Self-rated health: analysis of distances and transitions between response options
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Self-rated health: analysis of distances and transitions between response options Thomas V. Perneger • Ange`le Gayet-Ageron • Delphine S. Courvoisier • Thomas Agoritsas • Ste´phane Cullati
Accepted: 15 April 2013 Springer Science+Business Media Dordrecht 2013
Abstract Purpose We explored health differences between population groups who describe their health as excellent, very good, good, fair, or poor. Methods We used data from a population-based survey which included self-rated health (SRH) and three global measures of health: the SF36 general health score (computed from the 4 items other than SRH), the EQ-5D health utility, and a visual analogue health thermometer. We compared health characteristics of respondents across the five health ratings. Results Survey respondents (N = 1.844, 49.2 % response) rated their health as excellent (12.2 %), very good (39.1 %), good (41.9 %), fair (6.0 %), or poor (0.9 %). The means of global health assessments were not equidistant across these five groups, for example, means of the health thermometer were 95.8 (SRH excellent), 88.8 (SRH very good), 76.6 (SRH good), 49.7 (SRH fair), and 33.5 (SRH poor, p \ 0.001). Recoding the SRH to reflect these mean values substantially improved the variance explained by the SRH, for example, the linear r2 increased from 0.50 to 0.56 for the health thermometer if the SRH was coded as poor = 1, fair = 2, good = 3.7, very good = 4.5, and excellent = 5. Furthermore, transitions between response options were not explained by the same health-related characteristics of the respondents. Conclusions The adjectival SRH is not an evenly spaced interval scale. However, it can be turned into an interval variable if the ratings are recoded in proportion to the
T. V. Perneger (&) A. Gayet-Ageron D. S. Courvoisier T. Agoritsas S. Cullati Division of clinical epidemiology, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland e-mail: [email protected]
underlying construct of health. Possible improvements include the addition of a rating option between good and fair or the use of a numerical scale instead of the classic adjectival scale. Keywords Self-rated health Health status measurement Population surveys Response scale
A self-rated health (SRH) item is included in many health status questionnaires and population surveys. It is often phrased as ‘‘Would you say your health is… excellent/very good/good/fair/poor,’’ but other response scales have been used as well [1, 2]. This item is intuitively appealing, because it enables respondents to communicate their own assessment of their health, as they understand it. Furthermore, SRH predicts mortality [3–11], use of health services [12], and health expenditures [13] in various populations. Thus, the usefulness of this item is firmly established. Nevertheless, what exactly self-ratings of health mean is not entirely clear [1, 2, 14, 15]. The dimensions included under the umbrella of ‘‘health’’ may vary between individuals. Some respondents may consider absolute hea
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