Measuring Population Health: Correlates of the Health Utilities Index among English and French Canadians
Kopec, Jacek A, Williams, J Ivan, To, Teresa, Austin, Peter C, Canadian Journal of Public Health
This study used cross-sectional data from the 1994/95 National Population Health Survey (NPHS) in Canada. The objective of the study was to examine the relationship between several established correlates of health status in the general population and the Health Utilities Index (HUI), a multidimensional, preference-based measure of health status. Analyses were carried out separately for the English-speaking (n=9,853) and French-speaking (n=1,519) respondents. The index correlated strongly with selfratings of health status and functional disability and varied as expected according to age, sex, and income. Subjects classified to different categories of chronic conditions reported different levels of health, as predicted. The HUI was also associated with the use of drugs and recent history of hospitalization. No major differences in the findings were observed between the two cultural groups. The results should be treated with caution due to the cross-sectional design and other methodological limitations of the study.
Cette etude est basee sur un echantillon de donnees provenant de l'Enquete nationale sur la same de la population de 1994-95 au Canada. L'enquete avait pour objectif d'examiner la relation entre divers correlate acceptes pour l'etat de same de la population en general et de l'Indice de 1'etat de same (IES) qui est une mesure multidimensionnelle de l'etat de same basee sur la preference. Les analyses etaient effectuees separement pour les personnes interrogees anglophones (n = 9 853) et francophones (n = 1 519). L'indice correspondait nettement aux autoevaluations de l'etat de la same et de finvalidite fonctionnelle et, conformement aux attentes, differait d'apres Page, le sexe et le revenu. Comme prevu, les sujets classes dans des categories differentes d'etats chroniques signalaient des degree de santa differents. LIES etait egalement associe a (usage de medicaments et aux hospitalisations recentes. Aucune difference majeure n'a ete constatee entre les deux groupes culturels. Les resultats devraient etre traites avec prudence etant donne qu'ils etaient bases sur un echantillon et que l'etude avait d'autres restrictions methodologiques.
In the last two decades, there has been a growing interest in the application of multidimensional, preference-based health indices in evaluating population health and assessing the impact of health services.' Preference-based measures are intended to reflect people's preferences for different health states on a scale where 0 indicates being dead and 1 indicates being in perfect health.' Examples of such indices include the Quality of Well-Being,' the EQ SD (EuroQol)6 and the Health Utilities Index (HUI).78
The HUI has been developed by Torrance and colleagues at McMaster University. Previous versions of the index (Mark 1 and 2) were designed for clinical studies in children with specific health problems.9-" The current Mark 3 system is a generic measure of health status which provides the description of an individual's functional health based on eight attributes: vision, hearing, speech, mobility, dexterity, cognition, emotion, and pain/discomfort, with 5 or 6 levels per attribute8 (Appendix). With respect to each attribute, a person is first classified into an appropriate level of function. Each level of function is associated with a different preference score, derived from a community sample. To combine the attribute-specific preferences into an overall health utility score, a mathematical formula (scoring function) is used. The formula is based on a multiplicative model of interactions between the attributes, derived from multi-attribute utility theory.31
The HUI can be used as an outcome measure in clinical studies or a population health index. Some properties of the index in patients with specific conditions have been examined. 12-15 The test-retest reliability of the HUI in a general population sample was studied by Boyle et al. …