.,

. Vital and ,.HealthStatistics ~” Inventory of Pain Data From the National Center for Health Statistics

Series 1: Programs and Collection Procedures No, 26 In this report, National Center for Health Statistics data sets that contain information on pain and pain-related condi~ons are identified and a detailed summary of these data elements is provided,

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control National Center for Health Statistics

Hyattsville, Maryfand June 1992 DHHS Publictilon No, [PHS) 92-1308 Copyright Information

All material appearing in this reporl is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Suggested Citation

Turczyn, Kathleen M, An inventory of pain data from the National Center for Heaith Statistics, Kathleen M. Turczyn and Thomas F, Drury.

Library of Congress Cataloging-in-Publication Data

The 1989 revision of the U.S. standard certificates and reports. p,cm. – (Vital and health statistics. Series 1, Programs and collection procedures ; no. 26) (DHHS publication ; no. (PHS) 92-1 308) Includes bibliographical references. Supt. of Dots. no.: HE 20.6209:1/26 ISBN 0-8406-0439-4 1. Pain – United States– Statistics. 2, Intractable pain – United States– Statistics, 3, National Center for Health Statistics (U.S.) 1. Drury, Thomas F, Il. National Center for Health Statistics (U.S.) Ill, Title, IV. Seties, V, Series: DHHS publication ; No. (PHS) 92-1308. [DNLM: 1. Pain – epidemiology–United States, W2 A N148.a no. 26] RA409.U44 no, 26 [RB127] 362.1 ‘0723 S –dc20 [362.1 ‘960472’0973021 ] DNLM/DLC for Library of Congress 91-13401 ,CIP , National Center for Health Statistics

Manning Feinleib, M. D., Dr.P.H., Director Jacob J. Feldman, Ph. D., Associare Director for Analysis and Epidemiology Gail F. Fisher, Ph.D., Associate Direc[orfor Planning and Extramural Programs Peter L. Hurley, Associate Director for VW and Health Statistics Systems Robert A. Israel, Associate Director for International Statistics Stephen E. Nieberding, Associate Director for Management Charles J. Rothwell, Associate Director for Data Processing and Services Monroe G. Sirken, Ph. D., Associate Director for Research and Methodology David L. Larson, Assistant Direcfor, Atlanta

Division of Epidemiology and Health Promotion Ronald W. Wilson, Director Patricia M. Golden, Special Assistant Diane K. Wagener, Ph. D., Chief Environmental Studies Branch Ronald W. Wilson, Acting Chiej Health Status Measurement Branch Acknowledgments

The initial impetus for this inventory came from Drs. the Management of Pain; and the Social Science Research Ng and Bonica, editors of Pain, f)i-sconz~ortand Hzmzmzi­ Council’s Workshop on Cognition and Measurement of . tariarz Care (l), in which the need for a systematic exami­ Pain. The annual meetings of the American Pain Society nation of publicly available nationaI data resources for have also provided an important context for formal and comprehensive, population-based studies of pain is high- informal discussions of the need for and uses of general lighted. The consultation of Dr. Harold Merskey was also population data on a broad spectrum of pain problems. most helpful in the early “stages of the project with regard Within the National Center for Health Statistics (NCHS), to definitional approaches to pain and the classification of special acknowledgment needs to be given to Dr. Char­ pain syndromes. Further impetus for the project came lotte Schoenbom, whose earlier Inventory of Alcohol, from participation in a number of meetings of the U.S. Drug Use, and Mental Health Data Available through Department of Health and Human Services Commission NCHS Data Systems has provided a template for the on the Evaluation of Pain; the Institute of Medicine’s present effort. Finally, to all the contact persons who are Committee on Pain, Disability, and Chronic Illness listed throughout this publication as resource persons for Behavioq the National Institutes of Health Consensus specific NCHS data systems, our lasting gratitude. Development Conference on The Integrated Approach to

,.. Ill ... Acknowledgments,...... 111

Introduction ...... ’...... 1 Evaluating NCHS pain data...... 1“ NCHS data systems with pain data...... 2 Substantive perspectives underlying the inventory ...... 2 Sources of information on NCHS data systems...... , 4 Summary of the inventory’s content ...... 4 Organization of the inventory ...... 5 Using the inventory to identify multiple avenues ofanalysis: Thecase ofback pain andreIated back disorders.. 6 Secondary analysis for population-based studies of pain ...... , 9 Current and future efforts ..,...... 9 General Population Surveys ...... 10 National Health Examination Survey, Cycle I ...... 10 National Health Examination Survey, Cycle II...... 10 National Health Examination Survey, Cycle III ...... 11 First National Health and Nutrition Examination Survey ...... 12 Second National Health and Nutrition Examination Survey ...... 15 Hispanic Health and Nutrition Examination Survey ...... 18 Third National Health and Nutrition Examination Survey ...... 20 NHANESI Epidemiologic FolIowup Study ...... ’...... 22 \ National Health Interview Survey ...... 25 National Medical Care Utilization and Expenditure Survey ...... 35 National Sumeyof Personal Health Practices and Consequences ...... 35 National Surveyof Family Growth Cycles III and IVand Followup ...... 36 Health care surveys...... ,...... 38 National Ambulatory Medical Care Survey ...... 38 National Hospital Discharge Survey ...... 39 NationaI Nursing Home Sumey ...... , 40 Next-of-Kin Component ofthe 1985 NNHS ...... 41 National Master Facility Inventory and1986 Inventory ofLong-Term Care Places ...... 42 Vital statistics surveys ...... , 44 National Natality Survey and National Fetal Mortality Survey ...... 44 National Mortality Followback Survey ...... 44 1988 National Maternal and Infant Health Survey and 1990 Longitudinal Followup ...... 45 Vital statistics registration ...... 47 Mortality Statistics ...... 47 Divorce Statistics ...... 49 References ...... 51

Appendixes

1. Projected pain-related items in future NCHS surveys...... ,,. 57 II. 1989 National Health Interview Suwey Current Health Topics section R: Orofacial pain ...... 58

,$’ v J HI. 1989National Health Interview Survey Current Health Topics section S2: Abdominal pain...... 60 IV. Classification variables foranalysis of pain data ...... 62 V. Summary ofselected pain measures...... 63 VI. International Classification of Diseases description ...... 66

Text figure

1. Data systems with pain and pain-related data components within the organizational structure of the National Center for Health Statistics ...... 3

Symbols -- Data not available

. . . Category not applicable — Quantity zero 0,0 Quantity more than zero but less than O.05

* Figure does not meet standard of reliability or precision

vi Inventory of Pain Data From National Center for Health Statistics

by Kathleen M. Turczyn, M. P.H., and Thomas F. Drury, Ph.D.

Introduction

In the past 15 years, the Public Health Service and the . To clarify selected features of the problems and pros­ Department of Health and Human Services have increas­ pects of secondmy analysis for population-based ingly recognized chronic” pain as a major public health studies of pain. problem with enormous impact on the health care system . To sketch the relationship of this report to others that (l-7). The pain literature has continuously cited the need will appear in the near future either as NCHS reports for more complete and comprehensive epidemiologic data or as contributions to the journal literature on pain. on pain (8–9), has explored the feasibility of pooling and In accordance with these objectives, the remainder of sharing data from pain clinics and other treatment facili­ this introduction is organized into nine main sections. ties for this purpose (10-11), and has called repeatedly for more adequate measurement attention to pain phe­ nomena in general population surveys (1,2,4,6). Although many information gaps will be filled only by the collection Evaluating NCHS pain data . and analysis of new data, a number of questions are potentially, and at least partially, answerable through In response to the need for more and better informa­ secondary analysis of available data. A major barrier, tion on pain, several years ago the staff of the NCHS however, to such secondary analysis has been a basic lack Health Status Measurement Branch of the Division of of knowledge about the kinds of pain-related data that Epidemiology and Health Promotion, Office of Analysis exist nationally. In response to this need, this inventory and EpidemioIogy, began to evaluate the efforts that had provides an exhaustive listing of information obtained been made in NCHS data systems to measure pain and through National Center for HeaIth Statistics (NCHS) pain-related phenomena. As initially conceived, the eval­ data systems related to population-based studies of pain uation would deal with five basic aspects of the NCHS \ problems and identifies the sources for gaining access to statistical programs (12): this information. This introduction serves the following purposes: An evacuation of the efforts made to measure pain phenomena in the form of an inventory of pain data To position this inventory within the context of a com­ available from NCHS. prehensive evaluation of NCHS pain data. An evaluation of the effectiveness of these efforts in To acquaint the user of this inventory with the broad terms of the reliabili~ and validity of the resulting spectrum of NCHS data systems that include pertinent measures (13-16) and in terms of the epidemiologic information about pain. usefulness of the information obtained (17). To outline the substantive perspectives used as sifting An evaluation of the efficiency of the pain measure­ criteria in the review of NCHS data systems. ment process in terms of total survey design consider­ To identify the major sources of information used in ations (18). identi&ing relevant content. An evaluation of the adequaey of NCHS pain data in To describe key characteristics of the types of infor­ terms of the information actually needed at the national mation included in the inventory and provide a descrip­ level for societal enlightenment, program intelligence, ‘ tion of the analytical summary of its major content and operational feedback (19). areas. An evaluation of the process and procedural aspects of To explain how the inventory is organized. the survey measurement process–from identification To exemplify how the invento~ might be used to iden­ and conceptualization of pain phenomena, through the tify multiple avenues of analysis in the comprehensive political-economic aspects of obtaining funding and study of selected pain problems. organizational support for pain components on

1 surveys, to the development and implementation of Nonetheless, the data collection mechanisms of sampling, data collection, data analysis, and data NCHS that implement this broad mandate –general dissemination procedures (20). population surveys, health care surveys, special purpose surveys, and vital statistics – have obtained extensive, and The initial idea was to perform the entire evaluation in some instances intensive, information that may be used plan under one or more contracts. Because of funding to clarify important aspects of the magnitude, scope, and constraints, however, the overall plan had to be divided impact of selected pain problems in the United States. into priority projects that might be pursued by in-house The organizational chart shown in the figure identifies staff and into projects that would be more appropriately particular data systems relevant to pain and pain-related performed by contractors with national and international factors, and locates these data systems within NCHS expertise in pain. According to this revised plan, in-house programs primarily responsible for them. As is evident staff would evaluate the effort. Priority would also be from the chart, primary data collection and analysis given to having outside experts evaluate the adequacy of responsibilities for current NCHS data systems are located existing information for meeting national data needs in in the Office of Vital and Health Statistics Systems and the pain area. Funds permitting, evaluation of adequacy the Office of Analysis and Epidemiology, Detailed . would be followed by a series of analytical projects carried descriptions of these data systems have been published out by outside experts, possibly in collaboration with (21). in-house staff, under a series of professional services Other NCHS programs, however, play major roles in contracts. Major aspects of this more limited plan were the development, operation, and analysis of these data actually implemented. collection systems. The Office of Research and Method­ This report is the first publication in the NCHS L’ltal ology provides statistical consultation and technical assis­ and Health Statistics series from this evaluation project, tance to all NCHS data systems, and formulates statistical and it represents the efforts by in-house staff to evaluate standards regarding survey design, data collection, coding, the efforts made so far in NCHS data systems to measure data analysis, data presentation, and statistical computing. and assess pain phenomena. The relationships of this The Office of Planning and Extramural Programs report to others that are in press or in preparation at the serves as the focal point for coordination of health statis­ time of this writing are highlighted in the concluding tical activities within NCHS and for developing and coor­ remarks to this introductory overview. dinating the collaborative statistical activities of NCHS ‘“ with other organizations and agencies, both national and international. The Office of Planning and Extramural NCHS data systems with pain data Programs also collects, assesses, maintains, and dissemi­ nates current information on State and national health Although the mission of NCHS includes collection, statistics systems, both public and private. analysis, and dissemination of data on the Nation’s health, The Office of Data Processing and Services (ODPS) is , it does not currently have any explicit charge to collect the statistical operations component of NCHS. ODPS is t data on any specific pain syndrome or even on pain responsible for the collection of data for the National problems more generally. The enabling legislation for Health and Nutrition Examination Survey and NCHS NCHS activities specifically states that it shall collect data surveys conducted by mail; data preparation, data entry, on the following: and automated data processing for all NCHS surveys; the editing, composition, and printing of NCHS publications; The extent and nature of illness and disability of the and the marketing, dissemination, and information ser­ population of the United States and its subgroups. vices for NCHS statistical products. ODPS also provides The impact of illness and disability of the population on training and technical assistance to NCHS staff. the economy and on the well-being of the population, Environmental, social, and other health hazards. Determinants of health. Substantive perspectives Health resources, including health professionals by underlying the inventory specialty and types of practice, the supply of services by hospitals, extended care facilities, home health agen­ A major purpose of the inventory is to provide a cies, and other institutions. comprehensive listing of available data that might be � Utilization of health care, including ambulatory health useful in comprehensive, population-based studies of a services, hospitals, extended care facilities, home broad variety of pain problems. To achieve this overall health agencies, and other institutions. objective, it was necessary to develop a set of criteria that � Health care costs and financing. could be utilized in sifting through the various information � Family formation, growth, and dissolution. sources for each of the NCHS data systems. Given the � National vital statistics –births, deaths, marriages, and range of phenomena dealt with, as well as the complexity divorces. of the data systems being reviewed, a precise set of sifting

2 .------—

~ce of Office of the I Management Director

I Cflice of Cffice of Data Processing Research and Services Methodology

I I I I I I Zi!!!ilI Division of Division ‘bJA&c&l Division of Survey ~eg~l Statistical Epidemiologyand of Data ch3s3s#l Analysis Tec&hno$gy Health Promotion Processing services staff National Heatth and National Survey of Nutrition Examination Personal Health Epidemiologic FOIIOWUP Practices end suNey Consequences Next-of-kin Component of 1985 National Nursing Home Survey

Cffice of Planning and Extramural m Programs I I I I I I ) I I I I II Division of Diiision of Division of DivviQfiof vi H~;eas;cre HeaJ~r@ckw statistics Exa%mJ:;isM

NautiwiolNafality National National Healtfr Vational Health WWHE Ambulatory Interview Examination Medical Care suNey survey National Survey Survey Cycles 1, 11,and Ill of Family Growth National Medical National Hospital Care Utilization Mortality Vational Health Discharge Survey and Expenditure and Nutriion statistics suNey National Nurskrg Examination Divorce Home Survey Survey 1, 11,and 111 statistics National Master +Ispanic Health National Maternal and NuWon and Infant Health Facilii Inventory and 1986 Examination Survey and 1990 suNey Longitudinal Inventory of Followup Long-Term Care Suwey Places ‘ National Mortality Followback Survey

Figure. Data systems with pain and pain-related data components within the organizational structure of the National Center for Health Statistics

w 1, criteria were never developed. However, two broad sets of respect to diagnosis, treatment, and treatment outcomes criteria were developed and applied to each data system to (23). Some of the preceding topics go well beyond the determine, first, whether it should be included at all, and, fields of community and clinical epidemiology and address second, the measurement content for inclusion. The first a range of issues considered central to the field of health set of criteria took the form of a paradigm or a systematic services research (24). set of questions for population-based studies of pain. The second set of criteria took the form of a set of guiding Guiding images of pain images about pain. The second set of criteria used in sifting NCHS data systems for the measurement content of this inventory derive from recent efforts to define pain and classify pain Paradigm for population-based studies of syndromes, as well as from the lively discussions that have pain accompanied such efforts (9). The International Associa­ Data systems were considered pertinent to population- tion for the Study of Pain (IASP) has defined pain as “an based studies of pain (as identified below) if they had a unpleasant sensory and emotional experience associated bearing on any of the following: with actual or potential tissue damage, or described in terms of such damage” and has developed a taxonomy of pain � The identification and classification of various pain syndromes (25). As has been discussed elsewhere (20), cen­ syndromes and pain states, including issues sur­ tral to the IASP definition is an image of pain as a unitary rounding the development and validation of diagnostic subjective experience, which leads to an emphasis on self- criteria. reports as a source of information (26). Because much of the � The magnitude of various pain problems in the United pain data avaiIable from NCHS come from surveys utilizing States, including estimates of the size of the population interviews with respondents or household informants, the at risk for various pain problems, treated and untreated IASP framework has been very useful in crafting this inven­ prevalence of the problem, magnitude among nonin­ tory. At the same time, however, pain experts with a behav­ stitutionalized and institutionalized populations, inci­ ioral focus prefer to image pain as a set of events, which dence of the problem, and severity of the problem. leads to an emphasis upon pain behaviors as an information \ � The scope of the problem – that is, its relative fre­ source (27-29). Within this behavioral framework, a self- quency across sociodemographic groups. r report about pain or talking about pain is one of a range of � The structure of the problem in terms of types of pain pain behaviors. Loeser’s distinctions among nociception, I patients and interrelationships with various conditions pain, pain behavior, and suffering (30) have also been influ- 1 and other pain problems, including the identification of ential in clari~ing and providing a conceptual foundation I new pain syndromes. for partial integration of current definitional controversies. � The natural history and clinical course of the problem These images of pain have very different implications � The determinants of the problem, including the etio- for survey case definitions and provide different rationales Iogical processes and risk factors associated with var­ for obtaining, summarizing, and interpreting self-report ious pain problems. I and observational data (20). The question of what to � The consequences of various pain problems for indi­ include in this report was also influenced by general, even viduals, families, employers, and society at large in if somewhat more specific, discussions of acute pain, tetms of morbidity, disability, use of health services, recurrent or episodic pain, chronic pain, and cancer pain. health care expenditures, psychological well-being, Acute pain has traditionally been defined as pain of social and economic impact, and premature mortality. relatively short duration that is usually evoked by a well- � Treatments, medical and medicolegal processes, and defined noxious stimulus. It often has a rapid onset and the operation of the health care system with respect to diminishes progressively as healing occurs. Acute pain I specific pain problems, provider-patient relationships, produced by tissue damage is the most common type of quality of care, effectiveness, and costs of health care pain. It has an adaptive biological significance, as it often services. provides a warning signal to enable an organism to avoid � Availability of health care resources for dealing with harm and prolong survival. It is usually not associated with various pain problems. prolonged emotional distress, because the pain is expli­ � Historical trends and projections related to any of the cable and may be controlled effectively (31). Recurrent above aspects of various pain problems. pain can be thought of as a subset of chronic pain (see � Conceptual, research design, measurement, data ana­ below) or as a pain state in its own right. Sternbach (32) lytic, statistical, computational, and interpretive issues has argued that pain can be thought of as a series of states related to any of the above types of substantive issues. that vary along a temporal dimension and represent a The preceding topics focus on issues addressed by continuous interaction of biological, psychological, and h community-based epidemiology with respect to the fre­ social components. He defines recurrent pain as a current quency, distribution, and determinants of pain problems pain problem in which the episode has persisted for less in well-defined populations (22), as well as on issues than a month but which has occurred in three episodes or addressed within the field of clinical epidemiology with more over the patient’s lifetime.

4 Chronic pain is defined by Bonica (9) as pain that think about cancer pain epidemiologically as a special case “persists a month beyond the usual course of an acute in need of special study. disease or reasonable time for an injury to heal, or pain Despite the dearth of national information about that recurs at intervals for months or years.” This defini­ cancer pain, Bonica (36) has shown how the limited tion is similar to that adopted by the IASP Subcommittee information on mortality from cancers can be used to on Taxonomy, which has stated that chronic pain is “that develop estimates of the magriitude of the problem of pain which persists past the normal time of healing” (25). cancer pain by integrating estimates of severe pain in, Although the length of time that elapses after which acute different stages of cancer for various types of cancer pain is regarded as chronic pain is variable, depending on obtained from clinical studies and clinical series with the nature of the original injury, chronic pain is often estimates of the size of the population at risk for such pain defined as pain that persists for 3-6 months (31). The obtained from mortality data. Bonica’s pioneering work in IASP Subcommittee (25) adopted “three months as the this area needs to be continued, possibly by extending most convenient point of division between acute and existing data collection systems based on cancer registries. chronic pain.” In this context it is interesting to note that, except for conditions that are always considered chronic regardless of the time of onset, a 3-month time period has Sources of information on NCHS also conventionally been used by NCHS (particularly in data systems the National Health Interview Survey (NHIS)) for distin­ guishing chronic from acute conditions. In constructing the inventory, four principal sources Chronic pain may be distinguished from acute pain on were used: Questionnaires, data tape formats, method­ the basis of several features in addition to temporal ological reports, and consultations with NCHS staff duration (31). In the case of chronic pain, the source of responsible for the collection and analysis of data. First, noxious stimulation is usually poorly defined. The pain questionnaires were systematically reviewed for pain data generally has no biological significance as a warning content. The data tape formats were then examined for signal. There is usually prolonged physical and psycholog­ specific coding and editing algorithms. Methodological

/J ical distress, as evidenced by fatigue, sleeplessness, 10SSof reports were reviewed for background information about motion, restricted physical abilities, additional somatic the surveys and vital statistics systems. Program staff were complaints, irritabilily, fear, anger, anxiety, depression, consulted to clarify questions related to content, methods, and a preoccupation with somatic concerns. Situational coverage, and data availability, factors often include a lack of control over the pain, an increasing reliance on medication as the only possible source of relief, inaccurate expectations about the diag­ Summary of the inventory’s nosis and prognosis, and concerns about the life- content threatening potential of the source of the pain. The pain may also be refractory to treatment. The invento~ covers the approximately 20-year A broad spectrum of pain problems –acute and period for which NCHS public use data tapes are gener­ { chronic–come together in cancer pain. Some acute and ally available (37,38). Because a major purpose of the chronic cancer pains are related to tumors and tumor inventory is to stimulate the use of NCHS pain data for progression; others, to cancer treatments; and still others secondary analysis, it focuses on data available through (what some would prefer to label as “suffering”), to the the public use data tape distribution program. Pain data psychological stress of living with a potentially fatal dis­ elements are identified only for data years in which public ease. Because of the unique constellation of emotional, use tapes are or will be available. Surveys with pain or physiological, and behavioral consequences of the diag­ pain-related eIements that were in the planning or early nosis and treatment of cancer (31, 33, 34), cancer pain is design stages at the time this manuscript went to press are generally regarded as a special category of pain. listed in a~pendix I. NCHS. data systems that do not I Although it has recently been suggested that viewing address pain at some level have not been described here. cancer pain as a special case may have the unintended Most data systems within NCHS, however, contain at least i consequence of narrowing the range of treatment options some pain components. In the case of the 1989 NHIS, all considered in the management of cancer pain (35), from of the orofacial and abdominal pain components of the the standpoint of population-based studies of cancer pain, Current Health Topics Supplement are included in their it is perhaps crucial to recognize its special nature. Cancer original form in appendixes II and 111.In other cases, such is not one disease but many, and persons with specific as the arthritis components of the first and second types of cancer are not identified in most national surveys National Health and Nutrition Examination Surveys of the general population. (The sample sizes are too small (NHANES I and 11) and the NHANES I Epidemiologic to develop reliable estimates for specific cancer sites, and Followup ‘Sttidy, extensive detailed questions are docu­ for years asking about cancer was considered too sensitive mented. In yet”other cases, only a few relevant items in the a ,topic to include in a survey.) Thus, it is important to survey or da~a system can be documented. ‘ ; ‘‘ “$. ,.., ,,..,

5.

. Pain data elements have been broadly delimited for � Name of program or data system –The name of the this inventory. However, whenever possible, attention is survey or vital statistics system is provided, along with focused on specific pain syndromes. Specific acute pain its acronym. problems covered in this inventory include (but are not � Survey design –The target population and geographic ,. restricted to) acute headache, toothache, pain of acute boundaries of the survey or vital statistics system are myocardial infarction, labor pain, postoperative pain, identified and the sampling procedures are briefly severe posttraumatic pain, and burn pain, Specific chronic described. The data collection method and the time pain problems covered include headache, orofacial pain, period during which the data were collected are chest or heart pain, abdominal pain, back pain, and specified. arthritic (joint) pain, Items related to conditions or cir­ � Basic data elements – A brief overview is given of the cumstances that may have an impact upon, or be a types of nonpain data available from the data system. consequence of, a person’s painful condition, such as drug More complete summaries are available elsewhere. use, life event stress, and sleep disturbance, have also � Pain data elements –Pain and pain-related data ele­ been included. ments are identified and listed in detail. For the most An effort was also made to identify sociodemographic part, they are sequenced in the order in which they ‘, and other classification variables available in each of the appear in the questionnaires. Although they are sum- , surveys (appendix IV). An attempt was made to place the marized whenever possible, questionnaire items are pain data components in context by providing general documented in their entirety when summarization descriptions of the types of nonpain data available in each would make interpretation difficult. In two cases, the of the surveys and vital statistics systems. The brief magnitude and complexity of the pain elements are descriptions of data elements contained in this inventory such that appropriate sections of the questionnaires are primarily designed, however, to sketch possibilities for themselves are provided as appendixes. The data fre­ data analysis. quencies for pain variables have not been examined, Appendix V provides an overall summary of available and in some instances the number of cases maybe quite pain measures in NCHS data systems. The summary small. includes only major categories of variables and is neither � Data tape availabdi~ –A listing of available public use .!! definitive nor comprehensive. In some surveys, questions data tapes is provided. For persons with university affil- , about a specific pain syndrome were asked differently in iation, many NCHS tapes are available through the different years, covering a varying amount of epidemio­ schools of public health of major universities. Schools logic information. A detailed cross-classification of indi­ of public health at the following universities participate vidual questions is beyond the scope of this document in the NCHS data tape acquisition program at this time: because of the extent of variation in question wording and Boston University; University of California, Berkeley; intent among the surveys. Such a classification is available, University of California, Los Angeles; Columbia Uni­ however, for NHANES and the National Health Exami­ versity; Harvard University; University of Hawaii; Uni­ nation Survey (NHES) (39). versity of Illinois; Johns Hopkins University; Loma Linda University; University of Massachusetts; Univer­ sity of Michigan; University of Minnesota; University of v Organization of the inventory North Carolina, Chapel Hill; University of Pittsburgh; San Diego State University; University of South Caro­ The inventory is arranged according to survey or vital lina; University of South Florida; University of Texas; statistics system. General population surveys are described University of Washington, Seattle; and Yale University. first, followed by data systems dedicated to the production Names of appropriate contact persons at these schools of health care statistics, Vital statistics surveys are inven­ can be obtained by contacting the Scientific and Tech­ toried next, with the description of pertinent vital statistics nical Information Branch, NCHS, 6525 Belcrest Road, data systems rounding out the review. Hyattsville, Maryland 20782. The telephone number is ~ With the exception of the health examination surveys, (301) 436-8500. each survey or system is described once, regardless of the � Questionnaire source items –This component identifies number of years for which data are available. NHES /’,, references that contain the questionnaire items listed in Cycles I, II and 111; NHANES I, H and HI; NHANES I the inventory. Most of these references are available Epidemiologic Followup Study; and the Hispanic Health from the U.S. Government Printing Office, Wash­ and Nutrition Examination Survey are described sepa­ ington, D.C. 20402. If the questionnaire has not been rately because of the extensive pain data contained in published, a copy can usually be obtained from the each. technical contact person. Descriptions of the surveys or data systems have six components, designed to provide a brief overview of the After each pertinent data system has been described data system and detailed information concerning pain according to the above outline, there are six appendixes. data. The format is as follows: Appendix I lists future NCHS surveys in the planning and

6 design stages that have projected the inclusion of pain and disability days. Information is available from NHIS on pain-related data. whether aback injury occurred at work. Information is also The orofacial pain and abdominal pain questions for available from NHIS on chronic back pain, including the the 1989 NHIS were particularly detailed and not easily prevalence and characteristics of impairments of the back summarized; thus, they are included in their entirety as or spine. NIIIS is also a major source of information on appendixes II and III. various types of disability caused by back problems. I Appendix IV provides an overview of the classification NHANES 1 and II are a source of self-report data on variables available for each of the data systems that may back pain, physician examination findings of back prob­ ! be appropriate to the study of acute, recurrent, chronic, lems, and medical history information on diagnosed back and cancer pain. Appendix V is a summary of pain problems. NHANES II also has data on x-ray examination measures included in the various surveys. findings for the lower back, which cmdd be made available to . Appendix VI discusses the use of the International the public on a case-by-case basis. The 1982-84 NHANES I Classification of Diseases (ICD) for coding of NCHS Epidemiologic Followup Study (NHEFS) ako measures the morbidity and mortality data. The discussion is limited to magnitude of back pain. those data systems that are included in the inventory. In Data are available from NHIS and NMCUES on some instances the purpose of the question is not to elicit physician visits involving diagnosis or treatment for acute pain information specifically, but rather to gather general and chronic back problems, and extensive data are avail- health information, such as days lost from work or days able from the National Ambulatory Medical Care Survey spent in bed because of ill health. In reporting such (NAMCS) for visits to office-based physicians in the events, respondents provide information about conditions United States for back pain symptoms and back problems: that caused them to restrict their activity. These condi­ AIthough NAMCS and the National Hospital Dis­ tions are then coded into ICD categories that include charge Survey (NHDS) are provider-based surveys, back relevant painful condition codes. AIthough the IASP Clas­ pain data from these surveys measure the magnitude of sification of Chronic Pain, developed by the IASP Sub- the back pain problem among visits to office-based physi­ committee on Taxonomy and published as a supplement cians or to short-stay hospitak for treatment. ) to the journal Pain, has not been used in the coding of NHDS is a source of information on short-stay hos­ NCHS pain data, a crosswalk has been developed that pital discharges and hospital days for back problems, allows translation of codes to the eighth and ninth revi­ including important data on laminectomies and spinal sions of the International Classification of Diseases (40). fusions. NHIS also has selected information on short-stay hospitaI experiences for back problems. The National Nursing Home Survey (NNHS) is a Using the inventory to identify source of information on the prevalence of back problems multiple avenues of analysis: the among nursing home residents. Mortality data are also important in certain limited cases. case of back pain and related back From these data, it should be possible to extract a disorders comprehensive statement of alternative definitions of the magnitude of the problem of back pain in the United The usefulness of the inventory for identifying areas in which secondary analysis of existing data maybe a produc­ States. This comprehensive statement could be com~ared with and contrasted to other definitions and estimates in tive research strategy is perhaps best illustrated for the case the literature (41-47). of back pain and related back disorders, Although far from ,, being exhaustive of the analytic possibilities, the following Socioeconomic differentials examples show the extent to which the data systems of NCHS provide a rich national resource and an important set A major task in the epidemiology of back pain is to of scientific opportunities for population-based studies of clari~ the extent to which the problem of back pain varies pain. To provide some structure to this case study of the among sociodemographic categories of the population. usefulness of the inventory in identifying analytic possibil­ Many studies have found that back pain is proportionately ities, seven issue areas in the comprehensive study of back more common among people in the lower socioeconomic pain and related back disorders are identified and the rel­ strata. However, several aspects of this empirical general­ evance of existing NCHS data to these issue areas is dis­ ization need to be clarified. Socioeconomic status can be cussed. indexed in a variety of ways (including education, family income, occupation, and household social standing). How consistent is the generalization of socioeconomic status and Alternative definitions of the magnitude of the relative frequency of back pain across these different the problem i indicators? To what extent is the association of socioeco­ Data are available from NHIS and the National Med­ nomic status and back pain independent of the effects of ical Care Utilization and Expenditure Survey (NMCUES) other factors associated with bothsocioeconomic status and on the incidence of acute backaches and’ associated back pain? How does the independent effect of socioeco­ disability days, as well as back injuries and associated nomic status on back pain vary among categories of the

7 population defined in terms of factors associated either with attitudes related to various aspects of health promotion socioeconomic status or with back pain, but not with both? and disease prevention. How important is socioeconomic status as a predictor of To the extent feasible, the description of these health back pain, compared with other sociodemographic factors characteristics could take into account differences in the that are associated with back pain? Which components of sociodemographic characteristics of persons with and socioeconomic status have the greatest effects on back without back pain that are also associated with the health pain? characteristic being described. These analyses could serve What are the major alternative interpretations that to clarify important aspects of the structure of the can be advanced to explain the patterns of association problem of back pain and could have important implica­ ! between socioeconomic status and back pain? To what tions for the development of topologies of persons with extent can these alternative interpretations be evaluated back pain. directly or indirectly with available NCHS data? When the empirical implications of these alternative interpretations Risk factors for back pain and related can be evaluated with the data at hand, what do the back disorders results show? Based on all these analyses, what can be concluded A variety of workplace (48) and individual (49) char­ about the relationship between socioeconomic status and acteristics have been identified in the literature as factors back pain? How do these generalizations based on an that increase the risk of having an episode of low back pain analysis of available NCHS data compare with existing or that influence the seriousness or disabling consequences generalizations in the literature? What are the major of such an episode. implications of the results of these analyses and compari­ Workplace characteristics associated with the risk of sons with the literature? an episode of low back pain include the following: These questions and others related to socioeconomic . Physical work characteristics, such as the extent to differentials can be answered using NCHS data docu­ which a job requires heavy lifting, pushing, pulling, mented in the inventory. Data on the scope of the problem cyclic loading, exposure to vibrations, prolonged sitting, of back pain and related back disorders are available from and certain other postures a worker assumes in car­ the same data systems identified as dealing with the rying out job duties. magnitude of the problem, for comprehensive data on the . Psychological characteristics, such as monotony, sociodemographic characteristics of respondents are rou­ boredom, and job dissatisfaction. tinely collected in NCHS surveys. In addition to these data systems, sociodemographic differentials can be studied Individual characteristics associated with the occur­ using data from the 1988 National Maternal and Infant rence, seriousness, and disabling consequences of an epi­ Health Survey and the 1990 Longitudinal Followup, sode of low back pain include the following:

� Constitutional factors, such as age, physical fitness, Health characteristics abdominal muscle strength, flexor or extensor balance, and muscular insufficiency. In addressing the structure of the problem of back pain � Postural and structural factors, such as severe scoliosis, and related back disorders, a major strength of the certain congenital abnormalities, and a narrowed spinal population-based health surveys of NCHS is that persons canal. with a certain health problem can be compared with persons � Radiographic findings of specific structural abnormal­ without that particular problem in terms of a wide variety ities, namely, spondylolysis, fractures, multilevel degen­ of other health characteristics. The analyst could capitalize erative disc disease, and spondyloarthropathies. on these national data resources to compare the health � Personal health care factors, such as smoking, alcohol characteristics of persons with and without back pain and use, and diet. related back disorders. � Participation in certain kinds of recreational activities, The inventory identifies NHIS, NHANES I and II, such as golfing, tennis, football, gymnastics, jogging, and NMCUES as data systems from which a comprehen­ and cross-country skiing. sive description of persons with back pain could be pre- � Psychosocial factors, such as anxiety, depression, hypo­ pared in terms of acute illnesses and injuries, disability chondriasis, and somatization. days, selected chronic conditions (including conditions in � Other factors, such as familial clustering of back prob­ which pain predominates), limitation of activity from a lems and multiple births in females. chronic condition or impairment, limitation of mobility, I need for long-term care, self-assessed health status, psy­ Several NCHS data sets, including NHIS, NHANES I 1 chological well-being, depressive symptoms, use of physi­ and H, and the Hispanic Health and Nutrition Examina­ cians, use of dentists, use of short-stay hospitals, usual tion Survey, provide a basis for retrospective comparisons sources of medical care, health insurance, out-of-pocket of individuals with and without back pain in terms of many health expenses, health practice;, and knowledge and of these known risk factors. Information from the

8 NHEFS and NMCUES also provide a basis for several that provide base estimates of the magnitude and scope of prospective analyses of the effects of some of these risk the problem. Data are available from NHIS, NHANES I factors on back pain. Available NCHS data could be and II, NAMCS, NHES, and NMCUES. examined for their bearing upon the nature and relative A critical review of previous efforts to estimate the importance of these known risk factors and could be direct and indirect costs associated with back pain and explored for the relevarice of additional risk factors that related back disorders could be undertaken, and the have been suggested in the literature but never empirically development of more up-to-date estimates of the eco­ tested. nomic impact of back pain and related back disorders, going beyond the limitations of previous estimates to the extent feasible, could be attempted using available NCHS Economic impact data. One consequence of back pain problems is the eco­ nomic costs for the individual, his or her family and Back pain management employer, and society at large. Estimates of the economic . impact of illnesses in the United States are most commordy The management of back pain and related back disor­ developed using a “human capital” approach (50-53) that ders includes a variety of options for doctors and individuals differentiates two broad categories of costs: Direct medical (56). Physicians can diagnose the back problem, which usu­ care costs and indirect costs resulting from disability and ally involves the use of clinical tests and laboratory mea­ premature mortality. surements, and treat the problem, which may include Direct medical care costs include public and private prescribed bed rest; use of medications, braces, corsets, expenditures for prevention, detection, treatment, rehabil­ collars, traction, physical therapy, transcutaneous electrical itation, research, training, and capital investments in med­ nerve stimulation, injections, or surge~ or referral to a ical facilities. Under direct medical care costs are the back school or pain clinic. The services of chiropractors and more familiar specific categories of personal services and other health care professionals are also sometimes used. In supplies and nonpersonal services. The former of these addition to their compliance with medical interventions, specific categories, personal services and supplies, individuals can do many things to manage their own back includes hospital care, nursing home care, physicians’ problems. services, dentists’ services, other medical professional ser­ Data bearing on the management of back pain and vices, drugs and drug sundries, eyeglasses and appliances, related back disorders are available from NHIS, school health services, industrial health services, and med­ NHANES I and II, NHEFS, NMCUES, NAMCS, NHDS, ical activities in Federal units other than hospitals. The and NNHS. Most of these data are concentrated on the latter specific category, nonpersonal services, includes services of the medical care systerrq however, the informa­ medical agencies and health insurance costs. Because of tion from these various data sets could be integrated to the ambiguities that confound the allocation of these provide a fairly comprehensive description of the manage­ nonpersonal service costs to specific diseases, they are ment of back pain and related back disorders in the generally not estimated for specific diseases. United States. Indirect costs – a measure of potential productivity lost to society– include loss of output to the economy (as a Temporal variations result of illness, disability, and premature death) in terms of wages lost because of days lost from work. One compo­ A major task of an epidemiology of back pain is to nent of these indirect costs is morbidity 10SSbecause of clari~the extent to which problems of back pain and related decreased productivity on the job, absenteeism, and back disorders are changing over time with respect to mag­ unemployment. A second component is the value of pro­ nitude, scope, structure, etiology, consequences, and treat­ ductivity not realized in a year due to disease-related ments. Data systems of NCHS provide a basis for describing deaths as well as the present value of future productivity selected aspects of such changes in the United States. lost as a result of deaths in that year. Trend data are available from the NHIS on incidence In early efforts to document the economic impact of of acute backaches, disability days associated with acute back pain problems in the United States (54), an attempt backaches, the prevalence and impact of chronic back and. was made to estimate selected components of these costs spine impairments, the prevalence and impact of slipped using published data. More recently, efforts have been disc problems, physician visits involving diagnosis or treat­ made to develop a more comprehensive statement of the ment for acute and chronic back problems, and short-stay economic impact of back pain by estimating a broader hospital discharges for back problems, including surgical range of cost components using public use data tapes (43). treatment for back problems. NHANES I and II data Specialized studies codifying what is currently known provide replicate information on the prevalence and char­ about compensation costs for back pain have also been acteristics of adults with back pain. NAMCS provides published (55). trend information on the characteristics of visits to office- A great majority of the data for these studies of based physicians for back pain and related back disorders. economic impact are obtained from NCHS data systems NHDS provides trend information for short-stay hospital

9 discharges, hospital days, and surgery associated with back Secondary analysis, particularly analysis of large-scale, problems. NNHS has limited information on the preva­ complex surveys, requires careful consideration of the lence of problems of the back or spine among nursing intricacies and limitations of the data (18,98–101). home residents. Methods, target populations, units of analysis, and The analyst could use this information to describe response rates vary among data systems. Although items selected trends in the problem of back pain in the United may appear similar in a questionnaire, their possible uses States. To the extent that the data permit, an effort could can vary substantially. Trend studies in particular warrant also be made to evaluate the observed trends (57) in critical examination of methodological and measurement relationship to changes in survey procedure, changes in variation (57,102,103). Detailed discussion of these issues the SOC1‘ composition of the population, changes in the is beyond the scope of this report. The user is urged to organization and operation of the health care system, and consult other publications for a more complete description changes in values related to the definition, diagnosis, and of the data systems and for references to detailed meth­ report of back pain. Moreover, because increasing atten­ odological reports (21,37,104). Excellent overviews of the tion is being given in public health discussions to the current state of the art of pain measurement are also magnitude, scope, and impact of various health problems available in the literature (14,16) and constitute funda­ projected over the next several decades, an effort could mental resources for evaluating the sources and quality of also be made to develop preliminary projections (58) of pain data. the magnitude and severity of the problem of back pain in the United States in the future. Current and future efforts

Secondary analysis for During the past 15 years, there have been numerous population-based studies of pain efforts to document the problem of pain in the United States. Each of these efforts has called attention to the As the preceding case study amp[y demonstrates, the need for more complete and comprehensive information NCHS has collected a variety of data appropriate to the on pain with respect to the magnitude of pain problems study of pain and pain-related issues. A basic assumption and their scope, structure, sources, impact, treatments, of this inventory is that NCHS surveys are a good source and trends. Because NCHS is the only Government of data for secondary (and in some cases for primary) agency mandated by law to collect general-purpose, analysis of pain issues. Some of the data presented in this descriptive statistics on the Nation’s health, NCHS staff inventory have already been analyzed by NCHS staff or began several years ago to evaluate existing NCHS data on others. NCHS statistical compendiums such as Health, pain. The first step in this evaluation was an examination United Sfatet (59) have included selected information on of the efforts already made in NCHS data systems to pain syndromes, most notably on back pain, as have measure pain and pain-related phenomena, The results of selected reports in the Wal and Health Statistics series this initial evaluation of NCHS efforts in the study of pain (such as (60-73)) and in Advance Data From P2tal and are presented in the main body of this report, which Health Statistics (such as (74-96)). However, much of the follows this section. pain data collected by NCHS have not been analyzed, A second report, “Pain Data Available From the Even those data that have received attention offer poten­ National Center for Health Statistics: An Evaluation of tial for further analysis. This inventory is a first attempt to Adequacy, Epidemiologic Uses, and National Data systematically identify these data and make their existence Needs” (105), which focuses on the methodological known to interested researchers and poIicy analysts. quality, substantive adequacy, and epidemiologic uses of - The benefits of secondary analysis are many (97). On currently available NCHS pain data, is in the final stages the practical side, the approach requires fewer resources, of preparation at the time of this writing and will appear in terms of both money and time, than a full-scale survey in the near future in Series 4 of Vitaland Health Statistics. effort. Secondary analysis also has several substantive Because of funding and staffing constraints, only a advantages, It provides historical perspective on important limited number of analytical projects were funded, issues. It permits trend studies and comparative analyses including analyses of NHANES, NHDS, and NAMCS that a single research endeavor cannot achieve. It also data on back pain. The results of these analyses are promotes the expansion of existing theory by forcing the making their way into the pain literature through presen­ researcher to think broadly and abstractly to find overar­ tations and poster sessions at professional meetings, as / ching concepts or categories within which available indica­ well as through publication in appropriate journals tors can be contained. (106-111).

10 General population surveys

National Health Examination Presence of iritis in one or both eyes? Survey (NHES), Cycle I Tenderness? Pain on motion except distal-interphalangeal and spine? !. Survey design \ Benonite flocculation (dilution range from negative to Survey of U.S. civilian noninstitutionalized adults ages more than 1:16) 18-79 years, using a multistage, clustered probability Rheumatoid arthritis diagnosis: Classical, definite, sample stratified by geographic region and population size. probable, possible Interviews and examinations with about 6,700 persons con­ Frequency of joint pain ducted from October 1959 through December 1962. Think you have arthritis or rheumatism? Confirmed by .. a doctor? Duration Basic data elements Had in the past year? Data include a household interview, medical history, Take medicine for it? medical examination, dental examination, x ray, electro­ Have gout? cardiogram readings, laboratory blood tests, vision and hearing tests, and anthropometric measurements. Also Data tape availability included are a personal medical history and results of a physician examination related to the cardiovascular system, NHES I Cardiovascular Data (tape no 1004), NTIS acces­ arthritis, and diabetes. Data are located on multiple tapes. sion no PB 293138 NHES 10steoarthritis and Rheumatoid Arthritis (tape no 1005), NTIS accession no PB 293130 Pain data elements Technical contact: Cardiovascular data: Patricia Vaive Frequency of headaches in past few years Division of Health Examination Statistics Do they bother you? 6525 Belcrest Road, Room 900 Chest pain in past few years? Heart pain in past few years? HyattsviIle, MD 20782 Location { (301) 436-7081 Does it move around? Duration Questionnaire source items When does it usually come? When exercising, when quiet, makes no difference, other? When upset, makes National Center for Health Statistics. Plan and initial pro- ~ no difference, other? gram of the Health Examination Survey. National Center Take medication for chest pain? Take medication for for HeaIth Statistics. Vital Health Stat 1(4). 1965. heart pain? Leg cramps? Angina pectoris (examining physician’s impression)? National Health Examination Survey (NHES), Cycle II Osteoarthritis and rheumatoid arthritis: Osteoarthritis x-ray readings on hands and feet: None, Survey design doubtful, minimal, moderate, severe Rheumatoid x-ray readings on hands and feet: None, Survey of U.S. civilian noninstitutionalized children doubtful, minimal, moderate, severe ages 6 months–n years, using a multistage, clustered prob­ Osteoarthritis diagnosis ability sample stratified by geographic region and popula­ Limitation of activity tion size. Interviews and examinations with approximately 7,100 children conducted from 1963 through 1965.

11 Basic data elements laboratory tests. Major data elements are on one tape. Approximately one-third of the youths examined in Cycle Data include detailed medical and developmental his­ HI were examined earlier in Cycle II. These youths are tories from a household adult, usually the mother; infor­ identified on both the Cycle H and Cycle 111tapes, making mation from the school; medical, dental, and psychological longitudinal analyses possible. examinations; vision and hearing tests; and anthropometric measurements. Major data elements are on one tape. Pain data elements 1, Approximately one-third of the children examined in Cycle . II were reexamined in Cycle HI. These children are iden­ Medical Histoy of Youth From Parent tified on both the Cycle II and Cycle III tapes, making Questionnaire longitudinal analyses possible. Any bones ever broken? Ever had any serious accidents or injuries? Pain data elements Number Hospitalized for accident or injury Sore throats? International Classification of Diseases (8th revision) . Earaches? code for most serious illness or disease (using Inter- Injury to ears? national Classification of Diseases, Adapted for Use in Eardrums opened or lanced? the United States) Number of times Age when illness started Seriousness of illness or disease Data tape availability Any injury to ears? NHES II Integrated Data Tape (tape no 21DT), NTIS Earache in past year? accession no PB 293124 Inclination to consult physician if youth: Had a stomach { ache, sore throat, headache; hurt aIl over; had pain in Technical contact: chest Patricia Vaive Pain or discomfort from periods? Division of Health Examination Statistics How often painful: Very often, occasionally 6525 Belcrest Road, Room 900 Severity of pain or discomfort when present: Mild, Hyattsville, MD 20782 moderate, severe (301) 436-7081 Remedy used to ease pain: Takes medicine, goes to sickroom or nurse, stays in bed, stays home from Questionnaire source items school National Center for Health Statistics: Plan, operation, and Talked to a doctor about the pain? response results of a program of children’s examinations. Health Habits and Histoq – youth Questionnaire National Center for Health Statistics. Vital Health Stat Ever broken any bones? 1(5). 1967, (Selected questionnaire items only,) Number of times Questionnaires available upon request from technical con- Ever had any other injuries or accidents? tact person. Ears ever damaged or injured? Any earaches in past year? Anything that prevents complete use of legs or arms? Any backaches in past year or two? National Health Examination Inclination to consult physician if Had a stomach ache, Survey (NHES), Cycle Ill sore throat; hurt all over; had a headache; had pain in chest, sore gums, a toothache, sores in mouth Survey design Nurse’s Questionnaire – Females Survey of the U.S. civilian noninstitutionalized popu­ Pain or discomfort from periods? lation ages 12-17 years, using a multistage, clustered prob­ Frequency: Most periods, occasionally ability sample stratified by geographic region and Severity: Mild, moderate, severe population size, Interviews and examinations with approx­ Medicine for discomfort? imately 6,800 youths conducted from 1966 through 1970. Use sickroom or nurse? Miss school or work? Basic data elements Talked to doctor about pain or discomfort? Data include a household interview; detailed medical Data tape availability and developmental histories; information from the school; medical, dental, and psychological examinations; vision and NHES III Extended Data Tape (tape no 3EDT), NTIS hearing tests; anthropometric measurements; x rays; and accession no PB 296025

12 Technicalcontact: Arthritis? Gout? Heart attack? Peptic, stomach, or Patricia Vaive duodenal ulcer? Recurrent or chronic enteritis? Division of Health Examination Statistics Colitis? Gallstones? Hiatus hernia of the dia­ 6525 Belcrest Road, Room 900 phragm? Kidney disease or kidney stones? Malig­ Hyattsville, MD 20782 nant tumor or growth? Fracture of hip, wrist, spine, (301) 436-7081 any other bone? During the past 6 months have you used any medicine, Questionnaire source items drugs, or pills for any of the following: Headache? Other pains? Questionnaires available upon request from technical con- tact person. Detailed Medical History Supplement (ages25–74years) Health problems now that you would like to talk to a doctor about: First National Health and Nutrition Headaches? Trouble with joints, pain, aching, Examination Survey (NHANES 1) swelling, stiffness? Possible heart or circulatory . trouble including trouble with veins, leg pains, and Survey design chest pains? Gastrointestinal troubles including heartburn, abdominal pain? Kidney or bladder Survey of the U.S. civilian noninstitutionalized popu­ trouble, pain when passing urine? lation ages 1–74 years, using a multistage, clustered prob­ In past 5 years, injury resulting in a broken hip, wrist, ability sample stratified by geographic region and spine, other bone? population size. Interviews and examinations with about In past 5 years, a back injury? 21,000 persons yere conducted from 1971 through 1974. Ever had pain present for at least 1 month on most days: This sample was augmented with approximately 3,000 per­ In any of your joints either at rest or when moving “sons ages 25–74 in 1974 and 1975, them? In neck or back? Basic data elements In or around either hip joint? In or around the knee? Data on all examined persons include household and In a swollen joint? demographic information; nutrition information; medical, Ever had: Trouble with any pain or discomfort in your dental, derrnatological, and ophthalmological examina­ chest? tions; anthropometric measurements; hand-wrist x rays Severe pain across the front of your chest lasting for (ages 1-17 only); and a variety of laboratory tests. Infor­ half an hour or more? mation on a subsample of adults includes a supplementary Pains in either leg while waIking? medical history tobacco and alcohol use; mental health and Pain or burning sensation when passing urine? depression measures; supplementary inforriation con­ cerning arthritis, respiratory, and cardiovascular condi­ Health CareNeeds Questionnaire (ages25-74 years) tions; health care needs; an extended medical examination; Toothache was the main reason for last visit or talk with x rays of the chest and hip and knee joints; and a variety of a dentist at either his office or clinic. I additional clinical procedures and laboratory tests. Data are located on multiple tapes. General Well-BeingSchedule (ages25-74 years) ‘In past month, bothered by any illness, bodily. disorder, pains, or fears about health? Pain data elements SupplementA –Arthritis (ages25-74 years) Medical Hi.sto~ Questionnaire (ages1-11 years) Pain in either the back or neck on most days for at least Ever had a bad accident? 1 month? Still have the effects of it? Has pain been present on any one occasion for at Ages 6–11 years: least 6 weeks? Ever been treated for a stomach or intestinal dis­ Is pain usually located in neck? Upper back? Mid- order? Kidney disease or infection? Cancer or back? Lower back? tumors? Is pain most intense in neck? Upper back? Mid- Unable to do some things because of a condition back? Lower back? that has bothered for a long time? Is pain present when resting at night? MedicalHistory Questionnaire (ages 12–74years) Does pain awaken you from sleep at night? Episodes of pain or discomfort in abdomen or stomach Does pain in back ever seem to spread? at least 3 days a month? Does pain spread to the back of the right leg? Has a doctor ever told you that you have any of the Left leg? Both legs? Top of the head? The sides following conditions, and if so, do you still have it? How of the body? many years ago did you first have it? Has pain in neck ever seemed to spread?

13 If so, does pain spread to top and back of head? Was there surgery? Either shoulder area? The arms or hands? Had pain in or around knee on most days for at least Other locations? 1 month? Is back or neck pain made worse: Has pain in the knee area been present on any one By coughing, sneezing, or deep breathing? occasion for at least 6 weeks? With bending or twisting motion? In which knee did you first have it? After prolonged activity? Age when first experienced recurring pain in After prolonged sitting? the knee After prolonged standing? When knee pain present, is it most intense in right Age when first experienced recurring back or neck knee, left knee, both knees, behind the right knee, pain behind the Ieft knee or behind both knees? When last had this pain Does it hurt at rest as well as when moving? The longest episode of back or neck pain ever had Is there also swelling of the knee joint? Does back or neck pain occur more frequently now Ever had “locking” of the knee? than before? Has either knee ever “given way” under you? Ever had a sprained back because of some type of If yes, which knee gave way? physical activity? Last time had this knee pain Ever had a “whiplash” injury of the neck? Longest episode of knee pain ever had Ever had a ruptured disc in either your back or Ever had a fractured knee? neck? Which knee fractured? If so, at what age? Ever had a severe twisting of either knee with Were you in traction? resultant sprain or swelling lasting more than Was surgery necessary? 2 weeks? Which knee? Ever stayed overnight in a hospital for back or neck Ever had any other knee injury? Which knee? pain? Ever had hip, knee, or back disease treated by an oper­ Had pain in or around either hip joint on most days for ation? at least 1 month? Which joint? Has pain in the hip area been present on any one If hip, which hip? occasion for at least 6 weeks? If knee, which knee? Where did you first notice it? Left hip? Right hip? Had pain or aching in any joint other than the hip, back, Both hips? or knee on most days for at least 6 weeks? In hip area, is the pain usually most intense in the Were fingers painful? Which fingers? right buttock? Left buttock? Both buttocks? Right Was wrist painful? Which wrist? groin? Left groin? Both groins? Side of right thigh? Was elbow painful? Which elbow? Side of left thigh? Sides of both upper thighs? Was shoulder painful? Which shoulder? Other areas? Was ankle painful? Which ankle? From the hip, has the pain tended to spread to: Was foot painful? Which foot? The ins{de of your-leg? Any swelling of joints with pain present when the joint The front of your leg? was touched on most days for at least 1 month? The outside of your leg? Has this swelling been present on any one occasion The back of your leg? for at least 6 weeks? Had pain in or around the hip when either Is swelling and tenderness on touching: coughing or sneezing? In fingers? Which fingers? When hip pain present, does it hurt at rest as well In wrists? Which wrist? as when moving? In elbows? Which elbow? Age when first experienced recurring pain in the In shoulders? Which shoulder? hip In hips? Which hip? Last time had pain In knees? Which knee? Longest episode of hip pain you have ever had In ankles? Which ankle? Ever had a fractured hip? In feet? Which foot? If yes, which hip was broken? Age when first experienced this swelling of the Age when it happened joints Was hip in traction? Last time you had this swelling Was there surgery? Ever had pain, swelling, or stiffness in a joint as result Ever had a dislocated hip? of an accident or injury? If yes, which hip was dislocated? Was this the cause of the pain, swelling, or stiffness Age when it happened mentioned previously? Was hip in traction? Is this the cause of any pain, swelling, or stiffness

14 which might still be present? Supplement B–Respirato~ (ages 25–74 years) Ever been treated by any-of the following for your joint Chest pains: With persistent coughing? With morning troubles? coughing spells? Along with shortness of breath? General practitioner, internist, rheumatologist, Where? Upper back, lower back, upper chest, orthopedist, chiropractor, osteopath, foot doctor, along the rib edge, on the sides? physical therapist, occupational therapist, other, never been treated Supplement C– Cardiovascular (ages 25–74 years) Are you currently being treated by a doctor for the Have chest pains, chest discomfort, pressure, or heavi­ troubles you have just described? ness? Type of doctor specified Description of pain: Heaviness? Burning sensation? Doctor’s diagnosis: Acute arthritis; arthritis of Tightness? Stabbing pain? Pressure? Sharp pain? spine, hip, upper and lower extremities; arthritis Shooting pains? because of an infection; rheumatoid arthritis; Had it more than three times? osteoarthritis and allied conditions; other specified Been bothered by this within the past 12 months? forms “of arthritis; arthritis, unspecified; rheuma­ Age when first had it tism, polymyositis, and dermatomyositis; rheuma­ Get it if you walk at an ordinary pace on level [ tism, specified; osteomyelitis and periostitis; other ground? 1 diseases of the musculoskeletal system; other Get it if you walk uphill or hurry? , Last time saw doctor What do you do if you get it while walking: Stop, Who originally referred you to this doctor? S1OWdown, continue at same pace, take medicine? Where usually see doctor? If you do stop or slow down, is it relieved? How long will it be until next visit to doctor? How soon? v Have you ever used any of the following kinds of treat­ When you get pain or discomfort, where is it located: ment for your joint troubles? Do they do you any good? Upper middle chest? Lower middle chest? Left side of Do you use them regularly? chest? Left arm? Right side of chest? Other? Splints or casts? Braces? Diathermy or paraffin? Do any of these things tend to bring it on? Excitement Hot packs or heating pads? Cold packs or ice? or emotion, stooping over, eating a heavy meal, , Rest? Traction? Exercises or physical therapy? coughing spells, cold wind, exertion? Aspirin? Cane? Crutch? Stiff mattress? Bed Ever had severe pain across the front part of chest board? lasting half an hour or more? Ever had injections into joints? Did they do you any How many of these attacks have you had? good? Date of last attack (month, year) Ever taken any of the following medications for your Duration of pain during last attack joints? Did it do any good? See a doctor about last attack? Any cortisone-like medicine by mouth? Butazo- What did doctor say it was? Rheumatic fever, Iidin? Darvon or Tylenol? Indocin? chronic rheumatic heart disease, hypertension, Can you do the following things without the help of ischemic heart disease, other forms of heart dis­ I someone else or the help of some special device: ease, cerebrovascular disease, arteriosclerosis, Go up or down stairs? Get into or out of a car? Use other diseases of the circulatory system washing facilities? Dress yourself? Feed yourself? Get pain or disco~ort in either leg while walking? Get into or out of bed? Also get this pain in your legs while standing still? At present time, does joint condition restrict your phys­ Parts of leg in which pain is felt Lower (calf), upper ical activi~ very little, quite a bit, or a whole lot? (thigh); both Ever had to stay in bed for long periods of time because Have the leg pain while quiet or while sitting? of joints? Get it when you walk up a hill in a hurry? Ever stayed overnight in a hospital because of joint Get it when you walk at an ordinary pace on level problems? ground? With respect to your joint trouble, would you say your Does the pain in your legs come on after you have condition is mild, moderate, or severe? taken a few steps? .. Job status 1 month before first developing joint condi­ Does the pain disappear while you are still tion walking? Change in job status as a result of joint condition? What do you do when you get it while you are Current job status walking: Stop, slow down, continue at same pace, Number of workdays lost during past 12 months as take medicine? result of joint condition If you stop, is it relieved? How soon after stopping? X-ray readings

15 “ ,, Is the pain more likely to occur when you are Technical contact: hurrying than when you are walking at a slower, Patricia Vaive more even pace? Division of Health Examination Statistics Seen a doctor about chest pains, chest discomfort, pains 6525 Belcrest Road, Room 900 in the legs while walking, or heart failure? Hyattsville, MD 20782 Type of doctor: General practitioner, osteopath, (301) 436-7081 heart specialist, other specialist, other Types of diagnostic procedures Questionnaire source items Types of treatments National Center for Health Statistics. Plan and operation of Ever been disabled because of chest pain, leg pain, or the Health and Nutrition Examination Survey: United heart failure? States, 1971–1973, National Center for Health Statistics. Ever stayed overnight in a hospital because of chest Vital Health Stat l(lOb). 1977. pain, leg pain, or heart failure? Job status 1 month before developing chest pain, leg Engel A, Murphy RS, Maurer K, Collins E. Plan and oper­ pain, or heart failure ation of the HANES I Augmentation Survey of Adults As a result of your condition, has there been a change 25–74 years: United States, 1974-1975. National Center for in your job status? Health Statistics. Vital Health Stat 1(14). 1978. Current job status Medical Examination (ages 1-74 years) Second National Health and Pain on motion of knees: Active, passive, both; tenderness Nutrition Examination Survey Right and/or left medial (NHANES 11) Right and/or left lateral Survey design Right and/or left diffuse Pain on motion of hips: Survey of the U.S. civilian noninstitutionalized popu­ Active, passive lation ages 6 months-74 years, using a multistage, clustered Extension probability sample stratified by geographic region and pop­ Flexion ulation size. Interviews were conducted with approximately Abduction 25,000 persons. Of these respondents, approximately 21,000 Adduction persons were examined from 1976 through 1980. External rotation Internal rotation Basic data elements Pain on motion of (right and/or left) shoulder, elbow, Data include household and demographic information, wrist, (number of) metacarpophalangeal, (number of) a medical history, nutrition information, medication and proximalinterphalangeal, (number of) distalinterpha- vitamin usage, tobacco use, behavioral characteristics, exer­ Iangeal, ankle, foot cise frequency, a medical examination, anthropometric Pain on flexion, extension, right and/or left lateral , measurements, and a variety of clinical procedures and bending, right and/or left rotation of back (location): k laboratory tests. Information for all interviewed persons Cervical (not just examined persons) is located on multiple tapes. Thoracic Low back Pain data elements Diffuse Uncertain Child’s Medical History Questionnaire (ages 6 months- 11 years) Data tape availability Ever had any bad accidents? NHANES I Medical History Questionnaire, Ages 1-11 Burned? (tape no 4067), NTIS accession no PB 296031 Break a bone? NHANES I Medical History Questionnaire, Ages 12-74 Still have effects of accident? (tape no. 4081), NTIS accession no PB 296073 Unable to do some things because of a condition that NHA.NES I Detailed Medical History, Health Care Needs, has bothered for a long time? Respiratory, and Cardiovascular Supplements, Ages 25-74 Ever been treated for cancer or tumors? (tape no 4091), NTIS accession no PB 296029 Ever had any infections of the kidney, bladder, or uri­ NHANES I General Well-Being and the Center for Epi­ nary tract? demiologic Studies Depression Scale Developed by the Number of times National Institute of Mental Health, Ages 25-74 (tape no Ever seen a doctor for any kidney, bladder, or other 4171), NTIS accession no PB 296020 urinary problem? NHANES I Medical Examination, Ages 1-74 (tape no Type of doctor 4233), NTIS accession no PB 296035 Ever been told by a doctor that you had the following? ~

16 Still have it? When first had it? Estimated workdays lost because of a heart condition Nephritis? Chest pains along with shortness of breath? Kidney stones or stones in the ureter? Location of chest pains: Upper ches~? Upper back? Nephrosis? Lower,back? Along the lower, ribs~ On the sides? Kidney infection? Ever had p~n in your back qn mo,st days for at least Kidney abscess? 2.weeks? . . Bladder infection? Longest episode of back pain ever had Bladder stones? Usual locatiori of back pain: Upper back? Mid- Urinary tract infection? back? Lower back? ; Ear infection? Where is it most intense: Upper, back? Mid- back? Lower back? ,,, , ,, Health HistcnySupplement (ages 12–74years) ISback pain usually present when resting at ti,ght? Ever had any trouble with pain, discomfort, or pressure Does the back pain awaken you from sleeping at in your chest when you walk fast or uphill? night? ,. Description of pain: Heaviness? Burning sensation? Does the back pain ever seem to spread?. Tightness? Stabbing pain? Pressure? Sharp pain? Does it spread to the: Back of the,right leg? Shooting pains? Back of the left leg? Back of both legs? Top of Had the pain or discomfort more than three times? the head? Sides of the body? Been bothered by the pain or discomfort within the past Is your back pain made worse: By coughing, 12 months? sneezing, or deep breathing? ,With bending or Age when first had the pain or discomfort twisting motion? After prolonged sitting? After Get the pain or discomfort if walk at an ordinary pace prolonged standing? After prolonged activity? on level ground? Age when first experienced .recurring back pain If so, do you: Stop? S1OWdown? Continue at the Last time had this back pain ,. same pace? Take medicine? Does this back pain occur more frequently now If stop or slow down, is the pain or discomfort than it used to occur? relieved? Has this back pain usually been mild, moderate, or How soon is the pain relieved? severe? Where is the pain or discomfort located: Upper middle Ever had a sprained back because of some type of chest? Lower middle chest? Left side of chest? Left physical activity? arm? Right side of chest? Some other place? Ever had a disc pro?Jem in either your back or Do any of the following things tend to bring the pain or neck? discomfort on? A ruptured disc? ‘ Excitement or emotion? Was the disc problem in you; back or neck? Stooping over? Age when first had the disc problem Eating a heavy meal? Were you in traction? Coughing spells? Was surgery necessa~? Cold wind? Ever stayed in a hospitaI overnight or longer Exertion? for back pain? Ever had severe pain across front of chest lasting one- Ever had pain in-your neck on most days for at least half hour or more? 2 weeks? Number of these pain attacks Longest episode of neck pain ‘ Date of last attack Neck pain present when resting at nighl? ~ Duration of pain during last attack Does the neck pain ever seem to spread? Doctor seen about last attack Does it spread to: The top and, back .pf She: Doctor’s diagnosis: Rheumatic fever, chronic rheu­ head? Either shoulder area? The arms or matic heart disease, hypertension, ischemic heart hands? Other? . . i disease, other forms of heart disease, cerebrovas­ Is neck pain made worse: By coughing, sheering, or cular disease, arteriosclerosis, other diseases of the deep breathing? With bending or twisting motion? circulatory system, or other chest pain —not car­ After prolonged activity? Afterprolonged sitting?. diovascular After prolonged standing? “ “ ‘‘ Ever seen a doctor about chest pains, chest discomfort, Age when first experienced this recurring ne’ck or heart failure? pain” Type of doctor: General practitioner? Internist? Last time had this pain “ ; ““ “““ Osteopath? Heart specialist? Some other medical Does this neck pain occur more frequently “now .,; ., person? than it used to occur? - ., Ever stayed in a hospital overnight or longer because of Neck pain usually mild, moderate, or severe? ‘ - chest pains or a heart condition? Ever had a “whiplash” ‘injury of the neck? ‘‘ ~‘’ ; ~”‘“ ,.. ,, .,. .

17

,’ Ever used any of the following kinds of treatment for Fingers? Which fingers? your back or neck troub[e? Did it do you any good? Are Wrist? Which wrist? you using it regularly? Elbow? Which elbow? Splints or casts? Braces? Diathermy or paraffin? Shoulder? Which shoulder? Hot packs or heating pads? Cold packs or ice? Hip? Which hip? Rest? Traction? Exercises or physical therapy? Knee? Which knee? Aspirin? Cane? Crutch? Stiff mattress? Bed Ankle? Which ankle? board? Foot? Which foot? Back or neck condition restricts physical activity very Had any swelling of joints with pain present when the little, quite a bit, a whole lot? joint was touched on most days for at least 1 month? Ever had to stay in bed at home for long periods of time Has this swelling been present on any 1 occasion for because of back or neck trouble? at least 6 weeks? Ever stayed overnight in a hospital because of back or Joints usually involved whenever you have this neck problems? swelling and tenderness on touching: Would you say your back or neck condition is mild, Fingers? Which fingers? moderate, or severe? Wrist? Which wrist? At any time during the past year did your back or neck Elbow? Which elbow? trouble cause you to cut down on the things you usually Shoulder? Which shoulder? do? Hip? Which hip? Number of activity cut-down days Knee? Which knee? Number of days lost from work or school, not Ankle? Which ankle? counting work around the house Foot? Which foot? Number of days condition limited the kind or Age when first experienced this swelling of the amount of work around the house joints Number of bed days Last time had this Ever had pain, swelling, or stiffness in your back or Ever had a job which placed frequent stress or strain on neck as the result of an accident or injury? your back? Think the accident or injury is the cause of any Length of time worked at that kind of job pain, swelling, or stiffness that might still be Ever had pain or burning sensation on urination accom­ present? panied by more frequent urination than usual? Ever been treated by a medical person for back or neck Number of separate times this has happened trouble? Have a physical disability or handicap that prevents or Type of medical person: General practitioner? limits normal daily activities, such as the kind or amount Internist? Rheumatologist? Orthopedist? Chiro­ of work that you can do, housework, schoolwork, using practor? Osteopath? Physical therapist? Occupa­ public transportation, and so on? tional therapist? Other? Diagnosis: Arthritis; rheumatoid arthritis; osteoar­ Adult Medical Hhtory Questionnaire (ages 12–74 years) thritis and allied conditions; rheumatism, polymy ­ During the past 12 months, stayed in hospital overnight ositis, dermatomyositis; osteomyelitis and or longer for (painful) condition? Eighth Revision periostitis; other diseases Of the musculoskeletal International Classification of Diseases, Adapted for system Use in the United States (ICDA) code Now being treated by a medical person for back or neck (Painful) illness or condition that interferes with your trouble? eating, digestion, or appetite? ICDA code Type of medical person: General practitioner? Has a doctor ever told you that you had any of the Internist? Rheumatologist? Orthopedist? Chiro­ following conditions, and if so, do you still have it? How practor? Osteopath? Physical therapist? Occupa­ many years ago did you first have it? tional therapist? Other? Arthritis? Current diagnosis: Arthritis; rheumatoid arthritis; Back injury? osteoarthritis and allied conditions; rheumatism, Bladder infection? polymyositis, dermatomyositis; osteomyelitis and Bladder stones? periostitis; other diseases of the musculoskeletal Cancer? system Gallstones? Ever had an operation for a back or neck disease or Gout? injury? Heart attack? Was it your back or neck? Kidney infection? Had pain or aching in any joint other than the back or Kidney stones or stones in the ureter? neck on most days for at least 6 weeks? Neck injury? Which joints were painful? Nephritis? A peptic, stomach, or duodenal ulcer? 18 Recurrent or chronic enteritis? Data tape availability Spastic colon or mucose colitis? NHANES II Medical History Questionnaire, Ages Ulcerative colitis? 6 Months-n Years (tape no 5010), Urinary tract infection? NTIS accession no PB 83-215616 During the past 6 months, use of aspirin or aspirin-type NHANES II Health History Supplement, Ages 12–74 Years pills (tape no 5305), On the average, use these pills one or more times NTIS accession no PB 83-256537 per week? NHANES II Medical History Questionnaire, Ages 12–74 Ever had kidney stones? Years (tape no. 5020), Ever passed a stone? NTIS accession no PB 83-154815 Kind of treatment for stones: Medicines? Surgery? NHANES II Physician’s Examination, Ages 6 Months-74 Special diet? Any other treatment? Years (tape no 5302), NTIS accession no PB-242930 Have you ever,had any infections of the kidney, bladder, or urina~ tract? Technical contact: Number of times Patricia Vaive Number of times doctor seen Division of Health Examination Statistics Type of practitioner General practitioner? 6525 Belcrest Road, Room 900 Internist? Urologist? Nephrologist? Other? Hyattsville, MD 20782 Number of schooldays or workdays lost because of (301) 436-7081 kidney, bladder, or urinary condition Special x rays? Questionnaire source items Hospitalizations? Last time saw doctor McDowell A, Engel A, Massey JT, Maurer K. Plan and Specific treatments operation of the second National Health and Nutrition Had any trouble with pain from kidney, bladder, or Examination Survey, 1976-80. National Center for Health urinary problems? Statistics. Vital Health Stat 1(15). 1981. Location of pain: Right, left, or both sides and back? Area over the bladder? Lower abdomen? Number of times had this pain Hispanic Health and Nutrition Ever had any trouble with pain, discomfort, or pressure Examination Survey (HHANES) in your chest when you walk fast or uphill? Ever had severe pain across the front of chest lasting for Survey design half an hour or more? Survey of civilian noninstitutionalized persons of His- Number of these attacks panic origin ages 6 months-74 years, using a multistage, Ever had pain in back on most days for at least 2 weeks? clustered probability sample drawn from a universe com­ Ever had pain in neck on most days for at least 2 weeks? prised of 229 counties in Texas, Arizona, CoIorado, New Ever had pain or aching in any joint, other than the back Mexico, and California (the Mexican-American sample); or neck, on most days for at least 6 weeks? New York City (the Puerto Rican sample); and Miami (the Ever had any swelling of joints with pain present when Cuban-Anerican sample) areas. An estimated 76 percent the joint was touched on most days for at least 1 month? of the Hispanic-origin population of the United States Ever changed job or stopped working because of a resides in these counties. Interviews and examinations with health problem? about 12,000 persons were conducted from 1982 through Physician>Examination (ages6 months–74 years) 1984. Costovertebral tenderness Pain on motion of (right, left, both) shoulder, elbow, Basic data elements wrist, (number of) metacarpophalangeal, (number of) Data include household and demographic information, proximal interphalangeal, (number of) distal interpha­ a medical history, medication and vitamin use, tobacco and langeal, ankle, foot, knee, hip alcohol use, drug abuse, health care needs, utilization of Pain on flexion, extension, right and/or left lateral health services, a medical examination, a dental examina­ bending, right and/or left rotation of back (location): tion, anthropometric measurements, nutrition, and a Cervical: Severity of pain (none, doubtful, minimal, variety of clinical procedures and laborato~ tests. moderate, maximal) Thoracic Pain data elements Low back Diffuse Child Histo~ Questionnaire (ages6 months–n years) . Uncertain Ever had an ear infection or an earache?

19

/. .€ Number of times€ Age at first attack of this pain€ Ever treated by a doctor for it?€ Ever seen a doctor about this pain?€ Ever had tubes placed in ear(s) by a doctor?€ Doctor’s diagnosis€ Ever had a ruptured eardrum? Cause of this pain€ Cause of functional limitation: Ever received an injection of medication to relieve€ Acute (onset within past 3 months) this pain?€ Chronic (onset more than 3 months ago) Ever hospitalized for this pain?€ During the past year, had heartburn or burning pain The following information is not yet available on the after eating? current Child Sample Person public use data tape: Frequency Use of nonprescription medicines in past 2 weeks: Distress caused by any of the following foods: Pain relievers such as aspirin or Tylenol? Milk?€ Sleeping tablets, sedatives, or tranquilizers? Fatty foods?€ Use of prescription medicines in past 2 weeks: Green vegetables?€ Name Seafood?€ Strength Any other food?€ Prescribed dosage Prescribed frequency Cardiovascular conditions (ages 20 years and over): Problem for which prescribed Ever had any pain or discomfort in your chest? Frequency taken Do you get it when you walk uphill or hurry? Side effects – specified Do you get it when you walk at an ordinary pace on the level? Adolescent and Adult Medical Histoiy Questionnaire What do you do if you get the pain or discomfort (ages 12-74 years) while you are walking? Average number of hours of sleep each day€ Stop or slow down? Main reason for last visit for dental care was toothache€ Continue at the same pace? Digestive disease (ages 20 years and over)€ Take medicine? Has a doctor ever told you that you had gallstones?€ If you stand still, what happens to the pain or Have you ever had surgery or an operation for gall-€ discomfort? Is it relieved? stones or gallbladder disease?€ How soon is it relieved? During the past 5 years, have you had pain in your€ Location of pain or discomfort abdomen or lower chest which lasted a half hour or€ Doctor seen? more?€ Doctor’s diagnosis: Coronary heart disease; Location of pain€ other cardiovascular disease; respiratory con­ Last time had pain€ ditions; chest pain, noncardiovascular; stress, Usual duration€ tension, or nervous conditions Pain steady or come in waves?€ Ever had severe pain across the front of your chest When have the pain, do you move around or lie€ lasting for half an hour or more? still?€ Number of these attacks Time pain usually starts€ Date of first attack; duration of pain Ever been awakened from sleep by this pain?€ Date of last attack; duration of pain Get this pain while eating, after eating, or is it not€ See a doctor because of this pain? related to eating?€ Doctor’s diagnosis How long after eating do you get this pain?€ Functional impairment (ages 18-70 years): Usually feel sick to stomach either before or after€ Cause of functional limitation is: get this pain?€ Acute (onset within the past 3 months) Within a day or two of having the pain, had any of€ Chronic (onset more than 3 months ago) the following:€ Ever changed job, stopped working, or made any Fever or chills?€ changes in housework because of a disability or Itching?€ health problem? (ages 18 years and over) Yellow jaundice?€ Unusually dark colored urine?€ Condition list: Unusually light colored bowel movements?€ Doctor ever told you that you had a heart attack? Number of days in past year had this pain in the€ Time since had first attack abdomen or lower chest€ Doctor ever told you that you had kidney problems? In the past year, what was the longest period of€ Still have problems? days, weeks, or months in which you did not have€ Time since first had problems this pain?€

20 The following information is not yet available on the ETHANES Gallbladder Ultrasound Data, Ages 2&74 Years, current Adolescent and Adult Medical History public Version 1 (tape no 6504), ITITS accession no PB 89-164511 use data tape: H.HANES Measures of Depression, Ages 20-74 Years Use of nonprescription medicines in past 2 weeks: (tape no 6523), NTIS accession no PB 87-100391 Pain relievers such as aspirin or TyIenol? Technical contact Sleeping tablets, sedatives, or tranquilizers? Patricia Vaive Use of prescription medicines in past 2 weeks: Division of Health Examination Statistics Name 6525 Belcrest Road, Room 900 Strength Hyattsville, MD 20782 Prescribed dosage (301) 436-7081 Prescribed frequency Problem for which prescribed Questionnaire source items Frequency taken Side effects –speci@ Maurer KR. PIan and operation of the Hispanic Health and Nutrition Examination Survey, 1982–84. National Center Physician’s Examination (ages 6 months–74 years) for Health Statistics. Vital Health Stat 1 (19). 1985. Tender lymph nodes? Thyroid tenderness? Third National Health and Nutrition Costovertebral angle tenderness? Tenderness on palpation of the abdomen (nine spec- Examination Survey (NHANES Ill) ified areas)? During the past 5 years has examinee had pain in the Survey design gallbladder area that lasted a half hour or more? Sutiey of the U.S. civilian noninstitutionalized popu- Does examinee usually feel sick to his or her lation ages 2 months and over, using a multistage, clustered stomach either before or after getting this pain? probability samp~e stratified by geographic region and pop- Likelihood examinee has gallstones ulation size. Interviews and examinations will be conducted Leg ulceration: Which leg? from 1988 through 1994, with both the first and second Edema in legs: Which leg? Severi~? 3 years of data collection constituting national samples. The Pain with ankle dorsiflexion: Which leg? total sample size of 40,000 is expected to yield about 30,000 Tenderness in the following joints (ages 10 and over): examined persons. Hips? Which hip? Knees? Which knee? Basic data elements Ankles? Which ankle? Feet? Which foot? Data on all examined persons include household and Shoulders? Which shoulder? demographic information, nutrition information, medical Elbows? Which elbow? and dental examinations, anthropometric measurements, Wrists? Which wrist? and a variety of laborato~ tests. Examination data on sub- Hands? Which hand? samples, determined mainly by age of examinee, include Tenderness in the back (ages 5 and over): electrocardiograms, eye fundus photographs, radiographs Sciatic notch? Which side? of hand-wrist and knee, ultrasound of the gallbladder, Sacroiliac? Which side? spiromet~, bone densitometry, and tests for hearing, aller- Varicose veins: Which leg? Severe, moderate, or mild? gies, and physical and cognitive functions. Target diseases and conditions include cardiovascular disease, chronic Measures of Depression (ages 20-74 years) obstructive pulmonary disease, diabetes, kidney disease, National Institute of Mental HeaIth Diagnostic Inter- gallbladder disease, osteoporosis, arthritis, infectious dis­ view Schedule Depression Section eases, dental health, allergy, cancer, mental health, and Center for Epidemiologic Studies Depression Scale hearing. Data will probably be located on multiple tapes.

Gallbladder Ultrasound Data (ages 20-74 years) Pain data elements Household Youth Questionnaire (ages 2 months–16years) Data tape availability Selected conditions: HHANES Child History Questionnaire, Ages 6 Months– Complaints of headaches during the past 12 11 Years, Version 2 (tape no 6522), NTIS accession no PB months 8’7-182424 Complaints of stomach aches HHANES Adolescent and Adult History Questionnaire, Dental care and status (ages 2-16 years) Ages 12-74 Years, Version 2 (tape no 6521), Type of dental care needed now ReIief of pain? NTIS accession no PB 87-182440 Vision and hearing HHANES Physician’s Examination, All Ages (tape no Ever have an ear infection or an earache? 6509), NTIS accession no PB 87-158416 Number of times

21

,., - . Age at first infection or earache Hurt more, less, or no difference if moved around? Treated by a doctor? Ever seen a doctor about this pain? Tubes in ears? What doctor said caused the pain Has a doctor ever told you that you had gallstones? Household Adult Questionnaire (ages 17 years and over) Was pain the reason for visiting doctor the time Selected conditions: you were told that you had gallstones? Has a doctor ever told you that you had: Ever had gallbladder surgery? Arthritis? Age when surgery performed Type Did the pain that caused your doctor visit con­ Lupus? tinue after gallbladder surgery? Gout? Dental care and status: Cardiovascular disease: Ever had any pain or discomfort in your chest? Type of dental care needed now: Relief of pain? Get it when you walk uphill or hurry? Vitamin, mineral, and medicine usage: Get it when you walk at an ordinary pace on level Use of prescription medicines in past month ground? Name What do you do when you get it while walking: Problem for which prescribed Stop, slow down, continue at same pace? Length of time taken Pain or discomfort relieved if you stand still? Use of antacids in past month How soon? Name Location of pain or discomfort Frequency taken Ever had a severe pain across the front of your chest Magnitude of dosage lasting half an hour or more? Length of time taken Has a doctor ever told you that you had a heart attack? Use of nonprescription pain relief medicines Number In the past month, taken any Age at (first) attack Aspirin, Anacin, Bufferin, Ecotrin, Ascriptin, or Age at last attack Midol? Get pain in either leg while walking? Tylenol, Anacin-3, or acetaminophen? Does pain ever begin while standing still or sitting? Advil, Nuprin, Medipren, or ibuprofen? Pain in calves? Other (specified)? Frequency taken Get it when you walk uphill or hurry? Get it when you walk at an ordinary pace on level Physician’s Examination ground? Pain on passive motion of wrist, finger joints (specified), Pain ever disappear while walking? great toe, knee: right, left, or both (ages 60 years and What do you do if you get it while walking: Stop, over) slow down, continue at same pace? Home Examination (ages 2–1 1 months and 20 years and Pain relieved if you stand still? over) How soon? Pain reported on walking? Musculoskeletal conditions (ages 20 years and over): Family Questionnaire Ever had pain in back on most days for at least 1 month? Health insurance coverage Had this pain within the past 12 months? Medicare coverage Location of back pain Medicaid coverage during past 12 months Ever had pain in hands on most days for at least 6 Was father or mother ever told by a doctor that he or weeks? she had a heart attack or angina before the age of 50? Which joints? Ever had pain in knees on most days for at least 6 Data tape availability weeks? Right, left, both? The survey reaches its midpoint in 1991 with a 3-year Hurt at rest as well as when moving? national probability sample. Public use data tapes from this Ever had pain in hips on most days for at least 6 weeks? sample are projected to be available in 1994. The public use Right, left, both? data tapes from the full survey are expected to be available in 1997. Gallbladder disease: During the past 12 months, have you had pain in (the Technical contact; area shaded on a diagram shown the respondent)? Patricia Vaive Location of most uncomfortable pain Division of Health Examination Statistics Duration of longest episode of pain 6525 Belcrest Road, Room 900 Number of days in past 12 months with this pain Hyattsville, MD 20782 Was pain continuous, or did it tend to come and go? (301) 436-7081

22 Questionnaire source, items When do you get it? When you walk uphill or hurry? Copies of the questionnaires can be obtained by writing to When you walk at an ordina~ pace on level the following address: ground? National Center for Health Statistics What do you do if you get this pain or discomfort Division of Health Examination Statistics while you are walking? .. Survey Operations Branch Stop or SIOWdown? 6525 Belcrest Road, Room 900 Take nitroglycerin? Hyattsville, MD 20782 Continue at ‘the same pace? If you do stop or slow down, is pain relieved? How soon? NHANES 1 Epidemiologic Followup Ever had this pain or discomfort more than three Study (NHEFS) times? Age when first had it Been bothered by this pain or discomfort in the Survey design past 12 months? Conducted in three waves with respondents or their Year when last experienced the pain oi discomfort proxies (for deceased or incapacitated respondents) ini­ Region of pain indicated on a diagram shown the tially interviewed and examined during 1971–75 in the first respondent National Health and Nutrition Examination Survey Ever had a severe pain across the front of your (NHANES I). The 1982-84 first wave of NHEFS data col­ chest lasting half an hour or more? lection included all persons who were 25–74 years of age at See a doctor because of this pain? their NHANES I examination (n = 14,407). Personal inter- What did the doctor say it was? Angin~ coro­ views were conducted in respondents’ residences, including nary; other heart disease; intestinal or intraab­ institutions. The second wave, the 1986 NHEFS, was con­ dominal problems; lungs, pleura, trachea; ducted for members of the NHEFS cohort who were 55-74 chest waI1; other years of age at their baseline examination and not known to Number of these attacks be deceased at the 1982X34 NHEFS (n = 3,980). Year of (first) attack Computer-assisted telephone interviews were conducted Length of episode of pain with survey subjects or their proxies. In the 1987 NHEFS, Year of last attack the third wave of the ~EFS, information was collected Length of episode of pain from 11,750 subjects who were 25–74 years of age at baseline Since 1970, been hospitalized overnight for and not known to be deceased in the previous NHEFS this/these attacks? surveys. Get pain in either leg when walking? (1982-84) Pain ever begin when standing still or sitting? Basic data elements Part of leg affected Get this pain when walking uphill or hurrying? Data include demographic information; a family his- Get this pain when walking at an ordinary pace on tory a female medical history a health condition checklis~ level ground? sections on nutrition, arthritis, functional limitation (activ­ Does this pain ever disappear while still walking? ities of daily living), tobacco and alcohol use, mental status What do you do if get this pain while walking Stop measures, medication use, physical activity, sleep habits and or slacken your pace or continue at the same pace? problems, vision and hearing impairments, and dental prob- If you do stop, is the pain relieved? Iems.Blood pressure, pulse rate, and weight were measured How soon after stopping is the pain relieved? in the initial followup. Admission and discharge diagnoses Age when first had it coded according to the 9th Revision, International Classi­ Been bothered by this condition in the past 12 fication of Diseases were obtained for each health care months? facility stay. Death certificates were obtained for In what year did you last experience this problem? NHANES I participants who had died, and proxies pro­ Did a doctor ever tell you that a cyst or lump in your vided information on the decedents’ last days. breast was cancerous or malignant? (1982-84) Ever had one or both of your breasts removed? Pain data elements (1982-84) Subject Questionnaire’ Year told had breast cancer (1987) Ever had pain or discomfort in chest? (1982-84) Ever had a skin tumor, growth on your skin, skin ulcer, or other skirt lesions for which you received medical treatment by a doctor? Which? (1982-84) d Pain data were collected in all years of survey unless indicated by dates Listed skin conditions include shingIes and, lupus in parentheses. erythematosus

23 Number of times this condition recurred that Ever been told by a doctor that you had a slipped or required treatment by a doctor, including surgical ruptured disc in your neck? (1982–84) removal Were you in traction to treat this sIipped or rup­ Parts of the body on which this condition located: tured disc? Head or face, arms, hands, legs, feet, other (spec­ Ever stayed in a hospital overnight for neck pain? ified) (1982-84) Since 1970, ever stayed in a hospital overnight for Have any surgery for neck pain? (1982-84) treatment of this condition? Number of times Did a doctor ever tell you that you had any cancer? Had pain in back on most days for at least 1 month? (1982-84) (1982-84) Since (month and year) had any type of cancer diag­ The longest episode of back pain ever had nosed? (1986, 1987) Age when first experienced this recurring back pain Location Still having this pain? Type The last time you had this pain When first told Does this pain occur more frequently than it used Since 1970, been hospitalized overnight for this to? condition? Where is/was the pain located: Upper back, mid- When a child or teenager, were you ever sunburned so back, lower back? badly that your skin blistered? (1982-84) When have/had this pain, where is/was it most In the past 10 years, ever been confined to bed for most intense: Upper back, mid-back, lower back? of the day for at least a 2-week period? (1982-84) Was/is the pain present when resting at night? Ever had a bedsore, an open sore caused by being Does/did it awaken you from sleep at night? confined to bed for a long time or unable to move about Does/did the pain seem to spread? as usual? (1982-84) Does/did the pain spread to: Back of right leg? Had pain on most days for at least 1 month: In neck; in Back of left leg? Top of the head? Sides of body? back; in or around either hip joint, including the but­ Is/was your back pain made worse: tock, groin, and side of upper thigh; in or around the By coughing, sneezing, or deep breathing? knee, including back of knee? Which knee? With bending or twisting motion? Had pain or aching in any joint other than the hip, back, After prolonged sitting? or knee on most days for at least 6 weeks? (1982–84) After prolonged standing? Had any swollen joints that were painful when touched With other motion? on most days for at least 1 month? (1982–84) Ever had back pain caused by an injury? (1982-84) The longest episode of neck pain ever had: 1 month, 2-5 Was the back pain caused by playing a sport, doing months, 6-12 months, more than 1 year (1982–84) your job at work, or some other activity? Age when first experienced this recurring neck Ever been told by a doctor that you had a slipped or pain ruptured disc in your back? (1982–84) Still having this neck pain? Were you in traction to treat this slipped or rup­ When was the last time you had this pain? tured disc? Does this neck pain occur more frequently than it Ever stayed in a hospital overnight for back pain? used to? (1982-84) Pain present when you areiwere resting at night? Was this hospitalization since 1970? Pain awaken(s) you from sleep at night? Have any surgery? Pain seem(s) to spread? How many times? Pain spread(s) to: Had pain in or around either hip joint, including the The top and back of the head? buttock, groin, and side of the upper thigh, on most days Either shoulder? for at least 1 month? The arms or hands? Longest episode of hip pain ever had Is/was your neck pain made worse: Age when first experienced this recurring pain in By coughing, sneezing, or deep breathing? the hip With bending or twisting motion? Still having this hip pain? After prolonged sitting? When was the last time had the hip pain? After prolonged standing? Areas of the body the hip pain is/was usually most With other motion? intense: Right buttock, leftbuttock, right groin, left Ever had neck pain caused by an injury? (1982-84) groin, side of right upper thigh, side of left upper Was the neck pain caused by playing a sport, doing thigh, somewhere else? your job at work, or some other activity? From the hip does/did the pain tend to spread? Ever been told by a doctor that you had a “whiplash” injury of the neck? (1982–84)

24 ,. Does/did the pain .tend to spread to: Inside of Finger(s)? Right or left hand? ,, ,. leg, front of leg, outside. of leg, back of leg, Wrist? Right or left? sorne.where else?, Elbow? Right or left? Do/did you have pain in or around the hip when Shoulder? Right.,or left? either, coughing or sneezing? Hip? Right or left? ,:. . l$%en this pain islwas present, doesldid it hurt free? Right or left? .’. .,, when resting as well as when moving? Ankle? Right or left? ,, . Since 1970, stayed overnight in a hospital for prob­ Toes? Right or left foot? : lems related to,.your hip pain? Did you have any joints replaced? Which jgints? Had pain in or around the knee, including the back of How many replacements? the knee, on most days for at least 1 month? If finger(s), on right or left hand? Which knee? If hip, on right or left side? Longest episode, of .kqee pain ever had If knee, right or left? Age when first experienced recurring pain in the Any other joints? knee Ever stayed overnight in a hospital. because of joint Still having this knee pain? problems? (1982-84) Last time had this knee pain Arthritis ever diagnosed by a doctor?’ (1986, 1987) When this pain is/was present, does/did it hurt Type when resting as well as when moving? Ever had an x~for guthritis? : When. this @ee pain islwas present, islwas there Time since first x~{y ,, also swelling of the knee joint? Time since last x ,“ P Is/was the joint warm to the touch? Gout ever diagnosed by a doctor?. (1986, 1987) Does/did’ the joint appear red? Year first toId ,.. Ever had “locking” of the knee? (1982-84) Year had last episode of gout Which knee? Ever had an attack of arthritis that the doctor said was Has either knee ever “given way” under you? (1982-84) caused by gout? (1986, 1987) - Which knee? ~ - Since (1980 or 1970), hospitalized for arthritis/gout? Ever had a severe twisting of either knee resulting in a (1986, 1987) sprain or swelling lasting more than 2 weeks? (1982-84) Since 1970, stayed overnight in a hospital because of Which knee? joint problems? (1982-84). Had pain or aching in any joint other than the hip, back, Pain visual analog scale measure for joint condition neck, or knee on most days for at least 6 weeks? pain in the past week (1982-84) (1982-84) Ever been told by a doctor you had a fractured hip? Which joints were painful? ‘ A dislocated hip? (1982-84) . Finger(s)? Right or left hand? Which hip? Wrists? Right or left? Age when it happened Elbows? RigM or left? What year? (1986, 1987) Shoulders? Right or left? Another fractured hip since then? (1986, 1987) Ankles? Right or left? Have surgery? Toes? Right or left foot? Since 1970, hospitalized for this problem? Ever had any swollen joints that were painful when . Had any broken or fractured bones (other than hip) touched on most days for at Ieast 1 month? (1982-84) since 1970? (1986) Age when first experienced swelling of your joints Which bone? , Still having this swelling of your joints? What year? ,. ThS last time you had this swelling Hospitalized? Which joints are/were usually involved whenever Since (month and year) had a br~ken or fractured you have/had this swelling with tenderness on wrist? (1987) touching? Wliat yea?? Finger(s)? Right or left hand? Use of antacid:, aspirin, tranquilizers, antidepressants, Wrists? Right or left? vitamins, nutritional supplements (1982v84) Elbows? Right or left? Have any problems that prevent the use of one or more Shoulders? ‘Right or left? arms or legs? (1986, 1987) Hips? Right or left? Because of severe arthritis? .. Knees? Right or left? Which limbs are involved? Ankles? Right or left? ~ Use of special equipment (1986, 1987), , ‘“ Toes? ,Right: or left foot? For the following conditions, Did you ever have a surgical procedure on any of your Ever diagnosed by a physician? , ; ~ joints? (1982-84) Year first diagnosed , .:. ,. Which joints were operated on? Hospitalized since 1970 for this condition? 25

,, Migraines (1982-84) 1986 NHEFS Mortality, NTIS accession no PB 90-501651 Ulcers: Peptic, stomach, or duodenal 1986 NHEFS Health Care Facilities, NTIS accession no (1982-84) PB 90-501669 Kidney disorder or kidney stones 1986 NHEFS Interview, NTIS accession no PB 90-501667 Urinary tract or kidney infection more than 1986 NHEFS Vital and Tracing S~atus, NTIS accession no three times PB 90-501664 Colitis, enteritis (1982-84) Angina (1982-84): Technical contact: Frequency of (1982-84): Fanchon F. Finucane Trouble falling asleep Division of Analysis Trouble with waking up during the night 6525 Belcrest Road, Room 108(I Trouble with waking up too early and not being Hyattsville, MD 20782 able to fall asleep again (301) 436-5975 Getting so sleepy during the day or evening that you Questionnaire source items have to take a nap Taking a sedative or sleeping pill prescribed by a Cohen BB, Barbano HE, Cox CS, et al. Plan and operation doctor for sleep of the NHANES I Epidemiologic Followup Study, 1982–84. Compared with 1 year ago, have sleep problems much National Center for Health Statistics. Vital Health Stat more now, somewhat more now, somewhat less now, 1(22), 1987. much less now, or is sleeping pattern about the same? Fried VM, Finucane FF, Madans JH, et al. Plan and oper­ (1982-84) ation of the NHANES I Epidemiologic Followup Study, Usual number of hours of sleep (1982-84) 1986. National Center for Health Statistics. Vital Health Medicare coverage (1987) Stat 1(25). 1990. If subject dead (1982-84): Continued followup questionnaires can be obtained by Was pain medication received during the 24 hours pre- writing to technical contact person, ceding death? Whether medication was received or not, were there complaints of pain or evidence of pain during the 24 hours preceding death? National Health interview Survey Was the pain mild, moderate, or severe? (MIS) Any chest pain within 72 hours preceding death? Duration of pain Survey design Any medication to ease chest pain? General household health survey of the U.S. civilian Abbreviated General Well-Being Schedule (1982-84) noninstitutionalized population using a multistage proba­ During past month, bothered by any illness, bodily dis­ bility design that permits continuous sampling throughout order, pains, or fears about your health? the year. The sample is designed in such a way that the sample of households interviewed each week is represen­ Center for Epidemiologic Studies Depression Scale tative of the target population and that weekly samples are (1982+?4) additive over time. Independent samples are selected each Feelings during the past week year. Interviews have been conducted annually since 1957 with approximately 111,000 persons living in about 42,000 Data tape availability households. The sample has ranged in magnitude from a high of about 134,000 persons in some 44,000 households in 1982-84 NHEFS Mortality, NTIS accession no PB 88- 1972 to a low of about 62,000 people in approximately 102306 35,000 households in 1986. The 1986 sample represented 1982–84 NHEFS Health Care Facilities, NTIS accession no only one-half of the new sample, which was redesigned in PB 88-102280 1985. About 123,000 persons in 1987 and about 122,000 1982-84 NHEFS Interview, NTIS accession no PB 88- persons in 1988 and 1989 were interviewed in approximately 121298 47,000 households each year. 1982–84 NHEFS Vital and Tracing Status, NTIS accession no PB 88-102264 Basic data elements Technical contact: Data include information on household and sociode­ Christine S. Cox mographic characteristics; acute illnesses and injuries; dis­ Division of Analysis ability days (for example, bed days, work-loss days, and 6525 Belcrest Road, Room 1080 school-loss days) associated with acute and chronic condi­ Hyattsville, MD 20782 tions; prevalence of selected chronic conditions and (301) 436-5978 impairments; limitation of activity because of one or more

26 chronic conditions or impairments; and use of physicians, Received disability payments or benefits from dentists, and short-stay hospitals. Supplements to the core (1977): questionnaire change from year to year in response to cur- Social Security Administration? rent interest in special health topics. Health insurance Veterans Administration? information is collected periodically. Data are located on Public assistance? multiple tapes. Chronic condition checklists: Musculoskeletal system and skin condition list (1969, 1976, 1978-90), which includes: Pain data elements Arthritis or rheumatism Gout Core questionnaire items Lumbago Restricted activity in past 2 weeks because of (painful) Sciatica (198+90) condition? Coded according to the International Clas­ Bone cyst or bone spur (1989-90) sification of Diseases (ICD) Osteomyelitis (through 1988) Number of bed days Slipped or ruptured disc Number of work-loss days Repeated trouble with neck, back, or spine Number of school-loss days Bursitis or synovitis Number of reduced-activity days Trouble with fallen arches, flatfeet, or Limitation of activity because of ICD-coded (painful) clubfoot (through 1988) condition: Trouble with ingrown toenails or Unable to perform usual activity for one’s age and fingernails sex group? Trouble with bunions, corns, or calluses Limited in kind or amount of usual activity? Impairment condition list (1971, 1977-90), Limited, but not in usual activity? which includes: Physician visit(s) in past 2 weeks because of ICD-coded Repeated trouble with back or spine (painfuI) condition? Any trouble with fallen arches or flatfeet Type of doctor seen (most years) Any condition caused.by an old accident or Short-stay hospitalizations because of ICD-coded injury— specified (painful) condition (condition data available for Digestive condition list (1975, 1978-90), which 1969-81): includes: Number of discharges or episodes Gallstones Number of days Gallbladder trouble Average length of stay Ulcer Operations performed Hernia or rupture When and how bothered by condition (Most years Gastritis 1969-81) Enteritis Surgery for condition? (Most years 1969-81) Diverticulitis Hospitalization for condition? (Most years 1969-81) Colitis Injuries: Class of accident Cancer of the stomach, colon, or rectum Glandular, blood, nervous, and genitourinary Pain-related items - condition list (1973, 1978–90), which includes: Various pain-related items have been placed among Migraine core questionnaire items in different years. Some are Neuralgia or neuritis listed as follows: Sciatica (1973, 1978-83) Nephritis Limitation of mobility caused by (painful) chronic Kidney stones condition coded according to Eighth Revtiion Irzter­ Cardiovascular condition list (1972, 1978-90), national Classification of ,Dkeases, Adapted for Use which incIudes: in the United States (ICDA) (1969, 1971, 1972) Angina pectoris Duration Myocardial infarction Cause of pain on movement or joint tenderness Hemorrhoids (1969): Phlebitis or thrombophlebitis Any accident or injury Miscellaneous condition list (1973), which Exertion from sports and so forth includes: Bursitis and/or tendinitis Migraine Heart condition, hypertension, and so forth Neuralgia or neuritis Back, neck, or spine trouble Sciatica Arthritis, rheumatism, and so forth Nephritis Old age Kidney stones 27

,, All conditions and impairments are ICD-codeci and Cancer Control Supplement (ages 18 years and over) (1987) can be identified by individual code. Listings that group, Was last Pap smear, breast physical examination, mam­ or recode, common conditions and diseases have also been mogram, digital rectal examination, blood stool test, developed. Prior to 1982, there were five condition proctoscopic example because of a health problem? recodes. Recode 1 lists 278 categories of diseases, injuries, What was the problem? Pain? and impairments; recode 2 [ists 33 of the most common acute conditions from recode 1; recode 3 lists 53 chronic Supplement Booklet Section N2: Back Pain (ages 18 years conditions and impairments from recode 1; recode 4 is a and over) (1988) 38-code condition list used in tabulating the diagnosis Back pain other than menstrual pain every day for a reported for each hospitalization; and recode 5 is a week during the past 12 months? 58-code listing of diseases, injuries, and impairments. Number of ciays of back pain Since 1982, conditions and impairments have been Number of full days missed from work because of back recoded into three diagnostic recodes, Recode A consists pain of 32 four-digit categories of frequently reported acute Part of back bothered the most: Upper, middle, lower conditions, including fractures; sprains and strains; acute Back pain ever spread to: Buttocks? Thighs? Lower leg back, spine, and neck pain; and headache, excluding or foot? migraine. Recode B is a modified listing of diseases and Is the back pain the result of: injuries developed by the World Health Assembly and is A single accident or injury, such as slipping, falling, primarily used in NHIS to classify conditions reported as twisting, lifting something, or being in a car acci­ causing activity limitation. Recode C consists of 134 three- dent? digit categories of chronic conditions and impairments, Repeated activities, such as lifting, pushing, The categories correspond to the conditions that appear pulling, bending, twisting, or reaching? on the checklists of selected chronic conditions. These Where back pain started: At work, at home, recre­ categories are used in NHIS to produce prevalence esti­ ational site, other mates of selected chronic conditons. Occupation, industry, and type of work done Supplements to the core questionnaire are presented Cause of back pain here by type of data collected and are listed below according Has your back bothered you today? to the major epidemiologic uses, as outlined in appendix V. When last had back pain Number of consecutive days of back pain Year first had an episode of back pain that lasted for Type of data Major uses a week or more Number of years have had episodes of back pain lasting Morbidity– acute and Magnitude, scope, and for a week or more chronic structure Longest period of time had back pain every day Disability Magnitude, scope, and Ever stopped working at a job or changed jobs because structure of back pain? Ever made a major change in work activities because of General health status Magnitude, scope, back pain? and psychological structure, risk factors, well-being and impact Supplement Booklet Section N3: Hand Discomfort (ages 18 Health practices Risk factors years and over) (1988) During the past 12 months, had discomfort in hands, Use of health services Impact and wrists, or fingers? (Discomfort can mean pain, burning, and availability of management stiffness, numbness, or tingling.) resources Number of days in past 12 months with discomfort Social and economic Impact and in hands, wrists, or fingers management Have discomfort every day for a week or more Morbidi& (acute and chronic) during past 12 months? Which hand had discomfort: Right, left, or both? Accident Supplement (all ages) (1975) Discomfort worse when trying to sleep or did it awaken ICDA-coded condition resulting from an accident you from sleep? When accident happened: Past week, week before that, Hand(s) bothered you today’? 2weeks-1 month, 1–2 months, 2–3 months, 3–4 months, Time since last had discomfort 4-6 months, 6 or more months Number of consecutive days, weeks, or months of dis­ Number of times saw doctor comfort Restricted-activity days Year first noticed this hand discomfort Bed-disability days Total number of different years of hand discomfort Work- or school-loss days During past 12 months, were you away from work for Where accident happened more than 1 week for any reason? How accident happened 28 When away from work for more than 1 week, did Current Health Topics Section Q2 Diabetes Followup hand discomfort increase, decrease, or stay the Questions (ages 18 years and over) (1989) same? Has a doctor ever told you that you had angina? During past 12 months, miss at least a full day from Ever had symptoms of a bladder infection that lasted work because of hand discomfort? more than 3 months, such as frequent urination and Ever stopped working at a job or changed jobs because pain in your bladder? of hand discomfort? Were you told that you had painful bladder syn­ Ever made a major change in your work activities drome or interstitial cystitis? because of hand discomfort? Age when told Time since last saw or talked to a medical doctor, chi­ ropractor, physical therapist, or other medical person Current Health Topics Section R: Orofacial Pain (ages 18 about your hand discomfort years and over) (1989) Diagnosis See appendix II for a facsimile of the questionnaire. Ever had any of the following conditions? Current Health Topics Section S1: Specific Digestive Arthritis of the hand, wrist, or fingers? Conditions (ages 18 years and over) (1989) A broken bone in your hand, wrist, or fingers? During the past 12 months, have gallstones? Any other A condition affecting the ,wrist and hand called gallbladder trouble? carpal tunnel syndrome? Ever have gallstones? Any other gallbladder trouble? When first diagnosed Supplement Booklet Section N7: Conditions (ages 18 years During the. past 12 months, have an ulcer? and over) (1988) Ever had an ulcer? During past 12 months, had: When first diagnosed Repeated trouble with neck, back, or spine? Type: Gastric, duodenal, peptic, or other A condition affecting the wrist and hand called During the past 12 months, have spastic colon, func­ carpal tunnel syndrome? tional bowel, irritable colon, or irritable bowel syn­ A condition affecting the fingers and/or toes called drome? Raynaud’s phenomenon? Ever had spastic colon, functional bowel, irritable A condition affecting the tendons called tendinitis? colon, or irritable bowel syndrome? Ever told by a doctor or other medical person that Have hemorrhoids in the past 12 months? [above condition] was related to any job you ever Ever diagnosed by a doctor? had? When last talked to a doctor about hemorrhoids A worker’s compensation claim ever filed for your Ever had surgery for hemorrhoids? [above condition]? During past 12 months, told by your doctor or Current Health Topics Section S2 Abdominal Pain (ages 18 employer to stay home from work temporarily years and over) (1989) because of your [condition]? See appendix 111for a facsimile of the questionnaire. During past 12 months, did your employer transfer Current Health Topics Section S3: Normative Bowel you to another job, either temporarily or perma­ Functions (ages 18 years and over) (1989) nently, because of your [condition]? Frequency during past 12 months of bowel movements During past 12 months, did your employer give you accompanied by pain: lighter work or excuse you from certain duties at Always; most of the time; some of the time; rarely; work because of your [condition]? never Ever stop working at a job or change jobs because Have had a lot of trouble in the past year with: of your [condition]? Abdominal pain Occupation and industry related to your Chest or heart pain [condition]? Pain in the joints Pain in arms and legs, other than in the joints Supplement Booklet Section P5: Childhood Conditions Backaches (ages 17 years and under) (1988) Headaches Ever have: Pain when urinating Repeated tonsillitis or enlargement of the tonsils or adenoids? Current Health Topics Section T: Diabetes Risk Factors Frequent or repeated ear infections? (ages 18 years and over) (1989) Frequent or severe headaches, including migraines? Number of times in past 12 months had a bladder or Arthritis or any other joint disease or joint urinary tract infection problem? Ever had symptoms of a bladder infection that lasted Have [condition] in the past 12 months? more than 3 months, such as frequent urination and Have had [condition] for at least 3 months in Iifetime? pain in your bladder?

29 Told that you had painful bladder syndrome or Does (painful) disability or heaIth problem prevent interstitial cystitis? driving a car? Age when told Is car specially equipped for you? Hospital insurance coverage 1990 Supplement Booklet Section O: Podiatry Use of physical therapy, psychological counseling, job During the past 12 months, anyone in the family have counseling or guidance, job or vocational training in trouble with: past 12 months: Deformities of the toe or joint, including hammer Received service? toe, claw toe, and missing toes? Helped by service? Bunions? Now needs service? An injury, such as a sprain, strain, fracture, or Tried to get service? dislocation of the foot? Received services during past 12 months; if government Arthritis of the toes? agency involved, type Still have [problem] or has it gone away or been Tried to get information in past year about health cured? problem or disability? Duration of [problem] Source of information [Problem] serious enough to consider getting Specific source other than doctor professional care? Changes made to place of residence During the past 12 months, get medical care for Specific changes the foot problem(s)? If not, why not? Special Aids (all ages) (1977) Covered by health insurance that would pay for ICDA-coded condition(s) causing need treatment for the foot problem(s)? Chronic or acute If not, if insurance paid for the medical Onset of painful condition care, think you would have gone for the Type of aid: Artificial arm; artificial leg; brace, foot or foot problem(s)? leg; brace, other part of body; brace, not otherwise Types of health professionals seen in the past specified; crutches; cane or walking stick; special shoes; 12 months about the foot problem(s): Podia­ wheelchair; walker; guide dog trist, orthopedic specialist or surgeon, osteo­ Frequency of use path, physical therapist, any other medical Length of time used doctor, any other health professional Number of times seen each type HI Supplement (ages 20 years and over) (1977) Where seen Disability or h~alth problem prevents driving car Has or will health insurance pay for any Service-connected disability? part of the care for the foot problem(s)? Work-loss days in past 12 months If not, would you still have gone for Home Care Supplement (all ages) (1979-80) medical care for the foot problem(s)? Conditions are ICD-coded, as well as recoded to a Disability two-digit code reflecting acute or chronic status. Because of (painful) condition, needs help with: Disability Person Supplement (ages 3 years and over) Walking (1977) Going outside ICDA-coded conditions Using toilet Chronic or acute Bathing Onset of (painful) condition Dressing Because of (painful) condition, needs help with: Eating Getting around (or stays in bed) Getting in and out of bed Bathing Dressing Supplement Booklet Section M: MedicaI Devices (all ages) Eating (1988) Using toilet Artificial joints: How long help needed Have you had increased pain over time with the How often needs help [type of artificial joint] you have now? How often receives help Time had the [type of artificial joint] when the Person providing help: Relative, friend, nurse, other, increased pain was first noticed: Less than 30 days, unknown 30-90 days, more than 90 days Number of bed days in past 12 months Why needed a [type of artificial joint]: Osteoar­ Because of (painful) condition, needs help with using thritis; rheumatoid arthritis; arthritis, unspecified; public transportation injury; pain; some other reason

30 Fixation devices, intraocular lenses, pacemakers, other School limitation of activity for children ages 5-17 years devices: because of chronic condition? Ever had surgery to replace or repair fihe device]? Special classes or special help because of disability Reason for the surgery: Pain or irritation or health problem? Time had device before reason for surgery was first Behavioral problems? noticed: Impact of illness or”disability of child on family mem­ Less than 30 days, 30-90 days, more than 90 ber(s) \ days Usual number of hours of sleep each night . Other than discomfort generally associated with Usually takes naps? surgery and healing, have you had any other pain Aging Supplement (ages 55 years and over) (1984) with [the device] you have now? Chronic conditions coded according to 9th Revision of Time had [the device] when pain was first ICD noticed: Less than 30 days, 30-90 days, more Still have condition? Cured? Under control? than 90 days Length of time had condition before cured Genercdhealth status and psychologicalwell-being Condition present in past 12 months? Condition cause activity limitation? Child Health Supplement (ages 17 years and under) (1981) Social support Medications for mother during labor for sample child Retired because of health? under 6 years Retired because work caused health problem? Number of overnight hospitalizations for sample child Now receiving disability from any source? Operation(s) as inpatient and/or outpatient Time received disability Number Ever received disability payments from Social Type of operation Security? Child ever had chronic conditions: By yourself and not using aids, have any difficulty with Onset of condition the following? Degree of difficulty: Some, a lot, or Age at onset unable to do it? Number of years with specified diffi- Condition present during past 12 months C1.dty Status of condition Walking for a quarter of a miIe Length of time with condition Walking up 10 steps without resting Chronic or nonchronic? Standing or being on feet for about 2 hours Repeated ear infections? Sitting for about 2 hours Nephritis? Stooping, crouching, or kneeling Urinary tract infection? Reaching up over head Ulcer? Reaching out (as if to shake someone’s hand) Migraines? Using fingers to grasp or handle Frequent or severe headaches? Lifthg or carrying 25 pounds Colitis? Lifting or carrying 10 pounds Hernia or rupture? Think there are some kinds of work could do now if jobs Arthritis? were available? Rheumatism? Want to work at a job or business? Trouble with flatfeet? Ever had: Tendon, muscle, or cartilage disease? Osteoporosis? Sickle cell anemia? A broken hip? Cancer of any kind? Angina pectoris? Use of medications during 2-week reference period: A myocardiaI infarction? Pain relievers such as aspirin or Tylenol? Any other heart attack? Main health problem for which child took the Cancer of any kind? medication During the past 12 months, arthritis of any kind or Prescribed by physician? rheumatism? Recommended by physician? ICD-coded (painful) conditions causing difficulty Frequency taken in past 3 months with activities of daily living Tranquilizers or sedatives? Onset of condition Main health problem for which child took the Degree of difficulty (some, a lot, unable to do medication it) in: Prescribed by physician? Bathing or showering? Recommended by physician? Use of special equipment: Shower or Frequency taken in past 3 months bathtub seats, handrails

31 Dressing? Health practices Use of special equipment: Special Physical Fitness (all ages) (1975) clothes, fasteners, zipper pulls Types of regular exercise Eating? Sports participant, team member, or tournament player Use of special equipment: Special by type of sport in past 12 months utensils, trays Think you are more, less, or about as active as other Getting in and out of bed or chairs? persons same age? Use of special equipment: Cane, walker, special lifts Health Habits Supplement (ages 20 years and over) (1976) Walking? Used medicin&, drugs, or-pills for insomnia during the Use of special equipment: Cane, past 6 months? walker, crutch, wheelchair, artifi­ Used one or more times per week? cial leg, brace(s) Advised by doctor to take this medication? Getting outside? Used aspirin or aspirin-type pills in past 6 months? Use of special equipment: Cane, Used one or more times per week? walker, crutch, wheelchair, artifi­ Use of coffee, tea, tobacco cial leg, brace(s) Health status Using the toilet, including getting to the toilet? HI Supplement (ages 20 years and over) (1977) Use of special equipment: Cane, Number of hours usually slept walker, crutch, wheelchair, artifi­ Alcohol and tobacco use cial leg, brace(s), bedpan, raised toilet Physical activity relative to others same age seat, special toilet, handrails near Problems getting medical care toilet Height and weight (also body mass index) Receive help from another person? Who? Is this help paid for? Alcohol and Health Practices Supplement (ages 18 years ICD-coded (painful) conditions causing difficulty and over) (1983) with activities of daily living Ever had any of the following conditions: Onset of condition Arthritis or rheumatism? I Degree of difficulty (some, a lot, unable to do Insomnia or sleeplessness? I it) in: An ulcer, other than a skin ulcer? Preparing your own meals Heart attack or heart failure? Shopping for personal items Angina pectoris? Managing your money Cancer? Using the telephone Health Promotion and Disease Prevention (all ages) (1985) Doing heavy housework General health habits Doing light housework Number of hours of sleep Receive help from another person? Who? Is Have a usual place of care? this help paid for? Kind of place Use of special equipment or aids in activities of One particular doctor at usual place? daily living? Main reason no particular place What type? Injury control awareness ICD-coded (painful) condition causing confine­ Stress in past 2 weeks ment to bed or chair all or most of the time Effect of stress on health in past year Onset of condition Any physical exercise in past 2 weeks? Ever been a resident or patient in a nursing home? Type: Walking; jogging or running; hiking; gar­ Number of times dening or yardwork; aerobics or aerobic dancing; , Date admitted the first time other dancing; calisthenics or general exercise; Date discharged the last time golfi tennis; bowling; biking; swimming or water ‘ Number of months in nursing home the last exercises; yoga; weight lifting or training; basket- time ball; baseball or softball; football; soccer; volley- Number of weeks in past 12 months spent in ball; handball, racquetball, or squash; skating; nursing home skiing; other Worry over health: A great deal, some, hardly any, none Number of times in past 2 weeks Physical activity level Minutes spent each time Amount of control think have over future health: A Increase in heart rate or breathing great deal, some, very little, none at all

32 Degree of physical activi~ Number of days of wage-loss coverage (sick leave) A-nount of physical work required on job Health Maintenance Organization (HMO) (all ages) (1975) Hours per day physical work done on job Belong to HMO, covered by Blue Cross or Blue Shield, Amount of physical work required in main daily activity prepaid group, other health insurance? Hours per day physical work on daily activity See other doctors? On present job exposed to: Dangerous substances? Reason Dangerous work conditions? Risk of accident? Have one doctor or place of medical care? Type Type of placti Private doctor’s office, home, doc- Health effect: Cancer, headache, frostbite, bums tors’ clinic, group practice, hospital outpatient clinic, hospital emergency room, company or Useof health servicesand availabilityof resources industry clinic, other Prescribed Medicines Supplement (all ages) (1973) Health Insurance (all ages) (1976) Use of prescription medication in 2-week reference period Medicare coverage? Name of medication Medicaid used in past 12 months? Condition for which medication was taken (painful Private health insurance coverage? conditions or general pain symptom) Hospital How obtained: Surgical Written prescription Type of private health insurance plan Refill How obtained: Through employer or union, Call to pharmacist through other group Given by physician Hospital coverage? Source of payment Surgical coverage? Total cost Use in past 12 months Medical Care (all ages) (1974) Reason for no Medicare and/or private health insur­ U’ually, go to one particular doctor ante coverage Place of usual care: Private doctor’s office, home, doc- H1 Supplement (ages 20 years and over) (1977) tors’ clinic, group practice, hospital outpatient clinic, Problems getting medical care? hospital emergency room, company or industry clinic, Reasons: Not available when needed, cost of care, other didn’t know where to go, no transportation, incon­ Number of visits in past 12 months venient hours Kind of doctor usually seen In past 12 months, received Places doctor seen in past 12 months Veterans Administration medical care Reason for no particular doctor Medicare Sources of payment of doctor’s bills: Self or family Worker’s compensation social security Medicare; health insurance; worker’s Disability benefits or payments from: compensation, accident insurance; Civilian Health and Social Security Administration Medical Program of the Uniformed Services (CHAM- Veterans Administration PUS); veterans benefits; Medicaid; welfare; profes­ Public assistance sional courtesy; employer, company doctor, or union; other insurance; no charge; other Health Insurance (all ages) (1978) Problems getting care in past 12 months? Medicare coverage? Received as much care as needed? If not, why? Hospital? In past 12 months, received services from: Doctor? Chiropractor Private health insurance coverage? Podiatrist or chiropodist Hospital? Physical therapist Surgical? Reason for no Medicare and/or private health insur­ Currently Employed Person (ages 17 and over) (1974) ance coverage Number of days lost time from work during past 2 weeks Type of private health insurance plan because of own illness or injury, medical care visit, How obtained: Through employer or union, someone else’s health problem or medical care visit through other group? Number of hours lost from work paid for: Hospital coverage? By employer: FuII, part, none Surgical coverage? . By loss-of-pay insurance, worker’s compensation, Use in past 12 months State disability insurance, other Aid to Families with Dependent Children and/or Sup­ Earnings per hour plemental Securi~ Income coverage? Income per hour lost

33 Military pensioner or dependent? Covered by a plan that pays for a specific type of Coverage by Veterans Administration health benefits? service? Coverage by military benefits? Type Reason for no Medicare and/or private health insur­ Supplemental Person (all ages) (1978) ance coverage One source of care? Aid to Families With Dependent Children or Aid to Type Dependent Children? Location (State, county) Supplemental Security Income? Travel time Received Medicaid in past 12 months? One particular doctor? Other public assistance health insurance coverage? Place doctor last seen Military health insurance coverage? Reason for no one source of care Type Health Insurance (all ages) (1980) Have an Armed Forces service-related disability? Medicare coverage? Veterans Administration compensation? Hospital? Job layoff or loss in past 12 months? (1983, 1984, and Doctor? 1989) Private health insurance coverage? Number of times Hospital? Month laid off Surgical? Lost health insurance coverage? Reason for no Medicare and/or private health insur­ No health insurance because of job layoff or loss? ance coverage Length of time without health insurance Type of private health insurance plan Covered by other health care program? How obtained: Through employer or union, Length of time covered through other group? Months with no insurance and no health care pro- Hospital coverage? gram Surgical coverage? Receipt of unemployment insurance benefits? Use in past 12 months (1984, 1989) Doctor Service Supplement (all ages) (1983) Social and economic impacl Doctor visit in past 2 weeks for ICD-coded (painful) Family Medical Expenses (all ages) (1975-76) condition? Family type (by size, composition, and age of head) Place of visit Personal and family expenses for: Dental bills, doctor Medical doctor actually talked to? bills, hospital bills, prescription medicine, other bills, Kind of medical doctor health insurance premium Type of medical assistant seen or talked to Other expenses: Chiropractor, podiatrist, hearing Condition acute or chronic? aid, special braces, physical or speech therapy, spe­ Operations performed during this visit? cial nursing care, nursing home or convalescent Type of operation home care, multiple, and other Travel time Reason for visit to this specific place Data tape availability Health Insurance (all ages) (1982-84 and 1989) National Health Interview Survey, Core Data Medicare coverage? Hospital? Data year NTIS accession no Doctor or surgeon? 1969 PB 235543 Current coverage if under 65 years 1970 PB 237322 Type of health insurance plan(s) 1971 PB 238524 Is plan an HMO? (1989) 1972 PB 285460 Obtained through employer or union? 1973 PB 285511 Now carried through employer or union? 1974 PB 285517 Plan pays for some or all: Hospital bills; doctor or 1975 PB 281126 ‘ surgeon bills for operations? 1976 PB 300423 Plan pays for some or all: Dental services; pre­ 1977 PB 80-203953 scription drugs; mental health, alcoholism, or drug 1978 PB 81-179285 abuse services? (1989) 1979 PB 82-157173 Covered under private health insurance? 1980 PB 83-248922 Type 1981 PB 84-111657 Hospital coverage? 1982 PB 85-236172/HAl Doctor or surgeon coverage? 1983 PB 86-138856

34 1984 PB 87-121547 National Center for Health Statistics, Health Interview 1985 PB 87-148144 Survey procedure, 1957–1974. National Center for Health 1986 PB 88-146139 Statistics. Vital Health Stat 1(11). 1975. 1987 PB 89-140651 NationaI Center for Health Statistics. The National Health 1988 PB 90-501180 Interview Survey design, 1973–1984, and procedures, 1975–1983. National Center for Health Statistics. Vital National Health Interview Survey Supplements Health Stat 1(18). 1985. Data year Supplement Blanken GE. Current estimates from the Health Interview 1973 Prescribed Medicines Survey, United States, 1969. National Center for Health 1974 Currently Employed Statistics. Vital Health Stat 10(63). 1973. Medical Care 1975 Accident Supplement Wilder MH. Current estimates from the Health Interview HMO –All Persons Survey, United States, 1970. National Center for Health Physical Fitness Statistics. VitaI Health Stat 10(72). 1973. Family Medical Expenses Wilson RW. Current estimates from the Health Interview 1976 Health Habits Survey, United States, 1971. National Center for Health Health Insurance Statistics. Vital Health Stat 10(79). 1973. Family Medical Expenses 1977 Disabili~ Wilson RW. Current estimates from the Health Interview Special Aids Survey, United States, 1972. National Center for Health H1 Supplement Statistics. Vital HeaIth Stat 10(85). 1973. 1978 Insurance Wilder MH. Current estimates from the Health Interview Supplemental Person Survey, United States, 1973. National Center for Health 1979 Home Care –Person Statistics. Vital Health Stat 10(95). 1974. Supplement 1980 Home Care –Person Ries PW. Current estimates from the Health Interview Supplement Survey, United States, 1974. National Center for Health 1981 Child Health Statistics. Vital Health Stat 10(100). 1977. 1982 Health Insurance Drury TF. Current estimates from the Health Interview 1983 Doctor Service Alcohol and Health Survey, United States, 1975. National Center for Health Statistics. Vital Health Stat 10(115). 1977. Practices Health Insurance Black ER. Current estimates from the Health Interview 1984 Aging Survey, United States, 1976. National Center for Health Health Insurance Statistics. Vital Health Stat 10(119). 1977. 1985 Health Promotion and Dis­ Howie LJ, Drury TF. Current estimates from the Health ease Prevention Interview Survey, United States, 1977. National Center for 1987 Cancer Control Health Statistics. Vital Health Stat 10(126). 1978. 1988 Supplement Booldet 1989 Current Health Topics Givens JD.: Current estimates from the Health Inteiview 1990 Supplement Booklet Survey, United States, 1978. National Center for Health Statistics. Vital Health Stat 10(130). 1979. Supplement tapes are available from the Division of Health Jack SS, Ries PW. Current estimates from the National Interview Statistics. Health Interview Survey, United States, 1979. National Center for Health Statistics. Vital Health Stat 10(136). Technical contact: 1981. Nelma Keen Jack SS. Current estimates from the National Health Inter- Division of Health Interview Statistics view Survey, United States, 1980. National Center for 6525 Belcrest Road, Room 850 Health Statistics. Vital Health Stat 10(139). 1981. Hyattsville, MD 20782 (301) 436-7087 Bloom B. Current estimates from the Health Interview Survey, United States, 1981. National Center for Health Statistics. Vital Health Stat 10(141). 1982. Questionnaire source items National Center for Health Statistics. Current estimates Gleeson GA, Interviewing methods in the Health Interview from the National Health Interview Survey; United States, Survey. National Center for Health Statistics. Vital Health 1982. National Center for Health Statistics. Vital Health Stat 2(48). 1972. Stat 10(150). 1985.

35 National Center for Health Statistics. Current estimates Restricted activity since (reference date)h because of from the National Health Interview Survey, United States, (painful) condition: 1983. National Center for Health Statistics. Vital Health Number of bed days Stat 10(154). 1986. Number of work-loss days Number of days cut down on activities Ries PW. Current estimates from the National Health Limitation of activity because of (painful) condition: Interview Survey, United States, 1984. National Center for Unable to perform usual activity for one’s age and Health Statistics. Vital Health Stat 10(156). 1986. sex group? Moss AJ, Parsons VL. Current estimates from the National Limited in kind or amount of usual activity? Health Interview Survey, United States, 1985. National Limited, but not in usual activity? Center for Health Statistics. Vital Health Stat 10(160). Functional limitations? 1986. Visit to a medical person since (reference date)b? Type of provider seen Dawson DA, Adams PF. Current estimates from the Number of times seen (since reference date)b National Health Interview Survey, United States, 1986. Visit to emergency room because of (painful) condi­ National Center for Health Statistics. Vital Health Stat 10 tion? (164), 1987. Visit to a hospital c[inic or outpatient department since Schoenborn CA, Marano M. Current estimates from the (reference date)?b National Health Interview Survey, United States, 1987. Type of provider seen National Center for Health Statistics, Vital Health Stat 10 Hospitalized because of (painful) condition? (166). 1988. Number of nights Operations performed? Adams PF, Hardy AM. Current estimates from the Medicines prescribed for relief of pain? National Health Interview Survey, 1988. National Center Date last obtained for Health Statistics. Vital Health Stat 10(173). 1989. Number of times obtained since (reference date)’ Adams PF, Benson V. Current estimates from the National Total cost Health Interview Survey, 1989. National Center for Health Statistics, Vital Hea[th Stat 10(176). 1990. Data tape availability National Medical Care Utilization and Expenditure Survey, 1980, NTIS accession no PB 83-229542 National Medical Care Utilization and Expenditure Survey (NMCUES) Technical contact: Robert Wright Division of Health Interview Statistics Survey design 6525 Belcrest Road, Room 850 Health care expenditures and utilization survey of a Hyattsville, MD 20782 panel of 17,500 civilian noninstitutionalized individuals (301) 436-7100 throughout the United States and 13,400 individuals from Medicaid enrollment lists in California, Michigan, New Questionnaire source items York, and Texas. A multistage area probability sampling Bonham GS. Procedures and questionnaires of the procedure was used, and five mutually exclusive samples National Medical Care Utilization and Expenditure Survey. were obtained. Data were collected in five rounds of house- National MedicaI Care Utilization and Expenditure Survey hold interviews, conducted at 3-month intervals in 1980 and A(l). National Center for Health Statistics, Washington: 1981. Public Health Service. 1983.

Basic data elements National Survey of Personal Health Data include access to medical care; episodes of illness Practices and Consequences and injury; number of bed days, restricted-activity days, (NSPHPC) hospital admissions, physician and dental visits, other med­ ical care encounters, and purchases of prescribed medicine. Survey design Detailed data, including cost data, were obtained for each Telephone-administered two-wave panel survey of contact with the medical care system. 3,025 adults ages 20-64 years living in households with

Pain data elements ‘The refcrcncc date for the first round of interviews was January 1, 1980. Conditions coded according to the 9th revision, Inter- The rcfcrcnce date for rounds 2-4 was 3 months prior to the interview. national Classification of Diseases The date for the last round was Dcccmbcr 31, 1980.

36 telephones in the 48 contiguous United States. The multi- Eisenstadt R~ Schoenbom CA. Basic data from Wave 11 stage probability sample was selected using a random- of the National Survey of Personal Health Practices and digit-dialing technique. The first wave of the survey was Consequences: United States, 1980. Working Paper Serieq conducted in 1979. In 1980, 2,436 of the Wave I respon­ no 13. Hyattsville, MD: National Center for Health Statis­ dents were successfully contacted and reintewiewed with tics. 1982. virtually the same questionnaire.

Basic data elements National Survey of Family Growth Data include information on personal health practices (NSFG) Cycles Ill and IV and (such as smoking, drinking, sleeping, eating, physical Followup activity, brushing, flossing teeth, and use of seatbelts), health status, functional limitations, use of health services, Survey design and history of family longevity. Survey of U.S. women ages 1544 years, conducted on a cyclical basis using a multistage area probability sample. Pain data elements” Cycle III inte~ews were conducted in 1982 with approx­ Frequency of taking medicines in past month (1980): imately 8,000 women. Cycle IV interviews were conducted Aspirin during January-August 1988 with about 8,500 women. A Medicine for indigestion computer-assisted telephone interview (CATI) followup Sleeping pills was conducted during July–November 1990 and Cycle V is Tranquilizers scheduled for 1992. Taken Valium in past year? (1980) Last time taken Valium Worry over health in past year? Basic data elements Perceived control over health Data include marital history, a detailed pregnancy his- Frequency of headaches tory, fecundity, expected or intended future births, preg­ Social suppoti nancy planning practices, utilization of specific Social group participation – contraceptive methods, source of financing of family plan­ Labor or professional organizations ning services, information on sex education and the sexually Church active population, socioeconomic and demographic infor­ Scouts and so forth mation including religion, and, in Cycle IV, child care Community service arrangements. Frequency of visits with any close friends and relatives Number of friends and relatives seen at least Pain data elements monthly This survey provides denominators for women ages Enough close friends and relatives? 15-44 years at risk of menstrual, pregnancy, and childbirth- Marital happiness related pain.

Data tape availability Ear infections during first year of life of child (Cycle III) Ever been treated for pelvic inflammatory disease? National Survey of Personal Health Practices and Conse­ (Cycles 111and IV, CATI followup) quences, Waves I and II, NTIS accession no PB 83-104323 Number of times (Cycle IV, CATI followup) TechnicaIcontact: . When first received treatment (Cycle IV) Patricia M. Golden When last received treatment (Cycle IV) Division of Epidemiology and Health Promotion Number of times hospitalized for a pelvic infection 6525 Belcrest Road, Room 1070 (Cycles III and IV, CATI followup–half sample) Hyattsville, MD 20782 During (last) pregnancy, ever take any of the following (301) 436-7032 drugs or medications (Cycle IV): Tranquilizers such as Valium, Llbrium, Equanil, Questionnaire source items and so forth? Sedatives such as phenobarbital, Seconal, chloral Danchik KM, Schoenborn CA, Elinson J. Highlights from hydrate, and so forth? Wave I of the National Survey of Personal Health Practices and Consequences, United States, 1979. National Center for Health Statistics. Vital Health Stat 15(1). 1981. Data tape availability National Survey of Family Growth, Cycle III,, 1982 Combined Respondent-Interval File, NTIS accession no: cItems appear in both Waves I and H unless otherwise indicated. PB 85-100022 37 Technical Contact: Questionnaire source items William Pratt Questionnaires availab[e upon request from technical con- Division of Vital Statistics tact person. 6525 Belcrest Road, Room 840 Hyattsville, MD 20782 (301) 436-8731

I

38 Health care surveys

National Ambulatory Medical Care PhysicianInformatwn Survey (NAMCS) Special~ Type of practice (for example, group or private) Type of doctor (doctor of medicine, doctor of Survey design osteopathy) Survey of approximately 3,000 non-Federal physicians in office-based practices in the 48 contiguous United Data tape availability States who provide information, using medical record National Ambulatory Medical Care Survey encounter forms, on a systematic sample of about 50,000 patient visits annually. The survey is conducted weekly Data year NTIS accessionno throughout the year using a multistage probability sample. 1973 PB 293900 1975 PB 290478 NAMCS was conducted annually from 1973 through 1981, 1976 PB 291152 again in 1985, and annually again starting in 1989. 1977 PB 80-130230 Basic data elements ~ 1978 PB 80-204092 1979 PB 82-122029 Reasons for visit and diagnoses coded according to the 1980 PB 82-191941 International Classification of Diseases (ICD), including 1981 PB 84-188960 injuries and poisonings, are listed up to a maximum of three 1985 PB 88-103676 each. Also included are data on whether a patient was ever 1989 PB 91-509745 seen for the particular problem before and on diagnostic and therapeutic services ordered or provided. Sociodemo­ National Ambulatory Medical Care Survey-Drug graphic information on the patient includes date of birth, Mentions sex, race (all years), ethnicity ( 1979-81, 1985, 1989–90), Data year NTIS accessionno geographic region, and whether located in standard met­ 1980 PB 83–154799 ropolitan statistical area. 1981 PB 83-199570 1985 PB 88-146113 Pain data elements 1989 To be assigned Patient information Technical contact: Patient’s problem, complaint, or symptom: Ray Gagnon Principal Division of Health Care Statistics Other 6525 Belcrest Road, Room 952 Seriousness (1973-78) Hyattsville, MD 20782 Acute or chronic (1973-76, 1979-81) (301) 436-7132 Time since onset of symptoms (1977-78) Physician diagnosis (ICD coding): Questionnaire source items Principal Other NOTE Identical questionnaires were used for the years Treatment or service ordered or provided: shown in parentheses after the citation. Prescription DeLozier JE, Gagnon RO. The National Ambulatory Med­ Physiotherapy ical Care Survey 1973 summary, United States, May Psychotherapy or therapeutic listening 1973–April 1974. National Center for Health Statistics. Disposition of visit Vital Health Stat 13(21). 1975. (1973-74) Duration of visit Names of medications prescribed (1980-81, 1985, Koch H, McLemore T. The National Ambulatory Medical 1989-90) Care Survey: 1975 summary, United States,

39 January-December 1975. National Center for Health Sta­ Gout tistics. Vital Health Stat 13(33). 1978. (1975-76) Lumbago Ezzati T, McLemore T. The National Ambulatory Medical Lumbar intervertebral disc without myelopathy Care Survey: 1977 summary, United States, January-De­ Migraine cember 1977. National Center for Health Statistics, Vital Osteoarthritis Health Stat 13(44). 1980. (1977-78) Rheumatoid arthritis Sciatica Gagnon RO, DeLozier JE, McLemore T. The National Sprains and strains, site specified Ambulatory Medical Care Survey, United States: 1979 sum­ Traumatic amputation, site specified mary. National Center for Health Statistics. Vital Health Trigeminal nerve disorders Stat 13(66). 1982. (1979) Ulcer, site specified Cypress BK, Patterns of ambulatory care in general and family practice: The National Ambulatory Medical Care Data tape availability Survey; United States, January 1980-December 1981. Data year NTIS accession no National Center for Health Statistics, Vital Health Stat 13 1970 PB 270763 (73). 1983. (1980-81) 1971 PB 270765 1972 PB 270767 Nelson C, McLemore T, The National ArnbulatoV Medical 1973 PB 270769 Care Survey; United States, 1975-81 and 1985 trends. 1974 PB 270771 National Center for Health Statistics. Vital Health Stat 13 1975 PB 270773 (93). 1988. (1985) 1976 PB 82-179227 1977 PB 82-179326 1978 PB 82-179342 National Hospital Discharge 1979 PB 82-179334 Survey (NHDS) 1980 PB 83-126318 1981 PB 85-152338 Survey design 1982 PB 85-153658 1983 PB 85-152304 Survey of patient discharges from about 450 non- 1984 PB 86-107737 Federal, short-stay hospitals throughout the United States 1985 PB 87-125613 using a two-stage probability sample. Hospital selection is 1986 PB 88-129440 stratified by bed size, geographic region, and ownership. 1987 PB 89-121537 Data are abstracted from the face sheets of a systematic sample of discharged patients. The survey has been con­ Technical contact: ducted annually since 1965. Robert Pokras Division of Health Care Statistics Basic data elements 6525 Belcrest Road, Room 952 Hyattsville, MD 20782 From 1965, data elements include patient characteris­ (301) 436-7125 tics (age, race, and marital status); hospital characteristics (location, size, and ownership); all-listed diagnoses, including injuries and poisonings (coded according to the Questionnaire source items International Classification of Diseases (ICD) revision in NOTE: Identical questionnaires were used for the years use at the time of data collection); all-listed procedures; shown in parentheses after the citation. average length of stay; and discharge status. Since 1977, an item on expected source of payment has also been included. Ranofsky AL, Utilization of short-stay hospitals: Annual See appendix VI for discussion of ICD coding. summary for the United States, 1974. National Center for Health Statistics. Vital Health Stat 13(26). 1976. (1965-76) Pain data elements Haupt BJ, Utilization of short-stay hospitals: Annual sum­ Selected diagnoses involving pain. The following dis­ mary for the United States, 1977. National Center for orders are listed for illustrative purposes only. All disorders Health Statistics. Vital Health Stat 13(41). 1979. (1977-78) listed on the hospital record are available on the tape. McCarthy E. Inpatient utilization of short-stay hospitals by Angina pectoris diagnosis, United States, 1979. National Center for Health Ankylosing spondylitis Statistics. Vital Health Stat 13(69). 1982. (1979-80) Burns, site specified Degeneration of lumbar or lumbosacral intervertebral Graves EJ, Haupt BJ. Utilization of short-stay hospitals, disc United States: 1981 annual summary. National Center for Disorders of synovium, tendon, and bursa Health Statistics. Vital Health Stat 13(72). 1983. (1981-82)

40 Graves EJ. Utilization of short-stay hospitals, United Supervision over medications that may be self- States: 1983 annual summary. National Center for Health administered (1973–74 1977) Statistics. Vital Health Stat 13(83). 1985. (1983-84) Medications and treatments administered in accord­ ance with physician’s orders (1973–74, 1977) Graves EJ. Utilization of short-stay hospitals, United Rub and massage (1973-74, 1977) States, 1985 annual summary. National Center for Health Physical therapy (1973-74, 1977) Statistics. Vital Health Stat 13(91). 1987. (1985-86) Occupational therapy (1973-74, 1977) Graves EJ. National Hospital Discharge Survey: Annual Other rehabilitation therapies (1973-74, 1977) summary, 1987. National Center for Health Statistics. Vital Services provided to nonresidents: Health Stat 13(99). 1989. (1987-89) Physical therapy (1977, 1985) Services offered to residents (1985): The 1990 questionnaire can be obtained from the technical Medical services contact person. Nursing services Mental health services National Nursing Home Survey Physical therapy (NNHS) Occupational therapy Vocational rehabilitation Prescribed medicines or nonprescribed medicines Survey design Resident Questionnaire Survey of current residents, discharged residents, and Prima~ reason for admission employees of U.S. nursing homes, using a two-stage cluster Physical (illness or need for treatment) (1973-74, 1977) probability sample. Nursing home selection was stratified Primary diagnosis at time of admission by bed size and type of service. A systematic sample of Accidents, poisonings, and violence (for example, frac­ current residents, discharged residents (1977 and 1985), ture of hip, other broken bones, burns, concussion) and employees was then selected. (Only registered nurses (1973-74) were sampled in 1985.) Three cycles of NNHS have been Diseases of the musculoskeletaI system and connective conducted. The 1973–74 nationaI survey covered approxi­ tissue (for example, arthritis, rheumatism, back pain) mately 1,900 nursing homes, 19,000 current residents, and (1973-74) 21,000 employees. The 1977 national survey covered ICD code (1985) approximately 1,500 nursing homes, 7,000 current resi­ Primary diagnosis at time of last medical examination dents, 5,100 discharged residents, and 13,600 employees. Accidents, poisonings, and violence (for example, frac­ The national sample was augmented in 1977 in California, ture of hip, other broken bones, burns, concussion) Illinois, Massachusetts, New York, and Texas to produce (1973-74) State-level estimates. The total sample for these five States Diseases of the musculoskeletaI system and connective included 650 nursing homes, 3,100 current residents, 2,500 tissue (for example, arthritis, rheumatism, back pain) discharged residents, and 5,700 employees. The 1985 (1973-74) national survey covered approximately 1,100 nursing Arthritis or rheumatism (1977) homes, 5,200 current residents, 6,000 discharged residents, Gout (1977) and 2,800 registered nurses. Ulcers (1977) Current conditions or impairments Arthritis or rheumatism (1973-74, 1977) Basic data elements Any chronic trouble with back or spine (1973-74, 1977) Administrative information for the facility and the staff. ICD-coded (painful) condition (1985) Data for current and discharged residents consist of infor­ Therapy services received in past month (1973–74, 1977, mation on diagnoses –limited to a list in 1973–74 and 1977 1985): and full International Classification of Diseases (ICD) Physical therapy coding in 1985 —functional status, physician and other ser­ Occupational therapy vices received, visitors, and overnight leave. In 1985, addi­ Medications received during past 7 days (1973-74): tional information was obtained on diagnosis-related group Tranquilizers catego~ for any hospital visit and on sources of payment. Analgesics htianginal drugs Antidepressants Pain data elements Conditions for which resident received medication in past FacilityQuestionnaire 7 days (1977): Services routinely provided on premises: Arthritis or rheumatism Counseling or therapy by psychiatrist, psychologist, or Chronic back or spine problems (excluding stiffness mental health worker (1977) and deformity)

41 A rub or massage received in the past 7 days? (1977) 6525 Belcrest Road, Room 952 Is resident depressed or withdrawn? (1973-74, 1977) Hyattsville, MD 20782 Does resident display depression which restricts func­ (301) 436-8830 tioning nearly every day? (1985) Questionnaire source items Discharged Resident Questionnaire (197Z 1985) Exhibition of any of the following conditions or impair­ Sirrocco A, Koch H. Nursing homes in the United States ments by former resident? (1977) 1973–74, National Nursing Home Survey, National Center Arthritis or rheumatism for Health Statistics. Vital Health Stat. 14(17). 1977. Chronic back or spine problems (excluding stiffness Van Nostrand JF, Zappolo A, Hing E, et al. The National and deformity) Nursing Home Survey, 1977 summary for the United States. Primary diagnosis at time of former resident’s admission: National Center for Health Statistics. Vital Health Stat 13 Arthritis or rheumatism (1977) (43). 1979. Gout (1977) Hing E, Sekscenski E, Strahan G. The National Nursing Ulcers (1977) Home Survey: 1985 summary for the United States. ICD-coded (painful) condition (1985) National Center for Health Statistics. Vital Health Stat 13 Primary and other diagnoses (ICD-coded) at time of dis­ (97). 1989. charge (1985) A rub or massage received during last 7 days before dis­ charge? (1977) Next-of-Kin (NOK) Component of During month prior to discharge did former resident the 1985 National Nursing Home receive (1977): Survey (NNHS) Physical therapy? Occupational therapy? Survey design Staff Questionnaire (1973-74, 1977) Supplements the 1985 NNHS survey of current resi­ Number of nondegree training courses taken in past year in: dents and discharged residents of U.S, nursing homes using Physical therapy or rehabilitation a computer-assisted telephone interview system, Inter- Occupational therapy viewing took place from October 1985 through March 1986, Pharmacology and care of drugs Of the 11,181 people eligible, NOK interviews were com­ Enrollment in past 12 months in nondegree training in pleted for 9,084 subjects, using proxy respondents (prima­ mental or social problems of the aged or chronically ill? rily next of kin) if the subject could not participate. (1977) Administrators or other facility personnel were contacted Performs work, counseling services? (1977) for a few subjects who were in facilities and for whom no next of kin could be located. The NOK component was Nursing Questionnaire (1985) conducted by NCHS in collaboration with the National Taken a continuing education workshop during the past Institute on Aging. year on: Occupational therapy? Pharmacolo~ and the aged or chronically ill? Basic data elements Physical therapy or rehabilitation? The NOK was used to obtain information that was not readily available from patient records or other sources in Data tape availability the nursing home, Information was obtained on the resi­ dent’s status prior to the sample admission, past use of National Nursing Home Survey, 1973–74, NTIS accession nursing homes, hospital admissions and discharges, activi­ no PB 89–159420 ties of daily living at admission, reasons for entering the National Nursing Home Survey, 1977, NTIS accession no nursing home, method of payment, current vital status, and PB 80-188030 living arrangements, National Nursing Home Survey, 1977, five States (Califor­ Pain data elements nia, Illinois, Massachusetts, New York, Texas), NTIS accession no PB 80–188717 First five (pain-related) medical reasons for admission and main (pain-related) medical reason for admission: National Nursing Home Survey, 1985, NTIS accession no Hip fracture PB 89-159503 Other fracture Technical contact: Arthritis Esther Hing Central nervous system diseases, injuries Division of Health Care Statistics Burns, skin diseases, infections

42 Data tape availability Convalescent home (1971-76) Rest home (1971-73) Next-of-Kin Component, 1985 National Nursing Home Home for the aged (1971-73) Survey, NTIS accession no: To be assigned Residential facilities (1986) Technical contact: Nursing care unit of a retirement center (1971-76) Mary Ann Bush Average length of stay (1971) Division of Analysis Information collected but not available on data tapes: 6525 Belcrest Road, Room 1080 Number of full- and part-time occupational ther­ Hyattsville, MD 20782 apists (1973–78) (301) 436-7037 Number of full- and part-time occupational therapy assistants and aides (1973-78) Questionnaire source items Number of full- and part-time physical therapists (1973-78) Questionnaire available upon request from technical con- Number of full- and part-time physical therapy tact person. assistants and aides (1973–78) RoutineIy provided services: Supervision over medications that may be self- National Master Facility Inventory administered (NMFI) and 1986 Inventory of Medications and treatments administered in accordance with physician’s orders Long-Term Care Places (ILTCP) Rub and massage Hospitals: Survey design Type of service hospital provides to majority of patients: Surveys of ailhospitals in the United States were made Rehabilitation annually from 1963 through 1976. (Data for years subse­ Orthopedic quent to 1976 are available from the American Hospital Chronic disease . Association, 840 Lake Shore Drive, Chicago, Illinois Facilities and services located within the hospital: 60611.) Surveys of all nursing and related-care homes in the Bum care unit United States were made in 1963, 1967, 1969, 1971, 1973, PhysicaI therapy department 1976, 1978, 1980, and 1982. In 1986, the survey was called Occupational therapy department the Inventory of Long-Term Care Places, and, in addition Rehabilitation inpatient unit to nursing and related-care homes, it included facilities for Number of beds the mentally retarded. The data were gathered using a mail Rehabilitation outpatient unit questionnaire. Home care department Annual number of visits Basic data elements Clinical psychology services (1973-76) Comprehensive list of facilities in the United States that Data tape availability provide medical, nursing, personal, or custodial care to groupi of unrelated persons on an inpatient basis. Data for National Master Faciliq Inventory, nursing homes and hospitals include name of facility, ownership, type of other health facilities facility, number of beds, days of care, discharges, admis­ Data year NTIS accession no sions, type of service, outpatient visits, employees, and facil­ 1971 PB 287270 ities and services offered. Data for nursing homes and other 1973 PB 287268 health facilities include name of facility, address, number of 1976 PB 287230 beds, ownership, type of facility, ages and sexes served, and 1980 PB 83-178459 number of residents. 1982 PB 86-237872

Pain data elementsd Inventory of Long-Term Care Places Numing and related-care homes; Data year NTIS accession no Resident facility for: 1986 PB 88-110606 Extended care (1971-73) National Master Facilip Inventory, hospitals Skilled nursing home (1971-86) Skilled nursing facility of a hospital (1976, 1986) Data year NTIS accession no Nursing home (1971-86) 1971 PB 284912 1972 PB 284914 1973 PB 284916 dItems appear in all years of the survey unless otherwise noted. 1974 PB 284918

43 1975 PB 284920 Sutton JF, Sirrocco A. Inpatient health facilities as reported 1976 PB 284922 from the 1976 MFI Survey. National Center for Health Statistics. Vital Health Stat 14(23). 1980. Technical contact: Al Sirrocco€ Strahan GW. Inpatient health facilities statistics, United Division of Health Care Statistics€ States, 1978. National Center for Health Statistics. Vital 6525 Belcrest Road, Room 952€ Health Stat 14(24), 1981. HyattsvilIe, MD 20782€ Sirrocco A. Nursing and related care homes as reported (301) 436-8830€ from the 1980 NMFI Survey. NationaI Center for Health Statistics. Vital Health Stat 14(29). 1983. Questionnaire source items Sirrocco A. Nursing home characteristics: 1986 Inventory of Sirrocco A. Inpatient health facilities as reported from the Long-Term Care Places. National Center for Health Sta­ 1971 MFI Survey. National Center for Health Statistics. tistics. Vital Health Stat 14(33), 1989. Vital Health Stat 14(12). 1974. Sirrocco A. Inpatient health facilities as reported from the 1973 MFI Survey, National Center for Health Statistics. Vital Health Stat 14(16). 1976.

44 Vital statistics surveys

/ I National Natality Survey (NNS) and Type of delivery (1980) National Fetal Mortality Survey Number of aspirin tablets taken per month during preg­ nancy (1980) . (NFMS)

Survey design Data tape availability National Natality Surveys, conducted in 1963–69, 1972, The National Natality Survey and the National Fetal and 1980, were based on pr-obability samples of registered Mortality Survey– 1980, NTIS accession no PB births occurring in a calendar year in each registration area 84-177310 in the United States. Because all pain data elements were Technical contact: .) collected in the 1980 survey, only information from this \. Paul Placek or Kenneth Keppel survey is addressed here. For the first time in 1980, the Followback Survey Branch natality survey was accompanied by the 1980 National Fetal Division of Vital Statistics Mortality Survey, based on a sample of registered late fetal 6525 Belcrest Road, Room 840 \ deaths. In NNS and NFMS, questionnaires were mailed to Hyattsville, MD 20782 married mothers, hospitals where the deliveries occurred, (301) 436-7464 attendants at delivery, and x-ray technicians and radiolo­ gists. The data set contains birth certificate information for Questionnaire source items all sample births and questionnaire information for survey respondents. The sample contained approximately 9,900 Keppel KG, Placek PJ, Heuser R, et al. Methods and live births and 6,400 late fetal deaths to married and unmar- response characteristics – 1980 National Natality and Fetal II ried women in the 1980 survey. Of the 7,825 married women Mortali~ Surveys. National Center for Health Statistics. with live births and 4,815 married women with fetal deaths Vital Health Stat 2(100). 1986. who were sent questionnaires, response rates were 79.5 and 74.5 percent, respectively. National Mortality Followback

Basic data elements Survey (NMFS)

Survey data include about 300 items, including medical Survey design care of the mother, breastfeeding practices, information about previous pregnancies, childbearing expectations, Survey based on a systematic random national sample sterilization, smoking and aIcohol use, heaIth status of of 1 percent of U.S. resident deaths occurring in 1986 to mother and child, marital history, electronic fetal moni­ persons 25 years of age and over. The sample was stratified toring, and amniocentesis. The vital record contains basic for race, age, cause of death, month of death, State, and sex. sociodemographic data, State of birth, number of previous A total sample of about 18,500 decedents was drawn. Ques­ children born alive, number of fetal deaths, birth order, tionnaires were mailed to death certificate informants or birth weight, and completed weeks of pregnancy. other knowledgeable relatives and to all health care facil­ ities that were used by decedents in the last year of life. Data Pain data elements collection was completed in 1988. Total duration of labor (1980) Basic data elements Number of anesthetics used for delivery (1980) Type” of anesthetic used for delive~ (1980) Survey data from death certificate informants include Inhalation (general) hospital, nursing, and other facili& care in the last year of Local (pudendal block) life; number of doctor visits in last year of life; Medicare Spinal coverage, sources of payment for health care in the last year ‘Epidural of life; help for activities of daily living in the last year of life; Other anesthetic used problems getting care in the last year of life; lifestyle (for

45 example, tobacco and alcohol use, and diet); selected Basic data elements chronic conditions; occupation and income; family size; For NMIHS, data from mothers include barriers to history of heart attack in family; and total value of things prenatal care; source of payment; use patterns of those in owned by decedent, Health care facility data for each dis­ the Women, Infants, and Children (WIC) program; charge in the last year of life include length of stay, diag­ smoking; alcohol and marijuana use; work patterns before noses, and medical procedures. Death certificate data and after delive~; infant feeding practices; infant health include sociodemographic information, place of death, date and medical care up to 6 months; and sociodemographic of death, underlying cause, and relationship of informant to characteristics, Data from hospitals include maternal hos­ decedent. I pitalizations; maternal and infant diagnoses and procedures coded according to the International Classification of Dis­ Pain data elements eases, 9th Revision, Clinical Modification (ICD-9-CM); -. Cause(s) of death coded according to International charges for care and diagnosis-related groups; cesarean Classification of Diseases delivery and trial of labor; fetal monitoring; medicaI devices Ever had a heart attack? and monitors; neonatal intensive care; and infant hospital­ How long before death was first heart attack? izations up to 6 months. Data from prenatal care providers Ever had angina pectoris? include prenatal visit measures, patient education, acquired How long before death when first noticed? immunodeficiency syndrome (AIDS) and sexually trans­ Within the hour before death, did the person start mitted disease testing, sonograms and X rays, prescribed having anew or sharply increased problem such as chest medications and vitamins, amniocentesis and chorionic pain, difficulty breathing, or fainting? villus sampling, and charges for care. For the 1990 LF, data from mothers include child Data tape availability development and behavior up to 3 years of age; child care; child nutrition and WIC food use; child immunizations; National Mortality Followback Survey, 1986 barriers and costs of primary pediatric care; parental NTIS accession no PB 90-501800 smoking, drinking, and drug use; stress and social support; subsequent fertility; occupation; and environmental haz­ Technical contact: ards. Data from pediatric care providers include child Paul J. Placek medical histories, AIDS testing, lead screening, medica­ Chief, Followback Survey Branch tions, and charges for care. Data from hospitals incIude Division of Vital Statistics diagnoses and procedures (ICD-9-CM coding), child hos­ 6525 Belcrest Road, Room 840 pitalizations, and charges for care. Hyattsville, MD 20782 (301) 436-7464 Pain data elements Questionnaire source items 1988 National Ma[emal and Infant Health Survey Mother’s Questionnaire Questionnaires available upon request from technical con- Health problems or symptoms during this tact person. pregnancy: Abdominal cramps 1988 National Maternal and Infant Severe headaches Health Survey (NMIHS) and 1990 Hemorrhoids Illnesses or problems baby had during each of the Longitudinal Followup (LF) first 6 months: Ear infection Survey design Eye infection In the 1988 NMIHS, conducted from December 1988 Colic through December 1990, 21,000 vital records of live births, Injury from bad fall or accident infant deaths, and fetal deaths were sampled and a total of Prenatal Care Provider Questionnaire 60,000 mothers, hospitals where the births and infant deaths ICD-9-CM code for any diagnoses and diagnostic occurred, and providers of prenatal care were surveyed. or obstetric procedures performed during this Questionnaires were linked with the vital records, which pregnancy included 11,000 birth certificates, 6,000 death certificates Names, dosage, and duration of therapy of medi­ for infants, and 4,000 reports of fetal death of 28 weeks cations or drugs recommended, prescribed, or gestation or more. In the 1990 LF, linked to NMIHS, 10,000 administered respondents who had live births in 1988, their hospitals and Hospital Questionnaire pediatric providers, 1,000 women who had experienced ICD-9-CM code for any diagnoses and diagnostic infant deaths, and 1,000 women who had experienced still- or obstetric procedures for the mother: births were reinterviewed. During the delivery

46 During her pregnancy Pediatric Care Provider Questionnaire Up to 6 months after her delive~ Injuries requiring medical care? Methods of anesthesia during delivery Description Epidural Date Spinal Circumstances Local or pudendal block Reported as child abuse? Inhalation Poisoning requiring medical care? None Type Names, dosage, and duration of therapy of medi­ Date cations or drugs recommended, prescribed, or Circumstances administered Malignant or benign neoplasms? ICD-9-CM code for any diagnoses and procedures Type and site used on the infant after delivery and if Date of diagnosis rehospitalized Ever concerned the child has experienced or reported the child for: 1990 Longitudinal Followup Neglect? Mother’s Questionnaire Sexual abuse? Number and circumstances of serious injuries of Physical abuse? child that required a doctor’s or nurse’s care Hospital Questionnaire .- While riding in a car Hospitalization or emergency room episodes for child ‘i Other than from a car accident after the age of 6 months Child ever suffered a burn that needed a doctor’s Admission and discharge dates or nurse’s care? ICD-9-CM coded diagnoses and procedures Number of times Circumstances Data tape availability Any injuries as a result of using an apnea monitor? Type of injury National Matemal and Infant Health Survey, 1988 ,NTIS accession no PB 92-500081 Conditions of the child in the past 30 days Stomach ache without vomiting Tapes are not yet available for the 1990 J_S Stomach “flu” with vomiting and diarrhea Technical contact: Ear infection or earache (otitis media) with Paul J, P1acek fever Chief, Followback Survey Branch Sore throat with high fever Division of Vital Statistics Urinary tract infection 6525 Belcrest Road, Room 840 Tonsillitis Hyattsville, M_D20782 Over-the-counter medicines given the child in the (301) 436-7464 past 30 days Aspirin Questionnaire source items Tylenol Other pain relievers and fever reducers Questionnaires available upon request from technical con- Number of medical visits for child for injuries tact person.

47 Vital statistics registration

Mortality ,Statistics (MS) 1985 PB 88-101316 1986 PB 89-121180 Survey design 1987 PB 90-500133 One-hundred percent registration of deaths in the 1988 PB 91-506626 United States since 1933. Deaths are registered by the Vital statistics –-mortali(y, local area summa~ States and reported to NCHS on an ongoing basis. Data year NTIS accession no Basic data elements 1968 PB 238827 1969 PB 80-126618 Detailed data include characteristics of the location of 1970 PB 80-108749 residence of the deceased, age at death, day of death 1971 PB 80-126642 (1972-77), whether autopsy was performed (1972-77), 1972 PB 80-126667 whether findings were used (1972–77), multiple cause-of- 1973 PB 80-133374 death codes (1968-present), and underlying cause-of-death 1974 PB 80-126683 codes, which include codes for accidents and injuries. Mor­ 1975 PB 80-134158 tality data are coded according to the International Clas­ 1976 PB 80-134117 sification of Diseases (ICD) revision in use at the time of 1977 PB 80-131675 data collection, (See appendix VI,) Local area summary and 1978 PB 81-100232 cause-of-death summary tapes contain selected data from 1979 PB 83-143230 the detailed tapes. 1980 PB 83-261636 Pain data elements 1981 PB 84-212992 1982 PB 85-163913 All causes of death are ICD coded. To the extent that 1983 PB 86-120482 ICD rubrics can be used to identify painful conditions, 1984 PB 86-125639 magnitude and scope of mortality associated with pain can 1985 PB 88-101357 be ascertained. 1986 PB 89-121586 1987 PB 90-500158 Data tape availability 1988 PB 91-506642 Vital statistics – mortali(y, detail Vital statistics – mortali~, cause -of-dealh summaq Data year NTIS accession no Data year NTIS accession no 1968 PB 300800 1968 PB 80-126550 1969 PB 299676 1969 PB 80-133358 1970 PB 299679 1970 PB 80-133333 1971 PB 300802 1971 PB 80-133317 1972 PB 200885 1972 PB 80-133275 1973 PB 300805 1973 PB 80-126576 1974 PB 300807 1974 PB 80-133291 1975 PB 300809 1975 PB 80-134133 1976 PB 300811 1976 PB 80-134091 1977 PB 300798 1977 PB 80-126592 1978 PB 81-125106 1978 PB 81-100257 1979 PB 83-132357 1979 PB 83-132373 1980 PB 83-261552 1980 PB 83-261578 1981 PB 84-213016 1981 PB 84-213032 1982 PB 85-163897 1982 PB 85-163764 1983 PB 86-120441 1983 PB 86-120466 1984 PB 87-129706 48 1984 PB 87-129680 National Center for Health Statistics. Vital statistics of the 1985 PB 88-101332 United States, 1970, vol II, mortaIity, part B. Washington: 1986 PB 89-121602 Public Health Service. 1974. - 1987 PB 90-500141 National Center for Health Statistics. Vital statistics of the United States, 1971, vol II, mortali~, part A. Washington: Walstatisticsmortalip-multipleca useof death, detail Public Health Service. 1975. Data year NTIS accession no National Center for Health Statistics. Vital statistics of the I 1968 PB 82-191800 United States, 1971, VOIII, mortality, part B. Washington: 1969 PB 82-155011 Public HeaIth Service. 1974. 1970 PB 82–121716 1971 PB 82-142654 National Center for Health Statistics. Vital statistics of the 1972 PB 82-191966 United States, 1972, vol II, mortality, part A. Washington: 1973 PB 82-191644 Public Health Service. 1975. 1974 PB 82-186164 National Center for Health Statistics. Vital statistics of the 1975 PB 82-157322 United States, 1972, vol II, mortality, part B. Washington. 1976 PB 81-186827 Public Health Service. 1975. 1977 PB 81-217382 1978 PB 82-105743 National Center for Health Statistics. Vital Statistics of the 1979 PB 83-153031 United States, 1973, vol II, mortality, part A. Washington. 1980 PB 84-112200 Public Health Service. 1977. 1981 PB 85-153617 National Center for Health Statistics. Vital Statistics of the 1982 PB 85-224202 United States, 1973, vol II, mortality, part B. Washington. 1983 PB 86-138831 Public Health Service. 1975. 1984 PB87-16103O 1985 PB 87-235057 National Center for Health Statistics. Vital Statistics of the 1986 PB 89-121461 United States, 1974, vol 11, mortality, part A. Washington. 1987 PB90-500448 Public Health Service. 1978. 1988 PB 91-507343 National Center for Health Statistics. Vital Statistics of the Technical contact: United States, 1974, VOIH, mortality, part B. Washington. Mabel Smith Public Health Service. 1976. Division of Vital Statistics National Center for Health Statistics. Vital Statistics of the 6525 Belcrest Road, Room840 United States, 1975, vol H, mortality, part A. Washington. Hyattsville, MD 20782 Public Health Service. 1979. (301) 436-8980 National Center for Health Statistics. Vital Statistics of the The following vital statistics publications of the National United States, 1975, vol II, mortaliiy, part B. Washington. Center for Health Statistics – all published in Washington Public Health Service. 1977. by the Public Health Service-are now available. National Center for Health Statistics. Vital Statistics of the United States, 1976, vol H, mortality, part A. Washington Questionnaire source items Public Health Service. 1980. National Center for Health Statistics. Vital statistics of the National Center for Health Statistics. VitaI Statistics of the United States, 1968, VO111, mortality, part A. Washington: United States, 1976, VOI11, mortality, part B. Washington Public Health Service. 1971. Public Health Service. 1980. National Center for Health Statistics. Vital statistics of the National Center for Health Statistics. Vital Statistics of the United States, 1968, VO1II, mortality, part B. Washington: United States, 1977, VOIII, mortality, part A. Washington: Public Health Service. 1971. Public Health Service. 1981. t National Center for Health Statistics. Vital statistics of the National Center for Health Statistics. Vital Statistics of the United States, 1969, vol II, mortality, part A. Washington: United States, 1977, VO1II, mortality, part B. Washington: 1’ Public Health Service. 1974. Public Health Service. 1980. National Center for Health Statistics. Vital statistics of the National Center for Health Statistics. Vital Statistics of the United States, 1969, vol II, mortality, part B, Washington: United States, 1978, VOIII, mortality, part A. Washington: 1 Public Health Service. 1973. Public Health Service. 1982. r National Center for Health Statistics. Vital statistics of the National Center for Health Statistics. Vital Statistics of the ) United States, 1970, vol II, mortality, part A. Washington: United States, 1978, vol II, mortaliiy, part B. Washington: t Public Health Service. 1974. Public Health Service. 1982.

49 National Center for Health Statistics. Vital Statistics of the National Center for Health Statistics. Vital Statistics of the United States. 1979. vol II, mortality, part A. Washington: United States. 1987. vol H, mortality, part B. Washington: Public Health Service, 1984, Public Health Service. 1989. National Center for Health Statistics. Vital Statistics of the National Center for Health Statistics. Vital Statistics of the United States. 1979. vol II, mortality, part B. Washington: United States, 1988. VOIII, mortality, part A. Washington: Public Health Service. 1984. Public Health Service, 1991, National Center for Health Statistics, Vital Statistics of the National Center for Health Statistics. Vital Statistics of the United States. 1980. vol II, mortality, part A, Washington: United States. 1988. vol II, mortality, part B. Washington: Public Health Service. 1985. Public Health Service. 1990. National Center for Health Statistics. Vital Statistics of the Volumes for subsequent data years are not yet published, United States. 1980. vol II, mortality, part B, Washington: Public Health Service. 1985. Divorce Statistics (DS) National Center for Health Statistics. Vital Statistics of the United States, 1981. vol II, mortality, part A. Washington: Survey design Public Health Service. 1986. Divorce counts are obtained from all States and coun­ National Center for Health Statistics, Vital Statistics of the ties in the United States, In addition, States in the divorce- United States. 1981. vol II, mortality, part B. Washington: registration area (DRA) provide either microfilm copies of Public Health Service, 1986. divorce certificates or machine-readable data tapes. The detailed divorce tapes contain a sample from the microfilm National Center for Health Statistics. Vital Statistics of the records and all the records from States that supply machine- United States. 1982. VOIII, mortality, part A. Washington: readable tapes. Detailed data are available for all years Public Health Service. 1986. since 1958 for States in the DRA. The following areas have National Center for Health Statistics, Vital Statistics of the participated in the DRA: Alabama, Alaska, California, United States. 1982. VOIII, mortality, part B, Washington: Connecticut, Delaware, Georgia, Hawaii, Idaho, Illinois, Public Health Service. 1986. Iowa, Kansas, Kentucky, Maryland, Massachusetts, Mich­ igan, Missouri, Montana, Nebraska, New Hampshire, New National Center for Health Statistics. Vital Statistics of the York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode United States, 1983. VOIII, mortality, part A. Washington: Island, South Carolina, South Dakota, Tennessee, Utah, Public Health Service. 1987. Vermont, Virginia, Wisconsin, Wyoming, and the Virgin National Center for Health Statistics. Vital Statistics of the Islands. The number of participating States has expanded United States. 1983. vol II, mortality, part B. Washington: from 14 in 1958 to 31 in 1981. The District of Columbia Public Health Service, 1987. joined in 1986; California dropped out in 1978, National Center for Health Statistics. Vital Statistics of the United States. 1984. VOIII, mortality, part A. Washington: Basic data elements Public Health Service. 1987. For 1958-67, data are published showing tabulations of National Center for Health Statistics, Vital Statistics of the counts of divorces by region, State, and county. For regis­ United States. 1984. vol H, mortality, part B. Washington: tration States there are also tabulations on plaintiff, dura­ Public Health Service. 1987. tion of the marriage, and number of children. Shown separately for the husband and wife are race, ages at mar­ National Center for Health Statistics, Vital Statistics of the riage and divorce, and marriage order. United States. 1985. vol H, mortality, part A. Washington: Beginning in 1968, computer tapes are available in Public Health Service. 1988. addition to the published annual volumes. These tapes National Center for Health Statistics. Vital Statistics of the contain region, division, and State of divorce and mar­ United States, 1985. vol II, mortality, part B. Washington: riage; month and year of marriage, separation, and divorce Public Health Service. 1988. and durations between these events; plaintiff, and number of children under 18 years of age. They also contain, National Center for Health Statistics. Vital Statistics of the separately for the husband and wife, age; race; education; United States. 1986. vol II, mortality, part A. Washington: and number of times married, widowed, and divorced. Not Public Health Service. 1988. all items are reported by every registration State in each National Center for Health Statistics. Vital Statistics of the year. United States. 1986. VOIII, mortality, part B. Washington: Public Health Service. 1988. Pain data elements National Center for Health Statistics, Vital Statistics of the Denominators are provided for people at risk of painful United States. 1987. VOIII, mortality, part A. Washington: conditions that could be related to or exacerbated by I Public Health Service, 1990. stresses that can be associated with divorce. 50 Total U.S. population National Center for Health Statistics. Vital Statistics of the Number of divorces by region, State, and county United States, 1972,VOIIII, marriage and divorce. Washin~om ?! f Public HeaIth Servic& 1976. Divorce-registration area States Number of this marriage National Center for Health Statistics. Vital Statistics of the Previous marital status United States, 1973,VOIIII, marriage and divorce. Washington Duration of marriage Public Health Service. 1977. Number of children under 18 years of age National Center for ~ealth Statistics. Vit~ Statistics of the United States, 1974,VOIIII, marriage and divorce. Washington Data tape availability Pubiic Health Service. 1977. PWalstatistics-divorce, detail National Center for Health Statistics. Vital Statistics of the Data year NTIS accessionno United States, 1975,VOIIII, marriage and divorce. Washington: 1968 PB 238824 Public Health Service. 1979. PB 238825 1969 National Center for Health Statistics. Vit~ Statistics of the 1970 PB 80-186745 United States, 1976,vol III, marriage and divorm. Washington: 1971 PB 80-187164 Public Health Service. 1980. 1972 PB 80-187180 1973 PB 80-187149 National Center for Health Statistics. Vital Statistics of the 1974 PB 80-187123 United’StatR, 1977,vol III, marriage and divorce. Washington: 1975 PB 80-186786 Public HeaIth Service. 1981. 1976 PB 80-186760 NationaI Center for Health Statistics. Vital Statistics of the 1977 PB 80-186729 United States, 1978,vol III, marriage and divorce. Washington: 1978 PJ3 81-100216 Public Health Service. 1982. 1979 PB 81-238800 1980 . PB 83-242644 National Center for Health Statistics. Vital Statistics of the 1981 PB 84-164185 United States, 1979,vol III, marriage and divorce. Washington: 1982 PB 85-179430 Public Health Service. 1984. 1983 PB 86-165248 National Center for Health Statistics.. Vital Statistics of the 1984 PB 87-125506 United States, 1980;VOIIII, marriage and divorce. Washington 1985 PB 88-127865 Public HeaIth Service. 1985. 1986 PB 89-209415 1987 PB 90-501891 NationaI Center for Heakh Statistics. Vital Statistics of the 1988 ~ PB 91-507731 United States, 1981,vol III, marriage and chorce. Washington Public Health Sexvice. 1985. Technicalcontact: National Center for Health Statistics. Vital Statistics of the Barbara Wilson United States, 1983 vol III, marriage and divorce; Washington: Division of Vital Statistics Public Health Service. 1986. 6525 Belcrest Road, Room 840 . . Hyattsville, MD 20782 National Center for Health “Statistics. VitaI Statistics of the (301) 436-8978, United States, 1983,vol III, marriage and divorc& Washington Public Health Service. 1987. I Questionnaire source items National Center for Health Statistics. Vital Statistics of the United States, 1984, vol III, marriage and divorce. Washington: National Center for Health Statistics. Vital Statistics of the PubIic Health Sewice. 1988. United States, 1968, vol III, marriage and divorce. Wash­ ington: Public Health Service. 1971. National Center for Health Statistics. Vital Statistics of the United States, 1985,vol III, marriage and divorce. Washington: National Center for Health Statistics. Vital Statistics of the 4 Public Health Service. 1989. United States, 1969, vol III, marriage and divorce. Wash­ ington: Public Health Service. 1972. National Center for Health Statistics. Vital Statistics of the ,$ United Stat~, 1986,vol III, marriage and divorce. Washington National Center for Health Statistics. Vital Statistics of the Public HeaIth Service. 1990. United States, 1970, vol III, marriage and divorce. Wash­ ington: Public Health Service. 1974. NationaI Center for Health Statistics. Vital Statistics of. the United States, 1987,vol III, rnarnage and divorce. Washington: National Center for Health Statistics, Vital Statistics of the Public Health SeMce. 1991. United States, 1971,VOIIII, marriage and divorce. Washington: Public Health Service. 1975. Volumes for subsequent data years are not yet published.

..’ ,:

‘51

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,

55 Appendixes

Contents

I, Projected pain-re!ated items in future NCHS surveys ...... 57 II. 1989 National Health Intewiew Survey Current Health Topics section R: Orafacial pain. , ...... 58 HI. 1989 National Health Interview Survey Current Health Topics section S2: Abdominal pain...... 60 IV. Classification variables for analysis ofpain data ...... 62 V, Summary ofselected pain measures...... 63 VI. International Classification of Diseases description ...... 66

List of appendix tables

1. Classification variables available foranalysis ofpaindata, bysuwey or data system ...... 62 IL Pain measures, bysurvey or data system...... 63

56 Appendix I Projected pain-related : items in future NCHS ‘!! surveys al

1991 National Health Interview Survey supplement Cause Treatment Inability to perform activities of daily living because of a Impact physical or mental condition Incidence of falk in past 12 months Need help from another person in performing activities of Break hip as a result of a fail daily living because of a physical or mental condition Incidence of head injury where lost consciousness in past 12 1992 National Survey of Family Growth Cycle V months (18 years and over) Questions on pelvic inflammato~ disease Circumstances

. 57 . Appendix II 1989 National Health Interview Survey Current Health Topics section R: Orofacial pain

,.-—-.

~ 00 NO~erson 18 + In familv ICoverwww of H@fAl CHECK I O Avnitabl.a (Intro) Sfar”.Of SLW7Pk Pec50n ITEM 1 z O Callback rewired (Hhldptwy of HIS. 1) . m NonInterview (Section T)

I 6 CHECK t O Sample person has no teeth (2J Refer m 4b and 4f. ,, Oenral,. page 26. for sample person ITEM 2 I B= Other (1) I ----- 7 1 a. During the pa.~ 6 m.wmh.. did you have. toothache mor. th WI tin.., I o Ye” wh.m bltlql or .h.wdng? z � No /2/ .—. ——— ——— ——. ——— ——— ——— ——— ——— ——— —— b. Dld you fl..t hmve thl. p.in m.x. Xh.n 6 month. .w07 –,–~–y;; –––––––––– –––––––––– ––––”--u.

20N0

~ — .­ 2a. (Kku.lrw the p..t S month.) Dld vou have tmlnful sores or Ir.lt.tlons 1 0 Yes ..mmd m. IIF8. o. erI the rm’wve, cheek.. or Qurn. rnc. m than on.. ? z D N. (3) ————————— ——————————————.————————— —————————————————-.—————————-. —.— ~-i;, � � b. Did VO” fk=a ho- the -.9. or Irrlt-ri-n. m-r. *hen 6 month. 130? ! � Yes 20N0 --i

I.-- ?3. . 3a. {DIWIIWI th= P-t 6 month.) Did you h... . prolonged, une.pl.in.d burning 1 � Yes .=”..tlcm 1. your t.”wua or ..v other part of your mouth rnor. than 0.c,7 20No (4) ————-.————————..——. .————..—— —————..—- 9DOK ). 72 b. Whm you h... tfd. ..n..ttc.n, doe. K ..nn. ..d SF or 1. It I � Come and go CO”ttnuous mnd unlntunlpwd? 1 � Contlnuou%luninterrupted ———8 0 Other ———————.—----—-- uOOK ———————————————————————————————— ——— ——— ——— ——— ——— ——— ——— ——— ——— — —--- -—-— c. Durl”fI how rn..y DIFFERENT MONTHS i“ the P..t 6 month. dld “o” h.w. thl. .mt.ation? D hfonrhs :—— ————————— ———.———————————————————— ——— ———. ——— ——— ——— ——— ——— —— .—— —— — ; d. How snarIv ~otal d.v. 1“ th. P..* 6 month. did Y-U h.”. tht. sem..tlon? T � 1-3 days � � 16-30 days 7 D “Evmyday’” 204-10dwa s � 31-45 days 9DOK 3D 11-15 days .s � 46+ days ————————— ——————————————————————— —————————————————————————— ————— ——— *6 e. Old YOU flu% hew- this s-”sJM- more *h-m 0 tn~rmh. qm? 1 � Yes 1 20N0 I

4a. L-E._ tOurlnw *h. P*.C 6 month.) Dld vou ham p.in in *h. I.v# jolm o. lrt 1 � Y,, E fret ef the . . . mo+m th.m on..? 2 � No (5) ——-———.——————.——— -—————————————- —————————————————— —— ————————- — � � b. Wh.tt v-” h.w- this P.h’t, do.. it corn. nd w- or 1. It comtlrmmu. td t O Come and go I_-2.c udmmruptad? z � Cont!nuou%lu”ln terrupted e O Other SUOK ——— .- . .---- I ——————————————.—————————————————— 18 c. DurlmI hew m.”v DIFFERENT MONTHS in th. p..t S month. did 1 1 L-.-l VOU ha”. *h!. Pal”? ~ Month, ——— ——— ——— ——— ——— —__ ——— ——— ——— ——— —— _—— ——— ——— ——__— ——— ———_— ——— ——— ——— -. ,9—-- d. Mow mm”v ~ot-1 d-y, 1“ ti past S rn~”th, dld yc.u have this Pmlm7 1 0 1-3 days 4 � 16-30 days 7 � ,, Everyday,. 204-10daw so 31-46 days aOOK —————— ——— ——————————————————————— ,0 11-15 dav. e O 46+ da.. ———.——---1 20 a. D!d yaw flt.t h... this Pi. mom th.m S ,nc..tha �JW07 —— 1 •1 Yes 2UN0 ——______——— ——— ——— ——— ——— —————— ——-. r~zz f. On � 8=-1. of 1-10. -her- T 1s cnlld -“d 101. .-we,.. how would 12345678 910 YOU r.te thl. palm �i its wont? Circle only one. 723 I !ia. IDWII’WI *h. p=.t S month.] Dld you h.... dull, whlng P.in m.ro.. 1 n Yes your fmc. or ch.ek me.. th.m once? Do not count wlnu. pmtn. 2 � No (Check ttem 3) —————— ——— ——————————————————————— ——_— — — ______———— ————— 2.I b. Whmn VOU h-v- lhl, p-in, doom h c-m .nd IJO -.1. It co”tlnuou8 and I � Come and go unl.turuptod? 2 � Contlnuousluninlerrupted e a Other LIUOK ———————————————————————————————- ————— —— ——— c. Durlnw how m-v DIFFERENT MONTHS In the P=.* 6 rnomth. dld 26 you h... Ihl. p-h? = Months ——— ——— ——— ——— ——— ——— ——— ——— ——— ——— —— ————————————————————————— ——— —-. — —-— 26 d. How mmv *0*.I d.vw lm tfm POW* O memth. dld VCUI h... thl. p9hT7 I � 1-3 days 40 16–30 days 7 n ‘, Everyday.’ 2m4-10 days 6 � 31-45 d%’. SODK ———————————————————————————————— ,0 11-15 davs e O 46+ davs 4 ——.— 27 e. Dld VDU flti h-w this p-k mom than S month. qfo? 1 0 Ye. 2nNo ‘--l ——— ——— ——— ——— ——— ——— —. ——— ——— ——— —— - 12s —29 f. On � �C-IO CM 1-10. Wti 3 k ndld mnd ? 018 8-w-.*. hcsw would vou rwea thlw P91n A tt* w-*7 Circle only one. 1234567 891O

,O”M H!s. !A!, ,e, ) ,3 !....,

58 -——..—––------.-–. . . aacuon n — unum GuAL VAa N — conmnuea ~ 1I I %D Two or more months in ..-/ one of 3c. 4c. or sc (6) CHECK Ref.,ZoSC,e, and5C. I 8 D Other (Saczlo” S] ITEM 3 I

t Q 6a. 1“ th- w-t 6 month.. dJd vou .-or tmlk c- - DENTIST for 1 c1 Yes 1 Sh- p-l” w- J-* dls=u..ocl? 2 n No (6C) ——— ——— ——— ——— ——— ——— ——— ——— ——— ——— +——__— ______= b. Hew cn-nvtlcn-. d“ri”a th- I..t 6 morsth. dld you ---or t-lk t- a , d.”tl.t bout C180p.1.? 1 — Tim.=. .. . 1 999 D DK ——— ——— ——— ——— ——— ——— ——— ——— ——— ——— —— ~———————I ——— ——— ——— ——— ——— ——— ——— —.— m C. II” Ch- P.*< 6 mwmih.} Did you s- or ti:k to - MEDICAL DOCTOR , * n Ye.. . bout *h. Ja.1-7 2 n No (Se) ——————————————————————— -—————— .+-__ — ______d. H.ww cn.rwurn-.7 m : — Times ( 1 sss O DK ——— ——— ——— ——— ——— ——— ——— ——— ——— ——— —— I 0. {In th. P=*C 6 months] DJd YOU *-- or talk to � nv othor r–~ii;:––––––––– –––-––––––––––––-m tYP= Of h-.lth Profo=.bn.l -bout th- P-1”? 1 2 n No f6hl ——— ——— ——— ——— ——— ——— ——— ——— ——— ——— *______——— ——— ——— —____ Health professional e f. Wh-t kind of h--lth rmof-..l”.l?l? 1 1 t t ——— ——— ——— ——— ——— ——— ——— ——— ——— ——— ~——-— ———______—_____ ——— ——— ——— 9. How rn-”y Utn-s during sh- P=st 6 rno”th. did you s.. o, w 1 t.lk to ~h- /parson i“ 6f)? — Times 1 1 999 0 OK ——— ——— ——— ——— ——— ——— ——— ——— ——— ——— —— l—— ——— ——— —__ ——— ——— -- ———-—————————, t -CzCL h. ([m th. P..* 6 rnca”th.) D;d you worry about tho h=alth Of I YOUr SO-* -nd oums b-=-us- of tho P-1.? t o Yes : 2nNo -— —- ———-— ——— ——— ——— ——— ——— ——— ——— —— :—— — ______i. (In th. P-t 6 sno”thml Old you w-q .botn th- h.atth of 8“ ~ D Yes m I Y-.* bodv -=.”.. -r C18. p.l”? 20N0 t

H.4ND CARD R 7 . R.L!d list if tatephrlne in r-rview. 1 8 7. H-- Is - 11.t of Chi”g. P.OPI- do sh-n Ch.v h.”- t--th, mouth, o, I f-c- palm. PI---- c-11 m. M tilm~. you dld for the rmim d“rlmg tho p..= e m~.th.. I 1 circle *II rh.m apply. : ‘f — U.. - hot m. cold Gonwe.- 1 1 lE

2 — T-k-. PNsri@on dN.Z :2 ! 2- I IS 3 — T-k= .“ owm-~ounsw drug ~= : 4 - Drink -o- lZCWW or WIXI- &cmus- of UI. palm 14 1 4E

E — T-k- tins. off work 6 em :

s- St.V h-- rno~ US-. USU4 16 6=

7 — Avoid Tamlly mnd frb”dm :7 7E 8 1 S — Am@iln~ -Is-? (Specify]” 8 (Specify] 8= 8

0 - Non- of the above 10 OCIEC I 1 S — Dc.rIh know 9 9DZC :

Uocc.s

.“ ,.,.... -. ,’.,.- .-..,---- P*O . .

59 Appendix [11 1989 National Health InterYiew Survey Current Health Topics section S2: Abdominal pain

-- --

w sectlcmT S2 — ABDOMINAL PAIN I ~ Hmnd Card S 1. Th. .** ~e.tle.s � m .LMXN yin mu! dl..wntoe 1. the .bdome.. By 1 .bd.mn.”. W. me-n [ths .hmdod � m. e“ thl, dleiw. rnlth. .,.* between the / low.. rib. -A rlm hlp.1. Do not 1-14. p-in related to kldr.. y.. Mmddor, ix I .rlhrftl. [In.”.fi.tlo” m pmg”..cyl. , � ’YC!S ; 213N0 1. DURING THE PAST 12 MONTHS. h... you h-d .“Y fw.m of P-I” or C5ecflon S3/ .e”er, di%cmnfort in “our .bdom-r$ Ihr-e or m.,. tlme,7 1 90DK } ! ~ 2. H.”(I VO” .“-. m-d. m “l-it to - doctor for your =bdmnl”.1 Pal”? : t � Yes /f ssked, 0, tfm condltlo” thmt caused the Pal”. I 20N0 (4) 90DK 1 }

! Wh88t co”dltlon did .I’tm dc.cter ..Y wm. the cau,e of the P.lri? ma Doctor dldn,l nay 313. I (4) Enfer first 5 code numbers end rhe Cc.ndlr)ons in rhe order rnenrkmwd. t 990 DK } 1 Do not probe. 1 Code Condition 1 I E

1 l— m

1 — — E I m l— 1 m —- ——— ——— ——__—_ — ______—__ ;---~ ————____—_————_——————————- ——— —.. —— .--— If only one response to 3JI. enter in 3b u+ fhc.uc asking. I b. Which of thea- ec.”dltlgns C-USA tfs- MOST PC)I,I durl”g the par ~ .— (Check irern 1) = 12 sne”th.? ! Enttw code number and condition. 990 DK (Check hem 1) I

ea. Wh-t oo”dltlon do vou Chl”k wm. the C-USCJ of th- Pmln? 1 990 DK (5) Enter first 5 code numbers and the conditions in the order rnenrloned. I Do not probe. 1 Code Condition

I m 1

1 m 1 1 I_ EZ/IZ

1 m I

l— m ——— ——— ——— ——— ——— ——— ——— —- ——— ——— ——— ———-— —-— l—— ——— ——— ——— ——— ——— ——— ——— ——— ——— ——--. ——— —- —— -—-- - If onlv one response to 4.9, enrer in 4b w{rhcmt atsking. 1 b. which of the.. corditiorm c-”smd the MOST p.!” d“rln~ the, pal ~ 12 month.? (Check /zern 1) ~ ~ 1 Enter code number and cc.ndirion. 99ii DK (Check Irern 11

01 SPnstlc colon 22 G.llsvones 43 Tensloo 02 F“”ctiO”E.1 bowel 23 Gestrltle 44 Trouble swallowing 03 Irritable colon 24 Gastr.mnterltls 45 Tumor 0.3 Irritable bowel syndrome 26 Growth 4e ulcer

05 Allergies 26 Hewtb”rn 47 UIcmatlve colitis

0S A“xlety 27 Hepatitis 4B Vlr”tl 07 Arwe”diclti. 2S Hen+., other fhan hlatal

08 Cancer 29 Hlatd hernia . 65 Arthritis 09 Clrrhosl$ 30 Impaoted bowels . 66 Back problems 70 Cc.litls 33 Ilxlia.st lo” - 67 81adder

11 Conslipal!c.n 32 In fectIon - 6 B Kld”eya 12 Croh”

- DO not ask questions 6-27 -bout these conditions.

la. 62 ,0.M .,.. ,. !,*.*, ,,..0.0.

60 section S2 - ABDOMINAL PAIN - C6”tl”tmd

b Ask @estio”s S-27 about rhe first cond;rian coded 01 -04 i“ 3. o? 4.z. If “o”e, , k nbeut ccmdftion in 3fJ or 4b. If rhts Is an asrerlsked condition, ask about n-x? Cendltlon men tion.sd in 30 or da. tf rhls is . 7JK ‘e. begin wirh quest)on 6, bur d net read zfw Oar.mheticals . ,\f no erher Cond;tion, go to Section S3. , t ~ “-32 10. W-s tha pdh ort ih= right ,Id=. tha Iaft 1 1 � Right 6s — Code ,Idm, or dew” the InlddlM? 1 CHECK Snow code and I I 20 Left 66 condition. Mark all fh.st .Yp/J:”. I a O Middle 67 ITEM 1 ~ t Cc.ndltlon ss. ~ , ~ Wh-n you got tftld palm. how 10”s , do-, N USUALLY last? I 3s ( ,0 Minutes (Th--- m-xi qu.,tlomw �m � bouf PmlrI : “S.*WJ *- *O”* ~enua.t , Ask if .,Yes., in Z: .mherwi.e go 20 B. o m None (8) : i o one ~7777 m Cen=trmt. all the time s. H-w mmmv DIFFERENT docton h9.m ~ 2 0 Two YOM W1.ltod *O, *I. p.l”? 1SBS8 o Varies too much fo, a 1 3 n Three o, more usual duration 1 I 34-38 ez-e4 6. DURINQ TME PAST 32 MONTHS. ~ 00.0 None 12. Durtmg how rnsmv d-y, lit th. Pmmt : Oo, none (75) 1 hc.w m.”v cfocsor .M.. dld ycnJ h.- I 001 Oone v==* cfld TOM hmwothlw pmln? t beau,. of chls p-l”? _ Days 1 I_ Number ef visits ~ 3060 EveryVdav

1 If more Ihbn 7.$ days [h 72, QO to 74 I 1 es 13. old .11 of thfs m.1” mee”r d“.l”m nm. I 7 0 v., (75) 37 I 7. Wm.. .mv d ~ follcwni”g =..w de”. (s-: I two vv..k p.rind? ZONO dt.m”c!.. ~au, (c c.”ditb” in check kern 7~? , 66-67 1 14. D“r7”v h- t’!l.hv DIFFERENT ---*. . .I.. . .- 1 I ,1” th- P.ht v-m, did vOU hh.”- this p.!”? : a. Upp.? kll ..,8”7 — Months Read if necessamc v-u drfnk. =h.lkv 1 i c1 Yes Whti ffquld emll.d I bmrlum � “d th.” I 20No %-r-y. � ,- trek+. ! sDDK -— -- ______,__ &__ + ______b. tf.rf.m .rmrn.? 1 m

Read if “IK,7.,tJry: Vm” .“ @W.m .= : � “.m. .txu.fn;”m t a Yes b8rium .tsd X-r.p of i W&r9.bd ym-rt .- , 2UN0 I 90DIC

20. Whett VO”U ha”. thl. P-!”. ... VOU, I bouwml ma..m.om. USUALLY Ioc...r j 1 n Yes ————______, *hm’1 n.a,m.t? ,nNe Y d. LOW., ..dweepy e, .oi.rw.e.pv? :----’––---E R.-d {f necessaw: A 1!s.s n.xlbf. - , wffh . ll~ht em tk � nd 1. 1“.mrtti h th. j “=*”wI .- them sh. , 0 Yes limlrw of -1.-. : 2DN0 Imr..tlw s.” b. , soDk . ..ml..d. —- —______.__-; -— —_4______0. Sow.pr.m er uffr..e..d? I L&_ Read If necessary: A s.1 IS rvbb.d cm ~ vow UPPU rl.ht .fd. I .nd .n In*cNrrl=nt 1- I rncw.d round th. I .,.. whll- -- 1 1 0 Yes .x.nsi”.r W.smh-. 2UN0 -“ . twl.”i.len ; sDDK �C,*.”. 1 � Merk &. OF’mmk. I 2 I 0 ~T.lephc... I l-fand Card S 7. intmvlew (9) Lmokl”m M thle e=rd. tdl mm th- 8. 43 mn’nb8.. th.t .hcwy Wh.r. th. p.lm ; ?0 [from tho lcondit;on in Check item 1n w.., ~ = 44 Iec**-d? 1 � s t 30 40 46 h.%wk aff fhsr apply. 50 (17) 47 D.Y “or p,ebe. ; 1 so 4!! � 7n 9 t so 80 61 ;}E en

9. W.. th. flmhl .bOW. tfm w.1.tn-, i � 62 b-10W ehm wml.t. or round th. 1 Above W. I.W”*7 1 z n Below Sa 64 Mark o)! that a~~fy. 1 3 � Around E ,M HIS,. ,,,.s, ,,., C-.*,

, ,. ,’ ,, . .. . .

61 0) N Table 1. Classification variables available for analysis of pain data, by survey or data system

NHES NHANES NMF/ NNS NMIHS Q) Cycle Cycle Cyc/e NHANES and and and Classificatiorr variab/es / // /// / // HHANES /// NHEFS NHLS NMCLJES NSPHPC NSFG NAMCS NHDS NNHS NOK /LTCP NFMS NMFS LF MS DS

Sex ...... X x x x x x x x x x x x x x x x x x x x x x Age ...... X x x x x x x x x x x x x x x x x x x x x x Race ...... X x x x x x x x x x x x x x x x — x x x x x Hispanic origin . – — x x x x x x x x x x x x x x Ethnicorigin, ...... – i x x x x x x — — — x — Education of individual, X x x x x x x x x x x x — — — x x x Education of head of o household ...... X x x x x x x x x x — — — x x — — Personal income – — — — x x x — x — — x x — — Family income, . X x x x x x x x x x x x — — x x x Marital status. X — x x x x x x x x x x x — — x x x x i Employment status. X — x x x x x x x x x x — — — x x x Laborforcestatus. X — x x x x x x x x x x — — — — x x Occupation. ... X — x x x x x x — x — — — — x x x Industry...... X — x x x x x x x- x — — — x x x — Classofworker. X x x x x– x x– — — — x x x — Region ...... X x x x x x x x x x x x x x x — x — x x — Location of rasidence X x x x x x x– x x x x x — x — — x — x x — Size of location of residence ...... X x x x x x x — x — — — — — — x Placeofbirth...... – x x x x x x x — — — — — — x x x Veteran status, . . X — x x x — i i: — — — i x x — Twin status ...... – x x — — — — — — — x — — Numberofpersons in household ...... X x x x x x x x x x x x — — x x x — Family relationship X — x x x x x x x– x — — — — x x Family structure. – x x — — x x — x — — — — — — x — — Number of rooms. – — x x x x– x — — — — — — — — — Medical insurance – — — x x- x i — x — x — — — x x — — Disability status . – — x x x x x x x — — x — — Height and weight . X i x x x x x x x — x — — — — — x — — Self-assessed heafth status ...... X x x x x x x x x x x — — — — x — Note: X means relevant information available NHES National Health Examination Suwey. NHANES National Health and Nutrhion Examination Survey, HHANES Hispanic Health and Nutrition Examination Suwey. NHEFS NHANES I Epidemiologic Followup Study. NHIS National Health interview Su~ey, NMCUES Nationai Medical Care Utilizatiorr and Expenditure Survev. NSPHPC National Survey of Personal Heatth Practices and Consequences. NSFG National Suwey of Family Gmwih. NAMCS National Ambulatory Medical Care Survey. NHDS National Hospital Discharge Survey. NNHS Nabonal Nursing Home Survey. NOK Nefl-of-tOn Component of the 19a5 NNHS. NMFI Nationaf Master Facility Invenlory ILTCP Inventory of Long-Term Care Places. NNS National Natatii Survey. NFMS Natiorraf Fetal Moriatify Survey. NMFS National Mortaflty Fo[lowback Survey. NMIHS National Maternal and Infant Heafih Survey. LF Longitudinal Foflow’up tothe NMIHS. MS Mortalitv Statistics. DS Divorce Sf2Jistics ,Table Il. Pain measures, by survey or data system

,. NHES NHANES NMFI NNS NMIHS Cycle Cycle Cycle NHANES and and and Classification variables / Ii /// / Ii HHANES /// NHEFS NHIS NMCUES NSPHPC NSFG NAMCS NHDS NNHS NOK ILTCP NFMS NMFS LF MS

Headache ...... X — x — x x(23) (9 x (5) (9 (s) (3,7) Magnitude ., .,..,... x — x x x x x — — x Scope ...... X x x x x x Structur e ...... X — — x x x x i — x Risk factors ...... - x x i i x — Impact ...... - x [ x i x Management ...... - i x : x x — .Trende ...... - — i x x x Orofacial pain ...... - — X@) (’) (5, (% F) (3) Magnitude ...... - x — Scope ...... – — x 1 i Structure ...... - x x i x Risk factors, ...... – x x — — i i x Impact ...... – x x — x i x Management ...... - x x : x x — Trends ...... - x x x ,. .Earache, ...... - x x — x x x(z,3) (] x (9 (3) (9 — X(3) Magnitude ...... – x x — x : x x x — — x Scope ...... – x x x x x — x Structure ...... - : i x x 1! x x x i x . Risk factors ...... – x x — — x x x i i x Impact ...... - — x x — x x i — — — — Management ...... - i — — i i x x x x — — Trends ...... – i x — — x x

Toothache, ...... - — x x x X(2,5) (4) (5) f’) (9 (9 Magnitude ...... - — — x x x — .Scope ...... - — — — x x x — — — i Structure, ...... – — — x x x i — Risk.factors , ...... – — x x — i i “; ‘ Impact, ...... - x x x x ii x Management ...... - i i — x x x x x ,Trend$, . .,, .,..... - — — — x x x x — — — —

Ches~pain .’ ...... X x “x x x x X(3) () (5) (3) (6) x (3) .Magpitude~ ...... X x x x x x x x Scope ...... X x x x x x x x x i :. S;ru@ure ...... X x x x x x x x — i x x . tjtskfactors ...... X — x x x x x x x i i x x Impact ...,.....+.. – — — x x x x x x x x i — x x Management . , ...... X — x ; x x x x x x x x x Trends’...... - x x x — x x

;,,

‘.’!.’

-. . . . 03 .& Table Il. Pain measures, by survey or data system – Con.

NHES NHANES NMFI NNS NMIHS Cycle Cyc/e Cyc/e NHANES and and and C/assifi@tion variables / II Ill / II HHANES Ill NHEFS NHIS NMCUES NSPHPC NSFG NAMCS NHDS NNHS NOK ILTCP NFMS NMFS LF MS

Abdominal pain. . . — — X(8) x — x x — x (3) (’) — — (9 (9 (’9 — — — [3.7) Magnitude ...... — x x x x x x — — — — — x Scope ...... x x — x x — x x — — — — — — — x — Structure ...... — — x x — x x — x x — x — — — — x — Risk factors. . . — — — x — x x — — x i — — — — — x — Impact ...... — — — — x i — x x — — x x x Management. . — x — — x x — x x — — x x x — Trends ...... — — — — x x — — x x — — — — — —

Backpain ...... — x x x — x x X(3) (7 — — t’) (3 X(6) f’) f) Magnitude ...... x x x — x x x x — — Scope . . — — x x x x x x x — x Structure ...... — — x x x — x x x x — x — x Riskfactors . .— — — x x — x x x x — x x — x- Impact ...... x x — — x x x x x x — — — x — Management x x x x x x x x — x — — — — Trends ...... x x x — x x x — —

Joint or arthritis pain x — — x x x x x X(3) (’) — — (’) (3) X(6) x f’) — (9 — Magnitude ...... x . x x x x x x x — — — — — — — — Scope ...... x — — x x x x x x x — — — — — — — x Structure ...... x — x x x x x x x — — — — x i — — x Riskfactors — — — x x x x x x x — x x — x — x Impact ...... — — x x — — x x x — — x x x x x- Management . x x x — x x x x x x x Trends ...... x x x x x x x — — — —

Burns ...... — — — — x — — — (2.3) (4) — (’) (’) (=) (10) x — X(3) (9 Magnitude ...... — — — x — — — x x — — — — — — x x Scope ...... — — — — x — — — x x — — — — — — — — — x x Structure ...... — — — x — — — x x — — — x x — — x — Riskfactors — — — — — x x — x x — x — x — Impact ...... — — — — — — — — x x — x x x x — x Management — — — — — x — x x x — x Trends ...... x x x x — x

Injuries ...... — — x x x — — x X(3) (’) — t’) (’) X(6) X(I 1) F’) — — X(3) (3) Magnitude ...... — — x x x — — x x x — — — — — x x Scope ...... — — x x x — x x x — — — — — x x Structure ...... — x x x — — x x x — — x x — — x — Riskfactors — — — — — x x x — x i — x — — — x — Impact ...... — — — x x — — x x x — — x x x x — — x — Management — — x x x — — x x x — — x x x — i — — — — Trends ...... x x x x x — x — Table IL Pain measures, by survey or data system–Con.

. NHES NHANES NMF/ NNS NMIHS Cycle Cycle Cycle NHANES and and and Clas.sification variables I II Ill / II HHANES Ill NHEFS NHLS NMCUES NSPHPC NSFG NAMCS NHDS NNHS NOK ILTCP NFMS NMFS LF MS

Extremity pain . ...’... - – – x­ x x x X(3) (5) (9 (9 - (9 - - (3) ­ Magnitude ...... – – – X - x x x x -. — .- Scope ...... - - - x­ x x x x x x- Structure ...... - - - X ­ x x x x x — i:-:: x- Risk.factors ...... - _ - x­ x x x .x x — — i i -- x­ Impact ...... e.. - - - X – — x x x x x x i- x­ Management ...... - - - X – — x x x x. x x– i::–– Trends ...... - – – – – x x i x -- - -—

Labor pain ...... – - - - - (4) (5) (3) - - - x - X(3) - Magnitude ...... - - - - - x -— - Scope ...... - – – – - x — — -— Structure ...... – - - - - x Flkkfactors ...... – - – – – — x Impact ...... – – – – - Management ...... – - - - - 1 Trends ...... - - - - - x

,. ‘Variables are not identical across surveys. 21f reporfed as owuming in past 2 weeks and meete the NHIS specifications. 3[CD=oded ~ndi,lOns.

4Questions about health or mectkal consequences lead to lCD-coded conditions that maybe identified as painful. :5P!atients’ symptoms and physicians’ diagnoses. ‘lCD-coded condfions since 1985. 7Durirrg specified pregnansy. ‘Mensfrualpaln. ‘Ortffopadic, physical therapy, and rehabifila.flcrn services. 10BumS ara included in a category with skin diseasea and infeciiOn<­ . I lSelested injury data.

‘NH& National Health Examination Survey. NHANES National Health and Nuhition Examination Survey. HHAJ4ES Hispanic Health and Nutrition Examination Survey. ,,NHEFS NHANES I Epidemiologic Followup Study. NHIS National Healfh Interview Survey. NMCUES Nallonal Medical Care Utilization and Expenditure Survey. NSPHPC National Survey of Personal Health Practicas and Consequences. NSFG, National Survey of Family Growlh. NAMCS National Ambulatory Medical Care Survey. NHDS National Hospital Discharge Suwey. J4NHS National Nursing Home Suwey. . NOK , : Next-of.lQn Componant of Ihe 1985 NNHS, NMFI National Master Facifity Invanlory. ILTCF! Inventory of Lorrg-Term Care Places. NNS ~ National Natafity Survey. NFMS National Fetal Mortalibj Survey. NMFS National Morrafity Followback Survey. .NMIHS,’ National Maternal and Infant Heaflh Survey. ‘LF _ Longitudinal Followup to the NMIHS. MS. Morlafity Statistics. 0s”’ Divorce SL3fisfiss.

(

. . m m Appendix VI h7ternationa/ Classification of Diseases description

The International Classrjication of Diseases (ICD), The ICD is used for classifying cause of death for used to classify cause of death, is pubIished by the World NCHS mortality statistics, as well as the coding of condi­ Health Organization and revised approximately every 10 tions reported in the Hispanic Health and Nutrition years. It has been used in most National Center for HeaIth Examination Survey, the National Health Interview Statistics (NCHS) surveys in which condition data are col­ Survey, and the National Medical Care Utilization and lected. Most NCHS data systems that employ the ICD Expenditure Survey. An extensive coding manual, devel­ coding system began using the ninth revision of the ICD oped by the Division of Health Interview Statistics, pro­ (ICD-9) or the clinical modification of the ICD-9 (ICD- vides detailed guidelines for the coding of selected 9-CM) in 1979. (In the ICD-9-CM, developed jointly by diagnoses and impairments. (Impairment codes are inde­ NCHS, the Health Care Financing Administration, and pendent of the ICD.) other U.S. organizations in the health care field, an extra The ICD-9-CM has been used in classifying physician digit is added to many original codes and a number of the diagnoses reported in NAMCS, NHDS, the examination original ICD-9 codes are modified as well.) components of the National Health and Nutrition Exami­ Prior to the ninth revision, NCHS data systems did nation Surveys, and (in 1986) the National Mortality not begin using the new revisions in the same data year. Survey. Before 1979, if a condition was listed with a The eighth revision (including the ICD–Adapted) was symptom (such as “pain”), only the condition was coded used from approximately 1968 to 1978, and the seventh in NHDS. revision was used from approximately 1958 to 1967. Users Some NCHS data systems do not use the ICD coding who intend to use condition data from these earlier years system. The National Health Examination Surveys, Cycles should consult the data system’s technical contact I, II, and III, and the National Nursing Home Surveys regarding the ICD revision in use at the time and any (until 1985) contain data on clinical conditions, but these modifications made to the official ICD codes, Compara­ data are coded using non-ICD coding schemes. In the case bility ratios between the eighth and ninth revisions, using of the National Nursing Home Survey, a preceded list of data from two NCHS morbidity surveys – the National selected diagnoses, very much like but not identical to Ambulatory Medical Care Survey (NAMCS) and the ICD-9 categories, was used until 1985; since 1985, condi­ National Hospital Discharge Survey (NHDS) – are avail- tions have been coded using the ICD. The National able (112). Comparability ratios between the eighth and Survey of Personal Health Practices and Consequences, ninth revisions for selected causes of death, as well as the National Master Facility Inventory, the National comparability ratios for the seventh and eighth revisions, Survey of Family Growth, and the National Natality are also available (113). These ratios assist researchers in Survey contain no condition data that require medical interpreting trends in ICD-coded conditions that may be coding. attributable to changes in the classification system.

T!? U.S. GOVERNMENT PRINTING OFFICE 1992 –3 12 -0 82 I 6 00 06

66 Vital and Health Statistics series description

SERIES 1. Programs and Collection Procedures–Reports SERIES 15. Data From Special Su~eys–Statistics on health and describing the general programs of the National Center for health-related topics collected in special surveys that are Health Statistics and its offices and divisions and the data not a part of the continuing data systems of the National collection methods used. They also include definitions and Center for Health Statistics. other material necessary for understanding the data. SERIES 16. Compilations of Advance Data From Vital and Health SERIES 2. Data Evaluation and Methods Research –Studies of new Statistics –These reports provide early release of data statistical methodology including experimental tests of new from the National Center for Health Statistics’ health and survey methods, studies of vital statistics collection demographic surveys. Many of these releases are followed methods, new analytical techniques, objective evaluations by detailed reports in the Vital and Health Statistics Series.

of reliability of collected data, and contributions to statistical SERIES 20. Data on Mortality-Various statistics on mortali~ other theoty. Studies also include comparison of u..% than as included in regular annual or monthly reports. methodology with those of other countries. Special analyses by cause of death, age, and other SERIES 3. Analytical and Epidemiological Studies–Reports demographic variables; geographic and time series presenting analytical or interpretive studies based on vital analyses; and statistics on characteristics of deaths not and health statistics, carrying the analysis further than the available from the vital records based on sample surveys of expository types of reports in the other series. those records.

SERIES 4. Documents and Committee Reports – Final reports of SERIES 21. Data on Natality, Marriage, and Divorce-Various major committees concerned with vital and health statistics statistics on natality, marriage, and divorce other than and documents such as recommended model vital those included in regular annual or monthly reports. registration laws and revised birth and death certificates. Special analyses by demographic variables; geographic and time series analyseq studies of fertili~ and stati~cs SERIES 5. Comparative International Vital and Health Statistics on characteristics of births not available from the vital Reports-Analytical and descriptive reports comparing records based on sample surveys of those records. US. vital and health statistics with those of other countries. SERIES 22. Data From the National Mortality and Natality Surveys– SERIES 6. Cognition and Survey Measurement – Repofls from the Discontinued in 1975. Reporta from these sample surveys National Laboratory for Collaborative Research in Cognition based on vital records are included in Series 20 and 21, and Survey Measurement using methods of cognitive respectively. science to design, evaluate, and test survey instruments. SERIES 23. Data From the National Survey of Family Growth– SERIES 10. Data From the National Health Interview Survey– Statistics on fertility, family formation and dissolution, family Statistics on illness, accidental injuries, disability, use of planning, and related maternal and infant health topics hospital, medical, dental, and other services, and other derived from a periodic survey of a nationwide probability health-related topics, all based on data collected in the sample of women 1.5-44 years of age. continuing national household interview survey. SERIES 24. Compilations of Data on Natality, Mortali& Marriage, SERIES 11. Data From the National Health Examination Survey and Divorce, and Induced Termination of Pregnancy– the National Health and Nutrition Examination Survey– Advance reports of births, deaths, marriages, and divorces Data from direct examination, testing, and measurement of are based on final data from the National Vital Statistics national samples of the civilian noninstitutionalized System and are published annually as supplements to the population provide the basis for (1) estimates of the Monthly Vital Statistics Report (MVSR). These reports are medically defined prevalence of specific diseases in the followed by the publication of detailed data in Vital United States and the distributions of the population with Statistics of the United States annual volumes. Other respect to physical, physiological, and psychological reports including induced terminations of pregnancy issued characteristics and (2) analysis of relationships among the periodically as supplements to the MVSR provide selected various measurements without reference to an explicit finite findings baaed on data from the National Vital Statistics universe of persons. System and may be followed by detailed reports in the Vital SERIES 12. Data From the Institutionalized Population Surveys – and Health Statistics Series. Discontinued in 1975. Reports from these surveys are included in Series 13, For answers to questions about this report or for a list of titles of reports SERIES 13. Data on Health Resources Utilization – Statistics on the published in these series, contact utilization of health manpower and facilities providing long- term care, ambulatory care, hospital care, and family Scientific and Technical Information Branch planning services. National Center for Health Statistics Centers for Disease Control SERIES 14. Data on Health Resources: Manpower and Facilities– Public Health Service Statistics on the numbers, geographic distribution, and 6525 Belcrest Road, Room 1064 characteristics of health resources including physicians, Hyattsville, Md. 20782 dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities. 301-436-8500 ...

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