OP105 Does socio-economic status modify how individuals perceive and/or describe their own health? An assessment of reporting heterogeneity in the health survey for England

Background

Self-reported health is widely used as a proxy for health status; it is a simple, holistic measure of health and has been associated with other health outcomes. However, these associations have not been uniformly found for all groups, leaving open the possibility of systematic reporting differences. Findings on reporting heterogeneity in self-reported health by socio-economic status have been mixed.

Methods

Using data from the 2017 and 2018 waves of the Health Survey for England (n=14,116), we assessed the interaction between deprivation quintile (measured by the Index of Multiple Deprivation 2015) and self-reported health (dichotomised as very good/good and fair/poor/very poor) in multiple linear regression models predicting EQ-5D score. EQ-5D is a health-related quality of life measure using population-derived values and was used as a proxy for ‘objective’ health. We tested the hypothesis that if there were no reporting heterogeneity, no interaction would be seen. Analyses were conducted in R, stratified by sex, and accounted for age group, ethnicity, and marital status.

Results

Significant interactions were found between deprivation quintile and self-reported health in predicting EQ-5D score for participants in the two most deprived quintiles. The coefficients indicated that people who reported themselves to be in poor health in the two most deprived quintiles had lower EQ-5D scores than would be predicted given their deprivation and self-reported health status, with differences ranging from –0.041 to –0.098. The largest difference for men was in the second most deprived quintile (–0.075, p<0.001), which is similar to the impact of age for 55–59 year olds (relative to the reference group, 16–19 year olds). The largest difference for women was in the most deprived quintile (–0.098, p<0.001), which is greater than the impact of age in age groups up to and including 80–84 year olds (relative to 16–19 year olds). A secondary analysis found no such interaction in models predicting body mass index.

Conclusion

This analysis indicates that people from more deprived areas who report themselves to be in poor health may have worse health scores as measured by EQ-5D than those from less deprived areas. This suggests that metrics based on self-reported health, such as healthy life expectancy in England, could potentially underestimate health inequalities.