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The method for estimating unhealthy days is supported by the actual
pattern of survey responses to two individual questions. The majority of
individuals report substantially different numbers of physically unhealthy
days versus mentally unhealthy days; for example, in the 1998 Behavioral
Risk Factor Surveillance System (BRFSS) 67.8% of the 68,619 adults who
reported any unhealthy days, reported only physically unhealthy days or
mentally unhealthy days, while 4.5% reported equal numbers for each
measure. Additional evidence indicates that other reported days do not
overlap; for example, 10.5% of the 256 persons who reported both 15
physically unhealthy days and 15 mentally unhealthy days also reported
more than 15 days of recent activity limitation due to poor physical or
mental health. An alternative calculation method that assumed a maximum
amount of overlap in the two responses (e.g., a person who reports 4
physically unhealthy days and 2 mentally unhealthy days is assigned a
value of 4 unhealthy days) was not as plausible from the overall response
pattern. Furthermore, this latter method resulted in only a 0.4-day
overall mean difference in unhealthy days compared with the recommended
method and showed similar demographic patterns and subgroup differences
with aggregated population data.
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Origins and Use of CDC HRQOL Measures and
Data
Since 1993, the four core Healthy Days measures have been part of the
state based BRFSS's full sample. Also starting in 2000, the Healthy Days
Measures were added to the examination component of the National Health
and Nutrition Examination Survey (NHANES). The demonstrated value of these
measures and the continuous accumulation of public domain data have
resulted in support from the CDC Disability, Women's Health, and Arthritis
Programs. The HRQOL measures and data have also been used for research or
program planning by CDC's Cardiovascular Health and HIV/AIDS Programs as
well as by the Public Health Foundation, the Foundation for
Accountability, and several other government and academic programs.
In recent years, several organizations have found these Healthy Days
measures useful at the national level for (1) identifying health
disparities, (2) tracking population trends, and (3) building broad
coalitions around a measure of population health compatible with the World
Health Organization's definition of health.
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"Health is a state of complete physical,
mental, and social well-being, and not merely the absence of
disease or infirmity."
— World Health Organization, 1948 |
One of the greatest anticipated uses of the BRFSS Healthy Days measures
and data is at the state and local levels for tracking overall progress on
achieving the two major goals of Healthy People 2010:
- Increase quality and years of healthy life
- Eliminate health disparities
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SAS, SPSS & SUDAAN syntax
SAS, SPSS, and SUDAAN syntax to correctly
recode and/or create the Healthy Days Measures. For additional questions
about the syntax, please send the Health-Related Quality of Life
Assessment staff a message please contact us.
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Measurement Properties
Publications on the validity, reliability, and responsiveness of the
Healthy Days questions.
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