Abstract
Researchers interested in the effect of health on various life outcomes (such as employment, earnings and life satisfaction) often use self-reported health and disease status as an indicator of true, underlying health status. Self-reports appear to be reasonable measures of overall health. For example, self-assessed overall health has been found to be a reliable predictor of mortality. However, the validity of self-reports is questionable when investigating specific diseases such as diabetes and hypertension. A small and nascent body of research comparing self-reported status on certain diseases with the true status based on clinical diagnoses has found significant gaps. These validation exercises predominantly use data from high-income countries. In this paper, we use survey data from India to compare self-reports of disease prevalence to diagnostic tests conducted on the same individuals. We focus on hypertension and lung disease, two of the primary causes of death in India. We find that self-reported measures substantially understate the true disease burden for both conditions. The attenuation bias from using self-reports is over 80 percent for both diseases, and bigger than estimates from high-income countries. We test and reject the hypothesis that self-reports of the disease status are identical to the true disease status in expectation. We identify characteristics associated with false negative reporting (reporting not having the disease but testing positive for it) for both diseases. The large awareness gap between self-reports and true disease burden indicates multiple deficiencies in India’s public health policy. The survey data depicts limited access to medical facilities, high levels of health illiteracy, low rates of health insurance, and other barriers related to poverty and lack of equity in the delivery of health services. These factors prevent timely intervention for managing health and controlling disease, invariably leading to morbidity and often to premature death.
Highlights
Definition Basic correlates Age categories: 45-54; 55-64; 65-74; 75-85 – categorical variables =1 if female, 0 if male Scheduled castes (SC); scheduled tribes (ST); other backward class (OBC); None/Other – categorical variables Hindu; Muslim; Christian; Sikh; Other – categorical variables =1 if currently married, 0 otherwise Number of living children =1 if any child of respondent died Education categories: no education; < 6 years; 6-12 years; > 12 years – categorical variables Years of completed schooling =1 if respondent can read and write, 0 otherwise =1 if respondent is currently working for pay, or worked for pay for at least 6 months in the past, 0 otherwise Current circumstances =1 if living in an urban area, 0 otherwise Log-transformed total household per capita expenditure in last year =1 if the household uses coal, charcoal, natural gas, LPG, kerosene or electricity for cooking, and 0 otherwise =1 if the household uses natural gas, LPG, kerosene or electricity for cooking, and 0 otherwise =1 if house has indoor plumbing, 0 otherwise =1 if household has electricity, 0 otherwise =1 if household has private toilet, 0 otherwise Lifestyle variables Never smoked; current smoker; former smoker – categorical variables =1 if current or former smoker, 0 otherwise Never drank; current drinker; former drinker – categorical variables =1 if drinks alcohol or used to, 0 otherwise Never exercised; heavy exercise; moderate exercise – categorical variables =1 if does heavy or moderate exercise, 0 otherwise =1 if any household member smokes inside the house, 0 otherwise Objective health measures =1 if the mean systolic blood pressure measure is over 140 mmHg or the mean diastolic one is over 90 mmHg, and 0 otherwise
Based on spirometry test, averaged over 3 readings =1 if the BMI is in the 25-30 kg/m2 range, 0 otherwise =1 if the BMI is > 30 kg/m2 range, 0 otherwise Ratio of waist to hip circumference in centimeters pulse rate measured using a blood pressure monitor
Summary
Definition Basic correlates Age categories: 45-54; 55-64; 65-74; 75-85 – categorical variables =1 if female, 0 if male Scheduled castes (SC); scheduled tribes (ST); other backward class (OBC); None/Other – categorical variables Hindu; Muslim; Christian; Sikh; Other – categorical variables =1 if currently married, 0 otherwise Number of living children =1 if any child of respondent died Education categories: no education; < 6 years; 6-12 years; > 12 years – categorical variables Years of completed schooling =1 if respondent can read and write, 0 otherwise =1 if respondent is currently working for pay, or worked for pay for at least 6 months in the past, 0 otherwise Current circumstances =1 if living in an urban area, 0 otherwise Log-transformed total household per capita expenditure in last year =1 if the household uses coal, charcoal, natural gas, LPG, kerosene or electricity for cooking, and 0 otherwise =1 if the household uses natural gas, LPG, kerosene or electricity for cooking, and 0 otherwise =1 if house has indoor plumbing, 0 otherwise =1 if household has electricity, 0 otherwise =1 if household has private toilet, 0 otherwise Lifestyle variables Never smoked; current smoker; former smoker – categorical variables =1 if current or former smoker, 0 otherwise Never drank; current drinker; former drinker – categorical variables =1 if drinks alcohol or used to, 0 otherwise Never exercised; heavy exercise; moderate exercise – categorical variables =1 if does heavy or moderate exercise, 0 otherwise =1 if any household member smokes inside the house, 0 otherwise Objective health measures =1 if the mean systolic blood pressure measure is over 140 mmHg or the mean diastolic one is over 90 mmHg, and 0 otherwise.
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