Appendix C: Glossary
Activities of daily living (ADLs): Activities of daily living (ADLs) are basic activities
that support survival, including eating, bathing, and toileting. See Instrumental
activities of daily living (IADLs).
In the Medicare Current Beneﬁciary Survey, ADL disabilities are measured as difﬁculty
performing (or inability to perform because of a health reason) one or more of the
following activities: eating, getting in/out of chairs, walking, dressing, bathing,
Asset income: Asset income includes money income reported in the Current Population
Survey from interest (on savings or bonds), dividends, income from estates or trusts,
and net rental income. Capital gains are not included.
Assistive device: Assistive device refers to any item, piece of equipment, or product
system, whether acquired commercially, modiﬁed, or customized, that is used to increase,
maintain, or improve functional capabilities of individuals with disabilities.
Body mass index: Body mass index (BMI) is a measure of body weight adjusted for
height and correlates with body fat. A tool for indicating weight status in adults,
BMI is generally computed using metric units and is deﬁned as weight divided by
height2 or kilograms/meters2. The categories used in this report are consistent
with those set by the World Health Organization. For adults 20 years of age and
over, underweight is deﬁned as having a BMI less than 18.5; healthy weight is deﬁned
as having a BMI of at least 18.5 and less than 25; overweight is deﬁned as having
values of BMI equal to 25 or greater; and obese is deﬁned as having BMI values equal
to 30 or greater. To calculate your own body mass index, go to www.nhlbisupport.com/bmi.
For more information about BMI, see “Clinical guidelines on the identiﬁcation, evaluation,
and treatment of overweight and obesity in adults.”61
Cash balance pension plan: A hybrid pension plan that looks like a defined-contribution
plan but actually is a defined-benefit plan, a responsibility of the employer. In
a cash balance plan, an employer establishes an account for employees, contributes
to the account, guarantees a return to the account,
and pays a lump sum benefit from the account at job termination.
Cause of death: For the purpose of national mortality statistics, every death is
attributed to one underlying condition, based on information reported on the death
certiﬁcate and using the international rules for selecting the underlying cause-of-death
from the conditions stated on the death certiﬁcate. The conditions that are not
selected as underlying cause of death constitute the nonunderlying cause of death,
also known as multiple cause of death. Cause-of-death is coded according to the
appropriate revision of the International Classiﬁcation of Diseases (ICD). Effective
with deaths occurring in 1999, the United States began using the Tenth Revision
of the ICD (ICD–10). Data from earlier time periods were coded using the appropriate
revision of the ICD for that time period. Changes in classiﬁcation of causes of
death in successive revisions of the ICD may introduce discontinuities in cause-of-death
statistics over time. These discontinuities are measured using comparability ratios.
These measures of discontinuity are essential to the interpretation of mortality
trends. For further discussion, see the “Mortality Technical Appendix” available
at www.cdc.gov/nchs/deaths.htm62 See also comparability ratio; International Classiﬁcation
of Diseases; Appendix I, National Vital Statistics System, Multiple Cause-of-Death
Cause-of-death ranking: The cause-of-death ranking for adults is based on the List
of 113 Selected Causes of Death. The top-ranking causes determine the leading causes-of-death.
Certain causes on the tabulation lists are not ranked if, for example, the category
title represents a group title (such as “Major cardiovascular diseases” and “Symptoms,
signs, and abnormal clinical and laboratory ﬁndings, not elsewhere classiﬁed”) or
the category title begins with the words “Other” and “All other.” In addition, when
a title that represents a subtotal (such as “Malignant neoplasm”) is ranked, its
component parts are not ranked. Causes that are tied receive the same rank; the
next cause is assigned the rank it would have received had the lower-ranked causes
not been tied (i.e., they skip a rank).
Cigarette smoking: Information about cigarette smoking in the National Health Interview
Survey is obtained for adults age 18 and over. Although there has been some variation
in question wording, smokers continue to be deﬁned as people who have ever smoked
100 cigarettes and currently smoke. Starting in 1993, current smokers are identiﬁed
by asking the following two questions: “Have you smoked at least 100 cigarettes
in your entire life?” and “Do you now smoke cigarettes every day, some days, or
not at all?” (revised deﬁnition). People who smoked 100 cigarettes and who now smoke
every day or some days are deﬁned as current smokers. Before 1992, current smokers
were identiﬁed based on positive responses to the following two questions: “Have
you smoked at least 100 cigarettes in your entire life?” and “Do you smoke now?”
(traditional deﬁnition). In 1992, cigarette smoking data were collected for a half
sample with one-half the respondents (a one-quarter sample) using the traditional
smoking questions and the other half of respondents (a one-quarter sample) using
the revised smoking question. An unpublished analysis of the 1992 traditional smoking
measure revealed that the crude percentage of current smokers age 18 and over remained
the same as in 1991. The statistics reported for 1992 combined data collected using
the traditional and the revised questions. The information obtained from the two
smoking questions listed above is combined to create the variables represented in
Tables 26a and 26b on pages 111 and 112.
Current smoker: There are two categories of current smokers: people who smoke every
day and people who smoke only on some days.
Former smoker: This category includes people who have smoked at least 100 cigarettes
in their lifetimes but currently do not smoke at all.
Nonsmoker: This category includes people who have never smoked at least 100 cigarettes
in their lifetime.
Death rate: The death rate is calculated by dividing the number of deaths in a population
in a year by the midyear resident population. For census years, rates are based
on unrounded census counts of the resident population as of April 1. For the noncensus
years of 1981–1989 and 1991, rates are based on national estimates of the resident
population as of July 1, rounded to the nearest thousand. Starting in 1992, rates
are based on unrounded national population estimates. Rates for the Hispanic and
non-Hispanic white populations in each year are based on unrounded State population
estimates for States in the Hispanic reporting area through 1996. Beginning in 1997,
all States reported Hispanic origin. Death rates are expressed as the number of
deaths per 100,000 people. The rate may be restricted to deaths in speciﬁc age,
race, sex, or geographic groups or from speciﬁc causes of death (speciﬁc rate),
or it may be related to the entire population (crude rate).
Dental services: In the Medicare Current Beneficiary Survey (Indicators 30 and 34)
and in the Medical Expenditure Panel Survey (MEPS) and the data used from the MEPS
predecessor surveys used in this report (Indicator 33) this category covers expenses
for any type of dental care provider, including general dentists, dental hygienists,
dental technicians, dental surgeons, orthodontists, endodontists, and periodontists.
Disability: See Activities of daily living (ADLs) and Instrumental activities of
daily living (IADLs).
Earnings: Earnings are considered money income reported in the Current Population
Survey from wages or salaries and net income from self-employment (farm and nonfarm).
Emergency room services: In the Medical Expenditure Panel Survey (MEPS) and the
data used from the MEPS predecessor surveys used in this report (Indicator 33),
this category includes expenses for visits to medical providers seen in emergency
rooms (except visits resulting in a hospital admission). These expenses include
payments for services covered under the basic facility charge and those for separately
billed physician services. In the Medicare Current Beneficiary Survey (Indicators
30 and 34) emergency room services are included as a hospital outpatient service
unless they are incurred immediately prior to a hospital stay, in which case they
are included as a hospital inpatient service.
Fee-for-service: This is the method of reimbursing health care providers on the
basis of a fee for each health service provided to the insured person.
Group quarters: For Census 2000, the U.S. Census Bureau classiﬁed all people not
living in households as living in group quarters. There are two types of group quarters:
institutional (e.g., correctional facilities, nursing homes, and mental hospitals)
and noninstitutional (e.g., college dormitories, military barracks, group homes,
missions, and shelters).
Head of household: In the Consumer Expenditure Survey head of household is deﬁned
as the ﬁrst person mentioned when the respondent is asked to name the person or
people who own or rent the home in which the consumer unit resides.
In the Panel Study of Income Dynamics (within each wave of data), each family unit
has only one current head of household (Head). Originally, if the family contained
a husband-wife pair, the husband was arbitrarily designated the Head to conform
with U.S. Census Bureau deﬁnitions in effect at the time the study began. The person
designated as Head may change over time as a result of other changes affecting the
family. When a new Head must be chosen, the following rules apply: The Head of the
family unit must be at least 16 years old and the person with the most ﬁnancial
responsibility for the family unit. If this person is female and she has a husband
in the family unit, then he is designated as Head. If she has a boyfriend with whom
she has been living for at least 1 year, then he is Head. However, if the husband
or boyfriend is incapacitated and unable to fulﬁll the functions of Head, then the
family unit will have a female Head.
Health care: Health care services provided by the Veterans Health Administration
(Indicator 35) includes preventive care, ambulatory diagnosis and treatment, inpatient
diagnosis and treatment and medications and supplies. This includes home and community
based services (e.g., home health care) and long-term care institutional services
(for those eligible to receive these services).
Health care expenditures: In the Consumer Expenditure Survey (Indicator 12), health
care expenditures include out-of-pocket expenditures for health insurance, medical
services, prescription drugs, and medical supplies. In the Medicare Current Beneficiary
Survey (Indicators 30 and 34), health care expenditures include all expenditures
for inpatient hospital, medical, nursing home, outpatient (including emergency room
visits), dental, prescription drugs, home health care, and hospice services, including
both out-of-pocket expenditures and expenditures covered by insurance. Personal
spending for health insurance premiums is excluded. In the Medical Expenditure Panel
Survey (MEPS) and the data used from the MEPS predecessor surveys used in this report
(Indicator 33), health care expenditures refers to payments for health care services
provided during the year. (Data from the 1987 survey have been adjusted to permit
comparability across years; see Zuvekas and Cohen.54) Out-of-pocket health care
expenditures are the sum of payments paid to health care providers by the person
or the person’s family, for health care services provided during the year. Health
care services include inpatient hospital, hospital emergency room, and outpatient
department care; dental services; office-based medical provider services; prescription
drugs; home health care; and other medical equipment and services. Personal spending
for health insurance premium(s) is excluded.
Health Literacy: The degree to which individuals have the capacity to obtain, process,
and understand basic health information and services needed to make appropriate
Health maintenance organization (HMO): An HMO is a prepaid health plan delivering
comprehensive care to members through designated providers, having a ﬁxed monthly
payment for health care services, and requiring members to be in a plan for a speciﬁed
period of time (usually 1 year).
Hispanic origin: See speciﬁc data source descriptions in Appendix B.
Home health care/services/visits: Home health care is care provided to individuals
and families in their places of residence for promoting, maintaining, or restoring
health or for minimizing the effects of disability and illness, including terminal
illness. In the Medicare Current Beneficiary Survey and Medicare claims data
(Indicators 29, 30, and 34), home health care refers to skilled nursing care, physical
therapy, speech language pathology services, occupational therapy, and home health
aide services provided to homebound patients. In the Medical Expenditure Panel
Survey (Indicator 33), home health care services are classified into the “Other
health care” category and are considered any paid formal care provided by home health
agencies and independent home health providers. Services can include visits by professionals
including nurses, doctors, social workers, and therapists, as well as home health
aids, homemaker services, companion services and home-based hospice care. Home care
provided free of charge (informal care by family members) is not included.
Hospice care/services: Hospice care is a program of palliative and supportive care
services providing physical, psychological, social, and spiritual care for dying
persons, their families, and other loved ones by a hospice program or agency. Hospice
services are available in home and inpatient settings. In the Medicare Current Beneficiary
Survey (MCBS) (Indicators 30 and 34) hospice care includes only those services provided
as part of a Medicare benefit. In MCBS Indicator 30 (Medicare) hospice services
are included as part of the “Other” category. In MCBS Indicator 34 (Medicare) hospice
services are included as a separate category. In the Medical Expenditure Panel Survey
(MEPS) (Indicator 33) hospice care provided in the home (regardless of the source
of payment) is included in the “Other health care” category, while hospice care
provided in an institutional setting (e.g., nursing home) is excluded from the MEPS
Hospital care: Hospital care in the Medical Expenditure Panel Survey (Indicator
33) includes hospital inpatient care and care provided in hospital outpatient departments
and emergency rooms. Care can be provided by physicians or other health practitioners;
payments for hospital care include payments billed directly by the hospital and
those billed separately by providers for services provided in the hospital.
Hospital inpatient services: In the Medicare Current Beneficiary Survey (Indicators
30 and 34) hospital inpatient services include room and board and all hospital diagnostic
and laboratory expenses associated with the basic facility charge, and emergency
room expenses incurred immediately prior to inpatient stays. Expenses for hospital
stays with the same admission and discharge dates are included if the Medicare bill
classified the stay as an “inpatient” stay. Payments for separate billed physician
inpatient services are excluded. In the Medical Expenditure Panel Survey (Indicator
33) these services include room and board and all hospital diagnostic and
laboratory expenses associated with the basic facility charge, payments for separately
billed physician inpatient services, and emergency room expenses incurred immediately
prior to inpatient stays. Expenses for reported hospital stays with the same admission
and discharge dates are also included.
Hospital outpatient services: These services in the Medicare Current Beneficiary
Survey (Indicators 30 and 34) include visits to both physicians and other medical
providers seen in hospital outpatient departments or emergency rooms (provided the
emergency room visit does not result in an inpatient hospital admission), as well
as diagnostic laboratory and radiology services. Payments for these services include
those covered under the basic facility charge. Expenses for in-patient hospital
stays with the same admission and discharge dates and classified on the Medicare
bill as “out-patient” are also included. Separately billed physician services are
Hospital stays: Hospital stays in the Medicare claims data (Indicator 29) refers
to admission to and discharge from a short-stay acute care hospital.
Housing cost burden: In the American Housing Survey, housing cost burden is defined
as expen-Housing expenditures: In the Consumer Expenditure Survey’s Interview Survey,
housing expend-itures include payments for mortgage interest; property taxes; maintenance,
repairs, insurance, and other expenses; rent; rent as pay (reduced or free rent
for a unit as a form of pay); maintenance, insurance, and other expenses for renters;
Incidence: Incidence is the number of cases of disease having their onset during
a prescribed period of time. It is often expressed as a rate. For example, the incidence
of measles per 1,000 children ages 5 to 15 during a speciﬁed year. Incidence is
a measure of morbidity or other events that occur within a speciﬁed period of time.
Income: In the Current Population Survey, income includes money income (prior to
payments for personal income taxes, Social Security, union dues, Medicare deductions,
etc.) from: (1) money wages or salary; (2) net income from nonfarm self-employment;
(3) net income from farm self-employment; (4) Social Security or railroad retirement;
(5) Supplemental Security Income; (6) public assistance or welfare payments; (7)
interest (on savings or bonds); (8) dividends, income from estates or trusts, or
net rental income; (9) veterans’ payment or unemployment and worker’s compensation;
(10) private pensions or government employee pensions; and (11) alimony or child
support, regular contributions from people not living in the household, and other
periodic income. Certain money receipts such as capital gains are not included.
In the Medicare Current Beneﬁciary Study, income is for the sample person, or the
sample person and spouse if the sample person was married at the time of the survey.
All sources of income from jobs, pensions, Social Security beneﬁts, Railroad Retirement
and other retirement income, Supplemental Security Income, interest, dividends,
and other income sources are included.
Income categories: Two income categories were used to examine out-of-pocket health
care expend-itures using the Medical Expenditure Panel Survey (MEPS) and MEPS predecessor
survey data. The categories were expressed in terms of poverty status (i.e., the
ratio of the family’s income to the Federal poverty thresholds for the corresponding
year), which controls for the size of the family and the age of the head of the
family. The income categories were (1) poor and near poor and (2) other income.
Poor and near poor income category includes people in families with income less
than 100 percent of the poverty line, including those whose losses exceeded their
earnings, resulting in negative income (i.e., the poor), as well as people in families
with income from 100 percent to less than 125 percent of the poverty line (i.e.,
the near poor). Other income category includes people in families with income
greater than or equal to 125 percent of the poverty line. See Income, household.
Income, household: Household income from the Medical Expenditure Panel Survey (MEPS)
and the MEPS predecessor surveys used in this report was created by summing personal
income from each household member to create family income. Family income was then
divided by the number of people that lived in the household during the year to create
per capita household income. Potential income sources asked about in the survey
interviews include annual earnings from wages, salaries, withdrawals; Social Security
and VA payments; Supplemental Security Income and cash welfare payments from public
assistance; Temporary Assistance for Needy Families, formerly known as Aid to Families
with Dependent Children; gains or losses from estates, trusts, partnerships, C corporations,
rent, and royalties; and a small amount of other income. See Income categories.
Income ﬁfths: A population can be divided into groups with equal numbers of people
based on the size of their income to show how the population differs on a characteristic
at various income levels. Income ﬁfths are ﬁve groups of equal size, ordered from
lowest to highest income.
Inpatient hospital: See Hospital inpatient services.
Institutions: For Census 2000, the U.S. Census Bureau defined institutions as correctional
insti-tutions; nursing homes; psychiatric hospitals; hospitals or wards for chronically
ill or for the treatment of substance abuse; schools, hospitals or wards for the
mentally retarded or physically handicapped; and homes, schools, and other institutional
settings providing care for children.64 See Population.
Institutionalized population: See Population.
Instrumental activities of daily living (IADLs): IADLs are indicators of functional
well-being that measure the ability to perform more complex tasks than the related
activities of daily living (ADLs). See Activities of daily living (ADLs).
In the Medicare Current Beneﬁciary Survey, IADLs include difﬁculty performing (or
inability to perform because of a health reason) one or more of the following activities:
heavy housework, light housework, preparing meals, using a telephone, managing money,
Literacy: The ability to use printed and written information to function in society,
to achieve one’s
goals, and to develop one’s knowledge and potential.
Long-term care facility: In the Medicare Current Beneficiary Survey (MCBS) (Indicators
20 and 37), a residence (or unit) is considered a long-term care facility if it
is certified by Medicare or Medicaid; has 3 or more beds and is licensed as a nursing
home or other long-term care facility and provides at least one personal care service;
or provides 24-hour, 7-day-a-week supervision by a non-family, paid caregiver.
In MCBS (Indicators 30 and 34), a long-term care facility excludes “short-term institutions”
(e.g., sub-acute care) stays. See Nursing home (Indicator 36), Short-term
institution (Indicators 30 and 34), and Skilled nursing home (Indicator 29).
Mammography: Mammography is an x-ray image of the breast used to detect irregularities
in breast tissue.
Mean: The mean is an average of n numbers computed by adding the numbers and dividing
Median: The median is a measure of central tendency, the point on the scale that
divides a group into two parts.
Medicaid: This nationwide health insurance program is operated and administered
by the States, with Federal ﬁnancial participation. Within certain broad, Federally
determined guidelines, States decide who is eligible; the amount, duration, and
scope of services covered; rates of payment for providers; and methods of administering
the program. Medicaid pays for health care services, community-based supports, and
nursing home care, for certain low income people. Medicaid does not cover all low-income
people in every State. The program was authorized in 1965 by Title XIX of the Social
Medicare: This nationwide program provides health insurance to people age 65 and
over, people entitled to Social Security disability payments for 2 years or more,
and people with end-stage renal disease, regardless of income. The program was enacted
July 30, 1965, as Title XVIII, Health Insurance for the Aged of the Social Security
Act, and became effective on July 1, 1966. Medicare covers acute care services and
postacute care settings such as rehabilitation and long-term care hospitals, and
generally does not cover nursing home care. Prescription drug coverage began in
Medicare Advantage: See Medicare Part C.
Medicare Part A: Medicare Part A (Hospital Insurance) covers inpatient care in hospitals,
critical access hospitals, skilled nursing facilities, and other postacute care
settings such as rehabilitation and long-term care hospitals. It also covers hospice
and some home health care.
Medicare Part B: Medicare Part B (Medical Insurance) covers doctor’s services, outpatient
hospital care, and durable medical equipment. It also covers some other medical
services that Medicare Part A does not cover, such as physical and occupational
therapy and some home health care. Medicare Part B also pays for some supplies when
they are medically necessary.
Medicare Part C: With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries
were given the option to receive their Medicare benefits through private health
insurance plans, instead of through the Original Medicare plan (Parts A and B).
These plans were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003, the types of plans
allowed to contract with Medicare were expanded, and the Medicare Choice program
became known as “Medicare Advantage.” In addition to offering comparable coverage
to Part A and Part B, Medicare Advantage plans may also offer Part D coverage.
Medicare Part D: Medicare Part D subsidizes the costs of prescription drugs for
Medicare beneficiar-ies. It was enacted as part of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (MMA) and went into effect on January
1, 2006. Beneficiaries can obtain the Medicare drug benefit through two types
of private plans: beneficiaries can join a Prescription Drug Plan (PDP) for drug
coverage only or they can join a Medicare Advantage plan (MA) that covers both medical
services and prescription drugs (MA-PD). Alternatively, beneficiaries may
receive drug coverage through a former employer, in which case the former employer
may qualify for a retiree drug subsidy payment from Medicare.
Medigap: See Supplemental health insurance.
National population adjustment matrix: The national population adjustment matrix
adjusts the population to account for net underenumeration. Details on this matrix
can be found on the U.S. Census Bureau website: www.census.gov/population/www/censusdata/adjustment.html.
Nursing home: In the 2004 National Nursing Home Survey (Indicator 36), a nursing
home is a facility or unit licensed as a nursing home or a nursing facility by the
State health department or some other State agency and having three or more beds.
Facilities providing care solely to the mentally retarded and mentally ill are excluded.
Facilities may be certified by Medicare or Medicaid, or both. These facilities may
be freestanding or nursing care units of hospitals, retirement centers, or similar
institutions where the unit maintained financial and resident records separate from
those of the larger institutions. For the definition of a nursing home as used in
the 1985 National Nursing Home Survey, see Appendix B under “National Nursing Home
Survey.” In the Medicare Current Beneficiary Survey (Indicators 30 and 34), the
category “nursing home” is not a mutually exclusive category. See Skilled nursing
facility (Indicator 29), Short-term institution (Indicators 30 and 34), and Long-term
care facility (Indicators 20, 30, 34, and 37).
Obesity: See Body mass index.
Ofﬁce-based medical provider services: In the Medical Expenditure Panel Survey (Indicator
33) this category includes expenses for visits to physicians and other health practitioners
seen in office-based settings or clinics. Other health practitioner includes audiologists,
optometrists, chiropractors, podiatrists, mental health professionals, therapists,
nurses, and physician’s assistants, as well as providers of diagnostic laboratory
and radiology services. Services provided in a hospital based setting, including
outpatient department services, are excluded.
Other health care: In the Medicare Current Beneficiary Survey (Indicator 34), this
category includes “short-term institution,” “hospice,” and “dental” services. In
the Medical Expenditure Panel Survey (MEPS) (Indicator 33) other health care includes
“home health services” (formal care provided by home health agencies and independent
home health providers) and other medical equipment and services. The latter includes
expenses for eyeglasses, contact lenses, ambulance services, orthopedic items, hearing
devices, prostheses, bathroom aids, medical equipment, disposable supplies, alterations/modifications,
and other miscellaneous items or services that were obtained, purchased, or rented
during the year.
Other income: Other income is total income minus retirement beneﬁts, earnings, asset
income, and public assistance. It includes, but is not limited to, unemployment
compensation, worker’s compensation, alimony, and child support.
Outpatient hospital: See Hospital outpatient services.
Out-of-pocket health care costs: These are health care costs that are not covered
Overweight: See Body mass index.
Pensions: Pensions include money income reported in the Current Population Survey
from railroad retirement, company or union pensions (including proﬁt sharing and
401(k) payments), IRAs, Keoghs, regular payments from annuities and paid-up life
insurance policies, Federal government pensions, U.S. military pensions, and State
or local government pensions.
Physician/Medical services: In the Medicare Current Beneficiary Survey (Indicator
34), this category includes visits to a medical doctor, osteopathic doctor, and
health practitioner as well as diagnostic laboratory and radiology services. Health
practitioners include audiologists, optometrists, chiropractors, podiatrists, mental
health professionals, therapists, nurses, paramedics, and physician’s assistants.
Services provided in a hospital-based setting, including outpatient department services,
Physician/Outpatient hospital: In the Medicare Current Beneficiary Survey (Indicator
30), this term refers to “physician/medical services” combined with “hospital outpatient
Physician visits and consultations: In Medicare claims data (Indicator 29) physician
visits and consultations include visits and consultations with primary care physicians,
specialists, and chiropractors in their offices, hospitals (inpatient and outpatient),
emergency rooms, patient homes, and nursing homes.
Population: Data on populations in the United States are often collected and published
according to several different deﬁnitions. Various statistical systems then use
the appropriate population for calculating rates.
Resident population: The resident population of the United States includes people
resident in the 50 States and the District of Columbia. It excludes residents of
the Commonwealth of Puerto Rico and residents of the outlying areas under United
States sovereignty or jurisdiction (principally American Samoa, Guam, Virgin Islands
of the United States, and the Commonwealth of the Northern Mariana Islands). The
deﬁnition of residence conforms to the criterion used in Census 2000, which deﬁnes
a resident of a speciﬁed area as a person “usually resident” in that area. The resident
population includes people resident in a nursing home and other types of institutional
settings, but excludes the U.S. Armed Forces overseas, as well as civilian U.S.
citizens whose usual place of residence is outside the United States. As deﬁned
in “Indicator 6: Older Veterans,” the resident population includes Puerto Rico.
Resident noninstitutionalized population: The resident noninstitutionalized population
is the resident population not residing in institutions. For Census 2000, institutions,
as deﬁned by the U.S. Census Bureau, included correctional institutions; nursing
homes; psychiatric hospitals; hospitals or wards for chronically ill or for the
treatment of substance abuse; homes and schools, hospitals or wards for the mentally
retarded or physically handicapped; and homes, schools, and other institutional
settings providing care for children. People living in noninstitutional group quarters
are part of the resident noninstitutionalized population. For Census 2000, noninstitutional
group quarters included group homes (i.e., community-based homes that provide care
and supportive services); residential facilities “providing protective oversight
… to people with disabilities”; worker and college dormitories; military and religious
quarters; and emergency and transitional shelters with sleeping facilities.64
Civilian population: The civilian population is the U.S. resident population not
in the active duty Armed Forces.
Civilian noninstitutionalized population: The civilian noninstitutionalized population
is the civilian population not residing in institutions. For Census 2000, institutions,
as deﬁned by the U.S. Census Bureau, included correctional institutions; nursing
homes; psychiatric hospitals; hospitals or wards for chronically ill or for the
treatment of substance abuse; schools, hospitals or wards for the mentally retarded
or physically handicapped; and homes, schools, and other institutional settings
providing care for children. Civilians living in noninstitutional group quarters
are part of the civilian noninstitutionalized population. For Census 2000, noninstitutional
group quarters included group homes (i.e., “community based homes that provide care
and supportive services”); residential facilities “providing protective oversight
… to people with disabilities”; worker and college dormitories; religious quarters;
and emergency and transitional shelters with sleeping facilities.64
Institutionalized population: For Census 2000, the institutionalized population
was the population residing in correctional institutions; nursing homes; psychiatric
hospitals; hospitals or wards for chronically ill or for the treatment of substance
abuse; schools, hospitals or wards for the mentally retarded or physically handicapped;
and homes, schools, and other institutional settings providing care for children.
People living in noninstitutional group quarters are part of the noninstitutionalized
population. For Census 2000, noninstitutional group quarters included group homes
(i.e., “community based homes that provide care and supportive services”); residential
facilities “providing protective oversight … to people with disabilities”; worker
and college dormitories; military and religious quarters; and emergency and transitional
shelters with sleeping facilities.64
Poverty: The ofﬁcial measure of poverty is computed each year by the U.S. Census
Bureau and is deﬁned as being less than 100 percent of the poverty threshold (i.e.,
$9,669 for one person age 65 and over in 2006).65 Poverty thresholds are the dollar
amounts used to determine poverty status. Each family (including single-person households)
is assigned a poverty threshold based upon the family’s income, size of the family,
and ages of the family members. All family members have the same poverty status.
Several of the indicators included in this report include a poverty status measure.
Poverty status (less than 100 percent of the poverty threshold) was computed for
“Indicator 7: Poverty,” “Indicator 8: Income,” “Indicator 17: Sensory Impairments
and Oral Health,” “Indicator 22: Mammography,” and “Indicator 32: Sources of Health
Insurance,” and “Indicator 33: Out-of-Pocket Health Care Expenditures” using the
ofﬁcial U.S. Census Bureau deﬁnition for the corresponding year.
In addition, the following above-poverty categories are used in this report.
Indicator 8: Income: The income categories are derived from the ratio of the family’s
income (or an unrelated individual’s income) to the poverty threshold. Being in
poverty is measured as income less than 100 percent of the poverty threshold. Low
income is between 100 percent and 199 percent of the poverty threshold (i.e., $9,669
and $19,337 for one person age 65 and over in 2006). Middle income is between 200
percent and 399 percent of the poverty threshold (i.e., between $19,338 and $38,675
for one person age 65 and over in 2006). High income is 400 percent or more of the
Indicator 22: Mammography and Indicator 32: Sources of Health Insurance: Below poverty
is deﬁned as less than 100 percent of the poverty threshold. Above poverty is grouped
into two categories: (1) 100 percent to less than 200 percent of the poverty threshold
and (2) 200 percent of the poverty threshold or greater.
Indicator 33: Out-of-Pocket Health Care Expenditures: Below poverty is deﬁned as
less than 100 percent of the poverty threshold. People are classiﬁed into the poor/near
poor income category if the person’s household income is below 125 percent of the
poverty level. People are classiﬁed into the other income category if the person’s
household income is equal to or greater than 125 percent of the poverty level.
Prescription drugs/medicines: In the Medicare Current Beneficiary Survey (Indicators
30, 31, 34) and in the Medical Expenditure Panel Survey (Indicator 33) prescription
drugs are all prescription medications (including refills) except those provided
by the doctor or practitioner as samples and those provided in an inpatient setting.
Prevalence: Prevalence is the number of cases of a disease, infected people, or
people with some other attribute present during a particular interval of time. It
is often expressed as a rate (e.g., the prevalence of diabetes per 1,000 people
during a year). See Incidence.
Private supplemental health insurance: See Supplemental health insurance.
Public assistance: Public assistance is money income reported in the Current Population
Survey from Supplemental Security Income (payments made to low-income people who
are age 65 and over, blind, or disabled) and public assistance or welfare payments,
such as Temporary Assistance for Needy Families and General Assistance.
Quintiles: See Income ﬁfths.
Race: See speciﬁc data source descriptions in Appendix B.
Rate: A rate is a measure of some event, disease, or condition in relation to a
unit of population, along with some speciﬁcation of time.
Reference population: The reference population is the base population from which
a sample is drawn at the time of initial sampling. See Population.
Respondent-assessed health status: In the National Health Interview Survey, respondent-assessed
health status is measured by asking the respondent, “Would you say [your/subject
name’s] health is excellent, very good, good, fair, or poor?” The respondent
answers for all household members including himself or herself.
Short-term institution: This category in the Medicare Current Beneficiary Survey
(Indicators 30 and 34) includes skilled nursing facility stays and other short-term
(e.g., sub-acute care) facility stays (e.g., a rehabilitation facility stay). Payments
for these services include Medicare and other payment sources. See Skilled nursing
facility (Indicator 29), Nursing facility (Indicator 36), and Long-term care facility
(Indicators 20, 30, 34, and 37).
Skilled nursing facility stays: Skilled nursing facility stays in the Medicare claims
data (Indicator 29) refers to admission to and discharge from a skilled nursing
facility, regardless of the length of stay. See Skilled nursing facility (Indicator
Skilled nursing facility: A skilled nursing facility (SNF) as defined by Medicare
(Indicator 29) provides short-term skilled nursing care on an inpatient basis, following
hospitalization. These facilities provide the most intensive care available outside
of inpatient acute hospital care. In the Medicare Current Beneficiary Survey (Indicators
30 and 34) “skilled nursing facilities” are classified as a type of “short-term
institution.” See Short-term institution (Indicators 30 and 34), Nursing home
(Indicator 36), and Long-term care facility (Indicators 20, 30, 34, and 37).
Social Security beneﬁts: Social Security beneﬁts include money income reported in
the Current Population Survey from Social Security old-age, disability, and survivors’
Standard population: A population in which the age and sex composition is known
precisely, as a result of a census. A standard population is used as a comparison
group in the procedure for standardizing mortality rates.
Supplemental health insurance: Supplemental health insurance is designed to ﬁll
gaps in the original Medicare plan coverage by paying some of the amounts that Medicare
does not pay for covered services and may pay for certain services not covered by
Medicare. Private Medigap is supplemental insurance individuals purchase themselves
or through organizations such as AARP or other professional organizations. Employer
or union-sponsored supplemental insurance policies are provided through a Medicare
enrollee’s former employer or union. For dual-eligible beneficiaries, Medicaid acts
as a supplemental insurer to Medicare. Some Medicare beneﬁciaries enroll in HMOs
and other managed care plans that provide many of the beneﬁts of supplemental insurance,
such as low copayments and coverage of services that Medicare does not cover.
TRICARE: TRICARE is the Department of Defense’s regionally managed health care program
for active duty and retired members of the uniformed services, their families, and
TRICARE for Life: TRICARE for Life is TRICARE’s Medicare wraparound coverage (similar
to traditional Medigap coverage) for Medicare-eligible uniformed services beneﬁciaries
and their eligible family members and survivors.
Veteran: Veterans include those who served on active duty in the Army, Navy, Air
Force, Marines, Coast Guard, uniformed Public Health Service, or uniformed National
Oceanic and Atmospheric Administration; Reserve Force and National Guard called
to Federal active duty; and those disabled while on active duty training. Excluded
are those dishonorably discharged and those whose only active duty was for training
or State National Guard service.