title: Using self-rated health for analysing social inequalities in health: a risk for underestimating the gap between socioeconomic groups?
abstract: BACKGROUND
  The use of self-rated health (SRH) for measuring health inequalities could present some limits. The impact of the same disease on SRH could be different according to health expectations people have which are associated with social characteristics. The aim of this study was to analyse the link between physical health status and SRH, according to level of education.
  
  
  METHODS
  Data from the National Health and Nutrition Examination Survey for the years 2001-4 were used. Multivariate logistic regression analyses were performed for assessing the relation between health status and SRH according to educational level.
  
  
  RESULTS
  The sample consisted of 4661 men and 4593 women. Reporting functional limitation was associated more strongly with poor SRH in higher educated women than in lower educated women (OR, 8.73, 95% CI 5.87 to 12.98 vs OR, 3.97, 95% CI 2.93 to 5.38 respectively), as was reporting respiratory disease (OR, 5.17, 95% CI 3.67 to 7.30 vs OR, 2.60, 95% CI 1.72 to 3.95 respectively), cardiovascular disease (OR, 9.79, 95% CI 6.22 to 15.40 vs OR, 3.34, 95% CI 2.29 to 4.87 respectively) and dental problems (OR, 4.37, 95% CI 3.22 to 5.92 vs OR, 2.58, 95% CI 1.97 to 3.39 respectively). Reporting functional limitation was associated more strongly with poor SRH in higher educated men than in lower educated men (OR, 7.71, 95% CI 5.04 to 11.79 vs OR, 4.87, 95% CI 3.30 to 7.18 respectively), as reporting oral problems (OR, 2.62, 95% CI 1.84 to 3.74 vs OR, 3.63, 95% CI 2.81 to 4.68 respectively).
  
  
  CONCLUSIONS
  The impact of health problems on SRH is stronger among better educated individuals. This phenomenon could lead to an underestimate of the health inequalities across socioeconomic groups.
authors.affiliation: INSERM U, Toulouse, France. delpier@cict.fr
authors.forename: C
authors.initials: C
authors.lastname: Delpierre
authors.forename: V
authors.initials: V
authors.lastname: Lauwers-Cances
authors.forename: G D
authors.initials: GD
authors.lastname: Datta
authors.forename: T
authors.initials: T
authors.lastname: Lang
authors.forename: L
authors.initials: L
authors.lastname: Berkman
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D015986:Confounding Factors, Epidemiologic; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012650:Self Disclosure; D012737:Sex Factors; D012923:Social Class; D014481:United States; D055815:Young Adult