International Journal of Public Health

, Volume 64, Issue 5, pp 721–729 | Cite as

Do self-reported data accurately measure health inequalities in risk factors for cardiovascular disease?

  • Irina KislayaEmail author
  • Julian Perelman
  • Hanna Tolonen
  • Baltazar Nunes
Original article



This study aimed to compare the magnitude of educational inequalities in self-reported and examination-based hypertension and hypercholesterolemia and to assess the impact of self-reported measurement error on health inequality indicators.


We used the Portuguese National Health Examination Survey data (n = 4911). The slope index of inequality (SII) and the relative index of inequality (RII) were used to determine the magnitude of absolute and relative education-related inequalities.


Among the 25–49-year-old (yo) men, absolute and relative inequalities were smaller for self-reported than for examination-based hypertension (SIIeb = 0.18 vs. SIIsr = − 0.001, p < 0.001; RIIeb = 1.99 vs. RIIsr = 0.86, p = 0.031). For women, the relative inequalities were similar despite differences in self-reported and examination-based hypertension prevalence. For hypercholesterolemia, self-reported relative inequalities were larger than examination-based inequalities among the 50–74-yo men (RIIsr = 2.28 vs. RIIeb = 1.21, p = 0.004) and women (RIIsr = 1.22 vs. RIIeb= 0.87, p = 0.045), while no differences were observed among 25–49-yo.


Self-reported data underestimated educational inequalities among 25–49-yo men and overestimated them in older individuals. Inequality indicators derived from self-report should be interpreted with caution, and examination-based values should be preferred, when available.


Health examination survey Health inequalities Hypercholesterolemia Hypertension Self-report 



The Portuguese National Health Examination Survey (INSEF) was developed as part of the pre-defined project of the Public Health Initiatives Program, “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation,” that benefits from a 1.500.000€ Grant from Iceland, Liechtenstein, and Norway through the EEA Grants and Portuguese Government. The authors are grateful to all professionals who were involved in the INSEF implementation and to all INSEF participants.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

38_2019_1232_MOESM1_ESM.docx (34 kb)
Supplementary material 1 (DOCX 34 kb)


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Copyright information

© Swiss School of Public Health (SSPH+) 2019

Authors and Affiliations

  1. 1.Departamento de EpidemiologiaInstituto Nacional de Saúde Doutor Ricardo Jorge, IPLisbonPortugal
  2. 2.Centro de Investigação em Saúde Pública, Escola Nacional de Saúde PúblicaUniversidade NOVA de LisboaLisbonPortugal
  3. 3.Department of Public Health SolutionsNational Institute for Health and Welfare (THL)HelsinkiFinland

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