Exploring mental models behind self-rated health and subjective life expectancy through web probing

Abstract

Self-rated health (SRH) and subjective life expectancy (SLE) are widely used for understanding health and predicting mortality. However, what these items measure remains unclear, due to the lack of conceptual frameworks. We administered a web survey across the United States, Great Britain, Germany, Spain, and Mexico. The questionnaire included SRH and SLE, each immediately followed by a question that probed respondents’ thought processes. We examined the relationship between SRH and SLE, the response difficulty, and attributes that respondents considered for forming responses. Overall, SRH and SLE were moderately related, eliciting different information and varying in difficulty. Compared to SLE, SRH was perceived as easier but covered a narrower information spectrum. While illness and health behaviors were dominant attributes of SRH responses, family longevity history, life situations, and lack of control were additionally considered for SLE. When combined, SRH and SLE may capture a fuller range of attributes germane to health and mortality. Population aging has made mortality prediction an important scientific and policy topic for which two survey questions are often considered: self-rated health (SRH) and subjective life expectancy (SLE). However, with individuals lacking access to information about their own mortality, it is difficult to gather useful data. Moreover, few researchers have systematically examined these questions in tandem, instead conducting studies that rely on unverified aspects of mortality prediction based on these questions. Because of this, the field lacks a nuanced understanding of what SRH and SLE measure. This study focuses on improving our understanding about SRH and SLE, necessary for establishing their measurement frameworks. SRH asks respondents to rate their health and is by far the most popular health-related survey question (Fienberg et al. 1985). Shown to be a strong predictor of mortality, health outcomes, and care utilization (Idler and Benyamini 1997), SRH is recommended by health organizations (Hennessy et al. 1994). SLE, on the other hand, asks respondents to estimate their expectations about their own longevity and is administered in numerous aging-related surveys, such as the Health and Retirement Study in the United States (Perozek 2008). Like SRH, responses to SLE are shown to predict mortality (Siegel et al. 2003).