Assessment of the health of Americans: The average health-related quality of life and its inequality across individuals and groups

被引：37

作者：

Asada Y. ^{[1
]}

机构：

[1] Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7

来源：

Population Health Metrics | / 3卷 / 1期

关键词：

Income Inequality; Racial Group; Activity Limitation; Health Inequality; Gini Coefficient;

D O I：

10.1186/1478-7954-3-7

中图分类号：

学科分类号：

摘要：

Background: The assessment of population health has traditionally relied on the population's average health measured by mortality related indicators. Researchers have increasingly recognized the importance of including information on health inequality and health-related quality of life (HRQL) in the assessment of population health. The objective of this study is to assess the health of Americans in the 1990s by describing the average HRQL and its inequality across individuals and groups. Methods: This study uses the 1990 and 1995 National Health Interview Survey from the United States. The measure of HRQL is the Health and Activity Limitation Index (HALex). The measure of health inequality across individuals is the Gini coefficient. This study provides confidence intervals (CI) for the Gini coefficient by a bootstrap method. To describe health inequality by group, this study decomposes the overall Gini coefficient into the between-group, within-group, and overlap Gini coefficient using race (White, Black, and other) as an example. This study looks at how much contribution the overlap Gini coefficient makes to the overall Gini coefficient, in addition to the absolute mean differences between groups. Results: The average HALex was the same in 1990 (0.87, 95% CI: 0.87, 0.88) and 1995 (0.87, 95% CI: 0.86, 0.87). The Gini coefficient for the HALex distribution across individuals was greater in 1995 (0.097, 95% CI: 0.096, 0.099) than 1990 (0.092, 95% CI: 0.091, 0.094). Differences in the average HALex between all racial groups were the same in 1995 as 1990. The contribution of the overlap to the overall Gini coefficient was greater in 1995 than in 1990 by 2.4%. In both years, inequality between racial groups accounted only for 4-5% of overall inequality. Conclusion: The average HRQL of Americans was the same in 1990 and 1995, but inequality in HRQL across individuals was greater in 1995 than 1990. Inequality in HRQL by race was smaller in 1995 than 1990 because race had smaller effect on the way health was distributed in 1995 than 1990. Analysis of the average HRQL and its inequality provides information on the health of a population invisible in the traditional analysis of population health. © 2005 Asada; licensee BioMed Central Ltd.

引用

页数：11

共 58 条

[11]

Erickson P., Wilson R., Shannon I., Years of Health Life, Healthy People 2000, 7, pp. 1-14, (1995)

[12]

Healthy people 2000: National health promotion and disease prevention Ojectives, (1991)

[13]

Ko C.Y., Maggard M., Livingston E.H., Evaluating health utility in patients with melanoma, breast cancer, colon cancer, and lung cancer. A nationwide population-based assessment, Journal of Surgical Research, 114, pp. 1-5, (2003)

[14]

Livingston E.H., Ko C.Y., Use of the Health and Activity Limitation Index as a measure of quality of life in obesity, Obesity Research, 10, pp. 824-832, (2002)

[15]

Bradley C.J., Kroll J., Holmes-Rovner M., The Health and Activities Limitation Index in patients with acute myocardial infarction, Journal of Clinical Epidemiology, 53, pp. 555-562, (2000)

[16]

Murray C.J.L., Gakidou E.E., Frenk J., Health inequalities and social group differences: What should we measure?, Bulletin of the World Health Organization, 77, pp. 537-543, (1999)

[17]

Houweling T.A.J., Kunst A.E., Mackenbach J.P., World Health Report 2000: Inequality index and socioeconomic inequalities in mortality, Lancet, 357, pp. 1671-1672, (2001)

[18]

Gakidou E., King G., Measuring total health inequality: Adding individual variation to group-level differences, International Journal for Equity in Health, 1, pp. 1-12, (2002)

[19]

Kakwani N., Wagstaff A., van Doorslaer E., Socioeconomic inequalities in health: Measurement, computation, and statistical inference, Journal of Econometrics, 77, pp. 87-103, (1997)

[20]

Sitter R.R., Comparing three bootstrap methods for survey data, The Canadian Journal of Statistics, 20, pp. 135-154, (1992)

← 1 2 3 4 5 6 →