Vital and

Health Statistics

Advance Data

From Vital and

Health Statistics:

Numbers 101–110

Series16:

Compilations of Advance Data From Vital

and Health Statistics

No, 11

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

variables on number of discharges and average length of stay from short-stay hospitals;

contraception methods; usage of family planning and infertility services; infertility and

fecundiiy statuses of all women of reproductive age; selected estimates for 1982 of

diagnosis-related groups based on data from the National Hospital Discharge Survey; the

usage of topical antimicrobial medications in the office-based patient care setting; timing of

martial sexual intercourse in relation to first marriage, and the timing of marital dissolution and

remarriage; wanted and unwanted childbearing; selected characteristics of discharges,

diagnoses, and procedures for hospital usage by children; and office-based ambulatory care

for patients 75 years old and over, These repods were originally published in 1984 and 1985,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Heatth Service

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyaffsville, Maryfand

December 1993

DHHS Publication No. (PHS) 94-1870
,.——-

‘1

Copyright information

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

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

appreciated,

Suggested citation

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

statistics: numbers 101–1 10. National Center for Health Statistics. Vital Health

Stat 16(11). 1993.
National Center for Health Statistics

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

Jack R. Anderson, Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for AnaZysi.s

and Epidemiology

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

Extramural Programs

Peter L. Hurley, Associate Director for Ktal and Health

Statistics Systems

Robert A. Israel, Associate Director for International

Statktics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

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

and Methodology

David L. Larson, Assistant Director, Atlanta
1983 Summary: National Hospital Discharge Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N~.101

Use of Contraception in the United States, 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No.1O2

Use of Services for Family Planning and Infertility: United States, 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 103

Fecundity and Infertility in the United States, 1965–82 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No.104

Diagnosis-Related Groups Using Data From the National Hospital Discharge Survey United States, 1982... No.105

Use ofTopical Antimicrobial Drugs in Ofl-ice-Based Practice: United States, 1980-81 . . . . . . . . . . . . . . . . . . . . . N0.1c)6

Marriage and First Intercourse, Marital Dissolution, and Remarriage: United States, 1982 . . . . . . . . . . . . . . . . . No.1O7

Wanted and Unwanted Childbearing: United States. 1973.82 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO0108

Hospital Use by Children: United States, 1983 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No.1O9

Office-Based Ambulatory Care for Patients 75 Years Old and Over: National Arnbulatory Medical Care Survey,

1980 and 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 110

...

Ill
From Vital and Health Statistics of the National Center for Health Statistics September 28, 1984. Number 101

1983 Summary: National Hospital Discharge Survey

by Edmund J. Graves, Division of Health Care Statistics

introduction

During 1983 an estimated 38.8 million inpatients, excluding newborn infants, were discharged from short-stay nonFederal hospitals in the United States. These patients were

hospitalized an average of 6.9 days and used 268.3 milIion

days of inpatient hospital care. Patients hospitalized during

1983 accounted for 167 discharges and 1,155 days of care per

1,000 civilian population.

These and other statistics presented in this report are based

on data collected by means of the National Hospital Discharge

Survey, a continuous survey that has been conducted by the

NationaI Center for Health Statistics since 1965. In 1983, data

were abstracted from the face sheets of medical records of approximately 206,000 patients discharged from 418 shofi-stay

non-Federal hospitals. A brief description of the sample design,

data collection procedures, and estimation process, and definitions of terms used in this report can be found in the section

entitled “Technical notes.” A detailed discussion of tiese items,

as well as the survey form used to collect the data, have been

published.l,z

Coding of medical data for patients hospitalized is done

according to the International C1asszfzcation of Diseases, 9th

Revision, Clinical Modl~cation3 (lCD–9-CM). Up to seven

diagnoses and four procedures are coded for each discharge.

Although diagnoses included in the ICD-9-CM section entitled

“Supplementary classification of external causes of injury and

poisoning” (codes E800–E999) are used by the National

Hospital Discharge Survey, these diagnoses are excluded from

this report The conditions diagnosed and procedures performed

are presented here by chapter of lCD-9-CM. WMdn these

chapters, a few diagnoses and procedures or groups thereof

also are shown. These specfic categories were selected primarily

because of large numbers of occurrences or because they are of

special interest. Residual categories of the diagnostic and procedure classes, however, are not included in the tables. More

detailed analyses of these data will be presented in later reports

in Series 13 of Vital and Health Statistics.

Data highlights

Utilization by patient and

hospital characteristics

The number, rate, and average length of stay of patients

discharged from short-stay non-Federal hospitals are shown by

selected patient and hospital characteristics in tables I–3. The

38.8 million patients discharged from short-stay hospitals during 1983 included an estimated 15,6 million males and 23.2

million females. The rates per 1,000 population were 139 for

males and 193 for females, making the rate for females about

39 percent higher than the rate for males. The number and rate

of discharges are always higher for females than for males because of the large number of women in their childberuing years

(15-44 years of age) who are hospitalized for deliveries and

other obstetrical conditions. Excluding deliveries, the rate for

females discharged was 160, or only about 15 percent higher

than the rate for males.

The average length of stay was 7.4 days for maIes and 6.6

days for females during 1983. The length of stay for females

was shorter than that for maIes primarily because the average

length of stay of the 4.0 million women who were hospitalized

for deliveries was only 3.6 days. The average Iength of stay for

females who were not hospitalized for deliveries during 1983

was 7.2 days.

The number of discharges from shofi-stay hospitals by

geographic region during 1983 ranged from 13.9 million in the

South Region to 6.6 million in the West Region, and the rates

per 1,000 population ranged from 178 in the North Central

Region to 146 in the West Region. Regional differences in the

number of discharges are accounted for mainly by variations in

population sizes and to a lesser extent by variations in the disU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service
2 ackincedata

charge rates. This is apparent when number of discharges and

rate of discharges are compared among the regions. Although

the rate of discharges per 1,000 population was highest in the

North Central and South Regions with no significant difference

between them, the number of discharges and the civilian population in the South Region was about 30 percent higher than in

the North Central Region.

Average lengths of stay by geographic region were 5.9 days

in the West, 6.6 days in the South, 7.2 days in the North Central,

and 8.1 days in the Northeast.

Discharges from short-stay hospitals were about 40 percent

male and 60 percent female in every hospital bed-size group;

females with deliveries accounted for about 10.3 percent of all

discharges regardless of hospital size. The average length of

stay increased steadily from 5.8 days in the smallest hospitals

(6-99 beds) to 7.8 days in the largest hospitals (500 beds or

more) for all patients.

During 1983, voluntary nonprofit hospitals provided medical care to an estimated 26.7 million patients, or 69 percent of

all patients hospitalized. Hospitals operated by State and local

governments cared for 8.2 million patients, or 21 percent of all

discharges, and proprietary hospitals operated for profit cared

for 3.9 million patients or 10 percent of all discharges. Average

lengths of stay were 7.1 days in voluntary nonprofit hospitals,

6.3 days in State and local government hospitals, and 6.8 days

in proprietary hospitals.

Utilization by diagnosis

Diseases of the circulatory system ranked first in 1983

among the ICD–9-CM diagnostic chapters as a principal or

first-listed diagnosis among patients discharged from nonFederal short-stay hospitals. These conditions accounted for

an estimated 5.7 million discharges. Other leading ICD–9-CM

diagnostic chapters were diseases of the digestive system (4.5

million discharges) and supplementary classifications (including females with deliveries) (4.5 million discharges). Almost

40 percent of the patients discharged from non-Federal shortstay hospitals were included in these three ICD-9-CM diagnostic chapters.

The diagnostic categories presented in this report were

selected either because they appear as principal or first-listed

diagnoses with great frequency or because the conditions are of

special interest. Although many of these categories (such as

malignant neoplasms; psychoses; and fractures, all sites) are

groupings of more detailed diagnoses, they are presented as

single categories without showing all of the specific diagnostic

inclusions.

The ~umber and rate of discharges and average length of

stay for each ICD–9-CM diagnostic chapter and selected categories are shown by sex and age in tables 4-6. The most common diagnostic category for all patients was females with deliveries. This was followed by the diagnostic categories heart

disease and malignant neoplasms. Excluding females with deliveries, these last two non-sex-specific diagnostic categories

were also the most common first-listed diagnoses for each sex.

The most frequent first-listed diagnoses for 1983 varied for

the different age groups. For patients under 15 years of age, the

most frequent diagnoses were acute respiratory infections, except influenza and chronic disease of tonsils and adenoids. Excluding females with deliveries, the PWOmost frequent diagnoses

for patients 15–44 years of age were abortions and ectopic and

molar pregnancies, and factures, all sites. Patients 45–64 years

of age were hospitalized most frequently for heart disease. The

most common diagnoses for patients 65 years of age amd over

were heart disease and malignant neoplasms.

The average length of stay for all patients rangedl from a

low of 1.8 days for the diagnostic category chronic disease of

tonsils and adenoids, 1.9 days for patients admitted for sterilization, and 2.0 days for the diagnostic category abortions and

ectopic and molar pregnancies to a high of 18.0 days for the

diagnostic category fracture of neck of femur. Although the overall average length of stay for females was shorter than that for

males, females stayed in the hospital longer than males for

many of the specific diagnostic categories examined in this

report. Some categories for which women had substantially

longer stays included psychosis; arthropathies and related disorders; intervertebral disc disorders; and fractures, ail sites.

The average length of stay increased with increasing age

for most categories of diagnoses shown. Overall, the average

length of stay ranged from 4.6 days for patients under 15 years

of age to 9.7 days for patients 65 and over. By diagnosis, stays

were highest (when compared with the average length of stay)

for patients with fracture of neck of femur (18.0 days) and psychoses (15.4 days).

Utilization by procedures

One or more surgical or nonsurgical procedures were performed for an estimated 21.2 million of the 38.8 million inpatients discharged from short-stay hospitals during 1983. A

totid of 35.9 million procedures, or an average of 1.8 per patient

who underwent at least one procedure, were recorded in 1983.

Procedures are grouped in the tables of this report by the

ICD–9-CM procedure chapters. Selected procedures within

these chapters also are presented by specific categories. Some

of these categories (such as extraction of lens, open heart surgery, and hysterectomy) are presented as single categories although they may be divided into more precise subgroups.

Operations on the digestive system ranked first among the

surgical and nonsurgical procedures (5.8 million) pe~formed

during 1983. These were followed by miscellaneous diagnostic

and therapeutic procedures (6.3 million).

When grouped by chapters, miscellaneous diagnostic and

therapeutic procedures with 6.3 million procedures ranked first

among the surgical and nonsurgical procedures performed during 1983. These were followed by operations on the digestive

system with 5.8 million procedures performed. Other leading

procedures were obstetrical procedures and operations on the

female genital organs each with 3.9 million procedures and

operations on the musculoskeletal system with 3.8 million procedures. Approximately two thirds of all procedures performed

in 1983 were included in these five ICD-9-CM procedure

chapters.

The number and rate of all-listed procedures in 1983 for

each ICD-9-CM procedure chapter and selected procedure

categories are shown by sex and age in tables 7 and 8., Of the

35.9 million procedures performed during 1983, 14.0 million
ackmdaa3

were for males and 21.9 million were for females. The corresponding rates per 1,000 population were 155 for both sexes,

125 for males, and 183 for females. Of the procedures shown in

table 7, the most common ones for males were endoscopies on

the urinary system (natural orifice) and repair of inguinal hemisq

the most frequently performed procedures for females were

episiotomy and cesarean section.

The rate of procedures per 1,000 population increased with

advancing age from 44 for patients under 15 years to 358 for

patients 65 years of age and over. The most frequently performed procedures for patients under 15 years of age were tonsillectomy with or without adenoidectomy for patients 15-44

years of age, episiotomy and cesarean sectiow for patients

45-64 years of age, arteriorgraphy and angiocardiography, and

cardiac catheterization, and for patients 65 years of age and

over, extraction of lens, insertion of prosthetic lens (pseud~

phakos), and endoscopies of the urinary system (natural orifice).

TABLE 2. RATE OF INPATIENTS ox SCHARGEO FROM S+ ORT-STAY

HOSPITALS, W AGE, GEOGRAPHIC REG1ON, AND SEX: UNI TEO STATES ,

1983

(OX SCHARGES FROM NONFEDERAL NOSPITALS. EXCLWES NE UBORN

INFANTS )

AGE ANC REGION BOTH MALE FE14ALE

SEXES

RATE OF PATIENTS 31 SCHARGED

PER 1,000 POPULATION

TOT AL. . . . . . . . . . . . . . . . . . . . . . . . . . . . 16T. O 138.8 193.2

AGE

UNOER 15 YEARS . . . . . . . . . . . . . . . . . . . 70.8 79.0 62.3

15-44 YEARS . . . . . . . . . . . . . . . . . . . . . . 140.3 84.3 194.3

45-64 YE ARS. . . . . . . . . . . . . . . . . . . . . . 192.2 196.6 188.3

65 YEARS ANO OVER . . . . . . . . . . . . . . . . 412.7 637.2 396.3

REGION

NORTHEAST . . . . . . . . . . . . . . . . . . . . . . . . 157.7 136.0 177. s

NORTH CENT RAL . . . . . . . . . . . . . . . . . . . . i7a.4 151.1 204.1

SOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176.5 143.4 207.3

IAEST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145.6 118.5 171.7

TABLE 1. NUMBER OF INPATIENTS OISCHARGEO FROM SHORT-STAY

HOSPITALS BY SELECTEO CHARACTERISTICS: UNITE!) STATES, 1983

(DISCHARGES FROM NONFEDERAL FXISPITALS. EXCLUDES FJEhIBORN

INFANTS )

TABLE 3. AVERAGE LENGTH OF STAY FOR INPATIENTS DISCHARGED FROM

SHORT-STAY KISP ITALS BY SELECTEO CHARACTERI S72CS: UAITEO

STATES , 1983

(O IS CAIARGES FROM NONFEDERAL HOSP17ALS. EXCLUOES NEWORN

INFANTS )

SELECTEC CHARACTERISTIC BOTH MALE FEMALE

SEXES

NuWER OF PATIENTS

OISCHARGEO IN THOUSANDS

TONAL . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AGE

UNOER 15 YEARS . . . . . . . . . . . . . . . . . . .

15-44 YEARS . . . . . . . . . . . . . . . . . . . . . .

45-64 YE ARS . . . . . . . . . . . . . . . . . . . . . .

65 YEARS ANG OVER . . . . . . . . . . . . . . . .

REGION

NORTHEAST . . . . . . . . . . . . . . . . . . . . . . . .

NORTH CENT RAL . . . . . . . . . . . . . . . . . . . .

SRJTH . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HEAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BEo SIZE

6-99 8EOS . . . . . . . . . . . . . . . . . . . . . . . .

100-199 8EOS

200-299 BEDS....--.-”.....-”...”- . . . . . . . . . . . . . . . . . . . . .

300-499 BEDS . . . . . . . . . . . . . . . . . . . . .

500 BEOS OR NOD E . . . . . . . . . . . . . . . . .

OUNERSHIP

NONPROFIT . . . . . . . . . . . . . . . . . . . . . . . .

STATE ANO LOCAL GOVERNMENT. . . . . . .

PROPRIETARY . . . . . . . . . . . . . . . . . . . . . .

38,703

3,654

15.269

8,558

11,302

7.793

10,492

13.884

6,614

6,336

7,481

5,990

10.041

8,934

26, T26

8,190

3.867

15,573

2 ,08+

4,524

4,159

4,806

3,202

4,310

5,422

2,640

2,523

2,955

2,454

4 ,02+

3,615

10,66s

3,336

1,572

23,210

1,570

10,745

4.400

6,496

4.591

6.183

8,462

3,974

3,812

4,525

3,536

6,017

5,319

16,061

4,.954

2.295

S ELECT EO CHARACTERISTIC BOTH HALE FENALE

SEXES

AVERAGE LENGTH OF STAY IN OAYS

TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9 7.4 6.6

AGE

UNOER 15 YEARS . . . . . . . . . . . . . . . . . . . 4.6 4.5 4.6

15-44 YEAR S . . . . . . . . . . . . . . . . . . . . . . 5.0 6.2 4.6

45-64 YE ARS . . . . . . . . . . . . . . . . . . . . . . 7.6 7.6 1.6

65 YEARS ANO OVER . . . . . . . . . . . . . . . . 9.7 9.6 9.8

REG ION

NORTHEAST. . . . . . . . . . . . . . . . . . . . . . . . 8.1 8.5 1.8

NORTH CENT RAL . . . . . . . . . . . . . . . . . . . . 7.2 7.5 6.9

SOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.6 7.1 6.2

nest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.9 6.4 5.5

8E0 SIZE

6-99 BEDS . . . . . . . . . . . . . . . . . . . . . . . . 5.8 5.9 5.7

100-199 BEU . . . . . . . . . . . . . . . . . . . . . 6.4 6.9 6.1

200-299 BEDS . . . . . . . . . . . . . . . . . . . . . 6. a 7.1 6.6

300-499 BECK . . . . . . . . . . . . . . . . . . . . . 7.3 7.8 7.0

500 ISEOS OR MORE . . . . . . . . . . . . . . . . . 7. B 8.6 T.3

CiANERSHIP

NONPROFIT . . . . . . . . . . . . . . . . . . . . . . . . 7.1 7.6 6.B

STATE ANO LOCAA GOVERNMENT . . . . . . . 6.3 6.7 6.0

PROPRIETARY . . . . . . . . . . . . . . . . . . . . . . 6.8 7.1 6.5
4 aduancedata

TABLE 4. NUMBER OF INPATIENTS OISCHAa GEO FROM SHORT-STAY HoSPITALS, BY CATEGORY OF FIR ST- LISTEO OIAGNOSIS, SEX, 4N0 AGE:

STATES. 1983

UN1 TEO

(DISCHARGES FROM NONFEDERAL HOSPITALS. EXCLUOES NEUEICRN INFANTS. OIAGNOSTIC GROUPINGS ANII COOE NUM8ER INCLUSIONS ARE BASEO ON THE

INTERNATIoNAL cLA551FIcAT10N OF OIsEASEs, 9TH REV IS12N. CLINICAL MOOIF] CATION)

SEX AGE

CA TEGCRY OF FIR ST- LISTEO OIAGNOSIS ANO ICJ-+CM COOE

TOTAL HALE FEMALE UNDER 15 15-44 +5-64 65 YEARS

YEAR S YEARS YEARS ANO OVER

NJ14BER OF PAT I ENTS OISCHARGEO IN THOUSANOS

ALL CON DITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious ANO paRASITIC DISEASE S. . . . . . . . . . . . . . . . . ..-. .001- 139

NEOPLASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140-239

MALIGNANT NEOPLASf4S . . . . . . . . . . . . . . . . . . . . . . . . . . 140-208,230-234

MAL IGNANT NEOPLASM OF TRACHEA,

BRONCHUS, ANO LUNG . . . . . . . . . . . . . . . . . . . . . . .. 162,197.0,197.3

MALI GNfINT NEOPLASM OF BREAST . . . . . . . . . . . . . . . . 174-175 .198.81

ENDOCRINE, NuTRITIONAL ANO METABOLIC OISEASES,

ANO IMMUNITY OISOROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...240-279

01 A8ETES MELL ITUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...253

OISEASES OF THE 8LOO0 ANO fJLOOO-FORMING ORGAN S. . . . . . . ..28O-2W

MEN7AL oIsoRoERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-31?

PSYCHO SE S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-299

NEuROTIC ANO PERSONALITY OISOROERS . . . . . . . . . . . . . . . . . ..3 OO-3O1

ALCOHOL OEPENOENCE SYNDROME . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..3o3

OISEASES OF THE NERVOUS SYSTEM ANO SENSE ORGANS . . . . . . ..320-389

OISEASES OF THE CENTRAL NE RVoUS sVSTEM . . . . . ..32o-333+94o-3+9

CAT AR ACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

OISEASES OF THE EAR ANO MA STOIO PROCESS . . . . . . . . . . . . ..38 O-389

OISEASES OF THE CIRCULATORY SYSTEM . . . . . . . . . . . . . . . . . . ...390-459

ESSENT IAL HYPERTENSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401

HEART OISEASE . . . . ..391- 392.0 .3 S3-398.402 .404.410416.420-429

ACUTE H’fOCAROIAL INFARCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410

ATHEROSCLEROTIC HEART OISEASE . . . . . . . . . . . . . . . . . . . . . . ..414. o

OTHER ISCHEM IC HEART OISEASE . . . . . . . . ...411-413.414. 1414.9

CONGESTIVE HEART FAILURE . . . . . . . . . . . . . . . . . . . . . . . . . . . ..428. O

CEREBROVASCULAR OISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430-438

OISEASES OF THE RESPIRATORY SYSTEM . . . . . . . . . . . . . . . . . . . ..46 O-5L9

ACUTE RESPIRATORY INFECTIONS, EXCEPT INFLUENZA . . . . . ..46 O-465

CHRONIC OISEASE OF TONSILS ANO AOENOIOS . . . . . . . . . . . . . . . ...474

PNEUMONIA, ALL FORMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...480-406

ASTHMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

OISEASES OF THE CIGESTIVE SYSTEM . . . . . . . . . . . . . . . . . . . . ...520-579

ULCERS OF THE STOMACH ANO SMALL IN7ESTI NE . . . . . . . . . . ..53l-534

GASTRITIS ANO OUOOENITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535

APPEND IC IB IS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .540-543

INGUINAL HERNIA . . . . . . . . . . . . . . . . . . . . . . . . . . .." . . . . . . . . . . . ..55O

NONINFECTIOUS ENTERITIS ANO COLITIS . . . . . . . . . . . ...555-556.558

CHOLELITHI AS I S . . . . . . . . . . . . . . . . . . ..-. . . . . . . . . . . . . . . . . . . ...574

OISEASES OF THE GENITOURINARY SYSTE14 . . . . . . . . . . . . . . . . . ..58 O-629

CALCULUS OF I(IONEY ANO LMETER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592

DISOROERS OF MENSTRUATION AND OTHER

ABNORMAL VAGINAL 8LEEOING . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...626

COMPLICAT IONS OF PREGNANCY, CHILDBIRTH,

ANO THE PUERPERILM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 / 630-675

ABORT IONS ANO ECTOPIC ANO MOLAR PREGNANCIE S... . . . . ...630-639

OISEASES OF THE SKIN ANO SU8CUTANEOLS TISSUE . . . . . . . . . ..68 O-7O9

OISEASES OF THE MUSCULOSKELETAL SYSTEM

AND CONNECTIVE TISSUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..7 IO-739

ART HRCPATHIES ANO RELATEO OISOROERS . . . . . . . . . . . . . . . . ..71 O-719

INTERvERTEBRAL OISC OISOROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722

CONGENITAL ANO14AL IES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 740-759

CERTAIN CONDITIONS ORIGINATING IN THE

PER INATAL PERIOO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 760-179

SYMPTOHS, SIGNS, ANO IL L- OEFINEO CONDITIONS . . . . . . . . . . ..78O-799

INJURY ANO PO ISONING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999

FRACTURES, ALL SITE S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-829

FRACTURE OF NECK OF FEMuR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820

SPRAINS dNO STRAINS OF BACK ( INCLU31NG NECK) . . . . . . ...846-847

INTRACRANIAL INJURIES (EXCUOING TwSE WITH

SKULL FRACTUR E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...1350-854

LACERATIONS ANO OPEN 140UNOS . . . . . . . . . . . . . . . . . . . . . . . . ..87 O-9O4

SUPPLEMENTARY CL,t SSIFICAIION S. . . . . . . . . . . . . . . . . . . . . . . . .. VOI-VE2

PERSONS AOMITTEO FOR STERILIZE TION . . . . . . . . . . . . . . . . . . . ..v25.2

FEMALES WITH DEL IV ERIE S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..VZ7

30,783

677

2,642

2,024

339

244

1,207

675

360

1,701

576

264

388

1,878

429

534

360

5,654

330

3.597

676

466

938

464

860

3,632

564

397

837

459

4,530

352

268

261

477

584

422

3,311

330

321

1,348

492

577

2,432

576

+73

356

209

585

3,450

1,090

230

311

275

309

4, 532

146

3,976

15*573

319

1.136

993

210

*

431

255

152

874

266

08

295

795

210

211

16 T

2,896

129

1,911

424

261

544

2oa

405

1,833

287

1s o

426

190

2* 110

176

120

147

429

236

142

1,080

232

. . .

. . .

274

1,025

229

266

lB 5

117

279

1,906

543

1;:

17 i

232

159

*

. . .

23,210

358

1, 506

ls 031

129

242

776

420

209

827

311

176

93

1,083

219

382

193

2, 758

201

1,686

253

205

394

255

455

1, 799

277

217

411

269

2,420

177

169

114

48

348

340

2, 231

98

321

1, 04e

492

303

1,407

347

208

171

92

306

1,544

547

171

157

105

77

4, 373

142

3, 976

3,654

208

70

44

●

*

74

27

61

49

*5

*5

*

313

63

*

186

3a

2;

*

*

*

*

*

1,076

294

270

2.42

136

460

*

%

1::

●

136

*

*

*5

*

62

73

19

*

192

209

104

451

147

*

*

69

45

73

*

11

15,269

237

469

197

12

35

295

156

a7

950

294

164

227

355

140

15

64

530

57

256

43

12

6a

*a

30

753

90

122

122

110

1,429

84

117

14a

12a

la9

154

1,647

165

252

1,041

488

216

9a4

195

254

92

*

251

1,617

3ao

1;;

145

193

4,317

143

3,962

a*558

91

918

729

151

102

365

237

63

424

152

60

131

3 a4

90

9a

56

1,842

13a

1.231

251

Ist

437

a9

I 85

6ao

63

*

138

119

1,236

120

91

26

150

a7

160

760

107

66

*

*

145

774

165

161

47

*

140

599

167

22

79

30

41

87

*

●

11,302

142

1,185

1,053

176

137

474

?55

149

277

125

34

29

azs

136

47a

54

3,244

135

2,0a5

3a2

303

430

363

641

1,123

117

33;

94

1,405

147

65

lT

125

122

167

76a

55

*

. . .

. . .

153

603

196

57

25

90

783

396

196

37

31

31

54

*

1/ FIRS T-L ISTEO OIAGNOSIS FOR FEMALES HITH OELIVERIES [S C03E0 v27, SHOWN UNOER mSUPPLEMENTARY CL OSSIFICATIONS.-
dmcdata5

TAliLE 5. RATE OF INPATIENTS OISCHARGEO FRoH SdORT-STAY HOSPITALSS BY CATEGORY OF FIRST-LISTED OIAGNOSIS, SEX, ANO AGE:

STATES. 1’383

UNITEO

(DISCHARGES FROM Nonfederal Hospl TALS. Exc L~Es ~M130RN INFANTS. DIAGNOSTIC GROJPINGS ANO COOE NU.NBER INCLUSIONS ARE BASEO ON THE

INTERNATIONAL Classification oF oIsEASEs~ 9TH REv Is IQN* CLINICAL MODIFICATION)

SEX AGE

CAT EGCRY OF FIRST-LISTED OIAGNOSIS ANO Ic9-9-CM CODE

TOTAL MALE FEMALE UNDER 1S 15-44 45-64 65 YEARS

YEAR S YEAR S YEARS ANO OVER

RATE OF INPATIENTS DISC IURGEO PER 10,000 POPULATION

ALL CON D IT IONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INFECTIOUS ANO PARASITIC DISEASE S . . . . . . . . . . . . . . . . . . . ...001-139

1,669.6 1,388.3

28.4

101.3

88.5

18.7

*

3.9. +

22.7

13.5

7?.9

23. T

7.8

26.3

70.9

18.7

18.8

14.9

258.2

11.5

170.4

37.8

23.3

48.5

la.6

36.1

163.4

25.6

16.0

38.0

17.0

188.1

15.6

10.7

13.I

38.3

21.1

12.7

96.3

20.7

...

...

24.5

91.4

20.4

23.7

16.5

10.5

24.9

169.9

48.4

5.2

13.8

15.2

.?0.7

14.2

●

...

1.932.3 708.3

40.+

13.6

8.6

*

*

14.3

5.2

11.9

9.5

●1.O

*1.1

*

60.7

12.2

*

36.0

7.4

*

4.9

*

*

*

*

*

208.5

57.0

52.4

47.0

26.4

89.2

*

3.2

13.7

14.4

36.1

*

.26.3

*

*

*0.9

*

12.1

14.1

3.8

*

37.2

40.4

20.2

87.+

28.5

*

*

13.3

8.7

14.2

2.7

1,403.5

21.8

43.1

Ia.1

1.1

3.2

27.1

14.3

a.o

87.3

27.1

15.1

20.9

32.7

12.9

1.4

5.9

48.7

5.3

23.5

3.9

1.1

6.3

●0.8

2.8

6~.2

.s.2

11.2

11.2

10.1

131.3

7.7

10.7

13.6

11.8

17.4

14.2

151.4

15.2

23.2

95.7

44.9

19.9

90.4

17.9

23.4

a.s

*

23.0

148.7

34.9

*0.9

17.6

13.3

17.7

3S6.9

13.2

364.2

L.922.3

20.4

206.2

163.8

34.0

22.9

82.1

53.2

14.2

95.2

34.1

13.5

29.4

86.3

20.2

21.9

12.5

413.7

30.9

276.5

56.4

33.9

9a. 2

20.1

41.5

152.8

14.1

●

30.9

26.7

277.6

26.9

20.4

5.8

33.6

19.6

36.0

170.7

24.1

l+. 9

*

*

32.7

173-.s

37.1

36.3

10.6

*

31.4

134.5

37.5

4.9

17.8

6.9

9.3

19.5

*

*

4.127.1

51.7

432.9

304.5

64.1

39.1

173.3

93.2

54.5

101.3

45.6

12.3

10.5

301.4

49.7

174. !5

19.9

1 ,184.7

49.3

T61.2

139.6

110.6

156.8

132.7

234.1

+10.0

+2.9

*

122.2

34.2

513.1

53.5

23. T

6.3

45a

44.5

60.8

2ao.5

20.2

*

. . .

. . .

56.0

220.0

71. T

20.9

9. L

32.9

286.0

L4ct. 7

71.5

13.4

11.4

11.2

19.9

*

. . .

29.2 29.8

NEOPLASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

MALIGNANT NED PLASM S. . . . . . . . . . . . . . . . . . . . . . . ...140-2 08,230-234

MAL IGNANT NEOPLASM OF TRACHEA ,

aRGNCWS, ANO LUNG . . . . . . . . . . . . . . . . . . . . . . .. 162,197.0,197.3

MALIGNANT NEOPLASM OF BR EAST . . . . . . . . . . . . . . ..174- 175.19 .S.81

113.7

87.1

125.4

85.8

14.6

10.5

lo. a

20.1

EN OOCRINE, NUTRITIONAL AND METABOLIC OISEASES,

ANo 1MMUNIT% OISOROER S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240-279

OIABETES MEL L IT' S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..25o

52.0

29.0

64.6

34.9

17.4

68a

OIS EASES OF THE BLOOD ANO aLOOO- FORMING ORGAN S. . . . . . . ..28 O-289 15.5

,NENTAL D IS OR DERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319 73.2

24.8

11.3

16.7

PSYCHO SE A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-299

NEUROTIC ANO PERSONALITY OISOROERS . . . . . . . . . . . . . . . . . ..3 OO-3O1

ALCOHCL DEPENDENCE SYNOR014E. . . . . . . . . . . . . . . . . . . . . . . . . . . ...303

25.9

14.7

7.7

DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS. . . . . ...320-389

OISEASES OF THE CENTRAL NERVOUS SYSTE!4 . . . . . ..32 O-333494 O-349

CATARACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366

OISEASES OF THE EAR ANO MA STOIO PROCESS . . . . . . . . . . . . ..38 O-389

80 .a 90.1

18.5

25.6

15.5

la.3

31.a

16.1

OISEASES OF THE CIRCULATORY SYSTEM . . . . . . . . . . . . . . . . . . . ..39 O-459

ESSENTIAL HYPERTENSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4Ol

HEART OISEASE. . . . ..391- 392.0. 393-398 .402.404.410-416.420-429

ACUTE HYOCARCIAL IN FARCTION . . . . . . . . . . . . . . . . . . . . . . . . . ...410

243.4

14.2

154.9

29.1

229.6

16.7

140.4

21.1

ATHEROSCLEROTIC HEART D ISEA SE . . . . . . . . . . . . . . . . . . . . . ...414.0

OTHER IS CHEMIC HEART DISEASE . . . . . . . . . ..411-414 .914.1 -4I4.9

CONGESTIVE HEART FAIL WE . . . . . . . . . . . . . . . . . . . . . . . . . . . ..428.O

CERE8ROVASCULAR OISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..43O438

20.1

40.4

23.0

37.0

17.1

32.8

21.3

37.9

149..9

23.1

18.1

34.2

22.4

DISEASES OF THE RESPIRATORY SYSTEH . . . . . . . . . . . . . . . . . . . ..46O-519

ACUTE RESP IRATORY INFECTIONS, EXCEPT INFLUENZA.. . . ...460-466

CHRONIC OISEASE OF TONSILS ANO AOENOXOS . . . . . . . . . . . . . . . . . .474

PNEuMONIA, ALL FORM S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4a0-486

ASTHEA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..493

156.4

24.3

IT.1

36.0

19 .a

OISEASES OF THE OIGESTIVE SYSTEM . . . . . . . . . . . . . . . . . . . . . ..52 O-579

ULCERS OF THE STOMACH ANO SMALL IN TESTINE . . . . . . . . . ...53 1-534

GASTRITIS ANO OUOOENITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...535

APPENc IcITIs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..54o.543

INGu INAL HERNIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550

195.0

15.2

12.4

11.2

20.5

25.1

20 .a

201.5

14. T

14.0

9.5

4.0

29.0

28.3

NONINFECTIOUS ENTERITIS ANO COLITIS . . . . . . . . . . . . ..5 S5-556.558

CHOLELITHI AS IS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...574

OISEASES OF THE GENITOURINARY SYSTEM . . . . . . . . . . . . . . . . . ..58 O-629

CALCULUS OF KIONEY ANO wIENER . . . . . . . . . . . . . . . . . . . . . . . . . ...592

OISOROERS OF MENSTRUATION ANO OTHER

A8NORMAL VAGINAL BLEEOING . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...626

142.5

14.2

13 .a

185.7

8.1

26.7

COt4PLICATIONS OF PREGNANCY, CHILOSSIRTH,

ANO THE PUERPER ItJ&l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 630-676

AEIORTIONS ANO ECToP IC ANO MOLAR PREGNANCIES... . . . . ...630-639

45.1

21.2

87.2

40.9

OISEASES OF THE SKIN ANO SUa Cutaneous TISSUE . . . . . . . . . ..68 O-7O9 24.9 25.2

O! SEASES OF THE MUSCULOSKELETAL SYSTEM

ANO CONNECTIVE TISSUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 O-T39

ARTHROPATHIES ANO RELATED DISORDERS . . . . . . . . . . . . . . . . ..71 O-719

INTERVERTEBRAL OISC OISOROERS . . . . . . . . . . . . . . . . . . . . . . . . . ...722

104.7

24.8

20.4

117.1

2a.9

17.3

CONGENITAL ANOMALIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T40-759 15.3 14.2

CERTAIN CONDITIONS OR IGINATxNG IN THE

PER IN A7.AL PER IO D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T6D-779 9.0 7.6

SYMPTOMS. SIGNS, ANo 25.5 ILL-OEFINEO CONDITIONS . . . . . . . . . . ..78O-799 25.2

INJuRY ANO POISONING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . aoo-999

FRACTURES, ALL SIT ES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..aoo-a29

FRACTURE OF NECK OF FEMUR . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..a2O

SPRAINS ANO STRAINS OF 8ACK ( INCLLOING NECK1 . . . . . . . ..846-a47

INTRACRANIW INJUR IES IEXCLUING THOSE H17H

SKULL FRACTURE I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..a5o.854

lacerations ANC OPEN klOLNOS . . . . . . . . . . . . . . . . . . . . . . . . . . 870-904

148.5

46.9

9.9

13.4

128.6

45.6

14.3

13.1

11.8

13.3

a.7

6.4

SUPPLEMENTARY CLASSIFICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . vol-va2

PERSONS AoMITTED FOR STERILIZATI ON. . . . . . . . . . . . . . . . . . . .. V25.2

FEMALES 141TI- DEL Ivories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..v27

195.1

6.3

171.2

364.1

11. a

331.0

1/ FIRST -L ISTEO OIAGNOSXS FOR FE)IALES liITH C&LIVERIES IS COOEO V27, SHOUN UNOER ‘SUPPLEMENTARY CL OSSIFICATIONS.-
6

TABLE 6. AVERAGE LENGTH OF STAY FOR INPATI ENTS oISCHARGED FROM SHORT-STAY HOSP1 TALS$ BY CATEGORY OF FL RST-LI STEO OIAGNOSIS. SEX.

AND AGE: UNITED STATES, 1983

IO! SCHARGES FROM NONFEDERAL HOSPITALS. ExCLUOES NEIABDRN INFANTS. 01 AGNOST XC GROUPINGS ANO CODE NUMBER INCLUSIONS ARE BASED ON THE

lNTERNATICNAL CL ASS1F1CATION OF OISEASES, 9TH REvISION. CLINICAL MOO IF1CATION)

s EX AGE

CAT EGCRY OF FIRST-L I STEO OIAGNOSIS ANO ICD-9-CM COOE

TOTAL HAL E FEltALE UNDER 15 15-44 45-64 65 YEARS

YEARS YEARS YEARS 4N0 OVER

ALL CONOIT 10NS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INFECTIOUS ANO PARASITIC OISEASES . . . . . . . . . . . . . . . . . . . ...001-139

NEOPLASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

MALIGNANT NEOPLASM . . . . . . . . . . . . . . . . . . . . . . . ...140-2 08,230-234

MAL IGNANT NEOPLASM OF TRACHEA,

8RONCNIS, ANO LUNG . . . . . . . . . . . . . . . . . . . . . . ..162 .197. O.19T.3

MALIGNANT NEOPLASM OF 8REAST . . . . . . . . . . . . . . ..174- 175. I98.81

ENOOCRINE, NuTR IT IONAL ANO METABOLIC 01 SEASES,

ANo 1MMUNIT% OISOROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240-279

OIABETES MELLITUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..25D

OISEAS ES OF THE BLOOO ANO BLOOD-FORMING ORGANS . . . . . . . ..280-289

MENTAL DISORDERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

PSYCHOS ES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290- 299

NEuROTIC ANO PERSONALITY Of SOROERS . . . . . . . . . . . . . . . . . ..3 OO-3Ol

ALCOHOL DEPENDENCE SYNOROH E. . . . . . . . . . . . . . . . . . . . . . . . . . . ...303

OISEASES OF THE NERVOUS SYSTEM ANO SENSE ORGANS. . . . . ...320-389

OISEASES OF THE CENTRAL NERVOUS SYSTER. . . . ...320-336.340-349

CAT AR ACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

OISEASES OF THE EAR ANO MASTOIO PROCESS . . . . . . . . . . . . .. 380-389

OISEASES OF THE CIRCULATORY SYSTEM.....................39O+59

ESSENTIAL HYPERTENSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

HEART DISEASE. . . ...391-392.0.3$3-398.402,404,410-416,420-429

ACUTE HYOCARL! IAL IN FARCTION . . . . . . . . . . . . . . . . . . . . . . . . . ...410

ATHEROSCLEROTIC HEART OISEASE . . . . . . . . . . . . . . . . . . . . . . ..414. O

CT HER IS CHEMIC HEART OISEASE . . . . . . . . ...411-413.414.1-414.9

CONGESTIVE HEfIRT FAILURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42B. O

CERE8ROVASCULAR OISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..43 O-438

DISEASES OF THE RESPIRATORY SYSTEM . . . . . . . . . . . . . . . . . . ...460-519

ACUTE RESPIRATORY INFECTIONS, EXCEPT Influenza . . . . . ..460-466

CHRONIC CISEASE OF TONSILS ANO AOENOIOS . . . . . . . . . . . . . . . ...474

PNEuMONIA, ALL FORMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...480-486

ASTHMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

DISEASES OF THE DIGESTIVE SYSTEM . . . . . . . . . . . . . . . . . . . . . ..5 ZO-579

ULCERS OF THE STOt4ACH ANO SMALL INTESTI NE . . . . . . . . . ...531-534

GASTRITIS ANO CUOOENITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...535

APPEND ICITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .540-543

INGu INAL HERNI A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550

NONINFECTIOUS ENTERITIS ANO CO L IBIS . . . . . . . . . . . . . .555-556.558

CHOLELITHI AS I S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..5T4

oISEASES OF THE GENITOURINARY SYSTEM . . . . . . . . . . . . . . . . . ..58 O-629

CALCULUS OF KIONEY ANO URETER . . . . . . . . . . . . . . . . . . . . . . . . . ...592

OISOROERS OF MENSTRUATION ANO OTHER

ABNORMAL VAGINAL BLEED IN G . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...626

COMPLICATIONS OF PREGNANCY, CHILDBIRTH,

ANO THE PUERPER ILJM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/ 630-676

ABORTIONS ANO ECTOPIC ANO MOLAR PREGNANCY E S........ ..630-639

OIS EASES OF THE SKIN ANO SUBCUTANEOUS TISSUE . . . . . . . . . ..68 O-7O9

oISEASES OF THE iWSCULOSKELETAL SYSTEM

ANO CONNECTIVE TISSUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..710-739

ARTHROPATHIES ANO RELATEO OISOROERS . . . . . . . . . . . . . . . . ..7 IO-719

IN7ERVERTEFZRAL DISC OISDROERS . . . . . . . . . . . . . . . . . . . . . . . . . ...722

CONGENITAL ANOMALIES . . . . . . . . . . . . . . . . . . . . 0..............740-759

CERTAIN CONDITIONS ORIGINATING IN THE

PER IN AJAL PERIOC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...760-779

SYMPTOMS, SIGNS, AND lLL-OEFXNEO CONDITIONS . . . . . . . . . . ..78 O-799

INJURY ANO PO IRON IN G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-999

FRACTURES, ALL SIT ES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-829

FRACTURE OF NECK OF FEMUR . . . . . . . . . . . . . . . . . . . . . . . . . . . ...820

SPRAINS 4NC STRAINS OF BACK [ INCL~ING NE CKI . . . . . . ...846-847

INTRACRANIAL INJuRIES (EXCUDING THOSE tAITH

SKULL FRACTURE ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...850-854

LACERATIONS ANO OPEN UOLNOS . . . . . . . . . . . . . . . . . . . . . . . . ..87 O-9O4

SUPPLEMENTARY CL ASS IF ICATIONS . . . . . . . . . . . . . . . . . . . . . . . . .. VO1-V82

PERSONS AOMITTEO FOR STERILIZATI ON. . . . . . . . . . . . . . . . . . . .. V25.2

FEMALES uITH DEL IVORIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27

6.9

6.6

9.6

13.7

10.5

9.4

8.7

9.5

6.7

12.4

15.4

10.1

11.5

5.0

10.5

2.5

3.0

9.1

6.3

8.6

10.9

8.4

6.9

9.7

11.7

6.2

4.9

1.8

8.3

5.5

6.6

7.7

5.3

5.4

4.1

5.1

8.7

5.6

4.5

3.6

2.5

2.0

8.1

7.3

6.3

8.2

5.9

12.8

4.2

7.2

10.2

16.0

6.6

5.5

4.5

3.5

L .9

3.6

7.4

6.3

10.2

10.7

10.3

*

8.7

9.3

5.9

12.0

14.1

10.3

11.2

5.4

11.3

2.6

2.7

8.8

5.8

8.2

10.8

7.6

6.5

9.4

11.3

6.1

4.5

1.8

7.8

4.9

6.0

7.4

4.4

4.9

4.0

5.0

9.+

6.3

4.2

. . .

. . .

7.8

6.8

7.0

7.2

5.8

12.7

4.1

6.4

8.9

18.7

5.9

5.3

4.3

4.3

*

. . .

AVERAGE LENGTH OF STAY IN OAYS

6.6

6.8

9.2

10.6

10.7

9.4

8.6

9.6

7.2

12.9

16.6

10.0

12.5

4.7

9.7

2.5

3.3

9.4

6.7

8.9

11.1

9.4

7.4

9.9

12.2

6.2

5.3

1.9

8.3

5.8

7.0

7.9

6.0

5.9

4.6

5.3

8.3

5.2

5.2

3.6

2.5

2.0

8.4

7.7

9.1

9.4

6.0

12.9

4.3

8.2

11.5

17.8

7.3

5.9

5.1

3.5

1.9

3.6

4.6

4.2

5.0

5.7

●

●

5.5

6.6

4.2

16.3

*15.4

*15.9

*

3.2

6.9

*

2.3

6.3

*

t. 5

*

*

*

*

*

3.4

3.4

1.7

4.8

3.7

3.6

*

3.7

4.8

l.T

3.6

*

?.t

●

*

*1.9

●

3.9

5.8

5.9

●

5.6

12.8

3.2

4.3

5.3

●

●

2.9

3.6

4.3

3.:

5.0

4.9

6.6

8.1

7.9

7.4

6.8

7.3

6.3

12.1

15.5

10.2

11.7

5.6

8.2

2.4

2.5

6.5

5.2

6.4

9.4

4.7

5.7

*5.9

12.0

4.2

4.1

2.0

6.3

4.5

5.2

5.3

4.9

4.6

3.8

5.0

6.8

4.5

3.5

3.6

z. 5

2.0

6.5

5. e

4.7

7.6

4.9

*

3.6

5.7

8.1

*24. 7

6.3

5.5

4.3

3.5

1.9

3.6

7.6

8.3

9.1

9.9

10.0

8.9

B.4

9.3

6.7

11.9

14.9

9.8

10.8

5.5

11.0

2.4

3.5

8.1

5.8

7.7

10.7

6.4

6.4

9.3

10.7

7.2

6.4

*

8.6

6.4

6.7

6.9

5.0

7.1

4.2

5.7

8.1

5.7

5.0

3.9

*

●

8.4

7.5

9.2

8.5

7.7

*

4.4

7.4

9.1

t6.6

7.0

7. B

5.0

4.7

*

●

9.7

11.7

11.4

11.9

11.1

10.5

10.5

11.3

7.9

13.5

16.0

9.3

12.6

5.2

14.2

2.6

5.1

10.1

7.4

9.4

11.2

9.5

7.6

9.9

12.1

9.T

8.6

*

10.8

7.9

8.8

9.7

6.9

11.4

5.6

7.3

10.9

8.2

6.6

*

. . .

. . .

11.9

9.8

11.2

9.9

6.4

6.5

11.7

14.5

17.9

7.6

9.0

6.7

5.3

*

. . .

1/ FIRST -L ISTEO oIAGNOSIS FOR FEMALES WITH OELIVERIES IS COOEO v27, SHObl N UNOER aSUPPLEf4ENTARY CLASS 1FICA710NS. m
7

TABLE 1. NW!BER OF ALL-LISTED PROCEDURES FOR INPATIENTS DISCHARGEO FROM SHORT-STAY wJSPITALS, BY PROCEDURE CATEGORY, SEX, AND AGE:

UN ITEO STATES. 1983

[DISCHARGES FROM NONFEDERAL HOSPITALS. EXCLUDES NEtMORN INFANTS. PROCEOURE GROUP lNGS ANO CODE NUMBER INCLUSIONS ARE BASEO LTt4 THE

INTERNATXGNAL CLASSIFICATION OF OISEASES, 9TH REVISION, CLINICAL MOO IF ICATIONI

SEX AGE

PRO CEOURE CATEGORY ANO ICO-9-CH COOE

TOTAL MALE FE$4ALE UNDER 15 15-44 45-64 65 YEARS

YEARS YEAR S YEA RS ANO OVER

NUPIBER OF AL L-L ISTEO PROCEDURES IN THOUSANOS

13,993

453

28

602

227

184

206

108

729

125

187

585

137

1, 147

194

145

326

95

181

2,506

10 T

114

147

76

147

456

38

1,098

532

80

845

35T

91

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

1,826

21B

139

142

97

T9

51

709

*b

88

3, oT7

431

251

50 B

264

319

15,214

332

41

119

18

*7

83

10

b9L

188

140

182

34

232

21

11

61

*9

a5

2,003

52

1::

64

167

134

lao

422

135

37

131

*

19

2, S34

314

564

440

S3

281

421

58

3,902

1,531

B05

478

1,719

l$C

es

143

51

74

●7

740

17

55

l*5s7

212

145

104

225

115

ALL PROCEDURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,615

OPERATIONS ON THE NERVOUS SYSTEH.........................O1-O5

OPERATIONS ON THE ENoOCRINE SYSTEM . . . . . . . . . . . . . . . . . . . . . .. O6-O7

35,939

923

105

1,558

630

516

372

187

1,503

263

424

970

229

1,908

275

191

508

189

365

5,847

246

248

282

134

487

510

298

1,872

800

163

845

357

91

3,872

512

568

6T2

95

2B 1

632

150

3,914

1,943

808

479

3,762

423

237

258

147

147

159

1,830

116

154

6,292

871

453

825

695

685

21,94b

470

76

956

403

333

lb6

79

7T4

138

237

385

91

761

82

46

182

95

185

3,341

139

134

135

59

340

54

260

774

268

83

. . .

. . .

. . .

3,8T2

512

568

672

95

281

632

150

3*914

1,943

808

479

1,936

205

97

116

50

68

108

1,122

110

66

3, 215

440

202

31T

431

367

2,293

143

*5

67

*5

*

220

169

451

13

279

74

17

117

18

*

32

23

281

=9

*5

75

8;

*

95

31

13

126

9,Blb

192

22

257

36

1,077

501

427

OPERATIONS ON THE EYE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. OB-lb

EXTRACTION OF LEN S . . . . ..- . . . . . . . . . . . . . . . . . . .._ . . . ..13.1-13. b

INSERTION OF PROSTHETIC LENS (P SE WOPHAKOSI . . . . . . . . . . ...13.7

295

106

82

OPERATIONS ON THE EAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..18-2o

MY RI NGOTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..20. o

43

*5

2T

*

OPERATIONS ON THE NOSE, MOUTH, ANO PHARYNX . . . . . . . . . . . . . ..21-29

RHINOPLASTY ANO REPAIR OF NO SE . . . . . . . . . . . . . . . . . . . . . . . ...21.8

TONSILLECTOMY wITH OR HITHoUT AOENO1OECTOMY... . . ...28.2-28.3

223

46

*5

138

15

*

0PERA710NS ON THE RESPXRATORY SYSTEW . . . . . . . . . . . . . . . . . . ..3O-34

BRONCHDSCOPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..33.21 -33.23

335

76

378

102

OPERATIONS ON THE CARDIOVASCULAR SYSTEt4..................35-39

OPEN HEART SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...35.1-35.51.

35.53 -36.2,36 .9,37 .10-37. 11,37.32-3T .33,37.5

OIRECT HEART REvASCULAR IZATION . . . . . . . . . . . . . . . . . . . . . ...36.1

CAROIAC CATHETER IZATION . . . . . . . . . . . . . . . . . . . . . . . . ..37.21 -37.23

PACEMAKER INSERTION, REPLACEMENT, REMOVAL, REPAIR..37.7-3T.8

784 775

140

112

277

31

88

67

138

150

OPERATIONS ON THE HEMIC AND LYMPHATIC SYSTEM. . . . . . . . . . . ..4041 106

i,59b

91

::

50

162

155

151

OPERATIONS ON THE OIGESTIVE SYSTE14 . . . . . . . . . . . . . . . . . . . . ...42-54 1,966

95

148

15

21

156

140

ESOPHAGOSCOPY ANO GAS TROSCOPY (tAATLRAL CRIF I: E)..42.23,44.13

PARTIAL CAST RECTOFIY ANO RESECTION

OF INTESTINE . . . . . . . . . . . . . . . . . . . . . . . . . . ..43.5 -43.8 .45.6 -45..9

APPENDECTOMY, EXCLUOING IN CID ENTAL . . . . . . . . . . . . . . . . . . . ...47.0

HEMORRHOIOECTOMY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49.43-49 .46

CHOLECYSTECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..5l.2

REPAIR CF IN GU INAL HERN IA . . . . . . . . . . . . . . . . . . . . . . . . ..53.0-53 .1

O1VIS1ON OF PERITONEAL ADHESIONS . . . . . . . . . . . . . . . . . . . . . ...54.5 58

521

222

43

176

8L

12

688

153

18:

*

57

OPERATIONS ON THE URINARY SYSTEM . . . . . . . . . . . . . . . . . . . . . . ...55-59 834

ENOOSCOPIES (NATuRAL OR IF ICE) ..55.21 -55.22,56 .31 ,57.32,58.22

oILATION OF URETHRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...58.6

411

70

OPERATIONS ON THE MALE GENITAL ORGANS . . . . . . . . . . . . . . . . . . ..6O-64

PROSTATECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...60.2-60.6

CIRCUMCIS ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...64.0

+10

274

53 *8

10

*

*

*

*

*

10

●6

*

●

249

30

70

*5

*

*

121

*

18

202

46

18

::

14

OPERATIONS ON TiiE FEMALE GENITAL ORGAN S. . . . . . . . . . . . . . . . ..65-7 I

00PH0RECT0H% ANO SALP INGO-OOPHORE CTOMY... . . . . . . . ...65.3-65.6

BILATERAL OBSTRUCTION OR OCCLUS1ON

OF FALL CP IAN TUB ES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...66.2-66.3

240

44

53

. . .

HYSTERECTO MY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...68.3-68.7

CURETTAGE OF UTERUS TO TERPIINATE PREGNANCY . . . . . ..69.51 .69.5 I

OIL AT ION ANO CURETTAGE W UTERUS

AFTER DELIvERY OR ABORTION . . . . . . . . . . . . . . . . . . . . . . . . . ...69.02

DIAGNOSTIC OIL AT ION ANO CURETTAGE OF UTERUS . . . . . . . . . . . . 69.09

REPAIR OF CYSTOCELE ANO RECTOCELE . . . . . . . . . . . . . . . . . . . . . ..7O.5

*

166

56

.. .

+4

35

OBSTETRICAL PROCEDURES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72-75

EpIs IoTOHY UITh OR UITHOUT FORCEPS

OR VACUUM EXTRACT ION . . . . . . . . . . . . 72.1,72 .21,72 .31.72 .71,73.b

CESAREAN SEC TION . . . . . . . . . . . . . . . . . . . . . . ..74. &74.2 .74.4 .74.99

REPAIR OF CURRENT 0BSTE7RIC LACE RATION . . . . . . . . . . ...75.5-75.6

* .. .

●

☛

. . .

. . .

-. .

OPERAT IONS ON THE IWSCULOWELETAL SYSTEM. . . . . . . . . . . . . . . ..76-84

OPEN REOUCTION OF FRACTURE 76.72,

76.74, 76.7& 76.77,76 .T9,79.2-79 .3,79 .5-79. b

OTHER RECUCT ION OF

FRACT’_ORE. . . . . ..76.7 D-76.7 l. Tt.73.7h. 75.7 b.78.79. O-79.l.T9.6

964 830

70 133

36

ExCIS 10N OR OBSTRUCTION OF INTERVERTEBRAL OISC

ANO SPINAL FUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80.5, B1. o

EXCISION OF SEMILUNAR CARTILAGE OF KNEE . . . . . . . . . . . . . . . ..8o.6

ARTHROPLASTY ANO REPLACEMENT OF KNEE . . . . . . . . . . . . .81.41-B1.47

ART HROPLASTY ANO REPLACEMENT OF HIP . . . . . . . . . . . . . . ..8 I.5-81.6

OPERATIONS ON THE IN TEGUMENTARY SYSTEM . . . . . . . . . . . . . . . . . ..85-B6

MAST ECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..85.4

SKIN GRAFT IEXCEPT LIP OR MOUTH ) . . . . . . . . . . . . . . . . . .. B6.6-86.7

MISCELLANEOUS 01 AC2JOST lC ANO THERAPEUTIC PROCEDURES. . . . .. B7-99

COFIPUTERIZEO AXIAL TOMOGRAPHY .. B7. 03,87.41, S7. 71,88.01,88.38

PYELOGRAH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B7. T3-8T.75

ARTER 10 GRAPHY ANO ANGIOCAROIOGRAPHY

USING CONTRAST FIAT ERIAL . . . . . . . . . . . . . . . . . . . . . . . . ...88.4-88.5

DIAGNOSTIC ULTRASOUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7

RAOIO ISOTOPE SCAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92.0 -92.1

89

37

29

21

15

’41

34 118

559

54

42

610

44

40

2.027 2,366

240 373

137 153

389 316

189 249

230 322
8

TABLE 8. RATE OF ALL-LISTED PROCEDIJRES FOR INPATIENTS DISCHARGED FRDM SHORT-STAY HDSPITALS, BY PROCEOURE CA TEGDRY, SEX, ANO AGE:

uNITED STATES, 1963

(01SCHARGES FROM NONFEDERAL HOSPITALS. ExCLUOES NE’dBORN INFANTS. PRCKE@JRE GROUP INGS ANO COOE NulT8ER INCLUSIONS ARE BASEO ON THE

lNTERNhTIONAL CL ASS1FICATION OF OISEASES, 9TH REVISION, CLINICAL MODIFICATION)

SEX AGE

PROCEOURE CATEGORY AND lCO-9-CB COOE

TOTAL HALE FEMALE UNDER 15 15-44 45-64 65 YEARS

YEARS YEARS YEARS ANCI OVER

RATE OF ALL-L ISTEO PROCEDURES PER 100.000 POPULATION

ALL PRO CEDURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,471.8

OPERATIONS ON THE NERVOUS SYSTEM . . . . . . . . . . . . . . . . . . . . . . . ..01-05

OPERATIONS ON THE ENrn CRINE SYSTEM . . . . . . . . . . . . . . . . . . . . . .. O6-O7

OPERAT 10NS ON THE EYE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08-16

EXTRACTION OF LENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.1 -13.6

INSERTION OF PROSTHETIC LENS [PSEWOPHAKOSI . . . . . . . . . . . .. I3.7

OPERATIONS ON THE EAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..18-2o

MYRINGOTOMY . . . . . . . . . . . ..-. . . . . . . . . . . . . . . . . . . . . . . . . . . . ...20.0

OPERATIONS ON THE NOSE, MOUTH, ANO PHARYNX . . . . . . . . . . . . ...21-29

RHINOPLASTY ANO REPAIR OF NOSE . . . . . . . . . . . . . . . . . . . . . . . ...21.8

TONSILLECTOMY HITH OR HITHOUT AOENOIOECTDMY . . . . . . . .28.2 -28.3

OPERATIONS ON THE RESPIRATORY SYSTEM . . . . . . . . . . . . . . . . . . . ..3O-34

BRONCHOSCOPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..33.21 -33.23

OPERATIONS ON THE CARD1OLIASCULAR SYSTEM . . . . . . . . . . . . . . . ...35-39

OPEN hEART SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35.1-35.51,

35.53 -36.2 .36. S.37.10-37.11 ,37.32 -37.33,37.5

OIRECT HEART REVASCULAR IZATION . . . . . . . . . . . . . . . . . . . . . ...36.1

CAROI l.C CATHETERIZATION . . . . . . . . . . . . . . . . . . . . . . . ...37. 21-3T.23

PACEMAKER INSERTION, REPLACEMENT, REMOVAL. REPAIR. .37.7-37.8

OPERATIONS ON THE t4E!41C ANO LYMPHATIC SYSTEM . . . . . . . . . . . ..4O-4I

OPERATIONS ON THE OIGESTIVE SYSTEM . . . . . . . . . . . . . . . . . . . . ...42-54

ES OPHAGOSCOPY AND GASTROSCOPY (NATURAL ORIF ICE)..42.23,44.13

PART I AL GASTRECTOMV ANO RESECTION

OF INTESTINE . . . . . . . . . . . . . . . . . . . . . . . . . . ..43.5 -43. B .45.6-45.8

APPENDECTOMY, EXCLUOING INCIDENTAL . . . . . . . . . . . . . . . . . . . ...47.3

HE MORRHOIDECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..49.43 +9.46

CHOLECYSTECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...51.2

REPAIR OF IN GUINAL HERNIA . . . . . . . . . . . . . . . . . . . . . . . . . .53.0-53.1

OIV IS ION OF PERITONEAL ADHESION S . . . . . . . . . . . . . . . . . . . . . ...54.5

OPERATIONS ON TbE uRINARY SYSTEM . . . . . . . . . . . . . . . . . . . . . . ...55-59

ENOOS COPIES (NATURAL OR IF ICE I ..55.21-55.22.56. 31.57.32,58.22

DILATION OF URETHRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...58.5

OPERATIONS ON THE MALE GENITAL ORGANS . . . . . . . . . . . . . . . . . . ..6O-64

PROS TAT ECT014Y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...60.2-60.6

CIRCUMCIS 10N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...64.0

OPERATIONS ON THE FEMALE GENITAL ORGANS . . . . . . . . . . . . . . . ...65-71

00 PHORECTOHY ANO SAL PIN GO- OOPHORECTOMY. . . . . . . . . . ...65.3-65.5

BILATERAL OBSTRUCTION OR OCCLUSION

OF FALL CPIAN TuBES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...66.2-66.3

HYSTERECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...68.3-68.7

CURETTAGE OF uTERUS TO TERMINATE PREGNANC Y. . . . . ..69.51 .69.51

OIL AT ION ANC CURETTAGE OF uTERUS

AFTER cEL IvERY OR ABORT I ON . . . . . . . . . . . . . . . . . . . . . . . . . ...69.02

OIAGNOSTIC OIL AT ION ANO CURETTAGE OF UT ERUS . . . . . . . . . ...69. 09

REPAIR OF CYST OCELE AND REC70CELE . . . . . . . . . . . . . . . . . . . . . ..7O.5

OBSTETRICAL PRO CEDURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72-75

EPISICTOMY 141TF OR )JITHOUT FORCEPS

OR VACUUM EXTRA CT I ON . . . . . . . . . . . . 72. 1,72.21,72.31,72.71,73.6

CESAREAN SECT I ON . . . . . . . . . . . . . . . . . . . . . . . . 74. C-74.2,74 .4,74.99

REPAIR OF CURRENT OBSTETRIC LA AERATION . . . . . . . . . . . ..75.5-75.6

OPERATIONS ON THE MUSCULOSKELETAL SYSTEM . . . . . . . . . . . . . . . ..76-84

OpEN REDuCT 10N OF FRACTURE 76. T2,

76.74,76 .76-76.77,76.79,79.2-79.3 ,79.5 -79.6

OTHER REoUCTION OF

FRACTURE . . . . . ..76.7 O-76.7 l.76.73.76. 75.76 .78.79 .0-79. l.T9.4

ExCIS ION OR OBSTRUCTION OF INTERVERTEBRAL OISC

ANO SPINbL FUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...80.5.81.0

EXCISION OF SEMILUNAR CARTILAGE OF KNEE . . . . . . . . . . . . . . . ..8o.6

ART HROPL ASTY ANO REPLACEMENT OF KNEE . . . . . . . . . . ...8 1.41-81.47

ART HROPLPSTY 4NC REPLACEMENT OF HIP . . . . . . . . . . . . . ...81.5-81.6

OPERATIONS ON THE IN TEGuMENTARY SYS?EM . . . . .. ~...... . . . ...85-86

MASTECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85.4

SKIN GRAFT [ExCEPT LIP OR MOUTH ) . . . . . . . . . . . . . . . . . .. LI6.6-86.7

MISCELLANEOUS DIAGNOSTIC ANO THERAPEuTIC PROCEDURE S. . . . ..8 T-99

COHPUTER12E0 AXIAL TOMOGRAPHY ..87. 03,87.41 ,87. 71, B8.01, E18.3B

PYELOGRAH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. B7.73-B7 .75

ARTER ICGRAPHY ANC ANG ZOCARDIOGJ7APHY

USING CONTRAST f4ATERIAL . . . . . . . . . . . . . . . . . . . . . . . . ...88.4-08.5

DIAGNOSTIC ULTRASOUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7

RADIOISOTOPE SCAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...92.0-92.1

397.5

45.1

670.9

271.1

222.3

160.2

80.6

646.9

113.1

182.7

417.5

98.5

821-3

llB.6

82.4

218.8

81.5

157.3

2,517.0

106.0

106.9

121.4

57.8

209.6

219.5

128.2

806.0

344.2

73.4

363.8

153.6

39.3

1 ,666.9

223.5

244.4

209.4

41.0

121.0

272.1

64.5

1,685.1

B36.5

347.6

206.3

1,619.5

182.1

101.9

111.1

63.4

63.2

68.4

788.0

50.0

66.3

2,708.7

374.8

195.0

355.2

299.0

295.0

12,474.5

404.1

25.3

537.1

202.2

163.7

184.1

96.3

649.9

111.4

167.1

521.5

L22 .5

1,022.4

172.7

129.3

290.4

84.3

161.0

2,233.9

95.2

102.0

131.5

67.5

131.0

406. T

33.5

979.1

474.1

71.6

753.4

318.1

81.5

. . .

. . .

. . .

. . .

. . .

. . .

.-.

. . .

. . .

. . .

. . .

. . .

1,628.3

194.1

124.3

126.7

86.5

70.0

45.8

631.6

●5.4

78.6

2,742.8.=.

384.2

223.4

453.0

235.0

284.0

18,271.1

391.4

63.5

795.8

335.5

277.1

138.0

65.8

644.1

114.8

197.3

320.4

76.0

633.5

68. o

38.5

151.8

78.9

?-53 .9

2,781.5

116.1

111.4

112.0

48.8

283.0

44.6

216.6

644.4

223.0

69.2

. . .

. . .

. . .

3,223.6

426.4

472.7

559.7

79.3

234.0

526.3

124.8

3,258.7

1, 617.8

672.3

399.0

1,611.4

170.8

80.9

96.5

41.7

56.9

89.6

934.0

9L.7

54.8

.2,676.9

366.1

168.6

263.9

358.8

305.2

4* 445.7

276.3

*lo.1

129.5

*9.8

*

425.7

326.7

874.9

25..?

541.2

142.7

33.6

227.0

35.3

*

62.4

44.0

545.0

*17.7

*8.9

144. g

156.~

*

182.2

60.2

25.3

244.7

. . .

10Z.4

19.8

*

8

*

*

*

19.6

*11.6

●

●

483.4

58.4

135.2

*lo. 1

*

*

234.5

*

35.0

585.3

88.4

34.2

31.3

60.9

28.0

13,584.4

305.0

37.9

109.4

16.6

●6.8

76.7

9.5

634.7

173.1

128.3

167.6

31.5

212.9

19.4

9.7

55.7

*8.O

78.5

1,841.2

47.6

25.5

151.4

58.8

153.8

123.4

165.1

388.3

123.9

34.3

120.2

*

17.4

2,6S7.0

288.7

518.6

404.1

85.8

257.9

387.2

53.5

3,586.5

1,78D.I

740.4

438.9

1,579.9

174.6

81.6

131.5

84.0

68.4

*6.7

680.2

15.6

50.1

1,468.3

195.3

133.3

S5.8

206.9

109.2

19,351.1

577.7

80.9

663.7

238.4

183.3

95.7

*11.O

500.4

104.3

*10.9

753.5

169.7

1,760.7

332.2

252.3

622.9

69.1

238.2

3,585.7

203.5

153.4

62.5

111.5

364.1

348.5

130.8

1.170.7

499.7.

96.6

400.6

IB3.O

26.0

1,545.0

343.4

*

4D4.O

*

*

372.7

126.5

●

●

*

2,165.3

157.7

81.0

199.3

83.9

65.2

76.5

1,255.7

120.5

93.8

4,552.3

538.1

307.7

874.2

424.B

516.1

35 ,846.6

700.4

81.3

3 ,933.4

1 ,82T.9

1 .560.5

96a

*

504.0

55.0

*

1 ,381.7

370.8

2,830.6

322.1

246.3

504.2

547.6

552.4

7,179.8

345.7

539.4

54.1

75.6

570.1

510.5

207.1

3 ,046.0

1 ,501.9

255.9

1 ,496.4

999.1

*29.2

875.7

160.5

192.7

...

...

161.1

129.5

...

...

...

...

3,0<29.7

4!34.2

153.7

7b.8

54.9

149.0

429.3

1,498.5

162.5

144.7

8,639.7

1,362.2

560.0

1 ,152.4

909.0

1,176.5
akncdaa9

References

lNational Center for Health Statistics, W. R. Simmons Development

of the design of the NCHS Hospital Discharge Survey. Vital and

Health Statistics. Series 2, No. 39. PHS Pub. No. 1000. Public Health

Service. Washington. U.S. Government Printing Office, Sept. 1970.

‘National Center for Health Statistics, E. Graves and. B. J. Haupc

Utilization of short-stay hospitals, United States, 1981, annual summary. Vilal and Health Statistics. Series 13, No. 8. DHHS Pub. No.

(PHS) 84-1739. Public Health Service. Washington. U.S. GovernmentPrinting OffIce, Aug. 1983.

3U.S. Public Health Service and Health Care Financing Administra:

tiorx Inrenrational C1assl~cation of Diseases, 9th Revisio4 Clinicai

A40d!@atiom DHHS Pub. No. (PHS) 80-1260. Public Health Service.

Washington. U.S. Government Printing Office, Sept. 1980.

4Nationa1 centerfor He~th statistics, M. G. Sirkem utilization of

short-stay hospitals, summary of nonmedlcal statistics, United States,

1965. Vital and Hea/th Statistics. Series 13, No. 2. PHS Pub. No.

1006. Public Health Service. Washington. U.S. Government Printing

Office, Au& 1967.

‘National Center for Health Statistics, M. J. WMcin: Utilization of

short-stay hospitaIs by characteristics of discharged patients, United

States, 1965. Vital and Health Statistics. Series 13, No. 3. PHS Pub.

No. 1000. Public Health Service. Washington. U.S. Government Pnntirtg OffIce, Dec. 1967.

Symbols

.-. Data not available

. . . Catego~ not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
10 adwncedata

Technical notes

Source of data

The National Hospital Discharge Survey (NHDS) encompasses patients discharged from short-stay hospitals, exclusive

of military and Veterans Administration hospitals, located in

the 50 States and the District of Columbia. Only hospitals with

six or more beds and an average length of stay of less than 30

days for all patients are included in the survey. Discharges of

newborn infants are excluded from this report.

The universe of the survey consisted of 6,965 short-stay

hospitals contained in the 1963 Master Facility Inventory of

Hospitals and Institutions. New hospitals were sampled for inclusion in the survey in 1972, 1975, 1977, 1979, 1981, and

1983. In all, 553 hospitals were sampled in 1983. Of these hospitals, 78 retised to participate, and 57 were out of scope. The

418 participating hospitals provided approximately 206,000

abstracts of medical records.

Sample design

All hospitals with 1,000 or more beds in the universe of

short-stay hospitals were selected with certainty in the sample.

All hospitals with fewer than 1,000 beds were stratified, the

primary strata being 24 size-by-region classes. Wh.hin each of

these 24 primary strata, the allocation of the hospitals was

made through a controlled selection technique so that hospitals

in the sample would be properly distributed with regard to type

of ownership and geographic division. Sample hospitals were

drawn with probabilities ranging from certainty for the largest

hospitals to 1 in 40 for the smallest hospitals.

Sample discharges were selected within the hospitals using

the daily listing sheet of discharges as the sampling frame.

These discharges were selected by a random technique, usually

on the basis of the terminal digit or digits of the patient’s medical record number, a number assigned when the patient was

admitted to the hospital. The within-hospital sampling ratio for

selecting sample discharges varied inversely with the probability of selection of the hospital.

Data collection and estimation

The sample selection and the transcription of information

from the hospital records for abstract forms were performed by

the hospital staff or by representatives of the National Center

for Health Statistics or by both. The data were abstracted from

the face sheets of the medical records. All discharge diagnoses

and procedures were listed on the abstract in the order of the

principal one, or the first-listed one if the principal one was not

identified, followed by the order in which all other diagnoses or

procedures were entered on the face sheet of the medical record.

Statistics produced by the NHDS are derived by a complex

estimating procedure. The basic unit of estimation is the sample

inpatient discharge abstract. The estimating procedure used to

produce essentially unbiased national estimates in the NHDS

has three principal components: inflation by reciprocals of the

probabilities of sample selection, adjustment for nonresponse,

and ratio adjustment to fixed totals. These components of estimation are described in appendix I of two earlier publicaticms.4.5

Sampling errors and rounding of numbers

The standard error is a measure of the sampling variability

that occurs by chance because only a sample, rather th,an an

entire universe, is surveyed. The relative standard error of the

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. :Relative standard errors for discharges and first-listed diagnoses are

shown in table I, relative standard errors for days of care are

shown in table II, and relative standard errors for procedures

are shown in table III.

Table 1. Approximate relative standard errors of astimated numbers

of discharges. first-listed diagnosis, and all-listed diagnoses. bl/

selected patient and hospital characteristics: United States, 19183

Ownership of hospital

Proprietary

or State

and local All other

Size of estimate government Nonprofit characteristics

Relative standard error

5,000 . . . . . . . . . . . . . . . 29.6 15.7 15.1

10,000 . . . . . . . . . . . . . . 25.3 14.1 12.6

50,000 . . . . . . . . . . . . . . 18.3 11.4 8.8

100,000 . . . . . . . . . . . . . 16.2 10.5 7.7

300,000 . . . . . . . . . . . . . 13.7 9.4 6.4

500,000 . . . . . . . . . . . . . 12.7 8.9 5.9

1,000,000 . . . . . . . . . . . 11.6 8.4 5.3

3,000,000 . . . . . . . . . . . 11.2 7.8 4.6

5,000,000 . . . . . . . . . . . 9.7 7.5 4.3

10,000.000 . . . . . . . . . . 9.1 7.2 4.0

20,000.000 . . . . . . . . . . 8.6 6.9 3.8

30,000 .000 . . . . . . . . . . 8.3 6.8 3.6

40,000,000 . . . . . . . . . . 8.1 6.7 3.5

—

Table Il. Approximate relative standard errors of estimated numlbers

of days of care by selected patient and hospital characteristics:

United States, 1983

Proprietary All other

Size of estimate hospitals characten:stics

10,000 . . . . . . . . . . . . . . . . . . . . 36.6 24.6

30,000 . . . . . . . . . . . . . . . . . . . . 29.1 18.8

50,000 . . . . . . . . . . . . . . . . . . . . 26.2 16.6

100,000 . . . . . . . . . . . . . . . . . . . 23.0 14.1

300,000 . . . . . . . . . . . . . . . . . . . 18.8 10.9

500,000 . . . . . . . . . . . . . . . . ... . 17.2 9.8

1,000,000 . . . . . . . . . . . . . . . . . 15.4 8.4

3,000,000. . . . . . . . . . . . . . . . . 13.0 6.8

5,000,000 . . . . . . . . . . . . . . . . . 12.1 6.1

10,000,000 . . . . . . . . . . . . . . . . 11.0 5.4

50,000,000 . . . . . . . . . . . . . . . . 9.1 4.1

100,000,000 . . . . . . . . . . . . . . . 8.4 3,7

200,000,000 . . . . . . . . . . . . . . 7.8 3.3

—

NOTE: A hstof referencesfollowsrJretext.
dwmedaa 11

Table II 1. Approximate relative standard errors of estimated numbers

of all-listed procedures: United States. 1983

Refative

standard

Size of astimate error

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.9

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.7

25,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.5

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.2

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.2

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8

3,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1

5,000 .000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8

10,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4

15,0008000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2

20,0008000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1

25,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0

Estimates have been rounded to the nearest thousand. For

this reason detailed figures within tables do not always add to

the totals. Rates and average lengths ~f stay were calculated

from original, unrounded figures and will not necessarily agree

precisely with rates or average lengths of stay calculated from

rounded data.

Tests of significance

In this reporg the determination of statistical inference is

based on the twcAailed Bonfemoni test for multiple comparisons.

Terms relating to differences such as “higher” and “less” indicate that the differences are statistically signFlcanL Terms such

ss “similar” or “no difference” mean that no statistically signitlcant difference exists between the estimates being compared.

A lack of comment on the difference between any two estimates

does not mean that the difference was tested and found to be

not significant.

Definition of terms

Hospitals and hospital characteristics

Hospitals—Short-stay special and general hospitals have

six or more beds for inpatient use and an average length of stay

of less than 30 days. Federal hospitals and hospital units of

institutions are not included.

Bed size of hospital—Measured by the number of beds,

cribs, and pediatric bassinets regularly maintained (set up and

stafYed &r use) for patients; bassinets for newborn infants are

not included. In this report the classification of hospitals by

bed size reported by the hospitals is based on the number of

beds at or near midyear.

Type of ownership of hospital—Determined by the organization that controls and operates the hospital. Hospitals are

grouped as follows

● Vo[unta~ nonprojit-HospitaIs operated by a church or

another nonprofit organization.

● Govenmnenr-Hospitals operated by a State or local government.

. Propn.eta~—Hospitals operated by individuals, partnerships, or corporations for profit.

Terms relating to hospitalization

Patient—A person who is formally admitted to the inpatient service of a short-stay hospital for observatio~ care,

diagnosis, or treatment. In this report the number of patients

refers to the number of discharges during the year including

any multiple discharges of the same individual from one or

more shofi-stay hospitals. Infants admitted on the day of birth,

directly or by transfer from another medical facility, with or

without mention of disease, disorder, or immaturity, are included. All newborn infants, defined as those admitted by birth

to the hospital, are excluded from this repofi The terms “patient” and “inpatient” are used synonymously.

Discharge-The formal release of a patient by a hospital;

that is, the termination of a period of hospitaiization by death

or by disposition to place of residence, nursing home, or another

hospitaL The terms “discharges” and “patients discharged”

are used synonymously.

Discharge rate—The ratio of the number of hospital discharges during a year to the number of persons in the civilian

population on July 1 of that year.

Da.vs of care—The total number of patient days accumulated at time of discharge by patients discharged from stlortstay hospitals during a year. A stay of less than 1 day (patient

admission and discharge on the same day) is counted as 1 day

in the summation of total days of care. For patients admitted

and discharged on different days, the number of days of care is

computed by counting all days from (and inchtdmg) the date of

admission to (but not including) the date of discharge.

Rate of days of care—The ratio of the number of patient

days accumulated at time of discharge by patients discharged

from short-stay hospitals during a year to the number of persons

in the civilian population on July 1 of that year.

Average length of stay—The total number of patient days

accumulated at time of discharge by patients discharged during

the year, divided by the number of patients discharged.

Terms relating to diagnoses

Discharge diagnoses—One or more diseases or irjuries

(or some factor that influences health status and contact with

health services which is not itself a current illness or ir!jury)

listed by the attending physician or the medical record of a

patient. In the NHDS all discharge (or final) diagnoses listed

on the face sheet (summary sheet) of the medical record for

patients discharged from the inpatient service of short-stay

hospitals are transcribed in the order listed. Each sample discharge is assigned a maximum of seven five-digit codes according to ICD–9-CM.3 The number of principal or fret-listed

diagnoses is equivalent to the number of discharges.

pnnc@al diagnosis-The condition established after study

to be chiefly responsible for occasioning the admission of the

patienf to the hospital for care.

First-1isted diagnosis—The coded diagnosis identified as

the principal diagnosis or listed first on the face sheet of the

NOTE: A list of references follows the text.
12

medical record if the principal diagnosis cannot be identified.

The number of first-listed diagnoses is equivalent to the number

of discharges.

Procedure—One or more surgicaJ or nonsurgical operations, procedures, or special treatments assigned by the physician to patients discharged from the inpatient sewice of shortstay hospitals. In the NHDS all tefi listed on the face sheet

(summary sheet) of the medical record under the captions

“operation, “ “operative procedures,” “operations and/or speciaI treatmen~” and the like are transcribed in the order listed.

A maximum of four procedures are coded.

Rate of procedures —The ratio of the number of all-listed

procedures during a year to the number of persons in the civilian

population on July 1 of that year.

Demographic terms

Age—Refers to the age of the patient on the birthday prior

to admission to the hospikd inpatient sewice.

Geographic regions—One of the four geographic regions

of the United States corresponding to those used by the U.S.

Bureau of the Census:

Region

Northeast. . . . . .

North Central. . .

South . . . .

West. . . . .

. . . .

. . . .

States included

Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut. New

York, New Jersey, and pennavlvanla

Michigan. Ohio. Illinois, Indiana, Wisconsin, Minnesota. Iowa, Missouri, Nortt\

Dakota, South Dakota. Nebraska. ancf

Kansas

Delaware. Maryiand, District of Columbia,

Virginia. West Virg]nia, North Carolina,

South Carolina, Georgia. Florida. Kentucky, Tennessee, Alabama, Missisalppi,

Arkansas, Louisiana, Oklahoma, and Texas

Montana. Idaho, Wyoming, Colorado, New

Mexico, Arizona, Utah, Nevada. Wash.

ington, Oregon. California, Hawaii, and

Alaska
From Vital and Health Statistics of the National Center for Health Statistics Number 102. December 4, 1984

Use of Contraception in the United States, 1982

by Christine A. Bachrach, Ph. D., and William D. Mosher, Ph. D., Division of Vital Statistics

During the period 1973–82, use of sterilization as a contraceptive method increased and use of the oral contraceptive

pill declined among wives in the childbearing ages ( 15–44

years). By 1982, sterilization had become the leading method

of contraception for ever married women. The method most

commonly used by never married women in 1982 was the pill.

These findings are based on preliminary data from the National

Survey of Family Growth, Cycle III.

The National Survey of Family Growth is conducted

periodically by the National Center for Health Statistics on

topics related to childbearing, family planning, and related

aspects of maternal and child health. Most of the statistics in

this report are based on Cycle III of this survey, which included

interviews with a sample of 7,969 women 15-44 years of age

in the noninstitutional population of the conterminous United

States in 1982. Survey design and sampling variability are discussed fimther in the Tectilcal notes.

Data on the contraceptive status of all women of childbearing age, regardless of marital status, are presented for the

first time in this report. Statistics for married women update

those presented in reports based on previous cycles of the

National Survey of Family Growth.l-s

All women

In 1982, about 54 percent of American women 15–44

years of age were using some method of contraception: 18 percent were using contraceptive sterilization and 37 percent, other

methods (table 1). Some women were not using contraception

because they were not exposed to the risk of unintended pregnancy: 9 percent were sterile for noncontiaceptive reasons

(8 percent surgically sterile and 2 percent nonsurgically sterile),

S percent were pregnant or had been pregnant within 2 months

of the interview (postpartum), 4 percent were trying to become

pregnant, 14 percent had never had sexual intercourse, and

6 percent had not had intercourse in the 3 months before the

interview. Another 7 percent were exposed to the risk of unintended pregnancy but were not using contraception for other

reasons, such as indifference to the possibility of pregnancy, or

health or religious concerns. This last group also included some

women who had had sexual intercourse within 3 months of the

interview but reported that they were not currently having intercourse. Such women are considered exposed to the risk of

unintended pregnancy in order to include in the exposed population women with intermittent patterns of sexual intercourse. Of

women who were at risk of an unintended pregnancy-those

who had had sexual intercourse during the 3 months prior to

interview and were not pregnant, post partum, seeking pregnancy, or nonsurgically or noncontraceptively sterile-88 percent were using a method of contraception and 12 percent were

not (calculated from table 1).

The most widely used method of contraception in 1982

was sterilization (either male or female), used by 18 percent of

women, followed in order of popularity by the pill ( 16 percent),

condom (7 percent), diaphragm (5 percent), and IUD (4 percent). About 2 percent of women used some form of periodic

abstinence: rhythm by calendar, temperature methods, or natural

family planning. Each of several other methods, such as withdrawal, douche, foam, and suppositories were used by about

1 percent or less of women.

Black women were less likely than white women to be

using some method of contraception (5 I percent compared

with 55 percent, including sterilization), and more likely to be

having intercourse in the 3 tionths before the interview but not

using a method ( 13 percent compared with 6 percent). Female

contraceptive sterilization was more common among black

than white women (14 percent compared with 12 percent),

while male contraceptive sterilization was more commonly

relied upon by white women. Use of male or female sterilization as a contraceptive method was higher for white women

(18 percent) than for black women (15 percent). A higher proportion of black women (20 percent) than white women

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

Table 1. Number of women 15–44 years of age and percent distribution by current contraceptive status and method, according to age and race:

United States, 1982

[Prel,mrnaq’ data based on a sample of the household population of the conterm,nous Untted States. See Techrr,cal notes for est,maies of sampilng vanab!ltty and

deflnmons of termsJ

15-44 years 15-29 years 30-44 years

All All All

Contraceptwe status and method races 1 Wh\te Black races 1 Wh\te Black races 1 White Black

All women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Sterile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Surgically sterile . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contraceptwely sterile . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Noncontraceptwely sterile . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mace, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonaurgically sterile . . . . . . . . . . . . . . . . . . . . . . . . . .

Pregnant, post psrtum . . . . . . . . . . . . . . . . . . . . . . . . .

Seeking pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other nonusers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Never had intercourse . . . . . . . . . . . . . . . . . . . . . . . . .

Nolntercourse inlast3 months.. . . . . . . . . . . . . . . .

intercourse inlast3 months . . . . . . . . . . . . . . . . . . . .

Nonsurgical contraceptors . . . . . . . . . . . . . . . . . . . . . . .

Pill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Foam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penodice bstlnence . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nsturai family planning . . . . . . . . . . . . . . . . . . . .

Withdrawal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Douche . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Supposttorles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

54,099

100.0

27.3

25.7

17.9

12.0

5.9

7.9

7.4

0.5

1.5

5.0

4.2

27.0

13.7

6.0

7.3

36.6

15.5

3.9

4,5

6.7

1.3

2.2

0.3

1.1

*O. 1

1.3

0.7

45,367

100.0

27.8

26,2

18.4

11.6

6.7

7.8

7.3

“0,5

1.6

4.9

4.0

26.3

13.9

6.0

6.4

37.1

15.1

3.8

5.0

7.2

1.4

2.2

“0.4

1.2

0.0

1.2

0.6

6,985

100.0

23.7

22.3

15.0

14,2

“0.7

7.3

7.3

0.0

*1.4

5.6

5.4

29.6

10.3

5.9

13.4

35.7

19.8

4.7

1.8

3.2

1.4

1.6

*o. 1

‘0.7

“0.7

1.7

“1.0

Numbarln thousands

30,413 25,239 4,223

Percent distribution

100.0 100,0

8.0 7.7

7,1 6.8

5.6 5.4

3.7 3.1

2.0 2.3

1.5 1.4

1.4 1.3

“0.1 “0.1

0.9 “1.0

6.9 6.6

4.6 4.6

37.3 37.1

22.7 23.4

6.2 6.3

8.4 7.4

43.2 43.9

23.3 22.9

3.1 2.9

5.2 5.9

6.1 6.5

1.0 1.1

1.8 1.9

“0.3 ‘0.3

1.4 1.6

*o. 1

1.2 1.3

*0.5 “0.4

100.0

9.5

8.8

7.0

6.6

‘0.4

1.8

I.8

“0.7

8.3

4.6

36.0

16.6

5.6

13.9

41,5

27.8

4.1

“1.2

3.5

“0.8

*1.5

“0.1

“0.7

“0.6

“1.4

‘1.0

23,686

100.0

52.0

49.7

33.6

22,6

11.0

16.1

15.0

1.0

2.3

2.4

3.7

13.7

2.0

5.7

6.0

28.1

5.6

5.0

3.6

7.5

1.7

2.6

“0.4

‘0.6

“0.1

1.3

“0.9

20,128

100.0

52.9

50.5

34.6

22.3

12.4

15.9

14.8

“1.1

2.4

2.6

3.3

12.7

2.0

5.6

5.0

28.5

5.3

5.0

3.9

8.0

1.7

2.7

“0.4

“0.7

0.0

1,2

“0.9

2,762

100.0

45.4

42.9

27,1

25.8

“1.3

15.7

15.7

0.0

‘2.5

●1.4

6.5

19.9

“0.8

6.4

12.6

26.7

7.7

5.7

2.8

2.8

●2.2

*1.8

“0.3

“0.7

“0.9

●2.2

*1.1

llncludes whne, black, and olher races.

(15 percent) used the oral contraceptive pill. By contrast, white

women were more likely than black women to rely on the diaphragm (5 percent compared with 2 percent) and condom

(7 percent compared with 3 percent). Differences by race in

use of the pill and diaphragm were significant among women

aged 15–29, but not among older women.

A smaller proportion of women 15-29 years of age compared with women 30-44 years of age was using a method of

contraception (49 compared with 62 percent, including sterilization). This difference occurs because of substantial differences in the proportions of younger and older women who had

never had sexual intercourse (23 and 2 percent, respectively),

or were pregnant, post partum, or seeking pregnancy (12 and

6 percent); and despite the fact that younger women are less

likely than older women to be nonusers because they are sterile

for noncontraceptive reasons (2 and 18 percent, respectively).

To some extent, the lower proportion of younger than older

women using a method also reflects the greater predominance

of unmarried women among younger women, as discussed in a

later section, unmarried women are more likely than currently

married women to be having intercourse but not using a method.

Use of contraceptive sterilization and oral contraceptives

differed markedly by age. About 23 percent of women 15-29

years of age were using the pill, compared with less than

6 percent of women aged 30–44. By contrast, less thanl 6 percent of women aged 15–29, compared with about 34 percent of

women aged 30–44, used sterilization as a method of contraception. These differences in method choices probably reflect a

number of factors, including the greater probability that older

women had completed their families and were able to choose

permanent methods of contraception, and concerns about the

health effects of pill use among older women.4

Trends among currently married women

Table 2 presents data on the contraceptive status and

method choices of currently married women for the years 1973,

1976, and 1982. This table focuses on currently married women

because never married women were not filly represented in the

surveys conducted in 1973 and 1976 (see Technical notes).

“Other nonusers” —women who were not using contraception

for reasons other than pregnancy or noncontraceptive ste]ility—

are not differentiated in table 2 by whether they ever or recently

had sexual intercourse, because data are not available for the
aknce&a3

Table 2. Number of currently married women 15-44 years of age and percent distribution by current contraceptive status and method, according

to race: United States, 1973, 1976, and 1982

[Stawwcsare based on samples of the household population Ofthe conterm!nous United States. See Technical notes for estimates of samplmg vanabdity and defmmans

of terms. Data for 1982 are preliminary]

All races 1 White Black

Contraceptive sratus and method 1982 19762 19732 1982 19762 ?9732 1982 19762 19732

Allcurrently married women.... . . . . . . . . . . . . . . . . . .

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

Sterile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Surgically sterile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contraceptively stenie . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Noncontraceptively sterile. . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonsurgically sterile . . . . . . . . . . . . . . . . . . . . . . . . . .

Pregnant, post partum . . . . . . . . . . . . . . . . . . . . . . . . . . .

Seeking pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other nonuaers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonsurgical contraceptors . . . . . . . . . . . . . . . . . . . . . . . .

Pill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IUD ., ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Foam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Periodic abstinence . . . . . . . . . . . . . . . . . . . . . . . . . . .

Withdrawal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Douche . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

28,231

100.0

40.9

38.9

27.9

17.4

10.4

11.1

10.1

81.0

“2.0

7.2

6.7

5.0

40.1

13.5

4.8

4.5

9.8

2.0

3.2

*1.2

“0.1

*1.O

27,488

100.0

30.0

28.2

18.6

9.5

9.0

9.7

8.9

0.7

1.7

6.8

6.5

7.6

49.2

22.5

6.3

2.9

7.3

3.0

3.4

2.0

0.7

1.0

26,646

100.0

23.9

22.9

16.4

8.6

7.8

6.5

6.3

0.2

0.9

7.3

7.0

8.7

53.2

25.1

6.7

2.4

9.4

3.5

2.8

1.5

0.6

1.3

Number in thousands

25,195 24,795 24,249

Percent distribution

100.0 100.0 100.0

41.1 30.7 24.0

38.9 29.0 23.2

28.2 19.3 16.5

17.0 9.6 8.2

11.2 9.7 8.4

10.7 9.7 6.6

9.8 8.9 6.3

*1.O 0.8 0.3

*2.1 1.7 0.8

7.2 6.8 7.4

6.6 5.9 6.8

4.5 7.1 7.8

40.6 49.5 54.0

13.4 22.6 25.1

4.8 6.3 6.6

4.7 3.0 2.5

10.2 7.5 9.9

2.0 2.9 3.5

3.3 3.5 2.9

●1.2 2.1 1.6

0.0 0.6 0.5

80.9 1.0 1.4

2,130

100.0

37.8

36.3

23.2

21.0

2.2

13.2

13.1

“0.1

“1.4

6.1

8.5

9.8

37.8

15.6

5.9

3.3

4.3

*2. 1

“2.4

‘0.1

‘1.0

*2.1

2,169

100.0

24.4

21.6

12.7

10.9

*1.7

9.0

8.7

2.7

6.8

9.6

13.3

45.9

22.2

6.2

1,8

4.6

3.8

81.4

1.8

2.7

“1.4

2,081

100.0

22.7

20.8

14.6

13.6

1.0

6.2

6.1

“0.1

1.9

6.8

7.1

17.9

45.4

26.3

7.6

1.2

3.2

3.0

“0.8

“0.4

1.8

1.0

llnciudes white, black, and other races.

21nc\udes unmarried women Iwing with a partner.

previous cycles, and, in 1982, virtually all currently married

women had had intercourse within the last 3 months.

During the period 1973-82, the proportion of currently

married women who were other nonusers declined from about

9 percent in 1973 to 5 percent in 1982. The proportions pregnant or post partum. or seeking pregnancy did not change significantly over the decade, while the proportion surgically sterile

for noncontraceptive reasons increased. T’he percent of all wives

using a method (including sterilization) remained about the

same. However, among wives at risk of an unintended pregnancy (excluding those who were pregnant or post partum,

seeking pregnancy, or nonsurgically or noncontraceptively

sterile), the proportion using contraception increased from

89 percent in 1973 to 93 percent in 1982 (calculated from

table 2).

As reported e1sewhere,3,5 the rather substantial increase in

noncontraceptive surgical sterili~ beween 1973 and 1976

was largely or entirely due to a change in the wording of a

question concerning the contraceptive intent of sterilizing

operations (see Technical notes). If surgical sterilizations had

been classified in 1976 and 1982 by the same question as in

1973, we would expect the percents using contraceptive sterilization and using any method of contraception in 1976 and 1982

to be somewhat higher.

During the period 1973-82, the proportion of currently

married women using the pill declined substantially, from 25 to

14 percent, while the proportion using contraceptive sterilization increased substantially, from 16 to 28 percent. These

changes occurred mainly between 1976 and 1982. The increase

in sterilization between 1976 and 1982 was limited mainly to

female operations (10 percent of wives in 1976 and 17 percent

in 1982). Use of the IUD declined slightly between 1973 and

1982, from 7 to 5 pxxeent, while use of the diaphragm increased

slightly, from 2 to 5 percent. The proportion of wives using the

condom declined from 9 percent in 1973 to 7 percent in 1976,

and then increased again to 10 percent in 1982.

Never married women

As table 3 shows, one half of never married women either

had never had sexual intercourse (39 percent), or were not

having intercourse during the 3 months prior to the interview

(an additional 11 percent). Very few of the never married

women were pregnant, post partum, or seeking pregnancy

(4 percent), and even fewer were noncontraceptively sterile

(2 percent, data not shown). About 35 percent were using

some method of contraception, including sterilization, and

10 percent had had intercourse in the 3 months before the interview but were not using a method.

The proportion of never married women using contraception is largely determined by the proportions who have ever

had sexual intercourse, and who have had intercourse recently
4 admncedata

Table 3. Number of never married women 15-44 years of aga and percent distribution by current contraceptive status and mathod, according

to age and race: United Statea, 1982

[PrellmmaW data based on a sample of the household population of the conterrmmauaUnited States. See Techmcal notes for estimates of sampling vanabihry and definitions

of terms]

75-19 yeers

15-44 years Total 15- ?7 years 20-44 years

Contraceptive status AJI Ail All All

and method races 1 White Black races 1 White Black races 1 White Black races 1 Wh/te Black

All never married women. . . .

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

Sterile . . . . . . . . . . . . . . . . . . .

Contraceptively sterile . . . .

Female . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . .

Pregnant, post partum,

seeking pregnancy. . . . .

Other nonusers . . . . . . . . . . . .

Never had intercourse . . . .

No Intercourse in last

3 months, . . . . . . . . . . . . .

Intercourse in last

3 months . . . . . . . . . . . . . .

Nonsurgical contraceptors. . .

Pill . . . . . . . . . . . . . . . . . . . .

IUD . . . . . . . . . . . . . . . . . . .

Diaphragm . . . . . . . . . . . . .

Condom . . . . . . . . . . . . . . .

Foam . . . . . . . . . . . . . . . . . .

Periodic abstinence . . . . . .

Natural family

planning . . . . . . . . . . . .

Withdrawal . . . . . . . . . . . . .

Douche, . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . .

Suppositonea ., . . . . . . .

19,162

100.0

3.3

1.8

1.1

“0.6

3.7

59.9

38.7

11.3

10,0

33.1

18.5

1.8

4.8

4.1

“0.4

“0.9

*O. 1

1.2

*O. 1

1.3

“0.4

14,948

100.0

2.0

“1.0

“0.3

“0.8

2.3

63.5

42.4

12.5

8.6

32.2

17.2

“1.2

5.7

4.3

“0.3

* ‘0.8

“0.1

1.4

1.4

‘0.3

3,543

100.0

8.6

5.3

5.1

“0.2

10.3

43,1

20,3

7,2

15.5

38.0

25.5

3.5

●1.1

3.4

“1.1

“1.0

“0.6

“0.6

*1.2

“0.8

8,839

100.0

“0.5

*o. 1

“0.1

4.0

73.6

57.1

6.5

10.0

21.9

13.7

“0.2

*1.4

4.9

“0.1

“0.5

80.7

“0.1

“0.3

“0.1

Number in thousands

7,193 1,377 4,968

Percent distribuuon

100.0 100.0 100.0

“0.6 “0.4 “0.5

90.1

“0.1

3.0 9.2 *3.6

75.5 61.7 82.9

59.8 42.1 69.6

6.9 *3.6 4.9

8.8 15.8 8.3

21.0 28.7 13.1

12.6 20.5 8.3

0.0 ●1.2 “0.2

“1.6 “0.6 “0.5

5.2 ●3.7 “3.3

“0.6 “0.1

“0.5 “0.7 ‘0.2

“0.8 “0.5 80.5

“0.4 “0.1

“0.3 “0.5 “o. 1

“0.1 “0.3 “0.0

3,971

100.0

“0.5

*2.5

84.8

72.1

5.0

7.7

12.2

7.6

“0.0

“0.5

*3.5

“0.1

80.4

818

100.0

‘0.4

9.1

72.3

55.9

●3.8

12.6

18.2

11.8

“0.8

“0.3

●2.6

“0.4

“0.6

“0.6

“0.6

“0.4

“0.1

10,323

100.0

5.6

3.2

2.1

“1.1

3.5

48.2

22.8

15.4

10.0

42.7

22.7

3.1

7.6

3.4

‘0.7

*1.2

*0. I

*1.6

‘0. 1

2.1

“0.7

7,755

100.0

3.4

“1.9

“0.5

“1,4

“1.6

52.2

26.1

17.7

8.4

42.7

21.4

●2.4

9.5

3.5

“0.5

“1.0

“0.2

“2.0

*2.4

“0.6

2,166

100.0

13,8

8.6

8,3

“0.3

10.9

31.3

6.5

9.4

15.4

44.0

28.7

4.9

“1.5

3.2

“1.4

●1.2

“0.7

“0.7

“1.7

●1.1

1Includes white, black, and other races.

(in the 3 months prior to interview). These proportions vary

sharply by the age and race of never married women. About

70 percent of women aged 15– 17, 57 percent of women aged

15-19, and 23 percent of women aged 20–44 had never had

intercourse. An additional 5, 7, and 15 percent of these women,

respectively, had not had intercourse in the 3 months prior to

the interview. Black, never married women were more likely

than white women to have had intercourse, both ever and in the

3 months prior to interview.

Table 4 shows the percent of never married women using a

method of contraception among those who were exposed to the

risk of unintended pregnancy (that is, contraceptors and noncontraceptors who had sexual intercourse in the 3 months

before the interview and were not noncontraceptively sterile,

pregnant, post partum, or seeking pregnancy). Among these

women, white and black women were about equally likely to be

using a method of contraception (77 and 73 percent, respectively). Women 20–44 years of age were more likely to be

using a method than women 15– 19 years of age (80 percent

compared with 68 percent).

Table 4 also shows that over half of never married women

who used some method of contraception used the oral contraceptive pill (53 percent). The diaphragm and condom were

next in popularity, used by 14 and 12 percent of contraceptors,

respectively. About 5 percent of never married contraceptors

used sterilization, and 5 percent used the IUD. About 11 percent used other methods, including withdrawal (3 percent),

periodic abstinence (3 percent), foam ( 1 percent), and suppositories (1 percent, data not shown).

As in the case of all women, the method choices of never

married women differed appreciably by age and race. Ycunger

women (aged 15– 19) were more likely than older women (aged

20–44) to use the pill or condom, while older women were

more likely to use a diaphragm, IUD, or sterilization. ‘White

women were more likely than black women to use the diaphragm.

Race differences for other individual methods were not statistically significant, but taken as a group, the more effective

methods (pill, IUD, or sterilization) were more commonly

used by black than white women.

Compared with currently married women, never married

women who were apparently at risk of an unintended pregnancy

were less likely to be using a method of contraception. Excluding noncontracepting women who had never had intercourse;

had not had intercourse during the 3 months prior to interview;
5

Table 4. Number of never married women 15-44 years of age who were exposed to the risk of an unintended pregnancy, and percent using

a method of contraception, by race and age, and percent distribution of contraceptors by method of contraception, according to race and age:

United States, 1982

[Prel!minarf data based on a sample of the household population of the contermmous Umted States. See Techn!cal notes for eat!matea of sampllng vartab!lltv and

definmons of terms]

Using a All Other

Race and age Exposedl method methods Sterilization Pill IUD Diaphragm Condom methods2

All races3

15-44 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-17, ., . . . . . . . . . . . . . . . . . . . . . . .

20-44 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

15-44 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-17 . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

15-44 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-17 . . . . . . . . . . . . . . . . . . . . . . . . . .

20-44 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number !n

thousands

8,727

2,872

1,081

5,855

6.372

2,188

803

4,184

2,098

618

253

1,480

Percent Percent distribution

76.1

67.6

60.0

80.3

77.4

69.0

60.2

81.8

73.0

63.9

58.7

76.9

100.0 5.1 53.2 5.0 13.7 11.8 11.2

100.0 “0.4 62.2 “0.9 *6.4 22.3 *7.6

100.0 63.7 “1.3 *3.6 25.0 ●6.4

100.0 7.0 49.5 6.7 16.6 7.5 12.7

100.0 “3.1 51.6 “3.7 17.1 13.0 11.4

100.0 “0.6 59.6 *o. 1 “7.8 24.7 ‘7.3

100.0 62.4 80.3 ●4.4 “28.6 ●4.2

100.0 *4.2 48.1 ●5.4 21.2 7.9 13.2

100.0 12.1 58.9 8.0 ●2.6 7.9 10.4

100.0 71.4 “4.2 “2.0 *1 3.0 “9.5

100.0 65.1 “4.5 *1.5 “14.5 *14.3

100.0 16.3 54.6 9.4 *2.9 6.1 10.7

IIncludea women ualng contraception and those not using contraception who had sexual intercourse m the last 3 months and were not pregnant. post parrum. seektng

pregnancy, or noncontraceptwely sterile.

‘Includes foam, penodlc abstmance, withdrawal, douche, supposttortes. and other methods.

31ncl”des white, black, and other raceswere ttoncontraceptively sterile or were pregnant, post partum, the more effective methods-the pill, IUD, or sterilization (63

or seeking pregnancy, 93 percent of currently married women, versus 68 percent, respectively). However, pill use was much

compared with 76 percent of never married women, were wing more common among never married women, and sterilization

a method. Never married women who used a method were was much more common among currently married women, reabout as likely as currently married contraceptors to use one of fleeting differences in age and previous childbearing experience.

References

lNational Center for Health Statistics, K. Ford Contraceptive utilization, United States. Vital and Health Statistics. Series 23, No. 2.

DHEW Pub. No. (PHS) 79-1978. Public Health Sewice. Washington.

U.S. Government Printing Office, Sept. 1979.

‘National Center for Health Statistics, W. Moshec Contraceptive

utilization, United States, 1976. Vital and Health Statistics. Series

23, No. 7. DHHS Pub. No. (PHS) 81-1983. Public Health Service.

Washington. U.S. Government Printing Office, Mar. 1981.

3National Center for Health Statistics, W. Mosher and C. WestofE

Trends in Contraceptive Practice, United States, 1965-76. Vital and

Health Statistics. Series 23, No. 10. DHHS Pub. No. (PHS)

82-1986. Public Health Service. Washington. U.S. Government

Printing Oftice, Feb. 1982.

4R A. Hatcher, G. K. Stewart, F. Stewart, et al.: cofztmcep~i~e

Technology 1982-1983, 11th ed. New York. Irvington Publishers,

1982.

‘W. Pra& W. Grady, J. Menken, and J. Trussell: An overview of

experience with vaginal contraceptives in the United States, in

G. Zatuchni, A. Sobrero, J. Speidel, and J. Sciarra, eds.. Vaginal

Contraception: New DeseIopments. Hagerstown, Md. Harper and

ROW, 1980.

GNational Center for Health Statistics. D. French The National

Survey of Farniiy Growth, Cycle E Sample design, estimation procedures, and variance estimation. Vital and Health Statistics. Series

2, No. 76. DHEW Pub. No. (PHS) 78-1350. Public Health Service.

Washington. U.S. Government Printing Oflice, Jan. 1978.

7National Cenwr for Heaiti Statistics, W. Grady ~e National SurveY

of Family Growth, Cycle II: Sample design, estimation procedures,

and variance estimation. Viral and Health Statistics. Series 2,

No. 87. DHHS Pub. No. (PHS) 81-1361. Public Health Service.

Washington. U.S. Government Printing Office, Feb. 1981.
6 athncedata

Technical notes

Survey design

The National Survey of Family Growth is conducted

periodically by the National Center for Health Statistics to

collect data on fertility, family planning. and related aspects of

maternal and child health. Field work for Cycle I was conducted under contract in 1973 by the National Opinion Research

Center. Field work for Cycles II and HI was conducted by

Wes~at. Inc.. in 1976 and 1982, respectively.

In all cycles, personal interviews were conducted with a

multistage area probability sample of women 15-44 years of

age in the noninstitutional population of the conterminous

United States. In Cycles I and II. ever married women and

never married women with offspring living in the household

were eligible for the survey. In Cycle III. all women 15-44

years were eligible regardless of marital status or the presence

of offspring. Women living in group quarters (such as college

dormitories) were excluded from the samples in Cycles I and

II, but included in Cycle III. Intewiews were conducted with

9,797 women in Cycle I, 8.611 in Cycle II, and 7,969 in Cycle

III. The sample designs of Cycles I and H are described in

more detail in other reports of the National Center for Health

Statistics.s;

Field work for Cycle HI was conducted between August

1982 and February 1983. Black women and women aged

15– 19 were oversampled. Interviews were conducted by trained

female interviewers and lasted an average of one hour. The

interview focused on a woman’s pregnancy history; use of contraceptives in each pregnancy interval: ability to bear children;

future childbearing expectations; use of family planning and

infertility services: marital history: labor force participation;

and a wide range of social. economic. and demographic characteristics.

Reliability of estimates

Because the statistics presented in this report are based on

a sample, they may differ from the statistics that would result if

all 54 million women represented by the National Survey of

Family Growth had been interviewed. The standard error of an

estimate (SE) is a measure of such differences. The standard

error of an estimated number or percent presented in this report

may be calculated by using the appropriate values of A and B

from table I in the equations,

SE ()

B 1/2

(N) =A+~ XN

and

SE(P) =

( )

100– P’ I/2

BXPX ~

where N’ is the number of women, P is the percent, and X is

the number of women in the denominator of the percent. Ap

proximate standard errors for estimated percents of women of

all races in Cycle III are shown in table II.

Table 1. Estimates of A and S for calculating standard errors, by

cycle, marital status, and race: National Survey of Family Grovvth

Cycle, mar!tal status. and race A B

CYCLE I

Currently marr!ed women

Allraces andwhlte, . . . . . . . . . . . 0.000017613 4493.7916

Black . . . . . . . . . . . . . . . . . . . . . . . . 0.000040219 1600,4393

CYCLE II

Currently married women

All races . . . . . . . . . . . . . . . . . . . . . -0.000185899 6751.0619

White and other . . . . . . . . . . . . . . . . -0.000205624 7021.1665

Black . . . . . . . . . . . . . . . . . . . . . . . . . -0.000631040 2798.6440

CYCLE Ill

Ever married women

Allraces and white, . . . . . . . . . . . -0.001097329 29809,1677

Black . . . . . . . . . . . . . . . . . . . . . . . . . -0.000908632 6346.04B4

Never married women

Allracea and white . . . . . . . . -0.000935104 1760B.8B33

Black . . . . . . . . . . . . . . . . . . . . . . . . . -0.000908632 6346.0484

Table 11. Approximate standard errors for estimated percents

(expressed in percent) for women of all races: National Survey of

Family Growth. Cycle Ill

Estimated percent

Base of 2or 5or 10 or 20 or 30 or 40 or

percent 98 95 90 80 70 60 50

100,000 .,.... 6.5 10.1 13.8 18.5 21,2 22,6 23.1

500,000 . . . . . . 2.9 4.5 6.2 8.3 9,5 10.1 10.3

7,000,000 . . . . 2.0 3.2 4.4 5.8 6.7 7.2 7.3

5,000,000 . . . . 0.9 1.4 2.0 2.6 3.0 3,2 3.3

10,000,000 . . . 0.6 1.0 1.4 1.8 2.1 2.3 2.3

30,000,000 . . . 0.4 0.6 0.8 1.1 1.2 1.3 1.3

50,000,000 . . . 0.3 0.4 0.6 0.8 0.9 1.0 1.0

The chances are about 68 in 100 that a sample estimate

would fall within one standard error, and about 95 in 100 that

it would fall within two standard errors of a statistic based on a

complete count of the population represented by the National

Survey of Family Growth. Differen~es between percents discussed in this report were found to be statistically significant at

the 95-percent confidence level using a two-tailed r-test with

39 degrees of freedom. This means that in repeated samples of

the same type and size, a difference as large as the one observed

would occur in only 5 percent of samples, if there were, in fact,

no difference between the percents in the population.

The relative standard error of a statistic is the ratio of the

standard error to the statistic and is usually expressed as a

percent of the estimate. In this report, statistics with relative

standard errors of 30 percent or larger are indicated with an

asterisk (*). These estimates are considered unreliable by themselves. but may be combined with other estimates to make

comparisons of greater precision.
dancech7

Statistics in this Yeport also maybe subject to nonsampling

error, that is. errors or omissions in responding to the interview,

recording answers, and processing data. The data have been

adjusted for nonsampling error resulting from” nonresponse by

means of adjustments to the sample. weights assigned to each

case. Other types of nonsampling error were minimized by a

series of stringent quality control measures similar to those

used in Cycles I and 11.6.7

Definitions of terms

Contraceptive status

Sterile—A currently married woman was classified as

sterile for the purposes of determining current contraceptive

status if she-reported that it was impossible for her and her

husband to have a baby. An unmarned woman was classified

as sterile if she reported that it was impossible for her to have a

baby, or if her current method of contraception was male sterilization.

ZVonsurgical-A woman (or couple) was classified as

nonsurgically sterile if she reported that it was impossible for

her to have a baby for any reason other than surgical sterilization. Reported nonsurgical reasons for sterility included menopause and sterility resulting from accident, illness, or congenital

causes.

Su&icaI—A woman (or couple) was classified as surgically

sterile if she or her husband were completely sterile due to an

operation.

Because surgical sterilizations are very frequently obtained

exclusively or partly as methods of contraception that is, because of their complete effectiveness against conception rather

than for purely therapeutic reasons, they have been fi,u-ther

classified as contraceptive and noncontraceptive. In Cycle I, a

sterilizing operation was conhaceptive if the respondent answered

“yes” to the question “Was the operation done at least partly

so that you would not have any more children?” The question

was reworded in Cycles II and III to “Was one reason for the

operation because you had all the children you wanted?”

The percents of women contraceptively and noncontracep

tively sterile are not fully comparable between Cycle I and

Cycles II and III. The rewording of the question cited above

probably reduced the percent of sterilizing operations classified

as contraceptive, because an operation done to prevent a pregnancy that would be dangerous to the woman’s health usually

would have been reported as contraceptive in Cycle I, but as

noncontraceptive in Cycles II and III. Also, in Cycle I, if a

couple had had more than one sterilizing operation-for example, a vasectomy followed a few years later by a hysterectomy—the interviewer coded the earliest operation. In Cycles

11 and III, however, the woman’s operation was given priority.

Both of these factors tended to increase the proportion of sterilizing operations classified as noncontraceptive in 1976 and

1982 compared with 1973.

It should be noted that the estimates of male contraceptive

sterilization reflect the numbers of women relying on this

method, and not necessarily the numbers of men who have

been sterilized for contraceptive reasons.

Pregnant—A woman (or couple) was classified as pregnant if she replied affkrnatively to the question “Are you pregnant now?” or, for those in doubt. .-Do you think you probably

are pregnant or not?” However, a woman who reported that the

onset of her last menstrual period was within the 30 days prior

to the interview was automatically considered not pregnant.

Seeking pregnancy—A woman (or couple) was classified

as seeking pregnancy if she reponed she was not using a method

at the time of interview because she wanted to become pregnant.

Postparttzm-A woman (or couple) was classified as post

partum if she reported she was not currently using a method,

was not seeking a pregnancy, and her last pregnancy had terminated within 2 months before the date she was interviewed.

Other nonusers—Women (or couples) who reported they

were currently using no contraceptive method and could not be

classified in any of the preceding categories of noncontraceptors

were classified here. Among these are women who had never

had intercourse, had not had intercourse in the last 3 months.

were indifferent to the chances of pregnancy, had a very low

risk of pregnancy due to some fecundity impairment, or objected

to contraceptive methods for personal or religious reasons.

Never had intercourse—A woman (or couple) was classified as never having had intercourse if she was not cumently

using a method and she had never had sexual intercourse at

any time up to the time of interview. or if she had had sexual

intercourse but not since her menstrual periods began.

No intercourse in last 3 mon~hs—A woman (or couple)

was classified as not having had intercourse in the last 3 months

if she was not currently using a method and reported not having

sexual intercourse in any of the 3 months before the interview.

Intercourse in last 3 months—A woman (or couple) was

classified as having intercourse in the last 3 months if she was

not currently using a methti and was having sexual intercourse

currently or in any of the 3 months preceding the interview.

Confraceptors—A woman (or couple) who reported use of

a contraceptive method other than a surgical sterilization at the

date of interview was classified according to the specific method

used. Methods used by extremely small proportions of the

population such as jelly, cream, suppositories, or abstinence,

not in combination with any other methods, were grouped in

the category .’Other.” Where more than one method was reported in current use, the method generally considered the most

effective was used for classification purposes.

Demographic terms

Age—Age is classified by the age of the respondent at her

last birthday before the date of interview.

Race—Race refers to the race of the woman interviewed

and is reported as black, white, or other. In Cycle III, race was

classified according to the woman’s report of which race best

described her. In Cycles I and II, race was classified by the

observation of the interviewer. Comparisons of Cycle III data

indicate that results using either method of classification are

very similar.

Marital status—Persons were classified by marital status

as married. widowed, divorced, separated, or never married. In

Cycles I and II, informally married women—women who volimtewx? L!at they were sharing !iving quax?ers whh t!!eir sexual
8

partner-were classified as currently married. These women according to the 1982 definition of marital status makes little

constituted about 2 percent of currently married respondents in difference in the distributions of currently married women by

Cycle I and 3 percent in Cycle II. In Cycle III, such women contraceptive status for these years.

were classified according to their legal marital status. Thus. In all cycles, women who were married but separated from

statistics on currently married women for 1982 shown in tlis their spouse were classified as separated if the reason for the

report are not strictly comparable to those for 1973 and 1976. separation was marital discord, and as currently married otherHowever, reclassifying women in the 1973 and 1976 sumeys wise.
From Vital and Health Statistics of the National Center for Health Statistics December 20, 1984. Number 103

Use of Services for Family Planning and Infertility:

United States, 1982

by Marjorie C. Horn, M.A., and William D. Mosher, Ph. D., Division of Vital Statistics

In 1982, the annual rate of visits for family planning services

was 1,077 visits per 1,000 nonsterile women. Never married

women made greater use of family planning services in that

year than did women who had been married (1,227 visits compared with 1,010 visits per 1,000 women, respectively). Many

providers of family planning services also offer services or make

referrals for infertiIe couples. Over 6 million ever married

women in 1982 had used infertility services at some time during

their reproductive years.

These and related statistics on the use of family planning

and infertility services presented in this report for 1982 are

preliminary results from Cycle III of the National Survey of

Family Growth (NSFG), conducted by the National Center

for Health Statistics. Comparative data for 1973 and 1976 are

from Cycles I and II, respectively, of the NSFG.1~2 For Cycle

111.data were collected through personal interviews with a multistage area probability sample of 7,969 women aged 15-44

years in the noninstitutional population of the conterminous

United States. Between August 1982 and February 1983, interviews were conducted with 3,201 black women and 4,768

women of other races. Because the estimates of statistics in this

report are based on a sample, they are subject to sampling

variability. Sampling variability, the design of the survey, and

definitions of terms used in this report are discussed in the

Technical notes.

Use of family planning semices by

currently martied women

In the 1982 survey, a detailed series of questions was asked

to obtain relatively complete estimates of the extent and type of

family planning services received. The specific services included

in these questions are listed in the Technical notes. Statistics

on family planning services are limited to women who were

able to conceive 3 years before the interview date. A woman

was classified as not abIe to conceive (sterile) if she reported

that it was impossible for her or her husband to czmceive as a

result of(1) an operation that occurred more than 3 years before

the interview or (2) nonsurgical factors known to the respondent

3 years or more before the interview. All other women were

assumed to be able to conceive at the beginning of the period

for which use of family planning services was reported. These

women are referred to as “nonsterile,” although some will have

become sterile because of an operation or nonsurgical conditions during the 3 years before the interview.

Table I shows the number of currently married, nonsterile

women 15-44 years of age by race, Hispanic origin, and poverty level income, and the percent who used family planning

services in the 3 years before the survey. Overall, 79 percent of

currently married nonsterile women reported using some type

of family planning service during the previous 3 years. Although

white wives may have been more likely to have used family

planning services (79 percent) than black (75 percent) or Hispanic (77 percent) wives, neither of these differences was statistically significant. There were no significant differences between the two income groups.

In previous cycles of the survey, use of family planning

services was measured by the single question: “During the past

3 years, has a doctor or other trained person prescribed. or

talked with you about a method for delaying or preventing pregnancy?” This was found to be an inadequate question because

respondents apparently felt it excluded services otier than formal discussions about conwaception. In 1982, many women

who answered “no” to the above question (the old question)

nonetheless reported in response to the new series of questions

using other family planning services, including pregnancy tests,

and getting or renewing a method of contraception.

As a result, the older measure seriously underestimated

use of family planning services, which is demonstrated by comparing the estimates based on the old and new questions, As

US. DEPARTMENT OF HEALTH AND HUMAN SERVICES Publlc Health SewIce
2 advancedata —

Table 1. Number of currently married women 15-44 years of age who were not sterile 3 years before the date of interview, percent who used

family planning services in the last 3 years, and percent who talked to a doctor or other trained person about contraception in the Iaat 3 years,

by race, Hispanic origin, and poverty level income: United Statas, 1973, 1976, and 1982

[Staosttcs are based on a sample of the household population of the conterm!no.s Uruted States. See Technical notes for estimates of sampling variability and

defmmons of terms. Data for 1982 are prel!mtna~]

Used family Talked about

planning services contraception

Currently married m last 3 years in last 3 years

Race, Hispanic origin, and

poverty level income

—

1982 1976 1973 1982 1982 1976 1973

Number in thousands Percent

Allwomenl . . . . . . . . . . . . . . . . . . . .,, ,,, 220,813 222.923 23,863 278.8 249.5 258.6 5Z

Race

White . . . . . . . . . . . . . . . . . . . . . . . . 18,489 20,553 21,711 79.2 50.0 59.9 51.9

Black . . . . . . . . . . . . . . . . . . . . . . . . . 1,639 1,896 1,868 74,9 44.4 46.9 44,1

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,847 1,519 1,504 77.0 42.6 51.8 4.8.1

Non-H ispanic . . . . . . . . . . . . . . . . . . . . 18,386 21,357 22,359 78.7 50.3 59.0 5’1.3

Poverty level income

Less than 150 percent.......,.. . . . . . . . 3,095 3,001 3,693 82.0 47.6 58.3 52.6

150percent or more . . . . . . . . . . . . . . . . . . 15,029 17,513 20,170 78.7 50.7 60.4 50.9

—

Ilncludes whne, black, and other racea.

‘Includes Hlspan!c origin and poverty level Income not stated.

shown in table 1, in 1982, only about 50 percent of the women

had discussed contraception with a medical professional according to the old question, compared with 79 percent of the

women who used family planning services according to the

new, more comprehensive questions.

Despite the inadequacies of the old question, it was retained

in Cycle III to permit examination of changes over time. Thus,

table 1 also shows the percents of women in 1973, 1976, and

1982 who reported a discussion about contraception in the 3

years before the surveys. In 1982, approximately 10 million

women reported a discussion about contraception, a decrease

of about 3 million women since 1976. One-third of this difference resulted from a reduction in the number of currently married nonsterile women, and two-thirds from a decline in the

percent of women who had discussed contraception. (The decrease in the number of currently married, nonsterile women

results almost entirely from an increase in contraceptive sterility

between the 1976 and 1982 surveys. Preliminary findings on

contraception and on reproductive impairments, which will include data on sterility, will be reported in other Advance Dafa

reports.)

The change between 1976 and 1982 in the percent of wives

reporting a family planning discussion appears to be due primarily to chariges among white wives, who reported a decline

of almost 10 percentage points. The percents of black and Hispanic wives reporting a discussion about contraception may have

declined as well, but the differences between 1976 and 1982

were not statistically significant. The decreases from 1976 to

1982 for white and non-Hispanic wives were about the same

size as the increases between 1973 and 1976. A similar pattern

was found for black and Hispanic women. As aI result, there

were no significant changes between 1973 and 1982 in the

percent of white, black. Hispanic, or non-Hispanic women who

had a discussion about contraception. The same applies to, income groups: the percents increased from 1973 to 1976 and

decreased between 1976 and 1982.

Given the limitations of the older measure of family pllanning services, the changes over time are dlflicult to interpret.

They may represent real changes, or be artifacts of repenting

errors. Specifically, it cannot be assumed that a similar trend

over time characterized by a sharp peak in 1976 would have

been found with the new measure. However, the proportions

receiving family planning services were probably higher in 1973

and 1976 than is indicated by the old measure.

In all three survey years, white wives appeared more likely

than black or Hispanic wives to have talked with a medical

professional about contraception, as did wives with higher incomes compared with those with lower incomes. However, the

differences between white women (50 percent) and black

women (44 percent) were not statistically significant in 1982,

while those between white and Hispanic wives were significant

only in 1976. The percents in the income groups did not differ

significantly in any of the three surveys.

Annual family planning visit rates

In addition to information on use of family planning :$ervices in the past 3 years, data were collected in Cycle III on

use of services in the 12 months before the survey, to produce

annual rates of family planning visits. Further, the inclusion of

never married childless women made it possible to complute

these rates for all women who had ever had intercourse.

Table 2 presents rates per 1,000 women for family planning

visits made during the 12 months before the interview by sou~rce

of service, race, age, and marital status. As in table 1, statistics

in table 2 also refer to women who were not sterile 3 years or
acbncedata 3

labia 2. Numbar of women 15-44 years of age who ever had sexual intercourse and were not sterile 3 years before the date of interview and

number of family planning visits in tha last 12 months, by race. aga, and marital status, and number of family planning visits in the last 12

months per 1,000 women, by source of service, race, age, and marital status: United States, 19S2

[Preltmma~ data based on a sample of the household populatmn of the contermfnous Unned States. See Techmcal notes for estimates of samplmg varlabtl!ty and

definitions of terms]

Source of services

Private

All medical

Race, age. and marital status Women Visits sources services Clinics Counselors

ALL WOMENl

15-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

15-19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

White

15-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

15-19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Black

15-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

15-19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

35-44 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MARITAL STATUS

Never married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Currently married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Widowed, divorced, orseparated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number m

thousands

37,488 40,369

13.452

4,465

16,639

7,397

31,111

10,912

3,512

14,009

6,190

5,277

2,192

833

2,128

956

11,529

20,806

5,153

19.462

7,059

17,362

3,545

32.125

15,192

5,352

14,024

2,909

7,039

3,791

1,555

2,671

577

14,143

21,212

5,014

Visits oer 1,000 women

1,077 656 385 36

1,447

1,581

1,043

479

1,033

1,392

1,524

1,007

470

1.334

1.729

1,867

1,255

“603

1,227

1,020

973

702

609

743

377

670

738

661

748

375

556

530

451

632

*444

534

741

586

673

867

280

95

323

573

736

232

88

754

1,162

1,387

604

153

636

251

361

71

105

*2 I

“7

39

81

127

*21

*8

●24

“37

*29

*19

*6

*56

27

●26

I Includes white, black, and other races.

more before interview, however, unlike table 1, which includes

only currently married women, table 2 refers to all women who

ever had intercourse regardless of marital status. A family planning visit means that a woman went to a clinic, private medical

source, or counselor to obtain one or more family planning

services. (Family planning services and sources are defined in

the Technical notes).

Differences in family planning visit rates by age, race, and

marital status reflect the different distributions of contraceptive

methods used in these groups, which are described in another

NSFG report.J For example, the oral contraceptive pill is the

leading method among young and never married women. and it

requires repeated visits to a doctor or clinic to renew the prescription and check for side effects. Sterilization, the leading

method among older married wome~ requires fewer visits. Contracepting black women rely more on methods requiring medical services (except the diaphragm) than white women, and

tlis is reflected in the visit rates by race.

Nonsterile women aged 15-44 who had ever had sexual

intercourse used family planning services of all types at the rate

of 1,077 visits per 1,000 women per year. Teenagers had the

highest amual visit rate ( 1,581 per thousand) of any age group

for all sources of family planning services combined. Vkit rates

declined sharply with age, from 1,447 at 15-24 years to 479 at

ages 35-44. Similar declines with age also were found in the visit

rates for white and black women separately. Nevertheless, the

annual visit rate for black women (1,334 per 1,000 women)

was significantly higher than the rate for white women (1,033).

Vkit rates for black women also were higher than those for

white women within each age group (although for ages 35–44

the difference is not significant). The highest overall visit rate

in table 2 was for black women 15-19 years of age (1,867 per

1,000 women).

The visit rate of 1,227 per 1,000 never married women

was higher than that for either currently married or previously

married women (1,020 and 973, respectively). This suggests

that the observed differences in visit rates by age may reflecL

in part, the effects of marital status, because a large majority

of the youngest age group has never been married. It also may

be the case that visit rates are higher among never married

women because tiey are younger, as a group, than ever married

women.

Nearly two-thirds of all family planning visits were to private

medical sources. Teenagers of ail races had higher family planning service visit rates to clinics than to private medical services,

as did black women aged 15-24 years. White teenagers also

may have been more likely to obtain services from clinics than

from private medical services (736 compared with 661 visits
4 adwlncedata

per 1,000), but the difference was not significant. White women

aged 20 years and older had higher visit rates to private medical

services than to clinics.

Visit rates to private medical services were higher among

women aged 25-34 than among women 15– 19 years and

35-44 years old. Visit rates to clinics were highest among

15– 19 year olds. A similar panem was found when rates by

age were examined separately for white and black women, but

not every difference was statistically significant.

Never married women had higher visit rates to clinics than

currently or formerly married women. Currently married women

were more likely than either never or previously married women

to obtain family planning services from private medical sources.

In each age and race category, women were least likely to

obtain family planning services from counselors, who are not

able to offer as wide a range of services as doctors and clinics.

The highest visit rates to counselors were found for teenagers,

perhaps because teenage women may be more likely than other

women to turn to nonmedical counselors for information about

family planning methods.

Overall, white women had higher visit rates to private medical services than black women (at the 0.10 level of significance),

while black women had higher visit rates to clinics. These differences by race were statistically significant for teenagers sep

arately and for women aged 15–24. In addition, clinic visit

rates for black women were higher than rates for white women

among women 25–34 years of age.

Infertility semices

Family planning includes infertility services as well as services for limiting the number and planning the spacing of births.

Data also were collected in 1982 on use of medical services for

infertility by women who had difficulty in conceiving or in carrying a pregnancy to term. About 1 million ever married women

had one or more infertility visits in the 12 months before the

interview, about 825,000 of these were to private medical services. During the 3 years before interview, about 1.9 million

women had infertility visits, 1.5 million of which were to private medical services. Table 3 shows the percent of ever married women who had used services for infertility at any time,

according to the most recent source of those services, race,

Hispanic origin, and age. The statistics include. infertility visits

,made at any time in the past because there were not enough

cases to make statistically reliable estimates of infertility visits

in the last 12 months or 3 years for the subgroups of the population shown in table 3.

About 6.3 million ever married women 15-44 years of age

had used infertility services at some time. The percents ever

using services were higher for women aged 25–34 years and

35–44 years compared with younger women. The same pattern

is reflected when white women are considered separately. A

higher proportion of white women ( 19 percent) than black women

Table 3. Number of ever married women 15-44 yeers of age,

percent who ever used services for infertility, and percent

distribution by most recent source of services, according to race,

Hispanic origin, and age: United Statea, 1982

[Preliminary data based on a sample of the household population of the

contermnnous Umted States. See Technlcai notes for estimates of sampllng

var!ab!lmf and de finnions of terms]

Most recent source of

services

Ever Private

Race, age, and married All medical

Hispanic origin women sources services Clinics

ALL WOMEN1

15-44 years .,.......

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

15-19 years . . . . . . .

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

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

White

15-44 years . . . . . . . . .

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

15-19 years . . . . . . .

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

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

Black

15-44 years . . . . . . . . .

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

15-19 yeare . . . . . . .

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

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

HISPANIC ORIGIN

Hispanic

15-44 years . . . . . . . . .

15-29 years . . . . . . . . .

30-44 years . . . . . . . . .

Non-Hispanic

15-44 years . . . . . . . . .

Number in

thousands Percent

34,937

5,500

682

15,998

13,439

30,419

4,975

621

13,819

11,626

3,442

427

39

1,630

1,385

2.790

1,240

1,550

31,191

11,525

19,666

18.1

10.7

●3.1

18.9

20.2

18.6

10.5

*3.4

19.2

21.3

13.5

“10.7

0.0

14.8

12.8

●

☛

☛

3.6

1.8

5.0

15-29 years . . . . . . . . .

30-44 years . . . . . . . . .

IIncludes white, black, and other rata% also includes origin not stated.

18.5

14.9

20.7

14.9

“7.0

“1.4

15.4

17.7

15.7

“7.0

*1.5

16.3

18.8

9.0

“3.9

0,0

8.7

10.9

“9.7

“7.0

*1 2.0

15.4

11.6

17.7

3.2

*3.8

●1.8

3.5

●2.5

2.9

“3.6

●1.9

“2.9

*2.5

4.5

●8.9

0.0

6.1

*1.8

●3.9

●4a

●3.1

3.1

●3.3

2.9

(14 percent) had ever used infertility services. This difference

is due primarily to the high percent of white women aged 35-44

who had used infertility services; comparisons betweenl other

age groups yield no significant differences. Although non-Hispanic women appeared more Iiiely than Hispanic women to

have used infertility services, none of the comparisons yielded

significant differences. For all ever married women, as well as

for white and black women separately, infertility services were

much more likely to be secured from private medical sources

than nom clinics.
a&medaa5

References

‘National Center for Health Statistics, G. Hendershot Use of family

planning service! by currently married women 15-44 years of age,

United States 1973 and 1976. Advance Data Front Vital artdHealth

Statistics. No. 45. DHEW Pub. No. (PHS) 79-1250. Public Health

Setvice. Washington. U.S. Government Printing Oflice, Feb. 1979.

2National Center for Health Statistics, G. Hendershot and K:”Bauman:

Use of services for family planning and infertility, United States. Vital

and EfeaMt Statistics. Series 23, No. 8. DHHS Pub. No. (PHS)

82-1984. Public Health Service. Washington. U.S. Government Printing Of?ice, Dec. 1981.

3National Center for Health Statistics, C. A. Bachrach and W. D.

Mosher: Use of contraception in the United States, 1982. Advance

Data From Vital and Hea[th Statistics. No. 102. DHHS Pub. No.

(PHS) 85-1250. public Heakk Service. Hyattsville, Md. In preparation.

4Nationa1 Center for Health Statistics, D. French National Survey of

Family Growth, Cycle L Sample design, estimation procedures, and

variance estimation. Vitai and Health Stattitics. Series 2, No. 76.

DHE W Pub. No. (PHS) 78-1350. Public Health Setvice. Washington.

U.S. Government Printing Ofiice, Jan. 1978.

5National Center for Health Statistics, W. Grady National Survey of

Family Growth, Cycle II Sample design, estimation procedures, and

variance estimation. Vital and Health Statistics. Series 2, No. 87.

DHHS Pub. No.(PHS)81-1361. Public Health Service. Washington.

U.S. Government Printing Office, Feb. 1981.

%1.S. Bureau of the Censux Money income and poverty status of

families and persons in the United States: 1982. Current Population

Reports, table A-1. Series P-60, No. 140. Washington.U.S. GovernmentPrintingOftice,July 1983.

Technical notes

Survey design

The National Survey of Family Growth (NSFG) is conducted perio&cally by the National Center for Health Statistics

to collect data on fertili~, family planning, and related aspects

of maternal and child health. Field work for Cycle I was conducted under contract in 1973 by the National Opinion Research Center. Field work for Cycles II and III was conducted

by Westatj Inc., in 1976 and 1982, respectively.

In all cycles, personal interviews were conducted with a

multistage area probability sample of women 15–44 yeara of

age in the noninstitutionrd population of the conterminous

United States. In Cycles I and II, ever married women and

never married women with offspring living in the household

were eligible for the survey. In Cycle III, all women aged 15-44

years were eligible regardless of marital status or the presence of

offspring. Women living in group quartera (such as college

dormitories) were excluded from the samples in Cycles I and

II, but included in Cycle III. Interviews were conducted with

9,797 women in Cycle I, 8,611 women in Cycle II, and 7,969

women in Cycle 111.The sample designs of Cycles I and II are

described in more detail in other NCHS reports.4.5

7u.s. Bureau of the Censtss Characteristics of the population below

the poverty level, 1975. Cutrent Population Repo*, table A-3. Series

P-60, No. 106. Washington. U.S. Government Printing OffIce, June

1977.

8U.S. Bureau of the Census: Characteristics of the low-income population 1973. Current Poptdazion Repons, table A-3. Series P-60,

No. 98. Washington. U.S. Government Printing Oftice, Jan. 1975.

gNatiottal Center for Health Statistics, B. Hudson: Basic data on visits

to family planning service sites, United States, 1980. Vital and Health

Statistics. series 13, No. 68. DHHS Pub. No. (PHS) 82-1729. Public

Health Service. Washington. U.S. Government Printing Office, July

1982.

I!National Center for Health Statistics, B. K. Cypresx Patterns of

ambulatory care in general and family practice, The National Ambttlatoty Medical Care Survey, United States, January 1980-December 1981. Vital and Health Statistics. Series 13, No. 73. DHHS Pub.

No. (PHS) 83-1734. Public Health Service. Washington. U.S. Government Printing Otlice, Sept. 1983.

1lNatiottal Center for Health Statistics, B. K. Cypress Patterns of

ambulatory care in obstetrics and gynecology The National Ambulatory Medical Care Survey, United States, January 1980-December

1981. Vital and Health Sfa/istics. Series 13, No. 76. DHHS Pub.

No. (PHS) 84-1737. Public Health Service. Washington. U.S. Government Printing Office, Feb. 1984.

12S. O. Aral and W. Cates, Jr.: The increasing concern with infertility

why now? JAMA 250(17>2327-2331, 1983.

Field work for Cycle III was conducted between August

1982 and February 1983. Black women and women aged

15-19 years were oversarnpled. Interviews were conducted by

trained femaie interviewers and lasted an average of 1 hour.

The interview focused on a woman’s pregnancy history use of

contraceptives in each pregnancy interva~ ability to bear childre~ future childbearing expectations; use of family planning

and infertility servicex maritsd histow, labor force participatiorq and a wide range of social, economic, and demographic

characteristics.

Reliability of estimates

Because the statistics presented in ibis report are based on

a sample, they may dtier from the statistics that would result if

all 54 million women represented by the NSFG had been intervieweci.The standard error of an estimate is a measure of such

diiTerences.The standard error of an estimated number or percent presented in this report may be calculated by using the

appropriate values of A and B from table I in the equations

NOTE: A lk.tof references followstfte text.
6 acbncedata

Table 1. Parameters used to compute estimated standard errors

end relative standard errors of numbers and percents of women,

by marital status, age, and race: National Survey of Family Growth

Parameter

Year, race, marital status,

and age A B

1982

White; all races:

All marital statuses. . . . . . . . . . . -0.0003935957 21306.4134

Ever married . . . . . . . . . . . . . . . . -0.0010973290 39809.1677

Never married . . . . . . . . . . . . . . . -0.0009351043 17608.8833

15-19 yeara . . . . . . . . . . . . . . . . -0.0014564930 13862.1044

81ack

All marital statuses; ever

married; never married. . . . . . . -0.0009086323 6346.0484

15-19 years . . . . . . . . . . . . . . . . -0.0033223630 4727,0569

1976

Currently married:

All races . . . . . . . . . . . . . . . . . . . -0.0001858989 6751.0619

White . . . . . . . . . . ... . . . . . . . . . -0.0002056235 7021.1665

Black . . . . . . . . . . . . . . . . . . . . . . -0.0006310400 2798.6440

1973

Currently married:

Allraces; white . . . . . . . . . . . . . . 0.0000176130 4493.7916

Black . . . . . . . . . . . . . . . . . . . . . . 0.0000402190 1600.4393

snd

( )

100–P’ lfz

%’) = B“P’” ~

where N’isthe number ofwomen, P’is the percent, and Xis

the number ofwomen in the denominator ofthepercent. Approximate standard errors for estimated percents of women of

all races in Cycle III are shown in table H.

Thechances areabout68in 100that asampleestimate

would fall within one standard error, andabout95 in 100that

itwouldfallwithin twostandarderrors ofastatisticbased ona

complete count of the population represented bythe NSFG.

Differences between pxcents d~cussed in this report were found

to be statistically significant at the 95-percent confidence level

using a twd.ailed t-test with 39 degrees of freedom. This means

that in repeated samples of the same type and size, a difference

as large as the one observed would occur in only 5 percent of

Table II. Approximate stendard errors for estimated percents

expressed in percentage points for women of all races: National

Survey of Family Growth, Cycle Ill

Estimeted percent

2 or 5 or 10 or 20 or 30 or 40 or

Base of percent 98 95 90 80 70 60 50

100,000 . . . . . . 6.4 10.0 13.B 18.4 21.1 22.6 23.0

600,000 . . . . . . 2.9 4.5 6.2 8.2 9.4 10.1 10.3

1,000,000 . . . . 2.0 3.2 4.4 6.8 6.7 7.1 7.3

5,000,000 . . . . 0.9 1.4 2.0 2.6 3.0 3.2 3.3

10,000,000 . . . 0.6 1.0 1.4 1.8 2.1 2.3 2.3

30,000,000 . . . 0.4 0.6 0.8 1.1 1.2 1.3 1.3

50,000.000 . . . 0.3 0.4 0.6 0.8 0.9 1.0 1.0

samples, if there were in fact no difference between the percents

in the population.

The relative standard error of a statistic is the ratio of the

standard error to the statistic and is usually expressed as a

percent of the estimate. In this repo~ statistics with relative

standard errors of 30 percent or larger are indicated with an

asterisk (*). These estimates are considered unreliable by’themselves, but may be combined with other estimates to make comparisons of greater precision.

Statistics in this report also maybe subject to nonsampling

error, that is, errors or omissions in responding to the interview, recording answers, and processing data. The data have

been adjusted for nonsaxnpling error due to nonresponse by

means of adjustments to the sample weights assigned to each

case. Other types of nonsampling error were minimized by a

series of stringent quality control measures similar to those

used in Cycles I and 11.4’5

Definitions of terms

Family planning services-In Cycle III, to obtain more

complete estimates of the extent and types of family planning

services, women were asked a series of questions about their

use of specific services. These included the following (1) advice

or counseling about any problems or worries about sexual intercourse, an unwanted pregnancy or one that occurred at a bad

time, having a sterilization operation, or birth corttro~ (2) checkup or medical test to check for correct use, fit, or position of a

birth control metho4 health problems from using a birth control

methd, or pregnancy, and (3) visit to a doctor or clinic to

renew a method of birth control the woman was already using

or to obtain a new method of birth control. Women who reported

receiving one or more of these services were classified as hlaving

used family planning services. This is the basis for the stat~stics

on use of family planning services reported in table 1 and for

the visit rates in table 2. The new family planning use measure

based on these services will be retained in future cycles.

Talked about contraception in the last 3 years—In Cycles

H and III, women were asked, “During the past 3 years, has a

doctor or other trained person prescribed, or trdked with you

about a method for delaying or preventing a pregnancy?” In

Cycle I, women were asked the same question except that a

period of 5 years was specified rather than 3 years. Women

who answered that question atll-rnatively also were asked,

“When was the last time you talked about methods of Karnily

planning with a doctor or trained person?” Women who answered that question with a date less than 3 years before the

interview were considered to have made a family plaming visit

in the last 3 years. This measure was retained in 1982 to produce time series data between 1973 and 1982. It will be replaced in future cycles by the measure based on the fill range

of family planning services.

Source offamily planning services-Women who had received family planning services in the last 12 months were shown

a card containing the following list of types of places “Clinics”

included hospital, family planning, community health center,

public health departrnen~ military health service, and student

NOTE: A listof referencesfollowsthe text.
dwmedaa7

health service c]~ics; “private medical sources” included visits

to private doctors, private group practices, CO-OPS, or privately

?wned clinics: service providers classified as “counselors” included minister, priest, religious counselor, school counselor,

family and social service agency, and youth center.

Age—Age is classified by the age of the respondent at her

last birthday before the date of interview.

Race—Race refers to the race of the woman interviewed

and is reported as black, white, or other. In Cycle III, race was

classified according to the woman’s report of the race that best

described her. In Cycles I and II, race was classified by the

observation of the interviewer. Cycle 111 data indicated that

results using either method of classification were found to be

very similar.

Hispanic on@k-In Cycle III, a respondent was classified

as being of Hispanic origin if she reported that her only or

principal national origin was Puerto Rican, Cuban, Mexican

American, Central or South American, or other Spanish. In

Cycles I and II, if a respondent reported her origin or descent

as Puerto Rican, Cuban, Mexican American, Central or South

American, or other Spanish, she was classified as being of Hispanic origin, whether or not it was her principal origin. In tables

where data are presented for women according to race and

Hispanic origin, women of Hispanic origin are included in the

statistics for white and black women if they were classified as

such by race.

For a small number of respondents (O. 1 percent in Cycles

I and II and 3 percent in Cycle III), origin was not ascertained.

In Cycle I, values were imputed where missing, using a known

value of another similar, randomly selected respondent in Cycle

II and in this report for Cycle III, however, missing values of

Hispanic origin were not imputed, and only cases with known

values are included in statistics on Hispanic origin.

Man2al status—Persons were classified by marital status

as married, widowed, divorced, separated, or never married. In

Cycles I and II, informally married women—women who volunteered that they were sharing living quarters with their sexual

partner-were classified as currently married. These women

constituted about 2 percent of currently married respondents in

Cycle I and 3 percent in Cycle II. In Cycle III, such women

were classified according to their legal marital status. Thus,

statistics on currently married women for 1982 shown in this

report are not strictly comparable to those for 1973 and 1976.

However, reclassifying women in the 1973 and 1976 surveys

according to the 1982 definition of marital status makes little

difference in the distributions of currently married women by

other characteristics for these years.

In all cycles, women who were married but separated from

their spouse were classified as separated if the reason for the

separation was marital discord, and as currently married otherwise.

Sten.My-For this repo~ use of family planning services

in the kt 3 Years was considered inapplicable if a woman was

sterile 3 yeas or more before the interview that is, she

reported it was impossible for her and her husband to conceive

as a result of ~ oPemtion, accident, or illness that occurred

more than 3 Years before the interview-before January 1970

for Cycle I, before JSMWY 1973 for Cycle II, or before January

1979 for Cycle HI. All other women were classified as able to

conceive at the beginning of the period for which their use of

family plaming services was reported.

Poverty [evel income—The poverty levei index was calculated by dividing the total family income by the weighted

average threshold income of families with the head of the family

under 65 years of age based on the poverty levels published by

the U.S. Bureau of the Census. G-g This definition takes into

account the sex of the family head and the number of persons in

the family. Total family income includes income from all sources

for ail members of the respondent’s family. For substantial numbers of respondents (7 percent in Cycle I, 16 percent in Cycle

II, and 22 percent in Cycle III), total family income was not

ascertained. In Cycle I, values were imputed where missing,

using a known value of another similar, randomly selected responden~ in Cycle II and in this report for Cycle III, however,

missing values of family income were not imputed, and only

cases with known values are included in statistics on poverty

income level. Because of these high levels of missing data, small

differences by poverty level income should be interpreted with

caution.

Infetiility services-A woman was classified as having used

infertility services if she answered either of the following questionsailkmatively “Have you (or your husband) ever been to

a doctor or clinic to talk about ways to help you become pregnant’?” or “(Not counting routine care or advice about a pregnancy), have you (or your husband) ever been to a doctor or

clinic to talk about ways to help you prevent a miscarriage?”

Spch women may not be currently infertil~ for example, if the

advice or treatment was successful.

Related data

Data on family planning services also are available from

two other surveys conducted by NCHS. Data from the National

Reporting System for Family Planning Services were collected

annually from 1972 through 1980 from a sample of medical

organizations that provide farnily planning services. These data

excluded family planning visits to private physicians’ ot%ces,

visits for pregnancy tests only, and visits the sole purpose of

which was to obtain contraceptive supplies or counseling.9 The

National Ambulato~ Medical Care Survey obtains data on

visits for family pkmning services from reports from a sample

of office-based physicians.lO,l 1Both data systems use information from the providers of family planning services, in contrast

to the NSFG, which uses information from recipients of services. Because of this difference and differences in collection

procedures and definitions of terms, data from these sources

may differ but they do provide complementary perspectives on

family planning visits. Recent estimates of annual numbers of

visits to private physician’s oftlces for infertility were published

in an article in the JoumaZ of the American Medical Association.12 The data in the cited article may differ from the statistics in this report because they refer to a different period of

tim~ because they refer to visits, and women may have more

than one visit in a yeaq and because both estimates, being

based on samples, are subject to sampling variability.

NOTE: A list of references followsthe text.
From Vital and Health Statistics of the National Center for Health Statistics Number 104. February 11, 1985

Fecundity and Infertility in the United States, 1965-82!

by William D. Mosher, Ph. D., and William F. Pratt, Ph. D., Division of Vital Statistics

In 1982, about half of all American married couples with

wives in the childbearing ages were currently sterile or had

some childbearing impairment. Almost 8 million of these couples

were voluntarily sterilized because they had had all the children”

they wanted, However, another approximately 6 million couples

were unable or unlikely to have additional births, including

about 1.4 million couples who were childless. These and related

statistics on fecundity and infertility in the United States are

from the National Survey of Family Growth, most recently

conducted in 1982 by the National Center for Health Statistics.

This report presents, for the first time, preliminary nationwide statistics on the fecundity status of all women of reproductive age in the United States, regardless of marital status,

and reports the latest data on trends in fecundity and infertility

among married couples. The data on currently married women

in this report update statistics published in a previous report. 1

The data for 1976 and 1982 were collected in Cycles 11and III

of the National Surveys of Family Growth (NSFG’S); the data

for 1965 are from the 1965 National Fertility Study conducted

by Princeton University.z

The 1982 NSFG was based on personal interviews with a

national sample of 7,969 women in the childbearing ages

( 15-44 years of age) in the noninstitutionalized population of

the conterminous United States. Between August 1982 and

February 1983 interviews were conducted with 3,201 black

women and 4,768 women of races other than black. The interview focused on the respondent’s fecundity (or physical ability

to have children); past and current use of contraception; marital

and pregnancy history; use of family planning and infertility

services; labor force participation; and a wide range of social,

economic, and demographic characteristics.

The Concept of Fecundity Status

The respondent’s physical ability to have children was

measured by her answers to a series of questions, not by a

medical examination. The purpose of this series of questions

was to classi@ couples into three major groups: surgically sterile

(impossible to have a baby); impaired fecundity (nonsurgically

sterile or difficult or dangerous to have a baby); and fecund (no

known physical problem). The questions included the following

As far as you know, is it possible or impossible for you . . .

to get pregnant (again)?

As far as you know, is there any problem or ditliculty Ifor

you . . . to conceive or deliver a(nother) baby?

In these questions, the words “as far as you know” are

important. Many women who have never tried to become pregnant do not know whether they have a fecundity impairment.

Some women who reported that they did not know of any

physical problems nonetheless have had long periods of time in

which they did not conceive although they used no contracep

tion. A few women maybe classified as having fecundity problems because of underreporting of either contraceptive use or

pregnancies, but there is no evidence that this underreporting

has a significant effect on the estimates presented here.3 Finally,

while some women with fecundity problems subsequently may

have children, their reduced capacity for childbearing lhas an

impact on the nation’s birthrate and on the estimates of couples

neediig medical services to improve their chances of childbearing.

The category “surgically sterile” is divided into two subgroups: contraceptively and noncontraceptively sterile. The

category “contraceptively sterile” consists of women or their

current husbands who have had a sterilizing operation (tubal

ligation, hysterectomy, or vasectomy) at least partly because

they had had all the children they wanted. Table 1 shows that

in 1982, 17 percent of all women 15-44 years of age were

contraceptively sterile, including 1 percent of never married

women, 28 percent of currently married women (or their husbands), and 20 percent of formerly married women. Nlot surprisingly, in each marital status category the percent contraceptively sterile was much higher for women with children

(parity I or more) than for childless women (parity O).

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

Table 1. Number of women 15-44 years of age and percent distribution by facundity status. according to marital status, parity, and aga:

United States, 1982

[Prehmmary statwtlcs based on a sample of the female popultmon of the contermmous Umtad States. Saa Tachnical notes for esttmates of sampling variability and

da finmons of terms]

Surgically sterile Impaired fecundity

NonMarital status, parity, All All surgically Long

and age women Total Contraceptive Noncontraceptive impaired sterile Sub fecund interval Fecund

MARITAL STATUS

AND PARITY

All women . . . . . . . . . . . .

Parity O . . . . . . . . . . . . . .

Parttyl or more . . . . . . .

Never married

Allparmes. . . . . . . . . . . .

Parity O . . . . . . . . . . . . . .

Parltyl or more . . . . . . .

Currently married

All parities . . . . . . . . . . . .

Parity O . . . . . . . . . . . . . .

Parity l or more . . . . . . .

Formerly married

All parities . . . . . . . . . . . .

Parity O . . . . . . . . . . . . . .

Parity l or more . . . . . . .

AGE

15-19 yeare . . . . . . . . . .

20-24 years . . . . . . . . . .

25-29 years . . . . . . . . . .

30-34 years . . . . . . . . . .

35-39 years . . . . . . . . . .

40-44 years . . . . . . . . . .

Number in

thousands

54,099

22.941

31,158

Percent distribution

100.0 17.4 7.8 8.2 1.6 5.4 1.2 66.5

100.0

100.0

1.4

29.2

1.7

12.4

8.4 2.5

8.1 1.0

5.2

5.6

0.7 88.5

1.5 50.2

19,162

16.693

2,469

100.0

100.0

100.0

1.3

“0.3

7.9

“0.8

“0.4

*3.8

4.1 1.0

3.7 1.0

“6.4 0.8

3.0

2.6

5.6

0.1 93.8

0.1 95.6

0.0 81.8

26,231

5,098

23,134

100.0

100.0

100.0

27.8

“4.6

33.0

11.0

●5.3

12.3

10.5 2.0

21.7 7.2

8.0 0.9

6.3

11.8

5.1

2.1 50.7

2.6 68,4

2.0 46.7

6.706

1,150

5,556

100.0

100.0

100.0

19.9

“4.2

23.2

14.4

84.1

16.6

10.7 1.9

“1 6.6 2.1

●9.4 1.8

8.7

14.3

7.6

0.0 54.9

0.1 75.1

0.0 50.8

●2.1 “0.5

6.0 “0.9

10.3 ●1.5

9.2 81.7

12.6 3.1

10.8 *2.9

9,521

10,629

10,263

9,381

7,893

6,412

100.0

100.0

100.0

100.0

100.0

100.0

0.0

“0.6

3.7

10.1

18.4

21.8

*1.6

4.9

7.7

6.5

7.0

4.7

97.9

“0.2 89.7

*1.O 73.9

●1.1 54.0

●2.5 33.7

“3.2 28.0

3.7

12.1

26.7

35.3

39.4

Women classified as “surgically sterile for noncontracep

tive reasons” had sterilizing operations for reasons other than

limiting the size of their families. Table 1 shows that 8 percent

(about 4.2 million) had had such operations, including 1 percent of never married women, 11 percent of cuently married

women (or their current husbands), and 14 percent of formerly

married women. The percent sterilized for noncontraceptive

reasons also was higher for women with children than for childless women.

Women classified as “nonsurgically sterile” said that it

was impossible to have a baby for some reason other than a

sterilizing operation—such as acciden~ illness, or unexplained

inability to conceive. As of 1982, 0.9 million women (2 percent) were classified as nonsurgically sterile. The percent

nonsurgically sterile was 1 to 2 percent in each marital status

category.

Women classified as “subfecund” said that it was physically

diflicult for them to conceive or deliver a baby, or that a doctor

had told them never to become pregnant again, because of danger

to the woman, the baby, or both. In 1982, 5 percent, or about

2.9 million women, were classified as subfecund, including

3 percent of never married, 6 percent of currently married, md

9 percent of formerly married women (table l).

Women or couples who were continuously married (either

formally or informally), did not use contraception, and did not

become pregnant for 36 months or more were classified as

having a “long interval.” Although these women reported no

known physical problems, they were well beyond any normal

period for conception, indicating some impairment to childbearing and possibly sterility. As of 1982, 1 percent of all

women, or about 0.6 million women, had a long interval.

The category “impaired fecundity” includes women who

were classified as nonsurgicaily sterile, subfecund, or having a

“long interval” since their last pregnancy. About 4.4 million

women, or 8 percent, had impaired fecundi@. Of these, about

1.9 million were chiMess and about 2.5 million had 1 or more

children (calculated from table 1).

“Fecund” is a residual category consisting of women who

were not surgically sterile (and whose husbands were not surgically sterile) and did not have impaired feeundi~. In table 1,

94 percent of never married women were classified as fecund,

compared with about 51 percent of currently married and

55 percent of formerly married women. There are two main

reasons for this large difference between never married and

ever married women never married women are younger on

average than ever married women, and most never married

women have never been pregnant or tried to become pregnant.

As a resul~ never married women are much less likely to be
advamedata 3

surgically sterile than ever married women, and have had less

chance to develop or discover any fecundity problems.

Table 1 also contains data for all women by age. Differences between age groups also reflect differences in marital

status, parity, and other factors. The percent contraceptively

sterile increased with age, from 4 percent at ages 20–24 to

39 percent at ages 40–44. The percent noncontraceptively

sterile also increased with age, especially after age 30. The

percent with impaired fecundity ranged from 2 percent at ages

15-19 to 13 percent at ages 35–39. Because both surgical

sterility and impaired fecundity are more common at the older

ages, the percent fecund declined from 98 among teenagers to

28 among women 40–44 years of age.

Trends Among Married Couples:

1976 to 1982

In 1982, as in 1976, the proportions of couples in both

categories of surgical sterilization increased with age and both

were greater among couples with children than among childless

couples (table 2). However, the proportions contraceptively

sterile differ sharply by parity at each age while noncontracep

tive sterilization is little affected by parity. In both years, impaired fecundity was notably more common among childless

women. It also increased with age, especially among childless

couples: about half the childless couples 35–44 years of age

had impaired fecundity. The increase in impaired fecundity

with age was not statistically significant among couples with

children in 1982.

The percent of married couples who were contraceptively

sterile increased by half-from 19 percent in 1976 to 28 percent in 1982—as shown in table 2. The largest increase occurred among couples with wives 35–44 years of age who had

1 or more children. Changes in the percents surgically sterile

for noncontraceptive reasons were not marked and generally

were not statistically significant. The proportion of cumently

married couples who were surgically sterilized (all reasons)

rose at a faster rate from 1976 to 1982 than from 1965 to, 1976

(table 3): an increase of 10.7 percentage points from 1976 to

1982 (1.8 percentage points per year) compared with an increase of 12.4 percentage points from 1965 to 1976 (1.1 percentage points per year).

Overall and among those with children, between 1976 and

1982 the proportions of couples with impaired fecundity decreased, although at 15–24 years of age the decline was not

statistically significant. There was no significant change in any

of the three age groups in the proportion of childless couples

with impaired fecundity (table 2).

The proportion fecund decreased from 56 to 51 percent

overall, primarily because of the decline from 35 to 26 percent

among wives 35-44 years of age with children (table 2). The

overall decline in the proportion of childless couples whc) were

fecund (from 73 to 68 percent) was entirely due to the older

age composition of childless couples in 1982 compared with

1976; there were no significant declines in the percent fecund

in any age group of childless couples.

Infertility Among Married Couples

“Infertility” is a medical concept for identifying couples

potentially in need of medical services to improve their chances

of childbearing. When neither partner is surgically sterile, a

Table 2. Number of currently married women 15-44 years of age and percent distribution by fecundity status, according to parity and age:

United States, 1976 and 1982

[Stattst!cs are based on samples of the female population of the conterm,nous Unned States. See Technical notes for esttmatea of sampling variability and definitmns

of terms. Data for 1982 are prelimmary]

Surgically sterile

Noncontra- Impaired

All women Total Contraceptive ceptive fecundity fecund

—.

Perity and age 1982 1976 1982 1976 1982 1976 1982 1976 1982 1976 1982 1976

All parities

15-44 years . . . . . . . . . . . . . . . . . . .

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

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

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

Parity O

15-44 years . . . . . . . . . . . . . . . . . . .

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

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

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

Panty 1 or more

15-44 yaars . . . . . . . . . . . . . . . . . . .

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

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

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

Number in

thousands

28,231 27,488

4,741 6,020

12,924 12,179

10,566 9,288

5,098 5,235

1,989 2,738

2,256 1,931

853 565

23,133 22.253

2.752 3,282

10,668 10.248

9,713 8.723

Percent distribution

100.0 100.0 27.8 18.5 11.0 9.6 10.5 15.7 50.7 56.1

100.0 100.0 “6.6 3.5 “0.6 “0.4 “8.0 10.8 84.8 85.3

100.0 100.0 23.8 19.1 7.7 6.8 9.4 15.5 59.0 58.7

100.0 100.0 42.3 27.6 19.8 19.4 12.8 19.1 25.1 33.9

100.0 100.0 ●4.6 1.5 ●5.3 4.1 21.7 21.4 68.4 73.0

100.0 100.0 “0.2 “0.1 - *11.1 10.6 88.6 89.3

100.0 100.0 “6.2 ●1.8 *3.5 4.5 21.1 27.3 69.2 66.4

100.0 100.0 “10.8 ●6.5 “22.5 22.3 47.8 53.9 ●18.9 17.2

100.0 100.0 33.0 22.6 12.3 11.0 6.0 14.3 46.7 52.2

100.0 100.0 “11.3 6.2 81.0 “0.8 *5.8 11.1 81.9 82.0

100.0 100.0 27.6 22.3 8.6 7.2 7.0 13.2 56.8 57.3

100.0 100.0 45.0 29.0 19.6 19.2 9.7 16.8 25.7 34.9
4

Table 3. Number of currently married women 15-44 yeers of age and percant distribution by infertility status, according to age, parity, and

race: United States, 1965, 1976, and 1982

[Stat!smcs are based on samples of the female population of the contermmous United Stafes. See Techmcat notes for estimates of samplmg variability and definitions

of terms, Data for 1982 are prellmmary]

Infertility status

All women Surgically sterile Infertile Fecundz

Age, parity, and race 1982 1976 19651 Total 1982 1976 1965 1982 1976 ?965 1982 1976 1965

Number in thousands Percent distribution

Totala . . . . . . . . . . . . . . . . . . 28,231 27,488 26,454 100.0 38.9 28.2 15.8 8.4 10.3 11.2 52.7 61.6 73.0

AGE

15-19 years . . . . . . . . . . . . .

20-24 years . . . . . . . . . . . . .

25-29 years . . . . . . . . . . . . .

30-34 years . . . . . . . . . . . . .

35-39 years . . . . . . . . . . . . .

40-44 years . . . . . . . . . . . . .

612

4,130

6,442

6,482

5,763

4.783

1,043 1,032

4.977 4,397

6,443 4.953

5,736 5,074

100.0

100.0

100.0

100.0

100.0

100.0

“0.3 “1.0 “0.6

●8.2 4.5 3.1

19.6 16.6 9.5-

43.6 36.2 17.0

!58.2 45.3 22.8

66.7 49.0 26.8

●2.1 ●2.1 “0.6 97.7 96.6 98.9

9.7 6.4 ●3.5 82.1 89.2 93.4

7.0 9.0 6.5 73.4 74.4 84.0

7.7 10.3 11.6 48.7 53.5 71.3

10.2 12.5 14.2 31.6 42.2 63.0

9.0 15.9 20.2 24.3 35.2 52.9

4,814

4,474 }

10,998

PARITY

o . . . . . . . . . . . . . . . . . . . . . . 5,098

5,891

9,042

8,201

5,235 3,492

5,571 4,497

7,638 6,878

9,045 11,587

100.0

100.0

100.0

100.0

9.9 5.6 7.3

17.7 8.8 7.5

46.8 32.3 14.2

63.4 49.8 21.5

19.6 18.1 14.5 70.5 76.3 78.2

10.6 12.4 17.2 71.7 78.8 75.3

5.0 6.0 9.3 48.2 61.7 76.6

3.8 7.9 9.4 32.8 42.3 69.0

1 ......................

2 . . . . . . . . . . . . . . . . . . . . . .

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

RACE AND AGE

White

15-44 year3. . . . . . . . . . . . . 8.1 9.4 10.5 53.0 61.6 73.6

7.4 6.7 4.4 78.8 82.6 90.1

8.6 11.6 14.3 35.9 44.3 63.3

25,175

10,005

15,170

24.795 23,427

11,217 9,166

13,577 14,261

100.0

100.0

100.0

38.9 29.0 15.9

13.7 10.7 5.5

55.5 44.1 22.3

15-29 yeare . . . . . . . . . . . . .

30-44 years . . . . . . . . . . . . .

Black

15-44 years . . . . . . . . . . . . .

15-29 yeare . . . . . . . . . . . . .

30-44 yeare . . . . . . . . . . . . .

2,125

859

1,266

2,169 43,027

993 41,216

1,177 41,811

100.0

100.0

100.0

36.3 21.6 14.2

19.7 9.2 6.6

47.5 32.1 20.6

13.1 18.1 16.3 50.6 60.3 69.5

10.9 12.1 4.5 69.4 78.7 88.9

14.6 23.2 26.1 37.9 44.7 53.3

1For method of estlmatton, see Technical notes.

‘The definmon of ‘“fecund used in this table IS different from the definmon used m tables 1 and 2.

31ncludes white, black, and other races.

4Ftgures are for races other than wh!te.

couple is classified as infertile if, during the preceding 12

months or longer, they were continuously married (presumed

to be sexwdly active), had not used contraception, and had not

conceived.+d The measure of infertility generally provides

lower estimates than impaired fecundity, as in tables 1 and 2,

because it includes only wives who have difilculty conceiving,

and excludes wives who are using contraception because a pregnrmcy would threaten their health. An important advantage of

this measure is that we can measure the trend in infertility since

1965,1,s as shown in tables 3 and 4. Not shown in the tables is

the duration of infertility, which averaged (median) 27 months

in 1982, with 47 percent of infertile couples having been infertile for 30 months or more.

Changes in the percent infertile between 1976 and 1982

generally were not statistically signiflcan~ except for the decline

among women 40–44 years of age. However, during the longer

period between 1965 and 1982, the proportion infertile showed

a statistically significant decline, from 11 percent in 1965 to

8 percent in 1982. This overall decline occurred because the

increase in infertility among women under age 30 was more

than offset by the sharp decline in the percent infertile among

women 30-44 years of age.

The decline in infertility among older women and overall

is the result of the large increase in surgical steriIi2ations.

Although it is possible that more women who know they are

infertile may have surgical sterilizations, it seems more likely

that the increasing use of contraceptive sterilizations reduces

the proportions of women who otherwise would fmd themselves

infertile at age 30 and older.

When couples who were surgically steriIe are excluded,

the percent infertile did not change significantly between 1965

(13 percent) and 1982 (14 percent) (table 4). Among couples

who were not surgically sterile, for those with wives aged

20-24 years, the percent infertile increased from 4 percent in

1965 to 11 percent in 1982. This was the only statistically

significant change in any age or parity group in table 4.

Table 3 also contains data by race. The percent classified

as infertile was higher among black than white couples in all

three survey years; in 1982, 13 percent of black and 8 percent

of white couples were classified as infertile. The increase in the
dvancedata 5

Table 4. Percent of currently married women 15-44 years of age (excluding surgically sterile) who were infertile by age, parity, and race

United States, 1965, 1976, and 1982

[Statistics are based on samples of the female population of the contermlnous United States. See Techmcai notes for estimates of samplmg variability and de firr,tmns

of terms. Data for 1982 are preliminary]

Age, parify, and race 1982 1976 1965

Totall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age

Parity

Race

13.8

●2.1

10.6

8.7

13.6

24.4

27.2

21.8

12.9

9,3

●10.4

13.3

20.6

Percent

14.3

“2.1

6.7

10.8

16.1

22.8

31.1

19.2

13.6

6.9

15.8

13.3

23.1

13.3

“0.6

“3.6

7.2

14.0

18.4

27.7

16.6

18.6

10.8

12.0

12.5

19.0

1Includes black. white, and other races.

percent infertile, from 4 to 7 percent among white couples with tween 1965 and 1982 because there was a significant increase

wives 15–29 from 1965 to 1982, was not statistically signiti- at ages 15–29 years (5 to 11 percent) and a significant decant. There was a significant decrease, from 14 to 9 percent, crease at ages 30–44 years (26 to 15 percent). The changes

among white couples with wives 30–44. The percent infertile between 1976 and 1982 for white and black women 15-29

among black couples 15-44 did not change significantly be- yeara of age were not statistically significant.

References

lNational Center for Health Statistics, W. Mosher md W. Pram

Reproductive impairments among married couples: United States.

Vital and iYeaM .Watistics. Series 23, No. 11. DHHS Pub No. (PHS)

83-1987. Public Health Service. Washington. U.S. Government

Printing Oftice, Dec. 1982.

2N. B. Ryder ad C. F. Westofi Reproduction in the United States,

1965. Princeton, N.J. Princeton University Press, 1971.

3W. Moshec Infertility trends among U.S. couples: 1965-1976.

Family Planning Perspectives 14( 1):22-27, Jan./Feb. 1982.

4R. Hatcher, G. K. Stewart, F. Stewart, et al.: Contraceptive Technology 1982-1983, 11th cd., p. 214, New York. Irvington Inc., 1982.

‘R Kleinman and P. Senanayalw Handbook on Infertility. London.

International Planned Parenthmd Federation, 1979.

‘R Ansbacher, M. Shapiro, C. L. Wh.ten, and H. Barber lFOIWIX

Management of infertility. The Female Patient 4(8):26-30, 1!?79.

‘U.S. Bureau of the Census Marital status and family status: March

1965. Current Population Reports. Series P-20, No. 144, tables 1

and 3. Washington. U.S. Government Printing OffIce, Nov, 1965.

8U.S. Bureau of the Census: Fertility of the population June 1964

and March 1962. Current Population Reports. Series P-20, No. 147,

table 1. Washington. U.S. Government Printing Oflice, Jan. 1966.
6

Technical notes

Survey design

The National Survey of Family Growth (NSFG) is a

periodic survey conducted by the National Center for Health

Statistics to collect data on fertility, family plannin% and related

aspects of maternal and child health. Fieldwork for Cycles II

and III was conducted under contract by Westat, Inc., in 1976

and 1982, respectively.

Personal interviews were conducted with a multistage area

probability sample of women 15-44 years of age in the noninstitutionalized population of the conterminous United States.

In Cycle II, conducted in 1976, ever married women and never

married women with offspring living in the household were eligible for the survey. In Cycle III, all women aged 15-44 were

eligible regardless of marital status or the presence of offspring.

Women living in group quarters were excluded from the sample

in Cycle II but included in Cycle III. Interviews were conducted

with 8,611 women in Cycle II and 7,969 in Cycle III. Further

details of the sample design of Cycle II are given in the report

cited in reference 1.

Fieldwork for Cycle III was conducted between August

1982 and February 1983. Black women and women aged

15-19 were oversampled. Interviews were conducted by trained

female interviewers and lasted an average of 1 hour. The interview focused on the woman’s pregnancy histo~, use of contraceptives in each pregnancy intervab ability to bear children

in the future, use of family plaming and infertility services;

marital histo~, labor force participation, and a wide range of

social, economic, and demographic characteristics.

Reliability of estimates

Because the statistics presented in this report are based on

a sample, they may differ from the statistics that would result if

all 54 million women represented by the NSFG had been interviewed. The standard error of an estimate is a measure of such

differences. The standard error of an estimated number or percent is calculated by using the appropriate values of A and B

fkom table I in the equations,

and

SE(P) =

[ 1

B“P’”(lOO-P’) II*

x

where iV = the number of women

P = the percent

X = the number of women in the denominator of the

percent

NOTE: A list of references follows the text.

Table 1. Parameters used to compute estimated standard errors

and relative standard errors of numbers and percents of women,

by marital status and race: National Survey of Family Growth

Parameter

Cycle, marital status, and race A B

CYCLE [1! (1982)

Ever married woman

Allraces and white . . . . . . . . . . . . -0.001097329 39,809.1677

Black . . . . . . . . . . . . . . . . . . . . . . . -0.000908632 6,346.0484

All marital statuses

Allraces and white . . . . . . . . . . . . -0.0003935957 21,306.4134

black . . . . . . . . . . . . . . . . . . . . . . . -0.000908632 6,346.0484

CYCLE II (1 976)

Currently married women

All races . . . . . . . . . . . . . . . . . . . . . +.0001 85899 6,751.0619

White and other races. . . . . . . . . . -0.000205624 7,021,1665

black . . . . . . . . . . . . . . . . . . . . . . . -0.000631040 2,798.6440

The chances are about 68 out of 100 that a sample estimate

would fail within one standard error of a statistic based on a

complete count of the population represented by the NSFG.

The chances are about 95 in 100 that a sample estimate would

fall within two standard errors of the complete count estimated.

Differences between percents discussed in this report were

found to be statistically significant at the 95-percent confidence

level using a 2-tailed r-test with 39 degrees of freedom. This

means that in repeated samples of the same type and size, a

difference as large as the one observed would occur in only

5 percent of samples, if there were, in fac~ no difference between the percents in the population.

The relative standard error of a statistic is the ratio of the

standard error to the statistic and usually is expressed as a

percent of the estimate. In this repro% statistics with relative

standard errors of 30 percent or larger are indicated with an

asterisk (*). These estimates may be viewed as unreliable by

themselves, but they may be combined with other estimates to

make comparisons of greater precision.

Statistics in this report also maybe subject to nonsampling

error, that is, errors or omissions in responding to the interview, recording answers, and processing data. The data have

been adjusted for nonresponse by mearts of adjustments to the

sample weights assigned to each case. Other types of nonsampling error were minimized by a series of quality control

measures as described in reports on Cycle II. 1

The 1965 National Fertilii Study

The figures on infertility for 1965 in tables 3 and 4 were

computed from the 1965 National Fertility Study and were

published previously.1.3 The survey design and procedures are

described in references 1 and 2.

Unlike the NSFG. the 1965 National FertiliW Study did

not include procedures to obtain weighted numbers therefore,
adwwdaa7

approximate numbers of currently married women for 1965

were obtained from population estimates made by the U.S.

Bureau of the Census. The weighted numbers shown for 1965

in table 3 differ from those shown for 1976 and 1982 in the

following ways: in the 1965 figures, Alaska and Hawaii are

included, “black” includes women of all races other than white;

and the age range includes currently married women 14 years

of age. The population estimates for 1965 are obtained from

two reporta published by the U.S. Bureau of the Census.7.s

Definitions of terms

Fecwz@y stafus—Fecundity is the physical ability of a

woman or couple to have children at the time of interview, and

refers to women with any number of children, unless classified

by parity. It is determined by responses to questions asked in

the NSFG interview, not by a medical examination. Fecundity

status, as shown in tables 1 and 2, has three main categories:

surgically sterile, impaired fecundity, and fecund. Women

were classified as surgically sterile if they (or their current

husband) had had a sterilizing operation. Surgically sterile is

divided into two subcategories: contraceptive and noncontraceptive. Impaired fecundity is divided into the subcategories

nonsurgically sterile, subfecund, and long interval. Women

were classified as nonsurgically sterile if they reported that it

was impossible for them to have a baby for any reason other

than a sterilizing operatioxy as subfecund if it was ditlicuh or

dangerous to have a baby and as “long interval” if they had

been continuously married (formally or informally), had not

used contraception, and had not become pregnant for 3 or more

years. In tables 1 and 2, fecund is a residual category and means

that the woman (or couple) is not surgically sterile and does not

have impaired fecundity. The percent of currently married

couples with impaired fecundity is higher than the percent inNOTE: A list of references followsthe text.

fertile because impaired fecundity includes difficulty in conceiving and dit%culty or danger carrying to term, whereas infertility includes only difficulty in conceiving. For more detailed

discussicrn of the concept of fecundity status, see the text of this

report, and the report cited in reference 1.

Infertility status—[nfertility is a medical concept; it identifies couples that may need medical services to improve their

chances of having children. When neither spouse is surgically

sterile, a couple is considered infertile if, during the previous

12 months or longer, they were continuously married, had not

used contraception, and had not conceived. Infertility status, as

shown in tables 3 and 4, refers to the categories surgically sterile,

infertile, and fecund, where fecund means neither surgically

sterile nor infertile.

Age—Age is classified by the age of the respondent at her

last birthday before the date of interview.

Race—Race refers to the race of the woman interviewed

and is reported as black, white, or other. In Cycle III, ra~cewas

classified according to the woman’s report of the race that best

described her. In Cycle II, race was classified by the oloservation of the intemiewer. Cycle III data indicated that results

using either method of classification were very similar.

Marital status—Persons were classified by marital status

as married, widowed, divorced, separated, or never married. In

Cycle II, informally married women—women who volunteered

that they were sharing living quarters with their sexual partner—

were classified as cunently married. These women constituted

about 3 percent of currently married women in Cycle H. To

improve the comparability of NSFG results over time and with

other sources of data, in Cycle III such women were classified

according to their legal marital status. In both cycles, ‘women

who were mamied but separated from their spouse were classified as separated if the reason for the separation was marital

discord, and as currently married otherwise.

Parity-Parity refers to the number of live births the

woman has had.

Symbols

..- Data not available

. . . Catego~ not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standard of

reliability or precision (30 percent or

more relative standard error)
From Vital and Health Statistics of the National Center for Health Statistics January 18, 1985 ● Number 105

Diagnosis-Related Groups Using Data From the

National Hospital Discharge Survey: United States, 1982

by Robert Pokras and Kurt K. Kubishke, Division of Health Care Statistics

Introduction

This report presents selected estimates for 1982 of

diagnosis-related groups (DRG) based on data from the National Hospital Discharge Survey (NHDS). A similar report

has been published for 1981.1 The current plan is to publish

reports on DRG’s regularly because they determine the reimbursement rates of Medicare inpatients, about 30 percent of all

discharges from short-stay non-FederaI hospitals.z

Developed at the Yale School of Organization and Management, DRG’s are being used by the Health Care Financing

Administration, some States, and some third party payers to

reimburse hospitals for inpatient care on a prospective basis.3

This approach to health care reimbursement operates on the

principle that patients with similar medical conditions should

receive similar care and use approximately the same amount of

resources; therefore, in general a hospital should be reimbursed

the same amount for each patient in a DRG. While there is

variation In resource consumption among individuals within a

DRG, these are expected to balance across all patients.

DRG’s were developed under the guiding principle that

“The primary objective in the construction of DRGs was a

definition of case type, each of which could be expected to

receive similar outputs or services ffom a hospitaL”4 Their

formulation was accomplished using clinical judgment and

statistical procedures that classify patients by measuring resource utilization. The first step in this process was to cluster

the universe of medical diagnoses into broad, mutually exclusive categories. These groups were formed to be consistent in

their anatomical or physiopathological classification, or in a

manner in which they are clinically managed. Once these

major diagnostic groups were formed, an interactive statistical

program (AUTOGROUP4) was used to further classify each

major group into discrete DRG’s. This process incorporated

patient information regarding diagnoses(prinxuy and second~),

procedures, sex, and age to explain maximally a patient’s length

of stay. In all, there currently are 470 DRG’s.

Prospective reimbursement was authorized under the Tax

Equity aqd FiscaJ Responsibili& Act of 1983. Under this act

hospitals participating in the Medicare program were brought

into this system beginning with their fiscal year as of October

1, 1983. The HeaIth Care Financing Administration, which

operates the Medicare program, is allowing several years for

hospitals to make a transition to prospective reimbursement by

adjusting DRG payments based on certain hospital characteristics and geographic location. At the end of this phase-in period,

care provided to a Medicare inpatient will translate into a preestablished payment based solely on the patient’s DRG.

There is an important issue related to the NHDS and the

implementation of this prospective reimbursement system how

this system may fiect the selection of a patient’s principal diagnosis and/or comorbidities. Because the NHDS is designed to

collect data on the morbidity of the hospital inpatient population, any external influence on diagnostic practices may affect

NHDS data. For example, two patients admitted to a hospital

for treatment of chest pain-one diagnosed as having chest

pain and the other diagnosed as having angina-will be placed

into different DRGs and have diHerent reimbursement rates.

There is speculation that in cases such as thk prospective reimbursement may influence the selection of a diagnosis,3 which in

turn may affect estimates produced from the NHDS. Afier

prospective payment has been in place for a few years, it may

be possible to examine trends in NHDS data and determine

the magnitude, if any, of this type of effect.

The statistics in this report are based on data collected by

means of the NHDS, a continuous survey conducted by the

National Center for Health Statistics since 1965. Data for this

survey are sampled from short-stay non-Federal general and

specialty hospitrdsin the 50 States and the District of Columbia.

The sample for 1982 contained approximately 214,000 medical

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

records from 426 hospitals. The relevant variables required to

produce DRG’s (diagnoses, procedures, sex, age, and other

variables) were abstracted from the face sheet of each sampled

medical record, and NHDS data thereby could be used to pr~

duce national estimates of DRGs. These estimates may be of

value for hospitals to compare their experience with that of

other hospitals. For this reason, statistics in this report are

frequency estimates and associated average length of stay for

DRG’s by hospital bed size and region of the country.

Highlights

The frequency and average length of stay for the most

common DRG’s are presented by age, region of the country,

and hospital bed size (tables 1–4). Age is dichotomized as

under 65 years of age and 65 years of age and older. This

allows a comparison with the Medicare population because

Medicare covers most hospital costs for approximately 94 percent of discharges 65 years of age and over. Tables 1 and 2

provide regional data, while tables 3 and 4 provide bed-size

data for these DRG’s. Within each of these sets of tables, the

first (tables 1 and 3) are for patients under 65 years of age, and

the second (tables 2 and 4) are for patients 65 years of age and

over.

By definition, some DRG’s are only for patients in a specific age range. In such a case the DRG title and the table title

(tables 1-4) together define the age group of the estimate. That

is, the most restrictive case of either the table or DRG title

determines the age group of the estimate. For example, “Diabetes, age greater than 35 years” in table 2 only refers to patients

65 years of age and over because of the table title; whereas,

“Simple pneumonia and pleurisy, age greater than 69 years

Table 1. Number of discharges and average length of stay of patients under 65 years of age discharged from short-stay hospitals, by selected

diagnosis-related groups and geographic regions: United States, 1982

[Discharges from non-Federal short-stay hospitals. Excludes newborn Infants]

All North Ail North

Diagnosis-related group regions Northeast Central South West regions Northeast Central South West

All discharges . . . . . . . . . . . . . . . . . . . . . . .

Vaginal delive~ without complicating

diagnoses . . . . . . . . . . . . . . . . . . . . . . . . .

Medical back problems . . . . . . . . . . . . . . .

Esophagitis, gastroenteritis, and

miscellaneous digestive disorders,

age 18-69 years without substantial

comorbidity and/or complication. . . . . . .

Cesarean section without substantial

comorbidity and/or complication. . . . . . .

Nonradical hysterectomy, age less than

70 years without substantial comorbidity

and/or complication . . . . . . . . . . . . . . . . .

Unrelated operating room procedures. . . .

Esophagttis, gastroenteritia, and

miscellaneous digestive disorders,

age O-17 years . . . . . . . . . . . . . ... . . . . . .

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . .

Alcohol- and substance-induced organtc

mental syndrome . . . . . . . . . . . . . . . . . . .

Dilation and curettage of uterus;

ionization except for malignancy . . . . . .

Abortion with dilation and curettage

of uterus . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bronchitis and asthma. age O-1 7 years. . .

Simple pneumonia and pleurisy, age

0-17 years . . . . . . . . . . . . . . ...+. . . . . .

Tonsdlectomy and/or adenoidectomy,

age O-17 years . . . . . . . . . . . . . . . . . . . . .

lnguinal and femoral hernia procedures,

age 18-69 yeara without substantial

comorbidity and/or complication. . . . . . .

Diabetea, age greater than 35 years . . . . .

Vaginal delivery with sterilization

and/or dilation and curettage of

uterus . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other factors influencing health status . . .

Total cholecystectomy with common

bile duct exploration, age less than

70 years without substantial comorbidity

and/or complication .,.... . . . . . . . . . . .

Bronchitis and asthma, age 18-69 years

wtthout substantial comorb!dity

and/or complication ..,... . . . . . . . . . .

Number in thousands Average length of stay in days

“- -.. ,. - --- --------- -----

L!, UYO

2,784

● 790

673

649

495

401

392

388

360

345

325

313

279

279

271

25!3

247

242

233

227

3,304

524

121

97

125

70

75

69

95

157

111

136

65

36

43

76

52

44

53

48

45

I,YLY

765

245

178

145

128

116

111

118

90

85

65

96

86

106

74

72

57

68

63

62

Y,UU4

937

298

320

258

212

145

173

108

68

118

86

118

131

83

80

104

110

75

83

81

4,!JYZ5

559

125

78

121

85

65

39

68

45

32

39

34

28

48

42

30

37

46

39

38

5.9

2.9

7.2

4.1

5.7

7.2

11.2

3.8

16.5

10.6

1.8

1.3

3.9

4.7

1.8

4.2

8.2

3.6

3.5

7.8

5.3

6.5

3.4

9.0

4,5

6.7

7.9

13.8

3.9

19.1

9.8

1.7

1.0

4.6

5.3

1.7

4.0

9.9

4.2

3.6

8.1

5.9

6.3

3.3

7.3

4.2

6.2

7.6

12.0

3.8

19.7

11.9

1.9

1.7

3.8

5.0

1.~

4.4

8.7

4.1

3.8

7.9

5.8

5.6

2.7

6.B

4.2

5.3

7.1

9.7

3.8

13.8

10.7

2.0

1.5

3.8

4.6

2.1

4.7

7.4

3.3

3.2

8.1

4.9

5.0

2.2

6.2

3.3

4.8

6.2

10.1

3.3

11.6

10.9

1.2

1.1

3.3

4.1

1.2

3.0

6.4

2.8

3.4

6.7

4.6
3

Table 2. Number of discharges and average length of stay of patients 65 years of age and over discharged from short-stay hospitals, by

selected diagnosis-related groups and geographic regions: United States, 1982

[Dmcharges from non-Federal short-stay hosp!tals. Excludes newborn infants]

All North All Nonh

Diagnosis-related group regions Northeast Central South West regions Northeast Central South West

429

427

387

376

300

295

276

226

208

195

186

181

174

158

155

14a

144

142

137

135

81

99

88

63

54

64

51

59

49

49

38

35

44

28

39

22

29

23

36

27

127

109

108

102

76

76

80

65

56

47

58

51

44

43

42

38

42

34

34

45

119

Numbers in thousands Average length of stay in days

All discharges . . . . . . . . . . . . . . . . . . . . . . . 10,697 2,283 3.008 3,631 1.774 10.1 12.3 10.3 9.4 8.2

Lens procedures . . . . . . . . . . . . . . . . . . . . . 3.0

Atherosclerosis, age greater than

69 years and/or substantial comorbidity

and complication . . . . . . . . . . . . . . . . . . . 157 10.9

Heart failure and shock . . . . . . . . . . . . . . . . 132 11.8

Esophagitis, gastroenteritis, and

mwcellaneoua digestive disorders,

age greater than 69 years and/or

substantial comorbidity and

complication . . . . . . . . . . . . . . . . . . . . . . . 169 8.3

Chronic obstructive pulmonary disease. . . 117

Specific cerebrovascular disorders

except transient ischemic attack. . . . . . . 103

Simple pneumonia and pleurisy, age

greater than 69 years and/or substantial

comorbidity and complication . . . . . . . . . 106

Unrelated operating room procedures. . . . 72

Diabetes, age greater than 35 years . . . . . 77

Angina pectoris . . . . . . . . . . . . . . . . . . . . . . 67

Medical back problems . . . . . . . . . . . . . . . 63

Cardiac arrhythmia and conduction

disorders, age greater than 69 years

and/or substantial comorbidity

and complication . . . . . . . . . . . . . . . . . . . 65

Circulato~ disorders with acute

myocardial infarction without

cardiovascular complications,

discharged alive . . . . . . . . . . . . . . . . . . . . 62

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . 70

Transient ischemic attacks. . . . . . . . . . . . . 52

8ronchitis and asthms, age greater than

69 years and/or substantial comorbidity

and complication . . . . . . . . . . . . . . . . . . . 59

Transurethral prostatectomy, age grester

than 69 years and/or substantial

comorbidity and complication . . . . . . . . . 45

Kidney and urinary tract infections,

age greater than 69 years andlor

substantial comorbidity and

complication . . . . . . . . . . . . . . . . . . . . . . . 67

Respirato~ neop[asms. . . . . . . . . . . . . . . . 43

Hip and femur procedures except

major joint, age greater than 69 years

and/or substantial comorbidity and

complication . . . . . . . . . . . . . . . . . . . . . . . 38

102

62

59

42

54

52

38

29

24

32

27

30

24

17

22

29

28

17

24

25

2.9

8.7

9.7

6.7

9.8

15.4

10.7

17.3

10,0

6.6

9.3

7.1

12.2

7.9

7.6

8.3

9.3

8.5

10.9

19.5

11.9

20.4

11.8

20.0

13.9

8.0

11.5

9.1

13.6

8.8

9.6

9.2

11.1

9.9

11.0

25.1

3.3

9.0

10.3

6.9

10.2

16.2

10.6

17.5

9.7

6.4

9.7

7.2

12.9

7.7

7.8

8.0

9.5

8.8

11.9

19.9

3.0

8.2

8.8

6.3

8.8

13.2

10.7

15.8

8.4

6.6

7.7

7.7

11.8

7.6

7.3

8.3

9.4

8.1

11.2

18.5

2,4

6.3

7.7

5.8

9.2

12.2

9.5

15.0

8.1

4.9

8.8

4.8

9.4

8.4

4.3

8.0

6.8

7.1

9.0

14.3

and/or substantial comorbidi~ and complication” in table 2

would not include a patient under 70 years of age because of

the restriction in the DRG title.

The most common DRG for patients under 65 years of

age was “Vaginal delivery without complicating diagnoses”

(table 1), with an estimated 2.8 million discharges in 1982.

“Cesarean section without substantial comorbidity and/or

complication,” with 649,000 discharges, also was among the

most frequent DRG’s in this age group. For patients 65 years

of age and older (table 2), “Lens procedures” was the most

common DRG, 429,000, and “Atherosclerosis, age greater

than 69 years and/or substantial comorbidi~ and compIication~

427,000, was the second most common DRG for the elderly.

The average length of stay for specific DRG’s in the four

regions of the country generally reflects the pattern found for

all patients: the Northeast and North Central have the longest

average length of stay and the West has the shortest. Regional

length-of-stay dtierences were greater for patients 65 years of

age or more than for younger patients. The West had an average

length of stay of 5.0 days for patients under 65 years of age,

and the Northeast had an average length of stay of 6.5 days, a

difference of 1.5 days, or 30 percent greater. For older patients,

however, the Northeast had art average length of stay 4.1 days

greater than the elderIy patients in the West ( 12.3 versus 8.2

days), a difference of 50 percent.

Overall there was a tendency for length of stay to increase

with hospital bed size (table 3 and 4) for patients under 65

years of age as well as for older patients, but this pattern is not
4 admncedata

Table 3. Number of discharges and average length of stay of patients under 65 years of age discharged from short-stay hospitals, by selectad

diagnosis-related groups and hospital bed size United States, 1982

[Dmharges from non-Fedsral short-stay hospnals. Excludes newborn infants]

500

1oo- 2oo500300- or 1oo- 200- 300- or

All 6-99 799 299

Diagnosis-related group

399 more All 6-99 199 299 399

hospitals beds beds

more

beds beds beds hospitals beds beds beds beds beds

All discharges . . . . . . . . . . . . . . .

Vaginal delive~ without

complicating diagnoses. . .

Medical back problems . . . . . . .

Esophagitis, gastroenteritis, and

miscellaneous digestive

disorders, age 18-69 years

without substantial comorbidity

and/or complication. , . . . . . . .

Cesarean section without

substantial comorbidity and/or

complication . . . . . . . . . . . . . . .

Nonradical hysterectomy, age

less than 70 years without

substantial comorbidity and/or

complication . . . . . . . . . . . . . . .

Unrelated operating room

procedures . . . . . . . . . . . . . . . .

Esophagitis, gastroenteritis, and

miscellaneous digestive

disorders, age 0-17 . . . . . . . . .

Psychoses . . . . . . . . . . . . . . . . . .

Alcohol- and substance-induced

organic mental syndrome. . . . .

Dilation and curettaga of uterus;

ionization except for

malignancy . . . . . . . . . . . . . . . .

Abortion with dilation and

curettage of uterus. . . . . . . . . .

Bronchitis and aathma, age

O-17 years . . . . . . . . . . . . . . . .

Simple pneumonia and pleurisy,

age O-17 years . . . . . . . . . . . . .

Tonsillectomy and/or

adenoidectomy, age O-17

years . . . . . . . . . . . . . . . . . . . . .

Inguinal and femoral hernia

procedures, aga 18-69 years

without substantial comorbidity

and/or complication. . . . . . . . .

Diabetes, age greater than

35 years . . . . . . . . . . . . . . . . . .

Vaginal delivery with

sterilization and/ordination

and curettage of uterus . . . . . .

Other factors influencing

health status . . . . . . . . . . . . . . .

Total cholecystectomy with

common bile duct exploration,

age Iess than 70 years without

substantial comorbidity and/or

complication . . . . . . . . . . . . . . .

Bronchitis and asthma, age

18–69 years without

substantial comorbidity and/or

complication . . . . . . . . . . . . . . .

Numberln thousands

27,896 4,664 4,906 4.459 6,909 6,958

2,784

790

673

649

495

401

392

388

360

345

325

313

279

279

271

259

247

242

233

227

425

170

191

75

51

50

82

34

105

56

36

59

85

52

40

57

47

35

44

60

466

137

116

123

111

65

97

74

59

78

68

79

63

55

50

43

47

38

41

37

433

150

115

93

80

65

60

40

39

43

41

50

48

63

45

53

41

39

34

38

700

185

143

175

126

98

78

137

97

81

78

70

49

68

72

56

47

58

65

45

759

149

108

183

125

123

75

103

60

87

102

56

35

41

64

50

65

73

48

46

Averaae.- Ienath of stay.,indava

5.9 5.7

2.9

7.2

4.1

5.7

7.2

11.2

3.8

16.5

10.6

1.B

1.3

3.9

4.7

1.8

4.2

8.2

3.6

3.5

7.8

4.5

2.4

6.3

3.3

5.4

7.1

6.9

2.7

12.0

9.6

1.8

1.6

3.4

4.1

1.6

4.2

8.2

3.4

3.1

7.2

5.3 4.B

5.3

2.8

7.0

4.3

5.2

6.5

7.7

3.7

14.5

13.5

1.7

1.4

3.8

4.9

1.8

3.9

7.2

3.3

4.0

7.5

5.3

2.B

7.5

4.6

5.5

7.4

12.8

3.8

15.1

12.9

2.1

1.5

4.5

5.0

1.9

4.4

8.2

3.5

3.5

8.4

5.0

6.2

3.1

7.6

4.2

5.8

7.3

13.0

4.0

15.8

9.9

1.9

1.2

4.1

5.2

1.7

4.2

9.4

3.7

3.6

8.4

5.7

6.8

3.2

7.6

4.8

6.1

7.5

12.5

4.8

20.9

9.4

1.6

1.1

3.8

4.9

1.9

4.2

9.7

3.8

3.4

7.4

5.B

consistent for some of the individual DRG’s for which average 1–4) allows hospitals to compare their experience with that of

length of stay in small and medium-size hospitals is equal to or other hospitals. While comparison is tenuous on a case-bygreater than the average length of stay in large hospitals (500 case basis, a hospital with an average length of stay 2, 3, or

or more beds). more days longer than the national average for a specific DRG

The average length of stay associated with a DRG (tables may need to examine why it is so far from the norm. This kind
5

Tabla 4. Number of discharges and averaga Iarrgth of stay of patiants 65 yeara of age or over discharged from short-stay hospitals. by selected

diagrrosis-ralated groups and hospital bed size United States, 1982

[Discharges from non-Federal short-stay hospitals. Escludes newborn infants]

500 500

?00- 2oo- 300- or 1ooAil 6-99

2oo- 300- or

799 299 399 more All 6-99 199

Diagnosis-related group hospitels beds beds

299 399

beds

more

beds beds hospitafs beds beds beds beds beds

All discharges . . . . . . . . . . . . . . .

Lens procedures . . . . . . . . . . . . .

Atherosclerosis, age grester

than 69 years and/or

substantial comorbidity and

complication . . . . . . . . . . . . . . .

Heart failure and shock . . . . . . .

Esophagitis, gastroenteritis, and

miscellaneous digestive

disorders, age greater than

69 years and/or substantial

comorbidity and

complication . . . . . . . . . . . . . . .

Chronic obstructive pulmona~

disease . . . . . . . . . . . . . . . . . . .

Specific cerebrovascular

disorders excapt tranaient

ischemic attack . . . . . . . . . . . . .

Simple pneumonia and pleurisy,

age greater than 69 years

and/or substantial comorbidity

and complication . . . . . . . . . . .

Unrelated operating room

procedures . . . . . . . . . . . . . . . .

Diabetes, age greater than

35 years . . . . . . . . . . . . . . . . . .

Angina pectoris . . . . . . . . . . . . . .

Medical back problems . . . . . . .

Cardiac arrhythmia and

conduction disorders, age

greater than 69 years end/or

substantial comorbidity and

complication . . . . . . . . . . . . . . .

Circulato~ disorders with acute

myocardial infarction without

cardiovascular complications,

discharged alive . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . .

Transient ischemic attacks . . . .

Bronchitis and asthma, age

greater than 69 years and/or

substantial comorbidity and

complication . . . . . . . . . . . . . . .

Transurethral prostatectomy,

age greater than 69 years

and/or substantial comorbidity

and complication . . . . . . . . . . .

Kidney and urinary tract

infections, age greater than

69 years and/or substantial

comorbidity and

complication . . . . . . . . . . . . . . .

Respwatory neoplasms. . . . . . . .

Hip and femur procedures

except major joint, age greater

than 69 years and/or

substantial comorbidity and

complication . . . . . . . . . . . . . . .

Number in thousanda

10,697 “ ‘-- - ‘-- ‘ ‘-- ‘--- ‘-”-

429

427

387

376

300

294

276

226

208

195

186

181

174

158

155

148

144

142

137

135

L,} Id

32

90

113

123

76

66

98

29

50

54

45

49

35

39

36

47

14

48

22

16

I ,aLu

94

87

70

60

48

54

45

42

37

34

33

31

27

31

34

31

31

26

19

23

I ,Yu/

85

80

68

64

58

60

42

46

44

40

36

33

31

29

30

25

27

20

19

24

L.tl.m

118

107

82

78

71

63

56

58

44

44

41

37

46

27

32

28

38

31

40

40

L, 14U

99

63

54

51

48

50

36

52

33

23

31

30

35

32

24

17

33

18

37

32

Average length of stay in daya

10.1 9.6 10.2 10.8

2.9

8.7

9.7

6.7

9.8

15.4

10.7

17.3

10.0

6.6

9.3

7.1

12.2

7.9

7.6

8.3

9.3

8.5

10.9

19.5

8.?

2.9

7.3

8.1

5.6

8.1

11.2

9.3

14.1

8.2

5.9

7.8

5.7

11.2

6.2

5.5

6.9

9.2

7.2

7.7

18.3

3.0

8.1

9.3

7.2

9.5

15.8

10.9

17.3

9.2

6.3

8.3

6.6

11.6

7.3

7.5

9.6

8.3

9.2

10.8

18.1

2.6

8.8

10.5

6.9

10.7

16.1

11.7

16.0

10.3

6.3

8.5

7.8

12.1

9.3

7.6

8.7

10.2

8.5

10.0

17.9

3.0

9.6

10.8

8.3

10.6

14.9

11.8

17.5

10.9

7.6

11.6

7.8

12.9

7.7

9.7

8.8

9.2

9.2

11.8

20.3

11.5

3.1

10.2

11.0

6.5

10.5

20.1

11.6

19.9

12,1

7.4

10.2

8.5

12.9

9.6

8.2

8.2

9.5

9.4

12.4

21.3

of comparison may be worthwhile as a starting poin& but even reimbursement is likely to afect areas such as-cost savings,

within a DRG, average length of stay is not an exact measure quality of care, medical records keeping, and certain areas of

of resource consumption. medical practice. However, for at least two reasons data curThe change to prospective payment for Medicare inpatient rently available on DRG’s from the NHDS (this report and a
6 admncedata

similar report using 1981 datal ) should not be used to evaluate

the success of prospective payment. First. the prospective payment program was not implemented until october 1983, and,

second. historical trends must be studied to shed light on shortterm changes in hospital utilization.

For example, from 1981 to 1982 average length of stay

decreased 0.4 days for patients 65 years of age and over, and

References

1Nation~ Center for Health Statistics. R Pokras: Diagnosis-related

groups using data from the National Hospital Discharge Survey. United

States. 1981. Advance Data From Vital and Heaith Statistics.

No. 98. DHHS Pub, No. (PHS) 84-1250. Public Health Service.

Hyattsville, Md., July 20, 1984.

2National Center for Health Statistics, E. J. Graves: Utilization of

short-stay hospitals, United States, 1982 Annual Summary. Vita/ and

Health Statistics. Series 13, No. 78. DHHS Pub. No. (PHS) 84-

1739. Public Health Service. Washington. U.S. Government Printing

OtXce, Aug. 1984.

3J. Alsofrom: Playing the numbers. Medical World News, Oct. 24,

1983, pp. 38-55.

4R B. Fetter, S. Yowgsoo, J. L. Freeman, and others: Case mix

definition by diagnostic related groups. Medicaf Care 18(2), Supplement. (CopyrigJtt 1980: Used with the permission of Medical Care. )

sNational Center for Health Statistics, W., F. Lewis Utilization of

shofi-stay hospitals, summary of nonmedical statistics, United States,

1972. Vital and Health Statistics. Series 13, No. 19. DHEW Pub.

No. (HRA) 75-1770. Health Resources Administration. Washington.

U.S. Government Printing OfYice, June 1975.

bNatlunal Center for Health Statistics, M. G. Sirkem Utilization of

short-stay hospitals, summary of nonmedical statistics, I Tnited States,

Technical notes

Survey methodology

Source of data

The National Hospital Discharge Stuvey (NHDS) encompasses patients discharged from shot--stay hospitals, exclusive of military and Veterans Administration hospitals,

located in the 50 States and the District of Columbia. Only

hospitals with six or more beds and an average length of stay of

Iess than 30 days for all patients are included in the survey.

Discharges of newborn infants are excluded from this report.

The universe of the survey consisted of 6,965 short-stay

hospitals contained in the 1963 Master Facility Inventory of

Hospitals and Institutions. New hospitals were sampled for

inclusion in the survey in 1972, 1975, 1977, and 1981. The

sample for 1982 consisted of 550 hospitals. Of these, 71 refused

to participate and 53 were out of scope either because the hospital had gone out of business or because it failed to meet the

definition of a short-stay hospital. Thus 426 hospitals particisome specitic DRG’s also showed a reduction in average length

of stay. However, length of stay in short-stay non-Federal hospitals has been decreasing for over a decade (the average length

of stay for patients 65 years of age and over was 12.2 days in

1972s compared with 10.1 days in 1982). and it will take more

time to understand the effects prospective payment will have, if

any, on hospital utilization.

1965. Vital and Health Statistics. Series 13, No. 2. PHS Pub.

No. 1000. Public Health %xvice. Washington. U.S. Government

Printing Office, Aug. 1967.

TNational Center for Health Statistics, M. J. W itkin: Utilization of

short-stay hospitaIs by characteristics of discharged patients, United

States, 1965. Vitai and Health Stafisfics. Series 13, No. 3. PHS Pub.

No. 1000. Public Health Service. Washington. U.S. Government

Printing Office, Dec. 1967.

sNational Center for Health Statistics, R Pokras: Surgical and nonsurgical procedures in shorn-stay hospitals, United States, 1979. Vital

and Heakh Statistics. Series 13, No. 70. DHHS Pub. No. (PHS)

83-1731. Public Health Service. Washington. U.S. Government

Printing OtTice, Feb. 1983.

$’u.s. Pub]ic He~th Service and Health Care Financing Administration: International Classljication of Diseases, 9th Revision, Clinical

Modification. DHHS Pub. No. (PHS) 80-1260. Public Health Service. Washington. U.S. Government Printing O~ce, Sept. 1980.

loFederal RegistenVol. 48, No. 171, Part ~, Rules and Regulations,

Sept. 1, 1983.

pated in the survey during 1982 and provided approximately

214,000 abstracts of medical records.

Sample design

All hospitals with 1,000 or more beds in the universe of

short-stay hospitals were selected with certainty in the sample.

All hospitals with fewer than 1,000 beds were stratifiecl, the

primary strata being 24 size-by-region classes. Within each of

these 24 primary strata, the allocation of the hopsitals was

made through a controlled selection technique so that hospitals

in the sample would be properly distributed with regard to type

of ownership and geographic division. Sample hospitals were

drawn with probabilities ranging from certainty for the largest

hospitals to 1 in 40 for the smallest hospitals.

Sample discharges were selected within the hospitals using

the daily listing sheet of discharges as the sampling frame.

These discharges were selected by a random technique, usually

on the basis of the terminal digit or digits of the patient’s medical
dmcdata7

record number, a number assigned when the patient was admitted to the hospital. The within-hospital sampling ratio for

selecting sample discharges varied inversely with the probability

of selection of the hospital.

Data collection and estimation

The sample selection and the transcription of information

from the hospital records for abstract forms were performed by

the hospital staff or by representatives of the National Center

for Health Statistics or by both. The data were abstracted from

the face sheets of the medical records. All discharge diagnoses

were listed on the abstract in the order of the principal one, or

the first-listed one if the principal one was not identified, followed by the order in which all other diagnoses were entered

on the face sheet of the medical record.

Statistics produced by NHDS are derived by a complex

estimating procedure. The basic unit of estimation is the sample

inpatient discharge abstract. The estimating procedure used to

produce essentially unbiased national estimates in NHDS has

three principal component~ inflation by reciprocals of the

probabilities of sample selection, adjustment for nonresponse,

and ratio adjustment to fixed totals. These components of estimation are described in appendix I of two earlier publications.6.7

Diagnosis-related groups

The diagnosis-related groups (DRG’s) used in this report

were produced using the most current DRG program available

at the time (summer of 1983). This is a computer program that

groups patients into DRG’s based on diagnostic, surgical, and

patient information. The program is maintained and is commercially available at Health Systems International (DRG

Support Group, 100 Broadway, New Haven, Corm. 065 11).

However, the actual program used to produce estimates in this

report was obtained from the Health Care Financing Administration.

To help interpret the data in this report, two points are

worth mentioning. First, the entire NHDS tile was used to

produce estimates, including outliers. None of the data was

excluded, or trimmed, because of an abnormally long length of

stay. Second, the NHDS only codes three ICD-9-CM

Class 4 procedures:s.g circumcision, code 64.0; episiotomy,

code 73.6; and removal of intrauterine contraceptive device,

code 97.71. In certain instances Class 4 procedures can alter

the DRG designation for a patient. The effect of not coding

these procedures in the NHDS on determining DRG’s is unlmown, but probably quite small. In all other respects, the

DRG’s presented in this report are consistent with those in the

Federal Register of Thursday, September 1, 1983.10

In publications from the National Center for HeaIth Statistics using NHDS data, several schemes have been used to

group patients into categories based on either their diagnoses

or the procedures performed. These groups were developed to

report general purpose statistics to the many users of NHDS

data, and any similarity between the titles of those categories

and DRG titles is coincidental.

NOTE: A list of references follows the text.

Sampling errors and rounding of numbers

The standard error is a measure of the sampling variability

that occurs by chance because only a sample, rather than an

entire universe, is surveyed. The relative standard error of the

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate.

Table I shows relative standard errors for discharges and i%stlisted diagnoses for 1982. The standard errors for average lengths

of stay are shown in table II. Estimates have been rounded to

the nearest thousand. For this reason detailed figures within

tables do not always add to the totals.

Tests of significance

In this reporg the determination of statistical inference is

based on the tsv~tailed Bonferroni test for multiple comparisons.

Terms relating to differences, such as “higher” and “less,”’

indicate that the differences are statistically significant. Terms

such as “similar” or “no difference” mean that no statistically

significant difference exists between the estimates being compared. A lack of comment on the difference between any two

estimates does not mean that the difference was tested and

found to be not significant.

Definition of terms

Patient—A person who is formally admitted to the inpatient service of a short-stay hospital for observation, care. diagnosis, or treatment. In this report the number of patients refers

to the number of discharges during the year, including any

multiple discharges of the same individual from one or more

short-stay hospitals.

Table i. Approximate relativa standard errors of estimated numbar

of discharges and first-listed diagnoses United States, 1982

Relative

standard

Size of estimate error

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.3

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.2

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5

300,00Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.6

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.9

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1

4.000 .000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0

Table Il. Approximate standard errors of average lengths of stay

by number of discharges United States, 1982

Average length of stay in days

Number of discharges 2 6 10 20

Standard error in days

10,000 . . . . . . . . . . . . . . . . . . . 0.7 1.2 1.7 2.2

50.000 . . . . . . . . . . . . . . . . . . . 0.3 0.7 1.0 1.4

100,000 . . . . . . . . . . . . . . . . . . 0.3 0.6 0.9 1.2

500,000. . . . . . . . . . . . . . . . . . 0.2 0.5 0.8 0.9

1,000,000 . . . . . . . . . . . . . . . . 0.2 0.5 0.8 0.7

5,000,000 . . . . . . . . . . . . . . . . 0.2 0.5 0.8 . . .
8

Average iengrh of stay—The total number of patient days

accumulated at time of discharge by patients discharged during

the year divided by the number of patients discharged.

Age—Patient’s age refers to age at birthday prior to admission to the hospital inpatient service.

Discharge-Discharge is the formal release of a patient by

a hospital; that is, the termination of a period of hospitalization

by death or by disposition to place of residence, nursing home,

or another hospital. The terms “discharges” and “patients discharged” are used synonymously. -

Geographic region—Hospitals are classified by location

in one of the four geographic regions of the United States that

correspond to those used by the U.S. 13ureau of the Cens~

Region Stares included

Northeast. . . . . . Maine. New Hampshire, Vermont, Massachusetts. Rhode Island. Connecticut,

New York, New Jersey, and Pennsylvania

North Central. . . Michigan, Ohio, Illinois. Indiana, Wisconsin, Minnesota, Iowa, Missouri. North

Dakota, South Dakota, Nebraska, and

Kansas

Regton—Con. States inciuded—Con.

South . . . . . . . . . Delaware. Maryland, District of Columbia,

V\rginla. West Virginia, North Carolina.

South Carolina. Georgia, Florida, Kentucky, Tennessee. Alabama, Misswsippl.

Arkanaas, Louisiana, Oklahoma. and

Texas

West . . . . . . . . . Montana, Idaho. Wyoming, Colorado, New

Mextco, Arizona. Utah. Nevada. Washington, Oregon, California, Hawaii, and

Alaska

Hospifak-Short-stay special and general hospitals have

six beds or more for inpatient use and an average length ofstay

of less than 30 days. Federal hospitals and hospital units of

institutions are not included.

Bed size of hospital—Size is measured by the number of

beds, cribs, and pediatric bassinets regularly maintained (set

up and stafTed for use) for patien~, bassinets for newborn infants

are not included. In this report the classification of hospitals by

bed size is based on the number of beds at or near midyear

reported by the hospitals.
From Vital and Health Statistics of the, Nationai Center for Health Statistics Number 106 . April 10, 1985

Use of Topical Antimicrobial Drugs in Office-Based Practice:

United States, 1980–81

by Gloria J. Gardocki, Ph. D., Division of Health Care Statistics

This report examines the use of topical antimicrobial

medications in the ofFice-based patient care setting. The information used was obtained by combining the 1980 and 1981

results of the National Ambulato~ Medical Care Survey, a

sample survey of care provided by ofilce-based physicians.

Conducted annually by the National Center for Health Statistics from 1973 through 1981, the survey is being carrkd out

again in 1985.

Because of the nature of the data collected by means of the

National Ambulatory Medical Care Survey (NAMCS), the

investigation of the use of antimicrobial medications is limited

to an inspection of the patterns in physicians’ ordering or providing them to patients. It is not possible to assess the extent to

which the patients actually filled their prescription orders and

used the medications according to instructions.

The estimates presented in this report are based on a sample

of office visits, and so are subject to sampling variability.

Comparisons among statistics were tested for statistical significance using the Bonferroni test for multiple comparisons, a

modification of the t-test. Statements regarding differences

between or among statistics indicate that the test results showed

a difference significant at the p <.05 level. An explanation of

sampling errors and guidelines for judging the precision of

estimates, as well as a brief description of the survey design,

are presented in the technical notes appended to this report.

In selecting the drugs to be included in this analysis. AMA

Drug Evaluations, Fl~th Edition, 1 firstwas utilized to establish

a comprehensive list of drug ingredients (according to generic

or nonproprietary name) considered to have antimicrobial

activity. All drug mentions (that is, all drugs listed by physicians

as ordered or provided to patients) appearing in NAMC S in

1~~~ Dmg EL.~j~ations, Fr~th Edifion, Chs. 21,24$,62. ad 69-80. Chimw.

AmericanMedicalAssociation,1983.

1980 and 1981 then were screened for these ingredients. The

resulting list of antimicrobial drugs was divided into two sets:

those known to be used only topically and all others. The topical

drugs, and the patient visits associated with them, are discussed

in this reporq the other antimicrobial drugs will be presented in

an additional report scheduled for publication in 1985.

Thirty-six specific antimicrobial generic ingredients ap

peared in the topical drug mentions recorded in the 1980 and

1981 surveys. For the purposes of this analysis, they can be

classified in the foliowing eight categories:

●

●

●

●

●

s

a

●

Amphenicols (chlorarnphenicol).

Macrolide antibiotics (erythromycin).

Tetracycline (chlortetracycline, meclocycline, oxytetracycline, and tetracycline hydrochloride).

Aminoglycosides (gentarnicin and neomycin).

Polymyxins (polymyxin B).

Sulfonamides (silver sulfadiazine, sulfabenzamide, sulfacetamide, sulfanikunide, sulfathiazole, and sulflsoxazole).

Antifungal or antibacterial snd antifungal agents (amphotericin B, selenium sulfide, sc@um thiosulfate, tolnaftate, undecyclenic acid, and zinc pyrithione).

Miscellaneous antimicrobial agents (acetic acid, bacitracin,

carboi-fuchsin, gramicidin, iodochlorhydroxyquin, iodoquinol, nitrotlmzone, povidone-iodine, and silver nitrate).

Although gramicidin, neomycin, and polymyxin B also are

used systemically, such use is unusual, particularly in the offlcebased ambulatory care setting examined here. Consequently,

these three generic ingredients are included only in this topical

antimicrobial report.

The specific topical antimicrobial drugs containing the

above generic ingredients and appearing in NAMCS in 1980

and 1981 were subdivided according to the body site of application and the types of active ingredients included. This yielded

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

seven topical antimicrobial groups with frequencies large ● Vaginal drugs: Drugs for vaginal use only, containing one

enough for analysis: or more antibacterial and/or antifungal agents.

●

Ophthalmic antibacterial drugs: Drugs for ophthalmic

use only, containing one or more antibacterial agents.

Ophthalmic antibacterial-corticosteroid mixtures: Drugs

for ophthalmic use only, containing one or more antibacterial agents and one or more corticosteroids. (These drugs

have anti-inflammatory as well as anti-infective properties.)

Otic drugs: Drugs for otic use only, containing one or

more antibacterial and/or antifungal agents, with or without

a corticosteroid ingredient.

● Other topical antx@ngal drugs: Drugs for use on skin

and/or mucous membranes, containing one or more antifungal ingredients.

● Other topica[ anti-in fectives: Drugs for use on skin and/or

mucous membranes, containing one or more antibacterial

ingredients and/or antibacterial and antifungal agents.

● Other topical anti-infective and corticosteroid mixtures:

Drugs for use on skin and/or mucous membranes, containing one or more antibacterial and/or antibacterial and

Ophthalmic antibacterial drugs

Bleph

Chloromyxln

Chloroptlc

Econochlor

Genoptlc

Isopto Cetamide

Ophthochlor

Statrol

Sulamyd

%lfacel-15

Vaaosulf

Ophthalmic antibacterial-cort! costerotd

mixtures

Blephamide

Cetapred

Chloromycetin-Hyd rocortisone

Chloroptic-P

Isopto Cetapred

Maxitroi

Metimyd

Neo-Hydeltrasol

Ophthocon

Optimyd

Poly-Pred

Sulfspred

Otic drugs

Chloromycetin Otic

Domeboro Otlc

Dureze

Lidosporin

gentmn violet

Gyne-Lotrtmin

Koro-Sulf

Monlstat 7

Nylmerate

nystatin vaginal tablet

Sulfa Vaginal

sulfa nilam!de

Sultrin

Tncholan

Triconol

Tnpul Vaginal

Vagllia

Vagitrol

Vanobid

Other topical antifungal drugs

amphotericin

clotrimazole

Desenex

Exsel Lotion

Fungizone

Funglzone Lotion

Halotex

Head and Shoulders

Lotrimtn

MicaTin

mlconazole

Monistat

Mycelex

Nystaform

selenium

Selsun

Selsun Blue

Tinactln

BPN

carbol-fuchsin

Caatellani’s paint

Efodine

Elase-Chloromycetln

EryDerm

Furacin

Iodochlor

Meclan

Mity-Mycin

Mycitracin

neomycin

Neo-Polycin

Neosporin

nitrofurazone

Polysporin

Poi~tracin

povidone-iodine

Sebizon Lotion

Silvadene

silver nitrate

silver nitrate toughened sticks

silver sulfadiazine

Spectro-Biotic

Staticin

sulfacetamide

Sulfacet-R

sulfathiazole

Thiaphyli

Topicycline

Triple Antibiotic

Vioform

Other topical anti-infective and

corticosteroid mixtures

Neo-Cort-Dome Otic Tirrver LotIon Caquin

otic dropa undecyclenlc acid Cordran-N

Otobione Verdefam Cor-Tar-Quin

Otobiotic Zincon Cortisporin

Otocofi F-E-P

Otoreid-HC Other topical anti-infectwes

hydrocortasone-neomy cin

Pyocidin Mycolog

v&ol AfT/S Mytrex

V6SOI-HC acetic acid Neo-Cortef

acetic acid glacial Neo-Decadron

Vaginal drugs

Aureomycln Neo-Delta-Cortef

Bacimycin

AVC

Neo-Medrol

bacltracln

AVC/Dienestrol

Neo-Synalar

bacitracrn-neomycin-poly myxln Racet

Betadine Vaginal Oouche Betadine Terra-Cortril

Candeptin Biotres

Femguard

Vioform-Hydrocortisone

Biozyme Vytone

-.. _ .

Figure 1. Topical antimicrobial drugs named by physician respondents: United States, 1980-81
3

antifungal ingredients and one or more corticosteroid ingredients. (These drugs also have anti-inflammatory and

anti-infective properties.)

All analyses in this report are based on this categorization

of topical antimicrobial. The trade~ and generic names used

by physicians in reporting the specific drugs that appeared in

NAMCS in 1980 and 1981 are displayed according to categoty

in figure 1.

General findings

The 1980 and 1981 total number of office visits to physicians principally engaged in oftice-based practice, estimated

by means of NAMCS, was 1.1 billion. Of these visits, 62 percent

(0.7 billion) were drug visits, that is, visits at which one or

more therapeutic medications were ordered or provided. The

drug visits involved a total of 1.3 billion drug mentions.

The drug mentions defined as topical antimicrobial numbered 48.4 million, or 3.6 percent of all drug mentions. This

reflected an average annual rate of 108.6 topical antimicrobial

drugs per 1,000 population. (See table 1.) The most frequently

mentioned groups were ot/ter topical anti-invectives, with 13.1

million mentions (27.0 percent of the total), other topical anriinfective and corticosteroid mixtures, with 10.5 million mentions (21.6 percent), and vaginal drugs, with 8.1 miIlion

mentions (16,8 percent). Although vaginal drugs had an annual

average rate of 35.2 per 1,000 female population, other topical

anti-in~ecrives had a rate of 29.4 per 1,000 population, and

other topical anti-infective and corticosteroid nuktwes had a

rate of 23.5 per 1,000 population, these differences are not

statistically significant.

The 15 specific topical antimicrobial drugs mentioned

most frequently are listed in table 2. Together they accounted

for almost two-thirds of all drug mentions of this type.

Of the drug mentions under consideration. combination

drugs (that is, those containing multiple active ingredients)

constituted the majority (27.3 million drug mentions, or 56.1

2T’he “se of trade names is for identification only and does not imPIY endorsement by the Public Health Service or the U.S. Department of Health and Human

Services.

Tabla 2. Numbar and percent distribution of the 15 topical

antimicrobial drugs most frequently mentionad in office-based

practice: United Statea, 1980-81

Number of

Name of drug and mentions in Percent

Rank antimicrobial ingredients thousands distrvbutton

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

. . .

All topical antimicrobial drugs. . .

Cortwporin (polymyxin B,

bacltracin, and neomycin) . . . .

Neosporin (polymyxin B,

bacnracin, and neomycin) . . . .

Mycolog (nystatin, neomycin,

and gramicidin). . . . . . . . . . . . .

Max!trol (neomycin and

polymyxin B) . . . . . . . . . . . . . . .

Monistat 7 (miconazole) . . . . . .

AVC (sulfaniiamide} . . . . . . . . . .

Monistat (mrconazole) . . . . . . . .

Lotrimln (clotrimazole). . . . . . . .

Chloroptic [chloramphenicol). . .

Sultrin (sulfathiazole,

suifacetamide, and

sulfabenzam!de) . . . . . . . . . . . .

Betadine (povidone-iodine) . . . .

Gyne-Lotrimln (clotrlmazole) . . .

Neo-Decadron (neomycin). . . . .

Bacltracin . . . . . . . . . . . . . . . . . .

Siiver nitrate . . . . . . . . . . . . . . . .

Ail other topical and

antimicrobial druga. . . . . . . . . .

48,354

4,9B8

4,664

2,883

2.057

1.906

1.828

1,813

1,755

1,507

1,271

1,214

1.169

1,184

1,016

959

18,119

100.0

10.3

9.6

6.0

4.3

3.9

3.8

3.7

3.6

3.1

2.6

2.5

2.5

2.4

2.1

2.0

37.5

percent). The remainder (21.1 million, or 43.9 percent) were

single ingredient drugs. Table 3 lists the 15 generic ingredients

most frequently included in all topical antimicrobial drug mentions. Together these substances account for more than threefourths (78.0 percent) of the 109.8 million ingredient mentions

listed for these drugs. Although 9 of the 15 most common ingredients were antibacterial or antiftmgal in nature, 6 were not.

These latter ingredients were principally anti-inflammatory in

their effects.

NAMCS data tiles also contain American Hospital

Forrnulaty Service information as to the expected therapeutic

3American ~o~pita[ Fo~uIary Service C[assfication St”stem and ~eroPeulic

Ca/ego~ Codes. Washington. American Society of Hospital Pharmacists. Inc..

1980.

Table 1. Number, percent distribution, and average annual rate of topical antimicrobial drug mentions in office-baaed practice by drug group:

United Statas, 1980-81

Average annual

rate per 1,000

Number of civilian nonmentions in Percent institutionalized

Drug group thousands distribution population

Alltopical antimicrobial drugs.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48,354 100.0 108.6

Ophthalmic antibacterial drugs, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,471 7.2 7,8

Ophthalmic antlbacterial.corticosteroid mixtures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otic drugs . . . . . . . .

4,558 9.4 10.2

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.487 3.1 3.3

Vaginal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.106 16.8 135.2

Other topical antifungal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.198 14.9 16.2

Other topical anti. infectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.074 27.0 29.4

Other topical anti. infectwe and corticosteroid mixtures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,460 21.6 23.5

TRate IS based on the female population only.
4 achancedata

Table 3. Number and percent distribution of the 15 generic ingredients most frequently appearing in topical antimicrobial drug mentions, ‘with

principal therapeutic action: United States, 1980 and 1981

Number of

generfc ingredient

Rank

Principal therapeutic mentions in Percent

Generm mgredterrt action thousands distr!,bution

Allgenerlc lngredtents . . . . . . . . . . . . . . . . . . . . . . . . . 109,809 100.0

1 Neomycin . . . . . . . . . Antlbacter!al 17,585

2

16.0

Polymyxln B .l:;.;jj;:;l;j;jjj;.;Ijl; ;: Antibacterial 13,966

3

12.7

Bacltracm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,, Antlbactenal 12,128

4

11.0

Hydrocortlsone . . . . . . . . . . . . . . . . . . . . . . . . . . . Anti-inflammatory

5

6,564 6.0

Sulfacetamlde . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6

Antibacterial 5,836 5.3

Miconazole. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

Antifungal 4,447 4.0

Clotrlmazole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Antifungal

~.

3,727 3.4

Dexamethasone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Anti-inflammatory

9

3,241 3.0

Nyatatln, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Antifungal

10

2,948 2.7

Trlamclnolone, ,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11

Anti-inflammatory 2,916 2.7

Gramlc!dm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12

Antibacterial 2,883

Prednlsolone . . . . . . . . . . . . . . . . . . . ,,, .,..,,....,,,,.,.,,,

2.6

Anti-inflammatory

13

2,442

Sulfan!lamlde . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2

Antibacterial

14

2,435

Allantotn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2

Stlmulat!on of healthy tissue growth

15

2,255

Amlnacrlne ..,...,..,,,.,,,.,,, . . . . . . . . . . . . . . . . . . . . . . . .

2.1

Bacteriostatic 2,255 2.1

. . All others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,181 22.0

Other

Anti-lnfectwe (0 7%) Skin and

agents \ I mucous

(fz

Eye, ear, ;ose,

and throat

w

A

preparations

(34.9%) -

NOTE: Amarlcan Hosp!tal Formulary Sewlce categortas are gwen m

American Hospital Formulaw Serwce Classtfjcanon System and

Therapeutic Category Codes. Washington, Amer!can Socaety of Hospttal

Pharmacists, Inc.. 1980,

Figure 2. Distribution of topical antimicrobial drugs among

American Hospital Formulary Service therapeutic categories:

United States, 1980-81

effects of drugs mentioned. The therapeutic categories associated

with the topical antimicrobial drugs selected for examination in

this report are illustrated in figure 2. A slight majority (5 1.6

percent) of the drugs were classified as skin and mucous membrane preparations, and another large segment (34.9 percent)

was classified as eye. ear, nose, and throat preparations.

Overall, most of the topical antimicrobial medications

(90.6 percent) were available to patients only as prescription

drugs. Of the ones available without prescription, two-thirds

(67.2 percent) were classified for this report as orher fopical

anti-infecfives. Three of the drug groups—ophthalmic antibacterial drugs, ophthalmic antibacterial-co rticos~eroid mixtures, and other topical anti-infective and cGrticosteroid mixtures—were composed of prescription drugs only. Prescription

drugs dominated the remaining drug groups also, but in varying

proportions, ranging from 76.6 percent of other topical antiinfectives to 97.1 percent of otic drugs.

Visits involving topical antimicrobial drugs

During 1980 and 1981 there were 46.0 million patient visits

in which at least one topical antimicrobial drug was ordered or

provided. This represented one out of every 25 (4.0 percent)

oftlce visits that occurred during that period.

For these visits there was an average of 1.05 topical antimicrobial drug mentions per visit, an intensity rate indicating

that the simultaneous order or provision of multiple drugs of

this type was an exceptional event. In fact, two or more of

these drugs were ordered or provided in only 2.2 million visits,

or 4.9 percent of all topical antimicrobial drug visits.

Patient demographics

As shown in table 4, the overall average annual rate of

visits was 103.4 per 1,000 civilian non institutionalized population. The greatest number of visits ( 13.6 million, or 29.6I percent of all these visits) was made by persons 25-44 years of

age. Females made a substantial majority (62.3 percent) of the

visits involving topical antimicrobial, which did not (differ

noticeably from the proportion of all other of?ice visits made by

females (60.3 percent). Controlling for the relative sizes of the

male and female populations, the female rate of 124.4 visits

per 1,000 population per year was 54 percent higher than the

male rate of 80.6.

The racial distribution of visits shows that white persons

made 88.3 percent of the visits involving topical antimicrobial

drugs and persons of all other races made 11.7 percent, proportions that did not differ significantly from those observed for
aamedaa5

Table 4. Number, percent distribution. and averag? annual rate of

visits involving topical antimicrobial drugs by age, sex. and race:

United States, 1980-81

Rate per ?,000

Number of civilian nonvistts in Percent institutionalized

Age, sex, and race thousends distribution population

All topical

antimlcrobtal drug

visits . . . . . . . . . . . . .

Age

14 years and under. . .

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

25-44 years ...,....

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

65 years and over . . .

Sex

Male . . . . . . . . . . . . . .

Female, . . . . . . . . . . .

Race

White . . . . . . . . . . . . .

Another . . . . . . . . . . .

46,034

9,509

7,953

13.625

8.173

6,773

17,361

28,673

40,662

5,372

100.0

20.7

17.3

29.6

17.8

14.7

37.7

62.3

88.3

11.7

103.4

93.5

97.7

108.7

93.0

138.2

80.8

124.4

106.4

84.9

all other visits. The visit rate for white persons ( 106.4 per 1,000

population per year) was 25 percent higher than that for all

others (84.9).

Age, sex, and race distributions varied somewhat among

visits involving different types of topical antimicrobial drugs.

Excluding vaginal drugs, the largest sex differences appeared

in the visits involving other antlfiungal drugs (36.4 percent of

which were made by males) and ophthalmic antibacterialcorticosteroid mixtures (41.9 percent of which were made by

males). One factor influencing these sex differences is that

some of the other antl~ungal drugs may be used vaginally.

The age distribution of patients who received ophthalmic

antibacterial-corticosteroid mixtures reflects the significant

number of cataract patients. Fully one-third of the patients receiving these drugs (34.7 percent) were at least 65 years old,

and an additional 25.1 percent were 45-64 years of age. In

fact, the median age for all patients receiving this type of drug

was 56.9, which was strikingly higher than the median age of

31.0 for all patients who received topical antimicrobial drugs.

Similarly, the use of vaginal drugs was heavily concentrated in the middle age range. The median age of 29.6 years

for the patients receiving these drugs reflects the 77.1 percent

of these patients who were 15-44 years of age, and is influenced

by the relatively high susceptibility of women in the child-bearing

years to vaginal infections and inflammation.

The final major age difference in the use of the specific

types of topical antimicrobial drug was that children accounted

for disproportionate numbers of visits involving otic drugs

(36.9 percent), other topical anti-infectitres (27.0 percent),

and other topical anti-infective and corticosteroid mixtures

(30.9 percent). The median patient ages of 24.4, 29.7, and

27.2, respectively, for these groups thus may be indicative of

the relative susceptibility of youth to otic infections and superficial injuries.

Significant race differences in utilization of the different

types of topical antimicrobial were observed, but possible

explanations for these differences are unclear. Of the patients

who were ordered or provided with topical antimicrobial drugs,

persons of minority races were more likely than white persons

to be users of vaginal drugs (28.3 percent compared with 15.7

percent) and other topicai ant#imgal drugs (23.8 percent compared with 14.0 percent). The reverse was true for other topical

anti-infective dwgs—29. 1 percent of the whhe patients receiving

topical antimicrobial were ordered or provided with this type

of drug, compared with 18.9 percent of minority race patients.

Utilization of other topicai anti-infective and corticosteroid

mixtures, however, showed no difference between these two

racial groupings. Because the frequencies of use of ophthalmic

antibacterial drugs, ophthalmic antibacterial-corticosteroid

mixtures, and otic drugs by minority race persons were too

small to be statistically reliable, race differences in utilization

of these dtugs could not be tested.

Physician specialty and patients’ reasons

for visit

The distribution of visits involving topical antimicrobial

drugs according to physician specialty is presented in table 5.

Although general and family practitioners were the most frequently involved physicians (13.2 million visits, or 28.6 percent

of the total), they handled a somewhat smaller proportion of

these visits than of all other visits (33.1 percent). Also, the

physicians who utilized topical antimicrobial drugs were more

concentrated than other physicians in the specitlc few specialties

most concerned with the types of illness and injury associated

with the use of these medications-dermatology ( 11.2 percent

of the visits involving topical antimicrobial drugs, compared

with 4.1 percent of all other visits), obstetrics and gynecology

(14.3 percent compared with 9.2 percent), ophthalmology

( 17.9 percent compared with 4.9 percent), and otolaryngology

(4.4 percent compared with 2.2 percent). In fact, these four

specialty groups alone accounted for almost half (47.8 percent)

of all topical antimicrobial drug visits, but only one-fifth (20.4

percent) of all other visits.

Because so many infective processes are acute problems

rather than chronic ones, it was expected that visits involving

topical antimicrobial drugs wouId reflect more patients presenting

for acute care and with new problems. The data presented in

Table 5. Number and percent distribution of visits involving topical

antimicrobial drugs by physician special~ United States, 1980-81

Number of

visits in Percent

Physician specialty thousands distribution

Allspecialt!es . . . . . . . . . . . . . . . . . . . . . . . 46,034 100.0

General and family practice. . . . . . . . . . . . 13,170 28.6

Internal medjclne . . . . . . . . . . . . . . . . . . . . 2,298 6.0

Pedjatncs . . . . . . . . . . . . . . . . . . . . . . . . . . 4,872 10.6

Dermatology . . . . . . . . . . . . . . . . . . . . . . . . 5,170 11.2

General surgery . . . . . . . . . . . . . . . . . . . . . . 1,589 3.5

Obstetrics and gynecology . . . . . . . . . . . . 6,575 14.3

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . 8,222 17.9

Otola~ngology . . . . . . . . . . . . . . . . . . . . . . 2.044 4.4

Another specialties . . . . . . . . . . . . . . . . . . 2,094 4.5
6 advancedata

table 6 demonstrate that this was indeed the case. A majority

of the patients receiving topical antimicrobial drugs (58.4 percent) presented with an acute problem, compared with only

one-third (35.5 percent) of all other patients. However, the

proportion who presented for postsurgery or injury care was

the same. 8.8 percent, for both types of visit. More than half

(55.7 percent) of all visits involving topical antimicrobial drugs

were prompted by new problems. In contrast, only one-third

(35.9 percent) of all other visits involved anew problem.

The principal reasons cited by patients for making office

visits are summarized in tables 7 and 8. A full two-thirds (68.8

percent) of all patients receiving topical antimicrobial drugs

gave a symptom as their principal reason for visit. In contrast,

only half (53.5 percent) of all other patients said they visited a

physician primarily because of a symptom. Patients receiving

topical antimicrobial drugs also cited injuries and adverse effects

more frequently than other patients did (7.8 percent compared

with 3.9 percent) and cited diagnostic, screening, and preventive

reasons and treatment-oriented reasons less frequently (8.3

percent compared with 19.9 percent, and 6.9 percent compared

with 10.6 percent, respectively).

Of the 15 most commonly cited specific reasons for visit, 5

were related to eye problems, 4 to skin problems, 2 to vaginal

Table 6. Number and percent distribution of visits involving topical

antimicrobial drugs by major reason for visit and patient status:

United States, 1980-81

Number of

Major reason for visit and visits in Percent

patient status thousands distribution

All topical antimicrobial drug visits. . . . . .

Major reason for visit

Acute problem . . . . . . . . . . . . . . . . . . . . . .

Chronic problem . . . . . . . . . . . . . . . . . . . . .

Postsurgery orin]ury . . . . . . . . . . . . . . . . . .

Nontllness care . . . . . . . . . . . . . . . . . . . . . .

Pattent status

New patient, . . . . . . . . . . . . . . . . . . . . . . .

Returning patient, new problem , . . . . . . .

Returning patient, old problem . . . . . . . . .

46,034

26.876

11,774

4,065

3,3? 9

8,887

16,754

20,392

100.0

58.4

25.6

8.8

7.2

19.3

36.4

44.3

Table 7. Number and percent distribution of visits involving topical

antimicrobial drugs by principal reason for visit module:

United States, 1980-81

Number of

vmts m Percent

Principal reason for vls)t module 1 thousands distribution

All topical antlmlcrob!ai drug visits, . . . . . 46,034 100.0

Symptom . . . . . . . . . . . . . . . . . . . . . . . . . . 31,666 68.8

Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 3,005 6.5

Diagnostic, screening, and preventwe . . . 3.815 8.3

Treatment . . . . . . . . . . . . . . . . . . . . . . . . 3,157 6,9

Injuries and adverse effects. . . . . . . . . . . . 3,611 7.8

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 711 1.5

1Based on Nat!onal Center for Health Statw.t!cs, D, Schne!der, L Appleton.

andT, McLemore: A reason for vwt class!fmat!on for ambulato~ care [RVCj.

Vita/ arrd Hea/?h Sraosr/cs, Ser!es 2. No, 78, DHEW Pub, No. {PHSI 79-1352.

Public Health Serwce, Washington. U.S. Government Pnntzng office, Feb. 1979.

Table 8. Number and percent distribution of the 15 specific

principal reasone for visit most commonly given during visits

involving topical antimicrobial drugs: United States, 1980-81

Number of

Most common reason for visit visits in Percent

Rank and RVC codel thousands distribution

. . .

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

. .

All toptcal antlmmroblal drug

visits . . . . . . . . . . . . . . . . . . . . . .

Sktnrash . . . . . . . . . . . . ..(S86O)

Earache or ear Infection. (S355)

Vaginal d!scharge . . . . . . (S760)

Other vaginal symptoms. . (S765)

Abnormal sensations of the

eye . . . . . . . . . . . . . . . . . . (S320)

Skin lesion . . . . . . . . . . . . . (S865)

Postoperatwe visit. ., , . . . (T205)

Abnormal appearance of

eyes . . . . . . . . . . . . . . . . . (s330)

Foretgn body in eye. . . . . . (J600)

Progress visit, NOS . . . . . . (T800)

General medical

examination. . . . . . . . . . (xl 00)

Dtscharge from eye. . . . . . (S310)

Skin irritations, NEC . . . . . (S870)

Acne or pimples . . . . . . . . [S830)

Symptoms of eyelids. . . . . (S340)

46,034

3,384

2,936

2,331

2,160

1,941

1,622

1,573

100.0

7.4

6.4

5.1

4.7

4.2

3.5

3.4

,195 2.6

,035 2.2

,008 2.2

962 2.1

951 2.1

775 1.7

750 1.6

680 1.5

All other reasons for visit. . . . . . 22,729 49.4

lNatlonal Center for Health Stat! stox, D. Schne!der, L AFpleton, and

T. McLemore. A reason for vtslt class! ficatlon for ambulatow csre [RVC].

Vita/ arrd Hea/th .Sratmfcs. Series 2, No. 78. DHEW Pub, No. [PHS) 79-1352.

Publlc Health Service. Washington. U.S. Government Printing Off Ice, Feb. 1979.

symptoms, and 1 to ear symptoms. Twelve of these 15 reasons

explicitly mention specific body areas with which topical antimicrobial drugs are concerned. The relatively large proportions

of visits precipitated by problems labeled as acute and/or new,

the dominance of symptoms as the principal reasons for visit,

and the contents of the most common patient complaints together

reflect the often acute nature of the problems underlying the

visits of interest.

Diagnostic services and diagnoses

Patients receiving topical antimicrobial drugs were ordered

or provided with an average of 1.6 diagnostic services per visit,

the same as all other patients. The types of setvices differed,

however. The topical antimicrobial drug patients more frequently were ordered or provided with limited histories and/or

exams (78.0 percent compared with 63.8 percent), Pap tests

(8.0 percent compared with 4.2 percent), and vision tests (13.1

percent compared with 5.4 percent). Fewer of them received

no diagnostic services (3.5 percent compared with 8.3 percent),

general histories and/or exams ( 11.7 percent compared with

15.6 percent), X-rays (1.6 percent compared with 7.7 percent),

and blood pressure checks (23.0 percent compared with 34.7

percent). (See table 9.)

By far the most common class of principal diagnosis assigned to patients receiving topical antimicrobial drugs was

diseases of the nervous system and sense organs.” (See

~Based on public Health service and Health Care Financing Administration:

Inrernarional C[asstjicorion of Diseases, 9th Rerision, Clinical Modijicarion.

DHHS Pub. No. (PHS) 80-1260.Public Heahh Service. Washington. U.S.

Government Printing Ot%ce, Sept. 1980.
acklncedata 7

Table 9. Number and percent of office visits involving a topical

antimicrobial drug by diagnostic service ordered or provided

United States, 1980-81

Number of

visits in

Diagnostic service thousands Percentl

All topical antimicrobial drug visits . . . . . . . .

No diagnostic services . . . . . . . . . . . . . . . . . .

Limited history/examination. . . . . . . . . . . . . .

General histov/examination . . . . . . . . . . . . .

Pap test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CJinlcal lab test . . . . . . . . . . . . . . . . . . . . . . . .

Blood pressur.e check . . . . . . . . . . . . . . . . . . .

Vtsion test . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

46.034

1,597

35,914

5,368

3,658

9,079

10,601

6,008

744

3,432

100.0

3.5

78.0

11.7

8.0

19.7

23.0

13.1

1.6

7.5

‘Column does not add to 100.0 percent because mult]ple dmgnostlc services

were ordered or prowded during some visits.

table 10.) The 13.3 million patients who were so diagnosed

constituted 28.8 percent of the entire group; in contrast, only

8.6 percent of all other patients had this type of principal

diagnosis. Three other major categories of principal diagnosis

also were much more common among patients receiving topical

antimicrobial drugs than among other patients: infectious and

parasitic diseases (15.2 percent compared with 2.8 percent),

diseases of the genitourinary system (12.5 percent compared

with 5.6 percent), and diseases of the skin and subcutaneous

tissue (14.5 percent compared with 5.6 percent). These groups

of diagnoses clearly are related to the type of drug under consideration. This relationship between diagnosis and therapeutic

medication can be seen in more detail in table 11, which presents

the 15 most common specific diagnoses. All of them are concerned with the body sites to which topical antimicrobial drugs

are applied, and together they account for more than half (52.1

percent) of all visits involving these drugs.

As was expected, the most common diagnoses varied

among the groups of patients receiving the different types of

Table 10. Number and percent distribution of office visits involving

topicel antimicrobial druga by class of principal diagnosis:

United States, 1980-81

Number of

visits in Percent

Diagnostic class rhousands distribution

All topical antimicrobial drug wsits. . . . . , 46,034 100.0

Infectious and parasitic diseases. . . . . . . . 6,985 15.2

Diseases of the nervous system and

sense organs..........,.. . . . . . . . . . . 13,254 28.8

Diseases of the respiratory system . . . . . . 1,666 3.6

Diseases of the genmourinary system . . . . 5,793 12.6

Diseases of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,679 14.5

Inlury and poisoning . . . . . . . . . . . . . . . . . . 4,423 9.6

Factors influencing health status and

contact w!th health service . , ., . . . . . . . 3,068 6.7

Another diagnosesl . . . . . . . . . . . . . . . . . . 4,167 9.1

‘Includes neoplasms; endocnne, nutrmonal, and metabollc disesses

and tmmunlty disorders: mental disorders: diseases of the clrculatoty system:

d!seases of the dlgestwe system: dtseases of the musculoskeletal system:

Symptoms, Sagns, and dl.defti”ed co”dlt!o”s; a“d other. mgs~,ng, and “nk”O~n

diagnoses.

Table 11. Number and percent distribution of the 15 specific

principal diagnoses most commonly recorded during visits involving

topical antimicrobial drugs United States, 1980-81

Number of

Mosr common principal vistts m Percent

Rank diagnosis and ICD-9-CM code f thousands distribution

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

. . .

All topical antimicrobial drug

visits . . . . . . . . . . . . . . . . . . . . . .

lnflammatoW disease of cervix,

vagina. and vulva. . . . . . . . (616)

Disorders of conjunctival . . . (372)

Candidiasis . . . . . . . . . . . . ..[ll2)

Disorders cf external ear... (380)

Suppurative and unspeclfted

otitismedla . . . . . . . . . . . . (382)

Dermatophytosts . . . . . . . . . (1 10)

Inflammation of eyelids. . . . (373)

Contact dermatitis and other

eczema . . . . . . . . . . . . . . . . (692)

Diseases of sebaceous

glands . . . . . . . . . . . . . . . ..(7Q6)

Supefitcial injury of eye and

adnexa . . . . . . . . . . . . . . ..(918)

Cataract . . . . . . . . . . . . . . ..(366)

Foreign body on external

eye . . . . . . . . . . . . . . . . . . (930)

Other disorders of eye. . . . . (379)

Dermatomycosis, other and

unspecified . . . . . . . . . . . ..(l 11)

Keratms.. . . . . . . . . . . . . ..(37O)

All other diagnoses . . . . . . . . . . .

46,034

3,570

3,394

2,561

2.367

2,215

7.775

1,544

1,274

1,125

1,011

729

632

607

595

578

22,056

100.0

7.8

7.4

5.6

5.1

4.8

3.9

3.4

2.8

2.4

2.2

1.6

1.4

1.3

1,3

1,3

47.9

18ased on Pubhc Health Satvw.? and Health Care Flnanc!ng Aomlnlstratmn:

Inrernadonal Classtficar)orr of Diseases, 9rh Revwon, Climcal Modif/car/on

[ICO-9-CM]. DHHS Pub. No. (PHS) 80-1260. Publ!c Health Serace.

Washington. U.S. Government Pnrrtmg Office. Sepc 1980.

topical antimicrobial drug. For several of these drug groups,

particular diagnoses accounted for a relatively large proportion

of visits. Among patients receiving ophthalmic antibacterial

drugs, disorders of conjunctival was the principal diagnosis for

28.2 percent (944,000 visits) of all patients receiving this type

of drug. Among patients receiving the related ophthalmic arttibactenal-corticosteroid mixtures, the most common principal

diagnoses were disorders of conjunctival (866,000 visits, or

19.4 percent), inflammation of eyelids (590.000 visits, or 13.2

percent), and cataract (584,000 visits. or 13.1 percent). Two

diagnoses accounted for almost three-fourths of all patients

receiving otic drugs: disorders of external ear (603,000 visits,

or 40.5 percent) and suppurative and unspecified otitis media

(486,000 visits, or 32.7 percent). Similarly, among patients

receiving vaginal dngs, two diagnoses accounted for half of all

visits: inflammatory disease of cervix, vagina, and vulva

(2,693,000 visits, or 34.0 percent); and candidiasis ( 1,409,000

visits, or 17.8 percent). Among patients receiving other topical

arzfz~ungal drugs, five diagnoses reached reliable levels: dermatophytosis (1,528,000 visits, or 21.9 percent); candidiasis

(903,000 visits, or 12.9 percent); diseases of sebaceous glands

(856,000 visits, or 12.3 percent); other and unspecified dermatomycosis (561,000 visits, or 8.0 percent); and inflammatory

disease of cervix, vagina, and vulva (473,000 visits, or 6.8

percent). Two principal diagnoses attained reliable leveIs

among patients receiving other topical anti-in fectives: disorders

of conjunctival (1,210,000 visits. or 9.4 percent) and impetigo

(529,000 visits, or 5.1 percent). Finally. of the patients receiv-
8

ing other topical anti-infective and corticoste~oid m Lxtures,

four principal diagnoses appeared in reliable numbers: disorders

of external ear ( 1,673,000 visits, or 16.1 percent), suppurative

and unspecified otitis media (1,473,000 visits, or 14.2 percent),

contact dermatitis and other eczema (75 1,000 visits, or 7.2

percent), and disorders of conjunctival (478,000 visits, or 4.6

percent).

Therapeutic services, patient

disposition, and visit duration

An average of 0.5 nonmedication therapeutic services

were ordered or provided during each visit made by patients

receiving topical antimicrobial drugs. This was not significantly

different from the average for all other patients (0.6). Statistics

on specific types of therapeutic services are displayed in

table 12. Slightly more than half the patients receiving topical

antimicrobial drugs (26.0 million, or 56.4 percent) obtained no

nonmedication therapeutic services, a proportion that did not

differ from that for all other patients. The topical antimicrobial

drug patients, however, did receive office surge~ at a higher

rate (12.4 percent compared with 7.2 percent) and psychotherapy

or therapeutic listenin~ diet counseling, and family or social

counseling at lower rates (0.9 percent compared with 5.1 percent, 3.2 percent compared with 8.3 percent, and 0.9 percent

compared with 2.1 percent, respectively). Thus patients receiving topical antimicrobial drugs dld not differ from other patients

with respect to nonmedication therapeutic services rendered as

much as they did with respect to diagnostic services performed.

The disposition of patients receiving topical antimicrobial

drugs differed somewhat from that of other patients, but these

differences also were not large ones. No followup was ordered

for virtually identical proportions of each type of patient (11.4

percent of patients receiving topical antimicrobial drugs and

11.5 percent of all others). Patients who received topical antimicrobial drugs were instructed to return at a specified time

somewhat less frequently than others (56.5 percent compared

with 60.8 percent), but were requested to return if needed

somewhat more frequently (29.6 percent compared with 22.4

percent). (See table 13.)

Table 12. Number and percent of office visits involving topical

antimicrobial drugs with nonmedication therapeutic services

ordered or provided, by type of service: United States, 1980-81

Number of

visits in

Nonmedication therapeutic seivice thousands Percent’

All topical antlm!croblal drug vwlts . . . . . . . . 46,034 100.0

No nonmed!catlon therapeutic services . . . . 25,960 56.4

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . 1,691 3.7

Office surgety . . . . . . . . . . . . . . . . . . . . . . . . . 5,690 12.4

Family planning . . . . . . . . . . . . . . . . . . . . . . . . 1,193 2.6

Psychotherapy or therapeutic listening . . . . .

’420 “0.9

Diet counseling . . . . . . . . . . . . . . . . . . . . . . . 1,478 3.2

Family or social counseling . . . . . . . . . . . . . .

*41 7 “0,9

Medical counseling . . . . . . . . . . . . . . . . . . . . . 11,181 24.3

Other nonmedication therapy. . . . . . . . . . . . . 986 2.1

‘Column does not add to 100.0 percent because multlple nonmedtcat, on

therapy serwces were ordered or prowded during some VISIW.

Table 13. Numbar and psrcent distribution of office visita involving

topical antimicrobial drugs by patient dispositiorx United States,

1980-81

Number of

visits in Percent

Pat!ent disposition thousands distribution

All topical antimicrobial drug visits. . . . . 46,034 100.0

No followup . . . . . . . . . . . . . . . . . . . . . . . . 5,228 1 lJ .4

Return atspecified time . . . . . . . . . . . . . . . 25,998 56.5

Return lf needed . . . . . . . . . . . . . . . . . . . . . 13,640 29.6

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,826 6.1

NOTE: Categories do not add to totals because more than one disposition

was recorded for some patuents.

Table 14. Average duration of office visits involving topical

antimicrobial drugs by type of drug: Unitad States, 1980-81

Type of topical antimicrobial drug Average duration

involved in visit of visit

Minutes

All topical antimicrobial drugs. . . . . . . . . . . . . . . . . 13.9

Ophthalmic antibacterial drugs . . . . . . . . . . . . . . . . 15.7

Ophthalmic antibacterial-corf icostaroid mixtures. . . 12.7

Otic drugs . . . . . . . . . . . . ...<... . . . . . . . . . . . . . . 11.7

Vaginal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.8

Other topical antifungal drugs. . . . . . . . . . . . . . . . . 13.3

Other topical anti-infectives. . . . . . . . . . . . . . . . . . . 14.2

Other topical anti-infective and corticosteroid

mixtures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.0

Table 15. Number and percent distribution of co-occurring

medications during office visita involving topical antimicrobial

drugs by therapeutic category: Unitad Statea, 1980-81

M.unber of

drug mentions Percent

Therapeutic categoryl in thousands distribution

All co-occurring drug mentions , . . . .

Anti-infective agents . . . . . . . . . . . . . .

Skin and mucous membrane

preparations . . . . . . . . . . . . . . . . . . . .

Central nervous system drugs. . . . . . .

Eye, ear. nose, and throat

preparation . . . . . . . . . . . . . . . . . . . .

Hormones and synthetic substitutes. . .

Antthlstamines . . . . . . . . . . . . . . . . . . .

Cardiovascular drugs . . . . . . . . . . . . . .

Vitamins . . . . . . . . . . . . . . . . . . . . . . . .

Electrolytic, caloric, and water

balance agents . . . . . . . . . . . . . . . . . .

Serums, toxoids, and vaccines . . . . . .

Autonom!c drugs . . . . . . . . . . . . . . . .

Expectorants and cough

preparations . . . . . . . . . . . . . . . . . . . .

Allothe# . . . . . . . . . . . . . . . . . . . . . . . .

37,490

12.045

6,109

3,052

2,944

2,837

2,431

1,376

1,042

985

966

933

674

2,095

1Oc).o

32.1

16.3

8.1

7’.9

7.6

6.5

3.7

2.8

2.6

2.6

2.5

1.8

5.6

lAmer/c8n Hosp#al Formulory Service Classificatkm System and Therapeutic

Categow Codes. American Soc!ery of Hospital Pharmacists, Inc.

‘Includes antmeoplast!c agents: blood derwatwes: blood formation and

coagulauon agent% diagnostic agents; enzymes; gastrointestinal drugs: gold

compou rids; heavy metal antagomsts: local anesthetics: Oxytoctcs: radioactive

agents: spasmolyt!c agents unclasstfled therapeutic agents; devices;

pharmaceutdc aids: and undetermined agents.
.h ackmeda9

The average duration of visits involving topical antimicrobial drugs (shown in table 14) was 13.9 minutes, compared

with 15.5 minutes for all other visits. .T,he shortest visits were

those involving otic drugs ( 11.7 minutes), and the longest were

those involving vaginal drugs ( 15.8 minutes) and ophthalmic

antibacterial drugs ( 15.7 minutes).

Co-occurring drugs

As table 15 shows, there were 37.5 million other drugs

ordered or provided during visits involving topical antimicrobial

drugs. This was an average of 0.82 other drugs per visit. Of

these drug mentions, almost one-third (32. 1 percent) were

classified in the therapeutic category of anti-infective agents.

Skin and mucous membrane preparations also accounted for a

notable proportion (16.3 percent).

Only seven specific other drugs reached reliable frequencies. (See table 16.) These accounted for only 13.8 percent of

all co-occurring drug mentions, reflecting the fact that a wide

variety of other drugs, rather than a specific few, were utilized

during topical antimicrobial drug visits. It is noteworthy, however, that all of the leading other drugs are classified as antiTable 1& Number and parcent distribution of the 7 co-occurring

drugs most tlequently mentioned during office visits involving

topical antimicrobial drugs: United States, 1980-81

Number of

drug mentions Percent

Rank Name of drug in thousands distribution

. . . All co-occurring

medications . . . . . . . . . . . . . 37.490 100.0

1 Ampicillin . . . . . . . . . . . . . . . .

2

1,168 3.1

Tetracycline . . . . . . . . . . . . . .

3

862 2.3

Flagyl (metronidazole) . . . . . . 798 2.1

4 Erythromycm . . . . . . . . . . . . . .

5

781 2.1

Amoxicilli n. . . . . . . . . . . . . .

6

624 1.7

Amoxll (amoxicillin) . . . . . . . . 475 1.3

7 E.E.S. [erythromycin) . . . . . . . 461 1.2

. . . All other . . . . . . . . . . . . . . . . . 32,320 86.2

infective agents that may be administered systemically. This

suggests that a high priority in the dmg treatment of the cases

inspected here is a multipronged attack on the infective diseases

precipitating the visits.
10 acklncedata

Technical notes

Source of data and sample design

The estimates presented in this report are based on the

findings of the National Ambulatory Medical Care Survey

(NAMC S), a sample survey of otllce-based care conducted

annually from 1973 through 1981 by the National Center for

Health Statistics. The target universe of NAMCS is composed

of ofllce visits made by ambulatory patients to’ non-Federal

and noninstitutional physicians who are principally engaged in

office-based, patient-care practice. Visits to physicians practicing in Alaska and Hawaii are excluded from the range of

NAMCS. as are visits to anesthesiologists, pathologists, and

radiologists.

NAMC S uses a multistage probability sample design that

involves a step sampling of primary sampling units, physicians’

practices within primary sampling units, and patient visits within

physicians’ practices. The physician sample (5,805 physicians

for 1980 and 198 I ) was selected from master files maintained

by the American Medical Association and the American

Osteopathic Association. Those members of the sample who

proved to be in scope and eligible participated at a rate of 77.3

percent. Responding physicians completed visit records for a

systematic random sample of office visits made during a randomly assigned weekly reporting period. Telephone contacts

were excluded. During 1980 and 1981 responding physicians

completed 89,447 visit records on which they recorded 97,796

drug mentions. Characteristics of the physician’s practice, such

as primary specialty and type of practice, were obtained during

an induction interview. The National Opinion Research Center,

under contract to the National Center for Health Statistics,

was responsible for the field operations of the survey.

Sampling errors and rounding

The standard error is a measure of the sampling variability

that occurs by chance because only a sample, rather than the

entire universe, is surveyed. The relative standard error of an

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. In this

report, any estimate that exceeds a relative standard error of

30 percent is marked with an asterisk. Table I should be used

to obtain the relative standard error for aggregates of office

visits or for mentions of drugs by specific name (for example,

Darvon). Table II should be used to obtain the relative standard

error for drug mentions expressed as drug groups (for example,

the analgesic drug family).

In this report, the determination of statistical significance

is based on the Bonferroni modification of the t-test with a

critical value of 1.96 (0.05 level of significance). Terms relating to differences, such as “higher” or “less,” indicate that the

differences are statistically significant. Terms such as “similar”

or “no difference” mean that no statistical significance exists

between the estimates being compared. A lack of comment in a

comparison between any two estimates does not mean that the

difference was tested and was not significant.

In the tables of this report estimates have been rounded to

Table i. Approximate relative standard errors of estimated numbers

of office visits and of drug mentions when drug is listed by product

name (for example, Darvon), based on all physician specialties:

National Ambulatory Medical Care Survey, 1980-81

Relative

Est!mated number of office visits standard

or spec)fic drug ment)ons error

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

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

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

20.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

700,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

1,0008000, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent

*44,8

*:31.7

“:30.0

26.0

22.6

20.2

‘14.5

9.5

7,1

5.6

4,4

3.9

3.6

3.5

3,4

EXAMPLEOF USE OF TABLE: An aggregate estimate of 35,000,000 office

vrs Its has a reiatwe standard error of 5.0 percent or a stand~rd error of

1,750,000 vlslts (5.0 percent of 35,000,000 vIsIts).

Table ii. Approximate relative standard errors of estimated numbers

of drug mentions when drugs appear in groups (for example, the

analgesic drug family), based on all physician specialties: National

Ambulatory Medical Care Survey, 1980-81

Relative

Estimated number of standard

grouped drug mentions error

Number in thousands

“200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“400. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

100.000, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Percent

*54.2

“38.5

31,5

“30.0

27.3

24.5

17.6

11.6

13.7

!5.8

5.3

4.7

4.4

4.2

4.1

EXAMPLE OF USE OF TABLE: An aggregate estimate of 30,000,000 drug

menttons has a relatwe standard error of 7.0 percent or a standard error of

2,100.000 mentions (7.0 percent of 30,000,000 ment]ons).

the nearest thousand. For this reason, detailed estimates do not

always add to totals.

Definitions

An ofice is a place that physicians identify as a location

for their ambulatory practice. Responsibility for patient care
and professional services rendered in an office resides with the

individual physician rather than an institution.

A visit is a direct personal exchange bemveen an ambulatory

patient seeking health care and a physician, or staff member

working under the physician’s supervision, who provides the

health services.

A drug mention is the physician’s entry on the visit record

of a pharmaceutical agent ordered or provided by any route of

administration for prevention, diagnosis, or treatment. Generic

and brand-name drugs are included as are nonprescription and

prescription drugs. The physician records all new drugs and all

continued medications if the patient specifically is instructed

during the visit to continue the medication.

An acute problem is a morbid condition with a relatively

sudden or recent onset (within 3 months of the visit).

A chronicproblent is a morbid condition that existed for 3

months or longer before the visit. The care indicated is of a

regular, maintenance nature.

A chronic problem jlareup is a sudden exacerbation of a

preexisting chronic condition.

Noniliness care denotes health examinations and care

provided for presumably healthy persons. Examples of nonillness care include prenatal and postnatal care, annuaI physicals,

well-child examinations, and insurance examinations.

Symbols

. . . Data not available

. . . Categov not applicable

. Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standard of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
From Vital and Health Statistics of the National Center for Health Statistics No. 107 ● April 12, 1985

Marriage and First Intercourse,

Marital Dissolution, and Remarriage:

United States, 1982

by Christine A. Bachrach, Ph. D., and Marjorie C. Horn, M.A., Division of Vital Statistics

Changing patterns of marriage, divorce, and premarital

sexual behavior are reflected in recent trends in marital and

premarital births. Over the past two decades, the proportion

of births occurring to unmarned women has risen dramatically,

from 5 percent in 1960 to 19 percent in 1982.172 Slightly

more than half of this change is due to a rise in births

to u?married women, resulting from an increase in both

their fertility rate and their number in the population. The

increased fertility rate for unmarried women is associated

with a substantial shift in the timing of first sexual intercourse

in relation to marriage. Nearly half of women marrying in

the years 1960-64 delayed their first sexual interccmrse until

marriage, compared with only one-fifth of women Who first

married between 1975 and 1979. Declines in mtital fertility

rates account for the other half of the rise in the proportion

of births to unmarried women. Those declines may reflect,

in part, another fundamental change in the institution of

msrriage~eclining marital stability. The likelihood of divorce, separation, or widowhood within 5 years of marriage

was half as high among women first married during the

years 1960-64 as among those first married in the years

1975–79. These findings on timing of first sexual intercourse

and marital dissolution are based on preliminary data from

the National Survey of Family Growth (NSFG), Cycle III.

The National Survey of Family Growth is conducted

periodically by the National Center for Health Statistics

(NCHS) on topics related to childbearing, contraceptive practice, and related aspects of maternal and child health. In

Cycle III, conducted in 1982, interviews were completed

with a probability sample of 7,969 women 15-44 years of

age in the noninstitutional population of the conterminous

United States. The sample included 4,651 ever married and

3,318 never married women. Previous cycles of the survey

were conducted in 1976 and 1973. Further details about

the sample design and reliability of the data presented in

this reporr are given in the Technical notes.

A primary purpose of the National Survey of Family

Growth is to provide national estimates of factors that influence

childbearing. The most basic of these factors is, of course,

exposure to sexual intercourse. Marital status is an important

determinant of exposure to sexual intercourse. Women mlarrying during the 1960’s and 1970’s increasingly began their

sexurd experience before marriage, as this report shows, but

exposure to intercourse is still substantially higher among

ever married than never married women. This is true whether

exposure is measured as ever having had intercourse (or as

having had intercourse in the 3 months before the interwiew.3

Similarly, despite the increase in the proportion of births

occurring to unmarried women since the early 1960’s, the

great majority of ail births, and even of first births, still

occur within marriage. 1“zThus, marriage and marital dis,solution continue to be important factors in explaining

childbearing.

This report presents data on the timing of first sexual

intercourse in relation to first marriage, and the timing of

marital dissolution and remarriage among ever married women

in the United States. Data on age at first sexual intercourse

among all women, includhg never married women, will

be presented in a subsequent report.

Wining of first sexual intercourse

in relation to marriage

About two-thirds of ever married women 154$ years

of age had had sexual intercourse before marriage

(table 1). About 20 percent of all ever married women married

within 1 year of initiating sexual activity, 23 percent married

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health SC?rvice
2 adfancedata

within 1-3 years, and about 25 percent married 3 or more

years after their first intercourse.

The proportion of women who delayed sexual intercourse

until marriage declined from 48 percent among women msrrying during the period 1960-64, to 21 percent among women

marrying in the years 1975–79. The largest decline appears

to have Occuked between 1965-69, when 42 percent of

women marrying for the first time had not previously had

intercourse. and 1970-74, when only 28 percent had delayed

intercourse. This increase in the prevalence of premarital

intercourse has also been reported in studies of both ever

married and never married teenagers.=

Women who married in the late 1970’s experienced longer

periods of premarital sexual exposure than women who married in the early 1960’s. Among women marrying in the

years 1975–79, 23 percent had initiated their sexual experience

5 or more years before marriage, compmed with only

2 percent of women marrying during the years 1960-64.

About 17 percent of women marrying in the years 1960-64

married within 6 months of their first intercoume, compared

with only 7 percent of women marrying in the years 1975–79.

These changes reflect a probable decline in the average age

of first sexual intercourse as well as arf increase in the

median age of women at their first marriage.4’7

Data for women who married before 1960 are not shown

separately in table 1. Because the NSFG was restricted to

women aged 1544 in 1982, women marrying before 1960

who were 44 years of age at the time of the survey would

have to have married before age 23: women under 44 years

of age when the survey was conducted would have to have

married at progressively younger ages. These women would

have had fewer years to experience premarital intercourse

than women marrying during the same years but at older

ages. This bias may also have some effect on the comparison

between the 1960-64 and later groups shown in table 1.

Table I shows that white ever married women were

much more likely than black ever married women to delay

first sexual intercourse until maniage (35 percent compared

with 9 percent, respectively), and were less likely to have

delayed marriage 5 years or mroe after their first sexual

experience (11 compared with 26 percent). Among both

black and white women, those married in the years 1975-79

were less than half as likely as those married in the years

1960-64 to have deIayed their first sexual intercourse until

marriage. The difference among white women (22 compared

with 53 percent) was statistically significant, while the difference among black women (5 compared with 12 percent)

was not.

TArle 1. Nunberofeverrnambd wotnen 1544 yeara ofageend percent

- Hiswrkc@m endyearoffiratmarfiwe: UnitedWat~ 1982

dmautkmbYtinrin9 ofmarrkwarelafiwto6rataexuat-htarooura%==@f’mb

[Preiiiinaty data bsaad on a aarnpb of tha ncainabfufional popuiatkm of she mntafrrnnous Unitad Sfataa. Saa Tachcai rmfaa for

S@ datimtha of farmsl

dmmaionofula aam@am, a@nalss of aan-pkg Valisbilirj,

Mnfhs befm3en first intaroouma ard maniage

Race, Hispanic Ever Mamkga knbra

otigh, and year of mam”ad wsam9nronfhas 5 nwntis 611 12-35 36+9 60 months

first marriage kwrnan Total firaf infertwma Wbss months nronfhs nwrths ornwm

Totali

All years2 . . . . . . . . . . . . . . . .

1975-79 . . . . . . . . . . . . . . . .

1970-74 . . . . . . . . . . . . . . . .

196!5-69 . . . . . . . . . . . . . . . .

1960-64 . . . . . . . . . . . . . . . .

White

All years2 . . . . . . . . . . . . . . . .

1975-79 . . . . . . . . . . . . . . . .

1970-74 . . . . . . . . . . . . . . . .

1965-69 . . . . . . . . . . . . . . . .

1860-64 . . . . . . . . . . . . . . . .

Black

All yearsz . . . . . . . . . . . . . . . .

1975-79 . . . . . . . . . . . . . . . .

1970-74 . . . . . . . . . . . . . . . .

196s-69 . . . . . . . . . . . . . . . .

1960-64 . . . . . . . . . . . . . . . .

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . .

Non-1-fispamc . . . . . . . . . . . . .

Number in

34,937

7,336

8,266

7,326

5,505

30,419

6,4?7

7,176

6,400

4,804

3,442

687

785

709

533

2,790

31,191

Percent disflibutioll

100.0 32.6 122 7.3 23.4 12.3 12.2

100.0 21.4 7.0 6.7 24.8 16.9

100.0 28.1

23.2

13.5 8.6 29.0 12.2

100.0

8.6

42.2 14.3 6.7 19.1 10.7 6.9

100.0 48.3 17.3 “6.7 20.2 ●5.4 “2.1

100.0 34.6 12.5 7.1 23.4 11.3 11.0

100.0 22.4 7.2 7.2 25.1 16J?

100.0

21.9

28.5 73.7 8.8 28.8 10.8 7.4

100.0 45.1 14.5 “6.4 17.8 10.0

103.0

“6.2

52.6 17.6 “5.6 19.2 “3.4 ●1.6

100.0 8.8 9.0 8.4 25.2 22.9 25.7

100.0 “5.4 -4.7 “2.8 19.0 27.4

100.0

40.7

“7.7 8.6 102 252 27.0

100.0

21.3

122 122 7.7 35.6 17.4

100.0

14.9

12.0 “10.9 16.4 30.8 22.1 “7.8

100.0 44.7 “12.8 “5.7 18.3 “9.5

100.0 31.6

“9.0

11.9 7.5 23.7 12.7 12.7

f Indud-as whrte. black and offwr rams, and women of unknown.m@n.

zIrmltis all fimtmaniagaa hafore ISE4 and bsnvaan 1S84 and infarwaw.
advancedata 3

Women of Hispanic origin were more likely than other

women to delay their first sexual intercourse until marriage,

as shown in the bottom rows of table 1. About 45 percent

of Hispanic women, compared with 32 percent of nonHispanic women, first had intercourse after marriage.

Dissolution of first marriage

In 1982, approximately 30 percent of first marriages

to women aged 15-44 had been dissolved by divorce, separation, or death (table 2). Nearly 4 percent of all first marriages

were dissolved within 1 year of the date of the first marriage,

11 percent within 3 years, 15 percent within 5 years, and

24 percent within 10 years.

The proportion of first marriages dissolved within 5

years was approximately twice as high for women married

in the years 1975–79 (20 percent) as for women married

in the years 1960-64 (10 percent). Similarly, at each duration

greater than 1 year for which the experience of a marriage

cohort (a group of women marrying during the same time

period) had been completed, the more recent marriage cohorts

experienced a higher rate of marital dissolution than the

earlier ones, although in most cases the differences were

too small to be statistically significant. Note that the proportions of marriages disrupted within 3 to 10 years for the

1975–79 cohort, within 10 or 15 years for the 1970-74

cohorts, and within 15 years for the 1965-69 cohorts are

biased downward, because not all women in these cohorts

had completed the indicated number of years of marriage

by the time of the survey. This truncation bias has been

indicated in table 2 by italicizing the affected percents.

Marriages of black women were dissolved at a hligher

rate than marriages of white women at each duration of

marriage. By the time of the interview, about 29 percent

of white ever married women, compared with about

46 percent of black ever married women, had experienced

the dissolution of their first marriage. These differences appear

to have narrowed over time. Among women married during

the years 1960-64, 23 percent of black women, compared

with 9 percent of white women, had experienced a rriarhal

dissolution within 5 years; among women married in the

years 1975–79, the comparable proportions were 24 and

20 percent, respectively. Thus, the increase in marital dkuption appears to have been confined to marriages involving

white women. There were no significant differences in

cumulative rates of marital disruption between Hispanic and

non-Hispanic women, as shown in the bottom rows of

table 2.

Table 2. Number of ever married woman 15-44 years of age and cumulative pereant wtmsa tirat msnfage was dissolved by aapardow divoru% or dea@ by

years ainee first ma- aeeording to race, Hiapanii oiigiq and year of tirat manisge: Unitad Staterh 1962

[Prefiminafy data based on a sample C4tie rmninetiludonal population of tie contermimxs United States, Sss Tachnicaf rmtae for dmsaion of the aampfs deaigm, estimates of sanpling variahily,

snd definti of terms]

Yeats since first marriage

Race, Hispanic Ever

origin, and year of mamad 1 2 3 4 5 10 15 All

first marriage bwmen year years years yeaffi years years Yeats years

Number in

Total’

All yearsz . . . . . . . . . . . . . . . . . . . .

1975-79 . . . . . . . . . . . . . . . . . . . .

197&74 . . . . . . . . . . . . . . . . . . . .

1965-69 . . . . . . . . . . . . . . . . . . . .

1960-64 . . . . . . . . . . . . . . . . . . . .

White

All yearsz . . . . . . . . . . . . . . . . . . . .

197s-79 . . . . . . . . . . . . . . . . . . . .

1970-74 . . . . . . . . . . . . . . . . . . . .

1965-69 . . . . . . . . . . . . . . . . . . . .

1960-64 . . . . . . . . . . . . . . . . . . . .

Black

All yearaz . . . . . . . . . . . . . . . . . . . .

1975-79 . . . . . . . . . . . . . . . . . . . .

1970-74 . . . . . . . . . . . . . . . . . . . .

1965-69 . . . . . . . . . . . . . . . . . . . .

1960-64 . . . . . . . . . . . . . . . . . . . .

Htspanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . .

Ncm-Htspanic . . . . . . . . . . . . . . . . .

34,937

7,338

8,266

7,326

5,505

30,419

6,477

7,176

6,400

4,604

3,442

667

785

709

533

2,7S0

31,191

Cumulatiia oercent dissolved at time of interview

3.8 7.4 11.2 13.4 15.5 24.4 2a.4 30.4

“4.1 9.6 15.0 18.9 2L14 22.1 . . . 22.1

“3.5 7.8 12.6 15.6 18.7 32.6 33.1 33.1

“3.7 7.0 10.6 12.4 15.2 26.9 38.8 39.7

●3.4 “5.6 7.3 8.8 10.3 22.0 28.7 35.8

3.5 7.1 10.9 13.0 14.7 23.2 27.0 26.9

“4.1 10.0 15.0 18.8 .212 21.5 . . . 21.5

“3.2 7.3 12.5 15.3 16.0 31.5 31.8 31.6

“3.6 6.8 10.3 11.9 13.9 27.7 37.5 36.5

“2.6 “4.6 “6.4 7.9 6.6 19.3 26.4 32.7

6.4 11.4 15.2 16.6 23.9 36.9 43.0 45.6

“5.4 10.4 16.4 2’2.0 24.3 27.6 . . 27.6

●5.3 11.9 17.0 22.1 26.6 46.0 47.0 47.0

“6.5 11.7 15.6 17.6 28.1 44.1 556 55.9

“9.1 12.8 15.4 17.7 22.7 44.5 57.6 62.8

“3.9 “8.6 “13.1 15.2 17.3 24.3 27.2 29.0

3.7 7.3 10.9 13.2 15.2 24.3 28.4 30.4

‘ Includes whte, black ZI-ICIorfIer rams, and women of unknown ongm.

2 h0hJ&3 first marneg~ ~mmng &$fora 1960 and batwaan 19W3 and mtewmw.

NOTE Fgures in IUMi refkt mcampbre expananca of all or some wcinen m a given mamaga CX4-IWI(sae!em)
4 achtancedata

Remarriage

Nearly 60 percent of the women whose first marriages

were dissolved by divorce or death of the spouse had remarried

by the time of the survey (table 3). Women whose first

marriages ended in separation only are not included in this

table because they are not legally permitted to remarry. About

7 percent of women whose first marriages were dissolved by divorce or death had remarried within 1 year,

about 35 percent within 3 years. and about 48 percent within

5 years. Over half of the women who had remarried by

the time of the survey had done so within 3 years.

Table 3 shows proportions of women who remarried

according to the years in which their first marriages ended.

Over four-fifths of women who were divorced or widowed

in the 1960’s had remarried by the time of the survey,

compared with only about half of women divorced or widowed

during the period 1975-79. This reflects not only the longer

period to time in which the former group of women could

have remarried, but also a probable decline in the likelihood

of remarriage between the 1960’s and late 1970’s. Women

whose first marriages ended in the 1970’s tended to remany

within 2 to 5 years less often than women whose first marriages

ended in the 1960’s. Although none of these differences

is statistically significant, they consistently suggest a lower

rate of remarriage in the 1970’s than in the 1960’s. As

in table 2, some of the percents in table 3 are biased downward,

in this case because not all women whose marriages ended

during a given period of time had completed the indicated

number of years between dkokttion and interview. These

percents appear in italics.

Data from the marriage-registration area indicate a simihir

trend in remarriage (see Technical notes). These &ta show

that the yearly remarriage rate per 1,000 widowed or divorced

women aged 2544 varied between 140 and 157 during the

years 1963-72 and then fell from 155 to 128 during the

period 1972–79.8

Rates of remarriage among divorced or widowed women

were significantly lower for black women compared with

white women. Considering aII marriage cohorts together,

61 percent of white women and 46 percent of bIack women

had remarried by the time of the survey. Similar differences

appear in the cumulative proportions remarrying by 2 to

5 years after divorce or death, and for 2 of the 4 marriage

cohorts.

When all women whose first marriages d molved are

considered, including women whose first marriages ended

in separation only, the dhYerences by race in the percent

TaMa3. Nhrdwmn lWyemd~wti fimm~~~d~&m w~of~, timh —wb~ b

yaara Sinca rnaaol~ according to ~ Niapanii Or@@ and year of d880Mom united Statlsq 1982

[Preliminary data based am a ssmpfad thenOninMfulienal popuhfion of the ccmtarminun Unhd Statas. Sas Tachmcal rsxea for

m Cksfinmonsof terms]

dacuash of tfss Sarrrpb daaign, OsLinsstasof asmplirlg Vansblldy,

Yeara since diksolutkm of first mam”age

Race, Hispanb Firat

origin, and year mam’~ 1 2 3 4 5 Al

of diksdution d&rWed J“@ar yeacs years years ~ars years

Number in

Total’ tfsousands Cumulative percent remarried at time of intarview

All yearsz . . . . . . . . . . . . . . . . . . . . . . . . . 9,459 6.9 23.6 34.7 42.1 4s.2 59.1

197!5-79 . . . . . . . . . . . . . . . . . . . . . . . . . 3,165 “6.4 23.2 34.8 438 48.1

197(2-74 . . . . . . . . . . . . . . . . . . . . . . . . . 2,543

63.6

“9.0 22.1 35.1 42.2 52.2 66.8

1965-69 . . . . . . . . . . . . . . . . . . . . . . . . . 1,212 “6.5 32.5 45.5 54.4 59.6 82.7

1960-64 . . . . . . . . . . . . . . . . . . . . . . . . . 526 “3.7 ●31 .3 “43.6 S.6 6s.1 a9.1

White

All yearsz . . . . . . . . . . . . . . . . . . . . . . . . . 8,145 7.3 25.2 36.5 44.3 S).5 60.6

1975-79 . . . . . . . . . . . . . . . . . . . . . . . . . 2,631 ‘6.6 24.7 S.O 45.9 so. 1

1970-74 . . . . . . . . . . . . . . . . . . . . . . . . . 2,163

55.4

●10.5 24.0 3s.0 44.5

126%69 . . . . . . . . . . . . . . . . . . . . . . . . .

54.6 70.9

1,027 “5.4 34.1 49.1 56.9

196C-64 . . . . . . . . . . . . . . . . . . . . . . . . .

63.6 85.3

3s4 “3.0 37.4 46.8 63.5 80.0 94.6

Black

All year& . . . . . . . . . . . . . . . . . . . . . . . . . 1,056 “4.3 10.5 18.2 23.3 26.2 45.7

1975-79 . . . . . . . . . . . . . . . . . . . . . . . . . 277 “5.6 “9.2 “1Z4 “19.4

1970-74 . . . . . . . . . . . . . . . . . . . . . . . . .

24.9 30.2

30s “0.4 7.0 “15.6 2S.6

1965-69 . . . . . . . . . . . . . . . . . . . . . . . . .

29.6

164

51.0

7.7 “20.3 “21.7 “26.0

1960-64 . . . . . . . . . . . . . . . . . . . . . . . . .

34.5

118

70.7

“6.8 -9.3 “27.1 “37.0 38.1 69.1

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . 641 “4.0 ●17.5 “27.7

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . .

“34.3 -36.7

8,464

57.6

7.2 24.2 35.5 43.0 49.2 59.7

‘ Includes whne, black and other races. awl wmnan ofunkrsosm migm.

z Irclurks first msrnages tjik.qolva.j before 1960 and hstwaan 1920 and inle*,

NOTE F~ures m itslii refw incamplefeexpdenca of al ofaonw wurswn in agiwn mantagecobr (seetaxf).
ackncedata 5

remarrying are even larger (31 percent of black women compared with 55 percent of white women). This is because

the first fmm-iages of black women are more likely than

those of white women to end in separation only. As the

figure shows, 36 percent of dissolved first marriages of black

women ended in sepwation only, compared with 11 percent

Figure. Percent distribution of d~ed firai marriages of women 15-44

~o& of age by type of diaaolut@ aoootimg to mew United Stat~

1Oc

90

80

70

ao

g

~ 5(3

1%

40

30

20

10

0

)2.8 —

—

U Wh,te

❑ Black

S4.1

Oivorce Separation only Oeath

Type of dissolution

References

‘National Center for Health Statistics: Vital Statistics of the United

States, 1979, Vol. I. DHHS Pub. No. (PHS) 84-1100. Public Health

Service. Washington. U.S. Government Printing Office, 1984.

2National Center for Health Statistics: Advance report of final natality

statistics, 1982. Monthly Vital S~tistics Report. Vol. 33, No. 6 Supp.

DHHS Pub. (PHS) 84-1120. Public Health Service. Hyattsville, Md.,

Sept. 28, 1984.

SC. A. Bachmch: Conwceptive Practice, 1982. Paper presented at the

annual meeting of the Population Association of America. Minneapolis, May 3, 1984.

4M. Zelnik and J. F. Kantrtec Sexual activity, contraceptive use, and

pregnancy among metmpoiitan-area teenagers, 1971–79. Fm. Pkrn.

Perspect. 12(5): 230-237, 1980.

SM ~lnik j F K~mer, ~d K. Ford Sex and %gnarlcy in Adoles-

,..

cence. Beverly Hills, Calif. Sage Publications, 1981.

‘%V.F. Pratt and G. E. HendershoL Use of family planning services by

sexually active teenagers, 1982. Paper presented at the annual meeting

of the Population Association of America. Minneapolis, May 3, 1984.

‘National Center for Health Statistics: Advance report of final marriage statistics, 1981. Monthly Vital Statistics Report, Vol. 32, No. 11

of dissolved first marriages of white women. Thus the lower

percent of divorced or widowed black women who remarried

is compounded by a higher proportion of black women who

are no longer married and are not legally free to remarry.

Differences in remarriage rates between Hispanic and non-Hispanic women were not statistically significant.

Related sources of data

A detailed analysis of remarriage among women whose

first maniage ended in divorce is presented in a previous

report based on data from the National Survey of Family

Growth, Cycle II.9 These data are not directly comparable

to those presented in this report because the earlier data

were based on computed probabilities of remarriage rather

than cumulative proportions remarrying, and because the data

in the earlier report are limited to women whose first ma.miages

ended in divorce. Nevertheless, findings of both reports are

similar with respect to race differences in remarriage.

Data on marriage and divorce are also published annually

by the National Center for Health Statistics in Monthly Vital

Statistics Report, Advance report of final martiage statistics;

Monthly Vital Statistics Report, Advance report of final divorce statistics; and in Vital Statistics of the United States,

Volume III, Marriage and Divorce.

Supp. DHHS Pub. No. (PHS) 81-1120. Public Health Service.

Hyattsville, Md., Feb. 29, 1984.

8Nationa] Center for Health Statistics Vitaf &+tkJ-CS of we united

States, Vol. 111.Public Health Service. Annually.

%Iational Center for Health Statistics, W. Grady Remarriages of

women 1544 years of age whose first maniage ended in divorce,

United States, 1976. Advance Data Fmm Vital and HeaIth SWistics,

No. 58. DHEW Pub. No. (PHS) 80-1250. Public Health Service.

Hyattsville, Md., Feb. 14, 1980.

‘ONationalCenter for Health Statistics, D. French: The National Survey of Famiiy Growth, Cycle I, Sample design, estimation procedures,and variance estimation. Vital and Health Statistics. Series 2,

No. 76. DHEW Pub. No. (PHS) 78-1350. Public Health Se!rvice.

Washington. U.S. Government Printing Office, Jan. 1978.

I I Na~ion~ centerfor Health Statistics, W. Grady The National ‘urvey of Family Growth, Cycle II, Sample design, estimation prmedures, and variance estimation. Vital and Health Statistics. Series 2,

No. 87. DHEW Pub. No. (PHS) 81–1361. Public Health Service.

Washington. U.S. Government Printing Office, Feb. 1981.
6 achncedata

Technical notes

Survey design

The National Survey of Family Growth (NSFG) is conducted periodcaily by the National Center for Health Statistics

to collect data on fertility, family pkimsing, and related aspects

of maternal and child health. Field work for the first cycle

was conducted under contract in 1973 by the National Opinion

Research Center. Field work for the second and third cycles

was conducted by Westat, Inc., in 1976 and 1982,

respectively.

In all cycles, personal interviews were conducted with

a multistage area probability sample of women 1544 years

of age in the noninstitutional population of the conterminous

United States. In Cycles I and II, ever married women and

never married women with offspring living in the same household were eligible for the survey. In Cycle III, all women

aged 15-44 were eligible, regardless of marital status or

the presence of offspring. Women living in group quarters

(such as college dormitories) were excluded from the samples

in Cycles I and II, but included in Cycle III. Interviews

were conducted with 7,969 women in Cycle III.

Fieldwork for Cycle III was conducted between August

1982 and February 1983. Black women and women aged

15-19 were oversampied. Interviews were conducted by

trained female interviewers and lasted an average of 1 hour.

The interview focused on a woman’s pregnancy history, use

of contraceptives in each pregnancy interval, ability to bear

children, future childbearing expectations, use of family planning and infertility services, marital history, and labor force

participation; and incorporated a wide range of social,

economic, and demographic characteristics.

Reliabilii of estimates

Because the statistics presented in this report are based

on a sample, they may differ from the statistics that would

result if all 54 million women represented by the NSFG

had been interviewed. The standard error (SE) of an estimate

is a measure of such differences. The standard error of an

estimated number or percent presented in this report may

be calculated by using the appropriate values of A and B

from table I in the equations,

and

SE

()

B lt2

(N) = A+~ “N

( )

SE{P9 = B -P’. 10’OX:P “2

where N’ is the number of women, P’ is the percent, and

X’ is the number of women in the denominator of the percent.

Approximate standard errors for estimated percents of ever

married women of all races in Cycle III are shown in

table II.

Tdfel. Pamneterauaedto eomputeaatimefadatandardarromand rafafiw

atanded errors of nurnbara and percents of ever married ~ by

race NationalSurvey of Fem~Gro~ Cycle Ill

Race A B

Allraeesandwhfie . . . . . . . . . -0.001097329 39809.1677

Black . . . . . . . . . . . . . . . . . . . . +moo80a632 6346.0484

Tabb It. Approximate standard errors for estimated pereenta (expreaaad

h pereanfaga points)forever mmiad woman of all recaa: Nafiord Emmy

of I%@ Gro~ Cycle Ill

Base?of 2 or 5 or 10or 200r 30 or 40or

mnt 98 95%80 706050

100,CJJO. . . . . . . 8.6 13.8 18.9 25.2 28.9 30.9 31.5

500,000 . . . . . . . 4.0 6.1 8.5 11.3 12.9 13.8 14.1

l,OOO,OW.. . . . . 2.6 4.3 6.0 8.0 9.1 9.8 10.0

5,000,0Q0. . . . . . 1.2 1.9 2.7 3.6 4.I 4.4 4.5

Io,ooo,ooo . . . . . 0.9 1.4 1.9 2.5 2.9 3.1 3.2

W300,000 . . . . . 0.5 0.8 1.1 1.5 1.7 1.8 1.8

The chances are about 68 in 100 that a sample estimate

would fall within one standard error, and about 95 in 100

that it would fall within two standard errors of a statistic

based on a complete count of the population represented

by the NSFG. Differences between percents discussed in

this report were found to be statistically significant at the

95-percent confidence level using a two-tailed t-test with

39 degrees of freedom. This means that in repeated samples

of the same type and size, a difference as large as the

one observed would occur in only 5 percent of samples,

if there were in fact no difference between the percents

in the population.

The relative standard error of a statistic is the ratio

of the standard error to the statistic and is usually expressed

as a percent of the estimate. In this report, statistics with

relative standard errors of 30 percent or larger are indicated

with an asterisk (*). These estimates are considered unreliable

by themselves but may be combined with other estimates

to make comparisons of greater precision.

Statistics in this report may also be subject to nonsampiing

error, that is, errors or omissions in responding to the interview, recording answers, and processing data. The data have

been adjusted for nonsampling error resulting from nonrespnse by means of adjustments to the sample weights assigned

to each case. Other types of nonsampling error were minimized

by a series of stringent quality control measures similar to

those used in Cycles I and II. 10.11

Definitions of terms

Race—Race refers to the race of the woman interviewed

and is reported as black, white, or other. In Cycle III,

race was classified according to the woman’s tqsort of the

race that best described her.

Hispanic origin—In Cycle iTI, a respondent was classified

as being of Hispanic origin if she reported that her only

or principal national ongin was Puerto Rican, Cuban, Mexican

NOTE A list of references follows the text.
acklncedata _J

American, Central or South American, or other Spanish.

For 3 percent of respondents, origin was not ascertained.

In this report, vaiues have not been imputed, and oniy cases

with known vaiues are inciuded in the statistics on Hispanic

origin. In tabies where data are presented for women according

to race and Hispanic origin, women of Hispanic origin are

inciuded in the statistics for white and biack women if they

were classified as such by race.

Marital status—Persons were classified by marital status

as married, widowed, divorced, separated, or never married.

In Cycies I and II, informally married women—women who

volunteered that they were sharing iiving quarters with their

sexuai partner-were classified as currentiy married. These

women constituted about 2 percent of currently married respondents in Cycie I and 3 percent in Cycle II. In

Cycie III, such women were classified according to their

iegai maritai status. In aii cycles, women who were married

but separated from their spouses were classified as separated

if the reason for the separation was marital discord; otherwise,

they were classified as currentiy married. Formai maritai

status is used throughout this report. Thus, for example,

the number of years between first marriage and dissolution

refers to the time eiapsed between the date of the first

formal marriage and the date of dissolution; remarriage is

entry into a second formai union.

Marital dissolution—Dissolution of formai marriage inciudes death of the spouse, separation due to maritai discord,

and divorce. In the case of divorce, the date that a woman

and her husband separated is used to compute the number

of years between first marriage and dissolution.

Timing of j%st sexua[ intercourse—Persons were classified according to whether their first sexuai intercourse occurred after their first marriage, or, if not, how iong before

marriage it occurred. The date of first sexuai intercourse

was ascertained by the question: “Thinking back, after your

first menstruai period, when did you have sexuai intercourse

for the first time—what month and year was that?’ Wc)men

who were unabie to recali the exact month and year were

probed for a season and year, their age at first intercourse,

and whether or not it occurred before or after the birthday

for the given age. For women who gave ages or seasons

rather than exact dates of first intercourse, dates were estimated for purposes of classifying timing in reiation to marriage. Dates of first intercourse were then compared with

the date of first formal marriage. Thus, women whose first

intercourse occurred after initiating an informal marriage

were classified as having premarital intercourse.

Marriage-registration area (A4RA)-In 1963, the marriage-registration area consisted of 35 States and the District

of Coiumbia. It did not inciude Arizona, Arkansas, Coiorado,

Iliinois, Minnesota, Missouri, Nevada, New Mexico, Notth

Caroiina, North Dakota, Okiahoma, South Carolina, Texas,

Washington, and West Virginia. The 1971 MRA consisted

of 4 i States and the District of Coiumbia. Arizona, Arkansas,

Coiorado, Nevada, New Mexico, North Dakota, Oklahoma,

Texas, and Washington were not inciuded. Coiorado was

added to the MRA in i 979. Marriages performed in the

MRA inciuded 63 percent of the marriages registered in

the United States in 1963, 81 percent in 1971, and

79 percent in i979.

Symbols

. . . Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

().05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

●

Figure does not meet standards of

reliability or precision (more than 30-

percent relative standard error)

# Figure suppressed to comply with

confidentiality requirements
From vital and Health Statistics of the National Center for Health Statistics Numlw 108. May 9, 1985

Wanted and Unwanted Childbearing:

United States, 1973–82

by William F. Pratt, Ph.D. and Marjorie C. Horn, M.A., Division of Vital Statistics

A substantial decline in births that were unwanted at conception occurred between 1973 and 1982, according to results

from the National Survey of Family Growth, conducted in both

years by the National Center for Health Statistics. In 1982,

fewer than 10 percent of all births to ever married women in

the childbearing years had been unwanted at conception compared with 14 percent in 1973. A1though black women in 1982

continued to report larger proportions of unwanted births (22

percent) than white women (8 percent), they experienced a

greater percentage-point decline in unwanted births over the

decade. Of the 4.3 million children in 1982 who had been born

to never married women, 25 percent had been unwanted at

conceptio~ among the 75 percent that had been wante~ more

than half had been wanted at a later time. Only21 percent had

been deliberately conceived by stopping or not using, contraception for that purpose.

The statistics on wontedness and the timing status of births

presented in this report for 1982 are preliminmy results from

Cycle III of the National Survey of Farnily Growth (NSFG).

Data were collected from a multistage area probability sample

of 7,969 women aged 15-44 years, regardless of marital status,

in the noninstitutionalized population of the conterrninous United

States. Between August 1982 and February 1983, interviews

were conducted with 3,201 black women and 4,768 women of

other races. Comparative data for 1973 are from Cycle I of the

NSFG which also was based on a multistage area probability

sample of women 15-44 years of age, but which excluded most

never married women.1 Because the estimates of statistics in

this report are based on samples, they are subject to sampling

variability. Sampling variability, the design of the survey, and

definitions of terms used in this report are discussed in the

Technical notes.

The Concept of “Wontedness”

Theterms “wanted” and “unwanted births” as used in this

report are abbreviations for “wanted and unwanted pregnancies

ending in live births”; whether abirth was wanted or unwanted

refers to the mothefs attitude at the time of conception. It is

important to emphasize that an “unwanted birth” is not necessarily an “unwanted child”; many children whose concep

tions were not wanted nonetheless become cherished members

of their families.

The wontedness of each birth was determined from a series

of questions that asked whether the woman had wanted the

pregnancy at the time conception occurred. If contraception

had not been used or had been stopped prior to the pregnancy,

the woman was asked: “Was the reason you (had stopped/

were not) using any method because you yourself wanted to

become pregnant?” Women who had avoided or discontinued

use of contraception for some other reason or had become

pregnant while using contraception were asked “At the time

you became pregnant . . . , did you, yourself, actually want to

have a(nother) baby at some time?” Women who answered

neither “yes” nor “no” also were asked”. . .. as you look back

to just before thatpregnancy began, would you say you probably

wanted a(nother) baby at some time or probably not?”

The pregnancy was classified as wanted at conception if the

woman had stopped or was not using contraception because

she wanted to become pregnant, or if she had wanted or probably had wanted a(nother) child at some time. The pregnancy

was classified as unwanted if she had not wanted, or probably

had not wanted a(nother) child. If the respondent did not know

whether she had wanted a(nother) baby, or did not care, the

wontedness of the pregnancy was classified as undetermined.

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

However, the percents of pregnancies ending in live births ctas~

sified as “undetermined” were very small (0.3 and 0.2 percent

in 1982 and 1973, respectively); percents of births that were

wanted and unwanted at conception, therefore, are virtually

complementary, increasing and decreasing by the same magnitude.

Statistics on the proportions of births that were mistimed

also are presented in this report. Women whose pregnancies

were classified as wanted were asked. “Did you become pregnant sooner than you wanted, later than you wanted, or at about

the right time?” Births resulting from pregnancies that occurred

sooner than wanted by the mother were classified as mistimed.

Births that occurredlater than wanted are not included with

the mistimed births here because their delay was not subject to

choice or planning control.

Trend in the “Wontedness” of Births:

Ever Married Women

As shown in table 1, between 1973 and 1982 the proportion of all births to ever married women that resulted from

unwanted pregnancies declined significantly (from 14 to 10

percent) and. of course, the proportion of births that were

wanted rose correspondingly (from 86 to 90 percent). Over this

period the data suggest that the proportion of births that occurred sooner than they were wanted (that is, mistimed births)

increased slightly.

In 1982, the proportion of all births that were unwanted at

conception increased steadily with age among ever married

women from 5 percent for 15-19 year olds to 13 percent for

women aged 40-44. A similar increase in unwanted births with

increasing age was found in 1973. Not all of the increases between adjacent age groups were statistically significant, but the

general pattern seems clear.

The changes observed among all ever married women, between 1973 and 1982, largely were due to significant increases

in the proportions of wanted births and declines in unwanted

births among women in the ages 25 to 39 years. Among women

20-24 and 40-44 years of age,similar but not statistically

significant increases were observed in the proportions of wanted

births. Minor changes observed over this period in the proportion of births that were wanted but mistimed were not statistically significant for any of the age groups between 20 and 44

years. However, in both years, mistimed births accounted for

about two in every five births to women 20–24 years of age.

Ever married teenage women in 1982 had the highest proportion of wanted births (95 percent) and the lowest proportion

of unwanted births (5 percent) of any age group shown in~table

1; these proportions had not changed since 1973. However, the

proportion of mistimed births to these teenaged women rose

sharply from an already high 55 percent in 1973 to 75 percent

in 1982. It is quite likely that this high and rising prevalence of

mistimed births among ever married teenagers refleclts the

greater exposure to premarital intercourse at these ages and the

large number of pregnancies precipitating an early marriage.2

Couples continue to have far less success with contracep

tion in planning when their children will be born than in plauming

how many they will have. In 1982, mistimed births (28 percent)

were almost three times more frequent than unwanted births

(10 percent) but only two times more frequent in 1973. The

apparent small rise in mistimed births for all ever married

women and their more significant increase among younger

women may be due in large measure to the trend toward greater

use of barrier methods of contraception, which are generally

less effective than the pill or IUD.3,4

The proportion of unwanted births was twice as high among

formerly married women compared with currently married

women in both 1973 and 1982, but declined significantly in

both groups over the decade (table 2). The proportion of Ibirths

that were mistimed was practically unchanged among currently

married women between 1973 and 1982, but it increased sharply

among formerly married women. Among formerly married

women in 1982, at least one-third of their births had been

wanted but mistimed.

The notably higher proportions of unwanted and mistimed

births to formerly married women suggest the possibility that

Table 1. Number of children ever born to ever married women 15-44 years of age and percent distribution by whether the birth was wanted.

wantad but mistimed, or unwanted at conception, according to age of the mothec United Stetes, 1973 and 1982

[StatwIcsare baaed on samples of the female population of the conterrmnous Unned Statea; see Technical notes for estimates of samplmg variability and definitions

of terms; data for 1982 are prehminaw]

Wanted at conception

Children Unwanted at

ever born Total Mistimed conception

Age 1982 1973 ?982 1973 1982 1973 1982 1973

Number m thousands Percent distn”butionl

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65,878 66,239 90.1 85.8 28.2 25.7 9.6 Tm

15-19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445 548 95.3 94.9 74.8 54.7 “4.7 “5.1

20-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,398 5,215 93.5 91.5 44.0 40.3 ●6.5 8.4

25-29 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,304 11,102 93.1 89.5 28.0 28.3 6.3 10.4

30-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,346 15,160 91.7 86.6 26.8 27.3 8.2 13.2

35-39 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,983 16,307 89.3 83.0 26.4 23.7 10.4 16.8

40-44 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,401 1.7,907 66.7 83.4 26.0 19.4 13.0 16.4

7Percents of I!ve b!rths wanted and unwanted at conccptnon may not add co 100 due to the exclusmn of bwths for wh!ch the wontedness of the pregnancy was

classified aa “undetermined,’”
a&me&ta3

Table 2. Number of children ever born to ever married women 15-44 years of age and percent distribution by whether the birth was wanted,

wanted but mistimed. or unwanted at conception, according to race and marital status of the mothec United States, 1973 and 1982

[SratM!csare based on samples of the female population of the COriterMinOuS United Ststes: see Techmcal notes for estimates of sampl!ng var!ab!hty and def,”mcms of

terms; data for 1982 are prelimlnav]

Wanted at conception

Children Unwanted at

ever bc?rn Total Mistimed conception

Fface and marital status 1982 1973 1982 1973 1982 ?973 ?982 7973

Number in thousands Percent distribution

Allracesl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65,878 66,239 90.1 85.8 28.2 25.7

Currently married . . . . . . . . . . . . . . . . . . . . . .

9.6

52,873

14.0

57,158 92.0 87.6 26.6 25.6

Formerly married, . . . . . . . . . . . . . . . . . . . . . .

7.8 12.3

13,005 9,081 82.6 74.5 34.7 26.5 16.8 25.2

White. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55,497 57,012 92.1 88.4 27,7 25.5

Currently married . . . . . . . . . . . . . . . . . . . . . .

7.7 11.4

46,546 51,179 93.0 89.2 26.0 25.4

Formerly married . . . . . . . . . . . . . . . . . . . . . . .

6.8 10.6

8,952 5,834 87.4 81.3 36.7 26.3 12.2 18.5

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,467 B,634 77.5 68.0 32.2 27.4

Currently married . . . . . . . . . . . . . . . . . . . . . .

21.8 31.5

4,769 5,448 82.6 71.3 33.1 27.6

Formerly married . . . . . . . . . . . . . . . . . . . . . . .

17.2

3,69B

28.3

3,186 70.9 62.3 31.1 27.2 27.8 37.1

llncludes white, black. and other races.

unplanned childbearing is a factor in the instability of some

marriages. Formerly married women as a group appear to be

slightly older and to have borne more children on average than

currently married women, and both age and parity are associated with increases in unwanted births. Nevertheless, at each

parity shown in table 3, the data suggest that the proportion of

births classified as unwanted by formerly married women was

greater compared with currently married women.

The differences observed in the proportions of wanted and

unwanted births between white and black women are even

greater than the differences by marital status (table 2). In 1973,

ever married black women reported 32 percent of births had

been unwanted at conception compared with 11 percent reported by white women. By 1982, the proportions of unwanted

births had declined 10 percentage points among black women

and 3 percentage points among white women, to 22 percent

and 8 percent, respectively. In both race groups, formerly married women had notably higher proportions of unwanted births

than currently married women in 1973 and 1982, despite the

substantial reductions in unwanted births across the board.

The proportions of mistimed births increased for M.h black

and white women between 1973 and 1982; in both years black

women experienced a higher proportion mistimed compared

with white women, although the difference was significant only

Table 3. Number of children ever born to ever married women 1544 yeers of age and percent distribution by whether the birth waa wanted,

wanted but mistimed, or unwanted at conception, according to race and parity of the mother United States, 1973 and 1982

[Statisticsarebssed on samples of the female population of the conterrnmous United States; see Technical notes for estlmatas of samplmg vartabd[q and definmons

of term% data for 1982 are preiiminsry]

Wanted at conception

Children Unwanted at

ever born Total Mistimed conception

Race and parity 1982 7973 1982 1973 1982 1973 1982 1973

All racesl Number in thousands Percent distribution

All parities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65.878 66,239 90.1 85.B 2B.2 25.7 9.6 14.0

1-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29.549 21,571 96.3 95.3

3-4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27.9 27.7

27.734

3.6

26,924

4.6

8B.1

5 or more

85.7 28.5

8,594

25.0 11.7 14.1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,744 75.6 74.2 28.2 24.4 23.3 25.5

White

All parities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55,497 57,012 92.1 88.4 27.7 25.5 7.7 11.4

1-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,031 19,379

3-4

97.2 96.5 27.6 26.7 2.7 3.4

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,486

5 or more

24,094 89.6 87,2 28.0

5,980

24.7 10.3 12.6

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,539 79.6 79.0 27.3 24.9 19.5 20.8

Black

All parities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,467 8,634 77.5 68.0 32.2 27.4 21.8 31.5

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

34

2,655 1,955 87.4 83.0 32.1 37.4 12.4 16.2

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,290 2.596 78.7 72.2

5 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

33.5

2,522

27.8

4,083

20.9

65.6

27.4

56.0 30.6 22.4 33.0 41.5

‘Includes white, black, snd other races.
at the .10 level in 1982. However, among black women, the

increases in the proportion of mistimed births for currently married and formerly married women were not significan~ while

formerly married white women experienced a steep increase

(10 percentage points) in mistimed births over the decade.

The proportion of unwanted births increased with the

number of births a woman had had (that is, with her parity), as

may be seen in table 3. For instance, in 1982, among ever

married white women with only 1–2 births, less than 1 in 30

births had been unwanted at conception, while those with 5 or

more births reported 1 in 5 had been unwrmted. Similarly,

among black women at parity 5 or more, 1 in 3 births had been

unwanted at conception.

Although there appeared to be a reduction in the proportion

of unwanted births in each parity category for both white and

black women between 1973 and 1982, few of these declines

were statistically significan~ there is, however, some evidence

of a reduction among black women with 3 or more births.

None of these declines within the parity groups was as great as

the overall decline for the respective race groups. For instance,

between 1973 and 1982, the overall proportion of unwanted

births to white women declined by nearly 4 percentage points,

but the largest decline among the parity groups was about 2

percentage points among those with 3–4 births; similarly for

black women, an overall decline of close to 10 percentage points

exceeded the largest parity group decline of nearly 9 percentage

points among those with 5 or more births.

The overall decline in the proportion of unwanted births

between 1973 and 1982 was greater than the declines in the

separate parity groups because, not only were women interviewed in 1982 more successful in avoiding unwanted births,

but the number of births they wanted also was smaller. Over

this decade, women were postponing marriage for longer periods of time, and delaying childbearing within marriages-’ As

a result, we observe that in 1982 a larger propofiion of births

occurred to women who were parity 1-2 (45 percent) and a

smaller proportion to women who were parity 5 or more (13

percent), compared with 33 and 27 percent, respectively, in

1973. Another way to see the effect of the declining number of

wanted births is to note that if the declining proportions of unwanted births within the parity groups were the only change,

then the overall proportion of unwanted births in 1982 would

have been 12 rather than 10 percent. It is important not to

confuse the increase in the proportion of births that were wanted

at conception with wanting a larger number of children.

“Wontedness” of Births:

Never Married Women

Never married women were interviewed in the NSFG for

the first time in 1982 (table 4). Although it is no surprise that

births to never married women were wanted at conception (75

percent) less frequently than those born to ever married women

(90 percent), the proportion of wanted births to never married

women nonetheless was high. It is important to recall that a

wanted birth is one thaq at the time of conception, was wanted

by the mother “at some time” but not necessarily at that particular time. In fact, more than half the wanted births to never

married women (42 percent of the total births) were mistimed,

Table 4. Numbar of children avar born to naver marriad womon

15-44 years of age and percent distribution by whether the birth

was wanted, wantad but mistimed, or unwantad et conception,

according to age and race of tha mothafi United Statas, 1982

[Prel,mtnarf statmt,cs based on samples of the female population of the

contawmlnous United States; aee Technical notes for eatlmates of sampling

variability and defimtlons of terms]

Wanted

Children X conception Unwanted

ever at

Age and race born Total Mistimed conception

All raceal

15-44 years . . . . . . .

15-19 years . . . . . . .

20-24 years. . . . . . .

25-44 years. . . . . . .

White

15-44 yeara . . . . . . .

15-19 yeara . . . . . . .

20-24 years. . . . . . .

25-44 years. . . . . . .

Black

15-44 yeara . . . . . . .

15-19 years . . . . . . .

20-24 years. . . . . . .

25-44 years. . . . . . .

Number in

thousands

4,341

474

1,273

2,593

1,670

220

473

977

2,569

245

727

1,597

Percent distribut!otn

75.1 42.3 :24.8

75.6 54.9 :24.4

80.5 48.1 ‘19.5

72.3 37.1 :27,6

81.6 42.4 18.4

85.2 61.6 *14.8

89.9 53.5 ●1O.1

76.7 32.7 ;23.3

70.1 41.4 29.8

68.2 49.2 31.8

72.5 42.9 27.5

69.3 39.4 30.5

TIncludes white, black, and other races.

contrasted with less than one-third (28 percent of the total births)

among ever married women. Moreover, data not shown in table

4 reveal that, among the group of wanted births that were not

mistimed, only about two-thirds of mothers had not used, or

had stopped using, contraception because they wanted to become pregnant then. In sum, although 75 percent of births to

never married women were wanted “at some time,” the proportion that had been deliberately conceived or planned was on

the order of21 percent.

Differences in wontedness status by race and age found

among ever married women are similar to those for never married women. In 1982, the proportion of births classified as unwanted to all never married black women was higher than that

of never married white women aged 15–44 (30 compared with

18 percent). Within each age group, the propofions unwanted

also tended to be higher for black women than white women,

although the differences at age(s) 25–44 were not statistically

significant.

The proportions of births that were wanted but mistimed

are neariy the same for black never married women (41 percent)

as for white never married women (42 percent). At ages

15-24, it appears that white women classified a larger percent

of all births as mistimed compared with black women, but the

dfierence is not statistically significant. For black women, the

proportions of mistimed births among the never marrield were

substantially higher than among either their currently or formerly married counterparts (table 2). For white women a similar

pattern was found, b~t the difference in the proportions mistimed between never and formerly married women was not

significant.
a&medaa5

References

lNational Center for Health Statistics, D. French National Survey of

Family Growth, Cycle I: Sample design, estimation procedures, and

variance estimation. Vital and Hea/fh Stafisfics. Series 2, No. 76.

DHEW Pub. No. (PHS) 78-1350. Public Health Sewice. Washington.

U.S. Government Printing Ofllce, Jan. 1978.

2W. F. pra~ W. D. Mosher, C.’A. Bachrac~ and M. C. Horn Understanding U.S. Fertility. Population Bulletin. Vol. 39, No. 5. Washington. Population Reference Bureau, Dec. 1984.

3C. A. Bachrach: Contraceptive Practice, 1982. Paper presented at

the annual meetings of the Population Association of America. Minneapolis, May 1984.

4Nationa1 Center for Health Statistics, C. A. Bachrach and W. D.

Mosher Use of contraception in the United States, 1982. Advance

Data From Vital and HeaIth Statistics. No. 103. DHHS Pub. No.

(PHS) 85-1250. Public Health Service. Hyattsville, Md., Dec. 1984.

5U.S. Bureau of the Censu.x Marital status and living arrangements,

March 1982. Curnmt Population Repons. Series P-20, No. 380.

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

6NationaI Center for Health Statistics, S. J. Ventura: Trends in first

births to older mothers, 1970-79. Monthly Vital Statistics Report.

Vol. 31, No. 2 Supp. 2. DHHS Pub. No. (PHS) 82-1120. Public

Health Service. Hyattsville, Md., May 1982.

7National Center for Health Statistics: Advance rept of final natality

statistics, 1982. Monthly Vital Statiwics Repoti. Vol. 33, hro. 6. Supp.

DHHS Pub. No. (PHS) 84-1120. Public Health Service. Hyattsville,

Md., Sept. 1984.

Symbols

. . . Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standards of

reliability or precision (30 percent

or greater relative standard error)

# Figure suppressed to comply with

confidentiality requirements
6

Technical Notes

Survey design

The National Survey of Family Growth (NSFG) is conducted periodically by the National Center for Health Statistics

to collect data on fertility, family planning, and related aspects

of maternal and child health. Field work for Cycle I was conducted under contract in 1973 by the National Opinion Research Center. Field work for Cycle III was conducted by

Westat, Inc., in 1982.

In all cycles, personal interviews were conducted with a

multistage area probability sample of women 15–44 years of

age in the noninstitutional ized population of the conterminous

United States. In Cycle I, ever married women and never married women with offspring living in the household were eligible

for the survey. In Cycle III, all women aged 15–44 were eligible

regardless of marital status or the presence of offspring. Women

living in group quarters (such as college dormitories) were excluded from the samples in Cycle I, but included in Cycle III.

Interviews were conducted with 9,797 women in Cycle I and

7,969 in Cycle III. The sample design of Cycle I is described

in more detail in another report of the National Center for

Health Statistics. 1

Field work for Cycle HI was conducted between August

1982 and February 1983. Black women and women aged

15–1 9 were oversampled. Interviews were conducted by trained

female interviewers and lasted an average of 1 hour. The interview focused on a woman’s pregnancy history; use of contraceptives in each pregnancy interva~ ability to bear childrery

future childbearing expectations; use of family planning and

infertility services; marital history; labor force participation,

and a wide range of social, economic, and demographic

characteristics.

Reliability of estimates

Because the statistics presented in this report are based on

a sample, they may differ from the statistics that would result if

all 54 million women represented by the NSFG had been interviewed. The standard error of an estimate (SE) is a measure

of such differences. The standard error of an estimated number

or percent presented in this report may be calculated by using

the appropriate values of A and B from table I in the equations

() B 1/2

SE(N)= A+-~ “N’

( )

SE(F) = B cP’ s 100x– p “2

where N’ is the number of pregnancies, F’ is the percent, and X

is the number of pregnancies in the denominator of the percent.

Approximate standard errors for estimated percents of pregnancies to ever married women of all races in Cycle 111 are

shown in table H.

NOTE: A list of references follows the text.

Table 1. Parameters used to computa eatimatad standard errors

and relative standard errors of numbers and percents of

pregnancies by rata, marital status, and age of women: National

Survay of Family Growth

Parameter

Race, marital status, and age A B

1982

All pregnancies:

Allraces and white . . . . . . . . . . -0.000001353325.567,4424

black . . . . . . . . . . . . . . . . . . . . . 0.0001091980 7,143.2252

Pregnancies to ever married

women:

Allraces and white . . . . . . . . . . 0.0031203910 43,592.7254

Black . . . . . . . . . . . . . . . . . . . . . -0.0001123101 15,678.7103

Pregnancies to never married

women and to teenagers aged

15-19 years:

All races:

Never married . . . . . . . . . . . . 0.0138872800 8,660.9620

Teenagers . . . . . . . . . . . . . . . 0.0059512240 7,802.2084

White:

Never marr!ed . . . . . . . . . . . . 0.0709659500 13,265.3231

Teenagers . . . . . . . . . . . . . . . 0.0102484400 9,664.9170

Black

Never married; teenagers. . . . . 0.0045465070 3,430.7602

1973

Allraces and white . . . . . . . . . . . . 0.0000176130 4.493.7916

black . . . . . . . . . . . . . . . . . . . . . . . 0.0000402190 1,600.4393

The chances are about 68 in 100 that a sample estimate

will differ by no more than one standard error, and about 95 in

100 that it will differ by no more than two standard errors, from

a corresponding statistic based on a complete count of the pop

ulation represented by the NSFG. Differences among percents

discussed in this report were tested for statistical significance

at the 95-percent confidence level, using a two-tailed t-test with

39 degrees of freedom. This means that if there were no difference among the corresponding percents in the population as

a whole, then a difference as large as the one observed in the

sample would occur in fewer than 5 percent of repeated samples

of the same size and design as the NSFG. When the obsemed

difference between two statistics being compared is not statistically significant, the statistics are described as “similar,” but

terms such as “greater,” “less,” “larger,” and “smaller” indicate statistically significant differences. Marked ditTertmces

that would be expected in fewer than 10 percent of repeated

samples (that is, significant at the 90-percent confidence level)

are noted in a qualified manner (for example, by such phrases

as “the data suggest” or “some evidence for”).

The relative standard error of a statistic is the ratio clfthe

standard error to the statistic and usually is expressed as a

percent of the estimate. In this report, statistics with relative

standard errors of 30 percent or greater are indicated with an

asterisk (*). These estimates are considered unreliable by themselves, but may be combined with other estimates to lmake

comparisons of greater precision.
achlcaw7

Table Il. Approximate standard errors for estimated percents (expressed in percentage points) of pregnancies to women of all reces:

Netionai Survey of Family Growth, Cycle Ill

Estimated percent

2 or 5 or ?0 or 20 or 30 or 40 or

Base of percent 98 95 90 80 70 60 50

100.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 11.0 15.2 20.2 23.2 24.8 25.3

500.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 4.9 6.8 9.0 10.4 11.1 11,3

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 3.5 4.8 6.4 7.3 7.8 8.0

5D00,000. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 1.0 1.6 2.1 2.9 3.3 3.5 3.6

10,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 1.1 1.5 2.0 2.3 2.5 2.5

30,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.6 0.9 1.2 1.3 1.4 1.5

50,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.5 0.7 0.9 1.0 1.1 1.1

Statistics in this report also maybe subject to nonsampling

error, that is, errors or omissions in responding to the interview, recording answers, and processing data. The data have

been adjusted for nonsampling error due to nonresponse by

means of adjustments to the sample weights assigned to each

case. Other types of nonsampling error were minimized by a

series of stringent quality control measures similar to those

used in Cycle 1.1

Definitions of terms

Wontedness—Pregnancies were classified as “wanted” or

“unwante~” and wanted pregnancies that occurred earlier than

they were desired were subclassified as “mistimed.” A pregnancy was classified as wanted at conception if the woman had

stopped, or had not used, contraception because she wanted a

pregnancy, or if she had become pregnant while using contraception but nonetheless had wanted, or probably wanted,

a(nother) baby at some time. Similarly, a pregnancy was classified as unwanted at conception if the woman had stopped, or

had not used, contraception for reasons other than seeking pregnancy or had become pregnant while using contraception and

had not wanted, or probably had not wanted, a(nother) baby at

some time. In this report, a wanted pregnancy was considered

mistimed if the woman had wanted the pregnancy to occur at a

later date. Pregnancies that occurred sometime later than had

been desired, also might be considered mistimed for some purposes, but these did not represent failures in family planning that is subject to contraceptive control, and therefore

are classitled with other births that were wanted at conception.

NOTE: A list ofreferencesfollowsthe text.

Pregnancies that ended in live births, on which this report is

focused, were classified as wanted or unwanted births. However,

pregnancies that ended in multiple births are counted only once

because only the pregnancy is subject to contraceptive control.

Parity-Parity refers to the number of live births the respondent had had.

Age—Age is classified by the age of the respondent at her

last birthday before the date of interview.

Race—Race refers to the race of the woman interviewed

and is reported as black, white, or other. In Cycle III, race was

classified according to the woman’s report of the race that best

described her. In Cycle I, race was classified by the observation of the interviewer. Cycle 111 data indicated that results

using either method of classification were found to be very

similar.

Man”fal srarus—Persons were classified by marital status

8s married, widowed, divorced, separate~ or never married. In

Cycle I, informally married women—women who volunteered

that they were sharing living quarters with their sexual partner—

were classified as currently married. These women constituted

about 2 percent of currently married respondents in Cycle I. In

Cycle III, such women were classified according to their legal

marital status. Thus, statistics on currently married women for

1982 shown in this report are not strictly comparable to those

for 1973. Reclassi&ing women in the 1973 survey according

to the 1982 definition of marital status, however, makes little

difference in the distributions of currently mamied women by

other characteristics for that year.

In all cycles, women who were manied but separated from

their spouse were classified as separated if the reason for the

separation was marital discord, otherwise they were classified

as currently married.
From Vital and Health Statistics of the National Center for Health Statistics Number 109. May 23, 1985

Hospital Use by Children:

United States, 1983

by Eileen McCarthy and Lola Jean Kozak, Division of Health Care Statistics

Introduction

During 1983 an estimated 3.7 million children under

15 years of age were discharged from short-stay non-Federal

hospitals in the United States. They spent an average of

4.6 days in the hospital. These and other statistics presented

in this report are based on data collected by the National

Center for Health Statistics, by means of the National Hospital

Discharge Stuwey, a continuous voluntary survey. In 1983

data for the survey were abstracted from the medical records

of approximate y 206,000 patients discharged form 418 participating hospitals. A brief description of the sample design,

source of data, and definition of terms used can be found

in the Technical notes. The design of the survey has been

described in a published report. 1

Although other reportsz~ based on the 1983 survey

include data on children under 15 years of age, this report

contains data on the four age groups within the under 15

years group: under 1 year, 1-4 years, 5–9 years, and 10-14

years. Data for the age groups are presented by selected

characteristics of discharges, diagnoses, and procedures. Estimates of the number of discharges, rates per 1,000 population,

and average lengths of stay are shown for children. Summary

statistics for 1973 and 1978 are also presented. This is

the first detailed presentation of data from the survey on

the four specific age groups of children. The report is also

intended to update the U.S data from an earlier comparative

study, “Hospital Use by Children in the United States and

Canada,’Tswhich was based on 1978 &ta.

Data for newborn infants are excluded from this report.

The diagnostic and procedural data are coded according to

the International Classification of Diseases, 9th Revision,

Clinical Modification (lCD-9-S3+A).6

Highlights

● ‘:--L ----- -r -L:’ A--- ..-2-- ‘ ----- -c --- ‘------- 2

●

●

●

●

●

●

●

●

1ne CtmcikugcsVI WUUICII UIIUGI I ymr WI zigc mxmsea

from 15 percent of all children’s discharges in 19’73 to

26 percent in 1983.

In 1983 males had a higher rate of discharges than females

for the age groups under 1 year, 1-4 years, and 5–9

years.

The average length of stay for children did not (differ

significantly by sex or geographic region.

By region, the South had the largest number of children’s

discharges, an estimated 41 percent of the total,

Private insurance was the leading principal expected source

of payment of hospital costs for children.

Medicaid and the self-pay category were more likely to

be the expected source of payment for children under

1year of age and 1-4 years than for older children.

Diseases of the respiratory system accounted for a fourth

of the discharges for children under 1 year of age, more

than a third of the hospitalizations for children 14 and

5–9 years, and 20 percent of the discharges for the 10-14

years age group.

Disorders relating to short gestation and unspecified low

birth weight was a major diagnosis for children under

1year of age.

Pneumonia was an important diagnosis for children I-4

years; and chronic disease of tonsils and adenoids was

important for children 5-9 years and 10-14 years of age.

For children under 15 years of age, tonsillectomies with

or without adenoidectomies were the most frequently performed procedures, followed by myringotomies.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

—

Public Health Serwce
2 ackinceckta

Table 1. Numtnm rateq 8nd average lengths of may for Pa6enta Lmder 15 Yeara of age (exdwfing newborn infants) diaeherged from ahcm-stay

non-Federal hmpitdq by age groups and a=c United Stateaj 19= 1978, and 1983

1973 1978 1983

Aae amur 60m sexes Male Fema/a Eoth sexes Male Female Both sexes Male Female

Number of discharges

Under 15 yeare . . . . . . . . . . . . . . . . .

Under l year . . . . . . . . . . . . . . . . .

l+lyears . . . . . . . . . . . . . . . . . .

5-9years . . . . . . . . . . . . . . . . . .

10-14 years . . . . . . . . . . . . . . . . . .

3,938 2,231 1,700 3,488 1,946 1,542 3,654 2,084 1,570

580

1,2*4

1,138

1,001

337

703

639

552

243

510

499

448

691 394 297

1,044 601 443

910 506 404

843 445 398

938

1,146

769

803

542

664

451

427

394

482

319

375

Rate per 1,000 population

Undar15years . . . . . . . . . . . . . . . . .

Under l year . . . . . . . . . . . . . . . . .

14years . . . . . . . . . . . . . . . . . .

5-9years . . . . . . . . . . . . . . . . . .

lC-14years . . . . . . . . . . . . . . . . . .

70.0 77.9 61.8 67.1 73.3 6Q.7 70.8 79.0 62.3

220.7

69.6

40.6

43.2

207.7 231.6 182.6

84.2 94.7 73.1

52.6 57.3 47.7

44.5 46.0 43.0

255.8

80.9

48.1

45.1

289.2

91.7

55.1

47.0

185.6

88.4

62.2

47.6

211.0

100.3

68.5

51.5

156.5

75.9

55.7

43.5

Average length of slay in days

Under15years . . . . . . . . . . . . . . . . .

Under lyear . . . . . . . . . . . . . . . . .

l-4years . . . . . . . . . . . . . . . . . .

5-9years . . . . . . . . . . . . . . . . . .

10-14years . . . . . . . . . . . . . . . . . .

4.5 4.5 4.6 4.4 4.5 4.4 4.6 4.5 4.6

6.4

4.3

3.8

4.6

6.2

4.1

3.8

4.6

6.7

4.6

3.7

4.6

5.9 5.7 6.2

4.0 4.0 4.0

3.6 2..7 3.4

4.7 4.9 4.5

6.6

3.7

3.4

4.6

6.5

3.6

3.4

4.6

6.7

3.7

3.3

4.7

Children’s discharges

Trends byage and sex

The 3.8 million discharges for children under 15years

ofagein 1983 translated toarateof70.8 per 1,000 children

in the population (table 1). Neither the total number nor

the rate changed significantly from 1973 through 1983, but

therewerechanges duringthisperiod forspecific agegroups.

Children under 1 year of age, who had the highest

discharge rates of the four children’s age groups, were the

only age group for which the numbers and rates of discharges

increased. They accounted for 15 percent of children’s discharges in 1973, expanded to 20 percent in 1978, and to

26 percent in 1983. The discharge rate for children in this

age group grew 38 percent from 1973 through 1983. The

14 years age group made up virtually the same proportion

of the discharges, approximately 30 percent, in each of

the 3 years.

The hospitalizations of children 5–9 years of age decreased during the period 1973–83. This group made up

29 percent of children’s discharges in 1973, but fell to 26

percent in 1978, and to 21 percent in 1983. The discharge

rate of the 5-9 years age group decreased 23 percent during

the period, with the rate for males declining 20 percent

and the rate for females falling 27 percent. The number

of discharges for children 10-14 years of age also decreased.

Children in this group accounted for 25 percent of all children’s

discharges in 1973,22 percent in 1983.

Neither the total average length of stay for all children

under 15 years nor the lengths of stay for the four specific

age groups changed significantly from 1973 through 1983.

The longest lengths of stay were for children under 1 year

of age. The 5–9 years age group had lengths of stay below

the average for all children in 1973, 1978. and 1983.

Average lengths of stay were approximately the same

for both males and females in all the age groups in the

period 1973-83. However, discharge rates were higher for

males than for females under 15 years throughout the period.

Not all the sex differences in discharge rates for the specific

age groups were significant, but maies had consistently higher

discharge rates than females in the 1+ years age group.

In 1983 males also had higher discharge rates than females

in the under 1year and 5–9 years age groups.

Geographic distribution

The South Region of the country had the largest number

of children’s discharges in 1983 (table 2). Although the

South had the largest population of children of any region,

this high number of discharges also reflects a children’s

discharge rate that was higher than the average for all the

regions. In two of the three geographic divisions that make

up the region. East South Central and West South Central,

the discharge rates were higher than the average.

The North Central Region had the second highest population of children and the second highest number of children’s

discharges. Within the region, the West North Central Division

had a discharge rate that was higher than the average.

The third-ranking region in number of discharges was

the Northeast, even though it had the smallest regional population of children. The New England Division of this region

had the smallest number of children’s discharges of any

division because of its small population of children and a

discharge rate for children that was well below the average

for the country. Among the regions, the West had the smallest

number and rate of children’s discharges. This is primarily

attributable to the very low discharge rate for the Pacific

Division of the region. Lengths of stay for children by region
ac’kncedata 3

Table 2. Nunrbe~ ratea and average tengfha of stay for patients under 15 yeara of age (exducting newborn infanta) d~hargad from ahert-stay

non-t%daral hoapibd~ by geographic rq$ona and cfivkkrrrtK United State& 19S3

Rate par 1,000 Average !ength

Region and division Number in thousands population of stay in daya

All regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,654 70.8 4.6

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

New England . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Middle Atlantic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

EastNorthCentral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

South Atlantic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EastSouthCentral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

WestSouth Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

682

125

557

987

622

365

1,507

511

3s4

612

68.8

50.9

74.7

74.5

66.6

93.2

83.9

62.7

110.8

96.5

4.5

4.5

4.5

4.8

4.9

4.5

4.6

4.3

4.3

5.1

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 478 45.7 4.0

Mountain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 62.6 4.0

Pacific . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284 38.5 4.1

Tatrle3. Numbers, peroent dmtnbutions+ andavemge kn~aofshy for~n&utier 15yeamof sge(exdudng newbrninfan@) dwhargedtia,m

short-stay non-Fedeml hoap”tit$ byexpaotad pnncipalaourcas ofpayment and agegroup~lhtitad State$ 1983

Source of payment Under 15 years Under 1 year 1-4 years 5-9 years lC-14yeam

Number of discharges

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,664 936 1,146 769 803

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 801 248 288 139 126

Privatemsursnce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,295 485 692 542 575

Self pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325 129 98 47 51

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 74 68 47 51

Percent distribution

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

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.9 26.5 25.1 18.1 15.7

Privatemsurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62.8 51.8 60.4 70.5 71.7

Self pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.9 13.8 8.5 6.2 6.3

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 8.0 5.9 5.2 6.3

Average length of stay in days

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.6 6.6 3.7 3.4 4.8

Medtcsld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0 6.8 4.2 3.6 5.0

Private insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 5.9 3.4 3.3 4.6

Selfpay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 7.4 3.7 3.3 4.4

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 8.5 4.4 4.5 4.3

were not significantly different from the average for the

country as a whole.

Source of payment

The expected principal sources ofpayment forchildren’s

hospitalizations are shown in table 3. Private insurance was

the leading expected source for children in each of the four

age groups. It was the expected source of payment for more

than”70 percent of the hospitalizations of children 5–9 and

10-14 years ofage and a smaller proportion ofthehospitalizations of children 1-4 years and under 1 year, 60 percent

and 52 percent respective y.

Medicaid, a government health program that provides

benefits tolow-income persons. wasthe secondmostcornmon

expected source of payment for children, It was more likely

to be the expected principal source of payment for children

under 1 year and 14 years of age than for children in

the two older age groups.

The self-pay category is one iri-which thecostsofhospitalization are expected to be paid by the family rather

than any insurance or other program. More ofthehospitalizations of children under 1 year, 14 percent, fell intcl this

category than did hospitalizations ofother age groups ,thlough

children 14 years of age were more likely to have hospital
4 acklncedaia

stays in the self-pay category than were older children.

The average length of stay varied somewhat for hospitalizations with different expected principal sources of payment.

For children under 15 years of age as a group, average

stays were shorter when private insurance was the payment

source than when ,Medicaid or self pay were. Children und&

1 year in the self-pay category had significantly longer average

stays than those covered by private insurance. The 1-$ years

age group had significantly longer stays when covered by

Medicaid than when covered by private insurance. However,

for children 5-9 and 10-14 years of age, average stays

were not significantly different for these three payment

sources.

Diagnoses

Under 1 year of age

Estimates of numbers and rates of discharges and of

the average lengths of stay for children under 1 year of

age are shown in table 4 by selected diagnoses and sex.

Three diagnostic categories accounted for 61 percent of the

discharges of children in this age group: diseases of the

respiratory system, certain conditions originating in the

perinatal period, and diseases of the digestive system.

Diseases of the respiratory system were responsible for

one-foutth of the discharges of the under 1 year age group.

Acute bronchitis and bronchiolitis, other acute respiratory

infections, and pneumonia accounted for more than threefourths of the respiratory disease discharges.

Certain conditions originating in the perinatal period made

up 22 percent of the total discharges. Disorders relating

to short gestation and unspecified low birth weight accounted

for 42 percent of the discharges in the catego~. It should

be pointed out that babies who remain in the hospital where

they are born are categorized as newborn infants and are

not included in this report. However, infants admitted or

transfemed to another hospital at any time after birth are

considered patients under 1 year of age in the hospital to

which they are admitted or transferred. This latter group,

made up mainly of very young babies, accounts for a large

proportion of discharges in the perinatal conditions category.

Diseases of the digestive system made up 14 percent

of the total dkcharges of children under I year of age.

Two diagnoses accounted for three-fourths of the digestive

disease discharges: noninfectious enteritis and colitis (54 percent) and inguinal hernia (22 percent).

The discharge rate for males under 1 year was almost

a third larger than the rate for females, and the differences

in rates by sex were even larger for some of the diagnostic

categories. For example, the discharge rate for diseases of

the respiratory system was 49 percent higher for males, and

within the category, males had a 73-percent higher rate for

other acute respiratory infections. Males also had a 47-percent

higher discharge rate for diseases of the digestive system

and made up 89 percent of the discharges for inguinal hernia.

The average length of stay for the under-1-year age

group was 6.6 days, ranging from 1.7 days for inguinal

hernia to 19.5 days for disorders relating to short gestation

TafMe4. N-m~es*avemele~d~*-til yearofsga (excluding nawborn infants) diackgd frornahwt-stq

non-Federal hOs@ta@ by sabctad first.Eatacf diagnoses and sex: United Stataq 1983

Di8gnostk category and &th Ed/r Both

ICB9-CM CodeJ sexes Male Female sexes Male Fmkt saxes Male female

Totaiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious and parasitic diseases . . . . . . . . . . . . . . . . . . . . . 001-139

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

Ofltis mediaand eustachian tube disorders . . . . . . . . . . . . . . . w ,382

Diseaaas of thereapiratory system. . . . . . . . . . . . . . . . . . . . 460-519

Acute bronchitis and bronchiolitis . . . . . . . . . . . . . . . . . . . . . . 466

Other acute respiratory infactiins . . . . . . . . . . . . . . . . . . . 480-465

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 460+36

Oiseaaes of thedigestivesysfem . . . . . . . . . . . . . . . . . . . . 520-679

Inguinal herni a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..55ct

Nonmfactious enteritis and cotitis . . . . . . . . . . . . . . . . . . . 556-556

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . ...740-759

Certain conditions originating in the parirratal period . . . . . . . . . . 760-779

Oisorders relating to shorl gestation and unspecified low birth weight . . . 765

Intrauterine hypoxia, Mh asphyxia, and other respirs~ condiiWrs

ofnevtbor n . . . . . . . . . . . . . . . . . . . . . . . . . . ...768-770

Hemolytic diaaaaa of fetus or newborn due to iaoimmuni~tion @

other perinatsl jaundice . . . . . . . . . . . . . . . . . . . . . ...773-774

Symptoms, signs, and illdefined conditions . . . . . . . . . . . . . . . 760-799

lnjutyand ~isoning . . . . . . . . . . . . . . . . . . . . . . . . . ..600-ggg

lnjunes (including fracfur~) . . . . . . . . . . . . . . . . . . . . . . 800-959

Number m thousands

936

75

61

33

237

62

48

76

127

27

69

75

206

86

35

33

32

29

20

542 394

41 34

32 29

17 16

144 92

37 24

31 17

44 32

77 50

24 ●

35 33

45 30

116 90

49 36

21 14

20 14

19 13

17 12

12 “9

Rate per 1,000

moulation

<aa.o

20.4

18.7

8.9

64.6

16.8

13.2

20.7

34.6

7.5

18.7

20.4

56.2

23.6

9.5

9.1

8.8

7.9

5.5

. . . .

269.2 ‘“ -

21.8

17.1

9.0

77.0

20.0

16.6

23.2

41.0

126

18.7

23.9

61.6

26.0

11.2

10.6

10.4

9.1

6.2

L.w. (

19.0

16.4

8.9

51.6

13.5

9.6

18.1

27.9

.

18.8

16.7

50.5

21.1

7.6

7.6

7.2

6.7

“4.8

Average length of stay

in days

6.6

4.9

5.2

3.3

4.5

4.6

3.3

5.2

3.9

1.7

4.3

6.3

12.8

19.5

12.1

3.0

4.1

4.3

4.5

6.5

4.5

6.1

3.2

4.6

4.5

3.5

5.3

3.8

1.8

4.5

6.0

127

19.9

9.5

3.0

4.2

3.5

4.0

6.7

5.4

4.1

3.3

4.4

4.8

2.9

4.9

4.1

.

4.0

6.7

13.0

19.0

16.2

3.0

3.9

5.4

“5.1

‘ 6ased on the hrtematwral Class/fkstion of Diseases, 9fh Rawabr. Cfinicd Mcdr?caton (ICD-S-CM).

‘ircludas diagnosticamdiiiorrsnotskwn in table.
atkncedata 5

and unspecified low birth weight. A much longer than average

stay, 12.8 days, was recorded for “certain conditions originating in the perinatal period.” This category contained not

only the disorders relating to short gestation and unspecified

low birth weight but intrauterine hypoxia and other respiratory

conditions of the newborn, for which the average length

of stay was 12.1 days. On the other hand, the length of

stay for hemolytic disease of newborn due to isoimmunization

and other perinatal jaundice was only 3.0 days, well below

the average for all conditions.

In most diagnostic categories the average lengths of stay

for males and females under 1 year varied by less than

1 day. There were some exceptions, though. The stays of

males were 2 days longer than stays of females for diseases

of the nervous system and sense organs. Females had stays

1.9 days longer for injury and poisoning and 6.7 days longer

for intrauterine hypoxia and other respiratory conditions of

the newborn,

1-4 years of age

Children 1-4 years of age had a total of 1.1 million

discharges in 1983 (table 5). A greater number of these

discharges were for diseases of the respiratory system,

420,000 (37 percent), than for any other diagnostic category.

Every fourth diagnosis in the respiratory disease category

for this age group was pneumonia. Other acute respiratory infections contributed an additional 21 percent of the

respiratory dkease diagnoses. Chronic disease of tonsils and

adenoids and asthma were also important diagnoses for this

age group, accounting for 18 and 15 percent, respectively,

of the discharges for respiratory diseases.

Three categories were very similar in importance as

discharge diagnoses for the 14 years age group, each making

up 12 percent of total discharges. One category was “diseases

of the nervous system and sense organs. ” The major diagnosis

within this category was otitis media and eustachian tube

disorders, which was responsible for 63 percent of the discharges in the category. The second category, diseases of

the digestive system, also had one main diagnosis, nonirifectious enteritis and colitis, which accounted for 53 percent

of the discharges in the category. Almost half of the third

category, injury and poisoning, was made up of discharges

for a variety of injuries (other than fractures), such as concussions, sprains, lacerations, and bums.

The discharge rate for males 1-4 years of age was

almost one-third larger than the rate for females. In the

largest diagnostic category, diseases of the respiratory system,

the male discharge rate was 50 percent higher than the

female rate. Within the category, the sex difference was

particularly marked for chronic disease of tonsils and

adenoids, for which the male discharge rate was 65 percent

higher. Males also made up 71 percent of the discharges

for chronic and unspecified bronchitis.

In addition, a greater than average sex difference in

discharge rates was found for the “diseases of the digestive

system.” The male rate was 44 percent higher for the category

Table 5. Numbarq rate% and average lengths of stay for patients under 1-4 years of age discharged from short-stay non-Federai hosp~ by selected

first-listed dmgnoses and sex: United Stste~ lk

Diagnostic categoty and Both Both @oth

ICCL9-CA4 code’ sexes Male Female sexes Male Female sexes Male Female

Rateper 1,000 Average length of stay

Number in thousands population in days

Totai2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,148 684 482 80.9 91.7 69.6 3.7 3.6 G

Infectious snd parasitic diseases . , . . . . . . . . . 001-139 68 37 31 4.8 5.1 4.5 4.0 4.0 3.9

IXseases of the nervous system and sense organs . . . . . . 320-389 137 76 61 9.7 10.4 6.9 3.0 2.9 3.1

Oiezxders Of the Central nervous system . . . . . . . . . . . 3,20-336,341J-349 22 12 11 1.6 1.6 1.5 7.0 7.0

Otitis media and eustachian tube disorders . . . . . . . .381,382 86 49 37 6.1

7.1

6.8 5.4 2.2 2.2 2.3

Dkeases of the respiratory system . . . . . . . . . . . . . . . . . 460-519 420 257 164 29.7 35.4 23.6 3.3 3.3 3.3

Acute bronchtiis and bronchiolitis . . . . . . . . . . . . . . . . . 466 38 24 14 2.7 3.3 2.1 3.3 3.2

Other acute respiratory mfecoons . . . . . . . . . . . . . . 460+65 90

3.5

56 34 6.3 7.7 4.9 2.9 2.8 2.9

Chronic disease of tonsils and adenoids . . . . . . . . . . . . 474 75 46 27 5.3 6.6 4.0 1.7 1.7 1.6

Pneumoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 480+86 105 61 45 7.4 8.4 6.5 4.4 4.6

Bronchitis, chrome and unspecified . . . . . . . . . . 490491 24

4,3

17 “7 1.7 2.4 ‘0.9 3.4 3.3 ●3.8

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493 62 34 27 4.4 4.7 4.0 3.5 3.5 3.5

Oiseaaes of the digestive system . . . . . . . . . . . . . 520-579 135 81 54 9.5 11.2 7.6 2.9 2.7 3.2

Ingumal herma. . . . . . . . . . . . . .,.................550 26 21 “5 1.8 2.9 “0.7 1.6 1.6 “1.4

Nonmfectlous enteritis and CCMS . . . . . . . . . . . . . . 555-558 71 39 32 5.0 5.4 4.6 3.3 3.4 3.3

Oisesses of the gemtourinaty system . . . . . . . . . . . 580-629 44 21 23 3.1 2.9 3.3 3.6 3.8 3.4

Congenifsl anomalies . . . . . . . . . . . . . . . . . . . . . . . . ...740-759 64 41 24 4.5 5.6 3.4 5.7 5.3 6.5

Symptoms, s!gna, and Ill-defined condKions . . . . . . . . . . . . 780-799 24 14 10 1.7 2.0 1.4 3.1 2.9 3.4

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . ...800-999 133 77 56 9.4 1(I6 8.1 4.4 4.5 4.4

Fractures, allsltes . . . . . . . . . . . . . . . . . . . . . . . . ...800-629 26 15 11 1.8 2.1 1.6 7.0 7.5 6.3

Injuries other than fractures . . . . . . . . . 850-959 64 37 27 4,5 5.0 4.0 3.8 4.3 3.2

‘Sased on the /nternaf;ona/ Clawficat/on o/ Lkeases, 51h Revwmm, C/Inma/ McdfficsfIorI (ICO-94M)

21ncludes dlagmxtic condt!ms not shown m table.
6 achancedata

as a whole. Within the category, males accounted for 81

percent of the discharges for inguinal hernia. The male discharge rate was also 65 percent higher than the female

rate for the congenital anomalies category.

The average lengths of stay by diagnosis ranged from

1.6 days to 7 days for children 1+ years of age. Stays

of less than 2 days were the average for both inguinal

hernia and chronic disease of tonsils and adenoids. The

average stays of 7 days were recorded for disorders of the

central nervous system and fractures. Both the total average

lengths of stay and the average stays for specific diagnoses

were similar for males and females.

5-9 years of age

Table 6 shows hospital use by diagnostic categories for

children 5–9 years of age. The respiratory disease category

accounted for the largest number of discharges, 260,000,

which was one-third of the total number of discharges for

the children 5–9 years of age. Chronic disease of tonsils

and adenoids was the most important diagnosis within the

respiratory disease category. It made up almost half of

respiratory disease diagnoses, and by itself was responsible

for significantly more discharges than any of the other diagnostic categories except injury and poisoning.

Injury and poisoning ranked second in importance among

the diagnostic categories with 125.000 discharges, 16 percent

of total discharges. Fractures accounted for 40 percent of

the discharges in the category, and intracranial injuries, excluding those with skull fractures, made up an additional 18

percent of the category.

Other important diagnostic categories for the 5–9 years

age group were diseases of the nervous system and sense

organs with 10 percent of total discharges, and diseases

of the digestive system with 11 percent. Otitis media and

eustachian tube disorders made up more than half of the

discharges for dkeases of the nervous system and sense

organs. Noninfectious enteritis and colitis accounted for almost a fourth of the discharges for diseases of the digestive

system,

The dischqe rate was 35 percent higher for males

than for females 5–9 years of age. The sex difference was

especial] y pronounced for the injury and poisoning category,

in which the male discharge rate was 82 percent higher

than the female rate. Within the category males had a 70

percent higher discharge rate for fractures, and they accounted

for more than three-fourths of the discharges for intracranial

injury.

The sex difference in discharge rates was also large

for the congenital anomalies category, in which the male

rate was 85 percent higher than the female rate. In addition,

the male discharge rate was 57 percent higher for otitis

media and eustachian tube disorders and 94 percent higher

for asthma.

The range in average lengths of stay for diagnostic

categories was not wide, from 1.6 to 4.8 days. Stays of

less than 2 days were the average for otitis media and eustachian tube disorders and for chronic disease of tonsils and

adenoids. Average stays of more than 4.5 days were found

for pneumonia and fractures. The average lengths of stay

of males and females were different by less than a day

for all the diagnoses and diagnostic categories.

Table 6. Numberq rates and average Iengtha of stay for patients 5-9 yeara of age

fimt-llated dqnoaes and sex: United State* 1963

didwged fromahoR-atay non-F9deralhoa@tdq byaebeted

Diagnostic category and Both Both BolYr

ICEW-CM cede’ sexes Male Female sexes Male Female sexes Male Femala

TotalZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious andpereeitic disaaaes . . . . . . . . . . . . . . . . . . . . . 001-IW

D&eases of the nervous system and sense organs . . . . . . . . . . . 32&3g9

Otiiis media and eustachian tubs disorders . . . . . . . . . . . . . . 381-382

Diseases of the respiratory system. . . . . . . . . . . . . . . . . . . . 4s&51g

Acute respiratory infections . . . . . . . . . . . . . . . . . . . . . . 46C+66

Chronic diseases of tonsils and adenoida . . . . . . . . . . . . . . . . . . 474

pfleUMOflia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. WJ-136

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

Oiseaees of the digestive system . . . . . . . . . . . . . . . . . . . . 520-579

Noninfectious enteritis and colitis . . . . . . . . . . . . . . . . . . . 555-558

Oiseases of the genitourinary system . . . . . . . . . . . . . . . . . . 56&62S

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . ...742-759

Symptoms, signs, and illdefined conditions . . . . . . . . . . . . . . . 760-799

Injury andpoiaoning . . . . . . . . . . . . . . . . . . . . . . . . . .. K&sg9

Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . . ..scQ-s2g

Intracranial injury, excluding those with skull fracture . . . . . . . . . 850-654

Other injuries . . . . . . . . . . . . . . . . . . . . . . . ..s30-34s.8w959

Number in thousands

769

36

77

43

280

34

127

40

37

66

21

32

30

18

125

50

22

39

451

19

45

27

148

18

67

23

25

49

11

14

19

10

82

32

17

24

319

19

32

16

113

16

60

17

12

3s

10

17

10

“9

43

16

●5

15

1Based on the ktternwond C/ass(mafm d Diseases, 9fh Rews.$arr, C/imca/ Mcdficaoon (lCO-9-3M).

‘IncludesdiagnostcConditionsnotshownm table,

Rate per 1,000 Average kngth of stay

population in days

48.1

2.4

4.6

2.7

16.3

2.1

7.9

25

2.3

5.5

1.3

2.0

1.9

1.2

7.8

3.1

1.4

2.4

55.1

2.3

5.5

3.3

18.1

22

6.2

2.9

3.1

6.0

1.3

1.8

2.4

1.2

10.0

3.9

2.1

2.9

40.8 3.4

2.4 3.8

4.0 2.0

2.1 1.6

14.4 2.8

2.1 2.8

7.7 1.8

2.2 4.6

1.6 3.5

4.9 3.5

1.3 3.1

22 3.5

1.3 3.5

“1.1 2.3

5.5 4.7

2.3 4.7

“0.7 2.7

1.9 4.2

3.4

3.4

2.0

1.5

29

2.9

1.9

4.6

3.5

3.6

3.2

3.8

3.2

2.6

4.0

5.0

2.9

3.9

3.3

3.9

2.0

1.8

2.6

2.8

1.7

4.8

3.7

3.5

3.0

3.3

4.0

.2.1

4.2

4.2

●2.2

4.7
1Ck14 years of age

Children 10-14 years of age had 803,000 hospital discharges in 1983 (table 7). There were more diagnostic

categories with sizable numbers of dk.charges for this age

group than for the younger age groups. The following

categories each accounted for more than 20,000 discharges

for children 1Q- 14 years but for less than 20,000 discharges

for children in each of the other three age groups: neoplasms;

endocrine, nutritional and metabolic diseases, and immunity

disorders; diseases of the blood and blood- forming organs;

mental disorders: and diseases of the muscuioskeletal system

and connective tissue.

The leading diagnostic categories for the IO-14 years

age group were diseases of the respiratory system and injury

and poisoning, which were each responsible for 20 percent

of all discharges. Chronic disease of tonsils and adenoids

was again the most important respiratory dkease diagnosis,

making up 42 percent of all discharges in the categoty.

Fractures accounted for 39 percent of the discharges in the

injury and poisoning category.

Diseases of the digestive system was the third-ranking

diagnostic category in number of discharges. Fourteen percent

of all discharges for children 10-14 years were in this category.

Noninfectious enteritis and colitis was the most frequent diagnosis, making up 23 percent of the digestive disease category.

The total discharge rates for males and females 10-14

years of age were not significantly different, but sex

differences were found in the rates for specific diagnoses

and diagnostic categories. The discharge rate for chronic

disease of tonsils and adenoids was 78 percent higher for

females than for males. This difference is especially noteworthy because the rates for the diagnosis were higher for males

1-4 years of age and were not significantly different by

sex for children 5-9 years of age. However, for the injury

and poisoning category the discharge rate of males 113-14

years of age was almost twice the female rate. Whhin the

category males had rates more than 1.5 times higher than

females for fractures. They accounted for 69 percent of the

discharges for intracranial injury, and had more than double

the female rate for other injuries.

The longest average length of stay for children 10-14

years of age was 19.4 days for mental disorders. Lengths

of stay for other diagnostic categories ranged between 6.3

days for “endocrine, nutritional, and metabolic diseases and

immunity disorders” and 2.9 days for “symptoms, signs,

and ill-defined conditions” and “diseases of the respiratory

system.” The shortest stay, 1.7 days, for chronic disease

of tonsils and adenoids was within the respiratory dkease

category.

The total average lengths of stay for males and females

were not significantly different, but there were sex differences

in the lengths of stay for specific conditions. The length

of stay of females was twice that of males for dkieases

of the blood and blood-forming organs, and females had

Tabfe 7. Numbe~ rateaj and average lengths of stay for patients 1-14 yeara of age didwged

firat4ated diegnoeea and sex: United Stateq 1963

frumahoft-atay rlon+ederaf ~byaeieeted

Diagnostic categoty and Both Both Both

lC&5LCM code’ saxes Male Female sexes Male Female saxes Male female

—

Number in thousands

Total* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 803 427 375

Infectious and parasitic diseases . . . . . . . . . . . . . . . . . . 001-139

Naoplaams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Endocrine, nutritional and metabolic diseases, and

immunity disorders . . . . . . . . . . . . . . . . . . . . . . . . .. 240-279

Oiseases of the blood end blood-forming organs . . . . . . . . . 280-289

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . ...-319

Oiseaaes of the nefvous system and sense organs . . . . . . . . . . . 320-389

Diseases of the resplratovsystem. . . . . . . . . . . . . . . . . . 460-519

Acute respiratory infactions . . . . . . . . . . . . . . . . . . . . . 460-466

Chrome diseases of tonsils and adenoids . . . . . . . . . . . 474

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...460486

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

Dkesseso fthedigestives ysfem . . . . . . . . . . . . . . . 520-679

Noninfectious enteritis and cohtis . . . . . . . . . . . . . . . . . .555-558

Oiseeees of the genitourinar’y system . . . . . . . . . . . . . . . . . . 560-629

Oiseases of the musculoskeletal system and connecthre tissue. . . . 710-739

Congenital anomalies . . . . . . . ..- . . . . . . . . . . . . . . . .. 7+759

Symptoms, signs, and illdefinact conditions . . . . . . . . . . . . 780-799

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . ..-. 80H99

Fractures, allsltes . . . . . . . . . . . . . . . . . . . . . . . . . ..60C-629

Intracranial injury, excluding those with skull fracture . . . . . 850-854

Ofherinjtmes. . . . . . . . . . . . . . . . . . . . . . . ..63~.8~59

28

27

26

24

36

36

159

22

66

21

24

111

26

47

39

23

29

164

64

26

54

14

17

12

12

17

21

76

11

24

13

15

62

15

23

16

13

13

110

47

18

38

14

10

14

12

19

77

61

11

42

“6

“9

49

11

23

23

11

16

54

17

“8

17

Rate par 1,000

ootmlation . .

45.1 47.0 43.2

1.6

1.5

1.5

1.3

2.0

2.1

8.9

1.2

3.7

1.2

1.3

6.2

1.5

2.6

2.2

1.3

1.7

9.2

3.6

1.5

3.1

1.5

I.8

1.3

1.3

1.9

2.3

8.6

1.2

2.7

1.4

1.6

6.8

1,6

2.6

1.8

1.4

1.5

12.1

5.2

2.0

4.2

1.6

1.2

1.6

1.4

2.2

2.0

9.3

1.3

4.8

“0.9

“1.1

5.6

1.3

2.7

2.6

1.2

1.9

6.2

2.0

“0.9

1.9

Average length of stay

in days

4.6

3.6

3.6

6.3

4.2

I 9.4

3.6

2.9

3.1

1.7

5.0

3.6

4.1

3.2

3.7

6.9

5.8

2.9

4.2

5.0

3.6

3.7

4.6

3.6

2.7

5.1

2.8

17.7

3.5

3.0

3.2

1.6

4.8

3.7

3.9

3.0

3.3

7.1

6.9

2.8

4.8

5.7

4.0

3.9

4.7

3.4

5.1

7.3

5.6

21.0

3.7

2.7

2.9

1J]

“5.:1

“3.5

4.3

3.4

4.2

5.C)

4.6

3.CI

3.1

2.9

“2.8

3.3

‘Basedon the Mernatmal C/assIkakm of Dseases. %/r Rewon, Chvcd McWrbron (lCO-S-CM).

—

21ncludes diagnostic wndkms not show m table
8

89 percent longer stays for neoplasms. Males had 50 percent

longer stays for congenital anomalies and 55 percent longer

stays for injury and poisoning. Within the injury and poisoning

category, the average stays of males were almost twice those

of females for fractures.

appendectomies amd inguinai hernia repairs; operations on

the musculoskeletal system, 40 percent of which were reductions of fracture; and miscellaneous diagnostic and therapeutic

procedures, one-fourth of which were computerized axial

topographies and diagnostic ukrasounds.

The leading procedure categories for children under 1

year of age were somewhat different than for the other three

age groups. In addhion to operations on the digestive system

and miscellaneous diagnostic and therapeutic procedures, leading categories for these children were operations on the

nervous system and operations on the cardiovascular system.

The under- l-yew age group had higher rates than the other

three age groups for all these procedure categories. They

also had higher rates for cardiac catheterizations, repair of

inguinal hernia, computerized axial tomography, and for spinal

taps and biopsies of the nervous system, which accounted

for 81 percent of the operations on the nervous system.

The largest procedure category both for children 14

and 5–9 years of age was operations on the nose, mouth,

and pharynx. Tonsillectomies with and without adenoidectomies made up more than half of the procedures in the

category for children 14 years of age, and almost threefourths for children 5-9 years, who had the highest rate

for the procedure among the four age groups. Children 14

and 5–9 years were the only age groups for which operations

on the ear was a leading category. Myringotomies accounted

for more than 90 percent of the ear operations on children

Procedures

In 1983, 2.3 million operations and other procedures

were performed in hospitals on children under 15 years of

age. Both the numbers and the rates of procedures were

higher for males under 15 years than for females (tables

8 and 9). Children under 1 year of age had the lowest

number of procedures but the highest rate among the four

age groups. The other age groups each accounted for about

the same number of procedures, but the rate of procedures

for children 1CL14 years of age was significantly below

the average for all children under 15 years.

The largest number of procedures for children under

15 years was in the category “operations on the nose, mouth,

and pharynx,” which contained almost 20 percent of all

procedures. Tonsillectomies itk wd without adenoidectomies

were responsible for more than 60 percent of the procedures

in this category. The other major procedure categories for

children under 15 years were operations on the ear, more

than three-fourths of which were myringotomies; operations

on the digestive system, more than half of which were

Table 8. Number of aHiated procedures for patients under 15 yeara of age (excluding newborn infants) discharged from short-stay non%dwal Iwapiilis

by aeteoted prwadure categoriq se% and age groups: United State% 1983

Under 15 years

Procedure catego~ and &th Under 14 5-9 1(X14

lC13-9-CM wale’ sexes Male Female 7 year years years years

Number m thousands

947 423 643

66 60 32

Totaiz . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operations on the nervous system . . . . . . . 01-05

Spinal tap and biopsies on the

newous system . . . . . . . . . 01.1,03 .3,04.1,05.1

Operations on theear . . . . . . . . . . . . . . 18-20

Myringotomy . . . . . . . . . . . . . . . . ...20.0

Operations on the nose, mouth, and pharynx . . 21-28

Tonsillectomy wtih or

without adenoldectomy . . . . . . . . . . 28.2-28.3

Adenoidectomy without tonsillectomy . . . . . . 28.6

Operations on the oardiovsscular system . . . . 35-39

Cardiac catheterization . . . . . . . . . . 37,21-37.23

Operations on the digestive system . . . . . . 42-54

Appendectomy, excluding incidental . . . . . . . 47.0

Repair of inguinal hernia . . . . . . . . . . 53.0-53.1

Operations on the muaculoskeletal system . . . 76-84

Reduction Offr?XtUre . . . . . . . . . . 76.7,79.0-79.6

Operations on the integumentary system . . . . 85-66

Excision or destru&lon of lesion or tissue

of sldn and subcutaneous tissue . . . . . . . . 86.2

Miscellaneous diagnostic and

therapeutic procedures . . . . . . . . . . . . . 67-99

Computerized axial

tomography . . . . . 87.03,87.41,87.71,88.01 ,88.38

Diagnostic ultrasound . . . . . . . . . . . . . . 88.7

2,293

143

1,346

76

609 619

17 74

101 55 46 65 22

Sa “9 95

68 7 86

213 12 139

“8

91

66

178

“6

25

10

122

220 132

101

239

169

451

279

50

117

32

281

75

81

249

Ioi)

121

143

32

61

16

163

Sa

67

142

65

69

136 .

.

78

24

130 71

.

18 20

12

●6

64

25

17

5a

38

32

%

16

5a

11

65

28

13

.

36

12

11

.

96

36

13

65

.

28

87

47

“8

127

4a

45

107 42

34 12

52 “6 37

14 .

30 16 ‘8 “7 13

302 172 130 91 71 55 85

46

31

28

16

17 13 10

15 16 .

10

.

13

“8

fBasedon the /nfemaLWa/ C/essl/lcafonof Dwsases, 9rh Revrsmn, Clinfcs/ Modricabon (ICC-9-CM)

21ncludes wocadures rat shownm rsble,
Tebte 9. Rates for s#4istedprocedures for patients under 15 yesrs of age (exdudiig newborn infants)diacherged from short-stay non.t%cferalhoapiilq

by selected procedure estegorie% sex and age groups United State% 1SS3

Under 15 years

Procedure category and 6oth. Under 14 5=9 1O-Y4

IC>+CM code’ sexes Male Female 1 year yeara years yews

Rate per 10,000 population

444.6

27.6

510.2

28.9

375.8

26.3

381.3 347.9

10.3 7.9

“4.9 “3.1

56.9 14.10

41.2 5.4

111.5 68.7

81.5 39.7

12.6 .

7.3 6.2

‘3.6 .

39.9 49.1

15.6 26.7

10.5 “4.7

42.8 71.2

23.6 26.H

20.2 25.3

“4. 1 7.2

34.6 47.8

“6.1 7.1

.

“4.7

TotalZ . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operations on the newous system . . . 01-05

Spinal tap and biopsies on the

nervous system . . . . 01.1,03.3,04 .1,05.1

Operations on the ear . . . . . . . . . . . . . 16-20

Myringotomy . . . . . . . . . . . . . . . . . ..2o.o

Operations on the noee, mouth, and pharynx . . 21-29

Tonsillectomy with or

without adenoidectomy . . . . . . . . . 26.2-28.3

Adenoidectomy without tonsillectomy . . . . . . 28.6

Operations on the cardiovascular system . . . 35-39

Cardiac catheterization . . . . . . . 37.21-37.23

operations on the digestive system . . . . . 42-54

Appendectomy, excluding incidental . . . . . 47.0

Repair of inguinal hernia . . . . . . . . 53.0-53.1

Operations on the musculoskeletal system . . 76-64

Reduction of fracture . . . . . . . . . . 76.7,79.0-79,6

Operations on the integumentary system . . . . 85-86

Excision or destruction of lesion or tissue

of skin and subcutaneous tissue . . . . . 86.2

Miscellaneous diagnostic and

therapeutic procedures . . . . . . , . . . . . 67-99

Computerized axial

tomography . . . . 67.03,87.41,67.71,68.01 ,8&38

Diagnostic ultrasound . . . . . . . . . . . . 88.7

1,155.8 453.6

219.0 22.4

178.1 15.8

“25.0 88.8

“20.5 60.5

33.2 96.0

.

54.8

.

17.1

158.7 25.7

30.3 6.5

176.7 46.2

.

75.4 19.6

35.2 29.3

.

6.7

“1 7.7 26.2

.

“5.8

248.2 50.0

36.0 7.1

43.5 .

20.7

50.0

38.1

90.5

18.3

34.6

26.9

64.3

19.5

42.6

32.7

67.5

54.1

9.7

54.3

12.0

53.9

7.3

22.1

6.5

22.7

6.2

23.2

6.0

54,5

14.5

15.6

69.4

14.6

25.5

38.9

14.4

5.3

46.3

19.4

53.9

24,9

42.5

13.6

23.5 26.0 20.8

5.6 6.0 5.7

58.5 65.3 51.5

8.8

6.1

10.7

6.2

6.9

6.0

1Based on the Irrtematmrrd C/assJfcamr of Okeases, eth Revr.wort, C/incal hbdficatbr (lCO-e-CM),

‘Includes procedures not shown m Isble.

14 years and almost three-fourths on children 5–9 years. for more than half of the category for the 5–9 years age

The other leading procedure categories both for children 1-4 group, 38 percent for children 10-14 years of age. The

and 5–9 years of age were operations on the digestive system other leading procedure categories for the 10-14 years age

and miscellaneous diagnostic and therapeutic procedures. group were operations on the nose, mouth, and pharynx;

Children 5–9 years of age also shared with children operations on the digestive system; and the miscellaneous

10-14 years the leading procedure category “operations on category. This age group had a higher rate than the other

the musculoskeletal system.” Reduction of fractures accounted three for one procedure, appendectomy.
adwncedata 11

References

‘National Center for Health Statistics, W. R. Simmons and G.

A. Schnack: Development of the design of the NCHS Hospital

Discharge Survey. Vital and Health Statistics. Series 2, No. 39.

DHEW Pub. No. (HRA) 77–1 199. Health Resources Administration.

Washington. U.S. Government Printing Office, May 1977.

‘National Center for Health Statistics, E. J. Graves: 1983 summary:

National Hospital Discharge Survey. Advance Data From Vita/

and Health Statistics. No. 100. DHHS Pub. No. (PHS) 84-1250.

Public Health Service. Hyattsviile, Md., Sept. 28, 1984,

sNational Center for Health Statistics, E. J. Graves: utilization

of short-stay hospitals, United States, [983, annual summary. Viral

and Health Statistics. Series 13, No. 83. DHHS Pub. No. (PHS)

85-1744. Public Health Service. Washington. U.S. Government

Printing Office, Apr. 1985.

‘National Center for Health Statistics, L. J. Kozak and M. Moien:

Detailed diagnoses and surgical procedures for patients discharged

from short-stay hospitals, United States, 1983. Viral and Heahh

Statistics. Series 13, No. 82. DHHS Pub. No. (PHS) 85-1743.

Public Health Service. Washington. U.S. Government Printing Office, Mar. 1985.

5National Center for Health Statistics, L. J. Kozak and E. McCtihy:

Hospital use by children in the United States and Canada. Vital

and Health Statistics. Series 5, No. 1. DHHS Pub, No. (PHS)

84-1477. Public Health Service. Washington. U.S. Government

Printing Office, Aug. 1984.

6Public Health Service and Health Care R nancing Administration:

International Class@ation of Diseases, 9th Revision, Clinical Modifica[~on. DHHS pub. No. (PHS) 80-1260. public Health Sen/ice.

Washington. U.S. Government Printing Office, Sept. 1980.

‘National Center for Health Statistics, M. G. Sirken: Utilization

of short-stay hospitals, summary of nonmedical statistics, United

States, 1965. Vital and Health Statistics. Series 13, No. 2. PHS

Pub. No. 1000. Public Health Service. Washington. U.S. GovernmentPrinting Office, Aug. 1967.

gNational Center for Health Statistics, M. J. Witkin: Utiliz:Ition

of short-stay hospitals by characteristics of discharged patients,

United States, 1965. Vital and Health Statistics. Series 13, No.

3. PHS Pub. No. 1000. Public Health Service. Washington. IJ.S.

Government Printing Office, Dec. 1967.

Symbols

--- Data not available

. . . Category not applicable

- Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

●

Figure does not meet standard of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
ackancedata 13

Technical notes

Survey Methodology

Source of data

The National Hospital Discharge Survey (NHDS) encompasses patients discharged from short-stay hospitals, exclusive

of military and Veterans Administration hospitals, located

in the 50 States and the District of Columbia. Only hospitals

with six or more beds and an average length of stay of

less than 30 days for all patients are included in the survey.

Discharges of newborn infants are excluded from this report.

The original universe for the survey consisted of 6,965

hospitals contained in the 1963 National Master Facility Inventory. New hospitals were sampled for inclusion in the survey

in 1972, 1975, 1977, 1979, 1981, and 1983. In all, 553

hospitals were sampled in 1983. Of these hospitals, 78 refused

to participate, and 57 were out of scope. The 418 participating

hospitals provided approximately 206,000 abstracts of medical

records.

Sample design and data collection

All hospitals with 1,000 or more beds in the universe

of short-stay hospitals were selected with certainty in the

sample. All hospitals with fewer than 1,000 beds were

stratified, the primary strata being 24 size-by-region classes.

Within each of these 24 primary strata, the allocation of

the hospitals was made through a controlled selection technique so that hospitals in the sample would be properly

distributed with regard to type of ownership and geographic

division. Sample hospitals were drawn with probabilities ranging from certainty for the largest hospitals to 1 in 40 for

the smallest hospitals.

Sample discharges were selected within the hospitals

using the daily listing sheet of discharges as the sampling

frame. These discharges were selected by a random technique,

usually on the basis of the terminal digit or digits of the

patient’s medical record number, a number assigned when

the patient was admitted to the hospital. The within-hospital

sampling ratio for selecting sample discharges varied inversely

with the probability of selection of the hospital.

The sample selection and the transcription of information

from the hospital records to abstract forms were performed

by the hospital staff or by representatives of the National

Center for Health Statistics or by both. The data were

abstracted from the face sheets of the medical records. All

discharge diagnoses and procedures were listed on the abstract

in the order of the principal one, or the first-listed one

if the principal one was not identified, followed by the order

in which all other diagnoses or procedures were entered

on the face sheet of the medical record.

Presentation of estimates

Statistics produced by NHDS are derived by a complex

estimating procedure. The basic unit of estimation is the

sample inpatient discharge abstract. The estimating procedure

used to produce essential] y unbiased national estimates in

NHDS has three principal components: inflation by reciprocals

of the probabilities of sample selection, adjustment for nlonresponse, and ratio adjustment to fixed totals. These compcments

of estimation are described in appendix I of two earlier

publications.7.8

Based on consideration of the complex sample dlesign

of NHDS, the following guidelines are used for presenting

NHDS estimates in this report:

. If the sample size is less than 30, the value of the

estimate is not reported. Only an asterisk (*) is shown

in the tables.

. If the sample size is 30-59, the value of the estimate

is reported but should be used with caution. The estimate

is preceded by an asterisk (*) in the tables.

Sampfing errors and rounding of numbers

The standard error is a measure of the sampling variability

that occurs by chance because only a sample, rather than

an entire universe, is surveyed. The relative standard emor

of the estimate is obtained by dividing the standard error

by the estimate itself and is expressed as a percent of the

estimate. Relative standard errors for discharges and liirstlisted diagnoses are shown in table I, relative standard errors

for days of care are shown in table II, and relative standard

errors for all-listed procedures are shown in table III.

Estimates have been rounded to the nearest thousand.

For this reason detailed figures within tables do not always

add to the totals. Rates and average lengths of stay were

calculated from original, unrounded figures and will not

necessarily agree precisely with rates or average lengths

of stay calculated from rounded data.

Table h Approximate relative standard errore for estimated numbers of

discharges and first-kted diagnoses: United Stateq 1983

Relative

siandard

Size of estimate error

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.0

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.8

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.1

100,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8

300,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3

500,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8

f,OOO,OOO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2

3,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5

5,000,000. . . . . . . . . . . . ...? . . . . . . . . . . . . . . . . 3.2

10,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.9

20,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7

30,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5

40,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5
14 acklncedata

Tab!a k Approximate ratstive standard errors for estimated numbers of

days of care, by region md M other oharactafisk

United States 19S3

All other

Size of estimate Region characteristics

10,000 . . . . . . . . . . . . . . . . . . . . . . 38.4

30,000 . . . . . . . . . . . . . . . . . . . . . . 28.9

50,000 . . . . . . . . . . . . . . . . . . . . . . 25.4

100,000 . . . . . . . . . . . . . . . . . . . . . . 21.4

300,000 . . . . . . . . . . . . . . . . . . . . . . 16.5

500,000 . . . . . . . . . . . . . . . . . . . . . . 14.7

1,000,000 . . . . . . . . . . . . . . . . . . . . . 12.6

3,000,000 . . . . . . . . . . . . . . . . . . . . . 10.0

5,000.000 . . . . . . . . . . . . . . . . . . . . . 9.0

10,000,000 . . . . . . . . . . . . . . . . . . . . 7.9

50,000,000 . . . . . . . . . . . . . . . . . . . . 5.3

100,000,000 . . . . . . . . . . . . . . . . . . . 5.2

200,000,000 . . . . . . . . .. . . . . . . . . . 4.7

20.3

15.7

14.0

12.0

9.5

6.6

7.5

6.2

5.7

5.1

4.0

3.6

3.3

Tablalll: Approximate rela6ve standard ermr'Sfor eshatednumbemof

alMistedprooeduresUn itadStateq 19S3

Relative

standard

Size of estimate error

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.1

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.0

25,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.9

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.2

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.6

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1

3,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3

5,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0

10,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6

15,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5

20,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3

25,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3

Testsofsigniticsnce

In this report, the determination of statistical inference

isbasedon thetwo-tailed Bonferronitest formultiplecomparisons. Terms relating to differences such as “higher” and

“less” indicate that the differences are statistically significant.

Terms such as “similar” or “no difference” mean that no

statistically significant difference exists between the estimates

beingcompared. Alackofcomment onthedifference between

any two estimates does not mean that the difference was

testedandfound to benotsignificant.

Definitionofterms

Hospitals—Short-stay general and special hospitals have

six or more beds for inpatient use and an average length

of stay of less than 30 days. Federal hospitals and hospital

units ofinstitutions arenotincluded.

Patierzt-A patient isaperson whois formally admitted

to the inpatient service ofashort-stay hospital forobservation,

care, diagnosis, or treatment. In this report the number of

patients refers to the number of discharges during the year,

including any multiple discharges of the same individual

from one or more short-stay hospitals. Infants admitted on

the day of birth directly or by transfer from another medical

facility, with or without mention of disease, disorder, or

immaturity, are included. All newborn infants, defined as

those admitted by birth to the hospital, are excluded from

this report. The terms “patient” and ‘inpatient” are used

synonymously.

Discharge—A discharge is the formal release of a patient

by a hospital, that is, the termination of a period of hospitalizationbydeath or bydisposition toplace of residence, nursing

home, or other hospital. The terms “discharges” and “patients

discharged” are used synonymously.

Discharge rate—The ratio of the number of hospital

discharges during a year to the number of persons in the

civilian population on July 1 of that year makes up the

discharge rate.

Average length of sray—The total number of days of

care accumulated at the time of discharge by patients discharged during the year divided by the number of patients

discharged forms the average length of stay. A stay of less

than I day (patient admission and discharge on the same

day) is counted as I day in the summation of total days

of care. For patients admitted and discharged on different

days, the number of days of care is computed by counting

all days from (and including) the date of admission to (but

not including) the date of discharge.

Discharge diagnoses-One or more diseases or injuries

(or some factor that influences health status and contact

with health services which is not itself a current illness

or inju~) listed by the attending physician on the medical

record of a patient constitute the discharge diagnoses. In

NHDS all discharge (or final) diagnoses listed on the face

sheet (summary sheet) of the medical record for patients

discharged from the inpatient service of short-stay hospitals

are transcribed in the order listed. Each sample discharge

is assigned a maximum of seven five-digit codes according

to ICD-9-CM.6 The number of principal or first-listed diagnoses is equivalent to the number of discharges.

Principal diagrzosis-The condition established after study

to be chiefly responsible for occasioning the admission of

the patient to the hospital for care is the principal diagnosis.

First-1isted diagnosis—The coded diagnosis identified as

the principal diagnosis or listed first on the face sheet of

the medical record if the principal diagnosis cannot be identified is the first-listed diagnosis. The number of first-listed

diagnoses is equivalent to the number of discharges.

Procedure—A procedure is one or more surgical or nonsurgical operations, procedures, or special treatments assigned

by the physician to patients discharged from the inpatient

service of short-stay hospitals. In NHDS all terms listed

on the face sheet (summary sheet) of the medical record

under the captions “operation,” “operative procedures,” “operations and/or special treatment,” and the like are transcribed

in the order listed. A maximum of four procedures are coded.

Rate ofprocedures—The ratio of the number of all-listed

procedures during a year to the number of persons in the

civilian population on July I of that year makes up the

rate of procedures.
Age—Age refers to the age of the patient on the birthday

prior to admission to the hospital inpatient service.

Private insurance—Health insurance provided by nongovemment sources including consumers, insurance companies,

private industry, and philanthropic organizations is private

insurance.

Medicaid—Medicaid is a joint Federal-State welfare program available in virtually all States that provides medical

benefits for low income persons, including the aged. In order

to qualify for this program, a person must meet each State’s

definition of “low income.”

Se~pay—The major share of the total costs for a self-pay

hospitalization is expected to be paid by the patient, spouse,

parents, or next of kin.

Other paytnents-This includes all other sources of payment such as workmen’s compensation, Medicare, no charge,

and other government programs.

Geographic regions and divisions-The 50 States and

the District of Columbia are grouped by the Bureau of the

Census into 4 regions and 9 divisions as follows:

Region and division

Northeast

New England

Middle Atlantic

North Central

East North Central

West North Central

South

South Atlantic . . . .

East South Central

West South Central .

West

Mountain . . .

Pacific . . . . . . . .

States

Maine, New Hampshwc. Vermont.

Massachusetts, Rhode Island, Connectmt

New York, New Jemey, Pennsylvania

Michigan, Ohio. Illinois, [ndiana, Wisconsin

Minnesota. Iowa. Missouri. North Dakota,

South Dakota, Nebraska. Kansas

Delaware, Maryland, District of Columbia,

Virginia. West Virginia. North Carolina,

South Carolina, Georgia. Flon&

Kentucky, Tennessee, Alabama, Mississippi

Arkansas. Louisiana. Oklahoma, Texas

Montana. Maho, Wyoming, Colorado,

New Mexico, Arizona, Utah. Nevada

Washington, Oregon, California, Hawaii, Akzska
From Vital and Health Statistics of the National Center for Health Statistics Number 110 ● August 21, 1985

Office-Based Ambulatory Care for Patients 75 Years Old

and Oven National Ambulatory Medical Care Survey,

1980 and 1981

by Hugo Koch, Division of Health Care Statistics, and Mickey C. Smith, University of Mississippi

Introduction

This report offers a statistical description of the care provided in the physician’s ofllce to patients 75 years old and

over. This segment of the population, comparatively small in

the pas~ is projected to increase dramatically over the next few

decades. For the health community this increase means the

emergence of problems not encountered before. To anticipate

these problems and to furnish the resources necessary to solve

them, the Nation’s health planners need information about the

health needs of the advanced aging and the treatment settings

where these needs are met.

Although it is impofiant to examine the care provided to the

advanced aging in the Nation’s hospitals and nursing homes, it

is shortsighted to accept inpatient care as the model by which

the health problems and treatment of all aging patients are

judged. It is also necessa~ to examine outpatient settings, especially the doctor’s office, where most of the advanced aging

still seek their health care.

To establish normative patterns for the office-based care

of the advanced aging, the authors combined the 1980 and

1981 findings of the National ,&nbulatory Medical Care Survey,

an annual sample survey of office-based physicians conducted

from 1973 through 1981 by the National Center for Health

Statistics. The patient universe examined was the age group 75

years old and over, which was divided, where detailed analysis

was indicated and possible, into 5-year subgroups. The statistical bases for the report are shown in table 1.

The following aspects of the otllce visit will be successively

examined

● Sex of patient.

● Physician’s diagnoses.

● Patient’s symptoms.

TabIe 1. Number and percent distribution of office viaits by age

and sex of patient United States, 1980 and 1981

Office visits

Number in Percent

Patient age and sex thousands distribution

All office patients . . . . . . . . . . . . . . . . . . . .

All patients

Under 75 years old . . . . . . . . . . . . . . . . . . .

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

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

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

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

Female

Under 75 years old . . . . . . . . . . . . . . . . . . .

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

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

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

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

Male

Under 75years odd. . . . . . . . . . . . . . . . . . .

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

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

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

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

1,160,922

1,078.468

82,454

43,309

24,713

14,431

646,220

53,498

27,497

16,430

9,571

432,248

28,956

15,813

8,284

4,860

1’00.0

92.9

7.1

3.7

2.1

1.3

55.7

4.6

2.4

1.4

0.8

37.2

2.5

1.4

0.7

0.4

NOTE: Figures may not add m totals due to rounding.

● Medications ordered or provided.

. Nonmedication therapy.

● Former visit status and referrals.

● Disposition and duration.

● Physician’s specialty.

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

The data presented are estimates, based on a sample of

of?ice visits rather than on the actual number, and, thus, are

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

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

likely to be; this applies particularly to the 5-year, sex-age sub

groups. An asterisk preceding any estimate indicates that it

exceeds 30 percent relative standard error. Guidelines for judging the precision of estimates are provided in the Technical

notes at the end of this report, along with a brief description of

the survey design.

For greater ease of reference, the textual discussion will

sometimes use the following designato~

. AG group: patients 75 years old or over.

● Younger group patients under 75 years of age.

Data Highlights

General

Over the 2-year period from January 1980 through December 1981, patients in the AG group made an estimated

82,454,000 visits to the offices of non-Federal physicians practicing in the coterminous United States. This amounted to an

average of five visits per year for each person in the subpopulation over 74 years of age. (For the younger subpopulation,

the average was about three visits per year.) Slightly over onehalf (53 percent) of these 82,454,000 visits were made by

patients 75–79 years old, another 30 percent by patients 80-

84 years old, and the remaining 17 percent by patients in the

open-ended subgroup over 84 years of age (table 1). Similar to

the pattern found for most age subgroups, visits by AG females

substantially outnumbered visits by AG males, by a margin

that increased to almost two to one in the older two subgroups.

In large pa% this gender difference among the very old is a

function of relative longevity, reflecting an average life expectancy that in 1981 was 77.9 years for women versus 70.4 years

for men.

Diagnoses

For the majority of AG visits (52 percent), multiple diagnoses were the rule (table 2). The National Ambulatory Medical Care Survey (NAMCS) allows for the processing of up to

three of these diagnoses per visit. Of these, the first-listed is

designated as the principal diagnosis, for the reason that it is

the one most closely associated with the patient’s chief presenting symptom and thus usually commands the physician’s

immediate attention. For patient groups among which a single

diagnosis is the rule, an analysis by principal problem is prob

ably adequate to describe the diagnostic mix typical of the group.

At the AG visit, however, where coexisting problems are the

rule, a broader perspective seems indicated, one that accounts

for the overall impact of a disease entity, whether first listed or

coexistent.

Thus the approach used in tables 3-5 is to cumulate mentions of a diagnosis as a first-, second-, or third-listed problem

to produce an all-listed diagnosis. For example, essential hypertension was a first-listed diagnosis at 10 percent of AG visits

but an all-listed problem at 17 percenc the circulatory diseases

Table 2. Percent of office visits with multiple diagnoses by age

and sex of patient United States, 1980 and 1981

—

Percent of

visits with

multiple

Patient age and sex diagnoses

—

All patients

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.1

75years old And over . . . . . . . . . . . . . . . . . . . . . . . . . . 52.4

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50.(0

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54.lg

85years old And over . . . . . . . . . . . . . . . . . . . . . . . . 56.5

Female

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.(3

75yesrs old And over . . . . . . . . . . . . . . . . . . . . . . . . . . 52.1

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48.:3

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64.:B

85years old And over . . . . . . . . . . . . . . . . . . . . . . . . 58.4

Male

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.’7

75yeara old And over . . . . . . . . . . . . . . . . . . . . . . . . . . 53.2

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.0

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54.2

85years oldandovar . . . . . . . . . . . . . . . . . . . . . . . . 52.I3

.

as a group accounted for 28 percent of all principal diagnoses

but appeared as coexisting problems at yet another 27 percent,

producing an all-listed proportion of 55 percent.

Table 3 ranks the 25 diagnoses most frequently present at

AG visits. Clearly apparent is the dominant presence of certain

chronic diseases and their sequellae. The major afflictions of

the ambulatory aging (essential hypertension, ischemic heart

disease, diabetes, osteoarthrosis, and cataract) are ranked high

on the list for both AG males and females. One notable difference between the sexes is the presence of two male-specific

conditions, hyperpiasia and malignant neoplasm of the prostate. Ranked among the 10 problems most frequently encountered among AG males, these diseases are especially evident among male patients in the subgroup 75–79 years. Among

the other problems listed in table 3, the most substantial differences between male and female rankings were apparent for

the following

. Hypertensive heart disease (ranked 8th among AG females, 26th among males).

. Neurotic disorders (ranked 15th among females, 42d

among males).

● Chronic airway obstruction (ranked 8th among AG males,

52d among females).

It is interesting to observe that among these most fkequent prob

lems, there was no mention of a “senile” mental condition. In

tables 4 and 5, the specific diagnoses are gathered into diagnostic groups.

At AG visits, the following diagnostic groups exceeded in

rate of mention the level found for the younger group.

● Diseases of the circulatory system—Present at a W8fi1inL3

55 percent of AG visits, these conditions dramatically
dfmcdaa3

Table 3. Number of mentions per 1,000 office visits of patients 75 years old and over by the 25 all-listad diagnoaas most frequently mantioned

and ranks of diagnoses by sex: United States, 1980 and 1981

R

a

n

k Most frequent all-listed~ diagnoses and tCD-9-CM code2

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Chronic lschemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...414

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Osteoaflhrosis and allied disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...715

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428

Cardiac dysrhythmlas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Arthropathies, other and unspecified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...716

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Hypertensive heart disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...402

Angina pectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...413

Other disorders ox eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...379

Heart disease; ill-defined descriptions and complications. . . . . . . . . . . . . . . . . . . . . . ...429

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Chronic airway obstruction NEC3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...496

Other disorders ofurethraandurina~ tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...599

Cerebrovascular disease, other and ill-defined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...437

Other and unspecified anemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...285

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300

Other malignant neoplasm of skin.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...173

Acute upper respiratory infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...465

Malignant neoplasm of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...185

Generel symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...780

Hyperplasia of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600

Other retinal disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...362

Rank order by

Number of sex of patient

mentions per

1.000 visits Females Males

174

95

67

60

51

44

36

36

28

26

23

23

20

20

17

17

16

15

15

14

14

13

13

12

12

1

2

4

3

5

7

9

6

10

8

12

11

14

13

*52

16

26

17

15

27

18

. . .

23

. . .

19

1

2

3

7

5

4

6

14

13

“26

11

15

17

19

8

16

12

21

“42

18

●29

9

●22

10

●38

lA1l-listed diagnosix Cumulatea mentions as 1st-, 2d-, or 3d-listed diagnosis.

‘2Based ~n tha international classification of Diseases, 9th Revision, chiC.?i Modification (l CD-9-CM).

3Not elsewhere classified.

●

●

●

●

●

dominated the arena of office-based AG care. In relative

proportions, they were about equally evident among AG

females and males. Their rate of mention, largely due to

the growing presence of heart failure, hypertensive heart

disease, and cardiac dysrhythmias, continued to increase

for both sexes beyond the 84th year.

Diseases of the musculoskeietal system-Ahhough both

sexes showed a marked increase, it was among the AG

females that these conditions were more frequently encountered, underscoring a need for early use of postmenopausal treatment with hormones and calcium replacement. Mention rate did not increase for either sex beyond

the 84th year.

Eye disorders—Three times as frequent at AG visits, both

AG males and females were atTected, and the mention rate

continued to increase beyond the 84th year.

Diseases of the endocrz”ne glands (chiefly diabetes)—

Nearly twice as frequent at AG visits, both AG males and

females were affected about equally. For neither sex was

there an increase in mention rate beyond the 84th year.

Neoplasms—Increased rates of mention, though evident

for both sexes, were more substantial among AG males,

chiefly owing to an estimated 1,000,000 mentions of malignant neoplasm of the prostate. For neither sex was there

an increasing rate of mention beyond the 84th year.

Diseases of the blood and blood-forming organs (chiefly

unspecz~ed anemias)—One of the less frequently mentioned diagnostic groups, these conditions increased in

mention rate for both AG females and AG males. The

relatively small number of mentions precluded fl.uther analysis among the AG subgroups.

● Digestive disorders-Mention rate increased for AG females while remaining about the same for AG males.

. Diseases of the genitoun’naq system—Mention rate more

than doubled for AG males while decreasing by one-half

among AG females. Chiefly responsl%le was the substantial presence among male patients of prostatic hyperplasia.

For neither sex was there evidence of increasing rate of

mention beyond the 84th year.

For the following diagnostic groups, the AG mention rate

either fell below or roughly equaled the rate found among

younger office patien~

. Infectious and parasitic diseases-Mention rate was about

one-third the rate observed among younger patients.

. Mental disorders (dominantly nonpsychotic)—Whh this

group, though minor in rate of mention, the rate among

AG females was almost double that found among AG

males.

. Diseases of the respirator system—Rather than the acute,

self-limiting problems typical of younger patient groups,

among AG patients it is the presence of the chronic respiratory problems, for example, chronic airway obstruction

that chiefly accounted for the relatively large rates of mention of this diagnostic category. This presence was most

evident among AG males in the subgroup 80-84 years.
4

Table 4. Numbar of mentions per 1,000 office visits of patients.hy age, sex, and selected diagnostic 9rouPs composed of ail-listed diagnoses

United States, 1980 and 1981

All pattents Females &lales

A1l-lisred diagnosesl (irrse/ected d/agnosr/c groups) Under 75 75 years Under 75 75 years Under 75 75 years

and ICD-9-CLI code2 yetrrs and over years and over years ancf over

Infectious and parasitic diseases . . . . . . . . . . . . . . . . . . . ... . . ...001-139

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Endocrine, nutritional, and metabolic diseases and !mmunity

disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...240-279

Diseases ofendocrme glands . . . . . . . . . . . . . . . . . . . . . . . . ...240-259

Diseases of blood and blood-forming organs . . . . . . . . . . . . . ...280-289

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-31 9

Nonpsychotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300-31 6

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

Diseases of central nervous system. . . . . . . . . . . . . . . . . . . ...320-349

Eye disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...360-379

Diseases of circulatory system... . . . . . . . . . . . . . . . . . . . . . . ...390-459

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...410-414

Other selected circulatory diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428

Cardiac dysrhythmiaa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Hypertensive heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...402

Heart disease; ill-defined descriptions and complications . . . ...429

Cerebrovascular disease: other and ill-defined. . . . . . . . . . . . . ...437

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Angina pectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413

Diseases of respiratory system . . . . . . . . . . . . . . . . . . . . . . . . . ...460-519

Diseases of digestive system . . . . . . . . . . . . . . . . . . . . . . . . . . ...520-579

Diseases of genitourinary system. . . . . . . . . . . . . . . . . . . . . . . ...580-629

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

Diseases of musculoskeletal system . . . . . . . . . . . . . . . . . . . . . . . 710–739

Arthropathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...711-71 6

Symptoms, signs, and ill-defined conditions . . . . . . . . . . . . . ...780-799

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999

44

33

70

39

9

66

57

123

10

57

143

69

26

27

5

6

6

3

1

1

5

175

60

82

75

97

29

54

107

Number of mentions per 1,000 visits

15 43 15 45

76 34 54 31

104

81

26

38

33

206

16

155

540

174

131

186

44

36

26

20

17

20

23

110

81

70

57

167

103

60

62

80

43

11

67

59

112

10

54

128

69

17

24

4

6

6

2

1

1

4

154

55

109

71

94

33

54

81

103

80

27

46

40

217

17

164

540

201

120

181

41

33

33

21

11

21

21

94

89

52

56

192

121

58

68

56

32

7

63

55

140

10

60

166

69

40

34

6

8

6

4

1

2

7

206

69

41

81

100

23

54

146

16

116

106

82

24

24

20

187

*14

139

541

124

153

195

48

43

8’13

20

26

18

27

138

65

102

60

121

69

63

51

lAI1-listed diagnosis: Cumulates mentions as 1 st-, 2d-, or 3d-lisred diagnosis.

2Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).

●

●

●

Diseases of the skin and subcutaneous tissue—Although

skin diseases were generally more of a problem in the

younger patient group than they were at AG visits, they

showed their highest single rate of mention among AG

females over 84 years old.

Symptoms, signs, and ill-defined conditions—Recourse

by physicians to this vaguest of diagnostic categories was

no more common among AG office patienta than it was

among their younger counterparts.

Injury and poisoning (chiefly accidents)-Though relatively less frequent among the less active AG group, for

example, the rate for AG males decreased by tw~thirds,

the consequences of injury were much more serious for the

advanced aging.

Symptoms

Formal diagnoses represent the objective bases on which

the successful management of AG care principally depends.

But also clinically relevant are the more subjective aspects of

AG care, as represented by the complaints and symptoms that

AG patients present. Indeed, a significant part of AG treatment may be almost wholly symptomatic for example, the

treatment of degenerative joint disease. As with the diagnoses,

the National Ambulatory Medical Care Survey processes up

to three of the patient’s self-expressed symptoms per visit. the

first-listed entry being the most important from the patient’s

point of view. Continuing the approach applied in forming the

all-listed diagnoses, the findings in tables 6 and 7 cumulate

mention as a first-, second-, or third-listed symptom to produce

an all-listed symptom.

Listed in table 6 are the 25 symptoms most frequently

presented at AG visits. At about one-half of all AG visits, one

or more of these symptoms appeared. For most of them there is

a ready linkage to the 25 diagnoses in table 3.

Gender differences in the ranking of these symptoms were

uncommon. When they did occur, they generally showed a

close parallel to the male-female differences found among the

provenant diagnoses. For example, anxiety and nervousness,

symptoms three times as frequent among AG females, are chiefly

associated with a diagnosis of neurotic disorder, which is also

found in a three to one ratio favoring AG females. (It deserves

comment, however, that the overall findings testifi to the relatively high degree of emotional health enjoyed by AG patients.

whether male or female. This is further attested to by the filnding

that a symptom of depression was presented at fewer thlan 1

percent of AG visits.)
ackmdaa5

Table 5. Number of mentions per 1.000 office visits of patients by a9e and selected diagnostic 9roups composed of ail-listed diagnoses

United States, 1980 and 1981

All patients Females Males

A/l-listed diagnoses 1 [in selected 75-79 80-84 85 years 75-79 80-84 85 years 75-79 80-84 85 years

diagnostic groups) and ICD-9-CM code2 years years and over years years and over years years and over

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

Endocrine, nutritional, and metabolic diseases

and immunity disorders. . . . . . . . . . ...240-279

Diseases of endocrine glands. . . . ...240-259

Mental disorders . . . . . . . . . . . . . . . . ...290-319

Nonpsychotic disorders. . . . . . . . . ...300-316

Diseases of nenfous system and sense

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

Eye disorders . . . . . . . . . . . . . . . . . . .. 360-379

Diseases of circulator system . . . . . ...390-459

Essential hypertension . . . . . . . . . . . . . . ...401

Ischemic heart disease . . . . . . . . . ...410-414

Other selected circulator diseases3 . . . . . . . . .

Diseaaes of respirato~ system . . . . . ...460-519

Disaases of digestive system . . . . . . ...520-579

Disaases of genitourinary system. . . ...580-629

Diseases of skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . . ...680-709

Diseases of musculoskeletal system . ..710-739

Afihropathies . . . . . . . . . . . . . . . . . ...711-716

Symptoms, signs, and ill-defined

conditions . . . . . . . . . . . . . . . . . . . . . ...780-799

Injury and poisoning . . . . . . . . . . . . . ...800-999

87 62 65

110 103 89

86 84 59

42 33 34

37 27 “30

199 203 235

151 149 177

498 567 623

172 178 171

122 141 142

161 199 242

110 122 86

81 83 75

69 71 71

55 53 69

171 162 164

100 100 117

53 70 64

67 59 50

Number of mentions per 1,000 visits

62 42 50 130 102 95

117 93 81 98 123 105

93 74 55 74 104 *69

49 44 *38 31 ●11 *24

44 37 “34 “25 *8 ●21

218

170

480

192

109

158

97

88

45

205

146

581

202

134

189

101

99

60

234 166 198

176 118 153

641 522 539

219 137 125

127 146 155

240 164 221

74 134 164

75 69 *51

61 111 93

237

181

586

*76

172

247

110

*75

●89

51 46 86 63 68 *36

195 185 195 130 115 102

118 116 140 69 66 *73

51 66 66 56 78 ●59

73 66 54 58 “44 *4 I

lA1l.listed diagnosis Cumulates mentions as lst-, 2d-, or3d-listed diagnosis.

2Basedon thelnternational Classification of Diseases, 9th Revision, Clinical Modification (}CD-9-Ctvt).

31ncludes heanfallure (lCD428); cardiac dysrhythm!as (lCD 427); hypeflenstve heafldiaease (lCD402); hesndisease, ill-defined descrlpt[ons andcomplicatlons

(ICD 429); cerebrovascular dmase, other and ill-defined (ICD 437]: atheroaclercms (ICD 440): and angina pec:ons [ICD 41 3).

It is noteworthy that the topranked symptom, dizziness,

does not permit as easy a linkage to diagnosis as the linkage

evident for most of the other symptoms on the list. Transient

cerebral ischemias, for example, were associated with fewer

than 5 percent of the dizziness visits. Worthy of exploration

are the possible effects of the more intensive use of drugs in

AG treatment.

A complaint of pain was presented at roughly 21 percent

of the 82,454,000 AG visits, a proportion only slightly greater

than the comparable proportion (20 percent) found among patients under 75 years old. Of these 17,123,000 pain-associated

AG visits, five diagnostic categories accounted for a clearly

dominant proportion (76 percent).

Percent of all

pain-associated

Catego~ visits

Diseases of the musculoskeletal

system . . . . . . . . . . . . . . . . . . . . . . . . . 34.0

Disesses of the circulatory system. . . . . 18.5

Diseases of the digestive system. . . . . . 9.2

Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.1

Diseases of the nervous system and

sense organs . . . . . . . . . . . . . . . . . . . . 6.2

The findings in table 7 express the sex-age dispersions of

the pain-associated AG visits. They reveal that pain was more

apparent among the AG females than among the males, reaching ita highest proportion (23.4 percent) among females in the

subgroup 80–84 years. Beyond the 84th year, the proportion

of pain-associated visits declined among female patients while

remaining roughly the same among the male subgroup.

Medication Therapy

Figure 1 illustrates the prominent mle played by drugs in

the ofice-based care of the advanced aging. Seven of every ten

AG visits were dmg visits; that is, they involved the utilization

of one or more medications. For four of these seven drug visits,

drug therapy was the only form of treatment applied.

To assess the volume and nature of the drug therapy ap

plied by ofice-based practitioners, survey procedure required

that the physician respondents list up to eight of the medications

that they ordered or provided in the course of the visit. Nonprescription as well as prescription drugs were recorded an~

along with any new drugs, continuing drugs were liste~ if the

patient was specifically instructed during the visit to continue

the medication. The resulting drug mentions were distributed

according to the age and sex patterns shown in table 8.

It is clearly evident that the average rate of drug mentions

for the AG group well exceeded the rate of use found for the

younger group. Two major indicators support this more intensive use of drug therapy

. An estimated 70 percent of AG visits were drug visits, an

increase of 9– 10 percent over the proportion found for

drug visits by the younger group.
6

Table 6. Number of mentions par 1,000 office visits of patients

75 years old and over by the 25 all-listed symptoms most frequently

presented and rank of symptoms by sex United States, 1980

end 1981

R Rank order by

a Number of sex ofpamerrt

n Most fr+quent aI1-listedl ment)ons per

k symptoms 7,000 visits Females Males

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

Dizziness . . . . . . . . . . . . . . 38 1

Vision dysfunctions. . . . . . 34 2

Back pain . . . . . . . . . . . . . . 32 4

Leg pain . . . . . . . . . . . . . . . 31 3

Cough . . . . . . . . . . . . . . . . . 28 6

Chest pain . . . . . . . . . . . . . 27 5

Shortness of breath. . . . . . 26 9

General weakness. . . . . . . 26 8

Knee pain . . . . . . . . . . . . . 20 7

Skin lesion . . . . . . . . . . . . . 20 11

Abdominal pain. . . . . . . . . 19 13

Headache . . . . . . . . . . . . . . 18 10

Foot and toe pain . . . . . . . 17 14

Tiredness and

exhaustion . . . . . . . . . . . . 15 16

Hip pain . . . . . . . . . . . . . . . 15 15

Abnormal sensations

of the eye. . . . . . . . . . . . . 14 12

Head cold . . . . . . . . . . . . . 12 20

Shoulder pain . . . . . . . . . . 12 18

Anxiety and

nervousness. . . . . . . . . . . 12 17

Abnormal pulsations and

palpitations . . . . . . . . . . . 11 19

Nausea . . . . . . . . . . . . . . . . 10 27

Frequency and urgency

of urination . . . . . . . . . . . 10 32

Generalized pain, site

unspecified . . . . . . . . . . . 10 22

Symptoms of fluid

abnormalities. . . . . . . . . . 10 21

Skin irritations, . . . . . . . . . 9 24

3

7

2

6

4

8

1

5

●25

9

10

●16

11

*13

*16

*4O

●14

*22

●51

*23

●19

●15

●3O

“34

“32

lA1l-listed symptom: Cumulates mentions as 1st., 2d-, or 3d-listed symptom.

. Roughly 44 percent of AG visits involved the provision of

multiple drugs, an increase of about one-third over the

multiple-use proportion found at visits by younger patients.

W]thin the AG group, there were significant gender differences

in these two measures of drug intensity

. The proportion of drug visits was higher among the AG

females than among the males. (For both sexes, however,

the proportion did not show an increase beyond the 84th

year. )

. The relative exposure to multiple drugs was substantially

greater among AG females, especially in the older two

subgroups but, again, for both sexes it did not appear to

increase beyond the 84th year.

Table 9 offers a ranked listing of the 25 drugs most frequently ordered or provided at AG visits. Two agents, hydrochlorothiazide (a diuretic) and digoxin (a cardiac drug) head

the list by a considerable margin. Most of the other listed agents

also link rather closely to the most frequent diagnoses listed in

table 3 and the most frequent symptoms listed in table 6.

Table 7. Percent of office visits with symptomatic pain by sex

and age of patient United States, 1980 and 1981

Percent of

visits with

symptomatic

Patient sex and age paml

Under 75years odd . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

85years old And over . . . . . . . . . . . . . . . . . . . . . .

Male

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

85years old And over . . . . . . . . . . . . . . . . . . . . . .

20.0

17.B

19.3

16.4

15.6

7Cumulates visits where symptomatic pain was a 1st-, 2d-, or 3d-listed reason

for visiting the doctor.

Because the more frequent use of multiple medications at

the AG visits may increase the threat of adverse interactions,

the concomitant use of dregs needs detailed exploration not

possible in this brief repofi It may be instructive, however, to

cite the 10 agents that most commonly appeared in conjunction

,.,.-.. ............ - ,., .............

.....................In co njunc tIo n

.

..

.

...

.

.

.

.........3.....

.................

.......%-....... with nondrug ~~j$~

~?~:~:~~treatment ...:..................

..... %..,..

,.-.

.......... ~ ..

..

...

..

..

..

.

..

.....

......

...

(30 percent) ~.$:~::.+

❑

✚✎✚ O:.:.:

. . . .

:=; Orug therapy

m

Alternatives to drug therapy

Figure 1. Percent distribution of office visits of persons 75 years

and over by treatment modality United Statea, 1980 and 198”1
ackmdaa7

Table 8. Number and parcent distribution of drug mentions. percent of office visits with at least 1 drug mantion, and percent of office visits

with multipla drug mentions, by age and sex of patient: United Statas. 1980 and 1981

At /east Multiple

? drug drug

Patient age and sex Drug mentions mention mentions

Number in

thousands

All office patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,330,746

All patients

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.195,419

75years old And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135,327

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68,652

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41,914

85years oid And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,761

Female

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 712,725

75years old And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91,301

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44,783

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,402

85 years old and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,117

Male

Under 75 years LIO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482.695

75years old And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44,026

75-79 yaars old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,869

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,512

85 years old and over. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,644

Percent

distribution

100.0

89.8

10.2

5.2

3.1

1.9

53.6

6.8

3.4

2.2

1.3

37.2

3.3

1.8

0.9

0.6

Percent of visits

61.8 30.9

61.2 29.9

69.5 44.0

68.8 42.5

70.4 45,8

70.1 45.1

60.9 29.6

70.8 45.4

69.5 43.4

72.1 47.4

72.2 47.6

61.7 30.3

67.2 41.3

67.6 40.9

67.1 42.5

66.0 40.4

Table 9. Number of mantions per 1,000 offica visits of the 25 drugs most frequently ordarad or providad for patients 75 yaars old and over and

rank by sax: United Stataa, 1980 and 1981

R

a Number of Comparable rank

n mentions per

k Neme of drug (generic) therapeutic effect 1,000 visitsl Females MaIes

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Digoxin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Furosemide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triamterene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Propanolol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methyidopa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Potassium replacement solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-1 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitroglycerin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Isosorbide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reserpine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Multivitamins, general . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Acetaminophen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chlorthalidone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dihydroergotamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ibuprofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Meclizine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Theophylline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ironpreparation s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenobarbital

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chiorpropamide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Papaverine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Spironolactone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diuretic 126 1 2

Cardiac drug 109 2 1

Diuretic 69 3 3

Diuretic 46 4 4

Analgesic, and so forth 43 5 6

Cardiac drug 42 6 5

Antihypertensive agent 36 7 13

Replacement solution 35 9 9

Vitamin 32 10 12

Vasodilating agent 32 11 10

Vasodiiating agent 29 14 8

Antihypertensive agent 27 12 17

Vitamin 25 13 21

Analgesic and antipyretic 23 16 14

Diuretic 23 15 16

Treatment of migraine 20 19 15

Analgesic, anti-inflammatory 20 17 “31

Antinauseant 19 16 28

Spasmolytic agent 18 36 11

Anti-anemia agent 17 20 27

Sedatwe 17 23 22

Antidiabetic, agent 17 25

Spasmolytic agent 16 21 ●%

Diuretic 15 26 “35

Antibiotic 15 32 24

qIncludes rIVJntlOflS Of an agent aa a single-mgredtent drug and Its merwona as an ingredient of a combination dtug.
8 duancedata

with the ranking drug hydrochlorothiazide. In rank order of For the following drug classes the AG mention rate showed

frequency of c~occurrence these were as follows: an increase over the average level found for younger office

patients:

Rank Drug

●

l................... Triamterene ●

2 . . . . . . . . . . . . . . . . . . . Dtgoxln

3 . . . . . . . . . . . . . . . . . . . Methyldopa

4 Spironolactone

5::::::::::::::::::: Reserpine

6 . . . . . . . . . . . . . . . . . . . Propanolol

7 . . . . . . . . . . . Hydralazine

8: : : : : : : : . . . . . . . . . . . Potassium replacement solutions ●

9 . . . . . . . . . . . . . . . . . . . Aspirin

lo . . . . . . . . . . . . . . . . . . Furosemida

●

In tables 10 and 11 the individual agents are grouped into

therapeutic classes. Generally, there was a predictable relationship between the mention rate of a given drug class and that of ●

its associated diagnosis or symptom. ●

Analgesics.

Antineoplastic agents and estrogens. (When the estrogens

used in the treatment of prostatic carcinomas are added to

the formal class of antineoplastic agents, there is a predictable increase for AG males in the overall rate of antineoplastic mentions.)

Cardiovascular-renal agents (including the spasmolytic

agents used to relieve symptoms of the urinary tract).

Gastrointestinal drugs (including the spasmolytic agents

used in the symptomatic treatment of gastrointestinal hypermotility).

Hematologics.

Insulins and antidiabetic agents.

Table 10. Number of mentions per 1,000 office visits of drugs ordered or provided for patiants under 75 years old and over 74 years old by

selected drug categories: United States, 1980 and 1981

All patients Females Males

Under 75 75 years Under 75 75 years Under 75 75 years

Selected drug categories years and over years and ovar yaars and over

Number of mentions per 1,000 visits

All drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antihistamine drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-infective agents (systemic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antineoplastic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Autonomic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood formation and coagulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiac drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antihypertensive events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vasodilating agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Central newous system drugs.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analgesics andantipyretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major tranquilizers (for example: thorazine) . . . . . . . . . . . . . . . . . . . . . . .

Minor tranquilizers (for example: diazepam), sedatives, and

hypnotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Respiratory andcerebral stimulants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Replacement solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Expectorants and cough preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ophthalmic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Agents uaedto treat glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mydriatics andcyclopleglcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-infective and anti-inflammatory agents . . . . . . . . . . . . . . . . . . . . . . .

Gastrointestinal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antacids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Laxative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Emetics and anti-emetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Miscellaneous (chiefly agents used to treat duodenal ulcer). . . . . . . . . .

Hormones andsynthetic substances. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adrenals (systemic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estrogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulins andantidiabetic agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thyroid and antithyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Serums, toxoids, and vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skin preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Spasmolytic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,108

79

187

8

42

13

96

39

36

19

179

96

17

8

40

12

12

65

33

30

4

3

19

39

6

6

6

9

93

33

11

17

9

41

91

17

36

10

1,641

28

94

9

48

31

367

175

97

92

261

159

20

10

57

10

36

215

16

74

28

10

26

76

11

18

19

12

125

38

16

46

15

18

70

46

6B

38

1,103

73

176

10

41

15

81

31

35

15

187

94

20

8

44

15

12

68

30

28

4

3

17

38

6

6

7

8

112

33

17

16

13

34

90

13

49

12

1,707

34

85

9

52

29

385

177

115

89

290

173

24

12

66

12

39

226

13

72

29

*7

24

85

11

20

22

?4

127

40

13

43

18

22

66

40

75

41

1,117

88

204

5

43

9

117

51

37

27

168

99

13

8

35

6

11

61

37

34

6

3

21

40

6

5

5

11

64

34

“1

18

3

51

93

23

18

7

1,520

18

109

*9

40

36

333

172

65

96

209

132

*13

*7

38

●6

31

194

21

76

26

●14

30

59

●1 1

*13

*15

●9

121

34

21

51

*9

*12

77

56

56

33

‘ Drug categories are adapted from 2 sources The therapeuuc categories of the American Hospital Formulary Serwce, reproduced wnh permtasion of the American

Society of Hospital Pharmaclsta. and the drug classes used !n the Natmna/ Drug Code Dfrectory, 1982edmoo.
ackncechta 9

Table 11. Number of mentions per 1,000 office visits of drugs ordered or provided for patients 75 years old snd over by age, sex, and selected

drug categories United Statas, 1980 and 1981

All patients Females Males

75-79 80=84 85 years 75-79 80-84 85 years 75-79 6’0-84

Selected drug categories’ years

85 years

years and over years years and over years years and over

Number of mentions per 1,000 visits

Alldrug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . 1,585 1,696 1.716 1,629 1,790 1,788 1,509 1,510 1,573

Ant! -infectwe agents [systemic) . . . . . . . . . . . . . . . 92 103 83 82 99 70 109 112 107

Autonomic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 47 52 54 50 53 36 “42 *49

8100d formation and coagulation . . . . . . . . . . . . . . 26 34 43 “22 *29 51 34 “44 “27

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . . . . . . 353 379 389 370 406 392 323 324 381

Cardiac drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 187 195 166 185 195 155 190 195

Antihypertensive agents . . . . . . . . . . . . . . . . . .“. 94 101 101 109 126 116 69 “51 ●72

Vasodiiating agents . . . . . . . . . . . . . . . . . . . . . . . 93 91 92 89 94 82 97 83 113

Central nervous system drugs. . . . . . . . . . . . . . . . . 267 277 217 292 318 234 224 195 183

Analgesics and antipyretics . . . . . . . . . . . . . . . . 160 166 141 172 189 146 139 121 131

Major tranquilizers (for example: thorazine)

and antidepressants . . . . . . . . . . . . . . . . . . . . . 34 29 20 41 35 *22 *23 ●18 “13

Minor tranquilizers (for example: diazepam),

sedatives, and hypnotics. . . . . . . . . . . . . . . . . . 57 66 40 65 81 *45 42 “36 ●31

Replacement solutions . . . . . . . . . . . . . . . . . . . . . . 29 40 54 28 44 64 29 ’32 “34

Diuretics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 227 254 200 241 276 187 197 210

Ophthalmic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . 73 70 87 70 74 83 79 63 95

Gastrointestinal drugs . . . . . . . . . . . . . . . . . . . . . . . 69 73 99 72 94 106 65 “32 *86

Hormones and synthetic substitutes . . . . . . . . . . . 132 127 100 142 117 101 115 147 99

Adrenals (systemic) . . . . . . . . . . . . . . . . . . . . . . . 38 41 35 40 44 ●37 35 ●33 “32

[nsulins and antidiabetic agents. . . . . . . . . . . . . 48 48 38 51 35 “32 41 73 *48

Skin preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 69 88 56 66 97 80 74 “69

Spasmolytic agents . . . . . . . . . . . . . . . . . . . . . . . . . 44 46 52 40 37 47 51 65 *61

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 71 91 70 74 91 40 67 “90

t Drug categories are adapted from 2 sources The therapeutic categories of the American Hospital Formulaw Service. reproduced with permwsion of the American

Soc!ery of Hospnal Pharmac!ats, and the drug claases used in the Nationa/ Drug Code Directory, 1982edttion.

. Ophthalmic drugs.

. Sedatives, hypnotics, and minor tranquilizers. (The increase is apparent only for AG females it seems at least

partly linked to the increased presence of symptomatic

pain.)

● Vhamins.

For the remaining drug classes, the AG mention rate either

fell below or roughly equaled the rate for younger ofliee patients.

●

●

●

In spite of the increased presence of inflammatory disorders

among AG patients, it is noteworthy that the mention rate

for the systemic, anti-inflammatory agents differed little

between AG sufferers and the younger patients. In contrast, the use of the nonsteroidal anti-inflammatory agents

(not treated as a separate class in tables 10 and 11 ) nearly

doubled for AG patients, increasing from 69 mentions per

1,000 visits for the younger group to a rate of 124 mentions

per 1,000 visita for the AG group. It is evident that the

nonsteroidals were preferred for the routine maintenance

therapy that is so much a part of AG care.

Parallel with the diagnostic findings in table 5, skin preparations, although their average use is more intensive among

the younger patients, showed their highest single rate of

mention among AG females over 84 years of age.

Finally, there was a noteworthy decrease between younger

and older patients in the mention intensity of two sensitive

drug categories, controlled drugs and combination drugs.

For controlled drugs the mention proportion declined from

8-9 percent for the younger group to about 6 percent for

the AG patients. The controlled drugs most frequently

mentioned in AG care were the minor tranquilizers or

sedatives. For combination drugs the mention propotiion

decreased from 25 percent for the younger group to about

20 percent among the AG patients, the decline being most

apparent among the opioid-nonopioid combinations.

Nonmedication therapy

In sheer volume, the role of nonmedication therapy in AG

care is by no means as imposing as that played by drug therapy.

This is apparent from figure 1, which shows that nonmedication

therapy was ordered or provided at fewer than one-half (43

percent) of AG visits, at about two-thirds of which it occurred

concomitantly with the use of one or more drugs.

of six nonmedication procedures ordered or provided in

AG care (table 12), five either fell below or roughly equaled

their proportionate use among patients under 75 years of age.

These were physiotherapy, o%ce surgery, psychotherapy, diet

counseling, and family or social counseling. Three of these procedures warrant comment.

● Ofice surgety— Although relatively less frequent among

the AG group as a whole, surgical procedures showed their

highest single intensity of use among AG females in the

subgroup over 84 years of age. (This was chiefly due to

surgical intervention in the treatment of the senile keratoses.)
10 dancdaa

Table 12. Number and percant of office visits of patients, by age and nonmedication therapy orderad or provided United States. 1980 andl 1981

All patients

Under 75 75 years 75-79 80-84 85 years

Nonmedicat!on therap yl years and over years years and over

Number of visits in thousands

All office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~,~78,41j8 82,454 43,309 24,713 .14,431

Percent of wsits

Nononmedicatlon therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.6 56.6 57.0 56.7 55.5

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.9 4.1 4.2 4,1 3.8

Office surgeqf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5 5.9 5.7 5.1 7.9

Psychotherapy or therapeutic Iistenmg. . . . . . . . . . . . . . . . . . . . . . . . . 5.1 3.0 3.1 2.9 “2.7

Diet counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.1 8.1 8.1 8.3 7.6

Family andsocial counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1 1.4 1.2 “1.6 “1.3

Medical counseling2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.8 26.4 26.1 26.3 27.5

1Selected procedures.

2Probably also Includes inarructmn on drugs prowded.

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

●

●

Psychotherap.v or therapeutic listening—Along with the may have enabled them to cope independently with family

diagnostic and symptomatic evidence examined earlier, and social problems.

the infrequent resort to these procedures among AG patients offers further testimony to a relatively high degree of As the form of counseling most directly applicable !.o the

emotional health. practical, on-going management of chronic illness, it was preFamily and social counseling—One reason for the minidictable that medical counseling—to include instruction in the

mal use of these procedures may derive from the fact that

use of drugs-would be relatively more common among AG

they were marginal to treating the kind of specific, physio

patients than among younger counterpart.

logically rooted morbidity that dominates AG visits. (It is Other visit characteristics

estimated that 94 percent of all AG visits were strongly As a group, AG patients seldom changed doctors; about

illness oriented.) But the main reason is probably that AG 92 percent of their visits were made to the physician with whom

patients simply did not need this kind of counseling to the they had an established relationship (table 13). Thus continuity

extent required by aging patients in other treatment en- of care is seen to be a hallmark in the management of the aging,

vironments. The same survivor toughness that produced ambulatory patient. Of their visits to other physicians (8 perfewer emotional problems among the ambulatory aging cent), about one-half were referred by the parent physician.

Tabla 13. Percent distribution of office visits of patients by refe~al status snd patient-problem status, according to *9= united states,

1980 and 1981

All patients

Under 75 75 years 75-79 80-84 8!! years

Referrai status and patient-problem status years and over years years and over

Number of visits in thousands

All office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,078,468 82,454 43,309 24,713 14,431

Percent distribution

All office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

Referral status

Referred by another physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5 3.9 3.9

Not referred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95.5 96.1 96.1

100.0

3.0

97.0

100.0

5.3

94.6

Patient-problem status

New patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.8 8.3 a.4 7.2 9.7

Established patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85.1 91.8 91.7 92.8 90,4

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.9 13.9 14.5 13.5 12.7

Continuing problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62.2 77.9 77.2 79.3 77.7

NOTE: Figures may not add to Iotals dua to rounding.
adwmxkm 11

Voluntary doctor selection probably occurred at fewer than 4

percent of AG visits.

About 8 of every 10 AG visits was a return (progress)

visi~ usual] y for one or more of the chronic problems discussed

earlier. The presentation of new problems by AG patients generally signaled the onset of one of the sequellae of the longstanding, chronic diseases, for example, diabetic retinopathy

aggravated by hypertension.

Although the average proportion of referrals did not differ

significantly between the AG and the younger group, there ,was

a noteworthy increase in referred visits among AG patients in

the subgroup over 84 years of age (table 13). Earlier diagnostic

evidence suggests that this increased need for specialized attention was chiefly the result of three intensifying condition

circulatory problems, eye disorders, and skin ‘diseases.

In their followup instructions to AG patients, physicians

were substantially more specific than they were with the younger

group (table 14), because the conditions monitored were, in

large part, intensifying problems that offered little or no hope

for complete remission. Thus the disposition instruction “return

at specified time” was markedly more frequent at AG visits.

“Telephone followup,” a monitoring procedure certainly less

taxing to the aging, was, on the average, no more frequent

among AG patients than among younger patients.

Findings suggest that physicians spend more time in faceto-face contact with AG patients than they do with younger

patients, bu~ on the average, this increased encounter time

only amounted to an additional 1 or 2 minutes (table 14). The

longest average duration of contaq between 17 and 18 minutes,

occurred with AG patients 80 years old and over. Probably

much of this increased contact time was due to the need for

relatively more medical counseling and instruction in the use of

medications.

Providers

The final aspect of AG care to be explored is that of the

doctors of medicine and osteopathy providing the care (table

15). Four providers, general physicians, family physicians.

internists, and ophthalmologists, accounted for three-fourths of

the AG visits. It is noteworthy that two of these providers—the

general physician and the family physician-are generalists, in

the breadth of their clinical scope and in the demographic fact

that their patients range from one end of the age continuum to

the other. Their combined visit proportion (36 percent) constitutes the largest single share of the 82,454,000 AG visits, exceeding the comparable proportion (33 percent) found for the

group under 75 years old.

Next in relative frequency are the visits to internists. Their

proportion of AG visits (23 percent) was double the comparable

proportion found for the younger group. Although internists

qualifi as generalists in many of their practice characteristics, it

is probably their specialist skills in managing the circulatory

diseases that account chiefly for their prominent position in

AG care.

The increased presence of eye disorders among AG patients (tables 4 and 5) is predictably paralleled by the increased

frequency of their visits to the ophthalmologist.

Whh diagnostic correlates that are obvious, it was expected that nearly two-thirds of the 3,197,000 referred visits

Table 14. Percent distribution of office visits of patients by visit disposition and duration, according to age: United States. 1980 and 1981

All patients

Under 75 75 years 75-79 80-84 85 years

Disposition and duration years and over years yeers end over

Number of visits in thousands

All office visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,078,468 82,454 43.309 24,713 14,431

Percent of visits

All office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0

Dispositiorrl

No followup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.9 5.7 6.2 5.6 4.4

Return at specified time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59.7 72.8 72.3 72.8 74.2

Return if needed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.2 16.6 16.0 17.0 16.0

Telephone followup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 3.5 3.3 3.2 4.4

Admit to hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 3.3 3.2 2.9 4.2

Durationz

O minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 2.6 1.8 1.8 2.0 *1.7

1-10 minutes . . . . ...!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43.4 34.1 35.9 32.0 32.3

11-30 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. 47.9 58.5 57.1 60.8 59.4

31minutes or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 5.5 5.3 5.2 6.7

Mean visit duration4 in minutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.8 16.7 16.4 77.1 17.4

lSelected alternstwes. Therefore, figures W,II not add 10 totals.

2Figum$ may not add to totals due to rounding.

SNOface-to-face encounter between physician and pat[ent.

41ncludes OIIIY faCe-tO-faCe encounters between phys!c!an and patsent.
12 adwincedata

Table 15. Percent distribution of office visits of patients by specialty of the attending physician according to sex and age of patient

United States, 1980 and 1981

All patients Females Males

Under 75 75 years Under 75 75 years Under 75 7!i yeara

Physic/an specialty years and over years and over years and over

Number of ofhcewsits m thousands

Alloffice vlslts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

All office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Generai and family practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Obstetncsa ndgynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

Otolewngology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

All other specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,078.468

100.0

32.6

11.6

5.2

10.0

4.9

1.2

4.5

1.6

2.9

0.6

4.8

2.3

17.7

82,454

100.0

36.4

23.1

5.5

1.0

3.2

2.9

3.4

3.3

“0.4

“0.4

12.6

1.6

6.2

646,220 53,498

Percent distribution

100.0 100.0

32.4 37.8

11.2 23.1

4.9 5.5

16.6 1,5

3.7 3.8

0.9 2.4

4,5 3.7

0.9 1.2

2.8 “0.4

0.5 “0.4

4.6 13.2

2.0 1.5

15.0 5.5

432,248

100.0

33.0

12.2

5.8

6.7

1.6

4.4

2.5

3.1

0.6

5.2

2.7

22.2

28,956

100.0

33.8

23.0

5.3

1.9

3.9

3.0

7.2

“0.4

“0.6

11.6

1.8

7.5

NOTE: Figures may’ notaddto totals due to rounding.

made by AG patients would be to five specialists:

Percent of

Specialists referred visits

Internist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.3

General surgeon . . . . . . . . . . . . . . . . . . . . . . 15.5

Ophthalmologist . . . . . . . . . . . . . . . . . . . . . . 14.6

Orthopedic surgeon . . . . . . . . . . . . . . . . . . . . “1O.9

Dermatologist . . . . . . . . . . . . . . . . . . . . . . . . ●7.9

Summary

Office-based ambulatory care of the advanced aging may

be generally characterized by the following features:

●

●

●

●

●

●

Female patients accounted for tw~thirds of the care.

At most of the visits the physician had to cope with multiple

diagnoses.

Most of the morbidity encountered took the form of longterm, physiologically rooted, chronic diseases or their sequellae.

The sharply reduced prospect for complete cure led to an

emphasis on routine maintenance care carefully monitored

by the physician.

The strongj illness-based focus led to a reduced use of

nonillness care, including measures that were considered

marginal to the direct management of the illness (for example, fasnily and social counseling).

Drug therapy was markedly more frequent than other treatment mechanisms. It was relatively more intense with females than with males.

●

●

●

●

●

●

●

●

●

The increased use of multiple drugs created more potential

for adverse interactions.

Physicians gave evidence of an increased conservatism in

the use of controlled and combination drugs.

There is a need for further study of the possible linkage

between the increased intensity of drug use and such frequently occurring symptoms as dizziness and blurred vision.

Mental and emotional illness, including what is loosely

referred to as “senility,” was a relatively minor problem

for both sexes.

An increase in the female use of sedatives, hypnotics, and

minor tranquilizers may be due less to the existence of

emotional illness than to the increasing presence of symp

tomaticpain.

A long-standing relationship between physician and patient

is the rule. Referrals are relatively infrequen~ as is voluntary doctor shopping.

Most of the care, general or specialized, occurred in the

ofilces of three primary care physicians: the general physician, the family physician, and the internist.

The average contact between physician and patient lasted

about 17 minutes, only about 1 minute longer than the

average contact with younger patients.

These oldest of oflice patients display a certain swvivor

toughness of mind and body that needs liuther exploration—

especially among patients in the oldes~ open-ended subgroup.
admndaa 13

Technical notes

Source of data and sample design

The estimates presented in this report are based on the

findings of the National Ambulatory Medical Care Survey

(NAMCS), a yearlong sample survey of ofiice-based care conducted by the National Center for Health Statistics. Findings

for two survey years, 1980 and 1981, were combined to produce the estimates. The target universe of NAMCS is composed of ofllce visits made by ambulatory patients to nonFederal and noninstitutional physicians who are principally

engaged in office-based patient care practice. Vkits to physicians practicing in Alaska and Hawaii are excluded from the

range of the survey, as are visits to anesthesiologists, pathologists, and radiologists.

Table 1. Approximate relative standard errors of estimated numbars

of office visits and of drug mentions whan the drug is listed by

product name (for example, Valium), based on all physician

specialties: National Ambulato~ Medical Care Survey, 1980

and 1981

Relative

standard

Estimated number of office visits error in

or specific drug mentions in thousands percent

“200. . .. ... . . . .. . . . . .. . . . . . . .. . . .. . . . ... .. . .. . ●44.8

*BOO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●31 .7

9450 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

600

“30.0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.0

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.6

1,000 . . . . . . . . . . . ..- . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.2

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

5,000

14.5

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..a - 7.1

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4

EXAMPLE OF USE OF TABLE An aggregate estimate of 35.000,000 office

visns has a relative standard error of 5.0 percent or a standard error of 1,750,000

wans (5.0 percent of 35,000,000 wsits).

NAMCS uses a multistage probability sample design that

involves a stepwise sampling of primary sampling units. physicians’ practices within primary sampling units, and patient

visits within physicians’ practices. The physician sample (5,805

for the 2-year period) was selected tlom master files maintained

by the American Medical Association and the American Osteopathic Association. Those members of the sample who were

in scope and available participated at a rate of 77.3 percent.

Responding physicians completed visit records for a systematic

random sample of their office visits during a randomly assigned

7-day reporting perbd. During the combined years 1980 and

1981, responding physicians completed 89,447 visit records,

of which 6,384 were records of visits by patients 75 years old

or over. Characteristics of the physician’s practice, such as

primary specialty, were obtained or confirmed during an induction interview. The National Opinion Research Center,

under contract to the National Center for Health Statistics,

was responsible for the field operations of the survey.

Sampling errors and rounding

The sampling error is a measure of the sampling variability

that occurs by chance because ordy a sample, rather than the

entire universe, is surveyed. The relative standard error of an

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. In this

reporg any estimate that exceeds a relative standard error of

30 percent is marked with an asterisk Table I should be used to

obtain the relative standard error for aggregates of ofice visits.

Standard errors for estimated percents of visits (or for rates per

1,000 visits reduced to percents) are shown in table II.

The determination of statistical inference is based on a

one-sided t-test with a critical value of 1.645 (0.05 level of

confidence). Terms relating to differences, such as “exceeded”

or “fell below” indicate that the differences are statistically

significant Terms such as “similar” or “roughly equal” mean

that no statistical signii3cance exists between the estimates beTable il. Approximate standard errors of parcants of astimated numbers of office visits based on ail physician specialties National Ambulato~

Medical Care Survey, 1980

Estimeted percent

Base of percent

(number of office visits in thousands) 1 or 99 5 or 95 100r90 20 or 80 30 or 70 50

Standard error in percent

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 5.9 8.1

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

10.8 12.4 13.5

2,000 . . . . . . . ““”” ””””-””””-””””””””””””””””””” ““

1.9 4.2 5.7 7.6 8.7 9.5

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

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

1.3 2.9 4.0 5.4 6.2 6.7

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.8 1.9 2.6

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

3.4 3.9 4.3

. . . . . . . . . . . . . . . . . . . . . 0.6 1.3 1.8

20,000 . . . . . . . . . . . . . . . . . .

2.4 2.8 3.0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.9 1.3 1.7 2.0 2.1

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.6 0.8

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

1.1 1.2 1.3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

500.000

0.2 0.4 0.6 0.8 0.9 1.0

. . . . ...’. . . . . . . . . . . . . . . . . . . . . . . . . . . ...+.. . . . . . 0.1 0.2 0.3 0.3 0.4 0.4

EXAMPLE OF USE OF TABLE: An estimate of 30 percent based on an aggregate of 15.WOjOO0 vlstts has a standard error of 2.4 percent, or a relative standard error

of 8 percent (2.4 percent dwded by 30 percent).
14 aduancedata

ing compared. Estimates have been rounded to the nearest National Center for Health Statistics

thousand. 3700 East West Highway

Any questions regarding these tindings or the survey pro- Hyattsville, Md. 20782

cedures that produced them may be addressed to— Phone: 301-436-7132

Hugo Koch

Ambulatory Care Statistics Branch

“U.S.GowrnnmnlPrintingoflica 1993— SO1-019/KK121
Vital and Health Statistics

series descriptions

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geographic and trend analyses are included.

Data From the National Mortality and Natality Surveys –

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

Data From the National Survey of Family Growth –These

reports contain statistics on factors that affect birth rates,

including contraception, infertility, cohabitation, marriage,

divorce, and remarriag~ adoption; use of medical care for

family planning and infertilii and related maternal and infant

health topics. These statistics are based on national surveys

of childbearing age.

Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnanc~-

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly Wta/ Sfatktics Reporf (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Sfatktics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21,

For answers to questions about this report or for a list of reports published

in these series, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

Public Health Service

6525 Be!crest Road, Room 1064

Hyattsville, MD 20782

(301) 436-8500
DEP~TMENTOF

HEALTH & HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

6525 Belcrest Road

Hyattsville, Maryland 20782

E

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

DHHS Publication No. (PHS) 94-1870, Series 16, No. 11