The impact of symptoms and impairments on overall health in US national health data.
OBJECTIVE
To assess the effects on overall self-rated health of the broad range of symptoms and impairments that are routinely asked about in national surveys.


METHODS
We use data from adults in the nationally representative Medical Expenditure Panel Survey (MEPS) 2002 with validation in an independent sample from MEPS 2000.


METHODS
Regression analysis is used to relate impairments and symptoms to a 100-point self-rating of general health status. The effect of each impairment and symptom on health-related quality of life (HRQOL) is estimated from regression coefficients, accounting for interactions between them.


RESULTS
Impairments and symptoms most strongly associated with overall health include pain, self-care limitations, and having little or no energy. The most prevalent are moderate pain, severe anxiety, moderate depressive symptoms, and low energy. Effects are stable across different waves of MEPS, and questions cover a broader range of impairments and symptoms than existing health measurement instruments.


CONCLUSIONS
This method makes use of the rich detail on impairments and symptoms in existing national data, quantifying their independent effects on overall health. Given the ongoing availability of these data and the shortcomings of traditional utility methods, it would be valuable to compare existing HRQOL measures to other methods, such as the one presented herein, for use in tracking population health over time.
Stewart
Susan T
ST
Program for Health Systems Improvement, Harvard University, Cambridge, Massachusetts, USA. sstewart@nber.org
Woodward
Rebecca M
RM
Rosen
Allison B
AB
Cutler
David M
DM
D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001294:Attitude to Health; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D005221:Fatigue / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000523:psychology; D011788:Quality of Life; D012044:Regression Analysis; D015203:Reproducibility of Results; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States