Abstract
BackgroundResearchers interested in the effects of health on various life outcomes often use self-reported health and disease as an indicator of true, underlying health status. However, the validity of reporting is questionable as it relies on the awareness, recall bias and social desirability. Accordingly, biomedical test is generally regarded as a more precise indication of the disease.MethodsUsing data from the third wave of China Health and Retirement Longitudinal Study (CHARLS), we selected individuals aged 40–85 years old who participated in both health interview survey and biomedical test. Sensitivity, specificity, false negative reporting and false positive reporting were used as measurements of (dis) agreement or (in) validity, and binary and multinomial logistic regression were used to estimate under-report or over-report of hypertension and diabetes.ResultsSelf-reported hypertension and diabetes showed low sensitivity (73.24 and 49.21%, respectively) but high specificity (93.61 and 98.05%, respectively). False positive reporting of hypertension and diabetes were 3.97 and 1.67%, while false negative reports were extremely high at 10.14 and 7.38%. Educational attainment, hukou, age and gender affected both group-specific error and overall error with some differences in their magnitude and directions.ConclusionSelf-reported conditions underestimate the disease burden of hypertension and diabetes in China. Adding objective measurements into social survey could improve data accuracy and allow better understanding of socioeconomic inequalities in health. Furthermore, there is an urgent need to provide basic health education and physical examination to citizens, and promote the use of healthcare to lower the incidence and unawareness of disease in China.
Highlights
Researchers interested in the effects of health on various life outcomes often use self-reported health and disease as an indicator of true, underlying health status
This value was equivalent to hypertension/diabetes awareness among those with diseases; specificity was defined as the percentage of individuals who reported no hypertension/ diabetes among those with ‘normal’ biomedical measurements; false negative reporting was defined as those who reported no hypertension/diabetes but were diagnosed hypertension/diabetes, and false positive reporting was defined as those who reported hypertension/diabetes but were not diagnosed hypertension/diabetes
Sensitivity, specificity and false reporting of hypertension and diabetes The prevalence of hypertension was 37.88% based on biomedical test and 31.72% based on self-reported data, indicating that self-reporting led to an underestimation of hypertension by 16.26%
Summary
Researchers interested in the effects of health on various life outcomes often use self-reported health and disease as an indicator of true, underlying health status. Highquality estimates of prevalence based on biomedical measurements are needed for monitoring cardiovascular disease risks and planning public health preventions and. Sensitivity was defined as the percentage of respondents who reported hypertension/diabetes among those with biomedical hypertension/diabetes This value was equivalent to hypertension/diabetes awareness among those with diseases; specificity was defined as the percentage of individuals who reported no hypertension/ diabetes among those with ‘normal’ biomedical measurements; false negative reporting was defined as those who reported no hypertension/diabetes but were diagnosed hypertension/diabetes, and false positive reporting was defined as those who reported hypertension/diabetes but were not diagnosed hypertension/diabetes. Evidence from developed countries indicated that there was a big gap between self-reported diseases and biomedical diseases of hypertension and diabetes and it may differ by socioeconomic groups. More educated and higher socioeconomic individuals might have a better understanding of health information and were more capable of answering survey questions on disease diagnosis [5,6,7,8]
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