title: Demographic variation in SF-12 scores: true differences or differential item functioning?
abstract: BACKGROUND
  Demographic differences have been reported in summary measures of physical and mental health based on the SF-12 instrument.
  
  
  OBJECTIVE
  This study examines the extent to which differential item functioning (DIF) contributes to observed subgroup differences in health status. DIF refers to situations in which the psychometric properties of items are not invariant across different groups. The presence of DIF confounds interpretation of subgroup differences.
  
  
  METHODS
  A national sample of 11,626 adult respondents in the 2000 Medical Expenditure Panel Survey who completed a self-administered questionnaire.
  
  
  METHODS
  In addition to the SF-12, we collected data on demographic characteristics (age, gender, education, and race/ethnicity) and whether the person had ever been diagnosed with six chronic medical conditions.
  
  
  RESULTS
  Multiple-indicator multiple-cause latent variable models showed significant differences in physical health by gender, age, and education. Adjusting for DIF reduced but did not eliminate age and education differences. However, for mental health, adjusting for DIF resulted in Black-White differences becoming nonsignificant, and the effect for the oldest age group switched from positive to negative. Race/ethnicity was not associated with physical health status.
  
  
  CONCLUSIONS
  Age group comparisons of mental health may be particularly affected by DIF. Differences in education, as well as age and gender, need to be controlled when making group comparisons. Additional work is needed to understand factors that give rise to demographic differences in reported health status.
authors.affiliation: Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, Rockville, Maryland 20852, USA. jfleishm@ahrq.gov
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.forename: William F
authors.initials: WF
authors.lastname: Lawrence
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology; D003710:Demography; D005006:Ethnicity; D005163:Factor Analysis, Statistical; D005260:Female; D019538:Health Care Surveys; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011594:Psychometrics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology