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Scientific Data Documentation
National Hospital Discharge Survey, 1990-1991
DSN: CC36.NHDS90 CC36.NHDS91 ABSTRACT This material provides documentation for users of the National Hospital Discharge Survey (NHDS) data tapes. The NHDS is conducted annually by the National Center for Health Statistics (NCHS). Section I describes the survey and includes information on the history and scope of the NHDS, the methodology followed, including data collection and medical coding procedures, population estimates, measurement errors and sampling errors. Section II gives technical details of the tape including number of tracks and record length. Section III provides a detailed description of the contents of each data record, including the coding and location of each data element. Appendix A defines certain terms used in this document; Appendix B lists the ICD-9-CM Addenda; Appendix C provides population estimates to allow the user to calculate rates; and Appendix D provides unweighted and weighted frequencies for selected descriptive variables. DESCRIPTION OF THE NATIONAL HOSPITAL DISCHARGE SURVEY Introduction.--This document and its appendices allow one to use the data tape containing information collected by the 1991 National Hospital Discharge Survey conducted by the National Center for Health Statistics. This survey annually collects medical and demographic information from a sample of hospital discharge records, which serves as a basis for calculating statistics on hospital utilization. The sampled discharge records represent inpatients discharged from a national sample of non- Federal short-stay hospitals. For a description of the survey design and data collection procedures, see below. For a more detailed description of the survey design, data collection procedures, and the estimation process, see Reference 1. Publications based on the data for each survey year can be obtained from the Government Printing Office. History.--To provide more complete and precise information on the utilization of the Nation's hospitals and on the nature and treatment of illness among the hospitalized population, in 1962 the NCHS began exploring possibilities for surveying morbidity in hospitals. A national advisory group was established. The NCHS conducted planning discussions with other elements of the Public Health Service. Hospitalization material from the Survey Research Center of the University of Michigan, the American Hospital Association, and the Professional Activities Study was examined and evaluated. In 1963, a study by the School of Public Health of the University of Pittsburgh under contract to the NCHS demonstrated the feasibility of an NHDS type of program. An additional pilot study using enumerators from the Bureau of the Census was conducted in late 1964 and confirmed the University of Pittsburgh's findings. Finally, with advice and support from the American Hospital Association, the American Medical Association, individual experts, other professional groups, and elements of the U.S. Public Health Service, the NCHS initiated the National Hospital Discharge Survey in 1964. SURVEY METHODOLOGY Introduction Source of the Data.--The National Hospital Discharge Survey (NHDS) covers discharges from noninstitutional hospitals, exclusive of Federal, military, and Veterans Administration hospitals, located in the 50 States and the District of Columbia. Only short-stay hospitals (hospitals with an average length of stay for all patients of less than 30 days) or those whose specialty is general (medical or surgical) or children's general are included in the survey. These hospitals must also have six or more beds staffed for patient use. These criteria, used from 1988 through the current survey year, differ slightly from those used prior to 1988. Beginning with 1988, the NHDS sampling frame consisted of hospitals that were listed in the April 1987 SMG Hospital Market Tape (2), met the above criteria, and began accepting patients by August 1987. For 1991 the sample consisted of 528 hospitals. Of the 528 hospitals, 7 were found to be out of scope (ineligible) because they went out of business or otherwise failed to meet the criteria for the NHDS universe. Of the 521 inscope (eligible) hospitals, 484 hospitals responded to the survey. Sample design and data collection The NCHS has conducted the NHDS continuously since 1965. The original sample was selected in 1964 from a frame of short-stay hospitals listed in the National Master Facility Inventory. That sample was updated periodically with samples of hospitals that opened later. Sample hospitals were selected with probabilities ranging from certainty for the largest hospitals to 1 in 40 for the smallest hospitals. Within each sample hospital, a systematic random sample of discharges was selected. A report on the design and development of the original NHDS was published (1). In 1988, the NHDS was redesigned to provide geographic sampling comparability with other surveys conducted by the NCHS; to update the sample of hospitals selected into the survey; and to maximize the use of data collected through automated systems. The redesigned NHDS sample included with certainty all hospitals with 1,000 or more beds or 40,000 or more discharges annually. The remaining sample of hospitals was based on a stratified, three-stage design. The first stage consisted of selection of 112 primary sampling units (PSU's) that comprised a probability subsample of PSU's used in the 1985-94 National Health Interview Survey. The second stage consisted of selection of non-certainty hospitals from the sample PSU's. At the third stage a sample of discharges was selected by a systematic random sampling technique. These changes in the survey may affect trend data; that is, some of the differences between NHDS statistics based on the 1965-87 sample and statistics based on the sample drawn for the new design may be due to sampling error rather than changes in hospital utilization. For 1991, the NHDS sampling frame consists of eligible hospitals which began accepting inpatients before September 1, 1987, and were listed in the April 1987 SMG Hospital Market Data Tape (SMG Marketing Group, Inc. 1989). Two data collection procedures were used for the survey. The first was a manual system of sample selection and data abstraction, used for approximately 67 percent of the responding hospitals. The second was an automated method, used for approximately 33 percent of the respondent hospitals, that involved the purchase of computerized data tapes from abstracting service organizations, state data systems, or from the hospitals themselves. In the manual system, the sample selection and the transcription of information from the hospital records to abstract forms were performed at the hospitals. Of the hospitals using this system in 1991, about two- thirds had the work performed by their own medical records staff. In the remaining hospitals using the manual system, personnel of the U.S. Bureau of the Census did the work on behalf of NCHS. The completed forms, along with sample selection control sheets, were forwarded to NCHS for coding, editing, and weighting. For the automated system, NCHS purchased tapes containing machine-readable medical record data from which records were systematically sampled by NCHS. The Medical Abstract Form (Figure 1) and the automated data contain items relating to the personal characteristics of the patient, including birth date or age, sex, race, and marital status, but not name and address; administrative information, including admission and discharge dates, discharge status, and medical record number; and medical information, including diagnoses and surgical and nonsurgical procedures. Since 1977, patient zip code, expected source of payment, and dates of surgery have also been collected. (The medical record number, date of birth, and patient zip code are confidential information and are not available to the public.) Medical Coding and Edit The medical information that was recorded manually on the sample patient abstracts was coded centrally by NCHS staff. A maximum of seven diagnostic codes was assigned for each sample abstract; in addition, if the medical information included surgical or nonsurgical procedures, a maximum of four codes for these procedures was assigned. The system currently used for coding the diagnoses and procedures on the medical abstract forms as well as on the commercial abstracting services data tapes is the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM (3). All of the diagnostic and procedure codes in the ICD-9-CM are utilized. NHDS usually presents diagnoses and procedures in the order they are listed on the abstract form or obtained from abstract services, however, there are exceptions. For women discharged after a delivery, a code of V27 from the supplemental classification is entered as the second-listed code, with a code designating either normal or abnormal delivery in the first-listed position. In another exception, a decision was made to reorder some acute myocardial infarction diagnoses. If an acute myocardial infarction is listed with other circulatory diagnoses and is other than the first entry, it is reordered to first position. If a symptom appears as a first-listed code and a diagnosis appears as a secondary code, the diagnosis replaces the symptom which is moved back. Following conversion of the data on the medical abstract to computer tape and combining it with the automated data tapes, a final medical edit was accomplished by computer inspection and by a manual review of rejected records. Priority was given to medical information in the editing decision. Users of the National Hospital Discharge Survey (NHDS) diagnostic and/or procedure data, which is coded to the ICD-9-CM, must take into account annual ICD-9-CM addenda. The addenda lists new codes, new fourth or fifth digits to existing codes, as well as other modifications. A list of the changes for October 1986, October 1987, October 1988, October 1989, October 1990, and October 1991 are listed in Appendix B. The Uniform Hospital Discharge Data Set (UHDDS) --Starting with 1979 data, the NHDS has followed guidelines of the Uniform Hospital Discharge Data Set (UHDDS) within the confines of its contractual agreement with participating hospitals. The UHDDS is a minimum data set of items uniformly defined (4). These items were selected on the basis of their usefulness to a broad range of organizations and agencies requiring hospital information, uniformity of definition, and general availability from medical records and abstract services. Population Estimates.--Appendix C shows population estimates provided by the U.S. Bureau of the Census. The estimates are of the U.S. civilian resident population on July l of the data year. These population estimates are consistent with those published in Current Population Reports, Series P-25; however, these tables are not official population estimates of the Bureau of the Census. Measurement Errors.--As in any survey, results are subject to nonsampling or measurement errors, which include errors due to hospital nonresponse, missing abstracts, information incompletely or inaccurately recorded on abstract forms, and processing errors. Approximately one percent of the discharge records failed to include age or sex of patient or date of admission or discharge. If the hospital record did not state age or sex of patient, it was imputed by assigning the patient an age or sex consistent with the age or sex of other sampled patients with the same diagnostic code. If the dates of admission or discharge were not given, and if they could not be obtained from the monthly sample listing sheet transmitted by the sample hospital, a length of stay was imputed by assigning the patient a stay characteristic of the stays of other patients of the same age. Other edit and imputation procedures may have been applied to data in the NHDS collected in automated form. Sampling errors and rounding of numbers.--The standard error is primarily a measure of sampling variability that occurs by chance because only a sample rather than the entire universe is surveyed. The relative standard error of the estimate is obtained by dividing the standard error by the estimate itself. The resulting value is multiplied by 100, so the relative standard error is expressed as a percent of the estimate. Estimates of sampling variability were calculated with SESUDAAN software, which computes standard errors by using a first-order Taylor series approximation of the deviation of estimates from their expected values. A description of the software and the approach it uses was published by Shah (5). Relative Standard Errors for Aggregate Estimates Approximate relative standard errors for aggregate estimates are presented in Table 1. To derive error estimates that would be applicable to a wide variety of statistics, numerous variances were calculated and a best fit formula was produced. The curves were based on an empirically determined relationship between the size of an estimate X and its relative variance. The relative standard error is then derived by taking the square root of the relative variance. The relative standard error of an estimate X {RSE(X)}, expressed as a percent, may be calculated from the formula: RSE(X) = 100 sqrt( a + b/X) with a and b provided in Table 1. For example, in 1991 the estimated number of discharges from short-stay hospitals for females with a first-listed diagnosis of atherosclerotic heart disease (ICD-9-CM code 414.0) was 121,000. Using the applicable constants from Table 1 for estimates by sex produces: RSE(121,000) = 100 sqrt( .00099 + (442.186 / 121,000)) RSE(121,000) = 6.82% The relative standard error for the estimate of interest is 6.82 percent. From this the standard error is obtained by multiplying the relative standard error by the estimate: S(121,000) = 121,000 * 6.82% = 8,246 The standard error can be employed to generate confidence intervals for statistical testing. In this example, the 68% confidence interval for the estimate of female inpatients with a first-listed diagnosis of atherosclerotic heart disease is: (121,000 - 8,246) <-> (121,000 + 8,246) 112,754 <-> 129,246 Relative Standard Error for Estimates of Percents Approximate relative standard errors for estimates of percents may be calculated from Table 1 also. The relative standard error for a percent, 100 p (0<p<1), (expressed as a percent), may be calculated using the formula: RSE(p) = 100 sqrt( b*(1 - p)/(p*X)) where 100 p is the percent of interest, X is the base of the percent, and b is the parameter b in the formula for approximating the RSE(X). The values for b are given in Table 1. For example, in 1991 the estimated number of discharges from short-stay hospitals which were female was 18,620,000. This is 59.9 percent of the estimated 31,098,000 discharges for that year. Using the applicable constants from Table 1 for estimates by sex produces: RSE(.599) = 100 sqrt(442.186 * (1 - .599) / (.599 * 31,098,000)) RSE(.599) = 0.309% The relative standard error for the estimate of interest is 0.309 percent. From this the standard error is obtained by multiplying the relative standard error by the estimate: S(.599) = .599 * 0.309% = 0.00185. The standard error can be employed to generate confidence intervals for statistical testing. In this example, the 68% confidence interval for the estimate of the percentage of female inpatients is: (.599 - 0.00185) <-> (.599 + 0.00185) .5972 <-> .6008 or, equivalently, 59.7% <-> 60.1% Table 1 First-Listed Diagnoses or Number Parameter values for relative standard errors 1/ for National Hospital Discharge Survey aggregate statistics by statistic type: United States, 1991 FIRST-LISTED DIAGNOSES OR NUMBER OF DISCHARGES Constant a Constant b Overall 0.00101 546.321 Sex Male 0.00447 213.042 Female 0.00099 442.186 Race White 0.00234 927.094 Black 0.00569 273.368 All other 0.02889 280.075 Not stated 0.01666 427.619 Age Under 15 years 0.01786 65.842 15-44 years 0.00956 111.147 45-64 years 0.01292 44.094 65 years and over 0.01149 25.788 Region Northeast 0.00293 243.156 Midwest 0.00603 331.780 South 0.00247 547.686 West 0.00513 403.340 Source of Payment Worker's compensation 0.00250 588.807 Medicare 0.00548 883.428 Medicaid 0.00348 1979.378 Not stated 0.04490 639.387 Other Government 0.08079 177.390 Private 0.00148 780.110 Self 0.00244 662.998 No charge/other 0.02235 407.608 Table 2 All-Listed Diagnoses ALL-LISTED DIAGNOSES Constant a Constant b Overall 0.00112 589.046 Sex Male 0.00340 256.740 Female 0.00114 404.633 Race White 0.00237 777.966 Black 0.00621 283.703 All other 0.03698 356.210 Not stated 0.01895 793.131 Age Under 15 years 0.01788 74.015 15-44 years 0.00395 228.512 45-64 years 0.01283 43.455 65 years and over 0.01324 26.710 Region Northeast 0.00688 684.720 Midwest 0.00629 422.099 South 0.00289 631.339 West 0.00394 426.981 Source of Payment Worker's compensation 0.00313 1639.248 Medicare 0.00353 3623.733 Medicaid 0.00187 6418.479 Not stated 0.05308 1864.231 Other Government 0.07414 836.713 Private 0.00137 4173.164 Self 0.00196 3122.322 No charge/other 0.02406 1297.668 Table 3 Number of All-Listed Procedures NUMBER OF ALL-LISTED PROCEDURES Constant a Constant b Overall 0.00153 427.265 Sex Male 0.00568 139.827 Female 0.00164 342.466 Race White 0.00298 371.348 Black 0.01000 356.748 All other 0.03328 191.506 Not stated 0.02247 228.166 Age Under 15 years 0.03313 53.065 15-44 years 0.00986 87.726 45-64 years 0.01182 125.847 65 years and over 0.01629 12.837 Region Northeast 0.00746 181.945 Midwest 0.00781 333.914 South 0.00298 468.737 West 0.00753 251.058 Source of Payment Worker's compensation -0.00116 2181.297 Medicare 0.02736 232.797 Medicaid 0.00649 3457.633 Not stated 0.07787 548.170 Other Government 0.09720 319.395 Private 0.00179 2525.008 Self 0.00351 1511.651 No charge/other 0.07391 1138.992 Table 4 Number of Days of Care NUMBER OF DAYS OF CARE Constant a Constant b Overall 0.00173 2343.213 Sex Male 0.00518 5120.963 Female 0.00194 1634.957 Race White 0.00360 2087.655 Black 0.00926 1034.092 All other 0.04980 253.439 Not stated 0.02339 966.802 Age Under 15 years 0.07618 737.582 15-44 years 0.02384 475.352 45-64 years 0.02949 92.219 65 years and over 0.01849 25.558 Region Northeast 0.00451 1967.234 Midwest 0.01037 608.558 South 0.00400 1435.185 West 0.00891 871.769 Source of Payment Worker's compensation 0.00393 12444.000 Medicare 0.00456 6548.842 Medicaid 0.00136 18545.000 Not stated 0.05367 3639.382 Other Government 0.04261 988.154 Private 0.00169 12606.000 Self 0.00399 5923.664 No charge/other 0.02240 2779.271 Presentation of Estimates.--Publication of estimates for the NHDS is based on the relative standard error of the estimate and the number of sample records on which the estimate is based (referred to as the sample size). Estimates are not presented in NCHS reports unless a reasonable assumption regarding the probability distribution of the sampling error is possible. Based on consideration of the complex sample design of the NHDS, the following guidelines are used for presenting the NHDS estimates: If the sample size is less than 30, the value of the estimate is not reported. If the sample size is 30-59, the value of the estimate is reported but should not be assumed reliable. If the sample size is 60 or more and the relative standard error is less than 30 percent, the estimate is reported. If the sample size is 60 or more but the relative standard error is over 30 percent, the estimate is reported but should not be assumed reliable. How to Use the Data Tape.--The NHDS records are weighted to allow inflation to national or regional estimates. The weight applied to each record is found in tape location 111-115. To produce an estimate of the number of discharges, the weights for the desired records must be summed. To produce an estimate for number of days of care, the weight must be multiplied by the length of stay (tape location 101-104) and these products are summed. Length of stay data can be obtained by using recodes already on the tape (see items 14 and 18 in the tape layout), or by dividing days of care by number of discharges as calculated above. Appendix D contains unweighted and weighted frequencies for selected descriptive variables on the data tape. These may be used as a cross- check when processing the data on the user's system. Monthly and Seasonal Estimates Under the New Design An important difference between the old and new designs is the method used to adjust for nonresponse. In the old design, weights for responding hospitals were adjusted each month to account for hospitals that did not respond for that month. In the new design, the type of nonresponse adjustment applied depended on whether the hospital was considered a nonrespondent or partial respondent. A nonresponding hospital was one which failed to provide at least half of the expected number of discharges for at least half of the months for which it was inscope. In this case, weights of discharges from hospitals similar to the nonresponding hospital were inflated to account for discharges of the nonrespondent hospital. However, this adjustment was performed just once, after the close out of the survey for the year, instead of monthly as before. For partially responding hospitals, one or both of two adjustments were made. If the hospital provided at least half, but not all, of the expected number of abstracts for a given month, the weights of the abstracts actually collected for that month were inflated to account for the missing abstracts. If fewer than half of the expected number of abstracts were provided, the weights of the abstracts provided were inflated by a factor of two, then another adjustment was made to account for the excess nonresponse. In the second adjustment, the weights of the discharges in the hospital's respondent months were inflated by ratios that varied by category of first-listed ICD-9-CM diagnostic code. This adjustment ratio was based on the hospital's month(s) of nonresponse and the month-by-month distributions of first-listed diagnostic groups among discharges from hospitals which responded for all twelve months. The ratio accounts for the seasonality in the occurrence of the first-listed diagnostic groups for annual statistics, but not for partial year estimates. As a result monthly and seasonal estimates may be skewed. While the effect is believed to be small, it is recommended that partial year estimates NOT be produced. In the 1991 NHDS, 90 percent of the 484 responding hospitals provided data for all twelve months, and 94 percent provided at least 9 months of data. Diagnosis-Related Groups (DRGs).--Many users of the NHDS data tapes have expressed an interest in converting the data to DRGs. This has been done using DRG Grouper Programs obtained from the Health Care Financing Administration. The DRGs and the DRG Grouper Programs were developed outside of the National Center for Health Statistics; any questions about DRGs, other than specific questions about how they relate to NHDS data, should be addressed elsewhere. Questions.--Questions concerning data on the tape should be directed to Maria Owings, Ph.D., Hospital Care Statistics Branch, Division of Health Care Statistics, National Center for Health Statistics, Presidential Building, Room 956, 6525 Belcrest Road, Hyattsville, Maryland 20782, (301)-436-7125. REFERENCES 1National Center for Health Statistics: Development of the design of the NCHS Hospital Discharge Survey, by W. R. Simmons. Vital and Health Statistics. PHS Pub. No. 1000, Series 2-No. 39. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1970. 2SMG Hospital Marketing Group, Inc. 1989. Hospital Market Database. Healthcare Information Specialists, 1342 North LaSalle Drive, Chicago, Illinois. 3National Center for Health Statistics: International Classification of Diseases, 9th Revision, Clinical Modification. DHHS Pub. No. (PHS) 80- 1260. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1980. 4Office of the Secretary, Department of Health and Human Services: Health Information Policy Council: 1984 Revision of the Uniform Hospital Discharge Data Set. Federal Register, Volume 50, No. 147. July 31, 1985. 5Shah, B.V. 1981. SESUDAAN: Standard Errors Program for Computing of Standardized Rates from Sample Survey Data. Research Triangle Institute. Research Triangle Park, N.C. RECORD LAYOUT This section provides detailed information for each sampled record on the tape, with a description of each item included in the record. Data elements are arranged sequentially according to their physical location on the tape record. Unless otherwise stated in the Item Description, the data are derived from the abstract form or from automated sources. The SMG Hospital Market Tape and the hospital interview are alternate sources of data; some other items are computer generated. Item Tape Number of Number Location Positions Item Description and Codes 1-2 2 Blank 1 3 1 Discharge Status Recode 1: Alive 2: Dead 3: Not Stated 4-29 26 Blank 2 30-33 4 Age Units Number (Location 33) (Location 30-32) 1: Years 001-124 2: Months 001-011 3: Days 000-031 3 34 1 Sex 1: Male 2: Female 35 1 Blank 4 36 1 Marital Status 1: Married 2: Single 3: Widowed 4: Divorced 5: Separated 6: Not Stated 7: Unknown 5 37-41 5 Date of Admission 5.1 37-38 2 Month of Admission 01: January through 12: December 5.2 39-40 2 Day of Admission 01-31 5.3 41 1 Year of Admission 0: 1990 1: 1991 6 42-46 5 Date of Discharge 6.1 42-43 2 Month of Discharge 01: January through 12: December 6.2 44-45 2 Day of Discharge 01-31 6.3 46 1 Year of Discharge 1: 1991 2: 1992 7 47 1 Discharge Status 1: Routine Discharge/Discharged Home 2: Left Against Medical Advice 3: Discharged/Transferred to Another Short-Term Hospital 4: Discharged/Transferred to Long-Term Care Institution 5: Alive, Disposition Not Stated 6: Dead 7: Status Not Stated 48 1 Blank 8 49 1 Age Recode 1: Less than 15 Years 2: 15-44 Years 3: 45-64 Years 4: 65 Years and Over 9 50 1 Number of Diagnostic Codes Recorded 1 - Minimum 7 - Maximum 10 51 1 Number of Surgical Codes Recorded 0 - Minimum 4 - Maximum 11 52-56 5 Date of Surgery #3 11.1 52-53 2 Month of Surgery 01-12 11.2 54-55 2 Day of Surgery 01-31 11.3 56 1 Year of Surgery 0: 1990 1: 1991 2: 1992 12 57-61 5 Date of Surgery #4 Same format as above (52-56) 62-77 16 Blank 13 78-81 4 Length of Stay in Days This item was generated by the computer on the basis of date of admission and date of discharge. 14 82-83 2 Length of Stay Recode #1 (Computer Generated) 00: 00 Days 01: 01 Days . . . . . . 31: 31 Days and Over 15 84-85 2 Age Recode (Computer Generated) 00: Newborn 01: Under 1 Year 02: 01-04 Years 03: 05-14 Years 04: 15-24 Years 05: 25-34 Years 06: 35-44 Years 07: 45-54 Years 08: 55-64 Years 09: 65-74 Years 10: 75 Years and Over 16 86 1 Race 1: White 2: Black 3: American Indian/Eskimo/Aleut 4: Asian/Pacific Islander 5: Other 6: Not Stated 17 87 1 Marital Status Recode (Computer Generated) 1: Married 2: Not Married 3: Not Stated 18 88 1 Length of Stay Recode #2 (Computer Generated) 1: 00-07 Days 2: 08-14 Days 3: 15-21 Days 4: 22-28 Days 5: 29 Days and Over 89-90 2 Blank 19 91 1 Geographic Region 1: Northeast 2: Midwest 3: South 4: West 92-98 7 Blank 20 99 1 Number of Beds Recode (Interview) 1: 6-99 Beds 2: 100-199 Beds 3: 200-299 Beds 4: 300-499 Beds 5: 500 Beds or more 21 100 1 Hospital Ownership (Interview) 1: Proprietary 2: Government 3: Not for profit 22 101-104 4 Length of Stay in Days Data in 78-81 has been transferred to this data field with 0000 days recoded to 0001. 105-110 6 Blank 23 111-115 5 Weight Final Adjusted Weight (whole number) (see pg. 13 How to Use Tape) 116-130 15 Blank 24 131-136 6 Expected Source(s) of Payment 24.1 131 1 Principal 24.2 132 1 Other 24.3 133 1 Other 24.4 134 1 Other 24.5 135 1 Other 24.6 136 1 Other Code Source of Payment l: Worker's Compensation 2: Medicare 3: Medicaid 4: Not Stated 5: Other Government Payment 6: Blue Cross 7: Other Private/Commercial Insurance 8: Self-Pay 9: No Charge 0: Other 25 137-141 5 Date of Surgery #1 Same format as above (52-56) 26 142-146 5 Date of Surgery #2 Same format as above (52-56) 147-148 2 Blank 27 149-183 35 Diagnostic Codes** (Five-Digit Codes) 27.1 149-153 5 Diagnosis No. 1 27.2 154-158 5 Diagnosis No. 2 27.3 159-163 5 Diagnosis No. 3 27.4 164-168 5 Diagnosis No. 4 27.5 169-173 5 Diagnosis No. 5 27.6 174-178 5 Diagnosis No. 6 27.7 179-183 5 Diagnosis No. 7 28 184-199 16 Surgical Codes** (Four-Digit Codes) 28.1 184-187 4 Surgery No. 1 28.2 188-191 4 Surgery No. 2 28.3 192-195 4 Surgery No. 3 28.4 196-199 4 Surgery No. 4 200 1 Blank 29 201-203 3 DRGs -- Grouper Version 8.0 *************************************************************** If you have any suggestions about how to better provide NHDS data by DRGs to NHDS data users, please write to Maria Owings, NCHS, Room 956, 6525 Belcrest Road, Hyattsville, MD 20782. Your assistance is greatly appreciated. *************************************************************** __________________________________________________________________________ **Codes are in compliance with the ICD-9-CM. There is an implied decimal between positions 3 and 4 for each diagnostic code, (with the exception of E-codes, where the implied decimal is between 4 and 5) and between positions 2 and 3 for each surgical code. APPENDIX A Definition of Terms Terms relating to hospitals and hospitalization Hospitals-Short-stay hospitals or hospitals whose specialty is general (medical or surgical), or children's general. Hospitals must have 6 beds or more staffed for patients use. Federal hospitals and hospital units of institutions are not included. Type of ownership of hospital-The type of organization that controls and operates the hospital. Hospitals are grouped as follows: Not for Profit-Hospitals operated by a church or another not for profit organization. Government-Hospitals operated by State and local government. Proprietary-Hospitals operated by individuals, partnerships, or corporations for profit. Patient-A person who is formally admitted to the inpatient service of a short-stay hospital for observation, care, diagnosis, or treatment, or by birth. Discharge-The formal release of a patient by a hospital; that is, the termination of a period of hospitalization by death or by disposition to place of residence, nursing home, or another hospital. The terms "discharges" and "patients discharged" are used synonymously. Discharge rate-The ratio of the number of hospital discharges during the year to the number of persons in the civilian population on July 1 of that year. Days of care-The total number of patient days accumulated at time of discharge by patients discharged from short-stay hospitals during a year. A stay of less than 1 day (patient admission and discharge on the same day) is counted as 1 day in the summation of total days of care. For patients admitted and discharged on different days, the number of days of care is computed by counting all days from (and including) the date of admission to (but not including) the date of discharge. Rate of days of care-The ratio of the number of patient days accumulated at time of discharge to the number of persons in the civilian population on July 1 of that year. Average length of stay-The total number of days of care accumulated at time of discharge by patients discharged during the year, divided by the number of patients discharged. Terms relating to diagnoses and procedures Discharge diagnoses-One or more diseases or injuries (or some factor that influences health status and contact with health services that is not itself a current illness or injury) listed by the attending physician on the medical record of a patient. In the NHDS, discharge (or final) diagnoses listed on the face sheet (summary sheet) of the medical record are transcribed in the order listed. Each sample discharge is assigned a maximum of seven five-digit codes according to ICD-9-CM (2). Principal diagnosis-The condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. First-listed diagnosis-The coded diagnosis identified as the principal diagnosis or listed first on the face sheet of the medical record if the principal diagnosis cannot be identified. The number of first-listed diagnoses is equivalent to the number of discharges Procedure-One or more surgical or nonsurgical operations, procedures, or special treatments listed by the physician on the medical record. In the NHDS, all terms listed on the face sheet (summary sheet) of the medical record under the caption "operation," "operative procedures," "operations and/or special treatment," and the like are transcribed in the order listed. A maximum of four procedures are coded. Rate of procedures-The ratio of the number of all-listed procedures during a year to the number of persons in the civilian population on July 1 of that year determines the rate of procedures. Demographic terms Age-Refers to the age of the patient on the birthday prior to admission to the hospital inpatient service. Population-Civilian population is the resident population excluding members of the Armed Forces. Geographic regions-Hospitals are classified by location in one of the four geographic regions of the United States corresponding to those used by the U.S. Bureau of the Census: Geographic Region States included Northeast...... Maine, New Hampshire, Vermont Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania Midwest....... Michigan, Ohio, Illinois, Indiana, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas South......... Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, and Texas West.......... Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, California, Hawaii, and Alaska APPENDIX B Introduction Although the International Classification of Diseases, 9th Revision, Clinical Modification has been used for coding NHDS data since 1979, the classification undergoes annual updating. Assignment of new diagnostic and procedure codes, fourth and fifth digit expansion of codes, as well as code deletions, are contained in addenda developed by the ICD-9-CM Coordination and Maintenance Committee and approved by the Director of NCHS and the Administrator of the Health Care Financing Administration. Addenda to the ICD-9-CM become effective October 1 of the affected year and have been released for 1986, 1987, 1988, 1989, 1990, and 1991. As described earlier, the 1991 NHDS involved two data collection modes: manual and abstract. All data collected manually were coded using the third edition of the ICD-9-CM, which includes the addenda for 1986, 1987, 1988, 1989, 1990, and 1991. Data collected via abstract service were coded using two different ICD-9-CM revisions. For the first 9 months of 1991, the ICD-9-CM including the addenda of October 1, 1986-90 was used. Therefore, the reader is cautioned that annual estimates for new ICD-9-CM codes may be underestimated for 1991 and that it is necessary to note both the old and new descriptions for codes that were changed. In order to assist users in data retrieval, a conversion table is provided that shows for each new code, its date of introduction and the previously assigned code eguivalent, which had been used for reporting the selected diagnosis or procedure prior to issuance of the new code. Diagnosis Codes Current Code(s) Effective Previous Code(s) Assignment October 1 Assignment 042.0-042.9 1986 279.19 043.0-043.9 1986 279.19 044.0-044.9 1986 279.19 070.20-070.21 1991 070.2 070.30-070.31 1991 070.3 070.41-070.49 1991 070.4 070.51-070.59 1991 070.5 088.81, 088.89 1989 088.8 176.0-176.9 1991 173.0-173.9 203.00 1991 203.0 203.01 1991 V10.79 203.10 1991 203.1 203.11 1991 V10.79 203.80 1991 203.8 203.81 1991 V10.79 204.00 1991 204.0 204.01 1991 V10.61 204.10 1991 204.1 204.11 1991 V10.61 204.20 1991 204.2 204.21 1991 V10.61 204.80 1991 204.8 204.81 1991 V10.61 204.90 1991 204.9 204.91 1991 V10.61 205.00 1991 205.0 205.01 1991 V10.62 205.10 1991 205.1 205.11 1991 V10.62 205.20 1991 205.2 205.21 1991 V10.62 205.30 1991 205.3 205.31 1991 V10.62 205.80 1991 205.8 205.81 1991 V10.62 205.90 1991 205.9 205.91 1991 V10.62 206.00 1991 206.0 206.01 1991 V10.63 206.10 1991 206.1 206.11 1991 V10.63 206.20 1991 206.2 206.21 1991 V10.63 206.80 1991 206.8 206.81 1991 V10.63 206.90 1991 206.9 206.91 1991 V10.63 207.00 1991 207.0 207.01 1991 V10.69 207.10 1991 207.1 207.11 1991 V10.69 207.20 1991 207.2 207.21 1991 V10.69 207.80 1991 207.8 207.81 1991 V10.69 208.00 1991 208.0 208.01 1991 V10.60 208.10 1991 208.1 208.11 1991 V10.60 208.20 1991 208.2 208.21 1991 V10.60 208.80 1991 208.8 208.81 1991 V10.60 208.90 1991 208.9 208.91 1991 V10.60 237.70-237.72 1990 237.7 345.00-345.01 1989 345.0 345.10-345.11 1989 345.1 345.40-345.41 1989 345.4 345.50-345.51 1989 345.5 345.60-345.61 1989 345.6 345.70-345.71 1989 345.7 345.80-345.81 1989 345.8 345.90-345.91 1989 345.9 374.87 1990 374.89 403.00-403.01 1989 403.0 403.10-403.11 1989 403.1 403.90-403.91 1989 403.9 404.00-404.03 1989 404.0 404.10-404.13 1989 404.1 404.90-404.93 1989 404.9 410.00-410.02 1989 410.0 410.10-410.12 1989 410.1 410.20-410.22 1989 410.2 410.30-410.32 1989 410.3 410.40-410.42 1989 410.4 410.50-410.52 1989 410.5 410.60-410.62 1989 410.6 410.70-410.72 1989 410.7 410.80-410.82 1989 410.8 410.90-410.92 1989 410.9 411.81 1989 410.9 411.89 1989 411.8 429.71 1989 410.0-410.9 429.79 1989 410.0-410.9 446.20-446.21,446.29 1990 446.2 491.20-491.21 1991 491.2 493.20 1989 493.90 493.21 1989 493.91 518.81 1987 799.1 518.82-518.89 1987 518.8 524.60-524.69 1991 524.6 535.00-535.01 1991 535.0 535.10-535.11 1991 535.1 535.20-535.21 1991 535.2 535.30-535.31 1991 535.3 535.40-535.41 1991 535.4 535.50-535.51 1991 535.5 535.60-535.61 1991 535.6 537.82 1990 537.89 537.83 1991 537.82 562.02 1991 562.00 562.03 1991 562.01 562.12 1991 562.10 562.13 1991 562.11 569.84 1990 557.1 569.85 1991 569.84 645.0 1991 645 651.30-651.31,651.33 1989 651.00-651.01,651.03 651.40-651.41,651.43 1989 651.10-651.11,651.13 651.50-651.51,651.53 1989 651.20-651.21,651.23 651.60-651.61,651.63 1989 651.80-651.81,651.83 654.20-654.21,654.23 1990 654.2,654.9 654.90-651.94 1990 654.2,654.9 657.0 1991 657 670.0 1991 670 672.0 1991 672 702.0-702.8 1991 702 753.10-753.17,753.19 1990 753.1 759.81-759.89 1989 759.8 760.75 1991 760.79 764.00-764.09 1988 764.0 764.10-764.19 1988 764.1 764.20-764.29 1988 764.2 764.90-764.99 1988 764.9 765.00-765.09 1988 765.0 765.10-765.19 1988 765.1 795.8 1986 795.7 996.51-996.59 1987 996.5 996.60-996.69 1989 996.6 996.70-996.79 1989 996.7 996.80-996.89 1987 996.8 996.85 1990 999.8 V30.00-V30.01 1989 V30.0 V31.00-V31.01 1989 V31.0 V32.00-V32.01 1989 V32.0 V33.00-V33.01 1989 V33.0 V34.00-V34.01 1989 V34.0 V35.00-V35.01 1989 V35.0 V36.00-V36:01 1989 V36.0 V37.00-V37.01 1989 V37.0 V39.00-V39.0l 1989 V39.0 Procedure Codes Current Code(s) Effective Previous Code(s) Assignment October 1 Assignment 03.90 1987 03.99 (Insertion of Catheter) 11.75 1989 11.79 11.76 1989 11.62 20.96-20.98 1986 20.95 22.12 1988 22.11 26.12 1988 26.11 29.31 1991 83.02 29.32 1991 29.3 29.33 1991 29.3 29.39 1991 29.3 31.45 1988 31.43-31.44 31.95 1989 31.75 32.01 1989 32.0 32.09 1989 32.0 32.28 1989 32.29 33.27 1987 33.22 + 33.27 33.28 1987 33.27 33.29 1987 33.28-33.29 33.6 1990 33.5 + 37.5 35.84 1988 35.82 35.96 1986 35.03 36.00-36.03 1986 36.0 36.04 1986 39.97 36.05 1987 36.01 36.05 1986 36.01*,36.02 36.09 1991 36.00 (Code Deleted) 36.09 1986 36.0 *Before October 1986 contents of current code 36.05 would have been assigned to 36.0. 37.26-37.27 1988 37.29 37.34 1988 37.33 37.70 (Leads Only) 1987 (Leads/Device) 37.70 37.71-37.72 (Leads Only) 1987 (Leads/Device) 37.74 37.73 (Leads Only) 1987 (Leads/Device) 37.73 37.74 (Leads Only) 1987 (Leads/Device) 37.76 37.75 (Leads Only) 1987 (Leads/Device) 37.89 37.76 (Leads Only) 1987 (Leads/Device) 37.81 37.77 (Leads Only) 1987 (Leads/Device) 37.83-37.84 37.78 1987 37.71-37.72 37.79 1987 86.09 37.80 (Device only) 1987 (Leads/Device) 37.73-37.77 37.81 (Device only) 1987 (Leads/Device) 37.73-37.77 37.82 (Device only) 1987 (Leads/Device) 37.73-37.77 37.83 (Device only) 1987 (Leads/Device) 37.73-37.77 37.85-37.87 1987 37.85 37.89 1987 37.86+37.89 37.94-37.98 1986 37.99 38.22 1986 38.29 38.44 (Abdominal Aorta Only) 1986 38.44 (Entire Aorta) 38.45 (Thoracic Aorta Added) 1986 38.44-38.45 38.95 1989 38.93 39.28 1991 39.29 39.65 1988 39.61 39.66 1990 39.65 41.00-41.03 1988 41.0 42.25 1988 42.24 42.33 1989 42.32,42.39 42.33 1990 42.91 43.11 1989 43.1 43.19 1989 43.1,43.2 43.41 1989 43.41,43.49 44.21 1986 44.2 44.22 1986 44.99 44.29 1986 44.2 44.43 1989 43.49, 45.32 44.44 1989 38.86 44.49 1989 43.0 44.93-44.94 1986 44.99 45.16 1988 45.14 (45.15 before 1987) 45.30 1989 45.31,45.32 45.42 1988 45.41 45.43 1989 45.49 45.75 (Hartmann Resection 1988 48.66 (Code Deleted) Added) 45.95 1987 45.93 46.32 1989 46.39 46.85 1989 46.99 49.31 1989 49.3 49.39 1989 49.3 51.10 1989 51.97 51.11 1989 51.11,51.97 51.14 1989 51.12 51.15 1989 51.97 51.22 1991 51.21 (Code Deleted),51.22 51.23 1991 51.22 51.64 1989 51.69 51.84-51.88 1989 51.97 51.97 1986 52.91,51.99, or 51.82 51.98 1986 51.99 52.13 1989 51.97,52.91 52.14 1989 52.11 52.21 1989 52.2 52.22 1989 52.2 52.93 1989 52.93 + 52.91 52.94 1989 52.09 52.97 1989 52.91 52.98 1989 52.91 52.99 1989 52.93,52.94,52.99 54.24 1987 54.23 55.03-55.04 1986 55.02 56.33-56.34 1987 56.33 56.35 1987 45.12 57.17-57.18 1989 57.21 57.22 1989 57.22,57.82 58.31 1990 58.3 58.39 1990 58.3 58.93 1986 57.99 59.96 1986 59.95 60.95 1991 60.99 64.97 1986 64.95 68.15 1987 68.14 68.16 1987 68.13 77.56 1989 77.89,78.49,81.18 77.57 1989 77.89,80.48,81.18,83.85 77.58 1989 77.59,81.18 78.10 1991 78.40 78.11 1991 78.41 78.12 1991 78.42 78.13 1991 78.43 78.14 1991 78.44 78.15 1991 78.45 78.16 1991 78.46 78.17 1991 78.47 78.18 1991 78.48 78.19 1991 78.49 78.20 1991 78.10,78.20,78.30 78.21 1991 78.11,78.31 78.22 1991 78.12,78.22,78.32 78.23 1991 78.13,78.23,78.33 78.24 1991 78.14,78.34 78.25 1991 78.15,78.25,78.35 78.27 1991 78.17,78.27,78.37 78.28 1991 78.18,78.38 78.29 1991 78.11,78.16,78.19,78.29,78.39 78.39 1991 78.31 78.90* 1987 78.40 78.91* 1987 78.41 78.92* 1987 78.42 78.93* 1987 78.43 78.94* 1987 78.44 78.95* 1987 78.45 78.96* 1987 78.46 78.97* 1987 78.47 78.98* 1987 78.48 78.99* 1987 78.49 80.50-80.59 1986 80.5 81.03 1989 81.02 81.04-81.05 1989 81.03,81.04,81.05 81.06-81.07 1989 81.06,81.07 81.08 1989 81.06,81.07,81.08 81.09 1989 81.08 81.40 1989 81.69 81.51 1989 81.51,81.59 81.52 1989 81.61,81.62,81.63,81.64 81.53 1989 81.51,81.59,81.61,81.62, 81.63,81.64 *Codes 78.90-78.99 were retitled as "Insertion of bone growth stimulator" in October 1987; the previous contents of codes 78.90-78.99 were reassigned to codes 78.40-78.49. 81.54-81.55 1989 81.41 81.56 1989 81.48 81.57 1989 81.31,81.39 81.59 1989 81.39 81.72 1989 81.79 81.73-81.74 1989 81.86 81.75 1989 81.87 81.79 1989 81.79,81.87 81.80 1989 81.81 85.95 1987 85.99 85.96 1987 85.99 86.06 1987 86.09 86.07 1990 86.09 86.27 1986 86.22-86.23 86.28 1988 86.22 86.93 1987 86.89 88.90 1986 88.39 88.91 1986 89.15 88.92 1986 89.39 88.93 1986 89.15 88.94 1986 89.39 88.95 1986 89.29 88.97 1989 88.99 88.98 1989 88.90 88.99 1986 89.39 89.10 1989 89.15 89.17-89.18 1988 89.15 89.19 1989 89.15 89.50 1991 89.54 93.90 1988 93.92 94.61-94.69 1989 94.25 96.6 1986 96.35 96.70 1991 93.92 (Code Deleted) 96.71 1991 93.92 (Code Deleted) 96.72 1991 93.92 (Code Deleted) 97.05 1989 51.97 98.51-98.52 1989 59.96 (Code Deleted) 98.59 1989 59.96 (Code Deleted) 99.15 1986 99.29 99.71-99.79* 1988 99.07 99.85 1987 93.35 99.86 1987 93.39 99.88 1988 99.83 **Codes 99.71-99.79 were deleted in October 1987; their contents were not transferred elsewhere. In the October 1988 revision, codes 99.71-99.79 were reclassified as "Therapeutic apheresis." APPENDIX C Civilian Population* by Sex/Age/Geographic Region and Race: Civilian Population* by Sex, Age, Geographic Region and Race: United States, July 1, 1991 {Population estimates consistent with Series P-25, Current Population Reports, U.S. Bureau of the Census} Age, geographic Both region and race sexes Male Female All ages Population in thousands Total 250,566 121,539 129,027 Region: Northeast 50,871 24,433 26,439 Midwest 60,090 29,139 30,951 South 86,067 41,456 44,612 West 53,537 26,511 27,026 Race: White 209,647 102,132 107,515 Black 30,854 14,492 16,362 All other 10,065 4,915 5,150 Under 15 years Total 55,130 28,224 26,906 Under 1 year 4,011 2,052 1,959 1-4 years 15,210 7,784 7,426 5-14 years 35,909 18,389 17,520 Region: Northeast 10,263 5,256 5,007 Midwest 13,350 6,837 6,513 South 18,957 9,695 9,261 West 12,561 6,436 6,125 Race: White 43,924 22,546 21,378 Black 8,568 4,335 4,233 All other 2,638 1,344 1,295 *The NHDS used the civilian noninstitutional population to calculate hospital utilization rates from 1965 through 1983. Beginning in 1981, the civilian resident population has been used to calculate rates. If you have purchased NHDS tapes for years before 1981 and calculated rates using the civilian non- institutionalized population provided in the documentation, these rates will have to be adjusted to be comparable to 1991 rates using the civilian resident population. 15-44 years Total 116,973 58,063 58,909 15-24 years 35,727 18,011 17,715 25-34 years 42,249 20,873 21,376 35-44 years 38,997 19,178 19,819 Region: Northeast 23,625 11,689 11,936 Midwest 27,676 13,753 13,925 South 39,984 19,624 20,361 West 25,687 12,997 12,690 Race: White 96,715 48,424 48,291 Black 15,045 7,087 7,958 All other 5,213 2,551 2,661 45-64 years Total 46,710 22,461 24,249 45-54 years 25,706 12,531 13,175 55-64 years 21,004 9,931 11,073 Region: Northeast 9,939 4,729 5,209 Midwest 11,206 5,414 5,792 South 16,185 7,727 8,458 West 9,379 4,590 4,789 Race: White 40,428 19,626 20,802 Black 4,687 2,088 2,600 All other 1,594 747 847 65 years and over Total 31,753 12,791 18,963 65-74 years 18,280 8,022 10,258 75-84 years 10,314 3,888 6,426 85 years and over 3,160 881 2,279 Region: Northeast 7,043 2,758 4,287 Midwest 7,857 3,135 4,722 South 10,942 4,409 6,532 West 5,911 2,488 3,424 Race: White 28,580 11,536 17,044 Black 2,553 982 1,572 All other 620 273 347 Civilian Population by Age/Sex/Race, Ages 0-19 All races White Age Total Male Female Total Male Female Total 250,565,896 121,539,152 129,026,744 209,646,634 102,131,928 107,514,706 0-4 19,221,659 9,835,987 9,385,672 15,167,687 7,779,875 7,387,812 0 4,011,405 2,052,060 1,959,345 3,102,296 1,591,062 1,511,234 1 3,968,794 2,030,408 1,938,386 3,129,049 1,604,411 1,524,638 2 3,805,924 1,949,181 1,856,743 3,013,254 1,546,435 1,466,819 3 3,718,227 1,902,125 1,816,102 2,957,216 1,516,792 1,440,424 4 3,717,309 1,902,213 1,815,096 2,965,872 1,521,175 1,444,697 5-9 18,237,431 9,337,408 8,900,023 14,634,220 7,511,587 7,122,633 5 3,702,267 1,896,741 1,805,526 2,967,063 1,523,726 1,443,337 6 3,681,281 1,884,016 1,797,265 2,962,793 1,519,657 1,443,136 7 3,575,290 1,829,107 1,746,183 2,870,182 1,472,842 1,397,340 8 3,511,965 1,797,329 1,714,636 2,819,652 1,446,563 1,373,089 9 3,766,628 1,930,215 1,836,413 3,014,530 1,548,799 1,465,731 10-14 17,671,314 9,051,181 8,620,133 14,121,838 7,254,234 6,867,604 10 3,703,208 1,899,473 1,803,735 2,966,016 1,525,616 1,440,400 11 3,661,556 1,875,159 1,786,397 2,928,640 1,504,421 1,424,219 12 3,483,780 1,782,652 1,701,128 2,773,580 1,423,594 1,349,986 13 3,414,045 1,746,407 1,667,638 2,733,118 1,402,429 1,330,689 14 3,408,725 1,747,490 1,661,235 2,720,484 1,398,174 1,322,310 15-19 17,051,006 8,697,533 8,353,473 13,629,614 6,970,712 6,658,902 15 3,292,674 1,689,565 1,603,109 2,624,383 1,349,939 1,274,444 16 3,361,946 1,731,537 1,630,409 2,692,363 1,388,860 1,303,503 17 3,358,622 1,731,230 1,627,392 2,680,945 1,384,718 1,296,227 18 3,336,044 1,691,636 1,644,408 2,664,188 1,355,204 1,308,984 19 3,701,720 1,853,565 1,848,155 2,967,735 1,491,991 1,475,744 Black Other Races Age Total Male Female Total Male Female Total 30,854,035 14,492,360 16,361,675 10,065,227 4,914,864 5,150,363 0-4 3,099,248 1,568,421 1,530,827 954,724 487,691 467,033 0 677,391 342,934 334,457 231,718 118,064 113,654 1 645,001 326,126 318,875 194,744 99,871 94,873 2 613,346 310,996 302,350 179,324 91,750 87,574 3 583,202 294,737 288,465 177,809 90,596 87,213 4 580,308 293,628 286,680 171,129 87,410 83,719 5-9 2,746,688 1,390,766 1,355,922 856,523 435,055 421,468 5 561,856 284,488 277,368 173,348 88,527 84,821 6 548,835 278,397 270,438 169,653 85,962 83,691 7 535,760 270,308 265,452 169,348 85,957 83,391 8 523,440 265,242 258,198 168,873 85,524 83,349 9 576,797 292,331 284,466 175,301 89,085 86,216 10-14 2,722,254 1,376,093 1,346,161 827,222 420,854 406,368 10 559,728 283,480 276,248 177,464 90,377 87,087 11 564,931 285,288 279,643 167,985 85,450 82,535 12 545,932 275,967 269,965 164,268 83,091 81,177 13 520,997 262,781 258,216 159,930 81,197 78,733 14 530,666 268,577 262,089 157,575 80,739 76,836 15-19 2,615,482 1,313,308 1,302,174 805,910 413,513 392,397 15 510,557 258,794 251,763 157,734 80,832 76,902 16 512,876 261,586 251,290 156,707 81,091 75,616 17 515,580 262,640 252,940 162,097 83,872 78,225 18 516,547 257,093 259,454 155,309 79,339 75,97O 19 559,922 273,195 286,727 174,063 88,379 85,684 Civilian Population by Age/Sex/Race, Ages 20-44 All races White Age Total Male Female Total Male Female 20-24 18,675,525 9,313,862 9,361,663 15,229,703 7,643,279 7,586,424 20 3,960,808 1,980,662 1,980,146 3,202,991 1,608,510 1,594,481 21 3,853,162 1,925,341 1,927,821 3,136,512 1,574,000 1,562,512 22 3,627,390 1,809,584 1,817,806 2,977,056 1,494,961 1,482,095 23 3,539,746 1,762,294 1,777,452 2,885,489 1,447,787 1,437,702 24 3,694,419 1,835,981 1,858,438 3,027,655 1,518,021 1,509,634 25-29 20,341,534 10,062,220 10,279,314 16,746,074 8,360,250 8,385,824 25 3,752,051 1,860,277 1,891,774 3,061,621 1,531,153 1,530,468 26 3,960,668 1,954,890 2,005,778 3,250,724 1,618,705 1,632,019 27 4,141,567 2,050,111 2,091,456 3,415,422 1,706,410 1,709,012 28 3,993,182 1,971,498 2,021,684 3,308,399 1,648,370 1,660,029 29 4,494,066 2,225,444 2,268,622 3,709,908 1,855,612 1,854,296 30-34 21,907,014 10,810,700 11,096,314 18,230,806 9,097,968 9,132,838 30 4,423,122 2,182,795 2,240,327 3,676,965 1,834,427 1,842,538 31 4,360,733 2,152,727 2,208,006 3,620,512 1,807,234 1,813,278 32 4,320,474 2,128,687 2,191,787 3,593,462 1,790,836 1,802,626 33 4,325,777 2,127,395 2,198,382 3,614,476 1,797,804 1,816,672 34 4,476,908 2,219,096 2,257,812 3,725,391 1,867,667 1,857,724 35-39 20,338,144 10,010,295 10,327,849 17,030,765 8,479,831 8,550,934 35 4,271,164 2,105,221 2,165,943 3,555,053 1,771,981 1,783,072 36 4,149,667 2,044,008 2,105,659 3,471,086 1,730,332 1,740,754 37 4,082,663 2,005,855 2,076,808 3,418,040 1,698,557 1,719,483 38 3,744,895 1,835,671 1,909,224 3,153,374 1,563,906 1,589,468 39 4,089,755 2,019,540 2,070,215 3,433,212 1,715,055 1,718,157 40-44 18,659,170 9,167,928 9,491,242 15,847,763 7,871,840 7,975,923 40 3,803,367 1,867,145 1,936,222 3,187,117 1,583,510 1,603,607 41 3,692,540 1,810,800 1,881,740 3,102,168 1,539,493 1,562,675 42 3,609,385 1,769,220 1,840,165 3,056,622 1,514,358 1,542,264 43 3,567,839 1,744,165 1,823,674 3,033,716 1,499,380 1,534,336 44 3,986,039 1,976,598 2,009,441 3,468,140 1,735,099 1,733,041 Black Other Races Age Total Male Female Total Male Female 20-24 2,564,882 1,220,787 1,344,095 880,940 449,796 431,144 20 573,009 277,272 295,737 184,808 94,880 89,928 21 531,745 255,735 276,010 184,905 95,606 89,299 22 477,489 226,359 251,130 172,845 88,264 84,581 23 486,788 229,361 257,427 167,469 85,146 82,323 24 495,851 232,060 263,791 170,913 85,900 85,013 25-29 2,677,135 1,249,002 1,428,133 918,325 452,968 465,357 25 514,794 241,053 273,741 175,636 88,071 87,565 26 530,409 247,585 282,824 179,535 88,600 90,935 27 539,706 251,856 287,850 186,439 91,845 94,594 28 506,879 236,219 270,660 177,904 86,909 90,995 29 585,347 272,289 313,058 198,811 97,543 101,268 30-34 2,712,683 1,249,112 1,463,571 963,525 463,620 499,905 30 549,762 253,173 296,589 196,395 95,195 101,200 31 546,044 252,242 293,802 194,177 93,251 100,926 32 534,862 245,431 289,431 192,150 92,420 99,730 33 524,275 240,225 284,050 187,026 89,366 97,660 34 557,740 258,041 299,699 193,777 93,388 100,389 35-39 2,430,899 1,116,541 1,314,358 876,480 413,923 462,557 35 525,619 242,596 283,023 190,492 90,644 99,848 36 500,832 229,477 271,355 177,749 84,199 93,550 37 489,369 224,592 264,777 175,254 82,706 92,548 38 430,376 196,330 233,846 161,345 75,435 85,910 39 484,903 223,546 261,357 171,640 80,939 90,701 40-44 2,043,933 938,630 1,105,303 767,474 357,458 410,016 40 448,328 205,109 243,219 167,922 78,526 89,396 41 428,002 195,739 232,263 162,370 75,568 86,802 42 401,355 184,172 217,183 151,408 70,690 80,718 43 382,223 174,837 207,386 151,900 69,948 81,952 44 384,025 178,773 205,252 133,874 62,726 71,148 Civilian Population by Age/Sex/Race, Ages 45-69 All races White Age Total Male Female Total Male Female 45-49 14,066,752 6,880,052 7,186,700 12,073,018 5,961,144 6,111,874 45 2,823,989 1,384,061 1,439,928 2,406,585 1,191,669 1,214,916 46 2,814,163 1,377,138 1,437,025 2,410,166 1,191,745 1,218,421 47 2,842,686 1,386,941 1,455,745 2,432,763 1,198,449 1,234,314 48 2,851,877 1,392,620 1,459,257 2,490,338 1,226,561 1,263,777 49 2,734,037 1,339,292 1,394,745 2,333,166 1,152,720 1,180,446 50-54 11,638,973 5,650,469 5,988,504 10,007,637 4,902,918 5,104,719 50 2,525,690 1,231,503 1,294,187 2,169,490 1,067,161 1,102,329 51 2,338,073 1,137,831 1,200,242 2,004,644 984,528 1,020,116 52 2,296,438 1,114,621 1,181,817 1,978,809 968,983 1,009,826 53 2,279,151 1,103,879 1,175,272 1,963,099 959,596 1,003,503 54 2,199,621 1,062,635 1,136,986 1,891,595 922,650 968,945 55-59 10,421,776 4,985,493 5,436,283 9,035,644 4,366,265 4,669,379 55 2,128,163 1,022,140 1,106,023 1,824,863 884,407 940,456 56 2,194,895 1,053,443 1,141,452 1,908,799 926,608 982,191 57 2,068,091 990,918 1,077,173 1,788,830 865,185 923,645 58 1,945,742 927,227 1,018,515 1,697,102 816,869 880,233 59 2,084,885 991,765 1,093,120 1,816,050 873,196 942,854 60-64 10,592,096 4,945,017 5,637,079 9,312,026 4,395,706 4,916,320 60 2,123,576 994,307 1,129,269 1,858,390 878,672 979,718 61 2,099,890 993,743 1,106,147 1,847,080 883,943 963,137 62 2,076,303 971,055 1,105,248 1,822,192 861,271 960,921 63 2,144,662 1,003,914 1,140,748 1,900,018 898,368 1,001,650 64 2,137,665 981,998 1,155,667 1,884,346 873,452 1,010,894 65-69 10,037,375 4,491,366 5,546,009 8,925,526 4,019,093 4,906,433 65 2,071,681 939,332 1,132,349 1,820,353 832,837 987,516 66 2,068,542 932,801 1,135,741 1,837,854 832,707 1,005,147 67 2,026,366 910,033 1,116,333 1,806,213 818,763 987,450 68 1,910,507 847,550 1,062,957 1,703,412 758,725 944,687 69 1,960,279 861,650 1,098,629 1,757,694 776,061 981,633 Black Other Races Age Total Male Female Total Male Female 45-49 1,447,743 658,034 789,709 545,991 260,874 285,117 45 296,047 134,905 161,142 121,357 57,487 63,870 46 291,676 132,147 159,529 112,321 53,246 59,075 47 298,191 134,950 163,241 111,732 53,542 58,190 48 264,306 119,570 144,736 97,233 46,489 50,744 49 297,523 136,462 161,061 103,348 50,110 53,238 50-54 1,210,120 543,781 666,339 421,216 203,770 217,446 50 260,347 117,563 142,784 95,853 46,779 49,074 51 246,605 111,428 135,177 86,824 41,875 44,949 52 235,905 105,990 129,915 81,724 39,648 42,076 53 237,433 106,255 131,178 78,619 38,028 40,591 54 229,830 102,545 127,285 78,196 37,440 40,756 55-59 1,050,389 464,174 586,215 335,743 155,054 180,689 55 228,877 102,341 126,536 74,423 35,392 39,031 56 217,399 94,521 122,878 68,697 32,314 36,383 57 211,715 94,510 117,205 67,546 31,223 36,323 58 188,493 83,354 105,139 60,147 27,004 33,143 59 203,905 89,448 114,457 64,930 29,121 35,809 60-64 979,111 421,819 557,292 290,959 127,492 163,467 60 202,604 87,789 114,815 62,582 27,846 34,736 61 193,763 83,672 110,091 59,047 26,128 32,919 62 195,801 84,328 111,473 58,310 25,456 32,854 63 189,420 81,495 107,925 55,224 24,051 31,173 64 197,523 84,535 112,988 55,796 24,011 31,785 65-69 873,190 367,065 506,125 238,659 105,208 133,451 65 197,872 83,338 114,534 53,456 23,157 30,299 66 181,785 78,955 102,830 48,903 21,139 27,764 67 173,104 70,515 102,589 47,049 20,755 26,294 68 161,326 68,122 93,204 45,769 20,703 25,066 69 159,103 66,135 92,968 43,482 19,454 24,028 Civilian Population by Age/Sex/Race, Ages 70-94 All races White Age Total Male Female Total Male Female 70-74 8,242,309 3,530,770 4,711,539 7,411,771 3,192,715 4,219,056 70 1,885,626 828,010 1,057,616 1,687,773 746,584 941,189 71 1,731,378 750,067 981,311 1,550,719 675,207 875,512 72 1,648,669 709,919 938,750 1,484,157 642,215 841,942 73 1,518,235 636,781 881,454 1,372,234 578,754 793,480 74 1,458,401 605,993 852,408 1,316,888 549,955 766,933 75-79 6,279,233 2,482,262 3,796,971 5,679,262 2,252,029 3,427,233 75 1,405,178 576,025 829,153 1,271,395 523,534 747,861 76 1,334,486 539,541 794,945 1,211,476 491,810 719,666 77 1,244,448 490,949 753,499 1,125,392 446,057 679,335 78 1,204,470 462,061 742,409 1,086,499 418,494 668,005 79 1,090,651 413,686 676,965 984,500 372,134 612,366 80-84 4,034,671 1,405,636 2,629,035 3,677,429 1,277,051 2,400,378 80 970,199 352,312 617,887 881,337 320,148 561,189 81 882,777 314,481 568,296 802,314 284,850 517,464 82 799,422 278,782 520,640 732,194 254,292 477,902 83 738,569 249,380 489,189 676,454 227,542 448,912 84 643,704 210,681 433,023 585,130 190,219 394,911 85-89 2,090,211 624,783 1,465,428 1,914,913 567,134 1,347,779 85 540,662 171,082 369,580 496,070 155,982 340,088 86 494,991 151,121 343,870 451,863 136,587 315,276 87 418,768 123,601 295,167 383,769 112,185 271,584 88 351,846 100,158 251,688 322,245 90,722 231,523 89 283,944 78,821 205,123 260,966 71,658 189,308 90-94 811,728 201,184 610,544 740,922 180,597 560,325 90 260,870 69,103 191,767 234,525 61,066 173,459 91 196,454 49,719 146,735 178,875 44,489 134,386 92 145,720 34,720 111,000 135,027 31,696 103,331 93 115,477 26,634 88,843 106,816 24,328 82,488 94 93,207 21,008 72,199 85,679 19,018 66,661 Black Other Races Age Total Male Female Total Male Female 70-74 663,400 264,252 399,148 167,138 73,803 93,335 70 156,589 62,689 93,900 41,264 18,737 22,527 71 144,402 58,572 85,830 36,257 16,288 19,969 72 130,368 52,796 77,572 34,144 14,908 19,236 73 117,671 45,969 71,702 28,330 12,058 16,272 74 114,370 44,226 70,144 27,143 11,812 15,331 75-79 488,763 181,082 307,681 111,208 49,151 62,057 75 107,773 41,297 66,476 26,010 11,194 14,816 76 99,312 37,445 61,867 23,698 10,286 13,412 77 96,933 35,089 61,844 22,123 9,803 12,320 78 97,480 34,424 63,056 20,491 9,143 11,348 79 87,265 32,827 54,438 18,886 8,725 10,161 80-84 296,609 100,835 195,774 60,633 27,750 32,883 80 73,406 25,093 48,313 15,456 7,071 8,385 81 67,277 23,623 43,654 13,186 6,008 7,178 82 55,654 19,223 36,431 11,574 5,267 6,307 83 51,393 16,909 34,484 10,722 4,929 5,793 84 48,879 15,987 32,892 9,695 4,475 5,220 85-89 147,495 45,802 101,693 27,803 11,847 15,956 85 37,398 11,986 25,412 7,194 3,114 4,080 86 36,369 11,564 24,805 6,759 2,970 3,789 87 29,438 9,046 20,392 5,561 2,370 3,191 88 25,054 7,549 17,505 4,547 1,887 2,660 89 19,236 5,657 13,579 3,742 1,506 2,236 90-94 59,885 16,611 43,274 10,921 3,976 6,945 90 22,596 6,587 16,009 3,749 1,450 2,299 91 14,842 4,184 10,658 2,737 1,046 1,691 92 8,848 2,383 6,465 1,845 641 1,204 93 7,205 1,827 5,378 1,456 479 977 94 6,394 1,630 4,764 1,134 360 774 Civilian Population by Age/Sex/Race, Ages 95-100+, 0-85+ All races White Age Total Male Female Total Male Female 95-99 214,007 45,333 168,674 193,801 40,287 153,514 95 73,966 16,379 57,587 67,544 14,728 52,816 96 53,543 11,484 42,059 48,701 10,288 38,413 97 38,487 7,947 30,540 34,904 7,081 27,823 98 28,470 5,714 22,756 25,364 4,953 20,411 99 19,541 3,809 15,732 17,288 3,237 14,051 100+ 43,968 9,673 34,295 36,215 7,413 28,802 0-14 55,130,404 28,224,576 26,905,828 43,923,745 22,545,696 21,378,049 15-44 116,972,393 58,062,538 58,909,855 96,714,725 48,423,880 48,290,845 45-64 46,709,597 22,461,031 24,248,566 40,428,325 19,626,033 20,802,292 15+ 195,435,492 93,314,576 102,120,916 165,722,889 79,586,232 86,136,657 45+ 78,463,099 35,252,038 43,211,061 69,008,164 31,162,352 37,845,812 65+ 31,753,502 12,791,007 18,962,495 28,579,839 11,536,319 17,043,520 75+ 13,473,818 4,768,871 8,704,947 12,242,542 4,324,511 7,918,031 85+ 3,159,914 880,973 2,278,941 2,885,851 795,431 2,090,420 Black Other Races Age Total Male Female Total Male Female 95-99 17,352 4,309 13,043 2,854 737 2,117 95 5,513 1,403 4,110 909 248 661 96 4,129 1,026 3,103 713 170 543 97 3,062 741 2,321 521 125 396 98 2,696 652 2,044 410 109 301 99 1,952 487 1,465 301 85 216 100+ 6,774 1,936 4,838 979 324 655 0-14 8,568,190 4,335,280 4,232,910 2,638,469 1,343,600 1,294,869 15-44 15,045,014 7,087,380 7,957,634 5,212,654 2,551,278 2,661,376 45-64 4,687,363 2,087,808 2,599,555 1,593,909 747,190 846,719 15+ 22,285,845 10,157,080 14,830,848 7,426,758 3,571,264 3,855,494 45+ 7,240,831 3,069,700 4,171,131 2,214,104 1,019,986 1,194,118 65+ 2,553,468 981,892 1,571,576 620,195 272,796 347,399 75+ 1,016,878 350,575 666,303 214,398 93,785 120,613 85+ 231,506 68,658 162,848 42,557 16,884 25,673 Civilian Population by Sex/Age/Geographic Region, Ages 0-85+ Civilian Population by Sex, Age, and Geographic Region: United States, July 1, 1991 United United Age States Northeast MidWest South West States Northeast Midwest Both sexes Males Total 250,566 50,871 60,090 86,067 53,537 121,539 24,433 29,139 0-14 55,130 10,263 13,350 18,957 12,561 28,224 5,256 6,837 0-4 19,222 3,672 4,487 6,526 4,538 9,836 1,880 2,296 5-9 18,237 3,361 4,463 6,264 4,149 9,337 1,723 2,286 10-14 17,671 3,230 4,400 6,167 3,874 9,051 1,653 2,255 15-44 116,973 23,625 27,676 39,984 25,687 58,063 11,689 13,753 15-19 17,051 3,247 4,175 6,043 3,586 8,698 1,651 2,130 20-24 18,676 3,840 4,434 6,400 4,002 9,314 1,913 2,209 25-29 20,342 4,147 4,690 6,937 4,567 10,062 2,049 2,314 30-34 21,907 4,448 5,153 7,393 4,914 10,811 2,192 2,543 35-39 20,338 4,108 4,820 6,862 4,547 10,010 2,018 2,385 40-44 18,659 3,835 4,404 6,349 4,071 9,168 1,866 2,172 45-64 46,710 9,939 11,206 16,185 9,379 22,460 4,729 5,414 45-49 14,067 2,946 3,302 4,847 2,971 6,880 1,422 1,618 50-54 11,639 2,433 2,798 4,038 2,370 5,650 1,167 1,361 55-59 10,422 2,222 2,523 3,642 2,035 4,985 1,054 1,212 60-64 10,582 2,338 2,583 3,658 2,003 4,945 1,086 1,223 65+ 31,753 7,043 7,857 10,942 5,911 12,791 2,758 3,135 65-69 10,037 2,200 2,413 3,502 1,923 4,491 970 1,090 70-74 8,242 1,827 2,002 2,854 1,559 3,531 763 850 75-79 6,279 1,398 1,559 2,167 1,155 2,482 535 611 80-84 4,035 899 1,025 1,390 720 1,406 300 351 85+ 3,160 719 858 1,029 554 881 190 233 United Age South West States Northeast Midwest South West Males Females Total 41,456 26,511 129,027 26,439 30,951 44,612 27,026 0-14 9,695 6,436 26,906 5,007 6,513 9,261 6,125 0-4 3,337 2,323 9,386 1,792 2,191 3,188 2,215 5-9 3,202 2,126 8,900 1,638 2,177 3,062 2,023 10-14 3,156 1,987 8,620 1,577 2,145 3,011 1,887 15-44 19,624 12,997 58,909 11,936 13,925 20,361 12,690 15-19 3,067 1,850 8,353 1,596 2,045 2,977 1,736 20-24 3,135 2,057 9,362 1,927 2,225 3,265 1,945 25-29 3,383 2,316 10,279 2,098 2,377 3,554 2,251 30-34 3,606 2,470 11,096 2,256 2,610 3,787 2,444 35-39 3,335 2,272 10,328 2,090 2,436 3,527 2,275 40-44 3,098 2,032 9,491 1,969 2,232 3,251 2,039 45-64 7,727 4,590 24,249 5,209 5,792 8,458 4,789 45-49 2,362 1,478 7,187 1,524 1,684 2,485 1,493 50-54 1,949 1,173 5,989 1,266 1,437 2,089 1,197 55-59 1,727 992 5,436 1,167 1,311 1,915 1,043 60-64 1,689 947 5,637 1,252 1,360 1,969 1,056 65+ 4,409 2,488 18,963 4,287 4,722 6,532 3,424 65-69 1,557 874 5,546 1,230 1,323 1,945 1,049 70-74 1,222 695 4,712 1,064 1,152 1,632 864 75-79 853 483 3,797 863 948 1,314 672 80-84 485 270 2,629 600 674 904 451 85+ 292 166 2,279 530 625 737 388 Estimates after 4/1/90 are consistent with Dept. of Commerce Press Release CB92-93. They are based on methodology described in Current Population Reports Series P-25 No.101.
