[What the citizens of Croatia think about their health].

Aim: Since self-perceived health represents an important indicator of health status, the aim of this study was to explore socioeconomic differences in self-perceived health in Croatia.

Methods: The study was conducted during the 1997-1999 period in fourteen Croatian counties. A sample of 5,048 respondents aged 18 years and older were recruited by multistaged stratified sampling. Data were collected using an anonymous questionnaire which consisted of questions on the respondents' socioeconomic characteristics and self-perceived health.

Results: While 20.7% of the respondents evaluated their health as poor, 25.9% evaluated it as excellent or very good. Women, older respondents and those with lower educational level and lower income more frequently described their health as poor. When comparing their health to the health of age-matched persons, 23.6% of the respondents thought their health was better and 21.0% thought their health was worse than the health of persons of the same age. Women, older respondents and those with lower educational level and lower income more frequently thought their health was worse than the health of their coevals. As many as 53.7% of the respondents thought their health had not changed compared to the previous year, and 31.7% thought their health was worse than in the previous year. Older respondents, respondents with lower income and those with lower educational level more frequently thought that their health had worsened compared to the previous year.

Discussion: Results of the study revealed a complex relationship between socioeconomic factors and self-perceived health. Men and women differed significantly in self-perceived health. Women mostly described their health as being poor or satisfactory, while men described it as excellent or very good. These results, similar to those in a large body of literature, raise the question of gender differences in the perception of symptoms. In our research, self-perceived health was poorer in older respondents. This also applies to the comparison of self-perceived health to the health of age-matched persons. An exception was the group of respondents aged > 76; their self-perceived health was described as either much worse or much better than the health of their coevals. Older persons are inevitably sicker than younger ones and poor self-perceived health would be expected. Nevertheless, the relation between self-perceived health and age is sometimes ambiguous in the literature. Income and education are strong markers of socioeconomic status. In our research, respondents with lower income as well as those with lower educational level had poorer self-perceived health. Education is a particularly strong marker of socioeconomic status, and it predicts self-perceived health better than occupation does. A study of self-perceived health does not always give an accurate insight into the real self-perceived health of the respondents. For example, if a person, otherwise in good health, suffered from an acute condition, he could describe his health as being poor at that moment. We tried to minimize this potential bias by adding two questions in self-perceived health assessment--"How do you perceive your health compared to your health a year ago?" and "How do you perceive your health compared to health of the persons of the same age?" Women, older respondents, respondents with lower educational level and lower income generally described their health as poor more often. Since self-perceived health is correlated with health care utilization, these results could be used to identify the specific population groups who are more likely to be potential users of health care services.

Conclusion: Since education and income represent socioeconomic parameters, it could be concluded that self-perceived health of the respondents with lower socioeconomic status is poorer than self-perceived health of those with higher socioeconomic status.