Vital and

Health Statistics

Series 16:

Compilations of Advance

Vital and Health Statistics

No, 5

Data From

Data in this report from health and demographic surveys present

statistics by age and other variables on ambulatory medical care; the

use of intrauterine contraceptive devices; health care coverage; the use

of family planning services by currently married women; hemoglobin

and selected iron-related findings; and prevalence, disability, and health

care for Psoriasis, Estimates are based on the civilian noninstitutionalized

population of the United States. These reports were originally published

in 1978 and 1979,

US. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

Hyaftsville, Maryland

January 1991

DHHS Publication No. (PHS] 91-1864
Copyright Information

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

reproduced or copied wtthout permission; c!tation as to source, however, is

appreciated

Suggested Citation

National Center for Health Statistics Advance data from vital and hea]th

statistics: nos 41-50 National Center for Health Statistics Vital Health Stat

16(5) 1991.
National Center for Health Statistics

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

Robert A. Israel, Deputy Director

Jacob J, Feldman, Ph. D., Associate Director for ,4rzdysis

and Epidemiology

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

Extramural Programs

Peter L. Hurley, Associate Director for Vital and Health

Statistics Systems

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

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

and klethodolo~

David L. Larson, Assistant Director, Atlanta
Office Visits for Respiratory Conditions, National Ambulatory Medical Care Survey: United States,

1975-76 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office Visits to Cardiovascular Specialists, National Ambulatory Medical Care Survey United States,

1975-76 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Use of Intrauterine Contraceptive Devices in the United States... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health Care Coverage: United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Use of Family Planning Services by Currently Married Women 15-44 Years ofAge: United States, 1973and

1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hemoglobin and Selected Iron-Related Findings of Persons l–74Years ofAge: United States, 1971–74 . . . . .

Prevalence, Disability, and Health Care for Psoriasis Among Persons l-74 Years: United States... . . . . . . . . .

1977 Summary National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office Visits for Family Planning, National Ambulatory Medical Care Survey United States, 1977 . . . . . . . . . .

Office Visits by Black Patients, National Ambulato~ Medical Care Survey: United States, 1975-76 . . . . . . . . .

No. 41

No. 42

No. 43

No. 44

No. 45

No. 46

No. 47

No. 48

No. 49

No. 50
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ● Public Health Service I Number 41 . Octobsr 30, 1978

Office Visits for

Medical

Respiratory Conditions, National Ambulatory

Care Survey: United States, 1975-76’

According to data collected in the National

Ambulatory Medical Care Survey (NAMCS) by

the NationaI Center for Health Statistics

(NCHS), an estimated 163.4 million visits to

office-based physicians were attributed to diseases of the respiratory system during the 2-year

period January 1975 through December 1976.

Respiratory diseases comprised approximately

14 percent of alI office visits for that period and

were the leading morbidity related ICDA2 classified group of diseases treated.

NAMCS is a sample suvrey conducted annually by NCHS’S Division of Health Resources

Utilization Statistics. The estimates in this ~

report are based on information recorded by

part icipating physicians on brief encounter

forms (see Technical Notes) during sampled

office visits. A brief description of the sample

design and an explanation of the sampling errors

associated with selected aggregate statistics may

be found in the Technical Notes of this report.

Patients visiting with respiratory system

complaints were likely to present new rather

than continuing problems. This finding departs

significantly from the generaI trend towards

higher proportions of continuing problems in

most morbidity related diagnostic groups. Figure

1 illustrates the difference in problem status

1~~ ~epo~ wa5 prepared by Beulah K. Qpress,

Ph.D., Division of Health Resources Utilization Statistics.

2National Center for Health Statistics: Eighth Revirion International Classification of Diseases, Adapted

for Use in the United States. PHS Pub. No. 1693, public

Health Service. Washington. U.S. Government Printing

Office, 1967.

between visits for respiratory diseases and the

total of all other ICDA diagnostic groups.

Seriousness of the patient’s problem was

evzduated by the physician using the criterion of

the extent of impairment that might result if no

care were available. On a 4-point scale ranging

from not serious to very serious, attending

physicians usually judged respiratory conditions

as not serious or slightly serious. A small proportion (14 percent) of these conditions was

‘qum 1. PERCENTDISTRIBUTIONOF OFflCE VISITS FOR 01SW3ES

OF THE RESPIRATORY SYSTEM AND ALL OTHER MAJOR ICDA

DIAGNOSTIC GROUPS, BY SERIOUSNESS AND PROBLEM

STATUS: UNITED STATES, 1976-76

SER1OUSNESS ?ROSLEM STATUS

Nor MIOua Illnn Nw @mbtrm Ezll

Slighflv YOoQllI cantmuu-q WObw-n a

sU’mUsorbm7mmus -

o-of ?fm All OIIWI ICDA Dlm#m of Un All othu ICDA

rncalrxofv dmfic mwlrmw-f dq!OmIC

W3’lem Wws ivllml gouos
2 ackncedata

considered serious or very serious, which was

less than the proportion (20 percent) of serious

or very serious problems in the total of all other

diagnostic groups (figure 1).

Acute upper respiratory infections (acute

UIU), which are usually short duration, selflimiting conditions, accounted for almost half of

the visits in the respiratory diseases group (table

1). This may be one explanation for the relatively small proportion of office visits for

serious problems. The high proportion of acute

URI would also account for the relatively large

numbers of new problems that were presented.

Table 1. Number and percent distribution of office visits for

acute and chronic diseases of the respiratory system: United

States, 1975-76

In flu enza and pneumonia together accounted for approximately 10 percent of visits

for respiratory diseases. Six chronic diseases of

the respiratory system comprised an additional

37 percent (table 1). Emphysema, asthma, and

pneumonia were chiefly responsible for the visits

classified as serious or very serious. A future

report currently in preparation will provide additional indepth analysis of visits for specific

respiratory diseases, and will be published in

Series 13 of Vital and Health Statistics.

Table 2 displays age and sex distributions of

visits for selected diseases. Like most NAMCS

visits, proportions of femafes visiting for most

respiratory illnesses exceeded those of males.

However, male visits clearly exceeded fen-de

visits when the illness was dia.e-nosed as

Diagnosis and ICDA codel

All visits .............460-519

Acute upper respiratory

infect ions ............ .. 460-466

Acute nasopharyngitis and

acute upper respiratory

infections of multiple or

unspecified sites ..........460.465

Acute sinusitis ..................... 461

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

Acute tonsillitis ........... ........ 463

Acute laryngitis and

tracheit is........................... 464

Acute bronchitis and

bronchiolitis ................. ..... 466

influenza ........ ....................47 O-474

Pneumcmia .........................48 O-486

Chronic diseases of the respiratory system .....493.493.

502-503,507

Bronchitis, unqualified, and

chronic bronchitis ...... 490-491

Emphysema ..... .......... ... .......492

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

Chronic pharyngitis and

nasopharyngitis ........... ...... 502

Chronic sinusitis ................. . 503

WY fever ................ .............6O7

Other acute and chronic diseases of

the respiratory system .....5OO.5Ol.

504-506,508,510-519

Number

of visits in

thousands

163,401

78,585

37,693

2,598

17,414

12,573

2,982

5,326

10,312

5,194

59,722

15,765

5,223

10,951

2,486

8,284

17,012

9,548

Percent

distribution

100.0

48.1

23.1

1.6

10.7

7.7

1,8

3.3

6.3

3.2

36.5

9.6

3.2

6.7

1.5

5.1

10.4

5.8

1 ~5ed on the Eigh~h Re\,i~ion Interrratioraal CImsifimtion of

Diseases, Adapted for Use in the United Srates (ICDA).

emphysema.

Patients under 25 years of age were responsible for most of the visits for acute URf and for

pneumonia. But patients over 25 years of age

predominated the visits when the other respiratory diseases shown in table 2 were diagnosed.

However, patients under 15 years of age represented about one-third of the visits for bronchitis and for asthma and about 29 percent of

the visits for hay fever. Patients 65 years of age

or older were responsible for the smallest proportions of visits for all respiratory conditions

except emphysema. Patients 45 years of age and

over were responsible for almost all visits for

emphysema.

Figure 2 highlights the high rate of office

visits for acute URI by patients under 15 years

of age. For every 1,000 members of that age

group in the population, there were 343 visits to

a physician for acute URI. This number declined

by half or more for patients up to 64 years of

age and by about two-thirds for patients aged 65

years or older. Fi,gure 3 shows the average annual rate of office visits for influenza and for

pneumonia. Fi~res 4 and 5 illustrate three

chronic conditions—bronchitis, asthma, md hay

fever.

When physician specialty data were examined, it was observed that general and family

practitioners had the highest proportions of

visits for acute URI, influenza, pneumonia,

bronchitis, and emphysema (table 3). This observation is not a surprising resuIt since general

and family practice constitutes the highest

proportion of office-based physicians in the
amcedaa3

Table 2. Percent d cstribution of office visits for selected diseaws of the respiratory system by age and sex of patient:

United States, 1975-76

Diagnosis and ICDA codel

Acute upper respiratory infect ions ............... 460-466

influenza ......... ............................................. 470-474

Pneumonia ................................ ....... .... ...... ...48O.486

Bronchitis, unqualified, and chronic

bronchitis ................................. ........... ..... .. 490-491

Emphysem .........................................................492

Asthm . ............................................ .......... ....<....493

Chronic pharyngitis, naspoharyngitis, and

,.

slnuslt!s ............. ................. ............. ............502-503

Hay fever ............. .... ............................................5o7

II Age I sax

‘ercent I

-1.

Under

If visits 15 15-24 25-44 45-64 65 years Female

years

Male

years

years years and over

Percent distribution

100.0 46.0 14.4 18.9 15.0 5.8

100.0 18.1 14.3 31.7 25.9 10.0

100.0 37.7 12.4 17.1 20.3 12.5

100.0 32.9 9.0 20.3 25.2 12.6

100.0 ●1.1 *0.1 ‘4.8 44.9 49.0

100.0 32.9 10,9 18.1 28.1 10.1

100.0 13.8 14.4 34.6 25.4 11.8

100.0 29,2 16.6 30.9 17.7 5.6

18med on the Eighth Revision Inremarional Clas.tificarion of Diseases, .&lupred for U$ein rhe Unired States ([ CD A).

54.2

47.0

50.8

57.9

29.6

54.9

58.7

56.3

45.8

53.0

49.2

42.1

70.4

45.1

41.3

43.7

United States.3 Internists treated a higher highest proportion of ~~isits for that probIem.

proportion of patients visiting for emphysema Since about two-thirds of office visits to interthan they did those for other respiratory diseases and were responsible for the second

nists were by patients 45 years of age and over,4

qN’ational Center for Health Statistics: Office Vkits

to Internists: lNationaI Ambulatory Medical Care Survey: 3Goodman, L. J. and Mason, H. R. Physician Drktributiorrs and Medical Licensurc in the U. S., 1975. Cen- United States, 1975, by Beulah - K. Cypress. Advance

ter for Health Services Research and Development. Data from Vital and Health Statistics, N’o. 16. DHEW

.4merican Medical Association. Chicago, 1976. Pub. No. (PHS) 78-1250. Public Health Service, Hyattsvillc, Md., Feb. 7, 1978. I I

Figure 2. AVERAGE ANNUAL RATE OF OFFICE VISITS FOR ACUTE

UPPER RESPIRATORY INFECTIONS [460-?66), BY AGE OF

PATIENT: UNITED STATES, 1975-76

I

350

300

[\

I

LLu— under 1524 2534 35’44 4554 55.a4 65 and

15 over

AGE IN YEARS

Figure 3. AVERAGE ANNUAL RATE OF OFFICE VISITS FOR

INFLUENZA (47C-474} AND PNEUMONIA [46048S1, BY

AGE OF PATlENT: UNITED STATES, 1975-76

— ?neumrma

. . . . . Inf,”cnza

I

01 I 1 1 I 1 1 I

under 1524 25 ?4 25.44 4554 55 a4 %5 and

15 Ovc<

AGE IN YEARS
4

Fiwre 4. AVERAGE ANNUAL RATE OF OFFICE VISITS FOR

BRONCWTIS, UNQUAUFIED, AND CHRONIC BRONCHITIS

(4S0-4811, BY AGE OF PATiEN~ UNITED STATES, 197S-76

o~

um& 15.24 25.34 S&44 45-5$ 55+4 e6 and

over.

AGE IN YEARS

it is predictable that internists would see more

respiratory problems related to the elderly, such

as emphysem~ than they would see acute UR.1,

for example, where the visit rate was highest for

the youngest age group.

Allergists had the highest proportions of

asthma and hay fever visits.

F~ure 5. AVERAGE ANNUAL RATE OF OFFICE VISITS FOR HAY

FEVER AND ASTHMA, BY AGE OF PATIEN~ UNITED STATES,

197S-76

— Hay fever

“.. tih~

o~

ur& 1524 25.34 35-44 45.54 5S-64 65 md

AGE IN YEARS

Pediatricians treated about 22 percent of all

patients visiting for asthma and 18 percent of

those visiting for hay fever. This accounted for

58 percent of the visits made by patients under

15 years of age for “&thma and 49 percent for

T~le 3. Percent distribution of office visits for selected diseases of the respiratory system, by physician specialty:

United States, 197E-76

Diagnosis and ICDA codel

Physician specialty

Acute upper Bronchitis,

respiratory Influenza Pneumonia unqualified, Emphysema Asthma Hey fever

infections (470-474) (480486) a;:’::t;: (492) (493) (EJ17)

(460466)

(490-491 )

Percent distribution

All specialties ......... ... ...... ...... ...... 100.0 100.0 100.0 1W.o 1tx).o 100.0 Ico.o

General and family practice ....... ........... 57.5 78.5 50.5 56.9 52.4 28.5 26.3

Internal mdicine .. .... ................ ............. 7.8 7.3 14.9 12.5 30.3 10.6 9.9

Pdiatrics ........ ............ .......................... . 23.9 8.8 27.0 20.6 ‘0.6 21.9 17.8

General surgery ..... ................................. 2.9 ●1.9 “3.3 ●2.9 ●1 .3 “0.7 “0.8

Obstetrics and gynecology ..... ................ 1.1 ●1 .0 “0.3 “0,5 ‘0.6 ●0.3

~olawngology .......... ................ ... ........ 3.1 ‘0.3 ‘0.4 “0.7 9.6

Allergy ..................... .. ... ....... .... .. ............ “0.4 “0.8 ●3.1 32.3 30.6

All other specialties (residual) ............. ... 3.3 2.2 4.0 5.4 12.3 3.7 4.7

1Based on the Eighth Revisbn Intematbnal Ckssricatbn of Diseoseh Adapted for Use in the United States (ICDA).
a&nceMa5

the same age group visiting for hay fever. The average duration of visits rgnged from

Higher than average proportions of visits for 11 minutes for acute UIU to 17 minutes for

respiratory conditions included drug therapy (70 emphysema This time period hovered closely

percent) and injections (27 percent). However, around the 15-minute average duration of all

the blood pressure measurement rate of 24 per- estimated visits.

cent was less than average.

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 *
6 achancedata

TECHNICAL NOTES

SOURCE OF DATA: The information presented

in this report is based on data coIIected in the

National Ambulatory Medical Care Survey

(NAMCS) during 1975 and 1976. The target

population of NAiifCS encompasses office visits

within the conterminous United States made by

ambulatory patients to physicians who are principality engaged in office practice. The National

Opinion Research Center, under contract to

NCHS, was the orgmization resposibk for the

survev’s ficId operation.

primary sampling units (PSU’S), physician practices within PW’S, and patient visits within

practices. Each year a sample of practicing

physicians is seIected from master files maintained by the American Medical Association and

the American Osteopathic Association. The

1975-76 sample included 5,604 physicians with

a response rate of 80 percent for the 2 years.

These physicians were requested to complete

pzticnt RectJrds~ for a systematic random

sample of office visits taking place within their

SAMPLE DES~GN: NT.4JICS utilized a multi- -

stage probability design that invokes samples o f 5See figure I.

Figure 1. PATlENT RECORD

ASSURANCE OF C0N6ti0EN71ALlTY-AII ,nkm.m Wtiq.h wdd O.rmt d..t,hwm. 01 ● mdww.1,

I D-m. or ~. Wubl,%hm.m *III w ~CM co.f,d,.t,.j. W,II h USWJ..IV b’f 0-,,..s ..q~.d t. ,.d ‘W BN? Ih, w,c+,,, .1 It%+,uwe” ●nd w,II “0< - d,@05M ., ,elo,,ed 10 0!!!,, P,#m”, .3, “ted %1 w!’# *VW 0.100s8,

1. DATE OF VISIT PATIENT RECORD

M=i’%+

NATIONAL AMBULATORY MEDICAL CARE SURVEY

2. OATE OF BIRTH 4. Coil on 5. PATIINT3 PRINCIPAL PROBLEM(SI 6. SERIOUSNESS OF 7. HAVE YOU EVER SEW

COMPLAINT($). OR sYMPTOM(S) ~ VISIT PROBLEM IN ITEM 5a THIS PATIENT BEFORE?

*

(In PI,,.(’s own words) (Check one)

, ~ WHITE — , ~ YES

, G VERY SERIOUS

,QNO

}

3. SEX

, ~ NEGRO/

BuCK

a MOST

IMPORTP.NT I C SERIOUS It YES. for (he Problem

‘ ~ FEMALE s ~ OTHER

ind$cated m 1TEM 5a,>

I ~ SLIGHTLY SERIOUS

I ~ MALE . ~ UNKNOWN b OTHER . ~ NOT SERIOUS ! ~ YES 21JN0

8. MAJOR REASON(S) FOR THIS VISIT lCheci ill ofwf WW.$1 —

9. PHYSICIAN’S PFliNCIPAL OIACNOSIS Q& VISIT

a. OIAGNOSIS ASSOCIATE WITH ITEM 5. ENTRY

., ~ ACUTE PRO FJLEM . ~ WELL AOUL7 CHILO EXAM

,, ~ ACUTE PqOELEM. FOLLOW. UP . z FAMILY PLA%NING

,, C CHRONIC PROBLEM, ROUTINE , ,: COUNSELI:4G:A0VlcE

>. ~ CHRONIC PRO EL EM, FLAR6. UP ,, ~ IMMUNIZATION

. ~ PRENATAL CARE : ~ REFERHEO BY OTHER PHYS)AGENCY b OTHER SIGNIFICANT CURRENT OIAGNOSES

.. c POSTNATAL CARE ,, C AOMINISTRATIVE PURPOSE {In order of importance)

-. 0 POSTOPERATIVE CARE

7

a ~ OTHEfl (Spect(v]

( ODer.fwe mocedwe)

.— —

10. 01AGNOS71SfTHERAPEUTlC SERVICES OROEREWPROWOEIS THIS VISIT (Ckct #l/ msf m@Y/ 11. DISPOSITION THIS VISIT 12. OURATION OF

01 0 NONC (check ?N (hat *G)

THIS VISIT (Tim

11 a DRUG PRESCR18E0 za(ir Jprnt WI(J$

02 0 LIMITEO HISTORV/EXAh4 12 0 X.RAV ph”s(clanl

03 a G.5N6nAL HISTORVle XAM 1> a INJECTION , ~ NO FOLLOW. UP PLANNEO

04 0 CLINICAL us TEsT 14 0 IMMUNIZAT!ONIOESENSITIZA710N : ~ RETURN AT SPECIFIEO TIME

05 a aLOOO PRESSURE CWIZCK 15 Cl PHVSIOT!~ERAPV t E RETURN IF NEEOEO. P R N

06 0 EKG 19 ❑ MEDICAL COUNSELING . ~ TELEPHONE FOLLOW-UP PLANP4E0

07 ~ WEARING TEST 17 c1 6YCWTHER4PYKHER4 PEUT8C

, ~ REFERRED TO OTHER —MINUTES

Oa 0 Vlslotd TEST

PHYSICIAN {AGENCY

LISTSNING

o- Cl ENo@SCOPY

. : RE7URNE0 TO II EFtRRING

IS Ci OTHER 1$-+vl PHYSICIAN

10 Cl OF FICESURGFRV . ~ AOMIT TO HOSPITAL

, ,: OTHER (&7CCJ/V)—

HRA.3A.3 DEPARTMENT 0= HCPLTI+. EDuCATION 4N0 wELFARE O.M. E. =Sa.S72106

REV, 8-7* PUe’, C uEALTM SE@ V!CE ExPIRATION OATE 12/31/75

HEALTI’4 17ESOURCES AD Ml NlSTR4T10N

NATIONAL CENTER FOR uEfi LTH STATISTICS
aduamecklta 7

practices during a randomly assigned weekly reporting period. Participating physicians completed 114,000 Patient Records during the 2-

year period. Characteristics of the physician’s

practice, such as primary specialty and type of

practice, are obtained during an induction interview. A detailed description of the NAMCS

design and procedures can be found in Series 13,

Number Z3 of I~dal and Health Statist its.

S.4MPL1NG ERRORS: Since the estimates for

this report are based on a sampIe rather than the

entire universe, they are subject to sampIing variability. The relative standard error of an estimate is primarily a measure of sampIing variability. The relative standard error of the

estimate is obtained by dividing the standard

error of the estimate by the estimate itself and is

expressed as a percent of the estimate. Relative

standard errors of seIected aggregate statistics

are shown in table I. The standard errors appropriate for the estimated percentages of office

\isits are shown in table II.

ROUNTDING: Aggregate estimates of office visits

presented in the tables are rounded to the

nearest thousand. The rates and percents, however, were calculated on the basis of original,

unrounded figures. Due to rounding of percents,

the sum of percentages may not equal 100.0 percent.

Table 1. Approximate relative ~andard error of e~imated

numbers of office visits, NAMCS 1975-76

Relative standard

Estin_ate in thousends error in

percentage points

mo .................................. ................ .... .. 30.2

1.ooo ..................................................... 23.5

2,000..................................................... 16.7

4,000..................................................... 12.0

10,000................................................... 8.0

40,000................................................... 4.8

200,000................................................. 3,4

1.ooo.mo .............................................. 3.1

Example of we of table: An aggregate estimate of 25,000,000

visits has a relative standard error of 6.4 percent or a standard

error of 1,600,000 visits (6.4 percent of 25,000,000).

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

services who is neither bedridden nor currently

admitted to any health care institution on the

premises.

An office is a place that the physician

identifies as a location for his ambulatoq

patients. Responsibility over time for patient

care and professional services rendered there

generally resides with the individual physician

rather than an institution.

A tkit is a direct personaI exchange between

an ambulatory patient and a physician or a staff

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

rendering health services.

A physician is a duly licensed doctor of

medicine (M. D.) or doctor of osteopathy (D. O.)

currentiy in practice who spends time in caring

for ambulatory patients at an office location.

Excluded from NAMCS are physicians who spe-.

cialize in anesthesioIogy, pathoIogy, radioIogy;

physicians who are federally employed; physicians who treat only institutionalized patients;

physicians employed fulI time by an institution;

and physicians who spend no time seeing ambulatory patients.

Table 11. Approximate standard errors of Percentages for

estimated numbers of office visits, NAMCS 1975-76

I

I Standard error in percentage points

600........................ 3.0 6-5 9.Q 12.0 13,8 15.0

1,000..................... 2.3 5.1 7.0 9.3 10.7 11.6

2,000..................... 1.6 3.6 4.9 6.6 7.5 8.2

4,000..................... 1.2 2.5 3.5 4.7 5.3 5.8

10,000................... 0.7 1.6 2.2 2.9 3.4 3.7

40,000................... 0.4 0.8 1.1 1.5 1.7 1.8

200,000................. 0.2 Q.4 0.5 Q.~ Q.8 Q.8

1,000,000.............. 0.1 0.2 Q.2 0.3 Q.3 Q.4

Example of use of rable: An estimate of 20 percent based on

an aggregate estimate of 80,000,000 visits has a standard error of

1.3 percent. The relative standard error of 20 percent is 6.5 (1.3

percent + 20 percent).
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service ! Number 42 = October 31,1978

Office Visits to Cardiovascular

Medical Care Survey:

Using data from the N~tional Ambulato~

hledicrd Cm-e Survey (NAhfCS), this report describes an estimated 13,517,000 visits made to

the offices of cardiovascular specialists over the

2-year span from January 1975 through December 1976. NAhlCS is a sample survey designed to expIore the provision and utilization of ambulatory care in the physician’s

office, the setting where most Americans seek

health care. The survey is conducted annualIy

throughout the coterminous United States by

the Division of Health Resources Utilizat ion Statistics of the National Center for Health Statistics. The survey sample is selected from doctors of medicine and osteopathy who are

principally engaged in office-based patient-care

practice. Excluded from the sampIe are an indeterminate number of physicians who render

some office-based ambulatory care but whose

patient-care activities are secondary to another

primary role such as teaching, research, or

administration. Also excluded from the N.MICS

scope are physicians who are hospital-based;

those whose specialty is anesthesiology, pathology, or radiolo~; and physicians in the Federal

Service.

Because the estimates presented in this report are based on a sampIe rather than on the

e n tire universe of office-based, patient-care

physicians, they are subject to sampling variability. See the Technical Notes for an explanation and for guidelines in judging the

relative precision of estimates presented in this

1This report was prepared by Hugo Koch, Division of

Health Resources Utilization Statistics.

Specialists, National Ambulatory

United States, 1975-76’

report. The directions offered there ako provide

the basis for judging the statistical significance

of differences between estimates.

DATA HIGHLIGHTS

\Vith their estimated 13,517,000 office visits

in the 2-year span 1975-76, cardiovascuku- specialists were among the 13 specialists wh? figured

most prominently in the provision of officebased ambulatory care (see table 1).

Visit distributions in tabIe 2 show an emphatic preference for the metropolitan practice

locations, and indicate a slight preference for

solo practice over multiple-member practice

arrangements. In this choice of location and

type of practice, visits to cardiovascular specialTable 1. Number of visits to office-based specialists, by type of

specialty: United States, 1975-76

Number of

Specialty visits in

thousands

General and family practice ..... .................. ...... ...... 460,297

internal mtiicine ... .... ...................................... ..... 130,367

Pediatrics .................... ..... ........ .... ..... ....... .... .... ...... 107,085

Obstetrics and gynecology ..... ...... ....... ................... 97,070

General surgery ................ .................... ........ ... .. ..... 77,259

Ophtmlmlogy ..... ....................... ................ .... ...... 53,959

Orthopedic surgery ........... .... ................ ...... ......... .. 47,152

Dermtology ....................... ................. ....... ........... 35,721

Psychiatry ................ ........... ....... .......... ............ ...... 30,616

Otolaryngolqy ............ .......................................... 27,192

Urology .............. ........... ........................ ........ ........ 20,728

Gwdiovascuhr disease .... ... .................................... 13,517

Neurology ...................... ..... .................. .. ....... .... .... 3,784
2 adwlncedata

Table 2. Number and percent distribution of office visits to

cardiovascular specialists, and percent distribution of office

visits to all specialists, by characteristics of the physician:

United States, 1975-76

Number of

visits to

Physician cerdiocharacteristic vascular

specialists

in thousands

All visits

““”””’’””””E

Location of

practice

Metropolitan area . ..... 12,690

Non metropolitan

area ............................ 827

Type of

practice

.sO1O. ............................ 7,064

Other ........................... 6,453

Visits toCard io- All

vascu Iar specialists

specialists

1

Percent distribution

100.0

——

93.9

6.1

52.3

47.7

100.0

73.3

26.7

60,0

40.0

lBased on an estimated 1.155.900.000 visits made to all

office-based physicians in 1975-and- 1976.

2~cation within a standard metropolitan $tati?.tiC%.I area

(SMSA). Composition of SMSA’S does not reflect 1974 adjust ments.

ists agree with the average findings for all visits

to office-based practitioners.

It is evident from the visit-age distributions

in table 3 that cardiovascular problems become

increasingly manifest with advancing age. Four

of every 5 visits were made by patients 45 years

old and over. The median visit-age (calculated

from visit distributions rather than the individual patients who made the visits) was 59

years, exceeding by 22 years the median visit age

of 37 years characteristic of overaIl office-based

practice.

Vis its to cardiovascular specialists were

about equally divided between male and femzde

patients, making cardiovascular disease one of

the few office-based specialties where visits by

males equalled or exceeded visits by females.

The other notable exceptions were pediatrics,

urology, and orthopedic surgery.

Underscoring the chronic nature of much

cardiovascular disease is the finding that threeTable 3. Number and percent distribution of office visits to

=rdiovascular specialists, and percent distribution of office

visits to all specialists, by characteristics of the patient:

United Statesr 1975-76

Patient

characteristic

All visits, ... ........

—Age

Under 25 years ....... .....

25-44 years, ..... ........ ....

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

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

—sax

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

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

Prior visit status

New patient ............ .....

Old patient, new

problem .....................

Old patient, old

problem, .......... ........ ..

Number of

visits to

cardiovascular

specialists

n thousands

13,517

550

1,783

5,73a

5,453

6,766

6,751

1,547

1,903

10,067

Visits toPercent distribution

100.0

——

4.1

13.2

42.4

40.3

50.1

49.9

11.5

14.1

74.5

100.0

33.2

25,5

25.1

16.2

60.4

39.6

14.6

23.2

62.3

lBased on an estimated 1,1 55,90(),(X30 visits made ‘0 all

office-based physicians in 1975 and 1976.

fourths of the visits to cardiovascular specialists

were made by persons who were already established patients of the doctor and who were

returning with oId probIems (table 3, prior visit

status). For the 3,450,000 visits at which a new

problem was presented (i.e., the 1,547,000 visits

by new patients plus the 1,903,000 visits by old

patients with new problems), there were

10,067,000 return visits, an average of 2.9 return visits per new probIem per year. This return

visit rate substantially exceeded the average of

1.6 return visits per year common in overall

office-based practice; indeed, among the most

visited specialists, it was exceeded only by the

rate for office-based psychiatrists.

Table 4 shows the clinical content of cardiovascular office practice. The chronic circulatory

ailments clearly dominate. Two of them, chronic

ischemic heart disease and essential benign
ackanceciaa 3

Table 4. Percent distribution of office visits 10 cardiovascular

soeciaiists by Princiml (first-listed) diwnoses rendered by

the physician classified by ICDA ~tegory: United States,

1975-76

Principal diagrwsis and ICDA codel

All principal diagnoses ......... ..................

Diseasas of the circulatory system ....... ... ...390-458

Other diagnows ..... .......................... ..... ....... .... .......

Diseases of the respiratory system ........46O.5l 9

Special conditions and examinations

without sickness ... .......................... ... YOO-Y13

Symptoms and rlldefined conditions...7879696

Diseases of the musculosketal system...7l O-738

Endocrine, nutritional, and metabolic

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

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

Other conditions .... ...... ................... ....... ... ........

Diseases of the circulatory system.. 390-458

Chronic ischemic heart d iseasa ................ .... ..... 412

Essential benign hypertension ............. ........ .... . 401

Symptomatic heart diseasa . .... ............. ... ..........427

~her ischemic heart diseases .. ..... ...... 410,411,413

Chronic rheumatic heart disease ..... ........... 393-398

Other diseases of the circulatory systern...Residual

Percent

istribution

21(30.0

~

51.1

48.9

7.5

5.8

5.7

5.0

5.0

4.5

15.4

100.0

37.0

21.2

12.9

7.8

7.0

14.1

1 ~=d on E;ghrh R=yi~ion Znrernarional C&iflcarion Of

Di ease, Adapted for C& in rhe Unired Srares (ICDA).

3

8ased on 13,517,000 principal diagnoses.

hypertension, account for about 58 percent of

the 6.9 million visits where cardiovascular morbidity was the principal (first listed) diagnosis.

The vital screening function performed by the

cardiovascular specialist is apparent in the substantial number of visits that resulted in the

identification of a disorder other than a circulatory disease; e.g., the 1,000,000 visits diagnosed as respiratory disease and the 1,270,000

diagnoses which were about equaHy dhided

between diseases of the digestive system and

endocrine, nutritionzd, and metabolic diseases.

Table 3 points up the unique intensity of

diagnostic activity that is required in cardiovascular office practice: on the one hand, to

screen cardiovascular symptoms (for example,

chest pain), from similar symptoms that arise

from other disorders; on the other hand, to

monitor the usually proIonged course of a circukito~ disease once the diwgnosis is clearIy established.

Table 5. Number and percent of office visits to cardiovascular

specialists, and percent of office visits to all specialists. by

selected diagnostic and therapeutic services provided: United

States, 1975-76

Diagnostic and

therapeutic services

Diagnostic service

IJmited history and/or

examination ........ .......

General history and/or

exams natton ...............

Clinical laboratory

test ................ ......... .. .

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

Blood pressure check...

EKG ............................

Therapeutic service

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

Injection .... ................. .

Counsel ing .... ...............

Number of

visits to

cardiovascular

specialists

n thousand!

7,827

2,838

3,614

2,241

9,679

5,189

5,725

899

2,095

Visits tOCard io- All wsscular specilaiszsl

specilaists

Percent

57.9

21.0

26.7

16.6

71.6

38.4

42.4

6.7

15.5

51.6

16.3

22.8

7.6

33.2

3.3

43.6

13.1

13.0

l~sed on an e~i~ted 1.155,900,000 visits made to all

office-based physicians in 197S and” 1976.

Data on the seriousness of problems prese nted’ to the cardiovascular specialist pre-.

di ct ably place a substantial proportion of

problems (35 percent) in the serious-to-ve~-

sefious category, aImost twice the proportion

assigned this degree of severity in overall officebased practice (tabIe 6).

Directly reflecting the chronic nature as weIl

as the actuzd or potentiaI severity of most of the

problems presented to them, cardiovascular

specialists ended 3 of every 4 visits by scheduling a return visit at a specified time (table 6,

disposition). On the other hand, there is ako

evidence of a patient mobility which is greater

than average. Due in Iarge part to the intensive

diagnostic screening discussed above, about 8

percent of visits to the cardiovascular specialist

ended either in return to a referring physician or

in referral to another physician or agency.

Data on duration of visit (table 6) indicate

that the average face-to-face encounter between

patient aid cardiovascular specialist probabIy

lasted about 22 minutes, substantially exceeding

the 15-minute average calculated in overalI

office-based practice.
4 aduancedata

Table 6. Number and percent distribution of office visits to cardiowwxlar specialists, and percent distribution of office visits to all

specialists, by selected visit characteristics: Unitad States, 1975-76

———.

Visit characteristic

All visits .. ......................................... ...........

Seriousness of problem

seriousand very serious ....... ............................... ........

Slightly serious ............................... ............................

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

Disposition (selected actions)

No followup ....................... ........................................ .

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

Raturn if ne4ed .............................. ...........................

Telephone followp ......................................... ...........

Referred to other physician/agency .... ........ ............. ....

Returned to referring physician ........................ ...........

Admit to hospital ........................................................

Duration of physician-patient encounter

O minutes (no face-to-face enmunter with physician ...

1-6 minutes .......... .... .................................. ... ..............

8-10 minutes ........ ............... .................... ....................

11-16 minutes ................................. ............... ....... ......

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

31 minutes or more .... ................................ .................

Number of visits

to Cardiowscular

specialists in

thousands

13,517

4,763

5,187

3,567

650

10,253

2,084

580

47a

615

’267

● 204

“290

2,457

3,879

4,735

1,942

Visits to–

Card iovescu tar I

All specialists

specialists

I

Percent d istribut ion

100.0I 100.0

35.2

38.4

26.4

4.8

75.9

15.4

4.3

3.5

4.6

“2.0

I

I

●1 .5

●2.2

18.3

28.7

35.0

14.4

19.2

32.3

48.5

12.3

60.2

21.9

3.5

2.8

0.9

2.1

1.8

15.1

31.5

26.6

19.5

5.5

lESased on an estimated 1,155,900,000 visits made to all office-based physicians in 1975 and 1976.
damedda5

TECHNICAL NOTES

SOURCE OF DATA: The information presented

in this report is based on data collected in the

Nation al knbulatory Medical Care Survey

(NAMCS) during 1975 and 1976. The target universe of NAMCS is comprised of office visits

made within the coterminous United States by

ambulatory patients to non- FederaI 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 Htalth Statistics, was the organization responsible for the sumey ’s field operation.

SAMPLE DESIGN: NMICS utilizes a multistage

probability design that involves samples of primary sampling units (PSU’S), physician practices

within PSU’S, and patient visits within practices.

Each year a sample of practicing physicians is

selected from master fiIes maintained by the

American Medical Association and the .4merican

Osteopathic Association. (For the 2 year period

1975-76, a total of 152 cardiovascular specialists

were included in the sample. They achieved a

response rate of 73 percent.) Characteristics of

the physician’s practice, for example, primary

specialty and type of practice, are obtained during an induction interview. The physicians are

requested to complete Patient Records2 (brief

encounter forms) for a systematic xandom

sample of office visits during a randomly assigned weekly reporting period. (In the ~-year

period 1975-76, sampled cardiovascular specialists completed a total of 1,730 Patient Records.) A detailed description of the lNMICS design and procedures has been presented in the

publication “The National Ambulatory Medical

Care Survey: 1975 Summary.”3

SAMPLING ERRORS: Because the estimates

for this report are based on a sample rather than

2A facsimile of the Patient Record appears as figure I.

3 National Center for Health Statistics: The National

Ambulatory Medical Care Sumey, 1975 Summary,

United States, Janu~-December 1975. Vital and Health

Statistics. series 13-No. 33. DHEW Pub. No. (PHS)

78-1784. Washington. U.S. Government Printing Office,

Dec. 1977.

on the entire universe, they are subject to

sampling variability. The standard error is primarily a measure of sampling variability. The

relative standard error of an estimate is obtained

by dividing the standard error of the estimate by

estimate itself and is expressed as a percent of

the estimate. ReIative standard errors of selected

aggregate statistics are shown in table I. The

standard errors appropriate for estimated percentages of visits are show-n in table II.

Table 1. Approximate relative standard errors of estimated num.

ber of office vism. Unired States, 1975-76

I

Estimated number Relative

of office visits standard error

in thousands in percent

I

600 .......... ........................... ..... ...............

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

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

4,000 ......................................................

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

40,000 ....................................................

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

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

30.2

23.5

16.7

12.0

8.0

4.8

3.4

3.1

Exampte of use of ruble: An aggregate estimate of 25,000,000

visits has a relat~ve standard error of 6.4 percent or a standard

error of 1,600,000 visits (6.4 percent of 25,000,000).

Table 11. Approximate standard errors of percentages of emmated

number of office vmts: United States, 1975-76

Ease of percent

Esumawd percent

(number of vmts

in thousands) 19&- 59&r 10or 20 or 30 or so

90 80 70

I Standard error in percentage points

800 ...................... 3.0 6.5 9.0 12.0 13.8 15.0

1,000 ....... ............ 2.3 5.1 7.0 9.3 10.7 11.6

2,000 ......... .... ...... 1.6 3.6 4.9 &6 7.5 8,2

4,000 ............... .... 1.2 2.5 3.5 4.7 5.3 6.8

10,000 ................. 0.7 1.6 2.2 2.9 3.4 3.7

40,000 ................. 0.4 0.8 1.1 1.5 1.7 1.8

200,000 ..... ......... 0.2 0.4 0.5 0.7 0.8 0.8

1,000 ,000 ........ .... 0.1 0.2 0.2 0.3 0.3 0.4

Example of usc of ruble: An eitimate of 20 percent based on

an aggregate estimate Of 80,000,000 visits has a standard error of

1.3 percent. The relztive standard error of 20 perctint IS 6.5 percent (I.3 percent + 20 percent).
6 advancedata

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

services who is neither bedridden nor currently

admitted to any health care institution.

An office is a place that the physician

identifies as a Iocation 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.

vision for the purpose of seeking care and rendering health services.

A physician is a duly Iicensed doctor of

medicine (\I.D.) or doctor of osteopathy (D. O.)

current] y in office-based practice who spends

time in caring for ambulatory patients. ExcIuded

from NA.IIICS are physicians who are hospitaI

based; physicians who specialize in anesthesiology, pathology, or radioIogy; physicians who

are federally employed; physicians who treat only

A visit is a direct personal exchange between institutionaIized patients; physicians employed

an ambulatory patient and a physician or a staff full time by an institution; and physicians who

member \vorking under the ph}’sicim’s super- spend no time seein,g ~mbulatory patients.

Figure PATIENT RECORD

ASSURANCE OF CON FIOENTIALITY - All <n(mma,,on wo,c” .“oum owm,l ,d,”,,lsca,,O” of ,“ mdwniu,l.

● 0,,.28 .,, w ●“ .Stabl,,”rn.nt *,N be t.cki CO.ltaden,,,l *,,, M .,,d ..,, b. W,w”, ,.gag.a ,“ a.a b Bh’? !h, OJrw,,s d tn, w-w and .vdl . . . 3, dmc(o!cd or v,l...ccJ 1. other r,.<.o”i or “sad b ●“, alh.r Dwm,.

1. OATE OF VISIT

.~

PATIENT RECORD

NATIONAL AMBULATORY MEDICAL CARE SURVEY

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

R&CE COMPLAINT(S). OR sYMPTOM(S) ~ WIT PROBLEM IN ITEM h THIS PATIENT BEFORE?

(In @r,.1’s OW. wo,d,)

Day Yr

{Checa one)

-3

! ~ WHITE * I YES

c VERY SERIOUS

z5N0

3. SEX

, c NEG80/ a MOST }

BLACK IMPORTANT c SERIOUS . If YES. for the problem

! ~ FEMALE 3 E OTHER . , : SLIGHTLY SERIOUS

,ndtca fed m I TEIU 5a ?

> c MALE 1

+ ~ UNKNOWN b OTHER I

. ~ NOT SE R1OUS I

, ~ YES ~ONO

8. MAJOR REASON(SI FOR THIS VISIT ICki J//m,,or/,mnsl I

9. PHYSICIAN’S PRINCIPAL OIAGNOSIS THIS VISIT — —

a DIAGNOSIS ASSOCIATE WITH ITEM 5a ENTRY

~ ACUTE .ROELEM . : WELL AOUL7 CHILD EXA,M

., : ACUTE PROBLEM FOLLOW. UP . : FA.,411Y PL2YWNG

, C CHaONIC PROBLEW ROUTINE : COUNSELING ACVICE

. ~ CHRONIC PR08LEM FLARE. UP . : lMMu NIZArlON

. ~ PRENATAL CARE : REFERH53 OY OTHER PHYSIAGENCY

, ~ POSTNATAL CARE , ~ AOU9NISTRATIVE PURPOSE

, ~ POSTOPERATIVE CARE

7

. ,: OTHEH ( %ewfv]

b OTHER SIGNIFICANT CURRENT OIAGNOSES

(in ofder of ,mpoffance)

.—— — ( Omtaove .orocedure I I

10. 01AGN0sTlC~HERA?Eu7ic sERVtcE5 OROEREO/PROVIOEO TINS VIsJT/Ch@kz//rh,f app/f) 11. OISPOSITION THIS VISIT 12. DURATION OF

01 n NONE tl O ORUO PREscRt8C0 Ichfc* .// rtx ,ml THIS VISIT (h

izily spent Wllh

02 D LIMITED HISTORY, EXAM 12 a x.nA’f ph”s,c)an)

03 D GENERAL HISTORVIEXAM 13 ❑ INJECTION z NO FOLLOW UP PLANNED

o. ❑ CLINIWL LAB. TES7 14 ❑ lMMuNIZATIONIOESENSt TIZATION 1 : RETURN AT SPECIFIEO TIME

0$ D BLOOO PRESSURE CHECK 15 @ PHYSIOTP6RAPV

w ❑ EKG 16 0 MEOIC.4L COUNSELING

07 0 MFAelNG TEST 17 0 F-sycHoTHE RApYmMERAPEUTIC

0. ~ VK10f4 TEST LISTENING

o, 0 ENOOSCOPY 1s C 07WER :Swul”l ——

10 fl OSFICE SURGFRV

. c RETURN IF NEEOEO, P R N I

. Z TELEPHONE FQLLOW. UP PLANNEO !

, z akFERFiEO TO OTHER

PHYSICIAN 4GEVCY

- R6Tu R%ED TO REFt3R!NG

PHVS3ClAN

: AOMIT TO HOSPlr.tL

. C OTHER 1.2QePI/y]_

I

IRA.34.3 DEPARTMENT OF !-4EAL7H. EDuCATION 4N0 WELFARE

Ev a-74 PU6LIC I+EALTU SERVICE

0.M.6. =38. S72106

HEALTH RESOURCES AOMf NISTRATION

ExPIRATION 06TE 12/31/75

NATIONAL CENTER FOR HEALTH STATISTICS
a&ncecw7

SYMBOLS

Data not available ---

Category not applicable . . .

Quantity zero .

Quantity more than O but Icss than 0.05— 0.0

Figure does not meet standards of

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

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE - Public Health Service ] Number ~ . D.C.ITIb.~ 12.1978

Use of Intrauterine Contraceptive Devices in the United States’

INTRODUCTION

About 6 percent of the married women and

about 9 percent of the widowed, divorced, and

separated women were using an intrauterine contraceptive device (IUD) as of 1976. The Lippes

Loop was the most popukr IUD, followed by

the Copper 7.

The data presented in this report are the first

national estimates of the use of intrauterine contraceptive devices, by type of device, from the

1973 and 1976 National Surveys of Family

Growth conducted by the National Center for

Health Statistics. The data were collected by

means of person.d interviews with a mukistage

probability sample of women 15-44 years of age

in the household poptdation of the conterminous United States. Women were eligible

for inclusion in the sample if they were currentIy or previously married or were never

married but had offspring presently living in the

household. In this report the data refer only to

women who were currently married, widowed,

dhorced, or separated at the time of interview.

The interview was focused on the respondents’ marital and pregnancy histories, their

use of contraception and the planning status of

each pregnancy, their intentions regarding number and spacing of future births, their maternal

and family pkrming semices, and on a broad

range of social and economic characteristics.

Between June 1973 and February 1974, 3,856

lThis report was prepared by Kathleen Ford, Ph.D.,

formerly with the Division of VW Statistics.

black women and 5,941 women of other races

were interviewed for Cycle I of the National

Survey of Family Growth (NSFG). Between

January and September of 1976, 3,009 biack

women and 5,602 women of other races were

interviewed for Cycle 11.2 Further discussion of

the survey design, definition of terms, and sampling variability is in the TechnicaI Notes.

EXTENT OF IUD USE IN

THE UNITED STATES

Among married women in the United States,

the- use of the intrauterine device (IUD) increased from less than 1 percent in 1965 to

about 6 percent during the 1970’s (table 1).3 As

of 1976, simikr percents (6.1) of both white

and black married women were using the IUD.

2The numbers of black and white women interviewed

in Cycle II were revised for this report and differ slightly

from those numbers reported in Advance Data, Nos. 36

and 40. The revisions do not affeet any other statistics

reported here or previously.

3Data for 1965 and 1970 are from the flit and

second National Fertility Studies (NSF-I and NFS-11)

and arc reported, respectively, in IZeproducti”on in the

United States, 1965 by Ryder, N.B., and Westoff, C.F.,

Princeton, N.J. Princeton University Press, 1971; and in

The Contraceptive Revoktion, by Westoff, C.F., and

Ryder, N.B., Princeton, N.J., Princeton University Press,

1977. The figures in table 1 were computed from the

computer tapes obtained from the Data and Program

Libraq Service at the University of Wisconsin at

Madhon.
2

Table 1. percent of ever-married ta,mman 16-44 years of age and of

contraceptive method users who ware using the IUD at the

survey date. by rrssrital status and raw: United States. 1965.

1970; 1973; and 1976

Race and year

All mes2

1976 ...........................

1973 . .........................

,19703 %53 . ... ..... ....... .. ...

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

White

1976 . ............ ... ......-

1973 - ....................w.u

19703 . .............. . ......

19653 . ............. . ... .

Black

1976 - ................U......

1973 “.....-S”..N....S..”

19703 . ... ......... .... ..

19653 . ........ . . .. .... .

Xwently married

‘ercant

of

Noreen

6.1

6.7

5.0

●0.7

6.1

6.6

4.9

●0.7

6.1

7.6

5.0

●1.5

Percent

of

method

USarsl

12.5

12.5

9.3

●1.3

12.4

12.3

8.9

●1.2

13.4

16.9

11.1

*3.3

.

Widowed,

divorced

and seoarated

Percent

of

vwmen

9.1

7.2

●3.9

. . .

9.4

7.0

“3.6

..-

8.8

7.9

5.3

---

Percent

of

method

users 1

20.0

23.7

16.9

---

19.4

23.2

159

. . .

22.3

24.7

22.2

. . .

lMethod “~eexcludes surgical steriiizationin thia table.

2~lraces includes white, biack, and other races3Data for 1965 and 1970 arc from the tirst and second

Natiomd Fertility Studies.

Among widowed, divorced, and separated

women the proportion was higher (about 9 percent) than among married women.

AIthough the use of the IUD has increased in

the Iast 10 years, it still represents a smaH part

of American contraceptive practice. In 1976 the

IUD was used by 12.5 percent of married users

of nonsurgical contraceptive methods and by

20.0 percent of those who were widowed, divorced, or separated.

Type of IUD Usecl

In the 1976 NSFG, women whose current or

most recent method was the IUD were shown a

card displaying pictures of IUD’s and were asked

which type they had used most recently. About

9 percent of the married women and 8 percent

of the widowed, divorced, and separated women

did not know which type had been inserted.

Table 2 shows the number and percent distribution of ever-married women whose current

or most recent method of contraception was the

IUD by type of IUD, according to race and marital status. Among married women, the Lippes

Loop was the most popukr method mentioned

(37.7 percent of IUD users), followed by the

Copper 7 (27.8 percent), the Dalkon Shield

(16.9 percent), and the Safe-T-CoiI (12.5 percent). The relative popularity of the different

types of IUD’s among white and black women

was similar except that more black women used

the Safe-T-Coil than used either the Copper 7 or

the Dalkon Shield. Among widowed, divorced,

or separated women, the Lippes Loop was also

the most commonly used IUD, foIlowed by

the Copper 7, the Safe-T-Coil, and the Dalkon

Shield. As may be seen in table 3 and figure I,

the distribution of women who were currently

using the IUD at the survey date, by type of

IUD, is similar to that of women whose most

recent method was the IUD (table 2).

Figure 1. PERCENT DISTRIBUTION OF CURRENTLY MARRIED

WOMEN 1S44 YE4RS OF AGE USING THE IUD AT SURVEY

OATE, BY TYPE OF IUO USED: UNITED STATES, 1976

T

:00- COopu Oalkon Sal+

LmrI 7 SJm!4 T.cd Oslw

WPE OF fUO USEO Q
Table 2. Number of ever-married wornan 1544 yams of age whose most recent method of contmcaption WESthe IUD and percent distribution by type of IUD. according to rrmritei status and race: United States, 1976

Number of

Type Of IUD USCd

Marital status and race women in Lippes Safa-T- Coppfsr

thousands Total

Dalkon

LOOP Coil 7 Shield Other

I

Currently married I

All IYsCSS1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

u=

White . ..... ....... ....................... ...... ... .... .... ..... ... 1,802

Black . ... . . .. .. .. ............. ... ......... ..... ............. ... 159

Widowed. divorced, or separated I

All racesl . .... ........................... .... ........ ........

l====

423

Whita .......... . .............. ........................ ........ ... . ...... 305

Black . .........." . .. ......... ......... ......... .............. .......... 112

100.0

100.0

100.0

100.0

100.0

100.0

37.7 12.5 27.8 16.9 ●5.O

36.1 12.4 29.2 17.8 ● 4.5

52.7 ●1 7.4 *122 “9.5 ●8.3

46.5 16.6 23.8 ●8.5 “4.5

39.8 ● 17.3 27.4 ● 10.9 *4.5

62.3 ● 15.4 ●15.O ●2.4 +4.7

lMI ~ace$includes white, black, and other racesParity of IUD Users .--:- UslIlg the various types of IUD’s differed by

Among currently married women, IUD users pari;y or the number of live births they have had

are more likeIy to have had at least one child (table 4). For women with no live births, the

(87.5 percent) compared with users of other non- Copper 7 was the most popukir type IUD, but

surgicaI contraceptive methods (79.0 percent). for women with two or more children the

The proportion of cumentIy married women Lippes Loop was the type most often used.

Table 3. Number of evar-rnarried woman 15-44 years of age using the IUD at survey date and percent distribution by type of IUD, according to marital status and race: Unitad States. 1976

Number of

Type of IUD USd

Marital status and race vmmen in Lippas Safe-T- Copper

thousands Total

Dalkon

LOOP Coil 7 Shield Other

Currently married

All racasl ........." .. ...............................a....... 1,582 100.0 *

35.2 13.1 30.2 15.3 ●6.2

White . ..... ........... ......................... ....................... 1,436 100.0 33.7 13.1

Black

31.5 15.9 ●5.7

. . ...... . ... .............. ....... ... ........................ 124 100.0 61.3 * 15.8 “14.8 “1O.2 ●7.8

Widowad. divorced, or saparmed

All racasl .... ... ............................................. 311 100.0 48.5 ● 15.8 24.6 ●8.8 ●2.2

White .. ............................................................ ..... 230 100.0 41.9 ●17.7 27.3 ●11.6

Black

●7.5

. ...... ... . . . . .... ........... ... ............... .. ... 81 100.0 67.8 *’to.3 *Y 6.7 *O9 ●4.3

lAII racesincludes white. black. and other races.
Table 4. Number of currently rrerriad women 1544 years of age using the IUD at survey’ date and percent distribution by Wpe of IUD

used, acwrding to parity: United States, 1976

1 1

Number of

Type of 1UO used

Parity women in Lippes Safe-T- Copper

thousands Total

Dalkon

Loop Coil 7 Shield Other

All . . .... . .......................... ............................

I==&=ll 3’-21 “1 3021 ‘“l *62

Zero . . ..... ..... ... . ..... ... . .... ... .. .... ........... .... ...”.. 205

First

100.0 “20.5 ●2.6 50.6

351

‘23.6 “2.8

........ ..... ... . .. ...... .............. ... ........... ............ 100.0 24.8 ●12.3 36.3 ●15.6

second or more 1,026

● 10.9

................ .... .. . .... . .... ................... 100.0 42.3 I 5.8 23.4 13.3 ●5.2

TECHNICAL NOTES

The Survey Design

The National Sumey of Family Growth

(NSFG) is designed to provide data on fertility,

family planning, and related aspects of maternal

and ehiId health. FieId work for CycIe I was

carried out by the National Opinion Research

Center between June 1973 and February 1974.

FieId work for Cycle II was carried out by

Westat, Inc., between January and September

1976.

A multistage probability sample of women

in the household population of the conterminous United States was used in both cycles.

Each time, approximately 33,000 households

were screened to identify the sample of women

who would be eIigible for the NS FG, i.e., women aged 15 to 44 years, inclusive, who were

currently married or previously manied or who

were never married but had offspring presendy

living in the household. In households with more

than one eligible woman, a random procedure

was used to select only one to be interviewed.

Since the interi-iews were always conducted with

the sample person, the term “respondent” is

used as synonymous with sample person. A detailed description of the sample design for Cycle

I is presented in “National Suxvey of Family

Growth, Cycle I: Sample Design, Estimation

Procedures, and Variance Estimation, ” Series 2,

No. 76 in the Vital and Health Statistics series.

A similar report is in preparation for Cycle II.

While the interviews varied greatly in the

time required for their completion, they averaged about 70 minutes for Cycle I and about 58

minutes for Cycle II.

Quality control procedures were applied at

alI stages of the survey. These included a verification of listing completeness, with unlisted

dwelling units being brought into the sample; a

prelimin&y field review of completed questionnaires for possible missing data or inaccurate adminktration; a 10-percent sampIe recheck of rdl

households to be screened during the survey; observation of intem-iews in the field; and an independent recod~ng of a 5-percent subsample of

completed interwews.

Reliability of Estimates

Since the statistics presented in this report

are based on a sample, they may differ somewhat from the figures that would have been obtained if a complete census had been taken using
ahancedata 5

the same questionnaires, instructions, interviewing personnel, and field procedures. This

chance difference between sample results and a

complete count is refereed to as sampIing error.

In addition, the results are also subject to nonsampling error due to respondent misreporting,

data processing mistakes, and nonresponse. It is

very difficult, if not impossible, to obtain

accurate measures of nonsampling errors. These

types of errors were kept to a minimum by the

quality con trol procedures and by other

methods incorporated into the survey design and

administration.

Sampling error, or the extent to which samples may differ by chance from a complete

count, is measured by a statistic called the standard error of estimate. Approximate standard

errors for estimated numbers and percentages

from CycIe I are shown in tables I and II for the

total and white populations and in tables HI and

IV for the black population. Provisional estimates for standard errors for Cycle II for total

and white women can be obtained by multiplying the srandard errors for these women from

Cycle I by a factor of 1.1. Similarly, provisional

estimates of standard errors for Cycle II for

black women can be obtained by multiplying

the standard errors for these women from Cycle

I by a factor of 1.2.

Table 1. Approximate standard errors for estimated numbers for

white and total mmen: 1973 Nanonal .Surwy of Family GroMh

[ I

Size of

Relative

standard Standard

estimate

error

error

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

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

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

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

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

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

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

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

20,000,000 .......... ............ .....

30,0

21.2

15.0

9.5

6.7

4.8

3.0

2.2

1.5

i ?5,000

21,000

30,000

47,000

67,000

95,000

151,000

216,000

311,000

Table 11. Approximate standard errors for estimated percentages

expressed in percentage points for white and totaI women:

1973 National Sunrey of Family Growth.

Estimated oercentaae

8aseof —

percentage 2 or

98

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

600,000 ..........

1,Ooo,cwo .......

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

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

7,C)00,0C10 ........

10,000,000 . .....

3.0

1.3

0.9

0.5

0.4

0.3

0.3

T

5or 10or

95 80

1

4.6

2.1

1.5

0.8

0.6

0.5

0.5

6.4

2.8

20

1.2

0.9

0.8

0.6

8.5 I 9.7 I 10.4 I 10.6

3.8 4.3 4.6 4.7

2.7 3.1 3.3 3.3

1.5 1.8 1.9 1.9

1.2 1.4 1.5 1.!5

1.0 1.2 1.2 1.3

0.8 1.0 1.0 1.1

Table I I 1. Approxirnste standard errors for estimated numbers

for black women: 1973 National Sumey of Family Growth

Size of Relatiw Standard

estimate standard

error

error

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

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

1Oo,ooo .... ....... .... ........... ....

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

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

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

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

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

1,cQo,oQo..- ...... ................

25.3

17.9

127

10.3

8.0

6.8

5.7

4.7

4.0

6.000

9,000

13,000

16,000

20,000

24,000

28,000

35,000

40,000

Table IV. Approximate standard errors for esumated percentages

expressed in percentage points for black women: 1973

National Survey of fimily Growsh

5,0cro..._........

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

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

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

300,000 ...........

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

700,000 .......... .

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

7.9 123 17.01 226 25.9

5.6 8.7 120 16.0 18.3

2.5 3.9 5.4 7.1 8.2

1.8 2.7 3.8 5.1 5.8

1.0 1.6 2.2 29 3.3

0.8 1.2 1.7 2.3 2.6

0.7 1.0 1.4 1.9 2.2

0.6 0.9 1.2 1.6 1.8

27.7

19.6

8.8

6.2

3.6

2.8

2.3

2.0

28.3

20.0

8.9

6.3

3.6

2.8

24

2.0
6 dmxlxkb

The chances are about 68 out of 100 that an

estimate from the sample wouId differ from a

complete census by less than the standard error.

The chances are about 95 out of 100 that the

differences between the sample estimate and a

complete count would be Iess than twice the

standard error. The relative standard error is the

ratio of the standard error to the statistic being

estimated. In this report, numbers artd percentages which have a standard error that is

more 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 comparisons of

greater precision.

In this report, terms such as “similar” and

“the same” mean that any observed difference

between two estimates being compared is not statistically significant. Similarly, terms such as

“greater,” “less,” “larger,” and “smaller” indicate that the observed differences are statistically significant. The normal deviate test with a

0.5 Ievel of significance was used to test a.11comparisons which are discussed in the text. A statistically significant difference is one large enough

that in repeated samples of the same size and

type as this one, such a large difference would

be expected to be found in less than 5 percent

of the samples. Lack of comment in the text

between any two statistics does not mean the

difference was tested and found not to be significant.

Adjustment for nonsampling error due to

nonresponse was made in two ways. Nonrespondent cases, as distinct from missing data

items, were imputed by weighting for nonresponse within each primary sampling unit,

stratum, and age-race categoq. In the 1973 survey, codes for missing items were imputed using

a “hot deck” procedure. In the 1976 sumey,

imputation for missing data items has not been

performed and the distributions shown in the

tables are based only on those interviews where

enough information was obtained from the respondent to determine contraceptive status.

Cases for which the value of a given distribution is missing are shown in the totals. As a result,

in the 1976 figures. about 1,061,000 women out

of an estimated 31,847,000 total ever-married

women are not represented in the distribution

by contraceptive status.

Definition of Terms

Method Users.-A woman (or couple) who

reported use of a contraceptive method at the

date of interview was classified according to the

specific method used.

Most Recent Method.–A woman (or couple)

who reported use of a method at the time of

interview was classified according to the specific

method used. A woman (or couple) not using a

method at the time of interview was classified

according to the specific method used most

recently.

Type of Intrauten-ne Dem”ce.–Type of intrauterine device was determined by showing the

woman being interviewed a card with pictures

and names of IUD’s and asking her to identify

the type she was using or had used.

Age.–In this report, age is classified by the

age of the respondent at her last birthday before

the date of interview.

Race. –Classification by race, based on interviewer observation, was reported as black, white,

or other. Race refers to the race of the woman

interviewed.

Man.tal status. –Persons are classified by marital status as married, widowed, divorced, separated, or never married. Married persons include those who report themselves as married or

as informally married, such as living with a

partner or common-law spouse. Persons who are

temporarily separated for reasons other than

maritaI discord, such as vacation, ihess, or

Armed Forces, are classified as married. Divorced persons me those whose most recent marriage was legaIly dissolved and who are free to

remarry. Women with an annulIed marriage,

whiIe having the legal status of never having

been married, are classified together with the divorced. The category “separated” includes those
adwlncedata 7

who are IegalIy or inforrtdy separated from However, in the NSFG, only single women with

their most recent spouse due to marital discord. offspring Iiving in the household are included

The “never married” incIude those who have and separately ckssified.

never had a formal marriage and do not consider Pan”ty .–Parity refers to the number of live

themselves in any of the preceding categories. births the respondent has had.

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 preeision *
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, . Publ!c Health Serwce

EDUCATION, AND WELFARE Office of Health Research, Star! srlcs, and Technology Number 44 ● September ZO, 1979

Health Care Coverage: United States, 19761

As a national issue, the type and extent of

heaIth insurance coverage has been a matter

of concern for some time. The debate over the

various national hezdth insurance proposals

routinely focuses on the extent and type of

coverage to be made available under Ie<gislation.

In particular, the number of uninsured persons

and their characteristics have been a matter of

interest and investigation. Thus the population’s

current level of coverage must be presented in

both a time~y and relevant fashion. There is a

need to answer the folIowing questions: How

many persons have no health care coverage at

all? What are their characteristics? Among

persons who have health care coverage, how

many are covered under broad types of public

and private insurance prokgrams? How many

persons are covered exclusively under public

pro<grams? This report presents statistics that

bear directIy on these questions and are based

primarily on survey respondents’ perceptions

of their health care coverage.

Findings in this report include estimates

from the Health Interview Survey (HIS) of the

number of persons covered under specific plans

or pro&grams, regardless of other coverage, as well

as those covered exclusively under certain pIans

or programs.

During 1976, the HIS questionnaire included

questions designed to obtain information about

coverage under private and public health care

plans or programs in the civilian noninstitutionalized population of the United States. Data

were obtained on Medicare, Medicaid, and private hospital and surgicaI insurance coverage.

1This report was prepared by Larry S. Corder, Ph. D.,

formerly with the Division of Health Interview Statistics.

Information concerning health care covera,ge was

reported by one household respondent on behaJf of the entire household. Information on

private insurance coverage was collected in

severaJ areas: what services the plan paid for

(hospitaI and/or surgicaI expenses); how the plan

was obtained (through a company, union, or

some other method); and the type of pkm (Blue

Cross/B1ue Shield, prepaid, or other). If the

respondent had no private hospital insurance

coverage, no Nledicare coverage (for persons

65 years and over), and no Medicaid coverage,

a question was asked to determine the major

reason for lack of coverage.

Further, HIS collected information on persons receiving Aid to Families with Dependent

Children (AFDC) and SupplementaI Security

Income (SS1). Both -groups are usuaI1y eIigible

to receive medical care paid for by the LMedicaid program.

AH of the above data items are based primariIy on the survey respondents’ perceptions

of their health care coverage. When employed in

a way to insure the elimination of double counting, they provide a portrait of the extent of

health care coverage in the civilian noninstitutionaiized population. However, little in formation is avaiIable on the proportion o f health

care costs paid for by different public or private

pIans or programs.2

In 1976 approximately 186,583,000 persons, or 89.0 percent of the civiIian noninstitu2 Extensive information concerning adequacy of coverage will be available from the National .Medical Care

Expenditure Sumey (NMCES) in the near future.

IWMCES is a joint project of the National Center for

Health Statistics and the National Center for Health

Services Research.
2 advancedata —

tionalized population of the United States,

are estimated to have had some form of health

care coverage. The remaining 11.0 percent,

23,200,000 persons, who had no coverage

under either public or private programs are defined as the uninsured population.

An estimated 159,957,000 persons had private

insurance coverage. Approximately 145,880,000

of these persons had private coverage only, while

the remaining 14,077,000 reported Medicare

and/or Medicaid coverage as well. This figure includes an estimated 11,656,000 Medicare enrollees, 60.0 percent of all Medicare enrollees,

whose coverage was supplemented by some form

of private insurance plan.

An estimated 16,392,000 persons were covered by Medicaid regardless of other coverage.

About 12,162,000 of these had coverage under

the Medicaid program only. These estimates

differ from the 24.7 million recipients recorded

by Medicaid program statistics in 1976.

DATA HIGHLIGHTS

Table 1 presents information on the popuIation’ss health care coverage under private or

public plans or pro<grams. In this table, no person can be covered in more than one major

category of coverage. Once a person appears

under a major category of coverage, then that

person cannot appear in another major cate-

.go~ in the table. For example, a person cot’ercd

by both private hospital insurance and Jkdicare

3The term “poptdation” as used in this report refers

to the civilian noninstitutionaiizcd population.

Table 1. Number, percent. cumulative number, and cumulative percentof the population, by health care cowrage under types of private

or public plans or programs: United States, 1976

Type of private or public plan or program

Private hospital insumnm ... ........................................... .. .... ..

Private hospital insurance only . ... .............. .......... ................... ..... .....

Primte hospital insurance and Madicare .... .......... ...... ...... ............ ....

Private hospital insurance and Medicaid .. .............. ............ ...............

Medicare coverage, no privata hospital insurance . .. ...... ...... ....

Madicere coverage only ....... .............. ........................ ...................... .

Medicare and Medicaid coverage only ...... .... ........ .... .. ...... ............ ....

Medicaid coverage only ......... ............ ........ ...... ...... .......... ......

Other plans or programs onlyl ....... ....... .. ........... ............. .... ..

Private hospital insurance only, but don’t know what plan covers...

No other coverage; don’t know if covered by private hospital

insuranca ............ ........... ............... ........ ............... ...... .............. ...... .

No health care coverag+?.. .................................. ............ ........

1$.~her ~lan~ or ~ro~~ only” breakdown as follows:

CHAMPUS, CHAMPVA... 4,807

Private surgical insurance only .................. 236

Rofes.sional courtesy ...... . 41

Number in

thousands ‘

159,957

145,880

11,656

2,421

7.756

5,948

1,808

12,162

5,084

1,624

861

23,200

Percent

75.9

69.3

5.5

1.1

3.7

2.8

0.9

5.8

2.4

0.8

0.4

11.0

Cumulative

numbar in

thousands

159,957

145,880

157,536

159,.957

167,713

165,905

167,713

179,875

184,959

186,583

187,444

210,644

Cumulative

percent

75.9

69.3

74.8

75.9

79.6

78.8

79.6

85.4

87.8

88.6

89.0

l(XI.O

NOTE: In this table. a oerson meY atxrear only once in a major Cstegory reserdlesa of the number of Promms, P1ans~ or policies he

or she is covered under.
akmedda 3

would be counted in the major category “private hospitzd insurance. ” Further, that person

wouId be counted in the “private hospital

insurance and Medicare” subcategory, one of the

subcategories which sum to the “private hospitaI

insurance” major category. While this breakdown by major categories superficiality understates the number of persons covered under

various public programs, its use makes the

examination of a number o f policy -relevant

groups possible and eliminates multiple counting

of peopie with more than one form of coverage.

The elimination of muItiple counting for heaIth

care coverage is essential to arriving at an accurate estimate of the number of uninsured

persons.

Highlights from table 1 include an estimate

of the uninsured group, 23,200,000 persons,

or about 11 percent of the population; an estimate of the group covered by private hospital

insurance and/or Medicare, 167,713,000 persons, or approximately 80 percent of the population; and an estimate of the number of persons

covered by Medicaid only, 12,162,000 persons,

or approximately 6 percent of the population.

Table 1 shows that. 159,957,000 persons,

or approximately 76 percent of the population,

had private hospital insurance coverage during

1976. Included in this ~group are persons having

private hospitaI insurance and Medicare coverage, 5.5 percent of the population, and persons

having private hospitaI insurance and Medicaid

coverage (1. 1 percent).

Persons covered by ?vledic~e but not by private hospital insurance comprised approximately

4 percent of the population (7,756,000 persons). About 2.8 percent of the population had

Medicare coverage only, and 0.9 percent had

both Medicare and Medicaid coverage but no private hospitaI insurance. Persons covered only by

Medicaid comprised approximately 6 percent of

the population, 12,162.000 persons.

Cumulatively, therefore, approximately 85

percent of the population were covered under

some combination of private hospital insurance,

Medicare, or bfedicaid. An additional 2 percent

of the population were covered under other

plans or programs. These are the Civilian Health

and I’vIedicai Program for Veterans Administration (CH.%IIPVA), the CiviIian Health

and Medical Program for Uniformed Services

(CHAMPUS), professional courtesy, and private surgical insurance ordy. These programs,

along with Medicare, Nledicaid, and private

hospital insurance, provided approximately

88 percent of the population with some form

of heaIth care coverage. Another 1 percent

of the population, 1,624,000 persons, were

covered by private hospitaI insurance but did

not know if their plans covered hospiwd charges

or physicians’ fees while in the hospital. These

persons were not covered by any other p nvate

or pubIic hospital insurance pIan. .Adding these

to the insured population yieIds a totaI of

186,583,000 persons, or approximately 89

percent of the population, covered under some

combination of Medicare, Medicaid, p nvate

hospital insurance, other plans or programs, or

unidentified private hospitaI insurance only.

An estimated 861,000 persons did not know

if they had private hospital insurance but were

not covered by any other pubIic or private pIan

or program. Persons in this category were

counted as neither insured nor uninsured.

Rather, based on the respondents’ perception of

coverage, they were categorized under “no other

insurance, don’t know if covered by private

hospitai insurance.”

The remaining population, approximately 23

miIIion persons, or 11 percent of the population,

were not covered by any private or pubIic health

care coverage pIans or programs in 1976. These

persons are defined as uninsured. Twelve percent of the population under 65 years of age,

22,763,000 persons, were uninsured. Aday and

hderson, using their own methods and data

from a 1975-76 survey of the civilian noninstitutionaIized population, a.ko estimated that

12 percent of the group under 65 years of age

were uninsured.4

Major Health Care Coverage Categories

TabIe 1, in which multiple counting of covered persons is eliminated, presents estimates of

the number of uninsured persons but does not

4.%day, L. A., and Andersen. R.: Insurance coverage

and access: implications for health policy. Heaftis .%m.

Res. 13(4):369-377, Winter 1978.
Table 2. Number and percent of persons with health csre coverage under major private or public plans or programs, by age:

Umted States, 1976

All ages Under 65 years

65 years

Major private and over

or public plan

or progmm Number in Percent Number in Percent Number in Percent

thousands thousands thousands

All plans or programs .... ...... ............................ . 210,843 100.0 188,844 100.0 21,799 100.0

Private hospital insurance .................. .... ...................... 159,957 75.9 146,340

Medicare .

77.5 13,617 62.5

~di=id. ................ .................................... ............ .... 19,412 9.2 420 0.2 18,992 87.1

...................................................................... 16,392 7.8 13,835 7.3 2,557 11.7

Other plans or programsl ...... ....... ......... .. .... ................ 4,868 2.3 4,790 2.5 78 0.4

Private surgical insurance . ................................. .. ......... 156,276 74.2 143,450 76.0 12,826 58.8

1 Excludes Prfite SUKgid coverage Only.

NOTE: Types of coverage do not sum to the population total. The table reflects extent of coverage of each type and, thus, does not

exclude doub k counting.

accurately reflect the total number of persons

covered under each private and public procgram.

Table 2 presents information concerning the five

most common types of health care coverage

without eliminating multiple counting. A

person covered by both private hospital insurance and Medicare appears in both categories

in table 2. Therefore the total number of persons appearing in table 2 exceeds the total

population. In addition, the estimates presented

do not correspond to estimates of coverage

provided by specific programs. The reasons

for differences between HIS estimates and those

reported by the groups responsible for administering the various public programs are examined

in the following text.

The HIS estimates that 9 percent of the

population, 19,412,000 persons, were covered

by Medicare in 1976. This estimate falls short of

that prepared by the }Iedicare program. The

Medicare program estimates, based on enrollment records, that 22,849,782 persons 65 years

and over were covered during the year and that

an additional 2,339,502 persons under 63 years

of age were covered by Medicare disability and

end-stage renal disease provisions. The difference between the HIS estimate and Medicare

enrollment data for persons 65 years of age and

over may be attributed to a number of hctot-s.

First, HIS is a suwev of the civilian noninstitutionaliztd population and does not, therefore,

reach those persons in institutions who receive

LMedicare be-~efhs. Second, HIS may undercount

the number of persons who receive Medicare

benefits. Among persons under 65 years o f age,

the difference between the survey estimate o f

coverage and the estimate of coverage based on

enro[lme”nt data may be substantially attributed

to an additional factor related to the survey

instrument design. In 1976, HIS allowed persons

under 65 years of age to be counted as covered

by Medicare only if they affirmed that they

were not covered by private hospital insur.

ante or >ledicaid.

Persons categorized by HIS as being covered

under private hospital insurance constituted approximately 76 percent of the population,

159,957,000 persons. Respondents included in

that category claimed they had private hospital

insurance coverage and were able to supply the

name of their insurance plan. Persons covered

under private surgical insurance comprised

approximately 74 percent of the total population, 156,276,000 persons.

The primary source of comparable data

on private hospital insurance is the Health

Insurance Association of America (HIAA).

For 1976, their estimate of the number of

persons protected by hospital insurance was

176,581,000 persons of all ages–16-1,027,000

persons under 65 years of age and 12,554,000

persons aged 65 years and over. The differences
acbncedata 5

in the magnitude of HIS and HI.%% estimates

might be attributed to survey underc~unts (HIS)

and to inadequate adjustment for multiple coverage (HIAA).

The HIS estimates that during 1976,

16,392,000 persons, approximately 8 percent

of the population, were covered by Medicaid.

Respondents included in this categoqr either

specifically affirmed that they had been covered

by Jledicaid in the previous 12 months or met

other detailed criteria listed in the definitions.

The Jledicaid pn)gram, however, estimated that

2-!,666,252 pet-sons received semices paid for by

Aledicaid during fiscal year 1976. The )Iedicaid

estimate of its recipient population is based on

“unduplicated recipient counts” reported by 44

States and ratio adjustment for remaining States

which did not provide such an estimate. However, little information is avaiIabIe concerning

the manner in which the States counted hledic -

aid recipients, and it is speculated that these

counts may contain substantial duplication. The

difference between the Medicaid procgrarn’s estimate of its recipient population and the estimate

based on HIS data may be further expiained by

the HIS exciusion of the institutionaIized

population.

The major catego~ “other plans or programs” comprises persons who had no insurance

but who were covered by one of the foIIowing:

CHAAIPL%, CHAIPVA, or professional courtesy. Approximately 2 percent of the pOp.

uation, 4,868,000 persons, were covered under

some combination of these plans. Comparable program estimates of persons covered in

this category are not readily avaiIabIe.

Uninsured

Tables 3 and 4 show the number and percent

of persons by type of health insurance coverage

or Iack of coverage according to seIected characteristics. The uninsured, 11.0 percent of the

population, are not under any sort of health care

coverage, public or private. Differences in the

percent of the population under no health care

coverage between and among population subgroups are readiIy apparent.

A comparison of the age ,groups under 6

years and 65 years and over is most striking.

Among chiIdren under 6 years of age, 13.0

percent were uninsured, while among those

persons 65 years and over, 2.0 percent were uninsured. A lower proportion of white persons

(about 10 percent) than of dl other persons

(about 16 percent) were uninsured. The proportion of the poptdation without health coverage declines as family income rises. Among persons in famiIies with incomes of less than

$3,000, Z 1.8 percent were uninsured, while

among persons in famiIies with incomes of

$15,000 or more, approximately 4 percent \verc

uninsured. .+ smalIcr prop{)rtion [If pcrsf)ns \\”i[h

13 years or more of educutif]n were uninsurcc[

(7. 1 percent) compared with those with 11 years

of schooIing or Iess ( 14.3 percent).

Geographic, occupational, and industrial

variables and differences in utilization of health

services also are related to differences in the

extent of insurance coverage. lVith respect to

residence, approximately 19 percent of the

persons who Iived outside standard metropolitan statistical areas (SMSA’s) on farms

were uninsured, while 8.1 percent of persons

who Iived in SkISA’s but not in the central

city were uninsured. Regional differences in

the proportion of the population with no

health care coverage also show an interesting

pattern. Both the Arortheast and North Central

Regions had approximately 8 percent uninsured,

whiIe the South and West had 14.6 and 13.7

percent uninsured, respectively.

\Vide differences appear in the number and

percent of the uninsured in various population

subgroups according to occupation and indust~

groupings. Among professionaki, approximately

5 percent were uninsured, whiIe among farm

laborers and farm foremen, approximately -41

percent were uninsured. Among those not in

the labor force, 11.0 percent were uninsured.

These 12,842,000 uninsured persons not in the

labor force constituted approximately 55 percent of alI the uninsured. GeneralIv, whitecollar ~groups had a smalIer percentage of uninsured persons than the blue-collar -groups.

Wide differences between ~groupin~s by

industry are also apparent. Among those persons

in the a,griculturai grouping, approximately 29

percent were uninsured, while only 4.+ percent

of persons in public administration were uninsured. The groupinqs of mining. manufacturing, transportation and public utiiities, finance,
6

Table 3. Number and percent of the population, by twes of health care coverage and selected characteristics: United States, 1976

Selected characterisi-ic

All persons .... ...................

—Age

Under 6 years .......................... ...

6-18 years .... .... ........ ... ..... ...........

19-54 years .................................

5!3-64 years ........... ............ ..... .....

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

—Sex

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

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

Color

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

All other .......... .... ........... ............

Family incomel

Less than S3,000 .................. ......

$3,000-$4,999 ......... ........ ...........

$5,000-$6 ,998 ......... ............ .......

$7,000-s,999 .... ........................

$10,000-$1 4,999 ..................... ...

$15,000 or more ...................... ..

Education of individual

0-11 years ..... ..... ....................... ..

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

13 years or more ..... ...... .... ..........

Residence

SMSA ... ........ .................... ..........

Central city ..... ........... ...........

Not central city’ .............. ...... .

Outside SMSA . ......... ..................

Nonfarm ......... ......................

Farm ......................... ............

See footnote at end of table.

Health care coverage

Priwte hospital Medicaid Other plans or

nsurance, Medicare, or both

covemge only programs only

Number Number Number

in Per- in Per- in

thou- cent thou- carrt thousands sands sands

I 1 1 ,

167,713 79.6 12,162 5.8 5,084

13,237 70.0 2,373 12.5 631

37,942 75.3 4,550 9.0 1,474

79,283 79.5 4,177 4.2 2,365

16,292 82.1 815 4.1 527

20,958 96.1 247 1.1 87

81,367 80.1 4,923 4.8 2,381

86,346 79.2 7,239 6.6 2,704

150,855 82.5 6,883 3.8 4,369

16,858 60.7 5,279 19.0 716

6,409 51.0 3,068 24.4 176

9,087 55.4 3,438 20.9 194

11,534 62.8 2,271 12.4 470

18,327 75.8 1,087 4.5 843

38,619 86.8 715 1.6 1,283

69,960 92.3 426 0.6 1,663

39,129 76.6 3,821 7.4 854

44,803 84.0 1,390 2.6 1,252

37,062 88.4 440 1.0 1,026

116,328 80.7 8,992 6.2 3,302

46,109 75.1 6,008 9.8 1,409

70,219 84.8 2,983 3.6 1,892

51,385 77.4 3,171 4.8 1,783

46,354 77.4 3,069 6.1 1,676

5,031 76.!3 102 1.6 107

Perxmt

2.4

=

3.3

2.9

2.4

2.7

0.4

2.3

2.5

2.4

2.6

1.4

1.2

2.6

3.5

2.9

2.2

1.7

2.3

2.4

2.3

2.3

2’.-

2.7

2.E

1.6

%imte hospital

nsurance, don’1

know coverage

Number

in

thousands

1,624

-

104

389

913

174

43

783

840

1,398

225

108

83

156

192

289

486

35a

483

329

1,129

42S

704

49g

463

“32

Percent

0..5

0.6

0.8

0.9

0.9

0.2

0.8

0.8

0.8

0.8

0.9

0.5

0.8

0.8

0.7

0.6

0.7

0.9

0.8

0.8

0.7

0.9

0.8

0.8

“0.5

No other insurance; don’t

know if

covered by

private hospital insurance

Wrnber

in

thousands

861

106

228

378

122

“27

424

436

671

189

74

99

82

56

128

157

207

160

120

639

292

347

222

213

‘9

Per-

:ent

0.4

=

0.6

0.5

0.4

“:::

0.4

0.4

0.4

0.7

0.6

0.6

0.4

0.2

0.3

0.2

0.4

0.3

o.~

0.4

o.~

0.4

0’..

0.4

●0.1

No health

care coverage

dumber

in

thousands

23,200

2,469

5,825

12,550

1,919

437

11,746

11,452

18,675

4,525

2,740

3,500

3,857

3,658

3,437

3,104

7,404

5,278

2,965

13,837

7,168

6,669

9,363

8,106

1,257

Peramt

11.0

~

13.0

11.6

12.6

9.7

2.0

11,6

10.5

20.2

16.3

21.8

21.3

21.0

15.1

7.7

4.1

14.3

9.9

7.1

9.6

11.7

8.1

14.1

13.5

19.2
amcecMa7

Table 3. Nun-her and percent of the population, by types of health care coverage and selected characteristics: United States, 1976-Con.

Health care coverage

Private hospital Medicaid insumnce, Medicare, or both

coverage only

Sedectad charecteriscic

Geographic ragion

Northeaat ............................ .......

North Central ......... ..... .... ...........

South ............................... ..........

West ............................ .. .............

Physician visit

in last year

No,.............................................

Yea........................... ................”

Hospiteliaetion

in last year

No............... ..............................

Yea ...................... ......................

Number Number

in Per- in Perthou- cent thou- cant

sands sends

40,394 83.7 3,449 7.1

47,973 85.3 2,752 4.s

50,717 75.1 3,471 5.1

28,629 74.9 2,490 6.5

38,880 75.4 2,454 4.6

127,833 81.0 9,708 6.2

&

)rtcd income.

ars of age.

insurance and real estate, semice and miscellaneOUS, and pubIic administration were characterized by a lower percent uninsured than the

national average. Groupings with a higher percent of uninsured persons than the nationaI

average were agriculture, forestry and fisheries,

construction, and wholesale and retaiI trade,

which are industries characterized by seasonaI

employment, self-employment, and Iow leveIs

of unionization.

Among persons who did not see a physician

during the year, approximately 16 percent were

uninsured, while among persons who saw a physician, approximately 9 percent were uninsured.

For persons who were not hospitalized during

the year, approximately 11 percent did not have

heaIth care coverage, while among those persons

with a hospitalization, ap~roximately 8 percent

were uninsured.

T

other plans or

Priwate hospital

insurance, don’t

programs only

know coverage

m

II

468 1.0 391

464 0.8 425

2,682 4.0 676

1,470 3.8 231

1,032 2.0 625

4,062 2.6 1,088

4,506 2.4 1,500

578 2.6 124

Perxnt

0.8

0.8

0.9

0.6

1.0

0.7

0.8

0.6

No other insurance; don’t

know if

COWrad by

private hospital insurance

I

*umber

in Perthou- cent

sands

227 0.5

161 0.3

283 0.4

179 0.5

3m 0.6

560 0.4

800 0.4

60 0.3

No health

care coverage

Uumber

in

thousands

3,683

4,458

9333

5,225

8,677

14,522

21,471

1,728

Perznt

7.6

7.9

14.6

13.7

16.4

9.2

IT.4

7.7

In summary, a pattern of differences in the

extent of health care coverage for different population subgroups emerges according to standard

social and demographic characteristics. The uninsured are proportionately concentrated among

those who have Iow incomes, work in certain industries, have low educational attainment, are

very young and are other than white.

Private Hospital Insurance,

Medicare, or Both

Approximately 4 out of 5 persons were covered under private hospitaI and/or Medicare insurance in 1976. LMany persons were covered by

both, as indicated in table 1–1 1,656,000 persons, or 5.5 percent of the poptdation. As indicated in table 2, 19,412,000 persons, or

approximately 9 percent of the population, were
8

Table 4. Number and percent of the population, by type of health care coverage, occupation, and indusuy: United States, 1976

Occupation and industry

All persons ............ ..........

Occupation

Professional, technical, and

kindred workers .................. .....

Msnagers and administrators,

except farm .... .......... .......... ... ...

Ssles workers .............. ..... ...........

Clerical and kindred workers . ... ..

Craftsmen and kindred workers..

Operatives, except transport ......

Transpom equipment operatives..

Laborers, except farmers .. ..........

Farm rmnagers ...... ..... ........... .... .

Farm laborers and farm

foremen .............. .. ......... .... ......

%vice workers, except

private household ..... ...............

priwte household workers ... ......

Unknown ... ..... ............ ............. ..

Nor in labor force ......... .... .. .... ....

Industry

Agriculture ....... ...... ....................

Forestry and fisheries ................ .

Mining ............ ...... .............. ........

Construct ion ....................... .... ...

Manur%turing . ................ ...........

Transpo~tion and public

utilities ........ ....... ............. .........

Wholesale and retaii trade ......... ..

Finance, insurance, and

rrnl estate ............... .............. ....

8ewice and miscellaneous ........ ...

Public administmtion . .. ..............

Unknown ......................... ....... ...

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

‘rivate hospitai

nsurance, Medicare, or both

Nu tier

in

thousands

167,713

13,207

9,184

4,947

14,249

10,260

9,328

2,827

3.010

1,164

591

8,676

683

1,078

88,509

2,125

69

697

4.456

19,530

5.155

14,878

4,578

21,597

5,095

1,023

88,509

Perznt

79.6

~

92.6

89.5

84.6

87.9

84.0

83.6

80.8

72.2

78.4.

63.9

77.3

62.4

66.4

76.0

67.8

68.3

91.0

76.2

89.0

88.5

80.1

90.3

84.2

89.4

66.0

76.0

Health care coverage

I

Medicaid Other plans or

mverage oniy I

programs on Iy

Number

in

thousands

12,162

75

“32

84

274

136

278

61

103

●2

37

394

103

126

10,457

51

“4

●6

77

298

66

385

“30

585

73

130

10,467

p

Number ~

Per- in

cent thousands ~

5.8 5,084

0.5 204

“0.3 199

1.4 156

1.7 294

1.1 169

2.5 108

1.7 56

2.5 75

●0.1 “16

3.4 “15

3.5 310

9.4 ●

7.8 41

9.0 3,422

1.6 38

‘3.6 ●.

“0.8 ●6

1.3 103

1.4 161

1.1 59

2.1 441

“0.6 91

2.3 502

1.3 225

8.4 37

9.0 3,422

Per-

:enr

2.4

1.4

1.9

2.7

1.8

1.4

0.9

1.6

1.8

●1 ,1

●1 .3

2.8

.

2.6

2.9

1.2

*.

“0.7

1.8

0.7

1.0

2.4

1.8

2.0

3.9

2.4

2.9

rivate hospital

wurance, don’t

:now coverage

Number

in

thousands

1,624

90

84

47

190

110

135

38

55

+8

●-

117

●

.

123

●1 7

“1 o

●6

64

218

56

201

44

218

46

●22

723

Perzwrt

0.8

0.6

0.8

0.8

1.2

0.9

1.2

1.1

1.3

“0.6

●.

1.0

●

●

0.6

*0.5

●9.7

90.7

1.1

1.0

1.0

1.1

0.8

0.9

0.8

●1.4

0.6

No other insurance; don’t

know if

covered by

priwate hospitai insurance

Vumbel

in

sands

861

●31

●22

●19

52

●;Z

●22

“22

94

“4

. 53

“9

●21

540

*9

●.

●.

“24

41

●26

93

“14

86

‘1 o

“1 8

540

Perznr

—

0.4

“0.2

‘0.2

+0.3

0.3

0.3

‘0.2

“0.6

“0.5

“0.3

“0.3

0.5

“0.3

●1 .3

0.5

●0.3

+.

●.

‘0.4

0.2

●0.4

0.5

“0.2

0.3

“0.2

1.1

o.~

No health

care coverage

Uumber

in

thousands

23,200

663

741

591

1,150

1,504

1,288

496

906

289

449

1,672

273

334

12,842

895

“19

53

1,119

1,685

461

2,565

316

2,671

253

320

12,842

Per-

:ent

11.0

4.6

7.2

10.1

7.1

12.3

11.6

14.2

21.7

19.5

41.0

14.9

25.0

20.5

11.0

28.6

●8.3

6.9

19.2

7.7

7.9

13.8

6.2

10.4

4.4

20.6

11.0

covered bv. Medicare. and 159.957,000 . Persons, The Proportion of the population insured

or approximately 76 percent of the population, under ptkate hospital insurance, Medicare, or

were covered by private hospital insurance. both increased directiy with age. Among persons

(Figures from table 2 reflect coverage in these under 6 years of age, 70 percent had such ccwprograms regardless of other coverage.) erwge, while for persons 65 years and over,
ackmxMa9

approximately 96 percent were covered. While

there is very Iittle difference in the extent

of private hospital and/or Medicare coverage

between the sexes, the difference in coverage

between the two major color groups is substantird. Approximately 83 percent of white

persons were insured under private hospital

insurance and/or Nfedicare, compared with 61

percent of persons of all other races.

The proportion of persons with such coverage increased directly with increasing income.

Among persons in families with incomes of Iess

than $3,000, 51.0 percent of the population

were so insured. Among persons who belonged

to families with incomes of $15,000 or more,

approximately 92 percent were insured by private hospitaI insurance, Medicare, or both. The

same pattern was found when educational leveI

was examined. Approximately 76 percent of

those persons who had completed 0-11 years

of education were covered, compared with approximately 88 percent of those who had completed 13 years or more.

The extent of coverage ako varied by place

of residence and region. Approximately 77

percent of persons who lived on farms outside

of SMSA’S were covered, compared with approximately 85 percent of persons who lived in

SMSA’S outside central cities. Further, persons

who Iived in the Northeast and North Central

Regions were covered to a greater extent than

those who lived in the South or West.

With respect to utilization of health services,

approximately 75 percent of persons who did

not use the services of a physician during the

year were covered, while 81 percent of those

who did use physician sewices during the year

were covered. There was very little difference in

extent of coverage, however, when those who

were hospitalized during the year were compared with those who were not hospitzdized.

Both occupation and industry showed substantial differences between categories with

respect to the extent of coverage under private

hospital insurance , Medicare, or both. The extent of such coverage ranged from approximately 93 percent among professional, technical, and kindred workers to approximately

54 percent among Farm laborers and farm

foremen. With respect to industry, coverage

ranged from approximately 91 percent in mining

to 68 percent in agriculture. Approximate y

76 percent of persons not in the labor force

were covered under private hospital insurance,

Medicare, or both.

Medicaid Only

of the estimated 16.4 million persons covered by Medicaid in 1976, approximately 12.2

million persons had no other coverage. The

remaining persons were also covered by private

hospitaI insurance, 31edicare, CHAJIPU or

CHAiilPVA, or professional courtesy.

The proportion of the population covered

only by Medicaid declined with age. .4pproximately 13 percent of persons under 6 years of

age were covered ordy by hledicaid while 9 percent aged 6-18 years were so covered. Among

persons 65 years and over, only 1.1 percent were

covered by Medicaid only. The proportion of

females covered by LWedicaid was ~greater than

that for males-approximately 7 percent for

females and 5 percent for males.

The extent of coverage under Medicaid ordy

varied substantiality by color. Approximately 4

percent of white persons and 19 percent of all

other persons were covered by Medicaid only.

However, there were more white persons than

all other persons covered under hledicaid.

As expected, the proportion of persons covered only by LMedicaid decIined sharply as income level rose. Approximately 24 percent o f

persons in families with incomes of $3,000 or

less were covered by Medicaid onIy. As wouId

be expected because of eligibility requirements,

ordy about 1 percent of the persons who belonged to families with income of $15,000 or

more were covered by Medicaid onIy Four

hundred twenty-six thousand persons in this

category, Medicaid coveraqe only, had family

incomes in excess of S15,000 during the previous year. While it seems unusual that anyone

with a farniIy income in excess of $15,000

would be covered by hledicaid, there are a

number of ways in which such an event couId

Legitimately occur. First, information in HIS is

coIIected on the previous year’s income. Family

dissolution or catastrophic iIIness could have

intervened, causing Medicaid eIi,qibiIity. Second,

in certain States large families with incomes in
10

excess of $15,000 could qualify for .Medicaid

coverage.

The same pattern of inverse relation was

apparent for education. Approximately 7 percent of persons with O-1 1 years of education

were covered by Medicaid, compared with 1 percent of those with 13 years or more of education.

Substantial differences between places of

residence and among regions of the country

were found with respect to Jledicaid coverage.

Approximately 1 out of 10 residents of central

cities within SIVISA’S were covered by Medicaid

onIy, while less than 1 out of 50 persons who

lived on farms outside of SMSA’S were so covered. Approximately 7 percent of persons in

the Northeast Region were covered by ~Medicaid only, compared with approximately 5 percent in the North CentraI and South Regions.

Further, there were some differences in the

proportion of persons covered by Medicaid with

respect to utilization of services. For persons

who saw a physician during the year, 6.2 percent

were covered by .Medicaid only, whiIe 4.6 percent who did not see a physician were so COVered.’ Medicaid coverage with respect to occupation and industry revealed that, as expected,

few workers are covered by the Medicaid program only. One exception to this observation

occurred with private household workers. Approximately 9 percent were covered by Medicaid only. Further, 9.0 percent of persons not

in the labor force were covered by lMedicaid

onIy.

Other Types of C~vera9e

Other plans or pro~arns only .—Other

programs are defined herein as CHAMPUS,

CHAMPVA, professional courtesy, and private surgical insurance ordy. Approximately

5 milIion persons, or approximately 2 percent

of the civilian noninstitutionalized population,

were covered by these programs only. Questionnaire desi<gn prevents an estimate of the number

of persons covered under these programs regardless of other coverage. The extent of coverage

under these programs alone was not large for

any subgroup in the population. However, this

type of coverage was most concentrated among

persons under 6 years of age, persons in families

with incomes of $7,000-$9,999, persons in the

South Region, and persons empIoyed in public

administration.

Private hospital insurance only, but don ‘t

know couerage.–Persons in this category did

not constitute more than 1 percent of the population in any category of any of the standard

social and economic variables presented in this

report. These persons, however, are defined as

insured.

NO other coverage; don ‘t know ifcovered by

private hospital insurance.–Persons included in

this category did not constitute more than 1 percent of the population in any category of any

of the standard social and economic variables

presented in this report. These persons have

been considered neither insured nor uninsured.

Summary

The type and extent of the population’s

health insurance coverage is presented in this

report according to standard social and demographic characteristics. Every effort has been

made to insure that multiple coverage does not

affect the estimates of the uninsured population

shown in tables 1, 3, and 4. For that reason,

the size of the population enrolled in certain

public programs as reported in tables 1,3, and 4

is less than the totaI enrollment reported by

those programs. Estimates of the uninsured are

presented which are not affected by the common practice of counting each enrollment in a

public or private plan as a different insured person. Thus the fi<gure for coverage under public

programs, presented in table 1, may be interpreted as the extent to which these programs

covered persons who would otherwise be completely uncovered. This interpretation is particularly appropriate for persons under 65 years

of age. TabIe 2 presents estimates of coverage

under major private or pubIic plans or programs

regardless of muItipIe coverage. These estimates

reflect the total number of persons enrolled in

each program and are discussed relative to other

estimates o f coverage.
admncda 11

TECHNICAL NOTES

SOURCE OF DATA

The data presented in all tables in this report

were derived from household intetwiews of the

Health Interview Survey. These interviews were

conducted in a probability sampIe of the civilian

noninstitutionalized population of the United

States. During 1976 approximately 113,000 persons living in a total- of 40,000 households were

included in the sarnple. A more detailed description of the sample design and a copy of the

questionnaire used in collecting the health insurance dtita are shown in “Current Estimates

from the HeaJth Intemiew Suwey, United

States, 1976,” Vital and Health Statistics, Series

10, No. 119.

SAMPLE

Since the estimates shown are based on a

sarnpIe of the population, they are subject to

sampling error. For exampIe, table I shows the

standard errors appropriate for the percent of

persons with hospitaI or surgical insurance coverage.

Table 1. Standard errors, expre$se.d in percentage points, of

aaseof

percentage

in thousands

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

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

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

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

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

20,00+3.........

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

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

estimated &rcentages

Estimated percentages

2 or 5 or

98 95

1.1 I .a

0.8 1.2

0.6 0.9

0.4 0.6

0.3 0.4

0.2 0.3

0.1 0.2

0.1 0.2

10or I25 or so

90 75

2.4 3.5

1.7 2.5

1.2 1.8

0.8 1.1

0.5 0.8

0.4 0.6

0.3 0.5

0.2 0.4

4.0

2.9

2.0

1.3

0.9

0.6

0.5

0.4

DEFINITIONS OF TERMS

Persons were considered to be covered by

private hospital insurance if they specifically

affirmed that such coverage existed.

Persons were considered to be covered by

~Uedicarc if they were 65 years of age or older

and explicitv affirmed Medicare coverage or if

they responded that their main reason for having no insurance was Medicare. Both older persons and persons covered under Jledicare disability and end-stage renal disease provisions are

counted.

Persons counted as covered under the

L}ledicaid program incIuded those who reported

receipt of services paid by Medicaid during the

past year or no receipt of such services during

the past year but eligibility for such payment

under Aid to Families with Dependent Children

or Supplemental Security Income. Further,

persons who reported >ledicaid as their main

reason for no insumnce but did not report

receipt of services under Medicaid during the

past year or coverage under Supplemental

Security Income or Aid to Families with Dependent Children were ako counted in the

Medicaid coverage category.

Persons counted as covered under other

plans 07 programs reported that their main

reason for no insurance was the Civilian Health

and Medical Program for Veterans Administration (CWJIPVA), the CiviIian Health

and MedicaI Program for Uniformed Services

(CHAMPUS), professional courtesy, or private

sur<gical insurance.

Persons counted as covered under private

hospital insurance only, but don ‘t know what

plan covers specifically affirmed that they were

covered by private hospital insurance but did

not know whether the plan paid for hospital

costs or hospitaI physician fees. These persons

reported no other coverage.

Persons included under no other coverage;

don ‘t know if covered by pn.vate hospital insurance were included under no public or private

pIan or program for heaIth care coverage. However, they responded that they did not know if

they were covered by private hospital insurance.

Because of this group’s lack of knowledge concerning its private hospitaI insurance coverage, it

is defined as neither insured nor uninsured but

ratheras “don’t know. ”

Health care coverage is any plan or program

specifically designed to pay alI or part of the

medical or hospital expenses of a covered individual. In the case of insurance, coverage can

be provided through either a ~group or an individtud policy with the premium paid by the

individual, his employer, a third party, or a combination of these. Benefits received under such
12

pkans can be in the form of payrncnt to the individual or to the hospid or doctor. The plan,

however, must be a formal one with defined

membership ,and benefits rather than an informal

one. For example, an employer’s simply paying

the hospital bill for an emp Ioyec would not

constitute a health insurance pkm. Plans for

free care or highIy subsidized care avaiIable to

categorical groups such as Medicare, Medicaid, public assistance, or public we! fare; care

given free of charge to veterans; care given

under the Uniformed Semites Dependents

Medicd Care Program; and professional courtesy

are specifically defined herein as health care

coverage.

For this report, utilizing information from

HIS, health care coverage exciudes the foIIowing

kinds of plans: (1) plans limited to the “dread

diseases” such as cancer or polio; (2) care given

under the Crippled Chihiren’s Program or

similar programs and care of persons admitted

to an institution for research purposes; (3) insurance which pays biIIs ordy for acciden CS,such

m liabiIity insurance that covers children for

accidents at school or camp and insurance for a

worker that covers him onIy for accidents, injuries, or diseases incurred on the job; and (4)

insurance which pays ordy for Ioss of income.

SYMBOLS

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

Category not appli~ble ............. ..... ................ . . .

Quanc!ty zero. ......... .... .............. .. ................... . -

Quantity more than O but less than 0.0 S........- 0.0

Figure does noc meet standards of reliability

or preclslOn ............. .......... .... .......................-

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

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ● Public Health Service I Nutier 45 ■ February 7, 1979

Use of Family Planning Sewices by Currently Married

Women 1544 Years of Age: United States, 1973 and 19761

About 13,300,000 currently married women

received pro fessional family planning services

during the 3 years before the 1976 National Survey of Family Growth, an increase of about 1

million, or 8 percent, above the number who

made a famiIy planning visit in the 3 years

before a similar survey conducted in 1973.

Among fecund, or nonsterile, couples about

57.9 percent made a family pkmning visit in the

3-year period prior to the 1976 survey as compared with 51.2 percent in the 3-year period

prior to 1973. ‘

Among wives who reported making a family

planning visit in the 3 years before the 1976

sumey, a Iarge majority- (84 percent) reported

their most recent visit was with their own physician, whiIe a minority (16 percent) indicated

the last visit was with an organized medical

service. These figures are not significantly different from the comparable figures for 1973.

The statistics on use of family planning services are from the National Sumey of FamiIy

Growth, CycIes I and II, conducted by the National Center for Health Statistics. Data were

coIlected through personal interviews with a

multistage, probability sample of women in the

household population of the conterminous

United States. Women 15-44 years of age, inclusive, who were currently manied or previously married or who were never married but

had offspring presently living in the household

were eIigible for inchxsion in the sampIe.

The interview was highly focused on the respondent’s marital and pregnancy histories on the

*This report was prepared by Gerry E. Hendershot,

Ph.D., Division of Vital Statistics.

use of contraception and the pkmning status of

each pregnancy, on the respondent’s intentions

regarding number and spacing of future births,

on maternal and family planning services, and on

a broad range of socioeconomic characteristics.

For Cycle I, 3,856 bIack women and 5,941

women of races other than black were interviewed between June 1973 and February 1974.

For CycIe II, 3,009 black women and 5,602

women of other races were interviewed between

January and September of 1976. The numbers

of black women and women of other races interviewed in CycIe II were revised for this report

and differ dightiy from the numbers reported in

Advance Data Numbers 36 and 40. The revisions

do not affect any other statistics reported here

or previously mentioned. Because the estimates

of statistics in this report are based on a sample,

they are subject to sampiing variability. A

further discussion of sampling variability and of

the design of the survey and definitions of terms

can be found in the TechnicaI Notes.

Detailed findings on use of family pkmning

services from CycIe I of the National Sumey of

Family Growth are reported in an eariier report.z

This report presents preliminary findings

from CycIe II, with comparisons to findings

from CycIe 1; it wiII be followed by a detailed

report of findings from Cycle 11 in Series 23 of

Vital and Health Statistics.

2Najion~ cen~=r for He~fi Statistics: Utfiization of

family planning sexvices by currently married women

154 years of age, United States, 1973, by F. Notzon.

Vital and Health .Statz3tici. Series 23-No. 1. DHEW Pub.

No. (PHS) 78-1977. Public Health Service. Washington.

U.S. Government Printing Office, Nov. 1977.
2

Statistics used include only women who

were fecund 3 years before the interview date.

Consultations about problems of infertility are

not included in the definition of famiIy planning

services for purposes of this report. A woman

was considered to be sterile if she reported it

was impossible for her and her husband to conceive as a result of an operation, accident, or

illness which occurred more than 3 years before

the interview-before January 1970 for Cycle I,

or before January 1973 for Cycle II. All other

women were considered to be fecund, able to

conceive, at the beginning of the period for

which their use of famiIy planning services was

reported.

Table 1 shows the number of currently married, fecund women 15-44 years of age classified

by race or ethnicity, poverty leveI income, and

age and the percents in each group who reported a famiIy planning visit in the 3 years

before the survey in 1976 or 1973, by type of

place of the last visit.

Table 2 incIudes only wives who reported a

visit in the 3 years before each survey and shows

their numbers by race or ethnicity, poverty level

income, and age and the percent distribution of

each group by type of place of last fardy pkmning” visit.

The percent of fecund wives reporting a

fandy planning visit increased between 1973

and 1976 among white women but did not

change significantly in the other raciaI or ethnic

groups considered. In both years, white wives

were more likeiy than bIack wives or wives of

Hxspanic origin to report a visit, aIthough the

differences between white and Hispanic women

are not statistically significant. In 1976 the percents were 59.2 for white women, 51.4 for women of Hispanic origin, and 46.2 for black women.

In ail three racial or ethnic groups, wives

with a visit were more Iikely to have had the last

visit with their own physician than with an

organized medical service in both 1976 and

1973. In both years, however, organized medical

sewices had a larger share of last visits among

black wives (37.0 percent of Listvisits in 1976)

and wives of Hispanic origin (32.7 percent in

197 6) than among white wives (14.1 percent in

1976).

The share of M visits to organized medical

services did not change significantly in any of

the three racial or ethnic groups. However, the

decline among bIack wives from 42.2 percent in

1973 to 37.0 percent in 1976 approaches statistical significance, and is consistent with trends

in methods of contraception—increasing percents of bIack women are using traditional

methods such as the condom and the diaphragm,

which are less likeIy than other methods to be

obtained from organized medical services. (For

further discussion of these trends, see Advance

Data No. 36, “contraceptive Utdization in the

United States, 1973 and 1976.’:)

The percent reporting a family planning visit

increased between 1973 and 1976 among

women whose family income was 150 percent or

more of the poverty level and among women

whose famiIy income was below that level. In

neither 1973 nor 1976 was there a significant

difference between the two income groups in

the percent reporting a visit.

There was a difference between the income

groups, however, in the place of last farniIy planning visit (figure 1): among the poorer women,

about one-third (33.5 percent in 1976) of

wornen with a visit had the Iast visit with an

Figure 1. PERCENT OF CURRENTLY MARRIED FECUNO WOMEN

1S44 YEARS OF AGE WITH A FAMILY PIANNING VISIT IN

THE LAST 3 YEARS WHOSE IAST VISIT WAS WITH AN

ORGANIZED MEOICAL SERVICE, BY POVER?Y LEVEL lNCOM~ UNITEO STATES, 19X3 ANO 1976

\ I 1976

813“73 “r

Alt Inmm. Ln UIm 150 W4 puc8m w

hwts pwant of momofcotwlv

~~nl l-l ,nconw

FO/EtlTY LEVIIL INCOME
advamx?data 3

Table L. Number of cu~ently married fecund women 15-44 Years qf.age and percenc WiCh a f=ily planning visit in

the Iasc 3 years, by place of most ~e.CLM’it family planning vls Lt, race or echnicity, poverry level income, and

age: United States, 1973 and 1976

1976 1973

Race or ethnicity,

poverty level

incdme, and age

With family planning

visit in last 3 years

II 1

Number of

women in

thousands thousands

TocaL (Ml Organized

physician ~~r:::;

Total own

Organizec

physic ian ~yg~::

I

RACE OR ETHNICITY

I

Percent ?ercenc

~

All ages 15-44 years ----

I

22,923 57.9 48.7 9.2 23,863 I 51.2 42.2 9.0

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

15-19years-----------------

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

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

5,978

1,042

10,869

6,076

75.6 76.5

61.4

34.C

59.2

58.C

48.E

54.1

29.6

50.8

61.1

50.7

56.2

30.a

29.1

17.6

2;.7

4::

8.3

L6.O

26.8

6.6

3.9

L7.1

;,:;; 75.5

69.6

10;797 54.5

7,113 25.8

58.5

50.5

47.0

21.5

43.8

17.0

19.1

i::

~~e

ALL ages 15-44 years ---- 20,553 2L,711 51.9 8.1

5,361! 76.9

915 71.8

9,873 55.4

6,678 25.9

61.1

54.L

48.6

22.4

25.5

L5.8

L;.;

3:5

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

15-19 years -----------------

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

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

5,379

918

9,778

5,396

77.2

77.:

62a

34.7

46.2

-

ALL ages 15-44 years ---- 1,896 L,868 44.1 18.6

500

82;

550

60.1

70.7

48.3

30.3

51.4

S7.O

*42.O

59.1

30.7

57.7

76.2

69.8

53.5

35.8

59.8

31.5

45.5

33.:

20.3

34.6

28.6

*Z5.2

L5.o

10.1

16.8

61.9

47.4

46.5

22.6

48.1

33.4

*L6.L

30.7

9.9

30.9

28.4

3L.4

15.8

12.7

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

15-19 years---------------~-

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

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

His panic originl

All ages 15-44 years---- L,519 17.2

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

15-19 years -----------------

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

35-fw$years -------------------

465

6%

375

32.7

*.4

.41.2

25.4

38.6

4J.;

40:4

24.3

52.3

24.3

*32.5

L7.9

*5.2

19.3

412

5:!

529

3,693

66.6

&9.L

54.L

27.3

52.6

48.4

*30.9

33.6

14.3

35.0

18.2

*LS.2

20.5

13.0

POVERTY 7.EVEL

INCOME AND AGE

149 percent of poverty

Income and beLow

All ages L5-44 years---- 3,001 17.6

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

L5-L9years -----------------

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

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

1,075

299

1,::;

31.5

44.9

13.1

*11.5

7.5

1,198~ 72.8

285 1 66.2

L,jjji 52.3

28.7

&6.O

4L.8

38.0

17.1

43.6

26.8

24.3

14.3

11.6

L50 percene of poverty

1~ above

ALL ●ges L5-44 years----

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

15-19 years -----------------

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

35-U years -------------------

17,513 20,170I 50.9 7.3

4,345

595

8,50L

.4,667

78.0

82.2

63.9

35.3

63.8

61.9

57.5

32.0

14.2

20.2

6.4

3.3 -L4,755 76.2

7k3 7L.O

:,::; 5&.9

, 25.3

:;.;

48.4

22.2

14.5

L:.;

3:1

lIncLudes aLL women reportingany Hispanic origin , regardless of race or other ethnic origins reported.
4 achancedata

Table 2. Number of currently married fecund women 15-64 years of age with a family planning visit in che Last 3

years and percenc distribution by place Of most recenc family planning visit, according to

pOVerCY leVel inCcine, and age: United .$taces, L973 and Lg76 race or ethnic ity,

1976 L973

Race or ethnicity,

poverty level

income, and age

Place of visit

II I

Place of visit

Number of

women with

visit in

thousands

Number of

wcmen wick

visit in

thousands &zE ‘OtaL

own Organizec

‘Ocal physician ~y;g::

RACE OF ETHNICITY

AND AGE Percent distribution Percent distribut ion

TocaL

ALL ages L5-f+4years -- 13,262 82.5

4,520

797

6,674

2,069

100.0

100.0

LOO .0

100.0

100.0

LOO.0

LOO .0

100.0

100.0

LOO.O

100.0

84.1

76.8

63.8

88.1

86.9

85.9

79.2

65.4

89.4

88.7

63.0

L5.S

23.2

36.i

11.9

L3.1

14.1

X).8

34.6

LO.6

11*~

37.0

L2,2L6 LOO.0

100.0

100.0

100.0

LOO .0

Loo ,0

100.0

LOO.0

100.0

100.0

100.0

L7.5

L5-24 years-----------------

15-19 years ---------------

2S-34 years -----------------

3S-44 years -----------------

4,493

716

S,889

1,833

77.s

72.6

86.1

83.3

84.5

22.5

27.4

13.9

16.7

Whfal

All ages M-44 years --

1S-24 years-----------------

15-19 years ---------------

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

3S-44 years -----------------

12,164 11,268 15.5

4, L52

711

6,139

1,873

4,122

657

S,469

1.676

79.4

7s.k

87.6

86.7

57.8

20.6

24.6

12.4

13.3

‘42.2

Black

All ages 15-44 years -- 87S 824

LS-2f4years -----------------

1S-19 years ---------------

2S-34 years -----------------

3S-44 years -----------------

3::

408

167

LOO.0

LOO.0

100.0

100.0

LOO.0

52.4

64.4

69.0

66.8

67.3

47.6

*3S .6

31.0

33.2

32.7

33a

3::

122

100.0

100.0

100.0

LOO.0

100.0

S4. O

*33.9

66.0

43.9

46.0

66.1

34.0

S6.1

Hispanic origin!

All ages 1S-44 years-- 782 724 64.2

72.7

62.9

62. L

52.3

3S.8

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

L5-L9 years --------------

2S-34 years ----------------

3S-44 years ----------------

LOO.0

100.0

100.0

100.0

100.0

57.3

*22. S

69.7

82.9

66.5

S8.7

3s.7

7s. s

67.9

87. s

42.7

77. s

30.3

*17.1

33.5

275

3::

L45

100.0

100.0

LOO .0

100.0

100.0

27.3

*37.1

37.9

47.7

149 percent of poverty

income and below

All ages 3.5-44years-- 1,731 1.944 66. s 33. s

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

15-19 years ---------------

2S-34 years -----------------

3S-44 years -----------------

819

209

672

240

LOO.O

100.0

100.0

LOO .0

100.0

41.3

64.3

26.5

32.1

12. S

872

189

790

2a3

10,272

100.0

100.0

LOO.O

LOO.0

100.0

63.2

63.2

72.6

59.6

36.8

36.8

27.4

40.4

150 percent of povert~

Lnc 0s0e and above

All ages 1S-44 years -- 10,469 8s.6 L4.&

19.0

24.1

11.8

12.4

1S-24 ears -----------------

lS-L; years ---------------

2S-34 years -----------------

3S-44 years -----------------

3,388

5,%

1,646

LOO.0

100.0

100.0

100.0

81.8

7s.4

90.0

90.6

18.2

24.6

10.0

9.4

3,622

527

s, 099

1,ss1

LOO.O

100.0

100.0

100.0

;;.:

88:2

87.6

lIncLudes all women reporting any Hispanic OrigiSS, regardless of race or other ethnic origins reported.
a&mdata5

organized medical sewice, but among the

women with higher income, onIy 1 in 8 (12.5

percent in 1976) had the last visit with an

organized medical service. (See the Technical

Notes for a discussion of limitations to comparing 1973 and 1976 income data.)

The percents of women reporting a famfly

planning visit in the Iast 3 years vary with age,

women aged 15-24 years being most likely to

report a visit and women aged 35-44 years being

Ieast Iikely (figure 2). The pattern, which is observed in both survey years and most racial,

ethnic, and income groups, may reflect a decline

in women’s need for services as they gain experience and grow older, the differential impact of

recent growth in service programs for younger

women just beginning to plan their families, or

the depmture of oIder women from the fecund

population needing services by means of sterilizing operations.

Whatever the explanation for age differences

in use of family planning services, differences

were reduced between 1973 and 1976; in that

period use of services increased in age groups

25-44 years, but it did not change significantly

among women aged 15-24 years, narrowing the

gap between them (table 1).

Age differences in the distribution of last

visits by type of place are less pronounced; in

Fgura Z PERCENT OF CURRENTLY MARRIED FECUND WOMSN

1S44 YEARS OF AGE WITH A FAMILY PU.NNING VISiT IN

THE LAST 3 YEARS, BY AGE UNITED STATES, 1973 AND

1976

‘r 7S6 75,5 ~ 1S76

Allqm 1544 1S24 25.24 3s44

AGE IN YEARS

both age groups 25-34 years and 35-44 years

about 1 in 8 Iast visits were to an organized

medical service in 1976, about the same as in

1973. In the age group 15-24 years, also, the

percent of the last visits which were to organized

medical sexvices was unchanged between 1973

and 1976, but at a higher leveI, more than 1 in

5.

Because of recent interest in family planning

among teenagers, the statistics in tabIes 1 and 2

are shown separately for women aged 15-19

years. However, these data include only women

who were married at the time of the interview;

therefore many teenage women who were users,

or potential users, of family planning services are

not included. AIso, the numbers of sample

women in this age group are smalI, so statistics

estimated from them are less reliable than other

statistics .mthis report.

An earlier report by Jaffe and Dryfoos indicated that teenagers’ use of family planning,

especially from organized medicaI services, increased in the period 1973 -1975.3 In preparing

this report, it was anticipated that the trend continued into 1976 and would be reflected in comparisons of statistics from Cycles I and II of the

National Sumey of Family Growth. It was found

that the proportion of teenage wives reporting a

famiIy planning visit in the 3-year period before

the intewiew increased from 69.6 percent to

76.5 percent between 1973 and 1976. The trend

toward greater use of family phrming semices

occurred among both black and white teenage

wives but was stronger among biack women,

among whom the percent reporting a visit increased from 47.4 in 1973 to 70.7 in 1976.

Like other women, most teenage wives reported their Iast famfly planning visit was with

their own phy:ician (63.8 percent in 1976);

however, orgamzed services’ share of last visits

by teenage wives was substantia.iand increasing

–from 27.4 percent in 1973 to 36.2 percent in

1976. This trend is observed for white teenagers

and for teenagers with family income below 150

percent of the poverty level; for other groups of

teenage wives the differences between 1973 and

1976 in the share of last visits held by organized

services are not statistically significant.

3Jaffe, F. S., and Dry foos, J. G.: Fertility control services for adolescents, access and utilization. Farm Plann.

~&S@? Ct. 8(4): 167-175, Jdy-hq 1976.
6 acklncedata

TECHNICAL NOTES

The Survey Design

The National Survey of Family Growth

(NSFG) was designed to provide data on fertility, farniIy planning, and reiated aspects of

maternal and child health. Fieldwork for Cycle

I was carried out by the National Opinion Research Center between June 1973 and February

1974. Fieldwork for Cycle II was carried out by

Westat, Inc., between January and September of

1976.

A multistage probabilitv sample of women

in the household population of the conterminous United States was used in both cycles.

Each time, approximately 33,000 households

were screened to identify the sample of women

who would be eligible for the NSFG, i.e.,

women aged 15-44 years, inclusive, who were

either currendy married, previously married, or

never married but had offspring presently living

in the household. In households with more than

one eli,gible woman, a random procedure was

used to select only one to be interviewed. Since

the interviews were always conducted with the

sample person, the term “respondent” is used as

synonymous with sample person. For Cycle. I,

interviews were completed with 3,856 black

women and 5,941 women of races other than

black. For Cycle II, intewiews were completed

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

other races. A detailed description of the sample

design for Cycle I is presented in “NationaI Survey of Family Growth, Cycle I: Sample Design,

Estimation Procedures, and Variance Estimation, ” Series 2, No. 76, in the Vital and

Health Statistics series. A similar report is in preparation for Cycle II.

The interview was highIy focused on the

respondent’s marital and pregnancy histories, on

the use of contraception and the planning status

of each pregnancy, on the respondent’s intentions regarding the number and spacing of

future births, on maternal and famiIy planning

services, and on a broad range of socioeconomic

characteristics. While the interviews varied

greatly in the time required for their completion, they averaged about 70 minutes for

Cycle I and about 58 minutes for Cycle H.

Quality control procedures were applied at

aI1 stages of the survey. These included a verification of listing completeness with unlisted

dwelling units being brought into the sampIe, a

preliminary field revie~v of completed questionnaires for possible missing data or inaccurate

administration, a 10-percent sample recheck of

alI households to be screened in the survey, observation of interviews in the field, and an independent recoding of a 5-percent subsample of

completed intewiews.

Reliability of Estimates

Since the statistics presented in this report

are based on a sample, they may differ somewhat from the figures that would have been obtained if a complete census had been taken

using the same questionnaires, instructions, interviewing personnel, and field procedures. This

chance difference between sample results and a

complete count is refereed to as sampling error.

In addition, the results are also subject to nonsampling error due to respondent misreporting,

data processing mistakes, and nonresponse. It is

very difficult, if not impossible, to obtain

accurate measures of nonsampling errors. These

types of error were kept to a minimum by the

quality control procedures and other methods

incorporated into the survey design and administration.

Sampling error, or the extent to which

samples may differ by chance from a complete

count, is measured by a statistic called the

standard error o f estimate. Approximate

standard errors for estimated numbers and percents from Cycle I are shown in tables I and II

for white women and women of all races combined and in tables HI and IV for the black population. Provisional estimates of standard errors

for CycIe II for white women and women of all

races combined can be obtained by multiplying

the standard errors for these women from Cycle

I by factors of 1.09 for the latter and 1.06 for

white women. Similarly, provisional estimates of

standard errors for Cycle II for black women can

be obtained by multiplying the standard errors

for black women from Cycle I by a factor of

1.14.
Table 1. Approximate standard errors for estimated numbers for

white women and women of all races combtned: 1973

Nanonal Survey of Family Growth

Relarive

Size of estimate standard

error

w.ooo .............................................. 30.0

1oo,ow ............................................ 21.2

mo,ow ............................................ 15.0

5oo.ooo ................. .................. ... .... .. 9.5

1 ,ooo,ooo ............. ....... .............. ....... 6.7

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

4.8

5,000,000 ..... .............. ........... ..... ...... 3.0

10,000,000 . .. ........... ............. ............ 2.2

20,000,000 ........ .................. .............. 1.5

Standard

error

15,000

21,000

30,000

47,000

67,000

95,000

151,000

216.000

311,000

The chances are about 68 out of 100 that an

estimate fro m the sample wouId differ from a

compIete census by less than the standard error.

The chances are about 95 out of 100 that the

differences between the sample estimate and a

complete count would be less than twice the

standard error. The reIative standard error is the

ratio of the standard error to the statistic being

estimated. In this report, numbers and percents

which have a standard eqor that is more than

25 percent of the estimate itself are considered

unreliable. They are marked with an asterisk to

caution the user but may be combined to make

other types of comparisons of greater precision.

In this report, terms such as “simihr” and

“the same” mean that any observed difference

between two estimates being compared is not

statistically significant. SimiIarly, terms such as

“greater,” “Iess,” “larger,” and “smalIer,” inTable 11. Approximate standard errors for estimated percents ex.

pressed in percentage points for white women and women of

all races combined: 1973 National Survey of Family Growth

Wee of percent

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

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

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

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

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

7,000,000 .........

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

Estimated oercent

!_L 3.0 4.6 6.4 8.5

1.3 2.1 2.8 3.8

0.9 1.5

0.5 0.8

2.0 2.7

1.2 1.5

0.4 0.6 0.9 1.2

0.3 0.5 0.8 1.0

0.3 0.5 0.6 0.8

—

3001

70

—

9.7

4.3

3.1

1.8

1.4

1.2

1.0

— T

$0 or

60 50

10.4 10.6

4.6 4.7

3.3 3.3

1.9 1.9

1.5 1.5

1.2 1.3

1.0 1.1

Table I I 1. Approximate standard errors for estimated numbers

for black women: 1973 National Survey of Fam[ly Growth

Size of estimate

25.000 .............................. ........... .... .

50.wo ..... .................................. .......

1oo,ooo ......................... .................. .

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

250.000 ....................... ......... ..... .......

350.000 ................. ..... .......... ..... .......

5oo.ooo ................. ............... ...... ..... .

750.000 ............................ ... .. .... ..... ..

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

Relative

szandard

error

25.3

17.9

12.7

10.3

8.0

6.2

5.7

4.7

4.0

Standard

error

6,000

9,000

13,000

16,000

20,000

24,000

28,000

35,900

40,000

dicate that the observed differences are statisticaHy significant. The normal deviate test with a

.05 Ievel of significance was used to test aII comparisons which are discussed in the text. A statistically significant difference is one large enough

that in repeated samples of the same size and

type as this one such a Iqe difference would be

expected to be found in less than 5 percent of

the samples. Lack of comment in the text

between any two statistics does not mean the

difference was tested and found not to be significant.

Adjustment for nonsampling error due to

nonresponse was made in two ways. Nonrespondent cases, as distinct from missing data

items, were imputed by weighting for nonresponse within each primary sampling unit,

stratum, and age-race category. In the 1973 survey, codes for missing items were imputed for

Table IV. Approximate standard errors for estimated percents expressed in percentage points for black women: 1973 National

Survey of Family Growth

I

1- 6ase of percent z or

7

98

5,000 .... ............. 7.9

10,000 ....... ........ 5.6

50,000 ............... 2.5

100,000 ............. 1.8

300,000 .... ....... .. 1.0

500,000 ............. 0.8

700,000 ............. 0.7

1,000,000 .......... 0.6

.E.mmated percent

f

5or 10or

95 90

12.3 17.0

8.7 12.0

3.9 5.4

2.7 3.8

1.6 2.z

1.2 1.7

1.0 1.4

0.9 1.2

20 or

80

22.6

16.0

7.1

5.1

2.9

2.3

1.9

1.6

300

70

—

25.9

18.3

8.2

5.8

3.3

2.6

2.2

1.8

$001

60

27.7

19,6

8.8

6.2

3.6

2.8

2.3

2.0

50

28.3

20.0

8.9

6.3

3.6

2.8

2.4

2.0
8

each woman by assigning the reported value of a

case randomly selected from among women with

simiIar characteristics. In the 1976 sumey, for

this report, cases with missing data are allocated

among the ceIIs of a table in proportion to the

distribution of known cases with the same

characteristics.

DEFINITIONS OF TERMS

Family planning visit in the last 3 yearx.–h

Cycie II, women were considered to have made a

family planning visit in the last 3 years if they

answered affirmatively to the question “During

the last 3 years, has a doctor or other trained

person prescribed or taIked with you about a

method for delaying or preventing pregnancy?”

In Cycle I, women were asked the same question

except that a period of 5 yearn was specified

rather than 3 years. Women who answered

affirmatively to that question were also asked,

“When was the last time you talked about

methods of family planning with a doctor or

trained person?” Women who answered that

question with a date less than 3 years before the

interview were considered to have made a family

planning visit in the last 3 years.

Place of last family planning visit .–Women

with a family planning visit in the last 3 years

were asked where the last (most recent) visit

took place. “Own physician” includes visits of

the respondent with her own physician, whether

in the physician’s office or in a hospital; it includes group practices and prepaid medical

organizations. “Organized medicaI services” includes visits to alI other places: general clinics,

family planning clinics, hospitals, or elsewhere.

PIace of last famiIy pIanning visit was not ascertained for about 1 percent of women with a

visit in Cycle I and about 5 percent in Cycle II;

cases without place information were allocated

to place categories in proportion to the distribution of simiIar cases with complete place

information.

Age.–Age is ckssified by the age of the respondent at her last birthday before the date of

interview.

Race.–C1assification by race was based on

interviewer observation and was reported as

black, white, or other. Race refers to the race of

the woman interviewed.

Hispanic origin .– A respondent was cIasified

as being of Hispanic origin if she reported her

origin or descent as Mexicano, Chicano, Mexican

American, Puerto Rican, Cuban, or other

Spanish, regardless of whether she also

mentioned any other origin.

In tables where data are presented for

women according to race and Hispanic origin,

women of Hispanic origin are included in the

statistics for white and black women if they

were identified as such by the interviewer.

Man-tai status. –Persons are classified by marital status as married, widowed, divorced, separated, or never married. .Married persons include those who report themselves as married or

as informally married (living with a partner or

common-law spouse and the Iike). Persons who

are temporarily separated for reasons other than

marital discord, such as vacation, illness, or

Armed Forces, are classified as married.

Fecundity .—For this report, a woman was

considered to be sterile if she reported it was

impossible for her and her husband to conceive

as a result of an operation, accident, or illness

which occurred more than 3 years before the

interview-before January 1970 for Cycle I, or

before January 1973 for CycIe II. AII other

women were considered to be fecund, able to

conceive, at the beginning of the period for

which their use of family planning services was

reported.

Poverty level.–The poverty index ratio was

calculated by dividing the total family into me

by the weighted average threshoid income of

nonfarm famiIies with the head under 65 years

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

Bureau of the Census Current Population

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

in 1975 of Families and Persons in the United

States, “ tabIe A-3 (for Cycle II), and No. 98,

“Characteristics of the Low-Income Population,

1973, ” table A-3 (for Cycle I). This definition

takes into account the sex of the fandy head

and the number of persons in the family. Total

family income includes income from alI sources

for all members of the respondent’s famiIy. For

substantial numb ers of respondents (7 percent in

Cycle I and 16 percent in Cycle H), total family

income was not ascertained. In Cycle I, values
were imputed where missing, using a known

value of another similax, randomly selected respondent; in Cycle II, however, missing values of

family income were not imputed, and only cases

with known values are included in statistics on

poverty income Ievel. Because of this difference,

estimates of aggregate numbers in categories of

poverty income level cannot be compared

between the two surveys; percents may be compared, but such comparisons may be affected by

the differences in imputation procedures in the

two sumeys.

Household Population.–The househoId population consists of persons Iiving in households.

A househoId is a person or a group of persons,

provided no more than five are unrelated to the

head of the household, who occupy a room or

group of rooms intended as separate living quarters; that is, the occupants do not Iive and eat

w-ith any other persons in the structure, and

there is either (1) direct access from the outside

of the building or through a common halI or (2)

complete kitchen facilities for the exclusive use

of the occupants of the household.

RELATED DATA

Data on famiIy planning services are zdso colIected in two other surveys conducted by the

National Center for Health Statistics. Data for

the National Ambulatory Medical Care Survey

come from reports from a sarnple of office-based

physicians; data for the National Reporting

System for Family Planning Services come from

a sample of mediczd organizations which provide

famiIy pkmning services. \Vhereas these data

systems use information from the providers of

family pkmning services, the NationaI Survey of

Family Growth uses information from recipients

of the semices. Because of this difference and

differences in collection procedures and definitions of terms, statistics on family planning visits

from the three data systems may differ.
10 at%ncedata

SYMBOLS

Data not available .-.

Catego~ not applicable . . .

Quantity zero .

Quantity more than O but less than 0.05— 0.0

Figure does not meet standards of

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

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE = Public Health Service ] Number* Q .Jmuarv 26.1979

Hemoglobin

Persons 1-74

and Selected Iron-Related Findings of

Years of Age: United States, 1971-74a

This report presents seIected findings of the

hemoglobin;, sekm iron, and percent tr-msfernn

sat u ration determinations collected in the

Heal th and Nutrition Examination Survey

(HANES). The serum iron and transferringsaturation results supersede all previously pubIished resuits.I !2

HANES is a program of the NationaI Center

for Health Statistics in which measures of nutritional status are collected for a scientifically

designed sampIe representative of the civilian

nonins~itutionalized. population of the United

States aged 1-74 years.s

The data collected frbm April 1971 through

June 1974 are based on the examination of

20,749 persons from a total of 28,043 persons

aged 1-74 years who were selected in the national probability sample to represent the 194

million persons in that age group in the civiIian

no ninstitutionalized population. This was a

response rate of 74 percent or an effective response rate of 75 percent when adjustment is

made for the effect of oversampling among the

poor, preschool chiIdren, women of childbearing

age, and the elderly.

Detailed estimates of the distributions of

iron-related measurements and the prevalence

and distribution of iron deficiency anemia in the

United States will be described in a forthcoming reportA in Series 11 of the Vital and

Health Statistics.

BIood specimens were collected primariIy

by using venipuncture procedures. When these

‘This report was prepared by Clifford L. Johnson,

M.S.P.H. and Sidney Abmharn, Division of Health Examination Statistics.

procedures were unsuccessful, a finger stick

technique was used to obtain blood samples

from which the hematoIogica.1 determinations

could be made. For chiIdren aged 1-3 years,

a huge proportion of the specimens were colIected by the finger stick technique. The numbers of

bIood specimens coIIected by this technique for

persons aged 3 years and over were very small.

All hemoglobin concentrations for HANES

were determined on the Coulter HemogIobinometer in the mobiIe examination center. The

procedure is based on the hemoglobincyanide

(cyanmethemoglobin, HbCN) principIe.5 Serum

iron and totaI iron-binding capacity determinations were made by the Nutritional Biochemistry Section, CIinicaI Chemistry Division,

Bureau of Laboratories, Center for Disease Control, Atlanta, Ga. The analytical method was a

modification of the Technicon AutoAnalyzer

II-25 method based on the procedures of

Giovanniello, et al. and Rarnsey.s

Following the publication of the “Preliminary Findings of the First HeaIth and Nutrition

Examination Survey, United States, 1971-1972:

Dietary Intake and Biochemical Findings,’yl a

different analytical method for measuring serum

iron and totaI iron-binding capacitys was

adopted for the remainder of HANES. Akhough

based on the same analytical principles applied

in the original method of White and Flaschka,6

the AutohaIyzer method includes a dialysis

procedure. A comparison study of the original

and the AutoAnalyzer methods revealed unacceptable variability in the iron and total ironbinding capacity results obtained with the origimd method. For persons whose sera were

processed using the original method, portions of
2

the same serum specimens were taken from a

reserve vial collection stored at -20° C and were

reamdyzed by the AutoAnalyzer method between December 1974 and May 1975. As previously noted, these data for serum iron and

transfernn saturation results supersede all previously published results. 1)2

Except for children aged 1-3 years, a suffiaent number of serum iron and percent transfernn measurements are avadable for presenting

results for al.I persons 4-74 years of age. The

number of missing measurements for chiIdren

aged 1-3 years was large. AIthough results are

presented, no attempt was made to analyze the

data on persons of these ages because of possible

bias due to the missing values. The number of

missing hemoglobin concentrations was small for

all age groups, and results are analyzed for zdl

persons aged 1-74 years.

PRINCIPAL FINDINGS

Hemoglobin

The mean hemoglobin leveI for males increased with age from 11.9 g/all at age 1 year to

15.8 g/all at ages 18-19 years. It remains fairly

constant at ages 18-54 years and decIines sIightly

at the oIder ages to a vaIue of 15.3 g/all at ages

65-74 years (table 1, figure 1).

A different pattern was observed for females, where the mean hemoglobin IeveI increased with age from 12.0 g/dI at age 1 year to

a maximum value of 14.1 g/dI at ages 55-64

years. Then the IeveI dipped slightly to 14.0 g/all

in the age group 65-74 years (table 2, figure 1).

The differences in mean hemoglobin level

for males and females increased with age. For

Fioum 1. MEAN HEMOGLOBIN LEVELS FOR PERSONS AGED 1-74

YSARS, BY AGE AND SEX: UNITED STATES, 1971-74

18

17 L

[~~

Q~

5-11 12.17 18.19 2u24 2s.34 3544 45.54 55-64 85.74

example, the differences at ages 1-11 years were

small-ranging from 0.0 to 0.2 g/all (tables 1 and

2). However, at ages 12 years and over the mean

hemoglobin levels for males were consistently

higher than those for females. These differences

ranged from 1.0 g/dI at ages 12-17 years to 2.2

g/dI at ages 18-24 years (tables 1 and 2).

The hemoglobin pattern observed previously

for the total male population aged 1-74 years

was similar to the ones observed for white males

and black males separately (tabIe 1, figure 2).

Mean levels generally increased with age to ages

18-19 years, remained reasonably constant to

ages 45-54 years, and then declined at ages

55-74 years.

The age-hemoglobin pattern for the female

population was simiIar in all three categones–aIl

races, white females, and black femaIes. For

example, the pattern for white femaIes was

simiIar to the pattern observed for the total

female population, generaIIy increasing from

12.0 g/all at age 1 year to 14.2 g/all at ages 55-64

years, and declining sIightly to 14.1 g/dI at ages

65-74 years. Black females also generally folIowed the same pattern as the total female population, reaching a high value of 13.5 g/all at ages

45-54 years and declining to 13.1 g/dI at ages

65-74 years (table 2, figure 3).

For aII ages, white males had higher mean

hemoglobin IeveIs than bIack males (tabIe 1 and

figure 2). SimiIarly, mean hemoglobin levek for

white females were consistency higher than

those for black femaIes at all ages (table 2, figure

3). A detailed analysis of the hemoglobin data

for females of reproductive ageT reveals that this

mean difference between the races is not expIained by differences in iron nutriture as

measured by transfernn saturation values.

F~um 2, MEAN HEMOGLOBIN LEVELS FOR MALES AGED 1-74

YEARS, BY AGE AND RACE UNITED STATES, 1971-74

18

17[

* 19-

+J 15. .“-------~

g 14 -

--....

g 13 -

z 11 -..: Whim —

= 10 -

BI* —-

o~ btl 12.17 18-19 ZO.24 2S.34 3S4 4&54 %-64 65-74

AGE

I

AC F
ackincedata 3

Figure 3. MEAN HEMOGLOBIN LEVELS FOR FEMALES AGED 1-74

YEARS, BY AGE AND RACE: UNITED STATES, 1971-74

18

17

16 [

~ 15

; 14

j 13

l“—

. . . ...-....-”.-

.—-+......”””””—

g 12 . . ...’’--”-

Z 11 Whim —

~ 10 nklc .—

L

o~1 4.5 5-11 12.17 l&19 ‘2&24 25-24 35-44 45S 55-24 6674

AGE

Swum Iron

Mean sexum iron levels for males increased

from 86.3 pg/dI at ages 4-5 years to 119.4 ~gjdl

at ages 18-19 years. Thereafter, the mean levels

decreased with age to a low value of 102.4 ~g/dl

at ages 55-64 years, and then increased to 107.7

pg/dlat ages65-74 years (table 3, figure 4).

Table 4 and figure 4 show that the mean serum

iron levels for females increased with age from

89.4 pg/dl at ages 4-5 years to a high value of

106.2 pg/cU at ages 20-24 years. The mean levels

then decreased irregularly to a Iow of 97.6 pg/dl

at ages 65-74 years. Although females had higher

mean serum iron values th~ males at the younger ages, these differences were small. The differences in mean values were 3.1 pg/dl at ages

4-5 years and 2.0 pg/dl at ages 6-11 years. This

pattern was reversed at ages 12-74 years, with

males having consistently higher mean serum

iron levels.- These differences were largerFiIJum4. MEAN SERUM IRON LEVELS FOR PERSONS AGED 1-74

YEARS, BY AGE ANO SEX UNITED STATSS, 1971-74

@’t

0 1 1 , ! ! ! f , ! 1 I 1 I

! &5 bll 12.17 18.19 20.24 25-34 3544 46.s4 5s.44 65=74

AGE

Fwm E. MEAN SERUM IRON LEVELS FOR MALES AGED 1-74

YEARS, BY AGE ANO RACE: UNITED STATES, 1971-74

1“; nlak -—

00:

or,,,, 4

1 4-5 $11 1217 18.19 B24 25.34 3544 45.54 5584 55.74

AGE

ranging from 1.2 pg/dI at ages 55-64 years to

18.1 pg/dI at ages 18-19 years (tables 3, 4, and

figure 4).

Mean serum iron IeveIs for maIes did not folIow the same pattern as that for femaIes. The

IeveIs for black males and white males increased

with age from ages 4-5 years to 18-19 years and

then generalIy decreased at ages 20-74 years but

with no consistent pattern (tabIe 3, figure 5).

For white femaIes and black females, however,

the highest mean serum iron levels were obsemed at ages 20-24 years, 106.9 @dl and

103.2 pg/dI respectively. .4t ages 25-74 years the

mean Ievels decreased irregulady for both black

and white females (table 4, figure 6).

Wxth two exceptions, the white population

had higher mean serum iron leveIs than the bIack

Figure 6. MEAN SERUM IRON LEVELS FOR FEMALES AGEO 1-74

YEARS, BY AGE AND RACE: UNITED gATES, 1971.74

120

[

11OL

o~

1 45 6.11 12.17 15-W 20.24 2534 2S.44 45.54 55d4 55-74
Fgum 7. MEAN WRCENT TRAKFERRIN SATURATION LEVELS

R3R PERSONS AGED 1-74 YEARS, BY AGE AND SEX

UNITED STATSS, 1971-74

25r

2

0 ! 1 1 1 ! ! 1 f 1 1 , 1

1 45 &l 1 12.17 18.19 2U24 2.534 35-44 45.54 55.64 6574

AGE

Hgum 9., MEAN PERC~T TRANSFERRIN,SAmmmN I,EVEI..S

‘- FOR fEMALES AGED- 1-7A ~EAR~ ~ ~GE AND RACE:

UNITED S~ATES, 1S71-74 .

7-

I

10 I

Whiu —

Uac4t —

5

0,, (2 ( $ 1

1 +5 6.11 12.17 1S.19 2C-24 25.34 3544 45.54 55.64 65.74

AGE I

population did. One exception was at ages 2.5-34 fernn saturation levels. Nlean percent transferring

years, where black males had higher mean levels

than white males. The second e;ception was at

ages 12-17 years where black females had higher

levels than white females did.

Percent Transferring Saturation

The patterns observed for mean serum iron

IeveIs were also found for mean percent transF@a & MEAN PERCENT TRANSFERRINGSATURATION LEVELS

FOR MALES AGED 1-74 Yt24RS, BY AGE AND RACE UNITED

STATSS, 1971-74

“L__.EE- 1 46 C-11 12-17 18.10 ZG24 2S24 3S44 46.54 S&64 5S74

saturation levels for males increased with age

from 23.3 percent at ages 4-5 years to a high

value of 32.8 percent at ages 18-19 years. The

mean values then decreased irregtdarly to 29.8

percent at ages 55-64 years and increased again

to 32.5 percent at ages 65-74 years (table 5,

figure 7). The mean percent transfernn saturation Ievel for females ako increased with age

from 24.5 percent at ages 4-5 years to 29.2 percent at ages 55-64 years. At ages 65-74 years

there was a slightly lower mean value of 28.6

percent (table 6, figure 7).

Mean percent transfemin saturation levels for

females were higher than those for males at ages

4-11 years. At alI other ages, males had higher

mean levels than femaIes, ranging from 0.6 percent at ages 55-64 yeas to 6.0 percent at ages

18-19 years (tables 5, 6, and figure 7). In a

pattern similar to that for serum iron, and with

few exceptions, mean percent transferring saturation levels were higher for white maIes than for

black mzdes and for white females than for black

females (figures 8 and 9).
adwncedata 5

Table 1. Hemoglobin levels of males aged 1-74 years, sample size, estimated population in thousands,mean,

standard deviation, standard error of the mean, and selected percentiles,

1971-74

by race and age: United States,

Race and age

ALI races

1 year------------

2 years -----------

3 years-----------

4-5 years---------

6-11 years--------

12-17 years-------

18-19 years-------

20-24 years-------

25-34 years-------

35-44 years-------

45-54 years-------

55-64 years-------

65-74 years-------

White

1 year ------------

2 years-----------

3 years-----------

4-5 years---------

6-11 years--------

12-17 years-------

18-19 years-------

20-24 years-------

25-34 years-------

35-44 years-------

45-54 years-------

55-64 years-------

65-74 years-------

Black

1 year ------------

2 years-----------

3 years-----------

4-5 years---------

6-11 years--------

12-17 yaars-------

18-19 years-------

20-24 years-------

25-34 years-------

35-44 years-------

45-54 years-------

55-64 years-------

65-74 years-------

lg/dl

Sample

size

272

283

294

549

974

1,006

246

486

766

631

740

569

1,581

199

205

220

419

734

769

195

407

642

543

607

484

1,293

70

it

127

229

229

46

J;

126

2;;

Escimsced

population

h

thousands

1,811

1,778

1,802

3,427

11,819

12,558

3,667

8,088

12,991

10,663

11,195

8,971

5,470

1,502

1,500

1,513

2,893

10,017

1;,;;:

7;077

11,601

9,501

10,096

8,169

4,948

298

260

230

508

1,686

1,687

422

871

1,213

1,007

1,044

707

482

Mean

11.9

12.3

12.6

12.7

13.2

14.6

15.8

15,8

15.7

15.6

15.8

15.4

15.3

12.2

12.4

12.6

12.8

13.3

14.7

15.9

15.9

15.8

15.7

15.8

15.4

15.4

10.6

11.7

12.5

12.2

12.7

13.8

15.2

15.0

15.4

15.3

15.4

;:.:

.

Standard

deviation

1.7

1.1

1.1

:::

1.3

::;

1:1

1.3

1.4

1.4

1.5

1.0

2.0

M

1.0

H

1.2

1.2

0.9

1.1

1.6

1.3

1.6

Standard

error of

che mean

.08

.09

.09

.07

.05

.06

.06

.06

.07

.06

.05

.06

.04

.09

.1?.

.10

.07

.06

.06

.06

.07

.07

;&

.06

.04

.21

.10

.14

.11

.09

.08

.18

.12

.10

.12

.09

.12

.10

5th

J::

11.0

?-1.2

:;.:

14:0

14.0

13.9

13.9

13.9

13.2

13.0

J::

11.0

11.3

11.9

12.9

14.2

14.3

13.9

L3.9

14.0

13.2

13.2

6.8

1:::

10.8

11.1

11.7

11.8

12.6

L3.7

13.8

13.3

12.3

11.8

Percentile]

10eh

%

11.3

11.5

12.0

13.0

14.3

L4.6

14.3

L4.2

14.3

13.8

13.6

10.2

10.8

;;.:

12:2

13.2

14.7

14.7

14.3

14.3

14.4

13.8

13.8

J::

11.2

11.0

11.4

12.0

13.4

13.1

14.2

13.9

13.6

13.8

12.3

25th

11.2

11.6

11.9

12.1

12.6

13.7

15.1

15.1

15.1

L5.O

15.0

14.7

14.5

11.5

11.8

11.9

12.1

12.7

13.8

15.3

15.3

15.1

15.0

15.1

14.7

14.6

1:::

12.0

11.5

1.1.9

12.8

14.4

14.6

14.9

14.4

14.3

14.0

13.2

50th

12.1

?.2.4

12.5

12.7

13.3

14.5

15.9

15.8

15.8

15.6

15.8

15.5

15.3

12.3

12.4

12.5

12.7

13.4

14.6

15.9

15.9

15.9

15.6

15.8

15.5

15.5

11.1

12.0

12.5

12.2

12.6

13.7

15.2

15.1

15.4

15.3

15.3

14.9

14.4

75th

13.0

13.0

13.1

13.3

13.9

15.5

16.5

?.6.5

16.4

16.3

16.6

16.2

16.2

13.1

13.1

13.1

13.5

13.9

15.6

16.5

16.5

16.5

16.3

16.6

16.3

16.3

12.2

12.6

13.1

12.9

13.4

14.7

16.3

15.9

15.9

15.6

16.0

;;.:

.

9oth

13.6

13.7

L3.8

14.0

14.4

16.4

17.2

17.0

17.1

17.0

17.4

17.0

16.9

13.7

13.8

13.8

14.1

14.4

16.4

17.2

17.1

L7.2

16.9

17.4

?.7.0

16.9

12.7

13.2

13.7

13.3

14.2

15.6

16.5

16.4

16.5

16.8

17.6

16.0

15.9

95th

13.9

14.0

14.3

14.4

14.8

16.7

17.6

17.L

17.5

17.5

17.9

17.6

17.4

14.0

14.1

14.4

14.4

14.8

16.7

17.6

17.5

17.5

17.5

17.8

17.6

17.4

12.8

13.2

13.7

13.6

14.4

;$;

16:7

16.9

17.8

18.2

16.8

17.0
6 aciancedata

Table 2. Hemoglobin levels of females aged 1-74 years, sample size, e.stimaced population in thousands, mean,

standard deviation, standard error of the mean, and selected percenci.lea, by race and age: United States,

1971-74

Race and age

All races

1 year ------------

2 years-----------

3 years -----------

4-5 years---------

6-11 yesrs--------

12-17 years-------

18=19 years-------

20-24 years-------

25-34 years-------

35-44 years-------

45-54 years-------

55-64 years-------

65-74 years -------

White

1 year ------------

2 years -----------

3 years -----------

4-5 years---------

6-11 years--------

12-17 years-------

18-19 years-------

20-24 years-------

25-34 years-------

35-44 years-------

45-54 years-------

55-64 years-------

65-74 years-------

Black

1 year------------

2 years-----------

3 years-----------

4-5 years---------

6-11 years--------

12-17 years-------

18-19 years-------

20-24 years-------

25-34 years-------

35-44 years-------

45-54 years-------

55-64 years-------

65-74 years-------

lg/dl

Sample

size

254

257

278

571

974

1,006

260

1,171

1,793

1,584

788

639

1,728

179

197

204

418

734

76h

194

910

1,477

1,249

665

531

1,426

$!

148

234

235

2%

29k

307

118

105

294

Estimated

population

in

thousanda

1,729

1,742

1,694

3,299

11,392

12,187

3,810

9,047

13,943

11,577

12,180

9,998

7,138

1,426

1,459

1,417

2,768

9,602

10,391

3,263

7,827

12,193

10,100

10,878

9,058

6,486

267

270

259

503

1,715

1,709

530

1,053

1,623

1,314

1,256

872

629

Mean

12.0

12.4

12.4

12.8

13.2

13.6

13.6

13.6

13.7

13,7

14.0

14.1

14.0

12.0

12.5

12.5

12.8

13.2

13.7

13.8

13.7

13.8

13.8

14.0

14.2

14.1

11.6

11.8

11.8

12.5

12.6

13.0

12.6

13.0

13.1

13.2

13.5

13.3

13.1

Standard

deviation

1.2

1.1

1.0

i::

1.0

::?

+:;

1.3

1.1

1.2

1.1

1.1

1.0

::;

1.0

1.0

1.0

1.2

:::

1.0

1.2

u

1.0

;::

;::

1:2

:::

1.1

1.4

Standard

error of

che mean

.06

.09

.10

.07

.05

.06

.09

.06

.04

.04

.06

.06

.05

.06

.12

.11

.08

.05

.07

.11

.06

.05

.04

.06

.06

.05

.17

.13

.18

.10

.07

.06

.15

.09

.08

.07

.12

.15

.07

PercencLlel

5th

1::?

10.8

11.2

11.6

12.0

11.8

11.9

11.9

11.7

12.0

12.5

12.0

1::;

10.8

11.2

11.6

12.1

12.2

12.1

12.1

11.9

12.1

12.6

12.2

1::;

10.1

11.0

11.2

11.3

1:::

10.9

10.7

11.4

11.3

10.7

10th

10.5

11.0

11.2

11.5

11,9

12.3

12.3

12.3

12.3

12.2

12.5

12.7

12.4

10.9

11.0

11.2

11.6

12.1

12.4

12.6

12.5

12.4

12.3

12.6

12.9

12.6

J:;

10.6

11.1

11.5

11.7

11.1

11.5

11.5

11.3

12.0

11.8

11.3

25th

11.4

11.6

11.8

12.0

12.5

12.9

13.0

12.9

13.0

13.0

13.2

13.4

13.2

11.4

11.7

11.9

12.1

12.6

13.0

13.2

13.0

13.0

13.1

13.3

13.5

13.3

11.1

11.3

11.3

11.7

12.0

12.5

11.9

12.1

12.3

12.3

12.8

12.5

12.3

50th

12.1

12.5

12.4

12.7

:;.;

13:6

13.6

13.7

13.7

14.0

14.1

14.0

12.1

12.6

12.5

12.8

13.2

13.7

13.7

13.7

13.8

13.8

14.1

14.2

14.0

11.7

11.9

11.8

12.4

12.5

13.0

12”.8

12.9

13.2

13.2

13.6

13.4

13.1

75th

L2.6

13.1

13.1

13.5

13.8

14.3

14.3

14.3

14.5

14.4

14.7

14.9

14.8

12.7

13.2

13.2

13.5

13.8

14.4

14.3

14.3

14.6

14.4

14.8

14.9

14.9

12.5

12.3

12.3

13.1

13.2

13.8

13.4

14.0

14.0

14.1

14.2

14.1

14.0

90th

13.3

13.5

13.9

14.0

&;

15:0

14.9

15.2

15.2

15.4

15.5

15.5

13.3

13.6

14.0

14.0

14.4

15.1

15.0

15.0

15,3

15.3

15.4

15.6

15.6

13.0

12.6

13.1

13.8

13.7

14.2

14.2

14.6

14.6

14.8

14.7

14.5

14.7

95th

?.3.7

14.2

14.0

14.6

14.8

:;.;

15:3

15.6

15.7

15.9

15.8

15.8

13.6

l&.3

14.0

14.7

14.8

15.5

~:.j

15:7

15.7

16.0

15.8

15.9

13.4

12.9

1.3.3

14.1

14.2

14.5

14.3

15.0

14.8

15.3

15.0

15.2

15.1
adwncedata 7

Table 3. Serum iron Levels of males aged 1-74 years, sample size, estimated population in thousands,mean,

standard deviation, standard error Of che mean, and selected percentiles,by race and age: United states

1971-74

>

Standard

deviation

Estimated Percentile

population

in

thousands

Standard

error of

the mean

Sample

size Race and age

5th 10th 25tk 50th 75th 9otll I95tLl

All races

1 year--------

2 years-------

3 years-------

4-5 years-----

6-11 years----

12-17 years---

18-19 years---

20-24 years---

25-3& years---

35-U years---

45-54 years---

55-64 years---

6S-74 years---

109.8 128.1

128.8 146.1

128.8 148.2

131.2 145.3

138.7 153.2

161.0 180 0

;~~.~ ] 194”6

179:0

15~:Q, ~78.Q

152.2 171.0

151.0 173.7

p:

192

552

979

1,011

246

483

764

63&

715

556

1,545

1:?

142

411

719

753

189

394

632

539

579

46L

1,232

26

40

1:2

250

250

52

1;;

1%

2;:

(2)

(2)

(2.)

3,427

11,819

12,558

3,667

8,088

12,991

10,663

11,195

8,971

5,470

67.1

80.4

87.4

86.3

94.1

113.4

119.4

114.4

108.2

108.1

105.7

102.4

L07.7

68.9

82.2

85.0

87.2

94.5

115.4

119.5

115.7

108.0

108.7

106.4

102.3

108.6

61.1

74.0

9&.6

82.3

91.6

100.8

111.3

104.7

110.3

96.7

99.1

101.0

98.0

34.1

34.1

34.1

33.8

33.7

41.1

44.6

35.7

36.4

38.0

38.9

3&.9

34.9

32.6

31.7

34.4

33.6

34.4

42.0

44.5

36.2

:;.;

;;:;

34:7

38.8

37.9

34.4

34.8

30.0

32.6

43.3

;;.;

32:9

29.5

27.3

3s.9

(2)

(2)

(2)

1.4

1.2

::!

25.7

33.6

36.0

33.0

42.1

56.0

55.1

65.0

58.0

6L.O

53.8

51.3

57.0

26.0

36.2

35.1

33.0

42.0

56.0

55.5

65.0

57.0

62.0

53.3

51.0

57.0

23.6

25.0

;;.:

48:0

47.2

48.0

57.0

61.0

55.0

60.0

59.0

50.8

29.0

39.0

45.2

41.4

52.0

67.0

73.2

72.0

66.0

65.0

64.0

61.8

66.0

29.0

::.;

44:7

50.6

:;.:

72:1

65.0

67.0

64.0

61.0

67.0

25.6

32.0

55.0

35.0

53.0

65.0

62.2

71.0

74.0

61.3

63.5

68.9

59.0

41.0

54.0

60.0

63.0

70.0

87.0

93.0

89.0

84.0

80.0

79.9

78.8

84.0

45.0

56.0

56.5

64.0

70.0

88.0

93.0

89.9

82.6

01.8

80.0

78.6

85.0

34.0

$3.0

57.0

51.0

57.0

?8.0

36.6

36.8

38.f+

72.7

77.0

78.1

75.0

59.0

77.0

83.0

84.0

92.0

108.0

113.0

110.0

88.5

95.0

110.0

109.0

113.0

135.0

140.0

136.1

1.4 103.0 127.9

2.0

1.8

;:;

103.9

99.0

100.0

105.0

64.0

79.5

81.0

85.0

93.0

111.0

113.7

113.0

103.0

104.0

99.0

99.0

106.0

45.0

62.0

80.5

79.0

91.0

97.9

L02.0

97.5

10L.O

91.6

96.8

101.3

92.0

1~9.Q

126.5

121.0

126.0

88.0

95.2

107.5

109.0

114.0

138.0

140.0

138.0

127.0

129.0

127.0

121.0

128.0

81.5

93.0

116.0

108.3

110.2

120.0

129.0

120.3

134.0

115.4

114.5

116.0

116.0

149.8

153.8

170.0

167.0

130.2

144.0

151.0

145.4

154.0

182.0

193.9

179.2

;;;.;

175:0

171.1

166.9

119.3

144.0

144.1

141.9

M5.8

153.4

171.0

152.0

176.7

155.9

148.1

143.7

169.9

White

1 year--------

2 years -------

3 years-------

4-5,years-----

6-11 years----

12-17 years---

18-19 years---

20-24 years---

25-34 years ---

35-44 years---

45-54 years---

55-64 years---

65-74 years---

(2)

(2)

(2)

2,893

10,017

1:,;;;

7:077

11,601

9,501

10,096

8,169

4,948

(2)

(2)

:2;

1:4

1.6

?:!

1.5

2.3.

2.0

1.8

1.0

111.4

124.7

123.8

133.7

139.0

162.0

176.5

L61.O

152.1

L53.O

?.52.8

L51.O

154.0

Black

1 year--------

2 years-------

3 years-------

4-5 years-----

6-11 years----

12-17 years---

18-19 years---

20-24 years---

25-34 years---

35-44 years---

lJ5-54years---

55-64 years---

65-74 years---

.

(2)

(2)

(2)

508

1,686

1,687

422

(2)

(2)

(2)

2.6

;:2

::2

3.3

3.6

:::

1.7

102.4

L30.O

871

1,213

1,007

1,044

707

482

Iqzjdl

‘Estimated population in thousands and standard error of the mean not included because of uossible bias

due to missing-values.
8 dwwdata

Table 4. Serum iron Levels of females aged 1-74 years, sample size, estimated population in thousands,mean,

standard deviation, standard error of the mean, and selecced percentiles,by race and age: United States,

1971-74

Race and age

All races

1 year --------

2 years-------

3 years-------

4-5 years -----

6-11 years----

12-17 years---

18-19 years---

20-24 years---

25-34 years---

35-4k years---

45-54 years---

55-64 years---

65-74 years---

White

1 year--------

2 years -------

3 years-------

4-5 years-----

6-11 years----

12-17 years---

18-19 years---

20-24 years---

25-34 years---

35-44 years---

45-54 years---

55-64 years---

65-74 years---

Black

1 year--------

2 years-------

3 years-------

4-5 years-----

6-11 years----

12-17 years---

18-19 years---

20-24 years---

25-34 years---

35-44 years---

45-54 years---

55-64 years---

65-74 years---

1sg/dl

=!=Estimated

;ample population

size in

thousands

J;

175

571

988

1,:::

1,188

1,822

1,582

789

632

1,701

1::

130

405

720

744

191

903

1,468

1,221

658

514

1,375

:!

1:?

262

260

2;;

334

334

126

115

318

(2)

(2)

(2)

3,299

11,392

12,187

3,810

9,047

13,943

11,577

12,180

9,998

7,138

(2)

(2)

(2)

2,768

9,602

10,391

3,263

7,827

12,193

10,100

10,878

9,058

6,486

(2)

(2)

(2)

503

1,715

1,709

530

1,053

1,623

1,314

1,256

872

629

Meanl

78.3

8&.2

85.0

89.4

96.1

100.4

101.3

106.2

102.4

98.0

99.9

101.2

97.6

78.3

88.2

88.7

90.4

96.8

100.4

101.9

106.9

L:j.;

102:0

102.2

98.7

78.5

71.8

74.8

84.4

91.8

100.6

97.8

103.2

90.7

90.1

81.7

92.0

86.9

Standard

deviation

33.8

35.6

34.1

31.7

32.1

36.2

42.3

42.0

42.9

40.3

36.8

34.4

31.2

33.8

36.4

34.4

31.6

32.7

36.2

42.4

42.5

43.3

40.3

37.5

34.6

31.3

Standard

error of

the ❑ ean

(2)

(2)

(2)

1.8

1.2

1.4

2.3

::;

:::

3.a

0.6

(2)

(2)

j2~

.

H

2.6

1.3

1.0

M

3.2

0.7

(2)

(2)

$24

2:1

H

2.1

H!

2.3

H

5th

26.7

30.9

34.8

41.0

48.0

45.0

38.0

48.0

44.0

42.0

47.0

55.0

54.0

26.6

29.4

38.0

43.9

48.0

45.0

39.0

48.0

44.0

43.0

46.0

55.0

55.0

25.0

30.2

33.2

34.6

53.5

48.1

20.6

40.8

44.0

36.8

47,6

55.0

47.9

10th

36.4

35.9

43.0

52.6

58.0

55.0

50.0

55.0

52.0

53.0

58.1

61.5

60.0

36.2

37.0

45.0

54.0

58.0

;;.:

55:0

54.0

53.6

59.0

62.0

62.0

35.0

33.0

35.3

43.1

57.0

54.0

37.7

51.0

47.4

45.2

56.0

57.4

54.0

25th

;:.;

59:0

68.0

71.0

75.0

67.0

77.0

72.0

69,0

76.0

78.0

76.0

56.0

59.0

63.0

69.0

72.1

75.0

67.0

77.0

75.0

70.0

78.0

79.0

77.0

45.0

45.8

50.8

61.4

69.0

74.0

65.0

74.0

64.0

65.0

66.0

67.0

71.0

Percencilel

50th

74.0

83.5

83.5

86.0

95.0

99.0

95.0

1:;.;

94:0

94.0

97.0

95.0

74.0

85.0

i33.:

95:0

99.0

95.0

102.0

96.1

94.0

96.0

98.0

95.0

70.0

64.0

71.0

85.0

87.0

97.0

96.6

96.6

84.0

89.0

76.0

84.0

82.0

75th

9f+.8

113.0

105.5

108.0

117.0

;;; .:

130:0

127.0

L20.O

116.8

118.0

116.0

94.0

114.0

109.0

108.0

118.0

122.0

129.9

130.0

129.0

122.0

119.7

118.0

117.0

98.0

97.2

91.0

105.0

114.0

127.0

124.0

136.0

110.9

108.1

92.0

112.0

105.0

90th

122,3

134.0

124.0

129.8

137.0

146.3

154.0

161.4

161.0

149.0

152.0

138.0

135.0

121.4

140.0

124.0

131.0

138.0

147.2

153.8

165.0

161.0

y;.:

141:0

136.6

123.0

111.8

115.5

119.1

128.0

145.0

150.0

151.0

143.1

134.0

110.6

125.0

124.0

95th

150.6

144.d

146.0

144.1

147.0

163.0

173.5

182.0

180.9

171.0

172.0

164.8

152.0

151.4

146.6

151.0

7.44.5

149.1

163.0

176.6

183.O

182.2

173.0

175.0

167.0

153.5

138.0

120.0

140.3

143.4

137.4

156.4

162.6

168.8

162.5

138.5

133.2

p:. :

2~t~ted modulation in thousands and standard error of the mean not included because of possible bias

due co missing’v~lues.
ackancedata 9

Table 5. Percent transferringsaturation of males aged 1-74 years, sample size, estimated population in thousands, mean, standard deviation, standard error of the mean,

United States, 1971-74

and selected percentiles, by race and age:

Race and age

All races

1 year------------

2 years-----------

3 years-----------

4-5 years ---------

6-11 years--------

12-17

18-19

20-24

25-34

35-4&

45-54

55-64

65-74

years -------

years-------

years-------

years-------

years-------

years-------

years-------

years-------

-

1 year------------

2 years-----------

3 vears-----------

4-3 years---------

6-11 years--------

12-17

18-19

20-24

25-34

33-44

45-54

55-64

65-74

years -------

years -------

years-------

years-------

years-------

years-------

years-------

years-------

Black

Sample

size

113

150

192

552

979

1,:~:

&83

764

634

715

556

1,545

1%

142

411

719

753

189

394

632

539

579

464

1,232

26

::

138

250

250

52

1;;

1~~

294

Estimated

population

in

thousands

(1)

[

1)

3,4;!

11,819

12,S58

3,667

8,088

12,991

10,663

11,195

8,971

5,470

(1)

(1)

z $;

10:017

10,752

3,173

7,077

11,601

9,501

10,096

8,169

4,948

(1)

(1)

(1)

508

1,686

1,687

422

871

1,213

1,007

1,O&&

707

482

Mean

16.4

20.6

23.8

23.3

25.5

30.1

32.8

31.6

30.5

30.9

30.0

29.8

32.5

16.9

21.2

23.1

23.5

25.6

30.6

32.7

31.9

30.5

31.1

30.1

29.7

32.7

14.5

18.0

25.7

22.3

25.1

27.3

31.1

29.2

31.0

27.4

28.5

30.3

30.8

Standard

deviation

9.3

J:;

9.2

1?::

12.7

10.0

10.4

11.8

12.3

11.7

11.6

9.2

1:::

::;

12.0

12.6

10.1

10.5

11.9

12.5

12.0

11.6

9.8

1?::

:::

J:!

9.1

;:$

9.5

1?::

Standard

error of

the mean

(;;

[

1)

0.40

0.36

0.39

0.82

0.44

0.43

0.63

0.58

0.64

0.30

(1)

(1)

o (;:

0:39

0.45

0.87

0.46

0.46

0.67

0.63

0.70

0.32

[;]

(1)

0.63

0.64

0.40

2.47

1.19

0.97

1.24

0.95

1.01

0.52

5th

5.1

1:::

1!::

14.2

15.0

17.6

16.2

16.8

15.4

14.8

16.8

5.3

1::!

1;::

14.4

15.1

18.2

16.1

16.8

15.4

14.8

16.6

4.5

5.5

9.8

1!:!

13.8

14.8

16.0

17.8

16.1

15.4

15.7

17.2

10th

R

11.7

11.3

13.8

L7.4

19.5

20.6

18.2

18.6

17.4

17.3

19.6

L:::

11.2

L1.4

L3.6

L7.6

L9.5

20.6

18.2

L8.7

17.6

17.3

19.6

:.;

13:1

Lt:;

15.8

L7.5

16.7

L9.9

17.8

L6.1

L8.9

L9.5

Percentile

25th

A

I year------------

2 years-----------

3 years-----------

4-5 years---------

6-11 years--------

12-17 years-------

18-19 years-------

20-24 years-------

25-3k years-------

35-44 years-------

45-54 years -------

55-64 years-------

65-74 yesrs-------

lE~timced population in thousands and standard error of the mean not included because of possibLe bias

due co missing vaLues.

1::;

15.9

16.6

18.9

22.1

23.6

24.2

22.9

22.4

21.8

22.2

24.7

J:;

15.3

16.8

18.8

22.1

23.6

24.4

22.8

22.6

21.9

21.8

24.9

1%:

?.6.7

L5.1

19.0

21.2

22.3

23.5

23.7

19.7

20.4

24.7

23.1

50th

14.1

18.8

22.5

22.6

24.7

28.6

30.a

30.0

29.1

28.9

27.7

28.3

31.2

15.7

L9.9

21.6

23.0

24.8

29.1

29.5

30.2

29.1

29.2

27.7

28.0

31.4

L;:~

23.3

21.0

24.3

26.7

30.1

29.0

30.2

25.2

26.7

29.0

27.9

75th

21.4

26.2

29.7

29.0

31.1

35.9

38.5

37,8

36.5

37.0

35.3

35.7

39.1

21.5

26.6

28.6

29.1

31.3

36.5

38.4

38.1

36.3

37.0

35.3

35.6

39.2

19.8

23.2

31.4

28.5

3Z.O

31.5

36.5

32.5

37.5

32.3

35.3

37.2

36.6

90th

28.3

32.7

36.5

35.1

38.2

44.0

49.4

64.2

L2.9

43.4

44.1

43.9

46.1

27.5

32.6

36.3

35.3

38.5

44.8

49.4

44.6

42.9

43.5

44.4

44.5

46.3

27.9

32.2

38.8

::.;

38:4

&O.6

41.3

42.9

37.0

40.6

39.3

45.6

95th

33.4

36.8

40.8

38.8

42.4

50.5

60.1

&7.o

51.3

50.1

51.0

48.0

51.9

34.2

36.9

;;.;

43:1

50.5

60.2

47.1

53.0

49.7

52.1

48.1

52.1

31.6

35.8

41.2

40.0

39.8

40.8

49.6

62.4

&3.1

47.2

43.1

43.6

50.3
10 aduancedata

Table 6. Percent transferzin saturation of females aged 1-74 years, sample size,

thousands,

estimated population fn

mean, standard deviation, standard error of the mean, and selected percentiles, by race and age:

United States, 1971-74

Race and age

All races

1 year ------------

2 years -----------

3 years -----------

4-5 years ---------

6-11 years --------

12-17 years -------

18-19 years -------

20-24 years -------

25-34 years -------

35-44 years -------

45-54 years -------

55-64 years -------

65-74 years -------

White

1 year ------------

2 years -----------

3 years -----------

4-5 yeara ---------

6-11 years --------

12-17 years -------

18-19 years -------

20-24 yeazs -------

25-34 years -------

35-44 years -------

45-54 years -------

55-64 years -------

65-74 years -------

Black

1 year ------------

2 years -----------

3 years -----------

4-5 yeara ---------

6-11 years --------

12-17 years -------

18-19 years -------

20-24 years -------

25-34 years -------

35-44 years -------

45-54 years -------

55-64 years -------

65-74 years -------

Sample

size

+:;

571

988

1,:;:

1,188

1,822

1,582

789

632

1,701

1::

130

405

720

744

199

903

1,468

1,221

658

514

1,375

;:

1%

262

260

2;;

334

:;:

115

318

Estimated

popu~ncion

thousands

(1)

(1)

3 $;;

11:392

12,187

3,810

9,047

13,943

11,577

12,180

9,998

7,138

(1)

(1)

(1)

2,768

9,602

10,391

3,263

7,827

12,193

10,100

10,878

9,058

6,486

(1)

(1)

(1)

503

1,715

1,709

530

1,053

1,623

1,314

1,256

872

629

Mean

19.5

22.2

22.7

24.5

25.8

26.2

26.8

27.3

27.1

26.5

27.8

29.2

28.6

19.7

23.6

23.8

24.8

26.1

26.4

27.2

27.4

27.6

26.7

28.4

29.5

28.8

18.9

17.8

19.7

23.1

24.5

25.6

24.4

26.4

23.5

24.8

22.7

26.6

26.1

Standard Standard

error of deviation the mean

I

1:::

9.6

8.9

9.3

1;::

L1.5

11.9

11.6

11.3

10.6

10.0

l;:!

;::

.

1;:?

11.5

12.0

11.6

11.6

10.7

Lo.1

10.4

8.7

9.1

::!

1?::

10.9

10.3

11.3

;:;

8.1

(1)

(1)

o(;]

0:34

0.38

0.69

0.34

0.26

0.36

0.78

1.07

0.23

(1)

(1)

(1)

0.59

0.41

0.43

0.74

0.39

0.30

0.43

0.88

1.18

0.26

(1)

(1)

o (;;

0:65

0.62

1.30

0.59

0.50

0.59

0.62

1.15

0.37

5 til

6.5

6.2

1;:5

12.5

11.5

10.4

11.5

10.2

10.1

11.4

15.2

15.0

6.5

1:::

11.5

12.2

11.5

10.5

11.7

10.4

10.4

11.3

15.2

15.0

4.6

5.8

6.7

1%!

12.0

4.7

J::

1?::

14.8

13.0

10th

8.3

1!:;

13.3

14.8

14.6

12.7

14.5

13.2

13.2

16.2

17.1

17.1

8.7

1;:!

13.6

14.9

14.8

13.2

14.7

13.5

13.3

16.3

17.8

17.1

6.8

7.2

1?:;

&

1%;

11.9

11.6

14.2

15.2

16.1

Percentile

25th

12.7

14.8

15.4

18.2

18.8

19.2

18.7

:;.;

18:0

20.6

22.5

22.1

13.1

15.7

16.9

18.7

18.8

19.2

18.8

19.1

19.1

18.2

20.8

22.8

22.1

9.3

1;:;

16.6

18.7

18.9

14.4

19.0

16.0

16.9

17.6

18.3

21.4

50th

18.2

21.1

22.3

23.8

25.1

25.3

24.4

25.9

25.8

25.4

25.S

27.6

27.5

18.4

23.0

23.7

23.9

25.3

25.4

24,6

26.0

26.3

25.4

26.7

27.8

27.7

17.8

17.1

18,2

22.6

23.3

24,6

23.8

24.4

22..9

23.9

21.0

25.4

25.2

75th 90th

23.8 31.9

28.6 35.8

28.1 33.8

30.2 35.3

30.9 38.2

32.4 38.6

33.7 43.4

33.6 43,2

33.4 43.1

33.2 42.6

32.7 42.3

34.5 41.0

34.4 40.5

23.2 33.6

30.8 37.3

28.8 34.9

30.3 35.5

30.9 38,7

32.4 39.6

33.7 43.7

33.6 43.4

34.1 43.4

33.6 42.9

33.8 43.5

34.5 $1.2

34.5 40.9

25.2 30.7

23.9 30.1

24.5 30.0

28.0 32.3

29.9 35.0

32.7 38.2

30.6 38.7

33.5 39.8

28,7 34.2

29,8 37.9

25.8 31.2

34.5 38.1

31.3 35.7

95th

36.0

40.8

39.2

40.9

41.6

44.6

56.2

47.8

48.3

48.5

50.7

47.3

44.6

36.1

42,0

39.8

40.9

42.8

44.9

56.3

48.5

&

51:6

48.6

44.9

3L.7

31.6

33.7

40.5

38.9

39.0

42.1

44.7

43.6

42.7

35.9

;;.;

.

lEsti~ted ~oDulation in thousands and standard error Of the ‘can ‘ot included because of possible

bias due to missktg values.
adwmdaa 11

REFERENCES

1National Center for Health Statistics: Preiiminaxy

findings of the first Health and Nutition Examination

Sumrey, United States, 1971-1972, dictaq intake and

biochemical findings, by S. Abmham, F. W. Lowenstein,

and C. L. Johnson. DHEW Pub. No. (HRA) 741219-1,

Health Resources Administration. Washington. U.S.

Government Printing Office, Jan. 1974.

2Lowenstein, F. W.: Some preliminary findings from

the first Health and Nutition Examination Survey,

U.S. A., 1971-1972. Proceedings of the Western Hemisphere Nutrition Congress Iv, 197-L

3National Center for Health Statistics: Plan and

operation of the Health and lNutrition Examination

Survey, United States, 1971-1973, by H. W. Miller. Vital

and Health Statistics. Series 1-Nos. 10a and 10b. DHEW

Pub. No. (HSM) 73-1310. HeaIth Services and Lfental

Health Administration. Washington. U.S. Government

Printing Office, Feb. 1973.

4Nationai Center for Health Statistics: Biochemical

findings of persons 1-74 years of age in the United

Stat es: Hemoglobin and iron-reIated measurements

1971-1974. Series 11. PubIic Health Service, HyattsvilIe,

M land. To be published.

Y National Center for Health Statistics: HANES I,

hematology and clinical procedures developed or utilized

by the Bureau of Laboratories, Center for Disease Control, 1971-1975. LVCHS Instruction Manual, Part 16.

Public Health Service. HyattsviHe, Maryland, In preparation.

6White, J. }1., and Flaschka, H. A.: An automated

procedure, with use of ferrozine, for assay of serum iron

and totaI iron-binding capacity. C[in. Chem.:

19(5):526-528, May 1973.

‘Myers, L. D., Habicht, J. P., and Johnson, C. L.:

Components of the difference between bIack znd white

women in the U.S.A. of hemoglobin concentrations in

blood. Am J Epidemiol. In press.

TECHNICAL NOTES

The sampling pIan for the 65 preselected

examination Iocations in the Health and Nutrition Examination Sufiey followed a highly

stratified multistage probability design in which

a sample of the civilian noninstitutionzdized

pops.dation of the conterminous L’nited States

1-74 years of age was seIected. Successive elements of the sampling process were the primary

sampIing unit, census enumeration district, segment (a cluster of households), household,

eligible person, and finally, sample person. The

s am p Iing design provided for oversampling

among persons living in poverty areas, preschooI

chiIdren, women of childbearing age, and the

eIderIy.

The biochemical findings for each individual

have been “weighted” by the reciprocal of the

probability of seIecting the person. .ti adjustment for persons in the sampIe who were not

examined and poststratified ratio adjustments

were also made. Thus the fired sampling estimates of the population size were brought into

closer afignment with the independent U.S. Bureau of the Census estimates for the civifian noninstitutiomlized population of the United States

as of lNovember 1, 1972, by race, sex, and age.

SYMBOLS

Data not available— ..-

Category not applicable . . .

Quantity zero

Quantity more.than O but Iess than 0.05— 0.0

Figure does not meet standards of

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

U.S. DEPARTMENT OF HEALTH,

EDUCATION, AND WELFARE ● $f~~~ ~~~~~l~~~~s~arch, stati5tim, and Tectmr@Y Number 47 ● April 3,1979

Prevalence,

Among

Disability, and Health Care for Psoriasis

Persons 1-74 Years: United Statesa

This report presents national estimates for

the preval&ce ‘of psoriasis and related pathology, the resultant concern and handicap,

and the need for health care for these conditions

among the civilian noninstitutionalized population 1-74 years of age in the United States.

The data are based on direct examination

findings from the Health and Nutrition Examination Survey (HANES) of 1971-1974.

The first HANES program, in which these

data were obtained, was desiLgned to measure the

nutritional status as well as certain aspects of

general health status and health care needs in

the U.S. population. These programs secure”

information on the prevalence of medically defined illnesses, including previously unrecognized and undiagnosed conditions, as well as

on a variety of physical, physiological, and

psychological measures within the population

through direct examinations, tests, and measurements, as described in previous publications.1’4

The dermatology component of the first

HANES was planned at the request of and in cooperation with the Committee on Planning for

the NationaI Program for Dermatology of the

National Academy of Derrnatolo<gy. Dr. MarieLouise T. Johnson, Chairman of the Data CoIIection Unit for the NationaI ProLgram, was

primarily responsible for planning the content

of the exarnination, recruiting the dermatologists, and training them in the examination

methodolo~gy to minimize variation among

examiners.

aRepared by Marie-Louise T. Johnson, M. D.,Ph.D.,

Ncw York University School of Medicine, and Jean

Roberts, M.S., Division of Health Examination Statistics.

This second Aduance Data from the dermatology examination findings is limited to statistics on persons identified by the examiner as

having psoriasis as classified under code 7060

in the Code of Skin. Dz3eases.5 Further in formation on the demographic and socioeconomic

distribution of all types of skin pathoIogy,

the extent of disability or handicap caused by

skin conditions, and the extent to which medical

care for such conditions has been sought or

needed among the U.S. population is summarized in an earlier Advance Data6 and further

described and analyzed in a Vital and Health

Statistics series report.7 These data au~gment

those incIuded for psoriasis in the previously

published report.

An estimated

years of age in

TRENDS

5.8 per 1,000 persons 1-74

the U.S. civiIian noninstitutionalized population have psoriasis as deter- “

mined in the dermatology component of the

Health and Nutrition Examination Survey of

1971-1974. An additional 0.4 per 1,000 were

shown in the detailed examination to have active

psoriasis. NearIy 70 percent of those afflicted

were concerned enough to complain about their

condition, a rate of 4.0 per 1,000 population

(table 1).

Psoriasis is a chronic condition of the skin

that usuaIIy appears first in the third decade of

life but may appear at any time and can be seen

in children. C1assicaIIy, there are red plaques

with silvery scales over the eIbows and knees,

and occasionaNy the scalp, but psoriasis may become evident suddenly over the entire body as
2

Table 1. Frewlenw and prawlenca rates among persons 1-74 years Of age for all psoriasis diagnosed and such conditions evoking

complaints. by type of rendition and sex, with standard errors for total rates: United States, 1971-1974

Significant pathology Complaints

Type of psoriatic pathology and

New York University code 6oth

Male Female

8oth

Male Female 9sxes sexes

I

Number of persons in thow+nds

Fsoriasis,all types... ......... . ........ ... .... .. . . ....2060

RuPial .. ........ .. ......... .. ..... ............. . ...... 706050

Guttate . ... ... ...... ......... .. .. .... ...... . . . 706060

With arthritis ....... ........ .. ..... ........... ... . 7ffi070

Types N. O.S.l .... ............. ........ ....... ..... ..... 706090

Fsoriasis ................ ............ .......................... .... .... 7060

Rupial .................... ............." .......... ...........7om5o

Guttate ... .. ............ ......... ...................... ..... 706060

With arthritis ... ............ ............ ....... .......... 706070

Types N.O.S.l ....... ... ............... ....... ..... ..... 706090

1,117 584

.

3

50 39

1,065 556

5.8 6.3

“0.01 .

‘0.25 ●0.41

5.49 5.90

523 -1-I

803

7

3

11 51

509 745

Rate per 1,000 population

5.3 4.0

“0.04

“0.02

●0.1 1 ‘0.26

5.08 3.84

Standard error of ra~e

%riasis ..... ....... ......... ........... ... .. ...... ........... ...7O~

‘“76 II 1.’O1 ‘“mI ‘= II

401 402

7

.!

38 13

363 382

4.1 4.0

“0.07

“0.41 ●0.13

3.8s 3.82

0.86 I 0.93

1Nmo.s. +ot cjthenvise specKledsmaIl, scattered, drop-Iike lesions of redness and

scale, so-caIIed guttate psoriasis. Pitting of the

nads can be seen with lifting and flaring, a

form of psoriasis that may be associated with

arthritis.g ‘g

AIthough found in families, psoriasis is inherited in a pattern stilI uncIear. Through

genetic markers a group of psoriatic patients can

be identified who have a high rate of affected

reIatives, a younger onset of disease, and a more

severe form.

The HAPJES dermatologists recorded the

presence of psoriasis, its extent and severity, the

presence or absence of scalp involvement, and

arthritis. The most frequently diagnosed type of

the disease was psoriasis vulgaris, otherwise unspecified (afflicting 95 percent of those with

psoriasis diagnosed in the survey). Individuals

who had an associated arthritis were 4.0 percent

of the totaI; the remaining 1.0 percent had

guttate psoriasis, the expIosive form sometimes

associated with physiological stress such as fever,

or specific therapy such as antibiotics.

Psoriasis was found slightly more frequently

amon$ males (6.3 per 1,000) than femaIes (5.3

per 1,000), rdthough the difference in rates was

smalI enough to be due to sampIing variability

alone. The complaint rate was similar for both

sexes (4.1 and 4.0 per 1,000).

As would be expected with a problem beginning in most peopIe after age 20, the prevalence

rates for psoriasis were lowest among children

6-11 years and adults 18-M years of age (less

than 2 per 1,000), and highest among aduIts 45-

74 years (11-12 per 1,000 population).

Complaints concerning their skin pathoIogy

were comespondingly lower among children and

younger aduIts (through age 44), with rates of

1-3 per 1,000 population (table 2). For persons

age 45 years or older rates decreased slightly

with age from 10 per 1,000 population at 45-54

years to 7 per 1,000 at 65-74 years (figures 1-3).

Race made a difference in the prewdence of

psoriasis. White persons were affected more than

black persons (6.5 per 1,000 against 0.6 per

1,000). Correspondingly more white persons

(4.5 per 1,000) than bIack persons (0.4 per

1,000) registered concern about their condition,
ackmaaa3

Table Z prevalence rates for ail p=riasis diagnosed and such conditions ewking complaints, proportion considering psoriasis a handicap

by severity, age, sax, and race among persons 1-74 years of age, with standard errors for totals: United Stares, 1971-1974

Both saxes

EEIzzIz

I

All mces,

1-74 years

*

Condition or

handicap

Seth

II

Male Female =Xes

I

Rate per 1.000 population Standard error

4.3

28

0.76 1.10

0.58 0.86

All psoriasis

diagnosed. . .. . .... ........

psoriasis evoking

mmplaints .... ..... ........<

5.8

4.0

7.5

11.2

0.8

1.3

23.3

38.5

100.0

0.1

25

8.6

88.8

0.3

93.0

6.7

2.4

1.2

9.3

19.0

.

.

14.8

3(X4

0.6

0.4

29.2

42.7

.

.

29.2

42.7

1.09

0.93

5.24

7.68

.

.

7.20

11.13

-..

. . .

---

..-

-..

. . .

..-

-..

=me employment or

housework handicaps

among perwns with:

Psoriasis diagnosed..

Psoriasis evoking

complaints ............

Preferred employment

precluded among

persons with:

Psoriasis diagnosed..

Psoriasis ewking

mmplaints .... .... ....

Some social handicap

among persons with:

Psoriasis diagnosed.

Psoriasis evoking

complaints ............

6.9

10.7

25.8

35.6

7.3

10.2

1.4

1.8

24.0

41.0

7.0

10.8

1.5

2.3

24.5

36.4

8.1

11.6

.

.

21.9

40.5

7.2

10.8

0s

1.4

23.2

38.4

3.42

4.62

0.78

1.62

5.38

7.23

3.7e

5.71

1.47

2.21

7.47

11.33

. . .

. . .

. . .

. . .

. . .

. . .

.-.

. . .

Percent distribution of personi with psoriasis evoking complaints

100.0

By severity of employment or housework

handicap:

Totally

handicapped .........

partial-severe. ..........

%nial-minimei .......

Gsentially none .....

By severity of social

handicap:

Severe.... .. ............

Mini real .. ... .... ......

Essentially none ....

100.0 100.0 1OQ.o 100.0 --- . . . ..-

. . .

. . .

..-

. . .

-..

. . .

. . .

0.2

9.6

1.0

89.2

0.1

0.2

11.1

88.6

.

.

19.0

81.0

-

10.1

88.9

.

4.8

5.7

89.4

. . .

.-.

. . .

.-.

.-.

. . .

. . .

-..

0.5

35.1

64.4

0,3

35.2

W5

.

30.4

6%6

.

37.0

63.0

.

35.6

64.4

.-.

.-.

. . .

. . .

. . .

.-.

, , —

differences too Ianre to be attributable to sarn- WhiIe complicating Iife and compromising

pling variability a.&e (tabIe 2). Among both

racial groups, concern was expressed for about

two-thirds of the diagnosed psoriasis cond~tions.

Of aU psoriatic with compbints about

their skin condition, nearly three-foufis (71.9

percent) had the problem for more than 5

years; ordy 6.3 percent had been aware of it for

less than 2 years. The psoriasis had been active

in the preceding year in all but 25 percent.

employment and housework for some persons,

psoriasis was more IikeIy to be considered a

social handicap. It was considered such by 23,3

percent of those with significant disease and

38.5 percent of those who were concerned

about their condition. Only 7.5 percent of a?l

persons with psoriasis and 11.2 percent of those

concerned about their psoriasis compkiined

about interference with employment or house-
4 acklncedata

I%Jure 1. PREVALENCE RATES FOR ALL PSORIASIS DIAGNOSED’

AND PSORIASIS EVOKING COMPLAINTS, BY AGE: UNITED

STATES, 1971-74

zu_

g 15 -

i=

5 Dhgncd

ii

ij. ‘o :

a

2

:

<

a5

.. . . . . . .

0 t I I I 1 I

o 10 20 2U m 50 00 70

AGE IN YEARS

1t+w YorkUnlvw!itycc.ie7W3.5

Figure 2. PREVA~ENCE RATES FOR ALL PSORIASIS OIAGNOSED;

BY AGE AND SEX UNITED STATES, 1971-1974

20-

Males

g 15 -

1=

;

:

;

Females

25

/

o 10 m so 40 50 00 70

AGE IN YEARS

1NewYorkUnwxwy cede7WI.5

work. The proportion of those affected with

“either a soiid- or work handicap increased

consistently with age (table 2). Males were

somewhat Iess likely than females to consider

their psoriasis a handicap to work, but if they

were concerned, they were more apt than

females to consider it a social handicap. Of

interest despite their fewer numbers, black

persons were substantizdly more likely than

white persons to consider their psoriatic condition a handicap to employment or housework

and somewhat more likely to complain of a social handicap.

Fqure 3. PREVALENCE RAlW3 FOR PSjf)RIAsIS EVOKING CtXI.

PIAINTS; BY AGE AND SW: UNITED STATES, 1971-1974

g 15—

5

3

E

a ~,

z

:

~

5 -

0

.,

10 20 30 40 50 60 70

AGE IN YEARS

1Nw Y.rk Unwem,ycode70605

The majority of individuals with psoriatic

skin probIems considered themselves without a

handicap to work (89 percent) or socizd functioning (61 percent). Among those who did feel

a handicap to employment or housework, the

handicap was more Iikely to be thought of as

minimal (8.6 percent) than severe (2.5 percent),

and the social handicap was almost always considered minimal (93 percent).

Among those examined, psoriasis was more

apt to be active rather than inactive (6.2 per

1,000population against 1.3 per 1,000 for those

with inactive disease). For those under 45 years “

of age, the ratio was 3 to 1, and it increased to 7

active to 1 inactive in individuals over the age of

45 afflicted with psoriasis (table 3).

Psoriasis was found more frequently on both

scalp and extremities (2.9 per 1,000 population)

than on just the extremities (2.3 per 1,000) or

only the scalp (O.5 per 1,000). When psoriasis

occurred elsewhere on the body, the trunk alone

was more likely to be affected (1.9per 1,000)

than the trunk and seborrheic areas other than

the scalp (0.8 per 1,000) or these latter areas

alone (0.3 per 1,000).

More than half of those with psoriasis knew

of no family history of this problem (5.2 per

1,000 population). Of those reporting a family

history, the parents were more Iikely to have

had the condition (2.0 per 1,000 population)

than siblings alone (1.1 per 1,000) or both

parents and siblings (0.5 per 1,000).
a&ancda5

Table 3. PrewIence rates arnon9 Permns ~’74 Y-= of $98 fOr Psoriasis by marit~, artatomical locations. family history, adequacy of

medical care, obstacles 10 improvement, age and sex, with standard errom for totals: United States, 1971-1974

selected characteristics ralated

to psoriasis condition

Activity of w ndit ion

Actiw .. ... ................... .. .. ................... .....

Inactive .. ... . . ............ .... ... ........ .. ........””.

Severity of andition

severe ...................... ........ ..... .................. ..

Mod@rate ...... ... ................ ........................... .

Minimal ................. ................................ ..... .

Location of condition

Scalp only .. ...... ............................ ........ .......

Extremities only .. ........... ... .......... ....... ... ...

Both scalp and extremities .. .................. ......

Trunk only. ................ .... ..... ....... .......... ...... .

Seborrheic areas only . ..... ........... ... ...... .... .

Both trunk and seborrheic areas ..... ............

Family history of psoriasis

%ent only .... ................ .... ..... ....... .....”......

Sibling only ............ .. ....... .... ...... ..... ...... ......

Both parent and sibling ................ ... ..... ......

Nona .. .. ......... .............. .... ...........................

Adequacy of medical care for osoriasis

Adequate ........... ... .... ........................... .......

Inadequate ............. ......... ... .................. ..... ..

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

Obstacles to improvement

for psoriasis comolaint

Did not cmperate with doctor ................. .

Financial ................ ....... ........... .....".. ""."...

Other (too far, no transpo~ation

●vailable, etc.) ..... .... ............ ................. . ..

Both SeX~

I

1-74 years

1-74 1-17 1s44 46-74

years years years years

Male Femala

6.i

1.3

●0.I

2.1

4.9

0.5

2.3

29

1.9

0.3

0.8

20

1.1

“0.5

5.2

24

1.0

0.7

“0.6

●0.2

.

R

1.:

0.7

3.5

0.1

0.7

1.1

1.1

0.2

.

1.1

0.4

“0.3

---

0.9

0.1

0.2

●0.Y

*.

.

,perl,C

4.:

1’..

0.1

1.t

3.4

0.1

21

23

0.7

0.1

0.6

27

1.1

“0.5

-..

20

0.2

0.5

“0.4

●0.1

.

14.1

1.8

0.0

5.2

10.2

1.3

4.2

6.0

4.6

0.9

20

22

1.8

“0.9

. . .

4.6

3.0

1.4

1.5

“0.6

1-

7.:

0.4

●0.C

22

5.:

0.2

2.3

3.a

20

0.9

21

●1.4

“0.4

6.2

2.0

1.0

1.1

●1.O

“0.3

0.4

5.:

2.1

●0.1

1.5

4.6

0.7

2:

2.E

1.5

0.7

0.8

1.9

0.9

‘0.7

4.0

2.7

0.9

0.3

●0.3

●0.3

1.2

1-74 years

Both

S8XIH II I

Male Female

Stan

0.7(

0.4:

0.04

0.3$

0.6:

0.17

0.4s

0.51

0.51

0.19

0.25

0.49

0.46

0.27

0.66

0.38

0.32

0.22

0.03

0.13

0.31

i erqor of rate

1.16

0.23

0.01

0.52

1.06

0.22

0.66

0.59

a.88

0.02

0.36

0.56

0.87

0.22

1.26

0.65

0.51

0.42

0.06

0.09

0.03

1.0!5

0.74

0.08

0.59

1.03

0.28

0.67

0.72

0.57

0.38

0.38

0.62

0.30.

0.49

0.90

0.68

0.40

0.22

0.02 “

0.24

0.61

The medicaI care received by those with and for persons under 45 years of age. For those

psoriasis was judged by the exa&iner as ade-

.

age 45-74 years, however, the care was just as

quate or inadequate according to common IikeIy to be inadequate or nonexistent as it was

norms for therapy provided by derrnatoIo@ts in to be adequate. Obstacles to improvement were,

outpatient settir+gs. The assessment was more in most instances, due to Iack of time or concern

often of adequate treatment (2.4 per 1,000 rather than because of financial constraints or

population) than inadequate or nonexistent inadequate professional advice.

treatment (1.7 per 1,000) for all ages combined
6

REFERENCES

1National Center for Health Statistics: Plan and

initiaI program of the Health Examination Sssmey.

Vital and Health Statistics. PHS Pub. No. 1000-Series

l-No. 4. Public Health Service. Washington. U.S. GovernmentPrinting Office, July 1965.

2National Center for Health Statistics: Plan, operation, and response results of a program of children’s

examinations. Vital and Health Statistics. PHS Pub. No.

1000-Series l-No. 5. Public Health Sewice. Washington.

U.S. Government Printing Office, OCt. 1967.

3National Center for Health Statistics: Plan and

operation of a Health Examination Survey of U.S.

youths 12-17 ycsm of age. Vital and Health Statistics.

PHS Pub. No. 1000-Series I-No. 8. Public Health SerVice. Washington. U.S. Government Printing Office,

Sept. 1969.

4National Center for Health Statistics: Plan and

operation of the Health and Nutrition Examination

Suwey, United States, 197 I-1973, by H. W. Miller. Vital

and Heafth Statistz”cs. Series 1-Nos. 10a ad 10b. DHEW

Pub. Nos. (HRA) 76-1310 (lOa) and (HSM) 73-1310

(lOb). Health Resources Administration. Washington.

U.S. Govemnent Printing Office, Feb. 1973.

5The Depsmment of Dermatology, New York University School of Medicine: Code of Skin Diseases, 1st

rev. New York. New York University, Feb. 1968.

6National Center for Health Statistics: Prevakncc

of dcrmatologicd disease among persons 1-74 years of

age, United States, by M.-L. T. Johnson and J. Roberts.

Advance Data From VitaI and Health Statistics, No. 4.

DHEW Pub. No. (HRA) 77-1250. Health Resources

Administration. Rockville, Md. Jan. 26, 1977.

7National Center for Health Statistics: Skin conditions and related need for mcd:cal care among persons

I-74 years, United States, 1971-1974, by M.-L. T.

Johnson and J. Roberts. Vital and Health Statistics.

Series 1l-No. 212. DHEW Pub. No. (PHS) 79-166C.

PubIic Health Service. Washington. U.S. Government

Printing Office. NOV. 1978.

8Fitzpatrick, T. B., Eisen, A. Z., Wolff, K., Frcedberg, I. M., and Austen, K. F., eds.: Dermatology in

General Medicine. New York. McGraw-Hill Book Co.,

1979.

9MoscheIla, S. L., Pillsbury, D. M., snd Hurley, J. J.,

Jr.: Dermatology, 2d ed. PhiIa., Pa. W. B. Saunders Co.,

1975.

SYMBOLS

Data not available .-.

Categoq not applicable . . .

Quantity zero .

Quantity more than Obut Icss than 0.05— 0.0

Figure does not meet standards of

reliability or precision *
danceda7

TECHNICAL NOTES

The sampling plan for the 65 preselected

examination locations throughout the country

that were used consecutively in the Health and

Nutrition Examination Survey from April 1971

through June 1974 followed a stratified multistage probability design in which a sample of the

civilian noninstitutionalized population of the

coterminous United States 1-74 years of age was

selected. The sample was stratified by geographic region, population density, and rate of

population change between 1960 and 1970.

Within each stratum, cIuster-type sampIing was

used for selecting households and sample persons to be incIuded in each examination Iocation. The sample design provided for oversampling among persons living in poverty areas,

preschool-age children, and women 2044 years

of age.

Of the 28,043 sample persons selected to

represent the 194 million persons 1-74 years of

age in the U.S. population, 20,749, or 74.0 percent, were examined. This corresponds to an

effective response rate of 75.2 percent after adjustment is made for the effect of oversampling

among the poor, preschooI-age children, and

women 2044 years of age.

This dermatology part of the HANES examination included a complete’ clinicaI examination of the skin and surrounding tissue that

considered normal variations in texture and

color, certain manifestations of aging, and all

pathological changes. Significant diagnoses were

documented by tissue biopsy to determine

malignancy or culture to identify fungi whenever possible. Estimates were made of actinic

exposure experienced as weI1 as actinic damage

sustained and of occupational risk from irritant

and allergic contactants. For an examinee with

a significant hand, foot, or generalized problem,

the dermatologist made a judgment about the

burden to the examinee in terms of discomfort

or disability, about care sought, and about the

ef feet expected from current best care possible.

The “significant” skin conditions or pathologies

recorded are those the examining dermatologist

thought should be evaluated by a physician at

least once.

Prevalence rates of skin conditions are

shown as population estimates; that is, the examination findings for each individual have been

“weighted” by the reciprocal of the probability

of seIecting the person. An adjustment for persons in the sample who were not examined and

a poststratified ratio adjustment were also made

so that the final sample estimates of population

size agree exactly with independent U.S. Bureau

of the Census estimates for the civilian noninstitutionalized population of the United States

as of November 1, 1972, by color, sex, and age.
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S.DEPARTMENT OF HEALTH, . p@lic Health SemEDUCATION, AND WELFARE Office of Health Research, Statistics. and Technology Number 48 ● April 13, 1979

1977 Summary:

National Ambulatory Medical Care Suweyl

During 1977 an estimated 570.0 miIlion

office visits—an average of 2.7 per person per

year–were made to nonfederally empIoyed,

office-based physicians in the conterminous

United States. These and other estimates presented in this report are based on data coIlected

in the National Ambulatory Medical Care Survey

(NAhIICS), a probability sample survey conducted yearly by the Division of Health Resources

Utilization Statistics of the National Center for

Health Statistics. The survey sample is selected,

with the cooperation of the American Medical

Association and American Osteopathic Association, from a list of nonfederally empIoyed doctors of medicine and osteopathy who are principality engaged in office-based practice. In its

cwn-ent scope, NAMCS excludes physicians practicing in AIaska and Hawaii and physicians

whose specialties are anesthesiology, pathology,”

or radiology.

Figure 1 is a facsimiIe of the 1977 Patient

Record used by participating physicians to

record information obtained during office visits,

and it may be useftd as a reference as selected

aspects of the survey findings are presented.

Caution should be exercised when comparing the 1977 NAMCS data with NAMCS data

from previous years. Amdysis of the 1977

summary data presented in this report and preliminaq anzdysis of more detailed data indicate

that the 1977 resuIts for most data items are

sindar to those in 1975 and 1976. In 1977,

however, several changes were made in the

Patient Record that affect comparability between survey years. In particular, items relating

lThis report was prepared by Trcna Ezzati and

Thomas McLcmore, Division of Health Resources Utilization Statistics.

to the patient’s referral status (item 5) and to

the time since onset of compIaint or symptom

(item 7) were added to the 1977 Patient Record.

Items relating to prior visit status (item 9) and

seriousness of condition (item 10), which in previous years referred to the patient’s reason for

visit, now refer to the physician’s diagnosis.

Diagnostic services (item 11) and therapeutic

semices (item 12) were previously incIuded together as a singIe item. In addition, there were a

number of changes to the categories listed in

items 11 and 12—e.g., “drug prescribed” (1975

and 1976 Patient Records) was changed in 1977

to “drugs (prescription/nonprescription).” In

addition to changes in the Patient Record, a new

classification was used to code the patient’s

complaints, symptoms, or other reasons for visit

(item 6); therefore, the reason for visit data are

not comparable with those of previous years.

Further discussion of these changes will be published in the Vital and Health Statistics series.

Since the estimates presented in this report

are based on a sample rather than on the entire

universe of office-based physicians, the data are

-subject to sampIing variability. The “TechnicaI

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 desiugnand

definitions of certain terms used in NA.MCShave

been pubIished.2

2~ation~ centerfor He~th statistic: The National

Ambulatoq Medical Care Survey, 1975 Summary, United States, Januq-December, 1975, by H. Koch and T.

McL.cmore. Vital and Health Statistics. Series 13-No. 33.

DHEW Pub. No. (PHS) 78-1784. Public Health Service.

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

1978.
2

Figure 1.1977 PATlENT RECORD

ASSURANCE OF CO NFIOENT!ALITY-AI1 l“lornn,mn Mel! -“w m.-,, ,-,hf,c.,,a? d MI ,..5,.,,Ju.,.

. w=,,-. 0? MI -u811*”u”, -,11 b9 kld UW?lM-6. I. -It M U- .“1, w w-”. .“w ,. md to,

il.. ou,.om! d ,“. SU-V snd WIII no, b. dhd.md 0? ,.(..- to .!.., --”, 0, “M b .“” o*” 0“,..”.

ID

I

TIME OF

VISIT

1.DATE OF VISIT PATlENT RECORD

*

NATIONAL AMBULATORY MEDICAL CARE SURVEY

2. CEA7EOFWH” 13. SEX 4. CQLOR OR I!j. WAS PATIENT I 5 PA71ENI% COMPUIN7(S). SYMP70M{SI. OR OTMER

RACE REFEIIREO FOR REASON(Si FoR TH Is VISIT

THIS VISIT SY

/

cls,h4A.E i:::::o, ;..;;:’::W”-’*’

ANOTHER

PHYSICIAN?

Mo< OaV, /Y, SLACK

I O MALE

1

, ❑ YES

I o OTHER

I

b. OTHER

4 ❑ UNKNOWN ~clluo

7. TI?AE SINCE ONSET 8. PHYSICIAN% LSIAGNOSES 9. HAVE YOU SEEN

OF coMPIAINTt

10, SERIOUSNESS Of

SYMPTOM IN ITEM b

PATIENT BE FORE7 CONDITION IN

. . Pnl NCIPAL OIAGNOS#S/?n OSLEM ASSOCIATED WITM

(Chuk m?.) ITEM 6.

ITEM & (CiwC&on,)

I ❑ YES lUNO

, Q LESS THAN 1 DAY

--i

t

I a VERY SERIOUS

IF YES. FOR THE

i a 1.6 0AV9

. ..— . . . ..— —— CONOITION IN

z O SERIOUS

b. OTlkEPl SIG?41PICANT CURRENT DIAGNOSES

, n 1.3w EEKS

ITEM 0.7 10 SLIGHTLY

SERIOUS

==’ ~ ‘“Y’S‘“”0

.❑ F40TsEelOUS

● n NOT APPLICABLE

11. OIAGNEISTIC SE flVICES THIS 12. TNERAPEUTtC SERVICES THIS I 13. ~~:::flwysl, 14. OURATION OF

VISIT (C/reck●t: OMwed or nrob’tid) VISIT (C/reck ,/1 ota.nd ., .SCOW4MI THIS vISIT

I Q NONE

Ir;nm #CN.lly

1 0 LtMITEO EXAM/WSTORY

spmt wth

I O acr.I~nAL EXAM) HISTORY

pivicim)

. 0 ,a? TEST

, 0 CLINICAL LA8 TEST

. n X.RAY

T O EKG

o n VISION TEST

. ❑ EP400SCOPY

,. ~ SLOOO ●nSSSUBE CHECX

8I O OTHER C%UIIY)

$ 0 NONE

* O lMMUWIZATIONI

DESENSITIZATION

I O OPTI.IG5lP*ESCRtPTIONt

NONPRESCRIPTION)

. a alET COUNSELING

I n FAMILY PMNNIN6

. ❑ ME OICAL COUNSELING

, a PMySl OTWERA*Y

. 0 OF flCE SURGERY

, 0 PSVCI’IOTHE RAPY/

THERAPEuTIC LISTENING

, . ~ OTHER &uc,/),)

‘ O NOFOLLOW-U* PNNCi O

‘ a RETURN AT SPECIFIED TIME

‘ a RETURN IF NE ED EO, P.R N.

“ Cl TELCPWONE fOLLOW.UP ●LANNED

s a REFEfl REo T007HEn ●!+VSICIAN

. ~ RETURP+EDTO RECERRING

●HYSICt AN

t Q AOMIT TO HOSPITAL

g a OTI’IER /*a*)

_ MINuTES

I [

!

— ~R&J&2

REV. 9-76

0SpAR7MEN7 of W6AL7H EOUcArlON ANO WC LFAfIE O.M.@. 86a.B 1498

W8L, CF!CALT” SE RV, CE

PIE AI. TH RESOURCES AOM,lW, STm. T,ON

NATIONAL CE”TER SOPI b4EALTw STATISTICS

-.

DATA HIGHLIGHTS proportion in nonmetropoIitan areas (24 percent).

Physician Characteristics

Approximately haif of the 570.0 million

office visits made during 1977 were to general

and famiIy practitioners and to internists (table

1). Vkits to pediatricians accounted for an additional 10 percent of all visits. The distribution of

visits according to the physician’s type of

practice shows that approximately 59 percent of

all visits were to solo practitioners and about 41

percent were to physicians engaged in a multiple

member practice. Table 1 also shows that the

proportion of visits to physicians’ offices in

metropolitan areas (76 percent) exceeded the

Patient Characteristics

The data in table 2 show that visits by white

persons accounted for approximately 90 percent

of alI office visits. The office visit rate for white

persons (2.8 visits per person per year) was significantly higher than the rate for aH other races

(2.0 visits per person per year).

The visit rate by age varied from a low of 2.0

visits per year for persons under 15 years of age

to a high of 4.1 visits per year for persons 65

years and over. Annual office visit rates by sex

and age show that the rate, in generaI, tends to
danadaa3

Table 2. Number,percent distriburiofl,and numberof office

visits per person per year, by race, age, sex and age: United

States, 1977

Table 1. Number and percent distribution of office visits, by

physician specialty and typeand location of practice: United

States, 1977

i

Percent

distribution

100.0

Number

of visits Percent

in .,

distri -

thousands bution

Number of

visits per

person

per year

Number of

Physician characteristic visits in

thousands Patient characteristic

Allvisits .......................\ 570,052

All visits ... ....... .... ....... 570,052 \ 100.0 2.7

2.8

2.0

2.0

2.2

2.7

3.3

4.1

3.2

Physician specialty

I

Race

General and family practice . ...

F

222,919

Medical specialties .................. 155,501

Internal medicine . ... ........... .. 64,959

Pediatrics ................. ............. 54.762

Other ..................... .. ........... .. 35,780

39.1

27.3 White .............. ................ .

All other races ...... ...... ... ..

514,788 90.3

55,264 9.7 11.4

9.6

6.3

29.5

Aae

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

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

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

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

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

103,756 18.2

85,761 15.0

146329 25.7

142,163 24.9

92,043 16.2

Surgical specialties ...... ...... ......

F

167,927

General surgery .................... 36,124

Obstetrics and gynecology .... 49,273

Other ................ .... ..... .......... 82,530

Other sp=ialties ................ ..... 23,705

psych iatry ..... ........ ...... ......... 16,197

Other ....... ... ............... ........ .. 7,506

6.3

8.6

14.5

4.2

Sex and arte

Female ........... .......... ...... 345,187 I 60.5

2.8

1.3

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

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

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

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

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

50228

56,055

97,450

84,241

57.212

8.8

9.8

17.1

14.8

10.0

2.0

2.8

3.4

3.7

4.4

2.2

2.1

1.5

1.8

2.8

3.8

Type of practice

S9io........................................ 335,261

Otherl . .......... .................. ....... 234,791

58.8

41.2

Male ..... ......................... . 224,865 I 39.5 &cation of practice

I

53,527 9.4

29,706 5.2

48,880 8.6

57,922 10.2

34,831 6.1

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

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

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

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

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

Metropolitan ............ ............... 434,739

Nonmetropoi itan ......... ........ ... 135,313

76.3

23.7

lIncludes partnership and group practices.

with an onset of Iess than 24 ho&., indicating

the nonemergency nature of most office visits.

An estimated 22 percent of the patient problems

had an onset of less than 1 week, and approximately 30 percent had an onset of 3 months or

more.

Prior visit status. –Approximately 8!5 percent

of the visits made to office-based physicians

were by patients who had seen the physician

before (old patients). Furthermore, the majority

of visits (60 percent) were made by old patients

with oId probIems, i.e., problems which had

been previously treated by the physician.

Reason for visit. –Information in item 6 of

the Patient Record (figure 1) represents the

reasons for visiting physicians’ offices as exincrease with age for both ma.Ies and females.

The visit rate for females exceeded the rate for

males in all but the youngest age group.

Visit Characteristics

TabIe 3 shows the number and percent distribution of office visits by patient’s prior visit

status, referral status, and time since onset of

complaint or symptom.

Referral status. –Information from item 5 of

the Patient Record reveals that approximately 5

percent of all visits were the result of referrals

from another physician. Approximately 26 percent of aII new patient visits were referrals.

Time since onset of compiaint or symptom.–

About A percent of all visits were for probIems
4

Table 3. Nutier and percent distribution of office visits, by

patient’s referral status, time since onset of complaint or

symptom, and patient’sprior visit status: United States, 1977

Visit characteristic

All visits ..... .................!

Referral status

Referred by another

physician ..............................

Not referred by another

physician ............. .................

Time since onset of

complaint or symptom

Less than 1 day ............... .......

1-6 days ................................ .

1-3 weeks .. ...... .......................

1-3 months ........................ ... .

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

Nut applicabl~ ......................

Prior visit status

New patient ...........................4

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

New problem ....................

Old problem .... ..................

Number of

visits in

thousands

670,052

28,412

541,640

23,405

127,084

78,716

67,107

169,682

104,068

87,230

482,822

142,037

340,785

Percent

distribution

100.0

5.0

95.0

4.1

22.3

13.8

11.8

28.8

18.3

15.3

84.7

24.9

58.8

llncludes chiefly visits not involvinga symmom or Comdaint,

e.g.. annm] examination, well-baby ex~~ati&.

pressed by patients in their own words. These

data have been classified and coded according to

the Reason for Visit Classification for Ambulatory Care (RVC), which was used for the

first time during the 1977 NAMCS. The RVC

utilizes a moduIar structure with the following

moduIes:

(1) symptom,

(2) disease,

(3) diagnostic, screening, and preventive,

(4) treatment,

(5) injuries and adverse effects,

(6) test results, and

(7) administrative.

Dhcussion of the development of the RVC

and a detailed description of the seven modules

have been published in Series 2, No. 78 of P’itaf

and Health Statistics. 3 Table 4 presents data on

the patient’s principal reason for visit, i.e.,

problems or complaints listed first in item 6 of

the Patient Record.

Principal diagnosis. –Table 5 presents the

number amd percent distribution of office visits

according to the physician’s principal diagnosis.

This diagnosis refers to the one listed first in

item 8 of the Patient Record. The diagnostic

data in table 5 are grouped by the major classifications of the Eighth Revision Intema tionai

Classification of Diseases Adap ted for Use in the

United States (ICDA).q The ICDA category

SpeciaI conditions and examinations without illness accounted for the largest proportion of

visits (17 percent), and diseases of the respiratory, circulatory, and nervous systems accounted for approximately one-third of all visits.

Diagnostic and therapeutic services. —

Information on various types of diagnostic and

therapeutic services that may be ordered or provided during a visit is presented in table 6. A

limited history or examination was the most frequent diagnostic service ordered or provided (56

percent), and blood pressure checks were the

second most frequent diagnostic service ordered

or provided (34 percent). A Pap test was ordered

or provided during about 5 percent of alI visits;

however, this test was ordered or provided for

about 9 percent of the visitsby women. Among

the therapeutic services, a prescription or nonprescription drug was ordered or provided

during about 54 percent of the visits. Once again

caution should be exercised when comparing

this estimate with estimates from previous survey years due to changes in the 1977 Patient

Record.

Seriousness of condition .-TabIe 7 presents

information on the physician’s judgment of the

seriousness of the patient’s probIem in terms of

3 Nation~ center for He~th stati~ti~s: A re~~n for

visit classification for ambulatory care, by D. Schneider,

L. Appleton, and T. McLcmore. Vital and HeaIth StatLrtics. Series 2-No. 78. DHEW Pub. No. (PHS)79-1352.

Public Heatth Service. Washington. U.S. Government

Printing Office, Feb. 1979.

4Nationa.1 Center for Health Statistics: Eighth Revtiion In terruztionai Classification of Diseases, Adapted

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

Health SCMCC. Washington. U.S. Government Printing

Office, 1967.
aknceda5

Table 4. Number and percent distribution of office visits, by the patient’s principal reason for visit and RVC code: United States, 1977

Principal reason for visit and RVC codel

All reesons for visit ....................................................................................................................

Symptom module .............................................................................................................. S001 -S999

General symptoms ........................................................................................................... S001 -S099

Symptoms referable to psychological and mental disorders............................................. S100-s1 99

Symptoms referable to the nervous system (excluding senseorgans)............................... S200-S259

Symptoms refemble tothe@rdiow*ular andlymphatic w=ems ................................... S260-S299

Wwtomsreferable totheeyes andears ......................................................................... S300-S399

Symptoms referable tothe respiratory system................................................................. S400-S499

Symptoms referable tothedigestive sy=em .................................................................... S500S639

Symptoms referable totheganitourinaw wstem ............................................................ S640-S829

Symptoms referable to the skin, nails, and hair ............................................................... S830-S899

Symptoms referable tothemusculoskeletal system......................................................... SWXH999

.,

Disease module ..................................................................................................................‘0001-0999 .

Diagnostic, screening, and preventive module .................................................................. X1 OO-X599

Treatment module ............................................................................................................. T100-T899

Injuries and adverse effacts module ................................................................................... JOO1-X389

Teat results modula ................................................... ...................................................... R1OO-R7OO

Administrative module .......................................................... ......................................... A1OGA14O

Dthe? ............................................................................................................................. U980-U898

Number of

visits in

thousands

570.052

318,649

43.734

15s37

19,250

3,580

31,639

62,140

27,642

31,478

30,501

53,548

53,478

104,445

48,409

24,952

2,615

10,403

6,902

Percent

distribution

100.0

55.9

7.7

2.7

3.4

0.6

5.5

10.9

4.9

5.5

5.4

9.4

9.4

18.3

8.5

4.4

0.5

1.8

1.2

1Re=on for “i~it ~oup5 and codes are based on A Reason for visit Cb.rifican”on for Ambubtov Care.

Zincludes blanks; problems and complainq not elsewhere classified; CSItSkS Of “IIOIW” and illegibk entries.

Table 5. Number and percent distribution of office visits, by principal diagnoses and ICDA code: Unitad States, 1977

Principal diagnosis and ICDA codel

-- .

All diagnosas................................................................................................................ ..............

hsfactiw and parasitic diwas= ............................................................................................... 000-136

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

Endocrine, nutritional, and matabolic diseases....................................................................... 240-279

Mental disorders ..................................................................................................................... 290-315

Diseasesof the nervous system and sense organs .......... ...... .............................. .... ........ ...... .... 320-389

Diseasesof the circulatory system .......................................................................................... 380458

Diseasesof the respiratory system .......................................................................................... 460-519

Diseasesof the digestive system............................................................................................. 520-577

Diseasesof the genitourinary system .................................................................................... 580-629

Diseasesof the skin and subcutaneous tissue ........................................................................ 680-709

Diseasesof the musculoskeletal system .................................................................................. 710-738

Symptoms and illdefinad conditions ......................................................................................780-796

Accidants, poisonings, and violence ........................................................................................8~9W

Special conditions and examinations Whout sickness...........................................................YoGYl 3

All other diagno~s2 .............................................................................................................................

Number of

visits in

thousands

570,052

22,668

14,286

24,287

24,522

48,281

54,702

82,466

18,451

36,473

31,910

32,983

25,695

43,761

96,009

13,550

Percent

distribution

100.0

4.0

2.5

4.3

4.3

8.5

9.6

14.5

3.2

6.4

5.6

5.8

4,5

7.7

16.8

2.4 .

1 Diagnostic gSOUPS and corks are based on Eighth Rew”ss-onIrrreman’onal Ckun”ficarfcm of Dixases, .-Mapred for v= in the fJnfted

Stares, ICDA.

21ncludes 2go.289, diseases of the blood and blood.forming organs; 630-678, complications of Pre8nancY. childbirth, and ‘he

puerperium; 740-759, congenital anomalies; 760-779, certain causes of perinatal morbidity and mortality; blank diagnosis; noncodable

diagnosis; and illegible diagnosis.
6

Table 6. Nurr@er and percent of office visits, by diagnotic and

therapeutic servicesordered or provided: Unitad States, 1977

Diagnostic services

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

IJmitad examination or

history .................................

Genesal examination or

historj ................................!

Pep test.................................

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

x-ray .....................................

Etactrocardiogram .................

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

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

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

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

Thetacrautic services

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

Immunization or

desensitization .....................

Drugs (prescription or

nonprescription )..................

Diet counseling........‘..............

l%mily planning.....................

Medical cout-meting................

physiotherapy ........................

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

Psychotherapy or therapeutic

listening...............................

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

68,301

321,040

127,515

30,620

122,013

44,662

17,333

23,045

6,945

193,888

25,010

108,077

37,576

305,607

39,197

8,372

117,157

18,584

45,028

30,589

15,624

Percent of

visit

Table 7. Nutier as-d percent distribution of office visits, by

seriousness of cocdition, and disposition and duration of

visits: Unitad States, 1977

Visit chamcteristic

All visits.......................

12.0

56.3

22.4

5.4

21.4

7.8

3.0

4.0

1.2

34.0

4.4

19.1

6.6

53.6

6.9

1.5

2Q.6

3,3

7.9

5.4

2.7

the extent of impairment that might result if no

care were available. Fifty-one percent of all visits

involved conditions considered “not serious,”

while less than 1 in every 5 visits invoIved conditions categorized as “serious” or “very

serious. ” A large proportion of the “not serious”

visits were for routine prenatal care, immunizations, routine eye examinations, periodic

checkups, and other types of preventive health

care.

Dtiposition of visit.–Data on disposition

show that the majority of office visits involved

seriousness of condition

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

Slightly serious.......................

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

Disposition of visitl

No followup ..........................

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

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

Telephone follovmp planned..

Referred to other physician ....

Returned to referring

physician ..............................

Admit to hopsital ......... .........

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

Duration of visit

O minutee2 .............................

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

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

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

16.30 minutes........................

31 minutes or more. ...............

Nurrbar of

visits in

thousands

570,052

104,118

175,252

290,682

63,546

346,374

129,020

17,961

14,423

4,650

11,085

7,128

13,038

83,263

170,787

152,860

116,961

33,143

Percent

distribution

100.0

18.3”

30.7

51.0

11.2

60.8

22.6

3.2

2.5

0.8

2.0

1.3

2.3

14.6

30.0

26.8

20.5

5.8

1 Does not add to 1I)o.o since more than one disposition WS

possible.

2Repre~nts Wits in which there ws no face-to-face contact

between the patient and the physician.

some type of scheduled foIlowup. At about 61

percent of the visits the patient was advised to

return at a specified time, while at 2 percent

admission to a hospital was the result (table 7).

Duration of visit. -Duration of visit

represents ordy that amount of time spent by

the patient in face-to-face contact with the

physician. About 47 percent of the visits had a

duration of 10 minutes or less. The mean duration of aIl visits was 15.4 minutes (table 7).
dwlcdaa7

TECHNICAL NOTES

SOURCE OF DATA: The information presented

in this report is based on data collected in the

Nat ionrd Ambulatory Medical Care Survey

(NANICS) during 1977. The target population of

NAMCS encompasses office visits within the

conterminous United States made by ambulatory patients to physicians who are principally

engaged in office practice. The National Opinion

Research Center, under contract to the National

Center for Health Statistics, was responsible for

the survey’s field operations.

SAMPLE DESIGN: The NA31CS utilizes a multistage probability design that involves samples of

primary sampling units (PSU’S), physician practices within PSU’S, and patient visits within

practices. For 1977 a sample of 3,000 nonFederal office-based physicians was selected

from master fdes maintained by the American

Medical Association and American Osteopathic

Association. The physician response rate for

1977 was 77.5 percent. Sampled physicians were

requested to complete Patient Records (figure 1)

for a systematic random sample of office visits

taking pIace within their practice during a randomly assigned weekly reporting period. During

1977, 51,044 Patient Records were completed

by sampIed physicians.

SAMPLING ERRORS: The standard emor is primarily a measure of the sampling variability that

occurs by chance because ordy a sample, rather

than the entire universe, is surveyed. The relative

standard error of an estimate is obtained by dhiding 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 table I. The

standard errors appropriate for estimated percentages of visits are shown in table II.

ROUND ING OF NUMBERS: Estimates of

office visits have been rounded to the nearest

thousand. For this reason detaiIed figures within

tables do not always add to totals. Percents were

cakxdated on the basis of origird, unrounded

figures and w-W not necessady agree precisely

with percents which might be calculated from

rounded data.

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

services who is neither bedridden nor currentIy

admitted to any health care institution on the

premises.

Table L Approximate reletiw msndard errors of estimated

nuder of office visits, NAMC.S 1977

I

&imated nutier of offiie

visits in thousands

Relative

standard

error in

parant

..... .. .. . ......... ... ......... ........ ................. ......... 28.0

......... ............. ..................... ............. ... .... .... 26.5

.................... ........ ....... .......... ............ ......... 20.7

;Eo ..................... ................................................ 14.9

5.m .... ..... ..... .................................... .................... 9.9

1o.ooo ............ ...... .................................................. 7.6

20,000.................................................................... 6.1

m.mo .................................................................... 4.9

100,0QO.................................................................. 4.5

so.om .................................................................. 4.1

Example of rue of table: An aggregate estimate of 7S,000,000

viaita has a relative standard error of 4.7 percent or a standard

error of 3, S25,000 visits (4.7 percent of 7S,000,000).

Table IL Approxinnte standard errors of percentages of estimated

number of office visits, NAMC3 1977

6ese of percentage

(nurrber of visits

in thousands)

&imetad percentage

1 or 5 or 10or 20 or 30or

~ 95 80 m 70 w

Standard error in percentage points

29

2.6

2.0

1.4

0.9

0.6

0.5

0.3

0.2

0.1

5(X3 .........................”.

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

1,Ouo .........................

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

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

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

20,ctoo.......................

50,00a ..... .... .......... .

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

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

E%zmpla of rue of table: An estimate of 30 percent based on an

assresete of I S, OQ0,000nsits has a standard error of 2.s percent.

The relative standard error of 30 percent is 8.3 percent (2.S parcent + 30 percent).

L

6.3 6.6 11.5

5.7 7.9 10.5

4.4 6.1 8.1

3.1 4.3 5.7

2.0 2.7 3.6

1.4 1.9 2.6

1.0 1.4 1.8

0.6 0.9 1.1

0.4 0.6 O.%

0.2 0.3 0.4

13.2

12.0

9.3

6.6

4.2

2.9

21

1.3

0.9

0.4

14.4

13.1

10.2

7.2

4.5

3.2

2.3

1.4

t .0

0.5

An office is a place that the physician identifies

as a location for his ambulatory practice. Responsibility over time for patient care and professional services rendered there generally resides

with the individual physician rather than an institution.

A virit is a direct personal exchange between an

ambulatory patient and a physician or a staff

member working under the physician’s supervision for the purpose of seeking care and rendering health services.
8

A p hysz”cizn is a duly licensed doctor of

medicine (M. D.) or doctor of osteopathy (D. O.)

currentIy in office-based practice who spends

time in caring for ambulatory patients. ExcIuded

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.

SYMBOLS

Data not available—-. .-.

Category not applicable— ——. . .

Quantity zero .

Quantity more than Obut less t.hm 0.05— 0.0

Figure does not meet standards of

reliability or precision *
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STA TISTCS

U.S. DEPARTMENT OF HEALTH, . public Health semiEDUCATION, AND WELFARE Office of Health Research, Statistics, and Technolow Number 49 ● April 16, 1979

Office Visits for Family Planning, National Ambulatory

Medical Care Survey: United States, 1977’

According to data collected in the National

Ambulatory Medical Care Survey (NAMCS), an

estimated 11 milIion visits to office-based physicians incIuded a family planning service, either

as one of the stated purposes of the visit or as an

adjunct service. when patients visited for other

problems.

The NAMCS isa sampIe survey conducted annually by the Division of Health Resources Utilization Statistics in the National Center for Health

Statistics. The estimates in this report arebased on

information recorded by participating physicians

on brief encounter forms (Patient Record, see Advance Data No. 48, April 13, 1979) during sample

ofKlce visits. A brief description of the sample design and an explanation of the sampling errors

associated with selected aggregate statistics may

be found in the Technical Notes of this report.

Data on farniIy planning services are also reported from the National Survey of FamiIy

Growth (NSFG), based on a sample of currently

married women between the ages of 15 to 44

years, with a family planning visit in the last 3

years; and by the National Reporting System for

Family Planning Services (NRS FPS), bzsed on

reports by a sampIe of organized family planning

senice sites.2*3Because of the differences in the

lThk report was prepared by BeuIah K. Cypress,

Ph.D., Division of Health Resources Utilization Statistics.

‘National Center for Health Statistics: Use of

farniIy planning services by currently married women

15+4 years of age, United States, 1973 and 1976, by

G.E. Hendershot. Advance Data j%om Vital and Health

~t4tiStiCS, No. 45. DHEW Pub. No. (PHS) 79-1250.

Public Health Service. Hyattsville, Md. Feb. 7, 1979.

3Nation~ Center for Health Statistics, prOviSiOn~

Data from the National Reporting System for FamilY

Planning Services, January 1976-December 1976,

(mimeo).

populations sampled, and differences in the

definitions and collection procedures, statistics

on family planning visits from these several data

systems differ. According to NSFG statistics for

1976, an estimated 11,153,000 women in the

age range 15-44 years had visited their own physician within :he last 3 years for family planning

services. Provisional data from NRSFPS for

1976 indicated about 5,427,000 visits by

women of alI ages to organized family planning

cIinics.

In NAMCS, patients’ principal probIems,

compkints, or other reasons for visit, expressed

as nearIy as possible in the patient’s own words,

are recorded by the physician on the Patient Record. From 1973 to 1976 these reasons for visit

were coded according to a symptom classification deveIoped for use at the inception of the

survey! However, this classification scheme did

not provide much detail in the area of famiIy

pk-ming. The opportunity to obtain more complete information was presented by the 1977

revision of the classification.5 The new taxonomy delineated, among other presenting

patient probIems and compkiint.s, the most

commonly presented types of famiIy pIanning

reasons for visiting physicians given by patients.

4National Center for Health Statistics: The National AmbuIato~ Medical Care Survey: Symptom

classification, by S. Meads and T. McLemore. Vital and

Health Statistics. Series 2-No. 63. DHEW Pub. I’Jo.

(HRA) 74-1337. Health Resources Administration.

Washington. U.S. Government Printing Office, May

1974.

5National Center for Heslth Statistics: A reason

for vuit da.reification for ambulatory care, by D.

Schneider, L. .4pp1eton, and T. McLemore. Vital and

Health Statistics. Series 2-No- 78. DHEW pub. No.

(PHS) 79-1352. Public Health Service. Washington.

U.S. Government Printing Office. In press.
2

This permitted a cIearer identification of family

planning visits than was possible in earlier national sunreys of ambulatory care in physicians’

offices. Also in 1977 for the first time,’’family

pkmning” was included in the therapeutic

services listed on the Patient Record.

In NAMCS, a family planning therapeutic

semice is defined as services, counseling, or

advice which might enable patients to determine

the number and spacing of their chddren. It includes both contraception and infertility services. Information from this item was used to

estimate the number of visits which included

farniIy planning services even though the physician did not record that as the patient’s reason

for visiting the physician.

In about half of the 11 million family planning visits patients expressed a reason for visiting

the physician which was related to family planning. In the other half, reasons other than farniIy

planning were given but, in addition to other

medicaI care, some kind of family planning

therapeutic service was rendered during the visit

(table 1). It is not known whether some patients

were reluctant to say that family phmning was

their reason for the visit or whether the subject,

Table 1. Number and percent distribution of office visits for

family planning with a family planning reason for visit or with

a family planning therapeutic sewice included, by patient age

and sex: united States, 1977

I Family planninq vi.wts

Age and sex Reason for

visit

stated

Therapeutic

sewice

included

Total . . . . . . . 5,662 ] 5,341

& Percent distribution

Alleges . . . . .

I

100.0 I 100.0

15-19 years . . . . . 11.6

20-34 years . . . . . 76.3

3544year5 . . . . . 10.0

45 years and over . . “2.0

Female . . . . . . . . 90.8

Male . . . . . . . . . 9.2

10.1

68.8

10.2

10.8

94.9

5.1

possibly related to the presenting probIem, arose

during the course of the visit. But for the purpose of estimating the extent of utilization of

private physicians for family planning services,

these encounters were considered “family planning” visits.

It was postulated that teenagers might be

less inclined thzm older patients to cite family

planning as a reason for going to the physician’s

office. Apparently this was not the case since

differences between the proportions of teenagers’ visits in which they cited a reason and

those in which they simply received a service

were not statisticaHy significant. On the other

hand, patients 45 years and over were less likeIy

to give than not give family pkmning as a reason

when they received a family pkuming service

during the visit. This may or may not indicate

that for this group of patients family pIanning

was probably incidental to their purpose in

visiting the physician.

PATIENT SEX, RACE, AND AGE

The ratio of about 13 visits by women to

one visit by men was not unexpected (table 2).

However, the fact that about 791,000 fa.ndy

pkrming visits to physicians were made by men

provides a new perspective on the traditionally

female-oriented approach to discussion of family

pkuming visits. Because of the paucity of data

on family pkmning visits by men, most published reports have dealt exclusively with visits

by women. Unpublished data from NRSFPS

reveaI only about 39,000 visits by men in some

4,800 &ganized family pkmning service sites

during 1976.3 While the NAMCS visit rate of

about 10 visits by men for each 1,000 males

over 15 years in the population is quite low

compared to that of females (about 122 per

1,000), this may mark the beginning of a trend

and bears scrutiny in the future.

Available data sources indicate that white

patients tend to visit private physicians for family planning services at a higher rate than black

patients, while black ,patients visit organized

family planning clinics at a higher rate than

white patients do. Of the white female respondents in NSFG with a family planning visit

in the last 3 years, 86 percent reported visiting

a private physician; but only 63 percent of the
dacedda3

Table 2. Number, percent distribution. and rate of office visits

for famiW Plannin9, by Patient $ex, race, and age: United

States, 1977

Sex, race, and age

Total . . . . . . .

—Sex

Female . . . . . . . .

Male . . . . . . . . .

Race

White . . . . . . . . .

Black and all

other . . . . . . . .

Age

15-19 years . . . . .

20-34 years . . . . .

35-44 years . . . . .

45 years and over . .

Number Percent

in

thoudistribution

sands

I

I

10,213 92.8

791 7.2

9,998 90.9

1,006 9.1

1,199 10.9

8,000 72.7

1,110 10.1

695 6.3

Visit tate

1,r%

are higher when calculated for women only. A

forthcoming series report on “Office Visits by

Women” w-N include famiIy @arming data for

these groups.)

GEOGRAPHIC DISTRIBUTION

68;9

121.6

10.5

71.3

51.8

57.1

168.9

48.4

10.6

1B=ed on the civilia non institutionalized r)OPUhtiOn 15

yearn and over.

black respondents reported the location as the

physician’s office.z On the other hand, organized family planning cIinics which reported to

NRSFPS showed an enrollment rate of roughIy

144 per 1,000 black women 15-44 years of age

in the population, compared tith only about 44

per 1,000 white women of the same ages The

NAIvICS data also discIosed a differing utilization pattern by race with white women visiting

at a rate of 71 per 1,000, compared with 52 per

1,000 black and other women. The reader

should note that the NAMCS visit rate incIudes

initiaI and return visits, some of which may be

by the same patient; but the NRS FPS enrollment rate is based on an undupIicated count of

patients.

Most family planning visits to office-based

physicians were made by patients of both sexes

in the age range 20-34 years (73 percent), representing an average of about 159 visits for each

1,000 persons of that age in the United States

(takde 2). Patients aged 15-19 years accounted

for about 11 percent of the totaI with a visit rate

of about 57 per 1,000. (Visit rates by age groups

Proportions of family planning visits did not

differ significantly among the four geographic

re<gions when sampling variability was taken into

account (table 3), approximating the regional

proportions of all NAMCS visits. SimilarIy, visits

in metropolitan areas exceeded those in nonmetropoIitan areas, reflecting the high concentration of physicians’ offices in metropolitan

areas.

Table 3. Number, percent distribution, and rate of office visits

for famify planning, by geographic region and metropolitan

or nonmetropolitan area: United States, 1977

Region and area

Total . . . . . . .

Region

Northeast . . . . . .

Notih Central . . . .

South . . . . . . . . .

West . . . . . . . . .

Area

Metropolitan. . . . .

Nonmetropolitan . .

Number

in

thousands

11,003

2,589

2,485

3,553

2,377

9,019

1,984

Percent

distribution

100.0

23.5

22.6

32.3

21.6

82.0

18.0

Rate

per

1,000’

68.9

70.6

58.0

68.1

85.0

82.7

39,2

PHYSICIAN SPECIALITY

Most family planning visits (65 percent) occurred in the offices of obstetrician-gynccologists, with an additional 26 percent made to

general and family practitioners (GFP) (table 4).

NfaIe patients chiefly visited GFP’s and urologists. The patient’s age did not appear to make

a difference in the choice of physician by specialty.
4

Table 4. Number and percent distribution of office visits for family planning by most visited physician specialty, according to oatient

Age and sex I

Aliases . . . . .

Age —

15-19 years , . . . .

20-34 years , . . . .

3544 yaars . . . . .

45 years and

over . . . . . . . . .

Sex

Female . . . . . . . .

Male . . . . . . . . .

age and sex: United States, 1977

Number

in

thousands

11,003

1,199

8,000

1,110

695

10,213

791

Total

100.0

100.0

100,0

100.0

100.0

100.0

100.0

Physician specialty

General

and Obstetrics Urological

family and

gynecology

surgery

practice

25.8 64.8 3.1

Percent distribution

37.5

23.1

‘28.0

●32.7

24.8

●38.3

58.5

69.3

●58.8

●32.6

69.8

0.0

●3.5

‘4,6

●T.6

● 0.1

●42.O

All

other

special ities

6.3

“ 4.0

● 3.0

8,6

●33.1

● 5.3

‘19.7

PATI ENT’S REASON

FOR VISIT

ably, it was obsemed that teenagers were proportionately more likely to visit for contraceptive medication than” they were for a conAbout 93 percent of the 5.7 million visits traceptive device.)

by patients who specificaHy stated they were Surgical sterilization of patients of both

visiting for farniIy planning or related reasons sexes was performed during the visits for a relfeI.I chiefly in three major groups: those who ativeIy small number of patients. Of the estivisited for counseling, examinations, and general mated 240,000 such visits, about 80 percent

advice; those who required insertion, removzd, were for vasectomies. Patients electing sterilor checkup of contraceptive devices; and those ization ranged from 20 to 44 years of age.

who visited for the prescription or renewaI of Patients who visited seeking abortions ~r

contraceptive medication (table 5). (Predict- or whom abortions were performed during

Table 5. Number and parcent distribution of office visits with a familY Plannin9 mason for visit bY ~=on cete90W: United Statesr 1977

Reeson category and NAMCS code~

Number in ParCent

thousands distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,662 100.0

Family planning, N.0.S.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X500 2,085 36.8

Contraceptive device3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X51O 1,604 28.3

Contraceptive medication . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. X505 1,569 27.7

Otherreasons forvisit4. . . . . . . . . . . . . . . . . . . X515,X520,X525.X530 405 7.1

lBased on a reason for visit classification developed for use in NAMCS (see reference 5).

21ncludes counseling, Cxaminationa, and genera! advice regarding; birth control, N.O.S.; unwanted Prei?nancY: contmcePtive> N. CI-S.;

sterilization; infertility: genetics; contraception followup, N.O.S.

31nc]ude~ IUD insertion, removal, or checkup; diaphragm insertion. removal, or checkuP.

4[nc[ude~ ewluation for and arrangement for abortion, wants abortion, sterilization (this tisit), abortion (this ‘isit), and artificial

insemination.

NOTE: N.O.S. = not otherwise specified.
damdata5

Table 6. Number and percent distribution of office visits which included a famiW Plannin9 the~pmtic sewice but not a familY Plannin9

reason for visit, by most common principal reason for visie United States. 1977

Principal reason for visit and NAMCS codel Number in Percent

thousands distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,341 100.0

Gynecological examination . . . . . . . . . . . . . . . . . . . . . . . . . . .. X225 864 18.1

Postpartum examination . . . . . . . . . . . . . . . . . . . . . . . . . . . ... x215 902 16.9

Prenatal examination, routine.. . . . . . . . . . . . . . . . . . . . . . . .. -x205 787 14.7

Symptoms referable to the genitourinary system . . . . . . . . . . . . . S640-S829 668 12.5

Pap smear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X365 ● 336 6.3

Another reasons forvisit . . . . . . . . . . . . . . . . . . . . . . . . . . ..resldual 1,684 31.5

lBased on a reason for visit ckissification developed for use in NAMCS (see reference 5).

the visit were relatively rare in physicians’

offices.

It was posited that for the 5.3 million visits

in which patients received a family planning

therapeutic sewice without having directly

expressed farniIy planning as their reason for

visit, the primary reasons would cover the

broad array of problems usually found in office

medicaI practice (e.g., respiratory or circtdatory

problems). However, those visits were mo~e

likely to be associated with reasons involving

certain examinations and care of genitourinary

problems than they were with reasons related

to other problems. The types of care sought by

patients who also received family planning therapeutic services are listed in table 6. It is of interest to note that 15 percent of these visits

were for routine prenatal examinations and 17

percent for postpartum examinations, indicating

that family pkmning was Iikely to be a consideration both during pregnancy and following

delivery.

DIAGNOSTIC AND

THERAPEUTIC SERVICES

Compared to NAMCS visits for all reasons,

patients visiting for family planning received

proportionately more Pap tests, blood pressure

checks, clinical laboratory tests, and general

examinations (table 7).

The rate of Pap tests performed during family planning visits in physicians’ offices (about

46 percent) was similar to that of the organized

famiIy planning clinics measured by NRSFPS.3

However, bIood pressure checks were proportionately more frequent during clinic visits

(about 78 percent) than they were during

physician visits estimated in NAMCS (about 58

percent).

Patient age was hpparentIy not a determining

factor in the physician’s provision of services,

since for each service shown in table 7 the differTable 7. Number of NAMCS visits and number and percent of

family planning office visits for patients 15 years and over,

by most common diagnostic and therapeutic service: United

Statesr 1977

Most common diagnotic and

therapeutic arrrviw

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

Limited examination and/or history . .

Ganeral examination and/or history . .

Paptest . . . . . . . . . . . . . . . . . . .

Clinical laboratory test. . . . . . . . . .

Blood preaaura check . . . . . . . . . . .

Drugs (prescription and

nonprescription). . . . . . . . . . . . .

Dietcounsaling . . . . . . . . . . . . . .

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

466296 11,003

Percent of visits

57.6

20.2

6.5

22.4

40.0

54.5

2:::

49.5

36.2

45.8

33.8

58.2

42.8

7.7

22.1
6

ences in the proportions by age were not statis- than when a contraceptive device was involved

tically significant. However, the patient’s reason (tabIe 8). However, Pap tests are usually perfor visit may have influenced the use of some formed at a visit prior to the insertion of a conservices during some visits. General examina- tiaceptive device and, thus, such tests may have

tions, Pap tests, and clinical laboratory tests been included in a visit with a different reason.

were proportionately more frequent when Differences in the proportions of other services

patients visited for contraceptive medication were not statistically significant.

Table 8. Number and percent of visits for contraceptive medication and for contraceptive device, by selected diagnostic sanfices: United

states, 1977

Diagnostic service

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

Limited examination and/or history

General examination and/or history

Pap test . . . . . . . . . . . . . . . . .

Clinical laboratory test. . . . . . . .

Blood cwessurechack. . . . . . . . .

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

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

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

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

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

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

1,s9 1,604

Percent of visits

49.1 66.3

37.4 ●14.6

66.8 ‘24.0

36.0 ●14.4

579 36.6

SYMBOLS

Data not available . . .

Category not appIicabk . . .

Quantit~y zero .

Quantity more than O but less than 0.05— 0.0

Figure does not meet standards of

reliabtiity or precision *
adKmecw7

TECHNICAL NOTES

SOURCE OF DATA: The information presented

in this report is based on data coIlected in the

National Arnbulatory Medical Care Survey

(NAMCS) during 1977. The target population of

NAMCS encompasses office visits within the

conterminous United States made by ambulatory patients to physicians who are principality

engaged in office practice. The NationaI Opinion

Research Center, under contract to the National

Center for Health Statistics, was the organization responsible for the survey’s field operations.

SAIIIPLE DESIGN: N.NICS utilizes a multistage

probability design that involves samples of pnmmy sampling units (PSU’S), physician practices

within PSU’S, and patient visits within practices.

For 1977 a sample of 3,000 non-Federal officebased physicians was seIected from master files

maintained by the American Medical Association and American Osteopathic Association. The

physician response rate for 1977 was 77.5 percent. SampIe physicians were requested to complete Patient Records (brief encounter forms)

for a systematic random sampIe of office visits

taking pIace within their practice during a

randomly assigned weekly reporting period.

During 1977, 51,044 Patient Records were completed by sample 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 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. Relative standard

errors of selected aggregate statistics are shown

in table I. The standard errors appropriate for

estimates percentages of visits are shown in

table II.

DEFINITIONS: An mnbdatory patient is an

individual presenting himself for personal health

services who is neither bedridden nor currently

admitted to any health care institution on the

premises.

An ojjice is a place that the physician

identifies as a location for his ambulatory practice. Responsibility over time for patient care

and pro fessiord sewices rendered there generalIy resides with the individual physician, rather

than an institution.

Table 1. Approximate relative standard error of estimated number of office visits, NAMCS 1977

Estimated nutier of office Relative standard

visits in thousands . error in percent

5.mo ................m... ....................." ..............

lo.wo .........................M.................... .........

m*ooo .........................................................

50.000 .........................................................

1oo.ooo .......................................................

5oo.ooo .......................................................

28.0

26.5

20.7

14.9

9.9

7.6

6.1

4.9

4.5

4.1

Example of use of table: An aggregate estimate of 75,000,000

visits has a relative standard error of 4.7 percent or a standard

error of 3,525,000 visits (4.7 percent of 75,000,000).

Table IL Approximate standard errors of percentages of estimated

nuder of office visits, NAMCS 1977

6asa of percentage Gtimated percentage

number of visits 1 Or 5 or lOor 20 or 30 or ~ in thousands

99 95 80 80 70

I Standard error in percentage points

500 .............................. 2.9

600.............................. 2.6

1,00f3....... ................... 2.0

2,000 ........................... 1.4

6,000 ........................... 0.9

10,000 ........................ 0.6

20,000 ......................... 0.5

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

1Oo,oofl....................... 0.2

500,000 ...................... 0.1 1

6.3 8.6 11.5

5.7 7.9 10.5

4.4 6.1 8.1

3.1 4.3 “ 5.7

2.0 27 3.6

1.4 1.9 26

1.0 1.4 1.8

0.6 0.9 1.1

0.4 0.6 0.8

0.2 0.3 0.4 1

13.2 14.4

12.0 13.1

9.3 10.2

6.6 7.2

4.2 4.5

2.9 3.2

2.1 2.3

1.3 1.4

0.9 1.0

0.4 0.5

—Example of use of tabk: An estimate of 30 percent based on

an aggregate of 15,000,000 visits has a standard error of 2.5 percent. The reIative stm-idard error of 30 percent is 8.3 percent (2.5

percent + 30 percent).

A visit is a direct personaI exchange between

an ambulatory patient and a physician or a staff

member working under the physician’s supervision for the purpose of seeking care and rendering heaIth services.

A physician is a duly Iicensed doctor of

medicine (M.D.) or doctor of ostepathy (D.O.)

currentIy in office-based practice who spends

time in caring for ambulatory patients. Excluded

from NAMCS are physicians who are hospitaI

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

U.S.DEPARTMENT OF HEALTH, ● public Health Service

EDUCATION, AND WELFARE Office of Health Research, Statistics, and Technology Number 50 ● .kdy 23,1979

Office Visits by Black Patients, National

Medical Care Survey: United States,

Ambulatory

1975-761

Presented in this report are data about the

estimated 90.5 million office visits made by

black ambulatory patients over the 2-year span

from January 1975 through December 1976.

The data, which are contrasted with corresponding data for the overall visit universe, are based

on the findings of the National Ambulatory

Medical Care Survey (NAMCS). The NAMCS is a

continuing sample survey conducted annually by

the Division of Health Resources Utilization Statistics of the National Center for Health Statistics. The survey-national in range except for

Alaska and Hawaii–is designed to explore the

provision and utilization of ambulatory care in

the offices of non-FederaI, office-based physicians.

Figure 1 is a facsimile of the Patient Record

used by participating physicians to record information about their office visits. The reader may

find it useful to refer to figure 1 as selected

survey findings are presented.

DATA HIGHLIGHTS

General Perspective

During 1975 and 1976, the physician’s

office was the setting for an estimated

90,483,499 visits by black patients, about 7.8

percent of the total 1,155,900,228 office visits

made by ambtdatory patients of all races. This

represented an average annual visit rate of 1.9

office visits per year for black members of the

lThis ~Po~ was prepared by Hugo Koch -~d

Raymond O. Gagnon, Division of Health Resources

Utilization Statistics.

civilian noninstitutiondized population, a visit

rate which is markedly below t-he2.8 visits per

person per year estimated for all members of

that population. Black patients showed a relatively greater tendency to visit other ambulatory care sites. According to findings of the

Health Intetiew Survey, a national househoId

survey conducted by the NationaI Center for

Health Statistics, they visited hospital outpatient clinics and emergency rooms with a

frequeney that was about 2 to 3 times that of

white patients.

Provider Characteristics

About 77 percent of the office-based care

rendered to bIack patients was provided in the

offices of four specialists: the general or famiIy

physician, the internist, the pediatrician, and the

obstetrician gynecologist (table 1). Visits to

general and family physicians alone accounted

for nearly one-half of all visits. In a ratio of

about 3 to 2, visits to solo practitioners outnumbered visits to physicians in multiplemember practice. Table 1 also shows that about

three-fourths of -alIoffice-based care for black

patients was provided in metropolitan areas.

Patient Characteristics

Nearly 2 of every 3 visits by black patients

were made by persons under 45 years of age

(table 2). In contrast with the median visit age

of 37 years found for the entire visit universe,

the median visit age of black patients was a relatively youthful 33 years. Conforming with the

overd pattern of office-based care, the annuzd

visit rate for the black population generally increased in direct parallel to advancing age (tabIe
2 achancedata

Figure 1. PATlENT RECORD

r

ASSURANCE OF CON FIDE NTIALITY-AII ,nl.wna,o. .vh,ch would pefmot,denld,c.:lo. 01.. ,IIdwbd..l,

. PCKUC.. or . . e.t. ble$hmenlv411be held conf$de.tml,wd! be .sed only by 0.,%.s eng.aed t. and for D N? Thep.mose. of the S.WV and ‘Al not be d,sclosed., releasedto othecPefson%or wed Ior any ah., p.mose.

1. DATE Of VISIT PATIENT RECORD

.+w7$-

NATIONAL AMBULATORY MEDICAL CARE SURVEY

2. OATE OF BIRTH 4.” COLOR OR 5. PATIENT3 PRINCIPAL PROBLEM(S) 6. SERIOUSNESS OF 7. HAVE YOU EVER SEEN

RACE COMPLAINT(S), OR SYMPTOM (S] ~ VISIT PROIELEM IN ITEM 5a THIS PATIENT BEFORE?

~ —

(In paf!ent’s own words) (Check one)

I ❑ WHITE

I ❑ vERY SERIOUS

, Q Yfs >ONO

3. SEX

, ❑ NEGRO/ a. MOST

SLACK IMPORTANT ~ ❑ SERIOUS If YES. for the probiem

I ~ FEMALE I ❑ OTHER I ❑ SLIGHTLY SERIOUS ,

indicated m ITEM 5a J

, ~ MALE . C UNKNOWN b OTHER ~ ~ NOT SERIOUS ~ : YES .3N0

8. MAJOR REASON(S) FOR TIEIS —VISIT (Check 8//mJ/oJ masons) 9. PHYSICIAN’S PRINCIPAL DIAGNOSIS ~ VISIT

a DIAGNOSIS ASSOCIATED WITH ITEM 5a ENTRY

>1 ❑ ACUTE PROBLEM o, ~ WELL AOULT/CHILO EXAM

.) ❑ ACUTE PRoELEM, FOLLOW-UP os (1 FAMILY PLANNING

., ❑ CHRONIC PR08LEM, ROUTINE I. ❑ COUNSELING/AOVICE

,. ❑ CHRONIC PRo BLEM, FLARE .IJP II ❑ IMMUNIZATION

,s O PRENATAL CARE IZ ❑ REFERREO BY OTHER PHYS/AGENCY b. OTHER SIGNIFICANT CURRENT OIAGNOSES

., ❑ POSTNATAL CARE !, ❑ AOMINlsTRATIVE PuRPos E (In order of importance)

o, ❑ POSTOPERATIVE CARE

-’l

,. ❑ OTHER (Spec,fv)

I {Ope, ●we procedure) I

10. OIAGNOSTICfTHERAPEUTIC SERVICES O ROEREOIPROVIOEO THIS VISIT (Chccka// rhat a~p/”) II. DISPOSITION THIS VISIT 12. OURATION OF

01 ❑ NONE 11 a ORUG PRESCRIEIEO {Checkall that ~) ~ VISIT (fime

02 ❑ LIMITED HISTORY/EXAM 12 a X-RAY

acfually spent wtlh

03 ❑ GENERAL HISTORY/EXAM

ph)’sfcrm)

13 ❑ INJECTION , 0 NO FOLLOW-UP PLANNED

04 ❑ CLINIWL b3B. TESr 14 0 IMMUNIZATIONIOESENSI TIZATION ~ O RETURN AT SPECIFIEO TIME

05 0 BLOOD PUESSURE CHECK 15 n PHYS1OTHERAPY I ❑ RETu RN IF NEEDEO. P,R.N.

06 ❑ EKG 16 a MEOICAL COUNSELING . ❑ TELEPHONE FOLLOW-UP PLANNEO

07 ❑ HEARINO TEST 17 D PSYCFIOTHE RAPY~HERAPEUTIC s O REFERRED TO OTHER _—~flNUTES

08 ❑ VISION TEST LISTENING

PHYSICIAN/AGENCY

, ~ RETURNEO TO REFERRING

09 a ENDOSCOPY 18 ❑ OTHER LS+mof”l PHYSICIAN

10 0 OFFICE SURGERY

~ ❑ AOMIT TO HOSPITAL

o c OTHER (Spe.//v)_

I

I I

HRA.34-5 DEPARTMENT OF HEALTH, EDuCATION, AND WELFARE owe. -%0.s72105

?Ev. 8.74 PUeLIC HEALTH SERVICE EYFI RATION 0A7E 1::31,75

HEAL7H RESOURCES ADMINISTRATION

NATIONAL CENTER FOR HEALTH StatiStiCS

3). The rate for black patients of over 64 years yielding an average of about 1.3 return visits per

of age, however, faiIed to show the pronounced year for every new problem presented. The

increase common in the overall visit pattern. return visit rate for black Patients was lower

Vkits by black females substantially e~ceeded

those by black males, both in total number and

in annual visit rate (tables 2 and 3).

At an estimated 43 percent of their visits,

black patients presented problqms that the

physician had not previously encountered in

those patients (table 2, prior visit status). These

new problem encounters may be summed up as

all visits made by new patients (17 percent) plus

those made by old patients of the doctor at

which a new problem was presented (26 percent). The remaining 57 percent of visits are

return visits for previously treated problems,

than the return visit rate o~ 1.7 visits per year

found by similar method for the entire visit

universe, a difference that probably resuIted

chiefly from the relatively greater frequency

among black patients of acute conditions,

largely self-limiting in nature, which responded

rapidly to office-based care (e.g. respiratory illness). For about 60 percent of the visits by

black patients involving a symptom or complaint, the problem had an onset of less than 3

months before the visit and was therefore—for

NAMCS purposes-classified as an “acute” problem.
ackmdaa3

Table 1. Number and percent distribution of office visits of

black patients and percent distribution of office visits of all

oatients. bv ohvsician characteristics: United States, 1975-76

All visits ............ I 90,464

I

Specialty

General and family

practice ... ...... .............

Obstetrics and

gynecology .......... ......

Internal medicine ........

Pediatrics .. ...................

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

Omhopadic surgery ......

ophthalmology............

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

urology .......................

psychiatry ....................

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

Cardiovascular disease..

All other specialties .....

Location of practice

Metropolitan area . .....

Nonmetropolitan area..

Type of practice

solo .............................

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

42,183

9,905

9,692

7,760

5,657

3,177

2,854

1,813

1,308

995

991

713

3,436

68,137

22,346

55,415

35,068

Visits by-

=

Percent distribution

3

46.6 ~

11.0:

10.7

8.6,

6.3

3.5$

3.2

2.0

1.5

1.1

1.1

0.8

3.6

75.3

24.7

61.2

38.8

100.0

~

.

.39.8

8.4

11.3

9.3

6.7

4.1

4.7

3.1

1.8

2.7

2.4

1.2

4.5

73.3

26.7

60.0

40.0

1

Based on 1,155,900,228 office visits over the 2-year span.

2 ~cation ~thin the standard metropolitan statisti~l ‘eas

(sMSA’s). Composition of SMSA’S does not reflect 1974 adjust mentk.

Patient’s Reason for Visit

Table 4 presents in ranked order the 20 reasons that most frequently motivated black

patients to visit the doctor’s office. These

reasons are those expressed by the patient, and

they are coded according to a symptom classification developed for use by the NAMCS. The

listing, which includes nonsymptomatic as well

as symptomatic reasons, accounts for 52 percent

of all black visits. It is noteworthy that “pregnancy visits” head the list. Also distinctive of

office-based care provided black patients is the

relative prominence of respiratory symptoms

and of complaints involving the back and extremities.

Table 2. Number and percent distribution of office visits of

black patients and percent distribution of office visits of all

patients. by patient characteristic= Unitad States, 1975-76

Patient

characteristic

All visits ............

—Age

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

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

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

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

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

Sex and age

Femal e. .. ......................

Under 15 years .......

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

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

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

65 years and over ....

Ma Ie......... ....................

Under 15 years ... ...

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

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

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

65 years and over ....

Prior visit status

New patient ........ ..........

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

Nutier of

visits of

black

~tients in

thousends

90,484

15,271

14,935

28,122

22,229

9,926

57,875

7,587

10,960

19,165

13,728

6,433

32,609

7,684

3,974

8,957

8,500

3,494

15,159

75,325

Visits byBlack

I

All

pat ients patients]

Percent distribution

100.0

16.9

16.5

31.1

24.6

11.0

64.0

8.4

12.1

21.2

15.2

7.1

36.0

8.5

4.4

9.9

9.4

3.9

16.8

83.3

100.0

18.1

15.1

25.5

25.1

16.9

60.4

8.5

9.9

16.8

15.1

10.0

39.6

9.6

5.2

8.7

10.0

6.2

14.6

85.4

26.0

i

23.2

57.3 62.9

I

1~sed on 1,155,900,228 ciffiC.SVkitS OVSXthe z-yearspan.

Table 3. Number of office visits per year for black patients and

for patients of all races, by sex and age: United States, 1975-76

Sex and age I

Black IAH

pat ients patients

Total .................................. .......... 1.9 2.8

—Sex

Female ...... ...... ................................... 2.2 3.3

Male .............................................. .... 1.4 2.5

Age

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

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

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

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

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

1.0

1.5

2.5

2.8

2.7

2.0

2.2

2.7

3.4

4.3
4 zlChflC%&&l

Table 4. Nutier, percent, and cumulative percent of office visits of black Ptients and percent of visits of all patients, by the patients’

20 most common raesons for visits in ranked order: United States, 1975-76

Rank

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Patient’s principal reason for visit and NAMCS code

Pregnancy examination ............. .................. .................................. ..905

Pain, swalling, injury-beck region .... ..................... ....... ............ ........4l 5

tild ................................. ....... ........ ..... ............... ............................3l 2

Physical examination (excluding wall-baby ).......... ................... 900,801

Pain, swelling, injury–lower extremiW ...........................................~

Abdominal pain . ............... ..................... ............................. ..... .......5w

Surgical after~re ........ ............................................... ............. ........ 986

Pain, swalling, injury–upper extremity ...................... ............ .. ..... . 405

Headacha .................................................... ........................ ............O56

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

Pain, swelling, injury-face and neck ............ ............... ............ .. ..... 410

Sore thr~t ........ ............... ........... .. ................................................. 520

High blood pre~ure . .............................. ....... ..................................2O5

Allergic skin reaction . ...... ..................... ....................... ........ ........... 112

Wounds of stin .................................... ........................ ...................l 16

Pain in chest ............... ..... ...................... ........................ ................. 322

Vaginal discharge ............................. ............................................... 662

Fwer .......... ................................................ .. ....................... ....... .... 002

Well-baby e~mimtion ........... ........ ............................................ .... 806

Dizziness ........................... ............... ............... ................................O69

Black patients

Number of

visits in

thousends

4,203

3.880

3,392

3,241

3,222

3,108

2,883

2,590

2,585

2,314

1,917

1.870

1;652

1,741

1,627

1,407

1,281

1,260

1,258

1,222

Diagnostic Procedures and Diagnoses

To diagnose the problems that black patients

presented, physicians focused on the limited

examination (table 5), i.e., an examination confined to the body site or system directly connected with the patient’s chief complaint.

Reliance on this diagnostic approach, though

general throughout ambulatory care, was significantly stronger in the treatment of black patients. It is also noteworthy from table 5 that

blood pressure readings were taken substantially

more often during tisits made by black patients

than during the overall pattern of visits (40 percent of visits by black patients compared with

33 percent by all patients).

The distribution of office visits made by

black patients and by all patients is given in

table 6 by major diagnostic groups. The five

most common groups among black patients in

order of frequency are diseases of the respiratory system; special conditions and examinations without illness; diseases of the circulatory

system; accidents, poisonings, and violence; and

percent

of visits

4.7

4.3

3.8

3.6

3.6

3.4

3.2

2.9

2.9

2.6

2.1

2.1

2.1

1.9

1.8

1.6

1.4

1.4

1.4

1.4

1~~ed on 1,155,900,228 office visits b y patients of all races over the Z-Year sPan.

Cumulative

percent

4.7

9.0

12.8

16.4

20.0

23.4

26.6

29.5

32.4

35.0

37.1

39.2

41.3

43.2

45.0

46.6

48.0

49.4

50.8

62.2

Percent of

visits of

all patientsl

3.9

2.9

1.8

4.2

3.7

2.6

4.7

2.7

1.7

2.3

1.4

2.7

1.3

1.8

1.4

1.7

0.8

1.4

1.7

1.1

Table 5. Number and percent of office visits of black patients

and percant of office visits of a II patients, by d .mgnostic procedures ordered or provided: United States, 1975-76

Nu tier of

Diagnostic visits of

procedures orderad black

or provided pat ients in

thousands

Limited examination ..... 52,385

General examination .... . 16,944

Clinical laboratory test.. 22,932

x-ray ............................. 6,522

Blood pressure check ..... 36,126

Electrocardiogram ......... 2,483

Hearing test ................ ... 867

Vision test ............. ........ 3,426

Endoscopy .................... 545

18esed on 90,483,499 visit.+.

28ased on 1,155,900,228 wads.

Percent of visits byBlack

patientsl

57.9

17.6

25.3

G::

2.7

1.0

3.8

0.6

All

petients2

51.6

16.3

22.8

7.6

33.2

3.3-

1.3

5.0

1.2

diseases of the genitourinary system. Table 7

presents in ranked order the 20 specific conditions most frequently encountered; note that

they account for nearly one-half (47.3 percent)

of all visits made by black patients.
ackm@aa5

Table 6. Number and percent distribution of office visits of black patients and percent distribution of office visits of ail patients, by

rrwjor diagnostic groups and inclusive ICDA codes: United States, 1975-76

Major diagnostic groups and inclusive lCDA codesl

All vitits .... ............................ ..................................................... .............. ..... ..................

Number of

visits of

black

patients in

t housends

90,484

4,410

1,468

4.270

3,068

4,998

9,366

14,704

2,988

6,822

4,445

5,271

4,063

8,140

14,285

1,366

7Ba

VisitsbyIE_125-

Percent distribution

100.0

Infective and parasitic dima~s ...................... ....................... ...... ..................................~l 36

Nwplasms ............................. ....... ........... .. ........... ...................... .................................. 140.23g

Endocrine, nutritional, and metabolic diseases ... ....................................................... ... 240-279

Mental disorders ..................... ......................................................................................2W.3l 5

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

Diseases of circulatory symem ...... ........................ ................................................ ...... .. 390458

Diseases of respiratory symem .................... ................................................................ .. 460-519

Diseaws of digs.vtive sy=em ........................ ...... ............................................... .............52@577

Diseases of genitourinery sytiem ..... ...................... ........ ............................. .................. 680-629

Diseases of skin and subcutaneous tissue ..... .............................................. .................. 680-708

Diseases of musculoskeletal syHem ..............................................................................7l O-738

Symptoms and illdefined andkions ........................ ...................................................78G796

Accidants, poisonings, and violenca ..............................................................................~.9W

Special conditions and examinations without sicknes ... ...... ............. ...........................YWYl 3

Other diagnoaes3 ................................................................... ..... .................................... ...........

Diagnosis “none” or “unknown” . .............................................................................. . ..............

1Based on E&hth Revision Irrtematiorsal Classification of Diseases, Adapted for Use in the United State& ICDA.

2~~ed on 1,155,9(s0,228 office Wits by patients of all races over the 2-Year sPan 1975-76.

3Di~ea~s of blood and b]ood.forming organs complications of pregnancy, childbirth and the pueIPahrrn; Congenital anornelies; and certain causes of perinatal morbidity and mortality.

4.9

1.6

4.7

3.4

5.5

10.4

16.3

3.3

7.5

4.9

5.8

4.5

9.0

15.8

1.5

0.9

100.0

4.2

2.2

4.2

4.2

8.2

9.6

14.1

3.3

6.2

5.3

5.7

4.7

7.3

18.1

1.4

1.3

Table 7. Number, percent, and cumulative percent of office visits of black patients and percent of visits of all patients, by the physicians’

20 moat common diagnoses in ranked order: United States, 1976-76

Principal diagnosis and ICDA codel

Medical and special examinations .. ...... .. .... ........................... YOO

Essential benign hypertension . ................................ .............. 401

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

Prenatal care ......................................... ...... .............. ...... ..... Y06

Medical and surgical aftercare ...... .......... ..................... ...... .... YIO

Diabetes ...................................... .......................................... 250

Sprains, strains: other and unspecified parts of back .. ........... 847

Chronic ischemic heart disease .......... .......... .. ....................... 412

Neuroses .................. ......................... ............................... .... 300

Obesity ............... ........... ........................ ......................... ..... 277

Bronchitis (unqualified) ....................... ...... .................. ......... 490

Other ecsema and dermatitis .. ...... ....... ....................... .......... 692

Sprains, strains: sacroiliac region ..................... ...... ..... .......... B46

Acute pharyngitis . .............. ...... ........... .................................

Asthma

462

.............. ...... .......... .................................... .............. 493

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

Acute tonsillitis ...... ..... ................... ....... .... ................... ........ 463

Osteoe~hritis and allied conditions ............ ............. .... ........ 713

Disorders of menstruation ......... ............ ................ .. ...... ...... 626

Synovitis, bursitis, and tenosynovitis ... .. ............................... 73 I

Black patients

Number of

visits in

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

1Based on Eighth Revision International Classification of Diseases, Adapted For Use in the United States, ICDA.

2Based on 1,155,900,228 office visits by patients of all races over the 2-year span 1975-76.

5,177

5,019

4,403

4,211

3,179

2,228

1,993

1,743

1,712

1,329

1,311

1,299

1,230

1,177

1,168

1,167

1,083

1,051

1,048

1,028

Percent

of

visits

5.7

5.6

4.9

4.7

3.5

2.5

2.2

1.9

19

1.5

1.5

1.4

1.4

1.3

1.3

1.3

1.2

1.2

::,

Cumulative

percent

5.7

11.3

16.2

20.9

24.4

26.9

28.1

31.0

32.9

34.4

35.9

37.3

38.7

40.0

41.3

42.6

43.8

45.0

46.2

47.3

Percent

of visits

of all

patients2

7.4

4.0

2.9

3.7

4.9

1.7

1.0

2.3

2.2

1.4

1.2

1.7

0.7

1.5

1.0

0.8

1.1

1.1

0.7

1.0
6

Other Visit Characteristics

In the physician’s judgement, most of the

conditions presented by black office patients

were not very severe in prognosis. Four of every

five conditions could be categorized as ranging

from slightly serious to not serious (table 8).

This is about the same proportion as in visits by

aIl patients.

Drug therapy plays an extensive part in the

overall pattern of office care. It is even more

extensively applied in the care of black patients

since more than half of all such visits involve

treatment by a prescription or nonprescription

drug (table 8, therapeutic services).

In agreement with the overzdl tendency in

office ambulatory care , a return visit was the

form of disposition most frequently found in

@e care of black patients (table 9, disposition).

Table 9 shows that the slightly greater-thanaverage use of the direction “return if needed”

probably reflected the relatively higher incidence of acute, self-Iimiting conditions found

among black office patients.

Table 8. Number and percent of office visits of black patients

and percent of offiie visits of all patients, by seriousness of

problem and selected therapeutic services ordered or provided: United States, 197576

seriousness of Number of

problem and visits of

t--lPercent of visits bysalected therapeutic black

sewices ordered petierrtsin Black All

or provided thousands pet ients~ Patientsz

Seriousness of

problem

.%srious or very serious.,

Sightly serious .............

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

Therapeutic

-YGFzFF

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

Injection .... .... ...... ..... .

Immunization or

desensitization ..... .... ..

Offica surgery ...... ........

Physiot herep y ............. .

Medical wunseling .......

psychothempy and

therapeutic listening..

18ascd on 90,483,4

28esed on 1,1S5,90

16,898

32,008

41,576

48,852

12,604

2,961

3,975

3,084

11,258

1,720

visits.

2S visits.

18.7 I 19.4

35.4 32.0

48.0 46.6

54.0 43.6

13“9 13.1

3.3 4.8

4.4 6.9

3.4 2.6

12.4 13.0

1.9

I

4.2

Table 9. Number and permnt distribution of office visits of

black patients and percent distribution of office visits of all

patients, by disposition and duration of physician-patient

contact: United States, 1975-76

Disposition and

duration of

physician-pat ient

contact

All visits ...........

Disposition

No followup planned..

Return at specified

time ..........................

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

Telephone followup

planned ....... ..............

Referred to other

physician or agency..

Returned to referring

physicia n ...... ............

/Mmit to hospital . ......

Duration of contact

O minutes (no face-toface contact with

physician ]........... .....

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

8-10 minutes ..............

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

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

31 minutes or more. ...

Nutier 01

visits of

black

Wtients in

thousands

80,464

10,712

52,496

22,807

1,646

3,220

848

1,796

758

19,147

28,968

24,006

13,860

2,744

Visits by-

=T=

Percent distribution

100.0 I 100.0

1

11.8 12.3

58.0 60.2

25.0 21.9

2.0

I

3.5

3.6I 2.8

0.9 0.9

20 2.1

0.8 1.8

21.2 15.1

33.1 31,5

26.5 26.6

15.3 19.5

3.0 5.5

l~sed on 1,155,900,228 office visits by patientsof all races

over the 2-year spn 1975-76.

2WHI not total to 100.o since more than one disposition w-q

possible.

Data on duration of contact in table 9

suggest that the overall average length of time

spent in face-to-face contact with the physician

was less for black than for white patients. The

mean contact duration for black patients was 13

minutes as compared with an estimated average

of about 15 minutes for the total visit universe.

It would be inaccurate to infer, however, that

this shorter time was the direct product of color

or race. Rather, the difference stemmed chiefly

from the symptoms presented by black patients,

of which a greater proportion than average were

acute and self-decku-ing by nature, requiring

relatively less time to diagnose and treat.
dwlce&a7

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 1975 and 1976. The target

universe of the NAMCS is composed of office

visits made within the coterminous United

States to non-Federal 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, was the organization responsible for the survey’s field operation.

SAMPLE DESIGN: The NAMCS utilizes a multistage probabilityy design that involves samples of

primary sampling units (PSU’S), physician practices within PSU’S, and patient visits within

practices. Each year a sample of practicing

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

American Osteopathic Association. For the

2-year period 1975-76, a total of 6,529 physicians were included in the sample. Of those

found eligible for the survey, 79.9 percent participated. Characteristics of the physician’s

practice–for example, primary specialty and

type of practice–are obtained during an induction interview. During a l-week reporting

period, physicians who participated in the

NAMCS completed brief encounter forms for a

sample of their office visits (see Patient Record,

figure 1). The Patient Record included an entry

for color or race (item 4). The physician was

instructed to select the raciaJ category that,

based on his observation or prior knowledge of

the patient, was most appropriate for the

patient. The estimates presented in this report

are based on the Patient Records completed for

15,004 visits by black patients over the 2-year

period 1975-76. A detailed description of the

NAMCS design and procedures has been presented in an earIier publication.z

SAMPLIN’G ERRORS: Since the estimates for

this report are based on a sample rather than the

2National Center for Health Statistics: The National

Ambulatory Medical Care Survey, 1975 summary,

United States,January-December1975, by H. Koch and

T. McLcmore, Vital and Health Statistics. Series 13-No.

33. DHEW Pub. No. (PHS) 78-1784. Public Health Service. Washington. U.S. Government Printing Office, Jan.

1978.

entire universe, they are subject to sampling

variability. The standard error is primarily a

measure of sampling variability. The relative

standard error of an estimate is obtained by

dividing the standard error of the estimate by

the estimate itself and is expressed as a percent

of the estimate. Relative standard errors of selected aggregate statistics are shown in table I.

The standard errors appropriate for the estimated percentages of the office visits are shown

in table 11.

Table 1. Approximate relative standard error of estimated

numbers of office visits, NAMCS 1975-76

Estimate I

Relative standard

in error in

thousands percentage points

600 ......... ........ .... ........ .. .. ......... 30.2

1,000 ................ .. ........ ........ .. .. . 23.5

2,000 ................ ........ .... .. ...... .. . 16.7

4,000 .. ...... ..... ........... ...... .... .. ... 12.0

10,000 .......... ..... ...... ....... ..... .... 8.CI

40,000 ................. ....... .......... ... 4.8

mo,ooo . .... ..... ......... .............. . 3.4

7,000,000 ....... ...... ........... ..... ... 3.1

Example of use of table: An aggregate estimate of 25,000,000

visits has a relative standard error of 6.4 percent or a standard

error of 1,600,000 visits (6.4 percent of 25,000,000).

Table 11. Approximate standard errors of percentages for

estimated numbers of office wits, NAMCS 1975-76

Base of percentage

(number of visits

in thousands)

600 ........ ..... ...........

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

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

4,000 .....................

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

40,000 ......... ... ...... .

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

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

Estimated percentage

1 or 5 or 10or 20 or 30 or so

99 95 90 80 70

Standard error in percentage wints

3.0

2.3

1.6

1.2

0.7

0.4

0.2

0.1Ull_

6.5 9.0 12.0 13.8 15.0

5.1 7.0 9.3 70.7 11.6

3.6 4.9 6.6 7.5 8.2

2.5 3.5 4.7 5.3 5.8

‘1.6 2.2 2.9 3.4 3.7

0.8 1.1 1.5 1.7 1.8

0.4 0.5 0.7 0.8 0.8

0.2 0.2 0.3 0.3 0.4

Example of use of table: An estimate of 20 vercent based on

an aggseg~te estimate-of 80,000,000 visits has a ktandard error of

1.3 percent. The relative standard error of 20 percent is 6.5 (1.3

percent + 20 percent).

ROUNDING OF NUMBERS: Aggregate estimates of office visits presented in the tables are

rounded to the nearest thousand. The rates and

percents, however, were calculated on the basis

or originaI, unrounded figures. Because of

rounding of percents, the sum of percentages

may not equal 100.0 percent.
8 zldmrlCddzl

DEFINITIONS: An ambulatory patient is art

individual presenting himself for personal health

services who is neither bedridden nor currently

admitted to any health care institution on the

premises.

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

Responsibility over time for patient care and

professional services rendered there generally

resides with the individual physician rather than

an institution.

A visit is a direct personal exchange between an ambulatory patient and a physician or

a staff member working under the physician’s

supewision for the purpose of seeking care and

rendering herdth services.

A physician is a ds.dy licensed doctor of

medicine (M.D.) or doctor of osteopathy (D.O.)

currently in practice who spends time in caring

for ambulatory patients at an office location.

ExcIuded from NAMCS are physicians who

specialize in anesthesiology, pathology, or radiology; physicians who are federally employed;

physicians who treat only institutionalized

patients; physicians employed fuIl time by an

institution; and physicians who spend no time

seeing ambulato~ -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 .— *

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