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Related Experiment Videos

Demographic variation in SF-12 scores: true differences or differential item functioning?

John A Fleishman1, William F Lawrence

  • 1Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, Rockville, Maryland 20852, USA. jfleishm@ahrq.gov

Medical Care
|July 17, 2003
PubMed
Summary

Differential item functioning (DIF) impacts health status reporting. Adjusting for DIF changed mental health findings for race and age groups, highlighting its importance in demographic health comparisons.

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Area of Science:

  • Health Services Research
  • Psychometrics
  • Health Disparities

Background:

  • Summary measures of physical and mental health often show demographic differences.
  • The SF-12 instrument is commonly used to assess health status.

Purpose of the Study:

  • To investigate the impact of differential item functioning (DIF) on observed subgroup differences in health status.
  • To determine if DIF confounds the interpretation of health status disparities across demographic groups.

Main Methods:

  • Utilized data from a national sample of 11,626 adult respondents from the 2000 Medical Expenditure Panel Survey.
  • Employed multiple-indicator multiple-cause latent variable models to analyze SF-12 data, demographic characteristics, and chronic medical conditions.

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Main Results:

  • Significant physical health differences were observed by gender, age, and education, which were partially reduced by adjusting for DIF.
  • Adjusting for DIF eliminated Black-White differences in mental health and altered the mental health impact of the oldest age group.
  • Race/ethnicity was not significantly associated with physical health status.

Conclusions:

  • Differential item functioning (DIF) significantly affects mental health comparisons, particularly for age groups.
  • Controlling for DIF is crucial when comparing health status across demographic groups (age, gender, education).
  • Further research is needed to understand the underlying factors contributing to demographic variations in reported health status.