Journal of Public Health Advance Access originally published online on April 18, 2007
Journal of Public Health 2007 29(2):208-210; doi:10.1093/pubmed/fdm017
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Correspondence |
Could using general health and longstanding limiting illness as a joint health outcome add to understanding in social inequalities research?
F. Popham*
J. J. Walker
R. Mitchell
Research Unit in Health Behaviour and Change, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
* E-mail: f.popham{at}ed.ac.uk
The 2001 UK census included two widely used self-rated health questions. A question on general health joined the question on longstanding limiting illness first asked in 1991. While the two questions aim to capture different aspects of health status, previous studies have highlighted how they are strongly positively correlated and how each is an important independent predictor of the other.1–3 Given this close relationship, we hypothesized that relative differences in the established relationship between self-rated health and people's economic activity and socio-economic position (SEP)4 would vary by whether a person reports both not good general health and a limiting illness, not good general health only or a limiting illness only. We used the SARs data set, a 3% sample of the census.5 Our sample was 404 581 British men and 405 217 women of working age (25–59) who were not in full-time education and who reported they had worked at some time in their lives.
Reporting a limiting illness (13.3% of men and 13.2% of women) was more common than reporting not good general health (7.8 and 8.2%). As a joint outcome (that is, considering responses to both measures), reporting a limiting illness only (7% of men and 6.9% of women) and reporting both a limiting illness and not good general health (6.3% of men and women) were most common, however it was rare for men and women to report not good general health only (1.5 and 1.9%). Using Poisson regression with robust standard errors,6 we derived age adjusted relative differences for the three outcomes by economic activity and four measures of SEP (Table 1). As expected, the general pattern was for risk of poor health (however measured) to increase for people out of work and for those in lower SEP. The notable exceptions to this were the lower risk, compared to the employed, of reporting not good general health only among the permanently sick (who nearly all report a limiting illness) and the retired. We compared relative differences by combining estimation results using seemingly unrelated estimation and running Wald tests. All the relative differences for the reporting of both not good general health and a limiting illness were higher (and, with one exception, significantly so (P < 0.05)) than for the reporting of only one of the conditions. No consistent pattern was seen when comparing not good general health only to limiting illness only, with many comparisons showing no statistically significant difference (P > 0.05). However for all groups, reporting a limiting illness only was more common than reporting not good general health only.
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The rate of people reporting both not good general health and a limiting illness has previously been used as a proxy for area health need.7 Our results highlight how the largest social inequalities are seen for reporting of both conditions. Given this, it may be fruitful for the understanding of social inequalities in health to additionally analyse questions on general health and limiting illness as a joint health outcome in future studies.
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Acknowledgements |
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 TOP Acknowledgements References |
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This work is based on the SARs provided through the Centre for Census and Survey Research of the University of Manchester with the support of ESRC and JISC. SARs data are Crown copyright. The authors are funded by the Chief Scientist Office of the Scottish Executive Health Department.
These are the opinions of the authors, not the funders.
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References |
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TOPAcknowledgementsReferences |
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[Abstract/Free Full Text] - Manor O, Matthews S, Power C. Self-rated health and limiting longstanding illness: inter-relationships with morbidity in early adulthood. Int J Epidemiol (2001) 30:600–7.
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- Cathie Marsh Centre for Census and Survey Research. Samples of anonymised records: user guide to the SARs. (2004) Manchester: Cathie Marsh Centre for Census and Survey Research.
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