Search tips
Search criteria 


Logo of pubhealthrepLink to Publisher's site
Public Health Rep. 2004 Sep-Oct; 119(5): 493–505.
PMCID: PMC1497661

Worsening trends in adult health-related quality of life and self-rated health-United States, 1993-2001.


OBJECTIVES: Health-related quality of life and self-rated health complement mortality and morbidity as measures used in tracking changes and disparities in population health. The objectives of this study were to determine whether and how health-related quality of life and self-rated health changed overall in U.S. adults and in specific sociodemographic and geographic groups from 1993 through 2001. METHODS: The authors analyzed data from annual cross-sectional Behavioral Risk Factor Surveillance System surveys of 1.2 million adults from randomly selected households with telephones in the 50 states and the District of Columbia. RESULTS: Mean physically and mentally unhealthy days and activity limitation days remained constant early in the study period but increased later on. Mean unhealthy days increased about 14% during the study period. The percentage with fair or poor self-rated health increased from 13.4% in 1993 to 15.5% in 2001. Health-related quality of life and self-rated health worsened in most demographic groups, especially adults 45-54 years old, high school graduates without further education, and those with annual household incomes less than $50,000. However, adults 65 years old or older and people identified as non-Hispanic Asian/Pacific Islander reported stable or improving health-related quality of life and self-rated health. In 18 of the states and the District of Columbia, mean unhealthy days increased, while only North Dakota reported a decrease. CONCLUSION: Population tracking of adult health-related quality of life and self-rated health identified worsening trends overall and for many groups, suggesting that the nation's overall health goals as identified in the Healthy People planning process are not being met.

Full Text

The Full Text of this article is available as a PDF (219K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP. The spread of the obesity epidemic in the United States, 1991-1998. JAMA. 1999 Oct 27;282(16):1519–1522. [PubMed]
  • Mokdad AH, Ford ES, Bowman BA, Nelson DE, Engelgau MM, Vinicor F, Marks JS. Diabetes trends in the U.S.: 1990-1998. Diabetes Care. 2000 Sep;23(9):1278–1283. [PubMed]
  • Friedman Daniel J, Starfield Barbara. Models of population health: their value for US public health practice, policy, and research. Am J Public Health. 2003 Mar;93(3):366–369. [PubMed]
  • Patrick DL, Bergner M. Measurement of health status in the 1990s. Annu Rev Public Health. 1990;11:165–183. [PubMed]
  • McHorney CA. Health status assessment methods for adults: past accomplishments and future challenges. Annu Rev Public Health. 1999;20:309–335. [PubMed]
  • Hennessy CH, Moriarty DG, Zack MM, Scherr PA, Brackbill R. Measuring health-related quality of life for public health surveillance. Public Health Rep. 1994 Sep-Oct;109(5):665–672. [PMC free article] [PubMed]
  • Ford Earl S, Mannino David M, Homa David M, Gwynn Charon, Redd Stephen C, Moriarty David G, Mokdad Ali H. Self-reported asthma and health-related quality of life: findings from the behavioral risk factor surveillance system. Chest. 2003 Jan;123(1):119–127. [PubMed]
  • Mili Fatima, Helmick Charles G, Moriarty David G. Health related quality of life among adults reporting arthritis: analysis of data from the Behavioral Risk Factor Surveillance System, US, 1996-99. J Rheumatol. 2003 Jan;30(1):160–166. [PubMed]
  • Greenlund Kurt J, Giles Wayne H, Keenan Nora L, Croft Janet B, Mensah George A. Physician advice, patient actions, and health-related quality of life in secondary prevention of stroke through diet and exercise. Stroke. 2002 Feb;33(2):565–570. [PubMed]
  • Valdmanis V, Smith DW, Page MR. Productivity and economic burden associated with diabetes. Am J Public Health. 2001 Jan;91(1):129–130. [PubMed]
  • Ford ES, Moriarty DG, Zack MM, Mokdad AH, Chapman DP. Self-reported body mass index and health-related quality of life: findings from the Behavioral Risk Factor Surveillance System. Obes Res. 2001 Jan;9(1):21–31. [PubMed]
  • Ounpuu S, Chambers LW, Chan D, Yusuf S. Validity of the US Behavioral Risk Factor Surveillance System's health related quality of life survey tool in a group of older Canadians. Chronic Dis Can. 2001;22(3-4):93–101. [PubMed]
  • Andresen EM, Fouts BS, Romeis JC, Brownson CA. Performance of health-related quality-of-life instruments in a spinal cord injured population. Arch Phys Med Rehabil. 1999 Aug;80(8):877–884. [PubMed]
  • Verbrugge LM, Merrill SS, Liu X. Measuring disability with parsimony. Disabil Rehabil. 1999 May-Jun;21(5-6):295–306. [PubMed]
  • Ahluwalia Indu B, Holtzman Deborah, Mack Karin A, Mokdad Ali. Health-related quality of life among women of reproductive age: Behavioral Risk Factor Surveillance System (BRFSS), 1998-2001. J Womens Health (Larchmt) 2003 Jan-Feb;12(1):5–9. [PubMed]
  • Vest Joshua R, Catlin Tegan K, Chen John J, Brownson Ross C. Multistate analysis of factors associated with intimate partner violence. Am J Prev Med. 2002 Apr;22(3):156–164. [PubMed]
  • Broyles RW, McAuley WJ, Baird-Holmes D. The medically vulnerable: their health risks, health status, and use of physician care. J Health Care Poor Underserved. 1999 May;10(2):186–200. [PubMed]
  • Figgs LW, Bloom Y, Dugbatey K, Stanwyck CA, Nelson DE, Brownson RC. Uses of Behavioral Risk Factor Surveillance System data, 1993-1997. Am J Public Health. 2000 May;90(5):774–776. [PubMed]
  • Bloom Y, Figgs LW, Baker EA, Dugbatey K, Stanwyck CA, Brownson RC. Data uses, benefits, and barriers for the behavioral risk factor surveillance system: a qualitative study of users. J Public Health Manag Pract. 2000 Jan;6(1):78–86. [PubMed]
  • Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed]
  • Dominick Kelli L, Ahern Frank M, Gold Carol H, Heller Debra A. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clin Exp Res. 2002 Dec;14(6):499–508. [PubMed]
  • Waidmann T, Bound J, Schoenbaum M. The illusion of failure: trends in the self-reported health of the U.S. elderly. Milbank Q. 1995;73(2):253–287. [PubMed]
  • Manton KG, Corder L, Stallard E. Chronic disability trends in elderly United States populations: 1982-1994. Proc Natl Acad Sci U S A. 1997 Mar 18;94(6):2593–2598. [PubMed]
  • Cutler DM. Declining disability among the elderly. Health Aff (Millwood) 2001 Nov-Dec;20(6):11–27. [PubMed]
  • Sorenson AW. A better understanding of health issues through population-based surveillance. Why surveys? Soz Praventivmed. 2001;46(6):349–351. [PubMed]
  • Martin AJ, Stockler M. Quality-of-life assessment in health care research and practice. Eval Health Prof. 1998 Jun;21(2):141–156. [PubMed]
  • Sartorius N. The economic and social burden of depression. J Clin Psychiatry. 2001;62 (Suppl 15):8–11. [PubMed]
  • Wilber Nancy, Mitra Monika, Walker Deborah Klein, Allen Deborah, Meyers Allan R, Tupper Paul. Disability as a public health issue: findings and reflections from the Massachusetts survey of secondary conditions. Milbank Q. 2002;80(2):393–421. [PubMed]
  • Ravens-Sieberer U, Gosch A, Abel T, Auquier P, Bellach BM, Bruil J, Dür W, Power M, Rajmil L. Quality of life in children and adolescents: a European public health perspective. Soz Praventivmed. 2001;46(5):294–302. [PubMed]
  • Vuitton DA. Le réseau régional de recherche en santé publique INSERM "PRISMAL" (perception, représentation et prise en charge des risques pour la santé en milieu rural). Sante Publique. 2003 Apr;15(Spec No):169–178. [PubMed]
  • Rao Jaya K, Anderson Lynda A, Smith Suzanne M. End of life is a public health issue. Am J Prev Med. 2002 Oct;23(3):215–220. [PubMed]

Articles from Public Health Reports are provided here courtesy of Association of Schools of Public Health