Are Americans feeling less healthy? The puzzle of trends in self-rated health

Abstract

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

Figure 1.

Age-adjusted trends in self-rated health in males (A) and females (B) in 4 nationally representative surveys, United States, 1971–2007. Open circle, Behavioral Risk Factor Surveillance System; filled diamond, Current Population Survey; filled square, National Health and Nutrition Examination Survey; open triangle, National Health Interview Survey.

Figure 2.

Age-adjusted trends in self-reported diabetes (A) and body mass index (BMI) (B) based on self-reported weight and height among females in 3 nationally representative surveys, United States, 1971–2007. Open circle, Behavioral Risk Factor Surveillance System; filled square, National Health and Nutrition Examination Survey; open triangle, National Health Interview Survey.

Figure 3.

Trends in self-rated health across age, race/ethnicity, and education subgroups, United States, 1971–2007. Open circle, Behavioral Risk Factor Surveillance System; filled diamond, Current Population Survey; filled square, National Health and Nutrition Examination Survey; open triangle, National Health Interview Survey.

Figure 4.

Age-adjusted trends in self-rated health, by category of response, United States, 1998–2007. Open circle, Behavioral Risk Factor Surveillance System; filled diamond, Current Population Survey; filled square, National Health and Nutrition Examination Survey; open triangle, National Health Interview Survey.

Figure 5.

Average annual change in the odds of reporting “excellent” or “fair/poor” self-rated health, by sex, age, race/ethnicity, and education, United States, 1998–2007. Each bar shows the result of a separate logistic regression of self-rated health as a function of calendar year, estimated for a particular survey and population subgroup. Blue, Behavioral Risk Factor Surveillance System; green, National Health Interview Survey; orange, Current Population Survey.