Self-assessed Health Measures Research Articles

Work Disability, Work, and Justification Bias in Europe and the U.S.

To analyze the effect of health on work, many studies use a simple self-assessed health measure based upon a question such as do you have an impairment or health problem limiting the kind or amount of work you can do? A possible drawback of such a measure is the possibility that different groups of respondents may use different response scales. This is commonly referred to as differential item functioning (DIF). A specific form of DIF is justification bias: to justify the fact that they don't work, non-working respondents may classify a given health problem as a more serious work limitation than working respondents. In this paper we use anchoring vignettes to identify justification bias and other forms of DIF across countries and socio-economic groups among older workers in the U.S. and Europe. Generally, we find differences in response scales across countries, partly related to social insurance generosity and employment protection. Furthermore, we find significant evidence of justification bias in the U.S. but not in Europe, suggesting differences in social norms concerning work.

Ill-health as a household norm: Evidence from other people's health problems

This paper proposes that an individual's self-assessed health (SAH) does not only suffer from systematic reporting bias and adaptation bias but is also biased owing to confounding health norm effects. Using 13 waves of the British Household Panel Survey covering the period 1991–2005, I show that, while there is a negative and statistically significant correlation between SAH and individuals' own health problem index, this negative effect reduces with the average number of health problems per (other) family member. The relative health bias is small, however, which implies that measures of SAH may not suffer seriously from systematic health norm bias. This is an important finding for researchers working with SAH data as it indicates that we do not have to worry too much about controlling for confounding influences from the health of other household members when estimating SAH regression equations.

Income, relative income, and self‐reported health in Britain 1979–2000

We test the relative income hypothesis that an individual's health depends on the distribution of income in a reference group, as well as on the income of the individual. We use data on 231 208 individuals in Great Britain from 19 rounds of the General Household Survey between 1979 and 2000. Results are insensitive to the measure of self-assessed health used but the sign and significance of the effect of relative income depend on the reference group (national or regional) and the measure of relative income (Gini coefficient, absolute or proportional difference from the reference group mean, Yitzhaki absolute and proportional relative deprivation and affluence). Only one model (relative deprivation measured as income proportional to regional mean income) performs better than the model without relative income and has a positive estimated effect of absolute income on health. In this model the increase in the probability of good health from a ceteris paribus reduction in relative deprivation from the upper quartile to zero is 0.010, whereas an increase in income from the lower to the upper quartile increases the probability by 0.056. While our results provide only very weak support for the relative deprivation hypothesis, the inevitable correlation of measures of individual income and relative deprivation measured by comparing income and incomes in a reference group makes identification of the separate effects of income and relative deprivation problematic.

Health Effects in Army Gulf War Veterans Possibly Exposed to Chemical Munitions Destruction at Khamisiyah, Iraq: Part I. Morbidity Associated with Potential Exposure

In March 1991, U.S. troops detonated the Khamisiyah, Iraq, ammunition depot, possibly releasing two chemical warfare agents, sarin and cyclosarin. The long-term health effects associated with possible exposure to these chemical warfare agents are unknown. This study was undertaken to investigate whether possible exposure was associated with morbidity among Army Gulf War veterans using morbidity data for 5,555 Army veterans who were deployed to the Gulf region. Responses to 86 self-assessed health measures, as reported in the 1995 Department of Veterans Affairs National Health Survey of Gulf War Era Veterans, were evaluated. We found little association between potential exposure and health, after adjustment for demographic variables, and conclude that potential exposure to sarin or cyclosarin at Khamisiyah does not seem to have adversely affected self-perceived health status, as evidenced by a wide range of health measures.

Using Self-assessed Health to Predict Patient Outcomes after Total Knee Replacement

Self-assessed health status has been shown to be a powerful predictor of mortality, service use, and total cost of medical care treatment. We investigated the potential for self-assessed health to further serve as a predictor of improvement in health status after a clinical intervention. Using the five-category measure of self-assessed health (excellent, very good, good, fair, or poor), we examined patients' improvements in health status after total knee arthroplasty in each of the WOMAC-defined categories for health status in patients. The results indicate that the greater patients rated their preoperative health, the greater their postoperative improvement. The results suggest that a simple process of asking patients to rate their own health in a presurgery clinic could be a powerful tool in predicting patient outcome. This also suggests that by stratifying preoperative self-assessed health, potential improvements in health status will be more fully captured.

Subjective Health Measures, Reporting Errors and Endogeneity in the Relationship Between Health and Work

This paper explores the interrelation between health and work decisions of older workers. For this, two issues are of relevance. Firstly, health and work may be endogenously related because of direct effects of health on work and vice versa, and because of unobservables that may relate observed health and work outcomes. Secondly, social surveys usually contain self-assessed health measures and research indicates that these may be affected by endogenous, state-dependent, reporting behavior. A solution to the 'Health and Retirement Nexus' requires an integrated model for work decisions, health production and health-reporting mechanisms. We formulate such a model and estimate it on a longitudinal dataset of Dutch elderly.

The health of Swedish-speaking and Finnish-speaking schoolchildren in Finland.

It is well known that Swedish-speaking adults in Finland have higher life expectancy and better health than their Finnish-speaking counterparts. Among young people, similar comparisons have been scarce. The present paper aims to compare the health of Swedish-speaking and Finnish-speaking schoolchildren. Survey data from 1997, representing children at grades 8 and 9 of compulsory school in a bilingual region, are analysed with the help of logistic regression models. Self-rated health as well as objective measures of health are explored. We find that Swedish-speaking schoolchildren are healthier than Finnish-speaking ones in terms of objective measures of health, whereas there is no difference between language groups in terms of self-assessed health. Self-rated health seems to reflect well-being in a very broad context rather than objective health from a medical perspective. Risk factors and health behaviours being equal, both language groups consequently assess their health in a similar manner. Policy makers should be careful when advocating the health needs of schoolchildren based on survey results concerned with self-assessed health measures, particularly when they are concerned with targeting measures towards specific subgroups of the population. Self-rated health is obviously not well suited for reflecting overall and specific needs of medical assistance and expertise for schoolchildren.

Individual differences in self-assessed health: An information-processing investigation of health and illness cognition.

In 2 studies, the relation between measures of self-assessed health (SAH) and automatic processing of health-relevant information was investigated. In Study 1, 84 male and 86 female undergraduate students completed a modified Stroop task. Results indicated that participants with poorer SAH showed enhanced interference effects for illness versus non-illness words. In Study 2, 27 male and 30 female undergraduate students completed a self-referent encoding task. Results offered a conceptual replication and extension of Study 1 by confirming the specificity of the relation between SAH measures and automatic processing of health (vs. negative or positive general trait) information. These studies provide evidence that individual differences in SAH are reflected in schematic processing of health-relevant information.

The role of self-assessed health in the relationship between gender and depressive symptoms among adolescents.

To examine the concurrent and longitudinal relations between gender, self-assessed health (SAH), and depressive symptoms among adolescents. Two measures of SAH (physical symptom reports and global health ratings) and a measure of depression were completed on two occasions over two years by 232 adolescent boys and girls. Physical symptom reports were related to depressive symptoms both concurrently and longitudinally. Longitudinal path analysis revealed a significant path from gender to physical symptom reports (Wave 1) to depressive symptoms (Wave 2). Although global health ratings were related to depressive symptoms concurrently, the prospective relation was not significant in the cross-lagged path model. These findings suggest that the development of poorer SAH, particularly the perception of physical symptoms, may place adolescent girls at risk for subsequent depressive symptoms. Potential mechanisms for the SAH-depression relationship are discussed.

Positive aspects of caregiving: rounding out the caregiver experience.

To identify positive aspects of caregiving and examine how they are associated with caregiver outcomes. This study used a national sample of caregivers derived from the Canadian Study of Health and Aging (part 2). Two hundred and eighty-nine caregivers caring for seniors living in the community were questioned about their experience of caregiving. Caregivers were asked whether they could identify any positive aspects related to their role, the type of positive aspects and to rate their feelings about caring. Using a conceptual model developed by Noonan and Tennstedt (1997), a staged stepwise multiple regression approach was used factoring the background/contextual variables, stressor variables (3 MS score, ADL limitations), mediator variables (positive aspects of caregiving, number of services used) and outcome variables (depression, burden and self-assessed health measures) into the model. Two hundred and eleven caregivers (73%) could identify at least one specific positive aspect of caregiving. An additional 20 (6.9%) could identify more than one positive aspect. Positive feelings about caring were associated with lower CES-D scores ( p<0.001), lower burden scores ( p<0.001) and better self assessed health ( p<0.001). Clinicians should inquire about the positive aspects of caregiving if they are to fully comprehend the caregiver experience and identify risk factors for negative caregiver outcomes.

Health and Work of the Elderly Subjective Health Measures: Reporting Errors and the Endogenous Relationship between Health and Work

This paper aims to explore the interrelation between health and work decisions of elderly workers, taking the various ways in which health and work can influence each other explicitly into account. For this, two issues are of relevance. Self-assessed health measures are usually at hand in empirical analyses and research indicates that these may be endogenous, state dependent, reporting behaviour. Furthermore, even if an objective health measure is used, it is not likely to be strictly exogenous to labour market status or labour income. and labour market variables are correlated because of unobserved individual-specific characteristics (e.g., investments in human capital and health capital) Moreover, one's labour market status is expected to have a (reverse) causal effect on health. A solution to the Health and Retirement Nexus requires an integrated model for work decisions, health production and health reporting mechanisms. We formulate such a model and estimate it on a longitudinal dataset of Dutch elderly.

Self-assessed health among indigenous Australians: how valid is a global question?

This study assessed the validity of a global measure of self-assessed health among Indigenous Australians. Logistic regression was used to identify factors associated with self-assessed health in a nationally representative sample. Among 8782 adult respondents, poorer self-assessed health was strongly associated with several factors, including age, number of health conditions, and recent health actions. The association with health conditions was attenuated when the respondent's primary language was not English. Self-assessed health may be a valid measure among indigenous Australians whose primary language is English. However, although the measure draws on common experiences of health and illness, it may obscure differences in how people incorporate these experiences into social actions.

Intimate partner violence and health: self-assessed health, chronic health, and somatic symptoms among Mexican American women.

In medical settings intimate partner violence (IPV) has been linked to a variety of health problems. However, few population-based studies have assessed the health of abused women, particularly women from low socioeconomic groups such as Mexican Americans. This study examined the association between recent physical or sexual IPV and self-rated health, chronic health conditions, and somatic symptoms among Mexican American women. Participants were women (N = 1155) with current male partners enrolled in a household survey of 3012 Mexican-origin adults, ages 18 to 59 years, living in urban, town, and rural areas of Fresno County, California. Crude and adjusted odds ratios (ORs) were calculated for four self-assessed health measures, seven chronic diseases, and 32 somatic symptoms. In multivariate analyses, women reporting previous-year physical or sexual IPV were more likely to report 1) fair/poor overall health (OR, 1.9; confidence interval [CI], 1.0-3.7), physical health (OR, 2.1; CI, 1.2-3.9), and mental health (OR, 3.4; CI, 1.9-6.1), as well as worse comparative health (OR, 4.4; CI, 2.3-8.3); 2) a history of heart problems (OR, 17.0; CI, 4.3-66.7); 3) persistent health problems (OR, 3.3; CI, 1.5-7.0); and 4) numerous somatic symptoms. Physical or sexual IPV was associated with poorer self-assessed health and many health symptoms among this culturally distinctive Mexican American population.

A Cross-National Examination of the Determinants of Self-Assessed Health

Self-assessed health measures are often utilized in surveys of older adults, and these have been found to be powerful predictors of other health indicators and future health. However, there is still much that is puzzling about the measure. Few studies use comparative techniques to ascertain the determinants of self-assessed health across diverse settings. Using recent data from the Philippines, Taiwan, and Thailand, the current study tests whether determinants of self-assessed health are similar across samples and whether there are distinct country effects acting upon the association. Ordered probit models reveal that, on the one hand, the determinants of self-assessed health are relatively similar across the three countries, while, on the other, the overall probabilities of reporting favorable self-assessed health remain differentiated even when controlling for a broad series of determinants. The results suggest that cultural variation in the interpretation of health may be a factor and that more subtle measures should be included in future studies of this nature.

Self-care among older adults

Defining self-care as treatment for a perceived symptom, this paper posits that explanations for such illness behavior will differ depending on whether symptoms experienced are perceived as not serious and most amenable to self-treatment or more serious and less likely to respond to self-care. Borrowing from the Health Belief Model, two major concepts, a health set (consisting of five measures of perceived physical and mental health) and an attitude set (comprising four indicators of belief in physician efficacy) are included to explain rates of self-care across all reported symptoms. Self-care rate, calculated as the percentage of experienced symptoms self-treated without professional advice, was slightly higher for persons whose symptoms were seen as less serious. Measures of self-assessed health were related to self-care for those less severe symptoms, while lower faith in doctors as well as health were more closely related to the ailments perceived as more serious. Implications of the results for further studies are discussed.

The Retirement-Health Nexus: A New Measure of an Old Puzzle

Traditional empirical models of retirement which use a self-assessed health measure have often found that the wage rate has a surprisingly small effect on retirement. Using both a self-reported health measure and one not based on self-report (subsequent mortality experience) in a more general reduced-form joint-demand framework, we test the importance of the interaction effects of health and retirement. Our findings are consistent with a joint determination of health and retirement. The wage elasticity using either health measure is about equal to that found in a single-equation model when a mortality measure is used, but all three elasticities are five times greater than one found using self-reported health in a traditional single-equation model.