Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK.
BMC Public Health. 2022 Oct 5;22(1):1863. doi: 10.1186/s12889-022-14218-1.
Despite the widespread use of the single item self-rated health (SRH) question, its reliability has never been evaluated in Chinese population.
We used data from the China Health and Retirement Longitudinal Study, waves 1-4 (2011-2019). In wave 1, the same SRH question was asked twice, separated by other questions, on a subset of 4533 subjects, allowing us to examine the test-retest reliability of SRH. In addition, two versions of SRH questions (the WHO and US versions) were asked (n = 11,429). Kappa (κ), weighted kappa ([Formula: see text]), and polychoric correlation coefficient (ρ) were used for reliability assessment. Cox proportional-hazards models were estimated to assess the predictive validity of SRH measurement for mortality over 7 years of follow up. To do so, relative index of inequality (RII) and slope index of inequality (SII) were estimated for each SRH scale.
There was moderate to substantial test-retest reliability (κ = 0.54, [Formula: see text]=0.63) of SRH; 31% of respondents who used the same scale twice changed their ratings after answering other questions. There was strong positive association between the two SRH measured by the two scales (ρ > 0.8). Compared with excellent/very good SRH, adjusted hazard ratios (HR) of death are 2.30 (95% CI, 1.70-3.13) for the US version and 1.86 (95% CI, 1.33-2.60) for the WHO version. Using slope indices of inequality, the WHO version estimated slightly larger mortality differences (RII = 3.50, SII = 15.53) than the US version (RII = 3.25, SII = 14.80).
In Chinese middle-aged and older population, the reliability of SRH is generally good, although the two commonly used versions of SRH scales could not be compared directly. Both indices predict mortality, with similar predictive validity.
尽管单项自评健康（SRH）问题被广泛使用，但它在中文人群中的可靠性从未得到过评估。
我们使用了中国健康与退休纵向研究 1-4 波（2011-2019 年）的数据。在第 1 波中，针对 4533 名受试者的一个子样本，两次在其他问题之间询问相同的 SRH 问题，允许我们检验 SRH 的重测信度。此外，还询问了两种 SRH 问题版本（世卫组织和美国版本）（n=11429）。kappa（κ）、加权 kappa（[Formula: see text]）和多元相关系数（ρ）用于可靠性评估。使用 Cox 比例风险模型评估 7 年随访期间 SRH 对死亡率的预测有效性。为此，对每个 SRH 量表估计了相对不平等指数（RII）和不平等斜率指数（SII）。
SRH 的重测信度为中度至高度（κ=0.54，[Formula: see text]=0.63）；31%的受访者在回答其他问题后，使用相同量表两次的评分发生了变化。两种量表测量的两个 SRH 之间存在强烈的正相关（ρ>0.8）。与优秀/非常好的 SRH 相比，美国版本的死亡调整风险比（HR）为 2.30（95%CI，1.70-3.13），世卫组织版本为 1.86（95%CI，1.33-2.60）。使用不平等斜率指数，世卫组织版本估计的死亡率差异略大（RII=3.50，SII=15.53），而美国版本为（RII=3.25，SII=14.80）。
在中国中年及以上人群中，SRH 的可靠性总体良好，尽管两种常用的 SRH 量表版本无法直接比较。这两个指标都预测死亡率，具有相似的预测有效性。
