Use of Dental Services and Dental Health United States, 1986 Includes estimates on volume of dental visits, time interval since last dental visit, reason for last dental visit, private dental health insurance, use of fluoride products, dental sealants, and dentition status. Estimates are based on data collected in the National Health Interview Survey of 1986. Data From the National Health Survey Series 10, No. 165 DHHS Publication No. (PHS) 88-1593 U.S. Department of Health and Human Services Public Health Service Centers for Disease Control National Center for Health Statistics Hyattsville, Md. October 1988
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Use of DentalServices andDental HealthUnited States, 1986
Includes estimates on volume of dental
visits, time interval since last dental visit,
reason for last dental visit, private dental
health insurance, use of fluoride products,
dental sealants, and dentition status.
Estimates are based on data collected inthe National Health Interview Survey of 1986.
Data From the National Health SurveySeries 10, No. 165
DHHS Publication No. (PHS) 88-1593
U.S. Department of Health and Human
Services
Public Health Service
Centers for Disease Control
National Center for Health Statistics
Hyattsville, Md.
October 1988
.
All material appearing in this report is in the publii dC+IMinand maybe
reproduced or copied without permission; citation as to souroe, howevw, is
ww=+~~.
National Center for Health statistics, S. Jsok and B. Mom. 1S66. Use of dental
For sale by the Superintendent of Documents, U.S. Government Printing OISee, Washington, D.C. 20402
\
National Center for Health Statistics
Manning Feinleib, M.D., Dr.P.H., Director
Robert A. Israel, Deputy Director
Jacob J. Feldman, Ph.D., Associate Director for AnaZysisand Eptiemwlogy
Gail F. Fisher, Ph.D., Associate Director for Pkuming andExtramurfd Programs
Peter L. Hurley, Associate Director for VW and HealthStatistics Systems
Stephen E. Nieberdin& Associate Director for Management
George A. Schnack, Associate Director for Data Processingand Services
Monroe G. Sirken, Ph.D., Associate Director for Researchand Methodology
S“&draS. Smith, Infownation Officer
Division of Health Interview Statistics
Owen T. Thomber~, Jr., Ph.D., Division Director
Deborah M. Winn, Ph.D., Deputy Director
Gerry E. Hendershot, Ph.D., Chief IZlnessand Disabili&Statistics Branch
Nelma B. Keen, Chie$ Systems and Programming Branch
Stewart C. Rice, Jr., ChieJ Survey Pkmning andDevelopment Branch
Robert A. Wright, Chie$ Utilization and ExpenditureStatistics Branch
Cooper@”onof the U.S. BurearAof the Census
Under the legislation estahlfshing the National Health Interview Survey, thePubffc Heafth Serviee is authorized to use, insofar as possible, the services orfacilities of other Fede~ State, or private agenciea.
In accordance with specitkiitioms established by the Diviiion of HenkhIute*w Statistics, the U.S. Buremrof the Census, under a contractualarrangement,participated in planning the surveyand collecting the data.
Percentof persons2 yearsof age and over withdentalvisitsin pastyear and number oftisits per personperyear, by selected characteristic United States,1983 and 1986. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Percentof persons45 yearsof age and over who were edenlndous,by age, sex,and ractzUnitedStates,1983and 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Age-adjusted percent distributionof persons 2 years of age and over by intervalsince last dental visit,according to selected demographiccharacteristic United States,1986. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Age-adjusted percent distributionof persons 2 years of age and over by intervalsince last dental visit,a~rding toselectd w&oemnomic ch=acteristia: Unitd Statm, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Age-adjusted percent distributionof persons 2 years of age and over by intervalsince last dental visit,according to selected healthcharacteristicsUnited States,1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Age-adjustedpercent distributionof persons2 yearsof age and over by number of dentalvisitsin pastyear,according to selected demographiccharacteristic United States,1986. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Age-adjusted percent distributionof persons2 yearsof age and over by number of dentalvisitsin pastyear,according to selected socioeconomic characteristics:United States,1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Age-adjusted percent distr]%utionof persons2 yearsof age and over by number of dentalvisitsin pastyear,according toselected healthcharacteristk United States,1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Age-adjusted number of dentalvisitsper person per year, by sex and selected demographic characteristicUnited States,1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Age-adjustednumber of dentalvisitsper person per year,by sex and selectedsocioeconomic characteristicsUnited States,1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Age-adjusted number of dentalvisitsper person per year, by sex and selectedhealthcharacteristics:UnitedStates,1986. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Table M. Age-adjusted percent distribution of persons 2 years of age and over by private dental insurance status,according to selected demographic characteristics: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Table N. Age-adjusted percent distribution of persons 2 years of age and over by private dental insurance status,according to selected socioeconomic characteristics: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Table O. Age-adjusted percent distribution of persons 2 years of age and over by private dental insurance status,according to selected health characteristics United States, 1986 . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 10
Symbols
--- Data not available
. . . Category not applicable
Quantity zero
0.0 Quantity more than zero but less than0.05
z Quant.ky more than zero but less than500 where numbers are rounded tothousands
* Figure does not meet standard ofreliabiky or precision (more than30-percent relative standard error innumerator of percent or rate)
# Figure suppressed to comply withconfidentiality requirements
iv
Use of Dental Servicesand Dental Health:United States, 1986by Susan S. Jack, M.S., andBarbara Bloom, M.P.A., Division of HealthInterview Statistics
IntroductionFor the 1986 National Health Interview Survey
(NHIS), a cross-sectional household survey ecmducted bythe National Center for Health Statistics (NCHS), ques-tions were included on the dental health care of the civiliannoninstitutionalized population of the United States overthe age of 2 years. Included were questions on the intervalsince last dental visit, the number of dental visits, edentu-lousness (the loss of all natural teeth), the use of fluorideproducts and dental sealants, and private dental insurance.Some of the questions had been asked in previous years ofthe NHIS, but some were asked for the first time for 1986.Data on the use of dental services and other dental topicsfrom earlier years of the NHfS are available in severalreports from the National Center for Health Statistics(NCHS, 1972,1974,1982, 1986).
This report contains national estimates of the volumeand timing of dental visits and coverage by private dentaIinsurance. Other sections contain estimates of the dentalhealth practices and of the use of fluoride products bychildren, edentulousness and the use of services by personsin the middle and later years, and the use of dental servicesby persons with and without private dental insurance.
In addition to published reports from NHIS, data arealso available on microdata tapes. Public use tapes areavailable for dental topies as well as many other specialhealth topics included in NHIS from 1973 through 1986.Information on these tapes is available from the NationalCenter for Health Statistics, Division of Health InterviewStatistics, Systems and Programming Branch, 3700 East-West Highway, Hyattsville, Md. 20782.
Highlights
In 1986, more than half of the population (57.1 per-cent) reported having had a dental visit in the previous year.
Americans over the age of 2 years made an estimated466.8 million visits to dentists in 1986.
Subgroups of the population in which relatively largeproportions reported no dental visits in the previous yearwercx
. The very young (aged 2-4 years).
. Persons 55 years of age and over.
. Males.● Black persons.● Mexican-American persons.● Persons with less than a high school education.● Persons with low family income.
Groups with high rates of dental visits per person peryear included
●
●
●
●
●
●
●
●
Females.White persons.Non-Hispanic persons.Persons living in metropolitan statistical areas(MSA’S).Persons living in the Northeast.Persons with high family income.Persons with high education.Persons with dental insurance.
Nearly one-quarter of all Americans over the age of 45years had lost all their natural teeth, however, most eden-tulous persons were 65 years of age or older.
Edentulousness was relatively more common amongpersons who had a family income of less than $15,000 andpersons with less than a high school education.
Of the population 2 years of age and over, 37.8 percent(86.6 million persons) was reported to have private dentalinsurance coverage. More than half (56.7 percent, or 130million persons) was not covered. (Coverage. status wasunknown for the remainder.)
The proportion of the population covered by privatedental insurance differed by education, income, and healthstatus. In general, the higher the income or education orthe better the reported health status, the greater the pro-portion with coverage.
Coverage by private dentrd insurance was most com-mon for the following groups:
● White persons.. Non-Hispanic persons.● Persons living in suburban areas.● Persons living outside the South.● Dentate persons.
2
Source and limitationsof the data
The information from the National Health InterviewSurvey (NHIS) presented in this report is based on datacollected in a continuing nationwide household interviewsurvey. Each week a probability sample of the civiliannoninstitutionalizedpopulation of the United Statesis in-terviewedby personnel of the U.S. Bureau of the Census.Informationis obtained about the healthand other charac-teristicsof each member of the household.
Because of funding limitations,the 1986 NHIS wasconducted with a sample approximatelyhalf the size of thefull sample design. The interviewedsample for 1986 wascomposed of 23,838 households containing62,052 persons.The total noninterviewrate was 3.5 percent 2.3 percentwasdue primarilyto failureto locate an eligiblerespondentat home after repeated calls.
In 1985,the NHISwasgivenseveralnew sampledesignfeatures,althoughthe samplingplan concept remainedthesame as for the previous design. Major changes includedreducingthe number of primarysamplingunitshorn 376 to198 for samplingefficiency,oversamplingthe black popula-tion to improve the precision of the statistics,subdividingthe NHIS sample into four separaterepresentativepanelsto facilitatelinkagewithother NCHS surveys,and using anall-areaframe not based on the decennial census to facili-tateNCHS surveylinkageand to conduct NHIS followbacksurveys.A description of the survey design, the methodsused in estimation,and general qualificationsof the dataobtained from the surveyare presentedin appendixL
For this report, information about dental health wasobtained for all persons 2 years of age and over. Noquestionswere asked about infants and children under 2yearsof age, because childrenin thisage group are growingtheir first teeth and rarely, if ever, visit a dentist. Inaddition,one question on participationin a fluoride mouthrinseprogram at school was limitedto children 2-16 yearsof age.
Because the estimates presented in this report arebased on a sample of the population, they are subject tosamplingerrors.Samplingerrorsfor the 1986 estimatesarelarger than in preceding years because of the reducedsamplesize.Therefore, readersshouldpayp@icukr atten-tion to the section of appendixI entitled“Reliabilityof theestimates,”which presents formulas for calculating stan-dard errors and instructionsfor theiruse.
All information collected in the surveyis reported byresponsible family members residing in the household.
When possible, all adult familymembers participatein theinterview.However, proxy responses are accepted for fam-ily members who are not at home and are required for allchildren and for family members who do not meet theNHIS criteria for a respondent. AJthough a considerableeffort is made to ensureaccuratereporting,the informationfrom both proxy and self-reqmndents may be inaccuratebwause the respondentis unawareof relevantinformation,has forgotten it, does not wishto revealit to an interviewer,or misinterpretsthe question.
The major dental health and demographic conceptsdescribed in thisreport me defined in appendixII. Appen-dix III includes a copy of the questions used in 1986 toobtain dental healthinformation.The entire questionnairefor 1986 is presented in the 1986 Current Estimates(NCHS, 1987).
Most of the detailedtables in thisreport (tables 1–15)appear in parallelsetsof three, showingdentalvariablesbygroups of demographic, smioeconomi~ and health-relatedfactors.Table 1 showsthe number and table 2, the percentdistributionof persons by interval since last dental visit,according to a wide range of demographicvariables.Tables3 and 4 show the same interval data by socioeconomicfactors and tables5 and 6, by health-relatedfactors.Tables7–9, 10-12, and 13-15 show other dependent dentalvari-ables by the same three groups of demographic socioeco-nomic, and health-related variables. Tables 16 and 17concentrateon age subsets,children2–16 yearsof age, andthe middle-aged and older portions of the population.Tables 18 and 19 focus on the effects on dental sexvicesusage of dental insurance and the interrelatedfactors ofeducation and income. Tables 20-23 show the populationsused to calculate the unstandardized rates used in thisreport.
In thisreport, terms such as “similar” and “no differ-ence” mean that there is no statisticallysignificantdiffer-ence between the measures being compared. Termsrelatingto difference (for example, “greater than” or “lessthan”) indicate that differences are statisticallysignificant.The t-test, with a critical value of 1.96 (0.05 level ofsignificance), was used to test all comparisons that arediscussed. Lack of comment regarding the difference be-tween any two statisticsdoes not mean the difference wastested and found not to be significant.
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Sekcted topics
Dental data: 1983 and 1986
The proportion of the population with a recent dentalvisit (within the last year) increased from 55.0 percent in1983 to 57.1 percent in 1986. The increase occurred in mostage groups (table A).
The average number of dental visits per person peryear was 1.9 in 1983 and 2.0 in 1986. The rate of dentalvisits was higher in 1986 for those 55 years of age and over,particularly for males (not shown).
The estimated number of dental visits made by persons65 years of age and over increased from 32.5 million in1980 to 39.6 million in 1983 and to 58.4 million in 1986.
In 1986 the proportion of persons 45 years of age andover who were edentulous was 24.0 percent (18 millionpersons), a decrease from 25.5 percent (17.4 million) in1983 (table B).
Table A. Percent of persons 2 years of age and over with dentalvisits in past year and number of visits per person per year, byselected characteristics: United States, 1983 and 1986
Percent wiih tit Number of VMS perIn past year person perywr
There were wide variations between population sub-groups in the proportions reporting dental visits in the yearbefore the interview. More than half of the population (57.1percent, or about 131 million persons) was reported to havehad a dental visit in the year prior to the interview (tables Cand 1-2). Because the age distributions in many of thevarious population groups differ considerably, the datahave been age-adjusted to the total U.S. population in 1986.(By assuming identical age distributions for all groups, thisprocedure standardizes the age differences betweengroups.) Using age-adjusted data (tables GE), the charac-teristics associated with a relatively high proportion ofpersons having a recent dental visit were female, white,non-Hispanic, living in the suburbs (h&% not central city),college education, f@ly income more than $35,000, pri-vate dental insurance, excellent or very good health, anddentate (having at least one natural tooth).
i% important measure of inadequate dental care is theproportion of the population that has never seen a dentist.Although the vast majority of Americans over the age of 2years has visited a dentist, more than 11 million Americans(11.6 million) have never had-a dental visit (table 1). Only31.3 percent of children 24 years of age had seen a dentistin the previous year, and 58.7 percent (6.4 million) hadnever seen a dentist (tables 1 and 2).
The reported use of dental care services varied greatlyby age as well as by other demographic characteristics.Children 5-17 years of age were most likely to have re-ported a visit within the previous year, followed by thoseaged 25-44 years. At ages 45 years and over, the proportionwith a recent visit decreased with age, reflecting in part anincrease in edentulousness with age.
Overall, females were more likely than were males tohave had a visit in the previous year (59.2 percent and 54.9percent) (table 2). A smaller proportion of black personsthan of white persons (43.6 percent and 59.2 percent) hadrecent dental visits, and black children were more likelythan were white children never to have been to a dentist,particularly those 5–11 years of age.
In general, Hispanic persons were less likely thannon-Hispanic persons to have visited a dentist in the previ-ous year, due primarily to the lower proportion of Mexican-Americans who had had recent visits. More than one-fifthof all Hispanic children aged 2-4 years had had a dental
Table B. Percent of persons 4S years of age ●nd over who wore ●dentulous, by ●ge, se% ●nd race: Unftsd States, 1983 and 1966
Total45yRws 45+4 ai-tw 65-74 Byearsand Okw w w m andcwi
Table C. Age-adjusted percent distribution of persons 2 years of age and over by interval since last dental visi$ according to selecteddemographiccharacteristics: United States, 1986
Table D. Age-adjusted percent distribution of persons 2 years of age and over by interval since last dental visk according to selectedsocioeconomic characteristics: United States, 1986
Interval since lest dental vlsfl
1 year 2 yearsAt! Lees than up to up to 5years
CharackwWc intervald 1 year 2 yeals 5 ware or more Never
Table E. Age-adjusted percent distribution of persons 2 years of age and over by interval since last dental visitj according to sstlectedhealth characteristics: United States, 1986
Inierval since last dental vlslt
lyw 2yearsAll Le.ss than up to up to 5years
Charedef7stk lnterva/sl 1 year 2 Yeats 5years or more Never
visit in the year prior to interview, compared with nearlyone-third of all non-Hispanic children in the same agegroup.
Persons living inthe suburbs (MSA, not central cily)were more likely to report having had areeent dental visit(61.4 percent) than those living in a central city (54.3percent) or outside of an MSA (52.3 percent). Personsliving in the South were less likely to have had a recentdental visit than people in other regions.
Family income, dental insurance coverage, andeduca-tional attainment (for adults) were related to use of dentalservices (tables 3 and 4). Family income level was related tothe proportionof persons with arecent dental visit (table3): 40.9 percent of those with a family income below$10,000; 47.5 percent and 61.0 percent of those with familyincomes of $10,000-$19,999 and $20,000-$34,999, respec-tively and 73.5 percent of those with family incomes of$35,000 or more had had dentzd visits within the year prior
6
to the interview. In the two lowest income groups, however,the differences betsveen groups are apparent only at 35years of age and over.
Data on coverage by private dental insurance werecollected for the first time by the NHIS in 1986, Personswith dental insurance were significantly more likely to havehad a recent dental visit than were those without suchinsurance (table 4). Overall, 70.1 percent of those withcoverage had had a recent dental visit, compared ‘with49.9percent of those without coverage. The difference in theproportions with recent visits was greatest for those 65years of age and over, which maybe due to a self-selectionfactor: Those with teeth are more likely to have dental visitsand thus may be more likely to select health insurance withdental coverage than are those who are edentulous.
For adults 22 years of age and over, the higher theeducational level, the greater the proportion with a recentdental visit. Only 27.7 pereent of those with less than 9
years of formal education had had a recent dental visit,compared with 70.2 percent of those with some collegeeducation. For adults 22-34 years of age, about 10 percentof those with 9 or fewer years of education had never seena dentist, but less than 1 percent of those with some collegeeducation had never seen a dentist,
The physical condition of individuals as measured bytheir reported health status and activity limitation statuscorrelated positively with use of dental services, but lessstrongly than did dentition status (tables 5 and 6). This isthe reverse of the pattern of physician visits for persons inthe same assessed health status groups. Persons with severelimitation of activity also were less likely to have had arecent dental visit.
Anong persons aged 35 years and over, as might beexpected, those who were edentulous at the time of theinterview were significantly less likely to have been to adentist in the previous year compared with the dentatepopulation (10.6 percent and 63.6 percent, respectively)(table 6). Edentulous persons also were significantly morelikely not to have seen a dentist for at least 5 years. Even forthe youngest edentulous persons shown, those 3544 yearsof age, more than half (55.4 percent) had not seen a dentistin 5 or more years, compared with only 8.3 percent of thosewith teeth.
Number of visits in the past 12months
Dental health care providers recommend “regular pro-fessional care,” usually one or two dental visits annually fora checkup and cleaning. Three or more visits a year areoften considered an indicator of a dental problem, and novisit in a year is often considered an indicator of inadequatedental care (Maas, 1987). The proportion of the populationwith either three or more dental visits or no visits in theprevious year varied among the population subgroups(tables 7-9).
Using age-adjusted dat~ a larger proportion of fe-males, white persons, persons with higher income andeducation, and persons with private dental insurance andthose who were dentate than of others had three or morevisits (tables F-H). Those with the largest proportion withno dental visits were the very young, aged 2-4 years (65.0percent) and those age 75 years and over (64.6 percent)(table 7). Those with the largest proportion having three ormore visits in the previous year, indicating a dental prob-lem, were adolescents aged 12-17 years (20.7 percent),primarily for orthodontia, and those aged 35-54 years (17.3percent). Females 1S-44 years of age were significantly lesslikely than males of the same age to have had no dentalvisits in the previous year, and females 12–34 years weremore likely than males of the same ages to have had threeor more visits.
Black persons were more likely than white persons tohave had no dental visits in the previous year and less likelyto have had three or more visits. The differences betweenraces in the proportion with three or more visits weregreatest for adolescents 12-17 years of age (12.4 percent ofblack and 22.4 percent of white adolescents) and those aged
Table F. Age-adJueted percent distribution of persons 2 years ofage and over by number of dental visits in pest year, accordingto selected demographic characteristics: United States, 19SS
7.l17ciJrj.9spersona d dher nuea d shorn wixraldy.
Table G. Age-adjusted percent distribution of persons 2 years ofage and over by number of dental visits in past year, accordingto aaiected socioeconomic characteristics: United Statas, 1986
55 years and over. As noted previously, Hispanic personswere more likely than non-Hispanic persons to have had nodental visits in the previous year, due primarily to therelatively large proportion of Mexican-Americans (58.9percent) with no visits. Mexican-&nericans were also lesslikely to have had three or more visits than other Hispanicand non-Hispanic persons.
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Table H. Age-adjusted percent distribution of persons 2 years ofage and over by number of dental visits in past year, accordingto aekcted health characteristics: United States, 1986
Compared with people living in MSA’S, a greater pro-portion of persons not living in an MSA had had no recentdental visits (46.8 percent) and a smaller proportion hadmade three or more dental visits (11.8 percent). Thoseliving in the South were the least likely of all regionalgroups to have had three or more visits, and most likely tohave had no dental visits in the previous year.
The higher the educationzd level of those 22 years ofage and over, the higher the proportion having three ormore dental visits (table 8). There is also a positive associ-ation between use of dental services and family income.
A greater proportion of persons with no private dentalinsurance coverage than of those with coverage reported nodental visits (48.9 percent and 29.1 percent). Those withdental insurance were more likely than those without cov-erage to have had three or more visits in the previous year(19.1 percent and 12.5 percent).
People in fair or poor health were more likely to havehad no dental visits (59.6 percent) than were those withreported good health (47.4 percent) and those reported tobe in excellent or very good health (36.4 percent) (table 9).Those in excellent or very good health were more likely tohave had three or more dental visits (15.3 percent) thanwere those in only fair or poor health (12.7 percent).Persons who were unable to perform their usual activitybecause of a chronic health condition were more likely thanpersons in other categories of activity limitation to havereported no dental visits in the past year.
As might be expected, people having some naturalteeth (18.3 percent) were more likely to have had dentalvisits-specifically, more likely to have had three or morevisits-than were those who were edentulous at the time ofthe interview (3.9 percent).
Dental visits per person per year
One of the more common measures of access to dentalcare is the average number of dental visits per person peryear. To those interested in the provision of dental services,the actual number of visits made to dentists also is impor-tant (tables 10-12). The number of dental visits per personper year may be affected by the actual need for care, theperceived need for care, and the ability to pay for care.
Americans over the age of 2 years made an estimated466.8 million visits to a dentist in 1986 (table 10). Thosewith high rates of dental visits per person per year (ageadjusted) included females, whites, non-Hispanics, thoseliving in MSA’S and in the Northeast, females living in theWest, those with higher family income and education, thosewith dental insurance, and those who were dentate (tablesJ–L).
Overall, females had a higher number of dental visitsper person per year (2.2) than males had (1.9) (table 10).For females, after the high rate of 3.0 dental visits perperson per year for adolescents, the rate was relativelyconstant through age 74 years. Among older men andwomen, the rate of visits was significantly lower for those 75years of age and over.
White women had a higher dental visit rate (2.3) thandid their male counterparts (2.0); however, white males stillhad a significantly higher visit rate than did black females(2.0 and 1.5, respectively). Different age and sex ratepatterns appear when other demographic variables areconsidered, such as place of residence and region.
Table J. Age-adjusted number of dental visits per person peryear, by sex and selected demographic characteristics:United States, 1986
For both sexes, dental visit rates increased with incomeand level of education (table 11). Persons with privatedental insurance coverage had higher dental visit rates thandid persons without such coverage.
Dental insurance
A relatively new factor affecting the use of dentalservices is private dental insurance. A question was addedto the 1986 NHIS concerning health insurance coverage fordental care. The public health policy assumption is thatsome persons will be more likely to use dental services if atleast some portion of them is covered by a third-partypayer. Those with dental coverage, however, were not askedif the dental care they received was covered by the policy.
Of the total population 2 years of age and over, 37.8percent (86.6 million) was reported to have had privatedental insurance coverage at the time of the NHIS inter-view. More than half (56.7 percent, 130 million) did not,and it was not known whether the remaining 12.5 millionhad such coverage (tables M and 13-15).
Table M. Age-adjusted percent distribution of persons 2 years ofage and over by private dental insurance status, according toselected demographic characteristics: United States, 1986
People 25–54 years of age were more likely thanpersons of other ages to have coverage, and males weremore likely to have coverage than were females, particu-larly those age 45 years and over (table 13).A largerproportion of white persons (39.0 percent) than of blackpersons (29.1 percent) had coverage, and non-Hispanicswere more likely to be covered than were Hispanics (38.3percent and 31.3 percent, respectively). Using age-adjustedfigures (table M), 39.3 percent of white persons, 28.4percent of black persons, 38.5 percent of non-Hispanics,and 29.5 percent of Hispanics reported having privatedental insurance.
A greater proportion of those living in the suburbs(44.0 percent) than of those residing in the central city (35.3percent) or outside an MSA (28.7 percent) had dentalcoverage (table 13). There were differences between re-gions in the proportion of people with dental insuranc~those who lived in the West had the highest rate of coverage(44.3 percent), and those residing in the South had thelowest (30.8 percent).
The proportion of persons with dental coveragechanged with educational and income level. Using age-adjusted data (table N), 10.0 percent of those with incomesof less than $10,000 had coverage compared with 56.6percent of those with an income of $35,000 or more.
The better the reported health status, the greater theprobability of having private dental insurance coverage.
9
Table N. Age-adjusted percent distribution of pereons 2 yeara ofage and over by private dentsi insurance status, according toseiected socioeconomic characteristic= United States, 1966
Tabie O. Age-adjusted percent distribution of persons 2 years ofage and over by private dentai insurance status, according toseiected heaith characteristics: United States, 1986
Those who were unable to perform their usual activitieswere less likely to have dental &erage (16.8 percent) thanwere those with no limitation of activity (40.0 percent)(table 15). However, those with severe limitation are alsoless likely to be employed, and employers are the majorsource of health insurance coverage.
Overall, 39.4 percent of the dentate population hadsome private dental insurance coverage, as well as 18.5percent of the edentulous population. When age-adjusted,this apparent difference declines (table O).
Dental health of children
The dental care that children receive is particularlyimportant because good dental care at an early age can helpprevent poor dental health in later years (Corbin et al.,1987; Fielding, 1978; Office of Health Promotion andDisease Prevention, 1980). About one-third of all childrenaged 24 years-3.4 million—had visited a dentist in the
past year (table 16). The proportion of children with arecent dental visit ineressed to more than two-thirds foreach of the age groups 5-8, 9-11, 12-14, and 15-16 years.
For children aged 2-16 years, girls (63.7 percent) wereas likely as boys (61.4 percent) to have visited the dentist inthe past year. However, the proportion of white childrenwith a dental visit in the past year was about 25 percentgreater than the proportion of black children doing so (64.8percent and 50.8 percent, resp~tively).
The use of fluoride products is an effeetive method for:he prevention of dental caries (Corbin et al., 1987; Ismailet al., 1987; Swank, Vernon, and Lairson, 1986). In 1986,9of 10 children used fluoride toothpaste. The percent ofchildren using fluoride toothpaste ranged from 92.0 infamilies with an income less than $10,000 per year to 94.8in families with an income of $35,000 or more.
The use of fluoride supplements (fluoride drops, fluo-ride tablets, vitamin drops with fluoride, or vitamin tabletswith fluoride) was highest among children aged 2–8 yearsand lowest among adolescents aged 12–16 years. The per-cent of white children who used fluoride supplements (9.3percent) was more than double the percent of black chi?-dren who did so (3.8 percent).
Fluoride mouthrinses were another deeay-preventiveproduct used by children. About 13 percent of all childrenused a fluoride mouthrinse at home, and 10.5 percent ofchildren were in a fluoride mouthrinse program at school.The use of fluoride mouthrinses at home was greateramong children in families with incomes of more than$10,000 per year than in families with lower incomes.School mouthrinse programs generally are targeted toreach low-income populations (Maas, 1987); consequentlythe use of fluoride mouthrinses at school was greateramong children in families with incomes of less than$10,000 per year (13.5 percent) than in families with in-comes of $20,000-$34,999 (10.7 percent) or $35,000 ormore (7.5 percent).
Dental sealants are plastic coatings that are painted onthe teeth to prevent decay. Only 6.7 percent of all childrenhad had dental sealants applied. The proportion of whitechildren who had had dental sealants applied (7.5 percent)was more than triple the proportion of black children withsealants. Significantly more children in families with anincome of $35,000 or more (12.2 percent) had had dentalsealants applied than children in families with an income of$20,000-$34,999 (6.7 percent), $10,000-$19,999 (3.8 per-cent), or less than $10,000 (2.2 percent).
Dental health of Americans in themiddle and later years
One of the primary criteria of good dental care andgood dental health in older people is the retention ofnatural teeth. However, an estimated 17.4 millionAmericans 45 years of age or older (24.0 percent) wereedentulous in 1986 (table 17). The proportion of adults 45years of age and over who retained at least some of theirnatural teeth deereased with age from a high of 87.3
10
percent in the 45–54 year age group to a low of 44.3 percentfor those aged 85 years or older. There was no statisticallysignificant difference in the proportions of white and blackAmericans who were edentulous.
In the dentate population age 45 years and over, whitepersons were more likely than black persons to have had adental visit in the previous year (65.7 percent and 39.0percent). White dentate persons also reported a highernumber of visits per person per year than did their blackcounterparts (2.8 and 1.6).
The proportions of the population age 45 years andover that were edentulous in 1986 declined as familyincome increased; 40.3 percent of those with an income ofless than $15,000 was edentulous, compared with 21.4percent of those with an income of $15,000-$34,999 and9.7 percent of those with an income of $35,000 or more.
Educational attainment also was associated with eden-tulousness and dental visits. The higher the educationallevel, the lower the percent that was edentulou~ of thosewith less than 12 years of education, 39.5 percent wasreported to be edentulous, compared with only 9.5 percentof those with 13 or more years of education. For those 75years of age and over, this proportion declined from a highof 56.5 percent for those with less than 12 years of educa-tion to 23.7 percent for those with more than a high schooleducation. The number of visits per person per year for thedentate population increased from 1.9 in the lowest educa-tional group to 3.4 in the highest.
For the dentate population over age 45, the rate ofvisits increased from 2.1 for those in the lowest incomegroup to 3.2 in the highest category. Similarly, the propor-tion of the dentate population making a visit in the previousyear increased with family income, from 44.5 percent in thelowest income group to 77.2 percent in the $35,000 or moreincome group.
AS might be expected, the proportion who were eden-tulous was greater for those with no dental insurancecoverage (28.0 percent) than for those with coverage (143percent). This difference may be due to self-selection ofdentate persons in insurance coverage rather than to lack ofinsurance having a direct effect in causing edentulousness.
Both the percent who were dentate and their numberof dental visits were positively associated with income(above and below the poverty threshold) and education.Similarly, the proportion of the dentate population 45 yearsof age and over with a dental visit in the past year increasedwith education and was greater for persons with a familyincome above than below the poverty level.
For the dentate population 45 years of age and over,the proportion with a dental visit in the previous year washigher for those with dental insurance coverage than forthose without such coverage; 74.6 percent of those withcoverage reported a visit, compared with 57.5 percent ofthose without coverage.
Income, education, and use ofdental services
Considering only adults 22 years of age and over, theseparate and combined effects of education and income onthe use of dental services can be seen in table 18. In mostincome and age groups, the proportion with a visit in theprevious year increased with educational attainment for thepopulation as a whole. The effect of income and educationcan also be seen in the number of dental visits per personper yeaq however, this effect is modified by the limit on theneed for dental services. The optimum number of dentalvisits in a year is either one or two for the purposes ofcleaning and examination. It is thought that the rate of visitsper person increases with income and access to care toallow care of previously unmet need, then declines to alower level for routine preventive care. In the incomegroups below $25,000, the higher the educational attain-ment, the greater the rate of dental visitation reported inmost age groups.
Private health insurance and use ofdental services
Persons with private dental insurance had a highernumber of dental visits per person per year (2.6) than didpersons with no coverage (1.7). They also had a higherproportion with a visit in the previous year, a greaterproportion whose last visit was for a checkup, and a lowerproportion who were edentulous (table 19). These differ-ences existed for most age, S= and race group$ however,differences by age, se% and race still appear within insur-ance coverage groups. The usual pattern of increased use ofdental services with income was not as clear in the twolower income categories for those with private dental insur-ance coverage. Persons with a family income of less than$10,000 who had dental insurance coverage used dentalservices more often than did those with an income of$10,OOO-$19,999.
I
11
References
Corbin, S. B., W. R. Maas, D. V. Kleinman, and C. L. Backinger.1987. 1985 NHIS findings on public knowledge and attitudesabout oral diseases and preventive measures. Public Heakh Rep.102(1):53-60.
Fielding, J. E. 1978. Successes of prevention. Milbank Mem Fund56(3).
Ismail, A. I., B. A. Burt, G. E. Hendershot, S. Jack, and S. B.Corbin. 1987. Findings from the Dental Care Supplement of theNHIS, 1983. Journal of the American Dental Association 114(May):617-621.
Maas, W. R. 1987. Personal communication. Rockville, MD.
Moore, T. F. 1985. Redesign of the National Health InterviewSurvey. Unpublished technical paper. U.S. Bureau of the Census.
National Center for Health Statistics, E. Balarnuth and S. Shapiro.1965a. Health interview responses compared with medicalrecords. Vital and Health Statistics. Series 2, No. 7. PHS Pub. No.1000. Public Health Service. Washington: U.S. Government Print-ing Office.
National Center for Health Statistics, C. F. Carmen and F. Fowler.1965b. Comparison of hospitalization reporting in three surveyprocedures. Etal and Health Statistics. Series 2, No. 8. PHS Pub.No. 1000. Public Health Service. Washington U.S. GovernmentPrinting Office.
National Center for Health Statistics. 1965c. Reporting of hospi-talization in the Health Intemiew Suwey. V7tdand Health Statis-tics. Series 2, No. 6. PHS Pub. No. 1000. Public Health Service.Washington: U.S. Government Printing Office.
National Center for Health Statistics, W. G. Madow. 1967. Inter-view data on chronic conditions compared with information frommedical records. Mtal and Health Statistics. Series 2, No. 23. PHSPub. No. 1000. Public Health Service. Washington: U.S. Gover-nmentPrinting Office.
National Center for Health Statistics, C. F. Cannell, F. J. Fowler,Jr., and K. H. Marquis. 1968. The influence of intewiewer andrespondent psychological and behavioral variables on the report-ing in household interviews. T&al and Health Statistics. Series 2,No. 26. PHS Pub. No. 1000. Public Health SeMce. Washington:U.S. Government Printing Office.
National Center for Health Statistic+ C. S. Wilder. 1972. Dentalvisits, volume and intend since last visit, United States, 1969.
Vital and Health Statistics. Series 10, No. 76. DHEW Pub. No.(HSM) 72-1066. Health Services and Mental Health Administra-tion. Washington U.S. Government Printing Office.
National Center for Health Statistics, D.A. Koons. 1973. Qualitycontrol and measurement of nonsampling error in the HealthInterview Survey. V?tal and Health Statistics. Series 2, No. 54.DHEW Pub. No. (HSM) 73-1328. Health Services and MentalHealth Administration. Washington: U.S. Government PrintingOffice.
National Center for Health Statistics, C. E. Burnham. 1974.Edentulous persons, United States, 1971. !&d and Health Statis-tics. Series 10, No. 89. DHEW Pub. No. (ERA) 74-1516. HealthResources Administration. Washington U.S. Government Print-ing Office.
National Center for Health Statistics, C. S. Wilder. 1982. Dentalvisits, volume and interval since last visit, United States, 1978 and1979. T&al and Health Statistics. Series 10, No. 138. DHHS Pub.No.(PHS) 82-1566. Public Health Service. Washington U.S. Gov-ernment Printing Office.
National Center for Health Statistics, M. G. Kovar and G. S. Poe.1985. The National Health Intexview Survey design, 1973--84, andprocedures, 1975-83. Etal and Health Statistics. Series 1, No. 18.DHHS Pub. No. (PHS) 85-1320. Public Health SeMce. Washing-ton: U.S. Government Printing Office.
National Center for Health Statistics, S. S. Jack. 1986. Use ofdental%exvicex United States, 1983, Advance Data From Vital andHealth Statistics. No. 122. DHHS Pub. No. (PHS) 86-1250. PublicHealth Semite. Hyattsville, Md.
National Center for Health Statistics, D. A. Dawson and P. F.Adams. 1987. Current estimates from the National Health Inter-view Survey, United States, 1986. Vitaland Health Statish”cs.Series10, No. 164. DHHS Pub. No. (PHS) 87-1592. Public HealthService. Washington U.S. Government Printing Office.
Office of Health Promotion and Disease Prevention. 1980. Fluo-ridation and Dental Health, pp. 51–55, in Promoting Health,Preventing Disease: Objectives for the Nation. Public HealthService. Department of Health and Human Services. Washington:U.S. Government Printing OffIce.
Swank, M. E., S. W. Vernon, and D. R. Lairson. 1986. Patterns ofPreventive Dental Behavior. Public Health Rep. 101(2):175-184.
12
List of detailed tables
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Number of pemons 2 years of age and over, by intendsince last dental visit and selected demographic charac-teristics United States, 1986 . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pen%nt distribution of Pemns 2 years of age and overby interval since last dental visi$ according to selecteddemographic characteristics: United States, 1986 . .. . . . ..
Number of persons 2 years of age and over, by intervalsince last dental visit and selected socioeconomic char-acteristics United States, 1986 . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Percent distribution of persons 2 years of age and overby intend since last dental visit, according to selectedsocioeconomic characteristics United States, 1986 .. . . . .
Number of persons 2 years of age and over, by intervalsince last dental visit and selected health characteristicsUnited States, 1986 ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Percent distribution of persons 2 years of age and overby interval since last dental visit, according to selectedhealth characteristics: United States, 1986 .. . . . . . . . . . . . . . .
Percent dism%ution of persons 2 years of age and overby number of dental visits in past year, according toselected demographic characteristics United States,1986 ... . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . . . . . . . . . . . . . . . . . . . . .. . . . .. . .
Pement dism%ution of persons 2 years of age and overby number of dental visits in past year, according toselected socioeconomic characteristkx United States,1986 ... . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Percent distribution of persons 2 years of age and overby number of dental visits in past year, according toselected health characteristic= United States, 1986 ... . .
Number of visits and number of visits per person pervear. bv sex and selected demO=aDhiC characteristics. . . -.United States, 1986 ... . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. Number of visits and number of visita per person peryear, by sex and selected socioeconomic characteristicsUnited States, 1986 ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .
12. Number of visits and number of visita per person peryear, by sex and selected health characteristics UnitedStates, 1986 . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .
14
17
20
22
24
26
28
31
33
35
38
40
13. Number and percent distribution of persons 2 years ofage and over by private dental insurance status, accord-ing to selected demographic characteristics UnitedStates, 19% . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14. Number and percent distribution of pemons 2 years ofage and over by private dental insurance status, accord-ing to selected socioeconomic characteristics UnitedStates, 19M . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
15. Number and percent dism%ution of persons 2 years ofage and over by private dental insurance status, accord-ing to selected health characteristics United States,1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16. Number of total population, number of dental visits perchild per year, and percent of children 2-16 years of agewith selected preventive dental practices, by selectedcharacteristics United States, 1986 .. . . .. . . . . . . . . . . . . . . . . . . .
17. Number of dentate and edentulous population, percentof total population, rate of dental visits per person peryear, and percent of dentate and edentulous populationwith a dental visit in past year for persons 45 years ofage and over, by dentition status and selected charac-teristics: United States, 1986 ... . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .
18. Dental visits per pemon per year and percent with visitsin past year, by selected characteristics United States,-1986 . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20. Number of persons by sex and selected demographiccharacteristics United States, 1986 .. . . . . . . . . . . . . . . . . . . . . . . .
21. Number of persons by sex and selected socioeconomiccharacteristics: United States, 1986 .. . . . . . . . . . . . . .. . . . . . . . . .
22. Number of persons by sex and selected health charac-teristics United States, 1986 . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23. Number of persons by education level and selectedcharacteristics United States, 1986 .. . . . . . . . . . . . . . . . . . . . . . . .
42
46
48
50
52
56
59
62
65
67
69
13
Table 1. Number of persons 2 years of age and over, by Interval since last dental visit and selected demographic characteristic%United States, 1986
[Data are based on household interviews of me civilian nonlnstitutbnalizad populatbn. The survey daslgn, geneml quallficatbns, and Information on the ralietMLy ofthe estimales are given In appandlx L Deflnitbns of terms are gtwen In appendL%Ill
Intervalslrrm last dental vLsII
Lessthan 1year1year 2ysara
Ail Less then 6-11 up to up to 5yearaCheraoferMc Intervals Total 6 monttrs months 2yeers 5joara w-more New Unknown
Table 1. Number of persons 2 years of age and over, by Interval since last dental visit and selected demographic characteristics:United States, 1986-Con.
[Data are based on household Interviews of the chWen noninstttutbnalizwl popukrtbn. The SUWSYdedgn, general quattfkafbm and Inforrnatbn on the rEIllabitKyofthe estimates are given in appendk L Definltbns of Wnns are given tn appendk 11]
Internal shce last dentet VM
LassttMnly9Erlywr 2Jwers
Atl LeSsman 6-11 up to up to 5ysU3rsCharaoterwk krtervals Total 6 mwrths months 2yEws 5ywrs Orlrwu IVewY Unknown
Table 1. Number of persons 2 years of age and over, by interval since last dental visit and selected demographic characteriaticwUnited States, 1986-Con.
[Dafa are based on household interviews of the chfilian noninstitufionalizad population. The survey design, general qualifkatione, and Information on the reliability ofthe estimates are given In appendix 1.Definitionsof terms are given In appendb( 11]
Intewel since lest dental VISH
Lessthan 1yearIyear 2y&lrs
All Lessthan 6-11 up to up to 5 yeeraCherecteristb intervals Total 6 months months 2yefWs 5yWrs or more Never Unknown
Table 2. Percent distribution of persons 2 years of age and over by Intewal since last dental visitj according to selected demographiccharactaristica: United States, 1986
[Data am based on household Interviews of the civilian noninstitutbnallzed populafbn. The survey design, general qualifi@ions, end fnforrnatiin on the reliability ofthe eetknatee are given in appendix 1.Definttbns of terms are given fn appendix 11]
Interval since lad dental vist?
Lessthanlyear1 year z~rs
At\ Less than 6-11 up to up to 5yt3srsCherecfetwc kltervels~ Totel 6 months months 2y&lLs 5J@ltS or more Never
Table 2. Percent distribution of persons 2 yeara of age and over by interval since last dental visit according to selected demographiccharacteristics: United States, 1986—Con.
[Data are based on household [nterviaws of me civilian nonlnstifutbnaLzed population. The survey design, general qualtlcafions, and Infonnaflon on the reliability ofthe asflmafae are given In appand& 1.Definlfions of terms are given In appandbr 11]
Interval sfnca last dental v.W
Less than 1 yearIyaer 2years
All Less than &ll up to up/0Characferistb Irrtewat.d
5J@ersTotal 6 months months 2yk3a7s 5 years or more Never
Tabfe 2. Percent distribution of persons 2 years of ●ge ●nd over by interval since last dental VISN ●ccording to sefected demographiccharacteristics: United States, 1986-Con.
[Data are bawd on household Inlarvlewe of the civilian ncWneWMonallzed population. The survey design, general qualif&Wone, and Informetlon on the rWlatMily ofthe asthnatee am given in appendix L Daflnitbne of terms are gtven In SPIMI’KW 11]
Illtarwlskweki$t derltalvw
Lassmarllyear1 y- 2J&3ars
All Less tharr Gil up to up to 5yeamCharacteristb krtervalsl Total 6 months months 2jears 5y%9r3 Ormore New
1Irchdes unkccsvninterval.‘Incbdstspersonsof other races not strewn separately.
19
Table 3. Number of persons 2 years of age and over, by Interval since last dental visit and aelactad socioeconomic charactaristicmUnited States, 1986
[Data are based on household interviews of the ctvllian nonlnstlfufbnalizad poputatbn. The survey dasfgn, general quallfkafbns, and Infofmafbn on the WalMlty ofthe estimates are given in appendix 1.Definitbns of tarms are given in appendtx 11]
lntarval sincelestdental visit
Lassthanlywrl@U 2y03rs
All Less then 6-11 UP to LIDto 5yaamCharacter@ Intervats TokzII 6 months months 2yeafs 5years or mom Never Unknown
Table 3. Number of persons 2 yeara of age and over, by interval since last dental visit and selected socioeconomic characteristicrxUnited States, 1986-Con.[Data are based on househokt Intervlsws of me civilian nonlnsllfufbnalIzed population. The survey design, general qualifications, and Informafbn on the reliability ofthe estimates are given in eppendk L Definitbns of terms are given In apperrckx 11]
Intetvel skrce last dental vlsff
LesttranlmYyMr 2y9ars
All Less man 6-11 UJJto up to 5yearsCharaotetistk7 Intervals Tofat 6 months months 2j9ers 5j3ars “or mom Never Unknown
Table 4. Percent distribution of persons 2 years of age and over by Interval since last dental visig according to selected socioeconomiccharacteristic= United States, 1986
[Dafa are based on household lntervlawa of me civillan nonlnslitutional!zed population. The survey design, general qualifications, and Informafkm on the reliability ofthe estimates are given In appendix 1.Definitions of terms are given In appandL%11]
Iniervat since last dental VM
Lass than 1year1 year 2 yeara
All Lass than 6=1 1 UD tO UD tO 5 vearsCharadeddk Intewalst Total 6 months months 2 years 5 ~ears or more Never
Table 4. Percent distribution of persons 2 years of ●ge ●nd over by interval Awe last dental visitj ●ccording to selected socioeconomiccherscteristfcw United Ststes, 1986-Con.
[Data are based on househofd interviews of me cMllan nonlnslltumnahxi population.The survey design,general quaiWdbns, and information on the reliabllny ofthe estimates are given in appandLx 1.DefinHlons of terms are gtven in SPP+XWLXIi]
frrtsrvalshwe testde@rlW
Less than 1yearIykaar 2J@9ts
All Less than 6-11 LIp to up toCharaote*tb
5yeafs&rtervatsJ Total 6 months months 2yeals 5p5ws Ormore New
‘Ircbdesunkrww! interval.2Fws0rwJwilh unkmwn edudh.sl ISWI d ShOWrI Sep4Ud0&.
%raom wiih unknown Iffioma not shmvn SSp.WJely.4pWSOnS wtlh unknown Insurame coverage not Shavn SaPSrate$t
23
Table 5. Number of persons 2 years of age and over, by intervai since iast dentai visit and aeiected health characteristic=United States, 1986
[Dafa are baaed on household Inlerv!aws of the civilian nonlnstitutionalized population. The survey des!gn, general qualiflcsflons, and Information on the rellabiltly ofthe estimates are given In appendix 1.Definitions of terms are given in appendix Ill
Interval since last den.%1VM
Less then 1 yefw1 year 2 years
All Less then &ll up toCharecteristlc
up to 5yaarsintervals Tok# 6 months months 2 years 5 Vears or more Never Unknown
Table 5. Number of persons 2 years of ●ge ●nd over, by Intewal sinoe Iaat dental visit ●nd aaleoted health charaoteriatlcs:United States, 1986-Con.
[Dafa are based on household Infervkws of the cfviiien nonkwtilutbnelized populatbn. The sway daslgn, general quaiifkatlons, and hformatlon en W rallabiiily C4the estimates are glvan in appendk 1.Defirrltbns ot terms are given tn appandk 11]
Intervat sh-rcelast denfel w!s#
LessthenlyearIpsr 2yEws
All Less then &ll up to up to 5pswrsCharaofetwk Intervals ToW 6 nlonths months 2- 5y9at3 Wnlwa Ak3wr Unlmonn
Table 6. Percent distribution of persons 2 years of age and over by interval since last dental visit according to selected healthcharacteristics United States, 1986
[Deta era based on household Interdews of the civilian noninstitul!onslizad population. The survey des!gn, general qualiflcaflone, and Informallon on the reliability ofthe estimates are given in appendix 1.Deflnifkms of terms are given in appendix 11]
Interval since last dental VM
Less than 1yearIyear 2 years
All Less than (%1 1 w) to u/J to 5yaersCharacteristic Intevvslsq ToMt 6 months months 2yasrs 5jasrs or-more Never
Table 6. Percent distribution of persons 2 years of ●ge and over by interval since last dental VISKaccording to selected healthcharacteristics: United States, 1986-Con.
[Datsem based on househotdinterviewsof the civitiannonlnsfllutbnalizedpopulatbn. The surveydesign,generalqualiflcafbns,end Informatbnon the relbbilllyofthe estimatesere given in appendl%1.Deflnitbnsof termsera gfvenin appendb(Ii]
Lessman Iyar1- Zyeats
Ail Lessman 6-11 up to up toCtraracteMb
5JA9ei3Inkweisf Total 6months months 2Jwirs 5J@RLs or mom Never
Tablo 7. Percent distribution of persons 2 years of ●ge and over by number of dentai visits in past year, according to selecteddemographic characteristics: United Statas, 1988
iDaIa are baaed on household Intervlaws of me CMUSJ’Inonlnstituflonatked population. The survey des!gn, general quattffoatbns, and tnforrnatbn on the reliability ofthe estimates are gtvan tn appand~ 1.Definitbns of terms are gtven In appendix 11]
Table 7. Percent distribution of persons 2 years of ●ge ●nd over by number of dental visits In past year, according to selaotaddemographic characteristic United States, 1986-Con.
[Data era based on housahotd interviews of the cMlian nonlnslnutbnalizad populatbn. The survey daslgn, general quallflcatbns, and Informatbn on the nMaWty ofthe estimates are given In appendix 1. Deflnitbns of terms w gtven In appendLx 11]
Numberofkfsne krthepeetyw
3or 13orChamctevwc T&id None 1 2 more 3 4 5-12 more
Table 7. Percent distribution of persons 2 yeara of age and over by number of dental visits in paat year, according to selecteddemographic characteristic= United States, 1986-Con.
[Dat6 are based on household Interviewsof the ctWerr nonlrwtlfutbnalized populefbn. The survey design, general qualiffcatbns, and irrformatbn on the reliability ofthe esdlmafea are given In appemfbr 1. Deflniflona of terms are given in appandbr Ill
Table 8. Percent distribution of persons 2 years of age and over by number of dentsi visits in past year, according to selectedsocioeconomic characteristics: United States, 1936
[Data am bssed on household interview of the civlf!an noninstthrtionalked ~puleflon. The survey design, general queMicafions, end information on the relisbiltty ofthe estimefes are given in appendk 1.Oeflntlbns of terms are given In appendix 11]
Table 8. Percent distribution of persons 2 years of sge and over by number of dental visits in past year, according to selectedsocioeconomic characteristic= United Statea, 1986-Con.
[Dafeam basedon household inletviaws of the civilian noninstitutbnalized pcpulatbn. The survey design, general qualiffcatbns, and Informatbn on the reliability ofthe esthnaffss am gtven in appndix 1.Deflnifkms of terms are given in appendix 11]
Number of wWfsIn the past year
3 or 13 orCharadeti$tic Totef None 1 2 mom 3 4 5-12 more
11ncMe8unkncwn numberofvisils.%f60nswlthunlmwn educalionallc+mlnd shownsepwately.%rscmwlthunlrnmvn lncometmtshewnsqxralely.%’mna with unknc+m Inwmms wverage cd shmvn separately.
32
Tabfe 9. Percent distribution of p6rsons 2 years of age and over by number of denfal visits in past year, ●ccording to selected healthcharacteristlcx United States, 19S6
[Dda are baeed on hmehold Intervlawa of the civilian nonhwmnamed POPUiatbn.The wvay deeigrr, general quaMlcatbrra,and Wmnatbrr on ma ralhblmy oftheeetkn8t8e aIu@van hapfJandiX1. OeflnWns oftenns am@mnhappandkl~
Table 9. Percent distribution of persons 2 years of age ●nd over by number of dental visits in past year, according to seleoted heaithcharacteristics: United Statea, 1986-Con.
[Dafa are based on household Intervbws of the civilian nonlnsliiutionalized populefbn. The survey daslgn, general quaMkzdbns,and Informatbn on the reliability oithe estimates are given in appendk 1.Definltbns of terms are given In appendix 11]
Number of visits In the psi year
3 or 13 orCherackvisflc Totafi None 1 2 mom 3 4 S-12 more
1Iffihdes unknown rumber of tistts.2Persunswith unkfwwn hsslth ?tatus not sbwn separately.Spermns with unknown dentltlm status Cot slmwn Separately.
Table 10. Number of viafta ●nd number of vldta par person per year, by MIX ●nd selaoted demographic charscbsrlatka:United States, 1986
[Data are based orI household Interviews of the cMlfan nwdnstitutionaliZed populatbn. The survey design, general qualifbtbne, and Informetbn on the MelMtly otthe eetimalesaregiven in appandlx L Definitions of terms are gtvan In eppandl% 11]
Table 10. Number of visite and number of visits per person per year, by sex and selected demographic characteristics:United Statea,1986-Con.
[Data are based on household Interviews of the ctvllian nonlnslttutkmslized populaflon. The survey design, generet quallfkatbns, end Informafbn on the reliability ofthe estimates are given In eppendlx L Definifbne of terms are given in appendix 11]
Number of viMs Number of visks per person
ToWCharsct&Wlc populatkxr Male Female Total Male Femeie
Tabia 10. Number of visits and number of visits per person per year, by sex and selected demographic characteristics:United Statea, 1986-Con.[Dafa are based on household interviews of the ctiillan nonlnstitutionatizad ppulation. The survey des!gn, general quallficafions, and lnfornratbn on the reliability ofthe estimates am gt#en in apfxmdlx 1.DefinfIbns of terms are given in appandL%11]
Table 11. Number of vlsita and number of visits par paraon per year, by aex and selected socioeconomic characteristics:United Statea, 1936
[Dsta era baaed on householdIrrtervkwa of the cWen nonlnathutbneltzad populatbrr. Thesurvey dsslgn, general quetiflcafiona,end Informatkmon the reliability ofthe eaflmsfea are gtvenInepLwW%1.Dafinlt&nsoftermsaregiven In appendix11]
Table 11. Number of visits ●nd number of visits par person per yasr, by ssx and selected sorheconomio ofwaoteristics:United Ststes,1986-Con.
[Data are based on household Interviews of the CNII!JMInonlnstButkmaJizad FWJlation. The sway daelgn, general qualNloWons, and Information on the rWablBly ofthe aetimatas are given In appendix 1. Deflrdtbns of terms are gh%rnIn appandLx 11]
Number of MS Nurrber oi VMS perjwson
TotatChsmderisllc poprlleibn Male Fenrsks T@el Male Female
Table 12. Number of visits and number of visits per person par year, by sex and seleoted health charaoteristic~ United States, 19S6
[Deta are based on household Inlervfaws of the civilian nonktsfitutkxwzed populafbn. The survey destgn, general qualificafbns, and Infornrafbn on the ralkiblltty ofthe eetimafee are gtven in ap~ndix 1.Deflnltbns of terms are given In appsndtx 11]
Number of VISM Number of visnsperpereon
TotalCharecterkflc populafbr Male Ferrrale ToMI Male Female
Tabfe 12. Number of visits and number of visits per person per year, by sex and selected health characteristics:United States, 1986-Con.
[Date are based on household Intervlaws of Ihe civilian noninstitutbrral!zed popuiatkm. The sunmy desQn, general qualifications, and Informatbn on the reliability ofthe estirnafes are given in appendix 1.DefinRbns of terms are gtven in appendLx II]
Number ofvWts Numbarixfv&#s@r /wsorr
TotalCharactdsth? population Male F6mele Total Male v Female
Table 13. Number and percent distribution of persons 2 years of age and over by private dental insurance statua, according to selecteddemographic characteristics: United States, 1986
[Data are based on household Interviews of the civilian nonlnstltutionallzed population. The survey design, general quafiicatiins, and information on the reliiblfii ofthe SSllMSfS are given in appendix 1.Definitions of terms are given in appendix 11]
Persons who: Parsons who:
Do not Do notHave pttvate have private Have private have private
Table 12. Number ●nd percent distribution of pereons 2 year8 of ●ge and over by pnhratedental Irwrwme status, ●coording to selecteddemography ciwacteristics: United States, 1966-Con.
pataarw based cmhoueehoki Intarvleweof the chWannonlnstWtionallzedpopulatbn.The sun’ey daslgn, general quaJKlcatbns, and information on the rellablllty 04tha8Bttmaw an3gtuen inappendLxl. Dennlric+le ofterTns aregMall irrappandLKll]
Persons Wtw: Fw90ns who:
DOI’KX Donoll-law pttvate ham prhfate I-&we privaie haveplvate
Table 13. Number and percent distribution of persons 2 years of age and over by private dental Insurance status, according to selecteddemographic characteristic= United States, 1986-Con.
[Date are based on household interviews of the civllisn noninstitutioneltzed population. The suwey design, general quafificattort% and information on the reliability ofthe estimates are given in appendix 1.DefinMons of terms are given In appmdlx 11]
Persons who: lWscvlS who:
Do not Do notHaws pnVate have ptiVafe Hat@ prlkm have prhte
denkrl dental Unknown dentalCtlamckmtk
dentalInsurance Insurance f Oowmd Populat&rrf Insucance trrsur.ante
Table 12. Number ●nd percent distribution of pereons 2 years of ●ge and over by prfvate dental insurance status, according to selecteddemographic characterlatics: United Statea, 19S6-Con.
ptta am based on hourmholdInterviewsof the civkm nonins!itulbnamed populalbn. The sumy design, general qualifkaWns, and InfOnmtbn on the rellabilny oftWWHmmgM h-kl. D-tidtmmgWhmkl~
Table 14. Number and percent distribution of persons 2 years of age and over by private dental insurance status, according to selectedsocioeconomic characteristic United States, 1986
[Data era based on household Intervlsws of me civilian nonlnsttlufbnallzed populatbn. The survey design, general quallficatbns,arrd Informatbn on the reliability ofthe estimates are given in apperrdLx 1.Definitbns of terms are given In appandlx 11]
Parsons who: Persons who:
Do not Do nolHave private have prlvafe Have private haw prhfate
Table 14. Number ●nd percent distribution of persons 2 years of age and over by private dental Insurance status, according to selectedsocioeconomic characteristics: United Ststes, 1988-Con.
[Deta am based on household intervbws of the cMlian noninstltutlonelized populatbn. The rwvey design, general qualifk.xtions,and information on the reliebillly ofthe estimates are given in LWKJndiX1.Definltbns of terms are gt#en in appendix 11]
lwsons who: Perwxrs tvha:
Dorrot Do noti-lava ptfvaie haw ptiwde l-lava PtiVate
table 15. Number and percent distribution of parsons 2 years of age and over by private dental insurance status, ●ccording to selectedheaith characteristic= United States, 19SS
pta arebasedon household interviews of the civllien nontnstflutkmalized populatbn. The survey design, general qual~albns, and Informatbn on the reliability ofthe esllmates are gtven In appamlx 1.Deflntllons of terms are gtven in appendix 11]
Parsons who: Personswho:
Do not Do notHave private have private Have pnVate havepn!ate
Table 15. Number and percent distribution of persons 2 years of age and over by private dental Insurance status, according to selectedhealth characteristics: United States, 19SS-Con.
~ata are based on household fntervlaws of the cMllan nonlnsttfufbnalfzed populafbn. The survey design, general quallflcafbne, and fnformatbn on the Webllily ofthe estimates are glvan in appendtx 1.Definitbnsd termsara given In appendtx 11]
mfsons Wro: Parsons who:
Donot Do notl-law plfvafe hew ptfvafe
dentall-law pnVate hew private
dental Unhewn Ckvlfaimaractetisk
dwltalkrsutarrce hsurance r Cowmit Populafku$ kmmvlce kwulance
Table 16. Number of total population, number of dental visits per child per year, and percent of children 2-16 years of age with selectedpreventive dental practices, by selected characteristic= United Statas, 1986
[Data era based on household interviews of the civilian nonlnstifutionalized population. The survey design, general quelifioatbns, end Informatbn on the relbblllly ofthe estimates are given In appendLx L Definitbns of terms are given in appendix Ill
Ctrlktrtm who:
Are InHad a use flucrMedental use use fluoride mouth rinse Hake
Total weirs Vwt In fluorfde fluotkle mouth rinw ptugram et dentalCtraracleristk populefkur per child pasf year toothpaste supplenwnts at home Sohool Seetants
Table 16. Number of total population, number of dental visits par child per year, ●nd percent of children 2-16 years of age with selectedpreventive dental prastfoes, by ●ekcted charactaristicx United Ststas, 1986-Con.
pta am based on household interviews of the ctvliian norrkrstttutbnalized populatbn. Ttre survey design, general quatlkatbn& and k?formatbrr on the relbbtiily ofttre estimates am given in appendix L Definltbns of terms are ghfen in appandLx 11]
Chklrarr who:
.-tmhH&la use fluorMe
. darrtat use use fluor#a mouth rbzwTotal
HaveWsM Vknh ihlork% tfuorkfa
Ctraraotelistkmouth (hse
popwatbrrprvgrarrr at dantaf
Perchki pestyssr toothpaste Suppwnerrts athorns school SeaIam
Table 17. Number of dentate and edentuloua population, percent of total population, rate of dental visits per person per year, andpercent of dentate and edentulous population with a dental visit in past year for persons 45 years of age and over, by dentition statusand selected characteristics: United States, 1986
[Data are based on household Interviews of the civiltan noninstituttcmalized population. The survey deelgn, general qualifkaflone, and Informaflon on the reliabllii ofthe estimates are given In appendk 1.Definitions of terms are given in appendix 11]
lT~~ imludes pSIWnS of otlw races, unkrmvrr education, ircorne, imuranca coverage, and PCVertY status ~ s~wn sePar~elY.
52
Tablo 17. Number of dentate ●nd ederttulous population, percent of total population, rate of dental visfta per person per year, ●ndperoant of dentate and edentuioua population with ● dental visit in peat year for persons 45 yeara of ●ge and over, by dentftfon statusand selected charaoteriatfca: United Statea, 1986-Con.
[Dafa am based on household Infervlews of the civilian noninstitufbnellzed populafbn. The survey design, generaf quellfioatbns, end informalbn on the reliability ofthe estimates are given in appendk 1.Defhttbns of terms am gtven h appendix 11]
Table 17. Number of dentate and edentulous population, percent of total population, rate of dental visits per person per year, andpercent of dentate and edentulous population with a dental visit in past year for persons 45 years of age and over, by dentition statusand seiected characteristics: United 8tatea, 1986-Con.
[Data are based on household interviews of me civllien nonlnstlfutionalized population. The survey design, general quatiflcafions, and Information on the reliability ofthe estimates are given in appandlx 1.Deflnifbns of terms are given In appendix 11]
All ages, 45 years end over. . . . . . .45-54 years . . . . . . . . . . . . . . .
All ages, 55 years and over. . . . . . .55-64 years . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . .75yearsand over . . . . . . . . . . .
17,9727,176
10,7966,1013,6011,094
19.011.623.318.325.239.1
2.32.02.52.52.72.0
0.2*0.O0.2
*0.2*0.3*0.1
53.957.751.753.652.939.8
2.41.42.93.02.9
*2.8
54
Table 17. Number of dentate and edentulous population, percent of total population, rata of dental visits per person par year, ●ndpercent of dentate and edentulous population with a dental vlsft In past year for persons 45 years of ●ge ●nd over, by dentltfon statusand selected characteristics: United States, 1986-Con.
[Data are based on household Inlervlews of the clvillarr nonlnslllutbnehad population. The survey design, general quallflsafbns, and informatbn on the rellabliity ofthe estimates are gtven in appendix 1.Deflrrllbns of terms are given in appendtx 11]
Table 18. Dental visits per person per year and percent with visits in paat year, by selected characteristics: United States, 1986
[Data are based on household interviews of the civilian noninstitutkmatized population. The survey des!gn, general qualifkatlons,and information on the reliability ofthe estima!ea are given in appendix 1. Definitions of terms are gtven In appandLx 11]
Education leve~
Lass than 12 13 years Lass than 12’ 13 yewsChafacterlstti 72 years years or more 12 years years or more
Table 18. Dental visits per person par year and percent with visits In past year, by seieoted characteristic= United States, 1986–Con.
[Data are besed on household lntetviews of the chfillan noninsfitutionalized population. The survey design, general quallflcaticm%and Informetlon on the relkiblllty ofthe estimates am given in appandlx 1.Deflnifions of terms are given in appendLx 11]
Educabr led
Less tharr 12 13 years Less than 12 13 yearsCharacterMb 12yetw.s years or more 12y9ars m or more
Den!aivkltsperperson peryeer Percent wilh visit In past year
1.7 1.9 2.5 37.3 51.8 63.1
62562.862.864.765.4
*1.O*1.9*0.93.6
+1.0
1.51.9
*1.32.43.2
1.926
*223.93.4
44.438.730.736.2325
50.053.549.253.356.8
2.11.8 26
1.725253.75.1
49.2 60.6 74.4
68.376.275.879.979.5
*0.5*0.4*1.6●2.8*4.2
*1.12.72.427
*25
5U.I45.650.953.739.8
56.466.261.258.763.0
1.3
1.31.71.51.11.3
2.2 27
24293.03.23.3
34.6
46.041.836.931.827.2
58.3
59.461.360.956.850.2
73.7
71.777.277.073.869.1
2.2212.12.52.5
1.0
●1.1*1.1+0.4●1.1
1.0
1.7
1.7●1.3+1.4*1.520
1.9 29.044.786.029.123.123.6
43.4
50.643.640.826.638.2
57.4
60.41.3%3+4.0*1.9●1.8
56.054).455.849.9
1.5
*1.0*1.6*1.9*1.1
2.0
2.2 29 425
50.044.944.137.037.9
61.0
61.9e4?.559.6W.461.4
73.0
71.475.371.871.677.5
211.62.03.13.0
23a3283.14.7
2.9
*3.5*2.2*3.O*1.0*4.7
3.1
3.72.9293.1
%2.7
29
3.12827
49.4
55.460.946.949.236.4
71.4
70.072472773.263.6
81.5
76.663.462.763.483.6
3.5*1.9
1.4 2.2 26 34.6
44.140.326.433.427.6
56.5
56.659.858.555.550.7
71.8
68.974.975.374.466.2
1.11.61.21.91.2
E1.9262.7
2026263.63.7
57
Table 18. Dental visits per person per year ●nd percent with visits in past year, by selected characteristic~ United States, 1986--Con.
[Data are based on household interviews of the civilian noninstifutbnalized populefbn. The survey design, general quelificatbns,and information on the reliability ofthe estimates are given in appendl% 1.Deflnittons of terms era given In appendix 11]
Eduoaibn \eve#
Less man 12 13 years Less than 12f3heK3Ct8rlStk
13 years12 years w or mom 12 yixlrs years or more
Less then $15,000 Dental visits par person per year Percent with visit in past year
‘Ir?chdes unknown Income and persons of dher races nd sham separately.%chdes unknown Inconw not SkWtI SepSt’Stdy.
58
Tabia 19. Selected dental variabies, by private dental health Ineurmoa status ●nd aekted charactariaticx United Stataa, 1986
[Data are based on household Intervlsws of ttre cMlian noninstltutbnalizadpopulatbn.The survey dar4gn, general qualHlcatbrrs,and irdorrnatbn on the reibblllty oftha esMnates ara given In .appendLx1.Datlnillons of terms swa given in qxmctlx Iq
Table 19. Selected dental variables, by private dental health insurance status and seleoted characteristics: Unitad States, 1986.-Con.
[Data are based on household interviews of the civilian noninstitutkmalized population. The survey design, general qualiiloatlons,and information on the reliability ofthe estimates are given in appendLx 1.Definiflons of terms are given In appendix 11]
Rate of u/s/ts Last V.knperperson 1 or more 3 or more was
Table 19, Salaotsrd dental vmlabks, by private dental health Insurmca status and aakctad charactarlstica: United States, 1986-Con.
[Data am based on household kdawkws of the cMlian nonlnstilutbnsdlzed populatbn. The survey deskJn, general quallficatbns,end Infonnatbn on the reliability ofthe estimates are gtven in appmlx 1.IlaWbns of terms are gtven in appendix Ill
~able 20. Number of pereons by sex ●nd celected demographic characteristfc~ United Stctes, 1986
[Date are baaed on household interviews of me cMlian noninstWfbnalized populatbn. The sutvey design, general quaiifioations,and fnforrnatton on the reliability ofthe estlmafes are given In eppandlx L Definttbns of term are glvarr In appendix 11]
Tsble 20. Number of persons by sex ●nd selected demographic characteristics: United States, 1986-Con.
ftmta are based on howshold Intervlaws of the ctvlllan nonlnstWW@zed populatbn. The survey d@gn, general qualltkations,and krformatbn on the reliability ofthe esttmates am given W appendix 1.Definilbns of terms are gtmn in appendix 11]
Table 20. Number of persons by sex ●nd selected demofpphlc Charasteristitm: Unitad Statm, 1986-Con.
[Dam am based on household tntervkrvm of the ctdiian nonlnsflIufkmetized poputrdbn. Ttre survey design, general quel~bne,and Infonnafion on the rellaMRy ofthe esfimafes are given in appendix 1.Dennttions of terms are given in appendix IU
Table21.Numberof pwsonsby sex●nd selectedeoeioeoonomkchefactsristics:UnitedStstes,1986[Dateam beead on househokl Interviews of the ctMen honlnstitufbnellzisd populafbn. The survey design, general queliflcatkms,end Information on the reliability oftW~mgNM h**kl. HMstitemw*n~-&lfi
Table 21. Number of persons by sex and selected socioeconomic characteristics: United States, 1986-Con.
[Data are based on household Intervkwa of the civillan nonlnstttutlonallzed populatkm. The survey design, general qualifisatlons,and Information on the relisblliiy ofthe estimates are given In appandLx 1.Definitions of terms are given in appendix Ii]
Table 22. Number of persons by aex ●nd selected health characterlstfc= United Statea, 1986-COII.
[Dafa are based on household Interviews of the civilian noninafl!uflonaltzed population. The sway deafgn, general quafKli%sflorB,andInformetbn on the reliability ofthe eallmatea are given in appendix L Deflnltbns of terms are gtwm In appendk In
I Unknown health status roi shcwn separately.2U@nown dentitlon status ml shown separately.
68
Table 23. Number of pereons by educetfon Ievef ●nd eeleoted ch8rmteristIc* United Stetes, 1986
[Data am based on householdlnWviews of Iha civillannonlnslltutbnallzedpopulation.The aunmydesign,general quatUkatbm,and Inforn@ionon the rellsbiillyofthe estimatesare gtvenin appendix L Daftnitbnsof termsare glvan in appandlxIll
Table 23. Number of persons by education level and selected characteristics: United States, 1986-Con.
[Data are based on household interviews of the ctviltan nonlnstitutionstized population. The survey des!gn, general qualifkafkms,and Informaflon on the reliabilii ofthe estimates are given in appendix 1.Definitions of terms are gtven in appendix 11]
Education Ievefi
Lsss ftran 12 13 yearsCharacferisth? 12 years years or more
Table 23. Number of parsons by education level and selected characteristics: United States, 1936-Con.
[Data era based on household interviews of the ctdlian nonlnstilutbnalized populatbn. The survey design, general quallficatlons,and Informafbn on the relW41tIy ofthe aetimatee are glvan In appendix L DefinMons of terms are given in appendix 11]
I. The 60 poststratification age-sex-race cells in the National Health Interview Survey . . . . . . . . . . . . . . . . . . . . . . . . . 75II. Estimated standard error parameters for the 1986 National Health Interview Survey . . . . . . . . . . . . . . . . . . . . . . . 77
72
Appendix ITechnical notes onmethods
Background
This report is one of a series of statistical reportspublished by the staff of the National Center for HealthStatistics (NCHS). It is based on information collected in acontinuing nationwide sample of households included inthe National Health Interview Survey (NHIS). Data areobtained on the personal, sociodemographic, and healthcharacteristics of the family members and unrelated indi-viduals living in these households.
Field operations for the sumey are conducted by theU.S. Bureau of the Census under specifications establishedby NCHS. The U.S. Bureau of the Census participates inthe survey plaming, selects the sample, and conducts theinterviews. The data are then transmitted to NCHS forpreparation, processing and analysis.
Summary reports and reports on special topics for eachyear’s data are prepared by the staff of the Division ofHealth Interview Statistics for publication in the NCHS,Vial and Health Statistics, Series 10. Data are also tabu-lated for other reports published by NCHS staff and for useby other organizations and by researchers within and out-side the Government. Since 1969, public use tapes havebeen prepared for each year of data collection.
It should be noted that the health characteristics described by NHIS estimates pertain only to the resident,civilian noninstitutionalized population of the United Statesliving at the time of the interview. The sample does notinclude persons residing in nursing homes, members of thearmed forces, institutionalized persons, or U.S. nationalsliving abroad.
Statistical design of NHIS
General design
Data from NHIS have been collected continuouslysince 1957. The sample design of the survey has undergonechanges following each decennial census. This periodicredesign of the NHIS sample allows the incorporation ofthe latest population information and statistical methodol-ogy into the survey design. The data presented in this reportare from an NHIS sample design first used in 1985. It isanticipated that this design will be used until 1995.
The sample design plan of the NHIS follows a multi-stage probability design that permits continuous sampling
of the civilian noninstitutionalized population residing inthe United States. The survey is designed in such away thatthe sample scheduled for each week is representative of thetarget population and the weekly samples are additive overtime. This design permits estimates for high-frequencymeasures or for large population groups to be producedfrom a short period of data collection. Estimates for low-frequency measures or for smaller population subgroupscan be obtained from a longer period of data collection.The annual sample is designed so that tabulations can beprovided for each of the four major geographic regions.Because interviewing is done throughout the year, there isno seasonal bias for annual estimates.
The continuous data collection also has administrativeand operational advantages because field work can behandled on a continuing basis with an experienced, stablestaff.
Sample selection
The target population for NHIS is the civilian noninsti-tutionalized population residing in the United States. Forthe first stage of the sample design, the United States isconsidered to be a universe composed of approximately1,900 geographically defined primary sampling units(PSU’S). A PSU consists of a county, a small group ofcontiguous counties, or a metropolitan statistical area. ThePSU’S collectively cover the 50 States and the District ofColumbia. The 52 largest PSU’S are selected into thesample with certainty and are referred to asself-representing PSU’S. The other PSU’S in the universeare referred to as nonself-representing PSU’S. These PSU’Sare clustered into 73 strat~ and two sample PSU’S arechosen from each stratum, with probability proportional topopulation size. This gives a total of 198 PSU’S selected inthe first stage.
Within a PSU, two types of second-stage units, referredto as segments, are used. The first type, area segments, aredefined geographically, and each contains an expected eighthouseholds. The second type, permit area segments, covergeographical areas containing housing units built after the1980 census. The permit area segments are defined usingupdated lists of building permits issued in the PSU since1980; each contains an expected four households.
Within each segment, all occupied households aretargeted for interview. On occasion, a sample segment maycontain a large number of households. In this situation, the
73
households are subsampled to provide a manageable inter-viewer workload.
The sample was designed so that a typical NHIS sam-ple for the data collection years 1985-95 will consist ofapproximately 7,500 segments containing about 59,000 as-signed households. Of these households, an expected10,000 will be vacant, demolished, or occupied by personsnot in the target population of the survey. The expectedsample of 49,000 occupied households will yield a probabil-ity sample of about 127,000 persons.
New features of the NHIS sample redesign
Starting in 1985, the NHIS design incorporated severalnew design features. The major changes include the follow-ing
. Use of an all-area frame. The NHIS sample is nowdesigned so that it can serve as a sample frame forother NCHS population-based surveys. In previousNHIS designs, about two-thirds of the sample wasobtained tlom lists of addresses compiled at the time ofthe decennial censuy that is, a list frame. Due to U.S.Bureau of the Census confidentiality restrictions, thesesample addresses could be used for only those surveysbeing conducted by the U.S. Bureau of the Census. Themethodology used to obtain addresses in the 1985NHIS area frame does not use the census address lists.The sample addresses thus obtained can be used as asampling frame for other NCHS surveys.
● l%e NHIS as four panels. Four national subdesigns, orpanels, constitute the full NHIS. Each panel contains arepresentative sample of the U.S. civilian noninstitution-alized population. Each of the four panels has thesame sampling properties, and any combination ofpanels defines a national design. Panels were con-structed to facilitate the linkage of NHIS to othersurveys and also to efficiently make large reductions inthe size of the sample by eliminating panels from thesurvey.
Budgetary considerations required the NHIS sample tobe reduced by 50 percent for the 1986 data collection year.This was accomplished by dropping two panels from theNHIS design. For 1986 the sample consisted of 4,076segments, containing 29,751 assigned households. Of the24,698 households eligible for interview, 23,838 householdswere actually interviewed, resulting in a sample of 62,052persons.
●
74
Owrsampling of black persons. One of the goals indesigning the current NHIS was to improve the preci-sion of estimates for black persons. This was accom-plished by the use of differential sampling rates inPSU’S with between about 5 and 50 percent blackpopulation. Sampling rates for selection of segmentswere increased in areas known to have the highestconcentrations of black persons. Segment samplingrates were decreased in other areas within the PSU toensure that the total sample in each PSU was the same
size as it would have been without oversampling blackpersons.
● Reduction in the number of sampled PSU’S. Interviewertravel to sample PSU’S constitutes a large componentof the total field costs for the NHIS. The previousNI-IIS design included 376 PSU’S. Research showedthat reducing the number of sample PSU’S while in-creasing the sample size within PSU’S would reducetravel costs and also maintain the reliability of healthestimates (Moore, 1985). The design now contains 198Psu’s.
● Selectwn of two PSfJ’s per nonselj-representing Mratum.In the previous design, one PSU was selected fromeach nonself-representing stratum. This feature neces-sitated the use of less efficient variance estimationprocedures the selection of two PSU’S allows moreefficient variance estimation methodology (Moore,1985).
Collecting and processing the data
The NHIS questionnaire contains two major parts. Thefirst consists of topics that remain relatively the same fromyear to year. Among these topics are the incidence of acuteconditions, the prevalence of chronic conditions, thle num-ber of persons limited in activity due to chronic conditions, ,restriction in activity due to impairment or health problems,and utilization of health care services involving physiciancare and short-stay hospitalization. The second part con-sists of special topics added as supplements to each year’squestionnaire.
Careful procedures are followed to ensure the qualityof data collected in the interview. Most households in thesample are contacted by mail before the interviewers arrivqpotential respondents are informed of the importance ofthe survey and assured that all information obtained in theinterview will be held in strict confidence. Intewiewersmake repeated trips to a household when a respondent isnot immediately found. The success of these procedures isindicated by the response rate for the survey, which hasbeen between 96 and 98 percent over the years.
When contact is made, the interviewer attempts to haveall family members of the household 19 years of :age andover present during the interview. When this is not possible,proxy responses for absent adult family members are ac-cepted. In most situations, proxy respondents are used forpersons under 19 years of age. Persons 17 and 18 :years ofage may respond for themselves, however.
Interviewers undergo extensive training and retraining.The quality of their work is checked by means of periodicobservation and by reinterview and is also evaluated instatistical studies of the data they obtain in their interviews.A field edit is performed on all completed interviews sothat if there are any problems with the information on thequestionnaire, respondents may be recontacted to solve theproblem.
NOTE A list of references follows the text.
Completed questionnaires are sent from the U.S. Bu-reau of the Census field offices to NCHS for coding andediting. To ensure the accuracy of coding, 5 percent of allquestionnaires is recoded and keyed by other coders. A100-percent” verification procedure is used when certainerror tolerances are exceeded. Staff of the Division ofHealth Interview Statistics then edit the files to removeimpossible and inconsistent codes.
The interview, field work, and data processing proce-dures summarized above are described in detail in Phi andHeaZthStatistics, Series 1, No. 18 (NCHS, 1985).
Estimation procedures
Because the design of NHIS is a complex, multistageprobability sample, it is necessary to reflect its complexprocedures in the derivation of estimates. The estimatespresented in this report are based upon 1986 sample personcounts weighted to produce national estimates. The weightfor each sample person is the product of four componentweights
●
●
●
●
Probability of selection. The basic weight for each per-son is obtained by multiplying the reciprocals of theprobabilities of selection at each step in the desigmPSU, segment, and household.Household nonnnponse adjustment withba segment. InNHIS, interviews are completed for about 96 percentof all eligible households. Because of household nonre-sponse, a weighting adjustment is required. The nonre-sponse adjustment weight is a ratio, with the number ofhouseholds in a sample segment as the numerator andthe number of households actually interviewed in thatsegment as the denominator. This adjustment reducesbias in an estimate to the extent that persons in thenoninterviewed households have the same characteris-tics as the persons in the interviewed households in thesame segment.First-stage ratio adjustment. The weight for persons inthe nonself-representing PSU’S is ratio-adjusted to the1980 population within four race-residence classes ofthe nonself-representing strata within each geographicregion.Poststratiiication by age-sex-race. Within each of 60age-sex-~ace cells fiab~ 1), a weight is constructed eachquarter to ratio-adjust the first-stage population esti-mate based on the NHIS to an independent estimate ofthe population of. each cell. These independent esti-mates are prepared by the U.S. Bureau of the Censusand are updated quarterly.
The main effect of the ratio estimating process is tomake the sample more closely representative of the targetpopulation in age, se~ race, and residence. The poststrati-fication adjustment helps to reduce the bias resulting fromsampling frame undermverage; further, this adjustmentfrequently reduces sampling variance.
NOTE A list of reference follows the text.
Table L The W poststratification age-sex-race cells in theNational Health Interview Survey
Black ‘ All other
m Male Female Male Female
Under lyaar . . . . . . . . . . . . . . . . X x x xl-4yeers . . . . . . . . . . . . . . . . . . x x x x!5-9yesr3 . . . . . . . . . . . . . . . . . . x x x xl&14yeare . . . . . . . . . . . . . . . . x x x xlE-17years . . . . . . . . . . . . . . . . x x x x16-19 years . . . . . . . . . . . . . . . . x x x x20-24 yaars . . . . . . . . . . . . . . . . X x x x25-29 years . . . . . . . . . . . . . . . . X x x x3044years . . . . . . . . . . . . . . . . x x x x35-44 yeaE. . . . . . . . . . . . . . . . . x x x x45-49 years . . . . . . . . . . . . . . . . x x x x!icM4yasrs . . . . . . . . . . . . . . . . x x x x55-64 yeers . . . . . . . . . . . . . . . . X x x x65-74 years . . . . . . . . . . . . . . . . X x x x75yeara and over . . . . . . . . . . . . . X x x x
Types of estimates
Asnoted, NHIS data were collected on a weekly basis,with each week’s sample representing the resident, civiliannoninstitutionalized population of the United States livingduring that week. The weekly samples are consolidated toproduce quarterly files (each consisting of data for 13weeks). Weights adjusting the data to represent the U.S.population are assigned to each of the four quarterly files.These quarterly files are later consolidated to produce theannual fiIe, which is the basis of most tabulations of NHISdata.
NHIS uses various reference periods to reduce theamount of bias associated with poor respondent memo~. A2-week reference period is used in collecting data on theincidence of acute conditions, restriction in activity due to ahealth problem, and physician contacts. Each of theseinvolves health-related events that may be forgotten soonafter they occur, such as telephoning a physician about aminor illness, missing a day from work because of a routinehealth problem, or having a cold. Depending on the type ofstatistic, either a 12- or a 6-month reference period is usedfor hospitalization data, because hospitalization ordinarilyinvolves a major event in a person’s life and is not quicklyforgotten. Chronic condition prevalence estimates arebased on a 12-month reference period.
Because most NHIS estimates based on a 2-weekreference period are designed to represent the number ofhealth events for a 12-month period, these data must beadjusted to an annual basis. Data based on a 2-weekreference period are multiplied by 6.5 to produce the13-week estimate for the quarter. These reference periodadjustments are made at the time that the quarterly filesare produced. Therefore, the data can be used to produceestimates for each quarter and are used that way to studyseasonal variation. The data from the four quarterly files(representing the number of events in each quarter) aresummed to produce the annual estimate. Although thesedata are collected for only 2 weeks for each person includedin the survey, any unusual event during a particular 2-weekperiod does not bias the estimate, because the quarterly
. 75
estimate is a sum of the estimate produced for each week’ssample during the entire quarter and the annual estimate isthe sum of those for the four quarters.
For prevalence statistics, such as the number of per-sons limited in activity due to chronic conditions, the annualestimate results from summing the weighted quarterly filesand dividing by 4. This division is necessary because, asnoted above, each quarterly fide has been weighted toproduce an estimate of the number of persons in the U.S.population having a given characteristic. Summing the fourquarters and dividing by 4 in effect averages these quarterlyresults for the year. Thus, the type of prevalence estimateordinarily derived from NHIS data is an annual averageprevalence estimate.
For data related to short-stay hospital discharges thatare based on a 6-month reference period, cases identifiedduring any quarter of data collection are multiplied by 2 toproduce a quarterly estimate of the annual number ofcharacteristics associated with short-stay hospital dis-charges. The NHIS average annual estimate of hospitaldischarges is derived by summing the four quarterly esti-mates and dividing by 4, just as the prevalence estimatesare.
Reliability of the estimates
Because NHIS estimates are based on a sample, theymay differ somewhat from the figures that would have beenobtained had a complete census been taken using the samesurvey and processing procedures. Two types of errors arepossible in an estimate based on a sample survey samplingand nonsampling errors. To the extent possible, these typesof errors are kept to a minimum by methods built into thesurvey procedures described earlier (NCHS, 1973). Al-though it is very difficult to measure the extent of bias inNHIS, a number of studies of this problem have beenconducted. The results have been published in severalreports (NCHS, 1965a and b, 1967, 1968).
Nonsampling errors
Intewitig process. Such information as the numberof days of restricted activity caused by a condition can beobtained more accurately from household members thanhorn any other source, because only the persons concernedare in a position to report this information. However, thereare limitations to the accuracy of diagnostic and otherinformation collected in household interviews. For diagnos-tic information, for example, the household respondent canusuaily pass on to the interviewer only the information thephysician has given to the family. For conditions not medi-cally attended, diagnostic information is often no more thana description of symptoms. Further, a respondent mayanswer a question in other than the intended mannerbecause he or she has not properly understood the ques-tion, has forgotten the event, does not know, or does not
NOTE A list of references follows the text.
76
wish to divulge the answer. Regardless of the type ofmeasure, all NHIS data are estimates of known reportedmorbidity, disability, and so forth.
Reference period biar. NHIS estimates do not representa complete measure of any given topic during the specifiedcalendar period, because data are not collected in theinterview for persons who died or were institutionalizedduring the reference period. For many types of statisticscollected in the survey, the reference period is the 2 weeksprior to the interview week. For such a short period, thecontribution by decedents to a total inventory of conditionsor services should be very small; however, the contributionby decedents during a long reference period (such as 1year) might be significant, especially for older persons.
Underreporting associated with along reference periodis most germane to data on hospitalization. Analysis hasshown that there is an increase in underreporting of’hospi-talizations with an increase in the time interval betweendischarge and interview. Exclusive of the hospital experi-ence of decedents, the net underreporting using a 12-monthrecall period is in the neighborhood of 10 percent (INCHS,1965c). The underreporting of discharges within 6 monthsbefore the week of interview, however, is estimated to beonly about 5 percent (NCHS, 1965c). For this reason,hospital discharge data are based on hospital dischargesreported to have occurred within those 6 months.
Because hospitalization is common in the period im-mediately preceding death or institutionalization, and be-cause older persons are much more likely to die thlan areyounger ones, these data should not be used to estimate thevolume of hospitalization of the elderly—although they canbe used to measure characteristics of elderly people.
It should further be noted that, although the reportedfrequencies and rates related to hospital episodes are pre-sented by the year in which the data were collected, theesti~ates are, in most cases, based on hospitalizations thatoccurred during the year of data collection and the prioryear. Overall, approximately one-half of the reported hos-pitalizations for the 12-month reference period occurred inthe year prior to the year of data collection.
Population estimates. Some of the published tablesinclude population figures for specified categories. :Exceptfor overall totals for the 60 age, sex, and race groups, whichare adjusted to independent estimates, these figures arebased on the sample of households in NHIS. They am givenprimarily to provide denominators for rate computation,and for this purpose they are more appropriate for use withthe accompanying measures of health characteristics thanare other population data that may be available. With theexception of the overall totals by age, sex, and race men-
>tioned above, the population figures may differ from figures(which are derived from different sources) published inreports of the U.S. Bureau of the Census. Official popula-tion estimates are presented in the U.S. Bureau of theCensus reports, Series P-20, P-25, and P-60.
Rounding of rwnbem. In published tables, the @uresare rounded to the nearest thousand, although they are notnecessarily accurate to that detail. Derived statistics, such
as rates and percent distr]%utions, were computed after theestimates on which they are based were rounded to thenearest thousand.
Combining data yews. To reduce sampling error, somedata for a number of years may have been combined.However, in so doing, the questionnaire for each of theyears should be checked, because even a small change inquestionnaire design may lead to large changes in thederived estimates. This caution also applies to using NHISdata on health measures when changes in other events,such as legislative changes, have occurred over time.
Sampling errors
The standard error is primarily a measure of samplingerror, that is, the variations that occur by chance becauseonly a sample of the population is surveyed. The chancesare about 68 out of 100 that an estimate from the samplewould differ from data on a complete census by less thanthe standard error. The chances are about 95 out of 100that the difference would be less than twice the standarderror and about 99 out of 100 that it would be less than 2Y2
times as large.Individual standard errors were not computed for each
estimate in this report. Instead, standard errors were com-puted for a broad spectrum of estimates. Regression tech-niques were then applied to produce equations from whicha standard error for any estimate can be approximated. Theregression equations, represented by parameters a and b,
Table Il. Estimated standard error parameters for the 1986National Health Interview Survey
Ill Number of dentat visits, based on a2-weak reference period. . . . . . . . . O.OCO161O2 20S,204.0
NOIE The 1- NHISwas breed on a hdf SSMpb Ttwafom, only 23,S3E households wuwactually Inierdewed, rewtllrw in a sample cdS2,052 pemms. This refktbn la reflected in theedirnnkd parameters.
are presented in table II. Rules explaining their use arepresented below.
This procedure will, however, give an approximatestandard error of an estimate, rather than the precisestandard error. Particular care should be exercised whenthe denominator is small.
General rules for determining standarderrors
To produce an approximate standard error for NHISestimates, first determine the type of characteristics to beestimated-that i% which parameter set in table I to use.Then determine the type of estimate for which the standard
error is needed. The type of estimate corresponds to one offive general rules for determining standard errors
Rule 1. Estkated number of people or events-For theestimated numbers of people or events pub-lished in this report, there are two cases toconsider. For the first case, if the estimatednumber is any combination of the poststratifica-tion age-sex-race cells in table ~ then its valuehas been adjusted to official U.S. Bureau of theCensus figures and its standard error is assumedto be 0.0. This corresponds to parameter set IIin table II. AS an example, this would be thecase for the number of persons in the U.S.target population of the number of black per-sons aged 1844 years. Although the race class“white” is not specifically adjusted to CensusBureau figures, it dominates the poststratifica-tion “all other” race ckq consequently, age-sex-’’all other” race combinations in table I canbe treated as age-sex-white combinations for thepurpose of approximating standard errors.
For the second case, the standard errors forall other estimates of numbers of people orevents, such as the number of people limited inactivity or the number of dental visits, are ap-proximated using the parameters provided intable II and formula (1) below.
If the aggregate x for a characteristic hasassociated parameters a and b, then the approx-imate standard error for x, SE(x), can be com-puted by the formula
SE(x) =~czrz+bx. (1)
Rule 2. For rates, propom”ons, and percents for which thedenominator is generated by the poststratificationage-sew-ace classes (table Z)—In this case, thedenominator has no sampling error. For exam-ple, rule 2 would apply to the estimated numberof dental visits per person for black persons age65 years and over, because the denominator is acombination of the poststratification cells. Ap-proximate standard errors for such estimatescan be computed using parameters a and bassociated with the numerator characteristics,along with formula (2) below.
If the estimate of rate, proportion, or per-cent p is the ratio of two estimated numbers, p=x/y (where p may be inflated by 100 for per-cents or by 1,000 for rates per 1,000 persons),with Y having no sampling error, then the ap-proximate standard error for p is given by theformula
sE(p)=p Ja++ (2)
In this report, the value of the denominator Yisalways provided, but in a few cases the numera-tor value x is not published. For these
77
Rule 3.
Rule 4.
Rule 5.
cases theformula
x=pY
~=p~100
~_Py1,000
value of x may be computed by the
if p is a proportion or rate per unit,or
ifp is a percent or rate per 100 units,or
ifp is a rate per 1,000 units.
Propom”ons and pe~ents when the denominatork not generated by the postrtratzjication age-sex-race ck.sses-If p represents an estimated per-cent, b is the parameter from table II associatedwith the numerator characteristics, and y is thenumber of persons in the denominator uponwhich p is based, then the standard error of pmay be approximated by
4bp (loo-p)SE(p)= y (3)
(If p is a proportion, the above formula can beused with 100 replaced by 1.0,)
Rates when the denominator is not generated bythe poststratijhtion age-sex-race classes-lf theestimated rate p is expressed as the ratio of twoestimates, p = x/y (inflated by 100 or 1,000,when appropriate), then the estimated standarderror for p is given by the formula
SE(p)=p -#Ewwx Y
(4)
where SE(x) and SE(y) are computed using rule1 and x and y are obtained from the table. Noestimates of r, the correlation between the nu-merator and denominator, are presented in thisreport; therefore, only the first two terms areavailable. Assume that r = 0.0. Assuming r =0.0 will yield an overestimate of the standarderror if r is actually positive and an underesti-mate if r is negative.
Difference between two statistics (mean, rate, to-ta~ and propotiion) —If xl and X2 are two esti-mates, the standard error of the difference(x, –X2) can be computed as follow~
where SE(X1) and SE(X2) are computed usingrules 1-4, as appropriate, and r is the correla-tion coefficient between xl and X2.
Assuming r = 0.0 will result in an accuratestandard error if the two estimates are actuallyuncorrelated. It will result in an overestimate ofthe standard error if the correlation is positiveor an underestimate if the correlation is nega-tive.
Relative standard errors
Prior to 1985, relative standard error (RSE) curveswere presented in Current Estimates (Series 10, Vial andHecdth Statistics) for approximating relative standard error.For readers who wish to continue using them, the followingprovides guidance. The relative standard error (RSE) of anestimate is obtained by dividing the standard error (SE) ofthe estimate by the estimate x itself. This quantity isexpressed as a percent of the estimate:
RSE= 100 ~
Adjustment of rates
This report includes data that have been adjusted bythe direct method to the age distribution of the standardpopulation. The standard population used is the 1986civilian noninstittitionalized population of the UnitedStates. The standard age categories used are as follows:
AgeCatagoty
All 2+2-45-11
12-1718-4422-443s-4445-646s+
Standatd populatkwin thousands(both sexes)
229,03210,66123,50321,454
loo,98a88,34732,54844,69827,636
Age adjustment by the direct method is accomplishedby multiplying the age-specific rate for each age group bythe population for the corresponding age group in thestandard population. The cross-products of the multiplica-tions “are then summed and divided by the total of thestandard population to obtain the adjusted rate.
SE(X1–X2)=~ SE(X1)2+SE(X2)2-~E(x1)sE(x2)
78
Appendix IIDefinitions of certainterms used in this .report
Terms relating to dental health
Dental visit-A dental visit is defined as any visit to adentist’s office for treatment or advice, including services bya technician or hygienist acting under a dentist’s supervi-sion. Dental services given on a mass basis, such as screen-ing examinations given to a group of children at school, areexcluded.
Interval since last dental visit-’l%e interval since thelast dental visit is the len@ of time prior to the week ofinterview since a dentist or dental hygienist was last visitedfor treatment or advice of any type.
Fluoride mouthrinse-Any substance containing fluo-ride that is used as a mouthrinse. Commercial mouthrinsepreparations containing fluoride, as well as fluoride pow-der, that is dissolved in water and used as a mouthrinse areincluded. Topical fluoride treatments provided in a dentist’soffice are excluded.
Fluoride supplement%-Includes fluoride dro~ fluo-ride tablets, vitamin drops with fluoride, vitamin tabletswith fluoride, and any other fluoride supplement that isswallowed. Topical fluoride treatments provided in a den-tist’s office are excluded.
Fluoride toothpaste-A toothpaste or gel that containsfluoride.
Dental sealants-Pkstic coatings that are painted onthe chewing surfaces of teeth to prevent decay (usuallyprovided for children and youth). Sealants are placed in thegrooves and crevices of teeth by a dentist, dental hygienist,or dental assistant.
Dental insurance-Any insurance plan specifically de-signed to pay all or part of the dental expenses of theinsured individual, except oral surge~. The insurance canbe either a group or an individual policy, with the premiumspaid by the individual, the employer, a third party, or acombination of these. Benefits can be received under theplan in the form of payment to the individual or to thedentist. However, the plan must be a formal one, withdefined membership and benefits, rather than an informalone. For example, an employer’s simply paying a dental billfor an empIoyee would not constitute a herdth insuranceplan.
For the National Health Interview Survey, health insur-ance excludes the following kinds of plarw plans limited tothe “dread diseases: such as cancer and polio; free care,such as public assistance, public welfare, Medicaid, caregiven free of charge to veterans, care given under the
Uniformed Services Dependents Medical Care Program,care given under the Crippled Children Program or similarprograms, and care of persons admitted to a hospital forresearch purposes; insurance that pays bills only for acci-dents, such as liability insurance held by a car or propertyowner, insurance that covers children for accidents atschool or camp, and insurance for workers that covers themonly for accident> injuries, or diseases incurred on the job;and insurance that pays only for loss of income.
Terms relating to disability
Linuktion of activity because of chmnk conditions—Limitation of activity refers to a long-term reduction in aperson’s capacity to perform the average kind or amount ofactivities associated with his or her age group. Persons areclassified in terms of the major activity usually associatedwith their particular age group. The major activities for theage groups are ordinary play, for children under 5 years ofage; attending school, for those 5-17 years of agq workingor keeping house, for persons 1S-69 years of ag~ andcapacity for independent living (the ability to bathe, shop,dre~ eat, and so forth, without needing the help of anotherperson) for those 70 years of age and over. People aged18-69 years who are classified as keeping house are alsoclassified by their abflitj to work at a job or business. (Inthis repor~ the major activity of persons 65-69 years isassumed to be working or keeping housq however, ques-tions were also asked about the capacity for independentliving in this age group, which would permit an alternativedeftition of “limitation.”)
In regard to these activiti~ each person is classifiedinto one of four categories (1) unable to perform majoractivity, (2) able to perform a major activity but limited inthe kind or amount of this activity, (3) not limited in majoractivity but limited in the kind or amount of other activities,and (4) not limited in any way. In regard to these fourcategories, NHIS publications often classify persons only bywhether they are limited (groups 1-3) or not limited (group4). A person is not classified as limited in activity unless oneor more chronic conditions are reported as the cause of theactivity limitation. When more than one condition is report-ed, the respondent is asked to identi& the condition that isthe major cause of the limitation.
Assessed heaith status-The categories related to thisconcept result from asking the respondent, ‘Would you
79
say ‘s health is excellent, ve~ good, good, fair, orpoor?” As such, they are based on a respondent’s opinionand not directly on any clinical evidence.
Demographic terms
Age—The age recorded for each person is the age atlast birthday. Age is recorded in single years and grouped ina variety of distributions, depending on the purpose of thetable.
Geographic region—For the purpose of classifying thepopulation by geographic area, the States are grouped intofour regions. These regions, which correspond to thoseused by the U.S. Bureau of the Census, are as follows:
Region
Northeast. . . . . .
Midwest . . . . . . .
South . . . . . . . . .
West . . . . . . . . . .
States included
Maine, Vermont, New Hampshire,Massachusetts, Connecticut, RhodeIsland, New York, New Jersey,Pennsylvania
Delaware, Maryland, District ofColumbia, West Virginia, VirginiqKentucky, Tennessee, North Carolina,South Carolhq Georgia, Florida,Alabam~ Missouri, Louisiana,Oklahoma, Arkansas, Texas
Washington, Oregon, California,Nevad~ New Mexico, Arizon% Idaho,Utah, Colorado, Montana, Wyoming,Alaska, Hawaii
Place of residence—The place of residence of a mem-ber of the civilian noninstitutionalized population is classi-fied as inside or outside a metropolitan statistical area(MSA). Residence inside an MSA is further classified aseither central city or not central city.
Metropolitan statistical area-The definition and titlesof MSA’S are established by the U.S. Office of Manage-ment and Budget with the advice of the Federal Committeeon Metropolitan Statistical Areas. Generally speaking, anMSA consists of a county or group of counties containing atleast one city (or twin cities) having a population of 50,000or more plus adjacent counties that are metropolitan incharacter and are economically and socially integrated withthe central city. Towns and cities, rather than counties, arethe units used in defining MSA’S in New England. There isno limit to the number of adjacent counties included in anMSA, as long as they are integrated with the central city,nor is an MSA limited to a single State; boundaries maycross State lines. The metropolitan population in this reportis based on MSA’S as defined in the 1980 census and doesnot include any subsequent additions or changes.
80
Central city of an iVfSA-The largest city in an MSA isalways its central city. One or two additional cities maybesecondary central cities in the MS& on the basis of eitherof the following criteria The additional city or cities musthave a population one-third or more of that of the largestcity, with a minimum population of 25,dO0, or the addi-tional city or cities must have at least 250,000 inhabitants.
Not the central city of an MSA –This includes all of theMSA that is not part of the central city itself.
Not in an MSA —This includes all other places in thecountry.
Hispanic–Persons are Hispanic if any of the fc}llowingdescrl%es their national origin or ancestry-Puertol Rican,Cuban, Mexican, Mexicano, Mexican-American, Chicano,other Latin American, other Spanish. Respondents makethis determination by looking at a flashcard containing theabove-listed Hispanic groups and deciding whether one ofthem describes their national origin or ancestry. The His-panic population includes all Hispanic people, regardless ofrace.
Non-Hispanic-For this report, persons not classifiedas Hispanic are non-Hispanic. This includes persons whoseHispanic status is unknown.
Income of family or of unrelated individuals-Eachmember of a family is classified according to the totalincome of the family. Within the household, all personsrelated to each other by blood, marriage, or adoptionconstitute a family. Unrelated individuals are classifiedaccording to their own incomes.
The income recorded is the total of all income receivedby members of the family (or by an unrelated individual) inthe 12-month period preceding the week of interview.Income from all sources—for example, wages, salaries,rents from property, pensions, government payments, andhelp horn relatives–is included.
Education-The categories of education status showthe years of school completed. Only years completed inregular schools, where persons are given a formal educa-tion, are included. A regular school is one that advances aperson toward an elementary or high school diploma or acollege, university, or professional school degree. Thuseducation in vocational, trade, or business schools outsidethe regular school system is not counted in determining thehighest grade of school completed.
Race-The population is divided into three racialgroups “white: “black,” and “all other.” “M other”includes Aleut, Eskimo or American Indian, Asian, orPacific Islander, and any other races. Race characterizationis based on the respondent’s description of his or her racialbackground.
Poverty-Families and unrelated individuals are classi-fied as being above or below the poverty level, using thepoverty index that originated at the Social Security Admin-istration in 1964 and was revised by Federal InteragencyCommunities in 1969 and 1980. The poverty index is basedsolely on money income and does not reflect the fact thatmany low-income persons receive noncash benefits such asfood stamps, Medicaid, and public housing. The index is
based on the Department of Agriculture’s 1961 economy than speeiilc amounts of money, NHIS estimates of thefood plan and reflects the varying ecmsumption require- number of persons living in poverty will vary slightly fromments of families based on their size and composition. The Current Population Survey estimates. The 1986 povertypoverty thresholds are updated every year to refleet index is based on the 1985 poverty levels in the Augustchanges in the Consumer Price Index. Beeause NHIS data 1986 Current Population Survey.on family income are collected by income categories rather
81
Appendix [11Questionnaire
Section O. DENTAL HEALTHNow [-m galng m uk you - quntlons dtouf WATEn FLUORIDATION.
1. AD PU utimfmnd W wfwt b du INWPOWof addlw FLUORIOE to kfn pubflc drfnfdng W~tU?
Do not razd anmvercmagorfas, drcfe tfm ONE that&st fiis respondmt%answer.
1. Prevemmoth deay, protectteeth. or rahtad roaponma
S. Otir (Spadfy)
~. Don’t know
2=. Don tfm wafer that you drhk ●thonw boma from ● publfa w8twsy8twnorb H Imm ●nothmsource, -h u ● WOW
______________________________________________________________b. D- ti ddnkkng W- ttoue FLUORIDE kt it?
.
HAND CAf.ENDAR.T* Iwxt qu98tfonc ●m ■baut n08Mng dsiud orn.
3s. Dwfng tha 2 w..ks (butlhod bt mtf on tlmf *n&t),b,EIlnnln!JfAondky Wand andl~ dds p- SuadaVf@z&L,dld -v- bt tlm fwllv oo1o ● dmflsf? Induda OStypw of d-tbtm, such ●s orthodontists, oral aurpco~●t’ld~ltbthr datafal,pWib60t9, - Wd u (btlfd
c, Dmlng thou 2 weeks, did anyotm ●ba bt titsfimify go to ● dmtkf? ❑ Yes (Reask2b andd ❑ No
_____________________________________________________________ .Ask for each person with “Denfzl vw In3b:
d. DwincIth0n2 wnk,, hawnunytlmudkf -- gotomd,nlfwt?
MM box Ifunder two yews old.
_____________________________________________________________M7?k ‘82-tvmkdenW Id#ft’’bax m Pmw.m’, cahmn if”ktt(.) r8potmd In 3d.
b.H~~khbcti--UST~t~n~?
01 Referta 4b.
I
{Sonm P.oplogototh. dmtfat~s.sclhayth ink ffmyhswa probbm; o~r PMPIB goto t~ d9ntfst for ● chock+tp or m have thdr ta8th alwmwd.Smnwtfmaswhmt p=pl. S9for ● C~Ok+JP tho dmtbf dlaacwwa● problmn Out rind. m bo ty”tod. }
S. What W- tho MAIN RSASON -- fmt watttatlmdontlst?
Do not readWISWW cBte@ries, u“mfn tfm ONE mzk roam.
1.Went Inm own farchock-up, axsmlnmiimor cbming.
2. Wkk cafledin by the k“tist for clmck+p, exmnlnadonor clamning.
& Zmethlng W~S WOW. botkrlng w hurting-—.
4 Want fortraatment of abondltinnthatdmdttdkcowrad aaalbr CtW5k-llpw exanthadm.
B. Other(Slmffy)9. Don’t know
‘oOTNOTES
187 ‘
(Sm”fw
~1nRtblbwst2rsy#tm
s ❑ Other source9UDK-—---- ——------—
1❑ Ym E
2DN0ODOK
.1 ❑ OmtdVidt
u Numberoftknm
— Vldts
tin None--------------- ~-r=_
clUPwt2we&sn otrcparwd
[Mark 3b. nk 36)
2 n i-weak dantd &t3 •1 Owr2 wa4k8. I* fhnn
6 mtmtho
4C16manUurlWthsnl vow501 Pm, Iwo than 2 yam6C12y.arc, buthm6yama7!3 SyearXIXntomo ❑ Nevar
.I ❑ I#sfttan 2 ymrs in 4b {5)a ❑ Othw (NPJ
@
1224“z 9
(Specify)
82
Section O. DENTAL HEALTH, Continued
6mfDti_D_~ in tbg famify who baataatALL of hisor fwr•1 Yea ❑ No (7)
——————--— —-------------------- ______________ __________________b. Who Iethle?
7a. {Now 1wn golno to * ●bout somo Urlngothatpeopls may be doing to tafmcsreof thafrsaatb.)what &ca -- u-a ~h.n - - bmaha$- - taath - toothpaata,toothpowdor, or ●omethfng●ka?
-—_____________________ ——________________ _____________________b. Whti ~ W _ - USB m~~ ~~n d~~ th$ pm ~ W.?
Do notreadurewer ci?tepodee,ofrch ONE brarrd.1.Crest 4. Dmtagard 8. other LSpecifyJ2. Crest Tinter Control 5. Aquafresh S. Drn’t kllOWa. Colgata 6. AIm
b. Wbo Iathle?Mark‘Warrta/aaa/ant#”&xinparaan’aCCMUOWI.______________________________________________________________
e.Anyorw ●lsa?❑ Yes (Raesk1lb endc) ❑ No
PERSON 1
6b.
1 (NP)(Specify)
-- —--—————----———b. -12z2z
123458sz’
(soaaifvl
d. 12‘Z ‘
(Spscity)
FORMBW-l[SBI(1S081(lC-17.8SI
83
Section M. HEALTH INSURANCE
m. w-wetnta’-t@In ●nZtfnrf* ofhdtb I-urmw Pfwn●xcapt iho- wbkb pay only for●xirMnt8. (Not counthw Msdkmnl ISanvono h tfm f=ml[Y IIOW00vti by ● hwlfbInmmmux plan Which pays any pmt of ● bowital, doator% sumwn’s or den21a2%bill? ❑ YIIC ❑ No Wff) ❑ DK fbff)-—. --- —---- ——-—----- ———-. ------- —---- ——-------- _______________
b. What Istha nnmo of tk plan? Record h Ttbla Hf.
c. 1; ;nl=n;l;~h;f;fiUx;o-w-e-==-bx-M~%~= ‘k-l;h~n—w—m—w—t-a-==~ ---- ———-———-----” ‘-----pays ●y pati of ● bospltaf, doP20r’s.wuwmn-s or dmfist’s bill? ❑Y6s /Re#s&4bMdC) ❑ No
TABLE H.L
Yes No OK5a. Isthis61EU.WIplan● Hd2h
Yes No DK
Mslntsnancs OrUmizathm or ‘ 2 068. 00u tbb (nanmJ planpay any , ~ ~ 7.
pati of boapkd ●qmnma? ~HMQP 11 ___ &_, _-----------———- .— - b. Drns 2bls@8n psymIypM 1 2– m–
b, Was this planobta[rmd2brough‘ 2%) F(Fhl of dodor% or sur@ones● unployer .x union? bills for OPWatiOM?