Data from the Series 11 NATIONAL HEALTH SURVEY Number 160 Skeletal Maturity Of Youths 12-17 Years United States Skeletal age (hand-wrist), onset of ossification and bone-specific skeletal ages by chronolog- ical age and sex of boys and girls 12-17 years of age as assessedby the Health Examination Survey Standard based primarily on the Greulich-Pyle Radiographic Atlas. DHEW Publication No. (H RA) 77-1642 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health ResourcesAdministration National Center for Health Statistics Rockville, Md. November 1976 .— Library of Congress Cataloging in Publication Data Roche, Alex F Skeletal maturity of youths 12-17 years, United States. (Vital and health statistics: Series 11, Data from the National Health Survey; no. 160) (DHEW publication; no. (HRA) 77-1642) Includes bibliographical references. 1. Youth–United States–Growth. 2. Bone–Growth. 3. Man-Age determination. L Roberts, Jean, joint author. II. Hamill, Peter V. V., joint author. III. Title. IV. Series: United States. National Center for Health Statistics. Vital and health statistics: Series 11, Data from the National Health Survey, Data from the health examination survey; no. 160. V. Series: United States. Dept. of Health, Education, and Welfare. DHEW publication; no. (HRA) 77-1642. [DNLM: 1. Age determination by Skeleton–In adolescence. 2. Bone de- velopment–In adolescence. W2 A N148vk no. 160] RA407.3.A347 no. 160 [RJ140] 312’.’973s 76-5857 ISBN 0-8406 -0070-4 [312’.6] .— For sale by the Superintendent of Documents, U.S. Government Printiug Office, Washington, D.C. 20402- Price $1.55 NATIONAL CENTER FOR HEALTH STATISTICS DOROTHY P. RICE, Director ROBERT A. ISRAEL, Deputy Director JACOB J. FELDMAN, Ph.D., Associate Director for Analysis GAIL F. FISHER, Associate Director for the Cooperative Health Statistics System ELIJAH L. WHITE, Associate Director for Data Systems GEORGE P, FAILLA, Associate Director for Management PETER L, HURLEY, Associate Director for Operations JAMES M. ROBEY, Ph.D., Associate Director for Program Development ALICE HAYWOOD, Information Officer DIVISION OF HEALTH EXAMINATION STATISTICS ARTHUR J. McDOWELL, Director JEAN-PIERRE HABICHT, M.D., Ph.D., Special Assistant to Director PETER V. V. HAMILL, M.D., Medical Adviser JEAN ROBERTS, Chief Medical Statistics Branch ROBERT S. MURPHY, Chief Survey Planning and Development Branch COOPERATION OF THE BUREAU OF THE CENSUS In accordance with specifications established by the National Center for Health Statistics, the Bureau of the Census, under a contractual agreement, participated in the design and select- ion of the sample, and carried out the first stage of the field interviewing and certtin P~S of the statistical processing. Vital and Health Statistics - Series 1l-No. 160 DHEW Publication No. (HRA) 77-1642 Library of Congress Catalog Card Number 76-5857 CONTENTS Page Introduction ---------------------------------------------------------- 1 The Nature of Skeletal Maturation --------------------------- ----------- 3 Histological Changes ----------------------------------------------- 3 Radiographic Changes --------------------------- ------------------- 5 Scale of Maturity ------------------- ------------------ -------------- 5 The Usefulness of Skeletal Maturi~ Assessments ----------------------- 6 The Health Examination Survey Standard --------------------------- ----- 8 Method . --------------------------- ---------------------------- ------ 8 Field Radiography - --------------------------- --------- ------------ 9 Training of Assessors ---------------------------------------------- 9 Assessment Procedure --------------------- ------- -------------- --- 10 Findings - ---------------- -----”-” ------- -------- -------- *------ ------ 11 Skeletal Age (H=d-Wrist) ------------------------------------------ 11 Bone-Specific Skeletal Ages ----------------------------------------- 23 Range of Bone-Specific Skeletal Ages -------------------------------- 28 Onset of Ossification ----------------------------------------------- 28 Epiphyseal Fusion --------------------------- ------------------ ----- 30 Youths Also Examined as Children --------------------------- ---------- 32 Discussion “—------ --------------------------- ------------------------ 34 Mean Skeletal Age (Hand-Wrist) ------------------- ------------------ - 36 Variability of Means -------------------- -------------------- -------- 41 Bone-Specific Skeletal Ages -------------------- -------------------- - 41 Onset of Ossification --------- --------------- -------- ---------------- 43 Epiphyseal Fusion -------------------------------------------------- 43 Youths Also Examined as ChiMren ---------- ------------------------- 43 Conclusion ------- --------------- --------------- -------- ------------ 44 Summary - ----.-------” ----- “-------- --------------------------- ----- 44 Epiphyseal Fusion ----------.------------” ------------ -------------- 45 Youths Also Examined as Chiltien ----------------------------------- 45 References ---.” ---------------------- “-------- ------------.---” ------- 47 List of Detailed Tables ---------------------- ------- ------------------- 53 ill Page Appendix I. Statistical Notes ------------------ ----- ”--- . --- . -- .------” 85 The Survey Design --------------------- ------- . ----------- ..---”---- 85 Reliabili~--------------------------------------------------------- 86 Sampling and Measurement Error --------------------------- --------- 87 Small Numbers ----” ---------------------- --------- ---------------- 87 Appendix II. Reliability of Assessments ---------------------------- ---- 89 Area Skeletal Ages -------- ------- -------------- -------------------- 90 Bone-Specific Skeletal Ages --------------------------- -------------- 90 Factors Influencing Replicabili~------------------------------------- 90 SYMBOLS Data not available -------------------------------------- --- Category nonapplicable ------------------------------- . Quantity zero --------------------------------------------- - Quantity morethan Obutless than 0.05----- 0.0 Figure does not meet standards of reliability or precision ------------------------------ * SKELETALMATURITY OF YOUTHS 12-17YEARS tiexF. Roche, M.D., Fek Research Insitute, Jean Roberts and Peter V. V. Hard, M.D., Division of Health Examination Statistics INTRODUCTION port were obtained, collects health data by direct physical examinations, tests, and measurements This report presents national estimates of performed on samples of the population. The latter the levels of skeletal maturity of the hand-wrist program provides the best way of obtaining actual for noninstitutionalized United States youths age diagnostic data on the prevalence of certain medi- 12-17 years based on findings from the Health cally defined illnesses. It is the only effective way Examination Survey of 1966-70. This is the first to secure information on unrecognized and undiag- time estimates of skeletal maturity have been nosed conditions and on many physical, physiologi- made for the youth age span in this or any other cal, and psychological measures within the popula- country, but national estimates from a corre- tion. It also collects demographic and socioeco- sponding study of children age 6-11 years in the nomic data on the sample population under study to United States in 1963-65 have been reported pre- which the examination findings may be related. viously. 1,2 These national studies provide esti- The Health Examination Survey is organized mates of known reliability against which future as a series of separate programs or cycles, each possible changes in skeletal maturation rates for of which is limited to some specific segment of the country as a whole can be judged. the U.S. population and to specific aspects of The Health Examination Survey is one of the health. From data collected during the first cycle, major programs of the National Center for Health the prevalence of certain chronic diseases and the Statistics authorized under the National Health distribution of various physical and physiological Survey Act of 1956 by the 84th Congress as a con- measures were determined on a cross-section of tinuing Public Health Service function to determine the defined adult population as previously de- the health status of the United States population. scribed. 4’5 Four types of survey programs are used to For the second cycle or program, a probabil- carry out the intent of the National Health Survey.3 ityy sample of the noninstitutionalized children 6-11 The Health Interview Survey, collecting informa- years of age in the United States was selected and tion from samples of people by household inter- examined in 1963-65. The examination in this view, is focused primarily on the impact of illness cross- sectional study primarily assessed health and disability within various population groups. factors related to growth and development as de- The programs in the Divisions of Health Resources scribed in a previous report. G Utilization Statistics and Health Manpower and The third cycle, on which findings in this re- Facilities Statistics obtain health data as well as port are based, was designed as in the preceding health resource and utilization information childrenls program to collect data on the health through surveys of hospitals, nursing homes, and status of the youth population with particular em- other resident institutions and the entire range of phasis on factors and conditions related to their personnel in the health occupations. The Health