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Electronic Letters to:
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eLetters: Electronic letters published:
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Support for Composite Measures
- Mary L Adams, Douglas Shenson (26 February 2006)
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Mary L Adams, Consultant On Target Health Data LLC, Douglas Shenson
Send letter to journal:
targetsmom{at}cox.net Mary L Adams, et al.
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In the January Commentary article “Health Measurement in the Third Era of Health”(1) Breslow proposes creation of a set of indicators to provide a comprehensive view of a revised concept of “health”. And because health behaviors have an effect on future health, measurement of such behaviors needs to be included in this set of health measures. He suggests that population based health surveys be utilized to compile various measures for an individual that are combined into a form of “index” to provide a better summary of the health of the population. We couldn’t agree more, and offer some examples of such composite measures using survey data from the Behavioral Risk Factor Surveillance System (BRFSS). Combining all six cardiovascular disease risk factors (smoking, overweight, high blood pressure, high cholesterol, inadequate physical activity, and diabetes) as few as 15% of all adults are “healthy” in the sense of not reporting any of the risk factors (2,3). Cancer risk factors were measured in a similar way in some states (4,5), finding that fewer than 5% of all adults reported none of the selected modifiable risk factors for cancer. In a similar manner, we have been examining the receipt of clinical preventive services by measuring the percent of older adults who are “up- to-date” according to the US Preventive Services Task Force recommendations(6). Receipt of individual services tend to be relatively high (>50%) while the percent of older adults who are up-to-date according to the recommendations (and using available data) is low. In 2002, the percent of older adults that were “up-to-date” using our composite measure ranged from 21.1% for women age 50–64 (for Pap, Mammography, colon cancer screening and influenza vaccination) to 39.6% for men age 65 and older, (for colon cancer screening and pneumonia and influenza vaccination). Our results suggest the need for considerable improvement. We also support Breslow’s suggestion that surveys consider measurements that can be combined into an index that will better measure the comprehensive health status of the individual. Such measures could also be used to monitor the delivery of clinical preventive services or the effectiveness of public health interventions. Some consensus on which separate measures to include and the criteria to use will be critical for any type of index to be useful. Mary L. Adams MS, MPH Douglas Shenson, MD, MPH, MS References 1. Breslow, L. Health Measurement in the Third Era of Health. Am J Pub Health 96: 17-19. 2006. 2. Adams, ML Cardiovascular Disease Risk Factors in Wyoming: Results from the 2003 Wyoming Behavioral Risk Factor Surveillance System, Cheyenne, WY, July 2004. http://wdh.state.wy.us/brfss/pdf/WY03CVDreportFINAL.pdf 3. Cardiovascular Disease Risk Factors and Preventive Practices Among Adults -- United States, 1994. A Behavioral Risk Factor Atlas. MMWR Vol 47, No SS5;35 4. Adams, ML. Connecticut Behavioral Health Risks: Factors Related to Cancer, CT Dept of Public Health, Hartford CT, January 2000. 5. Adams, ML Cancer Risk Factors in Wyoming: Results from the 2003 Wyoming Behavioral Risk Factor Surveillance System, Cheyenne, WY, August 2004. 6. Douglas Shenson, Julie Bolen, Mary Adams, Laura Seeff, Donald Blackman. Are Older Adults Up- To-Date with Cancer Screenings and Vaccinations? Preventing Chronic Disease: Public Health Research, Practice, and Policy. Volume 2: No. 3, July 2005. www.cdc.gov/pcd |
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