, Volume 48, Issue 2, pp 699–724 | Cite as

Health Measurement in Population Surveys: Combining Information from Self-reported and Observer-Measured Health Indicators

  • George B. Ploubidis
  • Emily Grundy


Our primary aim is to develop and validate a population health metric for survey-based health assessment that combines information from both self-reported and observer-measured health indicators. A secondary objective is to use this index to examine gender and socioeconomic differentials in the health status of older people. We use data from the second wave of the English Longitudinal Study of Ageing (ELSA) conducted in 2004 (N = 8,870). Information from three observer-measured and three self-reported health indicators was combined, using a latent variable modeling approach. A model that decomposed the manifest health indicators to valid health, systematic error, and random error was found to fit the data best. The latent health dimension represented somatic health, and was tested against three external criteria: height, waist-hip ratio, and smoking status. We present the Latent Index of Somatic Health (LISH), as well as a procedure for deriving the LISH in surveys employing both self- and observer-measured health indicators. Observer-measured and self-reported indicators were found to be equally biased in indexing population somatic health, with the exception of self-reports of functional limitations, which was the most reliable somatic health indicator. As expected, results showed that women had worse health than men and that socioeconomic advantage is associated with better somatic health.


Health measurement Self-rated health Biomarkers Measurement error Socioeconomic position 


  1. Asao, K., Kao, W. H. L., Baptiste-Roberts, K., Bandeen-Roche, K., Erlinger, T. P., & Brancati, F. L. (2006). Short stature and the risk of adiposity, insulin resistance, and type 2 diabetes in middle age—TheThird National Health and Nutrition Examination Survey (NHANES III), 1988–1994. Diabetes Care, 29, 1632–1637.CrossRefGoogle Scholar
  2. Banks, J., Marmot, M., Oldfield, Z., & Smith, J. P. (2006). Disease and disadvantage in the United States and in England. Journal of the American Medical Association, 295, 2037–2045.CrossRefGoogle Scholar
  3. Barker, D. J. P., Osmond, C., & Golding, J. (1990). Height and mortality in the counties of England and Wales. Annals of Human Biology, 17, 1–6.CrossRefGoogle Scholar
  4. Barsky, A. J. (1988). The paradox of health. The New England Journal of Medicine, 318, 414–418.CrossRefGoogle Scholar
  5. Bennett, K. M. (2006). Does marital status and marital status change predict physical health in older adults? Psychological Medicine, 36, 1313–1320.CrossRefGoogle Scholar
  6. Benyamini, Y., Blumstein, T., Lusky, A., & Modan, B. (2003a). Gender differences in the self-rated health-mortality association: Is it poor self-rated health that predicts mortality or excellent self-rated health that predicts survival? The Gerontologist, 43, 396–305.Google Scholar
  7. Benyamini, Y., Leventhal, E. A., & Leventhal, H. (2003b). Elderly people’s ratings of the importance of health-related factors to their self-assessments of health. Social Science & Medicine, 56, 1661–1667.CrossRefGoogle Scholar
  8. Beresnevaite, M., Taylor, G. J., & Bagby, R. M. (2007). Assessing alexithymia and type A behavior in coronary heart disease patients: A multimethod approach. Psychotherapy and Psychosomatics, 76, 186–192.CrossRefGoogle Scholar
  9. Blaxter, M. (1990). Health and lifestyles. London: Routledge.CrossRefGoogle Scholar
  10. Bohannon, R. W. (2001). Dynamometer measurements of hand-grip strength predict multiple outcomes. Perceptual and Motor Skills, 93, 323–328.Google Scholar
  11. Boniface, D. R., & Tefft, M. E. (1997). The application of structural equation modelling to the construction of an index for the measurement of health-related behaviours. Statistician, 46, 505–514.Google Scholar
  12. Bowling, A. (1995). Measuring disease: A handbook for the assessment of quality of life. Milton Keynes, UK: Open University Press.Google Scholar
  13. Burstrom, B., & Fredlund, P. (2001). 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, 55, 836–840.CrossRefGoogle Scholar
  14. Calnan, M., & Johnson, B. (1985). Health, health risks and inequalities: An exploratory study of women’s perceptions. Sociology of Health & Illness, 7, 55–75.CrossRefGoogle Scholar
  15. Carroll, R. J., Ruppert, D., Stefanski, L. A., & Crainiceanu, C. M. (2006). Measurement error in nonlinear models: A modern perspective. Boca Raton, FL: Chapman & Hall.CrossRefGoogle Scholar
  16. DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2006). Mortality prediction with a single general self-rated health question. Journal of General Internal Medicine, 21, 267–275.CrossRefGoogle Scholar
  17. Desesquelles, A. F., Egidi, V., & Salvatore, M. A. (2009). Why do Italian people rate their health worse than French people do? An exploration of cross-country differentials of self-rated health. Social Science & Medicine, 68, 1124–1128.CrossRefGoogle Scholar
  18. Doll, R., Gray, R., Hafner, B., & Peto, R. (1980). Mortality in relation to smoking: 22 years’ observations on female British doctors. British Medical Journal, 280, 967–971.CrossRefGoogle Scholar
  19. Doll, R., Peto, R., Boreham, J., & Sutherland, I. (2004). Mortality in relation to smoking: 50 years’ observations on male British doctors. British Medical Journal, 328, 1519–1528.CrossRefGoogle Scholar
  20. Dowd, J. B., & Zajacova, A. (2007). Does the predictive power of self-rated health for subsequent mortality risk vary by socioeconomic status in the US? International Journal of Epidemiology, 36, 1214–1221.CrossRefGoogle Scholar
  21. Dunnell, K., Fitzpatrick, J., & Bunting, J. (1999). Making use of official statistics in research on gender and health status: Recent British data. Social Science & Medicine, 48, 117–127.CrossRefGoogle Scholar
  22. Elam, J. T., Graney, M. J., Beaver, T., Elderwi, D., Applegate, W. B., & Miller, S. T. (1991). Comparison of subjective ratings of function with observed functional ability of frail older persons. American Journal of Public Health, 81, 1127–1130.CrossRefGoogle Scholar
  23. Fayers, P. M., & Sprangers, M. A. G. (2002). Understanding self-rated health. Lancet, 359, 187–188.CrossRefGoogle Scholar
  24. Ferrer, M., Lamarca, R., Orfila, F., & Alonso, J. (1999). Comparison of performance-based and self-rated functional capacity in Spanish elderly. American Journal of Epidemiology, 149, 228–235.Google Scholar
  25. Grant, M. D., Piotrowski, Z. H., & Chappell, R. (1995). Self-reported health and survival in the Longitudinal study of Aging, 1984–1986. Journal of Clinical Epidemiology, 48, 375–387.CrossRefGoogle Scholar
  26. Groot, W. (2000). Adaptation and scale of reference bias in self-assessments of quality of life. Journal of Health Economics, 19, 403–420.CrossRefGoogle Scholar
  27. Grundy, E., & Sloggett, A. (2003). Health inequalities in the older population: The role of personal capital, social resources and socio-economic circumstances. Social Science & Medicine, 56, 935–947.CrossRefGoogle Scholar
  28. Hebert, J. R., Peterson, K. E., Hurley, T. G., Stoddard, A. M., Cohen, N., Field, A. E., & Sorensen, G. (2001). The effect of social desirability trait on self-reported dietary measures among multi-ethnic female health center employees. Annals of Epidemiology, 11, 417–427.CrossRefGoogle Scholar
  29. Huisman, M., Kunst, A. E., & Mackenbach, J. P. (2003). Socioeconomic inequalities in morbidity among the elderly; a European overview. Social Science & Medicine, 57, 861–873.CrossRefGoogle Scholar
  30. Huisman, M., van Lenthe, F., & Mackenbach, J. (2007). The predictive ability of self-assessed health for mortality in different educational groups. International Journal of Epidemiology, 36, 1207–1213.CrossRefGoogle Scholar
  31. 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.CrossRefGoogle Scholar
  32. Jane, J. S., Oltmanns, T. F., South, S. C., & Turkheimer, E. (2007). Gender bias in diagnostic criteria for personality disorders: An item response theory analysis. Journal of Abnormal Psychology, 116, 166–175.CrossRefGoogle Scholar
  33. Jylha, M., Guralnik, J. M., Ferrucci, L., Jokela, J., & Heikkinen, E. (1998). Is self-rated health comparable across cultures and genders? The Journals of Gerontology. Series B: Psychological Sciences and Social Sciences, 53, S144–S152.Google Scholar
  34. Krause, N. M., & Jay, G. M. (1994). What do global self-rated health items measure. Medical Care, 32, 930–942.CrossRefGoogle Scholar
  35. Lawlor, D. A., Ebrahim, S., & Smith, G. D. (2002). The association between components of adult height and Type II diabetes and insulin resistance: British Women’s Heart and Health Study. Diabetologia, 45, 1097–1106.CrossRefGoogle Scholar
  36. Lillard, L., & Swaminathan, M. (2000, March). Health in Bangladesh, Indonesia and the United States: A MIMC model with threshold responses and person, family and community components. Presented at the annual meeting of the Population Association of America, Los Angeles.Google Scholar
  37. Lindeboom, M., & van Doorslaer, E. (2004). Cut-point shift and index shift in self-reported health. Journal of Health Economics, 23, 1083–1099.Google Scholar
  38. Majdandzic, M., & van den Boom, D. C. (2007). Multimethod longitudinal assessment of temperament in early childhood. Journal of Personality, 75, 121–167.CrossRefGoogle Scholar
  39. Marmot, M., Banks, J., Blundell, R., Lessof, C., & Nazroo, J. (2002). Health, wealth and lifestyles of the older population in England: The 2002 English Longitudinal Study of Ageing. London: Institute for Fiscal Studies.Google Scholar
  40. McDowell, I., & Newell, C. (1996). Measuring health: A guide to rating scales and questionnaires. New York: Oxford University Press.Google Scholar
  41. Mokdad, A. H., Ford, E. S., Bowman, B. A., Dietz, W. H., Vinicor, F., Bales, V. S., & Marks, J. S. (2003). Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. Journal of the American Medical Association, 289, 76–79.CrossRefGoogle Scholar
  42. Murray, C. J. L. (2007). Towards good practice for health statistics: Lessons from the millennium development goal health indicators. Lancet, 369, 862–873.CrossRefGoogle Scholar
  43. Muthén, L. K., & Muthén, B. O. (1998–2007). Mplus User's Guide. Fourth Edition. Los Angeles, CAGoogle Scholar
  44. Myers, A. M., Holliday, P. J., Harvey, K. A., & Hutchinson, K. S. (1993). Functional performance measures: Are they superior to self-assessments? Journals of Gerontology, 48, M196–M206.Google Scholar
  45. Nichter, M., Ritenbaugh, C., Vuckvoic, N., & Aickin, M. (1995). Dieting and watching behaviours among adolescent females: Report of a multimethod study. The Journal of Adolescent Health, 17, 153–162.CrossRefGoogle Scholar
  46. Palmer, R. F., Dwyer, J. H., & Semmer, N. (1994). A measurement model of adolescent smoking. Addictive Behaviors, 19, 477–489.CrossRefGoogle Scholar
  47. Peck, A. M. N., & Vagero, D. H. (1989). Adult body height, self perceived health and mortality in the Swedish population. Journal of Epidemiology and Community Health, 43, 380–384.CrossRefGoogle Scholar
  48. Pollack, C. E., Chideya, S., Cubbin, C., Williams, B., Dekker, M., & Braveman, P. (2007). Should health studies measure wealth? A systematic review. American Journal of Preventive Medicine, 33, 250–264.CrossRefGoogle Scholar
  49. Prinstein, M. J., Nock, M. K., Spirito, A., & Grapentine, W. L. (2001). Multimethod assessment of suicidality in adolescent psychiatric inpatients: Preliminary results. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1053–1061.CrossRefGoogle Scholar
  50. Quesnel-Vallee, A. (2007). Self-rated health: Caught in the crossfire of the quest for “true” health? International Journal of Epidemiology, 36, 1161–1164.CrossRefGoogle Scholar
  51. Rabe-Hesketh, S., & Skrondal, A. (2008). Classical latent variable models for medical research. Statistical Methods in Medical Research, 17, 5–32.CrossRefGoogle Scholar
  52. Radloff, L. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  53. Robine, J. M., Michel, J. P., & Branch, L. G. (1992). Measurement and utilization of healthy life expectancy: Conceptual issues. Bulletin of the World Health Organization, 70, 791–800.Google Scholar
  54. Robine, J. M., Jagger, C., & Euro, R. G. (2003). Creating a coherent set of indicators to monitor health across Europe: The Euro-REVES 2 project. European Journal of Public Health, 13, 6–14.CrossRefGoogle Scholar
  55. Samejima, F. (1969). Estimation of latent trait ability using a response pattern of graded scores (Psychometric Monograph No. 17). Richmond, VA: Psychometric Society.Google Scholar
  56. Sen, A. (2002). Health: Perception versus observation—Self reported morbidity has severe limitations and can be extremely misleading. British Medical Journal, 324, 860–861.CrossRefGoogle Scholar
  57. Sigmon, S. T., Pells, J. J., Boulard, N. E., Whitcomb-Smith, S., Edenfield, T. M., Hermann, B. A.,.... Kubik, E. (2005). Gender differences in self-reports of depression: The response bias hypothesis revisited. Sex Roles, 53, 401–411.Google Scholar
  58. Silventoinen, K., Lahelma, E., & Rahkonen, O. (1999). Social background, adult body-height and health. International Journal of Epidemiology, 28, 911–918.CrossRefGoogle Scholar
  59. Singh-Manoux, A., Martikainen, P., Ferrie, J., Zins, M., Marmot, M., & Goldberg, M. (2006). What does self-rated health measure? Results from the British Whitehall II and French Gazel cohort studies. Journal of Epidemiology and Community Health, 60, 364–372.CrossRefGoogle Scholar
  60. Singh-Manoux, A., Dugravot, A., Shipley, M. J., Ferrie, J. E., Martikainen, P., Goldberg, M., & Zins, M. (2007). The association between self-rated health and mortality in different socioeconomic groups in the GAZEL cohort study. International Journal of Epidemiology, 36, 1222–1228.CrossRefGoogle Scholar
  61. Spearman, D. (1904). General intelligence objectively determined and measured. The American Journal of Psychology, 15, 201–293.CrossRefGoogle Scholar
  62. Svanborg, A. (1988). Practical and functional consequences of aging. Gerontology, 34(Suppl. 1), 11–15.CrossRefGoogle Scholar
  63. Tram, J. M., & Cole, D. A. (2006). A multimethod examination of the stability of depressive symptoms in childhood and adolescence. Journal of Abnormal Psychology, 115, 674–686.CrossRefGoogle Scholar
  64. van Doorslaer, E., & Gerdtham, U. G. (2003). Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data. Social Science & Medicine, 57, 1621–1629.CrossRefGoogle Scholar
  65. Vanitallie, T. B. (1985). Health implications of overweight and obesity in the United States. Annals of Internal Medicine, 103, 983–988.Google Scholar
  66. Waidmann, T., Bound, J., & Schoenbaum, M. (1995). The illusion of failure: Trends in the self-reported health of the US elderly. The Milbank Quarterly, 73, 253–287.CrossRefGoogle Scholar
  67. Wolf, D. A., Hunt, K., & Knickman, J. (2005). Perspectives on the recent decline in disability at older ages. The Milbank Quarterly, 83, 365–395.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2011

Authors and Affiliations

  1. 1.Centre for Population Studies, Department of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineUniversity of LondonLondonEngland

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