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PubMed2003

Decomposing world health inequality.

This study explores global inequality in health status and decomposes it into within- and between-country inequality. We rely on standardized height as our health indicator since it avoids the measurement pitfalls of more traditional measures of health such as morbidity, mortality, and life expectancy. It also avoids measurement problems associated with using monetary variables such as income or expenditure across time or place to compare welfare. Our calculation of world height inequality indicates that, in contrast with similar research on income inequality, within-country variation is the source of most inequality, rather than the differences between countries.

Body Height↗
PubMed1988

Using administrative data to predict important health outcomes. Entry to hospital, nursing home, and death.

This paper assesses our ability to use administrative data for developing indicators of health status. Traditionally, measures of health status have been derived from interviews. Here indicators from administrative data and from interviews are compared, i.e., their ability to predict important health outcomes for a large representative sample of elderly residents of Manitoba, Canada. Indicators of health status derived from an administrative data system and from health interviews are shown to provide roughly similar predictions of nursing-home entry. Administrative data provide significantly better predictions of death and future hospital entry than do variables from interview data.

Aged↗
PubMed2002

Analysing changes of health inequalities in the Nordic welfare states.

This study examined changes over time in relative health inequalities among men and women in four Nordic countries, Denmark, Finland, Norway and Sweden. A serious economic recession burst out in the early 1990s particularly in Finland and Sweden. We ask whether this adverse social structural'development influenced health inequalities by employment status and educational attainment, i.e. whether the trends in health inequalities were similar or dissimilar between the Nordic countries. The data derived from comparable interview surveys carried out in 1986/87 and 1994/95 in the four countries. Limiting long-standing illness and perceived health were analysed by age, gender, employment status and educational attainment. First, age-adjusted overall prevalence percentages were calculated. Second, changes in the magnitude of relative health inequalities were studied using logistic regression analysis. Within each country the prevalence of ill-health remained at a similar level, with Finns having the poorest health. Analysing all countries together health inequalities by employment status and education showed no major changes. There were slightly different tendencies among men and women in inequalities by both health indicators, although these did not reach statistical significance. Among men there was a suggestion of narrowing health inequalities, whereas among women such a suggestion could not be discerned. Looking at particular countries some small changes in men's as well as women's health inequalities could be found. Over a period of deep economic recession and a large increase in unemployment, particularly in Finland and Sweden, health inequalities by employment status and education remained broadly unchanged in all Nordic countries. Thus, during this fairly short period health inequalities in these countries were not strongly influenced by changes in other structural inequalities, in particular labour market inequalities. Institutional arrangements in the Nordic welfare states, including social benefits and services, were cut during the recession but nevertheless broadly remained, and are likely to have buffered against the structural pressures towards widening health inequalities.

Adolescent↗
PubMed2005

Self-reported health status of the general adult U.S. population as assessed by the EQ-5D and Health Utilities Index.

OBJECTIVE: This study aimed to describe the self-reported health status of the general adult U.S. population using 3 multi-attribute preference-based measures: the EQ-5D, Health Utilities Index Mark 2 (HUI2), and Mark 3 (HUI3). METHODS: We surveyed the general adult U.S. population using a probability sample with oversampling of Hispanics and non-Hispanic blacks. Respondents to this home-visit survey self-completed the EQ-5D and HUI2/3 questionnaires. Overall health index scores of the target population and selected subgroups were estimated and construct validity of these measures was assessed by testing a priori hypotheses. RESULTS: Completed questionnaires were collected from 4048 respondents (response rate: 59.4%). The majority of the respondents were women (52.0%); the mean age of the sample was 45 years, with 14.8% being 65 or older. Index scores (standard errors) for the general adult U.S. population as assessed by the EQ-5D, HUI2, and HUI3 were 0.87 (0.01), 0.86 (0.01), and 0.81 (0.01), respectively. Generally, younger, male and Hispanic or non-Hispanic black adults had higher (better) index scores than older, female and other racial/ethnic adults; index scores were higher with higher educational attainment and household income. The 3 overall preference indices were strongly correlated (Pearson's r: 0.67-0.87), but systematically different, with intraclass correlation coefficients between these indices ranging from 0.59 to 0.77. CONCLUSIONS: This study provides U.S. population norms for self-reported health status on the EQ-5D, HUI2, and HUI3. Although these measures appeared to be valid and demonstrated similarities, health status assessed by these measures is not exactly the same.

Adolescent↗
PubMedDate not supplied

The health of Hispanics in the southwestern United States: an epidemiologic paradox.

Recent reports in the literature on the health status of southwestern Hispanics, most of whom are Mexican Americans, are reviewed critically. The review is organized into the following sections: infant mortality, mortality at other ages, cardiovascular diseases, cancer, diabetes, other diseases, interview data on physical health, and mental health. Despite methodological limitations of much of the research, it can be concluded with some certainty that the health status of Hispanics in the Southwest is much more similar to the health status of other whites than that of blacks although socioeconomically, the status of Hispanics is closer to that of blacks. This observation is supported by evidence on such key health indicators as infant mortality, life-expectancy, mortality from cardiovascular diseases, mortality from major types of cancer, and measures of functional health. On other health indicators, such as diabetes and infectious and parasitic diseases, Hispanics appear to be clearly disadvantaged relative to other whites. Factors explaining the relative advantages or disadvantages of Hispanics include cultural practices, family supports, selective migration, diet, and genetic heritage. The recently completed Hispanic Health and Nutrition Examination Survey will go a long way to provide answers to many questions regarding the health of Hispanics in the Southwest or elsewhere.

Adult↗
PubMed2004

CSF circulation disorders: measuring progress in patients through quality of life and hope.

BACKGROUND: Cerebrospinal fluid circulation disorders are complex and multifaceted conditions making reliable assessment of progress problematic. AIMS AND OBJECTIVES: It is the aim of this paper to explore how efficient measures of quality of life and hope might be used to assess clinical progress for patients with disorders of cerebrospinal fluid circulation. It will be argued that a single-item 10-point quality of life scale and the Herth Hope Index are as effective at measuring progress as the more widely used, but considerably more complex, Short-Form 36. DESIGN: Patients attending a cerebrospinal fluid clinic were sent a questionnaire containing the three measures of progress. Questionnaires were returned in a stamp-addressed envelope to allow initial analysis before the clinic appointment and to enable discussion of results during the clinic appointment. Patients were also assessed using the Mini-Mental State Examination during the clinic appointment. METHODS: The relationship between the three measures of progress was calculated using Spearman's rank order correlation. Correlations of 0.40-0.70 are considered modest and correlations of 0.70 are considered strong; 5% levels of significance are considered significant and 1% levels are highly significant. Internal consistency of the Short-Form 36 was assessed using Cronbach's alpha coefficient. Reliability was considered acceptable for dimension comparisons when alpha > 0.70. RESULTS: All patients were diagnosed with benign intracranial hypertension (n = 74), congenital hydrocephalus (n = 35) or normal pressure hydrocephalus (n = 171). There was a modest to strong correlation between the quality of life-10 and all eight dimensions of the Short-Form 36 for benign intracranial hypertension and congenital hydrocephalus patients. A slightly weaker correlation was demonstrated in seven of the eight Short-Form 36 dimensions for normal pressure hydrocephalus patients. Normal pressure hydrocephalus patients scored significantly lower on the Mini-Mental State Examination, which may contribute to explaining the weaker correlation between the three measures and the weaker internal consistency between the dimensions with the Short-Form 36. Conclusions. This paper demonstrates that efficient indicators of progress (quality of life-10 and Herth Hope Index) can be as effective at assessing clinical progress as more complex indicators (Short-Form 36) in patients who do not demonstrate cognitive deficit. RELEVANCE TO CLINICAL PRACTICE: For clinical application, the Short-Form 36 is too long, difficult to complete, score and analyse for these patient groups. Quality of life-10 and Herth Hope Index could provide efficient and effective measures of clinical progress but this requires further psychometric examination.

Activities of Daily Living↗
PubMed1988

Health surveys in developing countries: the objectives and design of an international programme.

There have been calls recently for a major international effort to collect epidemiological information in developing countries. One approach to a World Health Survey is considered, namely single-round retrospective interview surveys. Surveys can contribute to the improvement of national health information systems by providing person-based, rather than episode-based, measures related to health that apply to the entire population. A programme of health interview surveys could be used to ascertain patterns of morbidity and mortality, to measure access to and use of health services and to develop and disseminate methodologies for collecting and analysing health related data. Single-round surveys could not be used to evaluate the impact of investments on health and would be of limited use for improving our understanding of the determinants of ill health. Attention is drawn to a number of conceptual, technical and logistic issues to be considered in the design of a World Health Survey.

Attitude to Health↗
PubMed2005

Quality-of-life assessment in community-dwelling, middle-aged, healthy women in Japan.

OBJECTIVES: To determine the quality of life (QOL) of middle-aged Japanese healthy women during the menopausal transition, to identify the correlation between decreasing quality of life and the severity of menopausal symptoms in those women, and to evaluate the number of women who sought treatment/health-care support and their expectations for health-care services. METHODS: This was a community-based study, performed in collaboration with the Munakata Women's Midlife Health Project. The participants attended an annual medical check-up and cancer screenings, and led an everyday life without receiving medical treatment. Their quality of life was assessed with the World Health Organization QOL assessment (WHOQOL) and the severity of menopausal symptoms was assessed with the Kupperman index. Their expectations for health-care services were determined with an open-ended questionnaire. RESULTS: The mean scores of the Kupperman index in the peri- and postmenopausal states were significantly higher than that in the premenopausal states, whereas there was no significant difference of quality of life scored by the WHOQOL in the three groups. In spite of recruiting healthy middle-aged women, 24.4% of the perimenopausal and 26.6% of the postmenopausal women suffered from moderate or severe menopausal symptoms. The decreasing level of quality of life was correlated with the severity of the menopausal symptoms in the peri- and postmenopausal women. The participants did not receive medical support except in two cases, but 83.0% of them wished to participate in a seminar concerning menopause. Several of them sought treatment, health-care support and advice on how to maintain their health during and after the menopausal transition. CONCLUSIONS: Nearly one-quarter of Japanese community-dwelling, healthy women in the peri- and postmenopausal states suffered from menopausal symptoms, which decreased their quality of life in everyday life.

Body Mass Index↗
PubMed1982

Effects of physical and mental health on health-state preferences.

Studies concerned with measuring values and preferences for health states and health status components have typically employed "direct" scaling techniques that require conclusions to be based on definition. Problems and limitations of direct scaling are discussed. The algebraic modeling approach is new to health services research; it emphasizes testing models of how respondents combine stimulus information. The model specifies the causal relationship between the stimulus information and the responses. Subjective stimulus and response scales are derived from the model when the data satisfy the model's predictions. Thus, the validity of the subjective scale values rests on the validity of the model. In the present research, university students judged preferences between health states, each described by a physical (degree of physical activity) and mental (level of happiness/depression) component. The object of the research was to determine the subjective trade-offs between physical and mental health values in these preference judgments. For all respondents, preference judgments were consistent with the predictions of a preference model that yielded interval scales of the health states. Also, there were systematic interactions between physical and mental values, so that when a health state was bad on one component (e.g., poor physical health), the other component had less of an effect. However, results revealed individual differences in emphasis placed on the physical and mental health components. Advantages of replacing presently used measurement techniques with the algebraic modeling approach in general population studies are discussed.

Adolescent↗
PubMed1999

Inequalities in health: evidence from Denmark of the interaction of circumstances and health-related behaviour.

It is well known that the experience of poor health depends on adverse social and material circumstances and on unhealthy behaviour. In 1990 a British study asserted that privileged people gain more health benefit from a healthy lifestyle than do deprived people. In the present study this assertion was taken as a hypothesis, assuming statistical interaction between circumstances and health behaviour. The combined effect of these variables was studied in Denmark. Data was obtained from a 1987 national Health and Morbidity Survey; variables were selected to correspond closely with those in the earlier British study. The analysis included a multivariate analysis of variance. The results show that health-related behaviour has a positive effect on health both for those who are deprived and those who are not deprived, which is at variance with the findings of the British study. It confirms earlier analyses of Danish and Dutch data.

Activities of Daily Living↗