Differential health reporting by education level and its impact on the measurement of health inequalities among older Europeans
Open Access
- 2 August 2008
- journal article
- research article
- Published by Oxford University Press (OUP) in International Journal of Epidemiology
- Vol. 37 (6), 1375-1383
- https://doi.org/10.1093/ije/dyn146
Abstract
Background This study aims to establish whether health reporting differs by education level and, if so, to determine the extent to which this biases the measurement of health inequalities among older Europeans. Methods Data are from the Survey of Health, Ageing and Retirement in Europe (SHARE) covering eight countries. Differential reporting of health by education is identified from ratings of anchoring vignettes that describe fixed health states. Ratings of own health in six domains (mobility, pain, sleep, breathing, emotional health and cognition) are corrected for differences in reporting using an extended ordered probit model. For each country and health domain, we compare the corrected with the uncorrected age–sex standardized high-to-low education rate ratio for the absence of a health problem. Results Before correction for reporting differences across the 48 combinations of country by health domain, there was no inequality in health by education (P > 0.05) in 32 of 48 cases. However, there were reporting differences by education (P < 0.05) in 29 out of 48 cases. In general, higher educated older Europeans are more likely to rate a given health state negatively (except for Spain and Sweden). Correcting for these differences generally increases health inequalities (except for Spain and Sweden) and results in the emergence of inequalities in 18 cases (P < 0.05), which may be considered ‘statistically significant’. The greatest impact is in Belgium, Germany and The Netherlands, where inequalities (P < 0.05) appear only after adjustment in four of the six health domains. Conclusions These results emphasize the need to account for differences in the reporting of health. Measured health inequalities by education are often underestimated, and even go undetected, if no account is taken of these reporting differences.Keywords
This publication has 35 references indexed in Scilit:
- The association between self-rated health and mortality in different socioeconomic groups in the GAZEL cohort studyInternational Journal of Epidemiology, 2007
- Income-related reporting heterogeneity in self-assessed health: evidence from FranceHealth Economics, 2006
- A new comprehensive and international view on ageing: introducing the ‘Survey of Health, Ageing and Retirement in Europe’European Journal of Ageing, 2005
- Cut-point shift and index shift in self-reported healthJournal of Health Economics, 2004
- Explaining the differences in income‐related health inequalities across European countriesHealth Economics, 2004
- Explaining income‐related inequalities in doctor utilisation in EuropeHealth Economics, 2004
- What Do Self-Reported, Objective, Measures of Health Measure?The Journal of Human Resources, 2004
- Self rated health: Is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes?Journal of Epidemiology and Community Health, 2001
- Income-related inequalities in health: some international comparisonsJournal of Health Economics, 1997