Quality of Life Research

, Volume 22, Issue 10, pp 2761–2768 | Cite as

Self-rated health: analysis of distances and transitions between response options

  • Thomas V. Perneger
  • Angèle Gayet-Ageron
  • Delphine S. Courvoisier
  • Thomas Agoritsas
  • Stéphane Cullati



We explored health differences between population groups who describe their health as excellent, very good, good, fair, or poor.


We used data from a population-based survey which included self-rated health (SRH) and three global measures of health: the SF36 general health score (computed from the 4 items other than SRH), the EQ-5D health utility, and a visual analogue health thermometer. We compared health characteristics of respondents across the five health ratings.


Survey respondents (N = 1.844, 49.2 % response) rated their health as excellent (12.2 %), very good (39.1 %), good (41.9 %), fair (6.0 %), or poor (0.9 %). The means of global health assessments were not equidistant across these five groups, for example, means of the health thermometer were 95.8 (SRH excellent), 88.8 (SRH very good), 76.6 (SRH good), 49.7 (SRH fair), and 33.5 (SRH poor, p < 0.001). Recoding the SRH to reflect these mean values substantially improved the variance explained by the SRH, for example, the linear r 2 increased from 0.50 to 0.56 for the health thermometer if the SRH was coded as poor = 1, fair = 2, good = 3.7, very good = 4.5, and excellent = 5. Furthermore, transitions between response options were not explained by the same health-related characteristics of the respondents.


The adjectival SRH is not an evenly spaced interval scale. However, it can be turned into an interval variable if the ratings are recoded in proportion to the underlying construct of health. Possible improvements include the addition of a rating option between good and fair or the use of a numerical scale instead of the classic adjectival scale.


Self-rated health Health status measurement Population surveys Response scale 


  1. 1.
    Jylhä, M. (2009). What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science and Medicine, 69, 307–316.PubMedCrossRefGoogle Scholar
  2. 2.
    Fayers, P. M., & Sprangers, M. A. G. (2002). Understanding self-rated health. Lancet, 359, 187–188.PubMedCrossRefGoogle Scholar
  3. 3.
    DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2005). Mortality prediction with a single general sefl-rated health question. A meta-analysis. Journal of General Internal Medicine, 20, 267–275.CrossRefGoogle Scholar
  4. 4.
    Kaplan, G. A., & Camacho, T. (1983). Perceived health and mortality: A 9-year follow-up of the human population laboratory cohort. American Journal of Epidemiology, 117, 292–304.PubMedGoogle Scholar
  5. 5.
    Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21–37.PubMedCrossRefGoogle Scholar
  6. 6.
    Fried, L. P., Kronmal, R. A., Newman, A. B., Bild, D. E., Mittelmark, M. B., Polak, J. F., et al. (1998). Risk factors for 5-year mortality in older adults: The cardiovascular health study. JAMA, 279, 585–592.PubMedCrossRefGoogle Scholar
  7. 7.
    McGee, D. L., Liao, Y., Cao, G., & Cooper, R. S. (1999). Self-reported health status and mortality in a multiethnic US cohort. American Journal of Epidemiology, 149, 41–46.PubMedCrossRefGoogle Scholar
  8. 8.
    Idler, E. L., Kasl, S. V., & Lemke, J. H. (1990). Self-evaluated health and mortality among the elderly in New Haven, Connecticut, and Iowa and Washington Counties, Iowa, 1982–1986. American Journal of Epidemiology, 131, 91–103.PubMedGoogle Scholar
  9. 9.
    Idler, E. L., Russell, L. B., & Davis, D. (2000). Survival, functional limitations, and self-rated health in the NHANES I epidemiologic follow-up study, 1992. American Journal of Epidemiology, 152, 874–883.PubMedCrossRefGoogle Scholar
  10. 10.
    Singh-Manoux, A., Gueguen, A., Martikainen, P., Ferrie, J., Marmot, M., & Shipley, M. (2007). Self-rated health and mortality: Short- and long-term associations in the Whitehall II study. Psychosomatic Medicine, 69, 138–143.PubMedCrossRefGoogle Scholar
  11. 11.
    Lima-Costa, F. M., Cesar, C. C., Chor, D., & Proietti, F. A. (2012). Self-rated health compared with objectively measured health status as a tool for mortality risk screening in older adults: Ten-year follow-up of the Bambui cohort study on aging. American Journal of Epidemiology, 175, 228–235.PubMedCrossRefGoogle Scholar
  12. 12.
    DeSalvo, K. B., Fan, V. S., McDonnell, M. B., et al. (2005). Predicting mortality and healthcare utilization with a single question. Health Services Research, 40, 1233–1246.CrossRefGoogle Scholar
  13. 13.
    DeSalvo, K. B., Jones, T. M., Peabody, J., et al. (2009). Health care expenditure prediction with a single item, self-rated health measure. Medical Care, 47, 440–447.PubMedCrossRefGoogle Scholar
  14. 14.
    Bailis, D. S., Segall, A., & Chipperfield, J. G. (2003). Two views of self-rated general health status. Social Science and Medicine, 56, 203–217.PubMedCrossRefGoogle Scholar
  15. 15.
    Knäuper, B., & Turner, P. A. (2003). Measuring health: Improving the validity of health-assessments. Quality of Life Research, 12(Suppl 1), 81–89.PubMedCrossRefGoogle Scholar
  16. 16.
    Mäntyselkä, P. T., Turunen, J. H. O., Ahonen, R. S., & Kumpusalo, E. A. (2003). Chronic pain and poor self-rated health. JAMA, 290, 2435–2442.PubMedCrossRefGoogle Scholar
  17. 17.
    Stevens, S. S. (1946). On the theory of scales of measurement. Science, 103, 677–680.CrossRefGoogle Scholar
  18. 18.
    Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill, Inc.Google Scholar
  19. 19.
    Perneger, T. V., Combescure, C., & Courvoisier, D. S. (2010). General population reference values for the French version of the EuroQol EQ-5D health utility instrument. Value Health, 13, 631–635.PubMedCrossRefGoogle Scholar
  20. 20.
    Perneger, T. V., & Courvoisier, D. S. (2011). Exploration of dimensions of health be included in multi-attribute health utility assessment. International Journal for Quality in Health Care, 23, 52–59.PubMedCrossRefGoogle Scholar
  21. 21.
    Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. conceptual framework and item selection. Medical Care, 30, 473–483.PubMedCrossRefGoogle Scholar
  22. 22.
    Leplège, A., Ecosse, E., Verdier, A., & Perneger, T. V. (1998). The French SF-36 Health Survey: Translation, cultural adaptation, and preliminary psychometric evaluation. Journal of Clinical Epidemiology, 51, 1013–1023.PubMedCrossRefGoogle Scholar
  23. 23.
    Rabin, R., & De Charro, F. (2001). EQ-5D: A measure of health status from the EuroQoL Group. Annals of Medicine, 33, 337–343.PubMedCrossRefGoogle Scholar
  24. 24.
    Greiner, W., Weijnen, T., Nieuwenhuizen, M., Oppe, S., Badia, X., Busschbach, J., et al. (2003). A single European currency for EQ-5D health states. Results from a six country study. The European Journal of Health Economics, 4, 222–231.PubMedCrossRefGoogle Scholar
  25. 25.
    Austin, P. C., & Steyerberg, E. W. (2012). Interpreting the concordance statistic of a logistic regression model: Relation to the variance and odds ratio of a continuous explanatory variable. BMC Medical Research Methodology, 12, 82.PubMedCrossRefGoogle Scholar
  26. 26.
    Jurges, H. (2007). True health versus response styles: Exploring cross-country differences in self-reported health. Health Economics, 16, 163–178.PubMedCrossRefGoogle Scholar
  27. 27.
    Martikainen, P., Aromaa, A., Heliövaara, M., Klaukka, T., Knekt, P., Maatela, J., et al. (1999). Reliability of perceived health by sex and age. Social Science and Medicine, 48, 1117–1122.PubMedCrossRefGoogle Scholar
  28. 28.
    Zajacova, A., & Dowd, J. B. (2011). Reliability of self-rated health in US adults. American Journal of Epidemiology, 174, 977–983.PubMedCrossRefGoogle Scholar
  29. 29.
    König, H. H., Bernert, S., Angermeyer, M. C., Matschinger, H., Martinez, M., Vilagut, G., et al. (2009). Comparison of population health status in six European countries. Results of a representative survey using the EQ-5D questionnaire. Medical Care, 47, 255–261.PubMedCrossRefGoogle Scholar
  30. 30.
    Salomon, J. A., Tandon, A., & Murray, C. J. L. (2004). World health survey pilot study collaborating group. Comparability of self-rated health: Cross sectional multi-country survey using anchoring vignettes. BMJ, 328, 258.PubMedCrossRefGoogle Scholar
  31. 31.
    Barclay-Goddard, R., Epstein, J. D., & Mayo, N. E. (2009). Response shift: A brief overview and proposed research priorities. Quality of Life Research, 18, 335–348.PubMedCrossRefGoogle Scholar
  32. 32.
    Raczek, A. E., Ware, J. E., Bjorner, J. B., Gandek, B., Haley, S. M., Aaronson, N. K., et al. (1998). Comparison of Rasch and summated rating scales constructed from SF-36 Physical Functioning items in seven countries: Results from the IQOLA project. Journal of Clinical Epidemiology, 51, 1203–1214.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Thomas V. Perneger
    • 1
  • Angèle Gayet-Ageron
    • 1
  • Delphine S. Courvoisier
    • 1
  • Thomas Agoritsas
    • 1
  • Stéphane Cullati
    • 1
  1. 1.Division of clinical epidemiologyUniversity Hospitals of Geneva and University of GenevaGenevaSwitzerland

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