Abstract
BackgroundThe assessment of population health has traditionally relied on the population's average health measured by mortality related indicators. Researchers have increasingly recognized the importance of including information on health inequality and health-related quality of life (HRQL) in the assessment of population health. The objective of this study is to assess the health of Americans in the 1990s by describing the average HRQL and its inequality across individuals and groups.MethodsThis study uses the 1990 and 1995 National Health Interview Survey from the United States. The measure of HRQL is the Health and Activity Limitation Index (HALex). The measure of health inequality across individuals is the Gini coefficient. This study provides confidence intervals (CI) for the Gini coefficient by a bootstrap method. To describe health inequality by group, this study decomposes the overall Gini coefficient into the between-group, within-group, and overlap Gini coefficient using race (White, Black, and other) as an example. This study looks at how much contribution the overlap Gini coefficient makes to the overall Gini coefficient, in addition to the absolute mean differences between groups.ResultsThe average HALex was the same in 1990 (0.87, 95% CI: 0.87, 0.88) and 1995 (0.87, 95% CI: 0.86, 0.87). The Gini coefficient for the HALex distribution across individuals was greater in 1995 (0.097, 95% CI: 0.096, 0.099) than 1990 (0.092, 95% CI: 0.091, 0.094). Differences in the average HALex between all racial groups were the same in 1995 as 1990. The contribution of the overlap to the overall Gini coefficient was greater in 1995 than in 1990 by 2.4%. In both years, inequality between racial groups accounted only for 4–5% of overall inequality.ConclusionThe average HRQL of Americans was the same in 1990 and 1995, but inequality in HRQL across individuals was greater in 1995 than 1990. Inequality in HRQL by race was smaller in 1995 than 1990 because race had smaller effect on the way health was distributed in 1995 than 1990. Analysis of the average HRQL and its inequality provides information on the health of a population invisible in the traditional analysis of population health.
Highlights
To assess the health of a population, we have traditionally relied on the average or overall level of health in a population
The analysis of health inequality by race in this present study looks at how much contribution this overlap term makes to the overall Gini coefficient, in addition to the absolute mean difference between groups
This study showed that the average Health and Activity Limitation Index (HALex) of Americans in 1990 and 1995 were the same (0.87), but inequality in the HALex across individuals was slightly greater in 1995 than 1990 (0.092) (p < 0.05)
Summary
To assess the health of a population, we have traditionally relied on the average or overall level of health in a population. Researchers and policy-makers have increasingly paid attention to health inequality as an indicator of population health [3,4,5] They believe that a traditional average health of a population does not provide enough information as a population health measure, and investigation of the distribution of health within a population is necessary. Such policy documents as Healthy People 2010 [5], the national health plan for the decade in the US, and The World Health Report 2000 [4] clearly state two goals of improving population health: the increase in the average or overall level of health and the decrease in health inequality or disparity. The objective of this study is to assess the health of Americans in the 1990s by describing the average HRQL and its inequality across individuals and groups
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