[Work Group Health Status Indicators; standardization of the study on quality of life related to health status].
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Health Status Indicators↗
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Diabetes-related inequalities in health status and financial barriers to health care access in a population-based study.
AIMS: We evaluated the relationship between diabetes, health status, household income and expenditure on health care in the general population in Trinidad. METHODS: Multistage sampling of 300 households was used to select a sample of 548 adults aged > or = 25 years. There were 64 (12%) who reported a diagnosis of diabetes. Comparison was made with 128 non-diabetic controls who were frequency matched for age and sex. RESULTS: Subjects with diabetes had lower income levels than non-diabetic controls [income < or = US dollars 533 per month for 66% diabetes cases and 48% controls, test for trend P = 0.007]. Compared with controls, subjects with diabetes were less likely to have good or very good self-rated health (diabetes 32%, controls 67%; P < 0.001), and more frequently reported long-standing illness, limitation of activities, visual impairment, or self-reported history of high blood pressure, angina or heart attack. Subjects with diabetes (11%) were less likely than controls (30%) to have private health insurance (P = 0.005). Diabetic subjects (35%) were more likely than controls (16%) to have incurred expenditure on doctors' services in the last 4 weeks (P = 0.021). CONCLUSIONS: Diabetes is associated with worse health status and more frequent expenditure on medical services but greater financial barriers to access in terms of low income and lack of health insurance. Policies for diabetes should specifically address the problem of income-related variations in risk of diabetes, health care needs and barriers to uptake of preventive and treatment services, otherwise inequalities in health from this condition may increase.
Adult↗
Demographic and health status indicators to guide health promotion for Hispanic and Anglo rural elderly.
Naturally occurring differences rather than simple breakdowns by ethnic category are being used to tailor strategies in a three year senior community health worker-delivered health promotion intervention. A survey conducted of persons 60 and over in a rural southwestern U.S. community identified New Anglos (recent settlers, n = 264), Old Anglos (long-time residents, n = 298) and Hispanics (n = 236) for a total of 798 persons. Significant demographic differences included less education, poorer health status and more chronic conditions among Hispanics. Low rates of screening were the norm but especially severe among Old Anglos. Patterned differences in health practices, as well as group variations in use of resources and sources of information, revealed New Anglos used a larger variety of services and media. Generally, adjustments being made are related to Hispanic culture, cosmopolitan orientation of the New Anglos, and long-term isolation from information and services for Old Anglos.
Aged↗
The impact of obesity on health status: some implications for health care costs.
Obesity (defined as a body mass index > 30 kg/m2) is common in middle-aged Europeans. The prevalence is notably high in women from Mediterranean and Eastern European countries. In most European countries the prevalence of obesity has been shown to be increasing. When the impact of obesity on health status is assessed this should be done at many levels. Not only should be looked at mortality or diseases and disorders associated with obesity. Physical functioning and quality of life are also of great importance although they may not be bound to any specific diagnosis. Mobility disability has been shown to be more strongly related to obesity than the association between obesity and mortality. Estimation of direct health care costs attributable to obesity vary between 1-5% of the total health care expenditure depending on the definition of obesity and the methods for calculating these costs. This ranks obesity among the major determinants of health care costs.
Adolescent↗
Mode of payment as a predictor of health status, use of health services and preventive health behavior: a report from the Los Angeles Health Survey.
Several issues relevant to Health Maintenance Organizations (HMOs) were examined in this article using data collected from the Los Angeles Health Survey. No support was found for the hypothesis that HMOs disproportionately attract people in poorer health. In fact, HMO members actually reported lower rates of acute or occasional illness and disability than fee-for-service subscribers (FFS). HMO members also reported lower total family incomes and educational status than FFS subscribers and they were less likely to report having a regular doctor. Few differences were found between the two groups in reports of using health services and practicing preventive health behavior. However, HMO members were more likely to report a recent physical examination--but only after taking into account the fact that they were less likely to have a regular doctor. It has been shown that these findings are consistent with recent evidence, and serve to amplify serveral key findings reported in other studies.
Adolescent↗
Iron status, erythropoiesis, meat colour, health status and growth performance of veal calves held on and fed straw.
Two experiments were designed to study the iron (Fe) status in veal calves (62 intact males) fed and held on straw. In experiment 1, two groups were fed 20 mg Fe/kg milk replacer (MR) and held unattached on rye or barley straw litter. In experiment 2, groups were fed 20 mg Fe/kg MR and held unattached on rye straw litter or on sawdust or attached on wooden slatted floors without straw litter or were fed 50 mg Fe/kg MR and held unattached on sawdust. Fe concentrations in tested straw sorts (rye, barley, wheat, triticale) were similar and ranged from 15 to 85 mg Fe/kg dry matter. Growth performance and health status were not significantly influenced by Fe intake through MR or straw. Straw intake in the group fed straw was greater (P < 0.01) at the end than at the start of the growth period, but intake of different straw sorts was similar. Calves fed 20, but not those fed 50 mg Fe/kg MR, developed marked hypoferraemia, but only moderate anaemia. Total iron binding capacity (TIBC) was significantly (P < 0.05) and transferrin (Tf) concentration was numerically higher in calves fed 20 than in those fed 50 mg Fe/kg MR on slaughter day. TIBC and Tf were positively correlated (r = 0.63). Haemin concentration and lightness of m. rectus abdominis were significantly (P < 0.01), whereas myoglobin concentration was numerically greater in calves fed 50 than in those fed 20 mg Fe/kg MR. In conclusion, haematological and blood chemical parameters and meat colour were influenced only by high Fe intake through MR, but not if calves were held on straw litter or were fed straw.
Anemia, Iron-Deficiency↗
[Study on health status and oral hygiene of children at a primary school. Health status and oral hygiene in schoolchildren].
The Authors refer about a research made in a primary school after checking mouth sickness in school boys. The research concerns three periods: 1st. medicaL examination, 2 nd. instructions about a correct oral hygiene, 3 rd. anew inspection. The conclusions they made, are the following: now only the children know what they must do for their teeth in order to avoid mouth sickness and how to prevent then, but also their parents and often their teachers are not sensitive to this problem. So it is necessary that the prevention work begun by the dentist, will be carried on by parents and by teachers.
Age Factors↗
A computer model of health status and costs in national health planning.
We developed a computer model which measures the impact of disease on a population, has the ability to track changes in disease incidence over time, and incorporates costs of disease prevention and treatment. This model was developed with data for Malaysia and used by the Ministry of Health in the development of their national health plan. The model uses the DHLL (DALY) measure which incorporates morbidity and mortality impacts of disease. The ability of the model to adjust for changes in disease incidence over a period of years allows health planners to accurately reflect demographic and development related changes in disease incidence. This model is of value to health planners because in incorporates information on population health status, costs of prevention and treatment, and changes in health status over time. It produces an evaluation of the cost effectiveness of possible interventions that can be used by health planners in making decisions on resource allocation.
Computer Simulation↗
Cross-cultural comparisons of health status in Canada using the Health Utilities Index.
OBJECTIVE: The purpose of this study was to examine the differences in health status, as measured by the Health Utilities Index (HUI), among seven cultural groups in Canada defined by place of birth and language. DESIGN: The study analysed cross-sectional data from the National Population Health Survey conducted by Statistics Canada in 1994-95. RESULTS: Age-standardized prevalence of dysfunction, defined as HUI < 0.83, varied from 12.7% in English-speaking immigrants to 17.8% in French-speaking Canadians. Considerable differences between the groups were found in the reporting of pain, emotional function, and cognitive function. The variation in HUI scores across the cultural groups could not be explained by differences in socioeconomic status and self-reported chronic conditions. CONCLUSIONS: Although the healthy immigrant effect is probably responsible for some of the variation in health status among cultural groups in Canada, considerable differences exist within the immigrant and Canadian-born populations. Cultural factors may have a substantial effect on the reporting of pain and mental health problems. Further studies are needed to determine the cross-cultural validity of the HUI.
Canada↗
Patient reports of health status as predictors of physiologic health measures in chronic disease.
Accurate assessment of health status and forecasting of risk for poor outcomes in chronic disease require a broad representation of health measures. To support this conclusion, the health of patients with diabetes (N = 73) and hypertension (N = 105) was assessed using measures of physical and role functioning, perceived health, and disease severity (blood sugar or diastolic blood pressure, respectively, for diabetes and hypertension). Health questionnaires measuring functional limitations, overall health rating, level of health concern, perceived susceptibility to illness, and number of health problems were administered at study enrollment. Laboratory tests for blood sugar (hemoglobin A1) and diastolic blood pressures were performed at enrollment and were repeated at a subsequent clinic visit, from 3 to 6 months later. Functional limitations correlated significantly with elevated blood sugar (r = 0.57) and blood pressure (r = 0.49) at study enrollment. Perceived poor health was not substantially related to either physiologic measure at enrollment. Using ordinary least squares regression, the best predictor of both blood sugar and blood pressure at follow-up was baseline blood sugar and blood pressure, respectively. However, both functional limitations and perceived poor health made significant and independent contributions to the prediction of blood sugar and blood pressure at follow-up. The results underscore the value of both health survey measures and clinical measures in studies of chronic disease.
Blood Glucose↗
Factors explaining disability-free life expectancy in Japan: the proportion of older workers, self-reported health status, and the number of public health nurses.
BACKGROUND: Disability-free life expectancy (DFLE) data for 47 prefectures in Japan were reported in 1999; however, few studies have identified the factors associated with the length of the DFLE. The objective of this study was to elucidate the primary factors that explain differences in DFLEs in Japan. METHODS: In our ecological study, 47 prefectures in Japan were used as units of analysis. The DFLEs for men and women at 65 years of age (DFLE65), calculated by Hashimoto et al using Sullivan's method, were set as dependent variables. From various national surveys, 181 factors associated with demographics, socioeconomic status, health status and health behaviors, medical environment, social relationships, climate, and other areas were gathered as independent variables. Pearson's or Spearman's correlation coefficients were calculated to screen independent variables potentially associated with the DFLE65s. Then, multivariate linear regression analyses were conducted for the selected 24 independent variables after adjusting for the proportion of older people (65 years or more) and population density. RESULTS: Multivariate linear regression analyses revealed that the large number of public health nurses per 100,000 population, a good self-reported health status, and a high proportion of older workers were significantly associated with long DFLE65s for both genders. CONCLUSIONS: These three factors could potentially explain the differences in DFLE of the older population in Japan.
Aged↗
Aggregate Health Status: a benchmark index for community health.
A qualitative review of population health assessment models used throughout the United States and Canada indicate both individual and community-level domains of health. Individual-level domains of health include health habits, education, public safety, environment, social, government, culture, and mobility. Community-level domains include the same general health domains but aggregated to the community level Aggregate Health Status (AHS). In the development of the AHS portion of our model, the dependent variable was the general health question from the Medical Outcomes Study. The remainder of the survey was partitioned into mutually exclusive individual measure subsets. A linear combination of these global variables then produces a single estimate relating the multiple domains of the broader determinants of health to health status. This global variable uniquely discriminates between the five categories of general health. This model serves as a framework and benchmark indicator that (1) provides a summary indicator of the overall health status of the population, (2) is broadly representative of populations rather than individuals, (3) is a population perspective rather than a provider perspective, and (4) emphasizes outcomes versus inputs and processes.
Benchmarking↗
An examination of self-reported chronic conditions and health status in the 2001 Medicare Health Outcomes Survey.
OBJECTIVES: To estimate the prevalence of chronic conditions in managed care-enrolled Medicare seniors (age 65 years plus) and to examine the association between self-reported chronic conditions and health status, as measured by the SF-36. METHODS: Data were obtained from the 2001 Medicare Health Outcomes Survey (HOS). The HOS is conducted to assess the quality of care provided to Medicare beneficiaries enrolled in managed care. The survey questionnaire, which was administered by phone or mail, includes the SF-36 and items addressing demographic characteristics, depressive symptoms, and chronic conditions. The SF-36 produces eight multi-item scale scores and physical and mental component summary scores. For this analysis, an ordinary least squares regression model was conducted using the SF-36 scales and summary scores as dependent variables to estimate the association between each chronic condition and the scale scores after adjusting for demographic variables. RESULTS: More than three-fourths of the respondents had at least one chronic condition. Among the conditions, hypertension (56.6%) arthritis of the hip or knee (39.7%) and arthritis of the hand or wrist (33.3%) were the most commonly reported. Compared with other variables, age and arthritis were most highly associated with the SF-36 measures reflective of physical health. Depressive symptoms had the strongest association with the SF-36 measures most reflective of mental health. Among the chronic conditions, the adverse impact of having difficulty in controlling urination, a relatively neglected condition, was only second to depressive symptoms in its negative relationship with vitality, social-functioning, and mental health. CONCLUSION: Chronic conditions were commonly reported among the older adults. The unique associations found between chronic conditions and domains of health status demonstrate the importance of examining the burden of these conditions in terms of functioning and well-being. The findings of this study may help inform decision making at the patient, health plan, and societal levels.
Adult↗
Health status of and access to health services by residents of urban encampments in Los Angeles.
This paper reports findings from a survey of 134 homeless people living in 42 urban encampments in central Los Angeles. These data, of concern to public health officials, include the physical conditions in the camps, the health status of residents, their use of drugs and alcohol, and their access to and use of health care services such as substance abuse treatment. Many encampment residents report poor health status; over 30 percent report chronic illnesses, and 40 percent report a substance abuse problem. Although outreach efforts have had success in bringing HIV and tuberculosis screening services to encampments, residents report significant barriers to using primary health care and drug and alcohol treatment services. Public hospitals and clinics remain the major source of primary medical care for homeless people living in encampments. Outreach and case management continue to be critical components of improved access to health care for homeless people.
Adult↗
A comparison of the socioeconomic and health status characteristics of uninsured, state Children's health insurance program-eligible children in the united states with those of other groups of insured children: implications for policy.
OBJECTIVES: To describe the sociodemographic and health status characteristics of the national uninsured, State Children's Health Insurance Program (SCHIP)-eligible population, and to compare this population with Medicaid-enrolled children, privately insured children, and privately insured children who have family income in the SCHIP eligibility range. PROCEDURES: Data were analyzed for 50 950 children 0 to 18 years of age included in the 1993 and 1994 National Health Interview Surveys. The survey obtained information on insurance coverage and sociodemographic and health status measures. Bivariate analyses were conducted to identify the relationships between SCHIP eligibility and sociodemographic and health status characteristics. Multivariate analyses were conducted to assess the independent association of the sociodemographic and health status variables with the likelihood of being uninsured, SCHIP-eligible. PRIMARY FINDINGS: Results indicate that SCHIP children exhibit markedly different socioeconomic and health status characteristics than do both Medicaid- enrolled and privately insured children, although these differences are less significant in privately insured children. SCHIP children more often live with college- educated (39.4%) and employed adults (91.2%) than do Medicaid-enrolled children (23.0% and 53.9%, respectively). However, SCHIP children live with college-educated and employed adults less than do all privately insured children (66.7% and 96.9%, respectively) and privately insured/same-income children (57.8% and 97.0%, respectively). Parents of SCHIP-eligible children are also disproportionately self-employed or employed in industries (e.g., retail trade) and occupations in which health insurance coverage is less available or affordable. SCHIP-eligible children are also 2 times more likely to be adolescents and 11/2 times more likely to be in excellent health than Medicaid-eligible children. Compared with privately insured children, SCHIP-eligible children are nearly 3 times more likely to be Hispanic and nearly 2 times more likely to be rated in fair or poor health. CONCLUSIONS: The results demonstrate that uninsured, SCHIP-eligible children are substantially different from children in these groups, particularly compared with Medicaid-enrolled children. These differences need to be taken into account when setting policies and implementing programs intended to increase health insurance coverage and access to health care.
Adolescent↗
Health status and the demand for health. Results on price elasticities.
The relationship between measured health status and the elasticity of demand for ambulatory physician services is estimated using data from the National Medical Care Utilization and Expenditure Survey (NMCUES). Although the theoretical relationship between health status and demand elasticity is ambiguous, results obtained in this study suggest that declines in health reduce the elasticity of the initial decision to seek care, but have no discernible effect on the elasticity of demand at mean levels of consumption. These results are consistent with the findings of Rand's HIE, and suggest that consumer price sharing has little effect on initial access to physicians for those in poor health.
Ambulatory Care↗
[Health status of the population of a large city's residential area. II. Health status].
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Persons with Disabilities↗
The persistent impact of breast carcinoma on functional health status: prospective evidence from the Nurses' Health Study.
BACKGROUND: Although physical and emotional function after the diagnosis of breast carcinoma have been described in clinic populations, to the authors' knowledge no previous study has measured change from the preillness level of functional health status in community-dwelling women. METHODS: The authors conducted a 4-year (1992-96) prospective study of functional recovery after breast carcinoma in a large sample of women, aged 54-73 years. They collected multidimensional measures of self-reported functional health status in 1992, before diagnosis of breast carcinoma, and again in 1996, to examine the risk of decline associated with incident breast carcinoma. RESULTS: After adjustment for age, baseline functional health status, and multiple covariates, women who developed incident breast carcinoma were more likely to have experienced reduced physical function, role function, vitality, and social function and increased bodily pain compared with women who remained free of breast carcinoma. Risk of decline was attenuated with increasing time since diagnosis. Risk of decline in physical function was evident across all stages of breast carcinoma, even after adjustment for women undergoing treatment for persistent or recurrent disease. We found evidence that the risk of decline among breast carcinoma cases compared with healthy women was largest among those who were most socially isolated. CONCLUSIONS: Breast carcinoma results in persistent declines in multiple dimensions of functional health status. These prospective data suggest that previous studies reporting no difference in physical function among breast carcinoma cases compared with disease free women underestimated the deleterious effect of the disease on function. Socially isolated women are an especially vulnerable group.
Adult↗