A Study On The Level And Distribution Of Population Self-reported Health

A Study on the Level and Distribution of Population Self-reported Health [BACKGROUND]The primary purpose of a health system is to improve the population health. Population health assessment, so, is the key to inform the health policy process or even to the public policy process. The traditional population health measure relying heavily on vital statistics is becoming increasingly uninformative because of the epidemiological transition. In this context, non-fatal health outcomes, as the complement to the previous mortality information, should be include to form a summary measure of population health. Self-reported health survey is one of key methods to collect data on the population non-fatal health status. However, the use of self-reported health information is quite limited due to its problem in cross-population comparability. In addition, rare study on summary measure of level and distribution of self-reported health also prevents its integration into the health policy making and its possible benefits to improve the health system performance. [OBJECTIVE]To capture the international research focus on non-fatal health assessment and some main issues facing self-reported health data, the study, by using the household survey data collected from 4 districts (Jiading, Baoshan, Jinshan and Chongming) of Shanghai municipality, studied the summary measure of level and distribution of population self-reported health on the basis of solving the problem of cross-population comparability of self-reported health data. The specific objectives are as follows:(1) To assess the population self-reported health data and to obtain the cross-population comparable self-reported health data;(2) Summary measure of the level of population self-reported health;(3) Summary measure of the distribution of population self-reported health;(4) Combination of the summary measure of the level and distribution of population self-reported health.[METHODS]The data came from the 2001 household survey conducted in the 4 districts (Jiading, Baoshan, Jinshan and Chongming) of Shanghai municipality. 10358 households were interviewed by trained interviewer. The content of the data includes the self-reported health and vignette information covering 6 core domains of health (mobility, pain, affection, cognition, self-care and usual activities) of each household member aged over 18. Socioeconomic and demographic information such as age, sex, education and household income and expenditure were also collected. Descriptive analysis and Classical Test Theory (CTT) and Item Response Theory (IRT) in psychometrics were used to assess the latent factor structure and internal consistency of the self-reported health data. The cut-point shift issue was also investigated by using health vignettes. Hierarchical Ordered Probit (HOPIT) model was used to calculate the severity-weighted prevalence of disability of the sample population, which was then combined with the period life table to obtain the Disability-Adjusted Life Expectancy (DALE); concentration index, pseudo-Gini coefficient, and their decomposition were used for obtaining the summary measure of the distribution of population self-reported health; and finally, based on the summary measure of the level and distribution of population self-reported health, the thesis discussed the theoretical construction of the combination of the summary measure of level and distribution, and also, mathematical relationship between the two kinds of combination methods were investigated and demonstrated with empirical evidence. [RESULTS]· Assessment of population self-reported health dataThe results of the study suggest that,the sample deviation indices calculated according to age and sex for each of the 4 sample districts are not systematically deviate from 1, indicating the good representation of the sample. The descriptive analysis of the socio-demographic information does not show the significant difference of sex, but with significant difference of age and...