Vital and Health Statistics; Series 16, No. 2 (10/89) · tion in Vital and Health Statistics,...

VitalandHealthStatisticsAdvance DataFrom Vital andHealth Statistics:Numbers 11–20

Series 16:Compilations of Advance Data FromVNal and Health StatisticsNo, 2Data in this report from health and demographic surveys present statistics byage and other variables on pregnant workers; ambulatory medical care;weight and height; episodes of persons injured; and exercise and sportsparticipation, Estimates are based on the civilian noninstitutionalizedpopulation of the United States. These reports were originally published in 1977and 1978,

US. DEPARTMENT OF HEALTH AND HUMAN SERVICESPublic Health ServiceCenters for Disease ControlNational Center for Health Statistics

Hyaftsville, MarylandOctober 1989DHHS Publication No. (PHS) 90-1861

All material appearing in thk repori is in the public domain and may bereproduced or copied without permission; citation as to source, however, isappreciated.

suggestedCita60n

National Center for Health Statistics. Advance data from vital and healthstatistics: nos 11–20. National Canter for Heaith Statistics. Vital Health Stat16(2). 1969,

National Center for Health Statistics

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

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for Ancdysisand Epidemiology

Gail F. Fisher, Ph.D., Associate Director for Planning andExtramural Programs

Peter L. Hurley, Associate Director for Vital and HealthStatistics Systems

Stephen E. Nieberding, Associate Director for Management

Charles J. Rothwell, Associate Director for Data Processingand Semites

Monroe G. Sirken, Ph.D., Associate Director for Researchand Methodology

Division of Vital Statistics

John E. Patterson, Director

James A. Weed, Ph.D., Deputy Director

Robert Bilgrad, Special Assistant to the Director

Robert J. Armstrong, Actuarial Adviser

Harry M. Rosenberg, Ph.D., Chiej Mortality StatisticsBranch

Robert L. Heuser, Chiej Natality St&”stics Branch

Robert L. Heuser, Acting Chiej Marriage and DivorceStatistics Branch

George A. Gay, Chiej Registration Methods Branch

William F. Pratt, Ph.D., Chiej Fami/y Growth SurvqBranch

Ronald Cha.mblee, Chie~ Technical Services Branch

Mabel G. Smith, Chie$ Statistical Resources Branch

Joseph D. Farrell, Chiej$ Systems and ProgrammingBranch

Pregnant Workers inthe United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 11

Ambulatory Medical Care Rendered in Physicians’ Office* United States, 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 12

Ambulato~ Medical Care Rendered in Pediatricians’ Offices During 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 13

Weight by Height and Age of Adults 18-74 Yearx United States, 1971–74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 14

National Ambulatory Medical Care Survey of Visits to General and Family Practitioners,January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 15

Office Visits to Internists National Ambulatory Medical Care Survey, United States, 1975 . . . . . . . . . . . . . . . . . . No. 16

Access to&nbulatory Health Carti United States, 1974 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 17

Episodes of Persons Injured United States, 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 18

Exercise and Participation in Sports Among Persons 20 Years of Age and Over: United States, 1975 . . . . . . . . . No. 19

Office Visits to Obstetrician-Gynecologist* National Ambulatory Medical Care Survey, United States, 1975 . . . No. 20

,..Ill

FROM VITA~& HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

US. DEPARTMENT OF HEALTH, EDJCATION, AND WELFARE I No. 11 Sept. 15, 1977 I Public Health Serwce. Health Resources Admln!stratlon

Pregnant Workers in the United States’

Of about 3,034,000 women who had a livebirth during a 12-month period in 1972-73, anestimated l,260,00d or 41.5 percent workedduring their pregnancy, according to the Na-tional Survey of FamiIy Growth (NSFG). ThisSurvey was conducted by the National Centerfor Health Statistics. Such pregnant workerscomprised about 8.8 percent of the estimated14,357,000 ever-married women of reproductiveage in the labor force at the time.

For the survey, there were interviews ofabout 9,800 women representing the populationof women aged 15-44 in households in the con-terminous United States who were married, pre-viously married, or single with their own chil-dren in the household. This report is based oninformation about women who had a live birthin the year before their interview. Because inter-viewing occurred over an 8-month period in1973-74, the years of preinterview experiencereported by women include different 12-monthperiods. The aggregated reports of years of pre-interview experience refer to an average 12-month period end ing on September 13,19 73–the interviewing midpoint. For that andother reasons, estimates of births reported hereare not comparable to calendar period estimatesfrom the birth registration system. Other aspectsof sample design and statistical reliability are dis-cussed in the Technical Notes to this report.

Table 1 shows estimates of the number ofwomen who had a live birth in the year beforethe interview, and who worked at some timeduring the nine months before the birth. Theestimates would have been somewhat higher hadthe sample included all single women instead ofjust those with their own children in the house-hold. Of the approximately 1,260,000 pregnantworkers, 83.9 percent were white women, and

1This report prepared by Gerry E. Hendershot, Ph.D.,Division of Vital Statistics.

16.1 percent were of “all other”z races. Womenunder 25 years of age were 53.3 percent of thetotal, and women 25 years and over were 46.6 per-cent of the total. Among pregnant workers under25 years of age, 78.9 percent were white women,while among pregnant workers 25 years andover, 89.8 percent were white. Among whitepregnant workers, 49.9 percent were 25 years andover; among pregnant workers of alI other races,only 30.0 percent were 25 years and over.

Table 2 shows estimates from the CurrentPopulation Survey3 of the numbers of ever-married women employed or seeking employ-ment in hlarch 1972, a date near the midpointof the period during which the pregnancies be-gan. These numbers estimate the populationpotentially becoming the pregnant workers intable 1, although single women with children oftheir own are not included.

The ratios in table 3 (derived by dividingthe numbers in table 1 by the numbers in table2 and multiplying this by 1,000) are crude in-dexes of the probability that during a l-yearperiod women in the labor force will work whilepregnant. The index was 85 per 1,000 for whitewomen as compared with 102 for aIl otherwomen. It is highest for women of all otherraces under 25 years of age (370 per 1,000),lowest for women of zdl other races who are 25years of age and over (38 per 1,000), and aver-ages 88 per 1,000 for the totzd population ofever-married, reproductive-age women in the la-bor force.

2The term “all other” refers to the combined group-ing of all races other than white.

3 Bureau of Labor Statistics: Marital and Family Char-acteristics of Workers, March 1972, Special Labor ForceReport 153. Washington. U.S. Government Printing Of-fice, 1973. This publication provides appropriately clas-s~led data nearest in time to the estimated midpoint ofthe period during which the women who are subjects ofthis report became pregnant.

2

Table 4 shows estimates of the number ofwomen in the sampled population who had alive birth in the year before their interview.Table 5 shows ratios of pregnant workers (fromtable 1) to women who had a live birth in theyear before their interview (from table 4). Theratios are approximations to proportions of re-cently confined women who worked duringtheir” pregnancy. The proportion is highestamong women of all other races in the youngerage category (48.5 percent), lowest among white

Table 1. Number and percent distributions of women 1544 years

of age who worked during a pregnancy ending in live birthduring a 12-month period in 1972-73 by color and age: UnitedStates

‘get=n==m=Number of women

15-44 years ... . ... .. I 1,260,000 ii 1,057,000 I 203,000

15-24 years .. .. .. ..... .. . 672,000 II 530,000

I

142,0002544 years .. . .... .... . . . 587,000 527,000 61,000

Percent distribution by color

1544 years., . .... ..

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

2544 years ... ... . ..... . .hamPercent distribution by age

1544 years . .. ..... .

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

25-44 years .... ... .. .....H-%-F=Table 2. Number of ever-married women 1644 years of age who

were in the labor force in March ‘1972, by color and age:United States

I Color

1644 years ... .... ..

w-

16-24 years ... .. .... ... .. I 3,265,000 I2,881,000 I 364,00025-44 years .. .. . .. ... . .. . 11,092,000 9,489,000 1,603,000

Source: Bureau of Labor Statistics, Marital and Family Charac-teristics of Workers, March 1972, Special Labor Force Report153. Washington, U.S. Government Printing Office, 1973.

women in the older age category (36.5 percent),and averages 41.5 percent for the total popula-tion of recently confined women.

A detailed anzdysis of these and related data,entitled “Patterns of Employment Before andAfter Childbirth, ” is being prepared for publica-tion in Vital and Health Statistics, Series 23. Foran earlier report based on a sampIe of Legitimatelive births, see “Employment During Pre~ancy:Legitimate Live Births, United States, 1963, ”Vital and Health Statistics, Series 22, No. 7,,

Table 3. Number of women 1544 years of age who worked dur-ing a pregnancy ending in live birth during a 12-month periodin 1972-73, per 1,000 women in the labor force in March1972, by color and age: United States

Color

1544 years .. .... .. .

I====II==+=Q=15-24 years .. .... .. ..... . 206

I

184 3702544 years .. .... . .. .... . 53 56 38

Table 4. Number of women 1544 years of age who hacl a livebirth during a 12-month period in 1972-73, by color and age:United States

Color

Age

Total WhiteAll

other

Table 5. Number of women 1544 years of age who worked dur-ing a pregnancy ending in live birth during a 12-month per-iod in 1972-73, per 1,000 women who had a live birth in thesame period, by color and age: Unitad States

‘9’ t71-=TiL-1544 years . .. .. . .. . 415 409 449

15-24 years . .... . .... . .. . 469 465 48525J14 years .. .. . ..... .. .. 366 365 384

admce&m3

TECHNICAL NOTES

DESIGN OF THE SURVEY. The National Sur-vey of Family Growth (NSFG) is designed toprovide data on fertility, family pkmning, andrelated aspects of maternal and child health.Field work for Cycle I was done by the NationaIOpinion Research Center in 1973 and early1974 with September 13, 1973 as the midpointof the interviewing.

A multistage probability sample of womenin the noninstitutional population of the con-terminous United States was used. Approxi-mately 33,000 households were screened toidentify the sample of women eligible for theNSFG, i.e., women aged 15 to 44 years, in-clusive, who were currently married, previouslymarried, or never married but had biologically -related children presently living in the house-hold. In households with more than one eligiblewoman, a random procedure was used to selectonly one to be interviewed.

Interviews were completed for 5,864 whitewomen and for 3,933 women of other races. Adetailed description of the sample design will bepresented in a forthcoming report, “Sample De-sign, Estimation Procedures and Variance Esti-mation for Cycle I of the National Survey ofFamily Growth.”

RELIABILITY OF ESTIMATES. Since the sta-tistics presented in this report are based on asample, they may differ from the figures that

would have been obtained from a complete cen-sus. This difference, referred to as sampling er-ror, is measured by a statistic called the standarderror of estimate. Approximate standard errorsfor estimated numbers from this survey areshown in table I.

The chances are about 68 out of 100 that anestimate from the sample would differ from acomplete census by less than the standard error.The chances are about 95 out of 100 that thedifferences between the sample estimate and acomplete count would be less than twice thestandard error.

Table 1. Approximate standard error for estimated numbers fortotal or white women and black women: 1973 NationalSurvey of Family Growth

Total and white

Size ofestimate

25,000 .. ..... .. .. ..50,000............100,000 . .. .. ... . .150,000 .. . .. .. .. .250,000..........350,000 ... . .... ..500,000 . .. .. .. .. .750,000 . . .. .... . .1,000,000 . .... ..

Standarderror

6,0009,000

13,00016,00020,00024,00028,00035,00040,000

Size ofestimate

50,000 . ... .. . . ....100,000 ... .. .. ...200,000 .... . ... ..500,000 . ... ... . ..1,000,000 ... . . ..2,000,000 .. .. . ..5,000,000 ... .. . .Io,ooo,ooo ... . .20,000,000 .. ...

Standarderrur

15,00021,00030,00047,00067,00096,000

151,000216,0W311.000

Black

DEFINITION OF TERMS

Age. –Age is classified by the age of the re- are included in the labor force estimates; otherspend-ent at-her last birthday befor~ the date ofinterview.

Color.–Classification by color of the womaninterviewed, based on interviewer observation,was reported as white or other. “AN other” re-fers to the combined grouping of all races otherthan white.

Labor Force Status. –A woman is catego-rized as being in the labor force if she was work-ing full-time or part-time, had a job but was not atwork because of temporary illness, vacation, or astrike, or if she was unemployed, laid-off, or look-ing for work. In this report ever-married women

estimates incIude single women with children.Work During Prepancy. –Women are classi-

fied as having worked during pregnancy if theyhad a live birth in the year before the interview,and reported that they worked within the ninemonths before the birth.

Live Birth. –A live birth is a fetus that givessigns of life after birth, regardless of the lengthof gestation. Since this report focuses on womenhaving a live birth in a specified period, ratherthan upon the births themselves, it does not al-low for plural births, and is not, therefore, com-parable to reports of births from the birth regis-

4

tration system. Because of the sample design, over an 8-month period, the years of preinter-this report also does not include births in Alaska view experience reported by women differ, andor Hawaii. Nor does it include women under 15 the aggregated experience is not directly com-nor over 44 years of age. Finally, the period for parable to any caIendar period for which datawhich births were reported is the 12 months be- from the birth registration system might be re-fore the interview. Since interviewing took place ported.

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

U S DEPARTMENT OF HEALTH, ECUCATION, AND WELFARE I No. 12 October 12, 1977 I Pubhc Health Serwce. Health Resources Admlmstratlon

Ambulatory Medical CareRendered in Physicians’ Offices: United States, 1975a

The estimates presented in this report areintended to highlight the findings of the 1975Nat io na.1 Ambulatory Medical Care Survey(NAMCS). NAMCS is a sample survey designedto explore the provision and utilization ofambulatory care in the physicizm’s office-thesetting where most Americans seek health care.The survey is conducted yearly over the conter-minous United States by the Division of HealthResources Utilization Statistics of the NationalCenter for Health Statistics. The survey sampleis selected from doctors of medicine and oste-opathy who are engaged in office-based, patientcare practice. In its current scope, NAMCSexcludes physicians practicing in Alaska andHawaii, physicians whose specialty is anesthe-siology, pathology, or radiology, and physiciansin Government service.

Previous publications describe the develop-ment and findings of NAMCS. 1-s

NAMCS findings have been published fortwo previous 12-month periods, May 1973-April 19741 *2 and Janum-y-Deccmbcr 1974.3

aprepared by Hugo K. Koch and Norma Jean Dennison,Division of Health Resources Utilization Statistics.

Data users are cautioned when making com-parisons between the numerical estimates for1975 and the numerical estimates previouslypublished for the two prior 12-month periods.Since these earlier data were released, a con-tinuing evaluation of the technical proceduresused to project the national estimates from thesample findings has resulted in a revision of theNAh4CS estimating procedures. The revisedprocedures, applied to the 1975 findings, resultin an estimated total of 567.6 million officeencounters (visits) for that year. The applicationof these revised procedures to the findings pre-viously reported results in the following ad-justment of total estimated visits.

Estimated visits(in millions)

NAMCS reporting pen.od

Published Revised

May 1973-April 1974 ........ 644.9 590.8

January-December 1974 .... 634.1 577.8

The most notable effect of the change inestimation procedure is to lt>wcr numericalestimates of office visits by 8-9 percent. Distrib-

Advance Data from Vital and Health Statistics replaces the supplements to the Monthly Vital Statistics Reportas the means for early release of selected findings from the health and demographic surveys conducted by theNCHS. Most of these releases will be followed by detailed reports in the Vital and Health Statistics series.

Provisional vital statistics as well as advance reports of fin-d data for a year will continue to be published in the

Monthly Vital Statistics Report.Advance Data is being distributed on the mailing keys for the Vital and Health Statistics series, and people

who now receive reports from a particular series will also receive all Aduance Data releases for that series.Temporarily, the mailing list for the Monthly Vital Statktics Report (M VSR,I is also being used. M WR readerswho wish to continue to receive Advance Data issues, as well as other persons who wish to receive all issues,should contact: National Center for HeaJth Statistics, Center Building, Room 1-57, 3700 East West Highway,Hyattsville, Maryland 20782, Phone: (301) 436-8500.

2 advamxklta—

utions and relationships—as expressed, for ex-ample, in percents and ratios —remain relativelyunaffected by the change.

Readers desiring more information about theNAMCS estimation procedures should addressinquiries to Ambulatory Care Statistics Branch,National Center for Health Statistics, CenterBuilding, 3700 East-West Highway, Hyattsville,Md. 20782.

Figure 1 is a facsimile of the Patient Recordused by participating physicians to record in-formation about “their office visits. Figure 1 maybe useful as a reference as the selected aspects ofthe survey findings are presented.

Since the estimates presented in this reportare based on a sample rather than the entireuniverse of office-based, patient-care physicians,they are subject to sampling variability. See page11 for an explanation and for guidelines injudging the relative precision of estimates re-ported.

DATA HIGHLIGHTS

Physician Speciality

Among the 13 most visited specialties, plri-mary care providers led the other specialists in

Figure 1. PATIENT RECORD

ASSURANCE OF CO NFIDENTIALITY—AII mf.fma[,on vvhcl! vvo.ld perm,l ,den?,fomno. of m mdnv,dud.. Pm.et!.e, or m Wz.bl,$hmem WIN be held con fodenual, wdl be used only bv P.rmns engaged m and f., DN? ,The purposes of !he survey and WIII not be dmlosed or .elomed 10 other pefsons or used for any olher purpose.

1. DATE OF VISIT PATIENT RECORD

.~NATIONAL AMBULATORY MEDICAL CARE SURVEY

2. DATE OF BIRTH 4. COLOR OR 5. PATIENT’S PRINCIPAL PROBLEM(SI 6. SERIOUSNESS OF 7. HAVE YOU EVER SEENRACE COMPLAINT(S), OR SYMPTOM(S) ~ VISIT PROBLEM IN ITEM 5a THIs PATIENT BEFORE?

d=+ —

(h patient’s L?wrlwords] (Check one)

! ❑ WHITE , E YESI ❑ VERY SERIOUS

:CNO

3. SEXz ❑ NEGROI a MOST t

BLACK IMPORTANT 1 •! SERIOUS // YES, for the problem

I ❑ FEMALE I ❑ OTHER I O SLIGHTLY SERIOUSmcf!cated in / TEM 5a 7

z ❑ MALE . ❑ UNKNOWN b, OTHER , ❑ NOT SERIOUS ~ ~ YES IIJNO

8. MAJOR REASON(S) FOR THIS VISIT [CAeci 8// mqor reasom) 9. PHYSICIAN’S PRINCIPAL OIAGNOSIS ~ VISIT—a OIAGNOSIS ASSOCIATE WITH ITEM 5i7 ENTRY

J, ❑ ACUTE PROBLEM .8 ❑ WELL ADULTICHILD EXAM

o, ❑ ACUTE PROBLEM, FOLLOW-UP u ❑ FAMILY PLANNING

o, ❑ CHRONIC PROBLEM, ROUTINE ,. ❑ COUNSELINGIADVICE

tI •l CHRONIC PROBLEM, FLARE-UP II Q IMMUNIZATION

,6 ❑ PRENATAL CARE II ❑ REFERRED BY OTHER PHYWAGENCY b OTHER SIGNIFICANT CURRENT DIAGNOSES

os ❑ POSTNATAL CARE ,! ❑ ADMINISTRATIVE PURPOSE (In order of importance)

w ❑ POSTOPERATIVE CARE7

,< ❑ OTHER (SPC?C)fY)

(Ope,atwe procedure)

10. DIAGNOSTIC/THERAPEUTIC SERVICES OROERELUPROVIOEO THIS VISIT (Checks// fhd app/y) I I . DISPOSITION THIS VISIT 12. OURATION OF

01 ❑ NONE 11 D ORUG PRESCRIBED (Checkall thut apply) ~ VISIT [he

02 ❑ LIMITED HISTORY/EXAM 12 0 X. RAYacwally spent withphysicim)

03 ❑ GENERAL HISTORY/EXAM 13 ❑ INJECTION I ❑ NO FOLLOW-UP PLANNED

04 ❑ CLINICAL LAB. TEST M ❑ lMMUNIZATION/DESENSI TIZATION : ❑ RETURN AT SPECIFIEO TIME

05 ❑ BLOOD PRESSURE CHECK 15 ❑ PHYs IoTHE RAPY I ❑ RETURN IF NE EDEO. PR N

06 ❑ EKG 16 ❑ MEDICAL COUNSELING . •l TELEPHONE FOLLOW-UP PLANNED

07 ❑ HEARING TEST 17 ❑ PSYCHOTHERAPYiTHE RAPEUTICb ❑ REFERREO TO OTHER MINUTES

00 D VISION TEST LISTENINGPHYSICIAN/AGENCY

09 ❑ EN DOSCOPY6 U RETURNED TO REFERRING

18 ❑ OTHER (Specifyl PHYSICIAN10 0 OFFICE SURGERY

, ❑ AOMIT TO HOSPITAL

@ ❑ OTHER (Spemfy)

HRA-34-5 DEPARTMENT OF HEALTH, EDUCATION ANG WELFAREREv. 8-74

O.M. B. %’6-S72106PUBLIC I-l EALfh 5ER./ICZ EXPI RATION DATE 1.?/31/75

HtALTH RESOU61;S; ADMINISTRATIONNATIONAL CENTER FOS HEALTH STATISTICS

—

ackmeda3

the provision of office-based ambulatory care;general and family physicians alone accountedfor 2 of every 5 visits (table 1).

Type and Location of Practice

In a ratio of about 3 to 2, visits to solopractitioners outnumbered visits to physicians inmultiple-member practice (table 1).

Visits within standard metropolitan statis-tical areas (SMSA’S) outnumbered nonmetro-politan visits in a ratio of roughly 3 to 1. Acomparison by annual visit rates also shows ahigher rate within SMSA’S (2.9 visits per resi-dent per year) than in the nonmetropolitanareas (2. 3 I isits per resident per year).

Patient’s Age, Sex, and Color

Office visits per year increased in a directparallel to advancing age; the rate for personsaged 65 and over more than douMed the rate forpersons aged under 15 years (table 2).

Females were more commonly seen in thephysician’s office than males; females madeabout 3 visits for every 2 visits made by males(titble 2).

This was due, in part, to the demographicfact that females outnumbered males in the gen-eral population. That other factors were atwork, howet’er, is confirmed by a comparison ofannual visit rates between the sexes; here also aratio of 3 to 2 prevailed in favor of the females.

The following tabulation shows that femalevisits outnumbered male visits in every age inter-val except the youngest.

Percent of all virits

Age Females Males

Total ..... ....... ..... ....... ... 60.4 39.6

Under 15 years ... . .. .. . .. . . .. . . . 8.1 9.315-24 years .. .. .. . . .. .. .. . . . .. . .. .. 10.1 5.225-44 years ... .. .. .. . . . . . ... .. . .. . . 16.7 8.645-64 years., .. . . .. .. . .. . .. . . .. . . . . 15.5 10.265 years and over .. . .. .. . . . .. . . 10.1 6.3

White patients outnumbered patients ofother races not only in absolute numbers ofvisits but also in visit rate per annum (table 2).

Major Reasons for Visit

The information in items 5 and 8 of the Pa-tient Record represents an effort to determine

the reasons for visiting the physician’s office, asexpressed by patients in their own words. Theterms and codes applied to the patient symp-toms, complaints, or other problems Ieadkg tothe visit came from a symptom classificationdeveloped for use in NANICS.5

Table 3 lists the 25 reasons most frequentlypresented.

Of all morbid states (e.g., conditions of ill-ness or injury) presented to office-based phy-sicians, about 55 percent were acute problems;about 45 percent were chronic. An acute prob-lem was defined as a condition having a rel-atively sudden or recent onset (i.e., within 3months of the visit). A chronic problem was de-fined as a preexisting condition with an onset of3 months or more before the visit.

The extensive role played by the office-basedphysician in family planning is underscored bythe finding that an estimated 7.3 million visitswere made at least partly for the purpose of ob-taining such services.

Principal Diagnosis

Table 4 lists the 25 most common, principaldiagnoses that were provisionally or finally as-signed to office visits by the physician. The clia-gnostic terms and codes are found in the EighthRevision lnternat ional Classification of Dtieascs,Adapted for Use in the Un;ted States (ICDA).Table 5 shows the classification of all principaldiagnoses by the major diagnostic (ICDA)groups. Table 6 offers diagnostic informationtabulated according to the age, sex, and color”of the patient.

The following fi~~e diagnostic groups ac-counted for an estimated 57 percent of all prin-cipal diagnoses rendered by physicians in officepractice.

Percent ofICDA &TOUfJ all principal

diagnoses

Special conditions 1 and examina-tions without illness ... . . .. .. .. . . .. .. .. .. 17.8

Diseases of the respiratory system .. . 14.1Diseases of the circulatory system ... 9.9Diseases of the nervous system

and sense organs ... . .. . .. .. . . . . .. .. . .. .. .. . 7.9Accidents, poisoning, and violence.. 7.2

1chiefly imm~nization, prenatal and postnatal care,

medical and surgical aftercare.

Visits lor respiratory diseases were morethan twice as frequent among patients under 15years as among patients of 15 years and over.

Visits for circulatory diseases accounted forthe largest proportion of all visits made by pa-tients over 44 years of age.

Visits for mental disorders were more com-mon in the age inter~,al from 25-44 yearsthan in other age intervals.

Visits for respiratory illnesses and for con-ditions resulting from accidents, poisoning, andviolence were substantially more commonamong males than among females.

Though overall visits by females out-numbered visits by males (table 1), in only twoof the diagnostic groups were visits by femalesmarkedly more common than those by males.These groups were “diseases of the genitourinarysystem” and the prevent ive and maintenance cat-egory “special conditions and examinations

Diagnostic and Therapeutic Services

Drug therapy was the most frequent form oftherapy provided in office-based practice. About44 percent of all visits resulted in treatment by aprescribed drug (table 7).

“Counseling” and “listening” were checkedby a physician only when they constituted a ma-jor part of the treatment provided during thevisit. The overall use of such intangible servicesis aImost impossible to quantify. Certainly, thefinding that these services were prominent infewer than 1 of every 5 visits understates theactual extent of this important aspect of thephysician’s office practice.

Prior Visit Status

The average office-based physician● Dealt chiefly with patients that he had

seen before (“old” patients). New FiI-tients accounted for onlv about 1 of. .

w;thout illness. ” every 7 visits (ta>les 8 and ‘g).

Figure 2. PERCENT OF OFFICE VISITS BY DEGREE OF SERIOUSNESS OF PATlENT’S PROBLEM, BY PATlENT’S AGEAND SEX: UNITED STATES, JANUARY-DECEMBER 1975

Fsssiss ‘otserious ~ Somedegree of seriousness

loo–

80 –

p~ 60 –>uo1-~C-) 40 _IIun

20 –

o —Under 25 2544 45-64 65 and over

AGE IN YEARS

—Female Male

SEX

a&mdata5

. Dealt chiefly with problems for which hehad treated the patient before (“old”problems). Only about 1 of every 4 visitsby an old patient concerned a new prob-lem.

Seriousness of Problem

These data express the physician’s judgmentas to the extent .of impairment that might resultif no care were available for the given problem.

Office-based ambulatory care does not cen-ter on the treatment of problems which are“serious to very serious” in prognosis. (Onlyabout 1 of every 5 visits was placed in thiscategory. See tables 8 and 9).

The largest proportion of visits (an esti-mated 49 percent) was given a “not serious”evaluation. This is no doubt due in largedegree to the substantial amount of preventivecare and routine maintenance care providedin the physician’s office, and to the relativelyhigh prevalence of acute, self-limiting conditionsencountered there.

Figure 2 shows the influence on judgmentsof seriousness produced by patient age andsex.

Disposition and Duration of Visit

Some form of scheduled followup was therule in office-based practice. In about 60 percentof visits the patient was directed to return at aspecified time (table 8).

Only 2 percent of visits ended in hospitaladmission.

Though it varied appreciably among specificspecialists, the average tendency to refer patients(found in 3 percent of visits) is perhaps anunderstatement. It may not realistically reflectthe actuzd amount of informal referral andconsultation that may occur, especially in amultiple-member practice.

Duration of visit is defined to include onlythe time spent in face-to-face encounter betweenphysician and patient (table 8).

The average encounter was of relatively briefduration-about 15 minutes. The following ta-ble shows the mean duration of an office en-counter with each of the 13 most \’isitedspecialists.

Specialty Mean duration(in minutes)

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

General and family practice ....... .... ..Internal medicine ...... ..... ............. ....Obstetrics and gynecology ..... ..... .....Pe&atrics ..... .. .... ...... ..... .. ....... ..... ... ..General surgery .... ... .. ................. .....Ophthalmology ........... .... .... .. ........ ..Orthopedic surgery ..................... .....Otolaryngology ........... ..... ....... ........Psychiatry ............................... ... .....Dermatology ................ .. ..... ..... ..... ..Urology .............. ....... ........... ...........Cardiovascular disease ................... ..Neurology ..... .......... .. ........ ....... ..... ..

15.0

12.618.213.112.112.720.314.513.646.911.915.021.535.5

REFERENCES

1National Center for Health Statistics: The NationalAmbulatory Medical Care Survey: 1973 Summary,United States, May 1973-Apnl 1974. Vital and HealthStatistics. Series 13, No. 21. DHEW Pub. No. (HRA)76-1772. Health Resources Administration. Washington.U.S. Government Printing Office, Oct. 1975.

2National Center for Health Statistics: NationalAmbulatory Medical Care Survey: hlay 1973-April 1974.Monthly Vital Statistics Report. Vol. 24, No. 4, Sup-plement (2). DHEW Pub. No. (HRA) 76-1120. HealthResources Administration. Hyattsville, Md. July 1975.

3National Center for Health Statistics: NationalAmbulatory Medical Care Survey: National AmbulatoryMedical Care Survey of Vkits to General and FamilyPhysicians, January 1974-December 1974. Monthly

Vital Statistics Report. Vol. 25, No. 2 Supplement (2).DHEW Pub. No. (HRA) 76-1120. Health ResourcesAdministration. Hyattsville, Md. May 1976.

4 National Center for Health Statistics: NationalAmbulatory Medical Care Survey: background andmethodology, United States. Vital and Health Statistics.Series 2, No. 61. DHEW Pub. No. (HRA) 76-1335.Health Resources Administration. Washington. U.S.Government Printing Office, .4pr. 1974.

5National Center for Health Statistics: The NationalAmbulatory Medical Care Survey: symptom classifica-tion, United States. Vital and Health Statistics. Series 2,No. 63. DHEW Pub. No. (HRA) 74-1337. HealthResources Administration. Washington. U.S. Gover-nmentPrinting Office, May 1974.

6 advancedata

Table 1. Number and percent distributions of office visits by selected physiciancharacteristics: United States, January-December 1975

Selected physician characteristics

All visits ------------------------

Most visited specialties

General and family practice -------------Internal medicine -----------------------Obstetrics and gynecology ---------------Pediatrics ------------------------------General surgery-------------------------Ophthalmology ---------------------------Orthopedic surgery----------------------Otolaryngology --------------------------Psychiatry ------------------------------Dermatology -----------------------------Urology---------------------------------Cardiovascular diseases -----------------Neurology -------------------------------All other specialties -------------------

Type of practice

solo ------------------------------------OtherI----------------------------------

Locationz

Metropolitan ----------------------------Nonmetropolitan -------------------------

Numberof visits

inthousands

567,600

234,66062,11748,07646,68441,29224,66719,31616,35514.80614;09410,8327.5562;032

25,113

339>554228,046

413,685153,915

Percentof

visits

100.0

41.310.98.58.2

2::3.42.92.62.51.9

$::4.4

59.840.2

72,927,,1

llkcludes partnership and group practices.‘Signifies location within or outside the standard metropolitan statistical areas

(94SA’S).

SYMBOLS

Datanotavailable--------------------------------------

Categorynotapplicable------------------------------...

Quantityzero----------------------------------------

Quantitymore thanO butlessthan0.05----- 0.0

Figuredoesnotmeetstandardsofreliabilityorprecision----—--—------------*

ackmeda7

Table 2. Number and percent distributions of office visits and number of visits perperson per yearl by selected patient characteristics:United States, January-December1975

Selected patient characteristics

All visits----------------------------

Age—

Under 15 years------------------------------15-24 years---------------------------------25-44 years---------------------------------45-64 years---------------------------------65 years and over---------------------------

Sex—

Female--------------------------------------Male----------------------------------------

Color

White---------------------------------------All other-----------------------------------

Numberof visits

inthousands

567,600

99,01086,570143,5251;:,;;;

9

342,896224,704

508,67258,928

Percentof

visits

100.0

17.415.325.325.616.4

89.610.4

Numberof visits

perpersonper year

2.7

2.82.2

lBased on population estimates for July 1, 1975 furnished by the Bureau of theCensus.

Table 3. Number, percent and cumulative percent of office visits, by most common pro-blems, complaints or symptoms classified by NAMCS code in rank order: United States,January-December 1975

Most comnon problem, complaint, orRANK symptom (coded)

Surgical aftercare----------------------986Physical exmhation----------------goo-golPregnancy examination-------------------9O5Pain, swelling, injury-lower extremity--4OOPain, swelling, injury-back region------4l5Sore throat-----------------------------52OPain, swelling, injury-upper extremity--4O5Abdominal pain--------------------------54O

-----------------------------------311CoughVisit for medication--------------------9lOGynecologic examination-----------------9O4Fatigue---------------------------------OO4Headache--------------------------------O56Allergic skin reaction------------------ll2Pain in chest---------------------------322Cold------------------------------------312~a;~zby examination-------------------9O6

---------------------------------735High blood pressure---------------------2O5Pain, swelling, injury-face and neck----4lOWounds of skin--------------------------ll6Eye examination-------------------------9O8Vision dysfunction, except blindness----7OlFever-----------------------------------OO2Vertigo---------------------------------O69

Nunberof visits

inthousands

26,09023,51822,06521,22917,06715,27914,93314,86213,60711,89311,09210,46610,1989,8279,7519,4538,2917,7547,7157,5557,5337,0607,0227,0156,315

Percentof

visits

4.64.13.9

M2.72.6

;:;2.12.0

R1.71.7

::<1.4

::!

::;1.21.21.1

hum-dativepercent

4.6

1!::16.319.322.024.627.2;;.:

33:735.537,339.040.742.443.945.346.748.0;:.;

51:752.954.0

8 aciwncedata

Table 4. Number, percent and cumulative percent of office visits by most common prin-cipal diagnoses by ICDA code: United States, January-December 1975

RANK

1

:45

678

1:

:;13141516

17

::202122232425

Most common principaldiagnosis (coded)

Medical or special examination------YOOMedical and surgical aftercare------YlOEssential benign hypertension-------4OlPrenatal care-----------------------yO6Acute respiratory infection, siteunspecified------------------------465

Neuroses----------------------------3OOChronic ischemic heart disease------4l2Otitis media------------------------38lDiabetes mellitus-------------------25OOther eczema and dermatitis---------692Acute pharyngitis-------------------462Refractive errors-------------------37OHay fever---------------------------5O7Obesity-----------------------------277Bronchitis, unqualified-------------49OObservation, without need forfurther medical care---------------793

Acute tonsillitis-------------------463Synovitis, bursitis-----------------73lInfluenza, unqualified--------------47OCystitis----------------------------595Diseases of sebaceous glands--------7O6Osteoarthritis----------------------7l3Arthritis, unspecified-------------- 715Inoculations and vaccinations-------YO2Asthma------------------------------493

Numberof visits

inthousands

40,86326,78222,82420,851

14,60713,64112,5139,8999,6719.6678;5318,1697,6757,5696,872

6,7946,4056,1715,8665,7215,5935,4454,8924,8464,633

Percentof

visits

;:?4.03.7

2.62.42.21.71.71.71.51.41.41.31.2

1.01.0

M0.90.90.8

Cumulativepercent

1;::15.919.6

22.224.626.828.530.231.933.434.836.237.538.7

39.941.042.143.144.145.146.147.047.948.7

Table 5. Number and percent distribution of office visita by principal diagnosis clas-sified by major ICDA group: United States, January-December 1975

1

Principal diagnosis classifiedby major ICDA group (coded)

All principal diagnoses----------------------------------

Infective and parasitic diseases------------------------000-136Neoplasma-----------------------------------------------l4O-239Endocrine, nutritional, snd metabolic diseases----------24O-279Diseases of the blood and blood-forming organs----------28O-289Mental disorders----------------------------------------29O-3l5Diseases of the nervous system and sense organs---------32O-389Diseases of the circulatory system----------------------390-458Diseases of the respiratory ayatem----------------------46O-5l9Diseases of the digestive system------------------------520-577Diseases of the genitourinary system---’----------------580-629Diseases of the skin and subcutaneous tissue------------68O-7O9Diseases of the musculoskeletal system------------------7lO-738Symptoms and ill-defined conditions---------------------78O-796Accidents, poisoninga, and violence---------------------8OO-999Special conditions and examinations without sickness----YY13Yl3Other diagnosesl-----------------------------------------------Diagnosis “none” or unknown -----------------------------------

Number>f visits

tho~~ands

567,600

22,74713,33224,1774,74425,06144,94156,35880,12520,06137,62628,56432,73226,17740,893100,7873,3125,963

Percentdistri-bution ofvisits

100.0

4.02.44.3

i:;

;:;14.13.56.65.05.8~.;

17;80.61.1

1Complications of pregnancy, childbirth, and the puerperium; congenital anomalies;

and certain causes of perinatal morbidity and mortality.2.1ncludeablank, noncodeable, and illegible diagnoses.

a&medaa9

Table 6. Number of office visits by selected patient characteristicsand percent distributionof office visits,byprincipal diagnoses as classifiedby major ICDA groups: United States, January-December1975

Age I Sex I Cal.orPrincipal diagnosis classifiedby major ICDA group (coded)

Uncler 15-24 25-44 45-64 65 years Female15 years years years years and over Male mite Other

99,010 186,571 I143,525 1145,434 I 93,061 1342,896[224,704]508,672 I 58,928All principal diagnoses----

Percent distribution

100.0 100.0 100.0Total-------------------- 100.0

4.12.0

4.87.9

6.0

4.6

12.1

3.4

9.2

4.5

5.1

5.4

8.0

20.92.0

100.0 100.0100.0

Infective and parasiticdiseases---------------OOO-l36

Neoplasms---------------l4O-239Endocrine,nutritional, andmetabolic diseases-----240-279

Mental disolders--------290-315Diseases of the nervous sys-tem and sense organ+ --320-389

Diseases of the circulatorysystem-----------------390-458

Diseases of the respiratorysystem-----------------46O-519

Diseases of the digestivesystem--.--------------52O-577

Diseases of the gcnitourinarysystem-----------------580-629

Diseases of the skin andsubcutaneoustissue----687097O9

Diseases of the muscu-loskeletal system------7lO-738

Symptoms and ill-definedconditions-------------78O-796

Accidents, poisonings, aadviolence---------------8OO-999Special condition~ and exs...is.ationswithoutillness----------------’iOO-Sl3

Residual’----------------------

5.41.2

2.23.5

:;:

7.4

16.6

11.7

4.5

7.5

4.1

9.0

4.7

6.7

10.21.7

::;6.32.5

9.4

25.9

8.4

4.8

5.5

3.6

9.3

3.7

4.5

6.92.9

:::

.2::7.6

9.2

12.4

3.3

8.6

4.8

5.8

4.8

5.0

2;.!

4.32.2

i:;

8.4

11.0

16.8

3.9

3.6

5.4

6.0

4.4

10.6

14.41.6

R4.24.5

8.1

10.0

14.0

3.5

6.4

5.1

5.8

4.b

7.1

17.92.5

4.91.6

4.73.3

6.8

9.4

15.2

3.6

8.2

4.5

5.8

4.7

8.4

16.72.2

0.91.5

11.7

0.5

26.9

1.8

1.8

6.3

1.7

2.44.1

6.2

1.3

13.1

2.8

7.8

7.7

2.4

4.3 4.6

7.6 9.4

24.7 I 29.02.7 2.6

lDiscasesof blood or blood-.fc!rmin~ctrgans;ccnplications of pregsancy, childbirth, and the puerp~.rium; con-genital anomalies; certain caux!s of pcrinatalmorbidity and nortality; diagnosis ““me” ar unknown.

Table 7. Number and percent distributionof office visits by diagnostic and therapeu-tic services provided:United States, January-December1975

Numberof visits

inthousands

Percentof

visits’Diagnosticand therapeuticservice provided

All visits -------------------------------------- 567,6oO 100.0

No services provided

Diagrqstic servicesLimited history or e:.:mination----------------------General history or examination----------------------Clinical lab test-----------------------------------X-Ray--------------.--------------------------------Blood pressure check--------------------------------EKG-------------------------------------------------Hearing test----------------------------------------Vision test-----------------------------------------Endoscopy-------------------------------------------

Therapeutic servicesDrug prescribed-------------------------------------Injection-------------------------------------------Immunizationor desensitization---------------------Office surgery--------------------------------------Physiotherap)~---------------------------------------Medical counseling----------------------------------Psychotherapyor therapeuticlistening--------------

Other servicesprovided-------------------------------

15,~oo 2.7

291,29489,377129,74041,701188,180L9,21O7,36926,6506,696

51.315.822.97.433.23.4

:::

251,53878,08525,70437,99112,56569,72124,234

44.31:.:

6:7

1;:$4.3

32,738 5.8

lWill not add to totals since more than one service might be provided.

10

Table 8. Number and percent distributions of office visits by selected characteris-tics of visit: United States, January-December 1975

Selected characteristics of visit

All visits ---------------------------------------

Prior Visit Status

New patient ------------------------- -------------------Old patient, new problem -------------------------------Old patient, old problem ---------------------- -------


Serious and very serious -------------------------------Slightly serious ------------------------------------- --Not serious ------------------ --------------------------

Diapositionl

No followup ------------------------------ --------------Return at specified time -------------------------------Return if needed ----------------- ----------------------Telephone followup -------------------------------------Referred to other physician or agency ------------------Returned to referring physician ------------------------Admit to hospital --------------------------------------

Duration of Visitz

O minutes (no face-to-face encounter withphysician)--------------------------------------------1-5 minutes ----------------- ---------------------------6-10 minutea -------------------------------------------11-15 minutes ------------------------------------------16-30 minutes ------------------------------------------31 minutes or more --------------------------------------

Numb erof visits

inthousands

567,600

84,807132,848349,945

106,981183,697276,923

74,542335,219126,63020,83416,0425,064

12,062

6,78191,730

177,442151,9641::, :;;

,

Percentof

visits

100.0

14.923.461.7

18.832.448.8

13.159.122.33.72.8

1::231.326.819.05.6

‘Will not add to totals since more than one disposition was possible.Zsignifies time spent in face-to-face encounter between physician and Patient.

Table 9. Number and percent distributions of office visits by selected patient characteristics,according to prior visit status and1975

seriousness of problem: United States, January-December

Selected patientcharacteristics

All visits-----

Age—

Under 15 years-------15-24 years----------25-44 years----------45-64 years----------65 years and over----

Sex—

Female---------------Male-----------------

Color

White----------------Other----------------

ofvisits

inthou-sands

567,600

99,01086,571143,525145,43493,061

342,896224,704

508,67258,928

Percentof

visits

100.0

100.0100.0100.0100.0100.0

100.0100.0

100.0100.0

Prior visit status

Newpatient

14.9

15.921.117.911.98.4

13.816.7

14.518.5

TOId Oldpatient patientnew old

problem problem

-a-T7

35.5 48.626.4 52.522.1 60.019.4 68.716.0 75.6

22.6 63.624.6 58.7

23.0 62.527.1 54.4

Seriousness of problem

Seriousor

veryserious

18.8

11.211.5L6.823.729.4

17.121.5

19.017.7

Slightly Notserious serious

F32.4 48.8

30.9 57.927.3 61.331.2 52.035.5 40.835.6 35.0

31.4 51.533.8 44.7

admceMa 11

TECHNICAL NOTES

SOURCE OF DATA: Data presented in this re-port were obtained during 1975 through theNat ion al Ambulatory Medical Care Survey(NAMCS). The target population of NAMCS en-compasses office visits within the conterminousUnited States made by ambulatory patients tophysicians who are principally engaged in officepractice.SAMPLE DESIGN: The 1975 NAMCS utilized amultistage probability desi~ that involved sam-ples of primary sampling units (PSU’S), physi-cian practices within PSU’S, and patient visitswithin practices. Within the 87 PSU’S composingthe first stage of selection, a sample of approxi-mately 3,500 physicians was selected from mas-ter files maintained by the American MedicalAssociation and the American Osteopathic Asso-ciation. Sampled physicians, randomly assignedto 1 of the 52 weeks in the survey year, wererequested to complete Patient Records (figure 1)for a systematic random sample of office visitstaking place within their practice during the as-signed reporting period. Additional data con-cerning physician practice characteristics such asprimary specialty and type of practice were ob-tained during an induction interview.

A complete description of the survey’s back-ground and development has been presented inan earlier publication in Series 2 of Vital and

Health Statistics (No. 61. DHEW Pub. NTO.

(HRA) 76-1335. Health Resources Administra-tion. Washington. U.S. Government PrintingOffice, Apr. 1974). A detailed description of the1975 NAMCS design and procedures will bepresented in future publications.SAMPLING ERRORS: Since the estimates forthis report are based on a sample rather than theentire universe, they are subject to sampling vari-ability. The standard error is primarily a measureof sampling variability. The relative standard er-ror of an estimate is obtained by dividing thestandard error of the estimate by the estimateitself and is expressed as a percent of the esti-mate. Relative standard errors of selected aggre-gate statistics are shown in table I. The standarderrors appropriate for the estimated percentagesof office visits are shown in table II.ROUNDING: Aggregate estimates of office visitspresented in the tables are rounded to the near-

est thousand. The rates and percents, however,were calculated on the basis of original, un-rounded figures. Due to rounding of percents,the sum of percentages may not equal 100.0 per-cent.

Table 1. Approximate relative standard errors of estimated, num-bers of office visits

—..

Estimate Relative standardin error in

thousands percentage points

500 .... .. ... .. .. .... . .. .... .... .. . . ..... ... .. 30.11,000 ....................................... 21.42,000....................................... 15,35,000....................................... 10.010,000 .. .... .. . .... . .. ... .. .. .. ... . .... .. . . 7.530,000..................................... 5.1100,000 ................................... 4.0550,000................................... 3.5

Example of use of table: An aggregate of 80,000,000 has arelative standard error of 4.3 percent or a standard error of3,440,000 (4.3 percent of 80,000,000).

Table 11. Approximate standard errors of percentages for esti-mated numbers of office visits

— -.—. —1

I Estimated percentageBase of percentage(number of visits

r1 or

in thousands), 99

1,000 ..................... 2.13,000..................... 1.25,000,.................... 0.910,000................... 0.750,000................... 0.3100,000 .. ... . ... .. .... . . 0.2500,000 ...... . .. ... ... .. 0.1

-L5or lOor

95 90

4.6 I 6.32.7 3.72.1 2.81.5 2.00.7 0.90.5 0.60.2 0.3

I I

8.54.93.82.71.2

0.80.4

9.7 10.65.6 6.14.3 4.73.1 3.31.4 1.51.0 1.10.4 0.5

Example of use of table: An estimate of 30 percent based onan aggregate of 75,000,000 has a standard error of 1.2 percent.The relative standard error of 30 percent is 4.0 percent (1.2 per-cent+30 percent).

DE FINTITIONS: An am bulatcmy patient is anindividual presenting himself for personaI healthservices who is neither bedridden nor currentlyadmitted to any health care institution on thepremises.

An office is a place that the physician identi-fies as a location for his ambulatory practice.

12 advancedata

Responsibility over time for patient care andprofessional services rendered there generally re-sides with the individual physician rather thanan institution.

A visit is a direct personal exchange betweenan ambulatory patient and a physician or a staffmember working under the physician’s super-vision for the purpose of seeking care andrendering health services.

A physician is a duly licensed doctor of med-

icine (M. D.) or doctor of osteopathy (D.O.) cur-rently in practice who spends time in caring forambulatory patients at an office location. Ex-cluded from NAMCS are physicians who spe-cialize in anesthesiology, pathology, radiology;physicians who are FederalIy employed; ph ysi-cians who treat only institutionalized patients;physicians employed full time by an institution;and physicians who spend no time seeing ambu-latory patients.

GPO 919.620

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

US. DEPARTMENT OF HEALTH, ECUCATION, AND WELFARE j No. 13 October 13, 1977 I Pubhc Health Serwce. Health Resources Adm!ntstratmn

Ambulatory Medical CareRendered in Pediatricians’ Offices During 1975a

This report presents statistics concerning anestimated 46.7 million visits to the officesof pediatricians practicing in the coterminousUnited States. The data were collected duringcalendar year 1975 in the National AmbulatoryMedical Care Survey (NAMCS), a continuoussurvey conducted yearly by the National Centerfor Health Statistics.

The estimates presented are based on infor-mation obtained from the “Patient Record,” afacsimile of which can be found in Ad\rance DataNo. 12. This form is used by sample physiciansto record selected information about their officeencounters. The sampling errors associated withthese estimates and information concerning thesample design used by the 1975 NANICS arepresented in the section, “Technical Notes,”that follows.

HIGHLIGHTS

During 1975 there were an estimated 567.6million visits to “office-based, patient-care”physicians practicing in the coterminous UnitedStates. The estimated total yearly volume ofoffice-based ambulatory medicaI care by spe-cialty is shown in table A. In terms of total of-fice visits, the 46,684,000 visits to pediatriciansranked fourth among all physician specialties.

Forty-two percent of these visits were topediatricians in practice by themselves while theremaining 58 percent were to pediatricians prac-ticing in a group or partnership arrangement.

a~hi~~e.oti ~a~ prep~ed by Trena Ezzati, Division

of Health Resources Utilization Statistics.

Table A. Number and percent distribution of office visits, byselected physician specialties: United States, 1975

I INumber of

Physician specialtyPercent

visits indistribution

thousands 1

All specialties ... .. .. .... .. .. ... . . 567,600 100.0

General family practice .... . . .... . 234,660 41.3Internal medicine . .. ... .. . .... .. . ... . 62,117 10.9Obstetrics/gynecology .. ..... .. .. .. 48,076 8.5PEDIATRICS . .. .... .. .. ... . .. .... .. .. . 46,684 8.2General surgery .... ... . ... .. .. ... .... . 41,292 7.3All other specialties ... .. .. .. .... .. . . 134,771 23.8

1Due to ~ ~efjnement of the NAMCS estimfiting procedurt

used to project notional estimates from stimple datir, cisutionshould be used when comparing these estimated numbers ~)foffice visits with previously published estimates for 1973 and1974.

Visits to pediatricians by males (52,3 per-cent) outnumbered those by females (47.7 per-cent), whereas the proportion of visits to allphysicians by females exceeded that by males(figure 1).

Information regarding the age distribution ofvisits to pediatricians is presented in figure 2. Anegative correlation exists between age and thenumber of visits to pediatricians, i.e., as the ageof patients increases, the number of visits de-creases. Less than 2 percent of the visits to pe-diatricians were by patients over 19 years of ageand only 5 percent were by patients 15-18 years ofage. Thus, the major portion of visits to pediatri-cians was by patients under 15 years of age.

Visit rates further show that there weremore visits made by chiIdren under 2 years ofage than by children in any other age group(table B), thus reflecting the most frequent rea-

2 &ncedata

Figure 1, PERCENT OF OFFICE VISITS, BY SEX: UNITEDSTATES, 1975

70

60

L’G5 50UJ0L 40

k

g 30

$g 20uLuL

10

0Female Male

Figure 2. PERCENT OF OFFICE VISITS TO PEDIATRI-CIANS, BY AGE OF PATl ENT: UNITED STATES, 1975

35

V)k 30Sn5~ 25a+ 200+

: 15

kR 1(J

c1U5wn

oUnder 2 2-5 6-10 11-14 15 and

over

AGE IN YEARS

Table B. Rate of office visits per 100 parsons by age: UnitedStates, 1975

I

Age I Rate

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

r

58

Under 2 yearn .. . .. ..... .. .. .... .. . .. ... ... .. .... .. . .... ... 2442-5 years . .... .... .. .. .... .. .. .... .. .. ...... . . .... .. .. .. .. .. . 1066-10 years ... .... .. .. .... .. .. ... .... . .... .... . .... . .... .. ... 5711-14 years ..... .. ... ... .... .. .. .. .... ... ... . ..... . . .. ... .. 3315-1 B years .... ... .. .... .. .. ...... .. .. .... .. . .... . ... .... .. 16

son for visiting a pediatrician—the well-baby ex-amination.

In addition to the well-baby examination,other common reasons for visits to pediatriciansas presented in the patient’s own words (orwhen necessary, the words of the parent or ac-companying adult) are show-n in table 1. These14 probIems, complaints, or symptoms ac-counted for about 67 percent of all visits. Thisreveals a relatively narrow clinicaI range for pe-diatricians as compared with the more variedrange for general and family practitioners whereit requires nearly two and one-half times asmany problems to account for a comparable 67percent of their visits. For about one of everythree visits to pediatricians, a “nonsympto-matic” problem (generally an examination) wasthe reason for a visit. Among “symptomatic”problems presented to pediatricians, cough,fever, sore throat, and earache were the mostcommon.

Data on the physician’s judgment of the seri-ousness of the patient’s probIem, complaint, orsymptom (in terms of the extent of impairmentthat might resuIt if no care were obtained) re-vealed that only 10 percent of the visits to pe-diatricians were “serious or very serious” (tabIeC). The proportion of conditions categorized as“not serious” (60 percent) is in part a reflectionof the relatively Iarge number of visits involvingexaminations and acute, self-limiting problemscommon to children.

Table C. Percent distribution of visits to pediatricians by degreeof seriousness of patient’s problem: United States, 1975

Degree of seriousness I Percentdistribution

Total .. .. ... .. .. .... ... .. ... ... . ..... . ... ..... . .. ... .. ... I 100.0

Serious or very serious ... .. .. .... .. .. .. .. .. .. .... .. .. 10.1

Slightly serious . .. .... . ... ... .. .. ..... .. .. .. .. . .. ..... . ... 29.5

Not serious . ... .. .... ... . .. .... .. .. .... .. .. . ... .. .. .... .. .. . 60.4

Data presented in table 2 provide statisticson. the most frequent physician diagnoses asso-ciated with the reasons for office visits topediatricians. The physician’s principal diagno-sis refers to the diagnosis listed first in item

acwncedata 3

9 of the Patient Record. The diagnostic dataare grouped by the classes used in the EighthRevision International Classification of Dis-eases, Adapted for Use in the United States(ICDA). As might be predicted from the previ-ous statistics presented on problems, the ICDAcategory “special conditions and examinationswithout illness” was the largest. This also re-flects that about one-third of all visits made topediatricians were for well-child care. In compar-ison with all other physicians, only obstetri-cians/gynecologists exceeded pediatricians in theproportion of visits for special conditions andexaminations (57 percent). The second most fre-quent category of illness or injury diagnosed bypediatricians were diseases of the respiratorysystem (28 percent). Acute pharyngitis, acutetonsillitis, acute upper respiratory infection, andbronchitis, unqualified, comprised over one-half(60 percent) of the diagnoses associated withdiseases of the respiratory system.

Further information abstracted from thePatient Record shows that the majority of visits(91 percent) to pediatricians were made by pa-tients who had seen the physician before (tableD).

Table D. Percent distribution of patient visits to pediatricians bypatient’s prior visit status: United States, 1975

IPatient’s prior-visit status Percent distribution

Total .. ... ..... .. . ... .. .. .... .. .. ... .. .. .... .. . ..... . .. .. 100.0

New patient . ... .. .. ... .. ... .... .. .. ... . ... ... .. .. .... .. .. . 9.2

Old patient, new problem ..... .. .. .. .... .. .... . ... . I 41.5

Old patient, old problem ... .. . ... . .. . .... .. . .... .. . . 49.3

However, the percentage of new problemspresented to pediatricians (51 percent) propor-tionately exceeded that for all physicians (38percent).

Further reflecting the large number of visitsto pediatricians for routine examinations, his-tory or examinations (either limited or general)were the most common diagnostic services pro-vided (table 3). The proportion of visits at whichhistory or examinations were performed wasgenerally higher for pediatricians than for allphysicians. Likewise the percentage of visitswhere medical counseling was a significant partof the office visit exceeded the percentage for allphysicians. On the other hand, the pediatricianfell below the overall average in the proportionof visits involving blood pressure checks, officesurgery, x-rays, and the prescription of drugs.The relatively large proportion of visits to pedia-tricians at which immunizations or desensitiza-tions were provided (23 percent) reflects the agecomposition of patients.

The duration of the visit represents theamount of time spent by the patient in face-to-face contact with the physician. The average en-counter time between pediatricians and their pa-tients was approximately 12 minutes, ascompared to an average time duration of 15minutes per visit for all physicians.

Finally, data on disposition (table 3) revealthat pediatricians, when compared to aU physi-cians, were more likeIy to have a telephone fol-Iowup and less likely to schedule a return visit,thus indicating acute, self limiting problemscharacteristic of children. No followup was plan-ned after 24 percent of the visits, thus reflectingthe large amount of well-child care occurring atambulatory pediatric office visits.

4 acklncedata

Table 1. Number, percent, and cumulative percent of office visits to pediatricians, by the most com-mon patient problems, complaints, or symptoms: United States, 1975

Most common patient problems, complaints or

symptoms (NAMCS code)

Well-baby examination .. ... . .. .. . .. . . .. . . .. .. . .. .. .. .. . . . .. . .. ...906General medical examination .. .. . .. . . .. .. . .. .. . .. .. .. .. . .. ...900Cough .. . . .. .. .. . .. .. . .. .. .. .. .. . .. . .. .. . . .. . .. .. . . . .. .. .. .. . .. . . ... . . .. .. .311Fever . .. .. .. . .. . .. ... . .. .. .. .. . . . .. . .. .. .. .. . .. .. .. . .. . . .. . .. ... . ... . . .. . ..OO2Visit for medication .. .. . ... . . .. .. .. . .. .. . .. ... . .. . . . .. . . . .. .. .. . ..91 OThroat soreness .. . .. .. . .. . . .. . .. . . .. . .. .. .. . . . ... . . . . .. . . .. .. .. . .. . ..52OEarache .. . . .. .. .. .. . .. . .. . . .. .. .. .. . .. . . .. .. .. . .. .. . . . .. .. . .. .. .. .. . .. ...735Allergic skin reactions .. .. .. . . .. . .. . .. .. .. . .. . . .. .. . .. .. .. .. . .. ...112Cold ... .. .. .. .. .. . .. . .. . .. . ... . . . .. . .. . .. . .. . .. .. .. . .. . . .. . .. .. . . .. .. . .. . ..3l2Required physical examination .. .. .. . .. .. .. . .. .. .. .. .. . .. ...901Abdominal pain .. . .. . .. .. .. .. .. . .. . . . .. .. . . .. . .. .. .. . .. .. .. .. .. . .. . ..54OWounds of skin.... . ... . .. .. .. . . ... .. . .. .. . .. . .. . .. .. .. . .. .. .. .. . .. . ..ll6Nausea and vomiting .. .. . .. ... . . .. . . .. .. . . . .. . . .. .. . ... . .. .. . .. ...572Problems of lower extremity .. .. .. .. . ... . .. .. .. . .. . . . ... . .. ...400

1Based on a total of 46,684,000 office visits.

Number ofvisits

in thousands

6,2334,6873,4253,1702,8592,4392,0011,6621,464

974764745571531

Percent ofvisits’

13.410.0

7.36.86.15.24.33.63.12.11.61.61.21.1

SYMBOLS

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

Category not applicable ------------------------------ . . .

Quantity zero ----------------------------------------------- -

Quantity more than Obut less than 0.05 ----- 0.0

Figure does not meet standards ofreliability or precision ---------------------------- *

Cumulativepercent

13.423.430.737.543.648.853.156.759.861.963.565.166.367.4

ackincedata 5

Table Z: Number and percent of office visits to pediatricians, by principal diagnoses most frequentlyrendered by the physician: United States, 1975

Principal diagnoses most frequently rendered bythe physician (ICDA code)

Infective and parasitic diseases ... .. . .. .. . .. .. . .. . . . .. .. .. .. . .. .. . . . .. .. .. . .. . . . 001-136Streptococcal sore throat and scarlet feverOther viral diseases

. .. .. .. .. . .. . .. .. .. .. . .. . .. .. . ....034... .. . .. . . .. .. . . . . .. .. . ... . . . . .. .. .. .. . .. .. .. . .. .. . .. .. . . .. . .. .. . .. . . . 079

Diseases of nervous system and sense organs ... . . .. . .. .. .. . . ... . ... . .. . ..320-389Otitis media .. .. .. .. .. . .. . . .. . .. . . .. . .. . . . .. .. .. . . . .. . .. .. .. . .. . . .. .. . . . .. . .. .. . .. .. .. . .. .. ...38l

Diseases of respiratory system .. . . .. . .. .. . .. . . . .. .. .. .. . .. . . .. . .. . . .. . .. . .. .. .. .. 460.519Acute pharyngitis . .. .. .. . .. .. . . . .. .. .. .. . . . .. . .. .. . .. .. . . . .. .. .. . .. .. .. . .. .. .. . .. . . . .. . . ...462Acute tonsi[l itis . . .. .. . . .. . .. . . .. . .. .. .. . .. . . . .. .. .. . .. . .. . . .. . . .. . .. . . .. . .. .. . ...o.. . .. . ...463Acute laryngitis and tracheitis .. .. . .. . . .. .. . .. .. . .. . .. . . .. .. .. . .. . . . .. .. .. . .. .. .. . 464Acute upper respiratory infection .. . . .. .. .. .. . . .. . . .. .. .. .. . . . . .. ... . .. . .. .. . ....465Bronchitis, unqualified .. .. .. .. .. . .. .. . . . .. .. . . .. . . .. .. .. .. . . . . ... . . . .. . ... . . .. .. .. . .. . 490Asthma . .. .. . ... .. . . .. . . .. . . . .. . .. .. .. . .. . . . .. . . .. . .. .. . .. .. .. .. . . .. . . .. .. .. . .. .. .. . .. . .. .. . . .. 493Hay fever . .. .. .. . .. . . .. . .. .. .. . . . . .. . . .. .. . . .. . . .. .. .. . . .. . . .. .. .. .. . . . .. . .. .. . .. . . . .. . . .. . .. . 507

Diseases of skin and subcutaneous tissue ... . . . . .. .. . . . .. . . .. . .. . . . .. .. .. . . . . 680-709Other eczema and dermatitis . . . .. .. .. .. . .. . . . .. .. .. .. . . . .. . .. .. .. .. . . .. .. .. .. . .. . . .. 692

Symptoms and ill-defined conditions . .. .. .. . .. . .. .. .. .. .. . .. .. . .. .. .. . .. . ...780-796Observation, without need for further medical care . .. . .. . .. . .. .. . .. . ...793

Accidents, poisoning, and violence ... .. .. . . . . .. .. .. . .. .. . . .. .. . . . . .. .. .. . .. .. ..8 OO.999Special conditions and examinations without sickness . .. .. . .. .. . . .. YOO-Yl3

Medical or special examination .. .. .. .. . .. . . .. . .. . . .. . .. .. .. .. . .. . .. . . .. .. . .. .. .. ..YOOProphylactic inoculation and vaccination .. .. . . . .. . .. .. .. . . . .. . .. .. .. . .. . . .. ..YO2Medical and surgical aftercare . .. . . . .. .. .. .. . . .. . . .. .. .. .. .. . . . .. . .. .. . .. . . .. . .. .. ..Yl O

1Based on a total of 46,684,000 office visits.

Number of visitsin thousands

3,286771754

4,6253,795

13,2201,8391,477

5302,9441,731

729981

2,8471,5771,967

7262,174

15,13712,462

1,667841

Percent ofvisitsl

7.01.7

:::8.1

28.3

::;1.16.33.71.6

::;3.44.21.6

3;::26.7

3.61.8

6 advancedata

Table 3. Number and percent distributions of office visits to pediatricians by selected diagnostic or

therapeutic services ordered or provided and disposition of patient: United States, 1975.—

Selected diagnostic or therapeutic services orderedor provided and disposition of patient

Diagnostic services

Limited history /exam ... .. .. . .. . . .. . .. .. .. . .. .. .. .. . .. .. .. .. .. . .. .. .. .. .General history/exam .. . .. .. . .. . .. .. .. .. . . .. . .. . .. . . .. .. .. .. . .. . . .. .. . ..Clinical lab test . .. .. .. . . .. . . .. .. ... . .. .. .. . .. .. .. . .. .. .. .. .. . .. . . .. . .. .. .. ..Blood pressure check .. .. .. .. .. .. .. .. . . . .. . ... . . . .. . .. .. . .. . . .. .. .. .. .. ..Vision test .. .. . .. .. . .. .. . .. . .. .. .. .. .. .. . . .. . .. . .. .. .. . .. . .. .. . .. . .. .. .. .. . .. .X.ray ... .. . .. . .. .. .. .. .. .. .. . .. .. .. .. . .. .. .. .. . .. . . .. .. . .. .. .. .. .. . .. .. .. . .. . . .. .Hearing test ... .. .. . .. .. .. .. .. .. .. . .. . . .. . .. .. .. .. . .. ... . . .. .. .. .. . ... . . ... . . .

Therapeutic services

Drug prescribed ... .. .. .. .. .. .. .. .. .. .. .. . . .. . .. .. . . .. .. . .. .. .. . .. .. . .. .. . ..Immunization/desensitization ... .. .. . .. . . .. . .. . . .. . ... . .. .. .. .. .. . .Medical counseling .. .. .. .. .. .. .. .. .. . ... . .. .. .. . .. .. .. .. . ... . .. .. . .. .. . . .injection .. .. ... . .. . . .. .. . .. .. .. .. .. . .. . . . .. .. .. .. . .. .. . .. . . .. .. .. .. . .. .. . ... .. .Office surgery . ... . .. .. .. .. .. . .. . .. . . .. .. .. .. .. . .. . . .. . .. .. .. .. . .. .. . . .. .. . ..

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

Disposition of patient

No followup planned .. . .. . .. . .. .. .. . .. .. .. .. . .. . . .. .. . .. . . .. .. .. . .. .. .. .Return at specified time .. . . .. .. .. . .. . .. . . .. . . .. .. .. . . . .. .. . .. .. .. .. .. .Return if needed .. . . .. .. . .. .. .. .. . .. .. .. . .. .. .. .. .. . .. . . .. . .. . . .. . .. .. .. .Telephone followup planned ... .. .. .. .. .. . .. .. .. . .. .. .. . . .. .. . .. . .. .Referred to other physician or agency .. . .. .. .. . . .. .. . .. .. .. .. ..

Number of visitsin thousands

19,13615,61210,442

3,6121,9551,9331,277

19,23510,693

7,3224,3401,482

1,339

11,00520,79511,015

4,5971,365

Percentdistributions

41.033.422.4

7.74.24.12.7

41.222.915.7

9.33.2

2.9

23.644.523.6

9.92.9

1Percents may total more than 100.0 since more than one treatment or more than one disposition could be given at asingle visit.

TECHNICAL NOTES

SOURCE OF DATA: Data presented in this re-port were obtained during 1975 through theNational Ambulatory Medical Care Survey(NAMCS). The target population of NAMCS en-compasses office visits within the conterminousUnited States made by ambulatory patients tophysicians who are principally engaged in officepractice.SAMPLE DESIGN: The 1975 NAMCS utilized amultistage probability design that involved sam-ples of primary sampling units (PSU’S), physi-cian pmctices within PSU’S, and patient visitswithin practices. Within the 87 PSU’S composing

the first stage of selection, a sample of approxi-mately 3,500 physicians was selected from mas-ter files maintained by the American MedicalAssociation and the American Osteopathic Asso-ciation. Sampled physicians, randomly assignedto 1 of the 52 weeks in the survey year, wererequested to complete Patient Records (brief en-counter forms) for a systematic random sampleof office visits taking place within their practiceduring the assigned reporting period. (A fac-simile of the Patient Record used is shown in aprevious issue of Advance Data From Vital andHealth Statistics, No. 12, October 12, 1977.)

a&maata7

Additional data concerning physician practicecharacteristics such as primary specialty andtype of practice were obtained during an induc-tion interview.

A complete description of the survey’s bacli-ground and development has been presented inan earlier publication in Series 2 of Vital andHealth ~tdZktiCS (No. 61. DHEW Pub. No.(HRA) 76-1335. Health Resources Administra-tion. Washington. U.S. Government PrintingOffice, Apr. 1974). A detailed description of the1975 NAMCS design and procedures will bepresented in future publications.SAMPLING ERRORS: Since the estimates forthis report are based on a sample rather than theentire universe, they are subject to sampling vari-ability. The standard error is primarily a measureof sampling variability. The relative standard er-ror of an estimate is obtained by dividing thestandard error of the estimate by the estimateitself and is expressed as a percent of the esti-mate. Relative standard errors of selected aggre-gate statistics are shown in table I. The standard

Table 1. Approximate relative standard error of estimated num-ber of office visits

Estimated of f!ce visits Ralative standard error in

in thousands percentage points

500 ............................................... 30.1

1,000 .. ... .. .. ..... . .. .. ... . .. .. ... . .. ..... .. .. .. 21.4

2,000 .... .. .. .. .. ... ... ... .. ... .... . .. .... .. ... .. 15.35,000 .. .... . ... .... .. ... ... .. .. .... .. . ..... . .. . .. 10.010,000 ..... .. .. ..... .. . .... .. .. .... .. .. .. .. .. .. . 7.530,000 .... .. ... .... .. . .... .. . . ..... .. . .... .. .. .. 5.1100,000 ... ... . ..... .. .. ... . .. .. .... .. .. .... . .. . 4.0

550,000 .... ... .. ... .. ... ..... .. .... .. .. ... ... . . 3.5

Example of use of ruble, An ag~rqmcc of 80,000,000 IIUS o rela-tive standard crr~)r of 4.3 percent w a stundwd error (rf 3,440,000(4.3 percent of 80,000,000).

errors appropriate for the estimated percentagesof office visits are shown in table II.ROUNDING: Aggregate estimates of office visitspresented in the tabIes are rounded to the near-est thousand. The rates and percents, however,were calculated on the basis of original, un-rounded figures. Due to rounding of percents,

Table 11. Approximate standard arrors of percentages for esti-matad numbar of office visits

Base of Dercentaqe I Estimated percentage

number of visitsin thousands 1 or 5 or 10 or 20 or 30 or so

99 95 90 80 73

I Standard error expressed inparentage points

1,000 ............... ...............3,000 ... .. .. .. .... .. . ..... .. . ... .. .5,000 ... ... ... . .... .. .. ... ... . .....10,000 .. .... .. .. .... . . .. .. .. .. ....50,000 .. ..... . .. ... . .... ... .. .. ...

100,000 . .... .. .. ... ... . ..... . . ...SO,ooo .. .... .. .. .. .... . .... . ... .

2.11.20.90.70.3

0.20.1

4.62.72.11-50.70.50.2

6.3 8.5 9.73.7 4.9 5.62.8 3.8 4.32.0 2.7 3.10.9 1.2 1.40.6 0.8 1.00.3 0.4 0.4

I I I

10.66.14.73.31.51.10.5

Example of use of table: An estimate of 30 perce:ll based on an

ww%ate of 75 J300,CS130h a standard error of 1.2 percent. Thertlntive standard error of 30 percent is 4.0 percent (1.2 percent +30 percent).

the sum of percentages may not eqwd 100.0 per-cent.DEFINITIONS: An ambulatory patient is aq in-dividual presenting himseIf for personal he~thservices who is neither bedridden nor currentlyadmitted to any health care institution on thepremises.

An office is a place that the physician identi-fies as a location for his ambulatory practice.Responsibility over time for patient care andprofessional services rendered there generaIly re-sides with the individual physician rather thanan institution.

A z,fiit is a direct personal exchange betweenan ambulatory patient and a physician or a staffmember \vorking under the physician’s super-vision for the purpose of seeking care andrendering health services.

A physician is a duly licensed doctor of med-icine (ill. D.) or doctor of osteopathy (D. O.) cur-rently in practice who spends time in caring forambulatory patients at an office location. Ex-cluded from NMICS are physicians who spe-cialize in anesthesiology, pathology, radiology;physicians ~vho are Federally employed; physi-cians who treat only institutionalized patients;physicians employed full time by an institution;and physicians who spend no time seeing ambu-latory patients.

GPO 919..533


US. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service [ Number 14. November 30, 1977

Weight by Height and Age of Adults 18-74 Years:United States, 1971-74a

The height and weight measurements ob-tained as a part of the Health and NutritionExamination Survey (HANES) conducted by theNational Center for Health Statistics April 1971through June 1974 were used to present heightand weight findings among men and womenaged 18-74 years in the United States; 1

HANES is a program in which measures ofnutritionzd status are collected for a scientif-ically designed sample representative of thecivilian noninstitutionalized population of theUnited States in a broad range of ages.

These HANES findings are based on theexamination of the 13,671 persons aged 18-74years selected from a total sampIe of 20,749examined persons aged 1-74 years. A nationwidep rob ability sample of 28,043 persons wasselected to be examined from eIigibIe house-holds in the 65 primary sampling units that werevisited between April 1971 and June 1974. TheHANES nutrition examination included a gen-eral medical examination by a physician toidentify indicators of nutritional deficiencies, askin examination by a dermatologist, and adental examination by a dentist. Body measure-ments were taken by a trained technician; dietaryinformation was obtained b-y the 24-hour recallmethod; and a food frequency questionnaire wasadministered. Numerous Laboratory tests wereperformed on whole bIood, serum, plasma, andurine. A description of the sampling process andHANES operation has been pubIished.1

Estimates in this report are based onweighted observations. The data obtained forthe examined persons were inflated to the level

aThis report prepared by Sidney Abraham, CliffordL. Johnson, M.S.P. H., and Matthew F. Najjar, Divisionof Health Examination Statistics.

of the total population, using the appropriateweights to account for both sampling fractionsand response results. The relationship of weightto height by age, sex, and race among the U.S.population based on findings from the HANESprogram will be analyzed and discussed in afuture report, Weight by Height and Age of

Adults 18-74 years, United States, 1971 -1974.2Selected data from that report are presentedhere in tables 1-5 and figures 1 and 2.

Mean weights for given heights were ob-tained from a Iinear regression equation for menand women for the six age groups 18-24, 25-34,35-44, 45-54, 55-64, and 65-74 years. Theequations of weight on height were fitted by theleast-squares method, which holds that the lineof “best fit” is one for which the sum of thesquares of the residual errors is a minimum.AIthough linear regression of weight on heightwas used, the relationship between weight andheight is not strictly Iinear, that is, the Iine ofrelationship does not correspond precisely to alinear line of trend, which describes the averagechange in weight as accompanied by a unit ofchange in height. The constants-regression coef-ficient (b) and Y-intercept (a)–in the regressionequation Y = a+bx ~d the st~dard error ofestimate around these regression lines for 12age-sex groups are shown in table 1. Itlore de-tailed examination of the linear relationship ofweight to height will be reported in the futurereport.2

Height-weight tables are presented for menand women within the age range 18-74 years,with mean weight values for each inch of heightfor the height range of 62-74 inches for men and57-68 inches for women (tables 2 and 3). Threeadditional values beIow and above the meanweight also given in the tables represent esti-

2 dwwedda

210 -

200 -

190 -

180 -

170 -

160 -

150 -

140 –

130 -

Figure 1. AVERAGE WEIGHTS] OF MEN BY AGE GROUP AND HEIGHT:UNITED STATES, 1960-62 AND 1971-74

18-24 YEARS

— HAN ES, 197’I.74

. . . . . . HES, 19& J.132

/

●*...,..

●.*●*●. .

/

. . . .***

●*●***

. .●.,*. *

o~62 63 64 65 66 67 68 69 70 71 72 73 74

210-

200 –

190 -

180 -

170 -

160 -

150 -

140 –

35-44 YEARS ,

130J

of I 1 I 1 I 1 1 1 I 1 t 1 \62 63 64 65 66 67 68 69 70 71 72 73 74

210 -

200 -

190 –

180 -

170 -

160 –

150 -

140 -

130}

55-64 YEARS

210 r 25-34 Y EARS

200

190 t

; 80

170

160

150

1401

13oj

o~d62 63 64 65 66 67 68 69 70 71 72 73 74

210 -

200 –

190 -

180 -

170 -

160 -

150 -

140 -

130 -5

45-54 Y EARS

v 62 63 64 65 66 67 68 69 70 71 72 73 74

210

L

65-74 YEARS

200

190 -

180 -

170 -

160 –

150 -

140 -.

o~62 63 64 65 66 67 68 69 70 71 72 73 74

HEIGHT IN INCHES

o~A62 63 64 65 66 67 68 69 70 71 72 73 74

HEIGHT IN INCHES

1~~imated “a]ue~ frOm regression equations of weights for specified age WOUPS.

NOTE: For 1960-62 and 1971-74, height was measured without shoes. For 1960-62 clothing weight was estimated asaveraging 2 pounds, which were deducted fr~m weights shown; for 1971-74 cIothing weight ranged-from-0.20 to 0.62 pound,which was not deducted from weights shown.

ackmeMa3

Figure 2. AVERAGE WEIGHTS* OF WOMEN BY AGE GROUP AND HEIGHT:UNITED STATES, 1960-62 AND 1971-74

180 r 18-24 YEARS

~ 170z3~ 160

1

_ HAN ES, 1971-74

. . . . . . HES, 1960.132= 1501-

5 140i

‘-1/

3 13(J ...**-*’●. . . .

,.. .. . . .. . . .

●m..=I20

●*... . . .

J-110

o-f ‘ I 1 I , 1 I , 1 1 1 -1

57 58 59 60 61 62 63 64 65 66 67 6Z

180

170

160

150

140

130

120

110/

0’

35-44 YEARS

57 58 59 60 61 62 63 64 65 66 67 68

180r

55-64 YEARS

170

1~

. . . . ●.*’

160●. . .

150●.*●*..

140 ●***,***

130

120

t

180

170

160

150

I

140

130

120

110

25-34 YEARS

*.*,.*

o~57 58 59 60 61 62 63 64 65 66 67 68

180

170

160

150

140

130

120

110

45-54 YEARS

o’~57 58 59 60 61 62 63 64 65 86 67 68

180

F

65-74 YEARS

T70

160

150

140

130

120

110

o? I I I 1 , , a I 1 t !

57 58 59 60 61 62 63 64 65 66 67 68

HEIGHT IN INCHES

01 I I I I I 1 I f I I I J

57 58 59 60 61 62 63 64 65 66 67 68

HEIGHT IN INCHES

1Fstimated values from regression equations of weights for specified age groups.

NOTE: For 1960-62 and 1971-74, height was measured without shoes. For 1960-62 clothing weight was estimated asaveraging z pounds, which were deducted from weights shown; for 1971-74 clothing weight ranged from 0.20 to 0.62 pound,which was not deducted from weights shown.

4 ackincedata

mates of the range of 60, 80, and 90 percent,respectively, of the population around the meanweight:

J“?.8416SY. X

Y* 1.2816 SY.X

Y + 1.6449 &

For example, assuming normality, the predicted

mean plus or minus .8416 standard error of theestimate indicates the range of weights that isexpected to include 60 percent of the examined

persons of a specific height for a given age andsex group.

In this instance one would expect 30 percentof the individuals to be within this weight rangebelow and above the mean weight, with 20 per-cent falling outside either of these ranges, valuesroughly equivalent to the lower and upper 20thpercentiles, respectively, of the distribution ofweight by height for age and sex groups.The other two estimates around the mean(Y* 1.2816S ~ .X and Y * 1.6449 SY ~ standarderror of estimate) represent an &ea of 80and 90 percent of the particular height group,which is roughly equivalent to the lower andupper 10th and 5th percentile, respectively,of the distribution of weight by height for ageand sex groups.

The height-weight tables–tables 2 and 3are summarized in table 4—show that theaverage weights by height for men and womenincrease with age but in different patterns.Average weights of men increase rapidly untilthe age group 25-34 years. The rate of increasethen flattens out, with the average weights

peaking in the agc group 45-54 years for thosemen of heights less than 68 inches and decliningthereafter. The average weights of men of

heights 68 inches and more peak at ages 35-44

years and then tend to decline.The average weights of women advance

rapidly to the age group 35-44 years. They in-crease less rapidly in the age groups 45-54 and

55-64 years, peak at the latter age group, and

then decline.The average weights of men and women by

height as measured in the Ileaith and NutritionExamination Survey of 1971-74 were generally

greater than those from the Health ExaminationSurvey (IIES) of 1960-62 (table 5). Among agegroup 18-24 years the differences betweenaverages cluring this period increased as heightincreased. This direction was less evident formen than for women, particularly in the shorterheights.

At ages 25-34 years, the pattern was reversedfor women. The difference between the averageweights of women in H~TES and in HESdecreased as height increased.

The differences in average weights for menand women 35-44 years showed the same pat-t e rn. When compared with HES findings,HANES data showed the average weights ofshorter men and women to be less than those inHES and more than those in HES for taIIer

persons and persons of medium height. Differ-ences in average weights for taller persons andthose of medium height ranged from !. to 13pounds.

Average weights of women aged 45-5-I years

in the HES \vere with (me exception 2 poundsless than those f)t women in HANKS. For men inthis same age group, the average weights were 2pounds less for those in HIM who were shorterthan 69 inches and from 2 to 5 pounds less forthose who were taller.

At ages 55 and over, the average weight forwomen in HANES differed little from that ofwomen in HF.S. On the other hand, differencesbetween average weight of men in HANES andthat of men in HES showed an increase in thedifference with increase in height. Men inHANES above average height (69 inches andmore) weighed more on the average–7 to 14pounds at ages 55-64 and 7 to 11 pounds at ages65-74 years–than men in HES did.

DISCUSSION

Comparison of an individual’s acutal weightwith a standard weight is the most widely usedcriterion of leanness or fatness. Interest in thismeasure stems from the findings of life insur-

ance and epidemiological studies relating excessbody weight status to unfavorable morbidity

and mortality experiences. The earliest and mostcommonly used method for measuring excessbody weight due to fat is to compare the height

dmncwkh5

and weight of persons with tables showing aver-age or standard weight. By using this method thelife insurance studies determined excess bodyweight status, which is defined as the deviationof actual weight for a given sex, age, and heightfrom the average weight tables, times 100,obtained initially from the Medico-ActuarialInvestigations (19 12)4 and later from the Buildand Blood Pressure Study (1959 ).5 Other studies

‘ such as the Fprningham Heart StudyG definedexcess body weight due to obesity as a relativeweight of 20 percent or more above the medianweight for a given height and sex.

Since it is recognized that height and weightalone are incomplete indications of obesity,“desirable” weight tables that take into con-sideration measurements of body build havebeen developed by the Metropolitan Life Insur-ance Company. These tables for aduIts 25 yearsand over show ranges of weights for givenheights. This was in answer to the criticism thatheight-weight tables ignored the disadvantages ofthe increase in body weight with advancing yearsas well as variations in body build that influencethe weight of individuals. The average weights inthe tables are for categories of body frame inwhich the determination of frame size has notbeen specified or defined in terms of bodymeasure. The user must exercise clinical judg-ment about type of body frame.

Such data are not satisfactory for studyingthe influence of obesity on mortality. Obesity,an excess accumulation of fat, is used inter-

changeably with overweight or excess bodyweight above standard u’eight. Total bodyweight is a measure of bone, muscle, and fat,and departure from average weight may be dueto one or a combination of these body com-ponents. Overweight prevention and control isdirected against overweight due to fat, which isprimarily attributed to excess food intake overthe energy demands of the individual. This is themajor form of overweight in the United States.

The height-~vcight tables in this report pre-sent estimates over and under excess body ~vcightof men and ~jwmcn by height and age. There arcno estimates of cxccss body fat other than whatcan bc inferred from the :ieviation of actualweight from the mean w-eight; such estimates willnot yield information of how much of the weight

difference is accounted for by excess fat.

The tables in this report are not presumed to

indicate “ideal” or “desirable” weight but onlyto present a reference base for the person’s ob-

served weight. This approach of predictingweight from height sho~ved a correlation whichranged from the order of +.460 at ages 35-44years to -!-.390 at ages 45-54 }’ears for mcn ofages 18-74 years (table 1). Corresponding cor-relation values f[)r \vomen ran:cd from +.270 atages 35-44 ycm to +.246 at ages 45-54 years.The highest correlation for mcn shouvd thatabout 20 percent of the variance of weight isaccounted for by the ~uriancc of height. Forwomen this \’aluc wus about ? percent.

REFERENCES

1National Center for Health Statistics: Plan andoperation of the Health and Nutrition Examination Sur-vey, United States, 1971-1973. Vital and Health Shztis-tics. Series I-Nos. 10a and 10b. DHEW Pub. No. (HSM)73-1310. Health Services and hientat Health Administra-tion. Washington. U.S. Government Printing Office, Feb.1973.

2National Center for Health Statistics: Weight byheight and age of adults, United States, 1971-74. Vitaland Health Stat&tics. Series 11. Health ResourcesAdministration, DHEW, Hyattsville, Md. To be pub-lished.

3National Center for Heatth Statistics: Weight byheight and age of adults, United States, 1960-62. Vitaland Health Statistics. PHS Pub. No. 1000. Series 1l-No.

14. Public Health Semite. Washington. U.S. GovernmentPrinting Office, May 1966.

4 .Association of Life Insurance hfedical Directors andActuariaJ Society of America: Medico-A ctuarihl Mor-talit Investigation, Vol. 1. New York. 1912.

?’Society of .4ctumies: Build and BIOOd PressureStud , Vol. 1. Chicago. 1959.

t?’Kannel, W. B., Pearson, G., and McNarnara, P. M.:Obesity as a force of morbidity and mortality, in FelixP. HeaId, cd., Adolescent Nuti”tion and Growth. NewYork. Appleton-Century-Crofts, 1962.

7I&pinos, B. D.: Weight-height standards based onWorld War 11” experience. J. of Am. Stat. Assoc.53:408 -419,June 1958.

6

Table 1. Coefficients of correlat-icm and constants for linear regression equations andstandard error of estimate of weight (W) on height (H) of adults aged 18-74 years:United States, 1971-74

..—

Sex and age

18-2425-3435-44;;-::

65:74

18-2425-3435-4445-54:;-;;

Men

years --------------------------years --------------------------years --------------------------years -------- -------. ..---------years -------- -------,.------.- --years --------------------------

Women

years -------- ----------------- --years --------------------------years -------- -------- -------- --

years --------------------------years --------------------------years --------------------------

Correlation

.438

.420

.460

.390

.426

.404

.285

a

-172.63-168.67-187.49-131.83-173.99-131.64

-56.28-&38.62-94.02-77.17-68.24-i%.38

b

4.8424.9415.2774.4545.0694.385

2.9653.5873.8153.5873.4923.583

SYMBOLS

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

Category not applicable ------------------------ . . .

Quantity zero --------------------------------- -

Quantity more than Obut less than 0.05---- 0.0

Figure does not meet standards ofreliability or precision ----------------------- *

sY.x

27.330.527.428.428.526.0

28.032.135.033.833.&29.0

admceda7

Tab1..2. Average weishts and selected percentiles for each inch of height: Men, aged 18-74 years, United States, 1971-74

Height

.—

62 inches----------

b3 inches----------

64 inches----------

65 inches----------

66 inches----------

67 inches----------

68 inches----------

Age group in years

18-2.6I25-34 \ 35-44 I45-54 I 5.5-64I65-74—

Weight in pounds

191 188180 178167 166@ ~

102 10891 98

195 193L84 183

$# #

106 11395 103

200 198189 188176 176~ q

111 118100 108

206 ;::195182 181~ ~

117 123106 113

210 208199 198186 186ql D##

121 128110 118

215 214204 204191 192CI# ~

126 134115 124

220 219209 209

$-!$ $?$131 139120 129

194 190183 180

# #j

111 106100 96

199 194188 184176 171LI& q

116 110105 100

207 205196 195184 182g ~

124 121113 111

211 210200 200188 187q$j ~

128 126117 116

216 215205 205193 192CG& CG$&

133 131122 121

Height

69 inches----------

70 inches----------

71 inches----------

72 inch’es----------

73 inches----------

74 inches----------

Age group in years

18-24I25-34 I35-44 / 45-54 I55-64 ] 65-74

209199187GJ

129119

213203191~

1331.23

218208196IzzJ

138128

223213201~

143133

228218206KX@

148138

233223211IizJl

153143

Weight in pounds

224 224214 213202 201D& DzJ

144 141134 130

229 229212 218207 206g ~

149 146139 135

235 234225 223213 211g D#j

155 151145 140

239 238229 227

g &

159 155149 144

245 243235 232223 220

~ g

155 149

1250 247240 236228 224QJjl DJ

170 164160 L53

225215202g

141131

230220207g

146136

236226213@

152142

240230217g

156146

244234221

~

150

250240227

~

156

NOTES: Examined persons were measured without shoes;clothingweight ranged from 0.20 to0.62 pound, which was not deducted fromweights shown.

The weight values were computed frcm the regression equation of weight on height by age. The values above and below the expectedmean value represent the t.8416, *1.2816, and il.6449 standard error Of the estimate covering within this range 60, 80,percent of the population around the mean, respectively.

and 90The first range is expected thus to identify 20, 10, and 5 percent of

the population of the specific height on either side of the range?

Figures inn are the expected means.

8 aciwncedata

Table 3. Average weights and selected percentiles for each inch of height for women by age group: United States, 1971-74

Height

57 inches----------

58 inches----------

59 inches----------

60 inches----------

61 inches----------

62 inches----------

Age group in years

Height

18-24 25-34 35-44 45-54 55-64 65-74

160150138

%?

;:

163153141q

8171

166156144q

8474

169159147q

8777

172162150~

9080

175165153g

‘9;

Weight in pounds II171 183159 170145 154~ q

77 8065 67

174 187162 174148q ~

80 8468 71

178 191166 178152 162q iI@

84 8872 75

181 195169 182155 166g ~

87 9275 79

185 199173 186

# @

91 9679 83

189 202177 189163 173~ ~

95 9983 86

187 178 63175 167160@ ~

89 9377 82

191 182 64179 171164 158~ g

9381 ::

195 185 65183 174168 2.61~ p

100;: 89

198 188 66186 177171 164g ~

100 10388 92

202 192 67190 181

#j #

104 10792 96

205 195 68193 184178 171~ ~

107 11095 99

inches-----------

inches-----------

inches-----------

inches-----------

inche~-----------

inches-----------

Age group in years

18-24 25-34 35-44 45-54 55-6), 65-74

Weight in pounds

2ot19:177IIIJ

10:9C

21C197181LL@

10794

214201185

~

98

217204188m130114101

22120819211#

158105

225212196~

122109

206193178~

10794

210197182g

11098

214201186g

115102

217204189~

118105

221208193IIGJ

122109

224211196@

125112

208 199196 188181 175@ II@

110 11498 103

212 202200 191185 178~ ~

114 117102 106

215 206203 195188 182@ p

117 121105 110

219 209207 ~:8

# #

121 124109 113

222 213210 202195 189~ D#

124 128112 117

226 217214 206199 193~ Iz#

128 132116 121

1 1

NOTES: Examined persons were measured without shoes; clothing weight rangedfrom body weight.

from 0.20 to 0.62 pound, which was not deducted

The weight values were computed from the regression equation of weight cm height by age. The values above and below the expectedmean value represent the *.8416, *1,2816, and il .6449 standard error of the estimate covering within this range 60, 80,percent 0[ the population aro””d the mean, respectively,

and 90The first range is expected thus to identiry 20, 10, and 5 percent of

the population of the specific height on either side of the range.7

Figures in~ are the expected means

admceMa9

Table 4. Average weightsl for men and women aged 18-74 years, by age group and height:United States, 1971-742

Sex and height

62636465

2!68

%

;;

;:

575859

%!62

:265666768

~

inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------

Women

inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------inches----------------------------

Age group in years

=T=l 35-44 I45-54I55-64I65-74

130135140145150154159164168173178183188

114117120123126129132i35138141144147

141145150156160165170174179184189194199

118121125128132136139;;;

150153157

Weight in pounds

143148153158163169174179184190194200205

125129133137141144148152156159163167

147152156160164169173177182187191196200

129133136140143147150154158161165168

143147153158163168173178183189193197203

132136140143147150153157160164167171

143147151156160164169173177182186190194

130134137140144147151154158161165169

1Estimated values from regression equations of weight on height for specified age

groups.2Height was measured without shoes. Two pounds were deducted from HES data to allow

for weight of clothing; total weights of all clothing for HAN13Sranged from 0.20 to0.62 pound, which was not deducted from weights shown.

10

Table 5. Comparison of average weights for men and women in HES (1960-62) and HANES (1971-74). bv a~eand height: United States ‘

,. ..=

Sex and height HES1960-62

WANES1971-74

Exc,esaof HANESOverHE:SI I HES

I I

Men

inchea ---------inches ---------in~hes ---------inchea ---------inche~---------

inchea ---------inches ---------inchea ---------inches ---------inchea ---------inches ---------in~he~---------

inches ---------

Wonen

inches ---------inches ---------inches ---------inchea ---------inches ---------inches ---------inches ---------inches ---------inchea ---------inchea ---------inches ---------inches ---------

Men—

in~hea ---------inchea ---------inches ---------~nches ---------=nches---------inches ---------in~hes ---------inches ---------in~hea---------inches ---------inchea ---------inches ---------inches ---------

Women

inches ---------inches ---------inchea ---------inches ---------inches ---------in~hea ---------inches ---------inches ---------inches ---------inches ---------inches ---------inches ---------

18-24 yeara 25-34 years 35-44 years

135138142145149152156159163166170173177

114116118120123125127129132134136138

130135140145150154159164168173178183188

114117120123126129132135138141144147

141145150156160165170174179184189194199

118121125128132136139142146150153157

143148153158163169174179184190194200205

125129133137141144148152156159163167

-5

:;

+1+2+3+5+5+7+8+6

+11

+1+2+3+3+4+5+6+6-!-7+8+9

+1+2+2+2+2+3+2+2+3+4+4+5+5

+2+3+2+2+2+2+2+2+2+2+2+2

139143148152157161166170175179184188192

110114118122126130134138142146150154

+2+2+2+4+3+4+4+4+4+5+5+6i-7

+8+7+7+6+6+6+5+4+4+4+3+3

:;

+2

z+6+7+9+11+11+12+14

-4

:;-2-1

+1+1+2+2+3

147150154158162166169173177180184188192

129132134136138141143145147150152154

-4-2-1

+1+3+5+6+7+1o+10+12+13

-4-3-1+1+3+3+5+7+9+9

+11+13

45-54 years 55-64 yeara 65-74 years

146150154158162166171175179183187191195

127130134138141145148152156159163166

143147153158163168173178183189193197203

132136140143147150153157160164167171

142146149152156159163166169173176180183

130133136140143147150154157161164168

147152156160164169173177182187191196200

129133136140143147150154158161165168

146149153156160164167171174178182185189

136139142145148150153156159162165168

143147151156160164169173177182186190194

130134137140144147151154158161165169

+1+1+2+4+4+5+6+7+8+9+10+10+11

+1+1

+1

+1

+1

+1+1

NOTE: Height waa measured without ahoes. Two pounds were deducted from HES data to allow for weightof clothing; total weighta of all clothing for HANES rangedducted from weighta shown.

from 0.20 to 0.62 pound, which waa not de-

dwlceMa 11

STATISTICAL NOTES

The sampling plan for the 65 examinationlocations in the Health and Nutrition Examina-tion Survey (HANES) followed a highly strat-ified multistage probability design in whicha sample of the civilian noninstitutionalizedpopulation of the conterminous United Statesaged 1-74 years was selected. Successive ele-ments dealt with in the process of samplingwere the primary sampling unit, census enumera-tion district, segment (a cluster of households),household, eligible person, and sample person.The sampling design provided for oversamplingamong persons living in poverty areas, preschoolchildren, women of childbearing age, and theelderly.

The weight and height measures are shownas population estimates, that is, the bodymeasure findings for each individual have been“weighted” by the reciprocal of the probabilityof selecting the person. An adjustment forpersons in the sample who were not examinedand poststratified ratio adjustments were alsomade so that the final sampling estimates of thepopulation size are brought into closer align-ment with the independent U.S. Bureau of theCensus estimates for the civilian noninstitution-aEzed population of the United States as ofNovember 1, 1972, by race, sex, and age.

Figure 3. MEAN SERUM CHOLESTEROL LEVELS OF GIRLS AGED 1-17 YSARS BY AGE AND RACE: UNITED STATES, 1971-74

210

r

160

150

1401

CORRECTION TOAD VANCE DATA NUMBER 8

In the key to figure 3 on page 4, — should indicate Negro, and ■ ===■ ==should indicate White

as shown below.

L0 I I I I I I 1 I I 1 I I I I I I

1 2 34 5 6 7 8 9 10 11 12 13 14 15 16 17

AGE IN YEARS

—


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service [ Number 15 = December14,1977

National Ambulatory Medical Care Survey of Visits toGeneral and Family Practitioners, January-December 19751

According to data collected in the NationalAmbulatory Medical Care Survey (NAMCS), anestimated 234,660,000 visits were made to theo f fices of general and family practitioners(GFP’s) during calendar year 1975. These visitsaccounted for over 41 percent of the estimated567.6 million visits made to all office-based phy-sicians in 1975.

The NAMCS is a sample survey desi~ed toexplore the provision and utilization of ambula-tory care in the physician’s office-the settingwhere most Americans seek health care. The sur-vey is conducted yearly over the coterminousUnited States by the Division of Health Re-sources Utilization Statistics of the NationalCenter for Health Statistics. The survey sampleis selected from doctors of medicine and osteop-athy who are engaged in office-based, patientcare practice. In its current scope, the NAAICSexcludes physicians practicing in Alaska andHawaii, physicians whose specialty is anesthesi-ology, pathology, or radiology, and physicians inGovernment service.

For a listing of publications describing tliedevelopment of the survey and definitions ofterms used in the survey see the TechnicalNotes. A detailed explanation of the sampledesign and the relative standard errors associatedwith selected aggregate statistics may be foundin that section.

IThis report was prepared by Beulair K. CSPress,Ph.D., l)ivision of Health Resources Lltilixation Statis-tics.

Provisional NAMCS data for calendar year1974 regarding general and family practitionershave been published.z Caution should be exer-cised in making comparisons between 1975 esti-mates and the provisiomd 1974 estimates previ-ously published. Since the 1974 provisional datawere released, refinement of the procedures usedto project the national estimates from the sam-ple findings has resulted in a lowering of thefinal 1974 numerical estimates of office visits by8 to 9 percent. In particular, the provisional esti-mate of 263.4 million office visits to general andfamily practitioners in 1974 was finalized to re-flect the more accurate figure of 242.9 millionoffice visits. Final distributions and percents,however, were virtually unchanged. The numberof total office visits for all specialties for calen-dar year 1974, estimated at 634.1 million in theprevious publication, has been adjusted to 577.8million.3

2 National Center for Health Statistics: National Am-bulatory kledical Care Sumey: National AmbulatoryMedical Care Survey of f7isits to General and FamilyPhysicians, January 1974December 1974. MonthlyVital Statistics Report. Vol. 25-No. 2, Supp. 2. DHEWPub. No. (HRA) 76-1120. Health Resources Adminis-tration. Rockville, Lid. hlay 19, 1976.

3 National Center for IIealth Statistics: Ambulatorymedical care rendered in physicians’ offices, UnitedStates, 1975. Aikance Data From l’ital and HealthStatistics, No. 12. DHEW Pub. No. (lIRA) 77-1250.Health Resources Administration. Hyattsville, Md. Oct-tober 12, 1977.

2 dvamedata

DATA HIGHLIGHTS

A comparison of visits made to office-basedphysicians in the most-visited specialties revealsthat visits to GFP’s during 1975–234.7 mil-lion–exceeded the total estimated visits to thenext four leading specialties combined– 198.2

million (table 1).

Table 1. Number and percent of visits tooff ice-based physicians , by the most-visited specialties: United States, Jan-uary- December 1975

Most -visitedspecialty

GENERAL AND FAMILYPRACTICE ---------------

Internal medicine -------Obstetrics and

gynecology -------------Pediatrics --------------General surgery ---------

Numberof

visitsin

thou-sands

234,66062,117

48,07646,68441,292

Per-cent

ofvis its

41.310.9

8.58.27.3


More visits were made to general and familypractitioners electing solo practice—73 per-cent—than to physicians having group or part-nership arrangements—27 percent (table 2).Thisreflects the fact that about 74 percent ofGFP’swere engaged in solo practice in 1975.

While visits to the offices of GFP’s Iocatedwithin standard metropolitan statistical areas(SMSA’S)4 outnumbered visits tononmetropoli-

4An SMSA is defined as a group ofcontiguouscoun-

ties containing at least one city of 50,000 inhabitants ormore, or two contiguous cities with a combined popula-tion of at least 50,000 inhabitants. The distinction“metropolitan/ nonmetropolitan” should not be con-fused with “urban/suburban” or “urban/rural” since anSMSA may contain urban, suburban, and rural subsec-tions.

tan-based offices (table 2), there was less dispar-ity between location categories than appearedin other specialties. Table 3 illustrates this differ-ence.

A greater number of visits to metropolitan-based GFP’s is reasonable since about 70 percentof the population resides within SMSA’S, andapproximately 65 percent of physicians in gen-eral and family practice are Iocated withinSMSA’S. However, the annual rate of visits tononmetropolitan offices of GFP’s (146 visits per100 persons) was more than half again as muchas the rate within SMSA’S (94 visits per 100 per-sons)—an indication that the population outsideof SMSA’S tends to visit GFP’s more often thanthose within SNISA’S.

Patient’s Age, Sex, and Color

The number of visits to office-based generaIand family practitioners increased with age, thegreatest number occurring in the age intervalfrom 45 to 64 years (table 2). For persons 65years and over, the rate of annual visits was tri-ple the rate for persons under 15 years of age.

Visits by females outnumbered visits bymales by a ratio of about 3 to 2 (table 2). Fur-ther, the tendency of females to make morevisits to the physician was clearly reflected intheir higher rate of annual visits. For every 100persons, there were 130 visits by females. Formales, this rate was 95 visits for 100 persons.

Table 4 shows the influence of sex and ageon percent and annual rate of visits. Femalevisits exceeded male visits in every age categoryexcept that under 15 years.

White persons (88.5 percent) outnumberedall other persons (1 1.5 percent) in office visits toGFP’s (table 2). The annual rate of office visitswas also higher for white persons than for therest of the population. These data could indicatethat members of other races availed themselvesmore often of other means of ambulatory medi-cal care since the NAMCS includes oniy office-based care.

Visits described by the joint classification,white and female, were greater than by anyother combination of sex and color as shown intable 5.

dmnceda3

Table 2. Number, percent distributions, and number of visits per 100 persons per yearto office-based general and family practitioners by type and location of the physi-cian’s practice and by age, sex, and color of the patient: United States, January-December 1975

—.—

Selected physician andpatient characteristics

All visits-------------------------------

PHYSICIAN CHARACTERISTIC

Type of practice

solo-------------------------------------------0ther2-----------------------------------------

Location3

Metropolitan-----------------------------------Nonmetropolitan--------------------------------

PATIENT CHARACTERISTIC

Age

Under 15 years---------------------------------15-24 years------------------------------------25-44 years------------------------------------45-64 years------------------------------------65 years and over------------------------------

Sex

Female-----------------------------------------Male-------------------------------------------

Color

White------------------------------------------0ther4-----------------------------------------

Number ofvisits inthousands

234,660

171,01063,650

136,53398,127

33,77237,56856,47664,50242,343

1:;,;;:a

207,66027,000

Pertentdistributionsof visits

100.0

72.927.1

58.241.8

14.416.024.127.518.0

59.240.8

88.511.5

Number ofvisits per100 per-sons peryearl

113

------

94146

65

l%152194

13095

11599

lBased on population estimates for July 1, 1975, Bureau of the Census, Current Pop-ulation Reports, Series P-25 and P-26.

‘Includes partnership and group practices.3sj-Enifies location within or outside the standard metrooolita statistical areas

(SMSA’=)..

qOf this category, about 81 percent are visits by blacks.

Major Reasons for Visitforvisitrecordedby thephysicianasnearlyas

The data concerning the most frequent com- possibk in the patient’s o-~ words. The b;oaclplaints, symptoms, or other reasons for a clinical range of the GFP’s practice is demon-patient’s visit (tabIe 6) were derived from an strated by the fact that it required 18 reasons toitem on the survey form that elicited the reason account for only haIfofaIl visits.

4

Table 3. Percent distribution of visitsto office-based physicians by location,according to specialty: United States,January-December 1975

Location

Total---

Metropol-itan-----

Nonraetro-politan--

Gen-eral Ob-

and Inter- stet-

fam-nal rics Pedi-

ily medi- and atrics

prac- cine gyne-

ticeCology

I I I

Percent distributionof visits

100.0 100.0 100.0 100.0

58.2 84.6 81.9 89.1

41.8 15.4 18.1 10.9

Table 4. Percent and annual rate of vis-its to office-based general and familypractitioners, by sex and age of thepatient: United States, Jan=ary-Decem-ber 1975

I I

I I Annual

Percent ofrate of

all visits visits per

Age of 100 per-

patientI

Fe-male

Under 15years ---------- 6.515-24 years ----- 9.725-44 years ----- 15.045-64 years ----- 16.8Over 65 years--- 11.1

I sons

In examining the maior reasons fo:

Male

697585

123183

Table 5. Percent of visits to office-based general and family practitioners,by sex and color: United States. Jan-uary-December 1975

Color of patient

White -------------------All other ---------------

Percent ofall visits

T-

Female Male

52.1 36.37.1 4.4

visits involvedprenataland postnatalcare.Only

the obstetrician-gynecologistexceeded theGFPin the number of visits for these three reasons.

Principal Diagnosis

Table 71ists the 25 most common principaldiagnoses assigned by GFP’s to office visits.These diagnose; constituted about one-half of allvisits made to office-based GFP’sin 1975.

Table 8 shows the number ofprincipal diag-noses according to major ICDA5 groups. Thefollowing four diagnostic groups account forslightly more than 50 percent of all principaldiagnoses rendered:

Diseases of the respiratory system,Special conditions and examinations vvith-

out sickness,Diseases of the circulatory system,Accidents, poisonings, and violence.


Limited or general histories and examina-tions were performed during about two-thirclsofall general and family practitioner (GFP) officevisits (table 9).

Blood pressure checks, performed during40

r a visitpercent of all GFP visits, were done frequently

shown in item 8 of the Pa~ient Record form, it isestimated that over 2 million visits at least partlyinvolved family planning, and over 6 million

5Eighth Revision International Classification of Dis-eases, Adapted for Use in the United States (iCDA).

Table 6. Number, percent, and cumulative percent of visits to office-based general andfamily practitioners, by the 25 most frequent patient problems, complaints, or symp-toms classifiedby the National Ambulatory Medical Care Survey (NAMCS) symptom class-ification code: United States, January-December 1975

—

Rank

1

1011121314151617

i;202122232425

Most frequent patient problem,complaint, or symptom and NAMCS codel

General and required physicalexaminations-----------------------------9OO,901Problems of back------------------------------4l5Throat soreness-------------------------------52OProblems of lower extremity-------------------4OOAbdominal pain--------------------------------54OProblems of upper extremity-------------------4O5Cough-----------------------------------------311Visit for medication--------------------------9lO~;;;gue---------------------------------------OO4

------------------------------------------312Headache--------------------------------------O56Pregnancy examination-------------------------9O5Pain in chest---------------------------------322Allergic skin reaction------------------------ll2Wounds of skin--------------------------------ll6High blood pressure---------------------------2O5Surgical aftercare----------------------------986Weight gain-----------------------------------OlOVertigo— dizziness----------------------------O69Problems of face, neck------------------------4lOEarache---------------------------------------735Fever-----------------------------------------oo2Wnecologic e=mination -----------------------904Shortness of breath---------------------------3O6F1u-------------------------------------------3l3


11,5829,5359,0058,8477,2797,2347,0466,4366,2216,0775,8365,7094,9194,7114,5764,4324,4143,6433,5543,1613,1473,0872,7492,6202,560

Percentof

visits

4.94.1

:::3.13.13.02.7

;:;2.52.42.12.02.01.91.91.61.51.41.31.31.21.11.1

Cumulativepercent

4.9

1;:;16.619.722.825.828.531.233.836.338.740.842.844.846.748.650.251.753.154.455.756.958.059.1

‘Symptomatic groupings and code number inclusions are based on a symptom classifi-cation developed for use in the NAMCS.

forpatientsover44years ofage and rarelyforpatientsunder 15 years.For personsover 44yearsofage, 53 percentofvisitsincludeddeter-minationof arterialpressureand inonly 10per-cent of visitsby patientsunder 15 yearswasarterialpressuremeasured.Drugs were themostcommon form of therapeusis.About 56 percentof visitsresultedin administrationor prescrip-tionofdrugs.

Prior Visit Status

Patientstendedto remainunder thecareof

thesame physiciansince7 of8 visitsto GFP’swere madeby “old” (returning)patients(table

10). Of these, about two-thirdsrelatedto pro-blems the physicianhad treatedpreviously.


The data on seriousnessof problem ex-pressedthe physician’sjudgment as to the ex-tentof impairment thatmight resultifno carewere availablefor the given problem. Theyshouldbe viewedinthecontextofthenatureofthespecialist’spractice.

Problemspresentedby patientswhen visitingthe officeof the GFP tended toward thelowerrangeof the “seriousness”scale(table10).Thelargest proportion of visits (48 percent) were

6 acklncedata

Table 7. Number, percent and cumulative percent of visits to office-based general andfamily Practitioners. by the 25 most common ICDA-coded minciDal diaznosis: UnitedStates,” January-Decernbe$ 1975

,

I

IRank Most common principal diagnosis and ICDA codel

I

123

456

:

1:111213141516

:;1920

;;232425

Medical or special examination----------------------YOOEssential benign hypertension-----------------------4OlAcute upper .respiratory infection, siteunspecified----------------------------------------465

Diabetes mellitus--=--------------------------------25OMedical and surgical aftercare----------------------YlOAcute pharyngitis-----------------------------------462Chronic ischemic heart disease----------------------4l2Other eczema and dermatitis-------------------------692Influenza, unqualified-----.------------------------47OObesity---------------------------------------------277Neuroses -------------------------------------------- 300Bronchitis, unqualified-----------------------------49OAcute tonsillitis-----------------------------------463Arthritis, unspecified------------------------------7l5Cystitis--------------------------------------------595Otitis media----------------------------------------38lOsteoarthritis--------------------------------------7l3Synovitis, bursitis---------------------------------73lOther nonarticular rheumatism-----------------------7l7Diarrheal disease-----------------------------------OO9Menopausal symptoms---------------------------------627Chronic sinusitis-----------------------------------5O3Hay fever-------------------------------------------5O7Sprains, strains of sacroiliac region---------------846Inoculations and vaccinations-----------------------YO2

,

Numberof

visitsin

thou-sands

14,69013,904

8,5055,7805,602;,:::

5;0754,9274,9054,1263,9033,8843,4573,2033,0872,8952,8682,8182,7092,5622,5462,5032,4372,347

Per-centof

visits

u--- ––

Cumula-tive

percent

6.35.9

;:22.42.2

;:;2.1

?:;1.71.71.51.41.3

::;1.2

:;:1.11.11.01.0

6.312.2

15.818.320.72;!.925.127.329.431.533.335.036.738.239.64o1.9-42,.143’.344.545.746.847.949.050.051.0

‘Diagnostic groupings and code number inclusions are based on the Eighth RevisionInternational Classification of Diseases, Adapted for Use in the United States.

rated “not serious”followed by about 35per-cent rated “slightlys erious.’’Only 17 percent ofvisits were judged “serious” or “very serious.”Since much of office practice focuses on pre-ventive and maintenance care, this result waspredictable.

Disposition and Duration of Visit

More than half(51 percent)of the visitsto

the GFP resulted in the specific direction to re-turn at a particular time (table 10). An addi-tional one-third involved followup if needed orfollowup by telephone. A very small proportion

(slightly more than 1 percent) of the GFP’spatients were admitted to a hospitaI. This alsosupports the findings that ambulatory officecare focuses on preventive care and health main-tenance with an accompanying small proportionof cases judged “serious.”

The average time spent in face-to-face en-counter between the GFP and the patient wasabout 13 minutes, slightly less than the averagetime for the 13 most-visited specialties. Whilethe duration of most visits was 6-15 minutes (asevidenced by the average), the proportion ofvisits consuming 16-30 minutes tended to iin-crease as the problems were judged more serious.

admceMa7

Table 8. Number and percent distribution of visits to office-based general and familypractitloners,by principal diagnosis classified by ICDA group:United States,January-December 1975

Principal diagnosis andICDA codel

All principal diagnoses----------------------------------

Infective and parasitic diseases------------------------OOO-l36Neoplasms-----------------------------------------------140-239Endocrine, nutritional, and metabolic diseases----------24O-279Diseases of the blood and blood-forming organs----------28O-289Mental diSorders----------------------------------------29O-3l5Diseases of the nervous system and sense organs---------32O-389Diseases of the circulatory system----------------------39O-458Diseases of the respiratory systen----------------------46O-5l9Diseases of the digestive system------------------------52O-577Diseases of the genitourinary system--------------------58O-629Diseases of the skin and subcutaneous tissue------------68O-7O9Diseases of the musculoskeletal system------------------7lO-738Symptoms and ill-defined conditions---------------------780-796Accidents, poisonings, and violence---------------------8OO-999Special conditions and examinations withoua sickness----yy13yl3Other diagnoses2-----------------------------------------------Dia~osis “none” or unknown3-----------------------------------


234>660

10,8782,79513.5683;0437,06410,90629,00543,3049,154

14,94610,72116,6689,22020.16830;188

5442,486

Percentdistribu-tion ofvisits

100.0

4.61.2

:::.

1::;18.5

:::4.67.1

:::12.90.21.1

lDiagnostic groupings and code number inclusions are based on the Eighth RevisionInternational Classification of Diseases. Adapted for Use in the United States.

‘Complicationsof pregnancy, childbirth and the puerperium (630-678), congenitalanomalies (740-759), certain causes of erinatal morbidity and mortality (760-779).

!sIncludes blank, noncodeable, and il egible diagnoses.

8 acivancedata

Table 9. Number and percent distribution of visits to office-based general and familypractitioners by diagnostic and therapeutic services ordered or provided:States,

UnitedJanuary-December 1975

Diagnostic and therapeutic service ordered or provided

All visits --------------------------------------------------

No services provided ----------------------------------------------

Diagnostic services:Limited history/examination -------------------------------------General history/examination -------------------------------------Clinical lab test -----------------------------------------------X-ray -----------------------------------------------------------Blood pressure check --------------------------------------------EKG-------------------------------------------------------------Hearing test----------------------------------------------------Vision test-----------------------------------------------------Endoscopy -------------------------------------------------------

Therapeutic services:Drug administered or prescribed2--------------------------------Injection---------------------------"----------------------------Immunization/desensitization------------------------------------Office surgery --------------------------------------------------Physiotherapy ---------------------------------------------------Medical counseling ----------------------------------------------Psychotherapy/th~rapeutic listening -----------------------------

Other services provided -------------------------------------------


234,660

4,082

130,51629,57050,61814,63894,3585,4181,8313,3071,474

130508127

276

,479,476,659,113,834,378,715

8,451

Percentof

visitsl

——

100.0

1.7

55.612.621.616.2

40.2

55.6211.53.75.23.31X.72.9

3.6

lPercents will not add to 100 because most patient visits required the provision ofmore than one treatment or service.

‘Includes prescription and nonprescription drugs.

9

Table 10. Number and Dercent distributions of visits to office-based ~eneral and fam-ily practitioners b? prior-visit status, seriousness of problem, ~isposition andduration of visit: United States, January-December 1975

Selected visit characteristics

All visits -------- ------------------------ -------- -

PatientPatientPatient

SeriousSlightly serious -----------------------------------------Not serious ----------------------------------------------

DisDositionl

Prior-visit status

seen for the first time --------------------------seen before—for another problem -----------------seen before—for current problem -----------------


and very serious -------- -------- -----------------

No followup planned -------- -------- -------- -------- ------Return at specified time ------------------------- -------- -Return if needed -----------------------------------------Telephone followup ---------------------------------------Referred to other physician/agency -----------------------;;i;zto hospital ----------------------------------------

------- ------- -------- ------- ------- ----.-- ------s -

Duration of visit3

O minutes ------------------------------------------------1-5 minutes ----------------------------------------------6-10 minutes ------- ------- ------- ------- ------- ------- ---11-15 minutes --------------------------------------------16-30 minutes ------- ------- ------- ------- ------- ------- --31 minutes or more ---------------------------------------


234,660

29,84771,446

133,367

39,94182,440112,279

36,326120,37968.4448;6586,9572,8612,276

3,88548,15679,96458,47839,8154,362

‘ercent dis-tributionsof visit

100.0

12.730.556.8

17.035.147.9

15.551.329.23.73.01.21.0

24.917.01.9

lPercents will not addto 100 because some patient visits had more than one disposi-tion.

21ncludes return to referring physician.3Signifies time spent in face-to-face encounter between physician and patient.

10 aduancedata

TECHNICAL NOTES

SOURCE OF DATA: Data presented in this re-port were obtained during 1975 through theNat ion aI Ambulatory Medical Care Survey(NAMCS). The target population of NAMCS en-compasses office visits within the conterminousUnited States made by ambulatory patients tophysicians who are principally engaged in officepractice.SAMPLE DESIGN: The 1975 NAMCS utilized amultistage probability design that involved sam-ples of primary sampling units (PSU’S), physi-cian practices within PSU’S, and patient visitswithin practices. Within the 87 PSU’S composingthe first stage of selection, a sample of approxi-mately 3,500 physicians was selected from mas-ter files maintained by the American MedicalAssociation and the American Osteopathic Asso-ciation. Sampled physicians, randomly assignedto 1 of the 52 weeks in the survey year, wererequested to complete Patient Records (brief en-counter forms) for a systematic random sampleof office visits taking place within their practiceduring the assigned reporting period. (A fac-simile of the Patient Record used is shown in aprevious issue of Advance Data From Vital andHealth Statistics, No. 12, October 12, 1977.)Additional data concerning physician practicecharacteristics such as primary specialty andtype of practice were obtained during an induc-tion interview.

A complete description of the survey’s back-ground and development has been presented inan earlier publication in Series 2 of Vital andHealth Statistics (No. 61. ~HEW Pub. No.(HRA) 76-1335. Health Resources Administra-tion. Washington. U.S. Government PrintingOffice, Apr. 1974). A detailed description of the1975 NAMCS desigm and procedures will bepresented in future publications.SAMPLING ERRORS: Since the estimates forthis report are based on a sample rather than theentire universe, they are subject to sampling vari-ability. The standard error is primarily a measureof sampling variability. The relative standard er-ror of an estimate is obtained by dividing thestandard error of the estimate by the estimateitself and is expressed as a percent of the esti-

mat e. Relative standard errors of selected aggTe-gate statistics are shown in table I. The standarderrors appropriate for the estimated percentagesof office visits are shown in table II.

Table 1. Approximate relative standard errors of estimated num-bers of office visits



500 .. . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . . . . . . 30.11,000 .. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . 21.42,000 .. . .. . . .. . . . . . . . . .. . . . . .. . . . . . . . . . . . . . . 15.35,000 ... . . . . . . .. .. . . .. .. . . . . .. .. . . . . . . .. . . . . 10.010,000 .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,530,000 .. . .. . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . 5.1100,000 .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 4.0550,000 .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . 3.5

ExampIe of use of table: An aggregate of 80,000,000 has arelative standard error of 4,3 percent or a standard error of3,440,000 (4.3 percent of 80,000,000).

Table II. Approximate standard errors of pf2rCeflta@ for eSti-mated numbers of office visits

Base of percentage

(number of visitsin thousands)

1,000 .....................3,000 .. . . . . . . . . . . .. . . . . . . .5,000 .. . . . . . . . . . . . . . . . . . . .10,000 ... . . . . . . .. . . .. . . . .50,000 .. . . . . . . . . .. . .. . . . .100,000 .. .. . . . . . .. . . . . . .500,000 .. . . . . . .. .. . . . . . .

Estimated percentage

I1or 5 or99 95

2.1 4.61.2 2.70.9 2.10.7 1.50.3 0.70.2 0.50.1 0.2

lOor 20 or 30 or so90 80 70

6.3 8.5 9.7 10.63.7 4.9 5.6 6.12.8 3.8 4.3 4.72.0 2.7 3,1 3.30.9 1.2 1.4 1.50.6 0.8 1.0 1.10.3 0.4 0.4 0.5

Example of use of table: An estimate of 30 percent based onan aggregate of 75,000,000 has a standard error of 1.2 percent.The relative standard error of 30 percent is 4.0 percent (1.2 per-cent+30 percent).

ROUNDING: Aggregate estimates of office visitspresented in the tables are rounded to the near-est thousand. The rates and percents, however.were calculated on the basis of original, un-

dmcedaa 11

rounded figures. Due to rounding of percents,the sum of percentages may not equal 100.0 per-cent.DEFINITIONS: An ambulatory patient is an in-dividual presenting himself for personal healthservices who is neither bedridden nor currentlyadmitted to any health care institution on thepremises.

An office is a place that the physician identi-fies as a location for his ambulatory practice.Responsibility over time for patient care andprofessional services rendered there generally re-sides with the individual physician rather thanan institution.

A vz3it is a direct personal exchange between

an ambulatory patient and a physician or a staffmember working under the physician’s super-vision for the purpose of seeking care andrendering health services.

A physician is a duly licensed doctor of med-icine (M. D.) or doctor of osteopathy (D. O.) cur-rently in practice who spends time in caring forambulatory patients at an office location. Ex-cluded from NMICS are physicians who spe-cialize in anesthesiology, pathology, radiology;physicians who are federally employed; physi-cians who treat only institutionalized patients;physicians employed full time by an institution;and physicians who spend no time seeing ambu-latory patients.

SYMBOLS

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

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

Quantity zero—-–---—-----—--–-––––

Quantity more than Obut less than 0.05— 0.0

Figure does not meet standardsofreliability or precision—-————-— *


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service ] Number 16 ■ February7,1978

Off ice Visits to Internists:National Ambulatory Medical Care Survey, United States, 1975’

According to data collected in the NationalAmbulatory Medical Care Survey (NAMCS), anestimated 62,117,000 visits were made to theoffices of internists during calendar year 1975.These visits accounted for almost 11 percent ofthe estimated total visits made to all office-basedphysicians in 1975.

The NAMCS is a sample survey designed toexplore the provision and utilization of ambula-tory care in the physician’s office–the settingwhere most Americans seek health care. The sur-vey is conducted yearly over the coterminousUnited States by the Division of Health Re-sources Utilization Statistics of the NationalCenter for Health Statistics. The survey sampleis selected from doctors of medicine and osteop-athy who are engaged in office-based, patientcare practice. In its current scope, the NAMCS.excludes physicians practicing in Alaska andHawaii; physicians whose specialty is anesthesi-ology, pathology, or radiology; and physicians inGovernment sewice.

Definitions of terms used in the survey and adetailed explanation of the sample design and

1This report was prepared by Beulah K. Cypress,Ph.D., Division of Health Resources Utilization Statis-tics.

2 Nation~ Center for Health Statistics: Ambulatory

medical care rendered in physicians’ offices: UnitedStates, 1975. Advance Data From Vital and Health Sta-

,tistics, No. 12, DHEW Pub. No. (HRA) 77-1250. HealthResources Administration. Hyattsville, Md., Oct. 12,1977.

the relative standard errors associated withselected aggregate statistics may be found in theTechnical Notes. A copy of the Patient Recordappears in an earlier report. 2

DATA HIGHLIGHTS

Comparison of visits made to office-basedphysicians in the five most visited specialitiesshows that visits to internists were exceededonly by the number of visits made to generaland family practitioners (table 1).

Table 1. Number and percent of vhits tooff ice -based physic ians. by selectedphysician specialties:January-December 1975

Selectedspecialty

General and familypractice ---------------

Internal medicine- --------Obstetrics and

gynecology -------------pediatrics --------------General surgery ---------

united States,

Numberof

visitsin

thou -sands

234,66062,117

48,07646,68441,292

Per -cent

ofvisits

41.310.9

8.58.27.3

2 aduancedata

Table 2. Number, percent distributions, and annual rate of visits to office-based in-ternists by type and location of practice, and age, sex, and color of patient: UnitedStates, January-December 1975

Selected physician andpatient characteristics

All visits ------------------------

Type of practice

solo ------------------------------------OtherZ ----------------------------------

Location of practice3

Metropolitan ----------------------------Nonmetropolitan -------------------------

Under 15 years --------------------------15-24 years -----------------------------25-44 years -----------------------------45-64 years -----------------------------65 years and over -----------------------

Sex

Female ----------------------------------Male- -----------------------------------

Color

White -----------------------------------All otherd ------------------------------


62,117

33,70628,411

52,5439,574

2,0475,474

13,10623,56517,925

36,97825,139

56,4385,679

Percentdistributions

of visits

100.0

54.345.7

84.615.4

3.38.8

21.137.928.9

59.540.5

90.99.1

Annual rateof visitsper 100 inpopulation]

...

. . .

. . .

3714

3525

3121

lBased on population estimates for July 1,1975: Bureau of the Census, Current Popu-lation Reports, Series P-25 and P-26.

21ncludes partnership and group practices.3Signifies location within or outside the standard metropolitan

(S14SA’S).statistical areas

.—qof i<is category about 82 percent are visits by black persons.

ackmdaa3


About 54 percent of visits to internists wereto those in solo practice (tabIe 2). This is adirect reflection of the fact that about 52 per-cent of the internists in the NAMCS sample wereestimated to have been engaged in solo practice.

Table 2 ako shows that 85 percent of thevisits to internists were to offices Iocated withinstandard metropolitan statistical areas(SMSA’S),3 a probable number since about 70percent of the population reside within SMSA’S.However, the visit rate was more than twice ashigh for visits to offices in metropolitan locations(37 visits for each 100 persons in metropolitanareas). This may signify an inclination for someof the population outside of SN4SA’S to visitinternists within SMSA’S.

Age, Sex, and Color of Patient

Information derived from table 2 indicatesthat the number of office visits to internists in-creased with advancing age to age 65 years, thegreatest number occurring in the age intervalfrom 45 to 64 years; and a very sma,II number(about 3 percent) representing the group under15 years of age. The annual rate of visits alsoshows a steady increase with age across all agegroups.

Two of three visits were made by females, asshown in table 2. This is partly explained by thefact that females (51 percent) outnumberedmales (49 percent) in the general population.However, the tendency of females to visit theinternist more often is demonstrated by theirhigher rate of annual visits. Figure 1 illustratesthe influence of sex and age on the annual visit

3An SMSA is defined as a group of contiguouscounties containing at least one city of 50,000 inhabitantsor more, or two contiguous cities with a combined popu-lation of at least 50,000 inhabitants. The distinction“metropolitan/nonmetropolitan” should not be confusedwith “urban/suburban” or “urban/rural” since an SMSAmay contain urban, suburban, and rural subsections.

rate. The annual rate of female visits exceededthe annual rate for males in every age categoryexcept under 15 years. The difference becamegreater after the age of 44, with the largest dif-ference in annual rate between females andmales occurring in the age group 65 years andover.

Figure 1. ANNUAL RATE OF VISITS TO INTERNISTSPER 100 IN POPULATION BY SEX AND AGE OFPATl ENT UNITED STATES. JANUARY-DECEMBER1975.

cc I: 30~

z20 -

10

0Under 15 1524 25-44

~ Male= Female

45.64 65 and over

AGE OF PATl ENT IN YEARS

Visits by white persons (91 percent) out-numbered visits by all others (9 percent) tointernists, paralleling to some degree the popula-tion ratio. However, the average annual rate ofoffice visits was also higher for white persons—31visits for each 100 white persons in the popula-tion were made to internists’ offices, whereasmembers of other races visited at a rate of21 out of 100. These data are similar to percent-ages found for general and family practitionersand could indicate that members of other racesavail themselves more often of other means ofambulatory medical care since the NAAfCS in-cludes onIy office-based care.

Table 3. Number and percent of visits tooffice-based internists, by sex andcolor of patient: United States, Jan-uary-December 1975

I IColor of patient Female I Male

The domination of the internist’spatient

load by the white female k illustratedin the

matrix shown in table3.

Patient’s Major Complaint, Symptom,or Other Reason for Visit

The data in table4arederived from an item

on the survey form which elicitsthe reason for

visitrecorded by the physicianas nearlyaspos-

siblein the patient’sown words. The symptoms

presentedby patientscovered a broad spectrum

Tab le 4. Number, percent, and cumulative percent of visits to office-based internists,by the 20 most frequent patient problems, complaints, or symptoms: United States,January-December 1975

Rank20 most frequent patient problems,

complaints, or symptoms and NAMCS codel

General and required physicalexaminations-----------------------9OO,9Ol

Pain in chest---------------------------322Problems of lower extremity-------------4O()Fatigue --------------- ------------------004Abdominal pain--------------------------54OHigh blood pressure---------------------2O5Problems of back region-----------------4l5Cough-----------------------------------3llProblems of upper extremity-------------4O5Vertigo —dizziness----------------------O69Shortness of breath ---------------------306Headache-- ------------------------------056Throat soreness -------------------------520Diabetes mellitus -----------------------991Cold------------------------------------3l2Visits for medication-------------------9loNervousness -----------------------------810Problems of face, neck ------------------410Allergic skin reactions-----------------ll2Other symptoms referable to cardiovas-cular system---------------------------22O


3,4552,8342,7242.4602;2921,8231.7561;6941,5001,4271.3651;2621.1371;072

960884831749716

672

Percentof

visits

:::4.44.03.72.92.82.72.4

;:;2.01.8

;:;1.41.31.21.2

1.1

Cumulativepercent ofvisits

5.61.0.21.4.618.622.325.22!8.0aJ(),7

33.135.437.639.641.443.144.746.147.448.649.8

50.9

I.Symptomatic groupings and code number inclusions are based on a symptom classifi-cation developed for use in the NAMCS.

admcdaa5

of problems sincethe 20 most common reasons These diagnosescoveredabout one-halfof allforvisitconstitutedonly about halfofallvisits. visitsmade tooffice-basedintemktsk 1975.

Table 6 shows the number of principaldi-Principal Diagnosis4 agnosesaccordingto major ICDJ3 groups.5The

Table5 Iktsthe 20 most common principaldiagnosesassi<gnedby interniststo officevisits.

5~ationa]Centerfor llealth Statistics: Eighth RCZIi-

sion In tcrnational Classi~cation oj”Diseases, Adap ted fo r~7SC in t~.g ~Tnited s~ates (lcD:\). p~~s pub. No. 1 fj93.

4Principal diagnosis is the first diagnosis listed by the Public Health Semite. JVashington. U.S. Go\,emmentphysician on the Patient Record. Printing Office, 1967.

Table 5. Number, percent, and cumulative percent of visits to office -based internistsby the 20 most common ICDA 3 -dizit cate$zories containing the mine ipal diagnos is:

&

U&ited States, January-December %975 -

Rank20 most common ICDA 3-digit

categories and code]

Essential benign hypertension -----------solChronic ischemic heart disease----------4l2Diabetes mellitus-----------------------250Medical or special examination----------yOOAcute upper respiratory infection-------465Neuroses --------------------------------300Osteoarthritis and allied conditions----7l3Symptomatic heart disease---------------427Medical and surgical aftercare----------ylORheumatoid arthritis and alliedconditions-------------------.---------712Obesity---------------------------------277Observation, without need for furthermedical care---------------------------793Emphysema-------------------------------492Hay fever-------------------------------507Other eczema and dermatitis-------------692Other nonarticular rheumatism-----------7l7Synovitis, bursitis, and tenosynovitiS--73lArthritis, unspecified------------------715Symptoms referable to respiratorysystem---------------------------------783Bronchitis, unqualified-----------------490

—.


5,7814,8942,7772,5661,5881,4301,4141,2531,101

1,011983

838837749746727662628

614577

Percentof

visits

Cumulativepercent

of visits

1;:;21.725.828.430.733.035.036.8

38.440.0

41.342.643.845.046.247.348.3

49.350.2

lDiagnostic groupings and code number inclusions are based on the Eighth RevisionInternational Classification of Diseases, Adapted for Use in the United States.

6 acklncedata

Table 6. Number and ptiercent distribution of visits to office-based internists byprincipal diagnosis classified by major ICDA groups: United States,January-December1975

Principal diagnosis classified by ICDA group and codel

All principal diagnoses ----------------------------

Infective and parasitic diseases -------------- ----000-136Neoplasms ---------------- -------------------------140-239Endocrine, nutritional, and metabolic diseases----240-279Diseases of the blood and blood-forming organs----280-289Mental disorders ----------------------------------290-315Diseases of the nervous system and sense organs---3238989Diseases of the circulatory system----------------39O-458Diseases of the respiratory system----------------46O-5l9Diseases of the digestive system- -----------------52O-577Diseases of the genitourinary system--------------58O-629Diseases of the skin and subcutaneous tissue------68O-7O9Diseases of the musculoskeletal system andconnective tissue --------------------------------710-738

Synnptoms and ill-defined conditions---------------78O-796Accidents, poisonings, and violence---------------8OO-999Special conditions and examinations withoutsickness ---------------------------------------- -YOO-Y13

Other diagnoses, “none,” and unknownz --------------------


62,117

1.7372;3105,678

7602,2502,033

15,4367.2953;4222,3271,597

5,3324,0852,674

4,317865

Percentdistribu-tion of!visits,

100,0

H9.11.2

;:!2!4.91.1.75.53.82.6

H!lDiagnostic groupings and code number inclusions are based on the Eighth Revision

International Classification of Diseases, Adapted for Use in the United States.‘630-678, Complications of pregnancy, childbirth, and the puerperium; 740-759, Con-

genital anomalies; blank, noncodable, and illegible diagnoses.

followingfour diagnosticgroups accounted for

over 54 percent of all principal diagnoses

rendered,with almost halfof theseincludedin

diseasesof the circulatorysystem: diseasesof

the circulatorysystem; diseases of the res-

piratorysystem;endocrine,nutritional,and met-

abolic diseases;and diseasesof the musculo-

skeletalsystem and connectivetissue.


Blood pressurechecks were provided inover

61 percent of allvisits,and EKG’s were per-

formed in 14 percent of visitsto the internkt

(table7). Only 33 percent of visitsto alloffice-

based physiciansincludedblood pressurechecks,

with an EKG performed in only 3percent ofallvisits, reflecting the high degree of diseases ofthe circulatory systcm diagnosed by internists.Almost half of all visits to the internist resultedin a drug administered or prescribed. Medicalcounseling was included in almost 18 percent ofthe visits to the internist, about 6 percent ]morethanto all office-based physicians.

abnceMa7

Table 7. Number and percent distribution of visits to office-based internists, by di-agnostic and therapeutic services ordered or provided: United States, January-December 1975

Diagnostic and therapeutic services orderedor providedl

All visits---------------------------------------

No services provided-----------------------------------

Diagnostic services

Limited history or examination-------------------------General history or examination-------------------------Clinical lab test-----------------------------,---------X-ray--------------------------------------------------Blood pressure check-----------------------------------EKG----------------------------------------------------Hearing test-------------------------------------------Vision test--------------------------------------------Endoscopy----------------------------------------------

Therapeutic services

Drug administered or prescribed2-----------------------Injection----------------------------------------------Immunization or desensitization------------------------Office surgery-----------------------------------------Physiotherapy------------------------------------------Medical counseling-------------------------------------psychotherapy or therapeutic listening-----------------

Other services provided--------------------------------


62,117

832

38,13212,49823,8938.13138;1568,663932

1,4651,005

30,7617,2091,596905701

11,0781,667

1,075

Percent ofvisi;s

100.0

1.3

61.420.138.513.16i:414.0

;::1.6

49.511.62.61.5

1;::2.7

1.7

Ipercentswill not add to 100 because most patient visits required the provision ofmore than one treatment,or service.

21ncludesprescription and nonprescription drugs.

Prior Visit Status and Seriousnessof Problem

Ilatafrom tables8 and 9 indicatethatabout 7 of 8 visits to internistswere by re-turningpatients,with continuingproblemspre-sentedby 6 of 8 patientsthephysicianhad seenbefore.The greaterthe age of the patient,thegreaterwasthc tendencytovisit}vitha recurringproblem.

Tables 8 and 9 alsoprovidedata thatex-pressthe physician’sjudgment asto theextentof impairmentthatmight resultifno carewereavailableforthegivenproblem.They shouldbeviewed in the context of the speciaIist’s practice.

About 71pcrcent of all visitswcrejudged bythe internist as cithernot serious or slightly seri-ous. However, the tendency to judge cases asbelongingin the more serious category increasedwith advancing age ofthc patient.

8 aduancecbta

Table 8. Number and percent distributions of visits to office-based internists byprior visit status, seriousness of problem, disposition of visit, and duration ofvisit: United States, January-December 1975

Selected visit characteristics

All visits -------------------------------------------

Prior visit status

Patient seen for the first time----------------------------Patient seen before for another problem --------------------Patient seen before for current problem --------------------


Serious and very serious -----------------------------------Slightly serious -------------------------------------------Not serious ------------------------------------------------

Disposition

No follomp ------------------------------------------------Return at specified time -----------------------------------Return if needed -------------------------------------------Telephone followup -----------------------------------------Referred to other physicianlagency -------------------------Admit to hospital ------------------------------------------Other2-------------------------------------------- ---------

Duration of visit3

O minute (no face-to-face encounter with physician) --------1-5 minutes -------------------------- ----------------------6-10 minutes -----------------------------------------------11-15 minutes ----------------------------------------------16-30 minutes ----------------------------------------------31 minutes or more -----------------------------------------


62,117

8,12212,99541,000

17,75120,88323,484

5,63542,46710,2483,0992,7511,037

890

4203,504

15,38122,11015,293

5,410

?ercent ofvisits

100.0

13.120.966.0

28.633.637,8

6;:;16.55.04.41.71.4

0.75.6

24.835.624.6

8.7

lpercents will not add to 100 because some patient visits had more than one dispo-sition.

sIncludes return to referring physician.Ssi@ifies time spent in face-to-face encounter between physician and patient.

abmdata9

Table 9. Numberand percentdistributionsof visits to office-basedinternistsby priorvisit statusand seriousnessof PC:,5?P,,accordingto age, sex, and color of patient:United States,Janusry-December1975

Age, sex, and color of patient

All visits-------------------

&

Under 15 years---------------------15-24 years------------------------25-44 years------------------------45-64 years------------------------65 years and over------------------

Sex—

Female-----------------------------Male-------------------------------

~r

White------------------------------All otherl-------------------------

Numberofvisits inthousands

62,117

2,0475,47413,10723,56517,925

36,97825,139

5;,;;;,

Percentdistribu-tion ofvisits

100.0

100.0100.0100.0Loo. o100.0

100.0100.0

100.0100.0

Prior visit status

Pa;’ch:en

first time

13.1

28.731.019.49.65.8

12.214.3

12.618.2

Patient seen before

For anotherproblem

20.9

40.032.223.719.015.8

21.220.5

20.921.2

For currentproblem

66.0

31.336.856.871.578.5

66.665.2

66.660.6

Seriousnessof problem

seriousSlightly0= Ve=y seriousseri.aus

28.6 33.6

10.6 27.312.0 28.220.6 33,032.5 33,636.5 36.5

26.8 34.937..3 31.7

28.8 33.926.3 31.1

Notserious

37,8

62.259.946.534.027.0

38.337.0

37.342.7

‘Of this categoryabout 82 percentare visits by black persons.

Disposition and Duration of Visit admittccl a vcv small percentage of his patients

to the hospital (sli~htl>.less than 2 pm-cent).

Over twe-thirds of the visits to internists’ “1’hc avm-a~c visit to the internist’s of[ice

offices resulted in the direction to return at a lasted 18.2 minutes, \vhich exceeded the aver-

spccified time (table 8), hi~hls correlating with ,aqe i)f 15.0 minutes for all specialties.6

the fact that 2 of 3 visits were made by re-

tumin~ patients with recurring problems. I.ike

the ~cneral and family practitioner, the internist

●

6See reference cited in footnote z.

10 aduancedata

TECHNICAL NOTES

SOURCE OF DATA: Data presented in this re-port were obtained during 1975 through theNat ional Ambulatory Medical Care Survey(NAMCS). The target population of NAMCS en-compasses office visits within the coterminousUnited States made by ambulatory patients tophysicians who are principally engaged in officepractice.SAMPLE DESIGN: The 1975 NAMCS utilized amultistage probability design that involved sam-ples of primary sampling units (PSU’S), physi-cian practices within PSU’S, and patient visitswithin practices. Within the 87 PSU’S composingthe fi;st stage of selection, a sample of approxi-mately 3,500 physicians was selected from mas-ter files maintained by the American MedicalAssociation and the American Osteopathic Asso-ciation. Sampled physicians, randomly assignedto 1 of the 52 weeks in the survey year, wererequested to complete Patient Records (brief en-counter forms) for a systematic random sampleof office visits taking place within their practiceduring the assigned reporting period. (A fac-simile of the Patient Record used is shown in aprevious issue of Advance Data From Vital andHealth Statistics, No. 12, October 12, 197 7.)Additional data concerning physician practicecharacteristics such as primary specialty andtype of practice were obtained during an induc-tion interview.

A complete description of the survey’s back-ground and development has been presented inan earlier publication in Series 2 of Vital andHealth Statistics (No. 61. DHEW Pub. No.(HRA) 76-1335. Health Resources Administra-tion. Washington. U.S. Government PrintingOffice, Apr. 1974). A detailed description of the1975 NAMCS design and procedures will bepresented in future publications.SAMPLING ERRORS: Since the estimates forthis report are based on a sample rather than theentire universe, they are subject to sampling vari-ability. The standard error is primarily a measureof sampling variability. The relative standard er-ror of an estimate is obtained by dividing thestandard error of the estimate by the estimateitself and is expressed as a percent of the esti-

mate. Relative standard errors of selected aggre-gate statistics are shown in table I. The standarderrors appropriate for the estimated percentagesof office visits are shown in table II.

Table 1. Approximate relative standard errors of estimated num-bars of office visits



500 ..........................................1,000 .......................................2,000 .......................................5,000 .......................................10,000 .....................................30,000 .....................................700,000 ...................................550,000 ...................................

30.121.415.310.07.55.14.03.5


Table II. Approximate standard errors of percentages for asti -

mated numbers of office visits

Base of percentage


1,000.....................3,000 .....................5,000.....................10,000 ...................50,000 ...................100,000 .................500,000 .................

1or99

2.11.20.90.70.30.20.1


5 or95

4.62.72.11.50.70.50.2

10or90

6.33.72.82.00.90.60.3T

20 or 30 or80 70

8,5 9.74.9 5.63.8 4.32.7 3.11.2 1.40.8 1.00.4 0.4

50

10.66.14.73.31.51.10.5

Example of use of table: An estimate of 30 percent based onan aggregate of 75,000,000 has a standard erro; of 1.2 percent.The relative standard error of 30 percent is 4.0 percent (1.2 per-cent+30 percent).

ROUNDING: Aggregate estimates of office visitspresented in the tables are rounded to the near-est thousand. The rates and percents, however,were calculated on the basis of original, un-rounded figures. Due to rounding of percents,

admceda 11

the sum of percentages may not equal 100.0 per-cent.DEFINITIONS: An ambulatory patient is an in-dividual presenting himself for personal healthservices who is neither bedridden nor currentlyadmitted to any health care institution on thepremises.


A visit is a direct personal exchange betweenan ambulatory patient and a physician or a staff

member working under the ph ysician’s super-vision for the purpose of seeking care andrendering health services.

A physician is a duly licensed doctor of med-icine (M. D.) or doctor of osteopathy (D. O.) cur-rently in practice tvho spends time in caring forambulatory patients at an office location. Ex-cluded from NAhlCS are physicians who spe-cialize in anesthesiolo~, pathology, radiology;physicians who are federally employed; physi-cians who treat only institutionalized patients;physicians employed full time by an institution;and physicians who spend no time seeing ambu-latory patients.

SYMBOLS

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

Category not applicable ------------------------ . . .

Quantity zero––-–-–-—------–--—-------– -

Quantity more than O but less than 0.05-— 0.0

Figure does not meet standards ofreliability or precision--—-—-–—--— *


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Savice I Number,, ■ February 23,1978

Access To Ambulatory Health Care: United States, 19741

Due to increasing concern over many prob-*lems surrounding the accessibility of heaIth care,particularly ambulatory care, there is a need forinformation to answer the following kinds ofquestions: How many Americans have a regular9ou9ce of care? What reasons de people give fornot having a regtdar source of care? To whatspecific types of heaIth care places do peoplewith a regular source of care usually go?Whether or not people have a regular source ofcare, to what extent do they contact office-based sources of care as contrasted to hospital-based sources or clinics that are not associatedwith hospitals? What proportion of the popula-tion uses a telephone to get help or advice abouta health problem? How many Americans have adoctor visit them at home? How many Ameri-cans have problems getting medical care? Dopeople feel that they are getting all the care theyneed?

This report presents data that bear directIyon these questions. Information was obtainedfrom a one-third subsample of respondents tothe 1974 Health Interview Survey who reportedfor themselves or for a child under 17 years ofage. (For further details on the survey designand procedures, see the TechnicaI Notes.)

REGULAR SOURCE OF CARE

The vast majority of Americans have a regu-lar source of medical care. In 1974 an estimated166.8 million people, 80.5 percent of the civil-ian population not confined in institutions, had

1Prepared by Thomas F. Drury, M. A., Division ofHealth Interview Statistics.

a particular doctor .or place where they couId gowhen they were sick or needed advice abouttheir health (table 1). Having a regukr source ofcare was relatively more common among fe-males and whtie persons than among males andali other cob groupz respectively. Childrenami youthc uder the age of 17 were the mostlikely of a# tlw age groups shown i- table 1 tohave a regdar xmrce of care; adults betweenthe ages of 17 and 44, the least likely. Amongaduhs 45 years and over, however, the Likelihoodof having a reguIar source of care increased ineach progressively older age group. Higher fami-ly income was also positively associated with agreater likelihood of having a regtdar source ofcare. Proportionately more people in the NorthCentral Region had a regular source of care thanin any other geographic region. Among place ofresidence groups, cent ral city residents were theleast likely to have a regular source of healthcare.

Reasons for Not Having a Regular Source of Care

While most Americans have a regular sourceof medical care, a substantial number do not. In1974 approximately 30.9 million people had noparticular doctor or place to which they couldgo when they were sick or needed advice abouttheir health (table 2). More than half (54.2 per-cent) of these people indicated that the mainreason for not having a regular source of medicalcare was that, as far as they could determine,they did not need one.

Not having a regular source of medical caremay reflect a person’s orientation toward seek-ing medical care. A substantial number of peoplewere classified as being without a regular sourceof care because they saw different doctors

2 aduanceckta

‘rable 1. Number and percent distribution of persons by whether or not they have a regular source of medical care, ac.cording to selected characteristics: United States, 1974

—. —

Characteristic

All persona l-------------

~

Male ---------------------------Female -------------------------

Age—

Under 17 years-----------------L7-44 years --------------------45,64 years -----, --------------65 years and aver --------------

.. .,

Colorf .—

Whzte-, -------------- --------- .All other i---------------------

Family income,,

Less than $5,000 ---------------$5,000 -$9,999 ----------: -------$10,000-$14,993----------------S15,000or more ----------------

Geographic region

Northeast ----------------------North Central ------------------South --------------------------West ---------------------------

Place of residence

SMSA --------------------------Central city -----------------Outside central city ---------

Outside SMSA -------------------Nonfarm----------------------Farm ----------- _------------,

Total

207,33L

100,024107,30$

62,952ao,77~42,86220,74C

180,72526,60$

32,31647,39851,66663,265

49,19655,54365,23237,363

142,95462,52080,43564,37956,8567,523

Persons —

With a Without aFor whom

regularinformat ion

regularsource of source of on source

care care of care isunavailable

Number in thousands

166,817

75,63491,183

56,17958,86634,14517,628

146,80420,014

25,18737,83442,19352,627

39,31046,35351,86829,286

114,16848,47465,69452,65046,3796,270

‘Includes persons with unknown income.

30,859

17,72313,135

5,81416,4016,1592,485

25,8594,999

6,1877,8487,2897,356

7,4466,46910>4176,526

21,71110,89510,8169,1488,1341,015

according to their various health needs. Interpre-tation of “seeing different doctors for differentproblems” as a reason for being without a regu-lar source of care is not without some ambi-guity, however. At least two different types ofpersons who ought to be distinguished from oneanother may have been grouped together here.The question that treated the subject of a regu-lar source of care in the i974 survey wasworded, “Is there ONE particular doctor orplace you usually go to when you are sick orwhen you need advice about your health?”

People affiliated with two doctors or morefrom whom they usually obtained care might

9,657

6,6662,991

9615,5112,558

627

8,0621,595

9421,7162,1843,282

2,4392,7202,9471,551

7,0763,1513,9252,5812,343

238

—

Persons —

I I

rOtal With a Without aFor whom

informat ionregular regularsource source of

on source

of care care of care isunavailable

100.0/

100.0100.0

100.0100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0100.0100.0


80.5

75.685.0

89.272.979.785.0

81.275.2

77.979.881.783.2

79.983.579.578.4

79.977.581.781.881.683.3

14.9

17.712.2

2:::14.412.0

14.318.8

19.116.614.111.6

15.111.616.017.5

15.217.413,414.214.313.5

4.7

6.72,8

:::6.03.0

4.56.0

properly consider themselves as having a regular,although multichannel, source of care. However,a “no” response to the question would classifythem as being without a regular source of care.People receiving care from the same set of doc-tors are in a somewhat different situation thanthose who go to different doctors for differentproblems but lack a regular set of doctorsfrom whom care is received. This latter grc)upmight well be described as being without either aregular or central source of care. The formergroup may or may not lack a central source ofcare, but could aptly be described as having aregular source of care.

ammdata3

Table 2. Number and percent distribution of persons without a regu:ar source of medical care by main reason, according to selectedcharacteristics: Un~ted States, 1974

Characteristic

All persons‘-------

~

Male---------------------Female-------------------

Ate

Under 17 years-----------17-44years--------------45-64 years--------------65 yearsand over--------

color

white--------------------

All other----------------

Fami1y income

Less than $5,000---------$5,000-$9,999------------$10,000-$14,999----------$15,000or mOre----------

Geographic region

Northeast----------------North Central------------south--------------------West---------------------

Place of residence

SMSA---------------------Central city-----------Outside central city---

Outside SMSA-------------NO*f~~----_.---------.F=~---.----..--------.

Main reason for not having a regular source of medical care

Number ofpersons Frev-without See dif- Unable

iousa regu~ar No ferent doctor Too Health Oa not use

source of Al1 doctor doctorscare fac- doctors

f~d expen-care in reasons lo~er ility unless Other

needed dependi?g right sivethousands available ser~ly

Onww:n; 1s doctor avail-able if needed “

L7,72313,135

5,81416,4016,1592,485

25,8594,999

6,1&177,8487,2897,356

7,4466,46910,4176,526

21,71110,89510,8169,148;,:13;

100.0100.0

100.0100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0100.0100.0

59.846.6

51.655.851.157.2

54.055.0

52.956.854.051.6

55.254.153.354.6

54.053.554.554.754.655.3

17.8

15.521.0

16.919.117.911.3

17.022.0

14.815.519.822.4

18.417.318.716.4

18.118.917.317.317.813.1


7.6

;::

9.2

i::7.4

:.;

8.0

:::6.7

9.87.4

;:?

;.:

9:06.06.0*5.3

7.5

:::

7.77.3

:::

8.33.5

6.67.67.97.6

~:;

8:5

6.96.3

;:?9.18.7

3--1.21.6

1.7

::;*1.4

1.41.5

3.61.1

*O.8*o. 5

i

*0.91.31.91.3

; :$1.11.31.3

*1.3

0.91.3

2.00.9*0.8W.8

0.91.9

2.1*0.8*0.7*0.8

*0.7*o.71.51.3

;::1.2*0.7*0.7*o.&

0.2

0.2*o.2

*o.1*o.3*o.2*-

*O.2*0.3

*0.2*0.2*o.3*0.1

*o.1*o.1*o.3*o.2

*0.2m3.2w. 2*0.2*0.I*0.6

8.2

l;

7.6

J::12.1

8.38.0

10.1

::$8.5

7.8

J:!6.8

;::

9:39.0

11.4

1.9

;:2

3.21.42.3

*1.2

H

1.62.41.11.7

1::2.11.8

2.02.21.9

i::*3.8

lIncludes persons with unknown income.

For a sizable number of people, some barrier a health care facility should they need one (e.g.,

to heaIth care precluded them from having a reg-

ular heaIth care source. Among those without a

regular source of care, 7.6 percent were unable

to find the right doctor. Loss of access to a doc-

tor who was previously being seen was the main

reason given by an additional 7.5 percent of the

people who were without a regular health care

source. For 1.4 percent of those without a re,gu-

Iar source of care, the high cost of health care

was given as the main barrier.

About 1 percent of the people without a

regular health care source indicated that their

reason for not having a particular doctor or

place of care was that they would have access to

civiIians working on military bases). Even fewer

people were without a regular source of care pn-

ma.dy because they did not use doctors unless

their ailment was very serious.

Place of Usual Medical Care

Among the majority of the population with

a regular source of medical care, the largest num-

ber (6Z.8 percent) obtained their health care

from a private doctor’s office or clinic (table 3).

Older persons, white persons, people in families

with a $5,000 income or more, and those resid-

ing outside of standard metropolitan statistical

4

Table 3. Number and percent distribution of persons with a remlar source of medical care by place of usual care, according toselected characteristics:United States. 1974

Characteristic

All persons’------------

sex—Male--------------------------Female------------------------

Age—

Under 17 years----------------17-44 years-------------------45-64 years-------------------65 years and Over-------------

Color

White-------------------------A1l other---------------------

Family income

Less than $5,000--------------$5,000-$9,999-----------------

:::::::-$’4>999--------------or mOre---------------

Geozrauhic rezion

Northeast---------------------North Central-----------------South-------------------------west--------------------------

Place of residence

SMSA --------------------------Central city----------------Outside central city--------

Outside SMSA------------------NOnfam ---------------------Fare ------------------------

.—‘?umberofpersonswith aregular;ourceofcare in:housands

166,817

75,63491,183

56,17958,86634,14517,628

146,80420,014

25,18737,83442,19352,627

39,31046,35351,86829,286

114,16848,47465,69452,65046,3796,270

1Includes persons with unknown inccnne.

Place of usual care

PrivateAll doctorts Group Hospital Hospital Company orplaces oj~$icor practice Ou:~:& em:yy industry Home Other Unknown

clinic

100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0

100.0

1

100.0100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0100.0100.0

62.8

62.563.1

58.962.466.270.1

64.252.4

60.362.863.563.0

72.663.461.251.5

61.558.363.965.665.864.1

areas (SMSA’S) were more likely than compara-

ble age, color, family income, and place of resi-

dence groups to have a private doctor’s office or

clinic as a regular source of care. Whether or not

people were affiliated with a private doctor’s

office or clinic vaned considerably among the

regions. People living in the Northeast were the

most likely, and those in the West the least

likely, to have a private doctor’s office or clinic

as a regular source of health care. Central city

residents were the least likely of all place of resi-

dence groups to have a private doctor’s office or

clinic as a regular source of care.

Group practices–three doctors or more whowork in the same office and share the same

equipment—were the next most common regular

27.2

27.027.3

29.727.125.422.6

27.921.7

22.224.928.530.5

17.330.226.836.3

26.725.321.628.327.633.2

Percent distributic.n

4.8

M

5.8

:::3.3

3.216.5

9.36.03.72.6

4.5

:::5.5

::?

::;2.51.3

0.5

:;:

0.60.5

*0.2W.3

0.31.4

0.80.70.40.1

1.0*O.10.5

*o.2

0.60.90.30.20.2

*0.2

0.3

%;

:::

4;:

0.30.6

0.30.40.30.3

0.6*0.10.30.5

i:;0.30.20.3*-

0.2

:::

*o. 10.2

*0.11.0

0.2*0.2

::;y.;

0.30.20.20.2

0.30.2

::;0.2*-

2.7

2.92.6

3.03.5

$::

2.35.7

5.33.5

::?

2.21.2

:::

3.1

;::

;:?*0.6

sources of care. As much as Z7 percent of those

with a regular source of care (22 percent of the

population) indicated affiliation with a group

practice, In 1974 the Health Interview Survey

did not measure prepaid group practice, a sub-

ject which was measured in the 1975 Health In-

terview Survey and is to be treated in a Iater

report in this series.

As regular sources of care, group practices

were relatively more common among younger

persons, white persons, and people in familieswith higher incomes. Regions differed with re-

spect to the percent of people who had a grouppractice as a regular source of care. The West

and North Central Regions had a greater percent-

age of such people than the South and Northeast.

dmcecMa5

A smaller but substantial number (4.8 per-cent) of the group that had a regular source ofcare identified hospital-based outpatient clinicsas their usual place of care. Although adults 17to 44 years old were similar to those 45 to 64years old in their selection of outpatient clinics,younger peopIe were generally more likely to beaffiliated with hospital outpatient cIinics as aregular source than were older people. People infamilies with less income were also more likelyto note outpatient clinics as their regular healthcare source, as were color groups other thanwhite. Persons living in the South and West weresimilar in tke extent to which they affiliatedthemselves with outpatient clinics as a reguIarsource of care. Both of these groups were morelikely than the other regional groups to have

outpatient clinics as a reguku- source of care.Central city residents were the most likelyamong place of residence groups to identify hos-pital outpatient clinics as regular sources of care.

Other sources of regular care were much Iesscommon. Less than 1 percent of those with aregular source identified emergency rooms as theusual place of care. Under O.5 percent receivedregular medical care at a company or industryclinic or at home.

CONTACTS WITH SOURCESAND PLACES OF MEDICAL CARE

Personal health care is obtainable, whetheror not a person has a regular source of care,from a wide variety of sources or places. Table 4

Table 4. Number and percent of persons utilizing specific sourcesor places of outpatient medical care during year prior to inter-view, by selected characteristits: United States, 1974

Characteristic

All personsl----------------

~Male------------------------------Female----------------------------

AF,e—

Under 17 years--------------------17-44 years-----------------------45-64 years-----------------------65 years and over-----------------

c-

white-----------------------------All other-------------------------

Family income

Less than $5,000------------------$5,000-$9,999---------------------$10,000-$14,999-------------------$15,000 or more-------------------

Geographic region

Northeast-------------------------North Central---------------------South-----------------------------West------------------------------

Place of residence

SMSA------------------------------Central city--------------------Outside central city------------

Outside SMSA----------------------Nonfarm-------------------------Fare ----------------------------

Numberof

personsinthou-sands

207,334

100,024107,309

62,95380,77842,86220,740

180,72526,608

32,31647,39851,66663,265

49,19655,54365,23237,363

142,95462,52080,43564,37956,8567,523

Source or place of care

private Hos- Hos-

doctor’s Group Tele- :$;:- Pitdl Company or ~bl iC ~%!;d Home ~theroffice practice phone t~ent ;y”:; industrv ~i:i: health

or clinic cIinicclinic room

center

Percent of persons utilizing any services

58.2

51.964.1

55.658.958.063.9

60.145.3

54.656.259.162.5

61.457.760.855.2

;:.;

61:457.5$;.;

16.6

14.618.4

19.815.115.315.3

17.312.2

13,014.817.719.7

10.818.716.922.1

16.615.417.516.716.319.8

16.1

12.219.7

23.014.511.011.6

17.46.7

10.414.417.919.6

16.117.814.616.0

17.415.319.113.013.59.7

8.9

8.49.4

%:9.17.5

12::

13.110.07.77.2

9.48.58.59.6

1;:;7.76.9

;::

14.1

15.113.2

16.215.410.79.5

13.816.4

15.915.614.312.5

15.913.813.812.7

14.815.314.412.613.09.6

3.1

:.:

0.2

:::0.4

3.13.2

1.7

:::3.9

3.6

H2.5

;:;3.51.71.8

*O.8

2.6

2.22.9

N1.31.0

2.25.4

5.0

H1.4

;::3.42.9

2.53.4

N2.82.1

1.0

;.!

1.4

;::0.5

0.72.8

2.2

::;0.4

0.90.9

::;

;:}0.60.70.7

*0.6

1.5

1.21,8

:::

i::

1.61.2

2.01.41.11.7

2.7

:::1.2

1.7

i:;

f:;~o.5

2.5

2.82.2

2.13.41.91.1

2.42.7

2.72.22.22.9

::;1.92.4

2.72.72.62.02.2

*0.9

1 Inc ludes persons with unknown income.

6

shows the percent of the population that usedmajor sources or places of care at least once dur-ing a 12-month period, irrespective of whether ornot they had a regular source of care. Almost 6out of 10 people (58.2 percent) contacted a pri-vate doctor’s office or clinic. The next two mostcontacted sources were group practices (17 per-cent) and hospital emergency rooms (14 per-cent). About 9 percent of the population con-tacted a hospital outpatient clinic. Company orindustry clinics and public health clinics wereeach utilized at least once by about 3 percent ofthe population; neighborhood health centers, by1 percent. Sixteen percent used the telephone toobtain help or advice about their health, and 1.5percent were visited by a doctor at home.

There were numerous differences among

population subgroups in respect to the percent-age of people contacting each source or place ofcare shown in table 4. The most consistent dif-ferences occurred among the family incomegroups (figure 1). People in families with higherincomes were more likely than those with lowerincomes to have received care at private doctor’soffices and group practices as well as over thetelephone. However, the reverse was true formost other sources of care. Contact with hospi-tal outpatient departments, emergency rooms,public health clinics, and neighborhood healthcenters was relatively more common among per-sons in families with lower incomes. Contactwith a company or industry clinic during theyear was slightly more likely among higher in-come groups.

Figure 1. PERCENT OF PERSONS IN EACH FAMILY INCOME GROUP UTILIZING SPECIFIC SOURCES OR PLACES OFMEDICAL CARE DURING YEAR PRIOR TO INTERVIEW: UNITED STATES, 1974

70

60

50

1- 40zLuuELun 30

20

10

0

Family Income

_ Lesstfm -$5,000

=1 $,,000-$9,$)99”

m $10,000-$14,999

~$15,0000rrn.ra

Private Group Telephone Company Hospital Hospital Public Neighborhood

doctor’s practice or outpatient emergency health healthoffice or industry clinic room clinic center

clinic clinic

a&mdata7

PROBLEMS IN GETTINGMEDICAL CARE

An estimated 10 percent of the populationexperienced some problem in getting medicalcare during the 12 months prior to the interview(table 5). A delay in getting an appointment wasthe most common problem, with 5 percent ofthe population reporting that difficulty. The un-availability of a doctor when one was neededand the cost of care were problems for nearly 3percent of the population in each case. Justunder 2 percent had a problem getting care be-cause office hours were inconvenient for them.

About 1 percent had a problem because theylacked transportation or did not know where togo.

OveralI, the likelihood of having had someproblem in getting medical care varied amongsex, age, and income groups. ln 197A fem~esand lower family income groups experiencedsome difficulty in getting care proportionatelymore often than other comparable groups.Among age groups, children and youths under17 years old were the least likely, and adults be-tween the ages of 17 and 44 were the most like-ly, to have experienced some problem in gettingmedical care. However, there were no differences

Table 5. Number of persons, percent of persons reporting 1 problem orto interview,

more in getting medical care during year priorand percent of persons reporting specific types of problems,

States, 1974by selected characteristics: United

Characteristic

All personsi--------------

~

Male----------------------------Female--------------------------

Age—

Under 17 years------------------17-44 years---------------------45-64 years---------------------65 years and over---------------

Color

White---------------------------All other-----------------------

Family inccme

JJSSSthan $5,000----------------$5,000-$9,999-------------------$10,000-$14,999-----------------$15,000 or more -----------------

Geographic region

Northeast-----------------------North Central-------------------south---------------------------West----------------------------

I I Type of problem

Number of Personswith 1 Could not

:~u:;d: problemNo doctor

get ap- Office Lack ofDid not

availablecost ih-

knowor more pointment when transpor- where Other

as soon needed venient tationas needed

to go

-1-207,334 10.4

62,95380,77842,86220,740

180,72526,608

32,316:;,:::

63;265

49,19655,54365,23237,363

142,95462,52080,43564,37956,8567,523

Place of residence

SMSA----------------------------Central city------------------Outside central city----------

Outside SMSA--------------------Nonfarm-----------------------Farm--------------------------

1Includes persons with unknown income.

1:::

7.613.110.C9.C

10.:Io.j

14.211.69.18.7

1%;10.112.9

10.~

10.i10.?10.110.66.6

Percent of population

2.32:: 3.1

3.2 2.1

::: 2:;2.7 2.2

5.1 2.83.9 2.1

5.1 3.22.9

2:; 2.65.2 2.6

4.0 2.92.6

:::6.2 ;::

L2.6

;:: 2.52.7

i:;5.1 H3.5 1.9

2.5

2.13.0

1.83.1

2::

2.43.3

5.1

::;0.8

2.31.72.73.9

2.6

;::2.52.61.3

1.7

H

:::1.20.8

1.71.7

1.71.91.71.6

1.71.91.51.7

1.81.8

;::

4:;

1.2

0.81.6

1.1

;:;2.8

;::

3.61.4

::;

0.91.1

H

1.21.51.01.2

4::

1.01 0.5

::;

0.6

::;1.0

1.01.1

1.3

::;0.6

1.10.90.81.1

::2

0.30.40.60.6

0.50.3

0.70.40.40.4

0.40.50.40.5

L1.1 0.51.3 0.51.0 0.50.6 0.4

0.42:; 0.2

8

between people 45 to 64 years old and those 65years of age and older.

These overall differences were not invariant,however. For example, while there was almostcomplete uniformity among the family groupsregarding such problems as doctor unavailability,the scheduling of appointments, and officehours, people in lower family income groupsconfronted cost, transportation, and knowledgebarriers to care proportionately more often thanpeople in higher family income groups.

SELF-PERCEIVED UNMETHEALTH cARE NEEDS

Self-perceptions may be imperfect indicatorsof unmet health care needs. People may be una-ware that they have a condition requiring medi-cal attention. They may perceive themselves asneeding certain kinds of health care which, froma medical point of view, they do not need. Theymay perceive themselves as not needing care fora known medical condition when a physicianwould deem care necessary. In the absence ofmore refhed and specific measurements, how-ever, global assessments of unmet health careneeds provide a useful, if tentative, indication ofthe number and kinds of people who feel thatour health care delivery systems are not fullyresponsive to their needs.

In 1974, 6 percent of the population feltthat they were not getting as much medical careas they needed. Among the various demographicand social groups shown in table 6, this feelingwas more prevalent in some groups than inothers. Perceptions of unmet health needs wererelatively more common among females, adultsbetween the ages of 17 and 64, color groupsother than white, lower family income groups,residents of the West and South Regions, andcentral city dwellers.

There were numerous reasons why peoplefelt that they were not getting all the medicaJcare they needed. The most frequently identi-fied reason was the high cost of care. Almosthalf (48.6 percent) of the people who reportedsome unmet health care need indicated thatcosts were a factor. A smaller but still substan-tial number of people identified the brevity of

time spent with the doctor (14 percent) and theinability to get an appointment ( 13.8 percent) assources of their perceived unmet needs. Diffi-culty getting to the doctor (6 percent) and in-convenient hours (8 percent) figured promi-nently in the perceptions of some people whofelt their needs were unmet. The large “other”category reflected the vast array of additionalreasons that led” to perceptions of unmet healthcare needs.

As shown in table 6, each of these reasonsplayed a more prominent role in the perceptionsof some groups than they did in others. Thesesubgroup differences highlight the diverse rea-sons for perceptions of unmet health care needsamong different social groups. Costs, transporta-tion, and a host of “other” specific reasons weremore frequently cited sources of perceived un-met needs among lower income groups. El[ow-ever, inconvenient office hours, difficulties ingetting appointments, and the feeling that thedoctor gave them an inadequate amount of time,were relatively more common reasons given byhigher income groups for self-preceived unmetneeds.

A CONCLUDING NOTE

There are many other descriptive questionsthat can be asked about sources of medical care.How many people have a particular doctor orother medical person that they usually see attheir regular source of care? What kinds of doc-tors do they usually see? How disposed arepeople to using their regular source of care?How many people contact their regular sourceof care during the course of a year and howoften? How many people receive services bothfrom their regular source of care and from othersources? How many people bypass their regularsource to obtain medical attention from anothersource of care? Are people who receive servicesfrom sources of care other than their regularsource referred by their regular source or dothey refer themselves? What sources of paymentdo people use to cover the expenses of the out-patient care they receive? A more detailed re-port that will deal with these questions is inpreparation.

9

Table 6. Number and percent of persons reporting self-perceived unmet health care needs, and percent of these persons giving spe-cific reasons, by selected characteristics: United States, 1974

Characteristic

AI1 persons]--------------------------

~Mle----------------------------------------Female --------------------------------------

Age—

Under 17 years------------------------------17-if+years---------------------------------45-64 years---------------------------------65 years and over--------------------—-----

Color

White---------------------------------------All other-----------------------------------

Family income

=ss than $5,000----------------------------;5,000-$9,999-------------------------------;10,000-$14,999-----------------------------)15,000or more-----------------------------

Geographic region

Northeast-----------------------------------North Central-------------------------------South---------------------------------------Vest----------------------------------------

Place of residence

sm.%----------------------------------------Central city------------------------------Outside central city----------------------

Outside SMSA--------------------------------Nonfarm-----------------------------------Fan--------------------------------------

Persons reportiag

IPercent

Number in of totalthousands popula-

tionI

-1-12,384 6.0

5,6956,689

2,5915,5722,9941,22s

;,;::>

3,3083,4722,6492,273

2,8162,3624,5662,641

8,8834,6294,2543,5013,;;:

::;

$;.

R

12:

10.2

k?3.6

::;7.07.1

6.2

;:$5.45.55.0

Self-perceived unmet health care need

Reascm for

DOctc.r Cannot get Difficulty office hOur~cost spends in-

adequate appoint- ge~~3=t0 inc .nwenient Othe=tinw

ment

percent of persons

48.6

47.649.5

47.749.050.344.7

47.352.6

55.257.943.129.3

43.038.251.858.3

47.950.045.650.550.351.9—

14.C

12.;15.1

7.415.615.915.9

12.113.316.217.6

12.118.812.115.0

14.314.614.013.312.7

*18.1

13.8

13.214.3

10.016.313.012.0

14.910.1

12.4

H:;17.7

14.918.411.512.2

13.112.613.715.416.0

*1O.4

8.3

6.89.6

10.34.3

2:::

8.29.46.9

%:*5.6

6.5 26.5

I

6.86.3

5.67.38.0

*1.4

6.95.4

3.2

::;8.9

9.7

j:!

;:;

::;5.4*-

27.925.4

21.029.625.127.9

27.324.1

27..225.128.336.8

27.725.926.426.2

27.025.22.9.925.425.921.8

lIncludes persons with unknown inccmse.

10

TECHNICAL NOTES

SOURCE OF DATA. The data presented in thisreport were obtained from household interviewsin the Health Interview Survey. These interviewswere conducted throughout 1974 in a prob-ability sample of the civilian noninstitution-alized population of the United States. Duringthat year approximately 116,000 persons livingin about 40,000 households were included in thesample. The questions about sources of medicalcare and problems in getting care were asked ofeach household member who was identified as a“sample person. ” This subsample included37,062 persons.

SAMPLING. The sampling pattern for sampleperson selection was based on the total numberof related and unrelated household members.Sample persons (a one-third subsample of theHealth Interview Survey sample) were selectedby the interviewer at the time of interview. Todetermine which household member(s) to de-signate as a sample person, the interviewer refer-red to a preselected flashcard after listing all re-lated and unrelated persons in the household onthe questionnaire. The flashcard contained, foreach household size, one person number or morethat were to be identified as the sample per-son(s).

Since the estimates shown are based on asample of the population rather than on the en-tire population, they are subject to samplingerror. Standard errors appropriate for the esti-mates of the number of persons are shown intable I; standard errors appropriate for percent-ages are shown in table 11.

LIMITATIONS AND QUALIFICATIONS OFDATA. While the procedures used in the HealthInterview Survey are designed to minimize non-sampling errors, including various forms of re-sponse errors, the data presented in this reportare, to some extent, still subject to this type oferror. Estimates derived from the 1974 HealthInterview Survey on sources of medical care andproblems encountered in getting care may alsodiffer somewhat from those derived from othersurveys dealing with the same subject matter dueto differences in definitions, sample design,question wording, and other procedural aspectsof the data collection process.

Table I. Standard errors of estimates ofaggregates

Size of estimate Standard errorin thousands in thousands

70---------------- 211oo---------------3oo--------------- ::5oo--------------- 557oo--------------- 65l,ooo-------------5,000------------- 1;:lo,boo------------ 24320,000------------ 33730,000------------ 40550,000------------ 501loo,boo----------- 626

Table II. Standard errors, expressed inpercentage points, of estimated per-centages

Base ofpercent-age in

thousands

70--------1oo-------3oo-------5oo-------7oo-------l,ooo-----5,000-----lo,ooo----20,000----30,000----50,000----loo,ooo---

.02or98

4.13.5

?::1.3

::;0.30.20.2

:::


.05or95

6.4;.:

2:4

H0.80.50.40.30.20.2

10or90

8.9

u

M2.31.00.70.50.40.30.2

20or80

11.89.9

2::3.73.11.4

::;0.60.40.3

50

14.812.47.1

::?

;:?

::;0.70.60.4

For a more detailed discussion of the limita-tions and qualifications of data collected in theHealth Interview Survey, see an earlier reportentitled “Current Estimates from the Health In-terview Survey, United States, 1974, Vital andHealth Statistics, Series 10, No. 100, DHEWPublication No. (HRA) 76-1527.

dmcedab 11

In this report, terms such as “similar” and of 1.96 (0.05 level of significance) was used to“the same” mean that no statistical significance test all comparisons which are discussed. Lack ofexists between the statistics being compared. comment regarding the difference bet ween anyTerms relating to differences (i.e., “greater,” two statistics does not mean the difference was“less,” etc.) indicate that differences are statis- tested and found to be not significant.tically significant. The t test with a critical value

SYMBOLS

Data not available ..-

Category not applicable . . .

Quantity zero

Quantity more than Obut less than 0.05— 0.0

Figure does not meet standards ofreliability or precision *

FROM VITAi_& HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE = Public Health Service I Number 18 ■ March 7,1978

Episodes of Persons Injured: United States, 1975’

Each year, as part of its interview survey ofthe civilian noninstitutionalized population ofthe United States, the National Center for HealthStatistics collects a limited amount of data oninjuries resulting from accidents and other causes.Data on this topic are obtained on the nature ofthe injury, where the accident happened, whetherthe person was at his or her job or business whenthe accident occurred, and whether a motor ve-hicle was involved.

During 1975 two supplements relating to in-,.

juries were included in the Health Interview Sur-vey. Both were developed in conjunction withthe Consumer Product Safety Commission.Since respondents were to be asked about in-juries occurring during the 6 months prior tointerview and memory decay was expected to bea major problem in using a reference period ofthis Iength, the first supplement served as an ex-tensive probe to improve reczdl of accidental in-juries during that period. The second supple-ment was intended to obtain—aside from all ofthe usual information collected each year oninjuries-the following types of additional infor-mation: (1) where (if it was medically attended)the person first received medical attentionfor the injury, (2) more detailed informationfor accidents in which motor vehicles were in-volved, (3) how the accident happened, (4) whatproduct or products (if any) were directly orindirectly involved, (5) whether there were anyspecial circumstances which contributed to caus-ing the accidental injury, and (6) whether theinjury was intentionally inflicted.

A 6-month reference period was used inorder to produce a more extensive data base

1This report prepared by Peter W. Ries, Ph. D., Divi-sion of Health Interview Statistics.

than is obtained from the customary 2-weekreference period used each year for accidentalinjuries in the Health Interview Survey. How-ever, in accordance with the usual annual proce-dure, data on accidental injuries were includedonly if they met at least one of two conditions:(1) the injury was medically attended, or (2) itcaused the person to cut down on his or herusual activity for at least 1 day.

Injury data may be tabulated in at leastthree different ways, depending on whether thetopic of interest is (1) the person involved in oneor more accidents causing injuries during a givenreference period, (2) the particular episode re-sulting in injury, or (3) each individual injuryitself. The unit used in this report is the episodeof persons injury, that is, the event which causedthe injury or injuries. The estimates shown inthe detailed tables are derived from the 1975accident and injury supplements; they are, how-ever, based on only those reported experiencesoccurring during the 2 weeks preceding the in-terview.

The results from the 1975 supplements indi-cate that during this period there were about74.2 million episodes of persons injured amongthe civilian noninstitutionalized population.2Tables 1-6 show these episodes distributed byresponses to several supplemental questions ac-cording to various sociodemographic andhealth-related characteristics. Tables 7 and 8show the types of products involved in the pro-duct-related episodes.

2This estimate differs from the estimate of 71,903million persons injured shown in the 1975 Current Estim-ates because (1) the definition of injury differs some-what, and (2) the estimates shown in Current Estz”matesare derived from the usual questionnaire and thoseshown in this report are derived from the data collectedin the supplements.

2 acklncedata

Respondents reporting episodes of acciden-tal injury were asked: “Where did the accidenthappen?” Tables 1 and 2 show that when un-known places are excluded about half of the epi-sodes (50.4 percent) happened at home, with28.9 percent happening in the house and 21.5percent occurring adjacent to the house. Indus-trial places accounted for 11.7 percent of theepisodes, followed by street and highway (9.5percent), place of recreation (8.8 percent),

school (8.2 percent), and other places (11.4 per-cent).

Tables 3 and 4 present the number and per-cent distribution of episodes by what the personwas doing when the accidental injury occurred,according to seIected characteristics.s An esti-mated 25.7 percent of the episodes occurred

3The precise wording was, “What was . . . doing Zitthe time of the accident?”

Table 1. Nunber of episodes of persons injured,by place where accident happened and selected characteristics:United States, 1975

11)x,,,Jw1,,,s.,1,,,,Imu.ddd UUCWI.W d XII. cwh.tn IB,,x>j$IscIt.ttc>t).lILc<l pop.1.cwn, The s.rv.y dmgn. $cncrd q..dtfutwns, A mformtmn on Lh. rch.iimhty of the cstm.rcs WC $Ivc!l m tbc

CcLl\,,lc.tl tn<>tml

At homeStreet

Selected characteristic Industrial school Place of other Placerecreation place unknown

LAll episodes---------------- 74,164

Sex—

Male ------------------------------ 39,653Female----------------------------34,511

Age. IUnder 17 years-------------------- 25,90S17-44 years-----------------------32,75745-64 years----------------------- 10,79665 years and over----------------- 4,703

Farnily income

Less than $5,000------------------$5,000-$9,999---------------------$10,000-$14,999-------------------$15,000-$24,999-------------------$25,000 or more-------------------Not reported----------------------

12,32716,53116,66017,4816,7344,431

Geographicregion

Northeast-------------------------15’,677North Central--------------------- 20,103South-----------------------------21,605west------------------------------16,779

Place of residence

SMSA, central city---------------- 22,215SMSA, not central city------------ 29,482Outside SMSA---------------------- 22,467

Days of restricted activity

None------------------------------2$,4421 or more-------------------------45,721

Bed days INone ------------------------------ 5fj,4361 or more ------------------------- 17,728

Medical attention

Attended at emergenty room-------- 25,227Attended, but not at emergentyroom-----------------------------29,936

Attended, place unkncx?n----------- 2,692Not medicallv attended------------ 16.309

35,736

15,44520,291

14,01912,4685,9593,290

6,9387,5477,753;,$;;

1;s47

7,1209,23010,604S,7S2

10,64414,49110,601

14,41521,321

27,683S,053

11,491

14,9421,6257.677

20,514

6,50014,014

6,48S8,1373,7472,142

4,2934,4004,8244,6301,5s1786

4,1535,1325,6115,618

6,5648,3885,562

S,21O12,304

15,8704,644

5,577

9,142924

4.871

Number of episodes in thousands

S,9456,277

2,9943,731

7,531 1,898$,;;: 3,374

1,0071;149 *446

2,645 1,2533,146 1,1552,928 1,0413,848 2,0061,593 *5961,061 675

2,966 1,4854,098 1,9004,993 1,9653,164 1,375

4,080 2,3526,103 2,3725,038 2,001

6,205 1,8479,016 4,S78

11,8123,409

4,45s2,267

15,914 3,435

5,s00 1,661701 *137

2,806 1,493

.8,312

;,;;:

*2176,6791,326*O

7102,3872,312l:~~;

7s7

1,6032,4942,7831,431

2,2073,4732,632

3,3974,915

6,2532,059

2,895

3,952*2861,1s0

*Numbers preceded by an asterisk have a relative standard e~ror of more than 30 percent;with other cells.

5,785

3,S161,969

3,9631,677*146*-

6831,1471,2001,611S63*2S1

1,1431,9011,3091,432

1,5662,3601,860

2,1663,620

4,S68917

1,671

2,528*L831,403

6,264

4,4091,855

2,3693,5039.354*3B

*4621,5511,4211,:;;

*377

1,9081,5171,5031,336

1,9002,7431,621

2,197&,067

;,;;;

2,806

1,3919<52

2,015

8,087

5,0763,011

2,3963,6771,507*50B

1,5132,162f,;$;

$<467$,419

1,3841,9022,6942,10s

2,6512,7072,728

2,8765,211

5>5692,517

2,425

3,773*1B71,701

3,254

9932,261

1,0471,379*498*330

76B*583868901*899<44

1,0341,158747

*314

8941,3361,024

1,5451,709

2,614640

*505

1,6S7*221S41

estimates given solely for combining

ackmeMa3

while the person was working, 17.5 percentwhile traveling, and 16.0 percent, whiIe the per-son was participating in some form of recrea-tion. Other forms of activity accounted for 32.5percent of the total, while no major activity wasindicated by the respondent for 8.3 percent ofthe episodes.

The term “working” as used in tables 3 arid4 appIies to any kind of work, incIuding workperformed while the person was not at his or her

job or business (for instance, cleaning up theyard). Table 5 shows the number and percentdistribution of episodes for persons 17 years aridover who were working at their job or businesswhen the episode occurred.J Thus, of the ap-proximately 17.2 million episodes shown in

4The question posed was: “Was . . . at work at his job

or business when the accident happened?”

Table 2. Percent distribution of episodes of persons injured by place where accident happenedtics: United States, 1975

, according to selected characteris-

[nat.arcbawd..Imuwlmldmtcrwcwsofthec,whmnoninst!rutrxmhzcdpopulation. The survey dcs,gn, general qualdmacmm, A mformaucm on the r.lddu, oftheew,matcsaregivenm dm

Selected characteristic

All episodes--------------------------

&e&

Male----------------------------------------Female--------------------------------------

Age—

Under 17 years------------------------------17-44 years---------------------------------45-64 years---------------------------------65 years and over---------------------------

Family income

kss than $5,000----------------------------$5,000-$9,999-------------------------------$10,000-$14,999-----------------------------$15,000-$24,999-----------------------------$25,000 or more-----------------------------Not reported--------------------------------

Geographic region

Northeast-----------------------------------North Central-------------------- --------South---------------------------------------West----------------------------------------

Place of residence

SMSA, central city--------------------------SMSA, not central city----------------------Outside SMSA--------------------------------


None----------------------------------------1 or more-----------------------------------

Bed days

None----------------------------------------1 or more-----------------------------------

Medical attention

Attended at emergency room-------------------Attended, but not at emergency room---------Attended, place unknown---------------------Not medically attended----------------------

tcchmcalmxcs]

11 I I I I IAt home

Al1 Streetlndus’=-ial School Place of Other

places] andInside ~ij~u~~ highway place

Total houserecreation place


100. (

100.(100.(

100.(100.t100.c100.C

100.C100.C100.c100.C100.C100.c

100.0100.0100.0100.0

100.0100.0100.0

100.0100.0

Loo.o100.0

100.0100.0100.0100.0

50.4

40.062.9

56.439.757.975.3

60.047.3g;.;

47:842.1

48.648.750.853.3

49.951.549.4

53.648.4

51.447.1

;;.;

65:849.6

28.S

16.:43.5

26.125.536.449.0

37.127.630.527.923.817.9

28.427.126.934.1

30.829.825.9

30.528.0

29.527.2

22.632.437.431.5

21.5

23.119.5

30.313.821.526.3

22.919.718.523.224.024.2

20.321.623.919.2

19,121.723.5

23.120.5

21.920.0

23.920.528.418.1

9.5

1:::

1:::9.8

*lo.2

10.87.2

1:::W.o15.4

10.110.09.48.4

11.0

:::

1::?

1:::

13.95.9

*5.59.7

11.7

17.94.:

*0.921.312.9*2.1

l::i14.69.3*8.517,9

10.913.213.38.7

10.412.312.3

12.611.2

11.612.1

11.714.0

*11.67.6

—.

8.2

9.96.1

15.95.3

*1.4*.

,5.97.27.6

1%:*6.4

1;::6.38.7

7.3

;:?

8.18.2

9.05.4

6.88.9

*7.49.1

8.8

11.45.8

1?:2*3.4*0.9

*4.O

::;

14:7*8.6

13.08.0

;:?

8.99.77.6

8.29.2

;.;

11.44.9*2.113.0

11.4

13.19.3

9.611.714.6

*11.6

13.113.613.18.8*7.O‘W.6

1?::12.912.8

12.4

11:$

10.711.8

10.314.7

11?::*7.611.0

lExcludes place unknciwm.*Nmnbers preceded by an asterisk have a relative standard error of more than 30 percent; estimates given solely for cmnbining

with other cells.

4

Table 3. Number of episodes of persons injured, by activity status and type of activity when accident hap-pened and selected characteristics: United States, 1975

[Dataare basedon homehol~interviewsoftheciviliannonimtitu[ionahzedpopulation.The survey design, gemral qualifications, and information on the reliability

of the estimates are given in the technical notesl


All episodes --------------------------

Sex—

Male---- ------------------------------------Female --------------------------------------

Age—

Under 17 years ------------------------------17-44 years ---------------------------------45-64 years ---------------------------------65 years and over ---------------------------

Family income

Less than $5,000 -----------------------------$5,000 -$9,999 --------------------------------$10,000 -$14,999 ------------------------------$15,000 -$24,999 ------------------------------$25,000 or more ------------------------------Not reported ---------------------------------

Geographic region

Northeast -----------------------------------North Central -------------------------------South ---------------------------------------West ----------------------------------------

Place of residence

SMSA, central city --------------------------SMSA, not central city ----------------------Outside SMSA --------------------------------


None ----------------------------------------1 or more -----------------------------------

Bed days

None ----------------------------------------1 or more -----------------------------------

Medical attention

Attended at emergency rem------------------Attended, but not at emergency room ---------Attended, place unkno~---------------------Not medically attended ----------------------

Activ -

Al 1ity

LctivityNo

Working ~yn- Trav-;tatuses cling

Other major k=wn

andact ivity or not

typesSpec -ified


74,164

39,65334,511

25,90832,75710,7964,703

12,32716,53116,66017,4816,7344,431

15,67720,10321,60516,779

22,21529,48222,467

28,44245,721

56>43617,728

25,22729,9362,692

16,309

18,646

12,5426,104

I1,414

12,1964,137

898

3,0453,6934,8313,8801,9801,217

3,1405,4276,6103,470

:,%;

6;375

7,28211,364

l:,::J,

6,9317,653601

3,461

11,613

8,3923,221

6,1235,175*315

*-

1,1722,6412,5033,1981,669*428

2,8313,3422372:2,71S

3,395,00’3,211

9,27:2,34(

4,14:3,75(*20:3,50$

12,717

5,5977,121

3,724;,;::

1;745

2,3033,0642,3433,122857

1,029

2,71(3,51(3,39(3,10:

3,59:4,67;4,44[

;,;;49?

9,08C3,638

5,6934,147*46 22.415

=4===9,869.3,670

,2,0417,6202,7331,145

;,;;;

5:4725,6301,5871,246

5,3616,180;,!;;9

7,621;,:$:,

9,75113,788

18,0055,533

6,08211,1791,0985,180

2,5373,475

1,9082,3761,044

684

1,1021,4161,2461,363*416*469

1,4091,3351,5381,73C

1,98!2,37:1,65:

2,16(3,84(

4,25;1,76[

2,1512,142*19:1,526-

1.,636

717920

698*486*223*230

*371*447*265*287*226+.41

*227*309674

*426

656678

*302

788848

1,,189>k447

+,2241,,059??135Y?218

*Numbers preceded by an asterisk have a relative standard error of more than 30 percent; estimates givensolely for combining with other cells.

amcdata5

Table 4. Percent distribution “of episodes of persons injured by activity status and type of ac-tivity when accidenthappened, according to selected characteristics:United States, 1975

[Dataare based on household interviews of the civilian noninstitutionaliied population. The survey design, general qualifications, and information on

the reliability of the estimates are given in the technical notes]

SelectedcharacteristicAll activitystatuses Working Recreation No majorTraveling Other activity

and typesl

All episodes---------------

Sex—

Male-----------------------------Female---------------------------

A&_

Under 17 years-------------------17-44 years----------------------45-64 years----------------------65 years and over----------------

Family income

Less than $5,000-----------------$5,000-$9,999--------------------$10,000-$14,999------------------$15,000-$24,999------------------$25,000 or more------------------Not reported---------------------

Geographicregion

Northeast------------------------North Central--------------------South----------------------------West-----------------------------

Place of residence

SMSA, central city---------------SMSA, not central city-----------Outside SMSA---------------------

Days of restricted activity—

None-----------------------------1 or more------------------------

Bed daya

None-----------------------------1 or more------------------------

Medical attention

Attended at emergency room-.----A-ttended, but not at emergencyroom----------.-.---------------

Attended, place unknown----------Not medically attended-----------

100.0

100.0100.0

100,0100.0100.0100.0

100.0100.0100.0100.0100.0100.0

100.0100.0100.0100.0

100.0100.0100.O

100.0100.0

100.0100.0

100.0

100.0100.0100.0


25.7

32.218.2

5.637.839.120.1

25.523.029.522.630.427.7

20.327.431.621.2

23.025.428.8

26.325.3

26.523.2

27.7

26.523.521.5

16.0

21.69.6

24.316.0*3.(3*-

12::15.318.625.6*.7

18.316.913.016.6

15.717.414.5

15.216.5

16.813.5

16.6

13.0*7.921.8

17.5

14.421.2

14.815.222.239.0

19.319.014.318.213.223.4

17.517.716.219.0

16.716.220.1

15.418.8

16.421,1

22.8

14.4*18.115.0

32.5

25.340.7

47.823.625.825.6

36.232.833.432.724.428,4

34.731.231.932.6

35.332.829.2

35.330.7

32.632.0

24.3

38.742.932.2

8.3

7.67.4

1?::

9.28:8

;:$*6.4

9.16.7

K?::

1;:;

8.6

7.4*7.59.5

lExcludesactivity unknown or not specified.*Numbers preceded by an asterisk have a relative standard error of more than 30 percent; esti-

mates given solely for combining with other cells.

6

Table 5. Number and percent distribution of episodes of persons injured aged 17 years and over by wheth-er person was at job or business when accident happened, according to selected characteristics: UnitedStates, 1975

[Dataarebasedon householdinterviewsofthecwihannoninstitmionalizedpopulation.The surveydesign,generalqualifications,and information)on the


All episodes ---------

Sex

Male -------------------- ---Female ---------------------

Age

17-44 years ----------------45-64 years ----------------65 years and over ----------

Family income

Less than $5,000-----------$5,000-$9,999--------------$10,000-$14,999------------$15,000-$24,999------------$25,000 or more ------------Not reported ---------------

Geographic region

Northeast ------------------North Central --------------South ----------------------West -----------------------

Place of residence

SMSA, central city ---------SMSA, not central city -----Outside SMSA ---------------

Days of restrictedactivity

None -----------------------1 or more ------------------

Bed days

None -----------------------1 or more ------------------

Medical attention

Attended at emergencyroom ----------------------

Attended, but not atemergency room ------------

Attended, place unknown----Not medically attended -----

lExcl~des unknown if at

*Numbers rmeceded bv an

celiabdityoftheestimatesaregivenin the technical notes]

Al 1 At job orNot at

episodes businessjob or Unknown

business


48,256

23,84324,413

32,75710,7964,703

8,88410,92810,13910,9714,1803,153

9,60612,85314,28811,509

14,51918,89314,844

17,32630,929

35,50812,747

15,444

19,6871,875

11,250

11,411

;,;;;>

8,8282,364*220

1,527p:

2;3246.57992

2,0053,0644,0502,293

3,1234,3803,909

4,4536,958

8,5822,830

4,150

5,168*4351,659

34,409

14,31220,097

22,3237,8874,199

6,7257,3446,5688,1333,5242,116

6,7899,0509,7158,856

10,68013,43010,300

11,63322,776

25,0469,363

10,964

13,1351,2629,048

2,435

7351,700

1,606*545*284

633*583660

*514-k-*44

812739

9c524*360

7161,083635

1,2401,195

1,880*555

*330

14;;;

*543

,Al 1 At job or Not at

episodesl business job orbusiness,

I I


100. c

100.C100. c

100.0100.0100.0

100.0100.0100.0100.0100.0100.0

100.0100.0100.0100.0

100.0100.0100.0

100,0100.0

100,0100.0

100.0

100.0100.0100.0

24.9

38.111.5

28.323.1*5.O

18.529.030.722.215.731.9

22.825.329.420.6

22.624.627.5

27.723.4

25.523.2

27.5

28.2*25.615.5

)b or business when accident happened.~terisk have a relative standard error of more than 30 percent;

75.’1

61.988.5

71.776.995.0

81.571.069.377.884.368.1

77.274.770.679.4

77.475.472.5

72.376.6

74.576.8

72..5

71.874.484.5

estimatesgiven solely-for combining with other cells.

dmcedaa7

table 3 for persons 17 years and over who weredoing some type of work when the episode oc-curred, about 11.4 million occurred while theperson was working at his or her job or business.These 11.4 million episodes constitute about23.6 percent of all of the episodes for this agegroup.

Respondents who reported medical atten-tion of accidental injuries were asked: “Wheredid . . . FIRST see or talk to a doctor–at aclinic, hospital, doctor’s office, or some otherplace?” Table 6 shows the number and percentdistribution of all episodes of persons injured bywhether or not the injury or injuries were medi-cally attended and, if so, where medical atten-tion was first received. It should be reempha-sized that these data do not include episodes inwhich the injuries were not medically attendedor did not cause the person to restrict his or heractivity for 1 day or more. As may be notedfrom table 6, 78.0 percent of the episodes re-sulted in some form of medical attention, while22.0 percent led to restricted activity but didnot involve medical attention.

This proportion between medically attendedepisodes and those not medically attended dif-fers from the proportions usually derived fromthe annuaI Health Interview Survey. Ordinarily,the proportions are about 84 percent medicallyattended and 16 percent not medically attended.The difference probably reflects the influence ofthe supplemental injury probe, which tended toscreen in additional relatively minor types of in-juries which did not require medical attention.

Of aII medically attended episodes, 41.3 per-cent were first treated at a hospital emergencyroom, 33.9 percent at a doctor’s office, and 24.8percent at other places (“other places” includestelephone calls to a medical doctor). Of the esti-mated 25.2 million episodes that were evertreated at a hospital emergency room, 92.5 per-cent (23.3 million) were fh-st treated there,while 7.4 percent followed a previous contactwith a medical person. When use of a hospitalemergency room is viewed in relation to all epi-sodes, whether or not they were medicallytreated, 32.0 percent were first treated at a hos-pital emergency room and 34.8 percent weretreated there at one time or another. All of thesepercents exclude the episodes for which theplace of first medical attention was unknown.

Data on product involvement in episodes ofpersons injured were obtained in response to thefollowing two questions: “What product or ob-ject came into contact with . . . and actuallycaused the injury?” and “What other productsor objects were involved in the accident?” Ininterpreting the estimates of product involve-ment, based on responses to these questions, itshould be noted that the data do not in any wayindicate whether or not any defect or propertyof the design of the product was responsible forthe accident.

The data on type of product involvement inaccidental injuries was coded according to thecoding system used in the hTationaI ElectronicInjury Surveillance System (NEISS) of the Con-sumer Product Safety Commission.5 The esti-mates shown in table 7 are based on the broadcategories used in that system. The frequency ofproduct involvement is based on the number oftimes a category of products was involved one ormore times in an episode of accidental injuryand not on the number of products involved inthat episode. As such, the frequency is to somedegree a function of the range of products usedin any category, and because of this, totals forsub~oups of a category will not usually sum tothe total for the entire category.

Up to three types of products were codedfor each of the two product-related questions.Thus any particular episode might have fromzero to six types of products involved. Of theapproximately 74.2 million episodes of personsinjured, about 56.3 milIion involved at least onetype of product. Using the broad categories ofproduct types found in the NEISS coding sys-tem, the estimated 56.3 million episodes in-volved about 69.5 million instances of type ofproduct involvement during 1975 (table 8).

Table 7 shows che percent of times the cate-gories of product types were involved in epi-sodes of persons injured for episodes among (1)all civilian noninstitutionalized persons, (2)males, (3) females, and episodes resulting in (4)1 day or more of restricted activity, and (5) avisit to a hospital emergency room.

As an example of the way in which to inter-pret the estimates show-n in table 7, the case of

5See iVEISS Coding Manual, U.S. Consumer ProductSafety Commission, Bureau of Epidemiology.

8 aduamedata

Table 6. Number and percent distributions of episodes of persons injured by whether medically attended and, if SO, place of firstmedical attention, according tO selected characteristics:IJ”itedstates, 1975

IIJ.11.,.mub.scd<,11Iho.wlmhl mtcrvrws of d). cwIII.iI1nonl,lst!tut,ojl.ltzcd pop.lacmn, Th. s.rv.y dcs,gn, yncral cIu,tlIfK.cIons. and ,ntonn.turj on CIICr.lial>illty of the cwiz..rcs arc gwn III chc

tc.l>n, c,l ,,<,,,,1

Place of first medical attencicm

All All NotSelected medi- medi.

characteristic epi- cally Emer- Doc- callysodes geney tor’s Other Un-

at- kncwn at-tended room Of- tende(epi- fice

sodes

All epi-sodes------

)

74,16

g

Male-------------- 39,65Female------------ 34,51

Age—

Under 17 years ----17-44 years -------45-64 years -------65 years and over-

Family income

Tess than $5,000--$5,000-$9,999-----$lo,ooo-$14,999---$15,000-$24,999---$25,000 or more---Nat repOrted------

Geographic region

Northeast---------North Central-----South-------------West--------------

SMSA, centralcity-------------SMSA, not centralcity-------------

Outside SMSA -----

25,90/32,7510,7914,70

12,32:16,53116,66(17,4816,73!4,431

15,67720,10:21,60516,779

22,215

29,48222,467

,*:edact ivity

1 or more..]None--------------28,44255,721

IBed days

INone----,---------1 or mOre---------Medical attention

Attended atemergenty roOm---

Attended, but notat emergentyrOOm-------------

Attended, placeunknwn----------

56,43617,728

25,227

29,936

2.692I


57,8?

31,2126,62

20,8425,o48,203,75

9,3912,66<13,9313,215,1213,52

12,80!15,99$16,56112,48:

16,88;

23,43517,532

28,44229,41?

45,55112,304

25,227

29,936

2,692

23,25

14,318,93

8,9510,192,921,18!

3,945,40(5,07!5,09,1,87”1,86(

6,07(6,75!6,64;3,78;

7,147

9,42:6,68:

9,90813,344

17,0486,204

23,252

...

...

19,04[

9,2679,782

6,3907,7503,3501,558

2,9233,9174,5354,8631,7561,055

3,0494,6506>0575,292

~

I

4,760

7,5296,759

9,4809,568

15,4573,592

929

17,657

*461

ention.

13,95

7,006,94I

5,14<6,26(1,62:91[

2,25(2,94:3,8812,92(1,35:60:

3,3764,2343,4072,938

4,467

5,8813,607

B,2285,727

1,7222,233

961

?,234

760

1,60[

62(97:

*35t84c

*312991

9~277,~406+<446*3319<140*-

*314>t362>k453.~47o

*513

602<<484

826773

.,3249<276

*84

*45

,471

16>30!

8,43{7,87:

5,05!7,70:2,58<95:

2,93(3,86;2,72:4,26:1,60C905

2,8684,1045,0414,296

5,328

6,0474,934

...6>309

0,8855,423

...

...

...

TTMedi- NotAl 1 med i-epi- cally

at- call}sodes] tended at-

tende


100.0

100.010(I.O

100.0100.0100.0100.0

100.0100.0100.0100.0100.0100.0

100.0100.0100.0100.0

100.0

100.0100.0

100.0100.0

100.0100.0

100.0

100.0

100.0

78.[.—

78.;77.:

80.576.576.079.8

76.276.683.775.676.279.5

;;,;

76:774.4

76.0

79.578.0

Loo.o64.3

80.769.4

100.0

100.0

100.0

22.0

21.322.8

19.523.524.020.2

23.823.416.324.423.820.5

18.320.423.325.6

24.0

20.522.0

...35.7

19.330.6

...

...

...

Place of first medicalattention

Percent distribution”

100. (

100.(100.(

100.c100,C100.c100.C

100.0100.0100.0Loo.o100.0100.0

100.0100.0100.0100.0

100.()

100.0100.0

Loo.o100.0

100.0100.0

100.0

10D.O

100.0

41.

46.{34.[

43.;42,137.(32.:

43.244.C37.639.537.653.C

48.643.241.331.5

43.7

;;.;

35.946.6

38.551.6

92.5

...

...

33.

30.38.

31.:32.(42.(42.(

32.132.(33.(37./35.:30.(

24.429.i37.644.1

29.1

33.039.6

34.333,4

34.929.9

3.7

59.1

37.8.

24.8.———

22.927.1

:25.1:25.920.625.1

24.724.028.822.72!7.217.1

.27.027.121.124.5

27.3

25.821.2

29.820.0

26.518.6

3.8

40.9

62.2

1Excludes unknown place of first medical at*Numbers preceded by an asterisk have a rel tive standard error of mare than 30 percent; estimates given solely for combining

with other cells,

a&medaa9

Table 7. Number of episodes of persona injured by selected characteristics, percent of episodes of persona in-jured by product type and selected characteristic; and direct product involvement as a percent of both directand indirect product involvement by product type: United States, 1975

[Dataarebasedon householdinterviews of the civilim noninstitutiomdimd population. The survey design, general qualifications, and information on the reliability of tbe

estimates wc @cn in the technical notes]

Episodes of persons injured and product type

All episodes --------------------------------

Product typel

General household appliances (O1O1-O132)----------Kitchen appliance (0202-0262)--------------------Space heating, cooling, and ventilatingappliances (0301-0355)----------------------------Housewares, nonpowered (0401-0459)----------------Home communica tions, entertainment, and hobbyequipment (0501-0542)----------------------------

Home furnishings and fixtures (0601-0697)---------Home alarm, escape, and protection devices(O7Ol-O7O8)--------------------------------------

Home workshop apparatus, tools, and attachments(O8Ol-O853)--------------------------------------

Home and family maintenance products(O9O2-O95O)--------------------------------------

Farm supplies and equipment (1001-1051)-----------Packages and containers for household products(llol-ll22)--------------------------------------

Sports and recreational equipment (1201-1299;32OO-32O9)---------------------------------------

TOyS (1301-1383)----------------------------------Yard and garden equipment (1401-1440)-------------Child nursery equipment and supplies(1502-1541)--------------------------------------

Personal use items (1601-1656)--------------------Miscellaneous products (1701-1726)----------------Home structures and construction materials(l8O3-l86O)--------------------------------------

Motor vehicles (1901)-----------------------------Foods (1904)--------------------------------------Prescribed drugs (1920-1922; 1924)----------------Industrial equipment, not used at work (2200)-----Medical equipment (2400-2465)---------------------Other products in the 1901-2465 range(1902-1903; 1905-1918; 1923; 2300) ---------------

Cosmetics (2500-2700)-----------------------------

Direct and indirect product involvement among:

I I

Episodes Episodes

resulting resulting

AllMales in 1 day in a vis -

persons Females it to aor more of hospitalrestrictedactivity emergenty

roomII I I I


74,164~/39,653

*0,71.0

1.13.2

1%:

*0.1

3.4

;:;

2.8

14.10.91.9

*0.54.41.3

20.69.6

;::1.2

*0.2

1.6*0.7

*0.4*0.7

;::

*1. O9.4

*0.2

5.9

1.9*1.4

2.8

19.2*1.53.1

*0.52.9

*1.2

21.69.12.32.92.0

*0.2

2.1*0.1

34,511 I 45,721 I

Percent of episodes

*1. O*1.4

*0.34.1

*0.811.7

*-

*0.4

*1.1*0.3

2.8

8.2*0.3*0.5

*0.66.0

*1.4

L9.410.1

12:;*0.3*0.1

*1. O*1.3

*0.7*0.9

*1.33.3

*0.910.8

*-

3.6

1.4*1.1

2.9

14.6*0.92.2

*0.34.81.7

L8.99.63.6

::;*0.1

*;:;

25,227 I

*0.3*1. O

*0.84.1

*0.910.6

*0.2

4.3

*2.2*1.1

2.8

17.3*1.8*2.2

3:;*1.1

24.513.93.0

*1.9*1.3

*-

*2. O*-

Directproduct

inv0lvementas a

percent ofboth directand indirectinvolvement

. . .

*73.O*59.5

*66.780.9

*47.963.4

*48.4

67,9

70.6*66.5

62.0

37.3*40.O74.7

*54.570.6

*56.7

80.962.849.799.0

*52.7*lOO.O

70.1*89.6

lThe numbers in parentheses represent the code range for the typea of products specified in the National Elec-tronic Injury Surveillance System coding manual.

*Numbers preceded by an asterisk have a relative standard error of more than 30 percent; estimatea given solelyfor combining with other cells.

“housewares” may be used. Housewares were in-

volved in 3.2 percent of all episodes of persons

injured. Among those episodes occurring to

males, they were involved 2.4 percent of the

time and for females 4.1 percent. For all epi-

sodes resulting in 1 or more days of restricted

activity or in a visit to a hospitaI, housewares

were involved 3.3 and 4.1 percent of the time,

respectively. All of these estimates include both

direct and indirect product involvement in the

accidental injury. The last column of table 7

shows that of all the times housewares were in-volved, the involvement was the direct “cause”

of the injury in 80.9 percent of the cases.

The large number of relatively unreliable es-

timates shown in table 7 indicates that the pro-

10

Table 8. Number of episodes of persons injured, number of episodes of persons injured involving one or more product types, and num-ber of instances product type involved in episodes of persons injured by selected characteristics:United States, 1975

IL%M arc based.. ho.schold mtcw,cws of tl,c .IVIIIA. :>..tnst)t.tt.nal! zcd p.p.latm. TIIe survey dcstgn. gmml qual)(,cac,ons, and mforrnamn . . cl,. rclmbky of the mcmms m givmm [h. t.chntcd n.tesl

AllResulting in 1 or more

Item Male Female days of restricted Resulting in a Vizitpersons activity to an emergency room

I Number in thousands

Episodes of persons injured------------------------------ 74,164 39,653 34,511Episodes of persons injured involving 1 or more producttypes----:---------------------------------------------- 56,302 30,822 25,481

Number of Instances product type involved in episodes ofpersons injured----------------------------------------- 69,502 38,432 31,070

:I__!E

Table 9. Percent distribution of times a type of product was involved in episodes of persons injured by selectedcharacteristics, according to type of product: United States, 1975

[Dataarcbmcd cm householdimmwews of the cwdian noninsritutmnahzed population. The survey des]gn, gmcral qualificaticms,andinfomnatimo“ chcreliabilityofchccstmmws

—


All episodeal -------------

Sex—Male ---------------------------Female -------------------------

Age—Under 17 yeara -----------------17-44 years --------------------45 years and over --------------

Family income2

Less than $10,000 --------------$10,000 -$14,999 ----------------$15,000 or more ----------------

Geographic region

Northeast ----------------------North Central ------------------South --------------------------West ---------------------------

Place of reaf.dence

SMSA, central city -------------SMSA, not central city ---------Outside SMSA -------------------


None ---------------------------1 or more ----------------------

Place treated3

Emergency room -----------------Not at emergency room ----------

arcgncnm the tcchnical”m,tcsj

House-wares,nOnpOw-ered

Homefdr-nish -ingsandfix-tures

T100.0 100.0

*39.9 48.160.0 51.9

*19. O 34.860.4 33.7

*20.5 31.6

50.5 53.5*20.8 21.9

28.7 24.6

*18.O 19.5*23.1 21.947.0 39.311.9 19.2

*23.9 36.835.9 27.640.2 35.5

35.6 36.564.4 63.5

*

Homework -shop

appar -atus,

tools,and

attach-ments

100.0

94.3*5.6

*11. 770.4

*17.9

44.525.230.3

28.9*24.O28.4

*18. 7

24.339.236.4

33.366.7

53.446.6

IPack-ages Sports

and con - andtainers recre -

for ationalhouse- equip -hold ment

products

Per-sona1use

items


Homestrut -tureaandcOn-

struc -tionmate-rials

100.0

52.747.3

29.257.1

*13. 7

41.8*16. 741.5

*23 .9*25 .0*27.3*23.8

*26.643.230.2

35.664.4

43.456.6

100.0

72.927.1

60.934.8*4.3

32.822.045.3

22.034.422.521.1

28.042.229.8

36.363.7

57.242.8

100.0

36.064.0

43.141.3

*15.6

45.7*3-8.735.6

15.529.927.427.3

36.235.728.0

:3.;

42.757.3

100.0

56.143.9

36.434.529.1

44.224.531.3

19.231.628.021.2

32.036.631.4

43.456.6

52.947.1

Motorvehi -cles(in-

eludingvehi -cle

parts)

100.0—-

50.749.3

17.957.924.1

38.519.542.0

13.827.235.823.2

29.944.L25.9

38.261.8

61.638.4

Foods

100.0

33.066.9

~17.353.529.3

38.431.630.0

k14.7k19.638.027.8

25,234.340,5

39.260.8

40.959.0

Pre -scribedmedi-cines

100.0

22.477.6

29.148.622.3

50.626.822.6

21.125.527.625.8

40.435.324.3

*12. 987.1

‘Includes unknown family income, injuries not medically attended, and unknown place of medical attention.ZExcludea unknown family income.3Excludes episodes not medically attended and unknown if person visited an emergency room.*Numbers oreceded bv an asterisk have a relative standard error of more than 30 Percent; estimates given solaly for

combining wikh other c~lla.

akmedaa 11

duct involvement categories produced too fewsample cases, based on a 2-week referenceperiod, for extensive cross-classification of thedata. Table 9 shows percent distributions ac-cording to the larger product groups and a re-duced set of variables. A more inclusive Iist ofproduct types and a more extensive cross-classi-fication of variables would produce a table in-cluding relatively unreliable estimates.

At this writing, plans are underway to at-tempt a report on product involvement using allof the data from the 6-month reference period.While such a procedure would reduce the vari-ances of the estimates, it will tend to underesti-mate the true number “of times various producttypes were involved in episodes of persons in-jured because of the large memory decay associ-ated with a 6-month reference period.

TECHNICAL NOTES

The estimates shown in this report are basedon data obtained in household interviews in acontinuing nationwide survey. Each week aprobability sample of households is interviewedby personnel of the U.S. Bureau of the Censusto obtain information about the health andother characteristics of each member of thehousehoId in the civilian noninstitutionalizedpopulation of the United States. During 1975there were about 40,000 interviewed householdscontaining about 116,000 persons.

The appendixes of the 1975 Current Esti-mates (Series 10, No. 115) should be consulted

Table 1. Standard errors of estimates of aggregates


100 ... . ... .. .. .. .. .. .. .... .. .. ... ... .. .. .. . ..

1,000.......................................5,000.......................................10,000.. . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . .20,000 .. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . .30,000 .. . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . .. . . .40,000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50,000 .. . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . .60,000 .. . . . .. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .70,000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

for a more detailed discussion of the sample de-sign (appendix I), definitions of certain termsused in the report (appendix H), and the ques-tionnaire used during 1975 (excluding the acci-dent supplement) (appendix III).

As noted above, the estimates shown in thisreport are based on a sample of the population.The approximate standard errors of the esti-mates of episodes of persons injured are shownin table I; the approximate standard errors forthe percents are shown in table H.

Table II. Standard errors, expressed in percents, of estimatedpercentages

Base ofpercentage

in thousands

73126178230519741

1,0671,3311,5631,7771,9782,170

100 ..................300 .. . . . . . . . . . . . . . . . .600 .. . . . . . . . . . . . . . . . .1,000 .. . . . . . . . . . . . . .5,000 .. . . . . . .. . . . . . .10,000 .. . . . . . . . . . . .20,000 .. . . . . . . . . .. .30,000 .. . . . . . . . . . . .40,000 .. . . . . . . . . . . .50,000 ... . . .. .. . . . .60,000 .. . . . . . . . . . . .70,000 .. . . . .. . . . . . .

2 or98

10.25.94.23.21.41.00.70.60.50.50.40.4


5 or lOor95 90

15.8 21.89.1 12.66.5 8.95.0 6.92.2 3.11.6 2.21.1 1.50.9 1.30.8 1.10.70.6 U0.6 0.8

T29.116.811.9

9.24.12.92.11.71.51.31.21.1

36.321.014.811.5

5.13.62.62.11.81.61.51.4

12

SYMBOLS

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

Category not applicable ----------------------------- . . .

Quantity zero ---------------------------------------

Quantity more than Obut less than 0,05---- 0.0

Figure does not meet standards ofreliabilityy or precision--------------------—- *


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ● Public Health Service I Number 19 ■ March 15,1978

Exercise and Participation in Sports AmongPersons 20 Years of Age and Over: United States, 1975’

During July-December 1975 the Health In-terview Survey questionnaire included a supple-ment to obtain information about exercise, par-ticipation in sports, and self-judgment of theindividual’s amount of physical activity for theU.S. civilian noninstitutionalized population 20years of age and over. Data were obtained inresponse to the following five questions: Whatexercises were done on a regular basis? Whatsports were participated in during the 12 monthsprior to interview? Was this participation as ateam member? Was any of the participation intournaments? and Do you consider yourselfmore, less, or about as active as other persons ofyour age? A copy of the questionnaire may befound in “Current Estimates from the HealthInterview Survey, United States, 1975,” Vitaland Health Statistics, Series 10, No. 115, DHEWPublication No. (HRA) 77-1543. Unlike mostdata gathered in this survey, the information onexercise and sports participation was obtainedfrom each sample person rather than from ahousehold respondent.

The data show that about 49 percent of per-sons 20 years of age and over reported doing oneregular exercise or more, while 51 percent re-ported no regular exercise (table 1). Amongspecific exercises, walking was the most com-mon form; approximately 7 out of 10 personswho exercised regularly reported this form. Dur-ing the 12 months before the interview about 42percent in this age group participated in one

1This report prepared by Jai W. Choi, Division ofHealth Interview Statistics.

kind of sport or more. Among specified types ofsports, the participation rate was highest forswimming (24.0 percent). Approximately 11percent of the group participated in sports as ateam member, and about 7 percent participatedin a tournament during the year.

Exercise

Tables 1 and 2 show the number and percentdistribution of persons by type of exercise ac-cording to selected characteristics. IValking (33.8percent) was the main form of exercise amongpersons 20 years of age or over. This was espe-cially true for older persons. For example,among persons 65 years or over who exercisedregularly, almost 9 out of 10 walked for exer-cise. Calisthenics was the second most popularform of exercise (13.5 percent). The next mostfrequently mentioned exercises were swimming(1 1.8 percent), bicycling (10.9 percent), jogging(4.8 percent), and weight lifting (3.4 percent).Figure 1 shows these percents by sex.

A higher proportion of younger persons ex-ercised regularly than did older persons. About54 percent of persons aged 20-44 years exer-cised, while only about 42 percent 65 years andover reported exercising regularly. Persons withhigher family income were more likely to exer-cise than were persons with lower family in-come.

Because many people do more than oneform of exercise, the sum of those who did dif-ferent forms is, of course, greater than the num-ber of those who exercised. Table 3 illustrates

2

Table 1. Percent distribution of Dersons 20 years of acre and over bv exercise status and ~ercent by type of exercise, according to selected

characteristics: United States, 1975

Characteristic

All per-sons 20

years andoverl

100.0

100.0100.0100.0

100.0

Oneegularxerciser more

48.6

53.743.442.3

48.5

Type of exercise

+

Noregular

Other exerciseBicycling

——

10.9

16.16.52.9

10.8

14.96.74.3

11.1

17.2

6.41.8

11.3

16.66.93.1

8.3

12.53.2

●

7.4

9.511,614,2

6.9

Calis-!hen ics

13.5

17.310.8

6.1

13.5

17.510.1

5.9

13.5

17.111.4

6.3

13.8

Jogging

4.8

7.32.71.2

7.2

/Valking

33.8

33.832.935.7

32.5

31.431.439.4

35.0

Weight Swim-Ii fting ming

SEX—

Both sexes

All ages 20 years and over..

20-44 years .. . . .... .. .. .... .. .. ...... . ..45-64 years ... .. .. .... .. .. .. .. .. .. ..... .65 years and over. .... .. . .... ... .. ....

Male

. All ages 20 years and over ..

20-44 years .... .. ... ... ... ... .... .. .. ...45-64 years .. ... .. .... .... .. .. .... .. .. ..65 years and over . .. .... . ... .... .. ..

Female

All ages 20 years and over ..

20-44 years . .. .. ..... .. .. ..... . ... .... ..45-64 years ... ... .. ... .. ... .. .. .. .. .....65 years and over ..... . ... .. .. ... ...

COLOR

White


20-44’ years . .. .. ... ... .. .... .. .. .... .. .45-64 years ... . .. .... .. .. .... .. . . .. .. ..65 years and over .... .. .. .... . ... ...

Ail other


20-44 years . . .... .. . .... ... . .... .. .. ...45-64 years .. . .... .. .. ... . .. .. ... .. ... .65 years and over . ... .... .. .. ... ... .

Family income

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

$10,000-$14,999 .. .. .. .. ... . ..... ...$15,000 or more ... .. . .... .. .. .... ..Unknown ... .... .. .. .... .. ..... .. ... ....

I

==1-6.8 51.1

6.9 46.16.5 56.36.9 57.4

3.4 11.8..—

5.41.5

●0.5

16.98.02.8

6.3 13.3

18.88.14.1

6.4 51.1

6.2 47.05.9 57.68.1 52.0

100.0100.0100.0

100.0

52.742.047.3

48.7

10.63.82.1

2.7

10.12.6

‘0.5

+

7.1 51.1.

7.5 45.27.1 55.26.0 61.1

t

0.8 10.5

1.1 15.0‘0.5 7.8‘0.4 1.9

100.0100.0100.0

100.0

54.644.638.7

49.3

54.144.543.8

42.9

4.11,6

‘0.6

4.7

7.02.81,2

6.1

9.5●1.4‘1.1

3.54.34.76.43.0

36.034.233.0

34.0-1-3.4 12.6 -L-6.8 50.4

100.0100.0100.0

100.0

17.811.1

6.5

11.0

14.08.6

●2.7

9.612.113.917.5

7.2

5.51.4

*0.5

18.08.73.0

33.533.436.8

32.4

36.328.224.4

35.634.233.734.527.2

6.8 45.66.7 55.27.2 55.8

*

6.3 56.8

7.4 48.95.1 65.8

*4.O 7’2.8

3.4 6.0

9.4●1.3*1.3

100.0100.0100.0

100.0100.0100.0100.0100.0

50.733.927.2

45.246.449.953.4

38.8

4.7●2.3

*

I5.9 54.76.4 53,46.6 49,97.5 46.37.0 60.7

2.43.03.64.32.C

6.710.313.515.2

7.8

lIn~ludes unknown exercise StatUS.

a&mcdda3

Table 1. Percent distribution of persons 20 years of age and over by exercise status and percent by type of exercise, according to selectedcharacteristics: United States, 1975–Con.

Characteristic

Geographic region

Northaast . .. .. .. .. ... ... . ... .. .. .. .....North Central .. ... ... .. . ..... . .. ... .. .South ... .. .. .... .. .. .... .. .. .. .. .. .... .. ..West ..... .. . ..... . . .... .. ... .. ... .. .. .. ... .

Self-perceivedphysical activity

Less active . ... . .. .... .. .. .... .. .. .... .. .As active as others the

same age .. .. ... . .... .. .. .... .. .. .. .. .. ..More active .... .. ... . .. ... ... . ... ... .. ..Unknown .... . .. ... . .. .... .. .. .... .. .. ..

All per-sons 20

years ancoverl

100.(100.(100.(100.(

100.(

100.(1Oo.c1Oo.c

lIncludes unknown exercise StatUS.

Oneregular

exerciseor morf

50.449.642.055.8

39.8

50.566.6

9.7

Bicycling

10.714.4

7.911.4

5.1

11.417.3

2.3

Figure 1. PERCENT OF PERSONS 20 YEARS OF AGEAND OVER WHO REPORTED REGULAR EXERCIS-ING, BY TYPE OF EXERCISE AND SEX: UNITEDSTATES, 1975.

Walking Cahsthemcs Swimmmg Btcydmg JWgmg Weight OtherIi fring

that about 46 percent of persons reported thatthey did two types or more of exercises, andabout 55 percent reported that they did onlyone type of exercise.

Among persons who were less active thanothers in the same age group, about 40 percent

Type of exercise I RI”

Calis-.fogging

thentics

I

14.0 4.813.4 4.310.4 4.218.1 6.7

7.4

12.423.5

2.3

0.9

3.411.1

1.4

Weightlifting

3.13.53.04.1

1.2

2.67.1

‘ 0.7

r .“

Swim-regular

mingWalking Other exercise

14.1 36.5 7.1 49.410.3 34.9 5.6 50.110.4 28.1 6.6 57.813.4 38.4 8.4 43.6

7.2 27.9 5.3 60.1

reported doing one type of exercise or more.Tie corresponding proportions were about 51percent for those who were about as active asothers their age and 67 percent for those whowere more active.

Participation in Sports

About 42 percent of the population 20 yearsof age and over participated in one type of sportor more, while 58 percent did not participate inany kind of sports. During the 12 months beforethe interview about 11 percent of persons partic-ipated in one type of sport or more as teammembers, and about 7 percent participated in atleast one tournament (tabIe 4).

A higher proportion of younger persons par-ticipated in sports than did oIder persons. Forinstance, about 58 percent of persons aged20-44 years participated in some form of sportwhile only about 10 percent of those 65 yearsand over participated (table 4).

About 37 percent of women reported theyhad participated in one kind of sport or more,while the comparable rate for men was about 47

4 adwancedata

Table 2. Number of persons 20 years of age and over by exercise status and type of exercise, according to selected characteristics:United States, 1975

All One Type of exercise3persons regular No

20 years regularexercise Bicycling &lis. Jogging Weight Swim.and overl. z or more

Walking Otherthenics lifting ming

exercise

Characteristic

~

Both sexes

All ages 20 yearsand over ... .... .... .. ... .. ..

20-44 years ..... . ... ..... .. .. .....45-64 years .. ..... .. ... ..... ... . ...65 years and over ... ... ... ... ...

W

All ages 20 yearsand over .. ..... . ... ..... . .. ..

20-44 years ..... . ... ... ... ... ... ..45-64 years.., .... .... .. .... .... ...65 years and over ... ... ... .. ...

Female

All ages 20 yearsand over ..... .. . ..... . ... ...

20-44 years .... . .. ... .... . .... ... .45-64 years .... ... .. .... .... .... ..65 years and over . ...... .. .. ...

COLOR

White

AH ages 20 yearsand over . .. .. . . ...... .. .. .. .

20-44 years .. .. ... ... .. ... .. .. . ... .45-64 years ..... . . .... .. . .. . .... . ..65 years and over ..... .. . ..... .

All other

All ages 20 yearsand over ... .. ..... .. . ......

20-44 years .. .. ..... . ... ... ... .. .. .45-64 years .. . .. ..... .. . .... ... . ...

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

Family income

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

$5,000 -$9,999 .... . ... ... .. . ... .$10,000-$1 4,999 .. . .. . ... ... .. .

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

Number in thousands

135,655 65,922 14,854 18,287 6,569 4,601 16,034 45,880 9,193 69,334

71,08443,14521,426

63,665

38,15818,710

9,054

30,893

11,4222,891611

6,853

12,3134,6611,312

8,604

5,1701,145

254

4,604

3,852651+99

4,031

11,9893,435

610

8,491

24,04514,197

7,639

20,716

4,8942,8231,475

4,074

32,73524,30812,291

32,~51

34,26820,567

8,830

71,990

18,0748,6384,180

35,030

6,0062,076

522

9,683

3,648773183

1,965

3,444540*47

570

6,4521,675

365

7,543

10,7736,4633,480

25,164

2,1331,223

718

5,119

16,10711,847

4,596

36,783

5,0921,380

381

8,001

36,81622,57912,595

120,141

20,08410,072

4,874

59,264

33,54517,202

8,517

6,658

6,3301,441

230

13,574

10,2832,679

611

1,280.—

1,139141

*

1,5632,7913,4166,300

784

6,3072,585

790

16,575

11,0374,2801,258

1,712

1,276381*54

2,0433,5454,1027,782

815

1,522372*7 I

5,627

4,3101,084

232

942

860*61*22

7381,2641,4022,831

334

407*III

*52

4,077

5,5381,760

245

15,100

13,2727,7334,159

40,847

2,7621,601

757

8,212

16,62812,461

7,695

60,523

28,28721,37910,857

8,811

61,99038,69619,455

15,515

3,429549●99

524

423,*101

*

514877

1,0771,907

227

11,1353,379

585

935

20,74612,942

7,159

5,033

3,2991,254

480

7,53610,010

9,95715,304

3,073

4,2202,5951,396

981

854“56*25

1,4263,0023,9906,739

878

674228● 7~

1,25E1,8611,9503,331

793

4,4482,9301,434

11,57615,62214,73920,530

6,868

9,0944,4501,971

21,18029,27129,53S44,35e11,307

4,6141,508

536

9,56613,57314,73323,665

4,384

See footnotes at end of table.

ackmeMa5

Table 2. Number of persons 20 years of age and over by exercise status and tyPe of exercise, according to selected char-eristics:United States, 1975-Con.

All One Type of exercise3 No

Characteristic persons regu IarCelis- Weight

regular20 years exercises Bicycling Jogging Swim-

thenics Walking Other exerciseand overl,z or more lifting ming

Geographic region

Northeast . ... ... .... .. . ... . ..... . . . 32,789North Central .... . ... .. ... .... .. . 35,951South .. ... .. .. .... ... ... . . ... ... . .... 41,991West ... .... .. . ..... . ... .. ... . ... ... . .. 24,925

Self-perceivedphysical activ:!y

16,53617,83017,63913,916

8,731

31,30724,425

1,459

3,5205,1783,3062,850

1,1 2(

7,04t6,34(

34[

Number in thousands

3,520 4,5764,806 1,5514,381 1,7514,523 1,682

L1,627 206

7,691 2,0908,616 4,067

353 205

1,585 1,030 11,965 2,334 16,1851,274 3,692 12,547 2,018 18,0031,280 4,363 11,790 2,754 24,2861,018 3,350 9,578 2,087 10,860

l~nc]ude~ “nkno~vn exercise status.Z=timate based on the civilian noninstitutionalized population, JUW-DeC~mb=1975-3The number of ~er~on~ ~articiPating in sPecific types of exercise is greater than the number of persons ~~ho exercise because more

than one form is repo~ted in some cases.

Table 3. Number and percent distribution of persons who exer-cised by number of types of exercise: United States, 1975

Number of typesof exercise

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

1 type ... .. .. .. .. .. ... .. .. ..2 types ... . .... . ... .. ... . ..3 types or more .. .. .. .

Number of persons Percentin thousands distribution

percent (table 5). The proportions of personswho participated in sports, who participated as ateam member, and who participated in one tour-nament or more decreased with increasing ageand were higher for males and white personsthan for females and persons of other races.These proportions increased with increasing fam-ily income. Not unexpectedly; the percent ofpersons in each type of participation categoryincreased dramatically as the self-perceived levelof physical activity increased from “less active”to “more active. ”

Participating in sports and doing regular ex-ercises are highly associated. Of the approxi-mately 82.8 million persons who participate inone or the other or both, about 20 percent par-ticipate only in sports, about 32 percent onlyexercise regularly, and about 48 percent are in-volved in both types of activity.

Type of Sports Participation

The rate of sports participation varies ac-cording to the specific type of sport. Table 5shows the number and percent of sport partici-pants 20 years of age and over for 14 differenttypes of sports. Among the sports specified onthe questionnaire, the participation rate washighest for swimming (24.0 percent) and Iowcstfor wrestling (1.0 percent ). Swimming (26.7 per-cent), bowling (16.9 percent), and softball ( 13.5percent) were the three most popular sportsamong men, and swimming (21.6 percent),bo~vling (15.4 percent), and tennis (9.5 percent)were most popular among women.

6 acktxedata

Table 4. Number, percent distribution, and percent of persons 20 years of age and over by sports participation status, according to selectedcharacteristics: United States, 1975

——

All per-Sports participation status

sons 20 One‘ears and type of Team Tourn - No par-over 1,2 sport or member ament ticipation

more

..

All per-Sports participation status

Characteristic

SEX—

PercentNumber in thousandsBoth sexes

All ages 20years and over ... .. .... .. .... .. .. S

I58.130.3

9.9

47.4

82.435.716.6

36.5

135,655

71,06443,14521,426

63,665

34,26820,567

8,830

71,980

56,460

41,26713,076

2,117

30;178

21,3727,3401,465

26,283

15,169

11,7183,139

312

9,153

7,1091,803

241

6,016

100.0

100.0100.0100.0

100.0

100.0100.0100.0

100.0

11.2

16.57.3 ~1.51

14.4

20.78.82.7

8.4

6.7

9.54.90.7

10.2’

58.1

41.769.489.9

52.3

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

45454 years .. . ..... .... . .... ... .. .... .. ....65 years and over .. .. .... .... ... .... .. .

6,776 29,6572,119 28,954

143 19,255

Male

t

6,492 33,307

4,882 12,6411,492 13,156*119 7,311

All ages 20years and over ... ..... .. ... ... ... ..

37.5164.0:B2.8

63.3

2044 years., .. .. ..... .. . .. .. .... . . .... .. ..45-64 years .. . ... ... .... .. .. .. ... . ... ... ...65 years and over .... ... .. .... .. .. .... .

14.27.3

*1.3

3.5

Female

Ail ages 20years and over .. ... .. .. .. .. .. ... ...

*20-44 years .. .. ... .. ... .... ... .. ... .. .. ....45-54 years .. .... ..... . . .. ... .. .. ... ... .. ..65 years and over .. .. ... ... .. .. ... .. .. .

36,81622,57912,595

120,141

bl ,98038,69619,455

15,515

19,8955,736

652

51,923

37,38712,452

2,083

4,538

4,6081,336

*7 I

14.071

1,894 16.8627 16,799*24 11,944

100.0100.0100.0

100.0

64.025.4

5.2

43.2

12.55.9

“0.6

11.7

5.12.8

*0.2

7.0

45.774.494.8

56.5

39.467.689.0

70.5

COLOR

WhiteI

+

8,424 67,925

6,213 24,4552,068 26,152

143 17,318

All ages 20years and over . ... .... ... . .... . ... .

;

60.332.210.7

29.2

42.714.0*1.7

23.134.847.755.025.6

10.015.30.7

4.0

6.2*1.1

*

2.84.77.6

10.22.6

2044 years.., . .. ..... . .. ... .. . ... .... .. ...45-64 years .... . .... .... ... .... ... . ..... ..65 years and over .. .. ... .... ... . .... .. .

10,7802,978

312

1,098

100.0100.0100.0

100.0 A17.4

7.71.6

7.1

10.3 ~3.6

*

4.78.3

13.716.1

5.0

614 10,941

All other

Al I ages 20years and over ... .... ... .. .... .. . ..

I

57.285.498.3

76.865.052.044.774.0

2044 years .. .. ... .. . .. . ... ..... .. .. .... ...45-84 years .. .... .. .. .. .. ... ..... .. .. .. .. ..65 years and over .. . ... .. ..... .. . .... ..

9,0844,4501,971

21,18029,27129,53844,35811,307

3,880624“34

4,88210,17514,09924,411

2,893

938161

●

1,0032,4434,0347,120

570

563 5,202*51 3,802

* 1,837

100.0100.0100.0

100.0100.0100.0100.0100.0

597 16,2761,376 19,0402,251 15,3734,521 19,807

284 8,370

Family income

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

$5,00@8,999 . .. . ..m. .. .. ..... . .. .... . ..$10,000-$14,999., .. .. .. .... ..s. ... .. ..$15,000 or more .... .... . ... .. .. ... .. ..Unknown .... .. ... .. .. .. .... ..... .. .. ... ...

See footnotes at end of tabk

7

Table 4. Number, percent distribution, and percent of persons 20 years of age and over by sports participation status, according toselected characteristics: United States, 1975–Con.

II

Characteristic

Geographic region

Northeast .. .. ... .. .. .. .... .. . .... .. . ... ... .North Central .. .. .. . .. . .. .. .... . .. .... ...South .. .. .. ... .. ... .. ... . ... . .. .... . ... .... . .West ... .. ... ... . ..... ... ... .. .. . .... . ... ... . ..

Self-perceivedphysical activity

Less active .. .... .. .. .... . .. .... .. .. ... .. . ..As active as others

the same age .. . ... .... ... ... .. .. ... .. . ..More active ... ... .. .... . ... .. .. .. .... . .. ...Unknown ... ... .. . . .. .. . ... .... .. . .... . . ...

All per-sons 20ears and

overl.2

32,78$35,95141,99124,92!

Sports participation status

F

Number in thousands

15,114 3,95515,500 4,96113,825 2,96412,021 3,288

L21,952 7,138 1,124

61,946 28,031 7,00036,666 20,098 6,53315,091 1,193 513

—

2,174 17,6072,788 20,3221,828 28,0892,247 12,848

526 14,814

3,471 33,8704,605 16,536

435 13,646

All per.sons 20ears amwerl,2

100.0100.0100.0100.0

100.0

100.0100.0100.0

Sports participation status

Onetype of Team Tour- No par-

sport or member ament ticipation

more

46.143.132.948.2

32.5

45.354.8

7.9

Percent

12.1 6.613.8 7.8

7.1 4.413.2 9.0

5.1 2.4

11.3 5.617.8 12.6

3.4 2.9

53.756.666.951.5

67.5

54.745.7Sn3.4

lInc]ud~~unk~o~” ~~~~ci~~~t~t”~.2&.tjmate based Oncitilian noninstitutionalized population, July-December 1975.

Table 5. Number andpercent ofpersons 20yeamof ageandover bysexand specific sDompatiicipated in: United States, 1975

Sport

All persons 20 years and over .... .. .. . ... .. . .... . ... ...

All persons who participate in

one type of sport or more . . .. .... .. . .... . ... .. .. .. .. .. .. .

Swim mi ng.. .. ... .. . ..... .. .. .... . . .... . .. ... .. . ..... .. . .... . . .... ... . ..Bowling .. .. .. . ... .. .. . ... . .. . .... . ... ... .. ... .. .. .... .. .. ... . .. ... ... . ..Tennis .. ..... .. ..... .. .. .. .. .... .. . ... .. .... .... .. . ... .. . ..... . .. ..... . .. .Softball .. .... . .. ... .. .. .... .. . .... . .. ... .. . ..... . .. ... .. . .... .. .. .... . .. .Golf .. .. ... ... ... . ... .. . .. .. ... .. ... . .. .... . . ... ... .. .. ... .. .... .. . ... .. .. .8asketball ... .. .... .. . .... .. .. . .. .... ... . .. .... .. .... ... . ... ... ...... .. .Volleyball ... . ...... .. .. . ... . .... . .. ... .. . ..... ... ... .. . .... . .. ..... .. . .Baseball ... .. .... .... . .. .... . . ..... .. ..... ... .. .. . . .... . .. ... .. . .... .. .. .Football .. ... . .. .... .. . .. .... . .. ... .. . .... . ... .. ... .... . .. .... .. .. ... . ...Gymnastics .. . .... .. .. ... ... .. ... . .. ... .. .. .. .. . .. .. .. .. .... .. .. ... ... .Handball .. .. . .. . .... . .. ... ... .... .. . ..... .... . .. . .. .... .. .... .. .. ... . .. .Track and field ... .. .. ... .. . ... . .. . .. .. . .... .. .. .... .. .... .. ... . .. ..Soccer .. .. .. . ... .. .. ... ... .. ... . .. .. .. .. ... ... . ... .. .. ... . .. .... ... ... ... .Wrestling .. ... .. .. .... . .. .... . . .. .. ... .. .. . .. . ... . .. .... . ... .. .. .. ... . ...Others .. ... ... .. ... .... .. . ..... ... .... .. .... .. . ... . .. .... . .. .. .. ... .... . ..

Number in thousandsl

H IBoth II Male I Femalesexes

56,460 30,178 26,283

32,542 17,000 15,54221,870 10,762 11,10814,965 8,139 6,82612,137 8,599 3,53811,370 8,044 3,32610,514 8,554 1,960

8,723 4,917 3,8066,710 5,202 1,5086,675 5,991 6843,233 1,514 1,7192,983 2,300 6831,935 1,375 5601,798 1,563 2351,332 1,110 221

11,070 7,310 3,760

Percent

8othsexes

Male

100.0 100.0

41.6 47.4

24.0 26.716.1 16.911.0 12.8

8.9 13.58.4 12.67.8 13.4

6.4 7.74.9 8.24.9 9.42.4 2.42.2 3.61.4 2.21.3 2.51.0 1.78.2 11.5

Female

100.0

36.5

21.615.4

9.54.94.62.7

5.32.11.02.40.9

0.80.30.35.2

l~stimate based oncivilian noninstitutional izedpOpuIatiOn, JuIY-December 1975.

8

Figure 2 shows the percent of persons whoparticipated in sports by sex. The rate of partici-pation was not greater for women than for menin any of the specified types of sports.

Table 6 shows the number and percent ofpersons who participated in sports by sex andwhether this participation was as a team memberor in a tournament during the year before theinterview. Participation as a team member is pro-portionally highest for those who bowl (35.5percent) and for those who play softball (32.2percent). Tournament participation is highestfor softball ( 19.4 percent), golf ( 16.7 percent),and bowling ( 14.4 percent).

Figure 2. PERCENT OF PERSONS 20 YEARS OF AGEAND OVER WHO PARTICIPATED IN 7 SPECIFIEDSPORTS, BY SEX.

30 r

25 –

20 -

$

LLJ15 -

a

k!!

10 -

5 -

0 -

= Female - km,,

BOWIIng Tennis Soflball Golf Basketball volleyball

9

Table 6. Number and percent of persons 20 yearn of age and over by type of sport participant, specific type of sport, and sex:United States, 1975

mNumber in thousands

Type of sport and sex

I member ment

Both sexes

All persons who participated in one typeof sport or more .. .. .. .. .. .... .. . ..... . . .... .. .. ... .. .. .

Percent

26.956,460 9,038 1Oo.c 16.015,169

Swimming ... .. ..... . .. ..... . .. .... .. .. ... ... .... .. .. .... .... .. .. .. ...Bowling . .. .... .. . .... . .. ...... .. .... . ... ... . .. .... .. .. .... .. . ... .. .. ..Tennis . .. .. .... .. .. .... .. .. .... .. .. ... . ... ... .. . ... .. .. .... . ... ... . .. ..Softball .. . .... ... . .... .. .. .... .. . ... .. .. .... . . .... .. .. .... . ... ... . .. ..

32,64221,87014,96512,13711,37010,514

8,7236,7106,6753,2332,9831,9351,7981,332

11,070

30,178

2577,759

7733,9141,5221,8751,120

861745148244193355●56912

9,153

863,147

7062,3491,901

816423304267●1I135141128●33657

6,492

1Oo.c1Oo.c1Oo.c1Oo.c1Oo.c1Oo.c1Oo.c1Oo.c1Oo.c1Oo.c1Oo.c1Oo.c100.0100.0100.0

100.0

O.E35.5

5.:32.213.417,812.s12.811.2

4.68.2

10.019.7

4.28.2

30.3

0.314.4

4.719.416.7

7.84.84.54.00.34.57.37.12.55.9

21.5

Golf .... .. ... .. .. .. .. .. .. .... .. .. .. .... .. .. .... . . ... ... .. ... .. ... .. .. .. .Basketball .. .. .. .... .. .. ... ... .. .. .. .. .... .. .. ... ... ..... . .. .... .. .. ..Volleyball ... .. .. .... .. .. .... .. .. ... .. . .... .. .. .... . . ..... . .. .... . . ...Baseball .. .... ... . .... .. .. .... .. . .... . .. ..... . .. ... .. . .... .. .. ... ... . .Football .. . ... .. .. .... .. . ..... .. . ... .. .. .... . ... ... .. ... .. ... . .... .. . .Gymnastics ... .. .. ... ... .. .... .. .. .. .. .. .... . ... ... . .. .... .. . .... .. . .Handball .. .. .... . .. ... .. ... ... .. .. .... .. .. .. .. .. .... . .. .... . .. .... . . .Track and field .... .. . ..... . . .. .. .. .. .... . .. ... .. .. .... .. .. .. .. ..Soccer ... .. .. .... .. . ..... .. . ... .. .. ... ... .. ... .. . .... .. .. .... .. .. .. ... .Wrestling . .. .... .. .. .... .. ...... . .. ... .. .. ... ... . ... .. ... .. ... .. ... .. .Other .... .. .. .... .. .. .... .. . ... .. .. .. .. .. .. .... .... ... . ... .. ... .. ... .. .

Male

One type of sport or more .. ... ... . ... .. .. .... . ... ... ..

Swimming .. .... .. .. .... .. .. .... .. .. .... .. .. .... .. .... .. .. ... .. . ..... .BOWI ing .. .. .. ... . ... ... .. .. .... .. ... ... .. .. .... .. . ... .. . . .... .. .. ....Tennis ... .... ..... . .. .... .. .. .... .. .. .... .. .. .... . . .... .. . .. ... .. .. ... .Softball ... .. .. .... .. . ... .. .. .. ... ... . .... . .. .... . .. ... ... . ... ... . ....

17,00010,762

8,1398,5998,0448,5544,9175,202

5,8811,6142,3001,3751,5631,1107,310

26,283

2023,665

3983,2221,0881,636

538739

687●51211171333●56

679

6,016

’751,696

4951,9691,605

722228272239●11

●102●119

128●33514

2,545

100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0

100.0

1.2

34.14.9

37.513.619.111.014.211.5

“3.49.2

12.421.3‘5.0

9.3

22.9

‘0.415.8

6.122.920.0

8.44.65.24.0

● 0.1●4.4●8.7

8.2*3.O

7.0

9.7

Golf ... . .. .. .. .. .... .. . ... .. .. ... .. .. .. .... .. . .... .... .... . .. ... .. . ....Basketball . .. .. .. .. .. .... .. .. .... .. .. .... .. . ... ... . .... . ... ... .. ... .. .Volleyball . .. .... ... . .... .. .. .... . . ..... .. . ..... . .. .... .. .. ... .. . .... .Baseball ... .. . .... .. .. .... .. .. .... . ... .... .. . ... .. .. .... . .. .... .. . ....Football ... . .... . ... .... .. . ..... . ... .... .. .... .. .. .... .. . ..... . .. ....Gymnastics . .... .. . .... .. ... ... .. .. .... .. .. .... ... ... ... .. ... .. .. ....Handball ... . ... .... .. .... .. .. .... .. .. ... .. .. ... .. . ..... .. .. ... ... . ...Track and field . .. ... .. ... ... ... . ... .. ... .... . . .... .. .. .... .. .. ..Soccer . .. .... .. .. .... . .... . ... . .... ... . ..... ... ... . .. .... ... . .... . .... .Wrestling . .. .. .. ..... .. . ... ... .. .. ... . .... .. .. ... .. .. .... ... . ... .. .. ..

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

Female

One type of sport or more . .. . .... . ... ... ... . .... .. . ...

Swimming ... .. .. ... ... .. .... . .. .... .. . ... .. . .. .... .. .. .. .. .. .... . ...Bowling .. . .... . .. .... .. .. .... .. .. ... ... . ... .. ... ... . . .... .. .. .... .. ..Tennis .... . .. ..... . .. .... .. . ..... . . .... .. . .... . .. . ... .. .. .... .. . ... ... .Softball . ... . .... . .. ..... . .. ... .. .. .... .. .. ... .. . .... .. . ... ... .. ... .. ..

15,54211,108

6,8263,5383,3261,9603,8061,508

6841,719

683560235

2213,760

’544,085

375692424239581

●122*58●97

’33’22●22

●

233

*II1,451

211380295● 94195“33●58

*

●33“22

●

*

143

100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0

“0.336.9

5.519.612.712.215.3●8.1‘8.5●5.6*4.8“3.9“9.4

●.

6.2

“0.013.1

3.110.7

8.9●4.8

5.1‘2.2●4.1

●.

‘4.8●3.9

●.●.

3.8

Golf .. .... .. .. ..... . .. ... .. .. .... .. . ..... . .. ... . ... .... . ... .. .. .. .... .. .Basketball . ..... .. .. ... .. .. .... . . .... .. .. .... .. . ... .. .. .... . . ..... . ..Volleyball .. . ... .. ... ... .. .. .... . .. ... .. .. .... .. .... .. .. ... .. ... ... . .Baseball . .. .. .... .. ... ... .. .. ... . .. .... .. .. .... .. . .... . .. .... .. .. ... ..Football .. . .. .... .. . .. ... . .. .... .. .. .... .. . ... ... . .... .. .. ... .. .. .... .Gymnastics . .... .. .. .... .. .. ... ... .. ... . .. .... . .. .... .. . .... .. .. ....Handball ... ... .... .. .. .... .. .. .... . . .... .. . .... .. .. ... .. .. ... .. ... ...Track and field .. .. .. ... . .... .. .. .... . .. ... .. .. .... .. .. .... . ... ..Soccer .. .... .. .. .. ... ... ... .. . .. .. .. .. .... .. . .... . ... ... ... . .... .. . ...Wrestlinci .... ... .... .. .. .. .. . ... ... . .. .... ... .... . .. .... . .. .... .. .. ...Other ..~. .. .. .. .. .. .... .. .... .. .. ... . ... .. .. . .... .. . .... .. .. .... . .. ...

10

TECHNICAL NOTES

SOURCE OF DATA. The data presented in thisreport were obtained from household interviewsin the Health Interview Survey. These interviewswere conducted during the final 2 quarters of1975 in a probability sample of the civilian non-institutionalized population of the UnitedStates. During that period approximately 58,000persons living in about 20,000 households wereincluded in the sample. The physical activityquestions were asked of each household member20 years of age and over who was identified as a“sample person. ” This subsample included ap-proximately 12,000 persons.SAMPLING. The sampling pattern for sampleperson selection was based on the total numberof related and unrelated household members.Sample persons (approximately a one-third sub-sample of the Health Interview Survey sample)were selected by the interviewer at the time ofinterview. To determine which household mem-ber to designate as a sample person, the inter-viewer referred to a preselected flashcard afterlisting all related and unrelated persons in thehousehold on the questionnaire. The flashcardcontained, for each household size, one personnumber or more that were to be identified as asample person.

Since the estimates shown are based on asample of the population rather than on the en-tire population, they are subject to samplingerror. Standard errors appropriate for the esti-mates of the number of persons are shown intable I; standard errors appropriate for estimatedpercentages are shown in table 11.LIMITATIONS AND QUALIFICATIONS OFDATA. All the limitations and qualificationsthat apply in general to Health Interview Surveydata apply to the data shown in this report. Afull statement of these limitations and qualifica-tions may be found in any report in Series 10 ofVital and Health Statistics.

Specific to the data shown in this report, itshould be noted that the intensity and durationof regular physical exercise and sports participa-tion were not considered in classifying peopleaccording to participation categories. The cate-gory classified as exercising regularly does notdistinguish between the person who takes a walk

Table 1. Standard errors of estimates of aggregates


50 . . . . . . . . . . . . . . . . . . . . . . .70 . . . . . . . . . . . . . . . . . . . . . . .100 . . . . . . . . . . . . . . . . . . . . . .125 . . . . . . . . . . . . . . . . . . . . . .300 . . . . . . . . . . . . . . . . . . . . . .500 . . . . . . . . . . . . . . . . . . . . . .700 . . . . . . . . . . . . . . . . . . . . . .1,000 . . . . . . . . . . . . . . . . . . . .5$000 . . . . . . . . . . . . . . . . . . . .10,000 . . . . . . . . . . . . . . . . . . . .20,000 . . . . . . . . . . . . . . . . . . . .30,000 . . . . . . . . . . . . . . . . . . . .50,000 . . . . . . . . . . . . . . . . . . . .100,000 . . . . . . . . . . . . . . . . . . .

242935386077

91109243342478579731

970

Table 11. Standard errors, expressed in percentage points, ofestimated percentages

Base of percentage

in thousands

50 . . . . . . . . . . . . . . . . . . . . .70 . . . . . . . . . . . . . . . . . . . . .100 . . . . . . . . . . . . . . . . . . . .300 . . . . . . . . . . . . . . . . . . . .500 . . . . . . . . . . . . . . . . . . . .700 . . . . . . . . . . . . . . . . . . . .1,000 . . . . . . . . . . . . . . . . . .5,000 . . . . . . . . . . . . . . . . . .10,000 . . . . . . . . . . . . . . . . .20,000 . . . . . . . . . . . . . . . . .30,000 . . . . . . . . . . . . . . . . .50,000 . . . . . . . . . . . . . . . . .100,000 . . . . . . . . . . . . . . . .


m

I6.8 10.7 14.75.8 9.0 12.44.8 7.5 10.42.8 4.3 6.02.2 3.4 4.61.8 2.8 3.81.5 2.4 3.30.7 1.1 1.50.5 0.8 1.00.3 0.5 0.70,3 0.4 0.60.2 0.3 0.50.2 0.2 0.3

19.616.513.8

8.06.25.24.42.01.41.00.80.60.4

50

.—

24.420.717.310.0

7.76.55.52.41.71.21.00.80.5

around the block once a week for exercise andthe person who walks 10 miles every day forexercise. Also it should be emphasized that aperson who says that he or she does not exerciseregularly may in fact be involved in more physi-cal activity than a person who says that they doexercise regularly. The critical point regardingthese data is that they reflect how the persondefines his or her own activity.

11

SYMBOLS

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

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

Quantity zero—–--—-----–-–--—-––— -

Quantity more than Obut less than 0.05—- 0.0

Figure does not meet standards ofreliabilityy or precision-——----——– *

GPO 927 120

....——..


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ■ Public Health Service ~ Number 20 ● March 13,1978

Office Visits to Obstetrician-Gynecologists:National Ambulatoy Medical Care Survey, United States, 19751

During 1975 an estimated 48 million visitswere made to the offices of obstetrician-gynecologists practicing in the coterminousUnited States. The data presented in this reportwere collected during calendar year 1975 in theNat ion al Ambulatory Medical C,are Survey( NAMCS ), a continuous survey conductedyearly by the National Center for Health Statis-tics.

The estimates presented are based on infor-mation obtained from the Patient Record usedby sample physicians to record selected informa-tion about their office encounters. (See Techni-cal Notes. ) Since the statistics for this report arebased on sample data, they are subject to sam-

1Thisreportwas prepmedby TrenaEzzati,Division

of Health Resources Utilization Statistics.

plingvariability.Further discussionof sampling

variabilityand the sample design used in the1975 N’AMCS appears in the Technical Notes.

DATA HIGHLIGHTS

During 1975 there were an estimated 567.6million visits made to the offices of office-basedpatient care physicians practicing in the coter-minous United States. The estimated totalyearly volume of office-based ambulatory medi-cal care by specialty is shown in table 1. Interms of total office visits, obstetrician-gynecologists ranked third among all physicianspecialties with 48,076,000 visits.

Thirty-nine percent of the visits to obstetri-cian-gynecologists were to those in practice by

Table 1. Number and percent distribution of office visits by physician specfalty:United States, 1975

T~

Physician specialty

Numberof visits Percent

distributioninthousands of visits

—

All specialties --------------------------------------- 567,600 100.0

,General and family practice --------------------------------- 234,660 41.3Internal medic ine ------------------------------------------- 62,117 10.9OBSTETRICS -~~COLO~--------------------------------------- 48,076 8.5Pediatrics -------------------------------------------------- 46,684 8.2General surgery---------------------------------------------All other

41,292---------------------- ----------------------- ------ 134,771 2;:;

]Due to a refinement of the N~CS estimating procedure used to Project national ‘s-

timates from sample data,caution should be used when comparing these estimated numbersof office visits with previously published estimates for 1973 and 1974.

Figure 1. PERCENT OF OFFICE VISITS TO OBSTETRICIAN- GYNECOLOGISTS BY AGE OF PATIENT: UNITED STATES, 1975.

Under 15 15-24 2544 45-64 65 and

over

AGE IN YEARS

themselves, and the remaining 61 percent were to those practicing in a group or partnership arrangement.

Office visits made by females in the childbearing interval, 15-44 years, accounted for 85 percent of the total number of visits to obstetrician-gynecologists (figure 1 ), naturally reflecting the most common reason for visits to obstetri- c ian-gynecologists-prenatal examinations and care.

The most frequent reasons patients had for their visits are ranked according to their order of frequencv / in table 2. The top six reasons account for about 68 percent of all visits to obstetrician-gynecologists. In contrast, 36 patient problems are required to account for a comparable 68 percent of the visits to general and family practitioners.

Data on the physician’s assessment of the seriousness of the patient’s problem (in terms of the extent of impairment that might result if no care were obtained) indicate that less than 1 in 10 (7.7 percent) of the visits to obstetrician-

Table 2. Number, percent, and cumulative percent of office visits to obstetrician- gynecologists, by the most common patient problems, complaints, or symptoms: United States, 1975

[Symptom titles and code numbers are based on a symptom classification developed for use in NAMCS]

Most comon patient problems, complaints, or symptoms and NAMCS code

Number of visits in thousands

Percent of visits1

Cumulative percent

of visits

Pregnancy examination, routine---------------905 Gynecological examination--------------------904 Vaginal discharge~--~ww~ww~~-~~~w~~~~~~~~~~~~~~~ Surgical aftercare ---w---w------------------- 986 Menstrual disorders w1---l-~wl-s-11--11------- 653 Abdominal pain--------------------------------540 Vaginal di~orders~--w---w------w-------------661 Vulvar disorders www~1w111~1ww-1~~--1--~-~~~~~ 663 Other symptoms referable to the female

reproductive system- ------------------------670 Visit for family planning services-

counseling-----ww------------------------~--93O pelvic symptoms------------------------------660 Visitfor family planning services-

medication --1-1-w--w-1---------------------- 931 None -I----------I----------------------- -----997 Visit for family planning services-

services --w-----w--------------------------- 932 Menopause symptoms ---11---------11--11------- 650

15,901 33.1 33,l 7,596 15,8 48.9 2,952 6.1 55.0 2,803 5,8 60.8 2,184 4.5 65.3 1,323 2.8 68.1

941 2.0 70.1 784 1.6 71.7

775 1.6 73.3

683 1.4 74.7 655 1*4 76,l

584 1.2 77.3 528 1.1 78.4

514 511

1.1 1.1

79.5 80.6

1

Based on a total of 48,076,OOO office visits.

admmxk@3

Table 3. Percent distribution of officevisits to obstetrician-gynecologists byphysician’s assessment of seriousnessof patient’s problem: United States,1975

I

Seriousness ofPercent

distributionpatient’s problem of visits

Serious or very serious---Slightly serious ---------- 1;:;Not serious --------------- 76.6

gynecologists were considered seriousor vev

seriousinnature (table3).

Data on the patient’s prior visit status show’that about 86 percent of all visits to obstetri-cian-gynecologists were made by patients whohad seen the physician before (table 4).0bstetri-cian-gynecologists also dealt chiefly with old pa-tient problems. The proportionof new problemspresented to obstetrician-gynecologists by oldpatients (18 percent) was slightly less than the

Table 5. Number and percent of office visitsfrequent diagnoses rendered by the

Table 4. Percent distribution of officevisits to obstetrician-gynecologi;;;t~~patient’s prior visit status:States, 1975

Patient’s prior visit Percentdistributionstatusof visits

New patient --------------- 14.2Old patient, new problem-- 18.0Old patient, old problem-- 67.9

corresponding proportion for all physicians (23percent).

Information concerning the most frequentprincipal diagnoses associated with ambulatoryvisits to obstetrician-gynecologists is presentedin table 5. The diagnostic data are grouped intoclasses according to the Eighth Revision Interna-tional Classification o-f Diwases, .4dapted forUscin the Urzited States (ICDA). AmongaII di-agnoses rtmdcred by obstetrician-gy necologists,

to obstetrician-gynecologistq by the mostphysician: United States, 1975

[Diagnoses andcode numbersae based on the Eighth Reuisio?z Intcrt,ationJ CLzwific.tion of Disem-es, .-ldapted for Use in the‘United Stc&x (ICDA)]

Principal diagnoses most frequently renderedby the physician and ICDA code

——

Infective and parasitic diseases -------------------------001-136Moniliasis-------------------------------------------------ll2

Neoplasms ---------------------------------------------- --140-239Endocrine, nutritional, and metabolic diseases-----------24O-279Diseases of genitourinary system-------------------------58O-629

Infective diseases of cervix uteri- ------------------------620Other diseases of cervix-----------------------------------62LImJ;;;ive diseases of uterus (except cervix), vagina, and

-----------------------------------------------------622Disorders of menstruation----------------------------------626

J

Menopausal s~ptoms----------------------------------------627Symptoms and ill-defined conditions ----------------------780-796

Observation, without need for further medical care---------793Special conditions and examinations without sickness -----Y13-Yl3

Medical or special examination-----------------------------yooPrenatal care (normal pregnancy) ---------------------------Yo6Postpartum observation --------------------------------- ----Y07Other person without complaint or illness------------------yO9Medical and surgical aftercare -----------------------------YLO

lBased on a total of 48,076,000 office visits.

. .


1,805882

1,5481,1458,990

647570

1,5771,995853

3,0082,130

27,4596,44715,1191,643995

2,596

Percentof

visitsl

3.8

H2.418.7

H

::?1.8

:::57.113.431.4

;::5.4

4 acklncedata

over 60 percent were associated with the ICDAclassifications “special conditions and examina-tions without sickness” and “symptoms and ill-defined conditions. ” Obstetrician-gynecologistsexceeded all other physician specialties in theproportion of visits for “special conditions andexaminations without sickness. ” (Prenatal careaccounted for over half of the diagnoses associ-ated with this diagnostic class. ) Visits for dis-eases of the genitourinary system accounted foran additional 19 percent of total office visits.

Of all office visits made during 1975 for pre-natal and postnatal care, approximately 70 per-cent were to the offices of obstetrician-gynecologists and another 26 percent to theoffices of general and family practitioners. Of allambulatory visits for family planning, about 62percent were to obstetrician-gynecologists and28 percent to general and family practitioners.

The diagnostic and therapeutic services pro-vided by obstetrician-gynecologists are shown intable 6. Among the diagnostic services provided,obstetrician-gynecologists exceeded all physi-cians in the proportion of visits involving clinicallab tests, general histories and examinations, andblood pressure checks, but they fell below theoverall average in the proportion of visits forX-rays. Among the therapeutic services pro-vided, obstetrician-gynecologists fell below theaverage for all physicians in the proportion ofdrugs prescribed, office surgeries performed, ~mdinjections.

Duration of visit is the time spent by thepatient in face-to-face contact with the physi-c i an. The average encounter time betweenobstetrician-gynecologists and their patients wasabout 13 minutes.

Finally, data on disposition of visits (table 6)

Table 6. Number and percent distribution of office visits to .obstetrician-g~n~colo -gists, by diagnostic and therapeutic services ordered or provided and dlsposltlon o.Evisit: United States, 1975

-—. ———. —

Selected diagnostic and therapeutic services orderedor provided and di.spositio? of visit

Diagnostic and therapeutic services

Diagnostic services:Blood pressure check --------------------------------------------Limited history and examination -------------------------------Clinical lab test--------"-------------------------------------General history and examination -------------------------------X-ray -------------------..-------------------------------------

Therapeutic services:Drug prescribed ----------..--,-----------..------------------------Medical counseling ---------------------------------------------Office surgery------------------------------------------;-----Injection-------------------------------------------------------

No diagnostic or therapeutic service----------------------------

Disposition of visit

No followp planned ---”---,--------------------------------------Return at specified time----------------------------------------Return if needed ----------G-------------------------------------Admit to hospital -------------A---------------------------------Telephone followup planned --------------------------------------Referred to other physician or agency ---------------------------

—- —

Number ofVisits in Percentlthousands

--+----

I27,596 57.425,991 54.125,199 52.412,194 25.4

850 1,8

17,109 35.65,535 11.51,458 3.01,088 2.31,481 3.1

3,5123;, ;;:

1:5521,184

776

7.375.713.03.22.51.6

lpercents may total more than 100.0 since more than one diagnostic or therapeuticservice and more than one disposition could be given at a single visit.

achncedata 5

show that followup care of some type was physicians (59 percent). Further, the tendencyadvised at 91 percent of the visits. Visits at to admit the patient to the hospitzd (3 percent)which the obstetrician-gynecologist advised the slightly exceeded this disposition for aII physi-patient to return at a specified time (76 percent) cians (2 percent).significantly exceeded the proportion for all

TECHNICAL NOTES

SOURCE OF DATA: Data presented in this re-port were obtained during 1975 through theNat ion al , Ambulatory Medical Care Survey(NAMCS). The target population of NAMCS en-compasses office visits within the coterminousUnited States made by ambulatory patients tophysicians who are principally engaged in officepractice.SAMPLE DESIGN: The 1975 NAMCS utilized amultistage. probability design that involved sam-ples of primary sampling units (PSU’S), physi-cian p~actices within PSU’S, and patient visitswithin practices. Within the 87 PSU’S composingthe first stage of selection, a sample of approxi-mately 3,500 physicians was selected from mas-ter files maifitained by the American MedicalAssociation and the American Osteopathic Asso-ciation. Sampled physicians, randomly assignedto 1 of the 52 weeks in the survey year, wererequested to complete Patient Records (brief en-counter forms) for a systematic random sampleof office visits taking place within their practiceduring the assigned reporting period. (A fac-simile of the Patient Record used is shown in aprevious issue of Advance Data From Vital andHealth Statistics, No. 12, October 12, 1977.)Additional data concerning physician practicecharacteristics such as primary specialty andtype of practice were obtained during an induc-tion interview.

A complete description of the survey’s back-ground and development has been presented inan earlier publication in Series 2 of Vital andHealth Statistics (No. 61. DHEW Pub. No,(HIL4) 76-1335. fIeaIth Resources Administra-tion. Washington. U.S. Government PrintingOffice, Apr. 1974). A detailed description of the1975 NAMCS design and procedures will bepresented in future publications.SAMPLING ERRORS: Since the estimates forthis report are based on a sample rather than theentire universe, they are subject to sampling vari-ability. The standard error is primarily a measure

of sampling variability. The relative standard er-ror of an estimate is obtained by dividing thestandard error of the estimate by the estimateitself and is expressed as a percent of the esti-mate. Relative standard errors of selected aggre-gate statistics are shown in table I. The standarderrors appropriate for the estimated percentagesof office visits are shown in tabIe II.

Table 1. Approximate relative standard errors of estimated num-bers of office visits



500 .. . . .. . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . .. 30.11,000 .. . . . . . .. . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . 21.42,000 .. . . . . . . . . . . . .. . . . . . . . . . . .. . . . . . . . . . . . . 15.35,000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.010,000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.530,000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1100,000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0550,000 .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5


Table 11. Approximate standard errors of percentages for esti-matednumbers of office visits

Base of percentage


1,000 .....................3,000 .. . . . . . . . . .. . . . . . . . . .5,000 .. . . . . . . . . . . .. . . . . . . .10,000 .. . . . . .. . . .. . . . . . . .50,000 .. . . . . . . . . .. . . . . . . .1 00,000 .. . . . . . . . .. . . . . . .500,000 .. . . . . . . . . . . . . . . .


T1or 5 or99 95

2.11.20.90.70.30.20.1

4.62.72.11.50,70.50.2

lOor90

6.33.72.82.00.90.60,3

I I

20 or

80

8.54.93.82.71.20.80,4

~0 or70

9.75.64.33.11.41.00,4

50

10.66.14.73.31.5

::;

Examule of use of table: An estimate of 30 uercent based onan aggreg;te of 75,000,000 has a standard erro; of 1.2 percent.The relative standard error of 30 percent is 4.0 percent (1.2 per-cent+30 percent).

6

ROUNDING: Aggregate estimates of office visitspresented in the tables are rounded to the near-est thousand. The rates and percents, however,were calculated on the basis of original, un-rounded figures. Due to rounding of percents,the sum of percentages may not equal 100.0 per-cent.DEFINITIONS: An ambulatory patient is an in-dividual presenting himself for personal healthservices who is neither bedridden nor currentlyadmitted to any health care institution on thepremises.


A visit is a direct personal exchange betweenan ambulatory patient and a physician or a staffmember working under the physician’s super-vision for the purpose of seeking care and ~rendering health services.

A physician is a duly licensed doctor of reed-icine (M. D.) or doctor of osteopathy (D. O.) cur-rently in practice who spends time in caring forambulatory patients at an office location. Ex-eluded from NAMCS are physicians who spe- I’cialize in anesthesiology, pathology, radiology; “physicians who are federally employed; physi-cians who treat only institutionalized patients;physicians employed full time by an institution; ,and physicians who spend no time seeing ambu-latory patients. ,.

SYMBOLS

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

Category not applicable------------------------- . . .

Quantity zero ------------------------------------- -

Quantity more than Obut less than 0.05----- 0.0

Figure does not meet standards ofreliability or precision--—---—----------– *

I I

—

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The National Death index (NDI) is a computerizedcentral file of death record information. Itis compiledfrom magnetic tapes submitted to the National Centerfor tieakh Statistics (NCHS) by the State vitalstatistics offices. These tapes contain a standard setof identifying information for each decendent,beginning with deaths occurring in 1979.investigators conducting prospective studies can usethe Ml] to determine whether persons in their studiesmay have died, and if so, be provided with the namesof the States in which those deaths occurred, thedates of death, and the corresponding deathcertificate numbers. The NDI user can then arrangewith the appropriate State offices to obtain copiesof death certificates or specific statistical informationsuch as cause of death.

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Please return completed order form to: Mr. Robert BilgradNDI, Division of Vital StatisticsNational Center for Health Statistics3700 East-West Highway, Room 1-44Hyattsville, Ma~y/and 20782.

VWal and Health Statisticsseries descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 6..

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

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Programs and Collection Procedural—Reports describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the data col-

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other material necessary for understanding the data.

Data Evaluation and Methods Research—Studies of new

statistical methodology including experimental tests of

new sumey methods, studies of vital statistics collection

methods, new analytical techniques, objective evaluations

of reliability of collected data, and contributions to

statistical theory. Studies also include comparison of

U.S. methodology with those of other countries.

Analytical and Epidemiological Studies-Reports pre-

senting analytical or interpretive studies based on vital

and health statistics, carrying the analysis further than

the exposito~ types of reports in the other series.

Documents and Committee Reports-Final reports of

major committees concerned with vital and health sta-

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registration laws and revised birth and death certificates.

Comparative International Vital and Health StatisticsReports-Analytical and descriptive reports comparing

U.S. vital and health statistics with those of other countries.

Cognition and Survey Measurement—Reports from the

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Data From the National Health Interview Survey-Statis-

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health-related topics, all based on data collected in the

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Data From the National Health Examination Survey and

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Data from direct examination, testing, and measurement

of national samples of the civilian noninstitutional ized

population provide the basis for (1) estimates of the

medically defined prevalence of specific diseases in the

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with respect to physical, physiological, and psycho-

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among the various measurements without reference to

an explicit finite universe of persons.

Data From the Institutionalized Population Surveys-Dis-continued in 1975. Reports from these surveys are in-

cluded in Series 13.

Data on Health Resources Utilization—Statistics on theutilization of health manpower and facilities providing

long-term care, ambulato~ care, hospital care, and family

planning sefvices.

Data on Health Resources: Manpower and Facilities—

Statistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

SERIES 15.

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Special analyses by cause of death, age, and other demo-

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Data on Natality, Marriage, and Divorce-Various sta-

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included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

series analyses; studies of fertility; and statistics oncharacteristics of births not available from the vital

records based on sample surveys of those records.

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Data From the National Survey of Family Grovvth-

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are based on final data from the National Vital Statistics

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