Open Access Research article

Biological health or lived health: which predicts self-reported general health better?

Cristina Bostan12*, Cornelia Oberhauser3, Gerold Stucki12, Jerome Bickenbach12 and Alarcos Cieza234

Author Affiliations

1 Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland

2 Swiss Paraplegic Research, Nottwil, Switzerland

3 Department of Medical Informatics, Biometry and Epidemiology – IBE, Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU), Munich, Germany

4 Faculty of Social and Human Sciences, School of Psychology, University of Southampton, Southampton, UK

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BMC Public Health 2014, 14:189  doi:10.1186/1471-2458-14-189

Published: 21 February 2014



Lived health is a person’s level of functioning in his or her current environment and depends both on the person’s environment and biological health. Our study addresses the question whether biological health or lived health is more predictive of self-reported general health (SRGH).


This is a psychometric study using cross-sectional data from the Spanish Survey on Disability, Independence and Dependency Situation. Data was collected from 17,739 people in the community and 9,707 from an institutionalized population. The following analysis steps were performed: (1) a biological health and a lived health score were calculated for each person by constructing a biological health scale and a lived health scale using Samejima’s Graded Response Model; and (2) variable importance measures were calculated for each study population using Random Forest, with SRGH as the dependent variable and the biological health and the lived health scores as independent variables.


The levels of biological health were higher for the community-dwelling population than for the institutionalized population. When technical assistance, personal assistance or both were received, the difference in lived health between the community-dwelling population and institutionalized population was smaller. According to Random Forest’s variable importance measures, for both study populations, lived health is a more important predictor of SRGH than biological health.


In general, people base their evaluation of their own health on their lived health experience rather than their experience of biological health. This study also sheds light on the challenges of assessing biological health and lived health at the general population level.

Self-reported general health; Biological health; Lived health; Graded Response Model; Random Forest; Spain