FRIDAY, Aug. 27, 2004 (HealthDayNews) -- More and more Americans say their physical and mental health is deteriorating, according to a new survey that's raising concerns among health experts.

Equally troubling, experts add, is that the research poses more questions than it answers.

"Quality of life appears to be deteriorating steadily," said Dr. David L. Katz, an associate clinical professor of public health, and director of the Prevention Research Center at Yale University School of Medicine. He was not involved with the research.

"Of particular concern, if no surprise, is that the declines in both self-reported mental and physical well-being are more severe in socially disadvantaged groups," he said.

The study's findings demand further investigation, Katz added. "Why is health, or at least the perception of health, declining? Are the responsible factors modifiable? What exactly needs to be done to arrest and reverse these trends?" he said.

The study, released this week by the U.S. Centers for Disease Control and Prevention, found that an increasing number of Americans say their physical and mental health and their ability to do usual activities has declined during the past decade.

"There has been a trend of worsening health-related quality of life," said lead researcher Dr. Matthew M. Zack, a medical epidemiologist at the CDC. "From 1993 through 2001, adult Americans' health-related quality of life has gotten worse. Most of that has happened since 1996."

The trend affects all groups. "It affects men and women, those of all ages, of all socioeconomic status and whether you have health insurance or not," Zack said.

However, there were groups that did worse than the overall average, Zack said. "For example, people from 45 to 54 years of age did generally worse than those who were younger or older," he said. And people in lower socioeconomic groups also did generally worse, he added.

Zack's team collected data from yearly Behavioral Risk Factor Surveillance System surveys. The surveys assess 1.2 million adults in the 50 states and the District of Columbia.

As part of the surveys, people were asked about their physical and mental health during the preceding month.

The researchers found that the average of "physically unhealthy days" per month increased from 3.0 in 1993 to 3.5 days in 2001. "Mentally unhealthy days" increased from 2.9 to 3.4 days, and days when one could not do usual activities increased from 1.6 to 2.0 days. Overall, unhealthy days increased from 5.2 to 6.0 days.

The percentage of people who rated their health as "fair" or "poor" also increased from 13.4 percent in 1993 to 15.5 percent in 2001, according to the report.

The findings were published in the September issue of Public Health Reports.

Since the last survey, overall unhealthy days increased in 18 states and the District of Columbia, but remained unchanged in 31 states. Only North Dakota saw an improvement in health-related quality of life, according to the report.

While the trend toward worsening health was widespread, the reasons aren't clear, Zack said. They can't be explained by age, sex, the increase in obesity and diabetes or any other disease-related factor, he noted. "Unfortunately, we don't have an answer for why," Zack said. "But we are trying find out what's causing it."

According to Zack, results of past surveys have accurately predicted future medical care costs, mortality, hospitalization and the use of medical care. "We think that this worsening trend could mean that in the future we are going to see more bad things happen to American adults," he said.

"We have to be concerned about these worsening trends. We have to figure out what is going on. We have to compare the groups that are doing better versus the groups that are doing worse and see why they're doing better or worse. We have to see if we can intervene on things we can control and change the perceptions that people have," Zack said.

Katz said, "Not long ago, objective measures of morbidity and mortality were the prevailing indices of health. There is now increasing recognition that people are not healthy unless they think they are healthy."

More information

The National Library of Medicine has plenty of information on wellness and healthy lifestyles.

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