Is the use of self-rated health measures to assess health inequalities misleading?

Abstract

In three studies published in IJE,1–3 authors examined whether the association between self-rated health (SRH) and mortality varied by socioeconomic status (SES). They then used the empirical results to comment on the potential discordance in the magnitude of social inequalities in health when estimated using SRH as opposed to mortality. The three studies, however, arrived at different conclusions about the potential misestimation of health inequalities when using SRH instead of mortality. Huisman and colleagues concluded that a weak interaction between SRH and education whilst predicting mortality is unlikely to result in over-estimation of educational differences in health status.1 Meanwhile, Singh-Manoux and colleagues concluded that use of SRH might under-estimate health inequalities by income and occupation.3 Dowd and colleagues reported that ‘self-rated health does not predict mortality as well at lower levels of SES’, but do not speculate on whether this will result in over- or under-estimation of social inequalities in health.2

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