|Type||Journal Article - International journal of epidemiology|
|Title||Author's Response Self-rated health may be adequate for broad assessments of social inequalities in health|
We thank the authors for their engaging responses,1–3 and especially applaud Singh-Manoux and colleagues and Huisman and colleagues for conducting additional analyses as a response to our letter.4 We take this opportunity to summarize what we have learned from this exchange on the question that implicitly or explicitly motivated the three studies:5–7 are assessments of social inequalities in health based on subjective health problematic? The quick answer, based on the original study and these exchanges, is, maybe not.
We reiterate—as we did in our original letter—we do not question the intrinsic relevance of examining whether the association between self-rated health (SRH) and mortality varies by socioeconomic status (SES). Our concern was mainly with interpreting these tests of interaction to comment on whether SRH-based health inequality assessments are misleading. The additional analysis conducted by Singh-Manoux and colleagues bolsters their initial claim that assessment of health inequalities based on SRH are likely to be conservative compared with assessment of health inequalities based on mortality. Their additional analysis also underscores that assessments of social inequalities in health may well depend on the specific measure of SES;1 an aspect that needs attention in general.8 The additional analysis conducted by Huisman and colleagues, meanwhile, suggests that assessments of social inequalities in health using SRH may depend on how we dichotomize ‘poor’ SRH.2 Under one specification (when SRH = fair/poor health or not) there is some over-estimation of social inequalities in health (compared with what is observed based on SES differentials in mortality). However, when SRH is dichotomized as fair/poor/good or not, the social inequalities in health using SRH are similar to those observed using mortality.2 Thus, the studies by Singh-Manoux and colleagues and Huisman and colleagues, with the benefit of these additional analyses, bring us some insights about the use of SES as well as the use of SRH in health inequalities assessment. At the same time, these additional analyses, in our view, do not suggest that we are in danger of getting the magnitude of social inequality in health completely wrong if we used SRH instead of an objective measure such as mortality.
|»||India - World Health Survey 2003|