Vitaland

HealthStatistics

Advance Data

From Vital and

Health Statistics:

Numbers 11–20

Series 16:

Compilations of Advance Data From

VNal and Health Statistics

No, 2

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

age and other variables on pregnant workers; ambulatory medical care;

weight and height; episodes of persons injured; and exercise and sports

participation, Estimates are based on the civilian noninstitutionalized

population of the United States. These reports were originally published in 1977

and 1978,

US. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

Hyaftsville, Maryland

October 1989

DHHS Publication No. (PHS) 90-1861
All material appearing in thk repori is in the public domain and may be

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

appreciated.

suggestedCita60n

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

statistics: nos 11–20. National Canter for Heaith Statistics. Vital Health Stat

16(2). 1969,
National Center for Health Statistics

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

Robert A. Israel, Deputy Director

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

and Epidemiology

Gail F. Fisher, Ph.D., Associate Directorfor Planning and

Extramural Programs

Peter L. Hurley, Associate Director for Vital and Health

Statistics Systems

Stephen E. Nieberding, Associate Director for Management

Charles J. Rothwell, Associate Director for Data Processing

and Semites

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

and Methodology

Division of Vital Statistics

John E. Patterson, Director

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

Robert Bilgrad, Special Assistant to the Director

Robert J. Armstrong, Actuarial Adviser

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

Branch

Robert L. Heuser, Chiej Natality St&”sticsBranch

Robert L. Heuser, Acting Chiej Marriage and Divorce

Statistics Branch

George A. Gay, Chiej Registration Methods Branch

William F. Pratt, Ph.D., Chiej Fami/y Growth Survq

Branch

Ronald Cha.mblee, Chie~ Technical Services Branch

Mabel G. Smith, Chie$ Statistical Resources Branch

Joseph D. Farrell, Chiej$ Systems and Programming

Branch
Pregnant Workers inthe United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 11

Ambulatory Medical Care Rendered in Physicians’ Office* United States, 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 12

Ambulato~ Medical Care Rendered in Pediatricians’ Offices During 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 13

Weight by Height and Age of Adults 18-74 Yearx United States, 1971–74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 14

National Ambulatory Medical Care Survey of Visits to General and Family Practitioners,

January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 15

Office Visits to Internists National Ambulatory Medical Care Survey, United States, 1975 . . . . . . . . . . . . . . . . . . No. 16

Access to&nbulatory Health Carti United States, 1974 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 17

Episodes of Persons Injured United States, 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 18

Exercise and Participation in Sports Among Persons 20 Years of Age and Over: United States, 1975 . . . . . . . . . No. 19

Office Visits to Obstetrician-Gynecologist* National Ambulatory Medical Care Survey, United States, 1975 . . . No. 20

,..

Ill
FROM VITA~& HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

US. DEPARTMENT OF HEALTH, EDJCATION, AND WELFARE I No. 11 Sept. 15, 1977 I Public Health Serwce. Health Resources Admln!stratlon

Pregnant Workers in the United States’

Of about 3,034,000 women who had a live

birth during a 12-month period in 1972-73, an

estimated l,260,00d or 41.5 percent worked

during their pregnancy, according to the National Survey of FamiIy Growth (NSFG). This

Survey was conducted by the National Center

for Health Statistics. Such pregnant workers

comprised about 8.8 percent of the estimated

14,357,000 ever-married women of reproductive

age in the labor force at the time.

For the survey, there were interviews of

about 9,800 women representing the population

of women aged 15-44 in households in the conterminous United States who were married, previously married, or single with their own children in the household. This report is based on

information about women who had a live birth

in the year before their interview. Because interviewing occurred over an 8-month period in

1973-74, the years of preinterview experience

reported by women include different 12-month

periods. The aggregated reports of years of preinterview experience refer to an average 12-

month period end ing on September 13,

19 73–the interviewing midpoint. For that and

other reasons, estimates of births reported here

are not comparable to calendar period estimates

from the birth registration system. Other aspects

of sample design and statistical reliability are discussed in the Technical Notes to this report.

Table 1 shows estimates of the number of

women who had a live birth in the year before

the interview, and who worked at some time

during the nine months before the birth. The

estimates would have been somewhat higher had

the sample included all single women instead of

just those with their own children in the household. Of the approximately 1,260,000 pregnant

workers, 83.9 percent were white women, and

1This report prepared by Gerry E. Hendershot, Ph.D.,

Division of Vital Statistics.

16.1 percent were of “all other”z races. Women

under 25 years of age were 53.3 percent of the

total, and women 25 years and over were 46.6 percent of the total. Among pregnant workers under

25 years of age, 78.9 percent were white women,

while among pregnant workers 25 years and

over, 89.8 percent were white. Among white

pregnant workers, 49.9 percent were 25 years and

over; among pregnant workers of alI other races,

only 30.0 percent were 25 years and over.

Table 2 shows estimates from the Current

Population Survey3 of the numbers of evermarried women employed or seeking employment in hlarch 1972, a date near the midpoint

of the period during which the pregnancies began. These numbers estimate the population

potentially becoming the pregnant workers in

table 1, although single women with children of

their own are not included.

The ratios in table 3 (derived by dividing

the numbers in table 1 by the numbers in table

2 and multiplying this by 1,000) are crude indexes of the probability that during a l-year

period women in the labor force will work while

pregnant. The index was 85 per 1,000 for white

women as compared with 102 for aIl other

women. It is highest for women of all other

races under 25 years of age (370 per 1,000),

lowest for women of zdl other races who are 25

years of age and over (38 per 1,000), and averages 88 per 1,000 for the totzd population of

ever-married, reproductive-age women in the labor force.

2The term “all other” refers to the combined grouping of all races other than white.

3Bureau of Labor Statistics: Marital and Family Characteristics of Workers, March 1972, Special Labor Force

Report 153. Washington. U.S. Government Printing Office, 1973. This publication provides appropriately class~led data nearest in time to the estimated midpoint of

the period during which the women who are subjects of

this report became pregnant.
2

Table 4 shows estimates of the number of

women in the sampled population who had a

live birth in the year before their interview.

Table 5 shows ratios of pregnant workers (from

table 1) to women who had a live birth in the

year before their interview (from table 4). The

ratios are approximations to proportions of recently confined women who worked during

their” pregnancy. The proportion is highest

among women of all other races in the younger

age category (48.5 percent), lowest among white

Table 1. Number and percent distributions of women 1544 years

of age who worked during a pregnancy ending in live birth

during a 12-month period in 1972-73 by color and age: United

States

‘get=n==m=

Number of women

15-44 years ......... I 1,260,000 ii 1,057,000 I 203,000

15-24 years .............. 672,000 II 530,000

I

142,000

2544 years .............. 587,000 527,000 61,000

Percent distribution by color

1544 years., .......

15-24 years ..............

2544 years ..............ham

Percent distribution by age

1544 years .........

15-24 years ..............

25-44 years ..............H-%-F=

Table 2. Number of ever-married women 1644 years of age who

were in the labor force in March ‘1972, by color and age:

United States

I Color

1644 years .........

w16-24 years ..............

I

3,265,000 I

2,881,000 I

364,000

25-44 years .............. 11,092,000 9,489,000 1,603,000

Source: Bureau of Labor Statistics, Marital and Family Characteristics of Workers, March 1972, Special Labor Force Report

153. Washington, U.S. Government Printing Office, 1973.

women in the older age category (36.5 percent),

and averages 41.5 percent for the total population of recently confined women.

A detailed anzdysis of these and related data,

entitled “Patterns of Employment Before and

After Childbirth, ” is being prepared for publication in Vital and Health Statistics, Series 23. For

an earlier report based on a sampIe of Legitimate

live births, see “Employment During Pre~ancy:

Legitimate Live Births, United States, 1963, ”

Vital and Health Statistics, Series 22, No. 7,,

Table 3. Number of women 1544 years of age who worked during a pregnancy ending in live birth during a 12-month period

in 1972-73, per 1,000 women in the labor force in March

1972, by color and age: United States

Color

1544 years .........

I====II==+=Q=

15-24 years ...... .. ...... 206

I

184 370

2544 years .............. 53 56 38

Table 4. Number of women 1544 years of age who hacl a live

birth during a 12-month period in 1972-73, by color and age:

United States

Color

Age

Total White All

other

Table 5. Number of women 1544 years of age who worked during a pregnancy ending in live birth during a 12-month period in 1972-73, per 1,000 women who had a live birth in the

same period, by color and age: Unitad States

‘9’ t71-=TiL1544 years ......... 415 409 449

15-24 years .............. 469 465 485

25J14 years .......... .... 366 365 384
admce&m3

TECHNICAL NOTES

DESIGN OF THE SURVEY. The National Survey of Family Growth (NSFG) is designed to

provide data on fertility, family pkmning, and

related aspects of maternal and child health.

Field work for Cycle I was done by the NationaI

Opinion Research Center in 1973 and early

1974 with September 13, 1973 as the midpoint

of the interviewing.

A multistage probability sample of women

in the noninstitutional population of the conterminous United States was used. Approximately 33,000 households were screened to

identify the sample of women eligible for the

NSFG, i.e., women aged 15 to 44 years, inclusive, who were currently married, previously

married, or never married but had biologically -

related children presently living in the household. In households with more than one eligible

woman, a random procedure was used to select

only one to be interviewed.

Interviews were completed for 5,864 white

women and for 3,933 women of other races. A

detailed description of the sample design will be

presented in a forthcoming report, “Sample Design, Estimation Procedures and Variance Estimation for Cycle I of the National Survey of

Family Growth.”

RELIABILITY OF ESTIMATES. Since the statistics presented in this report are based on a

sample, they may differ from the figures that

would have been obtained from a complete census. This difference, referred to as sampling error, is measured by a statistic called the standard

error of estimate. Approximate standard errors

for estimated numbers from this survey are

shown in table I.

The chances are about 68 out of 100 that an

estimate from the sample would differ from a

complete census by less than the standard error.

The chances are about 95 out of 100 that the

differences between the sample estimate and a

complete count would be less than twice the

standard error.

Table 1. Approximate standard error for estimated numbers for

total or white women and black women: 1973 National

Survey of Family Growth

Total and white

Size of

estimate

25,000 .. ...........

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

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

150,000 ..........

250,000..........

350,000 ..........

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

750,000 .... ......

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

Standard

error

6,000

9,000

13,000

16,000

20,000

24,000

28,000

35,000

40,000

Size of

estimate

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

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

200,000 ..........

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

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

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

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

Io,ooo,ooo .....

20,000,000 .. ...

Standard

errur

15,000

21,000

30,000

47,000

67,000

96,000

151,000

216,0W

311.000

Black

DEFINITION OF TERMS

Age. –Age is classified by the age of the re- are included in the labor force estimates; other

spend-ent at-her last birthday befor~ the date of

interview.

Color.–Classification by color of the woman

interviewed, based on interviewer observation,

was reported as white or other. “AN other” refers to the combined grouping of all races other

than white.

Labor Force Status. –A woman is categorized as being in the labor force if she was working full-time or part-time, had ajob but was not at

work because of temporary illness, vacation, or a

strike, or if she was unemployed, laid-off, or looking for work. In this report ever-married women

estimates incIude single women with children.

Work During Prepancy. –Women are classified as having worked during pregnancy if they

had a live birth in the year before the interview,

and reported that they worked within the nine

months before the birth.

Live Birth. –A live birth is a fetus that gives

signs of life after birth, regardless of the length

of gestation. Since this report focuses on women

having a live birth in a specified period, rather

than upon the births themselves, it does not allow for plural births, and is not, therefore, comparable to reports of births from the birth regis-
4

tration system. Because of the sample design, over an 8-month period, the years of preinterthis report also does not include births in Alaska view experience reported by women differ, and

or Hawaii. Nor does it include women under 15 the aggregated experience is not directly comnor over 44 years of age. Finally, the period for parable to any caIendar period for which data

which births were reported is the 12 months be- from the birth registration system might be refore the interview. Since interviewing took place ported.
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U S DEPARTMENT OF HEALTH, ECUCATION, AND WELFARE I No. 12 October 12, 1977 I Pubhc Health Serwce. Health Resources Admlmstratlon

Ambulatory Medical Care

Rendered in Physicians’ Offices: United States, 1975a

The estimates presented in this report are

intended to highlight the findings of the 1975

Nat io na.1 Ambulatory Medical Care Survey

(NAMCS). NAMCS is a sample survey designed

to explore the provision and utilization of

ambulatory care in the physicizm’s office-the

setting where most Americans seek health care.

The survey is conducted yearly over the conterminous United States by the Division of Health

Resources Utilization Statistics of the National

Center for Health Statistics. The survey sample

is selected from doctors of medicine and osteopathy who are engaged in office-based, patient

care practice. In its current scope, NAMCS

excludes physicians practicing in Alaska and

Hawaii, physicians whose specialty is anesthesiology, pathology, or radiology, and physicians

in Government service.

Previous publications describe the development and findings of NAMCS. 1-s

NAMCS findings have been published for

two previous 12-month periods, May 1973-

April 19741 *2 and Janum-y-Deccmbcr 1974.3

aprepared by Hugo K. Koch and Norma Jean Dennison,

Division of Health Resources Utilization Statistics.

Data users are cautioned when making comparisons between the numerical estimates for

1975 and the numerical estimates previously

published for the two prior 12-month periods.

Since these earlier data were released, a continuing evaluation of the technical procedures

used to project the national estimates from the

sample findings has resulted in a revision of the

NAh4CS estimating procedures. The revised

procedures, applied to the 1975 findings, result

in an estimated total of 567.6 million office

encounters (visits) for that year. The application

of these revised procedures to the findings previously reported results in the following adjustment of total estimated visits.

Estimated visits

(in millions)

NAMCS reporting pen.od

Published Revised

May 1973-April 1974 ........ 644.9 590.8

January-December 1974 .... 634.1 577.8

The most notable effect of the change in

estimation procedure is to lt>wcr numerical

estimates of office visits by 8-9 percent. DistribAdvance Data from Vital and Health Statistics replaces the supplements to the Monthly Vital Statistics Report

as the means for early release of selected findings from the health and demographic surveys conducted by the

NCHS. Most of these releases will be followed by detailed reports in the Vital and Health Statistics series.

Provisional vital statistics as well as advance reports of fin-d data for a year will continue to be published in the

Monthly Vital Statistics Report.

Advance Data is being distributed on the mailing keys for the Vital and Health Statistics series, and people

who now receive reports from a particular series will also receive all Aduance Data releases for that series.

Temporarily, the mailing list for the Monthly Vital Statktics Report (M VSR,I is also being used. M WR readers

who wish to continue to receive Advance Data issues, as well as other persons who wish to receive all issues,

should contact: National Center for HeaJth Statistics, Center Building, Room 1-57, 3700 East West Highway,

Hyattsville, Maryland 20782, Phone: (301) 436-8500.
2 advamxklta —

utions and relationships—as expressed, for example, in percents and ratios —remain relatively

unaffected by the change.

Readers desiring more information about the

NAMCS estimation procedures should address

inquiries to Ambulatory Care Statistics Branch,

National Center for Health Statistics, Center

Building, 3700 East-West Highway, Hyattsville,

Md. 20782.

Figure 1 is a facsimile of the Patient Record

used by participating physicians to record information about “their office visits. Figure 1 may

be useful as a reference as the selected aspects of

the survey findings are presented.

Since the estimates presented in this report

are based on a sample rather than the entire

universe of office-based, patient-care physicians,

they are subject to sampling variability. See page

11 for an explanation and for guidelines in

judging the relative precision of estimates reported.

DATA HIGHLIGHTS

Physician Speciality

Among the 13 most visited specialties, plrimary care providers led the other specialists in

Figure 1. PATIENT RECORD

ASSURANCE OF CO NFIDENTIALITY—AII mf.fma[,on vvhcl! vvo.ld perm,l ,den?,fomno. of m mdnv,dud.

. Pm.et!.e, or m Wz.bl,$hmem WIN be held con fodenual, wdl be used only bv P.rmns engaged m and f., DN? ,

The purposes of !he survey and WIII not be dmlosed or .elomed 10 other pefsons or used for any olher purpose.

1. DATE OF VISIT PATIENT RECORD

.~

NATIONAL AMBULATORY MEDICAL CARE SURVEY

2. DATE OF BIRTH 4. COLOR OR 5. PATIENT’S PRINCIPAL PROBLEM(SI 6. SERIOUSNESS OF 7. HAVE YOU EVER SEEN

RACE COMPLAINT(S), OR SYMPTOM(S) ~ VISIT PROBLEM IN ITEM 5a THIs PATIENT BEFORE?

d=+ —

(h patient’s L?wrlwords] (Check one)

! ❑ WHITE , E YES

I ❑ VERY SERIOUS

:CNO

3. SEX

z ❑ NEGROI a MOST t

BLACK IMPORTANT 1 •! SERIOUS // YES, for the problem

I ❑ FEMALE I ❑ OTHER I O SLIGHTLY SERIOUS

mcf!cated in / TEM 5a 7

z ❑ MALE . ❑ UNKNOWN b, OTHER , ❑ NOT SERIOUS ~ ~ YES IIJNO

8. MAJOR REASON(S) FOR THIS —VISIT [CAeci 8// mqor reasom) 9. PHYSICIAN’S PRINCIPAL OIAGNOSIS ~ VISIT

a OIAGNOSIS ASSOCIATE WITH ITEM 5i7 ENTRY

J, ❑ ACUTE PROBLEM .8 ❑ WELL ADULTICHILD EXAM

o, ❑ ACUTE PROBLEM, FOLLOW-UP u ❑ FAMILY PLANNING

o, ❑ CHRONIC PROBLEM, ROUTINE ,. ❑ COUNSELINGIADVICE

tI •l CHRONIC PROBLEM, FLARE-UP II Q IMMUNIZATION

,6 ❑ PRENATAL CARE II ❑ REFERRED BY OTHER PHYWAGENCY b OTHER SIGNIFICANT CURRENT DIAGNOSES

os ❑ POSTNATAL CARE ,! ❑ ADMINISTRATIVE PURPOSE (In order of importance)

w ❑ POSTOPERATIVE CARE

7

,< ❑ OTHER (SPC?C)fY)

(Ope,atwe procedure)

10. DIAGNOSTIC/THERAPEUTIC SERVICES OROERELUPROVIOEO THIS VISIT (Checks// fhd app/y) I I . DISPOSITION THIS VISIT 12. OURATION OF

01 ❑ NONE 11 D ORUG PRESCRIBED (Checkall thut apply) ~ VISIT [he

02 ❑ LIMITED HISTORY/EXAM 12 0 X. RAY

acwally spentwith

physicim)

03 ❑ GENERAL HISTORY/EXAM 13 ❑ INJECTION I ❑ NO FOLLOW-UP PLANNED

04 ❑ CLINICAL LAB. TEST M ❑ lMMUNIZATION/DESENSI TIZATION : ❑ RETURN AT SPECIFIEO TIME

05 ❑ BLOOD PRESSURE CHECK 15 ❑ PHYs IoTHE RAPY I ❑ RETURN IF NE EDEO. PR N

06 ❑ EKG 16 ❑ MEDICAL COUNSELING . •l TELEPHONE FOLLOW-UP PLANNED

07 ❑ HEARING TEST 17 ❑ PSYCHOTHERAPYiTHE RAPEUTIC b ❑ REFERREO TO OTHER MINUTES

00 D VISION TEST LISTENING

PHYSICIAN/AGENCY

09 ❑ EN DOSCOPY

6 U RETURNED TO REFERRING

18 ❑ OTHER (Specifyl PHYSICIAN

10 0 OFFICE SURGERY

, ❑ AOMIT TO HOSPITAL

@ ❑ OTHER (Spemfy)

HRA-34-5 DEPARTMENT OF HEALTH, EDUCATION ANG WELFARE

REv. 8-74

O.M. B. %’6-S72106

PUBLIC I-lEALfh 5ER./ICZ EXPI RATION DATE 1.?/31/75

HtALTH RESOU61;S; ADMINISTRATION

NATIONAL CENTER FOS HEALTH STATISTICS

—
ackmeda3

the provision of office-based ambulatory care;

general and family physicians alone accounted

for 2 of every 5 visits (table 1).

Type and Location of Practice

In a ratio of about 3 to 2, visits to solo

practitioners outnumbered visits to physicians in

multiple-member practice (table 1).

Visits within standard metropolitan statistical areas (SMSA’S) outnumbered nonmetropolitan visits in a ratio of roughly 3 to 1. A

comparison by annual visit rates also shows a

higher rate within SMSA’S (2.9 visits per resident per year) than in the nonmetropolitan

areas (2. 3 I isits per resident per year).

Patient’s Age, Sex, and Color

Office visits per year increased in a direct

parallel to advancing age; the rate for persons

aged 65 and over more than douMed the rate for

persons aged under 15 years (table 2).

Females were more commonly seen in the

physician’s office than males; females made

about 3 visits for every 2 visits made by males

(titble 2).

This was due, in part, to the demographic

fact that females outnumbered males in the general population. That other factors were at

work, howet’er, is confirmed by a comparison of

annual visit rates between the sexes; here also a

ratio of 3 to 2 prevailed in favor of the females.

The following tabulation shows that female

visits outnumbered male visits in every age interval except the youngest.

Percent of all virits

Age Females Males

Total ........................... 60.4 39.6

Under 15 years .................. 8.1 9.3

15-24 years ........................ 10.1 5.2

25-44 years ........................ 16.7 8.6

45-64 years., ...................... 15.5 10.2

65 years and over .............. 10.1 6.3

White patients outnumbered patients of

other races not only in absolute numbers of

visits but also in visit rate per annum (table 2).

Major Reasons for Visit

The information in items 5 and 8 of the Patient Record represents an effort to determine

the reasons for visiting the physician’s office, as

expressed by patients in their own words. The

terms and codes applied to the patient symptoms, complaints, or other problems Ieadkg to

the visit came from a symptom classification

developed for use in NANICS.5

Table 3 lists the 25 reasons most frequently

presented.

Of all morbid states (e.g., conditions of illness or injury) presented to office-based physicians, about 55 percent were acute problems;

about 45 percent were chronic. An acute problem was defined as a condition having a relatively sudden or recent onset (i.e., within 3

months of the visit). A chronic problem was defined as a preexisting condition with an onset of

3 months or more before the visit.

The extensive role played by the office-based

physician in family planning is underscored by

the finding that an estimated 7.3 million visits

were made at least partly for the purpose of obtaining such services.

Principal Diagnosis

Table 4 lists the 25 most common, principal

diagnoses that were provisionally or finally assigned to office visits by the physician. The cliagnostic terms and codes are found in the Eighth

Revision lnternat ional Classification of Dtieascs,

Adapted for Use in the Un;ted States (ICDA).

Table 5 shows the classification of all principal

diagnoses by the major diagnostic (ICDA)

groups. Table 6 offers diagnostic information

tabulated according to the age, sex, and color”

of the patient.

The following fi~~e diagnostic groups accounted for an estimated 57 percent of all principal diagnoses rendered by physicians in office

practice.

Percent of

ICDA &TOUfJ all principal

diagnoses

Special conditions 1 and examinations without illness ..................... 17.8

Diseases of the respiratory system ... 14.1

Diseases of the circulatory system ... 9.9

Diseases of the nervous system

and sense organs .......................... . 7.9

Accidents, poisoning, and violence.. 7.2

1chiefly imm~nization, prenatal and postnatal care,

medical and surgical aftercare.
Visits lor respiratory diseases were more

than twice as frequent among patients under 15

years as among patients of 15 years and over.

Visits for circulatory diseases accounted for

the largest proportion of all visits made by patients over 44 years of age.

Visits for mental disorders were more common in the age inter~,al from 25-44 years

than in other age intervals.

Visits for respiratory illnesses and for conditions resulting from accidents, poisoning, and

violence were substantially more common

among males than among females.

Though overall visits by females outnumbered visits by males (table 1), in only two

of the diagnostic groups were visits by females

markedly more common than those by males.

These groups were “diseases of the genitourinary

system” and the prevent ive and maintenance category “special conditions and examinations

Diagnostic and Therapeutic Services

Drug therapy was the most frequent form of

therapy provided in office-based practice. About

44 percent of all visits resulted in treatment by a

prescribed drug (table 7).

“Counseling” and “listening” were checked

by a physician only when they constituted a major part of the treatment provided during the

visit. The overall use of such intangible services

is aImost impossible to quantify. Certainly, the

finding that these services were prominent in

fewer than 1 of every 5 visits understates the

actual extent of this important aspect of the

physician’s office practice.

Prior Visit Status

The average office-based physician

● Dealt chiefly with patients that he had

seen before (“old” patients). New FiItients accounted for onlv about 1 of

. .

w;thout illness. ” every 7 visits (ta>les 8 and ‘g).

Figure 2. PERCENT OF OFFICE VISITS BY DEGREE OF SERIOUSNESS OF PATlENT’S PROBLEM, BY PATlENT’S AGE

AND SEX: UNITED STATES, JANUARY-DECEMBER 1975

Fsssiss‘otserious ~ Somedegree of seriousness

loo–

80 –

p

~ 60 –

>

u

o

1-

~

C-) 40 _

II

u

n

20 –

o —

Under 25 2544 45-64 65 and over

AGE IN YEARS

—

Female Male

SEX
a&mdata5

. Dealt chiefly with problems for which he

had treated the patient before (“old”

problems). Only about 1 of every 4 visits

by an old patient concerned a new problem.

Seriousness of Problem

These data express the physician’s judgment

as to the extent .of impairment that might result

if no care were available for the given problem.

Office-based ambulatory care does not center on the treatment of problems which are

“serious to very serious” in prognosis. (Only

about 1 of every 5 visits was placed in this

category. See tables 8 and 9).

The largest proportion of visits (an estimated 49 percent) was given a “not serious”

evaluation. This is no doubt due in large

degree to the substantial amount of preventive

care and routine maintenance care provided

in the physician’s office, and to the relatively

high prevalence of acute, self-limiting conditions

encountered there.

Figure 2 shows the influence on judgments

of seriousness produced by patient age and

sex.

Disposition and Duration of Visit

Some form of scheduled followup was the

rule in office-based practice. In about 60 percent

of visits the patient was directed to return at a

specified time (table 8).

Only 2 percent of visits ended in hospital

admission.

Though it varied appreciably among specific

specialists, the average tendency to refer patients

(found in 3 percent of visits) is perhaps an

understatement. It may not realistically reflect

the actuzd amount of informal referral and

consultation that may occur, especially in a

multiple-member practice.

Duration of visit is defined to include only

the time spent in face-to-face encounter between

physician and patient (table 8).

The average encounter was of relatively brief

duration-about 15 minutes. The following table shows the mean duration of an office encounter with each of the 13 most \’isited

specialists.

Specialty Mean duration

(in minutes)

All specialties ............................

General and family practice .............

Internal medicine ............................

Obstetrics and gynecology ...............

Pe&atrics .........................................

General surgery ...............................

Ophthalmology ...............................

Orthopedic surgery ..........................

Otolaryngology ...............................

Psychiatry .......................................

Dermatology ...................................

Urology ...........................................

Cardiovascular disease .....................

Neurology .......................................

15.0

12.6

18.2

13.1

12.1

12.7

20.3

14.5

13.6

46.9

11.9

15.0

21.5

35.5

REFERENCES

1National Center for Health Statistics: The National

Ambulatory Medical Care Survey: 1973 Summary,

United States, May 1973-Apnl 1974. Vital and Health

Statistics. Series 13, No. 21. DHEW Pub. No. (HRA)

76-1772. Health Resources Administration. Washington.

U.S. Government Printing Office, Oct. 1975.

2National Center for Health Statistics: National

Ambulatory Medical Care Survey: hlay 1973-April 1974.

Monthly Vital Statistics Report. Vol. 24, No. 4, Supplement (2). DHEW Pub. No. (HRA) 76-1120. Health

Resources Administration. Hyattsville, Md. July 1975.

3National Center for Health Statistics: National

Ambulatory Medical Care Survey: National Ambulatory

Medical Care Survey of Vkits to General and Family

Physicians, January 1974-December 1974. Monthly

Vital Statistics Report. Vol. 25, No. 2 Supplement (2).

DHEW Pub. No. (HRA) 76-1120. Health Resources

Administration. Hyattsville, Md. May 1976.

4 National Center for Health Statistics: National

Ambulatory Medical Care Survey: background and

methodology, United States. Vital and Health Statistics.

Series 2, No. 61. DHEW Pub. No. (HRA) 76-1335.

Health Resources Administration. Washington. U.S.

Government Printing Office, .4pr. 1974.

5National Center for Health Statistics: The National

Ambulatory Medical Care Survey: symptom classification, United States. Vital and Health Statistics. Series 2,

No. 63. DHEW Pub. No. (HRA) 74-1337. Health

Resources Administration. Washington. U.S. GovernmentPrinting Office, May 1974.
6 advancedata

Table 1. Number and percent distributions of office visits by selected physician

characteristics: United States, January-December 1975

Selected physician characteristics

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

Most visited specialties

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

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

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

Pediatrics ------------------------------

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

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

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

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

Psychiatry ------------------------------

Dermatology -----------------------------

Urology ---------------------------------

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

Neurology -------------------------------

All other specialties -------------------

Type of practice

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

OtherI ----------------------------------

Locationz

Metropolitan ----------------------------

Nonmetropolitan -------------------------

Number

of visits

in

thousands

567,600

234,660

62,117

48,076

46,684

41,292

24,667

19,316

16,355

14.806

14;094

10,832

7.556

2;032

25,113

339>554

228,046

413,685

153,915

Percent

of

visits

100.0

41.3

10.9

8.5

8.2

2::

3.4

2.9

2.6

2.5

1.9

$::

4.4

59.8

40.2

72,9

27,,1

llkcludes partnership and group practices.

‘Signifies location within or outside the standard metropolitan statistical areas

(94SA’S).

SYMBOLS

Datanotavailable ----------------------------------- ---

Categorynotapplicable ------------------------------ ...

Quantityzero--------------------------------------- -

Quantitymore thanO butlessthan0.05----- 0.0

Figuredoesnotmeetstandardsof

reliability orprecision----—--— ------------

*
ackmeda7

Table 2. Number and percent distributions of office visits and number of visits per

person per yearl by selected patient characteristics:United States, January-December

1975

Selected patient characteristics

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

—Age

Under 15 years------------------------------

15-24 years---------------------------------

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

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

65 years and over---------------------------

—Sex

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

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

Color

White---------------------------------------

All other-----------------------------------

Number

of visits

in

thousands

567,600

99,010

86,570

143,525

1;:,;;;

9

342,896

224,704

508,672

58,928

Percent

of

visits

100.0

17.4

15.3

25.3

25.6

16.4

89.6

10.4

Number

of visits

per

person

per year

2.7

2.8

2.2

lBased on population estimates for July 1, 1975 furnished by the Bureau of the

Census.

Table 3. Number, percent and cumulative percent of office visits, by most common problems, complaints or symptoms classified by NAMCS code in rank order: United States,

January-December 1975

Most comnon problem, complaint, or

RANK symptom (coded)

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

Physical exmhation----------------goo-gol

Pregnancy examination-------------------9O5

Pain, swelling, injury-lower extremity--4OO

Pain, swelling, injury-back region------4l5

Sore throat-----------------------------52O

Pain, swelling, injury-upper extremity--4O5

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

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

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

Gynecologic examination-----------------9O4

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

Headache--------------------------------O56

Allergic skin reaction------------------ll2

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

Cold------------------------------------312

~a;~zby examination-------------------9O6

---------------------------------735

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

Pain, swelling, injury-face and neck----4lO

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

Eye examination-------------------------9O8

Vision dysfunction, except blindness----7Ol

Fever-----------------------------------OO2

Vertigo---------------------------------O69

Nunber

of visits

in

thousands

26,090

23,518

22,065

21,229

17,067

15,279

14,933

14,862

13,607

11,893

11,092

10,466

10,198

9,827

9,751

9,453

8,291

7,754

7,715

7,555

7,533

7,060

7,022

7,015

6,315

Percent

of

visits

4.6

4.1

3.9

M

2.7

2.6

;:;

2.1

2.0

R

1.7

1.7

::<

1.4

::!

::;

1.2

1.2

1.1

hum-dative

percent

4.6

1!::

16.3

19.3

22.0

24.6

27.2

;;.:

33:7

35.5

37,3

39.0

40.7

42.4

43.9

45.3

46.7

48.0

;:.;

51:7

52.9

54.0
8 aciwncedata

Table 4. Number, percent and cumulative percent of office visits by most common principal diagnoses by ICDA code: United States, January-December 1975

RANK

1

:

4

5

6

7

8

1:

:;

13

14

15

16

17

::

20

21

22

23

24

25

Most common principal

diagnosis (coded)

Medical or special examination------YOO

Medical and surgical aftercare------YlO

Essential benign hypertension-------4Ol

Prenatal care-----------------------yO6

Acute respiratory infection, site

unspecified------------------------465

Neuroses----------------------------3OO

Chronic ischemic heart disease------4l2

Otitis media------------------------38l

Diabetes mellitus-------------------25O

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

Acute pharyngitis-------------------462

Refractive errors-------------------37O

Hay fever---------------------------5O7

Obesity-----------------------------277

Bronchitis, unqualified-------------49O

Observation, without need for

further medical care---------------793

Acute tonsillitis-------------------463

Synovitis, bursitis-----------------73l

Influenza, unqualified--------------47O

Cystitis----------------------------595

Diseases of sebaceous glands--------7O6

Osteoarthritis----------------------7l3

Arthritis, unspecified-------------- 715

Inoculations and vaccinations-------YO2

Asthma------------------------------493

Number

of visits

in

thousands

40,863

26,782

22,824

20,851

14,607

13,641

12,513

9,899

9,671

9.667

8;531

8,169

7,675

7,569

6,872

6,794

6,405

6,171

5,866

5,721

5,593

5,445

4,892

4,846

4,633

Percent

of

visits

;:?

4.0

3.7

2.6

2.4

2.2

1.7

1.7

1.7

1.5

1.4

1.4

1.3

1.2

1.0

1.0

M

0.9

0.9

0.8

Cumulative

percent

1;::

15.9

19.6

22.2

24.6

26.8

28.5

30.2

31.9

33.4

34.8

36.2

37.5

38.7

39.9

41.0

42.1

43.1

44.1

45.1

46.1

47.0

47.9

48.7

Table 5. Number and percent distribution of office visita by principal diagnosis classified by major ICDA group: United States, January-December 1975

1

Principal diagnosis classified

by major ICDA group (coded)

All principal diagnoses----------------------------------

Infective and parasitic diseases------------------------000-136

Neoplasma-----------------------------------------------l4O-239

Endocrine, nutritional, snd metabolic diseases----------24O-279

Diseases of the blood and blood-forming organs----------28O-289

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

Diseases of the nervous system and sense organs---------32O-389

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

Diseases of the respiratory ayatem----------------------46O-5l9

Diseases of the digestive system------------------------520-577

Diseases of the genitourinary system---’----------------580-629

Diseases of the skin and subcutaneous tissue------------68O-7O9

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

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

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

Special conditions and examinations without sickness----YY13Yl3

Other diagnosesl-----------------------------------------------

Diagnosis “none” or unknown -----------------------------------

Number

>f visits

tho~~ands

567,600

22,747

13,332

24,177

4,744

25,061

44,941

56,358

80,125

20,061

37,626

28,564

32,732

26,177

40,893

100,787

3,312

5,963

Percent

distribution of

visits

100.0

4.0

2.4

4.3

i:;

;:;

14.1

3.5

6.6

5.0

5.8

~.;

17;8

0.6

1.1

1

Complications of pregnancy, childbirth, and the puerperium; congenital anomalies;

and certain causes of perinatal morbidity and mortality. 2.1ncludeablank, noncodeable, and illegible diagnoses.
a&medaa9

Table 6. Number of office visits by selected patient characteristicsand percent distribution of office visits,by

principal diagnoses as classified by major ICDA groups: United States, January-December1975

Age I

Sex I

Cal.or Principal diagnosis classified

by major ICDA group (coded)

Uncler 15-24 25-44 45-64 65 years Female

15 years years years years and over

Male mite Other

All principal diagnoses---- 99,010 186,571 I143,525 1145,434 I 93,061 1342,896[224,704 ] 508,672 I 58,928

Percent distribution

Total-------------------- 100.0 100.0 100.0 100.0

4.1

2.0

4.8

7.9

6.0

4.6

12.1

3.4

9.2

4.5

5.1

5.4

8.0

20.9

2.0

100.0 100.0 100.0

Infective and parasitic

diseases---------------OOO-l36

Neoplasms---------------l4O-239

Endocrine, nutritional, and

metabolic diseases-----240-279

Mental disolders--------290-315

Diseases of the nervous system and sense organ+ --320-389

Diseases of the circulatory

system-----------------390-458

Diseases of the respiratory

system-----------------46O-519

Diseases of the digestive

system--.--------------52O-577

Diseases of the gcnitourinary

system-----------------580-629

Diseases of the skin and

subcutaneous tissue----687097O9

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

Symptoms and ill-defined

conditions-------------78O-796

Accidents, poisonings, aad

violence---------------8OO-999

Special condition~ and exs...

is.ationswithout

illness----------------’iOO-Sl3

Residual’----------------------

5.4

1.2

2.2

3.5

:;:

7.4

16.6

11.7

4.5

7.5

4.1

9.0

4.7

6.7

10.2

1.7

::;

6.3

2.5

9.4

25.9

8.4

4.8

5.5

3.6

9.3

3.7

4.5

6.9

2.9

:::

.2::

7.6

9.2

12.4

3.3

8.6

4.8

5.8

4.8

5.0

2;.!

4.3

2.2

i:;

8.4

11.0

16.8

3.9

3.6

5.4

6.0

4.4

10.6

14.4

1.6

R

4.2

4.5

8.1

10.0

14.0

3.5

6.4

5.1

5.8

4.b

7.1

17.9

2.5

4.9

1.6

4.7

3.3

6.8

9.4

15.2

3.6

8.2

4.5

5.8

4.7

8.4

16.7

2.2

0.9

1.5

11.7

0.5

26.9

1.8

1.8

6.3

1.7

2.4

4.1

6.2

1.3

13.1

2.8

7.8

7.7

2.4

4.3 4.6

7.6 9.4

24.7 I

29.0

2.7 2.6

lDiscases of blood or blood-.fc!rmin~ctrgans;ccnplications of pregsancy, childbirth, and the puerp~.rium; congenital anomalies; certain caux!s of pcrinatal morbidity and nortality; diagnosis ““me” ar unknown.

Table 7. Number and percent distributionof office visits by diagnostic and therapeutic services provided:United States, January-December1975

Number

of visits

in

thousands

Percent

of

visits’

Diagnostic and therapeuticservice provided

All visits -------------------------------------- 567,6oO 100.0

No services provided

Diagrqstic services

Limited history or e:.:mination----------------------

General history or examination----------------------

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

X-Ray--------------.--------------------------------

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

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

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

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

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

Therapeutic services

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

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

Immunizationor desensitization---------------------

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

Physiotherap)~---------------------------------------

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

Psychotherapyor therapeutic listening--------------

Other services provided-------------------------------

15,~oo 2.7

291,294

89,377

129,740

41,701

188,180

L9,21O

7,369

26,650

6,696

51.3

15.8

22.9

7.4

33.2

3.4

:::

251,538

78,085

25,704

37,991

12,565

69,721

24,234

44.3

1:.:

6:7

1;:$

4.3

32,738 5.8

lWill not add to totals since more than one service might be provided.
10

Table 8. Number and percent distributions of office visits by selected characteristics of visit: United States, January-December 1975

Selected characteristics of visit

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

Prior Visit Status

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

Old patient, new problem -------------------------------

Old patient, old problem ---------------------- -------

Seriousness of Problem

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

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

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

Diapositionl

No followup ------------------------------ --------------

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

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

Telephone followup -------------------------------------

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

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

Admit to hospital --------------------------------------

Duration of Visitz

O minutes (no face-to-face encounter with

physician)--------------------------------------------

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

6-10 minutea -------------------------------------------

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

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

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

Numb er

of visits

in

thousands

567,600

84,807

132,848

349,945

106,981

183,697

276,923

74,542

335,219

126,630

20,834

16,042

5,064

12,062

6,781

91,730

177,442

151,964

1::, :;;

,

Percent

of

visits

100.0

14.9

23.4

61.7

18.8

32.4

48.8

13.1

59.1

22.3

3.7

2.8

1::2

31.3

26.8

19.0

5.6

‘Will not add to totals since more than one disposition was possible. Zsignifies time spent in face-to-face encounter between physician and Patient.

Table 9. Number and percent distributions of office visits by selected patient characteristics,

according to prior visit status and

1975

seriousness of problem: United States, January-December

Selected patient

characteristics

All visits-----

Age —

Under 15 years-------

15-24 years----------

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

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

65 years and over----

—Sex

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

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

Color

White----------------

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

of

visits

in

thousands

567,600

99,010

86,571

143,525

145,434

93,061

342,896

224,704

508,672

58,928

Percent

of

visits

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Prior visit status

New

patient

14.9

15.9

21.1

17.9

11.9

8.4

13.8

16.7

14.5

18.5

T

OId Old

patient patient

new old

problem problem

-a-T7

35.5 48.6

26.4 52.5

22.1 60.0

19.4 68.7

16.0 75.6

22.6 63.6

24.6 58.7

23.0 62.5

27.1 54.4

Seriousness of problem

Serious

or

very

serious

18.8

11.2

11.5

L6.8

23.7

29.4

17.1

21.5

19.0

17.7

Slightly Not

serious serious

F

32.4 48.8

30.9 57.9

27.3 61.3

31.2 52.0

35.5 40.8

35.6 35.0

31.4 51.5

33.8 44.7
admceMa 11

TECHNICAL NOTES

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

Nat ion al Ambulatory Medical Care Survey

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

United States made by ambulatory patients to

physicians who are principally engaged in office

practice.

SAMPLE DESIGN: The 1975 NAMCS utilized a

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

within practices. Within the 87 PSU’S composing

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

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

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

requested to complete Patient Records (figure 1)

for a systematic random sample of office visits

taking place within their practice during the assigned reporting period. Additional data concerning physician practice characteristics such as

primary specialty and type of practice were obtained during an induction interview.

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

an earlier publication in Series 2 of Vital and

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

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

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

1975 NAMCS design and procedures will be

presented in future publications.

SAMPLING ERRORS: Since the estimates for

this report are based on a sample rather than the

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

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

standard error of the estimate by the estimate

itself and is expressed as a percent of the estimate. Relative standard errors of selected aggregate statistics are shown in table I. The standard

errors appropriate for the estimated percentages

of office visits are shown in table II.

ROUNDING: Aggregate estimates of office visits

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

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

the sum of percentages may not equal 100.0 percent.

Table 1. Approximate relative standard errors of estimated, numbers of office visits

—..

Estimate Relative standard

in error in

thousands percentage points

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

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

2,000....................................... 15,3

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

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

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

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

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

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

relative standard error of 4.3 percent or a standard error of

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

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

— -.—. —

1

I Estimated percentage

Base of percentage

(number of visits

r

1 or in thousands)

, 99

1,000 ..................... 2.1

3,000..................... 1.2

5,000,.................... 0.9

10,000................... 0.7

50,000................... 0.3

100,000 .. ............... 0.2

500,000 ................. 0.1

-L5or lOor

95 90

4.6 I 6.3

2.7 3.7

2.1 2.8

1.5 2.0

0.7 0.9

0.5 0.6

0.2 0.3

I I

8.5

4.9

3.8

2.7

1.2

0.8

0.4

9.7 10.6

5.6 6.1

4.3 4.7

3.1 3.3

1.4 1.5

1.0 1.1

0.4 0.5

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

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

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

DE FINTITIONS: An am bulatcmy patient is an

individual presenting himself for personaI health

services who is neither bedridden nor currently

admitted to any health care institution on the

premises.

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

Responsibility over time for patient care and

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

an institution.

A visit is a direct personal exchange between

an ambulatory patient and a physician or a staff

member working under the physician’s supervision for the purpose of seeking care and

rendering health services.

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

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

physicians who are FederalIy employed; ph ysicians who treat only institutionalized patients;

physicians employed full time by an institution;

and physicians who spend no time seeing ambulatory patients.

GPO 919.620
FROM VITAL & HEALTH Statistics OF THE NATIONAL CENTER FOR HEALTH STATISTICS

US. DEPARTMENT OF HEALTH, ECUCATION, AND WELFARE j No. 13 October 13, 1977 I Pubhc Health Serwce. Health Resources Adm!ntstratmn

Ambulatory Medical Care

Rendered in Pediatricians’ Offices During 1975a

This report presents statistics concerning an

estimated 46.7 million visits to the offices

of pediatricians practicing in the coterminous

United States. The data were collected during

calendar year 1975 in the National Ambulatory

Medical Care Survey (NAMCS), a continuous

survey conducted yearly by the National Center

for Health Statistics.

The estimates presented are based on information obtained from the “Patient Record,” a

facsimile of which can be found in Ad\rance Data

No. 12. This form is used by sample physicians

to record selected information about their office

encounters. The sampling errors associated with

these estimates and information concerning the

sample design used by the 1975 NANICS are

presented in the section, “Technical Notes,”

that follows.

HIGHLIGHTS

During 1975 there were an estimated 567.6

million visits to “office-based, patient-care”

physicians practicing in the coterminous United

States. The estimated total yearly volume of

office-based ambulatory medicaI care by specialty is shown in table A. In terms of total office visits, the 46,684,000 visits to pediatricians

ranked fourth among all physician specialties.

Forty-two percent of these visits were to

pediatricians in practice by themselves while the

remaining 58 percent were to pediatricians practicing in a group or partnership arrangement.

a~hi~~e.oti ~a~ prep~ed by Trena Ezzati, Division

of Health Resources Utilization Statistics.

Table A. Number and percent distribution of office visits, by

selected physician specialties: United States, 1975

I I

Number of

Physician specialty

Percent

visits in distribution

thousands 1

All specialties ..... .. ............. 567,600 100.0

General family practice ........... 234,660 41.3

Internal medicine .................... 62,117 10.9

Obstetrics/gynecology ............. 48,076 8.5

PEDIATRICS . ......................... 46,684 8.2

General surgery ....................... 41,292 7.3

All other specialties ......... ...... .. 134,771 23.8

1Due to ~ ~efjnement of the NAMCS estimfiting procedurt

used to project notional estimates from stimple datir, cisution

should be used when comparing these estimated numbers ~)f

office visits with previously published estimates for 1973 and

1974.

Visits to pediatricians by males (52,3 percent) outnumbered those by females (47.7 percent), whereas the proportion of visits to all

physicians by females exceeded that by males

(figure 1).

Information regarding the age distribution of

visits to pediatricians is presented in figure 2. A

negative correlation exists between age and the

number of visits to pediatricians, i.e., as the age

of patients increases, the number of visits decreases. Less than 2 percent of the visits to pediatricians were by patients over 19 years of age

and only 5 percent were by patients 15-18 years of

age. Thus, the major portion of visits to pediatricians was by patients under 15 years of age.

Visit rates further show that there were

more visits made by chiIdren under 2 years of

age than by children in any other age group

(table B), thus reflecting the most frequent rea-
2 &ncedata

Figure 1, PERCENT OF OFFICE VISITS, BY SEX: UNITED

STATES, 1975

70

60

L’

G

5 50

UJ

0

L 40

k

g 30

$

g 20

u

Lu

L

10

0

Female Male

Figure 2. PERCENT OF OFFICE VISITS TO PEDIATRICIANS, BY AGE OF PATl ENT: UNITED STATES, 1975

35

V)

k 30 Sn

5

~ 25

a

+ 20 0

+

: 15

k

R 1(J

c1

U5

w

n

o

Under 2 2-5 6-10 11-14 15 and

over

AGE IN YEARS

Table B. Rate of office visits per 100 parsons by age: United

States, 1975

I

Age I

Rate

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

r

58

Under 2 yearn .................... ............... .......... 244

2-5 years ........................... .. .............. ......... 106

6-10 years ......... ......................................... 57

11-14 years ....... .......... ............................... 33

15-1 B years ................................................ 16

son for visiting a pediatrician—the well-baby examination.

In addition to the well-baby examination,

other common reasons for visits to pediatricians

as presented in the patient’s own words (or

when necessary, the words of the parent or accompanying adult) are show-n in table 1. These

14 probIems, complaints, or symptoms accounted for about 67 percent of all visits. This

reveals a relatively narrow clinicaI range for pediatricians as compared with the more varied

range for general and family practitioners where

it requires nearly two and one-half times as

many problems to account for a comparable 67

percent of their visits. For about one of every

three visits to pediatricians, a “nonsymptomatic” problem (generally an examination) was

the reason for a visit. Among “symptomatic”

problems presented to pediatricians, cough,

fever, sore throat, and earache were the most

common.

Data on the physician’s judgment of the seriousness of the patient’s probIem, complaint, or

symptom (in terms of the extent of impairment

that might resuIt if no care were obtained) revealed that only 10 percent of the visits to pediatricians were “serious or very serious” (tabIe

C). The proportion of conditions categorized as

“not serious” (60 percent) is in part a reflection

of the relatively Iarge number of visits involving

examinations and acute, self-limiting problems

common to children.

Table C. Percent distribution of visits to pediatricians by degree

of seriousness of patient’s problem: United States, 1975

Degree of seriousness I

Percent

distribution

Total .................................................... I 100.0

Serious or very serious ............... ................ 10.1

Slightly serious ........................................... 29.5

Not serious ................ ................................. 60.4

Data presented in table 2 provide statistics

on. the most frequent physician diagnoses associated with the reasons for office visits to

pediatricians. The physician’s principal diagnosis refers to the diagnosis listed first in item
acwncedata 3

9 of the Patient Record. The diagnostic data

are grouped by the classes used in the Eighth

Revision International Classification of Diseases, Adapted for Use in the United States

(ICDA). As might be predicted from the previous statistics presented on problems, the ICDA

category “special conditions and examinations

without illness” was the largest. This also reflects that about one-third of all visits made to

pediatricians were for well-child care. In comparison with all other physicians, only obstetricians/gynecologists exceeded pediatricians in the

proportion of visits for special conditions and

examinations (57 percent). The second most frequent category of illness or injury diagnosed by

pediatricians were diseases of the respiratory

system (28 percent). Acute pharyngitis, acute

tonsillitis, acute upper respiratory infection, and

bronchitis, unqualified, comprised over one-half

(60 percent) of the diagnoses associated with

diseases of the respiratory system.

Further information abstracted from the

Patient Record shows that the majority of visits

(91 percent) to pediatricians were made by patients who had seen the physician before (table

D).

Table D. Percent distribution of patient visits to pediatricians by

patient’s prior visit status: United States, 1975

I

Patient’s prior-visit status Percent distribution

Total .................................................... 100.0

New patient .................................... ........... 9.2

Old patient, new problem ..........................

I

41.5

Old patient, old problem ............................ 49.3

However, the percentage of new problems

presented to pediatricians (51 percent) proportionately exceeded that for all physicians (38

percent).

Further reflecting the large number of visits

to pediatricians for routine examinations, history or examinations (either limited or general)

were the most common diagnostic services provided (table 3). The proportion of visits at which

history or examinations were performed was

generally higher for pediatricians than for all

physicians. Likewise the percentage of visits

where medical counseling was a significant part

of the office visit exceeded the percentage for all

physicians. On the other hand, the pediatrician

fell below the overall average in the proportion

of visits involving blood pressure checks, office

surgery, x-rays, and the prescription of drugs.

The relatively large proportion of visits to pediatricians at which immunizations or desensitizations were provided (23 percent) reflects the age

composition of patients.

The duration of the visit represents the

amount of time spent by the patient in face-toface contact with the physician. The average encounter time between pediatricians and their patients was approximately 12 minutes, as

compared to an average time duration of 15

minutes per visit for all physicians.

Finally, data on disposition (table 3) reveal

that pediatricians, when compared to aU physicians, were more likeIy to have a telephone folIowup and less likely to schedule a return visit,

thus indicating acute, self limiting problems

characteristic of children. No followup was planned after 24 percent of the visits, thus reflecting

the large amount of well-child care occurring at

ambulatory pediatric office visits.
4 acklncedata

Table 1. Number, percent, and cumulative percent of office visits to pediatricians, by the most common patient problems, complaints, or symptoms: United States, 1975

Most common patient problems, complaints or

symptoms (NAMCS code)

Well-baby examination ...........................................906

General medical examination .................................900

Cough .....................................................................311

Fever ......................................................................OO2

Visit for medication ...............................................91 O

Throat soreness ......................................................52O

Earache ..................................................................735

Allergic skin reactions ............................................112

Cold .......................................................................3l2

Required physical examination ..............................901

Abdominal pain ......................................................54O

Wounds of skin.......................................................ll6

Nausea and vomiting ..............................................572

Problems of lower extremity ..................................400

1Based on a total of 46,684,000 office visits.

Number of

visits

in thousands

6,233

4,687

3,425

3,170

2,859

2,439

2,001

1,662

1,464

974

764

745

571

531

Percent of

visits’

13.4

10.0

7.3

6.8

6.1

5.2

4.3

3.6

3.1

2.1

1.6

1.6

1.2

1.1

SYMBOLS

Data not available ---------------------------------------- ---

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

Quantity zero ----------------------------------------------- -

Quantity more than Obut less than 0.05 ----- 0.0

Figure does not meet standards of

reliability or precision ---------------------------- *

Cumulative

percent

13.4

23.4

30.7

37.5

43.6

48.8

53.1

56.7

59.8

61.9

63.5

65.1

66.3

67.4
ackincedata 5

Table Z: Number and percent of office visits to pediatricians, by principal diagnoses most frequently

rendered by the physician: United States, 1975

Principal diagnoses most frequently rendered by

the physician (ICDA code)

Infective and parasitic diseases ................................................. 001-136

Streptococcal sore throat and scarlet fever

Other viral diseases

..................................034

...................................................................... 079

Diseases of nervous system and sense organs .............................320-389

Otitis media ..................................................................................38l

Diseases of respiratory system ................................................... 460.519

Acute pharyngitis ..........................................................................462

Acute tonsi[l itis ..................................................................o.........463

Acute laryngitis and tracheitis .................................................... 464

Acute upper respiratory infection ................................................465

Bronchitis, unqualified ................................................................ 490

Asthma ........................................................................................ 493

Hay fever ..................................................................................... 507

Diseases of skin and subcutaneous tissue .................................... 680-709

Other eczema and dermatitis ........................................................ 692

Symptoms and ill-defined conditions ........................................780-796

Observation, without need for further medical care .....................793

Accidents, poisoning, and violence .............................................8 OO.999

Special conditions and examinations without sickness .............. YOO-Yl3

Medical or special examination ....................................................YOO

Prophylactic inoculation and vaccination .....................................YO2

Medical and surgical aftercare ......................................................Yl O

1Based on a total of 46,684,000 office visits.

Number of visits

in thousands

3,286

771

754

4,625

3,795

13,220

1,839

1,477

530

2,944

1,731

729

981

2,847

1,577

1,967

726

2,174

15,137

12,462

1,667

841

Percent of

visitsl

7.0

1.7

:::

8.1

28.3

::;

1.1

6.3

3.7

1.6

::;

3.4

4.2

1.6

3;::

26.7

3.6

1.8
6 advancedata

Table 3. Number and percent distributions of office visits to pediatricians by selected diagnostic or

therapeutic services ordered or provided and disposition of patient: United States, 1975

.—

Selected diagnostic or therapeutic services ordered

or provided and disposition of patient

Diagnostic services

Limited history /exam ...................................................

General history/exam ...................................................

Clinical lab test .............................................................

Blood pressure check ....................................................

Vision test ....................................................................

X.ray ............................................................................

Hearing test ..................................................................

Therapeutic services

Drug prescribed ............................................................

Immunization/desensitization ......................................

Medical counseling .......................................................

injection .......................................................................

Office surgery ...............................................................

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

Disposition of patient

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

Return at specified time ...............................................

Return if needed .................................................. .......

Telephone followup planned ........................................

Referred to other physician or agency ..........................

Number of visits

in thousands

19,136

15,612

10,442

3,612

1,955

1,933

1,277

19,235

10,693

7,322

4,340

1,482

1,339

11,005

20,795

11,015

4,597

1,365

Percent

distributions

41.0

33.4

22.4

7.7

4.2

4.1

2.7

41.2

22.9

15.7

9.3

3.2

2.9

23.6

44.5

23.6

9.9

2.9

1Percents may total more than 100.0 since more than one treatment or more than one disposition could be given at a

single visit.

TECHNICAL NOTES

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

National Ambulatory Medical Care Survey

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

United States made by ambulatory patients to

physicians who are principally engaged in office

practice.

SAMPLE DESIGN: The 1975 NAMCS utilized a

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

within practices. Within the 87 PSU’S composing

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

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

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

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

of office visits taking place within their practice

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

previous issue of Advance Data From Vital and

Health Statistics, No. 12, October 12, 1977.)
a&maata7

Additional data concerning physician practice

characteristics such as primary specialty and

type of practice were obtained during an induction interview.

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

an earlier publication in Series 2 of Vital and

Health ~tdZktiCS (No. 61. DHEW Pub. No.

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

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

1975 NAMCS design and procedures will be

presented in future publications.

SAMPLING ERRORS: Since the estimates for

this report are based on a sample rather than the

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

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

standard error of the estimate by the estimate

itself and is expressed as a percent of the estimate. Relative standard errors of selected aggregate statistics are shown in table I. The standard

Table 1. Approximate relative standard error of estimated number of office visits

Estimated of f!ce visits Ralative standard error in

in thousands percentage points

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

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

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

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

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

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

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

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

3.5

Example of use of ruble, An ag~rqmcc of 80,000,000 IIUSo relative standard crr~)r of 4.3 percent w a stundwd error (rf 3,440,000

(4.3 percent of 80,000,000).

errors appropriate for the estimated percentages

of office visits are shown in table II.

ROUNDING: Aggregate estimates of office visits

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

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

Table 11. Approximate standard arrors of percentages for estimatad numbar of office visits

Base of Dercentaqe I

Estimated percentage

number of visits

in thousands 1 or 5 or 10 or 20 or 30 or so

99 95 90 80 73

I

Standard error expressed in

parentage points

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

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

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

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

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

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

SO,ooo ..........................

2.1

1.2

0.9

0.7

0.3

0.2

0.1

4.6

2.7

2.1

1-5

0.7

0.5

0.2

6.3 8.5 9.7

3.7 4.9 5.6

2.8 3.8 4.3

2.0 2.7 3.1

0.9 1.2 1.4

0.6 0.8 1.0

0.3 0.4 0.4

I I I

10.6

6.1

4.7

3.3

1.5

1.1

0.5

Example of use of table: An estimate of 30 perce:ll based on an

ww%ate of 75 J300,CS130h a standard error of 1.2 percent. The

rtlntive standard error of 30 percent is 4.0 percent (1.2 percent +

30 percent).

the sum of percentages may not eqwd 100.0 percent.

DEFINITIONS: An ambulatory patient is aq individual presenting himseIf for personal he~th

services who is neither bedridden nor currently

admitted to any health care institution on the

premises.

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

Responsibility over time for patient care and

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

an institution.

A z,fiit is a direct personal exchange between

an ambulatory patient and a physician or a staff

member \vorking under the physician’s supervision for the purpose of seeking care and

rendering health services.

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

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

physicians ~vho are Federally employed; physicians who treat only institutionalized patients;

physicians employed full time by an institution;

and physicians who spend no time seeing ambulatory patients.

GPO 919..533
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

US. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service [ Number 14. November 30, 1977

Weight by Height and Age of Adults 18-74 Years:

United States, 1971-74a

The height and weight measurements obtained as a part of the Health and Nutrition

Examination Survey (HANES) conducted by the

National Center for Health Statistics April 1971

through June 1974 were used to present height

and weight findings among men and women

aged 18-74 years in the United States; 1

HANES is a program in which measures of

nutritionzd status are collected for a scientifically designed sample representative of the

civilian noninstitutionalized population of the

United States in a broad range of ages.

These HANES findings are based on the

examination of the 13,671 persons aged 18-74

years selected from a total sampIe of 20,749

examined persons aged 1-74 years. A nationwide

p rob ability sample of 28,043 persons was

selected to be examined from eIigibIe households in the 65 primary sampling units that were

visited between April 1971 and June 1974. The

HANES nutrition examination included a general medical examination by a physician to

identify indicators of nutritional deficiencies, a

skin examination by a dermatologist, and a

dental examination by a dentist. Body measurements were taken by a trained technician; dietary

information was obtained b-y the 24-hour recall

method; and a food frequency questionnaire was

administered. Numerous Laboratory tests were

performed on whole bIood, serum, plasma, and

urine. A description of the sampling process and

HANES operation has been pubIished.1

Estimates in this report are based on

weighted observations. The data obtained for

the examined persons were inflated to the level

aThis report prepared by Sidney Abraham, Clifford

L. Johnson, M.S.P. H., and Matthew F. Najjar, Division

of Health Examination Statistics.

of the total population, using the appropriate

weights to account for both sampling fractions

and response results. The relationship of weight

to height by age, sex, and race among the U.S.

population based on findings from the HANES

program will be analyzed and discussed in a

future report, Weight by Height and Age of

Adults 18-74 years, United States, 1971 -1974.2

Selected data from that report are presented

here in tables 1-5 and figures 1 and 2.

Mean weights for given heights were obtained from a Iinear regression equation for men

and women for the six age groups 18-24, 25-34,

35-44, 45-54, 55-64, and 65-74 years. The

equations of weight on height were fitted by the

least-squares method, which holds that the line

of “best fit” is one for which the sum of the

squares of the residual errors is a minimum.

AIthough linear regression of weight on height

was used, the relationship between weight and

height is not strictly Iinear, that is, the Iine of

relationship does not correspond precisely to a

linear line of trend, which describes the average

change in weight as accompanied by a unit of

change in height. The constants-regression coefficient (b) and Y-intercept (a)–in the regression

equation Y = a+bx ~d the st~dard error of

estimate around these regression lines for 12

age-sex groups are shown in table 1. Itlore detailed examination of the linear relationship of

weight to height will be reported in the future

report.2

Height-weight tables are presented for men

and women within the age range 18-74 years,

with mean weight values for each inch of height

for the height range of 62-74 inches for men and

57-68 inches for women (tables 2 and 3). Three

additional values beIow and above the mean

weight also given in the tables represent esti-
2 dwwedda

210 -

200 -

190 -

180 -

170 -

160 -

150 -

140 –

130 -

Figure 1. AVERAGE WEIGHTS] OF MEN BY AGE GROUP AND HEIGHT:

UNITED STATES, 1960-62 AND 1971-74

18-24 YEARS

— HAN ES, 197’I.74

. . . . . . HES, 19& J.132

/

●*...

,..

●.*

●* ●. .

/

. . . .

***

● ●****

. .

●.

,*. *

o~

62 63 64 65 66 67 68 69 70 71 72 73 74

210-

200 –

190 -

180 -

170 -

160 -

150 -

140 –

35-44 YEARS ,

130J

of I 1 I 1 I 1 1 1 I 1 t 1 \

62 63 64 65 66 67 68 69 70 71 72 73 74

210 -

200 -

190 –

180 -

170 -

160 –

150 -

140 -

130}

55-64 YEARS

210 r

25-34 Y EARS

200

190 t

; 80

170

160

150

140

1

13oj

o~d

62 63 64 65 66 67 68 69 70 71 72 73 74

210 -

200 –

190 -

180 -

170 -

160 -

150 -

140 -

130 -

5

45-54 Y EARS

v 62 63 64 65 66 67 68 69 70 71 72 73 74

210

L

65-74 YEARS

200

190 -

180 -

170 -

160 –

150 -

140 -

.

o~

62 63 64 65 66 67 68 69 70 71 72 73 74

HEIGHT IN INCHES

o~A

62 63 64 65 66 67 68 69 70 71 72 73 74

HEIGHT IN INCHES

1~~imated “a]ue~frOm regression equations of weights for specified age WOUPS.

NOTE: For 1960-62 and 1971-74, height was measured without shoes. For 1960-62 clothing weight was estimated as

averaging 2 pounds, which were deducted fr~m weights shown; for 1971-74 cIothing weight ranged-from-0.20 to 0.62 pound,

which was not deducted from weights shown.
ackmeMa3

Figure 2. AVERAGE WEIGHTS* OF WOMEN BY AGE GROUP AND HEIGHT:

UNITED STATES, 1960-62 AND 1971-74

180 r 18-24 YEARS

~ 170

z

3

~ 160

1

_ HAN ES, 1971-74

. . . . . . HES, 1960.132

= 150

1-

5 140

i

‘-1/

3 13(J .

● ..**-*’. . . .

,.. .

. . . .

. . . . ●m..=

I20 ●*..

. . . .

J- 110

o-f ‘

I 1 I , 1 I , 1 1 1 -1

57 58 59 60 61 62 63 64 65 66 67 6Z

180

170

160

150

140

130

120

110

/

0’

35-44 YEARS

57 58 59 60 61 62 63 64 65 66 67 68

180

r

55-64 YEARS

170

1~

. . . . ●.*’

160

●. . .

150

● ●.* *..

140 ●***

,***

130

120

t

180

170

160

150

I

140

130

120

110

25-34 YEARS

*.*

,.*

o~

57 58 59 60 61 62 63 64 65 66 67 68

180

170

160

150

140

130

120

110

45-54 YEARS

o’~

57 58 59 60 61 62 63 64 65 86 67 68

180

F

65-74 YEARS

T70

160

150

140

130

120

110

o? I I I 1 , , a I 1 t

!

57 58 59 60 61 62 63 64 65 66 67 68

HEIGHT IN INCHES

01 I I I I I 1 I f I I I J

57 58 59 60 61 62 63 64 65 66 67 68

HEIGHT IN INCHES

1Fstimated values from regression equations of weights for specified age groups.

NOTE: For 1960-62 and 1971-74, height was measured without shoes. For 1960-62 clothing weight was estimated as

averaging z pounds, which were deducted from weights shown; for 1971-74 clothing weight ranged from 0.20 to 0.62 pound,

which was not deducted from weights shown.
4 ackincedata

mates of the range of 60, 80, and 90 percent,

respectively, of the population around the mean

weight:

J“?.8416SY. X

Y* 1.2816 SY.X

Y + 1.6449 &

For example, assuming normality, the predicted

mean plus or minus .8416 standard error of the

estimate indicates the range of weights that is

expected to include 60 percent of the examined

persons of a specific height for a given age and

sex group.

In this instance one would expect 30 percent

of the individuals to be within this weight range

below and above the mean weight, with 20 percent falling outside either of these ranges, values

roughly equivalent to the lower and upper 20th

percentiles, respectively, of the distribution of

weight by height for age and sex groups.

The other two estimates around the mean

(Y* 1.2816S ~ .X and Y * 1.6449 SY ~ standard

error of estimate) represent an &ea of 80

and 90 percent of the particular height group,

which is roughly equivalent to the lower and

upper 10th and 5th percentile, respectively,

of the distribution of weight by height for age

and sex groups.

The height-weight tables–tables 2 and 3

are summarized in table 4—show that the

average weights by height for men and women

increase with age but in different patterns.

Average weights of men increase rapidly until

the age group 25-34 years. The rate of increase

then flattens out, with the average weights

peaking in the agc group 45-54 years for those

men of heights less than 68 inches and declining

thereafter. The average weights of men of

heights 68 inches and more peak at ages 35-44

years and then tend to decline.

The average weights of women advance

rapidly to the age group 35-44 years. They increase less rapidly in the age groups 45-54 and

55-64 years, peak at the latter age group, and

then decline.

The average weights of men and women by

height as measured in the Ileaith and Nutrition

Examination Survey of 1971-74 were generally

greater than those from the Health Examination

Survey (IIES) of 1960-62 (table 5). Among age

group 18-24 years the differences between

averages cluring this period increased as height

increased. This direction was less evident for

men than for women, particularly in the shorter

heights.

At ages 25-34 years, the pattern was reversed

for women. The difference between the average

weights of women in H~TES and in HES

decreased as height increased.

The differences in average weights for men

and women 35-44 years showed the same patt e rn. When compared with HES findings,

HANES data showed the average weights of

shorter men and women to be less than those in

HES and more than those in HES for taIIer

persons and persons of medium height. Differences in average weights for taller persons and

those of medium height ranged from !. to 13

pounds.

Average weights of women aged 45-5-I years

in the HES \vere with (me exception 2 pounds

less than those f)t women in HANKS. For men in

this same age group, the average weights were 2

pounds less for those in HIM who were shorter

than 69 inches and from 2 to 5 pounds less for

those who were taller.

At ages 55 and over, the average weight for

women in HANES differed little from that of

women in HF.S. On the other hand, differences

between average weight of men in HANES and

that of men in HES showed an increase inthe

difference with increase in height. Men in

HANES above average height (69 inches and

more) weighed more on the average–7 to 14

pounds at ages 55-64 and 7 to 11 pounds at ages

65-74 years–than men in HES did.

DISCUSSION

Comparison of an individual’s acutal weight

with a standard weight is the most widely used

criterion of leanness or fatness. Interest in this

measure stems from the findings of life insurance and epidemiological studies relating excess

body weight status to unfavorable morbidity

and mortality experiences. The earliest and most

commonly used method for measuring excess

body weight due to fat is to compare the height
dmncwkh5

and weight of persons with tables showing average or standard weight. By using this method the

life insurance studies determined excess body

weight status, which is defined as the deviation

of actual weight for a given sex, age, and height

from the average weight tables, times 100,

obtained initially from the Medico-Actuarial

Investigations (19 12)4 and later from the Build

and Blood Pressure Study (1959 ).5 Other studies

‘ such as the Fprningham Heart StudyG defined

excess body weight due to obesity as a relative

weight of 20 percent or more above the median

weight for a given height and sex.

Since it is recognized that height and weight

alone are incomplete indications of obesity,

“desirable” weight tables that take into consideration measurements of body build have

been developed by the Metropolitan Life Insurance Company. These tables for aduIts 25 years

and over show ranges of weights for given

heights. This was in answer to the criticism that

height-weight tables ignored the disadvantages of

the increase in body weight with advancing years

as well as variations in body build that influence

the weight of individuals. The average weights in

the tables are for categories of body frame in

which the determination of frame size has not

been specified or defined in terms of body

measure. The user must exercise clinical judgment about type of body frame.

Such data are not satisfactory for studying

the influence of obesity on mortality. Obesity,

an excess accumulation of fat, is used interchangeably with overweight or excess body

weight above standard u’eight. Total body

weight is a measure of bone, muscle, and fat,

and departure from average weight may be due

to one or a combination of these body components. Overweight prevention and control is

directed against overweight due to fat, which is

primarily attributed to excess food intake over

the energy demands of the individual. This is the

major form of overweight in the United States.

The height-~vcight tables in this report present estimates over and under excess body ~vcight

of men and ~jwmcn by height and age. There arc

no estimates of cxccss body fat other than what

can bc inferred from the :ieviation of actual

weight from the mean w-eight; such estimates will

not yield information of how much of the weight

difference is accounted for by excess fat.

The tables in this report are not presumed to

indicate “ideal” or “desirable” weight but only

to present a reference base for the person’s observed weight. This approach of predicting

weight from height sho~ved a correlation which

ranged from the order of +.460 at ages 35-44

years to -!-.390 at ages 45-54 }’ears for mcn of

ages 18-74 years (table 1). Corresponding correlation values f[)r \vomen ran:cd from +.270 at

ages 35-44 ycm to +.246 at ages 45-54 years.

The highest correlation for mcn shouvd that

about 20 percent of the variance of weight is

accounted for by the ~uriancc of height. For

women this \’aluc wus about ? percent.

REFERENCES

1National Center for Health Statistics: Plan and

operation of the Health and Nutrition Examination Survey, United States, 1971-1973. Vital and Health Shztistics. Series I-Nos. 10a and 10b. DHEW Pub. No. (HSM)

73-1310. Health Services and hientat Health Administration. Washington. U.S. Government Printing Office, Feb.

1973.

2National Center for Health Statistics: Weight by

height and age of adults, United States, 1971-74. Vital

and Health Stat&tics. Series 11. Health Resources

Administration, DHEW, Hyattsville, Md. To be published.

3National Center for Heatth Statistics: Weight by

height and age of adults, United States, 1960-62. Vital

and Health Statistics. PHS Pub. No. 1000. Series 1l-No.

14. Public Health Semite. Washington. U.S. Government

Printing Office, May 1966.

4 .Association of Life Insurance hfedical Directors and

ActuariaJ Society of America: Medico-A ctuarihl Mortalit Investigation, Vol. 1. New York. 1912.

?’Society of .4ctumies: Build and BIOOd Pressure

Stud , Vol. 1. Chicago. 1959.

t?’Kannel, W. B., Pearson, G., and McNarnara, P. M.:

Obesity as a force of morbidity and mortality, in Felix

P. HeaId, cd., Adolescent Nuti”tion and Growth. New

York. Appleton-Century-Crofts, 1962.

7I&pinos, B. D.: Weight-height standards based on

World War 11” experience. J. of Am. Stat. Assoc.

53:408 -419,June 1958.
6

Table 1. Coefficients of correlat-icm and constants for linear regression equations and

standard error of estimate of weight (W) on height (H) of adults aged 18-74 years:

United States, 1971-74

..—

Sex and age

18-24

25-34

35-44

;;-::

65:74

18-24

25-34

35-44

45-54

:;-;;

Men

years --------------------------

years --------------------------

years --------------------------

years -------- -------. ..---------

years -------- -------,.------.- --

years --------------------------

Women

years -------- ----------------- --

years --------------------------

years -------- -------- -------- --

years --------------------------

years --------------------------

years --------------------------

Correlation

.438

.420

.460

.390

.426

.404

.285

a

-172.63

-168.67

-187.49

-131.83

-173.99

-131.64

-56.28

-&38.62

-94.02

-77.17

-68.24

-i%.38

b

4.842

4.941

5.277

4.454

5.069

4.385

2.965

3.587

3.815

3.587

3.492

3.583

SYMBOLS

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

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

Quantity zero --------------------------------- -

Quantity more than Obut less than 0.05---- 0.0

Figure does not meet standards of

reliability or precision -----------------------

*

sY.x

27.3

30.5

27.4

28.4

28.5

26.0

28.0

32.1

35.0

33.8

33.&

29.0
admceda7

Tab1..2. Average weishts and selected percentiles for each inch of height: Men, aged 18-74 years, United States, 1971-74

Height

.—

62 inches----------

b3 inches----------

64 inches----------

65 inches----------

66 inches----------

67 inches----------

68 inches----------

Age group in years

18-2.6I25-34 \ 35-44 I45-54 I 5.5-64I65-74

—

Weight in pounds

191 188

180 178

167 166

@ ~

102 108

91 98

195 193

L84 183

$# #

106 113

95 103

200 198

189 188

176 176

~ q

111 118

100 108

206 ;::

195

182 181

~ ~

117 123

106 113

210 208

199 198

186 186

ql D##

121 128

110 118

215 214

204 204

191 192

CI# ~

126 134

115 124

220 219

209 209

$-!$ $?$

131 139

120 129

194 190

183 180

# #j

111 106

100 96

199 194

188 184

176 171

LI& q

116 110

105 100

207 205

196 195

184 182

g ~

124 121

113 111

211 210

200 200

188 187

q$j ~

128 126

117 116

216 215

205 205

193 192

CG& CG$&

133 131

122 121

Height

69 inches----------

70 inches----------

71 inches----------

72 inch’es----------

73 inches----------

74 inches----------

Age group in years

18-24I 25-34 I 35-44 / 45-54 I55-64 ] 65-74

209

199

187

GJ

129

119

213

203

191

~

133

1.23

218

208

196

IzzJ

138

128

223

213

201

~

143

133

228

218

206

KX@

148

138

233

223

211

IizJl

153

143

Weight in pounds

224 224

214 213

202 201

D& DzJ

144 141

134 130

229 229

212 218

207 206

g ~

149 146

139 135

235 234

225 223

213 211

g D#j

155 151

145 140

239 238

229 227

g &

159 155

149 144

245 243

235 232

223 220

~ g

155 149

1

250 247

240 236

228 224

QJjl DJ

170 164

160 L53

225

215

202

g

141

131

230

220

207

g

146

136

236

226

213

@

152

142

240

230

217

g

156

146

244

234

221

~

150

250

240

227

~

156

NOTES: Examined persons were measured without shoes;clothing weight ranged from 0.20 to0.62 pound, which was not deducted from

weights shown.

The weight values were computed frcm the regression equation of weight on height by age. The values above and below the expected

mean value represent the t.8416, *1 .2816, and il.6449 standard error Of the estimate covering within this range 60, 80,

percent of the population around the mean, respectively.

and 90

The first range is expected thus to identify 20, 10, and 5 percent of

the population of the specific height on either side of the range?

Figures inn are the expected means.
8 aciwncedata

Table 3. Average weights and selected percentiles for each inch of height for women by age group: United States, 1971-74

Height

57 inches----------

58 inches----------

59 inches----------

60 inches----------

61 inches----------

62 inches----------

Age group in years

Height

18-24 25-34 35-44 45-54 55-64 65-74

160

150

138

%?

;:

163

153

141

q

81

71

166

156

144

q

84

74

169

159

147

q

87

77

172

162

150

~

90

80

175

165

153

g

‘9;

Weight in pounds II

171 183

159 170

145 154

~ q

77 80

65 67

174 187

162 174

148

q ~

80 84

68 71

178 191

166 178

152 162

q iI@

84 88

72 75

181 195

169 182

155 166

g ~

87 92

75 79

185 199

173 186

# @

91 96

79 83

189 202

177 189

163 173

~ ~

95 99

83 86

187 178 63

175 167

160

@ ~

89 93

77 82

191 182 64

179 171

164 158

~ g

93

81 ::

195 185 65

183 174

168 2.61

~ p

100

;: 89

198 188 66

186 177

171 164

g ~

100 103

88 92

202 192 67

190 181

#j #

104 107

92 96

205 195 68

193 184

178 171

~ ~

107 110

95 99

inches-----------

inches-----------

inches-----------

inches-----------

inche~-----------

inches-----------

Age group in years

18-24 25-34 35-44 45-54 55-6), 65-74

Weight in pounds

2ot

19:

177

IIIJ

10:

9C

21C

197

181

LL@

107

94

214

201

185

~

98

217

204

188

m

130

114

101

221

208

192

11#

158

105

225

212

196

~

122

109

206

193

178

~

107

94

210

197

182

g

110

98

214

201

186

g

115

102

217

204

189

~

118

105

221

208

193

IIGJ

122

109

224

211

196

@

125

112

208 199

196 188

181 175

@ II@

110 114

98 103

212 202

200 191

185 178

~ ~

114 117

102 106

215 206

203 195

188 182

@ p

117 121

105 110

219 209

207 ~:8

# #

121 124

109 113

222 213

210 202

195 189

~ D#

124 128

112 117

226 217

214 206

199 193

~ Iz#

128 132

116 121

1 1

NOTES: Examined persons were measured without shoes; clothing weight ranged

from body weight.

from 0.20 to 0.62 pound, which was not deducted

The weight values were computed from the regression equation of weight cm height by age. The values above and below the expected

mean value represent the *.8416, *1 ,2816, and il .6449 standard error of the estimate covering within this range 60, 80,

percent 0[ the population aro””d the mean, respectively,

and 90

The first range is expected thus to identiry 20, 10, and 5 percent of

the population of the specific height on either side of the range.7

Figures in~ are the expected means
admceMa9

Table 4. Average weightsl for men and women aged 18-74 years, by age group and height:

United States, 1971-742

Sex and height

62

63

64

65

2!

68

%

;;

;:

57

58

59

%!

62

:2

65

66

67

68

~

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

Women

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

inches----------------------------

Age group in years

=T=l 35-44 I45-54I55-64I65-74

130

135

140

145

150

154

159

164

168

173

178

183

188

114

117

120

123

126

129

132

i35

138

141

144

147

141

145

150

156

160

165

170

174

179

184

189

194

199

118

121

125

128

132

136

139

;;;

150

153

157

Weight in pounds

143

148

153

158

163

169

174

179

184

190

194

200

205

125

129

133

137

141

144

148

152

156

159

163

167

147

152

156

160

164

169

173

177

182

187

191

196

200

129

133

136

140

143

147

150

154

158

161

165

168

143

147

153

158

163

168

173

178

183

189

193

197

203

132

136

140

143

147

150

153

157

160

164

167

171

143

147

151

156

160

164

169

173

177

182

186

190

194

130

134

137

140

144

147

151

154

158

161

165

169

1

Estimated values from regression equations of weight on height for specified age

groups.

2Height was measured without shoes. Two pounds were deducted from HES data to allow

for weight of clothing; total weights of all clothing for HAN13Sranged from 0.20 to

0.62 pound, which was not deducted from weights shown.
10

Table 5. Comparison of average weights for men and women in HES (1960-62) and HANES (1971-74). bv a~e

and height: United States ‘

,. ..=

Sex and height HES

1960-62

WANES

1971-74

Exc,esa

of HANES

Over

HE:S I I

HES

I I

Men

inchea ---------

inches ---------

in~hes ---------

inchea ---------

inche~---------

inchea ---------

inches ---------

inchea ---------

inches ---------

inchea ---------

inches ---------

in~he~---------

inches ---------

Wonen

inches ---------

inches ---------

inches ---------

inchea ---------

inches ---------

inches ---------

inches ---------

inches ---------

inchea ---------

inchea ---------

inches ---------

inches ---------

—Men

in~hea ---------

inchea ---------

inches ---------

~nches ---------

=nches---------

inches ---------

in~hes ---------

inches ---------

in~hea---------

inches ---------

inchea ---------

inches ---------

inches ---------

Women

inches ---------

inches ---------

inchea ---------

inches ---------

inches ---------

in~hea ---------

inches ---------

inches ---------

inches ---------

inches ---------

inches ---------

inches ---------

18-24 yeara 25-34 years 35-44 years

135

138

142

145

149

152

156

159

163

166

170

173

177

114

116

118

120

123

125

127

129

132

134

136

138

130

135

140

145

150

154

159

164

168

173

178

183

188

114

117

120

123

126

129

132

135

138

141

144

147

141

145

150

156

160

165

170

174

179

184

189

194

199

118

121

125

128

132

136

139

142

146

150

153

157

143

148

153

158

163

169

174

179

184

190

194

200

205

125

129

133

137

141

144

148

152

156

159

163

167

-5

:;

+1

+2

+3

+5

+5

+7

+8

+6

+11

+1

+2

+3

+3

+4

+5

+6

+6

-!-7

+8

+9

+1

+2

+2

+2

+2

+3

+2

+2

+3

+4

+4

+5

+5

+2

+3

+2

+2

+2

+2

+2

+2

+2

+2

+2

+2

139

143

148

152

157

161

166

170

175

179

184

188

192

110

114

118

122

126

130

134

138

142

146

150

154

+2

+2

+2

+4

+3

+4

+4

+4

+4

+5

+5

+6

i-7

+8

+7

+7

+6

+6

+6

+5

+4

+4

+4

+3

+3

:;

+2

z

+6

+7

+9

+11

+11

+12

+14

-4

:;

-2

-1

+1

+1

+2

+2

+3

147

150

154

158

162

166

169

173

177

180

184

188

192

129

132

134

136

138

141

143

145

147

150

152

154

-4

-2

-1

+1

+3

+5

+6

+7

+1o

+10

+12

+13

-4

-3

-1

+1

+3

+3

+5

+7

+9

+9

+11

+13

45-54 years 55-64 yeara 65-74 years

146

150

154

158

162

166

171

175

179

183

187

191

195

127

130

134

138

141

145

148

152

156

159

163

166

143

147

153

158

163

168

173

178

183

189

193

197

203

132

136

140

143

147

150

153

157

160

164

167

171

142

146

149

152

156

159

163

166

169

173

176

180

183

130

133

136

140

143

147

150

154

157

161

164

168

147

152

156

160

164

169

173

177

182

187

191

196

200

129

133

136

140

143

147

150

154

158

161

165

168

146

149

153

156

160

164

167

171

174

178

182

185

189

136

139

142

145

148

150

153

156

159

162

165

168

143

147

151

156

160

164

169

173

177

182

186

190

194

130

134

137

140

144

147

151

154

158

161

165

169

+1

+1

+2

+4

+4

+5

+6

+7

+8

+9

+10

+10

+11

+1

+1

+1

+1

+1

+1

+1

NOTE: Height waa measured without ahoes. Two pounds were deducted from HES data to allow for weight

of clothing; total weighta of all clothing for HANES ranged

ducted from weighta shown.

from 0.20 to 0.62 pound, which waa not de-
dwlceMa 11

STATISTICAL NOTES

The sampling plan for the 65 examination

locations in the Health and Nutrition Examination Survey (HANES) followed a highly stratified multistage probability design in which

a sample of the civilian noninstitutionalized

population of the conterminous United States

aged 1-74 years was selected. Successive elements dealt with in the process of sampling

were the primary sampling unit, census enumeration district, segment (a cluster of households),

household, eligible person, and sample person.

The sampling design provided for oversampling

among persons living in poverty areas, preschool

children, women of childbearing age, and the

elderly.

The weight and height measures are shown

as population estimates, that is, the body

measure findings for each individual have been

“weighted” by the reciprocal of the probability

of selecting the person. An adjustment for

persons in the sample who were not examined

and poststratified ratio adjustments were also

made so that the final sampling estimates of the

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

Census estimates for the civilian noninstitutionaEzed population of the United States as of

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

Figure 3. MEAN SERUM CHOLESTEROL LEVELS OF GIRLS AGED 1-17 YSARS BY AGE AND RACE: UNITED STATES, 1971-74

210

r

160

150

140 1

CORRECTION TOAD VANCE DATA NUMBER 8

In the key to figure 3 on page 4, — should indicate Negro, and ■ ===■ == should indicate White

as shown below.

L

0 I I I I I I 1 I I 1 I I I I I I

1 2 34 5 6 7 8 9 10 11 12 13 14 15 16 17

AGE IN YEARS

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

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service [ Number 15 = December14,1977

National Ambulatory Medical Care Survey of Visits to

General and Family Practitioners, January-December 19751

According to data collected in the National

Ambulatory Medical Care Survey (NAMCS), an

estimated 234,660,000 visits were made to the

o f fices of general and family practitioners

(GFP’s) during calendar year 1975. These visits

accounted for over 41 percent of the estimated

567.6 million visits made to all office-based physicians in 1975.

The NAMCS is a sample survey desi~ed to

explore the provision and utilization of ambulatory care in the physician’s office-the setting

where most Americans seek health care. The survey is conducted yearly over the coterminous

United States by the Division of Health Resources Utilization Statistics of the National

Center for Health Statistics. The survey sample

is selected from doctors of medicine and osteopathy who are engaged in office-based, patient

care practice. In its current scope, the NAAICS

excludes physicians practicing in Alaska and

Hawaii, physicians whose specialty is anesthesiology, pathology, or radiology, and physicians in

Government service.

For a listing of publications describing tlie

development of the survey and definitions of

terms used in the survey see the Technical

Notes. A detailed explanation of the sample

design and the relative standard errors associated

with selected aggregate statistics may be found

in that section.

IThis report was prepared by Beulair K. CSPress,

Ph.D., l)ivision of Health Resources Lltilixation Statistics.

Provisional NAMCS data for calendar year

1974 regarding general and family practitioners

have been published.z Caution should be exercised in making comparisons between 1975 estimates and the provisiomd 1974 estimates previously published. Since the 1974 provisional data

were released, refinement of the procedures used

to project the national estimates from the sample findings has resulted in a lowering of the

final 1974 numerical estimates of office visits by

8 to 9 percent. In particular, the provisional estimate of 263.4 million office visits to general and

family practitioners in 1974 was finalized to reflect the more accurate figure of 242.9 million

office visits. Final distributions and percents,

however, were virtually unchanged. The number

of total office visits for all specialties for calendar year 1974, estimated at 634.1 million in the

previous publication, has been adjusted to 577.8

million.3

2 National Center for Health Statistics: National Ambulatory kledical Care Sumey: National Ambulatory

Medical Care Survey of f7isits to General and Family

Physicians, January 1974December 1974. Monthly

Vital Statistics Report. Vol. 25-No. 2, Supp. 2. DHEW

Pub. No. (HRA) 76-1120. Health Resources Administration. Rockville, Lid. hlay 19, 1976.

3 National Center for IIealth Statistics: Ambulatory

medical care rendered in physicians’ offices, United

States, 1975. Aikance Data From l’ital and Health

Statistics, No. 12. DHEW Pub. No. (lIRA) 77-1250.

Health Resources Administration. Hyattsville, Md. Octtober 12, 1977.
2 dvamedata

DATA HIGHLIGHTS

A comparison of visits made to office-based

physicians in the most-visited specialties reveals

that visits to GFP’s during 1975–234.7 million–exceeded the total estimated visits to the

next four leading specialties combined– 198.2

million (table 1).

Table 1. Number and percent of visits to

off ice-based physicians , by the mostvisited specialties: United States, January- December 1975

Most -visited

specialty

GENERAL AND FAMILY

PRACTICE ---------------

Internal medicine -------

Obstetrics and

gynecology -------------

Pediatrics --------------

General surgery ---------

Number

of

visits

in

thousands

234,660

62,117

48,076

46,684

41,292

Percent

of

vis its

41.3

10.9

8.5

8.2

7.3

Type and Location of Practice

More visits were made to general and family

practitioners electing solo practice—73 percent—than to physicians having group or partnership arrangements—27 percent (table 2).This

reflects the fact that about 74 percent ofGFP’s

were engaged in solo practice in 1975.

While visits to the offices of GFP’s Iocated

within standard metropolitan statistical areas

(SMSA’S)4 outnumbered visits tononmetropoli4

An SMSA is defined as a group ofcontiguouscounties containing at least one city of 50,000 inhabitants or

more, or two contiguous cities with a combined population of at least 50,000 inhabitants. The distinction

“metropolitan/ nonmetropolitan” should not be confused with “urban/suburban” or “urban/rural” since an

SMSA may contain urban, suburban, and rural subsections.

tan-based offices (table 2), there was less disparity between location categories than appeared

in other specialties. Table 3 illustrates this difference.

A greater number of visits to metropolitanbased GFP’s is reasonable since about 70 percent

of the population resides within SMSA’S, and

approximately 65 percent of physicians in general and family practice are Iocated within

SMSA’S. However, the annual rate of visits to

nonmetropolitan offices of GFP’s (146 visits per

100 persons) was more than half again as much

as the rate within SMSA’S (94 visits per 100 persons)—an indication that the population outside

of SMSA’S tends to visit GFP’s more often than

those within SNISA’S.

Patient’s Age, Sex, and Color

The number of visits to office-based generaI

and family practitioners increased with age, the

greatest number occurring in the age interval

from 45 to 64 years (table 2). For persons 65

years and over, the rate of annual visits was triple the rate for persons under 15 years of age.

Visits by females outnumbered visits by

males by a ratio of about 3 to 2 (table 2). Further, the tendency of females to make more

visits to the physician was clearly reflected in

their higher rate of annual visits. For every 100

persons, there were 130 visits by females. For

males, this rate was 95 visits for 100 persons.

Table 4 shows the influence of sex and age

on percent and annual rate of visits. Female

visits exceeded male visits in every age category

except that under 15 years.

White persons (88.5 percent) outnumbered

all other persons (1 1.5 percent) in office visits to

GFP’s (table 2). The annual rate of office visits

was also higher for white persons than for the

rest of the population. These data could indicate

that members of other races availed themselves

more often of other means of ambulatory medical care since the NAMCS includes oniy officebased care.

Visits described by the joint classification,

white and female, were greater than by any

other combination of sex and color as shown in

table 5.
dmnceda3

Table 2. Number, percent distributions, and number of visits per 100 persons per year

to office-based general and family practitioners by type and location of the physician’s practice and by age, sex, and color of the patient: United States, JanuaryDecember 1975

—.—

Selected physician and

patient characteristics

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

PHYSICIAN CHARACTERISTIC

Type of practice

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

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

Location3

Metropolitan-----------------------------------

Nonmetropolitan--------------------------------

PATIENT CHARACTERISTIC

Age

Under 15 years---------------------------------

15-24 years------------------------------------

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

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

65 years and over------------------------------

Sex

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

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

Color

White------------------------------------------

0ther4-----------------------------------------

Number of

visits in

thousands

234,660

171,010

63,650

136,533

98,127

33,772

37,568

56,476

64,502

42,343

1:;,;;:

a

207,660

27,000

Pertent

distributions

of visits

100.0

72.9

27.1

58.2

41.8

14.4

16.0

24.1

27.5

18.0

59.2

40.8

88.5

11.5

Number of

visits per

100 persons per

yearl

113

---

---

94

146

65

l%

152

194

130

95

115

99

lBased on population estimates for July 1, 1975, Bureau of the Census, Current Population Reports, Series P-25 and P-26.

‘Includes partnership and group practices.

3sj-Enifies location within or outside the standard metrooolita statistical areas

(SMSA’=).

.

qOf this category, about 81 percent are visits by blacks.

Major Reasons for Visit forvisitrecordedby thephysicianasnearlyas

The data concerning the most frequent com- possibk in the patient’s o-~ words. The b;oacl

plaints, symptoms, or other reasons for a clinical range of the GFP’s practice is demonpatient’s visit (tabIe 6) were derived from an strated by the fact that it required 18 reasons to

item on the survey form that elicited the reason account for only haIfofaIl visits.
4

Table 3. Percent distribution of visits

to office-based physicians by location,

according to specialty: United States,

January-December 1975

Location

Total---

Metropolitan-----

Nonraetropolitan--

General Oband Inter- stetfam- nal rics Pediily medi- and atrics

praccine gynetice Cology

I I I

Percent distribution

of visits

100.0 100.0 100.0 100.0

58.2 84.6 81.9 89.1

41.8 15.4 18.1 10.9

Table 4. Percent and annual rate of visits to office-based general and family

practitioners, by sex and age of the

patient: United States, Jan=ary-December 1975

I I

I I Annual

Percent of rate of

all visits visits per

Age of 100 perpatient

I

Female

Under 15

years ---------- 6.5

15-24 years ----- 9.7

25-44 years ----- 15.0

45-64 years ----- 16.8

Over 65 years--- 11.1

I

sons

In examining the maior reasons fo:

Male

69

75

85

123

183

Table 5. Percent of visits to officebased general and family practitioners,

by sex and color: United States. January-December 1975

Color of patient

White -------------------

All other ---------------

Percent of

all visits

TFemale Male

52.1 36.3

7.1 4.4

visits involvedprenataland postnatalcare.Only

the obstetrician-gynecologistexceeded theGFP

in the number of visits for these three reasons.

Principal Diagnosis

Table 71ists the 25 most common principal

diagnoses assigned by GFP’s to office visits.

These diagnose; constituted about one-half of all

visits made to office-based GFP’sin 1975.

Table 8 shows the number ofprincipal diagnoses according to major ICDA5 groups. The

following four diagnostic groups account for

slightly more than 50 percent of all principal

diagnoses rendered:

Diseases of the respiratory system,

Special conditions and examinations vvithout sickness,

Diseases of the circulatory system,

Accidents, poisonings, and violence.

Diagnostic and Therapeutic Services

Limited or general histories and examinations were performed during about two-thirclsof

all general and family practitioner (GFP) office

visits (table 9).

Blood pressure checks, performed during40

r a visit

percent of all GFP visits, were done frequently

shown in item 8 of the Pa~ient Record form, it is

estimated that over 2 million visits at least partly

involved family planning, and over 6 million

5Eighth Revision International Classification of Diseases, Adapted for Use in the United States (iCDA).
Table 6. Number, percent, and cumulative percent of visits to office-based general and

family practitioners, by the 25 most frequent patient problems, complaints, or symptoms classifiedby the National Ambulatory Medical Care Survey (NAMCS) symptom classification code: United States, January-December 1975

—

Rank

1

10

11

12

13

14

15

16

17

i;

20

21

22

23

24

25

Most frequent patient problem,

complaint, or symptom and NAMCS codel

General and required physical

examinations-----------------------------9OO,901

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

Throat soreness-------------------------------52O

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

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

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

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

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

~;;;gue---------------------------------------OO4

------------------------------------------312

Headache--------------------------------------O56

Pregnancy examination-------------------------9O5

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

Allergic skin reaction------------------------ll2

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

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

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

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

Vertigo— dizziness----------------------------O69

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

Earache---------------------------------------735

Fever-----------------------------------------oo2

Wnecologic e=mination -----------------------904

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

F1u-------------------------------------------3l3

Number of

visits in

thousands

11,582

9,535

9,005

8,847

7,279

7,234

7,046

6,436

6,221

6,077

5,836

5,709

4,919

4,711

4,576

4,432

4,414

3,643

3,554

3,161

3,147

3,087

2,749

2,620

2,560

Percent

of

visits

4.9

4.1

:::

3.1

3.1

3.0

2.7

;:;

2.5

2.4

2.1

2.0

2.0

1.9

1.9

1.6

1.5

1.4

1.3

1.3

1.2

1.1

1.1

Cumulative

percent

4.9

1;:;

16.6

19.7

22.8

25.8

28.5

31.2

33.8

36.3

38.7

40.8

42.8

44.8

46.7

48.6

50.2

51.7

53.1

54.4

55.7

56.9

58.0

59.1

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

forpatientsover44years ofage and rarelyfor

patientsunder 15 years.For personsover 44

yearsofage, 53 percentofvisitsincludeddeterminationof arterialpressureand inonly 10percent of visitsby patientsunder 15 yearswas

arterialpressuremeasured.Drugs were themost

common form of therapeusis.About 56 percent

of visitsresultedin administrationor prescriptionofdrugs.

Prior Visit Status

Patientstendedto remainunder thecareof

the same physiciansince7 of8 visitsto GFP’s

were madeby “old” (returning)patients(table

10). Of these, about two-thirdsrelatedto problems the physicianhad treatedpreviously.

Seriousness of Problem

The data on seriousnessof problem expressedthe physician’sjudgment as to the extentof impairment thatmight resultifno care

were availablefor the given problem. They

shouldbe viewedinthecontextof thenatureof

thespecialist’s practice.

Problemspresentedby patientswhen visiting

the officeof the GFP tended toward the lower

rangeof the “seriousness”scale(table10).The

largest proportion of visits (48 percent) were
6 acklncedata

Table 7. Number, percent and cumulative percent of visits to office-based general and

family Practitioners. by the 25 most common ICDA-coded minciDal diaznosis: United

States,” January-Decernbe$ 1975

,

I

I

Rank Most common principal diagnosis and ICDA codel

I

1

2

3

4

5

6

:

1:

11

12

13

14

15

16

:;

19

20

;;

23

24

25

Medical or special examination----------------------YOO

Essential benign hypertension-----------------------4Ol

Acute upper .respiratory infection, site

unspecified----------------------------------------465

Diabetes mellitus--=--------------------------------25O

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

Acute pharyngitis-----------------------------------462

Chronic ischemic heart disease----------------------4l2

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

Influenza, unqualified-----.------------------------47O

Obesity---------------------------------------------277

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

Bronchitis, unqualified-----------------------------49O

Acute tonsillitis-----------------------------------463

Arthritis, unspecified------------------------------7l5

Cystitis--------------------------------------------595

Otitis media----------------------------------------38l

Osteoarthritis--------------------------------------7l3

Synovitis, bursitis---------------------------------73l

Other nonarticular rheumatism-----------------------7l7

Diarrheal disease-----------------------------------OO9

Menopausal symptoms---------------------------------627

Chronic sinusitis-----------------------------------5O3

Hay fever-------------------------------------------5O7

Sprains, strains of sacroiliac region---------------846

Inoculations and vaccinations-----------------------YO2

,

Number

of

visits

in

thousands

14,690

13,904

8,505

5,780

5,602

;,:::

5;075

4,927

4,905

4,126

3,903

3,884

3,457

3,203

3,087

2,895

2,868

2,818

2,709

2,562

2,546

2,503

2,437

2,347

Percent

of

visits

u--- ––

Cumulative

percent

6.3

5.9

;:2

2.4

2.2

;:;

2.1

?:;

1.7

1.7

1.5

1.4

1.3

::;

1.2

:;:

1.1

1.1

1.0

1.0

6.3

12.2

15.8

18.3

20.7

2;!.9

25.1

27.3

29.4

31.5

33.3

35.0

36.7

38.2

39.6

4o1.9-

42,.1

43’.3

44.5

45.7

46.8

47.9

49.0

50.0

51.0

‘Diagnostic groupings and code number inclusions are based on the Eighth Revision

International Classification of Diseases, Adapted for Use in the United States.

rated “not serious”followed by about 35percent rated “slightlys erious.’’Only 17 percent of

visits were judged “serious” or “very serious.”

Since much of office practice focuses on preventive and maintenance care, this result was

predictable.

Disposition and Duration of Visit

More than half (51 percent)of the visitsto

the GFP resulted in the specific direction to return at a particular time (table 10). An additional one-third involved followup if needed or

followup by telephone. A very small proportion

(slightly more than 1 percent) of the GFP’s

patients were admitted to a hospitaI. This also

supports the findings that ambulatory office

care focuses on preventive care and health maintenance with an accompanying small proportion

of cases judged “serious.”

The average time spent in face-to-face encounter between the GFP and the patient was

about 13 minutes, slightly less than the average

time for the 13 most-visited specialties. While

the duration of most visits was 6-15 minutes (as

evidenced by the average), the proportion of

visits consuming 16-30 minutes tended to iincrease as the problems were judged more serious.
admceMa7

Table 8. Number and percent distribution of visits to office-based general and family

practitloners,by principal diagnosis classified by ICDA group:United States,JanuaryDecember 1975

Principal diagnosis and

ICDA codel

All principal diagnoses----------------------------------

Infective and parasitic diseases------------------------OOO-l36

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

Endocrine, nutritional, and metabolic diseases----------24O-279

Diseases of the blood and blood-forming organs----------28O-289

Mental diSorders----------------------------------------29O-3l5

Diseases of the nervous system and sense organs---------32O-389

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

Diseases of the respiratory systen----------------------46O-5l9

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

Diseases of the genitourinary system--------------------58O-629

Diseases of the skin and subcutaneous tissue------------68O-7O9

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

Symptoms and ill-defined conditions---------------------780-796

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

Special conditions and examinations withoua sickness----yy13yl3

Other diagnoses2-----------------------------------------------

Dia~osis “none” or unknown3-----------------------------------

Number of

visits in

thousands

234>660

10,878

2,795

13.568

3;043

7,064

10,906

29,005

43,304

9,154

14,946

10,721

16,668

9,220

20.168

30;188

544

2,486

Percent

distribution of

visits

100.0

4.6

1.2

:::

.

1::;

18.5

:::

4.6

7.1

:::

12.9

0.2

1.1

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

International Classification of Diseases. Adapted for Use in the United States.

‘Complications of pregnancy, childbirth and the puerperium (630-678), congenital

anomalies (740-759), certain causes of erinatal morbidity and mortality (760-779).

sIncludes blank, noncodeable, and il!egible diagnoses.
8 acivancedata

Table 9. Number and percent distribution of visits to office-based general and family

practitioners by diagnostic and therapeutic services ordered or provided:

States,

United

January-December 1975

Diagnostic and therapeutic service ordered or provided

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

No services provided ----------------------------------------------

Diagnostic services:

Limited history/examination -------------------------------------

General history/examination -------------------------------------

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

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

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

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

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

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

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

Therapeutic services:

Drug administered or prescribed2--------------------------------

Injection---------------------------"----------------------------

Immunization/desensitization------------------------------------

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

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

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

Psychotherapy/th~rapeutic listening -----------------------------

Other services provided -------------------------------------------

Number of

visits in

thousands

234,660

4,082

130,516

29,570

50,618

14,638

94,358

5,418

1,831

3,307

1,474

130

50

8

12

7

27

6

,479

,476

,659

,113

,834

,378

,715

8,451

Percent

of

visitsl

——

100.0

1.7

55.6

12.6

21.6

16.2

40.2

55.6

211.5

3.7

5.2

3.3

1X.7

2.9

3.6

lPercents will not add to 100 because most patient visits required the provision of

more than one treatment or service.

‘Includes prescription and nonprescription drugs.
9

Table 10. Number and Dercent distributions of visits to office-based ~eneral and family practitioners b? prior-visit status, seriousness of problem, ~isposition and

duration of visit: United States, January-December 1975

Selected visit characteristics

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

Patient

Patient

Patient

Serious

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

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

DisDositionl

Prior-visit status

seen for the first time --------------------------

seen before—for another problem -----------------

seen before—for current problem -----------------

Seriousness of problem

and very serious -------- -------- -----------------

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

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

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

Telephone followup ---------------------------------------

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

;;i;zto hospital ----------------------------------------

------- ------- -------- ------- ------- ----.-- ------s -

Duration of visit3

O minutes ------------------------------------------------

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

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

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

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

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

Number of

visits in

thousands

234,660

29,847

71,446

133,367

39,941

82,440

112,279

36,326

120,379

68.444

8;658

6,957

2,861

2,276

3,885

48,156

79,964

58,478

39,815

4,362

‘ercent distributions

of visit

100.0

12.7

30.5

56.8

17.0

35.1

47.9

15.5

51.3

29.2

3.7

3.0

1.2

1.0

24.9

17.0

1.9

lPercents will not addto 100 because some patient visits had more than one disposition.

21ncludes return to referring physician.

3Signifies time spent in face-to-face encounter between physician and patient.
10 aduancedata

TECHNICAL NOTES

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

Nat ion aI Ambulatory Medical Care Survey

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

United States made by ambulatory patients to

physicians who are principally engaged in office

practice.

SAMPLE DESIGN: The 1975 NAMCS utilized a

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

within practices. Within the 87 PSU’S composing

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

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

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

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

of office visits taking place within their practice

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

previous issue of Advance Data From Vital and

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

Additional data concerning physician practice

characteristics such as primary specialty and

type of practice were obtained during an induction interview.

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

an earlier publication in Series 2 of Vital and

Health Statistics (No. 61. ~HEW Pub. No.

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

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

1975 NAMCS desigm and procedures will be

presented in future publications.

SAMPLING ERRORS: Since the estimates for

this report are based on a sample rather than the

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

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

standard error of the estimate by the estimate

itself and is expressed as a percent of the estimat e. Relative standard errors of selected aggTegate statistics are shown in table I. The standard

errors appropriate for the estimated percentages

of office visits are shown in table II.

Table 1. Approximate relative standard errors of estimated numbers of office visits

Estimate Relative standard

in error in

thousands percentage points

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

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

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

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

10,000 .. .. ... . ... .... .. ... .... . .. .... ... . .. 7,5

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

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

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

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

relative standard error of 4,3 percent or a standard error of

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

Table II. Approximate standard errors of pf2rCeflta@ for eStimated numbers of office visits

Base of percentage

(number of visits

in thousands)

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

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

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

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

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

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

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

Estimated percentage

I

1or 5 or

99 95

2.1 4.6

1.2 2.7

0.9 2.1

0.7 1.5

0.3 0.7

0.2 0.5

0.1 0.2

lOor 20 or 30 or so

90 80 70

6.3 8.5 9.7 10.6

3.7 4.9 5.6 6.1

2.8 3.8 4.3 4.7

2.0 2.7 3,1 3.3

0.9 1.2 1.4 1.5

0.6 0.8 1.0 1.1

0.3 0.4 0.4 0.5

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

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

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

ROUNDING: Aggregate estimates of office visits

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

were calculated on the basis of original, un-
dmcedaa 11

rounded figures. Due to rounding of percents,

the sum of percentages may not equal 100.0 percent.

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

services who is neither bedridden nor currently

admitted to any health care institution on the

premises.

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

Responsibility over time for patient care and

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

an institution.

A vz3it is a direct personal exchange between

an ambulatory patient and a physician or a staff

member working under the physician’s supervision for the purpose of seeking care and

rendering health services.

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

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

physicians who are federally employed; physicians who treat only institutionalized patients;

physicians employed full time by an institution;

and physicians who spend no time seeing ambulatory patients.

SYMBOLS

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

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

Quantity zero—-–---—-----—--–-––––

Quantity more than Obut less than 0.05— 0.0

Figure does not meet standardsof

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

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service ] Number 16 ■ February7,1978

Off ice Visits to Internists:

National Ambulatory Medical Care Survey, United States, 1975’

According to data collected in the National

Ambulatory Medical Care Survey (NAMCS), an

estimated 62,117,000 visits were made to the

offices of internists during calendar year 1975.

These visits accounted for almost 11 percent of

the estimated total visits made to all office-based

physicians in 1975.

The NAMCS is a sample survey designed to

explore the provision and utilization of ambulatory care in the physician’s office–the setting

where most Americans seek health care. The survey is conducted yearly over the coterminous

United States by the Division of Health Resources Utilization Statistics of the National

Center for Health Statistics. The survey sample

is selected from doctors of medicine and osteopathy who are engaged in office-based, patient

care .practice. In its current scope, the NAMCS

excludes physicians practicing in Alaska and

Hawaii; physicians whose specialty is anesthesiology, pathology, or radiology; and physicians in

Government sewice.

Definitions of terms used in the survey and a

detailed explanation of the sample design and

1This report was prepared by Beulah K. Cypress,

Ph.D., Division of Health Resources Utilization Statistics.

2 Nation~ Center for Health Statistics: Ambulatory

medical care rendered in physicians’ offices: United

States, 1975. Advance Data From Vital and Health Sta-

,tistics, No. 12, DHEW Pub. No. (HRA) 77-1250. Health

Resources Administration. Hyattsville, Md., Oct. 12,1977.

the relative standard errors associated with

selected aggregate statistics may be found in the

Technical Notes. A copy of the Patient Record

appears in an earlier report. 2

DATA HIGHLIGHTS

Comparison of visits made to office-based

physicians in the five most visited specialities

shows that visits to internists were exceeded

only by the number of visits made to general

and family practitioners (table 1).

Table 1. Number and percent of vhits to

off ice -based physic ians. by selected

physician specialties:

January-December 1975

Selected

specialty

General and family

practice ---------------

Internal medicine- --------

Obstetrics and

gynecology -------------

pediatrics --------------

General surgery ---------

united States,

Number

of

visits

in

thou -

sands

234,660

62,117

48,076

46,684

41,292

Per -

cent

of

visits

41.3

10.9

8.5

8.2

7.3
2 aduancedata

Table 2. Number, percent distributions, and annual rate of visits to office-based internists by type and location of practice, and age, sex, and color of patient: United

States, January-December 1975

Selected physician and

patient characteristics

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

Type of practice

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

OtherZ ----------------------------------

Location of practice3

Metropolitan ----------------------------

Nonmetropolitan -------------------------

Under 15 years --------------------------

15-24 years -----------------------------

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

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

65 years and over -----------------------

Sex

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

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

Color

White -----------------------------------

All otherd ------------------------------

Number of

visits in

thousands

62,117

33,706

28,411

52,543

9,574

2,047

5,474

13,106

23,565

17,925

36,978

25,139

56,438

5,679

Percent

distributions

of visits

100.0

54.3

45.7

84.6

15.4

3.3

8.8

21.1

37.9

28.9

59.5

40.5

90.9

9.1

Annual rate

of visits

per 100 in

population]

...

. . .

. . .

37

14

35

25

31

21

lBased on population estimates for July 1,1975: Bureau of the Census, Current Population Reports, Series P-25 and P-26.

21ncludes partnership and group practices.

3Signifies location within or outside the standard metropolitan

(S14SA’S).

statistical areas

.— qof i<is category about 82 percent are visits by black persons.
ackmdaa3

Type and Location of Practice

About 54 percent of visits to internists were

to those in solo practice (tabIe 2). This is a

direct reflection of the fact that about 52 percent of the internists in the NAMCS sample were

estimated to have been engaged in solo practice.

Table 2 ako shows that 85 percent of the

visits to internists were to offices Iocated within

standard metropolitan statistical areas

(SMSA’S),3 a probable number since about 70

percent of the population reside within SMSA’S.

However, the visit rate was more than twice as

high for visits to offices in metropolitan locations

(37 visits for each 100 persons in metropolitan

areas). This may signify an inclination for some

of the population outside of SN4SA’S to visit

internists within SMSA’S.

Age, Sex, and Color of Patient

Information derived from table 2 indicates

that the number of office visits to internists increased with advancing age to age 65 years, the

greatest number occurring in the age interval

from 45 to 64 years; and a very sma,II number

(about 3 percent) representing the group under

15 years of age. The annual rate of visits also

shows a steady increase with age across all age

groups.

Two of three visits were made by females, as

shown in table 2. This is partly explained by the

fact that females (51 percent) outnumbered

males (49 percent) in the general population.

However, the tendency of females to visit the

internist more often is demonstrated by their

higher rate of annual visits. Figure 1 illustrates

the influence of sex and age on the annual visit

3An SMSA is defined as a group of contiguous

counties containing at least one city of 50,000 inhabitants

or more, or two contiguous cities with a combined population of at least 50,000 inhabitants. The distinction

“metropolitan/nonmetropolitan” should not be confused

with “urban/suburban” or “urban/rural” since an SMSA

may contain urban, suburban, and rural subsections.

rate. The annual rate of female visits exceeded

the annual rate for males in every age category

except under 15 years. The difference became

greater after the age of 44, with the largest difference in annual rate between females and

males occurring in the age group 65 years and

over.

Figure 1. ANNUAL RATE OF VISITS TO INTERNISTS

PER 100 IN POPULATION BY SEX AND AGE OF

PATl ENT UNITED STATES. JANUARY-DECEMBER

1975.

cc I

: 30

~

z

20 -

10

0

Under 15 1524 25-44

~ Male

= Female

45.64 65 and over

AGE OF PATl ENT IN YEARS

Visits by white persons (91 percent) outnumbered visits by all others (9 percent) to

internists, paralleling to some degree the population ratio. However, the average annual rate of

office visits was also higher for white persons—31

visits for each 100 white persons in the population were made to internists’ offices, whereas

members of other races visited at a rate of

21 out of 100. These data are similar to percentages found for general and family practitioners

and could indicate that members of other races

avail themselves more often of other means of

ambulatory medical care since the NAAfCS includes onIy office-based care.
Table 3. Number and percent of visits to

office-based internists, by sex and

color of patient: United States, January-December 1975

I I

Color of patient Female I

Male

The domination of the internist’spatient

load by the white female k illustratedin the

matrix shown in table3.

Patient’s Major Complaint, Symptom,

or Other Reason for Visit

The data in table4arederived from an item

on the survey form which elicitsthe reason for

visitrecorded by the physicianas nearly aspossiblein the patient’sown words. The symptoms

presentedby patientscovered a broad spectrum

Tab le 4. Number, percent, and cumulative percent of visits to office-based internists,

by the 20 most frequent patient problems, complaints, or symptoms: United States,

January-December 1975

Rank

20 most frequent patient problems,

complaints, or symptoms and NAMCS codel

General and required physical

examinations-----------------------9OO,9Ol

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

Problems of lower extremity-------------4O()

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

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

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

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

Cough-----------------------------------3ll

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

Vertigo —dizziness----------------------O69

Shortness of breath ---------------------306

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

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

Diabetes mellitus -----------------------991

Cold------------------------------------3l2

Visits for medication-------------------9lo

Nervousness -----------------------------810

Problems of face, neck ------------------410

Allergic skin reactions-----------------ll2

Other symptoms referable to cardiovascular system---------------------------22O

Number of

visits in

thousands

3,455

2,834

2,724

2.460

2;292

1,823

1.756

1;694

1,500

1,427

1.365

1;262

1.137

1;072

960

884

831

749

716

672

Percent

of

visits

:::

4.4

4.0

3.7

2.9

2.8

2.7

2.4

;:;

2.0

1.8

;:;

1.4

1.3

1.2

1.2

1.1

Cumulative

percent of

visits

5.6

1.0.2

1.4.6

18.6

22.3

25.2

2!8.0

aJ(),7

33.1

35.4

37.6

39.6

41.4

43.1

44.7

46.1

47.4

48.6

49.8

50.9

I.Symptomatic groupings and code number inclusions are based on a symptom classification developed for use in the NAMCS.
admcdaa5

of problems sincethe 20 most common reasons These diagnosescovered about one-halfof all

forvisitconstitutedonly about halfof allvisits. visitsmade tooffice-basedintemktsk 1975.

Table 6 shows the number of principaldiPrincipal Diagnosis4 agnosesaccordingto major ICDJ3 groups.5The

Table5 Iktsthe 20 most common principal

diagnosesassi<gnedby interniststo officevisits.

5~ationa]Centerfor llealth Statistics: Eighth RCZIision In t crnational Classi~cation oj”Diseases, Adap ted fo r

~7SC in t~.g ~Tnited s~ates (lcD:\). p~~s pub. No. 1 fj93.

4Principal diagnosis is the first diagnosis listed by the Public Health Semite. JVashington. U.S. Go\,emment

physician on the Patient Record. Printing Office, 1967.

Table 5. Number, percent, and cumulative percent of visits to office -based internists

by the 20 most common ICDA 3 -dizit cate$zories containing the mine & ipal diagnos is:

U&ited States, January-December %975 -

Rank 20 most common ICDA 3-digit

categories and code]

Essential benign hypertension -----------sol

Chronic ischemic heart disease----------4l2

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

Medical or special examination----------yOO

Acute upper respiratory infection-------465

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

Osteoarthritis and allied conditions----7l3

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

Medical and surgical aftercare----------ylO

Rheumatoid arthritis and allied

conditions-------------------.---------712

Obesity---------------------------------277

Observation, without need for further

medical care---------------------------793

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

Hay fever-------------------------------507

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

Other nonarticular rheumatism-----------7l7

Synovitis, bursitis, and tenosynovitiS--73l

Arthritis, unspecified------------------715

Symptoms referable to respiratory

system---------------------------------783

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

—.

Number of

visits in

thousands

5,781

4,894

2,777

2,566

1,588

1,430

1,414

1,253

1,101

1,011

983

838

837

749

746

727

662

628

614

577

Percent

of

visits

Cumulative

percent

of visits

1;:;

21.7

25.8

28.4

30.7

33.0

35.0

36.8

38.4

40.0

41.3

42.6

43.8

45.0

46.2

47.3

48.3

49.3

50.2

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

International Classification of Diseases, Adapted for Use in the United States.
6 acklncedata

Table 6. Number and ptiercent distribution of visits to office-based internists by

principal diagnosis classified by major ICDA groups: United States,January-December

1975

Principal diagnosis classified by ICDA group and codel

All principal diagnoses ----------------------------

Infective and parasitic diseases -------------- ----000-136

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

Endocrine, nutritional, and metabolic diseases----240-279

Diseases of the blood and blood-forming organs----280-289

Mental disorders ----------------------------------290-315

Diseases of the nervous system and sense organs---3238989

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

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

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

Diseases of the genitourinary system--------------58O-629

Diseases of the skin and subcutaneous tissue------68O-7O9

Diseases of the musculoskeletal system and

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

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

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

Special conditions and examinations without

sickness ---------------------------------------- -YOO-Y13

Other diagnoses, “none,” and unknownz --------------------

Number of

visits in

thousands

62,117

1.737

2;310

5,678

760

2,250

2,033

15,436

7.295

3;422

2,327

1,597

5,332

4,085

2,674

4,317

865

Percent

distribution of!

visits,

100,0

H

9.1

1.2

;:!

2!4.9

1.1.7

5.5

3.8

2.6

H!

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

International Classification of Diseases, Adapted for Use in the United States.

‘630-678, Complications of pregnancy, childbirth, and the puerperium; 740-759, Congenital anomalies; blank, noncodable, and illegible diagnoses.

followingfour diagnosticgroups accounted for

over 54 percent of all principal diagnoses

rendered,with almost halfof these included in

diseasesof the circulatorysystem: diseasesof

the circulatory system; diseases of the respiratorysystem;endocrine,nutritional,and metabolic diseases;and diseasesof the musculoskeletalsystem and connectivetissue.

Diagnostic and Therapeutic Services

Blood pressurechecks were provided inover

61 percent of allvisits,and EKG’s were performed in 14 percent of visitsto the internkt

(table7). Only 33 percent of visitsto allofficebased physiciansincludedblood pressurechecks,

with an EKG performed in only 3percent ofall

visits, reflecting the high degree of diseases of

the circulatory systcm diagnosed by internists.

Almost half of all visits to the internist resulted

in a drug administered or prescribed. Medical

counseling was included in almost 18 percent of

the visits to the internist, about 6 percent ]more

thanto all office-based physicians.
abnceMa7

Table 7. Number and percent distribution of visits to office-based internists, by diagnostic and therapeutic services ordered or provided: United States, JanuaryDecember 1975

Diagnostic and therapeutic services ordered

or providedl

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

No services provided-----------------------------------

Diagnostic services

Limited history or examination-------------------------

General history or examination-------------------------

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

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

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

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

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

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

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

Therapeutic services

Drug administered or prescribed2-----------------------

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

Immunization or desensitization------------------------

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

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

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

psychotherapy or therapeutic listening-----------------

Other services provided--------------------------------

Number of

visits in

thousands

62,117

832

38,132

12,498

23,893

8.131

38;156

8,663

932

1,465

1,005

30,761

7,209

1,596

905

701

11,078

1,667

1,075

Percent of

visi;s

100.0

1.3

61.4

20.1

38.5

13.1

6i:4

14.0

;::

1.6

49.5

11.6

2.6

1.5

1;::

2.7

1.7

Ipercentswill not add to 100 because most patient visits required the provision of

more than one treatment,or service.

21ncludes prescription and nonprescription drugs.

Prior Visit Status and Seriousness

of Problem

Ilatafrom tables8 and 9 indicatethat

about 7 of 8 visits to internistswere by returningpatients,with continuingproblemspresentedby 6 of 8 patientsthephysicianhad seen

before.The greaterthe age of the patient,the

greaterwasthc tendencytovisit}vitha recurring

problem.

Tables 8 and 9 alsoprovidedata thatexpressthe physician’sjudgment as to theextent

of impairmentthatmight resultifno carewere

availableforthegivenproblem.They shouldbe

viewed in the context of the speciaIist’s practice.

About 71pcrcent of all visitswcrejudged by

the internist as cithernot serious or slightly serious. However, the tendency to judge cases as

belongingin the more serious category increased

with advancing age ofthc patient.
8 aduancecbta

Table 8. Number and percent distributions of visits to office-based internists by

prior visit status, seriousness of problem, disposition of visit, and duration of

visit: United States, January-December 1975

Selected visit characteristics

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

Prior visit status

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

Patient seen before for another problem --------------------

Patient seen before for current problem --------------------

Seriousness of problem

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

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

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

Disposition

No follomp ------------------------------------------------

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

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

Telephone followup -----------------------------------------

Referred to other physicianlagency -------------------------

Admit to hospital ------------------------------------------

Other2-------------------------------------------- ---------

Duration of visit3

O minute (no face-to-face encounter with physician) --------

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

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

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

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

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

Number of

visits in

thousands

62,117

8,122

12,995

41,000

17,751

20,883

23,484

5,635

42,467

10,248

3,099

2,751

1,037

890

420

3,504

15,381

22,110

15,293

5,410

?ercent of

visits

100.0

13.1

20.9

66.0

28.6

33.6

37,8

6;:;

16.5

5.0

4.4

1.7

1.4

0.7

5.6

24.8

35.6

24.6

8.7

lpercents will not add to 100 because some patient visits had more than one disposition.

sIncludes return to referring physician.

Ssi@ifies time spent in face-to-face encounter between physician and patient.
abmdata9

Table 9. Number and percentdistributionsof visits to office-basedinternistsby prior visit statusand seriousnessof PC:,5?P,,

accordingto age, sex, and color of patient:United States,Janusry-December1975

Age, sex, and color of patient

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

&

Under 15 years---------------------

15-24 years------------------------

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

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

65 years and over------------------

Sex —

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

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

~r

White------------------------------

All otherl-------------------------

Number of

visits in

thousands

62,117

2,047

5,474

13,107

23,565

17,925

36,978

25,139

5;,;;;

,

Percent

distribution of

visits

100.0

100.0

100.0

100.0

Loo. o

100.0

100.0

100.0

100.0

100.0

Prior visit status

Pa;’ch:en

first time

13.1

28.7

31.0

19.4

9.6

5.8

12.2

14.3

12.6

18.2

Patient seen before

For another

problem

20.9

40.0

32.2

23.7

19.0

15.8

21.2

20.5

20.9

21.2

For current

problem

66.0

31.3

36.8

56.8

71.5

78.5

66.6

65.2

66.6

60.6

Seriousnessof problem

seriousSlightly

0= Ve=y serious seri.aus

28.6 33.6

10.6 27.3

12.0 28.2

20.6 33,0

32.5 33,6

36.5 36.5

26.8 34.9

37..3 31.7

28.8 33.9

26.3 31.1

Not serious

37,8

62.2

59.9

46.5

34.0

27.0

38.3

37.0

37.3

42.7

‘Of this categoryabout 82 percentare visits by black persons.

Disposition and Duration of Visit admittccl a vcv small percentage of his patients

to the hospital (sli~htl>.less than 2 pm-cent).

Over twe-thirds of the visits to internists’ “1’hc avm-a~c visit to the internist’s of[ice

offices resulted in the direction to return at a lasted 18.2 minutes, \vhich exceeded the averspccified time (table 8), hi~hls correlating with aqe, i)f 15.0 minutes for all specialties.6

the fact that 2 of 3 visits were made by retumin~ patients with recurring problems. I.ike

the ~cneral and family practitioner, the internist

●

6See reference cited in footnote z.
10 aduancedata

TECHNICAL NOTES

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

Nat ional Ambulatory Medical Care Survey

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

United States made by ambulatory patients to

physicians who are principally engaged in office

practice.

SAMPLE DESIGN: The 1975 NAMCS utilized a

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

within practices. Within the 87 PSU’S composing

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

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

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

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

of office visits taking place within their practice

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

previous issue of Advance Data From Vital and

Health Statistics, No. 12, October 12, 197 7.)

Additional data concerning physician practice

characteristics such as primary specialty and

type of practice were obtained during an induction interview.

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

an earlier publication in Series 2 of Vital and

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

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

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

1975 NAMCS design and procedures will be

presented in future publications.

SAMPLING ERRORS: Since the estimates for

this report are based on a sample rather than the

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

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

standard error of the estimate by the estimate

itself and is expressed as a percent of the estimate. Relative standard errors of selected aggregate statistics are shown in table I. The standard

errors appropriate for the estimated percentages

of office visits are shown in table II.

Table 1. Approximate relative standard errors of estimated numbars of office visits

Estimate Relative standard

in error in

thousands percentage points

500 ..........................................

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

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

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

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

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

700,000 ...................................

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

30.1

21.4

15.3

10.0

7.5

5.1

4.0

3.5

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

relative standard error of 4.3 percent or a standard error of

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

Table II. Approximate standard errors of percentages for asti -

mated numbers of office visits

Base of percentage

(number of visits

in thousands)

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

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

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

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

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

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

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

1 or

99

2.1

1.2

0.9

0.7

0.3

0.2

0.1

Estimated percentage

5 or

95

4.6

2.7

2.1

1.5

0.7

0.5

0.2

10or

90

6.3

3.7

2.8

2.0

0.9

0.6

0.3T

20 or 30 or

80 70

8,5 9.7

4.9 5.6

3.8 4.3

2.7 3.1

1.2 1.4

0.8 1.0

0.4 0.4

50

10.6

6.1

4.7

3.3

1.5

1.1

0.5

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

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

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

ROUNDING: Aggregate estimates of office visits

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

were calculated on the basis of original, unrounded figures. Due to rounding of percents,
admceda 11

the sum of percentages may not equal 100.0 percent.

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

services who is neither bedridden nor currently

admitted to any health care institution on the

premises.

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

Responsibility over time for patient care and

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

an institution.

A visit is a direct personal exchange between

an ambulatory patient and a physician or a staff

member working under the ph ysician’s supervision for the purpose of seeking care and

rendering health services.

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

ambulatory patients at an office location. Excluded from NAhlCS are physicians who specialize in anesthesiolo~, pathology, radiology;

physicians who are federally employed; physicians who treat only institutionalized patients;

physicians employed full time by an institution;

and physicians who spend no time seeing ambulatory patients.

SYMBOLS

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

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

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

Quantity more than O but less than 0.05-— 0.0

Figure does not meet standards of

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

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Savice I Number,, ■ February 23,1978

Access To Ambulatory Health Care: United States, 19741

Due to increasing concern over many prob-*

lems surrounding the accessibility of heaIth care,

particularly ambulatory care, there is a need for

information to answer the following kinds of

questions: How many Americans have a regular

9ou9ce of care? What reasons de people give for

not having a regtdar source of care? To what

specific types of heaIth care places do people

with a regular source of care usually go?

Whether or not people have a regular source of

care, to what extent do they contact officebased sources of care as contrasted to hospitalbased sources or clinics that are not associated

with hospitals? What proportion of the population uses a telephone to get help or advice about

a health problem? How many Americans have a

doctor visit them at home? How many Americans have problems getting medical care? Do

people feel that they are getting all the care they

need?

This report presents data that bear directIy

on these questions. Information was obtained

from a one-third subsample of respondents to

the 1974 Health Interview Survey who reported

for themselves or for a child under 17 years of

age. (For further details on the survey design

and procedures, see the TechnicaI Notes.)

REGULAR SOURCE OF CARE

The vast majority of Americans have a regular source of medical care. In 1974 an estimated

166.8 million people, 80.5 percent of the civilian population not confined in institutions, had

1Prepared by Thomas F. Drury, M. A., Division of

Health Interview Statistics.

a particular doctor .or place where they couId go

when they were sick or needed advice about

their health (table 1). Having a regukr source of

care was relatively more common among females and whtie persons than among males and

ali other cob groupz respectively. Children

ami youthc uder the age of 17 were the most

likely of a# tlw age groups shown i- table 1 to

have a regdar xmrce of care; adults between

the ages of 17 and 44, the least likely. Among

aduhs 45 years and over, however, the Likelihood

of having a reguIar source of care increased in

each progressively older age group. Higher family income was also positively associated with a

greater likelihood of having a regtdar source of

care. Proportionately more people in the North

Central Region had a regular source of care than

in any other geographic region. Among place of

residence groups, cent ral city residents were the

least likely to have a regular source of health

care.

Reasons for Not Having a Regular Source of Care

While most Americans have a regular source

of medical care, a substantial number do not. In

1974 approximately 30.9 million people had no

particular doctor or place to which they could

go when they were sick or needed advice about

their health (table 2). More than half (54.2 percent) of these people indicated that the main

reason for not having a regular source of medical

care was that, as far as they could determine,

they did not need one.

Not having a regular source of medical care

may reflect a person’s orientation toward seeking medical care. A substantial number of people

were classified as being without a regular source

of care because they saw different doctors
2 aduanceckta

‘rable 1. Number and percent distribution of persons by whether or not they have a regular source of medical care, ac.

cording to selected characteristics: United States, 1974 —. —

Characteristic

All persona l-------------

~

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

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

Age

—

Under 17 years-----------------

L7-44 years --------------------

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

65 years and aver --------------

.. .,

Color

f

.—

Whzte-, -------------- --------- .

All other i---------------------

Family income

,,

Less than $5,000 ---------------

$5,000 -$9,999 ----------: -------

$10,000-$14,993----------------

S15,000or more ----------------

Geographic region

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

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

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

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

Place of residence

SMSA --------------------------

Central city -----------------

Outside central city ---------

Outside SMSA -------------------

Nonfarm ----------------------

Farm ----------- _------------,

Total

207,33L

100,024

107,30$

62,952

ao,77~

42,862

20,74C

180,725

26,60$

32,316

47,398

51,666

63,265

49,196

55,543

65,232

37,363

142,954

62,520

80,435

64,379

56,856

7,523

Persons —

With a Without a

For whom

regular informat ion regular

source of source of on source

care care

of care is

unavailable

Number in thousands

166,817

75,634

91,183

56,179

58,866

34,145

17,628

146,804

20,014

25,187

37,834

42,193

52,627

39,310

46,353

51,868

29,286

114,168

48,474

65,694

52,650

46,379

6,270

‘Includes persons with unknown income.

30,859

17,723

13,135

5,814

16,401

6,159

2,485

25,859

4,999

6,187

7,848

7,289

7,356

7,446

6,469

10>417

6,526

21,711

10,895

10,816

9,148

8,134

1,015

according to their various health needs. Interpretation of “seeing different doctors for different

problems” as a reason for being without a regular source of care is not without some ambiguity, however. At least two different types of

persons who ought to be distinguished from one

another may have been grouped together here.

The question that treated the subject of a regular source of care in the i974 survey was

worded, “Is there ONE particular doctor or

place you usually go to when you are sick or

when you need advice about your health?”

People affiliated with two doctors or more

from whom they usually obtained care might

9,657

6,666

2,991

961

5,511

2,558

627

8,062

1,595

942

1,716

2,184

3,282

2,439

2,720

2,947

1,551

7,076

3,151

3,925

2,581

2,343

238

—

Persons —

I I

rOtal With a Without a

For whom

informat ion regular regular

source source of on source

of care care

of care is

unavailable

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

Percent distribution

80.5

75.6

85.0

89.2

72.9

79.7

85.0

81.2

75.2

77.9

79.8

81.7

83.2

79.9

83.5

79.5

78.4

79.9

77.5

81.7

81.8

81.6

83.3

14.9

17.7

12.2

2:::

14.4

12.0

14.3

18.8

19.1

16.6

14.1

11.6

15.1

11.6

16.0

17.5

15.2

17.4

13,4

14.2

14.3

13.5

4.7

6.7

2,8

:::

6.0

3.0

4.5

6.0

properly consider themselves as having a regular,

although multichannel, source of care. However,

a “no” response to the question would classify

them as being without a regular source of care.

People receiving care from the same set of doctors are in a somewhat different situation than

those who go to different doctors for different

problems but lack a regular set of doctors

from whom care is received. This latter grc)up

might well be described as being without either a

regular or central source of care. The former

group may or may not lack a central source of

care, but could aptly be described as having a

regular source of care.
ammdata3

Table 2. Number and percent distribution of persons without a regu:ar source of medical care by main reason, according to selected

characteristics: Un~ted States, 1974

Characteristic

All persons ‘-------

~

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

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

Ate

Under 17 years-----------

17-44 years--------------

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

65 years and over--------

color

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

All other----------------

Fami1y income

Less than $5,000---------

$5,000-$9,999 ------------

$10,000-$14,999----------

$15,000or mOre----------

Geographic region

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

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

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

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

Place of residence

SMSA---------------------

Central city-----------

Outside central city---

Outside SMSA------------- NO*f~~----_.---------.

F=~---.----..--------.

Main reason for not having a regular source of medical care

Number of

persons Frevwithout See difUnable ious

a regu~ar No ferent doctor Too Health Oa not use

source of Al1 doctor doctors care fac- doctors

f~d expencare in reasons lo~er ility unless Other

needed dependi?g right sive

thousands available ser~ly

Onww:n; 1s doctor available if needed “

L7,723

13,135

5,814

16,401

6,159

2,485

25,859

4,999

6,1&17

7,848

7,289

7,356

7,446

6,469

10,417

6,526

21,711

10,895

10,816

9,148

;,:13;

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

59.8

46.6

51.6

55.8

51.1

57.2

54.0

55.0

52.9

56.8

54.0

51.6

55.2

54.1

53.3

54.6

54.0

53.5

54.5

54.7

54.6

55.3

17.8

15.5

21.0

16.9

19.1

17.9

11.3

17.0

22.0

14.8

15.5

19.8

22.4

18.4

17.3

18.7

16.4

18.1

18.9

17.3

17.3

17.8

13.1

Percent distribution

7.6

;::

9.2

i::

7.4

:.;

8.0

:::

6.7

9.8

7.4

;:?

;.:

9:0

6.0

6.0

*5.3

7.5

:::

7.7

7.3

:::

8.3

3.5

6.6

7.6

7.9

7.6

~:;

8:5

6.9

6.3

;:?

9.1

8.7

3--

1.2

1.6

1.7

::;

*1.4

1.4

1.5

3.6

1.1

*O.8

*o. 5

i

*0.9

1.3

1.9

1.3

; :$

1.1

1.3

1.3

*1.3

0.9

1.3

2.0

0.9

*0.8

W.8

0.9

1.9

2.1

*0.8

*0.7

*0.8

*0.7

*o.7

1.5

1.3

;::

1.2

*0.7

*0.7

*o.&

0.2

0.2

*o.2

*o.1

*o.3

*o.2

*-

*O.2

*0.3

*0.2

*0.2

*o.3

*0.1

*o.1

*o.1

*o.3

*o.2

*0.2

m3.2

w. 2

*0.2

*0.I

*0.6

8.2

l;

7.6

J::

12.1

8.3

8.0

10.1

::$

8.5

7.8

J:!

6.8

;::

9:3

9.0

11.4

1.9

;:2

3.2

1.4

2.3

*1.2

H

1.6

2.4

1.1

1.7

1::

2.1

1.8

2.0

2.2

1.9

i::

*3.8

lIncludes persons with unknown income.

For a sizable number of people, some barrier a health care facility should they need one (e.g.,

to heaIth care precluded them from having a regular heaIth care source. Among those without a

regular source of care, 7.6 percent were unable

to find the right doctor. Loss of access to a doctor who was previously being seen was the main

reason given by an additional 7.5 percent of the

people who were without a regular health care

source. For 1.4 percent of those without a re,guIar source of care, the high cost of health care

was given as the main barrier.

About 1 percent of the people without a

regular health care source indicated that their

reason for not having a particular doctor or

place of care was that they would have access to

civiIians working on military bases). Even fewer

people were without a regular source of care pnma.dy because they did not use doctors unless

their ailment was very serious.

Place of Usual Medical Care

Among the majority of the population with

a regular source of medical care, the largest number (6Z.8 percent) obtained their health care

from a private doctor’s office or clinic (table 3).

Older persons, white persons, people in families

with a $5,000 income or more, and those residing outside of standard metropolitan statistical
4

Table 3. Number and percent distribution of persons with a remlar source of medical care by place of usual care, according to

selected characteristics: United States. 1974

Characteristic

All persons’------------

—sex

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

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

Age —

Under 17 years----------------

17-44 years-------------------

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

65 years and Over-------------

Color

White-------------------------

A1l other---------------------

Family income

Less than $5,000--------------

$5,000-$9,999-----------------

:::::::-$’4>999-------------- or mOre---------------

Geozrauhic rezion

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

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

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

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

Place of residence

SMSA --------------------------

Central city----------------

Outside central city--------

Outside SMSA------------------

NOnfam ---------------------

Fare ------------------------

.—

‘?umberof

persons

with a

regular

;ource of

care in

:housands

166,817

75,634

91,183

56,179

58,866

34,145

17,628

146,804

20,014

25,187

37,834

42,193

52,627

39,310

46,353

51,868

29,286

114,168

48,474

65,694

52,650

46,379

6,270

1Includes persons with unknown inccnne.

Place of usual care

Private

All doctorts Group Hospital Hospital Company or

places oj~$icor practice Ou:~:& em:yy industry Home Other Unknown

clinic

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1

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

62.8

62.5

63.1

58.9

62.4

66.2

70.1

64.2

52.4

60.3

62.8

63.5

63.0

72.6

63.4

61.2

51.5

61.5

58.3

63.9

65.6

65.8

64.1

areas (SMSA’S) were more likely than comparable age, color, family income, and place of residence groups to have a private doctor’s office or

clinic as a regular source of care. Whether or not

people were affiliated with a private doctor’s

office or clinic vaned considerably among the

regions. People living in the Northeast were the

most likely, and those in the West the least

likely, to have a private doctor’s office or clinic

as a regular source of health care. Central city

residents were the least likely of all place of residence groups to have a private doctor’s office or

clinic as a regular source of care.

Group practices–three doctors or more who

work in the same office and share the same

equipment—were the next most common regular

27.2

27.0

27.3

29.7

27.1

25.4

22.6

27.9

21.7

22.2

24.9

28.5

30.5

17.3

30.2

26.8

36.3

26.7

25.3

21.6

28.3

27.6

33.2

Percent distributic.n

4.8

M

5.8

:::

3.3

3.2

16.5

9.3

6.0

3.7

2.6

4.5

:::

5.5

::?

::;

2.5

1.3

0.5

:;:

0.6

0.5

*0.2

W.3

0.3

1.4

0.8

0.7

0.4

0.1

1.0

*O.1

0.5

*o.2

0.6

0.9

0.3

0.2

0.2

*0.2

0.3

%;

:::

4;:

0.3

0.6

0.3

0.4

0.3

0.3

0.6

*0.1

0.3

0.5

i:;

0.3

0.2

0.3*-

0.2

:::

*o. 1

0.2

*0.1

1.0

0.2

*0.2

::;

y.;

0.3

0.2

0.2

0.2

0.3

0.2

::;

0.2*-

2.7

2.9

2.6

3.0

3.5

$::

2.3

5.7

5.3

3.5

::?

2.2

1.2

:::

3.1

;::

;:?

*0.6

sources of care. As much as Z7 percent of those

with a regular source of care (22 percent of the

population) indicated affiliation with a group

practice, In 1974 the Health Interview Survey

did not measure prepaid group practice, a subject which was measured in the 1975 Health Interview Survey and is to be treated in a Iater

report in this series.

As regular sources of care, group practices

were relatively more common among younger

persons, white persons, and people in families

with higher incomes. Regions differed with respect to the percent of people who had a group

practice as a regular source of care. The West

and North Central Regions had a greater percentage of such people than the South and Northeast.
dmcecMa5

A smaller but substantial number (4.8 percent) of the group that had a regular source of

care identified hospital-based outpatient clinics

as their usual place of care. Although adults 17

to 44 years old were similar to those 45 to 64

years old in their selection of outpatient clinics,

younger peopIe were generally more likely to be

affiliated with hospital outpatient cIinics as a

regular source than were older people. People in

families with less income were also more likely

to note outpatient clinics as their regular health

care source, as were color groups other than

white. Persons living in the South and West were

similar in tke extent to which they affiliated

themselves with outpatient clinics as a reguIar

source of care. Both of these groups were more

likely than the other regional groups to have

outpatient clinics as a reguku- source of care.

Central city residents were the most likely

among place of residence groups to identify hospital outpatient clinics as regular sources of care.

Other sources of regular care were much Iess

common. Less than 1 percent of those with a

regular source identified emergency rooms as the

usual place of care. Under O.5 percent received

regular medical care at a company or industry

clinic or at home.

CONTACTS WITH SOURCES

AND PLACES OF MEDICAL CARE

Personal health care is obtainable, whether

or not a person has a regular source of care,

from a wide variety of sources or places. Table 4

Table 4. Number and percent of persons utilizing specific sourcesor places of outpatient medical care during year prior to interview, by selected characteristits: United States, 1974

Characteristic

All personsl----------------

~

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

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

—AF,e

Under 17 years--------------------

17-44 years-----------------------

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

65 years and over-----------------

cwhite-----------------------------

All other-------------------------

Family income

Less than $5,000------------------

$5,000-$9,999---------------------

$10,000-$14,999-------------------

$15,000 or more-------------------

Geographic region

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

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

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

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

Place of residence

SMSA------------------------------

Central city--------------------

Outside central city------------

Outside SMSA----------------------

Nonfarm-------------------------

Fare ----------------------------

Number

of

persons

in

thousands

207,334

100,024

107,309

62,953

80,778

42,862

20,740

180,725

26,608

32,316

47,398

51,666

63,265

49,196

55,543

65,232

37,363

142,954

62,520

80,435

64,379

56,856

7,523

Source or place of care

private Hos- Hosdoctor’s Group Tele- :$;:- Pitdl Company or ~bl iC ~%!;d Home ~ther

office practice phone t~ent ;y”:; industrv ~i:i: health

or clinic cIinic

clinic room

center

Percent of persons utilizing any services

58.2

51.9

64.1

55.6

58.9

58.0

63.9

60.1

45.3

54.6

56.2

59.1

62.5

61.4

57.7

60.8

55.2

;:.;

61:4

57.5

$;.;

16.6

14.6

18.4

19.8

15.1

15.3

15.3

17.3

12.2

13,0

14.8

17.7

19.7

10.8

18.7

16.9

22.1

16.6

15.4

17.5

16.7

16.3

19.8

16.1

12.2

19.7

23.0

14.5

11.0

11.6

17.4

6.7

10.4

14.4

17.9

19.6

16.1

17.8

14.6

16.0

17.4

15.3

19.1

13.0

13.5

9.7

8.9

8.4

9.4

%:

9.1

7.5

12::

13.1

10.0

7.7

7.2

9.4

8.5

8.5

9.6

1;:;

7.7

6.9

;::

14.1

15.1

13.2

16.2

15.4

10.7

9.5

13.8

16.4

15.9

15.6

14.3

12.5

15.9

13.8

13.8

12.7

14.8

15.3

14.4

12.6

13.0

9.6

3.1

:.:

0.2

:::

0.4

3.1

3.2

1.7

:::

3.9

3.6

H

2.5

;:;

3.5

1.7

1.8

*O.8

2.6

2.2

2.9

N

1.3

1.0

2.2

5.4

5.0

H

1.4

;::

3.4

2.9

2.5

3.4

N

2.8

2.1

1.0

;.!

1.4

;::

0.5

0.7

2.8

2.2

::;

0.4

0.9

0.9

::;

;:}

0.6

0.7

0.7

*0.6

1.5

1.2

1,8

:::

i::

1.6

1.2

2.0

1.4

1.1

1.7

2.7

:::

1.2

1.7

i:;

f:;

~o.5

2.5

2.8

2.2

2.1

3.4

1.9

1.1

2.4

2.7

2.7

2.2

2.2

2.9

::;

1.9

2.4

2.7

2.7

2.6

2.0

2.2

*0.9

1 Inc ludes persons with unknown income.
6

shows the percent of the population that used

major sources or places of care at least once during a 12-month period, irrespective of whether or

not they had a regular source of care. Almost 6

out of 10 people (58.2 percent) contacted a private doctor’s office or clinic. The next two most

contacted sources were group practices (17 percent) and hospital emergency rooms (14 percent). About 9 percent of the population contacted a hospital outpatient clinic. Company or

industry clinics and public health clinics were

each utilized at least once by about 3 percent of

the population; neighborhood health centers, by

1 percent. Sixteen percent used the telephone to

obtain help or advice about their health, and 1.5

percent were visited by a doctor at home.

There were numerous differences among

population subgroups in respect to the percentage of people contacting each source or place of

care shown in table 4. The most consistent differences occurred among the family income

groups (figure 1). People in families with higher

incomes were more likely than those with lower

incomes to have received care at private doctor’s

offices and group practices as well as over the

telephone. However, the reverse was true for

most other sources of care. Contact with hospital outpatient departments, emergency rooms,

public health clinics, and neighborhood health

centers was relatively more common among persons in families with lower incomes. Contact

with a company or industry clinic during the

year was slightly more likely among higher income groups.

Figure 1. PERCENT OF PERSONS IN EACH FAMILY INCOME GROUP UTILIZING SPECIFIC SOURCES OR PLACES OF

MEDICAL CARE DURING YEAR PRIOR TO INTERVIEW: UNITED STATES, 1974

70

60

50

1- 40

z

Lu

u

E

Lu

n 30

20

10

0

Family Income

_ Lesstfm -$5,000

=1 $,,000-$9,$)99”

m $10,000-$14,999

~$15,0000rrn.ra

Private Group Telephone Company Hospital Hospital Public Neighborhood

doctor’s practice or outpatient emergency health health

office or industry clinic room clinic center

clinic clinic
a&mdata7

PROBLEMS IN GETTING

MEDICAL CARE

An estimated 10 percent of the population

experienced some problem in getting medical

care during the 12 months prior to the interview

(table 5). A delay in getting an appointment was

the most common problem, with 5 percent of

the population reporting that difficulty. The unavailability of a doctor when one was needed

and the cost of care were problems for nearly 3

percent of the population in each case. Just

under 2 percent had a problem getting care because office hours were inconvenient for them.

About 1 percent had a problem because they

lacked transportation or did not know where to

go.

OveralI, the likelihood of having had some

problem in getting medical care varied among

sex, age, and income groups. ln 197A fem~es

and lower family income groups experienced

some difficulty in getting care proportionately

more often than other comparable groups.

Among age groups, children and youths under

17 years old were the least likely, and adults between the ages of 17 and 44 were the most likely, to have experienced some problem in getting

medical care. However, there were no differences

Table 5. Number of persons, percent of persons reporting 1 problem or

to interview,

more in getting medical care during year prior

and percent of persons reporting specific types of problems,

States, 1974

by selected characteristics: United

Characteristic

All personsi--------------

~

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

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

Age —

Under 17 years------------------

17-44 years---------------------

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

65 years and over---------------

Color

White ---------------------------

All other-----------------------

Family inccme

JJSSSthan $5,000----------------

$5,000-$9,999-------------------

$10,000-$14,999-----------------

$15,000 or more -----------------

Geographic region

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

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

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

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

I I Type of problem

Number of Persons

with 1 Could not

:~u:;d: problem No doctor

get apOffice Lack of Did not

available

cost ihknow

or more pointment when transpor- where Other

as soon needed venient tation

as needed to go

-1- 207,334 10.4

62,953

80,778

42,862

20,740

180,725

26,608

32,316

:;,:::

63;265

49,196

55,543

65,232

37,363

142,954

62,520

80,435

64,379

56,856

7,523

Place of residence

SMSA----------------------------

Central city------------------

Outside central city----------

Outside SMSA--------------------

Nonfarm-----------------------

Farm --------------------------

1Includes persons with unknown income.

1:::

7.6

13.1

10.C

9.C

10.:

Io.j

14.2

11.6

9.1

8.7

1%;

10.1

12.9

10.~

10.i

10.?

10.1

10.6

6.6

Percent of population

2.3

2:: 3.1

3.2 2.1

::: 2:;

2.7 2.2

5.1 2.8

3.9 2.1

5.1 3.2

2.9

2:; 2.6

5.2 2.6

4.0 2.9

2.6

:::

6.2 ;::

L

2.6

;:: 2.5

2.7

i:;

5.1 H

3.5 1.9

2.5

2.1

3.0

1.8

3.1

2::

2.4

3.3

5.1

::;

0.8

2.3

1.7

2.7

3.9

2.6

;::

2.5

2.6

1.3

1.7

H

:::

1.2

0.8

1.7

1.7

1.7

1.9

1.7

1.6

1.7

1.9

1.5

1.7

1.8

1.8

;::

4:;

1.2

0.8

1.6

1.1

;:;

2.8

;::

3.6

1.4

::;

0.9

1.1

H

1.2

1.5

1.0

1.2

4::

1.01 0.5

::;

0.6

::;

1.0

1.0

1.1

1.3

::;

0.6

1.1

0.9

0.8

1.1

::2

0.3

0.4

0.6

0.6

0.5

0.3

0.7

0.4

0.4

0.4

0.4

0.5

0.4

0.5

L

1.1 0.5

1.3 0.5

1.0 0.5

0.6 0.4

0.4

2:; 0.2
8

between people 45 to 64 years old and those 65

years of age and older.

These overall differences were not invariant,

however. For example, while there was almost

complete uniformity among the family groups

regarding such problems as doctor unavailability,

the scheduling of appointments, and office

hours, people in lower family income groups

confronted cost, transportation, and knowledge

barriers to care proportionately more often than

people in higher family income groups.

SELF-PERCEIVED UNMET

HEALTH cARE NEEDS

Self-perceptions may be imperfect indicators

of unmet health care needs. People may be unaware that they have a condition requiring medical attention. They may perceive themselves as

needing certain kinds of health care which, from

a medical point of view, they do not need. They

may perceive themselves as not needing care for

a known medical condition when a physician

would deem care necessary. In the absence of

more refhed and specific measurements, however, global assessments of unmet health care

needs provide a useful, if tentative, indication of

the number and kinds of people who feel that

our health care delivery systems are not fully

responsive to their needs.

In 1974, 6 percent of the population felt

that they were not getting as much medical care

as they needed. Among the various demographic

and social groups shown in table 6, this feeling

was more prevalent in some groups than in

others. Perceptions of unmet health needs were

relatively more common among females, adults

between the ages of 17 and 64, color groups

other than white, lower family income groups,

residents of the West and South Regions, and

central city dwellers.

There were numerous reasons why people

felt that they were not getting all the medicaJ

care they needed. The most frequently identified reason was the high cost of care. Almost

half (48.6 percent) of the people who reported

some unmet health care need indicated that

costs were a factor. A smaller but still substantial number of people identified the brevity of

time spent with the doctor (14 percent) and the

inability to get an appointment ( 13.8 percent) as

sources of their perceived unmet needs. Difficulty getting to the doctor (6 percent) and inconvenient hours (8 percent) figured prominently in the perceptions of some people who

felt their needs were unmet. The large “other”

category reflected the vast array of additional

reasons that led” to perceptions of unmet health

care needs.

As shown in table 6, each of these reasons

played a more prominent role in the perceptions

of some groups than they did in others. These

subgroup differences highlight the diverse reasons for perceptions of unmet health care needs

among different social groups. Costs, transportation, and a host of “other” specific reasons were

more frequently cited sources of perceived unmet needs among lower income groups. El[owever, inconvenient office hours, difficulties in

getting appointments, and the feeling that the

doctor gave them an inadequate amount of time,

were relatively more common reasons given by

higher income groups for self-preceived unmet

needs.

A CONCLUDING NOTE

There are many other descriptive questions

that can be asked about sources of medical care.

How many people have a particular doctor or

other medical person that they usually see at

their regular source of care? What kinds of doctors do they usually see? How disposed are

people to using their regular source of care?

How many people contact their regular source

of care during the course of a year and how

often? How many people receive services both

from their regular source of care and from other

sources? How many people bypass their regular

source to obtain medical attention from another

source of care? Are people who receive services

from sources of care other than their regular

source referred by their regular source or do

they refer themselves? What sources of payment

do people use to cover the expenses of the outpatient care they receive? A more detailed report that will deal with these questions is in

preparation.
9

Table 6. Number and percent of persons reporting self-perceived unmet health care needs, and percent of these persons giving specific reasons, by selected characteristics: United States, 1974

Characteristic

AI1 persons]--------------------------

~

Mle----------------------------------------

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

Age —

Under 17 years------------------------------

17-if+years---------------------------------

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

65 years and over--------------------—-----

Color

White---------------------------------------

All other-----------------------------------

Family income

=ss than $5,000----------------------------

;5,000-$9,999-------------------------------

;10,000-$14,999-----------------------------

)15,000or more-----------------------------

Geographic region

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

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

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

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

Place of residence

sm.%----------------------------------------

Central city------------------------------

Outside central city----------------------

Outside SMSA--------------------------------

Nonfarm-----------------------------------

Fan--------------------------------------

Persons reportiag

I

Percent

Number in of total

thousands population

I

-1- 12,384 6.0

5,695

6,689

2,591

5,572

2,994

1,22s

;,;::

>

3,308

3,472

2,649

2,273

2,816

2,362

4,566

2,641

8,883

4,629

4,254

3,501

3,;;:

::;

$;

.

R

12:

10.2

k?

3.6

::;

7.0

7.1

6.2

;:$

5.4

5.5

5.0

Self-perceived unmet health care need

Reascm for

DOctc.r Cannot get Difficulty office hOur~

cost spends inadequate appoint- ge~~3=t0 inc .nwenient Othe=

tinw ment

percent of persons

48.6

47.6

49.5

47.7

49.0

50.3

44.7

47.3

52.6

55.2

57.9

43.1

29.3

43.0

38.2

51.8

58.3

47.9

50.0

45.6

50.5

50.3

51.9

—

14.C

12.;

15.1

7.4

15.6

15.9

15.9

12.1

13.3

16.2

17.6

12.1

18.8

12.1

15.0

14.3

14.6

14.0

13.3

12.7

*18.1

13.8

13.2

14.3

10.0

16.3

13.0

12.0

14.9

10.1

12.4

H:;

17.7

14.9

18.4

11.5

12.2

13.1

12.6

13.7

15.4

16.0

*1O.4

8.3

6.8

9.6

10.3

4.3

2:::

8.2

9.4

6.9

%:

*5.6

6.5 26.5

I

6.8

6.3

5.6

7.3

8.0

*1.4

6.9

5.4

3.2

::;

8.9

9.7

j:!

;:;

::;

5.4

*-

27.9

25.4

21.0

29.6

25.1

27.9

27.3

24.1

27..2

25.1

28.3

36.8

27.7

25.9

26.4

26.2

27.0

25.2

2.9.9

25.4

25.9

21.8

lIncludes persons with unknown inccmse.
10

TECHNICAL NOTES

SOURCE OF DATA. The data presented in this

report were obtained from household interviews

in the Health Interview Survey. These interviews

were conducted throughout 1974 in a probability sample of the civilian noninstitutionalized population of the United States. During

that year approximately 116,000 persons living

in about 40,000 households were included in the

sample. The questions about sources of medical

care and problems in getting care were asked of

each household member who was identified as a

“sample person. ” This subsample included

37,062 persons.

SAMPLING. The sampling pattern for sample

person selection was based on the total number

of related and unrelated household members.

Sample persons (a one-third subsample of the

Health Interview Survey sample) were selected

by the interviewer at the time of interview. To

determine which household member(s) to designate as a sample person, the interviewer referred to a preselected flashcard after listing all related and unrelated persons in the household on

the questionnaire. The flashcard contained, for

each household size, one person number or more

that were to be identified as the sample person(s).

Since the estimates shown are based on a

sample of the population rather than on the entire population, they are subject to sampling

error. Standard errors appropriate for the estimates of the number of persons are shown in

table I; standard errors appropriate for percentages are shown in table 11.

LIMITATIONS AND QUALIFICATIONS OF

DATA. While the procedures used in the Health

Interview Survey are designed to minimize nonsampling errors, including various forms of response errors, the data presented in this report

are, to some extent, still subject to this type of

error. Estimates derived from the 1974 Health

Interview Survey on sources of medical care and

problems encountered in getting care may also

differ somewhat from those derived from other

surveys dealing with the same subject matter due

to differences in definitions, sample design,

question wording, and other procedural aspects

of the data collection process.

Table I. Standard errors of estimates of

aggregates

Size of estimate Standard error

in thousands in thousands

70---------------- 21

1oo---------------

3oo--------------- ::

5oo--------------- 55

7oo--------------- 65

l,ooo-------------

5,000------------- 1;:

lo,boo------------ 243

20,000------------ 337

30,000------------ 405

50,000------------ 501

loo,boo----------- 626

Table II. Standard errors, expressed in

percentage points, of estimated percentages

Base of

percentage in

thousands

70--------

1oo-------

3oo-------

5oo-------

7oo-------

l,ooo-----

5,000-----

lo,ooo----

20,000----

30,000----

50,000----

loo,ooo---

.02

or

98

4.1

3.5

?::

1.3

::;

0.3

0.2

0.2

:::

Estimated percentage

.05

or

95

6.4

;.:

2:4

H

0.8

0.5

0.4

0.3

0.2

0.2

10

or

90

8.9

u

M

2.3

1.0

0.7

0.5

0.4

0.3

0.2

20

or

80

11.8

9.9

2::

3.7

3.1

1.4

::;

0.6

0.4

0.3

50

14.8

12.4

7.1

::?

;:?

::;

0.7

0.6

0.4

For a more detailed discussion of the limitations and qualifications of data collected in the

Health Interview Survey, see an earlier report

entitled “Current Estimates from the Health Interview Survey, United States, 1974, Vital and

Health Statistics, Series 10, No. 100, DHEW

Publication No. (HRA) 76-1527.
dmcedab 11

In this report, terms such as “similar” and of 1.96 (0.05 level of significance) was used to

“the same” mean that no statistical significance test all comparisons which are discussed. Lack of

exists between the statistics being compared. comment regarding the difference bet ween any

Terms relating to differences (i.e., “greater,” two statistics does not mean the difference was

“less,” etc.) indicate that differences are statis- tested and found to be not significant.

tically significant. The t test with a critical value

SYMBOLS

Data not available ..-

Category not applicable . . .

Quantity zero

Quantity more than Obut less than 0.05— 0.0

Figure does not meet standards of

reliability or precision *
FROM VITAi_& HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE = Public Health Service I Number 18 ■ March 7,1978

Episodes of Persons Injured: United States, 1975’

Each year, as part of its interview survey of

the civilian noninstitutionalized population of

the United States, the National Center for Health

Statistics collects a limited amount of data on

injuries resulting from accidents and other causes.

Data on this topic are obtained on the nature of

the injury, where the accident happened, whether

the person was at his or her job or business when

the accident occurred, and whether a motor vehicle was involved.

During 1975 two supplements relating to in-

,.

juries were included in the Health Interview Survey. Both were developed in conjunction with

the Consumer Product Safety Commission.

Since respondents were to be asked about injuries occurring during the 6 months prior to

interview and memory decay was expected to be

a major problem in using a reference period of

this Iength, the first supplement served as an extensive probe to improve reczdl of accidental injuries during that period. The second supplement was intended to obtain—aside from all of

the usual information collected each year on

injuries-the following types of additional information: (1) where (if it was medically attended)

the person first received medical attention

for the injury, (2) more detailed information

for accidents in which motor vehicles were involved, (3) how the accident happened, (4) what

product or products (if any) were directly or

indirectly involved, (5) whether there were any

special circumstances which contributed to causing the accidental injury, and (6) whether the

injury was intentionally inflicted.

A 6-month reference period was used in

order to produce a more extensive data base

1This report prepared by Peter W. Ries, Ph. D., Division of Health Interview Statistics.

than is obtained from the customary 2-week

reference period used each year for accidental

injuries in the Health Interview Survey. However, in accordance with the usual annual procedure, data on accidental injuries were included

only if they met at least one of two conditions:

(1) the injury was medically attended, or (2) it

caused the person to cut down on his or her

usual activity for at least 1 day.

Injury data may be tabulated in at least

three different ways, depending on whether the

topic of interest is (1) the person involved in one

or more accidents causing injuries during a given

reference period, (2) the particular episode resulting in injury, or (3) each individual injury

itself. The unit used in this report is the episode

of persons injury, that is, the event which caused

the injury or injuries. The estimates shown in

the detailed tables are derived from the 1975

accident and injury supplements; they are, however, based on only those reported experiences

occurring during the 2 weeks preceding the interview.

The results from the 1975 supplements indicate that during this period there were about

74.2 million episodes of persons injured among

the civilian noninstitutionalized population.2

Tables 1-6 show these episodes distributed by

responses to several supplemental questions according to various sociodemographic and

health-related characteristics. Tables 7 and 8

show the types of products involved in the product-related episodes.

2This estimate differs from the estimate of 71,903

million persons injured shown in the 1975 Current Estimates because (1) the definition of injury differs somewhat, and (2) the estimates shown in Current Estz”mates

are derived from the usual questionnaire and those

shown in this report are derived from the data collected

in the supplements.
2 acklncedata

Respondents reporting episodes of accidental injury were asked: “Where did the accident

happen?” Tables 1 and 2 show that when unknown places are excluded about half of the episodes (50.4 percent) happened at home, with

28.9 percent happening in the house and 21.5

percent occurring adjacent to the house. Industrial places accounted for 11.7 percent of the

episodes, followed by street and highway (9.5

percent), place of recreation (8.8 percent),

school (8.2 percent), and other places (11.4 percent).

Tables 3 and 4 present the number and percent distribution of episodes by what the person

was doing when the accidental injury occurred,

according to seIected characteristics.s An estimated 25.7 percent of the episodes occurred

3The precise wording was, “What was . . . doing Zit

the time of the accident?”

Table 1. Nunber of episodes of persons injured, by place where accident happened and selected characteristics:United States, 1975

11)x,, ,Jw1,,,s.,1 ,,,,Imu.ddd UUCWI.W d XII. cwh.tn IB,,x>j$IscIt.ttc>t).lILc<l pop.1.cwn, The s.rv.y dmgn. $cncrd q..dtfutwns, A mformtmn on Lh. rch.iimhty of the cstm.rcs WC $Ivc!l m tbc

CcLl\,,lc.tl tn<>tml

At home

Street

Selected characteristic Industrial school Place of other Place

recreation place unknown

All episodes----------------L74,164

Sex —

Male ------------------------------ 39,653

Female----------------------------34,511

Age . I

Under 17 years-------------------- 25,90S

17-44 years----------------------- 32,757

45-64 years----------------------- 10,796

65 years and over----------------- 4,703

Farnily income

Less than $5,000------------------

$5,000-$9,999---------------------

$10,000-$14,999-------------------

$15,000-$24,999-------------------

$25,000 or more-------------------

Not reported----------------------

12,327

16,531

16,660

17,481

6,734

4,431

Geographic region

Northeast------------------------- 15’,677

North Central--------------------- 20,103

South-----------------------------21,605

west------------------------------16,779

Place of residence

SMSA, central city---------------- 22,215

SMSA, not central city------------ 29,482

Outside SMSA---------------------- 22,467

Days of restricted activity

None------------------------------2$,442

1 or more-------------------------45,721

Bed days I

None ------------------------------ 5fj,436

1 or more ------------------------- 17,728

Medical attention

Attended at emergenty room-------- 25,227

Attended, but not at emergenty

room-----------------------------29,936

Attended, place unkncx?n----------- 2,692

Not medicallv attended------------ 16.309

35,736

15,445

20,291

14,019

12,468

5,959

3,290

6,938

7,547

7,753

;,$;;

1;s47

7,120

9,230

10,604

S,7S2

10,644

14,491

10,601

14,415

21,321

27,683

S,053

11,491

14,942

1,625

7.677

20,514

6,500

14,014

6,48S

8,137

3,747

2,142

4,293

4,400

4,824

4,630

1,5s1

786

4,153

5,132

5,611

5,618

6,564

8,388

5,562

S,21O

12,304

15,870

4,644

5,577

9,142

924

4.871

Number of episodes in thousands

S,945

6,277

2,994

3,731

7,531 1,898

$,;;: 3,374

1,007

1;149 *446

2,645 1,253

3,146 1,155

2,928 1,041

3,848 2,006

1,593 *596

1,061 675

2,966 1,485

4,098 1,900

4,993 1,965

3,164 1,375

4,080 2,352

6,103 2,372

5,038 2,001

6,205 1,847

9,016 4,S78

11,812

3,409

4,45s

2,267

1

5,914 3,435

5,s00 1,661

701 *137

2,806 1,493

.8,312

;,;;:

*217

6,679

1,326

*O

710

2,387

2,312

l:~~;

7s7

1,603

2,494

2,783

1,431

2,207

3,473

2,632

3,397

4,915

6,253

2,059

2,895

3,952

*286

1,1s0

*Numbers preceded by an asterisk have a relative standard e~ror of more than 30 percent;

with other cells.

5,785

3,S16

1,969

3,963

1,677

*146

*-

683

1,147

1,200

1,611

S63

*2S1

1,143

1,901

1,309

1,432

1,566

2,360

1,860

2,166

3,620

4,S68

917

1,671

2,528

*L83

1,403

6,264

4,409

1,855

2,369

3,503

9.354

*3B

*462

1,551

1,421

1,:;;

*377

1,908

1,517

1,503

1,336

1,900

2,743

1,621

2,197

&,067

;,;;;

2,806

1,391

9<52

2,015

8,087

5,076

3,011

2,396

3,677

1,507

*50B

1,513

2,162

f,;$;

$<467

$,419

1,384

1,902

2,694

2,10s

2,651

2,707

2,728

2,876

5,211

5>569

2,517

2,425

3,773

*1B7

1,701

3,254

993

2,261

1,047

1,379

*498

*330

76B

*583

868

901

*89

9<44

1,034

1,158

747

*314

894

1,336

1,024

1,545

1,709

2,614

640

*505

1,6S7

*221

S41

estimates given solely for combining
ackmeMa3

while the person was working, 17.5 percent

while traveling, and 16.0 percent, whiIe the person was participating in some form of recreation. Other forms of activity accounted for 32.5

percent of the total, while no major activity was

indicated by the respondent for 8.3 percent of

the episodes.

The term “working” as used in tables 3 arid

4 appIies to any kind of work, incIuding work

performed while the person was not at his or her

job or business (for instance, cleaning up the

yard). Table 5 shows the number and percent

distribution of episodes for persons 17 years arid

over who were working at their job or business

when the episode occurred.J Thus, of the approximately 17.2 million episodes shown in

4The question posed was: “Was . . . at work at his job

or business when the accident happened?”

Table 2. Percent distribution of episodes of persons injured by place where accident happened

tics: United States, 1975

, according to selected characteris-

[nat.arcbawd..Imuwlmldmtcrwcwsofthec,whm noninst!rutrxmhzcd population. The survey dcs,gn, general qualdmacmm, A mformaucm on the r.lddu, oftheew,matcsaregivenm dm

Selected characteristic

All episodes--------------------------

&e&

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

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

Age —

Under 17 years------------------------------

17-44 years---------------------------------

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

65 years and over---------------------------

Family income

kss than $5,000----------------------------

$5,000-$9,999-------------------------------

$10,000-$14,999-----------------------------

$15,000-$24,999-----------------------------

$25,000 or more-----------------------------

Not reported--------------------------------

Geographic region

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

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

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

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

Place of residence

SMSA, central city--------------------------

SMSA, not central city----------------------

Outside SMSA--------------------------------

Days of restricted activity

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

1 or more-----------------------------------

Bed days

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

1 or more-----------------------------------

Medical attention

Attended at emergency room------------------

-Attended, but not at emergency room---------

Attended, place unknown---------------------

Not medically attended----------------------

tcchmcalmxcs]

11 I I I I I

At home

Al1

Street

lndus’=-ial School Place of Other

places] and

Inside ~ij~u~~ highway place

Total house

recreation place

Percent distribution

100. (

100.(

100.(

100.(

100.t

100.c

100.C

100.C

100.C

100.c

100.C

100.C

100.c

100.0 100.0

100.0

100.0

100.0

100.0 100.0

100.0 100.0

Loo.o

100.0

100.0

100.0 100.0 100.0

50.4

40.0

62.9

56.4

39.7

57.9

75.3

60.0

47.3

g;.;

47:8

42.1

48.6

48.7

50.8

53.3

49.9

51.5

49.4

53.6

48.4

51.4

47.1

;;.;

65:8

49.6

28.S

16.:

43.5

26.1

25.5

36.4

49.0

37.1

27.6

30.5

27.9

23.8

17.9

28.4

27.1

26.9

34.1

30.8

29.8

25.9

30.5

28.0

29.5

27.2

22.6

32.4

37.4

31.5

21.5

23.1

19.5

30.3

13.8

21.5

26.3

22.9

19.7

18.5

23.2

24.0

24.2

20.3

21.6

23.9

19.2

19,1

21.7

23.5

23.1

20.5

21.9

20.0

23.9

20.5

28.4

18.1

9.5

1:::

1:::

9.8

*lo.2

10.8

7.2

1:::

W.o

15.4

10.1

10.0

9.4

8.4

11.0

:::

1::?

1:::

13.9

5.9

*5.5

9.7

11.7

17.9

4.:

*0.9

21.3

12.9

*2.1

l::i

14.6

9.3

*8.5

17,9

10.9

13.2

13.3

8.7

10.4

12.3

12.3

12.6

11.2

11.6

12.1

11.7

14.0

*11.6

7.6

—.

8.2

9.9

6.1

15.9

5.3

*1.4

*.

,5.9

7.2

7.6

1%:

*6.4

1;::

6.3

8.7

7.3

;:?

8.1

8.2

9.0

5.4

6.8

8.9

*7.4

9.1

8.8

11.4

5.8

1?:2

*3.4

*0.9

*4.O

::;

14:7

*8.6

13.0

8.0

;:?

8.9

9.7

7.6

8.2

9.2

;.;

11.4

4.9

*2.1

13.0

11.4

13.1

9.3

9.6

11.7

14.6

*11.6

13.1

13.6

13.1

8.8

*7.O

‘W.6

1?::

12.9

12.8

12.4

11:$

10.7

11.8

10.3

14.7

11?::

*7.6

11.0

lExcludes place unknciwm.

*Nmnbers preceded by an asterisk have a relative standard error of more than 30 percent; estimates given solely for cmnbining

with other cells.
4

Table 3. Number of episodes of persons injured, by activity status and type of activity when accident happened and selected characteristics: United States, 1975

[Dataare basedon homehol~interviews oftheciviliannonimtitu[ionahzed population. The survey design, gemral qualifications, and information on the reliability

of the estimates are given in the technical notesl

Selected characteristic

All episodes --------------------------

Sex —

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

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

Age —

Under 17 years ------------------------------

17-44 years ---------------------------------

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

65 years and over ---------------------------

Family income

Less than $5,000 -----------------------------

$5,000 -$9,999 --------------------------------

$10,000 -$14,999 ------------------------------

$15,000 -$24,999 ------------------------------

$25,000 or more ------------------------------

Not reported ---------------------------------

Geographic region

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

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

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

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

Place of residence

SMSA, central city --------------------------

SMSA, not central city ----------------------

Outside SMSA --------------------------------

Days of restricted activity

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

1 or more -----------------------------------

Bed days

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

1 or more -----------------------------------

Medical attention

Attended at emergency rem------------------

Attended, but not at emergency room ---------

Attended, place unkno~---------------------

Not medically attended ----------------------

Activ -

Al 1

ity

Lctivity No

Working ~ynTrav-

;tatuses cling Other major k=wn

and

act ivity or not

types

Spec -

ified

Number of episodes in thousands

74,164

39,653

34,511

25,908

32,757

10,796

4,703

12,327

16,531

16,660

17,481

6,734

4,431

15,677

20,103

21,605

16,779

22,215

29,482

22,467

28,442

45,721

56>436

17,728

25,227

29,936

2,692

16,309

18,646

12,542

6,104

I

1,414

12,196

4,137

898

3,045

3,693

4,831

3,880

1,980

1,217

3,140

5,427

6,610

3,470

:,%;

6;375

7,282

11,364

l:,::J

,

6,931

7,653

601

3,461

11,613

8,392

3,221

6,123

5,175

*315

*-

1,172

2,641

2,503

3,198

1,669

*428

2,831

3,342

2372:

2,71S

3,39

5,00’

3,211

9,27:

2,34(

4,14:

3,75(

*20:

3,50$

12,717

5,597

7,121

3,724

;,;::

1;745

2,303

3,064

2,343

3,122

857

1,029

2,71(

3,51(

3,39(

3,10:

3,59:

4,67;

4,44[

;,;;4

9?

9,08C

3,638

5,693

4,147

*46 2

2.415

=4===

9,869

.3,670

,2,041

7,620

2,733

1,145

;,;;;

5:472

5,630

1,587

1,246

5,361

6,180

;,!;;

9

7,621

;,:$:

,

9,751

13,788

18,005

5,533

6,082

11,179

1,098

5,180

2,537

3,475

1,908

2,376

1,044

684

1,102

1,416

1,246

1,363

*416

*469

1,409

1,335

1,538

1,73C

1,98!

2,37:

1,65:

2,16(

3,84(

4,25;

1,76[

2,151

2,142

*19 :

1,526

-

1.,636

717

920

698

*486

*223

*230

*371

*447

*265

*287

*226

+.41

*227

*309

674

*426

656

678

*302

788

848

1,,189

>k447

+,224

1,,059

??135

Y?218

*Numbers preceded by an asterisk have a relative standard error of more than 30 percent; estimates given

solely for combining with other cells.
amcdata5

Table 4. Percent distribution “of episodes of persons injured by activity status and type of activity when accident happened, according to selected characteristics:United States, 1975

[Dataare based on household interviews of the civilian noninstitutionaliied population. The survey design, general qualifications, and information on

the reliability of the estimates are given in the technical notes]

Selected characteristic

All activity

statuses Working Recreation No major Traveling Other activity

and typesl

All episodes---------------

—Sex

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

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

A&_

Under 17 years-------------------

17-44 years----------------------

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

65 years and over----------------

Family income

Less than $5,000-----------------

$5,000-$9,999--------------------

$10,000-$14,999------------------

$15,000-$24,999------------------

$25,000 or more------------------

Not reported---------------------

Geographicregion

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

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

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

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

Place of residence

SMSA, central city---------------

SMSA, not central city-----------

Outside SMSA---------------------

Days of restricted activity —

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

1 or more------------------------

Bed daya

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

1 or more------------------------

Medical attention

Attended at emergency room-.----Attended, but not at emergency

room----------.-.---------------

Attended, place unknown----------

Not medically attended-----------

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.O

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Percent distribution

25.7

32.2

18.2

5.6

37.8

39.1

20.1

25.5

23.0

29.5

22.6

30.4

27.7

20.3

27.4

31.6

21.2

23.0

25.4

28.8

26.3

25.3

26.5

23.2

27.7

26.5

23.5

21.5

16.0

21.6

9.6

24.3

16.0

*3.(3

*-

12::

15.3

18.6

25.6

*.7

18.3

16.9

13.0

16.6

15.7

17.4

14.5

15.2

16.5

16.8

13.5

16.6

13.0

*7.9

21.8

17.5

14.4

21.2

14.8

15.2

22.2

39.0

19.3

19.0

14.3

18.2

13.2

23.4

17.5

17.7

16.2

19.0

16.7

16.2

20.1

15.4

18.8

16.4

21,1

22.8

14.4

*18.1

15.0

32.5

25.3

40.7

47.8

23.6

25.8

25.6

36.2

32.8

33.4

32.7

24.4

28,4

34.7

31.2

31.9

32.6

35.3

32.8

29.2

35.3

30.7

32.6

32.0

24.3

38.7

42.9

32.2

8.3

7.6

7.4

1?::

9.2

8:8

;:$

*6.4

9.1

6.7

K?::

1;:;

8.6

7.4

*7.5

9.5

lExcludesactivity unknown or not specified.

*Numbers preceded by an asterisk have a relative standard error of more than 30 percent; estimates given solely for combining with other cells.
6

Table 5. Number and percent distribution of episodes of persons injured aged 17 years and over by whether person was at job or business when accident happened, according to selected characteristics: United

States, 1975

[Dataarebasedon householdinterviewsofthecwihan noninstitmionalized population.The surveydesign,generalqualifications, ad information) on the

Selected characteristic

All episodes ---------

Sex

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

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

Age

17-44 years ----------------

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

65 years and over ----------

Family income

Less than $5,000-----------

$5,000-$9,999--------------

$10,000-$14,999------------

$15,000-$24,999------------

$25,000 or more ------------

Not reported ---------------

Geographic region

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

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

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

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

Place of residence

SMSA, central city ---------

SMSA, not central city -----

Outside SMSA ---------------

Days of restricted

activity

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

1 or more ------------------

Bed days

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

1 or more ------------------

Medical attention

Attended at emergency

room ----------------------

Attended, but not at

emergency room ------------

Attended, place unknown----

Not medically attended -----

lExcl~des unknown if at

*Numbers rmeceded bv an

celiabdity oftheestimatesaregivenin the technical notes]

Al 1 At job or

Not at

episodes business job or Unknown

business

Number of episodes in thousands

48,256

23,843

24,413

32,757

10,796

4,703

8,884

10,928

10,139

10,971

4,180

3,153

9,606

12,853

14,288

11,509

14,519

18,893

14,844

17,326

30,929

35,508

12,747

15,444

19,687

1,875

11,250

11,411

;,;;;

>

8,828

2,364

*220

1,527

p:

2;324

6.57

992

2,005

3,064

4,050

2,293

3,123

4,380

3,909

4,453

6,958

8,582

2,830

4,150

5,168

*435

1,659

34,409

14,312

20,097

22,323

7,887

4,199

6,725

7,344

6,568

8,133

3,524

2,116

6,789

9,050

9,715

8,856

10,680

13,430

10,300

11,633

22,776

25,046

9,363

10,964

13,135

1,262

9,048

2,435

735

1,700

1,606

*545

*284

633

*583

660

*514

-k-

*44

812

739

9c524

*360

716

1,083

635

1,240

1,195

1,880

*555

*330

14;;;

*543

,

Al 1 At job or

Not at

episodesl business job or

business,

I I

Percent distribution

100. c

100.C

100. c

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

24.9

38.1

11.5

28.3

23.1

*5.O

18.5

29.0

30.7

22.2

15.7

31.9

22.8

25.3

29.4

20.6

22.6

24.6

27.5

27.7

23.4

25.5

23.2

27.5

28.2

*25.6

15.5

)b or business when accident happened.

~terisk have a relative standard error of more than 30 percent;

75.’1

61.9

88.5

71.7

76.9

95.0

81.5

71.0

69.3

77.8

84.3

68.1

77.2

74.7

70.6

79.4

77.4

75.4

72.5

72.3

76.6

74.5

76.8

72..5

71.8

74.4

84.5

estimates

given solely-for combining with other cells.
dmcedaa7

table 3 for persons 17 years and over who were

doing some type of work when the episode occurred, about 11.4 million occurred while the

person was working at his or her job or business.

These 11.4 million episodes constitute about

23.6 percent of all of the episodes for this age

group.

Respondents who reported medical attention of accidental injuries were asked: “Where

did . . . FIRST see or talk to a doctor–at a

clinic, hospital, doctor’s office, or some other

place?” Table 6 shows the number and percent

distribution of all episodes of persons injured by

whether or not the injury or injuries were medically attended and, if so, where medical attention was first received. It should be reemphasized that these data do not include episodes in

which the injuries were not medically attended

or did not cause the person to restrict his or her

activity for 1 day or more. As may be noted

from table 6, 78.0 percent of the episodes resulted in some form of medical attention, while

22.0 percent led to restricted activity but did

not involve medical attention.

This proportion between medically attended

episodes and those not medically attended differs from the proportions usually derived from

the annuaI Health Interview Survey. Ordinarily,

the proportions are about 84 percent medically

attended and 16 percent not medically attended.

The difference probably reflects the influence of

the supplemental injury probe, which tended to

screen in additional relatively minor types of injuries which did not require medical attention.

Of aII medically attended episodes, 41.3 percent were first treated at a hospital emergency

room, 33.9 percent at a doctor’s office, and 24.8

percent at other places (“other places” includes

telephone calls to a medical doctor). Of the estimated 25.2 million episodes that were ever

treated at a hospital emergency room, 92.5 percent (23.3 million) were fh-st treated there,

while 7.4 percent followed a previous contact

with a medical person. When use of a hospital

emergency room is viewed in relation to all episodes, whether or not they were medically

treated, 32.0 percent were first treated at a hospital emergency room and 34.8 percent were

treated there at one time or another. All of these

percents exclude the episodes for which the

place of first medical attention was unknown.

Data on product involvement in episodes of

persons injured were obtained in response to the

following two questions: “What product or object came into contact with . . . and actually

caused the injury?” and “What other products

or objects were involved in the accident?” In

interpreting the estimates of product involvement, based on responses to these questions, it

should be noted that the data do not in any way

indicate whether or not any defect or property

of the design of the product was responsible for

the accident.

The data on type of product involvement in

accidental injuries was coded according to the

coding system used in the hTationaI Electronic

Injury Surveillance System (NEISS) of the Consumer Product Safety Commission.5 The estimates shown in table 7 are based on the broad

categories used in that system. The frequency of

product involvement is based on the number of

times a category of products was involved one or

more times in an episode of accidental injury

and not on the number of products involved in

that episode. As such, the frequency is to some

degree a function of the range of products used

in any category, and because of this, totals for

sub~oups of a category will not usually sum to

the total for the entire category.

Up to three types of products were coded

for each of the two product-related questions.

Thus any particular episode might have from

zero to six types of products involved. Of the

approximately 74.2 million episodes of persons

injured, about 56.3 milIion involved at least one

type of product. Using the broad categories of

product types found in the NEISS coding system, the estimated 56.3 million episodes involved about 69.5 million instances of type of

product involvement during 1975 (table 8).

Table 7 shows che percent of times the categories of product types were involved in episodes of persons injured for episodes among (1)

all civilian noninstitutionalized persons, (2)

males, (3) females, and episodes resulting in (4)

1 day or more of restricted activity, and (5) a

visit to a hospital emergency room.

As an example of the way in which to interpret the estimates show-n in table 7, the case of

5See iVEISS Coding Manual, U.S. Consumer Product

Safety Commission, Bureau of Epidemiology.
8 aduamedata

Table 6. Number and percent distributions of episodes of persons injured by whether medically attended and, if SO, place of first

medical attention, according tO selected characteristics:IJ”itedstates, 1975

IIJ.11., .mub.scd<,11Iho.wlmhl mtcrvrws of d). cwIII.iI1nonl,lst!tut,ojl.ltzcd pop.lacmn, Th. s.rv.y dcs,gn, yncral cIu,tlIfK.cIons. and ,ntonn.turj on CIICr.lial>illty of the cwiz..rcs arc gwn III chc

tc.l>n, c,l ,,<,,,,1

Place of first medical attencicm

All All Not

Selected medi- medi.

characteristic epi- cally Emer- Doc- cally

sodes geney tor’s Other Unat- kncwn attended room Of- tende(

epifice

sodes

All episodes------

)

74,16

g

Male-------------- 39,65

Female------------ 34,51

Age —

Under 17 years ----

17-44 years -------

45-64 years -------

65 years and overFamily income

Tess than $5,000--

$5,000-$9,999-----

$lo,ooo-$14,999---

$15,000-$24,999---

$25,000 or more---

Nat repOrted------

Geographic region

Northeast---------

North Central-----

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

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

SMSA, central

city-------------

SMSA, not central

city-------------

Outside SMSA -----

25,90/

32,75

10,791

4,70

12,32:

16,531

16,66(

17,481

6,73!

4,431

15,677

20,10:

21,605

16,779

22,215

29,482

22,467

,*:ed

act ivity

1 or more..] None-------------- 28,442

55,721

I

Bed days

I

None----,---------

1 or mOre---------

Medical attention

Attended at

emergenty roOm---

Attended, but not

at emergenty

rOOm-------------

Attended, place

unknwn----------

56,436

17,728

25,227

29,936

2.692

I

Number of episodes in thousands

57,8?

31,21

26,62

20,84

25,o4

8,20

3,75

9,39

12,66<

13,93

13,21

5,121

3,52

12,80!

15,99$

16,561

12,48:

16,88;

23,435

17,532

28,442

29,41?

45,551

12,304

25,227

29,936

2,692

23,25

14,31

8,93

8,95

10,19

2,92

1,18!

3,94

5,40(

5,07!

5,09,

1,87”

1,86(

6,07(

6,75!

6,64;

3,78;

7,147

9,42:

6,68:

9,908

13,344

17,048

6,204

23,252

...

...

19,04[

9,267

9,782

6,390

7,750

3,350

1,558

2,923

3,917

4,535

4,863

1,756

1,055

3,049

4,650

6>057

5,292

~

I

4,760

7,529

6,759

9,480

9,568

15,457

3,592

929

17,657

*461

ention.

13,95

7,00

6 ,94I

5,14<

6,26(

1,62:

91[

2,25(

2,94:

3,881

2,92(

1,35:

60:

3,376

4,234

3,407

2,938

4,467

5,881

3,607

B,228

5,727

1,722

2,233

961

?,234

760

1,60[

62(

97:

*35t

84c

*312

991

9~27

,~406

+<446

*331

9<140

*-

*314

>t362

>k453

.~47o

*513

602

<<484

826

773

.,324

9<276

*84

*45

,471

16>30!

8,43{

7,87:

5,05!

7,70:

2,58<

95:

2,93(

3,86;

2,72:

4,26:

1,60C

905

2,868

4,104

5,041

4,296

5,328

6,047

4,934

...

6>309

0,885

5,423

...

...

...

TTMediNot

Al 1 med iepi- cally

atcall}

sodes]

tended attende

Percent distribution

100.0

100.0

10(I.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

78.[

.—

78.;

77.:

80.5

76.5

76.0

79.8

76.2

76.6

83.7

75.6

76.2

79.5

;;,;

76:7

74.4

76.0

79.5

78.0

Loo.o

64.3

80.7

69.4

100.0

100.0

100.0

22.0

21.3

22.8

19.5

23.5

24.0

20.2

23.8

23.4

16.3

24.4

23.8

20.5

18.3

20.4

23.3

25.6

24.0

20.5

22.0

...

35.7

19.3

30.6

...

...

...

Place of first medical

attention

Percent distribution”

100. (

100.(

100.(

100.c

100,C

100.c

100.C

100.0

100.0

100.0

Loo.o

100.0

100.0

100.0

100.0

100.0

100.0

100.()

100.0

100.0

Loo.o

100.0

100.0

100.0

100.0

10D.O

100.0

41.

46.{

34.[

43.;

42,1

37.(

32.:

43.2

44.C

37.6

39.5

37.6

53.C

48.6

43.2

41.3

31.5

43.7

;;.;

35.9

46.6

38.5

51.6

92.5

...

...

33.

30.

38.

31.:

32.(

42.(

42.(

32.1

32.(

33.(

37./

35.:

30.(

24.4

29.i

37.6

44.1

29.1

33.0

39.6

34.3

33,4

34.9

29.9

3.7

59.1

37.8

.

24.8

.—

——

22.9

27.1

:25.1

:25.9

20.6

25.1

24.7

24.0

28.8

22.7

2!7.2

17.1

.27.0

27.1

21.1

24.5

27.3

25.8

21.2

29.8

20.0

26.5

18.6

3.8

40.9

62.2

1Excludes unknown place of first medical at

*Numbers preceded by an asterisk have a rel tive standard error of mare than 30 percent; estimates given solely for combining

with other cells,
a&medaa9

Table 7. Number of episodes of persona injured by selected characteristics, percent of episodes of persona injured by product type and selected characteristic; and direct product involvement as a percent of both direct

and indirect product involvement by product type: United States, 1975

[Dataarebasedon householdinterviews of the civilim noninstitutiomdimd population. The survey design, general qualifications, and information on the reliability of tbe

estimates wc @cn in the technical notes]

Episodes of persons injured and product type

All episodes --------------------------------

Product typel

General household appliances (O1O1-O132)----------

Kitchen appliance (0202-0262)--------------------

Space heating, cooling, and ventilating

appliances (0301-0355)----------------------------

Housewares, nonpowered (0401-0459)----------------

Home communica tions, entertainment, and hobby

equipment (0501-0542)----------------------------

Home furnishings and fixtures (0601-0697)---------

Home alarm, escape, and protection devices

(O7Ol-O7O8)--------------------------------------

Home workshop apparatus, tools, and attachments

(O8Ol-O853)--------------------------------------

Home and family maintenance products

(O9O2-O95O)--------------------------------------

Farm supplies and equipment (1001-1051)-----------

Packages and containers for household products

(llol-ll22)--------------------------------------

Sports and recreational equipment (1201-1299;

32OO-32O9)---------------------------------------

TOyS (1301-1383)----------------------------------

Yard and garden equipment (1401-1440)-------------

Child nursery equipment and supplies

(1502-1541)--------------------------------------

Personal use items (1601-1656)--------------------

Miscellaneous products (1701-1726)----------------

Home structures and construction materials

(l8O3-l86O)--------------------------------------

Motor vehicles (1901)-----------------------------

Foods (1904)--------------------------------------

Prescribed drugs (1920-1922; 1924) ----------------

Industrial equipment, not used at work (2200)-----

Medical equipment (2400-2465)---------------------

Other products in the 1901-2465 range

(1902-1903; 1905-1918; 1923; 2300) ---------------

Cosmetics (2500-2700)-----------------------------

Direct and indirect product involvement among:

I I

Episodes Episodes

resulting resulting

All Males in 1 day in a vis -

persons Females it to a

or more of hospital

restricted

activity emergenty

room

II I I I

Number of episodes in thousands

74,164 ~/39,653

*0,7

1.0

1.1

3.2

1%:

*0.1

3.4

;:;

2.8

14.1

0.9

1.9

*0.5

4.4

1.3

20.6

9.6

;::

1.2

*0.2

1.6

*0.7

*0.4

*0.7

;::

*1. O

9.4

*0.2

5.9

1.9

*1.4

2.8

19.2

*1.5

3.1

*0.5

2.9

*1.2

21.6

9.1

2.3

2.9

2.0

*0.2

2.1

*0.1

34,511 I 45,721 I

Percent of episodes

*1. O

*1.4

*0.3

4.1

*0.8

11.7

*-

*0.4

*1.1

*0.3

2.8

8.2

*0.3

*0.5

*0.6

6.0

*1.4

L9.4

10.1

12:;

*0.3

*0.1

*1. O

*1.3

*0.7

*0.9

*1.3

3.3

*0.9

10.8

*-

3.6

1.4

*1.1

2.9

14.6

*0.9

2.2

*0.3

4.8

1.7

L8.9

9.6

3.6

::;

*0.1

*;:;

25,227 I

*0.3

*1. O

*0.8

4.1

*0.9

10.6

*0.2

4.3

*2.2

*1.1

2.8

17.3

*1.8

*2.2

3:;

*1.1

24.5

13.9

3.0

*1.9

*1.3*-

*2. O

*-

Direct

product

inv0lvement

as a

percent of

both direct

and indirect

involvement

. . .

*73. O

*59.5

*66.7

80.9

*47.9

63.4

*48.4

67,9

70.6

*66.5

62.0

37.3

*40.O

74.7

*54.5

70.6

*56.7

80.9

62.8

49.7

99.0

*52.7

*lOO.O

70.1

*89.6

lThe numbers in parentheses represent the code range for the typea of products specified in the National Electronic Injury Surveillance System coding manual.

*Numbers preceded by an asterisk have a relative standard error of more than 30 percent; estimatea given solely

for combining with other cells.

“housewares” may be used. Housewares were involved in 3.2 percent of all episodes of persons

injured. Among those episodes occurring to

males, they were involved 2.4 percent of the

time and for females 4.1 percent. For all episodes resulting in 1 or more days of restricted

activity or in a visit to a hospitaI, housewares

were involved 3.3 and 4.1 percent of the time,

respectively. All of these estimates include both

direct and indirect product involvement in the

accidental injury. The last column of table 7

shows that of all the times housewares were involved, the involvement was the direct “cause”

of the injury in 80.9 percent of the cases.

The large number of relatively unreliable estimates shown in table 7 indicates that the pro-
10

Table 8. Number of episodes of persons injured, number of episodes of persons injured involving one or more product types, and number of instances product type involved in episodes of persons injured by selected characteristics:United States, 1975

IL%M arc based.. ho.schold mtcw,cws of tl,c .IVIIIA. :>..tnst)t.tt.nal! zcd p.p.latm. TIIe survey dcstgn. gmml qual)(,cac,ons, and mforrnamn . . cl,. rclmbky of the mcmms m givm

m [h. t.chntcd n.tesl

All

Resulting in 1 or more

Item Male Female days of restricted Resulting in a Vizit

persons activity to an emergency room

I

Number in thousands

Episodes of persons injured------------------------------ 74,164 39,653 34,511

Episodes of persons injured involving 1 or more product

types----:---------------------------------------------- 56,302 30,822 25,481

Number of Instances product type involved in episodes of

persons injured----------------------------------------- 69,502 38,432 31,070

:I__!E

Table 9. Percent distribution of times a type of product was involved in episodes of persons injured by selected

characteristics, according to type of product: United States, 1975

[Dataarcbmcd cm householdimmwews of the cwdian noninsritutmnahzed population. The survey des]gn, gmcral qualificaticms, andinfomnatimo“ chcreliability ofchccstmmws

—

Selected characteristic

All episodeal -------------

Sex —

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

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

Age

—

Under 17 yeara -----------------

17-44 years --------------------

45 years and over --------------

Family income 2

Less than $10,000 --------------

$10,000 -$14,999 ----------------

$15,000 or more ----------------

Geographic region

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

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

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

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

Place of reaf.dence

SMSA, central city -------------

SMSA, not central city ---------

Outside SMSA -------------------

Days of restricted activity

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

1 or more ----------------------

Place treated3

Emergency room -----------------

Not at emergency room ----------

arcgncnm the tcchnical”m,tcsj

Housewares,

nOnpOw -

ered

Home

fdrnish -

ings

and

fix -

tures

T

100.0 100.0

*39. 9 48.1

60.0 51.9

*19. O 34.8

60.4 33.7

*20.5 31.6

50.5 53.5

*20.8 21.9

28.7 24.6

*18. O 19.5

*23.1 21.9

47.0 39.3

11.9 19.2

*23.9 36.8

35.9 27.6

40.2 35.5

35.6 36.5

64.4 63.5

*

Home

work -

shop

appar -

atus,

tools,

and

attachments

100.0

94.3

*5.6

*11. 7

70.4

*17.9

44.5

25.2

30.3

28.9

*24. O

28.4

*18. 7

24.3

39.2

36.4

33.3

66.7

53.4

46.6

I

Packages Sports

and con - and

tainers recre -

for ational

house- equip -

hold ment

products

Persona1

use

items

Percent distribution

Home

strut -

turea

and

cOnstruc -

tion

materials

100.0

52.7

47.3

29.2

57.1

*13. 7

41.8

*16. 7

41.5

*23 .9

*25 .0

*27.3

*23.8

*26.6

43.2

30.2

35.6

64.4

43.4

56.6

100.0

72.9

27.1

60.9

34.8

*4.3

32.8

22.0

45.3

22.0

34.4

22.5

21.1

28.0

42.2

29.8

36.3

63.7

57.2

42.8

100.0

36.0

64.0

43.1

41.3

*15.6

45.7

*3-8.7

35.6

15.5

29.9

27.4

27.3

36.2

35.7

28.0

:3.;

42.7

57.3

100.0

56.1

43.9

36.4

34.5

29.1

44.2

24.5

31.3

19.2

31.6

28.0

21.2

32.0

36.6

31.4

43.4

56.6

52.9

47.1

Motor

vehi -

cles

(ineluding

vehi -

cle

parts)

100.0

—-

50.7

49.3

17.9

57.9

24.1

38.5

19.5

42.0

13.8

27.2

35.8

23.2

29.9

44. L

25.9

38.2

61.8

61.6

38.4

Foods

100.0

33.0

66.9

~17.3

53.5

29.3

38.4

31.6

30.0

k14.7

k19.6

38.0

27.8

25,2

34.3

40,5

39.2

60.8

40.9

59.0

Pre -

scribed

medicines

100.0

22.4

77.6

29.1

48.6

22.3

50.6

26.8

22.6

21.1

25.5

27.6

25.8

40.4

35.3

24.3

*12. 9

87.1

‘Includes unknown family income, injuries not medically attended, and unknown place of medical attention.

ZExc ludea unknown family income.

3Excludes episodes not medically attended and unknown if person visited an emergency room.

*Numbers oreceded bv an asterisk have a relative standard error of more than 30 Percent; estimates given solaly for

combining wikh other c~lla.
akmedaa 11

duct involvement categories produced too few

sample cases, based on a 2-week reference

period, for extensive cross-classification of the

data. Table 9 shows percent distributions according to the larger product groups and a reduced set of variables. A more inclusive Iist of

product types and a more extensive cross-classification of variables would produce a table including relatively unreliable estimates.

At this writing, plans are underway to attempt a report on product involvement using all

of the data from the 6-month reference period.

While such a procedure would reduce the variances of the estimates, it will tend to underestimate the true number “of times various product

types were involved in episodes of persons injured because of the large memory decay associated with a 6-month reference period.

TECHNICAL NOTES

The estimates shown in this report are based

on data obtained in household interviews in a

continuing nationwide survey. Each week a

probability sample of households is interviewed

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

to obtain information about the health and

other characteristics of each member of the

househoId in the civilian noninstitutionalized

population of the United States. During 1975

there were about 40,000 interviewed households

containing about 116,000 persons.

The appendixes of the 1975 Current Estimates (Series 10, No. 115) should be consulted

Table 1. Standard errors of estimates of aggregates

Size of estimate Standard error

in thousands in thousands

100 ..........................................

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

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

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

20,000 ... .. .... .... .. .. . ..... .. .. ... . .. .. ..

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

40,000 .. ..... .. ..... ... . ... ... . .... . .. .... .

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

60,000 .. ... .. . .... .. .. ... .. .. .... .. ..... .. .

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

for a more detailed discussion of the sample design (appendix I), definitions of certain terms

used in the report (appendix H), and the questionnaire used during 1975 (excluding the accident supplement) (appendix III).

As noted above, the estimates shown in this

report are based on a sample of the population.

The approximate standard errors of the estimates of episodes of persons injured are shown

in table I; the approximate standard errors for

the percents are shown in table H.

Table II. Standard errors, expressed in percents, of estimated

percentages

Base of

percentage

in thousands

73

126

178

230

519

741

1,067

1,331

1,563

1,777

1,978

2,170

100 ..................

300 ... . .. ... .. .. ... ..

600 .. ... ... .. .. ... .. .

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

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

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

20,000 ... .. .. ... .. .

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

40,000 .. .. ... . .. ...

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

60,000 ... .. ... . ....

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

2 or

98

10.2

5.9

4.2

3.2

1.4

1.0

0.7

0.6

0.5

0.5

0.4

0.4

Estimated percentage

5 or lOor

95 90

15.8 21.8

9.1 12.6

6.5 8.9

5.0 6.9

2.2 3.1

1.6 2.2

1.1 1.5

0.9 1.3

0.8 1.1

0.7

0.6 U

0.6 0.8

T

29.1

16.8

11.9

9.2

4.1

2.9

2.1

1.7

1.5

1.3

1.2

1.1

36.3

21.0

14.8

11.5

5.1

3.6

2.6

2.1

1.8

1.6

1.5

1.4
12

SYMBOLS

Data not available ------------------------------------- ---

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

Quantity zero ---------------------------------------

Quantity more than Obut less than 0,05---- 0.0

Figure does not meet standards of

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

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ● Public Health Service I Number 19 ■ March 15,1978

Exercise and Participation in Sports Among

Persons 20 Years of Age and Over: United States, 1975’

During July-December 1975 the Health Interview Survey questionnaire included a supplement to obtain information about exercise, participation in sports, and self-judgment of the

individual’s amount of physical activity for the

U.S. civilian noninstitutionalized population 20

years of age and over. Data were obtained in

response to the following five questions: What

exercises were done on a regular basis? What

sports were participated in during the 12 months

prior to interview? Was this participation as a

team member? Was any of the participation in

tournaments? and Do you consider yourself

more, less, or about as active as other persons of

your age? A copy of the questionnaire may be

found in “Current Estimates from the Health

Interview Survey, United States, 1975,” Vital

and Health Statistics, Series 10, No. 115, DHEW

Publication No. (HRA) 77-1543. Unlike most

data gathered in this survey, the information on

exercise and sports participation was obtained

from each sample person rather than from a

household respondent.

The data show that about 49 percent of persons 20 years of age and over reported doing one

regular exercise or more, while 51 percent reported no regular exercise (table 1). Among

specific exercises, walking was the most common form; approximately 7 out of 10 persons

who exercised regularly reported this form. During the 12 months before the interview about 42

percent in this age group participated in one

1This report prepared by Jai W. Choi, Division of

Health Interview Statistics.

kind of sport or more. Among specified types of

sports, the participation rate was highest for

swimming (24.0 percent). Approximately 11

percent of the group participated in sports as a

team member, and about 7 percent participated

in a tournament during the year.

Exercise

Tables 1 and 2 show the number and percent

distribution of persons by type of exercise according to selected characteristics. IValking (33.8

percent) was the main form of exercise among

persons 20 years of age or over. This was especially true for older persons. For example,

among persons 65 years or over who exercised

regularly, almost 9 out of 10 walked for exercise. Calisthenics was the second most popular

form of exercise (13.5 percent). The next most

frequently mentioned exercises were swimming

(1 1.8 percent), bicycling (10.9 percent), jogging

(4.8 percent), and weight lifting (3.4 percent).

Figure 1 shows these percents by sex.

A higher proportion of younger persons exercised regularly than did older persons. About

54 percent of persons aged 20-44 years exercised, while only about 42 percent 65 years and

over reported exercising regularly. Persons with

higher family income were more likely to exercise than were persons with lower family income.

Because many people do more than one

form of exercise, the sum of those who did different forms is, of course, greater than the number of those who exercised. Table 3 illustrates
2

Table 1. Percent distribution of Dersons 20 years of acre and over bv exercise status and ~ercent by type of exercise, according to selected

characteristics: United States, 1975

Characteristic

All persons 20

years and

overl

100.0

100.0

100.0

100.0

100.0

One

egular

xercise

r more

48.6

53.7

43.4

42.3

48.5

Type of exercise

+

No

regular

Bicycling Other exercise

——

10.9

16.1

6.5

2.9

10.8

14.9

6.7

4.3

11.1

17.2

6.4

1.8

11.3

16.6

6.9

3.1

8.3

12.5

3.2

●

7.4

9.5

11,6

14,2

6.9

Calis-

!hen ics

13.5

17.3

10.8

6.1

13.5

17.5

10.1

5.9

13.5

17.1

11.4

6.3

13.8

Jogging

4.8

7.3

2.7

1.2

7.2

/Valking

33.8

33.8

32.9

35.7

32.5

31.4

31.4

39.4

35.0

Weight SwimIifting ming

—SEX

Both sexes

All ages 20 years and over..

20-44 years .............................

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

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

Male

. All ages 20 years and over ..

20-44 years .............................

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

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

Female

All ages 20 years and over ..

20-44 years .............................

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

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

COLOR

White

All ages 20 years and over ..

20-44’ years ............................

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

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

Ail other

All ages 20 years and over ..

20-44 years ............................

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

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

Family income

Less than $5,000 ....................

$5,000-$9,999 ...... .................

$10,000-$14,999 ....................

$15,000 or more ....................

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

I

==1- 6.8 51.1

6.9 46.1

6.5 56.3

6.9 57.4

3.4 11.8

..—

5.4

1.5

●0.5

16.9

8.0

2.8

6.3 13.3

18.8

8.1

4.1

6.4 51.1

6.2 47.0

5.9 57.6

8.1 52.0

100.0

100.0

100.0

100.0

52.7

42.0

47.3

48.7

10.6

3.8

2.1

2.7

10.1

2.6

‘0.5

+

7.1 51.1

.

7.5 45.2

7.1 55.2

6.0 61.1 t

0.8 10.5

1.1 15.0

‘0.5 7.8

‘0.4 1.9

100.0

100.0

100.0

100.0

54.6

44.6

38.7

49.3

54.1

44.5

43.8

42.9

4.1

1,6

‘0.6

4.7

7.0

2.8

1,2

6.1

9.5

●1.4

‘1.1

3.5

4.3

4.7

6.4

3.0

36.0

34.2

33.0

-1- 3.4 12.6 34.0 -L- 6.8 50.4

100.0

100.0

100.0

100.0

17.8

11.1

6.5

11.0

14.0

8.6

●2.7

9.6

12.1

13.9

17.5

7.2

5.5

1.4

*0.5

18.0

8.7

3.0

33.5

33.4

36.8

32.4

36.3

28.2

24.4

35.6

34.2

33.7

34.5

27.2

6.8 45.6

6.7 55.2

7.2 55.8

*

6.3 56.8

7.4 48.9

5.1 65.8

*4.O 7’2.8

3.4 6.0

9.4

●1.3

*1.3

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

50.7

33.9

27.2

45.2

46.4

49.9

53.4

38.8

4.7

●2.3

*

I

5.9 54.7

6.4 53,4

6.6 49,9

7.5 46.3

7.0 60.7

2.4

3.0

3.6

4.3

2.C

6.7

10.3

13.5

15.2

7.8

lIn~ludes unknown exercise StatUS.
a&mcdda3

Table 1. Percent distribution of persons 20 years of age and over by exercise status and percent by type of exercise, according to selected

characteristics: United States, 1975–Con.

Characteristic

Geographic region

Northaast ......................... .....

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

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

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

Self-perceived

physical activity

Less active ............. .. ...............

As active as others the

same age ...................... ...... ....

More active .............................

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

All persons 20

years anc

overl

100.(

100.(

100.(

100.(

100.(

100.(

1Oo.c

1Oo.c

lIncludes unknown exercise StatUS.

One

regular

exercise

or morf

50.4

49.6

42.0

55.8

39.8

50.5

66.6

9.7

Bicycling

10.7

14.4

7.9

11.4

5.1

11.4

17.3

2.3

Figure 1. PERCENT OF PERSONS 20 YEARS OF AGE

AND OVER WHO REPORTED REGULAR EXERCISING, BY TYPE OF EXERCISE AND SEX: UNITED

STATES, 1975.

Walking Cahsthemcs Swimmmg Btcydmg JWgmg Weight Other

Iifring

that about 46 percent of persons reported that

they did two types or more of exercises, and

about 55 percent reported that they did only

one type of exercise.

Among persons who were less active than

others in the same age group, about 40 percent

Type of exercise I RI”

Calis-

.fogging thentics

I

14.0 4.8

13.4 4.3

10.4 4.2

18.1 6.7

7.4

12.4

23.5

2.3

0.9

3.4

11.1

1.4

Weight

lifting

3.1

3.5

3.0

4.1

1.2

2.6

7.1

‘ 0.7

r .“

Swim- regular

ming Walking Other exercise

14.1 36.5 7.1 49.4

10.3 34.9 5.6 50.1

10.4 28.1 6.6 57.8

13.4 38.4 8.4 43.6

7.2 27.9 5.3 60.1

reported doing one type of exercise or more.

Tie corresponding proportions were about 51

percent for those who were about as active as

others their age and 67 percent for those who

were more active.

Participation in Sports

About 42 percent of the population 20 years

of age and over participated in one type of sport

or more, while 58 percent did not participate in

any kind of sports. During the 12 months before

the interview about 11 percent of persons participated in one type of sport or more as team

members, and about 7 percent participated in at

least one tournament (tabIe 4).

A higher proportion of younger persons participated in sports than did oIder persons. For

instance, about 58 percent of persons aged

20-44 years participated in some form of sport

while only about 10 percent of those 65 years

and over participated (table 4).

About 37 percent of women reported they

had participated in one kind of sport or more,

while the comparable rate for men was about 47
4 adwancedata

Table 2. Number of persons 20 years of age and over by exercise status and type of exercise, according to selected characteristics:

United States, 1975

All One Type of exercise3

persons regular No

20 years regular exercise Bicycling &lis. Jogging Weight Swim.

and overl. z or more

Walking Other

thenics lifting ming

exercise

Characteristic

~

Both sexes

All ages 20 years

and over ....................

20-44 years ......... ..............

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

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

W

All ages 20 years

and over .....................

20-44 years .......................

45-64 years.., .............. .......

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

Female

All ages 20 years

and over ....................

20-44 years .......................

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

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

COLOR

White

AH ages 20 years

and over ............. .. .....

20-44 years .... ....................

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

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

All other

All ages 20 years

and over ..... ..............

20-44 years ........................

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

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

Family income

Less than $5,000 ..............

$5,000 -$9,999 ..................

$10,000-$1 4,999 .............. .

$15,000 or more ...............

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

Number in thousands

135,655 65,922 14,854 18,287 6,569 4,601 16,034 45,880 9,193 69,334

71,084

43,145

21,426

63,665

38,158

18,710

9,054

30,893

11,422

2,891

611

6,853

12,313

4,661

1,312

8,604

5,170

1,145

254

4,604

3,852

651

+99

4,031

11,989

3,435

610

8,491

24,045

14,197

7,639

20,716

4,894

2,823

1,475

4,074

32,735

24,308

12,291

32,~51

34,268

20,567

8,830

71,990

18,074

8,638

4,180

35,030

6,006

2,076

522

9,683

3,648

773

183

1,965

3,444

540

*47

570

6,452

1,675

365

7,543

10,773

6,463

3,480

25,164

2,133

1,223

718

5,119

16,107

11,847

4,596

36,783

5,092

1,380

381

8,001

36,816

22,579

12,595

120,141

20,084

10,072

4,874

59,264

33,545

17,202

8,517

6,658

6,330

1,441

230

13,574

10,283

2,679

611

1,280

.—

1,139

141

*

1,563

2,791

3,416

6,300

784

6,307

2,585

790

16,575

11,037

4,280

1,258

1,712

1,276

381

*54

2,043

3,545

4,102

7,782

815

1,522

372

*7 I

5,627

4,310

1,084

232

942

860

*61

*22

738

1,264

1,402

2,831

334

407

*III

*52

4,077

5,538

1,760

245

15,100

13,272

7,733

4,159

40,847

2,762

1,601

757

8,212

16,628

12,461

7,695

60,523

28,287

21,379

10,857

8,811

61,990

38,696

19,455

15,515

3,429

549

●99

524

423,

*101

*

514

877

1,077

1,907

227

11,135

3,379

585

935

20,746

12,942

7,159

5,033

3,299

1,254

480

7,536

10,010

9,957

15,304

3,073

4,220

2,595

1,396

981

854

“56

*25

1,426

3,002

3,990

6,739

878

674

228

● 7~

1,25E

1,861

1,950

3,331

793

4,448

2,930

1,434

11,576

15,622

14,739

20,530

6,868

9,094

4,450

1,971

21,180

29,271

29,53S

44,35e

11,307

4,614

1,508

536

9,566

13,573

14,733

23,665

4,384

See footnotes at end of table.
ackmeMa5

Table 2. Number of persons 20 years of age and over by exercise status and tyPe of exercise, according to selected char-eristics:

United States, 1975-Con.

All One Type of exercise3 No

Characteristic persons regu Iar

Celis- Weight

regular

20 years exercises Bicycling Jogging Swimthenics Walking Other exercise

and overl,z or more lifting ming

Geographic region

Northeast .......................... 32,789

North Central ................. ... 35,951

South ............. ................... 41,991

West .................................. 24,925

Self-perceived

physical activ:!y

16,536

17,830

17,639

13,916

8,731

31,307

24,425

1,459

3,520

5,178

3,306

2,850

1,1 2(

7,04t

6,34(

34[

Number in thousands

3,520 4,576

4,806 1,551

4,381 1,751

4,523 1,682

L

1,627 206

7,691 2,090

8,616 4,067

353 205

1,585 1,030 11,965 2,334 16,185

1,274 3,692 12,547 2,018 18,003

1,280 4,363 11,790 2,754 24,286

1,018 3,350 9,578 2,087 10,860

l~nc]ude~ “nkno~vn exercise status.

Z=timate based on the civilian noninstitutionalized population, JUW-DeC~mb=1975-

3The number of ~er~on~ ~articiPating in sPecific types of exercise is greater than the number of persons ~~ho exercise because more

than one form is repo~ted in some cases.

Table 3. Number and percent distribution of persons who exercised by number of types of exercise: United States, 1975

Number of types

of exercise

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

1 type ... ...................

2 types ....................

3 types or more .......

Number of persons Percent

in thousands distribution

percent (table 5). The proportions of persons

who participated in sports, who participated as a

team member, and who participated in one tournament or more decreased with increasing age

and were higher for males and white persons

than for females and persons of other races.

These proportions increased with increasing family income. Not unexpectedly; the percent of

persons in each type of participation category

increased dramatically as the self-perceived level

of physical activity increased from “less active”

to “more active. ”

Participating in sports and doing regular exercises are highly associated. Of the approximately 82.8 million persons who participate in

one or the other or both, about 20 percent participate only in sports, about 32 percent only

exercise regularly, and about 48 percent are involved in both types of activity.

Type of Sports Participation

The rate of sports participation varies according to the specific type of sport. Table 5

shows the number and percent of sport participants 20 years of age and over for 14 different

types of sports. Among the sports specified on

the questionnaire, the participation rate was

highest for swimming (24.0 percent) and Iowcst

for wrestling (1.0 percent ). Swimming (26.7 percent), bowling (16.9 percent), and softball ( 13.5

percent) were the three most popular sports

among men, and swimming (21.6 percent),

bo~vling (15.4 percent), and tennis (9.5 percent)

were most popular among women.
6 acktxedata

Table 4. Number, percent distribution, and percent of persons 20 years of age and over by sports participation status, according to selected

characteristics: United States, 1975

——

All perSports participation status

sons 20 One

‘ears and type of Team Tourn - No parover 1,2 sport or member ament ticipation

more

..

All perSports participation status

Characteristic

SEX —

Number Percent Both sexes in thousands

All ages 20

years and over ......... .......... S

I

58.1

30.3

9.9

47.4

82.4

35.7

16.6

36.5

135,655

71,064

43,145

21,426

63,665

34,268

20,567

8,830

71,980

56,460

41,267

13,076

2,117

30;178

21,372

7,340

1,465

26,283

15,169

11,718

3,139

312

9,153

7,109

1,803

241

6,016

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

11.2

16.5

7.3 ~

1.51

14.4

20.7

8.8

2.7

8.4

6.7

9.5

4.9

0.7

10.2’

58.1

41.7

69.4

89.9

52.3

20-44 years .......... ......................

45454 years ............................ ....

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

6,776 29,657

2,119 28,954

143 19,255

Male

t

6,492 33,307

4,882 12,641

1,492 13,156

*119 7,311

All ages 20

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

37.5

164.0

:B2.8

63.3

2044 years., .... ..........................

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

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

14.2

7.3

*1.3

3.5

Female

Ail ages 20

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

*

20-44 years ............ ....................

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

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

36,816

22,579

12,595

120,141

bl ,980

38,696

19,455

15,515

19,895

5,736

652

51,923

37,387

12,452

2,083

4,538

4,608

1,336

*7 I

14.071

1,894 16.8

627 16,799

*24 11,944

100.0

100.0

100.0

100.0

64.0

25.4

5.2

43.2

12.5

5.9

“0.6

11.7

5.1

2.8

*0.2

7.0

45.7

74.4

94.8

56.5

39.4

67.6

89.0

70.5

COLOR

White I

+

8,424 67,925

6,213 24,455

2,068 26,152

143 17,318

All ages 20

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

;

60.3

32.2

10.7

29.2

42.7

14.0

*1.7

23.1

34.8

47.7

55.0

25.6

10.01

5.3

0.7

4.0

6.2

*1.1

*

2.8

4.7

7.6

10.2

2.6

2044 years.., ... ..........................

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

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

10,780

2,978

312

1,098

100.0

100.0

100.0

100.0 A

17.4

7.7

1.6

7.1

10.3 ~

3.6

*

4.7

8.3

13.7

16.1

5.0

614 10,941

All other

Al I ages 20

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

I

57.2

85.4

98.3

76.8

65.0

52.0

44.7

74.0

2044 years .......... ......................

45-84 years ................. ....... ........

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

9,084

4,450

1,971

21,180

29,271

29,538

44,358

11,307

3,880

624

“34

4,882

10,175

14,099

24,411

2,893

938

161

●

1,003

2,443

4,034

7,120

570

563 5,202

*51 3,802

* 1,837

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

597 16,276

1,376 19,040

2,251 15,373

4,521 19,807

284 8,370

Family income

Less than $5,000 .......................

$5,00@8,999 . .....m....................

$10,000-$14,999., .... ........s........

$15,000 or more .......................

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

See footnotes at end of tabk
7

Table 4. Number, percent distribution, and percent of persons 20 years of age and over by sports participation status, according to

selected characteristics: United States, 1975–Con.

II

Characteristic

Geographic region

Northeast ..................................

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

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

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

Self-perceived

physical activity

Less active ................. ................

As active as others

the same age .......... ..................

More active ................................

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

All persons 20

ears and

overl.2

32,78$

35,951

41,991

24,92!

Sports participation status

F

Number in thousands

15,114 3,955

15,500 4,961

13,825 2,964

12,021 3,288

L

21,952 7,138 1,124

61,946 28,031 7,000

36,666 20,098 6,533

15,091 1,193 513

—

2,174 17,607

2,788 20,322

1,828 28,089

2,247 12,848

526 14,814

3,471 33,870

4,605 16,536

435 13,646

All per.

sons 20

ears am

werl,2

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Sports participation status

One

type of Team Tour- No parsport or member ament ticipation

more

46.1

43.1

32.9

48.2

32.5

45.3

54.8

7.9

Percent

12.1 6.6

13.8 7.8

7.1 4.4

13.2 9.0

5.1 2.4

11.3 5.6

17.8 12.6

3.4 2.9

53.7

56.6

66.9

51.5

67.5

54.7

45.7

Sn3.4

lInc]ud~~unk~o~” ~~~~ci~~~t~t”~.

2&.tjmate based Oncitilian noninstitutionalized population, July-December 1975.

Table 5. Number andpercent ofpersons 20yeamof ageandover bysexand specific sDompatiicipated in: United States, 1975

Sport

All persons 20 years and over ...... ....................

All persons who participate in

one type of sport or more ..................... ...........

Swim mi ng..............................................................

Bowling ............ ..................... ............. ...................

Tennis ......... ............................. ........................... ...

Softball ................ ..................................................

Golf .... ........................................................ ...........

8asketball ....................... ................ .............. ........ .

Volleyball .... ...... ........ ........ .............. ......................

Baseball ..... ........................ ..... ...............................

Football ........................... ....... ......... ......................

Gymnastics ......... ........ .......................... .. .... .. ........ .

Handball ..................... ............ .............. .. ...............

Track and field .................... ................. ........ ........

Soccer .... ............. ......................................... ..........

Wrestling .......................... ................. .....................

Others .. ... .................... ....... ...... ....................... .......

Number in thousandsl

H I

Both II Male I

Female

sexes

56,460 30,178 26,283

32,542 17,000 15,542

21,870 10,762 11,108

14,965 8,139 6,826

12,137 8,599 3,538

11,370 8,044 3,326

10,514 8,554 1,960

8,723 4,917 3,806

6,710 5,202 1,508

6,675 5,991 684

3,233 1,514 1,719

2,983 2,300 683

1,935 1,375 560

1,798 1,563 235

1,332 1,110 221

11,070 7,310 3,760

Percent

8oth

sexes

Male

100.0 100.0

41.6 47.4

24.0 26.7

16.1 16.9

11.0 12.8

8.9 13.5

8.4 12.6

7.8 13.4

6.4 7.7

4.9 8.2

4.9 9.4

2.4 2.4

2.2 3.6

1.4 2.2

1.3 2.5

1.0 1.7

8.2 11.5

Female

100.0

36.5

21.6

15.4

9.5

4.9

4.6

2.7

5.3

2.1

1.0

2.4

0.9

0.8

0.3

0.3

5.2

l~stimate based oncivilian noninstitutional izedpOpuIatiOn, JuIY-December 1975.
8

Figure 2 shows the percent of persons who

participated in sports by sex. The rate of participation was not greater for women than for men

in any of the specified types of sports.

Table 6 shows the number and percent of

persons who participated in sports by sex and

whether this participation was as a team member

or in a tournament during the year before the

interview. Participation as a team member is proportionally highest for those who bowl (35.5

percent) and for those who play softball (32.2

percent). Tournament participation is highest

for softball ( 19.4 percent), golf ( 16.7 percent),

and bowling ( 14.4 percent).

Figure 2. PERCENT OF PERSONS 20 YEARS OF AGE

AND OVER WHO PARTICIPATED IN 7 SPECIFIED

SPORTS, BY SEX.

30 r

25 –

20 -

$

LLJ

15 -

a

k!!

10 -

5 -

0 -

= Female - km,,

BOWIIng Tennis Soflball Golf Basketball volleyball
9

Table 6. Number and percent of persons 20 yearn of age and over by type of sport participant, specific type of sport, and sex:

United States, 1975

m

Number in thousands

Type of sport and sex

I member ment

Both sexes

All persons who participated in one type

of sport or more ........................................

Percent

56,460 15,169 9,038 1Oo.c 26.9 16.0

Swimming ... .. ...................... ........ ............ .............

Bowling ......................... .......................... ............

Tennis ..... ............................................................

Softball ...............................................................

32,642

21,870

14,965

12,137

11,370

10,514

8,723

6,710

6,675

3,233

2,983

1,935

1,798

1,332

11,070

30,178

257

7,759

773

3,914

1,522

1,875

1,120

861

745

148

244

193

355

●56

912

9,153

86

3,147

706

2,349

1,901

816

423

304

267

●1I

135

141

128

●33

657

6,492

1Oo.c

1Oo.c

1Oo.c

1Oo.c

1Oo.c

1Oo.c

1Oo.c

1Oo.c

1Oo.c

1Oo.c

1Oo.c

1Oo.c

100.0

100.0

100.0

100.0

O.E

35.5

5.:

32.2

13.4

17,8

12.s

12.8

11.2

4.6

8.2

10.0

19.7

4.2

8.2

30.3

0.3

14.4

4.7

19.4

16.7

7.8

4.8

4.5

4.0

0.3

4.5

7.3

7.1

2.5

5.9

21.5

Golf ....................................................................

Basketball .......... ................ ................ ..................

Volleyball ........... .................................................

Baseball ..............................................................

Football ...................... ........ ................................

Gymnastics ..... .. ...................... .............................

Handball ................ ................ .............................

Track and field ..................................................

Soccer .................................................................

Wrestling ................. ............................................

Other .............. ............................ ........................

Male

One type of sport or more .............................

Swimming ...................................... ......................

BOWI ing .................................. ............................

Tennis ....... ..........................................................

Softball ..............................................................

17,000

10,762

8,139

8,599

8,044

8,554

4,917

5,202

5,881

1,614

2,300

1,375

1,563

1,110

7,310

26,283

202

3,665

398

3,222

1,088

1,636

538

739

687

●51

211

171

333

●56

679

6,016

’75

1,696

495

1,969

1,605

722

228

272

239

●11

●102

●119

128

●33

514

2,545

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

1.2

34.1

4.9

37.5

13.6

19.1

11.0

14.2

11.5

“3.4

9.2

12.4

21.3

‘5.0

9.3

22.9

‘0.4

15.8

6.1

22.9

20.0

8.4

4.6

5.2

4.0

● 0.1

●4.4

●8.7

8.2

*3.O

7.0

9.7

Golf .......... .................................... .....................

Basketball ... .........................................................

Volleyball ... .........................................................

Baseball ..............................................................

Football ................................ .. ...........................

Gymnastics .................................... ......................

Handball ........... ..................................................

Track and field ..................................................

Soccer . ..................................... ...........................

Wrestling .............................................................

Other .............................................. ....................

Female

One type of sport or more .............................

Swimming ...........................................................

Bowling ..............................................................

Tennis ....... ..........................................................

Softball ...............................................................

15,542

11,108

6,826

3,538

3,326

1,960

3,806

1,508

684

1,719

683

560

235

221

3,760

’54

4,085

375

692

424

239

581

●122

*58

●97

’33

’22

●22

●

233

*II

1,451

211

380

295

● 94

195

“33

●58

*

●33

“22

●

*

143

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

“0.3

36.9

5.5

19.6

12.7

12.2

15.3

●8.1

‘8.5

●5.6

*4.8

“3.9

“9.4

●.

6.2

“0.0

13.1

3.1

10.7

8.9

●4.8

5.1

‘2.2

●4.1

●.

‘4.8

●3.9

●.

●.

3.8

Golf ....................................................................

Basketball ...........................................................

Volleyball ...................................... .....................

Baseball ..............................................................

Football ................................ ..............................

Gymnastics ....................... ..................................

Handball ...... .......................................................

Track and field ..................................................

Soccer ................................................................

Wrestlinci ....... .......................... ............................

Other ..~............... ............. ..................................
10

TECHNICAL NOTES

SOURCE OF DATA. The data presented in this

report were obtained from household interviews

in the Health Interview Survey. These interviews

were conducted during the final 2 quarters of

1975 in a probability sample of the civilian noninstitutionalized population of the United

States. During that period approximately 58,000

persons living in about 20,000 households were

included in the sample. The physical activity

questions were asked of each household member

20 years of age and over who was identified as a

“sample person. ” This subsample included approximately 12,000 persons.

SAMPLING. The sampling pattern for sample

person selection was based on the total number

of related and unrelated household members.

Sample persons (approximately a one-third subsample of the Health Interview Survey sample)

were selected by the interviewer at the time of

interview. To determine which household member to designate as a sample person, the interviewer referred to a preselected flashcard after

listing all related and unrelated persons in the

household on the questionnaire. The flashcard

contained, for each household size, one person

number or more that were to be identified as a

sample person.

Since the estimates shown are based on a

sample of the population rather than on the entire population, they are subject to sampling

error. Standard errors appropriate for the estimates of the number of persons are shown in

table I; standard errors appropriate for estimated

percentages are shown in table 11.

LIMITATIONS AND QUALIFICATIONS OF

DATA. All the limitations and qualifications

that apply in general to Health Interview Survey

data apply to the data shown in this report. A

full statement of these limitations and qualifications may be found in any report in Series 10 of

Vital and Health Statistics.

Specific to the data shown in this report, it

should be noted that the intensity and duration

of regular physical exercise and sports participation were not considered in classifying people

according to participation categories. The category classified as exercising regularly does not

distinguish between the person who takes a walk

Table 1. Standard errors of estimates of aggregates

Size of estimate Standard error

in thousands in thousands

50 . . . . . . . . . . . . . . . . . . . . . . .

70 . . . . . . . . . . . . . . . . . . . . . . .

100 . . . . . . . . . . . . . . . . . . . . . .

125 . . . . . . . . . . . . . . . . . . . . . .

300 . . . . . . . . . . . . . . . . . . . . . .

500 . . . . . . . . . . . . . . . . . . . . . .

700 . . . . . . . . . . . . . . . . . . . . . .

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

5$000 . . . . . . . . . . . . . . . . . . . .

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

20,000 . . . . . . . . . . . . . . . . . . . .

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

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

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

24

29

35

38

60

77

91

109

243

342

478

579

731

970

Table 11. Standard errors, expressed in percentage points, of

estimated percentages

Base of percentage

in thousands

50 . . . . . . . . . . . . . . . . . . . . .

70 . . . . . . . . . . . . . . . . . . . . .

100 . . . . . . . . . . . . . . . . . . . .

300 . . . . . . . . . . . . . . . . . . . .

500 . . . . . . . . . . . . . . . . . . . .

700 . . . . . . . . . . . . . . . . . . . .

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

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

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

20,000 . . . . . . . . . . . . . . . . .

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

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

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

Estimated percentage

m

I

6.8 10.7 14.7

5.8 9.0 12.4

4.8 7.5 10.4

2.8 4.3 6.0

2.2 3.4 4.6

1.8 2.8 3.8

1.5 2.4 3.3

0.7 1.1 1.5

0.5 0.8 1.0

0.3 0.5 0.7

0,3 0.4 0.6

0.2 0.3 0.5

0.2 0.2 0.3

19.6

16.5

13.8

8.0

6.2

5.2

4.4

2.0

1.4

1.0

0.8

0.6

0.4

50

.—

24.4

20.7

17.3

10.0

7.7

6.5

5.5

2.4

1.7

1.2

1.0

0.8

0.5

around the block once a week for exercise and

the person who walks 10 miles every day for

exercise. Also it should be emphasized that a

person who says that he or she does not exercise

regularly may in fact be involved in more physical activity than a person who says that they do

exercise regularly. The critical point regarding

these data is that they reflect how the person

defines his or her own activity.
11

SYMBOLS

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

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

Quantity zero—–--—-----–-–--—-––— -

Quantity more than Obut less than 0.05—- 0.0

Figure does not meet standards of

reliabilityy or precision-——----——– *

GPO 927 120
....——..

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

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service ~ Number 20 ● March 13,1978

Office Visits to Obstetrician-Gynecologists:

National Ambulatoy Medical Care Survey, United States, 19751

During 1975 an estimated 48 million visits

were made to the offices of obstetriciangynecologists practicing in the coterminous

United States. The data presented in this report

were collected during calendar year 1975 in the

Nat ion al Ambulatory Medical C,are Survey

( NAMCS ), a continuous survey conducted

yearly by the National Center for Health Statistics.

The estimates presented are based on information obtained from the Patient Record used

by sample physicians to record selected information about their office encounters. (See Technical Notes. ) Since the statistics for this report are

based on sample data, they are subject to sam1Thisreportwas prepmed by TrenaEzzati,Division

of Health Resources Utilization Statistics.

plingvariability.Further discussionof sampling

variabilityand the sample design used in the

1975 N’AMCS appears in the Technical Notes.

DATA HIGHLIGHTS

During 1975 there were an estimated 567.6

million visits made to the offices of office-based

patient care physicians practicing in the coterminous United States. The estimated total

yearly volume of office-based ambulatory medical care by specialty is shown in table 1. In

terms of total office visits, obstetriciangynecologists ranked third among all physician

specialties with 48,076,000 visits.

Thirty-nine percent of the visits to obstetrician-gynecologists were to those in practice by

Table 1. Number and percent distribution of office visits by physician specfalty:

United States, 1975

T~

Physician specialty

Number

of visits Percent

distribution in

thousands of visits

—

All specialties --------------------------------------- 567,600 100.0

,

General and family practice --------------------------------- 234,660 41.3

Internal medic ine ------------------------------------------- 62,117 10.9

OBSTETRICS -~~COLO~--------------------------------------- 48,076 8.5

Pediatrics -------------------------------------------------- 46,684 8.2

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

All other

41,292

---------------------- ----------------------- ------ 134,771 2;:;

]Due to a refinement of the N~CS estimating procedure used to Project national ‘stimates from sample data,caution should be used when comparing these estimated numbers

of office visits with previously published estimates for 1973 and 1974.
Figure 1. PERCENT OF OFFICE VISITS TO OBSTETRICIANGYNECOLOGISTS BY AGE OF PATIENT: UNITED STATES, 

1975. 

Under 15 15-24 2544 45-64 65 and 

over 

AGE IN YEARS 

themselves, and the remaining 61 percent were 

to those practicing in a group or partnership 

arrangement. 

Office visits made by females in the childbearing interval, 15-44 years, accounted for 85 

percent of the total number of visits to obstetrician-gynecologists (figure 1 ), naturally reflecting 

the most common reason for visits to obstetric ian-gynecologists-prenatal examinations and 

care. 

The most frequent reasons patients had for 

their visits are ranked according to their order of 

frequencv / in table 2. The top six reasons 

account for about 68 percent of all visits to 

obstetrician-gynecologists. In contrast, 36 patient problems are required to account for a 

comparable 68 percent of the visits to general 

and family practitioners. 

Data on the physician’s assessment of the 

seriousness of the patient’s problem (in terms of 

the extent of impairment that might result if no 

care were obtained) indicate that less than 1 in 

10 (7.7 percent) of the visits to obstetricianTable 2. Number, percent, and cumulative percent of office visits to obstetriciangynecologists, by the most common patient problems, complaints, or symptoms: United 

States, 1975 

[Symptom titles and code numbers are based on a symptom classification developed for use in NAMCS] 

Most comon patient problems, complaints, 

or symptoms and NAMCS code 

Number of 

visits in 

thousands 

Percent of 

visits1 

Cumulative 

percent 

of visits 

Pregnancy examination, routine---------------905 

Gynecological examination--------------------904 

Vaginal discharge~--~ww~ww~~-~~~w~~~~~~~~~~~~~~~ 

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

Menstrual disorders w1---l-~wl-s-11--11------- 653 

Abdominal pain--------------------------------540 

Vaginal di~orders~--w---w------w-------------661 

Vulvar disorders www~1w111~1ww-1~~--1--~-~~~~~ 663 

Other symptoms referable to the female 

reproductive system- ------------------------670 

Visit for family planning servicescounseling-----ww------------------------~--93O 

pelvic symptoms------------------------------660 

Visitfor family planning servicesmedication --1-1-w--w-1---------------------- 931 

None -I----------I----------------------- -----997 

Visit for family planning servicesservices --w-----w--------------------------- 932 

Menopause symptoms ---11---------11--11------- 650 

15,901 33.1 33,l 

7,596 15,8 48.9 

2,952 6.1 55.0 

2,803 5,8 60.8 

2,184 4.5 65.3 

1,323 2.8 68.1 

941 2.0 70.1 

784 1.6 71.7 

775 1.6 73.3 

683 1.4 74.7 

655 1*4 76,l 

584 1.2 77.3 

528 1.1 78.4 

514 

511 

1.1 

1.1 

79.5 

80.6 

1 Based on a total of 48,076,OOO office visits. 
admmxk@3

Table 3. Percent distribution of office

visits to obstetrician-gynecologists by

physician’s assessment of seriousness

of patient’s problem: United States,

1975

I

Seriousness of Percent

distribution patient’s problem of visits

Serious or very serious---

Slightly serious ---------- 1;:;

Not serious --------------- 76.6

gynecologists were considered seriousor vev

seriousin nature (table3).

Data on the patient’s prior visit status show’

that about 86 percent of all visits to obstetrician-gynecologists were made by patients who

had seen the physician before (table 4).0bstetrician-gynecologists also dealt chiefly with old patient problems. The proportionof new problems

presented to obstetrician-gynecologists by old

patients (18 percent) was slightly less than the

Table 5. Number and percent of office visits

frequent diagnoses rendered by the

Table 4. Percent distribution of office

visits to obstetrician-gynecologi;;;t~~

patient’s prior visit status:

States, 1975

Patient’s prior visit Percent

distribution status of visits

New patient --------------- 14.2

Old patient, new problem-- 18.0

Old patient, old problem-- 67.9

corresponding proportion for all physicians (23

percent).

Information concerning the most frequent

principal diagnoses associated with ambulatory

visits to obstetrician-gynecologists is presented

in table 5. The diagnostic data are grouped into

classes according to the Eighth Revision International Classification o-f Diwases, .4dapted for

Uscin the Urzited States (ICDA). AmongaII diagnoses rtmdcred by obstetrician-gy necologists,

to obstetrician-gynecologistq by the most

physician: United States, 1975

[Diagnoses andcode numbersae based on the Eighth Reuisio?z Intcrt,ationJ CLzwific.tion of Disem-es, .-ldapted for Use in the

‘United Stc&x (ICDA)]

Principal diagnoses most frequently rendered

by the physician and ICDA code

——

Infective and parasitic diseases -------------------------001-136

Moniliasis-------------------------------------------------ll2

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

Endocrine, nutritional, and metabolic diseases-----------24O-279

Diseases of genitourinary system-------------------------58O-629

Infective diseases of cervix uteri- ------------------------620

Other diseases of cervix-----------------------------------62L

ImJ;;;ive diseases of uterus (except cervix), vagina, and

-----------------------------------------------------622

Disorders of menstruation----------------------------------626

J

Menopausal s~ptoms----------------------------------------627

Symptoms and ill-defined conditions ----------------------780-796

Observation, without need for further medical care---------793

Special conditions and examinations without sickness -----Y13-Yl3

Medical or special examination-----------------------------yoo

Prenatal care (normal pregnancy) ---------------------------Yo6

Postpartum observation --------------------------------- ----Y07

Other person without complaint or illness------------------yO9

Medical and surgical aftercare -----------------------------YLO

lBased on a total of 48,076,000 office visits.

. .

Number of

visits in

thousands

1,805

882

1,548

1,145

8,990

647

570

1,577

1,995

853

3,008

2,130

27,459

6,447

15,119

1,643

995

2,596

Percent

of

visitsl

3.8

H

2.4

18.7

H

::?

1.8

:::

57.1

13.4

31.4

;::

5.4
4 acklncedata

over 60 percent were associated with the ICDA

classifications “special conditions and examinations without sickness” and “symptoms and illdefined conditions. ” Obstetrician-gynecologists

exceeded all other physician specialties in the

proportion of visits for “special conditions and

examinations without sickness. ” (Prenatal care

accounted for over half of the diagnoses associated with this diagnostic class. ) Visits for diseases of the genitourinary system accounted for

an additional 19 percent of total office visits.

Of all office visits made during 1975 for prenatal and postnatal care, approximately 70 percent were to the offices of obstetriciangynecologists and another 26 percent to the

offices of general and family practitioners. Of all

ambulatory visits for family planning, about 62

percent were to obstetrician-gynecologists and

28 percent to general and family practitioners.

The diagnostic and therapeutic services provided by obstetrician-gynecologists are shown in

table 6. Among the diagnostic services provided,

obstetrician-gynecologists exceeded all physicians in the proportion of visits involving clinical

lab tests, general histories and examinations, and

blood pressure checks, but they fell below the

overall average in the proportion of visits for

X-rays. Among the therapeutic services provided, obstetrician-gynecologists fell below the

average for all physicians in the proportion of

drugs prescribed, office surgeries performed, ~md

injections.

Duration of visit is the time spent by the

patient in face-to-face contact with the physic i an. The average encounter time between

obstetrician-gynecologists and their patients was

about 13 minutes.

Finally, data on disposition of visits (table 6)

Table 6. Number and percent distribution of office visits to .obstetrician-g~n~colo -

gists, by diagnostic and therapeutic services ordered or provided and dlsposltlon o.E

visit: United States, 1975

——.

-—.— —

Selected diagnostic and therapeutic services ordered

or provided and di.spositio? of visit

Diagnostic and therapeutic services

Diagnostic services:

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

Limited history and examination -------------------------------

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

General history and examination -------------------------------

X-ray -------------------..------------------------------ -------

Therapeutic services:

Drug prescribed ----------..--,---------..------------------------

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

Office surgery ------------------------------------------;-----

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

No diagnostic or therapeutic service ----------------------------

Disposition of visit

No followp planned ---”---,--------------------------------------

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

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

Admit to hospital -------------A---------------------------------

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

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

—- —

Number of

Visits in Percentl

thousands

--+----

I

27,596 57.4

25,991 54.1

25,199 52.4

12,194 25.4

850 1,8

17,109 35.6

5,535 11.5

1,458 3.0

1,088 2.3

1,481 3.1

3,512

3;, ;;:

1:552

1,184

776

7.3

75.7

13.0

3.2

2.5

1.6

lpercents may total more than 100.0 since more than one diagnostic or therapeutic

service and more than one disposition could be given at a single visit.
achncedata 5

show that followup care of some type was physicians (59 percent). Further, the tendency

advised at 91 percent of the visits. Visits at to admit the patient to the hospitzd (3 percent)

which the obstetrician-gynecologist advised the slightly exceeded this disposition for aII physipatient to return at a specified time (76 percent) cians (2 percent).

significantly exceeded the proportion for all

TECHNICAL NOTES

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

Nat ion al , Ambulatory Medical Care Survey

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

United States made by ambulatory patients to

physicians who are principally engaged in office

practice.

SAMPLE DESIGN: The 1975 NAMCS utilized a

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

within practices. Within the 87 PSU’S composing

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

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

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

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

of office visits taking place within their practice

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

previous issue of Advance Data From Vital and

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

Additional data concerning physician practice

characteristics such as primary specialty and

type of practice were obtained during an induction interview.

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

an earlier publication in Series 2 of Vital and

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

(HIL4) 76-1335. fIeaIth Resources Administration. Washington. U.S. Government Printing

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

1975 NAMCS design and procedures will be

presented in future publications.

SAMPLING ERRORS: Since the estimates for

this report are based on a sample rather than the

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

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

standard error of the estimate by the estimate

itself and is expressed as a percent of the estimate. Relative standard errors of selected aggregate statistics are shown in table I. The standard

errors appropriate for the estimated percentages

of office visits are shown in tabIe II.

Table 1. Approximate relative standard errors of estimated numbers of office visits

Estimate Relative standard

in error in

thousands percentage points

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

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

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

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

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

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

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

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

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

relative standard error of 4.3 percent or a standard error of

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

Table 11. Approximate standard errors of percentages for estimatednumbers of office visits

Base of percentage

(number of visits

in thousands)

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

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

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

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

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

1 00,000 ... .. . ... .. .. .. ..

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

Estimated percentage

T

1or 5 or

99 95

2.1

1.2

0.9

0.7

0.3

0.2

0.1

4.6

2.7

2.1

1.5

0,7

0.5

0.2

lOor

90

6.3

3.7

2.8

2.0

0.9

0.6

0,3

I I

20 or

80

8.5

4.9

3.8

2.7

1.2

0.8

0,4

~0 or

70

9.7

5.6

4.3

3.1

1.4

1.0

0,4

50

10.6

6.1

4.7

3.3

1.5

::;

Examule of use of table: An estimate of 30 uercent based on

an aggreg;te of 75,000,000 has a standard erro; of 1.2 percent.

The relative standard error of 30 percent is 4.0 percent (1.2 percent+30 percent).
6

ROUNDING: Aggregate estimates of office visits

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

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

the sum of percentages may not equal 100.0 percent.

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

services who is neither bedridden nor currently

admitted to any health care institution on the

premises.

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

Responsibility over time for patient care and

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

an institution.

A visit is a direct personal exchange between

an ambulatory patient and a physician or a staff

member working under the physician’s supervision for the purpose of seeking care and ~

rendering health services.

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

ambulatory patients at an office location. Exeluded from NAMCS are physicians who spe- I’

cialize in anesthesiology, pathology, radiology; “

physicians who are federally employed; physicians who treat only institutionalized patients;

physicians employed full time by an institution; ,

and physicians who spend no time seeing ambulatory patients. ,.

SYMBOLS

Data not available ----------------------------------- ---

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

Quantity zero ------------------------------------- -

Quantity more than Obut less than 0.05----- 0.0

Figure does not meet standards of

reliability or precision--—---—----------– *
I

I

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