Vital and

Health Statistics

Advance

From Vital

Data

and

Health Statistics:

Numbers 91-100

Series 16:

Compilations of Advance Data From Vital

and Health Statistics

No, 10

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

age and other variables on Americans needing help to function at home,

hospital use and other health care by adolescents, discharge status of

inpatients discharged from hospitals, use of analgesic drugs, and management

of new pain, Estimates are based on the civilian noninstiiutionalized population

of the United States, These reports were originally published in 1983 and 1984,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyaitsville, Maryland

December 1993

DHHS Publication No, [PHS] 94-1869
Copyright information

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

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

appreciated.

Suggestsd citstion

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

statistics: numbers 91–1 00. National Center for Health Statistics. Vital Health

Stat 16(10). 1993.
National Center for Health Statistics

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

Jack R. Anderson, Deputy Director

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

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

Robert A. Israel, Associate Director for International

Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

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

and Methodology

David L. Larson, Assistant Director, Atlanta
Contents

An Overview of the 1980 NationaI Master Facility lnvento~ Survey of Nursing and Related Care Homes . . . .

Americans N’eeding Help To Function at Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wiiization of Short-Stav Hospitals bv .Adokwents: United States, 1980. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discharge Status of Inpatients Discharged From Short-Stay Hospitals: United States, 196S-81. . . . . . . . . . . . . .

1982 %unrnzuy N’ationai Hospital Discharge SW-Vq-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

UtiJ.ization of Analgesic Drugs in Office-Based Arnbuiatory Care: National Ambulatory Medicxd Care Survey,

1980-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The Management of New Pain in Office-Based Ambulatory Care: N’ational Ambulatory Medical Care Sumey,

1980 and 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . -------- -------- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diagnosis-Related Groups Using Data From the IQational Hospital Discharge Survey United States, 1981 . . .

HeaIth Care of Adolescents by Office-Based Physicians: National Ambulato~ MedicaI Care Survey,

1980-81 .. -- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CAT Scan Use in Short-Stav Non-Federal Hosnitals: United States, 1979-82 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. 91

N’o. 92

w 92

No. W

h’o. 9S

No. 96

No. 97

No. 98

No. 99

#—-––— ---- =_— . . No. 100
From Vital and Health Statistics of the National Center for Health Statlst!cs Number 91. August 11, 1983

An Overview of the 1980 National Master Facility

Inventory Survey of Nursing and Related Care Homes

by Al Sirrocco, Division of Health Care Statistics

Introduction

In this report the 1980 National Master Facility Inventory

Survey of nursing and related care homes is described. Statistics

are presented on the numbers of homes, beds, residents, and

employees, along with occupancy and turnover rates. These

variables are categorized by such characteristics as ownership

groups. bed size groups, and geographic regions. Additional

topics covered in this report include survey procedures, problems encountered, editing procedures, and qualifications of

the data.

The National Center for Health Statistics (NCHS) first

conducted the National Master Facility Inventory (NMFI)

Survey in 1963 and continued in 1967, 1969, 1971, 1973,

1976, and 1978. Prior to 1978, the inventory included hospitals, nursing and related care homes, and other types of inpatient health facilities including, for example, homes for the

blind, deaf, mentally retarded, and emotionally disturbed.1 The

1978 and 1980 NMFI surveys have data on only nursing and

related care homes. Data for hospitals are now obtained directly from the American Hospital Association (AHA). For

convenience, this report will use the terms “nursing and related

care homes” and “nursing homes” interchangeably.

The NCHS definition of “nursing homes” has remained

the same over the years of the NMFI surveys. The definition

states basically that a home must maintain three or more inpatient beds, and, at a minimum, it must provide one or more

personal care services (such as help with eating, walking, correspondence, shopping, dressing, bathing, or massage).

While this definition has remained constant, the coverage

of the NMFI has not. Due to changes in collection coverage

lNa[jOn~lcenter for I+ealthStatistics, G. Strahan: Inpatient health facilities

statistics, United States. 1978. Vira/ and Health Sfafisfics. Series 14-No. 24.

DHHS Pub. No. (PHS) 81-1819. Ofiice of Health Research. Statistics, and

Technology. Washington. U.S. Government Printing OffIce. Mar. 1981.

starting in 1976 (see Technical notes), certain types of facilities have been added and others deleted. The most notable

change in coverage for 1980 involved the addition of more

than 2,500 adult foster care homes in Michigan and 1,000

newly added residential community care facilities in California.

These homes may or may not have been in existence in prior

years, but were only recently identiled as meeting the minimum

definitional requirements of NCHS for inclusion in the NMFI.

One other notable change occurred in the 1980 coverage.

All identifiable hospital-based nursing homes and extended

care facilities were excluded from the survey. Previous NMFI

surveys included many of these; however, the inability to obtain data on alI such facilities from all States resulted in the

decision to drop them from the survey and use the AHA figures for these facilities.

Therefore, any comparisons made between the 1980

NMFI and prior NMFI’s must be done with extreme caution.

It is recommended that if comparisons are attempted they

should be performed using only the larger homes (25 beds or

more) because most of the addkions, deletions, and definitional

changes that occurred between NMFI surveys were in the

smaller homes. In addition, the hospital-based nursing homes

should be removed from the earlier counts when comparing

those surveys with the 1980 Survey.

Discussion

Facility characteristics

In 1980 the NMFI identified 23,065 nursing homes in

the United States. At the time of the survey there were

1,537,338 beds and 1,396,132 residents in these facilities.

Included in these figures were 2,524 adult foster care homes

(AFCH’S) in Michigan that had never been included as part

of the NMFI. These facilities had 18,824 beds and 15,709

residents. Excluded from the 1980 NMFI were hospital-based

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

Tabk A. tdumtir and percent distribution of nursing and related

care homes and beds by bed size. type of ownership. and

geographic regiom United States. 1980

Homes Beds

Characrerlsrm Percent Percenr

Number dlstri- Number distnbutlon butlon

Table 8. Average bed size of nursing and related care homes by

type of ownership and geographic region. including and

excluding Michigan-s adult foster care homes (AFCH”S):

United States. 1980

Average bed svze

Characrertsrfc Average bed s~ze excluding

of ail homes Mtchlgan k

AFCI-!3

All homes.. . . . . .

8ad stze

3-9 baas . . . . . . . . . . .

10-24 beds . . . . . . . . .

2549 beds . . . . . . . . .

50-74 becis. .

75-99 beds.... . . . .

1OO-I99 beds. . . . . . .

200-299 beds. . . . .

300-499 beds. . . . .

500 beds or more . .

Type of ownership

Government. . .

Proprietar y. . . . . . . . .

Nonproflz . . . . . . . . . . .

Geographic region

Northeast. . . . .

North Central .

south. . . . . . . . . . . . . .

Weal . . . . . . . . . . . . . . .

23.065 100.0 1.537.338 100.0 All homes . . . . . . . . . . . . 667 73.9

Type of ownership

5.492 23.8

3,006 13.0

3.030 13.1

3.332 14.4

2.375 10.3

4.737 20.5

766 3.3

250 1.1

77 0.3

29.238

47.965

112.093

199.673

208.995

617,165

177.581

90.584

54.044

I .9

3.1

7.3

13.0

13.6

40.1

11.6

5.9

3.5

Government . 1356 135.6

Proprleta~ . . . . . . . . . . . . . . . 57.4 65.2

Nonprofit . . . . . . . . . . . . . . . 97.7 977

Geograptnc reg!on

Northeas! . 857 857

North Central ,.. 632 878

South 793 793

Weal . . . . . . . . . 474 -a? 4

936 41

18.669 80.9

3.460 15.0

126,907

1,072.243

338.188

8.3

69.7

22.0

AFCIi”s would have little impact on this figure. reducing Ihe

rate of the North Central Region to 75.1.

There was moderate fluctuation in nursing home occupancy rates among bed size groups. ownership categories, and

geographic regions (~able C). A much wider fluctuation in the 3.762 16.3

8.252 358

5.306 23.0

5.745 24.9

322.530

521,661

420.762

272.385

21.0

33.9

27.4

177

80 Y 78.0

70

60

50

40

30

20

10

0

nursing homes and extended care facilities, which according

to AHA, numbered 1,056 facilities and 76,024 beds in 1980.2

Half of all nursing homes had less than 50 beds (table

A). Akhcmgh the largest group (5,492) had less than 10 beds,

the next Iargestgroup (4,737) had between 100 and 199 beds.

By contrasq only 1,093 nursing homes had more than 199

beds. Over 40 percent of all nursing home beds are in homes

having 100 to 199 beds.

As expected, the vast majori~ of nursinghomes were operated for profit. Approximately 81 percent of the homes and

70 percent of the beds were proprietary. The average government-operated home, however, was nearly 2!4 times bigger

than the average for-profit home (table B). Even when Micii

gan AFCH’S were excluded, the government-operated homes

were still more than twice the size of the propriety homes.

The nonprofit homes, with about a 98-bed average, were halfway between the two other ownership groups.

The North Central Region had by far more nursinghomes

and beds than any other region. Excluding the Michigan

AFCH’S the Notth Central Region would have had the highest

average bed size, but when these were included it was a distant

thirdbehind the Northeast and South Regions (table B).

The number of nursing home beds per 1,000 population

65 years of age and over are shown by region in figure 1. The

North Central Region had the highest such rate at 78.0 with

the West a distant second at 63.4. The exclusion of Michigan

U.S. average

= 60.3

63.4 &>

0

53.1

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......-..--.+.-.

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-.......--------

....

........

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

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.-...o. . . . . . . . . .

. . . . . . . .

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

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

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

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

. . . . . . . .

49.6

e

a

m

>

Northeast North South West

Central

Regions

2~erim H~i~ -i=tion: Hospiral Sfadstics.1981 editksI.Data fmm

?& AHA 1980 Annual Survey.

Figure 1. Beds in nursing and related care homes per 1.000 population

65 years of age and over by region: Umted States. 1980
achncedata 3

Table C. Occupancy rate and number of admissions per 10 beds

(turnovar rate) for nursing and related care homas, by bed size,

typa of ownarship, and geographic region: United States, 1980

turnover rate (admissions per bed) was found among these

three categories. The highest turnover rates among the bed size

groups were 8.5 and 8.4 admissions per 10 beds in homes with

100 to 199 beds and 75 to 99 beds. respectively (table C).

These rates were quite a bit higher than those for the two

smallest bed size groups, and considerably higher than those

for the two largest bed size groups.

The turnover rate for proprietary homes was nearly twice

the rate for government-operated homes. The West Region

had the highest turnover rate with every bed being turned over

once during the year (10 admissions per 10 beds).

Employee data

In 1980, an estimated 952,600 full-time equivalent (FTE)

employees worked in nursing homes. Of these, approximately

62,200 were registered nurses (RN’s) and about 76.700 were

licensed practical nurses (LPN’s) (table D). Data on the

numbers of these employees and their numbers per home and

per 100 beds are provided and categorized by bed size. ownership type, and geographic region (table D). The NMFI surveys

included in their counts only those nursing home employees

who are on the staff payroll; they excluded those employed

under contract. Because RN’s and LPN’s are sometimes employed under contract. they are somewhat undercounted.

As the bed-size groups get larger, the number of FTE

employees per home also increases. This is not surprising, because the more beds there are in a home, the more employees

are needed to staff them.

Characteristic Occupancy

Number of

ratel

admissions

per 10 bedsz

All homes . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

3-9 beds . . . . . . . . . . . . . . . . . . . . . . . . .

10-24 beds . . . . . . . . . . . . . . . . . . . . . . .

25-49 beds . . . . . . . . . . . . . . . . . . . . . . .

50-74 beds . . . . . . . . . . . . . . . . . . . . . . .

75-99 beds . . . . . . . . . . . . . . . . . . . . . . .

100-199 beds . . . . . . . . . . . . . . . . . . . .

200-299 beds . . . . . . . . . . . . . . . . . . . .

300-499 beds . . . . . . . . . . . . . . . . . . . .

500 beds or more . . . . . . . . . . . . . . . . . .

Type of ownership

Government . . . . . . . . . . . . . . . . . . . . . . .

Proprietary . . . . . . . . . . . . . . . . . . . . . . . .

Nonprofit . . . . . . . . . . . . . . . . . . . . . . . . .

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

90.8 7.6

B4.6

89.1

91.8

92.3

92.4

91.1

89.B

B7.9

87.1

6.0

5.8

6.2

7.1

8.4

8.5

7.9

5.3

3.5

91.3

91.4

8B.8

4.4

8.6

6.0

93.1

89.7

90.2

91.1

6.8

6.6

8.1

10.0

‘Number of residents dw!ded by number of beds set up and staffed (expressed

as a percent).

2Homes that d,j not reporr admissions ware excluded—there wera 6.648

such homes.

Table D. Number of full-time aquivalant (FTE) employees in nursing and relatad care homas that repo~ed full-time employees, number of

FTE employees par home, and number of FTE employees per 100 residents, by bed size. type of ownership, and geographic region: United States,

1980

Estimated numbar of all

FTE emplo yeesf.z FTE RNs1 .3

Characteristic

FTE LPNkl ,3

Total Per home Per 100 beds Total Per home Per 700 beds Total Per home Per 100 beds

All homes . . . . . . . . . . . . .

Bed size

3-9 beds . . . . . . . . . . . . .

10-24 beds . . . . . . . . . . .

25-49 beds . . . . . . . . . . .

50-74 beds . . . . . . . . . . .

75-99 beds . . . . . . . . . . .

100-199 beds . . . . . . . .

200-299 beds . . . . . . . .

300-499 beds . . . . . . . .

500 beds or more . . . . . .

Type of ownership

Government . . . . . . . . . . .

Proprietary . . . . . . . . . . . .

Nonprofit . . . . . . . . . . . . .

Geographic region

Ncrrtheast . . . . . . . . . . . . .

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

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

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

952,600 41.4 62.1 62,200 2.7 4.0 76,700 3.3 5.0

9,900

24,500

65.000

123,200

133.900

384,300

111,900

55,900

44,000

1.8

8.2

21.5

37.0

56.4

B1.2

146.1

223.6

571.4

33.9

51.1

58.0

61.7

64.1

62.3

63.0

61.7

81.4

48

900

3,800

7,100

8,500

26,800

7,900

4.100

3,100

0.0

0.3

1.2

2.1

3.6

5.7

10.3

16.5

40,4

0.2

1.8

3.4

3.5

4.1

4.4

4.4

4.5

5.7

35

1,300

5,200

9,900

11,500

32.500

9.300

3,800

3,200

0.0

0.4

1.7

3.0

4.9

6.9

12.2

15.1

41.6

0.1

2.7

4.6

5.0

5.5

5.3

5.2

4.2

5.9

104,200

623,200

225,200

111.3 82.1 6.500

33.4 58.1 39,400

65.1 66.6 16,200

7.0

2.1

4.7

5.1

3.7

4.B

8.600

52,400

15,700

9.2

2.8

4.5

6.8

4.9

4.6

230.100

306,300

252,700

163,500

61.2 71.3 22,600

37.1 58.7 18,500

47.6 60.1 11,100

28.5 60.0 10.000

6.0

2.2

2.1

1.7

7.0

3.5

2.6

3.7

18,500

21.600

25,700

10,900

4.9

2.6

4.8

1.9

5.7

4.1

6.1

4.0

‘ FTE = full.tl~ squivslen[s= full.tmse smployaas + % psrt.tims empioycss.

‘Sac Techmcal notes for explansti.m of estimstmn procedures.

3HE RN’s and l.pN.s were sctusl counts but hsve been rounded to nesrest hundred except when tOtZd wss leSS than 100.
4 advancedata

When the rates per 100 beds for all employees are compared by bed-size groups, a somewhat different picture appears.

Whereas the largest group (500 beds or more) has a rate almost 2!4 times as large as the smallest group (3 to 9 beds),

the six bed-size groups starting with 25 beds and ending with

499 beds have relatively small variations in rates.

The rates per 100 beds for both RN’s and LPN’s had

similar patterns. Their most substantial increases occurred from

the first (smallest) bed-size group to the second. from the

second to the third. and from the next-to-the-largest bed-size

group to the largest.

In terms of ownership. the government-operated homes

had the highest rates for both FTE employees per home and

FTE employees per 100 beds. This was true for RN’s and

LPN’s as well as for total employees.

These high rates can be understood by reviewing data

presented earlier. Specifically, the government-operated homes

averaged nearly 136 beds per home—far more than the other

two ownership types. Because large nursing homes have more

total employees, RN’s, and LPN’s than do small homes. the

government-operated homes would be expected to have the

highest employee-per-home rates. Conversely, because proprietary homes tend to be small and because smaller homes

have fewer employees, the proprietary homes had very low

rates of FTE employees per home. The government homes

also had the highest rates of FTE employees per 100 beds for

all three employee groups. Proprietary homes had the lowest

rates for all employees and for RN’s, but for LPN’s the rate

was slightly higher than the rate for nonprofit homes.

At the regional level. the Northeast had substantially

higher FTE employee-per-bed rates than the other regions for

all employees and for RN’s. The Northeast was second to the

South. however, in FTE LPN’s per bed.

Although the Northeast had fewer nursing homes than any

other region, it had the highest number of FTE RN’s-more

than the South and West Regions combined. This is dramatically shown where the number of FTE RN’s per home is 6.0

in the Northeast but only 2.2 or less in the other three regions

(table D).

A possible explanation for this could be in the types and

sizes of the nursing homes within regions. The certification

data collected in the survey were incomplete (see Technical

notes), but according to the information that was available the

Northeast had many more large skilled nursing fa~cilities

(SNF’S) than the South and West Regions did. In SNF homes

with 200 or more beds, the Northeast had 295. compared with

the Souths’ 113 and the Wests’ 64. Of the SNF homes with

500 beds or more, the Northeast had 37, the South 4. and the

West none.

Because SNF’S are required to ( 1) provide skilled nursing

care and (2) maintain 24-hour coverage by RN’s, they would

be expected to have more RN’s than noncertified homes. Results from the 1977 National Nursing Home Survey tended to

substantiate this with the finding that of the 66,900 estimated

FTE RN’s employed in nursing homes at that time, 53,000

(79 percent) were in homes classified as SNF’S.3 The Northeast. with many more large SNF-S. could therefore be expected

to have many more RN’s also.

3Nationai Center for Health Statistics. A. Sirrocco: Employeesin nursing

homes in the United States. 1977 National Nursing Home Survey. Vifaf and

Heafrh Sracisrics. Series 14-No. 25. DHHS Pub. No. (PHS) 81-1820. Office

of Health Research. Statistics. and Technology. Washington. U.S. Govemmem Printing OffIce. Feb. 1981.
ackme&a 5

Technical notes

Although the 1980 National Master Facility Inventory

(NMFI) Survey was a universe rather than a sample survey

and. as such. is not subject to sampling error. it is subject to

other types of errors. One type of error was questionnaire-item

nonresponse.

All the NMFI Surveys (of nonhospitals) through 1973

were conducted directly by the National Center for Health

Statistics (NCHS) with the assistance of the U.S. Bureau of

the Census. From 1976 through 1980 the Cooperative Health

Statistics System (CHSS) was active. This system decentralized the responsibility for collecting data from the Federal to

the State level. In 1976. 16 States within CHSS collected

some or all the NMFI data. In 1978 there were 26 States.

and in 1980 there were 38 States collecting NMFI data. In

each of these years NCHS surveyed in the non-CHSS States.

The agency within the CHSS States that collected the

NMFI data for NCHS was usually the licensing agency. Because their surveys are tied into licensing laws, there were differences in definitions. scope, and timing of the surveys among

the CHSS States. However, NCHS included personal care

homes. homes for the aged. rest homes. and the like. some

States did not license these types of homes and did not survey

them.

Data on nursing and related care homes may have biases

due to the following

● Data from nursing homes surveyed in the 1978 NMFI

were substituted in 1980 for Alaska and South Dakota.

● 1978 data were substituted for 48 nursing homes in Indiana and 96 homes in Connecticut.

●

●

●

●

Because neither 1980 nor 1978 data were avaiiable for

approximately 200 residential care homes in New York.

these homes were excluded from the figures in this report.

Number of beds and type of ownership were the only data

reported by the 3.013 residential community care facilities

in California. The number of residents was imputed by

multiplying beds by 0.90—the average occupancy rate in

nursing and related care homes. Admissions. discharges,

inpatient days of care. and employees were not imputed:

therefore. these homes were not inciuded in tables showing these variables.

The only information available for the 2.524 Michigan

adult foster care homes (AFCH.S) was number of beds.

The number of residents was imputed by multiplying beds

by 0.90. Based on existing knowledge of the AFCH.S.

these homes were assigned an ownership category of proprietary. No other data were imputed. so these homes

were excluded from tables showing any variables other

than beds, residents. and ownership.

Estimates were obtained for full-time equivalent (FTE)

total employees in the 5.888 homes for which data on iWtime total employees were not provided by the home. To

get these estimates. full-time employee averages were

computed for each bed-size and ownership group in the

17.177 homes that did report full-time employees. These

averages were then applied to the 5.888 homes with correspondhtg bed-size and ownership groups. and the resulting estimates were added to the known FTE data in the

17.177 homes.
From Vital and Health Statistics of the National Center for Health Statistics Number 92 ● September 14, 19S3

Americans Needing He[p “b Function at Home

by Barbara A Feller, MA. Divisionof Health Interview Statistics

Introduction

Recently, the perspective in Ion&term care has broadened

to include personal care needs of American aduItswho are able

to live in the community despite chronic disabilii. Long-term

care can now take pIace in different settingsthatprovide varied

services. Home health care, adult day care, and other ways of

providing care for people with chronic disabtities are develop

ing in some communities. The fbcus of this report is on the

types of home care services aduitswith chronic healthprobiems

need to continue to live in the community.

This report presents selected data from the Home Care

Supplement to the 1979 Nationai HeaIth interview Survey.

This survey is a cross-sectional nationwidestnvey by ItousehoId

interview of the civilian noninstitutionalized population of the

United States. The population estimates for this report are

based on the 1970 decennial census population projected to

1980, and therefore are slightly lower than if the poptdation

had been based on the 1980 Decemial Census. The Bureau of

the Census documents the percent error of cksure between

the 1980 Census and preliminary estimates of the poptdation

of the United States for April 1, 1980, by age, race, and sex.

Estimates of how many peop[e in the community need

help and whattypes of heIpthey need are presentedby age and

sex for selected activities. The question of how many people

need help because of a chronic health problem is crucial for

estimating the size of the target population for home care, and

the question of what Nes of help they need is essentkd for

appropriate delivery of health care services. ExampIes of specific items presented include seIected basic physical activities

and home management activities. The number of aciuhs who

need and/or receive heIp in at least one of tie seI& tities

Iu.s. Bur~u of the CCnaus preliminaryCSthWCSOfthe papla~ of*

United States. by age. sex. and rata 1970 to 1981. Current Population Rcparm Series P-ZS. No. 917. Washington U.S. Government Printing Ofticc.

1982

and the number of adultswho need or receive help in each type

of activity are discussed

In additiom estimatesof the numberof peopIe who usually

stay in bed alI or most of the time, the numberwho experience

problems controlling boweI movements or urination, the nmnber who need or receive the heIp of another person, and the

number of ~opIe who need and/or receive selected numingor

medicd treatment at home and the types of care received are

alsodkcussd For each itrm estimates of the numberof aduks

and rate per 1,000 persons are presented in tabks I–1 1.

Data highlights

According to data on the civilian noninstitutionaiized

populationfiorn the National Health IntetviewSuney (NHIS),

in 1979

●

●

●

●

●

An estimated 3.4 miilion adrdtsneeded or received help

from another person or by using speciaI equipment in at

least one of the following basic physical activities walkin%

going outside, bathingj&essirt& usingthe toileL getting in

or out of a bed or chair, or eating.

An estimated 4.1 million adults needed or received the

help of another pxawm in at Ieast one of the following

seIected home management activities shoppirt~ household

chores, preparing merds, or handlingmoney.

Overall, about 4.9 million adults livingin the community

needed the help of another person in carrying out everyday

activities.

A substantial number (tit 2 million) were under 65

years of age, with the majority (2.8 tnillion) 65 years of

age and over.

The need for the help of another person increases sharply

with age+especially among the elderly. Fewer than I in 10

who are 65–74 years of age needed help, compared with4

in 10 who are 85 years of age or over (table 1).

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Pubhc Heaith Serwce
2

Table 1. Rata par 1,000 adults who naed assistance, by type

of need and age: United States, 1979

Type of need

65– 74 75–84 85 years

years years and over

Rate per 1,000 persons

Needs help In 1 or more basic

phys!cal activ(tles . . . . . . . . . . . . . 52.6 114.0 348.4

Needs help in 1 or more home

management actwities . . . . . . . . . 57.3 141.8 399.0

Usually stays in bed . . . . . . . . . . . . . . 11.3 25.6 51.2

Has device to control bowel

movements or urination . . . . . 5.3 10.8 28.5

Needs help of another person in

oneormore of the above.. . . . . . . . 69.9 160.3 436.5

Basic physical activities

In this report, basic physical activities include walking,

going outside, bathing dressing using the toilet, getting in or

out of a bed or a chair, or eating. The category “needing or

receiving help” includes anyone who was reported, during the

household interview, to use special equipment and/or to need

or receive the help of another person because of a chronic health

problem, and anyone who needed help even though it was unknown whether a person or equipment was needed. Also included was anyone for whom it was reported that he or she

“doesn’t do” any one of the seven activities because of a chronic

health problem.

In 1979, 3.4 million adults living in the community needed

or received help in at least one of these activities, representing

a rate of 22.5 per 1,000 adults for all ages combined (tables 2

and 3). This estimate is an unduplicated person count because

it shows how many adults needed or received help in at least

one of the seven activities.

The rate of needing help in at least one basic physical

activity was substantially higher among persons in the older

age categories. About 5.1 per 1,000 people 18-44 years of age

needed help, compared with the rate of 20.6 per 1,000 people

45-64 years of age, 52.6 per 1,000 people 65–74 years of age,

and 157.0 per 1,000 people 75 years of age and over (table 3).

The rate for people 85 years of age and over (348.4 per 1,000)

was markedly higher than that for people 75-84 years of age

(1 14.0 per 1,000).

Although the number of women 75 years of age and over

needing help was twice that of men the same age, the differTable 2. Number of adults who need help in basic physical activities because of a chronic health problem by type of activity, sex, and agw

Unitad Statea, 1979

[Data are based on household interviews of the civilian nonmstitutionahzed population]

Sex and age

Needs help

All Using Getting

in 1 or

Walking Going 8athing Dressing the in or out

adults more basic outside

Eating

toilet of bed

activities or chair

Both sexes

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

18-44 years . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . .

Male

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

18-44 years . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . .

Female

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

18-44 years . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . .

153.178

86,378

43,457

22,744

20,713

14,929

8,414

6,869

1,544

72,224

41,834

20,773

10,991

9,782

6.494

3,122

2,586

537

80,954

44,544

22,684

11,752

10,931

8,435

5,291

4,283

1,008

3,444 2,470

443 313

895 597

302 203

593 394

785 585

1,321 975

783 574

538 401

1,409 1,044

238 180

424 319

150 118

274 201

321 245

425 300

263 190

162 110

2,035 1,426

205 134

471 277

152 85

320 192

464 339

895 676

520 384

375 292

Number in thousands

2,095

221

444

151

293

510

920

505

415

730

97

193

75

119

182

257

136

121

1,365

124

250

76

174

327

663

369

295

1.390 1,090

151 155

319 314

90 131

230 183

305 215

615 406

348 226

267 180

573 455

81 74

145 146

42 61

103 85

148 93

198 141

118 81

80 60

818 635

70 80

174 168

47 70

127 98

157 122

417 265

230 146

187 119

835

117

189

64

125

173

356

195

162

327

61

91

●32

59

78

96

57

39

508

56

98

*32

66

95

260

137

123

749 303

114 51

210 79

85 *22

125 57

135 58

290 116

177 58

112 58

283 143

48 ●24

98 48

37 *9

60 39

52 “34

86 37

52 *19

●34 “18

465 160

66 ●26

113 ●31

48 “13

65 “18

83 ●24

204 79

125 39

79 40
ackmdaa3

Table 3. Rate per 1,000 adults who naed help in basic physical activities because of a shronic health problem by type of activity, sex, and agst

United States. 1979

[Data are based on household mterwews of the ciwl,an noninst,tutionailzed population]

Needs help Using Getting

Sex and age

in 1 or Walking Going Bathing Dressing

in or out

more basic the Eating

outside toilet of bed

activities or chair

Both sexes

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

18-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

75-B4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male

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

18–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female

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

18-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22.5

5.1

20.6

13.3

28.6

52.6

157.0

114.0

348.4

19.5

5.7

20.4

13.6

28.0

49.4

136.1

101.7

301.7

25.1

4.6

20.8

12.9

29.3

55.0

169.2

121.4

372.0

16.1

3.6

13.7

8.9

19.0

39.2

115.9

83.6

259.7

14.5

4.3

15.4

10.7

20.5

37.7

96.1

73.5

204.8

17.6

3.0

12.2

7.2

17.6

40.2

127.8

89.7

289.7

Rate per 1,000 persons

13.7 9.1 7.1

2.6 1.7 1.8

10.2 7.3 7.2

6.6 4.0 5.8

14.1 11.1 8.6

34.2 20.4 14.4

109.3 73.1 48.3

73.5 50.7 32.9

268.8 172.9 116.6

10.1

2.3

9.3

6.8

12.2

28.0

82.3

52.6

225.3

16.9

2.8

11.0

6.5

15.9

38.8

125.3

86.2

292.7

7.9 6.3

1.9 1.8

7.0 7.0

3.8 5.5

10.5 8.7

22.8 14.3

63.4 45.2

45.6 31.3

149.0 111.7

10.1

1.6

7.7

4.0

11.6

18.6

78.8

53.7

185.5

7.8

1.8

7.4

6.0

9.0

14.5

50.1

34.1

118.1

5.5

1.4

4.3

2.8

6.0

11.6

42.3

28.4

104.9

4.5

1.5

4.4

●2.9

6.0

12.0

30.7

22.0

72.6

6.3

1.3

4.3

“2.7

6.0

11.3

49.1

32.0

122.0

4.9

1.3

4.8

3.7

6.0

9.0

34.5

25.8

72.5

3.9

1.1

4.7

3.4

6.1

8.0

27.5

20.1

“63.3

5.7

1.5

5.0

4.1

5.9

9.8

38.6

29.2

78.4

2.0

0.6

1.8

81.0

2.8

3.9

13.8

8.4

37.6

2.0

“0.6

2.3

“0.8

4.0

●5.2

11.9

*7.3

“33.5

2.0

“0.6

*1.4

●1.1

“1.6

“2.8

14.9

9.1

39.7

ence in the rate per 1,000 was not statistically significant

(169.2 and 136.1, respectively) (table 3).

Health planners and service providers also need estimates

of how many people need help in each particular type of activity. Such counts are duplicative in that a person may need help

in more than one activity. Each of the seven activities is shown

in tables 2 and 3 in descending order of the size of the estimate.

An estimated 2.5’ million people needed help with walking 2.1

million with going outsidq 1.4 million with bathing 1.1 million

with dressing 835,000 with tising the toile~ 749,000 with getting

in or out of a bed or a chain and 303,000 with eating (table 2).

For each type of activity, the rates increased with increased

age. For example, the rate per 1,000 people needing help to

walk was 3.6 per 1,000 people 18-44 years of age compared

with 13.7 for those 45-64 years of age, 39.2 for those 65–74

years of age, 83.6 for those 75–84 years of age, and 259.7 for

those 85 years of age and over (table 3). The rates for people

needing help to bathe ranged from 1.7 per 1,000 people 18–44

years of age to 172.9 per 1,000 for those 85 years of age and

over. A Iarge difference occumed in the rate for peop(e 75 years

of age and over who needed help to ea~ 8.4 for people 75-84

years of age compared with 37.6 for those 85 years of age and

over (table 3).

Although the number of women 75 years of age and over

who needed help in each type of activity was larger than that of

men, the differences between the rates per 1,000 people were

generally not statistically significant by sex. In general, few

statistically significant sex differences occurred in the rate per

1,000 adults who needed help in each type of activity.

Home management activities

Selected home management activities include shopping for

personal items, doing routine household chores, preparing

meals, or handling their own money. In tables 4 and 5, an

unduplicated person count of all adults is show~ the summary

by type of activity shows a duplicative count since a person is

included in as many types of activities in which help is needed.

The sum of the four types in the summary section is greater

than the 4.1 million unduplicated count of adults who need

help in one or more of the selected activities.

In 1979,4.1 million noninstitutionalized adults needed or

received help from another person in at least one of these selected

home management activities (tables 4 and 5). The rate per

1,000 adults needing this help rose with age, 6.1 for people 18–
4

Table 4. Number of adults who need or mcaive help in home management activities because of a chronic health problem, by selected combinations

of activities and aga United States. 1979

[Data are based on Itousehoid mterv!ews of the cwdian nonmstmmo”ahzed pqxJIatIon~

Age

SeJected combination of activities

Al!

adults ?8–44 45–64 45–54 55-64 65–74 75 years 75–84 85 vears

years years years years years and over yeara and- over

Total adult population . . . . . . . . . . . . . . . . . . . . . .

Alladults needing helpI . . . . . . . . . . . . . . . . . . . .

Shopping only . . . . . . . . . . . . . . . . . . . . . . . . . .

Chores only . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Handling money only . . . . . . . . . . . . . . . . . . . .

Meals only . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Shopping andchoras . . . . . . . . . . . . . . . . . . . .

Other combinations of 2 activities. . . . . . . . . .

Meals. shopping, and chores. . . . . . . . . . . . . .

Other combinations of 3 activities. . . . . . . . . .

Meala and shopping and chores and

handling money . . . . . . . . . . . . . . . . . . . . . . .

Unknown type . . . . . . . . . . . . . . . . . . . . . . . . . .

Nohelp reported needed . . . . . . . . . . . . . . . . . . .

Summary by type of activit#

Anymention ofsttopping . . . . . . . . . . . . . . . . . . .

Arty mention of chores . . . . . . . . . . . . . . . . . . . . .

Any mention of handling monay . . . . . . . . . . . . .

Anymention ofmeais . . . . . . . . . . . . . . . . . . . . . .

153,178

4.052

615

577

95

73

525

297

628

227

808

106

149.126

3.054

2.888

1.369

1.880

86.378

525

42

72

51

●13

41

67

55

38

117

*31

85.853

333

312

250

242

43.457

1,080

122

247

*23

“24

141

78

199

35

182

*29

42.377

Number in thousands

22.744 20.713 14,929

419 661 856

38 84 166

100 147 134

“17 “6 ‘6

●6 “18 “19

57 64 114

37 40 47

63 136 155

“15 ●2O 48

71 111 154

“14 “15 “13

22.325 20.052 14.073

709 261 448 651

832 318 514 615

270 118 152 227

473 171 302 378

8.414

1.591

286

124

“16

“17

229

106

219

106

455

“33

6,823

1.361

1.128

622

796

6.869

974

176

63

“16

97

162

72

126

58

247

“28

5,895

814

675

351

449

1,544

616

110

41

“9

67

“33

94

46

208

“6

928

548

453

271

347

‘This IS an unduplicated person count

%is IS a duplicative count in that a person ia included in ss many types of activities in which help is needed.

Table 5. Rate per 1,000 persons who need or receive help in home management mxivides because of a chmrtic health pmblarm by salactad

combinations of activiias and age: United Statas. 1979

[Dataarebasedon household interviews of the cMian naninstitutionalized population]

Age

Selected combination of activities

All

adults 18-44 45-54 45-54 55-64 65-74 75 years 75-84 d?5years

years years years years yeera and over years and over

Rate per 1,000 persons

Aliadults needing heist . . . . . . . . . . . . . . . . . . . . . .

Shopping only . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chores ody. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Handling money only . . . . . . . . . . . . . . . . . . . . . .

Meals only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Shoppirtg andchoma . . . . . . . . . . . . . . . . . . . . . .

Other combinations of 2 activities. . . . . . . . . . . .

Meals and shopping and chores . . . . . . . . . . . . .

Other combinations of 3 activities. . . . . . . . . . . .

Meals and shopping and chores and

handking money . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown type . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nohelp reported needed . . . . . . . . . . . . . . . . . . . . .

Summary by type of activityt

Anymerwion of shopping . . . . . . . . . . . . . . . . . . . . .

Anymention of chores . . . . . . . . . . . . . . . . . . . . . . .

Anymention of handling money. . . . . . . . . . . . . . .

Anymention ofmeais . . . . . . . . . . . . . . . . . . . . . . . .

26.5

4.0

3.8

0.6

0.5

3.4

1.9

4.1

1.5

5.9

0.7

973.5

19.9

18.9

8.9

12.3

6.1

0.5

0.8

0.6

“0.2

0.5

0.8

0.6

0.4

1.4

“0.4

993.9

3.9

3.6

2.9

2.8

24.9

2-8

5.7

‘0.5

“0.6

3.2

1.8

4.6

0.8

4.2

“0.7

975.1

16.3

19.1

6.2

10.9

18.4

1.7

4.4

“0.7

“0.3

2-5

1.6

2.8

“0.7

3.1

“O-6

981.6

11.5

14.0

5.2

7.5

31.9

4.1

7.1

●O3

“0.9

4.1

T.9

6.6

●1.O

5.4

“0.7

968.1

21.6

24.8

7.3

14.6

57.3

11.1

9.0

“0.4

81.3

7.6

3.1

10.4

3.2

10.3

“0.9

842.7

43.6

41.2

15.2

25.3

189-1

34.0

14.7

‘1.9

●2O

27.2

12-6

26.0

126

64.1

“3.9

8T0.9

161.8

134.1

73.9

94.6

141.8

26.6

12.1

*2.3

81.0

23.6

70.5

18.3

8.4

36.0

‘4.1

858.2

118-5

98-3

51-1

65.4

399.0

71.2

26.6

“5-8

43.4

“21 .4

60.9

31.1

134.7

“3.9

601.0

354.9

293.4

175.5

224.7

lThase rstas are based on an unduplicated person count.

%asa rsras are based on a duplicate count m that a petson IS included in as many types of actwmesin whtchhelp IS needed
5

44 years of age, 24.9 for those 45-64 years of age, 57.3 for

those 65–74 years of age, and 189.1 for those 75 years of age

or over (table 5]. The rates for people 75-84 years of age and

for those 85 years of age and over also differ significantly

(141.8 and 399.0 per 1,000, respectively).

Unduplicated counts of people needing help in selected,

frequently occurring, combinations of home management activities were also identified. With increased age, there was a

substantial increase in the rates for people needing the”help of

another person in the following selected combinations of activities shopping only chores only meals, shoppin% and chores

and meals, shopping, chores, and handling money.

In tables 4 and 5, the “summary by type of activity” category shows duplicative counts in each of the four activities.

A person is included in as many activities as he or she needs

help in.

For each type of activity, the likelihood of needing help

increases with age. A marked increase occurs between the two

oldest age categories.

Some patterns emerge for the elderly when the “summary

by type of activity” is examined (tables 4 and 5). For example,

people 65-74 years of age are more likely to need help with

shopping or chores (43.6 and 41.2 per 1,000, respectively)

than with meals (25.3 per 1,000) or money (15.2 per 1,000)

(table 5). Furthermore, the likelihood of their needing help

with meals (25.3 per 1,000) exceeds that of needing help with

handling money (15.2 per 1,000).

People 75 years of age and over are somewhat more likely

to need help shopping (161.8 per 1,000) than to need help with

chores (134. 1 per 1,000). Also, the need for help with shopping

or chores exceeds that for either meals or money (94.6 and

73.9 per 1,000, respectively) (table 5). This pattern also generally holds for people 75-84 years of age and 85 years of age

and over.

Adults usually staying in bed

An estimated 848,000 people living outside of an institution

were reported as usually staying in bed all or most of the time

because of a chronic health probiem (table 6). The rate is generally higher among older age categories, ranging from 1.4 per

1,000 people 18-44 years of ageto 51.2 for those 85 years of

age and over (table 6). A sharp increase occurred between 65–

74 years of age (11.3 per 1,000) and 75 years of age and over

(30.4 per 1,000). In general, no statistically significant difference was found between males and females in the rates per

1,000 adults who usually stay in bed all or most of the time.

Adults with bowel or urina~ trouble

An estimated 1.5 million noninstitutionalized adults had a

device to control bowel movements or urination or had other

trouble controlling bowel movement or urination (table 7). First,

a question was asked to ascertain whether a person had a deTable 6. Number of adults and rate per 1,000 who usually stey

in bed all or most of the time because of a chronic health problem,

by sex and age United States, 1979

[Data are based on household intenuews of the ciwhan nonmsutut,onalized

population]

Total Adults who Adults who

Sex and age adults usually stay usually stay

in bed in bed

Both sexes

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

18-44 years . . . . . . . . . . . . .

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

45–54 years . . . . . . . . . . .

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

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

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

75-84 years . . . . . . . . . . .

85 years and over . . . . . .

Male

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

18-44 years . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . .

85 vears and over . . . . . .

Rate per

1,000

Number in thousands Dersons

153,178

86.378

43.457

22,744

20.713

14,929

8,414

6,869

1,544

848

118

306

141.

165

169

256

176

79

5.5

1.4

7.0

6.2

8.0

11.3

30.4

25.6

51.2

72,224

41,834

20,773

10,991

9,782

6,494

3,122

2,586

537

399

66

165

76

88

77

91

58

“33

5.5

1.6

7.9

6.9

9.0

11.9

29.1

22.4

●61 .5

Female

Tots] . . . . . . . . . . . . . . . . . . . 80,954

18-44 years. . . . . . . . . . . . . 44,544

45-64 yeare . . . . . . . . . . . . . 22,684

45-54 years . . . . . . . . . . . 11,752

55-64 years . . . . . . . . . . . 10,931

65-74 years . . . . . . . . . . . . . 8,435

75 years and over . . . . . . . . 5,291

75-84 years . . . . . . . . . . . 4,283

85 years and over . . . . . . 1,008

450

52

142

65

77

92

165

118

46

5.6

1.2

6.3

5.5

7.0

10.9

31.2

27.6

45.6

vice. People who did not have a device were asked whether

they had any other trouble controlling bowel movements or

urination. About 10. I per 1,000 adults had such problem% 7.9

per 1,000 had other trouble and 2.2 per 1.000 had a device to

control bowel movement or urination (table 8).

The rates per 1.000 people who had a device to control

bowel movement or urination or other trouble controlling

twwel movement or urination increased with age. For example.

1.9 per 1.000 people 45-64 years of age. 5.3 per 1.000 people

65–74 years of age. and 13.9 per 1.000 people 75 years of age

and over had a device to control bowel movements or urination

(table 8). In addition. the rates for those who had other trouble

controlling bowel movement or urination were 7.5 per 1.000

people 45-64 years of age. 17.3 per 1.000 people 65-74 years

of age. and 46.7 per 1.000 people 75 years of age and over.

Generally, for most agc categories under 75 years of age.

females reported higher rates ofotlwr troutilc controlling bowel

movements or urination than nuilcs did.
6adwme&&

Table 7. Number of adults who have device to control bowel movement or urination, and number who have other trouble controlling bowol

movement or urination, by sex and age United States, 1979

[Data are baaed on household mterwews of the cwllran norrmst,tutlonal!zed populatmn]

Sex and age

Has device

All Has device

or other trouble Has other trouble

adults controlling bowel to control controlling

bowel or bladder

or bladder bowel or bladder

Both sexes

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

18-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male

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

18-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 y’ears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

75-84 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female

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

18-44 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

153,178

86,378

43,457

22,744

20,713

14,929

8,414

6,869

1.544

72,224

41,834

20,773

10,991

9,782

6,494

3,122

2,586

537

80,954

44,544

22,684

11,752

10,931

8,435

5,291

4,283

1,008

1,543

284

412

149

263

338

510

337

172

534

89

158

73

85

95

191

127

63

1,009

194

253

76

178

243

319

210

109

Number in thousands

335

55

84

●33

50

79

117

74

44

176

*24

62

●3O

“32

38

52

35

“17

159

*31

●22

*4

●18

41

65

38

●27

1,208

229

328

116

21:!

258

393

26fL

129

357

65

97

44

53

57

139

92

4 j,

85CI

164

231

72

159

202!

254

172

82

Adults needing the help of

another person

The following items were used in the Home Care Supplement to define people who needed the help of another person2

in selected essential activities due to a chronic health problem:

● Need or receive the help of another person3 in one or more

of the following seven activities: walking, going outside,

bathing, dressing, using the toile~ getting in or out of a bed

or a chair, or eatin~

● “Doesn’t do” one or more of the seven activities listed

above (these people were assumed to need the help of another person);

● Need or receive the help of another person in one or more

of the following four activities: shopping for personal items,

2The~e ~rjteria 5]s0 define the Individual Home care Population for whom

additional information was obtained on who provided the help and how often

the help was provided.

Speop]e repofled to have functional disability who use SPeCiai equlPment ‘niy

or people for whom it is unknown whether they use spec]al equipment or need

the help of snother person are not included. They are included m tables 2 and 3.

doing routine household chores, preparing their own meals,

or handling their own money;

. Usually stays in bed all or most of the time (these people

were assumed to need the help of another person);

. Need or receive the help of another person with a device to

control bowel movement or urination.

An estimated 4.9 million adults 18 years of age and over

living in the community needed the help of another person in

these selected activities in 1979 (table 9). The rate per 1,000

people was substantially higher among older adults than among

young ones. The rates of adults who needed the help of another

person were 7.8 per 1,000 people 18-44 years of age, 31.2 for

those 45-64 years of age, 69.9 for those 65-74 years of age,

and 211.0 for those 75 years of age and over (table 9). The

rates for people 75-84 years of age and those 85 years of age

and over also differ significantly ( 160.3 per 1,000 and 436.5

per 1,000, respectively).

In general the rates for women 45 years of age and over

were significantly higher than those for men. For example,

237.2 per 1,000 women 75 years of age and over needed help,

compared with 166.6 per 1,000 men 75 years of age and over

(table 9).
aduancedata 7

Table 8. Rate per 1,000 persons who have device to control

bowal movement or urination and number who have other trouble

controlling bowel movement or urination, by sex and age United

Statea, 1979

[Dataarebased on household interviews of the civdian nonmstttuttonalized

population]

Has device Has Has other

or other

Sex and age

device

trouble

trouble

to control

controlling controlling

bowel

bowel bowel

or bladder

or bladder or bladder

Both sexes

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

18-44 years . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . .

85 years and over. . . . . . .

Male

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

18-44 years . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . .

B5 years and over. . . . . . .

Female

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

18-44 yeara . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . .

85 years and over. . . . . . .

Rate par 1,000 persons

10.1 2.2 7.9

3.3 0.6 2.7

9.5 1.9 7.5

6.6 *1.5 5.1

12.7 2.4 10.2

22.6 5.3 17.3

60.6 13.9 46.7

49.1 10.8 38.4

111.4 28.5 83.5

7.4

2.1

7.6

6.6

8.7

14.6

61.2

49.1

117.3

2.4

“0.6

3.0

●2.7

83.3

5.9

16.7

13.5

*31 .7

12.5 2.0

4.4 “0.7

11.2 ‘1.0

6.5 90.3

16.3 *1.6

28.8 4.9

60.3 12.3

49.0 8.9

108.1 *26.8

4.9

1.6

4.7

4.0

5.4

8.8

44.5

35.6

87.5

10.5

3.7

10.2

6.1

14.5

23.9

48.0

40.2

81.3

Adults receiving nursing

or medical care

Each person was also asked about the following four types

of nursing or medical treatment received at home: injections,

physical therapy, changing bandages, and “other.” Approximately 1.3 million people received at least one of these specified types of medical or nursing treatments at home (table 10).

The rate per 1,000 people ranged from 3.3 for people 18-44

years of age to 88.7 for those 85 years of age and over (table 11).

The difference in rates was not significant by sex, although for

each sex the rates rose with age for most of the categories.

Injection was the type of treatment received by most of the

Table 9. Number of adults and rate per 1,000 who need the help

of another person in one or more salected activities, by sex and

age: United States, 1979

[Data are based on household interviews of the civilian nontnstmmonaiized

population]

Sex and age

All

Needs help of another adults

Both sexes

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

18-44 years . . . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . . . .

85 years and over. . . . . . . . .

Male

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

18-44 years . . . . . . . . . . . . . . .

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

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

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

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

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

75–84 years . . . . . . . . . . . . .

85 years And over . . . . . . . . .

Female

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

18-44 years . . . . . . . . . . . . . . .

45–64 year n. . . . . . . . . . . . . .

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

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

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

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

75-84 years . . . . . . . . . . . . .

85 years and over. . . . . . . . .

Number

in thousands

153,178 4,851

86,378

43,457

22,744

20,713

14,929

8,414

6,869

1,544

72,224

41,834

20,773

10,991

9,782

6,494

3,122

2,586

537

80,954

44,544

22,684

11,752

10,931

8,435

5,291

4,283

1.008

676

1,357

526

832

1,043

1.775

1,101

674

1,741

303

559

223

336

359

520

330

190

3,110

373

798

303

495

684

1,255

771

483

Rate per

1,000 persons

31.7

7.8

31.2

23.1

40.2

69.9

211.0

160.3

436.5

24.1

7.2

26.9

20.3

34.3

55.3

166.6

127.6

353.8

38.4

8.4

35.2

25.8

45.3

81.1

237.2

180.0

479.2

1A person IS considered as needing the help of another person If at least one

of the following Items was reported as applicable because of a chronm health

pmblerm (A} Needs or receives the help of another person m performmg one

or more of the following 7 acuvmes-walkmg. going outside. bathing, dresamg,

eating, using the to!let, or gemng m or out of bed or chain (people who need

spec!al equ!pment only and people for whom tt was unknown whether they needed

special equupment or the help of another person were not included:) (B) ““Doesn’t

do”” one or more of the 7 activities Issted above: [C] Needs or recewes the help

of snother person m one or more of these 4 actwmea-preparmg own

meals. shopping for personal items. doing rouone chores, or handling own monefl

(D) Usually stays m bed all or most of the t!me: (E) Needs the help of another

parson m taking care of a dewce to control bowel movement or urmatlon.

people. The rate for people receiving injections ranged from

2. ~ per 1,000 people 18–44 years of age to 33.7 per 1,000

people 85 years of age and over (table 11). Marked increases

occurred between 65–74 years of age, 75-84 years of age, and

85 years of age and over. In general, rates for males receiving

injections at home were not significantly different from those

for females.
8

Table 10. Number of adults who receive selected services, by type of services, sex, end age: United States, 1979

[Data are based on household interwews of the cwdtan nonmstitutmnalized population]

Type of nursing or medical care received

Sex and age

All

adults 1 or more

Injections Physical Changing

treatments therapy bandages Other

Both sexes

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

18-44 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

55–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

7’5-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male

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

18-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female

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

18-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

45-54 yeare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . .

153,178

86,378

43,457

22,744

20,713

14,929

8,414

6,869

1,544

72,224

41,834

20,773

10,991

9,782

6,494

3,122

2,586

537

80,954

44,544

22,684

11,752

10,931

8,435

5,291

4,283

1,008

1,309

2B3

407

198

210

221

398

261

137

544

121

201

91

110

90

132

80

52

765

162

207

107

100

131

266

181

85

Number in thousanda

791 200

184 52

2B6 51

155 “13

131 37

130 “33

192 64

140 42

52 ●22

337 74

76 ●28

137 *16

70 “2

68 “13

61 ●8

63 “22

38 “15

●25 ●7

454 127

107 “24

148 35

85 “11

63 ●24

70 “25

129 42

101 “27

’27 ●15

128

*26

38

’23

“15

●14

50

35

*15

57

*11

*26

●15

●11

*1 1

●8

“3

*6

71

●14

●11

●8

*3

“3

42

●32

*lo

347

38

59

“18

41

79

171

100

72

121

●13

●29

*8

“21

“27

52

“33

*19

226

“25

“30

●lo

*2O

52

119

66

53
admcdaa9

Table 11. Rateperl.000 pemtnuwho rachadectad s-f-a.bm=of~ =JLti=lF u*6=ee. lg78

[Datawe baaedcmhcwseholdrote- of the civihennowmmmrma lied PCWletmn]

Type of nursing or mediwl care received

S8s and age Iormore

lnje~s Fhysiwl Changing

treatments therapy bandages Other

8oth Seses

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

1644 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 yeas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

75yeara andover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75.84 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years andover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3

9.4

8.7

10.1

14.8

473

38.0

88.7

Rate per 1.000persons

5.2 1.3

21 0.6

6.6 1.2

6.8 “0.6

6.3 1.8

8.7 “z?

2Z8 7.6

20.4 6.1

33.7 “14.2

0s

80.3

0.9

●I .0

“0.7

“03

5.8

5.1

*9.7

23

0.4

1.4

‘0.8

20

5.3

203

14.6

46.6

TomI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7s

18-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

75years andovar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fema[e

2s

9-7

82

112

13.9

422

309

86.6

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.4

18-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4SWpa= . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yearn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

6S74waw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75yeara andovar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75.84 yeas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.6

9.1

9.1

9.1

155

503

423

643

4.7 1.0

1.8 *0.7

6.6 “0.8

6.4 *O2

7.0 “1.3

9.4 “1.2

20.2 “7.0

14.7 “5-8

“46.6 “13.0

5.6 1.6

24 ●O3

6.5 1.5

7.2 “09

5s “2.2

8.3 “3.0

24.4 7.9

23.6 ‘6_3

●26.8 “34.8

0.8

“0.3

“1.3

81.4

●1.1

*1.7

*2.6

●1.2

“112

03

“03

“0.5

“0.7

80.3

‘0.4

7.8

●7.5

*9.9

T.7

“0.3

*1.4

“o-?

*21

‘4.2

16-7

“IZ8

“35.4

Z8

“0.6

“13

“0.9

*1.8

62?

225

15.4

52-6
10

Technical notes

Source and limitationsof data

The National Health Interview Survey (NHIS) is a crosssectional, nationwide survey conducted by household interview.

A probability sample of households is interviewed each week

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

information on the health and other characteristics of each

member of the household in the civilian noninstitutionalized

population.

During the 52 weeks in 1979, the sample consisted of ap

proximately 42,000 households including about 111,000 people

living at the time of the interview. The total nonintetview rate

was about 3.9 percent—2.2 percent of which was due to respondent refusal and the remainder primarily due to an inability

to locate an eligible respondent at home after repeated calls. A

description of the survey design, methods used in estimation,

and general qualifications of the NHIS data is provided in

Current Estintatesfiom the Nalional Health Interview Survey:

United States, 1979.4

The estimates shown in this report are based on a sample

of the civilian noninstitutionalized population rather than on

the entire population. Therefore, they are subject to sampling

error. Some tables in this report contain cells in which the estimate is small for a given characteristic. When an estimate or

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

error may be relatively high. Approximate relative sampling

errors for estimates in this report are shown in tables I and II.

Detailed information on reliability of estimates is available in

the appendix of another publication.4

For comparative statements in this report, terms such as

“similar” and “the same” mean that no statistically significant

difference exists between the statistics being compared. Terms

relating to differences, such as “greater,” and “less,” indicate

that the differences are statistically significant. A critical value

dNati~nal Center for Health Statistics. S. Jack and P. Ries: Current Estimates

from the National Health Interview Survey, United States. 1979. Vital and

Hea/rh .Smfisrics. Series IO-NO. 136. DHHS Pub. No. (PHS) 81-1564. Public

Health Service. Washington. U.S. Government Printing Ofilce. Apr. 1981.

Table 1. Standard errors of estimates of aggregates

Standard

size of estimate in thousands error in

thousands

35, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

300 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

5,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 174

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

30,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278

150,000, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393

Table 11. Standard errors, expressad in parentage points of rates

per 1,000 parsona

Estimated rates per 1,000

Base of rates

per 1,000 20 50 100 200

in thousands 500

9;0 9;0 9:0 8;0

100 . . . . . . . . . . 25 39 54 72 90

300 . . . . . . . . . . 15 23 31 42 52

500 . . . . . . . . . . 11 18 24 32 40

1,000 . . . . . . . . 8 12 17 23 29

5,000 . . . . . . . . 4 6 8 10 13

10,000 . . . . . . . 3 4 5 7 9

20,000 . . . . . . . 2 3 4 5 6

30,000 . . . . . . . 1 2 3 4 5

150,000 . . . . . . 1 1 1 2 2

of 1.96 (0.05 level of significance) was used to test all comparisons that are discussed. Lack of comment regarding the

differences between any two statistics does not mean that the

difference was tested and found to be not significant.

Definitions of terms

The Home Care Supplement to the 1979 NHIS obtained

information on the need for assistance in selected fictional

activities, condition causing the need for assistance, and bowel

and urinary trouble. In addition, for people needing the help of

another person, information was obtained on who provided the

help and how often the help was provided. A copy of the complete supplement is provided in Series 10-No. 136.4

Although specific definitions were not given to the respondents for the Home Care Supplement, interviewers were

provided with the following guidelines regarding some terminology.

Doing household chores refers to routine chores such as

washing dishes, doing laundry, dusting or sweeping. Heavier

or more diflicult jobs, such as washing windows or wallls or

making repairs to the house. are not included.

Shopping does not include persons who need help getting

to the store, but once there can shop without assistance.

Handling money includes paying bills, cashing checks,

managing accounts, and related activities.

Receiving or needing help requires physical assistance to

perform one or more of seven selected activities. This includes

such help as support from another person, someone to wash the

back or turn on the shower, or being fed. It also includes people

who are able to perform the’ activity without help but must be

supervised. for example, someone must be present in case the

person falls while bathing.

5u s, DePa~ment of Commerce, Bureau of the census. Acting as a collecting

agent for U.S. Public Health Service: Health Interview Survey Interviewer’s

Manual. HIS-1OO (1979).
dwncdda 11

Using special equipment includes use of equipment or devices used specifically to aid in a particular activity such as a

cane, a walker, or a special spoon or fork. Includes devices

installed to aid in the activity, such as rails along the bathtub or

toile~ ramps, or elevators.

Using the toilet in the bathroom includes adjusting clothes

and cleaning oneself after using the toilet,

Bathing includes getting or turning on the water for a bath,

shower, or sponge bath, getting to, in, and out of a tub or a

shower, and if used, washing and drying oneself.

Dressing includes putting on braces, getting clothes from

closets and drawers, putting them on, fastening buttons, zippers,

snaps, or other closures. However, it does not include the occasional need to have someone help with a zipper or other

closures that a normally healthy person would have difficulty

doing.

Eating includes getting the food from the plate into the

mouth, but does not include cutting or otherwise preparing the

food.

Gezting in and out of bed or chairs includes wheelchairs.

Accidents or trouble controlling bowel or urination includes

accidentally wetting or soiling one’s self, but does not include

occasional slight “leaking.” Also, people are considered as

having “accidents or trouble controlling” if they must always

have enemas because they are unable to empty their bowels.

Colostomy and un”nary catheter are surgical openings

artd/or devices used to aid in urination or bowel movements

when the person has lost natural control of these functions

through illness, disability, surgery, or other causes.

Receives or needs help from anotherperson in taking care

of the device includes personal assistance or supervision in

operating or cleaning the device, or in emptying the bags.

Chronic conditions, disabili~, or health problem includes

a condition that is described by the respondent as having first

been noticed more than 3 months before the week of the interview, or one of the conditions always classified in the NHIS as

chronic regardless of onset A list of these conditions is provided

in another publication.4 Only people with a chronic condition,

disability, or health problem were included. Those with acute

conditions were excluded from the data base. However, for

anyone found to have an unknown type of condition causing

the need for help, the NHIS concept of major limitation of

activity due to a chronic condition or impairment was used to

indirectly determine chronic limitation. Major activi~ limitation

is defimed in another repor&6

6National Center for Health Statistics, B. A. Fellen Health characteristics of

personswith chronicactivity limitation, United States, 1979. Vital and Health

.Wafistics. Series 1O-NO.137. DHHS Pub. No. 82-1565. Public Health Service.

Dec. 1981.

Symbols

..- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
Utilization of Shoti-Stay Hospitals by Adolescents:

United States, 1980

by Edmund J. Graves, Division of Health Care Statistics

Introduction

Estimates of the characteristics and diagnostic conditions

of patients 12– 19 years of age discharged from non-Federal

short-stay hospitals during 1980 are presented in this repott.

The statistics in this report are based on data collected through

the National Hospital Discharge Survey, a continuous voluntary survey conducted by the National Center for Health Statistics since 1965. Approximately 224,000 medical records

from 420 participating hospitals were included in the 1980

Sumey.

A brief description of the sample design, source of data,

and definition of terms used can be found in the technical notes.

A description of the design of this survey was published in

1977.1

Although previous reports have included data by the four

major age groups (less than 15 years, 15-44 years, 45–64

years, and 65 years and over), this report includes data only for

adolescents 12-19 years of age. It provides national estimates

on the use of non-Federal short-stay hospitals by this group

during 1980. Data are summarized by selected demographic

characteristics of patients discharged and conditions diagnosed.

Types of hospital utilization shown are frequencies, rates, percent distribution of discharges and average length of stay. The

estimates are presented by age, sex, geographic region, and

expected source of payment.

Conditions diagnosed are coded by the International ClasszJ7cation of Diseases, 9th Revision, Clinicai i140dl~cation2

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

design of the NCHS Hospital Discharge Survey, Vital and Health Statistics.

PHS No. 1000-Series 2-No. 39. Public Health Service. Washington. U.S. Government Printing Oftice, Sept. 1970.

2Nation~ Center for Healti Statistics Inrernationaf chS@CcXiOn OflXseases, 9th Revision, Clinical Modification DHHS Pub. No. (PHS) 80-1260.

Public Health Service. Washington. U.S. Government Printing Oftice, Sept.

1980.

(ICD-9-CM) and are presented by the chapters of the ICD9-CM and for selected conditions based on this coding scheme.

Highlights

Highlights of hospital utilization among adolescents are

shown bdOW.

● Adolescents 12-19 years of age comprised approximately

14 percent of the United States civilian population but

only about 7 percent of the discharges from non-Federal

short-stay hospitals.

. Of the 2.8 million adolescents discharged, 36 percent were

male and 64 percent were female.

● Private insurance was expected to be the principal payor

for over 60 percent of all hospitalizations for adolescents

and Medicaid was expected to be the principal payor for

under 20 percent.

. Obstetrical deliveries accounted for about one third of female

discharges for adolescents.

● Injury and poisoning accounted for about one third of male

discharges for adolescents.

Utilization

Selected measures of hospital utilization by sex for adolescents are shown in table 1. During 1980, 2.8 million adolescents

12-19 years of age were discharged from shofi-stay hospitals.

T3tiswas about 7 percent of the 38.5 million patients (excluding

newborn infants) d~charged from short-stay hospitals. Of the

2.8 million adolescent discharges, 1.0 million (36 Wrcent) were

male and 1.8 million (64 percent) were female. The rate for

males was 628 per 10,000 population and for females it was

1,167 per 10,000 population. Thus, the rate for females was

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

of discharges are higher for females than for males because a

*large number of teenage women were hospitalized for delivU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Heakh Serwce
2

Table 1. Number, percent distribution, rete, and average length of stay for adolescents discharged from short-stay non-Federal hospitals by ege

of patient according to sex United States, 1980

Age

Sex

Total 12 13 14 75 76 17 18 19

years years years years years years years years

Number of discharges in thousands

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,837 149 167 212 290 378 475 555 610

Male . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . 1,008 85 80 99 121 138 159 168 158

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,829 64 87 113 170 240 316 386 452

Female (excluding obstetrical conditions} . . . . . . . . 1,059 63 83 95 130 157 167 180 185

Percent distribution

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 5.3 5.9 7.5 10.2 13.3 16.8 19.5 21.5

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 8.4 7.9 9.9 12.0 13.7 15.8 16.7 15.7

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 3.5 4.8 6.2 9.3 13.1 17.3 21.1 24.7

Female (excluding obstetrical conditions) . . . . . . . . 100.0 6.0 7.8 9.0 12.2 14.8 15.7 17.0 17.4

Rate per 10,000 population

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 894.6 423.4 462.2 566.7 727.5 905.4 1,131.5 1,334.9 1,420.0

Mele . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 628.3 471.6 432.7 519.7 592.3 648.2 746.5 812.0 “747.3

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,167.3 373.2 492.9 615.6 868.2 1,173.2 1,526.6 1,856.0 2,072.4

Female (excluding obstetrical conditions) . . . . . . . . 675.9 366.6 467.4 518.8 662.3 767.1 804.0 866,1 846.1

Average length of stay

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 5.2 4.7 5.2 4.9 4.9 4.8 4.6 4.4

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4 4.9 4.5 4.7 4.8 5.8 6.1 5.6 6.0

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4 5.7 4.8 5.8 5.0 4.4 4.1 4.1 3.8

Female (excluding obstetrical conditions) . . . . . . . . 5.0 5.7 4.9 5.4 5.3 5.0 5.0 5.0 4.6

cries and other obstetrical conditions. Excluding this category,

the rate for female discharges was 676 per 10,000 population

which was not sigti~lcantly diRerent from the rate for males.

Approximately three-fifths of all adolescent discharges occurred among 17-19 year olds, while only one fifth of all adolescent discharges occurred among 12-14 year ohis. Nearly

threequarters of the 17-19 year olds discharged were female

while only about half of the 12-14 year olds were female.

Annual rates of discharges per 10,000 population for adolescents increased consistently with increased age. The rate increased from 423 for 12 year olds to 1,402 for 19 year olds—

an overall increase of 235 percent. With the exception of males

13 and 19 years old, the annual rates of discharges for males

and females followed the same pattern as the amual rates of

discharges for all adolescents. The rate for males increased

from 433 for 13 year olds to 812 for 18 year oids—an overall

increase of 88 percent. For females, the increase was from 373

for 12 year olds to 2,072 for 19 year olds-an overall increase

of 455 percent Annual rates of discharges for females, excluding

deliveries and obstetrical conditions, were similar to the change

in discharge rates for males-increasing from 367 for 12 year

olds to 846 for 19 year okis-an overall increaseof131 percerk

The average length of stay for adolescents 12–19 years of

age was 4.7 days. For males it was 5.4 days and for females it

was 4.4 days. However, if females with deliveries and other

obstetrical conditions are excluded, the differences iP the average length of stay between sexes was not significant-5.4 for

males and 5.0 for females.

In 1980, discharges from short-stay hospitals by geographic region for adolescents was higher in the South 987,000

(35 percent) and North Central 857,000 (30 percent) regions

and lower in the Northeast 546,000 (19 percent) and West

446,000 (16 percent) (table 2). These figures are consistent

with the dkribution of discharges of ail ages—34 percent for

the South, 29 percent for North Central, 21 percent for the

Northeast and 16 percent for the West.

Average lengths of stay in days for adolescents by gee

graphic region were 4.2 days in the Westj 4.3 days in the South,

5.0 days in the Northeast, and 5.3 days in the North Central.

For adolescents, hospitalization was longest in the North Central and Northeast Regions and shortest in the South and West

Regions. Average length of stay for all patients showed a sliy$tly

different pattern. For all patients the highest length of stay was

8.5 days for patients in the Northeast while the lowest length of

stay was 6.1 days for patients in the South.

Of the 2.8 million adolescents discharged from nonFederal short-stay hospitals in the United States during 1980,

Tabla 2. Number, percent distribution, and average length of stay

for adolescents discharged from short-stay non-Federal hospitals,

by geographic ragiorx United States. 1980

Number of

Region discharges

Percent Average length of

(in thousands) ‘istr’b”t’on

stay in davs

All regions. . . . . 2,837 100.0 4.7

Northeast. . . . . . 546 19.2 5.0

North Centrsl. . . 857 30.2 5.3

South . . . . . . . . . 987 34.8 4.3

West . . . . . . . . . . 447 15.8 4.2
adwwe&a3

private insurance was the principal expected source of payment for 63 percent of the dkcharges, Medicaid for 17 percent

and self (family) payment for 11 percent (table 3). However,

only 36 percent of female adolescents admitted for delive~

expected private insurance to pay for their bill and 30 percent

expected to be covered by Medicaid (table 4).

There were no significant differences in the average length

of stay for adolescents by specific age and source of payment.

The average length of stay for all adolescents was 4.7 days.

The average length of stay for patie “, using private insurance

was 4.9 days, for those citing Medica~ as a source of payment

it was 4.5 days, for those paying their own bills it was 3.9 days,

and for those using other sources of payment, it was 5.3 days.

As shown in table 5, 2.2 million (78 percent) of the adolescents discharged from short-stay h~spitais were never married while 0.4 million (16 percent) were currently married. Of

those adolescents that were married, 94 percent were female.

This is to be expected since many female adolescents are hospitalized for deliveries or other pregnancy-related conditions.

Of the 582,000 deliveries, 279,000 (48 percent) were to nevermarried women and 272,000 (47 percent) were to currently

married women. The remaining 30,000 (5 percent) were separated or divorced women or women whose marital status was

not stated. Also of significance is that single females comprised

66,000 (73 percent) of the 91,000 abortions performed on adolescents in hospitals.

Number, rate, and average length of stay for adolescents

by diagnostic classes and related diagnoses are given in table 6.

Supplementary classification (which includes females with deliveries), injuries and poisons, and diseases of the digestive

system, accounted for about 50 percent of all adolescent

discharges.

Table 4. Number and percent distribution of female adolescents

with deliveries discharged from short-stay non-Fadaral hospitals.

by principal expected source of payment United States. 1980

Expected source of payment Number Percent

distn”burion

Total..., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 582 100.0

Private i.,. rsnce . . . . . . . . . . . . . . . . . . . . . . 211 36.2

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 30.0

Seif pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 21.8

Other sources . . . . . . . . . . . . . . . . . . . . . . . . . 70 12.1

For femaIes, deliveries was the ‘leading diagnostic condition and accounted for 582,000 (32 percent) of female adolescent discharges. Abortion with 91,000 discharges (5 percent)

and complications mainly related to pregnancy with 83,000

discharges (5 percent) were also leading diagnostic conditions

for adolescent females. A leading diagnostic condition for female

adolescents not connected with the genitourinary-reproductive

system was chronic disease of the tonsils and adenoids with

76,000 ducharges (2 percent).

For males, fractures was the leading diagnostic condition

and accounted for 105,000 (10 percent) of male adolescent

discharges. Lacerations and open wounds, with 47,000 discharges (5 percent), and appendicitis and other dkeases of the

appendix, with 46,000 discharges (5 percent), were ako leading

diagnostic conditions for adolescent males.

The average length of stay for adolescent patient discharges

from short-stay hospitals during 1980 was 4.7 days (table 6).

This was significantly less than the average of 7.3 days for all

patients discharged from these hospitals during 1980. Teenagers with mental disorders had the longest lengths of stay—

Table 3. Number. percent distribution, and average length of stay for adolescanta discharged from short-stay non-Fadwal hospitals by age

of patient according to principal expected source of paymenti United States, 1980

Age

Source of peyment All 12 13 14 15 16 r7 18 19

ages years years years years yeers years yeers years

Numbar of discharges in thousands

Total . . . . . . . . . . . . . . . . . . . . . . 2,837 149 167 212 280 378 475 555 610

Private insuranca . . . . . . . . . . . . 1,793 107 121 151 196 251 307 322 338

Medicaid . . . . . . . . . . . . . . . . . . . 463 25 26 35 46 57 81 100 110

Self pay . . . . . . . . . . . . . . . . . . . . 308 8 7 14 23 36 53 76 91

Another sourcea, . . . . . . . . . . . 253 9 13 12 23 33 35 56 70

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 lm.o 100.0 100.0 100.0 100.0 100.0 100.0

Private insurance . . . . . . . . . . . . 63.2 71.3 72.3 71.1 67.6 66.6 64.6 58.0 55.5

Medicaid . . . . . . . . . . . . . . . . . . . 17.0 16.9 15.6 16.6 16.5 15.2 17.1 18.1 18.1

Self pay . . . . . . . . . . . . . . . . . . . . 10.9 5.5 4.1 6.4 8.0 9.5 11.0 13.7 15.0

Allothersouroes . . . . . . . . . . . . 6.9 6.3 8.0 5.9 8.0 8.7 7.3 10.1 11.5

Avarsge length of stay

Total . . . . . . . . . . . . . . . . . . . . . . 4.7 5.2 4.7 5.2 4.9 4.9 4.8 4.6 4.4

Private insuranca . . . . . . . . . . . . 4.9 5.1 4.9 5.5 4.7 5.2 5.0 4.5 4.3

Medicaid . . . . . . . . . . . . . . . . . . . 4.5 6.5 3.7 4.5 4.9 4.4 4.3 4.2 4A

Self pay . . . . . . . . . . . . . . . . . . . . 3.9 4.3 4.2 3.6 4.3 3.4 3.9 4.0 3.9

All other sources . . . . . . . . . . . . 5.3 4.3 4.7 5.3 5.1 5.0 5.0 6.3 582
4 advancedata

Table 5. Number and-percent distribution of adolescence discharged from short-stay non-Federal hospitals. by marital status

United States, 1980

Number of discharges Percent distribution in thousands

Marital status

Both Male Female Both

sexes

Mala Fetnale

sexes

—

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,837 1,008 1,829 100.0 100.0 1C)o<o

Currently reame d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440 27 414 15.5 2.7 ;!2.6

Never married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,222 926 1,297 78.3 91.8

Other and not stated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70.9

175 56 119 6.2 5.5 6.5

16.4 days for all mental disorders and 24.0 days for psychosis. disorders. It should be noted that the chapter mental disorders

The average length of stay ( 16.4 days) for all mental disorders includes diagnoses of drug and alcohol dependence as well as

was over twice as long as any other ICD–9–CM chapter total other psychotic and neurotic disorders. By selected conditions,

for adolescents and was significantly longer than the average other long stays were noted for malignant neoplasms (7.5 days)

length of stay of 13.5 days for patients of all ages with mental and fractures (7.0 days).
adma?&h5

Table 6. Number. rate, and avaraga length of stay for adohmcmtt d-as. by ~ Stsdaelc Unitsdstates,1860

[Oiaehargasfmm shon-stayrmrr+edamlhospitals.Diagnosticgruwirrgs●nd coda numbanfonn the In?amationat Uassilieaabn of Diseas~ 9dr ffeuisim, Chiricd

Moditicatriwr]

Diagnosis and ICD-9-CM codex Total Male Female Tmal Male Female Total Male Female

All conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h’tfestiousand parasitic diseases . . . . . . . . . . . . . . . ml -139

Viral diseases . . . . . . . . . ...045-079. 138. 139.0-139.1

Other infectious and parasitic

diseases . . . . . . . . . . . . . . . . . 001-041 .080-137.139.8

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignant neoplasms . . . . . . . . . . . . . . . . . . . ...140-208

8enqn neoplasms. carcinoma in situ and neoplesms of

unceflain behavior . . . . . . . . . . . . . . . . . . . . . ...210-239

Endocrine, nutritional and metabolic diseases and immunity

disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240-279

Diabetes meilitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250

Diseases of the blood and blood forming organs.. ..280-289

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . ..2g&319

Psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..2gt&29g

Disease of the nervous system and sense organs . ..320-389

Dkeases of the circulatory system . . . . . . . . . . . ...390459

Diseases of the respireto~ system -............460-519

Chronic disease of the tonsils and adnoids . . . . . . ...474

Pneumonia. all forms . . . . . . . . . . . . . . . . . . . ...430-486

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-......493

Dks.easesof the digestive system . . . . . . . . . . . . ...520-579

Disturbance of tooth emption . . . . . . . . ...-......520.6

Appendicitis and other diseases of the

appendix .-- . . . . . . . . . . . . . . . . . . . . . . . . . ...54&543

lnguinai herma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..55o

Non-infectious enterids and colitis . . . . . . . . . ...-555-558

Dkeases of the genitourinary system . . . . . . . . ...560-629

Inflammatory disease of female pelvic organs.. ..614-616

Disordera of menstruation . . . . . . . . . . . . . . . ...619-629

Complications of pregnancy. childbirth, and the

puerperium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...630-676

Abortion - . . . . . . . . . . . . . . . . . ...-...........630-639

Complications mainly related to pregnancy . . . . 640—648

Diseases of the skin and subcutaneous tissue . . . . 030_70g

Diseases of the muscoloskeietal system and connective

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

D:eordets of bone and cattilage... . . . . . . . . ...730-733

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . ...74.0-759

Certain conditions originating in the perfnatal

period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...760--779

Symptoms, signs and ill-defined conditions . . ...760-799

Injutyand poisoning . . . . . . . . . . . . . . . . . . . . . . ...600-999

Fractures . ..-............................600-629

Dislocation without ft-SCtUIIS. . . . . . . . . . . . . . . . . 830-839

@ncuaaion (excluding those With SJOJIIfCSCIU~) . . . . . . . ~50

facaration and open wound . . . . . . . . . . . . . . ...870-904

Sprains and strains of joints and adjacent

muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~

Supplementary classification . . . . . . . . . . . . . . . . .. W1-V82

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . ..v27

Number of discharges

in thwsanda

---

2.837 1.829

74

41

32

46

18

28

54

32

41

122

24

82

28

258

105

26

32

320

49

92

21

54

196

46

56

188

91

83

63

143

29

35

“o

65

480

145

47

42

59

41

632

582

I .wa

32

18

14

17

9

8

21

13

21

57

13

44

14

107

29

15

17

147

17

46

18

25

43

. . .

. . .

. . .

. . .

. . .

35

72

20

17

*o

28

331

105

31

27

47

28

20

. . .

42

24

18

29

9

20

33

18

20

65

11

38

14

151

76

11

15

173

32

46

2

29

153

46

56

188

91

63

28

71

9

18

. . .

37

159

41

16

15

12

13

612

582

Rate per 10.000

Wpulation

894.6

232

13.0

102

14.6

5.7

8S)

17.0

10.0

13.0

38.5

7.6

25.8

8.9

81.3

33.1

8.1

10.2

1(XI.8

Y5.6

29.0

6.5

16.9

61.7

14.6

17.6

59.2

28.6

262

19.8

45.1

92

11.1

●0.I

20.4

154.6

45.9

14.7

13.1

18S

13.0

199.3

183.5

628.3 ..,.-..

19.9

11.0

8.9

10.8

5.6

5.1

13.3

8.3

132

35.8

8.4

27.3

8.7

66.7

17.8

9.0

10.7

91.6

10.8

28.7

11.4

15-3

26.8

...

...

...

...

...

21.9

44.8

12.7

10.6

“02

17.4

206.6

65.1

19.0

16.8

29.1

17.7

12.6

...

f.]of.s

26.8

15.1

11.6

18.5

5.7

128

20.8

11.8

127

41.3

6.8

24.3

9.2

96.3

48.7

7.0

9.7

110.2

20.5

292

1.5

18.6

97.4

29.6

35.7

119.9

573

53.1

17.7

45.4

5.6

11.5

...

23.6

101.4

26.1

10.2

9.4

7.7

8.1

390.5

371.5

Average length of stay

4.7

4.3

4.3

4.3

4.8

7.5

3.1

6.1

6.2

3.5

16.4

24.0

5.4

6.7

3.5

20

5.7

4.7

3.9

1.9

4.5

3.3

3.7

4.1

4.8

3.3

2.5

1.8

3.1

4.8

5.2

6.6

6.8

“9.0

3.5

5.2

7.0

4.7

3.6

4.7

4.0

3.7

3.7

5.4

4-3

4.1

4.5

6.6

9.6

3.3

5.7

5.3

3.3

17.1

20.6

6.1

6.8

4.0

2.1

5.9

5.0

4.0

20

4.6

3.4

3.5

3.8

...

..-

...

...

...

5.6

4.8

62

6.9

“9.0

3.3

5.1

6.4

4.5

2.9

4.8

3.7

3.7

...

4.4

4.3

4.4

4.1

3.7

5.4

3.0

6.5

6.9

3.7

15.7

28.2

4.7

6.6

3.1

2.0

5.5

4.3

3.7

1.8

4.4

2.6

3.8

4.2

4.8

3.3

2.5

1.8

3.1

3.9

5.5

7.6

6.7

. . .

3.7

5.6

8.4

5.0

4.7

4.1

4.6

3.7

3.7

1Nat#onal Center forHeslthStatmtissInternationalClassificatkmof Diseases.9thRavisioa CAicel Mdi&e&wr. DHHS Pvb. No.(PHS)80-1 26D.PutdisHealth

Sarwca.Wzshmgton. U.S. GovernmentPrintingOfNce,Sept.1980.
6

Technical Notes

Survey methodology

Source of data

The scope of the National Hospital Discharge Survey encompasses patients discharged from shofi-stay non-institutionaliied hospitals, exclusive of military and Veterans Administration hospitals, located in the 50 States and the District of

Columbia Only hospitals with six beds or more and an average length of stay less than 30 days for all patients are included

in the survey.

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

hospitals contained in the 1963 Master Facility Inventory of

Hospitals and Institutions. New hospitals were sampled for

inclusion into the survey in 1972, 1975, 1977, and 1979. In

all, 544 hospitals were sampled in 1980. Of these hospitals, 72

refused to participate, and 52 were out of scope. The 420 participating hospitals provided approximately 224,000 abstracts

of medical records.

Sample design

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

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

All hospitals with fewer than 1,000 beds were stratile~ the

primary strata being 24 size-by-region classes, Within each of

these 24 primary strata, the allocation of the hospitals was

made through a controlled selection technique so that hospitals

in the sample would be properly distributed with regard to type

of ownership and geographic division. Sample hospitals were

drawn with probabilities ranging from certainty for the largest

hospitals to 1 in 40 for the smallest hospitals.

Subsamples of discharges were selected within the sample

hospitals using the daily listing sheet of discharges as the sampling frame. These discharges were selected by a random technique, usually on the basis of the terminal digit(s) of the patient’s medical record number, a number assigned when the

patient was admitted to the hospital. The within hospital sampling ratio for selecting sample discharges varied inversely with

the probability of selection of the hospitals.

Sampling errors

Since the estimates for this report are based on a sample

rather than the entire universe, they are subject to sampling

variability. The standard error is primarily a measure of the

variability that is attributed to using a value obtained from a

sample as an estimate of a population value. The value that

would have been obtained had a complete enumeration of the

population been made will be contained in an interval represented by the sample estimate plus or minus 1 standard error

about 68 out of 100 times, and plus or minus 2 standard errors

about 95 out of 100 times.

The relative standard error is obtained by dividing the standard error by the estimate. The resulting value is multiplied by

100, which expresses the standard error as a percentage. The

relative standard error applicable to patients discharged (or

first-listed diagnosis) and days of care for 1980 data presented

in this report are provided in table I.

Table 1. Approximate relative standard errors of estimated number

of first-listed diagnoses and days of care

First- ~8yS

siZe Of estimate in thousands listed of

diagnoses care

Relative standard elrror

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.370 ...

lo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.165 0.295

100. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.080 0.165

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . ... . 0.050 0.100

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.035 0.062

—

Tests of signfilcence

In this repoz the determination of statistical inference is

based on the two-tailed Bonfemoni test for multiple comparisons. Terms relating to differences such as “higher” and “less”

indicate that the differences are statistically significant. Terms

such as” similar” or “no difference” mean that no statistically

significant difference exists between the estimates being compared. A lack of comment on the difference between any two

estimates does not mean that the difference was tested and

found to be not sign~lcan~

Defintiton of Terms

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

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

refers to the number of discharges during the year including

any multiple discharges of the same individual from one or

more shofi-stay hospitals.

Disc/zargc+The formal release of a patient by a hosplita~

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

or by disposition to place of residence, nursing home, or another hospital. “Discharges” and “patient discharges” are used

synonymously.

Days of care-The total number of patient days accumulated at the time of discharge by patients discharged from silortstay hospitals during a year. A stay of less than 1 day (patient

admitted and discharged on the same day) is counted as 1 day

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

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

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

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

Average length of stay—The total number of patient days

accumulated at time of discharge by patients discharged during

the year divided by the number of patients discharged.

First-listed diagnosis—The coded diagnosis identified as

the principal diagrmis or else listed first on the face sheet of

the medical record.’The number of first-listed diagnoses is equivalent to tlvi. number of discharges

Age-Patient’s age refers to age at birthday prior to admission to the hospital inpatient service.

Blue Cross and otherprivate irzsurartce-Hea.lth insurance

provided by nongovernment sources including consumers, insurance companies, private industry, and philanthropic organizations.
awmedab7

Medicaid—A joint federai-state welfare program avail- pitalization is expected to be paid by the patien~ spouse, parable in virtually all states that provide medical benefits for low ents, or next of kin.

income persons, including the aged. In order to quali~ for this Otherpayrnents-Ttis includes all other sources of payprogramj a person must meet each State’s definition of “low ment such as workmen’s compensatio~ medicare, no charge,

income.” and other government payments.

SeV-pay-The major share of the total costs for this hosSymbols

. . . Data not available

. . . Category not applicable

. Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands.

*

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
From Vital and Health Statistics of the National Center for Health Statistics Number 94. November 22, 1983

Discharge Status of Inpatients

Discharged From Short=Stay Hospitals:

United States, 1965-61

by Robert Pokras, Divisionof Health Care Statistics

Introduction

This report provides national estimates on the discharge

status of patients dischtiged from non-Federal short-stay hospitals from 1965 through 1981. For this report discharge

status is defined at two levels: alive and dead. The frequency

and percent distribution of patients discharged alive and dead

are provided for each year from 1965 through 1981 (with

“not stated” data also included); while other trend data are

presented for the years 1965, 1970, 1975, and 1981 (with

“not stated” data excluded).

The statistics in this report are based on data collected

through the National Hospital Discharge Survey (NHDS),

a continuous survey conducted by the National Center for

Health Statistics since 1965. The data for the survey are

obtained from the face sheets of a sample of the medical

records of inpatients discharged from a national sample of

short-stay general and specialty hospitals in the United States.

Various revisions of the International Classification of Diseases have been used in NHDS to code medical data since

1965.The seventh revision* was used from 1965 through

1968, the eighth revision2 covered the period 1970-78, and

the ninth revision3 was used from 1979 through 1981. The

survey design, data collection procedures, and estimation

process are described briefly in Technical notes, and a more

detailed report on the design of NHDS has been published.4

Familiarity with the definitions used in NHDS is important

for interpreting the data and for making comparisons with

statistical data on hospital utilization that are available from

other sources. For example, patients who are dead on arrival

or who dle in the emergency room of a hospital without

being admitted to the hospital are not included in the scope

of this survey. Definitions of the terms used in this report

are presented in Technical notes.

Information on the number and cause of deaths in the

United States is collected by the Division of Vital Statistics

of the National -Center for HeaIth Statistics. Estimates in

this report reflecting a deceased patient’s first-listed diagnosis

do not necessarily reflect the underlying cause of death.

Discharge status 196S-81

The disrnbution of patients according to whether they

were discharged alive or dead is quite consistent from 1965

through 1981 (table 1). About 2.8 percent of all patients

were discharged dead from short-stay hospitals in 1965, and

about 2.5 percent were discharged dead in 1981. This demonstrates one of the most notable characteristics of the statistics

in this report: their consistency overtime.

Between 1965 and 1976 the number of patients with

their discharge status not stated never exceeded 20 percent

of the number of patients discharged dead. The abstract

form used by NHDS to colIect data was modified in 1977.

This mcdfication produced some ambiguity in coding the

variable discharge status and resulted in an increase in the

number of cases of dkcharge status not stated for the years

1977–80. This was comected, and in 1981 the number of

patients with an unknown discharge status was reduced considerably.

When discharge status is examined by age, the data

bear out the expected, that the number of patients discharged

dead is largest in the older age groups. This is true for

males and females for each year presented in table 1. Patients

65 years of age and over accounted for 58.8 percent of

all patients discharged dead in 1965; this increased to 69.4

pxcent in 1981. The distribution of deaths in hospitals by

age was quite similar for both sexes in each of the years

1965, 1970, 1975, and 1981 (table 2).

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

TiWe 1. Number and percent distribution of inpatients d=harged from short-stay hoapWa by dkharge atatw United Stateaj 1365-81

[Dischargesfrom inn-Federal hospitals, excluding newborn infants]

Year of Discharge status

discha.:9 All discharges Alive Dead NotSiwad All discharges Alive Dead Not sta@d

Number in thousands Percent distribution

1981, . . . . . . . . . . . . . 38,544 36,905 982 657 10+).0 95.7 2.5 1.7

1980 . . . . . . . . . . . . . . 37,832 35,212 964 1,657 100.0 93.1 2.5 4.4

1979 . . . . . . . . . . . . . . 36,747 33,612 924 2,011 100.0 92.0 2.5 5.5

1978 . . . . . . . . . . . . . . 35,616 32,657 881 1,879 100.0 92.3 2.5 5.3

~9n . . . . . . . . . . . . . . 35,902 32,215 851 2,836 100.0 89.7 2.4 7.9

1976 . . . . . . . . . . . . . . 34,372 33,416 852 103 100.0 97.2 2.5 0.3

1975 . . . . . . . . . . . . . . 34,043 33,117 839 87 1CO.o 97.3 2.5 0.3

1974 . . . . . . . . . . . . . . 33,018 32,081 847 90 100.0 97.2 2.6 0.3

1973 . . . . . . . . . . . . . . 32,125 31,154 847 97 100.0 97.0 2.7 0.3

1972 . . . . . . . . . . . . . . 31,627 30,503 880 144 100.0 96.8 2.6 0.5

1971 . . . . . . . . . . . . . . 29,459 26,460 833 186 100.0 86.6 2.6 0.6

1970 . . . . . . . . . . . . . . 29,127 26,116 853 157 100.0 86.5 2.9 0.5

1969 . . . . . . . . . . . . . . 26,529 27,502 867 160 100.0 86.4 3.0 0.6

1668 . . . . . . . . . . . . . . 28,070 27,086 860 124 100.0 96.5 3.1 0.4

1967 . . . . . . . . . . . . . . 27,964 26,966 836 159 1(x).() 96.4 3.0 0.6

1966 . . . . . . . . . . . . . . 26,477 27,579 811 67 100.0 86.8 2.8 0.3

1865 . . . . . . . . . . . . . . 29,100 26,246 818 35 100.0 97.1 2.6 0.1

Table2. N*randprmt&ntiofin~tid*@ti~~-~~~ sexsndsgmUnitadStattw% 1965

1970, 197% and 1681

_rgasfmmnon-Fsderal Imsptis,excludmgnewbom infsnfe]

Year of discharge, Disctrsrgestatus

sax, and age Alldisctrarges Alive Dead NofatatadAlldiadrarges Afive Dead #&tstated

1965

6otheexes, alleges . . . . . . . . . .

Under 15 yeara . . . . . . . . . . . .

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

45-64 yeara . . . . . . . . . . . . . .

E5yeara And over . . . . . . . . . .

Mele, all eges . . . . . . . . . . . . . .

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

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

45-64 yeara . . . . . . . . . . . . . .

85 years and over . . . . . . . . . .

Femele, all eges . . . . . . . . . . . . .

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

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

45-84 yeare . . . . . . . . . . . . . .

66 yeerssnd over . . . . . . . . . .

1970

6othaexee, alleges . . . . . . . . . .

Under 15 year n . . . ...’.... . .

15-14 years . . . . . . . . . . . . .

45-84 yeara . . . . . . . . . . . . . .

85 yeare and over . . . . . . . . . .

kle,slla gee. . . . . . . . . . . . . .

UrWr15y eara. . . . . . . . . . . .

15-14 years . . . . . . . . . . . . . .

45-64 yeara . . . . . . . . . . . . . .

E5yeara and over . . . . . . . . . .

Female, all agea . . . . . . . . . . . . .

Under 15 yeare . . . . . . . . . . . .

1541 years . . . . . . . . . . . . . .

45-84 yeare . . . . . . . . . . . . . .

E5yeara and over . . . . . . . . . .

Number inthousands Percent distribution

29,100

4,580

13,126

6,702

4,692

11,330

2,576

3,464

3,130

2,159

17,72~

1,997

9,646

3,560

2,519

29,127

3,873

12,664

6,893

5,897

11,431

2,173

3,488

3,104

2,687

17,696

1,669

9,178

3,588

3,230

26,248

4,504

13,083

6,476

4,203

10,886

2,533

3,436

3,008

1,909

17,313

1,984

9,810

3,456

2,282

28,116

3,633

12,526

6,445

5,311

10,921

2,151

3,434

2,971

2,366

17,195

1,882

9,093

3,474

2,945

818

63

51

217

461

40

25

117

28

28

99

233

24

62

211

556

461

14

33

117

402

10

28

84

35

7

13

6

7

14

3

4

5

3

21

4

9

4

5

157

16

75

38

30

a

9

19

16

14

88

8

58

20

16

100.0

15.7

45.1

23.0

16.1

lCO.O

22.7

30.6

27.6

19.1

100.0

11.3

54.4

20.1

14.2

100.0

13.3

43.5

23.0

20.2

100.0

19.0

30.5

27.2

23.3

100.0

9.6

51.9

20.3

16.3

100.0

15.9

46.2

22.9

14.9

100.0

23.3

31.6

27.6

17.5

100.0

11.3

55.5

20.0

13.2

100.0

13.6

44.6

22.9

18.9

100.0

19.7

31.4

27.2

21.7

100.0

9.6

52.9

20.2

17.1

100.0

6.5

6.2

26.5

68.6

100.0

9.4

5.6

27.3

57.5

100.0

7.5

6.7

25.7

60.2

100.0

2.6

7.2

24.6

85.2

100.0

3.2

7.3

26.0

63.6

1ca.o

2.4

7.2

23.3

67.1

100.0

19.1

36.4

23.6

2Q.9

100.0

199

25.8

33.5

21.0

1Ot).o

18.6

43.2

17.4

20.6

100.0

10.3

47.7

2%1

19.0

100.0

14.8

33.5

27.5

24.3

100.0

7.6

56.0

20.5

15.9
ahame&b3

Tsbb 2. Number and persant distribubn of inpatients dkhargd from short-stay hOepiWs by disdwge atshm 88x and agw United Stat% 1966,

1970,1975, Snd 1981-CM.

pischargesfrcmnan-Fedard hospitals, excluding newborn htanls]

Yearofdisoharge, Oisshargast.stus

sex, andaaa Alldischargas Alive Dead M7tstamd A#dSc/rargas Aliw Dead Mtstated

1975

RXhsexes,a llages . . . . . . . . . .

Under 15 yeare . . . . . . . . . . . .

15-W years . . . . . . . . . . . . . .

45-64 year n . . . . . . . . . . . . .

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

Mele, all ages . . . . . . . . . . . . . .

Under 15 yeare . . . . . . . . . . . .

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

4S-84yeere . . . . . . . . . . . . . .

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

Female, all ages . . . . . . . . . . . . .

Under 15 yeare . . . . . . . . . . . .

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

45-64 yeare . . . . . . . . . . . . . .

65yeare And over . . . . . . . . . .

1981

BOthaexes, alleges . . . . . . . . . .

Und+3r15 years . . . . . . . . . . . .

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

4S6-4 yeara . . . . . . . . . . . . . .

S5yeara and over . . . . . . . . . .

Male, aJl ages . . . . . . . . . . . . . .

Under 15 yeara . . . . . . . . . . . .

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

45-64 yasrs . . . . . . . . . . . . . .

65yeara arrd over . . . . . . . . . .

Female, allagae . . . . . . . . . . . . .

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

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

45-64 yeara . . . . . . . . . . . . . .

85yesmarrd over . . . . . . . . . .

Number in thousands Percent dsttibution

34,043

3,826

14,171

8,391

7,654

13,519

2,143

4,107

3,870

3,389

20,523

1,682

10,064

4,522

4,258

38,544

3,733

15,725

8,677

10,406

15,379

2,101

4,672

4,098

4,507

23,1S5

1,832

11,053

4,578

5,901

33,117

3,799

14,077

8,166

7,073

13,034

2,126

4,063

3,743

3,102

20,063

1,672

10,014

4,425

3.971

36,905

3,631

15,393

8,308

9,571

74,626

2,049

4,563

3,924

4,081

22,279

1,562

10,830

4,386

5,480

839 87

16 9

54 40

206 17

581 21

450 36

11 6

3i 13

120 7

287 10

380 51

7 3

23 27

67 10

274 11

982 657

33 68

57 276

211 157

661 156

500 253

17 35

31 78

107 67

344 72

482 404

16 24

26 197

104 68

337 64

100.0

11.2

41.6

24.6

22.5

100.0

15.9

30.4

28.6

25.1

100.0

82

49.0

22.0

20.7

100.0

9.7

40.6

22.5

27.0

100.0

13.7

30.4

26.7

28.3

100.0

7.0

47.7

19.6

25.5

100.0

11.5

42.5

24.7

21.4

100.0

16.3

31.2

28.7

23.6

100.0

8.3

49.9

220

19.6

100.0

9.8

41.7

225

25.9

100.0

14.0

31.2

26.8

28.0

100.0

7.1

48.6

19.7

24.6

100.0 100.0

2.1 10.5

6.4 48.2

24,6 19.4

66.9 23.9

100.0 100.0

2.5 16.4

7.0 35.5

26.7 20.1

63.9 26.0

100.0 100.0

1.7 6.4

5.8 53.6

22.2 19.0

70.3 21.1

100.0 100.0

3.3 11.5

5.8 41.9

21.5 22.8

69.4 23.7

100.0 100.0

3.4 13.9

6.2 31.0

21.5 26.7

68.9 28.4

100.0 100.0

3.2 7.3

5.4 49.6

21.6 22.0

89.8 20.8

The two most common causes of death in the United

States are cancer and heart disease. Although data from

NHDS on diagnoses do not necessarily reflect cause of death,

a first-listed diagnosis of cancer or of a disease of the circulatory system accounts for a relatively large proportion of

patients discharged dead. Data relating diagnosis and discharge

status across years of the survey are not directly comparable

because of changes in the diagnostic classification system

used to code data. The changes instituted in 1,970tid 1979

make comparisons across decades imprecise. Nonetheless,

diseases of the circulatory system and cancer ranked first

and second, respectively, as the most frequent diagnoses

for patients discharged dead from 1%5 through 1981. The

most recent NHDS data, for 1981, indicated that 39.1 percent

of all patients discharged dead had aa a first-listed diagnosis

a disease of the circulatory system and that 25.0 percent

had a first-listed diagnosis of cancer.

There is an interesting relationship between a patient’s

discharge status, whether or not the patient had surgery,

and the patient’s length of stay in the hospital. Figure I

indicates that patients discharged aIive had similar lengths

of stay whether they had surgery or not. However, patients

discharged dead had a longer length of stay on the average

than patienta discharged alive; tlrthermore, patients discharged dead who had surgery had the longest average lengths

of stay. This phenomenon was fairly consistent for the years

1965, 1970, 1975, and 1981, as presented in figure 1. This

pattern was examined in a previous repo< using 1979 data

that revealed this relationship also to be consistent across

patient age.
4 admncedata

25

20

15

10

5

c

.

.

.

7,6 7,6

193

Dead

1965

79

7,4

1

Alive

NOTE:Oiaaitsrgesfrom rwn.Federal hesfstals, excluding newborn Infants.

Oead

1970

90

74 77

J_

Ahve

1975

ENInpatients without surge~

n inpatients with surgery

215

Dead Alwe

10.2

70 70

19.9

Oead

1981

Figure 1. Averege bngth of stay in short-stay hospiMs for inpetiants with surgery and for inpatients wfthout surgery, by diacherge statux United Steteq

188S, 1970, 1975 end 1981
adwwe&a5

References

* National Center for Health Statistics: International CIdrslf7cation

of Diseases, Adapted for Indexing Hospital Records by Diseases

and Operations. PHS Pub. No. 719 (Rev.). Public Health Sewice.

Washington. U.S. Government Printing Office, Dec. 1%2.

2 National Center for Health Statistics: Eighth Revision international

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

Vols. 1 and 2. PHS Pub. No 1693. Public Health Service.

Washington. U.S. Government Printing Office, 1967 and 1968.

3 U.S. Public Health Service and Health Care I%mncing Administration: International Class@ation of Diseases, 9th Revision, Clinical

Modij7cation, Vol. 3. DHHS Pub. No. (PHS) 80-1260. Public

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

1980.

4 National Center for Health Statistics, W.R. Simmons Development

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

Health Statistics. PHS Pub. No. 1000-Series I-No. 39. Public Health

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

s National Center for Health Statistics, Robert Pdaa.s: Surgical

and nonsurgical procedures in short-stay hospitals, United States,

1979. Vital and Health Statistics. Series 13-No. 70. DHHS Pub.

No. (PHS) 83-1731. Public HeaIth Service. Washington. U.S. Government Printing OtXce, Feb. 1983.

6 National Center for Health Statistics, M.G. Sirken: Utilization

of short-stay hospitals, summary of nonmedical statistics, United

States, 1965. Viral and Health Statistics. PHS Pub. No. 1000-Series

13-No. 2. Public Health Service. Washington. U.S. Government

Printing Office, Aug- 1%7.

7 National Center for HeaIth Statistics, MJ. Witkin: Utilization

of short-stay hospitals by characteristics of discharged patients,

United States, 1%5. Viraf and Health Statistics. PHS Pub. No.

1000-Series 13-No. 3. Public Health Service. Washington. U.S.

Government Printing OtlIce, ~c. 1%7.
6

Technical notes

Sfmeymethodology

Sourceofektta

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

of military and Veterans Administration hospitals, located

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

with six beds or more and an average length of stay of

less than 30 days for all patients are included in the survey.

Discharges of newborn infants are excluded from this report.

The universe of the s~ey consisted of 6,965 short-stay

hospitals contained in the 1963 Master Facility Invento~

of Hospitals and Institutions. New hospitals were sampled

for inclusion in the survey in 1972, 1975, 1977, and 1981.

Sample design

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

of short-stay hospitals were selected with certain~ in the

sample. All hospitals with fewer than 1,000 beds we=

stratified, the primary strata being 24 size-by-region classes.

Within each of these 24 primary strata, the allocation of

the hospitals was made through a controlled selection technique so that hospitals in the sample would be properly

distributed with regard to type of ownership and geographic

division. Sample hospitals were drawn with probabilities ranging from certainty for the largest hospitals to 1 in 40 for

the smallest hospitals.

Sample discharges were selected within the hospitals

using the daily listing sheet of discharges as the sampling

frame. These discharges were selected by a random technique,

usually on the basis of the terminal digit or digits of the

patient’s medical record number, a number assigned when

the patient was admitted to the hospital. The within-hospital

sampling ratio for selecting sample discharges varied inversely

with the probability of selection of the hospital.

Data collection and estimation

The sample selection and the transcription of information

from the hospital records for abstract forms were performed

by the hospital staff or by representatives of the National

Center for Health Statistics or by both. The data were

abstracted from the face sheets of the medical records. All

discharge diagnoses were listed on the abstract in the order

of the principal one, or the first-listed one if the principal

one was not identified, followed by the order in which all

other diagnoses were entered on the face sheet of the medical

record.

Statistics produced by NHDS are derived by a complex

estimating procedure. The basic unit of estimation is the

sample inpatient discharge abstract. The estimating procedure

used to produce essentially unbiased national estimates in

NHDS has three principal components: inflation by reciprocals

of the probabilities of sample selection, adjustment for non-response, and ratio adjustment to fixed totals. These components

of estimation are described in appendix I of two earlier

publications.h”

-g errors and rounding of numbers

The standard error is a measure of the sampling variability

that occurs by chance because only a sample, rather than

an entire universe, is surveyed. The relative standard error

of the estimate is obtained by dividing the standard error

by the estimate itself and is expressed as a, percent of the

estimate. Table I shows relative standard errors for dkcharges

and first-listed diagnoses for 1981. The standard errors for

average lengths of stay are shown in table II. Standard errors

for each year from 1965 through 1981 are not presented,

both in order to save space and because they are relatively

simihtr from year to year. Therefore, while these tables provide

a general idea of sampling variability, more precise values

can be provided by NHDS.

Estimates have been rounded to the nearest thousand.

For this reason detailed figures within tables do not always

add to the totals. Percents and average lengths of stay were

calculated from original, unrounded figures and will not necessarily agree precisely with percents or average lengths of

stay calculated from rounded data.

Tests of significance

In this report, the determination of statistical inference

is based on the two-tailed Bonfemoni test for multiple comparisons. Terms relating to differences such as “higher” and

“less” indicate that the differences are statistically significant.

Terms such as “similar” or “no difference” mean that no

statistically significant difference exists between the estima;es

Table L Approximate relative atendard errora of eatirnated ntanber of

disofurrgeq 1981

Sizeof

estimate

Relative

standard

wror

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . “16.3

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

I(x),oot) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5

3W,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.6

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.9

I,ooo,ooo ........................... 5.1

4,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0

Tabk Il. Approximate standard errors of average lengths of stay, 1981

Average /ength of stay

Numberof dkeharges in days

2 6 10 20

Standarderrorin days

10,OW . . . . . . . . . . . . 0.7 1.2 1.7 2.2

50J300... . . . . . . . . . 0.3 0.7 1.0 1.4

Ioo,ooo . . . . . . . . . . . . 0.3 0.6 0.9 1.2

500,000 . . . . . . . . . . . . 0.2 0.5 0.8 0.9

I,ooo,ooo. . . . . . . . . . . 0.2 0.5 0.6 0.7

5,000,000. . . . . . . . . . . 0.2 0.5 0.6 ...

NOTE: A list of references follows the text.
daruxMa7

being compared. A lack of comment on the difference between

any two estimates does not mean that the difference was

tested and found to be not significant.

Definition of terms

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

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

refers to the number of discharges during the year, includhg

any multiple discharges of the same individual from one

or more short-stay hospitals.

Average lengfh ofstay—The total number of patient days

accumulated at time of dkcharge by patients discharged during

the year divided by the number of patients discharged.

First-listed diagnosis—The coded diagnosis identified as

the principal diagnosis or listed first on the face sheet of

the medical record. The number of first-listed diagnoses is

equivalent to the number of discharges.

Symbols

--- Data not available

. . . Categofy not applicable

. Quantity zero

0.0 Quantity more than zero but lees than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

●

Figure does not meet standards of reliability or precision (more than 30-percent

relative standard error)

# Figure suppressed to comply with confidentiality requirements
,..

From Vital and Health Statistics of the National Center for Health Statistics Number 95. December 27, 1983

1982 Summary: National Hospital Discharge Survey

by Barbara Haupt, formerly with the Division of Health Care Statistics

Introduti-on

During 1982 an estimated 38.6 million inpatients, excluding newborn infants, were discharged from short-stay nonFederal hospitals in the United States. These patients were

hospitalized an average of 7.1 days and used 272.6 million

days of inpatient hospital care. Patients hospitalized during

1982 accounted for 168 discharges and 1,186 days of care per

1,000 civilian population.

These and other statistics presented in this report are baaed

on data collected by means of the National Hospital Discharge

Survey, a continuous survey that has been conducted by the

National Center for Health Statistics since 1965. In 1982, data

were abstracted from the face sheets of medical records of approximately 214,000 patients dkcharged from 426 shoti-stay

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

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

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

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

published. 1$2

Coding of medical data for patients hospitalized is done

according to the International CIassz~cation of Diseases, 9th

Revision, Clinics/ i140dljication3 (ICD-9-CM). Up to seven

diagnoses and four procedures are coded for each discharge.

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

“Supplemen@ classification of external causes of kjury and

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

Hospital Discharge Survey, these diagnoses are excluded fkom

this report. The conditions diagnosed and procedures performed

are presented here by chapter of ICD–9-CM. Whhin these

chapters, a few diagnoses and procedures or groups thereof

aIao are shown. These specific categories were selected primariIy

because of large numbers of occurrences or because they are of

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

detailed analyses of these data will be presented in later reports

in Series 13 of Vital and Health Statistics.

Data highlights

Utilizationby patient and

hospital characteristics

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

discharged fkom short-stay non-Federai hospitrds are shown by

selected patient and hospital characteristics in tables 1–3. The

38.6 million patients discharged from short-stay hospitals during 1982 included an estimated 15.5 million males and 23.1

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

males and 194 for females, making the rate for females about

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

of discharges are always higher for females than for males

because of the large number of women in their childbearing

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

and other obstetrical conditions. Excluding deliveries, the rate

for females discharged was 161, or only about 16 percent higher

than the rate for males.

The average length of stay was 7.5 days for males and 6.8

days for females during 1982. The length of stay for females

was shorter than that for males primarily because the average

length of stay of the 3.9 million women who were hospitalized

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

females who were not hospitalized for deliveries during 1982

was 7,4 days.

The number of discharges from short-stay hospitals by

geographic region during 1982 ranged from 13.4 million in the

South Region to 6.4 million in the West Region, and the rates

per 1,000 population ranged from 186 in the North Central

Region to 143 in the West Region. Regional differences in the

number of discharges are accounted for mainly by variations in

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

charge rates. This is apparent when number of discharges and

rate of discharges are compared among the regions. Although

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

North Central Region, the South Region had the highest number

of discharges because the population in the South was about 30

percent larger than that in the North Central Region.

Average lengths of stay by geographic region were 5.9

days in the West. 6.6 days in the South, 7.4 days in the North

Central, and 8.2 days in the Northeast.

Discharges from short-stay hospitals were about 40 percent

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

females with deliveries accounted for about 10.2 percent of all

discharges regardless of hospital size. The average length of

stay increased steadily from 5.7 days in the smallest hospitals

(6-99 beds) to 8.0 days in the largest hospitals (500 beds or

more) for all patients.

During 1982, voluntary nonprofit hospitals provided medical care to an estimated 27.2 million patients, or 70 percent of

all patients hospitalized. Hospitals operated by State and local

governments cared for 8.3 million patients, or 21 percent of all

discharges, and proprietary hospitals operated for profit cared

for 3.1 million patients or 8 percent of all discharges. Average

lengths of stay were 7.2 days in voluntary nonprofit hospitals,

6.4 days in State and local government hospitals, and 7.1 days

in proprietary hospitals.

Utilization by diagnosis

Diseases of the circulatory system ranked first in 1982

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

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

an estimated 5.5 million discharges. Other leading ICD-9–CM

diagnostic chapters were diseases of the digestive system (4.6

million discharges) and supplementary classifications (including females with deliveries) (4.6 million discharges). Almost

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

The diagnostic categories presented in this report were

selected either because they appear as principal or first-listed

diagnoses with great frequency or because the conditions are of

special interest. Although many of these categories (such as

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

groupings of more detailed diagnoses, they are presented as

single categories without showing all of the specific diagnostic

inclusions.

The number and rate of discharges and average length of

stay for each ICD–9–CM diagnostic chapter and selected

categories are shown by sex and age in tables 4–6. The most

common diagnostic category for all patients was females with

deliveries. This was followed by the diagnostic categories heart

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

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

The most frequent first-listed diagnoses for 1982 varied

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

the most frequent diagnosis was chronic disease of tonsils and

adenoids. Excluding females with deliveries, the two most frequent diagnoses for patients 15–44 years of age were abortions

and ectopic and molar pregnancies, and fractures, all sites.

Patients 45-64 years of age were hospitalized most frequently

for heart disease. The most common diagnoses for patients 65

years of age and over were heart disease and malignant

neoplasms.

The average length of stay for all patients ranged frc)m a

low of 1.9 days for the diagnostic category chronic disease of

tonsils and adenoids to a high of 18.6 days for fracture of neck

of femur. Although the overall average length of stay for females

was shorter than that for males, females stayed in the hospital

longer than males for many of the specific diagnostic categories

examined in this report. Some categories for which women had

substantially longer stays included alcohol dependence syndrome; arthroplasties and related disorders; intervetebral disc

disorders; and fractures, all sites.

The average length of stay increased with increasing age

for most categories of diagnoses shown. Overall, the average

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

of age to 10.1 days for patients 65 and over. By diagnosis,

stays were highest (when compared with the average length of

stay) for patients with fracture of neck of femur ( 18.6 days),

psychoses (15.5 days), and cerebrovascular disease ( 12.2 days).

Utilization by procedures

One or more surgical or nonsurgical procedures were performed for an estimated 20.8 million of the 38.6 million inpatients discharged from short-stay hospitals during 1982. A

total of 34.6 million procedures, or an average of 1.7 per patient

who underwent at least one procedure, were recorded in 1982.

Procedures are grouped in the tables of this report by the

ICD-9–CM procedure chapters. Selected procedures within

these chapters also are presented by specific categories. Some

of these categories (such as extraction of lens, open heart surgery, and hysterectomy) are presented as single categories

although they may be divided into more precise subgroups.

Operations on the digestive system ranked first among the

surgical and nonsurgical procedures (5.8 million) performed

during 1982. These were followed by miscellaneous diagnostic

and therapeutic procedures (5.5 million), operations on the

female genital organs (4.0 million), and obstetrical procedures

(3.9 million). Over one half (56 percent) of the procedures

performed in 1982 were included in these four ICD-9-CM

procedure chapters.

The number and rate of all-listed procedures in 1982 for

each ICD–9–CM procedure chapter and selected procedure

categories are shown by sex and age in tables 7 and 8. C}fthe

34.6 million procedures performed during 1982, 13.3 million

were for males and 21.3 million were for females. The corresponding rates per 1,000 population were 151 for both sexes,

120 for males, and 179 for females. Of the procedures shown

in table 8, the most common ones for males were endoscopies

on the urinary system (natural orifice) and repair of ingttinal

hernia; the most frequently performed procedures for females

were episiotomy and diagnostic dilation and curetSage of uterus.

The rate of procedures per 1,000 population increased with

advancing age from 43 for patients under 15 years to 326 for

patients 65 years of age and over. The most frequently per-
ackmdaa3

fozmed procedures for patients under 15 years of age were tonsillectomy with or without adenoidectom~ for patients 15-44

years of age, episiotomy and cesarean sectioq for patients

45–64 years of age, arteriography and angiocardiography,. and

cardiac catheterization; and for patients 65 years of age and

over, extraction of lens and endoscopies on the urinary system

(natural orifice).

TABLE 1. NuMSER OF INPATIENTS 01 SCHARGEO FROM SHORT-STAY

HOSPITALS BY SELECTED CHARACTERISTICS: UNI TEO STATES, 1982

(O IS CHARGES FROM NONFEDERAL HOSPITALS. EXCLUOES NE HBORN

INFANTS I

SELECTEO CHARACTERISTIC BOTH HALE FEMALE

SEXES

TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AGE

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

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

45-6+ YE AR S . . . . . . . . . . . . . . . . . . . . . .

65 YEARS ANO OVER . . . . . . . . . . . . . . . .

REGION

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

NORTH CENTRAL . . . . . . . . . . . . . . . . . . . .

SOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BE ST . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SEO SIZE

6-99 BED S. . . . . . . . . . . . . . . . . . . . . . . .

100-199 BEDS . . . . . . . . . . . . . . . . . . . . .

200-299 13EDS. . . . . . . . . . . . . . . . . . . . .

300-+99 BE DO . . . . . . . . . . . . . . . . . . . . .

500 8EOS OR HARE . . . . . . . . . . . . . . . . .

OWNERSHIP

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

STATE ANO LOCAL GOVERNMENT . . . . . . .

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

NuMBER OF PAT1 ENTS

01 SCHARGEO I N THOUSANOS

38,593 15,.+70 23,123

3,654 2,098 1,556

15,554 4,615 10,939

8*688 4*i43 4,545

10*697 4,614 6,003

7,867 3,238 4,610

10,93B 4,398 6,540

13,435 5,268 8.167

6,373 2,566 3,807

6,B36 2,732 4.104

6,738 2,648 4;0s9

6,366 2,587 3.780

9,547 3 *874 5,673

9,i06 3,629 5,47s

27,207 10,820 16,387

0,254 3,365 4,BB9

3,133 1,285 1,848

TABLE 2. RATE OF INPATIENTS 01 SCHARGEO FROFI SHORT-STAY

HOSPITALS, 8Y AGE, GEOGRAPHIC REGION, ANO SEX: UNITEO ST AT Es,

1982

(O15CHARGES FROM NONFEDERAL HOSPITALS. EXCLUOES NEWBORN

INFANTS 1

AGE ANO REGION 80TH HALE FEMALE

SEXES

RATE OF PATIENTS OISCHARGEO

PER 1,000 POPULATION

TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167.9 139.4 1%.5

AGE

UNOER 15 YEARS . . . . . . . . . . . . . . . . ..- 71.2 79.9 62.0

15-+4 YEARS . . . . . . . . . . . . . . . . . . . . . . 145.0 B7.4 201.0

45-64 YEARS . . . . . . . . . . . . . . . . . . . . . . 195.5 196.3 194.8

65 YEARS ANO OVER . . . . . . . . . . . . . . . . 398.8 +28.1 379.1

REGION

TABLE 3. AVERAGE LENGTH OF STAY FOR INPATIENTS OISCHARGEO FROM

SHORT-STAY +iUSP ITALS 8Y SELECTEO CHARACTERISTICS: UNITEO

STATES. 1982

IO IS CHARGES FROII NONFEDERAL NDSPI TALS. EXCLUOES NEMBORN

INFANTS )

SELECTEO CHARACTERISTIC BOTH MALE FEMALE

SEXES

AVERAGE LENGTH OF STAY I N OAYS

TOTAL . . . . . . . . . . . . . . . . . . . . . . . 7.1 7.5 6.8

AGE

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

15-44 YEARS . . . . . . . . . . . . . . . . . 5.1 6.3 4.6

45-64 YE AD S. . . . . . . . . . . . . . . . . 7.9 7.B 8.0

65 YEARS ANO OVER . . . . . . . . . . . 10.1 9.8 10.3

REGXON

NORTHEAST . . . . . . . . . . . . . . . . . . . 8.2 B.7 7.9

NORTH CENTRAL . . . . . . . . . . . . . . . 7.4 7.8 7.1

SOUTH . . . . . . . . . . . . . . . . . . . . . . . 6.6 7.1 6.4

!dEST . . . . . . . . . . . . . . . . . . . . . . . . 5.9 6.4 5.6

BEO SIZE

6-99 8EOS . . . . . . . . . . . . . . . . . . . 5.7 5.s 5.6

100-199 BE DO . . . . . . . . . . . . . . . . 6.5 7.0 6.3

200-299 SEAS . . . . . . . . . . . . . . . . 7.1 7.4 6.9

300-499 BEDS . . . . . . . . . . . . . . . . 7.5 7.9 7.3

500 BEOS OR MORE . . . . . . . . . . . . 8.0 8.8 7.5

OiiNERSHIP

NONPROFIT . . . . . . . . . . . . . . . . . . . 7.2 7.7 7.0

STATE ANO LOCAL GOVERN14ENT.. 6.4 6.9 6.L

PROPRIETARY . . . . . . . . . . . . . . . . . 7.L 7.4 7.0

NORTHEAST . . . . . . . . . . . . . . . . . . . . . . . . 159.0 137.6 178.6

NORTH CENTRAL . . . . . . . . . . . . . . . . . . . .

SOUTH

186.1 154.3 216.0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 173.9 L41.8 203.5

lest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143.3 117.7 167.8
4 achancedata

TABLE 4. NuMBER OF INPATIENTS 01 SCHARGEO FRO/4 SHORT-STAY HOSP!TALS. EY CATEGORY OF FIRST- LISTEO DIAGNOSIS* SEX* ANo AGE:

STATES. i9a2-

UNI I’EO

(DISCHARGES FROM NONFEDERAL HOSPITALS. EXCI.UOES NEkBORN INFANTS. DIAGNOSTIC GROUPINGS ANO COOE NUHBER INCLUSIONS ARE BASEO ON THE

INTERNATIONAL CLASSIFICATION OF OISEASES. 9TH REV IS1ONV CLINICAL MOO IF ICATiON)

s EX AGE

CATEGORY OF FIR ST-L lSTEO DIAGNOSI S ANO lCO-9-CM COOE

TOTAL MALE FEMALE UNOER 15 1 +44 45-64 65 YEARS

YEARS Y EARS YEARS AN[) OVER

ALL 50N01TIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INFECTIOUS ANO PARASITIC OISEASES . . . . . . . . . . . . . . . . . . . . ..001-L39

NEOPLASii S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140-239

MALIGNANT NEOPLASM . . . . . . . . . . . . . . . . . . . . . . . . ..14W208 ,230-234

HAL I GNANT NEOPLASM OF TRACHEA,

8RONChUS, ANO LUNG . . . . . . . . . . . . . . . . . . . . ..-. i62v197-ov 197 .3

MALIGNANT NEOPLASN OF BREAST . . . . . . . . . . . . . . . . 174-175 .198.81

EN CGCRINE, NUTRITIONAL AND METABOLIC OISEASES,

ANO 1MMUNIT% DISORDER S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...240-279

DIABETES MEL LITuS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

oISEASES OF THE OLOOO ANO EILoOC-FORA41N6 ORGANS. . . . . . . ..2a0-2a9

MENTAL OISOROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . ..290-319

PSYCWJSES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-299

NEuROTIC ANO PERSONALITY LIISOROERS . . . . . . . . . . . . . . . . ...300-301

ALCOHOL OEPENOENCE SYNOROHE . . . . . . . . . . . . . . . . . . . . . . . . . . . ...303

oIsEAs Es OF THE NERVOUS SYSTEM ANO sENsE ORGANS... . . . ..320-3a9

OISEASES OF 7HE CENTRAL NERVOUS SYSTEM . . . . . ..320-336.340-349

uTARACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

OISEASES OF THE EAR ANO MA STOi O PROCESS . . . . . . . . . . . . ..3aO-3a9

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

ESSENTIAL HYPERTENSI ON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

HEART OISEASE . . . . ..391-392. 0.393-398.402 .404.410-41 6,42 O-429

ACUTE MYOCAROIAL lNFARCT ION . . . . . . . . . . . . . . . . . . . . . . . . . ...410

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

OTHER ISCHEMIC HEART DISEASE . . . . . . . . . . .41 A-413.414.1-414.9

CONGESTIVE HEART FAILURE . . . . . . . . . . . . . . . . . . . . . . . . . . . ..42a. O

CEREBROVASCULAR OISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430438

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

ACUTE RESPIRATORY INFECTIONS, ExCEPT INFLu ENZA . . . . . ..46O466

CHRONi C OiSEASE OF TONSi LS ANO AiYENOi OS . . . . . . . . . . . . . . . ...474

PNEuMONi A, ALL FOR MS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4a0-486

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

oiSEASES IIF THE OIGESTiVE SYSTEH . . . . . . . . . . . . . . . . . . . . . ..52O-579

ULCERS OF THE STOMACH ANO SHALL iNTESTi NE. . . . . . . . . . ..53i-534

GASTRi TiS ANO OUOOENi TiS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...535

Append icitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...540-543

iNGuiNM HERNIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550

NONINFECTIOUS ENTERi TiS ANO COLi TiS . . . . . . . . . . . ...555-556 C55a

CHOLELi THi ASi S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...574

OiSEASES OF THE GENi TOL!&i NARY SYSTEM. . . . . . . . . . . . . . . . . ..5a0-629

CALCULUS OF KiONEY ANO uRETER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592

C21SOROER S OF MENSTRUATION ANO OTHER

ABNORMAL vAGiNAL 8LEEOiNG . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...626

COMPLICATIONS OF PREGNANCY. Childbirth.

ANO THE PUERPERIUH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..-.l/ 630-676

A30RTi ONS ANO ECTOPi C AND MOLAR Pregnancies . . . . . . . ...630-639

OiSEASES OF THE SKiN ANO SUECUTANEOUS TISSUE . . . . . . . . . ..68 O-7O9

OiSEASES OF THE MUSCULOSKELETAL SYSTEM

ANO Connective Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

ARTHROPATHi ES ANO RELA7ED OiSOROER S. . . . . . . . . . . . . . . ...710-719

iNTERvERTEBRAL OiSC OISGROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722

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

CERTAiN Conditions Originating iN THE

PERi NATAL PER IOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..760- 719

SVMPTOHS, SiGNS, ANO iLL-OEFINEO Condition s............780-799

iNJuRy ANO PoisoNiNG ...................................8oo.999

FRACTURES, ALL sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..aoo-a29

FRACTURE OF NECK OF FE14uR . . . . . . . . . . . . . . . . . . . . . . . . . . . ...820

SPRAi NS AN12 STRAiNS OF BACK (i NCLUOING NEcKI . . . . . . ...846-847

INTRACRANIAL iNJURi ES (EXCUOING THOSE U17H

SKULL FRACTURE ).....................................85O.a54

LACERATi ONS AND OPEN WOUNDS. . . . . . . . . . . . . . . . . . . . . . . ...810-904

SUPPLEMENTARY CLASS IF ICATIONS . . . . . . . . . . . . . . . . . . . . . . . . .. VOl-Va2

PERSONS AOUi TTEO FOR Sterilize tion . . . . . . . . . . . . . . . . . . . ..v25.2

FEHALES ‘dITH Deliver ies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..v27

3a,593

695

2,594

1,972

3i9

227

1,161

66i

36T

1,T46

574

285

4i7

1,828

429

555

345

5*4a8

333

3,4T7

681

500

a22

439

a34

3,459

459

436

824

434

4,628

351

261

254

512

611

496

3,411

297

360

L,ola

4a4

566

2,377

56a

436

335

166

624

3.568

1,132

228

305

2a5

32a

4,563

zoo

3*945

NuMBER GF PATi ENTS OiSCHARGEO iN THOUSANOS

15,470

326

1,096

9.41

198

*

432

.?65

i59

899

260

95

321

806

202

210

174

2,7a5

138

l,a49

414

272

474

195

3a 8

i,715

224

176

416

190

2, 162

176

ii3

i45

455

259

129

1,079

i96

...

...

277

1,016

233

23a

17L

95

2a9

i.9a5

565

57

i36

i7a

245

i77

*

...

Z3*123

369

l,49a

1,031

lZ1

2Z6

729

396

208

a47

3i3

i90

95

1.022

226

345

170

2,T03

195

1,627

266

227

34a

2+3

446

i,744

235

Z59

40a

245

2,466

ii’4

i4a

110

3;:

367

2,33Z

ioi

360

1.018

4a4

2a9

1.361

336

i98

163

li

334

1.5a3

567

17i

170

106

83

6,3a5

L9T

3,945

3,654

224

73

46

*

*

62

22

66

57

*5

*9

*

309

6L

*

177

45

*

29

●

●

*

.4.

*

1,0Z9

229

280

Z70

151

4 a6

1:

62

85

204

*

159

*

*

*5

*

69

7a

La

●

174

164

i21

464

i53

●

*

TZ

48

69

13

15,554

234

492

Z15

15

31

302

158

94

972

305

170

238

36a

146

la

62

535

65

250

4Z

17

65

*a

33

170

aa

149

iza

104

1,496

1:;

151

135

Z06

174

1 ,6a9

i53

2T6

1,009

477

Z29

943

iaa

225

93

*

267

1,714

404

1::

152

204

4,346

197

3,92a

8,688

102

912

716

147

103

372

241

55

448

151

72

143

413

9a

107

60

l,7ao

139

1.171

257

165

3a6

72

I ao

656

63

12;

9a

1,292

123

79

Z8

160

03

167

ai6

99

az

*5

●

133

77a

170

15a

43

L4a

643

189

26

7a

Z9

4a

92

●

●

10,697

135

:1, LL7

995

155

93

4Z6

Z40

151

269

113

33

33

739

123

428

46

3,12a

126

2,026

3ao

316

369

356

61a

1,003

79

30:

8i

1,354

i39

63

13

i3z

i18

153

74a

42

●

. . .

. . .

135

578

193

52

25

au

747

387

i9z

33

32

28

55

*

...

1/ FiRST-Li SIEO OiAGNOSi S FOR FEMALES WiTH Deliveries iS COOEO v27, SHO14N uNOER ‘SUPPLEMENTARY Class if ications. ”
advancedata 5

TABLE 5. ltATt OF INPATIENTS OISCHARGELI FfiCM SHCRT-5TAY HOSPITALS. BY CATEGORY OF FIR ST-L ISTEO DIAGNoSIS. SEX. ANO AGE:

STATES. LS82

uNITEO

IO ISCHARGES FROM NUNFEDERAL HOSPITALS. EXCLUOES NEhBORN INFANTS. DIAGNOSTIC GROUP lNGS ANO COOE NUMBER INCLUSIONS ARE 5ASE0 CN THE

lhTEANATIGNAL CLASSIFICATION OF OISEASES, 9TH REVISICN, CLINICAL NOOIFICATIONJ

s EX AGE

CAT EGGKY OF FIR ST-L ISTEO OIAGtiGS1 S ANG IcD-9-CM CODE

TOTAL MALE FEMALE uNOER 15 1 5+4 45-64 65 YEARS

YEARS YEARS YEARS ANO OVER

RATE OF INPATIENTS DISCHARGED PER 10,000 POPULATION

ML CGNOIIIGNS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

NE OPLASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

HAL IGNAtiT NEOPLASHS . . . . . . . . . . . . . . . . . . . . . . . . ..l4O-2O8.23*234

MALI GNANT NEOPLASM OF TRACHEA,

eRCINChUS, ANO LUNG . . . . . . . . . . . . . . . . . . . . . ...162.197.0.197.3

MALIGNANT NEOPLASM OF BREAST . . . . . . . . . . . . . . ..17+ 175.198.8L

ENGOCRINE, NuTRITIONAL ANO t4ETABOL1C DISEASES,

ANO IHNUNITY DISORDER S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..240-279

OIABETES MEL LITUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..250

DISEASES OF THE BLOOO ANO 8LOO0-FORHING ORGANS . . . . . . . ..2.30-289

!lENTAL OISGROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..29O.3l9

PSYCWSES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-299

NEUROTIC ANO PERSONALITY OISOROERS . . . . . . . . . . . . . . . . ...300-301

ALCOHOL OEPENOENCE SYNDROME. . . . . . . . . . . . . . . . . . . . . . . . . . . ...303

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

DISEASES OF THE CENTRAL NERVOUS SYSTEM..... ..320-336,340-349

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

OISEASES OF THE EAR ANO MASTOID PROCESS . . . . . . . . . . . . ..38 O-389

DISEASES OF THE CIRCULATORY SYSTE?4 . . . . . . . . . . . . . . . . . . . ..39O+59

ESSENTIAL HYPERTENSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4OI

HEART OISEASE. . . ...391-392.0.393-398.402 .404,410-416,420-429

ACUTE HYOCAROIAL INFARCTION . . . . . . . . . . . . . . . . . . . . . . . . . ...410

ATHEROSCLEROTIC HEART OISEASE . . . . . . . . . . . . . . . . . . . . . ...414.0

OTHER ISCHEHIC HEART OISEASE . . . . . . . . . ..411-414 .914.1-4I4.9

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

CEREeROVASCULAR OISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..43O438

OISEASES OF THE RESPIRATORY SYSTEM . . . . . . . . . . . . . . . . . . . ..46O-519

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

CHRONIC OISEASE OF TONSILS At@ AOENOIOS . . . . . . . . . . . . . . . ...474

PNEu!S3NIA, ALL FORMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..480+86

uTHM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

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

ULCERS OF THE STOMACH ANO SMALL INTESTINE.. . . . . . . . ...531-534

GASTRITIS ANO OUOOENITI S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...535

APPENOIC IT' S........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-.540-543

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

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

CWL~ITHIASIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...574

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

CALCULUS OF KIDNEY ANO URETER . . . . . . . . . . . . . . . . . . . . . . . . . ...592

OXSOROERS OF MENSTRUATION ANO OTHER

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

COMPLICATIONS OF PREGNANCYS CHILOSIRTH,

ANO THE PUERPERIUU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l/ 630-676

AEIORTIfflS ANO ECTOPIC ANO NOLAR PREGNAWIES . . . . . . . ...630-639

DISEASES OF THE SKIN ~0 SUBCUTANEOUS TISSUE. . . . . . . . ...680-709

OISEASES OF THE MUSCULOSKELETAL SYSTEM

4N0 CWNECTIVE TISSUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

ART HRoPATHIES ANO RELATED OISOROERS . . . . . . . . . . . . . . . . ..710-719

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

CONGENITAL ANOMALIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74O.T59

cERTAxN CONOIT IONS ORIGINATING IN 7HE

PERINAT& PERIOO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..76O.779

SYMPTOMS, SIGNS, AND ILL-OEFINEO CUNOI TIONS . . . . . . . . . ...780-799

INJURY AND POIS~lNG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..8 OO+99

FRACTURES, ALL SITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..8OO-@29

FRACTURE OS NECK OF FEHuR . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..8zo

SPRAINS ANO STRAINS OF BACK ( INCLUOIW NECK) . . . . . . ...846-047

INTRACRANIAL INJuRIES ( EXCLX31NG THOSE MI 7H

SKULL FRACTUREJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..85O.854

LACERATIONS ANO OPEN HOUNOS . . . . . . . . . . . . . . . . . . . . . . . . ..67O-9O4

SUPPLEMENTARY CLASSIFICATIONS . . . . . . . . . . . . . . . . . . . . . . . . .. VOI-V8Z

PERSIMS AOMITTEO FOR STERILIZATION . . . . . . . . . . . . . . . . . . . .. V25.2

FEHALES !41TH DEL IVERIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27

1,679.0

30.2

112*8

85.8

L3.9

9.9

50.5

28.8

16.O

76.0

25.0

12.+

18.1

79.5

18.6

24.2

L5.O

238.6

14.5

151.2

29.6

21.7

35.8

19.1

36.3

150.5

20.0

19.o

35.9

1.s.9

201.3

15.3

11.4

11.1

22.3

26.6

21.6

148.4

12.9

15.1

44.3

21.1

24.6

103.4

24.7

19.0

14.6

7.2

27. L

155.2

49.3

9.9

13.3

12.4

14.3

19.9.5

6.7

171.6

1.394.0

29.4

98.7

84.8

17.8

●

38.9

23.9

14.3

81.0

23.5

8.6

29.0

72.6

18.2

19.0

15. T

251.0

12.4

166.6

37.3

24.5

42.7

17.6

35.0

154.5

20.2

15.9

37.5

17.1

194.8

15.9

10.1

1?-1

41.0

23.3

11.6

97.2

lT.6

. . .

. . .

24.9

91.5

21.0

21.4

15.4

8.6

26.1

178.9

50.9

5.1

12.2

16.1

22.1

16.0

*

. . .

1s944.9

31.0

126.0

e6.7

10.2

19.0

61.3

33.3

17.5

71.2

26.4

16. O

8.0

86.0

19.0

29.0

14.3

227.3

16.4

136.9

22.4

19.1

29.2

20.5

37.5

146.7

19.7

21. !5

34.3

20.6

207.4

14.7

12.5

9.2

4.7

29.6

30.9

196.2

8.5

30.3

85.6

40.7

24.3

114.5

28.2

16.7

13.7

5.9

2a.1

133.1

47.7

14.4

14.3

8.9

7.0

360.9

16.6

331. s

T1l.6

43.6

14.1

8.9

*

*

12.0

4.3

12.9

11.1

*1-O

*1.8

●

60.1

12.0

*

34.4

8.8

*

5.7

*

*

●

●

*

200.5

44.5

54.5

52.5

29.3

94.6

*

2.4

12.2

16.5

39.7

*

30.9

*

*

*T.. O

●

13.5

15.2

3.5

*

33.9

32. o

23.6

90.4

29.7

*

*

14.0

9.3

13.5

2.5

1,450.2

21.8

45.9

20.1

1.+

2.9

28.2

14. T

8.8

90.7

28.5

15.9

22.2

34.3

13.6

1.6

5.8

49.9

6.1

23.3

4.0

1.6

6.0

●o.e

3.1

71.8

a. 2

13.9

11.9

9.7

139.5

8.1

10.0

14.1

12.6

19.2

16.2

157.5

14.3

25.7

94.0

44.5

21.3

87.9

17.5

20.9

8.7

●

24.9

159. a

37.7

●o. 7

17.8

14. z

19.0

405.2

1s.4

366.2

1,955.2

22.9

205.3

161.0

33.2

23.2

83.7

54.3

12.4

100.8

33.9

16.3

32.2

93.0

22.0

24.1

13.4

400.6

31.4

263.5

57.9

37.1

86.9

16.2

40.4

147.7

14.2

*

28.5

22.1

290.7

27. T

lT.8

6.2

36.0

18.7

37.5

183.6

22.2

18.5

81.0

*

30.0

175.1

38.3

35.6

9.6

33.4

144.7

42.4

5.8

17.6

6.5

10.8

20. T

*

*

3,987.9

50.3

4L6.3

370.9

Sa. o

34.6

158.6

89.5

56.5

100.1

42. o

12.4

12.5

275.4

45.9

159.7

17.0

1,166.3

46.8

755.2

L41.5

118.0

137.6

132.6

230.3

374.0

29.6

*

111. a

30.4

504.7

51. T

23.4

4.9

49.1

44.1

57.2

278.9

15.8

*

. . .

. . .

50.3

215.4

71.8

19.5

9.3

32.6

278.6

14% 2

71.4

12.4

11.8

LO.4

20.5

*

. . .

1/ FIRST-L ISTEO OIAGNOSIS FOR FEMALES WITH DELIVERIES IS COOEO v27, SHOWN uNOER WSUPPLEHENTARY CLASSIFICATIONS. N
6 admncedata

TABLE b. AVERAGE LENGTH of STAY FOR [NPATIENTS ”OIs CHARGEO FROM SHGRT-STAY HOSPITALS. BY CATEGORY OF FIRST-LISTED OIAGNOSIS. SEX,

ANO AGE : uNITEO STATES, 1982

(DISCHARGES FRCM WNFEOERAL HOSPITALS. ExCLuDEs NEh BORN INFANTS. DIAGNOSTIC GROUPINGS At4D COOE NuI18ER INCLUSIONS ARE BASEO ON THE

INTER NATIO’{AL LLASSIF ICATION OF JISEASES, 9TH REV IS ICN. CLINICAL MODIFICATION]

SEX AGE

CAT EGO~Y OF FIR ST-L ISTEO OIAGNOSIS ANO ICO-9-CM COOE

TOTAL MALE FEMALE wOER 15 15-44 +5-64 65 YE.ARS

YEARS YEARS YEARS ANO OVER

ALL COND IT IONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lNFECTiOUS ANO PARASITIC OISEASES . . . . . . . . . . . . . . . . . . . ...001-139

NE OPLASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 140-239

MALIGNANT NE OPLASIIS . . . . . . . . . . . . . . . ..- . . . . . . .. L40-2 08,230-234

MALIGNANT NEOPLASM OF TRACHEA,

BRONCHUS, ANO LUNG. -......................162 ,19 T.0,197.3

MALIGNANT NEOPLASM OF BREAST . . . . . . . . . . . . . ...174-1 75,198.81

ENGCCRINE, NUTRITIONAL ANO ME TA80L1C OISEASES,

AND IMMUNITY OISGRDERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...240-279

DIABETES MEL LITuS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..25o

OISEASES OF THE 8LOO0 ANO BLOOG-FORMING ORGANS . . . . . . . ..28 O-289

IIENTAL DISGROERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

PSYCI+3SES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-299

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

ALCOHOL OEPENOENCE SYNDROME . . . . . . . . . . . . . . . . . . . . . . . . . . . ...303

OISEASES OF THE NERVOUS SYSTEM ANO SENSE ORGANS . . . . . . ..32 O-3B9

OISEASES OF THE cENTRAL NERv0u5 SY5TEM . . . . ...320-336.340-349

CATARACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...”..... . . . . . 366

OISEASES OF THE EAR ANO HA STOIO PROCESS . . . . . . . . . . . . ..3 BO-389

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

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

HEART OISEASE . . . . . .391 -392 .0,393-398,402,404,4 L0-416,420-429

ACUTE MYOCAROIAL INFARCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410

ATHEROSCLEROTIC HEART DISEASE . . . . . . . . . . . . . . . . . . . . . ...414.0

OTHER ISCHEMIC HEART DISEASE . . . . . . . . ...411-413.414.1-414.9

CONGESTIVE HEART FAILURE . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4Z8. O

CERE8ROVASCULAR 01 SEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +30-438

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

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

CHRONIC OISEASE OF TONSILS ANO AOENOIOS . . . . . . . . . . . . . . . . ..4T4

PNEUMONIA, ALL FORMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..480-486

MT HMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

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

ULCZRS OF THE STOMACH ANO SMALL INTESTINE . . . . . . . . . ...531-534

GASTRITIS ANO DuOOENITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...535

APPEND IC IB I S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...540-543

lNGu INAL HERNIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..55O

NONINFECTIOUS ENTERITIS AND COLITIS . . . . . . . . . . . ...555-556.558

cHoLalTHIAs Is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..5T4

DISEASES OF THE GENITOURINARY SYSTEM . . . . . . . . . . . . . . . . ...5.30-629

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

OISOROERS OF MENSTRUATION ANO OTHER

ABNORMAL VAGINAL 8LEE01NG . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...626

COHPLXCATIONS OF PREGNANCY, CHILO&. IRTH,

ANO THE PUERPERIUf4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l/ 630-676

ABORTIONS ANO ECTOPIC ANO NOLAR PREGNANCIES . . . . . . . ...630-639

DISEASES OF THE SKIN ANO SWCUTANEOUS TX SUE . . . . . . . . . ..680-709

OISEASES OF THE )NJSCULOSKELETAL SYSTEM

ANO CONNECTIVE TX SSUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..71 O-739

ART HROPATHIES MO RELATEO OISOROERS . . . . . . . . . . . . . . . ...710-719

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

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

CERTAXN CONOITIONS ORIGINATING IN THE

PER INATAL PERIOO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...760-779

SYMPTOMS, SIGNS, M40 ILL-O EFINEO CONDITION S. . . . . . . . . . ..780-799

INJURY ANo POISONING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-999

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

FRACTURE OF NECK OF FEWJR . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..82O

SPRAINS NO STRAINS OF BACK [ INCLUOING NECK ]....... ..846-E47

INTRACRANIAL INJURIES (EXCUDING THOSE WITH

SKULL FRACTURE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..85O.854

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

SUPPLEMENTARY CLASS IF ICATIONS . . . . . . . . . . . . . . . . . . . . . . . . .. VO1-V82

PERSONS AONITTEO FOR STERILIZAT ION . . . . . . . . . . . . . . . . . . . .. V25.2

FEMALES WITH DELIVER IES..................................V27

7.1

6.7

9.9

11.1

10.9

10.0

8.8

9.5

7.0

12.1

15.5

10.1

11.2

5.4

11.0

2.9

3.2

9.4

6.4

8.9

11.2

8.8

7.1

10.1

12.2

6.2

4.8

1.9

8.0

5.5

6.8

7.9

5.3

5.3

4.5

5.3

8.9

5.6

4.8

3.5

2.5

2.0

8.3

7.7

8.5

9.5

6.1

12.7

4.1

7.4

10.1

18.6

7.4

5.6

5.3

3.6

2.0

3.6

7.5

6.3

10.4

11.2

11.2

*

8.5

9.1

6.7

11.6

14.7

9.8

10.6

5.7

11.6

2.8

2.9

9.0

5.9

8.5

11.0

7.9

6.8

9.3

11.5

6.2

4.5

1.8

7.9

4.9

6.4

7.3

4.8

5.0

4.5

5.3

9.6

6.4

4.4

. . .

. . .

8.2

7.0

6.9

8.7

5.9

12.6

3.9

6.6

8.3

18.2

T.2

5.5

5.4

4.1

●

. . .

AVERAGE LENGTH OF STAY IN OAYS

6.8

7.0

9.6

11.L

10.5

10.D

9.0

9.7

7.2

12.6

16.2

10.3

13.0

5.1

10.4

3.0

3.5

9.8

6.8

9.4

11.6

9.9

7.5

10.7

12.9

6.3

5.2

2.0

8.1

5.9

7.2

8.6

5.7

5.7

4.7

5.3

8.7

5.2

5.6

3.5

2.5

2.0

8.5

8.2

9.6

10.6

6.3

12.8

4.2

8.4

11.8

18.7

7.6

5.8

5.2

3.5

2.0

3.6

4.6

4..?

5.9

7.5

*

*

5.8

6.2

4.9

13.7

*28.3

● 11.4

●

3.5

7.7

*

2.4

7.1

*

6.9

*

*

*

●

*

3.5

3.7

1.7

5.0

3.6

4.0

●

3.0

4.5

2.5

4.0

●

3.5

●

●

●2.3

*

4.3

5.1

5.5

●

5.5

12.7

3.1

4.3

5.2

●

*

3.1

4.0

3.7

4.3

5.1

5.6

6.6

8.1

7.8

7.4

6.6

6.9

4.9

11.8

14.T

10.6

11.2

6.1

9.3

2.6

3.2

6.6

4.6

6.7

9.1

5.0

5.6

*1O.2

11.2

4.1

3.9

2.1

6.3

5.2

5..4

5.8

4.2

4.8

3.8

5.5

7.2

4.6

3.9

3.5

2.5

2.0

6.0

6.2

5.0

8.7

5.7

*

3.5

5.8

7.2

*20.4

7.0

5.7

5.1

3.5

2.0

3.6

7.9

8.6

1::!

10.5

10.1

0.8

9.7

8.1

12.0

16.4

9.3

10.9

5.B

11.4

2.8

4.0

8.2

6.1

7.9

10.7

7.1

6.6

8.7

11.2

T.5

6.1

*

8.8

6.4

7.1

7.2

5.5

7.5

4.7

5.9

8.4

5.5

5.2

3.5

*3.O

●

0.8

7.7

8.8

9.7

7.7

4.4

8.0

9.7

16.5

7.9

8.4

5.9

4.8

*

●

10.1

11.0

11.8

1,2.2

11.6

10.8

10.9

11.3

8.8

13.0

15.7

9.0

12.2

1::;

3.0

5.2

10.5

7.8

9.8

11.9

9.9

7.9

10.4

12.6

9.7

8.0

11.:

L1.1

9.0

10.0

7.6

11.1

(6.3

6.8

11.4

13.5

7.6

*

...

<,.

13.8

10.7

I;L.8

12.4

II.5

6.5

12.6

15.2

131.7

9.1

8.7

8.0

6.8

●

...

U FIR ST-L ISTEO OIAGNOSIS FOR FEMALES uITH DELIVERIES IS COOEO V27, SHO14N UNOER ‘SUPPLEMENTARY CLASS IF ICATIONS. -
aduancedata 7

TABLE 7. NuMBER OF ALL-LISTED PROCEDURES FOR INPATIEtuTS 131SCHARGE0 FROM SHORT-STAY HOSPITALS, BY PROCEOURE CATEGORY, SEX, ANO AGE:

UN17’EO STATES, 1982

(DISCHARGES FROH NONFEDERAL HOSPITALS. EXCLUOES NE IWORN INFANTS. PROCEOURE GROUPINGS ANO COOE NUMBER INCLUSIONS ARE BASEO ON THE

INTERNATIONAL CLASSIFICATION GF OISEASES, 9TH REVISICh, CLINICAL MOO IF ICATION1

PROCEOURE CA TEGaRY AND 1CO_9-CM CODE

SEX AGE

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

YEARS YEARS YEARS ANO OVER

&L PR~EDURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

OPERATIONS ON THE ENOOCRINE SYSTEM . . . . . . . . . . . . . . . . . . . . . . .06-07

OPERATIONS UN THE EYE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. O8-16

ExTRACrl ON OF LENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...13.1-13.6

INSERTION OF PROSTHETIC LENS lPSEUOOPHAKOS I . . . . . . . . . . . ..13.1

operations ON THE EAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...18-20

MYRIWOTOMY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..20.0

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

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

TONSILLECTOMY wITH OR HITHOUT AOENOIOECTOHY . . . . . ...23.2-28.3

OPERATIONS ON THE RESPIRATORY SYSTEM. . . . . . . . . . . . . . . . . . ...30-34

8RONCHOSCOPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..33.2 l.33.23

Operations CN THE CARDIOVASCULAR SYSTEM. . . . . . . . . . . . . . . ...35-39

OPEN HEART SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..35.l-35.5l.

35. 53-36 .2,36 .9.37 .LO-37.11 ,37.32- 37.33,37.5

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

CAR OIAC CA THE TERIZATION . . . . . . . . . . . . . . . . . . . . . . . ...37 .21-37 .23

PACEMAKER INSERTION, REPLACEMENT, RENOVAL. REPAIR ..3 T.7-37.8

OPERATIONS ON THE HEMIC ANO LYMPHATIC SYSTEFI. . . . . . . . . . ...40-+1

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

ESOPHAGOSCOPY ANO GA STROSCOPY I NATURAL ORIFICE). .42.23,44.13

PART IAL GASTRECTO)IY ANO RESECTION

OF IN TEST ICE . . . . . . . . . . . . . . . . . . . . . . . . . ...43.5-+3.8 ,45.6 -45.8

APPENDECTOMY, EXCLUOING lNCXOENIAL . . . . . . . . . . . . . . . . . . . ...47.0

HEUORRtX310ECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..49.43 -49.46

C~LECYSTECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..5l.2

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

OiVISION OF PERITONEAL ADHESION S . . . . . . . . . . . . . . . . . . . . . ...54.5

OPERATIONS ON THE URINARY sYSTEM .........................55-59

ENOOSCOPIES (NATURAL ORIFICE). .55.21-55.22 .56.31,57 .32 ,58.22

OILATION GF URETHRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..5ti.6

OPERATIONS ON THE HALE GENITAL ORGAN S. . . . . . . . . . . . . . . . . ...60-64

PROSTAIECTWY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..6O.2.6O.6

circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..64.o

OPERATIONS ON THE FEMALE GENITAL ORGAN S. . . . . . . . . . . . . . . . ..65-71

00 PHORECTOHY ANO SALPINGO-OOPHOREC TOMY.. . . . . . . . . ...65.3-65.6

BILATERAL OBSTRUCTION OR OCCLUSIaN

OF FALLaPIAN TuBES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. b6.2-66.3

HYSTERECTOFIY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..68.3 -68. T

CURETTAGE OF UTERUS Ta TERHINATE PREGNANCY . . . . . ..69.O1 ,69.51

oILATIDN ANO CURETTAGE OF UTERUS

AFTER aELIVERY aR A8DRT1aN . . . . . . . . . . . . . . . . . . . . . . . . . . ..69. O2

OIAGKLSTIC OILATION ANO CURETTAGE OF UTERUS . . . . . . . . . . ..69. O9

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

OBSTETRICAL PRaCEOURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T2-75

EPISIOTaHY uITH aR IAXTHOUT FaRCEPS

OR VACUUM Extraction . . . . . . . . . . . . 72.1.72 .21,72 .31, T2.71, T3.6

CESAREAN SECTIW . . . . . . . . . . . . . . . . . . . . . . ..74. O-74.2 .74.4 .74.99

REPAIR af CURRENT aSSTETRXC Laceration . . . . . . . . . . . .. T5.5-75.6

OPERATIONS ON THE INJSCULOSKELETAL SYSTEH . . . . . . . . . . . . . . ...76-84

OpEN REOUCTIaN OF FRACTURE 76.72,

76.74,76 .7b76.77,76.79,79 .2-79.3,79.5-79.6

OTHER REOUCTION OF

FRACTURE . . . . . ..76.7 W76.71.76.73.7b .75.7 b.78.79. O-79.l.79.4

EXCISICVA OR DESTRUCTXaN aF INTERVERTEBRAL OISC

ANO SPINAL Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...80.5.81.0

EXCISION aF SEMILUNAR CARTILAGE aF tiNEE . . . . . . . . . . . . . . . ..aLI.6

ARTHRGPLASTY ANO REPLACEMENT OF KNEE . . . . . . . . . . ...81 .41-81 .47

ARTHRaPLASTY ANO REPLACEMENT OF HIP . . . . . . . . . . . . . . ..81.5-8I.6

aerations aN THE lNTEGWENTAR% SYSTEM ....... ............85-86

WSTECTaHY ............ ..................................85.4

SKIN GRAFT [EXCEPT LIP OR MOUTHJ . . . . . . . . . . . . . . . . . ..86.6-8b.7

MISCELLANEOUS Diagnostic ANO THERAPEUTIC PROCEDURES . . . . . .87-99

COMPUTERIZE AXIAL TO#aGRAPHY..8T. O3.87.4l ,87.71,88.01,88.38

PYELOGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..87.73 -87.75

ARTERXOGRAPtIY ANO ANGlaCAROIOGRAPHY

USING CCNTRAST HA TERIAL . . . . . . . . . . . . . . . . . . . . . . . . ...88.4-88.5

aIAGNOS71C ULTRASalNO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7

RADIO ISOTaPE SCAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..92.0-92.1

34,632

859

109

1,402

599

418

332

1b3

1,492

25o

438

921

207

1,749

243

170

471

202

362

5,790

249

240

277

165

493

549

286

1,901

841

184

85o

358

90

4,023

500

602

b50

106

275

741

154

3*945

2,032

730

449

3.583

434

256

227

151

137

148

1,862

111

L56

5,454

600

464

740

561

641

NuM8ER OF AU-L ISTEO PROCEDURES IN THaUSANOS

L3,331

436

31

565

i30

158

178

95

709

117

IT9

554

127

1,051

168

125

309

102

182

2,544

115

113

1+6

82

132

489

40

1,098

552

90

850

358

90

...

...

...

...

...

...

...

...

...

...

...

...

1,814

2+0

145

126

106

74

46

722

?8

2,597

289

235

456

204

284

21,302

424

79

837

369

26L

153

68

783

133

259

367

81

697

75

45

161

100

179

3,246

134

127

131

3::

60

246

802

289

94

...

...

...

4,023

500

602

650

106

275

741

154

3,945

2.032

730

449

1,769

195

112

101

45

63

10L

1,140

105

56

2,857

311

229

284

357

357

2,219

L39

*

64

*6

*

184

144

424

*10

269

51

●11

106

15

3:

*

27

294

●9

*

65

9;

*

113

+2

18

LIT

. . .

46

13

●

*

*

*

*

16

*7

●

*

253

30

64

●5

*

*

●

126

1;

2.38

4+

18

::

12

15,296

286

46

128

21

*5

73

*11

732

191

163

177

30

229

23

14

61

*6

81

2,078

58

34

170

1::

A39

177

448

155

51

128

2:

3,00b

301

595

410

105

272

493

5+

3,925

2,024

727

447

1,664

195

99

120

97

69

*8

810

16

65

1.485

150

153

101

198

123

8,368

254

37

289

114

75

47

*5

215

39

*5

340

80

723

130

105

262

34

104

1,630

87

76

28

63

166

167

59

548

243

46

209

96

14

736

153

lH

*

*

200

55

●

*

●

928

79

45

85

38

25

38

555

52

41

1.750

158

136

368

149

208

8,T50

180

22

922

458

337

27

*

120

*lo

*

354

87

691

74

50

114

161

149

1,789

95

127

E

138

150

48

792

401

b9

396

261

*7

26.9

45

58

. . .

. . .

47

45

. . .

. . .

. . .

. . .

738

130

48

16

;;

102

370

42

34

1,931

248

15b

254

192

297
8 aduancedata

TABLE 8. RATE OF AL L- LIS.TED PROCEDURES FGR 1NPA11ENT5 DISCHARGED FROH SHORT-STAY HOSPITALS, By PROCEDURE CA TEGGKY, SEX, ANO AGE:

LJtiIrEo STATES, 1982

lQi SCHAMbES FROM NONFEDERAL HGSPITALS. EXCLUDES NEhBChN lNFAt#TS. PTU3CECWRE GROIJPltAGS AND CODE NUMBER 1NCLUS1ONS ARE BASED ON WE

INTERNATIONAL CL ASSIF ICATION OF DISEASES. 9TH REv IS ILN. CLINICAL HOOIFICATIONI

SEX AGE

PRCICEOURE CA TEGiiRY AtW IdJ-9-CM COOE

TOTAL MALE FEMALE UNOER 15 1 5-4+ 45-64 65 YEARS

YEARS YEAR S YEARS AtW OVER

RATE OF ALL-L ISTEO PROCEDURES PER 100,000 POPULATICN

ALL PRGCEOURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,066.4

OPERATIONS ON THE NERvGu S SYSTEM . . . . . . . . . . . . . . . . . . . . . . ...01-05

OPERATIONS LJN THE ENCX3CR1NE SYSTE14 . . . . . . . . . . . . . . . . . . . . . .. O6-O7

OPEf(ATI(JNS UN THE EYE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...08-16

EXTRACTION OF LEN S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...13. 1- 13.6

INSERTION OF PROSTHETIC LENS lPSEUGOPHAKOS) . . . . . . . . . . ...13.7

OPERATIONS ON THE EAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...18-20

t4YRINti OTCltlY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...20.0

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

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

TONSILLECTOMY wITH OR wITHOUT AD ENOIDECT014Y . . . . . . . . 28.2 -28.3

OperatiOnS ON THE RESPIRATORY SYSTEM . . . . . . . . . . . . . . . . . . ...30-34

BRONLHOSCOPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33.21 -33.23

OPERATIONS GN THE CARDIOVASCULAR SYSTEM . . . . . . . . . . . . . . . ...35-39

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

35.5+ 36.2,36 .S,37.1O-3T.11 ,37.32 -3 T.33,37.5

DIRECT HEART REVASCULAR 12 AT I ON . . . . . . . . . . . . . . . . . . . . . ...36.1

CAROIAC CATHETER IZATION . . . . . . . . . . . . . . . . . . . . . . . . ..37.2 l.37.23

PACEP)AKER INSERTION, REPLACEMENT. REf4LVAL, REP AI R. .37.7-37.8

OPERATIONS ON THE HEMIC ANO LYMPHATIC SYSTE14 . . . . . . . . . . . ..4O-41

LIBERATIONS ON THE OIGESTIVE SYSTEfl . . . . . . . . . . . . . . . . . . . . ...42-54

ESOPHAGOSCOPY ANO GASTROSCOPY [NATURAL GRIFICE )..42.23,44. 13

PART IAL GASTRECTOMY ANO RESECTION

OF IN TEST INE . . . . . . . . . . . . . . . . . . . . . . . . . ...43.5.43.8.45.6.45.8

APPENOECTOHY, EXCLUOING INCIDENTAL . . . . . . . . . . . . . . . . . . . ...47.0

HEMORRHOIOECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..49.63 -49.46

CHGLECYSTECT014 Y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...51.2

REPAIR OF INGUINAL HER NIA . . . . . . . . . . . . . . . . . . . . . . . ...53.0-53.1

OIVISION OF PERITONEAL AOHESIONS . . . . . . . . . . . . . . . . . . . . . ...54.5

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

ENOOSCOPIES (NATURAL OR IF ICE J..55.21-55.22,56 .3 L,57.32 ,58.22

OILATION OF URETHRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..58.6

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

PROSTATE CTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..60.2.60. b

CIRCW4CIS CON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...64.0

OPERATIONS ON THE FEMALE GENITAL ORGAN S. . . . . . . . . . . . . . . ...65-71

00 PHORECTOMY ANO SAL PINGO-00PHORECTGt4Y. . . . . . . . . . ...65.3-65.6

81 LATERAL OESTRUCTXON OR OCCLUSICN

GF FALLOPIAN TUB ES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..66.2-66.3

hYSTERECTOMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68.3 -68.7

CURETTAGE OF UTERUS TO TERMINATE PREGNANCY . . . . . ..69.51 .69.51

DILATION ANO CURETTAGE OF UTERUS

AFTER OEL IVERY OR ABORT I ON . . . . . . . . . . . . . . . . . . . . . . . . . ...69. 02

OIAGMSTIC O1LATION ANO CURETTAGE OF UTERUS . . . . . . . . . ...69.09

REPAIN OF CYSTOCELE ANO RECIOCELE . . . . . . . . . . . . . . . . . . . . ...70.5

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

EPIS1OTOHY wITH 04. wITHOUT FCRCEPS

OR VACUUM EXTRACT ION . . . . . . . . . . . . 72.1,72 .21,72.31,72.71,73.6

CESAREAN SECTION . . . . . . . . . . . . . . . . . . . . . ...74.0-74.2.74.4 ,76.99

REPAIR OF CURRENT OBSTETRi C LA AERATION . . . . . . . . . . . .. T5. 5-75.6

OPERATIONS ON THE Mu SCULOSKELETAL SYSTEM . . . . . . . . . . . . . . . .. T6-84

GPEN REOUCT 10N OF FRAC TuRE 76.72,

76. T4,76. T& T6.77,76. T9 ,79.2 -7’3.3 ,79.5-79.6

OTHER REOUCTION OF

FRACTURE . . . . ...76.71.76.71. 76.73, 76.75,76 .78v T9. O-79. 1 ,79.4

EXCIS1ON OR OESTRUCT 10N OF 1NTERVERTE5RAL DISC

At4CJ SPINAL FuSi LIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...80. 5,81.0

EXCISION OF SEHIL(JNAR CARTILAGE OF KNEE . . . . . . . . . . . . . . . ..8O.6

ART HROPLASTY ANG REP LACEt4ENl OF KNEE . . . . . . . ..81. .81 .41-81.47

AR THROPLASTY ANO REPLACEMENT OF HIP. . . . . . . . . . . . . . . . 81.5-81.6

OPERATIONS ON THE lNIEGUMENTARY SYSTEH . . . . . . . . . . . . . . . . . .. I35-W

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

SKIN GRAFT iEXCEPT LIP OR MOUTH ) . . . . . . . . . . . . . . . . ...86.6-86.7

3T3.8

47.5

609.8

260.6

182.0

L44.4

70.7

649.0

108.9

190.7

400.7

90.2

T60.8

105.6

74.0

204.7

87.7

157.3

2,519.0

108.4

104.3

120.3

71. T

214.3

238.9

124.6

026.9

366.0

80.1

369.8

155.9

39.3

1 ,750.0

217.6

261.8

282.8

46.3

119.5

322.3

67.1

1,716.2

883.8

317.7

195.4

1,558.6

18’9.0

111.5

98.6

65.5

59.6

64.3

810.0

48.3

68.0

MISCELLANEOUS oIAGNGSTIC ANO THERAPEuTIC PROCEDURE S.. . ...87-99 2,372.5

COHPUTERIZEO AXIAL TOMOGR.4PHY...903,87841,8787. 71,88.01,88.38 260.9

PYELOGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..87.73 .87.75 201.9

ART ERIOGRAPHY ANO AN G1GCAR0112GRAPHY

uSING CONTRAST MA TERIAL . . . . . . . . . . . . . . . . . ..-........88.4-88.5 321.8

DIAGNOSTIC ULTRASOUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7 244.1

FUOIOISOTOPE SCAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...92.0-92.1 27a.7

12,012.4

392.6

27.5

509.1

207.1

142.0

160.8

85.4

638.6

105.3

ltl.5

498.9

114.0

947.5

151.4

112.9

278. T

91.6

164.2

2,292. T

103.4

101.7

131.4

74.0

118.8

440.9

36.1

989.7

4?T.5

81.5

766.0

322.9

ai.4

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

1,634.2

216.2

130.4

113.3

95.3

66.6

41. a

650.7

● 5.3

aa.7

2,340.0

260.4

212.1

410.9

~a4.2

2.55.6

17.916.9

356.3

66.2

703.9

310.5

219.3

129.1

57.0

65a. a

112.2

217.9

309.1

68.0

5a6.5

62.9

37.7

135.7

a4.1

150.9

2,730.2

113.0

106.7

110.0

69.7

303.4

50.4

207.3

675.0

243.3

78.9

. . .

. . .

. . .

3,383.4

420.7

506.1

546.7

a9.5

231.1

623.2

129.7

3,318.0

l,70a. a

614.3

377.8

1,488.1

163.6

93a

84.8

37.7

53.1

a5.3

950.7

aa. +

4a.7

2,402.8

261.4

192.3

238.7

300.0

300.2

4, 320.1 14,261.4

270. L

*

124.0

*lL.4

*

358.3

279.9

a26. 3

*18.8

523.3

9a.5

*20.8

205.4

29.6

*

64.9

●

52.5

572.1

*18.3

*

126. a

*

181.9

*

220.0

81.8

34.2

228.4

. . .

90.2

25.4

*

*

*

*

*

32.0

13.0

●

*

492.3

58.6

125.2

●9. 7

*

*

*

246.2

●

32.9

559.9

84.8

36.0

33.4

4.?.2

23.7

267.1

42.5

119.1

19.4

●

60.2

*1O.5

6a2 .4

178.1

i51.6

165.0

27.7

213.8

21.2

13.1

57.0

*5.1

75.3

1*937.5

54.4

31.3

158.1

74.6

173. a

129. a

165.1

417.9

i44. T

47.8

119.5

*

20.7

2,802.5

280.2

555.0

3a2.5

97.8

253.5

459.7

50.4

3 ,659.2

1 ,886.7

677.4

ft16.7

1 ,551.2

la2. o

92.3

112.2

90.5

64.5

*7.1

755.7

14.7

60.2

1 ,384.4

139. a

142.6

94.0

ia4.4

114.9

18. a31.9

572.5

83.7

649.7

256.9

169.3

106.6

*1O.2

4a4.6

aa. a

● 11.2

764.1

180.3

1,626.3

293.4

237.3

590.1

T5.8

235.0

3,667.4

195.5

170.4

62.7

141.7

374.0

375.1

133.6

,233.1

547a

103.9

469.7

216.3

32.4

,655.7

343a

*14. 1

4oa.4

●

*

450.2

124.2

●

*

*

320620.3

670.0

82.0

3 “435.9

1,,707.7

1,257.2

101.9

*

449.1

●37.7

*

1,,320.2

324.1

2,577.3

277.5

186.6

424.5

600.0

557. i

6 ,669.0

352.6

472a

52.5

al.6

514.2

559.0

177.5

2 ,951.6

1 ,493.8

257.9

1 ,475.7

974.0

*27.6

999.1

169. O

0.6

216.6

. . .

. . .

176.2

16T.4

. . .

. . .

. . .

. . .

2,0a8. a 2,751.4

178.5 4a4. i

Loz. 1 177.2

190. a 61.5

86.6 46.9

55.2 145.7

84.7 3ao.3

l,24a.4 l,3ao.2

116.7 158.2

92.1 126.7

3,93a. o T,199.9

355.6 925.3

306.5 5a3. o

a2s.4 945.7

335. a 717.1

4.5a.3 i,lo7.3
dmcedaa9

References

INatjonal Center for Health Statistics, W. R Simmons: Development

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

Health Stankics. Series 2-No. 39. PHS Pub. No. 1000. Public Health

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

2National Center for Health Statistics, E. Graves and B. J. Haup~

Utilization of short-stay hospitals, United States, 1981, annual summary. Vital and Health Statistics. Series 13-No. 72. DHHS Pub.

No. (PHS) 83-1733. Public Health %-vice. Washington. U.S. Government Printing Oflice, Aug. 1983.

SU.S. pub]jc Health Service and Health Care Financing Administration; International Classification of D&eases, 9th Revision, Clinical

Modification. DHHS Pub. No. (PHS) 80-1260. Public Health Service. Washington. U.S. Government Printing OtTice, Sept. 1980.

4Natjonal Center for Health Statistics, M. G. Sirken: Utilization of

short-stay hospitals, summary of nonmedical statistics, United States.

1965. Viral and Health Statistics. Series 13-No. 2. PHS Pub. No.

1000. Public Health Service. Washington. U.S. Government Printing

Otlice, Aug. 1967.

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

short-stay hospitals by characteristics of discharged patients, United

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

No. 1000. Public Health Service. Washington. U.S. Government

Printing Office, Dec. 1967.

Symbols

..- Data not available

. . . Categoty not applicable

. Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
10 aduancedata

Technical notes

Source of data

The National Hospital Discharge Sumey (NHDS) encompasses patients discharged from short-stay hospitals, exclusive of military and Veterans Administration hospitals,

located in the 50 States and the District of Columbia. Only

hospitals with six or more beds and an average length of stay of

less than 30 days for all patients are included in the survey.

Discharges of newborn infants are excluded from this report.

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

hospitals contained in the 1963 Master Facility Inventory of

Hospitals and Institutions. New hospitals were sampled for

inclusion in the survey in 1972, 1975, 1977, 1979, and 1981.

In all, 550 hospitals were sampled in 1982. Of these hospitals,

71 refused to participate, and 53 were out of scope. The 426

participating hospitals provided approximately 214,000 abstracts of medical records.

Sample design

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

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

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

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

these 24 primary strata, the allocation of the hospitals was

made through a controlled selection technique so that hopsitals

in the sample would be properly distributed with regard to type

of ownership and geographic division. Sample hospitals were

drawn with probabilities ranging from certainty for the largest

hospitals to 1 in 40 for the smallest hospitals.

Sample discharges were selected within the hospitals using

the daily listing sheet of discharges as the sampling frame.

These discharges were selected by a random technique, usually

on the basis of the temninal digit or d@s of the patient’s medical

record number, a number assigned when the patient was admitted to the hospital. The within-hospital sampling ratio for

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

Data collection and estimation

The sample selection and the transcription of information

from the hospital records for abstract forms were performed by

the hospital statY or by representatives of the National Center

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

the face sheets of the medical records. All discharge diagnoses

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

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

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

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

Statistics produced by the NHDS are derived by a complex

estimating procedure. The basic unit of estimation is the sample

inpatient discharge abstract. The estimating procedure used to

produce essentially unbiased national estimates in the NHDS

has three principal components: inflation by reciprocals of the

probabilities of sample selection. adjustment for nonresponse,

and ratio adjustment to fixed totals. These components of estimation are described in appendix I of two earlier publications.4’s

Sampling errors and rounding of numbers

The standard error is a measure of the sampling variability

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

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

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. Relative

standard errors for discharges and first-listed diagnoses are

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

shown in table II, and relative standard errors for procedures

are shown in table III.

Table 1. Approximate relative standard errors of estimated numbers

of discharges, first-listed diagnosis, and all-listed diagnoses, ~Y

selected pstient and hospital characteristics: United States, 1982

Ownership of hospital

Proprietary

or State Bed size All other

Size of and local less than characterestimate government Nonprofit 100 is tics

Relative standard error

5,000 ...,.... 40.4 22.7 25.8 20.5

10,000 . . . . . . . 35.7 19.9 20.7 16.3

50,000 . . . . . . . 27.9 15.2 13.1 10.2

100,000 . . . . . . 25.5 13.7 11.0 8.5

300.000 . . . . . . 22.4 11.9 8.6 6.6

500,000 . . . . . . 21.2 11.2 7.8 5.9

1,000,000. , . . 19.9 10.4 6.8 5.1

3.000,000 . . . . . 18.1 9.4 5.7 4.2

5,000,000 . . . . . 17.4 9.0 5.2 3.9

10,000,000 . . . 16.5 8.5 4.7 3.5

15,000,000 . . . 16.1 8.3 4.5 3.3

20,000,000 . . . 15.8 8.1 4.3 3.2

30,000.000 . . . 15.4 7.9 4.1 3.0

40,000,000 . . . 15.2 7.8 4.0 2.9

Table Il. Approximate relative standard errors of estimated numbers

of days of care by selacted patient and hospital characteristics:

United States. 1982

Proprietary All other

Size of estimate hospitals characteristics

10,000 . . . . . . . . . . . . . . . . . . . . 46.3 29.2

30,000 . . . . . . . . . . . . . . . . . . . . 37.1 22.2

50,000 . . . . . . . . . . . . . . . . . . . . 33.7 19,6

100,000 . . . . . . . . . . . . . . . . . . . 29.6 16.6

300.000 . . . . . . . . . . . . . . . . . . . 24.5 13.0

500,000 . . . . . . . . . . . . . . . . . . . 22.6 11.6

1,000,000 . . . . . . . . . . . . . . . . . 20.3 10.0

3,000,000 . . . . . . . . . . . . . . . . . 17.3 8.0

5,000,000 . . . . . . . . . . . . . . . . . 16.1 7.2

10.000 .000 . . . . . . . . . . . . . . . . 14.8 6.4

50;000;000 . . . . . . . . . . . . . . . .

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

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

300,0008000 . . . . . . . . . . . . . . .

NOTE: A listof referencesfollow thetext.

2.3 4.9

1.5 4.4

0.7 4.0

0.4 3.8
Table Ill. Approximate relative standard errors of estimatad numbers

of ell-listad procedures: United States, 1982

Relative

standard

Size of estimate error

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

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

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

50.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

IO, OQO.OOO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

35,000.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21.9

18.3

14.6

12.6

10.9

8.2

7.4

6.4

6.0

5.5

5.3

5.1

5.0

4.9

Estimates have been rounded to the nearest thousand. For

this reason detailed figures within tables do not always add to

the totals. Rates and average lengths of stay were calculated

from original, unrounded figures and will not necessarily agree

precisely with rates or average lengths of stay calculated from

rounded data.

Tests of sign.iticance

In this report, the determination of statistical inference is

based on the twc-trtiled Bonferroni test for multiple comparisons.

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

such as “similar” or “no difference” mean that no statistically

significant difference exists between the estimates being compared. A lack of comment on the difference between any two

estimates does not mean that the difference was tested and

found to be not significant.

Definition of terms

Hospitals and hospital characteristics

l%spitals—Short-stay special and general hospitals have

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

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

institutions are not included.

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

cribs, and pediatric bassinets regularly maintained (set up and

staffed for use) for patients; bassinets for newborn infants are

not included. In this report the classification of hospitals by

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

beds at or near midyear.

Type of owners?zip of hospital—Determined by the organization that controls and operates the hospital. Hospitals are

grouped as follows:

● Voiuntary nonprofit-Hospitals operated by a church or

another nonprofit organization.

. Governrnent-Hospitals operated by a State or local government.

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

Terms relating to hospitalization

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

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

refers to the number of discharges during the year including

any multiple discharges of the same individual from one or

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

directly or’ by transfer from another medical facility, with or

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

to the hospital, are excluded from this report. The terms

“patient” and “inpatient” are used synonymously.

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

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

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

hospital. The terms “discharges” and “patients discharged”

are used synonymously.

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

population on July 1 of that year.

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

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

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

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

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

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

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

days accumulated at time of discharge by patients discharged

t?om short-stay hospitals during a year to the number of persons

in the civilian population on July 1 of that year,

Average length of stay—The total number of patient days

accumulated at time of discharge by patients discharged during

the year, divided by the number of patients discharged.

Terms relating to diagnoses

Discharge diagnoses—One or more diseases or injuries

(or some factor that influences health status and contact with

health services which is not itself a current illness or injury)

listed by the attending physician or the medical record of a

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

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

patients discharged from the inpatient service of short-stay

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

diagnoses is equivalent to the number of discharges.

Principal diagnosis—The condition established after study

to be chiefly responsible for occasioning the admission of the

patient to the hospital for care.

First-iisted diagnosis—The coded diagnosis identified as

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

NOTE: A list of references follows the text.
12 advancedata

medical record if the principal diagnosis cannot be identified.

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

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

(summary sheet) of the medical record under the captions

“operation, “ “operative procedures, “ “operations and/or special treatment,” and the like are transcribed in the order listed.

A maximum of four procedures are coded.

Rate ofprocedures—l%e ratio of the number of all-listed

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

population on July 1 of that year.

Demographic terms

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

to admission to the hospital inpatient service.

Geographic regions—One of the four geographic regions

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

Bureau of the Census:

Northeaet. . . .

North Central. .

South . . . . . . . . .

West . . . . . . . . .

States included

Maine, New Hempshire, Vermont, Massachusetts, Rhode Island, Connecticut, New

York, New Jersey, and Pennsylvania

Michigan, Ohio, Illinois, Indiana, Wis.

consin, Minnesota, Iowa, Missouri, North

Dakota, South Dakota, Nebraska, and

Kansaa

Delaware, Matyland, District of Columbia,

Virginia, West Viratnia, Narth Carolina,

South Carolina, G;orgia, Florida, Kentucky, Tennessee, Alabama, Mississippi,

Arkansaa, Louisiana, Oklahoma, and Texas

Montana, Idaho, Wyoming, Colorado, New

Mexico. Arizona, Utah, Nevada, WOSIV

ington, Oregon, California, Hawaii, tirx:

Alaska

Recent Issues of Advance Data From Vital and Health Statistics

No. 94. Discharge Status of Inpatients Discharged From Short-Stay No. 91. An Overview of the 1980 National Master Facili& Inventory

Hospitals: United States, 1965-81 (Issued November 22, 1983) Survey of Nursing and Related Care Homes (Issued August 12, 1[983)

No. 93. Utilization of Short-Stay Hospitals by Adolescents: United No. 90. Utilization of Psychotropic Drugs in Oftice-Based AmlbulaStates, 1980 (Issued September 14, 1983) tory Care National Ambulatory Medical Care Survey, 1980 and 1981

No. 92. Americans Needing Help to Function at Home (Issued (Issued June 15, 1983)

September 14, 1983)

Suggested Ctiation

National Center for Health Statistics, B. Heupt:

1982 Summary: National Hospital Discharge

Survey. Advance Data From Vital and Heaith Copyright Information

Statistics, No. 95. DHHS pub. No. (PHS) 84–1 250.

Public Health Service, Hyattsville, Md.

Dec. 27,1983.

This report may be reprinted without further

pcrmiaaion.

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Serwce

E

THIRD CL4SS

National Center for Health Statistics

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PENALTY FOR PRIVATE USE, $300

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the National Center for Health Statistics by

calhng 301 436-NCHS.

DHHS Publication No. (PHS) 84-1250
From Vital and Health Statistics of the National Center for Health Statistics Number 96 ● March 14, 1984

Utilization of Analgesic Drugs

in Office= Based Ambulatory Care:

National Ambulatory Medical Care Survey,

1980-81

by Hugo Koch, Division of Health Care Statistics, and Deanne E. Knapp, Ph. D., National Center for Drugs and Biologics

Introduction

The purpose of this report is to describe the utilization

of analgesic drugs in office-based ambulatory care. The report

combines the 1980 and 198 I findings of the National Ambulatory Medical Care Survey, an annual. sample survey of officebtied physicians conducted from 1973 through 1981 by the

National Center for Health Statistics. The National Ambulatory

Medical Care Survey (NAMCS) is scheduled to take the

field again in 1985 and every third year following.

The term utilization is limited to the ordering or providing

of an analgesic drug by the office-based physician in the

course of an office visit. It does not include drugs ordered

by phone contact, nor does it attempt to measure ultimate

patient compliance with the doctor’s instruction.

The drugs described are those classified as Ceno-af Nervous System Drugs: Analgesics and Antipy-etics, according

to the American Hospital Formulary Service Classification

System. 1 Description centers on drugs of this class that were

named by physician respondents in i 980-81. A list of the

named analgesics appears in figure 1. Along with all new

analgesics ordered or provided, the physician also recorded

confinued analgesics if the patient was specifically instructed

during the visit to continue the medication. (However, the

data base does not distinguish between the new and the

continued medication. ) The listed agents appear as brand2

or generic names, depending on the choice made by the

physician in ordering the analgesic. They are divided into

two subcategories:3

● Opioids: Produce analgesia by their interaction with specific opioid binding sites in the central nervous system.

(The terms “opioid” and “opiate” are interchangeable).

. Nonopioids: Do not bind to the opioid receptors. (Indeed.

the exact mechanism of their analgesic action remains

unknown].

By restricting its scope to an arbitrarily selected class

of analgesics this study understates the overall use of pain-relieving drugs in oftlce practice. For example. it does not

account for the presence of analgesic ingredients in drugs

primarily classified under other rubrics. as in the following

cases:

Mambars with

Drugclass analgesic ingradients

Psychotropic agents . . . . . . . such as Equsgeslc, Fionnal

Skeletal muscle relaxants . . . . such as Parafon forte,

Sorna compound

Anbhrstammes . . . . . . . . . .such as Synalgos

Antltussives . . . . . . . . . . . .codeine camt)tnallons

Antidiarrheal agents . . . . . ,apmm combinations

Because the estimates presented in this report are based

on a sample of office visits and drug mentions rather than

the entire universe of visits and mentions, they are subject

to sampling variability. The technical notes at the end of

the report provide a brief description of the sample design,

an explanation of sampling errors. and guidelines for judging

the precision of the estimates.

‘American Hospital Formsdary Service Classification S.wem and Therapeutic

Category Codes: Copyright, 1980, American Society of Hospital Pharmacists.

Inc.

%he use of trade names is for identification onIy and does not imply

endorsement by the Public Health Service of the U.S. Demu-tment of Health

andHuman Se=ices.

3Based on AMA .iJrug Evaluations, Fifth Edition: Chapter 4: American

MedicalAsswiation, 1983.
2 dvmcdab

Oplolds Nonoplolds

Aceta w)codeme Dtlaudid pentszocme Acets Butfenn

acetammophen Dolacet

Gemmsyn phenylbutazone

Percocet-5 acetammophen Butfenn arlhrms ibuprofen alka

w)codeme Dolene Percodan Acetycol strength Indocin Ponstel

Anexsla-D Oolene Percodandeml Alupnn Butszohdm mdomethacin Presalin

Anexsla wtcodeine compound-65 Phenaphen Amphenol Butazohdm alka bqulpnn

Anodvnos-DHC Oolophme

SK-APAP

w codeine Anacin Cama Magan sochum

APAP w,codelne Dovaphen propoxyphene Anaprox Capron Measunn

aspmn, phenacetm. Duradyne DHC

sallcylate

propoxyphene APAP choline sahcylate Meclomen suhndac

catfeme. codeine Empmn w.codeme compound 65 aspmn, phenacetm. Cinn Mobldm

Ascnptm w.codeme Empmn compound

Suppap

propoxyphene caffeine Clmonl Motnn Tandeanl

aspmn w,codeine wlcodeme w acetammophen asplnn, phenacetm, colchoane Nalfon Tempra

B&O supprettes Empracet propoxyphene catteme compound Colsahde Naprosyn Thlolate

CaplIal w,codeine innovar w APAP Arrhralgen Dasm naproxen Tlmoral

Chrlstodyne-DHC Levo-dromoran SK-65 Arlhntts pam Datnl Neopap Th!osal

Codap Llqulx C SK-65 APAP formula Dlmmdol Norgestc Tolectm

codeine Mepergan SK-65 compmnd Arthrolate

Copavm

Dtsalc!d Os-cal-geslc tolmetm

mependme Stadol Arthropan Ecotrm Oxalld Tngeslc

Damason-P methadone Talwm Ascnptm Empmn P-A-C compound Tnlwate

Darvocet-N morphme Talwm cumpound Aspergum Empmn compound

Darvon

Pabalate Tylenol

Nubam Tylenol aspmn Esglc Pam rel]ever-E Valacet

Darvon compound opmm and w,codeine aspmn compound Excedrin Pers@m

Darvon w,A.S.A.

Vanqumh

belladonna Tylox Azohd

Darvon-N

Febrmol Phenaphen zscwrn

opwm extract Un!geslc-A B-A Fever reducer Phencaset

Dawon-N WIAS.A.

Zomax

P-A-C compound Wcodin Buffadyne

Demerol

St. Joseph phenylbutazone

w;codeme Wygestc

Demerol-APAP

NOTES Included m the categoV Opmds are all opmd.ncircpmd combmatrons,Includedm the category Nonopmds are nonopgold-nonopiodcombinations

Drug names are tisted m brand or genenc form. accarchrqto acrual survey responses

. . . . .. . . . . ----- .

F~ure 1. Analgesic drugs named by physician reapanrfenls Unnea states, lYtKJ+l

Table 1. The 25 analgeaic drugs mast frequently mentioned in afficebased practice, by name of drug and numkr and percent retribution of

mentians UnitedStates, 198H1

General findings

According to findings from the National Ambulatory

Medical Care Survey for 1980 and 1981 combined, an estimated 1,160,922,000 visits were made to physicians who

identified themselves as primarily engaged in office-based,

patient care practice. Of this total, 717,775,000 (62 percent)

were drug visits; that is, visits at which one or more of

any type of drug was ordered or provided. The totai number

of drug mentions for the 2-year span amounted to an estimated

i ,330,746,000 mentions.

Visits invoiving the utilization of an inscope anaigesic

numbered i06,718.000, about 9 percent of the overaii number

of office visits and about 15 percent of ail drug visits. The

totai number of anaigesic drug mentions was 1I6.64 i ,000.

Of these an estimated 31,380,000 (27 percent) were opioids.

The remaining 85,26 i ,000 (73 percent) were nonopioids.

Tabie i iists the 25 anaigesic products most frequently

mentioned. They accounted for virtuaily nine-tenths of ail

anaigesic mentions. The generic names most frequently represented among these 25 products are shown in the foilowing

listing:

Number of mentions

Genenc name m rhousarrds

aspirin . . . . . . . . . . . . . . . . . . . . . . 28,446

acetaminophen . . . . . . . . . . . . . . . . . 21,318

codeine . . . . . . . . . . . . . . . . . . . . . 12,794

ibuprofen . . . . . . . . . .. . . . . . . . . . . 11,786

sulindac . . . . . . . . . . . . . . . . . . . . . 6,670

propoxyphene . . . . . . . . . . . . . . . . . . 6,497

naproxen . . . . . . . . . . . . . . . . . . . 6,431

indomethacin . . . . . . . . . . . . . . . . . . 6,288

phenylbutezone, . . . . . . . . . . . . . . . 4,252

zomepwac, . . . . . . . . . . . . . . . . . . 3.495

R Number

a 0(

n mentfons in Percent

k Name of drug thousands distribution

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

Allanalgeslcs . . . . . . . . . . . . . . . . . .

25 drugs most frequently mentioned

aspirin (includes A.S.A.) . . . . . .

Motrin (ibuprofen) . . . . . . . . . . . . . . .

Tylenol w/codeine

(acetaminophen, codeine) . . . . .

Tylenol (acetammophen) . . . . .

Clinord (sulmdac) . . . . . . . . . . . . . . . . .

Naprosyn (naproxen) . . . . . .

Indacm (mdomethacm) . . . . .

Darvocet-N (acetammophen,

propoxyphene) . . . . . . . . . . . . . . . . .

Zomax(zomeprac) . . . . . . . . . . . .

Nalfon (fenoprofen) . . . . . . . . . . .

Butezokdm alka (phenylbutezone,

elummum hydroxide, magnesium

trmlicate). . . . . . . . . . . . . . . . . . . .

Norgeslc (orphenadnne, aspmn,

phenacetm, caffeine) . . . . . . . . . . . . .

Empmn w)codeme (aspmn,

codeine) . . . . . . . . . . . . . . . . . .

Aecriptm (eepmn). . . . . . . . . . . . . . . .

Percadan and Percodan-deml

(oxycodone, espinn) .

Tolectin(tolmetm) . . . . . . . . . . . . . . . .

Demerol(mependine) . . . . . . .

Talwm(pentazocme) . . . . .

Meclomen (meclofenamate) . . . .

Darvon and Darvon-N (propoxyphene) .

Phenaphen w/codeine (dcetammophen,

codeine ) . . . . . . . . . . . . . . . .

Empmn compound w codeine

(aspmn.c odeme) . . . . . . . . . . . . . . .

Butezohdm (phenylbutezone) . . .

Bufferin (buffered aspmn) .

Tandeanl (oxyphenbutazone) . . . .

116,641 100.0

16,342 14.0

11,786 10.1

7,746 6.6

7,086 6.1

6,670 5.7

6,431 5.5

6,288 5.4

5,199 4.4

3,495 3.0

3,153 2.7

3.092 2.7

2,691 2.3

2.519 2.2

2.366 2.0

2.144 1.8

2.077 1.8

1,703 1.5

1.505 1.3

1,346 1.2

1.298 1.1

1,287 1.1

1.242 1.1

1.160 1.0

1.142 1.0

1.051 0.9
dmcdata 3

Table 2. Number and percent d~tributicmof analgesic mentions by

category of analgax according to selected drug dimensions

United State* 19Sf&61

Ana/ges/c ment{ons

Selected

drugd!merwons Ail

analgesca Op/o!ds Nonopfo/ds

Number in thousands

Total mentions . . . . . . . 116,641 31,380 65.261

Percent distribution

100.0

Entry status’

Genencnace . . . . . . . . . . .

13randname . . . . . . . . . . . .

Prescnptlon status

Prescnptlon drug . . . . . . . .

Nonprescnpoon drug . . . . . . .

Federal control status

Controlled by DEA2 . . . . . .

Schedule 11 . . . . . . . . . . .

Schedule ill . . . . . . . . . . .

Schedule IV, . . . . . . . . .

Schedule V . . . . . . . . . . .

Noncontrolled . . . . . . . . . . .

Composmon status

Smgle-mgredlent drug . . . . .

Combmatlon drug . . . . . . . . .

19.2

80.7

72.8

27,2

26.4

5.7

11.9

8.7

“o.1

73.5

74.4

25.6

100.0 100.0

10.1 22.6

69.9 77.3

100.0 62.6

37.1

t00.0

21.1

46.1

32.4

“0.4

100.0

21.2 93.9

78.8 6.0

lThe form of the drug name (brand or genenc) represents the choice of the

physician m preparing the order.

‘Drug Enforcement Admmlstratron.

Drug dimensions

Table 2 describes some key dimensions of the analgesic

drugs.

Entry status— in ordering an analgesic. physicians showed

a strong tendency to favor brand name choices over their

generic counterpane. About 4 of every 5 of the overall class

were identified by trade name. The tendency was strongest

in the opioid subclass: here. only 1 of every 10 mentions

was generically identified.

Prescription mfus-l%e utilization of nonprescription

drugs. apparent in 27 percent of analgesic mentions. was

more than double their proportionate use in overall. officebased dm.g therapy ( 12 percent).

Controi status-Becawse of its opioid component. the

analgesic family has a substantial proportion of controlled

agents among its members. Controlled agents accounted for

26 percent of analgesic mentions. the majority of their number

clmsitled in Schedules III and IV, Thus the prescribing physician. faced with the need to moderate pain. also needs to

weigh the desired therapeutic effect against the potential hazards of dependence or habituation.

Composition status

The proportionate use of combination products among

the analgesics (apparent in about 26 percent of mentions)

conforms closely to the proportionate use of combinations

throughout otllce-based drug therapy. By fiir the most common

analgesic mixtures involved the combination of an opioid

with a nonopioid, with codeine or propoxyphene appearing

as the most common opioid ingredient. Ample support for

the use of this type of analgesic combination is provided

by the AIVA Drug Evaluations, Fifth Edition:

The combination of an opiate or opioid with a nonopiate (analgesic-antipy retie) appears to be rational because the mechanism of action of each drug differs and

the results of controlled studies have shown that the

analgesic effects of the individual drugs are additive.

Since the nonopiates have a ceiling analgesic effect and

the dosage of opiates should be limited to prevent adverse

effects, a combination of this type may provide greater

pain relief with a minimum of adverse effects in a convenient form for the patient .J

Apparent in only 6 percent of analgesic mentions, the combination of a nonopioid with another nonopioid is manifestly

uncommon in the office-based utilization of analgesics, possibly because of the reason stated in AbfA Drug Evaluations.

Fijth Edition: .’... it can be concluded that mixtures c)f

analgesic-antipyretic drugs with or without caffeine have not

been proved to be superior to optimal doses of their individual

components.”~

Diagnosis

By far the most intensive use of analgesic therapy occurs

within two diagnostic groups: “Injuries”’ and “Diseases of

the Musculoskeletal System” (table 3) .s This is demonstrated

more clearly in the following listing of the specific conditions

most frequently associated with analgesic utilization:

Rank

1.........

2 ..,......

3 . . . . . . . . .

4

5:::::::::

Rank

1.........

2 . . . . . . . . .

3

4:::::::::

5 . . . . . . . . .

In contrast to

Op,oidtfrerapy

Diagn.wsandlCO-54M Cod.#

Back sprains and strains . . . . . . .

Intervertebral d[sc disorders . . . .

Other and unsp.mfwd back dwxders

Sprains and strains of the Sacrodlac

Ostaoarlhrosis . . . . . . ...’.....

Norroptafdffrerapy

D:agnosmandlC>9-CM Cc&#

Ostaoarthrosw . . . . . . . . . . . . . .

Other and unspemfmd arthropathies . .

Peripheral enthesopalhles . , . . . .

Rheumatoid arthrrtls , . . . . . . .

Acute upper respiratory mfectlon . .

647

722

,. 724

. S46

. . 715

. . 715

. . 716

. . 726

. 714

. . 465

other drug classes. the rate of analgesic

utilization in the category “Symptoms and ill-defined conditions” is relatively higher. documenting the physician’s tendency to respond to symptomatic pain in advance of a clearly

established diagnosis. However, it would be a mistake to

assume that an analgesic is automatically ordered whenever

pain appears as a symptom. Indeed, according to another

NAMCS study (in preparation), about 70 percent of nearly

70 million newly encountered problems where pain was the

chief presenting symptom did not involve the use of an

inscope analgesic.

‘AMADrugi7ru/uu/ions.opcit. p I(11.

‘Based ua InrerrwinrrulCIu.wijicarianof Diseases. W Revision. Clinical

Modificafiou(ICD-9-CM ).
4 amcdata

Table 3. Number of office visits, number of analgesic mentions, and number of mentions per 1,000 visits, by principal diagnosis and problem cetgorieq

and percent distribution by opioid and nonopioid mentions, according to principal diagnosis and problem category United Stateq 1980-81

Analges!c ment!ons

Number —

All analgesms Opio/ds Nonopiotds

of

VEILS Percent of Percent of

m NumOer Rate per all all

Prrnc{pal d!agnosw and thousands m 1,000 analgeslc analgestc

problem category ffrousands Wslts mentions menttons

All pnnc!pal diagnoses 1,160,922 99.581 86 28.3 71.7

Major diagnostic groups (selected)

Inlectioua andparasmcd! seases.

Neoplasm, . . . . . . . . . . . . . . .

Endocnne. nutntional, and metabolic

dseases. andtmmuntyd isorders. . . . . . . . . . . . . . . . . .

Mentaldisorders . . . . . . . . . . . . . . . . . . . .

Diseases ofnewous system and sense organs

Diseases ofcirculatory system,

Dwsaseso fresptratorys ystem. ,. . . .

Dmeases ofdigeative system,.,.. . . . . . . . . . . . . . . . . . . . . .

Diseases ofgenitourmary system . . . . . . . . . . . . . . . . .

Dk.eases ofskmand subcutaneous tissue. .

Diseases ofmusculoskeletal system . . . .

Symptoma, signs, andill-defined condmons . . . . .

Injufyand potsonmg . . . . . . . . . . . .

Normal pregnancy....,.,,, . . . . . . . . . . . . . . . . .

37.714

30,707

2,451

1,300

65

42

21.9

57.0

78.1

43.0

45,371

47,624

109.573

112,344

146,014

49,080

68,504

69,421

79,206

38,526

94,723

51,307

2,281

1,622

4.465

8.142

10,255

2.610

3,394

1.303

37,208

3.261

16,561

“205

50

34

41

72

70

53

50

19

470

85

175

“4

16.1

50.5

43.1

19.5

22.3

44.2

52.5

39.5

18.9

39.4

38.1

.

83.9

49.5

56.9

60,5

77.7

55.8

47.5

60.5

81.0

60.6

61.9

Problem categories

Acute problem......,.. . . . . . . . . . . . . . . .

Chromcp roblem,r outing..,., . . . . . . . . . . . . . . . . . ,,.,.

Chronic problem. flareup . . . . . . . . . . . . . .

Postsurgeryorpostinjuq . . . . . . . . . . . . . . . . . . . . .

Nonillness care......,,, . . . . . . . . . . . . . . . . . . . . .

422,223

325,791

106,393

101,792

204.722

46.386

25.066

16,239

7,125

2.765

115

n

29.0

24.2

27.9

41.8

“20.6

71.0

75.8

72.1

5&2

79.4

153

70

14

‘Includes only those analgesca ordered or provided for the principal diagnosis. excluding some 17,060.000 mentions where analgesics were utilized for “all other

reasons.”

Table4. Number ofoffice visits nwberof ana~esic mentions, andnumber ofmentions perl,WWti, byqeand sexofpatien~a ndpement

dstnb@on byoptid andnono@oid mentionq acmrting toageand sex of patient United State% 19S0-61

Analgesic mentions

Number

—

All analgesim Opioids Nonopioids

of —.

visits Percent of Percent of

in Number Rate per all all

Age and sex thousands in 1.000 analgesic analgesic

of patient thousands visits mentions mentions

Allwsits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,160,922 116.641 100 26.9 73.1

Age

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

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

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

25-29 years . . . . . . . . . . . . . . . . . . . . . . . . . .

30-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-39years . . . . . . . . . . . . . . . . . . . . . . . . . . .

40-44years. . . .

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

45-49yeara. . . . . . . . .

50-54years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-59years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

60-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

65-69years. . . . . . . . . . . . . . . . .

70-74years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-79years, . . . . . . . . . . . . . . . . .

80yearsand over . . . . . . . . . . . . . . .

216,128

160,795

310,384

97,109

86,896

69,611

56.768

265,700

56,265

68,032

70,825

70,578

207,915

67,884

57,577

43,309

39.145

9,310

10.044

28.899

7,159

7,421

7.053

7.266

36.638

6.459

9.907

10,390

10,081

31.550

9,549

8.925

6,931

6.145

43

62

93

74

85

101

9.8

34.2

39.0

42.6

37.4

37.8

38.3

26.3

29.6

30.9

24.2

21.7

19.3

22.8

19.5

15.2

17.9

80.2

65.8

61.0

57.4

62.6

62.2

61.7

73.7

70.4

69.1

75.8

78.3

60.7

77.2

80.5

84.8

82.1

128

139

115

146

147

143

152

141

155

160

157

Sex

Female . . . . . . . . . . . . . . . . . 699,718 69,856 100 26.7 73.3

Male. .,.....,., . . . . . . . . . . . . . . . . . . . . . . . . . . . 461,204 46,785 101 27.2 72.8
(J L

_ Allanaigeslcs

. . . . . . . . Nonorxobds (152)

------ Op!olds

(139)

(62)

(43)

(39)

Under 15-24 25-44 45-64 65 years

15 years years years years and over

Age of pattent

Fgure 2. Anatgesic utilization rates by category of analgesic and age of

petient United Statee. 1980-81

Patient characteristics

From its lowest rate. for patients under 15 years of

age. the overall utilization of analgesics generally increased

in each successive age group throughout the age spectmm.

the sharpest acceleration occurring in the age interval from

the 25th through the 64th year (table 4 and tigure 2). It

is the utilization rates for the nonopioids that chiefly determine

the shape of the overall curve: these rates, in their turn.

largely retlected the strong preference for the m-mopioids

in the treatment of the musculoskeletal diseases. Opioid utilization. probably due chiefly to the above-average preference

for opioids in the treatment of injuries. rises steadily up

to the 45th year (the injury-prone period). levels off in the

45-to-64 age group. and probably declines slightly in the

later years of life.

Although the average overall mtes of analgesic utilization

were the same for both male and female patients

(table 4), there were marked differences between the sexes

in the age intervals at which the analgesic therapy was most

intensely applied (table 5 and tlgure 3). The male rate.

substantially higher in the age interval 15-44 years. results

chietly from the fact that the.proportion of visits for injuries

in this age group was almost twice as great among male

patients as among females. The female rate. higher among

patients age 45 years and over, largely reflects a growing

proneness toward musculoskeletal disease that is proportionately greater among older females than among their male

counterparts.

Tsbb 5. Number of office vi- number of analgesic merntion% and number of mentions per 1,000 visitq by safacted patient characteria~ and percent

distribution by opioii and nonopioid rnentionq according to selected patient charscteristicx Unitad Sfsfm 1960-61

Analgesti menbcnrs

Number

of

Ail analges= Oplo+ds Norrqxoids

vi.wts Percent of Percent of

in Number Rate per all all

thousands in Iwo anslgesrc anaigesc

Saiacted patisnt characteristic thousands Vws Mentmns marrttons

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,160.922 116.541 Ioa 26.9 73.1

Sex and age

Female

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102,633 4,394 43 “8.0 92.0

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107,276 5,525 52 37.4 62.6

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206,394 16,352 79 39.5 60.5

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157,031 22.311 142 26.4 73.6

65years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126,383 21,275 15a i8.1 61.9

Male

Under 15yeacs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113,495 4,916 43 “11.4 86.6

15-24yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53,519 4,519 84 30.4 69.6

2544years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103,290 12,548 121 38.3 61.7

45-6.4yeat3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106,668 14,527 134 26.1

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

73.9

81,532 10,275 126 21.6 78.4

Race’

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,037,590 100.634 97 25.5 74.5

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110,546 14,784 134 36.4 63.6

Ethnicity

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53,337 6,144 115 25.7 74.3

Not Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,107.585 110.497 100 27.0 73.0

‘Excludes abOut 12,788,000 visits by patients of rams other than white or black.
6 dwincedata

Thesignitlcantly higher rate amongblackoffice patients

(table 5) is chietly related to the finding that black patients

suffered proportionately more than white patients from the

four conditions that command the highest mtes of analgesic

use: musculoskeletal diseases. injuries. circulatory diseases.

and symptoms and ill-defined conditions.

. . . . . . . Male

_ Female (168P

(121)-....””,

(43)

/

142)

o

L 1 I I I

Under 15-24 25-44 45-64 65 years

15 years years years years and over

Age of patient

Figure 3. Analgesic utilization rates by sex and age of patient Uniied

States. 1980-S1

Physician characteristics

Of the most-visited. office-based specialities. tlve exceeded the average rate of analgesic utilization (table 6).

Ranked by magnitude of rate. these specialties were:

Rank Specialty

1 . . . . . . . . . Orthopedic surgery

2. . . . . Internal mtitcme

3 . . . . . . . . . Neurology

4 . . . . . . . . General and famdy practice

5. . . . . . . Cardiovascular dtseaae

Shifting attention from rate of analgesic utilization to sheer

volume of use. it is worthy of note. however. that two

primary-care providers. the internist and the general or family

practitioner. accounted for fully two-thirds of all analgesic

mentions and nearly the same proportion (62 percent) of

opioid mentions.

Other visitcharacteristics

The most conservative utilization of analgesics occurred

with new patients (table 7), a pattern common throughout

all office-based drug therapy. The most intensive use occurred

when a new problem was presented by a patient with whom

the doctor already had a clinical relationship. Thus, given

what may be the same problem. the physiciart. s decision

whether or not to use an analgesic is obviously influenced

by familiarity with the patient’s history. including possible

drug reactions.

The findings in table 8 document the associations of

analgesic therapy with the forms of nondrug treatment that

most frequently accompanied it. Perhaps most arresting is

Table 6. Number of office visit% number of anatgeeic mention% and number of mentions par 1,000 viaii by selected physician charactaristicq ●nd

percent dmtributionby opioid and nonopioii mention% according to aetacted physician chamotaMicx United SMteq 1960-61

Analgesic mentions

Number

All analgesics

of

Opioids Nonopioids

visits Percent of Percent of

in Number Rate per all all

thousands h l,two analgesic ana/gesic

Se/ec@d physician characteristic thousands vrsits mentions mentions

All office-based physicians

General and family pra~ce

Internal medicine . .

Pediatrics . . . . . . . . . .

Obstetrics and gynecology

General surgery. . .

Orthopedic surgery . . .

Cardiovascular disease

Psychiatry . . . . . . . . . .

Neurology . .:.......

Doctor of medicine . . .

Doctor of osteopathy .

solo . . . . . . . . . . . .

Multiple member . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . 1,160,922 116,641 100 26.9 73.1

Selected specialties

. . . . . . . . . . . . . . . . . . . . . . . 361,710 51,255 134 27.9 72.1

. . . . . . . . . . . . . . . . . . . . . . . . 144,172 26,252 182 19.8 80.2

. . . . . . . . . . . . . . . . . . . . . 126,762 5,429 42 “1O.6 69.4

. . . . . . . . . . . . . . . . . . 109,035 2,669 24 38.1 61.9

. . . . . . . . . . . . . . . . . . . 61,013 5,823 95 38.7 61.2

. . . . . . . . . . . . . . . . . . . . . . . 55.470 12,071 216 26.3 73.7

. . . . . . . . . . . . . . . . . . . . . . . . 14,781 1,867 126 “21.9 76.1

. . . . . . . . . . . . . . . . . . . . . . . 31,810 “615 “19 “57.6 “42.4

. . . . . . . . . . . . . . . . . . . . . . . . 6,379 1,117 175 “19.7 80.3

Professional identity

. . . . . . . . . . . . . . . . . . . . 1,089,636 108.468 100 27.0 73.0

. . . . . . . . . . . . . . . . . . . . . 71,284 6,173 115 25.3 74.7

Type of practice

. . . . . . . . . . . . . . . 635,651 63.624 100 27.4 72.6

. . . . . . . . . . . . . . 525,271 53.017 101 28.3 73.7
adwncedaia 7

Tabfe 7. -Numberof office viait!&number of analgesic mentkmq ad number of mentkms per 1,000 viai@ by setected visit charscteriatiq and percent

dbwbutwn W ~ and nonoricrid H** ammding to Aected w-sit characteristics: United states+ 1WI

Analgeslc mentions

Number All analgesa Qnoids

of

Mnropioids

visits Percent of Percent of

in Number Rate per all all

thousands in 1,(3W analgesic analgesic

Selected visit characteristic thousands wsita rnantmns mentions

Ail visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,160,922 116,641 100 26.9 73.1

Referral status

Referred byanother physician . . . . . . . . . . . . . . . . . . . . . . . . . . 51,392 4,513 88 28.9 71.1

Notreferred by another physician . . . . . . . . . . . . . . . . . . . . . . . . 1,108,530 112,128 101 26.6 73.2

Patient visit status

New patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166,675 15,346

Oldpatient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

92 31.0

994,247

69.0

101,294 102 26.3 73.7

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258,778 31,793 123 26.4 73.6

Oldproblem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 735,469 69,501 94 26.2 73.8

Problem stalus

Newproblem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425,453 47,140 111 27.9 72.1

Retumvisitforoldproblem . . . . . . . . . . . . . . . . . . . . . . . . . . . . 735.469 69,501 94 26.2 73.6

the broad extent to which drug therapy was the exclusive

form of treatment employed. At about one-half of the visits

that involved the use of an analgesic-alone oraccomptmied

by agents of other drug classes—there was no concurrent

useofanyform ofnondrugtherapy.

Tabfe8. Number andpercent dkstribufiorrofanslgesicvisi@by

nonmedicstiin therapy United State& 1980-61

Anafgeslc vkm.sz

Number

m Percent

Norrmedbation therapy’ tfrousarxfs distntwtion

Toi%ilvisits. . . . . . . . . . . . . . . . . . . . . 108.718 lm.o

Ma. . . . . . . . . . . . . . . . . . . . . . . . 52.070 4S8

Madicalcounseling, . . . . . . . . . . . . . . . . 31,454 .?95

Physiotherapy . . . . . . . . . . . . . . . . . . . . 14,891 14.0

CM%esurgery. . . . . . . . . . . . . . . . . . . . 4,178 3.9

Paycfrotherapyortherapeuticlisterrmg. . . . . . . 3s57 3.3

Other . . . . . . . . . . . . . . . . . . . . . . . . 12.43s 11.7

%ecause!twasposs!ble touaemorethan one fornrofnomrradicabon therapy

atagiven visit, estimates wi//exceed thetota/s atthet@ of fhem/umns.

‘An anafges[c wsitisan office visit at whkh one ornrore anagwsicagenis was

utilized.

Co-occurrence

Utilized at 62 percent of ail office visits. drug therapy

(of all types) is by far the most frequent form of treatment

provided in office practice. Further. when they do use a

drug, physicians tend to use more than one. The overall

average is about twodrugs per drug visit. but Iarger multiples

are not uncommon, especially when the patient suffers from

more than one disorder. With co-occumence the rule rather

than the exception, it is instructive to explore the patterns

of concomitant utilization of drugs that occurred in the office

visits at which an analgesic agent was ordered or provided.

At the 106.7 million visits at which an analgesic agent

was utilized. its use (expressed as a percent of these visits)

co-occurred most frequently with the use of one or more

members of the following ten therapeutic families:

Co-occumngtfrarapautk p8f@fJt Of

famlfye Co-mcurrance

Antibmtics . . . . . . . . . . . . . . . . . . . . . . . 12.2

Oiurafics . . . . . . . . . . . . . . . . . . . . . . . . 12.2

Antianxiety agents, sedafwes, hypnotics , . . . . . 8.3

Cardiac drugs . . . . . . . . . . . . . . . . . . . . 6.9

Adrensla . . . . . . . . . . . . . . . . . . . . . . . 6.6

Antihypeflenswee . . . . . . . . . . . . . . . . . . . 6.4

Gastromtestmal drugs . . . . . . . . . . . . . . . . 5.3

Skeletal muscle relaxants . . . . . . . . . 3.9

Antrdepresswes and antlpsychotms . . . . . . . 3.4

Expectorants and cough preparations . . . . . . 3.0

‘Americcm Hospiru/ Formulu? Clu.wiiicution .$~,wcm.opcif.
8 advancedata

Technical notes

Source of data and sample design

The estimates presented in this report are based on the

findings of the National Ambulatory Medical Care Survey

(NAMCS ), a sample survey of office-based care conducted

annually from 1973 through 198 I by [he National Center

for Health Statistics. The target universe of NAMCS is composed of office visits made by timbulatory patients to non-Federal and noninstitutional physicians who are principally engaged in office-based. patient-care practice. Visits to physicians practicing in Alaska and Hawaii are excluded from

the range of NAMCS, as are visits to anesthesiologists,

pathologists. and mdiolqgists.

NAMCS uses a multistage probability sample design

that involves a step sampling of primary sampling uni~s

(PSU’S). physicians’ pmctices within PSU’S, and patient visits

within physicians’ practices. The physicjan sample (5.805

physicians for 1980 and 198 I) was selected from master

files mtiintained by the American Medical Association and

the American Osteopathic Association. Those members of

the sample who proved to be inscope and eligible participated

at a rate of 77.3 percent. Responding physicians completed

visit records for a systematic random sample of office visits

made during a mndrrmly assigned weekly reporting period.

Telephone contacts were excluded. During 1980 and 198 I

responding physicians completed 89,447 visit records on

which they recorded 97,796 drug mentions. Characteristics

of the physician’s practice. such as primary specialty and

type of practice. were obtained during an induction interview.

The National Opinion Research Center. under contract to

the National Center for Health Statistics. was responsible

for the field operations of the survey.

Table 1. Approximate relative atendard errors of estimated numbers of

office visits snd of drug mentions when drug is listed by product name

(for example, Darvon), based on aft physician speeiatties

National Ambulatory Medal Care Survey, 1980-61

F7e/atrve

.!3h-nated number of office vwts slandard

or spectfic drug mentions error

Number in thousands Percent

“200 . . . . . . . . . . . . . . . . . . . . “44.8

“400 . . . . . . . . . . . ... “317

“450 . . . . . . . . . . “30.0

600 . . . . . . . . . . . 260

800 . . . . . . . . . 22.6

1.000 . . . . . . . . . . . . . . . . . . . . 20.2

2.000 . . . . . . . . ~~ 145

5.000 . . . . . . . . . . . . . . . . . . . . . . . 9.5

10,000 . . . . . . . . . . . . . . . . . . . . 7.1

20.000 . . . . . . . . . . . . ~~ . . 5.6

50.000 . . . . . . . ,. 4.4

100,000 . . . . . . . . . . . . . . . . . . . . . 3.9

200,000. . . . . . . . . ~~ 3.6

500,000 .,. 35

1.000.000, . . . . . . . . . 34

Example of use of table. An aggregate est!mateof 35,000,0000ffice vtslts has

arelatwe standard error of 5.0 percent or a standard error of 1,750,000 vIsIts

(5.0 percent of 35,000,000 vmts).

Sampling errors and rounding

The standard error is a measure of the sampling variability

that occurs by chance because only a sample, rather than

the entire universe. is surveyed. The relative standard error

of an estimate is obtained by dividing the standard error

by the estimate itself and is expressed as a percent of the

estimate. In this report. any estimate that exceeds a relative

standard error of 30 percent is marked with an asterisk.

Table I should be used to obtain the relative standard error

for aggregates of office visits or for mentions of drugs by

specific name (for example, Darvon). Table H should be

used to obtain the relative standard error for drug mentions

expressed as drug groups (for example, the analgesic drug

family),

In the tables of this report estimates have been rounded

to the nearest thousand. For this reasons, detailed estimates

do not always add to totals.

Table Il. Approximate retetive standard errore of estimated numbers of

drug mentions when drugs appear in groups (for exampte, the

anatgesic drug family), beeed on all physician speciaitie= National Ambulsto~ Mediesl Care Survey, 1960-61

Reiatwe

Est/mated number of standard

grouped drug mentions error

Number m thousands Percent

“200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . %4.2

“400. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3[1.5

“600, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “31.5

“650 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30.0

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.3

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.5

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . li7.6

5.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.6

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [).7

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8

50,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3

100.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4

500.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,2

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1

Example of use of fable: An aggregate estimate of 30,000.000 drug mentrons

has a relatwe standard error of 7.0 percent or a standard error of 2,100,000

menttons (7.0 percent of 30.000.000 mentions).

Definitions

An@ceisa placetha tphysicians identify as a location

for [heir ambulatory practice. Responsibility for patient care

and professional services rendered in an office resides with

the individual physician rather than an institution.

A }i.~itisadirectp ersonal exchange between anambulatory patient seeking health care and a physician. or staff

member working under the physician’s supervision. whol provides the health services.

A tfrwg rrwnrion is ttie physician’s entry on the visit

record of a pharmaceutictil agent ordered or provided by

uny rout eofitdministmtion for prevention, diagnosis. or treatment. Generic as well as brand-name drugs are included.
admncedata 9

as are nonprescription as well as prescription drugs. The isofa regular, maintenance nature.

physician records all new drugs and also records all continued A chronic probletnjlure up is a sudden exacerbation

medications if the patient is specifically instructed during of a preexisting chronic condition.

the visit to continue the medication. Nonillness care denotes health examinations and care

An ucure prob/em is a morbid condition with a relatively provided for presumably healthy persons. Examples of nonillsudden or recent onset (within 3 months of the visit). ness care include prenatal and postnatal care, annual physicals.

A chronic problem is a morbid condition that existed well-child examinations. and insurance examinations.

for 3 months or longer before the visit. The care indicated
From Vital and Health Statistics of the National Center for Health Statistics Number 97. June 13,1984

The Management of New Pain in Office-Based Ambulatory

Care National Ambulatory Medical Care Survey,

1980 and 1981

by Dee A. Knapp, Ph. D., University of Maryland at Baltimore, and Hugo Koch, Division of Health Care Statistics

Introduction

The otllce-based practitioner is no stranger to the management of acute and chronic pain. The problem of diagnosing and

treating pain-producing conditions is especially challenging

when the pain and its associated morbidity are encountered for

the first time in a particular patient-that is, at the s~called

new-pain visit. The purpose of this report is to present and

analyze some of the defining features of these new-pain visits.

To accomplish this end, the authors combined the 1980 and

1981 findings of the National Ambulatory Medical Care Survey, an annual sample survey of oftlce-based physicians conducted from 1973 through 1981 by the National Center for

Health Statistics.

Because the estimates presented in this report are based

on a sample rather then on the entire universe of office visits,

they are subject to sampling variability. A brief description of

the sampie design and guidelines for judging the precision of the

eatirnates is provided in the “Technical notes” at the end of

the report. Also provided are definitions of key terms used in

the survey.

The reader will fmd it usefil to refer to the data collection

instrument (figure 1: Patient Record, National Ambulatory

Medical Care Survey) as selected aspects of new-pain visits

are discussed.

Data highlights

Over the 2-year span from January 1980 through December 1981, ambulatory patients made 1.2 billion visits to the

offices of non-Federal, oftlce-based physicians practicing in

the coterminous United States. Of this total, 70,259,000

(6. 1 percent) were new-pain visits. A new-pain visit is distinguished by the following characteristics:

● The visit was umeferred (figure 1, item 13).

. Pain was the chief symptom presented by the patient

(figure 1, item 6a).

● The physician had not previously seen the patient for the

condition associated with the pain (figure 1, item 10).

Symptoms

The pain symptoms most frequently associated with the

new-pain visits are listed in table 1. (See figure 1, item 6a.)

Symptoms have been classified and coded according to a previous publication.l

Though the list is headed by such diverse complaints as

earache, headache, and general chest pain, it is musculoskeletal

pain-with upper or lower back pain predominant-that accounts for the kwgest proportion (41 percent) of the pain symp

toms associated with the new-pain visits.

Diagnostic affort

Confronted with a new-pain symptom, the oflice-based

practitioner tends to intensiQ the diagnostic effort required to

find its cause. At virtually every new-pain visit, one or more of

the diagnostic procedures appearing in figure 1, item 8, was

ordered or provided. Considering the dominating presence of

lNatiOn~center for HealtfsStatistics, D. ScIsneicfer,L. Apdems. and T.

McLemore A reason for visit ciaasitication for ambulatory care. Vital and

HeaIth Statx3tics. Series 2, No. 78. DHE W Pub. No. (PHS) 79-1352. Public

Health Service. Washington. U.S. Government PrintingOffice. Feb. 1979.

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

-_LL ::::L’

..4.., h D,, Ytar

7. MAJOR REASON FOR THIS

VISIT /Check onei

*❑ AC”TEPFICMLEM

,0 CHRONIC PR08LEM,ROUTINE

3 UCHRONICPFU3E!LEM,FLAREUP

. (_+3STS”RGERY/POST INJURY

5 ❑ NON4LLNESS CARE I!40u TINE

PRENATAL. GENERAL EKAM

WELL BABY, ETC I

lom HAVE YOU SEEN

PATl ENT BEFORE?

,nys 2(--J..

I

IF YES. FOR THE

CONOITION IN

ITEM 9.3

,❑ ws , ❑ NO

NATIONAL AMBULATORY MEDICAL CARE SURVEY

8. COLOR OR RACE I 5. ETHNICITY

— I

=

& DIAGNOSTIC SERVICES THIS vISIT

ICheck all ordered w provtdrdl

, ❑ WE , ❑ ,KG

2 ❑ LM41T6DHISTORYJEXAM 9 ❑ “IS,ON TEST

5 ❑ CLINICAL Me TEsT

6 ❑ . .. . .

12 QOTHERsI,.(,JI/

7 @8 L000PRESSUf4E CHECK

& PATI ENT’S COMPLAINTIS), SYMPTOM(S). OR OTHER —

REASON(SI FOR ~ VISIT /{n parwnrk own words/

a MOST IMPORTANT

b OTHER

9. PHYSICIANS OIAGNOSES

, PRINC! PAL OIAGNOSIS/PR08LEM .4SSOC!ATE0 WITH ITEM 62

b !JTHER SIGNIFICANT CURRENT DIAGNOSES

110 MEDICATION THERAPY THIS VISIT

[ L’sin8 bmnd or xenerrc namer, recutd all new and con rrnued medicarzons ordered, mjecfed, administered, or otlrcrwtse

provided at thts wss Include rmmuntzmg and desensin:inK agen B]

a. FOR PRINCIPAL OIAGNOSES IN ITEM9~ b. FOR ALL OTHER REASONS

1 1

2 2

3, 3,

4 4.

12. NON-MEDICATION THERAPY

\Check all services ordered or provided this visir/

1❑ NONE

2 ❑ P”YSIOWSAPV

3DOFFICES”RGERV

. QFAMILYPUWJNING

5 ❑ PSYCHOTHERAPY/

THERAPEUTIC LISTENING

6 ❑ D,ETCOUNSELING

7 (JFAMII_Y/50CIAL

COUNSELING

t ❑ MEOICAL COUNSELING

9 ❑ owER (S,.<,,)

P MS-61 OS-C (9/79)

138WAS PATIENT

REFERRED

FOR THIS VISIT

BY A~HER

PHYSICIAN?

, u -f,,

,nNO

-u

14. ;;:::S;;1:() ::;: ylSIT

1❑ NO FOLLOW4JP PLANNEO

2 ❑ RETURN AT SPECIFIED TIME

3 ❑ RETURN IF NEEOEO. P R N.

4 ❑ TELEpHONE FoLLowwPuNwo

5 lJREFERF7E0T00THER PI+YSIC,AN

6 ❑ RETURN120TOFWFERRING PHYSICIAN

7 ❑ ACIMITTO 140sPlT*L

—

15. ::fi:ioN

VISIT

/Time acruall.v

spenr with

ph \,21cran /

—.

M8”.le,

OME No. 6s-R149.9

Figure 1. National Ambulatory Medical Care Sumey Patient Record, 1980 and 1981

musculoskeletal pain. . .it is not surprising to find that X-ray was item 9a. ) In most cases their agreement with the symptoms in

utilized about three times as often at the new-pain visit as it

was at the average otllce visit. .A visit for what is perhaps the

most ominous of new-pain symptoms—general chest pain—is

three times as likely to elicit an EKG as the average office visit

and twice as likely to elicit a blood pressure reading.

Diagnoses

Findings on the principal (first-listed) diagnoses associated

with new-pain visits are presented in tables 2 and 3. (See figure 1,

table 1 is dose. For example, a new earache most frequently

signals the presence of an otitis media or a disorder of the external ear. Musculoskeletal pain, presented at 41 percent of

new-pain visits, results in a corresponding 40 percent of diagnoses being identified as injuries or diseases of the rnusculoskeletal system. The ominous overtones of chest-pain symp

toms are for the most part relieved by the tinding that the

symptoms were most frequently linked to respiratory clisease,

musculoskeletal problems, or disorders of the digestive system.

At only 6 percent of the 6,485,000 visits with new chest pain
adwldab3

labia 1. Number and percent distribution of new-pain visits by soleoted principal reasons for visit United Statas, 19S0 and 1981

Number of

visits in Percent

Rank Principal reason for pain visit and RVC codel 2 thousands distribution

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

All principal reasons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Earache, pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355.1

Chest pain and related symptoms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. O5O.O

Headache. pain in head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...210.0

Back pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...905.1

Low back pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...910.1

Stomach pain, crampa, spasms... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..- . . . ..- . . . . ..545.O

Abdominal pain, cramps, spasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550.0

Knee pain, ache, soreneaa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- .925.1

Pain, site not referable to specific body system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...055.0

Shoulder pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...940.1

Foot andtoepain, ache, soreness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 935.1

Neck pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...900.1

Painful urination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..650.0

Legpain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...920.1

Pain and related symptoms, generalized. site unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...060.0

Armpain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..945.1

Eye pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...320.1

Hand and finger pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...960.1

Hip pain, ache,. soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...915.1

Ankle pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...930.1

Pain orsorenesa of breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800.0

Elbow pain, ache, soreness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..950.1

Wrist pain, acha, aoreneas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..955.1

Pain in anus-rectum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..605.1

Another pain reasons3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70,259

8,761

6,485

6,190

5,939

4.068

3.375

3.086

3,068

2.951

2,817

2,625

2.334

2,108

2.039

1,592

1.509

1,434

1,292

1,027

935

817

743

729

710

3,625

100.0

12.5

9.2

8.6

8.5

5.8

4.8

4.4

4.4

4.2

4.0

3.7

3.3

3.0

2.9

2.3

2.1

2.0

1.8

1.5

1.3

1.2

1.1

1.0

1.0

5.2

1Based on codes in National Center for Health Statistics, D. Schneider, L Appleton, and T. McLemoro A reason for visit classification for ambulatow care [RVC].

Vital and f#e#/th Statistics. Series 2, No. 78. DHEW Pub. No. (PHS) 79-1352. Public Health Service. Washington. U.S. Government Printing Office. Feb. 1979.

20nly principal reasons accounting for >1.0 percent of new-pain visits are listed.

Slncludes the following symptom R!/C ~~de~ 265.0,410.1,455.2, 5C0.2, 510.1, 515.1, 610.1,665.1.670.1, 700.1.715.1, 745.2.766.1, 775.1.790.1, 790.4, 825.0,

870.1, 965.1,970.1,980.0.

Tabla 2. Numbar and parcant distribution of naw-pain visits by selectad principal diagnostic classas: Unitad Ststas, 1980 and 19S1

Number of

visits in Percent

Rank Principal diagnostic class and ICD-9-CM codesl,2 thousands distribution

Allprincipal diagnostic classes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70,259 100.0

1 Musculoskeletal and connective tissue disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739 15,711 22.4

2 Injuries and poisoninga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999 12,336 17.6

3 Nervous system andsense organ diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...320-389 9.780 13.9

4 Genitourinary diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...580-629 5,929 8.4

5 Digestive diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...520-579 5,639 S.o

6 Respiratory diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...460-519 5,509 7.8

7 Symptoma, signs, andill-defirred conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...780-799 3.803 5.4

8 Circulatory diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390-459 2,641 3.8

9 Supplementary claaaification3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VO1-V82 1,687 2.4

10 Skin and subcutaneous tissue diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 680-709 1,659 2.4

11 Irtfectious and parasitic diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001-139 1.650 2.3

12 Mental disordere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319 1.634 2.3

13 Endocrine, nutritional, and metabolic diseases and immunity disorders . . . . . . . . . . . . . . . . . . . . . . ...240-279 743 1.1

1Based on U.S. public Health Sewice and Heeith Care Financing .Adminitration Intematiorrd C%SSifiCatiOfl Of Diseases, 9th ffeviston. C\ifliCai Modification

[ICD-9-CM]. DHHS Pub. No. (PHS) 60-1260. Public Health Servica. Washington. U.S. Government Printing Office, Sept. 1960.

20nIy principal disgnosia ciasses accounting for >1,0 percent of new-pare visits are listed.

Scontains Categories for entries other than dis8ases and iniurles.

as the chief presenting symptom did the pain signal a ckar or Patient characteristics

suspected angina pectorix at only 1,5 percent was the diagnosis

one of ischemic heart disease; and fewer than 1 percent of the It was noted earlier that new-pain visits accounted for

visits were listed as an acute myocardial infarction. (Interest- 6.1 percent of all oilice visits. Expressed as a new-pain rate,

ittgly, another 6 percent of the chest-pain visits were treated as this amounted to an average of 61 new-pain visits per 1,000

“neurotic disorders,” more than double the average appearance of?ice visits. The extent to which this average rate fluctuates

of these diagnoses in office practice.) with patient age and sex is shown in table 4 and figure 2. Ac-
4

Table 3. Number and parcant distribution of new-pain visita by sahctad principal diagnoses Unitad Statas, 1980 and 1981

Number of

visits in Percent

Rank Principal disgnosis and ICD-9-CM codel.2 thousands distribution

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

Allprincipal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.%ppurative andunspeclfied otlti amedia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...382

Peripheral enthesopathiea and allied syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...726

Sprains andstrains ofother andunspeclfied parts of back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...847

Other soft tissue disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...729

Other andunspecified back d&-orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 724

External ear disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..380

Sprains andstratns of sacroiliac region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-...................846

Other andunspecified arthropathies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...716

Other synovium, tendon, and bursa disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727

Osteoarthrosis andallieddiaorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...715

Acute upper respiratory infections of multiple or unspecified sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...465

Cystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-......595

Other urethra andurinaw tract disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . ...599

Other andill-defined spraina and strains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...848

Symptoms involving respiratory system and other chest symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...786

Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4S7

Symptoms involving head and neck. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...784

Chronic sinusitla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...473

Other symptoma involving abdomen andpelvia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...789

Intervertebral disc diaordars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...722

Sprains andstrains ofankle and foot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...845

Special mental disorder symptoms or syndromes, not elsewhere classified. . . . . . . . . . . . . . . . . . . . . . . . ...307

Gastritis andduodenitia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-.........535

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 558

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..300

Other andunspecified joint disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...719

Muscle, ligament, and faaciadiaorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...728

70,259 100.0-

4,176 !5.9

2,482 :3.5

2,407 :3.4

2,341 :3.3

2,214 :3.2

2,135 :3.0

1,866 2.7

1,302 1.9

1,222 1.7

1,142 1.6

1,120 1.6

1,110 1.6

1,088 1.6

1,070 1.5

921 1.3

840 1.2

819 1.2

811 1.2

771 1.1

766 1.1

757 1.1

748 1.1

712 1.0

695 1.0

692 1.0

687 1.0

682 1.0

18ased on U.S. Public Health Serwce and Public Health Cam Financing Admtn!stration: Intonational Classification of Diseases, 9th Revision, Clinical Modification

yCD-S-CM]. OFIHS Pub. No . (PHS) 80-1260. Public Health Service. Washington. U.S. Government Printing Office. Sept. 1980.

Only principal disgnoaes accounting for >1.0 percsnt of new-pare wsits are Iistsd.

Tabla 4. Number of offica visits, number and parcmtt distribution of new-pain visits. and naw-Pain Visit rata by Patiant a9a and sax-a9e 9rouP*

Unitad Statea, 1980 and 1981

A!l ofice

Patient age and sex visits New-pain visits

Both sexes

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

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

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

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

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

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

Female

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

Under 15 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

65 years and over . . . . . . . . . . . . . ..- . . . . . . . . . . . . . . .. ~. . . . . . . . . . . . . . . . . . .

Male

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

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

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

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

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

65vears and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

1,160,922

216.129

160,795

310.384

265.700

207,914

699,718

102,633

107,276

206,395

157,031

126,383

461.204

113,495

53,519

103,990

108,668

81.532

Number in

thousands

70,259

10,982

11,304

22,313

16,853

8,806

40,840

5,462

6,634

12,854

10,252

5,638

29,419

5,521

4,671

9,459

6,600

3,169

Percent

distribution

100.0

15.6

16.1

31.8

24.0

12.5

58.1

7.8

9.4

18.3

14.6

8.0

41.9

7.9

6.6

13.5

9.4

4.5

New-pain

viait ratel

61

51

70

72

63

42

58

53

62

62

65

45

64

49

87

91

61

39

1Number of new-pare VISIE. per 1,000 office wsns
ackmdaa5

ii

a

(n

.=

.$

c.-

Z

i

al

c

95

91

87 ~de -e

I

85

/f

\

/

\

/

\

75

/ 70

72 \

/

/ 65

/ ●#.-.-w ------ -----

55

53

49

45

35

● 39

4

0

I I I 1 I

Under 15-24 25-44 45-64 65 years

15 years years yesrs years and over

Age ofpatient

_ All patients

= _ Male patienta

_ . _ Female patients

figure 2. New.pain visit rataa by sox and age of patierrti Unitad States, 1980-1981

cording to the findings, new-pain visits were most frequent

among patients in age group 15-44 years. It is among these

patients, for example, that many pain-producing injuries and

acute diseases are most prevalent or that the physician observes

the first warning signals of painful, chronic diseases that will

continue into the later years of life. At the older extreme of the

age spectmm the volume and rate of new-pain visits are at their

lowest point. With this group the physician is probably more

concerned with the management of chronic pain, which lost its

newness some time before. New-pain visit rates for male and

female patients do not differ markedly in the age groups under

15 years or over 44 years. It is in the age interval from the 15th

to the 45th year that sex differences are most notable, revealed

in male rates that substantially exceed those for female patients. In large p- this finding is explained by diagnostic evidence that the proportion of a&cidents or injuries in this age

group was almost twice as great among male ol%cepatients as

among females.

Variations in new-pain visit rates as they occurred among

seiected racial or ethnic groups of ofike patients are examined

in table 5. Between black and white patients the apparent difference is not sufficiently marked to demonstrate statistical

significance. (Much of it could be accounted for by sampling

“error.)It would be premature to infer that the significantly higher

Hispanic rate points to any speciai ethnic prediiposition toward

the new-pain conditions. The difference may simply be due to

the relative fractions of visits by patients in the 15-44 years of

age interval-the interval with the highest volume and rate of

new-pain visits. This proportion was about 7 percent higher

among Hispanic patients than it was for their non-Hispanic

counterparts.

Physician characteristics

The extent to which the various ofice-based specialties

were involved in the new-pain visits is documented in table 6.

In magnitude of new-pain visit rate (number of new-pain visits

per 1,000, otlice visita), three specialties were appreciably

more active than others; these were general or family practice,

internal medicine, and orthopedic surgexy.Owing to the essentially primary nature of a new-pain visi~ it is not surprising that

two of these three are conventionally classified as primary care

specialties. In total volume of visits, the three specialties accounted for about 7 of every IO new-pain visits.

Chiefly owing to their traditional involvementwith muscul~

skeletal problems, it was predictable that osteopathic physicians

would reveal a higher new-pain visit rate (77 per 1,000 visits)

than doctors of medicine (59 per 1,000).
6

Table 5. Number of office visits, number and percent distribution of new-pain visits, and new-pain visit rate by patient race and Hispanic origin:

United States, 1980 and 1981

All office

Patient race and Hispanic origin visits New-pain visits

Number m

thousands

Number in

thousands

Percent

diatnbution

New-pain

vialt ratel

All patienta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,160,922

Racez

White. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,037,590

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110,546

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53,337

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,107,585

70,259

61,842

7,384

4,064

66,195

100.0

88.0

10.5

5.8

94.2

61

60

67

76

60

1Number of new-pain visits per 1,000 office vislta.

zEx~lude~ 12,786,000 ~fice visits by members of other racial groups such as American Indian or AsIan.

Table 8. Number of office visits, number and percent distribution of new-pain visits, and new-pain visit rate by physician specialty: Unite,d

States, 1980 and 1981

All offica

Physician specialty visits New-pain visits

Number in Number in Percent New-pain

thousands thousands distribution visit rate!

Allspeciakies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

——

1,160,922 70.259 100.0 61

Generel and family practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381,710 33,966 48.3 89

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144,172 9,952 14.2 69

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128,762 6,181 8.8 48

Obstetrics and gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109,035 3,148 4.5 29

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62,485 1,561 2.2 25

Generai aurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61,013 3,207 4.6 53

Orthopedic surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55,470 6,105 8.7 110

Otolaryngology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,151 1,190 1.7 46

Cardiovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,781 783 1.1 53

Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198470 546 0.8 28

Another specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157,873 3,620 5.1 23

lNumber of new-pare visits per 1,000 office visits.

Treatment

Ordered or provided at about 62 percent of all otl’ice visits,

drug therapy is by far the most popular form of treatment in

oflice practice. For new-pain visits, the utilization of drugs (at

70 percent of these visits) was even more intensive. The 25

drugs most frequently mentioned in the treatment of new-pain

conditions are listed (using generic names) in table 7. On this

list the largest single proportion of mentions (about 36 percent)

are analgesics; the next largest fraction (33 percent) are antiinfectives; and the balance of the mentions are distributed diffusely among such drug classes as autonomic drugs, antiinflammatory agents, antihistamines, diuretics, and the sedativehypnotics. Perhaps the most useful insight to be derived t%om

these findings is not the expected fact that the analgesic family

dominated other drug families in frequency of mention, but

rather the discovexy that the utilization of analgesics was substantially less intensive than might have been anticipated. After

all, every one of the new-pain visits was, by definition, associated with pain of varying degrees of severity. The obvious conclusion is that it would be a mistake to assume that an analgesic

is routinely ordered whenever new pain appears as a symptom.

The findings suggest that drug therapy at new-pain visits is

more strongly linked to the associated diagnosis than it is to the

pain that attends that diagnosis.

At 38 percent of the 70,259,000 new-pain visits, drug

therapy was the only form of treatment utilized. At another

32 percent it was used in conjunction with some form(s) of

nondrug therapy. (See figure 3 and table 8.) Thus, only at the

remaining 30 percent of the new-pain visita dld physicians

choose an alternative approach that did not involve drug treatment. At about on-half of these nondrug visits, physicians

specified the form of nondrug therapy used. At the remmhing

half of the nondmg visits, no alternative nondrug therapy was

specified. In these cases, it seems safe to infer that physicians

were at least partly relying on the self-restorative capacities of

the body as an alternative to intervention by drugs or other

means of treatment.
@wxechb7

Table 7. Number of mentions and percent distribution of the 25 drugs most frequently ordered or provided for principal diagnoses of new-pain

visits by generic name of drug U nitad Stataa, 1980 and 1981

Number of Number of

mentions in Percent mentions in

Rank Generic name of drug

Percent

thousandsl distribution Renk Generic name of drug thousendsl distribution

Top25 drugs . . . . . . . . . . . . . . . . . 58,857 100.0 13 Polymixin B . . . . . . . . . . . . . . . . . . 2,201 3.7

1 Aspirin . . . . . . . . . . . . . . . . . . . . . . 6,863 11.7 14 Hydrocortisone . . . . . . . . . . . . . . . 2,108 3.6

2 Acetaminophen . . . . . . . . . . . . . . . 4,695 8.0 15 8acitracin . . . . . . . . . . . . . . . . . . . . 1,907 3.2

3 Ampicillin . . . . . . . . . . . . . . . . . . . . 2.662 4.5 16 Chlorpheniramine . . . . . . . . . . . . . 1,898 3.2

4 Phenylpropanolamine . . . . . . . . . . 2.607 4.4 17 Sulfamethoxazole . . . . . . . . . . . . . 1.757 3.0

5 Amoxiciilin . . . . . . . . . . . . . . . . . . . 2,560 4.3 18 Hydrochlorothiazide . . . . . . . . . . . 1.709 2.9

6 Neomycin . . . . . . . . . . . . . . . . . . . . 2,531 4.3 19 Erythromycin . . . . . . . . . . . . . . . . . 1,838 2.8

7 Penicillin . . . . . . . . . . . . . . . . . . . . 2,529 4.3 20 Trimethoprim . . . . . . . . . . . . . . . . . 1,632 2.8

8 Caffeine 2.481 4.2 21 Hyoscyamine . . . . . . . . . . . . . . . . .

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

1,612 2.7

9 Phenacetin . . . . . . . . . . . . . . . . . . . 2,410 4.1 22 Propoxyphene . . . . . . . . . . . . . . . . 1,598 2.7

10 Ibuprofen . . . . . . . . . . . . . . . . . . . . 2,398 4.1 23 Phenylbutazone . . . . . . . . . . . . . . . 1.521 2.6

11 Phenylephrine . . . . . . . . . . . . . . . . 2,339 4.0 24 Codeine . . . . . . . . . . . . . . . . . . . . . 1,461 2.5

12 Pseudoephedrine. . . . . . . . . . . . . . 2.281 3.9 25 Phenobarbital . . . . . . . . . . . . . . . . 1,459 2.5

‘Combines the mentions of a generic substance as a smgle-mgredient agent with its mentmrs aa an ingredient of a fixed-combimmon drug.

❑ Alternatives

to drug

therapy

IZl Drug

therapy

Figure 3. Percent of new-pain visits by treatment modalitiaw

Unitad Statas. 1980 and 1981

Duration and followup instrimtion

Physician-patient contact was somewhat longer for the

average new-pain visit than it was for the office visit in general

(table 9), a difference probably due to the increased intensity of

diagnostic effort at the new-pain visit.

As documented in table 10, the physician’s followup of

Table 8. percent of visits by most frequent forms of nOndmg

tharapy: United Statas, 1980 and 1981

Nondrug therapy All visits Na w-pain visits

Percent

Physiotherapy . . . . . . . . . . . . . . . . . . . . . 4.8 12.2

Medical counseling . . . . . . . . . . . . . . . . . 23.0 27.5

Tabla 9. Parcwrt of visita by duration of physician-patient contac~

United States, 1960and 1981

Duration All visits New-pain visits

Percent

1-10 minutes . . . . . . . . . . . . . . . . . . . . . 42.7 38.8

llminutes orlonger . . . . . . . . . . . . . . . 54.7 60.7

Table 10. Percant of visits by selected forms of foilowup

instructions for vis~ Unitad States, 1960-81

Followup All visits New-pain visits

Percent

No followup planned . . . . . . . . . . . . . . . . 11.5 12.3

Retumat specified time . . . . . . . . . . . . . 60.7 42.8

Return if needed . . . . . . . . . . . . . . . . . . . 22.7 34.8

Telephone followup planned . . . . . . . . . 3.4 6.5

new-pain conditions was substantially less specific than it was

for ofice visits in general. Helped to an undetermined extent

by the self-restorative capacities of the body, the treating physician placed a below-average reliance on the formal return

visit and an above-average reliance on the more tentative “telephone followup” or “return if needed.”
8 aduancedata

Technical notes

Source of data and sample design

The estimates presented in this report are based on the

findings of the National Ambulatory Medical Care Survey

(NAMCS), a sample survey of oflice-based care conducted

rumually from 1973 through 1981 by the National Center for

Health Statistics. The target universe of NAMCS is composed

of ofilce visits made by ambulatory patients to non-Federal

and noninstitutional physicians who are principally engaged in

office-based, patient-care practice. Visits to physicians practicing in Alaska and Hawaii are excluded from the range of

NAMCS, as are visits to anesthesiologists, pathologista, and

radiologists.

NAMCS uses a multistage probability sample design that

involves a stepwise sampling of primary sampling units, physicians’ practices within primary sampling units, and patient

visits within physicians’ practices. The physician sample

(5,805 for the combined years 1980 and 1981) was selected

from master files maintained by the American Medical Association and the American Osteopathic Association. Those

members of the sample who proved to be in scope participated

at a rate of 77.3 percent. Responding physicians completed

visit records (figure 1) for a systematic random sample o? their

oftlce visits made during a randomly assigned weekly reporting

period. Telephone contacts were excluded. During 1980 and

1981 responding physicians completed a 2-year total of 89,447

Patient Record forms on which they recorded 97,796 drug

mentions. Characteristics of the physician’s practice, such as

primary specialty and type of practice, were obtained during an

induction interview. The National Opinion Research Center,

under contract to the National Center for Health Statistics,

was responsible for the field operations of the survey.

Sampling errors, statistical significance,

and rounding

The standard error is a measure of the sampling variability

that occurs by chance because only a sample, rather than the

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

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. Table I

should be used to obtain the relative standard error for aggregates of ot%ce visita or for mentions of drugs by generic name

(for example, hydrocortisone). Standard errors for estimated

percents of visits (or for new-pain visit rates per 1,000 visits)

are shown in table II.

In this repo% the determination of statistical significance

is based on the t-test with a critical value of 1.96 (0.95 level of

signflcance). Terms relating to differences, such as “higher”

or “less, “ indicate that the dfierence- me statistically significant. Terms such as “similar” or “no difference” mean that no

statistical significance exists between the estimates being compared. A lack of comment in a comparison between any two

Table 1. Approximate relative standard errore of estimated numbers

of office visits and drug mentions, based on all physician specialties.

National Ambulatory Medical Care Survey, 1980 and 1981

Relative

standard

Estimated number of office visits or drug mentions error in

in thousands l~ercent

450 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.0

600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.0

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.6

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.2

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.5

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6

500,000. . . . . . . . . . . . . . . . . . . . . . . ..-. . . . . . . . . . . . . 3.5

1,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4

EXAMPLEOF USE OF TABLE An aggregate estimateof 35,000.000 office visits

haa a relatwe standard error of 5.0 percent or a standard error of 1.750,000

visns (5.0 percent of 35,000,000 visits).

Table Il. Approximate stendard errora of percent of estimated numbers of office visits or of new-pain visit rates per 1,000 visit= NAMCS,

1980–81

Estimated percenr of office visits or estimated new-pain

visit rates per 1,000 visits

Estimated number of office visits in thousands 1 or 99 5 or 95 10 or90 20 or 80 30 or 70 .50

Standard error in percent

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.8 6.2 8.5 11.3 12.9 14.1

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.0 4.4 6.0 8.0 9.1 10.0

2,000 . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 3.1 4.2 5.6 6.5 7.1

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 1.9 2.7 3.6 4.1 4.5

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 1.4 1.9 2.5 2.9 3.2

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 1.0 1.3 1.8 2.0 2.2

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.6 0.8 1.1 1.3 1.4

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.3 0.4 0.6 0.6 0.7

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

EXAMPLE OF USE OF TABLE: An esttmate of 20 percent based on an aggregate of 3.500,000 visna has a standard error of 4.6 percent or a relative standard error of

23 percent (4.6 percent -20 percent}.
admcecw9

estimates does not mean that the difference was tested and was

not signiilcant.

In the tables of this report estimates have been rounded to

the nearest thousand. For this reason, detailed estimates do not

always add to the total.

Definitions

Anzbulato~ patient-An individual seeking personal

health services who is neither bedridden nor currently admitted

to any health care institution on the premises.

Drug mention—The physician’s entry of a pharmaceutical

agent ordered or provided—by any route of administration—

for prevention, diagnosis, or treatment. Generic as well as brandnarne drugs are included, as are nonprescription as well as prescription drugs. The physician records all new drugs and continued medications when the patient is specifically instructed

during the visit to continue the medication. (This report includes

only those drug mentions that were associated with the principal diagnosis.)

Medical counsefing— Instructions and recommendations

regarding any health problem, including advice or counsel

about change of habit or behavior. Physicians were instructed

to check this category only if medical counseling was a critical

part of the treatment.

O#ce—A place that physicians identify as a location for

ambulatory practice. Responsibility over time for patient care

and professional services rendered there generally resides with

the individual physician rather than an institution.

Physiotherapy—Any form of physical therapy ordered or

provided, including any treatment using hea~ ligh~ sound, physical pressure, or movemenq for example, ultrasonic, ultraviolet,

inhe~ whirlpool, diathermy, cold therapy, and manipulative

therapy.

Visit—A direct personal exchange between an ambulatory

patient and a physician, or with a staff member working under

the physician’s supervision, for the purpose of seeking care or

rendering health services.

X-ray—Any single or multiple X-ray examination for diagnostic or screening purposes. Radiation therapy is not included

in this category.
From Vital and Health Statistics of the National Center for Health Statistics Number 98 ● July 20, 1984

Diagnosis-Related Groups Using Data From the

National Hospital Discharge Survey: United States, 1981

by Robert Pokras, Division of Health Care Statistics

Introduction

This report presents selected estimates on diagnosis-related

groups for 1981. These groups, developed at the Yale School

of Organization and Management, are being used by the Health

Care Financing Administration, some States, and some third

PartY payom to reimburse hospitals for inpatient care.* This

approach to health care reimbumement operates on the principle that patients with similar medical conditions should receive

similar care and use approximately the same amount of resources; therefore, the hospital should be reimbursed the same

amount. While there is variation in resource consumption

among individuals within a diagnosis-related group, these are

expected to balance across all patients. Diagnosis-reiated

groups and prospective reimbursement are likely to play an

increasingly important role in health care financing in the t%ture.

The Health Care Financing Administration, which operates the Medicare program, is taking the next several years to

make the transition to the use of diagnosis-related groups

(DRG’s) for hospital inpatient reimbursement. The phase-in

period allows adjustments based on selected hospital characteristics and geographic locations so hospitals can adjust to this

method of reimbursement. At the end of this time, care provided

to an inpatient covered by Medicare in a specific DRG will

translate into a preestablished amount of payment to the hospital regardless of its characteristics and location.

DRG’s were developed under the guiding principle that

“The primary objective in the construction of DRGs was a

definition of case type, each of which could be expected to

receive similar outputs or services from a hospital.”2 This was

accomplished using clinical judgment and statistical procedures

that ciassify patients by measuring resource util~ation. The

first step in this process was to cluster the universe of medical

diagnosis into broad, mutually exclusive categories. These

groups were formed to be consistent in their anatomical or

physiopathological classification, or in the manner in which

‘they are clinically managed. Once these major diagnostic groups

were formed, an interactive statistical program (AUTOGRPZ)

was used to fimther ckwsifi each major group into discrete

DRGs. This process incorporated patient information regarding diagnoses (primary and secondary), procedures, sex, and

age to explain maximally a patient’s resource use, which was

approximated by a patient’s length of stay. In all, there are

currently 470 DRG’s.

There are many important issues to be studied concerning

a change in reimbursement procedures, most of which are

beyond the scope of this paper. One issue relevant to the National Hospital Discharge Survey (NHDS) is how this sytem

may affect the seiection of a patient’s principal diagnosis. For

example, two patients admitted to the hospital for treatment of

chest pain—one diagnosed as having chest pain and the other

diagnosed as having angina-will have different reimbursement

rates. 1There is speculation that DRG reimbursement may influence the selection of a diagnosis in cases such as this. If so,

changes may show up in fbture DRG estimates produced from

NHDS data. The estimates in this repon can be viewed as a

baseliie tQ compare fiture estimates of DRG’s.

The statistics in this report are based on data collected by

means of the NHDS, a continuous survey conducted by the

National Center for Health Statistics since 1965. Data for this

survey are sampled from short-stay non-Federrd general and

specialty hospitals in the 50 States and the District of Columbia.

The sample for 1981 contained approximately 227,000 medical

records from 428 hospitals. The relevant variables required to

produce DRG’s (diagnoses, procedures, sex, age, and other

variables) were abstracted from the face sheet of each sampled

medical record, and the NHDS could thereby produce national

estimates of DRG’s. These estimates may be of value for hospitals to compare their experience with that of other hospitals.

For this reason, statistics in this report are frequency estimates

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

and associated average length of stay for DRG’s by hospital

bed size and region of the country.

Highlights

The frequency and average length of stay for the most

common DRG’s are presented by age, region of the country,

and hospital bed size (tables 1–4). Age is dichotomized as

under 65 years of age and 65 years of age and older. This

allows a comparison with the Medicare population because

Medicare covers most hospital costs for approximately 94 percent of discharges 65 years of age and over. Tables 1 and 2

provide regional data, while tables 3 and 4 provide bed-size

data for these DRGs. Within each of these sets of tables, the

first (tables 1 and 3) are for patients under 65 years of age, and

the second (tables 2 and 4) are for patients 65 years of age

and over.

By deffition, some DRG’s are only for patienta in a specitic

age range. In such a case the DRG title and the table title

(tables 1-4) together define the age group of the estimate. That

is, the most restrictive case of either the table or DRG title

determines the age group of the estimate. For example,

“Diabetes, age greater than 35 years” in table 2 only refers to

patients 65 years of age and over because of the table title;

whereas, “Simple pneumonia and pleurisy, age greater than

69 years and/or substantial comorbidity and complication” in

table 2 would not include a patient under 70 years of age because of the restriction in the DRG title.

The most common DRG for patients under 65 years

of age is vaginal delivery without complicating diagnoses

(table 1), with an estimated 2.8 million discharges in 1981.

Cesarean section, with 631,000 discharges, was also among

the most frequent DRG’s in this age group. For patients 65

years of age and older (table 2), atherosclerosis is the most

Table 1. Number of discharges and average length of stay of patients under 65 years of aga discharged from short-stay hospitals, by

selected diagnosis-ralated groups and geographic regiorv United States, 1981

[Discharges from non-Federal short-stay hospitals. Excludes newborn infants]

All North All North

Diagnosis-related group regions Northeast Central South West regions Northest Central South West

Number in thousands Average length of stay in days

All discharges . . . . . . . . . . . . . . . . . . . . . . .

Vaginal delivery without complicating

diagnoses . . . . . . . . . . . . . . . . . . . . . . . . .

Medical back problems . . . . . . . . . . . . . . .

Esophagitis, gastroenteritis, and miscellaneous digestive disorders, ages 18-69

yaars without substantial comorbidity

and/or complication . . . . . . . . . . . . . . . . .

Cesarean section without substantial

comorbidity and/or complication. . . . . . .

Nonradical hysterectomy, age less than

70 years without substantial comorbidity

and/or complication . . . . . . . . . . . . . . . . .

Unrelated operating room procedures. . .

Alcohol- and substance-induced organic

mental syndrome . . . . . . . . . . . . . . . . . . .

Dilation and curettage of utarus, ionization except for malignancy. . . . . . . . . . . .

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . .

Esophagitis, gastroenteritis, and miscellaneous digestive disorders, ages

O-17 years . . . . . . . . . . . . . . . . . . . . . . . .

Abortion with dilation and curettage of

uterus . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bronchitis and asthma, ages O-1 7

year . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tonsillectomy sndlor adenoidectomy,

ages O-17 years . . . . . . . . . . . . . . . . . . . .

Inguinal and femoral hernia procedures,

ages 18-69 years without substantial

comorbidity and/or complication. . . . . . .

Diabetes, age more than 35 years. . . . . . .

Vaginel de!ive~ with stabilization and/or

dilation and curettage of uterus. . . . . . . .

Simple pneumonia and pleurisy, ages

O-17 years . . . . . . . . . . . . . . . . . . . . . . . .

Knee procedures, age less than 70 years

without substantial comorbldity and/or

complication . . . . . . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . . . . .

Otitis media and upper respirato~

infection, ages O-1 7 years. . . . . . . . . . .

----- ---- -.--- --- ----

ZU,lilb

2,790

800

688

631

527

406

403

392

383

379

355

299

295

253

249

246

243

232

229

227

b,tizl

517

126

83

133

71

71

182

114

99

68

140

62

49

68

52

39

29

39

38

37

WI /1

796

267

188

154

130

117

112

101

129

110

71

95

109

71

66

51

70

85

60

71

3,/15

922

280

340

228

218

148

66

135

86

168

101

108

90

67

103

119

120

59

102

99

4,bL4

555

127

76

115

109

70

44

42

69

32

44

33

48

47

27

37

25

48

29

20

5.9 6.6

3.0 3.5

7.2 8.9

4.3 5.0

6.1 7.3

7.3 8.2

10.7 14.3

10.0 8.7

1.9 1.7

16.9 20.1

3.7 3.9

1.4 1.1

4.1 4.3

1.7 1.6

4.4 4.4

8.1 10.8

3.6 4.5

5.1 5.6

4.6 5.3

5.9 6.3

3.3 3.5

6.2

3.5

7.4

4.3

6.3

8.0

10.4

12.8

2.0

17.0

3.4

1.8

4.2

1.8

4.7

7.7

3.9

5.1

4.2

6.5

3.1

5.7

2.8

6.9

4.3

5.7

7.1

10.1

9.9

2.2

13.3

3.7

1.6

4.3

2.0

4.9

7.4

3.4

5.2

5.3

5.6

3.5

5.1

2.3

5.9

3.3

5.0

6.1

8.8

8.6

1.2

16.4

4.0

1.1

2.9

1.3

3,2

6.9

3.1

3.8

3.7

5.3

2.8
a&mceMa3

Table 2. Number of discharges and average length of stay of patients 65 years of age and over from short-stay hospitals, by selected diagnosisrelated groups and geographic region: United States, 1981

[Discharges from non-Federal short-stay hosp!tats. Excludes newborn infants]

All Norrh All North

Diagnosis-related group regions Northeast Central South West regions Northeasf Central South West

All discharges . . . . . . . . . . . . . . . . . . . . . . .

Atherosclerosis, age greater than 69 years

andlor substantial comorbidity and corn.

placation . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lena procedures . . . . . . . . . . . . . . . . . . . . .

Esophagitls, gaatroententis,and miscellaneous dtgestwe dtsorders, age greater

than 69 years and/or substantial comorbidityand compllcauon . . . . . . . . . . . . . .

Heart failure and shock . . . . . . . . . . . . . . . .

Chronic obstructive pulmonary disease. . .

Specific cerebrovascular disorders except

transien! ischemic attack... . . . . . . . . . .

Simple pneumonia and pleurisy, age

greater than 69 years and/or substantial

comorbidity and complication . . . . . . . . .

Diabetes, agegreaterthan35 years . . . . .

Unrelated operating room procedures. . . .

Circulatory disorders with acute myocardial infarction without cardiovascular

complication, discharged alive . . . . . . . .

Medical back problems . . . . . . . . . . . . . . .

Cardiac arrhythmia and conduction disorders, age greater than 69 years and/

or substantial comorbidity and complication . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . . . . .

Angina pectoris . . . . . . . . . . . . . . . . . . . . . .

Tranaient ischemic attacks. . . . . . . . . . . . .

Transurethral prostatectomy, age greater

than 69 years a?d/or substantial comorbidi~ and complication . . . . . . . . . . . . . .

Bronchitis and asthma, age greater than

69 years and/or substantial comorbidity

and complication . . . . . . . . . . . . . . . . . . .

Gastrointestinal hemorrhage, age greater

than 69 yaars and/or substantial comorbidity and complication . . . . . . . . . . . . . .

Respirato~ neoplasms. . . . . . . . . . . . . . . .

Kidney and urinaty tract infections, age

greater than 69 years and/or substantialcomorbidity and complications . . . . .

Number in thousands Average ienqth of stay in davs

10,408 - ‘-- ‘--- - ‘-- - ‘-”

422

387

372

363

304

294

281

218

211

179

173

168

162

161

150

140

126

126

126

124

,L,<U I

93

75

58

83

59

67

50

44

55

42

31

36

26

35

35

32

25

29

33

19

common DRG, 422,000, and lens procedures, 387,000, is the

second most common DRG for the elderly.

The average length of stay for specific DRGs in the four

regions of the country generally reflects the pattern found for

all patients: the northeast has the longest average length of stay

and the west has the shortest. Regional length-of-stay differences are greater for patienta 65 years of age or more than for

younger patients. The west has an average length of stay of 5.1

days for patients under 65 years of age and the northeast has

an average length of stay of 6.6 dayq a difference of 1.5 days,

or 29.4 percent greater. For older patients, however, the northeast has an average length of stay 4.8 days greater than the

elderly patients in the west ( 13. I versus 8.3 days), a difference

of57. 8 percent.

Overall there is a tendency for length of stay to increase

with hospital bed size (table 3 and 4) for patients under 65

4, YL!cl

107

114

111

100

79

83

75

61

66

44

49

49

47

47

39

39

34

34

29

30

a,4us

161

100

154

122

116

95

114

90

62

56

64

51

68

58

53

44

46

39

40

59

1./04

60

97

49

59

50

48

41

23

28

37

28

32

22

21

24

24

21

24

23

16

9.4

3.2

7.0

9.9

9.9

15.8

11.2

9.9

18.5

12.6

8.8

7.3

7.7

7.0

7.6

10.5

8.7

9.2

11.3

9.3

13.1

11.7

3.4

8.9

12.6

11.7

20.4

13.9

14.1

24.8

14.1

10.1

9.0

9.5

8.4

10.3

13.4

12.0

11.2

13.4

11.0

10.6

9.5

3.4

7.0

9.9

10.0

14.7

11.4

9.4

16.1

13.7

8.6

8.2

7.6

8.0

8.1

10.7

8.4

9.5

11.1

9.8

9.9

8.9

3.1

6.9

9.1

9.3

15.2

10.5

8.9

17.2

12.5

8.4

6.9

7.7

6.?

6.7

9.9

8.2

9.4

11.4

9.2

8.3

6.8

2.9

5.4

7.5

9.0

12.2

9.7

7.4

14.3

9.6

8.4

5.1

5.7

5.1

4.9

7.3

6.6

6.3

8.3

6.4

years of age as well as for older patients, but this pattern is not

consistent for some of the individual DRG’s. For example,

patients with psychoses under 65 years (table 3) had a longer

length of stay in the smallest hospitals, and for some DRG’s

the average length of stay in medium-size hospitak is equal to

or greater than the average Iength of stay in large hospitals

(500 or m6re beds).

The average length of stay associated with a DRG (tables

1-4) alIows hospitak to compare their experience with that of

other hospitals. While comparison is tenuous on a case-bycase basis, a hospital with an average length of stay 2, 3, or

more days longer than the national average for a specific DRG

may need to examine why it is so far from the norm. This kind

of comparison may be worthwhile as a starting point, but even

within a DRG, average lengl.h of stay is not an exact measure

of resource consumption.
Table 3. Number of discharges end everege length of stay of patients under 66 yeere of ege discharged from short-stay hospitals, by selectad diegnosis-related groups and hospital bed size:

United States, 1981

[Discharges from non-Federal short-stay hospitals. Excludes newborn infants)

All 6-99 100-199 200-299 300-499 500 or All 6-99 100-199

Diagnosis-related group

200–299 300-499

hospitals beds beds beds beds

500 or

more beds hospitals beds beds beds beds more beds

All discharges . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vaginal delivery without complicating diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical back problems . . . . . . . . . . . . . . . . . . .

Esophsgitis, gastroanteritis, and miscellaneous digestive disorders, ages 1S-69 years

without substantial comorbldity and/or comphcatlon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cesaresn section without substantial comorbldity and/or complication. . . . . . . . . . . . . . . .

Nonradical hysterectomy, age less than 70

years without substantial comorbldity and/

or complication . . . . . . . . . . . . . . . . . . . . . . . . .

Unrelated operating room procedures . . . . . . .

Alcohol- and substance-induced organic

mental syndrome,,,..,.,,. . . . . . . . . . . . . .

Dilation and curattage of uterus, conizatton

except for malignancy . . . . . . . . . . . . . . . . . . .

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Esophag\tis, gastroenteritis, and mwcallaneous dlgastive disorders, ages O-17

years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Abortion with dilation and curettage of

uterus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bronchitis and asthma, ages 0-17 years ., , , ,

Tonsillectomy and/or adenoidectomy, ages

O-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inguinal and femoral hernia procedures, ages

18-69 yesrs without substantial comorbidity

and/or complication . . . . . . . . . . . . . . . . . . . . .

Diabetes, aga more than 35 years. , . . . . . . . . .

Vaginal delivery with sterilization and/or dilation and curettage of uterus. . . . . . . . . . . . . . .

Simple pneumonia and pleurisy, ages O–1 7

years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Knee procedures, age Iesa than 70 years

without substantial comorbidity and/or complacation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otitis media and upper respiratory infection,

ages O–1 7 years. . . ... . . . . . . . . . . . . . . . . . .

Number in thousands

28,136 4,783 5,149 4,351 6,874 6,979

2,790

800

688

831

527

406

403

392

383

379

355

299

295

253

249

246

243

232

228

227

422

159

204

76

70

49

133

66

44

74

40

55

52

41

57

47

75

22

56

58

486

155

132

122

127

72

61

82

54

87

65

75

61

44

42

53

57

33

45

59

454

133

106

9?

87

67

48

50

46

59

46

43

62

43

41

31

39

53

33

34

672

193

134

159

110

99

96

99

122

91

83

70

67

73

57

48

3s

66

52

43

755

159

112

182

133

118

65

95

117

67

122

56

53

53

51

67

34

59

43

33

Average Ienath of stav in davs

5.9

3.0

7.2

4.3

6.1

7.3

10.7

10.0

1.9

16.9

3.7

1.4

4.1

1.7

4.4

8.1

3.6

5.1

4.6

5.9

4.7

2.5

6.6

3.7

5.7

7.1

7.2

8.3

2.0

22.0

3.0

1.8

3.3

1.8

4.6

6.8

3.3

4.2

4.2

5.0

2.9

5.4

2.9

7.0

4.2

5.5

6.6

8.2

11.0

1.7

I 5.4

3.6

1.3

4.3

1.9

4.3

7.8

3.4

5.3

4.2

5.8

3.3 3.3

2.6

6.8

4.6

6.0

7.2

11.0

13.9

2.0

12.2

4.1

1.5

4.6

1.6

4.5

8.0

3.5

6.0

4.6

6.2

3.6

6.3

3.3

7.6

4.5

62

7.5

11.0

9.4

1.9

17.5

3.6

1.6

4.3

1.6

4.3

9.3

3.8

5.3

4.9

6.1

3.2

3.3

7.8

4.9

6.4

7.8

13.2

0.9

2.0

6.8

4.1

1.1

3.9

1.8

4.4

;.5

4.0

5.1

4.6

7.0

3.8
Tab)e 4, Number of discharges and average length of stay of patients 65 yeers of age end over discharged from short-stay hospitals, by selected diagnosis-ralated groups and

hospital bed aiza: United States, 1981

[Dtschargas from non-Faderal short-stay hospitals. Excludas newborn infants]

All 6-99 100-199 200-299 300-499 500 or All 6-99 100-f99 200-299 300-499 5m or

Diagnosis-related group hospitals beds beds beds beds more beds hospitals beds beds beds beds more beds

All discharges . . . . . . . . . . . . . . . . . . . . . . . . . . .

Atherosclerosis, age greater than 69 years

and/or substantial comorbidity and complication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lens procedures ..,........,,.. . . . . . . . . . .

Esophagitis, gastroenteritis, and miscellsneoua digestive disorders, age graater than

69 years and/or substantial comorbldity and

complication . . . . . . . . . . . . . . . . . . . . . . . . . . .

Heart failure andshodk ...,...,.. . . . . . . . . .

Chronic obstructive pulmonary disease . . . . . .

Specific cerebrovascular disorders except transient ischemic attack . . . . . . . . . . . . . . . . . . . .

Simple pneumonia and pleurisy, age ~raater

than 69 years snd/or substantial comorbldity

and complication . . . . . . . . . . . . . . . . . . . . . . .

Diabetea, age greater than 35 yeara. . . . . . . . .

Unrelated operating room procadurea . . . . . . .

Circulatory disorders with acute myocardial

infarction without cardiovascular complications, discharged alive . . . . . . . . . . . . . . . . . . .

Medical back problems . . . . . . . . . . . . . . . . . . .

Cardiac arrhythmia and conduction disordera,

age graater than 69 years and/or substantial

comorbidity and complication. , . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Angina pectoris . . . . . . . . . . . . . . . . . . . . . . . . . .

Transient ischemic attacks , . . . . . . . . . . . . . . .

Transurethral prostatectomy, age graater than

69 yeers and/or substantial comorbidity and

complication . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bronchitis and asthma, age greater than 60

yesrs ancf/or substantial comorb!dhy and

complication . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gastrointestinal hemorrhage, age graster than

69 years and/or substantial comorbidity and

complication . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reapiratow neoplasms. . . . . . . . . . . . . . . . . . . .

Kidney and urinary tract infections, age greater

than 69 years and/or substantial comorbldity

and complication . . . . . . . . . . . . . . . . . . . . . . .

Number in thousands

10,408 2,160 1,867 1,741 2,543 2,097

422

367

372

363

304

294

281

218

21 i

179

173

168

162

161

150

140

126

126

126

124

93

32

127

106

89

66

101

56

22

36

47

4!5

50

46

37

18

38

26

15

43

85

79

69

67

62

56

47

44

42

26

32

29

35

31

30

33

26

21

16

24

79

77

56

61

46

47

38

36

39

38

26

28

24

23

30

22

17

19

21

14

98

115

73

74

64

70

67

50

57

44

39

33

27

39

34

34

28

34

35

25

68

82

46

56

42

64

37

32

51

31

29

33

26

22

19

33

17

24

36

18

Average length of stay-in daya

10.5

9.4

3.2

7.0

9.9

9.9

15.8

11.2

8.9

18.5

12.6

8,8

7,3

7.7

7.0

7,6

10.5

8.7

9.2

11.3

9.3

8.3

7.3

3.2

6,3

8.6

8.4

12.2

10.1

8.1

13.1

10,4

8.1

5.8

6.9

6.6

5,6

9.7

6.8

7.2

11.4

8.4

9.8

9.1

3.2

7.0

9.8

10,2

14.9

1087

10.7

15.3

13.2

7.9

6.2

7.7

6,7

6.3

10,2

8.9

9.4

9.9

8.6

10.9

9.6

3.1

7.2

9.3

10.2

18.2

13,1

10.0

20.3

12.3

8.5

7.?

7.8

8.3

7,6

8,6

9.1

9.5

12.3

9.6

. . . ---

11.s

10.5

3.1

7.8

11.2

10.8

16.8

12.5

10,6

16.5

14.0

9.6

7.8

7.9

7.7

10.0

10.6

10.6

10.1

11.7

10,0

11.v

10.5

3.3

7.4

11.1

10.9

17.4

11.2

10.7

21.9

13.1

10.1

9.6

8.9

7.6

9.2

11.7

8.3

9.8

10.9

10.5
6 ackncedata

References

‘J. Alsofrorn Playing the numbers. Medical World News, Oct. 24,

1983, fJp. 38-55.

2R. B. Fetter, S. Youngsoo, J. L. Freeman, and Others: case mix

definition by diagnostic related groups. Medicai Care 18(2), Supplement. (Copyright 1980: Used with the permission of Medical Care. )

3National Center for Health Statistics, M. G. Sirken: Utilization of

short-stay hospitals, Summary of nonmed:cal statistics, United States,

1965. Vital and Health Statistics. Series 13, No. 2. PHS Pub. No.

1000. Public Health Semite. Washington. U.S. Government Printing

0t7ice, Aug. 1967.

4Na~iona1 centerfor Hea]th Statistics, M. J. Witkin: Utilization ‘f

short-stay hospitals by characteristics of discharged patients, United

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

Technical notes

Survey methodology

Source of data

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

of military and Veterans Administration hospitals, located in

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

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

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

newborn infants are excluded from this report.

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

hospitals contained in the 1963 Master Facility Inventow of

Hospitals and Institutions. New hospitals were sampled for

inclusion in the survey in 1972, 1975, 1977, and 1981. The

sample for 1981 consisted of 550 hospitals. Of these, 71 refused to participate, and 51 were out of scope either because

&e hospital had gone out of business or because it failed to

meet the definition of a short-stay hospital. Thus 428 hospitals

participated in the survey during 1981 and provided approximately 227,000 abstracts of medical records.

Sample design

A1l hospitals with 1,000 or more beds in the universe of

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

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

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

these 24 primary strata, the allocation of the hospitals was

made through a controlled selection technique so that hospitals

in the sample would be properly distributed with regard to type

of ownership and geographic division. Sample hospitals were

drawn with probabilities ranging from certainty for the largest

hospitals to 1 in 40 for the smallest hospitals.

Sample discharges were selected within the hospitals using

No. 1000. Public Health Service. Washington. U.S. Government

Printing Oftice, Dec. 1967.

sNational Center for Health Statistics. R. Pokras: !hrgiCd ad rronsurgical procedures in short-stay hospitals, United States, 1979. Vital

and Health Statistics. Series 13, No. 70. DHHS Pub. No. (PHS)

83-1731. Public Health Service. Washington. U.S. Government

Printing Otlice, Feb. 1983.

6U s public Health Service and Health Care Financing Administra- . .

tion: International C[asszJ7cation of Diseases, 9th Revision, Clinical

Modification. DHHS Pub. No. (PHS) 80-1260. Public Health Service. Washington. U.S. Government Printing Otlice, Sept. 1980.

TFedera/ Register. Vol. 48, No. 171, Part II, Rules and ReguMionS,

Sept. 1, 1983.

the daily listing sheet of discharges as the sampling frame.

These discharges were selected by a random technique, usually

on the basis of the terminal digit or digits of the patient’s medical

record number, a number assigned when the patient was admitted to the hospital. The within-hospital sampling ratio for

selecting sample discharges varied inversely with the probability

of selection of the hospital.

Data collection and estimation

The sample selection and the transcription of information

from the hospital records for abstract forms were performed by

the hospital staff or by representatives of the National Center

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

the face sheets of the medical records. All discharge diagrtoses

were listed on the abstract in the order of the principal one, or

the first-listed one if the principal one was not identified, followed by the order in which all other diagnoses were entered

on the face sheet of the medical record.

Statistics produced by NHDS are derived by a complex

estimating procedure. The basic unit of estimation is the sample

inpatient discharge abstract. The estimating procedure used to

produce essentially unbiased national estimates in NHDS has

three principal components: inflation by reciprocals of the

probabilities of sample selection, adjustment for nonresponse,

and ratio adjustment to fixed totals. These components of estimation are descnied in appendix I of two earlier publications.3’4

Diagnosis-related groups

The diagnosis-related groups (DRG’s) used in this report

were produced using the most current DRG program available

at the time (summer of 1983 ). This is a computer program that

groups patients into DRG’s based on diagnostic, surgical, and

NOTE: A list of referencesfollowsthe text.
ackmaaa7

patient information. The program is maintained and is commercially available at Health Systems International (DRG

Support Group, 100 Broadway, New Haven, Corm. 065 11).

However, the actual program used to produce estimates in this

report was obtained from the Health Care Financing Administration.

To help interpret the data in this report, two points are

worth mentioning. First, the entire NHDS file was used to

produce estimates, including outliers. None of the data was

excluded, or trimmed, because of an abnormally long length of

stay. Second, the NHDS only codes three ICD-9-CM Class 4

procedures:s.e circumcision, code 64.0; episiotomy, code 73.6;

and removal of intrauterine contraceptive device, code 97.71.

In certain instances Class 4 procedures can alter the DRG

designation for a patient. The effect of not coding these procedures in the NHDS on determining DRG’s is unknown, but

probably quite small. In all other respects, the DRG’s presented

in this report are consistent with those in the Federal Register

of Thursday, September 1, 1983.7

In publications from the National Center for Health Statistics using NHDS data, several schemes have been used to

group patients into categories based on either their diagnoses

or the procedures performed. These groups were developed to

report general purpose statistics to the many users of NHDS

data, and any similarity between the titles of those categories

and DRG titles is coincidental.

Sampling errors and rounding of numbers

The standard error is a measure of the sampling variability

that occurs by chance because oniy a sample, rather than an

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

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. Table I

shows relative standard errors for discharges and first-listed

diagnoses for 1981. The standard errors for average lengths of

stay are shown in table II. Estimates have been rounded to the

nearest thousand. For this reason detailed figures within tables

do not always add to the totals.

Tests of significance

In this report, the determination of statistical inference is

based on the two-tailed Bonferroni test for multiple comparisons.

Terms relating to differences, such as “higher” and “less,”

NOTE: A list of references follows the text.

Tabla 1. Approximate ralative standard arrors of estimatad number

of discharges and first-listed diagnoses: Unitad Statas, 1981

Tabla Il. Approximate standard errors of average lengths of stay

by number of discharges Unitad States. 1981

Average length of stay

in days

Number of discharges 2 6 70 20

Standard error in days

10,000 . . . . . . . . . . . . . . . . . . . 0.7 1.2 1.7 2.2

50.000 . . . . . . . . . . . . . . . . . . . 0.3 0.7 1.0 1.4

100.000 . . . . . . . . . . . . . . . . . . 0.3 0.6 0.9 1.2

500.000 . . . . . . . . . . . . . . . . . . 0.2 0.5 0.8 0.9

1,000,000, . . . . . . . . . . . . . . . 0.2 0.5 0.8 0.7

5.000,000 . . . . . . . . . . . . . . . . 0.2 0.5 0.8 . . .

indicate that the differences are statistically significant. Terms

such as “similar” or “no difference” mean that no statict k a1W

significant dhTerence exists between the estimates being cumpared. A lack of comment on the difference between arty two

estimates does not mean that the difference was tested and

found to be not significant.

Definition of terms

Patient—A person who is formally admitted to the inpatient

service of a short-stay hospital for observation, care, diagnosis,

or treatment. In thk report the number of patients refers to the

number of discharges during the year, including any multiple

discharges of the same individual from one or more short-stay

hospitals.

Average length of stay—The total number of patient days

accumulated at time of discharge by patients discharged during

the year divided by the number of patients discharged.

Age—Patient’s age refers to age at birthday prior to admission to the hospital inpatient service.

Discharge-Discharge is the formal release of a patient by

a hospital; that is, the termination of a period of hospitalization

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

or another hospital. The terms “discharges” and “patients discharged” are used synonymously.

Geographic region—Hospitals are classified by location

in one of the four geographic regions of the United States that

correspond to those used by the U.S. Bureau of the Census:

Region

Northeast. . . . . .

Notth Central. . .

Relative

standard

Size of estimate error South . . . . . . . . .

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.3

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.2

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.6

500,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.9

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1

4,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0

West . . . . . . . . .

States included

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

York, New Jersey, and Pennsylvania

Michigan, Ohio. Illinois, Indiana, Wisconsin, Minnesota, Iowa, Missouri, North

Dakota, South Dakota, Nebraska, and

Kansas

Oelawara, Ma@and. Oistrict of Columbia,

Virginia, West Virginia, North Carolina,

South Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi,

Arkansas, Louisiana, Oklahoma, and

Texas

Montana, Idaho, Wyoming, Colorado, New

Mexico. Arizona, Utah, Nevada, Washington, Oregon, California, Hawaii, and

Alaska
8

Hospitals—Short-stay special and general hospitals have beds, cribs, and pediatric bassinets regularly maintairied (set

six or more beds for inpatient use and art average length of stay up and statTed for use) for patients; bassinets for newborn inof less than 30 days. Federal hospitals and hospital units of fants are not included. In this report the classification of hosinstitutions are not included. pitals by bed size is based on the number of beds at or near

Bed size of hospitalize is measured by the number of midyear repotted by the hospitals.

Recent Issues of Advance Data From Wat and Health Statistics

No. 97. The Management of New Pain in OffIce-Based Ambulatory No;’94. Discharge Status of Inpatients Discharged From Short-Stay

Care National Ambulatory Medical Care Survey, 1980 and 1981 Hospitals: United States, 1965-81 (Issued November 22, 1983)

(Issued June 13, 1984) No. 93. Utilization of Short-Stay Hospitals by Adolescents: United

No. 96. Utilization of Analgesic Drugs in Oflice-Based Ambulatory States, 1980 (Issued September 14, 1983)

Care National Ambulatory Medical Care Survey, 1980-81 (Issued

March 14, 1984)

No. 95. 1982 Summary: National Hospital Discharge Survey (Issued

December 27, 1983)

Suggested C itetion

National Center for Health Statistics, R. Pokras:

Diagnosis-related groups using data from the

National Hospital Discharge Suwe~ United States,

1981. Advance Data From Vital and Health

Statistics, No. 98. DHHS Pub. No. (PHS) 84-1250.

Public Health Service. Hyattsville, Md., July 20, 1984

Copyright Information

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obtained permission from the copyright hcdders to

reproduce certain quoted material in this report.

Further reproduction of this material is prohibited

without specific permission of the copyrtght

holders. All other material contained in the report

is in the public domain and may be used and

reprinted without special permission; citation as to

source, however, is appreciated.

U.S. DEPARTMENT OF HEALTH AND

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E

THIRD CIASS

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POSTAGE & FEES PAID

PHS

PERMIT No. G29

DHHS Publication No. (PHS) 84-1250
Health Care of Adolescents by Office-Based Physicians:

National Ambulatory Medical Care Survey, 1980–81

by Beulah K. Cypress, Ph. D., Division of Health Care Statistics

Introduction

Adolescents 11-20 years of age do not utilize physician

services as frequently as other persons do. Among age groups

of patients visiting ofllce-based physicians in 1980 and 1981,

adolescents 11–20 years of age had the lowest visit rate (figure 1).

Although persons 11–20 years old constituted 17 percent of the

population of the United States, they made only 11 percent of

the oflice visits. However, this does not necessarily indicate

I I I I I 1

Under 11-20 21-24 25-44 45-64 65 yeara

11 years years years years yeara and over

Age

Figure 1. Average annual rate of office visits by age of patierw

United States, 1980-81

a low incidence of illness for thk group because they sIso had

a higher incidence of acute conditions than older age groups in

the population did. The low rate of oflice visits maybe related

to the self-limiting nature of most acute conditions that usually

do not require as many return visits to the physician’s ofice as

chronic conditions do.

This report examines the nature of the conditions presented

by adolescents and the health care provided by oflice-based

physicians. lt is based on data collected in the National Ambulatory Medical Care Survey (NAMCS) during the 2-year period

January 1980-December 1981. NAMCS is a sample survey

of office-based physicians conducted annually through 1981 by

the National Center for Health Statistics. Data will be collected

again in 1985. Because the estimates presented in this report

are based on a sample rather than on the entire universe of office visits, they are subject to sampling variability. A brief description of the sample design and guidelines for judging the

precision of the estimates are provided in the “Technical notes”

at the end of the report. Definitions of key terms used in the

survey also are provided.

Patient characteristics

Because of the many developmental changes patients 11-20

years of age undergo during this period of life, data on visit

characteristics are presented for “early” adolescence, 11-14

years, and “late” adolescence, 15-20 years. Table 1 indicates

that the Iatter group visited at a higher rate than the former,

and, as in NAMCS data for other age groups, females 15-20

years of age visited at a higher rate than males the same age

did. The visit rate for white adolescents exceeded that of black

adolescents.

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

Table 1. Average annual off!ce visit rate of adolescents and all

other age groups by sex, race, and age United States, 1980-81

A9e

All

1?-14 15-20 11-20 other

Sex and race years years yews ages

Sex Rate per 100 population

Both sexes . . . . . . . . . . . . . . . . 140 179 165 281

Female . . . . . . . . . . . . . . . . . . . 142 219 191 326

Male . . . . . . . . . . . . . . . . . . . . . 138 139 139 231

Race

White . . . . . . . . . . . . . . . . . . . . 151 192 177 291

Black . . . . . . . . . . . . . . . . . . . . . 89 124 111 239

Other . . . . . . . . . . . . . . . . . . . . . 95 50 67 127

Vkit characteristics

Table 2 includes data on the condition and management of

adolescent patients, and the specialties most likely to provide

their health care. For contrasc similar information is provided

on visits by all other patients. As suggested in the introduction,

adolescents tend to make proportionately fewer return visita to

the same physician than other patients. About half their visits

were made by patients the physician had seen before, who were

returning for care of old problems, compared with about 65 percent by returning patients in all other age gnoups. The higher

than average proportion of acute problems as the major reason

for visit reflects the higher incidence of acute conditions found

in the adolescent population. Nonillness care is proportionately

greater in late adolescence than in early adolescence because

visits for prenatal care and gynecological examinations are more

likely at that age. Table 3 shows the 20 most frequent reasons

given by patients for their visits. Symptoms of acute illness

such as cough, throat, or ear problems accounted for 13 percent of the reasons presented by the younger group. General

medical examination and physical examinations for extracurricular activities and for school were reasons in 1I percent of

visits. Acne, skin rash, allergy medication, and allergy, not

otherwise specified, were also common reasons for visit for thk

group. Prenatal examination and acne account for about 15 percent of the visits by the older group. The juxtaposition of these

two reasons provides some insight into the rapid changes that

occur during adolescence.

The distinction between the health care needs of patients

in the early and late stages of adolescence is also evident in the

kinds of diagnoses rendered during their visits to physicians.

For the younger group, diseases of the respiratory system (21 percent) was the leading diagnostic category, followed by diagnoses

in the supplementmy class~lcation (chiefly examinations, 16 percent), and injury and poisoning (16 percent, table 2). For the

older group, diagnoses in the supplemental classification (25 percent) were the most common, with diseases of the skin and subcutaneous tissue ranked second with 14 percent. Diseases of

the respiratory system and injury and poisoning each accounted

for 13 percent.

The developmental process is more clearly exemplified by

an examination of the distribution of specific principal diagnoses. The 20 most frequent principal diagnoses are shown in

table 4. The variability in the degree of maturation that is typ

ical of adolescence is reflected by the two leading diagnoses

made for patients 15-20 years of age normal pregnancy (9 percent) and diseases of the sebaceous glands (chiefly acne other

than variolifoimis, 7 percent). Acne accounted for 8 percent of

males’ visits and 6 percent of females’ visits, but the difference

is not statistically significant. General medical examination is

prominent on the list of diagnoses for each adolescent age group.

Gynecological examination and contraceptive management

emerge as diagnoses in late adolescence.

Adolescents are more likely to visit dermatologiista and

less likely to visit internists than other patients are. It is not unexpected that visits to obstetrician-gynecologists were more

likely during late adolescence (14 percent) than during the earlier

period.

The diagnostic services and therapy likely to be utilized

when adolescents visit office-based physicians do not differ

considerably from those used when other patients visit (table 2).

The higher proportion of office surgery performed for adolescents than for other age groups was probably the resullt of the

former’s greater tendency to have injuries. Family planning

was included in about 5 percent of visits by patients 15–20

years of age, a higher than average proportion. However, diet

counseling was relatively less frequent than average. The importance of proper nutrition at this stage of life may needl greater

emphasis. Physicians also tend to make proportionately fewer

blood pressure measurements for patients under 21 years of

age than for those older.

One or more drugs were included in about 57 percent of

adolescents’ visits, and a single drug was more likely to be prescribed thrm were two, three, or more. NAMCS data indicate

that multiple drug prescription is more likely to occur during

visits by middle-aged and older patients than during tlhose by

younger patients. For these young patients, antibiotics, antihistamine drugs, skin and mucous membrane preparations, and

analgesics and antipyretics accounted for over 60 percent of

drug mentions (table 5). The specific drugs most frequently

prescribed during their visits are listed in table 6 according to

the dmg name recorded by the physician on the NAMCS Patient Record form (the NAMCS data collection instrument).

The generic substances represented by these dregs are shown

in table 7 with a description of their most common therapeutic

uses.

Visits lasting less than 11 minutes were more likely for adolescents than for other age groups. About 46 percent of encounters with physicians by patienta 11-14 years of age and

51 percent of those by patients 15-20 years of age were less

than 11 minutes in duration, compared with 42 percent of those

by all other age groups (table 2), In about 6 percent of the

youngest group’s visita, patients were not seen by the physician

but by a member of the staff. This higher than average proportion of “O-minute” visits probably reflects the visits in which

patients were given allergy relief or shots (table 6).

The disposition of the visit is often related to the likelihood of acute or chronic conditions. Generally, patients with
dmcedaa3

Table 2. Number of office visits made b)’ adolescents and ail other a9a 9rowa and percent distribtiion by seiacted visit characteristics,

according to age United States, 1980-81

Age Age

11-14 15-20 All other

Characteristic

11-14 15–20 All other

yeara years ages Characteristic yeers years ages

Allwsits . . . . . . . . . . . . . . . . . . . . . . . .

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

Sex

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

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

Race

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

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

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

Hispanic origin

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

Non-Hispanic . . . . . . . . . . . . . . . . . . .

Prior visit status

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

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

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

Major reason for visit

Acute problem . . . . . . . . . . . . . . . . . .

Chronic problem, routine. . . . . . . . . .

Chronic problem, flareup . . . . . . . . . .

Postsurgery or postinjuq. . . . . . . . . .

Nonillness care . . . . . . . . . . . . . . . . . .

Principal diagnosis catego~

and ICD-9-CM code]

Infectious and parasitic

diseases . . . . . . . . . . . . . ..001 -l39

Neoplasms . . . . . . . . . . ...140-239

Endocrine, nutritional and metabolic

diseases, and immunity

disorders . . . . . . . . . . . . . . 240-279

Mental disorders. . . . . . ...290-319

Diseases of tha nervous system and

sense organs. . . . . . . . ...320-389

Diseases of the circulatory

system . . . . . . . . . . . . . ...390-459

Diseases of the respiratory

system . . . . . . . . . . . . . . ..46O–5l 9

Diseases of the digestive

system . . . . . . . . . . . . . . ..52 O-579

Diseases of the genitourinary

system . . . . . . . . . . . . . . ..5 BO-629

Diseases of the skin and

subcutaneous tissue. . . . . 6B0-709

Diseases of the musculoskeletal

system and connective

tissue . . . . . . . . . . . . . . . ..7lo-739

Symptoms, signs, and ill-defined

conditions. . . . . . . . . . ...780-799

Injury and poisoning. . . ...800-999

Supplementary

classification. . . . . . . . . . . VO1 -V82

Allotherdlagnoses . . . . . . . . . . . . . .

Unknown diagnoses. . . . . . . . . . . . . .

Numbar in thousands

40.269 B7,172 1,033,482

Percent distribution

100.0

49.4

50.6

8B.B

9.4

1.8

4.6

95.4

1B.3

31.7

50.0

47.2

20.5

6.2

9.4

16.8

6.2

“0.7

“0.7

2.2

11.1

“0.5

20.7

3.0

2.7

8.7

4.8

3.4

16.1

16.4

1.4

1.6

I 00.0

61.3

38.7

B9.7

9.7

0.7

5.4

94.6

20.8

26.1

53.2

41.0

19.4

5.7

9.9

24.0

5.5

0.9

1.5

2.9

6.3

1.1

13.3

2.8

6.0

13.6

3.6

2.5

12.5

24.9

1.5

1.0

100.0

60.6

39.4

89.4

9.5

1.1

4.5

95.5

13.7

21.6

64.7

35.6

29.1

9.6

8.7

17.1

2.9

2.9

4.2

4.3

9.6

10.8

12.2

4.4

6.0

5.2

7.2

3.4

7.5

16.9

1.3

1.2

Diagnostic servicesz

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

Limited history and/or

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

General history and/or

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

Pap test . . . . . . . . . . . . . . . . . . . . . . . .

Clinical laboratory test. . . . . . . . . . . .

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

8100d pressure check. . . . . . . . . . . . .

Electrocardiogram. . . . . . . . . . . . . . . .

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

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

Mental status examination. . . . . . . . .

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

Nonmedication therapyz

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

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

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

Family planning . . . . . . . . . . . . . . . . .

Psychotherapy or therapeutic

listening . . . . . . . . . . . . . . . . . . . . . .

Diet counseling . . . . . . . . . . . . . . . . . .

Family or social counseling. . . . . . . .

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

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

Number of medications

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

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

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 ormore . . . . . . . . . . . . . . . . . . . . . .

Physician specialty

General and family practica. . . . . . . .

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

Pediatrics . . . . . . . . . . . . . . . . . . . . . .

Obstetrics and gynecology . . . . . . . .

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

General surgary . . . . . . . . . . . . . . . . . .

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

Dtolaryngology . . . . . . . . . . . . . . . . . .

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

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

Duration of visit

O minutes3 . . . . . . . . . . . . . . . . . . . . .

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

6-10 minutes . . . . . . . . . . . . . . . . . . .

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

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

31minutes orlonger . . . . . . . . . . . . .

Disposition of visid

No followup pianned . . . . . . . . . . . . .

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

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

Telephone followup planned. . . . . . .

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

Returned to referring physician. . . . .

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

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

13.0

62.1

15.9

“0.4

20.3

9.2

15.8

*0.5

8.2

“0.2

“0.9

3.3

57.3

4.6

13.2

“0.5

2.3

3.8

2.5

19.5

3.4

43.8

34.3

15.3

6.6

34.1

2.8

29.3

‘0.9

6.4

3.3

4.9

2.6

1.7

14.1

5.6

15.6

30.7

26.0

18.6

3.7

19.7

47.2

28.2

3.8

2.6

“0.7

1.2

“0.2

Percent distribution

9.8

64.3

15.3

4.8

23.9

7.4

29.5

0.5

5.6

“0.4

1.4

3.9

52.9

5.3

11.7

4.9

3.7

4.6

2.2

20.3

2.4

43.3

31.5

17.0

8.3

35.8

5.8

8.3

13.9

11.1

4.7

3.9

2.1

2.3

12.1

2.2

17.8

32.9

25.5

17.3

4.3

17.6

53.2

24.1

3.5

2.7

80.4

1.6

“0.3

7.8

64.4

15.5

4.5

21.8

7.4

35.4

3.3

5.7

1.0

1.5

5.1

53.8

4.8

6.8

1.9

5.1

8.5

2.1

23.4

2.5

37.5

30.7

17.9

13.9

32.6

13.4

10.6

9.3

3.8

5.4

5.5

2.3

2.8

14.4

2.5

12.1

29.8

28.1

21.2

6.3

10.7

61.8

22.4

3.4

2.6

0.8

2.4

0.2

1Based on u.S. Public Health Serwce and Health Care Financing Admimstratmn: International Classification of Diseasas, 9th Revision. Clinical Modification

.

(ICD-9-CM). DHHS Pub. No. [PHS) 80-1260. Public Health Serwce. Washington. U.S. Govemmerr~ Printing Office, Sept. 1980.

ZParcents ~111 not total 100.o because more than 1 service or therapy may have been provided during a vlsit3Vmts in which there was no face-to-face encounter between pattent and physician.

4Percems WIII not total 100.0 because more than 1 disposnion was possible.
4

Table 3. Number of office visits made by adolescents and percent distribution by the 20 most frequent principal reasons for visit, according to

age: United States, 1980-81

Number of Number of

Age, principal reason wsits in Percent Age, principal reason

for visit, and RVC code7

visits in Percent

thousands dwtribution for visit, and RVC code? thousands distribution

11-14 years

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

Symptoms referable to throat . . . . . . . S455

General medical examination . . . . . . . Xl 00

Allergy medication . . . . . . . . . . . . . . .. TIOO

Earache, or ear infection . . . . . . . . . . . S355

Acne or pimples . . . . . . . . . . . . . . . . .. S830

Cough . . . . . . . . . . . . . . . . . . . . . . . . ..s440

Skin rash. . . . . . . . . . . . . . . . . . . . . . . . S860

Physical examination for extracurricular

activities . . . . . . . . . . . . . . . . . . . . . .. A115

Knee symptoms . . . . . . . . . . . . . . . . .. S925

Progress visit, not otherwise

specified . . . . . . . . . . . . . . . . . . . . . .. T800

Physical examination required for

school . . . . . . . . . . . . . . . . . . . . . . . .. A11O

Headache, pain in head. . . . . . . . . . . .S210

Stomach pain, cramps and spasms. . . S545

Eye examination . . . . . . . . . . . . . . . . .. X230

Postoperative visit . . . . . . . . . . . . . . . . T205

Fever . . . . . . . . . . . . . . . . . . . . . . . . . .. S010

Warts, not otherwise specified . . . . . . S850

Allergy, not otherwise specified . . . . . S090

Vision dysfunctions . . . . . . . . . . . . . . . S305

Head cold, upper respiratory infection

(coryza) . . . . . . . . . . . . . . . . . . . . . . .. S445

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40,269

2,646

2,431

1,780

1,482

1,356

1,196

1,187

1,091

860

723

708

678

670

644

626

575

555

555

543

491

. . .

100.0

6.6

6.0

4.4

3.7

3.4

3.0

2.9

2.7

2.1

1.8

1.8

1.7

1.7

1.6

1.6

1.4

1.4

1.4

1.3

1.2

48.3

15-20 years

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

Prenatal examination, routine . . . . . . . X205

Acne or pimples . . . . . . . . . . . . . . . ,.. S630

Symptoms referable to throat . . . . . . . S455

General medical examination . . . . . . . Xl 00

Skin rash . . . . . . . . . . . . . . . . . . . . . . ..s860

Postoperative visit . . . . . . . . . . . . . . . . T205

Progress visit, not otherwise

specified . . . . . . . . . . . . . . . . . . . . . .. T800

Cough . . . . . . . . . . . . . . . . . . . . . . . . . .S440

Abdominal pain, cramps, spasms . . . . S550

Physical examination required for

school . . . . . . . . . . . . . . . . . . . . . . . .. A11O

Allergy medication . . . . . . . . . . . . . . .._fIoo

Physical examination for extracurricular

activities . . . . . . . . . . . . . . . . . . . . . .. A115

Earache, or ear infection . . . . . . . . . . . s355

Knee symptoms . . . . . . . . . . . . . . . . .. Sg25

Headache, pain in head. . . . . . . . . . . . S21O

Head cold, upper respirato~ infection

(coryza) . . . . . . . . . . . . . . . . . . . . . . .. S445

8ack symptoms . . . . . . . . . . . . . . . . ,.s905

Eya examination . . . . . . . . . . . . . . . . .. x230

Gynecological examination . . . . . . . . . X225

Warts, not otherwise specified . . . . . . S850

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

87,172

6,985

5,811

4,937

2,892

2,084

1,761

1,737

1,452

1,441

1,423

1,329

1,268

1,239

1,138

1,120

1,062

1,044

965

889

876

. . .

100.0

8.0

6.7

!5.7

3.3

2.4

2.0

2.0

1.7

1.7

1.6

1.5

1.5

1.4

1.3

1.3

1.2

1.2

1.1

1.0

1.0

52.4

1Baaed on: National Center for Health Statistics, D. Schneider, L. Appleton, and T. McLemore A reaaon for visit classification for ambulato~ care (RVCJ. Vita/and

Hea/rh Sramtics. Series 2, No. 78. DHEW Pub. No. (PHS) 79-1352, Publ!c Health Service. Washington. U.S. Government Printing OffIce, Feb. 1979.

chronic conditions are more likely to be scheduled for return shows, the proportion of visits that culminated with this instrucvisits than are those with acute self-limiting conditions. tion is higher in late adolescence than in early, but both groups

Because the youngest gsoup (I 1–14 years) had proportion- have lower proportions of visits in which return visita were

ately more acute problems than other patients, they were also scheduled than other age groups did.

least likely to be told to return at a specified time. As table 2
dancdaa5

Table 4. Number of office visits mada by adolescents and percent distribution by the 20 most fraquent principal diagnoaes, according to aga:

United States, 1980-81

Number of Number of

Age, principal diagnosis, visits in Percent Age, principal diagnosis. visits in Parcant

and ICD-9-CM codeT thousands distribution and ICD-9-CM codel thousands distribution

11-14 yeare

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

General med!cal examination . . . . . . . . V70

Allergic rhinitis . . . . . . . . . . . . . . . . . ...477

Diseases of sebaceous glandsz . . . . . . . 706

Acute phatyngitis . . . . . . . . . . . . . . . ...462

Acute upper respiratory infections of

multiple or unspecified sites . . . . . ...465

Suppurative and unspecified otitis

media . . . . . . . . . . . . . . . . . . . . . . . . ...382

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

Disorders of refraction and

accommodation . . . . . . . . . . . . . . . ...367

Routine infant or child health

check . . . . . . . . . . . . . . . . . . . . . . . .. V20.2

Certain adverse effects not elsewhere

classified . . . . . . . . . . . . . . . . . . . . ...995

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

Other diseases due to viruses and

chlamydiae . . . . . . . . . . . . . . . . . . . ...078

Contact dermatitis and other

eczema . . . . . . . . . . . . . . . . . . . . . . . . . 692

Fracture of radius and ulna. . . . . . . . ...813

Disorders of external ear . . . . . . . . . ...380

Curvature of spine . . . . . . . . . . . . . . . ...737

Bronchitis, not specified as acute or

chronic . . . . . . . . . . . . . . . . . . . . . . ...490

Observation and evaluation for suspected

conditions . . . . . . . . . . . . . . . . . . . . . ..W1

Other noninfective gastroenteritis and

colitis . . . . . . . . . . . . . . . . . . . . . . . . ...558

Followup examination . . . . . . . . . . . . . . V67

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40,269

2,832

1,760

1,629

1.297

1,296

1,177

1,109

1,054

930

808

791

770

684

551

527

460

“435

●422

●41 3

“405

. . .

100.0

7.0

4.4

4.0

3.2

3,2

2.9

2.8

2.6

2.3

2.0

2.0

1.8

1.7

1.4

1.3

1.1

1.1

1.0

1.0

1.0

52.1

15-20 yeara

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

Normal pregnancy . . . . . . . . . . . . . . . ..V22

Diseases of sebaceous glands. . . . . ...706

General medical examination . . . . . . . . V70

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

Acute upper respirato~ infections of

multiple or unspecified sites . . . . . ...465

Special investigations and

examinations . . . . . . . . . . . . . . . . . . ..W2

Dkorders of refraction and

accommodation . . . . . . . . . . . . . . . ...367

Allergic rhinitis . . . . . . . . . . . . . . . . . ...477

Other diseases due to viruses and

chlamydiae . . . . . . . . . . . . . . . . . . . ...078

Followup examination . . . . . . . . . . . . . . V67

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

Contact dermatitis and other

eczema . . . . . . . . . . . . . . . . . . . . . . . . . 692

Suppurative and unspecified otitis

media . . . . . . . . . . . . . . . . . . . . . . . . ...382

Contraceptive management . . . . . . . . . . V25

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

Disorders of menstruation and other

abnormal bleeding from female genital

tract . . . . . . . . . . . . . . . . . . . . . . . . . ...626

Bronchitis, not specified as acute or

chronic . . . . . . . . . . . . . . . . . . . . . . ...490

Disorders of external ear . . . . . . . . . ...380

Chronic sinusitis . . . . . . . . . . . . . . . . ...473

Neurotic disordera . . . . . . . . . . . . . . ...300

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

87,172

7,926

7,306

5,457

2,439

2,242

1,756

1,525

1,482

1,427

1,345

1,254

1,146

955

866

851

820

78.8

731

722

719

. . .

100,0

9.1

8.4

6.3

2.8

2.6

2.0

1.7

1.7

1.6

1.5

1.4

1.3

1.1

1.0

1.0

0.9

0.9

0.8

0.8

0.8

52.3

1Based on U.S. Public Health Service and Health Care Financing Administration: InternationalClassificationof Diseases,9th Revision,ClinicalModification

(ICO-9-CM), DHHS Pub. No. (PHS) 80-1260. Public Health Servics. Washington. U.S. Government Printing Mtce, Sept. 1980.

‘Chiefly 706.1, acne othsr than varioliforrms.

3Chlefly 995.3, allergy unspecified.

4Chiefly V72.3, gynecological examination.
6 adwancedata

Table 5. Number of drug mentions in ofilce visits made by adolescents and all other age groups and parcent distribution by therapeutic

category, according to aga: United States. 1980-81

Age

71-14 15-20 All other

Therapeutic category? years years trges

All categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . ,

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

Antihistamine drugs . . . . . . . . . . . .

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

Anti-infective agents . . . . . . . . . . . .

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

Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . 4. . . . . . . . . . . . .

Autonomic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood formation and coagulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antianemia drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Central newous system drugs... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analgesics andantipyretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychotherapeutic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sedatives and hypnotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diagnostic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..+

Electrolytic, caloric, and water balance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Expectorants and cough preparations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Eye, ear, nose and throat preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-infectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-inflammatory agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gastrointestinal druga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hormones and synthetic substitutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adrenals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contraceptives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .<.....+.

Serums, toxoida and vaccines.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Toxoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . .

Skin andmucous membrane preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-infectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-inflammatory agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cell stimulants andproliferants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Keratolytic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Spasmolytic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -

Other, unclassified or undetermined, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Numbar in thousands

B1 ,382 1,214,414

100.0

17.7

27.4

26.3

3.3

‘0.4

80.4

“0.5

7.9

5.6

“0.3

*1.0

1.8

1.8

“0.6

5.1

5.2

2.4

81.0

*1.5

4.2

2.7

“0.4

4.8

1.9

2.6

13.9

2.8

4.4

“1.0

3.2

2.2

“0.8

2.7

Percent distribution

100.0

9.0

29.6

27.2

3.3

1.0

1.0

“0.7

9.5

6.3

0.9

1.5

0.8

0.8

1.0

3.2

3.4

1.4

0.8

2.2

8.2

2.6

4.2

3.0

1.8

1.1

17.6

3.2

4.1

1.8

5.6

“0.7

4.4

2.4

100.0

6.1

14.5

12.2

3.8

1.3

0.8

10.9

16.9

9.0

2.5

3.8

0.4

0.4

8.8

2.7

3.7

0.9

0.7

3.8

8.5

3.0

0.9

3.4

1.3

2.0

7.0

1.7

2.9

0.2

0.6

1.7

3.4

3.1

1Based on American Society of Hospital Pharmamsta, Inc.: The American Hospital Formulary Service, Washington. Jan. 1980.
dmmdata7

Table 6. Number and percent distribution of drug mentions in office visits made by adolescents (and percent distribution) by age and most

frequently named drugs: United States, 1980-81

Number Number

Age and in Percent Age and in Percent

name of drugl thousands distribution name of drugl thousands distribution

11-14 years

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

Allergy relief orshots . . . . . . . . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . .

Tuberculin tine test . . . . . . . . . . . . . . . . . . . .

E.E.S.(e~hromycin) . . . . . . . . . . . . . . . . . . .

Erythromycin . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dimetapp . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pen-Vee K . . . . . . . . . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

V-Cillin (penicillin) . . . . . . . . . . . . . . . . . . . . .

Cleocin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Poliomyelitis vaccine . . . . . . . . . . . . . . . . . . .

Diphtheria tetanus toxoids . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-20 years

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

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . .

Allergy relief orshota . . . . . . . . . . . . . . . . . .

Cleocin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycin . . . . . . . . . . . . . . . . . . . . . . . . .

34,950 100.0

2,678 8.2

1,090 3.1

1,032 3.0

937 2.7

912 2.6

835 2.4

609 1.7

554 1.6

533 1.5

503 1.4

461 1.3

461 1.3

“433 1.2

●427 1.2

“405 1.2

“360 1.0

. . . 64.6

81,382 100.0

3,724 4.6

2,354 2.9

2,307 2.8

2,195 2.7

2,065 2.5

1,446 1.8

15-20 years—Con.

Retin-A

~pirin: ulu:::: lll:ll:jll l::: u:::::::

Desquam-X (benzoyl peroxide). . . . . . . . . . .

Minocin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ortho-novum . . . . . . . . . . . . . . . . . . . . . . . . .

Tuberculin tine teat . . . . . . . . . . . . . . . . . . . .

E-mycin (erythromycin) . . . . . . . . . . . . . . . . .

Pen-Vee K . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prednisone . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E.E.S.(erythromycin) . . . . . . . . . . . . . . . . . . .

Lo/ovral . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prenatal vitamins . . . . . . . . . . . . . . . . . . . . . .

Benzac (benzoyl peroxide) . . . . . . . . . . . . . .

Diphtheria tetsnus toxoida . . . . . . . . . . . . . .

Tetanus toxoid . . . . . . . . . . . . . . . . . . . . . . . .

Dimetapp . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cortisporin . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skin preparation . . . . . . . . . . . . . . . . . . . . . . .

8enadryl . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benzoyl (benzoyl peroxide). . . . . . . . . . . . . .

Sumycin (tetracycline). . . . . . . . . . . . . . . . . .

Benzagel (benzoyl peroxide).. . . . . . . . . . . .

Drixoral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Monistat . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.335 1.6

1,253 1.5

946 1.2

911 1.1

858 1.1

831 1.0

812 1.0

806 1.0

777 1.0

692 0.9

687 0.8

629 0.8

624 0.8

624 0.8

618 0.8

572 0.7

564 0.7

542 0.7

509 0.6

496 0.6

478 0.6

476 0.6

471 0.6

457 0.6

457 0.6

*446 0.5

. . . 60.5

I Baaed on the physician.s entry on the Patient Record form.
8

T-d% 7. Number of generic drugs utilized in office visits made by adolescents by age and the 30 most frequently used generic substances

described by their most common therapeutic uses Unitad States, 1980-81

Number Number

Age, generic substance, and in Age, generic substance, and In

most common therapeutic use thousands most common therapeutic use thousands

11-14 years

Penicillin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylpropanolamine (sympathomimetic) . . . . . . . . . . . . . .

Phenylephrine (sympathomimetic) . . . . . . . . . . . . . . . . . . . .

Amplciliin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pseudoephedrine (antihwtsminic, cough suppressant) . . . .

Chlorpheniramine (antihlstaminic) . . . . . . . . . . . . . . . . . . . .

Tetracycline (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Guaifenesin (cough suppressant) . . . . . . . . . . . . . . . . . . . . .

Amoxicillin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin (analgesic, antipyretic) . . . . . . . . . . . . . . . . . . . . . . .

Neomycin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tuberculin (tuberculosis skin test) . . . . . . . . . . . . . . . . . . . .

Hydrocortisone (anti-inflammatory). . . . . . . . . . . . . . . . . . . .

Brompheniramine (expectorant) . . . . . . . . . . . . . . . . . . . . . .

Benzoyl peroxide (keratolytic, acne treatment) . . . . . . . . . .

Codeine (analgesic, antltussive) . . . . . . . . . . . . . . . . . . . . . .

Polymyxin B (antibacterial) . . . . . . . . . . . . . . . . . . . . . . . . . .

Bacitracin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Theophylline (vasodilator) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triprolidine (antihistaminic). . . . . . . . . . . . . . . . . . . . . . . . . .

Atropine (anticholinerglc) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hyoscyamine (anticholinergic) . . . . . . . . . . . . . . . . . . . . . . .

Promethazine (antihistaminic). . . . . . . . . . . . . . . . . . . . . . . .

Acetaminophen (analgesic, antipyretic) . . . . . . . . . . . . . . . .

Salicylic acid (antifungal, keratolytlc) . . . . . . . . . . . . . . . . . .

Phenobarbital (anticonvulsant, sedative, hypnotic) . . . . . . .

Scopolamine (hypnotic, sedative, anticholinergic) . . . . . . .

Clindamycin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Polio vaccine (immunization) . . . . . . . . . . . . . . . . . . . . . . . .

2,179

1,696

1.645

1,369

1,308

1,239

1,232

1,191

1,112

1,097

1,025

959

835

830

803

736

714

694

660

647

584

513

508

499

498

491

463

460

●427

“405

15-20 yeare

Tetracycline (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penicillin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benzoyl peroxide (keratolytic, acne treatment) . . . . . . . . . .

Estradiol (estrogen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin (analgesic, antipyretic) . . . . . . . . . . . . . . . . . . . . . . .

Chndamyci n(antibiotic ) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pseudoephedrine (antihistaminic, coughsuppressant) . . . .

Ampicillin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Multivitamins prenatal (vitamins) . . . . . . . . . . . . . . . . . . . . .

Phenylpropanolamine (sympathomimetic) . . . . . . . . . . . . . .

Phenylephrine (sympathomimetic) . . . . . . . . . . . . . . . . . . . .

Chlorpheniramine (antihistaminic) . . . . . . . . . . . . . . . . . . . .

Norethindrone (oral contraceptive). . . . . . . . . . . . . . . . . . . .

Hydrocortisone (anti-inflammatory). . . . . . . . . . . . . . . . . . . .

Brompheniramine (expectorant) . . . . . . . . . . . . . . . . . . . . . .

Tretinoin (keratolytic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neomycin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cod?ine (analgesic, antitussive) . . . . . . . . . . . . . . . . . . . . . .

Acetaminophen (analgesic, antipyretic) . . . . . . . . . . . . . . . .

Iron preparations (iron deficiency) . . . . . . . . . . . . . . . . . . . .

Polymyxin B (antibacterial) . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxicillin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Guaifenesin (cough suppressant) . . . . . . . . . . . . . . . . . . . . .

Salicylic acid (antifungal, keratolytic) . . . . . . . . . . . . . . . . . .

Troprolidine (antihistaminic) . . . . . . . . . . . . . . . . . . . . . . . . .

Bacitracin (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triamcinolone (anti-inflammatory) . . . . . . . . . . . . . . . . . . . .

Minocycline (antibiotic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Norgestrel (oral contraceptive) . . . . . . . . . . . . . . . . . . . . . . .

5,077

4,1331

3,473

3,367

2,!579

2,461

2,347

2,302

2,201

2,128

1,964

1,712

1,657

1,615

1,445

1,:390

1,:335

1,278

1,272

1,246

1,’186

1,059

1,C)5B

1,044

1,021

!998

!983

923

919

901
advancedata 9

Technical notes

Source of data and sample design

The estimates presented in this report are based on the

findings of the National Ambulatory Medical Care Survey

(NAMCS), a sample survey of office-based care conducted

annually from 1973 through 1981 by the National Center for

Health Statistics. The target universe of NAMCS is composed

of oflice visits made by ambulato~ patients to non-Federal and

noninstitutional physicians who are principally engaged in offlcebased, patient-care practice. Visits to physicians practicing in

Alaska and Hawaii are excluded from the range of NAMCS,

as are visits to anesthesiologists, pathologists, and radiologists.

NAMCS uses a multistage probability sample design that

involves a step sampling of primary sampling units (PSU’s),

physicians’ practices within PSU’S, and patient visits within

physicians’ practices. The physicirm sample (5,805 physicians

for 1980 and 1981) was selected from master files maintained

by the American Medical Association and the American Ostee

pathic Association. Those members of the sample who proved

to be in scope and eligible participated at a rate of 77.3 percent.

Responding physicians completed visit records for a systematic

random sample of office visits made during a randomly assigned

weekly reporting period. Telephone contacts were excluded.

During 1980 and 1981 responding physicians completed 89,447

visit records on which they recorded 97,796 drug mentions.

Characteristics of the physician’s practice, such as primary

specialty and type of practice, were obtained during an induction interview. The National Opinion Research Center, under

contract to the National Center for Health Statistics, was responsible for the field operations of the survey.

Sampling errors and rounding

The standard error is a measure of the sampIing variability

that occurs by chance because only a sample, rather than the

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

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. In this

report, any estimate that exceeds a relative standard error of

30 percent is marked with an asterisk. Table I should be used

to obtain the relative standard error for aggregates of office

visits or for mentions of drugs by specific name (for example,

Darvon). Table II should be used to obtain the relative standard error for drug mentions expressed as drug groups (for example, the analgesic drug family).

In this report, the determination of statistical significance

is based on the t-test with a critical value of 1.96 (0.05 level of

significance). Terms relating to differences, such as “hider”

or “less, “ indicate that the differences are statistically significant. Terms such as “similar” or “no difference” mean that no

statistical significance exists between the estimates being compared. A lack of comment in a comparison between any two

estimates does not mean that the difference was tested and was

not signiflc~t.

In the tables of this report estimates have been rounded to

the nearest thousand. For this reason, detailed estimates do not

~ways add to totals.

Table 1. Approximate relative standard errora of estimated numbers

of ofice visita and of drug mentions when drug is listed by produst

neme (for example, Darvon), based on all physician specialties

National Ambulato~ Medical Care Survey, 1980-81

ReIative

Estimated number of office visits standard

or specific drug mentions error

Number in thousands

“200. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“400 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“450 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

50.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Percent

●44.8

*31.7

“30.0

26.0

22.6

20.2

14.5

9.5

7.1

5.6

4.4

3.9

3.6

3.5

3.4

EXAM PLE OF USE OF TABLE An aggregate estimate of 35,000,CX30 offtce

vis!ts has a relatwe standard error of 5.0 percent m a standard error of

1,750,000 vialts (5.0 percent of 35.000,000 visits}.

Tabla 11. Approximate relative standard errors of estimatad

numbers of drug mentions when drugs eppear in groups (for

example, tha analgesic drug family), based on all physicien

specialties National Ambulato~ Medical Care Survey, 1980-81

Ralative

Estimated number of standard

grouped drug mentions error

Number in thousands Percent

“200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘54.2

*BOO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●38.5

‘600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●31 .5

●650 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “30.0

800. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.3

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.5

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.6

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.6

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.7

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7

200,000 .......- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2

1,000,000 . . . . ..- .- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1

EXAMPLE OF USE OF TABLE An aggregate estimate of 30,000,000 drug

memiona has a relatwe standard error of 7.0 percent or a standard error of

2,100,000 mentions (7.0 percent of 30,0C0,000 mentions}.

Definitions

An oflce is a place that physicians identify as a location

for their ambulatory practice. Responsibility for patient care

and professional services rendered in an off]ce resides with the

individual physician rather than an institution.

A visit is a direct personal exchange between an ambulatory patient seeking health care and a physician, or staff member working under the physician’s supervision, who provides

the health services.
10 aduamedata

A drug mention is the physician’s entry on the visit record

of a pharmaceutical agent ordered or provided by any route of

administration for prevention, diagnosis, or treatment. Generic

as well as brand-name drugs are included as are nonprescription

as well as prescription drugs. The physician records all new

drugs and also records all continued medications if the patient

is specifically instructed during the visit to continue the medication.

An acute problem is a morbid condition with a relatively

sudden or recent onset (within 3 months of the visit).

A chronic problem is a morbid condition that existed for

3 months or longer before the visit. The care indicated is of a

regular, maintenance nature.

A chronic problem jlareup is a sudden exacerbation of a

preexisting chronic condition.

Nonillness care denotes health examinations and care provided for presumably healthy persons. Examples of nonillness

care include prenatal and postnatal care, annual physicak+ wellchild examinations, and insurance examinations.
dumceda 11

Symbols

.-. Data not available

. . . Categoty not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
From Vital and Health Statistics of the National Center for Health Statistics September 28, 1984 ● Number 100

CAT Scan Use in Short-Stay Non-Federal Hospitals:

United States, 1979-82

by Edmund J. Graves, Division of Health Care Statistics

This repofi presents statistics on the use of computerized

axial tomography scans by inpatients during the period 1979-

82. The age and sex of the patients who received these scans,

their diagnoses, the types of scans they received, and the expected sources of payment for the scans are shown. In addition,

information on the hospitals in which the scans were performed

is reported, including the geographic region, size, and ownership

of the facility. Hospital use measurements include frequencies,

percent distributions, and population-based rates.

The statistics presented in tMs report are based on data

collected by means of the National Hospital Discharge Survey,

a continuous survey that has been conducted by the National

Center for Health Statistics since 1965. Statistics are presented

for discharges from 1979 through 1982. In each of these years

data were abstracted from the face sheets of medical records of

approximately 220,000 patients discharged from over 400

short-stay non-Federal hospitals. A brief description of the

sample design, data collection and estimation procedures, and

definition of terms used in thk report can be found in the section

entitled “Technical notes.” A detailed discussion of these items

and the survey form used to collect the data have been pubIished.l’z

The coding of medical data for hospitalized patients is

done according to the International ClassrYcation of Diseases,

9th Revision, Clinical Mod@cation (ICD-9–CM).3

Background of CAT scans

A computerized axial tomography (CAT) scanner is a

radiographic device that combines the technologies of radiology,

computer processing, and cathode ray tube (CRT) display. This

radiographic device produces an image of the transverse section

of the body part in question. The image resembles an anatomic

section.4 Tomography is defined as a technique of X-ray

photography by which a single plane is photographed, with the

outlines of structures in other planes eliminated.s Computerized

tomography, also known as computerized axial tomography

and computerized transverse axial tomography, has been

rapidly accepted by the American medical community since its

development in 1970.6 The number of CAT scanners in use in

hospitals in the United States has grown from a mere handful

in 1973, when the technique was introduced in the United

States, to 1,716 in 1982.7The principles underlying CAT were

first elucidated in 1961, and 11 years later the fiist scanner

(designed by G. H. Hounst5el& a researcher with the British

firm EMI, Ltd.g) became available.g’lo

Clinical applications and historical

background of CAT scanners

TheCAT scanner can depict various intracranial or intraabdominal abnormalities that previously might have required

invasive procedures or surgical exploration. CAT scans can

generally identi& space-occupying lesions of the brain, such as

tumors, hematomas, cysts, cerebral infarcts, hemorrhagic

changes, calcification, metastatic disease, and hydrocephalus.

Body scanners enable technicians to evaluate extensive abnormalities in the liver, retroperitoneal area, pancreas, bladder

and related structures, and other pelvic structures.4

The major advantage of CAT scanning lies in its ability to

provide clear radiographic definition of structures not visible

by other techniques. It is a noninvasive procedure without significant risk, morbidity, or discomfort. The quality of CAT

scans may be improved if used in conjunction with a dye that

produces clearer images, especially of tumors. A disadvantage

of the early units was the relatively slow scan time, which not

only resulted in image degradation but also necessitated relatively long exposure to radiation. New scanners have been

developed that can scan in 5 seconds or less. Motion, which

once caused image degradation, is no longer a serious technical

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES p~hliq 14e~!~~ Semlce
2

limitation. Scanners that will evaluate cardiac fimction in a

matter of milliseconds are being developed.4

The CAT scan provides surgeons with a long-sought

method for better diagnosing of low back pain. It can spot spinal

anomalies that were missed by the myelogram and by the operating surgeon. It has been reported by one hospital that the

success rate for certain back surgeries has increased from 5 to

80 percent, with most of the credit for the success rate increase

given to CAT scans. 1i The CAT scan is now used in conjunction with the position emission tomography (PET) scanner to

provide an accurate diagnosis of Alzheimer’s disease without

extensive testing. 12

The data presented in the National Hospital Discharge

Survey have shown a tremendous increase in inpatient use from

1979 through 1982. In spite of the rapid growth of this technology, there are some drawbacks to the use of the CAT scanner.

First, a CAT scanner is expensive. In 1974 the cost of a scarmer

was $300,000. By 1980 this cost had risen to $700,000. This

increase was offset partially by the efilciency of the newer

models. 13Second, the cost to the patient is hig~ the cost of one

scan was approximately !3250 in 1980.14 A third drawback is

the exposure to radiation. This is a serious deterrent, despite

the faster scanning time of new equipment, and limits the number

of CAT scans that can be performed on a patient in any one

year. Because of concern with the cost and appropriate supply

and distributiori of this expensive technology, the national health

planning program promulgated standards for the purchase and

use of CAT scanners. These standards were included in the

“National guidelines for health plarming~’ which were published

in March 1978.*5 Health planning agencies were to use the

standards as benchmarks against which to assess local conditions and needs. The agencies’ assessments, based on these

standards, determined whether a certitlcate of need was granted

to allow purchase of new or addhional equipment.

The standards published in 1978 were as follows: (1) A

CAT scanner (head and body) should operate (for the second

and subsequent years of operation) at a minimum of 2,500

medically necessary patient procedures per year, and (2) no

additional scanners should be approved unless each scanner in

the health service area is performing at a rate greater than 2,500

medically necessary patient procedures per year.

These standards were in effect until November 1982. At

that time, the Department of Health and Human Services rescinded the CAT standard from the “National guidelines for

health plaming.”]b It was decided that the standard did not

adequately take into account recent advances in scanner technology. State health planning agencies remain free to develop

their own standards for review of certificate-of-need applications to purchase CAT scanners.

The CAT scanner may eventually be supplanted by equipment that has broader capabilities. These are the positron emission tomography (PET) scannerl’ and the nuclear magnetic

resonance (NMR) scanner. *8 The latter uses a magnetic field,

thus avoiding radiation altogether. Unlike the CAT scanner,

which only shows the size of tumor, stroke damage, and so

forth, NMR equipment reveals anatomical changes (by examining the chemical and metabolic functioning of organs) that

indicate not only current problems but problems that may occur

in the future. For example, the NMR scanner reveals the sodium

content of brain cells, which aids in ascertaining the extent of

stroke darnage. The Food and Drug Administration has recently

given its approval for the use of the NMR scanner, which makes

its use eligible for patient insurance coverage.

Highlights

●

●

●

●

●

●

o

The number of CAT scan procedures performed in shortstay hospitals during the period 1979 through 198;2 has

tripled (from 194,000 to 600,000).

Approximately 40 percent of all CAT scans performed in

short-stay hospitals during the period 1979 through. 1982

were performed on patients 65 years of age and over.

Of the patients who had CAT scans performed, approximately 42 percent expected medicare to pay for them and

approximately 39 percent expected private insurance to

pay for them.

Over 25 percent of all CAT scans performed during the

period were in the Middle Atlantic Division. However, the

West North Central Division had a higher rate of procedures per 10,000 population than the Middle Atlantic

Division did.

Over 40 percent of all CAT scans performed in short-stay

hospitals during the period 1979-1982 were performed in

hospitals having 500 beds or more.

About 75 percent of all CAT scans done in shofl-stay

hospitals in the period 1979 through 1982 were done in

nonprofit hospitals.

About 60 percent of all CAT scans performed in shortstay hospitals during the period 1979 through 1982 were

performed on the head.

Sex and age of patient

The estimated number of CAT scans performed on inpatients in short-stay non-Federal hospitals has risen from

approximately 194,000 in 1979 to 600,000 in 1982: (an increase of about 200 percent (table 1). It should be emphwized

that these scans are for inpatients only there are a considerable

number of CAT scans performed in outpatient departments,

medical clinics, and mobile units. Outpatient departments have

the use of in-house scanners if time is available. In addition,

19 percent of all CAT scanners in use have been purchased by

hospital outpatient deparbnents and doctor’s offices.]g

The rate of CAT scans per 10,000 population ranged from

8.6 to 26.0 for males during this period while the rate for females

ranged from 8.8 to 26.1 for the same period. Although the rates

increased over time for each sex, the rates between the sexes

showed no significant differences. The number and rate of pre

cedures per 10,000 population by age is smallest for those under

15 years of age and largest for those 65 years of age and over.

Rates per 10,000 population for those under 15 years of age

ranged from 3.5 to 8.5 during the period 1979-1982, while for

those 65 years and over they ranged from 26.5 to 92.5. Approximately 40 percent of the CAT scans performed on patients

were performed on those 65 years of age and over, while only 8

percent were performed on those under 15 years of age. “Varia-
Table 1. Number, rate, and percent cliatrilwticmof CATscans for patients discharged from ahoti-stay non-Federal hoapitala by sex and age:

United States, 1979-82

Sex and age 7979 7980 ?987 1982 7979 7980 7981 1982 7979 7980 7981 ?982

Number in thousands Rate per 10,000 population Percent

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 306 424 600 8.7 13.6 18.6 26.1 100.0 100.0 100.0 100.0

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 152 205 289 8.6 13,9 18.7 26.0 47.9 49.5 48.4 48.2

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 154 219 311 8.8 13.2 18.6 26.1 52.1 50.5 51.6 51.8

Aga

Less than 15 years . . . . . . . . . . . . . . . . . . 18 27 34 44 3.5 5.3 6.6 8.5 9.2 8.9 8.0 7.3

15-44 yeara . . . . . . . . . . . . . . . . . . . . . . . 54 74 103 150 5.3 7.1 9.8 14.0 28.1 24.1 24.3 25.0

45-65 yea= . . . . . . . . . . . . . . . . . . . . . . . 55 85 114 15s 12.4 19.0 25.6 35.6 28.3 27.7 26.8 26.4

65 years and over . . . . . . . . . . . . . . . . . . . 67 120 173 248 26.5 46.7 66.0 92.5 34.4 39.3 40.9 41.4

tions in the percent distribution by age showed no significant

difference from year to year.

Source of payment

Medicare, which is primarily for those 65 years of age and

over, was the expected source of payment for approximately

42 percent of all CAT scans performed in short-stay nonFederal hospitals between the years 1979 and 1982, while

private insurance was the expected source of payment for about

39 percent (table 2). Medicaid was the expected source of

payment for about 7 percent of the CAT scans, while other

payments and self-pay accounted for about 5 percent each.

Workmen’s compensation accounted for the remaining 2 percent. There was no significant difference in expected source of

payment from year to year.

Geographic division

The Middle Atlantic Division recorded the largest number

of CAT scan procedures (433,000) performed on patients during the period 1979-82, while the Mountain Division recorded

the smaIlest number of CAT scans about 30,000 (table 3). For

most years rates per 10,000 population were highest in the

West North Central Division and lowest in the West South

Central and Mountain Divisions. In 1982 the rates ranged tlom

Table 2. Number and percent distribution of CAT scans for patients discharged from short-stay non-Federal hospitals by expected source of

payment: United States, 1979-82

Expected source of payment 7979 1980 1981 ?982 1979 7980 7981 1982

Number in thousands Percent

All sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 306 424 600 100.0 100.0 100.0 100.0

81ue Cross and other private insurance . . . . . . . . 76 124 161 239 39.1 40.4 38.1

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

39.9

69 129 184 261 35.5 42.0 43.4 43.5

~\/]:jdicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 21 29 37 6.6 6.8 6.9 6.1

Self-pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 17 21 29 5.9 5.6 5.0 4.8

Workmen.s compensation . . . . . . . . . . . . . . . . . .

* *

11 16 * ●

Other payments . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.5 2.7

24 13 17 17 12.2 4.1 4.0 2.9

Table 3. Number, rate, and percent distribution of CAT scana for patients discharged from short-stay non-Federal hospitals by geographic

divisions: Unitad States, 1979-82

Geographic division 7979 1980 7981 ?982 7979 7980 1981 f982 ?979 7980 1981 7982

Number in thousands Rate per 40,000 population Percent

All divisions . . . . . . . . . . . . . . . . . . . . . . . 194 306 424 600 8.7 13.6 18.6 26.1 100.0 100.0 100.0 100.0

New England . . . . . . . . . . . . . . . . . . . . . . *5 11 17 27

Middle Atlantic

●4.3 8.7 13.7 21.7 *2.8 3.5 4.0 4.5

. . . . . . . . . . . . . . . . . . . . . 50 78 117 188 13.5 21.3 31.8 51.1 26.0

East NOflh Central . . . . . . . . . . . . . . . . . . 20 29 45 3g 4.7 7.o

25.6 27.6 31.4

10.8 9.5 10.2

West NORh Central . . . . . . . . . . . . . . . . . 27 57 71 100

9.5 10.6 6.6

15.7 33.1 41.6 57.8 14.0

SouthAtlantic . . . . . . . . . . . . . . . . . . . . . 19 34 67 95 5.4 9.2

18.5 16.8 16.6

18.1 25.2

East South Central . . . . . . . . . . . . . . . . . . ●7

9.8 11.1 15.9 15.8

17 17 17 “4.7 11.4 11.8 11.5 ●3.5 5.5 4.1 2.8

Wast South Central . . . . . . . . . . . . . . . . . ●7 *8 16 20 ●3.1 ●3.6 6.5 8.0 ●3.6 ●2.8

Mountain . . . . . . . . . . . . . . . . . . . . . . . . . * ●

3.7 3,3

Pacific

*8 17** *6.5 6.6 * ● *1.8

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 70 66 97 17.8 22.1 20.6 29.8 28.2 22.8 15.5 1t:
4 aduatKx3(k&

6.6 per 10,000 population for the Mountain Division to 57.8

per 10,000 population for the West North Central Division.

The differences in the CAT scan rates could not be attributed

to the age differences in the population.

Size of hospital

The number and percent of CAT scans performed during

the period 1979–82 were lowest in hospitals with less than 100

beds (3 percent in 1982) and largest in hospitals with more

than 500 beds (39 percent in 1982) (table 4). In comparison,

for all procedures, 11 percent were performed in hospitals with

less than 100 beds and 29 percent in hospitals with more than

500 beds. One possible reason for the small number of CAT

scan procedures performed in the smallest hospitals may be

that CAT scanners are quite expensive and require trained personnel to operate them. Small hospitals often do not have the

resources in personnel or finances to purchase and operate them.

The standards in the “National guidelines for health planning,” which were in effect until November 1982,15,16 also

tended to discourage smaller hospitals from purchasing this

equipment. The target of 2,500 patient procedures per year for

efficient utilization requires a larger patient population than is

available in many smaller hospitals.

Hospital ownership

During the period 1979-82, 1,141,000 CAT scans

(75 percent) were performed in nonprofit hospitaly 321,000

(21 percent) were performed in State or local government

hospitals; the remaining 4 percent were performed in proprietary

hospitals (table 5). Within the 4 years there was no significant

shift by hospital ownership in the percent of CAT scans lperformed.

Anatomical site

Of the 1,524,000 CAT scans performed during the period

1979-82,921,000 (60 percent) were scans of the head (table 6).

This is not surprising because head scanners werethefmt scanners introduced, and the head is the area of the body where this

type of noninvasive procedure is most useful. Head scans are

used to determine the extent of brain tumors and whether they

are operable, and the extent of stroke damage to ascertain the

feasibility of cleaning up the stroke debris. The other area of the

body where CAT scanning is quite common is the abdomen.

There were 180,000 (12 percent) perfotmed on the abdomen.

Of the 600,000 CAT scans performed during 1982,

359,000 were scans of the head (table 7). Of these 359,000

Table 4. Numbar and parcent distribution of CAT scans for patients discharged horn short-stay non-Federal hospitals by bed size United Stetes,

1979-82

Bed size 1979 1980 1981 1982 1979 1980 1981 Y982

Number in thousands Percent

All sizes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 306 424 600 100.0 100.0 100.0 100.0

6-99 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

* ●7 18 16 * ●2.2 4.4 2.7

100-199 beds..,...........,.. . . . . . . . . . . . 32 53 63 93 16.6 17.2 14.8 15.5

200-299 beda . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 30 51 98 10.3 9.9 12.0 16.4

300-499 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 73 107 158 26.4 23.7 25.2 26.4

5000r more beds, . . . . . . . . . . . . . . . . . . . . . . . . 90 144 185 234 46.2 47.0 43.6 39.0

Table 5. Number end percent distribution of CAT scans for patients discharged from short-stay non-Federal hospitals by type of ownerahipc

United States, 1979-82

Type of ownership 1979 1980 1981 1982 1979 1980 1981 1982

Number in thousands Percent

Allhospitais . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 306 424 600 100.0 100.0 100.0 100.0

Nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 228 306 467 72.2 74.5 72.0 77.8

Proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 15 16 21 5.0 4.9 3.8 3.6

State and local government . . . . . . . . . . . . . . . . . 44 63 102 112 22.8 20.7 24.1 18.6

Table 6. Number, rate, and percant distribution of CAT scans by site of scan for patiants discharged from short-stay non-Federal hospitals:

United Statas, 1979-82

Site of CA T scan 1979 1980 1981 ?982 1979 1980 1981 1982 1979 1980 1981 1982

Number in thousands Rate per 10,000 population Percent distribution

All CAT scana . . . . . . . . . . . . . . . . . . . . . . 194 306 424 600 8.7 13.6 18.6 26.1 100.0 100.0 100.0 100.0

Had . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 190 266 359 4.7 8.4 11.7 15.6 54.6 62.1 62.7 59.8

Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . 15 32 56 77 0.7 1.4 2.4 3.4 7.7 10.5 13.2 12.8

Other specified . . . . . . . . . . . . . . . . . . . . . ● *8 11 23 ● “0.3 0.5 1.0 ● ●2.6 2.6 3.8

Other unspecified . . . . . . . . . . . . . . . . . . . 69 75 gl 141 3.1 3.3 4.0 6.1 35.6 24.5 21.5 23.5
amcedaa5

Table 7. Number and percant of CAT scans, by sitas of scans and

principal diagnosas for patients discharged from short-stay

non- Fedaral hospitals: Unitad Statas, 1982

Site of CA T scan and diagnosis and Number in

ICD-9-CM code 1 thousands Percent

All head scans . . . . . . . . . . . . . . . . . . . . . . . . . . 359 100.0

Cerebrovascular disease. . . . . . . ...400-438 82 22.9

Malignant neoplasm ., . . . . . . . . ...140-208 29 8.1

Concussion and intracranial injury. .. 850-854 23 6.5

Heart disease . . . . . . . . . . . . . . . ...391-392.

393-398,402.404,410, 416,420-429 20 5.6

Allabdoman scans . . . . . . . . . . . . . . . . . . . . . . 77 100.0

Malignant neoplasm . . . . . . . . . . ...140-208 20 26.2

‘U.S. Public Health Service and Health Cara Financing Admlnistrstiom

international Classification of Diseases. 9th Revision, Clinical Modification.

DHHS Pub. No. (PHS) 80-1280. Publw Health Serwe. Washington. U.S.

Government Printing Office, Sept. 1980.

head scans, 82,000 were for cerebrovascular disease, 29,000

were for malignant neoplasm, 23,000 were for concussion and

intracranial injr.uy,and 20,000 were for heart disease. The other

anatomical site where there were significant numbers of scans

was the abdomen. There were 77,000 scans of the abdomen

during 1982, and, of these, 20,000 were forsuspected neoplasm.

Diagnosis

The two leading diagnostic groups for which CAT scans

were performed were circulatory diseases (150,000 or 25 percent) and neoplasms (82,000 or 14 percent) (table 8).

Of the 150,000 CAT scans performed on the circulator

system, 96,000, or 64 percen~ were performed for cerebrvascular disease; of the 82,000 CAT scans performed because

of suspected neoplasms, 71,000 or 86 percent were for suspected malignancy. Other leading diagnoses were injury and

poisoning (68,000) and diseases of the nervous system and

sense organs (60,000).

Table 8. Number and percent distribution of CAT scana by all-listed

diagnoses and ICD-9-CM codas for patients discharged from

short-stay non- Fedaral hospitals: Unitad Statas, 1982

Number in Percent

Diagnosis and ICD-9-CM code 1 thousands distribution

All CATscans . . . . . . . . . . . . . . . . . . . . . . .

Infectious and parasitic

diseases . . . . . . . . . . . . . . . . ...001-139

Neoplasms . . . . . . . . . . . . . . ...140-239

Endocrine, nutritional, and metabolic

diseases and immunity

disorders . . . . . . . . . . . . . . . ...240-279

Diseasas of the blood and blood-forming

organs . . . . . . . . . . . . . . . . . . .. 280-289

Mental disordera. . . . . . . . . . ...290-319

Diseasas of the nervous system and

sensa organs. . . . . . . . . . . . ...320-389

Diseases of the circulatory

system . . . . . . . . . . . . . . . . . . . .390-459

Diseases of the respiratory

system . . . . . . . . . . . . . . . . . . . . 460-519

Diseases of the digestive

system . . . . . . . . . . . . . . . . . . . .520-579

Diseaaes of the genitourinary

system, . . . . . . . . . . . . . . . . . . . 580-629

Complications of pregnancy, childbirth,

and the puerperium . . . . . . ...630-676

Disaases of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . .680-709

Diseases of the musculoskeletai

system . . . . . . . . . . . . . . . . . . . .710-739

Congenital anomalies. . . . . . ...740-759

Certain conditions originating in the

perinatal period. . . . . . . . . . ...760-779

Symptoms, signs, and ill-defined

conditions . . . . . . . . . . . . . . . .. 780-799

Injury and poisoning. . . . ..800

Supplementary classifications.. . VOl -V82

600

12

82

22

●5

40

60

150

19

39

16

*

●

50

“7

*

20

68

“5

100.0

2.1

13.7

3.7

“0.9

6.7

10.0

24.9

3.1

6.5

2,7

*

*

8.4

81.1

●

3.3

11.3

“0.9

1U.S. Public Health Service and Health Care Financing Administration:

international Classit7cation of Diseases. 9th Ravision. Clinical Modifrcarion.

DHHS Pub. No. (PHS) S0-1260. Public Health SetVice. Washington. U.S.

Govarnmant Pr+mng Office, Sapt. t 980.

Symbols

..- Data not available

. . . Category not applicable

. Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
6 advancedata

References

lN&ynalCenter for Health Statistics, W. R Simmons: Development

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

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

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

zNationa] Center for Health Statistics, E. Graves ad B. J. Haupti

Utilization of short-stay hospitals, United States, 1981, annual summary. Vital and Health S~atistics. Series 13, No. 72. DHHS Pub.

No. (PHS) 83– 1733. Public Health Service. Washington. U.S. Government Printing OffIce, Aug. 1983.

3u.s. public Health Service and Health Care Financing Administration: International Class.ijication of Diseases, 9th Revision, Clinical

A40dficarion. DHHS Pub. No. (PHS) 80-1260. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1980.

4Merck ~d CO., Inc.: The Merck Manual of Diagnoses ~d TheraPY,

14th cd., pp. 1353-1357. Rahway, N.J. Merck and Co., Inc., 1982.

5The World Wb]ishing Co.: Webster’s New World Dictiona~ of the

Amen.can Language, 2d college cd., p. 1496. New York and Cleveland.

World Publishing Co., 1970.

6Banta, H. D.: The difision of the computed tomography (CT) scanners in the United States. M. 1 Public Health 10(2):251-268, 1980.

7American Hospital Associatiorx Hospita[ Statistics, 1983 cd., p. 201.

Chicago. Nov. 1983.

‘K. F. Ganchon Diagnostic imaging, An inside look. Hospitals

55(1):86-88, JaiI. 1, 1981.

9J. c. M. Bms.t, p. C. T. Dickinson, and E. B. Healtorx Failure of CT

sharing in a large municipal hospital. N. Eng. .7. Med. 304(23):1388,

June 4, 1980.

10D. H. B~ta and B. j. McNeil: Evaluation of the CAT scanner

and other diagnostic technologies. Health Care Management Rev.

3(1):7-19, Winter, 1978.

1lcT scmning hailed as a guide to dramaticrdiy better back surgery.

Med. World News 23( 1}26-27, July 19, 1982.

12PET PIUS CT SCSUISequal to battery of tests in spotting Alzheim~rs.

Med. World News 23(23):28-29, Nov. 8, 1982.

1sMcGraw-Hill Book CO., Inc.: McGraw-Hi/l YeUrhOOk of sciej~ce

and Technology, p. 150. New York. McGraw-Hill Book Co., Inc.,

1982.

14M. Goietein: Benefits and cost of computerized tomography in radiation and therapy. JAMA 244(12):1347-1349, Sept. 19, 1980.

‘sFederal Register, Vol. 43, No. 60, p. 13049, Mar. 28, 1978.

16Federa1 Register, Vol. 47, No. 230, pp. 53853-53856, Nov. 30,

1982.

]‘PET scan research spreads to Illinois. Hospitals 56(1):52, July 16,

,

1982.

18D. Havrom NOW see sodium via NMR scanner. Med. Tribune

24(23):8-9, 14, NOV. 9, 1982.

19u-s. plans to ~op curbs on hospital purchases of CT sc~ers.

Med. World News 23( 14]:26-27, July 5, 1982.

20National Center for Health Statistics, M. G. Sirken: Utilization of

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

1965. Vital and Heakh Statistics. Series 13, No. 2. PHS Pub. No.

1000. Public Health Service. Washington. U.S. Government Printing

Office, Aug. 1967.

21National Center for Health Statistics, M. J. Witkirx Utilization of

short-stay hospitals by characteristics of discharged patients, United

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

No. 1000. Public Health Service. Washington. U.S. Government

Printing Office, Dec. 1967.

Recent Issues of Advance Data From Vital and Health Statistics

No. 99. Health Care of Adolescents by OffIce-Based Physicians: No. 96. Utilization of Analgesic Drugs in Office-Based Ambulatory

National Ambulato~ Medical Care Survey. 1980-81 (Issued Sept. Care: National Ambulatory Medical Care Survey, 1980-81 (Issued

1984) March 14, 1984)

No. 98. Diagnosis-related groups using data from the National No. 95. 1982 Summary: National Hospital Discharge Survey (IsHospital Discharge Survey: United States. 1981 (Issued July 20, sued December 27, 1983)

1984)

No. 97. The Management of New Pain in Office-Based Ambulatory

Care: National Ambulatory Medical Care Survey, 1980 and 1981

(Issued June 13, 1984)
aknceda7

Technical notes

Source of data

The National Hospital Discharge Survey (NHDS) encompasses patients discharged from short-stay hospitals, exclusive of military and Veterans Administration hospitals,

located in the 50 States and the District of Columbia. Only

hospitals with six or more beds and an average length of stay of

less than 30 days for all patients are included in the survey.

Discharges of newborn infants are excluded from this report.

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

hospitals contained in the 1963 Master Facility Inventory of

Hospitals and Institutions. New hospitals were sampled for

inclusion in the survey in 1972, 1975, 1977, 1979, and 1981.

In all, 550 hospitals were sampled in 1982. Of these hospitals,

71 refused to participate, and 53 were out of scope. The 426

participating hospitals provided approximately 214,000 abstracts of medical records.

Sample design

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

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

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

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

these 24 primary strata, the allocation of the hospitals was

made through a controlled selection technique so that hospitals

in the sample would be properly distributed with regard to type

of ownership and geographic division. Sample hospitals were

drawn with probabilities ranging from certainty for the largest

hospitals to 1 in 40 for the smallest hospitals.

Sample discharges were selected within the hospitals using

the daily listing sheet of discharges as the sampling frame.

These discharges were selected by a random technique, usually

on the basis of the terminal digit or digits of the patient’s medical

record number, a number assigned when the patient was admitted to the hospital. The within-hospital sampling ratio for

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

Data collection and estimation

The sample selection and the transcription of information

from the hospital records for abstract forms were performed by

the hospital stti or by representatives of the National Center

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

the face sheets of the medical records. All discharge diagnoses

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

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

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

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

Statistics produced by the NHDS are derived by a complex

estimating procedure. The basic unit of estimation is the sample

inpatient discharge abstract. The estimating procedure used to

produce essentially unbiased national estimates in the NHDS

has three principal components: inflation by reciprocals of the

probabilities of sample selection, adjustment for nonresponse,

and ratio adjustment to fxed totals. These components of estimation are descrii in appendix I oftwo earlier publications.zo~]

Sampling errors and rounding of numbers

The standard error is a measure of the sampling variability

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

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

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. Relative

standard errors for procedures are shown in table I.

Estimates have been rounded to the nearest thousand. For

tits reason detailed figures within tables do not always add to

the totals. Rates and average lengths of stay were calculated

from original unrounded figures and ‘willnot necessarily agree

precisely with rates or average lengths of stay calculated from

rounded data.

Tests of significance

In this repo% the determination of statistical inference is

based on the tw~tailed Bonferronitest for multiple comparisons.

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

such as “similar” or “no diiYerence”mean that no statistically

significant difference exists between the estimates being compared. A lack of comment on the difference between any two

estimates does not mean that the difference was tested and

found to be not significant.

Definition of terms

Hospitals and hospital characteristics

Hospitals—Short-stay special and general hospitals have

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

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

institutions are not included.

Table 1. Approximate relative standard errors of estimated numbers

of all-listed procedures: United States, 1982

Relativa standard

Size of estimate error

5,000. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 15.4

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

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

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

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

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

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

3,000,Q00. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1

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

10,OOO,OOO... . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4

15,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2

Zo,ooo,ooo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1

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

NOTE: A Iist of references follows the text.

“U.S. Gowrrment Printing OHise: 1S9S — SO1-01WO02U
8 ackincedata

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

cribs, and pediatric bassinets regularly maintained (set up and

staffed for use) for patients; bassinets for newborn infants are

not included. In this report the classification of hospitals by

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

beds at or near midyear.

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

grouped as follows:

● Voiunta~ nonprojit-Hospitals operated by a church or

another nonprofit organization.

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

● Proprieta~—Hospitals operated by individuals, partnerships, or corporations for profit.

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

(summary sheet) of the medical record under the captions

“operation,” “operative procedures,” “operations andlor

special treatment,” and the like are transcribed in the order

listed. A maximum of four procedures are coded.

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

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

population on July 1 of that year.

Demographic terms

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

to admission to the hospital inpatient service.

Census division—One of the nine geographic divisions of

the United States corresponding to those used by the Bureau of

the Census:

Division

New England .,....,.

Middle Atlantic . . . . . .

South Atlantic . . . . . . .

East North Central. . . .

Eaat South Central . . .

Weat North Central. . .

West South Central. . .

Mountain . . . . . . . . . . .

Pacific . . . . . . . . . . . . .

States included

Connecticut, Maine, Maasachusetta,

New Hampshire, Rhode Island, Vermont

New Jersey, New York, Pennsylvania

Delaware, District of Columbia,

Florida, Georgia, Maryland, North

Carolina, South Carolina, Virginia,

West Virginia

Illinois, Indiana, Michigan, Ohio,

Wisconsin

Alabama, Kentucky, Miaaisaippi,

Tennessee

Iowa, Kansas, Minnesota, Miaaouri,

Nebraaka, North Dakota, South

Dakota

Arkansas, Louisiana, Oklahoma,

Texas

Wlzona, Colorado, Idaho, Montana,

Nevada, New Mexico, Utah,

Wyoming

Alaaka, California, Hawaii, Oregon,

Washington

Suggested Citation

Nattonal Center for Health Statistics, E. J. Graves:

CAT scan uae in short-stay non-Federal hospitals,

United States, 1979-82. Advance Deta From Copyright Information

Vital and Health Statistics, No. 100. OH HS Pub.

No. (PHS) 84-1250. Public Health SewIce. This report may be reprinted without further

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