Content area
Full text
Since the original study by Mossey and Shapiro in 1982, 1 many studies have shown that self-rated health (SRH) is associated with mortality, in various populations, even after adjusting for a variety of factors. 2 - 6
This measure, based on a single-item, is attractive because it is easy to use and refers to a wide, multidimensional definition of health. 3 However, SRH is strongly associated with physical and mental health status. 7 - 9 Singh-Manoux et al 7 showed in two large studies that physical and mental health status explained 34.7% and 41.4% of the variance in SRH respectively, suggesting that SRH could be a reasonable measure of objective health status.
However, as reported by Adams and White 10 SRH may also result from a balance between one's actual health status and the best health that one could expect for oneself. And expectations that people have about their health can vary according to several factors, such as socioeconomic status (SES), cultural or social issues, which can lead to differences in reporting health status for the same "objective" health status, and constitute a limitation of using SRH as an objective health measure. According to comparison processes theory, people compare themselves with others with whom they are socially alike. 11 12 As shown by Ross and Van Willigen, 13 socially advantaged groups, such as the well educated, have the highest expectations about their quality of life and health. Therefore, in the presence of the same illness, more highly educated people may experience a greater negative impact on their perceived health than lower educated people in whom expectations are lower. This phenomenon could lead to an underestimation of the health inequalities existing between socioeconomic groups when using SRH as an indicator of health.
Three recent papers have shown that the predictive value of SRH on subsequent mortality differed according to level of education: two studies showed that the predictive value was higher for high educated people 14 15 and one showed the opposite result. 16 But to our knowledge, little work has investigated how SES might modify the association between physical health status and SRH. The aim of this study was thus to assess the link between physical health status and SRH, according to socioeconomic position.
METHODS