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Current Trends National Mortality Followback Survey: Characteristics of Persons Who Died from Diseases of the Heart -- United States, 1986
The National Mortality Followback Survey (NMFS) is a periodic survey conducted by CDC's National Center for Health Statistics and is designed to collect detailed information not otherwise available on a sample of decedents. This report describes the health and financial status of persons who died from heart disease in 1986 and illustrates the usefulness of the NMFS in addressing public health issues such as the financial burden of chronic disease.
The 1986 NMFS is a stratified random sample of 18,733 (approximately 1%) deaths from all causes among U.S. residents greater than or equal to 25 years of age (1). Of these, 6665 were reported as dying from heart disease. Next of kin or others familiar with the decedent's lifestyle were asked to provide information concerning use of medical and other care facilities in the last year of the decedent's life; sources of payment of medical care; impairments in daily activities; medical conditions; health practices and behaviors; social and economic characteristics; and the identity of all health facilities in which the decedent stayed during the last year of life.
Diseases of the heart (International Classification of Diseases, Ninth Revision 390-398, 402, 404-429) are the most common cause of death in the United States. In 1986, 765,490 deaths (36% of all deaths in the United States) were reported to have resulted from heart disease (1), compared with an estimated 759,431 deaths based on the above sample. Financial Status
At death, based on estimates from the NMFS, 67,650 (18%) men and 13,240 (5%) women who died from heart disease were employed (Table 1). In the last year of life, women were more likely than men to have had low family income: 53% of women with less than $9000 compared with 35% of men, and 16% of women with greater than or equal to $25,000 compared with 21% of men.
Reported family income reflects the combined resources of all members of the family unit. Therefore, decedent living arrangements had a direct bearing on family income. Thirty-two percent of women who died from heart disease reportedly lived alone or with unrelated persons in the last year of life. An additional 22% had lived in a nursing home, other health-care facility, or institution during this time. By contrast, less than 20% of men lived alone or with unrelated persons, and 8% lived in institutional settings before death.
One measure of decedents' financial status was the total value of their assets (e.g., home, cash, stocks, bonds, cars, jewelry, and business interests) at death. Women were more likely to have had assets less than $5000; 23% of women had no assets (Table 1). Women (24%) were less likely than men (35%) to have had assets greater than or equal to $50,000 at death. Health Status
In addition to heart disease, many decedents had other serious health problems, including high blood pressure, stroke, angina pectoris, diabetes, cancer, asthma, and other lung conditions (Table 2). Except for angina pectoris and other lung conditions, women were more likely to have had these health problems.
More women (45%) than men (27%) were reported to have received help from others or used special equipment in performing activities of daily living (e.g., walking, eating, bathing, dressing, or using the toilet) (Table 2). Forty-five percent of women and 33% of men also received help with home medical care (e.g., taking medicines or pills, receiving injections, having bandages changed, and receiving nursing care). Health-Care Use and Sources of Payment
The 1986 NMFS assessed whether the decedent had been an overnight patient in a health facility during the last year of life. A larger proportion of women than men used hospitals or nursing homes, other health-care facilities, and home hospice care.
Medicare was reported as the major health payment source for approximately half the decedents (Table 2). For women, the next most frequently reported payment source was self/family (14%) or private insurance/health maintenance organizations (HMOs) (14%). In comparison, 12% of men used their own or their family's funds and 23% used private insurance/HMOs. An estimated 42% of women and 46% of men spent less than $500 for their medical care. Eighteen percent of women and 11% of men spent greater than or equal to $5000 of their own money. Reported by: Office of Vital and Health Statistics Systems, National Center for Health Statistics, CDC.
Editorial Note: Mortality followback surveys collect information not typically available from death certificates and therefore enable investigators to learn more about the characteristics of decedents and the circumstances of their death. The 1986 NMFS is the fifth mortality followback survey conducted by NCHS; the previous four, conducted in the 1960s, were less comprehensive than the 1986 survey.
At least two caveats apply to interpretation of the 1986 NMFS data. First, because these data are national estimates based on a sample survey, they are subject to respondent and sampling errors. Second, although 82% of the respondents who com pleted the NMFS questionnaire were close relatives (e.g., spouse, parent, sibling, or adult child) of the decedent, insufficient recall or knowledge about details of the decedent's life may have reduced the accuracy of the replies to certain questions.
The finding that women were more likely to be in "poor health," living without family support, or with fewer financial resources reflects in part the differences in age and marital status at death among persons dying from heart disease. Approximately 70% of women (in contrast to less than 50% of men) were aged greater than or equal to 75 years when they died; moreover, three times more women than men were widowed.
These findings can aid in addressing the health-care needs of those with chronic disease. Other NMFS survey data can be used in addressing other public health issues.
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