Health Measures and Health Inequality Over the Life Course

累积优势/劣势(CAD)假说预测，健康方面的教育差异会随着年龄的增长而增加。之前对这一假设的所有测试都是基于自我报告的健康衡量标准。最近的研究表明，自我报告的健康衡量标准可能不能充分反映关键分析概念的差异，包括教育、年龄、队列、性别和国家背景。这引发了人们对之前关于教育差异身体健康轨迹的研究结果的可靠性的怀疑，这些差异是通过受访者的自我评估来衡量的。该项目的总体目标是通过探讨自我报告和客观的健康措施在研究生命过程中的健康不平等方面的作用来解决这一问题。为了实现这一目标，该项目将分三个步骤进行。首先，该项目将揭示关于CAD假说的结论在多大程度上受到健康衡量标准的选择的影响。具体地说，该项目将通过比较自我报告的健康状况(例如自我评估的健康状况、自我报告的功能局限)和客观的健康衡量指标(例如握力、肺活量)来评估CAD假说。第二，该项目将检查健康衡量标准的有效性和可靠性是否具有社会分层，以及在多大程度上具有社会分层。具体地说，拟议的研究将比较(A)客观和自我报告的健康衡量标准与常见健康风险和死亡率的相关性有多强，以及(B)这些关系因教育、年龄、性别、队列和国家背景而有何不同。第三，该项目旨在开发自我报告和客观身体健康的新通用衡量标准。具体地说，该项目将使用潜变量模型，根据10多个观察者测量的健康结果的信息，构建一个客观的健康衡量标准，评估这一衡量标准的组间效度，并将其与自我报告的和混合的通用健康衡量标准进行比较。该项目将使用SOEP、ELSA和SHARE的纵向数据，不仅为德国和英国的情况提供证据，也为16个欧洲国家的直接国际比较提供证据。

The cumulative advantage/disadvantage (CAD) hypothesis predicts educational differences in health to increase with age. All previous tests of this hypothesis were based on self-reported health measures. Recent research has suggested that self-reported health measures may not adequately capture differences in key analytical constructs, including education, age, cohort, gender, and country context. This raises doubts about the robustness of previous findings on educational differences in physical health trajectories, as measured by respondents’ self-assessments. The overarching goal of this project is to address this issue by exploring the role of self-reported and objective health measures in research on health inequality over the life course. To reach this goal, the project will proceed in three steps. First, the project will uncover the extent to which conclusions about the CAD hypothesis are affected by the choice of health measures. Specifically, the project will evaluate the CAD hypothesis by comparing self-reported (e.g. self-rated health, self-reported functional limitations) and objective measures (e.g. grip strength, lung capacity) of health.Second, the project will examine whether and to what extent the validity and reliability of health measures are socially stratified. Specifically, the proposed research will compare (a) how strongly objective and self-reported measures of health are related to common health risks and mortality, and (b) how these relationships differ by education, age, gender, cohort, and national context.Third, the project aims to develop novel generic measures of self-reported and objective physical health. Specifically, the project will use latent variable modelling to construct an objective measure of health on the basis of information on more than 10 observer-measured health outcomes, evaluate this measure in terms of intergroup validity, and compare it with self-reported and mixed generic measures of health. Finally, the project will provide evidence on the CAD hypothesis using this novel health measure.The project will use longitudinal data from SOEP, ELSA and SHARE, providing evidence not only for the German and British context, but also for 16 European countries in direct international comparison.