Do self-reported data accurately measure health inequalities in risk factors for cardiovascular disease?

• Published in: International Journal of Public Health
• Main Authors: Kislaya, Irina, Perelman, Julian, Tolonen, Hanna, Nunes, Baltazar
• Format: Article in Journal/Newspaper
• Language: English
• Published: Springer 2020
• Subjects: Health Inequalities; Health Examination Survey; Hypertension; Hypercholesterolemia; Measurement Error; Estados de Saúde e de Doença; Norway; Iceland
• Online Access: http://hdl.handle.net/10400.18/6583; https://doi.org/10.1007/s00038-019-01232-1

Objectives: This study aimed to compare the magnitude of educational inequalities in self-reported and examination-based hypertension and hypercholesterolemia and to assess the impact of self-reported measurement error on health inequality indicators. Methods: We used the Portuguese National Health Examination Survey data (n = 4911). The slope index of inequality (SII) and the relative index of inequality (RII) were used to determine the magnitude of absolute and relative education-related inequalities. Results: Among the 25-49-year-old (yo) men, absolute and relative inequalities were smaller for self-reported than for examination-based hypertension (SIIeb = 0.18 vs. SIIsr = - 0.001, p < 0.001; RIIeb = 1.99 vs. RIIsr = 0.86, p = 0.031). For women, the relative inequalities were similar despite differences in self-reported and examination-based hypertension prevalence. For hypercholesterolemia, self-reported relative inequalities were larger than examination-based inequalities among the 50-74-yo men (RIIsr = 2.28 vs. RIIeb = 1.21, p = 0.004) and women (RIIsr = 1.22 vs. RIIeb= 0.87, p = 0.045), while no differences were observed among 25-49-yo. Conclusions: Self-reported data underestimated educational inequalities among 25-49-yo men and overestimated them in older individuals. Inequality indicators derived from self-report should be interpreted with caution, and examination-based values should be preferred, when available. The Portuguese National Health Examination Survey (INSEF) was developed as part of the Pre-defined project of the Public Health Initiatives Program, “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, that benefits from a 1.500.000€ Grant from Iceland, Liechtenstein and Norway through the EEA Grants and by Portuguese Government. info:eu-repo/semantics/publishedVersion