Multivariate models of self-reported health often neglected essential candidate determinants and methodological issues.
OBJECTIVE
Self-reported health is an important indicator of overall well-being that may be influenced by diverse parameters. We intended to evaluate the variety of candidate determinants used in models of self-reported health (SRH) and to examine the methodological problems encountered in multivariate models used in recent studies in this field.


METHODS
Medline searches identified articles published in 2002 in which SRH was included as an outcome, at least one other variable was used as a determinant of SRH, and the study population was not defined by the presence of specific diseases.


RESULTS
Of 1,991 initially identified reports, 56 were eligible. In 91% of the eligible articles, multivariate models were used. In total, 133 different determinants of SRH were considered (median 7 determinants considered per study with multivariate models). The proportions of studies with problems in multivariate modeling were: overfitting, 10%; nonconformity to a linear gradient, 29%; no report of tests for interactions, 63%; unspecified coding of variables, 49%; and unspecified selection of variables, 29%.


CONCLUSIONS
Models that try to identify what influences SRH should consider appropriate lists of candidate determinants, with proper attention to methodological aspects of multivariate modeling.
Mantzavinis
Georgios D
GD
Department of Hygiene and Epidemiology, University of Ioannina, School of Medicine, Ioannina 45110, Greece.
Pappas
Noula
N
Dimoliatis
Ioannis D K
ID
Ioannidis
John P A
JP
D015340:Epidemiologic Research Design; D006304:Health Status; D006801:Humans; D015233:Models, Statistical; D015999:Multivariate Analysis; D011788:Quality of Life; D012647:Self-Assessment