Economists rely heavily on self-reported measures of health status to examine the relationship between income and health. In this paper we directly compare survey responses to a self-reported measure of health that is commonly available in nationally-representative surveys, with objective measures of the same health condition. Our particular focus is on hypertension, which is one of the most prevalent health conditions in Western countries. Using data from the Health Survey for England, we find that there is a substantial difference in the percentage of adult survey respondents reporting that they have hypertension compared to that found from measurements by a trained nurse. Importantly, we find no evidence of an income/health gradient using self-reported hypertension, but a sizeable gradient when using objectively measured hypertension. We also find that the probability of false negative reporting, that is an individual not reporting to have hypertension when in fact they have it, is significantly higher for individuals living in low income households. Given the wide use of such self-reported chronic health conditions in applied research, and the asymptomatic nature of many major illnesses such as hypertension, diabetes, heart disease and cancer at moderate and sometimes elevated levels, our results suggest that using commonly available self-reported chronic health measures might lead to an underestimate of true income-related inequalities in health.
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