pain symptom, anddiagnosric group visits pain visits proportion proponion pain wsits

Number in

thousands Percent of analgesics

Allchronic pain visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PATlENT CHARACTERISTIC

Age

Under 45 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Sex

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race3

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MOST FREQUENT PAIN SYMPTOM

Back pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chest pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Abdominal pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Knee pare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DIAGNOSTIC GROUP (SELECTED)

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental dworders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the nervous system and sense organs. . . . . . . . . . . . . . . . . . . . . . .

Dwesses of theckculatory system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dweases of theresplratoty system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of thedtgestwe system.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dweases of thegenltourinary system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dmeases of themusculoskeletal system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Symptoms, signs, and ill-defined condmons. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Injury andpoworrlng . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

72,364

28,503

25,281

18,590

43,945

28,429

62,647

9,097

4,310

68,064

12,899

8,297

6,762

5,518

4,321

1,402

2,257

4,670

9,193

4,396

6,053

4,480

24,625

4,014

6.074

34.4

26.6

38.1

41.4

35.5

32.8

33.7

38.2

37.5

34.2

46.7

21.9

16.6

12.0

50.4

34.5

20.5

17.9

20.1

●1O.2

12.0

19.8

60.0

22.5

34.2

26.9

35.5

27.3

18.0

26.7

27.4

24.9

38.6

*1 9.2

27.5

30.8

54.7

●23.1

●56.2

●9.1

“70.0

●55.7

“44.1

“20.6

●39.6

●43.8

“48.2

20.3

54.8

28.2

73.1

64.5

72.7

82.0

73.3

72.6

75.1

61.4

80.8

73.4

69.2

45.3

76.9

43.7

90.9

“30.0

●44.3

55.9

79.4

“60.4

●56.2

51.8

59.7

45.2

71.8

11.9

10.1

13.8

12.1

13.4

9.6

12.0

12.1

●18.2

11.5

12.8

32.8

14.6

11,5

“4.3

“7.7

61.8

13.7

14.9

●6.1

10.2

83,3

9.5

20.5

7.8

lVISItS at whtch 1 or more analgeslc agents were ordered or prowded. Included m the optoad proportmn are SH optmd.nonoplotd combmaltons.

2Vmts at wh!ch 1 or more psychotropic drugs were ordered or prowded. The psychotropic category includes ant!anxtety agents, sedatwes, hypnotics, antidepressants,

and ant!psychot!c drugs.

3Because of their very mmor representation !n the data base, other races are omnted from thm study,

while nonopioids are more frequently associated with the harmful to the needs of the outpatient, who generally must

treatment of mild to moderate pain. ) In ambulatory care, the carry on with the requirements of everyday life.

salutary effects of the opioids must always be weighed against

The findings in table 8 support an approach to analgesic therapy

certain of their adverse effects; for example: that. in most cases. seems conservative and clinically appm-

. Over the long period required in the management of chronic

pain. opioids may create a state of drug dependence or

conditioned pain behavior.

● Substance abuse is a more serious threat in outpatient

treatment because there are fewer controls over patient

compliance with the dosage regimen.

● Fully effective doses of the opioids usually cause a sedation

or dulling of mental processes, altering behavior to a degree

priate; for example:

. An analgesic was ordered at only I of every 3 chronic

pain visits: an opioid at only 1 in 10.

● While analgesic therapy intensifies in direct proportion to

advancing age, the use of opioids shows an opposite

tendency, reaching its lowest point among chronic pain

sufferers over 64 years of age, the age at which the opioids

may produce their most serious adverse effects.
8

● While musculoskeletal pain accounted for the most liberal

use of analgesics. a conservative 60 percent of these were

nonopioids.

● The most intensive use of opioids occurs predictably in the

treatment of neoplastic pain.

● Gender differences in the use of the analgesics were modest

to insignificant.

Some findings, however, evade full explanation; for example:

● The author cannot account for the more intensive use of

opioids among black patients. Diagnostic correlates alone

are not adequate to explain it.

s A somewhat more marginal application of opioid therapy

is its prominent use in the treatment of psychosomatic/

symptomatic pain, where it is second in intensity only to

the treatment of neoplastic pain. In treating psychosomatic/

symptomatic pain (surely the most subjective of the pain

symptoms) physicians seem to be taking an indirect approach to dulling the pain by making use of another function

of the opioids—their power to suppress the anxiety and

apprehension that in turn may intensi& the perceived

severity of the pain.

Psychotropic agents were utilized at a conservative 12

percent of chronic pain visits (table 8). By far their greater

proportion (70 percent) consisted of antianxiety agents, sedatives, and hypnotics. Antidepressants made up 23 percent of

their number, while the antipsychotic subclass accounted for a

very minor 7 percent.

By their direct alteration of the psychological states associated with the chronic pain, the psychotropic may indirectly

perform a function similar to that of the opioids, that is, they

may reduce the perceived severity of the pain itself. However,

in common with the opioids, they also involve an increased risk

of drug dependence, substance abuse, and conditioned pain

behavior.

The findings in table 8 reveal a psychotropic usage that

was somewhat more intensive for female than for male patients,

and more evident among Hispanic than non-Hispanic patients,

although because of sampling error much of the latter difference

may be more apparent than real.

It was predictable that the most intensive use of psychtropic therapy would occur at chronic pain visits that were

associated with psychosomatic/symptomatic pain.

Nondrug therapy was provided or ordered at 52 percent of

the chronic pain visits (table 9 and figure 4). Though it was

clearly less intensive than the use of cintg therapy, it still exceeded by a respectable margin the customary use of nondrug

procedures by the office-based physician. Contributing sigrtificantly to this heightened tempo of nondrug therapy was an

increase in the amount of counseling brought to bear in the

treatment of chronic pain and its disruptive effects. For the

purpose of this analysis, “counseling” is interpreted as including

the following

● General medical instructions and recommendations.

● Instruction in the proper use of medications.

● Advice regarding diet or dietary habits.

● Advice designed to alter psychological states.

Table 9. Percent distribution of all office visits and of chroni(c pain

visits by nondrug therapy provided or ordered at the visit

United States, 1980 and 1981

All Chronic

Nondrug therapy provided or ordered office visits pain visits

Percent distribution

Alltreatmentsl . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.8 48.4

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . 4.8 14.5

Ot%cesurgery.. . . . . . . . . . . . . . . . . . . . . . . 7.4 2.5

Counselmg2 . . . . . . . . . . . . . . . . . . . . . . . . . 38.1 43.9

Other nondrug procedures . . . . . . . . . . . . . 2.9 2.5

ITotalsexceed 100.0 because more than 1 procedure could be applled per v!sit.

2Counselmg includes general medical instructions and recommendatmns, advice

about diet or dieta~ habits, and adwce destgned to alter psychological states

or to cope w!th problems of family relaoonships and social adjustment.

El ~:j~:j. Alternatives to drug therapy

......

Izl

Orug therapy

Figure 4. Percent of chronic pain visits by treatment modalities

United States, 1980 and 1981

. Advice to help the patient cope with problems of family

relationships and social adjustment.

Counseling was applied at an averttge 44 percent of chronic

pain visits (table 9). Its maximum use (80 percent) was ap

parent at visits for neoplastic pain and for the psychogenic pain

associated with a diagnosis of Mental disorder.

It is something of a contretemps to discover that symptomatic pain (that is, pain associated with the diagnosis of

Symptoms, signs, and ill-defined conditions) did not elicit an

above-average counseling effort. For the first time in thks analysis, the conceptual unity of psychosomatic/symptomatic pain is

no longer operative.

Continuity of care is a hallmark in the management of
ackmaMa9

Table 10. Percent of all offica visits, chronic pain visits, and acute

pain visits by referral status, followup, and mean visit duratiom

United States, 1980 and 1981

The survey findings presented in tables 11 and 12 document

the variations in the management of chronic pain that occurred

among different physician speciakies. Many of these variations

can be explained by the survey findings already presented.

Some, however, warrant highlighting or interpretive commenu

for example

Referral status, followup, All Chronic Acute

and mean visit duration office visits pain visits pain visitsJ

Percent

100.0 ●

●

●

●

The largest single proportion (one-third) of the 72,374.000

chronic pain visits were made to general or family physicians. Together with internists and orthopedic surgeons,

these physicians accounted for 7 of every 10 chronic pain

visits.

As a relative part of a physician’s total practice, the involvement with chronic pain reached its highest levels

among neurologists, orthopedic surgeons, and internists.

Considering the disruptive emotional effects potential to

chronic pain, it is somewhat surprising that the psychiatrist

was only minindy active in its treatment.

Of the chronic pain treated by the neurologist, psychoAll visits . . . . . . ..- . . . . . . . 100.0 100.0

Patient referred for this visit

by another physician?

Yes . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . .

4.5

95.5

6.0

94.0

4.4

95.6

Pollowup

(selected mstructlons)

No followup . . . . . . . . . . . .

Return at specified time. . .

Return if needed . . . . . . . . .

Telephone foilowup

planned . . . . . . . . . . . . . . .

11.5

60.7

22.7

3.4

6.2

61.5

24.5

4.1

Minutes

16.8

13.0

41.3

35.2

7.1

somatic/symptomatic pain accounted for about one-tbird—

nearly four times the average presence of this kind of pain

in office practice. Because this most elusive type of pain is

Mean visit durationz . . . . . . 15.9 14.8

IVmts for a condition w!th an onset of fewer than 90 days prior to the visit, for

wh!ch the most tmportant reaaon for the visit was a complaint or symptom

of pare.

ZLlmited to tnne spent in face-to-face contact bemveen physician and Patient Table 11. Parcent distribution and number of chronic pain visits per

1,000 office visits by characteristics of the attending physiciam

United States, 1980 and 1981

Physician characteristic Chronic pain visits chronic pain. An estimated 88 percent of chronic pain encounters were return visits to a parent physician. Of the remaining 12 perceq, at which the chronic pain patient was being

seen by the physician for the fmt time, roughly 7 percent were

the result either of voluntary walk-ins or of referral from sources

‘other than physician colleagues. Only a very minor proportion

(4-5 percent) were referred between physicians (table 10).

This average referral rate did not vary greatly with the changing, clinical substratum of the pain, the most intensive use of

referral (at 6-7 percent of visits) appearing at visits for musculoskeletal pain and for pain of psychosomatic/symptomatic

origin.

In their followup instructions at the end of the chronic pain

visits (table 10), physicians were substantially more demanding

and specific than they were at visits motivated by acute pain

(pain with an onset of less than 3 months prior to the visit).

Helped to a larger extent by the self-restorative capacities of

the My, the physician treating acute pain could place an

above-average reliance on the more tentative “telephone folIowup” or “return if needed.” Chronic pain and its associated

impairments, on the other hand offered no such assurance of

unassisted remission of symptoms. Both the pain and its impairments required maintenance therapy to keep them at a

therapeutically acceptable level, and a rigorous monitoring of a

drug regimen that, with its continuin~ above-average reIiance

on opioids and psychotropic drugs, held an increased threat of

drug dependence or pain conditioned behavior.

Measured by face-to-face contact between physician and

patient, the average chronic pain visit lasted about 17 minutes

(table 10). This somewhat exceeded the mean contact time

found for all ofllce visits, in large Part because of the increased

counseling effort typical of the management of chronic pain.

Number

per 1,000

office visits

Number in

thousands

All physicians . . . . . . . . . . . . . . . . . . . . . . 72,374 62

Percent

distribution

All physicians . . . . . . . . . . . . . . . . . . . . . . 100.0 62

Professional identl~

Doctor of medicine . . . . . . . . . . . . . . . . . .

Doctor of osteopathy . . . . . . . . . . . . . . . .

91.6

8.4

61

66

Specialty

General or family practice. . . . . . . . . . . . .

Internal medicme . . . . . . . . . . . . . . . . . . .

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . .

General surgery . . . . . . . . . . . . . . . . . . . . .

Obstetrics and gynecology. . . . . . . . . . . .

Orthopedic surgery . . . . . . . . . . . . . . . . . .

Cardiovascular medicine. . . . . . . . . . . . . .

Dermatology . . . . . . . . . . . . . . . . . . . . . . .

Urology . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . .

Neurology . . . . . . . . . . . . . . . . . . . . . . . . .

Ophthalmology . . . . . . . . . . . . . . . . . . . . .

Otolaryngology . . . . . . . . . . . . . . . . . . . . .

33.5

23.1

2.4

5.1

3.1

13.8

1.9

“0.5

2.2

0.9

1.8

1.3

2.2

64

116

14

59

20

180

91

●8

82

20

208

14

60

Type of practice

solo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Multiple member . . . . . . . . . . . . . . . . . . . .

55.1

44.9

63

62

Regton of practice

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

22.6

24.5

32.8

20.1

60

60

63

68
10

Table 12. Percent of chronic pain visits by key aspects of its presentation and management and selected physician characteristics

United States, 1980 and 1981

New patient visits

Walk-in

or

Visits for Referred referred

Chronic psychosomatic Opioid or Nondrug by from

Physician

Mean

pain or symptomatic Drug Analgesic psychotropic therapy Counseling another another visit

characteristic visits pam 1 visits2 visits3 vlslts~ visits5 visitse physician source duration 7

All physicians . . . . . . .

Professional identity

Doctor of medtcme. . .

Doctor of osteopathy . .

Specialty

General or family

practice . . . . . . . . . . .

Internal medicine . . .

General surgery. . . . . .

Orthopedic surgery. . .

urology . . . . . . . . . . . .

Neurology . . . . . . . . . .

Otolaryngology. . . . . .

Number in

thousands

72,364

66,256

6,118

24,265

16,721

3,681

9,986

1,592

1,324

1,561

Percent of chronic pa!n visits

8.6 72.1 34.4 21.2 51.6 43.9 4.5 7.2

9.1 72.2 34.7 21.4 54.9 45.1 4.6 7.5

●4.7 71.0 31.4 16.8 77.1 30.1 ●1.7 “4.0

EI,6 80.7 38.1 26.8 51.6 38.4 “0.5 5.7

8.8 85.6 45.5 24.4 55.7 63.4 3.8 3.7

13.6 57.4 23.7 15.0 38.5 30.5 ●5.2 15.2

“1.1 47.3 38.0 10.1 56.0 24.8 10.3 12.2

“5.4 62.0 ●7.9 ●6.8 49.2 34.3 *4.8 ●7.2

“32.0 70.5 *29.6 43.1 47.5 43.2 ●21 .6 *7.8

“3.5 62.1 “7.3 ‘9.4 46.6 37.9 *11.8 ●1 7.4

Minutes

.—

16.8

17.0

14.3

14.4

19.8

15.0

15.3

17.3

27.8

13.7

‘Includes ws!ts assoc! ared wnha dmgnosm m the dlagnost!c groups Mental dtsorders or Symptoms, signs, and ill-defined conditions.

‘Vtsttsalwh!ch 1 ormoredrugs ofanykmd were ordered orprovlded.

3V!SKSat Wh!Chan analgesic agent was ordered orprowded.

4Vm!tsat wh!ch anopnotd analgesic orapsychotropfic drug was ordered orprowded.

5VtSKSat wh!ch 1 ormorenondrug treatments were prowdedorordered.

6Counsellng includes general medical mstructlons and recommendations. adwce about d)etordieta!y habits, and advice designed toalter psy’chological atates (or to

cope wnh problems of family relatmnshtps and socml adpmtment.

7Llmned totgme spent m face-to-face contact between physlcnan and patient

the form most frequently referred, it is not surprising that

neurologists report a proportion of referred chronic pain

\isits that exceeds the referral rate for any other specialty.

It is also probable that their substantially longer visit durations are at least partly a result of their diagnostic efforts

to find a neurological basis for this psychosomatic/symp

tomatic pain.

Survey findings are not adequate to describe the use of

surgical intervention in the control of recalcitrant pain. but

clues to its apparently infrequent utilization probably lie

not only inthevisits to neurologists but also in the nature

andmanagement of the chronic pain presented tothegeneral surgeon.

Though the two primary-care providers, internists and

general (or family) practitioners, agree in their aboveaverage application ofdrugtherapy-including the use of

opioid analgesics and psychotropic drugs-internists are

markedly more inclined to make use of counseling and to

devote more contact time to their chronic pain patients.

Questions, comments, or suggestions for further analysis are

encouraged and may be directed to—

Hugo Koch

Ambulatory Care Statistics Branch

National Center for Health Statistics

3700 East-West Highway

Hyattsville, MD 20782

Telephone: (301 ) 436-7132
ackmdaa 11

Technical notes

source of data and sample design

The estimates presented in this report are based on ~e

findings of the National Ambulatory Medical Care Survey

(NAMCS), a sample survey of oflice-based care conducted

annually from 1973 through 1981 by the National Center for

Health Statistics. The target universe of NAMCS is composed

of off]ce visits made by ambulatory patients to non-Federal

and noninstitutional physicians who are principally engaged in

office-base& patient-care practice. VLsits to physicians practicing in Alaska and Hawaii are excluded from the range of

NAMCS, as are visits to anesthesiologists, pathologists, and

radiologists.

NAMCS uses a multistage probability sample design that

involves a step-wise sampling of primary sampling units, physicians’ practices within primary sampling units, and patient

visits within physicians’ practices. The physician sample (5,805

for the combined years 1980 and 198 1) was selected from

Table 1. Approximate relative standard errors of estimated numbers

of office visita and chronic pain visits, based on ail physician

spaciattiex National Ambulatory Medical Care Survay, 1980 and 1981

Relative

standard

Estimated number of office visits or drug mentions error in

in thousands percent

450 ........................................... 30.0

600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.0

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.6

I.om. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.2

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.5

!moO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5

10.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1

20.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4

EXAMPLE OF USE OF TABLE An aggrsgateesumateof 35.000,000 office

vmts has ● relatwe standard error of 5.0 percent or a standard error of

1.750,000 vmts (5.0 percent of 35.000,000 vmts).

master files maintained by the American Medical Association

and the American Osteopathic Association. Those members of

the sample who proved to be in scope participated at a rate of

77.3 percent- Responding physicians completed visit records

(figure 1) for a systematic random sample of their ofllce visits

made during a randomly assigned weekly reporting period.

Telephone contacts were excluded. During 1980 and 1981

responding physicians completed a 2-year totai of 89,447

Patient Record forms of which 5,869 were records of chronic

pain visits. Characteristics of the physician’s practice, such as

primary specialty and type of practice, were obtained during an

induction interview. ‘l%e National Opinion Research Center,

under contract to the National Center for Health Statistics,

was responsible for the field operations of the survey.

Sampling errors, statistical significance,

and rounding

The standard error is a measure of the sarnpling variability

that occurs by chance because only a sample, rather than the

entire universe, is surveyed. The relative standard error of an

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. Table

I should be used to obtain the relative standard error for aggregates of office visits or for mentions of drugs by class name

(for exampIe, analgesic visits). Standard errors for estimated

percents of visits (or for chronic pain visit rates per 1,000

visits) are shown in table II.

In this reporg the determination of statistical signiticmtce

is based on the r-test with a critical value of 1.12 (0.75 level of

significance). Terms relating to differences, such as “higher”

or “less,” indicate that the differences are statistically significant. Terms such as “similar” or “no difference” mean that no

statistical significance exists between the estimates being compared. A lack of comment in a comparison between any two

estimates does not mean that the difference was tested and was

not significant.

In the tables of this report estimates have been rounded to

the nearest thousand. For this reason, detailed estimates do not

always add to the total.

Tabio IL Approximate standard errors of parcant of astimated numbars of ofica visits or of chronic-pain visit rates par 1,000 visits:

NAMCS. 1980 and 1981

Estimated percent of office visits or estimated chronic-pain

visit rates per 1,O&7 visits

Estimated number of office visits in th~”sands 1 or 99 5 or 95 10 or 90 20 or 80 30 or 70 50

Standard error in percent

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.8 6.2

1.000

8.5 11,3 12.9 14.1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.0 4A

2.000

6.0 8.0 9.1 10.0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 3.1 4.2

5.000

5.6 6.5 7.1

.. -- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 1.9 2.7

10.000

3.6 4.1 4.5

. . . . ..-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 1.4 1.9 2.5

20.000

2.9 3.2

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 1.0 1.3 1.8 2.0

50000

2.2

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

200,000

0.3 0.6 0.8 1.1 1.3 1.4

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.3 0.4 0.6 0.6 0.7

1.Ooo,om . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.1 0.2 0.3 0.3 0.3

EXAMPLE OF USE OF TABLE An estimateof 20 percent baaed on an aggregate of 3.500,000 wms has a standard error of 4.6 percant or a relatwe standard error of

23 percent (4.6 percent+ 20 percent).
12

. . .

. . .

-

0.0

z

●

#

Symbols

Data not available

Categow not applicable

Quantity zero

Quantity more than zero but less than

0.05

Quantity more than zero but less than

500 where numbers are rounded to

thousands

Figure does not meet standard of

reliability or precision (more than

30-percent relative standard error)

Figure suppressed to comply with

confidentiality requirements
From Vital and Health Statistics of the National Center for Health Statistics Number 124. September 30, 1986

Aging in the Eighties,

Age 65 Years and Over— Use of Community Services

Preliminary Data From the Supplement on Aging to the

National Health Interview Survey United States, January–June 1985

Robyn Stone, Dr. P. H., National Center for Health Services Research

Introduction

The National Health Interview Survey is the National

Center for Health Statistics’ large continuing survey of the

health of the civilian noninstitutionalized population of the

United States. Each yew people in about 42,000 households

are interviewed by the U.S. Bureau ‘ofthe Census interviewers

to obtain tiormation about their health and use of health care.

Demographic information that is needed to interpret the data is

also obtained. The interviewers have special training on this

survey in addition to their regular training, and response rates

are high-about 97 percent, The only item with a relatively

Iow response rate is family income.

In 1984 a special supplement was added to the questionnaire to obtain information about older people who were living

in t?I‘ emmnunity. This supplement, the Supplement on Aging

{32,:’,), was designed to collect information about physical

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

sewices, and other health-related and social information about

middle-aged and older people. All household members age 65

years and over and a half sample of those 55-64 years of age

were asked tie questions on the supplementthemselves where

possible. Another household member was interviewed only

when the selected person was unable to answer either because

of physical or mental problems or wx going to be away from

the household for a longer period than the interviewer would be

in the area Preliminary background data based on the first 6

months of interviews for the SOA are provided in a recent

National Center for Health Statistics Advance Data report.l

The data in this report are ilom interviews completed

during the first 6 months of 1984. The data are prelimin~

because only one-half of the year is included and because

the data from the SOA have not been edited. Including

the full year wiIl double the size of the sample and make

estimates more reliable. It also will reduce any possibility

of bias because of seasonadity. Editing will change some

of the estimates because information from other parts of the

questionnaire will be used to correct missing or inconsistent

information.

The purpose of this document is to provide estimates of

people 65 years of age and over who reported using community

services during the past year. These services encompass both

community-based services (for example, senior citizen centers

and senior center meals, adult day care, and special transportation for the elderly) and in-home services (such as homemaker services, home health aides, visiting nurses, homedeIivered meals, and telephone call-check services).

The data in this report are of particular interest because

the published national data on the use of services by the elderly

have focused primarily on hospital, physician, and nursing

home utilization. Policymakers, however, are expressing interest in community-based and in-home care. In particular,

these community services are seen as ways to enhance the

independent living of the elderly, in turn preventing or delaying

institutionalization. The data presented in this paper provide

preliminary estimates of the current use of community services

by persons 65 years of age and over.

When interpreting the data, the reader should note that the

estimates are based on a sample and they may differ from estimates based on a complete census using exactly the same

questions and interviewing techniques. Therefore, the reader

should read the “TechnicaJ notes” and consider the size of the

sampling error.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service
2 aduameciata

Use of community services

In early 1984 there were approximately 26 million people

age 65 years and over in the United States who were living in

communities outside of nursing homes or other institutions.

Perhaps the major finding in this report is that a relatively

small proportion of the elderly (22 percent) had used community services during the preceding year. The most frequently

used community service was the senior citizen center approximately 4 million persons age 65 years and over or 15 percent

of the aged population reported use of t.hk service in the 12

months before the interview (table 1). A little over 2 million

elderly persons or 8 percent of the elderly population also reported that they ate meals at the senior center.

Only a small proportion of persons age 65 yearn and over

who were living in the community had used in-home services

during the preceding year. Approximately 376,000 persons or

1 percent of the elderly living in the community used homemaker services. Three percent of those 65 years and over, or

775,000 persons, received care from visiting nurses and approximately 425,000 persons or 2 percent of the elderly population used home health sides. Reliable national estimates of

the use of telephone call-check services or of adult day care

cannot be made because the number of the sample respondents

who reported using these services was too small to make reliable national estimates.

The number and percent distribution of elderly persons

who had used one or more services are presented in table 2.

Almost four-fifths of people age 65 years and over or approximately 21 milIion elderly individuals did not use any community service during the past year. Three million elderly persons, or 11 percent of this population, reported using only one

service, and 60 percent of this subgroup were senior center

users. Approximately 2 million persons age 65 years and over,

or 7 percent of the elderly population used two community

services, and about 3 percent reported the use of three or more

services.

Information on the use of community services by age and

gender is reported in table 3. Due to the very low utilization

rates of adult day care and telephone call-check services, these

services have not been included in this analysis. Approximately

Table 1. Population estimates and percent of people age 65 years

and over living in the community who had used community services

during the preceding yeac United States, January-June 19S4

Use of

Service Population sefvices

Number m

thousands Percent

Total estimated population . . . . . . . . . . . . . . . 26,290 100.0

Senior center . . . . . . . . . . . . . . . . . . . . . . . . . . 3,970 15.1

Senior center meals . . . . . . . . . . . . . . . . . . . . . 2,057 7.8

Special transportation for the elderly . . . . . . . 1,231 4.3

Telephone call-check service . . . . . . . . . . . . .

● ●

Home-delivered meals . . . . . . . . . . . . . . . . . . . 497 1.9

Homemaker service . . . . . . . . . . . . . . . . . . . . . 376 1.4

Visltln gnurse s. . . . . . . . . . . . . . . . . . . . . . . . 75 2.9

Home health aide . . . . . . . . . . . . . . . . . . . . . . . 425 1.6

Adult day care . . . . . . . . . . . . . . . . . . . . . . . . .

* *

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

living in the community by number of community services used

during the preceding yeac united States, January-June 19S4

Use of

Number of services Population services

Number in Percent

thousands distribution

Total estimated population ., . . . . . . . . . .

——

26,290 100.0

o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,638 78.5

I or more . . . . . . . . . . . . . . . . . . . . . . . . . . 5,652 21.6

lonel y. . . . . . . . . . . . . . . . . . . . . . . . . . 2,997 11.4

Z only . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,945 7.4

3 or more . . . . . . . . . . . . . . . . . . . . . . . . 770 2.7

15 percent of persons age 65-74 years and 16 percent of those

age 75 years and over reported that they had used senior centers. Similarly, 8 percent of those in the former age category

and 9 percent of those in the latter age group reported that they

ate meals at the senior center. There does appear to be an

increase in the use of special transportation and in-ho]me services with age, although these differences may not be substantive given the very small number of service users within each

age category,

There also is evidence that a larger proportion of females

than males used a senior center during the year before they

were interviewed in early 1984. Among persons age 65–74

years, 17 percent of the females versus 12 percent of the males

attended a senior centeq the comparable fig&es for those age

75 years and over were 17 and 14 percent, respectively. (Gender

comparisons of the use of special transportation and in-home

services cannot be made reliably because of the very small

numbers of persons using these services.

Because utilization may vary depending upon living arrangements and level of functional limitation, the data presented in table 4 are categorized according to these two characteristics. The use of community services by persons age”65

years and over varied by living arrangement. Of the 8 million

elderly living alone in the community in early 1984,20 ]percent

reported using a senior center during the past year compared

with 12 percent of the 18 million living with others. Siinilarly,

12 percent of those living alone reported eating meals at the

senior center compared with 6 percent of those living with

others. Approximately 11 percent of the elderly living alone

used special transportation for the elderly while only 2 percent

of those living with others made use of this service. The relatively small proportion of persons using in-home services precludes statistically reliable comparisons;, however, it does

appear that a larger proportion of elderly persons liv”ingalone

than those living with others received home-delivered meals

and homemaker services.

The data presented in table 4 also suggestthat serviceuse

varied by limitation of activity due to chronic health pralblems.

A larger proportion of those moderately or severely limited

than those with no or slight limitations received h-home services including home-delivered meals, homemaker servkes, and

home health care either from a visiting nurse or a home health

aide.
a9ncdab3

Table 3. Percent of people age 65 years and over living in the community who had used community services during the preceding year by age

and sex United 8tatas, January-June 1984

65-74 years 75 years and over

Service Total Male Female Total Male Female

Number

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,731 1,625 2,106 2,251 822 1,429

Number in thousands

Estimated population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,227 7,048 9,178 10,063 3,685 6

Percent

Senior center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.7 11.5 17.1

Special transportation for tha eldarly . . . . . . . . . . . . . . . . . . . . . . . .

15.8 13.8

3.6 1.8 4.9

Senior center meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.2 3.8

7.6 6.1 8.8

Home-delivered meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3 8.9

1.2 1.1 1.3

Homemaker service

3.2 2.4

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.8 0.5 1.0

Home health services7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.7 1.0

2.3 2.3 2.4 5.5 4.8

7.0

9.1

9.4

3.7

3.6

6.3

1 Includes vistting nurses and home health aidas.

Table 4. Percent of people age 65 years and over living in the community who had usad community services during the preceding year by

living arrangement and limitation of activity: United States, Janua~-Juna 1984

Living alone Living with others

Moderately Not limited Moderately Not limited

to severely to slightly to severely to sltghtly

Service Total Iimitedi limited2 Total iimited~ l!mlted2

Number

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,809 429 1,380 4.773 1,064 3,109

Number in thousands

Estimated population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,018 1,919 6.099 18,272 4,677 13,595

Percent

Semorcanter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senior center meals . . . . . . . . . . . . .

20.3 18.8 20.8 12.4 7.5

11.9

13.1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.6 12.0

Spectal transportation forthe elderly . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.4 4.4 6.7

10.5 15.4 8.4

Home-delivered mails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.

2.4 2.7

3.8

2.2

10.3 1.7

Homemaker sewlce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

1.2 2.4

3.0

0.7

10.4 0.5

Home health sewicesa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.9 1.7 0.5

4.2 13.2 1.4 3.1 8.6 1.2

‘Ona IS moderately hmned if one IS lnmned ]n the kmd or amount of one’s mapactnmy, One IS severely I#mtted tf one IS mrableto perform ones majorac:lv,ly

‘One IS shghtlylimned if one is Iimned m outs!de actwty only. The.’ not hmneff category includes persons wnh unknown responses.

31ncludes viamng nurses and home health atdes.

These preliminq data provide tentative evidence that the

relationship between service use and limitation of activity is

tiected by living arrangements. For example, among those

living alone there appears to be no d~erence in the use of

senior centers between those with moderate or severe limitation (19 percent) and those not limited or only slightly limited

(2 I percent). However, among the elderly living with others, a

larger proportion of those with no or only sli@t limitations ( 13

percent) than those with moderate or severe limitations (8 percent) used senior centers. While tis relationship must be interpreted with caution, one can speculate that despite their

limitations, moderately to severely limited elderly persons living

alone were more likely to participate in senior center programs

for social support. In contrast, those living with others were

perhaps not as likely to use senior centers k.cause they received

thisSUpportat home.

Discussion

The use of community services by persons age 65 years

and over has been examined in this report. The most revealing

finding is the low utilization rates among the elderly population. Only one-fifth of the elderly reported using at least one

service in the past year, and about 3 percent used three or more

services. The most frequently cited service was the senior

centeq in-home services were used by a small proportion of the

elderly, and only a minute fraction of the elderly population

used adult day care.

These data are consistent with the fmdirtgs of a previous

study2 that examined the use of health and social services by

elderly participants of the Massachusetts HeaIth Care Panel

Study. Nevertheless, the data in this report must be viewed

with caution. These figures do not take into account availa-
4 aduancedata

biliry of and access to community services by the elderly. They

do no~ for example, consider the wide geographic variation in

the number and kinds of community services available to the

elderly. They also do not address other barriers including the

ability to pay for services. Furthermore, the data presented

here do not consider the amount of unpaid care provided to the

elderly by family and friends, care that might substitute for

formal community-based and in-home services. Finally, these

estimates do not reflect the use of community services before

death by elderly persons who died within the year. Research

indicates that hospitalization rates are much higher during the

last year of life.3-5 It is likely that the use of home health services also would increase during the year preceding deatlh.

These estimates do provide tentative evidence that the use

of community services increases with age. Furthermore, it appears that elderly persons living alone and those with moderate

to severe fimctionaJ limitations are more likely to use these

services than are those living with others and those with less

fictional impairment. The larger sample when data for tlhe full

year are available will enable us to learn more about the use of

community services by the elderly.
References

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

eighties, preliminary data from the Supplement on Aging to the National Health Interview Survey, United States, January-June 1984.

Advance Dafa From Vital and Health Statistics No. 11S. DHHS

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

May 1, 1986.

ZC. Evashwick, G. Rowe, P. Diehr, and L. Branch Factors explaining

the use of health care services by the elderly. Health Services Reseatrh

19(3), August 1984.

‘National Center for Health Stat.isties: Use and costs of Medicare

services in the last years of life, by J. Lubkz and R Prihoda. Health,

Unired States, 1983. DHHS Pub. No. (PHS) 84-1232. Public Health

Swice. Washington. U.S. Government Printing Oflicc, Dec. 1983.

ackmeda5

4He~~ c= Finmting Adrrdnistration, C. Heblin~ Medicare: Use

and reimbursement for aged persons by survival status, 1979. Heaffh

Care Financing Notes. HCFA Pub. No. 03166. Ofiice of Research

and Demonstrations. Baltimore, Md., Nov. 1983.

sM. G. KOVFC Hedfi of elderly people living in the community in

1980. MiIbank Memoria[ Fund Quarterly 64(1), Feb. 1986.

6National Center for Health Statistics, M. G. Kovar and G. S. POIX

The National Health Interview Survey design, 1973-84, and procedures, 1975-83. Vital and Health Statistics. Series 1, No. 18.

DHHS Pub. No. (PHS) 85-1320. Public Health Service. Washington. U.S. Government Printing Ofke, Aug. 1985.
6

“Tachnical notes

Each week a probability sample of households in the

United States is v~ited by U.S. Bureau of the Census interviewers to obtain a wide range of information about the health

and health care characteristics of the people living in those

households. A description of the survey design, methods used

to make the national estimates, and general qualifications of

the &ta are provided in The National Health Interview Survey

Designj 1973-84, and Procedures, 1975-83.6

During January-June 1984 there were about 21,000

households in the sample. The total nonintmview rate was

about 3 percent—primarily because the interviewer was unable to locate an eligible respondent despite repeated calls.

The rules for the survey are that all adults who are in the

household when the interviewers call are asked to join in the

interview and to respond for themselves. People age 65 years

and over are likely to be at home and are, thus, more likely to

respond for themselves to the questions on the basic, or core,

questionnaire. During the first 6 months of 1984, 84 percent

answered the questions themselves.

For the Supplement on Aging (SOA), the interviewers

made an additional effort to encourage the people selected to

answer the SOA questions to respond for themselves. They

encouraged the household respondent to ask an older person to

talk to the interviewer and, if necessary, made extra calls. The

results of their efforts were both positive and negative. The

positive result was that an even higher proportion, 92 percent,

of the responses to the SOA were completely self-responses.

The negative result was that in a few cases information was

obtained from a household respondent for the core questions

but no information was obtained for the supplement. Fortunately, the latter was rare; 5,629 of the 5,982, people age 65

years and over who were in the sample during January-June,

95 percent, had complete interviews on the supplement.

The estimates in this report are based on a sample rather

than on the entire population of people age 65 years and over

in the civilian noninstitutionalized population. Therefore, the

estimates are subject to sampling error. In addition, the

sample had a complex design that has the effect of making the

Smilplhg errors somewhat larger than they would be from a

simple random sample of the same size using the same procedures. A conservative estimate is that, on the average, the

variance for estimated proportions from this sample is 20 percent larger than it would have been from a sample of the same

size using the same procedures.

To estimate the sampling errors, corwert the percent to a

proportion, calculate the variance of a proportion assuming

simple random sampling, multiply that variance by 1.2 to allow

NOTE: A list of referencesfollowsthe text.

for the complex sample, then compute standard errors, confidence intervals, or significance tests.

For example, the estimate is that 21 percent of the

8,018,000 people age 65 years and over and living alone used

senior centers. There were 1,809 people in the sample age 65

years and over and living alone. Therefore,

Variance (simple random sample) = ~

= (0.21 )(0.79)

1,809

= 0.000092

Variance (complex sample) = (0.000092)(1.2)

= 0.00011

Standard error = (0.00011)1/2

= 0.0105

95 percent confidence interval= 21 * (1.96)(1.05)

= 21 A 2 percent

Perhaps more important for interpretation than sampling

errors, however, is a thorough understanding of what data~from

this, or any other, cross-sectional survey can provide. There

are two issues—one important for any cross-sectional analysis

and the other of special importance for older people.

The National Health Interview Survey is a point-in-time

study. Associations at one point in time should not be interpreted as causality. The differences among the age groups, for

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

could be the result of different cohorts moving through time.

Based on external knowledge, one could interpret a difference

in the use of community services as the result of aging, but the

data from a cross-sectional survey do not enable one to make

that distinction.

The second is that this is a study of people who were living

in the community at the time they, or proxy respondents, were

interviewed. All of the elderly people who had left the population, either through death or institutionalization, are excluded.

Thus, the estimate that 3 percent of the elderly had used visiting

nurse services during the preceding year should not be interpreted to ,mean that only 3 percent of all elderly people used

this service during the year. It is likely that the use of home

health services would be higher during the year preceding death

or institutionalization, and the experience of those people is not

included in these estimates.
7

.-.

. . .

-

0.0

z

*

#

Symbols

Data not available

Catego~ not applicable

Quantity zero

Quantity more than zero but less than

0.05

Quantity more than zero but less than

500 where numbers are rounded to

thousands

Figure does not meet standard of

reliability or precision (more than

30-percent relative standard error)

Figure suppressed to comply with

confidentiality requirements
From Vital and Health Statistics of the National Center for Health Statistics Number 125. September 19, 1986

Aging in the Eighties,

Impaired Senses for Sound and Light

in Persons Age 65 Years and Over

Preliminary Data From the Supplement on Aging to the

National Health Interview Survey United States, January–June 1984

by Richard J. Haviik, M. D., Office of Program Planning, Evaluation, and Coordination

Introduction

The National Health Interview Survey is the National

Center for Health Statistics’ large continuing survey of the

civilian noninstitutionalized population of the United States.

Each year people in about 42,000 households are interviewed

by U.S. Bureau of the Census interviewers to obtain information about their health and use of health care. Demographic

information that is needed to interpret the data is also obtained.

The interviewers have special training on this sumey in addition

to their regular training and response rates are high-about 97

percent. The only item with a relatively low response rate is

family income.

In 1984 a special supplement was added to the questionnaire to obtain information about elderly people who were living

in the community. 1 This supplement the Supplement on Aging

(SOA), was designed to collect information about physical

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

services, and other heafth-related information about middleaged and older people.

All household members age 65 years and over and a half

sample of those 55-64 years of age were asked the questions

on the supplement themselves where possible. Another household member was interviewed only when the seiected person

was unable to answer either because of physical or mental

problems or because of being away flom the household for

a longer period than the interviewer would be in the area.

Response rates to the SOA were also high. Of the 5,982

people age 65 years and over who were in interviewed households in January-June 1984, 96 percent had complete interviews; 92 percent answered the questions on the SOA for

themselves.

The data in this report are from the interviews that were

completed during the fwst 6 months of 1984. The data are preliminary because only one-half of the year is included and

because the data from the SOA have not been edited. Including

the full year will double the size of the sample and make estimates more reliable. It will also eliminate any possibility of

bias because of seasonality. Editing will change some of the

estimates from the SOA that are in the text because information

from other parts of the questionnaire or from other family

members will be used to correct missing or inconsistent information.

The preliminary data about people age 65 years and over

are being published because the need for information about the

elderly is critical, and 5,982 people is a large enough sample to

make estimates that are reliable for many purposes. The reader

should use the material in the technical appendix before deciding that differences not mentioned in the text are likely to be

statistically significant. The number of people in the sample is

given in each table in addition to the national population

estimates.

The primary purpose of this repent is to provide estimates

of the prevalence of self-reported impairments of hearing and

vision in the elderly. In addition, the designof the survey also

allows simultaneous consideration of associated limitations in

activities of daily living and related medical conditions. Such

information may have applications in fostering further scientific

inquiry or assisting in future policy decisions.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service
2

Background

Impairments in hearing and vision are known to be common

in the elderly. These deficiencies result from various medical

conditions of the ears;z from environmental exposures to the

eyes, such as sunligh~3 as well as from the possible effects of

the aging process, such as changes of already formed proteins

in the lens.4 National estimates of the prevalence of such impairments are available from the National Health Interview

Survey (NHIS) through responses to questions related to

medically diagnosed and self-perceived decreases in hearing

and vision.s.b In 1982, 30.0 percent of those 65 years and over

reported hearing impairments and 10.1 percent had visual impairments.5

Because questions concerning medical conditions, activities of daily livin~ and sensory impairments were asked of the

same individuals in the SOA, this design, in contrast to NHIS,

provided the opportunity to describe the frequency of multiple

problems in the elderly. Combinations of such problems have

the likely effect of compounding the consequences for the

elderly. They can result in a marked diminution in the quality

of life for older citizens. Also, there is the likelihood of dependency and possible need for long-term care. The frequency

of such multiple problems is much more common in nursing

facilities.7 However, the results to be presented in this report

deal only with the noninstitutionalized population.

Because of the relatively high frequency of hearing and

vision troubles among the elderly, it is possible, even in this

half-sample of 5,982 persons, to describe impairments by sex

and the three age subgroups of 65-74 years, 75–84 years, and

85 years and over. Some caution is urged in interpretations of

data from the oldest-old (85 years and over) group. However,

because of the general paucity of information concerning this

subgroup, presentation of some data was thought justified.

Hearing impairments

Hearing problems are quite frequent in the elderly (table

1). Hearing impairment is defined as the reported presence of

Deafness in one or both ears or Any other trouble hearing.

Depending on age, from 30.0 percent to 58.3 percent Iofmen

reported hearing impairment compared to 17.5 percent 1.044.3

percent of women. A similar sex differential has been observed

previously both as determined by interview in NHIS reports5.6

and by direet examination techniques, using audiometry testing

in the National Health Examination Survey* and in the Framingham Study.2 Data from the Framingham Study suggest it is

Table 1. Percent distribution of people age 65 yews and over living in the community by selected hearing characteristics, according to age

and sex United States, January-J une 1984

65-74 years 75-84 years 85 years and over

Both 8oth Both

Hearing characteristic Total sexes Men Women sexes Men Women sexes Men Women

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimated population . . . . . . . . . . . . . . . . . . . .

TotalI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hearing impairment

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deafness

No deafness . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deafness [nl ear . . . . . . . . . . . . . . . . . . . . . . .

Deafness in both ears . . . . . . . . . . . . . . . . . . . .

Any other trouble hearing

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Use heartng aid

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Describe hearing (with hearing aid)

No trouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Little trouble . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lot of trouble . . . . . . . . . . . . . . . . . . . . . . . . . .

5,982

26,290

100.0

72.2

27.8

87.1

7.5

5.2

81.5

18.3

92.0

8.0

61.1

33.3

5.5

3.731

16,227

100.0

77.0

23.0

89.8

6.7

3.3

84.6

15.3

94.4

5.6

66.9

29.8

3.2

1,625

7,048

100.0

70.0

30.0

86.7

8.5

4.5

79.4

20.5

93.0

7.0

59.2

36.6

4.1

Number

2,106 1,803 690 1,113

Number in thousands

9,178 8,073 3.111 4,962

Percent distribution

100.0 100.0

82.5 67.3

17.5 32.7

92.1 85.4

5.4 7.6

2.5 6.7

88.4 77.9

11.5 21.8

95.5 88.9

4.5 11.0

72.8 55.0

24.6 38.0

2.5 6.8

100.0 100.0

60.1 71.8

39.9 28.2

81.0 88.0

9.8 6.4

8.7 5.4

72.1 81,2

27.1 18,7

85.2 91.1

14.8 8.8

47.7 59.4

41.9 35.7

10,1 4.8

448

1,990

100.0

51.6

48.4

71.7

12.9

14.5

68.9

30.0

84.0

15.8

37.5

43.2

19.1

132

574

100.0

41.7

58.3

61.5

18.5

19.2

69.2

30.8

76.6

23.4

33.9

43.9

22.3

316

1,417

100.0

55.7

44.3

76.2

10.3

12.4

68.8

29.7

87.2

12.4

39.1

43.0

17.7

‘ Figures may not add to total because of unknowns and roundtng.
unlikely that a difference in environmental noise exposure between the sexes is the reason for the male preponderance in

hearing 10SS.2Because past estimates of hearing impairments

have been made in NHIS using the same questions and similar

interviewing techniques, it may be possible with the full data

set to examine time trends.

The proportion of men and women age 65 years and over

and living in the community who indicated defiess in one or

both ears was 12.7 percent, or over 3 million of the total 26

million elders (table l). Eight percent of the elderly, or about 2

million men and women, reported using hearing aids.

When all persons in the survey (including those using

hearing aids) were asked to give the best description of their

hearing from 27.1 to 66.2 percent, depending on age and sex,

indicated little or a Lot of trouble with hearing. The total 61.1

percent with “no trouble” hearing is slightly lower than the

abmdata3

72.2 percent with no “hearing impairment.” This inconsistency

is possibly because some people who reported having a “little

trouble” hearing did not think it serious enough to respond

positively in the context of questions on deafness or other trouble

hearing.

Visual impairments

The category Visual impairment, which combines reported

Blindness in one or both eyes and Any other trouble seeing,

was found in from 9.5 percent of noninstitutionalized persons

ages 65–74 years to 26.8 percent in those 85 years and over

(table 2). Thus, there is an apparent trend of increasing prevalence of failing vision with older age. In this noninstitutionalized

population, blindness in one or both eyes is relatively uncomTable 2. Percent distribution of people age 65 years and over living in the community by selected visuel characteristics, according to age

and sex United States, January-June 1984

65-74 years 75-84 years 85 years and over

Both Both Eoth

Visual characteristic Total sexes Men Women sexes Men Women sexes Men Women

Number

2,106 1,803 690

Number in thousands

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,982

26,290

100.0

87.2

12.8

95.6

3.2

1.0

89.7

10.2

79.5

19.1

89.5

10.5

5.2

94.8

68.9

25.6

5.4

3,731

16.227

100.0

90.5

9.5

97.3

2.2

20.5

92.1

7.9

86.1

12.9

92.9

7.0

5.1

94.9

75.3

21.9

2.8

1,625

7,048

100.0

90.3

9.7

96.6

2.9

=0.4

92.4

7.6

89.5

9.6

93.2

6.8

6.4

93.6

76.7

20.8

2.6

1,113 448 132 316

9,178

100.0

90.6

9.4

97.8

1.6

20.6

91.9

8.1

83.5

15.4

92.8

7.3

4.1

95.9

74.2

22.7

3.0

Estimated population .,....... . . . . . . . . . . . 8,073 3,111

Percent distribution

4,962 1,990 57.4 1,417

TotalI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vksual impairment

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blindness

No blindness. . . . . . . . . . . . . . . . . . . . . . . . . . .

Blindness inl eye . . . . . . . . . . . . . . . . . . . . . .

Blindness in both eyes . . . . . . . . . . . . . . . . . . .

Any other trouble seeing

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cataracts

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operation for cataracts

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Use eyeglasses

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Describe vision (wtth glasses)

No trouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ltttle trouble . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lot of trouble . . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

84.0

16.0

94.2

4.4

21.3

87.4

12.3

71.2

27.0

64.6

15.2

4.4

95.6

60.7

32.1

7.0

I 00.0

83.3

16.7

92.9

5.9

21.1

87.1

12.3

75.4

22.3

84.9

14.9

5.3

94.7

62.0

31.9

6.0

100.0 100.0 100.0 100.0

84.4

15.6

73.2

26.8

75.0

25.0

72,5

27.5

95.0

3.6

21.4

B8.1

26.9

24.B

B7.7

25.4

26.9

88.3

27,6

23.8

87.7

12.3

77.6

21.4

82.0

217.2

75.7

23.2

68.6

29.9

59.0

37.9

66.9

31.5

55.5

40.8

84.4

15.4

80.3

19.7

81.0

219.1

80.0

20.0

3.8

96.2

9.3

90.7

212.5

87.5

27,9

92.1

60.0

32.3

8.0

47.4

30.9

21.2

55.0

25.8

218.3

44.1

33.1

22.4

‘ F#guresmay not add to total becauae of unknowns and rounding,

2Less than 30 persons wnh wsual characrenst!c m age-aex subgroup.
4 &ncedata

men; however, in the group age 85 years and over, about 12

percent had blindness in one or both eyes.

The frequency of visual impairments is similar in men and

women. However, in the age subgroups 65–-14 years and 75-

84 years, there is a statistically significant excess of reported

cataracts in women when compared with men. Such an increased frequency in women has been identified in previous

surveys both by report in NHIS5.S and by direct examination of

a population-based sample in Framingham.9 It should also be

noted in table 2 that the sex difference in frequency of operative

procedures for cataracts is not statistically significant. Although

this observation of more reported cataracts in women but equivalent surgery might suggest less severe lens opacification in

women, eye examinations performed on men and women in

Framingham demonstrated a similar excess in women of both

minor and major changes of the lenses.9

Finally, the percent of individuals using ,glasses is shown.

In the elderly population 94.8 percent reported that they used

glasses, most of which were prescribed. Deterioration of close

vision is quite common with aging even at younger ages than

are described here.4 However, in the total group (including

those wearing glasses) about 50 percent of the oldest old described some trouble seeing. Presumably, this percent is h@her

than the figure for visual impairment because of inclusion of

additional individuals with cataracts in those who described

some trouble seeing.

Impairments and associated limitations

Vkmal and hearing impairments, besides limiting communication and sensory stimulation, also may contribute to

compromising the physical mobility and independent ~activity

of the elderly. A series of questions dealing with the activities

of daily living (such as walking going outside, and so forth) has

been developed to describe limitations in common movements.

An association between an impairment and a limitation maybe

the result of the sensory loss adding to the dificulty in performing the task. For example, balance necessary for walking may

be affected by loss of visual cues or by problems in the semicircular canals of the ears.

In tables 3 and 4, data on impairments and limitations are

shown for the two extreme age groups. Data from the age sub

Table 3. Percent distribution of people aga 65-74 and 85 yeara and over living in the community by selected limitations and conditions,,

according to age and visuel impairment United States, Januety-June 1964

65-74 years 85 years and over

No visual Visual No visual lVisua/

Limitation or condition Total impairment impairment Total impairment i~patrrnent

——

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimated populstionl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Totalz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.

Difficulty walking

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Difficulty getting outside

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Difficulty getting in and out of bed or chair

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arthritis or rheumatism

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular disease

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypertension

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,524

15,322

100.0

85.6

14.4

94.2

5.8

93.0

7.0

48.2

51.0

87.1

12.9

55.8

43.8

3,170 354 419 300 119

Number in thousands

13.784 1,538 1,859 1,341 519

Percent distribution

100.0 100.0 100.0 100.0 ‘100.0

87.7

12.3

66.7 56.6

33.1 43.0

60.7

39.0

46.2

52.9

95.6

4.4

81.6 65.5

18.4 33.8

70.8

28.9

52.1

46.2

94.2

5.8

82.2 79.2

17.8 20.8

80.7

19.3

75.6

24.4

49,9

49.2

32.7 44.9

66.8 54.4

46.0

53.3

42.0

57.1

88.7

11.3

72.1 69.6

27.9 30.4

75.0

25.0

!55.0

45.0

57.1

42.6

44.6 55.1

55.1 43.9

58.9

39.7

45.4

54.6

lTotal sample number and estimated population reduced from tabla 2 because of mtssmg data or “Don’t know” responses.

2Fkgures may mm add to total because of unknowns and rounding.
zlCkziK4akl 5

Table 4. Percent distribution of people age 65-74 and 85 years and over living in the community by selected limitations and conditions,

according to hearing impairment United States, January-June 1984

65-74 years 85 years and over

No hearing Hearing No hearing

Limitation or condition

Hearing

Total impairment impairment Total impairment impairment

SampleI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimated populationl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Totalz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Difficulty walking

No. . . . . . . . . . . -------- -------- . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Difficultv getting outside

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Difficulty getting in and out of bed or chair

No . . . . . . . . . . . . . . . ..- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arthritis or rheumatism

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular disease

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypertension

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,524

15,322

100.0

85.6

14.4

94.2

5.8

93.0

7.0

48.2

51.0

87.1

12.9

55.8

43.8

2,673 851 419

Number in thousands

3,703 1,859

Percent dmtribut}on

100.0 100.0

203 216

11.620 906 954

100.0 100.0 100.0

87.1

12.8

80.7 56.6

19.3 43.0

64.0

35.5

49.5

50.0

94.7

5.3

92.5 65.5

7.5 33.8

72.4

26.6

58.9

40.7

93.9

6.1

90.1 79.2

9.9 20.8

85.7

14.3

73.2

26.9

50.7

48.5

40.1 44.9

58.6 54.4

52.5

47.6

37.8

60.8

89.1

10.9

80.6 69.6

19.4 30.4

77.9

22.1

60.8

39.2

56.3

43.4

54.4 55.1

45.0 43.9

59.3

39.7

51.2

47.9

‘Total sample number and estimated population reduced from table 1 because af m!ssmg data .x .’Don.t know’, resDtmsea.

2Flgures may not add to total because of unknowns and rcwnding.

.

group 75-84 years (not shown) are similar to age groups in the

tables. The sample numbers are reduced fkom tables 1 and 2

because of missing data or “Don’t know” responses. The

presence of visual impairments in persons is associated with a

higher ffequency of Iimhations. In both the 65-74 year and the

85 year and over subgroups, those with a visual impairment

(table 3) are more likely to be limited in walking and getting

outside. Jn additio% transferring thm bed and chair, an indicator

of more severe liitation of activity, shows a similar relationship. As would be expected a larger percent in each of the

activity categories is limited at older ages. For exmplq over~,

only 5.8 percent of the young old (ages 65–74 years) had problems getting outside but 33.8 percent of the oldest old (ages 85

years and over) were so limited. If, in addition, the subgroup

85 years and over had a visual impairment, the prevalence of

difficulty getting outside increased from 33.8 to 46.2 percent,

Similar relationships for hearing impairments and limitations

exist in the oldest old (table 4). Further analyses on the fill

data set and additional studies in other populations are necessary

before any final conclusions can be reached concerning the

meaning of these relationships.

Impairments and associated medical

conditions

Analogous to the association of impairments with increased

ffequency of limitations in the activities of daily living medical

conditions may be present more frequently in those with sensory

deficits. Such associations may be the result of the medical

condhion causing the impairmen~ for example, diabetes and

cataracts. Another possibility is that a separate etiologicrd factor

affects both the condition and the impairmen~ and results in an

observed association between them. An example of the latter

case is that the common factor “noise” might affect both the

hearing impairment and hypertension. Also. those receiving

regular medical care for a condhion may be more likely to have

other conditions or impairments diagnosed and, thus, produce

an association. For example, those reporting any urin~ difficulty have a greater frequency of at least three medical conditions being presen~ when compared with those without

urinary difHculties.10

Respondents were asked on the SOA if they ever had

“hypertension, sometimes called high blood pressure,” various
6 ZKimncedata

types of cardiovascular disease, and other chronic conditions.

For arthritis the question was “During the past 12 months did

yotr have . . . ?“ After considering various hypotheses, certain

of these common medical conditions were selected for analysis.

As shown in tables 3 and 4 there is an increased frequency of

various medical conditions in those with the presence of either

visual or hearing impairments. For example, recent history of

atthrhis was reported more frequently with both impairments.

The presence of cardiovascular disease (a category including

self-reported arteriosclerosis, coronary heart disease, angina

pectoris, myocardird infarction, any other heart attack or stroke)

is more frequent in those with hearing or visual problems. Although in the 65–74 year subgroup the frequency of hypertension is no higher in those with a hearing impairment than in

those with no hearing impairment, there is an excess in the 85

year and over subgroup. The possible relationship with hypertension is more pronounced in those with visual impairments.

Because of potential validity problems with self-reported medical

information: the nonspecificity of the broad impairment groups

created for the analysis; the small numbers, especially in the

oldest-old subgroup, the multiple comparisons and the selective

nature of the illustrated comparisons, any associations should

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eighties, Prelirnina~ data from the Supplement on Aging to the National Health Interview Survey, United States, January-June 1984.

Advance Data From Vital and Health Statistics. No. 115. DHHS

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

May 1, 1986.

2.E. K. Mos~icki, E. F. E]kkts, H. M. Baum, et al.: Hearing ]0S5 in the

elderly An epidemiologic study of the Framingharn Heart Study

Cohort. Ear and Hearing 6(4):1 84-190, 1985.

3L, B. Bril]iant, N. c. GrasSet, R P. pokhrel, et al.: Associations

among cataract prevalence, sunlight hours, and altitude in the Himalayas. Am. J. Epidemiol. 118:250-264, 1983.

4P. M. Masters: Senile cataracts: A Model for Studying postTranslational Changes in Structural Proteins, in R. T. Schirnke, cd.,

Biological Mechanisms in Aging. NIH Pub. No. 81-2194. Public

Health Service. Bethesda, Md., June 1981.

sNationa] Center for Health Statistics Current estimates from the

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1578. Public Health Service. Washington. U.S. Government Printing

Office, Sept. 1985.

‘National Center for Health Statistics, B. A. Feller Prevalence of

selected impairments, United States, 1977. Viral and Healrh S[atisrics.

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be considered only as preliminary observations and not necessarily the result of cause and effect.

Comment

The health issues involved with visual and hearing impairments in the elderly must be put into perspective. Although

such impairments are frequent concomitants of age and chronic

disease, they are not inevitable and not necessarily disabling.

In face until the age of 85 years, the majority of noninstitutionalized persons are free of major sensory problems.

On the other han~ such impairments do result in a sensoryIimited world for a number of older Americans. Even with

modest losses communication becomes more difficult. Fortunately, fo; many of the elderly, assistance devices to amplify

sound or magnify words and palliative or corrective surgery on

eyes or ears can be salutary. However, such therapy has an

impact on out-of-pocket expenses.

If more could be learned about etiolon of impairments of

the senses for sound and light, some sensory loss might be

prevented or slowed. The SOA provides useful information for

bdth scientific purposes and policy considerations.

7National Center for Health Statistics, J. F. Van Nostrand, A. ZapPolo,

E. Hin~ et al.: The National Nursing Home Survey, 1977 Summary

for the United States. Vifa/ and Healrh Sfarisrics. Series 13, No. 43.

DHEW Pub. No. (PHS) 79-1794. Public Health Service. Washington.

U.S. Government Printing Ofilce, July 1979.

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and Health Sfafisrics. Series 11, No. 215. DHEW Pub. No. (PHS)

80-1663. Public Health Service. Washington, U.S. Government

Printing Ofiice, Jan. 1980.

9The Fr~in@am Eye Study Monograph, III, Cataracf- SurveY of

Ophthalmology 24, SUPP.:350-365, May-June 1980.

10Nationa] Center for Health Statistics, T. Hanis: Aging in the eighties,

Prevalence and impact of urinary problems in individuals age 65 years

and over, Preliminary data from the Supplement on Aging to the National Health Interview Su~ey, United States, January-June 1984.

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Pub. No. (PHS) g6-1 250. Public Health Service. Hyattsville, Md.,

Aug. 27, 1986.

11National Center for Health Statistics, M. G. Kovar and G. S. Poe:

The National Health Interview Survey design, 1973-84, and pr~

cedures, 1975–83. Viral and Healrh Srarisrics. Series 1, No. 18.

DHHS W’s. No. (PHS) 85-1320. Public Health Service. Washington.

U.S. Government Printing Otllce, Aug. 1985.
admncedata 7

Technical notes

Each week a probability sample of households in the

United States is visited by U.S. Bureau of the Census interviewers to obttin a wide range of information about the health

and health care characteristics of the people living in these

households. A description of the survey design, methods used

to make the national estimates, and general qualifications of

the data are provided in The National Health Interview Survey

design, 1973-84, and procedures, 1975183.11

In January-June 1984” there were about 21,000 households in the sample. The total noninterview rate was about 3

percent—mostly because the interviewer was unable to locate

an eligible respondent despite repeated calls.

The rules for the survey are that all adults who are in the

household when the interviewer calls are asked to join in the

interview and to respond for themselves. People age 65 years

and over are likely to be at home and are, thus, more likely to

respond for themselves to the questions on the basic, or core,

questionnaire. During the first 6 months of 1984, 84 percent

answered the questions themselves.

For the Supplement on Aging ( SOA), the interviewers

made an additional effort to encourage the people selected to

answer the SOA questions and to respond for themselves. They

encouraged the household respondent to ask an older person to

talk to the intewiewer and, if necessary, made extra calLs. The

results of their efforts were both positive and negative. The

positive result was that an even higher proportion, 92 percent,

of the responses to the SOA were completely self responses.

The negative result was that in a few cases information was

obtained from a household respondent for the core questions

but no information was obtained for the supplement. Fortunately the latter was rarq 5,629 of the 5,982, 95 percen~

people age 65 years and over who were in the sample during

January-June had complete interviews on the supplement.

The estimates in this report are based on a sample rather

than on the entire population of people age 65 years and over

in the civilian noninstitutionalized population. Therefore, the

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

had a complex design that has the effect of making the sampling

errors somewhat larger than they would be from a simple random

sample of the same size using the same procedures.

A conservative estimate is that on the average, the variance for estimated propmions from this sample is 20 percent

larger than it would have been from a simple random sample of

the same size using the same procedures.

To estimate the samplingerrors, convertthe percent to a

proportion, calculate the variance of a proportion assuming

simple random sampling multiply that variance by 1.2 to allow

for the complex sarnpIe, then compute standard errors, confidence intervals, or significance tests.

For example, the estimate is that61 percent of the 954,000

persons age 85 years and over reporting a hearing impairment

(table 4) had arthritis or rheumatism. There were216 people

NOTE: A list ofreferencesfollowsthe text

reporting a hearing impairment in the sample age 85 years and

oven therefore,

Variance (simple random sample) = ~

= (0.61 )(0.39)

216

= 0.0011

Variance (complex sample) = (0.0011)(1 .2)

= 0.0013

Standard error = (0.00 13)1’2

= 0.0364

95 percent confidence interval= 61 ~ (1.96)(3.64)

= 61 & 7 percent

Because the estimation procedure includes poststratification to independent U.S. Bureau of the Census estimates, there

is no sampling error for the number of people age 65 years and

over—either for the total or for either sex. 11The only sampling

error is in the numerator. Therefore, the sampling errors for

those groups are somewhat smaller than estimated by this

method

Perhaps more important for interpretation than sampling

errors, however, is a thorough understanding of what data from

this, or any other, cross-sectional survey can provide. There

are two issues—one important for arty cross-sectional analysis

and the other of especial importance for older people.

The NHIS is a point-in-time study. Associations at one

point in time should not be interpreted as causality. The differences among the age groups, for example, could be the result of

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

cohorts moving through time. Based on external knowledge,

one could interpret a dfierence in health status as the result of

aging and a diiTerence in educational status as the result of

cohort differences, but the data from a cross-sectional survey

do not enable one to make that distinction.

The second is that this is a study of peopIe who were Iiving

in the community at the time they, or a proxy respondent, were

interviewed. All of those elderly people who had left the population, either through death or institutionalizatio~ are excluded.

Thus, the estimate that 1 percent of eIderly people had blindness in both eyes should not be interpreted to mean that onIy I

percent of the elderly people were so Mticted. Data from the

1977 Nursing Home Survey indicated that 5.5 percent of residents were blind7
From Vital and Health Statistics of the National Center for Health Statistics Number 126. September 19, 1986

Health Promotion Data for the 1990 Objectives

Estimates From the National Health Interview Survey

of Health Promotion and Disease Prevention: United States, 1985

by Owen T. Thornber~, Ph. D., Division of Health Interview Statistics, Ronald W. Wilson, M. A.,

and Patricia M. Golden, M. P. H., Division of Epidemiology and Health Promotion

The National Center for Health Statistics included the

topic of health promotion and disease prevention as part of the

1985 National Health Interview Survey questionnaire. Provisional findings from the first 6 months of data collection on

that topic have been previously publishecil This report presents

final summary findings based on fully edited and weighted data

from the fill 12 months of data collection.

“The 1985 Health Promotion and Disease Prevention study

was designed to monitor progress toward one of the major initiatives of the Department of Health and Human Services. This

initiative is described in Healthy Peopie- The Swgeon General’s Report on Health Prornofi”on and Disease Preventio~

1979.2 In that repo~ broad goals were established for the improvement of the health of Americans. The 1980 Public Health

Service report, Promoting HealtWPreventing Disease Objectives for the )Tatioq 3 details specific objectives necessary for

attaining those goals in each of 15 priority areas. The target

data for achieving the objectives is 1990. The 1985 questionnaire will be used for data collection again in 1990 for the

purpose of monitoring progress achieved in the intervening 5

years.

lN~tiondcenterfor HesMI Statistics, O. T. Thomkry, R w. WIISOILMd p.

Golden Health promotionand d~ease preventionprovisionaldata fromtbc

National Health Interview Survey, United Statea, January-June 1985. Advance

Data From Vital and Health Statistics. No. 119. DHHS Pub. No. (PHS) 86-

1250. public Health Service. Hyattaville, Md. May 14, 1986.

20~ce of the .&sisttmt Secretary for HeaIth and SurgeonGeneral: Ifealth.v

People- The Surgeon General’s Repofi on Health Promotion and Disease

Prevention-Background Papexr, 1979. DHEW Pob. No. (PHS) 79-55071A

3u-s. D.$pmentof Hcalti and Human Services, Public Health Semite: Promoting HealttVPreventing Disease: Objectives for the Nation Washington.

U.S. Government Printing Oflice, 1980.

The 1985 Health Promotion and Disease Prevention study

is devoted primarily to the collection of baseIine data on the

following topics: general health (including nutrition), injury

control, high blood pressure, stress, exercise, smoking, alcohol

use, dental care, and occupational safety and health. These

topics were selected after consultation with the OffIce of Disease Prevention and Health Promotion (Assistant Secretary

for Health) as well as with the agencies designated by the Assistant Secretary for Health as having “lead” responsibility for

implementing and monitoring progress toward achieving the

1990 objectives. Within each agency, subject matter experts

were consulted during the development of the questionnaire.

This report presents estimated percents or percent distributions for all persons 18 years of age and over and for four age

groups and both sexes. Generally, except for the questions on

knowledge of health practices where “don’t know” is a legitimate response, “don’t know” and other inappropriate responses

were excluded from the denominator in the calculation of the

estimates. In most cases, the actual question asked of the respondent is shown along with the response categories. In a few

cases, there has been minor paraphrasing or combining of

questions. Each question is referenced to the item number on

the questiomaire.

In general, the items in the questionnaire are about either

individual health behaviors or knowledge of health practices.

Most of the questions on knowledge of health practices have

answers that are currently presumed to & correct (as determined by the Public Health Service agency with “lead” responsibility) and are indicated in bold type. For some questions,

references are provided to selected publications that present

related data from previous data collection by the National

Center for Health Statistics.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Serwce
2 adwna?data

Seieoted findings

General health habits: Most adults eat breakfast almost

every day (55 percent), get 7-8 hours of sleep each night

(66 percent). and have a usual place to go for health care

(78 percent).

Weighr Men are more likely to consider their wei&t “just

about right” than are women (55 versus 42 percent).

However, one-qumer of men and almost one-half of

women are trying to lose weight, primarily by eating fewer

calories, or increasing physical activity.

Preventive exams for wome~ About one-half of women

have had a Pap smear test (46 percent) or a breast examination (50 percent) by a health professional within less

than one year. The majority of women (87 percent) know

how to examine their own breasts for lumps, but only onethird do so more than six times a year.

Sear belts: There is evidence (not shown in table 1) that

seat belt use is increasing rapidly. The percent of adults

wearing seat belts most of the time increased from 30 percent for the first 3 months of 1985 to 41 percent for the

last 3 months (annual rate of 35 percent). This no doubt

reflects the impact of seat belt legislation in many States

during 1985.

Child safety The majority (88 percent) of persons in families with children under 10 years of age have heard about

Poison Control Centers and have the telephone number

for a Center in their area (60 percent). Almost all (98

percent) of the adults with children under 5 years of age

know about child safety seats, and almost one-half (45

percent) have been advised by health professionals about

the importance of using them.

Home safety: About two-ftis of homes do not have a

working smoke detector. Most adults do not know the

temperature of the hot water in the home (64 percent), and

most adults do not know the temperature above which scald

injuries will occur.

High blood pressure Three-quarters (74 percent) of adults

have had their blood pressure taken by health professionals

within the past year. Women are more likely than men to

have their blood pressure taken, and persons over 65 years

are more likely than younger persons. Slightly more than

half of adults believe that sodium (salt) is the substance in

food most often associated with high blood pressure.

Heart disease: A large majority of adults (86 percent or

higher) is aware of three of the four principal risk factors

associated with heart disease (smoking, elevated cholesterol, and high blood pressure). Only 61 percent are aware

that diabetes is also a principal risk factor.

Stress: One-half of adults reported experiencing at least a

moderate amount of stress during the 2 weeks preceding

the interview, with the lowest percent for the elderly (28

percent). In addition, almost one-half of the adults felt that

stress had had some effect on their health in the past year.

● Exercise: Less than one-half (40 percent) of the adult

population exercises on a regular basis, and only onequarter have done so for 5 years or more. A higher percent

of adults in the younger than the older age groups engage

in regular exercise. However, over four-fifths of adults

consider themselves as active or more active than other

persons of the same age. The majority are not knowledgeable regarding the specific requirements for exercise to

strengthen the heart and lungs (frequency and duration of

exercise, and heart and breathing rate during exercise).

. Cigarette smoking: Although a continuation of the downward trend in cigarette smoking has been occurring since

the 1964 Surgeon General’s Report on Smoking and

Healrk 3 in 10 adults still smoke (32 percent of men and

28 percent of women). The majority of adults (79 percent

or higher) are aware of the major conditions associated

with smoking (emphysem% chronic bronchitis; and cancer

of the lung, larynx, and esophagus). The exception is

bladder cancer, which only about one-third associate with

smoking.

● Alcohol use: With the exception of cirrhosis of the liver,

the adult population appears less knowledgeable about the

effects of alcohol on health than the effects of smoking.

Whereas 93 percent feel that heavy alcohol consumption

increases the chances of getting cirrhosis of the liver, only

about one-third recognize the association between heavy

alcohol use and cancers of the throat (40 percent) and

mouth (32 percent). Eight percent of adults are classified

as heavier drinkers (two or more drinks per day), 19 percent as moderate drinkers, and 24 percent as lighter clrinkers (three drinks or less per week). Ten percent of all adults

admitted to driving at least once in the last year whenl they

perhaps had had too much to drin& and one-fifth of young

adults admitted to doing so.

● Dental care: While most adults appear to know the major

preventive measures relative to tooth decay and gum disease, man} do not discriminate between the two diseases.

For example, many people do not understand that fluoridated water and fluoride toothpaste/mouthrinse are clefinitely important for the prevention of tooth decay. At the

same time they overestimate the importance of fluoride in

the prevention of gum disease. People know that gum

disease is an important cause of tooth loss in adults and

that tooth decay is an important cause of tooth loss in

children. Although only about one-quarter of adults have

heard of dental sealants, of those who have heard of tlhem,

most (80 percent) know their purpose is to prevent tooth

decay.
dmncdaa3

Table I. Estimates of the percent of population with selected behaviors and know7edge from the 1985 National Health Interview

Survey Questionnaire on Health Promotion and Disease Prevention, by age and sex: United States, 1985

(Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general

qualifications, and information on the reliability of the estimates are given in Technical notes.)

Age Sex

Section

and

itern Al1 18-29 30-44 45-64 65 years

number Health behaviors and knowledge ages years years years and over Male Female

Percent of population

N.1.

N.2.

N.3.

N.5.

N.“6.

N.?.

N.8.

N.9.

N.IO.

N. Il.

N.15.

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

GENERAL HEALTH HA8ITS

How often do you eat breakfast?l

Almost every day................................................

Sometimes.......................................................

Rarely or never.................................................

Including evening snacks, how often do you eat between meals?l

Almost every day................................................

Sometimes.......................................................

Rarely or never.................................................

When you visit a doctor or other health professional for

routine care, is eating proper foods discussed?

Often...........................................................

Sometimes.......................................................

Rarely or never.................................................

Oon'tvisit for routine care....................................

In your opinion which of these are the two best ways to 1ose

weight?

Don’teat at bedtime............................................

Eat fewer calories ..............................................

Take diet pills.................................................

Increase physical activity......................................

Eat no fat......................................................

Eat grapefruit with each meal...................................

Oon’t know......................................................

Are you now trying to lose weight?2 (Yes).........................

Are you eating fewer calories to 1ose weight?2 (Persons trying

to lose weight (yes) in N.6) (Yes)................................

Have you increased your physical activity to lose weight?2

(Persons trying to lose weight (yes) in N-6) (Yes)................

Do you consider yourself overweight, underweight, or just

about right? (If overweight) Would you say you are very

overweight, somewhat ovemeight, or only a 1ittle overweight?2~3

Very ovemeight .................................................

Somwhat oveweight .............................................

Only a little ovemeight ........................................

About right.....................................................

Undeweight .....................................................

On the average, how many hours of S1eep do you get in a

24-hour period?l

Less than 7 hours...............................................

7-8 hours.......................................................

9ormrehours .................................................

Is there a particular clinic, health center, doctor’s office,

or other place that you usually go to if you are sick or need

advice about your health?4 (Yes)..................................

Abcut how 1ong has it been since you had a Pap smear

test?5 (Females only)

Less than lyear ................................................

I year ..........................................................

2 years .........................................................

3-4 years .......................................................

5 ormreyears .................................................

Never...........................................................

See footnotes at end of table.

100

55

20

24

39

32

29

10

16

65

10

;:

7:

11

4

7

35

81

57

8

;;

48

6

22

66

12

78

46

17

10

1:

7

100

42

%

42

38

20

8

16

65

11

29

70

8:

7

4

5

32

75

69

5

;:

57

9

20

66

14

69

60

16

:

2

13

100

46

:

41

33

25

1:

67

9

27

75

7;

8

3

5

39

81

59

9

:

46

4

24

69

7

76

%’

10

9

8

1

100

62

;;

::

32

1:

62

10

45

77

6;

12

?

40

84

49

;:

23

40

3

23

67

10

83

38

17

13

10

18

4

100

87

;

31

:;

11

::

9

31

73

5:

20

5

17

24

83

40

6

;

51

8

20

59

21

89

25

13

/:

25

15

100

:

25

41

30

29

8

;

14

::

7:

12

4

9

25

76

58

4

;:

55

8

23

66

11

72

. . .

. . .

. . .

. . .

. . .

. . .

100

%

24

37

34

28

11

:;

6

28

78

7;

10

4

6

44

83

56

::

21

42

4

21

66

13

84

46

1?

10

8

12

7
4 atklncedata

Table 1. Estimates of the percent of population with selected behaviors and knowledge from the 1985 National Health Interview

Survey Questionnaire on Health Promotion and Disease Prevention, by age and sex: United States, 1985--Con.

(Data are based on household interviews of the civilian noninstitutional ized population. The survey design, general

qualifications, and information on the reliability of the estimates are given in Technical notes. )

Section

Age. Sex

and ——

itern Al1

number

18-29 30-44 45-64 65 years

Health behaviors and knowledge ages years years years and over Male Female

N.16a.

N.16b.

N.16C.

O.la.

O.lb.

0.3.

0.4.

0.10.

0.12a.

0.13.

0.14.

GENERAL HEALTH HA81TS--Con.

About how long has it been since you had a breast examination

by a doctor or other health professional ?5 (Females only)

Less than l year ................................................

I year. .........................................................

2 years .........................................................

3-4 years .......................................................

5or more years .................................................

Never ...........................................................

Do you know how to examine your own breasts for

lumps? (Females only) (Yes).......................................

About how many times a year do you examine your own breasts

for 1umps? (Females only)

120rm0re times ................................................

7-11 times ......................................................

2-6 times .......................................................

Once a year .....................................................

Never ...........................................................

Oon'tknow howtoexami ne own breast ............................

INJURY CONTROL AND CHILD SAFETY ANO HEALTH

Have you ever heard about Poison Control Centers? (Persons in

families with children under 10 years of age) (Yes)...............

Do you have the telephone number for a Poison Control Center

in your area? (Persons in families with children under 10 years

of age) (Yes).....................................................

Have you heard about child safety seats, sometimes called car

safety carriers, which are designed to carry children while

they are riding in a car? (Persons in families with children

under 5years of age) (Yes).......................-...............

Oid a doctor or other health professional ever tell you about

the importance of using car safety seats for your children?

(Persons in families with children under 5 years of age) (Yes)....

When driving or riding in a car, do you wear a seat belt3--

All ormostof the time .........................................

Some of the time ................................................

Once in a while .................................................

Never ...........................................................

Don’tride in car ...............................................

Does this home have any working smoke detectors? (Based on

Items O.lla.-c.) (Yes)............................................

Do you know about what the hot water temperature is in this

home? (Yes).......................................................

In the past 12 months, have you (or has anyone in your household)

used a thermometer to test the temperature of the hot water here?

(Yes) .............................................................

Above what temperature will hot water cause scald injuries?

127 degrees br less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

128-139 degrees (can produce burns in less than a minute ).......

140 degrees or above (can produce burns in 5 seconds or less )...

Oon’t know. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnotes at end of table.

50

18

10

;

8

87

32

3:

1:

13

88

60

98

45

35

18

:;

1

60

36

4

14

2:

64

60

16

6

4

1:

86

27

3:

5

16

14

87

55

98

48

33

19

:;

o

58

24

3

20

2

15

63

Percent of population

52

21

10

8

6

2

92

35

3

37

5

11

8

91

66

98

43

39

18

:

0

65

41

5

16

3

;;

45

18

12

8

12

5

89

37

3:

1:

11

77

47

96

32

36

18

::

1

60

45

4

10

2

.x

39

14

10

8

15

14

78

29

2

26

1:

22

66

35

97

23

33

15

:;

2

56

35

3

6

1

;:

. . . 50

. . . 18

. . . 10

. . . 7

. . . 8

. . . 8

. . . 87

. . . 32

. . .

. . . 3:

. . . 4

. . . 14

. . . 13

86 90

59 61

98 98

38 50

34 37

60 60

48 26

4 3

16 12

3: 1;

51 75
aduameckita 5

Table 1. Estimates of the percent of population with selected behaviors and knowledge from the 1985 National Health Interview

Survey Questionnaire on Health Promotion and Disease Prevention, by age and sex: United States, 1985--Con.

(Data are based on household interviews of the civilian noninstituti onalized population. The survey design, general

qualifications. and information on the reliability of the estimates are given in Technical notes. )

Age

Section

Sex

and

itern Al 1 18-29 30-44 45-64 65 years

number Health behaviors and knowledge ages yea rs years years and over Male Female

HIGH BLOOO PRESSURE

P.1. I am going to read a list of things which may or may not

affect a person’s chances of getting heart disease. After I

read each one, tell me if you think it definitely increases,

probably increases, probably does not, or definitely does not

increase a person’s chances of getting heart disease.

Cigarette smoking

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don't know/No opinion .........................................

Worry or anxiety

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase.. ..............................

Don’tknow/No opinion .........................................

High blood pressure

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Diabetes

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Prabably does not increase ..................................

Definitely does not increase. ...............................

Don’tknow/No opinion .........................................

Being very overweight

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Overwork

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don't know/No opinion .........................................

Drinking coffee with caffeine

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

See footnotes at end of table.

90

66

23

4

3

;

i!

44

8

6

:

%

23

3

2

:

61

32

29

10

<

30

93

69

23

2

:

5

71

31

40

19

13

1:

51

13

%

22

7 --

20

:;

24

3

2

:

81

33

48

12

:

7

93

68

24

3

2

:

65

32

33

10

8

3

25

93

72

22

3

2

1

4

76

32

44

16

12

4

7

53

12

41

30

24

6

17

Percent of population

92

69

23

3

2

:

%

44

7

6

;

;:

20

2

2

:

64

34

30

10

8

2:

%

23

2

1

:

77

34

43

16

11

4

7

54

13

41

28

23

Ii

89

65

24

4

3

;

87

44

42

6

4

;

%

22

3

2

;

59

32

27

10

:

31

;;

24

2

1

1

4

67

31

36

23

16

7

10

51

E

!?

2:

81

58

24

:

1:

80

38

42

6

5

2

14

84

58

26

3

2

1:

49

:

:

4;

86

60

27

3

2

1:

57

25

32

24

16

1:

43

i;

28

19

3:

89

66

23

4

3

;

82

38

44

9

7

2

9

91

::

3

2

i

60

32

28

10

<

30

::

24

3

2

1

5

67

28

;:

16

7

10

48

::

31

24

2:

90

66

24

3

2

;

86

41

45

7

5

2

7

91

:;

2

2

i

61

%

10

7

2:

93

70

23

2

1

:

74

34

41

H

5

10

54

13

40

26

20

2:
6 advancedata

Table 1. Estimates of the percent of population with selected behaviors and knowledge from the 1985 National Health Interview

Survey Questionnaire on Health Promotion and Disease Prevention, by age and sex: Uni ted States, 1985--Con.

(Data are based on household interviews of the civilian noninstitutional ized population. The survey design, general

qualifications, and information on the reliability of the estimates are given in Technical notes. )

Section

Age Sex

—.

and

itern Al1 18-29 30-44 45-64 65 years

number Health behaviors and knowledge ages years years years and over Male Female

P.1.

P.2.

P.3.

P.12a

P.12b.

HIGH BLOOD PRESSURE--Con.

I am going to read a list of things which may or may not

affect a person’s chances of getting heart disease. After I

read each one, tell me if you think it definitely increases,

probably increases, probably does not, or definitely does not

increase a person’s chances of getting heart disease. --Con.

Eating a diet high in animal fat

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Family history of heart disease

Increases .....................................................

Definitely increases ........................................

Probably increases .........................................-

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

High cholesterol

Increases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definitely increases ........................................

Probably increases ..................................

Does not increase .....................................

Probably does not increase ..........................

Definitely does not increase ........................

Don't know/No opinion .................................

The following conditions are related to having a stroke.

your opinion, which of these conditions nmst increases a

person’s chances of having a stroke?

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

n

Diabetes ........................................................

High blood pressure .............................................

High cholesterol ................................................

Oon’t know ......................................................

Which one of the following substances in food is mest often

associated with high blood pressure?

Sodium (or salt) ................................................

Cholesterol .....................................................

Sugar ...........................................................

Don’ t know ......................................................

About how long has it been since you last had your blood

pressure taken by a doctor or other health professional ?2$3

Less than 6mnths ..............................................

6-11 mnths .....................................................

12mnths to23mnths ..........................................

24 nmnths and over ..............................................

Blood pressure is usually given as one number over another.

Were you told what your blood pressure was, in numbers? (persons

with blood pressure checked within 24 months in 12a) (Yes)........

P.14. Have you ever been told by a doctor or other health

professional that YOU had high cholesterol? (Yes) .................

See footnotes at end of table.

80

42

38

B

6

1:

83

49

34

8

5

3

9

86

54

32

4

3

Ii

4

77

12

7

58

25

9

9

57

17

14

12

68

5

77

37

40

lD

8

1:

85

47

38

7

5

3

7

88

52

36

4

3

:

7;

15

7

54

28

11

7

51

19

15

14

65

1

Percent of population

83

44

39

7

5

1:

86

54

33

7

4

3

7

89

57

32

4

2

;

8:

11

6

63

23

7

7

50

20

16

14

70

3

83

46

37

6

5

1:

83

51

33

8

5

3

9

B7

58

29

4

3

:

8;

10

7

61

24

7

B

61

15

;;

71

9

76

40

35

6

4

1:

70

3B

32

12

7

1:

77

48

29

:

1;

7:

10

12

50

23

11

16

72

12

8

8

67

11

77

38

39

10

;

13

80

44

36

10

6

1:

85

52

33

5

3

1:

7;

13

7

56

25

10

9

51

17

16

16

70

6

83

45

38

6

4

1:

85

53

33

:

2

9

8B

57

31

3

2

;

7:

10

7

60

25

7

8

61

18

12

9

67

5
advancedata 7

Table 1. Estimates of the percent ot population with selected behaviors and knowledge from the 1985 National Health Interview

Survey Questionnaire on Health Promotion and Disease Prevention, by age and sex: United States, 1985--Con.

(Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general

qualifications, and information on the reliability of the estimates are given in Technical notes.)

Age Sex

Section

and

——— .+-.

itern Al1 18-29 30-44 45-64 65 years

number Health behaviors and knowledge ages years years years and over Male Female

——

Q.1.

Q.2.

Q.3a.

Q.3b.

Q.4.

R.2a.

R.3.

R.4.

R.5a.

R.7a.

R.7b.

STRESS

During the past 2 weeks, would you say that you experienced a

lot of stress. a moderate amount of stress. relatively little

stress, or almost no stress at all?

Alot of stress.................................................

Arcoderate amount of stress.....................................

Relatively little stress........................................

Almost none.....................................................

Oon’tknow what stress is.......................................

In the past year, how much effect has stress had on your health?

A lit...........................................................

Some............................................................

Hardly any or none..............................................

Don’tknow what stress is.......................................

In the past year, did you think about seeking help for any

personal or emtional problems from family or friends? (Yes)......

In the past year, did you think about seeking help for any

personal or emotional problems from a helping professional or a

self-help group? (Yes)............................................

Did you actually seek any help? (Yes) From whom did you seek

help?

Family or friends...............................................

Professional orself-hel p group.................................

EXERCISE

In the past 2 weeks, have you done any of the fol

exercises, sports, or physically active hobbies6-

Walking for exercise...........................

Jogging or running.............................

Calisthenics or general exercise...............

8iking.........................................

owing

................

................

................

................

Swinning or water exercises.....................................

Do you exercise or play sports regularly? (Yes)...................

For how 1ong have you exercised or P1ayed sports regularly?

Less than l year ................................................

l-2 years.......................................................

3-4 years.......................................................

5ormreyears .................................................

Do not exercise regularly.......................................

Would you say that you are physically more active, less active,

or about as active as other persons your age?l,3 Is that (a lot

more or a little more/a lot less or a little less) active?

Alotnwe ......................................................

Alittle rmme...................................................

About as active.................................................

A lot less......................................................

A little less...................................................

How many days a week do you think a person should exercise

to strengthen the heart and 1ungs?

Less than 3 days................................................

3-4 days........................................................

5daysor rime .................................................

Don’t know......................................................

For how many minutes do you think a person should exercise

on each occasion so that the heart and lungs are

strengthened?

Less than 15 minutes............................................

15t025 minutes................................................

More than 25 minutes............................................

Don’t know......................................................

See footnotes at end of table.

20

31

22

25

2

:?

55

2

15

11

7

7

41

;:

11

10

40

:

2:

60

18

;:

1;

4:

38

17

2!

52

20

21

32

25

21

1

::

54

1

21

12

11

7

43

:

14

16

53

7

7

4

::

15

;:

1:

5;

34

8

2;

65

9

Percent of population

24

::

17

1

::

50

1

19

15

1:

40

11

24

12

11

42

6

6

4

24

59

19

30

22

27

2

:

55

2

9

9

3

6

41

4

15

8

6

31

4

4

3

;;

11

:1

46

5

2?

65

5

4

4

2

3

41

Ii

5

2

29

2

4

3

;?

:1

22

27

2

9

:;

2

10

8

4

5

37

E

11

10

43

3

4

3;

57

22

:;

24

2

::

49

2

18

14

9

8

45

2;

10

9

38

7

7

4

19

63

7 4 3 6 5

49 31 40

34 44 :: 37 :;

11 21 35 16 17

7 9 5 7

22 23 20 21 24

58 44 55 49

12 26 :: 20 20
8 adwncedata

Table 1. Estimates of the percent of POPU1 ation with selected behaviors and knowledge from the 1985 National Health Interview

Survey Questionnaire on Health Promotion and Disease Prevention, by age and sex: Uni ted States, 1985--Con.

(Data are based on household interviews of the civilian noninstitutional ized population. The survey design, general

qualifications, and information on the reliability of the estimates are given in Technical notes. )

——

Section

Age Sex

and

——

itern Al1 18-29 30-44 45-64 65 years

number Health behaviors and knowledge ages years yea rs years and over Male Female

EXERCISE--Con.

R.7c. Ouring those (number in 7bl minutes, how fast do you think

a person’s heart rate and breathing should be to strengthen

the heart and 1ungs? Do you think that the heart and

breathing rate should be--

No faster than usual ............................................

Alittle faster than usual ......................................

Alotfaster outtalking impossible. ...........................

So fast that talking is not possible ............................

Don’t know ......................................................

SMOKING

Cigarette smoking status (Based on Items S.1-3)

Never ...........................................................

Former ..........................................................

Current (Includes unknown amount smoked )........................

Less than 15 ..................................................

15.24 .........................................................

25 and over ...................................................

S.3. On the average, about how many cigarettes a day do you now

smoke?7 (Current smokers)

Less than 15....................................................

15-24 ...........................................................

25 and over .....................................................

S.4. Tell me if you think cigarette smoking definitely increases,

probably increases, probably does not, or definitely does

not increase a person’s chances of getting the following

problems?

Emphysema

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Bladder cancer

Increases .....................................................

Definitely increases ........................................

Probably increase s..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Cancer of the 1arynx or voice box

Increases .....................................................

Definitely increases ........................................

Probably increase s..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Oon’tknow/No opinion .........................................

Cataracts

Increases.....................................................

Definitely increase s........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

See footnotes at end of table.

4;

34

1

17

45

24

30

1;

8

;;

27

90

73

17

2

1

i

35

::

25

17

4:

B7

55

31

:

1:

16

4

:;

22

20

43

Percent of population

2

43

43

1:

42

23

34

1:

11

$

33

93

76

16

2

1

:

34

11

:;

20

3;

9D

59

32

3

2

1

7

14

4

;$

23

s

4:

28

2:

37

31

31

1:

10

:;

31

91

74

17

2

i

7

33

i

21

14

4;

86

54

32

3

2

1:

13

4

3;

19

::

7

44

12

3!

50

34

16

6

7

3

38

43

19

86

70

16

2

1

1;

31

12

::

9

5:

::

30

4

2

2:

12

:

29

14

:;

3

44

36

1

17

36

31

32

1?

10

::

32

89

7D

19

3

2

:

36

13

23

24

17

3:

86

53

33

4

3

1;

16

1:

42

22

20

42

4

45

32

1:

54

;;

10

12

6

37

43

21

91

75

16

2

1

:

34

;;

25

17

4!

87

58

30

;

16’

15

4

:;

21

20

44
advancedata 9

Table 1. Estimates of the percent of population with selected behaviors and knowledge from the 1985 National Health Interview

Survey Questionnaire on Health Promotion and Disease Prevention, by age and sex: United States, 1985--Con.

(Data are based on household interviews of the civilian noninstitutional ized population. The survey design, general

qualifications, and information on the reliability of the estimates are given in Technical notes. )

Section

Age Sex

and

itern Al 1 18-29 30-44 45-64 65 years

number Heal th behaviors and knowledge ages years years years and over Male Female

SMOKING--Con.

5.4. Tell me if you think cigarette smoking definitely increases,

probably increases, probably does not, or definitely does

not increase a person’s chances of getting the following

problems ?--Con.

Cancer of the esophagus

Increases .....................................................

Definitely increases .........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Chronic bronchitis

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probablj :ucs not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Gall stones

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not incwase .............................................

Probably does not increase ..................................

Definitely does noti Krease ................................

Don't know/No opinion .........................................

Lung cancer

Increases .....................................................

Definitely increases ........................................

Probably increases ........................................,.

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

5.4. Does cigarette smoking during pregnancy definitely increase,

probably increase, probably not or definitely not increase

the chances of--( Persons under 45 years of age)

Miscarriage

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don't know/No opinion .........................................

Stillbirth

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase .................................

Don’tknow/No opinion .........................................

Premature birth

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

See footnotes at end of table.

79

42

37

6

4

1;

85

E

5

;

10

11

i

45

22

::

94

79

15

2

1

1

5

73

34

38

12

:

15

65

28

37

14

11

2:

70

::

12

9

3

18

83

45

38

:

1;

88

55

32

4

3

:

15

1;

49

27

22

36

96

85

11

1

i

3

76

36

40

11

:

13

68

29

39

13

10

1;

72

:;

11

9

1:

Percent of population

82

45

37

:

1:

88

:!

4

3

2

7

10

3

5;

25

26

39

95

81

14

1

1

1

3

;;

37

;

1:

85

53

32

5

3

2

10

10

3

4:

19

:;

93

75

18

2

1

1

5

69

35

33

6

3

2:

75

44

31

:

2

20

:

3!

14

18

59

87

71

16

2

1

1

11

77

41

36

;

2

16

84

:;

5

4

1:

11

:

46

22

24

43

93

77

16

2

1

1

5

80

44

37

5

3

1:

87

:!

4

2

:

11

:

X

22

45

94

80

13

1

i

5

70 . . . . . . 71 74

33 . . . . . . 33 36

37 . . . . . . 38 39

13 . . . . . . 14

: 10

: ::: ::;

17 . . . . . . 13 1;

62 ... ... 62 67

27 ... ... 26 30

35 . . . . . . 37 37

15 . . . . . . 13 16

11 . . . .;. 10 11

2: ::: ::: 2; 1;

13 ... ... 13 11

9 ... ... ID 8

3

2: ::: :::, 24 1:
10 achElncedaa

Table 1. Estimates of the percent of population with selected behaviors and knowledge from the 1985 National Health Interview

Survey Questionnaire on Health Promotion and Ilisease Prevention, by age and sex: United States, 1985--Con,

(Data are based on household interviews of the civilian noninsti tutionalized population. The survey design, general

qualifications, and information on the reliability of the estimates are given in Technical notes. )

Section

Age Sex

and ——

itern

number

Al1 18-29 30-44 45-64 65 years

Health behaviors and knowledge ages yea rs years years and over Male lFemale

5.4.

S.5a.

T.lc.

T.2.

T.3.

T.6.

T.7.

T.8.

SMOKING--Con.

Does cigarette smoking during pregnancy definitely increase,

probably increase, probably not or definitely not increase

the chances of--(Persons under 45 years of age) --Con.

Low birth weight of the newborn

Increases .....................................................

Oefinitelv increases ........................................

Probably increases .............

Does not increase ................

Probably does not increase.. ...

Definitely does not increase ...

Don’t know/No opinion ............

If a woman takes birth control pills,

to have a stroke if she smokes than i

(Persons under 45 years of age)

klorelikel y........................

. . . . . . . . . . . . . .. . . . .

. . . . . . . . . .. . . . . . . . .

. . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . .

is she more 1ikely

she does not smoke’

. . . . . . . .

. . . . . . . .

.. . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . . . . . .. . . . . . . . . . . . . . . .

Not likely.......................................................

Don’t know ......................................................

ALCOHOL USE

Have you had at least one drink of beer, wine or liquor

during thepastyear?l (Yes)......................................

In the past 2 weeks, on how many days did you drink any

alcohol ic beverages, such as beer, wine, or 1iquor?l,3

Dldnotdrink in past year ......................................

None ............................................................

l-4 days ........................................................

5-9 days., ......................................................

I.o-ll days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

In the past 2 weeks, on the days that you drank alcoholic

beverages, how many drinks did You have per day, on the

average?1~3

Oidnotdrink in past year..... .................................

None ............................................................

1 drink .........................................................

2 drink s........................................................

3-4 drinks ......................................................

5or more drinks ................................................

Drinking Index (2-week daily drinking, based on items T.1-3)7

Did not drink in past year ......................................

None ............................................................

Light (.01 to .21 ounce absolute alcohol ).......................

Moderate (.22 to .99 ounce absolute alcohol )....................

Heavier (1.00 ounces or more absolute alcohol )..................

Ouring the past 12 months, on how many days did you have 9 or

more drinks of any alcoholic beverage?

Ior more days ..................................................

5or more days ..................................................

During the past 12 months, on how many days did you have 5 or

more drinks of any alcoholic beverage?l

lor Mredays ..................................................

10or more days .................................................

During the past year, how many times did you drive when YOU

had perhaps too much to drink?

1 time ..........................................................

2or more times .................................................

See footnotes at end of table.

79

44

35

7

5

2

14

62

3:

64

36

:;

1:

36

;:

16

12

7

36

14

24

19

8

12

7

24

12

3

7

80

45

35

7

5

1:

64

3:

72

28

;:

11

6

28

13

12

17

18

11

28

i

25

8

22

12

39

20

6

14

Percent of population

77

43

34

7

;

15

61

6

34

72

28

:;

i!

28

15

18

18

14

7

28

::

21

1

13

7

28

13

4

8

. . .

. . .

. . .

.. .

. . .

. . .

. . .

. . .

. . .

. . .

61

39

;;

1;

39

;:

16

;

39

;$

16

8

:

15

8

:

. . .

.. .

. . .

.. .

.. .

. . .

. . .

. . .

. . .

. . .

43

57

12

15

1;

57

12

17

9

4

1

57

::

11

6

1

1

5

3

0

0

73 85

36 52

37 33

8 6

6 4

2

2: 9

52 72

4; . 2:

75 55

16 6

25 45

14

R 16

18 13

8

1: 3

25 45

13 14

24 25

26 13

13 3

20 5

12 2

36 13

21 5

4 2

12 3
adwlncedata 11

Table 1. Estimates of the percent of population with selected behaviors and knowledge from the 1985 National Health Interview

Survey Questionnaire on Hea? th Promotion and Disease Prevention, by age and sex: United States, ]985--Con.

(Data are based on household interviews of the civilian noninstitutional ized population. The survey design, general

qualifications, and information on the reliability of the estimates are given in Technical notes. )

Age

Section

Sex

and

itern Al1 18-29 30-44 45-64 65 years

number Heal th behaviors and knowledge ages years years years and over Male Female

ALCOHOL USE--Con.

T.9. Tell me if you think heavy alcohol drinking definitely

increases, probably increases, probably does not, or definitely

does not increase a person’s chances of getting the following

probl ems?

Throat cancer

Increases .....................................................

Definitely increases, .......................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Cirrhosis of the liver

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don't know/No opinion .........................................

B1 adder cancer

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Cancer of the mouth

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Arthritis

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don't know/No opinion .........................................

Blood clots

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

T.9. Does heavy drinking during pregnancy definitely increase,

probably increase, probably not or definitely not increase

the chances of--( Persons under 45 years of age)

Miscarriage

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don't know/No opinion .........................................

See footnotes at end of table.

40

;!

33

22

:;

93

7B

15

1

i!

6

:!

3B

11

8

2;

32

11

21

X

:;

15

1:

46

24

22

40

34

;:

31

18

12

35

85

48

37

4

3

1:

Percent of population

36

;:

39

26

13

25

96

82

13

:

0

4

67

27

40

13

:

20

29

9

:;

27

14

30

13

3

2!

27

:2

32

2?

36

22

15

31

41

17

24

29

19

::

94

BO

14

1

:

5

$

36

11

8

2:

34

;?

31

i;

35

15

4

;;

20

21

44

29

2:

32

18

:

44

21

23

17

11

3:

87

71

16

1

;

12

%

32

7

;

36

38

17

22

19

11

8

43

15

5

10

30

14

:;

26

9

18

21

11

10

53

37

13

24

37

25

::

%

17

1

:

6

::

38

12

:

22

29

9

::

27

E

15

4

11

48

25

23

38

32

2;

35

20

14

33

42

;:

29

20

2;

94

81

13

:

0

6

%

38

10

7

2;

35

;:

31

20

11

34

14

4

;:

23

21

42

35

;!

27

17

11

37

82 . . . . . . 82 87

43 . . . . . . 44 51

39 . . . . . . 38 36

5 . . . . . . 4 4

4 . . . . . . 3 3

1: ::: ::: 1: :
12 achiancedata

Table 1. Estimates of the percent of population with selected behaviors and knowledge from the 1985 National Health Interv

Survey Questionnaire on Health Promotion and Disease Prevention, by age and sex: United States, 1985--Con.

[Data are based on household interviews of the civilian noninsti tutionalized population. The survey design, general

qualifications, and information on the reliability of the estimates are given in Technical notes. )

iew

Section

Age Sex

and

itern Al1 18-29 30-44 45-64 65 years

number Health behaviors and knowledge ages years years years and over Male Female

T.9.

T.1O.

U.1.

ALCOHOL USE--Con.

Does heavy drinking during pregnancy definitely increase,

probably increase, probably not or definitely not increase

the chances of--(Persons under 45 years of age) --Con.

Mental retardation of the newborn

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Low birth weight of the newborn

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Birth defects

Increases .....................................................

Definitely increases ........................................

Probably increases ..........................................

Does not increase .............................................

Probably does not increase ..................................

Definitely does not increase ................................

Don’tknow/No opinion .........................................

Have you ever heard of Fetal Alcohol Syndrome? (Persons under

45years of age) (Yes)...........................................

DFNTAL CARE

This next question is about preventing tooth decay. After I

read each of the followirm. tell me if you think it is

definitely important, pro~dbly important, probably not, or

definitely not important in preventing tooth decay.

Seeing a dentist regularly

I~ortant .....................................................

Definitely important ........................................

Probably important ..........................................

Not important .................................................

Probably not important ......................................

Definitely not important ....................................

Oon'tknow/No opinion .........................................

Drinking water with fluoride from early childhood

U3portant.. .............................. .....................

Definitely important ........................................

Probably important ..........................................

Not important .................................................

Probably not important ......................................

Definitely not important ....................................

Don't know/No opinion .........................................

Regular brushing and flossing of the teeth

I~ortant .....................................................

Definitely important ........................................

Probably important ..........................................

Not important .................................................

Probably not important ......................................

Definitely not important ....................................

Don’ t know/No opinion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnotes at end of table.

83

47

37

;

1

12

84

46

38

4

3

Ii

84

48

36

4

3

1;

56

x

12

2

2

i

78

45

33

8

6

1:

97

88

8

:

0

3

86

52

34

4

3

1:

::

36

4

3

1:

87

54

33

3

3

1

10

52

:;

13

2

A

2

83

46

37

9

7

;

97

90

7

i

o

2

Percent of population

80

41

39

5

4

1

14

::

39

4

3

1

14

81

43

38

5

4

1;

59

::

12

2

:

2

84

52

32

7

5

;

98

91

6

0

:

2

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

;

12

3

2

:

76

44

32

8

5

1:

::

9

A

o

3

. . .

. . .

. . .

.. .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

.. .

%

14

2

2

;

62

32

30

8

5

3;

93

B1

12

:

0

6

79

41

38

5

4

1

15

79

i%’

:

1;

80

42

38

5

4

1

15

49

%

15

3

2

1

4

z

34

9

6

3

14

96

86

10

;

o

3

87

52

35

4

3

1

9

88

52

36

3

2

;

88

54

34

4

3

;

62

:2

10

1

1

0

3

80

48

32

7

5

1:

97

9D

7

0

0

0

3
admm4da 13

Table I. Estimates of the Percent of population with selected behaviors and knowledge from the 1985 National Health Interview

Survey Questionnaire on Health Promotion and Disease Prevention, by age and sex: United States, 1985--Con.

(Data dre based on household interviews of the civilian noninstitutionalized population. The survey design, general

qualiflcations, and information on the reliability of the estimates are given in Technical notes.)

Section

Age Sex

and

itern Al1 18-29 30-44 45-64 65 years

number Health behaviors and knowledge ages years years years and over Male Female

DENTAL CARE--Con.

U.1. This next question is about preventing tooth decay. After I

read each of the following, tell me if you think it is

definitely important, probably important, probably not, or

definitely not important in preventing tooth decay.--Con.

Using fluoride toothpaste or fluoride mouth rinse

Important......................... ............................

Definitely important........................................

Probably important..........................................

Not important.................................................

Probably not important......................................

Definitely not important....................................

Oon’tknow/No opinion.........................................

Avoiding between-meal sweets

Important.....................................................

Definitely important........................................

Probably important..........................................

Not important.................................................

Probably not important......................................

Definitely not important....................................

Oon'tknow/No opinion.........................................

U.2. Now I ‘m going to ask about preventing gum disease. In your

opinion, how important or not important is each of the

foilowing in preventing gum disease?

Seeing a dentist regularly

Important.....................................................

Definitely important........................................

Probably important..........................................

Not important.................................................

Probably not important......................................

Definitely not important....................................

Don’tknow/No opinion.........................................

Drinking water with fluoride from early childhood

Important.....................................................

Definitely important........................................

Probably important..........................................

Not important.................................................

Probably not important......................................

Definitely not important....................................

Don’tknow/No opinion.........................................

Regular brushing and flossing of the teeth

Important.....................................................

Definitely important........................................

Probably important..........................................

Not important.................................................

Probably not important......................................

Definitely not important....................................

Don’t know/No opinion.........................................

Using fluoride toothpaste or fluoride nwuth rinse

Important.....................................................

Definitely important........................................

Probably important..........................................

Not important.................................................

Probably not important......................................

Definitely not important....................................

Oon'tknow/No opinion.........................................

Avoiding between-meal sweets

Important.....................................................

Definitely important........................................

Probably important..........................................

llotimportant ................................................

Probably not important......................................

Definitely not important....................................

Don’t know/No opinion.........................................

See footnotes at end of table.

94

72

22

:

i

89

z

8

7

;

::

13

2

:

3

$

35

16

12

1;

96

86

11

1

:

3

85

57

28

9

7

2

6

83

49

35

11

9

2

5

Percent of population

:

31

:

2:

81

53

29

6

5

1:

89

75

14

2

2

;

%

25

11

7

3:

90

74

16

1

:

9

68

39

28

9

:

23

75

48

28

:

Ii

87

58

29

5

3

ii

87

56

31

:

2

6

93

78

15

3

2

:

62

:i

18

13

1:

;

14

;

o

5

z

30

H

1:

78

47

31

13

10

3

9
14 adwincedata

Table 1. Estimates of the percent of population with selected behaviors and knowledge from the lg85 National Health Interview

Survey ouestionnai re on Health Promotion and Disease Prevention, by age and sex: united States, 1985--Con.

(Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general

qualifications, and information on the reliability of the estimates are given in Technical notes.)

Section

Age Sex

and ——

i tern Al1 18-29 30-44 45-64 65 years

number Health behaviors and knowledge ages years years years and over Male Female

U.3.

U.4.

U.5a.

U.5b.

V.la.

V.2a.

V.3a.

DENTAL CARE--Con.

In your opinion, which of the following is the main cause of

tooth loss in children?

Tooth decay.....................................................

Gum disease.....................................................

Injury to the teeth.............................................

Don’t know.........................”............................

In your opinion, which of the following is the main cause of

tooth loss in adults?

Tooth decay.....................................................

Gum disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Injury to the teeth.............................................

Don’t know......................................................

Have you ever heard of dental sealants? (Yes).....................

Which of the fol1owing best describes the purpose of dental

sealants--to prevent gum disease, to prevent tooth decay, or

to hold dentures in PIace? (Persons who have heard of dental

sealants (yes) in U.5a.

Prevent gum disease.............................................

Prevent tooth decay.............................................

Hold dentures in place..........................................

Don’t know......................................................

OCCUPATIONAL SAFETY AND HEALTH

In your present job, are you exposed to any substances that

could endan er your health, such as chemicals, dusts, fumes

or gases?3 iCurrently employed persons) (Yes).....................

In your present job, are you exposed to any work conditions

that could endanger your health, such as loud noise, extreme

heat or CO1d, physical or mental stress, or radiation?3

(Currently employed persons) (Yes)................................

In your present job are you exposed to any risks of accidents or

injuries?3 (Currently employed persons) (Yes)....................

57

2!

5

40

53

3

4

23

8;

12

4

35

36

40

55

3:

3

42

52

4

3

18

7:

18

3

36

36

45

Percent of population

56 59 61

3: 2: 1?

3 5 14

35 40 44

60 54 43

2 2 2

2 4 11

31 23 14

8:

9

3

6 5

41 38

51 56

3 2

5 4

22 23

10 13 13 11

5 9 4 4

37 32 17

40 33 13

40 37 26

44 23

42 28

51 26

lNational Center for Health Statistics, C. A. Schoenborn, and K. M. Danchik: Health Practices Among Adults: United StateS, 1977.

Advance Data From Vital and Health Statistics. No. 64. DHEW Pub. No. (PHS) 78-1250. Public Health Service. Hyattsville, Md.,

?iov. 4, 1980.

2National center for Health Statistics, A. J. Moss and G. Scott: Characteristics of persons with hypertension, United StateS,

1974. Vital and Health Statistics. Series 10, No. 121. DHEW Pub. No. (PHS) 79-1549. Public Health Service. Washington. U.S.

Government Printing ffIce, Dec. f978.

3National Center for Health Statistics, C. A. Schoenborn, K. M. Danchik, and J. Elinson: Basic data from Wave I of the National

Survey of Personal Health Practices and Consequences, United States, 1979. Vital and Health Statistics. Series 15, No. 2. DHHS

Pub. No. (PHS) 81-1163. Public Health Service. Washington. U.S. Government Printing OttIce, Aug. 1981.

4National Center for Health Statistics, B. Bloom and S. S. Jack: Persons with and without a regular source of medical care,

United States. Vital and Health Statistics. Series 10, No. 151. OHHS Pub. No. (PHS) 85-1579.

5National Center for Health Statistics, A. J. Moss and M. H. Wilder: Use of selected medical procedures associated with

preventive care, United States, 1973. Vital and Health Statistics. Series 10, No. 11O. DHEW Pub. No. (HRA) 77-1538. Health

Resources Administration. Washington. U.S. Government Prlntlng ffice, Mar. 1977.

6Natfonal center for Health s~tistics, J . w. Choi: Exercise and Participation in Sports Among Persons 20 Vears of Age and [Over:

United States, 1975. Advance Oata From Vital and Health Statistics. No. 19. .DHEW Pub. No. (PHS) 78-1250. Public Health

Service. Hyattsville, Md., March 15, 19/8.

7National Center for Health Statistics: Health, United States, 1985. DHHS Pub. No. (PHS) 85-1232. Public Health Service.

Washington. U.S. Government Printing Office, Dec. 1985.
adwlncedata 15

Technical notes

The National Health Interview Survey (NHIS) is a continuous, cross-sectional, nationwide survey conducted by

household interview. Each week a probability sample of households in the civilian noninstitutionalized population is interviewed by personnel of the U.S. Bureau of the Census to obtain

information on the health and other characteristics of each

member of the household. A description of the survey design,

methods used in estimation, and general qualifications of the

NHIS data is provided in Current Estimates From the National Health Interview Survey, 1985.4

The 1985 NHIS sample consisted of 36,399 eligible

households. The total noninterview rate for the basic health

and demographic household questionnaire was about 4 percent—

about 2-3 percent of which was due to respondent refbsal and

the remainder primarily due to an inability to locate an eligible

respondent at home after repeated calls. For the Health Promotion and Disease Prevention questionnaire, self-res~nse

was required and one adult per family was randomly selected

as the respondent. This procedure resulted in an additional

nonresponse of about 7 percent. The number of completed

~Nati~~~centerfor Heslti Statktics,A. J. Moss Current esdMateSfrom tie

National Hestth InterviewSurvey,United States, 1985. Viral and Health Starisfics. Series IO, No. 160. DHHS Pub. No. (PHS) 86-1588. Public Health

Service. Washmgtort. U.S. GovcsturtentPrirtdrtgO!l’ice.Sept. 1986. In preparation.

Health Promotion and Disease Prevention questionnaires was

33,630, representing art estimated 90 percent of eligible respondents.

The estimated population for each of the demographic

categories is shown in table I to allow readers to derive an

estimate of the number of people in the United States with a

given characteristic. However, the estimates are based on a

sample of the population rather than on the entire population

and are, therefore, subject to sampling error. Some estimates in

table 1 me small for given characteristics, When an estimate or

the numerator or denominator of a rate is small, the sampling

error may be relatively high. Approximate standard errors for

estimates in this report are shown in table II.

Release of data

To expedite the early release of data from the Health

Promotion and Disease Prevention questionnaire, provisional

estimates previously were made available. * This report represents the first release of estimates from the final edited and

weighted data file. A number of additional publications are in

preparation, including a Series 10 report similar in format to

this publication but with detail by age, sex, and race, and with

the complete questiomaire and a description of the survey

methoc@another Series 10 publication showing selected health

behavior and knowledge variables by detailed sociodem~

Table 1. Estimetes of selected civilien noninstitutionelized populations by age and sex United States, 1985

Age Sex

All 18-29 30-44 45-64 65 years

Selected populations ages years years years and over Male Female

Population in thousands

Total adult population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170,972 48,325 51,092 44,512 27,043 80,779 90,192

Females . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90,192 24,756 26,201 23,297

Population in families with children under 10 yeara of age . . . . . . . . . .

15,939 90,192

45,826 17,922 23,931 3.491 20,145

Population in families with children under 5 years of age. . . . . . . . . . . .

481 25,681

29,916 14,753 13,189 1.756

Currently employed population.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

218 13,241 16,675

107.376 34,641 40,781 28,645 3,250 60,052 47.264

Table Il. Standard errors, expressed in percentage points, of estimated percents by selected age and sex groups: National Health Interview

Survey Questionnaire on Health Promotion and Disease Prevention, United Ststes, 1985

Age Sex

All 18-29 30-44 45-64 65 years

Estimated percent ages yeara yeers years and over Male Female

Standard error m percentage points

5or95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.13 0.25 0.24 0.26 0.30 0.20 0.17

100r90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.18 0.35 0.33 0.36

15rx85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.41

0.21

0.28

0.42

0.24

0.39 0.43 0.49 0.33 0.28

200r80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.24 0.47 0.44 0.48

250r75 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.55

0.26

0.37

0.51

0.31

0.47 0.52

300r70 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.59

0.27

0.40

0.54

0.34

0.50 0.55 0.63 0.42 0.36

350r65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.28 0.56 0.52 0.57 0.65 0.44 0.37

400r60 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.29 0.57 0.53 0.59 0.67 0.45 0.38

450r55 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.30 0.58 0.54 0.60 0.68 0.46 0.39

500r50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.30 0.58 0.54 0.60 0.68 0.46 0.39
16 aduancedata

graphic charactensti=, and a Series 5 publication providing a

comparison of data from this survey with data km the 1985

Canada Health Sunrey. In additiom a number of ~search reports

prepared by the staffs of agencies designated ~ having lead

responsibility for particular 1990 objectives will appear in the

November-December 1986 issue of Public Health Reports.

A public use data fde based on the 1985 IHealthPromotion

and Disease Prevention questionnaire is schechded for release

in December 1986. Information regarding the purchase of the

public use tape can be obtained by writing the Division of

Health Interview Statistics, National Center for Health Statistics, 3700 East-West Highway, Hyattsvilk, Md. 20782.

Collaboration with Federal agencies

The following Federal agencies provided partial finding

for the 1985 Health Promotion and Disease Prevention study,

and/or palicipated in the planning and development of the

questionnak

OfXce of the Assistant Secretary for Health

Office of Disease Prevention and Health Promotion

0t3ice on Smoking and Health

Alcoho4 Drug Abuse, and Mental Health Administration

National Institute of Alcohol Abuse and Alcoholism

National Institutes of Health

National Hem Lung and Blood Institute

National Cancer Institute

National Institute of Dental Research

National Institute of Child Health and Humau

Development

Health Resources and Services Administration

Centers for Disease Control

Center for Prevention Services

Center for Infectious Diseases

Center for Environmental Health

Center for Health Promotion and Education

National Institute for Occupational Safety and Health

Food and Drug Administration

Bureau of Foods

Department of Transportation

Office of Driver and Pedestian Research

The President’s Cixqii, on Physical Fitness and Sports

Symbols

--- Data not available

Q“tegov not applicable

. Quantny zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

●

Figure does not meet standard of

reliability or precision (more than

30-percent relative standard error)

* Figure suppressed to comply with

confidentiality requirements
1985

Introduction

Summary National Hospitai Discharge

Hospital Care Statistics Branch. Division of Health Care Statistics

Survey

drop in discharge rates from 1983 to 1985 (figure 1). In addi- .-.

tio~ the average length of stay for hospitalized patients is conWM a rate of 148 per 1,000 discharges, 1985 marked the timing to drop. The average stay in 1985 was 6.5 days comfirst year since 1971 that the discharge rate has fallen below pared with 7.7 days a decade ago (figure 2).

150 per 1,000. This is primarily ?he result of an 1l-percent During 1985 an estimated 35.1 million inpatients, exclud-

/J140

Oe I I I I I I I I I I I 1 I I I I I I 1 I

1965 1970 ?975 1980 1985

Figure 7. Dischugo rat. in noII-Fodusl short-stayhospitdx Unitd Stat.$, 196S-65

S. DEPARTMENT OF HEALTH AND HUMAN SEWICES Public Health Service
2—

J

6

‘r

o

I I I I I I I I I I I I I I I I I 1 I I 1

1965 1970 1975 1980 1985

.-- —-. Figure2. AveragoImrgthof stq in non-Fodoralshwt-stay Iwspitdx UnitedStates.1965-85

ing newborn infants, were discharged Ikrm shoti-stay non- chapters, a few diagnoses and procedures or groups thereof

Federal hospitals in the United States. These patients were hpitalized an average of 6.5 days and used 226.2 million days

of inpatient hospital care. Patients hospitaked during 1985

accounted for 148 discharges per 1,000 civilian population.

These and other statistks presented in this report are based

on data collected by means of the National Hospital Discharge

Survey, a continuous sumey that has been conducted by the

National Center for Health Statistic since 1965. in 1985,

data were abstracted from the medical records of approximately

194,800 patients discharged fkom414 short-stay non-Federal

hospitals. A brief description of the sample desi~ data collection procedures, and estimation process, and detlnition of

terms used in this report can be found in the section entitled

*’Technical notes.” A detailed discussion of these items, as

well as the sumey form used to collect the da% have been

published.l~

Coding of medical data for patients ho@talized is done

according to the International C1ass8catr”onof Diseases 9th

Revisiofi Clinical Mod$cation3 (ICD-9-CM). Up to seven

diagnoses and four procedures are coded for each discharge.

Although diagnoses included m the ICD-9-CM section entitled

“Supplementary classification of external causes of injury and

poisoning” (codes E800-E999) are used by the National

Hospital Discharge Survey, these diagnoses are excluded tim

this report The conditionsdiagnosed and pmdures perfotmed

are presented here by chapter of ICD-9-CM. Within these

also are shown. These specific categories were selected primarily because of large numbers of occurrences or because

they are of special interest Residual categories of the diagnostic

and procedure classes, however, are not included in the tables.

More detailed amdyses of these data will be presented in later

reports in Series 13 of Vital and Health Statistic&

In 1985, approximately 17 percent of the hospitals submitted machine-readable data tapes through commercial a~

stracdng semices. Preihniwuy analysis indicates that a greater

number of nonsurgical procedures per patient are obtained

horn these hospitals than tim hospitals submitting data in the

traditional manual mode (see Tec~Ical notes). This has resulted in increases from 1984 to 1985 in the estimates for miscdlaneous diagnostic “mdtherapeutic produma ~ ~-fore,

for total procedures.

-.

Data’ highlights

UtilizationIV patient and

hospital chsractaristics

me number, rate, and average length of stay of patients

&charged horn short-stay non-Federal hospitals are shown by

selected patient and hospital characteristics in tables 1-3. The

35.1 million patients discharged from short-stay hospitals during 1985 included an estimated 14.2 million males and 20.9

million females. The rates per 1,000 population were 124 for
aduancedata 3

males and 171 for females, making the rate for females about

38 percent higher than the rate for males. The number and rate

,of discharges are always higher for females than for males

&cause of the large number of women in their childbearing

years (15-44 years of age) who are hospitalized for deliveries

and other obstetrical conditions. Excluding deliveries, the rate

for finales discharged was 139, or only about 12 percent higher

than the rate for males.

The average length of stay was 6.9 days for males aud 6.2

days for females during 1985. The length of stay for females

was shorter than that for males primarily because the average

length of stay of the 3.9 million women who were hospitalized

for deliveries was only 3.3 days. The average length of stay for

females who were not hospitalized for deliveries during 1985

was 6.8 days.

The number of discharges horn short-stay hospitals by

geographic region during 1985 ranged from 12.3 million in the

South Region to 6.5 million in the West Regio% and the rates

per 1,000 population ranged ilom 154 in the Midwest Region to

138 in the West Regiom Regional differences in the number of

discharges are accounted for mainly by variations in population

sizes.

Average lengths of stay by geographic region were 5.4

days in the West 6.0 days in the Souw 6.8 days in the Midwes~ and 7.7 days in the NorthessL

Discharges tlom short-stay hospitals were about 40 percent

male and 60 percent female in every hospital bed-size group.

The average length of stay increased steadily tlom 5.2 days in

the smallest hospitals (6-99 beds) to 7.4 days in the largest

hospitals (500 beds or more) for all patients.

During 1985, voluntary nonprofit hospitals provided medical care to an estimated 24.0 million patients, or 68 percent of

all patients hospitalized. Hospitals operated by State and local

governments cared for 7.8 million patients, or 22 percent of all

discharges, and proprietary hospitals operated for profit cared

for 3.3 million patients or 9 percent of all discharges. Average

lengths of stay were 6.7 days in voluntary nonprofit hospitals,

5.9 days in State and local government hospitals, and 6.3 days

in proprietary hospitals.

Utilization by diagnosis

Diseases of the circulatory system ranked fmt in 1985

among the ICD-9-CM diagnostic chapters as a principal or

first-listed diagnosis among patients discharged fkom nonFederal short-stay hospitals. These conditions accounted for

an estimated 5.5 million discharges. Other leading ICD-9-CM

diagnostic chapters were supplementary chssifications (including females with deliveries) (4,3 million discharges) and diseases of the digestive system (3.9 million discharges). Over 38

percent of the patients discharged from non-Federal short-stay

hospitals were included in these three ICD-9-CM diagnostic

chapters.

The diagnostic categories presented in this report were

selected either because they appear as principal or first-listed

diagnoses with great frequency or because the conditions are of

special interes~ Although many of these categories (such as

malignant neoplasmy psychoseq and fkactures, all sites) are

groupings of more detailed diagnoses, they are presented as

single categories without showing all of the specific diagnostic

inclusions.

The number and rate of discharges and average length of

stay for each ICD-9-CM diagnostic chapter and selected

categories are shown by sex and age in tables 4-6. The most

common diagnostic category for all patients was females with

deliveries. This was followed by the diagnostic categories heart

disease and malignant neoplasms. Excluding females with deliveries, these last two non-sex-spec~lc diagnostic categories

were also the most common first-listed diagnoses for each sex.

The most frequent fnt-listed diagnoses for 1985 varied

for the different age groups. For patients under 15 years of age,

the most frequent diagnoses were acute respiratory infections,

except Mluenz% pneumoni% all forms; and chronic disease of

tonsils and adenoids. Excluding females with deliveries, the

most frequent diagnoses for patients 15-44 years of age were

fractures, all sitev psychoses; and abortions and ectopic and

molar pregnancies. Patients 45-64 years of age were hospitalized most frequently for heart disease. The most common

diagnoses for patients 65 years of age and over were heart

disease and malignant neoplasms.

The average length of stay for all patients ranged from a

low of 1.5 days for the diagnostic category chronic disease of

tonsils and adenoids, 1.6 days for patients admitted for sterilization, 2.0 days for the diagnostic category of cataracl and

2.1 days for abortions and ectopic and molar pregnancies to a

high of 14.9 days for psychoses, and 14.7 days for fkacture of

neck of femur. Although the overall average length of stay for

females was shorter than that for males, females stayed in the

hospital longer than males for many of the specific diagnostic

categories shown in this report

The average length of stay increased with increasing age

for most categories of diagnoses shown. Overall, the average

length of stay ranged from 4.6 days for patients under 15 years

of age to 8.7 days for patients 65 years and over.

Utiktation by procedures

One or more surgical or nonsurgical procedures were perfoxmed for an estimated 20.7 million of the 35.1 million inpatients discharged from short-stay hospitals during 1985. A

total of 36.8 million procedures, or an average of 1.8 per patient

who underwent at least one procedure, were recorded in 1985.

Procedures are grouped in the tables of this report by the

ICD-9-CM procedure chapters. Selected procedures withih

these chapters also are presented by ~ecific categories. Some

of these categories (such as extraction of lens, open heart surgq, ~d hysterectomy) are presented as single categories a]-

though they may be divided into more precise subgroups.

When grouped by chapters, miscellaneous diagnostic and

therapeutic procechms with 8.8 million procedures ranked first

among the surgical and nonsurgical procedures performed during 1985. These were followed by operations on the digestive

system with 5.7 million procedures performed. Other leading

procedures were obstetrical procedures with 4.3 million pr~

ccdures, operations on the musculoskeletal system with 3.5

miilion procedures and operations on female genital organs
4

with 3.3 million procedures. Approximately twcdirds of all

procedures performed in 1985 were included in these five

ICD-9-CM procedure chapters.

The number and rate of all-listed procedures in 1985 for

each ICD-9-CM procedure chapter and selected procedure

categories are shown by sex and age in tables 7 and 8. Of the

36.8 million procedures performed during 1985, 14.7 million

were for males and 22.1 million were for fernales. The corresponding rates per 1,000 population were 155 for both sexes,

128 for males, and X80 for femaies. Of the procedures shown

in table 7, some common ones for males were arteriography

and angiocsrdiography and ccsnputerized axial tomograph

the most frequently performed procedures for females were

episiotomy and cessrean section.

The rate of procedures per 1,000 population inme=es

with advancing age from 37 for patients under 15 years to 387

for patients 65 years of age and over. The most fiquently

performed procedures for patients under 15 years of age!were

tonsillectomy with or without adenoidectomy, for patients

15-44 years of age, episiotomy and cesaresn sectiow for patients 45-64 years of age, srteriography and angiocardio~aphy,

and computerized axial tomography, and for patients 65 years

of age and over, computerized axial tomography and diagnostic

ultrasound.
5

TABLE 1. NUMBER OF INPATIENTS DISCHARGED FROM SHORT-STAY

HOSPI TALS BY SELECTEO CHARACTERISTICS: UN ITEO STATES. 1985

1 DISCHARGES FROM NONFEDERAL HDSP ITALS. EXCLUOES NEUBORN

INFANTS)

sELECTED CHARACTERISTIC BOTH HALE FEMALE

SEXES

TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AGE

UNDER 15 YE ARS . . . . . . . . . . . . . . . . . . .

1544 YEARS . . . . . . . . . . . . . . . . . . . . . .

45-64 YEA AS. . . . . . . . . . . . . . . . . . . . . .

65 YEARS ANO OVER . . . . . . . . . . . . . . . .

REGION

NORTH EAST . . . . . . . . . . . . . . . . . . . . . . . .

HIDNEST . . . . . . . . . . . . . . . . . . . . . . . . . .

SOUTH . . . . . . . . . . . . . . . ..-. . . . . . . . . .

#E ST . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BEO SIZE

6-99 BEDS . . . . . . . . . . . . . . . . . . . . . . . .

100-199 BEDS. . . . . . . . . . . . . . . . . . . . .

200-299 BEDS . . . . . . . . . . . . . . . . . . . . .

300-499 BEDS . . . . . . . . . . . . . . . . . . . . .

500 BEDS OR MORE. . . . . . . . . . . . . . . . .

DNNERSHIP

NONPROFIT . . . . . . . . . . . . . . . . . . . . . . . .

STATE AND LOCAL GOVERNMENT.. . . . . .

PROPRIETARY . . . . . . . . . . . . . . . . . . . . . .

NuMBER OF PAT1 ENTS

O ISCHARGEO IN THOUSANOS

35,056 14,160 20.896

2,972 1,698 1,274

13.966 4?,153 9.813

7,610 3,776 3* 834

10,508 4,533 5,9T5

7,168 2 ,99B 4,170

9,111 3,734 5s378

12.274 4,850 7,425

6,502 2,579 3,923

5*331 2,11s 3,213

6,443 2,565 3,87B

6,953 2,905 4,04B

8,625 3,459 5,167

7,703 3.113 4,590

23.984 9,645 14,339

7,776 3,153 4.623

3,296 1.362 1*933

ABLE 2. RATE OF INPATIENTS OISCNARGELS FROM SHDRT-STAY

HOSPITALS, BY AGE, GEOGRAPHIC REGION, AND SEX: UNI TEO STATES,

19B5

(DISCHARGES FROH NONFEDERAL FKISPITALS. ExCLUDES NEIABORN

INFANTS I

AGE ANO REG1ON BOTH HALE FEHALE

SEXES

RATE OF PATIENTS OISCHARGEO

PER 1,000 POPULATION

TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147.9 123.5 170.7

AGE

UNDER 15 YEARS . . . . . . . . . . . . . . . . . . . 57.2 63.8 50.2

15-44 YEARS . . . . . . . . . . . . . . . . . . . . . . 125.1 75.4 173.4

45-64 YEARS . . . . . . . . . . . . . . . . . . . . . . 169.5 176.2 163.4

65 YEARS ANO OVER . . . . . . . . . . . . . . . . 36B.3 393.2 351.4

REGION

TABLE 3. AVERAGE LENGTH OF STAY FOR INPATIENTS OISCHARGEO FROM

SHORT-STAY WSPITALS BY SEL ECTEO CHARACTERISTICS: uNITEO

STATES, 1985

[DISCHARGES FROM NONFEDERAL HOSPITALS. EXCLUOES NEwBORN

INFANTS I

SELECTEO CHARACTERISTIC C BOTH HALE FEMALE

SEXES

AVERAGE LENGTH OF STAY IN OAYS

TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 6.9 6.2

AGE

UNOER 15 YE ARS . . . . . . . . . . . . . . . . . . . 4.6 4.5 4.6

15-44 YEARS . . . . . . . . . . . . . . . . . . . . . . 4.8 6.1 4.3

45-64 YE AD S. . . . . . . . . . . . . . . . . . . . . . 7.0 b. 9 7.1

65 YEARS ANO OVER . . . . . . . . . . . . . . . . 8.7 8.4 9.0

REGION

NORTHEAST . . . . . . . . . . . . . . . . . . . . . . . . 7.7 8.0 7.6

MI OMEST . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 7.2 6.4

SOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.0 6.4 5.8

wEST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.+ 5.9 5.1

8E0 SIZE

6-99 BEDs . . . . . . . . . . . . . . . . . . . . . . . . 5.2 5.4 5.1

100-199 BEDS . . . . . . . . . . . . . . . . . . . . . 5. a 6.2 5.5

200-299 BEDS . . . . . . . . . . . . . . . . . . . . . 6.5 6.B 6.3

300_499 SEAS . . . . . . . . . . . . . . . . . . . . . 6.8 7.3 6.5

500 8EOS OR MORE . . . . . . . . . . . . . . . . . 7.4 B.O 7.0

C41NERSHIP

NONPROF IT . . . . . . . . . . . . . . . . . . . . . . . . b. 7 7.1 6.4

STATE ANO LOCAL GOVERNMENT.. . . . . . 5.9 6.3 5.6

PROPRIETARY . . . . . . . . . . . . . . . . . . . . . . 6.3 6.7 6.0

NORTHEAST . . . . . . . . . . . . . . . . . . . . . . . . 144.1 --- ---

FIIDHEST . . . . . . . . . . . . . . . . . . . . . . . . . . 154.3 --- ---

SOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151.6 --- ---

HEAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137.6 ------
6 aduancedata

TABLE 4. NUMBER OF INPATIENTS DISCHARGED FROM SHORT-STAY Hospitals 3.Y CATEGORY OF FIR ST-L ISTEO OIAGNOS]S, SEX, ANO AGE: UNITEO

STATES, 1985

[DISCHARGES FRGM NONFEDERAL HosP IThLs. ExcLuoES NEl#30RN INFANTS. DIAGNOSTIC GROUPINGS ANO COOE NUMBER INCLUSIONS ARE BASEO ON THE

INTERNATIONAL CLASSIFICATION OF OISEASES, 9TH REVISION, CLINICAL MOOIF ICATIONI

SEX AGE

CATEGORY OF FIRST-LISTED OIAGNOSIS ANO lCD-9-CM CCOE

TOTAL MALE FE14ALE uNOER 15 15-44 45-64 65 YEARS

YEARS VEARS VEARS ANO OVER

NuMBER OF PAT I ENTS OISCHARGEO IN THOUSANOS

14,160

308

1,008

892

206

●

609

196

149

918

325

68

312

537

196

1:;

2,783

89

1,910

466

190

549

247

416

1.591

236

124

433

195

1,839

156

87

143

343

191

140

958

215

. . .

. . .

268

939

188

281

156

82.

260”

1,800

550

1::

162

203

156

*

20,896

361

1,403

1,019

110

207

659

286

193

782

376

126

76

674

229

114

142

2,6e6

124

1,674

289

114

443

310

500

1,6+7

229

164

421

266

2,034

137

116

107

42

266

333

1,848

110

193

968

3B2

273

1,231

276

227

113

77

275

1,503

579

196

120

107

74

4,168

80

3,854

7,610

95

794

64a

132

91

279

160

56

396

164

1:

267

93

38

47

1,728

84

1.204

267

134

423

12

612

59

14:

97

1,038

86

57

23

118

66

154

646

119

43

*

*

134

699

130

191

30

●

135

603

181

24

63

31

35

92

*

95

10,508

172

1,094

991

169

81

44a

171

138

260

135

26

26

409

126

138

39

ALL CONDITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35,056

669

2,972

193

69

43

●

*

70

21

58

49

●6

*5

*

229

64

11:

35

2:

*

*

●

*

●

048

229

166

206

144

346

2

15

65

1:3

●

101

●

*

*5

*

5a

70

18

*

150

158

85

398

132

●

●

64

38

52

*

11

13,966

210

454

229

13

35

271

128

90

INFECTIOUS ANO PARASITIC OISEASES . . . . . . . . . . . . . . . . . . . ...001-139

NEOPLASMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l4O.239

MALIGNANT NEOp LA5F15 . . . . . . . . . . . . . . . . . . . . . . . ...140-208. z3D-z34

MALIGNANT NEOPLASM OF 7RACHEA,

BRCNCHUS, ANO LUNG . . . . . . . . . . . . . . . . . . . . . . ..162 .197. O.197.3

MALIGNANT NEOPLASM OF BREAST . . . . . . . . . . . . . . .. 174-175 .198.81

2,411

1,911

315

208

ENDOCRINE, NUTRITIONAL ANO MET A80LIC OISEASES,

ANO [MMUNITV OXSOROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..24 O-279

OIABETES NELLITUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..25O

OISEASES OF THE BLOCC ANO BLOOC-FORMING ORGANS . . . . . . . ..2 W-289

1,068

4B0

342

1,014

396

120

239

MENTAL OISOROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290-319

PSYCHOSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..29O.299

NEUROTIC ANO PERSGNALITV OISOROERS . . . . . . . . . . . . . . . . . ..3 OO-3O1

ALCCHOL OEPENOENCE SYNOROI!E . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..3O3

1,700

701

195

388

OISEASES OF THE NERVDIJS SVS7EM ANO SENSE ORGANS . . . . . . ..32 O-389

OISEASES OF THE CENTRAL NERVOUS SYSTEN . . . . . ..32O-333494O-349

CAT ARACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

OISEASES OF THE EAR ANO NASTOIO PROCESS . . . . . . . . . . . . ..3 I3D-389

1,211

425

182

259

305

143

●6

55

3,224

B2

2,111

436

157

501

OISEASES OF THE CIRCULATOR SYSTEM . . . . . . . . . . . . . . . . . . . ..39O-459

ESSENTIAL HYPERTENSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4Ol

HEART OISEASE . . . . ..391-392. 0.393-398.402.4 O4.4l+4l6,42O-429

ACUTE tlYOCAROIAL INFARCTION . . . . . . . . . . . . . . . . . . . . . . . . . . ..41O

5,470

214

3,584

755

481

45

250

50

13

67

;:

ATHEROSCLEROTIC HEART OISEASE . . . . . . . . . . . . . . . . . . . . . ...414.0 30;

OTHER ISCHEMIC HEART DISEASE . . . . . . . . ...411-414.914.1-414.9 992

CONGESTIVE HEART FAILURE . . . . . . . . . . . . . . . . . . . . . . . . . . . ..428. O 557

CEREBROVASCULAR OISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..43 O-438 916

446

686

,121

98

400

97

, 267

131

51

14

120

94

157

735

39

*

. . .

. . .

147

542

103

51

17

79

793

419

2;;

34

23

82

. . .

OISEASES OF THE RESPIRATOR SYSTEH . . . . ..- . . . . . . . . . . . . ..46 O-5I9

ACUTE RESPIRATORY INFECTIONS, EXCEPT IN FL UENZA . . . . . ..46 O-466

CHRONIC OISEASE OF TONSILS ANO AOENOIOS . . . . . . . . . . . . . . . ...474

PNEUMONIA, ALL FOR PIS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..48O-486

3,238

+6+

288

854

462

656

78

11%

124

1,222

73

79

148

100

165

162

ASTHMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

OISEASES OF THE OIGESTIVE SVSTEM . . . . . . . . . . . . . . . . . . . . . ..52O-579

uLCERS OF THE STOMACH ANO SMALL intestine . . . . . . . . . ...531-534

GASTRITIS ANO OUOOENITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...535

APPEhOICIT1 S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .540-543

INGUINAL HERNIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..55O

NON IN FECTIWS ENTERITIS ANO COLITIS . . . . . . . . . . . ...555-556.558

CHOLELITHIASI S. . . . . . . . . . . . . . . . . . . . . . . . ...-........-......574

3,873

292

203

250

384

457

474

OISEASES OF THE GENXTOURINARY SYSTEM . . . . . . . . . . . . . . . . . ..58 O-629 2.805 1,324

CALCULUS OF KIONEY ANO URETER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 325 165

DISORDERS OF MENSTRUATION ANO OTHER

ABNORMAL VAGINAL BLEELING . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...626 193

COHPLICATIONS OF PREGNANCV, CHILDBIRTH,

ANO THE PUERPERIUP1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l/ 630-676 96B

ABORTIONS ANO ECTOPIC ANO MOLAR PREGNANC I ES . . . . . . . . ..630- 639 382

148

961

378

DISEASES OF THE SKIN ANO SUBCUTANEOUS TISSUE . . . . . . . . . ..68 O-7O9 542 203

OISEASES OF THE MUSCULOSKELETAL SVS7EM

ANO CONNECTIVE TISSUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..7l&739

ART HROPATHIES ANO RELATEO DISORDERS . . . . . . . . . . . . . . . . . .710-719

IN7ERVER7E8RAL OISC OISOROERS . . . . . . . . . . . . . . . . . . . . . . . . . ...722

2s170

465

5 D8

269

860

133

265

CONGENITAL ANOMALIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74 O.759 72

CERTAIN CONDITIONS CRIGINATING IN ThE

PER INATAL PER IOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..760-779 159 ●

SVMPTOHS, SIGNS, ANO IL L-OEFINEO CONDITION S . . . . . . . . . . ..780- 799 534 235

INJURV ANO POISON IN G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..8 O&999

FRACTURES, ALL SITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..80 C+B29

FRACTURE OF NECK OF FEMuR. . . . . . . . . . . . . . . . . . . . . . . . . . . . ..82O

3,303

1s129

25B

1,510

398

11

SPRAIhS ANO STRAINS OF BACK (I NCLUOING NECK) . . . . . . ...846-847 237

INTRACRANIAL INJURIES (EXCUOING THOSE 141TH

SKULL FRACTURE ) . . . . . . . . . . . . . . .." . . . . . . . . . . . . . . . . . . . .. B5O.854 26B

LACERATIONS ANO OPEN UOUNOS. . . . . . . . . . . . . . . . . . . . . . . ...870-904 277

146

140

181

SUPPLEMENTARY CL AS SIFICATION S........ . . . . . . . . . . . . . . . . .. VO1-V82 4,324

PERSONS AOMITTEO FOR STERILI ZATION . . . . . . . . . . . . . . . . . . . ..v25.2 82

FEMALES wITH DEL IVERIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. V27’ 3*854

4,098

81

3.838

1/ FIRST-L ISTEO OIAGNOSIS FOR FEMALES IAITH DELIVERIES 1s COOEO v27, SHOWN UNOER ‘suPPLEuENTARv CL ASS IFICATIONS.11
admceda7

TABLE 5. RATE OF lhPATIENTS DISCHARGED FROM SHORT-STAY HOSPITALS, BY CATEGORY OF FIRS T-L ISTEO OIAGNOSIS, SEX, ANO AGE:

STATES, 1985

UNITEO

fOISCHARGES FROM NONFEDERAL HOSPITALS. ExCLUOES NEWORN INFANTS. DIAGNOSTIC GROUPINGS ANO COOE NUMBER INCLUSIONS ARE BAsEO ON THE

INTERNATIONAL CLASSIFICATION OF OISEASES, 9TH REVISION, CLINICAL MODIFICATION

SEX AGE

CATEGORY OF FIRST-L ISTEO DIAGNOSX S ANO ICD-9-CM COOE

TOTAL HALE FEMALE UNOER 15 1 5-+4 45-64 65 YEARS

YEARS YEARS YEARS ANO OVER

RATE OF INPATIENTS OISCHARGED PER 10,000 POPULATION

ALL CONOITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INFECTIOUS ANO PARASITIC OISEASES . . . . . . . . . . . . . . . . . . . . ..00 I-I39

NEopLAsH$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l+@239

MALIGNANT NEOPLASM . . . . . . . . . . . . . . . . . . . . . . . . . . 14D-208,23Ll-234

HAL 16NANT NEOPLASM OF TRACNEA,

BRONCHUS, ANO Ll#AG . . . . . . . . . . . . . . . . . . . . . . ..162.197. o. I97.3

MALIGNANT NEOPLASM OF BREAST . . . . . . . . . . . . . . ..17+ 175,198. Ex

1,478.9

28.2

101.7

80.6

13.3

8.8

45.1

20.2

14.4

71.7

29.6

8.2

16.4

51.1

17.9

7.7

10.9

230.8

9.0

151.2

3L.8

12.8

41.8

23.5

38.6

136.6

19.6

12.1

36.0

19.5

163.4

12.3

8.6

1o.5

16.2

19.3

20.0

ua.3

13.7

a. 1

40.8

16.1

22.8

91.6

19.6

21.4

11.4

6.7

22.5

139.4

47.6

10.9

10.0

11.3

11.7

182.4

3.5

1.235.5

26.9

1,706.9

29.5

571.9

37.2

13.3

8.4

*

*

13.4

4.1

11.1

9.4

●1.1

*lo

●

44.1

12:2

*

22.7

6.8

*

3.8

*

*

*

*

*

163.1

44.0

35.7

39.7

27.8

66.5

0.4

2.8

12.5

9.0

25.6

●

19.4

*

*

● 1.O

*

11.1

13.4

3.5

*

28.8

30.4

16.3

76.5

25.3

0.6

0.6

12.2

7.3

10.0

●

2.0

1,250.8

18.8

40.6

20.5

1.2

3.1

24.3

11.5

8.1

90.8

35.5

10.7

21.4

27.3

12.8

● 0.5

4.9

43.1

4.1

22.4

4.5

1.2

6.0

1.0

3.0

58.8

7.0

8.8

9.0

11.1

109.4

6.6

7.1

13.3

9.0

14.7

14.5

118.6

14.8

13.2

86.1

33..9

18.2

77.0

11.9

23.T

6.4

*

21.1

135.2

35.6

1.0

13.1

12.5

:6.2

367.o

7.2

343.8

1,695.2

21.1

177.0

144.3

29.4

20.2

62.3

35.5

12.6

88.3

36.6

9.7

26.9

59.5

20.6

8.4

10.6

385.1

18.7

268.2

59.5

29.9

94.3

21.4

42.9

136.4

13.2

●

32.8

21.5

231.3

19.1

12.8

5.1

26.2

14.7

34.3

143.9

26.4

9.5

●

*

29.9

155.8

29.0

42.6

6.7

●

30.2

134.4

40.3

5.4

14.0

6.8

T. 9

20.4

*

*1.2

3,683.2

60.2

303.3

347.3

59.4

28.3

156.9

59.9

48.3

84.3

47.2

9.0

9.3

143.5

44.1

48.2

13.8

1.130.2

28.8

739.8

152.7

54.9

lT5.6

156.3

240.3

393.1

34.5

140.3

34.1

444.1

45.9

18.0

4.8

42.1

32.8

55.0

25T.6

13.T

*

...

...

51.5

189.9

64.2

18.0

6.1

27.5

277.8

146.8

76.9

S.a

12.1

8.1

2a.8

...

a7.9

77.a

114.6

a3.3

17.9

*

8.9

16.9

ENOOCRINEO NU7RITIGNAL ANO HETABU. IC DISEASES,

AND IMMUNITY oISOROER$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..24o-279

OIABETES NELL ITuS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-......250

OISEASES DF THE BLOCO ANO 8LOD0-FORHING ORGANS . . . . . . . ..28 O-289

35.7

16.9

13.0

80.1

2a.4

6.0

27.3

53a

23.4

15a

MENTAL 01 SOROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290-319

PSYCHOSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..29 O.299

NEURGTIC ANO PERSONALITY OISOROERS . . . . . . . . . . . . . . . . . ..3OO-3OI

ALCOHOL OEPENOENCE SYNORDNE... - . . . . . . . . . . . . . . . . . . . . . . . . ..3O3

63.9

30.7

10.3

6.2

orsEAs Es oF THE NERvOUs SYSTEH ANO sENsE ORGANS . . . . . . . .320-3a9

E CENTRAL NERVOUS SYSTEN... . ...320-336.340-349

CAT BRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

OXSEASES OF THE EAR ANO NASTOIO PROCESS . . . . . . . . . . . . ..38O-389

46.8

17.1

5.9

55.1

la.7

9.4

11.6

DISEASES OF TH ----- .-—

10.2

242a

7.a

166.7

40.6

OISEASES OF THE CIRCULATORY WSTEH. . . . . . . . . . . . . . . . . . . ..39 O-459

ESSENTIAL WPERTENSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4Ol

HEART OISEASE . . . . ..391-392 .D.393-39E,402,404,41 cb416,42D-+29

AcuTE MYDCAROIAL IN FARCTION . . . . . . . . . . . . . . . . . . . . . . . . . . ..4Jo

ATHEROSCLEROTIC HEART OISEASE . . . . . . . . . . . . . . . . . . . . . ...414.0

OTHER ISCHENIC HEART OISEASE . . . . . . . . ...411-413.414.1414.9

CONGESTIVE HEART FAILURE . . . . . . . . . . . . . . . . . . . . . . . . . . . ..42a. o

CEREBROVASCULAR OISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430-438

219.4

10.2

136.7

23.6

9.3

36.2

16.6

47.9

21.5

36.3

25.4

40.8

OISEASES OF THE RESPIRATORY SYSTEM .-... -...............460-519

ACUTE RESPIRATORY INFECTIONS. ExCEPT INFLUENZA . . . . . ..46O-466

138.a

20.6

lo.a

37.a

134.5

16.7

13.4

34.4

21.a

CHRONIC OISEASE OF 70 NSILS ANO ADHOIOS . . . . . . . . . . . . ..i. i.~?~

PNEUMONIA, ALL FOR MS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4ao+a6

ASTHMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-...-......493 17.0

OISEASES OF THE OIGESTIVE SYSTEN . . . ...-.--.............520-579 160.4

ULCERS OF THE STOMACH ANO SHALL INTES71NE . . . . . . . . . . ..53 I-534

GASTRITIS AND OUOOENITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...535

31c ITIs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..54o.543

41 A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..55o

IINFECTIOUS ENTERITIS ANO COLITIC . . . . . . . . . . . ...553-556.558

cHoLELITHIAs Is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...574

166.2

11.2

9.5

a.7

3.4

21.7

2T.2

13.6

7.6

12.5

29.9

16.7

APPENO

INGurNAL HERf

NON

12.2

a3.5

18.7

OISEASES OF THE GENITOURINARY SY$TEM . . . . . . . . . . . . . . . . . ..58o-629

CALCULUS OF KIONEY ANO URETER . . . . . . . . . . . . . . . . . . . . . . . . . ...592

DISGRDERS OF MENSTRUATION ANO OTHER

ABNORMAL VAGINAL BLEECING . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...626

150.9

9.0

15. a

CONPL ICAT IONS OF PREGNANCY, CHIL081RTH,

ANO THE PuERPERIuM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..I/ 630-676

ABORTIONS ANO ECTOPIC ANO MOLAR PREGNANCI ES . . . . . . . ...630-639

OISEASES CF THE SKIN ANO S~CUTANEOUS TISSUE . . . . . . . . . ..68O-7O9

01 SEASES OF THE PIUSCULCSKELE7AL SYSTEH

ANO CONNECTIVE TISSUE . . . . . . . . . . . . . . . . .._ . . . . . . . . . . . . ..7l&739

ARTHROPATHIES AND RELATEO OISOROER$ . . . . . . . . . . . . . . . . ..7 IO-719

INTERvERTE3T(AL OXSC LTISORDERS . . . . . . . . . . . . . . . . . . . . . . . . . ...722

CONGENITAL ANOMALIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74O.759

CERTAIN CONDITIONS CRXGINATING IN THE

PERINATAL PERIOO . . . . . . . . . . .._ . . . . . . . . . . . . . . . . . . . . . . . ..76w779

SYMPTOMS, SIGNS, ANO ILL-OEFINEO CONDITIONS . . . . . . . . . . ..78 O-799

INJURY AND POISON lNG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..8o@9g9

FRACTURES, ALL SITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..aoo-a25

FRACTURE OF NECK OF FEMUR . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..a2o

SPRAINS ANO STRAINS OF .BACK 12 NCLU01NG NECK} . . . . . . ...846-847

INTRACRANIAL INJURIES (EXCUDING THOSE HITH

SKULL FRACTURE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a50-a54

LACERATIONS ANO OPEN UOUNOS . . . . . . . . . . . . . . . . . . . . . . . . ..87O-9O4

79.1

31.2

22.3

. . .

. . .

23.4

82.0

16.4

24.5

13.6

100.6

22.6

la.6

9.2

7.2 6.3

22.6 22.4

157.0

48.0

5.4

10.2

122.8

47.3

16.0

9.a

14.1

17.7

a.7

6.1

SUPPLEMENTARY CLASS IFIcATIoNs . . . . . . . . . . . . . . . . . . . . . . ..-. vol+5z

PERSONS AOUITTEO FOR STERILIZATION . . . . . . . . . . . . . . . . . . . .. V25.2

FENALES uITH DELIVERIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v27 162.6

1/ FIRST-LISTEO OIAGNOSIS FOR FE HALES HITH DELIvERIES IS COOEO V27$.SHONN UNOER WSUPPLEMENTARY CLASS IFICATIONS. W

13.6

●

. . .

340.5

6.6

314.8
8

TABLE 6. AVETfAGE LENGTH OF STAY FOR INPATIENTS oISCHARGEO FROM SHORT-STAY HOSPITALS, BY CATEGORY OF FIR ST-L ISTEO OIAGNOSIS, SEX,

ANO AGE: uNITED STATES, 1985

I DISCHARGES FROM NONFEDERAL HOSPITALS. ExCLUOES NEHBORN INFANTS. DIAGNOSTIC GROUPINGS ANO CODE NuMBER INCLUS1ONS ARE BASEO ON THE

INTERNATIONAL CLASSIFICATION OF OISEASES, 9TH REV1S1ON, CLINICAL MOOIF ICATIONI

SEX AGE

CATEGORY OF FIRST-L ISTEO OIAGNOSIS ANO ICO-9-CM COOE

TOTAL HALE FEMALE UNOER 15 15-44 45-64 65 YEARS

YEARS YEARS VEARS ANO OVER

ALL CONDITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INFECTIOUS ANO PARASITIC OISEASES . . . . ..m . . . . . . . . . . . . . . .001- 139

NE OPLASFVS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

MALIGNANT NEOPLASMS . . . . . . . . . . . . . . . . . . . . . . . . ..l4O.2OI3.23O.234

MALIGNANT NEOPLASM OF TRACHEA,

BRONCHUS, ANO LUNG . . . . . . . . . . . . . . . . . . . . . . . . 162,197 .0.197.3

MALIGNANT NEOPLASM OF BREAST . . . . . . . . . . . . . . . . 17+175 .198.81

ENOOCRINE. NuTRITIONAL ANO METABOLIC OISEASES.

ANO IHXIJNITY OISOROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240-279

OIABETES HELL IT' S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-......250

DISEASES OF THE BLOCD ANO BLOOC+FORMING OR GANS . . . . . . . ..28 O-2B9

MENTAL OISOROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

PSYCHO SEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..29 C+299

NEuROTIC ANO PER SCNALITV OISOROERS . . . . . . . . . . . . . . . . ...300-301

ALCOHOL DEPENDENCE SVNORWE . . . . . . . . . . . . . . . . . . . . . . . . . . . ...303

OISEASES OF THE NERVOUS SYSTEH ANO SENSE ORGANS. . . . . ...320-389

OISEASES OF THE CENTRAL NERVOUS SYSTEM . . . . ...320-3334940-349

CAT ARACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

OISEASES OF ThE EAR ANO MASTOID PROCESS . . . . . . . . . . . . ..38 O-3B9

OISEASES OF THE CIRCULATORY SYSTEM . . . . . . . . . . . . . . . . . . . ..39(k459

ESSENTIAL HVPERTENSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4Ol

HEART OISEASE . . . . ..391-392. 0.393-39B.402.4 04.41 O-4l6,42O-429

ACUTE MYOCAROIAL INFARCT I ON . . . . . . . . . . . . . . . . . . . . . . . . . ...410

ATHEROSCLEROTIC HEART DIsEAsE . . . . . . . . . . . . . . . . . . . . . . ..414.0

OTHER XSCHEf41C HEART 01 SEA SE . . . . . . . . ...411-414.914.1-414.9

CONGESTIVE HEART FAILURE . . . . . . . . . . . . . . . . . . . . . . . . . . . ..428. O

CEREBROVASCULAR DISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..630-43B

OISEASES OF THE RESPIRATORY SYSTEH . . . . . . . . . . . . . . . . . . . ..46O-519

ACUTE RESPIRATOR INFECTIONS, EXCEPT INFLUENZA . . . . ...460-466

CHRONIC OISEASE OF TONSILS ANO AoENo Ios . . . . . . . . . . . . . . . ...474

PNEUMONIA, ALL FORMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...480-486

ASTHE A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493

OISEASES OF THE OIGESTXVE SYSTEM . . . . . . . . . . . . . . . . . . . . . ..52O-579

ULCERS OF THE STOMACH ANO SMALL intestine . . . . . . . . . ...531-534

GASTRITIS ANO OUODENI TIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .535

APPENo IcITIs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..54o.543

INGUINAL HERNIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..55O

NONINFECTIOUS ENTERITIS ANO COLITIS . . . . . . . . . . . . . .555 -556,556

CHOLELITHI ASI S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...574

OISEASES OF THE GENITOURINARV SYSTEM . . . . . . . . . . . . . . . . ...58&629

CALCULUS OF KIONEV ANO uRETER . . . . . . . . . . . . . . . . . . . . . . . . . ...592

OISOROERS OF FIENSTRUATION ANO CTHER

ABNOR14AL vAGINAL BLEED ING . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...626

COMPLICATIONS OF PREGNANCV, CHXLOBIRTH,

ANO THE PUERPERIUM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l/ 630-676

ABORTIONS ANO ECTOPIC ANO MOLAR PREGNANc I ES . . . . . . . . . .630-639

OISEASES OF THE SKIN ANO SUBCUTANEOUS TIssu E . . . . . . . . . ..6 BO-7O9

OISEASES OF THE FIUSCULCSKELETAL SVSTEM

ANO CONNECTIVE T IS SUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

ART HROPATHIES ANO RELATEO OISOROE AS. . . . . . . . . . . . . . . ...710-719

INTERVERTEBRAL OISC DISORDERS . . . . . . . . . . . . . . . . . . . . . . . . . ...722

CONGENITAL ANOMALIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74O.759

CERTAIN CONDITIONS CRIGINATING IN THE

PER INATAL PER IOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..76 C+779

SYMPTOMS, SIGNS, ANO IL L-OEFINEO CONDITIONS . . . . . . . . . . ..78 O-799

INJURY ANC PO ISONING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999

FRACTURES, ALL SITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-829

FRACTURE OF NECK OF FE MAR. . . . . . . . . . . . . . . “..............820

SPRAINS ANO STRAINS OF BACK (X NCLUOING NECK I . . . . . . . .. W6-847

INTRACRANIAL INJURIES (EXCUSING. THOSE wITH

SKULL FRACTURE ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..85O.854

LACERATIONS ANO OPEN UOUNOS . . . . . . . . . . . . . ..” . . . . . . . . ..87 O-9O4

SUPPLEMENTARY CLASS IF ICATIONS . . . . . . . . . . . . . . . . . . . . . . . . .. VO1-V82

PERSONS AOHITTEO FOR STERILIZATION . . . . . . . . . . . . . . . . . . . .. V25. 2

FEMALES HITH DEL IVERIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27

6.5

7.0

B.Z

8.9

9.2

7.2

7.3

8.1

6.0

12.3

14.9

10.0

10.7

5.4

9.6

2.0

2.8

7.9

4.9

7.3

9.5

6.6

5.4

B. O

10.5

6.0

4.5

1.5

7.9

4.9

6.2

7.1

4.8

5.0

3. z

4.9

7.5

5.2

3.7

3.7

2.5

2.1

7.9

6.7

7.7

7.3

5.6

13.0

3.8

6.6

8.7

14.7

6.0

5.6

4.3

3.3

1.6

3.3

6.9

7.2

8.6

9.1

8. B

*

7.5

8.0

5.9

11.5

13.1

10.4

10.7

5.5

9.7

2.0

2.6

7.5

4.4

T.O

9.0

5.B

5.3

7.8

10.0

6.0

4.4

1.5

7.B

4.5

5.7

6.8

4.3

5.1

3.1

4.6

8.3

5.5

3.5

. . .

. . .

7.6

6.6

7.0

6.8

5.7

12.2

3.7

6.1

7.7

16.6

5.6

6.1

4.4

4.4

*

. . .

AVERAGE LENGTH OF STAV IN OAYS

6.2

6.7

7.9

B. 7

9.9

7.2

T. 3

8.2

6.1

13.3

16.4

9.7

11.1

5.4

9.6

2.0

3.0

8.3

5.2

7.6

10.3

7.9

5.6

8.2

10.9

6.1

4.6

1.6

8.1

5.3

6.6

T. 5

5.1

4.9

4.0

5.1

7.2

5.0

4.2

3.7

2.5

2.1

8.2

6.9

8.2

7.9

5.5

13. s

3.9

7.3

% 8

14.1

6.4

4.8

4.2

3.3

1.6

3.3

4.6

4.1

4.2

5.0

●

☛

5.1

5.3

3.9

20.3

*26. 3

*2o.5

*

3.6

7.0

●

2.2

7.1

●

7.9

*

*

*

*

*

3.2

3.2

1.6

4.3

3.5

3.4

3.6

2.9

4.3

1.B

3.0

*

3.6

*

●

*2.1

*

4.0

5.4

6.1

*

5.6

12.9

3.3

3.9

5.0

*

*

2.6

3.6

4.7

*

3.4

4.8

5.4

5.9

6.9

7.9

5.2

5.9

5.9

5.4

11.8

14.1

9.7

11.0

5.5

7.9

*2.5

2.7

5.9

4.0

5.6

7.1

4.8

4.2

6.6

9.3

4.1

4.0

1.4

6.6

4.3

4. B

5.1

4.2

4.3

2.6

4.7

6.1

4.2

3.1

3.7

2.5

2.2

6.6

5.4

4.1

6.B

4.1

*

3.3

5.4

6.B

12.7

5.7

5.7

4.2

3.2

1.6

3.3

7.D

8.6

8.2

8.7

9.1

6.5

7.2

8.2

6.4

11.8

15.6

8.7

9.8

5.7

9.6

2.2

3.3

7.2

4.B

6.6

9.5

5.3

4.8

7.3

11.1

7.2

5.3

●

8.5

6.1

6.4

6.8

4.9

7.6

3.1

5.8

7.0

5.1

3.9

3.8

●

*

T.8

6.7

7.8

7.4

7.B

*

4.1

6.7

7.4

12.7

6.3

6.8

4.3

3.9

●

*3. O

0.7

11.2

9.4

9.7

9.3

8.B

8.6

10.1

7.1

13.8

16.0

11.0

12.3

6.3

12.9

1.9

4.3

8.6

5.6

7.9

9.7

7.9

6.1

B.2

10.4

B.7

7.1

9.9

6.7

8.1

B-6

6.0

11.7

4.4

7.4

9.5

7.2

6.2

*

. . .

. . .

11.4

9.1

10.5

9.3

8.0

5.3

10.3

12.4

15.0

7.6

9.5

6.1

5.7

. . .

1/ FIRST- LISTEO OIAGNOSIS FOR FEMALES uITH OELIVERIES IS COOEO V27, SHOWN UNOER ‘SUPPLEMENTARY CLASS IFICATIONS. ”
achancedata 9

TABLE 7. NUMBER OF ALL-LISTED PROCEDURES FOR INPATIENTS OISCHARGEO FROFI SHORT-STAY HOSPITALS. BY PROCEOURE CATEGORY. SEX. ANO AGE:

uNITEC STATES, 1905

I DISCHARGES FROM NONFEDERAL HOSPITALS. ExCLUDES NE MBORN INFANTS. PROCEOURE GROUPINGS ANC COOE NU*BER INCLUSIONS ARE BASEO ON THE

INTERNATIONAL CLASSIFICATION OF DISEASES, 9TH REVISION, CLINICAL MODIFICATION)

SEX AGE

PROCEOURE CATEGORY AND 1Cp9-CM COOE

TOTAL MALE FEMALE UNOER 15 15-44 45-64 65 YEARS

YEARS YEARS YEARS ANO OVER

ALL PROCEWRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

OPERATIONS ON THE NERVOUS SYSTEM . . . . . . . . . . . . . . . . . . . . . . . .. O1-O5

OPERATIONS ON THE ENDOCRINE SYSTEM . . . . . . . . . . . . . . . . . . . . . .. O6-O7

OPERATIONS ON THE EYE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. OB-16

EXTRACTION OF LENS . . . . . . . . . . . . . . . . . . . . . . . . . . . ..-... I3.1-13.6

INSERTION OF PROSTHETIC LENS ( PSEUOOPHAKOS ) . . . . . . . . . . ...13.7

OPERATIONS ON THE EAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..- . . . ..18-2o

wRIffioTouY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..20. o

OPERATIONS ON THE NOSE, MOUTH, ANO PHARYNx . . . . . . . . . . . . . ..2 I-29

RHINOPLASTY ANO REPAIR OF NOSE . . . . . . . . . . . . . . . . . . . . . . . . . . 21.8

TONSILLECTOMY llITH OR h’ITHOUT AOENOIOECTOIIY . . . . . ...23.2-28.3

OPERATIONS ON THE RESPIRATORY SYSTEM . . . . . . . . . . . . . . . . . . . ..3O-34

BRONCHOSCOPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..33.2 l.33.23

OPERATIONS ON THE CJROIOVASCULAR SYSTEM . . . . . . . . . . . . . . . ...35-39

OPEN HEART SURGERY... - . . . . . . . . . . . . . . . . . . . . . . . . . ..35.l-35.5l.

35.53-36 .2,36 .9,37 .lD-37. 1A,3T.32-37.33,37.5

OIRECT HEART REVASCULARI ZATION . . . . . . . . . . . . . . ...-......36.1

CAROXAC CATHETER IZATION . . . . . . . . . . . . . . . . . . . . . . . . ..37.2 l.37.23

PACEMAKER INSERTICN, REPLACEMENT, REMOVAL, REPAIR. .37.7-37.8

OPERATIONS ON THE HEMIC ANO LYMPHATIC SYSTEM.............4 D-41

OPERATIONS CW THE OIGESTIVE SYSTE)I . . . . . . . . . . . . . . . . . . . . ...42-54

ESOPHAGOSCOPY ANO 6ASTROSCOPY (NATURAL ORIFICE 1..42.23,44.13

PARTIAL GASTRECTOHY ANO RESECTION

OF INTESTINE . . . . . . . . . . . . . . . . . . . . . . . . . . ..43.543 .B.45.6.45. B

APPENOEC70NY, EXCLUOING INCIDENTAL . . . . . . . . . . . . . . . . . . . . ..47.O

HEM ORRHOIOECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..49.4349 .46

CHOLECYSTECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..5l.2

REPAIR OF INWINAL HERNIA . . . . . . . . . . . . . . . . . . . . . . . . ..53. D-53.1

OIVISION OF PERITONEAL ADHESIONS . . . . . . . . . . . . . . . . . . . . . ...54.5

OPERATIONS ON THE URINARY SYSTE)4 . . . . . . . . . . . . . . . . . . . . . . ...55-59

ENOOSCOPIES (NATURAL ORIFICE )..55.21-55.22,56 .31,57 .32,58.22

OIL AT ION OF URETHRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...58.6

OPERATIONS ON THE MALE GENITAL ORGANS . . . . . . . . . . . . . . . . . . ..6O-64

PROSTATEcTOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..6 C.2.6O.6

CIRCUHCISION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..64. O

OPERATIONS ON THE fEHALE GENITAL ORGANS . . . . . . . . . . . . . . . ...65-71

IXSPHORECTOUT ANO SALPING@OOPHORECTOMY.. . . . . . . . . ...65.3-65.6

BILATERAL OBSTRUCTION OR OCCLUSION

OF FALLOPIAN TUBES- . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...66.2-66.3

HYSTERECTONV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...68.3-68. 7

CURETTAGE OF UTERUS TO TERMINATE PREGNANCY . . . . . ..69.51 .69.51

DILATION ANO CURETTAGE OF UTERUS

AFTER OELIVERY OR ABORTION . . . . . . . . . . . . . . . . . . . . . . . . . ...69.02

DIAGNOSTIC DILATION ANO CURETTAGE OF UTERUS . . . . . . . . . . ..69. O9

REPAIR OF CYSTOCELE ANO RECTOCELE . . . . . . . . . . . . . . . . . . . . . ..7O.5

OBSTETRICAL PROCEDURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..7z75

EPISIOTOMY l/ITH OR MI THOUT FORCEPS

OR vACUUM Extraction . . . . . . . . . . . . 72.1,72 .21,72 .31,72 .71, T3.6

CESAREAN SECTION . . . . . . . . . . . . . . . . . . . . . . ..74. &74.2 .74.4 .74.99

REPAIR OF CURRENT OBSTETRIC LACERATILTN . . . . . . . . . . . ..75. S-75.6

OPERATIONS ON THE PNJSCULOSKELETAL SYSTEN . . . . . . . . . . . . . . . ..76-E4

OPEN REOUCTION OF FRACTURE 76.72,

76.74,76.7676 .77,76.79.79.2-79.3,79.5-79.6

OTHER REDUCTICN OF

FRACTURE . . . . . ..76.7 &76.7 l.76. T3.76.75.76.78.79 .O-79.l.79.4

EXCIS1ON OR DESTRUCTION OF iNTERVkRTEBRiL OISC

ANO SPINAL FUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..8 0.5.81. O

EXCISION OF SEMILUNAR CARTILAGE OF KNEE . . . . . . . . . . . . . . . ..8D.6

ART HROPLASTY ANO REPLACEMENT OF KNEE . . . . . . . . . . . ..81.41-81 .47

ARTHROPLASTY ANO REPLACEMENT OF HIP . . . . . . . . . . . . . . ..81. %81.6

OPERATIONS ON THE IhTEGuMENTARY SYSTEM . . . . . . . . . . . . . . . . . .. B5-S6

MAST ECTDNY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-.............85.4

SKIN GRAFT IExCEPT LIP OR HOUTH); . . . . . . . . . . . . . . . ...86.6-86.7

H: SCELLANEOUS DIAGNOSTIC AND THERAPEUTIC PROCEDURES... . .. S7-99

CDMPUTERXZEO AXIAL TOMOGRAPH Y..67.03,.37.41,87 .71,88 .O1, E8.3B

PYELOGRAH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..87.73.87 .75

ART ERIOGRAPHY AND ANG1OCARO1OGRAPHY

USING CONTRAST 14ATERIAL . . . . . . . . . . . . . . . . . . . . . . . . ...88.4-88.5

OIAGNOSTIC ULTRASOLUO- . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-...88.7

RAOIOISCTOPE SCAN..............................-...92 .C+92.1

36,760

898

95

718

211

180

256

104

1,173

193

317

981

195

2,414

379

230

a

223

397

5,740

207

2B2

283

123

475

416

3D9

1,729

683

119

744

367

52

3,31.5

525

466

670

50

227

349

165

4,304

1,820

877

548

3,523

492

240

323

97

160

196

1,653

116

,-157

8,819

1,378

442

1,117

1,234

838

NUMBER OF AL L- LISTEO PROCEDURES I N THOUSANOS

16,694

451

24

309

79

67

130

60

589

99

135

582

123

1,425

264

172

439

118

190

2,53D

100

127

150

67

147

3T0

44

1,049

487

73

744

367

52

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

-..

1,736

251

125

191

66

86

6D

658

9:

693

47B

375

22,066

447

71

409

132

113

126

44

584

94

183

398

71

989

114

58

241

105

207

3.210

106

155

133

3E

2::

679

195

47

...

...

...

3,31B

525

466

670

50

227

349

165

4,304

1,820

877

568

1,T89

241

1X5

132

31

75

137

994

114

60

4,540

707

200

425

75.6

463

1,937

157

*

54

●

●

129

89

306

●6

197

52

13

98

11

24

*

21

236

*7

*

69

*

5:

*

71

19

●8

83

. . .

31

14

*

*

*

*

*

●

*

13

*7

*

*

233

29

62

●5

*

*

103

1:

364

68

●9

12

49

17

14,957

312

37

93

*8

*

70

●7

567

139

114

168

25

304

37

15

79

●8

96

1,870

47

1%

55

167

106

179

387

115

21

87

*

●8

2,438

304

461

421

48

225

232

56

4.287

1,812

875

546

1,543

215

89

1 S3

60

66

11

674

17

62

2,024

311

156

128

379

150

8.838

242

29

159

42

37

40

*6

1B8

35

*6

331

67

973

193

126

350

47

113

1,555

62

78

26

47

157

125

59

451

173

2T

160

81

%

605

165

*6

lW

*

*

83

64

*

*

*

*

886

91

37

108

26

32

37

471

50

41

2,630

349

133

514

300

249

11,027

187

25

413

157

139

18

*

111

12

●

429

89

1.038

137

89

227

167

167

2,079

91

155

14

1;:

131

68

ala

375

62

414

284

*6

260

54

60

...

...

33

45

...

...

...

...

861

157

51

27

10

58

148

405

4B

39

3*801

650

143

463

506

421
10 adwtwedata

TABLE 8. RATE OF ALL-L ISTEO PROCEDURES FOR INPATIENTS DIsCHARGED FROM SHORT-STAY lic SPJTALS, BY PROc EOURE cATEGORY, SEX, AND AGE:

UNITEO STATES, 1985

(OISCHARGES FROM NONFEDERAL HOSPITALS. EXCLUOES NEIABORN INFANTS. PROCEOURE GRouPINGs ANC COOE NUMBER INCLUS1ONS ARE BASEO ON THE

IN7ERNAT10NAL CL A551FiCAT10N OF DISEASES, 91H REVISION, CL INXCAL f40Di FIcA7[0Nl

SEX AGE

PROCEOURE CATEGORY ANO ICD-9-CFI COOE

TOTAL MALE FEMALE UNDER 15 15-44 45-64 65 YE4RS

YEARS YEARS YEARS ANO OVER

RATE OF ALL- LISTEO PROCEDURES PER 100,000 POPULATION

ALL PROCEDURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .

OPERATIONS ON THE NERVOUS SYSTEM . . . . . . . . . . . . . . . . . . . . . . ...01-05

OPERATIONS ON THE ENOOCRINE SYSTEM . . . . . . . . . . . . .. . . . . . . . . .. O6-O7

OPERATIONS ON THE EYE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..o8-16

EXTRACTION OF LENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. I3.1-I3.6

INSERTION OF PROSTHETIC LENS (PSEUOOPHAKOS) . ...-........13.7

OPERATIONS ON THE E4R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-20

IWRINGOTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..zo. o

OPERATIONS ON THE NOSE, MOUTH, ANO PHARYNX . . . . . . . . . . . . ...21-29

RHINOPLASTY ANO REPAIR OF NOSE . . . . . . . . . . . . . . . . . . . . . . . ...21.8

TONSILLECTOMY WITH OR HITHOUT AOENOIOECTOMY . . . . . ...23.2-28.3

OPERATIONS ON THE RESPIRATORY 5YSTEM . . . . . . . . . . . . . . . . . . . ..3 O-34

BRONCHOSCOPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33.21-33.23

operations oN THE cardiovascular SYSTEM . . . . . . . . . . . . . . . ...35-39

OPEN HEART SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..35. I-35.5l.

35.53-36.2,36.9,37.10-37. 11,37 .32-37.33,37.5

OIRECT HEART REVASCULARI ZATION . . . . . . . . . . . . . . . . . . . . . ...36.1

CAROIAC CATHETER IZATION . . . . . . . . . . . . . . . . . . . . . . . . ..3 T. Zl.37. Z3

PACEMAKER INSERT ICN, REPLACE14ENT, REMOVAL, REPAIR. .37.7-3T.8

OPERATIONS ON THE HEMIC ANO LYMPHATIC 5YSTEM . . . . . . . . . . . ..4O-41

OPERATIONS ON THE OIGESTIVE SYSTEM. . . . . . . . . . . . . . . . . . . . . ..42-54

ESOPHAGOSCOPY ANO GASTROSCOPY INATuRAL OR IF ICE I ..42.23,44 .13

PARTIAL GASTRECTOF!V ANO RESECTION

15,508.1 12,820.1

393.5

20.6

269.4

69.0

58.4

113.8

52.2

513.6

86.1

117.4

508.1

10T.5

1,243. A

230.7

150.5

3B3.2

103.0

165.5

2,207.2

07.5

110.6

130.9

58.6

128.6

322.5

38.4

915.4

425.1

63.3

648.8

320.0

45.2

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

1,512.5.

218.6

108..3

166.5

57.6

74.9

52.0

574.5

1.3

84.1

3,733.7

585.3

211.5

604.2

416.8

326.8

18,024.7

365.0

58.3

334.5

108.0

92.4

102.7

35.8

477.4

76.7

149.3

325.3

58.3

807.6

93.4

47.3

197.2

86.1

169.3

2,622.5

86.9

126.4

108.7

45.6

267.4

37.6

216.3

55+. 9

159.6

38.0

. . .

. . .

. . .

2, T09.9

428.5

3a~.~

347.6

40.5

185. L

284.8

134.4

3,515.5

L.486.9

716.2

447.3

1,461.6

196.9

94.0

10T.7

25.5

6L. O

111.6

812.1

*

49.3

3,708.3

57T.4

163.0

346.8

617.6

378.6

3,728.4

301.3

●

104.3

*

*

247.4

171.5

589.4

*11.9

378.4

100.5

25.4

189.5

20.9

46.0

*

40.9

453.7

*12.8

*

133.0

*

*

102.1

●

137.3

36.5

*15.6

159.2

. . .

59.1

27.5

*

*

*

*

*

*

*

24-4

*

*

*

448.0

56.4

119.9

*8.7

*

●

19E.3

*

27.6

700.2

130.2

●161. o

23.0

13,395.6

279.7

33.0

82.9

*T.1

*

62.9

*6.5

508.2

124.3

101.8

150.9

22.8

272.3

33.5

13.7

71.2

*7.4

85.8

1,675.2

42.2

41.0

155.2

49.2

149.4

95.2

160.5

346.9

103.4

19.0

77.9

*

*7.6

2,183.1

272.7

412.6

376.7

43.0

201.6

207.5

50.3

3,839.0

1,622.6

783.4

488.9

1,381.7

192.2

79.7

164.1

54.1

59.6

10.2

603.2

15.2

55.3

1,812.7

278.8

139.6

114.9

339.3

134.3

19,689.5

539.4

65.5

38,651.0

378.8 655.3

40.1 88.7

303.0

89.2

76.0

108.1

43.8

353.7 1 .446.8

93.4 551.2

82.2 488.3

88.6

*12.5

418.6

79.1

*13.3

737.3

149.1

2,167.7

430.5

281.7

779.3

104.7

251.7

3,463.7

137.B

173.6

58.5

105.3

349.1

279.3

131.2

1,005.5

385.1

61.0

356.4

181.0

*14.4

1,348.6

367.0

*12.6

423.2

*

62.0

*

494.9 390.6

42.7

●

81.2

133.9

43.3.7

82.1

1,018.3

1 ,503.4

311.6

3,638.8

159.8

9T.2

287.1

94.3

481.2

310.6

797. i

587.0

167.5

2,421.7

87.2

584.8

7.288.0

319.4

OF INTESTINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43.5- 43.0,45.6-45.8

APPENDECTOMY, EXCLUOING lNCIOENTAL . . . . . . . . . . . . . . . . . . . . ..47. O

HEM ORRHOIOECTO)IY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49.43-49.46

CHOLECYSTECTOHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..5l.2

REPAIR OF INGUINAL HERN1 A. . . . . . . . . . . . . . . . . . . . . . . . . . 53.0-53.1

OIVISION OF PERITONEAL AOHESIONS . . . . . . . . . . . . . . . . . . . . . ...54.5

OPERATIONS ON THE URINARY SYSTEH . . . . . . . . . . . . . . . . . . . . . . ...55-59

ENOOSCOPIES (NATURAL ORIFICE I ..55.21 -55.22,56 .31,57 .32,58.22

OILATION OF URETHRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...5.3.6

OPERATIONS ON Tli E HALE GENITAL ORGANS . . . . . . . . . . . . . . . . . . ..6O-64

PROSTATECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6C.2-60.6

CIRCUMCISION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64.0

OPERATIONS ON THE FENALE GENITAL ORGAN S. . . . . . . . . . . . . . . ...65-71

00 PHOREC70MY ANO SAL PING& OOPHORECTOMY . . . . . . . . . . ...65.3-65.6

81 LATERAL OBSTRUCTION OR OCCLUSION

OF FALLOPIAN TUBES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..66. Z-66.3

HYSTERECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..68.3-6s.7

CURETTAGE OF UTERUS TO TERUINATE PREGNANCY . . . . . ..69.51 .69.51

OIL AT ION ANO CURETTAGE OF UTERUS

AFTER OELIVERY OR ABORTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69.02

OIAGNCSTIC OIL AT ION ANO CURETTAGE OF UTERUS . . . . . . . . . . ..69. O9

REPAIR OF CYSTOCELE ANO RECTOCELE . . . . . . . . . . . . . . . . . . . . . ..7O.5

542.2

50.7

68.2

!526.4

$458.9

,?38.4

119.5

52.0

200.3

175.4

130.3

729.2

288.0

50.3

2,868.0

1,315.2

:218.9

313.7

154.7

21.9

1,450.7

‘996.6

1*21.S

1,399.6

221.3

Y12.4

189.5

196.8

282.0

20.9

:208.7

...

95.6

147.1

69.4

●

184.7

141.8

. ..

1114.8

:156.0

OBSTETRICAL PROCEDURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72-75

EPISI070HY WITH OR HITHOUT FORCEPS

OR VACUUM EXTRACTION . . . . . . . . . ...72.1.72.21.72.31.72.71.73.6

CESAREAN SECTION . . . . . . . . . . . . . . . . . . . . . . ..74.0- 74.2.74 .4.74.99

REPAIR OF CURRENT OBSTETRIC LACERATION . . . . . . . . . . . ..75. S-75.6

1,815.6 * . ..

767.9

369.9

231.0

*

*

●

. ..

. ..

. ..

OPERATIONS ON 7HE ML2SCULCSKELETAL SYSTEM . . . . . . . . . . . . . . ...76-8+

OPEN REOUCT ION OF FRACTURE 76.72,

76.74,76 .7~76.77,76.79,79 .2-79.3,79.5-79.6

OTHER REOUCTION OF

FRACTURE . . . . ...76.71.76.71. 76.73,76 .75,76.78,79.0-79.1,79.4

EXCISION OR OESTRUCTION OF INTERVERTEBRAL OISC

ANO SPINAL FuSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..8 0.5.81. O

EXCISION OF SEMILUNAR CARTILAGE OF KNEE . . . . . . . . . . . . . . . ..8o.6

ART HROPLASTY ANO REPLACEMENT OF KNEE . . . . . . . . . . . ..2I1.41-81.47

ART HROPLASTY ANO REPLACEMENT OF HIP . . . . . . . . . . . . . ...81.5-81.6

1,486.2 1,974.7 3,017.4

207.4 202.8 !549.1

101.2 83.1

240.0

1179.6

136.1 95.1

41.0

67.7

82.8

56.8

71.3

81.7

35.1

:!03.4

519.3

OPERATIONS CN THE XNTEGUMENTARY SYSTEM . . . . . . . . . . . . . . . . . ...35-86 697.2

48.9

66.1

1,050.1

110.8

92.4

1 ,418.2

1,68.0

1137.1

MASTECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...35.4

SKIN GRAFT IEXCEPT LIP OR MOUTH I . . . . . . . . . . . . . . . . ...86.6-86.7

MISCELLANEOUS OIAGNOST IC ANO THERAPEUTIC PROCEDURE S.... ..8T-99

COMPUTE RIZEO AXIAL TOISOGRAPHY..8T .O3, 87.41,87.71,8.9.01,88.38

3,720.6

581.2

186.4

5,859.0

777.0

297.1

13.323.8

2,278.1

501.7

1.b23.7

1.ir75. O

1.4t T7. O

PYEI.GGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..8 T.73-87.75

ART ER1OGRAPHY ANL! ANG1CCARO1OGRAPHY

USING CONTRAST IIATERIAL . . . . . . . . . . . . . . . . . . . . . . . . . ..88.4-E8.5

OIAGNOSTIC ULTRA SOUNO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7

RAOIOISOTOPE SC AN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..92. @9Z. 1

471.3

520.5

353.6

1,144.1

668.1

555.7

93.7

33.3
References

1National Center for Health Statistics, W. R Simmons: Development

of the design of the NCHS Hospital Discharge Survey. Vital and

Health Statistics. Series 2, No. 39. PHS Pub. No. 1000. Public Health

Service. Washington. U.S. Government Printing Office, Sept. 1970.

2National Center for Health Statistics, E. J. Graves Utilization ofshortstay hospitals, United States, 1984, annual summary. Vital and Health

Statistics. Series 13, No. 84. DHHS Pub. No. (PHS) 86-1745. Public

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

1986.

3U.S. Public Health Service and Health Csae Financing Atimistr&

tiou International Ciassfication of Diseases, 9th Revisioq Clinical

Mod~catiom DHHS Pub. No. (PHS) 80-1260. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1980.

dmmedaa 11

‘National Center for Health Statistics, M. G. Sirkesx Utilization of

short-stay hospitals, summary of nonmedlcal statistics, United States,

1965. Vital and Health Sratisrics. Series 13, No. 2. PHS Pub. No.

1000. PubIii Health Service. Washington. U.S. Government Printing

Office, Aug. 1967.

‘National Center for Health Statistics, M. J. WMitx Utilization of

short-stay hospitals by characteristics of discharged patients, United

States, 1965. Vital and Heakh Statistics. Series 13, No. 3. PHS Pub.

No. 1000. Public Health Service. Washington. U.S. Government

Printing Ot%ce,Dec. 1967.
12 amcedda

Technical notes

Survey methodology

Source of data

The National Hospital Discharge Survey (NHDS) encompasses patients discharged from short-stay hospitals, exclusive of military and Veterans Administration hospitals,

located in 50 States and the District of Columbia. Only hospitals with six or more beds and an average length of stay of

less than 30 days for all patients are included in the survey.

Discharges of newborn infants are excluded from this report.

The original universe for the survey consisted of 6,965

hospitals contained in the 1963 National Master Facility Inventory. New hospitals were sampled for inclusion in the survey

in 1972, 1975, 1977, 1979, 1981, 1983 and 1985. In all, 558

hospitals were sampled in 1985. Of these hospitals, 82 refused

to participate, and 62 were out of scope. The414 participating

hospitals provided approximately 194,800 abstracts of medical

records.

Sample design and data collection

All hospitals with 1,000 or more beds in the universe of

short-stay hospitals were selected with certainty in the sample.

All hospitals with fewer than 1,000 beds were stratitiet the

primary strata being 24 size-by-region classes. Within each of

these 24 primary strata, the allocation of the hospitals was

made through a controlled selection techrique so that hospitals

in the sample would be properly distributed with regard to type

of ownership and geographic division. Sample hospitals were

drawn with probabilities ranging from certainty for the largest

hospitals to 1 in 40 for the smallest hospitals. The withinhospital sampling ratio for selecting sample discharges varied

inversely with the probability of selection of the hospital.

In 1985, for the first time, there were two data collection

procedures used for the survey. The fwst was the traditional

manual system of sample selection and data abstraction. The

second was an automated method used in approximately 17

percent of the sample hospitals; it involved the purchase of

data tapes ffom commercial abstracting services.

In the manual hospitals, sample discharges were selected

using the daily listing sheet of discharges as the sampling fkarne.

These discharges were selected by a random technique, usually

on the basis of the terminal digit or digits of the patient’s medical

record number. The sample selection and abstraction of data

from the face sheet and discharge summary of the medical

records were performed by the hospital stafYor by representatives of the National Center for Health Statistics (NCHS). The

completed forms were forwarded to NCHS for coding editin%

and weighting procedures.

For the automated hospitals, tapes containing machinereadable medical record data are purchased from commercial

abstracting services. These tapes are sttbject to NCHS sampling, editing and weighting procedures. A detailed description

of the automated process is to be published.

The Medical Abstract Form and the abstract service data

tapes contain items relating to the personal characteristics of

the patien~ including birth date, sex, race, and marital status

Table 1. Approximate relative standard errors of estimated numbers

of first-listed discharges and all-listed procedures: United Ststes, 19S5

First-1isted Al,f-lisred

Size of estimate diagnosis procedures

5,000 . . . . . . . . . . . . . . . . . . . . . . . . 13.2 17.3

10,000 . . . . . . . . . . . . . . . . . . . . . . . 10.5 14.2

50,000 . . . . . . . . . . . . . . . . . . . . . . . 6.7 9.5

100,000 . . . . . . . . . . . . . . . . . . . . . . 5.6 8.2

500,000 . . . . . . . . . . . . . . . . . . . . . . 3.9 6.0

1,000,000 . . . . . . . . . . . . . . . . . . . . 3.4 5.4

3,000,000, . . . . . . . . . . . . . . . . . . . 2.8 4.6

5,000,000 . . . . . . . . . . . . . . . . . . . . 2.6 4.3

10,000,000 . . . . . . . . . . . . . . . . . . . 2.4 3.9

20,000,000 . . . . . . . . . . . . . . . . . . . 2.2 3.6

30,000,000 . . . . . . . . . . . . . . . . . . . 2.1 ,..

40,000,000 . . . . . . . . . . . . . . . . . . . 2.0 . .

but not name and address administrative information, including

admission and discharge dates, discharge status, and medical

record number and medical information, including diagnoses

and surgical and nonsurgical operations or procedures. Since

1977, patient zip code, expected source of payment, and dates

of surgery have also been collected. (The medical record number and patient zip code are considered cordidential information

and are not available to the public.)

Presentation of estimates

Statistics produced by NHDS are derived by a complex

estimating procedure. The basic unit of estimation is the sample

inpatient discharge abstract., The estimating procedure used to

produce essentially unbiased national estimates in NHDS has

three principal components: Inflation by reciprocals of the

probabilities of sample selection, adjustment for nonresponse,

and ratio adjustment to f~ed totals. These components of estimation are described in appendix I of two earlier publications.4’5

Based on consideration of the complex sample design of

NHDS, the following guidelines are used for presenting NHDS

estimates in this repoti

. If the sample size is less than 30, the value of the estimate

is not reported Only an asterisk(*) is shown in the tables.

. If the sample size is 30-59, the vahe of the estimate is

reported but should be used with caution. The estimate is

preceded by an asterisk (*) in the tables.

Sampling errors and rounding of numbers

The standard error is a measure of the sampling variability

that occurs by chance because only a sample, rather than an

entire universe, is surveyed. The relative standard error of the

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. Relative

standard errors for fwst-listed diagnoses and all-listed pr~

cedures are shown in table L The relative standard errors for

region and ownership of hospital are approximately 1?4 times

larger. The standard errors for average lengths of stay are

shown in table II.

NOTE A list of references follows the texL
advancedata 13

Table 11. Approximate standard errors of average lengths of stay

by number of discharges: United States, 1985

Average length of sta y m days

Number of discharges 2 6 10 20

Standard error m days

10,000 . . . . . . . . . . . . . . . . . . . 0.7 1.2 1.7 2.2

50,000 . . . . . . . . . . . . . . . . . . . 0.3 0.7 1.0 1.4

100,000 . . . . . . . . . . . . . . . . . . 0.3 0.6 0.9 1.2

500,000 . . . . . . . . . . . . . . . . . . 0.2 0.5 0.8 0.9

7,000,000 . . . . . . . . . . . . . . . . 0.2 0.5 0.8 0.7

5,000,000 . . . . . . . . . . . . . . . . 0.2 0.5 0.8 . . .

Estimates have been rounded to the nearest thousand. For

this reason detailed figures within tables do not always add to

the totals. Rates and average lengths of stay were calculated

tlom origins unrounded figures and will not necessarily agree

precisely with rates or average lengths of stay calculated from

rounded data.

Tests of significance

In this repo~ the determination of statistical inference is

based on the two-tailed Bonferroni teat for multiple comparisons.

Terms relating to differences such as “higher” and “less” indicate that the differences are statistically signi.t3cant., Terms

such as “similar” or “no difference” mean that no statistically

si@lcant difference exists between the estimates being compared. A lack of comment on the difference between any two

estimates does not mean that the difference was tested and

found to be not signiticsnt.

Definition of terms

Terms relating to hospitals and

hospital characteristics

Hospitals— Short-stay special and general hospitals have

six or more beds for inpatient use and an average length of stay

of less than 30 days. Federal hospitals and hospital units of

institutions are not included.

Bed size of hospital—Measured by the number of beds,

cribs, and pediatric bassinets regularly maintained (set up and

staffed for use) for patients; bassinets for newborn infants are

not included In this report the classification of hospitals by

bed size reported by the hospitals is based on the number of

beds at or near midyear.

Type of ownership of hospita&Determined by the organization that controls and operates the hospital. Hospitals are

grouped as follows:

● Voluntary nonproj?t-Hospitals operated by a church or

another nonprofit organization.

. Governnzent-Hospitals operated by a State or local government.

● Proprietary-Hospitals operated by individuals, pe3tnerships, or corporations for profit.

Terms relating to hospitalization

Patient-A person who is formally admitted to the inpatient

service of a short-stay hospital for observation, care, diagnosis,

or treatment. In thk report the number of patients refers to the

number of discharges during the year including any multiple

discharges of the same individual from one or more short-stay

hospitrds. Infants admitted on the day of birth, directly or by

transfer from another medical facility, with or without mention

of disease, disorder, or immaturity, are included. All newborn

infants, defined as those admitted by birth to the hospital, are

excluded from this report. The terms “patient” and” inpatient”

are used synonymously.

Discharge-The formal release of a patient by a hospitr&

that is, the termination of a period of hospitalization by death

or by disposition to place of residence, nursing home, or another

hospital. The terms “discharges” and “patients discharged”

are used synonymously.

Discharge rate—The ratio of the number of hospital discharges during a year to the number of persons in the civilian

population on July 1 of that year.

Da-vs of care—The total number of patient days accumulated at time of discharge by patients discharged from shortstay hospitals during a year. A stay of less than 1 day (patient

admission and discharge on the same day) is counted as 1 day

“in the summation of total days of care. For patients admitted

and discharged on different days, the number of days of care is

computed by counting all days from ( and including) the date of

admission to (but not including) the date of discharge.

Rate of days of care—The ratio of the number of patient

days accumulated at time of discharge by patients discharged

from short-stay hospitals during a year to the number of persons

in the civilian population on July 1 of that year.

Average length of stay—The total number of patient days

accumulated at time of discharge by patients discharged during

the year, divided by the number of patients discharged.

Terms relating to diagnoses

Dischaqe diagnoses—One or more diseases or injuries

(or some factor that influences health status and contact with

health services which is not itself a current illness or injury)

listed by the attending physician or the medical record of a

patient. In the NHDS all discharge (or final) diagnoses listed

on the face sheet (summary sheet) of the medical record for

patients discharged horn the inpatient service of shot--stay

hospitals are transcribed in the order listed. Each sample discharge is assigned a maximum of seven five-digit codes according to ICD-9-CIW3 The number of principal or fust-listed

diagnoses is equivalent to the number of discharges.

Principal diagnosis— The condition established after study

to be chiefly responsible for occasioning the admission of the

patient to the hospital for care.

“First-listed diagnosis— The coded diagnosis identified as

he principal diagnosis or -listed first on the face sheet of the

medical record if ~e principal diagnosis cannot be identified.

:The number of first-@d diagnoses is equivalent to the number

of discharges.

Procedures—One or more surgical or nonsurgical operations, procedures, or special treatments assigned by the phyNOTEA list ;f refersn~s followsthe text.
14 advancedata

sician to patients discharged born the inpatient service of shortstay hospitals. In the NHDS all terms listed on the face sheet

(summary sheet) of the medical record under the captions

“operation,” “operative procedures,” “operations and/or special treatmenk” and the like are transcribed in the order listed

A maximum of four procedures is coded.

Rate of procedures— The ratio of the number of all-listed

procedures during a year to the number of persons in the civilian

population on July 1 of that year.

Demographic terms

Age—Refers to the age of the patient on the birthday prior

to admission to the hospital inpatient service.

Population—Civilian population is the resident population

excluding members of the Armed Forces.

Geographic regions— One of the four geographic regions

of the United States corresponding to those used by the U.S.

Bureau of the Censux

Region States included

Northeast. . . Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut,

New York, New Jersey, and Pennsylvania

Midwest. . . . M:chigan, Ohio, Illinois, Indiana, Wisconsin,

Minnesota, Iowa, Mtsaouri, North Dakcna,

South Dakota, Nebraska, and Kanaas

South . . . . . . Delaware, Maryland. Oiatrict of Columbia,

Vtrgmia, West Virginia, North Carolina,

South Carolina, Georgia, Florida, Kentucky,

Tennessee, Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, and Texas

West . . . . . . Montana, Idaho, Wyoming, Colorado, New

Mexico, Arizona, Utah, Nevada, Washington, Oregon, California, Hawaii, and Alaska.
dmcedaa 15

Symbols

..- Data not available

. . . Category not applicable

. Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standard of

reliability or precision (more than

30-percent relative standard error)

# Figure suppressed to comply with

confidentiality requirements
From Vital and Health Statistics of the National Center for Health Statistics Number 128 ● Januafy 23, 1987

1985 Summary: National Ambulatory Medical Care Survey

by Tommy McLemore, M. S.P.H., and James DeLozier, M. S., Division of Health Care Statistics

From March 1985 through February 1986 an estimated

636.4 million office visits were made to nonfederally employed, ot%ce-based physicians in the conterrninous United

States, an average of 2.7 oftlce visits per person per year.

This represents an increa’se of about 60 million office visits

since 1980, however, the annual visit rate has remained approximately constant since that time. These and other estimates

presented in this report are based on data collected by means

of the National Ambulatory Medical Care Survey (NAMCS),

a national probability sample survey conducted by the Division

of Health Care Statistics of the National Center for Health

Statistics.

This report provides an overview of the data from the

1985 NAMCS. These data should be considered provisional,

as final editing may produce minor changes in the data. Use

of office-based ambulatory care services is described in terms

of the number, percent, and rate of office visits. Statistics

are presented on physician, patient, and visit characteristics

asfollows:

Table I Physician specialty, type of practice,

and professional identity

Table 2 Patient age and sex

Table 3 Patient race and ethnicity

Table 4 Referral status and prior visit status

Tables 5 and 6 Patient’s principal reason for visit

Table 7 Diagnostic services

Tables 8 and 9 Principal diagnosis

Table 10 Medication therapy

Table 11 Nonmedication therapy

Table 12 Disposition

Table 13 Duration of visit

The text figure, a facsimile of the 1985 NAMCS Patient

Record p~icipating physicians used to record information

about their office visits, will serve as a useful reference when

reviewing survey findings.

Because the estimates presented in this report are based

on a sample rather than the entire universe of oftlce visits,

the data are subject to sampling variability. The technical

notes at the end of this report provide a brief description

of the sample design, an explanation of sampling errors, and

guidelines to judge the precision of the estimates. A detailed

description of the 1985 NAMCS sample design and survey

methodology is forthcoming.

The physician sample for the NAMCS was selected with

the cooperation of the American Medical Association and

the American Osteopathic Association. Their contribution to

this effort is gratefully acknowledged.

Data highlights

Physician characteristics

Among office-based physicians, general and family practitioners led all other specialties in the volume of office visits,

accounting for about 30 percent of all office visits (table 1). This share of visits, however, has continued to decline

steadily since 1975, when general and family practitioners

accounted for 41 percent of all visits. 1 The distribution of

visits by the physician’s type of practice shows that 51 percent

of ~all visits were made to solo practitioners and 49 percent

were made to physicians engaged in multiple-member practices. The percent of visits to solo practitioners has also declined steadily since 1975, when this group accounted for

60 percent of all visits. i

Patient characteristics

Office visit data, according to patient demographic characteristics, are presented in tables 2 and 3. As shown in table 2, females accounted for about 61 percent of all visits.

Tje female visit rate was higher than the male rate for all

age groups except the under 15 years group. White persons

(85 percent of the civilian noninstitutionalized population)

accounted for 90 percent of all office visits (table 3). As

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Pubhc Health Service
2 advmcedata

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Nw.Jml Center Ior Health SmlIstIcs A 119606

1. MTE OF VISIT

&

PATlENT RECORD OMB NO 0937-0141

NATIONAL AMBULATORY MEDICAL CARE SURVEY

Excnres 9f3D186

2. :~;~ 3mSEx

(PHSI 6105-A

4s6-232

4. ~11 OR

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EXPEC7ED SOURCE(S) OF PAYMENT 7U WAS PATIENT

1❑ WH2TE

REFERRED

1 QSELW?4Y 4 ❑ wEgE:w

FOR T-

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, ❑HwJilc 7 ❑ WCI+ARGE VISIT BY

ANOTHER

~❑ AwW:&.CIFIC 2 D MEDICARE ~ ❑ ~~JRRA;:4MERClAL ~ ❑ OWIER FHYSICIAN?

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2 ❑ MALE

‘clil!f:HN’flR&

2DNOTHWANIC

so MEDICAID 6 ❑ HMO,W.WC)PLAN

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lows 2f-JNo

s WTIENT’S COMPLAINT(S), SYMFR3M(S), OR OTHER

“ REASON(S) FOR ~ VtStT I {n pafwnf i own word I

9, :;:UJ:SE q 0, OTHER DIAGNOSTIC SERVICES THIS VISIT

THIS VISIT

I <’htth (III ordered (v prowded]

● MOST IMPORTAN7

(,)d,wdo, ‘ ❑ “m’

I <’heck all 60 uHINALWS I! DBLCODF8ESS”RECHGCK

PIorlded I 2 ❑ BREAST EXAM 70 HEMATOLOGY 120 EKG

! ❑ NCWE 3 ❑ FfLWC EXAM 8❑ BLOGO CHEMISTRY 130 CHEST X-RAY

2 ❑ BLOOD

4DRECTALEXAM 9DIW=TK5T 14DOTHERRADI0,CGY

b OTHER

5 ❑ VISUAL ACUITY I,DOTHERIABTEST ,50 ULTRASOUND

3❑ URINE 16DOTHERSERV,CE,.,,,.,,,,

4 ❑ ORAL

1 j . I+EYSICIAN’S OIAGNOSES

1 Z. ~#~E&O&~&?

13. NON-MEDICATION THERAPY

I Ciwck oil wrricm ordered or provided thfs rtw /

a, $%1=:~ ~GNOSISIFSOSLEM ASSOOATEO

IDYES ,Hm 1❑ NCINE 5 ❑ PSYCHOTHERAPY 9D CORRECTIVE LENSES

1

2 ❑ PHYSIOTHERAPY 6 ❑ FAMILY FUNNING 10D OTHER !+,,/, I

IF YES FOR

b OTHER SIGNIFICANT CURREN7 OIAGWS%S THE CONOITION IN

ITEM 11a7 3 ❑ AMBULATORY SURGERY 7 ❑ DIET COUNSELING

?❑ YES 2DN0 4D RA0,AT,0N7HERAPY 8DOTHERCO+JNSEL,NG

14, ~EtNCAT1OM THEWPYlRecwd all new or con,mued medm.,wm ordered or pmuded a, fh,,

w W. U.w=the same brand name or genen”c name entered on am, Rx or ottice med(cal record. ] 15“ ::%%s%%:z:,;’s= 16. :;~;;;; ‘F

IFAACtAE,CHECK HSRE ❑ I lJNOF-OLLOW..PRANNE.

I fime actual!.

a

I

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NEW FOR DX

MEDICATION?

2 ❑ RETURN AT SWCIFIEO TIME

I

1“ ITEM lla~

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1

,~ ,~ ~ ,’~ ,6

::;::”- ‘RN

‘cl 2rJ ~ la ,D

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2-

3

5 ❑ REFERRED TO OTHER FWYS,CIAN

‘cl ‘a ~ ‘cl ‘n Go RETuRNEO TO REFERHING Ff+YSICIAN

4

‘n ‘n 1 ‘n 20

7 ❑ AOMITTOHOsRTAL

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5

Figure. 1SSS National Ambulatory MacIii Care Survey Patient Record

also shown in table 3, persons of Hispanic origin accounted the physician before (“old” patients). The majority of the

for approximately 6 percent of all visits. (Ethnic classification

of the patient was based on the physician’s knowledge or

judgment. )

Visit characteristics

Referral srarus—Approximately 6 percent of all office

visits were the result of referral from another physician (table 4). However, about 28 percent of all “new” patient visits,

that is, visits by patients not previously seen by the physician,

were referrals from another physician.

Prior visit srarus—Approximately 83 percent of the visits

to office-based physicians were by patients who had seen

visits (60 percent) were made by “old patients with “old”

problems, that is. pro~lems that had previously been treated

by the physician.

Reason for visir—Data in tables 5 and 6 represent the

principal reason for visiting the physician’s office as expressed

in the pa~tient’s own words. The principal reason for visit

is the problem, complaint, or reason listed first in item 8

of the Patient Record. These data have been classified and

coded according to the Reason for Visit Classification for

Ambulatoq Care (RVC).2

The RVC is divided into eight modules or groups of

reasons, as shown in table 5. Those reasons for visit classified
advmcedata 3

Tabta 1. Number andpwcent distriMion ofof@evisifa byph@&n

apaOMty, type of pmctica, and profesaionat identity United Stat+ 1985

Number of

Pt@sian specialty, type of practice, Visrtsm Percent

and professional identity thousands distribution

Allvisifs . . . . . . . . . . . . . . . . . . . . .

Physician specialfy

General and family practice . . . . . . . . . .

Intemel madbine. . . . . . . . . . . . . . . .

Padiatnca . . . . . . . . . . . . . . . . . . . .

Obstetrics and gynecology . . . . . . . . . . .

Ophthalmology. . . . . . . . . . . . . . . . .

Orthopeckc surgery . . . . . . . . . . . . . . .

General surgery . . . . . . . . . . . . . . . . .

Dermatology . . . . . . . . . . . . . . . . . .

Psychiatry . . . . . . . . . . . . . . . . . . . .

Otorhinolaryngology . . . . . . . . . . . . . .

Urologicalsurgery . . . . . . . . . . . . . . .

CaKtiovasculardiseaae. . . . . . . . . . . . .

Neurokgy . . . . . . . . . . . . . . . . . . . .

AlloWmrspacialfies. . . . . . . . . . . . . . .

Typeofpracfice

Sob . . . . . . . . . . . . . . . . . . . . . . .

Partnership . . . . . . . . . . . . . . . . . . .

other’ . . . . . . . . . . . . . . . . . . . . . .

Professional idenfify

~ofofmcine. . . . . . . . . . . . . . .

Oooforofosteopathy . . . . . . . . . . . . . .

636.366

193,995

73,727

72,693

56,642

40,062

31.462

29.658

24,124

17,969

16,097

11,68s

10,617

4,992

52,408

323,653

113.317

199,416

600,514

35,872

100.0

30.5

11.6

11.4

8.9

6.3

4.9

4.7

3.8

2.8

2.5

1.8

1.7

0.8

&2

50.9

17.8

31.3

e4.4

5.6

~Ircludesgrouppracticeandother.

Table2. Number, peroent d~tribution, andannW@eofo~~by

aexsmdageofpafknk UnitedState$ 1985

Number of

Number of k-kitsper

visvtsin Percent

Sex and age

person per

thousands distnbutti year’

Seth sexes

Alleges . . . . . . . . . . . . . .

Under 15years . . . . . . . . . .

15-24 years . . . . . . . . . . .

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

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

65yearsandover . . . . . . . .

Female

Alleges . . . . . . . . . . . . . .

Under 15years . . . . . . . . . .

15-24years . . . . . . . . . . .

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

4.5-64years . . . . . . . . . . .

65yearsandover . . . . . . . .

Male

Alleges . . . . . . . . . . . . . .

Under15years . . . . . . . . . .

lE-24yeat3 . . . . . . . . . . .

25+4yeara . . . . . . . . . . .

4S-64yeara . . . . . . . . . . .

65yearsandover . . . . . . . .

836,386 1W.o 2.7

118,78$ 18.7 2.3

73,964 11.6 1.9

175,724 27.6 2.5

137,391 21.6 3.1

130,538 20.5 4.8

387,481 60.9 32

56,176 9.1 2.3

48,883 7.7 2.5

118,557 18.6 3.2

82,331 12.9 3.6

79,535 12.5 5.0

248,905 39.1 2.2

60,594 9.5 2.3

25,081 3.9 1.3

57,167 9.0 1.6

55,060 8.7 2.6

51,004 8.0 4.6

‘Rates are based on estmates Of shecivib, m~tiakzed poputatbnof UseUnrtsd

States,exchdmgAlaskaawl Hawaii,ss of Jufy1, 1SS5.

Number of

VJsitsin Percent

Race and ethnkity ttwusands d!stnbut!on

AllWfs .. . . . . . . . . . . . . . . . . . . . 636,386 100.0

Race

Whit e . . . . . . . . . . . . . . . . . . . . . 572,507 90.0

Another. . . . . . . . . . . . . . . . . . . . . 63,879 10.0

Black . . . . . . . . . . . . . . . . . . . . . 52,143

ASanorpaciflc islander . . . . . . . . . . .

8.2

7,657 1.2

American lndlanor Alaskan Native . . . . . 4,079 0.6

Hispani c . . . . . . . . . . . . . . . . . . . . 40,609 6.4

Notl-iispa ma . . . . . . . . . . . . . . . . 595,7Z’ 93.6

Tab&e4. Number andperoent&atrhtm “ ofofticeviaita byreferrai

statuaand prior visit atsstwlhsite dstateq 1985

Number of

Vkrts in Percent

Visit cfraracteristfc thousrrds distribution

AllvMfs... . . . . . . . . . . . . . . . . . . 636,3s6 100.0

Referral status

Referred byanotherphyeician . . . . . . . . . 35,742 5.6

Notreferred byanotherphysician . . . . . . . 600,643 94.4

Prior visit status

Newpahent . . . . . . . . . . . . . . . . . . . 107,624

Oldpetiint . . . . . . . . . . . . . . . . . . .

16.9

528,762 63.1

New problem . . . . . . . . . . . . . . . . . 144,634 22.7

Oldproblem . . . . . . . . . . . . . . . . . 3S4,128 60.4

as symptoms (symptom module) accounted for 55 percent

of aIl visits, with symptoms of the respiratory and musculoskeletal systems attributed to 20 percent of all visits. The

ZI) most common s%cific principa] reasons for visit, listed

in table 6, accounted for 40 percent of all visits. (These

20 reasons were unchanged from the 1981 study. ) Note that

the rankings presented in table 6 maybe somewhat artificial

as some estimates may not be statistically different from other

near estimates because of sampling variability.

Diagnostic services-Information on various diagnostic

services that may be ordered or provided during an office

visit is presented in table 7. of the services listed, a blood

pressure check was most frequently ordered or provided

(39 p$rcent). A pap test was ordered or provided during about

4 percent of all visi~; however, this represents about 7 percent

of the visits by females. Similarly, pelvic and breast exams

were ordered or provided in about 9 and 7 percent of all

Vt$]ts, but this represen~, respectively, 14 and 11 percent

of female visits.

Principal diagnosis—Tables 8 and9present data on the

principal diagnosis rendered by the physician. The principal

diagnosis refers to the first-listed diagnosis in item 11 on

the Patient Record, that associated with the patient’s principal
4 advamedata

Tnfslq 5. Number and percent d=tnbutiin of offie visits by patient’s prirrapal reason for visit United States, 1963

Number of

wits in Percerrf

Prrncpal reason for vJsItand RVC code’ thousnds distribution

Allvmts. . . . . . . . . . . . . .

Symptom module . . . . S001–S999

General symptoms . . S001-S099

Symptoms referable to psychological and

mental disorclers S1OC-S199

Symptoms referable to the nervous system

(excluding aense organs). . S200-S259

Symptoms referable to the cardiovascular

andlymphabcsystems S260-S299

Symptoms referable to eyes and

ears . . . . . . . . . . . . . . S300-S399

Symptoms referable tothe respiratory

system . . . . . . . . . . . . S400-S499

Symptoms referable to the dlgestwe

system . . . . . . . . . . .. S500-S639

636,366 100.0

347,354 W.6

42,290 6.6

16,206 2.5

18,802 3.0

3,024 0.5

41,045 6.4

61,734 9.7

30,542 4.8

Number of

LWtS in Percent

Pnncpal reason for w.ut and RVC code’ Ifrousnds distribution

Symptom module-Con.

Symptoms referable to the genkourinary

syelem . . . . . . . . . . .. S64O-S829

Symptoms referable totheakin, nails,

andhair . . . . . . . . . . . S63CMW99

Symptoms referable to the muaculoskeletal

system ., . . . . . . . . .. S900-S9gg

D}sease module. . . . . . . . . DOO1-D999

Dlagnoatlc, screening, and preventive

module . . . . . . . . . . . . . .. X1 OO-X599

Treatment module . . . . . . . . . TIOO-T899

Injuries and adverse effects

module . . . . . . . . . . . . . . .. JOO1-J999

Test results mcdule. . . . . . . . . R1oo-R7oo

Admwwtratwe module . . . . . . A1OO-A14O

Dfhe? . . . . . . . . . . . . . . .. U99cMJ99g

32,053

37.579

64,079

65.998

116,500

60,063

25,689

5,167

8,517

7,077

5.0

5.9

lC).1

10.4

18.3

9.4

4.0

CI.8

1.3

1.1

~8esedon”A ReasonforVkit Claa.?if=tim forAmbulatoryCare- (RVC), f@e/ecdHeaSh. StzWsacs,Sar+es2 No. 7S, Feb. 1979.

‘Inclurkblenks, pmWems,rmd complaintsnotelsawlwre clasdfmd.enfriesof-,” andillagibleentnas.

Table 6. Number and percent of office visii by the 20 most common

principal reasons for visit United Steteq 1985

Number of

Most common principal reason for visits in

Rank visit and RVC code’ thousands Percent

1

2

3

4

5

6

7

6

9

10

11

12

13

14

15

16

17

18

1!)

20

General rnedIcel exammafion . . . . X1OO

Prenatal examination . . . . . . . X205

Wefl-bsby examination . . . . . . . . X105

Symptoms referable to the throat . . S455

Postoperabve visit . . . . . . . . . . T205

Cough . . . . . . . . . . . . . . .. S44O

Progress visit not otherwise

w=”-.. . . . . . . . . . . ..T600

Earache, or ear infection . . . . . S355

Sacksyntptoms . . . . . . . . . .. S905

Skinreah . . . . . . . . . . . . . .. SEf6O

Blood pressure test. . . . . . . X320

Vision dysfunctions . . . . . S305

Fever . . . . . . . . . . . . . . . . .S010

Headcold, upper respiratory

infedlon . . . . . . . . . . . . . .. S445

Abdominal pain, crampa, spasms . . S550

Hypertension . . . . . . . . . . . . . D51O

Headache, pain in head . . . . . . S21O

Chest pain and related

symptoms . . . . . . . . . . . . . .S050

Kneesyrnptoms . . . . . . . . . .. S925

Eye examinations . . . . . . . . X230

Another reasons . . . . . . . . . . . . . .

30,821

25,747

16,447

16,371

16,303

36,124

~3,636

11,402

?1,311

10,360

9,446

9,266

9.050

8,902

8,901

8,814

8,S64

8,099

7,407

7,170

3a2,122

4.8

4.0

2.6

2.6

2.6

2.5

21

1.6

1.8

1.8

1.5

1.5

1.4

1.4

1.4

1.4

1.4

1.3

1.2

1.1

60.0

‘8saed on “A Raasanfor Vkit Classtfcstronfor AmbulatoryCare”(RVC), Wsf and Heaffh

Staf@cs,Swies 2. No 7S, Feb. 1979.

presenting problem. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD–94M)3 was

used to classify these data. The Supplementary Classification

of the ICD-9-CM, which contains categories for diagnoses

other than diseases and injuries, such as general medical and

normal pregnancy examinations, accounted for the largest

proportion of visits (15 percent), with diseases of the respiratory system representing the second largest proportion (12 percent). The 20 most common three-digit ICD-9-CM categories,

presented in table 9, accounted for 35 percent of all office

visits. Essential hypertension was the most common diagnosis.

Tabfe 7. Number and percent of office visfte by diagnostic service,

according to patient’s sex United Stetesj 1985

Number of

visits in Seth

Diagnostic service thousands sexes Female Male

None . . . . . . . . . . . . . . . 228,970 36.1 32.4 42.0

Breast exam . . . . . . . . . . . 43,170 6.8 11.0 0.3

Pelvic exam . . . . . . . . . . . . 54,854 8.6 14.2 -

Recfslexam . . . . . . . . . . . 34,191 5.4 5.7 4.8

Visuefacuify . . . . . . . . . . . 40,945 6.4 6.1 6.9

Urinalyeia . . . . . . . . . . . . . 66,009 13.8 16.0 10.4

Hemafofogy . . . . . . . . . . . . 58,963 9.3 10.1 8.0

Blood chemistry . . . . . . . . . . 43,913 6.9 6.7 7.3

Paptesf . . . . . . . . . . . . . . 28,549 4.5 7.4 -

Gtherlab test . . . . . . . . . . . 53,514 8.4 8.9 7.7

Blood pressure cheek . . . . . . 245,886 38.8 43.0 31.9

Electrocardiogram . . . . . . . 20,288 3.2 2.6 4.1

Cheat bray . . . . . . . . . . . . 17,549 2.8 2.4 3.3

Other radiology . . . . . . . . . . 37,806 5.9 5.7 6.3

Ultrasound . . . . . . . . . . . . 5,996 0.9 1.2 0.5

Glucose teat . . . . . . . . . . . 64,249 13.2 15.7 9.5

Other . . . . . . . . . . . . . . . 87,778 10.7 10.9 10.3

The presence of several large categories from the Supph:mentary Classification is evident. As in table 6, these rankings

may vary somewhat because of sampling variability.

Medication thet-apy-in item 14 of the Patient Record,

the physician was asked to record aH new or continued medications ordered, injected, administered, or otherwise provided

at this visit, including immunization and desensitizing agents.

As used in the NAMCS, the term “drug” is interchangeable

with the te&n “medication, ” and the term “prescribing” is

used in the broad sense to mean ordering or providing any

medication, either prescription or nonprescription.

Data on the provision of medication by office-based lphysicians are highlighted in table 10, which also include!; data

on “drug visits,” that is, visits during which at least one

medication was prescribed. Approximately 6 I percent of all

office visits were drug visits. By specialty, the percent of

drug visits ranged from 81 percent for cardiovascular disease

specialists to 27 percent for orthopedic surgeons.
advmcedata 5

Table 8. fksnber amf percent &SfiMkm of office *by Principal

dfsgrlos& Uniied State% 1986

Taf#e 9. Number and percent of office visits by the 20 most cmnmon

principal ciisgnosefc United Stat- 1985

Number of

visits in Percent

Principal diagnosis ad ICBSW24 cede’ thousands distribution

Number of

Most conrrrwr principal diagnosis w.W5 in

Rank ad ICD-MIU coda’ thousands Percent

Alldlagnoses . . . . . . . . . . . . . . . . . .

Infacfkms and parasitic diseases . . . 001-139

Neoplasm . . . . . . . . . . . . . . 140-239

Endocrine, nutritional, and matatmtic dweeses

and immunity disorders . . . . . . . 240-279

Mental diac+ders . . . . . . . . . . . 290-319

Oiaeases of the nervous system and sense

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

Dseeses of the circulatory system . . 390-459

O&ma-es of the resprat~ system. . 460-519

Diseases of the digestive system . . 520-579

Oisaaees of the genitounnary

System . . . . . . . . . . . . . . . . 560-629

Oiaeasaa of the sMn and sulwufaneous

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

Cweases of the muscukrskelatal system

and connective tissue . . . . . . . . 710-739

Symptoms, signs, and ill-defined

conditions . . . . . . . . . . . . ..76c+799

Injury and pomoning . . . . . . . . . 600-999

Supplamerdaw classificaticm . . . . . VOI-V62

Allofhardiagnose# . . . . . . . . . . . . . .

Unknown diagnosesa . . . . . . . . . . . . . .

636,366

24,869

19,996

Z?i@a

25,988

69,852

55,953

77’,008

27,222

38,999

36,196

45,064

22,469

52,743

97,536

10,435

9,553

1OQ.O

3.9

3.1

3.5

4.1

11.0

6.8

12.1

4.3

6.1

5.7

7.1

3.5

8.3

15.3

1.6

1.5

%asedon the hternalKvL9/ cbs21rEefknr orLkeasas, Sth Rensmr, Chcal Modmlci?tsm

(ICP9-CM).

%mkxlesdwe.%esof h W andbbcd-fcmmg ergme (280-2S9): complsatvmsof

Pnw-wWY,Cf21!dtirth, andme puqmllm (63G676); Cmgmital Snomslles (740-759); end

certain cO@ffms ongm.e~ kr the pematal period (760-77’9).

3k!dUCbS blank dtqtosis, rmmdsbk d!agnosis,end il@lbk dagrmk.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Essential hypeflension . . . . . . . . . ..401

Nonnalpregnsnsy . . . . . . . . . . . . .V22

Heatth supervision of infant or child . . . . V20

Suppurafive and unspesifii otitis

media . . . . . . . . . . . . . . . . ...382

General medcsl examination . . . . . . . WO

Acute respiratory infections of multiple

or unspecified sites . . . . . . . . . ...465

Diabetes mellius . . . . . . . . . . . . ..z5o

Neurotic dscdws...... . . . . . ..300

Acute pharyngitis . . . . . . . . . . . . ..462

Followup examinations (dlagnoais

unspecified) . . . . . . . . . . . . . . ..V67

Disorders of refrarXon and

accommodatio n . . . . . . . . . . ...367

Diseases of sebaceous glands. . . . . . .706

Allergic rhinitis . . . . . . . . . . . . . ..477

Bronchtis, rwt specified as acute

or chronic . . . . . . . . . . . . . . ...490

Other forms of chronic ischemlc

heart diseaae . . . . . . . . . . . . . ..414

Asthma . . . . . . . . . . . . . . . . . ..493

Cataract . . . . . . . . . . . . . . . . . . .366

Certain adverse effects, not

elsewhere cleesifW2 . . . . . . . . . . . s95

Special investigations awl

examinations . . . . . . . . . . . . . ..V72

Contact dermatitk and other

26,049

24,182

17,066

15,607

14,916

14,691

12,302

9,320

9,302

9,2i7’

8,266

8,104

7,835

7,563

6,732

6,503

6,285

5,880

5,636

eczema . . . . . . . . . . . . . . . ...692 5,637

Alloherdiagnosas. . . . . .. . . . . . . . . . 414,816

4.7

3.8

2.7

2.5

2.3

2.3

1.9

1.5

1.5

1.5

1.3

1.3

1.2

1.2

1.7

1.0

1.0

0.9

0.9

0.9

65.2

18ssed on tlm Internetmnsf Cla.wksfm of Dresses, 9fhRewmrr, Clmcd Moddcabcm

(lCD-S-CM).

2Primmly alb~y, ur?+sdfmd (995.3).

T* 10. Mmnberard pamefttdraMndm. of drug visits ●nd drug mentions by physician apecMty: United Sate% 1985

Number of NumLmr of

drug d~ Percent

visita Percent rnenfiofts Percent dmg

Phyakxan spadal& in thousands’ distributkxr in thousands distribution visits2

Allspeciatfies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369,398 100.0 693,355 100.0 61.2

General and family prasdce.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140,988 36.2 250,119 36.1 72.7

Internal rnwlicin e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57,069 14.7 126,219 18.2 77.4

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46,538 12.5 66,856 9.9 66.8

Obsfetncs andgynesoiogy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,545 6.6 33,632 4.9 45.1

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,357 4.2 25,820 3.7 40.8

Orthopedic surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,624 2.2 12,060 1.7 27.4

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,492’ 3.0 18,i7’4 2.7 36.5

Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,406 4.2 29,2S3 4.2 6%0

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,324 2.1 14,626 2.1 46.3

Cwhmola@ogy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,323 1.9 10,761 1.6 45.5

Urokrgical surgafy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,461 1.4 6,737 1.0 46.7

Cerdovasculard!seasa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,565 2.2 26,812 3.9 80.9

Neurology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,8S6 0.7 4,664 0.7 57.4

Aliothersptwalt!es . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31,817 8.2 64,602 9.3 60.7

‘Vntsal Awhcms ormored~were pfeecribed.

2Nunrbsr 01 drug wsrls dhdsd ty rwrnber of office tisits nrufbphsd by 100.

Data on the number and percent of “drug mentions,” The NAMCS drug database permits classification by such

that is, the total number of medications listed in item 14 variables as: specific product name; generic class; entry form

of the Patient Record form, are also presented in table 10. chosen by the physician, that is, brand name, generic name,

There were 693.4 million drug mentionsin 1985, an average or the therapeutic effect desired; prescription status, that is,

of 1.1 drug mentions for every office visit or 1.8 mentions prescription (Rx) or nonprescription (OTC); federally confor every visit at which one or more medications were trolled substance status (for addicting or habituating drugs);

prescribed. composition status, that is, single or multiple ingredient; and
6

therapeutic category. A report that describes the method and

instruments used to collect and process drug information for

the NAMCS has been published.4 Futute reports will present

detailed drug data from the 1985 NAMCS.

Nonmedication therapy-Table 11 presents data on

selected types of nonmedication therapy that may be ordered

or provided during an office visit. Counseling, d]et and others

combined, was the most frequently used therapy. Although

counseling in the broad sense is part of nearly every offke

visit, it is recorded in the NAMCS only when considered

by the physician to be a “significant part of the treatment.”

Ambulatory surgety was ordered or performed at about 7 percent of all office visits. All other services were ordered or

provided at less than 5 percent of the visits.

Tkblell.Nurdmandpereent ofoftieeviaitaby ~-

Orderedor pro* united states! 19s5

Nvnber of ~h

Non-rrre&afion thetapy Percwnt

None . . . . . . . . . . . . . . . . . . . . . . . . 438,406 66.9

Physiotherapy . . . . . . . . . . . . . . . . . . . . 26,465 4.2

Ambulatory surgery . . . . . . . . . . . . . . . . . 4“1,931 6.6

Radiation therapy . . . . . . . . . . . . . . . . . . 666 0.1

Psychotherapy . . . . . . . . . . . . . . . . . . . 21,343 3.4

Family planning . . . . . . . . . . . . . . . . . . . 12.146 1.9

Dietcouneeling . . . . . . . . . . . . . . . . . . . 41* 6.5

Other couneefing . . . . . . . . . . . . . . . . . . 59,102 93

CorrecWelenabs. . . . . . . . . . . . . . . . . . 10,661 1.7

Other . . . . . . . . . . . . . . . . . . . . . . . . 7,767 12

Table 12. Numberarrd percent of oftieevieita by &po@60m United

Statq 1966

Number of

~m

Disposition tkVsan& Percent

No followup pJanned . . . . . . . . . . . . . . . . 62,136 9.8

Retumatsp4fiedtime . . . . . . . . . . . . . . 391,142 61.5

Retumif needed, P.R.N. . . . . . . . . . . . . . . 145,s52 22.9

Telephone followup planned . . . . . . . . . . . . 2s,229 4.0

Referred to other physician . . . . . . . . . . 20,075 32

Returned 10 referring physician. . . . . . . . . . . 4,947 0.8

Admit tohoapitef . . . . . . . . . . . . . . . . . . 10.261 1.6

Otter . . . . . . . . . . . . . . . . . . . . . . . . 3,416 0.5

References

‘National Center for Health Statistics, R. Gagnon, J. DeLozier,

and T. McLemore: The National Ambulato~ Medical Care Survey,

United States, 1979 Summary. ViZaf and Heahh Statistics. Series

13, No. 66. DHHS Pub. No. (PHS) 82–1727. Public Health Service.

Washington. U.S. Government Printing Office, Sept. 1982.

‘National Center for Health Statistics, D. Schneider, L. Appleton,

and T. McLemore: A reason for visit classification for ambulatory

care. Vital and Health Statistics. Series 2, No. 78. DHEW Pub.

No. (PHS) 79-1352. Public Health Service. Washington. U.S. Government printing Office, Feb. 1979.

Disposition—Data on the visit disposition show that the

majority of office visits involved some type of scheduled

followup (table 12). For about 65 percent of the visits a

return visit or telephone followup was planned. Approxinnately

2 percent of the office visits resulted in admission to a hospital.

Duration of visit—Duration of visit refers to the amount

of time spent in face-to-face contact between physician and

patient. This time is estimated and recorded by the physician

and does not include time spent waiting to see the physician,

time spent receiving care from someone other than the physician without the presence of the physician, or time spent

by the physician in reviewing records and test results. In

cases where the patient received care from a member (of the

physician’s staff, but did not actually see the physician during

the visit, the duration of visit was recorded as zero minutes.

Some 71 percent of the visits had a duration of 15 minutes

or less (table 13). The mean duration of all visits was 16.1

minutes.

More detailed 1985 NAMCS data are forthcoming in

the Vital and Health Statistics series. In addition, survey

data will be available on computer tape at a nominal cost

in early 1987 from the National Technical Information Service.

Questions regarding this report, future reports, or the NAMCS

may be directed to the Ambulatory Care Statistics Branch

by calling (301)436-7132.

TsMe 13. Nwnber and percent distribution of office visits by duration of

Vieik united statq 19s5

Nwn&er of

visits in Percent

Duration thousands disfrrbutlon

Allduretiona . . . . . . . . . . . . . . . . 100.0

Ominufes’ . . . . . . . . . . . . . . . . . . . 14,436 2.3

l-5minutes . . . . . . . . . . . . . . . . . . . 65,250 ‘10.3

6-10 minutes . . . . . . . . . . . . . . . . . . 161,191 28.5

11–15 minutes . . . . . . . . . . . . . . . . . 190,954 :30.0

lS-3Cf minutes . . . . . . . . . . . . . . . . . 144,211 22.7

31 minutes And over . . . . . . . . . . . . . . 40,343 6.3

Mean duration 16.1 minutes

‘ Representaofka wsk in w+’khtherewas no face-to-lacecontactbetweenthe patientand

rlw ph@dan.

Spublic Health Sewice ~d Health Care Financing Administration:

International Classijlcation of Diseases, 9th Revision, Clinical Modijkafion. DHHS Pub. No. (PHS) 80-1260. Public Health S,ervice.

Washington. U.S. Government Printing Office, Sept. !980.

4National Center for Health Statistics, H. Koch and W. Campbell:

The collection and processing of drug information, National Ambulatory- Medical “Care Survey, United States, 1980. Vifa/ and Heahh

Statistics. Series 2, No. 90. DHHS Pub. No. (PHS) 82-1364. Public

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

1982.
dwmxxkb 7

Technical notes

Source of data and sample design

The information presented in this report is based on data

collected by means of the National Ambulatory Medical Care

Survey from March 1985 through February 1986. The target

universe of NAMCS includes office visits made with the

conterminous United States by ambulatory patients to nonfederally employed physicians who are principally engaged in

office practice, but not in the specialties of anesthesiology,

pathology, or radiology. Telephone contacts and nonofflce

visits are excluded.

A multistage probability sample design is used in

NAMCS, involving samples of primary sampling units

(PSU’S), physician practices within PSU’S, and patient visits

within physician practices. For 1985, a sample of 5,032 nonfederal, office-based physicians was selected from master files

maintained by the American Medical Association and American Osteopathic Association. The physician response rate for

the 1985 NAMCS was 70.2 percent. Sample physicians were

asked to complete Patient Records (see text figure) for a

systematic random sample of office visits Occurnng during

a randomly assigned 1-week reporting period. Responding

physicians completed 71,594 Patient Records. Characteristics

Table L Provisional rela6ve standard errors of eatinatert ntmixers of

offioe visits baaed on atl physician ape&aMes NAM= 1965

EeIafkJa

standard

Estimated number of offka?

visits in thousands =

200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.8

50Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.1

I,ooo................................ 172

2.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.6

20,LM 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9

Ex.smpk? of use of fahW An aggregate estimate of 15,000,000 ‘dadshas a relalrve atandwd

error of 6,0 percent, or a standard error of 900,000 waxs (6.0 percenl of 15,000,LXKJ).

of the physician’s practice, such as primary specialty and

type of practice, were obtained during an induction interview.

The National Opinion Research Center, under contract to the

NCHS, was responsible for the survey’s data collection and

processing o~rations.

sampling errora

The standard error is primarily a measure of the sampling

variability that occurs by chance when only a sample, rather

than an entire universe, is surveyed. The relative standard

error of an estimate is obtained by dividing the standard error

by the estimate itselfi the result is then expressed as a percent

of the estimate. Approximate relative standard errors of

selected aggregate statistics are shown in table I, and the

standard errors for estimated percentages of visits are shown

in table II. Standard errors for estimates of drug mentions

will be included in future reports.

Rounding of numbers

Estimates of office visits have been rounded to the nearest

thousand; consequently, detailed figures within tables will

not always add to totals. Rates and percents were calculated

based on original unrounded figures and do not necessarily

agree with percents calculated from rounded data.

Definitions of terms

Ambulatory patient—An ambulatory patient is an individual seeking personaI health services who is not currently

admitted to any health care institution on the premises.

Physician—A physician is a duly Iicensed doctor of

medicine (M. D.) or doctor of osteopathy (D. O.) who is currently in office-based practice, and who spends some time

caring for ambulatory patients. Excluded from NAMCS are

physicians who are hospitaI-based; who specialize in anesthesiology, pathology, or radiology; who are federally employed; who treat only institutionalized patients; who are employed full time by an institution, and who spend no time

seeing ambulatory patients.

TableIL Provisional standard errors of pemanta of estjnated n~ of office visits M on ~ physicim ~ ~ 1935

Esfmratad mwcant

Base ofpenxnt lor 5m 10 or aor iwor

(number of ofice vkts in thousarkia) 99 95 w 30 70 50

Staridard error in parcantage points

200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7 82 11.3 15.0 17.2 18.8

50Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 52 7.1 9.5 10.9 11.9

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.7 3.7 5.0 6.7 7.7 8.4

2J300.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 2.6 3.6 4.8 5.4 5.9

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 1.6 2-3 3.0 3.4 3.8

10.OOO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 12 1.6 2.1 2.4 2.7

20,0fxl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.8 1.1 1.5 1.7 1.9

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 0.5 0.7 1.0 1.1 t .2

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 0.4 0.5 0.7 0.8 0.8

6ocfootto. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.1 02 0.3 0.3 0.3

,%ampk! of use of r.sb/e An estimate of 20 percent based cm m sggrsg.ste esfunsfs of 15.o(m,m W@ hss a afandvd

-20 percent).

enor of 1.8 p3u3nt, or a relative standard error of 9.0 percent ( 1.8 percent
8 advmcedata

Oflce-oftlces are the premises physicians identify as Visit—A visit is a direct personal exchange between an

locations for their ambulatory practice; these customarily in- ambtdatory patient and a physician or a staff member walrking

elude consultation, examination, or treatment spaces the pa- under the physician’s supervision, for the purpose of seeking

tients associate with the particular physician. care and rendering personal health services.

---

. . .

.

0.0

z

●

.#

Symbols

Data not available

Category not applicable

Quantity zero

Quantity more than zero but less than

0.05

Quantity more than zero but less than

500 where numbers are rounded to

thousands

Figure does not meet standards of reliabilii or precision

Figure suppressed to comply with confidentiality requirements
From Vital and Health Statistics of the National Center for Health Statistics Number 129. February 17, 1987

Visits to Office-Based Physicians by Hispanic Persons:

United States, 1980-81

by Gloria J. Gardocki, Ph. D., Division of Health Care Statistics

This report presents National Ambulatory Medical Care

Survey (NAMCS) information on visits to office-based physicians by Hispanic persons. NAMCS is a national survey used

to collect data on the demographic characteristics, medical

problems, and medical management of patients making visits

to office-based physicians. As such, the survey is uniquely

valuable for providing an overview of the office-based medical

care obtained by Hispanic Americans.

Although the Hispanic population of the United States

is the sixth largest in the world,* only recently has much

attention been focused on this group’s need for health care

services. Increased interest in the specific factors affecting

this minority’s use of health care resources also has been

evident. Two of the factors most often considered are

socioeconomic statusz-s and type of medical insurance coverage, ifany.3”6

Cumently, the principal source of objective information

on the health status of Hispanic Americans is the Hispanic

Health and Nutrition Examination Survey (HHANES), which

was conducted by the National Center for Health Statistics

from July 1982 through December 1984? HHANES was designed to assess the physical and mental health status of three

special population subgroups in selected areas of the United

States-Mexican Americans in selected areas of five Southwestern States (Texas, Colorado, New Mexico, Arizona, and

California); Cuban Americans in Dade County, Flondw and

Puerto Ricans in the New York City metropolitan area (New

York, New Jersey, and Connecticut). The health and nutritional

status of the sample members was assessed by means of

physical examinations (including dental examinations and anthropometnc measurements), diagnostic testing (including laboratory analyses), and personal interviews. The survey was

not designed to be a national Hispanic survey, so national

estimates for the Hispanic population cannot be made, but

it is estimated that the three HHANES universes included

approximately 76 percent of the population of Hispanic origin

in the United States in 1980. Initial results of the survey

are being publicized!”g

The prime source of national estimates of the level of

use of all health care services by Hispanic persons, and of

information on seIf-reported health status, is the National

Health Interview Survey (NHIS). In this population-based

survey, respondents from a sample of households are asked

numerous health-related questions, and also are asked if they

have specific Hispanic national origins or ancestry (for example, “Puerto Rican,” “Mexican-American,” or “Other

Spanish”). Consequently, NHIS information on self-reported

health items can be used not only for comparisons between

Hispanic and non-Hispanic persons, but also for comparisons

among the major Hispanic-origin groups in the United States.

In an NCHS report analyzing selected 1978-80 data on Hispanic Persons,]o the authors found that the average annual

number of all outpatient physician contacts (including hospital

cIinic visits and telephone calls) did not differ significantly

among Hispanic persons (4.4 per person), white non-Hispanic

persons (4.8), and black non-Hispanic persons (4.6). Further

analysis, however, revealed that nationai origin had substantial

effects which were obscured by grouping all Hispanic persons

together-Mexican Americans had significantly fewer physician contacts (3.7 per person per year) than either white or

black non-Hispanic persons, and Puerto Ricans and Cuban

Americans had significantly more (6.0 and 6.2 contacts, respectively). Therefore, national origin must be viewed as a

very important variable in understanding Hispanic persons’

use of health care services.

Data source and limitations

This report summarizes the characteristics of Hispanic

persons’ 1980 and 198 I visits to office-based physicians. Significant differences between the visits made by Hispanic patients and those made by other patients also are discussed.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service
2 aCh/anCE?Ma

NAMCS is a sample survey of the ambulatory care provided

during office visits to office-based physicians in the United

States, excluding Alaska and Hawaii. NAMCSwasconduc[ed

annually by the National Center for Health Statistics from

1973 through 1981, and again in 1985. A summary of the

survey methodology is presented in the technical notes appended to this report, as are selected definitions and guidelines

forejudging the precision of estimates.

It is important to note that the statistics presented in

this report are derived from combined 1980 and 1981 NAMCS

data files. Consequently, the frequency estimates represent

visit totals for the 2-year period, but the percent distributions

and rates represent annual averages.

Two aspects of NAMCS are particularly crucial to the

interpretation of the information presented in this report and

warrant special attention. First, NAMCS includes only visits

made to the offices of physicians who are engaged primarily

in office-based care; the data cannot be generalized to describe

all outpatient medical care. Second, the question of defining

the Hispanic population is always difficult and somewhat arbitrary.] In NAMCS, sample physicians are asked to report

whether a patient making a sample visit is of “Hispanic origin”

(defined as “a person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin,

regardless of race”), or is “not Hispanic” (defined as “any

person not of Hispanic origin”). As a result, NAMCS has

no information on the specific national ongins of the Hispanic

patients who make sample visits. In addition, the reporting

of Hispanic ethnicity depends on the extent and accuracy

of the physician’s knowledge of, and perceptions of, the patient’s back~und. Because of this factor, NAMCS may underestimate the number of visits made by Hispanic persons, and

such underestimation may affect the results of analysis. Thi$

issue is considered in greater detail later in this report.

Patient demographics

During 1980 and 1981, Hispanic persons made an estimated total of 53.3 million visits to office-based physicians,

or 1.8 per person per year (see table 1). This was substantially

lower than the estimated rate for non-Hispanic persons

(2.7 visits per person per year). Although the visit rate for

Hispanic persons was lower than that for all other persons

for each of the five age groups displayed in table 1, the

differences are statistically significant for only the three

youngest groups. In the age groups of under 15 years, II5–24

years, and 25-44 years. Hispanic persons had average annual

visit rates of 1.3. 1,3. and 1.9 visits per person. respectively.

In comparison, the corresponding average annual visit rates

for all other persons were 2.2, 2.1. and 2.5 visits per person,

respective] y.

The differences between the rates for Hispanic persons

and those for non-Hispanic persons highlight the most problematic aspect of the information presented in this report-the

question of the accuracy with which Hispanic ethnicity was

reported in NAMCS. Careful consideration of other relevant

information leads to the conclusion that the extreme magnitude

of this difference is an artifactual finding resulting from the

survey methodology.

Evidence that NAMCS underestimated Hispanic persons’

visits to office-based physicians in 1980 and 1981 can be

found in NHIS data. NHIS rates should be similar to, but

not identical with, NAMCS rates because the universe of

office visits as measured by NHIS overlaps, but does not

coincide with, the universe of office visits to office-based

physicians as measured by NAMCS. However, unpublished

estimates from the 1980 and 1981 NHIS surveys yield office

visit rates of 3.0 per person per year for Hispanic persons

and 3.2 per person per year for non-Hispanic persons. The

difference between these rates is in the same direction as

the NAMCS difference in rates but is not large enough to

be statistically significant.

The major reason for the difference between the NAMCS

data and the NHIS data appears to be the different approaches

used to identify Hispanic persons. The self-identification

method of ethnicity classification utilized in NHIS appears

to be much stronger than the provider-identification method

used in NAMCS. For this reason, the large difference found

in NAMCS between the visit rate for Hispanic persons and

that for non-Hispanic persons should be considered the result

of an undercount of visits made by Hispanic persons and

a concomitant overcount of visits made by non-Hispanic

persons.

The percent distributions displayed in table 1 also indicate

that the Hispanic patients were significantly younger than

the non-Hispanic patients. Of all visits made by Hispanic

persons, 70.2 percent were made by patients under 45 years

of age, compared with 58.7 percent of the visits made by

non-Hispanic persons. The median ages further illustrate this

difference: the estimated median patient ages were 30 years

Table 1. Number, percent dstributio~ and average annual rate of office Vffii to oftke-basad phyaieiana by patient age, aeeording to patient ethnieity

United Stateq 1960-S1

Hwpanic ethmcffy Other ethrricity

Number m Percent Average annual Number m Percent Average annual

Age thousands dlstrbution rate par person’ thousands distribution rate per person’

Allpatlents . . . . . . . . . . . . . . . 53,337 100.0 1.8 1,107.585 100.0 2.7

LJnder15 years . . . . . . . . . . . . . . 12,206 22.9 1.3 203,922 18.4 2.2

15-24 years . . . . . . . . . . . . . . . 8,714 16.3 1.3 152,081 13.7 2.1

25+4 years . . . . . . . . . . . . . . 16,503 30.9 1.9 293,881 26.5 2.5

4S-64 years . . . . . . . . . . . . . . . 10,540 19.8 2.4 255,160 23.0 3.1

65 years and over . 5.374 10.1 3.8 202,541 16.3 4.3

‘Rates were C!nnputed using National Health Inlewlew %rvey est,mates of the cwqhan mxmst!tutmmdued HIspamc and “on. H8span,c populations (see the techmcal notes)
dvmceckib 3

for the visits made by Hispanic personsand 37 years for

al] other visits. Th& different patient age distributions reflect

the relative youth ‘of the American Hispanic population. as.

can be seen in the population estimates presented in the technical notes.

In addition to the differences in the age distributions,

a significant difference appeared in the race distributions.

Of the visits made by Hispanic persons, 94.2 percent were

made by white persons, compared with only 89-1 percent

of the visits m’ade by non-Hispanic persons. The sex distributions were virtually identical, however, with females accounting for 60.1 percent of the visits made by Hispanic persons.

Medical characteristics

The same methodological difference between NAMCS

and NHIS that is the source of NHIS”S strength in identifying

Hispanic persons also is the source of NAMCS’S greatest

strength. Because the basic data in NAMCS are supplied

by health care providers, the medical information contained

in NAMCS can be expected to be relatively complete, precise,

and accurate. In this respect, NA,MCS information on the

medical aspects of Hispanic persons’ visits to office-based

physicians can be regarded as less problematic than the population rates. It is extremely important to note, however, that

the apparent undercount of Hispanic patients’ visits in NAMCS

may have biased the results. Unfortunately, there is no information available for determining if such bias occurred, or for

assessing the direction and amount of it.

The 1980 and 1981 NAMCS data indicate that Hispanic

and non-Hispanic patients who visited physicians were equally

likely to have been referred by another physician-5.6 percent

of Hispanic patients’ visits were the direct result of referrals.

The visits of Hispanic persons, however, were more likely

to have been prompted by a new problem than were other

visits (42.0 percent compared with 36.4 percent, respectively).

Although significant, this difference is not large, and it may

be simply the result of the relative youth of the Hispanic

population. This is because younger people are more likely

to develop short-term problems that are completely resolved,

and older people are more likely to develop chronic problems

that may be controllable but not curabIe.

In NAMCS, the general type of medical care sought

by each patient making a visit is recorded by the responding

physician in the variable “major reason for visit.” For the

1980 and 198 I visits made by Hispanic patients, the most

common major reason was obtaining care for an acute problem

(38.9 percent), followed by obtaining routine care for a chronic

problem (24. 8 percent). Nonillness care, such as prenatal

care, was the third most common major reason (18.0 percent).

The least common major reasons for visit were seeking care

for a flareup of a chronic problem (9.6 percent) and obtaining

aftercare for surgery or an injury (8.7 percent). Hispanic patients were significantly less likely than non-Hispanic patients

to have been seeking routine care for a chronic problem

(24.8 percent of visits compared with 28.2 percent, respectively). Again the difference was not large and easily can

be explained by the differing age distributions of the two

populations.

T-2. Number and pereent cks~ of offke visits made by

Hisparsiopatient$ by pincipd reason for visit United Stat- 19S&Sl

Pnnapal reason for visit Number of VL5XS Percent

and RVC tie’ in thcirsands distr~bukm

AIIvIws. . . . . . . . . . . . . . . . . . . . . .

Symptom mcdule . . . . . . . S001-S999

General symptoms . . . . . . . SOOI-S099

Systems referable to psychol~ical

and mental disorders . . . . , . S100-S199

Symptoms referable to the

nervous system (excluding

sense organs) . . . . . . . . . . S200-S259

Symptoms referable to the

cardiovascular and

lymphatic systems . . . . . . . S2MI-S299

Symptoms referabfe !O the eyes

end ears . . . . . . . . . . . . . S300-S399

Symptoms referable to the

respiratory system . . . . . . . S40Q-S499

Symptoms referable to the

digestive system . . . . . . . . SS00-S639

Symptoms referable to the

genitourinaty system . . . . S64C-S829

Symptoms referable to the

skin, nads, and ha!r . . . . S830-S899

Symptoms referable to the .

musculoskele!al system . . . . . S900-S999

Disease module. . . . . . . . . . . 00014)999

Diagnostic, screening, and

preventwe module . . . . . . . Xl (XI-X599

Treatment module . . . . . . . . TIoo-T899

Iniunes and adverse effects

module . . . . . . . . . . . . . . .. JOO1-.J999

Other* . . . . . . . . . R1OO-R7OO, A1OO-AI4O,

U990-U999

53.337

31,389

5.145

979

2.027

“323

2.322

4.781

3.501

3.206

2,662

6,444

4.426

9,044

4,064

2,492

1,904

100.0

58.8

9.6

1.8

3.8

“0.6

4.4

9.0

6.6

6.0

5.0

12.1

6.3

17.0

7.7

4.7

3.6

‘Band cm“AReasonforV& ClassrfwatcmforAmbulatoryCare,”VI@ad HaSMISLstistcs,

Series 2, Ma. 78. Feb 1979

‘lrwlu~s tear resultsrnowe, admmstratrvamodule,blanks,problemsand complamtsrmt

elsewhered.ss.stisd,entnesof mom.- endw@& entnss,

Patients’ specific reasons for visit are classified in NAMCS

according to the system established in “A Reason for Visit

Classification for Ambulatory Care.’” 1 Table 2 shows the

principal reasons for visit. grouped into modules of related

reasons, for Hispanic persons’ 1980 and 1981 visits. By far

the most common principal reason for visit was a symptom;

the complaints classified in the symptom module precipitated

58.8 percent of all visits. Different types of symptoms wcurred

with varying frequencies, ranging from the 0.6 percent of

all visits precipitated by symptoms of the cardiovascular and

lymphatic systems to the 12.1 percent of ail visits precipitated

by symptoms related to the muscuIoskeletal system.

Next to symptoms, the most common principal reasons

for visit were those in the diagnostic, screening, and preventive

module, which includes such services as regularly scheduled

examinations and inoculations. In comparison with symptoms,

however, this module accounted for a far smaller proportion

of all visits by Hispanic persons-17.O percent. Even smaller

were the proportions of visits with principal reasons in the

disease and treatment modules, which accounted for 8.3 percent and 7.7 percent of all visits. respectively. Injuries and

adverse effects made up the smallest proportion (4.7 percent)

of all visits by Hispanic persons.

Only two significant differences in the type of principal

complaint appeared between visits made by Hispanic persons

and visits made by other persons. The principal reasons for
4

Table 3. Number and percent distribution of office vieii made by

H~anic petien~ by the 10 apachic principal reeeons ‘for visit most

commonly given: United States 19S0-S1

Principal reason for vmt Number of wsds Percent

and R VC code 1 in thousands d/stnbut/on

Allvmts.. ,, ..,,,, . . . . . 53,337 100.0

Prenatal exammatlon, routine X205

General medical exammat!on Xl 00

Fever, , . ., .,,..... .,, .S010

Cough .,..,,., ,, S440

Postoperatwe wst . T205

Abdominal pan. cramps, spasms S550

Headache, pam m head . S21O

Back symptoms . . S905

Symptoms referable \o”throat S455

Chest pam and related symptoms (not

referable to body system) . . S050

All other reasons for ws!t . . Reslduai

2,729

2,482

1,671

1,621

1,534

1,246

1,164

1,040

1.026

968

37,853

5.1

4.7

3.1

3.0

2.9

2.3

2.2

2.0

1.9

1.8

71.0

‘Basedon “AReasonfor V&t Class! ficatmn for Ambulatory Care,- Wa/ and Hea/m .9aflstcs.

Series 2, No 7S, Feb 1979,

Hispanic patients’ visits were somewhat more likely to be

symptoms (58.8 percent compared with 53.8 percent) and

somewhat less likely to be specifically for obtaining treatment

(7.7 percent compared with 10.6 percent). These differences

also cart be attributed to the differing health problems of

populations with different age structures.

Of the 10 most common specific principal reasons for

Hispanic patients’ visits, shown in table 3, 7 were symptoms

typical of acute diseases or injuries: feve~ cough; abdominal

pain, cramps, or spasms; headache or head pain; back

symptoms; throat symptoms; and chest pain and related

symptoms. In examining table 3, it should be noted that

not all differences between the ranked frequencies and percents

are statistically significant. All 10 of the most common reasons

together accounted for more than one-fourth (29.0 percent)

of all office visits by Hispanic persons. h contrast, the same

reasons accounted for only 24.9 percent of all other visits,

indicating that these particular problems were somewhat less

common among non-Hispartic persons visiting office-based

physicians.

The principal diagnoses made by the physicians in Hispanic patients’ visits, grouped into categories based on the

International Class[jication of Diseases, 9th Revision, Clinical

Modification (ICD-9-CM], 12are shown in table 4. Two groups

of diagnoses were used more frequently than arty other group,

and together these groups accounted for almost one-third of

the totai. These groups were the supplementary classification

(including prenatal care, immunizations, general examinations,

and all other well-person care), which was listed for 17.6

percent of all visits by Hispanic persons, and diseases of

the respiratory system (many of which are acute infections

of the upper respiratory tract), which accounted for

13.9 percent.

This distribution of Hispanic patients’ visits among the

various diagnostic categories was remarkably similar to the

comparable distribution for non-Hispanic patients. In fact,

Table 4. Number and percent disfrfbtion of office Wits made by

Hispanic patient% by principal diagnostic class United State% 1980-s1

Pnrwpal diagnostic class Number of vmts Percent

and ICD-9-CM codel in thousands dfstnbuoon

Allvmts. .,,.,,...,.. . . . . . . . 53,337 100.0

Infectious and parasitic

diseases . . . . . . . . . . . . . ..(OOl–l39) 1,552 2.9

Neoplasms . . . . . . . . . . . . (14C-239) 912 1.7

Endocrine, nutrmonal, and metabohc

diseases, and immunity disorders. (240-279) 2,408 4.5

Mental disorders . . . . (290-31 9) 1.788 3.4

Dseases of the nervous system

and sense organs . . . . (320-3S9) 3,940 7.4

Diseases of the circulatory

system . . . . . . . . . . . . . . . . (39&459) 3,084 5.8

Dtseases of the respirato~

system, . . . . . . . . . . . , .(460-519) 7,391 13.9

Diseases of the digestive

S&.tWIl . . . . . . . . . . . . . . . .(520-579) 2,905 5.4

Diseases of the gemtourinary

~stem . . . . . . . . . . . . . . ..(58M29) 3,903 7.3

Diseases of the skm and

subcutaneous ttssue . . . . . . (680-709) 3,331 6.2

ok.t?aSeS of the musculoskeietal

system and connective tissue . . . (710-739) 4,480 8.4

Symptoms, signs. and Ill-defined

conditions, . . . . . . . . . . . . . (780-799) 1,596 3.0

Injury and poisomng . . . (600-999) 4,965 9.3

Supplementa~ classlflcatlon of factors

influencing health status and contact

with health serwces . . . . . . (VO1-V82) 9,373 17.6

0ther2 . . . . . . . . . . . . . . . . .. Residual 1,710 3.2

‘Sssed on me Infemaf/onalClas.wkationof Lkeases, 9tfr Revwon, Clmcal Modircatlon

(lCO-WM),

‘Includes diseases of the blood and b!aod-formmg organs (2a0-ZS9): camphcanons of

prsgnarwy, cluldtwlh, and the puerperfum (630-676); congemtal anomalies (740-759):

SWtSIn conditions Onglflalmg in the perinatal pWWd (760-779): ad blank, noncedable, Srrd

illqble dmgrwses.

only one significant difference between the distributions appeared in the results: diseases of the circulatory system were

recorded less frequently for Hispanic patients’ visits than for

non-Hispanic patients’ visits (5. 8 percent compared with

9.9 percent, respectively). The direct relationship of hypertension and other chronic cardiovascular problems to age is well

known, and this difference also can be attributed to the age

difference between Hispanic and non-Hispanic persons.

The 10 specific principal diagnoses that were most commonly made during Hispanic patients’ visits are shown in

table 5. Again, the differences between the ranked frequencies

and percents are not necessarily statistically significant. Six

of these specific diagnoses are from the two leading groups

of diagnoses: normal pregnancy, health supervision of an infant

or child, and a general medical examination are all welll-care

services included in the supplementary classification clf the

ICD-9-CM: and acute upper respiratory infections of multiple

or unspecified sites, asthma, and acute pharyngitis are all

included in the category of respiratory system diseases. Together the 10 diagnoses accounted for more than one-fourth

(27.2 percent) of all office visits by Hispanic persons in 1980

and 1981. The same 10 diagnoses were recorded for a slightly

smaller proportion (24.7 percent) of the visits made by nonHispanic persons.
dwmedaa 5

Table 5. Number and percent distnk!tion of ofrice visits made by

Hispanic patients, by the 10 specific principal diagnoses most commoniy

gWen:United States. 1980-61

,: .%ls 53.:37 lcpo

142-- al ~,ec~ar,:{ - V22 3.1:5 53

Hez,:n 5ucer~.3 on or rjam m c311c! ~i23 1.717 ~,~

Ac-:e ~ocer ‘ssrxrafory mfecticns of

-,”lttple or unsoec iled sites 465 1.546 2.9

Essenttal hypertension .401 1,529 2.9

Suopuratwe and unspecrf!ed otltls media 382 I ,43a 2.7

General medtcal examination . V70 I .208 2.3

As:>ma, ,,, . . . . . . . . . . . . . ...493 1,091 2.0

Daoetesmelhtus . .250 I ,087 2.0

Obesity andother hyperahmentat!on . ,278 980 1.8

Acute pha~ngms . . . . . . . . . . . ...462 743 1.4

Allotherd/agnoses . . . . . Residual 38,842 72.8

‘Based on the /nfernaf/ona/ CJass/fic.?oon of flseases, 9UI f?emwon. C&mca/ Mcdficafmn

(ICO-WM)

Physician characteristics

The specialty distribution of the physicians visited by

Hispanic patients is shown in table 6. The vast majority of

the visits were divided almost equally among general and

family practitioners (33.2 percent), medical specialists

(29.8 percent), and surgical specialists (32.7 percent). The

remaining few visits (4.3 percent) were made to all other

specialists.

Of the visits to medicaI specialists, visits to pediatricians

(14. 1 pwcent of all visits) exceeded visits to internists

(9.6 percent), which, in turn, exceeded visits to other medical

specialists (6.2 percent). Of the visits to surgical specialists,

however, the largest proportion was made to physicians in

the residual category of other surgical specialties (15.9 percent

of all visits), followed by visits to obstetricians and

gynecologists ( 11.5 percent). Visits to general surgeons accounted for the smallest proportion (5.3 percent).

Only two significant differences between this distribution

and the comparable one for the visits made by non-Hispanic

patients were noted, and both clearly were caused by the

differing age structures of the Hispanic and non-Hispanic populations. Pediatricians, who primarily treat infants and young

children,13 accounted for a somewhat larger proportion of

the visits made by Hispanic patients than of the visits made

by all other persons ( 14.1 percent compared with 10.9 percent,

respectively). Conversely, internists, whose patients are principally the middle-aged and elderly, 1Aaccounted for a significantly smaller proportion of the visits made by Hispanic persons than of all other visits (9.6 percent compared with

12.6 percent, respectively).

Hispanic patients’ visits were distributed unevenly among

the four major geographic regions of the United States (see

table 7). The largest proportion (35.2 percent) occurred in

the West, followed by the South (29.3 percent), and then

the Northeast (23. 7 percent). Only 11.8 percent were made

in the Midwest. This distribution differed markedly from that

observed for all visits made by non-Hispanic persons, as the

Northeast was the only region that claimed essentially equal

Table 6. Number and percent distribution of of?ice visits made by

Nispenic patients. by physician specieity United States, 198N1

Number cf WSIIS Percent

Phys/c!an SCC=C’.%w n ,Y.ousaPci 51str:4U:Ton

AllvIsIts, ,. .,.,. ,,, 53.337 :00.0

General and fam!ly Dract!ce i 7.703 232

All medcal soeclatt:es . . 15,X4 292

Intema[ rrwdtcme 5.700 95

Pedatr!cs, ...,...,., ... . 7.505 ,4,1

O!her medcal specialties . . 3.299 6.2

All surgical sp+clalt!es . . . , . 17,429 32.7

General surge~ . . . . . . . . . . . ... ,, 2.628 5.3

Obstetrics and gynecology . . . . 6.139 11.5

Other surg!cal specmkes . 8,462 15.9

Another speclalt[es. . . . . . . . . . . . . . . 2,301 4,3

Psychiatry . . . . . . . . . . . . . . . . . . . 954 1.8

Other speaalt!es. . . . . . . . . . . . . . . . 1,347 2.5

Table 7. Number and percent d=tributiorr of office visits made by

Hspanic patfens by geographw region: United Sfste~ 1980-81

Number of vmts Percent

Geographic region in thousands dismbu!ton

Allvkita. . . . . . . . . . . . ... . . . . . . . . 53,337 100.0

Northeast . . . . . . . . . . . . . . . . . 12,635 23.7

Midwest . . . . . . . . . . . . . . . . . . . . . . 6.308 11.8

South . . . . . . . . . . . . . . . . . . . . . . . 15,620 29.3

West . . . . . . . . . . . . . . . . . . . . . . . 18,774 35.2

proportions of Hispanic and non-Hispanic patients’ visits

(23.7 percent and 23.6 percent, respectively). The most striking differences appeared in the West, which accounted for

35.2 percent of Hispanic patients’ visits but only 17.6 percent

of other patients’ visits, and in the Midwest, which accounted

for only 11.8 percent of Hispanic patients’ visits and

26.0 percent of all other visits. These differences are explained,

of course, by the geographic distribution of the American

Hispanic population, which has a relatively high concentration

in the Southwest and a relatively low one in the iMidwest.

The remaining region, the South, accounted for 29.3 percent

of the visits made by Hispanic persons and 32.8 percent

of those made by non-Hispanic persons. Although this is

a statistically significant difference, it is not a substantively

large one.

Another locational variable utilized in NAMCS is the

metropolitan status of the mea in which the visit occurred.

Although large majorities of both the visits made by Hispanic

persons and those made by non-Hispanic persons took place

in metropolitan areas, the visits of Hispanic persons were

substantially more concentrated in those areas (87.1 percent

compared with 75.5 percent, respectively).

Hispanic patients’ visits were quite similar to non-Hispanic

patients’ visits on the remaining variables describing the physicians and their practices. Of the Hispanic patients’ visits,

3.9 percent involved female physicians and 7.2 percent involved Doctors of Osteopathy (D. O.’s), rather than Doctors

of Medicine (M.D. ‘s). A large majority of the visit total

was divided almost equally between physicians 44 years of

age or younger (39.9 percent) and physicians 45-60 years
6 advmcedata

of age (44.2 percent). Only 16.0 percent of.~he visits were

made to physicians 61 years of age or older. In addition,

a majority of the visits (57.5 percent) were tg solcpractitioners.

Although this was significantly larger than the compamble

proportion of all visits made by non-Hispanic persons (54.6

percent ). the difference was not a large one.

Visit management

Physicians utilized a sin’gle diagnostic service in almost

half of all visits made by Hispanic persons (46.0 percent).

Two such services were used in fewer visits (30.6 percent),

and three or more were used in” still fewer ( 16.6 percent).

Only 1 of every 15 visits (6.8 percent) involved no diagnostic

services.

The rates at which various specific diagnostic services

were ordered or provided during Hispanic patients’ visits are

shown in table 8. The services can be ranked according to

their frequency of use as follows.

. Limited medical histories and/or examinations (64.4 percent of the visits).

● Blood pressure measurements (33.7 percent).

. One or more clinical laborato~ tests (21.5 percent) and

general medical histories and/or examinations ( 17.5 percent).

● One or more x rays (9.0 percent).

. Pap tests (4.2 percent) and vision tests (3.6 percent).

. Electrocardiograms (2.6 percent), mental status examinations (1.7 percent), and endoscopies ( 1.0 percent).

This usage pattern for diagnostic services is remarkably similar

to the one that appeared for non-Hispanic patients’ visits.

In fact, only one significant difference was found: vision

tests were utilized in the visits made by Hispanic patients

somewhat less frequently than in all other visits (3.6 percent

compared with 5.8 percent. respectively).

Hispanic patients’ visits and ail other visits also were

very similar with respect to the use of therapeutic services

other than medication. Physicians utilized no therapeutic services other than medication in a slight majority of all visits

made by Hispanic persons (54.2 percent). Another large proTable 8. Number and percent of office visits made by Hispanic patientq

by type of diagnostic service ordered or provided United State%

19e&81

Number of visits

Diagnostic sewce m thousands Percent

None, . . . . . . . . . . . . . . . . . . . . . .

Limited historyexam . . . . . . . . . . . . . . . .

General history/exam . . . . . . . . . . . . . . .

Paptest, , .,.........,,,. . . . . . .

Clinical lab test . . . . . . . . . . . . . . . . .

B ray . . . . . . . . . . . . . . . . . . . . . . . .

Blood pressure check . . . . . . . . . . . . . . .

Electrocardiogram .

Wiontest. . . . . . . . . . . . . . . . . . . .

Endoscopy . . . . . . . . . . . . . . .

Mental status exam . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . .

3,609

34,341

9,360

2,215

11,453

4,779

17,965

1,392

1,908

551

667

2,179

6.6

84.4

17.5

4.2

21.5

9.0

33.7

2.6

3.6

1.0

1.7

4.1

NOTE:Morethan one dlagnostm sewce was ordered or provtded during some VISItS

Table 9. Number and percent of office visits made by Hispanic patients,

by type of nonmedicetion therapeutic service ordered or provided United

State* 1980-81

Number of wits

Nonmed/cat/on therapeutic servrce in thousands Percent

None . . . . . . . . . . . . . . . . . . . . .

Physiotherapy . . . . . . . . . . . . . . .

Oficesurgev . . . . . . . . . . . . . . .

Famdyplanmng . . . . . . . . . . . . . . .

Psychotherapy therapeutic Iistenmg

Dtetcounselmg . . . . . . . . . . . . . . . .

Famtlysocial counseling , . . . . .

Med[cal counselin g . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . .

28,906

3,455

3,471

1.522

1.628

4,965

1,036

11,812

1,063

54.2

6.5

6.5

2.9

3.1

9.3

1.9

22.1

2.0

NOTE More than one nonmedicauon therepeut8c serwce was ordered or prowded during

some wsk

portion of the visits (38.3 percent) involved just one such

service. Fewer than 1 of every 10 visits made by Hispanic

persons involved the order or provision of more therapeutic

services-two services were used by physicians in only 6.7

percent of the visits, and three or more services in just 0.9

percent.

Grouped according to their order of frequency of use,

the specific therapeutic services on which information was

collected by means of NAMCS in 1980 and 1981 were as

follows (see table 9).

● Medical counseling (22.1 percent of all visits made by

Hispanic persons).

. Diet counseling (9.3 percent), office surgery (6.5 percent),

and physiotherapy (6.5 percent).

. Psychotherapy and/or therapeutic listening (3.1 percent),

family planning (2.9 percent), and family ancVor social

counseling ( I.9 percent).

Of all these services, only one, psychotherapy andlor therapeutic listening, was utilized significantly less often in the visits

made by Hispanic persons (3. 1 percent) than in all other

visits (5.0 percent).

In the visits made by Hispanic patients, as in all other

visits, by far the most common therapeutic service was for

the physician to order or supply one or more medications.

In NAMCS, the term “drug visits” refers to the visits in

which this was done. Drug visits accounted for 63.3 percent

of all visits made by Hispanic patients. Medications are used

to control common chronic conditions whose incidence is

direcd y related to age, such as diabetes and hypertension,

as well as to treat other conditions. Because of this, the

use of medications in the treatment of Hispanic patients by

office-based physicians was expected to be related to age,

and this expectation was confirmed. Drug visits accounted

for 71.0 percent of all visits made by Hispanic patients 45

years of age and older, but only 60.0 percent of those made

by younger Hispanic patients. Neither the overall level of

medication usage in Hispanic patients’ visits nor the age difference that appeared differed significantly from the comparable

statistics observed for all other visits.

The principal unit of measurement used in NAMCS in

assessing medication utihzation is the drug mention, or the

order or provision of a particular drug during a patient visit.
ammdata7

Table 10. Average number of drug mentions per visit and per drug visit

made by Hispanic patient%by patient agtx United Stete~ 1W&W

Average number Average number

of drug menfrons of drug mentions

Age pH v/sit per dmg visd

AllvMs. ... . .. . . . . . . . . . . 1.13 1.79

Under 15 years . . . . . . . . . . . . 1.10 1.64

lS-24 years . . . . . . . . . . . . . 0.86 1:56

25-44 years . . . . . . . . . . . . . 0.97 1.69

45-64 years . . . . . . . . . . . . . 1.31 1.92

65 years and over . . . . . . . . 1.77 2.30

Tabie 11. Number snd percent diatribufkm of drug mentions during

office viaits made by Hispanic patient% by therapeutic category

United State% 1960-S1

Number of

drug mentions Percent

Therapeutic category’ m thousands distribution

All, . . . . . . . . . . . . . . . . . . . 60.260 100.0

Antlhlstamme drugs . . . . . . . . . . . . . . . .

An!]-mfectwe agents . . . . . . . .

Autonomic drugs . . . . . . . . . . . . . . . . .

Cardiovascular drugs . . . . . . . . . . . . .

Cantral nervous system drugs . . . . . . . . .

Elac!rolytIc, caloric, and water

balance . . . . . . . . . . . . . . . . . . . . .

Expectorants and cough preparations . . . . . .

Eye. ear, nose, and throat preparations . . . . .

Gastrointestinal drugs . . . . . . . . . . . . . .

Hormones and synthetic substances . . . . . . .

Serums, toxoids, and vaccines . . . . . . . . . .

Skin and mucous membrane preparations . . . .

Spasmo[yhcagents . . . . . . . . . . . . . . . .

Vitamins . . . . . . . . . . . . . . . . . . . . . .

0fher2 . . . . . . . . . . . . . . . . . . . . . . .

3,273

10,612

2,694

3,381

11,383

2,996

2,353

1,513

2,532

5,781

2.469

5,055

1,136

2,142

2,939

5.4

17.6

4.5

5.6

16.9

5.0

3.9

2.5

4.2

9.6

4.1

8.4

1.9

3.6

4.9

~Based on the pharmaso!qic-tfrerapeurkclassrficaticaof Iha American6oc@y of Hosptal

Pharmacists.

‘Includes anmwaplasttcagents,bbal formafion and Coagulatmn agents. dmgnoslw agents,

enzymes, gold compcurds, heavy m@al antagarsfa, local arwsrheocs. oxymacs.

unclasstimd Iherspeutm agen k, d.etices. pharmacewc ads. and undetermined substances.

In the 1980 and 1981 NAMCS, as many as eight drug mentions

were recorded for a sample visit. The amount of drug usage

for all patients can be assessed by evaluating the average

number of drug mentions per visit. The averages for visits

made by Hispanic persons in different age groups are dispiayed

in table 10.

For all visits made by Hispanic patients, an average of

1.13 drugs were ordered or provided per visit. This varied

with the age of the patient, however. Children 14 years of

age and younger frequently need immunizations and are prone

to infective diseases that are often treated with antibiotics.

For these children, an average of 1.10 medications per visit

were used. Usage by adolescents and young adults 15-24

years of age was significantly lower (0.86 medications per

visit), and usage remained low for the next age group also

(0.97 per visit for adults 25+4 years of age). For the group

45+S4 years of age, usage rose significantly, to 1.31 drugs

per visit. This is the age range in which chronic diseases

requiring medication therapy are often first detected. A significantly higher average of 1.77 medications per visit was

ordered or provided for the remaining age group, persons

65 years of age and older. This undoubtedly reflects both

the relatively high prevalence of chronic conditions among

the elderly and the increase in acute problems that occurs

as the effectiveness of the immune system decreases with age.

The intensity of drug usage among the patients who were

ordered or provided with at least one medication is retlected

in the average number of drug mentions per drug visit. In

1980 and 1981, an average of 1.79 drug mentions was made

during each drug visit made by a Hispanic person. The averages

for the different age groups indicate that. except among the

elderly, age did not affect the intensity of drug usage once

the decision to use at least one medication had been made.

None of the pairs of successive age groups differed significantly in the intensity of drug usage during drug Vkits. In

fact, in comparing each age group with every other age group.

the only significant differences that appeared were that more

drugs were used in drug visits made by the elderly (2.30

drugs per drug visit) than in the drug visits made by the

three youngest age groups ( 1.64 for children under 15 years

of age, 1.58 for youth 15–24 years of age, and 1.69 for

adults 25J14 years of age).

All drug mentions recorded in NAMCS in 1980 and 1981

were coded into categories describing the various therapeutic

effects that can be expected of medications. The categories

used were based on the classification system developed by

the American Society of Hospital Pharmacists.’s As shown

in table 11, an estimated 60.3 million drug mentions were

made during Hispanic patients’ visits in 1980 and 1981. Two

drug categories were used significantly more frequently than

any other category: central nervous system drugs (18.9 percent

of all drug mentions) and anti-infective agents (17.6 percent).

Each of the other drug categories accounted for less than

10 percent of all drug mentions.

This distribution of drug mentions for Hispanic patients

was very similar to the distribution observed for all other

patients. In fact. only two significant differences appeared.

Compared with the drugs used with non-Hispanic patients.

the drugs ordered or provided to Hispanic patients were less

likely to be cardiovascular drugs (5.6 percent, compared with

10.2 percent) and less likely to be electrolytic, caloric, or

water balance agents (5.0 percent, compared with 8.2 percent).

These differences in drug utilization stem from the differing

health problems physicians encounter during visits by Hispanic

and non-Hispanic patients. Both of these types of drugs are

used frequently to treat hypertension and other diseases of

the cardiovascular system, and diseases of the circulatory

system accounted for a smaller proportion of Hispanic patients’

visits than of all other patients’ visits.

The final aspects of Hispanic patients’ office visits to

be considered here are visit duration and patient disposition.

A distinct majority of all visits by Hispanic patients

(60.5 percent) lasted 6-15 minutes. Almost one-third of the

visits (27.9 percent) lasted longer than 15 minutes, and the

smallest proportion (11.6 percent) lasted 5 minutes or less.

The only significant difference in dumtion between Hispanic

patients’ visits and non-Hispanic patients’ visits was that nonHispanic patients’ visits were more likely to be in the shottest

duration category ( 15.4 percent of all visits).

Finally, table 12 shows that asking the patient to return
8 advmcedata

Table 12. Number and percent of visrts made by Hispanic patienta by

patient dispasltion: United States, 198&81

Number of vIsI&

P3(,em d’SDOS/f;Or) n !hwsanus Perceor

Vo ‘o:w .3 :arr+a 5 J306 If)g

ae!urn d! s~ec, ed time 31 “89 59 ~

~etur- ,: ?eecea, p r n 12,:22 233

Te4e; r2ne 1s, owus clanr.ea 1.919 3.6

Referred :0 ::.-er pnyslclan 1268 26

Adm!t to bso:tal 1,490 2.8

Other . ,. 630 12

NOTE More &an one pauem dlspos!t!on was recordsd Ior some vmts

at a specitk time was by far the most common disposition

in Hispanic patients’ visits (59.6 percent). The patients were

instructed [o return if needed in one-fourth of the visits

(23.3 percent). and no followup was planned in one-tenth

of the visits ( 10.9 percent). Each of the other dispositions

was made in fewer than 1 of every 25 visits. This distribution

did not differ significantly in any respect from the comparable

distribution for all other patients.

Conclusions

This report has been devoted to describing the 1980 and

198 I visits to office-based physicians made by Hispanic persons in terms of the patients’ medical problems and the physicians’ diagnostic actions and therapeutic interventions. In addition, differences between these visits and those made by nonHispanic persons were highlighted. The comparisons revealed

that the two sets of visits had many more similarities than

differences. Most of the differences [hat did oppetir were

relatively minor ones thu[ can be understood in light of [he

reltitive youth of the !+isptinic populwon in the United Stutes.

The only m:jor differcnw> th.u tippearcd cun be ‘;iewed w

rerlw[ing ~hc differing yogmphIc di:;mburiorrs ot”!he Hispmtc

find n(m-Hi\punic populations.

A curwt-y view of /he N.4\lCS visit mtw, for Hispanic

and non-Hispanic pers(ms suggests that in 1980 m.i 198 I

the Hispanic population obtained substa,ntitilly less heulth cure

from office-bawd physicians than the non-Hispanic population

obtained. Closer examination of the NAMCS and NHIS findings and methodologies, however. leads to the conclusion

that the magnitude of the difference in rates shown by NA!vICS

is an artifactual finding. NAMCS’S reliance on ethnicity information supplied by medical care providers, rather than ethnicity

identifications that are self-reported. apparently leads to an

undercount of visits made by Hispanic persons.

Because of this apparent undercounting, all of the population-based rates presented in this report must be interpreted

with particular caution. In addition, there is a possibility that

the undercounting may have introduced an element of bias

that may have distorted the results of the visit analyses. (Unfortunately, there are no indicators for assessing the existence,

amount, or type of any possible bias. Despi!e these problems,

these findings are uniquely valuable in being based on a

national-level survey with extensive medical data supplied

by medical care professionals. Consequently, the results constitute an important contribution to the currently sparse literature

available on the utilization of health care resources by Hispanic

persons.
adwweda9

References

‘F. M. Trevino: Vital and health statistics for the U.S. Hispanic

population. Am. J. Public Heal/h 72(9):979-981, Sept. 1982.

2A. Gliebe and L. R. Malley: Use of the health care delivety system

by urban Mexican-Americans in Ohio. Public Health Rep. 94(3):

226-230, May-June 1979.

3w LoP~z.A~ueres, B. Kemp, F. Staples, and K. Brummel-Smith:

Use of health care services by older Hispanics. J. Am. Geriutr.

Sot. 32(6):435-440, June 1984.

‘S. Markides, S. Levin, and L. A. Ray: Determinants of physician

utilization among Mexican-Americans. Med. Care 23(3):23&246,

Mar. 1985.

5E. Robe~ and E. s. Lee: Medical care use by Mexican-Americans.

evidence from the Human Population Laboratory Studies. Med. Care

18(3):266-281 , Mar. 1980.

6National Center for Health Statistics, F. M. Trevino and A. J.

Moss: Health insurance coverage and physician visits among Hispanic

and non-Hispanic people. Health, Unired States, 1983. DHHS Pub.

No. (PHS) 84-1232. Public Health Service. Washington. U.S. Government Printing Office, Dec. 1983.

TNational center for HeaIth Statistics: Plan and operation of the

Hispanic Health and Nutrition Examination Survey, 1982-84. Vital

and Health S~atistics. Series 1, No. 19. DHHS Pub. No. (PHS)

85-1321. Public Health Service. Washington. U.S. Government

Printing Office, Dec. 1985.

‘National Center for Health Statistics: News of the Hispanic Health

and Nutrition Examination Survey. No. 5. Public Health Service.

Washington. U.S. Department of Health and Human Services,

NOV. 1985.

~ational Center for Health Statistics: News of the Hispanic Heafth

and Nutrition Examination Survey. No. 6. Public Health Service.

Washington. U.S. Department of Health and Human Services, May

1986.

‘ONationaf Center for Health Statistics, F. M. Trevino and A. J.

Moss: Health indicators for Hispanic, black, and white Americans.

Vital and Health Statistics. Series 10, No. 148. DHHS Pub. No.

(PHS) 84-1576. Public Health Service. Washington. U.S. GovernmentPrinting Office, Sept. 1984.

1‘National Center for Health Statistics, L. AppIeton and T. McLemore: A reason for visit classification for ambulatory care. Viral

and Heahh Statistics. Series 2, No. 78. DHEW Pub. No. (PHS)

79-1352. Public Health Service. Washington. U.S. Government

Printing Office, Feb. 1979.

‘%blic Health Service and Health Care Financing Administration:

International Classification of Diseases, 9th Revision, Clinical Mod-

@cation. DHHS Pub. No. (PHS)80-1260.Public Health Service.

Washington. U.S. Government Printing Office, Sept. 1980.

‘3National Center for Health Statistics, B. K. Cypress: Patterns of

ambulatory care in pediatrics, the National Ambulatory Medlcal Care

Survey, United States, January 1980-December 1981. Vital and

Health Statistics. Series 13, No. 75. DHHS Pub. No. (PHS) 84-1736.

Public Health Service. Washington. U.S. Government Printing Office, Oct. 1983.

!4National Center for Health Statistics, B. K. Cypress: patterns ‘f

ambulatory care in internal medicine, the National Ambulatory MedicaI Care Survey, United States, January 1980-December 1981. Vital

and Heuhh Statistics. Series 13, No. 80. DHHS Pub. No. (PHS)

84-1741. Public Health Service. Washington. U.S. Government

Printing Office, Sept. 1984.

IsAmerican Hospita[ Formu[a~ Service Classification $-stem ad

Therapeutic Category Codes. Washington. American Society of Hospital Pharmacists, Inc., 1980.

IsNation~ Center for Health Statistics, S. S. Jack: Current estimates

from the National Health Interview Survey, United States, 1980.

Vital and Health Starisrics. Series 10, No. 139. DHHS Pub. No.

(PHS) 82–1567. Public Health Service. Washington. U.S. GovernmentPrinting Oftlce, Dec. 1981.

17Nationa1 Center for Health Statistics, B. Bloom- Cumnt estimates

from the National Health Interview Survey, United States, 1981.

Vital and He@h Statistics. Series 10, No. 141. DHHS Pub. No.

(PHS) 82-1569. Public Health Service. Washington. U.S. GovernmentPrinting Office, Oct. 1982.

Symbols

. . . Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

●

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
10

Technical notes

Source of data and sample design

The estimates presented in this report are based on the

findings of the National Ambulato~ Medical Care Survey

(NAMCS), a sample survey of office-based care conducted

annually from 1973 through 1981 by the National Center

for Health Statistics. The target universe of NAMCS is composed of office visits made by ambulatory patients to non-FederaI and noninstitutional physicians who are principally engaged in office-based, patient-care practice. Visits to physicians practicing in Alaska and Hawaii are excluded from

the range of NAMCS, as are visits to anesthesiologists,

pathologists, and radiologists.

A multistage probability sample design, involving a step

sampling of primary sampling units, physicians’ practices within primary sampling units, and patient visits within physicians’

practices, was employed in NAMCS. The physician sample

(5,805 physicians for 1980 and 198 1) was selected from master

files maintained by the American Medical Association and

the American Osteopathic Association. Those members of

the sample who proved to be in scope and eligible participated

at a rate of 77.3 percent. Responding physicians completed

visit records for a systematic random sample of ofllce visits

made during a randomly assigned weekly reporting period.

Telephone contacts were excluded. During 1980 and 1981

responding physicians completed 89,477 visit records on which

they recorded 97,796 drug mentions. Characteristics of the

physician’s practice, such as primary specialty and type of

practice, were obtained during an induction interview. The

National Opinion Research Center, under contract to the National Center for Healtii Statistics, was responsible for the

field operations of the survey.

Sampling errorq statistical testing, and rounding

The standard error is a measure of the sampling variability

that occurs by chance because only a sample, rather than

the entire universe, is surveyed. The relative standard error

of an estimate is obtained by dividing the standard error by

the estimate itself and is expressed as a percent of the estimate.

In this report, any estimate that exceeds a relative standard

error of 30 percent is marked with an asterisk. Table I should

be used to obtain the relative standard error for aggregates

of office visits, and table 11 should be used to obtain the

relative standard error for drug mentions expressed as drug

groups (for example. the analgesic drug family).

In this report, the determination of statistical inference

is based on the Bonferroni test for multiple comparisons,

a modification of the f-test. Terms relating to differences,

such as “higher” and “less,” indicate that the differences are

statistically significant at the p < .05 level. Terms such as

“similar” or “no difference” mean that no statistical significance exists between the estimates being compared. A lack

of comment regarding the difference between any two estimates

does not mean that the difference was tested and found to

be not significant.

Table 1. Approximate relativeatsndard errora of eatirnatednumbers of

offioe visit& baaed on allphysician speciattk NetionalAmbulato~

Mediil Care Survey, 19S0-S1

Relative

standard

Estimated number of office visits error

Esttmated number in thousands Percent

450, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310.0

600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.0

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.6

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.2

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.5

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4

EXAMPLE OF USE OF TABLE’ An aggregateest!mate of 35,003,003 otfica vistt.s has a

relalwe sfardsrd enor of 5.0 percent or a srandard error of 1,750,000 w.wts (5.0 psrcent of

35,000,W0 Vlsda).

Tebfe Il. Approximate relativestandard errors of estimatednumbers of

drug mentions when drugs appear in groups (for example, the snslgeeic

drug fsmily), baaed on allphya’kian specialties NationalArnbulstory

Medkal Care Survey, 19W1

Relative

Est)ma@d number of standard

grouped drug mentions error

Estimated number in thousands Percent

“650 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “30.3

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.3

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.5

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.6

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1“1.6

10,000 . . . . . . . . . . . . . . . . . . . . 0.7

20,000 . . . . . . . . . . . . . . . . . . . . . 6.8

50,000 . . . . . . . . . . . . . . . . . . . . . . . . 5.3

100,000 .,, . . . . . . . . . . . . . . . . 4.7

200,000 . . . . . . . . . . . . . . . . . . . . 4.4

500,000 . . . . . . . . . . . . . . . . . . . . . . 4.2

1,000,000 . . . . . . . . . . . . . . . . . . 4.1

EXAMPLE OF USE OF TABLE An aggregate estfmate of 30.000,000 drug mentions has a

ralatweslandard error oi7.0percent orastandard error of 2,100,000 menlions (7. O!xrcenl

of 30.000,OCQ mentions),

Frequency estimates presented in this report have been

rounded to the nearest thousand. For this reason, detailed

estimates donotalways addtototds.

Population estimates and rate computation

The population estimates used in computing the average

annual visit rates presented in this report are shown in table III. These estimates represent the 1980-81 average annual

civilian noninstitutionalized population of the United States.

Except Ior the totals by age, which are adjusted to independent

estimates furnished by the U.S. Bureau of the Census, these

estimates are based onthesamples ofhouseholds in the 1980
advmcedata 11

Tab+altl. G~es Of~ec M~~nn Onina~*a~Z~~ u~~nOft* Un~~Sta tesus4inm p@in9ave wannmlmte sinW[srewfi by age and

efhrtjcify 1960-61

All Under 75-24 2544 45-64

Ethrvcity

65 years

ages 15 years years years years and over

Number in thousands

Allethmcities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221,485 50.525 40,416 62,319 43,857 24,369

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,215 4,615 3.343 4,380

Non-Hispani c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,164 713

206,271 45,910 37,073 57,939 41,693 23,655

NOTE Figures may not add b total due to rwndmg,

and1981 National Health Interview Surveys. Detailedinformation on the source and reliability of these estimates can be

foundinthetechnicrd notesofearlierpublications .]6.]7

Average annual visit rates were computed by dividing

visit totals for 1980 and 1981 by twice the average annual

population.

Definitionsofterms usedinthis report

An ofice is a place that physicians identify as a location

for their ambulatory practice. Responsibility for patient care

and professional services rendered in an oftlce resides with

the individual physician rather than with an institution.

A t’isitis adirect personal exchange between anambulatory patient seeking health care and a physician, or staff

member working under the physician’s supervision, who provides the health services.

NOTE: A list of references follows the text.

A drug mention is the physician’s entry on the visit record

of a pharmaceutical agent ordered or provided by any route

of administration for prevention, diagnosis, or treatment.

Generic and brand-name drugs are included as are nonprescription and prescription drugs. The physician records all new

drugs and all continued medications if the patient specifically

is instructed during the visit to continue the medication.

An acute problem is a morbid condition with a relatively

sudden or recent onset (within 3 months of the visit).

A chronic problem is a morbid condition that existed

for 3 months or longer before the visit. The care indicated

is of a regular, maintenance nature.

A chronic prob!em jlareup is a sudden exacerbation of

a preexisting chronic condition.

Nonillness care denotes health examinations and care provided for presumably healthy persons. Examples of non illness

care include prenatal and postnatal care, annual physicals,

well-child examinations, and insurance examinations.
From Vital and Health Statistics of the National Center for Health Statistics Number 130. July 31, 1987

Prevalence of Known Diabetes Among Black Americans

by Thomas F. Drury, Ph. D., and Anita L Powell, Division of Epidemiology and Health Promotion

Highlights

In 1985, approximately 1.0 million black Americans had

known diabetes-a rate of 35.9 per 1,000 population. Compared with 22 years ago, these 1985 estimates represent a substantial increase in both the number and the rate of black

‘@ericans with known diabetes, In 1963, only an estimated

228,000 black individuals had known diabetes, representing a

fate of 11.7 known diabetics per 1,000 population.

Among black persons, known diabetes is relatively more

frequent among older persons, females, the less educate~ the

formerly married, those living alone, and persons in families

with low annual incomes. It is also proportionately more common among central city residents than among metropolitan area

residents living outside a central city. Among black persons,

those living in the West have the highest rate of known diabeteq

those living in the Northeast, the lowest rate. Some of these

sociodemographic variations in the rate of known diabetes

among black persons are associated with the fact that certain

categories have higher proportions of older ~rsons, who are

more likely than younger persons to have known diabetes.

Differences in the rate of known diabetes among black individuals by marital status and living arrangement are largely

explainable in these terms.

In both absolute and relative terms, the increase in the

prevalence of known diabetes over the past 22 years has been

greater for black persons than for white persons. From 1963 to

1985, the number of white known diabetics increased by about

2!4 times, and a twofold increase occurred in the rate for white

persons. During that same perid there was a fourfold increase

in the number of black persons with known diabetes, and a

threefold increase occurred in the rate for black Americans.

Known diabetes is now relatively more common among

~lack persons than it is among white persons. However, this

jverall difference in the relative likelihood of known diabetes

was not always the case. From 1963 to 1968, the overall rates

of known diabetes among black and white persons were similar.

Moreover, during the 1963–68 time period, when the relative

frequency of known diabetes for the two racial groups was

similar, there were offsetting trends among males and females.

Over the 22-year period for which data are available, black

females have consistently had higher observed rates of known

diabetes than white females have had. From 1963 to 1967,

however, black males had lower overall rates than white males

had. By 1975 (the second year after 1968 for which data are

available) a crossover had occurred The overall observed rate

of known diabetes for black males was higher than that for

white males.

The currently higher rate of known diabetes among black

than white persons is pervasive. Across all se% age, education,

maritaI status, living arrangemen~ and regional categories and

across most family income and location of residence categories

of the population, black individuals are relativel y more likely to

have known diabetes than white persons are. Among black individuals 17 yearn of age and over, but not among white individuals in this age span, family income differences in the

relative frequency of known diabetes are explained by educational attainment differentials that are associated with family

income and the relative likelihood of having known diabetes.

Background

“Diabetes mellitus” is a term that refers to a heterogeneous

group of disorders characterized by glucose intolerance. The

National Health Interview Survey (NHIS) of the National

Center for Health Statistics (NCHS) is designed to produce

estimates of the number and characteristics of persons who

have been told by a physician that they have diabetes. Estimates of the prevalence of known diabetes in the United States

have been available from NHIS for more than 25 years, but it

is only in the past 5 years that estimates of the prevalence of

known diabetes specifically for black persons have been rouU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service
2 advan@Ckb

tinely published In 1960, NHIS statistics on the prevalence of

known diabetes and associated disability and medical care

were published for the period July 1957-June 1959.1 However, these statistics were shown only for the total population

and for specific age and sex categories. In 1967, NHIS information on the prevalence of known diabetes by race was published for the first time. This information was based on data

collected in a special supplement on know”n diabetes conducted

from July 1964 through June 1965.2 These data for fiscal year

1965 were not shown separately for black persons. They were

classified only for white and all other races, a practice which

continued in routine NHIS statistical reports through 1977.3

As a resulL when the Workgroup on Epidemiology of the

Committee on Scope and Impact of the National Commission

on Diabetes published its report in 1977,4 NHIS information

on the prevalence of known diabetes among black Americans

was notably absent, It was still lacking when the important

compilation Diabetes Data: Compiled 1977 appeared in

1978.5

NHIS information on the prevalence of known diabetes

among black Americans apparently appeared for the first time

in an ofilcial NCHS publication, Health: United States,

1981.6 In an article published in this report, age-adjusted rates

of known diabetes were shown for white and black individuals,

and age-specific rates for white and black persons were shown

by sex and educational attainment. A more detailed NCHS

analysis of the role of obesity in explaining age-sex-race differentials in the relative frequency of known diabetes (which

focused explicitly on black-white differences) was also subsequently published7

Recognition of the important gaps that existed in the pub

lished literature with respect to the number and characteristics

of black Americans with known diabetes gave rise to a concerted effort by NCHS staff to tabulate and compile available

NHIS data on known diabetes for fiscal year 1963 (the earliest

year for which NHIS data tapes still existed) through the current time period. The results of these computer analyses were

made available to the National Diabetes Data Group of the

National Institute of Diabetes, Digestive, and Kidney Diseases.

This organization made excellent use of them, in conjunction

with its own analyses of NCHS data tapes, in Diabetes in

America. 8These data were also later used in the Report of the

Secretary’s Task Force on Black and Minon”ty Health.9~Q

This report represents an update and extension of NHIS

data presented in Diabetes in Arnen”ca and is based on more

recent and detailed data analyses. Whereas the prevalence of

known diabetes among black knericans was shown through

1981 in Diabetes in Amen”ca, data for 1982-85 are presented

here. In Diabetes in America, rates of known diabetes were

shown for white and black persons by sex and age for 1979-

81; here, these rates are shown for an extensive set of sociodemographic categories. Age-adjusted rates by race and sex

shown in Diabetes in Amen”ca were based on 1976 NHIS data.

Here, age-adjusted rates for 1979–8 1 are shown for white and

black persons according to an extensive array of sociodem~

graphic characteristics. Finally, in Diabetes in Amen”ca, the

trend for white and black individuals from 1963 through 1981

was shown for all age~ here, data for 1963-85 are shown by

age and sex.

Scope and objectives

The data on the prevalence of known diabetes amongl

black Americans shown in this publication have been selected

to provide the information needed to answer the following

kinds of questions. How many black Americans now have

known diabetes? How does the rate of known diabetes vary

among sociodemographic categories of black Americans? To

what extent can variations in the rate of known diabetes among

sociodemographic categories of black Americans be explained

in terms of the older age composition of these groups? How

different are the rates of known diabetes for black and white

persons? To what extent are black-white differences in the

relative frequency of known diabetes associated with differences

in the age and social composition of black and white persons?

How has the overall prevalence of known diabetes among

black Americans changed over the past 22 years? How has the

change in the prevalence of known diabetes among black Americans varied among sex and age categories of the black pop

ulation? In what respects has the change in the prevalence of

known diabetes among black persons differed-from the change

among white individuals?

Source of data

The data presented in this report were obtained through

the National Health Interview Survey of the National Center

for Health Statistics. The bulk of the data presented are based

on three one-third subsampies of NHIS for which diabetes information was collected during the 1979-81 time period 11-]3

However, individual-year data for the period 1963-68, as well

as pooled data for 1982 through 1985, have also been used in

describing the change in the prevalence of known diabetes

among black Americans.

A brief description of the procedures used in NHIS is

given in the Technical notes section of this report.

Variations in prevalence among black

Americans

The average annual number of persons with knowm diabetes during 1979-81 by race, age, and selected sociodem~

graphic characteristics is shown in table 1. The number of

persons with known diabetes per 1,000 population during

1979-81 is shown by these same characteristics in table 2.

Major variations in the relative frequency of known diabetes

among black Americans, based on the data shown in table 2,

are highlighted.

● During the period 1979-81, the relative frequency of

known diabetes among black persons was 16 times higher

for the group 65 years and over (131.7 per 1,000 population) than for the group under 45 years of age (8.3 per

1,000 persons).

. Among black individuals, known diabetes was also prportionately more common among females than among

males, particularly in the group 45 years of age and over.

● The rate of known diabetes among black individuals with

less than 12 years of education (78.3 per 1,000 popula-
aancdaa3

Table 1. Average annual numbar of persona with knowm diabetes. by age. rata, and selectad sociodemographic characteristics: United States,

1979-81

[Data are based on annual one-third subsam~les of Natronal Health interview Survey household interviews of the ciwlian nonmstttutionalized pop”latio”]

All ages Under 45 years 45-64 years 65 years and over

All All All

Characteristic

All

recesz White “Black racesl White Black racesl White Black racesl White Black

Number of Dersons with known diabetes in thousands

Totalz . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . .

Education of individuals

Leas than 12 years . . . . . . . . . . . . .

12yeara or more . . . . . . . . . . . . . . .

Marital statuss

Married . . . . . . . . . . . . . . . . . . . . . .

Formerly married . . . . . . . . . . . . . . .

Never married . . . . . . . . . . . . . . . . .

Living arrangement

With spouse . . . . . . . . . . . . . . . . . .

With relatives . . . . . . . . . . . . . . . . .

With nonrelatlves. . . . . . . . . . . . . .

Living alone . . . . . . . . . . . . . . . . . . .

Family income4

Less than $7,000 . . . . . . . . . . . . . .

$7,000-$ 9,999 . . . . . . . . . . . . . . .

310,000-$14,999 . . . . . . . . . . . . .

$15,000-$24,999 . . . . . . . . . . . . .

$25,0000 r more . . . . . . . . . . . . . . .

Location of residence

SMSA5 . . . . . . . . . . . . . . . . . . . . . . .

Central ctty . . . . . . . . . . . . . . . . .

Outside central city. . . . . . . . . . .

Outside SMSAs . . . . . . . . . . . . . . . .

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . .

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

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

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

5.129

2,357

3,072

2,861

2,435

3,510

1,520

346

3.464

963

89

913

1,453

585

828

952

1,190

3,604

1,684

1,920

1,825

1.205

1,415

1,981

827

4,512

2,011

2,501

2,259

2,143

3,030

1.163

273

3,000

712

63

737

1,134

519

655

833

1,063

2,896

1,110

1,786

1,616

1,068

1,228

1,516

700

834

305

529

572

240

409

348

71

394

247

*26

167

312

66

150

107

99

638

532

107

195

135

170

448

81

900

370

530

251

586

573

117

158

565

261

●26

49

153

89

87

242

332

613

276

338

287

181

253

309

158

730

302

429

178

497

488

70

126

483

194

●2O

●34

116

63

59

202

307

478

167

311

252

161

222

215

133

163

65

99

73

82

79

47

●32

76

67

●5

●15

37

●6

“27

40

●25

131

107

● 24

“33

“19

“27

95

●23

2,406

1,146

1,259

1,190

1,191

1,741

554

111

1,720

340

’30

316

470

254

396

417

643

1,611

789

872

745

533

627

914

332

1,942

954

988

103

1,018

1,487

379

76

1,476

229

●19

218

296

207

307

378

555

1,291

499

791

652

451

519

710

262

408

164

244

270

133

205

171

*32

195

111

811

91

166

47

77

“34

60

322

262

60

86

80

94

191

43

2,123

840

1,283

1,421

659

1,196

850

77

1,179

363

“33

548

830

263

346

293

216

1,330

619

711

793

491

536

758

337

1,839

755

1,084

1,177

627

1,055

714

71

1,041

289

●24

485

722

250

289

253

201

1,128

444

684

712

456

487

591

305

262

76

186

229

“24

125

131

*6

123

70

*9

60

109

“13

45

“33

*14

186

163

●23

77

36

49

163

“15

1Includes all other races not shown as separate categories.

‘Includes unknown edu..xmon of mdiwdual, marital status, and famdy income.

30nly persons 17 years and over are included in the category ‘all ages.’: the category “under 45 years’. comprises paraons 17-44 years of age.

4Data are for 1981 only because Information on annual famdy income IS available only for brosd Income categories and IS techmcally dtff! cult to adlust for tnflatlon

over the 3.year ome period.

5SMSA = standard metropolitan statlst!cai area.

SOURCE: Natmnal Center for Health Stattstlcs Computed by the Divmon of Eptdemtology and Health Promotion from 1979-81 Nat!onal Health Interwew Survey dats

prowded by the Dtwsmn of Health Intewlew Statlst!cs.

tion) was three times higher than the rate among those

with 12 or more years of education (26.2 per 1,000 pop

ulation). The higher rate of known diabetes among less

educated black Americans is partly explained by the older

age composition of this group.

Among black persons, the rate of known diabetes was 84.9

per 1,000 population for the formerly married but only

13.9 per 1,000 for the never married. However, this difference is largely attributable to the fact that the formedy

married are considerably older than the never ma~le~

and increased age is strongly associated with a higher

relative likelihood of known diabetes. Once age is taken

into accoun~ the d~erence between these two marital

status categories is substantially reduced (table 3). Differences between the married and the other marital status

categories are also substantially reduced by adjustment for

variations in the age composition of these groups.

. The rate of known diabetes was about four times higher for

black persons living alone (73.2 per 1,000 population)

than for those living with their relatives (15.9 per 1,000).

QPC~ again,ther!ifferenc~ is largely explainable in terms

of age differences between these groups (table 3).
4 adwxedm

Table 2. Average annual number of persons with known diabetes per 1,000 population, by age, race, and selected sociodemographic

characteristics: United States, 1979-81

[Dataare based on annual one.thtrd subsamples of Nat!onal Health lmerwew Survey household mterwew. of the ctwllan nonmstltutmnallzed populatlcm]

All ages Under 45 years 45-64 yeers 65 years and over

All All All All

Charactermtic racasl Wh/te Black racesl White Black racesl White Black races! White Black

Totalz . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . .

Education of individual

Less than 12 years . . . . . . . . .

12years or more . . . . . . . . . . .

Maritsl status3

Married . . . . . . . . . . . . . . . . . . .

Formerly married. . . . . . . . . .

Never married . . . . . . . . . . . . .

Living arrangement

Wlthspousa, . . . . . . . . . . . . .

With relatives . . . . . . . . . . . . .

With nonrelativas . . . . . . . . . .

Living alone . . . . . . . . . . . . . . .

Family incomes

Less than $7,000 . . . . . . . . . .

$7.000-$ 9.999 . . . . . . . . . . . .

$10,000-$ 14,999 . . . . . . . . .

$15,000-$24,999 . . . . . . . . .

$25,0000 r more . . . . . . . . . . .

Location of residence

SMSAS . . . . . . . . . . . . . . . . . . .

Central icy.. . . . . . . . . . . . .

Outside central city. . . . . . .

Outside SMSA5 . . . . . . . . . . . .

Geographic region

Northeast . . . . . . . . . . . . . . . . .

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

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

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

24.7

22.2

27.0

58.1

22.2

34.0

61.6

10.4

33.9

10.3

18.3

47.2

44.5

33.7

24.6

17.2

16.4

24.0

27.9

21.4

26.2

25.0

24.4

27.5

20.0

23.8

21.9

25.6

55.0

21.8

32.4

57.3

9.9

32.3

9.4

14.8

43.8

45.5

35.0

24.1

16.6

16.0

22.9

25.1

21.7

25.6

24.8

23.5

26.3

19.2

32.3

25.5

38.1

78.3

26.2

52.8

84.9

13.9

52.4

15.9

‘54.3

73.2

42.8

30.4

29.1

22.5

23.2

32.0

37.0

19.2

33.2

28.3

32.7

33.0

35.5

Number of persons w!th known diabetes per 1,000 population

5.9

4.9

6.9

12.2

8.1

10.3

14.3

5.3

10.3

3<1

*6.3

6.2

8.1

6.2

4.7

5.8

5.8

5.9

6.7

5.3

6.1

5.6

6.3

6.2

5.4

5.7

4.7

6.6

0.7

7.9

9.8

0.9

5.1

9.8

2.8

●5.6

‘5.0

7.9

5.5

4.8

5.5

5.8

5.5

5.8

5.4

5.9

5.7

6.2

5.5

5.2

8.3

6.9

9.4

21.1

11.3

17.4

28.2

●6.9

17.3

4.8

●16.8

●15.0

9.5

●9.9

“5.1

8.9

●6.9

8.5

9.8

●5.3

‘7.5

“5.2

*6.7

9.2

“13.0

55.0

55.0

55.1

78.9

42.6

50.5

77.3

53.8

50.3

75.5

“60.9

69.6

97.3

76.2

67.3

45.6

35.0

55.4

65.3

48.6

54.3

52.1

54.7

64.5

42.3

49.8

51.1

48.7

72.1

39.4

47.1

66.5

44.2

47.1

67.0

*49.6

56.7

85.0

74.7

62.0

42.3

33.2

49.0

53.1

46.8

51.6

48.0

49.0

59.4

37.3

100.8

89.7

109.9

116.9

83.3

86.3

124.4

●106.5

83.9

113.4

“106.O

141.5

135.7

96.6

110.5

●86. 1

63.5

105.2

112.4

82.3

87.0

103.6

119.8

90.2

114.6

88.3

85.1

90.6

104.8

67.6

89.6

91.0

57.1

89.8

100.4

“111.3

78.5

100.8

83.4

84.7

79.4

99.7

85.5

86.4

84.7

93.5

85.8

85.3

97.0

80.6

64.4

84.5

84.3

99.0

67.4

85.2

87.4

55.8

85.3

95.9

●94.8

76.7

96.9

81.6

79.2

76.3

96.3

81.2

75.4

85.4

90.0

83.6

82.6

69.6

79.2

131.7

93.8

158.0

148.6

“70.4

149.3

120.9

“88.5

154.0

133.0

“201 .7

97.0

126.9

*1 13.8

174.2

●155.4

*234.6

128.2

142,0

“75.5

141.0

131.4

131.6

135.5

*101.7

I Includes all other races not shown as separate categories.

‘Includes unknown education of individual, marital status, and family income.

30nly persons 17 years and over are included in the catego~ ‘“ail ages’”; the categow ‘“under 45 years” comprises persona 17-44 years of age.

4Data are for 1981 only because Information on annual famliy income is available only for broad income categories and is techmcally difficult to adjust for in fiatmn

over the 3-year time period.

5SMSA = standard metropolitan statlst!cal area.

SOURCE National Canter for Health Statistics: Computed by the Diwston of Ep!demtology and Health Promonon from 1979-81 National Health Interwew Sutvey data

provided by the Division of Health Intarwew Statistics.

●

●

The prewdence of known diabetes per 1,000 black individuals was almost twice as high for persons in families

with amual incomes of less than $7,000 (42.8 per 1,000)

than for persons in families with annual incomes of $25,000

or more (23.2 per 1,000).

Known diabetes was relatively more prevalent among black

central city residenta (37.0 per 1,000) than among black

metropolitan area residents living outside the central city

(19.2 per 1,000). This is particularly the case among black

persons 45 years of age and over (table 2).

Black-white differences in prevalence

During the period 1979-81, the rate of known diabetes

among black persons, 32.3 per 1,000 population, was 1.4 time=

higher than the rate among white persons was, 23.8 per 1,00C

(table 2). In each of the three age categories shown in table 2,

the ratio between the rates of diabetes for black and white

persons is at least 1.4, and it is about 2.0 among persons 45-

64 years of age. Indeed, were it not for the fact that the black

population is younger than the white populatio~ the black-
adAmdda5

Tabla 3. Age-adjusted avaraga annual number of persons with known diabetes per 1,000 population and associated standard errors, by race

and selected sociodemographic characteristics: United States, 1979-81

[Data are based on annual one-third subsampies of National Health Interwew Survey household mtewtews of the cwd!an nonmst!tut,onal, zed popuiatlon]

All All

Characteristic racesl White Black races~ White Black

Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Education of individual

Less than 12 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12years ormora . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Marital statusa

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Formerly married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Never married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Living arrangement

With spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

with relatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

With nonreiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Living alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Family income7

Less than $7,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$7.mo.$9.999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$10,000-$ 14,999..,.....,......6.. . . . . . . . . . . . . . . . . . . . . . . . . . .

$15.0W.$24.999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$25,0000 rmore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location of residence

SMSA8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Central city . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Outside central city . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Outside SMSAe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

West, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age-sd)usted2 numbar of

persons with known diabetes

per 1,000 population

24.8

23.7

25.7

44.1

26.4

33.0

42.8

26.1

27.0

28.2

28.7

26.8

37.5

29.6

25.8

23.6

20.7

24.5

27.1

22.7

25.3

23.6

24.6

27.8

21.0

23.1

22.7

23.6

40.5

25.3

31.2

37.4

23.3

25.5

25.8

24.1

23.2

34.7

29.5

22.8

22,0

20.0

22.5

22.8

22.5

24.3

22.7

23.1

25.5

19.7

40.2

33.0

45.8

66.1

39.6

55.7

68.1

46.0

45.6

40.5

54.9

49.2

48.2

34.7

52.5

68.1

40.4

40.9

44.8

28.4

38.0

38.7

42.9

39.2

43.0

Standard erro~ 4 .

0.5

0.6

0.6

1.1

0.7

0.8

1.7

2.6

0.6

1.4

5.3

1.5

2.4

3.4

2.7

2.0

2.0

0.5

0.9

0.7

0.9

0.9

0.7

1.0

1.1

0.5

0.7

0.7

1.3

0.7

0.8

1.8

2.7

0.7

1.4

4.9

1.6

2.9

3.7

2.7

2.0

2.1

0.6

1.1

0.8

0.9

1.0

0.8

1.0

1.2

2.1

3.0

2.7

4.5

4.0

4.0

5.6

11.2

3.4

4.6

16.0

5.4

6.3

9.5

10.0

13.8

18.8

2.4

2.6

4.3

4.4

5.8

3.1

3.1

5.3

1Includes all other rscsa not shown as separate catG90rim.

ZAge adjusted by the direct method to the 1979-81 cwlian noninstttutmnalized population usm9 3 age 9fouPs.

3Ccmputed using :he statistical software package SESLIDAAN. See B. V. Shatx Standard Errors Program for Computing Standardized Rates Fmm Sample Survey Data.

Research Triangle Park, N.C. Research Triangle Insthute. Apr. 1981.

495-percent confidence inteiwals for the rates ahcwn can be obtained by multiplying the standard error by 1.96 and adding and subtracting the obtamsd value from

the observed rate.

51ncludes unknown education cf individual, marital statua, nnd family income.

60nty Pemona 17 Yearn and ever are inciudad in the categov ,-*11 ages..; the categOV ..u”der 45 yeats’. Comprcms perscns 17-44 yeare Of age.

7Data are for 1981 ~nly bacau~a infomatic” on annuaI famt{~ income is available only for broad income categories and !S techmcaliydlfflcult10ad)ustfor inflatlonover

tha 3-yaar time period.

e$jMSAs standard metropolitan statistical area.

SOURCE National Center for Health Statistics Computed by tha Division of Epidemiology and Health Promotion fmm 1979-81 Nstlonal Health Int.mwew Survey dsta

provided by the Division of Health Interview Statistics.

white differences would be even larger than observed This is relative likelihood of known diabetes among black individuals

easily seen by comparing the differences between the unadjusted is pervasive. With the exception of metropolitan area residents

rates for black and white persons in table 2 with the differences outside the central city and persons in families with annual

between the age-adjusted rates in table 3. incomes of less than $10,000, irrespective of the categoty

The black-white difference in the relative fkequency of examined, black individuals have a higher rate of known diaknown diabetes is not explained by variations in the social betes than white persons have (table 2). This is tme even when

composition of the black and white populations. The greater black-white differences are viewed simultaneously by educa-
6 aduamx<zi

tion and geographic characteristics ( as in table 4) or by education and income (as in the figure).

Also highlighted in the figure is the fact that family income

differences in the relative frequency of known diabetes among

black persons 17 years of age and over, but not among similarly

aged white individuals, are largely explained by differences in

educational attainment When education is controlled (by comparing family income variations in the relative frequency of

known diabetes within educational categories), there is no relationship between family income and the rate of known diabetes among black persons 17 years and over. Among white

individuals in this same age span, however, the relative frequency of known diabetes varies inversely with family income

even when education is controlled.

Change in prevalence among black

Americans

Although there has been a general increase in the prevalence of known diabetes over the past 22 years, the percent

increase in both the number and the rate of known diabetes has

been greater for black persons than for white persons. From

1963 to 1985, the number of white persons with known diabetes increased by 2% times (table 5), and the rate increased

twofold (table 6). During this same 22-year period, there was a

fourfold increase in the number of black Americans with known

diabetes (table 5), and there was a threefold increase in the rate

(table 6).

Among black Americans, the change in the prevalence of

known diabetes from 1963 to 1985 varied slightly by age

(table 6). Black individuals under age 45 had the smallest increase those 45-64 years of age, a slightly greater increase;

and those 65 years and over, the greatest increase. The change

in prevalence among black persons differs from the change

among white Persons, for whom less variation by age is seen.

Perhaps the most interesting tinding that can be gleaned

from the data in table 6 is the fact that only in the past 15 years

has the overall ratio of the black and white rates of known

diabetes clearly exceeded 1.0. Moreover, during the 1963-68

time period, when the relative frequency of known diabetes for

black persons was similar to that for white persons, there were

offsetting trends among males and females. Throughout the 22-

year period for which data are shown in table 6, black females

had higher observed rates of known diabetes than white females had.

For males, however, the reverse was true. During the

period 1963-67, black males had lower rates of known diabetes than white males had. Not until 1975 is the observed rate

for all black males slightly higher than the observed rate for all

white males.

Age variations in this crossover pattern, as well as the

timing of the crossover, are difficult to assess, however, for two

reasons—the lack of precision in the estimates for black males

and the lack of individual-year data for the period 1969–72.

Nonetheless, it appears that the rates for black males in their

middle years converged with those for middle-aged white males

around 1964, and the rates for younger and eider black males

appear m have converged with those for similarly aged white

males in the late 1960’s.

Concluding remarks

In this brief repo~ black-white differentials in the prevalence of known diabetes in the United States are documented.

Information showing that the change in the relative frequency

of known diabetes in the United States over the past 22 years

Table 4. Age-edjusted avarage enrrual numbar of persons 17 years and over with known diabetes per 1,000 population, by education of

individual, race. and selected geographic characteristics: U nitad States. 1979-81

[Data are based on annual one-third subsamples of National Health Interview Survey household intetwiewa of the civilien noninstitutionalized population]

Education of individual

All years of education Less than 12 years 12 years or more

All All All

Characteristic races~ White Black races~ White Black raced White Black

Age-adjustedz number of persons with known diabetes per 1,000 population

Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33.3 31.0 55.3 44.1 40.5 66.1 26.4 25.3 39.6

SMSA4 location of residence

Central ity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36.5 30.5 61.3 49.0 40.6 74.6 28.4

Outside central city . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.4

25.0 44.6

30.1 39.0 40.6 39.7 46.5 25.5 25.4 28.2

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.8 30.4 53.1 41.4 38.5 69.1 25.2 24.7

North Cantrai . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36.0

33.1 31.0 59.3 42.8 38.6 76.8 27.8 26.8 45.3

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.4 34.1 53.8 49.5 45.4 63.9 27.5 26.5 33.0

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28.3 26.5 59.2 37.0 36.0 54.8 24.2 22.2 48.5

1Includes all other races not shown m separate categonea.

‘Age adjusted by the dtrect method to the 1979-81 cwllia” nonmstnutionalized population of persons 17 ysars and over uamg 3 age groups.

3krcludea persona residing outside standard metropolitan statistical areas.

4SMSA = standard metropolitan statmtical area.

SOURCE National Center for Health Statmtms Computed by the Dwla,on of Epdemlolog’f and Health Promotion from 1979-81 National Health Irrterwew Suwey data

prowded by the Divmon of Health Interview Stat\$wx.
ackme&a7

80

70

60

50

40

30

20

10

0

Less than 12 years of educatton

T

Less than $10,000

Family income

$10$000 or more

al

G

a

80 -

70

60

50

40

30

20

10

0

12 years of education or more

❑ White

❑ Black

Less than $10,000 $10,000 or more

Family income

lAge adjusted by the direct method to the 1979-81 crwlmn noninst!tutlonalized population 17 years and over using 3 age groups.

NOTE: Confidence Intervals are the rate plus or mgnus the standard error of the rate.

SOURCE: Nattonal Center for Health Staustlcx Compu!ed by the Dwmon of Epldem!oiogy and Health Pmmotlon from 1979-81 National Health Intemtew

Survey data prowded by the Dr.won of Health Imerwew Statwt(ca.

Figure. Average age-adjusted’ number of known diabetes per 1,000 persons 17 yams snd over, by race, family income, and education of

individual: Unitad States, 1979-81

has been greater for black than for white Americans is also

presented, So far as we know, the crossover in black-white

rates of known diabetes among males, which took place during

the period 1968-75, is identified here for the first time. A

number of questions requiring further study are raised by these

findings.

Why are the rates of known diabetes higher for black

persons than for white persons? The differential does not appear

to be a result simply of age and other sociodemographic differences between white and black individuals. The black sub

population is actually younger than the white subpopulation.

Were it not for this fac~ black-white differentials in rates of

known diabetes would be even larger than those currently observed. Moreover, irrespective of which sociodemographic category one examines, the rate of known diabetes for the group is

generally higher for black than for white individuals. If soci~

demographic factors do not account for the higher rate of known

diabetes among black individuals, what does?

A frequent answer is that black persons are more likely

than white persons to have non-insulin-dependent diabetes, for

which persistent obesity is a major risk factor.g Black persons,

particularly females, are more likely than white persons to be

obese and are therefore at greater risk of becoming diabetic.

Researchers who have examined this interpretation have generally found that obesity does indeed play a major role in the

etiology of non-insulin-dependent diabetes among black AmeriC811S.7 However, hcause of limi~tions of ~~t studies of ob~

sity as a risk factor for non-insulindependent diabetes,14 better

studies of black Americans’ risks of becoming diabetic are

clearly needed

What is the explanation for the change in the prevalence of

known diabetes among black Americans over the past 22 years?

This particular change is part of a long-term increase in the

prevalence of known diabetes in the generaI U.S. population

that has extended over the past 50 years. Although a definitive

study of the reasons for this secular trend has yet to be undertaken, explorations of the reasons for the overaIl trendls,lb shed

some light on the change in the prevalence among black Americans.

The prevalence of known diabetes at the end of a year

reflects both the number of new cases of diabetes identified

during the year and the number of previously diagnosed cases

that have survived to the end of the year. There are some data

to support the view that identification of new diabetes cases

was the major reason for the increase in the prevalence of

known diabetes during the 1960’s but that improvements in

survivorship have been the major factor for the increase during

the past 12 years. The confluence of aggressive screenin~

greater medical care access, and better methods of detection

appears to be the major source of new cases of known diabetes

during the 1960’s. Because cardiovascular diseases are major

causes of death among diabetics, improvements in survivorship
8 acktncedata

Table 5. Number of persons with known diabetes, by sex, race, age, and setwcted time periods: United Statas, 1963-85

[Data are based an household int.ervlews of the Cwl,an non!nstmx,onahzed pop.latton]

Both sexes Male Female

All All All

Age and time perfod~ races2 Wh{te Black races2 White 81ack races2 Whrte Black

All ages

FY 1963, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1964 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1965, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1967 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 19683 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1973 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1979 -81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1982 -65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 45 years

FY 1963 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1964 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1965 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1967 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 19683 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1973 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1979 -81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1982 -85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 yeara

FY 1963 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1964 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1965 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1967 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 19683 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1973 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1979- 61 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1982 -85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over

FY 1963, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1964 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1965, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1966, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1967 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 19683 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1973 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1979-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1982 -85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,101

2,313

2,385

2,772

3,091

3.175

4,191

4,780

4,377

5,429

5,870

356

435

415

507

571

569

789

847

790

900

1,076

942

992

1,033

1,174

1,339

1,371

1,813

2,166

1,895

2,406

2,439

803

887

938

1,091

1,181

1,236

1,589

1,767

1,692

2,123

2,445

Number of persons w!th known dtabetes In thousands

1,856

2,030

2,076

2,453

2.703

2,781

3,570

4,040

3,724

4,512

4,751

312

370

361

453

491

486

650

697

662

730

899

804

850

881

1,007

1,134

1,173

1,518

1,801

1,576

1,942

1,887

740

811

834

993

1,078

1,122

1,402

1,542

1,486

1,839

2,037

228

256

277

304

355

372

585

704

599

834

1,015

41

53

42

51

71

80

133

146

115

163

165

131

129

140

163

161

178

282

349

408

492

56

75

95

90

103

114

171

209

184

262

376

930

964

996

1,190

1,273

1,343

1,620

2,028

1,871

2,357

2,474

181

176

196

244

218

263

295

362

318

370

467

439

432

431

551

628

564

819

983

881

1,146

1,107

310

354

369

394

426

516

506

684

673

640

939

853

685

903

1,085

1,145

1,202

1,446

1.763

1,605

2,011

2.080

167

163

176

226

199

237

254

302

275

302

401

395

392

389

495

553

497

731

859

752

954

886

291

330

339

365

393

468

461

602

578

755

819

70

69

79

93

115

133

166

248

233

305

357

“14

“12

“13

*16

●19

●26

39

58

39

65

63

40

●34

42

54

63

59

86

114

113

164

198

*16

●23

●23

“24

●33

48

40

76

81

76

109

1,171

1,349

1,389

1,583

1,818

1,832

2,571

2,752

3,117

3,072

3,396

175

256

219

263

352

306

494

485

472

530

609

503

560

602

623

710

807

993

1,183

1,014

1,259

1,332

493

533

568

696

755

725

1,083

1,083

1,019

1,283

1,505

1,003

1,144

1,173

1,368

1,558

1.579

2,124

2,277

2,119

2.501

2,671

144

206

186

226

291

249

395

395

386

429

499

409

457

492

512

582

677

787

942

824

988

1,001

449

481

495

628

684

653

941

940

908

1.084

1,218

158

187

198

211

240

239

420

456

366

529

658

●28

41

●29

36

52

54

94

88

76

99

102

91

94

97

109

118

118

196

236

187

244

293

39

52

72

66

70

67

130

133

104

186

267

1CY = calendar year. FY = fiscal year.

21ndudes all other races not shown as separata Categories.

3CY 1968 data are for July-Oammber OnlY.

SOURCE National Centar for Health Statistics Computed by the Oiws!on of Epidamlology and Health Promotion from 1963-85 Nat!onal Health Interwew Survey data

provided by the Divwlon of Health Interview Statistma.

among diabetics during the past 15 years are clearly linked to extent to which the crossover in black and white rates of known

the general decline in coronary heart disease and stroke mor- diabetes (which appears to have taken place among males

tality since 1970. Evaluation of how adequately this interpre- during the period 1968-73) is explainable within this same

tation of the generaI increase in the prevalence of known dia- framework.

betes accounts for the change in the prevalence among black To what extent does the change in the prevalence of known

Americans has yet to be conducted. Also in need of study is the diabetes among black Americans mean that a reservoir of un-
acklncedata 9

Table 6. Number of persons with known diabetes per 1,000 population, by sax, race. age, and selected time periods: United States, 1963-85

[Data are based m household intewlews of the cwd$an nonmstnuttonalned Dowlatmn]

Both sexes Mele Female

All Ail All

Age and time periodr racesz White Black ra ce# White Black races2 White Black

All ages

FY 1963 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1964.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1965 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1966.......................,.. . . . . . . . . . . . . . . . . . .

W 1967 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY1968S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1973 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1979-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1982 -85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under45 yeara

FY 1963 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1964 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1965 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

W 1967 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 19683 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1973 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1979-61 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1962-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 yeere

FY 1963 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1964 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1965 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1967 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 19683 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1973 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1975, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1979-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1982 -85, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over

FY 1963 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1964 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1965 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FY 1967 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 19683 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1973 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1979-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CY 1982 -85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.5

12.5

12.7

14.5

16.1

12.6

20.4

22.9

20.8

24.7

25.5

2.8

3.3

3.1

3.8

4.2

3.1

5.5

5.9

5.4

5.9

6.6

25.5

26.4

2’1.0

30.3

34.1

28.5

42.5

50.3

43.8

55.0

55.1

47.6

52.1

54.2

62.1

66.1

60.2

78.5

83.0

77.6

88.3

93.3

Number of persons with known diabetes per 1,000 population

11.5

12.4

12.5

14.6

16.0

12.6

19.9

22.2

20.4

23.8

24.1

2.8

3.2

3.1

3.9

4.2

3.1

5.3

5.6

5.3

5.7

6.6

24.0

24.9

25.5

28.7

31.9

26.9

39.6

46.6

40.7

49.8

48.3

47.6

51.6

52.3

61.3

65.5

59.3

75.9

79.7

75.2

84.4

86.0

11.7

12.7

13.8

14.6

16.9

13.1

24.7

28.9

24.1

32,3

36.9

2.8

3.4

2.7

3.2

4.4

3.5

7.3

7.9

6.1

8.3

7.7

40.6

38.8

42.2

47.7

53.7

42.9

72.5

87.3

73.0

100.8

114.9

46.2

61.5

77.2

69.6

77.4

74.6

101.8

114.3

97.9

131.7

172.9

10.5

10.7

10.9

12.9

13.7

11.0

16.3

20.1

18.4

22.2

22.2

2.9

2.8

3.0

3.7

3.3

2.9

4.2

5.1

4.4

4.9

5.8

24.6

23.8

23.4

29.7

33.4

24.4

40.6

47.8

42.7

55.0

52.6

41.3

46.9

48.6

51.3

54.9

58.3

60.3

77.9

75.1

85.1

87.7

10.9

11.1

11.2

13.3

14.0

11.2

16.6

20.0

18.1

21.9

21.8

3.0

2,9

3.1

3.9

3.5

3.0

4.2

4.9

4.4

4.7

5.9

24.4

23.8

23.3

29.3

32.4

23.7

40.1

46.4

40.5

51.1

47.3

42.1

47.6

48.4

51.6

55.2

57.8

60.5

75.9

71.4

84.5

84.5

7.6

7.2

8.3

9,4

11.6

9.8

15.0

21.8

20.1

25.5

28.0

●1 .9

*1.6

●1.8

“2.0

●2.5

●2.4

4.5

6.6

4.3

6.9

6.2

26.2

“22.0

27.5

34.0

40.6

31.0

48.8

62.6

60.3

89.7

104.9

“29.8

“41 .8

●42.5

●42.0

“55.0

66.6

56.6

96.6

100.9

93.8

125.6

12.4

14.1

14.3

16.1

18.3

14.0

24.1

25.4

23.0

27.0

26.5

2.7

3.8

3.2

3.8

5.1

3,3

6.8

6.6

6.4

6.9

7.5

26.3

28.8

30.4

31.0

34.7

32.3

44.4

52.5

44.8

55.1

57.3

52.7

56.2

58.7

70.4

74.8

61.6

91.3

86.6

79.4

90.6

97.2

12.6

13.6

13.7

15.8

17.8

13,8

22.9

24,3

22.5

25.6

26.4

2.5

3.6

3.2

3.8

4.9

3.1

6.4

6.4

6.2

6.6

7.3

23.7

26.0

27.5

28.2

31.5

30.0

39.2

46.7

40.8

48.7

49.2

51.9

54.8

55.3

68.7

73.4

60.5

86.7

82.4

77.8

84.3

87.0

15.5

17.6

18.8

19,2

21.6

16.0

33.2

35.0

27.6

38.1

44.6

‘3,5

5.0

‘3.6

4.2

6.1

4.6

9.8

9.0

7.7

9.4

9.1

53.4

53.7

54.9

59.7

64.9

53.2

92.2

107.9

83.7

109.9

122.8

59.6

77.7

104.4

91.7

95.6

79.5

135.1

127.7

95.7

158.0

204.1

1CY = calendar year. FY = fiscal year,

Zlncludes ail other races not shown as separate cate90ries.

3CY 1968 data are for July-December OnlY,

SOURCE Nat!onal Center for Health Stattstic= Computed by the Divmon of Eptdemlology and Health Promotion from 1963-85 Nauonal Health Imerwaw Survey data

prowded by the Dwmon of Health Interwew Statistics.

diagnosed diabetes is slowly being exhausted by improved change in the “true” prevalence. From this perspective, a

methods of detection? If one views the “true” prevalence of change in the prevalence of known diabetes means simply that

diabetes in the population at any point in time as the sum of a change has occurred in the ratio of diagnosed to undiagnosed

persons with diagnosed diabetes and persons with undiagnosed diabetes. Has something akin to this happened historically

diabetes, it is conceivable that a change in the prevalence of among black Americans?

diagnosed diabetes could take place even though there was no A definitive answer to this question would require histor-
10 achmncecbta

ically comparable, replicated measurements of the prevalence

of diagnosed and undiagnosed diabetes among black Americans for the past 22 years. Unfortunately, the estimates of

diagnosed and undiagnosed diabetes from the second National

Health and Nutrition Examination Survey (NHANES II) are

the first estimates available for a national probability sample of

U.S. adults. Moreover, earlier estimates17 are not comparable

with the NHANES H assessments in at least three respects:

(1) Earlier estimates of the total prevalence of diabetes were

based on selected community samples, (2) the methods of

ascertainment used were less sensitive than the 2-hour 75-gram

oral glucose tolerance test used in the NHANES H suwey,

and (3) estimates were never published for different racial categories of the population.

From earlier estimates of the total prevalence of diabetes

in selected communities, it appears that the ratio of diagnosed

to undiagnosed diabetes was about 1 to 1.17 The NHANES II

estimates for 1976-80 indicate that, among black Americans,

there was about one undiagnosed diabetic for evexy diagnosed

one. 18Therefore, it would appear that the change in the prevalence of known diabetes among black Americans over the

past 22 years is not simply the result of a change in the ratio of

diagnosed to undiagnosed diabetes. It is conceivable, of course,

that the less sensitive methods of case ascertainment used in

the earlier surveys produced underestimates of the ratio of

diagnosed to undiagnosed diabetes. If the ratio of diagnosed to

undiagnosed diabetes among black people was historically

much higher than the ratio found in NHANES II, then observed

trends in known diabetes among black Americans might reflect,

to some exten~ a change in the ratio. Further study of this issue

is clearly needed. It is hoped that data that shed some light on

stability or change in this ratio during the period 1976–93 can

be collected in the 1988-93 National Health and Nutrition

Examination Survey, which is currently being planned.

Readers interested in pursuing these and related questions

about diabetes among bIack Americans might well begin by

consulting summaries of extant information that have recentiy

appeared in government and other publications. g.lo.lg-z!
akmecaa 11

References

Ipub]i~Health Service, Division of Public Health Methods, L. E.

Who Diabetes reported in interviews, United States, July 1957-June

1959. Health S!atisrics From the U.S. iVatiotrai Health .Survey.

Series B. No. 21. pub. No. (PHS) 584-B21. Washington. U.S. Government Printing OffIce, Sept. 1960.

~Na[ional Center for Health Statistics, M. L. Bauer Characteristics of

persons with diabetes, United States, July 1964-June 1965. Vita/

and Health Sraristics. Series 10, No. 40. (PHS) Pub. No. 1000.

Public Health Service. Washington. U.S. Government Printing Otlice,

Oct. 1967.

~Nationai Center for Health Statistics, G. SCOtt Prevalence of chronic

conditions of the genitourinary, nervous, endocrine, metabolic, and

blood and blood-forming systems and of other selected chronic conditions. United States, 1973. Vi/a/ and Health Statistics. Series 10,

No. 109. DHEW Pub. No. (HRA) 77-1536. Health Resources Administration. Washington. U.S. Government Printing 0t17ce, Mar.

1977.

~National Institutes of Health Report of the National Commission on

Diabetes to the Congress of the United States, VoIume 111,Reports of

Committees, Subcommittees, and Workgroup, Parr 1, Scope and

Impact on Diabetes(1). DHEW Pub. No. (NIH) 77-1021. Bethesda,

Md., 1977.

‘National Institute of Arthritis, Metabolism, and Digestive Diseases,

National Diabetes Data Group: Diabetes Data, Compiied 1977.

DHEW Pub. No. (NIH) 78-1468. National Institutes of Health.

Washington. U.S. Government Printing Office, 1978.

6National Center for Health Statistics, T. F. Drury, M. Hams, and L.

E. Lipsetc Prevalence and management of diabetes. Health, United

Stares, 1981. DHHS Pub. No. (PHS) 82-1232. Public Health Service. Washington. U.S. Government Printing Otlice, Dec. 1981,

pp. 25-31.

7G. S. Bonham and D. W. Brock The relationship of diabetes with

race, sex and obesity. Am. J. Ciin. Nutr. 41:776-783, 1985.

SNational Institutes of Health, J. M. Rosemam Diabetes in Black

Americans, in Diabetes in America. NIH Pub. No. 85-1468. Washington. U.S. Government Printing OffIce, Aug. 1985, pp. VIII-l-24.

9U.S. Department of Health and Human Servicex Repofi of [he Secretaqv ’s Task Force on Black and Minori(v Health, Vo[ume z Executive Summary. Washington. U.S. Government Printing OfFice,

AUS. 1985, pp. 107-128.

*“U.S. Depantttent of Health and Human Services Report of the Secretaty > Task Force on Black and Minority Health, Volume VI~

Chemical Dependency and Diabetes. Report of the Subcommittee on

Diaberes. Washington. U.S. Government Printirig Oflice, JarL 1986,

pp. 214-229.

“National Center for Health Statistics, S. S. Jack and P. W. Riex

Current estimates from the Health Interview Survey, United States,

1979. Vita{ and Health Statistics. Series 10, No. ]36. DHHS Pub.

No. (PHS)81- 1564, Public Health Service. Washington. U.S. Government Printing Office, Apr. 1981.

12National Center for Health Statistics, S. S. Jaclc Current estimates

from the National Health Interview Survey, United States, 1980.

Vital and Hea/th Statistics. Series 10, No. 139. DHHS Pub. No.

(PHS) 82-1567. Public Health Semite. Washington. U.S. GovernmentPrinting Office, Dec. 1981.

IsNational Center for Health Statistics, B. Bloom: CUrrent eStiI’Oates

from the National Health Interview Survey, United States, 1981.

Vital and Health Statistics. Series 10, No. 141. DHHS Pub. No.

(PHS) 82-1569. Public Health Service. Washington. U.S. Government Printing OffIce, OCC 1982.

14K. FIegak E’idemio[ogicai Studies on the Relationship Between

Diabetes and Obesity in Human Popuiatiotss: A Review, of rhe Literature. Repon prepared for National Institutes of Health. Ithaca, N.Y.

Cornell University, Division of Nutrttional Sciences, Mar. 1979.

‘SM. Hams: The Prevalence of Diagnosed Diabetes, Undiagnosed

Diabetes, and Impaired Glucose Tolerance in the United States, in J.

S. Melish, J. Hanna, and S. Baba, eds., Genetic Environmental Interaction in Diabetes A4eIlitus. Amsterdam. Excerpts Medics, 1981,

pp. 71-76.

lbNational Center for Health Statistics, T. F. DrurY The change in

the prevalence of known diabetes in the United States: 1935-85. Advance Data From Vital and Hea[th Statistics. Public Health Service.

Hyattsville, Md. To k published.

17Q. R Remeim A current estimate of the prevalence of diabetes melIitus in the United States. Ann. N. K Acad. Sri. 82:229-235, 1959.

18National Institutes of Health, M. 1. Harrk Prevalence of Noninsulin-Dependent Diabetes and Impaired Glucose Tolerance, in

Diabetes in America NIH Pub. No. 85-1468. Washington. U.S.

Government Printing Office, Au~ 1985, pp. VI-l-39.

19National Center for Health Statistics, T. F. Drury and A. L. Powell:

Prevalence, impac~ and demography of known diabetes in the United

States, Advance Data From Vital and Health Statistics. No. 114.

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

Md, Feb. 12, 1986.

20A. S. Krolewski and J. H. Warranx Epidemiology of Diabetes Me[-

litus, in A. Marble et al., eds., Joslin’s Diabetes Mel[itus, 12th ed.

Philadelphia. Lea and Febiger, 1985, pp. 12-42.

21National Center for Health Statistics, W. C. Hadden and M. I.

Harrk Prevalence of diagnosed diabetes, undiagnosed diabetes, and

impaired glucose tolerance in adults 20-74 years of age. Vital and

Heaith Statistics. Series 11, No. 237. DHHS Pub. No. 87-1687.

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

Feb. 1987.

22National Center for Health Statistics, J. G. Collins Prevalence of

selected chronic conditions, United States, 1979-81. Vital and Hea[th

Statistics. Series 10, No. 155. DHHS Pub. No, (PHS) 86-1583.

Public Health Setvice. Washington. U.S. Govemrnent Printing OffIce,

hdy 1986.
12 advana?data

Technical notes

The data presented in all tables in this report were derived

from household interviews of the National Health Interview

Survey. These intetwiews were conducted in a probability

sample of the civilian noninstitutionalized populatio-n of the

United States. From July 1963 through June 1968, information on the prevalence of known diabetes was collected each

year from the full NHIS sample. After 1968, however, similar

information was collected from the full NHIS sample only in

1973, 1975, and 1976. During the period 1978-81, information on the prevalence of known diabetes was collected in

NHIS from a one-third subsample of respondents. Since 1982,

however, this information has been obtained from only a onesixth subsample of respondents.

Because the estimates shown in this report are based on a

sample of the population, they are subject to sampling error. In

table I, standard errors for 1979-81 estimates of the number of

persons with known diabetes (shown in tables 1 and 2 of this

report) are given. Standard errors appropriate for percents,

including the percent of persons with known diabetes during

1979-81 (which can be derived from the data shown in

table 2) are given in table II. Standard errors for data prior to

1979, as well as standard errors for 1982 and later data, are

available in published sources. 1-3.22The standard errors for the

age-adjusted rates shown in table 3 of this report are not available elsewhere and have therefore been shown in that table.

Estimates of diabetes based on household reports are limited to conditions individuals know about and are willing to

report Moreover, although it is widely recognized that the

temn “diabetes mellitus” refers to a heterogeneous group of

disorders characterized by glucose intolerance, it is not possible to routinely tabulate National Health Interview Sumey

diabetes data to identify different types of diabetics. Because it

Table 1. Standard errors of estimates of aggregates based on

one-third subsample of National Health Interview Suwey, 1979-81

Standard error

-%?e of estimates m rhousands in thousands

35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

100...................................... 113

300 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5’7

5.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

10.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

20.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

30.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27:3

150,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393

Table Il. Standard errors. expressed in percentage points, of

aatimated percents based on one-third sub sample of National Health

Interview Survay, 1979-81

-—

Estimated percents

Base of percents 2 or 5 or 10 or 30 or

in thousands 98 95 90 70 50

200 . . . . . . . . . . . . . . . . . . . . . . . 1.8 2.8 3.8 5.9 6.4

300 . . . . . . . . . . . . . . . . . . . . . . . 1.4 2.0 3.1 4.8 5.2

400 . . . . . . . . . . . . . . . . . . . . . . . 1.2 1.9 2.7 4.1 4.5

500 . . . . . . . . . . . . . . . . . . . . . . . 1.1 1.8 2.4 3.7 4.0

1,000 . . . . . . . . . . . . . . . . . . . . . 0.8 1.2 1.7 2.6 2.9

2.000 . . . . . . . . . . . . . . . . . . . . . 0.6 0.9 1.2 1.8 2.0

5,000 . . . . . . . . . . . . . . . . . . . . . 0.4 0.6 0.8 1.1 1.3

10.OOO . . . . . . . . . . . . . . . . . . . . 0.3 0.4 0.5 0.8 0.9

20,000 . . . . . . . . . . . . . . . . . . . . 0.2 0.3 0.4 0.6 0.6

30,000 . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.3 0.5 0.5

50.000 . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.2 0.4 0.4

is estimated that general population samples contain mainly

non-insttlindependent diabetics, one should be cautious in

generalizing the descriptions in thk report to insulin-dependent

NOTE: A list of references foilows the text diabetics.

---

. . .

0.0

z

●

#

Symbols

Datanot available

Category not applicable

Quantity zero

Quantity more than zero but less

than 0.05

Quantity more than zero but less

than 500 where numbers are

rounded to thousands

Figure does not meet standad of

reliability or precision

Figure suppressed to comply with

confidentiality requirements

“U.S. Govmrnant PrintingOfticsc1093 — 301 -019/S4023
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 6.

SERIES 10,

SERIES 11,

SERIES 12.

SERIES 13.

Programs and Collection Procedures –These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the

methods used to collect and process the data, definitions,

and other material necessaty for understanding the data.

Data Evaluation and Methods Research –These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies

also include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

Analytical and Epidemiological Studies–These reports

present analytical or interpretive studies based on vital and

health statistics.These reports carry the analyses furtherthan

the exposito~ types of reperk in the other series.

Documents and Committee Reports–These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

International Vital and Health Statistics Reports-These

reports are analyticalor descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

Cognition and Survey Measurement–These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

Data From the National Health Interview Survey-These

reports contain statistics on illness unintentional injuries;

disability use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey–

Data from direct examination, testing, end measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributionsof the population with respect to

physical, physiological, and psychological characteristics,

and (2) analyses of trends and relationships among various

measurements and between survey periods.

Data From the Institutionalized Population Surveys –

Discontinued in 1975. Reports from these surveys are

included in Series 13.

Data From the National Health Care Survey– These

reports contain statisticson health resources and the public’s

use of health care resources including ambulatory, hospital,

and longterm care services based on data collected directly

from health care providers and provider records.

SERIES 14.

SERIES 16.

SERIES 16.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

SERIES 24.

Data on HeaIth Resources: Manpower and FacIl[tles–

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

Data From Special Surveys – These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

Compilations of Advance Data From Vital and Health

Statistics –Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reporta in Series 10-13.

Data on Mortality–These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

Data on Natality, Marriage, and Divorce–These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

Data From the National Mortality and Nata[ity Surveys–

Discontinued in i 975. Reports from these sample surveys,

based on vital records, are now pub!ished in Series 20 or 21.

Data From the National Survey of Family Growth –These

reports contain statistics on factors that affect birth rates,

including contraception, infertility, cohabitation, marriage,

divorce, and remarriage; adoption; use of medical care for

family planning and infertili~ and re!ated maternal and infant

health topics. These statistics are based on national surveys

of childbearing age.

Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy–

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National vital

StatisticsSystem that were published as supplements to the

Monthly VitalStatisticsRepoti (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vita/ Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reporLsin Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact

Date Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

Public Health Service

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782

(301) 438-8500
DEPMTMENT OF

HEALTH & HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

6525 Belcrest Road

Hyattsville, Maryland 20782

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