NATIONAL CENTER Series 22 

For HEALTH STATISTICS INumber:6 

VIXAL and HEALTH STATISTICS 

DATA FROM THE NATIONAL VITAL STATISTICS SW3TEM 

Medical X-ray Visits 

and Examinations 

During Pregnancy 

United States 1963 PRWPRWFWE ‘ PL.W.!CATKIK5
 W3ANCI-?


iiww” MHARY 

Statistics on the number of medical X-ray visits and examinations 

during pregnancY for women having a live birth, by selected demographic characteristics of the women by trimester, previous pregnancy experience and type of examination, and by type of facility. 

Based on data collected in a survey of physicians and hospitals 

providing care to a sample of women having a’ live birth in 1963. 

Washington, DC. June 1968 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION, AND WELFARE Public Health Service 

Wilbur -f. Cohen Wil Iiam H. Stewart 

Secretary Surgeon General 
*. 

. 

... , 

Public Health Service Publication No. 1000%eries 22-No. 5 

For sale by the Superintendent of Doouments, U.S. Government Prin~mg Office 

WasMngton, D. C., ‘20402 - Pries 40 cents 
,,NATIONAL CENTER FOR HEALTH STATISTICS ....4., 

THEODORE D.WOOLSEY, Director 

PHILIP S. LAWRENCE, SC.D., Associate Director 

OSWALD K. SAGEN, PH. D.,, Assistant Director for Health Statistics Development 

WALT R. SIMMONS, M.A., Assistant Director for Research and Scientific Development 

ALICE M. WATERHOUSE, M. D., Medical Corzsul&zt ‘“ ‘ 

JAMES E. KELLY, D. D. S., Denttil Advisor 

LOUIS R. STOLCIS, M. A., Executive Officer 

MARGERY R. CUNNINGHAM, Information O//icer 

,. 

DIVISION OF VITAL STATISTICS ,. 

., 

ROBERT D. GROVE, Ph. D., Director ‘ 

ROBERT A. ISRAEL, M. S., Deputy Director 

ARTHUR A. CAMPBELL, special ,Assistant to tke Director 

‘ROBERT A. ISRAEL, M. S., Acting Chief, Mortality ‘Stati~tics Branch 

PATIENCE LAURIAT, M. A., “Acting chief, Natality .Statistics Branch 

ROBERT D. GROVE, ph. D., Acting Chic/, Registration MetAods Branch 

PATIENCE LAURIAT, M. A., Chief, Marriage and Diuorce Statistics Branch 

ARNE B. NELSON, M. A., chief, vital Records Survey Branch 

ALICE M. HE TZEL, chief, Statistical Resources Sectian 

,“ 

Public Health Service Publication No. 1000-Series 22-5 

Library of Congress Catalog Card Nurn ber 68-60059 
.

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. ....” “.:, . 

.. ‘,.’. .,, 

,,” ,,, 

,- ,, -

,. CQNTENTS . . , ..

~~ .,, ,, ,. . . . 

Introduction -----T----y .“ . . .


,. 

Selected F,&@gs------------------~---7,--------.-~---------------~TT--

Sources and Limitations of Data--~---------------=--------------------­

,, 

Mothers Witi Medical X-Ray Visits---------"-----------------------------­ .,,. 

,, ., ,,.,_ ,-: ._. 

X-Rqy Visits and Ex~tiations-~----7-v------T---------------------------

Color and Age ofMother---------~--~---------~---------,------:-r---

Geographic Region mdMetropolitm Status-------:-~----------:---=---

Color and Family hcome-------v--u----------U-,-----,-----------------

T~eof Ex&tiation----------------~-----------------------T----Y-----'


Type of Facility by T~eof Examtiation


Trtiesterv of Emmtiation-----------J----------------~--------------,


Color and Age of Mother---------~------------------------J---------


Previous Pregnancy Experience------=-----------------------:-------


Color and Family hcome


.,, . 

,. Page 

Comparison With Rates for Women in General Population
 ,. .


References --------------------------------~---------------------=---

,,, ..,. 

Detailed Tables


Appendix 1. Tectiicd Notes on Mefiods


Statistical Desi@of National Natality Survey --------------------------


Reliability of Esttiates


Appen& II. Definitions of Certain Terms Used in This,ReportT


Appendix III. Source Forms


Standard Certificate of Live Btith--=---------------------------------


Survey Questiomaire for Mothers-----------;-------------,-----------


Survey of Medical and'Dental Cme----------------------------------- ,


Survey Questionnaire for Physicians


Survey of Radiological Exatiat~ons


Survey Questiomatie for Medical Facilities---,


Survey of Radiological ExamMations


. 

1 

1 

2 

3 

3 

3 

4 

5 

5 

5 

6 

7 

8 

10 

10 

11 

12 

23 

23 

24 

28 

30 

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31 

32 

34 

35 

38 

39 

... [11 

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IN THIS REPORT statistics ave pvesented on the num.bev of medical 

X-ray visits and examinations duving @egnancy of wornen who h@ a 

live birth during 1963. Differences in the volume of medical X-vay cave 

are shown by such dem.og7aphic characteristics as CO1OY,age, income, 

geographic vegion, and vesidence in metropolitan ov n.onmetvopolitun 

aveas. Othev vaPtab@ incl@e 7@@of medical facz~ity, type of exami­ . . nation, tvim%iti of examination, and pkeviou3 ‘j#egnancy expedience. 

The.data ave, based on,.a probability sample of, 4,096 live.,;. bivths OCCUY-, ..’ 

%&.ik ‘1963. ‘., 5 :“’‘ 

About 900,000, OY 23 pwcent, of the women gz”ving birth in 1963 had 

1,085,000 medical X-ray visits dum”ngpregnancy. A higher pvopovtion 

of nonwhite ,pothers than white had ,medical X-ray visits. Nonwhite females rnaEi@ visits showed greater” va?c?’abili~yby age tl& white females. The visit vate was 27 visits pev 100 pregnant women. Both visit 

rates and examination vates weve highev fov nonwhite females in each 

age group than fov white. The greatest difference in visit rates was fov 

mothers aged 25-29 years, and in examination rates it was for mothezs 

aged 25-29 and 30-34 years. Mothers in the West Re@”onhad the highest 

visit and examination vates; those in the South and Novtheast had the 

lowest. Mothers in metropolitan areas had highti visit and examination 

vates than those in nonmetvopolitan aveas. Both rates were faivly unifom in metropolitan areas by ve~”on, and quite variuble in rwnmetro-’ 

‘politan aveas. 

Almost 84 percent of the examinations veported duving pregnancy we?% 

pevfovmed in such facilities as hospitals and clinics. ,The variation in 

type of’ facility accovding to type of examination shows that about one- ,. 

fourth of the examinations of the utems and pelvic ve~”on weve peYfovmed in ph~sicians’ offices: one-thivd of these ware pevfqfied ??Y 

general fivactitionezs and one-thivd by obstetricians and gynecolop”sts. ,, 

A b?<yu.-o?@hj,Yd of the examinations d~ri~l the, .@st trimeste-r wev~ f~v . . .~..— 

X-YcIy, pelvimefry-%-~24 ”>~~&%~-w–&e-.~#arni@-tio-ns-‘of”the abdomen, . . wh$ch w&e related to pvegnuncy. Exam’%ations tiuving,the fivst and’”kee,-’ . . ... .. .>+.7 

ond tvimes ten were pvedo.minuntly of the chest. Rates fov chest examinations were higher for nonwhite females than fov white; those for ex.-

arninations of the abdomen weve about thq same for white ati ~nw~ite 

females, and fov pelvimetvy they were somewhat highev for white. The 

,vate fov pelvimetvy was highev for pvimipavous, thun for multipavoqs 

women. Rates $or othev examinations of the abdomen ware somewhat 

highev at highev pavities. At each parity the medical X-ray exarninaiion 

rate was significantly higher for women who had had a priov fetal loss. 

Most of the differences here velate to examinations of the abdomen.., 

X-vay examination rates generally do not appear to be related to income. 

. -’. . . . . . . . 

I


I SYMBOLS


Data not available 

Category not applicable 

Quantity zero 

Quantity more than O but less than 0.05 -----

Figure does not meet standards of 

reliability or precision 

r 

1 $ ,. 

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-—. ---- ------------- . .. ... ------- . ...’--

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,!, ,.. ? .,, . . ,8 . 

,. “L 

,. .,. , 

.- ME616AL X-RAY VISITS “ 

AND EXAMINATIONS I)(JRING PREGNANCY


Morton L. prown, National Center fw” Radiological Health, 

Arne B. Nelson, National Center for Health Stu;istics 

INTRODUCTION 

The importance of X-rays as a major source 

of radiation exposure has been recognized in 

recent years. The need to obtain reliable data 

on the extent of medical X-ray exposure to various segments of the population underlies the development of programs to promote the most 

efficient use of the X-ray. One segment of the 

population for which information is of particular 

significance is ‘that represented by pregnant 

women, since exposure to this group may have 

- implications mot OI@ for the woman herself but 

also for the developing fetus. 

This report provides estimates of the extent 

of medical X-ray visits and examinations during 

pregnancy of women who had a live birth during 

1963. It is based on data collected in the National 

Natality Survey for a probability sample of 4,096 

women. Information about medical” X-ray care 

received by these women was obtained from phy-’ 

sicians, hospitals, clinics, and other institutions 

which provided the care. The data derived from 

this survey provide national estimates riot previously available. 

In this report data are presented describing 

the volume of’ medical X-ray care received by 

women during pregnancy in terms of the amount 

of such care and its relationship to selected characteristics. . . 

SELECTED FINDINGS 

About 23 percent of all women having liveborn 

infants during 1963 had one medical X-ray visit. 

or more during pregnancy, with the proportion of 

nonwhite mothers (26 percent) being higher than 

that of white (22 percent). The rate for medical ‘ 

X-ray visits was more variable by age for nonwhite mothers than for white: this rate was somewhat higher for, nonwhite mothers mder 20 years 

of age and 25-29 years than for white. 

The rate of medical” X-ray visits for all 

mothers was 27 visits 4per 100 pregnant women.’ 

‘This rate was higher for nonwhite’ mothers than 

for white in each age group. For both white and 

nonwhite mothers the rate was fairly uniform for 

each age group except for-the comparatively low ,.. 

rate for white mothers aged 25-29 years: The 

visit rate for nonwhite mothers was 58 percent 

above that for white mothers in this age group.’ 

For white and npnwhite mothers the examination 

rate was slightly above the visit rate at all ages 

except 25-29 and 30-34, where there was a substantially higher examination rate among nonwhite 

mothers. 

Many of the mothers who made medical X-ray 

visits during pregnancy had more than one visit. 

When visit and examination rates are based on 

these mothers, the rates reached a peak for white 

mothers at ages 25-29 and a low point at ages 

30-34. In ‘contrast, rates were relatively high 

for nonwhite mothers aged 30-34 and relatively 

.low for those 25-29. . 

-Mothers in the West Region had the highest 

visit and examination rates; those in the South 

and N~rtheast had the lowest. Mothers in metropolitan areas had higher visit and examination 

rates than those, in nonmetropolitan areas. The 

“visit. and examination rates by region in metro1


...< 
politan areas were fairly uniform; those @ nonmetropolitan areas were quite variable—visit 

rates ranged from a low of 17 per 100 mothers 

in the Northeast Region to 27 per 100 mothers in 

the West. 

Visit and examination rat~s show little relationship to family income. Hp&ti@, hijgher ‘:~. 

rates were shown for nonwhite mothers than for 

white “IN‘fa@ili@ with,’ inc@me..Jevels of; $2_Jl~0’.‘“ 

$3 ,999”’atid $4:000:$6:%<. “’ : . ., ,, Almost 84 percent of the medical X-ray 

examinations during pregnancy, were per for.rned. , 

in places other than physicians 1 private offices. 

cantly higher for women who had one fetal loss 

or more prior to the present pregnancy. Most of 

the difference in examination rates were for 

examinations of the abdomen. 

Examination rates’ for X-ray pelvimetry and 

other examinations of the abdomen did not appear 

to be, s~gnificaqtly: ~e~ated to income. However, 

the rate for chest examinations, particularly for 

wliitej mother’s,; ,a~peaye,dto,declin’~ wifh;n.cre,asing ../, ., income; ‘“ ‘“ -

SOURCES AND 

Of ‘the remaining 16 percent, ‘one-fourth ‘were ‘“”‘ : WiiITATIONS OF DATA 

performed by general practitioners, one-third 

by obstetricians or gynec~logists, and the balance 

by. other specialists, including ,radiologists. Almost one-fourth of the examinations of the uterus 

and.. pelvic region ~ere, performed in physicians’ 

offices. Of these, approximately one-thir~ were 

done. by general practitioners and one-third by 

obstetricians and gynecologists.. 

More than one-half of the medical. X-ray 

examin@iqns- during pregnancy ,were done during 

the @jrd, ‘trimester, Approximately one-third .,of 

me ,examinations during the third trimester were 

fqr, X-ray. pelvimetry aqd, one-fourth were for 

other exap-@@ions of the abdomea related to 

pregnapcy. During the, firstand second trimesters 

a Iarg.e proportion of the examinations wqre of the 

chest. Virtually all X-ray pelvimetry was done 

during, the last trimester as were over, nine-tenths 

of :the other abdominal examinations related to 

pregnancy.. ,. 

: Nonwhite women had higher rates for chest 

examinations than did white women. Rates for 

examinations of the abdomen were about the same 

for while women as for nonwhite; however, the 

rate of ~-r.ay pelvimetry for white mothers was 

higher than, that for nonwhite. The rate of women 

having, X-ray, pelvimetry ,duriyg+ pregnancy, appeared generally to decline with increasing age, 

while the rate for other examinations related to 

pregnancy generally increased with age. 

The rate of X-ray pelvimetry was significantly higher among primi.parous women than 

among multiparous women. Correspondingly, 

othe,r examinations of the abdomen had somewhat 

higher rates at high parities. At each parity the 

medical examination rate appeared to be signifi -

Statistics presented,iq th~s”-report are based 

on information obtained in a mail survey of 

mothers. and physicians,. hospitals,, orother, medical facilities identified in a representative sample, 

of live births occurring during. 1963. me s~mple 

of., 4,096 live. births. was selected, fqoW among the 

more than, 4 ,million events that occurred t~:at 

year. Birth .recoyds weze jselected independen~ly, 

from within, ,the file for each State and other in-j 

detpeqdent, ~egistration ,areas at a rate “of one, 

record per l, OOO:liye.,births- , , “‘ -,.,, 

Data $or the, survey “were obtained, @orn five 

sources: the bimh re,cord” itself, the mother ~a?, 

identified on the birth yecord,, physicians, d,entists,. and hospitals or other medical facilities 

providing. care “to, the mother, during the, Year 

prior, to the birth. The birth record provided 

data on color, land age of mother, mother’s plqce 

of residence, and, live-birth o,~der of the, $hild. 

as,, well as the name of’ the attending physician 

and.. hospital (if ,any). The mother ,was questioned 

abut selected socioeconomic characteristics and,. 

was, asked to identify the physicians, ”dentists? 

and medical facilities. which bad provld~d her, 

care. The sources named by the .rn,other, thqse 

named on the birth certificate,, and any additional 

sources named by these primary sources. were 

questioned by mail ,concerning possible medical 

X-ray examination, or ~treatment of the rnotper. 

Their responses represent the sole source of 

X-ray ,information, since the mother was not 

directly asked abow her medical X-ray visits 

and examinations.’ Mothers of illegitimate children were not as,ke,d, for information, However, 

medical sources identified on the birth record 

2 
.

were questioned about possible X-ray care given 

the mother, and referrals from their sources 

were also questioned. 

Although the survey design included all uses 

of medical X-ray for diagnosis or therapy, it 

should be noted that all of the data reported in 

the survey related to diagnostic uses rather than 

to X-ray therapy. Facsimiles .of the questionnaires sent to hospitals,’ physicians, dentists, 

and informants appear in Appendix III. A description of methods and procedures followed in the 

survey may be found in Appendix I along with a 

description of the estimation procedures. Terms 

used in this report are defined in Appendix II. 

The data in this report are based on a sample 

and are therefore subject to sampling error. Tables of approximate sampling errors and instructions for their use are prwented in Appendix I. 

Sources of error associated with nonresponse, 

with possible misunderstanding of questions in 

the survey, and with processing and compilation 

of data affect the quality of the data presented in 

this report and may create bias in the statistics. 

Nonsampling errors and some measures relating 

to bias in the survey are also discussed in Appendix I. 

MOTHERS WITH MEDICAL 

X-RAY VISITS 

Over 900,000 mothers had one medical X-ray 

visit or more during pregnancy in 1963 (tabie 1). 

A higher proportion of nonwhite mothers than of 

white had medical X-ray visits during pregnancy 

(26 percent and 22 percent, respectively). 

The proportion of mothers at different ages 

who had medical X-ray visits is shown in figure 1. 

The data for white mothers show little variation 

by age, except for a comparatively low proportion 

having X-ray visits at ages 25-29 years (17 percent). Among nonwhite mothers there was greater 

variability by age. The experience of nonwhite’ 

mothers was about the same as that of white 

mothers at ages 20-24 and 30-34; at ages under 20 

and 25-29, however, nonwhite mothers had a 

considerably higher proportion of X-ray visits 

than did white mothers. A lower percent of nonwhite mothers than of white had medical X-ray 

visits at ages 35 and above. 

301


‘%,%, . . ;. ‘:’ 

~,, ,,,. ..%,,,, ., ..”. 

+,+,.,,,, **..,,,. ,,,. +,

‘%,,;. , .. : :, 

+,<,..* ~,, 

20 —
 b


a-


w,. -,
 s.


+ .,’


E .
 :.. .
 L , . .,”: ‘:;
 .,.
 o ~. : ... . ~.-. .’ ‘:. . .. . ., 

z. Y,:-“ : -.. . 

.. 

. . 

,“ ,.. . . . 

Figure “l.” Percent of mothers wi’th One’-.med ical 

X-ray, visit or ,more during pregn”~ncy,!Iiy“age of


mother and colo’r. ‘. .S “:‘


.,


X-RAY VISITS AND EXAMINATJO.NS 

A substantial proportion of mothers who had 

medicaI X-ray visits durkg pregnancy made 

more than one such visit. The total number o~ 

X-ray visits was 1,085,000, representing about 

1.2 visits per woman having me@cal, X-ray 

visits. The overall visit rate was 27 visits per 

100 pregnant women (table 2). , ~~ 

... . Color and Age of Mother 

. . .. 

The rate of. visits for white rno~ers ~was. 

about 22 percent below that for nonwhite mothers. 

Except for a comparatively low rate of. 21 visits 

per 100 pregnancies for mothers 25-29 .year,s 

of age, the visit rate for white mothers was fairly 

uniform at 26 to ,28 visits per 100 pregnancies 

(fig. 2). For nonwhite mothers .fie visit rat~,, 

showed even. greater uniformity, varying: from 

31 to 35 visits per 100 mothers. The greatest. 

difference in visit rates for white and nonwl@e 

., 

3.


I 
U White 

@jjNwwbite 34,8 

Under 20 20.24 25-29 30-34 35 years 

yeore yeors years years md over 

AGE OF MOTHER 

Figure 2. Rate per 100 mothers of medical X-ray


::;::: during pregnancy, by age of mother and


mothers was in the age group 25-29 years,where 

the rate for nonwhite mothers was 58 percent 

above that for white. 

The examination rates for all mothers were 

slightly above the visit rates for all mothers in 

each age group. This was also true of the examination and visit rates by age for white females. 

Among nonwhite females, the examination rate 

was substantially higher than the visit rate at 

ages 25-29 and 30-34. 

Visit rates which are based on all mothers 

do not adequately measure the impact of the 

relatively small numbers of mothers who had 

more than one X-ray visit. For this reason, 

rates per 100 mothers with one medical X-ray 

visit or more were also calculated and are 

shown in table 2. A comparison of these rates 

by age shows some differences from the rates 

based on all mothers in the survey. In particular, white females had a higher visit rate at 

ages 25-29; nonwhite females showed a greater 

variability in rates, with low rates for ages under 

20 and for 25-29 years. Examination rates by 

age present somewhat the same picture as visit 

rates. In addition the examination rates for white 

females were substantially higher than the visit 

rates except for age groups 20-24 and 30-34 years. 

For nonwhite females they were substantially 

higher for ages 25-29 and 30-34. 

Geographic Region and Metropolitan Status 

Mothers in the West Region had the highest 

visit rate, and those in the South and Northeast 

had the lowest (table 3 and fig. 3). The examination rates followed about the same pattern as the 

visit rates. The visit rate for mothers with one 

X-ray visit or more differed from the visit rates 

for all mothers in that both the South and West 

Regions had high rates. The examination rates for 

mothers with one X-ray visit or more were highest 

in the South Region and lowest in the North Central. 

Mothers in metropolitan areas had higher 

visit rates and examination rates than those in 

nonmetropolitan areas. This was true for each 

region. In regional comparisons both visit and 

examination rates were fairly uniform for metro­

“@itan areas but quite variable for nonmetropolitan areas. The visit rates for nonmetropolitan 

areas varied from a low of 17 visits per 100 

mothers for the Northeast to a high of 27 visits 

per 100 mothers for the West. The examination 

rates followed about the same pattern. 

When the rates are based on the number of 

mothers with one X-ray visit or more, there is 

greater variability in both visit and examination 

rates and a changing relationship between metropolitan and nonmetropolitan areas. Both visit rates 

and examination rates for metropolitan areas were 

highest in the South and lowest in the North Central. In nonmetropolitan areas the visit rate was 

highest for the West and lowest for the Northeast. 

The examination rates for nonmetropolitan areas 

were lower than those for metropolitan areas in 

each region except the West, where the rate for 

nonmetropolitan areas was higher than that for 

metropolitan areas. 

4

------

I 

-Metropolitan “ , 

@ Nonme?ropliton 

Allregions NortheastNorth Centml South West 

GEOGRAPHIC REGIONS 

visits during pregnancy, by geographic region 

W! residence in metropolitan and nonmetropolitan areas. 

Color and Family Income 

Visit and examination rates do not show much 

relationship to family income for either white or 

nonwhite mothers (table4 and fig. 4). Rates were 

lower for nonwhite mothers in families withincome less than $2,000 than for those with income 

levels of $2,000-$3,999 and $4,000-$6,999. Hoyever, the same was not true for white mothers. 

Comparison of white and nonwhite mothers by 

income levels showed higher rates among nonwhite mothersin families withincomes of$2,000-

$3,999 and $4,000-$6,999 than among white mothers in these same income groups. This difference 

may reflect relatively greater use by nonwhite 

women of medical care provided by public clinics 

and hospitals. 

The rates for visits and for examinations for 

mothers with one X-ray visit or more showed 

abok the same relationship to income as that 

shown above. Also, a comparison of rates for 

white and nonwhite mothers with one visit or more 

showed about the same relationship to income 

as did the rates for all mothers. 

TYPE OF EXAMINATION 

Type of Facility by Type of Examination 

Almost 84 percent of the examinations reported during pregnancy were not performed in 

physicians’ private offices (tables 5 and A). Of the 

16 percent done, in physicians’ offices, about onefourth were performed by general practitioners, 

40 

_ Under $2,000 

EZZ4 $2,000-$3,999 

~ $4,000-$6,999 

m $7,000 and over 

= Not .scert.i.ed 

r 

30 

w 

K 

g 

,:-. . I 

o 

z 

o .. 0 20 -

E 

u 

n 

w 

ia 

a 

10 -


0-


White Nonwhite 

COLOR 

Figure 4. Rate per 100 mothers of medical X-ray .-& 

visits during pregnancy, by color and fa!mily 

income. 

5

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-------- -------- --------

-------------------- ------------------

Table A. Percent distribution of X-ray examinations during pregnancy 

cility according to type of examination: United States, I. \ 

Type of examination All 

facilities 

Total 

Examination of the abdomen: 

Pelvi.metry 

Other related to pregnancy 

Lower abdomen not related to 

pregnancy 

Upper abdomen not related to 

pregnancy 

Examination of: 

Chest -. 

Extremities 

Head and neck 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

almost one-third by obstetricians andgynecolo­

@sts, and the balance by other specialists,, jm-. 

cludhiig r~diologi-sms. . .~e, .WW”faiion’<n ““type of 

facility according to type-of examination shows 

that almost one-fourth of the examinations of the 

uterus and pelvic region were performed inphysicians’ offices; approximately one-third ofthese 

were done by general practitioners and one-third 

by obstetricians and gynecologists. Only 12 percent of the radiographic chest examinations and 

only 10 percent of photofluorographic chest films 

(mass miniature screening films)wereperformed 

in physicians’ offices. 

Trimester of Examination 

Approximately one-third of the examinations 

done during the last trimesterof pregnancy were 

for X-ray pelvimetry ,while an additional 24percent were other examinations of the abdomen 

related to pregnancy (tables 6 and B). Less than 

“v’ Type of facility 

/ 

Physician’s office 

. . L 

other 

Other places 

= 

Percent distribution 

16.3 4.3 5.2 6.8 83.7 

21.6 7.7 6.2 7.7 78.4 

23.5 7.6 7.6 8.3 76.5 

15.2 9.1 6.1 84.8 

16.7 16.7 83.3 

12.2 2.9 4.2 87.8 

22.9 2.9 2.9 12: 77.1 

26.3 26.3 73.7 

40 percent of the examinations during the last 

trlm=t=i”-+’~~e ‘of-the chest;-hovwer, !he first 

and second trimesters were more heavily 

weighted by such examinations. Chest examina~ “ 

tions amounted to77 percent of the examinations 

during the first trimester, and over 85 percent 

of those during the second trimester (table B). 

Virtually all X-ray pelvimetry was done 

during the last trimester, as were over 90percent of the other abdominal examinations related 

to pregnancy (table C). Over halfof theabdominal 

e& minations not related to pregnancy were done 

during the first trimester; about one-fourth were 

done during the third trimester. Most of the 

photofluorographic (mass miniature screening) 

examinations were done during the third trimester, many on admission for delivery. However, 

other chest examinations (primarily radiographic) 

were more evenly distributed over the three 

trimesters. 

6 
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----

-------------

---------

--------

---------

Table B. Percent distribution of X-ray examinations during pregnancy, by type of ex­
 amination according to trimester of examination: United States, 1963


Abdomen Chest


Total I All 

medical Other Other I I other 

Trimester exami- examinations Pel- related not 

to related Photo- Other nations
 fluoro- Chest
 vimetry to
 preg- preg- graphic


nancy


nancy


Percent distrifmtian


Total------------- 100.0 18.7 14.1 G*2 7*5 50.4 5.1


First trimester 100.0 0.4 1.4 11.5 6.5 70.6


Second trf.mester 100.0 2.8 8.6 77.3 :::


Third trimester 100.O 3::? 2::: 2.1 7.4 30.2 2.5


Color and A,ge of Mother	 thatthisdifference may reflectahigher
 incidence 

of tuberculosisand otherchestdiseasesamong


Number of examinationsand ratesper 100 nonwhitewomen. Rates for examinationsof the -—


women by typeof examinationand by colorand abdomen appearnottovarysignificantly
 between


age of mother are presentedin tables7 and8. thetwogroups.Thereissome evidence,
 however,


The overallrates for nonwhitemothers were thatthe rateof X-ray pelvimetryis somewhat


significantly
 higherthanthoseforwhitemothers higherforwhitewomen thanfornonwhite.


at every age. However, thisdifferential
 was The rateofwomen havingX-ray pelvimetry


largelyaccountedforby thehigherratesofchest during pregnancy appears to declinegenerally


examinationsfornonwhitewomen. Itimprobable withincreasingage (tableD).This is undoubt
-


Table C.	 Percent distribution of X-ray examinations during pregnancy, by trimester of


examination according to type of examination: United States, 1963.


Chest


I Total Other All


medics1 Other other
 Trimester not
 exami- Pel- related related Photo- exami­
 nations to fluoro- Other nations
 vimetry to chest


Total


First trimester


Second trimester


Third trimester


preg- preg- graphic


nancy nancy


Percent distribution


II I I mI I

7 
------

-------------------------

--------------------

------------------- ----------

Table D. Percent distribution of X-ray examinations during pregnancy,by age of mother


according to type of examination:United States, 1963


Abdomen Cheat


Total All


medics1 Other Other 7 other
 Age of mother mo:;:r~ exami- Pe1- related related Photo- exami­
 not


nation to to fluoro- :;:: nations
 vimetry preg- preg- graphic


nancy nancy


Percent distribution 

Total---- ] 100.OI 100.OII 100.0{ 100.01 loo.oj 100.OI1OO.OI 100.0 

Under 20 yeara- 14.4 15.0 20.0 13.9 20.9 14.5 16.5 

20-24 years---- 35.4 37.2 42.1 3%: 23.4. 35.6 37.6 26.6 

25-29 years---- 25.0 21.7 16.6 22.3 27.9. 17.8 23.4 23.0 

30-34 years---- 14.9 15.1 14.0 19.5 11.2 13.7 13.9 24.9 

35+ years 10.1 11.0 7.3 13.7 23.6 12.0 10.6 9.0 

— ..- edlya function oftherelationship
 betweenhigher Previous Pregnancy Experience 

parityand increasingage. The rateforother


examinations
oftheabdomen relatedtopregnancy As might be expected,the rate of X-ray


appears generallyto risewithage.The rates pelvimetryfor primiparouswomen wassignifi­


for examinationsof the chestappearnot to be cantlyhigher thanthatformultiparouswomen


relatedtoage (table 8). (table
E).Elevenwomen perlOOwitb noprevious


Table E. Medical X-ray examination rates during pregnancy, by type of examination and


live-birth order: United States, 1963


Total Abdomen All


other
 Live-birth order medics1 Chest exami­
 exami­


nations Total Pe1- Other nations
 vimetry


Rate per 100 women


Total 27 10 5 5 16 1


..Firstlive birth 35 16 11 5 18 1


Second live birth 7 4 1


Third or fourth live birth $: ,: 5 ;2 1


Fifth live birth or more------------ 27 1: 3 7 15 2


8 
-------------------------------

------------------------------

------------------------------------

---------------

--- --

pregnancy had X-ray pelvimetryas compared


with only 2 per 100 withthirdor fourthorder


births.There is some evidenceto sugg&stthat


otherexaminationsof the abdomen have some-


what higherratesat highparities.
Itshouldbe


keptinmind thattheseare olderwomen who may


experiencea different
 patternofmorbiditythan


thoseatlowparities.
 The rateofchestexamina­


tions appears to be unrelatedto birthorder


(tables
E and9).


At eachparity,
 themedicalX-rayexamination


rateseems significantly
 higherforwomen who


have had one fetalIoss or more priortothe


presentpregnancy(tableF). For women having


a firstlivebirth, theexamination
rateforthose


witha previousfetaI
losswas 42per100compared


with only 35 per 100 women withno previous


pregnancy.Similardifferentials
 were observed


at each of the otherparities.
 Again,most ofthe


difference is representedby examinations
ofthe


Table F. Medical X-ray examination rates during pregnancy, by type of examination and


pregnancy history: United States, 1963


Total Exami- Exami- All


medical nation nation other
 Pregnancy history exami- of of exami­
 nations abdomen chest nations


All live births Rate per 100 women


Total-------- 27


No fetal death prior to this live birth----------- 27


One fetal death or more prior to this live birth-- 31


First live birth


Total--------- 35


No fetal death prior to this live birth-----------
 One fetal death or more prior to this live birth-- :;


Second live birth


-.~ ~~$i..%y 23


No fetal death prior to this live birth----------- 23


One fetal death or more prior to this live birth-- 29


Third or fourth live birth


Total--------------------------------------- 23


No fetal death prior to this live birth----------- 23


One fetal death or more prior to this live birth-- 25


Fifth live birth or more
 /


Total-----------------.-..-s. 27


No fetal death prior to this live birth----------- 25


One fetal death or more prior to this live birth-- 37


10 ==Ql==J 

16 .x--’- 16 ;


,/


/
 .


18 I 1 

“ 

1#~ 18 1 

27 * * 

- r 

7 15 I 1 I 

15 1 

15 15 * 

. 

7 15 1
 — -i--

14 1


16 *


15 2


A_! 

9

-------------

-------------

-------------

-------------------

----------------

---------------

-----------

-------------------

--------------------

-------------------

-----------

.. 

~. 

abdomen. Examinations of the chest do not appear 

to be significantly related to previous history of 

fetal loss during pregnancy. 

Color and Family Income 

The rate of medical X-ray examinations 

during pregnancy does not generally appear to be 

related to income (tables 10 and 11). However, the 

data do suggest that the rate of chest examinations, 

particularly for white mothers, declines with 

increasing income. This differential may reflect 

the concentration of chest screening programs 

among the lower income segments of the population. 

COMPARISON WITH RATES FOR 

WOMEN IN GENERAL POPULATION 

Medical X-ray visit rates derived from the 

1963 National Natality Survey were compared 

with similar data for women aged 15-44 years 

in the general population. The latter data were 

derived from the 1960-61 Household Interview 

Survey of the National Health Survey. 1 To fa­

~k cilitate the comparison, X-ray visit rates during 

~~gnancy p..% have been adjusted oh an annual basis.

‘fhe annual medical X-ray visit rate of 59 

per 100 women estimated for the general Population is sigfit!l.c+ntly higher than the estimate Of 

35 per 100 pregn5Rt w-omen. A comparison of visit 

rates by age group, color, geographic region, and 

type of examination (table G) indicates that for 

all of these characteristics the estimated annual 

visit rates applicable to pregnant women are 

significantly lower than those found for women 

aged 15-44 in the general population. It is likely 

that the lower rates for pregnant women result 

both frf;m a generally better health status enjoyed 

“by wqnen who deliver a live birth than by women 

in the general population and from the increasing 

attention given by physicians to the possible 

risks of X-ray examination of pregnant women. 

Table G. Comparison of medical ‘ . visit rates for women during pregni “ 

with those for women in the genet. 

population, by selected characteristics 

1

General During 

Characteristic popula- pregtion nancy 

Rate per 100 

womena 

Total 59 35 

Age 

15-29 years 

30-44 years 

Color 

White 

Nonwhite 

Geographic region 

Northeast


North Central


south


West


Type of examination 

Chest


Other medical


aPregnancy data are based on X-ray examinations reported during pregnancy, expressed as annual visit rates per 100 

pregnant woxpen. General population data are based on National Health Survey estimates for women aged 15r-44fl. ywr>””-~.Y 

ra,ces,. .axs est~fited pkm 10Ci women in the 

civillan, noninstitutional population. 

10

REFERENCES


lU.’S. National Health Survey: Volume of X-ray visits. 

Heai!th Statistics. PHS Pub. No. 584B38. Public Heidth Service. Washington. U.”S. Government Printing Office, Oct. 1962. 

2National Center for Health Statistics: Methods and response characteristics, National Natality Survey, United 

States, 11963,vital and Health Statietrb. PHS Pub. No. 1000-

Series 22-No. 3. Public Health Service. Washington. U.S. 

Government Printing Office, Sept. 1966. 

%atiord Center for Health Statistics: Replication, an 

approach to the analysis of data from complex surveys. Vii%t 

and HeaZt7i Statistics. PHS Pub. No. 1000+eries 2-No. 14. 

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

Office, Apr. 1966. 

?National Centerfor Health Statistics: Episodes and duration of hospitalization in the last year oflife, United States, 

1961. VitaZ and Hea2th Statistics. PHSPuh. No. 1000-Series 

22-No.2. Public Health Service. Washington. U.’S.Government 

Printing Office, June 1966. 

5

U.S. Bureau of the Census: U.S. Censw of Population, 

1960. Vol I, Characteristics of the Population. Part I, United 

States ‘Summary,Washington. U.S. Government Printing Office, 

1964. pp. XXXI and XXXIL 

000 

11

-------------------------------------------

Table 1.


2.


3.


4.


5.


6.


7.


8.


9.


10. 

11. 

DETAILED TABLES 

Number of all mothers and nuber and percent of all mothers with one medical


X-ray visit or more during pregnancy, by color and age of mother: United states,


1963----------------------------------------.------------.-----------------------


Number and rate per 100 mothers of medical X-ray visits and examinations during 

pregnancy for all mothers, and visit and examination rate for mothers with one medical X-ray visit or more, by age of mother and color: United States, 1963-----

Number and rate per 100 mothers of medical X-ray visits and examinations during


pregnancy for all mothers, and visit and examination rate for mothers with one


medical X-ray visit or more, by geographic region and metropolitan and nonmetro­


politan area: United States, 1963--......----------------..............----------


Number and rate per 100 mothers of medical X-ray visits and examinations during


pregnancy for all mothers, and visit and examination rate for mothers with one


medical X-ray visit or more, by color and familY income: United ‘tates~ 1963-----


Number of X-ray examinations during pregnancy, by type of examination and type of


facility: United States, 1963--------------------------------.--.....------------


Number of X-ray examinations during pregnancy, by type of examination, trimester


of examination, and age of mother: United States, 1963---------------------------


Number of X-ray examinations during pregnancY, by tYPe of examination, color, and


age of mother: United States, 1963--------.---------.-..---------------.---.-----


Rate of X-ray examinations per 100 women during pregnancy,by type of examination,


color, and age of mmther: United States, 1963------------------------------------


Number of X-ray examinations during presnancy,by tYPeof examination and Pre@ancy


history: United States, 1963----------


Number of X-ray examinations during PresnancY, by tYPe of examination, cOIOr, and


family income: United States, 1963-----------..-------.--..--..------------------


Rate of X-ray examinations per 100 women during pregnancy,by type of examination,


color, and family income: United States, 1963------------------------------------


Page -

13


,r 

14


15


16


16 

17 

18 

19 

20 

21 

22 

12

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--------------------------- -----

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-----------------------------------------------------

---------------------------------------------------

-----------------------------------------------

--------------------------- --------------

-----------------------------------------

-----------------------------------------------------

-----------------------------------------------------

-------- -------------------------------

Table 1. Number of all mothers and number and percent of all mothers with one medical X-ray visit
 or more during pregnancy,by color and age of mother: United States, 1963


Mothers with one
 medicalX-ray visit


All or more during


mothers pregnancy


Color and age of mother in


thousands


\ 

Under


20-24


25-29


30-34


Total 

All ages


20 years


years 

years 

years


Number Percent


in of all


thousands mothers


4.071 915 22.5 

588 142 24.1 

1,442 347 24.1 

1,018 189 18.6 

608 140 23.0 

35 years and over 412 94 22.8 

White


All ages ------------------ 3,414 744 21.8 

Under 20 years 451 101 22.4 

20-24 years 1,228 294 23.9 

25-29


30-34 years


35 years and over


Under


20-24


25-29


30-34


Nonwhite


All ages ---------

20 years-----.---

years


years


35 years and over ------.-


871 148 17.0


515 118 22.9


347 81 23.3


656 L70 25.9


137 40 29.2


214 52 24.3


147 41 27.9


92 22 23.9


63 13 20.6


13

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---------------

---------------

---------------

------------

---------------

---------------

------------

---------------

---------------

---------

Table 2. Number and rate per 100 mothers of medical X-ray viaits and examinations during pregnancy for all mothers, and visit and examination rates for mothers with one medical X-ray visit 

or more, by color and age of mother: United States, 1963 

Medical X-ray visits and One medical X-ray Visit 

examinations during pregnancy or more 

Color and age of mother 

Tumber of “’’rat+= EIEiiE mothers EIEii

Number in thousanda Rate per 100 iumber in Rate per 100 

mothers :housands mothers 

All agea 4,071 1,085 1,120 26.7 I 27.5 915 118.6 122.4 

Under 20 years------------ 588 162 167 27.6 28.4 142 114.1 117.6 

20-24 years 1,442 409 418 28.4 29.0 347 117.9 120.5 

25-29 years 1,018 228 242 22.4 23.8 189 120.6 128.0 

30-34 years 608 164 169 27.0 27.8 140 117.1 120.7 

35 years and’over--------- 412 118 122 28.6 29.6 94 125.5 129.8 

White 

All ages 3,414 870 893 25.5 26.2 744 116.9 120.0 

Under 20 years------------ 451 119 123 26.4 27.3 101 117.8 121.8 

20-24 years 1,228 339 346 27.6 28.2 294 115.3 117.7 

25-29 years 871 180 188 20.7 21.6 148 121.6 127.0 

30-34 years--------------- 515 132 133 25.6 25.8 118 111.9 112.7 

35 years and over--------- 347 97 101 28.0 29.1 81 119.8 124.7 

Nonwhite 

All age’s 656 214 227 32.6 34.6 170 125.9 133.5 

Under 20 yeara------------ 137 43 43 31.4 31.4 40 107.5 107.5 

20-24 years--------------- 214 70 72 32.7 33.6 52 134.6 138.5 

25-29 years 147 48 54 32.7 36.7 41 117.1 131.7 

30-34 years 92 32 35 34.8 38.0 22 145.5 159.1 

35 years and over 63 20 20 31.7 31.7 13 153.8 153.8 

14 
---------------

--------------

-----------

---------------

--------------

-----------

---------------

--------------

-----------

---------------

--------------

-----------

---------------

--------------

-----------

Table 3. Number and rate per 100 mothers of medical X-ray visits and examinations during preg­


nancy for all mothers, and visit and examination rates for mothers with one medical X-ray visit
 or more, by geographic region and metropolitan and nonmetropolitan area: United States, 1963


Medical X-ray visits and One medical X-ray visit 

examinations during pregnancy or more Geographic region and ,,,

Al. .L 

metropolitan status mothers 

Visits Exami -

nations 

N;~tmnbr;f Visits Exami - nations 

-) I 

All regions Number in thousands Rate per 100 

mothers 

Number in Rate per 100 

thousands mothers 

Total 4,071 1,085 1,120 26.7 27.5 915 118.6 122 � 4 

I I 

Metropolitan 2,639 775 801 29.4 30.4 650 119.2 123.2


Nonmetropolitan 1,431 310 319 21.7 22.3 265 117.0 120.4


Northeast


Total 936 237 245 25.3 26.2 201 117.9 121.9


Metropolitan 750 205 212 27.3 28.3 --L 171 119.9
 124.0 

Nonmetropolitan 186 32 33 17.2 17.7 29 110.3 113.8


I 

North Central


Total 1,133 315 325 27.8 28.7 279 112.9 116.5


Metropolitan 711 219 227 30.% 31.9 193 113.5 117.6


Nonmetropolitan 422 96 97 22.7 23.0 851 112.9 114.1


South


Total 1,316 323 337 24.5 25.6 127.7


Metropolitan 670 189 198 28.2 29.6 -4-= 130.3 

Nonmetropolitan 645 133 139 20.6 21.6 112 118.8 124.1


West


Total 684 208 212 30.4 31.0 170 122.4 124.7


Metropolitan 507 160 163 31.6 32.1 132 121.2 123.5


--t 

Nonmetropolitan 176 47 49 26.7 27.8 37 127.0 132.4


15

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-----------

-----------

-----------

-----------------

-------------------

---------

----------------------------------

--------------------

Table 4. Number and rate per 100 mothers of medical X-ray visits and examination during preg­


nancy for all mothers, and visit and examination rates for mothers with one medical X-ray visit


or more, by color and family income: United ‘States, 1963


I Medical X-ray visits and One medical X-ray visit


examinations during pregnancy or more


Color and family


income


Exami - Number of
 “’w==Visits nations mothers


Total Number in thousands Rate per 100 Number in Rate per 100 

mothers thousands mothers 

All incomes 4,071 1,085 1,120 26.7 118.6 122.4 ===4=== 

Under $2,000-------------- 458 131 134 28.6 29.3 114 114.9 117.5 

$2,000-$3,999------------- 838 259 271 30.9 32.3 209 123.9 129.7 

$4,000-$6,999------------- 1,473 382 397 25.9 27.0 322 118.6 123.3 

$7,000 and over 973 224 227 23.0 23.3 197 113.7 115.2 

Not ascertained 327 85 88 26.0 26.9 71 119.7 123.9 

White


1% 

All incomes--------- 3,414 870 893 25.5 26.2 744 116.9 120.0 

Under $2,000-------------- 274 79 28.8 29.2 116.’2 117.6 

$2,000-$3,999------------- 686 199 2% 29.0 30.5 119.2 125.1 

$4,000-$6,999------------- 1,363 343 352 25.2 25.8 290 118.3 121.4 

$7,000 and over----------- 939 220 223 23.4 23.7 193 114.0 115.5 

Not ascertained 149 25 25 16.8 16.8 23 108.7 108.7 

Nonwhite


All incomes--------- 656 214 227 32.6 34.6 170 125.9 133.5 

Under $2,000-------------- 183 27.9 29.0 46 110.9 115.2 

$2,000-$3,999------------- 151 39.1 41.1 41 143.9 151.2 

$4,000-$6,999------------- 109 35.8 41.3 31 125.8 145.2 

$7,000 and over----------- 100.0 100.0 

Not ascertained 1% 59 3;:: 3;:: 125.5 131.9 

Table 5. Number of X-ray examinations during pregnancy, by type of’examination and type of fa­


cility: United States, 1963


II Abdomen II 

A. Total Other All


medical Other other


Type of facility exami- Pel- related not Chest exami­


nations to related nations
 vimetry pregto


preg­
 nancy nancy


Number of X-ray examinations


AH facilities-------------------- WI 209,000 158,000 47,000 648,000 56,000


I I I I 

Physicians’ offices


General practitioners


Obstetricians and gynecologists


Others


All other places 935,000 163,000 121,000 40,000 569,000 42,000 

II I I I 1 

e’ 

16


I 
-----------------

-----------------

--------------------

--------------------

--------------------

--------------

-----------------

-----------------

--------------------

--------------------

--------------------

--------------

-----------------

-----------------

--------------------

--------------------

--------------------

--------------

-----------------

-----------------

--------------------

--------------------

--------------------

--------------

Table 6. Number of X-ray examinationsduring pregnancy,by type of examination,trimesterof ex­


arnination,
and age of mother: United States, 1963


Abdomen Chest


Tota1 All


medical Other Other other
 Trimesterand age of mother exami- Pel- related not Photo- exami­


re~oted .fl~or
 o- Other nations
 ‘o
 nations vimetry	 preg- preg- graphic chest


nancy nancy


Total Number of X-ray examinations


All ages 1,117,000 209,000 158,000 47,000 84,000 564,000 56,000


Under 20 years 167,000 42,000 11,000 7,000 18,000 82,ooO 9,000


20-24 years 415,000 88,000 60,000 11,000 30,000 212,000 15,000


25-29 years 243,000 35,000 35,000 13,000 15,000 132,000 13,000


30-34 years 169,000 29,000 31,000 5,000 12,000 78,000 14,000


35 years and over 123,000 15,000 22,000 11,000 10,000 60,000 5,000


First trimester


All ages 232,000 1,000 3,000 27,000 15,000 164,000 22,000 

Under 20 years 28,000 1,000 4,000 2,000 17,000 4,000 

20-24 years 84,000 1,000 6,ooO 5,000 64,000 8,000 

25-29 yeara 55,000 1,000 8,000 3,000 35,000 7,000 

30-34 years 30,000 1,000 2,000 25,000 2,000 

35 years and O~er 35,000 1,000 8,000 2,000 22,000 2,000 

Second trimester


All ages 280,000 4,000 9,000 8,000 24,000 217,000 19,000 

Under 20 yeara 48,000 1,000 8,000 36,000 3,000 

20-24 years 97,000 2,000 2,000 7,000 81,000 4,000 

25-29 years 63,000 1,000 3,000 3,000 6,000 48,000 3,000 

30-34 years 48,000 1,000 3,000 1,000 1,000 33,000 8,000 

35 years and over 25,000 2,000 1,000 1,000 1,000 19,000 1,000 

Third trimester


All ages 605,000 204,000 146,000 13,000 45,000 183,000 15,000


Under 20 years 92,000 41,000 11,000 2,000 7,000 29,000 3,000


20-24 years 234,000 88,000 56,000 3,000 17,000 66,000 3,000


25-29 years 125,000 34,000 31,000 3,000 5,000 49,000 3,000


30-34 years 91,000 28,000 28,000 3,000 8,OOO 20,000 4,000


35 years and over 63,000 13,000 20,000 2,000 7,000 19,000 2,000


17

-----------------

-----------------

--------------------

--------------------

--------------------

--------------

-----------------

-----------------

--------------------

--------------------

--------------------

--------------

-----------------

-----------------

--------------------

--------------------

--------------------

--------------

Table 7. Number of X-ray examinationsduring pregnancy, by type of examination, color, and age


of mother: United States, 1963


Abdomen Chest


Total All


medical Other Other other
 Color and age of mother exami- Pel- related related Photo- exami­
 not


to fluoro- Other nations nations
 vimetry preg- to chest


preg- graphic


nancy nancy
 r


Total Number of X-ray examinations


All ages 1,117,000 209,000 158,000 47,000 84,000 564,000 56,000


Under 20 years 167,000 42,000 11,000 7,000 18,000 82,000 9,000 

20-24 years 415,000 88,000 60,000 11,000 30,000 212,000 15,000 

25-29 years 243,000 35,000 35,000 13,000 15,000 132,000 13,000 

30-34 years 169,000 29,000 31,000 5,000 12,000 78,000 14,000 

35 years and over 123,000 15,000 22,000 11,000 10,000 60,000 5,000 

White 

All ages 893,000 182,000 136,000 30,000 60,000 438,000 47,000


Under 20 years 123,000 34,000 6,000 7,000 8,000 61,000 9,000


20-24 years 346,000 79,000 55,000 7,000 22,000 170,000 13,000


25-29 years 188,000 30,000 27,000 9,000 10,000 99,000 12,000


30-34 years 133,000 25,000 29,000 4,000 11,000 58,000 7,000


35 years and over 102,000 14,000 19,000 3,000 10,000 51,000 5,000


Nonwhite


All ages 224,000 27,000 22,000 17,000 24,000 125,000 9,000


Under 20 years 44,000 8,000 5,000 . 10,000 21,000


20-24 years 69,000 9,000 5,000 4,000 8,000 42,000 2,000


25-29 years 55,000 4,000 8,000 4,000 5,000 32,000 1,000


30-34 years 36,000 5,000 2,000 1,000 1,000 21,000 7,000


35 years and over 21,000 1,000 2,000 8,000 9,000


18

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-------------------

----------------------

----------------------

----------------------

----------------

-------------------

-------------------

----------------------

----------------------

----------------------

----------------

-------------------

-------------------

----------------------

----------------------

----------------------

----------------

Table 8. Rate of X-ray examinations per 100 women during pregnancy,by type of examination, color,


and age of mother: United States, 1963


I Abdomen I Chest I 

Total All
 Other
 medical Other other
 Color and age of mother exami- related not Photo- exami­
 nations Pel- to related fluoro- Other nations
 vimetry to chest
 preg- preg- graphic


nancy
 nancy


Total Rate per 100 women


7$ All ages 27.4 5.1 3.9 1.2 2.1 13.8 1.4 

Under 20 years 28.5 7.1 1.8 1.1 3.0 14.0 1.6 

20-24 years 28.8 6.1 4.1 0.8 2.1 14.7 1.0 

25-29 years 23.8 3.4 3.4 1.3 1.5 12.9 1.3 

30-34 years 27.8 4.8 5.0 0.9 1.9 12.8 2.3 

35 years and over 29.8 3.7 5.3 2.7 2.5 14.5 1.2 

White 

All ages 26.1 5.3 4.0 0.9 1.8 12.8 1.4


Under 20 years 27.4 7.5 1.3 1.4 1.7 13.5 2.1


20-24 years 28.2 6.5 4.5 0.6 1.8 13.8 1.0


25-29 years 21.6 3.5 3.1 1.0 1.1 11.4 1.4


30-34 years 25.8 4.8 5.6 0.8 2.0 11.2 1.4


35 years and over 29.3 4.0 - 5.6 0.9 2.9 14.5 1.5


Nonwhite


All ages 34.2 4.1 3.3 2.6 3.7 19.1 1.4 

Under 20 years 32.1 5.9 3.6 7.3 15.3 

20-24 years 32.2 4.0 2.2 1.7 3.8 19.5 1.0 

25-29 years 37.1 3.0 5.4 2.8 3.4 22.1 0.5 

30-34 years 38.5 5.1 2.0 1.0 1.0 22.3 7.1 

35 years and over 32.6 1.8 3.6 12.7 14.5 

19

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---------

--------------------

--------------------

------------

--------

--------------------

--------------------

------------

---------

--------------------

--------------------

------------

--------

--------------------

--------------------

------------

---------

--------------------

--------------------

Table 9. Number of X-ray examinations during pregnancy,by type of examination and pregnancy his-


tory: Uni’tedStates, 1963


II I 1 

II Abdomen I Chest I 

Total All


medical m Other other
 Pregnancy history not Photo- exami­
 related f~uoro- Other
 nations
 to graphic chest


preg­


nancy


I 

Number of X-ray examinations


Total live births .,117,000 209,000 158,000 47,000 84,000 564,000 56,000 ‘ 

No fetal death prior to this ( 

live birth-------------------- 996,000 188,000 137,000 40,000 78,000 507,000 47,000 

One fetal death prior to this 

live birth 100,000 15,000 17,000 6,000 6,000 45,000 10,000 

Two fetal deaths or more prior 

5,000 

I?ixstlive birth 404,000 128,000 38,000 15,000 29,000 179,000 15,000 

to this live birth------------ 22>000 1 4,000 1,000 11,000 

No fetal death prior to this


live birth 388,000 124,000 33,000 12,000 28,000 175,000 15,000


One fetal death prior to this


live birth 12,000 3,000 3,000 2,000 1,000 3,000


Two ‘fetal deaths or more prior


to this live birth + + * J6 J$ + +.


Second live birth 224,000 33,000 27,000 6,000 15,000 131,000 12,000


No fetal death prior to this


live birth 199,000 26,000 23,000 6,000 14,000 119,000 11,000


One fetal death prior to this


live birth 22,000 7,000 4,000 1,000 9,000 1,000


WO fetal deaths or more prior


to this live birth * + + * w * +


Third live birth 186,000 16,000 41,000 4,000 17,000 102,000 7,000


No fetal death prior to this


live birth 168,000 15,000 35,000 4,000 17>000 91,000 6,000


One fetal death prior to this


live birth 17,000 1,000 5,000 9,000 1,000


Two fetal deaths or more prior


to this live birth + + + % Y. + ?-


{

Fourth live birth 105,000 9,000 17,000 6,000 3,000 61,000 8,000


No fetal death prior to this


live birth 89,000 7,000 15,000 6,000 3,000 50,000 8,000


One fetal death prior to this


live birth 13,000 1,000 1,000 10,000 {


Two fetal deaths or more prior


to this live birth * * * * * * *


Fifth live birth 199,000 23,000 36,000 17,000 19,000 90,000 14,000


No fetal death prior to this


live birth 151,000 16,000 31,000 12,000 15,000 72,000 6,000


One fetal death prior to this


live birth 36,000 4,000 3,000 4,000 4,000 13,000 8,000


‘ho fetal deaths or more prior


to this live birth------------ 12,000 3,000 2,000 1,000 5,000


20

--------------

------------------

------------------

----------------

----------------

--------------

------------------

------------------

----------------

----------------

---------------

------------------

------------------

----------------

----------------

Table 10. Number of X-ray examinationsduring pregnancy,by type of examination,color, and fam­


ily income: United States, 1963’


II Abdomen I Chest I 

Total All


medical Other Other other
 Color and family income not
 exami- Pel- related related Photo- exami­
 nations vimetry ‘0 to fluoro- Other nations


preg- preg- graphic chest


nancy nancy


Total Number of X-ray examinations


All incomes 1,117,000 209,000 158,000 47,000 84,000 564,000 56.000


Under $2,000-------------------


$2,000-$3,999


$4,000-$6,999


$7,000 and over


Not ascertained


White


All incomes


Under $2,000-------------------


$2,000-$3,999


$4,000-$6,999


$7,000 and over


Not ascertained


Nonwhite


All incomes


Under $2,000-------------------


$2,000-$3,999


$4,000-$6,999


$7,000 and over


Not ascertained


134,000 24,000 16,000 5,000 12,000 74,000 3,000


271,000 46,000 38,000 16,000 16,000 141,000 13,000


398,000 79,000 66,000 17,000 25,000 191,000 20,000


229,000 49,000 32,000 8,000 15,000 109,000 17,000


85,000 11,000 6>000 1,000 17,000 48,000 3,000


893,000 182,000 136,000 30,000 60,000 438,000 47,000


81,000 16,000 10,000 4,000 5,000 42,000 3,000


209,000 41,000 32,000 7,000 13,000 107,000 9,000


353,000 72,000 61,000 12,000 23,000 167,000 18,000


225,000 49,000 32,000 8,000 14,000 106,000 17,000


25,000 3,000 1,000 5,000 16,000


224,000 27,000 22,000 17,000 24,000 125,000 9,000 

54,000 8,000 5,000 2,000 6,000 32,000 

61,000 4,000 6,000 9,000 4,000 34,000 5,000 

45,000 7,000 6,000 5,000 2,000 24,000 2,000 

* * * * * * * 

60,000 8,000 5,000 l,QOO 12,000 32,000 3,000 

21

----------------

--------------------

------------------

------------------

----------------

------------------

------------------

------------------

------------------

Table 11. Rate of X-ray	 examinations per 100 women during pregnancy, by type of examination,


color, and family income: United States, 1963


Abdomen Chest


Total All
 Other
 medical Other other
 Color and family income exami- not


nations Pel- related related Photo- Other exami­


vimetry to to fLlo-ro- chest nations


Total


All incomes


Under $2,000---------------------


$2,000-$3,999


$4,000-$6,999--------------------


$7,000 and over


Not ascertained


White


All incomes


Under $2,000---------------------


$2,000-$3,999--------------------


$4,000-$6,999--------------------


$7,OOO and over


Not ascertained


Nonwhite


All incomes----------------


Under $2,000---------------------


$2,000-$3,999--------------------


$4,000-$6,999--------------------


$7,000 and over


Not ascertained


preg- graphic
 preg­
 nancy
 nancy


Rate per 100 women


27.4 5.1 3.9 1.2 2.1 13.8 1.4 — ; 

29.3 5.3 3.4 1.2 2.5 16.2 0.7 

32.3 5.5 4.5 1.9 2.0 16.8 1.6 

27.0 5.4 4.5 1.1 1.7 13.0 1.3 

21.3	 4.5 2.9 0.7 1.4 10.2 1.6


26.1 3.3 1.9 0.3 5.1 14.7 0.9


26.2 5.3 4.0 0.9 1.8 12.8 1.4 

29.4 6.0 3.8 1.4 1.9 15.3 1.2 

30.5 6.0 4.7 1.0 1.9 15.6 1.3 

25.9 5.3 4.4 0.9 1.7 12.3 1.3 

24.0 5.2 3.4 0.8 1.5 11.3 1.8 

17.1 2.1 0.6 3.4 11.0 

34.2 4.1 3.3 2.6 3.7 19.1 1.4


29.2 4.3 2.8 0.9 3.5 17.6 

40.6 2.9 3.9 6.1 2.3 22.4 3.0 

41.6 6.4 5.1 4.5 1.6 22.1 1.8 

9< * * * * * 7’< 

33.9 4.2 3.0 0.5 6.5 18.0 1.7 

-

22

APPENDIX I 

TECHNICAL NOTES ON METHODS 

‘1 Statistical Design of National Natality Surviey 

Survey pYoceduves.—The procedures used for the 

National Natality Survey maybe viewedas anextension 

of the birth registration system of the United States. 

The birth record was used as the sampling unit, and 

births to be included in the survey were selected from 

the frame of records representing all registered births. 

The survey was conducted Imth with primary sources 

of information identified on the birth record (mother of 

child, attending physician, institution of birth) and with 

referral or secondary sources reported by a primary 

source (other physicians who saw or treated the mother, 

other institutions at which the mother received care, 

and dentists from whom the mother received care). 

The principaI method of data collection for the 

National Natality Survey was by mail questionnaire. 

Mailing addresses for primary sources were almost 

always reported on the birth certificate or were readily 

ascertained by consulting available directory sources. 

Mailing addresses of referral or secondary sources 

were usually reported by the primary sources identifying these reporters. Provision was also made for 

collecting data by means other than mail, including 

telephone and personal interviews. 

In order to facilitate sampling of births, tie sample 

was selected from the file of microfilmed birth records 

which were received at approximately monthly intervals 

by the NationaI Center for Health Statistics (NCHS) 

from the 54 birth-registration areas of the United States. 

As a general rule, these microfilm images are assigned 

a number prior to or during filming of the birth record 

by each of the registration areas. Each thousand consecutively numbered images are defined as a !‘reel” 

and are assigned an identifying reel number starting 

with zero. Within each reel, the images were numbered 

from 1 to 1,000. 

The sampling for the survey was based on a probability design which used these preassigned reel and 

image numbers on the birth records. Each reel was 

considered a primary sampling unit; within each reel, 

one record was chosen on a random basis. Thus a sam ­

ple of 1 out of every 1,000 births was selected from the 

monthly shipment of records from the registration 

areas. This procedure produced a sample of 4,096 

births for the year 1963. 

As copies of the selected birth certificates were 

received in NCHS, they were reviewed to ascertain 

which sources would be queried and at what addresses. 

For all births occurring in institutions (primarily hospitals) a questionnaire as shown in Appendix III was 

prepared for mailing. Information was requested about 

care received during the l-year period preceding the 

date of birth, in particular, care involving X-ray examinations or treatments. The attendant at birth was 

also queried for similar information, except for those 

caaes where the attendant signing the certificate was 

an intern at the hospital where the birth occurred. With 

the exception of births reported as illegitimate or 

inferred to be illegitimate on the baais of indirect 

evidence from the birth certificate, a questionnaire 

was also prepared for mailing to the mother (Appendix 111). Tlis questionnaire was devised to obtain the 

names of physicians, dentists, clinics, and hospitala 

from which the mother had received care during the 

year prior to the birth of her child and also to obtain 

such information as education, family income, and employment during pregnancy. 

Any physicians, clinics, hospitals, or dentists identified by the mother as having provided care during the 

l-year period who had not already been queried were 

subsequently queried for information on X-ray treatments or examinations received by the mother. 

Followup mailings were routinely sent to all sources 

not responding to the original questionnaire. Additional 

mailings were also made to obtain complete and consistent information on questionnaires rejected as “inadequate’ by a concurrent editing procedure. A more 

detailed description of survey procedures used in the 

National Natality Survey can be found in another report 

in this series. 2 

Estimating methods. —The statistics shown in this 

report are estimates prepared by means of a post23 
-------

-------

-------

-------

------

------

stratified ratio estimation procedure. This procedure 

was used for each of the following groups: 

Group Age of 

mother Color Live-birth 

order 

1 

2-------

:-------

Under 20 years 1-19 years 

20-24 years 

20-24 years 

20-24 years 

White 

White 

White 

White 

White 

1 

2+ 

1 

2 

3+ 

2------- 25-29 years White 1 

:-------

9-------

1o------

11------

12------

13------

14------

15------

25-29 years 

25-29 years 

25-29 years 

30-34 years 

30-34 years 

30-34 years 

35t years 

35+ years Under 20 years 

White 

White 

White 

White 

White 

White 

White 

White 

Nonwhite 

3-: 

1-? 

3-4 

5+ 

1-4 

5+ 

1 

16------

17------

Under 20 years 

20-24 years 

Nonwhite 

Nonwhite 1-? 

18------ 20-24 years Nonwhite 3+ 

25-29 years Nonwhite 

%----- 25-29 years Nonwhite 

21------ 25-29 years Nonwhite 

30-34 years Nonwhite 

%----- 30-34 years Nonwhit~ 

24------ 35+ years Nonwhite 

The national count of births was obtained for each of 

the 24 groups, andthe ratio of this count to the sample 

count was determined. Each birth in the group was 

then assigned a constant weight so that the sum of the 

weights equalled the national total for thatgroup. 

Rounding of numbws. —l%e tabulations on which 

the tables inthis report were based showfiguresto the 

nearest unit, except for selected tables inwhichfigures 

were truncated to the nearest thousand in tabulation. 

The tables in this report have all been roundedor 

truncated to the nearest thousand. Neither numbers 

nor derived figures such as percents, rates, and averages are necessarily accurate in the detail shown. 

Reliability of Estimates 

The errors to which a survey such as the National 

Natality Survey is subject may be conveniently grouped 

into two classes. On the one hand, the statistics derived 

from the survey are estimatesbased onasample rather 

than on a complete enumeration. Such estimates are 

subject to variability from the figure which might have 

been obtained had a survey covering all births been 

conducted using the same questionnaires and procedures. Apart from sampling errors, theresults of such 

a survey are also subject to errors of measurement, 

which may include those errors which arise from formation of concepts, ambiguities in definition, construction of the questionnaire, nonresponses or incomplete 

responses, and problems associatedwiththeprocessing 

of survey data (such as coding errors, editing mistakes, 

and tabulation errors). 

Sampling ewor. —The standard error is primarily 

a measure of the sampling variations that occur by 

chance because only a sample rather than an entire 

ppulation is surveyed. The chances are about 680ut 

of 100 that an estimate from the sample differs from 

the value obtained from a survey of the entire popuIation by less than the standard error. The chances 

are about 95 outof 100 that the difference is less than 

twice the standard error. 

The relative standard error of an estimate is 

obtained by dividing the standard error of the estimate 

bytheestimate itselfi itisexpressedas a percentage of 

the estimate. 

The variance ofastatistic depends notordy on the 

design of the sample, butalso onthedistribution of the 

statistic itselfi the variance is greater for measurements which are highly variable from one individual 

to another and lower for measurements which are less 

variable. Since the estimates of the sampling error are 

obtained from the sample data, they are themselves 

subject to sampling error, which may be large in some 

instances. 

Estimates of sampling variability for the statistics 

derived from this survey were based on 20 random 

half-sample replications. This technique yields overall 

estimates of variability through observation of variability among random subsamples of the total ssmple. 

It reflects both the error that arises from sampling 

andapart of the measurement error; itdoesnot, however, measure any systematic biases in the data. A 

general discussion of the development and evaluation 

of a replication technique for estimating varisnce has 

been published.3 The procedures and computations 

used to estimate variances by this method in the 1963 

National Natality Survey are briefly described below. 

For the survey each record from the entire file 

of records was assigned systematically to a random 

group betweenl and 40. Twenty pairsofrandom groups 

were created from these40 groups. Ahalf sample was 

formed by randomly selecting one group from eachof 

the 20 pairs. This process was repeated until 20 

replicate \

half samples were formed from which variance estimates were derived. The composition of the 

20 half samples shown intable Iwasdetermined by an 

orthogonal plan. 

After the composition of each of the half samples 

was determined, the estimation procedures used to 

produce the final estimates from the entire sample 

were applied separately to each of the resulting half 

samples. An estimated variance S: of an estimated 

statistic X’ of the parameter is obtained by applying 

the following formula: 

24 
--------------------

-------- --------- ---- -------- ----

---- --------------------

----

Table I. Composition of the 20 half-sample replicates 

Half-sample Bandom groups included replicates 

;--------------------

13 18 

17 

19 

20 

23 26 

24 26 

28 32 

31 

38 :2 

3 :: 18 19 24 26 % 34 35 

L--------

5-------------------- 10 

13 

14 15 :: 20 

20 3. 27 

27 

33 

33 

35 

36 

6--------“------- 13 16 18 23 28 34 36 37 

1; 14 16 18 % 23 27 35 37 ;---------------------

q-------------”-. 

9 

10 

14 

14 

16 

16 

18 

17 

19 

19 

24 32 

31 

% 

33 

35 37 

35 37 

id------------------- 5810 14 15 17 20 31 33 35 38 

11-------------------2 6810 15 18 19 

12-------------------1 6810 :: 16 19 27 :: 13-------------------2 689 14 15 ;; 20 23 25 27 36 

AL------------------- 2 

id-------------------2 

16-------------------2 

67 

7 

8 1; 

9 

13 

13 

14 

18 

18 

17 

20 

19 

19 

23 25 

23 25 

23 26 

27 

;; 

35 

% 

17-------------------1 7 14 17 19 24 25 36 

18------------------- 7 1: 13 17 19 23 26 36 19------------------- ; 8 10 11 13 15 17 20 24 25 

iii------------------ 2 8 10 12 14 16 18 20 24 26 % 38 

— 

where Table III. Approximate standard errors for es­ timated percentages shown in this report 

x!is the estimateofXbasedontieentire sample,and


Xiii is the estimate of Xbasedonthe ithhalfsample. Estimated percent


Base of Estimates ofstativd ~ors. -Approximate rela- percentage 2 5 10 20 30 

tive standard errors andcorrespondingstandarderrors or or or 50


of estimated numbers are shown in table II. Table III 98 E 90 E 70


contains the approximate standard errors for the esti- I J I 1 I t


mated percentages. Relative standard errorsofnumber Standard error


of medical X-ray examinations or visits are given in


6.4 tsble IV. Table V presents estimates of relative stand- 30,000----- 2.0 3.1 4.2 

50,000----- 1.5 2.4 R 5.0

arderrors ofmedical X-ray visitor examinationrates 100,000---- 1.1 1.7 H 3.1 3.5 

bythesize of the baseonwhichthe rate was calculated. 250,000---- 0.7 1.5 1.9 2.2 

Difference between two sample estimates. —The 500,000---- 0.5 ;:$ 1.6 

1,000,000-- 0.3 0.5 H M standard error of a difference is approximately the 2,000,000-- 0.2 0.5 0.7 ::: square root of the sum of the squares ofeach standard	 3,000,000-- 0.2 !:$ 0.4 0.6 0.6 J

4,000,000-- 0.2 0.3 0.4 0.5 0.5

Table II. Approximate standard errors for es­ timated numbers shown in this report error considered separately. ‘This formula will represent the actual standard error quite accurately for the 

Relative difference between separate and uncorrelated characSize of estimate 

standard Standard err or teristics although it is in fact only an approximation. error EWOYS associated with. nonrespo~e.-Appro& pk~nt mately 14percent of tie forms mailed tomothers were 

either not returned or were returned with the needed 

25,000--------------------- 16.8 4,200 information incomplete .Thecorresponding nonresponse 50,000--------------------- 12.0 6,OOO rate was about 7 percent for physicians and about 2 75,000--------------------- 7,350 

100,000-------------------- ::; 8,500 percent for medical facilities. A more complete dis250,000-------------------- 5.0 12,500 cussion of nonresponse and response characteristics 

500,000-------------------- 3.3 16,500 in this survey will be found in another report in this 750,000-------------------- 18,750 

1,000,000------------------ ;:: 20,000 series.4 Of primary concern in the design oftheNa1,500,000------------------ 1.5 22,500 tional Natality Survey was the probable impact ofnonresponse on the completeness ofcoverageof the X-ray 

25 
-------

-----------

--------

-------

------

-------

--------

---------

Table IV. Relative standard error of number of value of the total number of examinations which would 

X-ray examinations or visits have been reported had there been no nonresponseis 

equal to the number of such examinations reported 

Number of Relative Number of Relative weighted by the inverse of theresponseratesfrom each 

standard examinations error in examinations standard type of reporting source. Thus for examinations rein thousands percent in thousands error in ported only by a physician, theestimated total number percent of such examinations would be equalto 100/93 multiplied by the actual number of reported examinations. 

28.0 3oo--------- H----------- 19.8 350--------- ::; 

For examinations which were reported by more than 

30----------- 16.0 4oo--------- 4.4 one source (which amounted to about 30percent ofaH


40----------- 14.0 450--------- 4.1 examinations), it may be shown that the joint proba-


50----------- 12.4 5oo--------- 3.9 bility of nonresponse from two sources is virtually
 75----------- 10.2 600---------


1oo---------- 8.8 7oo--------- ;:: zero.


125---------- 7.8 800--------- 3.1 Table VI presents estimates of the number of ex-


150---------- 9oo--------- aminations reported in the survey and the estimated


175---------- ;:: l,ooo ;::


2oo---------- 6.2 1,500------- 2.2 number including adjustment for nonresponse.


250---------- 5.6 2,000------- 1.9 EYYOVassociated with incomplete vesponse. —Nonresponse to items on questionnaires returned by the 

mothers was minimal in most instances and amounted 

experience of women during pregnancy. Since this in- to nomorethan 3.1 percent for any single item. 

formation was collected from the medical sources for Table ,VII shows the percent not ascertained for 

each mother, nonresponse rates from physicians and specific socioeconomic items by age ofmother andby 

medical facilities may have a significant impact on the live-birth order. In order to reduce the effect ofsuch 

completeness of coverage of the survey. The extent incomplete reporting on survey estimates, statistic 

of undercoverage is dependent both on the magnitude derived from querying the mother were adjusted for 

of nonresponse and on the relative proportion of ex- incomplete reporting by imputing to those who did not 

aminations reported by a single source andthoae re- respond the characteristics of similar respondents. 

ported by two sources or more. For methodological The procedure used is described in greater detailin 

purposes it may be assumed that if a responseis another report in this series.’t 

received from any of the sources questioned, all rele- Virtually all items on the questionnaire sent to 

vant examinations will, in fact, be reported. Thus for medical sources were satisfactorily completed. The 

examinations reported only byonesource ,theestimated few cases for which information was missing were 

mainly imputed by consulting a staff radiologist. 

Table V. Relative standard errors of medical 

X-ray visit rates, by size of base for rate 

Table VI. Unadjusted and adjusted estimates of 

X-ray 

Relative standard

base 

error in percent X-ray examinations received during pregnancy for of— visit 

rate 

per 100 

women 

5 

1o-------

15-------

100,000 

women 

46.0 

33.0 

27.0 

250,000 

women 

26.0 

18.0 

15.0 

500,000 

women 

16.0 

11.3 

1,000,000 women 

13.0 

9.0 

Class of 

examination 

Number 

of 

exami -

nations 

reported 

survey 

in 

Adjustment 

factor 

for 

response nonAdjusted 

numb e r 

of 

exami -

nations 

20------- 23.0 13.0 ::: ;:; 

25-------

30-------

20.5 

19.0 

11.6 

10.6 ::: 

5.8 Total 1,370 . . . 1,407 

---.--- 17.6 9.8 6.1 ::; 

:L------ 16.5 9.2 5.7 4.6 Reported by 1 

45------- 15.5 8.6 5.4 4.3 physician 263 100/93.1 282 

50------- 14.7 8.2 4.1 Reported by 1 

60------- 13.4 ::; 3.7 hospital 732 100/97.6 750 

I 

12.4 ;:2 4.3 3.5 Reported by 2 

%------ 11.6 6.5 4.0 3.2 sources 297 . . . 297 

90------- 11.0 6.1 3.8 3.1 Reported by 3 

1oo------ 10.4 5.8 3.6 2.9 or more sources- 78 . . . 78 

26 
------------------

--------------- ------------------

------------------

------------------ ------------

------------------------

------------------------

-----------------------

Table VII. Percent of respondentsfor whom specifieditems were not ascertained,by age of mother 

and live-birthorder: 1963 National Natality Survey 

I 

Total Mother’s Fatherrs
 Age of mother and number of Family Education Education


live-birth order respondents income of mother of father employment employment


status status


Total 3,218


Age of mother


Under 20 years 373


20-24 years 1,074


25-29 years


30-34 years


t 35 years and over


Live-birthorder


First


Second-----------------------


Third


Fourth


Fifth birth and over---------


948


486


337


864


777


595


409


573


Percent not ascertained


3.1 0.2 0.8 0.1 0.7 

6.2 :.; 3.0 0.; . M 

1.8 0.3 

3.3 M ?:: 1.4 

3.9 0.3 1.2 0.3 

4.2 0.2 0.6 

2.1 0.4 0.4 

0.; 1.3 1.0 

;:? 0.5 1.0 0.7 

4.5 0.9 1.4 0.; 1.0 

27

-------

---

-----------

-----------

APPENDIX II 

DEFINITIONS OF CERTAIN TERMS USED IN THIS REPORT 

Age of mother.—Age of mother is recorded or 

derived from entries on the birth certificate. 

Colov. —Color is recorded or derived from entries 

on the birth certificate for color or race as white or 

nonwhite. Nonwhite includes persons classified as 

Negro, American Indian, Chinese, Japanese, Aleut, 

Eskimo, Hawaiian, or part-Hawaiian. The category 

white includes all other persons. Persons stated td be 

Mexican or Puerto Rican are included with white. 

Fetal loss. —This term is used synonymously with 

fetal death. A fetal death is death prior to the complete 

expulsion or extraction from its mother of a product 

of conception, irrespective of the duration of pregnancy. 

The death is indicated by the fact that after such separation the fetus does not breathe or show any other 

evidence of life such as beating of the heart, pulsation 

of the umbilical cord, or definite movement of voluntary 

muscles. Variation in the registration requirements in 

regard to completed weeks of gestation has an important 

bearing on this definition. Many States require the registration of fetal deaths of 20 or more completed weeks 

of gestation, while some require the registration of all 

products of conception irrespective of the duration of 

pregnancy. 

Live-bivth ovder. —Live-birth order is derived 

from entries on the birth certificate and refers to the 

number of children born alive to the mother, including 

the” sample child. 

Le@”timacy status. —For States reporting legitimacy data on the birth record, legitimacy status of a 

birth is recorded from entries on the birth certificate; 

for States not reporting legitimacy on the birth record, 

it is inferred from other evidence on the birth certif icate. The following 16 States did not report legitimacy 

statistics on the birth record in 1963: Arizona, Arkansas, California, Colorado, Connecticut, Georgia, Idaho, 

Maryland, Massachusetts, Montana, Nebraska, New 

Hampshire, New Mexico, New York, Oklahoma, and 

Vermont. 

Family income. —Family income refers to the 

total of all income received during the preceding 

year by all persons related to each other by blood, 

marriage, or adoption and living in the same household when the baby was born. Income from all sources 

is included, such as wages, salaries, unemployment 

compensation, and help from relatives, 

Metropolitan status. —Usual residence of mother 

was classified by location inside or outside counties 

falling in standard metropolitan statistical areas (metropolitan State economic areas in New England) as 

delineated by the Office of Statistical Standards, U.S. 

Bureau of the Budget, for the 1960 census. 5 Although 

metropolitan status does not correspond exactly to the 

conventional urban-rural differentiation, it maybe useful in classifying the population into those living in or 

near metropolitan areas and those living elsewhere, 

Region. —State of usual residence of mothers is 

classified according to four regions which correspond 

to the regions used by the U.S. Bureau of the Census. 

These are comprised as follows: 

Re@”on States Included 

Northeast	 Connecticut, Maine, Massachusetts, 

New Hampshire, New Jersey, 

New York, Pennsylvania, 

Rhode Island, Vermont 

North Central	 Illinois, Indiana, Iowa, Kansas, 

Michigan, Minnesota, Missouri, 

Nebraska, North Dakota, Ohio, 

South Dakota, Wisconsin 

South	 Alabama, Arkansas, Delaware, 

District of Columbia, Florida, 

Georgia, Kentucky, Louisiana, 

Maryland, Mississippi, North 

Carolina, Oklahoma, South Carolina, 

Tennessee, Texas, Virginia, 

West Virginia 

West	 Alaska, Arizona, California, 

Colorado, Hawaii, Idaho, Montana, 

Nevada, New Mexico, Oregon, Utah, 

Washington, Wyoming 

Medical X-ray visit. —A medical X-ray visit is 

defined as a visit to a physician’s office, hospital, 

mobile X-ray unit, Public Health Department, and so 

forth, during the course of which X-ray equipment is 

used for diagnosis or treatment. X-ray includes X-ray 

film photography and X-ray emission for treatment and 

fluoroscope but excludes the use of radioisotopes. Only 

one visit is counted for any single day, regardless of 

the number of X-ray examinations made. Medical X-ray 

visits exclude dental examinations taken for the primary 

28 

1 
purpose of studying the condition or formation of the 

teeth. 

Medical X-ray examination.-A medical X-ray 

examination is defined as the use of X-ray or fluoroscopic procedures to determine the presence, absence, 

or state of a disease or condition. For the purposes of 

this report, examinations also include the use of X-rays 

for treatment of a condition which has already been 

diagnosed. An X-ray visit may include several X-ray 

examinations. 

Radioqaphic examination. —A radiographic examination is one in which the X-ray beam is passed through 

the patient’s body and is recorded on X-ray film. 

Photojluoro~aphic examination. —A photo fluoro -

graphic examination (usually of the chest) is one in 

which the X-ray beam is passed through the patient’s 

Imdy and excites a fluorescing screen, which is then 

photographed by a miniature format camera using 

photographic film. 

Type of examination.— For the purposes of this 

report, examinations were classified into major groups, 

based primarily on the part of the body toward which 

the X-rays were directed. Examinations of the uterus 

and pelvic region related to pregnancy include pri ­

marily X-ray pelvimetry (measurement of fetal size 

and pelvic proportions), fetography (direct examination 

of the fetus), placentography (examination of the placental structure), and a small number of other examinations of the pelvic area. In the tables showing this 

data, this category has been subdivided into two subcategories: (a) pelvimetry, and (b) other examinations of 

the abdomen related to pregnancy. 

Type of facility. —Type of facility is a classification 

of the types of places at which an X-ray visit or examination took place. The definitions of the two categories 

are as follows: 

1.	 Physicians office is defied as the office of 

any doctor who has his own X-ray equipmen~ 

these may be subdivided according to the medical speciality of the physician’s practice. 

2.	 Other places is defined as including hospitals 

(both inpatient and outpatient services) as well 

as other places at which X-ray services are 

provided, including private clinics, schools, 

mobile units, Public Health Departments, and 

so forth. 

— 

29 
APPENDIX Ill 

SOURCE FORMS 

Standard Certificate of Live Birth 

Form .mrowd


Bud,., B. . . . . No, 68-R87L2,


. ...- CERTIFICATE OF LIVE BIRTM . .. . . ,.,k”r m,.,” ~0, 

PLACE or 81*TH ,2. L$g:A+cRcslDmcE or MOTHER fv:’JN~ mother{i,,?] 

0. cOuNTv 

O. CITY. TOWN, OR I.CCATION C, CITY. ToWN. OR LCWATION 

c,	 NAMEOF (If ml in hdrp{fol, #&e :trecf addre”) d. STREET ADDRESS 

HOSPITALOR 

!Nsr ,>1!0” 

d. IS PLACEOF BIRTH INSIDE CITY LIMITS? ?, IS RESIDENCEINSIDE CITY LIMITS? f. !S RESIDENCEON A FARM? 

Yfscl Nun YESD NOD YES � ~n 

3, Maw Pir*t Middle L-lM 

) ;Jlltil or 

i 4. SEX h THIS BIRTH 5b. IF TWIN OR TRIPLET, WAS CHILD EORN 6, DATE dfmfh Day Ymr 

SINGLE � ‘IWIN � TRIPLET � 1ST � 20 � 30 !J BI%H 

7, NAME Fir$t Mfddlt .Lad 8, COLOROR RACE 

, 

i 9. hGE (At time oflhk birth) 10. BIRTHPUCE (.%ie or forekm counm) 11.. uSUALOCCUPATION 1lb, KIND OF BUSINESSOR INDUSTRY 

VEARS 

I. 

~ 12. MAIDEN NAME Fird Middl, Lw[ 13, COLOROR RACE 

J 

; 14, AGE (At lfm of fhia birth) 15. BIRTHPLACE(S1alt or r.reion C07@rV) !6. PREVIOUSDELIVERIESTO MoTHER (Do NOT include /h& bi,lh) 

YEARS . . M“m nun, b, HQW m“. OTHh’R Wt. c, lie. ma .“ !c,.11 d.alk, 

OTHER cAil&,m ::” *Td*, *W,, Elk b., m. (Wnna tin dmd at A .Vi’ 

I?IFORWAMT .- .W ri.i.cf dim .!tcr . ..utii.m) T 

6, MoTHEI?$ MAILING AOCIRE35 

18! slaPIATunc k%. A’17ENDANTAT BIRTH 

1 Ae,cbv L7rlfl, 

that thb child M, D. � D. 0. � MIDWIFE � OTHER (St)ccifr) 

80., y~ ~lg 

on I&, ADDRESS 18.4 DATE SIGNED 

dated tie. 

3. DATE RECD. BY LCCAL REG. 30, REGISTRARS SIGNATURE 21, DATEON WHICH GIVEN NAME ADDED 

BY (R<vi,/r,v) 

FOR	 � EDICAL Al10 HEALTH U$C O“LV 

(Th& #wire MLWT k filled out) 

Z@, LENGTH OF PREGNANCY 23b, WEIGHT ATBIRTH 33, LEGITIMATE 

COMPLETED 

WEEKS LB. OL YES I-J No �

(SPACEFOR ADDITION OF MEDICALANO HEALTH ITEMS BY INDIVIDUAL STAT33) 

30 
Survey Questionnaire for Mothers 

,F’ R DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

(.. ) PUBLIC HEALTH SERVICE WASHINGTON q, D. C. 

@ u.. 

., 

r


L


The U. S. PublicHealthSerntceis doing a nationalstudyto find out how


much and what kinds of medicaland dentalcarewomen axe receitingduring


the year beforethe birth of a child. Nothingis known aboutthe extent


of the care receivedby expectantmothers,even thoughsuch care is of the


greatestimportancefor the futurehealthof both motherand baby. A


kaowledgeof what is actuallyhappeningthroughoutthe Nationwill go a


longway in helpingto improvethe healthof mothersand babies.


The informationneededfor this studywill be based on the experienceof 

the mothersof 4,(XXIbabiesout of the 4 millionborn during1963. These 

motherswere selectedas a rsmlomsampleof all motherswho have a baby, 

antiyou axe one of thoseso selected. We axe thereforeaskingyou to answer 

the questionson the followingpages of this form,and to returnit to us 

in the enclosesenvelopewhichrequiresno postage. 

Pleasenoticethat $n the firstpart of the form the questionsask about


every.ioctor, dentzist,
 hospital,or clinicfromwhich you receives~ care 

duringthe entireyear beforeyour baby was born. Your answersshouldnot 

be just for~c=—connecteflw ith pregmancy,but for any EUV3all medical 

antidentalcare or che@supsduringthese E’ months. 

All.informationaboutyou and your baby willbe kept completelyconfidential.


Your auswerswillbe used for healthresearchonly and for no otherpurpose.


As you might expect,it Is particularlyimportantthat we receiveyour


answersema thoseof all the other4,000mothers,sinceeach of you really


represents1,(X3O
mothers.


Your cooperationin this studyis deeplyappreciated.


Sincerely yours, 

O. K. Sagen,1%. D., Chief


NationalVital Statistic.a
 Division


NationalCenterfor’HealthStatistics


Name of Child 

Date of Birth File Number I 

M


31


i 
-------

COIIFIDEMTIALITY has b.. n � smvr. d the In.dlv idual ma published i. the F*daral Register lfmY 20. 1959 

FORM APPROVED


BUDOET BUEEAU NO 68-8823


SURVEY OF MEDICAL AND DENTAL CARE 

PART I. SOURCESOF AEDICAL AND DENTAL CARE DURING ONE-EAR PERl~DBEFQRE ——. -..—cHlLDBlRTH -...— -- ... ..

..	 Please provide the information requested 3. were you seen by a dentist during this 

bsluw about the physician, chiropractor or ore-year pericd? 

midwife who attended you at the recent 

birth of your child. � YES (_J# o
 (Go on t.Question 4)

Name 1 

Complete a section below


Address for each dentist.


mm City (town) and State 

Address Bow many time. were YOU seen by this 

doctor during the one-year period? I 

City (t-) md Stat.


!.Were you seen by any other physician


or chiropractor during the one-year U.. many time. were you seen by this


psriod bafora the recent birth of dentist dwring the one-year p=riod?


your child?


� YES � MO (Go cm t. Question 3) Name 

1
 Address


Complete a section below for II
 each doctor or chiropractor.
 City(town)and State


,%Ma 

now m.my time= we=. You seen by this 

dentist during the one-year period?
 Addre..


I
 4. During this one-year period, were you treated
 City (town) and State
 or examined in a clinic or hospital not


reported above? (In. Iude health checkups at 

Row many times were you see. by this work, visit= to mobile health units, etc. ) 

doctor during the one-year period? 

� YEs alto (G. on to next page) 

Name 1


Complete a section below for each
 &bire8a
 place where you were treated or exmnined.


II


Ci ty”(tom)and State


How many time. were yo” a..” by this 

doctor during the one-year period? 

Name 1+


Address NIII 

City ( townj and Stat. Address “ 

II 

flowmany times were You seen by this City (tcm)‘d Stat.

doctor during the one-year period? 

PLEASE GO ONTO PART 11~


32 
--------------

-----------------

--------------

PART Il. RELATED INFOtiATION 

L.	 Were ym eaployed outside yaw ha at any time 4. Was your husband eaplo~d at the time of your 

during ycur recent pregnancy? child’s birth? 

� FMLL-TIHE? OY ES (An...r a ..d Do (GO on to DYES - Was he working 

b blow) “Qu..tion 2.) 

� ao 

fcheck one> 

{ � PART-TfIIET 

a. Did YDU work full-time at all during


your recent pregnancy?


�YES Dno 5. Hhat”kind of work was your husband doing at the 

time of your child!s birth? 1 

lkhendid you atDP taxklng full-time?


~


b. Did you work part-tfmm at all during


ycur recent pregnancy?


QY!?S on o


1


MIM did you stop working part-time? 

(If he wa. not


~rkinf :hen, plea.e iim information for his 

Ia. t jpbj 

GIVS FuLL DSSCS2PYIM (For example: erocery 

cierk, �itto mmchanic, elementary .choal te.cher) 

6. What waa the total inccma of your family during 

Mm th I D.y I Year. 1962? (Include �ll income such aa wages. caIariea, 

19—


2. that was the highest grada (or year) of regular 

school that you ever attended? 

(Circle hiihe. t trade �ttended) 

ROBE----------------- O


ELEHEIIYARY SCHOOL---- 12$S8678


II18H SCHOOL---------- 1 2 > 4


COLLEGE 1 z s 4 s 6+


Did you COMPLETE this grade? DYEs Oilo


3. E&hatwas the h.ichestmade (or yaar) of remlar 

school that ycu; huab&d ever a~tended? -

(Circle hi~hest #rd. �tte.d.d> 

uO#E O


ELI!HEIITARY tlCHOOL---- 12 Y456Y. S


H I @N SCIIOOL----------- 1 2 Y 4


COLLECT 1 2 5 Z 5 6+


Did he COHPLEIZ this grade? f_JYEs � no 

[s-442s-19 (p.,. ,) 

-s1 

rm..ploymen t tic.apenm tion, help from relatives, 

. tc. , received by �ll members of the family Iivind 

with you when your baby was born) 

� solic 

� USOER S1.000 

� s1,000 - $1.999 

� $z, ooo -$2.999 

~s, ooo -53,999 

0s4.000 -44.999 

� s5.000 -$6.999 

� s7.000 -$9.999 

� s10.000- sl&999 

� s1s.000 OR OVER 

7, Whera did you live when ymr baby was born?


(Please tiv. your home #ddre..)


Nuaber a“d Street


City (tin) md State —


, county 

Is this place on a city lot (or in an 

apertmant building)? 

OYES ~0


?Name and address of person ..mpietiq this form)


PIEMSEIBE FAC!ICPAGEIOR COMMENTS


33 
Survey Questionnaire for Physicians

~’~ @%.,, %* DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE . ; ~ * %. @ .,44.$ PUBLIC HEALTH SERVICE WASHINGTON 25, D. C. (it5J %.’ USA 

r


L 

Your assistance is needed in a small but important sample survey conducted 

by the U. S. Public Health Serv5ce with the approval of your State Health 

Department. The prisnwy purpose of this surwy is to estimate how often 

mothers are exposed to ionizing radiation in the year preceding a birth. 

The survey will also provide useful data on the extent to which expectant 

n@hers avail themselves of medical care. The mothers on whom fk?itabeing collected were iiientlfiedfrom a random sample of about 4,000 births 

out of the 4 million occurring in the United States during 1963. 

According to our records, the mother namea below was seen or treated by 

you at some time during the yesx prior to the recent birth of her child. 

We ask your cooperation in answering the questions on the following pages, 

which relate to the medical care she received during the one-year period 

preceding childbirth. The exact dates coveredby this period are shown 

below. Information is needed on each e~osure to ionizing radiation this 

womsm experienced during this period, irrespective of its relationship 

to pregnancy. 

Since the survey is based on only a small sample of mothers, it is particularly important that we obtain .t%llinformation on each. A postage-free 

envelope is enclosed for your convenience in replying. You may be assured 

that your report willbe held in strictest confidence andueed only for 

statistical research. 

Your cooperation in this study is deeply appreciated. 

Sincerely yours, fl 

O.K. E@gen, PI@., Chief 

National Vital Statistics Division 

National Center for Health Statistics 

P 

Name of Mother Maiden Name 

Address Place of Birth of Child 

City-State Date of Birth File Number 

IPERIODCOVEREDBYT”ISSURVEY: FROM TO I 

34 
CONFIDENTIALITY has be. n � ssu red ths Individual � s published In tha Fadaral R*gist*r )lay 20, 1959 

ronu AFPEOVED. 

BUDOST BUREAU NO. 68-R82s 

SURVEY OF RADIOLOGICAL EXAMINATIONS 

PART I. Radiological EXAMINATIONS OR TREATMENTS OURINGONE-YEAR PERIODBEFORE CHlLDBlR~ 

To your knowledge, was the mother examined or treated by X-ray or fluoroscope at any time during€

the one-year pericd bsfore childbirth as spscified at the bottcm of the preceding page?€

� 110 (Skip toP.srtIIcmlastps@)


DYES - How many radiologicalexaminationsor treatments. 

did ahe receiveduringthis one-yearparicd? 

- (Complete section(s) below, then go on to last page) 

> Complete a separate section below for EACH radiological examination or treatment performed riuring 

the ONE-YEAR PERIOD, whether or not related to pregnancy. 

~ If the.S4ME TYPE of procedure was performed UORE THAN ONCE, please report E4CHSEPARATSLY.


� If more than ... procedure was performed on the SANE DATE, please report ii4CHSEPARATELY. 

~ In reporting NUHBER OF EXPOSURES, please include those which may have been technically 

unsatisfactory. 

� If necessary, continue on a separate sheet. 

SECTION1. FIRSTRADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD 

1. Type of radiological€ /	 equipment used? 

(check one) 

Date of 

(aminaticm 

treatment? 2. Primary arsa of€

bcdy exposed?€

3. Typs of service€

rendered to mother? menth) (check one) 

{


(day) 4. Number of sxposures? 

5. Place whera (year) 

‘;”€

~ DDIAGHOSTIC uAoiocRApny � OIAGHOsTIC FLU OROSCOPY 

: 00 IAGNOSTIC PHOTOFLUOROGRAPHY OX-RAY THERAPY 

: a PELVIHETRY a I HTRAVEIIOUS PYELOGRAtl 

: � PLACEIITOGRAPHY � OTIIER (specify) 

~ iJROUTINE CHEST 

j ~number) (includethosetech”ica:ly wsatisfactory) 

Nameof physician. hospi taI or clinic 

1 ‘O;”-€

35 
SECTION 2. SECOND RADIOLOGICAL EXAMINATION OR TREATMENT DURING ONE-YEAR PERIOD 

( 1.Type of radiological ; O DIAGNOSTIC RAOIOGRAPH~ � DIAGflOSTIC FLUOROSCOPE 

equipment used? ; � DIAGNOSTIC PHoTOFLUOROGRAPHY ~ X-RAY THERAPY 

(check one) 

Date of


examination
 2. Primary area of
 r treatment?
 bcdy exposed?


3, Type of service : � PELVI HETRy u ISTRAVESOUS PYELoGRAM 

(month) 

rendered to mother? ; lJPLAcEIITOGRAPHY � OTHER (specify) (check one) 

: � ROUTIHE cHcs7 

(day) 4. Number of exposures? ~ (include those technically u“satisf.ctory) 

(number) 

5. Place where (year) 

Nmne of physician, hospital or clinic 

““ I ‘Di’T-


SECTION 3. THIRD RADIOLOGICAL EXAMINATION OR TREATMENT DURING ONE-YEAR PERIOD 

1, Type of radiological ; � 01AGHOSTIC RADIOGRAPHY � OIAGHOSTIC FLUOROSCOPE 

equipment used? ! � OIAGSOSTIC PHOTO FLUOROGRAPHY O X-RAY THERAPY (check one) 

Date of 

examination 

r trsatment? 2. Primary arsa of


bcdy exposed?


3, Type of service ~ lJPELv I14ETRy UIIITRAVEN0u5 PYELOGRM4 

(month) 

rendered to mother? ; � PLACESTOGRApHY � OTHER (specify) (check one) 

: � ROUTINE CHEST 

(dey) 4. Number of exposures? ~ (include those technically unsatisfactory) 

(number) 

(year) 5. Place whers ; � DONE AT MY OWN OFFICE 

examination or OR Nameof physician. hospital or clinic treatment wss 

performed? s
 Address 

\ Ci ty.State 

SECTION 4. FOURTH RADIOLOGICAL EXAMINATION OR TREATMENT OURING ONE-YEAR PERIOD 

1, Type Of radiO@i~l ~ � DIAGNOSTIC RADIOGRAPHY � oIAGSDSTIC FLUOROSCOPE 

equipment used? I D oIAGIIOSTIC PHOTO FLUOROGRAPIIY O X-RAY THERAPY (check one) 

Date of :“ examination 2. Primary area of
 r treatment?
 bcdy exposed?


3. Typs of service : IJ PELv IHETRY I_JIIITRAVEIIOUS PyELOGRAH 

rendered to mother? 

(month) (check c.”e) : � PLAcEsTOGRAPIIY � OTHER (specify) 

: aROUTISE CHEST 

{ 

(day) Q. Number of sxposures? ~ (include those technically unsatisfactory) 

(number) 

(year) 5. Place where ; DOOME AT MY OWN OFFICE 

examination or 

OR Name of physician, hospi t.1 or clinic treatment was 

performed? s
 Address 

\ City. St.9te 
PART II. MEDICAL CARE RECEIVED BY MOTHER DURINGONE-YEAR PERIOOBEFORE CHlLDBlRTH 

1. How many times did you see this patientduringthe 5. If you referredthis patientto anotherphysician, 

one-yearpericd? (If exact number not know”. or to a hospitalor clinic,please give names and 

pleasegivekst estimate) addrsssesof physiciansor institutionsto which 

r4ferred. 

Number of times 

2. On what date did you see her for the first tire+?


duringthe one-yearperioi?


Honth ‘iDay, year 

3. On what date did you see her for the last time


duringthe one-yearperiod?


Month Day , ~ya 

19 

4. If this patientwas referrsdto you, pleasegive


names and addressesof referringphysicians,clinics


or hospitals.


Name 

Address 

City -.State 

Nmne 

Address 

City-State 

~ 

~ 

6. If this patient was seen or treatedduringthe 

one-yearpsricd & any other physician,hospital 

or clinicnot reportedabove or on the previous 

pags, please give names.ardaddresses. 

~ 

Name 

Address 

City-State 

<Nameofperscxi campletind this form) 

37 
Survey Questionnaire for Medical Facilities 

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

PUBLIC HEALTH SERVICE WASHINGTON %5, D. C. 

L 

Your assistanceis neededin a smallbut importentsamplesurveyconducted


by the U. S. PublicHealthservicewith the approvalof your StateHealth


Department.The primarypurposeof this surveyis to estimatehow often


mothersare exposedto ionizingradiationin the year precedinga birth.


The surveywill alsoproyid.e useful.
data on the extentto which expectant


mothersavailthemaelvesof medicalcare. The motherson whom data are


being collectedwere identifiedfrom a randomsampleof about4,000births


out of the 4 millionoccurringin the UnitedStatesduring1963.


According to our records, the mothernmneti belowwas seenor treateii
at


your institutionat sometimeduringthe year priorto the recentbirth of


her chila. We ask your cooperationIn answeringthe questtonson the


followingpages,whichrelateto the medicalcare she receivmiciuring
the


one-yeexperioil
precedingchildbirth.The exactdatescovereaby this


perioii
are shownbelow. Infomsationis neeaedon each exposureto ionizing


radiationthiswomanexperiencesduringthisperioa,irrespective
of its


relationshipto pregnancy.


Sincethe surveyis basea on only a smallsampleof mothers,it is particu­


larlyimportantthatwe obtainfull informationon each. A postage-free


envelopeis enclosesfor your conveniencein replying. You may be assured


thatyour reportwill be heltlin strictestconfidenceand useilonly for


statisticalresearch.


Your cooperationin this studyis deeplyappreciated.


Sincerelyyours,


0. K%5*


NationalVital StatisticsDivision


NationalCenterfor HealthStatistics


Name of Mother Maiden Name 

Address Place of Birth of Child 

City-State Date of Birth File Number 

PERIOO COVEREO BY THIS SURVEY: FROM To 

38


I 
COW FIDEWTIALITY has boon �ssu red tho individual � s publ l-hod in the Fed*rsl Rogi8t6r Hay 20. 1959 

mnu 4PPmlv#D. 

SUDGST BEI;SAU MO. e,.aa,, 

SURVEY OF RADIOLOGICAL EXAMINATIONS 

PARTI. RADIOLOGICAL EXNINATIONS OR TREATMENTS DURINGONE-YEAR PERIODBEFORE CHlLDBlRTH 

To your knowledge, was the mother examined or treated by X-ray or fluoroscope at any time during


the one-year pericd before childbirth as spscified at the bottom of the preceding pags?


� IIO (Skip to Part IIon I.stpsge) 

DYES + Howmany radiologiml e~minations ortreatmnts. 

did she receive during this one-year period?


(Complete section(s) below, then go on to last page) (number> 

�	 Completes sepsrate section below for EACff radiological examination or treatment performed duri”g 

the ONE-YEAR PERIOD, whether or not related to pregnancy. 

� If the SAME TYPE of procedure was performed MORE THAN ONCE, please report EACllSEPARATELY. 

F If more than one procedure was performed on the SAME DATE, please report EACH SEPARATELY.


�	 In reporting NUHBER OF EXPOSURES, please include those which may have been technicality 

unsatisfactory. 

� If necessary, continue on a separate sheet. 

SECTION1. FIRSTRADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD 

1. Type of radiological : � DIAGIIOSTIC RAOIOGRAPIIY � 01 A6110sTIc FLUOROSCOPE 

equipment used? : � DIAGfiOSTIC PHOTOFLUOROGRAPHY � X-RAY THERAPY (check one) 

Date of


:xamination 2. Primary area of
 . treatment?
 bcdy exposed?


3. Type of service : � PELVIHETRY DINTRAVEMOUS PYELOGRAH 

(month) 

rendered to mother? ! � IPLACEIiTOGRJPHY l_JOTHER (.pecify) (check one) 

j DROUTIHE CHEST 

(<lay) U. Nurrkw of exposures? ; (inc~de tho.e technically unsatisfactory) 

(number) 

(year) 5. Place where 

Name of physician, hospital or clinic 

‘“ Ino’i’’l===

SECTION2. SECONORAOIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD 

1. Type of radiological ~ � Diagnostic RADIOGRhpny l_JcIl A6n0sTlc FLuORoscopY 

/	 equipment used? : � DIAGNOSTIC PHOTOFLUOROGRAPHY OX-RAY THERAPY (check one) 

Date of 

examination 2. Primary area of
 r treatment?
 bcdy exposed?


3. Type of service 1 lJPELVI HETRy I_JIH7RAvEH0us pycLocRAH 

rendered to mother? ; 13 PLACEIIT0GRAPHY l_JOTHER {specify) (month) (check one) 

: � ROuTliiE cHEsT 

((lay) 4. Number of exposures? : (includethose technically unsatisfactory) 

(number) 

(year) 5. Place whet-s 

Name of physician, hospital or clinic 

““a’ in’;iATF=== 

SECTION3. THIRORADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD 

1. Type of radiological ; � DIAGNOSTIC RADIOGRAPHY � DlA6M0sTflc FLuoROscOPY 

/	 equipment used? ; � LIIAGNOSTIC PHOTOFLUOROGRAPHY OX-RAY THERAPY 

(check one) 

Date of 

exami nat ion 2. Primary area of r treatment? body exposed? 

3, Type of service : l_JPELvlnETRy DIN TRAvCHOus PyELOcRAm 

(month) 

rendered to mother? : � lpLACEt ITOGitApHY l_JoTHcR (sp.cify) (check one) 

; lJROUTIIIE CHEST 

(day) 4. Number of exposures? : (include those technically unsatisfactory) 

(“wnl>er) 

(year) 5. Place where 

Name of physician, hospital or clinic 

‘%’” l“o;AT-


SECTION4. FOURTH RADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD 

1. Type of radiological : � DIAGtIOSTIC RADIOGRAPHY � OIAGHOsTIC FLUOROSCOPE 

equipment	 used? I DIAGNOSTIC PHOTOFLUOROGRAPHY IJX-RAY THERAPY (check one) 

Date of 

examination 2. Primary area of F treatment? body exposed? 

3. Type of service : � pELv IHETRy � NT RAVEHOUS pYELOGRAM 

rendered to mother? ; � pLAcEH70GRApHY � OTHER (specify) (month)	 (check one) 

! � 170uTl NE cHEs7 

( 

((lay) 4. Number of exposures? ; <incI.dethO.etechnicallyunsatisfactory) 

(“”ml>., ) 

— 

(year) 5. Place where ~ � DONE AT THIS INSTITUTION 

examination or OR Name of physician, hospital or clinic 

treatment was % performed? Add, . s . 

\ City.. State 

I 
PART Il. MEDICAL CARE RECEIVED BY MOTHER DURING ONE-YEAR PERIOD BEFORE CHILDBIRTH 

1.. How many times was the patientseen at your 5, ~f you institutionreferzwdthis patientto 

institutionduringthe one-yearperiod? anotherhospitalor clinic or to a private 

(If exact number not known, pleas. give best estimte) physician,please give names and addrassesof 

physiciansor institutionsto which referred. 

Number of times 

N.mm
 I 

2.	 On what date was she seen for the first time Address 

duringthe one-yearperiod? City-State 

I J 

Mm th I Day I Year 

I 19 

3.	 Gn what date was she seen for the last time 

duringthe ma-year period? 

+.	 If this patientwas referredto your instituticm, 

pleasegive names and addressesof referring 

hospitals,clinicsor privatephysicians. 

Name 

Address 

Cify. Staf= 

Name 

Address 

city-stat=


b, If this patientwas seen or treatedduringthe


cme-yearperiod by any other hospital,clinicor


physiciannot reportedabove or on the previous


page, please give names and addrssses.


Name 

City-.State


Name 

Address 

City-State 

(Name of per.cm .-PI. t ing this form) 

CowENTS 

ooo — 

41

OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publication No. 1000 

Seyies 1. 

Sevies 2. 

Sem”es 3. 

Series 4. 

SeYies 10. 

Series 11. 

Se2-ies 12. 

PYograms and collection proceduves.— Rewrts which describe the general programs of the National 

Center for Health Staris~cs and its offices and divisions, data collection rneth~ds used, definitions, 

and other material necessary for understanding the data. 

Data evaluation and methods YesearcJz. —Studies of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, new analytical 

techniques, objective evaluations of reliability of collected data, contributions to statistical theory. 

AnuJyticaJ studies. —Reports presenting analytical or interpretive studies based on vital and health 

statistics, carrying the analysis further than the exqmsitory types of reports in the other series. 

Documents and committee YepoYts. —Final reports of major committees concerned with vital and 

health statistics, and documents such as recommended model vital registration laws and revised birtli 

and death certificates. 

Data porn the Healtk InteYview Suvvey. —Statistics on illness, accidental injuries, disabili@, use of 

hospital, medical, dental, and other services, and other health-related topics, based on data collected 

in a continuing national household interview survey. 

Data f%om the HeaJtk Examination Szmvey. - Data from direct examination, testing, and measurement of national samples of the population provide the basis for two types of reports: (1) estimates 

of the medically defined prevalence of specific diseases in the United States and the distributions of 

the population with respect to physical, physiological, and psychological characteristics; and (2) 

analysis of relationships among the various measurements without reference to an esilicit finite 

universe of persons. 

Data ji-om the Institutional Po&zLation Survey s.- Ststistics relating to the health characteristics of 

persons in institutions, and on medical, nursing, and personal care received, based on national 

samples of establishments providing these services and samples of the residents or patients. 

SeYies 13. 

Sen”es 20. 

SeYies 21. 

Series 22. 

Data j?onz tke Hospital Discharce Survey. -Statistics relating to discharged patients in short-stay 

hospitals, based on a sample of patient records in a national ssmple of hospitals. 

Data on mo~taMy.-Various statistics on mortality other than as included in annual or monthly 

reports— special analyses by cause of death, age, and other demographic variables, also geographic 

and time series analyses. 

Data on natality, mayriage, anddivorce. —Various statistics on natality, marriage, and divorce other 

than as included in annual or monthly reports—special analyses by demographic variables, also 

geographic and time series analyses, studies of fertility. 

Data jrom the National iVataMy and Mortality Survevs. —Statistics on characteristics of births and 

deaths not available from the vital records, b&ed on krnple surveys stemming from these records, 

including such topics as mortality by socioeconomic class, medical experience in the last year of 

life, characteristics of pregnancy, etc. 

For a list of titles of reports published in these series, write to: Office of Information 

National Center for Health Statistics 

U.S. Public Health Service 

Washington, D.C. 20201