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Research Findings #22: Restricted-activity Days in the United States, 1997 and 2001

Jeffrey A. Rhoades, PhD

Introduction

This report provides estimates of restricted-activity days (workdays or schooldays lost due to physical illness, injury, a mental or emotional problem, or caring for a family member with health problems) for the civilian noninstitutionalized population of the United States. Presented are data from the 1997 and 2001 Medical Expenditure Panel Survey (MEPS) Household Component representing a 5-year span, with 2001 data being the most recent data available. The percent of the population with restricted-activity days and the number of restricted-activity days per year are shown in relation to selected socioeconomic and demographic characteristics. The variables shown include age, race/ethnicity, sex, marital status, education, health insurance coverage, income, health status, and area of residence.

Restricted-activity days provide an indication of the burden of illness in the workplace and in school. With a greater understanding of the variation of this burden among groups, policymakers and health care providers would be better informed to put into practice health care that results in similar outcomes for all.The Technical Appendix describes restricted activity days in more detail and explains how estimates were derived.

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Findings

The restricted-activity days of interest are: (1) workdays lost due to physical illness, injury, or a mental or emotional problem; (2) workdays lost to care for a family member with health problems; and (3) schooldays lost due to physical illness, injury, or a mental or emotional problem.

Workdays Lost

Workdays lost for the working-age population (ages 16-64) are shown in Tables 1 and 2.

Age
In 1997 and 2001, the age group 25-54 had the highest percent of people with workdays lost due to illness, injury, or mental or emotional problems in the working-age population. In 2001, 42.0 percent of people ages 25-54 had workdays lost, compared to 37.2 percent and 34.5 percent for ages 16-24 and 55-64, respectively (Table 1).

Race/Ethnicity
Whites and others had the highest percentage of people with workdays lost due to illness, injury, or mental or emotional problems in both 1997 and 2001. (The category “whites and others” comprises whites and a small proportion of people whose race/ethnicity is not Hispanic, black, or white.) In 2001, 41.6 percent of whites and others had workdays lost, compared to 34.3 percent of Hispanics and 38.0 percent of blacks (Table 1).

In 1997 and 2001, a greater percent of whites and others than Hispanics or blacks had workdays or schooldays lost due to illness, injury, or mental or emotional problems.

Sex
A greater proportion of women than men have work absences. Pregnancy is a major reason for this difference. But pregnancy aside, women still generally have a higher absenteeism rate than men (Ballagh, Maxwell, and Perea, 1987; Bridges and Mumford, 2001).

A greater proportion of females than males had workdays lost due to illness, injury, or mental or emotional problems. In 2001, 46.5 percent of females versus 34.6 percent of males had workdays lost (Table 1). Comparing 1997 and 2001, there was a decrease in the proportion of both females (49.4 percent to 46.5 percent) and males (37.7 percent to 34.6 percent) with workdays lost (Table 1). However, from 1997 to 2001, the mean number of workdays lost during the year for people who had any workdays lost remained relatively stable at 12-13 days for females and 10-11 days for males (Table 2).

Education
As educational level increased, the proportion of people with workdays lost increased. In 2001, 32.3 percent of people with no high school education had workdays lost, compared to 42.4 percent of people with more than high school education (Table 1). At the same time, people with higher educational levels who had workdays lost had fewer such days. In 2001, people with more than high school education had 10.2 workdays lost, while those with no high school education had 13.7 workdays lost (Table 2).

Individuals with the least amount of education were the least likely to report workdays lost due to illness, injury, or mental or emotional problems in 1997 and 2001.

Perceived Health
As people’s reported health and mental health status declined, the percentage with workdays lost increased. Workers’ subjective health evaluation has been found to be strongly and significantly related to absenteeism (Leigh, 1983). In 2001, 59.7 percent of people with fair or poor health status had workdays lost, compared to only 29.3 percent of people in excellent health (Table 1). From 1997 to 2001, the proportion of people in fair or poor health or very good health who had workdays lost decreased. The proportion of people in fair or poor health who had workdays lost decreased from 66.3 percent in 1997 to 59.7 percent in 2001 (Table 1).

The number of workdays lost (among people with any lost days) also increased with deteriorating physical and mental health. Those with fair or poor health had 23.3 workdays lost in 2001, as opposed to 6.8 days for those with excellent health status (Table 2).

Workdays Lost To Care for a Family Member

Tables 3 and 4 show data on workdays lost to provide care for a family member for the working-age population (ages 16-64).

Age
In 1997 and 2001, in the working-age population, the age group 25-54 had the highest percent of people with workdays lost to care for a family member with health problems. In 2001, 23.3 percent of people ages 25-54 had workdays lost to care for a family member, compared to 9.0 percent for ages 16-24 and 15.9 percent for ages 55-64 (Table 3).

Sex
In both 1997 and 2001, a greater proportion of females than males had workdays lost to care for a family member. In 2001, 25.0 percent of females and 15.5 percent of males missed work to care for a family member (Table 3).

Marital Status
A greater proportion of married than unmarried people had workdays lost to provide care for a family member in both 1997 and 2001. In 2001, 24.8 percent of married people, compared to 13.1 percent of unmarried people, had workdays lost to provide care for a family member (Table 3). Among people who provided care to a family member, there was no difference in the mean number of days lost in 1997 and 2001 or for married compared to unmarried people (Table 4).

Metropolitan Statistical Area
People not living in a metropolitan statistical area were more likely to miss work to provide care for a family member in 1997 and 2001. In 2001, 22.1 percent of people living outside metropolitan areas, compared to 19.6 percent of people living in a metropolitan statistical area, had workdays lost to provide care for a family member (Table 3). However, among people who took off work to care for family members, there was no difference in the mean number of days lost (Table 4).

Schooldays Lost

Tables 5 and 6 show information on schooldays lost among the school age population (ages 5-22).

Race/Ethnicity
A higher proportion of whites and others than blacks or Hispanics had schooldays lost due to illness, injury, or mental or emotional problems in 1997 and 2001. In 2001, 56.6 percent of whites and others but only 42.4 percent of Hispanics and blacks had schooldays lost (Table 5). This race/ethnicity pattern also held true for both sexes in 1997 and 2001; for both females and males, whites and others had the highest percent with schooldays lost. In 2001, 56.9 percent of white and other females had schooldays lost, compared to 44.8 percent of Hispanic females and 42.5 percent of black females; 56.2 percent of white and other males had schooldays lost, compared to 40.1 percent of Hispanic males and 42.3 percent of black males (Table 5). The mean number of schooldays lost for people who had schooldays lost remained relatively stable for all race/ethnicity groups and both sexes in 1997 and 2001 (Table 6).In 1997 and 2001, a greater percent of whites and others than Hispanics or blacks had workdays or schooldays lost due to illness, injury, or mental or emotional problems.

Health Insurance Coverage
The uninsured were the least likely to have schooldays lost due to illness, injury, or mental or emotional problems in 1997 and 2001. In 2001, 33.2 percent of the uninsured had schooldays lost (Table 5). People with only public health insurance had the highest number of schooldays lost in both years. In 2001, people with only public health insurance had 6.8 schooldays lost, compared to 5.1 days for both privately insured and uninsured people (Table 6).

Perceived Health
For both perceived physical and mental health, as an individual’s reported health declined, the number of schooldays lost increased in both years. In 2001, people in fair or poor health had 22.8 schooldays lost, while those in excellent health had only 4.0 schooldays lost (Table 6). In addition, people in fair or poor health had the greatest increase in the number of schooldays lost from 1997 to 2001, an increase from 14.6 to 22.8 schooldays lost (Table 6). The pattern was similar for perceived mental health status.

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Conclusions

Findings show that restricted-activity days do vary by socioeconomic and demographic characteristics (age, race/ethnicity, sex, marital status, education, health insurance coverage, health status, and area of residence). Some examples of variation in restricted-activity days by socioeconomic and demographic characteristics follow.

People ages 25-54 were the most likely to have workdays lost due to illness, injury, or mental or emotional problems, as well as workdays lost to care for a family member, in 1997 and 2001.

In 1997 and 2001, a greater percent of whites and others than Hispanics or blacks had workdays or schooldays lost due to illness, injury, or mental or emotional problems. In 2001, 41.6 percent of whites and others ages 16-64 had workdays lost, versus 34.3 percent of Hispanics and 38.0 percent of blacks.

Females were more likely than males to have restricted-activity days. In both years, a greater percentage of females than males had workdays lost due to illness, injury, or mental or emotional problems and workdays lost to care for a family member with health problems. In 2001, 46.5 percent of females ages 16-64 had workdays lost, compared with 34.6 percent of males.

Individuals with the least amount of education, less than high school, were the least likely to have workdays lost due to illness, injury, or mental or emotional problems in 1997 and 2001. In 2001, 32.3 percent of working-age people with no high school education had workdays lost, compared to 42.4 percent of those with more than high school education.

People in fair or poor health (physical or mental) were at greater risk for experiencing workdays lost in 1997 and 2001. People in fair or poor health also had a greater number of restricted-activity days when they had such days. In 2001, 59.7 percent of working-age people in fair or poor health had workdays lost due to illness, injury, or mental or emotional problems, compared to only 29.3 percent of those in excellent health. The average number of workdays lost in 2001 was 23.3 for people in fair or poor health but only 6.8 for people in excellent health.

For additional information on restricted-activity days, analysts are encouraged to visit the MEPS Web site (www.meps.ahrq.gov). Under Data and Publications, links to the full year consolidated files HC-020 (1997), HC-028 (1998), HC-038 (1999), HC-050 (2000), and HC-060 (2001) are available. Data files provide detailed documentation pertaining to restricted activity days variables.

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Tables

Tables showing restricted-activity days in 1997 and 2001:
1. Percent with workdays lost due to illness, injury, or mental or emotional problems
2. Mean workdays lost due to illness, injury, or mental or emotional problems
3. Percent with workdays lost to care for a family member
4. Mean workdays lost to care for a family member
5. Percent with schooldays lost due to illness, injury, or mental or emotional problems
6. Mean schooldays lost due to illness, injury, or mental or emotional problems

Table 1. Population ages 16-64 with workdays lost due to illness, injury, or mental or emotional problems: United States, 1997 and 2001
Population characteristic
Population with workdays lost, 1997
(Number in thousands)
Population with workdays lost, 1997
(Percent)
Population with workdays lost, 2001
(Number in thousands)
Population with workdays lost, 2001
(Percent)
Total
62,036
43.3
60,704
40.3
Age in years
16-24
  9,401
37.9
  9,578
37.2
25-54
46,864
45.1
45,164
42.0
55-64
  5,772
39.9
  5,962
34.5
Race/ethnicity
Total Hispanic
  5,101
34.6
  6,337
34.3
Total black
  6,367
39.1
  6,554
38.0
Total white and other
50,568
45.0
47,813
41.6
Hispanic male
  2,550
29.4
  3,028
28.3
Black male
  2,330
30.7
  2,458
31.1
White and other male
23,500
39.9
21,802
36.2
Hispanic female
  2,551
42.1
  3,310
42.6
Black female
  4,037
46.5
  4,096
43.8
White and other female
27,068
50.7
26,011
47.5
Sex
Male
28,380
37.7
27,288
34.6
Female
33,656
49.4
33,416
46.5
Marital status
Married
37,233
43.1
34,877
39.2
Not married
24,803
43.7
25,827
41.8
Health insurance coverage
Private
52,232
45.3
50,959
41.6
Public only
  2,570
38.4
  2,768
40.7
Uninsured
  7,234
34.2
6,978
32.5
Income
Poor
  4,118
38.5
  3,854
38.4
Near poor
  2,021
43.6
  1,894
41.0
Low income
  6,918
40.9
6,618
40.2
Middle income
21,558
44.5
20,141
41.8
High income
27,441
43.8
28,197
39.5
Education
No high school
  1,106
25.3
  2,170
32.3
Some high school
  6,084
38.4
  7,298
37.1
High school graduate
19,465
42.8
19,051
40.0
More than high school
35,339
45.6
32,034
42.4
Perceived health status
Fair/poor
  4,924
66.3
  4,676
59.7
Good
16,968
52.2
18,789
49.8
Very good
27,502
43.9
26,571
38.6
Excellent
12,615
31.1
10,639
29.3
Perceived mental health status
Fair/poor
  1,948
61.3
  2,101
61.7
Good
12,518
51.3
13,085
46.9
Very good
26,304
43.9
27,545
41.3
Excellent
21,238
38.1
17,944
34.1
Metropolitan statistical area (MSA)
MSA
50,547
43.5
49,879
40.2
Non-MSA
11,379
42.7
10,825
40.1
Census region
Northeast
11,202
41.4
11,162
39.2
Midwest
15,217
43.8
14,900
41.4
South
21,515
43.3
20,509
39.4
West
14,103
44.4
14,134
41.3
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.

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Table 2. Mean workdays lost due to illness, injury, or mental or emotional problems for the population ages 16-64: United States , 1997 and 2001
Population characteristic

Population with workdays lost, 1997
(Population in thousands)

Population with workdays lost, 1997
(Mean workdays losta)

Population with workdays lost, 2001
(Population in thousands)

Population with workdays lost, 2001
(Mean workdays losta)
Total
62,036
12.3
60,704
11.3
Age in years
16-24
  9,401
  8.6
  9,578
  7.5
25-54
46,864
12.6
45,164
11.6
55-64
  5,772
16.1
  5,962
15.0
Race/ethnicity
Total Hispanic
  5,101
13.5
  6,337
11.4
Total black
  6,367
15.8
  6,554
15.8
Total white and other
50,568
11.8
47,813
10.7
Hispanic male
  2,550
13.0
  3,028
11.0
Black male
  2,330
13.0
  2,458
13.7
White and other male
23,500
11.6
21,802
  9.9
Hispanic female
  2,551
14.0
  3,310
11.9
Black female
  4,037
17.4
  4,096
17.1
White and other female
27,068
11.9
26,011
11.3
Sex
Male
28,380
11.8
27,288
10.4
Female
33,656
12.7
33,416
12.1
Marital status
Married
37,233
12.9
34,877
11.8
Not married
24,803
11.4
25,827
10.7
Health insurance coverage
Private
52,232
12.2
50,959
11.0
Public only
  2,570
16.5
  2,768
13.5
Uninsured
  7,234
11.8
  6,978
12.6
Income
Poor
  4,118
11.9
  3,854
15.2
Near poor
  2,021
19.0
  1,894
10.2
Low income
  6,918
12.9
  6,618
14.1
Middle income
21,558
13.1
20,141
11.8
High income
27,441
11.2
28,197
  9.8
Education
No high school
  1,106
18.3
  2,170
13.7
Some high school
  6,084
13.4
  7,298
12.2
High school graduate
19,465
14.2
19,051
12.5
More than high school
35,339
10.9
32,034
10.2
Perceived health status
Fair/poor
  4,924
29.9
  4,676
23.3
Good
16,968
14.1
18,789
14.0
Very good
27,502
10.2
26,571
  9.0
Excellent
12,615
  7.6
10,639
  6.8
Perceived mental health status
Fair/poor
  1,948
28.3
  2,101
24.1
Good
12,518
17.1
13,085
13.5
Very good
26,304
11.1
27,545
10.5
Excellent
21,238
  9.5
17,944
  9.5
Metropolitan statistical area (MSA)
MSA
50,547
12.1
49,879
11.3
Non-MSA
11,379
13.0
10,825
11.6
Census region
Northeast
11,202
13.5
11,162
12.9
Midwest
15,217
12.8
14,900
11.1
South
21,515
12.4
20,509
11.0
West
14,103
10.7
14,134
10.7
aMean workdays lost are for people who had any lost workdays.  
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.

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Table 3. Population ages 16-64 with workdays lost to care for a family member with health problems: United States, 1997 and 2001
Population characteristic
Population with workdays lost, 1997
(Number in thousands)
Population with workdays lost, 1997
(Percent)
Population with workdays lost, 2001
(Number in thousands)
Population with workdays lost, 2001
(Percent)
Total
28,754
20.1
30,160
20.0
Age in years
16-24
  2,385
  9.6
  2,322
  9.0
25-54
24,418
23.5
25,093
23.3
55-64
  1,951
13.5
  2,745
15.9
Race/ethnicity
Total Hispanic
  2,689
18.3
  3,111
16.9
Total black
  3,254
20.0
  3,102
18.0
Total white and other
22,811
20.3
23,946
20.8
Hispanic male
  1,215
14.0
  1,316
12.3
Black male
  1,098
14.4
     961
12.2
White and other male
  8,974
15.2
  9,940
16.5
Hispanic female
  1,473
24.3
  1,792
23.1
Black female
  2,156
24.8
  2,142
22.9
White and other female
13,837
25.9
14,006
25.6
Sex
Male
11,287
15.0
12,217
15.5
Female
17,467
25.7
17,943
25.0
Marital status
Married
21,398
24.8
22,084
24.8
Not married
  7,356
13.0
  8,076
13.1
Health insurance coverage
Private
24,597
21.3
25,768
21.1
Public only
  1,156
17.3
  1,402
20.6
Uninsured
  3,001
14.2
  2,990
13.9
Income
Poor
  1,897
17.7
  1,870
18.6
Near poor
     844
18.4
     871
†18.9
Low income
  3,523
20.9
  3,268
19.9
Middle income
10,611
21.9
  9,559
19.8
High income
11,879
19.0
14,593
20.5
Education
No high school
*
*
*
*
Some high school
  2,368
15.0
  2,757
14.0
High school graduate
  9,474
20.9
  9,503
19.8
More than high school
16,485
21.3
17,132
22.7
Perceived health status
Fair/poor
  1,494
20.1
  1,760
22.5
Good
  7,190
22.1
  7,981
21.2
Very good
12,852
20.5
13,772
20.0
Excellent
  7,218
17.8
  6,649
18.3
Perceived mental health status
Fair/poor
*
*
*
*
Good
  5,341
21.9
  6,109
21.9
Very good
12,139
20.3
13,151
19.7
Excellent
10,598
19.0
10,095
19.2
Metropolitan statistical area (MSA)
MSA
22,564
19.4
24,319
19.6
Non-MSA
  6,177
23.2
  5,842
22.1
Census region
Northeast
  4,755
17.6
  5,121
18.0
Midwest
  7,448
21.4
  8,469
23.6
South
10,993
22.1
10,994
21.1
West
  5,558
17.5
  5,576
16.3
*Sample size too small to produce reliable estimates.
†Relative standard error greater than or equal to 30 percent.
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.

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Table 4. Mean workdays lost to care for a family member with health problems by the population ages 16-64: United States, 1997 and 2001
Population characteristic

Population with workdays lost, 1997
(Population in thousands)

Population with workdays lost, 1997
(Mean workdays losta)

Population with workdays lost, 2001
(Population in thousands)

Population with workdays lost, 2001
(Mean workdays losta)
Total
28,754
4.2
30,160
4.5
Age in years
16-24
  2,385
3.4
  2,322
3.9
25-54
24,418
4.3
25,093
4.4
55-64
  1,951
4.9
  2,745
6.0
Race/ethnicity
Total Hispanic
  2,689
5.2
  3,111
4.2
Total black
  3,254
4.5
  3,102
4.8
Total white and other
22,811
4.1
23,946
4.5
Hispanic male
  1,215
4.8
  1,316
4.6
Black male
  1,098
3.6
     961
4.9
White and other male
  8,974
3.8
  9,940
4.1
Hispanic female
  1,473
5.6
  1,795
4.0
Black female
  2,156
5
  2,142
4.7
White and other female
13,837
4.3
14,006
4.7
Sex
Male
11,287
3.9
12,217
4.2
Female
17,467
4.5
17,943
4.7
Marital status
Married
21,398
4.2
22,084
4.3
Not married
  7,356
4.3
  8,076
5.0
Health insurance coverage
Private
24,597
4.2
25,768
4.2
Public only
  1,156
5.2
  1,402
6.5
Uninsured
  3,001
4.2
  2,990
6.2
Income
Poor
  1,897
4.2
  1,870
6.2
Near poor
     844
5.3
     871
†6.5
Low income
  3,523
4.4
  3,268
5.7
Middle income
10,611
4.4
  9,559
4.2
High income
11,879
3.9
14,593
4.0
Education
No high school
*
*
*
*
Some high school
  2,368
3.7
  2,757
4.1
High school graduate
  9,474
4.2
  9,503
4.7
More than high school
16,485
4.3
17,132
4.3
Perceived health status
Fair/poor
  1,494
4.7
  1,760
4.9
Good
  7,190
4.3
  7,981
4.7
Very good
12,852
4.4
13,772
4.5
Excellent
  7,218
3.9
  6,649
4.1
Perceived mental health status
Fair/poor
*
*
*
*
Good
  5,341
4.6
  6,109
5.5
Very good
12,193
4.3
13,151
4.2
Excellent
10,598
3.9
10,095
4.1
Metropolitan statistical area (MSA)
MSA
22,564
4.3
24,319
4.3
Non-MSA
  6,177
4.1
  5,842
5.2
Census region
Northeast
  4,755
4.5
  5,121
4.3
Midwest
  7,448
3.9
  8,469
4.4
South
10,993
4.4
10,994
4.9
West
  5,558
4.2
  5,576
4.0
aMean workdays lost are for people who had any lost workdays.  
*Sample size too small to produce reliable estimates.
†Relative standard error greater than or equal to 30 percent.
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.

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Table 5. Population ages 5-22 with schooldays lost due to illness, injury, or mental or emotional problems: United States, 1997 and 2001
Population characteristic
Population with schooldays lost, 1997
(Number in thousands)
Population with schooldays lost, 1997
(Percent)
Population with schooldays lost, 2001
(Number in thousands)
Population with schooldays lost, 2001
(Percent)
Total
38,883
55.1
37,916
52.0
Race/ethnicity
Total Hispanic
  4,623
45.2
  5,310
42.4
Total black
  4,997
45.2
  4,686
42.4
Total white and other
29,263
59.4
27,921
56.6
Hispanic male
  2,354
44.2
 2,621
40.1
Black male
  2,476
45.7
  2,376
42.3
White and other male
14,231
57.3
14,009
56.2
Hispanic female
  2,269
46.3
  2,689
44.8
Black female
  2,521
44.7
  2,310
42.5
White and other female
15,031
61.6
13,911
56.9
Sex
Male
19,062
53.6
19,006
51.3
Female
19,821
56.8
18,910
52.7
Health insurance coverage
Private
28,864
59.2
27,464
55.1
Public only
  6,169
50.8
  7,461
52.7
Uninsured
  3,849
40.1
    2,991
33.2
Income
Poor
  6,537
49.5
  5,055
43.7
Near poor
  1,876
53.5
  1,794
47.4
Low income
  5,779
50.8
  5,520
48.3
Middle income
13,584
57.3
12,973
55.0
High income
11,106
59.3
12,574
55.7
Perceived health status
Fair/poor
     985
64.4
     828
61.0
Good
  5,741
57.3
  5,652
52.7
Very good
16,275
55.3
16,561
52.2
Excellent
15,882
53.8
14,874
51.0
Perceived mental health status
Fair/poor
     864
58.6
     893
65.0
Good
  5,072
56.4
  4,606
49.5
Very good
14,661
53.9
15,393
51.7
Excellent
18,286
55.7
17,024
52.3
Metropolitan statistical area (MSA)
MSA
30,826
54.7
30,852
51.6
Non-MSA
  7,995
57.5
  7,065
53.6
Census region
Northeast
  7,144
55.4
  6,506
52.4
Midwest
  9,696
57.6
  9,067
56.6
South
12,862
53.2
13,289
50.2
West
  9,180
55.2
  9,054
50.1
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.

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Table 6. Mean schooldays lost due to illness, injury, or mental or emotional problems for the population ages 5-22: United States, 1997 and 2001
Population characteristic

Population with schooldays lost, 1997
(Population in thousands)

Population with schooldays lost, 1997
(Mean schooldays losta)

Population with schooldays lost, 2001
(Population in thousands)

Population with schooldays lost, 2001
(Mean schooldays losta)
Total
38,882
  5.6
37,916
  5.5
Race/ethnicity
Total Hispanic
  4,623
  5.7
  5,310
  5.9
Total black
  4,997
  6.0
  4,686
  5.7
Total white and other
29,263
  5.5
27,921
  5.3
Hispanic male
  2,354
  5.2
  2,621
  5.7
Black male
  2,476
  5.5
  2,376
  5.2
White and other male
14,231
  5.6
14,009
  5.2
Hispanic female
  2,269
  6.3
  2,689
  6.1
Black female
  2,521
  6.4
  2,310
  6.2
White and other female
15,031
  5.5
13,911
  5.5
Sex
Male
19,062
  5.5
19,006
  5.3
Female
19,821
  5.7
18,910
  5.6
Health insurance coverage
Private
28,864
  5.3
27,464
  5.1
Public only
  6,169
 7.3
  7,461
  6.8
Uninsured
  3,849
  5.3
  2,991
  5.1
Income
Poor
  6,537
  6.7
  5,055
  6.5
Near poor
  1,876
  7.3
  1,794
  5.9
Low income
  5,779
  5.9
  5,520
  6.0
Middle income
13,584
  5.5
12,973
  5.3
High income
11,106
  4.7
12,574
 4.9
Perceived health status
Fair/poor
     985
14.6
     828
22.8
Good
  5,741
  8.5
  5,652
  7.9
Very good
16,275
  5.4
16,561
  5.1
Excellent
15,882
  4.2
14,874
 4.0
Perceived mental health status
Fair/poor
     864
14.9
     893
22.0
Good
  5,072
  7.6
  4,606
 7.5
Very good
14,661
  5.4
15,393
  5.0
Excellent
18,286
  4.7
17,024
  4.4
Metropolitan statistical area (MSA)
MSA
30,826
  5.5
30,852
 5.5
Non-MSA
  7,995
  6.0
  7,065
  5.4
Census region
Northeast
  7,144
  6.0
  6,506
  5.9
Midwest
  9,696
  5.6
  9,067
  5.6
South
12,862
  5.5
13,289
  5.2
West
  9,180
  5.4
  9,054
  5.5
aMean schooldays lost are for people who had any lost schooldays.  
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.

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References

Ballagh J, Maxwell E, Perea K. Absenteeism in the workplace. Chicago: Commerce Clearing House, Inc.; 1987.

Bridges S, Mumford K. Absenteeism in the UK: A comparison across genders. The Manchester School. 2001 June; 69(3):276-84.

Cohen J, Monheit A, Beauregard K, et al. The Medical Expenditure Panel Survey: a national health information resource. Inquiry 1996; 33:373-89.

Cohen S. Sample design of the 1996 Medical Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Methodology Report No. 2. AHCPR Pub. No. 97-0027.

Leigh J. Sex differences in absenteeism. Industrial Relations 1983 Fall; 22(3):349-61.

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Technical Appendix

Technical Appendix
Restricted-activity days   Standard Error Table A
Population characteristics   Standard Error Table B
Sample design and accuracy of estimates   Standard Error Table C
Rounding   Standard Error Table D
Comparisons with other data sources   Standard Error Table E
Standard Error Tables   Standard Error Table F

 

The data in this report were obtained in interviews conducted for the Household Component (HC) of the 1997 and 2001 Medical Expenditure Panel Survey (MEPS). MEPS is cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health Statistics (NCHS). The MEPS HC is a nationally representative survey of the U.S. civilian noninstitutionalized population that collects medical expenditure data at both the person and household levels. The focus of the MEPS HC is to collect detailed data on demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment. In other components of MEPS, data are collected on the use, charges, and payments reported by providers.

The sample for the MEPS HC was selected from respondents to the National Health Interview Survey (NHIS), conducted by NCHS. NHIS provides a nationally representative sample of the U.S. civilian noninstitutionalized population and reflects an oversampling of Hispanics and blacks.

The MEPS HC collects data through an overlapping panel design. In this design, data are collected through a precontact interview that is followed by a series of five rounds of interviews over 21/2 years. Interviews are conducted with one member of each household, who reports on the health care expenses of the entire household. Medical expenditure and utilization data for two calendar years are collected from each household using computer-assisted personal interviewing. This series of data collection rounds is launched each subsequent year on a new sample of households to provide overlapping panels of survey data which, when combined with other ongoing panels, provide continuous and current estimates of health care expenditures.

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Restricted-Activity Days

The restricted-activity days section of the core interview contains questions about time lost from work or school because of a physical illness, injury, mental or emotional problem, or caring for a family member with a health problem. Data were collected on each individual in the household. Questions were repeated in each round of interviews (Rounds 1 through 5). The reference period for these questions is the time period between the beginning of the panel or the previous interview date and the current interview date or between the previous interview date and the end of the year (Round 5).

The variables on time lost from work represent whether individuals ages 16-64 lost a half-day or more from work because of illness, injury, or mental or emotional problems during the year and how many workdays were lost. Another set of variables indicates whether an individual took a half-day or more off from work to care for a family member with health problems and how many workdays were lost. If the individual did not work, these variables were coded -1 (inapplicable). Respondents were not asked about workdays lost for people under 16 years old. The total number of workdays lost was accumulated for the year.

The variables on time lost from school represent whether individuals missed a half-day or more of school because of illness, injury, or mental or emotional problems during the year and how many schooldays were lost. Respondents were asked about schooldays only for individuals ages 3-22. A code of -1 indicates that the person did not attend school. There was no attempt to reconcile schooldays lost with the time of year (e.g., summer vacation). For the purposes of this analysis the population was restricted to persons ages 5-22.

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Population Characteristics

Age
The respondent was asked to report the age of each family member as of the date of each interview. In this report, age is usually based on the sample person’s age at the end of the reference year. If data were not collected at the end of the year because the sample person was out of scope (e.g., deceased or institutionalized), then age at the time of the previous interview(s) was used.

Race/Ethnicity
Classification by race and ethnicity is based on information reported for each family member. Respondents were asked if each family member’s race was best described as American Indian, Alaska Native, Asian or Pacific Islander, black, white, or other. They also were asked if each family member’s main national origin or ancestry was Puerto Rican; Cuban; Mexican, Mexicano, Mexican American, or Chicano; other Latin American; or other Spanish. All persons whose main national origin or ancestry was reported in one of these Hispanic groups, regardless of racial background, were classified as Hispanic. Since the Hispanic grouping can include black Hispanic, white Hispanic, and other Hispanic, the race categories of black, white, and other do not include Hispanic. Only data for people identified as Hispanic (of any race), non-Hispanic blacks, and non-Hispanic whites and others are included in this analysis.

Marital Status
Marital status was constructed from information available at three points in time during the reference year, the interview dates for the first two rounds of the reference year and at the end of the year.

Health Insurance Coverage
The household respondent was asked if, during the reference period, anyone in the family was covered by any of the sources of public and private health insurance discussed below. Persons classified as uninsured for this report were uninsured throughout the reference year.

Private insurance -- Private health insurance was defined as insurance that provides coverage for hospital and physician care (including Medigap coverage). Private health insurance could have been obtained through an employer, union, self-employed business, directly from an insurance company or health maintenance organization, through a group or association, or from someone outside the household.

Public coverage only -- People were considered to have only public coverage if they met both of the following criteria:

  • They were not covered by private insurance during the reference year.
  • They were covered by one of the following public programs: Medicare, CHAMPUS/CHAMPVA/TRICARE (Armed-Forces-related coverage), Medicaid or State Children’s Health Insurance Program (SCHIP), or other public hospital/physician coverage.

Uninsured -- The uninsured were defined as persons not covered by Medicare, CHAMPUS/CHAMPVA/TRICARE, Medicaid/SCHIP, other public hospital/physician programs, or private hospital/physician insurance (including Medigap coverage) during the reference year. People covered only by noncomprehensive State-specific programs (e.g., Maryland Kidney Disease Program) or private single-service plans (e.g., coverage for dental or vision care only, coverage for accidents or specific diseases) were not considered to be insured. People uninsured for the entire year did not have insurance coverage at any time during the survey year.


Income
Sample persons were classified according to the total yearly income of their family. Within a household, all people related by blood, marriage, or adoption were considered to be a family. Personal income from all family members was summed to create family income. Possible sources of income included annual earnings from wages, salaries, bonuses, tips, and commissions; business and farm gains and losses; unemployment and Workers’ Compensation; interest and dividends; alimony, child support, and other private cash transfers; private pensions, individual retirement account withdrawals, Social Security, and Department of Veterans Affairs payments; Supplemental Security Income and cash welfare payments from public assistance, Aid to Families with Dependent Children, and Aid to Dependent Children; gains or losses from estates, trusts, partnerships, S corporations, rent, and royalties; and a small amount of “other”income.

Income categories are defined by the ratio of family income to the Federal income thresholds, which control for family size and age of the head of family.

Categories are defined as follows:

  • Poor -- Persons in families with income less than or equal to the poverty line; includes those who had negative income.
  • Near-poor -- Persons in families with income over the poverty line through 125 percent of the poverty line.
  • Low income -- Persons in families with income over 125 percent through 200 percent of the poverty line.
  • Middle income -- Persons in families with income over 200 percent through 400 percent of the poverty line.
  • High income -- Persons in families with income over 400 percent of the poverty line.

Education
Respondents were asked to report the years of date of the interviews. Categories are defined as follows:

  • No high school -- Less than 9 years of schooling.
  • Some high school -- 9 through 11 years of schooling.
  • High school graduate -- 12 years of schooling.
  • More than high school -- More than 12 years of schooling.

Perceived Health Status
In every round, the respondent is asked to rate the health of every member of the family. The exact wording of the question is: "In general, compared to other people of (PERSON)'s age, would you say that (PERSON)'s health is excellent, very good, good, fair, or poor?" A similar question is asked about mental health status. For this report, the response categories "fair" and "poor" were collapsed.
 
Place of Residence
People are identified as residing either inside or outside a metropolitan statistical area (MSA) as designated by the U.S. Office of Management and Budget, which applied 1990 standards using population counts from the 1990 U.S. census. An MSA is a large population nucleus combined with adjacent communities that have a high degree of economic and social integration with the nucleus. Each MSA has one or more central counties containing the area's main population concentration. In New England, metropolitan areas consist of cities and towns rather than whole counties. MSA data are based on MSA status as of the end of the reference year. If MSA status as of December 31 was not known, then MSA status at the time of the previous interview was used.
 
Region
Each MEPS sample person was classified as living in one of the following four regions as defined by the Bureau of the Census:

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

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Sample Design and Accuracy of Estimates

MEPS is a nationally representative subsample of the households responding to the previous year's NHIS. MEPS reflects the oversampling of Hispanic and black households resulting from the NHIS sample design. The 1997 MEPS sample consisted of 32,636 people. The response rate was 66.4 percent. The weighted MEPS population estimate for the civilian noninstitutionalized population as of December 31, 1997, was 267,704,802. For 2001, the corresponding numbers were 32,122 people, 66.3 percent, and a civilian noninstitutionalized population of 284,247,327.

The statistics presented in this report are affected by both sampling error and sources of nonsampling error, which include nonresponse bias, respondent reporting errors, interviewer effects, and data processing misspecifications. For a detailed description of the MEPS survey design, the adopted sample design, and methods used to minimize sources of nonsampling error, see Cohen (1997) and Cohen, Monheit, Beauregard, et al. (1996).

The MEPS person-level estimation weights include nonresponse adjustments and poststratification adjustments to population estimates derived from the Current Population Survey based on cross-classifications by region, MSA status, age, race/ethnicity, and sex. The overall MEPS response rate reflects response to both the MEPS and the preceding NHIS interview.

Tests of statistical significance were used to determine whether the differences between populations exist at specified levels of confidence or whether they occurred by chance. Differences were tested using z-scores having asymptotic normal properties at the 0.05 level of significance. Unless otherwise noted, only statistical differences between estimates are discussed in the text.

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Rounding

Estimates presented in Tables 1, 3, and 5 were rounded to the nearest 0.1 percent, while estimates school completed by each household member as of the presented in Tables 2, 4, and 6 were rounded to the nearest tenth (0.1). Therefore, some of the estimates presented in the tables for population totals of subgroups will not add exactly to the overall estimated population total. Standard errors, presented in Tables A-F, were rounded to the nearest 0.01.

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Comparisons With Other Data Sources

Because of methodological differences, caution should be used when comparing these data with data from other sources. A range of results is frequently found among surveys based on question wording, the sequencing of questions, the placement of questions, and whether or not the respondent was a proxy for other
household members.

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Standard Error Tables

Table A (Corresponds to Table 1). Standard errors for percent of population ages 16-64 with workdays lost due to illness, injury, or mental or emotional problems: United States, 1997 and 2001
Population characteristic
1997
2001
Total
0.57
0.56
Age in years
16-24
1.35
1.17
25-54
0.65
0.69
55-64
1.46
1.19
Race/ethnicity
Total Hispanic
1.18
1.09
Total black
1.27
1.43
Total white and other
0.66
0.65
Hispanic male
1.49
1.45
Black male
1.76
1.82
White and other male
0.81
0.81
Hispanic female
1.57
1.48
Black female
1.92
1.89
White and other female
0.87
0.81
Sex
Male
0.70
0.74
Female
0.75
0.70
Marital status
Married
0.66
0.66
Not married
0.90
0.80
Health insurance coverage
Private
0.63
0.61
Public only
1.86
1.85
Uninsured
1.20
1.21
Income
Poor
1.55
1.76
Near poor
2.45
2.40
Low income
1.44
1.38
Middle income
0.92
0.84
High income
0.85
0.86
Education
No high school
1.98
1.90
Some high school
1.38
1.17
High school graduate
0.88
0.86
More than high school
0.73
0.71
Perceived health status
Fair/poor
1.80
1.74
Good
0.98
1.05
Very good
0.86
0.73
Excellent
0.87
0.94
Perceived mental health status
Fair/poor
3.14
2.92
Good
1.19
1.10
Very good
0.84
0.73
Excellent
0.82
0.84
Metropolitan statistical area (MSA)
MSA
0.64
0.63
Non-MSA
1.14
1.18
Census region
Northeast
1.15
1.38
Midwest
1.18
1.12
South
0.94
0.90
West
1.30
1.26
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.

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Table B (Corresponds to Table 2). Standard errors for mean workdays lost due to illness, injury, or mental or emotional problems for the population ages 16-64: United States, 1997 and 2001

Population characteristic

1997
2001
Total
0.39
0.37
Age in years
16-24
0.82
0.6
25-54
0.47
0.44
55-64
1.35
1.50
Race/ethnicity
Total Hispanic
1.09
0.77
Total black
1.44
1.58
Total white and other
0.42
0.38
Hispanic male
1.66
1.12
Black male
1.94
1.78
White and other male
0.68
0.50
Hispanic female
1.26
0.91
Black female
1.96
2.20
White and other female
0.55
0.59
Sex
Male
0.62
0.45
Female
0.53
0.55
Marital status
Married
0.54
0.46
Not married
0.64
0.57
Health insurance status
Private
0.42
0.40
Public only
1.98
1.52
Uninsured
1.18
0.97
Income
Poor
1.02
1.61
Near poor
3.65
1.33
Low income
1.37
1.16
Middle income
0.73
0.63
High income
0.54
0.50
Education
No high school
3.28
1.53
Some high school
1.23
1.05
High school graduate
0.76
0.61
More than high school
0.49
0.5
Perceived health status
Fair/poor
2.53
1.66
Good
0.73
0.85
Very good
0.55
0.41
Excellent
0.61
0.47
Perceived mental health status
Fair/poor
4.53
4.11
Good
1.19
0.74
Very good
0.52
0.49
Excellent
0.58
0.51
Metropolitan statistical area (MSA)
MSA
0.44
0.42
Non-MSA
0.81
0.68
Census region
Northeast
1.00
0.94
Midwest
0.91
0.85
South
0.6
0.55
West
0.74
0.68
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.

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Table C (Corresponds to Table 3). Standard errors for percent of population ages 16-64 with workdays lost to care for a family member with health problems: United States, 1997 and 2001
Population characteristic
1997
2001
Total
0.43
0.44
Age in years
16-24
0.76
0.67
25-54
0.51
0.52
55-64
0.99
1.02
Race/ethnicity
Total Hispanic
0.95
0.98
Total black
1.16
1.01
Total white and other
0.50
0.52
Hispanic male
1.12
0.97
Black male
1.58
1.20
White and other male
0.57
0.60
Hispanic female
1.52
1.45
Black female
1.45
1.35
White and other female
0.67
0.72
Sex
Male
0.49
0.51
Female
0.58
0.58
Marital status
Married
0.58
0.63
Not married
0.54
0.54
Health insurance status
Private
0.48
0.47
Public only
1.35
1.53
Uninsured
0.88
0.82
Income
Poor
1.22
1.17
Near poor
1.92
†2.00
Low income
1.11
1.16
Middle income
0.72
0.69
High income
0.69
0.65
Education
No high school
*
*
Some high school
1.00
0.81
High school graduate
0.73
0.66
More than high school
0.59
0.56
Perceived health status
Fair/poor
1.72
1.53
Good
0.84
0.76
Very good
0.59
0.67
Excellent
0.73
0.84
Perceived mental health status
Fair/poor
*
*
Good
0.92
0.86
Very good
0.65
0.62
Excellent
0.70
0.66
Metropolitan statistical area (MSA)
MSA
0.45
0.48
Non-MSA
1.11
1.12
Census region
Northeast
0.80
1.05
Midwest
0.97
0.94
South
0.73
0.74
West
0.87
0.76
*Sample size too small to produce reliable estimates.
†Relative standard error greater than or equal to 30 percent.
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.

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Table D (Corresponds to Table 4). Standard errors for mean workdays lost to care for a family member with health problems by the population ages 16-64: United States, 1997 and 2001
Population characteristic
1997
2001
Total
0.15
0.17
Age in years
16-24
0.28
0.31
25-54
0.16
0.16
55-64
0.58
1.01
Race/ethnicity
Total Hispanic
0.66
0.49
Total black
0.44
0.42
Total white and other
0.15
0.18
Hispanic male
0.96
1.02
Black male
0.45
0.72
White and other male
0.24
0.33
Hispanic female
0.89
0.25
Black female
0.61
0.47
White and other female
0.20
0.21
Sex
Male
0.22
0.31
Female
0.19
0.17
Marital status
Married
0.17
0.15
Not married
0.34
0.44
Health insurance coverage
Private
0.16
0.14
Public only
0.95
1.80
Uninsured
0.40
0.66
Income
Poor
0.35
0.85
Near poor
1.19
†2.79
Low income
0.43
0.45
Middle income
0.27
0.21
High income
0.21
0.19
Education
No high school
*
*
Some high school
0.36
0.34
High school graduate
0.22
0.34
More than high school
0.21
0.17
Perceived health status
Fair/poor
0.62
0.57
Good
0.25
0.3
Very good
0.25
0.28
Excellent
0.24
0.23
Perceived mental health status
Fair/poor
*
*
Good
0.37
0.56
Very good
0.23
0.20
Excellent
0.23
0.22
Metropolitan statistical area (MSA)
MSA
0.17
0.17
Non-MSA
0.26
0.48
Census region
Northeast
0.45
0.29
Midwest
0.24
0.36
South
0.25
0.32
West
0.29
0.25
*Sample size too small to produce reliable estimates.
†Relative standard error greater than or equal to 30 percent.
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.

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Table E (Corresponds to Table 5). Standard errors for percent of population ages 5-22 with schooldays lost due to illness, injury, or mental or emotional problems: United States, 1997 and 2001
Population characteristic
1997
2001
Total
0.77
0.73
Race/ethnicity
Total Hispanic
1.41
1.41
Total black
1.70
1.64
Total white and other
0.94
0.95
Hispanic male
1.90
1.88
Black male
2.25
2.14
White and other male
1.22
1.27
Hispanic female
1.82
1.85
Black female
2.25
2.21
White and other female
1.27
1.22
Sex
Male
0.97
0.96
Female
1.06
0.94
Health insurance coverage
Private
0.94
0.90
Public only
1.70
1.54
Uninsured
1.91
1.62
Income
Poor
1.69
1.65
Near poor
3.32
2.67
Low income
1.99
1.81
Middle income
1.40
1.14
High income
1.40
1.37
Perceived health status
Fair/poor
4.50
4.41
Good
1.68
1.66
Very good
1.14
1.06
Excellent
1.17
1.13
Perceived mental health status
Fair/poor
4.30
4.32
Good
1.76
1.86
Very good
1.23
1.07
Excellent
1.06
1.04
Metropolitan statistical area (MSA)
MSA
0.88
0.81
Non-MSA
1.63
1.55
Census region
Northeast
1.78
2.05
Midwest
1.30
1.53
South
1.49
1.17
West
1.52
1.41
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.

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Table F (Corresponds to Table 6). Standard errors for mean schooldays lost due to illness, injury, or mental or emotional problems for the population ages 5-22: United States, 1997 and 2001
Population characteristic
1997
2001
Total
0.13
0.15
Race/ethnicity
Total Hispanic
0.27
0.33
Total black
0.38
0.39
Total white and other
0.15
0.18
Hispanic male
0.30
0.46
Black male
0.44
0.38
White and other male
0.25
0.24
Hispanic female
0.39
0.50
Black female
0.60
0.70
White and other female
0.18
0.24
Sex
Male
0.19
0.20
Female
0.16
0.21
Health insurance coverage
Private
0.14
0.17
Public only
0.41
0.37
Uninsured
0.32
0.37
Income
Poor
0.37
0.33
Near poor
0.89
0.78
Low income
0.34
0.34
Middle income
0.19
0.24
High income
0.20
0.28
Perceived health status
Fair/poor
2.06
3.40
Good
0.49
0.44
Very good
0.16
0.16
Excellent
0.13
0.14
Perceived mental health status
Fair/poor
2.33
3.54
Good
0.45
0.48
Very good
0.19
0.14
Excellent
0.13
0.13
Metropolitan statistical area (MSA)
MSA
0.15
0.17
Non-MSA
0.27
0.31
Census region
Northeast
0.32
0.32
Midwest
0.30
0.32
South
0.21
0.20
West
0.24
0.37
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1997 and 2001.
 

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Suggested Citation: Research Findings #22: Restricted-activity Days in the United States, 1997 and 2001. July 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/data_files/publications/rf22/rf22.shtml