Open Access Open Badges Research article

The evolution of health status and chronic conditions in Catalonia, 1994-2006: the paradox of health revisited using the Blinder - Oaxaca decomposition

Anna García-Altés1236*, Jaime Pinilla4 and Vicente Ortún56

Author affiliations

1 Agència de Salut Pública de Barcelona, Spain

2 Fundación Instituto de Investigación en Servicios de Salud, Spain

3 CIBER Epidemiología y Salud Pública (CIBERESP), Spain

4 Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Spain

5 Departament d'Economia i Empresa, Universitat Pompeu Fabra, Spain

6 Centre de Recerca en Economia i Salut, Universitat Pompeu Fabra, Spain

For all author emails, please log on.

Citation and License

BMC Health Services Research 2011, 11:116  doi:10.1186/1472-6963-11-116

Published: 23 May 2011



The paradox of health refers to the improvement in objective measures of health and the increase in the reported prevalence of chronic conditions. The objective of this paper is to test the paradox of health in Catalonia from 1994 to 2006.


Longitudinal cross-sectional study using the Catalonia Health Interview Survey of 1994 and 2006. The approach used was the three-fold Blinder - Oaxaca decomposition, separating the part of the differential in mean visual analogue scale value (VAS) due to group differences in the predictors (prevalence effect), due to differences in the coefficients (severity effect), and an interaction term. Variables included were the VAS value, education level, labour status, marital status, all common chronic conditions over the two cross-sections, and a variable for non-common chronic conditions and other conditions. Sample weights have been applied.


Results show that there is an increase in mean VAS for men aged 15-44, and a decrease in mean VAS for women aged 65-74 and 75 and more. The increase in mean VAS for men aged 15-44 could be explained by a decrease in the severity effect, which offsets the increase in the prevalence effect. The decrease in mean VAS for women aged 65-74 and 75 and more could be explained by an increase in the prevalence effect, which does not offset the decrease in the severity effect.


The results of the present analysis corroborate the paradox of health hypothesis for the population of Catalonia, and highlight the need to be careful when measuring population health over time, as well as their usefulness to detect population's perceptions.

health status; chronic conditions; prevalence; severity; Blinder - Oaxaca decomposition