How good is "very good"? Translation effect in the racial/ethnic variation in self-rated health status

To examine the influence of translation when measuring and comparing self-rated health (SRH) measured with five response categories (excellent, very good, good, fair, and poor), across racial/ethnic groups. Using data from the California Health Interview Survey, which were administered in five languages, we analyzed variations in the five-category SRH across five racial/ethnic groups: non-Hispanic white, Latino, Chinese, Vietnamese, and Korean. Logistic regression was used to estimate independent effects of race/ethnicity, culture, and translation on SRH, after controlling for risk factors and other measures of health status. Latinos, Chinese, Vietnamese, and Koreans were less likely than non-Hispanic whites to rate their health as excellent or very good and more likely to rate it as good, fair, or poor. This racial/ethnic difference diminished when adjusting for acculturation. Independently of race/ethnicity, respondents using non-English surveys were less likely to answer excellent (OR = 0.24-0.55) and very good (OR = 0.30-0.34) and were more likely to answer fair (OR = 2.48-4.10) or poor (OR = 2.87-3.51), even after controlling for other measures of SRH. Responses to the five-category SRH question depend on interview language. When responding in Spanish, Chinese, Korean, or Vietnamese, respondents are more likely to choose a lower level SRH category, "fair" in particular. If each SRH category measured in different languages is treated as equivalent, racial/ethnic disparities in SRH among Latinos and Asian subgroups, as compared to non-Hispanic whites, may be exaggerated.