Subjective/Objective Health Measures by Race/Ethnicity

描述（由申请人提供）：目的：种族和民族群体之间在主观健康测量方面的差异有据可查。然而，主观评估也因与种族/民族相关的混杂变量以及其他潜在的系统性偏倚来源（例如语言和/或文化）而不同。因此，一些最广泛使用的主观指标可能对美国所有亚群都无效。本研究旨在探讨SF-36的测量等效性（主观测量）和基于性能的测量（PBM）的身体功能指数（“金标准”），解决以下问题：1）是否存在结构等同性差异（测量不变性）在这些人群的主观测量和PBM; 2）是否有迹象表明，在种族/民族组的主观测量中存在项目功能差异（DIP）; 3）主观测量是否在各组中同样预测基于表现的测量（度量和标量等效），控制其他变量后;和4）是否有任何观察到的差异根据性别而变化？研究方法：将从克利夫兰和芝加哥的4家全科医学诊所和其他社区中心招募4个人种/种族组（非西班牙裔白人、非西班牙裔非洲裔美国人、讲英语的西班牙裔美国人、讲西班牙语的西班牙裔美国人; N=1320）中各约330例45-64岁的受试者。将由经过培训的临床研究助理对每例受试者进行SF-36（一项简短的人口统计学调查）和11项体力任务（上肢和下肢力量、耐力、敏捷性/灵巧性、步态和爬楼梯）。病历将被审查，慢性病和药物记录。本研究将使用结构方程模式、验证性因素分析、多元回归技术及项目反应理论进行资料分析。重要性：这项研究将是第一个验证身体功能和一般健康状况的主观措施，使用基于性能的“黄金标准”，包括中年英语和西班牙语的西班牙裔，增加了我们增长最快的种族人口的健康状况测量的知识。无论结果如何，研究结果都将为指导进一步研究提供启发性价值，并将为评估当前调查的变化提供指导。

DESCRIPTION (provided by applicant): Aims: Differences between racial and ethnic groups in subjective measures of health are well documented. However, subjective assessments also differ by confounding variables related to race/ethnicity as well as other potential sources of systematic bias, for example, language and/or culture. Hence, some of the most widely used subjective measures may not be valid across all sub-populations in the United States. This study examines measurement equivalence properties of the SF-36 (subjective measure) and a performance based measure (PBM) index of physical functioning ("gold standard") among several diverse racial/ethnic groups, addressing the following questions: 1) are there structural equivalence differences (measurement invariance) in the subjective measure and PBM across these populations; 2) are there indications of differential item functioning (DIP) within the subjective measure by racial/ethnic group; 3) does the subjective measure predict the performance-based measures equally across each group (metric and scalar equivalence), after controlling for other variables; and 4) do any observed differences vary according to gender? Methods: Approximately 330 subjects age 45-64 from each of the 4 racial/ethnic groups (non- Hispanic whites, non-Hispanic African-Americans, English-speaking Hispanics, Spanish-speaking Hispanics; N=1320) will be recruited from 4 general medicine clinics and other community centers in Cleveland and Chicago. The SF-36, a short demographic survey, and 11 physical tasks (upper and lower extremity strength, endurance, agility/dexterity, gait, and stair climbing) will be administered to each subject using trained clinical research assistants. Medical charts will be reviewed and chronic conditions and medications recorded. Data analysis using structural equation modeling, confirmatory factor analysis, multivariate regression techniques, and item response theory (IRT) will be used to investigate the above aims. Significance: This study will be the first to validate subjective measures of physical functioning and general health status using a performance-based "gold standard" including middle-age English and Spanish speaking Hispanics, adding to the knowledge of health status measurement of our fastest growing ethnic population. Regardless of outcome, results will provide heuristic value in directing further research, and will provide guidance in evaluating changes to current surveys.