Self-rated health and healthy days: Examining the “disability paradox”

Charles E. Drum, J.D., Ph.D., Willi Horner-Johnson, Ph.D., Gloria L. Krahn, Ph.D., M.P.H.

Oregon Institute on Disability & Development, Oregon Health & Science University, Portland, OR 97201-0574, USA

Disability and Health Journal, April 2008 Volume 1, Issue 2, Pages 71–78



There is an important need to better understand how self-evaluations of health are reached among people with and without disabilities. The purpose of the present study was to use epidemiological data to confirm differences in self-rated health and health-related quality of life among people with and without disabilities, and to demonstrate that disability status influences how one thinks about self-rated health.


Secondary analysis of cross-sectional data from the Behavioural Risk Factor Surveillance System (BRFSS). Health-related quality of life (HRQOL) core questions were asked, including self rated health, and the Healthy Days Index. Participants consisted of 303,822 adults (18 or older) from all states, the District of Columbia, and all U.S. territories who responded to the BRFSS in 2004.


Adults who self-reported an activity limitation or use of adaptive equipment reported poorer self-rated health, more recent days when physical health or mental health was not good, and fewer healthy days. Within the same SRH category, people with disabilities reported significantly more recent days when physical health was not good, more days when mental health was not good, and fewer healthy days than people without disabilities.


The findings suggest that people with disabilities may construct health or the self-rating process differently than persons without disabilities. Further understanding of the underlying process of health and HRQOL self-assessment may help elucidate the meaning of self-rated health among adults with and without disabilities. This conceptual disentangling of health from disability is necessary to track the achievement of national health objectives.