Aging in Sub-Saharan Africa Recommendations for Furthering Research (2006) / Chapter Skim
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10. Survey Measures of Health: How well do Self-Reported and Observed Indicators Measure Health and Predict Mortality?
10. Survey Measures of Health: How well do Self-Reported and Observed Indicators Measure Health and Predict Mortality?
Pages 314-342
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From page 314... ...
Yet data to compare health indicators are rare. Rarer still is follow-up information to assess how well these measures predict subsequent mortality -- the ultimate measure of poor health -- in developing countries.
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The study is based on health measures collected in the 1996 Matlab Health and Socioeconomic Survey (MHSS)
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From page 316... ...
SIMPLE-TO-OBSERVE HEALTH INDICATORS The indicators examined in this study are • self-reported health (SRH) , whereby respondents are asked to classify their current health status as good, fair, or poor; • an index based on self-reported activities of daily living; • an index of self-reported major acute and chronic morbidity conditions; • an index of physical disability based on observed activities of daily living; and • current nutritional status as measured by body mass index.
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From page 317... ...
. In several nations in which allocation of resources is perceived to be biased in favor of men, men are less likely to report poor SRH; however, women have lower adult mortality rates.
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This analysis seeks to investigate relationships among these measures of health further, with particular emphasis on age and gender differences and to examine how well they predict mortality. DATA AND METHODS Setting Matlab is a rural area about 55 km from the Dhaka, the capital of Bangladesh.
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From page 319... ...
. Panel surveys have the advantage of offering far more detailed data on longitudinal changes in health status, nutrition, and morbidity.
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From page 320... ...
Individuals were dropped if information was missing on self-reported activities of daily living, the major disease index, or observed activities of daily living, or if BMI was either missing or out of range. Most nonresponses stem from the fact that there were special teams for collection of observed health indicators and for anthropometric measurement.
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From page 321... ...
+ m = 1∑ β2+ j + mOBSim + ... + εik 1 − µik j =1 m=1 where µik is the risk that person i who survived to the start of follow-up year k dies in that year, Femalei is 1 if person i is female and 0 if male, Ageik is person i's age at the start of follow-up year k, SRij is the jth of J selfreported health indicators, and OBSim is the mth of M observed health indicators for person i.
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From page 322... ...
Table 10-2 also shows lower mortality rates for women than for men; however, as is shown later, with more precise controls for age, sex differences are not significant. Health Indicators The five health indicators are defined below.
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From page 323... ...
, to which we refer as major disease, was assessed with a checklist of 14 sentinel conditions (anemia, arthritis, broken bones, cataracts, vision problems, asthma, other breathing difficulty, diabetes, pain or burning on urination, paralysis, tuberculosis, gastric/ulcer problems, edema, and a residual category called other conditions)
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From page 324... ...
In this society, the slowest rise with age is in observed severe malnutrition. There are striking sex differences in poor health according to nearly 100 Poor SRH male Poor SRH female ADL limitation male ADL limitation female 80 Major disease male Major disease female 60 Percentage 40 20 0 15 25 35 45 55 65 75 Age Group FIGURE 10-1 Self-reported health indicators, by age and sex.
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From page 325... ...
Until about age 40, there was little difference in the proportion severely malnourished, but after that age, women disproportionately were underweight for their height. Extent to Which the Various Health Indicators Are Interrelated Bivariate and multiple correlations (when each indicator is estimated from the other four)
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From page 326... ...
SRH = self-reported health; SR-ADL = self-reported activities of daily living; SR-MD = self-reported major disease; OBS-ADL = observed activities of daily living; OBS-BMI = observed body mass index.
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From page 327... ...
SRH = self-reported health; ADL = activities of daily living; BMI = body mass index. Mortality in the Five Years Subsequent to the MHSS in Relation to the Health Indicators Health status, as measured by each of the five indicators treated dichotomously, is substantially related to subsequent mortality (Table 10-4)
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From page 328... ...
Observed ADL scores may capture extreme levels of poor health better: respondents who scored five or more experienced a subsequent mortality risk that approached 30 percent. Multivariate Models We turn to multivariate models of mortality to address several questions.
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From page 329... ...
For total person-years, SRH adds .01 to the pseudo-R2 and those with poor SRH have odds of dying 2.28 times the odds of those of the same age and sex who do not report poor SRH. In all three models, poor SRH is significantly associated with increased subsequent mortality.
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From page 330... ...
SRH = self-reported health; ADL = activities of daily living; BMI = body mass index. aThe odds ratio for female is from the model with age and sex; those for the health indicators are from models with age and sex plus that indicator as predictors.
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From page 331... ...
in which age and sex were entered first and then health indicators entered in the order of the magnitude of their additional predictive power. For total person-years and the over-50 subsample, observed ADLs entered first, followed by selfreported ADLs, BMI, and SRH.
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From page 332... ...
. SRH = self-reported health; ADL = activities of daily living; BMI = body mass index.
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From page 333... ...
With the exception of major disease, each appears to capture, at least in part, a different dimension of health from the others. These findings support the notion that individuals can effectively assess their own health status even in settings of poor education and low levels of interaction with modern health systems.
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From page 334... ...
In fact, it predicts mortality better than a number of more complex health indicators. 2The battery includes blood cholesterol (total cholesterol, high density lipoprotein, low density lipoprotein, triglycerides)
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From page 335... ...
Time Labor Capital Total All Under 50 Age 50+ Self-Reported SRH 0:20 0.01 0 0.01 1.2 2.8 1.2 ADLs 4:40 0.12 0 0.12 2.4 4.8 2.3 Major disease 6:00 0.16 0 0.16 0.6 2.8 0.6 Observed ADLs 10:00 0.50 0.05 0.55 1.4 0.1 2.0 Body mass index 5:00 0.30 0.10 0.40 1.0 1.7 1.0 Blood-drawn biomarkers 20:00 22.00 38.00 60.00 – – – NOTE: Taken from Table 10-5; change when each health measure is added to model with age and sex. SRH = self-reported health; ADL = activities of daily living; BMI = body mass index.
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From page 336... ...
In contrast, SRH and the self-reported ADL index increase with age and are significant mortality predictors, perhaps because younger adults recognize change in their own abilities or differences in comparison with peers even when their disabilities do not put them in a range considered unusual by the observer. We suspect that, unless the set of tasks is changed to detect more subtle disability, observed ADL measures for younger adults should be included in survey data collection only as a baseline for longitudinal follow-up rather than as valid health indicators.
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From page 337... ...
INDEPTH sites routinely collect the follow-up data needed to study relationships of health measures to subsequent mortality. In addition, if these measures were included periodically in subsequent DSS rounds, their sensitivity to trends and emerging differentials in health could be assessed.
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From page 338... ...
Increasingly, programs include direct adult health interventions, such as Agincourt's South African Stroke Prevention Initiative. Regular observation of simple health measures can provide a baseline for assessing differences between experimental and control groups, and follow-up information for assessing the long-term impact of interventions on comparable health status measures.
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From page 339... ...
. Health, fertility, and socioeconomic status as predictors of survival and later health of women: A 20-year prospective study in rural Bangladesh.
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From page 340... ...
. Relating self-reported and objective health indicators to adult mortality in Bangladesh.
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From page 341... ...
. Perceived health status and mortality among older men and women.
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