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Evaluation of a population-based measure of quality of life: the Health and Activity Limitation Index (HALex)

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Abstract

This paper briefly discusses the rationale and methods for developing and evaluating the Health and Activity Limitation Index (HALex), a generic measure of health that consists of two attributes: perceived health and activity limitation. Using a multiattribute utility scoring system, information from these attributes was combined to form a single score that represents health-related quality of life (QoL) on a 0.0-1.0 continuum. The construct and incremental validity are evaluated using data from a sample of over 40,000 adults who participated in the 1990 US National Health Interview Survey. The health state distributions for known groups, defined in terms of personal or lifestyle characteristics such as sex, age and smoking status, were comparable to those for similarly defined states that have been studied by other researchers. Of the regression models examined in this analysis, age, years of schooling and being in a high-risk group based on body mass index (BMI) were found to have the largest impact on health as measured by the HALex. Although this measure was developed to be combined with mortality data to form a quality-adjusted life year (QALY) for detecting changes in the health of the US population from 1990 to 2000, it may also be useful for inclusion in clinical studies, in particular as the national data are readily available for use as norms.

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References

  1. Department of Health and Human Services. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: US Government Printing Office, 1990.

    Google Scholar 

  2. National Center for Health Statistics. Healthy People 2000 Review 1994. Hyattsville, MD: National Center for Health Statistics, 1995.

    Google Scholar 

  3. Erickson P, Wilson R.W, Shannon I. Years of Healthy Life: Statistical Note Number 7. Hyattsville, MD: National Center for Health Statistics, 1995.

    Google Scholar 

  4. Idler EL, Kasl S. Health perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol 1991; 46: S55-S65.

    Google Scholar 

  5. Idler EL, Kasl SV, Lemke JH. Self-evaluated health and mortality among the elderly in New Haven, Connecticut and Iowa and Washington Counties, Iowa, 1982–1986. Am Epidemiol 1990; 131:91-103.

    Google Scholar 

  6. Wannamethee G, Shaper AG. Self-assessment of health status and mortality in middle-aged British men. Int Epidemiol 1991; 20: 239-245.

    Google Scholar 

  7. Chyba MM, Washington LR. Questionnaires from the National Health Interview Survey, 1985–89. Vital and Health Statistics Series 1, Number 31. Hyattsville, MD: National Center for Health Statistics, 1993.

    Google Scholar 

  8. Torrance GW, Erickson P, Patrick DL, Feldman JJ. Technical notes. In: Erickson P, Wilson RW, Shannon I, eds. Statistical Note Number 7. Hyattsville, MD: National Center for Health Statistics, 1995: 10-14.

    Google Scholar 

  9. Adams PF, Marano MA, Current Estimates from the National Health Interview Survey, 1994. Vital and Health Statistics Series 10, Number 193. Hyattsville, MD: National Center for Health Statistics, 1995.

    Google Scholar 

  10. Greenacre M, Hastie T. The geometric interpretation of correspondence analysis. J Am Stat Assoc 1987; 82(398): 437-447.

    Google Scholar 

  11. SAS Institute. SAS/STAT User's Guide, Version 6, 4th edn, Vol 1. Cary, NC: SAS Institute, 1989: 615-675.

    Google Scholar 

  12. Torrance GW. Measurement of health state utilities for economic appraisal. J Health Econ 1986; 5(1): 1-30.

    Google Scholar 

  13. Torrance GW. Multiattribute utility theory as a method of measuring social preferences for health states in long-term care. In: Kane RL, Kane RA, eds. Values and Long-Term Care. Lexington, MA: D.C. Heath and Company, 1982: 127-156.

    Google Scholar 

  14. Anastasi A. Psychological Testing 6th edn. New York: Macmillan, 1988: 139-164.

    Google Scholar 

  15. Nunnally J. Psychometric Theory 2nd edn. New York: McGraw-Hill Book Company, 1978: 94-109.

    Google Scholar 

  16. Kaplan RM, Bush JW, Berry CC. Health status: types of validity and the index of well-being. Health Services Res 1976; 11(4): 478-507.

    Google Scholar 

  17. Stewart AL, Hays RD, Ware JE. Methods of validating MOS health measures in: Stewart AL, Ware JE, eds. Measuring Function and Well-Being. Durham, NC: Duke University Press, 1992: 309-324.

    Google Scholar 

  18. Ware JE Jr, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey: Manual and Interpretation Guide. Boston, MA: New England Medical Center, The Health Institute, 1993.

    Google Scholar 

  19. Chen VM. Smoking and the health gap in minorities. Ann Epidemiol 1993; 3(2): 159-164.

    Google Scholar 

  20. Manton KG, Patrick CH, Johnson KW. Health differentials between Blacks and Whites: recent trends in mortality and morbidity. Milbank Q 1987; 65(Suppl 1): 129-199.

    Google Scholar 

  21. Kutner NG, Schechtman KB, Ory MG, Baker DI. Older adults' perceptions of their health and functioning in relation to sleep disturbance, falling, and urinary incontinence. J Am Geriatrics Soc 1994; 42(7): 757-762.

    Google Scholar 

  22. House JS, Lepkowski JM, Kinney AM, Mero RP, Kessler RC, Herzog AR. The social stratification of aging and health. J Health Soc Behav 1994; 35(3): 213-234.

    Google Scholar 

  23. Kramer RA, Allen L, Gergen PJ. Health and social characteristics and children's cognitive functioning: results from a national cohort. Am Public Health 1995; 85(3): 312-318.

    Google Scholar 

  24. Pincus T, Callahan LF. Associations of low formal education level and poor health status: behavioral, in addition to demographic and medical, explanations? J Clin Epidemiol 1994; 47(4): 355-361.

    Google Scholar 

  25. Weiss BD, Hart G, McGee DL, D'Estelle S. Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills. J Am Board Family Pract 1992; 5(3): 257-264.

    Google Scholar 

  26. Goldman N, Korenman S, Weinstien R. Marital status and health among the elderly. Soc Sci Med 1995; 40(12): 1717-1730.

    Google Scholar 

  27. Preston DB. Marital status, gender roles, stress, and health in the elderly. Health Care Women Int 1996; 16(2): 149-165.

    Google Scholar 

  28. Joung IM, van de Mheen H, Stronks K, van Poppel FW, Mackenbach JP. Differences in self-reported morbidity by marital status and by living arrangement. Int J Epidemiol 1994; 23(1): 91-97.

    Google Scholar 

  29. Department of Health and Human Services. The Health Benefits of Smoking Cessation. Atlanta, GA: Centers for Disease Control and Prevention, Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, 1990.

    Google Scholar 

  30. Kenkel DS, Should you eat breakfast? Estimates from health production functions. Health Econ 1995; 4(1): 25-29.

    Google Scholar 

  31. Hodgson TA. Cigarette smoking and lifetime medical expenditures. Milbank Q 1992; 70(1): 81-125.

    Google Scholar 

  32. Centers for Disease Control and Prevention. From the Centers for Disease Control and Prevention: medical care expenditures attributable to cigarette smoking — United States, 1993. JAMA 1993; 272(6): 428-429.

    Google Scholar 

  33. Goldberg RJ, Burchfiel CM, Reed DM, Wergowske G, Chiu D. A prospective study of the health effects of alcohol consumption in middle aged and elderly men. Circulation 1994; 89(2): 651-659.

    Google Scholar 

  34. Launer LJ, Harris T, Rumpel C, Madans J. Body mass index, weight change and risk of mobility disability in middle aged and older women: The epidemiologic follow-up study of NHANES I. JAMA 1994; 271(4): 1093-1098.

    Google Scholar 

  35. SAS Institute, Inc. Statistical Analysis System (SAS) Version 6.08 User's Guide. Cary, NC: SAS Institute, Inc., 1990.

    Google Scholar 

  36. Shah BV, Barnwell BG, Bieler GS. SUDAAN User's Manual: Software for Analysis of Correlated Data, Release 6.40. Research Triangle Park, NC: Research Triangle Institute, 1995.

    Google Scholar 

  37. Korn EL, Graubard BI, Analysis of large health surveys: accounting for sample design. J R Stat Soc Ser A 1995; 158: 263-295.

    Google Scholar 

  38. McDowell I, Newell C. Measuring Health: A Guide to Rating Scales and Questionnaires. New York: Oxford University Press, 1987.

    Google Scholar 

  39. Patrick DL, Erickson P. Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation. New York: Oxford University Press, 1993.

    Google Scholar 

  40. Berzon RA, Donnelly MA, Simpson RL Jr, Simeon GP, Tilson HH. Quality of life bibliography and indexes: 1994 update. Qual Life Res 1995; 4(6): 547-569.

    Google Scholar 

  41. Kaplan RM, Bush JW, Berry CC. The reliability, stability, and generalizability of a health status index. In: Proceedings of the American Statistical Association. Washington, DC: Social Statistics Section, 1978: 704-109.

    Google Scholar 

  42. Berthelot JM, Roberge R Jr, Wolfson M. The calculation of health-adjusted life expectancy for Ontario using a health status index. In: Proceedings of the 1993 Public Health Conference on Records and Statistics, Hyattsville, MD: National Center for Health Statistics, 1994: 28-33.

    Google Scholar 

  43. Erickson P, Kendall EA, Odle MP, Torrance GW. Assessing Health-related Quality of Life in the National Health and Nutrition Examination Survey. Hyattsville, MD: National Center for Health Statistics, 1992.

    Google Scholar 

  44. Ware JE Jr, Keller SD, Gandek B, Brazier JE, Sullivan M. Evaluating translations of health status questionnaires: methods from the IQOLA project. Int J Technol Assess Health Care 1995; 11(3): 525-551.

    Google Scholar 

  45. Gold MR, Franks P, McCoy KI, Fryback DG. Toward consistency in cost-utility analyses: using national measures to create condition-specific values. Submitted for publication.

  46. National Center for Health Statistics. Healthy People 2000 Review, 1995. Hyattsville, MD: US Public Health Service, 1996.

    Google Scholar 

  47. Erickson, P, Wilson, R.W. (1996) Years of Healthy Life: A Measure of Healthy Life Span for Healthy People 2000. Submitted for publication.

  48. Erickson, P. (1996) Relationships Between Health and Economic Well-Being in the United States. Submitted for publication.

  49. Fiscella K, Franks P. Cost-effectiveness of the transdermal nicotine patch as an adjunct to physicians' smoking cessation counseling. JAMA 1996; 275(16): 1247-1251.

    Google Scholar 

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  1. Pennsylvania State University, Pennsylvania, USA

    P Erickson

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Erickson, P. Evaluation of a population-based measure of quality of life: the Health and Activity Limitation Index (HALex). Qual Life Res 7, 101–114 (1998). https://doi.org/10.1023/A:1008897107977

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