Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7, Canada.
Soc Sci Med. 2012 Jul;75(1):1-9. doi: 10.1016/j.socscimed.2011.10.030. Epub 2011 Dec 3.
Self-rated health is a widely used measure of health typically obtained from a question, "How do you rate your health?" Despite the measure's popularity, debates continue as to what exactly self-rated health captures. This study augments the rich literature on the construct of self-rated health using a unique measurement approach. We conceptualize self-rated health as consisting of two components: latent health and reporting behaviour. We operationalize a preference-standardized health-related quality of life as a measure of latent health, and its systematic deviation from self-rated health as a measure of reporting behaviour. Using the 2005 Canadian Community Health Survey, we assess comparatively how the deviations between self-rated health and latent health, measured by the Health Utilities Index Mark 3, vary systematically by demographic, socioeconomic, and cultural factors. We present reporting behaviour by these factors in terms of pessimism and optimism relative to the assessment of the average Canadian. Our analysis shows reporting behaviour statistically and clinically significantly varies by age and socioeconomic status: those aged 80+ years and those with less income and education exhibit optimism about their health. In addition, our analysis indicates a tendency for persons with healthier lifestyles to be slightly pessimistic about their health. Our results imply that it may be misleading to take self-rated health at face value as a measure of health status for applications where preferences should be standardized. For this popular measure to continue to play an important role in population health research and policy development, its users must acknowledge and understand the determinants of self-rated health, including reporting behaviour.
自评健康是一种广泛使用的健康衡量标准，通常通过一个问题来获取，“你如何评价自己的健康？”尽管该衡量标准广受欢迎，但关于自评健康具体捕捉到什么，仍存在争议。本研究使用独特的测量方法，为自评健康的结构增添了丰富的文献。我们将自评健康概念化为由两个组成部分：潜在健康和报告行为。我们将偏好标准化的健康相关生活质量作为潜在健康的衡量标准，并将其与自评健康的系统偏差作为报告行为的衡量标准。我们使用 2005 年加拿大社区健康调查，评估自评健康和潜在健康之间的偏差（由健康效用指数 Mark 3 衡量）如何系统地受人口统计学、社会经济和文化因素的影响。我们根据平均加拿大评估的悲观和乐观程度，以这些因素表示报告行为。我们的分析表明，报告行为在统计学和临床方面因年龄和社会经济地位而显著不同：80 岁以上的人群和收入和教育程度较低的人群对自己的健康状况表现出乐观态度。此外，我们的分析表明，生活方式更健康的人对自己的健康状况略有悲观。我们的结果表明，对于需要标准化偏好的应用程序，将自评健康作为健康状况的衡量标准可能会产生误导。为了让这个流行的衡量标准继续在人口健康研究和政策制定中发挥重要作用，其用户必须承认并理解自评健康的决定因素，包括报告行为。
