Does reporting heterogeneity bias the measurement of health disparities?

Heterogeneity in reporting of health by socio-economic and demographic characteristics potentially biases the measurement of health disparities. We use anchoring vignettes to identify socio-demographic differences in the reporting of health in Indonesia, India and China. Homogeneous reporting by socio-demographic group is rejected and correcting for reporting heterogeneity tends to reduce slightly estimated disparities in health by education (not China) and to increase those by income. But the method does not reveal substantial reporting bias in measures of health disparities.     

ARE HEALTH SHOCKS DIFFERENT? EVIDENCE FROM A MULTISHOCK SURVEY IN LAOS

Using primary data from Laos, we compare a broad range of different types of shocks in terms of their incidence, distribution between the poor and the better off, idiosyncrasy, costs, coping responses, and self‐reported impacts on well‐being. Health shocks are more common than most other shocks, more concentrated among the poor, more idiosyncratic, more costly, trigger more coping strategies, and highly likely to lead to a cut in consumption. Household members experiencing a health shock lost, on average, 0.6 point on a five‐point health scale; the wealthier are better able to limit the health impacts of a health shock. Copyright © 2013 The World Bank Group.     

The Conceptual and Empirical Link Between Health Behaviors,Self Reported Health,and the Use of Home Health Care in Later Life

ABSTRACT

The primary qualification for Medicare's home health care benefit is being homebound, typically by a chronic disability. Disability and functional ability in late-life are heavily influenced by the long-term practice of health behaviors. One of the goals of Healthy People 2000 is to increase the years of healthy life which are measured, in part, by self reported health status. This compression of morbidity would, in effect, reduce the need for long term care. This paper examines three conceptual models linking health behaviors to self reported health in a unique sample of older adults who have chosen to participate in a corporate sponsored wellness program. It is hoped that these findings will encourage further research on formulating empirical pathways from health behaviors to reduced need for home health care.     

Racial and ethnic disparities in self‐assessed health status: Evidence from the national survey of families and households

We examined racial and ethnic disparities in global health assessment and functional limitations of daily activities among whites, blacks and Hispanics, and within the Hispanic origin among Mexicans, Puerto Ricans, Cubans, and ‘Others’. Logistic regressions were employed to estimate the log odds of reporting ‘poor health’ and ‘having functional limitations’ among 12 814 respondents from the 1987—1988 National Survey of Families and Households. Compared with whites, blacks had an increased risk of reporting poor health and functional limitations. Hispanics had even a higher risk of reporting poor health, but did not have an increased risk of reporting functional limitations. Among Hispanics, Mexicans were more likely than whites to report poor health, whereas Puerto Ricans were more likely than whites to experience functional limitations. Both race and ethnicity remain important factors in explaining the disparities in self‐assessed health status independent of socioeconomic status (SES). Meanwhile, the way self‐assessed health status varies with ethnicity is importantly stratified by SES as measured by income and education. These results suggest that future research should analyze the interplay between ethnicity and SES rather than assuming measuring either captures all the important variation.     

Health and labour force participation of older people in Europe: What do objective health indicators add to the analysis?

This paper studies labour force participation of older individuals in 11 European countries. The data are drawn from the new Survey of Health, Ageing and Retirement in Europe (SHARE). We examine the value added of objective health indicators in relation to potentially endogenous self-reported health. We approach the endogeneity of self-reported health as an omitted variables problem. In line with the literature on the reliability of self-reported health ambiguous results are obtained. In some countries self-reported health does a fairly good job and controlling for objective health indicators does not add much to the analysis. In other countries, however, the results show that objective health indicators add significantly to the analysis and that self-reported health is endogenous due to omitted objective health indicators. These latter results illustrate the multi-dimensional nature of health and the need to control for objective health indicators when analysing the relation between health status and labour force participation. This makes an instrumental variables approach to deal with the endogeneity of self-reported health less appropriate.     

Are there health benefits of being unionized in late career? A longitudinal approach using HRS

Objective

To assess whether unionization prevents deterioration in self‐reported health and depressive symptoms in late career transitions.

Methods

Data come from the Health and Retirement Study (N = 6475). The change in self‐perceived health (SPH) and depressive symptoms (CESD) between wave 11 and wave 12 is explained using an interaction effect between change in professional status from wave 10 to wave 11 and unionization in wave 10.

Results

The odds of being affected by a negative change in CESD when unionized are lower for unionized workers remaining in full‐time job (OR:0.73, CI95%:0.58;0.89), unionized full‐time workers moving to part‐time work (OR:0.66, CI95%:0.46;0.93) and unionized full‐time workers moving to part‐retirement (OR:0.40, CI95%:0.34;0.47) compared to non‐unionized workers. The same conclusion is made for the change in SPH but with odds ratios closer to 1.

Conclusion

The reasons for the associations found in this paper need to be explored in further research.

     

Health and income: a robust comparison of Canada and the US

This paper uses sequential stochastic dominance procedures to compare the joint distribution of health and income across space and time. It is the first application of which we are aware of methods to compare multidimensional distributions of income and health using procedures that are robust to aggregation techniques. The paper's approach is more general than comparisons of health gradients and does not require the estimation of health equivalent incomes. We illustrate the approach by contrasting Canada and the US using comparable data. Canada dominates the US over the bottom part of the bi-dimensional distribution of health and income, though not generally over the uni-dimensional distributions of health or income. The paper also finds that welfare for both Canadians and Americans has not unambiguously improved during the last decade over the joint distribution of income and health, in spite of the fact that the uni-dimensional distributions of income have clearly improved during that period.     

Primary care,self-rated health,and reductions in social disparities in health

OBJECTIVE: To examine the extent to which good primary-care experience attenuates the adverse association of income inequality with self-reported health. DATA SOURCES: Data for the study were drawn from the Robert Wood Johnson Foundation sponsored 1996-1997 Community Tracking Study (CTS) Household Survey and state indicators of income inequality and primary care. STUDY DESIGN: Cross-sectional, mixed-level analysis on individuals with a primary-care physician as their usual source of care. The analyses were weighted to represent the civilian noninstitutionalized population of the continental United States. DATA COLLECTION/EXTRACTION METHODS: Principal component factor analysis was used to explore the stricture of the primary-care indicators and examine their construct validity. Income inequality for the state in which the community is located was measured by the Gini coefficient, calculated using income distribution data from the 1996 current population survey. Stratified analyses compared proportion of individuals reporting had health and feeling depressed with those with good and bad primary-care experiences for each of the four income-inequality strata. A set of logistic regressions were performed to examine the relation between primary-care experience, income inequality, and self-rated health. PRINCIPAL FINDINGS: Good primary-care experience, in particular enhanced accessibility and continuity, was associated with better self-reported health both generally and mentally. Good primary-care experience was able to reduce the adverse association of income inequality with general health although not with mental health, and was especially beneficial in areas with highest income inequality. Socioeconomic status attenuated, but did not eliminate, the effect of primary-care experience on health. In conclusion, good primary-care experience is associated not only with improved self-rated overall and mental health but also with reductions in disparities between more- and less-disadvantaged communities in ratings of overall health.     

Validity of self reported utilisation of primary health care services in an urban population in Spain

STUDY OBJECTIVE: To assess the validity and factors related with the validity of self reported numbers of visits to a primary health care centre, in comparison with the recorded number. DESIGN: Cross sectional study. SETTING: The urban area served by the Zaidín-Sur Primary Health Care Centre (Granada, Spain). PARTICIPANTS: Two population samples (236 high users and 420 normal users) who were seen at the centre from 1985 to 1991 were interviewed in 1993. MAIN RESULTS: A net tendency to overreport the actual number of visits was observed. Absolute concordance between self reported and recorded utilisation decreased as time interval lengthened, although this mainly reflected the increase in maximum variability both with time interval length and with the number of recorded visits. Corrected Spearman rho coefficients obtained between the number of self reported and recorded visits ranged from 0.602 for the two weeks before the interview to 0.678 for the year before. Regression slopes of self reported utilisation upon recorded utilisation did not change between periods. In multiple regression analyses the actual number of visits was the main factor associated with both underreporting and overreporting. Older age was also significantly associated with underreporting. Poor health status and high satisfaction with health care were significantly associated with overreporting. CONCLUSIONS: There was a substantial degree of inaccuracy in self reported utilisation, with a net tendency to overreport the number of visits. In relative terms, however, accuracy of self reports did not seem to decrease appreciably as the recall time lengthened. To compare the accuracy of different measures, it is important to take into account the maximum variability of each one. Otherwise, contradictory results may be obtained.     

Ethnic differences in self reported health in Malmö in southern Sweden

STUDY OBJECTIVE—The aim of this study was to investigate ethnic differences in self reported health in the city of Malmö, Sweden, and whether these differences could be explained by psychosocial and economic conditions.
DESIGN/SETTING/PARTICIPANTS—The public health survey in Malmö 1994 was a cross sectional study. A total of 5600 people aged 20-80 years completed a postal questionnaire. The participation rate was 71%. The population was categorised according to country of origin: born in Sweden, other Western countries, Yugoslavia, Poland, Arabic speaking countries and all other countries. The multivariate analysis was performed using a logistic regression model in order to investigate the importance of possible confounders on the differences by country of origin in self reported health. Finally, variables measuring psychosocial and economic conditions were introduced into the model.
MAIN RESULTS—The odds ratios of having poor self reported health were significantly higher among men born in other Western countries, Yugoslavia, Arabic speaking countries and in the category all other countries, as well as among women born in Yugoslavia, Poland and all other countries, compared with men and women born in Sweden. The multivariate analysis including age and education did not change these results. A huge reduction of the odds ratios was observed for men and women born in Yugoslavia, Arabic speaking countries and all other countries, and for women born in Poland after the introduction of the social network, social support and economic factors into the multivariate model.
CONCLUSIONS—There were significant ethnic group differences in self reported health. These differences were greatly reduced by psychosocial and economic factors, which suggest that these factors may be important determinants of self rated health in certain minority groups.


     

The role of income differences in explaining social inequalities in self rated health in Sweden and Britain.

STUDY OBJECTIVE: To analyse to what extent differences in income, using two distinct measures-as distribution across quintiles and poverty-explain social inequalities in self rated health, for men and women, in Sweden and Britain. DESIGN: Series of cross sectional surveys, the Swedish Survey of Living Conditions (ULF) and the British General Household Survey (GHS), during the period 1992-95. PARTICIPANTS AND SETTING: Swedish and British men and women aged 25-64 years. Approximately 4000 Swedes and 12 500 Britons are interviewed each year in the cross sectional studies used. The sample contains 15 766 people in the Swedish dataset and 49 604 people in the British dataset. MAIN RESULTS: The magnitude of social inequalities in less than good self rated health was similar in Sweden and in Britain, but adjusting for income differences explained a greater part of these in Britain than in Sweden. In Britain the distribution across income quintiles explained 47% of the social inequalities in self rated health among women and 31% among men, while in Sweden it explained, for women 13% and for men 20%. Poverty explained 22% for British women and 8% for British men of the social inequalities in self rated health, while in Sweden poverty explained much less (men 2.5% and women 0%). CONCLUSIONS: The magnitude of social inequalities in self rated health was similar in Sweden and in Britain. However, the distribution of income across occupational social classes explains a larger part of these inequalities in Britain than in Sweden. One reason for this may be the differential exposure to low income and poverty in the two countries.