Health Disparities Research: Measurements of Health Status

The myth and reality of disability prevalence: measuring disability for research and service.

McDermott S, Turk MA.  Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC 29208, USA.  Disabil Health J. 2011 Jan;4(1):1-5. Epub 2010 Nov 5.

The concept of disability has medical, functional, and social components. We review the frameworks for the definition of disability and endorse a multidimensional approach that is parsimonious and has utility for epidemiology. We need to be able to count people with disabilities to quantify service and support needs, to study the life course of people with specific disabilities, and to accurately target prevention strategies. In addition, it is important to have some precise measures of disability so comparisons can be made between impairments, to identify disparities and differences, and to measure changes over time. We need to ensure that there is no confusion about cause and effect (attributing associated conditions as outcomes of disability when they are in fact the cause of the functional limitation) and that comparisons to people without disabilities are fair. If people who experience disability due to a condition such as obesity are included in the case definition of disability, then we cannot say people with disability are more likely to be obese. The credibility of disability epidemiology and the disability field is at stake.


Methodological issues in monitoring health services and outcomes for stroke survivors: A case study.

Stuart M, Papini D, Benvenuti F, Nerattini M, Roccato E, Macellari V, Stanhope S, Macko R, Weinrich M.  Health Administration and Policy Program, University of Maryland, Baltimore County, Baltimore, Maryland, USA.  Disabil Health J. 2010 Oct;3(4):271-81.

BACKGROUND:  Obtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum of understanding between the National Institutes of Health and the Istituto Superiore di Sanità (its Italian equivalent) to foster collaborative research on rehabilitation.

OBJECTIVE:  The purpose of this study was to pilot a methodology using administrative data to monitor and improve health outcomes for stroke survivors in Tuscany.

METHODS:  This study used qualitative and quantitative methods to study health resources available to and used by stroke survivors during the first 12 months poststroke in two Italian health authorities (AUSLs 10 and 11). Mortality rates were used as an outcome measure.

RESULTS:  Number of inpatient days, number of prescriptions, and prescription costs were significantly higher for patients in AUSL 10 compared with AUSL 11. There was no significant difference between mortality rates.

CONCLUSION:  Using administrative data to monitor process and outcomes for chronic stroke has the potential to save money and improve outcomes. However, measures of functional impairment and more sensitive outcome measures than mortality are important. Additional recommendations for enhanced data collection and reporting are discussed.


The dilemma of measuring perceived health status in the context of disability.

Krahn GL, Fujiura G, Drum CE, Cardinal BJ, Nosek MA; RRTC Expert Panel on Health Measurement. Oregon Health & Science University, Portland, Oregon 97239, USA.   Erratum in Disabil Health J. 2009 Jul;2(3):165. Disabil Health J. 2009 Apr;2(2):49-56. Epub 2009 Mar 20.

BACKGROUND:  Advances in the conceptual differentiation of health from disability have not been incorporated in popular measures of perceived health status. The inclusion of function in the measurement of health presents a dilemma for researchers assessing the perceived health of people with functional limitations.

OBJECTIVES:  The purposes of the present paper are to identify this problem in health measurement, describe its implications for disability and health researchers, and outline potential strategies for future measure development of perceived health status.

METHODS:  Reflecting the International Classification of Function, Disability, and Health, distinctions among the concepts of health, function, and disability are reviewed. Implications of confounded health measurement are discussed in terms of monitoring health status, assessing health disparities, using health as a mediator or moderator of other outcomes, and assessing effectiveness of interventions. The problem of function confounded with health measurement is illustrated with findings using the SF-36 with persons with spinal cord injury.

RESULTS:  Recommendations are provided for developing function-neutral measures of perceived health status.

CONCLUSION:  New measures of perceived health status are needed that do not confound function with health.


Reliability, validity, and scoring of the Health Status Questionnaire-12 version 2.0.

Barry TL, Kaiser KL, Atwood JR.  College of Nursing, Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198-5330, USA.  J Nurs Meas. 2007;15(1):24-35.

Measuring health status as an indicator of individual, population, and community health is critical in reducing health disparities in populations. The purpose of this study was to test the psychometric properties of the Health Status Questionnaire-12 (HSQ-12) Version 2.0, a brief self-reported health status instrument available within the public domain, in a low-income sample (N = 7,793). The internal consistency reliability was .88. Initial and confirmatory factor analysis revealed two factors explaining 67% of the variance, interpreted as super scales of physical and mental health. Second order factor analysis isolated one factor explaining 82% of the variance, interpreted as a total health status. Comparison of subjects with and without disabilities using t tests and the Mann-Whitney U Test showed that the scale, super scale, and total scale scores differentiated significantly. The HSQ-12 is a reliable, valid, and low-cost measure of health status.