Vital and

Health Statistics

Advance Data

From Vital and

Health Statistics:

Numbers 61-70

Series 16:

Compilations of Advance Data From Vital

and Health Statistics

No, 7

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

age and other variables on ambulatory medical care; selected demographic

characteristics of teenage wives and mothers; expected principal source of

payment for hospital discharges; health practices among adults; and utilization

of short-stay hospitals in the treatment of mental disorders, Estimates are based

on the civilian noninstitutionalized population of the United States, These reports

were originally published in 1980 and 1981,

U.S. DEPARTMENT OF HEALTH AND HUfvfAN SERVICES

Public Heaith Service

Centers for Disease Control and Prevention

National Center for Heaith Statistics

Hyattsville, Maryland

December 1993

DHHS Publication No. (PHS] 94-1866
..

. --

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: nos 61–70. National Center for Health Statistics. Vital Health Stat

16(7). 1993.
National Center for Health Statistics

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

Jack R. Anderson, Depup Director

Jacob J. Feldman, Ph.D., Associate Director for Aru+sis

and Epidemiology

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

lWramural Programs

Peter L. Hurley, Associate Director for J%al and Health

Statistics Systems

Robert A. Israel, Associate Director for International

Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

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

and Methodology

David L. Larson, Assistant DirectoL Atlanta
Selected Demographic Characteristics of Teenage Wives and Mothers . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . .

Expected Principal Source of Payment for Hospital Discharges: United States, 1977. . . . . . . . . . . . . . . . . . . . . . .

Office Visits for Male Genitourinary Conditions: National Ambulatory Medical Care Survey United States,

1977-78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health Practices Among Adults: United States, 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cough as the Reason for Office Visits, National Ambulatory MedicaI Care Survey United States, 1977-78 . . .

1979 Summary National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Headache as the Reason for Office Visits, National Ambulatory Medical Care Survey United States,

1977-78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stroke Survivors Among the Noninstitutionalized Population 20 Years of Age and Oven United States,

1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office Visits for Preventive Care, National Ambulatory Medical Care Survey United States, 1977-78 . . . . . . .

Utilization of Short-Stay Hospitals in the Treatment of MentaI Disorders: 1974-1978 . . . . . . . . . . . . . . . . . . . . .

No. 61

No. 62

No. 63

No. 64

No. 65

No. 66

No, 67

No. 68

No. 69

No. 70
FRCWl VITAL & HEAL77i STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U..S.DEPARTMENT OF HEALTH . pub;IC Health Serwce

AND HUMAN SERVICES Office of Health Research. Starmms, and TechrIoIoqv ~m~ 61 ● *p-f=r ~. ~9@3

Selected Demographic Characteristics of

Teenage Wives and Mothers a

INTRODUCTION

In the United States in 1976, about 1,122,000

women 15-19 years of age were married, divorced, widowed, or separated; of these, 480,000

were mothers of at least one child. Another

332,000 women in this age group were never

married mothers who had offspring Iiving with

them. The 1,122,000 ever married women 15-19

accounted for about 11 percent, and the 332,000

never married mothers, about 3 percent of the

10.4 milIion women 15-19 years of age in 1976.

This report provides the first and most recent

national estimates of the current contraceptive

practice and famiIy background of teenage wives

and mothers and their husbands. It also compares

them with their counterparts 20-44 years of age

m terms of these and other selected characteristics. These esdrnates are based on a special

ardysis of data from Cycle II of the National

Suxvey of FamiIy Growth (NSFG), conducted in

1976 by the NationaI Center for Health Statistics.

A number of trends have prompted recent

concern about teenage marriageand childbearing.

These trends include the increasing number of

women 15-19 years of age (a result of thehigh

birth rate during the late 1950’s), the increasing

number of teenage marriages, and the increasing

proportion of all births occurring to teenage

mothers.

The U.S. Bureau of the Census has reported

that the number of women 15-19 years of age

increased by 57 percent from 1960 through

‘This l’CpOrSW* prepared by Sara .Mtian, ~.A.,

and WiUiaxn D. Mosher, Ph.D., Division of VW Statistics.

1976, from 6.6 million to 10.4 million. Reflecting this increase in the number of young

women, the annual numbers of teenagemarriages

ako increased over the same period.

However, the rates for teenage marriagesand

births did not increase. Data from the marriage

registration system (table 1) show that of all

brides marrying for the firsttime in 1976 about

38 percent (or 571,000) were under 20 years of

age. In 1960 teenage brides had accounted for

48 percent (or 482,000) of alI first marriages.

From 1940 through 1960, birth rates to

women 15-19 years of age (births per 1,000

women 15-19) increased from 54.1 to 89.1.

From 1960 through 1976, however, this rate

decreased from 89.1 to 53.5, a 40 percent

reduction, and approximately the 1940 leveL

Among women 20 years of age and older, however, birth rates declined even more fkom 1960

through 1976.X As a resuk of this differential

deeliie and the increase in the number of

women 15-19 years of age, births to teenage

mothers accounted for 18 percent of dl births

m 1976, compared with 14 percent in 1960.

Since 1976, the birth rates for women 15-19

have remained at about the same levels.

The data for this report were coflected by

means of personaI intemiews with a multistage

area probability sample of women 1544 years

of age in the household population of the conterminous United States. Women were eligible

for inelusion in the sample if they were eurre@y

married, previously marrie~ or never married

but ivith offipring presendy living in the household. This report does not include the relatively

snd number of teenage mothers under 15 years

of age.z Stmikdy, never manied teenage mothers

whose offspxing were not Iiving with them were
2

Table 1. Nunlmr of first marriages and Percent distribution bv age of brido and ●m of ~m at first marriage:

Unitad Stetaa. 1980 and 1976

6ride Groom

Age

1976 1960 1976 1980

Nu* of first muriagaa in thoueend% .. . . . . ... . —- .. . ..—.—

Age et first marriage

All qa% .-- —. ——”..—”” —..-—.-----—-— —

Under 18 years. . ....... ... ... ... . . ...... ...... ... . . .. ....... ... . ... ... .... . . ..........—--”

16-19 years ................. ...... . ...m.... .. .. ......... ...... ................ ....... ... ......... ...... . .. .

20 years and over ... .. . ....”.-. ..........”.............”.. ......... ...... .. ..... . .......... . ... ....

20 years ..... .. . . ...... . ... .. . . ... .... .... . .... ... .... ... . ..... .. ............ . . . .

1.491 I 1,015I 1,460I 1,026

Pafcant distribution

100.0 100.0I lm.o I 100.0

11.9 15.1 21 1.8

25.4 32.4 15.4 15.2

61.6 52.5 82.5 83.0

12.1 11.0 10.9 9.1

1 I I I

SOURCES: National Center for Heaith Statistics: Vital StatLrtics o/ tfre United States 1960, vol. III, .Uamhge and Divorce. public

Heatth Service. Washington. U.S. Government Printing Office, 1964. table 2-6.

Nationat Center for Heat!h Statiatica: First marriages, United State& 1968-1976, by 8. F. W:lson and E. Hume. Vital and Heafrh

Shrtfrtics. Series 21-No. 35. DHEW Pub. No. (PHS) 79-1913. Public HeaItlr Service. Washiocton. U.S. Government Printinr ~+~--

Sept. 1979, tables B and C and unpublished tebulatioks.

not incIuded in the sample. (Approximately 7

percent of out-of-wedlock babies born to women

aged 15-19 were not Iiving with their mothets

in 1976. The comparable figure for 1971 was

about 14 percent. It should be noted, however,

that these percents are based on only 148 cases

in 1976 and 259 cases in 1971 and refer only to

out-of-wedlock babies born horn first conceptions. They should, therefore, be interpreted

with some cautions )

From January through September 1976,

3,009 black women and 5,602 women of other

races were intemievved in the NSFG. Of these,

448 women were 15-19 years of age. This report

is based on information provided by these

teenage women, of whom 193 were black and

255 were of races other than black. The information from these women was inflated to provide natiomd estimates of these statistics.

Because they are based on a sample, estimates

from the NSFG are subject to sampling error.

Fufier discussion of sarnpfing error, comparisons with other dat~ and definitions of selected

terms can be found in the Technical Notes.

The statistics on women 2044 years of age

are shown in this report ordy for purposes of

comparison. Other groups could be used, but

m -------

this group is convenient for the purposes of

this report-principally, to highlight some of the

characteristics of teenage wives and mothers. It

shotdd not necessarily be inferred that teenage

maniage or childbearing is the only or the prinapal cause of differences between teenagers and

the older women described. These differences

may be the result of such things as their ages at

intemiew or the social customs prevailing when

they were married or when they had their chiL

dren.

CHARACTERISTICS OF EVER MARRIED

TEENAGE WOMEN AND THEt R HUSBANDS

Tables 2 and 3 present selected characteristics

of the 1,122,000 ever married teenage women

and their husbands and of the 30,725,000 ever

married women 2044 years of age and their

current or last husbands, in the United States in

1976. (k this xepo~ for convenience, the ever

maxried teenage women are referred to as

“teenage wives,” although a very small proportion of them were no longer currently married

at the time of rntemiew. See Definitions of

Terms.)
ad&meMa3

Table 2. Nutiar of ewr IIurried woman 15.44’ yearsof age, by age and mea, md paroantdistribution by selectedcharacteristics,

●cootitngto am ●nd race:United States.1976

Characteristic

Nur’fhr of wonwnin thousands. ... .. . . ..

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

16-19 years....... .. . ........... . ...... .. . ...”.....

20-24 yOWS . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .." . . . . . . . .

25-28 years...”..” .“”””... . .. . ...... . . .. .. .

3044 years....... . .. ... .. ... ... .... .. ....”...

Ageat marriage

Under18y~rs .... . . . ........ ..... . ... . . . .

16-19 years.”. ... . .. .... . ... . . ..... .

20.44 years. .. . .... . . . . . . .. . . . .

Am at first birth

Under18 yMrS.... . .. .. .... . . .. . . . . .... .

16-19 years............... .... ... .. .... ... . .. .

2M4 years......... ..... ........ ... ....... ........

No livebi~hs...”.”. ”......”“.... ... . . ............

Timirm of first birth

Prerrmrital bi~h . .. . ..... . . .... .. .. .. ... ...

O-7 months after nnrriage .... .. .. .. . . ..--- ...

8 months after nwriage or more.. .... .......

No live bkths ..... ... . . ......... .... .. . ...

Childrenewr born

None ....--.. -.-”-. -.. ” . . ..”--. ”----—

1 .. . ... . ....... .. ... . . . .......... . .. . ..

2 or more ..” .... ....... ..... .... .... .. .... .

Education

0-11years...””._._.._” ——-—

12 years or mora. .. . . ... . .. .. ... .

Rwarty level income

MOW POwfty levelinmma. . .. . .._.__.

Fbvamylevel inmna ●nd ●vow . .. . . ..

Labor force status

In the labor force . . . . . .. . .. .. .

Working. ... . ...... ... ... .... . . ..

Unemployedor vith a job but not ●t

writ. ... . ... . . . .. . . . . . . . .

Not in the laborforce.. ._._

In school...... . . . . . .. —-..”..

Keeping housaor other .. .. . .. .. .. . .

Seefootnoteat endof table

15-44ymrs of age [1 15-19 yaarsofaga I XM4warsofaga

Percent distribution

100.0

0.6

29

17.!5

23.4

55.6

20.5

31.7

47.7

11.2

19.5

50.8

18.5

6.6

15.4

58.4

18.7

18.4

20.6

61.0

24.5

75.5

2:

51.3

47.8

3.5

48.7

S’

100.(

~

0.1

2!

17:

23-!

55.:

20.:

32.d

47:

9.4

19.:

51.$

19.4

3.{

~4-g

62.C

19.E

19.4

20.1

60.s

23.0

77.0

E

50.5

47.1

3.4

49.5

1.8

47.7

1Oo.c

●0.4

29

16.7

a .2

56A

~

45.8

27.6

23.0

39.3

10.1

33.3

20.5

35.9

10.3

10.0

228

67.2

36.5

63.5

28:2

71.8

59.7

55.3

4.5’

40.3

3.2

37.1

100.0

17.2

82.8

. . .

. . .

. . .

%!

. . .

26.3

16.2

. . .

57.5

“8.4

16.9

17.4

57.3

57.2

34.5

*8.2

52.6

47.4

14.6

85.4

41.3

37.6

● 3.7

58.7

●5.8

52.8

100.{

=

17.[

82.,

. .

. .

. .

59.d

40.[

. .

23.$

16.S

. .

59.:

●4A

17.7

18.4

59.1

58.0

34.0

●7.O

53.8

46.2

12.2

87.8

41.4

37.7

“3.8

58.6

●5.7

529

100.(

~

●13.:

86:

. .

. .

. .

702

28.i

. .

54.4

●14.4

. .

31.2

42.9

●14.a

“11.8

31.2

31.2

47.1

“21 .6

46.2

53.8

38.8

60.2

33.6

33.6

“0.0

55.4

“9.4

57.0

100.(

~

. .

1;1

242

57.t

19.1

31.4

49.!

10.7

19.6

521

17.1

6.5

15.3

60.6

17.2

17.0

E

23.5

76.5

9:

51.7

48.2

::

13

46.5

lm.(

~

..

..

18.:

24.4

57.:

18.f

32.1

49.1

8.S

19.4

53.8

18.(I

3.5

14.6

63.6

18.1

17.9

19.6

62.4

21.6

78.2

9::

50.8

47.4

4E

1.7

47.5

100.0

. . .

. . .

17.3

21.9

60.7

23.4

28.1

47.4

%~

40.7

9.4

33.0

20.7

36.7

9.6

9.2

:.:

36.2

63.8

27.8

72.2

60.6

55.0

32:

2.9

36.4
4

Table 2. Number of ever married IMJmen 15-44 years of age. by age and race, and oercant distribution bv selected chasmteristics.

Characteristic

Receipt of Aid to Families

With Dependent Children (AFDC)

Received AFDC ...........................................

Did not receive AFDC ............................ ....

Living arrangements at age 14

Living with both parents..............................

Living with one or neither rmrent.................

Current contraceptive status

Serile ..........................................................

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

3eeking pregnancy .................................. ...

Other nonuser..............................................

Oral mntraceptive pill .............................. ..

intrauterine device ................................”.....

Other methods .............................................

mrding to age and race: Unitad States, 1976-Con.

‘16-44 years of age

~

15-19 years of age

!

2044yaarsofaga

II I I r ,, ,

All IIWhite I

Black II All II I I

All

raceal recesl White Black

reces~ ‘h* I

Black

7.1 5.4

929 84.6

76.7 79.1

23.3 20.9

29,6 30.2

6.1 6.2

5.6 5.3

10.7 9.7

22.7 23.0

6.6 6.5

18.6 19.1

20.4

79.6

56.5

43.5

26.5

5.5

6.3

18.5

21.6

7.1

14.5

Percent distribution

9.4 -8.5

%.6 91.5

56.3 56.3

43.7 41.7

●1.8 91.7

14.5 15.0

●7.7 ●5.9

●6.9 “6.5

50.7 51.6

●6.5 ● 6.3

12.0 13.0

●I 9,6

60.2

50.1.

49.8

‘3.2

●14.1

●11.3

●12.0

46.2

●9.1

%?.1

7.0

93.0

n.4

22.6

30.7

5.8

5.5

10.8

21.7

6.6

18.9

5.3

84.7

79.8

20.2

31.3

5.6

!E

22.0

6.5

19.3

E

56.7

43.3

27.3

5.2

6.1

18.6

20.7

7.1

14.9

lIncludes white, black, and other races,

NOTE Statistics in tabla 2, 3, and 4 are baaed on a sample of the househotd population of the conterrrdnoua Usdted States. Sk

Technical Notes for estimates of sampling vasisbility and definitions of selected terms.

About 5 of 6 (83 percent) of the teenage

wives were 18-19 years of age. Only 17 percent

were 15-17 years of age. Table 2 shows that

about 31 percent of ever married women 20-44

years of age had their first child before the age

of 20. The differences described in this report

between ever married teenagers and ever married

women 20-44 would probably be larger if

women who had first married or had had their

first child as teenagers were exciuded from the

age group 20-44. For an analysis of differences

in fertility after the teen years between women

who had a teenage birth and women who did

not, and a review of the literature on some other

differences between teenage mothers and other

women, see reference 4.

Living arrangements of the respondent at

age 14 may be viewed as an indicator of the

stability of her family Iife while she was growing

up. By this indicator the family background of

teenage wives was more likely to have been

unstable than that of other wives. About 44

percent of teenage ever married women, compared with ordy 23 percent of ever married

women 20J44 years of age, were living with only

one or neither parent at age 14. A report by the

U.S. Bureau of the Census indicates that about

21 percent of persons 10-17 years of age were

living with only one or neither parent in 1976.s

Although only 17 percent of teenage wives

were under 18 yeaxs of age, about 53 percent

had not compIeted high school by the date of

the interview. This suggests that the education

of some of the teenage wives was interrupted

or terminated by marriage or childbearing.6

Teenage wives were significantly Iess likeiy to

have completed high school than wives aged

20+4: 47 percent of teenage wives and 77 percent of wives 2044 had completed 12 years of

education by the date of intefiew.

Teenage wives were significandy more likely

than wives aged 2044 to have had no births

(57 percent compared with 17 p-ent) or only

one birth (34 percent compared with 20 percent) by the date of interview. Teenage wives

were also significandY mom ‘kelY ‘0 be Preg-
amcedaa5

Table 3. Nunhw of war rrnrriad vwx$sn 16-44 Ye=$ of age, by age and race. and percent d~tribution by selected dtamcfari$tic$of their

currem or last husband. according to age and race: Unimd States. 1976

characteristic of husband

Number of wumen in thousands ... . . . . .

All woman.“.-.--.”--..---” .-..

Age at wife’sfirst nnrriage

Under 18 yam.--..-.-..-..-.-—--”.-.

18-19 yaars.....".. ... . .. .... . ... .. ........... . ..

=24 years.... ....... ..””” ..-. ”-. .. ..”. ””.....

25 years and oven...- . ...... ..- . . . ...-.-.”

Occupation

Professional, managerial, sales, clarical.

●nd kindred... ...... . ..... . . . . ... .. . .. .

Craft, operatives, labor, trartspoRation,

farm labor, service, and kindrad..-.....-

fuevarvvorked-------------------------

=UCation

0.17 ymrs —.

12 years or mcwa... . . . . . -------------------

l.hfi~ arrangements ●t a- 14

Uving with both parents ...—........——..——

Wing with on- or neither srerent..-- . . ..

15-14 yeamofaga !1 15-19 yearsof age

al i II I

All races%IIWhite I 8kd IIS’lb’t”I“*

31,647 1127s I 3,314 II 1,122 II =2 I 1~

Percent distribution

100.0 [ 100.0

2.2 3.t

17.7 18.0

54.0 54.7

25.1 24.2

41.4 43.8

53.5 5%5

5.1 3.5

24.1 ml

75.8 76.8

77.3 78-5

227 2t.5

100.0 I 100.0

4a ●8.4

17.6 329

48.5 49.6

29.1 9.1

19.6 14.8

61.4 65.1

19.0 ●0.1

34.6 33.9

65.4 66.1

86.8 70.3

331 28.7

1Oo.c

●8.9

33.3

49.5

●8.3

15.0

84.9

●0.1

35.0

55.0

70.1

29.8

100.0

95.4

33.5

42.3

.18.8

●17.3

62.7

‘0.0

●28.3

71.7

“22

2tW$ yearsof age

All

raaal IIWhite

I

Black

30,725 II 28,847 I 3,205

100.0

3.0

17.2

54.1

25.7

424

52.3

5.3

23.7

76.3

77.6

224

100.0

29

17.4

S.9

24.7

45.0

51.3

3.7

2Z6

77.4

78a

21.2

100.0

4.7

17.0

48.8

28.5

19.7

50.7

19.7

34.8

65.2

66.5

33.5

%ndudes white. black, and other r“CSS.

NOTE statistics in tsbks 2, 3, and 4 are b=sd on a sample of the household population of the contermiwu$ United states. Se@

Technical Notaa for estimates of sampling variabfiw and defiiitiom ofselectedt~

nant or post partum at the date of rntcrvicw

than wives 20-44 yeacs of age (15 percent compared with 6 percent).

Teenage wives were not significantly more

Iikely than wives 20+4 years of age to have had

a premarital birth (8 percent compared with 7

percent). Similarly, the teenage wives were not

significantly more Iikely to have had a premarkd conception: the proportion of wives

whose first birth occurred within 7 months of

maniagc was 17 percent for teenage wives and

15 percent for the women 20-44 years of age,

not a significant difference.

About 15 percent of ever married teenage

women were living in households with below

poverty level incomes, compared with about 9

percent of ever mamied women 2044 years of

age. This difference, although statisticallysigniflcanG shouId be interpreted with caution (see

“Definitions of Terms”). Ever married women

15-19 were less likely to be in the labor force

than ever married women 20-44 (41 percent

compared with 52 percent). The ever man-ied

teenagers were not, however, significady more

likely to be receiving Aid to Families With Dependent Children (AFDC) than those 204

(9 percent comp=d with 7 pe=nt).

Ever married teenagers were much more

likeIy to be using the oral contraceptive piII at

the date of the interview than ever married
6dmme&ta

women 20-44 (51 percent compared with 22

percent-figure 1). Because use of the piII requires a doctor’s prescription and medical

folIowup, the high percent of teenage wives

Figure 1. PERCENT OF WOMEN 15-44

YEARS OF AGE USING THE ORAL

CONTRACEPTIVE PILL, BY AGE

AND MARITAL STATUS: UNITED

STATES, 1976

.50 r

1—[ 15-19 Years

W 2044 Years

I 51

50 m

own offspring

using the pill may be reIated to a finding in an

earlier report that teenage wives were more

likely than other wives to have had a recent

family planning visit.7 In that report, the place

where the most recent famiIy planning visit

occurred was classified as either “with own

physician” or at an “organized medlcaI semice”

(cIinic or other place). The teenage wives were

more likely than other wives to have had their

most recent family planning visit at an organized

medical sewice. Table 2 indicates that there was

no significant difference between teenage and

other ever married women in the percents trying

to become pregnant or using the intrauterine

device (IUD). Teenage wives were Iess likely

than the ever married women 2044 to be using

contraceptive methods other than the piIl and

IUD (12 percent compared with 19 percent).

Statistics in table 2 show that a larger proportion of ever married bIack women had their

Erst child at a relatively young age than white

ever married women did. About 28 percent of

black ever married women 15-44 had had their

first birth before the age of 18 compared with

about 9 percent of ever married white women.

Similarly, overall and in both age groups, the

percent of women with no birth by the date of

interview was lower for black women than for

white women.

The percent of ever married women who

had a premarital birth was higher for black

women among both teenagers and women 20-44

years of age. About 43 percent of bIack teenage

wives and 5 percent of white teenage wives had

a premarital birth. A recent study of teenage

pregnancy may help to explain the Iarger percent

of black ever married women than white ever

married women who had a premarital birth

(table 2). That study found that black singIe

teenage women were more likely than white

single teenage women to become premaritally

pregnant, and much less likely than white

single teenagers to marry before the outcome

of a premarital pregnancy (see tables 1-3 of

reference 3).

Selected characteristics of the husbands of

teenage and other ever married women are shown

in table 3. About 41 percent of the husbands of

teenage wives were also teenagem at the wife’s

first marriage. Another 50 percent were 20-24

years of age; only 9 percent were 25 years of age

or older. The data on the occupation of the
dmcedda7

wife’s current or last husband show that 85

percent of the husbands of teenage wives were

in “bIue collar” occupations-craft, operatives,

labor, transportation, farm l~or, service, and

kindred. This compares with 52 percent of the

husbands of wives 2044 years .of age. Only 47

percent of teenage wives (table 2), but 66 percent of their husbands (table 3), had finished

high schooI by the date of interview. This

large difference may be expItined in part by the

older age of their husbands, but it may also

reflect the wives’ lower levels of educational

attainment, or longer delays in completing

high school. About 56 percent of teenage

wives were Iiving with both parents at the age

of 14, compared with 70 percent of their

husbands. Thus teenage wives were less likeIy

than their husbands to have finished high school

by the date of the interview and less likely to

have come from two-parent households.

CHARACTERISTICS OF SINGLE

(NEVER MARRIED) MOTHERS

From 1960 through 1976, the number of

out-of-vvedIock births in the United States increased from about 224,000 to 468,000, a 109-

percent increase (see table 5 of reference 1). One

important reason for this increase was the rising

number of young women during this period.

Another was a widespread postponement of

marriage. A third factor was an increase in the

rate of out-of-wedlock births. The out-of-wedIock

birth rate (out-of-wedlock births per 1,000

unmarried women 1544 years of age) rose from

21.6 to 24.7 from 1960 through 1976, a 14-

percent increase.1 For unmarried women 15-19

years of age, howwer, this rate increased 57

pcrcen~ from 15.3 in 1960 to 24.0 in 1976.S

The rates for 1977 and 1978 were about the

same as in 1976.

If a woman has had an out-of-wedlock birth,

has kept the baby, and has never married, she is

classified in this report as single with her own

offspring living in the household. TabIe 4 shows

selected characteristics of the estimated 332,000

singIe (never married) mothers 15-19 years of

age and the 739,000 singIe mothers 20-44 years

of age who had offspring living with them in

1976. The sing~e mothers were younger than the

ever married women. About 65 percent of the

singIe mothers were under 25 years of age compared with ordy 21 percent of ever married

women.

Table 4 shows that 67 prcent of the 332,000

single teenage mothers and 70 percent of the

739,000 single mothers 20-44 years of age were

black women. So black women accounted for a

larger percent of single mothers than of the

general population. This difference appears to

reflect different outcomes of out-of-wedlock

pregnancies among white and black teenagers

as much as any difference in the chances of

becoming pregnant in the first pIace. One recent

study of teenage pregnancy revealed that black

single teenage women were more Iikely than

white singIe teenage women to become singIe

mothers through a combination of five factors:

a higher percent of black teenage women had

had intercourse; a higher percent of black

sexually active women had had a premarital

first pregnancy; a lower percent of black premaritalIy pregnant women had married before

the baby was born; a lower percent of black

women had married soon after a premarital

birth; and a Iarger percent of black than white

teenage mothers had kept their babies.3

As mentioned previously, the Iiving arrangements of the respondent at age 14 maybe viewed

as an indicator of the stability of her family Iife

during her youth. About 42 percent of single

mothers were living with only one or neither

parent at age 14, compared with 23 percent of

ever married women. Only about 1 in 5 (19 percent) singIe teenage mothers had finished high

school by the date of intetiew, although 3 in 5

(61 percent) were 18 or 19 years of age at that

date. This suggests that for many of these young

women, motherhood interrupted their education.6

Table 4 also indicates that about 79 percent

of singIe teenage mothers in 1976 had their first

birth before the age of 18, compared with 29

percent of single mothers 20-44 years of age, 26

percent of teenage wives, and 11 percent of ever

married women aged 20-44 years. The high

proportion of vexy eady first births for single

teenage mothers probably reflects two facts:

first, teenage mothers cannot by definition

incIude any women whose first births occurred

after age 19, so the proportion with a birth

before 17 is higher. Secondly, on reaching the

age of 18 and the completion of high school,
a

Table 4. Number of never rmrriad women 1544 years of age wtIo have their own offaoring living with them and percent distribution

by selamad ch==terimics. according to age: Unitad S&es, 1976

Age

Characteristic Characteristic

16-44 15-19 20-44

Number of vmmen in thousmtts.. 1,071 332 739 bverly level income

Percent distribution Below poverty lewd income .... .. .... .. .

All womb. . .......... ....... ...

l=== 100.0

Race I

White ....... ......... .... .... ...........”...... 28.7

Black ............... ........ .... .. ... . ...... . 69.3

Age —

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

18-19 years .................... .............

20-24 years .................. ...... ...... .

25-28 years ...................... . ..........

3044 years ......... ............ .... ...”....

Age at first birth

Under 18 years . ..... .. ...... ..... .......

16-19 years . .............. .... ..... .... . ..

2044 years .. ..... ....... ........... . ....

Children ever born

.

2 or more . ........ ......... ................ .

Education

011 years ............ ................. .....

12 years or more . ............... .... ....

lIncludes white, black, and ot

12.1

18.9

34.2

16.1

18.7

44.3

25.8

28,8

62.8

37.2

56.6

43.4

races.

100.0

31.4

67.3

38.0

61.0

. . .

. . .

. . .

78.4

“20.6

. . .

65.4

●14.6

81.4

“la6

-i

poverty level income and above . .... . ..

100.0

Mm force status

In the labor force ...................... .... ...

Working .........................................

26.9 Unemployed or with a job but

70.3 not at work ....... . ... ...... ..... ........

Not in the labor force ..... . .......... .. ....

In school .............”... ..... ..................

Keeping house or other .......... ...... ..

. . .

. . . Receipt of Aid to Families W ith

49.6 Dependent Chiidren (AFDC)

23.3

27.1 Received AFDC .........................”..””..

Did not receive AFDC..”, ............... ...”

Living arrangements at age 14

26.6

28.2 Living with both parents ............... ..

43.2 Living with one or neither parent . .....”

II

Current contraceptiw status

52.6

47.4

45.3

54.7

Sterile ...... ...”...............”..........”......”..

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

Seeking Pragneney ................. ....”....”..

Other nonuser ............ ... . .......... ..... ..

Oral contreceptiw pill..” .. .. ..... .... . ..

Intrauterine device ........... ... ..............

Other methods .... .. ...... .. ......... . . . ....

Age

1S44 I 15-19 I 20-44

Percent distribution-Con.

61.0

36.0

30.1

26.6

●3.5

68.9

12.4

57.5

70.3

28.7

57.8

422

●7.9

●7.3

. . .

27.8

36.5

120

“8.5

56.3

43.7

●14.7

●1 3.1

●1.6

65.3

26.4

56.9

75.9

24.1

49.1

!34).9

●I .3

●14.0

. . .

26.1

40.6

●10.8

*4.8

62.9

37.1

37.0

32.7

●4.3

63.0

●5.2

57.7

67.7

32.3

61.7

36.3

●10.9

●4.3

. . .

27.6

34.6

12.5

●10.2

I

NOTE: Statistics in tables 2, 3, and 4 are based on a sample of the household population of the contettninoos United States. See

Technical Notes for estimates of sampling variability and definitions of selected terms.

women maq at a sharply increased rate+ thus

many singIe teenage mothers may eventuaUy

marry, perhaps after they complete their education. They would therefore not be classified as

singIe mothers at some Iater time, but rather as

ever married women with a premarital birth.

SingIe mothers (table 4) were much more

Iikely than ever married women (tabIe 2) to be

receiving AFDC (70 percent compared with 7

percent) and to have incomes beIow the poverty

Ievel (61 percent compared with 9 percent).

Overall and in both age groups, singIe mothers

were less likeIy than ever married women to be

in the labor force. In addition, the teenage single

mothers were less Iikely than singlemothers 20-

44 to be in the labor force.

About 41 percent of teenage single mothers

and 35 percent of those 20-44 years of age were

using the oral contraceptive piII at the date of

intetiew (figure 1). This difference was not

statistically significant.
a&medaa9

REFERENCES

lNa~ion~ center for He~~Stat~tics; ~uctso~~i~~

and Death. DHEW Pub. No. (PHS) 791122,2. Public

Health Sexwice. Hyattsville, McI. NOV. 1978, table 4.

2Nation~ Center for Hcalth statistics: Teenage

childbearin~ United States, 1966-75, by S. J. Ventura.

Monthly Vital Statktics Report, ~Vol. 26, No. 5, Supp.

DHEW Pub. No. (I-IRA) 77-1120. Health Resources

Administration. Hyattsvillc, Md. SepL 8, 1977, tables 1

and 2.

3Zelnik, M., and Kantner, J. F.: Firstprcgnancies to

women aged 15-19: 1976 snd 1971. F’am. Plum. Perspect. 1O(I): table 6, Jan.-Feb. 1978..

4MilIman, S. R., and Hendershot, G. E.: Early

fertiIity and lifetime fertility: evidence from the National

Sunmy of FamiIy Growth; Cycle II. Fare. Plum. Perspect. 12. May-June 1980.

5U.S. Bureau of the Census: Mtitd status ~d

living arrangements: March 1976, Cument Population

Reports, Series P-20, No. 306, table 4. Washington. U.S.

Government Printing Officc,Jan. 1977.

6Moore, K. A., and Waite, L. J.: Early childbearing

and educational attainmen~ Fan. Pfann. Perspect. 9(5):

220-225, Sept.-Ott. 1977.

7National Center for Health Statistics: Use of

family pkuming sewices by currently married women 15-

44 years of age: United States, 1973 and 1976, by G. E.

Hendersho~ Advance Data From Vital and Health Statistics, No. 45. DHEW Pub. No. (PHS) 79-1250. Public

Heaith Sewice. Hyatt@le, Md. Feb. 7, 1979.

8National Center for Hesith Statistics: Advance

rcpo~ final natality statistics, 1976. Monthly Vital

Statktks Report, Vol. 26, No. 12, Supp. DHEW Pub.

No. (PHS) 78-1120. Public Health Service. Hyattsvilk,

Md. Mar. 29, 1978, tabIe 12; and National Center for

Health Statistics: Vital Statistics of the United States,

1960, VOL I, Natality. Public Health Service. Washington.

U.S. Government Printing Office, 1962, table I-X.

9Nation~ Center for Health Statistics: Advance

report, final marriage statistics, 1976. Monthly Vital

Statfitics Report, Vol. 27, No. 6, Supp. DHEW Pub.

No. (PHS) 78-1120. Public Health Semite. Hyattsvilk,

Md. Sept. 13, 1978, table 3.

SYMBOLS

Data not available .-.

Category not applicable . . .

Quantity zero .

Quantity more than O but less than 0.05— 0.0

Figure does not meet standards of

reliability or precision *
10

TECHNICAL NOTES

RELIABILITY OF ESTIMATES

Because the National Sunrey of Family

Growth (NSFG) is a sample of the household

population of the conterminous United States

rather than a compIete count, the estimates in

tables 2-4 are subject to sampling variability.

TO calculate the standard error of an aggregate

number or percent, the appropriate estimates of

A and B from table I are used in the equations

SE ~Nt) = (A + B/N’)% x N’, and

SE(Pt) = [B xP’ X (100 -P’) /X’]~,

where N’ is the number of women, P’ is the percent, and X’ is the number of women in the

denominator of the percent. Statements in the

text of this report were tested using a 2-tailed

t-test with 40 degrees of freedom. The relative

standard error is the ratio of the standard error

to the statistic being estimated. In this report,

numbers and percents that have a relative standard error that is greater than 25 percent of the

estimate itseIf are considered unreliable. They

are marked with an asterisk to caution the user

but may be combined to make other types of

Table 1. Estimates of A and B for relative standard error curves,

by marital status and race: National Survey of Family

Growth, Cycle II

Marital status

and race

Ever married

All races ...... ......

White ....... ........... ...... ..

Black ........ .... ...... .........

Nevar married with

own of fsprinq and

All races ...... ..... .

White ......... ....... ...........

Black ...........................

A

0.0001700390

0.0000422037

4.0004520643

J).0001 926913

-0.0002362857

-0.00046133S8

B

6,486.5185

7.111.5185

2#48.2362

6.494.6569

6,892.2852

2,698.6043

comparisons of greater precision. Details of the

procedure used to estimate standard errors can

be found in “National Survey of Family Growth,

Cycle I: Sample Design, Estimation Procedures,

and Variance Estimation ,“ Vital and Health Sta.

tzktics, Series 2, No. 76, January 1978. A similar

report is in preparation for Cycle II.

In Cycle 11 of the NSFG, missing data items

were not imputed, and percent distributions are

based on cases with known data.

The NS FG estimates of numbers of ever

married women 15-19 years of age, ever married

women 15-19 years of age who had ever had a

live birth, and never married (single) women

15-19 years of age Iiving with their own

offspring are in close agreement with estimates

from other sources. In “Fertility of American

Women: June 1976 ‘! (Current Population

Reports, Series P-20, No. 308, June 1977, table

43), the U.S. Bureau of the Census estimated a

total of 1,125,000 ever married women 15-19

years of age, and of these, 505,000 were estimated to have had at least one child. Researchers

at The Johns Hopkins University have provided

an estimate of 311,000 never married (single)

women 15-19 years of age living with their own

offspring. This unpublished estimate is based on

a 1976 sampie survey of women 15-19 years of

age in the noninstitutional population of the

conterminous United States. None of these estimated numbers is significantly different from

the NS FG estimate.

DEFINITIONS OF TERMS

Demographic Terms

Age. –In this report, “teenager” refers to a

woman 15-19 years of age at the date of interview.

Marital status. –Persons are classified by

maritaI status as married, widowed, divorced,

separated, or never married. Married, widowed,

divorced, and separated women are referred to

as “ever married.” For convenience, ever married women 15-19 years of age are also referred

to as “teenage wives” since alI but 7 percent of

sampIed ever married teenage women (19 cases)
adwmdaa 11

were curhmtIy -, married at the sumey. date.

Never” married women with offsPring ~vrng in

the household were included in the sample and

chissified separately in tabie 4.

Poverty level. -The poverty index ratio was

calculated by dividing the total family income

by the weighted average threshold income of

nonfann families with the head under 65 years

of age based on the poverty levels shown in U.S.

Bureau of the Census, Czment Population

Reports, Series P-60, No. 106, “Money Income

in 1975 of FamiIies and Persons in the United

States,” table A-3. Poverty level was not ascertained for 35 percent of sampled teenage mothers

or for 18 percent of sampled teenage wives.

Because missing data on income may be nonrandomly dis&ibuted with respect to other variables, small differences by poverty level income

should be interpreted with great caution.

“BeIow poverty level income” refers to a total

famiIy income that is Iess than the poverty

threshold, while “poverty level income and

above” refers to a totaI fa.rdy income that

equals or exceeds that threshold.

Receipt of Aid to Families With Dependent

Children. –Respondents were asked, “Did you or

any members of your family living here receive

income in the past 12 months from . . . welfare

payments for aid to your dependent chiIdren?”

Respondents who replied “yes” were classified

as having received AFDC.

Labor force status. –Respondents were asked

“Last week were you working fulI-time, parttime, going to schooI, keeping house, or what?”

“In the Iabor force” includes those working fuller part-time; those with a job but not at work

because of temporary illness, vacation, strike, or

maternity leave; and those unemployed, Iaid off,

or looking for work. “Not in labor force”

includes those in school, those keeping house,

and those engaged in other activities not in the

labor force. This classification gives priority to

working over other activities. For example,

women who were both working and attending

school, or working and keeping house, were classified as working.

Current Contraceptive Status

Sten7e. –A woman (or couple) was classified

as sterile if she reported that it was impossible

for her to have a baby. Most of the women (or

couples) classified as sterile have had sterilizing

operations {see Advance Data No. 36).

Seeking pregnancy. –A currently manied

woman was classified as seeking pregnancy if she

reported that she was not using a contraceptive

method at the time of intexview because she

wanted to become pregnant. Never married

mothers and widowed, divorced, and separated

women were not asked if they were tqing to

become pregnant.

Post parturn. –A woman (or couple) was

classified as post partum if she reported that she

was not currently using a contraceptive method,

that she was not seeking pregnancy, and that her

last pregnancy had terminated within 2 months

before the date she was intenriewed.

Other nonusers. –Women (or coupIes) who

reported that they were currently using no contraceptive method and were not sterile, pregnant,

post partum, or seeking pregnancy were classified here.

Method users.-A woman (or couple) who

reported use of a contraceptive method other

than a surgicaI sterilization at the date of interview was classified according to the specific

method used. For a detailed ckuxification of

currentiy married women by specific contraceptive methods, see Advance Data No. 36.

Related Data

More extensive definitions of terms can be

found in previous reports based on Cycle II of

the NSFG–for example, see Advance Data Nos.

36,43,45,55, and 56.
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH ● PublICHealthSewl=

AND HUMAN SERVICES Off ice of Health Resaamh. Statistics. and Technology Nuttbar G! ● oetCbSv31#19so

Expected Principal Source of Payment for Hosp”til Discharges:

United States, 1977a

INTRODUCTION

This report presents statistics based on data

collected through the National HospitaI Discharge Survey, a continuous survey conducted

by the National Center for HeaIth Statistics

since 1965. In 1977 data were abstracted from

the face sheets of medical records of approximately 224,000 patients discharged from 423

short-stay non-Federal hospitals. These data

were used to produce estimates of hospital utilization by an estimated 35.9 milIion inpatients

(excluding newborn infants) in the United

States.

From 1968 through 1970, information on

hospital charges from a subsample of the National Hospital Discharge Sutvey (NHDS) sample

was collected.1 No information on charges or

source of payment was collected from 1971

through 1976. In 1977, however, data on a

patient’s expected (in contrast with actual)

principal source of payment and other expected sources of payment were collected from

the face sheets of all medical records in the

NHDS sample. Statistics in this report reflect

only the patient’s principal expected source of

payment. The survey form used to collect these

aThis report was prepared by Robert Pokras and

Gloria Gardocki, Division of Health Resources Ut.iIization Statistics.

1National Center for Health Statistics: Patient

charges in short-stay hospitals, United States, 1968-

1970, by M. Moien. Vital and Health Statistics. Series

13-No. 15. DHEW Pub. NO. (HRA) 74-1766. Public

Health Service. Washington. U.S. Government Printing

Office, Jiay 1974.

data is reproduced in a previous publication of

me NationaI Center for Health Statistics.2

There is an obvious but important limitation

to these &k the expected payment source recorded on the face sheet of the medicaI record

may not have been the actual source of paymerk For ucample a patient admitted to a hospital foIlowing an automobile accident may have

ated Blue Cross as the ~peeted source of

payment when, m fac~ an automobile insurance company ultimately made restitution Also,

because of the manner in which this variable was

collect~ there is no way to determine the

charge for the hospital stay or what proportions

of the hospitaI stay and medical sexviees provided were covered by the principaI expected

source of payment indicated.

HIGHLIGHTS

Private Inswanee

Private health insuranc~ consisting of Blue

Cross and other private or commercial insurance,

was the prineipaI expected source of payment

for approximately 19.3 million discharges in

1977, or about 54 percent of all discharges

(table 1). The average length of stay for patients

using private insumnce -s 6.0 days compared

2National Center for Health Statistics: Inpatient

utilization of short-stay hospi~ armual summary of

the United States, 1977, by B. J. HaupL Vial and

HeuZth Statistics. series 13-No. 41. DHEW Pub. No.

(PI-IS) 79-1792. Public Health Servia. Washington

U.S. Government Printing Office, Mar. 1979.
2

l~le 1. Number and persant distribution of patients discherp from non-Faderal shorz-stay hospitals by princi~l expected stmrceof

payment, ageand sexof patient: Unitad States,1977

ill expected Frivete Workmen’s ~i- Madic. Other

sources of insurance COmpen- cere aid gcwernmant

paymsnt sation pawnerlts

Sex and age

Both sexes Number in thousands

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

+

35,902 863 I 8,954 2,936 I 1,110

I I

19,325 2,338

Under 15 years.................

1544 years......................

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

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

Male

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

Under 15 years.................

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

45-84 years......................

85 years and war .............

Female

All a~s .. ............ .......

A

3,775

15,180

8,604

8,344

14,385

2.549

10,334

6,135

307

45

I ‘1

213

446 238 1.636 607

250

1,574

452

62

13

56

14

8

31

71

289

113

13

195 883 546 266

22 7,766 119 24

7.497 527 4.031 901 415 789 195

2,137

4,553

4,042

3,653

21,518

1,444 23 362 124 139

3.081 362 124 306 160 405

2,807 153 499 164 120 216

155 12 3,385 49 11 28

11,828 136 4.923 2.035 665 1,549

8

I

37

11 95

7 56

l--6 7

60 281 , *

1,105 22 273 m 111

7.243 64 114 1,330 447 1,169

3.328 42 364 362 146 236

152 10 4,403 70 13 33

Under 15 years.................

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

45-84 years............. ........

65 yearsand war .............

1,638

10,627

4.562

4,660

5 34

45 164

7 57

3 6

Both SeXeS Farcant

All ages................. 100.0 53.8 1.8

Under 15 years................

1544 years......................

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

65 yearsand mrer.............

100.0

100.0

100.0

100.0

57.5

66.1

71.3

3.7

52.1

2.9

2.3

0.3

3.7

93.3 1.4 0.3 0.7 0.1

28.0 6.3 2.9 5.5 0.2

0.2

1.4

Male

All ages........... .. ........ 100.0

Under 15 years................

1844 years................. ....

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

65 years and war .............

100.0

100.0

100.0

100.0

67.6

67.9

68.4

4.2

55.0

1.1 16.9

6.7

4.6

1.3

5.8

3.5

3.0

0.3

+

6.5 0.4

8.9 0.2

5.3

0.8 E

7.2 0.3

6.7 0.3

11.0 0.4

5.2 0.2

0.7 0.1

1.7

2.1

:::

7.8

3.8

0.3

0.6

2.7

12.4

92.7

Ferrolc

All ages....................... 100.0 22.9 9.5 3.2 1.4

100.0

100.0

100.0

100.0

16.7

12.5

7.9

1.5

Under 15 years................

1544 years......................

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

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

67.4

66.2

73.0

3.2

1.3

1.1

8.4

93.8

5.4

4.2

3.2

0.3

2.1

1.8

1.2

0.1

0.8

0.6

0.2
a&mceda3

Table 2. Number and percent distribution of days of care and average length of smy for patients dischar@ from non-federal short+tay

hospitals by princip.d expected source of payment United States, 1977

[ II

All expected

Days of care

sources of

m

Blue tioss.

payment and other Workmen’s

private Compeninsurance sation

~

with 7.3 days for aII patients (table 2). This difference is partiaHy a function of the age of these

patients. That is, average length of stay increases with age, and the average age of patients

using private insurance was 35.5 years, while the

average age of aH patients was just over 40 years

(tabIe 3). The shorter average length of stay

means that a proportionately smaller number of

days of care were used by these patients: while

54 percent of all discharges were covered by

private insurance, only 45 percent of the totzd

days of cam in short-stay non-FederaI hospitak

were used by these patients.

The five most frequent first-Iisted diagnoses

for patients using private insurance (table 4)

were delivery (with or without mention of comTable 3. private. public, and other expected sources of payment

for patients discharged from non-%deral short-stay hospitals

by total number of dischar~, days of are, average length of

stay, and age: Unitad States, 1977

Item

Total nutier of

discharges in

mill ions .............. ..

Total days of care

in millions ........... .

Awrage length of

say in days...... ...

&arsrgaageof

patientsin vain...

All II 5xpectedsourceof Peymant

expected

souras of

payment private

36.9 19.3

262.4 115.6

7.3 6.0

40.6 35.5

T

.%Ifq)ey,

ublic o *rg*.

other

13.7 2.9

131.0 15.8

9.* 5.5

58.8 31.8

Principal expected source of ~ymefrt

I 1 i 1 1

r

100,364 19#261 6,662 12,087 610 3,065

38.2 7.3 2.5 4.6 0.2 1.2

10.9 6.6 6.1 5.2 6.8 6.4

placation), maIignant neoplasms, benign neoplasms, hypertrophy of tonsils and adenoids,

and chronic ischemic heart disease. The diagnostic categories used to determine this ranking are

discussed in the Technical Notes. Of the 3.33

million patients hospitalized for deliveries in the

United States in 1977,2.05 milIion (62 percent)

listed Blue Cross or another private insurance

plan as the principaI expected source of payment. This large proportion of deliveries contributed in part to the shorter average length of stay

of patients using private insurance, because

a delivery generally resuhs in a relatively short

length of stay–from about 3 to 5 days.

TabIe 5 provides data on all-Iisted surgeries

for inpatients, with a maximum of three procedures recorded on the IWIDS survey form. The

five most frequent surgical procedures (see

Technical Notes for a discussion of surgical

categories) performed for patients using private

health insurance were diagnostic diIation and

curettage of uterus, hysterectomy, tonsillectomy

with or without adenoidectomy, bilateral

ligation and division of fallopian tubes, and

oophorectomy or SaIpingo-oophorectomy. Of

these five procedures, four are femaIe specific,

and private insurance was the principal expected

source of payment for more than 75 percent of

each of them.

The numbers of maIes and females discharged were relatively similar in all age groups

except 15-44 years (table 1). Of the discharges

in this age group Ming Blue Cross or other

private insurance as the expected source of payment, more than twice as many were females as

males. This was due to the Iarge number of
4

T#de 4. Nu@ar of dischargesfor the 5 most frequent dmgmstic categoriesfsx patientsd-bclssgpd from non-Fedeml short-ay hospitals

for each principal expected sourta?of payment, and percent of all discha~ with dse dia~osi~ Unitad States, 1977

I

Most frequent diag-mstic categories and ICDA codes Number of discharges

in thammds

Private insuranm

Da!ivary with or without mention of Complication ... . .. . -.——650661

Malignant newlas . ......................... ..... ................... . . . . ... ..lO=

8anign naoplasrm and neoplasms of unspecified nature—-.-.-.-.—-.2 lO-238

Hypatlrophy of tonsils and adenoidz ........ ... .. ............ .... . . .. .... . ....- ~

Chronic ischemic heefi disease....... ....................... ...... .... .. ...... ... .. . . 412

Mdicare

Malignant neoplasms................................. ............... .. ... ... ..... .... . 140.208

Chronic ischemic heart disaasa............... .. ........ ... . .. . . . .. . . .. .. 412

Cerabrovascular disease. ................ ........ . . ......... .... . ... . . ... . ... .

Pneumonia, all forms ............H............... ...................... ... .. ... ...ti... ...- 480-t86

C3taract......................." .................... .... .." ..... .......... . . ....."." .. . . .. .. ..m4

Mtdicraid

Delivery with or widmut mention of compli=tim ....-.---..—.--—~l

Abortion (induced or sponmneous) ... ... . . .. .. .. . . . . .. . ~

hlignant n~las . .................Q...... ..... . . .... .... . .. . . . .. . . ....- 140-208

Pneumonia, all forms .... .... ........ ..... .... . .. .. .. .. . . . ————

Hypartrophy of tonsils and adenokfs.—.—--......——— 500

Workman’s Canpensation

Displacement of intervertebral disc....- ... ....- . . ..-—..---__._.72S

Sprains and strains of back and neck..—......-...— --------- 848-847

lacerations and open wound [excluding eye, ear, and haad)-...—..—— 874-807

lnWinal hernia....... .......... ..... .......... ... . .. ...... ....- . . . ..- .. ..550s2

Dislocation without fracture ...... ...... . . .. .. .... .. . . . . . . ..

Other government payments

Daliwsry with or without mention of complication . . .. .._....--......-.-_66068l

Alcohol ism.. . . ......... ....... ..... ... ..... . . ... ... .... ..

Hypetirophy of tonsils and adenoids . ...... ....- . .. ... . ..—_._— . ...-...——

*ligsant neWlasm..- .........._ ....- ......--.-. -a ....-e---- ... ..” . . ...-140-209

Fsycho,ss..... . .... .... ....... . . ...... .. . .. . . . . .. mm

alf-pay

Dal”~ with or without mention of complication.--.-.....66O+6l

Abortion (induced or spontanaous).——

Alcoholism ... .. . ....”.. .... . . . .. . . ... —...--. 703

Msligumt naoplasms...- . .. .. . . ..—.—.—..——...... 140-2(M

tinrplications of Pragmncy, ..... .. . .. ..——————..— 630-634

Delivery with or without mention of complication..._ --560661

Maliqsant neopiasms...... ... .._ .. .._.. . ..__._..._. 140-209

Alcoholism. . ....... . ... .. . .. ... ..... ... . . 303

Intracranrnl injury (including skull fr&Xura)-—..— ~

8enigrt naoplaams and neopiasrns of urrspacifii nature 210-m

2.049

708

593

492

410

827

766

456

258

245

411

93

z

76

74

66

37

36

32

No charm

Delivery with or withmt mention of compkation —-1

Pneumonia, all fohms............ .. .. . ..._.. ._._. .. .

Abortion (induced or spontaneous) .—-...—— — 640645

Cholelithissis...............””. ”” ......... ---------- S74

Psychoses...... ........ ....... .. ... .......... .. . ..--- .... .. ... —------ 29W=

139

46

33

33

33

613

78

76

56

66

80

16

17

12

11

26

●4

●3

●2

“2

Percent of

all d“whargas

61.5

41.0

72.2

77.6

32.1

47.8

59.9

71.4

35.7

70.4

12.3

199

4.8

11.1

12.0

18.7

18.3

15.7

7.2

15.2

4.2

9.8

5.2

1.9

8.0

18.4

16.7

16.1

3.2

16.2

2.4

0.8

3.6

3.1

1.3

0.8

0.6

0.6

0.4

0.5
dmc$xwls

Table 5. Number of all-listed surgeries-for the 5 moat frequent surgical cate~-es for patients didvsrgad fmm non-l%deral short-ay

hospitals for each Princiml expected sow= of paynsen~ and parrxmt of all such surgeriespasformad: United States,1977

Most frequent surgicalcategoriesad ICDA codPrivatrs‘insuranos

Dilation and curettage of uterus, diagnostic 70.3

Hysterectomy .............. ....... ....... ... .....- 68.1+8.5

Tonsillectomy with or widmut X&’IOtiIW . . .. ..-Z1.l-zl.z

fJ@tion and division of fellodian tubes, biked. — . . ...68.5

@phoractorny; salpingo-oophorectorrry ----- —.-.-..67.2-.5

Medicasa

Extraction of lens.................................. .. . . . .. . . . . 14.4-14.6

%o*tetiomy ........................................ .....- —....-- 58.1 -58.3

Reduction of fracture with fixation ...... ... . ..——.....—..... —.—..-...- . . ... 822

tiolwysetiomy .......................... ... .. . . .. ..- . . . . . . .. . 43.5

Rapair of inguinal hernia.................... ...——..—..——— —382-38.3

Medics-kl

Dilation and curettage of uterus. diagnostic.... . . . ..——.———.———————— 70.3

Tomiilectomy with or without adenoidactomy... . . .._21.l-212

L@ion and divisim of fallopian tubas, bii-ral—...--.-.-.---.---=

Gsereen section............... .......... .... ......... .

Hysterectomy ........................ ..” ......-.. ”-------- —._..J8.Te2

Workman’s CompansatissSS

Repair of in~irrel hernia .... . .... ..... . . ~-

Neurosurgery ......... ... ............." ....... .. . Ota

Opamtions on muscles, mndons, facia, ●nd Cxsrxa._-

Excision of inasrvambml cartilage (WOW dii) —86.4

Suture of skin or mucous merrtimna.-..........

Other gx’amrnant payments

Tonsillectomy with or without adenoidectorny...— _..2l.l-2l2

Dilation and curettage of uterus, diagmadc.... 70.3

lJ~tion and division of fallopian tubas. bilataml. —w

Hyme*omy ........ .......................... .. .. .. . .68.1 -.5

~ramr section.................................... .. ... . . . 77

SeIf+.=v

Cesareensection................ ........... . . . .

Rapair of Iacemtion, obstetrical....---- 762-7G

Dilation and curettage of uterus, diagmetic. 70.3

I.@tion and division of fallopian tubes, bilatard #tn5

Dilation and curettage aftar delivery or abortion 78.1

Other WVMS51tS

Repair of Iacamtion, obstetrical....... ..... . 782-78.3

Dilation and curattaw of uterus, diagmstic.

Hysterectomy ..... ....... ............“... . . ... 133.IAY

s2wwsransection....... ........................ ... ..-. 77

I.@ion and division of fallopian tubes. bilateral —685

No charm

Qsaman saction”..” ............. .. .. ... .. . 77

Hysterectomy ........ .. ......................... . . — =.1-.6

Liqtion and division of fallopian tubes... 68.5

Cholacystectomy ... ................... ...... ...

Dilation and cumttaga after delivery w abortion. — 78.1

Number ofall-listed

sur@es in thousands

76E

24~

214

16f

lyg

llC

37

37

3Z

34

Is

33

28

21J

18

17

70

60

48

45

43

12

11

10

10

8

●4

●2

“2

“2

“2

Percent of all

mch surgeries

n.o

78.6

n.6

75.2

n.1

70.1

71.6

47.9

25.8

20.6

8J3

11.8

11.6

11.4

&4

6.8

9.5

2%

9.8

5.3

28

3.4

2.6

3.7

15.4

18.4

4.6

7.7

14.8

4.4

1.1

E

“1.4

0.8

0.2

0.3

0.4

0.7
6

females admitted for delivery and femalespecific surgery.

Public Programs

Public programs for hospitaI care payments

include Medicare, Medicaid, Workmen’s Compensation, and other forms of government payments. Together these programs were listed as

the principzd expected source of payment for

13.7 million, or 38 percent, of all discharges

(table 1). Of these, 66 percent were Medicare

patients, 21 percent were Medicaid patients, 5

percent benefited from Workmen’s Compensation, and 8 percent received other forms of

government payments. While private insurance

accounted for 54 percent of aIl discharges and

only 45 percent of the total days of care, public

health programs accounted for 38 percent of the

totil discharges and 49 percent of the total days

of care. This dispmity resulted from a greater

average length of stay, 9.4 days, for patients

covered by public programs. The longer average

Iength of stay was itself due in great part to the

fact that .Medicare was the expected source of

payment for 93 percent of dl patients 65 years

of age or over (table 1); as a result, the average

age of patients covered by public programs was

aImost 59 years.

Because of their specific characteristics,

the public programs showed considerable

variability among the most frequent diagnoses

and surgical procedures. The most obvious case

was Workmen’s Compensation, in which the five

most frequent principal diagnostic conditions

refIected injuries, accidents, and physical ailments related to the work environment (table

4). Likewise, the five most frequent surgical

procedures covered by Workmen’s Compensation reflected medical care provided for accidents and injuries (table 5). For Medicare, 3 of

the 5 most frequent principaI dia~oses reflected

the age of the population using this pro-:

chronic ischemic heart disease, cerebrovascuhr

disease, and cataract. Medicare was the principal

expected source of payment for 60, 71, and 70

percent, respectively, of all patients with these

conditions. Also, 2 of the 5 most frequently

performed surgical procedures, extraction of

lens and prostatectomy, reflected the age of the

Medicare population.

The most frequent diagnoses and surgical

procedures for Medicaid and other government

payments did not reflect as specific a class of

patients as Workmen’s Compensation and Medicare did. Rather, those patients covered by Medicaid and other government payments were more

similar to patients covered by private insurance.

Of the 5 most frequent diagnoses for Medicaid

and other government payments, 3 (delivery,

malignant neoplasms, and hypertrophy of

tonsiIs and adenoids) were also among the 5

most frequent diagnoses for both Blue Cross

and other commercial insurance (table 4). AIso,

of the 5 most frequent surgical procedures for

Medicaid and other government payments, 4

were among the 5 most frequent surgeries performed for patients using private insurance.

These were diagnostic dilation and curettage of

uterus, biIateral ligation and division of fallopian

tubes, tonsillectomy with or without adenoidectomy, and hysterectomy (tabIe 5).

In the age by sex distribution in table 1, the

most prominent sex difference in number of

discharges was in the 15-44 years category. For

each expected source of payment except

Workmen’s Compensation and Medicare there

were more than twice as many femaIe as male

discharges in this age category. In the Medicare class, the number of discharges for females

and males was quite similar (114,000 and,

124,000, respectively), and, not unexpectedly,

in the Workmen’s Compensation class the sex

difference was the reverse of that for other

insurance sources: there were 362,000 males and

84,000 femzdes discharged who were in the

1544 years age group.

Self-Pay

More than 6 percent (2.3 miIlion) of all patients expected to pay for their hospital care

principally by themselves. Delivexy, the leading

diagnosis for this group (table 4), was the firstIisted diagnosis for 26 percent of,these patients.

No other diagnosis accounted for more than 14

percent of the total number of discharges in any

source of payment category except for no

charge (as discussed below). The large proportion of self-pay patients admitted for delivexy

largeIy accounts for two other characteristics of

the seIf-pay group: 67 percent were between the
admceda7

ages 15-44 years, and the average length of stay

for them was only 5.2 days (table 2).

No Charge

In 1977, an estimated 91,000 discharges

(table 1) were not charged for approximately

610,000 days of care (table 2); this was only

about two-tenths of 1 percent of all days of care

in short-stay hospitals. When data in this category are broken down into most frequent diagnoses and surgical procedures, the frequencies have relative standard errors greater than

30 percent and consequently are too smzdl to

be considered reliable estimates. The only

exception was the most frequent diagnosis—

delivery with or without mention of complication-for which there were 26,000 no

charge deliveries in 1977 that accounted for

29 percent of all no charge patients.
8

TECHNICAL NOTES

SOURCE OF DATA

The National Hospital Discharge Suxvey encompasses patients discharged from short-stay

noninstitutional hospitals, exclusive of military

and Veterans Administration hospitals, located

in the 50 States and the District of Columbia.

Only hospitals with six beds or more and an

average length of stay Iess than 30 days for aU

patients are included in the survey. Discharges

of newborn infants are excluded from this

report.

The universe of the sumey consisted of

6,965 short-stay hospitals contained in the 1963

Master Facility Inventory of Hospitals and Institutions. New hospitals were sarnpled for inclusion into the sumey in 1972, 1975, and 1977.

In ail, 535 hospitals were sampled in 1977. Of

these hospitak, 68 refused to participate, and

44 were out of scope. The 423 participating

hospitals provided approximately 224,000 medicaI records.

SAMPLE DESIGN

AU hospitals with 1,000 beds or more in the

universe of short-stay hospitah were selected

with certainty in the sampIe. AU hospitals with

fewer than 1,000 beds were stratified, the primary strata being 24 size-by-region classes.

Within each of these 24 primary strat% 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. SampIe hospitals were drawn with

probabilities ranging from certainty for the

largest hospitak to 1 in 40 for the smalIest

hospitals.

Sample discharges were selected within the

hospitals using the daily Ming sheet of discharges as the sampIing fi-ame. 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.

SAMPLING ERRORS, NONRESPONSE,

AND DATA EDITS

Since the estimates for this report are based

on a sample rather than the entire universe, they

are subject to sampling variability. The relative

standard errors presented in table I are obtained

by dividing the standard error of the estimate by

the estimate itself and are expressed as a percent

of the estimate.

About 8.5 percent of the discharges sampled

for the 1977 NHDS did not have information

concerning source of payment on the face sheet

of the medical record. Therefore, all frequency

estimates in this report have been adjusted for

non response by assuming that non responses are

distributed among the principal expected

sources of payment in the same proportions

as responses are. However, the ratio estimates

of average length of stay and average age in

tables 1 and 5 do not incorporate nonresponse

data

There were several edits performed on the

raw data When a principal expected source of

payment was not indicated, but a single expected

source of payment was listed as a secondary

source of payment, the indicated secondary

source of payment was assumed to be the

principal expected source of payment. When

Workmen’s Compensation was listed in conjunction with other insurance sources, Workmen’s

Compensation was taken as the principal

expected source of payment; and when Medicare

was Iisted in conjunction with other insurance

sources (except Workmen’s Compensation),

Table 1. Relative standard errors of estimates, by source of data

First-listed diagnosis and

number of discharges

of payment ex- orslv

Cept self-pay

I,ooo...............

Io,ooo .............

1W,ooo ...........

1,1300,000 ........

10,000,000 ......

100, 000,000 ....

160,000,000 ....

35.0

19.5

9.2

6.2

3.6

. . .

. . .

1

27.4

15.2

13.6

. . .

. . .

All-listed

sur~ries

21.8

8.1

4.0

. . .

. . .

Days of

care

. . .

. . .

16.9

10.1

6.3

4.0

3.7
ackmeda9

Medicare was taken as the principal expected

source of payment.

DIAGNOSTIC AND SU.RGICAL CATEGORIES

The most frequent diagnostic and surgicaI

categories in this report come from a grouping

scheme devised by NHDS for reporting purposes.s *4 For diagnoses, these categories are subsets of the 17 major diagnostic classes of the

Eighth Revtiion In.ternati”onalCksification of

Direases, Adapted for Use in the United States5

(ICDA-8) and were developed to reduce the detail of ICDA-8 while retaining specificity of conditions. For this report, two changes in this

3National Center for Health Statistics: Inpatient utilization of short-stay hospitals by diagnosis, United

States, 1974, by L. S. Glickman. Vital and Health Statk

tiCS.!&k I>No. 30. DHEW Pub. NO. (HRA) 77-1783.

Public HeaIth Sewice. Washington. U.S. Government

Printing Office, July 1977.

4National Center for Health Statistics: Surgical Operations in shost-stay hospitals, United States, 1975, by A.

L Ranofsky. VitalandHealthStatistics.Series13.-No.

34. DHEW Pub. No. (PHS) 78-1785. Public HeaItb

Scmice. Washington. U.S. Government Printing Office,

July 1977.

5NationaI Center for Health Statistics: Eighth Revision Intemationul Clw”ficatiora of Diseases, Adapted

for Use in the United States. (PHS) Pub. No. 1693.

Public Health Service. Washington- U.S. Government

Printing Office, 1967.

grouping scheme were made: 1. deliveries without mention of complication (ICDA-8 code

650) and deliveries with mention of complication (ICDA-8 codes 651-661) were combined;

and 2. neoplasms were categorized as malignant

or benign without regard to site. For surgical

procedures the categories used are subsets of the

first 16 major surgical classes in ICDA-8

(biopsies are excluded). These surgical groups

represent single surgical procedures or groups of

associated surgical procedures that are performed

frequendy. In both diagnostic and surgical

recoding schemes there are “other” categories

that group diagnoses or surgeries into catch-all

groups (e.g., “other abdominal surge~”). These

categories were not used in determining the five

most frequent diagnoses or surgeries.

DEFINITIONS

First-lkted diagnosis.-The coded diagnosis

identified as the principal diagnosis or eke Iisted

first on the face sheet of the medical record. The

number of first-listed diagnoses is equivalent to

the number of discharges.

A1l-Ested operations. -AH coded operations

Iisted in positions 1-3 on the face sheet of the

rne&lcal record exciusive of certain obstetrical

procedures, diagnostic. endoscopy and radiography, radiotherapy, and certain other treatments

not generaIIy considered as surgery.
10

SYMBOLS

Data not available —. . .

Catego~ not applicable . . .

Quantity zero .

Quantity more.than Obut less than 0.05— 0.0

F@re does not meet standards of

rcliabiMy or precision *
FROM VITAL & HE!ALTH STA TtSTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH . Public Health Serwce

AND HUMAN SERVICES Office of Health Research. Statistics.and Technology Number 63 ● November 3, 1980

OffIce Visits for Male Genitourinary Conditions:

National Ambulatoy Medical Care Survey:

United States, 1977-78’

This report combines estimates from the

1977 and 1978 National Ambulatory MedicaI

Care Sumeys to describe office visits made by

men who, over the 2-year period, sought treatment for problems of the genitourinary system.

Conducted annually by the National Center for

Health Statistics, the National Ambulatory

Medical Care Survey (NAMCS) is a sample

survey designed to explore the provision and

utilization of ambulatory care in the offices of

non-Federal, office-based physicians. (See the

‘Technical Notes” at the end of this report for

information on the survey design and terminology.) Because the statistics used in this report

are based on a sample rather than on the entire

universe of office-based physicians, they are

estimates only and are subject to sampling

variability. Guidelines for judging the precision

of the estimates may be found in the “TechnicaI

Notes.” A premonitory note: any visit estimate

that is under 340,000, or its percentage equivalent, is preceded by an asterisk, signifying that it

exceeds a relative standard error of 30 percent.

A genitouriraary virit is an office visit for

which the principaI diagnosis was a condition

ekmified in the major diagnostic group

“Diseases of the Genitourinary System” (diagnostic codes 580-629), according to the Eighth

Revision International Classification of Diseases,

Adapted for Use in the United States

lW report waspreparedby Hugo Koch, Division

of Health Resources UtilizationStatistics.

(ICDA-8).2 Genitourinary visits are divided

into two subgroups: a un”na~ visit, which is

defined as a visit for which the principal

diagnosis was a disease of the urinary system

(ICDA subgroup 580-599), and a genital visit,

which is defined as avisit for which the principal

diagnosis was one of the conditions listed in the

ICDA code range 600-629.

DATA HIGHLIGHTS

Over the 2-year span 1977-78, the mzde visit

rate for genitourinary problems was estimated at

76 office visits per year for every 1,000 men in

the population. As shown in tables 1 and 2,

supplemented by figures 1 and 2, the genitourinary visit rate for men was modest compared

with the corresponding visit rate for women. At

an estimated 254 office visitsper year per 1,000

women in the population, the femaie visit rate

was over three times as great as the rate for

males, chiefly due to the dramatic difference

between the sexes in the visit rates for genital

disorders. For genital problems, which unlike

urinary problems, are sex-speafic, the visit rate

for women was 176 visits per year per 1,000 as

opposed to 46 visits per year per 1,000 for men.

2NaaonaI Center for HcaIth’-Statiatics: .??iglst~ Z?etin International Cks.@cation of Diseases, Adapted

for Use z%the United States. PHS Pub. No, 1693. Public

Health Service. Washington. U.S. Government Printing

Office, 1967.
2

The male genitourinary visit rate increased

directly and steeply with advancing age (table 2

and figure 2). Male patients 65 years of age and

over made 8 times as many urinary visits and 11

times as many genital visits as those under 25

years of age did.

Wits made for genital ailments by men

outnumbered visits made for urinary problems

in a ratio of about 3 to 2. Note in table 3 that

the prostate is the organ requiring the most

office treatment. The conditions of hyperplasia

and prostatitis together account for 40 percent

of all male genitounnary visits.

In a 1978 study of the national prevalence

of urinary disease, women showed a higher rate

for almost all urinary ailments than men did

(36.4 urinary conditions per 1,000 women as

opposed to 14.6 urinary conditions per 1,000

men). Only with calcdus of the kidney and

ureter was the prevalence among men (4.7 per

1,000) higher than among women (3.4 per

1,000 ).3 The NAMCS findings in table 4 show

the impact of prevalence on one treatment

setting—the doctor’s office. These findings suggest an average of about 2 office visits per year

for every person who suffered from a urinary

disease and faithfully reflect the female-male

differences found in the prevalence study.

3Unpublished findings from the Health Interview

Survey, 1978, a household survey conducted yearly by

the National Center for Health Statistics.

Table 1. Number of all office visits and of genitourinary visits

noninstitutionelized population, by sax of patiant and pril

i

Both sexes

Principal diagnostic condition and Number Number of

ICDA codesl of visits visits per

in year per 1,000

thousands population

All conditions, all visits .......... 1,154,550 2,727

Diseases of the genitourina~ system ............560-628 I 71,224 I 168 ,

1

Diseases of the urinary I

system ..... ...............................58O-599 23,867 56

Dkaases of the genital

system ................. ....... ...........600-629 47357 112

The majority (52 percent) of all male genitourin~ visits were made to an office-based

urologist (table 5). Men were especially prone to

visit this specialist when the y suffered from a

genital ailment. It would be shortsighted, however, to underestimate the role played by the

primary-care physician. Table 5 shows that

nearly one-half of the visits by men for urinary

ailments were made to physicians in the

primary-care specialties of general and family

practice and internal medicine.

When the male genitourinary ailment was a

new condition (in about 1 of every 3 visits), it

resulted in roughly 2 return visits during the

course of a year (table 6). This finding is

compatible with the ea.dier statistic derived from

prevalence data. Referral of male patients was

more than twice as common for genital disorders

than it was for urinary disorders. The direction

of this patient flow (from primary-care physician to urologist) underscores the prominence of

this secondary-care provider in the treatment of

male genital disease.

The NAMCS makes it possible to identify

the patient’s symptoms that are associated with

the doctor’s diagnosis. For male genitourinary

visits, the leading 10 presenting symptoms in

order of frequency were:

1. Frequency and urgency of urination.

2. Painful urination.

nd vkit rate per year per 1,000 members of the civilian

ipel diagnostic condition: United States, 1977-78

Male Female

Numtmr Number of Number Number of

of visits visits per of visits visits par

in year per 1,000 in year per 1,000

thousands population thousands population

460,119 2,252 694,431 3,170

15583 76 55,630 254

6,141 30 17,725 81

I

29,452 I

46

I

37,805 173

lBased on Eighth Revision Interrratiorml Cla@ication of Diseases, Adapted for Use’in the United States (lCDA-8]. z~ndud=~ .312,0M VM5 for breast dkease.
admce&a3

3.

4.

5.

6.

7.

8.

9.

10.

Other urinary dysfunctions (e.g., retention, hesitancy, large volume).

Symptoms of the scrotum and testes

(e.g., pain, swelling, inflammation,

growths, itching).

Prostate symptoms (e.g., sweIIiig, infection).

Abnormalities of urine (e.g., presence of

blood or pus, unusual color or odor).

Penile discharge.

Back symptoms.

Penis symptoms (e.g., pain, inflammation, sweIling, growths).

Pain, site not referable to a srsecific

bod~~ system (e.g., side or groin pin).

Table 7 explores the diagnostic procedures

that were brought to bear on the presenting

symptoms of male genitourinary disease. Predictably, the key diagnostic tooI (appIied in 2 of

every 3 visits) was the laboratory test. A general

examination was the exception, as it is throughout all male ambulatory care. The frequency of

blood pressure checks during male genitourinary

visits (22 percent) is primarily due to their

Table 2. Numbar of urinary and genital visits and visit rate par

year per 1,000 members of the civilian non institutionalized

population. by sex and age of patient: United States,

1977-78

I

Number in thousands

All ages . .... 6,141 I 17,725 [ 29,140 I 37$05

I

Number per yaar per 1,000 population

Under 25 years ‘eta’-”-””””-”m ...........

2544 years ................

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

65 years end over .......

1Bud on Eighth Revision Inremationa2 cm=ifiims of

Diseases, Adapted for Use in the United Statrs (ICDA-8). 2Exc]ud~$ .312,000 visits for bre=t disezse.

Figure1. PERCENT DISTRIBUTION OF ALL GENITOURINARY

VISITS,l BY SEX OF PATIENT ANO GENITOURINARY SUBGROUP UNITED STATES.1977-78

F@Ire 2 NUMBER OF URINARY AND GENITAL VISITS PER

YEAR PER 1,000 MEMBERS OF THE CIVILIAN NONIN~lTUTIONALIZED POPULATION, BY SEX OF PATlENT: UNITED

=ATES, 1977-7S

...... m ~ “h

+

IN

i .’., —-mtiu

i

-<. --- I%llA Unnuy Wmm

;

5

\

i

, --—- hm8kg9nlrdviutl

\,

i \

i ;

i i,

i 1,

i \

! i

f’ ;,

i \

i i

i

i

..-”

~~””

..-

.“’a

,/’

/’

,/

o~

65 d

25 M

AGE OF PATIENT IN YEARS
4

Table 3. Number and percent distribution of male genitourinary visits and visit rate per year per 1,000 male members of the civilian

noninstitutional ized population, by principal diagnostic condition associated with visit: United States, 1977-78

Principal diagnostic condition associated with male genitourinary visit and

ICDA codesl

All male genitourinary diseases .. ..... ............................................. ..............58G6O7

All diseases, male urinary system ............ .... .......... ...... .................... ................ ...... .....5~.599

Diseases of the kidney and ureter .......................... .................... ...................... .....5~593

calculus of kidney and ureter ......................... ..................... ............ ............ ..........592

Residual: nephritis and nephrosis; infections of kidney; hydronephrosis;

other diseases of kidney and urmer .................................... ...... ...... ......................... .

Diseases of the bladder and urethra and other diseases of the urinary tract ... .. .....584-588

Cystitis ................................................ ........... ............ ........ ........ .............. ............595

Urethritis (nontmnereal )............. .. ........ ... ........ .................... ................... . ............597

Stricture of urethra ..... .............. .............. ..............................................................598

Residual: calculus; other diseases of the bladder and urinary tract .. ............... .. ........

All diseases, male genital system ............. .................... ..................... ..... ....................6OMO7

Hyperpiasia of prostate ....................... ........................... ...... ................ ................6OO

Prostatitis ........................ .................... .............. .................... ..................... ...........6Ol

Orchitis and epiddymitis .................................. .................... ............. ........ ..........5M

Sterility ............................. ......... .. ....... ..................................................................606

Residual: othar prostate disaase: hydrocele; redundant prepuce and

phimosis; other diseases of male genital or~ns ................................................. .......

Male genitourinar-y visits

Number

in

thousands

215.281

6,141

1,908

743

1,166

4,232

782

803

684

1953

9,140

2,354

3,810

338

1,859

I Number

Percent par year

distribution per 1,000

mele

=

population

100.0 75

40.2 30

12.5 9

4.8 4

7.6

27.7

6

21

5.1 4

5.3 4

4.5 3

12.8 10

59.8 I 45

15.4 12

24.9 19

5.1 4

2.2 2

12.2 I

9

1Based on Eighth Revision In ternatiorsal CJw”ficasion of Diseases. Adapted for Use in the United states (lCDA-S).

z~xcludes ● 3 I2,000 visits for breast disease.

Table 4. Number of urinary visits and visit rate per year per 1,000 members of the civilian noninstitutionalized population, by sex of

patient and principal diagnostic condition associated with visit: United States. 1977-78

Male Female

Principal diagnostic condition associated with urinary visit and Number Number of Number Number of

ICDA codesl of visits visits par of visits visits per

in year per in year per

thousands 1,000 thousands 1,000

population population

All diseases, urinary system ......... .. ...... .. ................................58@599 6,141 30 17,725 81

Diseases of the kidney and ureter .................................. ................... .....58@593 1,909 9 2,615 12

Calculus of kidney and uretar ............................................ ...... .... .... ........592 743 4 445 2

Residual: nephritis and nephrosis; infections of kidney;

hydronephrosis; other diseases of kidney and ureter ....... .................... ........ 1,156 4 2,170 10

Diseases of the bladder and urethra and other diseases of the

urinary tract ................................. ............... .... ............. ........... ..........584-599 4,232 21 15,111 88

Cystitis ........... . ..... ....... .......... .............. ...... ...........................................595 782 4 6,607 30

Urethritis (nonvenereal) ........................ .. ......................................... ...... ..597 803 4 1,055 5

Stricture of uretira . ....................................................................... .........598 694 3 1,777 8

Residual: calculus; other dkeases of the bladder

and urinary tram ...................................... .............................. ............. ........ 1 #853 10 5,672 26

1Based on Eighth Revision International C7m”fication of Diseases, Adapted for Use in the United Srares (I CDA-8).
dAnceaa5

Table 5. Number and percent distribution of male 9-WitourinarY visits (with comPonent subgroups), W specialty of physician visited:

United States, 1977-78

Physician specialty

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

TotaI ............ ............ .... ........ ...................... .. ............. .......... ............................ .... ........

Male genitourinary visits

ExSIS!K

Number in thousands

15,281 I I 6,141 [ 29,140

Percent distribution

100.0 I I 100.0 I 100.0

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

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

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

All other specialties ..............................................................................................................

lBmed on Eighth Revision International Chr.rsij7catfon of Diseases, Adapted for Use in the United States (ICDA.8).

2Exclude~ ●31 2,000 visits for breast disc==

3Chieft~ general surgery and Pediatrics.

51.6 36.0

28.3 35.8

9.0 12.6

11.1 15.6

62.2

23.2

6.6

8.0

Table 6. Number and percent distribution of all male visitsend of male genitourina~ visits (with component subgroups), by prior-visit

statusand referral statusof patient: Unitad States, 1977-78

Prior-visit and referral status

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

Prior-visit status

New patient (a) ... ................................................................ ....... ................ .........

Old patient ................................................................................. ............. .... .... ......

New problem (b) ..................................... .................. ................... ......... . .........

Old problem (c)............................................................................. ............. .......

New problem visit (a+ b) ... .. .. ...... ...................... .......... ................. .. .......... ...........

Return visit (c) .............................. .......................................... ................................

Referral status

AH

male

visits

Male genitourinary visits

I IIUrinaw

Total visits

(560-599}1

Genital

visits

(600-607)]

Number in thousands

460,119 [ j 15,281 I j 6,141 I 29,140

Percentdistribution

1 ‘“

700.0 100.0 100.0

16.4 17.6 13.8

83.6 82.3 66.3

24.9 16.9 22.1

58.7 65.4 64.2

41.3 34.5 35.8

58.7 65.4 64.2

●5.3

%=: 9~6 84.7

Referred by another physician ...... ...................." ... ......H. ... . . .. .... . ... ... ..........._

Not referred by another physician .. . . .. .. . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . ..H . . . . . . . . . . . .

lB-d on Eighth Rev&ion In rernational C7ar.djlcationof D&uses, Adapted for U= in theUnitid States (ICDA-8).

2Exc1udes ●3 12,000 visim for breast disease.

100.0

20.2

78.8

13.5

66.3

33.7

66.3

12.1

87.9
6

relative rarity during genital visits. Symptoms of

urinary d]sease, on the other hand, are much

more likely to prompt a measurement of blood

pressure, probably because a disorder of the

urinary system can be more directly influenced

by a circulatory malfunction. For example, with

a suspected kidney disorder blood pressures

were taken in 40 percent of the visits.

Table 7 also shows that physicians judged

the average male urinary disorder to be

markedly more serious in prognosis than the

average male genital disorder.

The data in table 8 show that drug therapy

was the treatment most frequently provided or

ordered for male genitourinary conditions. Its

use in 58 percent of male genitourinary visits

exceeded its average application in all male

office-based care. Data on disposition in the

same table demonstrate that two-thirds of male

genitourinary visits ended with the direction to

return at a specified time. This directive is

evidence of a need for continuing care that

somewhat exceeds the average experience for

the entire range of male visits. Also noteworthy

is the finding that the frequency of hospital

admission (in 5 percent of the visits), a relatively

rare form of deposition for male genitourinary

conditions, was still more than double the

proportion found for the entire group of male

visits.

Data on the duration of the visit reveal that

the average personal encounter between the

physician and the male patient with a genitourinary disease lasted about 14 minutes, not

markedly different from the 15-minute average

calculated for all male visits.

An additional 1,031,223 visits for which the

principal dia~osis was a malignant neoplasm of

the prostate were not included in the diagnostic

scope of this report. An estimated 85 percent of

these visits were made by men 65 years of age

and over resulting in a visit rate for this

condition of 47 per 1,000 members of the male

population.

Table 7. Number and percent distribution of all male visits and of male genitourinery visits (with component subgroups), by selected

diagnostic procedures and seriousness of condition: United States, 1977-78

Selected diagnostic procedures and seriousness of condition

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

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

Selected diagnostic procedures

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

Limited examination ................................................. ...... ...... ........ ................ ............

General examination ...... ...................... .......... .. ........ .... .................. ...... ...... .. ........ ....

Clinical lab t~ ........ ............ ..................... ............................................ ...... ..............

X-ray ......................................................... ......................... ............. ....................... ...

Endoscopy .......... ................................................................................. ...... ....... .. ....

Blood P17XSUre chink .................................... .......... .......... ............ .............. ...............

Seriousness of condition

Serious and very serious . ...... ...................... .............................. ...............................

S1ightly serious ........................................................................... .............. .......... . ....

Not serious .................................................. ................ ....................... .......................

m

Number in thousands

460,119 I ] 15,281 I I 6,141 I 29,140

100.0

11.4

59.0

21.7

18.2

9.9

1.1

27.0

21.0

32.9

46.1

Percent distribution

100.0 I

:

6.4

58.1

18.9

62.1

8.9

3.4

22.2

18.7

38.1

43.2

100.0

7.1

59.2

18.6

63.6

.30.3

●2.2

30.7

28.3

36.9

33.8

100.0

6.0

57.3

19.2

61.0

7.9

4.1

16.6

11.6

38.9

49.5

1Based on Eighth Revision International Classification of Diseases, Adapted for Use in the United states (ICDA-8). z~xclude~ ●31 2,000 vkIt5 for breast disease.

3w~l not add to I CIO.Opercent because more than 1 procedure w= po=ible-
ackmeMa7

Table 8. Number and percent distribution gf all male visits and of male genitourinary visits (with component subgroups), bV selected

therapeutic services ordered or provided and selected dispositions of visiti United States, 1977-78

Selected therapeutic services and dispositions of visit

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

Selected therapeutic services3

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

Drugs (prescription or nonprescription) .... ..... .............. .............. ........................... ...

Oiet counseling ... ........ .. .......... .... .... .. .... ................ .... . ...... ...... .. ...... .................... .......

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

Physiotherapy ...... .................. ........ ...... .............. ................ .......................................

Office surg~4 ...... .................. .... ................................ ............... ...............................

Selected dispositions of visit3

No folIovvup ............................................. ............... .................... .................. .......

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

Raturn if neaded “ .......... .. ...... ................................ ... . ........................... ....... ....... .. .

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

Referred to other physician ...... ............. ............. ......... ......... ............." ......" ............

Admitted to hospital .................... ........." .......... ............. .. .. ........ ........." ...... ......."

Number in thousands

460.119 I I 15,2S1 I I 6.141 I 29,140

Percent distribution

100.0

18.9

51.2

6.3

19.6

4.0

9.4

13.2

57.6

23.1

3.3

26

2.2

1Oo.c

19.7

67.7

3.6

21 .E

7.6

7.7

4.8

65.9

19.9

3.8

4.5

4,6

100.0

13.9

61.1

6.3

23.6

●O.7

12.6

●2.8

%

5.8

4.0

4.1

100.0

23.5

55.4

●1 .8

20.5

12.2

4.3

6.1

65.?

18.9

“2.5

4.9

4.9

lBased on Eighth Rsvision International CLts.@batfon of Disease% Adapted for Lke in the Uni=d States (XCDA-8). 2Ex~lude~ 93 IZ,OOO visits for breast di~~.

3~1 not add to 1000 percent ~cau~ more than 1 service or more than 1 disposition of ri~t w= -ib[e.

4hy swtical ~rw=&e ~efio~ed * the office dufig this viait, including suture of wounds; reduction of fractirewwli-tion or

removal of casts: incision and dmining of abscesses: and ail irrigations, aspirations, ddatations, and excisions.
8

TECHNICAL NOTES

SOURCE OF DATA AND SAMPLE DESIGN

The information presented in this report is

based on data coIlected in the National Ambulatory Medical Care Survey (NAMCS) during 1977

and 1978. The target universe of NAMCS

encompasses office visits within the conterrninous United States made by ambulatory

patients to nonfederally employed physiaans

who are principally engaged in office practice.

The National Opinion Research Center, under

contract to the National Center for Health

Statistics, was responsible for the survey’s field

operations.

The NAMCS utilizes a multistage probability

design that involves samples of primary sampling

units (PSU’S), physicians’ practices within PSU’S,

and patient visits within practices. For 1977-78

a sample of 6,007 non-Federal, office-based

physicians was selected from master files maintained by the American Medical Association and

American Osteopathic Association. The physician response rate for 1977-78 was 75.1 percent.

Sampled physicians were asked to complete

Patient Records for a systematic random sample

of office visits taking place within their practice

during a randomly assigned weekly reporting

period. During 1977-78, 98,335 Patient Records

were completed by sampled physicians, of which

1,567 involved a male genitourinary disease as

the principal diagnosis.

The standard errors for estimated percentages of

visits are shown in tables III and IV.

Estimates of office visits have been rounded

to the nearest thousand. For this reason detailed

figures within tables do not always add to totals.

Percents were calculated on the basis of original,

unrounded figures and will not necessarily agree

precisely with percents calculated from rounded

dat~

labia 1. Approximate relatiw standard errors of estimated

number of office visits based on alI physician specialtie~

NAMC3, 1977-78

Estimated numtsx of office

visits in thousands

Relatiw

standard

error in

percent

l.m ...................." ........... ........" .........................

2.m ....................................... ...............................

5.0m ..................... ............. ..... .............................

60;OO0................. ................................................ .

loo.m ...................................................................

5oo.m .............." ...................................?..............

24.9

17.7

12.7

8.3

6.2

4.8

3.6

3.3

3.0

Example of use of table: An aggregate of 3S,000,000 visits has s

relative standard error of 4.3 percent or a standard error of

1,505,000 visits (4.3 percent of 35,000,000).

Table II. Approximate relatiw standard errors of estimated

numk of offtce visits based on an individual physician

speciairy: NAMCS, 1977.78

SAMPLE ERRORS AND

ROUNDING OF NUMBERS

The standard error is primarily 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 of the estimate by the estimate

itself and is expressed as a percentage of the

estimate. Relative standard errors of selected

aggregate statistics are shown in tables I and II.

Relatiw

Estimated number of offica standard

visits in thousands error in

percent

5oo.......................................................................... 27.0

1.om ....................................................................... 19.6

2.wo" ..................................................................... 14.5

5.m ....................................................................... 70,3

lo.m ..................................................................... 8.5

m.wo .......................e ............................................ 7.4

w.m ..................................................................... 6.7

loo.m ................................................................... 6.4

mo.m..; ................................................................ 6.3

Example of use of fable: An aggregate of 7,500,000 visits has a

relative standard erro? of 9.4 percent or a standard error of

705,000 visits (9.4 percent of 7,500,000).
damedabg

Table II 1. Approximate standard errors of percent of estimated numbers of office visits based on all physician specialties: NAMCS,

1977-78

Base of percent

Estimated percent

(number of office visits in thousands) 1 or 99 5 or 95 100r80 20 or 80 30 or 70 50

500 ..... ............. ........... ....................... ...................................... ...... ......... 2.5

1,000

5.4 7.4 9.9 11.4 12.4

...... ..... ..... ........................................................ .. .. ........ . .............. .. 1.7 3.8 5.3 7.0 8.0 8.8

2,000 ................ ............ .... ....... .......... . ............... .... .... .. ......... ... .. ...... .. 1.2

5,000

2.7 3.7 6.2

......... .................. ............ ........................................... ....... .......... .. 0.8 1.7

10,000

2.3 E z 3.9

............... .. .... .............................. ..................................... ..... ...... . 0.6 1.2

20,000

1.7 2.2 2.5 2.8

............ .... ....... ................................. .. ................... ...... ................. 0.4 0.9

50,000

1.2 1.6 1.8 2.0

...... .. ... ............ .................... . ..................... ................. .............. .. . 0.2 0.5 0.7 1.0

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

1.1 1.2

0.4

500,000

0.5 0.7 0.8 0.9

....... .......... .......... ...... .......... .......... ................................ ........ .. ... 0.1 0.2 0.2 0.3 0.4 0.4

Example of use of table: An estimate of 20 percent based on an aggregate of 15,000,000 visits has a standard error of 1.9 percent or a

relative standard error of 9..5 percent (1.9 percent + 20 percent).

Table IV. Approximate standard errors of percent of estimated numbers of office visits based on an individual physician specialty:

NAMCS, 1977-78

Base of percent

Estimated parcent

(number of office visits in thousands) 1 or 99 5 or 95 100r90 20 or 80 30 or 70 50

500 .............. ....... . ......................................................... .. ...... .... .............

1,000

2.6 5.7 10.5 12.1 13.1

.............. ...................... ..... ................... ................. .. .... ............ ......

2,000

1.9 4.1 E 7.4 8.5 9.3

...... ...... ..... .... ..... .... ..... ................. ...... .............. ................ ............

5,000

1.3 2.9 3.8 6.6

................ .......... . ... ............................... .....................” ................. 0.8

10.000

1.8 2.5 :: ::: 4.2

............... ......... .........”.... .... . ........ . . ......... ...... ........ .......... ....... .

20,000

0.6 1.3 1.8 2.4 2.7 2.9

..... ..... ...................... . ........... ... ........... ..... ........ ....................... ..

50,0U0

0.4 0.9 1.2 1.7 1.9 2.1

............ ............... ..... ................ ..... ........................... ..... ............. 0.3

Ioorooo

0.6 0.8 1.1 1.2 1.3

.................. ............. .... .................. ............... ..................... .......

200,000

0.2 0.4 0.6 0.7 0.9 0.9

...... .... ................ ..... ..... . ... ............. ................ ........ .. ............. .... 0.1 0.3 0.4 0.5 0.6 0.7

Exarnp& of use of ttrbfe: An estimate of 50 percent based on an aggregate of 1S,000,000 visits has a standard error of 2.S percent or a

relative standard error of s percent (2.s percent + so percent).

DEFINITIONS

Ambulatory patient.–b ambulatory patient is an individual presenting himsdf for

personaI health services who is neither bedridden

nor currently admitted to any heaIth care institution on the premises.

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

practice. Responsibility over time for patient

care and pro fessionaI semices rendered there

generdy resides with the individual physician

rather than an institution.

Visit.–A visit is a direct personal exchange

between an ambulatory patient and a physician

or a staff member working under the physician’s

supemision for seeking care and rendering heahh

services.

l%ym-c~az-A physician is a duiy licensed

doctor of medicine (M.D.) or doctor of osteopathy (D.O.) currently in an office-based practice who spends time in caring for ambulatory

patients. Excluded from NAMCS are physicians

who are hospital based; physicians who specialize in anesthesioIogy, pathology, or radioIogy;

physicians who are federzdlyempIoyed; physiaans who treat oniy institutionalized patients;

physiaans empIoyed full time by an institution;

and physicians who spend no time seeing ambulatory patients.
10

SYMBOLS

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

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

Quantity zero––-—–—---——---- .

Quantity more than O but less than 0.05— 0.0

Figure does not meet standards of

reliability or preeision- — *
FROM VITAL & HEALTH STA TISTiCS OF THE NATIONAL CENTEi3 FOR HEALTH STATISTICS

u.S. DEPARTMENT OF HEALTH s public Health Serv’ce

AND HUMAN SERVICES .Office of Health Research, Statistics. and Technology . November 4, 1980

Health Practices Among Adults: United States, 1977a

A study of the relationship between personal

health practices and health consequences was

conducted in Alameda County, California, in

1965 by the Human Population Laborato~ of

the California State Department of Public

Health. 1 Findings indicated a positive relationship between good health practices and physical

health status..+ 9-year followup study, examining

mortality rates among the original sample of

.6,928 adults, showed a strong inverse relationship between the total number of good health

@actices reported in 1965 and age-specific

,mortalit y rates.2 Seven good health practices

were identified in this study: (1) sleeping an

average of 7-8 hours a night; (2) eating breakfast almost evexy day; (3) seldom, if ever, eating

snacks; (4) controlling one’s weight (weighing

within 5 percent under and 19.9 percent over

the desirable standard weight, if maIe, or

weighing not more than 9.9 percent over the

desirable standard weight, if femaie); (5) exercising: engaging in active sports, swimming,

taking long walks, gardening, or doing physicaI

exercises; (6) limiting aIcohol consumption to

less than five drinks at one sitting; and (7) never

having smoked cigarettes. Persons reporting six

or seven of these health practices were shown

to have better health status and to live longer

than persons reporting less than four of them.

In 1977 the PJational Health Intemiew Survey

included a supplement designed to obtain data

on the prevalence of seven preventive health

practices among the noninstitutionalized IJ.S.

poptdation aged 20 years and over. The quesaThis report was prepared by Charlotte .4. Schoenbom,

M.P. H., and Kathleen M. Danchik, Division of Analysis.

tions on health practices, modified somewhat

from those of the Alameda County study,

included (1) average number of hours of sleep

per night; (2) frequency of eating breakfast;

(3) frequency of eating snacks; (4) physicaI

activity level relative to one’s peers; (5) frequency and quantity of alcohol consumption;

(6) smoking status (never smoked, former

smoker, or current smoker) and amount smoked;

and (7) body weight as compared with desirable

body weight (weight for height). This report

presents data on persons 20 years of age and

over for these seven practices, by sex, race or

ethnicity, age, income, and education.

SLEEPiNG

Data on sleeping practices are presented in

table 1. Approximately two-thirds of the respondents reported getting an average of 7-8

hours of sleep a night, with about 2 in 10

reporting 6 hours of sleep or less. .%-early identical proportions of men and women reported

sleeping 7-8 hours a night. Proportionately more

men reported sleeping 6 hours or less, while

proportionately more women reported sleeping

9 hours or more.

S1ight differences in sleeping habits were

found among white, black, and Hispanic respondents. About 68 percent of white respondents reported sleeping 7-8 hours a night, in

contrast to about 61 percent of Hispanic respondents and 56 percent of black respondents.

EATING BREAKFAST

Estimates of breakfast-eating habits of the

U.S. population are shown in table 2. A majority

of persons (58.1 percent) reported eating breakfast every day, about 16 percent reported eating
2 akmedah

Table 1. Total population 20 years of age”and over and percent dkri bution of persons 20 years of age and over by average number of

hours of sleap a night, according to selected characteristics: Unitad States. 1977

Characteristic

All persons 20 years of age and over ......

sex

Wle . ...... .......................... ......................................

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

Race or ethnicitv

White ~lack .. ..... .. ......................... .. .......... ....... .... ........... .

.............. ...................... ................ ..................

His~nic .................................................................

Age —

2034 years .... .. .. ... .................. .............. ...... ..... ....

36-44 years ...." ................. ................... ........ .........

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

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

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

Income

Less than .$6,000 .......................... ........................

$5,000-$8,999 ....... ........... ............................ . . ..

sl 0,000-$14,999 ........................... ........................

$1 5.000624.%9 ............. ... ........... . ....... .... .......

$25.000 or mme ............. ... ............... ......... . .......

Education of individual

k than 12 years ..................... .... . ....................

12 yearn ..... ... .. ........ ............................... . ........o.

Mom then 12 ymrs .... .. .... . ... ............................ ...

1!nciudca unknowna.

z~~ludes unknow hours Of SkeP.

Total

population

20 yea= of

IKE and werl

Number in

thousands

139,959

65,798

74,162

108,055

13,544

6,192

51.230

23,106

23,180

20,166

22,266

18,020

25,965

26.564

34,630

21.679

44.430

50?857

42.349

breakfast sometimes, and about 26 percent said

they never eat breakfast. There are almost no

differences in ths practice between men and

women. A pattern emerges, however, with

respect to age. The proportion of peopie eating

breakfast every day increases steadily with

advancing age, from about 42 percent for those

20-34 years of age to about 86 percent for those

65 years and over.

There are also differences in breakfast-eating

habits according to race or ethnicity. About 60

percent of white respondents and about 56 perHours of s(eep

Tota12 6or lass 7 a 9 or more

Percent distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

21.7

23.3

20.4

20.5

28.2

24.5

20.2

21.9

23.0

22.8

22.7

27.0

21.4

21.4

20.8

19.3

25.3

20.8

19.1

27.9

28.8

26.4

28.4

21.2

19.5

28.9

31.2

31.5

25.4

21.2

20.4

24.4

28.8

31.7

33.6

21.3

29.0

33.8

37.8

35.8

39.5

38.2

34.3

41.3

38.2

37.7

36.8

%

35.2

38.6

38.9

37.8

38.0

37.0

38.7

37.7

12.5

11.1

13.7

11.9

16.2

14.7

12.6

9.2

8.8

13.3

18.6

17.3

15.5

10.9

9.7

9.2

16.4

11.5

9.3

cent of Hispanic respondents reported that they

eat breakfa& evezy day, while only 47 percent

of black respondents reported regdar breakfasteating habits. Approximately 26 percent of

black respondents and about 23 percent of

Hispanic respondents reported that they sometimes eat breakfast, in contrast to 14.3 percent

of white respondents. About equaI proportions

of black and white persons reported that they

never eat breakfast (27.8 percent and 25.9

percent, respectively), compared with a smalIer

proportion of Hkpanic persons (21.6 percent).
ackncda3

People in the lower income categories are

relatively more likely to eat breakfast than those

at the higher end of the income spectrum. Approximately 65 percent of those with incomes

of less than $5,000 reported eating breakfast

every day, while only about 53 percent of persons with incomes of $15,000-$24,999 reported

similar behavior. The proportion of persons eating breakfast every day rises slightly in the

highest income category, to approximately 57

percent. The proportion of persons reporting

Table 2. Percent distribution of persons 20 years of age and over

by frequency of eating breakfast, according to selected cheracteristicx United States, 1977

Characteristic

All persons 20

years of age

and over .........

—Sex

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

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

Race or ethnicitv

White ..........................

Black ............... ............

Hispanic ......................

Age —

20-34 years .................

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

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

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

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

Income

Less than $5,000 .........

S5,000-$9,889 ............

$10.000-s7 4,999 ........

$1 5,000-$24,999 ........<

$25,000 or more., .......

Education of

individual

Less then 12 years .......

12 years ......................

More than 12 years ......

Eats breakfast:

Totall Every 8omeday Never

times

II I I

Percent distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

68.1

57.3

58.7

59.8

46.6

55.8

41.6

49.3

61.5

73.1

66.2

64.9

59.6

56.4

53.3

56.5

62.2

54.0

58.2

15.9

15.8

15.9

14.3

25.6

22.6

22.7

18.3

14.1

9.5

5.7

14.8

15.3

16.8

17.2

15.3

14.5

17.1

15.9

26.1

27.0

25.4

25.9

27.8

21.6

35.8

32.4

24.3

17.4

8.0

20.3

25.1

26.8

28.5

28.1

23.3

28.9

25.9

that they sometimes eat breakfast remains

relatively constant across all incom,e groups.

EATING SNACKS

Table 3 shows that among American adults,

approximately 38 percent eat snacks every day,

about 27 percent sometimes snack, and about

35 percent never snack. The practice of eating

between meals, like the practice of eating

breakfast, appears to be reIated to age. The perTable 3. Percent distribution of persons 20 years of age and over

by frequency of eating snacks, according to selected characteristics: Unitad States. 1977

Characteristic

All persons 20

years of age

and over .........

—sex

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

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

Race or ethnicity

White ..........................

black ..........................

Hispanic ......................

Age

20-34 years . .............. ..

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

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

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

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

Income

Less than $5,000 ........

$5,000-$9,988 ........... .

S 0,000-$14,999 ........

$1 5,000-$24,999 ........

$25,000 or more . ..... .

Education of

-

Less than 12 years .... ...

12 yaars .............. ........

More than 12 years ......

Gts snack=

Totell II Every S.3medav Never times

100.

1of.),

1(Y).

100.

1CQ.

1m.

1.00.

100.

100.

100,

100,

100.

100.

100.

100.

100.

100.

100.

100.

Percent distribution

38.0

40.1

36.3

38.4

37.0

34.2

43.2

40.5

36.6

34.6

28.3

33.9

37.2

39.6

40.7

38.6

35.8

39.7

38.2

27.4

25.4

28.9

26.9

28.1

30.6

31.7

29.1

26.4

z2.7

21.1

25.3

27.6

28.8

28.0

26.7

24.9

28.5

28.6

34.7

34.4

34.8

34.7

34.0

35.1

25.1

30.4

37.1

42.7

50.5

40.8

35.3

31.6

31.2

34.7

39.3

31.8

33.3

1 Fxc]udes “finown breakfast-eating habits. lExc]udes unknown snacking habits.

NOTE: See table 1 for population. NOTE: See table 1 for population.
4 acimncedata

cent of persons reporting that they snack

every day declines from about 43 percent of those

aged 20-34 years to about 28 percent of those

65 years of age and over. The proportion of

people reporting that they sometimes eat

snacks simihrly decIines-from approximately 3

in 10 in the youngest group to about 2 in 10

among those 65 years of age and over. Together,

the data on breakfast eating and snacking

indicate that reguIar eating habits (eating breakfast every day and avoiding snacks) are positively associated with age.

PHYSICAL ACTIVITY

The physical activity measure used in the

National Health Interview Sumey (table 4)

provides only a rough approximation of the

level of physical activity in the adult population.

Respondents were asked to rate their own level

of physical activity relative to other persons their

age: more active, about as active, or less active.

About half of the respondents judged their own

activity level to be about the same as that of

their peers, with sIightly less than 4 in 10 saying

they are more active than others. Among women,

54 percent indicated they are about as active as

others their age; about 46 percent of men gave

this response. Proportionately more men than

women (42. 1 percent and 33.3 percent, respectively) reported that they are more active than

their peers. The seIf-perceived level of physical

activity exhibits a positive relationship to income. As income level increases, the percent

of persons who indicated that they are more

active than their peers increases, and the percent

of persons indicating that they are less active

decreases.

ALCOHOL CONSUMPTION

Estimates of the frequency and quantity of

alcohoI consumption are shown in table 5. Respondents were asked: “HOW often do you drink

wine (beer, Iiquor)—never, occasionally, once or

twice a week, or more than twice a week?”

Separate questions were asked for each type of

alcoholic beverage. The data in table 5 reflect

the consumption frequency of the most frequently consumed beverage. Persons who stated

that they drink two or three types of alcohol

once or twice a week may be misclassified in this

analysis. A person who drinks beer twice a week

Table 4. percent distribution of persons 20 years of age and over

by physical activity level relativeto Personsof same age, according to selected characteristics: United States, 1977

Characteristic

All parsons 20

years of age

and over ..........

sex —

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

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

Race or ethnicitv

White ...........................

Black ...........................

Hispanic ................ .......

Age —

20-34 years ..................

3544 years .............._.

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

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

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

Income

Lass than $5,000 .........

$5,000-$9,999 ......... ....

$1O,OCQ-$14,999 .........

$1 5,000-$24,999 .........

$25,000 or more .........

Education of

individual

Lass than 12 years ........

12 years .................... ..

More than 12 years .. ....

Physical activity level

Totall More Same we

activa actwa

1oci.a

I m.a

100.0

100.0

I oo.a

100.0

I 00.0

100.0

100.0

I oo.a

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Percent distribution

37.2

42.1

33.3

38.6

30.2

33.8

33.6

36.2

35.6

37.0

44.7

31.1

34.6

36.8

38.4

44.9

32.2

36.5

43.4

50.5

46.2

54.0

49.9

53.4

51.1

56,2

51,5

52.4

45.9

40.1

47.5

50.4

52.9

52.8

47.3

51.4

52.7

47.2

12.3

11.7

12.7

11.5

16.4

15.2

10.2

10.2

12.0

17.1

15.2

21.5

15.0

10.3

8.9

7.7

16.5

10.8

9.4

l~clud~ unknown physical activitY level.

NOTE: See table 1 for population.

and wine once a week, for example, is classified

here as drinking “once or twice a week,” while

in fact he drinks three times a week. The magnitude of the potential error is smaII, however,

with a maximum possible misclassification of

only about 2Y2 percent of the adults who drink

alcohol.

The data on quantity are based on responses

to the questions: “When you drink wine (beer,

liquor), how many drinks do you have at one

sitting?” and “On any one occasion during the
aclwnceciaa 5

Table 5. Percent distribution of persons 20 years of age and over by frequency of alcohol consumption and percent of persons who drink

alcohol who consumed 5 or more drinks at one sitting in pest year, according to selected characterisucs: Unitad States. 1977

Characteristic

All persons 20 years of age and over ............

Mie .............................................................................

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

Race or ethnicitv

White ..................... ................................. .......... . .........

Black ................ ......... ..... ....... ....... ................ .. ............

Mspanic ............................... ......... ....... ....." .. .. .. ...

Age

20-34 years .. ....................- ........ .. .. . . . ..-.. ----- ..---....”-

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

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

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

66 years and over .................”... ........ . . . .. .. ........... .

I mm me

Less than .s6.mo................. .. . ... ..... . . ..... ......

S6,00N8,999 ..... .... ... ................. .. . . . ....... ............

S 0.000-s14,999 ..... . ................... .... . . ............. ......

w 5,000-S24,999 ..... ............ . ........... .. ......... .. ..... ....

S25,000 or more .... . . ...... ... . ... . ... . . .. ..... .. .....

Education of individual

Lass than 12 yeers .. ........... ..... .... .... .. . . . ......".. .....

12 yam ................. .............................. . ..".." .... .. .. ..-

More than 12 years .. .. ......... .......... .“... -..” . ... . ..... .

Totall

Alcohol consumption

T

Never Occasionally

Percent distribution

100.0

100.0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1m.o

100.0

II

21.5

34.2

26.2

34.1

32.1

18.9

24.5

27.3

35.0

48.6

46.2

34.3

26.4

21.1

14.9

42.1

25.7

17.0

41.9

35.9

46.7

42.7

40.2

43.2

47.3

43.5

40.7

37.7

33.3

35.0

40.9

44.6

45.5

42.5

36.2

45.5

45.0

lor2

times

a week

15.5

20.2

11.8

15.9

15.2

15.3

19.5

17.3

14.8

12.6

8.2

10.3

13.6

16.1

17.1

2Q.7

120

15.6

19.2

3 or

more

times

a week

14.0

22.5

7.3

15.2

10.5

9.4

14.3

14.7

17.2

13.6

9.9

8.5

11.2

129

16.3

21.9

10.7

13.2

18.8

5 or more

drinks

at one

sitting

Percent of

nxsons who

rink alcohol

28.4

43.1

18.5

30.3

26.4

32.2

43.1

33.7

26.7

18.4

7.2

20.4

26.2

32.2

33.4

36.8

22.1

31.1

35.4

l~cItiu alcohol consumption.

NOTE See table 1 for populatiotspast 12 months, did you have five or more casionaIIy. About 16 Percent of American adults

&inks of wine, beer, or liquor?” The data on

quantity reflect the proportion of persons who

had five or more drinks at any one sitting during

the past 12 months. No distinction can be made

between the habitual heavy drinker and the

occasional heavy drinker.

Approximately 3 in 10 adults reported that

they never drink any type of alcoholic beverage,

and about 4 in 10 reported drinking only ocsaid they drink wine, beer, or liquor an average

of once or twice a week, and the remaining 14

percent drink alcohol an average of three or

more times a week. Among respondents who

drink alcohoI, about 3 in 10 indicated that they

had consumed five or more drinks at a sitting

at least once during the past 12 months.

Men and women exhibit different patterns

of aicohoI consumption. .%greater proportion of
6

women reported that they never drink (34.2

percent compared with 21.5 percent of men) or

only drink occasionally (46.7 percent compared

with 35.9 percent of men). While less than 2 in

10 women reported that they drink at least once

a week on a regular basis, more than 4 in 10 men

reported this behavior. Similarly, among men

and women who reported drinking alcohol, 43.1

percent of men and 18.5 percent of women

reported having five or more drinks at least once

during the past year.

Drinking habits are cleariy related to age,

income, and education. Both frequency and

quantity of alcohol consumption decrease with

advancing age and increase with income and

education.

Among adults 20-34 years of age, 34 percent

reported drinking at least once a week. In contrast, only about 18 percent of persons 65 years

and over reported drinking this often. Similarly,

the percent of aIcohol drinkers who reported

having had five or more drinks at one sitting

declines steadily from about 43 percent in the

youngest age group to about 7 percent among

the oldest respondents.

Persons with higher incomes drink more

than persons with lower incomes. The percent of

persons who reported drinking three or more

times a week increases from 8.5 percent among

those with incomes of less than $5,000 a year to

about 22 percent among those with incomes of

$25,000 or more. The proportion of persons

drinking once or twice a week increases from

about 1 in 10 to about 2 in 10 between the

lowest and the highest income groups. In the

lowest income category, about 20 percent of

adults who drink alcohol reported having had

five or more drinks at one sitting, while about

37 percent of those in the highest income group

reported this behavior.

Persons with higher levels of education

reported more frequent alcohol consumption

than did persons with less education. While

38 percent of respondents having more than

12 years of education reported drinking at

least once a week, only 29 percent of those with

12 years of education and less than 23 percent

of those with under 12 years of education reported drinking this often. .4bout 42 percent of

respondents having less than 12 years of education reported that they never drink alcohol,

while only 17 percent of persons with more than

12 years of education reported abstaining.

Quantity of alcohol consumption also increase:

with education. The proportion of alcohoI

drinkers who reported consuming five or more

drinks at one sitting ranges from 22 percent of

those with less than 12 years of education to

about 35 percent of those with more than 12

years of education.

SMOKING

Table 6 provides information on the smoking practices of the U.S. adult population iri

1977. At the time that these data were collected, about 36 percent of adults aged 20 years

and over currently smoked cigarettes, about 20

percent had smoked at least 100 cigarettes in

their Iifetimes but were not currently smoking

(former smokers), and about 44 percent had

never smoked. hlen were more likely to currently be smoking than were women (40.9

percent and 32.1 percent, respectively). They

were also more likely to have quit. Adjusting for

differences in the proportions of men and

women who had ever smoked shows that about

4 in 10 male smokers had quit, while only about

3 in 10 female smokers had quit.

More recent data on smoking, collected in

1978 and 1979, are currently available in The

Health Consequences of Smoking for Women,

A Report of the Surgeon General, 3 an earIier

Advance D;ta repo~,4 and Health,

States, 1979.5 Additional 1979 data

available in Health, United States,

BODY WEiGHT

United

will be

1980.6

The final health measure included in the

1977 National Health Interview Sutvey was

body weight as compared with desirable body

weight. Respondents were asked to estimate

their height and weight.b This ratio was compared with a standard table of desirable weights

prepared by the Metropolitan Lxfe Insurance

Company.a People were ckissified according to

how closely their height-weight ratio approximated the Metropolitan Life standard: 10 percent or more below desirable body weight;

5-9.9 percent below; plus or minus 4.9 percent;

5-9.9 percent above; 10-19.9 percent above;

b For a discussion of the vaIidity and reliability of

self-reported height and weight data, see reference 7.
adwamda7

Table 6. Percent distribution of persons 20 Years of age and over by smoking status and percent distribution of current smokers by

number of cigarettes smoked dai Iv, according to selected chamcteristics: United States, 1977

Characteristic

All persons 20 years of age and ovar ....

—Sex

Mle . ..... ........ .................... .............. .............

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

Race or ethnicity

White ......................... ........ ..........................

Black ............................... ... .......... ...............

His~nic .. ............. ....................... .. ...............

Age —

20-34 ymrs .......................... ........................

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

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

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

66 years and over ....... ........ . ........ ................

Income

Lessthan $5,000 .. ... ... . ... . . .. .. . . .. ... .. . ... ... ... . . .

S5,000-S8,999 ....... ..... ... ................. ... ......

$10,000-$14,889 .. ... ... .... . .. ........... ..... ..

$15,00LM24,889 ...... ........... ... ....... .............

$25,000 or more .... ......... .............. ...............

Education of individual

Lesstha 12 yaws. ......... .................... ..........

12 years..."" ....""" ....-".. " .......... .." ..........

More than 12 years....... ............ .. ...... ......

Smoking status Number of cigarett= smoked daily

Never Former Current Cu:lt Less

rOtall

35 or

smoked srmsker than 15-24 25-34

“’’Okw smoker? 15

more

Percent distributions

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

I m.o

100.0

100.0

100.0

100.0

1W.o

1OQ.o

100.0

100.0

100.0

100.0

43.9

30.9

54.4

43.1

45.0

54.1

45.3

37.1

36.8

40.3

57.8

50.0

43.6

42.2

41.1

40.9

43.1

41.7

47.2

20.1

28.2

13.5

21,7

13.0

12.3

14.6

19.5

23.4

25.2

24.8

16.4

18.6

19.3

21.6

25.3

19.2

19.0

22.1

36.0

40.8

32.1

35.2

42.0

33.5

40.1

43.4

39.8

34.5

17.4

33.5

37.8

38.4

37.3

33.9

37.6

38.3

30.6

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

lal.o

1W.o

100.0

100.0

1W.o

1fxl.o

100.0

100.0

100.0

100.0

1m.o

30.3

24.4

36.2

25.2

53.8

59.1

33.3

23.8

26.3

28.0

42.1

39.3

35.0

26.3

26.2

26.8

31.1

27.8

32.8

*

43.2 12.8

42.3 15.1

44.2 10.5

45.1 14.0

36.2 7.3

27.0 4.9

45.1 11.7

42.7 15.4

40.7 13.7

44.1 12.4

38.6 10.5

40.2 9.5

38.2 11.6

47.1 14.3

44.9 14.2

43.8 12.7

43.0 11.0

45.0 13.3

40.8 13.5

13.7

18.2

9.1

15.8

2.7

8.7

9.9

18.0

19.3

14.5

7.8

11.0

14.1

12.2

14.6

16.6

14.2

13.8

12.9

lExchsdas unknown smoking status.

2EXCIUdea unknown amount smoked.

NOTE: See table 1 for population.

20-29.9 percent above; and 30 percent or more tively). There me sex differences, however, in

above. The distribution is shown in tabie 7.

Only about 24 percent of the adults were

found to be within 5 percent of their desirable

body weight using this standard, with about 18

percent below and 58 percent above the optimaI

range. Almost 15 percent of the adult population

is 30 percent or more overweight using the

Metropolitan Life standard.

Approximately equal proportions of men

tild women are within 5 percent of their optimal

weight (21. 6 percent and 24.9 percent, respee

some’ of the other weight categories. Women

are more likely to be underweight than men are

(23.1 percent and 12.0 percent, respectively),

and men are more likely to be 5-29.9 percent

overweight (about 55 percent of men versus

about 35 percent of women). -4 larger proportion of women than men, however, falI in the

highest weight category, 30 percent or more

overweight. About 17 percent of women are in

this catego~, in contrast to about 12 percent of

men. Overall, about 69 percent of men and
8 aduamectata

Table 7. Percent distribution of persons 20 years of age and over by body wsight,l according to selected characterist its:

Characteristic

All persons 20 years

of age and over ......

—sex

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

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

Race or ethnicity

White .................. ..............

Black .................... .............

Hispanic ............................

Age —

20-34 years ............. .........

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

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

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

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

Income

Leasthan $5,000 ..............

S5,000-S9,999 ..........”......

$10,000-$14,999 ...... .......

81 5,000-$24,999 ......... ....

.825,mo or more ...............

Education of

individual

Less than 12 years....... .....

12 years................. ...........

More then 12 years............

II

Tota12

100.(

100.0

I 00.0

100.0

100.0

100.0

104).0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

10 percent

or more

below

desirable

weight

9.1

5.2

12.2

9.4

6.0

5.8

13.0

6.8

5.1

5.3

10.2

11.5

9.2

9.0

8.0

8.9

7.8

9.3

10.3

United States, 1977

5-9.9

Plus or

59.9 10-19.9 20-28.9 30

minus

percent percent percent percent

percent

below

4.9 perabove above

or more

cent of above

deswable desirable desirable desirable

above

desirable

weight desirable

vwight weight weight weight weight

9.1

6.8

10.9

9.4

6.2

8.6

12.8

6.5

6.4

6.4

6.4

:::

8.3

9.7

10.3

6.5

9.2

11.5

percent distribution

21.6

24.9

24.3

20.1

19.0

27.6

23.2

20.8

19.6

20.5

20.5

22.9

23.1

24.4

26.0

18.5

24.4

27.6

12.5

16.3

9.6

12.8

9.7

11.6

12.4

13.2

13.3

12.3

?1.4

9.8

11.5

12.8

13.5

14.0

11.0

12.2

14.4

20.2

24.4

16.9

20.2

20.1

23.2

16.6

21.4

23.5

22.1

22.2

?8.9

19,7

21.2

20.3

20.5

21.1

20.6

18.7

11.1

14.0

8.9

11.0

13.0

13.0

7.6

11.8

13.4

14.8

12.8

11.4

11.1

11.0

11.3

10.7

14.0

10.7

8.7

14.!5

~

11.7

16.7

13.1

25.01

18.8

10.0

15.0

17.5

19.6

16.4

19.2

16.5

14.5

12.6

9.5

21.0

13.5

8.8

lDesimb]e weight modified from 1960 Metropolitan Life Insurancebmpanydata.

2Ex~ude~ unknown height or weight.

NOTE: S.ee table 1 for population.

about 58 percent of women are in the weight reported height-weight ratios within 5 percent of

categories identified as “good” by the Alameda

County study. 1

Desirable weight is inversely reIated to age in

this population. \Yith advancing age, there is a

small but steady decline in the proportion of

persons reporting optimal weight. About 28 percent of persons aged 20-34, compared with

about 21 percent of those 65 years and over,

the Metropolitan Life standard. Desirable weight

is positively related to both income and education. As these increase, the proportion of

persons in the optimal weight categoq (plus or

minus 4.9 percent of desirable weight) increases,

and the proportion of persons in the extreme

overweight category (30 percent or more) decreases.
..—.-— .

dmcedab9

Black persons are overreprcsented in the

most extreme weight category. About one-quarter of all black persons are 30 percent or more

overweight, compared with about 13 percent of

white persons and about 19 percent of the

Hispanic group. Racial and ethnic differences in

the other weight categories are minimal.

SUMMARY

This report has presented estimates of the

prevalence of seven health practices pertaining

to hours of sleep, eating breakfast, eating snacks,

physical activity, aIcohol consumption, smoking,

and weight. In future publications from the

National Center for Health Statistics, interrelationships found among these practices wiIl

be discussed in more detaiI and examined in

relation to physical health status. The data

presented here will be further examined in a

Series 10 report in the ViW and Health Statistics

series.g A comparison of the National Health

Interview Survey findings with those of the

Alameda County study is planned.

The health practices supplement to the

National Health Intexview Sumey was designed

to provide national estimates of the health

habits found to be important in Alameda

County so that their relationship to health status

could be examined. The measures used were

only rough approximations of those employed

in the origimd Human Population Laboratory

study. The National Center for Health Statistics

is currently conducting a national telephone

sumey designed to include some of the features

of the Alameda County study. thalysis of these

data will shed light on the issue of the generalizability of the Alameda County findings on the

relationship between health practices and

physical health status.

REFERENCES

1Belloc, N. B., and Breslow, L.: Relationship of 6National Center for HeaIth Statistics: Health,

physical health status and health practices. Prev. Med. United States, 2980. DHHS Pub. No. (PHS) 81-1232.

1(3) :409421, 1972. Public Health Service, DHHS, Hyattsville, .Md. In prepa2Breslow, L., and EnStrom, J. E.: Persistence of ration.

health habita and their relationship to mortality. Prev. ‘The Rand Corporation: Conceptualisati”on and

Me(i 9:469483, 1980. Measurement of ?feakh Habits for Adults in the Heaith

3 Department of Health, Education, and Welfare: Insmmce Study: Voi. II, Overweight, by A. L. Stewart,

The Heakh Consequences of Sm eking for Women, A R. H. Brook, and R L Kane. R-2374/2-HEW. Santa

Report of the Surgeon Gen~ 1980. Monica. Calif. ‘Ihe Rand Corporation. In press.

4National Center for Health Statistics: Changes in 8Metropolkan Life fnsurance Company: Ovemeight,

cigarette smoking and current smoking practices among its prevention and si~]cance. Statiticd BuUeti of the

adults, United States, 1978, by A. J. Moss. Advance Data Metropolitan L~e Insurance Company, 1960.

From Vital and Heaith Statistics, No. 52. DHEW Pub. ‘National Center for Health Statistics: Lifestyle and

No. (PHS) 79-1250. Public Health Semite. Hyattsviile, health of U.S. adults, 1977, by G. S. Bonham. Vital and

Md. Sept. 19, 1979. Health Statistics. Series 10. Public Health Semite, DHHS,

5National Center for HeaIth Statistics: Health, Hyattsville, Md. To be published.

L’nitcd States, 1979. DHEW Pub. No. (PHS) 80-1232.

Public Health Sesvice. Washington. U.S. Government

Printiug Office, 1980.
10

TECHNICAL NOTES

Data presented in this report were obtained

from household interviews of the National

Health Interview Survey. These interviews were

conducted among a probability sample of the

civilian nonitmitutionaiized population of the

United States. During 1977, approximately

111,000 persons Iiving in about 41,000 households were included in the sample. The total

noninterview rate for the National Health

Interview Survey was about 3.3 percent, incIuding 1.9 percent due to respondent refusal

and 1.4 percent due to failure to find an eligible

respondent at home after repeated calls.

Questions concerning health practices were

asked of a one-third subsample of all persons 20

years of age and over, or approximately 23,000

persons. Self-reporting was genera.ily required

for these questions, but proxy responses were

accepted when subsample persons were physically or mentally incapable of answering the

questions for themselves. The nonintemiew rate

for the subsample was about 9.4 percent. In

addition, individual item nonresponse ranged

from about 0.2 to 1.7 percent. Persons with

unknown characteristics are excluded from the

analysis.

Estimates for the white and black populations, shown in table 1, are based on selfTable 1. Standard errors, expressed in percentage points, of

~

Baseof

percent

in

thouaends

50 ....... .....”..

70 ................

1m ...... ... ..

.......”.....

........... ..

700 ..........”..

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

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

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

20,000 .........

30.000 .........

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

100,000 .......

r—

estimated.—naremts -—.__....

Estimated percent

2or

98

5.0

4.2

3.5

2.0

1.6

1.3

1.1

0.5

0.4

0.3

0.2

0.2

0.1

5or lOor

95 80

7.8 10.7

6.6 9.1

5.5 7.6

3.2 4.4

2.5 3.4

21 2.9

1.7 2.4

0.8 1.1

0.6 0.8

0.4 0.5

0.3 0.4

0.2 0.3

0.2 0.2

60

T

14.3 179

12.1 15.1

10.1 12.7

5.9 7.3

4.5 5.7

3.8 4.8

3.2 4.0

1.4 1.8

1.0, 1.3

0.7 0.8

0.6 0.7

0.5 0.6

0.3 0.4

reported racial identifications and therefore are

not identical to official U.S. Census estimates

for the same period, which are based primtily

on interviewer obsenration. Hispanic classi fication is also based on self-reporthg. The white,

black, and Hispanic categories are mutually

exclusive. For detailed definitions of other

sociodemographic terms used here, see appendix

II in most Series 10 reports in the Vital and

Health Statistics series.

Since the estimates shown in this report are

based on a sample of the population rather than

on the entire population, they are subject to

sampling error. Standard errors appropriate for

estimated percentages of persons are shown in

table I. These standard errors may be somewhat

underestimated for the Hispanic population.

Information on vital statistics for Hkpanic

persons does not currently exist, and thus there

are no benchmark population estimates that can

be used to adjust the sample weights for this

ethnic category.

In this report, terms such as “similu” and

“the same” mean that no statistical significance

exists between the statistics being compared.

Terms relating to differences (“Weater,” “]ess,”

etc.) indicate that differences are statistically

significant. The t-test with a critical value of

1.96 (0.05 level of significance) was used to test

all comparisons that arc discussed. Lack of

comment regarding the difference between

any two statistics does not mean the difference

was tested and found to be not significant.

To better understand the limitations of the

estimates presented in this report, data users are

encouraged to familiarize themselves with the

survey design, the methods used in estimation,

and the general qualifications of the data, which

are described in appendix I of the 1977 Current

Estimates report (Series 10, No. 126, in the

VitaZ and HeaZth Stat&tics series). Definitions of

certain terms used in this report but not specifically addressed in this section and the questionnaire and flashcards used during 1977 appear in

appendixes 11and III of that report.
FROM VITAL & HEALTH STA TLSTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

.

u.S. DEPARTMENT OF HEALTH ● Pubfic Health Serwce

AND HUMAN SERVICES Office of Health Research, Statistics.and Technology Number 65 ● Nowtier 5, 1980

Cough as the Reason for Office Visits, National Ambulato~

Medical Care Survey: United States, 1977-781

Cough was the principal reason for an

estimated 29,059,242 visits to office-based

physicians during 1977-78. Cough ranked fifth

among all principal reasons for visits but was the

second most frequent symp tomatk reason given

by patients (table 1).

The estimates in this report are based on

data collected in the National Ambulatory

Medical Care Survey (NAMCS), a probability

sampIe survey conducted yearly by the Division

of Health Resources Utilization Statistics of the

National Center for Health Statistics.

Since the estimates presented in this report

are based on a sample rather than on the entire

universe of of~xce-based physicians, the data

are subject to samp Iing v=iabilit y. The Technical’ Notes at the end of this report provide a

brief explanation and guidelines for judging the

precision of the estimates presented. A more

detailed description of the sample design and

definitions of certain terms used in N.WICS have

ako been published ekewhere.~

Figure 1 is a facsimile of the 1977-78 Patient

Record used by participating physicians to record information about office visits. The patient’s complaint, symptom, or other reason for

the visit, expressed as nearly as possibIe in the

patient’s own words, is recorded by the physi1This ~epom ~= prepared by Bedah ~ CYPress~

Ph. D., and Thomas ,McLemorc, M.S.P.H., Division of

Health Resources Utilization Statistics.

2NationaI Center for Health Statistics: The National Ambulatory hfedical Care Sumey, 1977 Summary: United States, January-December 1977, by T.

Ezzati and T. McLcmorc. Vital and Health Statistics.

Series 13-No. 44. DHEW Pub. No. (PHS) 80-1795.

-PubIic Health Service. Washington. U.S. Government

Printing Office, Apr. 1980.

cian in item 6. The principal reason is the one

that in the physician’s judgment was most responsible for the patient making the visit. It

is the first-listed reason in this item. These data

were ckssified and coded according to a reason

for visit classification (RVC) system presented

in A Reason for V&it Classification for A mb ulatory Care.3 Since 1977 was the first year

that this classification system was used, caution should be exercised in comparing the

data presented in this report with those of

prior years.

DATA HIGHLIGHTS

Table 2 provides the age and sex of patients

who visited office-based physicians for medicaI

care related to cough. Most of these visits (46

percent) were made by children under 15 years

of age. Cough accounted for about 8 percent of

aU visits to pediatricians’ offices, a higher proportion than to those of other specialties (table

3).

The rates of visits made because of cough

were higher in the Northeast and the West than

in the North CentraI %md the South, and in

metropolitan than in nonmetropolitan areas

(table 4).

The principaI diagnosis made by the physician for the patient who presents cough as the

3NationaI Center for Health Statistics: A reason for

visit classification ior atnbtdatory care, by D. Schneider,

L. Appleton, and T. McLemore. Vital and Heaith Statistics. Series 2-No. 78. DHEW Pub. No. (PHS) 79-1352.

Public Health Semite. Washington. U.S. Government

Printing Office, Feb. 1979.
2

Figure 1. NATIONAL AMBULATORY MEDICAL CARE SURVEY PATIENT RECORD FORM:

1977-78

ASSURANCE OF C0NF10ENTlAL17Y- Allmfmcl-4khsM~m!c Mmwlikacmnolm mawnw.t,

●m.cum-.t maclsm. 0r9naU8UdInwnS tmsu!.my dwilib willIWXWcaafiidal.

8.dk109d or.=i.-

wd4b.

morh.r

tiatUv

numn.

Ix ~.s.ng99M

of .nd f.. ..v

i.nul

cm!-

for

.a.rcmm, A 033012

1. GATE OF VISIT PATl ENT RECORD

/ / NATIONAL AMBULATORY MEDICAL CARE SURVEY

wO/lw / Yr

2. DATE OF BIRTH 3. 55X 4. Wwa e4R 5. WAS PATIENT 6. PATIENl”S COMPtilFJTISl, SYMPTOM(SI. OR OTHER

RAcs REFERRED FOR FEEASON{SI POR THIS VISIT

THIS vISIT tlY (In pment.s own WX.2ZJ

/, , ❑ WHITE ANOTHER

z2%- 1 0 FEMALE * ❑ ?4EGROI PHYSICIAN? . Mosr

SJukcx lMPOflTANT

~ ❑ MALE S ❑ YES

s ❑ OTIIER b. OTHER

● •1 UNKNOWN .~ONO

7. TIME SINCE ONSET

OF COMPLAINTI

SYMPTOM IN ITEM&

(Ch?ck OIW)

: a LESS THAN 1 OAY

* o l+ OAYS

. ❑ 1-3 wEEKS

● n 14 MONTHS

$0 MOREWAN

3 MONTHS

I I ,

~. PNYSICIAWS OtAGNC6ES 9. HAVE YOU SEEN

PATIENT BEFORE?

& PRINCIPAL DIAGNOSNVW!06LEM ASSOC]ATEO WITH

ITEM & I ❑ YES SONO

t

IF YES. FOR THE

CONOITION IN

b. OTHER SIGNIFICANT CURnENT DIAGNOSES ITEM S.?

I ❑ YES .0?40

[1. DIAGNOSTIC 3ERVICES THIS 12. THEWUTIC SSRVICES THIS 13. OISFOSITION THIS VISIT

VJSJT Kbrck ●l! cxdFmd or /xwidrd) Vca-r IOauk dla—d#md w LwvW&d) (CImck ●ll tit WD:V)

I ❑ NONE

z ❑ LIMITED EXAM/HISTORY

s ❑ GENEUAL EXAMIHI=OFIY

● O P- TEST

s ❑ CLINICAL LAO TEsT

● ❑ X-RAY

7 fi EKG

. ❑ VISION TEST

● O ENOOSCOPY

. ❑ BLOOO FRESSURE CHECK

% D OTHER (SPutfv)

, ❑ NONE

. ❑ lMMuMIZAllON/

OESEW3TIZATION

~ D OflUGS lPRESCnlHION/

NONPHESCIWPTION)

● n CNET COUNSELING

s O FAMILY PUNNING

● ❑ MEDICAL COUNSELING

* ❑ FNYSIOTHERAPY

s ❑ OFFICE SURGERY

● n PSYC1’iOTMERAPY/

TNERAPEuTIC LISTENING

,. 0 OTHER ~,fy)

10. SERIOUSNESS OF

CONOITION IN

lTEhk & (CInck ad

I ❑ vERY SERIOUS

z ❑ SERIOUS

, ❑ SLJOHTLY

SERIOUS

● o NOT SE HIOUS

1 0 NO FOLLOW-UP PIANNEO

‘ o RETURN AT SPECIFIEO TIME

i c! RETUnN IF NE EOEO, P.R.N.

4 n TELEPHONE FOLLOW-W PLANNGO

1 0 REFERP4E0 TO OTHER PHYSICIAN

.

‘ O ‘ETuRNEo TO REFERRING PHYSICIAN

v ❑ AOMIT TO HOSPITAL

a o OTHER (S#uJfV)

~1A-34-2 DEPAflTMEN7 OF HEALTH, EDuCATION ANO WELFARE

:V. 9-76 FUEJLIC HEALfM SEHVICE

HEALTH RESOURCES AOMt NlSTRA710N

NATtONAL CENTER FOR HEALTH STAIISTI CS

14. OURATION OF

THIs VISIT

f7inw axlmlky

Want w“th

dw-wciad

MINUTES

V.M.S. ME-R1498
acwx#Ma3

Table 1. Number, percent, and averageannual rate of offia visits,by most frequent princiwl reasonsfor visi~ United States, 1977-78

Percent

Avmga

annual

visit rate

par 1,000

persons

2,727.1

139.6

95.4

82.4

70.1

68.6

Number of

visits in

thousands

Principal reason for visit and RVC codel

1,154550 lm.o

5.1

3.5

3.0

2.6

2.5

All reasons................................................. . ................ .. ........... ... . ..-... -.. ".."-----------------

General medical examination ................................ ....... ........................ .... ...... ...... ..”.-...-.Xloo

Prenatal examination. routine .... .................................................................... .....-.. ”---------X205

Symptoms referable to throat ........................................................................." . . . . ... . . S455

Postoperatiw visit................................................................................................. ............ T205

Clwgh. .......................................................................................................... .... . ........ ....

lBased on A Reason for Visfr Clam”fication for Ambulatow Cars (RVC).

59,115

40?384

34,864

2%674

28,059

Table 3. Number and percent of office visits with cough as the

principal reason for visit. according to selected physician

specialties: United States, 1977-7S

Table 2. Number, percent distribution, and averageannual rate

of office visits with cough asthe principal reason for visit by

ageand sex of patient: United States, 1977-78

Averags I Number in thousands I

annual

visit rate

per 1,000

persons

Number of

visits in

thousands ‘“’W m ‘r””= Percent

distribution Age and sex

.AII specialties...

Both sexes

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

General and family

practice..... .. ... . . ...

Internal medicine... .._

Pediatrics...... . . . .. ....

General surgery...... .. .

Otolaryngology .... ... ..

433936

133,281

114#921

6%223

32.193

1!5.185

3,279

8,571

567

●255

3.5

2.5

7.5

0.8

0.8

28,059 100.0 68.6

Undar 15 years............

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

2544 years.................

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

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

13,438

3,048

4,706

4,899

2,869

46.2

10.5

16.2

16.9

10.2

132.3

38.5

42.2

56.7

66.1

72.0

122.6

49.1

48.5

70.2

65.6

65.1

chief complaint is recorded in item 8 of the

Patient Record. Diagnostic codes are based on

the Eighth Revision, International Classification of Diseases [ICDA).4

Table 5 contains a list of the most frequent

associated diagnoses. Bronchitis (acute, unqualified, and chronic) accounted for about 30 percent of these visits.

Femala

All ages.................. 15,769 54.3

21.0

6.8

9.6

10.9

6.0

Under 15 years.. ..........

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

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

45-64 years.” ...............

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

6,103

1,976

2,794

3,164

1.732

Male

All ages ....... ........... 13,280 I 45.7

Under 15 years............

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

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

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

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

7,335

1,072 /

1,912;

1.735 !

1,237 ~

25.2

3.7

141.5

32.1

35.5

42.1

66.7

4National Center for Health Statistics: J??@tth

Reuision Inter-nationol Ckssification of Diseases, Adapted

for Use in the United States. PHS Pub. No. 1693. PubIic

Health SCMCC. Wxhington. U.S. Government Printing

Office, 1967.
4

Table 4. Number, percent, and average annual rate of offica visits with cough as the principal reason for visit, according to geographic

region and type of area of practice: United States, 1977-78

{

Region and type of area

~ Number in thousands

Region I

Nonhean .................. ................................................................................... ......... 271,440

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

South

291,571

................ ..................................................................................................... 355,754

w* ...................................................................... ................................................. 235,785

Type of area

I

Metropolitan ............................................. ................ ........................ .......... ............

I

865,549

Non metropolitan ..... ...... ............................ ........ ........................................ ............. 289.001

7,600

7377

8,281

5,591

21,365

7,684

Percent

2.8

2.6

2.3

2.4

2.5

2.7

Table 5. Number and percent distribution of office visits with cough as the principal reason for visit

by principal diagnosis: United States, 1977-78

Principal diagnosis and ICDA codel

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

Otitis media without mention of mastoiditis ................ ........... ................................................................ 381

Acute nasopharyngitis (common cold) .................................................................................................... 480

Acute pharyngitis ......................................................... ..................................................... ...................... 482

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

Acute upper respimto~ infection of multiple or unspecified sit~ ............................................. .............. 465

Acute bronchitis and bmnchiolitis .................................................................................. .............. ............ 466

Influenza, unqualifi4 ...... .............................................................. ........................................................... 470

Pneumonia, unspecified ..................... .. ..................................................................................................... 466

8ronchitis, unqualified ......................... ............................................ ............................... .......................... 490

Chronic bronchitis .................................................................................. ...................................................

Asthma

491

.......................... .................................. .......................................................................................... 493

Chronic sinusitis ............. ........................................................................................................................... 503

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

Other diseases of respiratory ~mem ......................................................................... ..... ...................... ..... 519

Symptoms referable to respiratory system ....... ........................................... .............................................. 783

All other diagnoxs ...................... ................... ................................................................. ........ ............. residual

Number of

visits in

thousands

28.059

825

910

984

602

7,539

2,177

798

894

6,243

375

1,012

757

855

837

453

3,798

Average

annual

visit rate

per 1,000

persons

78.3

88.5

60.0

75.3

73.8

57.5

Percent

distribution

100.0

2.8

3.1

3.4

2.1

25.9

7.5

2.8

2?:

1.3

3.5

2.6

2.9

2.9

1.6

13.1

lBased on the Eighrh Revision International Classs”ficationof Diseases, Adapted for Uw in the United Stares (lCDA).
adwceMa5

Table 6 shows the percent of visits with selected diagnostic and therapeutic services. Drug

therapy (either prescription or nonprescription)

was used in 92 percent of the visits related to

cough, a proportion that exceeded the average

of 53 percent of all NAMCS visits.

Like most visits for acute, self-limiting conditions, most visits for treatment of conditions

due to cough were of short duration. Table 7

shows that about 41 percent of such visits took

only 6 to 10 minutes, and another 29 percent

lasted no longer than 15 minutes.

Table 6. Percent of office visits with cough as the principal mason

for visit, by selected diagnostic and therapeutic services mdered or provided: Unitad States, 1977-78

Diagnostic and therapeutic services

Diagnostic service

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

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

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

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

X*ay ........................ ...................... ............. ......... ......

EKG ............ ... ................................. ..........................

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

Therapeutic service

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

lmmunization/desensitimtiom....................................

Drugs (pre*ription/nonprWription)..........................

Diet counseling ................................ ..........................

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

Percent

of visits

3.0

70.3

23.0

13.6

11.5

1.2

25.2

3.3

4.3

92.3

2%

Patients were most often instructed to return

if needed (43 percent of visits) .or to return at a

specified time (about 36 percent).

Additional data on cough. and other remons

for office visits will be presented in more detaiI

in a forthcoming public~tion.

Table 7. Percent distribution of ~ffice visits with cough as the

princirM reason for vkit by duration and dispositionn of visit:

Unitti States, 1977-78

Duration and disposition

Duration

O minutesl ...........................................................

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

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

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

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

31 minutes or more ............”.... ............................

Disposition

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

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

Return if needad, P.R.N. .......... ....... ..................

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

Referred to other physician ............... .................

Admit to hospital ............ ...................................

Return to referring physician or othar

disposition. ................ .....”.. ........ ....... ...............

Percent

distribution

of visits

100.0

1.2

15.3

40.8

28.0

12.7

*1.1

15.8

35.5

43.0

7.3

‘0.8

1.2

“0.5

l~~im in which there .,VSS no faCe-tO.faCC COntaCt bet~”een

the atient and the physician.

I’Will not add to 100.0 since more than one disposition was

possible.
6

TECHNICAL NOTES

SOURCE OF DATA

‘1’he information” presented in this rqxjt-L is

based on d;lLa c{}llcctcd in the Natiund Ambulatory Mcdicul Cm-e Sumey (X.SICS) during

1977 and 1978. The NAMCS tmivm-sc is comp{)sed of {~[}icc visits made tyithin the contcrminous L’nitcd States by ambulatory patients

to nfmfcdct-dly employed physicians who arc

principall~” cn~~gcd in ofllcc practice and am

not in the specialties (If anesthesiology, palhOh)gy, or radiology. The Sd(i(Jfl~l Opinion

Research Cm Mr, under conu-acL to the .National Center for Health Statistics, is rsxponsibk for the .S.-UICS field operations.

SAMPLE DESIGN

N.UICS utilizes a mtdtistqge prohahility

design that involves samples of primaq- sampling units (PSU’S), physician prwticcs within

PSIYS, and patient visits within physician practices. For 1977-78 a samrrlc of 6,007 nonFederal, office-based physi~izms was selected

from master fiIes maintained by the American

Medical Association and the .4mcrican Osteopathic Association. The physician response rate

for this period was 75. I percent. Sampled

physicians were requested to complete Patient

Records (figure 1) for a systematic random

sample of office visits taking place during a

randomIy assigned weekly reporting period.

During 1977-78, 98,335 Patient Records were

completed by responding physicians.

SAMPLING ERRORS

The standard error is primarily a measure of

the sampling variability that occurs by chance

because onIy a sample, rather than the entire

universe, is sampled. The relative standard

error of an estimate is obtained by dividing the

standard error of the estimate by the estimate

itself and is expressed as a percent of the estimate. Relative standard errors for aggregate

statistics m-e shown in tables I and H. Standard

errors for estimated percentages are shown in

tables III and IV.

Table 1. Approxirrete relative standard errors of estimated-nurn.

ber of office visits based on ail physician specialties: NAMCS,

1977-78

~

mo ......................."..e . ............ ... ................ ......

1.ooo ........................................ ..e. ...........e.. ....

2.wo ....................................." ........ ....................

5.mo ........................................ ........................ ..

1o.wo ............................................................... ..

20.000 ...................................... .... ........... ........-

50.mo ..................................... . ..........................

2m.m ................................................................

1.000,000 ........................... .................................

24.9

17.7

12.7

8.3

6.2

4.8

3.8

3.1

2.9

I

Example of use of tobk: Air aggregate of 1S.000,000 vkits

has a relative standard error of 5.S percent or a standard error

of 825,000 visits (S. S percent of 15,000,000).

Table 11. Approximate relativestandarderrors of estimated number of office visits based on an individual physician specialty:

NAMCS, 1977-78

Relative

Estimated number of offica standard

visits in thousands error in

percent

500 ...............................”. ............................. . ... . 27.0

1.mo .........................." .............M"....................... 19.6

Z,ooa .......................................... ......................... 14.5

5,000 .................................................. ................. 10.3

1o.wo .... ............................................................. 8.5

20.mo ..................................................................

N.ow .............................." ............................... .. z

1oo.om ......................................." ....................... 6.4

wo.om ................................................................ 6.2

Exsrmp/e of use of table: An aggregate of 7, S00.000 visits has

a relative surndwd error of 9.4 percent or a standard error of

705,000 visits (9.4 percent of 7,500,000).

DEFINITIONS

A mbulato~ patient.–h ambulatory patient is an individual presenting himseIf for

personal health services who is neither bedridden nor currently admitted to any health

care institution on the.premises.

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

practice. Responsibility over time for patient

care and professional services rendered there
7

Table II1. Approximate standard errors of percent of estimated

numbers of office visits based on all phvsiciah sp’kcialties:

NAMCS, 1977-78

Table IV. Approximate standard errors of percent of estimated

numbers of office visits based on an individual physician

specialty: NAMCS, 1977-78

Base of percent

(number of office

visits in thousands)

......... ............... ...

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

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

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

1O,mo ....... ....... ........

20,W0. ........ ..............

50,000 ..................”....

2m,ooo ......................

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

Estimated percent

1 or 5 or 10 or 20 or 3;; 5(y

99 95 “ w ~

Standard error in percentage points

25

1.7

1.2

0.8

0.6

0.4

0.2

0.1

0.1

5.4

3.8

27

1.7

1.2

0.9

0.5

0.3

.0.1

—

7.4

5.3

3.7

2.3

1.7

1.2

0.7

0.4

0.2

9.9

7.0

5.0

3.1

2.2

1.6

1.0

0.5

0.2

11.4

8.0

5.7

3.6

2.5

1.8

u

0.3

—

12.4

8.8

6.2

3.9

2.8

2.0

1.2

0.6

0.3

Example of use of table: An estimate of 20 percent based on

wr aggregate of 15.000.000 visits hits a standard error of 1.9 percent or a relative standard error of 9.5 percent (1.9 percent + 20

percent).

generally resides with the individual physician

rather than an institution.

Vr3it.-A v$it is a direct ‘personal exchange

‘zetween an ambulatory patient and a physician

or a staff member worhng under the physician’s

supervision for the purpose of seeking care and

rendering health semices. :..

Physiczim.-A physician is ~ duly licensed

doctor of medicine (M.D.) or doctor of osteopathy (D. O.) currently in office-based practice

Base of percent

(number of office

visits in thousands)

..... . .....................

1,Ooo..........................

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

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

Io,ooo ........................

20,000 ........................

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

1Oo,ooo......................

400,000 ......................

Estimated percent

59

Standard error in percentage points

L

2.6 5.7 7.9

1.9 4.1 5.6

1.3 2.9 3.9

0.8 1.8 2.5

0.6 1.3 1.8

0.4 0.9 1.2

0.3 0.6 0.8

0.2 0.4 0.6

0.1 0.2 0.3

10.5

7.4

5.3

3.3

2.4

1.7

1.1

0.7

0.4

12.1

8-5

6.0

3.8

2.7

1.9

1.2

0.9

0.4

13.1

9.3

6.6

4.2

2.9

2.1

1.3

0.9

0.5

E~nzple of use of @ble: An estimate of 90 percent hosed

on an aggregate of 3,500,000 visits has a standard error of 3.2

percent. or a relative standard error of 3.6 percent (3.2 percent + 90 percent).

who spends time in caring for ambulatory patients. Excluded from .NAMCS are physicians

who are hospitai based; physicians who speciake in anesthesiology, pathoIogy, or radioIogy; physicians who are federally cmpIoyed;

physicians who treat only institutiomdized patients; physicfidns employed fuII time by an

institution; and physicians who spend no time

seeing ambulatory patients.

SYMBOLS

Data not available ---

Category not applicable . . .

Quantity zero .

Quantity more. than Obut less than 0.05— 0.0

Figure does not meet standards of

reliability or precision— *
From Vital and Health Statistics of the National Center for Health Statistics Number 66. March 2, 1981

1979 Summary

National Ambulatory Medical Care Survey

by ThomasMcLemore,Divisionof HealthCareStatistics

During 1979 an estimated 556.3 million office

visits were made to nonfederally employed, ofticebased physicians in the conterminous united States,

an average of 2.6 office visits per person per year. A1-

though these estimates are approximately 5 percent

lower than the corresponding estimates for 1978, the

differences between the estimates for the 2 years

are not statistically significant. The estimates presented in this report are based on data collected in

the National Ambulatory Medical Care Survey, a

probability sample survey conducted annually by

the Division of Health Care Statistics of the National

Center for Health Statistics. The physician sample

for the survey was selected, with the cooperation of

the American Medical Association and the American

Osteopathic Association, from a list of nonfederally

employed doctors of medicine and osteopathy who

were principally engaged in office-based practice.

Excluded were physicians practicing in Alaska and

Hawaii, and physicians in the specialties of anesthesiology, pathology, and radiology.

Figure 1 is a facsimile of the 1979 National

Ambulatory Medical Care Survey (NAMCS) Patient

Record used by participating physicians to record

information about their office visits. It wilI be useful

as a reference when reviewing the survey findings

presented in the following tables.

This report provides an overview of the data from

the 1979 NAMCS. Utilization of ambulatory medical

care services is described in tern-s of the number and

percent of office visits and of annual visit rates. Data

are presented on patient, physician, and visit characteristics as follows:

Table 1 Patient race and ethnicity

Table 2 Patient age and sex

Table 3 Physician specialty and type of

practice

Table 4 Referral status, major reason for

visit, and prior visit status

Tables 5 and 6 Principal reason for visit as expressed by patient

Tables 7 and 8 Pcincipal diagnosis rendered by

physician

Table 9 Diagnostic and therapeutic services ordered or provided

Table 10 Disposition and duration of visit

Since the estimates presented in this report are

based on a sample rather than on the entire universe

of office visits, the data are subject to sampling

variability. The technical notes at the end of this

report provide a brief explanation of sampling errors

and guidelines for judging the precision of the estimates. A more detailed description of the NAMCS

sample design and survey methodology have been

published elsewhere. I

Caution should be exercised when comparing

the 1979 NAMCS data with data from previous years

because changes have been made in data collection

and processing. Two major changes on the Patient

Record should be noted in particular. First, the item

on patient color or race {item 4) was expanded in

1979 to four categories: white, black, Asian or

Pacific Islander, and American Indian or Alaskan

native; and an item on patient ethnicity, of Hispanic

or not of Hispanic origin, was included for the first

time. Second, beginning in 1979 the International

Classification of Diseases, 9th Revision, Clinical

Modification (ICD-9-CM) was used to code the

NAMCS diagnostic data (item 9 on the Patient

Record).~ Prior to 1979 the Eighth Revision international Classification of Diseases, Adapted for Use

lNa~iO”~lcen~~~for Health Statistics: The National AmhuiatorY

Medical Care Survey, 1977 summary, United States, January .December

1977, by T. E“za ti and T. McLemore. briral and Health Stah”sfics.Series

13-No. 44. DHEW Pub. No. (PHS) 80-179S. Public Health Service.

Washington. U.S. Government Printing Office, Apr. 198o.

2Crrm mission on I%ofes.. iorvd and Hospital Activities: International

Classification of Diseases, 9th Revision, Clinical .Vfodification. Ann

Arbor. Edwards Brothers, Inc., 1978.

U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service, Office of Health Research, Statktiis, and Technology
2

TIME OF

VISIT

am

.,

p.m

a.m

p.m

Figure 1.1979 Patient Record

SS”RANCE OF CONFIDENTIALITY A,, II,,w.m,!, t,” ‘am<” .,,wkl ,wm!l .!”.”, ! 0e9~,fm..1 of Health, Educxm., ●nd W.lfme

U,!n” !.1.1>!“(l!”., !-1. . .. ... . . . . “, .,!, .W*,,,,. IF,W “4,, ,P he,, .,,., !,,.,!,! ,, .“! , ,- P.bh. Health Serwce

. . . ,,.,, ,,, r... !!,’ #m*.., 10.“4, l!. ,Iw ,“,,,,,U,. ,,, ,m.,“,.., .,!., *)11t!,!!,,.,,1, Of fOceof Health Ren.rch, S1.1,S1!.S,and Technolow

B

... .. ?.,..”.!, !ml!”,“.s0.,“!....Ir,~,1>,*r.,r,l,>w

N.tI.a.N Ce.t.r for Health SISWU.S

1.

DATE OF VISIT

/, PATl ENT RECORD

--=7~ NATIONAL AMBULATORY MEDICAL CARE SURVEY

2- ~;:HOF 3. SEX

r

4. ;tJ;~OR 5. ETHNICITY & WAS PATIENT 7. PATIENTS COMPLAINTISL SYMpTOMl=

REFERREO FOR OR OTHER REASJJN(SI FOR U VISIT

T~S VISIT [m OM,enrk mm wntdd

la WHITE ,0 HISPANIC BY ANOTHER a. MOST

=7’+ ==LE 3?!??*V, ‘O;;:lc ,:: ..::;NT _

, u YES

~. MAIOR REASON

FOR THIS VISIT

/cn,c* 0“.,

J a CHRONIC PRO13LEM,

FLARE UP

4 n PCIST SURGERY

POST lNJ”RY

b a NON ILLNESS CARE

lRCUTINE PRENATAL,

GENERAL EXAM

WEIL BABY. ETC )

]. PHYSICIAN’S OIAGNOSES

1,

PRINCIPAL DIAGNOSIS ,SROE?LE:J

ASSOCIATED W1lH I.EW la

OTHER SIGNIFICANT CURRt NT

OIAGNOSES

1 !

lotiA::YxJ:::#E? 11. Ol#;::;:::S;;::;;HIS VISIT —

OYES 70N0 , 0 NON! 80EKG

+

? n LIMITED UIST3RV EXAM 9 c1 VISION TEST

IF YES. FOR THE J D GCNERAL HIsTORY EXAM 10 = ENDOSCO$Bv

CONOITION IN .! a PAP TEST 1I n MENTAL STATUS

ITEM %? .90 CLINICAL LA8 TEST EXAM

blgxi3AY 12 a OTHER (SL.FC,I,)

,1 )nYES .ONO \ t a EILOOD PRESSURE cHfcK

12. THERAPEUTIC SERVICES THIS VISIT

[Olrck & “rdrfrd or provodd

13. DISPOSITION THIS VISIT

Iche* ,,, ,+,, .,~”)

14. ::IW:ON 15. :Hf;;g:TyN FOR

a NONE

VISIT IChwh end

8 0 MEOICAL COUNSELING

, =ORUG IPRESCRIPTIONI

I Q NO FOLLOb\ w PLANNFU Inlnc 10 ACCIDENTAL INJURY

9 m PHYSIOTHERAPY . n RETuW4AT SPECIFIEf> ll\lE ZIllall” IA”- 16.19)

t OORUG 4N0NPRESC3mP710Nl 10 OOFFICE SURGERY > m HET1lHN :5 NEELIEII PM .\ sprnr w#th 2 a ~~LONO&\~RE LATEO

.) O INJECTION

$0 YELEP+UINE FOLLOW \) PPLANNED

11 a PSYCHOTHERAPY

@vs=tMl

,, nREFERs ED 10 IITI+ER pHv51cIbh IA”,vwr 16.191

., mIMMuNI.2AT10N/ Therapeutic LISTENING t, QRETURNED TO HEFEI?HIN1; PMVSICIAN

DESENSITIZATION 12 007 HER I*dYI / a ADMIT TO HOSPITAL 3 D NEITHER OF THE

b ODIET COUNSELING R 00 THER ,S”., 1,. UINU?ES - AOOVE q

1a FAMILV PLANNING

I I I ST;P

I I I (GOto-nextmtmr,l

l& DESCRIBE ALL OSJECTS.

PRODUCTS. OR SUBSTANCES

INVOLVEO IN THE ACCIOENT

OR PRODUCT RELATEO ILLNESS

/* xd,.)

,,,..,,,,!. ,, !. ,,

17. LOCATION OF

ACCIOENT OR

EXPOSURE TO

PROOUCT

Icn-h owl

! a PRIVATE RESIDENCE

2 n ELSEWHERE 15PwII.I

10 UNKNOWN

[8. WAS PATlENT AT 19. WAS PATIENT PREVIOUSLY

WORK. JOE OR TREATEO FOR THIS CONOITION?

8USINESS WHEN (Clwck.1! ,Ikw4901”1

ACCIOENT OR

ExPOSURE

tXCURRED? ;B %sH0SpITALEMEf7GENcYR 00M

3 n YES PRIVATE PHYSICIANS OFFICE

A O yES. PHYSICIAN ELSEWHERE lsp~c,fv)

la YES

20N0

J D uNKNOWN

u n YES PLACE UNKNOWN

6 m UNKNOWN
adamdah3

in the United States had been used to code these

data.s Discussion of these changes and the~ effect

on NAMCS data will be included in future Vital and

Health Statistics series reports.

3National center for H&~Ith Statistics: ~ig~l th Revision ftl f.S/?SUtiO?YUf

Classification of Diseases, Adapted fir Use in the United Stafes. PHS

Pub. No. 1693. Public Health Service. Washington. U.S. Government

Printing Office, 1967.

Table 1. Number and percent distribution of office visits by

race and ethnicity of patient: United Statea, 1979

Number of Percent

Race and ethnicity visitsin distribution

thousands of visits

Allvisits. . . .. . . . .. . . .. . . .. . ..

Race

White . . . . . . . . . . . . . . . . . . . . . . .

Another . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . .

Asian or Pacific Islander . . . . . . . . . .

American Indian or Alaskan native . . . .

Ethnicity

Hispanic . . . . . . . . . . . . . . . . . . . . .

Not Hispanic . . . . . . . . . . . . . . . . . . .

556,313

5’02927

53,387

46,788

5,560

1,038

26,731

528,563

100.0

90.4

9.6

8.4

1.0

0.2

4.8

95.2

Table 2. Number, percent distribution, and annual rate of office visits

bysexand ageof patient: United States, 1979

Number of Percent Number of

Sex and age visitsin distribution visitsper

thousands of visits person

per year

Both sexes

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

Under 15years . . . . . . . . .

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

2544years . . . . . . . . . . .

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

65yearsand over . . . . . . . .

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

Under 15years . . . . . . . . .

15-24 Yeats . . . . . . . . . . .

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

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

65yearsand over. . . . . . . .

Male

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

Under 15years . . . . . . . . .

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

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

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

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

556,313

101,352

82390

151,714

128,584

92363

337,086

48.735

52,345

102,000

76,003

58,012

219,218

52,617

29,945

49,714

52,591

34,351

100.0 2.6

18.2 2.0

14.8 2.1

27.3 2.6

23.1 3.0

16.6 4.0

60.6 3.0

8.8 2.0

9.4 2.6

18.3 3.4

13.7 3.4

10.4 4.2

39.4 2.1

9.5 2.1

5.4 1.5

8.9 1.8

9.5 2.5

6.2 3.6
4

Table 3. Number and percent distribution of office visits by physician

specialty and type of practice: United States, 1979

Number of Percent

Physician specialty and type of prac tice visits in distribu don

thousands of visits

All visits . . . . . . . . . . . . . . . . . . . . . 556.313 100.0

Physician specia Ity

General and family practice . . . . . . . . . . 190,194 34.2

Medicel specialties . . . . . . . . . . . . . . . 164,109 29.5

Internal medicine . . . . . . . . . . . . . . 66,908 12.0

Pediatrics . . . . . . . . . . . . . . . . . . . 58,126 10.4

Other . . . . . . . . . . . . . . . . . . . . . 39,075 7.0

Surgical specialties . . . . . . . . . . . . . . . 173,457 31.2

General surgery . . . . . . . . . . . . . . . 33,740 6.1

Obstetrics and gynecology. . . . . . . . . 50,823 9.1

Other . . . . . . . . . . . . . . . . . . . . . 88,894 16.0

Other specialties . . . . . . . . . . . . . . . . . 28,553 5.1

Psychiatry . . . . . . . . . . . . . . . . . . 17,093 3.1

Other . . . . . . . . . . . . . . . . . . . . . 11,461 2.1

Type of practice

solo . . . . . . . . . . . . . . . . . . . . . . . . 315,390 56.7

Other! . . . . . . . . . . . . . . . . . . . . . . 240,924 43.3

?ln~lude~partnersh ip, group practice, and other.

Table 4. Number and percent distribution of office visim by patient’s

referral status, major reason for visit, and prior visit status: United

States, 1979

Number of Percent

Visit characteristic visits in distribution

thousands of visits

All visits. . . . . . . . . . . . . . .

Referral status

Referred by another physician . .

Not referred by another physician

Major reason for visit

Acute problem . . . . . . . . . . .

Chronic problem, routine . . . . .

Chronic problem, flareup . . . . .

Postsurgery orpostinjury . . . . .

Nonillnesscarel. . . . . . . . . . .

Prior visit status

New patient . . . . . . . . . . . . .

Old patient . . . . . . . . . . . . . .

New problem . . . . . . . . . .

Oldproblem . . . . . . . . . . .

. . . . . . 556,313 100.0

. . . . . . 22,413 4.0

. . . . . . 533,900 96.0

. . . . . . 200,012 36.0

. . . . . . 160,603 289

. . . . . . 48,310 8.7

. . . . . . 51,241 9.2

. . . . . . 96,148 17.3

. . . . . . 88,136 15.8

. . . . . . 468,178 84.2

. . . . . . 125,647 22.6

. . . . . . 342,530 61.6

llnciude~, for example, routine prenatal care, general ex(eminationt or

well-baby examination.
danceda5

Table 5. Number and percent distribution of office visits by patient’s

principal reason for visit: United States, 1979

Table 6. Number and percent of office visits, by the 20 most common

principal seasons forvisit: United States, 1979

Numbsr of Percent

PrincipaI reason for visit and R VC code? visitsin distribution

drousands of visits

Allvisits.. .. . . .. . .. . .. . . .. . ..

Symptom module. . . . . . . . . S001-S999

General symptoms . . . . . . S001-S099

Symptoms referable to

psychological and mental

disorders . . . . . . . . . . . S1OO-S199

Symptoms referable to the

nervous system (excluding

sense organs) . . . . . . . . . S200-S259

Symptoms referable to

the cardiovascular and

lymphatic systems. . . . . . S260-S299

Symptoms referable to

the eyes and ears. . . . . . . S300-S399

Symptoms referable to the

respirato~ system. . . . . . S400-S488

Symptoms referable to the

digestive system . . . . . . . S500-S639

Symptoms referable to the

genitourinary system . . . . S640-S829

Symptoms referable to the

skin, nails, and hair . . . . . S830-S899

Symptoms referable to the

musculoskeletal system. . . S900-S999

Disease moduIe . , . . . . . . . .DOOI-D999

Diagnostic, screening, and

preventive module. . . . . . . .X1 OO-X599

Treatment module . . . . . . . . TIOO-T899

Injuries and adverse effects

module . . . . . . . . . . . . . .JOO1-J999

Test results module. . . . . . . .R1OO-R7OO

Administrative module . . . . . .A1OO-A14O

0ther2 . . . . . . . . . . . . . .. U99O-U999

556,313

308,588

43,736

15,864

16,492

3,!561

32,801

54,488

27,414

27,840

30,650

55,742

42,748

101,203

58,712

22,473

3,367

9,154

10,069

100.0

55.5

7.9

2.9

3.0

0.6

5.9

9.8

4.9

5.0

5.5

10.0

7.7

18.2

10.6

4.0

0.6

1.6

1.8

Most common principal reason for Number of ~erent

Rank visitand R VC coda~ visitsin

thousands

of visi~

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

GeneraI medical examination . . . . X1OO

Prenatal examination. . . . . . . . . X205

Progress visit not otherwise

specified . . . . . . . . . . . . . .. TBOO

Symptoms referable to throat. . . . .S455

Postoperative visit. . . . . . . . . . . T205

Cough . . . . . . . . . . . . . . . . ..S44O

Backsymptoms . . . . . . . . . . . ..S9O5

Heed cold, upper respiratory

infection . . . . . . . . . . . . . . ..S445

Skinrash . . . . . . . . . . . . . . . ..S86O

Chest pain and related symptoms (not

referable to body system) . . . . . .S050

Blood pressure test . . . . . . . . . . X320

Earache, or ear infection. . . . . . . .S355

Vision dysfunctions. . . . . . . . . . .S305

Abdominal pain, cramps, spasms . . .S550

Headache, pain in head. . . . . . . . .S210

Fever . . . . . . . . . . . . . . . . . ..S010

Well-baby examination. . . . . . . . X105

Allergy medication . . . . . . . . . . TIOO

Hypertension . . . . . . . . . . . . . D51O

Kneesymptoms. . . . . . . . . . . . .S925

32,160

21.717

14,827

14,556

13,886

12,628

11.100

10,462

9,441

8,798

8.681

8,575

8,498

8,364

8,174

7,285

7,102

6,904

6,297

6,272

5.8

3.9

2.7

2.6

2.5

2.3

2.0

1.9

1.7

1.6

1.6

1.5

1.5

1.5

1.5

1.3

1.3

1.2

1.1

1.1

144A R~~50n for visit Clas~ifi~atiOn for Am b”jatOry Care,,, vital and

Health Statistics, Series 2-No. 78, Fab. 1979.

1 Based on “A Reason for Visit Classification for Ambulatory Care,’”

vital and Health Statistics, Series 2-No. 78, Feb. 1979.

21ncludes blanks, problems and complaints not elsewhere classified,

entries of “none,” and illagible entries.
6

Table 7. Number and percent distribution of office visits by

principal diagnosis: United States, 1979

Table 8. Number and percent of office visits, by the 20 most common

principal diagnoses: United States. 1979

Number of Percent

Principal diagnosisand ICD-9-CM code~ visitsin distribution

drousands of visits

All diagnoses . . . . . . . . . . . . . . . . . . .

Infectious and parasitic diseases. . .001-139

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

Endocrine, nutritional, and

metabolic diseases and

immunity disorders . . . . . . . . .240-279

Mental disorders. . . . . . . . . . . .290-319

Diseases of the nervous system and

sense organs . . . . . . . . . . . . .320-389

Diseases of the circulatory

system . . . . . . . . . . . . . . ..390459

Diseases of the respirato~

system . . . . . . . . . . . . . . ..460-519

Diseases of the digestive system . ..520-579

Diseases of the ganitourinary

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

Diseases of the skin and

subcutaneous tissue . . . . . . . . .680-709

Diseases of the musculoskaietal

system and connective tissue. . . .710-739

Symptoms, signs, and ill-defined

conditions . . . . . . . . . . . . . .780-799

Injury and poisoning . . . . . . . . .800-999

Supplementary classification . . . VOI-V82

Another diagnosesz . . . . . . . . . . . . . .

Unknown diagnoses3 . . . . . . . . . . . . . .

566,313

19,711

14,205

22,856

24,580

50,560

49,607

73,433

24,711

36,632

29,132

37,004

17,251

51,782

87,903

8,161

8,786

100.0

3.5

2.6

4.1

4.4

9.1

8.9

13.2

4.4

6.6

5.2

6.7

3.1

9.3

15.8

1.5

1.6

1 Based on International Classification of Diseases, 9th Revision, Clinical Modification (I CD-9-CM).

21 nc]”de~ disaasa~ of the blood a“d bl~~d.f~rmi”g organs (280.289):

complications of pregnancy, childbirth, and the puercmrium (630-676);

congenital anomalies (740-759); and certain conditions oriEinatin9

in the perinatal period (760-779).

31 ncl”des blsnk diagnosis, noncodable diegnosis, and illegible diagnosis.

Most common principal diagnosis and Number of Pement

Rank ICD-9-CM code~ visitsin,

thousatufs

of visits

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Essential hypertension . . . . . . . . . 401

Normal pregnancy . . . . . . . . . . . V22

General medical examination . . . . . v70

Acute upper respiratory inactions

of multiple or unspecified sitea . . . 465

Health supervision of infant or child . V20

Suppurative and unspecified otitis

media . . . . . . . . . . . . . . . ...382

Neurotic disordera . . . . . . . . . . . 300

Allergic rhinitis . . . . . . . . . . . . . 477

Diabetes mellitus . . . . . . . . . . . . 250

Disorders of refraction and

accommodation . . . . . . . . . . . . 367

Obesity and other hyperalimentation. 278

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

Diseeses of sebaceous glands. . . . . . 706

Special investigations and

examinations. . . . . . . . . . . . . . V72

Followup examinations . . . . . . . . V67

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

Other forms of chronic ischemic

heart disease . . . . . . . . . . . . . .414

Certain adverse effects not elsewhere

classified . . . . . . . . . . . . . . ..995

Contact dermatitis and other eczema. 692

Acute tonsillitis . . . . . . . ; . . . . . 463

23,607

22,426

16,575

14,946

14,022

11,166

11,102

9,823

8,947

8,527

8,348

8,149

7,385

7,176

6,792

6,786

5,857

5,697

5,683

5.420

4.2

4.0

3.0

2.7

2.5

2.0

2.0

1.8

1.6

1.5

1.5

1.5

1.3

1.3

1.2

1.2

1.1

1.0

1.0

1.0

1Ba=d O“ Imernational Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).
adKm4aa7

Table 9. Number and percent of office visits, by diagnostic and

therapeutic services ordered or provided: United States, 1979

Number of

Diagnostic md tfre;apeutic ~mice5 PeEent

visitsin

thousands of visits

Diagnostic service

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

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

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

Pap test . . . . . . . . . . . . . . . . . . . . . .

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

X-ray . . . . . . . . . . . . . . . . . . . . . . .

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

Electrocardiogram . . . . . . . . . . . . . . .

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

Endoscopy . . . . . . . . . . . . . . . . . . . .

Mental status exam . . . . . . . . . . . . . . .

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

Therapeutic service

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

Drug (prescription). . . . . . . . . . . . . . .

Drug (nonprescription). . . . . . . . . . . . .

Injection . . . . . . . . . . . . . . . . . . . . .

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

Dietcounseling . . . . . . . . . . . . . . . . .

Family planning . . . . . . . . . . . . . . . . .

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

Physiotherapy . . . . . . . . . . . . . . . . . .

C$fficesurgefy . . . . . . . . . . . . . . . . . .

Psychotherapy /therapeutic listening . . . . .

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

56,622

350.637

93,35a

27,414

129,187

45,846

200,501

15,22B

33,457

7,335

8,261

19,616

110,021

260,332

24.740

53,327

28.849

33.154

7,943

123,682

17,084

40,988

24,719

19,215

10.2

63.0

16.8

4.9

23.2

8.2

36.0

2.7

6.0

1.3

1.5

3.5

19.8

46.8

4.4

9.6

5.2

6.0

1.4

22.2

3.1

7.4

4.4

3.5

Table 10. Number and percent distribution of office visits by

disposition andduretion of visit: United States, 1979

Number of Percent

Disposition and duration ‘visits in distribution

thousands of visits

All visits . . . . . . . . . . . . . . . . . . . . . 556,313 100.0

Disposition

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

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

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

Telephone followupplanned . . . . . . . . .

Referred tootherphysician . . . . . . . . . .

Returned to referring physician. . . . . . . .

Admit tohospitei . . . . . . . . . . . . . . . .

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

64,686

344,028

114,069

21,194

13,797

3,561

11,431

3,764

11.6

61.8

20.5

3.8

2.5

0.6

2.1

0.7

Duration

0minutes2 . . . . . . . . . . . . . . . . . . . . 18397 3.4

l-5 minutes . . . . . . . . . . . . . . . . . . . 67,610 12.2

6-10 minutes . . . . . . . . . . . . . . . . . . . 169,217 30.4

11-15 minutes . . . . . . . . . . . . . . . . . . 149,291 26.8

16-30 minutes . . . . . . . . . . . . . . . . . . 118,171 21.2

31minutas or more . . . . . . . . . . . . . . . 33,027 53

lwi(i nottid to 100. tJsincemorathan onodisposition wac possible.

2RePre=nts viSi~ in which there was no faCe-tO-faCe COritwt batwem

the patient and the physician.
8

Technical notes

Source of data and sample design

The information presented in this report is

based on data collected in the National Ambulatory

Medical Care Survey (NAMCS) during 1979. The

target universe of NAMCS encompasses office visits

made within the conterminous United States by

ambulatory patients to nonfederally employed

physicians who are principally engaged in office

practice. The National Opinion Research Center,

under contract to the National Center for Health

Statistics, was responsible for the survey’s field

operations.

NAMCS utilizes a multistage probability design

that involves samples of primary sampling units

(PSU’S), physicians’ practices within PSU’S, and

patient visits within practices. For 1979 a sample

of 3,023 non-Federal, office-based physicians was

selected from master files maintained by the American Medical Association and the American Osteopathic Association. The physician response rate for

1979 was 71.8 percent. Sampled physicians were

asked to complete Patient Records (figure 1) for a

systematic random sample of office visits taking

place during a randomly assigned weekly reporting

period. During 1979, 45,351 Patient Records were

completed by responding physicians.

Sampling errors and rounding

of numbers

The standard error is primarily 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 of the

estimate by the estimate itself and is expressed as a

percent of the estimate. Provisional relative standard

errors of selected aggregate statistics are shown in

tables I and IL The provisional standard errors for

estimated percents of visits are shown in tables III

and IV.

Table 1. Provisional relative standard errors of estimated numbers of

office visits based on all physician specialties: NAMCS, 1978

Relative

Estimated number of office standard

visitsin thousands error in

persent

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.8

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.4

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.3

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.0

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.0

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7

50,000 . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . 4.8

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4

500,000 .’ . . . . . . . . . . . . . . . . . . . . . ...”.... ,4.1

Example of u;e of table: An aggregate of 75,000,000 visits has a relative standard error of 4.6 percent, or a standerd error of 3,450,000

visits (4.6 percent of 75,000,000).

Table IL Provisional relative standard errors of estimated numbers of

office visits based on an individual physician specialty:

NAMCS, 1978

Relative

Estimated number of office standard

visitsin thousands error in

percent

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 28.5

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.0

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.9

5,0CS0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.9

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 10.2

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.2

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.6

100,000 . ;., . . . . . . . . . . . . . . . . . . . . . . . . . . 8.3

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.2

Example of use of table: An aggregate of 15,000,000 visits has a rela-.

tive standard error of 9.7 percent, or a standard error of 1,455,000

visits (9.7 percant of 15,000,000).
admCwMa9

Table 1IL Provisional standard errors of percents of estimated numbers

of office visits based on all physician specialties: NAMCS. 1978

Base of percent

Estimated percent

(number of office Ior 5or 10or 200r 300r ~

viw-ts in thousands)

99 95 90 80 70

Standard error in percentage points

500 . . . . . . . . . . . . . ...2.5 5.5 7.6 10.2 11.7 12.7

1,000 . . . . . . . . . . . . ...1.8 3.9 5.4 7-2 8-2 9.o

2,000 . . . . . . . . . . . . ...1.3 2.8 3.8 5.1 5.8 6.4

5,000 . . . . . . . . . . . . ...0.8 1.8 2.4 3.z 3.7 4.0

10,080 . . . . . . . . . . . ...0.6 1.2 1.7 2.3 2.6 2.8

20,000 . . . . . . . . . . . ...0.4 o.9 1.2 1.6 1.8 2.o

50,000 . . . . . . . . . . . ...0.3 o.6 0.8 l.o 1.2 1.3

100,CCXI . . . . . . . . . . . ..O.2 0.4 0.5 0.7 0.8 0.8

500,000 . . . . . . . . . . ...0.1 0.2 0.2 0.3 0.4 0-4

Example of use of table: An estimate of 30 percent basad on an aggregate of 15,000,000 visits has a standard error of 2.2 percent, or a relative standard error of 7.3 percent (2.2 percent + 30 percent).

Table IV. Provisional standard errors of percents of estimated numbers

of office visits based on an individual physician specialty:

NAMCS, 1978

Base of percent

Estimated percent

(numbar of office lor 5or 10or zor 3~~ 50

visits in thousands)

99 95 90 80

Standard error in percentage pointa

500 . . . . . . . . . . . . . ...2.7 6.0 8.2 109 12.5 13.7

1,000 . . . . . . . . . . . . . ...1.9 4.2 5.8 7.7 8.8 9.7

2,000 . . . . . . . . . . . . ...1.4 3.0 4.1 5.5 6.3 6.8

5,000 . . . . . . . . . . . . ...0.9 1-9 2.6 3.6 4.0 4.3

10,000. . . . . . . . . . . ...0.6 1.3 1.8 2.4 2.8 3.1

20,000 . . . . . . . . . . . ...0.4 0.9 1.3 1.7 2.0 2.2

50,0 CO . . . . . . . . . . . . ..o.3 0.6 0.8 1.1 1.3 1.4

100,000 . . . . . . . . . . ...0.2 0.4 0.6 0.8 0.9 1.0

200,000 . . . . . . . . . . ...0.1 0.3 0.4 0.5 0.6 0.7

Example of uea of table: An estimate of 90 percent based on an aggragete of 7,500.000 visits has a standard error of 2.2 Percent. or a mlativa standard arror of 2.4 Percent (2.2 Percent+ 90 Parcent)-

Estimates of office visits have been rounded to

the nearest thousand. For this reason detailed figures

within tables da not always add to totals. Percents

were calculated on the basis of original, unrounded

figures and will not necessarily agree precisely with

percents calculated from rounded data.

Definitions

Ambulatory patient. –An ambulatory patient is

an individual presenting himself for personal health

senrices who is neither bedridden nor currently

admitted to any health care institution on the premises.

Office. –An office is a place that the physician

identifies as a location for his ambulatory practice.

Responsibility over time for patient care and professional services rendered there generally resides

with the individual physician rather than an institution.

Visit.–A visit is a direct personal exchange between an ambulatory patient and a physician, or

between a patient and a staff member working

under the physician’s supervision, for the purpose

of seeking care and rendering health services.

Physician.-A physician is a duly licensed doctor

of medicine (M.D.) or doctor of osteopathy (D.O.)

currently in office-based practice who spends time in

caring for ambulatory patients. Excluded from

NAMCS are physicians who are hospital based; physicians who specialize in anesthesiology, pathology,

or radiology; physicians who are federally employed;

physicians who treat only institutionalized patients;

physicians employed full time by an institution; and

physicians who spend no time seeing ambulatory

patients.
10 dwlcdaa

Duration of visit.– Duration of visit is time the time the physician spent reviewing rmxmis, tmt

physician spent in face-to-face contact with the results, etc. In cases where the pati6rIlt received

patient, not including time the patient spent wait- care from a member of the physician’s staff, but

ing to see the “physician, time the patient spent did not see the physician during the visit, the durareceiving care from someone other than the phy - tion of visit was recorded as zero minutes.

sician without the presence of the physician, or

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quanti~ more than O but less than 0.05

* Figure does not meet standards of

reliability or precision
Ambulatory Medical Care Survey: United States,

by Beulah K. Cypress, Ph.D., Division of Health Care Statistics

1977-78

Headache was the principal cause of an estimated

18,341,923 visits to office-based physicians during

1977-78. Headache was the seventh most frequent

symptomatic reason for visits given by patients.

The estimates in this report are based on data

collected in the National Ambulatory MedicaI Care

Survey (NAMCS), a probability sample survey conducted yearly by the Division of Health Care Statistics

of the National Center for Health Statistics. Since the

estimates presented in this report are based on a

sample rather than on the entire universe of officebased physicians, the data are subject to sampling

vanabiIity. The Technical Notes at the end of this

report provide a brief explanation of sampling errors

and guidelines for judging the precision of the estimates

presented. A more detailed description of the sample

design and additional definitions of certain terms used

in NAMCS have been published elsewhere. 1

Figure 1 is a facsimile of the 1977-78 Patient

Record used by participating physicians to record

information about office visits. The patient’s complaint, symptom, or other reason for the visit, expressed

as nearly as possible in the patient’s own words, is

recorded by the physician in item 6. The principal

reason (listed fmt in this item) is the one that in

the physician’s judgment was most responsible for the

patient making the visit. Data on principal reason were

classified and coded according to a reason for visit

classification system presented in another report.z

Since 1977 was the first year that this classification

system was used, caution should be exercised in comparing data presented in this report with those of prior

years.

1Nationalcenterfor Health Statistics: The NationaI Ambulatory Medical

CarC Survey, 1977 summary: United States, January-December 1977, by

T. Ezzati and T. McLemore. Vital and Health Statistics. Series 13-No. 44.

DHEW Pub. No. (PHS) 80-1795. Public Health Service. Washington. U.S.

Government Printing Office, Apr. 1980.

2 Nationa] Center for Health Statistics: A reason fOr ViSit ChSifiC’StiOrr for

ambulatory care, by D. Schneider, L. Appleton, and T. McLemore. Vital

and Health Stadsrics. Series 2-No. 78. DHEW Pub. No. (PHS) 79-13S2.

U.S. Government Printing Office, Feb. 1979.

Data highlights

Table 1 provides the age and sex of patients who

visited office-based physicians for medical care related

to headache. The average annual rate of these visits

increased with the advancing age group of the patients.

Females over 15 years of age tended to visit more

frequently for headache problems than males did. Visit

rates for female patients over 44 years of age were

about twice as high as those for their male counterparts.

Headache accounted for about the same proportion

of total visits regardless of the geographic Iocation of

Table 1. Number, percent distribution, and everageannual mte of office

visits with headache as the principal reason for visit by sex and age of

oatient: United States. 1977-78

Average

Number of

Perctwt

annual

Sex and age visirsin

distribution

visit rate

thousands per 1,000

persons

Both saxes

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

Under 15years . . . . . . . .

15-24 year n . . . . . . . . .

2544years . . . . . . . . . .

4W4yeam . . . . . . . . . . .

65years And over . . . . . . .

Female

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

Under 15years . . . . . . . .

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

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

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

65years And over . . . . . . .

Male

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

Under 15years . . . . . . . .

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

2544yearz . . . . . . . . . .

45-64 year n . . . . . . . . .

65yean and over . . . . . . .

18,342

1,793

2,486

5,8%3

5,186

2,871

12,148

787

1,645

3,858

3.699

2,159

6.184

1,006

841

2,138

1,496

713

100.0

9.8

13.6

32.7

28.3

15.7

66.2

4.3

9.0

21.0

20.2

11.8

33.8

5.5

4.6

11.7

8.2

3.9

43.2

17.6

31.4

53.8

60.2

63.9

55.4

15.8

40.8

67.0

82.0

81.8

30.3

19.4

21.7

39.7

36.3

38.4

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service, Offie of Health Research, Statistics, and Technobgy
2

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than O but less than 0.05

+

Figure does not meet standards of

reliability or precision

Fiaure 1. NATIONAL AMBULATORY MEDICAL CARE SURVEY PATlENT RECORD FORM:

1977-78

ASSURANCE OF CON F 10E NT IALIT Y -All Inforrnatlon which would rsrmlt lc4nWf ic.tion d m WIew!d.sl.

.m. fna.tk.. or ● .stmbl+slwno.t will m hold cOnNd..tl.l, will M u-d only m pgma. s.~ h and qtx A 033 p.rcmn. Qf m. S.*U. V ..d will net M dltclomd or ..l..m to c.char D.mO.s or .nd 107 ..v e?lwf 0WW9. 012

1. DATE OF VISIT

&*

2. DATE OF BIRTH

PATIENT RECORD

NATIONAL AMBULATORY MEDICAL CARE SURVEY

]. SEX

7. TIME SINCE ONSET

OF COMPLAINT/

SYMPTOM IN ITEM Ss

fckwck o?*I

, 0 LESS THAN 1 OAY

, 0 ~40AYS

t ❑ 1.3 WEEKS

. ❑ *4 MONTHS

IE MORE THAN

3 MONTHS

● D NOT APPL1CA8LE

❑ FEMALE

❑ MALC

COLOR OR

RACE

❑ WHITE

D NEGROI

BLACK

D OTHER

D UNKNOWN

1. PHYSICIANS DIAGNOSES

i WAS PATIENT

REFERRED FOR

THIS VISIT OY

ANOTHER

FNYSlC\AN7

: ❑ YES

3DN0

6. PATIENT3 COWMINTKl, SYMPTOM(SI, OR OTHER

●✎

b.

REASONIS) FOR TNIS VISIT

On wwnt> onm twmA)

MOST

IMPORTANT

OTHER

9. H4VE YOU SEEN

PATIENT BEFORE?

. . PF+INCIPAL DIAGNOSISIPROBLEM ASSOCIATE WITH

ITEM 6. $ •1 YES iONO

t

IF YES, FOR THE

CONOITION IN

b. OTHER SIGNIFICANT CU13FIENT DIAGNOSES ITEM 8.?

I ❑ YES JONO

11. DIAGNOSTIC SERVICES THIS

VkSIT IChcck●if Oftimd or provtdsdl

I G NONE

, 0 LIMITEO EXAM/ WS70RY

> ~ GENERAL EXAM/HISTORY

. 0 PAP TEST

, D CLINICAL LAB TEST

.OX RAY

$ L EKG

. ❑ VISION TEST

● ❑ ENOOSCOPY

● ❑ BLOOD PRESSUfl E CHECX

t O OTHER (Spectfyl

*6.34.2

;v. 9.?6

:2. THEP!APEUTIC SERVICES THIS

VISIT \CbcckW ordcmdor wwti)

, ❑ NONE

1 ❑ IMMuNIZATION{

DESENSITIZATION

J ❑ DRuGS lPRESCRIPTION/

NONPRESCRIPTION)

. ❑ WET COUNSELING

s ❑ FAMILY PLANNING

o ❑ ME OICAL COUNSELING

‘1 D ●HYSIOTHERAPY

o ❑ OFFICE SU@GERY

* ❑ ●SYCH07HEFl APY/

T1.lEflAPEUTIC LISTENING

@ ~ OTHER fSmct/vJ —,

13. OISFOSITION TMIS VISIT

!Clmck ●II tf18t~PIY)

1 ❑ NO POLLOW.U? ●LANNEO

‘ ❑ RETUnN AT S? ECIFIEO TIMI?

3 ❑ RETuRN IF NE EOEO. ●.R.N.

10. SERIOUSNESS OF

CONOITION IN

ITEM & ICtwckofw)

I D VEn YSERIOUS

I ❑ SERIOUS

● ❑ TELEPHONE FOLLOYWP’PLANNEO

‘ ❑ mEFERREOTO OTHEn ●HYSICIAN

‘ IJ ‘E Tun NEo 10 9EFEn RING ●HYSICIAN

1 D AOMIT TO HOSPITAL

‘ c1 OTHII R I.?psclry)

. DEPARTMENT 06 HEALTH, EOUCATION AND wELFARE

●uBLICHEALI I’!SEIfylCE

HEALTH RESOURCES AOMINISTn ATION

NATIONAL CENTER FOR wE*LTH STATISTICS

❑ :#&Y

O NOT SERIOUS

14. DURATION OF

THIS VISET

fftms msuslly

*1 #fh

Pllplaml

_ MINUTES

O.M.e. =6&m149S
@mcedaa3

Table 2. Number of office visits and number, percen~ ●nd average annual

rate of office visits with haadeche es tha pfincipal reason for visit, by

location of physician’s prectica: Unitad States, 1977-78

Number in thoum& AVOW

annual

Location of practice All visits Visits for Ibcan t visit mm

headache per 7,000

persons

Geographic ragion

Noflheast . . . . . . . . . . . 271,440 4,5s0 1.7 47.1

North central . . . . . . . . . 291,571 4,404 1.5 38.6

south . . . . . . . . . . . . . . 355,7s4 5,613 1.6 40.6

West . . . . . . . . . . . . . . 235,785 3,745 1.6 50.5

Type of ●rea

Matmpolitan. . . . . . . . . . 865,549 13,479 1.6 4.5.5

Nonmetropolitan . . . . . . . 289,001 4,563 1.7 36.3

the physi~ian’s pfictice (table 2). However, visit rates

varied, indicating higher utilization rates in the Northeast and West Regions than in the North Central and

South, and -in metropolitan than in nonmetropolitan

areas.

The specialists most commordy visited by patients

presenting headache as the reason for visit are shown

in table 3. Eighteen percent of visits to neurologists

were made by patients with a principal complaint of

headache. Other specialists treated headache patients

in 1 or 2 percent of their visits.

Table 3. Number of office visits ●d number ●nd percent of office visits

with headache es tha principal raason for visit, by selected physician

specialties: Unitad States, 1977-78

Number in thousands

Specialty Visitsfor Percent

All visits

headache

Allsmcialties . . . . . . . . . . . . . . . 1,154,550

General and family practice . . . . . . . 433,936

Internal medicine . . . . . . . . . . . . . 133.281

Fediatri~. .O . . . . . . . . ..O. . . . 114,921

6eneral surgery . . . . . . . . . . . . . . 6g,223

Ophthatmolm . . . . . . . . . . . . . . 58.851

Neuro\~ . . . . . . . . . . . . . . . . . 5,108

Otolaryngology . . . . . . . . . . . . . . 32,193

18.342

9.526

2,764

905

1,053

938

802

1.6

2.2

2.1

0.s

0.8

1.8

18.4

2.5

Patients who developed a headache that was a

new problem were likely to visit their physicians

within 3 weeks of its onset, with over 40 percent of

visits occurring in less than a week (table 4).

About half the visits for headache involved a condition evaluated by the physician as not serious in nature

(table 5). There was no statistically significant difference in this proportion by sex of the patient.

The principai diagnosis made by the physician -for

the patient who presents headache as the chief complaint is recorded in item 8 of the Patient Record.

Diagnostic codes are based on the Eighth Revision

International Classification of Diseases (ICDA).3 Table

6 contains a list of the diagnoses most frequently

associated with headache. Headache, as a diagnosis,

appeared in an estimated 31 percent of such visits

(ICDA codes 306, 346, and 791). An additional 14

percent were attributed to hypertension.

3National Center for Heatth Statistics: E&hth Revfsbrr Inre?MZfOM/

C7arsffication ofDfseases, Adapted for Usein the United Stares. PHS Pub.

No. 1693. Public Hcslth Semite. Washington. U.S. Government Printing

Office, 1967.

Table 4. Percmt of office visits with headache es a new problem, by sax

of patient and time since onset of cornpiainti United States. 1977-78

7ime since onset of complu”nt Female Mele

Percent

Lassthan lwaak . . . . . . . . . . . . . . . . . . . 43.9 49.3

Iawaaks . . . . . . . . . . . . . . . . . .. . . . . . 16.3 22.7

l-3 months . . . . . . . . . . . . . . . . . . . . . . . 16.1 13.6

Morethan 3 months . . . . . . . . . . . . . . . . . 20.5 13.7

Table 5. Percent distribut~on of office visits with headache as the principal reason for visit, by seriousness of problem, ~ording to sax of

petient:.Unitad States, 1977-78

Sentnmnass of problem Fernde Male

Percent distribution

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0

Notserious . . . . . . . . . . . . . . . . . . . . . . . . 51.4 47.3

Slightly serious . . . . . . . . . . . . . . . . . . . . . 35.6 38.3

%riousorvew serious . . . . . . . . ... . . . . . . . . 12.9 14.5
4

Ttilc 6. Number and percent distribution of office visitswith headache

as the principal reason for visit by principal diagnosis: Unitad States,

1977.78

Number of Percent

Principal diagnosis and ICDA code 1 visi~ in

tiousands

distribution

Alldiagnoses . . . . . . . .. l.... . . . . . 18,342 100.0

Neuroses . . . . . . . . . . . . . . . . .. 300 653 3.6

Special symptoms not elsewhere

Okssifiedz.. . . . . . . . . . . . . .. 306 1.692 9.2

Migraine . . . . . . . . . . . . . . . ...346 1,635 8.9

Refractivearrors . . . . . . . . . . ...370 5m 2.7

Essentialbtrnign hypenension. . . . . . 401 2.494 13.6

Acuto upper respirato~ infection of

multipla or unspecified sites . . . . . . 465 640 3.5

Chronic sinusitis. . . . . . . . . . . . . . 503 1.332 7.3

Havfavar . . . . . . . . . . . . . . . . .. 507

Haadache3 . . . . . . . . . . . . . . . . . 791

2.3

2;: 12.6

Concussion. . . . . . . . . . . . . . . .. 860

Allothwdiagnosas. . . . . . . . . . rasidu~ 6% :::

Is- on th- Eighth Rauision Intsrnstional Cbeeiflc~tiOn Of Disc-es.

Adaomd for Use )n ma United Ssasaa lICDAJ.

2Th- records coded 30S.8, dm ICDA cataoov fOr cwhalalok lnCluding”hmdecho of nonorganic origin ●nd mnsion hoadacha.

3Exclud~ h~dacho of nonorganic origin (308.89, mfemina (*). ●nd

tension haadachg (306. S).

Table 7. Percent of office visits with headacheasthe principalreasonfor

visit, bti selecteddiagnosticand therapeuticsasvicasosderador provided: United States. 1977-78

Diagnostic and tierapautic services

Pwwnt

of visits

Diagnostic satwices

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1

Limited exam/historv . . . . . . . . . . . . . . . . . . . . . . 62.2

General oxam/histo~ . . . . . . . . . . . . . . . . . . . . . . . 23.9

Paptast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1.4

Clinical labtast . . . . . . . . . . . . . . . . . . . . . . . . . . 16.2

x-w . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.0

EKG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5

Vision tact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3

Bloodpressurecheck . . . . . . . . . . . . . . . . . . . . . . . 49.2

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1

Therapautfcsemicas

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

immunization/dmen$itization. . . . . . . . . . . . . . . . . . 3.1

Drugs [prascriptiOn/nonprescription). . . . . . . . . . . . . . 73.8

Dietcounwling . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5

Medical counseling . . . . . . . . . . . . . . . . . . . . . . . . 21.0

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0

Officasu*~ . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘1.3

ptVchOtherapy/therapeuticlistaning . . . . . . . . . . . . . . 5.0

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Table 8. Percent distributirxs of df&visits with heedache astheprincipal reason forvisit byduration ~di~ositionofvisiC United States,

1977-78

Pwwnt

Durationandd~tion disrn”bution

of visits

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Duration

fJmirrut=l. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2

l+minutas. . . . . . . . . . . . . . . . . . . . . . . . . . . . ?1.2

6-10minutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.9

11-15minutes. . . . . . . . . . . . . . . . . . . . . . . . . . . 30.5

16-30minutas . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.7

31 minutas ormore . . . . . . . . . . . . . . . . . . . . . . . . 7.5

Disposition

No foliowupplannad . . . . . . . . . . . . . . . . . . . . . . . 9.4

Retumatspacified time . . . . . . . . . . . . . . . . . . . . . S2.4

Ratumifnaedetf,p. ran...... . . . . . . . . . . . . . . . . 32.3

Telephonefollovmpplanned . . . . . . . . . . . . . . . . . . 3.3

Raferrad tootharphysiawt . . . . . . . . . . . . . . . . . . . 4.6

Returntorefarringphysiciws. . . . . . . . . . . . . . . . . . ●1.8

Admitto hospital . . . . . . . . . . . . . . . . . . . . . . . . . ●1.2

Otherdisposition . . . . . . . . . . . . . . . . . . . . . . . . . “0.8

lVisits in which them wn no feto-facecontcct batvvaarl Sho pstiant

●nd tfwphyaician.

2Wlll not total 100.Osincemora than onodi~osition wospomibla.

The potential presence ofhypertensionis reflected

in the higher than average proport.ion ofvisitsin which

bIood pressure was measured. Table 7 shows that

blood pressure was checked during49 percent ofvisits

for headache compared witlithe NAMCS average of

34percentofallvisits.

Drug therapy (either prescription ornonprescription)wasusedin 74 percent ofvisits, aproportion that

exceeded the averageof53 percentofall NAMCS visits.

Table 7 also shows the percent of visits !m which

various diagnostic and therapeutic senices were either

ordered orprovided.

Table 8 provides data on the duration and disposition of visits for headache.

Additional data on headache and other reasons for

visits will be presented in more detail in a report f~m:

the Vital and Heaith Stat&tics series. C)uestio~,

regarding this report may be directed to the Ambulatory Care Statistics Branch by calling 301-436-7132.
Technical notes

source of data

The information presented in this report is based on

data collected in the National Ambulatory Medical

Care Survey (NAMCS) during 1977 and 1978. The

NAMCS universe is composed of office visits made

within the conterminous United States by ambulato~

patients to non federally employed physicians who are

principally engaged in office practice and are not in

the specialties of anesthesiology, pathology, or radiology. The National Opinion Research Center, under

contract to the National Center for Health Statistics,

is responsible for the NAMCS field operations.

Sample design

NAMCS utilizes a multistage probability design that

involves samples of primary sampling units (PSU’s),

physician practices within PSU’S, and patient visits

within physician practices. For 1977-78 a sample of

6,007 non-Federal, office-based physicians was selected

from master fdes maintained by the American Medical

Association and the &nencan Osteopathic Association.

The physician response rate for this period was 75. I

percent. Sampled physicians were requested to complete Patient Records (figure 1) for a systematic random

sample of office visits taking place during a randomly

assigned weekly reporting period. During 1977-78,

98.335 Patient Records were completed by responding

physicians.

Sampling errors

The standard error is primarily a measure of the

sampling variability that occurs by chance because

only a sample, rather than the entire universe, is

wmpled. The relative standard error of an estimate is

obtained by dividing the standard error of the estimate

by the estimate itself and is expressed as a percent of

the estimate. Relative standard errors for aggregate

statistics are shown in tables I and II. Standard errors

for estimated percentages are shown in tables III and

IV.

Table 1. Approximate relative standard errors of estimated numbers

of office visits based on all physician specialties: NAMCS, 1977-78

Relative

Estimafed number of office standard

visits in dsousands error in

percent

500 ... .. . ... .. . . .... . . . . .. . . . . . . .. .. . . 24.9

1,000.. .. .. ... . . . .. .. . . . . . . . .. . . . .. . . . . 17.7

2,000.. .. . ... . . .. . . .. . . . . . . .. . . . . . . . . . . 12.7

5,000. . .. .. .. .. . . .. .. . . . . . . . . .. . . .... . . 8.3

10,000. .. .. .. .. .. .. .. . . . . . ... .. . .. . . . . . 6.2

20,000. .. .. . .. . . ... .. . . . .. . .. .. .. .. . . .. 4.8

50,000. .. .. . .. . . . .. . .. . . . . . . . . . .. . . . . . . 3.8

200,000. . ... . .. . . ... . . . . . .. . . .. . . . . .. .. 3.1

1,000,000. .. .. .. . . ... . .. . . . . . . . .. . . . . . . . 2.9

Example of uea of tablt: An ●ggregate of 15,000,000 visits has a ralativc

standard wror of 5.5 porcont, or ● stsndard ● rror of 825,000 visits (5.5

percent of 15,000,000).

Table II. Approximate relative standard errors of estimated numbers

of office visits based on an individual physician specialty: NAMCS,

1977-78

Relative

Estimased number of office standard

visits in thousands error in

percent

500 . .. . .. .. .. . ... . . .. . . . . . ... . .. . . .. .. 27.0

1,000.. .. . .. . . . . .. . . . . .. . .. . . . . . . .. . . . . 19.6

2,000.. . . ... . . . . ... . . . . . . .. . . . .. . .. .. . . 14.5

5,000.. . . .. .. .. . .. .. . . . . . . . .. . . . . .. . . . . 10.3

10,000. .. . ... .. . . . .. . . . . . . .. . . . .. . .. .. . 8.5

20,000... .. .. . .. . .. . . . . .. . .. . . . . . .. . . . . 7.4

50,000.. .. .. .. . .. ... .. . . .. . . . . . . . . . . . . . 6.7

100,000.. .. .. .. . . .. .. . . . . .. . . . . .. .. . . . . 6.4

400,000.... ... . . . .. . . . . . . . . .. . . . . . . . . . . 6.2

Exampl@ of use of table: An aggregate of 7,500,000 visits has a relmive

standard ●rror of 9.4 percent, or e standard wror of 705,000 visits (9.4

percent of 7,500,000).

Definitions

Ambulatory patient. -An ambulatory patient is an

individual presenting himself for personal health

services who is neither bedridden nor currently admitted to any health care institution on the premises.
6

Office.-An office is a place that the physician

identifies as a location for his ambulatory practice.

Responsibility over time for patient care and professional services rendered there generally resides with the

individual physician ratherthan an institution.

Vz3it.-A visit is a direct personal exchange between

an ambulatow patient and a physician, or-between a

patient and a staff member working under the physician’s supervision, for the purpose of seeking care and

rendering heaIth services.

Physiciun.-A physician is a duly licensed doctor

of medicine (M.D.) or doctor of osteopathy (D.O.)

currently in office-based practice who spends time in

caring for ambulatory patients. Excluded from NAMCS

are physicians who are hospital based; physicians who

specialize in anesthesiology, pathology, or radiology;

physicians who are federally employed; physicians who

treat only institutionalized patients; physicians employed full time by am institution; and physicians who

<spend no time seeing ambulatory patients.

Tsble II 1. Approximate standard errors of percents of estimated numbers

of office visits based on all physician specialties: NAMCS, 1977-78

Basa of penxnt

Estimated perrwst

(number of office lor 5or 10 or 20 or 20 or so

visits in thousands) ~ 95 so 80 70

Standard error in percentage points

!500 . . . . . . . . . . ...2.5 5.4 7.4 9.9 11.4 12.4

l,OQO. . . . . . . . . ...1.7 3.8 5.3 7.0 8.o 8.8

2.000 . . . . . . . . . ...1.2 27 3.7 5.0 6.2

5,000 . . . . . . . . . ...0.8 1.7 2.3 3.1 z 3.9

10.000 . . . . . . . . ...0.6 1.2 -1.7 2.2 2.5 2.8

20.000 . . . . . . . . ...0.4 0.9 1.6 1.8 2.0

50,000 . . . . . . . . ...0.2 0.5 H 1.0 1.2

200,000 . . . . . . . ...0.1 0.3 0.4 0.5 ;:; 0.6

1.000,000 . . . . . . . . . 0.1 0.1 0.2 02 0.3 0.3

Table IV. Appmximata standard errors of percents of estimated num~

of office visits based on ●n individual physician specinltv: NAMs,

1977.78

Dae Ofpmant Estimated pefcen t

(numbr of ofh

visila in fhousndd lor 5or 10or 200r 300r so

99 96 90 80 30

Standard error in percentage points

500.............26 5.7 7.8 10.5. 12.1 13.1

1,000 . . . . . . . . . . . . 1.9 4.1 5.6 7.4 8.5 9.3

2.000 . . . . . . . . . ...1.3 2.9 3.9 5.3 6.0 6.6

5.000 . . . . . . . . . ...0.8 1.8 2.5 3.3 3.8 4.2

10,000 . . . . . . . . ...0.6 1.3 1.8 2.4 ;2.7 2.9

20,000 ., . . . . . . . ..O.4 0.9 7.2 1.7 . ‘1.9 2.1

60,000 . . . . . . . . ...0.3 0.6 0.8 1.1 !.2 1.3

100,ooo . . . . . . . . ..O2 0.4 0.6 ().9 0.8

400,000. . . . . . . . ..O.1 0.2 0.3 & 0.4 0.5

Examplo of uaa of table: An ●stimam of 90 oarcant bawd on ●n WSraeata

of 3,500,000 visits has ● standard ●ror of 3.2 r-cent, or a rdmhfa

standard wror of 3.6 peraant (3.2 oerant + 90 Percmt).

Ex8mpla of U- of toblo: An ●stimata of 20 pwcent baud an ●n sggreaate

Of 1S,000.000 visits hm ● emndard grror of 1.9 percent or ● rolmiv.

standard ●rror of 9.5 p.rwnt (1.9 pwcant + 20 parcont).
From Vital and Health Statlstlcs of the National Center for Health Statistics Number 68 s May 13, 1981

Stroke Survivors Among the Noninstitutionalized Population

20 Years of Age and Over: United States, 1977

by Abigail J. Moss, Division of Health Interview Statistics

Findings from a special stroke supplement to the

1977 National Health Interview Survey questionnaire

are presented in this report from the National Center

for Health Statistics. The supplement was developed

in response to a request from officials at the National

Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health.

Their particular data needs centered around three

major areas: (1) estimating the number of adults

among the noninstitutionalized population who have

survived a stroke, (2) gaining information on the

relationship between selected chronic conditions and

a history of stroke, and (3) describing the characteristics of persons who have had symptoms associated

with stroke. This report addresses each of these objectives and presents related stroke data by three

demographic variables-age, sex, and race.

According to data from the National Health Interview Survey (NHIS), in 1977 an estimated 2,692,000

persons 20 years of age and over in the U.S. civilian

noninstitutionalized population had experienced a

cerebrovascular accident–a stroke–and survived

(table 1).

Some persons reported stroke in response to

questions on the NHIS questionnaire concerning

doctor visits or restricted activity in the past 2

weeks, chronic limitation of activity, or selected

chronic conditions. However, the question that is

the primary source of information on the prevalence

of stroke survivors, asked of all persons who had not

reported stroke in response to earlier questions, was

“Has -- EVER had a stroke?”

Both self-respondents and proxy respondents

were asked the stroke questions. Because of the

characteristic manifestations of stroke, the use of

proxy respondents probably produced little underreporting of this condition. At the same time, proxy

respondents and self-respondents alike probably contributed to some overreporting of this condition.

Users of these data should remember that NHIS

stroke estimates are representative only of the civilian

noninstitutionalized population living at the time of

interview. Excluded from the estimates are persons

“who had experienced a stroke but were not living at

the time of the interview as well as those residing in

long-term care facilities. (About one-fourth of all

residents in nursing homes have cerebrovascular

disease. 1)

Furthermore, the above estimate of about 2.7

million stroke survivors is based on respondents’

perceptions of a stroke’s occurrence; that is, it is

based on self-diagnosed as well as medicaIIy diagnosed strokes. A stroke is classified as medically

diagnosed whenever there was a positive response

to the question: “Has a doctor EVER told - -he had

a stroke?” While an estimate based only on medically confmmed strokes might be more precise than

one based on both self-diagnosed and medically

confirmed strokes, no significant differences were

noted between medically confined and non-medically

confined strokes by sex, age, or race to warrant

separate treatment of the data. Limiting the data

presented to medically confined strokes was considered, but there is evidence to suggest that some

strokes are not actually medically diagnosed. Excluding all persons without a medical diagnosis would

probably result in an undercount. No doubt the estimate in this report does include persons who would

not have been medically diagnosed as having had a

stroke had they been examihed .by a medical doctor.

All NHIS data are subject to this kind of reporting

error. Therefore, the fact that some persons might be

misclassified is not sufficient reason to exclude all

persons without a medical confirmation.

Specifically, medically confined strokes were

reported for 92 percent of the stroke population

(table 2). (Persons who did not know whether the

stroke was medically confirmed were excluded from

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service, Office of Health Research, Statistics, and Technology
2

Table 1. Number and percent distribution of persons 20 years of age and over by stroke status, according to race, sex, and age: United States, 1977

[Data are based On household intemiews Of the civilian ncminstitutionalimd population. The source Of data, sampling, and limitations and qualifications

of data ara given in the technical notes]

Ever Never Ever Never

Race, sex, and age Total’ had a had a Totalz had a had a

stroke stroke stroke stroke

All races3 Number in thousands Percent distrib~ution

Bothsexes 20 years And over... . . . . . . . . . . . . . . . . . . . . . . . . . . .

2044 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-84yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Male20years Andover. ..: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Female 20yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2044years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

White

20yearsand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2044years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Black

20yearsand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2044 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Me’le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

139,965

74,341

43,357

22,266

65,801

35,904

20,700

9,197

74,164

38,437

22,657

13,070

123,626

64,671

38,792

20,163

58,519

65,106

14,420

8,372

4,098

1,950

6,339

8,081

2,692

287

881

1,524

1,316

125

484

708

1,376

163

397

817

2,314

220

751

1,344

1,162

1,152

362

56

130

176

148

215

134,487

72,639

41,605

20,243

63,234

35,136

19,812

8,286

71,253

37,503

21,793

11,957

118,928

63,268

37,266

18,394

56,277

62,651

13,672

8,091

3,878

1,702

6,031

7,641

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

2.0

0.4

2.1

7.0

2.0

0.4

2.4

7.9

1.9

0.4

1.8

6.4

1.9

0.3

2.0

6.8

2.0

1.8

2.6

0.7

3.2

9.4

2.4

2.7

98.0

99.6

97.9

93.0

98.0

99.6

97.6

92.1

98.1

99.6

98.2

93.6

98.1

99.7

98.0

93.2

98.0

98.2

97.4

99.3

96.8

90.6

97.6

97.3

‘Includes unknowns.

‘Excltides unknowns.

s,”c,”da~all races nOt ShOwn separately.

the population base used to calculate this percent.)

Men and women stroke victims had similar proportions of medically confirmed strokes. At first glance,

it would appear that there are differences among the

three age groups shownin table 2and between black

and white persons in the percent for whom medical

attention was reported. In this sample, however, these

variations were not statistically significant.a

As ameasure of the approximate number ofadult

stroke survivors currently in the noninstitutionalized

population, the figure of2.7 millionb is probablya

fairly complete estimate when compared with estimates of certain other chronic conditions that are

derived from household interview surveys. Chronic

aThe r-test with a critical value of 1.96 (0.05 level of signitlcance) was

used to test all comparisons discussed itsthis report.

bFor comparative purposes, the stroke prevalence estimate derived

from data collected by NHIS was 1.5 millionperson sin 1972, andin

1978 it was 1.7 million persons. During these years a checklist of

chronic conditions which included stroke was read to the household

respondent.

conditions are generally underreported in health

interviews. A number of methodological, studies

have shown that respondents report only conditions that they know of and are willing to discuss.

The conditions that are best reported in health

interviews are those-such as stroke–with the most

impact on a person, Limiting participation in one’s

usual activities, resulting in costly treatnnent, or

requiring medical care or daysin bed.z

For further details on the survey design and

procedures used to obtain data shown in this

report, see the technical notes.

Age, sex, and race

An estimated 2 percent of the 1977 civilian

noninstitutionalized population 20 years of age

and over had suffered a stroke and survived. The

prevalence rates for the youngest and oldest age

groups differed markedly, from a low of 4 persons

per 1,000 population aged 2044 years to ahighof
dvameckita 3

Table 2. Percent of persons with stroke for whom medical confirmation

of stroke wasreported, byage, sex, and race: United States, 1977

[Data are based on household interviews of the civilian noninstitutionalized population. The source of data, sampling, and limitations and

qualifications of date are givan in the technical notes]

Percent

Age, sex, and race medically

con firmed

All persons 20 years and over . . . . . . . . . . . . . 92.0

Age

2044 years . . . . . . . . . . . . . . . . . . . . . . . 87.0

45-64 years . . . . . . . . . . . . . . . . . . . . . . . 91.4

65 years And over . . . . . . . . . . . . . . . . . . . . 92.9

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 92.5

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . 91.4

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . 92.5

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . 88.6

NOTE: Denominator of percent excludes unknown medical confirma~ion.

70 persons per 1,000 population 65 years of age

or older. In fact, over one-half of the stroke victims

surveyed were at least 65 years of age; this reflects

the fact that stroke is a disease of the aged.s

The stroke prevalence rate was similar for men

and women under 45 years of age. For ages 45 and

over, however, the reported prevalence for men was

somewhat higher-40 per 1,000 population compared

to 34 per 1,000 population. National Health Inter-

\’iew Survey results further show black persons to

have slightly higher stroke prevalence estimates than

white persons have (2.6 and 1.9 percent, respectively).

Similarly, when these data have been age adjusted to

the U.S. adult population, the age-standardized estimates of stroke are higher for black persons (2.9 percent) than for white persons (1.9 percent).c These

racial differences, for the most part, occurred regardless of age. Statistically different stroke estimates by

sex and color, however. were observed only between

black women (2.7 percent) and white women (1.8

percent).

Age at time of fl~st ~tr~ke

All respondents who reported stroke were asked:

‘.How old was -- at the time he had his first stroke?”

Data derived from this question are shown in table 3.

A higher proportion of male than female stroke surcDa ta were adjusted to the age distribution of the 1977 U.S. civilian

noninstitutionalized population 20 years of age and over. The reader

should use the age-adjusted rates only for examination of the relationships within a given va-iable. Any quotation of percents and age-spec~lc

rates should be of the crude rates rather than the age-adjusted data.

vivors experienced their initial attack before they

were 65 years old–64.7 percent compared with 57.1

percent.

Data for black and white stroke victims seem to

suggest that black persons are more likely than white

persons to have their fmt stroke at an early age. However, the apparent black-white differences seen in

table 3 are not statistically significant.

Further examination of table 3 suggests that the

data shown there may partly reflect the disproportionate age distribution of black and white persons

in the population. For 1977, the U.S. Bureau of the

Census estimated that 11.4 percent of the white pop

ulation and 7.7 percent of the black population were

65 years of age or older.q

Table 3. Number and percent distribution of persons 20 years of age

and over with stroke by age at time of first stroke, according to race

and sex: United States, 1977

[Data are baaed on household interviews of the civilian noninstitutionalized population. The source of data, sampling, and limitations and

qualifications of data ara given in the technical notas]

All persons A-at time of first stroke

Ram and sex

20 years

and over Under 45-64 65 years

with stroke 45 yew-s years and over

All racesl

Both sexes . . . . . . .

Male . . . . . . . . . .

Female . . . . . . . . .

White

Both sexes . . . . . . .

Male . . . . . . . . . .

Female . . . . . . . . .

81ack

Both sexes . . . . . . .

Male . . . . . . . . . .

Female . . . . . . . . .

All racesl

Both sexes . . . . . . .

Male . . . . . . . . . .

Female . . . . . . . . .

White

Both sexes . . . . . . .

Male . . . . . . . . . .

Female . . . . . . . . .

Black

8oth sexes . . . . . . .

Male . . . . . . . . . .

Female . . . . . . . . .

Number in thousands

2,692 476 881

1,316 196 671

1,376 280 420

2,314 390 863

1,162 165 505

1,152 224 358

362 84 129

148 ●29 67

215 55 62

Percent distribution

100.0 19.7 41.1

100.0 16.5 48.2

100.0 22.8 34.3

100.0 18.7 41.5

100.0 15.6 47.9

100.0 21.8 34.9

100.0 25.9 39.8

100.0 ●22.5 51.9

100.0 28.2 31.8

945

418

527

829

385

445

111

“34

77

39.2

35.3

43.0

39.8

36.5

43.3

34.3

“26.4

39.5

1, ncludes all races IIOt Shown *paratelv2Excludes unknowns.

NOTE: When a figure is shown with an asterisk, it is presented only

for the purpose of combining with other cells. An estimate has a

relative standard error of less than 30 percent when the aggregate is at

least 35,000.
Table 4, which presents the percent of stroke

survivors aged 65 years and over by age at time of

first stroke, shows no appreciable difference between

white and black persons with respect to age at first

stroke.

Table 4. Number of persons 65 years of age and over with stroke and

percent distribution by age at time of first stroke, according to sex

and rata: United States, 1977

[Data are based on household interviews of the civilian noninstitutionalizad population. The source of data, sampling, and limitations and

qualifications of data are givan in the technical notes]

Number of

persons 65 Age at rime of first stroke

Sex and race

years and Tots/l

over with

Under stroke in 45-64 65 years

drousands 45 years years and over

Percent distribution

Tota12 . . . . . 1,524 100.0 4.8 28.5 66.8

Sex

Male ..,... 708 100.0 ‘4.4 31.9 63.7

Female . . . . . 817 100.0 5.0 25.6 69.4

Race

White . . . . . . 1,344 100.0 4.5 29.4 66.2

Black . . . . . . 176 100.0 *7.O 22.3 70.7

lExcludes unknowns

zlncl”de~ all raCaS fIOt Shown $aParateiy.

NOTE: When a figure is shown with an asterisk, it is presented only for

the purpose of combining witi other cells. An estimate has a relative

standard error of less than 30 percent when the aggregate is at Iaast

35,000.

Hospitalization for stroke

During the NHIS interview, respondents were

asked whether stroke survivors were hospitalized for

their first stroke. Responses to this item indicate that

about 62 percent of the stroke survivors were hospitalized for their first stroke (table 5). A hospitalization

was reported for proportionately more men than

women (66.5 compared with 58.3 percent).

Moreover, a higher percent of males under 65

than 65 years of age or older were hospitalized for

their initial stroke (73.4 compared with 61.3 percent).

In contrast, the proportion of females hospitalized

for stroke did not vary appreciably among specific

age groups.

The overall percents of white and black persons

hospitalized for initial strokes are similar. When these

data are compared for males and for females, it

appears that a substantially greater proportion of

black males than white males were hospitalized (74.6

compared with 65.6 percent). The difference between

these estimates, however, could be due to sampling

variability.

Chronic activity limitation

Besides the frequent loss of life associated with

stroke, a high proportion of stroke victims who survive are left with permanent disabilities. As an illustration, table 6 contrasts the percent of persons with

and without stroke by the kind of activity limitation

they had at the time of interview. These data are

derived from a series of NHIS questions tha[t enable

sample persons to be classified into one of four broad

limitation categories-unable to perform major

activity, limited in amount or kind of major activity,

limited in other activities, and not limited, in any

activities. Major activities include working, keeping

house, and going to school. In NHIS, only activity

limitations caused by at least one chronic condition

are classified.

In 1977, an estimated 72 percent of the stroke

population were limited in performance of their

major or other activities in some way because of

either a stroke or some other chronic conditioned In

contrast, 17.4 percent of adults without stroke were

limited in some way. As expected, with each sLlcceeding age group there was an increase in reported

activity limitation for both the stroke and nonstroke

populations. Among stroke victims, 39 percent of

those 20-44 years of age reported some limitation,

compared with 78.5 percent of persons 65 years of

age or older.

Over 40 percent of the stroke population surveyed were unable to perform their major activity at

all (compared with less than 5 percent of other

adults in the population). While this estimate varied

appreciably between males and females (58. 1 and

25.1 percent, respectively), the dissimilarity may

primarily reflect a sex difference in the NHIS definition of usual activity roles. For example, women

who had to leave the work force because of a stroke

and now consider their usual activity as “keeping

house” are asked about any limitations associated

with housework and classified accordingly. Men in

the same situation are classified according to their

ability to work outside the home.

AII limitations combined were reported for a

higher proportion of males with stroke (75.8 percent)

than females (68. 1 percent). The pattern is consistent

with activity limitation estimates for males and females in the general population.

Some of the difference in the limitation-of-activity

estimates for persons with and without stroke is

attributable to the disproportionate number of older

persons in the stroke population. When making

comparisons between population groups with varying

dFor this ~a[Y5is, no data were available on whether a stroke SU1’VivOt’S

activity limitation was related to the stroke.
admncedata 5

Table 5. Number and percent distribution of persons 20 years of age and over with stroke by whether hospitalized for first stroke, according to race,

sex, and age: United States, 1977

[Data are based on household inte~iew$ of the civilien nonin-itutionalized population. The Source of date, sampling, ●nd limitations and qualifications

of date are given in the technics! notes]

All parsons H~italized Not All W12SMS

20 years

Hospitalized Not

Race, sex, and age for first ho~itelized 20 yea= for first h~itafized

and over for first stroke and over for first

with stroke stroke stroke with stroke~ stroke

Al I recesz

Both sexes 20 years and over . . . .

2044years . . . . . . . . . . . . . .

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

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

Male 20 years and over. . . . . . . .

2044 years . . . . . . . . . . . . . .

45$4 years . . . . . . . . . . . . . .

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

Female 20 years and over . . . . . .

2044yeers . . . . . . . . . . . . . .

45-64 year n . . . . . . . . . . . . .

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

White

20years And over . . . . . . . . . . .

2044yeea . . . . . . . . . . . . . .

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

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

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

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

Black

20years And over . . . . . . . . . . .

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

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

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

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

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

Number in thousends Percent distribution

2,692

287

681

1,524

1,316

125

484

708

1,376

163

397

817

2,314

220

751

1,344

1,162

1.152

362

56

130

176

148

215

1,526

132

530

864

797

59

328

408

728

72

200

456

1J08

103

447

758

695

613

213

“27

83

104

100

113

921

76

271

574

401

“26

116

259

521

50

155

315

798

2::

512

365

433

119

●25

35

59

“34

85

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

62.4

63.5

66.2

60.1

66.5

69.4

73.9

61.3

58.3

58.5

56.2

59.1

37.6

36.5

33.8

39.9

33.5

30.6

26.1

38.8

41.7

40.7

43.5

40:9

62.1 37.9

67.8 32.9

65.4 34.6

58.7 40.3

65.6 34.4

58.6 41.4

64.2 35.8

●52.9 “49.0

70.3 29.7

63.8 36.2

74.6 25.4

56.8 42.7

‘Excludes unknowns.

2, “eludes ~11racesnot shown separately.

NOTE: When a figure is shown with an asterisk,it is prasentad only for the purpose of combining with other calls. An ●stimate hes ● relative standard

error of lessthan 30 percent when the ●ggregatais at Iaast35,000.

age distributions, it is helpful to take these differ- Chronic conditions associated with stroke

ences into account. Comparisons can be made within

age groups or by using age-standardized percents. Four health conditions associated with stroke

Table 7 shows limitation-of-activity data with and were listed on the 1977 NHIS questionnaire: (1)

without age adjustment. Age adjustment reduces the diabetes or sugar diabetes, (2) high blood pressure or

estimate of the proportion of the stroke population hypertension, (3) heart disease or heart trouble, and

comprising the most severe limitation-of-activity (4) blood clots in arms, legs, or lungs. Data obtained

categoxy from 41.2 to 26.1 percent. However, the from responses to questions as to whether sample

difference between the estimates of the most severe persons had any of these conditions in the 12-month

limitation for persons with and without stroke m- penod preceding the interview are shown in tables

mained substantial (26.1 compared with 4.7 percent). 8 and 9.

Age adjustment had little or no effect on the esti- The methodology employed for obtaining data

mates for the two remaining limitation-of-activity on these conditions was not intended to produce

categories. (see footnote c.) prevalence figures similar to the estimates of chronic
6 advancedata

Table 6. Number of persons 20 years”of age and over and percent distribution by degree of activity limitation, according to stroke status, age, sex,

and race: United States, 1977

[Data are based on household interviews Of the civilian nonin$titutionalized population. The source of data, sampling, and limitations and qualifications of data are given in the technical notes]

Activity limitation status

Number of

Stroke status, age, persons in Total Unable to Limited in

A II degrees Limited No

sex, and race thousands

perform amount or

of limitation major kind of in other acfivit y

activity activities limitation major activity

With stroke

Age

20 years and over . . .

2044 years . . . . . .

45-64 years

65 years and over . . .

Sex

Male . . . . . . . . . .

Female . . . . . . . . .

Race

White . . . . . . . . . .

Black . . . . . . . . . .

Without stroke

Age

20 years and over. . .

2044 years . . . . . .

45-64 years . . . . , .

65 years and over . . .

Sex

, Male . . . . . . . . . .

Female . . . . . . . . .

Race

White . . . . . . . . . .

Black . . . . . . . . . .

Percent distribution

2,692

287

881

1.524

100.0

100.0

100.0

100.0

71.8

39.0

70.9

78.5

41.2

12.5

37.9

48.6

25.0

20.9

27.6

24.3

5.6

●5.6

5.4

5.7

28.2

61.0

29.1

21.5

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

1,316

1.376

100.0

100.0

75.8

68.1

58.1

25.1

13.9

35.6

3.8

7.3

24.2

31.9

2,314

362

100.0

100.0

71.4

77.3

40.8

45.6

24.6

27.9

6.0

●3.6

28.6

22.9

134,487

72,639

41,605

20,243

100.0

100.0

100.0

100.0

17.4 4.6

1.2

5.6

14.8

9.0

4.4

12.0

19.7

3.8

2.8

4.5

5.8

82.6

91.5

78.0

59.7

8.5

22.0

40.3

63,234

71,253

100.0

100.0

18.2

16.7

7.6

2.0

7.0

10.8

3.6

3.9

81.8

83.3

118,928

13,672

100.0

100.0

17.2

20.3

4.4

7.1

9.0

10.5

3.9

2.8

82.8

79.6

NOTE: When a figure is shown with an asterisk, it is presented only for the purpose of combining with other calls. Anestimate hasa relative standard

error of Iess than 30percent whan the aggregate isat least 35,000.

conditions routinely produced from NHIS. Rather,

the items were viewed as providing gross measures

for observing any differences in the rates between

stroke victims and the rest of the population. These

qualifications should be considered when using the

data shown in these tables.

For each condition included in table 8, the

age-specific rates were markedly higher among

stroke victims than among other persons. The most

pronounced difference is for heart conditions, reported for almost one-third of the stroke population

compared with only one-twentieth of other adults

surveyed. A similar comparison of estimates for the

three remaining condition groups reveals the following differences: diabetes– 14.6 compared with 3.1

percent, hypertension–48. 1 compared with 12.5

percent, and blood clots–4.4 compared with 0.8

percent.

When data in table 9 are compared for diabetics

and nondiabetics, hypertensives and nonhypertensives, and persons with and without heart disease,

similar patterns are found. Specifically, there were

proportionately more stroke victims amcmg the

groups with either diabetes, hypertension, or heart

disease than among the group without these conditions. Furthermore, persons with all three of these

conditions were considerably more likely than others

to have had a stroke. Approximately 1 out of 5

persons (22.6 percent) with diabetes, hypertension,

and heart disease was also reported to have had a

stroke. Similarly, the rate of persons with all of

these conditions was almost 15 times higher among

the group of persons who had had a stroke than

among those who had not (49.0 compared with 3.4

per 1,000 persons). Even after age adjustment, the

variation between the estimates of stroke survivors
adwncedata 7

Table 7. Unadjusted and age-adjusted percent distributions of persons

Xl years of age and over by limitation of activity status, according

to stroke status: United States, 1977

[Data are baaed on household interviews of the civi!ian noninstitutionalized population. The source of data, sampling, and limitations and

qualifications of data ara given in the technical notes]

Activity

Unadjusted A@-edjusred’

limitation With Without

status

With Without

stroke stroke stroke stroke

Percent distribution

All persons 20 years and

over . . . . . . . . . . . . . 100.0 100.0 100.0 100.0

All degrees of limitation . . . 71.8 17.4 55.2 17.7

Unable to perform major

activity . . . . . . . . . . . 41.2 4.6

Limited in amount or kind

26.1 4.7

of major activity . . . . . 25.0 9.0 23.5

Limited in other activities . .

9.2

5.6 3.8 5.6 3.8

No activity limitation. . . . . 28.2 82.6 44.8 82.3

lAdju~td by the direct method to the ega distribution of the total

civilian nonirsstitutionalized population of the United States.

with and without these conditions remains substantial.

These data are consistent with findings from several

epidemiological studies in which high blood pressure,

heart disease, and diabetes have been identified as

cardinal risk factors for strokes ~G

Symptoms associated with stroke and

transient ischemic attack (TIA)

There is general agreement among researchers and

the medical profession that the risk of stroke is

substantiaIly increased among persons who have

experienced transient ischemic attack (TIA).s TIA is

most often described as a history of a neurological

deficit that clears in a defined period of time, but

there is less consensus in the criteria for its diagnosis.

Diagnosis of TIA is difficult for several reasons: the

transience of symptoms, the similarity of TIA

symptoms to those of other diseases, the absence of

residual disability, and the lack of a diagnostic test.

The symptom data contained in this report were

derived from responses to a checklist of some of the

symptoms associated with cerebrovascular disease

and TIA. The specific symptoms chosen are those

determined to be caused least often by conditions

other than cerebrovascular disease and TIA.e The

following symptom checklist was read to household

‘% this survey, no attempt was made to limit reporting of symptoms to

those caused by certain conditions, such as stroke or TIA. However,

symptoms were excluded if the respondent volunteered the information

that they occurred over a paduel period of time or resulted from en

accident or injury (e.g., loss of vklon due to old age or a blow to the

head).

respondents: ( 1) sudden paralysis or weakness of an

at-m and leg on the same side of the body, (2) sudden

numbness on one side of the body, (3) sudden

loss of vision, and (4) sudden loss of speech. The

reference period for this checklist was the 12 months

immediately preceding the interview.

The duration of symptoms used to define TIA or

to distinguish it from stroke is not standardized.7

Symptoms characteristic of TIA generally last from

5 to 30 minutes, but internals of up to 24 hours also

occur. Stroke diagnosis is linked to symptoms lasting

more than 24 hours.

For this report, symptoms were classified according to whether they lasted for more than 24 hours

or 24 hours or less. Because of the problems associated with identifying persons with TIA even in a

clinical setting, however, symptom data in this report

are not presented as prevalence estimates of TIA.

Furthermore, the estimated number of persons with

symptoms is small, further limiting analysis of data

shown in the remaining tables of this report.

Only about 2 percent of the adult population

surveyed were reported to have had one or more

symptoms during the year preceding the interview

(table 10). As expected, however, a considerably

higher proportion of persons with a history of stroke

were reported to have had symptoms. Approximately

1 out of 5 persons with stroke experienced symptoms

during the year preceding the interview ( 17.9 percent

compared with 1.7 percent of persons without a

stroke). The population having suffered a stroke can

also be classified by whether the stroke was suffered

recently-within 12 months of the interview date. Of

recent stroke victims, 48.1 percent had one or more

symptoms, compared with 10.7 percent of the

residual stroke population. Unfortunately, the number of sample persons with recent strokes is too

small for detailed tabulation of the data.

When the population with one or more stroke-like

symptoms is examined, it can be seen that approximately two-thirds (64.3 percent) of the population

with no stroke, compared with less than one-half

(47.5 percent) of the stroke population, had their

symptoms completely disappear within 24 hours.

For both population subgroups, the differences

observed for duration of symptoms by age, sex, or

race were not statistically significant.

The group of persons without a stroke who had

symptoms lasting more than 1 day is also sizable

(35.7 percent). As TIA symptoms usually disappear

in less than 1 day, it appears that many of the persons

surveyed reported symptoms that were associated

with some other health condition.

About one-half of the stroke population experiencing stroke-Iike symptoms in the past year were 65

years of age and over, whereas almost one-half (46.8

percent) of persons without a stroke who had these
8 aduancedata

Table 8. Number of persons 20 years of age and over and percent by selected conditions, stroke status, sex, and age: United States, 1977

[Data are based on household Interviews of the civilian noninstitutionalized Population. The source of data, sampling, and Imitations and qualifications of data are given in the technical notes]

Stroke status, sex, and age

Condition

Number of Blood clots

Persons in Diabetes Hypertension

Heart in arms.

disease legs, or thousands

lungs

With stroke

Bothsexes 20 years And over... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2044years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Male20 yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2044years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Female 20yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Without stroke

Bothsexes 20yearsandover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

45-64 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Male2f3 yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Female20yearsand over... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2044years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

2,692

287

881

1,524

1,316

125

484

708

1,376

163

397

817

134,487

72,639

41,605

20,243

63,234

35,136

19,812

8,286

71,253

37,503

21,793

11,857

Percent of persons

14.6

“6.6

13.4

16.8

14.5

“8.0

13.2

16.4

14.7

“5.5

13.6

17.1

3.1

1.0

4.6

7.4

2.8

0.9

4.4

7.4

3.3

1.2

4.8

7.4

48.1 31.8

27.5 17.4

52.7 29.7

49.4 35.6

42.8 33.6

●27 .2 “20.0

54.1 32.9

38.0 36.6

53.2 30.0

27.6 ●16.O

50.9 25.9

59.4 34.8

12.5 4.9

5.0 1.2

18.2 6.4

27.8 15.2

10.4 5.0

49 1.1

16.1 7.4

19.9 16.1

14.4 4.8

5.0 1.3

20.1 !5.4

33.3 14.6

4.4

“3.1

5.3

4.1

3.8

●1.6

*4.3

“4.0

4.9

●4.3

*6.5

4.3

0.8

0.4

1.0

1.6

0.5

0.2

0.8

1.1

1.0

0.5

1.2

1.6.

MOTE: When a figure is shown with an asterisk. it is Drassrnted only for the gurnose of combining with other cells. An estimate has a relative standerd

error of less than ~0 percent when the aggregata’is at ieast 35,000. “

symptoms were aged 20-44years(table 11). Men and

women with stroke were equally likely tohaveexperienced stroke-like symptoms within theyear. Among

the population without a stroke, however, there were

proportionately more women than men with

symptoms.

About three-fourths of the persons with symptoms had only one of the symptoms listed on the

questionnaire (table 12). About one-half of the stroke

population, compared with only about 15 percentof

persons without astroke,had two symptoms ormore

dunngthe year preceding the interview. Paralysis was

the symptom most frequently reported for persons

having had a stroke (65.8 percent), while numbness

was experienced by the greatest number of persons

whohad never had astroke (66.9 percent).

One or two additional questions were asked of

persons reporting symptoms:

“Did -- see a doctor for his (symptoms) (at that

time)?” and, if a doctor was seen,

“Was -- hospitalized because of the (symptoms)?”

Table 13 contains data derived from answers to

these questions. About 60 percent of persons with

stroke-like symptoms during the year preceding the

interview sought medical attention for the symptoms,

and about 1 out of every 3 persons who saw a doctor

was subsequently hospitalized. A greater proportion

of persons with stroke than without stroke reported

medical attention for the symptoms (78.3 percent

compared with 56.4 percent). Of persons who saw a

doctor for their symptoms, proportionately about 3

times as many persons with stroke as without stroke

were hospitalized (62.8 percent compared with 22.0

percent).
— aduancedata 9

Table 9. Number of persons 20 years of age andover and percent distribution and rate per 1,000 population bystroke status, according to selected

groups of conditions: United States, 1977

[Data are based on household interviews of the civilian noninstitutionalized population. The source of data, sampling, andlimitations andqualificationsof data aragivanin thetechnicel notes]

Number of

TotaI1

With Without With Without

persons in

thousands

stroke stroke stroke stroke

Rate per 1,000

population

Diabetes.. .. . . .. .. . ... . .. . . . .. .. ... ... .. . . . . .. 4,593

Nodiabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135,314

100.0 8.6 91.4 146.0 30.9

100.0 1.7 98.3 851.8 968.8

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,269 100.0 7.2 92.8

No hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121,508

481.4 125.0

100.0 1.2 98.8 514.5 873.8

Heartdisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,518 100.0 11.5 88.5

No heartdisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132,332

318.0 48.9

100.0 1.4 98.6 680.2 950.4

Diabetesonly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,100 100.0 3.9 86.1

Hypertension only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30.5 14.9

13,235 100.0 4.8

HeartdiseaseOnly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

95.2 234.8 92.9

3,513 100.0 7.1 93.0 91.0 24.0

Diabetes andhypertensism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,348 100.0

Diabetesand heartdisease. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.9 92.1 39.4 9.2

388 100.0 13.4 86.6

Hypertension andh.eartdisease . . . . . . . . . . . . . . . . . . . . . . . . . .

18.9 2.5

2,608 1m.o 14.0 86.0 134.5 16.5

Diabetes, hypertension, andheartdiseaw . . . . . . . . . . . . . . . . . . . . 590 100.0 22.6 77.4 49.0 3.4

lExclud=perWnS with unknownatroke status.
10 aduancedata

Table 10. Number of persons 20 years of age andover and percent distributions by whether stroke-like symptoms present in Past vear and duration

of symptoms, according tostroke status, age, sex, and race: United States, 1977

[Data are based on household interviews of the civilian noninstitutionalizad population. Thasourcaof data, sampling, andlimitations arrdqualificationsof data are given in the technical notas]

Number of Symptoms in past year Total with Duration of symp toms

Stroke status. age, sex, and race persons in To tall 1 symptom

thousands None 1 ormore

24 hours More than

or more’

or less 24 hours

Total

Age

20years andover2 . . . . . . . . . . . . . . . . . . . . . . . . .

204 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Sex

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

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

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

With stroke

Age

20yearsand over2 . . . . . . . . . . . . . . . . . . . . . . . . .

2044years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Sex

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

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

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Withoutstroke

Age

20yearsand over2 . . . . . . . . . . . . . . . . . . . . . . . . .

2044years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Sex

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

Female, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

139,965

74,347

43,357

22,266

65,801

74.164

123,626

14,420

2,692

287

881

1,524

1,316

1,376

2,314

362

134,487

72,639

41,605

20,243

63,234

71,253

118,928

13,672

Percent distributions

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

97.9

98.5

97.5

97.1

98.1

97.8

98.0

96.9

82.1

84.7

78.1

83.9

80.6

83.5

82.5

78.5

98.3

98.5

98.0

98.1

98.5

98.1

98.4

97.4

2.1

1.6

2.5

2.9

1.9

2.2

2.0

3.1

17.9

15.3

21.9

16.1

19.4

16.5

17.5

21.5

1.7

1.6

2.0

1.9

1.5

1.9

1.6

2.6

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

61.6

64.2

60.3

59.0

57.1

64.8

62.9

53.5

47.5

“65.9

44.9

46.4

45.0

50.0

49.9

●35.9

64.3

63.7

63.8

67.0

60.5

66.8

65.3

57.8

38.4

35.8

39.7

41.0

42.9

35.3

37.1

46.3

52.5

‘34.1

55.1

53.6

55.0

49.5

50.1

64.1

35.7

36.3

36.1

33.0

39.5

33.2

34.7

42.2

lExcludes unknowns.

Zl”c!ude$aJl rece$not shown saParateiV.

NOTE: Whan a figure is shown with ansrsterisk, it is presented orslyfor thepurpoaaof combining with otharcells. Anestimata hasa relative standard

arrorof lass than 30 parcent whan the aggregate isat laast 35,000.
acbmdab 11

Table 11. Number and percent distributions of Persons 20 Years of aw and over with stroke-like wmPtoms by sw and SeXt *cording to duration

of symptoms and stroke status: United States, 1977

[Data are based on household interviews of the civilian nonirwtitutionalizad Population. The source of data, sampling, and limitations and qualifications of data are given in tha technical notes]

Stroke status,age,and sax

Total with Duration of symptoms Tora/ with Duration of symp toms

1symptom 24 hours Afom than 1 symp tom

or more’ or more’ 24 hours Mora than

or less 24 hours or less 24 hours

Total

Age

20 years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2044 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Sex

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

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

With stroke

Age

20 years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2044years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -

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

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

Sex

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

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

Without stroke

Age

20 yearsand over . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2044years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Sex

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

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

Numberinthousands Percent distributions

2,877

1,151

1,076

650

1,220

1,657

482

44

193

245

255

227

2,326

1,088

851

386

940

1285

1,671

709

605

357

647

1,024

214

●29

83

103

104

1?0

1,417

665

506

246

532

885

1$343 100.0 100.0 100.0

396 40.0 42.4 38.0

399 37.4 36.2 38.3

248 22.6 21.4 23.8

466 42.4 38.7 46.6

558 57.6 61.3 53.5

237

●15

102

119

127

108

100.0

9.1

40.0

50.8

52.8

47.1

100.0 100.0

*13.6 ●6.3

38.8 43.0

48.1 50.2

48.6 53.6

51.4 46.0

786 100.0 100.0 100.0

379 46.8 46.9 48.2

266 36.6 35.7 36.4

121 16.6 17.4 15.4

347 40.4 37.5 44.1

440 59.5 62.5 56.0

ll”cjud=unknown dwsnbm

NOTE: Whan afigure is shown with anastarisk, it is presented onlyforthepurpow of combining with otharcalls. Arsastimate has a relative standard

error of lessthan 30 percent when tha aggragate is at least35,000.
Q

Table 12. Number and percent of persons 20 years of age and over with stroke-like symptoms, by stroke status, number of sYmPtoms, and kind of

symptom: United States, 1977

[Data are baaad on household interviews of tha civilian noninstitutionalizad population. The source of data, sampling, and limitations and qualifications of data are given in the technical notes]

Number and kind of symp roms

Total with With Without Total with

1 symptom 1 symp tom

With Without

stroke stroke

ormore ’ or more’

stroke stroke

Number of symptoms

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

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Kind of symptom2

Paralysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Numbness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vision less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Speech less. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in thousands Percent distribution

2,877 482 2,326 100.0 100.0 100.0

2,236 236 1,962 77.7 49.0 84.4

474 160 293 16.5 33.2 12.6

116 60 50 4.0 12.4 2.1

52 ●26 ’20 1.8 ●5.4 ●0.9

Number in thouwnds Percent

978 317 629 34.0 65.8 27.0

1,861 260 1,555 64.7 53.9 66.9

593 110 462 20.6 22.8 19.9

305 152 132 10.6 31.5 5.7

1,nclud~~ unknown stroke status.

2percentS by kind of symptom add to more than 100 as catefsorias are not mutuallv exclusive.

NOTE: When a figure is shown with an asterisk, it is presanted only for tha purpose of combining with other cells. An estimata has a ralative standard

error of leas than 30 percent when the aggregate is at least 35,000.

Table 13. Number and percent distributions of persons 20 years and over with stroke-like symptoms by whether doctor seen and, if so, whether

hospitalized, according to stroke status: United States, 1977

[Data are based on household irrtenriews of the civilian noninstitutional ized population. The source of data, sampling, and limitations and qualifications of data are given in the technical notes]

Doctor visit and hospitalization status

Total with With Without Total with

1 symptom 1 symptom

With Without

stroke stroke

ormore ’ or more’

stroke stroke

Number in thousands Percent distributions

Doctor visit status

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,877 482 2,326 100.0 100.0 100.0

Doctor sawn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,492 329 1,121 60.4 78.3 56.4

Doctor notsaen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 978 91 866 39.6 21.7 43.6

Hospitalization status3

Total, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,492 329 1,121 100.0 100.0 100.0

Hospitalized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458 203 247 30.8 62.8 22.0

Nothospitalizad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1$327 121 874 69.2 37.5 78.0

ll”cludes unknownstroke stms.

2Numbers j“clude””knO~” if doctor aaen; percents exclude UnlcnOwn if doctOr$aen.

3~xcludm Per~~ns who did notsaa a doctor.

‘tNumber~ i“=luda unknown if hospitalized; percents exclude unknOwn if hospitalized-
ackmecw 13

References

1National Center for Health Statistics: Chronic conditions and

impairments of nursing home residents, United States, 1969,

by A. Sirrocco. Vital and Health Statistics. Series 12-No. 22.

DHEW Pub. No. (HRA) 74-1707. Health Resources Administration. Washington. U.S. Government Printing Office,

Dec. 1973.

2National Center for Health Statistics: Prevalence of chronic

circulatory conditions, United Stat es, 1972, by C. S. Wilder.

J’iral and Health Statistics. Series 10-No. 94. DHEW Pub. No.

(HRA) 75-1521. Health Resources Administration. Washingt on. U.S. Government Printing Office, Sept. 1974.

3Li.lienfeld, A. M., and Gifford, A. J.: Chronic Diseases and

Public Health. Baltimore. The Johns Hopkins Press, 1966.

p. 284.

4U.S. Bureau of the Census: Statistical A bstract of the United

States, 1978, 99th ed. Washington, D.C., 1978. p. 29.

5Mules, J.: A population survey of symptoms suggestive of

transient ischemic attacks. Stroke. 2:114-127, Mar.-Apr. 1971.

6Lavy, S.: Hypertension and diabetes as risk factors in stroke

patients. Stroke. 4:751-759, Sept.-Ott. 1973.

7Kuller, L. H.: Survey of stroke epidemiology studies. Stroke.

3:579-585, Sept.-Ott. 1972.
14 adwncedata

Technical notes

The information from the National Health Interview Survey presented in this report is based on data

collected during 1977 in a continuing nationwide

survey by household interview. Each week a probability sample of households was interviewed by

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

information about the health and other characteristics

of each member of the household in the civilian noninstitutionalized population of the United States.

During 1977, there were about ZI1,000 interviewed households including about 111,000 persons.

The total noninterview rate was about 3.3 percent,

of which 1.9 percent was due to respondent refusal,

and the remainder was primarily due to the failure

to find an eligible respondent at home after repeated

calls. Stroke data were obtained for each household

member 20 years of age and over. This sample included approximately 73,000 persons.

Since the estimates shown in this report are based

on a sample of the population rather than on the

entire population, they are subject to sampling

error. Many tables in this report contain cells in

which the estimate of a given characteristic is

small. When an estimate or the numerator or denominator of a percent is, small, the sampling efior

may be relatively high. Therefore, differences observed in many of the tables between figures for

specific population groups may be due to sampling

variabilityy.

Cells containing estimates of questionable statistical reliability are noted by an asterisk (*) and

are ‘provided solely to allow readers to recombine

cells into useful groupings with greater reliability.

Standard errors appropriate for estimates of the

number of persons are shown in table I; standard

errors appropriate for estimated percents are shown

in table H.

To better understand the limitations of the

estimates presented in this report, data users are

encouraged to familiarize themselves with the survey

design, methods used in estimation, and general

qualifications of the data, which are described in

appendix I of the 1977 Current Estimates report

(Series 10, No. 126, in the Vital and Health Statistics series).

Definitions of certain terms used in this report

and the questionnaire used during 1977 appear in

appendixes 11 and III of the 1977 Current Estimates

report.

Whenever possible, data users should seek other

data sources to provide comparative statistics derived

from a variety of data-collection mechanisms.

Table 1. Standard errors of estimates of aggregates

Size of estimate in thousands Standard error

in thousands

35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

300. . . . . . . . . . . . . . . . . . . . . . . . . . . .

500. . . . . . . . . . . . . . . . . . . . . . . . . . . .

700. . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

11

13

15

18

26

31

40

48

57

98

125

174

278

325

340

Table 11.Standard errors, expressedin percentage points, of

estimated percents

Estimated percent

Base of percent in thousands

2or 5or 10or 200r SO

98 95 90 80

50 . . . . . . . . . . . . . . . . . . ...3.6 5.6 7.7 10.2 12.8

70 . . . . . . . . . . . . . . . . . . ...3.0 4.7 6.5 8.6 10.8

100 . . . . . . . . . . . . . . . . . ...2.5 3.9 5.4 7.2 9.0

200 . . . . . . . . . . . . . . . . . ...1.8 2.8 3.8 5.1 6.4

300 . . . . . . . . . . . . . . . . . ...1.5 2.3 3.1 4.2 5.2

500 . . . . . . . . . . . . . . . . . ...1.1 1.8 2.4 3.2 4.0

700 . . . . . . . . . . . . . . . . . ...1.0 1.5 2.0 2.7 3.4

1,000 . . . . . . . . . . . . . . . . ...0.8 1.2 1.7 2.3 2.9

3,000 . . . . . . . . . . . . . . . . ...0.5 0.7 1.0 1.3 1.6

5,000 . . . . . . . . . . . . . . . . ...0.4 0.6 0.8 1.0 1.3

10,000 . . . . . . . . . . . . . . . ...0.3 0.4 0.5 0.7 0.9

30,000 . . . . . . . . . . . . . . . ...0.1 0.2 0.3 0.4 0.5

50,000 . . . . . . . . . . . . . . . ...0.1 0.2 ().2 0.3 0.4

70,000, . . . . . . . . . . . . . . ...0.1 0.1 0.2 0.3 0.3
Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than O but lessthan 0.05

* Figure does not meet standards of

reliability or precision
From Vital and Health Statistics of the National Center for Health Statistics Numbar 69 ●April 1, 1981

Office Visits for Preventive Care, National Ambulatory

Medical Care Survey: United States, 1977-78

by Beulah K. Cypress, Ph. D., Division of Health Care Statistics

This report provides an estimate of public utilization of office-based physicians for purposes of

preventive care. Its focus is on visits for certain

examinations and tests that are likely to be undertaken because of the patient’s interest in good health

maintenance or early detection of disease.

Data on visits for such health-monitoring activities

are collected in the National Ambulatory Medical

Care Survey (NAMCS) of the National Center for

Health Statistics. In this survey the patient’s complaint, symptom, or other reason for visit, expressed

as nearly as possible in the patient’s own words, is

recorded by the physician in item 6 of the data

collection form. Physicians are instructed to record

key words or phrases verbatim to the extent possible.

Figure 1 is a facsimile of the 1977-78 Patient Record

used by participating physicians to record information about office visits. The principal reason (the

mason that is listed fust in item 6) is the one that in

the physician’s judgment was most responsible for

the patient making the visit. Data on reasons were

classified and coded according to a reason for visit

classification system presented in another report. 1

NAMCS is a probability sample survey conducted

yearly by the Division of Health Care Statistics. Since

the estimates presented in this report are based on a

sample rather than on the entire universe of officebased physicians, the data are subject to sampling

variability. The technical notes at the end of this

report provide a brief explanation of sampling errors

and guidelines for judging the precision of the estimates presented as well as definitions of certain terms

used in NAMCS. A more detailed description of the

lN*ti~n~l c~nter for Health Stattiics: A reason for Visit &lZ.$ifiGltiOn

for ambulatory care, by D. Schneider, L. Appleton, and T. McLemore.

Vital and Health S’tatimlx. Series 2-No. 78. DHEW Pub. No. (PHS)

79- 13S2. Public Health Service. Washington. U.S. Government Printing

Office, Feb. 1979.

sample design and additional definitions have been

published elsewhere.z The reader shouid note that

estimates of numbers of visits contained in this Eport are for a 2-year period, but ratios and rates

represent average annual estimates.

Pain, discomfort, and other morbidity-related

symptoms classified in the symptom module of the

reason for visit classification system, because of

their compelling nature, were the reasons given

most frequently by patients. These reasons constituted 56 percent of all office visits during the 2-year

period 1977-78 (table 1). Visits for diagnostic,

sueening, and preventive care-usually made by

asymptomatic patients for reasons other than

illness-made up the second largest group, accounting

for about 18 percent. The examinations and tests

Iisted in table 2 composed the major part of the

diagnostic, screening and preventive care group and

were responsible for about 17 percent of aU visits.

These specific reasons for visits were selected for this

analysis because they are likely to be patient motivated rather than physician initiated; they are also the

reasons for visits that arqleast likely to be related to a

morbid condition. TI& they offer a measure of

patients’ interest in preventive care.

As a group, illness-related reasons in the symptom

module exceeded those not necessmily related to

illness. Among all specific reasons, however, two

nonillness reasons were predominant, ranking first

and second. These were general medical examinations and routine psenatal examinations, which

accounted for about 5 percent and 4 percent of

visits, respectively (table 2). For women, prenatal

zNa*iOna[center for Health Ststistia: The National Ambulatow

Medical Care Survey, 1977 summary: United States, January-December

1977, by T. Ezzati and T. McLemore. VTtal and Health Statf.rtics.

Series 13-No. 44. DHEW Pub. No. (PHS) 80-1795. Public Health

Service. Washington. U.S. Government Printing Office, Apr. 1980.

U.S. DEPARTMENT OF HEALTH AND HUMA~ SERVICES, Public Health Service, Office of Health Research, Statistics, and Technology
2

ASSURANCE OF CON FIOENT IALIT Y-AII mlorrfumon -h,=h wo.ld o.rmn le9.ttl K.lum 01 an mat.m. al.

● PI=CNU. or s. 9subh*m.nt w116Lu tmld cmWdwnd. -811 b MM onlv by F9rvns •~ in ..e for

TMms..wmxnofThe w-v ● nd wall nor 0. diuloud or rel..md m sm., w-s m .s8a 90, ..v omur n.rswm, A 033012 _

1.DATE OF VISIT PATlENT RECORD

,*

NATIONAL AMBULATORY MEDICAL CARE SURVEY

2. DATE OF BIRTH ‘ 3. SEX 4. COLOR OR 5. WAS PATIENT

RACE REFERRED FOR

I 6. PAT,EN~S~WM!NT,S,. SVW70M,S,.OROTHE~ –

REASONIS) FOR THIS VISIT

THIS VISIT SY h wtmt> own twrds)

*

, ❑ WHITE ANOTHER

1 0 FEMALE ~ O NEGROI PNYSICIAN7 s. MOST

BLACK IMPORTANT

* a MALE 1 ❑ YES

3 0 OTHER b. OTHER

1 ● O UNKNOWN ~nNO

7. TIME SINCE ONSET 8. Pt4YSlClAN% DIAGNOSES 9. HAVE YOU SEEN 10. SERIoLfSNESS OF

OF COMPLAINT/

SYMPTOM IN ITEM Sn

PATIENT BEFORE? CONOITION IN

● . ●RI NCIPAL OIAGNOS:S/PROBLEM ASSOCIATED WITH

Ichuk 0.8)

ITEM Sa (Chssk end

ITEM 6S I ❑ YES 2DN0

I D LESS THAN 1 OAY

t

I D VERY SERIOUS

IF YES. FOR THE

z ❑ SERIOUS

30 1-6 OAYS CON OITION IN

b. OTMER SIGNIFICANT CUFIRENT o#AGNosEs

~ ❑ 1-3 WEEKS

ITEM E~7 , D SLIGHTLY

SERIOUS

‘=;::N ~ “’”s‘“No4nN0Ts 4 ❑ 1.3 MONTHS

so

● ❑ NOT APPLICABLE

I

11. DIAGNOSTIC SERVICES THIS 12. THERAPEUTIC SERVICES THIS

—

13. OISFOSSTION THIS VISIT 14. OURATION OF

VISIT [Check #i or~md Or prevtid) VISIT fChsck ●ll wdwrd or prowduf) (Cfbsck ●ll th6t#PP{V) THIS VISIT

I n NONE I ❑ NONE trime ecSua#v

] D NO FOLLOW.UP PLANNEO

z D LIMITEO EXAM/HISTOn Y

~ D iMMUNIZATION/ -t swrh

1 a GE NE HAL EXAMIMIS70RY DESENSITIZATION 2 D nETUBN AT SPECIFIEO TIME

. 0 ●AP TEST

Phv=ekt

J D DRuGS (PRESCRIPTION/

‘ O RETuRN IF NE EOED, ●.R.N.

s Cl CLINICAL LAB TEST

NONPRESCRIPTION)

● O OIET COUNSELING “ O TELEPHONE FOLLOW.UP ●LANNEO

. a X. RAY I D FAMILY ●LANNING ‘ D REFERREo TO OTl+En ●MYSICIAN

T ~ EKG ● D ME OICAL COUNSELING

MINUTES

1 a VISION TEST ~ ❑ ●I’IYSIOTHE nAPY

. n RETURNEO TO nEFERnlNG

●HYSICIAN

● n ENOOSCOPY , 0 OFFICE SUI?GERY ‘ O AOMIT TO HOSPITAL

1* ❑ BLOOO PPIESSUFIE CHECK * D PSYCHOTHERAPY/

: B O OTHER (Smdv) THERAPEuTIC LISTENING ‘ D 07HEn fxc]fy)

I ● ❑ OTUEn lSWtfy)

b

mnA.34.2 DEPARTMENT OF HEALTH. EOUCATION ANO WELFARE

—

SSEV. 9-76

u.M.B. =68-Q 1498

PUSLIC HE ALr HSEHVICE

WEALTH RESOURCES ADMINISTRATION

NATIONAL CENTEn’Fo@ HEALTH STATISTICS

Fwuta 1. National Ambulatory Medical Cam Sutwy Patient Racotd Form: 1977-78

Table 1. Numbsr and percent distribution of office visits by reason for

visit module: United States, 1977.78

NumLsw of Percent

Reascmfor visit module and R VC codel visiu in distribution

tfmuwnds of visits

All modules . . . . . . . . . . . . . . . . ...1.154.550 100.0

.?iymptom module. . . . . . . . . SOO1.Sggg 648$90 56.2

IXseasa module . . . . . . . . . .0001-0898 100902 8.7

Di~ostic, screening,and

pmvenn”vemodule. . . . . . . . X700.X599 211,680 18.3

Treatment module . . . . . . . . Tl@T699 103,566 9.0

Injuries and adverse effects

module . . . . . . . . . . . . . .JOO1.J999 48,941 42

Test results module. . . . . . . .R1oO-R7OO 6337 0.5

Administrative m~ule . . . . . .A1oo.A140 19,028 1.7

Othe# . . . . . . . . . . . . . .. U99W~ 15.185 1-3

I ~==d ~n tie ~=n for visit cjassiftition ( RVC). % raf •r*~ 1-

21 ncludes blanks, probloms ●nd complaints not ●bwhora claeeif “~d,

●nTrios of ““nom.” ●nd ihgiblo •mri~

examinations were proportionately more frequent

than general medical examinations. A rough measure

of patient motivation toward health care is the ratio

of return visits to new-problem visits. On the average,

patients giving prenatal care as the reason for visit

made about 5.3 return visits for each new-problem

visit. Because of these and other sex-specific examinations, the preventive measures shown in table 2

accounted for about 20 percent of visits made by

wqrnen, compzued with 11 percent of those made by

men.

Table 3 presents the percent distribution and

average annual rates of visits for the selected pnwentive care measures by sex and age of patients. When

the visits were for general medical examinations, eye

examination% or family planning visit rates for

females in all age groups exceeded those for their
admce&b3

Visits for blood pressure tests were more common

among men 15-44 years of age than among women

the same age, but the comparison is reversed for a~s

55 and over. During the middle years, 45-54, women

were as likely to visit for Mood pressure tests as men

were. Figure 3 highlights this phenomenon. Additional

information on blood pressure measurement (not

necessarily related to the reason for visit) has been

published earlier.3

Women 25-44 years of age had higher visit rates

for gynecological examinations and Pap smears than

women in other age groups had. Although professional

opinions VEUYregarding the optimal age and interYal

for testing for cexvical cancer, it appears from these

data that women in the childbearing years are more

likely than other women to have concern for this

aspect of health status.

Table 4 presents data on the utilization for preventive care of the four most visited physician specialties. More than half the visits to specialists in

Table 2. Number of office visits and percent of visiti for Preventive

care, by. sax of patient and selected PrinciPal reasons for visi~

Unitad States, 1977-78

Principal raason for visit

and R VC coda’

Both Female Male

saxes

Number of visits in thousands

All reasons. . . . . .- . . - . . . - . . . 1*154.550 694.431 460S119

Percent of visits

General medical examination . . Xl 00 5.1 5.0 5.3

Well-baby examination. . . . . . X105 1.2 1.0 1.5

Prenatal examination, routine. . X205 3.5 5.8 . . .

Postpartum examination. . . . . X215 0.4 0.6 . . .

Breast examination . . . . . . . . X220 0.1 0.1 “0.0

Gynecological examination . . . X225 1.2 1.8 . . .

Eye examination . . . . . . . . . X230 1.0 1.1 1.0

Blood pressure test . . . . . . . . X320 2.1 2.0 22

Papsmear . . . . . . . . . . . .. X365 0.7 1.1 . . .

Prophylactic inoculations . . . . X400 0.7 0.6 0.8

Family planning. . . . . . .X5OO-X51O 0.7 1.0 0.2

1Bam,j on tha reason for visit classification ( RVC). SOerd’arance 1.

male counterparts. Figure 2 demonstrates how visit

rates for general medical examinations increased with

advancing age of the patients, regardless of sex. Rates

for well-baby examinations and prophylactic irtocuIations were similar for both sexes, as might be

expected.

%.tional Center for Health Statistics: Office visits for d=ases of the

circulatory system, the National Ambulatory Medicat Care Survey:

United States, 197 S-76, by B. K. Cypress. Vitol and Heofth Stntf.stzk

series 13-No. 40. DHEW Pub. No. (PHS) 79-1791. PubIii Heaftb

Service. Waahhgton. U.S. Government Printing Office, Jan. 1979.

Table 3. Number. percwt distribution, and average annual rate of office visits for preventive care by sex and age of patient,

according to selected principal reasons for visit: Unitad Statas, 1977-78

Number of ‘oh Female Male

Princijxd reason for visit visitsin saxes,

and R VC codel thousands all Under 15-24 254 45-64 65 yews Undw 1524 25-44 4564 65 yaws

a* 15 years years years years and over 15 years yearn years years and over

Percent distribution of visits

12.5 13.5 10.0 17.0 2.5 5.3

. . . . . . 51.1 . . . . . .

51.8 ‘0.4 ;:: . . . . . . . . .

52.6 “0.7 . . . . . . . . . . . .

“35.1 *35.7 “15.2

50.9 25.1 4.3 . . . . . .

12.7 19.7 12.5 5.9 5.6 ;:1”

4.7 26.0 26.5 “0.1 “0.9 6.8

50.6 23.3 ●4.1 . . . . . . . . .

8.0 9.5 7.2 23.9 “3.7 7.7

46.6 “1.3 ●0.8 - ‘0.6 7.1

Average annual visit rate per 1,000 parsons ‘

128.1 176.2 224.4 193.4 38.1 58.3

27563 ... ...

. . . . . .

363.2 “3..6 :;; . . . . . . . . .

37.6 ●0.3 :.. . . . . . . . . .

●5.6 “7.2 *5.3 - - -

117.3 73.6 21.6 . . . . . . . . .

26,4 32.1 56.5 13.6 17.1 15.7

19.4 136.4 238.2 “0.4 “5.2 30.1

67.0 39.3 *11.8 . . . . . . . . .

11.3 17.2 22.2 37.5 “7.9 11.7

70.5 “2.4 “2.4 - ●1.2 20.0

General medical examination. . . X1OO

Well-baby examination. . . . . . . X105

Prenatal examination, routine . . X205

?ostpartum examination. . . . .. X215

8reast examination . . . . . . . . . X220

Gynecological examination . . . . X225

Eye examination. . . . . . . . . . . X230

Blood pressure test . . . . . . . . . X320

Papsmaar . . . . . . . . . . . . . .. X365

Prophylactic inoculations . . . . . X400

Family planning . . . . . . .X5OO-X51O

59,115

13,726

40,394

4,114

915

100.0 17.7

100.0 48.9

100.0 ‘0.5

100.0 *3.6

100.0 -

700.0 40.1

100.0 7.6

100.0 “0.6

100.0 “0.7

100.0 22.9

100.0 ●1.5

5.4 9.6 6.6

. . .

47.2

. . . . . .

. . . . . .

43.1

● 12.8

. . . . . .

“1.3

13,262

11.952

19.7

10.0

“ 0.4

21.5

5.4

40.9

. . .

11.0

20.5

. . .

8.0

23;696 13.6

7,631

8,152

7,94B

. . .

6.9

91.2

. . .

4.9

General medical examination. . . X1OO

Well-baby examination. . . . . . . X105

Prenatal examination, routine . . X205

Postpamm examination. . . . .. X215

Breast examination . . . . . . . . . X220

Gynecological examination . . . . X225

Eye examination. . . . . . . . . . . X230

8100d pressure test . . . . . . . . . X320

Papsmear . . . . . . . . . . . . . .. X365

Prophylactic inoculations . . . . . X400

Family planning . . . . . . .X5OO-X51O

138.6 208.8

2758.4 2760.1

31 B42 “3.9

318.8 ● 3.0

2.2 -

3605 “0.2

28.2 16.2

56.0 “2.6

334.8 “1.0

19.3 37.5

18.B “2.3

. . . 79.1 137.6 211.3

. . .

. . .

. . .

473.6

44.0

“2.9

54.7

. . . . . .

. . . . . .

. . . . . . . . .

“0.6

. . .

51.3

173.9

. . .

21.4

. . .

. . .

. . .

. . .

. . .

. . .

31.9

117.5

. . .

13.6

“ 2.8

29.7

“2.3

40.6

10.9

90.0

. . .

. . .

1Ba~ed on the ~ea~on for visit classification (R VC). See reference 1-

z~ated on the ~opulatio”n under 3 years of a9e.

3~a~ed ,m the female POpuhtiCIn ‘nk.
4

30~

Male

/’

:20 -

ii

g

\ k

\

a

a

~ 10 \

\

\

/0

\

//

-----

0- 1 I I I I t I

[

Under 15 1524 25-34 3544 45-54 56.64 65-74 75 and

over

Age in years

Figure 2. Average annual rata of office visits for genaral medical examinations. by sex and m of patient: United States, 1977-78

30 -

g20 -

i?

;

s

n

~

z 10

-+

+-N

o

15-24 25-34 5!S64 65-74 .75 and

over

*inyaem

Figure 3. Average annual rata of Offtcavisits for blood prasauretests.& sex ●nd ageof patiant: Unitad States.1977-7S

obstetrics and gynecology were for preventive care, nists and physicians in general and family practice

with prenatal examinations the predominant qpe of provided proportionately about the same amount

visit. Because of the large proportions of general of preventive care (about 14 percent of visits for the

medical examinations and well-baby examination former and 13 percent for the latter). However,

about one-fourth of the average pediatrician’s prac- general medical examinations and blood pressure

tice included visits chiefly for pnwentive care. Inter- ests constituted a larger share of preventive care
achmAaa5

Table 4. Number of office visitsand parcefikof visits for p~tiw cafe, by physician specialty, type of practice,and selected

prikipel reasonsfor vti Unitad Statas. 1977-78

Physician spaciaity Type of practice

Principal reason for visit and R VC code’

Genera/

and Internal Obstatn”cs

f~ily medicine pediatrics and solo Otie#

practice

gmecofogy

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433936

General medical examination.. . . . . . . . . . . . . . . . .. X1OO

Well-babyexamination . . . . . . . . . . . . . . . . . . . . . .. X105

Prenatal examination, routine. . . . . . . . . . . . . . . . . . . X205

Postpatwm examination . . . . . . . . . . . . . . . . . . . . .. X215

Eraastexamination . . . . . . . . . . . . . . . . . . . . . . . .. X220

Gyrrecologicai examination . . . . . . . . . . . . . . . . . . .. X225

Blood prassure test . . . . . . . . . . . . . . . . . . . . . . . .. X320

Papsmaar . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X365

Prophylactic inoculations . . . . . . . . . . . . . . . . . . . . . X400

Family planning . . . . . . . . . . . . . . . . . . . . . . .. X5W-X51O

4.3

0.8

2.2

0.2

“0.0

0.3

3.2

1.0

0.9

0.4

Number of visits in thousands

133,261 114321 104.412

7.7

. . .

0.0

:0.1

0.1

5.5

0.4

0.5

0.1

Percent of w-sits

316.0 5.5

48.5 . . .

“0.1 28.1

. 3.0

“0.2

“0.1 :1.1

:0.0 0.1

0.0 2.2

1.2 “0.2

“0.0 1.7

683,404

4.6

0.8

25

0.3

0.1

0.7

24

0.5

:;

471.146

5.8

1.7

4.9

0.5

0.1

1.8

1.6

0.8

0.3

1.1

visits for. internists than they did for general and family practitioners, probably because internists see

proportionately mom older patients.

Eye examination is not included in table 4 since

94 percent of such visits were to ophthalmologists.

Eye examination as a reason for visit was responsible

for 19 percent of the visits to ophthairnologists.

According to the data on lype of practice shown

in tabIe 4, certain types of preventive care axe more

common in offices with practice arrangements other

than solo. Except for breast examinations, prophylactic inoculations, and blood pressure tests, preventive care visits made up a smaller proportion of

visits to soIo practitioners than of visits to physicians

with other practice arrangements. Blood pressure

tests were proportionately more frequently the

reason for visits to physicians in solo practice than to

others. It is not possible to determine from NAMCS

data why visits for certain kinds of preventive cam

were more common in group than in other practice

arrangements. However, the availability of more

than one speciaIty may be a factor since, according to

an American Medical Association report, multispecialty groups constituted 59 percent of group

practice arrangements in 1975.4

Often, patients who visit primarily for illnessrdated problems also seek preventive care. The

4Goodman, L. J., Sennett, E. H., and odem, R. J.: Group Jfedicai

Pmrxice in tie U.S., 1975. Chicago. Center for Health ServicesResearch

and Deveiopmen t.American Medical Association, 1976.

secondary reason for visit is also recorded on the

Patient Record (figure 1). It is noteworthy that the

kinds of preventive care shown in table 5 were

mentioned as second reasons for 19.6 million visits

m 1977-78. There were almost as many visits with

breast examination mentioned second as there were

with the same examination given as the principal

reason. Obtaining a Pap smear was also frequently

a second reason for a visit A well-baby examination

or a routine prenatal examination was likely to be

the sole reason for a visit since a relatively small

number of records listed either of them second.

An exhaustive Iist of preventive care activities

comprises more than the examinations and tests

dressed in this report. Depending on the definition

of preventive care that is used, NAMCS preventive

Table 5. Numlmr of office visits with preventivecara assecond reason

for visit: United Stares. 1977-78.

Scond mason for visit

Wd RVC CO&l

Number of

viw-tain

dmusands

General medical examination . . . . . . . . . . . . . . . X1OO 2936

Prenatalexamination, routine. . . . . . . . . . . . . . . X295 773

Bmaetexmination . . . . . . . . . . . . . . . . . . . .. X220 852

Gynacolo@cel examination . . . . . . . . . . . . . . . . X225 1,480

Eyeexmination . . . . . . . . . . . . . . . . . . . . .. X230 852

Btood Pressura tact . . . . . . . . . . . . . . . . . . . .. X320 4252

Papsmear . . . . . . . . . . . . . . . . . . . . . . . . .. X365 4>96

Prophylacde inoculations . . . . . . . . . . . . . . . . . x400 1,727

Family planning. . . . . . . . . . . . . . . . . . . .X5OO-X51O 2.345

1a- on*O ~eti”forvisit ciassific~tion(RVC). SSCrafaran~ 1-
6

cane visits also include visits for such reasons as pa- coming report from the Vital and Health Stat&tics

tient education, diet and nutritional counw”ling, .senes. Questions regarding this report may be disocial problem counseling, and glucose level deter- rected to the Ambulatory Care Statistics Branch by

mination. Additional data on these and other types calling 301-436-7132.

of preventive care as well as on other reasons for

visit will be presented in more detail in a forthTechnical notes

Source of data

The information presented in this report is

based on data collected in the National Ambulatory

Medical Care Survey (NAMCS) during 1977 and

1978. The NAMCS universe is composed of office

visits made within the conterminous United States by

ambulatory patients to nonfederally employed

physicians who are principally engaged in office

practice and are not in the specialties of anesthesiology, pathology, or radiology. The National Opinion

Research Center, under contract to the National

Center for Health Statistics, is responsible for the

NAMCS field operations.

Sample design

NAMCS utilizes a multistage probability design

that involves samples of primary sampling units

(PSU’S), physician practices within PSU’S, and patient

visits within physician practices. For 1977-78 a

sample of 6,007 non-Federal, office-based physicians

was selected from master fdes maintained by the

American Medical Association and the American

Osteopathic Association. The physician response

rate for this period was 75.1 percent. Sampled

physicians were requested to complete Patient

Records (figure 1) for a systematic random sample

of office visits taking place during a randomly assigned weekly reporting period. During 1977-78,

98,335 Patient Records were completed by responding physicians.

Sampling errors

The standard error is primarily a measure of the

sampling variability that occurs by chance because

only a sample, rather than the entire universe, is

sampled. The relative standard error of an estimate

is obtained by dividing the standard error of the

estimate by the estimate itself and is expressed as a

percent of the estimate. Relative standard errors for

aggregate statistics are shown in tables I and II.

Standard errors for estimated percents are shlown in

tables III and IV.

Table L Approximate relativestandard errors of qimated numbers of

office visits baaedon all physician specialties: NAMCS, 1977-78

fielariw

Estimatad number of oftka smndad

visitsin dsousands frrror in

percent

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.8

I,ooo............................... 17.7

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.7

5,mo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.8

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1

I,ooo,ooo............................ 2.8

Exampla of use of teblo: An aggrogetoof 15,000,000 visits has ● r-la.

tive standard error of 5.5 percmt. or ● standard wror of 82 S,000

visits (5.5 porcont of 15,000,0mJ.

Teble IL Approximate relative stendad errors of estimated numbars of

office visits based on an individual physician specialty:

NAMCS, 1977-78

Relative

Estimati number of offka siandard

visitsin thouands error in

pemartt

600. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.0

1.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.6

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.5

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.3

Io,ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5

20,000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7

100.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2

ExmrwJloof use of table: An aggregata of 7,500,000 visits has ● roietirra smndmrd arror of 9.4 percent, or ● srendwd ● rror of 705,000

visits(9.4 per-m of 7,500.000).
TabIe II L Approximme standard e;rors of percents of estimated numbers

of office visitsbased on all physician s~”akies: NAMCS, 1977-78

Base of pament

Estimated pamant

(number of office

for 5or 10or 200r 3;; 50 visitsin thousands) 99 95 w p

Standard error in percentage points

!XIO. . . . . . . . . . . . . . ..Z5 5.4 7.4 9.9 11.4 12.4

1,000. . . . . . . . . . . . ...1.7 3.8 5.3 7.0 8.0 8.8

2.000. . . . . . . . . . . . ...1.2 Z7 3.7 5.0 5.7 6.2

5,000. . . . . . . . . . . . ...0.8 1.7 2.3 3.1 3.6 3.9

10,000. . . . . . . . . . . ...0.6 1.2 1.7 2.2 2.5 2.8

20,000 . . . . . . . . . . . ...0.4 0.9 1.2 1.6 1.8 2.0

60,000. . . . . . . . . . . ...0.2 0.6 0.7 1.0 1.1 1.2

200,000 . . . . . . . . . . . ..O.1 0.3 0.4 0.5 0.6 0.6

l,OOO,OOQ. . . . . . . . . . ..O.1 0.1 0.2 0.2 0.3 0.3

Exampla of uaa of table: An astimata of 20 percent based on ●n aggragctmof 15,000,000 visits has ● standard error of 1.9 P-cant. or a relative standard wror of 9.5 percant (1.9 P--m + 20 Pare.nt).

Table IV. Approximate standad errors of percents of estimated numbers

of office visits based on an individual physician specialty:

NAMCS, 1977-78

Base of percent Estimatad percent

(number of offica I or 50r loor ~or 3~~ 50

visitsin thousanc&)

99 95 m 80

Standard error in percentafp points

500 . . . . . . . . . . . . . ...2.6 5.7 7.9 10.5 12.1 13.1

1.8 4.1 5.6 7,4 as 9.3

%%::: :::: :::: :: :1.3 2.6 3.9 5.3 6.0 6.6

5,000 . . . . . . . . . . . . ...0.8 1.8 2.5 3.3 3.8 4.2

10,000 . . . . . . . . . . . ...0.6 1.3 1.8 2.4 2.7 2.9

20,000 . . . . . . . . . . . ...0.4 0.9 1.2 1.7 1.9 2.1

60,000 . . . . . . . . . . . ...0.3 0.6 0.8 1.1 1.2 1.3

100,000 . . . . . . . . . . ...0.2 0.4 0.6 0.7 0s 0.9

4oo,oc0 . . . . . . . . . . . ..al 0.2 0.3 0.4 0.4 0.!5

Definitions

Ambukwy patient.– An ambulatory patient is

an individual presenting himself for personal health

services who is neither bedridden nor currently

admitted to any health care institution on the premises.

Office.-An office is a place that the physician

identifies as a location for his ambulatory practice.

Responsibility over time for patient care and professional services rendered there generaily resides

with the individual physician rather than an institution.

Visit.-A visit is a direct personal exchange between an ambulatory patient and a physician, or

between a patient and a staff member working

under the physician’s supervision, for the purpose

of seeking cue and rendering health services.

Physiciaq.-A physician is a duly licensed doctor

of medicine (M. D.) or doctor of osteopathy (D.O.)

currently in office-based practice who spends time in

caring for ambulatory patients. Excluded from

‘NAMCS are physicians who are hospital based; physicians who specialize in anesthesiology, pathology,

or mdiology; physicians who are federally employed;

physicians

physicians

physicians

patients.

Examplo of uu of table: An astimma of 90 percent b8ti on an sgwagate of 3,500.000 visits has ● Standard ●rror of 3.2 percent. or 8 r@lath+astandard arror of 3.6 Pareant (3.2 Parcm’it+ 90 Percent).

Symbols

who treat only institutionalized patients;

empioyed full time by an institution; and

who spend no time seeing ambulatory

--- Data not available

. . . Gtegory not applicable

. Quantity zero

0.0 Quantity more titan O but less than 0.05

● Figure does not meet standards of

reliability or preeision
From Vital and Health Statistics of the National Center for Health Statistics Number 70 ● May 22, 1981

Utilization of Short-Stay Hospitals in the Treatment of

Mental Disorders: 1974-1978

by Edmund Graves, Division of Health Care Statistics, and Chris Lovato, formerly with this Division

Introduction

This report presents national estimates on the utilization of non-Federal short-stay hospitals by patients

discharged with a diagnosis of mental disorder. Included in the report are data on patients whose firstIisted diagnosis is psychosis, neurosis, personality

disorder (including alcoholism and drug dependence),

or other nonpsychotic mental disorder coded according to the Eighth Revision International Classification

of Diseases, Adapted for Use in the United States. ~

Information on the number of mental disorder discharges, average length of stay, and most frequent diagnostic categories are presented according to patient

characteristics for 1974-78. Also included are data on

the average length of stay according to patient’s expected source of payment for 1978. Discharges of

newborn infants are excluded from this report.

The statistics presented are based on data collected

through the National Hospital Discharge Survey, a

continuous survey which has been conducted since

1965 by the National Center for Health Statistics. A

brief description of the sample design, source of data,

and definitions of terms used in this report can be

found in the technical notes. Several factors should

be kept in mind in using the data discussed in this

report. It should be noted that the survey does not

include persons discharged from long-stay psychiatric

facilities. Also, statistics are presented on discharges,

not individual patients, since an ~dividual may have

been discharged from a hospital more than once.

Since the data presented in this report are based

on a sample of all discharges, they are subject to

sampling error. See the technical notes for further

discussion of sampling error.

Findings

General trends

From 1974 to 1978 an average of 1.5 million

persons with a first-listed diagnosis of mental disorder were discharged each year from short-stay

hospitals in the United States. The incidcncc of

discharges increased from 1974 to 1978 (table 1).

There were an estimated 1.3 million such discharges

in 1974 and 1.7 million in 1978, an increase of 28

percent.

When the number of mental disorder discharges

are compared with the number of ail patients discharged from short-stay hospitals, an average annual

mentaI disorder discharge rate of 44 per 1,000 is

indicated across 5 years of data. This rate increased

slightly from 41 per 1,000 discharges in 1974 to 48

in 1978. For a given hospitaI subpopulation, the

mental disorder discharge rate is the number of

mental disorder discharges divided by the total

number of discharges multiplied by 1,000. The rate

can be expressed as:

numberof first-listedmental

disorderdischargesx 1,000

MDDR =

total number of discharges

Table 1 also presents the average length of stay

for all mental disorder discharges for each year from

1974 to 1978. During this”period, the average length

of stay for patients diagnosed as having a mental disorder was 11.0 days, compared with 7.5 days for all

other diagnoses.

Table 1. Number of patients with a diagnosed mental disorder and

aweragalength of stay: United States, 1974-78

[Dischargesfrom non-Federal short-stay hospitals. Excludes

newborn infentsl

Year

Number of

Average

discharges

length

of stay

in thousands in days

1978 . . . . . . . . . . . . . . . . . . . . . . . . . 1,713 11.2

1977 . . . . . . . . . . . . . . . . . . . . . . . . . 1,613 10.9

1976 . . . . . . . . . . . . . . . . . . . . . . . . . 1,471 10.5

1975 . . . . . . . . . . . . . . . . . . . . . . . . . 1.476 11.1

1974 . . . . . . . . . . . . . . . . . . . . . . . . . 1J38 11.3

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service, Office of Health Research, Statistics, and Technology
2 adwncedata

Patient characteristics

As indicated in figure 1, the mental disorder

discharge rate was higher for all other patients than

for white patients. The largest difference is seen for

1975, in which there was a mental disorder discharge

rate of 40 for white patients discharged and 52 for

all other patients. It should be noted that color was

not stated in a large number of cases (approximately

15 percent). As a result, interpretations should be

made with caution.

Table 2 shows, by age and sex group, the number

and rate of patients diagnosed as having a mental

disorder who were discharged from short-stay hospitals. From 1974 through 1978, the number of

60

[

~ White

= All other

50

40

30

20

10

0 [

1976 1977 1978

Figure 1. Mental disorder discharge rate, by color: United States, 1974-78

males and females hospitalized with a mental disorder was about the same. The rate of hc}spitalization per 1,000 civilian noninstitutiomdized

population was higher in 1978 than in 1974. The

rates for males were 8.3 and 6.6, respectively, and

those for females were 7.8 and 6.3.

In 1974-78 a total of 3 million patients in the

age groups 25-34 and 3544 with a diagnosed mental

disorder were discharged from short-stay hospitals.

Together these age groups accounted for 39 percent,

or almost 4 out of every 10 patients with a mental

disorder. The age groups 15-24 and 45-54 accounted

for 33 percent, or a little over 3 out of every 10

patients with a mental disorder. The remaining 30

percent was distributed among the other three age

groups, with the under 15 years group accounting

for less than 5 percent of the discharges during this

period.

Most frequent diagnostic categories

During 1974-78, the two most frequent diagnostic

categories for all mental disorder discharges were

alcoholism and neurosis (table 3). Together these two

categories accounted for almost 6 out of every 10

persons diagnosed with a mental disorder (56 percent). Schizophrenia and effective psychosis ranked

third and fourth, respectively, over the 5-year period.

These two diagnostic categories accounted for an

average of 18 percent of these discharges.

Of the four most common diagnoses described

above, affective psychosis and schizophrenia had the

two longest average lengths of stay, with an average

of 17.5 and 16.6 days, respectively. The average

length of stay for neurosis and alcoholism was 9.9

and 8.2 days, respectively.

For females, neurosis was the most common

diagnosis for each of the 5 years from 1974 through

1978. This diagnostic category accounted for approximately 38 percent of all females diagnosed ‘with a

mental disorder. Alcoholism- and schizophreniii were

the next two leading categories of female discharges

in the 5-year period under discussion. Together

these two categories accounted for approximately

26 percent of all diagnoses of mental disordms for

females. For males, alcoholism was the leading

mental disorder diagnostic category for each year

of data analyzed. Approximately 45 percent of all

males with a ~mental disorder diagnosis were discharged with a diagnosis of alcoholism. The second

and ‘third most frequent diagnoses were neurosis

and schizophrenia, respectively. Together these two

diagnostic categories accounted for 29 percent of

all males diagnosed with a mental disorder.

Expected source of payment

In 1977, the National Hospital Discharge Survey

began collecting data on patient’s expected principal
aklce&a3

Table 2. Number and rate of patients with a diagnosed mental disorder discharged from short=tey hospitals, by sex and age: United States, 1974-78

[Discharges from non-Faderal short-av hospitals. Excludes r’mwborninfants]

Sex and age 1974 1975 1976 1977 1978

Ail mental conditions (except mental retardation] . . . . . . . . .

sex

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

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

Age

Under 15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

Allmental conditions (except mentel retardation) . . . . . . . . .

Sex

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

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

Age

Under 15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

1,338

657

680

41

230

270

248

230

187

153

6.5

6.6

6.3

0.8

6.1

9.3

11.1

9.8

8.7

7.4

Numberof dischargesinthousends

1,476 1,471 1,613

712 713 810

765 758 803

42 46 47

223 236 280

294 284 347

281 270 283

264 254 272

178 185 200

192 187 193

Rate of dischargesper 1,000 population

7.1 7.0 7.6

7.1 7.0 7.9

7.1 7.0 7.3

0.8 0.9 0.9

5.8 6.0 6.5

9.8 9.4 10.8

12.6 119 12.7

11.2 10.9 11.7

9.1 9.3 9.8

9.0 8.6 8.7

1,713

853

860

42

278

364

319

274

207

229

8.0

8.3

7.8

0.8

7.0

11.0

13.3

119

10.1

10.0

source ofpayment. This section describes these data

for patients with and without mental disorders who

weredischargedin 1978.

Figure 2depicts the percent distibution offmtIisted diagnosis by source of payment for thosepa

tients with and without mental disorders. Approximately 50 percent of all patients without mental

disorders and 43 percent of patients with mental

disorders listed private or commercial insurance as

their principal source ofpayment. The second leading

payment category for patients with and without

mental disorders was Medicare. For patients without

mental disorders it was 26.1 percent, while for

patients with a mental disorder it was 16.6 percent.

Together these two payment sources were used by

75.6 percent of all patients without a mental disorder, and 58.8 percent ofaUpatients with amental

disorder. At the other end of the spectrum, Workmen’s Compensation was a source of payment for

1.6 percent of all patients without a mental disorder,

and 0.3 percent with a mental disorder. “Other”

was a source of payment for 1.4 percent of all patients without a mental disorder, and 2.3 percent

with a mental disorder. There was no charge for

0.1 percent of all patients without a mental disorder,

and 0.2 percent with a mentaI disorder. Fourteen

percent of the patients with mental disorders and 6

percent of the patients without mental disorders did

not state their source of payment.

As shown in table 4, the distribution of days of

care by source of payment was similar to the distribution of discharges. Individuals with a diagnosed

mental disorder expecting to pay hospital ch~es

through private or commercial insurance caxriers

used the largest proportion of days of care (45.6

percent, or approximately 8.8 milIion days). Medicare

patients utilized the second highest percent of total

days of care (19.3 percent, or 3.7 million days). Of

the major sources of payment the smallest proportion of days of care was utilized by patients with

Workmen’s Compensation (0.2 percent, or 46,000

days of care).

Overall, there was Iittle significant variation in

length of stay by source of payment. The most

noticeable difference was that patients using private

or commercial insurance carriers as a method of

payment stayed an average of 3.8 days longer than

those utilizing their own resources as a source of

payment.
4 dvancedata

Table 3. Number of patients with a diagnosed mental disorder discharged from short-stay hospitals and average length of stay, by selected first-listed

diagnostic categories and sex: United States, 1974-78

[Discharges from non-Federal short-stay hospitak Excludes newborn infants]

Selected first-listed diagnostic categories,

ICDA code, 1 and sax

1974 1975 1976 1977 1978 7974 1975 1976 1977 1978

All mental disorders (290309)

Both WXeS . .

Male . . . . .

Female . . . .

Both sexes . .

Male . . . . .

Female . . . .

Both B2X13S. .

Male . . . . .

Female . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

Alcoholism (303)

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

Neuroses (300)

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

Schizophrenia (295)

Bothwxes . . . . . . . . . . . . . .

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

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

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

Affective psychosis (296)

Botheexes . . . . . . . . . . . . . . . . . . . . . .

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

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

Number of discharges in thousands

1,338

657

680

339

274

65

424

131

293

153

71

82

77

25

52

1,476

711

765

424

324

100

421

123

298

165

73

93

83

26

56

I ,471

713

758

428

328

102

391

118

273

179

84

95

85

24

62

1,613

810

803

468

362

105

425

133

293

221

101

120

97

35

62

1,713

853

860

519

397

122

437

136

301

222

108

114

124

41

83

Average length of stay in days

11.25

10.36

12.10

7.98

7.69

9.19

10.12

10.30

10.05

18.17

16.81

19.61

19.35

19.62

19.22

11.08

9.90

12.14

7.90

7.71

8.53

10.22

9.91

10.34

17.21

14.46

19.36

18.71

20.31

17.97

10.50

10.18

10.80

8.08

8.22

7.85

9.37

10.43

8.92

15.99

14.88

16.91

18.71

16.51

16.76

10.85

10.30

11.42

8.54

8.66

8.13

9.28

8.99

9.43

15.69

13.88

17.22

16.71

18.02

15.97

11.23

10.49

11.96

8.60

8.08

993

10.25

10.20

10.27

16.59

16.61

16.58

16.73

15.84

17.17

1 Eighth Revision I “ternational Cleseification of Diseases, Adapted for USe in the Unit@ States, 1965.

Table 4. Days of care, number of first-listed diagnosis, and average length of stay for inpatients with and without mental disorders discharged from

short-stay hospitals, by sources of paymant: United States, 1978

[Dischar~s from non-F ederssl short-stay hospitels. Excludes newborn infants]

With mental disorders Without mental disordem

Source of payment Number of Average Number of A varaga

Days of care first-listed Iangth Days of care first-listed length

diagnosis of stay diagnosis of stay

In thousands In days In thousands In days

Allsources of payment . . . . . . . . . . . . . . . . . . . . . 19,232 1,714 11.2 242,736 33,902 6.9

Self pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,204 144 8.3 9,920 1936 5.1

Workmen’s compensation . . . . . . . . . . . . . . . . . . . 46 5 9.7 3,689 556 6.6

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,7%4 284

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.1 93.778 8,834 10.6

1,753 181 16,142 2,547 6.3

Other government payments. . . . . . . . . . . . . . , . . . 812 91 V 4,484 783 5.7

Blue Cross, other privete orcommercial insurance . . . . . 8,772 723 12.1 97,283 16,787 5.8

No charge . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3 10.1 254 38 6.7

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 40 ,,10.2 2,870 461 6.2

Not stated . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,487 243 10.2 14,316 1 /861 7.3
akmedaa5

50

40

30

20

10

0

Insurance Medicwe Medicaid Self pay Other govern- Other Workmen’s No charge

ment pewnents Comfxrnsation

Source of payment

Figure 2. Percent distribution of first-listed diagnosis, by source of payment: United States, 1978

References

1National Center for Health Statistics: Eighth Revision Irzternational Classification of Diseases, Adapted for Use in the

United States. PHS Pub. No. 1693. Public Health Service.

Washington. U.S. Government Printing Office, 1967.

2National Center for Health Statistics: Utilization of shortstay hospitals, annual summary for the United States, 1974,

by A. L. Ranofsky. Vital and Health Statistics. Series 13-No.

26. DHEW Pub. No. (HRA) 76-1777. Health Resources Administration. Washington. U.S. Government Printing Office,

Sept. 1976.

3National Center for Health Statistics: Utilization of shortstay hospitals, annual summary for the United States, 1975,

by A. L. Ranofsky. Vital and Health Statistics. Series 13-No.

31. DHEW Pub. No. (HRA) 77-1782. Health Resources Administration. Washington. U.S. Government Printing Office,

Apr. 1977.

4National Center for Health Statistics: Utilization of shortstay hospitals, annual summary for the Uttited States, 1976,

by A. L. Ranofsky. Vital and Health Statistics. Series 13-No.

37. DHEW Pub. No. (PHS) 78-1788. Public Health Service.

Washington. U.S. Government Printing Office, June 1978.

‘National Center for Health Statistics: Utilization of shortstay hospitais, annuai summary of the United States, 1977,

by B. J. Haupt. Vital and Health Statistics. Series 13-No.

41. DHEW Pub. No. (PHS) 79-1557. Public Health Service.

Washington. U.S. Government Printing Office, Mar. 1979.

6National Center for Health Statistics: Utilization of shortstay hospitals, annual summary for the United States, 1978,

by B. J. Haupt. Vital and Health Statistics. Series 13-No.

46. DHEW Pub. No. (PHS) 80-1797. public Health Service.

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

7National Center for Health Statistics: Utilization of shortstay hospitals, summary of nonmedical statistics, United

States, 1973, by W. F. Lewis. Vital and Health Statistics.

Series 13-No. 23. DHEW Pub. No. (HRA) 76-1774. Health

Resources Administration. Washington. U.S. Government

printing Office, July 1976.
6

Technical Notes

Survey methodology

Source of data

The scope of the National Hospital Discharge

Survey encompasses patients discharged from shortstay noninstitutionalized hospitals, exclusive of

military and Veterans Administration hospitals,

located in the 50 States and the District of Columbia.

Only hospitals with six beds or more and an average

length of stay less than 30 days for all patients are

included in the survey.

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 into the survey

in 1968, 1972, 1975, and 1977.

The sample size and number of medical records

provided for the survey are presented below. Detailed information in regard to the sample can be

found in certain Vital and Health Statistics Series

reports.2 ‘b

Number of Number of

Year participating records

hospitals provided

1978 . . . . . . . . . . . . . . . . . 413 219,000

1977 . . . . . . . . . . . . . . . . . 423 224,000

1976 . . . . . . . . . . . . . . . . . 419 223,000

1975 . . . . . . . . . . . . . . . . . 4’= 232,000

1974 . . . . . . . . . . . . . . . . . 426 227,000

Sample design

All hospitals with 1,000 beds or more in the universe of short-stay hospitals were selected with

certainty in the sample. All hospitals with fewer than

1,000 beds were stratified~ the primary strata being

24 size-by-region classes. Within each of these 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.

Subsamples of discharges were selected within

the sample hospitals using the daily listing sheet of

discha~es as the sampling frame. These discharges

were selected by a random technique, usually on the

basis of the terminal digit(s) 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 vaned

inversely with the probability of selection of the

hospitals.

Sampling errors

Since the estimates for this report are based on a

sample rather than the entire universe, they are subject to sampling variability. The standard error is

primarily a measure of the variability that is attributed to using a value obtained from a sample as an.

estimate of a population value. The value that would

have been obtained had a compIete enumeration of

the population been made will be contained in an

interval represented by the sample estimate plus or

minus 1 standard error about 68 out of 100 times,

and plus or minus 2 standard errors about 95 out of

100 times.

The relative standard error is obtained by dividing

the stan tird error by the estimate. The resulting

value is. 2 ultiplied by 100, which expresses the standard error as a percentage. The relative standard error

applicable to patients discharged (or fust-listed

diagnosis) and days of care for 1978 data presented in

this report are provided in table I. Relative standard

error estimates for 1974 through 1977 can be found

in earlier publications.z -5 The formula used for

computing the variance of average length of stay has

also been published.7 The two-tailed Bonferroni test

for multiple comparisons was performed for testing

the difference between two estimates.

Table 1. Approximate relative standard errors of estimated number of

first-listed diagnoses and days of care

First- Days

Size of estimatein thousands Iistad of

diagnoses care

Relative standard error

1 . . . . . . . . . . . . . . . . . . . ,370 ..-

10: : : : : : . . . . . . . . . . . . . . . . . . . .165 .290

100 . . . . . . . . . . . . . . . . . . . . . . . . .080 .165

1,000 . . . . . . . . . . . . . . . . . . . . . . . .050 .100

10,000 . . . . . . . . . . . . . . . . . . . . . . .035 .060

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

NOTE: A list of references follow text
aknceda7

discharges of the same individual from one or more

short-stay hospitals.

Discharge.–The formal release of a patient by a

hospital; that is, the termination of a period of

hospitalization by death or by disposition to pIace

of residence, nursing home, or another hospital.

“Discharges” and “patient discharges” are used

synonymously.

lkzys of Care.–The total number of patient days

accumulated at the time of discharge by patients discharged from short-stay hospitals during a year. A

stay of less than 1 day (patient admitted and’ discharged on the same day) is counted as 1 day in the

summation of total days of care. For patients admitted

and discharged on different days, the number of days

of care is computed by counting all days from (and

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

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.

Mental Disorder Discharges. -Discharges discussed

in this report are those designated with a frost-listed

diagnosis of mental disorder in the Eighth R“evision

International Classification of Diseases, Adapted for

Use in the United States. 1 Included are three-digit

code numbers 290 through 309. Mental Retardation,

code 310, is not included in this report.

First-Listed Diagrzosi.s.-The coded diagnosis identified as the principal diagnosis or else listed first on

the face sheet of the medical record. The number of

frost-listed diagnoses is equiwdent to the number of

discharges.

Age. –Patient’s age refers to age at birthday prior

to admission to the hospital inpatient service. ‘

Color. –Patients are classified into two groups,

“white” and “ail other.” The all other classification

includes all categories other than white.

NOTE: A list of references follow texL

Symbols

--- Datanot available

. . . Category not applicable

Quantity zero

0.0 Quantity more than O but less than 0.05

● Figure does not meet standards of

reliability or precision

“U.S.Gownment Printingoffics 1993— 301-01WO015
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 6.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures–These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the

methods used to collect and process the data, definitions,

and other material necessary for understanding the data.

Data Evaluation and Methods Research –These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies

also include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

Analytical and Epidemiological Studies –These reports

present analytical or interpretive studies based on vital and

health statistics.These reports carry the analyses furtherthan

the expository types of reports in the other series.

Documents and Committee Reports–These are final

reports of major committees concerned with vital and health

statisticsand documents such as recommended model vital

registration laws and revised birth and death certificates.

International Vital and Health Statistics Reports-These

reports are analyticalor descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

Cognition and Survey Measurement–These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

Data From the National Health Interview Survey-These

reports contain statistics on illness; unintentional injuries;

disability use of hospita!, medical, and other health servicew

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey–

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributionsof the population with respect to

physical, physiological, and psychological characteristics,

and (2) analyses of trends and relationships among various

measurements and between survey periods.

Data From the Institutionalized Population Surveys –

Discontinued in 1975. Reports from these surveys are

included in Series 13.

Data From the National Health Care Survey–These

reports contain statisticson health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14.

SERIES 15.

SERIES 16.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

SERIES 24.

Data on Health Resources: Manpower and Facilities–

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

Data From Special Surveys–These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

Compilations of Advance Data From Vital and Health

Statistics –Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reperk in Series 10-13.

Data on Mortality–These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

Data on Natality, Marriage, and Divorce–These reports

contain statistics on rmtality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

Data From the National MortaIHy 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 infertility and related maternal and infant

health topics. These statistics are based on national surveys

of childbearing age.

Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy–

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

hforJth/yVW Statistics f?eporf (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vita/ Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed 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 Belcrest Road, Room 1064

Hyattsville, MD 20782

(301) 436-6500
DEPARTMENT OF

HEALTH & HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

6525 Betcrest Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

DHHS Publication No. (PHS) 94-1866, Series 16, No. 7