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Surveys may muddle research in monitoring health status trendsNew IHME study reveals conflicts between self-reported health surveys over nearly four decades August 1, 2009–Researchers hoping to find out whether U.S. citizens are becoming healthier or getting sicker over time should take care when relying on self-reported surveys, according to new research from the Institute for Health Metrics and Evaluation at the University of Washington. IHME scientists, working with researchers at the Harvard University Initiative for Global Health, evaluated four national surveys from 1971 to 2007, which covered more than 900,000 people aged 18 and higher. They found that while one set of surveys showed that Americans were increasingly likely to report “fair” or “poor” health over the last decade, another set of surveys showed the opposite trend. “If you want a report card on how healthy Americans are feeling from year to year, this research shows that the standard question we’ve been asking for decades can really muddle the picture,” said Joshua A. Salomon, an associate professor of international health at the Harvard School of Public Health and the lead author on the study. The study, "Are Americans Feeling Less Healthy? The Puzzle of Trends in Self-rated Health", appears in the Aug. 1, 2009 issue of the American Journal of Epidemiology. It shows that the certain demographic groups had greater inconsistencies in their responses than others, particularly young adults, Latinos and those who did not finish high school. The research comes at an important time. Policymakers at the federal and state levels are looking for new ways to deliver high-quality health care to a people who are uninsured or under-insured. At the international level, the World Health Organization (WHO), the G8 and other groups are discussing how funds for health aid to developing countries should be spent to have the maximum impact. Currently, the U.S. Centers for Disease Control and Prevention, WHO and the European Commission all recommend using a simple question that asks people to rate their own current health as “excellent, very good, good, fair or poor” as a reliable way to track progress over time in population health. A recent report by the Institute of Medicine proposed including this indicator as one of a small number of items to be used for ongoing monitoring of health improvements in the U.S. The IHME and Harvard team found that while responses to this question are good predictors of health care utilization and even mortality at the individual level, they are too inconsistent to be used to measure trends in overall population health. “We don’t know exactly why the survey results vary so much, but the fact that they do vary tells us that they are not a solid foundation for making policy decisions,” said Stella Nordhagen, a former IHME post-graduate fellow and one of the study’s authors. The researchers suggest that the widespread use of this single, global self-report on health in research studies and policy analyses needs to be reconsidered. They also suggest that more time be spent evaluating the strength of surveys that use detailed questions and more symptom-specific questions. Read the article: Salomon JA, Nordhagen S, Oza S, Murray CJL. Are Americans Feeling Less Healthy? The Puzzle of Trends in Self-rated Health. American Journal of Epidemiology 2009; doi: 10.1093/aje/kwp144. |
