Are Americans Feeling Less Healthy? The Puzzle of Trends in Self-rated Health

摘要

Although self-rated health is proposed for use in public health monitoring, previous reports on US levels andntrends in self-rated health have shown ambiguous results. This study presents a comprehensive comparativenanalysis of responses to a common self-rated health question in 4 national surveys from 1971 to 2007: the NationalnHealth and Nutrition Examination Survey, Behavioral Risk Factor Surveillance System, National Health InterviewnSurvey, and Current Population Survey. In addition to variation in the levels of self-rated health across surveys,nstriking discrepancies in time trends were observed. Whereas data from the Behavioral Risk Factor SurveillancenSystem demonstrate that Americans were increasingly likely to report ‘‘fair’’ or ‘‘poor’’ health over the last decade,nthose from the Current Population Survey indicate the opposite trend. Subgroup analyses revealed that the great-nest inconsistencies were among young respondents, Hispanics, and those without a high school education. Trendsnin ‘‘fair’’ or ‘‘poor’’ ratings were more inconsistent than trends in ‘‘excellent’’ ratings. The observed discrepanciesnelude simple explanations but suggest that self-rated health may be unsuitable for monitoring changes in pop-nulation health over time. Analyses of socioeconomic disparities that use self-rated health may be particularlynvulnerable to comparability problems, as inconsistencies are most pronounced among the lowest education group.nMore work is urgently needed on robust and comparable approaches to tracking population health.