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Surveillance for Sensory Impairment, Activity Limitation, and Health-Related Quality of Life Among Older Adults -- United States, 1993-1997

Vincent A. Campbell, Ph.D.1
John E. Crews, D.P.A.1
David G. Moriarty2
Matthew M. Zack, M.D., M.P.H.2
Donald K. Blackman, Ph.D.3

1Division of Birth Defects, Child Development, and Disability and Health
National Center for Environmental Health
2Division of Adult and Community Health
3Division of Cancer Prevention and Control
National Center for Chronic Disease Prevention and Health Promotion

Abstract

Problem/Condition: Increases in life expectancy in the United States are accompanied by concerns regarding the cumulative impact of chronic disease and impairments on the prevalence of disability and the health status and quality of life of the growing number of older adults (defined as persons aged greater than or equal to 65 years). Although older adults are the focus of these surveillance summaries, persons aged 55-64 years have also been included, when data were available, as a comparison. One important public health goal for an aging society is to minimize the impact of chronic disease and impairments on the health status of older adults, maintain their ability to live independently, and improve their quality of life. This report examines three dimensions of health status: sensory impairments, activity limitations, and health-related quality of life among older adults.

Reporting Period: This report examines data regarding activity limitations and sensory impairments for 1994 and health-related quality of life for 1993-1997.

Description of System: The 1994 National Health Interview Survey (NHIS) Core, NHIS disability supplement (NHIS-D1), and the 1994 NHIS Second Supplement on Aging (SOA II) were used to estimate vision impairments, hearing loss, and activity limitation. Data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1993 through 1997 were used to estimate two general measures of health-related quality of life: a) the prevalence of self-rated fair or poor general health and b) the number of days during the preceding 30 days when respondents reported their physical or mental health was "not good."

Results: Sensory impairments are common among older adults. Among adults aged greater than or equal to 70 years, 18.1% reported vision impairments, 33.2% reported hearing impairments, and 8.6% reported both hearing and vision impairments. Although older adults who reported vision and hearing impairments reported more comorbidities than their nonhearing-impaired and nonvisually impaired peers, impaired adults with sensory loss were able to sustain valued social participation roles.

Advancing age was associated with increased likelihood of difficulty in performing functional activities and instrumental and basic activities of daily living, regardless of race/ethnicity, sex, and region of residence in the United States. Unhealthy days (a continuous measure of population health-related quality of life) was consistent with self-rated health (a commonly used categorical measure) and useful in identifying subtle differences among sociodemographic groups of older adults. An important finding was that adults aged 55-64 years with low socioeconomic status (i.e., less than a high school education or an annual household income of less than $15,000) reported substantially greater numbers of unhealthy days than their peers aged 65-74 years.

Interpretation: Sensory impairments are common in adults aged greater than or equal to 70 years, and prevalence of activity limitations among older adults is high and associated with advancing age. Health-related quality of life is less closely related to age, particularly when health-related quality of life includes aspects of mental health.

INTRODUCTION

Increases in life expectancy in the United States are accompanied by the cumulative impact of chronic disease and impairments on the prevalence of disability and the health status and quality of life among the growing number of older adults (1-3). Although declines in the prevalence of disability associated with chronic disease among older adults might have occurred, advancing age is associated with an increase in the number of health conditions that can lead to disability (4,5). Important public health goals for older adults include minimizing the impact of chronic disease and impairments on their health status, maintaining their ability to live independently, and improving their quality of life (6). This report examined three dimensions of health status: sensory impairments, activity limitations, and health-related quality of life (HRQOL) among older adults.

METHODS

Vision and Hearing Impairments

Data from the 1994 National Health Interview Survey (NHIS) Core and the 1994 NHIS Second Supplement on Aging (SOA II) were used to estimate vision impairments, hearing loss, and activity limitation. NHIS is an ongoing, annual, cross-sectional household survey of the U.S. civilian, noninstitutionalized population (7). Whenever possible, all adult family members participate in the interview; proxy interviews are allowed, however, for elderly persons who are unable to participate because of illness or impairment. All respondents to the 1994 NHIS Core who were aged greater than or equal to 70 years were included in SOA II, regardless of disability status. All respondents to SOA II who reported a disability were also administered NHIS Disability Phase 1 Supplement (NHIS-D1).

Vision impairment was defined as blindness in one eye, blindness in both eyes, or any other trouble seeing. SOA II has nine self-report items regarding vision, including questions concerning a) diagnoses of cataracts and glaucoma; b) blindness in one or both eyes; c) use of glasses; d) trouble seeing, even with glasses; and e) cataract surgery, lens implant, contact lenses, and use of magnifiers. A general question regarding "trouble seeing even with glasses" is also included in SOA II.

Hearing impairment was defined as deafness in one ear, deafness in both ears, or any other trouble hearing. SOA II has six questions related to hearing loss, including self-reported deafness in one or both ears, any other trouble hearing, cochlear implant, and use of hearing aids. Data for 8,767 respondents who were aged greater than or equal to 70 years were included in the vision and hearing analyses.

Estimates of vision and hearing impairments were made for the U.S. population aged greater than or equal to 70 years, by race (black, white, and other [Native American and Asian/Pacific Islander]), Hispanic or non-Hispanic ethnicity, sex, and region of residence in the United States*. Data were also available for activity of daily living and instrumental activity of daily living limitations, prevalence of selected chronic diseases, opportunities for social interaction, and self-rated health.

Activity Limitations

Data from the 1994 NHIS-D1 were used to estimate limitations in three areas of routine activity in the population aged greater than or equal to 55 years: functional activities, activities of daily living (ADL), and instrumental activities of daily living (IADL). Data were collected on all members of sampled households in face-to-face interviews; proxy responses were accepted when a household member could not be interviewed. The 1994 NHIS-D1 included questions regarding each respondent's ability to perform a) a set of basic functional activities (i.e., lifting, climbing stairs, walking, sustained standing, bending, reaching, and grasping); b) ADL (i.e., bathing, dressing, getting around inside the home, toileting, eating, and getting in and out of beds and chairs); and c) IADL (i.e., shopping, managing money, using the telephone, performing household chores, and preparing meals). Estimates of activity limitations in these three activity areas were made for the U.S. population aged greater than or equal to 55 years, grouped in 10-year intervals by race/ethnicity, sex, and region of residence in the United States. Data regarding 22,486 respondents were used for these estimates of activity limitations.

Respondents were defined as having an activity limitation in basic functional activities, ADL, or IADL if they reported one or more difficulties in the activity area. Results were analyzed by age, race** Hispanic*** or non-Hispanic ethnicity, and sex. Native Americans and Asians/Pacific Islanders were categorized as other because of small age-group-specific sample sizes.

Health-Related Quality of Life (HRQOL)

Data from the Behavioral Risk Factor Surveillance System (BRFSS) for the years 1993-1997 were used to estimate a) the prevalence of self-reported fair or poor general health and b) the number of days during the preceding 30 days when respondents reported their physical or mental health was "not good". BRFSS is an ongoing, state-based, random-digit-dialed, telephone survey of U.S. civilian, noninstitutionalized persons aged greater than or equal to 18 years, which tracks health- and safety-related characteristics. This survey collects self-reported information on behaviors related to health status (with the understanding that self-reports can overestimate or underestimate the prevalence of certain behaviors). BRFSS data were weighted to reflect the age, sex, and race distribution of each state's estimated population for the year of the survey. State data were aggregated to produce nationwide estimates for the 50 states and the District of Columbia.

From 1993 through 1997, BRFSS respondents were asked to rate their general health on a 5-point scale from "excellent" to "poor." Each respondent was asked, "Now, thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?" and "Now, thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?" Respondents were also asked questions regarding their sex, race/ethnicity, highest educational level, annual household income, occupational status, marital status, whether they had one or more of several chronic health conditions, and selected health behaviors and characteristics (e.g., being overweight or smoking).

This report presents analyses of two measures of HRQOL that are among a set of 25 community health profile indicators recommended by the Institute of Medicine in a 1997 report (8). First, overall self-rated health was defined as a dichotomous variable indicating fair or poor self-rated health (1) or not (0). In addition, an unhealthy days index was derived by adding the responses from the two questions regarding the number of days during the preceding 30 days when the respondents' physical or mental health was not good, with the restriction that the unhealthy days index could not exceed 30 days. The minimal overlap assumption used in this index was found in other analyses to be the most reasonable and straight-forward approach for combining the mental and physical health measures.

HRQOL prevalence data were collected from 1993 through 1997 from each of the 50 participating BRFSS states and the District of Columbia, except for Wyoming in 1993, Rhode Island in 1994, and the District of Columbia in 1995. To ensure adequate sample sizes for analyses of subpopulations (e.g., age and sex subgroup comparisons within each state), data for 1993 through 1997 were combined to complete these analyses. To account for the complex sample design of both NHIS and BRFSS, SUDAAN statistical software was used for analyses (9). Except where noted, response categories of "don't know/not sure," "refused," and categories indicating data were missing are excluded from analyses. Data were not reported when the standard error was greater than or equal to 30% of the prevalence estimate.

RESULTS

Vision Impairments

Vision impairment, which is defined as blindness in one eye, blindness in both eyes, or any other trouble seeing, was reported by 18.1% of adults aged greater than or equal to 70 years, representing approximately 3.6 million persons (Table 1) (10). Men were less likely than women to report vision impairments, and adults in the northeast reported a lower frequency of vision impairments than other respondents. Blindness in both eyes was reported by 1.7% of adults aged greater than or equal to 70 years, and an additional 4.4% reported blindness in one eye (Table 2). Although all potential causes of vision impairments were not reported, 24.5% of older adults reported having a cataract, and 7.9% reported having glaucoma. Approximately 91.5% of respondents reported wearing glasses, 17.0% reported using a magnifier, and 15.1% reported having a lens implant to treat a cataract.

Older adults who reported any vision impairment were compared with those who did not report vision impairments to determine whether either group was more likely to have certain activity limitations, comorbidities and secondary health conditions, and participation restrictions (Table 3). Older adults who had visual impairments reported substantial differences in activity limitations compared with those who did not report vision impairments. Older adults with vision impairments were more than twice as likely as older adults without vision impairments to report difficulty walking (43.3% versus 20.2%), difficulty getting outside (28.6% versus 10.4%), difficulty getting into and out of a bed or chair (22.1% versus 9.3%), difficulty managing medication (11.8% versus 4.4%), and difficulty preparing meals (18.7% versus 6.7%). Older adults who had vision impairments were more likely than sighted, older adults to have experienced falls during the preceding 12 months (31.2% versus 19.2%) and to have suffered a broken hip (7.1% versus 4.2%). Moreover, older adults who had vision impairments were more likely than sighted, older adults to have experienced hypertension (53.7% versus 43.1%), heart disease (30.2% versus 19.7%), stroke (17.4% versus 7.3%), and depression or anxiety (13.3% versus 7.0%).

Unlike the findings for comorbidities and activity limitations, proportional differences in participation in selected social roles were small. Older adults who reported vision impairments were less likely than sighted, older adults to get together with friends (65.3% versus 72.5%) and less likely to go out to eat at a restaurant (55.7% versus 65.1%).

Hearing Impairments

Hearing impairment, which is defined as deafness in one ear, deafness in both ears, or any other trouble hearing, was reported by 33.2% of older adults, representing approximately 6.7 million persons in 1994 (Table 1). Women, blacks, and adults residing in the northeast were less likely than other respondents to report hearing loss. Deafness in both ears was reported by 7.3% of older adults, and an additional 8.3% reported deafness in one ear (Table 2). Whereas one third of the population reported hearing impairments, 11.6% (2,343,000 adults) reported using a hearing aid during the preceding 12 months. Of older adults, 0.1% reported having a cochlear implant.

Older adults who had hearing loss also reported greater difficulties with functional activities than those without hearing impairments (Table 3). However, these activity limitations were not as extensive as those among older adults who had vision impairments. Approximately 30.7% of older adults with hearing loss reported difficulty walking, whereas 21.3% of those who did not report hearing loss had difficulty walking. In addition, older adults who reported hearing loss were more likely than those without hearing impairments to report difficulty getting outside (17.3% versus 12.0%), getting into and out of bed or a chair (15.1% versus 9.8%), and managing medication (7.7% versus 4.8%). Older adults with hearing impairments reported more occurrences of falls (28.4%) than those without hearing impairments (17.8%) and more occurrences of broken hips (5.4%) than those who did not report hearing impairments (4.4%). Also, older adults with hearing impairments were more likely than those without hearing impairments to report hypertension (46.7% versus 44.3%), heart disease (27.6% versus 18.6%), stroke (11.8% versus 7.8%), and depression (9.9% versus 7.2%).

Difficulty with hearing was not associated with restriction in participation. Older adults with hearing impairments are only slightly less likely than those without hearing impairments to get together with friends (68.6% versus 72.4%). No substantial differences existed for eating at a restaurant or getting together with relatives.

Hearing and Vision Impairments

Approximately 1,724,000 adults (8.6%) of the population aged greater than or equal to 70 years reported both hearing and vision impairments (Table 1). Older adults who reported vision and hearing impairments were more than two times more likely than their peers without impairments to report difficulty walking (48.3% versus 22.2%), three times more likely to report difficulty getting outside (32.8% versus 11.9%), and almost two and one half times more likely to report difficulty getting into or out of bed or a chair (25.0% versus 10.4%). In addition, older adults who experienced both vision and hearing impairments were three times more likely than their peers without impairments to report difficulty preparing meals (20.7% versus 7.8%) and more likely to report difficulty managing medication (13.4% versus 5.0%).

Furthermore, older adults who reported both vision and hearing loss were more likely than those without either vision or hearing impairments to have a) fallen during the preceding 12 months (37.4% versus 19.8%), b) broken a hip (7.6% versus 4.5%), c) reported a higher prevalence of hypertension (53.4% versus 44.3%), d) reported heart disease (32.2% versus 20.6%), and e) experienced a stroke (two times as likely) (19.9% versus 8.1%) (Table 3). Older adults who experienced both hearing and vision loss reported less participation in social activities (e.g., getting together with friends [63.4% versus 71.9%] or going out to a restaurant [55.8% versus 64.1%]) than their peers without impairments; both groups were equally likely to report getting together with relatives.

Activity Limitations

For adults aged greater than or equal to 55 years, limitations in basic functional skills were reported most frequently, followed by limitations in ADL and IADL (Table 4). The prevalence of limitation in all three areas of activity increased with advancing age. Among respondents aged greater than or equal to 85 years, 60.8% reported having difficulty with at least one functional activity. Blacks were more likely than whites to report more difficulties in all areas of activity and in all age groups. A higher percentage of women reported difficulty in the three activity areas and across all age groups. Data for Hispanics and non-Hispanics were comparable for prevalence of activity limitation at younger ages; however, Hispanics had a higher prevalence of activity limitation for adults aged greater than 75 years in ADL and IADL. In the analyses for Hispanics, the confidence intervals were broad, and results should be interpreted with caution. Activity limitation was most prevalent in the south for all three activity areas.

Health-Related Quality of Life

The overall percentages of adults aged greater than or equal to 55 years who reported fair or poor self-rated health increased substantially with increasing age. Among male respondents, 21.1% of those aged 55-64 years; 25.9%, 65-74 years; and 32.8%, greater than or equal to 75 years reported fair or poor health. Among female respondents, 20.8% of those aged 55-64 years; 26.5%, 65-74 years; and 34.4%, greater than or equal to 75 years reported fair or poor health (Table 5). Older black or Hispanic adults and adults who had less than a high school education, earned less than $15,000 annual household income, were unable to work, were without health-care coverage, lived in the south, reported diabetes mellitus or consistently high blood pressure, were underweight or overweight, were current smokers, or did not participate in leisure-time activities were consistently more likely than the overall group to report fair or poor health status. Men and women aged 55-64 years and 65-74 years were approximately equally as likely to report fair or poor health (Table 5). Women aged greater than or equal to 75 years were slightly more likely than men of the same age to report fair or poor health. The pattern of an increased prevalence of a fair or poor self-rated health status with increasing age also occurred in each state and the District of Columbia; the prevalence ranged from 12.9% to 36.3% for adults aged 55-64 years, from 19.9% to 42.2% for adults aged 65-74 years, and from 25.5% to 51.3% for adults aged greater than or equal to 75 years (Table 6).

The mean number of reported unhealthy days in the preceding 30 days was the same for those aged 55-64 years and 65-74 years (5.6 days) but was higher for adults aged greater than or equal to 75 years (6.8 days) (Table 8). The mean number of unhealthy days was 1.1 days to 1.2 days higher for women than for men in each age group (Table 7). For each age and sex subgroup, adults reported having higher levels of unhealthy days than other respondents if they had less than a high school education or reported an annual household income of less than $15,000, an inability to work, nonparticipation in any physical activity during the preceding month, or not having health-care coverage. Respondents who had been told by a physician that they had diabetes, or that their blood pressure was higher than normal on two or more occasions, or who were current smokers, reported higher mean unhealthy days than other respondents. For each age group, women who reported having breast cancer also reported higher numbers of unhealthy days than those who did not report having breast cancer. Conversely, for each age group, adults who reported the lowest levels of unhealthy days also reported the following: having a college degree, having health-care coverage, having never smoked, having some level of physical activity, not having diabetes or hypertension, being currently employed, being a married man, being an overweight man**** *****, or being a normal-weight woman****.

Some relations between the number of unhealthy days and characteristics of respondents were more complex (Table 7). For example, men and women who had less than a high school education reported the highest number of unhealthy days in the youngest age group (55-64 years) versus the two oldest age groups, whereas men and women who had college degrees reported progressively higher levels of unhealthy days with increased age. Similarly, adults who had annual household incomes of less than $15,000 reported a higher mean number of unhealthy days in the youngest age group (55-64 years) versus the two oldest age groups, whereas those who had annual household incomes of greater than or equal to $50,000 reported a progressively higher mean number of unhealthy days with increased age. Men and women who reported the fewest numbers of unhealthy days for each age and sex group resided in the midwest (aged 55-64 years), northeast (aged 65-74 years), and west (aged greater than or equal to 75 years). Men and women (aged 55-64 years) who resided in the west and men and women (aged 65-74 years and greater than or equal to 75 years) who resided in the south reported the highest mean number of unhealthy days for each age and sex group.

At the state level (with the exception of Alaska and Tennessee), the mean number of unhealthy days reported by the oldest age group (greater than or equal to 75 years) was consistently higher than the mean number reported in the next oldest age group (65-74 years) (Table 8). However, differences in the mean number of unhealthy days between adults aged 55-64 years and aged 65-74 years were not statistically significant (p greater than or equal to 0.05) for most states. For each state and the District of Columbia, the mean number of unhealthy days for adults aged 55-64 years ranged from 3.4 days to 7.7 days; for adults aged 65-74 years, from 3.4 days to 7.2 days; and for adults aged greater than or equal to 75 years, from 4.4 days to 9.6 days (Table 8).

For men and women aged greater than or equal to 65 years, a direct relation existed between their self-rated health status and mean number of unhealthy days (Figure); however, the numbers of mean unhealthy days were substantially smaller for those who reported excellent, very good, or good health status (range = 1.4 days-4.3 days) compared with the mean number of unhealthy days of respondents who reported a fair or poor health status (range = 9.1 days-22.9 days). Although separate analyses (not shown) indicated that most unhealthy days are attributed to days when physical health was not good versus when mental health was not good for adults aged greater than or equal to 65 years, a substantial percentage of these respondents (6.2%) reported greater than or equal to 2 weeks of recent poor mental health.

DISCUSSION

Chronic illnesses and their related activity limitations are a major health problem for older adults. These illnesses and limitations involve reduced functioning, cognitive impairments, depressive symptoms, the need for extended care, and burdensome health-care costs (11,12). Large declines have been reported in the proportions of older U.S. adults who are functionally impaired (13). However, preserving a good quality of life is as important as increasing life expectancy; the ability of older adults to function independently is a critically important public health issue (14).

Vision and Hearing Impairments

Compared with the information available regarding risk factors for specific diseases, few studies have examined risk factors for age-related functional decrements (15). Among older adults in communities, available research identified hearing and vision impairments as important risk factors that lead to functional decline and increased mortality as well as imbalance, hip fracture, and depression (16-24). Moreover, declining hearing and vision in older adults pose important challenges for families and family caregivers (25-27).

This report examined the important relation between sensory loss and activity limitations. Sensory impairments are common among older adults. Eighteen percent of adults aged greater than or equal to 70 years reported blindness in one eye, blindness in both eyes, or any other trouble seeing; 33.2% reported hearing impairments, and 8.6% reported both hearing and vision impairments. Because these experiences are common, they are often overlooked or dismissed (28). Moreover, normal, age-related changes in hearing and vision might not be separated from abnormal sensory changes that can compromise function. In addition, both hearing and vision impairments are not visible disabilities, and both might lead to misdiagnosis or misunderstanding. Because vision and hearing occur on a continuum, discerning when a sensory impairment arises might be difficult. When changes in hearing and vision exceed normal age-related changes, they might begin to compromise the ability of an older adult to perform routine activities that define social roles and affect quality of life (29).

In these analyses, a pattern occurred from examining the comorbidities and activity limitations among adults who reported hearing impairments, vision impairments, and both hearing and vision impairments. Older adults who had hearing impairments also reported more comorbidities than their nonhearing-impaired peers. Similarly, older adults who had vision impairments also reported more comorbidities and substantially more difficulty performing activities; those who reported both hearing and vision impairments reported increasingly greater comorbidities and greater difficulty performing activities. Despite the greater prevalence of functional impairments, these findings indicated that older adults who had sensory loss sustained valued social participation roles, although they had multiple activity limitations (30,31).

Untangling the relation among sensory loss, comorbidities and secondary conditions, and activity limitations poses an important challenge for public health and the development of public policy. For example, regarding the relation between sensory limitations and activity limitations, more information is needed concerning the relation between underlying conditions, activity limitations, and secondary conditions. How do difficulty walking and difficulty getting outside affect the development of heart disease and hypertension among older persons with sensory impairments? How does difficulty preparing meals affect the nutrition of older persons who have problems seeing and hearing? Regarding the relation between activity limitations and environment, more information is needed concerning the effect of environmental accommodations or supports on the ability of adults with sensory impairments to live independently. For example, would the presence of sidewalks and larger print size on medicine bottles make a difference in the general health and independence of older adults with vision impairments? How does environmental noise hinder older adults from understanding conversation? Finally, more information is needed regarding the strategies that many older adults who have a disability employ to sustain participation in the community.

Activity Limitations

Advancing age is associated with increased likelihood of limitation in functional activities, ADLs, and IADLs, regardless of demographic and geographic factors (32-34). In all three activity domains, the differences that occurred between men and women as age increased support earlier reports of higher prevalence of limitation for women and higher mortality for men (34). The racial disparity in prevalence of limitations in functional activities, ADLs, and IADLs is similar to those noted by other researchers (35). Reduction in ability to perform functional activities, ADLs, and IADLs are associated with an increased need for social services and medical care (34). Despite reports that indicate that the prevalence of limitations is decreasing (13), increases in the absolute number of adults who experience limitation in activities will have substantial effects on the service delivery and health-care systems and on the demand for institutionalization (34).

The concept of what constitutes a disability continues to evolve (3). The World Health Organization is revising its International Classification of Impairments, Disabilities, and Handicaps report and will emphasize the role of environmental factors in mitigating or exacerbating the effect of activity limitations in daily life (36,37). Regarding activity limitations, population estimates were analyzed for three broad areas (i.e., functional activities, IADLs, and ADLs) related to independent living -- the major activity for adults aged greater than or equal to 65 years. Unfortunately, data regarding environmental factors were not available from NHIS. The extent to which environmental factors might affect the portion of the older adult population that is affected by limitations in functional activities, ADLs, or IADLs, is not addressed in this report. In addition, data were taken from the special disability supplement in the 1994 NHIS. Continued and improved monitoring of the older adult population requires that instruments (e.g., NHIS) include in the recurring core routine questions concerning specific activities and environmental factors that affect independent living.

Health-Related Quality of Life

Chronic health conditions and increased levels of activity limitations are associated with lower levels of HRQOL (38,39). Some efforts to improve the health of older adults by prevention and treatment of specific conditions have been successful but are difficult to evaluate because of problems of competing morbidity in this population (5). The best measures of HRQOL are believed to be each person's subjective experience (40). This report included two self-reported measures of overall health: a general rating of health status and an estimate of the number of days in the preceding 30 days when physical or mental health was perceived as not good. The direct relation between self-rated health and number of unhealthy days supported the validity of both measures for measuring HRQOL of older adults. Findings also indicated that older adults who reported either fair or poor self-rated health also reported substantially greater numbers of recent unhealthy days than those who reported excellent, very good, or good self-rated health. The number of unhealthy days for older adults -- as a continuous measure of both physical and mental health perception -- is a useful index for identifying vulnerable subpopulations. Previous analyses of the mental health component of unhealthy days suggested the importance of mental health to the quality of life of older adults and the potential value of prevention and treatment of psychiatric disorders in this population (38,41).

A consistent relation exists between the mean number of unhealthy days and socioeconomic characteristics that have been associated with increased disease, disability, and mortality (e.g., unemployment and lower levels of income and education), and this finding confirmed earlier findings in a general adult population study (42). Both men and women in their preretirement years (aged 55-64 years) who had the least education and lowest annual household income reported higher numbers of unhealthy days than their counterparts with the least education and lowest annual household income reported in the two older age groups. This finding was in contrast to age-associated increases in the mean number of unhealthy days for the highest socioeconomic status(SES) groups (i.e., college graduates and adults with annual household incomes of greater than or equal to $50,000) and produced a narrowing of HRQOL disparities with older age between the upper and lower SES groups. These findings might reflect health gains from improved access to health and social services when adults become eligible for Medicare, social security, and other retirement benefits. Researchers also found that respondents who said that they were unable to work reported substantially high levels of unhealthy days. This relation had also been observed among working-aged adults in other analyses of BRFSS data and has been documented as highly correlated at the state and county levels with 1990 U.S. Bureau of the Census estimates of severe work disability (43).

This report has several limitations. NHIS is limited to the civilian, noninstitutionalized population and might underrepresent the oldest of the elderly, who are more likely to reside in institutions. Furthermore, reports could be provided by the reference person directly or by a proxy respondent. Of the 22,486 adults in the 1994 NHIS-D1 sample of adults aged greater than 54 years, 28.3% were proxy respondents.

The 1994 SOA II has two limitations. First, the dataset does not include adults aged 65-69 years; this exclusion makes comparability with some cohorts more difficult because research concerning aging typically includes adults aged greater than or equal to 65 years. Second, questions regarding vision and hearing are limited because they do not address functional activities. Questions regarding the ability to read newspaper print, recognize a street sign, or hear conversation in a crowded room are generally more useful when activity limitation and participation are examined.

BRFSS has several limitations. First, like NHIS, BRFSS is limited to the civilian, noninstitutionalized population and might underrepresent the oldest of the elderly, who are more likely to reside in institutions. Second, BRFSS does not include in the sampling frame adults who did not have telephones (i.e., approximately 5% of U.S. households) (44). However, differences in geographic and demographic characteristics of households with and without telephones were small according to one recent study, suggesting that this limitation might not limit generalizability (45). Third, BRFSS samples might include only small numbers in subgroups of particular interest (e.g., Native Americans or Asians/Pacific Islanders). Estimates for these subgroups were accurate but less precise than estimates for subgroups with larger numbers of respondents.

Acknowledgment

The authors thank Daniel Chapman, Ph.D., Epidemiologist, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, for his assistance with data regarding the mental health status of older adults.

References

  1. Vita AJ, Terry RB, Hubert HB, Fries JF. Aging, health risks, and cumulative disability. N Engl J Med 1998;338:1035-41.
  2. Andresen E. Introduction. In: Andresen E, Rothenberg B, Zimmer JG, eds. Assessing the health status of older adults. New York, NY: Springer Publishing Co, 1997.
  3. Pope AM, Tarlov AR. Disability in America: toward a national agenda for prevention. Washington, DC: National Academy Press, 1991.
  4. Manton KG, Corder L, Stallard E. Chronic disability trends in elderly United States populations: 1982-1994. In: Proc Natl Acad Sci U S A 1997;94:2593-8.
  5. Gerontological Society of America. Public health and an aging population: a call to action. Washington, DC: Gerontological Society of America, 1998.
  6. Diwan S, Moriarty D. A conceptual framework for identifying unmet health care needs of community dwelling elderly. Journal of Applied Gerontology 1995;14:47-63.
  7. Adams PF, Marano MA. Current estimates from the National Health Interview Survey, 1994. Hyattsville, MD: US Department of Health and Human Services, Public Health Service, CDC, National Center for Health Statistics, 1995; DHHS publication no. (PHS)96-1521. (Vital and Health Statistics; series 10, no. 193).
  8. Durch JS, Bailey LA, Soto MA, eds. Improving health in the community: a role for performance monitoring. Washington, DC: National Academy Press, 1997.
  9. Shah BV, Barnwell BG, Bieler GS. Software for survey data analysis (SUDAAN), Version 7.5. Research Triangle Park, NC: Research Triangle Institute, 1997.
  10. Havlik RJ. Aging in the eighties: impaired senses for sound and light in persons age 65 years and over: preliminary data from the Supplement on Aging to the National Health Interview Survey: United States, January-June 1984. Hyattsville, MD: US Department of Health and Human Services, Public Health Service, CDC, National Center for Health Statistics, 1986. (Advance data from the vital and health statistics; no. 125).
  11. Brummel-Smith K. Introduction. In: Kemp B, Brummel-Smith K, Ramsdell JW, eds. Geriatric rehabilitation. Boston, MA: Little, Brown and Co, 1990:3-21.
  12. Salive ME, Guralnik JM. Disability outcomes of chronic disease and their implications for public health. In: Hickey T, Speers MA, Prohaska TR, eds. Public health and aging. Baltimore, MD: The Johns Hopkins University Press, 1997:87-106.
  13. Freedman VA, Martin LG. Understanding trends in functional limitations among older Americans. Am J Public Health 1998;88:1457-62.
  14. Crimmins EM, Saito Y, Ingegneri D. Trends in disability-free life expectancy in the United States, 1970-1990. Population and Development Review 1997;23:555-72.
  15. Guralnik JM, Fried LP, Salive ME. Disability as a public health outcome in the aging population. Annu Rev Public Health 1996;17:25-46.
  16. LaForge RG, Spector WD, Sternberg J. The relationship of vision and hearing impairment to one-year mortality and functional decline. Journal of Aging and Health 1992;4:126-48.
  17. Gerson LW, Jarjoura D, McCord G. Risk of imbalance in elderly people with impaired hearing or vision. Age Ageing 1989;18:31-4.
  18. Bate, HL. Hearing impairment among older persons: a factor in communication. In: Orr AL, ed. Vision and aging: crossroads for service delivery. New York, NY: American Foundation for the Blind Press, 1994.
  19. Daubs, JG. Visual factors in the epidemiology of falls by the elderly. J Am Optom Assoc 1973;44:733-36.
  20. Brummel-Smith K. Falls and instability in the older person. In: Kemp B, Brummel-Smith K, Ramsdell JW, eds. Geriatric rehabilitation. Boston, MA: Little, Brown and Co, 1990:193-208.
  21. Felson DT, Anderson JJ, Hannan MT, Milton RC, Wilson PWF, Kiel DP. Impaired vision and hip fracture: the Framingham Study. J Am Geriatr Soc 1989;37:495-500.
  22. Rovner BW, Zisselman PM, Shmuely-Dulitzki Y. Depression and disability in older people with impaired vision: a follow-up study. J Am Geriatr Soc 1996;44:181-4.
  23. Rovner BW, Ganguli M. Depression and disability associated with impaired vision: the MoVIES Project. J Am Geriatr Soc 1998;46:617-9.
  24. Horowitz, A. Aging, vision loss and depression: a review of the research. Aging and Vision News 1995;7:6-7.
  25. Crews JE, Frey WD. Family concerns and older people who are blind. Journal of Visual Impairment and Blindness 1993;87:6-11.
  26. Silverstone B. Aging, vision rehabilitation, and the family. In: Crews JE, Whittington FJ, eds. Vision loss in an aging society: a multidisciplinary perspective. New York, NY: American Foundation for the Blind Press (In press).
  27. Silver R. Meeting the challenge. In: Boone SE, Watson D, Bagley M, eds. The challenge to independence: vision and hearing loss among older adults. Little Rock, AR: Rehabilitation Research and Training Center for Persons Who are Deaf or Hard of Hearing, 1994.
  28. Branch LG, Horowitz A, Carr C. The implications for everyday life of incident self-reported visual decline among people over age 65 living in the community. Gerontologist 1989;29:359-65.
  29. Drummond MF. Measuring the quality of life of people with visual impairment: proceedings of a workshop. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Eye Institute, 1990; DHHS publication no. (NIH)90-3078.
  30. Kemp, BJ. Psychosocial considerations in a rehabilitation model for aging and vision services. In: Crews JE, Whittington FJ, eds. Vision loss in an aging society: a multidisciplinary perspective. New York, NY: American Foundation for the Blind Press (In press).
  31. Gignac MAM, Cott C. A conceptual model of independence and dependence for adults with chronic physical illness and disability. Soc Sci Med 1998;47:739-53.
  32. US Senate Special Committee on Aging, American Association of Retired Persons, Federal Council on the Aging, US Administration on Aging. Aging America: trends and projections. Washington, DC: Department of Health and Human Services, 1991; DHHS publication no. (FCoA)91-28001.
  33. Hobbs FB, Damon BL. 65+ in the United States. Washington, DC: US Department of Commerce, Economics and Statistics Administration, Bureau of the Census, April 1996. (Current population reports, no. P23-190).
  34. Fried LP, Guralnik JM. Disability in older adults: evidence regarding significance, etiology, and risk. J Am Geriatr Soc 1997;45:92-100.
  35. LaPlante MP, Carlson D. Disability in the United States: prevalence and causes, 1992. Washington, DC: US Department of Education, National Institute on Disability and Rehabilitation Research, 1996. (Disability statistics report [7]).
  36. World Health Assembly. International classification of impairments, disabilities, and handicaps: a manual of classification relating to the consequences of disease. Geneva, Switzerland: World Health Organization, 1980. (Resolution WHA29.35).
  37. World Health Organization. ICIDH-2: international classification of impairments, activities, and participation: a manual of dimensions of disablement and functioning--Beta-1 draft for field trials, 1997 (Includes basic Beta-1 Field Trial forms). Geneva, Switzerland: World Health Organization, 1997.
  38. CDC. Health-related quality of life and activity limitation--eight states, 1995. MMWR 1998;47:134-40.
  39. Andresen EM, Fouts BS, Romeis JC, Brownson CA. Performance of health-related quality-of-life instruments in a spinal cord injured population. Arch Phys Med Rehabil 1999;80:877-84.
  40. Hennessy CH, Moriarty DG, Zack MM, Scherr PA, Brackbill R. Measuring health-related quality of life for public health surveillance. Public Health Rep 1994;109:665-72.
  41. CDC. Self-reported frequent mental distress among adults--United States, 1993-1996. MMWR 1998;47:325-31.
  42. Newschaffer CJ and Center for Research in Medical Education and Health Care, Jefferson Medical College. Validation of Behavioral Risk Factor Surveillance System (BRFSS) HRQOL measures in a statewide sample. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, National Center for Chronic Disease Prevention and Health Promotion, 1998.
  43. Borawski E, Bowlin S, Wu G, Jia H, Chen H. The use of the Behavioral Risk Factor Surveillance System (BRFSS) in estimating disability at the state and substate levels. Presented at the annual meeting of the American Public Health Association, Indianapolis, IN, 1997.
  44. Lavrakas PJ. Telephone survey methods: sampling, selection, and supervision. 2nd ed. Applied Social Research Methods Series Vol 7. Newbury Park, CA: Sage Publications, 1993.
  45. Anderson JE, Nelson DE, Wilson RW. Telephone coverage and measurement of health risk indicators: data from the National Health Interview Survey. Am J Public Health 1998;88:1392-5.

* Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; and West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

** Race/ethnicity data are presented only for non-Hispanic whites, non-Hispanic blacks, and Hispanics because sample sizes for other racial/ethnic groups were too small for meaningful analysis.

*** Persons of Hispanic origin can be of any race.

**** World Health Organization categories of body mass index.

***** The WHO category "overweight" is misleading because it does not include those who are very overweight (i.e., "obese").



Table 1

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TABLE 1. Percentage distribution of hearing and vision limitations among adults aged >=70 years, by selected sociodemographic characteristics -- United States, National Health Interview Second Supplement on Aging, 1994*

 

Vision impairment n = 1,397

Hearing impairment n = 2,905

Vision and hearing impairment n = 675

Characteristic

Population

%

(95% CI)

Population

%

(95% CI)

Population

%

(95% CI)

Population aged >=70 yrs

3,652,626

18.1

(1.1)

6,697,497

33.2

(1.3)

1,724,277

8.6

(0.7)

Sex

                 

Male

1,319,000

16.4

(1.4)

3,214,181

40.0

(1.9)

726,200

9.0

(1.1)

Female

2,333,626

19.2

(1.3)

3,483,316

28.7

(1.5)

998,077

8.2

(0.9)

Race

                 

White

3,246,700

17.9

(1.1)

6,243,983

34.5

(1.4)

1,588,000

8.8

(0.8)

Black

307,273

19.6

(3.1)

303,450

19.3

(2.7)

82,604

5.3

(1.5)

Other

98,653

20.6

(9.8)

150,064

31.3

(8.8)

53,673

Hispanic ethnicity**

                 

Yes

137,787

18.7

(4.6)

215,513

29.3

(5.4)

69,401

8.2

(3.5)

No

3,469,017

18.1

(1.1)

6,405,472

33.4

(1.3)

1,644,370

8.6

(0.8)

Region††

                 

Northeast

654,391

14.3

(1.8)

1,396,180

30.6

(2.3)

314,159

6.9

(1.4)

Midwest

959,465

18.7

(1.9)

1,744,938

34.0

(2.6)

457,091

8.9

(1.3)

South

1,304,254

19.9

(2.1)

2,176,528

33.3

(2.6)

604,377

9.2

(1.5)

West

734,516

18.8

(2.6)

1,379,851

35.3

(2.7)

348,650

8.9

(1.7)

* Total population = 8,767.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Race data are presented only for whites, blacks, and others because sample sizes for other racial groups were too small for meaningful analysis.
Analyses were not performed for subgroups when the relative standard error of an estimate was >= 30%.
** Persons of Hispanic origin can be of any race.
†† Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; and West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

Source: National Center for Health Statistics, CDC, 1998. Data File Documentation, National Health Interview Second Supplement on Aging, 1994 (Machine-readable data file and documentation), National Center for Health Statistics, Hyattsville, MD.


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Table 2

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TABLE 2. Percentage distribution of selected vision and hearing impairments among adults aged >=70 years -- United States, National Health Interview Second Supplement on Aging, 1994*

Sensory characteristic

Population aged >=70 yrs

%

(95% CI)

Vision impairments (n = 1,397)

3,652,626

18.1

(1.1)

Blind in one eye

879,215

4.4

(0.4)

Blind in both eyes

338,492

1.7

(0.3)

Any other trouble seeing

2,853,053

14.4

(0.9)

Glaucoma

1,601,041

7.9

(0.6)

Cataract

5,125,760

24.5

(1.1)

Lens implant

3,038,524

15.1

(1.0)

Used magnifier

3,376,160

17.0

(1.0)

Wear glasses

18,127,245

91.5

(0.7)

Hearing impairments (n = 2,905)

6,697,497

33.2

(1.3)

Deaf in one ear

1,542,163

8.3

(0.7)

Deaf in both ears

1,478,727

7.3

(0.7)

Any other trouble hearing

4,193,478

22.5

(1.2)

Used hearing aid during preceding 12 months

2,343,064

11.6

(0.8)

Cochlear implant

28,018

0.1

(0.1)

* Total population = 8,767.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.

Source: National Center for Health Statistics, CDC, 1998. Data File Documentation, National Health Interview Second Supplement on Aging, 1994 (Machine-readable data file and documentation), National Center for Health Statistics, Hyattsville, MD.


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Table 3

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TABLE 3. Selected comorbidities, secondary health conditions, and activity limitations among adults aged >=70 years who reported a vision and/or hearing impairment or no impairment -- National Health Interview Second Supplement on Aging, 1994*

 

Vision (n = 1,397)

Hearing (n = 2,905)

Vision and Hearing (n = 675)

 

Reported impairment

No impairment (n = 7,370)

Reported impairment

No impairment (n = 5,862)

Reported impairment

No impairment (n = 8,092)

Category

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Activity limitations

                       

Difficulty walking

43.3

(2.5)

20.2

(1.0)

30.7

(1.9)

21.3

(1.2)

48.3

(3.7)

22.2

(1.1)

Difficulty getting outside

28.6

(2.3)

10.4

(0.8)

17.3

(1.6)

12.0

(1.0)

32.8

(3.2)

11.9

(0.8)

Difficulty getting into and out of bed or a chair

22.1

(2.5)

9.3

(0.7)

15.1

(1.6)

9.8

(0.8)

25.0

(3.6)

10.4

(0.8)

Difficulty managing medication

11.8

(1.7)

4.4

(0.6)

7.7

(1.0)

4.8

(0.6)

13.4

(2.4)

5.0

(0.6)

Difficulty preparing meals

18.7

(2.2)

6.7

(0.7)

11.6

(1.3)

7.6

(0.8)

20.7

(0.7)

7.8

(2.9)

Comorbidities and secondary health conditions

                       

Fallen during preceding 12 months

31.2

(2.5)

19.2

(1.0)

28.4

(1.8)

17.8

(1.2)

37.4

(3.7)

19.8

(1.1)

Broken hip

7.1

(1.3)

4.2

(0.5)

5.4

(0.9)

4.4

(0.5)

7.6

(2.0)

4.5

(0.5)

Hypertension

53.7

(2.7)

43.1

(1.3)

46.7

(2.1)

44.3

(1.4)

53.4

(4.0)

44.3

(1.2)

Heart disease

30.2

(2.7)

19.7

(1.0)

27.6

(1.2)

18.6

(1.6)

32.4

(3.6)

20.6

(1.0)

Stroke

17.4

(1.8)

7.3

(0.7)

11.8

(1.3)

7.8

(0.8)

19.9

(2.8)

8.1

(0.7)

Participation restrictions

                       

Frequently depressed or anxious

13.3

(2.1)

7.0

(0.7)

9.9

(1.3)

7.2

(0.8)

15.6

(2.9)

7.4

(0.7)

Get together with friends

65.3

(2.9)

72.5

(1.5)

68.6

(1.9)

72.4

(1.7)

63.3

(4.0)

71.9

(1.5)

Get together with relatives

74.2

(2.5)

76.1

(1.3)

76.9

(1.8)

75.2

(1.4)

75.5

(3.0)

75.8

(1.2)

Go out to eat at restaurant

55.7

(2.5)

65.1

(1.6)

62.7

(2.0)

63.7

(1.7)

55.8

(3.5)

64.1

(1.5)

* Total population = 8,767.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.

Source: National Center for Health Statistics, CDC, 1998. Data File Documentation, National Health Interview Second Supplement on Aging, 1994 (Machine-readable data file and documentation), National Center for Health Statistics, Hyattsville, MD.


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Table 4

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TABLE 4. Percentage of older adults with limitations in functional activities, activities of daily living, and instrumental activities of daily living, by selected sociodemographic characteristics -- United States, 1994*

 

Age group (yrs)

 

55-64

65-74

75-84

>=85

Characteristic

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Functional Activities

Region

               

Northeast

18.4

(2.0)

22.8

(2.7)

39.8

(3.8)

60.1

( 6.2)

Midwest

19.8

(1.8)

26.3

(2.2)

42.1

(2.9)

56.8

( 7.1)

South

22.3

(1.8)

32.5

(2.5)

46.0

(3.4)

67.1

( 5.4)

West

18.6

(2.1)

27.1

(3.0)

40.6

(4.8)

55.3

( 6.4)

Sex

               

Male

17.6

(1.2)

23.9

(1.5)

37.0

(2.5)

50.0

( 5.0)

Female

22.4

(1.3)

30.9

(1.7)

46.2

(2.2)

65.6

( 3.9)

Race

               

White

19.1

(1.0)

26.5

(1.4)

42.1

(1.9)

59.5

( 3.4)

Black

31.0

(3.2)

41.0

(4.1)

52.5

(5.5)

76.3

( 8.9)

Other

15.2

(4.1)

26.3

(5.9)

26.3

(11.6)

61.3

(19.6)

Hispanic ethnicity**

               

Yes

22.3

(4.3)

27.0

(5.6)

43.7

(7.6)

77.2

(11.6)

No

20.0

(1.0)

27.8

(1.3)

42.6

(1.9)

60.0

( 3.2)

Total

20.2

(1.0)

27.8

(1.3)

42.6

(1.8)

60.8

( 3.1)

 

Activities of Daily Living

Region

               

Northeast

2.9

(0.9)

4.1

(1.0)

13.4

(2.4)

26.6

( 6.8)

Midwest

3.4

(0.8)

5.1

(1.2)

9.8

(1.8)

23.8

( 6.2)

South

3.5

(0.8)

5.9

(1.0)

14.3

(1.9)

31.4

( 5.2)

West

3.7

(0.9)

5.4

(1.5)

11.4

(2.7)

22.1

( 6.5)

Sex

               

Male

3.0

(0.5)

4.5

(0.7)

10.6

(1.6)

21.0

( 4.4)

Female

3.7

(0.6)

5.8

(0.8)

13.5

(1.3)

29.2

( 3.8)

Race

               

White

3.2

(0.5)

5.0

(0.6)

11.9

(1.1)

25.8

( 3.2)

Black

4.9

(1.5)

8.5

(2.3)

19.0

(4.7)

35.0

( 8.0)

Other

2.9

(1.9)

1.9

(1.7)

8.3

(6.8)

33.8

(27.0)

Hispanic ethnicity

               

Yes

3.4

(1.5)

3.1

(1.7)

19.1

(7.0)

29.3

(17.2)

No

3.4

(0.5)

5.3

(0.6)

12.1

(1.1)

26.5

( 3.2)

Total

3.4

(0.4)

5.2

(0.6)

12.4

(1.1)

26.6

( 3.1)

 

Instrumental Activities of Daily Living

Region

               

Northeast

10.1

(1.6)

13.0

(1.8)

27.8

(3.3)

53.4

( 6.8)

Midwest

9.9

(1.3)

15.3

(2.0)

27.5

(3.1)

49.0

( 7.9)

South

12.4

(1.4)

18.6

(2.1)

31.1

(3.3)

56.9

( 5.1)

West

9.5

(1.6)

13.7

(2.4)

25.1

(3.9)

50.5

( 8.3)

Sex

               

Male

8.7

(0.9)

12.4

(1.2)

21.9

(2.2)

42.1

( 5.7)

Female

12.6

(1.1)

18.1

(1.4)

32.3

(2.1)

57.9

( 3.9)

Race

               

White

10.3

(0.8)

15.1

(1.1)

27.8

(1.8)

52.1

( 3.5)

Black

15.0

(2.5)

21.4

(2.9)

34.4

(5.0)

61.3

(10.9)

Other

9.9

(3.3)

12.3

(6.4)

24.3

(11.8)

67.4

(21.8)

Hispanic ethnicity**

               

Yes

11.5

(2.9)

13.8

(4.0)

33.3

(7.5)

58.7

(20.1)

No

10.7

(0.8)

15.7

(1.1)

28.0

(1.7)

52.8

( 3.5)

Total

10.7

(0.7)

15.6

(1.1)

28.2

(1.7)

53.0

( 3.4)

* For all age groups, the total population for sections on region, sex, and race was 22,486; the sample size for 55-64 years was 8,945; 65-74 years, 8,013; 75-84 years, 4,396; and >=85 years, 1,132.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; and West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
Race data are presented only for whites, blacks, and others because sample sizes for other racial groups were too small for meaningful analysis.
** Person of Hispanic origin can be of any race.

Source: National Center for Health Statistics (1996). Data File Documentation, National Health Interview Survey of Disability, Phase I, 1994 (Machine readable data file and documentation), National Center for Health Statistics, Hyattsville, Maryland.


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Table 5

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TABLE 5. Percentage of fair or poor self-rated health reported by older adults, by selected demographic and risk factors -- 50 states and the District of Columbia, Behavioral Risk Factor Surveillance System, 1993-1997*

 

Age group (yrs)

 

55-64 (n = 64,919)

65-74 (n = 67,469)

>=75 (n = 46,458)

 

Male (n = 26,820)

Female (n = 38,099)

Male (n = 25,840)

Female (n = 41,629)

Male (n = 13,890)

Female (n = 32,568)

Characteristic

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Total

21.1

( 0.8)

20.8

(0.6)

25.9

( 0.8)

26.5

( 0.6)

32.8

( 1.2)

34.4

( 0.8)

Race

                       

White

19.8

( 0.8)

18.3

(0.6)

24.7

( 0.8)

24.6

( 0.7)

32.1

( 1.2)

33.5

( 0.8)

Black

31.4

( 3.2)

36.5

(2.4)

39.8

( 3.5)

43.3

( 2.6)

42.8

( 5.1)

46.5

( 3.3)

Asian/Pacific Islander

16.3

( 6.0)

19.3

(6.4)

22.1

(11.5)

18.2

( 6.8)

25.6

(12.5)

28.6

(13.4)

Native American/Alaskan Native

23.2

( 8.2)

44.1

(9.4)

32.5

(10.3)

42.0

(11.1)

48.7

(15.1)

38.9

(12.2)

Hispanic ethnicity

                       

Yes

33.9

( 4.6)

37.3

(4.0)

32.7

( 5.0)

39.3

( 4.2)

39.5

( 8.3)

45.8

( 6.0)

No

20.3

( 0.7)

19.7

(0.6)

25.5

( 0.8)

25.9

( 0.6)

32.6

( 1.2)

34.0

( 0.8)

Educational level

                       

Less than high school graduate

42.2

( 2.2)

43.5

(1.8)

40.7

( 1.8)

42.4

( 1.4)

43.3

( 2.2)

44.8

( 1.4)

High school graduate

21.7

( 1.3)

19.5

(1.0)

25.9

( 1.4)

24.9

( 1.0)

30.7

( 2.1)

32.7

( 1.4)

Some college

17.9

( 1.5)

14.4

(1.2)

22.1

( 1.9)

19.2

( 1.3)

29.0

( 2.7)

27.2

( 1.8)

College graduate

9.6

( 1.0)

8.5

(1.1)

13.3

( 1.3)

13.1

( 1.4)

23.1

( 2.6)

22.3

( 1.9)

Annual household income

                       

<$15,000

51.1

( 2.8)

44.3

(1.8)

42.8

( 2.2)

38.1

( 1.3)

42.9

( 2.6)

41.6

( 1.3)

$15,000-$24,999

28.8

( 2.0)

22.5

(1.4)

30.3

( 1.7)

25.7

( 1.3)

34.2

( 2.3)

31.7

( 1.7)

$25,000-$34,999

21.2

( 1.9)

16.1

(1.5)

19.6

( 1.8)

18.0

( 1.6)

25.3

( 3.0)

25.5

( 2.8)

$35,000-$49,999

14.4

( 1.6)

10.5

(1.4)

13.6

( 1.9)

13.8

( 2.0)

24.6

( 3.7)

22.5

( 3.7)

>=$50,000

10.8

( 1.2)

13.3

(1.4)

17.3

( 2.1)

26.3

( 2.2)

27.3

( 3.6)

32.2

( 2.6)

Employment status

                       

Employed

12.6

( 0.8)

11.3

(0.7)

15.1

( 1.6)

13.8

( 1.5)

17.2

( 4.0)

15.0

( 3.2)

Out of work

32.0

( 4.8)

31.9

(4.0)

31.2

(13.2)

30.2

( 7.6)

52.7

(26.2)

29.1

(1 7.3)

Homemaker

37.3

(19.0)

22.4

(1.5)

28.1

( 2.0)

34.3

( 2.6)

Retired

23.2

( 1.5)

20.0

(1.2)

26.5

( 0.9)

26.1

( 0.7)

33.4

( 1.2)

34.0

( 0.9)

Unable to work

79.3

( 2.6)

75.5

(2.5)

75.0

( 5.5)

74.3

( 3.6)

64.4

(14.6)

73.5

( 5.4)

Marital status

                       

Married

19.2

( 0.8)

17.6

(0.7)

24.1

( 1.0)

24.0

( 0.9)

32.0

( 1.5)

32.8

( 1.7)

Divorced

28.8

( 2.3)

25.1

(1.8)

30.3

( 2.6)

28.4

( 2.2)

37.7

( 6.4)

35.6

( 3.8)

Widowed

32.9

(5.2)

28.7

( 1.7)

34.8

( 2.4)

29.6

( 1.0)

34.3

( 2.1)

35.3

( 0.9)

Separated

29.7

(5.5)

40.4

( 5.0)

39.1

( 7.5)

47.1

( 6.8)

37.5

(11.5)

35.1

(10.4)

Never married

28.1

(4.0)

23.9

( 3.4)

30.5

( 4.3)

25.8

( 3.3)

34.2

( 6.4)

31.4

( 3.7)

Unmarried couple

20.5

(8.6)

19.7

(10.3)

Region**

                       

Northeast

17.7

(1.6)

18.4

( 1.4)

23.4

( 1.8)

24.5

( 1.5)

32.5

( 2.8)

32.3

( 1.9)

Midwest

19.7

(1.4)

18.1

( 1.1)

25.5

( 1.6)

24.6

( 1.2)

32.2

( 2.2)

34.7

( 1.4)

South

25.4

(1.3)

25.1

( 1.0)

29.3

( 1.4)

31.6

( 1.1)

37.1

( 2.1)

39.2

( 1.3)

West

19.1

(1.8)

19.0

( 1.6)

22.7

( 1.9)

21.4

( 1.6)

26.7

( 2.7)

27.9

( 1.9)

Diabetes mellitus

                       

Told has diabetes

51.0

( 3.1)

54.0

( 2.6)

47.3

( 2.7)

55.2

( 2.2)

50.8

( 3.8)

57.3

( 2.6)

No diabetes mellitus

17.9

( 0.7)

17.3

( 0.6)

22.7

( 0.8)

22.8

( 0.6)

30.4

( 1.2)

31.7

( 0.8)

Told has high blood pressure

                       

Never told

16.1

( 1.0)

14.3

( 0.9)

22.1

( 1.2)

19.7

( 0.9)

28.4

( 1.8)

29.0

( 1.3)

Told once

16.5

( 3.2)

20.7

( 3.4)

21.5

( 3.3)

22.0

( 2.7)

29.2

( 5.2)

27.6

( 3.4)

Told >=2 times

32.0

( 1.9)

35.0

( 1.6)

34.2

( 1.9)

37.5

( 1.4)

40.7

( 2.7)

44.1

( 1.6)

Reported breast cancer

                       

Yes

††

††

33.2

( 4.5)

††

††

36.1

( 3.8)

††

††

40.6

( 4.4)

No

††

††

20.5

( 0.6)

††

††

26.1

( 0.7)

††

††

34.2

( 0.8)

World Health Organization body mass index category

                       

Underweight

44.3

(10.9)

29.0

( 4.9)

48.9

( 9.8)

38.1

( 4.1)

51.2

( 9.4)

39.8

( 3.2)

Normal

19.6

( 1.3)

14.4

( 0.9)

25.4

( 1.4)

20.4

( 0.9)

33.7

( 1.7)

31.1

( 1.1)

Overweight

18.3

( 1.0)

19.5

( 1.1)

22.8

( 1.2)

26.2

( 1.1)

28.9

( 1.8)

34.2

( 1.5)

Obese (Class I)

26.5

( 2.2)

30.4

( 1.9)

33.7

( 2.6)

35.5

( 2.0)

37.6

( 4.7)

42.1

( 2.8)

Obese (Class II)

34.1

( 5.1)

41.1

( 3.7

40.3

( 5.8)

48.4

( 4.1)

55.0

(12.0)

50.1

( 6.2)

Obese (Class III)

47.1

( 8.5)

53.7

( 5.2)

42.1

(11.0)

59.3

( 7.2)

57.3

(11.1)

Cigarette smoking

                       

Never smoked

15.6

( 1.3)

19.7

( 0.9)

18.9

( 1.2)

24.7

( 0.8)

29.6

( 1.9)

33.8

( 0.9)

Former smoker

21.7

( 1.1)

20.0

( 1.1)

27.7

( 1.2)

28.6

( 1.3)

34.6

( 1.6)

36.2

( 1.7)

Current smoker (<1 ppd)

27.6

( 3.1)

23.8

( 2.1)

34.9

( 3.7)

29.0

( 2.5)

37.4

( 6.1)

35.2

( 3.9)

Current smoker (>=1 ppd)

27.5

( 2.1)

25.7

( 2.0)

33.2

( 3.0)

29.3

( 2.6)

39.1

( 6.9)

35.9

( 5.6)

Drank >=5 alcoholic beverages at least once during preceding month

                       

Yes

17.0

( 2.5)

12.3

( 4.1)

20.8

( 3.5)

20.6

( 6.8)

30.5

( 8.2)

27.7

(11.4)

No

21.2

( 1.0)

21.3

( 0.8)

26.6

( 1.0)

26.7

( 0.8)

32.9

( 1.4)

35.0

( 1.0)

Participate in leisure-time physical activity

                       

Yes

17.2

( 1.2)

14.8

( 1.0)

19.6

( 1.3)

18.8

( 1.0)

26.3

( 2.1)

24.5

( 1.4)

No

29.1

( 2.0)

32.0

( 1.7)

37.8

( 2.1)

38.5

( 1.6)

42.5

( 2.8)

43.4

( 1.6)

Has health-care coverage

                       

Yes

20.0

( 0.8)

18.9

( 0.6)

25.7

( 0.8)

26.3

( 0.6)

32.8

( 1.2)

34.4

( 0.8)

No

31.1

( 2.9)

35.1

( 2.3)

35.0

( 6.4)

35.5

( 5.8)

31.6

( 8.1)

35.6

( 7.0)

* Total population = 178,846. The sample sizes are for known data regarding age, sex, and self-rated health status.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Persons of Hispanic origin can be of any race.
Data were not reported when the standard error was >= 30% of the prevalence estimate.
** Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
†† Questions regarding breast cancer were posed to women only.
Categories are underweight (< 18.5 kg/m2); normal (18.5 kg/m2-24.9 kg/m2); overweight (25.0 kg/m2-29.9 kg/m2); obese class I (30.0 kg/m2-34.9 kg/m2); obese class II (35.0 kg/m2-39.9 kg/m2); and obese class III ( >= 40 kg/m2).
Pack(s) per day.


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Table 6

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TABLE 6. Percentage of fair or poor self-rated health reported by older adults, by state and age -- 50 states and the District of Columbia, Behavioral Risk Factor Surveillance System, 1993-1997*

 

Age group (yrs)

 

55-64 (n = 64,919)

65-74 (n = 67,469)

>=75 (n = 46,458)

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

28.5

(3.1)

37.0

(2.8)

45.5

(3.8)

Alaska

16.8

(4.3)

24.7

(5.8)

28.7

(9.0)

Arizona

16.7

(2.9)

20.0

(3.0)

25.5

(3.8)

Arkansas

31.1

(2.9)

36.7

(3.1)

44.8

(3.8)

California

20.4

(2.1)

22.4

(2.1)

26.6

(2.7)

Colorado

17.2

(2.6)

19.9

(2.9)

29.3

(4.4)

Connecticut

12.9

(2.4)

21.9

(2.7)

30.6

(3.6)

Delaware

21.8

(2.5)

25.3

(2.5)

34.0

(3.6)

District of Columbia

17.9

(3.4)

21.9

(3.7)

26.2

(5.2)

Florida

20.6

(1.9)

24.5

(1.8)

30.8

(2.3)

Georgia

18.2

(2.6)

29.2

(2.5)

48.5

(4.4)

Hawaii

18.3

(3.0)

21.5

(2.7)

34.9

(4.4)

Idaho

16.8

(2.2)

23.4

(2.4)

28.8

(3.2)

Illinois

20.8

(2.3)

25.4

(2.5)

31.6

(3.2)

Indiana

20.0

(2.3)

27.5

(2.7)

40.0

(3.4)

Iowa

14.3

(1.8)

20.2

(2.0)

29.4

(2.5)

Kansas

15.2

(2.5)

22.1

(2.8)

40.0

(3.6)

Kentucky

33.3

(2.6)

39.9

(2.3)

44.7

(2.9)

Louisiana

27.5

(3.2)

31.3

(3.2)

40.9

(4.4)

Maine

19.0

(2.8)

24.6

(3.0)

30.2

(3.8)

Maryland

18.3

(1.8)

23.8

(2.0)

29.3

(2.7)

Massachusetts

15.8

(2.7)

22.1

(2.9)

30.8

(3.9)

Michigan

18.6

(2.2)

27.6

(2.6)

33.3

(3.6)

Minnesota

13.4

(1.5)

22.0

(1.9)

31.3

(2.4)

Mississippi

35.5

(3.2)

42.2

(3.4)

51.3

(4.2)

Missouri

21.2

(2.9)

26.6

(3.0)

37.0

(3.9)

Montana

17.2

(2.9)

20.8

(2.9)

27.9

(3.9)

Nebraska

15.1

(2.3)

22.8

(2.5)

37.4

(3.0)

Nevada

18.9

(3.3)

24.0

(4.0)

29.2

(5.6)

New Hampshire

14.0

(2.5)

20.5

(2.9)

29.6

(4.4)

New Jersey

19.5

(3.0)

23.7

(3.0)

31.4

(4.1)

New Mexico

20.9

(3.2)

27.0

(3.7)

31.7

(4.5)

New York

17.8

(2.1)

24.3

(2.4)

33.6

(3.2)

North Carolina

27.7

(2.4)

34.4

(2.4)

43.7

(3.2)

North Dakota

20.1

(2.8)

24.5

(2.6)

37.9

(3.2)

Ohio

22.1

(3.1)

25.3

(3.0)

34.5

(4.0)

Oklahoma

22.6

(2.8)

23.0

(2.3)

37.6

(3.5)

Oregon

19.6

(2.1)

21.8

(2.1)

27.0

(2.8)

Pennsylvania

19.9

(1.9)

25.2

(2.0)

32.8

(2.8)

Rhode Island

23.2

(3.2)

28.1

(3.4)

31.7

(3.9)

South Carolina

27.3

(2.9)

33.4

(3.0)

42.8

(4.5)

South Dakota

18.3

(2.6)

23.5

(2.6)

32.3

(2.9)

Tennessee

30.9

(2.5)

37.6

(2.6)

41.7

(3.1)

Texas

26.7

(3.1)

32.1

(3.6)

38.2

(4.6)

Utah

18.1

(2.6)

23.8

(3.0)

33.9

(3.8)

Vermont

18.2

(2.2)

21.9

(2.5)

30.8

(3.2)

Virginia

20.1

(2.7)

25.8

(3.0)

32.7

(4.7)

Washington

14.9

(1.8)

20.2

(2.2)

27.4

(2.9)

West Virginia

36.3

(2.6)

39.1

(2.6)

45.0

(3.1)

Wisconsin

13.6

(2.4)

22.2

(2.9)

28.6

(3.8)

Wyoming

18.2

(2.6)

22.1

(3.0)

31.6

(4.3)

Total

21.0

(0.5)

26.2

(0.5)

33.8

(0.7)

* Total population = 178,846. The sample sizes are for known data regarding age, sex, and self-rated health status.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.


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Table 7

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TABLE 7. Mean number of unhealthy days during the preceding 30 days, by selected demographic and risk factors -- 50 states and the District of Columbia, Behavioral Risk Factor Surveillance System, 1993-1997*

 

Age group (yrs)

 

55-64 (n = 63,138)

65-74 (n = 64,933)

>=75 (n = 43,549)

 

Male (n = 26,258)

Female (n = 36,880)

Male (n = 25,144)

Female (n = 39,789)

Male (n = 13,233)

Female (n = 30,316)

Characteristic

Mean

(95% CI)

Mean

(95% CI)

Mean

(95% CI)

Mean

(95% CI)

Mean

(95% CI)

Mean

(95% CI)

Overall

5.0

(0.2)

6.2

(0.2)

5.0

(0.2)

6.1

(0.2)

6.1

(0.3)

7.2

(0.2)

Race

                       

White

4.9

(0.2)

6.0

(0.2)

4.9

(0.2)

6.0

(0.2)

6.0

(0.3)

7.1

(0.2)

Black

5.9

(0.8)

7.6

(0.6)

6.3

(0.8)

7.2

(0.6)

7.3

(1.2)

9.1

(0.9)

Asian/Pacific Islander

3.2

(1.1)

4.4

(1.4)

4.3

(2.1)

4.1

(1.2)

4.0

(2.6)

7.2

(3.3)

Native American/ Alaskan Native

6.5

(2.1)

9.6

(2.4)

7.3

(1.9)

5.7

(1.9)

5.4

(2.7)

6.6

(2.4)

Hispanic ethnicity

                       

Yes

7.5

(1.1)

7.8

(1.0)

7.1

(1.3)

8.0

(1.0)

7.3

(2.0)

8.1

(1.4)

No

4.8

(0.2)

6.1

(0.2)

4.9

(0.2)

6.0

(0.2)

6.0

(0.3)

7.1

(0.2)

Educational level

                       

Less than high school graduate

8.6

(0.6)

9.4

(0.5)

7.0

(0.4)

8.0

(0.3)

7.6

(0.6)

8.7

(0.4)

High school graduate

4.8

(0.3)

5.9

(0.2)

4.8

(0.3)

5.9

(0.2)

5.5

(0.5)

6.8

(0.3)

Some college

4.7

(0.4)

5.7

(0.3)

4.6

(0.4)

5.5

(0.3)

5.5

(0.6)

6.4

(0.4)

College graduate

3.3

(0.3)

4.3

(0.3)

3.5

(0.3)

4.6

(0.4)

5.0

(0.6)

5.7

(0.5)

Annual household income

                       

<$15,000

11.8

(0.8)

10.7

(0.5)

8.2

(0.6)

8.2

(0.3)

8.5

(0.7)

8.5

(0.3)

$15,000-$24,999

6.3

(0.5)

6.4

(0.3)

5.4

(0.4)

6.0

(0.3)

5.8

(0.5)

6.9

(0.4)

$25,000-$34,999

4.6

(0.4)

5.4

(0.4)

4.1

(0.4)

4.7

(0.4)

4.7

(0.7)

5.6

(0.6)

$35,000-$49,999

3.6

(0.4)

4.6

(0.4)

3.2

(0.5)

4.6

(0.5)

5.0

(0.8)

5.3

(0.8)

>=$50,000

3.2

(0.3)

4.8

(0.4)

4.1

(0.4)

5.8

(0.5)

5.4

(0.8)

6.9

(0.6)

Employment status

                       

Employed

3.0

(0.2)

4.3

(0.2)

3.1

(0.4)

4.0

(0.4)

3.2

(0.8)

3.9

(0.9)

Out of work

9.7

(1.4)

8.8

(1.0)

7.8

(3.7)

7.3

(1.8)

16.0

(7.8)

6.1

(3.1)

Homemaker

5.5

(3.1)

6.2

(0.4)

6.3

(0.5)

6.7

(0.6)

Retired

5.1

(0.4)

5.5

(0.3)

5.0

(0.2)

6.0

(0.2)

6.1

(0.3)

7.1

(0.2)

Unable to work

20.5

(0.8)

20.3

(0.7)

19.2

(1.8)

18.0

(1.2)

16.1

(4.2)

20.2

(1.6)

Marital status

                       

Married

4.5

(0.2)

5.5

(0.2)

4.7

(0.2)

5.7

(0.2)

5.7

(0.3)

6.9

(0.4)

Divorced

6.6

(0.5)

7.3

(0.5)

6.3

(0.6)

7.0

(0.5)

6.3

(1.5)

9.0

(1.1)

Widowed

8.3

(1.4)

7.8

(0.5)

6.0

(0.5)

6.7

(0.3)

7.0

(0.5)

7.3

(0.2)

Separated

6.8

(1.4)

9.7

(1.4)

8.0

(1.9)

9.1

(1.6)

6.8

(2.7)

9.9

(3.0)

Never married

5.9

(1.0)

6.9

(0.9)

5.9

(1.0)

5.4

(0.7)

6.0

(1.5)

6.2

(0.9)

Unmarried couple

9.8

(3.7)

5.7

(2.5)

6.4

(3.6)

Region**

                       

Northeast

4.8

(0.4)

6.1

(0.4)

4.7

(0.4)

5.9

(0.3)

6.3

(0.7)

7.0

(0.5)

Midwest

4.6

(0.3)

5.7

(0.3)

5.1

(0.4)

6.0

(0.3)

6.0

(0.5)

7.4

(0.3)

South

5.2

(0.3)

6.3

(0.3)

5.1

(0.3)

6.3

(0.3)

6.5

(0.5)

7.5

(0.3)

West

5.3

(0.5)

6.6

(0.4)

4.9

(0.4)

6.2

(0.4)

5.1

(0.6)

6.6

(0.5)

Diabetes mellitus

                       

Told has diabetes

10.2

(0.8)

11.1

(0.6)

9.0

(0.7)

10.4

(0.6)

9.1

(0.9)

11.2

(0.7)

No diabetes mellitus

4.5

(0.2)

5.7

(0.2)

4.4

(0.2)

5.6

(0.2)

5.6

(0.3)

6.7

(0.2)

Told has high blood pressure

                       

Never told

4.1

(0.2)

5.0

(0.2)

4.3

(0.3)

5.0

(0.2)

5.1

(0.4)

6.2

(0.3)

Told once

3.9

(0.7)

5.7

(0.7)

4.4

(0.8)

5.3

(0.6)

4.9

(1.3)

5.8

(0.8)

Told >=2 times

6.9

(0.5)

8.7

(0.4)

6.2

(0.4)

7.9

(0.3)

7.5

(0.6)

9.1

(0.4)

Reported breast cancer

                       

Yes

††

††

7.8

(1.0)

††

††

8.0

(1.0)

††

††

9.1

(1.0)

No

††

††

6.1

(0.2)

††

††

6.1

(0.2)

††

††

7.1

(0.2)

World Health Organization body mass index category

                       

Underweight

10.3

(3.0)

8.2

(1.3)

8.9

(2.0)

8.6

(1.0)

14.0

(2.8)

8.9

(0.9)

Normal

4.7

(0.3)

4.9

(0.2)

4.9

(0.3)

5.2

(0.2)

5.9

(0.4)

6.5

(0.3)

Overweight

4.6

(0.3)

6.1

(0.3)

4.5

(0.3)

5.9

(0.3)

5.3

(0.4)

7.3

(0.4)

Obese (Class I)

6.1

(0.6)

7.9

(0.5)

6.2

(0.6)

8.0

(0.5)

7.4

(1.2)

8.5

(0.7)

Obese (Class II)

6.3

(1.0)

10.2

(1.0)

8.6

(1.5)

10.6

(1.0)

12.0

(3.6)

11.1

(1.7)

Obese (Class III)

8.5

(1.9)

13.0

(1.3)

11.0

(2.7)

10.8

(1.7)

9.4

(6.7)

12.6

(3.0)

Cigarette smoking

                       

Never smoked

3.9

(0.3)

5.6

(0.2)

4.0

(0.3)

5.6

(0.2)

5.1

(0.4)

6.9

(0.2)

Former smoker

5.1

(0.3)

6.5

(0.3)

5.2

(0.3)

6.8

(0.3)

6.6

(0.4)

7.9

(0.4)

Current smoker (<1 ppd††)

6.0

(0.7)

7.0

(0.5)

6.6

(0.9)

6.5

(0.6)

6.6

(1.4)

7.6

(1.0)

Current smoker (>=1 ppd)

6.5

(0.6)

7.8

(0.5)

6.4

(0.6)

7.3

(0.7)

7.3

(1.6)

8.0

(1.3)

Drank >=5 alcoholic beverages at least once during preceding month

                       

Yes

4.3

(0.6)

7.1

(1.4)

4.0

(0.7)

4.3

(1.1)

6.6

(2.1)

6.8

(2.6)

No

5.1

(0.2)

6.2

(0.2)

5.1

(0.2)

6.2

(0.2)

6.1

(0.3)

7.3

(0.2)

Participate in leisure-time physical activity

                       

Yes

4.2

(0.3)

4.9

(0.2)

3.8

(0.3)

4.8

(0.2)

4.5

(0.5)

5.0

(0.3)

No

6.6

(0.5)

8.6

(0.4)

7.3

(0.6)

8.2

(0.4)

8.4

(0.7)

9.2

(0.4)

Has health-care coverage

                       

Yes

4.7

(0.2)

5.9

(0.2)

5.0

(0.2)

6.1

(0.2)

6.0

(0.3)

7.2

(0.2)

No

7.5

(0.8)

8.4

(0.6)

7.0

(1.8)

7.3

(1.3)

7.5

(2.1)

9.0

(1.9)

* Total population = 171,620. The sample sizes are for known data regarding age, sex, and questions on unhealthy days.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Persons of Hispanic origin can be of any race.
Data were not reported when the standard error was >= 30% of the prevalence estimate.
** Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; and West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
†† Questions regarding breast cancer were posed to women only.
Categories are underweight (< 18.5 kg/m2); normal (18.5 kg/m2-24.9 kg/m2); overweight (25.0 kg/m2-29.9 kg/m2); obese class I (30.0 kg/m2-34.9 kg/m2); obese class II (35.0 kg/m2-39.9 kg/m2); and obese class III ( >= 40 kg/m2).
Pack(s) per day.


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Table 8

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TABLE 8. Mean number of unhealthy days during the preceding 30 days, by state and age -- 50 states and the District of Columbia, Behavioral Risk Factor Surveillance System, 1993-1997*

 

Age group (yrs)

 

55-64 (n = 63,138)

65-74 (n = 64,933)

>=75 (n = 43,549)

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

5.9

(0.7)

6.6

(0.6)

7.7

(1.0)

Alaska

5.2

(1.1)

6.5

(1.6)

5.0

(2.1)

Arizona

4.9

(0.7)

4.2

(0.7)

4.5

(0.8)

Arkansas

6.3

(0.7)

6.5

(0.7)

7.7

(1.0)

California

6.4

(0.5)

6.0

(0.5)

6.1

(0.6)

Colorado

6.0

(0.7)

5.6

(0.7)

6.9

(1.0)

Connecticut

4.8

(0.8)

4.2

(0.6)

6.0

(0.9)

Delaware

6.0

(0.7)

5.4

(0.6)

7.3

(0.9)

District of Columbia

3.4

(0.8)

3.9

(0.9)

4.4

(1.2)

Florida

6.0

(0.5)

5.9

(0.4)

6.9

(0.6)

Georgia

4.7

(0.6)

5.3

(0.5)

9.6

(1.1)

Hawaii

4.4

(0.7)

4.0

(0.6)

4.9

(0.9)

Idaho

5.4

(0.6)

5.8

(0.6)

6.8

(0.8)

Illinois

5.2

(0.5)

5.4

(0.6)

6.2

(0.7)

Indiana

6.2

(0.6)

6.9

(0.7)

8.8

(0.9)

Iowa

4.9

(0.5)

5.5

(0.5)

6.6

(0.6)

Kansas

4.0

(0.6)

4.5

(0.6)

5.7

(0.8)

Kentucky

7.7

(0.7)

7.2

(0.6)

8.4

(0.7)

Louisiana

5.9

(0.8)

5.8

(0.8)

6.4

(1.0)

Maine

5.1

(0.7)

5.2

(0.7)

5.7

(0.9)

Maryland

4.5

(0.4)

5.2

(0.5)

5.9

(0.7)

Massachusetts

5.8

(0.7)

5.5

(0.7)

7.0

(1.0)

Michigan

5.4

(0.5)

6.3

(0.6)

7.4

(0.9)

Minnesota

4.8

(0.4)

6.1

(0.5)

7.8

(0.6)

Mississippi

6.4

(0.8)

6.2

(0.8)

7.1

(1.0)

Missouri

5.5

(0.7)

5.7

(0.7)

8.1

(1.0)

Montana

5.8

(0.8)

5.0

(0.7)

6.0

(0.9)

Nebraska

4.8

(0.6)

5.6

(0.6)

6.8

(0.7)

Nevada

6.1

(0.9)

6.0

(0.8)

6.6

(1.3)

New Hampshire

4.7

(0.7)

5.5

(0.8)

5.9

(1.0)

New Jersey

5.5

(0.7)

6.0

(0.7)

6.7

(1.0)

New Mexico

5.6

(0.8)

6.3

(0.9)

7.2

(1.1)

New York

5.2

(0.5)

5.2

(0.6)

7.1

(0.8)

North Carolina

5.1

(0.5)

5.4

(0.5)

7.2

(0.8)

North Dakota

5.5

(0.7)

5.6

(0.6)

7.8

(0.8)

Ohio

5.1

(0.7)

4.7

(0.6)

5.6

(0.9)

Oklahoma

4.9

(0.7)

3.4

(0.5)

5.1

(0.7)

Oregon

5.9

(0.5)

5.3

(0.5)

5.9

(0.6)

Pennsylvania

6.0

(0.5)

5.5

(0.5)

6.7

(0.7)

Rhode Island

6.4

(0.8)

6.1

(0.8)

6.5

(0.9)

South Carolina

5.9

(0.7)

4.8

(0.6)

7.2

(1.0)

South Dakota

4.7

(0.6)

4.6

(0.6)

5.8

(0.7)

Tennessee

6.2

(0.6)

6.5

(0.6)

6.5

(0.7)

Texas

6.4

(0.8)

6.3

(0.9)

7.4

(1.2)

Utah

5.9

(0.7)

5.8

(0.7)

7.7

(0.9)

Vermont

5.1

(0.5)

4.8

(0.6)

6.1

(0.8)

Virginia

4.7

(0.6)

5.6

(0.7)

6.8

(1.2)

Washington

5.3

(0.5)

5.2

(0.6)

5.7

(0.7)

West Virginia

6.9

(0.6)

6.0

(0.6)

6.8

(0.7)

Wisconsin

4.7

(0.6)

5.8

(0.7)

7.3

(1.0)

Wyoming

5.4

(0.7)

5.0

(0.7)

6.6

(1.1)

Total

5.6

(0.1)

5.6

(0.1)

6.8

(0.2)

* Total population = 171,620. The sample sizes are for known data regarding age, sex, and questions on unhealthy days.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.


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Figure

Figure
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