Methods and Limitations
The percentages of U.S. adults aged 18 years or older with diabetes who reported fair or poor general health or at least 1 day in the past 30 days of poor mental health, poor physical health, and inability to do usual activities were determined using data from the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS, an ongoing, yearly, state-based telephone survey of the noninstitutionalized adult population in each state, provides state-specific information about behavioral risk factors for disease and preventive health practices.
Respondents were considered to have diabetes if they responded yes to the question, Has a doctor ever told you that you have diabetes? Women who indicated that they only had diabetes during pregnancy were not considered to have diabetes. Responses to the following questions were used to determine the prevalence of poor mental and physical health and inability to do usual activities among persons with self-reported diabetes: Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?; Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?; During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?. We also combined information on mental health and physical health to estimate the percentage of adults with diabetes having either poor mental or physical health as well as having both poor mental and physical health. Prevalence of fair-poor general health was determined by fair or poor responses to the question: Would you say in general your health is...? Three-year averages were used to improve the precision of the annual percentages by state. National estimates were based on single years of data. The race groups include persons of both Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Estimates were age-adjusted to the 2000 U.S. standard population using age groups 18–44, 45–64, 65–74, and 75 and older for national estimates and age groups 18–64 and 65 years and older for state estimates.
Health status questions are in the core section of the BRFSS and are asked every eyear by all states. However, in 2002 these questions were in an optional module that was used by 20 states. Therefore, the 2002 estimates may not be nationally representative and were not presented in the national report.
Persons residing in nursing homes and in households without telephones are not included in this survey; therefore, these results cannot be generalized to those segments of the population. All data in the BRFSS are obtained by self-report and are subject to recall and social desirability bias or may be underreported or overreported. Self-report of diabetes and self-report of sociodemographic characteristics are highly accurate.1-3 Further investigation of the reliability and validity of self-reported general health status, and mental and physical health is needed.
- Bowlin SJ, Morrill BD, Nafziger AN, Lewis C, Pearson TA. Reliability and changes in validity of self-reported cardiovascular disease risk factors using dual response: the Behavioral Risk Factor Survey. J Clin Epidemiol. 1996;49:511-7.
- Stein AD, Courval JM, Lederman RI, Shea S. Reproducibility of responses to telephone interviews: demographic predictors of discordance in risk factor status. Am J Epidemiol. 1996;141:1097-1106.
- Saydah SH, Geiss LS, Tierney E, Benjamin SM, Engelgau M, Brancati F. Review of the performance of methods to identify diabetes cases among vital statistics, administrative, and survey data. Ann Epidemiol. 2004;14(7):507–516.