Health-related quality of life and self-rated health complement mortality and morbidity as measures used in tracking changes and disparities in population health. The objectives of this study were to determine whether and how health-related quality of life and self-rated health changed overall in U.S. adults and in specific sociodemographic and geographic groups from 1993 through 2001.
Methods.
The authors analyzed data from annual cross-sectional Behavioral Risk Factor Surveillance System surveys of 1.2 million adults from randomly selected households with telephones in the 50 states and the District of Columbia.
Results.
Mean physically and mentally unhealthy days and activity limitation days remained constant early in the study period but increased later on. Mean unhealthy days increased about 14% during the study period. The percentage with fair or poor self-rated health increased from 13.4% in 1993 to 15.5% in 2001. Health-related quality of life and self-rated health worsened in most demographic groups, especially adults 45–54 years old, high school graduates without further education, and those with annual household incomes less than $50,000. However, adults 65 years old or older and people identified as non-Hispanic Asian/Pacific Islander reported stable or improving health-related quality of life and self-rated health. In 18 of the states and the District of Columbia, mean unhealthy days increased, while only North Dakota reported a decrease.
Conclusion.
Population tracking of adult health-related quality of life and self-rated health identified worsening trends overall and for many groups, suggesting that the nation's overall health goals as identified in the Healthy People planning process are not being met.
References
1.
Institute of Medicine. The second fifty years: promoting health and preventing disability. Washington: National Academy Press; 1992.
2.
Institute of Medicine. FeasleyJC, editor. Health outcomes for older people: questions for the coming decade. Washington: National Academy Press; 1996.
3.
Institute of Medicine. Toward environmental justice: research, education, and health policy needs. Washington: National Academy Press; 1999.
4.
Institute of Medicine. SmedleyBDSymeSL, editors. Promoting health: intervention strategies from social and behavioral research. Washington: National Academy Press; 2000.
5.
Institute of Medicine. KohnLTCorriganJMDonaldsonMS, editors. To err is human: building a safer health system. Washington: National Academy Press; 2000.
6.
Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington: National Academy Press; 2001.
7.
Institute of Medicine. WunderlichGSKohlerP, editors. Improving the quality of long-term care. Washington: National Academy Press; 2000.
8.
Department of Health and Human Services (US). Healthy people: the Surgeon General's report on health promotion and disease prevention. Washington: Government Printing Office; 1979. DHEW Pub. No.: (PHS) 79-55071.
9.
Department of Health and Human Services (US). Healthy people 2010: understanding and improving health and objectives for improving health. 2nd ed.2 vols.Washington: Government Printing Office; 2000 Nov.
10.
KramarowELentznerHRooksRWeeksJSaydahS. Health and aging chartbook. Health, United States, 1999. Hyattsville (MD): National Center for Health Statistics; 1999.
11.
MokdadAHSerdulaMKDietzWHBowmanBAMarksJSKoplanJP. The spread of the obesity epidemic in the United States, 1991–1998. JAMA1999;282:1519–22.
12.
MokdadAFordESBowmanBANelsonDEEngelgauMM. Diabetes trends in the U.S.: 1990–1998. Diabetes Care2000;23:1278–83.
13.
FriedmanDJStarfieldB. Models of population health: their value for U.S. public health practice, policy, and research. Am J Public Health2003:366–9.
14.
Institute of Medicine. The future of public health. Washington: National Academy Press; 1988.
15.
PatrickDLBergnerM. Measurement of health status in the 1990s. Annu Rev Public Health1990;11:165–83.
16.
KronickR. Numbers we need: health statistics and health policy. Commissioned by the National Committee for Vital and Health Statistics. Presented at the Committee on National Statistics Workshop: Toward a Health Statistics System for the 21st Century; 1999 Nov 4; Washington, DC. Revised December 1999 [cited2003 Aug 23]. Available from: URL: http://www.ncvhs.hhs.gov/hsvision/CP-kronick.pdf
17.
McHorneyCA. Health status assessment methods for adults: past accomplishments and future challenges. Annu Rev Public Health1999;20:309–35.
18.
HennessyCHMoriartyDGZackMMScherrPABrackbillR. Measuring health-related quality of life for public health surveillance. Public Health Rep1994;109:665–72.
19.
FordESManninoDMHomaDMGwynnCReddSCMoriartyDG. Self-reported asthma and health-related quality of life: findings from the Behavioral Risk Factor Surveillance System. Chest2003;119–27.
20.
MiliFHelmickCHZackMMMoriartyDG. Health-related quality of life among adults reporting arthritis: analysis of data from the Behavioral Risk Factor Surveillance System, U.S., 1996–1999. J Rheumatol2003;30:160–6.
21.
GreenlundKJGilesWHKeenanNLCroftJBMensahGAHustonSL. Physician advice, patient actions, and health-related quality of life in secondary prevention of stroke through diet and exercise. Stroke2002;33:565–71.
22.
ValdmanisVSmithDWPageMR. Productivity and economic burden associated with diabetes. Am J Public Health2001;91:129–30.
23.
FordESMoriartyDGZackMMMokdadAHChapmanDP. Self-reported body mass index and health-related quality of life: findings from the Behavioral Risk Factor Surveillance System. Obes Res2001;9:21–31.
24.
OunpuuSChambersLWPattersonCChanDYusufS. Validity of the U.S. Behavioral Risk Factor Surveillance System's health-related quality of life survey tool in a group of older Canadians. Chronic Dis Can2001:22:93–101.
25.
AndresenEMFoutsBSRomeisJCBrownsonCA. Performance of health-related quality of life instruments in a spinal cord injured population. Arch Phys Med Rehabil1999;80:877–84.
26.
VerbruggeLMMerrillSSLiuX. Measuring disability with parsimony. Disabil Rehabil1999;21:295–306.
27.
AhluwaliaIBHoltzmanDMackKAMokdadA. Health-related quality of life among women of reproductive age: Behavioral Risk Factor Surveillance System (BRFSS), 1998–2001. J Womens Health2003;12:5–10.
28.
VestJRCatlinTKChenJJBrownsonRC. Multistate analysis of factors associated with intimate partner violence. Am J Prev Med2002;22:156–64.
29.
BroylesRWMcAuleyWJBaird-HolmesD. The medically vulnerable: their health risks, health status, and use of physician care. J Health Care Poor Underserved1999;10:186–200.
30.
CalsynRJWinterJP. Predicting four types of service needs in older adults. Eval Prog Plann2001;24:157–66.
31.
Centers for Disease Control and Prevention (US). Health risks in America: gaining insight from the Behavioral Risk Factor Surveillance System. Rev. ed.Atlanta: Department of Health and Human Services (US); 1997.
32.
FiggsLWBloomYDugbateyKStanwyckCANelsonDEBrownsonRC. Uses of Behavioral Risk Factor Surveillance System data, 1993–1997. Am J Public Health2000;90:774–6.
33.
BloomYFiggsLWBakerEADugbateyKStanwyckCA. Data uses, benefits, and barriers for the Behavioral Risk Factor Surveillance System: a qualitative study of users. J Publ Health Manag Pract2000;6:78–86.
34.
Centers for Disease Control and Prevention (US). 1993 BRFSS quality control report. Atlanta: Department of Health and Human Services (US); 1994.
35.
Centers for Disease Control and Prevention (US). 2001 BRFSS summary data quality report. Atlanta: Department of Health and Human Services (US); 2002 Aug 23.
36.
ShahBVBarnwellBGBielerGS. User's manual: SUDAAN software for the statistical analysis of correlated data: release 7.0. Research Triangle Park (NC): Research Triangle Institute; 1996.
37.
Census Bureau (US). Census 2000 summary file 1 100-percent data. Detailed table P12. United States. Sex by age. Universe: total population [cited 2003 Aug 26]. Available from: URL: http://factfinder.census.gov/servlet/BasicFactsServlet
38.
MoriartyDZackM. Seasonal patterns in health-related quality of life among adults—Behavioral Risk Factor Surveillance System (BRFSS), 1993–2000. In: Quality of life research. Ninth Annual Conference of the International Society for Quality of Life Research; 2002 Oct 30–Nov 2; Orlando, FL. Quality of Life Res2002;11(7):635.
39.
NewschafferCJ. Validation of Behavioral Risk Factor Surveillance System (BRFSS) HRQOL measures in a statewide sample. Atlanta: Centers for Disease Control and Prevention (US), National Center for Chronic Disease Prevention and Health Promotion; 1998.
40.
WareJEJrSherbourneCD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care1992;30:473–83.
41.
DominickKLAhernFMGoldCHHellerDA. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clin Exp Res2002;14:499–508.
42.
United Health Foundation. America's health: United Health Foundation state health rankings. 2002 edition. A call to action for people and their communities. November 2002 [cited 2003 Aug 23]. Available from: URL: http://www.unitedhealthfoundation.org/shr2002/
New Jersey. Healthy New Jersey 2010. Volume I. June 2001. Who we are—New Jersey compared to the nation [p. 19–24] [cited 2003 Aug 23]. Available from: URL: http://www.state.nj.us/health/chs/hnj2010vol1.pdf
47.
BuescherPAGizliceZ. North Carolina Department of Health and Human Services, North Carolina Public Health, State Center for Health Statistics. Healthy life expectancy in North Carolina, 1996–2000. SCHS Studies No. 129. January 2002 [cited2003 Aug 23]. Available from: URL: http://www.schs.state.nc.us/SCHS/pdf/SCHS-129.pdf
48.
Centers for Disease Control and Prevention (US). Measuring healthy days: population assessment of health-related quality of life. Atlanta: CDC; 2000 Nov.
49.
WaidmannTBoundJSchoenbaumM. The illusion of failure: trends in the self-reported health of the U.S. elderly. Milbank Q1995;73:253–87.
50.
MantonKGCorderLStallardE. Chronic disability trends in elderly United States populations: 1982–1994. Proc Natl Acad Sci U S A1997;94:2593–8.
51.
CutlerDM. Declining disability among the elderly. Health Aff2001;20:11–27.
52.
HagertyMRCumminsRAFerrissALLandKMichalosACPetersonM. Quality of life indexes for national policy: review and agenda for research. Soc Indicators Res2001;55:1–96.
53.
GoldM. Summary measures of population health and beyond: a look at U.S. federal activities in measuring the health of populations. Presented at Joint ECE/WHO Expert Meeting on Health Statistics Measurements; 2000 Oct 23–25; Ottawa, Canada. Conference of European Statisticians Working Paper No. 11 [cited2003 Aug 23]. Available from: URL: http://www.unece.org/stats/documents/2000/10/health/wp.11.e.pdf
54.
SorensonAW. A better understanding of health issues through population-based surveillance: why surveys?Soz Praventivmed2001;46:349–51.
55.
MartinAJStocklerM. Quality-of-life assessment in health care research and practice. Eval Health Prof1998;21:141–56.
56.
SartoriusN. The economic and social burden of depression. J Clin Psychiatry2001;62Suppl 15:8–11.
57.
WilberNMitraMWalkerDKAllenDMeyersARTupperP. Disability as a public health issue: findings and reflections from the Massachusetts Survey of Secondary Conditions. Milbank Q2002;80:393–421.
58.
DasbachEJTeutschSM. Quality of life. In: HaddixACTeutschSMCorsoPS, editors. Prevention effectiveness: a guide to decision analysis and economic evaluation. 2nd ed.New York: Oxford University Press; 2003. p. 77–91.
59.
Ravens-SiebererUGoschAAbelTAuquierPBellachBMBruilJ. Quality of life in children and adolescents: a European public health perspective. Soz Praventivmed2001;46:294–302.
60.
VuittonDA. A regional public health research network INSERM “PRISMAL” (Perception, Representation, and Risk Management in Rural Health Settings). Sante Publique (Vandoeuvre-Les-Nancey)2003;15 Spec No:169–78.
61.
RaoJKAndersonLASmithSM. End of life as a public health issue. Am J Prev Med2002;23:215–20.
