Abstract
BackgroundSelf-rated Health (SRH) and health-related quality of life (HRQoL) are used to evaluate health disparities. Like all subjective measures of health, they are dependent on health expectations that are associated with socioeconomic characteristics. It is thus needed to analyse the influence played by socioeconomic position (SEP) on the relationship between these two indicators and health conditions if we aim to use them to study health disparities. Our objective is to assess the influence of SEP on the relationship between physical health status and subjective health status, measured by SRH and HRQoL using the SF-36 scale.MethodsWe used data from the French National Health Survey. SEP was assessed by years of education and household annual income. Physical health status was measured by functional limitations and chronic low back pain.ResultsRegardless of their health status, people with lower SEP were more likely than their more socially advantaged counterparts to report poor SRH and poorer HRQoL, using any of the indicators of SEP. The negative impact of chronic low back pain on SRH was relatively greater in people with a high SEP than in those with a low SEP. In contrast, chronic low back pain and functional limitations had less impact on physical and mental component scores of quality of life for socially advantaged men and women.ConclusionsBoth SRH and HRQoL were lower among those reporting functional limitations or chronic low back pain. However, the change varied according SEP and the measure. In relative term, the negative impact of a given health condition seems to be greater on SRH and lower on HRQoL for people with higher SEP in comparison with people with low SEP. Using SRH could thus decrease socioeconomic differences. In contrast using HRQoL could increase these differences, suggesting being cautious when using these indicators for analyzing health disparities.
Highlights
Self-rated Health (SRH) and health-related quality of life (HRQoL) are used to evaluate health disparities
Recent studies conducted in the U.S have shown that the relative impact on SRH of a given chronic condition was greater in people with a higher years of education than in those with less education [17,18,19], suggesting that using SRH as a measure of health could lead to underestimation of the magnitude of health inequalities existing between socioeconomic groups, as observed by Mackenbach et al [12]
Interaction of socioeconomic position and health conditions on SRH (Tables 2 and 3) Functional limitations (FL) and chronic low back pain were associated with poorer SRH using each indicator of SEP in both men and women
Summary
Self-rated Health (SRH) and health-related quality of life (HRQoL) are used to evaluate health disparities. Self-rated health (SRH) [1] and health-related quality of life (HRQoL) [2], which is defined as the perception of the impact of health problems on different spheres of life, including physical, mental, and social aspects, are two outcome measures used to assess health status. Because they are self-reported, they are inexpensive and easy to use, and it has been shown that SRH [1,3,4] and in a lesser measure HRQoL [5,6,7,8,9], are independent predictors of subsequent mortality and morbidity. Some others studies conducted on Canadian samples have shown no such interaction or a relative lower impact of health condition on SRH [20,21]
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